2011-05-13T16:21:56-05:00 2010-06-30 SEILER LLP THREE LAGOON DRIVE STE 400 REDWOOD CITY CA 94065 990 2009-07-01 940545320 HEBREW HOME FOR AGED DISABLED HEBR 4153342500 302 SILVER AVENUE SAN FRANCISCO CA 941121510 KEVIN POTTER 4153342500 2011-05-11 true DEBRA K MCCALL 6503654646 2009 2016-02-24 21:20:13Z JEWISH HOME OF SAN FRANCISCO DANIEL RUTH 302 SILVER AVENUE SAN FRANCISCO CA 94112 65977677 false X www.jhsf.org X 1871 CA WE ARE A LICENSED NURSING HOME THAT PROVIDES TO SENIORS LIFE ENRICHING SERVICES THAT PROMOTE INDIVIDUAL DIGNITY, ENCOURAGE INDEPENDENCE, AND REFLECT THE SOCIAL, CULTURAL AND SPIRITUAL VALUES OF JEWISH TRADITION. 16 16 797 380 0 0 11036509 10672722 49975326 55155909 60906 18564 -172851 -172770 60899890 65674425 1750000 0 0 0 44740535 48517400 18104 0 497934 19080941 17202109 65589580 65719509 -4689690 -45084 110920304 114389986 47075968 46228867 63844336 68161119 The Organization is a licensed skilled nursing facility specializing in programs, services, and care for older adults. The Organization is a nine-acre comprehensive senior care center with five distinct buildings, serving more than 420 residents with diverse care needs, and providing rehabilitation services to numerous others seeking short-term care stays. Our mission is to become a regional resource as an integral part of a continuum of care throughout the Bay Area that provides senior adults with a variety of life enriching programs and services that are accessible, promote individual dignity, encourage independence, connect them to their community, and reflect the social, cultural, and spiritual values of Jewish tradition. false false 59369699 0 55155909 The organization provides long-term care, short-term rehabilitation, and acute psych care services. It provides professional and comprehensive programs that include personal and health care to residents in its over 400-bed facility. In the current fiscal year, the organization served an average of 424 residents a day. There were 104 new admissions for long-term care, 337 short-term care patients and 17 patients that required acute psych hospitalization. 59369699 true true false false false false false false true true true false false false false false false false false false true false false true true false false false false false true false false false false false false false false false false false false false true 111 0 true 797 true false false false false false false false false false 16 16 false false false false false false false true true false false true true true true true true true true false CA X KEVIN POTTER 4155622505 302 SILVER AVENUE SAN FRANCISCO CA 94112 MICHAEL W ADLER 2.0 X X 0 0 0 STEPHAN KRIEGER 2.0 X X 0 0 0 ALAN SILVERMAN 2.0 X X 0 0 0 DAVID J ARRICK 2.0 X X 0 0 0 ERIC B FASTIFF 2.0 X X 0 0 0 BENJAMIN ANIXTER 2.0 X 0 0 0 RICHARD BAUM 2.0 X 0 0 0 BENJAMIN EISLER 2.0 X 0 0 0 SUSAN FOLKMAN 2.0 X 0 0 0 MARK L MYERS 2.0 X 0 0 0 BILL POMERANZ 2.0 X 0 0 0 CAROL S ROBERTS 2.0 X 0 0 0 JOEL I ROOS 2.0 X 0 0 0 MATTHEW SLEPIN 2.0 X 0 0 0 JEFFERY STEIN 2.0 X 0 0 0 MICHAEL STRUNSKY 2.0 X 0 0 0 DANIEL R RUTH 40.0 X 497041 0 110610 KEVIN POTTER 40.0 X 203059 0 14822 EDWIN CABIGAO 40.0 X 172800 0 12120 SHERIE A KOSHOVER 40.0 X 195719 0 79777 JAY S LUXENBERG 40.0 X 179546 0 48968 SANDRA C SIMON 40.0 X 234889 0 48992 MARK DENTON 40.0 X 220438 0 25101 IDA SLEPNYOV 40.0 X 139527 0 13751 MICHAEL GEISER 40.0 X 134429 0 32631 THOMAS BOOKWALTER 40.0 X 131827 0 6614 SHIRLEY HUAN 40.0 X 129674 0 5907 KATHLEEN J SKINNER 40.0 X 123600 0 11907 2362549 0 411200 30 false true false KRUIT PAINTING 4505 CALIFORNIA STREET STE 8 SAN FRANCISCO CA 94118 PAINTING 118319 1 398834 10273888 9899 10672722 PROGRAM SERVICE REVENUE 623000 55155909 55155909 0 55155909 18564 0 18564 0 0 0 0 0 130482 303252 -172770 0 -172770 0 65674425 55155909 0 -154206 0 0 0 0 1803246 695221 878528 229497 0 35089355 32779560 2172927 136868 1969526 1864749 104777 7009447 6711484 259689 38274 2645826 2438731 185461 21634 0 117817 80432 37385 85618 85618 0 0 0 444439 151266 259741 33432 95049 94496 553 5753014 5637163 109621 6230 0 0 1649085 1349020 300065 0 0 0 1289661 876969 412692 0 3039740 2612271 421031 6438 490312 490312 CONTRACT SERVICES 3140399 2483135 654588 2676 EQUIPMENT RENTAL & MTNCE 282696 201632 77816 3248 TAX & LICENSES 187451 169106 18345 COST REIMBURSEMENTS -349451 -349451 AMORTIZATION OF BOND COSTS 346096 346096 630183 482552 128547 19084 65719509 59369699 5851876 497934 11599 17641 8049487 5772382 1055089 1339028 5086249 5598277 800000 800000 422472 294097 912252 492241 98351575 39883390 57387799 58468185 37195357 41608135 110920304 114389986 7797742 6939583 1250000 750000 35440000 34840000 500000 1000000 2088226 2699284 47075968 46228867 X 17499212 22679686 9768596 9382130 36576528 36099303 63844336 68161119 110920304 114389986 X false true true X false X 7933448 1655627 27652647 11036508 10672721 58950951 7933448 1655627 27652647 11036508 10672721 58950951 2280609 56670342 294789 650520 270701 60906 11987 1288903 60239854 240685310 0.94075 0.87910 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 29666200 122775 3192587 0 600000 0 32381562 38484514 30425 -5085714 0 3763025 0 29666200 0.00000 1.00000 0.00000 true false 90849 90849 79430663 31145487 48285176 16077728 7898583 8179145 2752335 839320 1913015 58468185 BENEFICIAL INTEREST IN JHSLF 35000768 TRUSTEE ACCOUNTS 4662927 OTHER ASSETS 305763 BOND ISSUANCE COSTS 560157 INTEREST IN NET ASSETS-JHSLF 1078520 41608135 0 DERIVATIVE FINANCIAL INSTRUMENT 2131041 RESIDENTS' TRUST ACCOUNT 209117 RESIDENTS' MAINTENANCE ACCOUNT 73635 SPLIT INTEREST AGREEMENTS 19560 DEFERRED COMPENSATION PAYABLE 265931 2699284 65674425 65719509 -45084 4918347 4918347 4873263 71144168 5476320 5476320 65667848 6577 6577 65674425 66270905 557973 557973 65712932 6577 6577 65719509 INTENDED USE OF ENDOWMENT FUNDS PART V, LINE 4 THE ORGANIZATION'S ENDOWMENT ASSETS CONSIST OF FUNDS ESTABLISHED TO GENERATE OPERATING SUPPORT TO THE ORGANIZATION AND CAPITAL CAMPAIGN FUNDS WHICH THE BOARD OF TRUSTEES MAY USE TO REPAY THE PRINCIPAL PORTION OF THE CONSTRUCTION DEBT. RECONCILIATION OF CHANGES IN NET ASSETS PART XI, LINE 8 INCREASE IN VALUE OF SPLIT INTEREST AGREEMENTS $767,924 INCREASE IN BENEFICIAL INTEREST IN JEWISH HOME & SENIOR LIVING FOUNDATION (JHSLF) $3,315,362 INCREASE IN INTEREST IN NET ASSETS OF JEWISH HOME & SENIOR LIVING FOUNDATION (JHSLF) $2,213,520 BOOK TO TAX ADJUSTMENT CHANGE IN NET ASSETS OF JEWISH HOME & SENIOR LIVING FOUNDATION (JHSLF) $(828,520) BOOK TO TAX ADJUSTMENT PRIOR YEAR CONTRIBUTIONS $8,034 UNREALIZED LOSS ON DERIVATIVE FINANCIAL INSTRUMENT $(557,973) ----------- TOTAL $4,918,347 =========== RECONCILIATION OF REVENUE PART XII, LINE 2D INCREASE IN VALUE OF SPLIT INTEREST AGREEMENTS $767,924 INCREASE IN BENEFICIAL INTEREST IN JEWISH HOME & SENIOR LIVING FOUNDATION (JHSLF) $3,315,362 INCREASE IN INTEREST IN NET ASSETS OF JEWISH HOME & SENIOR LIVING FOUNDATION (JHSLF) $2,213,520 BOOK TO TAX ADJUSTMENT CHANGE IN NET ASSETS OF JEWISH HOME & SENIOR LIVING FOUNDATION (JHSLF) $(828,520) BOOK TO TAX ADJUSTMENT PRIOR YEAR CONTRIBUTIONS $8,034 ----------- TOTAL $5,476,320 =========== RECONCILIATION OF REVENUE PART VII, LINE 4B BOOK TO TAX ADJUSTMENTS $6,577 RECONCILIATION OF EXPENSES PART XIII, LINE 2D UNREALIZED LOSS ON DERIVATIVE FINANCIAL INSTRUMENT $557,973 RECONCILIATION OF EXPENSES PART XIII, LINE 4B BOOK TO TAX ADJUSTMENTS $6,577 true true true X true X true true false true true 132781 0 132781 0.00020 50756023 41400079 9355944 0.14240 0 0 0 0.00000 50888804 41400079 9488725 0.14260 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 852812 398834 453978 0.01000 0 0 0 0.00000 852812 398834 453978 0.01000 51741616 41798913 9942703 0.15260 true 113027 0 6717225 6903204 -185979 X true true ACUTE PSYCHIATRIC HOSPITAL

302 SILVER AVENUE SAN FRANCISCO CA 94112

X NONE The cost to charge ratio as determined by worksheet 2 was used to calculate the amounts reported on Line 7a and 7b. The costing methodology used on Line 7h was calculated based on actual costs from the organization's general ledger. Bad Debt expense is reported as a net adjustment to patient charges and therefore not included as part of total expenses from Part IX, Line 25, column (A). Uncollected resident accounts are analyzed based on standard procedures for all resident accounts. The result of the analysis is what is recognized as bad debt expense. The organization follows HFMA Statement 15 and therefore no part of bad debt, as defined by statement 15, represents amounts attributable to patients eligible to receive financial assistance. The audited financial statements does not contain a footnote that describes bad debt expense. The audited financial statements contains a footnote describing patient service revenues and charity care which reads as follows: Patient service revenues are recorded on the accrual basis in the period services are provided at established rates regardless of whether collection in full is anticipated. Contractual allowances and the provision for uncollectible accounts are reported as deductions from patient service revenues. Contractual allowances include differences between established billing rates and amounts estimated by management as payable under various contractual arrangements in effect, including those with the Medicare and Medi-Cal programs. Estimation differences between final settlements and amounts accrued in previous years are reported as adjustments to the current year's contractual allowances. The Home accepts residents of the San Francisco Bay Area who meet certain requirements regardless of their ability to pay. A resident is classified as a charity resident by reference to established policies of the Home. Essentially, these policies define charity services as those services for which lesser payment is anticipated. Charity care is included in gross patient service revenue and a corresponding allowance is reflected in determining net patient service revenue. Medicare allowable costs were calculated using a cost-to-charge ratio. Caring for Medicare patients fulfills a community need and relieves a government burden as these patients typically have low and/or fixed income. Medicare does not provide sufficient reimbursement to cover the cost of providing care for these patients forcing the organization to use other funds to cover the deficit of $185,979. Therefore, the organization believes the entire shortfall should be considered community benefit. The amounts reported in lines 5, 6 and 7 come from the Hospital's filed Medicare Cost report. The total revenue equates to Medicare payments and the Medicare Allowable Costs are determined on the Medicare Cost Report that utilized cost to charge ratios applied to covered Medicare Revenues. The organization is a member of Building a Healthier San Francisco (BHSF), a collaboration of San Francisco hospitals, the Department of Public Health, United Way, human services providers, philanthropic foundations, and numerous community-based organizations. BHSF is committed to working toward improving the health status of all people in San Francisco. To that end, BHSF needs-assessment process utilizes the best secondary data available on selected indicators of the health or conditions affecting the well-being of San Francisco's population and subpopulations, and seeks feedback and input from the community to guide the assessment and direct the call to action. A Resident Services Coordinator staff is available to assist residents and/or their family members or legal representatives through the process of determining their eligibility for all government programs and assist them in the application process. The organization serves the most medically/cognitively frail, as well as financially indigent elders (86 percent of the organization residents are indigent and/or Medi-Cal recipients who do not pay the full cost of care), with an average age of 86. It provides professional and comprehensive programs that include personal and health care to the elderly who primarily reside in the greater San Francisco Bay Area. Not Applicable The Organization is involved in numerous community building activities to promote the health and well-being of the communities it serves as well as to provide training and internship opportunities to the future caretakers and leaders of the communities. Following is a list of some of those activities: The organization's staff attended and presented in conferences related to issues on the care for the elderly. Over the past 36 years, the organization has partnered with San Francisco City College in offering several adult education classes to the general community. Approximately 20 to 25 students enroll each semester in the Creative Arts class. The organization partners with local high schools that aim to involve youth in their community by encouraging them to fulfill needs in their respective milieus. Mutual goals include the promotion of civic responsibility and the development of leadership skills. Students from University of California, San Francisco, Samuel Merritt College, Dominican University, San Jose State, and San Francisco State University (SFSU) continue to intern with the Organization's physical, occupational, and speech therapists. The organization regularly opens its doors to professional organizations and community groups, offering them free meeting space, continuing education credits. Staff supported the efforts of the San Francisco Food Bank by hosting and participating in a two-month-long food drive at the end of 2009. The organization's efforts resulted in the collection of 312 pounds of food, which enabled the Food Bank to distribute enough food for 248 meals to low-income families, senior citizens, and other individuals in need in our community. The organization partners with local organizations, fostering dialogue, collaborations, and ongoing communications with its neighbors. Geriatric fellows from the University of California, San Francisco receive training at the organization. Fourth-year pharmacy students at UCSF spend 12 hours a week, in 12-week rotations, in the Organization's Pharmacy department. Through its affiliation with the Organization, six to seven Touro University School of Pharmacy students per academic year receive six-week's training in long-term care pharmacy. They learn how the geriatric patient processes drugs differently from a younger population, are exposed to how drugs are dispensed and utilized, and gain an understanding of third-party payers. The Organization collaborates with Jewish Family and Children's Services and the San Francisco Jewish Community Center to provide hot, nutritious meals to Jewish seniors. CA X X X X true false false false false false false false false DANIEL R RUTH 497041 0 0 0 0 0 76760 0 33850 0 607651 0 0 0 EDWIN CABIGAO 172800 0 0 0 0 0 6400 0 5720 0 184920 0 0 0 SHERIE A KOSHOVER 195719 0 0 0 0 67460 0 12317 0 275496 0 0 0 JAY S LUXENBERG 179546 0 0 0 0 0 16159 0 32809 0 228514 0 0 0 KEVIN POTTER 203059 0 0 0 0 0 7775 0 7047 0 217881 0 0 0 SANDRA C SIMON 234889 0 0 0 0 0 15062 0 33930 0 283881 0 0 0 MARK DENTON 160438 0 0 0 60000 0 12916 0 12185 0 245539 0 0 0 IDA SLEPNYOV 139527 0 0 0 0 0 12557 0 1194 0 153278 0 0 0 MICHAEL GEISER 134429 0 0 0 0 0 13443 0 19188 0 167060 0 0 0 SEVERANCE PAYMENT PAID TO EMPLOYEE PART I, LINE 4A THE ORGANIZATION MADE SEVERANCE PAYMENTS TO THE FOLLOWING PERSON LISTED ON FORM 990, PART VII, SECTION A, LINE 1A. MARK DENTON $60,000 ABAG FINANCE AUTHORITY FOR NON-PROFIT CORPORATIONS 942832478 00037CGX2 2005-12-01 35440000 SEE SCHEDULE O false true 35440000 0 0 0 658124 0 34781876 2008 false false true true false false false false true 0.00000 0.00000 0.00000 true false true true ALLIED IRISH BANKS 7.3 true AIG MATCHED FUNDING 1.3 true false true DANIEL R RUTH COMPENSATION PACKAGE X 800000 800000 false true true 800000 REVIEW OF FORM 990 FORM 990, PART VI,LINE 11A A COPY OF THE FORM 990 IS PROVIDED TO ALL BOARD OF TRUSTEES PRIOR TO FILING. THE BOARD REVIEWS AND APPROVES THE FORM 990 PRIOR TO IT BEING FILED. IN ADDITION, MANAGEMENT OF THE ORGANIZATION REVIEWS THE COMPLETED FORM 990 AND FOLLOWS UP WITH THE TAX RETURN PREPARATION FIRM TO ANSWER ANY QUESTIONS PRIOR TO FILING. MONITORING AND ENFORCEMENT OF COMPLIANCE FORM 990, PART VI, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. EACH TRUSTEE AND PRINCIPAL OFFICER OF THE ORGANIZATION AND EACH MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS ANNUALLY SIGNS THE CONFLICT OF INTEREST STATEMENT AND DISCLOSURE FORM. THE BOARD OF TRUSTEES REVIEW AND DETERMINE IF ANY CONFLICTS OF INTEREST EXIST AND TAKE THE APPROPRIATE ACTION AS OUTLINED IN THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. DETERMINATION, REVIEW AND APPROVAL OF OFFICERS' COMPENSATION FORM 990, PART VI, LINE 15b THE COMPENSATION COMMITTEE REVIEWS AND APPROVES THE ANNUAL COMPENSATION PACKAGE FOR THE CHIEF EXECUTIVE OFFICER AND THE CHIEF FINANCIAL OFFICER BASED ON VARIOUS FACTORS SUCH AS: COMPENSATION DATA OBTAINED FROM SURVEYS, PERFORMANCE APPRAISALS AND NON-PROFIT RESOURCES FOR SIMILAR ORGANIZATIONS IN THE SAME GEOGRAPHICAL AREA. THE BOARD OF TRUSTEES APPROVES THE CHIEF EXECUTIVE OFFICER'S EMPLOYMENT CONTRACT. THE CHIEF EXECUTIVE OFFICER REVIEWS AND APPROVES THE ANNUAL COMPENSATION FOR THE OTHER EXECUTIVE TEAM MEMBERS BASED ON VARIOUS FACTORS SUCH AS ANNUAL COMPENSATION SURVEYS, PERFORMANCE APPRAISALS AND OTHER NON-PROFIT RESOURCES FOR SIMILAR ORGANIZATIONS. THE BOARD OF TRUSTEES APPROVES THE ANNUAL BUDGET THAT INCLUDES COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. AVAILABILITY OF DOCUMENTS FOR PUBLIC INSPECTION FORM 990, PART VI, LINE 19 THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON WRITTEN OR ORAL REQUEST. The governing documents and conflict of interest policy are not made available to the public. PURPOSE OF TAX-EXEMPT BONDS SCHEDULE K, PART I, LINE A (f) TO FINANCE THE CONSTRUCTION OF THE EAST WING WHICH WAS COMPLETED IN 2007. AUDIT OVERSIGHT FORM 990, PART XI, LINE 2C THE ROLE AND THE PROCESS OF THE AUDIT COMMITTEE HAS NOT CHANGED. PURPOSE OF A LOAN TO THE CHIEF EXECUTIVE OFFICER SCHEDULE L, PART II, COL (A) THE ORGANIZATION MADE A LOAN OF $800,000 IN SEPTEMBER 2002 TO THE CHIEF EXECUTIVE OFFICER AS PART OF HIS COMPENSATION PACKAGE THAT REQUIRED HIM TO RELOCATE TO CALIFORNIA. THE COMPENSATION PACKAGE WHICH INCLUDED THE LOAN WAS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE AND THE BOARD OF TRUSTEES AS REASONABLE AND FAIR. THE LOAN IS INTEREST FREE AND IS SECURED BY A SECOND DEED OF TRUST. INTEREST EXPENSE IS IMPUTED ANNUALLY USING THE APPLICABLE FEDERAL RATE (AFR) FOR DEMAND LOANS AND REPORTED AS COMPENSATION BY THE OFFICER.