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MCV HEALTH CARE FACILITIES INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
MCV HEALTH CARE FACILITIES INC (EIN 31-1257250)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-07-26
IRS object ID
201242089349300914
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-07-26T16:43:19-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN381357951EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line165 EAST STATE ST STE 600AddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43215ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN311257250EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MCV HEALTH CARE FACILITIES INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMCVHNameControl
Phone5139315000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line18097 HAMILTON AVENUEAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45231ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameROGER H SCHWARTZName
TitleCFOTitle
Phone5139315000Phone
Date Signed2012-07-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBERNIE OSTROWSKIName
PTINP00366367PTIN
Phone6148493000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJ DONALD SAMSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1411 WESTERN ROW ROADAddressLine1
CityMASONCity
StateOHState
ZIP Code45040ZIPCode
FieldValueIRS element (for citing)
Gross Receipts11575772GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CHRISTIANBENEVOLENT.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1988YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionFOUNDED IN 1988, MCV HEALTH CARE FACILITIES IS A NOT-FOR-PROFIT PROVIDER OF RETIREMENT SERVICES, OFFERING A VARIETY OF LIVING STYLES, FROM RESIDENTIAL LIVING APARTMENTS, ASSISTED LIVING AND SKILLED NURSING CARE. THE ORGANIZATION'S MISSION IS TO PROVIDE SECURE, QUALITY LIVING IN A CHRISTIAN ENVIRONMENT, DIRECTED ESPECIALLY TO PERSONS IN THEIR RETIREMENT YEARS. MCV HEALTH CARE FACILITIES' MINISTRY SERVES OVER 150 OLDER ADULTS. OUR SERVICES ARE DEDICATED TO THE ENHANCEMENT OF THE SPIRITUAL, PHYSICAL, SOCIAL, CULTURAL AND EMOTIONAL WELL-BEING OF EACH RESIDENT IN AN ENVIRONMENT THAT RECOGNIZES AND PROMOTES PERSONAL DIGNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees256TotalNbrEmployees
Total Nbr Volunteers108TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year13763ContributionsGrantsPriorYear
Contributions Grants Current Year56188ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10845623ProgramServiceRevenuePriorYear
Program Service Revenue CY11281841ProgramServiceRevenueCY
Investment Income Prior Year-6629InvestmentIncomePriorYear
Investment Income Current Year17886InvestmentIncomeCurrentYear
Other Revenue Prior Year225680OtherRevenuePriorYear
Other Revenue Current Year202228OtherRevenueCurrentYear
Total Revenue Prior Year11078437TotalRevenuePriorYear
Total Revenue Current Year11558143TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year111309GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY107848GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5219229SalariesEtcPriorYear
Salaries Etc Current Year5185430SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5255150OtherExpensePriorYear
Other Expenses Current Year6095380OtherExpensesCurrentYear
Total Expenses Prior Year10585688TotalExpensesPriorYear
Total Expenses Current Year11388658TotalExpensesCurrentYear
Revenues Less Expenses Prior Year492749RevenuesLessExpensesPriorYear
Revenues Less Expenses CY169485RevenuesLessExpensesCY
Total Assets BOY14267970TotalAssetsBOY
Total Assets EOY15487865TotalAssetsEOY
Total Liabilities BOY16460656TotalLiabilitiesBOY
Total Liabilities EOY15764819TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-2192686NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-276954NetAssetsOrFundBalancesEOY
Mission DescriptionSERVING WITH EXCELLENCE REFLECTING JESUS' COMPASSION.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense9797870Expense
Grants107848Grants
Revenue11463487Revenue
DescriptionNURSING CARE SERVICE PROGRAMS INCLUDE SEMI-PRIVATE ROOMS AND A LIMITED NUMBER OF PRIVATE ROOMS, ASSISTED LIVING AND RESPITE CARE WITH ALL THE AMENITIES OF RESIDENTIAL LIVING IN A PRIVATE/SHARED OCCUPANCY STUDIO. CHARGES ARE BASED ON INDIVIDUAL ASSESSMENTS TO DEVELOP PERSONALIZED CARE AND SERVICE. RESIDENTIAL SERVICES INCLUDE A FULL CALENDAR OF LIFE ENRICHING RELIGIOUS (CHAPEL AND PASTORAL CARE), SOCIAL AND EDUCATIONAL PROGRAMS, SERVICES AND ACTIVITIES. SERVICES INCLUDE WEEKLY HOUSEKEEPING, LAUNDRY, MAINTENANCE, UTILITIES, TRASH REMOVAL, AND DINING CONSISTING OF THREE MEALS A DAY.Description
Total Program Service Expense9797870TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109621NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees256NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JOHN BARROWBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3145877921TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1622 EMERSON ROAD SUITE 310AddressLine1
CityST LOUISCity
StateMOState
ZIP Code63141ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (10 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
PATRICK LARRICK
CHAIR & DIRECTOR1.00XX000
LARRY COLLINS
VICE CHAIR & DIRECTOR1.00XX000
RICHARD YOST
TREASURER & DIRECTOR1.00XX000
WAYNE MOCK
SECRETARY & DIRECTOR1.00XX000
JONATHAN D SAMS
DIRECTOR1.00X000
CHRISTINA FRANCIS
DIRECTOR1.00X000
KIMBERLI LAYER
DIRECTOR1.00X000
TOM MOLL
DIRECTOR1.00X000
J DONALD SAMS
CEO5.00X011464942000
ROGER SCHWARTZ
CFO9.00X0975850
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs212234TotalReportableCompFrmRltdOrgs
Total Other Compensation42000TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
KINDRED REHAB SERVICES
PO BOX 277365ATLANTAGA303847365THERAPY SERVICES600563
MIDWEST CHRISTIAN VILLAGES
200 N POSTVILLE DRIVELINCOLNIL62656MANAGEMENT SERVICES421889
SYSCO FOOD SERVICES
PO BOX 62066CINCINNATIOH452620066FOOD & DIETARY PRODUCTS345888
HOME CARE PHARMACY
PO BOX 715268COLUMBUSOH432715268PHARMACY SERVICES195840
FAWNSINLOES HEATING COOLING & APPLI
157 NORTH B STREETHAMILTONOH45013HVAC SERVICES131014
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
All Other Contributions56188AllOtherContributions
Total Contributions56188TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNURSING HOME FEESDescription
Business Code532000BusinessCode
Total Revenue Column11281841TotalRevenueColumn
Related Or Exempt Function Income11281841RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue11281841TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5386TotalRevenueColumn
Exclusion$5,386ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other12500Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other12500Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column12500TotalRevenueColumn
Exclusion$12,500ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory38211GrossSalesOfInventory
Cost Of Goods Sold17629CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column20582TotalRevenueColumn
Exclusion$20,582ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
COMMUNITY FACILITY REV532000139070139070
OTHER REVENUE9999994257642576
FieldValueIRS element (for citing)
Total Other Revenue181646TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11558143TotalRevenueColumn
Related Or Exempt Function Income11463487RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$38,468ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total107848Total
Program Services107848ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3970754Total
Program Services3684795ProgramServices
Management And General285959ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total39136Total
Program Services36318ProgramServices
Management And General2818ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total843078Total
Program Services782363ProgramServices
Management And General60715ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total332462Total
Program Services308519ProgramServices
Management And General23943ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total687488Total
Management And General687488ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total113562Total
Management And General113562ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total872535Total
Program Services872535ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total36517Total
Program Services36517ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total628261Total
Program Services584283ProgramServices
Management And General43978ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total21679Total
Management And General21679ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total568962Total
Program Services529135ProgramServices
Management And General39827ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total7599Total
Program Services2156ProgramServices
Management And General5443ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total14462Total
Management And General14462ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1049251Total
Program Services975803ProgramServices
Management And General73448ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1049769Total
Program Services976285ProgramServices
Management And General73484ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total124387Total
Management And General124387ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
FOOD452268452268
LICENSES & FEES27993026033519595
FINES & PENALTIES169806169806
BAD DEBT EXPENSE1662516625

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2279Total
Program Services2279ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11388658Total
Program Services9797870ProgramServices
Management And General1590788ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2500BOY
EOY2500EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY936444BOY
EOY1351638EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY475601BOY
EOY582800EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY31340BOY
EOY31340EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY87182BOY
EOY139443EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis18855793LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec8281672LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY10196640BOY
EOY10574121EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2538263BOY
EOY2806023EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY14267970BOY
EOY15487865EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY969675BOY
EOY872854EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY10135000BOY
EOY11045200EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY5355981BOY
EOY3846765EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY16460656BOY
EOY15764819EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-2192686BOY
EOY-276954EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-2192686BOY
EOY-276954EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY14267970BOY
EOY15487865EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses169485ReconcilationRevenueExpenses
Reconcilation Other Changes1746247ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years23430CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20839CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years39786CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year13763CurrentTaxYearMinus1Year
Current Tax Year56188CurrentTaxYear
Total154006Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10180082CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10377488CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10621467CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11026664CurrentTaxYearMinus1Year
Current Tax Year11463487CurrentTaxYear
Total53669188Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10203512CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10398327CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10661253CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11040427CurrentTaxYearMinus1Year
Current Tax Year11519675CurrentTaxYear
Total53823194Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year13763CurrentTaxYear
Total13763Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year54035CurrentTaxYearMinus1Year
Total54035Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year54035CurrentTaxYearMinus1Year
Current Tax Year13763CurrentTaxYear
Total67798Total
FieldValueIRS element (for citing)
Public Support Total50953755396PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years52081CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years30791CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9035CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5741CurrentTaxYearMinus1Year
Current Tax Year5386CurrentTaxYear
Total103034Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years52081CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years30791CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9035CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5741CurrentTaxYearMinus1Year
Current Tax Year5386CurrentTaxYear
Total103034Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years141947CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years167243CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years155888CurrentTaxYearMinus2Years
Total465078Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10397540CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10596361CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10826176CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11046168CurrentTaxYearMinus1Year
Current Tax Year11525061CurrentTaxYear
Total54391306Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98830PublicSupportPercentage509
Prior Year Support Percentage0.98480PriorYearSupportPercentage
Investment Income Percentage0.00190InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00260PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INTERCOMPANY SERVICE FEES BAD DEBT RECOVERY COMMUNITY FEEGeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$1,115OtherActivitiesAmount
Total Lobbying Expenditures IIB1115TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationA PORTION OF DUES PAYMENTS TO AOPHA ARE RELATED TO LOBBYING ACTIVITIES. THE AMOUNT ABOVE REPRESENTS 9% OF AOPHA DUES IN 2011.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis149498OtherCostOrOtherBasis
Book Value149498BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis16363871OtherCostOrOtherBasis
Depreciation6593732Depreciation
Book Value9770139BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1956274OtherCostOrOtherBasis
Depreciation1451611Depreciation
Book Value504663BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis386150OtherCostOrOtherBasis
Depreciation236329Depreciation
Book Value149821BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings10574121TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
CONSTRUCTION IN PROGRESS12749
DEFERRED LOAN COSTS270532
SECURITY DEPOSIT & OTHER ESCROW ACCOUNTS2506051
RELATED PARTY RECEIVABLE16691
FieldValueIRS element (for citing)
Total Book Value Other Assets2806023TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
RELATED PARTY PAYABLE$3,385,782
RESIDENTS DEPOSITS$460,983
FieldValueIRS element (for citing)
Total Of Amounts3846765TotalOfAmounts
Total Revenue11558143TotalRevenue
Total Expenses11388658TotalExpenses
Excess Or Deficit For Year169485ExcessOrDeficitForYear
Other$1,746,247OtherAmount
Total Adjustments1746247TotalAdjustments
Excess Or Deficit Per FS1915732ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt13172932TotRevenueEtcAuditedFinclStmt
Other Revenues1746247OtherRevenues
Revenue Not Rptd F9901746247RevenueNotRptdF990
Revenue Subtotal11426685RevenueSubtotal
Other Revenues Not Included131458OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt131458RevenueNotRptdOnFinStmt
Total Revenue Per Form99011558143TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt11257200TotExpensesEtcAuditedFinclStmt
Other Expenses Included-131458OtherExpensesIncluded
Expenses Not Rptd F990-131458ExpensesNotRptdF990
Expenses Subtotal11388658ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99011388658TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 8 - OTHER ADJUSTMENTS:ACCRUED INTEREST WRITTEN OFF DUE TO REFINANCING 1,746,247.
PART XII, LINE 2D - OTHER ADJUSTMENTS:ACCRUED INTEREST WRITTEN OFF DUE TO REFINANCING 1,746,247.
PART XII, LINE 4B - OTHER ADJUSTMENTS:RECLASS OF TELEPHONE & TRANSPORTATION REVENUE 41,239. RECLASS OF CONSULTING EXPENSE 90,219.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:RECLASS OF TELEPHONE & TRANSPORTATION REVENUE -41,239. RECLASS OF CONSULTING EXPENSE -90,219.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantRESIDENT SUBSIDYTypeOfGrant
Number Of Recipients7NumberOfRecipients
Amount Of Cash Grant107848AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: A RESIDENT OR THEIR FAMILY CAN SUBMIT A REQUEST TO THE ORGANIZATION FOR SUBSIDY OF THEIR RENT AT MCV HEALTH CARE FACILITIES. A COMMITTEE HAS BEEN ESTABLISHED WHICH REVIEWS THE APPLICANT'S CIRCUMSTANCES AND WILL DETERMINE WHETHER ASSISTANCE WILL BE GRANTED BASED ON SPECIFIC CRITERIA. THE COMMITTEE HAS A RESTRICTION ON THE AMOUNT OF FUNDS TO USE FOR SUBSIDY PURPOSES, WHICH WILL ONLY BE EXCEEDED IN THE CASE OF RESIDENTS WHO WERE GRANDFATHERED IN UNDER PREVIOUS ARRANGEMENTS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonJ DONALD SAMSNamePerson
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs114649CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs42000NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs156649TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 1AReturnReference
ExplanationJ. DONALD SAMS RECEIVED A HOUSING ALLOWANCE IN THE AMOUNT OF $42,000 IN 2011.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (14 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2BOARD DIRECTOR JONATHAN D. SAMS IS THE SON OF J. DONALD SAMS, CEO.
FORM 990, PART VI, SECTION A, LINE 3EFFECTIVE APRIL 1ST OF 2010, THE MANAGEMENT SERVICES WERE PROVIDED BY MIDWEST CHRISTIAN VILLAGES. MIDWEST CHRISTIAN VILLAGES PROVIDES AN EXECUTIVE DIRECTOR FOR THE CAMPUS. IN ADDITION, MIDWEST CHRISTIAN VILLAGES PROVIDES OPERATIONS, ACCOUNTING, BILLING, AND ITS SUPPORT.
FORM 990, PART VI, SECTION A, LINE 6THE RELATED TAX-EXEMPT ORGANIZATION, CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI, INC. ("CBA"), IS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7ACBA, THE MEMBER OF THE FILING ORGANIZATION, HAS THE RIGHT TO ELECT OR APPOINT ONE OF MORE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY, WHETHER PERIODICALLY, OR AS VACANCIES ARISE, OR OTHERWISE.
FORM 990, PART VI, SECTION A, LINE 7BCBA, THE MEMBER OF THE FILING ORGANIZATION, HAS THE RIGHT TO APPROVE OR RATIFY DECISIONS OF THE ORGANIZATION'S GOVERNING BODY SUCH AS APPROVAL OF THE GOVERNING'S BODY'S DECISION TO DISSOLVE THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 8BWITH THE EXCEPTION OF THE DEVELOPMENT COMMITTEE, INDIVIDUAL COMMITTEES DO NOT CONTEMPORANEOUSLY DOCUMENT MEETINGS HELD OR WRITTEN ACTIONS UNDERTAKEN DURING THE YEAR. ACTIONS OF THE ANNUAL NOMINATING COMMITTEE ARE DOCUMENTED IN THE GOVERNING BODY'S MINUTES.
FORM 990, PART VI, SECTION B, LINE 11THE CFO REVIEWS THE FORM 990 AND THEN WILL PROVIDE ELECTRONIC COPIES OF THE FORM 990 TO ALL BOARD MEMBERS PRIOR TO FILING. MAJOR POINTS OF THE FORM ARE ADDRESSED WITH THE BOARD EITHER VIA EMAIL OR AT THE CLOSEST BOARD MEETING DATE.
FORM 990, PART VI, SECTION B, LINE 12COFFICERS AND DIRECTORS REVIEW AND SIGN THE CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS. IT IS THE RESPONSIBILITY OF OFFICERS AND DIRECTORS TO DISCLOSE THE EXISTENCE OF A CONFLICT AND SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF THE CONFLICT IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THOSE WITH CONFLICTS ARE SUBJECT TO VOTING AND PARTICIPATION RESTRICTIONS.
FORM 990, PART VI, SECTION B, LINE 15ATHE BOARD OF DIRECTORS OF A RELATED ORGANIZATION, CHRISTIAN BENEVOLENT ASSOCIATON OF GREATER CINCINNATI, INC., DETERMINES THE CEO'S COMPENSATION THROUGH USE OF REVIEW BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DECISION. THE PROCESS WAS LAST COMPLETED IN 2011.
FORM 990, PART VI, SECTION C, LINE 18FORM 1023 AND 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VII, AVERAGE HOURS PER WEEK TO RELATED ORGANIZATION:HOURS DISTRIBUTION FOR J. DONALD SAMS: (40 HOUR WORK WEEK) A. CBA: 50% - 20 HOURS B. CBA FOUNDATION: 15% - 6 HOURS C. MT HEALTHY: 10% - 4 HOURS D. MCV HEALTH CARE FACILITY: 12.5% - 5 HOURS E. MASON CHRISTIAN VILLAGE: 12.5% - 5 HOURS HOURS DISTRIBUTION FOR ROGER SCHWARTZ: (30 HOUR WORK WEEK) A. CBA: 15% - 4.5 HOURS B. CBA FOUNDATION: 5% - 1.5 HOURS C. MT HEALTHY: 40% - 12 HOURS D. MCV HEALTH CARE FACILITY: 30% - 9 HOURS E. MASON CHRISTIAN VILLAGE: 10% - 3 HOURS
FORM 990, PART XI, LINE 5:ACCRUED INTEREST WRITTEN OFF DUE TO REFINANCING 1,746,247. TOTAL TO FORM 990, PART XI, LINE 5: 1,746,247.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2C:CHRISTIAN BENEVOLENT ASSOCIATION, A RELATED ORGANIZATION, HAS AN AUDIT COMMITTEE WHICH OVERSEES AUDIT OF THE FINANCIAL STATEMENTS AND IS INVOLVED IN THE SELECTION OF THE INDEPENDENT ACCOUNTANT WHICH COMPLETES THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
MT HEALTHY CHRISTIAN HOME INC
8097 HAMILTON AVENUECINCINNATIOH45231310714767RETIREMENT SERVICESOH501(C)(3)509(A)(2)CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC1
MASON CHRISTIAN VILLAGE INC
8097 HAMILTON AVENUECINCINNATIOH45231311173965RETIREMENT SERVICESOH501(C)(3)509(A)(2)CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC1
CHRISTIAN BENEVOLENT ASSOCIATION FOUNDATION FOR THE AGING INC
8097 HAMILTON AVENUECINCINNATIOH45231311413825FUNDRAISING & FINANCIAL SUPPORT FOR CBA OF GREATER CINCINNATIOH501(C)(3)509(A)(3)CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC1
CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC
8097 HAMILTON AVENUECINCINNATIOH45231310675610MANAGEMENT/SUPPORT SERVICES FOR RELATED TAX-EXEMPT RETIREMENT COMMUNITIESOH501(C)(3)509(A)(1)0N/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC
C107848CASH TRANSACTION
MASON CHRISTIAN VILLAGE INC
N311339PAYROLL ALLOCATION
MASON CHRISTIAN VILLAGE INC
M139430SQUARE FOOTAGE ALLOCATION
CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC
Q529681CASH TRANSACTION
CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC
R1746247CASH TRANSACTION