2014-11-17T13:14:19-06:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2013-01-01 621827185 THE VILLAGE AT GERMANTOWN INC VILL 9017374242 7820 WALKING HORSE CIRCLE GERMANTOWN TN 38138 RON RUKSTAD EXECUTIVE DIRECTOR 9107522524 2014-11-17 1 JEFF PARKER P00970069 3149254300 2013 2015-11-30 17:44:51Z RON RUKSTAD 7820 WALKING HORSE CIRCLE GERMANTOWN TN 38138 15223144 0 X WWW.VILLAGE-GERMANTOWN.COM X 2000 TN TO OPERATE AS A CONTINUING CARE RETIREMENT COMMUNITY 5 5 220 98 0 0 61429 277167 15183862 14441638 432 43542 0 460797 15245723 15223144 0 0 0 0 5644369 6391835 0 0 0 11163671 11675412 16808040 18067247 -1562317 -2844103 71971624 71533228 93163346 105480136 -21191722 -33946908 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 15883644 14441638 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 199 INDEPENDENT LIVING UNITS (INCLUDING 171 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 17,257 HEALTHCARE DAYS- 2,794 FOR DEMENTIA, 4,706 FOR ASSISTED LIVING, AND 9,757 SKILLED. OF THESE DAYS, 5,365 WERE MEDICARE DAYS, 11,883 PRIVATE PAY DAYS, AND 9 OTHER INSURANCE BILLABLE DAYS. OUR INDEPENDENT LIVING OCCUPANCY WAS 189 OUT OF 199. 15883644 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 32 0 220 1 0 0 0 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 0 0 0 DONALD SELHEIMER CFO 40.00 X 48818 0 0 PAM LEET DIRECTOR OF MARKETING 40.00 X 148249 0 0 SARA OSTHEIMER HC ADMINISTRATOR/ASSISTANT 40.00 X 136243 0 0 JESSE CRITTENDON DIRECTOR OF DINING SERVICES 40.00 X 104136 0 0 TIMOTHY NORWOOD DIRECTOR OF ENVIRONMENTAL SERVICES 40.00 X 118500 0 0 555946 0 0 4 0 0 0 REHABCARE PO BOX 5035345 ST LOUIS MO 63150 CONTRACT THERAPY 826496 CRSALCS MANAGMENT LLC 400 LOCUST ST SUITE 820 DES MOINES IA 50309 MANAGEMENT SERVICES 469071 TYRONE CLAY 1375 BYHALIA RD HERNANDO MS 38632 DRYWALL REPAIR/PAINTING 284533 SOUTHERN HOSPITALITY RENOVATIONS 185 WINDOVER RD PIPERTON TN 38017 BUILDING RENOVATIONS 250784 KENNY FLOOR COVERING INC 2665 BROAD AVENUE MEMPHIS TN 38112 FLOORING 241145 13 277167 277167 PROGRAM SERVICE REVENUE 623000 14441638 14441638 14441638 43542 43542 MEAL INCOME 623000 233501 233501 ENG AND MAINT 623000 142172 142172 BEAUTY SHOP 623000 48179 48179 36945 36945 460797 15223144 14441638 0 504339 48818 48818 5478389 4597170 881219 401455 333904 67551 463173 385237 77936 233408 233408 128644 128644 673342 522120 151222 206802 182741 24061 134656 78642 56014 146410 146410 1415794 1361035 54759 52120 18773 33347 32476 17107 15369 2358224 2267014 91210 3249407 3123729 125678 198969 191273 7696 ANCILLIARY 1187151 1187151 DIETARY 839155 839155 MAINTENANCE 609992 609992 HOUSEKEEPING 91794 91794 117068 76807 40261 18067247 15883644 2183603 0 6202065 9057716 249893 75078 1271495 1182684 27256 38029 197126 168252 75396291 20027141 56032863 55369150 7990926 5642319 71971624 71533228 3453158 3118043 45667251 59348277 39401079 39416894 4333339 3440649 308519 156273 93163346 105480136 X -21191722 -33946908 -21191722 -33946908 71971624 71533228 -2844103 -45873 -9865210 0 X X 0 1 X 1 0 X 61429 277167 338596 13419939 14708911 16175498 15183862 14441638 73929848 13419939 14708911 16175498 15245291 14718805 74268444 0 0 0 74268444 3618 448 413 432 43542 48453 3618 448 413 432 43542 48453 58945 5426065 460797 5945807 13482502 20135424 16175911 15245723 15223144 80262704 0.92530 0.92630 0.00060 0.00260 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISC - 2009 AMOUNT: $ 58,945. 2010 AMOUNT: $ 5,426,065. 2013 AMOUNT: $ 36,945. MEAL INCOME - 2013 AMOUNT: $ 233,501. BEAUTY SHOP - 2013 AMOUNT: $ 48,179. ENG AND MAINT - 2013 AMOUNT: $ 142,172. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5349049 5349049 65841035 18998506 46842529 309625 89343 220282 3255200 939292 2315908 641382 641382 55369150 DEFERRED PRE-OPENING COSTS 1079065 DEFERRED FINANCING COSTS 1421296 HELD BY TRUSTEE UNDER BOND INDENTURE 3141958 5642319 ENTRANCE FEE DEPOSITS 73178 WAIT LIST DEPOSITS PAYABLE 83095 156273 X 15177271 -45873 -45873 15223144 0 15223144 18067247 0 18067247 0 18067247 PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION APPLIES THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS AND NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE TAX RETURNS FOR THE YEARS 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. 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 A 39401079 2520082 34090099 788007 2002891 0 1 0 1 A 0 1 1 1 0 0 0 1 A 0 1 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS 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. THE ORGANIZATION INCURRED EXPENSE OF APPROXIMATELY $231,480 UNDER THE TERMS OF THIS AGREEMENT FOR THE YEAR ENDED DECEMBER 31, 2013. 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 $186,685 FOR 2013. 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.