2011-10-27T10:51:11-05:00 2011-03-31 DIXON HUGHES GOODMAN LLP 500 RIDGEFIELD COURT ASHEVILLE NC 28806 990 2010-04-01 620699106 CHRISTIAN HOME FOR THE AGED INC CHRI 4236108500 309 PRINCETON ROAD JOHNSON CITY TN 37601 MYRA ZUMWALT PAESSLER 4236108500 2011-10-27 1 AMY BIBBY 8282542254 2010 2016-03-07 17:11:31Z APPALACHIAN CHRISTIAN VILLAGE MYRA ZUMWALT PAESSLER 309 PRINCETON ROAD JOHNSON CITY TN 37601 16082284 0 X WWW.CHRISTIANVILLAGE.ORG X 1954 TN HELPING WITH THE CHALLENGES OF AGING BY PROVIDING QUALITY HOUSING, HEALTHCARE, AND SERVICES. 15 15 373 120 0 0 157120 36994 15065652 15789757 293145 218908 37749 36625 15553666 16082284 2334 10310 0 0 6208375 6272588 0 0 371837 8904818 9164164 15115527 15447062 438139 635222 30492260 30331773 22213776 21243257 8278484 9088516 X TO REFLECT CHRIST'S LOVE BY BEING THE PREMIER REGIONAL PROVIDER OF QUALITY SENIOR LIVING SERVICES. 0 0 13275118 10310 15793982 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 85 INDEPENDENT LIVING UNITS, 109 CONGREGATE LIVING UNITS, 103 INTERMEDIATE AND SKILLED CARE NURSING BEDS, AND 100 ASSISTED LIVING UNITS.BLOOD DRIVE, AUGUST 10, 2010: 14 PINTS OF BLOOD GIVEN. ANNUAL FOOD DRIVE FOR GOOD SAMARITAN MINISTRIES, NOVEMBER 10, 2010: 234 POUNDS OF FOOD DONATED. WARMING CLOTHING DRIVE, NOVEMBER 10, 2010: PINE OAKS RESIDENTS, FAMILIES, AND STAFF SPONSORED, DONATING HATS, SCARVES, AND GLOVES TO THE SALVATION ARMY. PINE OAKS ANGEL TREE DONATIONS, DECEMBER 10, 2011. PINE OAKS CANNED FOOD DRIVE FOR RONALD MCDONALD HOUSE, NOVEMBER 10, 2010. TWO PINE OAKS TEAM MEMBERS CERTIFIED THROUGH AAAD AND UT EXTENSION AS TRAINERS FOR THE "LIVING WELL WITH CHRONIC CONDITIONS SELF-MANAGEMENT PROGRAM", MARCH 11, 2010. PINE OAKS ANNUAL ALZHEIMERS YARD SALE, MAY, 2010: RAISED $2,000. PINE OAKS IS INVOLVED IN THE MOUNTAIN VIEW ELEMENTARY SCHOOL MULTI-GENERATIONAL PARTNERSHIP. STUDENTS COME MONTHLY DURING THE SCHOOL YEAR AND RESIDENTS HELP THEM WITH READING, MUSIC, AND CRAFT PROJECTS. ACV DONATES DENTED CANS OF FOOD TO SECOND HARVEST FOOD BANK: 389 POUNDS. HOST LUNCHEONS FOR CHURCH SENIOR GROUPS CATERED A COMMUNITY LEADERS FORUM LUNCHEON AT GROUPS. THE JOHNSON CITY SENIOR CENTER: 500 PEOPLE FED. AFFILIATION WITH THE TENNESSEE TECHNOLOGY SCHOOL OF PRACTIVAL NURSING, WHICH ALLOWS LPN STUDENTS TO GAIN CLINICAL EXPERIENCE AND TRAINING. 13275118 1 1 0 1 0 0 0 0 0 1 0 0 0 1 0 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 0 0 0 1 45 0 1 373 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 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 JOHNNY HENSLEY 1.00 X X 0 0 0 PAUL DAVID WALKER 1.00 X X 0 0 0 RICHARD MEASNER 1.00 X X 0 0 0 STARLA BROOKS 1.00 X 0 0 0 MITZI MCNAB 1.00 X 0 0 0 LARRY REAVES 1.00 X 0 0 0 LESLIE OSBORN 1.00 X 0 0 0 PHIP SAMS 1.00 X 0 0 0 SHERYL PACK SHIPLEY 1.00 X 0 0 0 LARRY REYNOLDS 1.00 X 0 0 0 RONALD SALYER 1.00 X 0 0 0 DOUGLAS THEOBALD 1.00 X 0 0 0 DR MELESSIA WEBB 1.00 X 0 0 0 TOM SEXTON 40.00 X 164332 0 6034 MYRA PAESSLER 40.00 X 84803 0 6721 249135 0 12755 1 0 1 0 SODEXHO INC & AFFILIATES PO BOX 536922 ATLANTA GA 30319 FOOD SERVICES & FACILITIES MANAGEMENT 1745294 TEKA BUILDING 142 OKLAHOMA ROAD TELFORD TN 37690 CONSTRUCTION RENOVATION 1433706 FUNCTIONAL PATHWAYS PO BOX 102426 ATLANTA GA 303682426 THERAPY SERVICES 609054 3 36994 36994 RESIDENT SERVICES 623000 15789757 15789757 15789757 141494 141494 32400 32400 32400 32400 77414 77414 77414 77414 OTHER INCOME 900099 4225 4225 4225 16082284 15793982 0 251308 10310 10310 5353758 4596206 641671 115881 452698 383015 58228 11455 466132 407436 49841 8855 344631 181661 110565 52405 133630 133630 2539937 1961677 544356 33904 235025 122324 110314 2387 1207410 1189181 18132 97 42845 23013 15596 4236 1122685 1087962 34723 1275166 1233312 37120 4734 167886 123443 44443 FOOD COSTS 1747329 1744121 3208 BAD DEBT 238418 131289 107129 EMPLOYEE EXPENSE 61883 40322 21079 482 EDUCATION AND TRAINING 24109 16636 6910 563 BEAUTY SHOP EXPENSE 23210 23210 15447062 13275118 1800107 371837 4095 3080 654526 437481 1467743 1435794 20559 21847 62220 96181 33123998 13440529 19793200 19683469 6971625 7284360 82458 80362 1435834 1289199 30492260 30331773 879034 758808 2893065 2864742 17882684 17535761 467000 27660 91993 56286 22213776 21243257 X 8197334 9016962 81150 71554 8278484 9088516 30492260 30331773 X 635222 174810 X 0 1 1 X 0 X 45699 98550 148685 157120 36994 487048 12023287 12442194 14184904 15065652 15789757 69505794 12068986 12540744 14333589 15222772 15826751 69992842 0 0 0 69992842 310908 337508 243252 293145 251308 1436121 310908 337508 243252 293145 251308 1436121 1020 7404 3525 5349 4225 21523 12380914 12885656 14580366 15521266 16082284 71450486 0.97960 0.98190 0.02010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1231 1231 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: THE ORGANIZATION PAID DUES OF $12,314 TO THE TNAHSA. OF THOSE DUES, APPROXIMATELY $1,231 RELATED TO LOBBYING EXPENDITURES. 1385609 1385609 26690560 11308508 15382052 4852373 2055899 2796474 195456 76122 119334 19683469 PATIENT TRUSTS 9128 SECURITY DEPOSITS 46805 ANNUITY OBLIGATIONS 353 56286 16082284 15447062 635222 174810 174810 810032 0 X X X 0 0 0 1 0 0 0 0 0 TOM SEXTON 154332 0 10000 0 0 0 0 0 6034 0 170366 0 0 0 PART I, LINE 5 THE ORGANIZATION PAYS BONUSES TO THE CEO AND CFO THAT FACTOR IN NET EARNINGS OF THE ORGANIZATION. HEALTH AND EDUCATIONAL FACILITIES BOARD OF JOHNSON CITY TN 521464028 47827VAH6 2004-11-10 19096778 RENOVATION AND CONSTRUCTION 2004A,B,C 0 0 0 1610000 21573530 1410622 381936 275246 19489391 2006 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 0 0 1 1 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 OCCURED 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 POLICY BY ANNUALLY ASKING EACH BOARD MEMBER TO 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 CONSTITUTE A CONFLICT OF INTEREST. THE POLICY CONTAINS DETAILED PROCEDURES ON HOW THE ORGANIZATION HANDLES CONFLICTS ONCE THEY ARISE. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES REVIEWS, VOTES ON, AND APPROVES COMPENSATION FOR BOTH THE CHIEF EXECTIVE OFFER AND THE CHIEF FINANCIAL OFFICER ON AN ANNUAL BASIS. AAHSA'S CCRC SALARY & BENEFITS REPORT FOR THE CURRENT FISCAL YEAR IS USED IN COMPENSATION DETERMINATION. THIS INFORMATION IS REPORTED IN 3 MANNERS: BASED ON STATE, BASED ON REVENUE AND BASED ON 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 GAINS ON INVESTMENTS: 174,810. 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 N/A 0 LIBERTY HOUSING CORPORATION 309 PRINCETON ROAD JOHNSON CITY TN 37601 621611779 HOUSING NC 501(C)(3) PF N/A 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 APPALACHIAN CHRISTIAN VILLAGE FOUNDATION C 36994 APPALACHIAN CHRISTIAN VILLAGE FOUNDATION K 1265532 LIBERTY HOUSING CORPORATION J 391931