MAPLE MANOR CHRISTIAN HOME INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- MAPLE MANOR CHRISTIAN HOME INC (EIN 35-0913539)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-10
- IRS object ID
- 202223149349306272
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-10T15:26:29-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N MERIDIAN ST SUITE 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 350913539 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAPLE MANOR CHRISTIAN HOME INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MAPL | BusinessNameControlTxt |
| Phone | 8122464866 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 643 W UTICA ST | AddressLine1Txt |
| City | SELLERSBURG | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 471721163 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEPHEN WILSON | PersonNm |
| Person Title | DIRECTOR OF FINANCE | PersonTitleTxt |
| Phone | 8122464866 | PhoneNum |
| Signature | 2022-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | STEPHEN | PersonFirstNm |
| Person Last | WILSON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | NATHAN A RODGERS CPA | PreparerPersonNm |
| PTIN | P01568275 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Preparation | 2022-11-02 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | STEVE CUNNINGHAM | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 643 W UTICA ST | AddressLine1Txt |
| City | SELLERSBURG | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 471721163 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,313,492 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | MAPLEMANORCHRISTIANHOME.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1972 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | NURSING HOME TO PROVIDE MEDICAL CARE INCLUDING ROOM AND BOARD (FORMED IN 1972). ALSO PROVIDING PHYSICAL PROPERTY FOR CHILDREN'S HOME (FORMED 1945). | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 70 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $22,443 | PYContributionsGrantsAmt |
| CY Contributions Grants | $24,622 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,407,915 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,266,918 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,350 | PYInvestmentIncomeAmt |
| CY Investment Income | $9,952 | CYInvestmentIncomeAmt |
| PY Other Revenue | $16,437 | PYOtherRevenueAmt |
| CY Other Revenue | $12,000 | CYOtherRevenueAmt |
| PY Total Revenue | $3,452,145 | PYTotalRevenueAmt |
| CY Total Revenue | $3,313,492 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $100 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,694,590 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,575,943 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $123,528 | PYOtherExpensesAmt |
| CY Other Expenses | $139,806 | CYOtherExpensesAmt |
| PY Total Expenses | $2,818,618 | PYTotalExpensesAmt |
| CY Total Expenses | $2,715,849 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $633,527 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $597,643 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,657,411 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,261,378 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,774 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,770 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,655,637 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,254,608 | NetAssetsOrFundBalancesEOYAmt |
| Mission | NURSING HOME TO PROVIDE MEDICAL CARE IN ADDITION TO ROOM AND BOARD; PROVIDE PHYSICAL PROPERTY FOR OPERATIONS OF CHILDREN HOME TO CARE FOR DISPLACED AND AT-RISK CHILDREN. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,534,655 | ExpenseAmt |
| Grant | $100 | GrantAmt |
| Revenue | $3,278,918 | RevenueAmt |
| Desc | MAPLE MANOR IS A CMS TOP RATED FIVE STAR FACILITY WITH 57 LICENSE BEDS FOR INDIANA STATE MEDICAID PROVIDING INDIGENT CARE. | Desc |
| Total Program Service Expenses | $2,534,655 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 70 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STEPHEN WILSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8122464866 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 643 W UTICA ST | AddressLine1Txt |
| City | SELLERSBURG | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 471721163 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| NATHAN GRIMES | |||||||
| PRESIDENT | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NICK RAY | |||||||
| VICE PRESIDENT | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KENNETH PETTIT | |||||||
| SECRETARY | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JONATHAN BINGHAM | |||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| HOUSTON COCKRELL | |||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| ROB JONES | |||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| KENNY LEACH | |||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| SAM MARSH | |||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| BEN MARSH | |||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| JONATHAN RAKICH | |||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| RICK SIMPSON | |||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| STEVE CUNNINGHAM | |||||||
| ADMINISTRATOR/CEO | 40.00 | Yes (X) | Yes (X) | $93,449 | $0 | $40,144 | |
| CULLEN ISTRE | |||||||
| DIRECTOR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| STEPHEN WILSON | |||||||
| DIRECTOR OF FINANCE | 40.00 | Yes (X) | $59,368 | $0 | $12,620 | ||
| JACQUELYN PIKE | |||||||
| DIRECTOR OF NURSING | 40.00 | $161,038 | $0 | $4,374 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $313,855 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $57,138 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MAXIM HEALTHCARE SERVICES INC | |||||
| 12558 COLLECTIONS CENTER DR | CHICAGO | IL | 60693 | STAFFING AGENCY | $382,810 |
| ACCURATE HEALTHCARE PROFESSIONALS | |||||
| 2221 BUECHEL AVE STE 1 | LOUISVILLE | KY | 40218 | STAFFING AGENCY | $318,696 |
| HTS HEALTHCARE THERAPY SERVICES | |||||
| 1500 AMERICAN WAY SUITE 110 | GREENWOOD | IN | 46143 | THERAPY SERVICES | $184,981 |
| TOP NOCH NURSING AGENCY LLC | |||||
| 176 HALEY AVE | SHEPHERDSVILLE | KY | 40165 | STAFFING AGENCY | $104,394 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $24,622 | AllOtherContributionsAmt |
| Total Contributions | $24,622 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| OTHER MGMT SVC REVENUE | 623000 | $2,575,942 | $2,575,942 |
| LEASE REVENUE | 623000 | $444,000 | $444,000 |
| MANAGEMENT SERVICE REV | 623000 | $246,976 | $246,976 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,266,918 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,952 | TotalRevenueColumnAmt |
| Exclusion | $9,952 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $12,000 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $12,000 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,000 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,000 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,313,492 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,278,918 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $9,952 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100 | TotalAmt |
| Program Services | $100 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $205,582 | TotalAmt |
| Program Services | $102,791 | ProgramServicesAmt |
| Management And General | $102,791 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,003,069 | TotalAmt |
| Program Services | $2,003,069 | ProgramServicesAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,285 | TotalAmt |
| Program Services | $27,947 | ProgramServicesAmt |
| Management And General | $1,338 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $174,841 | TotalAmt |
| Program Services | $168,895 | ProgramServicesAmt |
| Management And General | $5,946 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $163,166 | TotalAmt |
| Program Services | $147,972 | ProgramServicesAmt |
| Management And General | $15,194 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,030 | TotalAmt |
| Management And General | $3,030 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,739 | TotalAmt |
| Program Services | $5,739 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,687 | TotalAmt |
| Program Services | $1,687 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,770 | TotalAmt |
| Program Services | $6,770 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,164 | TotalAmt |
| Program Services | $5,164 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,790 | TotalAmt |
| Program Services | $52,895 | ProgramServicesAmt |
| Management And General | $52,895 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,609 | TotalAmt |
| Program Services | $9,609 | ProgramServicesAmt |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,017 | TotalAmt |
| Program Services | $2,017 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,715,849 | TotalAmt |
| Program Services | $2,534,655 | ProgramServicesAmt |
| Management And General | $181,194 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $267,453 | BOYAmt |
| EOY | $139,449 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,454,522 | BOYAmt |
| EOY | $1,521,471 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $361,983 | BOYAmt |
| EOY | $1,052,959 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $80,000 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,605 | BOYAmt |
| EOY | $5,605 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,387,174 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,964,087 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,523,877 | BOYAmt |
| EOY | $1,423,087 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,971 | BOYAmt |
| EOY | $38,807 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,657,411 | BOYAmt |
| EOY | $4,261,378 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $6,770 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,774 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,774 | BOYAmt |
| EOY | $6,770 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,655,637 | BOYAmt |
| EOY | $4,254,608 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,655,637 | BOYAmt |
| EOY | $4,254,608 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,657,411 | BOYAmt |
| EOY | $4,261,378 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $597,643 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,328 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Community Trust | Yes (X) | CommunityTrustInd |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $29,137 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $58,094 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $28,014 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $22,443 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $24,622 | CurrentTaxYearAmt |
| Total | $162,310 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $29,137 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $58,094 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $28,014 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $22,443 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $24,622 | CurrentTaxYearAmt |
| Total | $162,310 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $162,310 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9,380 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,080 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $31,491 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $17,350 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $21,952 | CurrentTaxYearAmt |
| Total | $82,253 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $85 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,437 | CurrentTaxYearMinus1YearAmt |
| Total | $4,522 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $249,085 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $9,767,319 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.65160 | PublicSupportCY170Pct |
| Public Support PY170 | 0.71030 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | OTHER INCOME - 2019 AMOUNT: $ 85. 2020 AMOUNT: $ 4,437. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $100,664 | OtherCostOrOtherBasisAmt |
| Book Value | $100,664 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,298,359 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,559,277 | DepreciationAmt |
| Book Value | $739,082 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,077,958 | OtherCostOrOtherBasisAmt |
| Depreciation | $517,683 | DepreciationAmt |
| Book Value | $560,275 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $910,193 | OtherCostOrOtherBasisAmt |
| Depreciation | $887,127 | DepreciationAmt |
| Book Value | $23,066 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,423,087 | TotalBookValueLandBuildingsAmt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JACQUELYN PIKE | PersonNm |
| Title | DIRECTOR OF NURSING | TitleTxt |
| Base Compensation Filing Org | $161,038 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $4,317 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $57 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $165,412 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 1A | FormAndLineReferenceDesc |
| Explanation | THE ADMINISTRATOR/CEO WAS PROVIDED RENT-FREE HOUSING ON CAMPUS DURING 2021. THE HOUSING PROVIDED WAS NOT INCLUDED IN TAXABLE INCOME. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | SAM AND BEN MARSH HAVE A FAMILY RELATIONSHIP (FATHER AND SON). |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS AVAILABLE TO ALL BOARD MEMBERS FOR REVIEW. THE ADMINISTRATOR AND THE DIRECTOR OF FINANCE REVIEW THE 990 WITH THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH BOARD MEETING, THE DIRECTORS ARE ASKED IF THEY HAVE A CONFLICT OF INTEREST TO DISCLOSE AND IS RECORDED IN THE MINUTES. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION'S OFFICERS' COMPENSATION IS SET AND DETERMINED BY THE BOARD OF DIRECTORS EACH YEAR AT THE BOARD MEETING IN OCTOBER BEFORE THE START OF THE NEW YEAR. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS UPON REQUEST TO MAPLE MANOR 643 WEST UTICA STREET, SELLERSBURG, INDIANA ATTN: STEVE CUNNINGHAM. |
| FORM 990, PART XII: | THE FINANCIALS ARE COMPILED AND REVIEWED BY BKD, AN ACCOUNTING FIRM, TO FILE SKILLED NURSING FACILITY FEDERAL MEDICARE COST REPORT AND INDIANA ANNUAL MEDICAID REPORTS. THESE REPORTS ARE THEN REVIEWED BY MYERS AND STAUFFER FOR RATE REIMBURSEMENTS AND ARE SUBJECT TO REVIEW AND AUDIT. |