2024-02-29T18:34:46-06:00 2023-12-21 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2023-07-01 800291740 JEWISH SENIOR LIVING GROUP JEWI 4155622600 302 SILVER AVENUE SAN FRANCISCO CA 94112 MARY CONNICK TREASURER AND CFO 4155622600 2024-02-29 1 MARY CONNICK 999009999 0 MICHAEL LUMSDEN P01262236 4159561500 2024-02-29 2 AAL1 IAL1 2023 2023-04-26 12:10:37Z X JIM KOSHLAND 302 SILVER AVENUE SAN FRANCISCO CA 94112 523577 0 X N/A X 2008 CA TO PROMOTE THE PROVISION OF JEWISH LIVING SERVICES, FACILITIES, AND AGING SERVICES IN NORTHERN CALIFORNIA BY PROVIDING SERVICES DESIGNED TO ASSIST THE SUPPORTED CHARITIES IN THEIR OWN OPERATIONS. EFFECTIVE DECEMBER 21, 2023, THE ORGANIZATION CEASED OPERATIONS AND MERGED WITH THE HEBREW HOME FOR AGED DISABLED, A RELATED ORGANIZATION. X 5 5 0 5 0 0 0 496673 4607877 0 0 26904 2595 0 4610472 523577 0 0 0 0 2835236 350 0 0 0 1480603 206566 4315839 206916 294633 316661 842841 0 1060132 0 -217291 0 X SEE SCHEDULE O 0 1 142560 0 0 THE ORGANIZATION PROVIDES ADMINISTRATIVE, FINANCE AND ACCOUNTING, IT, PUBLIC RELATIONS, COMMUNICATIONS, AND HUMAN RESOURCES FUNCTIONS VIA SERVICE AGREEMENTS WITH THE FOLLOWING NONPROFIT PUBLIC BENEFIT CORPORATIONS: HEBREW HOME FOR AGED DISABLED DBA SAN FRANCISCO CAMPUS FOR JEWISH LIVING; AND THE JEWISH HOME AND SENIOR LIVING FOUNDATION. EFFECTIVE DECEMBER 21, 2023, THE ORGANIZATION CEASED OPERATIONS AND MERGED WITH HEBREW HOME FOR AGED DISABLED. 142560 1 1 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 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 1 8 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 0 0 0 CA X MARY CONNICK 4155622650 302 SILVER AVENUE SAN FRANCISCO CA 94112 JAMES KOSHLAND CHAIR, INTERIM PRESIDENT & CEO 1.00 0.00 X X 0 0 0 DAVID FRIEDMAN SECRETARY, IMMEDIATE PAST CHAIR 1.00 1.00 X X 0 0 0 MICHAEL EISLER TRUSTEE 1.00 0.00 X 0 0 0 STEVE FAYNE TRUSTEE 1.00 1.00 X 0 0 0 REBECCA MACIEIRA KAUFMAN TRUSTEE 1.00 0.00 X 0 0 0 MARY CONNICK TREASURER AND CFO 4.00 36.00 X 0 625473 8277 MICHAEL SKAFF CIO (THROUGH 2/2023) 5.00 35.00 X 0 188988 1500 KEVIN BEUTLER CHIEF HUMAN RESOURCES OFFICER 2.00 38.00 X 0 240469 1086 DANIEL RUTH FORMER PRES. & CEO (THROUGH 2/2022) 0.00 0.00 X 0 460393 0 0 1515323 10863 0 1 1 0 LEONARD LINDE 51 NORTHFIELD GATE PITTSFORD NY 14534 IT SERVICES 217796 1 496673 496673 26904 0 26904 26904 26904 523577 0 0 26904 350 324 26 1693 1693 41896 41896 1574 1457 117 132 80 52 62240 57588 4652 8232 7615 617 80886 74820 6066 DUES, FEES, MEMBERSHIPS 825 571 254 LICENSES 50 46 4 FOOD 35 35 9003 59 8944 206916 142560 64356 0 305362 0 0 0 0 0 0 0 0 86891 0 0 0 9624 0 428218 0 0 0 0 12746 0 842841 0 192662 0 867470 0 1060132 0 X -217291 0 -217291 0 842841 0 X 316661 -99370 X 0 0 0 X X X 2 HEBREW HOME FOR AGED DISABLED 940545320 7 1 0 0 THE JEWISH HOME & SENIOR LIVING FOUNDATION 020724278 7 1 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART I, LINE 12G, COLUMN (VI): THE ORGANIZATION PROVIDES FINANCE AND ACCOUNTING, HUMAN RESOURCE, INFORMATION TECHNOLOGY, AND OTHER ADMINISTRATIVE BACK-OFFICE SERVICES TO THE SUPPORTED ORGANIZATIONS LISTED IN SCHEDULE A, PART I, LINE 12G, COLUMN (VI). RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 0 0 0 MARY CONNICK TREASURER AND CFO 0 471128 0 100000 0 54345 0 7500 0 777 0 633750 0 0 DANIEL RUTH FORMER PRES. & CEO (THROUGH 2/2022) 0 0 0 0 0 460393 0 0 0 0 0 460393 0 0 KEVIN BEUTLER CHIEF HUMAN RESOURCES OFFICER 0 188854 0 30000 0 21615 0 0 0 1086 0 241555 0 0 MICHAEL SKAFF CIO (THROUGH 2/2023) 0 41838 0 50 0 147100 0 1500 0 0 0 190488 0 0 PART I, LINE 3 THE ORGANIZATION DID NOT COMPENSATE ITS PRESIDENT & CEO DURING THE DECEMBER 21, 2023 FINAL SHORT-YEAR. PART I, LINES 4A-B DURING THE 2023 CALENDAR YEAR, DANIEL RUTH AND MICHAEL SKAFF RECEIVED TAXABLE SEVERANCE PAYMENTS OF $423,193 AND $80,976, RESPECTIVELY, WHICH HAS BEEN REPORTED WITHIN "OTHER REPORTABLE COMPENSATION" ON SCHEDULE J, PART II, COLUMN (B)(III). DURING THE 2023 CALENDAR YEAR, DANIEL RUTH WAS A PARTICIPANT IN A SUPPLEMENTAL 457(F) PLAN SPONSORED BY THE ORGANIZATION. THERE WERE NO EMPLOYER CONTRIBUTIONS TO THE 457(F) PLAN DURING THE 2023 CALENDAR YEAR, NOR WERE ANY AMOUNTS REQUIRED TO BE REPORTED AS TAXABLE COMPENSATION DUE TO VESTING OF THE PLAN. CASH AND CASH EQUIVALENTS 2023-12-21 184018 BOOK VALUE 940545320 HEBREW HOME FOR AGED DISABLED 302 SILVER AVENUE SAN FRANCISCO CA 941121510 501(C)(3) PROPERTY, PLANT, AND EQUIPMENT, NET 2023-12-21 11947 BOOK VALUE 940545320 HEBREW HOME FOR AGED DISABLED 302 SILVER AVENUE SAN FRANCISCO CA 941121510 501(C)(3) INVESTMENTS - PUBLICLY TRADED SECURITIES 2023-12-21 415928 BOOK VALUE 940545320 HEBREW HOME FOR AGED DISABLED 302 SILVER AVENUE SAN FRANCISCO CA 941121510 501(C)(3) ACCRUED PAYROLL (ASSUMED BY HEBREW HOME FOR AGED DISABLED) 2023-12-21 -65787 BOOK VALUE 940545320 HEBREW HOME FOR AGED DISABLED 302 SILVER AVENUE SAN FRANCISCO CA 941121510 501(C)(3) CAPITAL LEASE OBLIGATIONS (ASSUMED BY HEBREW HOME FOR AGED DISABLED) 2023-12-21 -30808 BOOK VALUE 940545320 HEBREW HOME FOR AGED DISABLED 302 SILVER AVENUE SAN FRANCISCO CA 941121510 501(C)(3) 457 SUPPLEMENTAL EXECUTIVE PLAN LIABILITY (ASSUMED BY HEBREW HOME FOR AGED DISABLED) 2023-12-21 -415928 BOOK VALUE 940545320 HEBREW HOME FOR AGED DISABLED 302 SILVER AVENUE SAN FRANCISCO CA 941121510 501(C)(3) 1 1 0 0 1 1 1 1 0 PART I, LINE 2E: PERSON(S) INVOLVED: STEVEN FAYNE, MARY CONNICK, KEVIN BEUTLER PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: STEVEN FAYNE, WHO SERVED AS A BOARD MEMBER OF JEWISH SENIOR LIVING GROUP, ALSO SERVES AS A BOARD MEMBER OF THE HEBREW HOME FOR AGED DISABLED (AND WILL CONTINUE TO DO SO AFTER THE MERGER, EFFECTIVE DECEMBER 21, 2023).MARY CONNICK, WHO SERVED AS THE CHIEF FINANCIAL OFFICER OF JEWISH SENIOR LIVING GROUP, ALSO SERVES AS THE CHIEF FINANCIAL OFFICER OF HEBREW HOME FOR AGED DISABLED (AND WILL CONTINUE TO DO SO AFTER THE MERGER, EFFECTIVE DECEMBER 21, 2023). ADDITIONALLY, KEVIN BEUTLER, WHO SERVED AS THE CHIEF HUMAN RESOURCES OFFICER OF JEWISH SENIOR LIVING GROUP, ALSO SERVES AS THE CHIEF HUMAN RESOURCES OFFICER OF HEBREW HOME FOR AGED DISABLED (AND WILL CONTINUE TO DO SO AFTER THE MERGER, EFFECTIVE DECEMBER 21, 2023). FORM 990, PART III, LINE 1 TO CONDUCT OR SUPPORT ACTIVITIES FOR THE BENEFIT, OR TO CARRY OUT THE PURPOSES, OF A CLASS OF ORGANIZATIONS (COLLECTIVELY, THE "SUPPORTED CHARITIES"): (I) THAT ARE DESCRIBED IN CODE SECTIONS 501(C)(3) AND 509(A)(1) OR (A)(2), AND (II) THAT PROVIDE, OR PROMOTE THE PROVISION OF JEWISH LIVING SERVICES, FACILITIES AND/OR AGING SERVICES IN NORTHERN CALIFORNIA. THE SUPPORTED CHARITIES INCLUDE, WITHOUT LIMITATION, HEBREW HOME FOR AGED DISABLED DBA SAN FRANCISCO CAMPUS FOR JEWISH LIVING AND THE JEWISH HOME AND SENIOR LIVING FOUNDATION. THE ORGANIZATION PROVIDES SERVICES DESIGNED TO ASSIST THE SUPPORTED CHARITIES IN THEIR OWN OPERATIONS. BY PROVIDING THE SERVICES, THE ORGANIZATION WILL HELP THE SUPPORTED CHARITIES MAXIMIZE UTILIZATION OF AVAILABLE RESOURCES, REDUCE FUNCTIONAL OVERLAPS AND DUPLICATION OF EFFORT, PROMOTE ECONOMIES OF SCALE, AND ENHANCE ADMINISTRATIVE EFFICIENCY. THE SERVICES ARE PROVIDED TO THE SUPPORTED CHARITIES ON TERMS THAT ARE MORE FAVORABLE THAN THE SUPPORTED CHARITIES COULD OBTAIN IN THE MARKETPLACE. FORM 990, PART III, LINE 3 EFFECTIVE DECEMBER 21, 2023, THE ORGANIZATION CEASED OPERATIONS AND MERGED WITH HEBREW HOME FOR AGED DISABLED, A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION DOES NOT HAVE "MEMBERS" BY DEFINITION OF THE BYLAWS; HOWEVER, THE FORM 990 INSTRUCTIONS ALSO DEFINE A "MEMBER" AS ANY PERSON (INCLUDING A CORPORATION OR OTHER LEGAL ENTITY) WHO HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE, INCLUDING ELECTING MEMBERS OF THE GOVERNING BODY. AS SUCH, IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS, JSLG HAS TWO MEMBERS: (I) HEBREW HOME FOR AGED DISABLED DBA THE SAN FRANCISCO CAMPUS FOR JEWISH LIVING (SFCJL) AND (II) THE JEWISH HOME AND SENIOR LIVING FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A A MAJORITY OF THE TRUSTEES SERVING ON THE BOARD OF JSLG AT ANY GIVEN TIME SHALL BE TRUSTEES APPOINTED BY THE HEBREW HOME FOR AGED DISABLED AND THE JEWISH HOME AND SENIOR LIVING FOUNDATION. THE REMAINING TRUSTEES OF JSLG ARE THEN APPOINTED BY HEBREW HOME FOR AGED DISABLED AND THE JEWISH HOME AND SENIOR LIVING FOUNDATION ACTING JOINTLY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE TAX PROFESSIONAL IN CONJUNCTION WITH THE ORGANIZATION'S ACCOUNTING AND FINANCE STAFF. MANAGEMENT OF THE ORGANIZATION THEN REVIEWS THE COMPLETED FORM 990 AND FOLLOWS-UP WITH THE TAX PREPARATION FIRM TO RESOLVE ANY OUTSTANDING QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. EACH PERSON WHO IS DEEMED TO HAVE SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION (INCLUDING TRUSTEES, OFFICERS, AND KEY EMPLOYEES) SIGNS AN ANNUAL DISCLOSURE STATEMENT WHICH AFFIRMS THAT THE PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTOOD THE POLICY, AND HAS AGREED TO COMPLY WITH THE POLICY, AND DISCLOSES ANY DIRECT OR INDIRECT AFFILIATIONS. ALL ANNUAL DISCLOSURE STATEMENTS ARE SUBMITTED TO THE SECRETARY. EACH EMPLOYEE DISCLOSES TO THE CHIEF EXECUTIVE OFFICER ALL MATERIAL FACTS REGARDING THE AFFILIATION OF SUCH EMPLOYEE WITH ANY PERSON WITH WHOM THE ORGANIZATION IS CONSIDERING ENTERING A TRANSACTION; THE CHIEF EXECUTIVE OFFICER THEN DETERMINES WHETHER A CONFLICT OF INTEREST EXISTS FOR THESE EMPLOYEES. THE CHIEF EXECUTIVE OFFICER AND ANY OTHER PERSON WITH SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION SHALL DISCLOSE TO THE BOARD ALL MATERIAL FACTS REGARDING HIS OR HER AFFILIATION WITH ANY PERSON WITH WHOM THE JEWISH HOME IS CONSIDERING ENTERING A TRANSACTION; THE BOARD THEN DETERMINES IF A CONFLICT OF INTEREST EXISTS FOR THE CHIEF EXECUTIVE OFFICER OR PERSON WITH SUBSTANTIAL INFLUENCE OVER THE ORGANIZATION. IF A BOARD MEMBER IS THE INDIVIDUAL WITH WHICH A CONFLICT OF INTEREST IS BEING DETERMINED, THE BOARD MEMBER IS NOT ALLOWED TO VOTE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B, LINES 15A AND 15B HAVE BEEN ANSWERED "NO" (IN ACCORDANCE WITH THE FORM 990 INSTRUCTIONS) AS THE ORGANIZATION DID NOT COMPENSATE ANY EMPLOYEES (ALL JEWISH SENIOR LIVING GROUP EMPLOYEES WERE TRANSFERRED TO THE PAYROLL OF HEBREW HOME FOR AGED DISABLED, A RELATED ORGANIZATION, IN DECEMBER 2022). PLEASE REFERENCE THE FORM 990 FOR HEBREW HOME FOR AGED DISABLED FOR A DISCUSSION ON HOW COMPENSATION WAS ESTABLISHED FOR THE OFFICERS AND KEY EMPLOYEES APPEARING ON JEWISH SENIOR LIVING GROUP'S FORM 990, PART VII. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER OF NET ASSETS TO HEBREW HOME FOR AGED DISABLED -99,370. HEBREW HOME FOR AGED DISABLED 302 SILVER AVE SAN FRANCISCO CA 94112 940545320 SEE PART VII CA 501(C)(3) LINE 7 N/A 0 THE JEWISH HOME AND SENIOR LIVING FOUNDATION 302 SILVER AVE SAN FRANCISCO CA 94112 020724278 SEE PART VII CA 501(C)(3) LINE 7 N/A 0 BAY AREA JEWISH SENIOR LIFE 302 SILVER AVE SAN FRANCISCO CA 94112 455092344 SEE PART VII CA 501(C)(3) LINE 12A, I JEWISH SENIOR LIVING GROUP 1 BAY AREA SENIOR HEALTH SERVICES INC 302 SILVER AVENUE SAN FRANCISCO CA 94015 454293287 MANAGEMENT CO CA JSLG C 1.00000 1 0 0 1 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 PART II, COLUMN (B) THE JEWISH HOME AND SENIOR LIVING FOUNDATION PRIMARY ACTIVITY: TO PROMOTE AND SUPPORT THE PROVISION OF JEWISH AGING SERVICES, INCLUDING THE MISSION AND ACTIVITIES ASSOCIATED WITH THE HEBREW HOME FOR AGED DISABLED. PART II, COLUMN (B) HEBREW HOME FOR AGED DISABLED PRIMARY ACTIVITY: 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. NON-RESIDENTIAL CARE IS OFFERED THROUGH THE HOME'S SHORT-TERM AND REHABILITATION SERVICES (STARS) AND ACUTE PSYCHIATRIC SERVICES. PART II, COLUMN (B) BAY AREA JEWISH SENIOR LIFE PRIMARY ACTIVITY: TO ASSIST THE SUPPORTED CHARITIES IN THEIR OWN OPERATIONS AND ASSIST WITH DEVELOPING NEW SERVICES AND FACILITIES IN THE AFFILIATED NETWORK.