2011-08-15T12:35:14-05:00 2010-12-31 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2010-01-01 311257250 MCV HEALTH CARE FACILITIES INC MCVH 5139315000 8097 HAMILTON AVENUE CINCINNATI OH 45231 ROGER H SCHWARTZ 5139315000 2011-08-15 1 BERNIE OSTROWSKI 6148493000 2010 2016-02-24 21:20:13Z J DONALD SAMS 411 WESTERN ROW ROAD MASON OH 45040 11094070 0 X WWW.CHRISTIANBENEVOLENT.ORG X 1988 OH SCHEDULE OFOUNDED 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. 9 9 258 94 0 0 139709 13763 10621467 10845623 9035 -6629 163053 225680 10933264 11078437 99923 111309 0 0 5218553 5219229 0 0 0 5317239 5255150 10635715 10585688 297549 492749 14350932 14267970 17036367 16460656 -2685435 -2192686 SERVING WITH EXCELLENCE REFLECTING JESUS' COMPASSION. 0 0 8909622 111309 11041297 NURSING 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. 8909622 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 26 0 1 258 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 OH X BRENDA LAVIN 2177329651 200 N POSTVILLE DRIVE LINCOLN IL 62656 X PATRICK LARRICK 1.00 X X 0 0 0 LARRY COLLINS 1.00 X X 0 0 0 ROGER BARCELONA 1.00 X X 0 0 0 WAYNE MOCK 1.00 X X 0 0 0 MARK DAVIS 1.00 X 0 0 0 CHRISTINA FRANCIS 1.00 X 0 0 0 KIMBERLI LAYER 1.00 X 0 0 0 TOM MOLL 1.00 X 0 0 0 RICHARD YOST 1.00 X 0 0 0 J DONALD SAMS 5.00 X 0 101090 47031 DAVID BICKEL 12.00 X 0 92770 0 ROGER SCHWARTZ 9.00 X 0 81904 1327 0 275764 48358 1 0 0 0 KINDRED REHAB SERVICES PO BOX 277365 ATLANTA GA 303847365 THERAPY SERVICES 295934 LIFE CARE SERVICES LLC CAPITAL SQUARE 400 LOCUST STE 82 DES MOINES IA 50309 MANAGEMENT SERVICES 252102 SELECT REHAB INC 35338 EAGLE WAY CHICAGO IL 60678 THERAPY SERVICES 207631 MIDWEST CHRISTIAN VILLAGES 200 N POSTVILLE DRIVE LINCOLN IL 62656 MANAGEMENT SERVICES 195386 HOME CARE PHARMACY PO BOX 715276 COLUMBUS OH 43271 PHARMACY SERVICES 189352 5 13763 13763 NURSING HOME FEES 532000 10845623 10845623 10845623 5741 5741 12370 -12370 -12370 -12370 33269 3263 30006 30006 COMMUNITY FACILITY REV 532000 139430 139430 OTHER REVENUE 999999 56244 56244 195674 11078437 11041297 0 23377 111309 111309 4134233 3836501 297732 33648 31225 2423 711478 660240 51238 339870 315394 24476 623100 623100 94210 94210 705621 524911 180710 45777 45777 642105 597158 44947 545387 507210 38177 26238 7443 18795 5960 5960 999887 929895 69992 548593 510191 38402 165534 165534 FOOD 476312 476312 LICENSES & FEES 291006 270636 20370 BAD DEBT EXPENSE 36071 36071 RESIDENT ACTIVITIES 22591 22591 26758 26758 10585688 8909622 1676066 0 2500 2500 640278 936444 553281 475601 31340 31340 98569 87182 17906793 7710153 10556949 10196640 2468015 2538263 14350932 14267970 2465431 969675 10350000 10135000 14727 4206209 5355981 17036367 16460656 X -2685435 -2192686 -2685435 -2192686 14350932 14267970 492749 X X 0 1 1 X 1 1 X 28024 23430 20839 39786 13763 125842 9807464 10180082 10377488 10621467 11026664 52013165 9835488 10203512 10398327 10661253 11040427 52139007 0 54035 54035 54035 54035 52084972 40736 52081 30791 9035 5741 138384 40736 52081 30791 9035 5741 138384 146267 141947 167243 155888 611345 10022491 10397540 10596361 10826176 11046168 52888736 0.98480 0.98230 0.00260 0.00300 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INTERCOMPANY SERVICE FEES BAD DEBT RECOVERY COMMUNITY FEE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 496 496 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: A PORTION OF DUES PAYMENTS TO AOPHA ARE RELATED TO LOBBYING ACTIVITIES. THE AMOUNT ABOVE REPRESENTS 6% OF AOPHA DUES IN 2010. 149498 149498 15608423 6116028 9492395 1753573 1375912 377661 395299 218213 177086 10196640 CONSTRUCTION IN PROGRESS 100283 DEFERRED LOAN COSTS 401222 SECURITY DEPOSIT & OTHER ESCROW ACCOUNTS 2036758 2538263 RELATED PARTY PAYABLE 5029917 RESIDENTS DEPOSITS 326064 5355981 11078437 10585688 492749 0 492749 10982057 -51325 -51325 11033382 45055 45055 11078437 10489308 -45055 -45055 10534363 51325 51325 10585688 PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASS OF CONSULTING EXPENSE -51,325. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF TELEPHONE & TRANSPORTATION REVENUE 45,055. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RECLASS OF TELEPHONE & TRANSPORTATION REVENUE -45,055. PART XIII, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF CONSULTING EXPENSE 51,325. 1 RESIDENT SUBSIDY 7 111309 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE 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 WILL REVIEW 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. FORM 990, PART VI, SECTION A, LINE 3 IN JANUARY-MARCH OF 2010, LIFE CARE SERVCIES LLC PROVIDED TWO EXECUTIVE DIRECTORS, ONE OF WHOM ACTED AS OPERATIONS MANAGER OVER CHRISTIAN BENEVOLENT ASSOCIATION AND ALL OF THE RELATED ENTITIES. AN ADMINISTRATOR OF THE HEALTH CARE CENTER WAS ALSO PROVIDED IN ADDITION TO SOFTWARE PROGRAMS, TRAINING, AND MANAGEMENT SUPPORT. EFFECTIVE 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 6 THE 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 7A CBA, 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 7B CBA, 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 8B WITH 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 11 THE 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 12C OFFICERS 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 15A 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 2010. FORM 990, PART VI, SECTION C, LINE 18 FORM 1023 AND 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND THE 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 HOURS DISTRIBUTION FOR DAVID BICKEL: (40 HOUR WORK WEEK) A. CBA: 15% - 6 HOURS B. CBA FOUNDATION: 5% - 2 HOURS C. MT HEALTHY: 40% - 16 HOURS D. MCV HEALTH CARE FACILITY: 30% - 12 HOURS E. MASON CHRISTIAN VILLAGE: 10% - 4 HOURS 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. MT HEALTHY CHRISTIAN HOME INC 8097 HAMILTON AVENUE CINCINNATI OH 45231 310714767 RETIREMENT SERVICES OH 501(C)(3) 509(A)(2) CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC 1 MASON CHRISTIAN VILLAGE INC 8097 HAMILTON AVENUE CINCINNATI OH 45231 311173965 RETIREMENT SERVICES OH 501(C)(3) 509(A)(2) CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC 1 CHRISTIAN BENEVOLENT ASSOCIATION FOUNDATION FOR THE AGING INC 8097 HAMILTON AVENUE CINCINNATI OH 45231 311413825 FUNDRAISING & FINANCIAL SUPPORT FOR CBA OF GREATER CINCINNATI OH 501(C)(3) 509(A)(3) CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC 1 CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC 8097 HAMILTON AVENUE CINCINNATI OH 45231 310675610 MANAGEMENT/SUPPORT SERVICES FOR RELATED TAX-EXEMPT RETIREMENT COMMUNITIES OH 501(C)(3) 509(A)(1) N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 MASON CHRISTIAN VILLAGE INC M 139430 SQUARE FOOTAGE ALLOCATION CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC C 100791 CASH TRANSACTION CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC L 326732 CASH TRANSACTION MASON CHRISTIAN VILLAGE INC N 382363 PAYROLL ALLOCATION