PIERCE MEMORIAL BAPTIST HOME INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
PIERCE MEMORIAL BAPTIST HOME INC (EIN 06-0677159)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-06
IRS object ID
201242199349301019
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-06T15:13:26-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1O'Connor Davies LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1100 Great Meadow Road Suite 401AddressLine1
CityWethersfieldCity
StateCTState
ZIP Code06109ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN060677159EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Pierce Memorial Baptist Home IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPIERNameControl
Phone8607749050Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 326AddressLine1
CityBrooklynCity
StateCTState
ZIP Code06234ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLeonard GoldbergName
TitlePresidentTitle
Phone8607749050Phone
Date Signed2012-08-03DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMarcia Marien CPAName
Phone8602571870Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLeonard GoldbergNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line144 Canterbury RoadAddressLine1
CityBrooklynCity
StateCTState
ZIP Code06234ZIPCode
FieldValueIRS element (for citing)
Gross Receipts12032755GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1951YearFormation
State Legal DomicileCTStateLegalDomicile
Activity Or Mission DescriptionTo own and operate a benevolent and charitable home and provide nursing care to its aging residentsActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees247TotalNbrEmployees
Total Nbr Volunteers95TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year174573ContributionsGrantsPriorYear
Contributions Grants Current Year22291ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9455700ProgramServiceRevenuePriorYear
Program Service Revenue CY9543583ProgramServiceRevenueCY
Investment Income Prior Year343646InvestmentIncomePriorYear
Investment Income Current Year181938InvestmentIncomeCurrentYear
Other Revenue Prior Year2342OtherRevenuePriorYear
Other Revenue Current Year9522OtherRevenueCurrentYear
Total Revenue Prior Year9976261TotalRevenuePriorYear
Total Revenue Current Year9757334TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5378497SalariesEtcPriorYear
Salaries Etc Current Year5369117SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year18043TotalFundrsngExpCurrentYear
Other Expense Prior Year4149432OtherExpensePriorYear
Other Expenses Current Year4172796OtherExpensesCurrentYear
Total Expenses Prior Year9527929TotalExpensesPriorYear
Total Expenses Current Year9541913TotalExpensesCurrentYear
Revenues Less Expenses Prior Year448332RevenuesLessExpensesPriorYear
Revenues Less Expenses CY215421RevenuesLessExpensesCY
Total Assets BOY23124037TotalAssetsBOY
Total Assets EOY22731325TotalAssetsEOY
Total Liabilities BOY14940786TotalLiabilitiesBOY
Total Liabilities EOY14370141TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY8183251NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8361184NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionPierce Memorial provides a continuum of care by making available adult day care, housing, rehabilitative services, respite, hospice, 24 hour nursing care and other services in a Christ-centered environment. Residents are encouraged to grow spiritually as they live their lives at a level of independence appropriate to their needs. Services are provided to all as an extension of the ministry of the American Baptist Churches of ConnecticutMissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense6331207Expense
Revenue7467061Revenue
DescriptionSkilled Nursing Care - 68 Beds, Intermediate Nursing Care - 4 Beds,Home for the Aged - 8 BedsDescription

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1328011Expense
Revenue1854578Revenue
DescriptionCreamery Brook: An 83 apartment senior housing facility, designed to provide "home-like" housing to seniors as opposed to "institutional" settings. Monthly room charges are assessed to cover the cost of daily meals, housekeeping, and laundry services. Consistent with its charitable purposes, Pierce has established a policy of setting its rental charges for units at the lowest feasible rate.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense80565Expense
Revenue183373Revenue
DescriptionCottages: The Home is in the process of completing 10 independent living units (The Cottages at Creamery Brook)Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense37174Expense
Grants1099Grants
Revenue28928Revenue
DescriptionAdult Day Care: Two days a week elderly individuals meet at PMBH in the recreation room to socialize, listen to music and participate in other activities. They are supervised for 6 hours by professionals and are given a hot lunch at noon. This is designed for caregivers to have a day off. The price is $50 a day.Brooklyn Collaborative Grant: Young children birth to eight will visit PMBH and interact with the elderly as a way for youth to gain a better connection with the elderly in their community.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp37174TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt1099TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev28928TotalOfOtherProgramServiceRev
Total Program Service Expense7776957TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109611NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees247NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons0AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement0RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledCTStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Diana Baule Office ManagerBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8607749050TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1Route 169AddressLine1
CityBrooklynCity
StateCTState
ZIP Code06234ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Timothy Bates
Board Member5.00X000
Roberta Davis
Board Member5.00X000
Mark Kane
Board Member5.00X000
Scot Rapoza
Board Member5.00X000
Rev Gregory Thomas
Board Member5.00X000
Charles Wyand
Board Member5.00X000
Rev Judy G Albee
Ex-Officio Board Member5.00X000
Rev Dale Peterson
Ex-Officio Board Member5.00X000
William Mcmunn
Chairman10.00000X
William Smith
Vice Chairman10.00000X
Shirley DeFlavis
Secretary10.00000X
John Riesen
Treasurer10.00000X
Leonard Goldberg
President/CEO50.00185258023641X
Frances Cote RN
Director of Nursing5.001104890959X
FieldValueIRS element (for citing)
Total Reportable Comp From Org295747TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation24600TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
People First Rehabilitation
Box 277365AtlantaGA30384Provides PTOT and ST services to residen395488
Omnicare
PO Box 715268ColumbusOH43271Pharmacist Consultant102620
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
All Other Contributions22291AllOtherContributions
Total Contributions22291TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Pierce Nursing/Housing62300074670617467061
Creamery Brook Housing53111018545781854578
Cottages531110183373183373
Adult Day Care Program6241002892828928
Brooklyn Collaboratice624100610610

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column9033TotalRevenueColumn
Related Or Exempt Function Income9033RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue9543583TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column240909TotalRevenueColumn
Related Or Exempt Function Income240909RelatedOrExemptFunctionIncome

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real14861Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real11771Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real3090Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column3090TotalRevenueColumn
Exclusion$3,090ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities2183379Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities2242350Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-58971Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-58971TotalRevenueColumn
Exclusion-$58,971ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events1522GrossIncomeFundraisingEvents
Fundraising Direct Expenses623FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column899TotalRevenueColumn
Exclusion$899ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory26210GrossSalesOfInventory
Cost Of Goods Sold20677CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column5533TotalRevenueColumn
Related Or Exempt Function Income5533RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9757334TotalRevenueColumn
Related Or Exempt Function Income9790025RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$54,982ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total291045Total
Program Services192099ProgramServices
Management And General80903ManagementAndGeneral
Fundraising18043Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4228633Total
Program Services3892840ProgramServices
Management And General335793ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total16565Total
Program Services14481ProgramServices
Management And General2084ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total495140Total
Program Services370139ProgramServices
Management And General125001ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total337734Total
Program Services302945ProgramServices
Management And General34789ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total21236Total
Management And General21236ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total82063Total
Management And General82063ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total56Total
Program Services56ProgramServices

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total35912Total
Management And General35912ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total699079Total
Program Services629764ProgramServices
Management And General69315ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total124511Total
Management And General124511ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total411830Total
Program Services304009ProgramServices
Management And General107821ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total11960Total
Management And General11960ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total750515Total
Program Services574020ProgramServices
Management And General176495ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total23101Total
Program Services446ProgramServices
Management And General22655ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total10877Total
Program Services6874ProgramServices
Management And General4003ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total168851Total
Program Services168851ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total500564Total
Program Services480801ProgramServices
Management And General19763ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total105025Total
Management And General105025ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Licenses, dues and fees365935365935
Food351592351592
Licenses, dues and fees170578170578
Bad Debt Expense157801157801
Service Contracts929845115741827

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total88326Total
Program Services70948ProgramServices
Management And General17378ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9541913Total
Program Services7776957ProgramServices
Management And General1746913ManagementAndGeneral
Fundraising18043Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY731987BOY
EOY373351EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2570924BOY
EOY2656461EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1000924BOY
EOY1471856EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2523BOY
EOY2185EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY28089BOY
EOY78081EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis18089701LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec8730241LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY9739606BOY
EOY9359460EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY4327500BOY
EOY4258867EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY256246BOY
EOY264363EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY517431BOY
EOY497672EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3948807BOY
EOY3769029EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY23124037BOY
EOY22731325EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY732473BOY
EOY623433EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY960443BOY
EOY932710EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY12860000BOY
EOY12570000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY219630BOY
EOY238898EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY168240BOY
EOY5100EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY14940786BOY
EOY14370141EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY5885383BOY
EOY6234127EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY122001BOY
EOY26760EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2175867BOY
EOY2100297EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8183251BOY
EOY8361184EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY23124037BOY
EOY22731325EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses215421ReconcilationRevenueExpenses
Reconcilation Other Changes-37488ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years164443CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years55427CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years70378CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year183693CurrentTaxYearMinus1Year
Current Tax Year23190CurrentTaxYear
Total497131Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8721179CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8943045CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8899606CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9443192CurrentTaxYearMinus1Year
Current Tax Year9540083CurrentTaxYear
Total45547105Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8885622CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8998472CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8969984CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9626885CurrentTaxYearMinus1Year
Current Tax Year9563273CurrentTaxYear
Total46044236Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years257109CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years171601CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years194516CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year215911CurrentTaxYearMinus1Year
Current Tax Year154568CurrentTaxYear
Total993705Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years257109CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years171601CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years194516CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year215911CurrentTaxYearMinus1Year
Current Tax Year154568CurrentTaxYear
Total993705Total
FieldValueIRS element (for citing)
Public Support Total50945050531PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years400625CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years317549CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years230565CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year219365CurrentTaxYearMinus1Year
Current Tax Year243999CurrentTaxYear
Total1412103Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years400625CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years317549CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years230565CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year219365CurrentTaxYearMinus1Year
Current Tax Year243999CurrentTaxYear
Total1412103Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2209CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11187CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5495CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3388CurrentTaxYearMinus1Year
Current Tax Year9033CurrentTaxYear
Total31312Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9288456CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9327208CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9206044CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9849638CurrentTaxYearMinus1Year
Current Tax Year9816305CurrentTaxYear
Total47487651Total
FieldValueIRS element (for citing)
Public Support Percentage5090.94870PublicSupportPercentage509
Prior Year Support Percentage0.94960PriorYearSupportPercentage
Investment Income Percentage0.02970InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.03070PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$56OtherActivitiesAmount
Total Lobbying Expenditures IIB56TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Other Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1i:ReturnReference
ExplanationThe organization supported lobbying expenses through payment of dues to Connecticut Association of Healthcare Facilities.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance5239270BeginningOfYearBalance
Investment Earnings Or Losses113474InvestmentEarningsOrLosses
Other Expenditures151835OtherExpenditures
Administrative Expenses30613AdministrativeExpenses
End Of Year Balance5170296EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance4047765BeginningOfYearBalance
Contributions130297Contributions
Investment Earnings Or Losses1245051InvestmentEarningsOrLosses
Other Expenditures154660OtherExpenditures
Administrative Expenses29183AdministrativeExpenses
End Of Year Balance5239270EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance4140428BeginningOfYearBalance
Contributions26006Contributions
Investment Earnings Or Losses1000231InvestmentEarningsOrLosses
Other Expenditures154660OtherExpenditures
Administrative Expenses25885AdministrativeExpenses
End Of Year Balance4986120EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.83000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.16000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.01000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis16252020OtherCostOrOtherBasis
Depreciation7574100Depreciation
Book Value8677920BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1676344OtherCostOrOtherBasis
Depreciation1042889Depreciation
Book Value633455BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis161337OtherCostOrOtherBasis
Depreciation113252Depreciation
Book Value48085BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings9359460TotalOfBookValueLandBuildings

Other Assets OtherAssets (5 entries)

DescriptionDescriptionBook ValueBookValue
Accrued Interest9178
Construction in Progress645311
Interest in Trust1333031
Restricted Investments and Cash961641
Unrealized gain or loss on investme819868
FieldValueIRS element (for citing)
Total Book Value Other Assets3769029TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionWater and Sewer AssessmentDescription
Amount$5,100Amount
FieldValueIRS element (for citing)
Total Of Amounts5100TotalOfAmounts
Total Revenue9757334TotalRevenue
Total Expenses9541913TotalExpenses
Excess Or Deficit For Year215421ExcessOrDeficitForYear
Net Unrealized GL On Investments63185NetUnrealizedGLOnInvestments
Prior Period Adjustments-100675PriorPeriodAdjustments
Other$2OtherAmount
Total Adjustments-37488TotalAdjustments
Excess Or Deficit Per FS177933ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt9850724TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments63184NetUnrealizedGainsInvestments
Other Revenues30204OtherRevenues
Revenue Not Rptd F99093388RevenueNotRptdF990
Revenue Subtotal9757336RevenueSubtotal
Other Revenues Not Included-2OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-2RevenueNotRptdOnFinStmt
Total Revenue Per Form9909757334TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt9572116TotExpensesEtcAuditedFinclStmt
Other Expenses Included30204OtherExpensesIncluded
Expenses Not Rptd F99030204ExpensesNotRptdF990
Expenses Subtotal9541912ExpensesSubtotal
Other Expenses Not Included1OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1ExpensesNotRptdOnFinStmt
Total Expenses Per Form9909541913TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part IV, Line 2b:Funds that are held on behalf of residents by the facility
Part V, Line 4:To provide interest and earnings to support operating and capital needs.Description of Intended Use of Endowment Funds:
Rounding 2.Part XI, Line 8 - Other Adjustments:
Portions of COGS shown net/gross in financials 17,810. Special Events shown gross in financials 623. Rental expenses shown gross in financials 11,771.Part XII, Line 2d - Other Adjustments:
Rounding Differrence -2.Part XII, Line 4b - Other Adjustments:
Portions of COGS shown net/gross in financials 17,810. Special Events shown gross in financials 623. Rental expenses shown gross in financials 11,771.Part XIII, Line 2d - Other Adjustments:
Rounding 1.Part XIII, Line 4b - Other Adjustments:
Part XI 8 Rounding adjustments Part XII 2d Effect of showing the costs of goods sold and special events gross in the financial statements Part XIII 2d Effect of showing the costs of goods sold and special events gross in the financial statements, effect of depreciation error Part XIII 4b Rounding adjustments

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonLeonard GoldbergNamePerson
Base Compensation Filing Org179469BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org5789BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org13708DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org9933NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org208899TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePart I, Line 7ReturnReference
ExplanationThe CEO received a bonus in the amount of $5,789. The Head of Nursing received a bonus in the amount of $3,378.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CHEFA Series A Variable Rate BondBusinessNameLine1
FieldValueIRS element (for citing)
CUSIP Number20774UTA3CUSIPNumber
Date Issued2008-01-17DateIssued
Issue Price8575000IssuePrice
Description Of PurposeRefunding on Series 1999 BondDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made0FinalAllocationMade
Adequate Books And Recds Maintaind0AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs0PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 8bThe Board of Trustess, which makes the final decisions, keeps minutes regarding each meeting and action taken. Committee's may hold a meeting that is not documented, but any actions agreed upon are sent to the Board of Trustees for final approval.
Form 990, Part VI, Section B, line 11A copy of the 990 is made availabe to each board member and also reviewed in conjunction with the preparer accountant, finance and executive committee.
Compensation of the CEO is reviewed annually to outside sources such as, other form 990's of comparable facilities and independent compensation consultants recommendations and established with a compensation committee, approval of the board and a written employment contract.Form 990, Part VI, Section B, line 15a
Governing documents, financial statements and the conflict of interest statement are available at the Facility's office.Form 990, Part VI, Section C, line 19
Changes in Net Assets or Fund Balances:Net unrealized gains on investments: 63,185. Prior period adjustments: -100,675. Rounding 2. Total to Form 990, Part XI, Line 5: -37,488.Form 990, Part XI, line 5:
The facility has a committee that assumes responsibility for oversight of the financial statements and the selection of the CPA. There was no change in the process from last year.

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