2020-05-12T09:13:47-05:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2019-01-01 371017284 CLARK-LINDSEY VILLAGE INC CLAR 2173442144 101 WEST WINDSOR ROAD URBANA IL 61802 TIMOTHY F MAST CFO 2173442144 2020-05-08 1 JEFF PARKER P00970069 3149254300 67.137.57.251 2020-05-08 14:13:14 CD P E087ECC427FCF6F1386F54131AA171D58D37D782 8930F06402091CE01DE01F5E1C46450EDDF6C8AB 2019 2020-11-19 02:30:22Z DEBRA S REARDANZ 101 WEST WINDSOR ROAD URBANA IL 61802 25321716 0 X WWW.CLARK-LINDSEY.COM X 1970 IL TO PROVIDE HOUSING AND HEALTHCARE FACILITIES/SERVICES FOR ELDERLY PERSONS 11 11 413 500 0 0 419230 114637 19456546 20146773 445342 438243 333943 304681 20655061 21004334 66124 125380 0 0 10371647 10791837 0 0 0 9505400 9695267 19943171 20612484 711890 391850 52662566 55103274 32208220 32320339 20454346 22782935 X TO PROVIDE HOUSING AND HEALTHCARE FACILITIES/SERVICES FOR ELDERLY PERSONS ON A NON-PROFIT BASIS, WITHOUT REGARD TO RACE, RELIGION, SEX, CREED OR NATIONAL ORIGIN. 1 0 15828488 20146773 ALL OF CLARK-LINDSEYS BUILDINGS ARE LOCATED ON A SINGLE SITE COMPRISED OF 27 ACRES ADJACENT TO MEADOWBROOK PARK AND THE UNIVERSITY OF ILLINOIS. INDEPENDENT LIVING OPTIONS FOR PEOPLE AGE 62 AND OVER INCLUDE 131 APARTMENTS AND 16 VILLA UNITS. RESIDENTS CAN PURCHASE A LIFE PLAN RESIDENCY CONTRACT, WHICH GUARANTEES THEM RESIDENCY IN THE APARTMENTS OF VILLAS AND ACCESS TO THE HEALTH CENTER FOR LIFE. ASSISTED LIVING CONSISTS OF 12 LICENSED BEDS IN A GREEN HOUSE HOME. THE 12 ROOM HOME PROVIDES FOR CARE IN A SMALLER HOME LIKE SETTING. PROFESSIONAL NURSING STAFF IS ON DUTY 24 HOURS A DAY. SKILLED CARE CONSISTS OF 105 LICENSED BEDS. 12 BEDS ARE IN A SECOND GREEN HOUSE HOME. 93 BEDS ARE IN MEADOWBROOK HEALTH CENTER. 37 BEDS ARE MEDICARE CERTIFIED. PROFESSIONAL NURSING STAFF IS ON DUTY 24 HOURS A DAY. IN ADDITION TO RESIDENCY AND IN-PATIENT SERVICES, CLARK-LINDSEY PROVIDES OUTPATIENT THERAPY INCLUDING PHYSICAL, OCCUPATIONAL AND SPEECH. 125380 THE MISSION OF CLARK-LINDSEY IS TO OFFER SENIOR ADULTS EXCEPTIONAL SERVICES AND LIVING ENVIRONMENTS DESIGNED TO ENGAGE THE MIND, SPIRIT, AND BODY IN WELLNESS AND COMMUNITY. THE MISSION IS FURTHERED AND SUSTAINED THROUGH YEARS OF CHARITABLE GIVING. GENEROUS DONORS HAVE PROVIDED FOR A FRIENDSHIP FUND TO ASSIST COMMUNITY MEMBERS WHO NO LONGER HAVE THE FINANCIAL RESOURCES TO PROVIDE FOR THEIR HOME AND HEALTH CARE COSTS. CLARK-LINDSEY PROVIDES CARE TO RESIDENTS WHO MEET CERTAIN CRITERIA UNDER ITS FRIENDSHIP FUND POLICY WITHOUT CHARGE OR AT REDUCED RATES. KEY ELEMENTS USED TO DETERMINE ELIGIBILITY INCLUDE A RESIDENTS DEMONSTRATED INABILITY TO PAY. CLARK-LINDSEY MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS FRIENDSHIP FUND POLICY, THE ESTIMATED COST OF THOSE SERVICES AND SUPPLIES, AND EQUIVALENT SERVICE STATISTICS. DURING THE YEARS ENDED DECEMBER 31, 2019, TWO RESIDENTS RECEIVED FINANCIAL ASSISTANCE FROM THE FRIENDSHIP FUND. 15828488 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 50 0 413 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IL X DEBRA REARDANZ CEO 2173442144 101 WEST WINDSOR ROAD URBANA IL 61802 DAVID HOOD BOARD MEMBER 2.00 X 0 0 0 ROLAND WHITE CHAIR 2.00 X X 0 0 0 KATHLEEN HOLDEN VICE CHAIR 2.00 X X 0 0 0 TANYA GALLAGHER SECRETARY & ASSISTANT TREASURER (TERM ENDED 01/19) 2.00 X X 0 0 0 GENE GRANDONE BOARD MEMBER 2.00 X 0 0 0 JAMES GREEN BOARD MEMBER 2.00 X 0 0 0 WADE HAMPTON BOARD MEMBER 2.00 X 0 0 0 DAVE LINE TREASURER & ASSISTANT SECRETARY 2.00 X X 0 0 0 WENDY BARTLO BOARD MEMBER 2.00 X 0 0 0 DENNIS BEARD BOARD MEMBER 2.00 X 0 0 0 AMIN KASSEM BOARD MEMBER 2.00 X 0 0 0 CINDY GUTHRIE BOARD MEMBER 2.00 X 0 0 0 DEBRA S REARDANZ PRESIDENT / CEO 40.00 X 257231 0 31399 TIMOTHY P MAST VICE PRESIDENT OF FINANCE 40.00 X 128803 0 22281 RIKKI BRADY VICE PRESIDENT OF HEALTH SERVICES 40.00 X 120578 0 22876 RON WILCOX VP OF RESIDENTIAL SERVICES 40.00 X 107891 0 31036 KRISTA BORBELY VP OF HUMAN RESOURCES 40.00 X 102390 0 26782 JASON RICE DINING SERVICE DIRECTOR 40.00 X 100736 0 28116 817629 0 162490 6 0 1 0 SODEXO INC & AFFILIATES PO BOX 360170 PITTSBURGH PA 15251 ENVIRONMENTAL SERVICES 1251137 HEALTHPRO HERITAGE LLC 536 OLD HOWELL ROAD GREENVILLE SC 29615 THERAPY SERVICES 953046 THOMPSON ELECTRONICS 905 S BOSCH RD PEORIA IL 61607 ELECTRONICS CONTRACTOR 333257 MTK TECHNOLOGIES 701 DEVONSHIRE DR C-14 CHAMPAIGN IL 61820 IT SERVICES 329880 COLONY SQUARE CLEANERS 701 DEVONSHIRE DR CHAMPAIGN IL 61820 LAUNDRY SERVICE 180660 5 114637 114637 RESIDENT SERVICES 623000 18459375 18459375 AMORTIZATION OF DEFERRED REVENUE 623000 1687398 1687398 20146773 425365 425365 4289141 4210635 65628 78506 -65628 12878 12878 39368 41119 -1751 -1751 MEAL REVENUE 900099 100833 100833 HAIR SALON SERVICES 900099 87093 87093 GUEST SUITE 900099 63460 63460 55046 55046 306432 21004334 20146773 0 742924 125380 125380 851267 851267 8230661 7223651 1007010 208247 100683 107564 804376 388899 415477 697286 337123 360163 27398 27398 62039 62039 83691 83691 1147991 1086095 61896 53985 53985 634787 530373 104414 387779 9367 378412 1440325 1305768 134557 101740 78953 22787 66168 53625 12543 389412 353033 36379 2685706 2434805 250901 183577 183577 DIETARY 983684 795148 188536 ANCILLARY 375889 375889 ADMINISTRATION 283856 283856 REPAIRS 269272 142137 127135 517968 487559 30409 20612484 15828488 4783996 0 16806 269978 1665415 1530758 1099840 1275950 24968 24968 200306 156772 62627564 28851537 34448959 33776027 15206272 18054769 0 14052 52662566 55103274 2040058 2082444 17581707 18065131 12293929 11807024 13358 16761 126500 126500 152668 222479 32208220 32320339 X 19941656 22183164 512690 599771 20454346 22782935 52662566 55103274 391850 1936739 0 X X 0 1 X 1 0 X 311955 450517 192272 419230 114637 1488611 15165427 15173741 17752597 19456546 20146773 87695084 38478 39368 77846 15477382 15624258 17944869 19914254 20300778 89261541 0 0 0 89261541 224769 245612 286388 290511 425365 1472645 224769 245612 286388 290511 425365 1472645 345265 333301 353267 337230 306432 1675495 16047416 16203171 18584524 20541995 21032575 92409681 0.96590 0.96570 0.01590 0.01450 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2015 AMOUNT: $ 7,889. 2016 AMOUNT: $ 3,019. 2017 AMOUNT: $ 1,841. 2018 AMOUNT: $ 702. 2019 AMOUNT: $ 7,020. MEAL REVENUE - 2015 AMOUNT: $ 105,622. 2016 AMOUNT: $ 122,001. 2017 AMOUNT: $ 127,985. 2018 AMOUNT: $ 130,001. 2019 AMOUNT: $ 100,833. SALON SERVICES - 2015 AMOUNT: $ 58,149. 2016 AMOUNT: $ 57,230. 2017 AMOUNT: $ 65,269. 2018 AMOUNT: $ 75,411. 2019 AMOUNT: $ 87,093. GARAGE FEES - 2015 AMOUNT: $ 37,320. 2016 AMOUNT: $ 35,640. 2017 AMOUNT: $ 36,629. 2018 AMOUNT: $ 35,819. 2019 AMOUNT: $ 33,872. LAUNDRY INCOME - 2015 AMOUNT: $ 18,149. 2016 AMOUNT: $ 17,118. 2017 AMOUNT: $ 18,576. 2018 AMOUNT: $ 15,642. 2019 AMOUNT: $ 14,094. PERSONAL SERVICE ATTENDANT - 2015 AMOUNT: $ 3,385. 2016 AMOUNT: $ 3,436. 2017 AMOUNT: $ 1,569. 2018 AMOUNT: $ 3,465. 2019 AMOUNT: $ 60. GROCERY STORE - 2015 AMOUNT: $ 45,227. 2016 AMOUNT: $ 42,104. 2017 AMOUNT: $ 36,268. GUEST SUITE INCOME - 2015 AMOUNT: $ 69,524. 2016 AMOUNT: $ 52,753. 2017 AMOUNT: $ 65,130. 2018 AMOUNT: $ 76,190. 2019 AMOUNT: $ 63,460. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 2442707 30450 378213 7642 11621 2832107 2595209 20370 -105405 56098 11369 2442707 2392134 25580 276536 84699 14342 2595209 2311535 21420 93413 20947 13287 2392134 2334249 33000 -12519 30206 12989 2311535 0.83210 0.16790 0.00000 0 0 225000 225000 49912898 21355834 28557064 2125569 1310943 814626 10280283 6184760 4095523 83814 83814 33776027 DEFERRED COMPENSATION 222479 222479 X PART IV, LINE 2B: THE RECORDS OF THREE COMMITTEES, INCLUDING THE MEADOWBROOK AUXILIARY FUND, THE RESIDENT COUNCIL FUND, AND THE LIBRARY FUND, ARE MAINTAINED BY CLARK-LINDSEY, BUT THE MONEY IS NOT CLARK-LINDSEY'S TO SPEND. IN ADDITION, MONEY IS MAINTAINED FOR HEALTH CENTER RESIDENTS IN A SEPARATE ACCOUNT, BUT THE MONEY IS NOT CLARK-LINDSEY'S TO SPEND. THESE FUNDS ARE INCLUDED IN CASH AND IN A LIABILITY CAPTIONED "FUNDS HELD FOR OTHERS". PART V, LINE 4: THE ARMSEY BEAUTIFICATION FUND IS A TERM ENDOWMENT USED TO PROVIDE FINANCIAL SUPPORT FOR CLARK-LINDSEY RESIDENT GROUNDS AND GARDENS. THE THOMPSON LIBRARY FUND IS A TERM ENDOWMENT USED TO PROVIDE FINANCIAL SUPPORT OF THE CLARK-LINDSEY RESIDENT LIBRARY. THE WEBBER EDUCATIONAL FUND IS A PERMANENT ENDOWMENT USED TO PROVIDE FINANCIAL SUPPORT OF CONTINUING EDUCATION FOR HEALTH CENTER STAFF. THE STEWART LIBRARY FUND IS A PERMANENT ENDOWMENT USED TO PROVIDE FINANCIAL SUPPORT OF THE CLARK-LINDSEY RESIDENT LIBRARY. THE KAULFERS FUND IS A BOARD DESIGNATED, QUASI ENDOWMENT USED TO PROVIDE FINANCIAL SUPPORT FOR QUALITY OF LIFE IMPROVEMENTS INCLUDING PROGRAMS AND FACILITIES ESPECIALLY DEVELOPED FOR SENIOR CITIZENS. PART X, LINE 2: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. 1 CHARITY CARE - FINANCIAL ASSISTANCE FOR HOME AND HEALTH CARE COSTS. 2 125380 PART I, LINE 2: CLARK-LINDSEY MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS FRIENDSHIP FUND POLICY, THE ESTIMATED COST OF THOSE SERVICES AND SUPPLIES, AND EQUIVALENT SERVICE STATISTICS X X X X X 0 1 0 0 0 0 0 0 0 DEBRA S REARDANZ PRESIDENT / CEO 240231 0 17000 0 0 0 14755 0 16644 0 288630 0 0 0 TIMOTHY P MAST VICE PRESIDENT OF FINANCE 122343 0 6124 0 336 0 8208 0 14073 0 151084 0 0 0 PART I, LINE 4B DEBRA S. REARDANZ RECEIVED AN EMPLOYEE MATCH PAYMENT OF $6,356 TO HER 457 PLAN IN 2019. ON JANUARY 1, 2017, CLARK-LINDSEY ENTERED INTO A SUPPLEMENTAL COMPENSATION AGREEMENT COVERING DEBRA S. REARDANZ WHICH PROVIDES FOR THE OFFICER TO RECEIVE, UPON TERMINATION OF EMPLOYMENT, PAYMENT IN CASH, IN FULL, WITHIN 90 DAYS. THE BENEFIT TO WHICH THE OFFICER IS ENTITLED TO RECEIVE BECOMES FULLY VESTED ON THE 10TH FULL CALENDAR YEAR AFTER THE GRANT DATE. IF DEATH OR DISABILITY OCCURS DURING THE PERIOD COVERED BY THE AGREEMENT, THE BALANCE OF THE ACCOUNT BECOMES 100% VESTED WITH THE BENEFIT PAYMENTS MADE TO THE BENEFICIARY. CLARK-LINDSEY'S FUNDING OF THIS BENEFIT IS BEING RECOGNIZED AS COMPENSATION COST ON AN ANNUAL BASIS AND INTENDS TO USE CASH FROM OPERATIONS TO FUND THIS OBLIGATION. AT DECEMBER 31, 2019 AND 2018, CLARK-LINDSEY HAS RECORDED A DESIGNATED INVESTMENT BALANCE AND A DEFERRED COMPENSATION LIABILITY OF APPROXIMATELY $35,000 AND $18,000. PART I, LINE 7 BONUSES ARE PROVIDED BASED UPON THE ORGANIZATION'S FINANCIAL OUTCOME. A CITY OF URBANA CHAMPAIGN COUNTY ILLINOIS 376000524 NONEAVAIL 2004-05-20 5000000 IMPROVEMENTS TO HEALTHCARE FACILITY 0 0 0 B CITY OF URBANA CHAMPAIGN COUNTY ILLINOIS 376000524 NONEAVAIL 2015-12-30 10000000 IMPROVEMENTS AND ADDITIONS TO HEALTHCARE FACILITY 0 0 0 A 2534811 5000000 97185 4902815 2005 0 0 1 1 B 540690 9986267 135458 9850809 2017 0 0 1 1 A 0 1 0 0 0.00080 0.00000 0.00080 0 0 1 B 0 1 0 0 0.00080 0.00000 0.00080 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 A 1 B 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF URBANA, CHAMPAIGN COUNTY, ILLINOIS DATE THE REBATE COMPUTATION WAS PERFORMED: 05/31/2019 SCHEDULE K, PAGE 1 - ISSUE PRICE VS. TOTAL PROCEEDS OF ISSUE THERE IS A DIFFERENCE IN THE ISSUE PRICE VS. THE TOTAL PROCEEDS OF ISSUE IN THE AMOUNT OF $13,733. SARA COOK DAUGHTER OF BOARD OF DIRECTOR DAVE LINE 49779 GROSS WAGES 0 FORM 990, PART III, LINE 2 AT HOME WITH CLV, LLC WAS ORGANIZED DURING 2019 AND BEGAN OPERATIONS IN OCTOBER OF 2019 WITH THE MISSION OF PROVIDING HOME AND COMMUNITY-BASED CARE. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD DIRECTS THAT AT LEAST ONE BOARD MEMBER, WHO SERVES ON THE FINANCE COMMITTEE, CONDUCT THE ANNUAL REVIEW OF THE FORM 990 AND PRESENT IT TO THE FULL BOARD PRIOR TO BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD DIRECTS THAT OFFICERS, DIRECTOR, AND KEY EMPLOYEES ANNUALLY DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. THE COMPLIANCE OFFICER IS RESPONSIBLE FOR PREPARING QUARTERLY REPORTS TO THE BOARD FINANCE COMMITTEE THAT DISCLOSES ACTUAL, POTENTIAL OR PERCEIVED CONFLICTS OF INTEREST. IN THE EVENT THAT A CONFLICT EXISTS, THE PERSON IS REQUIRED TO RECUSE HIMSELF OR HERSELF FROM PARTICIPATING IN THE DECISION. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD DIRECTS THAT THE PERSONNEL & POLICY COMMITTEE (P&PC) CONDUCT THE PRESIDENT'S ANNUAL PERFORMANCE REVIEW AND DEVELOP SALARY AND COMPENSATION RECOMMENDATIONS FOR FULL BOARD APPROVAL. A COMPARATIVE ANALYSIS OF THE PRESIDENT'S ANNUAL COMPENSATION IS REVIEWED BY THE P&PC USING SOURCES SUCH AS INDEPENDENT SALARY SURVEYS, REVIEW OF FORM 990S AND OTHER INFORMATION AS IT IS AVAILABLE. TO ENSURE THE INDEPENDENCE AND OBJECTIVITY OF THE COMPARATIVE REVIEW, THE DATA AND ANALYSIS IS PREPARED BY SOMEONE OTHER THAN THE PRESIDENT. IN REGARDS TO OTHER OFFICERS AND KEY EMPLOYEES, THE PRESIDENT PERFORMS A SIMILAR PROCESS USING INDEPENDENT SALARY SURVEY DATA TO DETERMINE COMPENSATION. THESE PROCESSES WERE LAST UNDERTAKEN IN 2020 AND 2019, RESPECTIVELY. FORM 990, PART VI, SECTION C, LINE 19 CLARK-LINDSEY VILLAGE, INC.'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST FOR PUBLIC INSPECTION. FORM 990, PART XII, LINE 2C THE PROCESS FOR REVIEW AND OVERSIGHT OF THE AUDIT PROCESS IS CONSISTENT WITH PRIOR YEARS. AT HOME WITH CLV LLC 101 W WINDSOR RD URBANA IL 61802 842989449 HOME HEALTH CARE IL RELATED 219830 0 1 0.80000 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 AT HOME WITH CLV LLC B 200000 FMV