2015-08-17T12:56:39-05:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2014-01-01 621827185 THE VILLAGE AT GERMANTOWN INC VILL 9017374242 7820 WALKING HORSE CIRCLE GERMANTOWN TN 38138 RON RUKSTAD EXECUTIVE DIRECTOR 9107522524 2015-08-11 1 JEFF PARKER P00970069 3149254300 2014 2016-03-07 17:11:31Z RON RUKSTAD 7820 WALKING HORSE CIRCLE GERMANTOWN TN 38138 16177023 0 X WWW.VILLAGE-GERMANTOWN.COM X 2000 TN TO OPERATE AS A CONTINUING CARE RETIREMENT COMMUNITY 5 5 377 100 0 0 277167 0 14441638 15284996 43542 437888 460797 454139 15223144 16177023 0 0 0 0 6391835 6907180 0 0 0 11675412 11655734 18067247 18562914 -2844103 -2385891 71988228 92695341 105935136 129055988 -33946908 -36360647 X THE MISSION OF THE VILLAGE AT GERMANTOWN IS TO PROVIDE A QUALITY, STIMULATING, AND SAFE COMMUNITY THAT PROMOTES INDEPENDENCE AND WELLNESS THROUGH INNOVATIVE PROGRAMS, SUPPORTIVE SERVICES, AND AN EXCEPTIONAL STAFF. WE RESPECT AND VALUE THE DIGNITY OF EACH PERSON THROUGH OUR AFFILIATION WITH METHODIST HEALTHCARE. WE SERVE THE COMMUNITY AS A RESOURCE FOR SENIOR WELLNESS PROGRAMS AND INFORMATION. 0 0 16352043 15284996 THE VILLAGE AT GERMANTOWN, INC. (THE COMPANY) WAS FORMED ON JULY 25, 2000 AS A NOT-FOR-PROFIT CORPORATION UNDER THE LAWS AND REGULATIONS OF THE STATE OF TENNESSEE. THE COMPANY'S PURPOSE IS TO ACQUIRE REAL PROPERTY AND TO DEVELOP, MARKET AND OPERATE THE PROPERTY AS A CONTINUING CARE RETIREMENT COMMUNITY IN SHELBY COUNTY, TENNESSEE, KNOWN AS THE VILLAGE AT GERMANTOWN, INC. (THE PROJECT). THE PROJECT CONSISTS OF 198 INDEPENDENT LIVING UNITS (INCLUDING 170 APARTMENTS AND 28 PATIO HOMES), AND A HEALTHCARE FACILITY CONSISTING OF APPROXIMATELY 13 ASSISTED LIVING UNITS, 8 SPECIAL CARE DEMENTIA UNITS, AND 30 SKILLED NURSING BEDS. PERMANENT FINANCING OF THE PROJECT OCCURRED IN DECEMBER OF 2003 WITH CONSTRUCTION BEGINNING THAT SAME MONTH. THE PROJECT WAS SUBSTANTIALLY AVAILABLE FOR OCCUPANCY BEGINNING ON OCTOBER 2005. WE BILLED 16,902 HEALTHCARE DAYS- 2,565 FOR DEMENTIA, 4,502 FOR ASSISTED LIVING, AND 9,835 SKILLED. OF THESE DAYS, 5,434 WERE MEDICARE DAYS, 11,468 PRIVATE PAY DAYS, AND 9 OTHER INSURANCE BILLABLE DAYS. OUR INDEPENDENT LIVING OCCUPANCY WAS 192 OF 198. 16352043 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 37 0 377 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 TN X X DONALD SELHEIMER 9017522508 7820 WALKING HORSE CIRCLE GERMANTOWN TN 38138 X WILLIAM KENLEY CHAIRMAN 1.00 X X 0 0 0 DAVID PECK DIRECTOR 1.00 X 0 0 0 DR JOHN DOBSON SECRETARY 1.00 X X 0 0 0 DONNA ABNEY DIRECTOR 1.00 X 0 0 0 CHRIS MCLEAN DIRECTOR 1.00 X 0 0 0 RON RUKSTAD EXECUTIVE DIRECTOR 40.00 X 103277 0 0 DONALD SELHEIMER CFO 40.00 X 219889 0 0 PAM LEET DIRECTOR OF MARKETING 40.00 X 159359 0 0 MELISSA RUKSTAD DIRECTOR OF WELLNESS 40.00 X 124687 0 0 JESSE CRITTENDON DIRECTOR OF DINING SERVICE 40.00 X 117495 0 0 724707 0 0 5 0 1 0 REHABCARE PO BOX 5035345 ST LOUIS MO 63150 CONTRACT THERAPY 911999 CRSALCS MANAGMENT LLC 400 LOCUST ST SUITE 820 DES MOINES IA 50309 MANAGEMENT SERVICES 390390 ADAM REESE LLP PO BOX 2153 BIRMINGHAM AL 35287 BUILDING RENOVATIONS 252089 TYRONE CLAY 1375 BYHALIA RD HERNANDO MS 38632 DRYWALL REPAIR/PAINTING 185480 CORDOVA CARPET 7750 TRINITY ROAD STE 101 CORDOVA TN 38018 FLOORING 110941 6 PROGRAM SERVICE REVENUE 623000 15284996 15284996 15284996 335671 335671 102217 102217 MEAL INCOME 623000 244755 244755 MISCELLANEOUS 623000 84244 84244 ENG AND MAINT 623000 79558 79558 45582 45582 454139 16177023 15284996 0 892027 183806 183806 5759643 4946293 813350 18486 15385 3101 447624 372524 75100 497621 414133 83488 145465 145465 135399 135399 657859 512421 145438 175484 155067 20417 259144 164443 94701 123416 123416 1429139 1373864 55275 71273 40981 30292 27641 14863 12778 2333388 2243139 90249 3435920 3303028 132892 199840 192111 7729 ANCILLIARY 1269033 1269033 DIETARY 813669 813669 MAINTENANCE 387635 387635 HOUSEKEEPING 71580 71580 119849 61874 57975 18562914 16352043 2210871 0 4076165 4008148 75078 192845 1182684 771428 38029 29986 168252 204345 78430126 22544594 55369150 55885532 4981551 6297264 2500361 2663234 3596958 22642559 71988228 92695341 3118043 4239775 59348277 59539582 39871894 61988430 3440649 2942961 156273 345240 105935136 129055988 X -33946908 -36360647 -33946908 -36360647 71988228 92695341 -2385891 -27848 0 X X 0 1 X 1 0 X 61429 277167 338596 14708911 16175498 15183862 14441638 15284996 75794905 14708911 16175498 15245291 14718805 15284996 76133501 0 0 0 76133501 448 413 432 43542 437888 482723 448 413 432 43542 437888 482723 5426065 460797 454139 6341001 20135424 16175911 15245723 15223144 16177023 82957225 0.91770 0.92530 0.00580 0.00060 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISC - 2010 AMOUNT: $ 5,426,065. 2013 AMOUNT: $ 36,945. 2014 AMOUNT: $ 84,244. MEAL INCOME - 2013 AMOUNT: $ 233,501. 2014 AMOUNT: $ 244,755. BEAUTY SHOP - 2013 AMOUNT: $ 48,179. 2014 AMOUNT: $ 45,582. ENG AND MAINT - 2013 AMOUNT: $ 142,172. 2014 AMOUNT: $ 79,558. 5349049 5349049 66282141 21225904 45056237 309625 99715 209910 3785055 1218975 2566080 2704256 2704256 55885532 HELD BY TRUSTEE UNDER BOND INDENTURE 22642559 22642559 ENTRANCE FEE DEPOSITS 214085 WAIT LIST DEPOSITS PAYABLE 131155 345240 16149175 -27848 -27848 16177023 0 16177023 18562914 0 18562914 0 18562914 X 0 0 0 0 0 0 0 1 0 DONALD SELHEIMER CFO 155539 0 64350 0 0 0 0 0 0 0 219889 0 0 0 PAM LEET DIRECTOR OF MARKETING 77109 0 82250 0 0 0 0 0 0 0 159359 0 0 0 PART I, LINE 7 THE ORGANIZATION PAID A PERFORMANCE BONUS TO THE CFO. A HEALTH EDUCATION & HOUSING FACILITIES BOARD OF THE COUNTY OF SHELBY TN 521283414 82169JAK9 2012-12-05 39401079 REFUNDING PRIOR ISSUANCES FROM 2003 AND 2006 AND CAPITAL PROJECTS 0 0 0 B HEALTH EDUCATION & HOUSING FACILITIES BOARD OF THE COUNTY OF SHELBY TN 521283414 82169JAP8 2014-10-01 22059660 FINANCE THE ACQUISITION, CONSTRUCTION, AND EQUIPPING OF THE EXPANSION 0 0 0 A 455000 39401079 2553003 788007 36060069 2014 0 1 1 1 B 22059660 1327030 1671938 441193 1222405 17397094 2016 0 0 0 1 A 0 1 1 1 0 0.00210 0.00210 0 0 1 B 0 1 1 1 0 0.00210 0.00210 0 0 1 A 0 1 0 0 0 0 0 1 B 0 1 0 0 0 0 1 BAYERISCHE LANDESBANK 8.000000000000 1 1 A 1 B 1 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAD AN AGREEMENT WITH LIFE CARE SERVICES (LCS) TO PROVIDE MANAGEMENT SERVICES OF ALL ASPECTS OF NORMAL OPERATIONS INCLUDING BUDGETING, BILLING, ACCOUNTING, AND OTHER MANAGEMENT RESPONSIBILITIES. EFFECTIVE JULY 1, 2014, THE ORGANIZATION MODIFIED THE AGREEMENT WITH LCS TO PROVIDE MANAGEMENT CONSULTING SERVICES FOR A PERIOD OF FIVE YEARS TERMINATING ON JULY 1, 2019. DURING THE TERM OF THIS AGREEMENT, LCS WILL CONSULT, ADVISE, AND MAKE RECOMMENDATIONS IN AN ADVISORY CAPACITY. THE ORGANIZATION INCURRED EXPENSES OF APPROXIMATELY $144,000 UNDER THE TERMS OF THE AGREEMENT FOR THE YEAR ENDED DECEMBER 31, 2014. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR OF THE ORGANIZATION PRIOR TO FILING WITH THE IRS. EACH BOARD MEMBER RECEIVES A COPY OF THE FORM 990 FOR THEIR REVIEW. THE FORM 990 IS REVIEWED BY THE BOARD AT A BOARD MEETING PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EMPLOYEES ARE REQUIRED TO SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY. FURTHERMORE, THE POLICY IS EXPLAINED DURING EACH NEW HIRE ORIENTATION AND THE ORGANIZATION MAINTAINS AN OPEN DOOR POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR IS AN EMPLOYEE OF LIFE CARE SERVICES (LCS), AND LCS DETERMINES HIS ACTUAL COMPENSATION. LCS BILLS THE VILLAGE AT GERMANTOWN FOR THE EXECUTIVE DIRECTOR'S SERVICE PER A WRITTEN EMPLOYMENT CONTRACT. THE CONTRACT WITH LCS IS APPROVED BY THE BOARD OF DIRECTORS. THE EXECUTIVE DIRECTOR DETERMINES COMPENSATION FOR DEPARTMENT DIRECTORS WITH INPUT FROM THE HR DIRECTOR. THE EXECUTIVE DIRECTOR DETERMINES THE COMPENSATION FOR THE KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST DIRECTED TO ITS HOME OFFICE AT 3350 PLAYERS CLUB PKWY, SUITE 300, MEMPHIS, TN 38125. THE ORGANIZATION MAKES ITS AUDITED FINANCIAL STATEMENTS AVAILABLE ON THE INTERNET AT HTTP://EMMA.MSRB.ORG/. FORM 990, PAGE 7, PART VII AND FORM 990 PAGE 10 PART IX RON RUKSTAD, EXECUTIVE DIRECTOR, WAS COMPENSATED IN THE AMOUNT OF $183,806 FOR 2014. THIS AMOUNT WAS NOT RECORDED ON PAGE 7 OR PAGE 10 AS HE RECEIVES HIS W-2 FROM LIFE CARE SERVICES, AND NOT FROM THIS ENTITY. FORM 990, PAGE 12, PART XII, LINE 2C THE ORGANIZATION'S POLICY REGARDING THE OVERSIGHT OF THE AUDIT IS CONSISTENT WITH THE PRIOR YEAR.