` Return of Organization Exempt From Income Tax Form ~JO ...990s.foundationcenter.org/990_pdf_archive/941/... · return sp--f-c911 N. STUDEBAKER ROAD Final InsWc- Or eturn eturn lions

o ̀ Return of Organization Exempt From Income Tax VMCNO 1,9,-UU~

Form ~JO Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black loop 2002 Department o1 the Treasury benefit trust or private foundation) Open to Public Internal Revenue Service " The organization may have to use a copy of this return to satisfy state reporting requirements. Inspection A For the 2002 calendar year, or tax year period beginning DEC 1 2002 and ending NOV 3 0 . 2003

F Amounting method " Cash LM Accrual

H and I are not applicable to section 527 organizations . H(a) Is this a group return for affiliates 0 Yes Ell No H(b) If 'Yes," enter number of affiliates" H(c) Are all affiliates included? N/A E::] Yes E] No

(If 'No,' attach a list) H(d) Is this a separate return fled by an or-

J Organization type (check onryane) lEk] 501(0)( 3 )" cnsert no) L-] 4947(a)(1) or 0 52 K Check here " E:1 if the organization's gross receipts are normally not more than $25,000 . The

organization need not file a return with the IRS; but if the organization received a Form 990 Package in the mad, it should file a return without financial data. Some states require a complete return .

M Check 1 FXI if the organization is not required to attach L Gross receipts : Add lines 6b, 8b, 9b, and 10b to line 121 4 , 380 , 517 . Sch . B (Form 990, 990-EZ, or 990-PF). Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances

1 Contributions, gifts, grants, and similar amounts received: a Direct public support 1a 220 . b Indirect public support 1b c Government contributions (grants) is d Total (add lines 1a through 1c) (cash $ 220 . noncash $ ) id 220 .

2 Program service revenue including government fees and contracts (from Part VII, line 93) 2 4 , 274 , 078 . 3 Membership dues and assessments 3 4 Interest on savings and temporary cash investments 4 16 488 . 5 Dividends and interest from securities 5 6 a Gross rents 6a

4 b Less: rental expenses 6b c Net rental income or (loss) (subtract tine 6b from line 6a) 6c

d 7 Other investment income (describe " RESTRICTED CASH RESERVES 7 7 , 602 . ~'c~ 8 a Gross amount from sale of assets other A Securities B Other

than inventory 8a ~ b Less: cost or other basis and sales expenses 8b

c Gain or (loss) (attach schedule) 8c d Net gain or (loss) (combine columns (A) and (B)) Bd

9 Special events and a ~(5 attarl~ hedule) a Gross revenu of contributions

reporte ~e (~~ ~ 9a b : d enses ~h, r~h fun +51 expenses 9b c t inc e or I ss~ro~h specie is (s tract line 9b from line 9a) 9c

10 a Gr s spa s ntory, I _ et allowances 10a b Less . es~t f good 10b c Gross oft ~~ sales of inventory (attach schedule) (subtract line 10b from line 10a) 10c

11 Other rev ue f art VI I, line 103) 11 82 , 129 . 12 Total reve e add lines 1d 2 3 4 5 6c 7 8d 9c 10c and 11 12 4 , 380 517 . 13 Program services (from line 44, column (B)) 13 4 , 444 , 468 . 14 Management and general (from line 44, column (C)) 14 280 228 .

a 15 Fundraising (from line 44, column (D)) 15

w 16 Payments to affiliates (attach schedule) 16 17 Total expenses add lines 16 and 44 column A 17 4 , 724 , 696 . 18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 -344 179 . N 19 Net assets or fund balances at beginning of year (from line 73, column (A)) 19 828 740 .

Z N Q 20 Other changes in net assets or fund balances (attach explanation) SEE STATEMENT 1 20 - 3 954 .

21 Net assets or fund balances at end of year (combine lines 18, 19, and 20 21 480 607 . f 2 oos LHA For Paperwork Reduction Act Notice, see the separate instructions . Form 990 (2002)

1 14281006 744504 096138-105 2002 .09000 CATHEDRAL PIONEER CHURCH HO 096138S1

B Check .r Please C Name of organization applicable use IRS ATHEDRAL PIONEER CHURCH HOMES II

Address label w [:]change pnntor BA PIONEER HOUSE C / O RHF =

Name type change Number and street (or P.O . box if mail is not delivered to street address

"" See

return sp--f-c911 N . STUDEBAKER ROAD Final InsWc-

Oreturn

eturn lions City or to Wfl, state or country, and ZIP + 4 OAmended ONG BEACH CA 90815 r

Application * Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts pending must attach a completed Schedule A (Form 990 or 990-EZ) .

D Employer identification number

-7%-ivL2u Room/suite E Telephone number

" CATHEDRAL PIONEER CHURCH HOMES II DBA PIONEER HOUSE C/0 RHF 94-1629086

Pelt statement of All organizations must complete column (A). Columns (B), (C), and (D) are required for section 501(c)(3) Page 2 0II Functional Expenses and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others.

Do not include amounts reported on line (B) Program (C) Management 6b . 8b, 9b . 10b, or 16 of Part l. (A) Total carvicac and neneral (D) Fundraising

22 Grants and allocations (attach schedule) cash $ noncash $

23 Specific assistance to individuals (attach schedule) 24 Benefits paid to or for members (attach schedule) 25 Compensation of officers, directors, etc. 26 Other salaries and wages 27 Pension plan contributions 28 Other employee benefits 29 Payroll taxes 30 Professional fundraising fees 31 Accounting fees 32 Legal fees 33 Supplies 34 Telephone 35 Postage and shipping 36 Occupancy 37 Equipment rental and maintenance 38 Printing and publications 39 Travel 40 Conferences, conventions, and meetings 41 Interest 42 Depreciation, depletion, etc. (attach schedule) 43 Other expenses not covered above (itemize):

a b c d e SEE STATEMENT 2

29 .1 289,029 .

Grants and allocations e Other program services (attach schedule) (Grants and allocations $ ) f Total of Program Service Expenses (should equal line 44, column (B), Program services) " 4,444 , 468 . 223011 01-22-03 Form 990 (2002)


7 , 695 . 1 , 837 , 695 .

7,471 . 697,471 .

UM T b°'a""°"'°"a'np

eun xPo

colu"5

ns 85 ~a

44 rpanin uo com j~)iBcai~`y ihes°e igtzls towlines 13-15 144 I 4,724,696 .1 4,444,468 .1 280,228 .1 Joint Costs . Check 1 0 if you are following SOP 98-2. Are any point costs from a combined educational campaign and fundraising solicitation reported in (B) Program services? " E] Yes EE No If 'Yes,' enter (i) the aggregate amount of these point costs $ ; (ii) the amount allocated to Program services $ ;

Part III Statement of Program Service Accomplishments What is the organization's primary exempt purpose? LOW AND VERY LOW INCOME HOUSING AND SKILLED NURSING CARE . Pro gram Service All organizations must describe they exempt purpose achievements in a clear and concise manna State the number of clients served, publications issued, etc Discuss

XPenses (Required for 501(cX3) and

achievements that are not measurable Section 501(c 3 and organizations and 4847 a 1 nonexempt charitable trusts must also enter the amount of ants and X ) (4) ( X ) 9r (4) ores , and 4947(aXt) allocations to others ) trusts, but optional for others

a TO PROVIDE QUALITY LIVING & SKILLED NURSING FACILITIES FOR AND VERY

4 .444,468 . b

c

d

CATHEDRAL PIONEER CHURCH HOMES II Form 990 (2002) ~ DBA PIONEER HOUSE C/O RHF 94-1629086 Page 3

Part IY Balance Sheets

Note :, Where required, attached schedules and amounts within the descnption column (A) I I (B) should be for end-of-year amounts only. Beginning of year End of year


45 Cash - non-interest-bearing 5 -/ Z 6 .3 4 . 45 44U , 5 -/ b . 46 Savings and temporary cash investments 46

47 a Accounts receivable 47a 361 , 005 . b Less: allowance for doubtful accounts 47b 128 , 511 . 95 , 441 . 47c 232 , 494 .

48 a Pledges receivable 48a b Less: allowance for doubtful accounts 48b 48c

49 Grants receivable 49 50 Receivables from officers, directors, trustees,

and key employees 50 N d 51 a Other notes and loans receivable 51a N

b Less: allowance for doubtful accounts 51b 51c Q 52 Inventories for sale or use 52 53 Prepaid expenses and deferred charges 60 , 124 . 53 25 , 565 . 54 Investments - securities " ~ Cost 0 FMV 54 55 a Investments - land, buildings, and

equipment basis 55a

b Less: accumulated depreciation 55b 55c 56 investments - other SEE STATEMENT 3 297 , 661 . 56 156 , 204 . 57 a Land, buildings, and equipment basis 57a 3 , 802 , 816 .

b Hess: accumulated depreciation STMT 4 57b 2 , 692 , 933 . 739 , 843 . s7c 1 , 109 , 883 . 58 Other assets (describe t SEE STATEMENT 5 ) 306 292 . 2 . 5e 332 , 387 .

59 Total assets add lines 45 through 58 must e q ual line 74 2 072 , 195 . 59 2 , 297 , 109 . 60 Accounts payable and accrued expenses 643 , 779 . 60 552 , 765 . 61 Grants payable 61 62 Deferred revenue 62

N 63 Loans from officers, directors, trustees, and key employees 63 i7

a 64 a Tax-exempt bond liabilities 64a 20 b Mortgages and other notes payable 503 , 631 . 64b 712 , 616 .

65 Other liabilities (describe " SEE STATEMENT 6 ) 96 , 045 . 65 551 , 121 .

66 Total liabilities add lines 60 through 65 1 243 , 455 . 66 1 816 , 502 . Organizations that follow SFAS 117, check here " ~ and complete lines 67 through

69 and lines 73 and 74 . 67 unrestricted 828 , 740 . 67 480 , 607 . 68 Temporarily restricted 68

m 69 Permanently restricted 69 Organizations that do not follow SFAS 117, check here " D and complete lines

70 through 74. y 70 Capital stock, trust principal, or current funds 70 r y 71 Paid-in or capital surplus, or land, building, and equipment fund 71 N a 72 Retained earnings, endowment, accumulated income, or other funds 72 Z 73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72 ;

column (A) must equal line 19; column (B) must equal line 21) 8 2 8 , 7 4 0 . 73 480 , 607 . 74 Total liabilities and net assets / fund balances (add lines 66 and 73) . . . . . . . . . . . . . . . . . . . . . . 2,072,195 .1 74 ~ 2,297,109 .

Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization . How the public perceives an organization in such cases may be determined by the information presented on its return . Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments .

223021 01-22-03

CATHEDRAL PIONEER CHURCH HOMES II 4 %nr ~-* -iv16 .7 vvv

art IV-B Reconciliation of Expenses per Audited Financial Statements with Expenses per Return

a Total expenses and losses per E audited financial statements " a 4 , 724 ,

b Amounts included on line a but not on line 17, Form 990:

(1) Donated services and use of facilities $

(2) Prior year adjustments reported on line 20, Form 990 $

(3) Losses reported on line 20, Form 990 $

(4) Other (specify) :

Add amounts on lines (1) through (4) " b c Line a minus line b " c d Amounts included on line 17, Form

990 but not on line a :

(1) Investment expenses not included on line 6b, Form 990 $

(2) Other (specify) :

Add amounts on lines (1) and (2) " d e Total expenses per line 17, Form 990

(line c plus line d) 10, e Employees (List each one even if not compensated .)

(B) Title and average hours (C) Compensation (D~Contrit per week devoted to (If not paid, enter P,~lS & d

0

(E) Expense account and

other allowances (A) Name and address

75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations If 'Yes,' attach schedule. ~ ~ Yes Ek] No Form 990 (2002)

223031 01-22-03


Form 990 (2002) tart iX'A I Heconcuiation of Revenue per Auaitea

Financial Statements with Revenue per Return

a Total revenue, gains, and other support per audited financial statements ~ a 4 3 76 , 5

b Amounts included on line a but not on line 12, Form 990:

(1) Net unrealized gains on investments $

(2) Donated services and use of facilities $

(3) Recoveries of prior year grants $

(4) Other (specify): STMT 7 $ -3,954 .

Add amounts on lines (1) through (4) " b - 3 , 9 c dine a minus line b " c 4 , 380 , 5 d Amounts included on line 12, Form

990 but not on line a :

(1) Investment expenses not included on line 6b, Form 990 $

(2) Other (specify):

Add amounts on lines (1) and (2) " d e Total revenue per line 12, Form 990

(line c plus line d) e 4 . 3 Part V List of Officers, Directors, Trustees,

---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041- Check here " D and enter the amount of tax-exempt interest received or accrued during the tax year " 1 92 ~ N/A

zzaoai 0,-22-03 Form 990 (2002)


CATHEDRAL PIONEER CHURCH HOMES II Form 990 (2002) ~ DBA PIONEER HOUSE C/O RHF 94-1629086 Page s Part YI Other Information Yes No

76 Did the organization engage in any activity not previously reported to the IRS If "Yes,' attach a detailed description of each activity 76 X 77 Were any changes made in the organizing or governing documents but not reported to the IRS? 77 X

If 'Yes,' attach a conformed copy of the changes. 78 a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? 78a X

b If 'Yes,' has it filed a tax return on Form 990-T for this year? N/A 78b 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? 79 X

If 'Yes,' attach a statement 80 a Is the organization related (other than by association with a statewide or nationwide organization) through common membership,

governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization? 80a X b If 'Yes,' enter the name of the organization " SEE STATEMENT . 9

and check whether it is 0 exempt or F-1 nonexempt 81 a Enter direct or indirect political expenditures. See line 81 instructions 81a 0 .

b Did the organization file Form 1120-POL for this year? 81b X 82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than

fair rental value? 82a X b If 'Yes," you may indicate the value of these items here . Do not include this amount as revenue in Part I or as an

expense m Part II. (See instructions in Part III .) 82b N/A 83 a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a X

b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? 83b X 84 a Did the organization solicit any contributions or gifts that were not tax deductible? 84a X

b If 'Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductibles N/A 84b

85 501(c)(4), (5), or (6) organizations. a Were substantially all dues nondeductible by members N/A 85a b Did the organization make only in-house lobbying expenditures of $2,000 or less? N/A 85b

If "Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year.

c Dues, assessments, and similar amounts from members 85c N /A d Section 162(e) lobbying and political expenditures 85d N /A e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e N/A f Taxable amount of lobbying and political expenditures (line 85d less 85e) 85f N/A g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f? N/A 85 h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of dues

allocable to nondeductible lobbying and political expenditures for the following tax year? N/A 85h 86 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on line 12 86a N/A

D Gross receipts, included on line 12, for public use of club facilities 86b N/A 87 501(c)(12) organizations. Enter : a Gross income from members or shareholders 87a N/A

b Gross income from other sources . (Do not net amounts due or paid to other sources against amounts due or received from them.) 87b N/A

BB At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301 .7701-2 and 301 .7701-3? If *Yes,* complete Part IX SB X

89 a 501(c)(3) organizations. Enter : Amount of tax imposed on the organization during the year under. section 49111 0 . ; section 49121 0 . ; section 4955 . 0 .

b 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year? If 'Yes,' attach a statement explaining each transaction 89b X

c Enter. Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 . 0 .

d Enter : Amount of tax on line 89c, above, reimbursed by the organization 1 0 . 90 a List the states with which a copy of this return is filed " CALIFORNIA

b Number of employees employed m the pay period that includes March 12, 2002 ~ 90b ~ 8 9 91 The books are in care of 10- FOUNDATION PROPERTY MANAGEMENT, INC Telephone no . " (562)257-5100

Located at " 911 N . STUDEBAKER ROAD, LONG BEACH, CALIFORNIA ZIP + 4 . 90815

CATHEDRAL PIONEER CHURCH HOMES II Form 990 (2002) - DBA PIONEER HOUSE C/ O RHF 94-1629086 Page s Part YII Analysis of Income-Producing Activities (See page 31 of the instructions .) Note : Enter gross amounts unless otherwise Unrelated business income excluded by section 512, sis, « spa

indicated. (A) (B) E~~~_ (D) Related or exempt B codess Amount ~aa Amount function income 93 Program service revenue :

a ANCILLARY SERVICE REV . 711 373 . b LOW INCOME RENTS 817 803 . c NURSING REVENUE 1 , 851 , 820 . d BAD DEBT SETTLEMENT 8 , 000 . e ( Medicare/Medicaid payments 885 , 082 . p Fees and contracts from government agencies

94 Membership dues and assessments 95 Interest on savings and temporary cash investments 14 16 , 488 . 96 Dividends and interest from securities 97 Net rental income or (loss) from real estate : a debt-financed property b not debt-financed property

98 Net rental income or (loss) from personal property 99 Other investment income 14 7 , 602 .

100 Gam or (loss) from sales of assets other than inventory

101 Net income or (loss) from special events 102 Gross profit or (loss) from sales of inventory 103 Other revenue:

a SEE STATEMENT 10 82 , 129 . b c d e

ioa Subtotal (add columns (B), (D), and (E)) 0 . 1 106,219 . E 4,274,078 . 105 Total (add line 104, columns (B), (D), and (E)) " 4 ,3 80,297 . Note : Line 105 plus line 1d, Part l, should equal the amount on line 12, Part I Part VIII Relationship of Activities to the Accomplishment of Exempt Purposes (See page 32 of the instructions .) Line No . Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's

exempt purposes (other than by providing funds for such purposes) .

Part IX (See page 32 of the instructions .)

Name, address, arid~EIN of corporation, I Percentage of I Nature of activities I T

Paid signature ,I "J Preparer's F�m~sname (� gD0 SEIDMAN, LLP Use Only ~~'~�;PloYe4 ' 3200 BRISTOL ST ., 4TH F 223161 address, and 01-22-03 ZIP + < COSTA MESA CA 92626

14281006 744504 096138-105 2002 .09000

%Part X Information Regarding Transfers Associated H (a) Did the organization, during the year, receive any funds, directly or indirectly, ti: (b) Did the organization, during the year, pay premiums, directly or indirectly, on a Note : If °Yes" to b file Form 8870 and Form 4720 see instructions).

Under penalties of penury, I declare that I have examined this return, including accomF Please correct, and complete Declar 'on of preparer (other than officer) is based on a~ll infof

Sign ' ~( .e~~ E 1 ftJ// Here /Sign r ofofficer

SCHEDULE,A Organization Exempt Under Section 501(c)(3) (Form 380 or 990-EZ) (Except Private Foundation) and Section 501(e), 501((), 501(k),

501(n), or Section 4947(a)(1) Nonexempt Charitable Trust

Department of the Treasury Supplementary Information-(See separate instructions.)

Internal Revenue Service jo~ MUST be completed by the above organizations and attached to their Form 990 or 990-Ei Name of the organization CATHEDRAL PIONEER CHURCH HOMES I I

LOOL

Employer identification number

ALLEGIANCE STAFFING

ERVI

1 -1 . CITRIS HEIGHTS . CA 95610 MEDICAL SERVI

Total number of others receiving over $50,000 for professional services " I 0 2231o1ro1-zz-oa LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ . Schedule A (Form 990 or 990-EZ) 2002


OMB No 1545-0047

Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the instructions. List each one. If there are none, enter 'None!) a Name and address of each employee aid (b) Title and average hours (d) Contributions to (e) Expensf

per week devoted to c Com ensation employee benefit account and o1 more than $50,000 p ( ~ p a~~s 8 deferred DOSItI0f1 compensation allowances

VIRGINIA HIGHTS .V .N .

6652 75TH ST ., SACRAMENTO, CA 95828 40

LETICIA HIBBERT ERT NUR AS

5201 LAGUNA OAKS #107 . ELK GROVE . CA 40

JEANETTE MATTOS____________________PIET DIREC

50 .198 .

LINDA SOiJICI________________________WRSING DIR .

Total number of other employees paid over $50,000 . 0 Part II Compensation of the Five Highest Paid Independent Contractors for Professional Services

(See page 2 of the instructions. List each one (whether individuals or firms) . If there are none, enter 'None.')

(a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation

BURGER THERAPY SERVICES -------------------------------------------- HYSICAL THERAPY

1301 E . BIDWELL ST . #201, FOLSOM, CA 95630 SERVICES 66,254 .

HI-TECH MEDICAL SERVICES

259 .837

Line (a) Name(s) of supported organization(s) (b) from abover

14 n An organization organized and operated to test for public safety. Section 509(a)(4). (See page 5 of the Schedule A (Form 990 or 990-EZ) 2002

O

14281006 744504 096138-105 2002 .09000 CATHEDRAL PIONEER CHURCH HO 096138S1

CATHEDRAL PIONEER CHURCH HOMES II Schedule A (Form 990 or 990-EZ) 2002 DBA PIONEER HOUSE C / O RHF 94-1629086 Page 2

Part Ill Statements About Activities (See page 2 of the instructions .) Yes No

1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendum? If 'Yes," enter the total expenses paid or incurred in connection with the lobbying activities " $ $ (Must equal amounts on line 38, Part VI-A, or line i of Part VI-B.) 1 X Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A . Other organizations checking

'Yes; must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities . 2 During the year, has the organization, either directly or indirectly, engaged m any of the following acts with any substantial contributors,

trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, masonry owner, or principal beneficiary (If the answer to any question is "Yes," attach a detailed statement explaining the transactions .)

a Sale, exchange, or leasing of property? 2a X

b Lending of money or other extension of credit? I 2b I I X

c Furnishing of goods, services, or facilities?

d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)

e Transfer of any part of its income or assets? 2e X

3 Does the organization make grants for scholarships, fellowships, student loans, etc.? (See Note below .) 3 X 4 Do you have a section 403(b) annuity plan for your employees 4 X Note : Attach a statement to explain how the organization determines that individuals or organizations receiving grants or loans from it in furtherance o/ its charitable programs "qualify' to receive payments .

I part IV I Reason for Non-Private Foundation Status (See pages 3 through 5 of the instructions .)

The organization is not a private foundation because it is: (Please check only ONE applicable box) 5 D A church, convention of churches, or association of churches . Section 170(b)(1)(A)(i). 6 0 A school . Section 170(b)(1)(A)(u). (Also complete Part V.) 7 0 A hospital or a cooperative hospital service organization . Section 170(b)(1)(A)(ui). 8 ~ A Federal, state, or local government or governmental unit Section 170(b)(1)(A)(v) .

9 0 A medical research organization operated m conjunction with a hospital . Section 170(b)(1)(A)(ui) . Enter the hospital's name, city,

and state 10 0 An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(iv) .

(Also complete the Support Schedule in Part IV-A) 11a D An organization that normally receives a substantial part of its support from a governmental unit or from the general public .

Section 170(b)(1)(A)(vi) . (Also complete the Support Schedule in Part IV-A) 11b 0 A community trust Section 170(b)(1)(A)(w). (Also complete the Support Schedule in Part IV-A) 12 ~ An organization that normally receives: (1) more than 33 1/396 of its support from contributions, membership fees, and gross

receipts from activities related to its charitable, etc., functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2) . (Also complete the Support Schedule in Part IV-A)

13 0 An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in : (1) Dries 5 through 12 above ; or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2). (See section 509(a)(3).)

Provide the following information about the supported organizations . (See page 5 of the instructions.)

223111 01-22-03

17 Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization's charitable, etc ., purpose 3 , 902 , 230 . 4,117,602 .

18 Gross income from interest, dividends, amounts received from payments on securities loans (section 512(a)(5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organization after June 30, 1975 3 8 9 0 5 . 62 , 031 .

19 Net income from unrelated business activities not included in line 18

yp Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf

41,859 .1 3,927,085 .

40,016 .1 28,20

21 The value of services or facilities furnished to the organization by a governmental unit without charge . Do not include the value of services or facilities generally furnished to the public without charge

22 Other income. Attach a schedule. Do not include gain or (loss) from sale of capital assets

23 Total oflines l5through 22 3 , 941 , 268 . 4 , 179 , 696 . 4 , 082 , 044 . 3 , 955 , 288 . 16 158 296 . 24 Line 23minus line l7 39 , 038 . 62 , 094 . 40 , 185 . 28 , 203 . 169 520 . 25 Enter 1% ofline 23 39 413 . 41 , 797 . 40 , 820 . 39 , 553 . 26 Organizations described on lines 10 or 11 : a Enter 2% of amount in column (e), line 24 . 26a N /A b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental

unit or publicly supported organization) whose total gifts for 1998 through 2001 exceeded the amount shown in line 26a. Do not file this list with your return . Enter the sum of all these excess amounts " 26b N /A

c Total support for section 509(a)(1) test Enter line 24, column (e) " 26c N /A d Add : Amounts from column (e) for lines: 18 19

22 26b 00- 26d N/A e Public support (line 26c minus line 26d total) " 26e N/A i Public support percentage (line 26e (numerator) divided by line 26c (denominator)) " 26f N/A %

27 Organizations described on line 12 : a For amounts included m lines 15, 16, and 17 that were received from a 'disqualified person ; prepare a list for your records to show the name of, and total amounts received in each year from, each disqualified person .' Do not file this list with your return . Enter the sum of such amounts for each year. (2001) 0 . (2000) 0 . (1999) 0 . (1998) 0 .

b For any amount included m line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records to show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000. (Include m the list organizations described m lines 5 through 11, as well as individuals.) Do not file this list with your return . After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year: (2001) 0 . (2000) 0 . (1999) 0 . (1998) 0 .

c Add: Amounts from column (e) for lines : 15 365 . 16 17 15,988,776 . 20 21 00- 27c 15 989 141 .

d Add: Line 27a total 0 . and line 27b total 0 . " 27d 0 . e Public support (line 27c total minus line 27d total) " 27e 15 , 989 , 141 . f Total support for section 509(a)(2) test Enter amount on line 23, column (e) " 27t 16 , 158 296 . g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) 1 27 98 .9531% h Investment income percentage line 18 column e numerator divided b line 27f denominator 1 27h 1 . 0469%

28 Unusual Grants : For an organization described m line 10, 11, or 12 that received any unusual grants during 1998 through 2001, prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant Do not file this list with your return . Do not include these grants in line 15.

223121 01-22-03 NONE schedule a (Form eso or 990-En 2002 9


CATHEDRAL PIONEER CHURCH HOMES II Schedule A (Form 990 or 990-EZ) 2002 DBA PIONEER HOUSE C/O RHF 94-1629086 Page 3

Part LV-A Support Schedule (Complete only if you checked a box on line 10, 11, or 12 ) Use cash method of accounting . Note: You ma use the worksheet in the instructions for convertin g from the accrual to the cash method of accounting.

Calendar year (or fiscal year be innin in " a) 2001 b 2000 c 1999 d 1998 e Total

15 Gifts, grants, and contributions received . (Do not include unusual orants_ See line 28 .) 133 . 1 6 3 . I 16 9 . 1 0 . I 365 .

34 a Does the organization receive any financial aid or assistance from a governmental agency? b Has the organization's right to such aid ever been revoked or suspended

If you answered 'Yes'to either 34a or b, please explain using an attached statement 35 Does the organization certify that it has complied with the applicable requirements of sections 4 .01 through 4 .05 of Rev. Proc. 75-50,

1975-2 C.B. 587, covenna racial nondiscrimination? If 'No .' attach an explanation Schedule A (Form 990 or 990-EZ) 2002

10

14281006 744504 096138-105 2002 .09000 CATHEDRAL PIONEER CHURCH HO 09613851

CATHEDRAL PIONEER CHURCH HOMES II Schedule A (Form 990 or 990-EZ) 2002 DBA PIONEER HOUSE C / O RHF 94-1629086 Page 4 Part V Private School Questionnaire (See page 7 of the instructions.) N/A

(To be completed ONLY by schools that checked the box on line 6 in Part I~

Yesl No 29 Does the organization have a racially nondiscriminatory policy toward students by statement m its charter, bylaws, other governing

instrument, or in a resolution of its governing body? 29 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues,

and other written communications with the public dealing with student admissions, programs, and scholarships 30 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of

solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves? 31 If 'Yes," please describe ; if 'No,' please explain . (If you need more space, attach a separate statement)

32 Does the organization maintain the following : a Records indicating the racial composition of the student body, faculty, and administrative staff? b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student

admissions, programs, and scholarships d Copies of all material used by the organization or on its behalf to solicit contributions?

If you answered 'No' to any of the above, please explain . (If you need more space, attach a separate statement.)

33 Does the organization discriminate by race in any way with respect to:

a Students' rights or privileges? 33a

33b b Admissions policies?

c Employment of faculty or administrative staff? 33c

d Scholarships or other financial assistance 33d

e Educational policies? 33e

33f f Use of facilities?

p Athletic programs? 33

h Other extracurricular activities? 33h

If you answered 'Yes'to any of the above, please explain . (If you need more space, attach a separate statement.)

223131 01-22-03

CATHEDRAL PIONEER CHURCH HOMES II Schedule A (Form 990 or 990-EZ) 2002 DBA PIONEER HOUSE C/O RHF 94-1629086 Page s Part VI-A Lobbying Expenditures by Electing Public Charities (See page s of the instructions.) N/A

(To be completed ONLY by an eligible organization that fled Form 5768) " n I I it a" and 'limited control' p rovisions app ly .

(a) (b) Affiliated group To be completed for ALL

totals electing organizations

N/A 36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 38 Total lobbying expenditures (add lines 36 and 37) 39 Other exempt purpose expenditures 40 Total exempt purpose expenditures (add lines 38 and 39) 41 Lobbying nontaxable amount. Enter the amount from the following table -

If the amount on line 40 is - The lobbying nontaxable amount is -Not over $500,000 20% of the amount on line 40

Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000

Over $1,000,000 but not over $1,500,000 $175,000 plus 1096 of the excess over $1,000,000

Over $1,500,000 but not over $7,000,000 $225,000 plus 5% of the excess over $1,500,000

Over $17,000,000 $1,000,000

42 Grassroots nontaxable amount (enter 25% of line 41) 43 Subtract line 42 from line 36 . Enter -0- if line 42 is more than line 36 44 Subtract line 41 from line 38 . Enter -0- if line 41 is more than line 38

37

Caution : If there is an amount on ether line 43 or line 44, you must file Form 4720.

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns

below. See the instructions for lines 45 through 50 on page 11 of the instructions .)

Lobbying Expenditures During 4-Year Averaging Period N/A

(e) 2001 2000 1999 Total

0

50 Grassroots lobbying

Part VI-B Lobbying Activity by Nonelecting Public Charities (For reporting only by organizations that did not complete Part VI-A) (See page 11 of the instructions.) N /A

During the year, did the organization attempt to influence national, state or local legislation, including any attempt to Yes No Amount influence public opinion on a legislative matter or referendum, through the use of

a Volunteers b Paid staff or management (Include compensation in expenses reported on lines c through h .) c Media advertisements d Mailings to members, legislators, or the public e Publications, or published or broadcast statements f Grants to other organizations for lobbying purposes p Direct contact with legislators, their staffs, government officials, or a legislative body h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means i Total lobbying expenditures (Add linesc through h .) ~T 0 .

If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities .

oi3zz os Schedule A (Form 990 or 990-EZ) 2002 11


Limits on Lobbying Expenditures

(The term 'expenditures' means amounts paid or incurred.)

Calendar year (or (a) fiscal year beginning in) 1111111. 2002

45 Lobbying nontaxable amount

46 Lobbying ceding amount 150% of line 45 (e ))

47 Total lobbying

48 Grassroots nontaxable amount

49 Grassroots ceding amount

51a(i) X (i) Cash

(ii) Other assets a(ii) X

6 Other transactions:

(i) Sales or exchanges of assets with a nonchantable exempt organization b(i) X

(ii) Purchases of assets from a noncharitable exempt organization b(fl) X

(iii) Rental of facilities, equipment, or other assets b(iii)

(iv) Reimbursement arrangements b(iv) X

(v) Loans or loan guarantees b(v) X

(vi) Performance of services or membership or fundraising solicitations b(vi) X

c Sharing of facilities, equipment, marling lists, other assets, or paid employees C X

d If the answer to any of the above is 'Yes,* complete the following schedule. Column (b) should always show the fair market value of the

goods, other assets, or services given by the reporting organization . If the organization received less than fair market value in any

52 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? 1 0 Yes Eil No


CATHEDRAL PIONEER CHURCH HOMES II Schedule A (Form"990 or 990-EZ) 2002 DBA PIONEER HOUSE C /O RHF 94-1629086 Page 6 Part VII Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations (See page 12 of the instructions .) 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section

501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a nonchantable exempt organization of Yes No

ziezei # - Current year section 179 (D) - Asset disposed OS-01-02 13


216281 # ~ Current year section 179 (D) - Asset disposed os-o1-oz

14281006 744504 096138-105 2002 .09000 CATHEDRAL PIONEER CHURCH HO 096138S1 14

216281 # - Current year section 179 (D) - Asset disposed os-o1-oz 15


210281 # - Current year section 179 (D) - Asset disposed os-o1-oz 16


216261 # - Current year section 179 (D) - Asset disposed 05-0 1-02 17


21eze1 # - Current year section 179 (D) - Asset disposed 05-0 1-02 18


216281 # - Current year section 179 (D) - Asset disposed os-oi-o2 19


ziszsi # - Current year section 179 (D) - Asset disposed os-oi-oz 20


CATHEDRAL PIONEER CHURCH HOMES II DBA PI 94-1629086

FORM 990 OTHER CHANGES IN NET ASSETS OR FUND BALANCES STATEMENT 1

AMOUNT

-3,954 .

-3,954 .

DESCRIPTION

UNREALIZED LOSS ON INVESTMENT

TOTAL TO FORM 990, PART I, LINE 20

FORM 990 OTHER EXPENSES STATEMENT 2

(D)

FUNDRAISING

12,400 . 206,508 .

4,571 .

12,442 . 995,807 . 18,537 .

123,083 . 7,403 .

89,760 .

38,746 .

1,509,257 .

12,442 .

TOTAL TO FM 990, LN 43 1,290,307 . 218,950 .

FORM 990 OTHER INVESTMENTS STATEMENT 3

VALUATION DESCRIPTION METHOD AMOUNT

RESTRICTED CASH COST 156,204 .

TOTAL TO FORM 990, PART IV, LINE 56, COLUMN B 156,204 .

21 STATEMENT S) 1, 2, 3 14281006 744504 096138-105 2002 .09000 CATHEDRAL PIONEER CHURCH HO 096138S1

DESCRIPTION

DUES & SUBSCRIPTIONS MANAGEMENT FEES MARKETING FEES MISCELLANEOUS ADMINISTRATIVE FEES NURSING EXPENSES PURCHASED SERVICES TAXES & LICENSES LOAN FEES BAD DEBT EXPENSE MISCELLANEOUS EXPENSE

(A)

TOTAL

(B) PROGRAM SERVICES

12,400 .

4,571 .

995,807 . 18,537 .

123,083 . 7,403 .

89,760 .

38,746 .

(C) MANAGEMENT AND GENERAL

206,508 .

94-1629086 CATHEDRAL PIONEER CHURCH HOMES II DBA PI

FORM 990 DEPRECIATION OF ASSETS NOT HELD FOR INVESTMENT STATEMENT 4

22 STATEMENT S) 4 2002 .09000 CATHEDRAL PIONEER CHURCH HO 096138S1 14281006 744504 096138-105

DESCRIPTION

LAND BUILDING ELEVATOR IMPROVEMENT KITCHEN HAND RAIL FIRE ALARM FLOW SWITCH NEW OFFICE RECREATION ROOM IMPROVEMENTS REAR DOOR PAINTING AIR CONDITIONING PLUMBING ALTERATIONS COOLING SYSTEM REFURBISH ELEVATOR REMODEL PAVING CARPET DRAPES ELEVATOR IMPROVEMENTS ALTERATIONS 4TH FLOOR ALTERATIONS 4TH FLOOR ALTERATIONS DRAPES CARPET/DRAPES FURNISHINGS REMODEL S .N .F . PATIO ROOFING BACKFLOW PREVENTOR PATIO IMPROVEMENT ALT & IMPROVEMENTS REPLACE TILES ALTERATIONS ARCHIT SVCS/REMODEL 5&6T FINEGOLDS 5TH/6TH FLOOR CAMPBELL CONSTR . 5/6TH FLOOR REMODEL FLOOR TILES CARPET FIXTURES BIG VALLEY SUPPLY CHAIRS-REC ROOM RANGE FAN TABLE - REC RM

COST OR ACCUMULATED OTHER BASIS DEPRECIATION BOOK VALUE

93,431 . 0 . 93,431 . 1,481,281 . 1,382,130 . 99,151 .

3,087 . 3,087 . 0 . 93,205 . 83,885 . 9,320 .

223 . 184 . 39 . 850 . 734 . 116 . 680 . 588 . 92 .

1,654 . 1,436 . 218 . 48,435 . 37,367 . 11,068 . 4,307 . 4,307 . 0 . 4,067 . 4,067 . 0 . 8,031 . 8,031 . 0 .

17,480 . 17,480 . 0 . 2,770 . 2,770 . 0 .

23,251 . 23,251 . 0 . 39,886 . 39,886 . 0 . 7,175 . 7,175 . 0 .

22,172 . 22,172 . 0 . 5,869 . 5,869 . 0 . 3,103 . 3,103 . 0 . 7,770 . 7,770 . 0 . 8,145 . 8,145 . 0 . 5,598 . 5,598 . 0 . 1,527 . 1,527 . 0 .

19,440 . 19,440 . 0 . 19,001 . 19,001 . 0 . 5,620 . 5,620 . 0 .

15,701 . 15,701 . 0 . 66,701 . 66,701 . 0 . 6,329 . 6,329 . 0 .

133,122 . 133,122 . 0 . 7,989 . 7,989 . 0 . 3,765 . 3,765 . 0 .

12,335 . 11,826 . 509 . 17,146 . 9,144 . 8,002 . 6,567 . 3,504 . 3,063 .

172,500 . 92,000 . 80,500 . 165,285 . 57,848 . 107,437 .

1,700 . 1,700 . 0 . 28,161 . 28,161 . 0 . 4,457 . 4,457 . 0 . 2,118 . 2,118 . 0 .

11,242 . 11,242 . 0 . 785 . 785 . 0 .

3,059 . 3,059 . 0 . 2,500 . 2,500 . 0 .

2 3 STATEMENT S) 4 14281006 744504 096138-105 2002 .09000 CATHEDRAL PIONEER CHURCH HO 096138S1


OFF FURN 995 . 995 . 0 . NEW ALARM 2,214 . 2,214 . 0 . REFRIGERATOR 980 . 980 . 0 . OFFICE FURNITURE 1,207 . 1,207 . 0 . 28 TABLE TOPS 2,480 . 2,480 . 0 . RANGE 343 . 343 . 0 . FIRE CHIMES 726 . 726 . 0 . 2 REFRIGERATORS 780 . 780 . 0 . 2 RANGES 1,185 . 1,185 . 0 . 3 REFRIGERATORS 1,147 . 1,147 . 0 . 4 RANGES 2,138 . 2,138 . 0 . 16 REFRIGERATORS 6,592 . 6,592 . 0 . 11 RANGES 3,103 . 3,103 . 0 . TELEPHONE EQUIPMENT 3,572 . 3,572 . 0 . OFFICE FURNITURE 229 . 229 . 0 . REFRIGERATORS & RANGES 14,912 . 14,912 . 0 . CABINETS 7,326 . 7,326 . 0 . REFRIGERATORS/RANGES 5,461 . 5,461 . 0 . RANGES 925 . 925 . 0 . DISPOSALS 344 . 344 . 0 . FAX MACHINE 1,076 . 1,076 . 0 . RANGES 1,430 . 1,430 . 0 . KITCHEN RANGE 657 . 657 . 0 . REPLACE CALL SYSTEM 15,000 . 15,000 . 0 . REPLACE CALL SYSTEM 32,204 . 31,395 . 809 . RANGE 399 . 383 . 16 . REPLACE CALL SYSTEM 1,770 . 1,593 . 177 . 2 ELECTRIC RANGES 644 . 576 . 68 . TELEPHONE SYSTEM 9,635 . 7,230 . 2,405 . COMPUTER AND RELATED 13,025 . 13,025 . 0 . COMPUTER EQUIPMENT 668 . 668 . 0 . COMPUTER AND RELATED 6,444 . 6,444 . 0 . REFRIGERATORS AND RANGES 2,322 . 1,740 . 582 . REFRIGERATORS AND RANGES 2,322 . 1,739 . 583 . COMPUTER AND RELATED 6,444 . 4,830 . 1,614 . COMPUTER EQUIPMENT 315 . 240 . 75 . FURNISHINGS 4,190 . 3,143 . 1,047 . COMPUTER EQUIPMENT 142 . 142 . 0 . AIR CONDITIONING 5,025 . 5,025 . 0 . AIR CONDITIONING 1,620 . 1,620 . 0 . FURNITURE 3,581 . 3,581 . 0 . FURNITURE 771 . 771 . 0 . KITCHEN EQUIPMENT 910 . 910 . 0 . WALK IN COOLER 16,032 . 16,032 . 0 . FOOD STEAMER 1,760 . 1,760 . 0 . KITCHEN EQUIPMENT 3,509 . 3,509 . 0 . FOOD SLICER 769 . 769 . 0 . KITCHEN EQUIPMENT 1,085 . 1,085 . 0 . KITCHEN STEAMER 1,834 . 1,831 . 3 . MED EQUIP 2,585 . 2,585 . 0 . FILING CABINETS 2,066 . 2,066 . 0 . HOSPITAL BEDS 6,758 . 6,758 . 0 . 50 BEDS AND MATTRESSES 57,904 . 57,899 . 5 .

CATHEDRAL PIONEER CHURCH HOMES II DBA PI

6,750 . 269 .

7,500 . 386 .

750 . 117 .

24 STATEMENT S) 4 2002 .09000 CATHEDRAL PIONEER CHURCH HO 096138S1 14281006 744504 096138-105

2 SUPPLY STATIONS MEDICAL EQUIPMENT TELEPHONE SYSTEM COMPRESSOR FIRE PROTECTION TELEPHONE EQUIPMENT PHONE SYSTEM DINING ROOM EXPANSION BATH UNIT IMPROVEMENT PRINTER ELEVATOR IMPROVEMENT ELEVATOR IMPROVEMENT DESK COMPUTERS PRINTER COMPUTERS MONITOR MODEM SOFTWARE SOFTWARE UPGRADE SOFTWARE UPGRADE SOFTWARE UPGRADE ICE MACHINE FINAL PAYMENT ON BUILDING RENOVATIONS BUILT IN CABINETS ELEVATOR IMPROVEMENTS BUILT IN CABINETS REMODEL FIRST FLOOR DINING ROOM BUS COMPUTER & EQUIPMENT FILE CABINETS COMPUTER DEAD DRIVE SIDEWALK REPAIRS BUILDING FOUNDATION INSPECTION ADDITIONAL ROOM INSPECTION ADDITIONAL ROOM INSPECTION SOFTWARE UPGRADE SOFTWARE UPGRADE ADDITIONAL ROOM INSPECTION ADDITIONAL ROOM INSPECTION AIR CONDITIONING TWO PRINTERS ALARM SYSTEM AC FURNITURE COMMAIR MECHANICAL DIRECT SUPPLY, INC . ELEVATOR SERVICE COMPANY MARKETING/CENSUS SOFTWARE ARCHIETECHTUAL SERVICES - 4TH FL REMODEL UPGRADE ON FABRICS

970 . 5,733 .

988 . 14,186 .

725 . 3,190 . 1,335 . 2,061 .

10,980 . 717 .

23,500 . 23,500 . 1,032 . 4,786 .

646 . 5,480 . 1,080 .

592 . 2,540 .

125 . 250 .

1,645 . 2,263 .

20,392 . 5,897 .

18,642 . 5,897 .

137,408 . 48,374 . 6,712 . 4,728 .

861 . 3,468 . 1,400 .

686 . 550 .

1,200 . 150 . 490 . 770 .

8,790 . 1,079 . 3,742 . 6,111 . 2,199 . 3,541 . 2,926 . 3,847 .

962 . 5,539 .

988 . 14,186 .

725 . 3,190 . 1,335 .

424 . 6,588 .

414 . 13,513 . 13,513 .

592 . 2,594 .

352 . 2,968 .

585 . 592 .

2,540 . 125 . 250 .

1,645 . 1,356 .

12,234 . 3,540 .

11,184 . 3,540 .

82,446 . 28,936 . 6,712 . 2,247 .

803 . 1,619 .

642 . 310 . 248 .

1,080 . 133 . 216 . 340 .

3,663 . 882 .

1,527 . 2,139 .

660 . 1,269 . 1,147 . 2,671 .

94-1629086

8 . 194 .

0 . 0 . 0 . 0 . 0 .

1,637 . 4,392 .

303 . 9,987 . 9,987 .

440 . 2,192 .

294 . 2,512 .

495 . 0 . 0 . 0 . 0 . 0 .

907 .

8,158 . 2,357 . 7,458 . 2,357 .

54,962 . 19,438 .

0 . 2,481 .

58 . 1,849 .

758 . 376 . 302 . 120 . 17 .

274 . 430 .

5,127 . 197 .

2,215 . 3,972 . 1,539 . 2,272 . 1,779 . 1,176 .


2 5 STATEMENT S) 4, 5 14281006 744504 096138-105 2002 .09000 CATHEDRAL PIONEER CHURCH HO 09613851

REPLACE . NETWORK 5,221 . 2,958 . 2,263 . CARPET 7,301 . 1,460 . 5,841 . CONIIMAIR SWAMP COOLER 4,227 . 634 . 3,593 . REMODELING WORK 4,512 . 451 . 4,061 . XCS DIGITAL COPIER 16,157 . 4,577 . 11,580 . COMPUTER FOR MARKETING DEPT . 1,639 . 601 . 1,038 . FAX MACHINE 563 . 65 . 498 . 4TH FLOOR MODEL 25,900 . 486 . 25,414 . 4TH FLOOR MODEL 9,583 . 160 . 9,423 . 5TH FLOOR BATHING UNIT 1,819 . 27 . 1,792 . BUILDING EXTERIOR 18,000 . 225 . 17,775 . CARPET CLEANER 5,306 . 531 . 4,775 . 4TH FLOOR RENOVATIONS 43,300 . 541 . 42,759 . COUNTERTOP #320 766 . 32 . 734 . 4TH FLOOR RENOVATIONS 95,911 . 999 . 94,912 . 4TH FLOOR RENOVATIONS 194,202 . 1,618 . 192,584 . 4TH FLOOR RENOVATIONS 68,285 . 427 . 67,858 . CARPET - APTS 309 628 . 10 . 618 . 4TH FLOOR RENOVATIONS 5,995 . 12 . 5,983 . CARPET - APTS 218 & 222 1,634 . 14 . 1,620 . CARPET - APTS 306 & 311 1,449 . 12 . 1,437 . CARPET - APTS 523 1,041 . 9 . 1,032 . CARPET - APTS 524 & 530 956 . 8 . 948 . CARPET - APTS 503 984 . 8 . 976 . CARPET - APTS 519 & 521 956 . 8 . 948 . CARPET - APTS 505 & 513 957 . 8 . 949 . FIRE/WATER SYSTEM REPAIR 1,682 . 14 . 1,668 . REPAIR BOILER LEAK 3,365 . 56 . 3,309 . CUB TUB (3) 1,200 . 10 . 1,190 . COUNTERTOP (2) 1,382 . 12 . 1,370 . BUILDING EXTERIOR 15,550 . 130 . 15,420 . 13 TUBS CUT 5,200 . 54 . 5,146 .

TOTAL TO FORM 990, PART IV, LN 57 3,802,816 . 2,692,933 . 1,109,883 .

FORM 990 OTHER ASSETS STATEMENT 5

DESCRIPTION AMOUNT

SECURITY DEPOSITS 63,432 . NOTE RECEIVABLE-OTHER 232,689 . DEFERRED FINANCING COSTS 36,266 .

TOTAL TO FORM 990, PART IV, LINE 58, COLUMN B 332,387 .


FORM 990 OTHER LIABILITIES STATEMENT 6

AMOUNT

63,432 . 91,445 .

396,244 .

551,121 .

DESCRIPTION

SECURITY DEPOSITS MISCELLANEOUS CURRENT LIABILITIES DUE TO AFFILIATES

TOTAL TO FORM 990, PART IV, LINE 65, COLUMN B

FORM 990 OTHER REVENUE NOT INCLUDED ON FORM 990 STATEMENT 7

AMOUNT

-3,954 .

-3,954 .

UNREALIZED LOSS ON INVESTMENT

TOTAL TO FORM 990, PART IV-A

26 STATEMENT S) 6, 7, 8 14281006 744504 096138-105 2002 .09000 CATHEDRAL PIONEER CHURCH HO 09613851

DESCRIPTION

FORM 990 PART V - LIST OF OFFICERS, DIRECTORS, STATEMENT 8 TRUSTEES AND KEY EMPLOYEES

EMPLOYEE TITLE AND COMPEN- BEN PLAN EXPENSE

NAME AND ADDRESS AVRG HRS/WK SATION CONTRIB ACCOUNT

ALL C/0 RETIREMENT HOUSING FOUNDATION 911 N . STUDEBAKER ROAD 0 . 0 . 0 . LONG BEACH, CA 90815

DONALD KING PRESIDENT 0 .3 0 . 0 . 0 .

L . SNYDER, ESQ . VICE PRESIDENT 0 .5 0 . 0 . 0 .

PETER HALL TREASURER 0 .3 0 . 0 . 0 .

2 7 STATEMENT S) 8, 9 14281006 744504 096138-105 2002 .09000 CATHEDRAL PIONEER CHURCH HO 096138S1

r


BECKY NAMAN SECRETARY 0 .5 0 . 0 . 0 .

i

DONALD BROWN DIRECTOR 0 .3 0 . 0 . 0 .

II HARVEY LAIB DIRECTOR 0 .3 0 . 0 . 0 .

LAVERNE JOSEPH DIRECTOR 0 .3 0 . 0 . 0 .

I' KEVIN MANZ DIRECTOR 0 .3 0 . 0 . 0 .

JAMES TRUESDELL DIRECTOR 0 .3 0 . 0 . 0 .

RAY GRAETZ DIRECTOR 0 .3 0 . 0 . 0 .

STEWART SIMINGTON DIRECTOR 0 .3 0 . 0 . 0 .

STUART SMITS DIRECTOR 0 .3 0 . 0 . 0 .

TOTALS INCLUDED ON FORM 990, PART V 0 . 0 . 0 .

FORM 990 IDENTIFICATION OF RELATED ORGANIZATIONS STATEMENT 9 PART V2, LINE 80B

NAME OF ORGANIZATION EXEMPT NONEXEMPT

FOUNDATION PROPERTY MANAGEMENT, INC . X RETIREMENT HOUSING FOUNDATION X

CATHVR.AL PIONEER CHURCH HOMES II DBA PI 94-1629086

GARAGE/PARKING SPACE 03 2,224 . UTILITY SURCHARGE 03 17,161 . EMPLOYEE GUEST MEALS 03 3,132 . INSUR . PREMIUM REFUND 01 30,420 . DEFENSE COST REIMBURS . 01 11,298 . MISC . INCOME 01 2,251 . INSURANCE CLAIM 01 1,399 . ADMINISTRATOR COVERAGE 03 12,848 . BUS . MANAGER COVERAGE 03 1,396 .

82,129 . TO FORM 990, PART VII, LINE 103

93A THE ACTIVITY FOR WHICH PROGRAM SERVICE REVENUES WERE RECEIVED ENABLE 93B THE ORGANIZATION TO PROVIDE AFFORDABLE AND COMFORTABLE LIVING 93C FACILITIES & SKILLED NURSING FACILITIES FOR LOW AND VERY LOW INCOME 93D SENIOR CITIZENS . 93F

28 STATEMENT S) 10, 11 14281006 744504 096138-105 2002 .09000 CATHEDRAL PIONEER CHURCH HO 09613851

FORM 990 OTHER REVENUE STATEMENT 10

RELATED OR BUS UNRELATED EXCL EXCLUDED EXEMPT FUNC-

DESCRIPTION CODE BUSINESS INC CODE AMOUNT TION INCOME

FORM 990 PART VIII - RELATIONSHIP OF ACTIVITIES TO STATEMENT 11 ACCOMPLISHMENT OF EXEMPT PURPOSES

LINE EXPLANATION OF RELATIONSHIP OF ACTIVITIES

;i hat e QUL..._ Tale G C Notice to Applicant - To Be Completed by the IRS

(~ We have approved this application . Please attach this form to the organization's retain . - We have not approved this application . However, we have granted a 10~day grace period from the later r date of the organization's retain (including any prior extensions) . This grace period is considered tc% a , otherwise required to be made on a timely retain . Please attach this form to the organization's return .

0 We have not approved this application . After considering the reasons stated in item 7, we cannot'grant , file . We are not granting the 10-day grace period . We cannot consider this application because R was filed after the due date of the retain for which an e:

0 Other Ilk

Date. 10- 7 WO Y

MMVNArPRM

AUG 0 5 2004 .cw uintCTpR,

SUBMISSION PROCFCCtN(: oGOEN _

Date Director

Alternate Mailing Address - Enter the address If you want the copy of this application for an adddi4al 3-month extension returned to an address different than the one entered above .

- :: Name

- P- -

Type or print

Number and street Include suds, room, or apt. no .) Or a P.O box number 3200 BRISTOL ST ., 4TH FL . City or town, province or state, and country Including pclsfal or ZIP code)

Form 8868 (12-2000

Form 8868(12-2000) Page 2

0 If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II and check this box , .

Note: Only complete Part Il ii you have already been granted an automatic 3-month extension on a previously filed Form 8868 . 0 If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1) . Part'll Additional (not automatic) 3-Month Extension of Time - Must file Original and One Copy.

Name of Exempt Organization , Employee identification number Type or

CATHEDRAL PIONEER CHURCH HOMES II "- print

gA PIONEER HOUSE C/O RHF - 94-1629086 File by we extended Number, street, and room or suite no . If a P.O . box, see instructions . - For IRS use only sue seta for 911 N . S TUDEBAKER ROAD filing the _ _ retain see City, town or post office, state, and ZIP code . For a foreign address, see instructions . - - _ - - = - _= -Instructions LONG BEACH CA 90815 - - = - - - - ' - -Check type or reiurn to ba~`led (File a eeparatc- applicat:om for each retain) :

Form 990 0 Form 990-EZ ~ Forth 990~T (sec . 401(a) or 408(a) trust) [] Form 1041 ~A Q Form 5227 [] Form 8870 0 Form 990-BL ~ Form 990-PF 0 Forth 990-T (trust other than above) [] Form 4720 El Form 6069

STOP : Do not complete Part II if you were not already granted an automatic 3-month extension on a previously filed Form 8868.

" If the organization does not have an office or place of business in the United States, check this box . . . , . . 1 0 " If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) . If this is for the whole group, check this box 1 0 . If it is for part of the group, check this box 00- F-1 and attach a list with the names and EINs of all members the extension is for.

4 i request an additional 3-month extension of time until OCTOBER 15, 2 00 4. 5 For calendar year , or other tax year beginning DEC 1, 2002 and ending NOV 30, 2003 6 If this tax year is for less than 12 months, check reason : 0 Initial retain 0 Final retain 0 Change in accounting period 7 State in detail why you need the extension

INFORMATION NECESSARY TO PREPARE A COMPLETE AND ACCURATE TAX RETURN HAS NOT YET BEEN RECEIVED FROM THIRD PARTIES .

8a if this application is for Form 990-BL, 990-PF, 990~T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits . See instructions . . . , . . $

b If this application is for Form 990-PF, 990~T, 4720, or 6069, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit and any amount paid previously with Form 8868 ., _ . , . . . . . . . . $

c Balance Due. Subtract line Bb from line 8a . Include your payment with this form, or, d required, deposit with F7D coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions . : ~._ . $ N/A

Signature and Verification Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, A is true, correct, and complete, and that I am authorized to prepare this form.

Application for Extension of Time To File an Exempt Organization Return

Form 8868 (December 2000) Department of the Treasury Internal Revenue Service

OMB No . 1545-1709

1 File a for each return .

3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits . See instructions

b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made . Include any prior year overpayment allowed as a credit . . . $

223831 OS-01-02

1

" If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box . . . . . . " If you are fling for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this form) Note: Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed Form 8868.

Part I Automatic 3-Month Extension of Time - Only submit original (no copies needed

Note: Form 990-T corporations requesting an automatic 6-month extension - check this box and complete Part I only . , All other corporations (including Form 990-C filers) must use Form 7004 to request an extension of time to file income tax returns. Partnerships, REMICs and trusts must use Form 8 736 to request an extension of time to /de Form 1065, 1066, or 1041 .

Type or Name of Exempt Organization Employer identification number print CATHEDRAL PIONEER CHURCH HOMES II

DBA PIONEER HOUSE C / O RHF 94-1629086 File by the due date for Number, street, and room or suite no . If a P.O. box, see instructions . filing your 911 N . STUDEBAKER ROAD return . See Instructions City, town or post office, state, and ZIP code. For a foreign address, see instructions .

LONG BEACH CA 90815

Check type of return to be filed (file a separate application for each return)

Form 990 F-1 Form 990-T (corporation) 0 Form 4720 Form 990-BL E:1 Form 990-T (sec . 401(a) or 408(a) trust) 0 Form 5227 Form 990-EZ ~ Form 990-T (trust other than above) ~ Form 6069

0 Form 990-PF ~ Form 1041-A ~ Form 8870

" If the organization does not have an office or place of business in the United States, check this box . . . . . 10. = " If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) . If this is for the whole group, check this box 1 = . If it is for part of the group, check this box 1 = and attach a list with the names and EINs of all members the extension will cover .

1 I request an automatic 3-month (6-month, for 990-T corporation ) extension of time until JULY 15, 2004 to file the exempt organization return for the organization named above. The extension is for the organization's return for . mi. ED calendar year or

tax year beginning DEC 1, 2002 , and ending NOV 3 0 , 2003

2 If this tax year is for less than 12 months, check reason : E= Initial return =Final return 0 Change in accounting period

c Balance Due . Subtract line 3b from line 3a . Include your payment with this form, or, if required, deposit wdh FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) . See instructions . $ N/A

Signature and Verification

Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, It is true, correct, and complete, and that I am authorized to prepare this form .

Signature Jo. i/ etp(- 0 J)v,~ Title " ~ P tT Date " ,7 L2 6 f 0 y LHA For Paperwork Reduction Act Notice, see instruction Form 8868 (12-2000

Documents

` Return of Organization Exempt From Income Tax Form ~JO ...990s.foundationcenter.org/990_pdf_archive/941/... · return sp--f-c911 N. STUDEBAKER ROAD Final InsWc- Or eturn eturn lions