2012-12-21T08:20:27-06:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2011-07-01 370987659 FAIR HAVENS CHRISTIAN HOME FAIR 3145877903 622 EMERSON RD NO 310 ST LOUIS MO 63141 SUSAN MCGHEE 3145877903 2012-12-20 1 ALLAN LARSON P00028482 3149254300 2011 2016-02-24 21:20:13Z SUSAN MCGHEE 622 EMERSON RD NO 310 ST LOUIS MO 63141 17044668 0 X WWW.CHRISTIANHOMES.ORG X 1975 IL TO PROVIDE QUALITY CARE FOR THE AGED IN A CHRISTIAN ENVIRONMENT. 15 15 421 2232 0 0 89976 48014 14015760 16746451 90219 149550 116785 100043 14312740 17044058 0 0 0 0 6600959 8359256 0 0 0 6346656 9017650 12947615 17376906 1365125 -332848 32389107 32452532 20499709 20902569 11889398 11549963 X THE MISSION OF FAIR HAVENS CHRISTIAN HOME IS TO CREATE AN EXCITING LIFESTYLE AND TO PROVIDE HIGH QUALITY CARE FOR SENIORS ON A CONTINUUM OF CARE CAMPUS. PROVIDING CARE IN A CHRISTIAN ENVIRONMENT PROVIDES A UNIQUE OPPORTUNITY TO MEET THE NEEDS OF SENIORS PHYSICALLY, MENTALLY, AND SPIRITUALLY. OUR COMMITMENT TO EXCELLENCE IS MOTIVATED BY OUR CHRISTIAN BELIEF THAT ALL ARE PRECIOUS IN THE SIGHT OF GOD. 0 0 14644403 16752121 FAIR HAVENS CHRISTIAN HOMES, INC. PROVIDES QUALITY CARE OF SENIORS IN A CHRISTIAN ENVIRONMENT. THE CAMPUS HAS A SKILLED NURSING FACILITY WITH 61,246 PATIENT DAYS OF SERVICE DURING THE YEAR, AND AN ASSISTED LIVING FACILITY PROVIDED 15,673 ASSISTED PATIENT DAYS. 52 RESIDENTS WERE SERVED IN THE INDEPENDENT LIVING APARTMENTS. 14644403 1 1 0 0 0 0 0 0 0 1 1 0 0 1 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 0 0 0 0 1 32 0 1 421 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X MIDWEST CHRISTIAN VILLAGES 3145877903 622 EMERSON RD SUITE 310 ST LOUIS MO 63141 JIM BLALOCK 3.00 X 0 0 0 BOB CROSBY 3.00 X X 0 0 0 BILLY D CARTER 3.00 X X 0 0 0 RANDY CLARK 3.00 X 0 0 0 JAMES S FRASURE MD 3.00 X 0 0 0 MAURINE COLLETT 3.00 X 0 0 0 TERRY GOODNER 3.00 X X 0 0 0 NICHOLAS A FILING 3.00 X 0 0 0 MARYLYN ROWE 3.00 X 0 0 0 DICK HART 3.00 X 0 0 0 RONALD F SEWELL 3.00 X X 0 0 0 PATRICIA LINCOLN 3.00 X 0 0 0 BILIE W LASH 3.00 X 0 0 0 MARK A BEHRENDS 3.00 X 0 0 0 VICTOR S WILLIAMS 3.00 X 0 0 0 TIMOTHY PHILLIPPE 40.00 X 0 435271 6156 SUSAN MCGHEE 40.00 X 0 235979 13656 MARK LONGENECKER 40.00 X 0 201119 9156 SHERRY GUTERMUTH 40.00 X 0 200683 13656 LAURIE BROWN 40.00 X 0 154949 13031 JOHN RUPKEY 40.00 X 0 173381 13031 KELLY KELLEY 40.00 X 0 181306 13656 GREG WITTE 40.00 X 0 152772 13031 MARK CANTY 40.00 X 0 169999 1500 ROBERT VINCENT 40.00 X 0 153063 6156 0 2058522 103029 0 0 1 0 KINDRED REHAB SERVICES PO BOX 277365 ATLANTA GA 303847365 THERAPY SERVICES 990181 LEADERSTAT 1322 B MANNING PARKAWAY POWELL OH 43065 CONSULTING 127188 2 48014 48014 NURSING HOME OPERATION 623000 14260870 14260870 ASSISTED LIVING 623990 1793849 1793849 INDEPENDENT RETIREMENT 623990 691732 691732 16746451 93229 93229 56931 0 610 56931 -610 56321 56321 BEAUTY AND BARBER 900099 54853 54853 CABLE TV 900099 24084 24084 TELEPHONE 900099 12151 12151 8955 5670 3285 100043 17044058 16752121 0 243923 6712779 6176255 536524 1141211 1049999 91212 505266 464882 40384 1120192 1120192 66814 66814 1793270 1705746 87524 77439 20981 56458 1202126 1089248 112878 455900 455900 22084 9416 12668 4820 2184 2636 891935 891935 1290836 1290836 184908 184908 RAW FOOD 570495 570495 MISCELLANEOUS 522343 2537 519806 PURCHASED SERVICES 443185 443185 REAL ESTATE TAXES 276870 276870 94433 9026 85407 17376906 14644403 2732503 0 5632869 3282251 1391483 795287 2882425 29639 32323 19729 23348 31245217 10326593 14270287 20918624 1508626 1586423 10132670 2335655 32389107 32452532 1502794 2296583 704384 646790 15389237 15090212 562564 527509 2340730 2341475 20499709 20902569 X 11842704 11547665 46694 2298 11889398 11549963 32389107 32452532 X -332848 -6587 X X 0 1 1 X 0 X 52599 51397 56576 89976 94435 344983 11307713 12953711 13491078 14015760 16746451 68514713 11360312 13005108 13547654 14105736 16840886 68859696 0 0 0 68859696 163860 165948 138123 53271 93229 614431 163860 165948 138123 53271 93229 614431 88383 93504 100149 106408 100093 488537 11612555 13264560 13785926 14265415 17034208 69962664 0.98420 0.98200 0.00880 0.01060 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 816017 41406 857423 780775 35242 816017 782155 -1380 780775 815662 -33507 782155 1.00000 0 0 414454 414454 27276521 8231074 19045447 3554242 2095519 1458723 20918624 ACCRUED INTEREST RECEIVABLE 10590 RESIDENT TRUST 31568 OTHER NON-CURRENT ASSETS 6353 BOND FUND 1132485 ENDOWMENT FUND 857423 DEFERRED FINANCING COSTS 226447 CONSTRUCTION IN PROGRESS 70789 2335655 DUE TO AUXILIARY 292742 CURRENT PORTION OF REFUNDABLE ENTRANCE FEE 335400 REFUNDABLE ENTRANCE FEES 1712168 SECURITY DEPOSITS PAYABLE 1165 2341475 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ORGANIZATION HOLDS FUNDS IN ENDOWMENT DESIGNATED BY THE BOARD OF DIRECTORS TO BE USED FOR RESIDENT CARE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION QUALIFIES AS A TAX-EXEMPT CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ORGANIZATION IS NOT SUBJECT TO FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE CODE. THE ORGANIZATION IS CLASSIFIED AS A PUBLICLY-SUPPORTED CHARITABLE ORGANIZATION UNDER THE CODE AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS A CHARITABLE TAX DEDUCTION FOR THE CONTRIBUTOR. THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATIONS FINANCIAL STATEMENTS. IT ALSO PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THIS STANDARD HAS NO IMPACT ON THE ORGANIZATIONS' FINANCIAL STATEMENTS. THE ORGANIZATIONS' 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 THEIR TAX-EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES OTHER THAN WHAT IS ALREADY BEING REPORTED. THE TAX RETURNS FOR THE YEARS 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. X 1 1 X X X X 0 0 0 0 0 0 0 1 0 TIMOTHY PHILLIPPE 0 366959 0 60800 0 7512 0 0 0 6156 0 441427 0 0 SUSAN MCGHEE 0 209979 0 26000 0 0 0 0 0 13656 0 249635 0 0 MARK LONGENECKER 0 160030 0 35700 0 5389 0 0 0 9156 0 210275 0 0 SHERRY GUTERMUTH 0 160619 0 35700 0 4364 0 0 0 13656 0 214339 0 0 LAURIE BROWN 0 123470 0 28961 0 2518 0 0 0 13031 0 167980 0 0 JOHN RUPKEY 0 142822 0 25000 0 5559 0 0 0 13031 0 186412 0 0 KELLY KELLEY 0 158580 0 22726 0 0 0 0 0 13656 0 194962 0 0 GREG WITTE 0 126137 0 24453 0 2182 0 0 0 13031 0 165803 0 0 MARK CANTY 0 169999 0 0 0 0 0 0 0 1500 0 171499 0 0 ROBERT VINCENT 0 130774 0 17932 0 4357 0 0 0 6156 0 159219 0 0 PART I, LINE 1A TIMOTHY PHILLIPPE RECEIVED A HOUSING ALLOWANCE OF $14,500 AND ROBERT VINCENT HAS A HOUSING ALLOWANCE OF $28,600. PART I, LINE 7 TIM PHILLIPPEE, MARK LONGENECKER, SHERRY GUTERMUTH, LAURIE BROWN, JOHN RUPKEY, ROBERT VINCENT AND GREG WITTE RECEIVED $7,512, $5,389, $4,364, $2,518, $5,559, $4,357 AND $2,182, RESPECTIVELY, FOR SELLBACK OF PTO AND IS INCLUDED IN OTHER REPORTABLE COMPENSATION FROM A RELATED ORGANIZATION. ILLINOIS FINANCE AUTHORITY 861091967 45200B6K9 2007-06-28 37578378 REFINANCE 0 0 0 ILLINOIS FINANCE AUTHORITY 861091967 45200F5E5 2010-07-29 24614950 REFINANCE SERIES 2007C AND FUND CONSTRUCTION PROJECTS 0 0 0 466900 8643027 891835 161056 2971794 4618342 2010 1 0 1 1 49803 4626048 518163 92521 2387224 1628141 2012 1 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 X PROCEEDS OF 2007 BOND ISSUANCE: THE PROCEEDS OF THE 2007A, 2007B AND 2007C BONDS WERE USED TO REFUND THE $4,775,000 SERIES 1989A BONDS OF BENSENVILLE HOME SOCIETY, REFUND THE $17,100,000 SERIES 1995A BONDS OF LIFELINK CORPORATION OBLIGATED GROUP, REFUND THE $18,410,000 SERIES 1998 BONDS OF LIFELINK CORPORATION OBLIGATED GROUP, REFUND THE $1,920,000 SERIES 2002 BONDS OF LEWIS MEMORIAL CHRISTIAN VILLAGE, AND REFUND THE $6,800,000 SERIES 2004 BONDS OF FAIR HAVENS CHRISTIAN HOME. PROCEEDS OF 2010 BOND ISSUANCE: THE PROCEEDS OF THE 2010 BOND ISSUANCE WAS FOR THE BENEFIT OF: CHRISTIAN HOMES, INC 37-0841562 $4,545,361 FAIR HAVENS CHRISTIAN HOME, INC 37-0987659 $4,626,048 LEWIS MEMORIAL CHRISTIAN VILLAGE 51-0173104 $5,352,230 MIDWEST SENIOR MINISTRIES, INC. 20-1053401 $10,091,311 PROCEEDS OF 2007 BOND ISSUANCE: THE PROCEEDS OF THE 2007 BOND ISSUANCE WAS FOR THE BENEFIT OF: CHRISTIAN HOMES, INC. 37-0841562 $6,388,324 FAIR HAVENS CHRISTIAN HOME, INC. 37-0987659 $8,643,027 LEWIS MEMORIAL CHRISTIAN VILLAGE 51-0173104 $4,885,189 MIDWEST SENIOR MINISTRIES, INC. 20-1053401 $17,661,838 SCH K, PART II, LINE 7: FAIR HAVEN CHRISTIAN HOME HAS ELECTED TO AMORTIZE THE ISSUANCE COST OVER THE LIFE OF THE BOND. THIS HAS LED TO A DIFFERENCE BETWEEN THE ISSUED 8038 AND THE BOOK VALUE OF ISSUANCE COST. SCH K, PART III, LINE 5: MIDWEST SENIOR MINISTRIES, A RELATED ORGANIZATION LISTED ON SCHEDULE R, LEASES OFFICE SPACE TO THREE UNRELATED NONPROFIT ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES MANAGEMENT DUTIES INCLUDING SUPERVISING PERSONNEL, OPERATIONS, AND BUDGETING TO MIDWEST CHRISTIAN VILLAGES, A MANAGEMENT COMPANY AND RELATED EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD GETS A DRAFT OF THE 990 ELECTRONICALLY SENT TO THEM FOR REVIEW PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENT IS INCLUDED IN THE EMPLOYEE HANDBOOK WHICH EVERY EMPLOYEE IS GIVEN A COPY OF AND SIGNS AN ACKNOWLEDGEMENT FOR ON THEIR FIRST DAY OF EMPLOYMENT. IF A VIOLATION OCCURS EMPLOYEES CAN REPORT DIRECTLY TO THEIR SUPERVISOR OR USE THE 800 NUMBERS WHICH ARE POSTED AT EACH LOCATION. VIOLATIONS ARE INVESTIGATED BY INDIVIDUALS AT THE VICE PRESIDENT LEVEL AND AT LEAST TWO INDIVIDUALS WOULD MAKE THE FINAL DETERMINATION AS TO THE APPROPRIATE ACTION TO BE TAKEN. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION PARTICIPATES IN SEVERAL (MINIMUM OF 3) INDUSTRY SPECIFIC, EXECUTIVE SALARY SURVEYS EACH YEAR TO HELP DETERMINE COMPETITIVENESS OF OUR EXECUTIVE AND SENIOR MANAGEMENT POSITIONS. THE SALARIES ARE DISCUSSED AND REVIEWED BY THE PRESIDENT AND VICE PRESIDENT OF HUMAN RESOURCES. IF A NEW HIRE IS BEING CONSIDERED FOR AN EXECUTIVE LEVEL POSITION, IT MAY ALSO BE DISCUSSED WITH THE BOARD. IN 2010, THE ORGANIZATION ESTABLISHED A COMPENSATION COMMITTEE OF THE BOARD HEADED BY A PERSON WHOSE ENTIRE CAREER WAS IN HUMAN RESOURCES AND INCLUDES THE ORGANIZATION'S VICE PRESIDENT OF HUMAN RESOURCES AS WELL AS A FEW OTHER BOARD MEMBERS. REVIEW AND PARTICIPATION IN SEVERAL INDUSTRY SPECIFIC SALARY SURVEYS WHICH PROVIDE DATA ON OTHER EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION POSTS ITS FINANCIAL STATEMENTS ON ITS WEBSITE MONTHLY. FINANCIAL STATEMENTS CAN ALSO BE OBTAINED ON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -6,587. AUDIT COMMITTEE OVERSIGHT & REVIEW FORM 990, PAGE 12, PART XII, LINE 2C THE ORGANIZATION HAS NOT CHANGED ITS PROCESS FROM THE PRIOR YEAR. CHRISTIAN HOMES INC 200 N POSTVILLE DR LINCOLN IL 62656 370841562 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS IL 501(C)(3) LINE 9 N/A 0 LEWIS MEMORIAL CHRISTIAN VILLAGE 3400 W WASHINGTON ST SPRINGFIELD IL 62711 510173104 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS IL 501(C)(3) LINE 9 N/A 0 HOOSIER CHRISTIAN VILLAGE 621 S SUGAR ST BROWNSTOWN IN 47220 237423749 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS IN 501(C)(3) LINE 9 N/A 0 SPRING RIVER CHRISTIAN VILLAGE 201 S NORTHPARK LANE JOPLIN MO 64801 431341462 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS MO 501(C)(3) LINE 9 N/A 0 CHICAGOLAND CHRISTIAN VILLAGE 6685 E 117TH ST CROWN POINT IN 46307 311114614 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS IN 501(C)(3) LINE 9 N/A 0 RISEN SON CHRISTIAN VILLAGE 3000 RISEN SON BLVD COUNCIL BLUFFS IA 51503 421279738 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS IA 501(C)(3) LINE 9 N/A 0 VILLAGE CHRISTIAN PARKE 675 SOUTH FORD RD ZIONSVILLE IN 46077 311172227 RETIREMENT APARTMENTS IN 501(C)(3) LINE 9 N/A 0 MIDWEST SENIOR MINISTRIES 111 E WASHINGTON BENSENVILLE IL 60106 201053401 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS IL 501(C)(3) LINE 9 N/A 0 MIDWEST CHRISTIAN VILLAGES 200 N POSTVILLE DR LINCOLN IL 62656 260275009 MGMT NURSING AND RETIREMENT COMMUNITIES IL 501(C)(3) LINE 9 N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 MIDWEST CHRISTIAN VILLAGES L 1120192 FMV CHRISTIAN HOMES INC O 535967 FMV MIDWEST SENIOR MINISTRIES O 554485 FMV