2012-08-14T10:59:56-05:00 2011-09-30 CLIFTONLARSONALLEN LLP 101 N TRYON STREET SUITE 1000 CHARLOTTE NC 28246 990 2010-10-01 541327568 THE BALLENTINE HOME CORPORATION BALL 7574407400 7211 GRANBY STREET NORFOLK VA 23505 J BENJAMIN UNKLE JR 7574961104 2012-08-13 1 GREGORY W JOHNS 7049985200 2010 2016-02-24 21:20:13Z J BENJAMIN UNKLE JR 3100 SHORE DRIVE VIRGINIA BEACH VA 23451 3132424 0 X WWW.THEBALLENTINE.COM X 1985 VA TO PROVIDE ASSISTED LIVING, MEALS, SPIRITUAL, SOCIAL AND OTHER SERVICES FOR THE ELDERLY. 8 8 88 8 0 0 155925 146508 2789346 3111652 2183 24627 11500 -150363 2958954 3132424 151161 154505 0 0 1471740 1541783 0 0 0 1087373 1271827 2710274 2968115 248680 164309 6191762 6143572 4256536 4048232 1935226 2095340 THE RELIGIOUS AND CHARITABLE PURPOSES OF OPERATING A RESIDENTIAL HOME FOR AGING PERSONS AND PROVIDING RELATED SERVICES. 0 0 2104584 154505 3111652 OPERATES RESIDENTIAL ASSISTED LIVING FACILITY FOR ELDERLY INDIVIDUALS WITH AN AVERAGE OF APPROXIMATELY 66 RESIDENTS. SERVICES PROVIDED INCLUDES MEALS, NURSING CARE, SPRITUAL AND SOCIAL EVENTS. IN ADDITION, MONTHLY FELLOWSHIP ASSISTANCE, WHICH TOTALED $154,505 FOR THE YEAR, WAS AWARDED TO 7 INDIVIDUALS. 2104584 1 1 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 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 1 0 0 0 0 1 13 0 88 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X JOSEPH F BELVEDERE JR CFO 7574961104 3100 SHORE DRIVE VIRGINIA BEACH VA 23451 X ROBERT MCFARLAND 1.00 X X 0 0 0 REVERENT ALBERT G BUTZER III 1.00 X 0 0 0 THE REV CANON WIN LEWIS 1.00 X 0 0 0 BJ TAYLOR 1.00 X 0 0 0 DONNA SHIVAR 1.00 X 0 0 0 EMILY S WASHINGTON 1.00 X X 0 0 0 THE RT REV HOLLY HOLLERITH 1.00 X 0 0 0 THE REV DR J RICHARD SHORT 1.00 X 0 0 0 J BENJAMIN UNKLE JR SCH J PT III 40.00 X 0 385855 35513 DANIEL C OETZEL 40.00 X 0 214949 28968 ROBERT A HEELY 40.00 X 0 134134 26241 LORRAINE D MAHONE 40.00 X 0 142098 24033 JUDITH RAYMOND 40.00 X 0 137059 19262 ERLE MARIE LATIMER 40.00 X 0 14530 101450 0 1014095 134017 0 1 1 0 OPTIMA HEALTH PLAN PO BOX 791148 BALTIMORE MD 21279 HEALTH PLAN 173686 US FOODSERVICE INC PO BOX 396 NORFOLK VA 23501 FOOD SUPPLIER 107141 2 146508 146508 RESIDENT SERVICES 623000 3109991 3109991 1661 1661 3111652 24627 24627 LOSS ON DEBT 900099 -150363 -150363 -150363 3132424 3111652 0 -125736 154505 154505 1246490 1014428 232062 28052 20434 7618 176040 38 176002 91201 73967 17234 160236 160236 10720 10720 5000 5000 202187 110899 91288 40121 40121 74638 48818 25820 123044 123044 2097 744 1353 4892 2462 2430 92161 92161 195711 195711 69329 69329 FOOD COSTS 167172 167172 124519 100201 24318 2968115 2104584 863531 0 555036 342740 64611 110996 7590 7495 16182 6887 9936866 5542892 4534422 4393974 848226 1208051 165695 73429 6191762 6143572 165696 195320 3955000 3752500 135840 100412 4256536 4048232 X 1797937 1966048 137289 129292 1935226 2095340 6191762 6143572 X 164309 -4195 X X 0 1 1 X 0 X 217436 169943 179429 155925 171135 893868 2476747 2718044 2748242 2789346 3111652 13844031 2694183 2887987 2927671 2945271 3282787 14737899 0 0 0 14737899 38921 62062 44647 26251 24627 196508 38921 62062 44647 26251 24627 196508 -150363 -150363 2733104 2950049 2972318 2971522 3157051 14784044 0.99690 0.98720 0.01330 0.00690 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 998717 998717 8097053 4784709 3312344 663613 587935 75678 177483 170248 7235 4393974 INVESTMENTS 1208051 F 1208051 PRESENT VALUE OF INTEREST RATE SWAP 100412 100412 3132424 2968115 164309 -4195 -4195 160114 3136226 -4195 154505 150310 2985916 146508 146508 3132424 2968115 0 2968115 0 2968115 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: BALLENTINE HOME CORPORATION IS A NOT-FOR-PROFIT ORGANIZATIONS EXEMPT FROM FEDERAL AND STATE INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). BALLENTINE FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD ANY STATUS BE CHALLENGED IN THE FUTURE, THE 2009, 2010, AND 2011 TAX YEARS ARE OPEN FOR EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. MANAGEMENT IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE THE TAX-EXEMPT STATUS OF BALLENTINE. MANAGEMENT IS NOT AWARE OF ANY SIGNIFICANT ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES FOR BALLENTINE. BALLENTINE HAVE ADOPTED GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE IMPLEMENTATION HAS HAD NO IMPACT ON THE CORPORATION'S FINANCIAL STATEMENTS. 1 MONTHLY FELLOWSHIP ASSISTANCE 7 154505 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: CANDIDATES COMPLETE AN APPLICATION, WHICH IS THEN REVIEWED BY THE BALLENTINE HOME ADMINISTRATOR AND WESTMINSTER CANTERBURY'S VP OF RESIDENT AND HEALTH SERVICES. CANDIDATES WHO MEET THE QUALIFICATIONS FOR FELLOWSHIP ARE APPROVED BASED ON AVAILABLE FUNDS. ANY CONCERNS REGARDING THE APPLICATION ARE THEN ADDRESSED BY THE BALLENTINE HOME BOARD OF TRUSTEES. X 1 0 X X X X X 0 0 0 0 0 0 0 0 0 J BENJAMIN UNKLE JR SCH J PT III 0 265000 0 77500 0 43355 0 13329 0 22184 0 421368 0 0 DANIEL C OETZEL 0 166233 0 769 0 47947 0 10112 0 18856 0 243917 0 0 ROBERT A HEELY 0 130513 0 769 0 2852 0 6882 0 19359 0 160375 0 0 LORRAINE D MAHONE 0 125196 0 769 0 16133 0 7141 0 16892 0 166131 0 0 JUDITH RAYMOND 0 85734 0 0 0 51325 0 4835 0 14427 0 156321 0 0 PART I, LINE 1A TEMPORARY HOUSING IS PROVIDED AS PART OF RELOCATION ASSISTANCE. PART I, LINE 1B APPROVED EXPENSE REPORT ALONG WITH SUPPORTING RECEIPTS MUST BE SUBMITTED PRIOR TO REIMBURSEMENT. SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART II, CEO COMPENSATION: CEO COMPENSATION IS DETERMINED BY THE BOARD OF TRUSTEES AFTER REVIEWING THE RECOMMENDATIONS OF AN INDEPENDENT THIRD PARTY CONSULTANT THAT SPECIALIZES IN EXECUTIVE COMPENSATION. THE FIGURES INCLUDE RELOCATION EXPENSES SUCH AS THE VALUE OF TEMPORARY HOUSING ON-CAMPUS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS MADE AVAILABLE TO THE BOARD OF TRUSTEES FOR THEIR REVIEW BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C INDIVIDUALS WHO SERVE ON THE BOARD OF TRUSTEES ARE ASKED TO READ OUR CONFLICT OF INTEREST POLICY AND COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY. IF ANY POTENTIAL CONFLICTS ARE DISCLOSED IN THE ANNUAL QUESTIONNAIRE, THE SITUATION IS REVIEWED WITH THE PRESIDENT AND THE CHAIR OF THE BOARD. IF NECESSARY, BOARD MEMBERS RECUSE THEMSELVES FROM VOTING IF THERE IS A POSSIBILITY OF A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 IT IS THE GOAL OF THE ORGANIZATION TO SET COMPENSATION AT THE 50TH PERCENTILE OF MARKET PAY FOR EMPLOYEES WHO ARE FULLY COMPETENT IN THEIR POSITIONS. MARKET PAY IS DETERMINED BY INDEPENDENT, OUTSIDE COMPENSATION EXPERTS. TO DETERMINE COMPENSATION FOR THE PRESIDENT AND CEO, THE BOARD ENGAGES AN INDEPENDENT CONSULTANT WHO SPECIALIZES IN EXECUTIVE COMPENSATION. THE INDEPENDENT CONSULTANT UTILIZES SURVEY DATA FROM EXPERT SURVEY SOURCES. THE DATA SELECTED REPRESENTS A COMPARABLE POSITION IN ORGANIZATIONS OF SIMILAR INDUSTRIES AND SIMILAR REVENUE AND BUDGET SIZE. THE INDEPENDENT CONSULTANT PROVIDES THE COMPETITIVE MARKET DATA TO THE ORGANIZATION'S EXECUTIVE COMMITTEE, WHICH SERVES AS THE PERSONNEL COMMITTEE FOR THE BOARD OF TRUSTEES. THE EXECUTIVE COMMITTEE USES THE INFORMATION AND RECOMMENDATIONS OF THE INDEPENDENT CONSULTANT AS A BASIS FOR COMPENSATION DECISIONS. TO DETERMINE COMPENSATION FOR KEY EMPLOYEES, THE PRESIDENT AND CEO USES THE INFORMATION AND RECOMMENDATIONS OF THE INDEPENDENT CONSULTANT AS A BASIS FOR COMPENSATION DECISIONS. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, DESCRIPTION OF HOURS FOR RELATED ORGANIZATIONS: OFFICERS AND KEY EMPLOYEES LISTED ON PART VII WORK AN AVERAGE OF 40 HOURS PER WEEK. THEIR TIME IS SHARED BETWEEN THE FILING ORGANIZATION AND OTHER RELATED ENTITIES LISTED ON SCHEDULE R. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -4,195. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. FORM 990, PAGE 6, PART VI, SECTION C, LINE 20: DANIEL C. OETZEL RESIGNED FROM HIS POSITION OF CHIEF FINANCIAL OFFICER EFFECTIVE JANUARY 13, 2012. JOSEPH F. BELVEDERE, JR. WAS HIRED AS CHIEF FINANCIAL OFFICER EFFECTIVE FEBRUARY 27, 2012. WESTMINSTER-CANTERBURY OF HAMPTON ROADS FOUNDATION 3100 SHORE DRIVE VIRGINIA BEACH VA 23451 541666603 SUPPORT VA 501(C)(3) 509(A)(3) N/A 0 WESTMINSTER-CANTERBURY OF HAMPTON ROADS INC 3100 SHORE DRIVE VIRGINIA BEACH VA 23451 541071734 SERVICES TO THE ELDERLY VA 501(C)(3) 509(A)(2) N/A 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 WESTMINSTER-CANTERBURY OF HAMPTON ROADS INC K 157741 % OF REVENUE WESTMINSTER-CANTERBURY OF HAMPTON ROADS INC O 49510 TRANSFER