2020-11-13T08:02:09-06:00 2019-12-31 390859910 BAKER TILLY US LLP 777 E WISCONSIN AVENUE FLOOR 32 MILWAUKEE WI 53202 990 2019-01-01 383087328 HENRY FORD VILLAGE HENR 3135841000 15101 FORD ROAD DEARBORN MI 48126 BRUCE BLALOCK EXECUTIVE DIRECTOR 3135841000 2020-11-12 1 TROY MARINE CPA P00187863 4147775500 2020-11-12 65.26.60.15 2020-11-12 23:16:18 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 61F2587C9083E5D801196A980749F72D4837C79B 2019 2021-01-29 14:40:06Z BRUCE BLALOCK 15101 FORD ROAD DEARBORN MI 48126 39703930 0 X N/A X 1992 MI PROMOTION OF HEALTH FOR THE ELDERLY BY PROVIDING A CONTINUING CARE RESIDENTIAL COMMUNITY IN DEARBORN, MI WITH RECREATION, SOCIAL, AND RELIGIOUS ACTIVITIES FOR RESIDENTS. 9 9 680 336 0 0 993217 1661520 37838694 37626751 330821 231093 191855 184566 39354587 39703930 0 0 0 0 14885165 16120506 0 0 169751 25151736 24118183 40036901 40238689 -682314 -534759 100386517 97327981 175068012 172165515 -74681495 -74837534 PROMOTION OF HEALTH FOR THE ELDERLY BY PROVIDING A CONTINUING CARE RESIDENTIAL COMMUNITY LOCATED IN DEARBORN, MICHIGAN WITH RECREATIONAL, SOCIAL, AND RELIGIOUS ACTIVITIES FOR RESIDENTS. 0 0 28922073 37744323 HENRY FORD VILLAGE, INC. IS A MICHIGAN NON-STOCK CORPORATION ESTABLISHED TO OPERATE A NOT-FOR-PROFIT CONTINUING CARE RETIREMENT COMMUNITY LOCATED IN DEARBORN, MICHIGAN. THE PROPERTY IS PRESENTLY ZONED FOR 853 INDEPENDENT LIVING UNITS, 96 ASSISTED LIVING UNITS, AND 89 SKILLED NURSING BEDS. AS OF DECEMBER 31, 2019 THERE WERE 789 OCCUPIED UNITS, WHICH CONSISTED OF 627 INDEPENDENT LIVING UNITS, 94 ASSISTED LIVIING UNITS AND 68 SKILLED NURSING BEDS. 28922073 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 67 0 680 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 MI X KUSHANT SHAH 3135841000 15101 FORD ROAD DEARBORN MI 48126 BRUCE BLALOCK EXECUTIVE DIRECTOR 40.00 X 331660 0 0 WAYNE HINDMARSH DIRECTOR OF SALES 40.00 X 137733 0 0 CHARLIQUE NELSON TO 102919 FORMER DIRECTOR OF NURSING 40.00 X 118992 0 0 ROBERT O DISANTO DIRECTOR OF GENERAL SERVICES 40.00 X 113686 0 0 KAMEL ELKADRI DIRECTOR OF DINING 40.00 X 107245 0 0 ADAM STERLING DIRECTOR OF RESIDENT LIFE 40.00 X 101172 0 0 KUSHANT SHAH DIRECTOR OF FINANCE 40.00 X 78072 0 0 JOE LIPIEC TO 32219 CFO/VP OF FINANCE 40.00 X 49132 0 0 JOHN BYRNE BOARD CHAIRMAN 4.00 X 0 0 0 CURT YUN SECRETARY/TREASURER 4.00 X 0 0 0 DR KAREN ROSS MEMBER 4.00 X 0 0 0 DR WALTER TALAMONTI MEMBER 4.00 X 0 0 0 DONALD JESMORE BOARD VICE CHAIRMAN 4.00 X 0 0 0 LINDA HIVELEY MEMBER 4.00 X 0 0 0 PETER FALZON MEMBER 4.00 X 0 0 0 MARY LOU POSA MEMBER 4.00 X 0 0 0 LYNN FORD ALANDT HONORARY BOARD MEMBER 0.00 X 0 0 0 1037692 0 0 7 0 1 0 REHABCARE GROUP THERAPY SERVICES 680 SOUTH FOURTH STREET LOUISVILLE KY 48202 PHYSICAL, OCCUPACTIONAL AND SPECIAL THER 1821231 SYSCO FOOD SERVICES PO BOX 33580 DETROIT MI 48233 FOOD AND KITCHEN SUPPLIES 1582239 ALTERNATIVE CONTRACTING INC 7703 DONNA WESTLAND MI 48185 GENERAL CONTRACTOR 1461410 DRIVEN SOLUTIONS INC 404 E 10 MILE RD STE 100 PLEASANT RIDGE MI 48069 SALES AND ADVERTISING 910902 SBM MANAGEMENT SERVICES LP 5241 ARNOLD AVE MCCLELLAN CA 95652 HOUSEKEEPING 861349 34 1661520 1661520 OCCUPANCY REVENUE 623000 34379065 34379065 ANCILLARY FEES 623000 1921055 1921055 RESIDENT FEE AMORTIZATION 623000 1120905 1120905 205726 205726 37626751 181797 181797 117572 0 117572 117572 117572 49296 0 49296 49296 49296 MISCELLANEOUS 900099 66994 66994 66994 39703930 37744323 0 298087 331660 278009 52846 805 12353979 10355539 1968463 29977 31935 22289 9501 145 2411733 1786225 616125 9383 991199 832228 156586 2385 401945 395916 6029 308790 304158 4632 59750 58854 896 2798037 2073003 714158 10876 1243755 1225099 18656 2647609 1767299 867105 13205 3954386 3895070 59316 4654238 4634085 19851 302 496397 488951 7446 DIETARY AND RELATED SUP 3664573 3664573 BUILDING, GROUNDS AND M 2314961 2153612 158929 2420 SUPPLIES 824517 786059 37881 577 BAD DEBT 433285 389956 42679 650 315940 179196 134693 2051 40238689 28922073 11146865 169751 1376375 1553429 863361 897499 3693827 4476059 167976 176896 426923 811945 176237647 94896325 82230853 81341322 11627202 8070831 100386517 97327981 6252607 6666789 9628891 11735322 51223211 50585746 787026 882781 107176277 102294877 175068012 172165515 X -75999798 -75637090 1318303 799556 -74681495 -74837534 100386517 97327981 -534759 378720 0 X X 0 1 X 1 0 X 603036 555651 993978 993217 1661520 4807402 36278488 34713798 36845588 37838694 37626751 183303319 36881524 35269449 37839566 38831911 39288271 188110721 0 0 0 188110721 95312 28527 107378 408457 299369 939043 95312 28527 107378 408457 299369 939043 36976836 35297976 37946944 39240368 39587640 189049764 0.99500 0.99600 0.00500 0.00400 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 5350 109558 113803 1105 3805 95412 93867 5350 3712 105228 105135 3805 29438 113645 139371 3712 43506 99855 113923 29438 1.00000 0 1 1 4992523 4992523 156663069 85412926 71250143 4622418 1258014 3364404 9562932 8225385 1337547 396705 396705 81341322 ASSETS WHOSE USE IS LIMITED 5697322 BOARD-RESTRICTED INVESTMENTS 2373509 8070831 RESIDENT DEPOSITS 93626090 FUNDS HELD FOR RESIDENTS 116897 REFUNDS DUE TO RESIDENTS 5752759 ACCOUNTS PAYABLE - RELATED PARTY 2765136 CHARITABLE GIFT ANNUITY 33995 102294877 X 40082650 378720 378720 39703930 0 39703930 40238689 0 40238689 0 40238689 PART IV, LINE 2B: RESIDENTS ARE REQUIRED TO REMIT ENTRANCE DEPOSITS, WHICH MAY VARY IN AMOUNT DEPENDING UPON THE UNIT TO BE OCCUPIED. PROSPECTIVE RESIDENTS ARE REQUIRED TO MAKE CERTAIN INSTALLMENT PAYMENTS PRIOR TO THE FINAL SETTLEMENT OF THE GIVEN UNIT. THESE AMOUNTS ARE INCLUDED IN ADVANCE DEPOSITS IN THE ACCOMPANY BALANCE SHEETS. DEPOSIT TIMING DIFFERENCES MAY CAUSE ESCROW CASH NOT TO BE EQUAL TO ADVANCE DEPOSITS. AS OF 12/31/2019 ADVANCE DEPOSITS WERE $531,282 PART V, LINE 4: HENRY FORD VILLAGE, INC. ADMINISTERS AN ENDOWMENT FUND WITH THE PURPOSE TO FUND THE STAFF APPRECIATION FUND. THE TOTAL ASSET AS OF 12/31/19 WAS $1,105 PART X, LINE 2: THE COMMUNITY IS A NONPROFIT ORGANIZATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON ITS EXEMPT INCOME UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE. X 1 1 X 1 0 0 0 0 0 0 0 0 BRUCE BLALOCK EXECUTIVE DIRECTOR 203881 0 127779 0 0 0 0 0 0 0 331660 0 0 0 PART I, LINE 1A EXECUTIVE DIRECTOR HAS A MEMBERSHIP TO DEARBORN COUNTRY CLUB, PAID FOR BY THE ORGANIZATION. PART I, LINE 3 ON DECEMBER 1, 2010, THE COMMUNITY CONTRACTED WITH LIFE CARE SERVICES, (LCS) FOR MANAGEMENT SERVICES. THE LCS CONTRACT TERM WAS FOR FIVE YEARS AND WAS EXTENDED UNTIL SEPTEMBER 30, 2021. MANAGEMENT FEES INCURRED UNDER THIS CONTRACT WERE $401,945. THE EXECUTIVE DIRECTOR AND ADMINISTRATOR ARE EMPLOYEES OF LCS, BUT THEIR SALARIES AND RELATED EMPLOYEE BENEFITS ARE REIMBURSED BY THE COMMUNITY. REIMBURSEMENT PAID TO LCS FOR LCS EMPLOYEES IN 2019 TOTALED $575,668 AND IS INCLUDED IN GENERAL AND ADMINISTRATIVE EXPENSES IN THE STATEMENT OF OPERATIONS. OTHER CORPORATE SERVICES THAT THE COMMUNITY MAY OBTAIN ARE NOT REQUIRED CONTRACTUALLY AND ARE ON AN AS-NEEDED BASIS. PART I, LINE 4A CHARLIQUE NELSON $8,445.08 A EDC OF CITY OF DEARBORN 521310485 242563AX2 2017-09-28 14185000 CAPITAL INVESTMENT AND IMPROVEMENTS 0 0 0 B EDC OF CITY OF DEARBORN 521310485 242563AWY 2008-10-01 42535000 CAPITAL INVESTMENT AND IMPROVEMENTS 0 0 0 A 14185000 1418500 837000 13803915 2019 0 0 0 0 B 3520000 42535000 1004757 0 0 0 0 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 1 B 1 FORM 990, PART VI, SECTION A, LINE 3 LIFE CARE SERVICES, LLC IS A FOR-PROFIT IOWA LIMITED LIABILITY COMPANY WHICH OPERATES AND MANAGES A VARIETY OF CONTINUING CARE RETIREMENT COMMUNITIES NATIONWIDE, INCLUDING HENRY FORD VILLAGE, INC. HENRY FORD VILLAGE, INC. (THE COMMUNITY) IS GOVERNED BY AN INDEPENDENT BOARD OF DIRECTORS AND IS ADVISED BY A RESIDENTS COUNSIL ELECTED BY THE HENRY FORD VILLAGE COMMUNITY. ON DECEMBER 1, 2010, HENRY FORD VILLAGE CONTRACTED WITH LIFE CARE SERVICES LCS) FOR MANAGEMENT SERVICES. THE LCS CONTRACT WAS EXTENDED UNTIL SEPTEMBER 30, 2021. THE EXECUTIVE DIRECTOR, ASST. EXECUTIVE DIRECTOR, AND ADMINISTRATOR ARE EMPLOYEES OF LCS, BUT THEIR SALARIES AND RELATED EMPLOYEE BENEFITS ARE REIMBURSED BY THE COMMUNITY. REIMBURSEMENT PAID TO LCS FOR LCS EMPLOYEES IN 2019 TOTALED $575,668 AND IS INCLUDED IN GENERAL AND ADMINISTRATIVE EXPENSES IN THE STATEMENT OF OPERATIONS. OTHER CORPORATE SERVICES THAT THE COMMUNITY MAY OBTAIN ARE NOT REQUIRED CONTRACTUALLY AND ARE ON AN AS-NEEDED BASIS. FORM 990, PART VI, SECTION B, LINE 11B BRUCE BLALOCK (EXECUTIVE DIRECTOR) AND KUSHANT SHAH (CURRENT DIRECTOR OF FINANCE) WILL REVIEW THE 2019 FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C COMPLIANCE WITH THE CONFLICT OF INTEREST, WHISTLEBLOWER, AND DOCUMENT RETENTION AND DESTRUCTION POLICIES WAS MONITORED BY THE MANAGMENT COMPANY, LIFE CARE SERVICES, LLC. BOARD MEMBERS SIGN A CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 MANAGEMENT (HENRY FORD VILLAGE, INC. & LIFE CARE SERVICES, LLC) CONDUCTS MARKET SURVEYS ON AN ANNUAL BASIS TO DETERMINE IF A COMPENSATION ADJUSTMENT IS WARRANTED. BASED ON THIS INFORMATION MAMANAGMENT RECOMMENDS ANNUAL SALARIES, TYPICALLY A PERCENTAGE INCREASE FROM THE PRIOR YEAR. THE BOARD APPROVES THE BUDGET ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FORM 990 IS AVAILABLE UPON REQUEST. KUSHANT SHAH, HENRY FORD VILLAGE DIRECTOR OF FINANCE, HAS PUBLIC INSPECTION COPIES AVAILABLE AT 15101 FORD ROAD, DEARBOR, MI 48126. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT ASSUMES RESPONSIBILITIES FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PREVIOUS YEARS.