2012-09-05T09:21:32-05:00 2012-03-31 560747981 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2011-04-01 620699106 CHRISTIAN HOME FOR THE AGED INC CHRI 4236108500 309 PRINCETON ROAD JOHNSON CITY TN 37601 MYRA ZUMWALT PAESSLER 4236108500 2012-08-22 AMY BIBBY P00445891 8282542254 2011 2016-02-24 21:20:13Z APPALACHIAN CHRISTIAN VILLAGE MYRA ZUMWALT PAESSLER 309 PRINCETON ROAD JOHNSON CITY TN 37601 16680227 0 X WWW.CHRISTIANVILLIAGE.ORG X 1954 TN HELPING WITH THE CHALLENGES OF AGING BY PROVIDING QUALITY HOUSING, HEALTHCARE, AND SERVICES. 18 18 435 34 0 0 36994 84053 15789757 16182971 218908 376944 36625 36259 16082284 16680227 10310 62299 0 0 6272588 6591550 0 0 352947 9164164 9817160 15447062 16471009 635222 209218 30331773 30295395 21243257 21324337 9088516 8971058 X TO REFLECT CHRIST'S LOVE BY BEING THE PREMIER REGIONAL PROVIDER OF QUALITY SENIOR LIVING SERVICES. 0 0 14151635 62299 16252053 CHRISTIAN HOME FOR THE AGED, INC. D/B/A APPALACHIAN CHRISTIAN VILLAGE IS A NOT-FOR-PROFIT CORPORATION, ESTABLISHED BY CHRISTIAN CHURCHES TO PROVIDE HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO THE RETIRED AND AGED IN JOHNSON CITY, TENNESSEE, AND NEIGHBORING COMMUNITIES. CHRISTIAN HOME FOR THE AGED, INC. CONSISTS OF 83 INDEPENDENT LIVING UNITS, 97 CONGREGATE LIVING UNITS, 103 INTERMEDIATE AND SKILLED CARE NURSING BEDS, AND 89 ASSISTED LIVING UNITS.PINE OAKS RESIDENTS, FAMILIES, & STAFF SPONSORED ANGEL TREE DONATIONS FOR APPROXIMATELY 70 SENIORS - 12/2011, TWO PINE OAKS TEAM MEMBERS CERTIFIED THROUGH AAAD & UT EXTENSION AS TRAINERS FOR THE "LIVING WELL WITH CHRONIC CONDITIONS SELF-MANAGEMENT PROGRAM" HAVE FACILITATED A TOTAL OF FOUR COURSES THROUGHOUT THE TRI-CITIES REGION-2/2012, TWO PINE OAKS TEAM MEMBERS DELIVER MEALS ON WHEELS TWO MONDAYS PER MONTH BEGINNING 2012, OVER 1800 HOME DELIVERED MEALS DELIVERED IN FY2012, ACV DONATES CANS TO SECOND HARVEST FOOD BANK - 389 POUNDS COLLECTED IN FY2012, ACV'S HR DEPARTMENT LED A FOOD DRIVE AMOUNT EMPLOYEES AND 464 POUNDS OF ASSORTED FOOD WAS COLLECTED FOR GOOD SAMARITAN MINISTRIES - 11/2011, ACV EMPLOYEES DONATED MONEY TO WCAR WITH SECOND HARVEST FOOD BANK TO PURCHASE THANKSGIVING MEALS FOR 12 FAMILIES - 11/2011, ACV DONATED USED APPLIANCES TO THE SALVATION ARMY-9/2011, PINE OAKS EMPLOYEES PARTICIPATED IN A CARFIT EVENT WHICH WAS A FREE EDUCATIONAL EVENT OPENED TO THE PUBLIC FOR SENIOR DRIVERS AND THEIR VEHICLES - 9/2011, BLOOD DRIVE THROUGH MARSH REGIONAL BLOOD CENTER IN WHICH 8 UNITS OF BLOOD WAS COLLECTED - 11/2011,ACV SUPPLIES LAUNDRY SERVICE YEAR ROUND FOR THE INTERFAITH HOSPITALITY NETWORK (HOMELESS ASSISTANCE) WHEN THE FAMILIES STAY AT HOPWOOD MEMORIAL CHRISTIAN CHURCH EVERY 6-8 WEEKS, PINE OAKS HELD A CANNED FOOD DRIVE FOR THE RONALD MCDONALD HOUSE - 11/2011, PINE OAKS HELD AN ANNUAL ALZHEIMER'S YARD SALE AND RAISED $2,000 - 5/2011, PINE OAKS IS INVOLVED IN THE MOUNTAIN VIEW ELEMENTARY SCHOOL MULTI-GENERATIONAL PARTNERSHIP WHERE STUDENTS COME MONTHLY DURING THE SCHOOL YEAR AND OUR RESIDENTS HELP THEM WITH READING, MUSIC, AND CRAFT PROJECTS - FY2012 14151635 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 64 0 1 435 1 0 0 0 0 0 0 0 0 0 0 X 18 18 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X MYRA ZUMWALT PAESSLER 4236108556 309 PRINCETON ROAD JOHNSON CITY TN 37601 ADAM CROUCH 1.00 X X 0 0 0 RONALD HICKS 1.00 X X 0 0 0 JOHN HENSLEY 1.00 X X 0 0 0 RICHARD MEASNER 1.00 X X 0 0 0 PAUL DAVID WALKER 1.00 X X 0 0 0 STARLA BROOKS 1.00 X 0 0 0 LESLIE H OSBORN 1.00 X 0 0 0 LARRY REAVES 1.00 X 0 0 0 LARRY REYNOLDS 1.00 X 0 0 0 RONALD SALYER 1.00 X 0 0 0 L PHILLIP SAMS 1.00 X 0 0 0 SHERYL SHIPLEY 1.00 X 0 0 0 DOUGLAS THEOBALD SR 1.00 X 0 0 0 JACK CARRIER 1.00 X 0 0 0 MICHAEL FRENCH 1.00 X 0 0 0 JAMES RICHARD LEWIS 1.00 X 0 0 0 MITZI MCNAB 1.00 X 0 0 0 MELISSA WEBB 1.00 X 0 0 0 TOM SEXTON 40.00 X 170393 0 11198 MYRA PAESSLER 40.00 X 122847 0 25840 293240 0 37038 2 0 1 0 TEKA BUILDING & DEVELOPMENT 142 OKLAHOMA ROAD TELFORD TN 37690 CONSTRUCTION, RENOVATION, & FACILITY MAN 1817384 SODEXHO INC PO BOX 536922 ATLANTA GA 30319 FOOD SERVICES 1585547 FUNCTIONAL PATHWAYS PO BOX 102426 ATLANTA GA 303682426 THERAPY SERVICES 831770 PNS PHARMACY PO BOX 5289 JOHNSON CITY TN 37604 PHARMACY 366548 4 65223 18830 18095 84053 RESIDENT SERVICES 623000 16182971 16182971 16182971 158956 158956 32400 0 32400 32400 32400 217988 0 217988 217988 217988 OTHER INCOME 900099 3859 3859 3859 16680227 16186830 0 409344 62299 62299 330278 330278 5302653 4778196 409069 115388 460701 406356 43057 11288 497918 434464 54059 9395 546098 260271 243469 42358 130849 130849 2799879 2227954 550784 21141 273258 156329 111792 5137 1278090 1248097 29596 397 52656 20416 24872 7368 1091333 1067176 24157 1345371 1299063 41027 5281 171805 124596 47209 FOOD COSTS 1821211 1817127 4084 BAD DEBT 162131 143741 18390 EMPLOYEE EXPENSES 83777 61140 22612 25 EDUCATION AND TRAINING 60860 44568 16056 236 -158 -158 16471009 14151635 1966427 352947 3080 3680 437481 485121 1435794 1354516 21847 24399 96181 99339 34426447 14785899 19683469 19640548 7284360 7373863 80362 75876 1289199 1238053 30331773 30295395 758808 1025673 2864742 3060517 17535761 17169358 27660 28265 56286 40524 21243257 21324337 X 9016962 8895754 71554 75304 9088516 8971058 30331773 30295395 X 209218 -326676 X 0 1 1 X 0 X 98550 148685 157120 36994 18830 460179 12442194 14184904 15065652 15789757 16248194 73730701 12540744 14333589 15222772 15826751 16267024 74190880 0 0 0 74190880 337508 243252 293145 251308 409344 1534557 337508 243252 293145 251308 409344 1534557 12878252 14576841 15515917 16078059 16676368 75725437 0.97970 0.97960 0.02030 0.02010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1710 1710 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE ORGANIZATION PAYS DUES TO ANINDUSTRY ASSOCIATIONS. THE ORGANIZATION WAS NOTIFIED THAT APPROXIMATELY 6.3% OR $1,710 OF ITS DUES WERE USED FOR LOBBYING. 1385609 1385609 27331448 12440467 14890981 5307249 2261690 3045559 402141 83742 318399 19640548 PATIENT TRUSTS 10421 SECURITY DEPOSITS 32830 ANNUITY OBLIGATIONS -2727 40524 16680227 16471009 209218 -326676 -326676 -117458 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ACV IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; ACCORDINGLY, THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS DO NOT REFLECT A PROVISION OR LIABILITY FOR FEDERAL AND STATE INCOME TAXES. ACV HAS DETERMINED THAT IT DOES NOT HAVE ANY MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF MARCH 31, 2012. FISCAL YEARS ENDING ON OR AFTER MARCH 31, 2009 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAX AUTHORITIES. 1 LIBERTY HOUSING CORPORATION 309 PRINCETON ROAD JOHNSON CITY TN 37601 621611779 501(C)(3) 56093 FMV CONTRIBUTION TO RELATED ORGANIZATION FOR OPERATING EXPENSES APPALACHIAN CHRISTIAN VILLAGE FOUNDATION INC 309 PRINCETON ROAD JOHNSON CITY TN 37601 311789637 501(C)(3) 6206 FMV CONTRIBUTION TO RELATED ORGANIZATION FOR OPERATING EXPENSES 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION PROVIDED FUNDS TO ITS RELATED ORGANIZATIONS DURING THE YEAR. THE USE OF THE FUNDS WAS MONITORED THROUGH THE COMMON SUPERVISION AND MANAGEMENT OF THE RELATED ORGANIZATIONS. X X 0 0 0 1 0 0 0 0 0 TOM SEXTON 149638 0 15000 0 5755 0 2788 0 8410 0 181591 0 5000 0 PART I, LINE 5 THE ORGANIZATION'S CEO AND CFO ARE PAID BONUSES WHICH ARE DETERMINED BY BOTH PERFORMANCE AND EARNINGS OF THE ORGANIZATION. THE HEALTH AN EDUCATIONAL FACILITIES BOARD OF THE CITY OF JOHNSON CITY TN 521464028 47827VAH6 2004-11-10 19096778 RENOVATION AND CONSTRUCTION 2004 0 0 0 1610000 21573530 1410622 381936 275246 19489391 2006 0 0 1 1 0 0 0 0 0 0 1 0 0 1 1 FORM 990, PART VI, SECTION A, LINE 3 SODEXO IS A CONTRACTOR OF THE ORGANIZATION PROVIDING DINING SERVICES INCLUDING PREPARATION OF MEALS AS WELL AS MANAGEMENT OF ALL DINING FACILITY LABOR FOR ALL OF THE FACILITIES. TEKA IS ALSO A CONTRACTOR THAT WAS CONTRACTED BY THE ORGANIZATION TO MANAGE THE ORGANIZATION'S MAINTENANCE SERVICE DEPARTMENT AND ALL OF THE REMODELING WORK THAT IS CURRENTLY TAKING PLACE AT ALL FACILITIES. TEKA ALSO IS CONTRACTED FOR THE MANAGEMENT OF MAINTENANCE LABOR AND ENVIRONMENTAL SERVICES LABOR. FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE COMMITTEE REVIEWED THE FORM 990 AND MADE A RECOMMENDATION TO THE FULL BOARD OF DIRECTORS FOR APPROVAL. THIS APPROVAL OCCURRED AT THE LAST BOARD MEETING BEFORE THE FORM 990 WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POILCY BY ASKING EACH BOARD MEMBER TO, AT THE RENEWAL OF EACH TERM, SIGN A STATEMENT INDICATING THAT HE OR SHE HAS READ AND UNDERSTANDS THE POLICY AND ASKING EACH BOARD MEMBER TO DISCLOSE IN WRITING ANY ORGANIZATIONAL RELATIONSHIP OR OTHER ACTIVITY OR INTEREST THAT MIGHT POSSIBLY CONSITITUTE A CONFLICT OF INTEREST. IN ADDITION, THE POLICY REQUIRES THE ORGANIZATION TO IDENTIFY CONFLICTS OF INTEREST AS THEY ARISE AND CONTAINS DETAILED PROCEDURES ON HOW THE ORGANIZATION HANDLES CONFLICTS AS THEY ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS THE COMPENSATION FOR BOTH THE CEO AND CFO ON AN ANNUAL BASIS. AAHSA'S CCRC SALARY & BENEFIT REPORT FOR THE CURRENT FISCAL YEAR IS USED IN COMPENSAITON DETERMINATION. THIS INFORMATION IS REPORTED IN 3 MANNERS: BASED ON STATE, BASED ON REVENUE AND BASED ON THE NUMBER OF UNITS. THE EXECUTIVE COMMITTEE IS PROVIDED WITH THE REPORT FOR EACH MANNER AND AN AVERAGE OF THE THREE. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION MAKES ITS FORM 990 AVAILABLE UPON REQUEST. ADDITIONALLY, RECENT FILINGS OF THE FORM CAN BE FOUND ON GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -326,676. APPALACHIAN CHRISTIAN VILLAGE FOUNDATION INC 309 PRINCETON ROAD JOHNSON CITY TN 37601 311789637 TO RAISE FUNDS FOR APPALACHIAN CHRISTIAN VILLAGE NC 501(C)(3) 11, I CHRISTIAN HOME FOR THE AGED INC 1 LIBERTY HOUSING CORPORATION 309 PRINCETON ROAD JOHNSON CITY TN 37601 621611779 HOUSING NC 501(C)(3) PF CHRISTIAN HOME FOR THE AGED INC 1 0 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 LIBERTY HOUSING CORPORATION B 56093 FMV APPALACHIAN CHRISTIAN VILLAGE FOUNDATION INC K 1300489 FMV LIBERTY HOUSING CORPORATION J 459465 FMV