2021-11-12T11:32:44-06:00 2020-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2020-01-01 463385153 INDIANA SENIOR HOUSING HEALTH CARE PROPERTIES INC INDI 8123329295 226 S COLLEGE SQ BLOOMINGTON IN 47404 KATHY ETTENSOHN TREASURER 8123329295 2021-11-12 1 KATHY ETTENSOHN 999009999 ANGELA N CRAWFORD CPA P00573197 3176334705 2021-11-12 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CEDAR VILLAGE SENIOR LIVING KATHY ETTENSOHN 226 S COLLEGE SQ BLOOMINGTON IN 47404 24270450 0 X N/A X 2013 IN ISH STRIVES TO PROMOTE, PROVIDE, AND SUPPORT RESIDENTIAL, CUSTODIAL, NURSING, MEDICAL, AND HOSPITAL CARE FOR THE ELDERLY BY OPERATING AND MAINTAIN FACILITIES FOR THE CARE OF THE AGED AND ELDERLY. 4 4 408 0 0 0 110017 4062507 20762260 19288246 256 2963 34498 916734 20907031 24270450 0 5000 0 0 10060476 10919971 0 0 0 13129975 9909338 23190451 20834309 -2283420 3436141 38827391 38938663 31566778 28629924 7260613 10308739 ISH STRIVES TO PROMOTE, PROVIDE, AND SUPPORT RESIDENTIAL, CUSTODIAL, NURSING, MEDICAL, AND HOSPITAL CARE FOR THE ELDERLY BY OPERATING AND MAINTAIN FACILITIES FOR THE CARE OF THE AGED AND ELDERLY. 0 0 15960365 5000 19291646 ISH STRIVES TO PROMOTE, PROVIDE, AND SUPPORT RESIDENTIAL, CUSTODIAL, NURSING, MEDICAL, AND HOSPITAL CARE FOR THE ELDERLY BY OPERATING AND MAINTAIN FACILITIES FOR THE CARE OF THE AGED AND ELDERLY. 15960365 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 433 0 1 408 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 IN X THE ORGANIZATION 8123329295 226 S COLLEGE SQ BLOOMINGTON IN 47404 JAMES LOWELL WHITLACH PRESIDENT 2.00 X X 8000 0 0 KATHY ETTENSOHN TREASURER 2.00 X X 8000 0 0 DENNIS MCGUIRE SECRETARY 2.00 X X 8000 0 0 HIRSCH WISE BOARD MEMBER 2.00 X 8000 0 0 MICHAEL MOBLEY ADMINISTRATOR 40.00 X 182598 0 7947 MELISSA HINES DIRECTOR OF NURSING 40.00 X 110842 0 8107 325440 0 16054 2 0 1 0 LIFESPAN THERAPY 118 MEDICAL DRIVE CARMEL IN 46032 THERAPY 1790512 SKILLED CARE PHARM OF OHIO 6175 HI-TECK COURT MASON OH 28201 PHARMACY 469412 UNIDINE CORPORATION 1000 WASHINGTON ST STE 510 BOSTON MA 02118 CONTRACTED SERVICES DIETARY 403463 ENERVISE LLC 10226 ALLIANCE RD BLUE ASH OH 45242 HVAC SERVICES 215573 INDIANA UNIVERSITY HEALTH 2501 RELIABLE PARKWAY CHICAGO IL 60686 COVID TESTING 185100 8 1461804 2600703 4062507 PATIENT & RESIDENT SERVICE REVENU 900099 19288246 19288246 19288246 2963 2963 3400 0 3400 3400 3400 WORKERS COMPENSATION REFUND 900099 908514 908514 4820 4820 913334 24270450 19291646 0 916297 X 5000 5000 32000 32000 9456942 8244494 1212448 20577 17939 2638 580155 505775 74380 830297 723847 106450 160525 160525 9635 9635 33983 33983 2455345 1892402 562943 76608 76608 415321 170419 244902 221734 221734 909047 23161 885886 19427 19427 1345120 1030445 314675 994228 761640 232588 126805 126805 MEDICAL SUPPLIES 1983388 1983388 QUALITY ASSESSMENT FEE 785648 601855 183793 DUES & SUB. 82077 82077 290447 290447 20834309 15960365 4873944 0 456844 968760 1793269 1624405 95976 78479 38066723 2347172 36387992 35719551 93310 547468 38827391 38938663 1060816 675184 105094 26964255 26723081 3541707 1126565 31566778 28629924 X 7260613 10308739 7260613 10308739 38827391 38938663 X 3436141 -388015 X X 0 1 X 1 1 1 X 193441 110017 4971021 5274479 11305234 20762260 19288246 51355740 11498675 20872277 24259267 56630219 0 0 0 56630219 327249 10584 6363 344196 327249 10584 6363 344196 4066 24028 913334 941428 11829990 20906889 25178964 57915843 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2018 AMOUNT: $ 4,066. 2019 AMOUNT: $ 24,028. 2020 AMOUNT: $ 913,334. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5045400 5045400 30410746 1892120 28518626 391869 33138 358731 2218708 421914 1796794 35719551 INTERCOMPANY PAYABLES 217325 ACCRUED INTEREST 99799 SERVICE BUREAU FEE PAYABLE 730610 SECURITY DEPOSITS 78831 1126565 X 23882435 -388015 -388015 24270450 0 24270450 20834309 0 20834309 0 20834309 PART X, LINE 2: CEDAR VILLAGE IS ORGANIZED AS A NOT-FOR-PROFIT CORPORATION UNDER SECTION 501 OF THE UNITED STATES INTERNAL REVENUE CODE. AS SUCH, CEDAR VILLAGE IS GENERALLY EXEMPT FROM INCOME TAXES. HOWEVER, CEDAR VILLAGE IS REQUIRED TO FILE FEDERAL FORM 990 RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX, WHICH IS AN INFORMATIONAL RETURN ONLY. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY CEDAR VILLAGE AND RECOGNIZE A TAX LIABILITY IF CEDAR VILLAGE HAS 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 CEDAR VILLAGE, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. CEDAR VILLAGE 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: UNREALIZED LOSS ON DERIVATIVE -388,015. 1 THE UNIVERSITY OF CINCINNATI FOUNDATION PO BOX 19970 CINCINNATI OH 452190970 310896555 501C3 5000 CONTRIBUTION 1 PART I, LINE 2: GRANTS ARE MONITORED THROUGH A CAPITAL EXPENSE BUDGET. 0 0 0 0 0 0 0 0 0 MICHAEL MOBLEY ADMINISTRATOR 170598 0 12000 0 0 0 0 0 7947 0 190545 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 CEDAR VILLAGE HAS A MANAGEMENT AGREEMENT WITH A THIRD PARTY, CARDON MANAGEMENT COMPANY LLC (MANAGER), AN EXPERIENCED MULTI-FACILITY LONG-TERM CARE MANAGER, TO MANAGE THE FACILITY ON BEHALF OF CEDAR VILLAGE FOR AN INITIAL TERM THAT EXPIRES ON MAY 31, 2025. THE AGREEMENT STATES THE GOVERNING BOARD OF CEDAR VILLAGE WILL RETAIN ULTIMATE AUTHORITY AND LEGAL RESPONSIBILITY FOR THE OPERATION AND CONTROL OF THE FACILITY. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS REVIEWED AND SIGNED BY THE TREASURER. THE SECRETARY ALSO RECEIVES A COPY OF FORM 990 TO RETAIN IN THE ORGANIZATION'S RECORDS AND IS AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC JAMES LOWELL WHITLACH - 226 S COLLEGE SQ, BLOOMINGTON, IN 47404. KATHY ETTENSOHN - 21 SE THIRD STREET STE 500, EVANSVILLE, IN 47708. DENNIS MCGUIRE - 3690 STERLING AVE, BLOOMINGTON, IN 47401. HIRSCH WISE - 8150 CORP PARK DR STE 160, CINCINNATI, OH 45242. MICHAEL MOBLEY - 226 S COLLEGE SQ, BLOOMINGTON, IN 47404. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,892,402. MANAGEMENT AND GENERAL EXPENSES 562,943. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,455,345. FORM 990, PART XI, LINE 9: UNREALIZED LOSS ON DERIVATIVE -388,015. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT.