2012-05-01T14:35:56-05:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2011-01-01 621827185 THE VILLAGE AT GERMANTOWN INC VILL 9017374242 7820 WALKING HORSE CIRCLE GERMANTOWN TN 38138 EDDY HERBERT 9107374242 2012-04-27 1 ALLAN LARSON P00028482 3149254300 2011 2016-02-24 21:20:13Z EDDY HERBERT 7820 WALKING HORSE CIRCLE GERMANTOWN TN 38138 16175911 0 X WWW.VILLAGE-GERMANTOWN.COM X 2000 TN TO OPERATE AS A CONTINUING CARE RETIREMENT COMMUNITY 5 5 287 135 0 0 0 0 14708911 16175498 448 413 5426065 0 20135424 16175911 0 0 0 0 5245559 5084052 0 0 0 11123723 11609276 16369282 16693328 3766142 -517417 71549521 70682427 87801011 87451334 -16251490 -16768907 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 14782398 16175498 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 16,858 HEALTHCARE DAYS- 2,835 FOR DEMENTIA, 4,615 FOR ASSISTED LIVING, AND 9,408 SKILLED. OF THESE DAYS, 6,349 WERE MEDICARE DAYS AND 3,059 PRIVATE PAY DAYS. INDEPENDENT LIVING OCCUPANCY WAS 183 OUT OF 199. 14782398 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 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 21 0 1 287 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 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 EDDY HERBERT 40.00 X 0 214072 0 PAM LEET 40.00 X 120669 0 0 SALLY OSTHEIMER 40.00 X 113189 0 0 233858 214072 0 2 0 1 0 REHABCARE PO BOX 503534 ST LOUIS MO 63105 CONTRACT THERAPY 905219 CRSALCS 3350 PLAYERS CLUB PARKWAY SUITE 30 GERMANTOWN TN 38125 MANAGEMENT SERVICES 422478 US FOODS 61 FORSYTH ST SW 8T90 ATLANTA GA 30384 FOOD 398243 OMNICARE INC 1504 SOUTH GRAND BLVD ST LOUIS MO 63104 PHARMACY COMPANCY 235357 TYRONE CLAY 1375 BYHALIA ROAD HERNANDO MS 38632 DRYWALL REPAIR/PAINTING 169725 10 PROGRAM SERVICE REVENU 623000 16175498 16175498 16175498 413 413 16175911 16175498 0 413 4388157 4052453 335704 278731 238648 40083 417164 357174 59990 550054 550054 175797 175797 669651 471561 198090 174568 75501 99067 107640 61880 45760 89200 89200 1221289 1174053 47236 27857 17524 10333 37025 16751 20274 2515333 2418047 97286 3206158 3082153 124005 185139 177978 7161 ANCILLIARY 1275053 1275053 DIETARY 740957 740957 MAINTENANCE 384076 384076 LETTER OF CREDIT AND BA 96221 96221 153258 142368 10890 16693328 14782398 1910930 0 1237995 3077807 192575 140652 768794 833600 27745 30266 135159 185601 73184510 15238120 59873222 57946390 9314031 8468111 71549521 70682427 3238740 5852953 45895674 43542101 35363287 34807103 206727 204497 3096583 3044680 87801011 87451334 X -16251490 -16768907 -16251490 -16768907 71549521 70682427 -517417 0 X X 0 1 1 X 0 X 11121905 12536558 13419939 14708911 16175498 67962811 11121905 12536558 13419939 14708911 16175498 67962811 0 0 0 67962811 281149 196609 3618 448 413 482237 281149 196609 3618 448 413 482237 9750 51301 58945 5426065 5546061 11412804 12784468 13482502 20135424 16175911 73991109 0.91850 0.92030 0.00650 0.00950 X 5349049 5349049 64724727 14548625 50176102 215675 48478 167197 2851790 641017 2210773 43269 43269 57946390 DEFERRED PRE-OPENING COSTS 2407145 DEFERRED FINANCING COSTS 2682098 HELD BY TRUSTEE UNDER BOND INDENTURE 3378868 8468111 LONG-TERM ACCRUED INTEREST PAYABLE 1433000 ENTRANCE FEE DEPOSITS PAYABLE 184680 FEES PAYABLE 1427000 3044680 16175911 16693328 -517417 -517417 16175911 0 16175911 0 16175911 16693328 0 16693328 0 16693328 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 2008 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. X 0 0 0 0 0 0 0 0 0 EDDY HERBERT 0 189325 0 24747 0 0 0 0 0 0 0 214072 0 0 HEALTH EDUCATION & HOUSING FACILITIES BOARD OF THE COUNTY OF SHELBY TN 511283414 82169JAB9 2003-12-18 75620946 CONSTRUCTION AND OPERATIONS 0 0 0 HEALTH EDUCATION & HOUSING FACILITIES BOARD OF THE COUNTY OF SHELBY TN 521283414 82169JAG8 2006-07-01 2400000 CONSTRUCTION AND OPERATIONS 0 0 0 42770946 75620946 3378868 1505207 1553343 3648000 65535528 2006 1 0 1 1 2200000 2400000 48000 2352000 2006 0 0 1 1 0 1 0 0 1 0 1 0 0 1 0 0 0 0 1 0 0 0 0 0 1 0 X SCHEDULE K, PAGE 1, PART II, LINE 14 REFUNDING ISSUE DETAILS THE BONDS REFUNDED BY THIS ISSUE WERE ISSUED ON SEPTEMBER 20, 2000. SCHEDULE K,PAGE 2, PART IV, LINE 2 THE 2003 BONDS INCLUDED A FIXED RATE AND VARIABLE RATE ISSUANCE. AS OF 12/31/11, THE VARIABLE RATE ISSUANCE BONDS WERE RETIRED. 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 $196,000 UNDER THE TERMS OF THIS AGREEMENT FOR THE YEAR ENDED DECEMBER 31, 2011. 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 ITS GOVERNING DOCUMENTS AND CONLICT OF INTEREST POLICY AVAILABLE UPON REQUEST DIRECTED TO ITS HOME OFFICE AT 7820 WALKING HORSE CIRCLE, GERMANTOWN, TN 38138. THE ORGANIZATION MAKES ITS AUDITED FINANCIAL STATMENTS AVAILABLE ON THE INTERNET AT HTTP://EMMA.MSRB.ORG/. FORM 990, PART XI, LINE 2C THE ORGANIZATION'S POLICY REGARDING 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 1 0 1 1 0 0 0 CRSALIFE CARE SERVICES L 196000 MANAGEMENT AGREEMENT CRSALIFE CARE SERVICES N 354054 EMPLOYMENT CONTRACTS