2012-08-06T15:13:26-05:00 2011-09-30 O'Connor Davies LLP 100 Great Meadow Road Suite 401 Wethersfield CT 06109 990 2010-10-01 060677159 Pierce Memorial Baptist Home Inc PIER 8607749050 PO Box 326 Brooklyn CT 06234 Leonard Goldberg 8607749050 2012-08-03 1 Marcia Marien CPA 8602571870 2010 2016-02-24 21:20:13Z Leonard Goldberg 44 Canterbury Road Brooklyn CT 06234 12032755 0 X N/A X 1951 CT To own and operate a benevolent and charitable home and provide nursing care to its aging residents 13 12 247 95 0 0 174573 22291 9455700 9543583 343646 181938 2342 9522 9976261 9757334 0 0 0 0 5378497 5369117 0 0 18043 4149432 4172796 9527929 9541913 448332 215421 23124037 22731325 14940786 14370141 8183251 8361184 X Pierce 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 Connecticut 0 0 6331207 7467061 Skilled Nursing Care - 68 Beds, Intermediate Nursing Care - 4 Beds,Home for the Aged - 8 Beds 1328011 1854578 Creamery 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. 80565 183373 Cottages: The Home is in the process of completing 10 independent living units (The Cottages at Creamery Brook) 37174 1099 28928 Adult 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. 37174 1099 28928 7776957 1 0 0 1 0 0 0 0 1 1 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 11 0 247 1 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 1 0 1 0 0 CT X Diana Baule Office Manager 8607749050 Route 169 Brooklyn CT 06234 Timothy Bates 5.00 X 0 0 0 Roberta Davis 5.00 X 0 0 0 Mark Kane 5.00 X 0 0 0 Scot Rapoza 5.00 X 0 0 0 Rev Gregory Thomas 5.00 X 0 0 0 Charles Wyand 5.00 X 0 0 0 Rev Judy G Albee 5.00 X 0 0 0 Rev Dale Peterson 5.00 X 0 0 0 William Mcmunn 10.00 X 0 0 0 William Smith 10.00 X 0 0 0 Shirley DeFlavis 10.00 X 0 0 0 John Riesen 10.00 X 0 0 0 Leonard Goldberg 50.00 X 185258 0 23641 Frances Cote RN 5.00 X 110489 0 959 295747 0 24600 2 0 1 0 People First Rehabilitation Box 277365 Atlanta GA 30384 Provides PTOT and ST services to residen 395488 Omnicare PO Box 715268 Columbus OH 43271 Pharmacist Consultant 102620 2 22291 22291 Pierce Nursing/Housing 623000 7467061 7467061 Creamery Brook Housing 531110 1854578 1854578 Cottages 531110 183373 183373 Adult Day Care Program 624100 28928 28928 Brooklyn Collaboratice 624100 610 610 9033 9033 9543583 240909 240909 14861 11771 3090 3090 3090 2183379 2242350 -58971 -58971 -58971 1522 623 899 899 26210 20677 5533 5533 9757334 9790025 0 -54982 291045 192099 80903 18043 4228633 3892840 335793 16565 14481 2084 495140 370139 125001 337734 302945 34789 21236 21236 82063 82063 56 56 35912 35912 699079 629764 69315 124511 124511 411830 304009 107821 11960 11960 750515 574020 176495 23101 446 22655 10877 6874 4003 168851 168851 500564 480801 19763 105025 105025 Licenses, dues and fees 365935 365935 Food 351592 351592 Licenses, dues and fees 170578 170578 Bad Debt Expense 157801 157801 Service Contracts 92984 51157 41827 88326 70948 17378 9541913 7776957 1746913 18043 731987 373351 2570924 2656461 1000924 1471856 2523 2185 28089 78081 18089701 8730241 9739606 9359460 4327500 4258867 256246 264363 517431 497672 3948807 3769029 23124037 22731325 732473 623433 960443 932710 12860000 12570000 219630 238898 168240 5100 14940786 14370141 X 5885383 6234127 122001 26760 2175867 2100297 8183251 8361184 23124037 22731325 X 215421 -37488 X X 0 1 1 X 0 X 164443 55427 70378 183693 23190 497131 8721179 8943045 8899606 9443192 9540083 45547105 8885622 8998472 8969984 9626885 9563273 46044236 0 257109 171601 194516 215911 154568 993705 257109 171601 194516 215911 154568 993705 45050531 400625 317549 230565 219365 243999 1412103 400625 317549 230565 219365 243999 1412103 2209 11187 5495 3388 9033 31312 9288456 9327208 9206044 9849638 9816305 47487651 0.94870 0.94960 0.02970 0.03070 X 0 0 0 0 0 0 0 0 1 56 56 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: The organization supported lobbying expenses through payment of dues to Connecticut Association of Healthcare Facilities. 0 1 5239270 113474 151835 30613 5170296 4047765 130297 1245051 154660 29183 5239270 4140428 26006 1000231 154660 25885 4986120 0.83000 0.16000 0.01000 0 0 16252020 7574100 8677920 1676344 1042889 633455 161337 113252 48085 9359460 Accrued Interest 9178 Construction in Progress 645311 Interest in Trust 1333031 Restricted Investments and Cash 961641 Unrealized gain or loss on investme 819868 3769029 Water and Sewer Assessment 5100 5100 9757334 9541913 215421 63185 -100675 2 -37488 177933 9850724 63184 30204 93388 9757336 -2 -2 9757334 9572116 30204 30204 9541912 1 1 9541913 Part IV, Line 2b: Funds that are held on behalf of residents by the facility Description of Intended Use of Endowment Funds: Part V, Line 4: To provide interest and earnings to support operating and capital needs. Part XI, Line 8 - Other Adjustments: Rounding 2. Part XII, Line 2d - 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 4b - Other Adjustments: Rounding Differrence -2. Part XIII, Line 2d - 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 4b - Other Adjustments: Rounding 1. 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 X X X X X 0 0 0 0 0 0 0 1 0 Leonard Goldberg 179469 0 5789 0 0 0 13708 0 9933 0 208899 0 0 0 Part I, Line 7 The CEO received a bonus in the amount of $5,789. The Head of Nursing received a bonus in the amount of $3,378. CHEFA Series A Variable Rate Bond 20774UTA3 2008-01-17 8575000 Refunding on Series 1999 Bond 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Form 990, Part VI, Section A, line 8b The 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 11 A copy of the 990 is made availabe to each board member and also reviewed in conjunction with the preparer accountant, finance and executive committee. Form 990, Part VI, Section B, line 15a 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 C, line 19 Governing documents, financial statements and the conflict of interest statement are available at the Facility's office. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 63,185. Prior period adjustments: -100,675. Rounding 2. Total to Form 990, Part XI, Line 5: -37,488. 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.