2011-08-08T12:36:53-05:00 2010-09-30 BLUM SHAPIRO & COMPANY PC CPA'S 29 S MAIN STREET PO BOX 272000 WEST HARTFORD CT 061272000 990 2009-10-01 060763898 CHURCH HOMES INC CONGREGATIONAL CHUR 8605279126 217 AVERY HEIGHTS HARTFORD CT 061064200 RAYMOND A GASPERINI 8605279126 2011-08-02 1 8605614000 2009 2016-02-24 21:20:13Z RAYMOND A GASPERINI 217 AVERY HEIGHTS HARTFORD CT 06106 40840000 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 11 562 259 0 0 975836 929762 39994247 39357125 -493058 94329 403843 416697 40880868 40797913 9917 6000 0 22990254 23102884 0 199381 19102401 16688081 42102572 39796965 -1221704 1000948 61602146 60793740 32240372 29553703 29361774 31240037 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 36225698 39756122 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. 36225698 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 64 0 1 562 1 0 0 0 0 0 1 1 0 0 0 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 PETER G CAREY 1.00 X 0 0 0 PATRICK Y YUNG 1.00 X 0 0 0 LARRY C BROWN 1.00 X 0 0 0 JOSEPH C BLACK JR 1.00 X 0 0 0 MERCEDESE E LARGE 1.00 X 0 0 0 DAVID E CANUEL 1.00 X 0 0 0 HENRY B MCNULTY 1.00 X X 0 0 0 DAVID E POLK 1.00 X X 0 0 0 STEPHEN E RONAI ESQUIRE 1.00 X 0 0 0 ELIZABETH S GAGNE 1.00 X 0 0 0 PETER B MATTHEWS 1.00 X 0 0 0 PATRICK GILLAND 40.00 X 264769 0 44937 RAYMOND GASPERINI 40.00 X 180123 0 30057 EILEEN MULLIGAN 40.00 X 166385 0 25160 MIRIAM PARKER 40.00 X 185584 0 33756 MARJORIE K TESSMAN 40.00 X 54820 0 10199 BONITA GANIM 40.00 X 103666 0 15929 955347 0 160038 5 0 1 0 ALLIANCE REHAB OF CT 1520 KENSINGTON ROAD STE 110 OAK BROOKE IL 60523 REHAB THERAPY 1212931 HEALTHCARE SERVICES GROUP 3220 TILLMAN DR STE 300 BENSALEM PA 19020 HOUSEKEEPING/LAUNDRY SERVICES 899854 QUALITY FLOOR COVERINGS INC 21 BRENNAN ROAD AMSTON CT 06231 CARPETING 161011 MURTHA CULLINA LLP 185 ASYLUM STREET HARTFORD CT 06103 LEGAL 142956 COMFORTS OF HOME INC 77 MAIN ST NORTH SOUTHBURY CT 06488 DESIGN/FURNISHING 122270 12 55790 873972 929762 RESIDENT SERVICES 623000 39256517 39256517 OTHER SERVICES 623000 100608 100608 39357125 103641 103641 17700 17700 17700 17700 1305 7529 3088 -7529 -1783 -9312 -9312 31470 55790 31470 0 OTHER INCOME 900099 385722 385722 FEES INCOME 900099 13275 13275 398997 40797913 39756122 0 112029 6000 6000 981744 981744 16223240 14908955 1196437 117848 1143357 1082290 52512 8555 3380399 3015480 341083 23836 1374144 1202002 162641 9501 5428 5428 68537 68537 73917 73917 4229413 4191970 27494 9949 132482 126653 5829 288753 168204 94031 26518 84171 11983 63395 8793 4062183 4022951 39232 11836 6874 4876 86 6015 4207 1245 563 19985 19985 2585568 2530287 55281 250477 216380 34097 PROVIDER TAX 1404941 1404941 FOOD 1075638 1075638 SUPPLIES 758301 737900 20401 PRESCRIPTIONS & DRUGS 443738 443738 MAINTENANCE 295906 295906 890792 753354 143706 -6268 39796965 36225698 3371886 199381 6910401 7950123 3226419 2566325 3417870 3108824 197657 182025 710931 672126 75473418 43585399 33408194 31888019 7889165 13906123 5834278 515371 7231 4804 61602146 60793740 3656687 3668419 25851933 25621737 2731752 263547 32240372 29553703 X 21560879 22575755 5153630 6017017 2647265 2647265 29361774 31240037 61602146 60793740 X 0 1 1 X 0 X 910728 562990 900844 995528 929762 4299852 36807198 37296337 39324192 39944247 39756122 193128096 37717926 37859327 40225036 40939775 40685884 197427948 0 0 0 197427948 344459 797925 458327 184505 121341 1906557 344459 797925 458327 184505 121341 1906557 204866 279523 386093 398997 1269479 38062385 38862118 40962886 41510373 41206222 200603984 0.98420 0.98400 0.00950 0.01060 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10176093 228623 902670 1415437 9891949 10248098 30490 52850 155345 10176093 0.34000 0.27000 0.39000 1 0 2744217 2744217 47354002 25183390 22170612 21545068 15895692 5649376 3830131 2506317 1323814 31888019 ANNUITIES PAYABLE 75045 MISCELLANEOUS 160859 DUE TO THIRD PARTY REIMBURSEMENT AG 27643 263547 40797913 39796965 1000948 885851 -8536 877315 1878263 41706698 885851 -8536 877315 40829383 -31470 -31470 40797913 39828435 31470 31470 39796965 0 39796965 Part V, Line 4: Description of Intended Use of Endowment Funds: INVESTMENT INCOME UTILIZED TO SUPPORT OPERATIONS AND ACQUISITIONS OF FIXED ASSETS. Part XI, Line 8 - Other Adjustments: CHANGE IN VALUE OF SPLIT INTERERST AGREEMENTS: -8536. Part XII, Line 2d - Other Adjustments: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS: -8536. Part XII, Line 4b - Other Adjustments: FUNDRAISING EVENT EXPENSES: -31470. Part XIII, Line 2d - Other Adjustments: FUNDRAISING EVENT EXPENSES: 31470. GOLF OUTING 65894 42942 22952 6047 16347 558 FESTIVAL OF TREES 21366 12848 8518 8518 87260 55790 31470 6047 24865 558 31470 0 1 SCHOLARSHIPS 2 6000 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: SCHOLARSHIP ASSISTANCE IS OFFERED TO EMPLOYEES OR THEIR CHILDREN WHO WISH TO PURSUE PROFESSIONAL AND VOCATIONAL COURSES OF STUDY THAT ARE RELATED TO THE EMPLOYEE'S POTENTIAL FOR PROMOTION OR MINIMUM JOB REQUIREMENTS. ALL COURSES MUST BE OFFERED THROUGH AN ACCREDITED INSTITUTION OF HIGHER LEARNING OR BE APPROVED FOR CONTINUING EDUCATION UNITS. TO QUALIFY, THE EMPLOYEE MUST BE EMPLOYED 32 HOURS OR MORE AND HAVE COMPLETED ONE YEAR OF CONTINUOUS EMPLOYMENT. THE EMPLOYEE MUST HAVE A GOOD WORK ATTENDANCE RECORD. THE EMPLOYEE OR THEIR CHILD MUST MEET THE REQUIREMENTS OF THE INSTITUTION OR AGENCY OFFERING THE COURSE. THE SCHOLARSHIP ASSISTANCE IS AVAILABLE IF THE APPLICANT IS NOT ELIGIBLE FOR ASSISTANCE FROM OTHER SOURCES OF REIMBURSEMENT. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 PATRICK GILLAND 237269 0 27500 0 0 0 29441 0 15496 0 309706 0 0 0 RAYMOND GASPERINI 177623 0 2500 0 0 0 20664 0 9393 0 210180 0 0 0 EILEEN MULLIGAN 164385 0 2000 0 0 0 18611 0 6549 0 191545 0 0 0 MIRIAM PARKER 182984 0 2600 0 0 0 21811 0 11945 0 219340 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 DIRECTOR 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. 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 1 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0