American Baptist Homes of the West

Social Responsibility and Accountability

REPORT

Community Reporting: REPORTING YEAR: 2008

Person Reporting: Date:

Inventory of Community Services[1]

Services and Activities Occurring for the Benefit of Residents:

What types of educational, religious, hospital, scientific, or charitable activities did your retirement community provide or sponsor within your retirement community in calendar year 2008? For each community service, check the appropriate box below and then provide a more detailed explanation on the next page) .

Research activities that are community benefits

Educational activities for professionals such as education and training programs for doctors, nurses and other health professionals

Subsidized (or charity) allowances to residents unable to pay fully established rates (private pay), excluding Medi-Cal

Payment for items not reimbursed by the Medi-Cal program or other public program with unpaid costs.

Please specify:

Other, please specify:

Activities Provided or Sponsored for the Broader Community at Large:

What types of educational, religious, hospital, scientific, or charitable activities did your organization provide or sponsor for your retirement community in calendar year 2008? When answering, include only significant or frequent activities that occurred outside your facility. Do not include activities and services provided to your residents. (Please refer to the “Guidelines” sheet attached for examples and check all that apply:

Community health and supportive services provided for low-income persons and for the boarder community at large

Subsidized housing or other care excluding nursing care

Subsidized meals to non-residents

Financial assistance to non-residents who were unable to pay for necessary living expenses

Subsidized adult day care or other community-based services

Use of the retirement community by community-based organizations

Community-building and leadership activities

Community benefit operations activities

Other, please specify:

Return the Inventory of Community Services and the Summary of Community Services to:

David A. Grant, Senior Vice President and General Counsel, ABHOW,

6120 Stoneridge Mall Road, 3rd Floor, Pleasanton, CA 94588.

SUMMARY OF COMMUNITY SERVICES

CASELOAD

Type of Service/ Brief Target Persons ESTIMATED EXPENSE*

Program description Population Served Encounters (IN THOUSANDS)

1.
2.
3.
4.
5.
6.
7.
8.

[Use additional pages as needed]

1

[1] To assist you in filling out the two forms, please refer to the information and examples on the attached “Guidelines for Reporting Charitable Benefits.”