2015-11-09T08:32:21-06:00 2015-03-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2014-04-01 620699106 CHRISTIAN HOME FOR THE AGED INC CHRI 4236108500 309 PRINCETON ROAD JOHNSON CITY TN 37601 SIGNING OFFICER CEO 4236108500 2015-11-02 1 AMY BIBBY P00445891 8282542254 2014 2016-03-07 17:11:31Z APPALACHIAN CHRISTIAN VILLAGE TOM SECTON 309 PRINCETON ROAD JOHNSON CITY TN 37601 16317000 0 X WWW.CHRISTIANVILLIAGE.ORG X 1954 TN HELPING WITH THE CHALLENGES OF AGING BY PROVIDING QUALITY HOUSING, HEALTHCARE, AND SERVICES. 14 14 497 63 0 0 28015 2057 16307590 16000789 277346 102933 70651 76509 16683602 16182288 3920 1915 0 0 7237003 6776324 0 0 536797 10051618 10421662 17292541 17199901 -608939 -1017613 29504529 28632049 23482190 23660790 6022339 4971259 X TO REFLECT CHRIST'S LOVE BY BEING THE PREMIER REGIONAL PROVIDER OF QUALITY SENIOR LIVING SERVICES. 0 0 15153031 1915 16031290 CHRISTIAN HOME FOR THE AGED, INC. D/B/A APPALACHIAN CHRISTIAN VILLAGE IS A NOT-FOR-PROFIT CORPORATION, ESTABLISHED BY CHRISTIAN CHURCHES TO PROVIDE HOUSING, HEALTHCARE, AND OTHER RELATED SERVICES TO THE RETIRED AND AGED IN JOHNSON CITY, TENNESSEE, AND NEIGHBORING COMMUNITIES. CHRISTIAN HOME FOR THE AGED, INC. CONSISTS OF 83 INDEPENDENT LIVING UNITS, 97 CONGREGATE LIVING UNITS, 103 INTERMEDIATE AND SKILLED CARE NURSING BEDS, AND 89 ASSISTED LIVING UNITS.APRIL WAS SERVATHON MONTH: PARTICIPATED IN THE JR. LEAGUE FOOD DRIVE AT FOOD CITY IN ELIZABETHTON: COLLECTED OVER 1,000 POUNDS OF FOOD FOR SECOND HARVEST FOOD BANK. ACV HELD BLOOD DRIVES IN APRIL 2014, JULY 2014, AND JANUARY 2015 SUPPORTING MARSH REGIONAL BLOOD CENTER RESULTING IN 51 PINTS OF BLOOD DONATED, POTENTIALLY SAVING 123 LIVES. ACV AND SODEXO EMPLOYEES WORKED AT THE LOCAL SOUP KITCHEN, THE MELTING POT, AND SERVED OVER 200 MEALS. HOSTED A CANNED FOOD DRIVE AND FUND RAISER: COLLECTED OVER 900 POUNDS OF FOOD FOR SECOND HARVEST FOOD BANK. COLLECTED $250.00 FOR THE SODEXO FOUNDATION TO HELP FIGHT HUNGER. RAISED $257.00 FOR THE ALZHEIMER'S ASSOCIATION THROUGH EMPLOYEE EFFORTS DURING A "PIE IN THE FACE" FUNDRAISING EVENT; EMPLOYEES PARTICIPATED IN THE "WALK TO END ALZHEIMER'S" EVENT. COMPLETED OVER 155 POUNDS OF LAUNDRY FOR INTERFAITH HOSPITALITY NETWORK WHICH PARTNERS WITH FAMILY PROMISE TO ASSIST HOMELESS FAMILIES IN OUR COMMUNITY. DONATED VARIOUS ITEMS VALUED AT OVER $2,000 TO GOOD SAMARITAN MINISTRIES AND HAVEN OF MERCY THRIFT STORE. $343.00 IN DONATIONS TO OTHER NON-PROFIT ORGANIZATIONS IN MEMORY OF RESIDENTS. DINING SERVICES DELIVERED 2 COMPLETE MEALS TO NEEDY FAMILIES DURING THE THANKSGIVING HOLIDAY. RAISED $1,080 FOR THE LOCAL BRANCH OF THE AMERICAN CANCER SOCIETY BY HOLDING A RAFFLE OPEN TO EMPLOYEES AND RESIDENTS. IN NOVEMBER 2014, COLLECTED FOOD ITEMS FOR DONATION TO THE GOOD SAMARITAN MINISTRIES. DONATED MISCELLANEOUS LINENS INCLUDING BLANKETS, SHEETS, PADS, PILLOW CASES, ETC. TOTALING OVER 280 ARTICLES TO BENEFIT APPALACHIAN FERAL CAT ALLIES WHICH WORKS WITH LOCAL ANIMAL SHELTERS TO PROVIDE NEEDED ITEMS FOR RESCUED ANIMALS. FY14 ACV ACCOMPLISHMENTS ACCOUNTING AND FINANCE HIRED A CASE MANAGER TO HELP DETERMINE COSTS WHILE COMPLETING THE ADMISSIONS PROCESS. HIRE A BILLING OFFICE MANAGER AND NOW PERFORM ALL HCC BILLING FROM THE SHERWOOD FACILITY. WE ARE NOT ONLY 100% WITH INSURANCE VERIFICATIONS BUT WE ARE NOW 100% WITH ALL CLAIM FILING AND PROCESSING THROUGH ABILITY WEBSITE. WE HAVE MOVED OUR BANK ACCOUNTS FROM SUNTRUST TO BB&T AND HOPE TO SAVE $12,000+ PER YEAR IN BANK SERVICE CHARGES. RENOVATIONS/CAPITAL PROJECTS GENERAL: O PARTICIPATED IN THE JR LEAGUE FOOD DRIVE AT FOOD CITY IN ELIZABETHTON: COLLECTED OVER 1,000 POUNDS OF FOOD FOR SECOND HARVEST FOOD BANK O HOSTED A CANNED FOOD DRIVE AND FUND RAISER: COLLECTED OVER 900 POUNDS OF FOOD FOR SECOND HARVEST FOOD BANK AND COLLECTED $200 FOR THE SODEXO FOUNDATION TO HELP FIGHT HUNGER HCC PLANS BEING DRAWN FOR NEW RESPIRATORY UNIT ESTABLISHED EXCELLENT RELATIONSHIPS WITH MSHA, HEMA, FRANKLIN WOODS, & JCMC HOSPITALS NEW ADMINISTRATOR AND DON NEW NURSING POLICY & PROCEDURE MANUAL NEW RESTORATIVE NURSING PROGRAM NEW CASE MANAGER POSITION TO INCREASE RESIDENT CENSUS IMPLEMENTING NEW MEAL TRAY DELIVERY SYSTEM DINING DINING SERVICES RECEIVED DOUBLE GOLD ON THEIR ANNUAL FOOD SAFETY AND HEALTH & SAFETY AUDITS. THESE AUDITS ARE TOTALLY UNANNOUNCED DINING SERVICES WAS AUDITED BY BARE INTERNATIONAL, THIRD PARTY EXTERNAL AUDIT AGENCY, AND RECEIVED THE FOLLOWING SCORES: PRODUCTION-100&; SKILLED NURSING-98% AND DINING SERVICES-96%. DINING SERVICES HAD A ZERO DEFICIENCY STATE INSPECTION SERVED OVER 6,000 MEALS OVER 200 INTERNAL CATERED EVENTS STARTED A NEW DINING VENUE AT SHERWOOD: SIMPLY TO GO, A GRAB AND GO KIOSK IN THE CAF STARTED A NEW EMPLOYEE MEAL PROGRAM AT PINE OAKS WITH A BIGGER SELECTION OF ITEMS TO EAT. NAMED THE PINE OAKS CAF . HUMAN RESOURCES HAD A REDUCTION IN STAFF BUT THE HR TEAM HAS BEEN ABLE TO ACCOMMODATE THE NEEDS OF THE COMPANY, THE EMPLOYEES, THE RESIDENTS, AND THE PUBLIC WITH NO LOSS OF SERVICE. - CONDUCTED THE FIRST COMPANY-WIDE EASTER EGG HUNT FOR EMPLOYEE'S FAMILY MEMBERS AT PINE OAKS. WELL ATTENDED AND GREAT PARTICIPATION FROM STAFF/VOLUNTEERS. - REPLACED DON POSITION AFTER THE DISMISSAL OF A SEVEN YEAR DON. HAS REPLACED THE POSITION THREE TIMES BUT HAVE FILLED THE POSITION WITH AN INDIVIDUAL WITH THE SKILLS TO HELP ACV SUCCEED IN NEW VENTURES. - ACV RECEIVED A $26K SAFETY DIVIDEND FOR MAINTAINING LOW ACCIDENT CLAIMS AND DOLLARS. THIS DIVIDEND WAS EQUITABLY DISTRIBUTED TO ALL EMPLOYEES, EXCEPT DIRECTORS, WHO HAVE BEEN EMPLOYED FOR MORE THAN 90 DAYS. THIS DISBURSEMENT WAS GREATLY APPRECIATED. - ACV HAS QUALIFIED FOR THE SECOND YEAR FOR THE SAFETY DIVIDEND. THIS DIVIDEND WILL AGAIN BE DISBURSED TO THE EMPLOYEES PRIOR TO CHRISTMAS. - ACV'S WORKERS COMP MODIFIER FELL TO 0.80 FROM 0.95. - ACV HAD 29 EMPLOYEE ACCIDENTS IN FY15 WHICH IS A REDUCTION OF 6 FROM FY14, 35. - UNEMPLOYMENT CLAIMS WERE REDUCED BY MORE THAN HALF; $19,072 IN FY14 TO $6,515 IN FY15. 15153031 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 1 0 0 0 1 109 0 1 497 1 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 1 1 1 1 0 X MYRA PAESSLER 4236108556 309 PRINCETON ROAD JOHNSON CITY TN 37601 RON HICKS BOARD PRESIDENT 1.00 X X 0 0 0 PAUL DAVID WALKER VICE PRESIDENT 1.00 X X 0 0 0 JOHN HENSLEY SECRETARY 1.00 X X 0 0 0 L PHILLIPS SAMS FINANCIAL SECRETARY 1.00 X X 0 0 0 DOUGLAS THEOBALD SR TREASURER 1.00 0.10 X X 0 0 0 STARLA BROOKS BOARD MEMBER 1.00 X 0 0 0 TISHA BARBER BOARD MEMBER 1.00 X 0 0 0 DWAYNE DICKSON BOARD MEMBER 1.00 0.10 X 0 0 0 BETH SCHREINER BOARD MEMBER 1.00 X 0 0 0 RONALD SALYER BOARD MEMBER 1.00 X 0 0 0 RUTH KETRON BOARD MEMBER 1.00 X 0 0 0 SHERYL SHIPLEY BOARD MEMBER 1.00 X 0 0 0 ANN BOOKER BOARD MEMBER 1.00 X 0 0 0 ADAM CROUCH BOARD MEMBER 1.00 0.10 X 0 0 0 TOM SEXTON CEO 40.00 0.10 X 163862 0 13913 MYRA PAESSLER CFO 40.00 0.10 X 140000 0 10988 303862 0 24901 2 0 1 0 SODEXO INC PO BOX 536922 ATLANTA GA 30319 FOOD SERVICES 1741211 TEKA BUILDING & DEVELOPMENT 142 OKLAHOMA ROAD TELFORD TN 37690 CONSTRUCTION, RENOVATION, & FACILITY MAN 1550095 RELIANT REHABILITATION 11616 SOUTHFORD AVE SUITE 101 BATON ROUGE LA 70816 THERAPY SERVICES 812655 PNS INSTITUTIONAL INC PO BOX 5289 JOHNSON CITY TN 37604 PHARMACY 267721 MEDLINE INDUSTRIES INC DEPT CH 14400 PALATINE IL 60055 MEDICAL SUPPLIES 126489 6 2057 2057 RESIDENT SERVICES 623000 16000789 16000789 16000789 237641 237641 4 4 46008 0 46008 46008 46008 134712 -134712 -134712 -134712 TOWER CAFE REVENUE 900099 23291 23291 OTHER INCOME 900099 4361 4361 VENDING INCOME 900099 1889 1889 960 960 30501 16182288 16031290 0 148941 X 1915 1915 328763 310986 17777 5666946 5270437 295615 100894 472571 414911 42508 15152 308044 271173 34857 2014 14525 14525 1825757 1421388 320568 83801 300221 43800 150 256271 1410197 1187736 182742 39719 170200 64797 104482 921 1016197 985050 31147 63680 25655 22407 15618 26705 19503 7202 917700 893267 24433 1584266 1525011 56060 3195 210253 148149 62104 FOOD COSTS 1245004 1245004 MEDICAL SUPPLIES EXPENS 1005464 1005464 BED TAX 360916 360916 BAD DEBT 192244 192244 78333 76611 287 1435 17199901 15153031 1510073 536797 3715 4295 89295 119547 1083656 982172 20938 39178 113664 167754 37939992 19016596 19236881 18923396 8244741 7658977 88252 103700 623387 633030 29504529 28632049 1001783 1214166 3180527 3499208 19262489 18908023 37391 39393 23482190 23660790 X 6022339 4971259 6022339 4971259 29504529 28632049 -1017613 -33467 0 X 0 1 X 1 0 X 36994 18830 3887 28015 2057 89783 15789757 16248194 15774888 16307590 16000789 80121218 15826751 16267024 15778775 16335605 16002846 80211001 0 0 0 80211001 251308 409344 206659 287831 283653 1438795 251308 409344 206659 287831 283653 1438795 18785 24643 30501 73929 16078059 16676368 16004219 16648079 16317000 81723725 0.98150 0.98160 0.01760 0.01790 X 0 0 0 0 0 0 0 0 1 2120 2120 0 PART II-B, LINE 1: THE ORGANIZATION PAYS DUES TO AN INDUSTRY ASSOCIATIONS. THE ORGANIZATION WAS NOTIFIED THAT APPROXIMATELY 25% OR $2,210 OF ITS DUES WERE USED FOR LOBBYING. 1385609 1385609 27607303 14436930 13170373 855993 447632 408361 7579638 3963687 3615951 511449 168347 343102 18923396 PATIENT TRUSTS 15893 SECURITY DEPOSITS 23500 39393 X PART X, LINE 2: ACV IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. ACV HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF MARCH 31, 2015. FISCAL YEARS ENDING ON OR AFTER MARCH 31, 2012 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. X X 0 0 0 1 0 0 0 0 0 TOM SEXTON CEO 158449 0 5413 0 0 0 2596 0 11317 0 177775 0 0 0 MYRA PAESSLER CFO 122308 0 17692 0 0 0 7100 0 3888 0 150988 0 0 0 PART I, LINE 5 THE ORGANIZATION'S CEO AND CFO ARE PAID BONUSES WHICH ARE DETERMINED BY BOTH PERFORMANCE AND EARNINGS OF THE ORGANIZATION. A THE HEALTH AN EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN 521464028 4782R4AP6 2013-02-15 19853552 SEE PART VI 0 0 0 A 350000 19853552 17451947 390399 2011206 2014 0 1 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 1 0 A 1 FORM 990, PART VI, SECTION A, LINE 1 THE BOARD ELECTED UNDER THE BOARD OF DIRECTORS SHALL IN TURN ELECT FROM THEIR NUMBER: - PRESIDENT - VICE-PRESIDENT - SECRETARY - TREASURER - FINANCIAL SECRETARY THESE OFFICERS SHALL BE THE EXEUCTIVE COMMITTEE. THE IMMEDIATE PAST PRESIDENT SHALL BE AN EX-OFFICIO MEMBER OF THE EXECUTIVE COMMITTEE IN ORDER TO PROVIDE CONTINUITY FROM YEAR TO YEAR. HE/SHE SHALL HAVE NO VOTING PRIVILEGES. FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE COMMITTEE REVIEWED THE FORM 990 AND MADE A RECOMMENDATION TO THE FULL BOARD OF DIRECTORS FOR APPROVAL. THIS APPROVAL OCCURRED AT THE LAST BOARD MEETING BEFORE THE FORM 990 WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POILCY BY ASKING EACH BOARD MEMBER TO, AT THE RENEWAL OF EACH TERM, SIGN A STATEMENT INDICATING THAT HE OR SHE HAS READ AND UNDERSTANDS THE POLICY AND ASKING EACH BOARD MEMBER TO DISCLOSE IN WRITING ANY ORGANIZATIONAL RELATIONSHIP OR OTHER ACTIVITY OR INTEREST THAT MIGHT POSSIBLY CONSITITUTE A CONFLICT OF INTEREST. IN ADDITION, THE POLICY REQUIRES THE ORGANIZATION TO IDENTIFY CONFLICTS OF INTEREST AS THEY ARISE AND CONTAINS DETAILED PROCEDURES ON HOW THE ORGANIZATION HANDLES CONFLICTS AS THEY ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS THE COMPENSATION FOR BOTH THE CEO AND CFO ON AN ANNUAL BASIS. AAHSA'S CCRC SALARY & BENEFIT REPORT FOR THE CURRENT FISCAL YEAR IS USED IN COMPENSAITON DETERMINATION. THIS INFORMATION IS REPORTED IN 3 MANNERS: BASED ON STATE, BASED ON REVENUE AND BASED ON THE NUMBER OF UNITS. THE EXECUTIVE COMMITTEE IS PROVIDED WITH THE REPORT FOR EACH MANNER AND AN AVERAGE OF THE THREE. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE UPON REQUEST. ADDITIONALLY, RECENT FILINGS OF THE FORM CAN BE FOUND ON GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 917,676. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 917,676. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 503,712. MANAGEMENT AND GENERAL EXPENSES 320,568. FUNDRAISING EXPENSES 83,801. TOTAL EXPENSES 908,081. APPALACHIAN CHRISTIAN VILLAGE FOUNDATION INC 309 PRINCETON ROAD JOHNSON CITY TN 37601 311789637 TO RAISE FUNDS FOR APPALACHIAN CHRISTIAN VILLAGE TN 501(C)(3) 11, I CHRISTIAN HOME FOR THE AGED INC 1 LIBERTY HOUSING CORPORATION 309 PRINCETON ROAD JOHNSON CITY TN 37601 621611779 HOUSING TN 501(C)(3) PF CHRISTIAN HOME FOR THE AGED INC 1 0 0 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0