2012-08-06T12:10:43-05:00 2011-06-30 VICENTI LLOYD & STUTZMAN LLP 2210 E ROUTE 66 SUITE 100 GLENDORA CA 91740 990 2010-07-01 710876594 HOLLENBECK PALMS HOLL 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 JOHNNY YOUNG 3232636195 2012-08-06 1 TIMOTHY D EVANS CPA 6268577300 2010 2016-02-24 21:20:13Z JOHNNY YOUNG 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 18392644 0 X WWW.HOLLENBECKPALMS.COM X 2001 CA HOLLENBECK PALMS IS COMMITTED TO PROVIDING A RESIDENCE FOR THOSE IN THE LATER YEARS OF THEIR LIVES THAT ENCOMPASSES A HEALTHY ENVIRONMENT OF COMFORT, SAFETY, AND ENJOYMENT; THAT ATTENDS TO THEIR PHYSICAL, MENTAL, AND SPIRTUAL NEEDS; AND THAT IS QUICK TO RESPOND TO AND ASSIST IN THOSE NEEDS WHETHER IMMEDIATE OR LONG TERM, AND TO DO SO WITH GREAT COMPASSION, HONESTY, DIGNITY, AND GENUINE LOVE. 6 6 207 0 0 0 192962 553614 13224245 14872593 1113522 1084087 149207 190090 14679936 16700384 0 0 0 0 7225360 7497938 0 0 0 8108139 8147393 15333499 15645331 -653563 1055053 69942263 76051591 42848286 43045968 27093977 33005623 NONE 0 0 9469180 14872593 HOLLENBECK PALMS PROVIDES CARE FOR THE AGING, INCLUDING RESIDENTIAL AND SKILLED NURSING CARE LIVING ARRANGEMENTS FOR THEIR MEMBERS. 9469180 1 1 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 26 0 1 207 1 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 CA X JOHNNY YOUNG 3232636195 573 SOUTH BOYLE AVENUE LOS ANGELES CA 90033 DAVID ADAMS 1.00 X 0 0 0 PHIL SWAN 1.00 X 0 0 0 CAROL A JOHNSTON 1.00 X 0 0 0 CHARLENE LEIBAU 1.00 X 0 0 0 DAVID WATTS 1.00 X 0 0 0 TRACY HIRREL 1.00 X 0 0 0 WILLIAM HEIDEMAN 40.00 X 181877 0 46403 MORRIS SHOCKLEY 40.00 X 135381 0 28025 JOHNNY YOUNG 40.00 X 89333 0 22655 RAY SHIVELY 40.00 X 137964 0 27648 CAMILLE GOLDSMITH 40.00 X 132000 0 27446 JOHN M SHIVELY 40.00 X 111079 0 19759 787634 0 171936 5 0 1 0 SODEXHO SERVICES DEPT 48283 LOS ANGELES CA 90088 FOOD SERVICES 1166689 TEAM REHAB INC 6531 SILENT HARBOR DR HUNTINGTON BEACH CA 92867 THERAPY 550505 SKILLED NURSING PHARMACY 16666 E JOHNSON DRIVE CITY OF INDUSTRY CA 91745 PHARMACY 509717 DJMB SERVICES 3475 BARHITE STREET PASADENA CA 91107 HOUSEKEEPING 505749 CREATIVE LANDSCAPE & MAINT 14877 SHETLAND LN FONTANA CA 92336 LANDSCAPING 172758 7 553614 553614 SNF & RESIDENTIAL CARE 623990 10671449 10671449 MEDICARE/MEDICAID PAYM 623990 4201144 4201144 14872593 941580 941580 1834767 1692260 142507 142507 142507 BEAUTY/BARBER SHOP 900099 53436 53436 ROYALTIES 900099 41008 41008 MISCELLANEOUS REV 900099 29942 29942 65704 65704 190090 16700384 14872593 0 1274177 503674 503674 4833219 4335441 497778 490380 397810 92570 1240447 1006285 234162 430218 349004 81214 11750 11750 28357 28357 78865 78865 180520 62696 117824 102205 102205 747369 656901 90468 636022 636022 1047 1047 13185 3328 9857 288361 288361 1180348 1180348 311184 311184 OTHER MEDICAL & MEDICAR 912125 912125 PURCHASED SERVICES 736867 736867 FOOD EXPENSES 666851 666851 SERVICES 392869 137420 255449 DUES 196087 74094 121993 1663381 130358 1533023 15645331 9469180 6176151 0 3241250 4279607 721131 1194086 442884 1958085 1893618 172132 157557 196831 187625 44819777 16047786 29473490 28771991 30890107 35189625 3289237 3934598 69942263 76051591 3527983 3004085 24540000 24055000 14780303 15986883 42848286 43045968 X 25737049 31444403 583605 787897 773323 773323 27093977 33005623 69942263 76051591 X 1055053 4856593 X X 0 1 1 X 0 X 344874 464103 389590 192962 553614 1945143 11650427 11504841 11279803 13224245 14872593 62531909 11995301 11968944 11669393 13417207 15426207 64477052 0 0 0 64477052 1510185 1985563 1006691 911599 941580 6355618 1510185 1985563 1006691 911599 941580 6355618 126313 180726 198408 149207 190090 844744 13631799 14135233 12874492 14478013 16557877 71677414 0.89950 0.89080 0.08870 0.09740 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 28092 28092 39523283 12657638 26865645 248138 180762 67376 5020264 3209386 1810878 28771991 LIFE INSURANCE RECEIVABLE - MEMBERS 27867 OIL ROYALTY/REAL ESTATE 428763 BOND INTEREST RECEIVABLE 117224 NON- QUALIFIED PENSION PLAN 405424 OTHER RECEIVABLE 303983 SAVINGS ACCOUNTS-MEMBERS 540182 LIFE INSURANCE- MEMBERS 332485 ANNUITY- MEMBERS 1778670 3934598 DEFERRED REVENUE FROM ACCOMODATION FEES 4762110 ASSIGNED ASSETS 11224773 15986883 16700384 15645331 1055053 4856593 4856593 5911646 21518386 4818002 4818002 16700384 0 16700384 15624734 -20597 -20597 15645331 0 15645331 PART XI, LINE 8 - OTHER ADJUSTMENTS: UNREALIZED GAIN ON INVESTMENTS 4,371,880. CHANGE IN PREMIUM PENSION 446,122. REALIZED GAIN FROM BOND REDEMPTION 17,994. PREPAID REAL ESTATE TAX 20,597. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED GAIN ON INVESTMENTS 4,818,002. PART XIII, LINE 2D - OTHER ADJUSTMENTS: INCREASE IN PENSION LIABILITY PREPAID REAL ESTATE TAX -20,597. X X 0 0 0 0 0 0 0 0 0 WILLIAM HEIDEMAN 178252 0 0 0 3625 0 19721 0 26682 0 228280 0 0 0 MORRIS SHOCKLEY 128796 0 0 0 6585 0 13305 0 14720 0 163406 0 0 0 RAY SHIVELY 137274 0 0 0 690 0 15464 0 12184 0 165612 0 0 0 CAMILLE GOLDSMITH 131310 0 0 0 690 0 14966 0 12480 0 159446 0 0 0 CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 13079GAH6 2007-02-01 5525000 THE BONDS PROCEEDS WERE USED BY HOLLENBECK PALMS TO DEMOLISH CERTAIN 0 0 0 CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 10379GAJ2 2007-02-01 15035000 EXISTING BUILDINGS, CONTRUCT A NEW THREE-STORY BUILDING CONSISTING OF 0 0 0 CALIFORNIA STATEWIDE COMMUNITIES DEVELOPMENT AUTHORITY 13079GAK9 2007-02-01 2700000 RESIDENTIAL UNITS, UNDERGROUND PARKING, AND RELATED FACILITIES. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 NO REVIEW WAS OR WILL BE CONDUCTED FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE SIGNED BY TRUSTEES ANNUALLY AND REVIEWED BY MANAGEMENT. FORM 990, PART VI, SECTION B, LINE 15 BOARD OF TRUSTEES DETERMINES COMPENSATION FOR ALL ORGANIZATIONS AND KEY EMPLOYEES, BASED ON COMPARABLE SALARIES IN THE LOCAL AREA. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: UNREALIZED GAIN ON INVESTMENTS 4,371,880. CHANGE IN PREMIUM PENSION 446,122. REALIZED GAIN FROM BOND REDEMPTION 17,994. PREPAID REAL ESTATE TAX 20,597. TOTAL TO FORM 990, PART XI, LINE 5: 4,856,593.