2012-11-09T09:33:02-06:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2011-07-01 311002846 WESTMINSTER VILLAGE WEST LAFAYETTE INC WEST 7654637546 2741 NORTH SALISBURY STREET WEST LAFAYETTE IN 47906 VICKI GREGORY 7654637546 2012-10-30 1 JEFF PARKER P00970069 3149254300 2011 2016-02-24 21:20:13Z VICKI GREGORY 2741 NORTH SALISBURY STREET WEST LAFAYETTE IN 47906 14209273 0 X N/A X 1976 IN PROVIDES RESIDENTIAL FACILITIES DESIGNED TO MEET THE NEEDS OF THE ELDERLY. 9 9 270 112 0 0 92045 113599 13982511 13608659 12188 -379 454844 483096 14541588 14204975 0 164824 0 0 6200358 6555289 0 0 0 7023148 7373857 13223506 14093970 1318082 111005 42614098 54160302 35885459 49076764 6728639 5083538 PROVIDES RESIDENTIAL FACILITIES DESIGNED TO MEET THE NEEDS OF THE ELDERLY AND PROVIDE FOR THE PHYSICAL, MENTAL AND FINANCIAL WELL BEING OF ITS RESIDENTS. FINANCIAL ASSISTANCE IS PROVIDED TO THOSE RESIDENTS UNABLE TO MEET THEIR LIVING EXPENSES. 0 0 12243379 164824 13608659 WESTMINSTER VILLAGE WEST LAFAYETTE, INC. IS A NOT-FOR-PROFIT, CONTINUING CARE RETIREMENT COMMUNITY LOCATED IN WEST LAFAYETTE, INDIANA. FACILITIES INCLUDE 130 RESIDENTIAL UNITS (INDEPENDENT LIVING CENTER), 57 INDEPENDENT LIVING COTTAGES, A 55 BED COMPREHENSIVE CARE FACILITY (THE HEALTH CENTER), AND A 76 BED ASSISTED LIVING FACILITY. WESTMINSTER'S PRIMARY PURPOSE IS THE PROVISION OF CONTINUING CARE SERVICES TO THE CITIZENS OF WEST LAFAYETTE, INDIANA AND THE SURROUNDING COMMUNITIES. 12243379 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 1 17 0 270 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X WESTMINSTER VILLAGE WEST LAFAYETTE 7654637546 2741 NORTH SALISBURY WEST LAFAYETTE IN 47906 DAVID LUHMAN 12.00 X X 0 0 0 PETER NEISEL 5.00 X 0 0 0 MARILYN WHITSEL 5.00 X X 0 0 0 JOLENE MILLER 5.00 X 0 0 0 THOMAS PEARSON 15.00 X X 0 0 0 ROBERT WOERNER 12.00 X X 0 0 0 JAMES ALMOND 5.00 X 0 0 0 STEVEN HABBEN 10.00 X 0 0 0 MARTHA CHISCON 5.00 X 0 0 0 DAWN WALKER 40.00 X 126719 0 0 126719 0 0 1 0 0 0 KETTELHUT CONSTRUCTION 740 SAGAMORE PARKWAY SOUTH LAFAYETTE IN 47903 CONSTRUCTION 3747000 CRSA LCS MANAGEMENT LLC 400 LOCUST ST SUITE 820 DES MOINES IA 47903 MANAGEMENT SERVICES/ EMPLOYMENT 854448 GORDON FOOD SERVICE DEPT CH 10490 PALATINE IL 60055 FOOD, SUPPLIES, CHEMICALS 832969 HUSTON ELECTRIC PO BOX 904 KOKOMO IN 46903 ELECTRICAL SYSTEMS 601078 THE TROYER GROUP 550 UNION STREET MISHAWAKA IN 46544 ARCHITECTURAL SERVICES 550479 17 104824 8775 113599 SERVICE FEES 623000 12888213 12888213 LIFE OCC. FEE AMORTIZA 623000 720446 720446 13608659 3919 3919 4298 -4298 -4298 -4298 OTHER INCOME 623000 202198 202198 PHARMACY INCOME 623000 77671 77671 GUEST ROOMS/MEALS 623000 74305 74305 128922 128922 483096 14204975 13608659 0 482717 60000 60000 104824 104824 5337761 4591628 746133 33362 28699 4663 783092 673628 109464 401074 345010 56064 457129 457129 4099 4099 55221 55221 944182 932182 12000 226076 226076 517943 407562 110381 54951 54951 656258 656258 113497 113497 300743 282656 18087 2647073 2487984 159089 238930 238930 FOOD 830130 830130 EQUIPMENT AND MAINT 122951 122951 MISCELLANEOUS 75985 31426 44559 RESIDENT ENTERTAINMENT 62864 62864 65825 65825 14093970 12243379 1850591 0 2960370 4432909 4034125 4018847 411909 189903 48441 57120 11865 36025 69577763 24595589 34699234 44982174 448154 443324 42614098 54160302 1790192 1317689 19133408 22845246 14843359 23804349 118500 1109480 35885459 49076764 X 6720138 5066262 8501 17276 6728639 5083538 42614098 54160302 X 111005 -1756106 X X 0 1 1 X 0 X 86010 81875 103346 92045 113599 476875 10123723 12109227 12603449 13982511 10582729 59401639 10209733 12191102 12706795 14074556 10696328 59878514 0 0 0 59878514 142599 68268 29715 12188 3919 256689 142599 68268 29715 12188 3919 256689 359384 383577 402801 454844 483096 2083702 10711716 12642947 13139311 14541588 11183343 62218905 0.96240 0.96120 0.00410 0.00710 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2939505 2939505 56650982 21975786 34675196 6411408 2619803 3791605 3575868 3575868 44982174 RESIDENT DEPOSITS 129000 FAIR VALUE OF INTEREST RATE SWAPS 980480 1109480 14204975 14093970 111005 -15279 -1006121 -734706 -1756106 -1645101 13350166 -15279 -734706 -749985 14100151 104824 104824 14204975 13989146 0 13989146 104824 104824 14093970 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE VILLAGE ADOPTED 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 VILLAGE DOES NOT CURRENTLY INCLUDE AN INCOME TAX PROVISION IN THE FINANCIAL STATEMENTS. MANAGEMENT MONITORS THE REPORTING OF UNCERTAIN TAX POSITIONS, WHICH COULD RESULT IN RECORDING OF AN INCOME TAX PROVISION IN THE FUTURE. WESTMINISTER VILLAGE WEST LAFAYETTE, INC. TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE VILLAGE IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX EXEMPT STATUS AND IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAX EXCEPT FOR THOSE THAT ARE ALREADY REPORTED ANNUALLY. THE TAX RETURNS FOR THE YEARS 2009 THROUGH 2011 ARE OPEN TO EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: UNREALIZED LOSS ON SWAP -734,706. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED LOSS ON SWAP -734,706. PART XII, LINE 4B - OTHER ADJUSTMENTS: GRANT EXPENSES NETTED WITH REVENUE ON F/S 104,824. PART XIII, LINE 4B - OTHER ADJUSTMENTS: GRANT EXPENSES NETTED WITH REVENUE ON F/S 104,824. 1 CITY OF WEST LAFAYETTE INDIANA 609 NAVAJO DRIVE WEST LAFAYETTE IN 47906 356001233 60000 PAYMENT IN LIEU OF REAL ESTATE TAXES AS PART OF COMMUNITY SUPPORT INITIATIVES. 1 FINANCIAL ASSISTANCE 5 104824 0 FAIR MARKET VALUE PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FINANCIAL ASSISTANCE IS PROVIDED ON AN ANNUAL BASIS WITH THE REVIEW AND WRITE OFF OF THE ACCOUNTS RECEIVABLE. CITY OF WEST LAFAYETTE IN 356001233 NONEAVAIL 2010-08-26 8500000 REPAY PREVIOUS MORTGAGE. 0 0 0 CITY OF WEST LAFAYETTE IN 356001233 NONEAVAIL 2010-08-26 17000000 NEW CONSTRUCTION, RENOVATION OF EXISTING FACILITY, LAND PURCHASE 0 0 0 135000 8500000 8299814 200186 2010 0 0 0 1 17000000 353522 570709 14515118 1560651 2012 0 0 0 1 0 1 0 0 1 0 1 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 PAGE 1, PART III, LINE 2 THE INSTITUTION DOES REGULARLY "LEASE" OR MAKES PROPERTY AVAILABLE FOR USE BY THE ELDERLY AS PART OF ITS TAX EXEMPT MISSION. STEVE HABBEN STEVE HABBEN IS A MEMBER OF THE BOARD OF DIRECTORS 3747000 STEVE HABBEN IS A MEMBER OF THE BOARD OF DIRECTORS AND HE IS ALSO AN EXECUTIVE AT KETTELHUT CONSTRUCTION, INC., WHICH PERFORMED CONSTRUCTION SERVICES FOR THE FACILITY DURING THE YEAR. 0 FORM 990, PART VI, SECTION A, LINE 3 THREE KEY MANAGEMENT EMPLOYEES, THE EXECUTIVE DIRECTOR, CONTROLLER, AND THE HEALTH FACILITY ADMINISTRATOR ARE EMPLOYEES OF CRSA/LCS, THE MANAGEMENT COMPANY. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE BOARD OF DIRECTORS. THE FORM 990 IS APPROVED BY THE FINANCE AND MANAGEMENT COMMITTEE. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD OF DIRECTORS ARE REQUIRED TO REVIEW AND SIGN A CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. IF A POSSIBLE CONFLICT OF INTEREST DOES ARISE, THE ISSUE IS VOTED ON BY ALL BOARD MEMBERS THAT DO NOT HAVE AN INTEREST IN THE OUTCOME. FORM 990, PART VI, SECTION B, LINE 15 REVIEW OF COMPENSATION FOR A SIMILAR POSITION IN THE GEOGRAPHIC AREA. FORM 990, PART VI, SECTION C, LINE 19 ALTHOUGH NOT REQUIRED, THE ORGANIZATION WILL PROVIDE PHOTOCOPIES OF ITS FINANCIAL STATEMENTS TO ALL WHO REQUEST THEM. A COPY OF THE FINANCIAL STATEMENTS IS ALSO LOCATED IN THE WESTMINSTER VILLAGE LIBRARY. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -15,279. PRIOR PERIOD ADJUSTMENTS: -1,006,121. UNREALIZED LOSS ON SWAP -734,706. TOTAL TO FORM 990, PART XI, LINE 5: -1,756,106. FORM 990, PAGE 12, PART XII, LINE 2C THE ORGANIZATION HAS A FINANCE AND MANAGEMENT COMMITTEE THAT IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT. THIS PRACTICE IS CONSISTENT WITH THE PRIOR YEARS. WESTMINSTER VILLAGE FOUNDATION OF WEST LAFAYETTE INDIANA INC 2741 N SALISBURY STREET WEST LAFAYETTE IN 47906 351537414 SUBSIDIZE EXEMPT ACTIVITIES IN 501(C)(3) 509(A)(3), TYPE 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 WESTMINSTER VILLAGE FOUNDATION OF WEST LAFAYETTE INDIANA INC C 104824