2012-04-05T11:57:41-05:00 2011-09-30 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2010-10-01 060763898 CHURCH HOMES INC CONGREGATIONAL CHUR 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 RAYMOND A GASPERINI 8605279126 2012-03-28 1 ELIZABETH SOLECKI 8605614000 2010 2016-02-24 21:20:13Z RAYMOND A GASPERINI 217 AVERY HEIGHTS HARTFORD CT 06106 41314871 0 X WWW.CHURCHHOMES.ORG X 1957 CT TO PROVIDE, ON A NOT-FOR-PROFIT BASIS AND WITHOUT DISCRIMINATION, A FULL RANGE OF RESIDENTIAL LIVING AND HEALTH CARE SERVICES FOR OLDER ADULTS. 12 11 585 281 0 0 929762 404860 39357125 39796863 94329 522706 416697 320200 40797913 41044629 6000 3650 0 0 23102884 21977253 0 0 90907 16688081 17878694 39796965 39859597 1000948 1185032 60793740 58797199 29553703 27433070 31240037 31364129 X TO PROVIDE, ON A NOT-FOR-PROFIT BASIS AND WITHOUT DISCRIMINATION, A FULL RANGE OF RESIDENTIAL LIVING AND HEALTH CARE SERVICES FOR OLDER ADULTS BY PROMOTING AND IMPLEMENTING SYSTEMS THAT MAINTAIN AND SUPPORT EVERY INDIVIDUAL'S OPTIMAL INDEPENDENCE AND LIFE WISHES IN A SAFE, DIGNIFIED ATMOSPHERE CONDUCIVE TO QUALITY RETIREMENT, BY ASSURING KNOWLEDGEABLE AND CONSISTENT LEADERSHIP IN RETIREMENT LIVING, LONG-TERM CARE, HOME CARE AND SUPPORT SERVICES AND BY DEVELOPING INNOVATIVE PROGRAMS AND SERVICES WHICH RESPOND TO THE CHANGING NEEDS OF ITS RESIDENTS AND CLIENTS AND THE SOCIETY IT SERVES. 0 0 36370735 40098913 CHURCH HOMES, INC., CONGREGATIONAL IS A NOT-FOR-PROFIT CORPORATION, WHICH OWNS AND OPERATES RETIREMENT AND HEALTH CARE FACILITIES IN HARTFORD, CT (AVERY HEIGHTS), AND SALISBURY, CT (NOBLE HORIZONS). AVERY HEIGHTS CONSISTS OF 130 SKILLED NURSING BEDS, 69 INTERMEDIATE CARE BEDS, 14 ACCOMODATIONS IN A HOME FOR THE AGED, 66 INDEPENDENT LIVING COTTAGES, AND 137 INDEPENDENT LIVING APARTMENTS. IN ADDITION, AVERY HEIGHTS OPERATES A HOME HEALTH AGENCY AND BETTY LARUS ADULT DAY HEALTH CENTER. NOBLE HORIZONS CONSISTS OF 61 SKILLED NURSING BEDS, 30 INTERMEDIATE CARE BEDS, 50 INDEPENDENT LIVING COTTAGES AND 19 ACCOMODATIONS IN A HOME FOR THE AGED. 36370735 1 1 0 0 0 0 0 0 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 127 0 1 585 1 0 0 0 0 0 1 1 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 CT X RAYMOND A GASPERINI 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 PATRICK GILLAND 40.00 X X 242527 0 46003 DAVID E POLK 1.00 X X 0 0 0 HENRY B MCNULTY 1.00 X X 0 0 0 LARRY C BROWN 1.00 X 0 0 0 JOSEPH C BLACK JR 1.00 X 0 0 0 DAVID E CANUEL 1.00 X 0 0 0 ELIZABETH S GAGNE 1.00 X 0 0 0 PETER G CAREY 1.00 X 0 0 0 PATRICK Y YUNG 1.00 X 0 0 0 STEPHEN E RONAI ESQUIRE 1.00 X 0 0 0 PETER B MATTHEWS 1.00 X 0 0 0 MERCEDESE E LARGE 1.00 X 0 0 0 RAYMOND GASPERINI 40.00 X 173433 0 32028 EILEEN MULLIGAN 40.00 X 163456 0 25191 MIRIAM PARKER 40.00 X 178606 0 33713 MARJORIE K TESSMAN 40.00 X 52584 0 16311 BONITA GANIM 40.00 X 101848 0 16087 ANNA LUKAS 40.00 X 106858 0 22611 MICHELLE PASCETTA 40.00 X 102236 0 25565 1121548 0 217509 7 0 1 0 HEALTHCARE SERVICES GROUP 3220 TILLMAN DR STE 300 BENSALEM PA 19020 HOUSEKEEPING/LAUNDRY/DIETARY SERVICES 1504349 ALLIANCE REHAB OF CT 1520 KENSINGTON ROAD STE 110 OAK BROOKE IL 60523 REHAB THERAPY 1000339 H&H LINEN SERVICES 135 CITY AVE NEW BRITAIN CT 06051 LINEN SERVICE 160971 QUALITY FLOOR COVERINGS INC 21 BRENNAN ROAD AMSTON CT 06231 CARPETING 142837 SECURITY SERVICES OF CONNECTICUT PO BOX 53 BRATTLEBORO VT 05302 SECURITY 128839 10 110032 294828 404860 RESIDENT SERVICES 623000 39688793 39688793 OTHER SERVICES 623000 108070 108070 39796863 233047 233047 18150 18150 18150 18150 513668 224009 513668 -224009 289659 289659 46233 110032 46233 0 OTHER INCOME 900099 295917 295917 FEES INCOME 900099 6133 6133 302050 41044629 40098913 0 540856 3650 3650 985524 985524 15367990 14111931 1247071 8988 1081171 1023524 57060 587 3315894 2945965 368239 1690 1226674 1068924 157137 613 5400 5400 89225 89225 74600 74600 5894771 5856292 17858 20621 135585 131117 4218 250 254202 155326 89522 9354 86747 17835 64652 4260 3988911 3973722 15189 11840 5732 6108 3799 1808 1991 27326 27326 2584713 2553656 31057 204977 171846 33131 PROVIDER TAX 1504300 1504300 SUPPLIES 665672 652419 13253 FOOD 600571 600571 MAINTENANCE 366508 366508 BAD DEBTS 337673 337673 1041874 860610 136720 44544 39859597 36370735 3397955 90907 7950123 8011849 2566325 1939557 3108824 3270862 182025 186904 672126 633290 74221943 44129704 31888019 30092239 13906123 14178722 515371 428154 4804 55622 60793740 58797199 3668419 3282854 25621737 23854052 263547 296164 29553703 27433070 X 22575755 22977737 6017017 5734127 2647265 2652265 31240037 31364129 60793740 58797199 X 1185032 -1060940 X 0 1 1 X 0 X 562990 900844 995528 929762 404860 3793984 37296337 39324192 39944247 39756122 40098913 196419811 37859327 40225036 40939775 40685884 40503773 200213795 0 0 0 200213795 797925 458327 184505 121341 233047 1795145 797925 458327 184505 121341 233047 1795145 204866 279523 386093 398997 64383 1333862 38862118 40962886 41510373 41206222 40801203 203342802 0.98460 0.98420 0.00880 0.00950 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 9891949 87500 -210959 287280 9481210 10176093 228623 902670 1415437 9891949 10248098 30490 52850 155345 10176093 0.35000 0.28000 0.37000 1 0 2744217 2744217 47588730 26547614 21041116 20236370 14978396 5257974 3652626 2603694 1048932 30092239 ANNUITIES PAYABLE 90887 MISCELLANEOUS 160552 DUE TO THIRD PARTY REIMBURSEMENT AG 44725 296164 41044629 39859597 1185032 -1048384 -12556 -1060940 124092 39983689 -1048384 -12556 -1060940 41044629 0 41044629 39859597 0 39859597 0 39859597 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: INVESTMENT INCOME UTILIZED TO SUPPORT OPERATIONS AND ACQUISITIONS OF FIXED ASSETS. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -12,556. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -12,556. GOLF OUTING 132920 94160 38760 9237 27893 1630 FESTIVAL OF TREES 23345 15872 7473 7473 156265 110032 46233 9237 27893 9103 46233 0 X 1 1 X X X X 0 0 0 0 0 0 0 0 0 PATRICK GILLAND 232527 0 10000 0 0 0 29441 0 16562 0 288530 0 0 0 RAYMOND GASPERINI 173433 0 0 0 0 0 19850 0 12178 0 205461 0 0 0 EILEEN MULLIGAN 160956 0 2500 0 0 0 18252 0 6939 0 188647 0 0 0 MIRIAM PARKER 178606 0 0 0 0 0 20962 0 12751 0 212319 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED WITH THE BOARD OF DIRECTORS AT REGULARLY SCHEDULED BOARD OF DIRECTORS MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE PRESIDENT OF CHURCH HOMES, INC. REVIEWS THE RESPONSES TO THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE WITH THE COMMITTEE ON DIRECTORS. WHERE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST EXISTS, THE COMMITTEE ON DIRECTORS IS AUTHORIZED TO TAKE APPROPRIATE CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 CHURCH HOMES, INC. PERSONNEL COMMITTEE REVIEWS AND APPROVES OFFICER COMPENSATION ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,048,384. CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -12,556. TOTAL TO FORM 990, PART XI, LINE 5: -1,060,940. FORM 990, PART V, LINE 7B: CHURCH HOMES NOTIFIED THE DONOR OF THE VALUE OF THE GOODS OR SERVICES PROVIDED UPON REQUEST. CONNECTICUT ALLIANCE FOR LONG TERM CARE 705A NEW BRITAIN AVE HARTFORD CT 06106 061465316 ADMINISTER PROVIDER BASED NETWORK TO PROVIDE COST-EFFECTIVE HEALTH CARE CT 501(C)(3) LINE 11A, I N/A 0 0 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0