2013-08-09T10:33:57-05:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2012-01-01 621827185 THE VILLAGE AT GERMANTOWN INC VILL 9017374242 7820 WALKING HORSE CIRCLE GERMANTOWN TN 38138 RON RUKSTAD 9107522524 2013-08-06 1 JEFF PARKER P00970069 3149254300 2012 2016-02-24 21:20:13Z RON RUKSTAD 7820 WALKING HORSE CIRCLE GERMANTOWN TN 38138 15245723 0 X WWW.VILLAGE-GERMANTOWN.COM X 2000 TN TO OPERATE AS A CONTINUING CARE RETIREMENT COMMUNITY 6 6 285 101 0 0 0 61429 16175498 15183862 413 432 0 0 16175911 15245723 0 0 0 0 5084052 5644369 0 0 0 11609276 11163671 16693328 16808040 -517417 -1562317 70682427 71971624 87451334 93163346 -16768907 -21191722 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 14852454 15183862 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 17687 HEALTHCARE DAYS- 2710 FOR DEMENTIA, 4925 FOR ASSISTED LIVING, AND 10052 SKILLED. OF THESE DAYS, 5998 WERE MEDICARE DAYS, 3902 PRIVATE PAY DAYS, AND 152 OTHER INSURANCE BILLABLE DAYS. OUR INDEPENDENT LIVING OCCUPANCY 187 OUT OF 198. 14852454 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 1 0 0 0 1 26 0 1 285 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 TN X X JUANITA LAVY 9016844977 7820 WALKING HORSE CIRCLE GERMANTOWN TN 38138 MAURICE ELLIOTT 1.00 X X 0 0 0 DAVID PECK 1.00 X X 0 0 0 DR JOHN DOBSON 1.00 X 0 0 0 DONNA ABNEY 1.00 X 0 0 0 CAMERON WELTON 1.00 X 0 0 0 CHRIS MCLEAN 1.00 X 0 0 0 EDDY HERBERT 40.00 X 0 111763 0 RON RUKSTAD 40.00 X 0 104231 0 WILLIAM KENLEY 1.00 X 0 0 0 PAM LEET 40.00 X 130332 0 0 SALLY OSTHIEMER 40.00 X 132143 0 0 262475 215994 0 2 0 0 0 REHABCARE PO BOX 5035345 ST LOUIS MO 63150 CONTRACT THERAPY 868621 US FOODS 61 FORSYTH ST SW 8T90 ATLANTA GA 30384 FOOD 443904 CRSALCS 400 LOCUST ST SUITE 820 DES MOINES IA 50309 MANAGEMENT SERVICES 413093 TYRONE CLAY 1375 BYHALIA ROAD HERNANDO MS 38632 DRYWALL REPAIR/PAINTING 199787 ADAMS REESE LLP PO BOX 2153 BIRMINGHAM AL 35287 LEGAL 194537 8 61429 61429 PROGRAM SERVICE REVENU 623000 15183862 15183862 15183862 432 432 15245723 15183862 0 432 478469 478469 4404441 4092496 311945 335837 281474 54363 425622 356725 68897 186078 186078 105881 105881 663024 500386 162638 209993 90822 119171 106652 64610 42042 88686 88686 1280770 1231233 49537 45535 20814 24721 28200 13260 14940 2444672 2350119 94553 3212743 3088483 124260 193749 186255 7494 ANCILLIARY 1210303 1210303 DIETARY 759383 759383 MAINTENANCE 425636 425636 HOUSEKEEPING 90779 90779 111587 89676 21911 16808040 14852454 1955586 0 3077807 6202065 140652 249893 833600 1271495 30266 27256 185601 197126 73635900 17603037 57946390 56032863 8468111 7990926 70682427 71971624 5852953 3453158 43542101 45667251 34807103 39401079 204497 4333339 3044680 308519 87451334 93163346 X -16768907 -21191722 -16768907 -21191722 70682427 71971624 X -1562317 -2860498 X X 0 1 X 1 0 X 61429 61429 12536558 13419939 14708911 16175498 15183862 72024768 12536558 13419939 14708911 16175498 15245291 72086197 0 0 0 72086197 196609 3618 448 413 432 201520 196609 3618 448 413 432 201520 51301 58945 5426065 5536311 12784468 13482502 20135424 16175911 15245723 77824028 0.92630 0.91850 0.00260 0.00650 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5349049 5349049 64955917 16771198 48184719 243782 62943 180839 2977984 768896 2209088 109168 109168 56032863 DEFERRED PRE-OPENING COSTS 1743105 DEFERRED FINANCING COSTS 1564302 HELD BY TRUSTEE UNDER BOND INDENTURE 4683519 7990926 ENTRANCE FEE DEPOSITS 308519 308519 X 15245723 0 15245723 0 15245723 16808040 0 16808040 0 16808040 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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 2009 TO 2011 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 0 0 0 0 0 A 0 1 0 0 0 0 0 1 A 1 SCHEDULE K,PAGE 1, PART II, LINE 15 REFUNDING ISSUE DETAILS THESE BONDS WERE ISSUED TO ADVANCE REFUND THE SERIES 2003A AND 2006 BONDS. BOTH OF THOSE ISSUES WERE LEGALLY DEFEASED DURING 2012 AND HAVE ZERO OUTSTANDING PRINCIPAL BALANCE AS OF DECEMBER 31, 2012. AS SUCH THEY HAVE BEEN REMOVED FROM THE 2012 SCHEDULE K. 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 $182,000 UNDER THE TERMS OF THIS AGREEMENT FOR THE YEAR ENDED DECEMBER 31, 2012. 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/. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: LOSS ON REFINANCING -2,860,498. FORM 990, PAGE 12, PART XII, LINE 2C THE ORGANIZATION'S POLICY REGARDING THE OVERSIGHT OF THE AUDIT IS CONSISTENT WITH THE PRIOR YEAR. LIFE CARE SERVICES 400 LOCUST SUITE 820 DES MOINES IA 50309 MANAGEMENT OF COMMUNITY IA N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 CRSALIFE CARE SERVICES L 413093 MANAGEMENT AGREEMENT CRSALIFE CARE SERVICES O 47809 EMPLOYMENT CONTRACTS