2023-11-15T14:02:36-06:00 2022-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2022-07-01 351447417 GRACE VILLAGE HEALTHCARE FACILITY INC GRAC 5743726290 337 GRACE VILLAGE DRIVE WINONA LAKE IN 46590 MARK SCHWOB DIRECTOR OF FINANCE 5743726498 2023-11-15 1 MARK SCHWOB 999009999 0 EMILIE M KNIERIEM CPA P01330194 3176334705 2023-11-15 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JUSTIN KIMBRELL 337 GRACE VILLAGE DRIVE WINONA LAKE IN 46590 3377789 0 X GRACEVILLAGE.ORG X 1978 IN GRACE VILLAGE'S MISSION IS TO ENABLE OLDER ADULTS TO LIVE TO THEIR FULLEST POTENTIAL IN THE SECURITY OF A CHRISTIAN COMMUNITY. 10 10 195 16 0 0 1297259 34330 7391886 3233341 110121 69107 39481 41011 8838747 3377789 0 0 0 0 5425099 2685936 0 0 17453 3252767 512545 8677866 3198481 160881 179308 4795562 4763917 4734761 4431145 60801 332772 GRACE VILLAGE'S MISSION IS TO ENABLE OLDER ADULTS TO LIVE TO THEIR FULLEST POTENTIAL IN THE SECURITY OF A CHRISTIAN COMMUNITY. 0 0 2583081 3233341 GRACE VILLAGE HEALTHCARE PROVIDES MEDICAL AND NURSING CARE, WHICH INCLUDES BUT IS NOT LIMITED TO HOUSING, NURSING, DIETARY, SOCIAL SERVICES, AND ACTIVITIES FOR THE ELDERLY IN WINONA LAKE, INDIANA. GRACE VILLAGE LEASES ITS NURSING HOME OPERATIONS TO WOODLAWN HOSPITAL. 2583081 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 33 0 1 195 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 0 0 IN X MARK SCHWOB - DIRECTOR OF FINANCE 5743726290 337 GRACE VILLAGE DRIVE WINONA LAKE IN 46590 CHAD HUMMEL CHAIR 0.50 0.50 X X 0 0 0 ADAM LENON SECRETARY & TREASURER 0.50 0.50 X X 0 0 0 DENNIS DUNCAN BOARD MEMBER 0.50 0.50 X 0 0 0 GLENN HALL BOARD MEMBER 0.50 0.50 X 0 0 0 CHUCK JOSEY BOARD MEMBER 0.50 0.50 X 0 0 0 DAVID KOONTZ BOARD MEMBER 0.50 0.50 X 0 0 0 DAN LEININGER BOARD MEMBER 0.50 0.50 X 0 0 0 MARK MCCOLLOM BOARD MEMBER 0.50 0.50 X 0 0 0 JENNIFER PIERCE BOARD MEMBER 0.50 0.50 X 0 0 0 DALE ROBBINS BOARD MEMBER 0.50 0.50 X 0 0 0 JUSTIN KIMBRELL CEO 28.00 12.00 X 203693 0 19570 SONDREA HAMILTON CFO/HFA 28.00 12.00 X 140434 0 25044 COURTNEY WALLEN LPN 40.00 0.00 X 130138 0 4509 474265 0 49123 3 0 1 0 MORRISON MANAGEMENT SPECIALISTS INC 2400 YORKMONT ROAD CHARLOTTE NY 28217 DIETARY SERVICES 238416 WINONA IT LLC 1037 MARINERS DRIVE WARSAW IN 46580 INFORMATION TECHNOLOGY 161820 PRIME TIME HEALTHCARE LLC 15380 WEIR ST OMAHA NE 68137 CONTRACT NURSING 143350 UNITED STAFFING SOLUTIONS PO BOX 219472 KANSAS CITY MO 64121 CONTRACT NURSING 108390 4 34330 34330 MANAGEMENT REVENUE 623000 2929051 2929051 LEASE REVENUE 623000 304290 304290 3233341 63538 63538 6000 6000 5569 0 5569 5569 5569 MISCELLANEOUS INCOME 900099 35011 35011 35011 3377789 3233341 0 110118 146129 146129 1976214 1768034 188266 19914 36202 29782 6085 335 391067 321710 65734 3623 136324 112146 22915 1263 1849 1849 1245 1033 203 9 1262 1070 119 73 2609 2400 205 4 166337 85924 80413 13 13 96970 87273 9697 193010 173709 19301 49614 49614 OTHER 8638 0 2039 6599 DUES & SUBSCRIPTIONS 5640 0 5378 262 EXPENSE ALLOCATION -14642 0 0 -14642 3198481 2583081 597947 17453 258486 116737 6956 1832 71981 71981 10149 73161 9111793 5845191 3425000 3266602 951268 968177 71722 265427 4795562 4763917 780545 547669 3792092 3722142 162124 161334 4734761 4431145 X -736121 -464150 796922 796922 60801 332772 4795562 4763917 X 179308 20938 71725 X X 0 1 X 1 0 X 128737 131577 1278103 1297259 34330 2870006 9538776 9326207 7544056 7391886 3233341 37034266 9667513 9457784 8822159 8689145 3267671 39904272 0 0 0 39904272 96654 137085 129626 98069 69538 530972 96654 137085 129626 98069 69538 530972 1078 1078 27481 35011 64648 9764167 9595947 8952863 8814695 3372220 40499892 0.98530 0.98790 0.01310 0.01150 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 802060 73387 7262 3945 878764 759012 156546 11920 125418 802060 747776 118392 11059 118215 759012 713721 113474 17503 96922 747776 636398 112711 15570 50958 713721 0.00000 0.66346 0.33654 0 0 5145842 3075119 2070723 1530271 1021126 509145 2424971 1748946 676025 10709 10709 3266602 SCHWAB - CARING FRIENDS ENDOWMENT 728092 C CAPITAL INVESTMENT - SAMARITAN ALLI 133892 C THUMS INVESTMENT 106193 C 968177 REFUNDABLE DEPOSITS 160567 DERIVATIVE ASSET 104860 265427 DEFERRED COMPENSATION PLAN OBLIGATIONS 165610 LOAN INSURANCE COST -4276 161334 X 3470451 20937 71725 92662 3377789 0 3377789 3198481 0 3198481 0 3198481 PART V, LINE 4: THE CARING FRIENDS ENDOWMENT FUND IS TO FINANCIALLY ASSIST LONG TIME RESIDENTS AT GRACE VILLAGE THAT HAVE DEPLETED THEIR FINANCES. PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THEIR ORGANIZATIONS AND RECOGNIZE A TAX LIABILITY IF THEY HAVE TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY GRACE AND NATIONAL FELLOWSHIP AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2022 AND JUNE 30, 2022, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: GAIN/LOSS ON INTEREST RATE SWAP 71,725. X 0 0 0 0 0 0 0 0 0 JUSTIN KIMBRELL CEO 203693 0 0 0 0 0 19570 0 0 0 223263 0 0 0 SONDREA HAMILTON CFO/HFA 140434 0 0 0 0 0 8840 0 16204 0 165478 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE CFO ASSISTS BLUE & CO., LLC IN PREPARATION OF THE 990 BEFORE IT IS FILED. THE CFO REVIEWS THE FORM 990 BEFORE IT IS FILED. BLUE & CO. FILES THE FORM 990 ONCE FINAL APPROVAL IS RECEIVED FROM THE CFO. THE CEO AND FULL BOARD ARE GIVEN A COPY OF THE FORM 990 UPON COMPLETION OF THE PREPARATION AND FILING. FORM 990, PART VI, SECTION B, LINE 12C GRACE VILLAGE TRIES TO AVOID SITUATIONS THAT COULD POTENTIALLY BE SEEN AS CONFLICTS OF INTEREST. IF A CONFLICT IS FOUND, IT IS DEALT WITH ON A CASE BY CASE BASIS, AND THE BOARD OF DIRECTORS MAKES A DECISION AS TO MATERIALITY OF THE CONFLICT, AND WHETHER TO TERMINATE TRANSACTIONS WITH PARTIES THAT HAVE A CONFLICT OF INTEREST. CONFLICTS OF INTEREST ARE MONITORED AND DEALT WITH AT EVERY LEVEL OF THE ORGANIZATION, FROM HOURLY EMPLOYEES, TO SALARIED EMPLOYEES, TO BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S SALARY IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST FORM 990, PART XI, LINE 9: (GAIN) LOSS ONF INTEREST RATE SWAP 71,725. FORM 990, PART XII, LINE 2C THE PROCESS FOR THE SELECTION OF INDEPENDENT ACCOUNTANT AND OVERSIGHT OF SUCH PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. NATIONAL FELLOWSHIP BRETHREN RETIREMENT HOMES INC 337 GRACE VILLAGE DRIVE WINONA LAKE IN 46590 351282401 RETIREMENT HOME IN 501C3 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0 0 0 0