ST JOHN RETIREMENT VILLAGE: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: ST JOHN RETIREMENT VILLAGE (EIN 94-1636507)
Tax period: 2020-10-01 to 2021-09-30
Filed: 2022-08-15
IRS object ID: 202212279349301921
Schema version: 2020v4.2
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
Form 990
Schedule A
Schedule B
Schedule D
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-08-15T10:05:30-05:00	ReturnTs
Tax Period End	2021-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	390758449	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	WIPFLI LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	7733 FORSYTH BLVD SUITE 1200	AddressLine1Txt
City	ST LOUIS	CityNm
State Abbreviation	MO	StateAbbreviationCd
ZIP	63105	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2020-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	941636507	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ST JOHNS RETIREMENT VILLAGE	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	STJO	BusinessNameControlTxt
Phone	5306621290	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	135 WOODLAND AVENUE	AddressLine1Txt
City	WOODLAND	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	95695	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	MARILYN MITCHELL	PersonNm
Person Title	BOARD PRESIDENT	PersonTitleTxt
Phone	5306621290	PhoneNum
Signature	2022-08-11	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	MARILYN	PersonFirstNm
Person Last	MITCHELL	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	KARYN A NUNN	PreparerPersonNm
PTIN	P00096490	PTIN
Phone	3148622070	PhoneNum
Preparation	2022-08-11	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	2	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2020	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	BILL SCHARBACH	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	135 WOODLAND AVENUE	AddressLine1Txt
City	WOODLAND	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	95695	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$5,406,958	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.SJRV.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1964	FormationYr
Legal Domicile State	CA	LegalDomicileStateCd
Activity Or Mission	TO HONOR THE ORGANIZATION'S RESIDENTS' DIGNITY, INDEPENDENCE AND SPIRITUALITY BY PROVIDING THEM WITH A SAFE, SUPPORTIVE AND CARING ENVIRONMENT IN WHICH TO LIVE. THE ORGANIZATION'S MISSION IS TO PROVIDE HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO RESIDENTS IN ITS MULTI-LEVEL ASSISTED LIVING FACILITIES.	ActivityOrMissionDesc
Voting Members Governing Body	8	VotingMembersGoverningBodyCnt
Voting Members Independent	7	VotingMembersIndependentCnt
Total Employee	220	TotalEmployeeCnt
Total Volunteers	7	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$1,680,404	PYContributionsGrantsAmt
CY Contributions Grants	$34,435	CYContributionsGrantsAmt
PY Program Service Revenue	$9,620,951	PYProgramServiceRevenueAmt
CY Program Service Revenue	$5,338,287	CYProgramServiceRevenueAmt
PY Investment Income	$358	PYInvestmentIncomeAmt
CY Investment Income	$270	CYInvestmentIncomeAmt
PY Other Revenue	$6,497	PYOtherRevenueAmt
CY Other Revenue	$33,966	CYOtherRevenueAmt
PY Total Revenue	$11,308,210	PYTotalRevenueAmt
CY Total Revenue	$5,406,958	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$6,703,619	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$3,752,757	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$27,862	CYTotalFundraisingExpenseAmt
PY Other Expenses	$4,179,760	PYOtherExpensesAmt
CY Other Expenses	$2,991,251	CYOtherExpensesAmt
PY Total Expenses	$10,883,379	PYTotalExpensesAmt
CY Total Expenses	$6,744,008	CYTotalExpensesAmt
PY Revenues Less Expenses	$424,831	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$1,337,050	CYRevenuesLessExpensesAmt
Total Assets BOY	$6,358,631	TotalAssetsBOYAmt
Total Assets EOY	$5,423,553	TotalAssetsEOYAmt
Total Liabilities BOY	$3,043,649	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$3,823,023	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$3,314,982	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$1,600,530	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	TO HONOR THE ORGANIZATION'S RESIDENTS' DIGNITY, INDEPENDENCE AND SPIRITUALITY BY PROVIDING THEM WITH A SAFE, SUPPORTIVE AND CARING ENVIRONMENT IN WHICH TO LIVE. THE ORGANIZATION'S MISSION IS TO PROVIDE HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO RESIDENTS IN ITS MULTI-LEVEL ASSISTED LIVING FACILITIES.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	Yes (1)	SignificantChangeInd
Expense	$5,856,106	ExpenseAmt
Revenue	$5,338,287	RevenueAmt
Desc	MULTI-LEVEL ASSISTED LIVING FACILITIES. ASSISTED LIVING FOR ACTIVE RESIDENTS WITH MINIMAL CARE NEEDS IN COTTAGES AND APARTMENTS CALLED THE VILLAGE. ASSISTED LIVING FOR RESIDENTS WITH MODERATE CARE NEEDS IN THE PERSONAL CARE UNIT (PCU). HIGH LEVEL OF CARE FOR RESIDENTS IN NEED OF COGNITIVE AND MEMORY SUPPORT IN THE MANORS. RESPITE CARE IS AVAILABLE FOR A MINIMUM OF TWO WEEKS PRO-RATED AT THE MONTHLY RATE. - APPROXIMATELY 31,000 RESIDENT/PATIENT DAYS	Desc
Total Program Service Expenses	$5,856,106	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	0	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	0	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	0	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	0	OperateHospitalInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	0	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	0	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	37	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	220	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	8	GoverningBodyVotingMembersCnt
Independent Voting Member	7	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	Yes (1)	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	0	MembersOrStockholdersInd
Election Of Board Members	0	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	CA	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	THE ORGANIZATION	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	5306621290	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	135 WOODLAND AVENUE	AddressLine1Txt
City	WOODLAND	CityNm
State Abbreviation	CA	StateAbbreviationCd
ZIP	95695	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt
SEAN BELOUD
ED (THRU 11/20), MEMBER (FROM 11/20)	40.00	Yes (X)	Yes (X)	$127,493	$0	$21,194
BILL SCHARBACH
EXECUTIVE DIRECTOR (FROM 10/2020)	40.00		Yes (X)	$0	$0	$0
MARILYN MITCHELL
PRESIDENT	2.00	Yes (X)	Yes (X)	$0	$0	$0
SUZANNE ANDERSON
VICE PRESIDENT	0.13	Yes (X)	Yes (X)	$0	$0	$0
JENEE RAWLINGS
TREASURER	0.13	Yes (X)	Yes (X)	$0	$0	$0
ERIC DOWDY
SECRETARY	0.13	Yes (X)	Yes (X)	$0	$0	$0
JANE MARTIN
MEMBER	0.13	Yes (X)		$0	$0	$0
LISA SMITH-YOUNGS
MEMBER	0.13	Yes (X)		$0	$0	$0
UTE TURNER
MEMBER	0.13	Yes (X)		$0	$0	$0

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$127,493	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$21,194	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	1	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	0	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
SYSCO FOOD SERVICES OF SACRAMENTO
PO BOX 138007	SACRAMENTO	CA	958138007	FOOD & SUPPLIES FOR KITCHEN	$319,724
AMERICAN MEDICAL RESPONSE WEST
PO BOX 841439	DALLAS	TX	752841439	AMBULANCE AND COVID RELATED EXPENSES	$227,265
DYNAMIC MEDICAL MANAGEMENT INC
4605 W IMPERIAL VIEW CT	ROCKLIN	CA	95677	PHYSICAL THERAPY FOR PATIENTS	$167,380
ESKATON PROPERTIES INC
5105 MANZANITA AVENUE	CARMICHAEL	CA	95608	ACCOUNTING & IT SERVICES	$148,166

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	4	CntrctRcvdGreaterThan100KCnt
All Other Contributions	$34,435	AllOtherContributionsAmt
Total Contributions	$34,435	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
ASSISTED LIVING REVENU	623000	$5,309,260	$5,309,260
OTHER PROGRAM REVENUE	623000	$29,027	$29,027

Field	Value	IRS element (for citing)
Total Program Service Revenue	$5,338,287	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$270	TotalRevenueColumnAmt
Exclusion	$270	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$33,966	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$33,966	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$33,966	TotalRevenueColumnAmt
Exclusion	$33,966	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$5,406,958	TotalRevenueColumnAmt
Related Or Exempt Func Income	$5,338,287	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$34,236	ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$30,172	TotalAmt
Management And General	$30,172	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$2,980,075	TotalAmt
Program Services	$2,628,820	ProgramServicesAmt
Management And General	$336,154	ManagementAndGeneralAmt
Fundraising	$15,101	FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$394,882	TotalAmt
Program Services	$344,853	ProgramServicesAmt
Management And General	$48,048	ManagementAndGeneralAmt
Fundraising	$1,981	FundraisingAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$347,628	TotalAmt
Program Services	$303,586	ProgramServicesAmt
Management And General	$42,298	ManagementAndGeneralAmt
Fundraising	$1,744	FundraisingAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$231,823	TotalAmt
Program Services	$173,867	ProgramServicesAmt
Management And General	$57,956	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$29,886	TotalAmt
Management And General	$29,886	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$50,328	TotalAmt
Management And General	$50,328	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$492,380	TotalAmt
Program Services	$401,004	ProgramServicesAmt
Management And General	$91,376	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$12,918	TotalAmt
Management And General	$12,918	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$84,118	TotalAmt
Program Services	$70,547	ProgramServicesAmt
Management And General	$5,428	ManagementAndGeneralAmt
Fundraising	$8,143	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$118,697	TotalAmt
Program Services	$94,958	ProgramServicesAmt
Management And General	$23,739	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$463,983	TotalAmt
Program Services	$417,585	ProgramServicesAmt
Management And General	$46,398	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$15,659	TotalAmt
Program Services	$15,659	ProgramServicesAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$99,226	TotalAmt
Program Services	$89,303	ProgramServicesAmt
Management And General	$9,923	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$443,799	TotalAmt
Program Services	$399,419	ProgramServicesAmt
Management And General	$44,380	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$238,513	TotalAmt
Program Services	$214,662	ProgramServicesAmt
Management And General	$23,851	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
FOOD SERVICES	$242,488	$242,488
SUPPLIES	$211,130	$206,632	$4,498
REPAIRS & MAINTENANCE	$110,425	$110,425
DUES & SUBSCRIPTIONS	$74,722	$74,722

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$71,156	TotalAmt
Program Services	$67,576	ProgramServicesAmt
Management And General	$2,687	ManagementAndGeneralAmt
Fundraising	$893	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$6,744,008	TotalAmt
Program Services	$5,856,106	ProgramServicesAmt
Management And General	$860,040	ManagementAndGeneralAmt
Fundraising	$27,862	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$453,578	BOYAmt
EOY	$133,639	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$1,368,806	BOYAmt
EOY	$1,298,930	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$344,648	BOYAmt
EOY	$80,861	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$78,665	BOYAmt
EOY	$110,354	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$13,978,898	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$10,190,664	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$4,101,399	BOYAmt
EOY	$3,788,234	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$11,535	BOYAmt
EOY	$11,535	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$6,358,631	BOYAmt
EOY	$5,423,553	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$458,022	BOYAmt
EOY	$480,402	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$53,697	BOYAmt
EOY	$20,861	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$2,530,301	BOYAmt
EOY	$3,320,671	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,629	BOYAmt
EOY	$1,089	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$3,043,649	BOYAmt
EOY	$3,823,023	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$3,285,372	BOYAmt
EOY	$1,575,432	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$29,610	BOYAmt
EOY	$25,098	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$3,314,982	BOYAmt
EOY	$1,600,530	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$6,358,631	BOYAmt
EOY	$5,423,553	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	-$1,337,050	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	-$377,402	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	0	FSAuditedInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	Yes (X)	PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$370,099	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$229,314	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$114,127	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$1,680,404	CurrentTaxYearMinus1YearAmt
Current Tax Year	$34,435	CurrentTaxYearAmt
Total	$2,428,379	TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$10,312,136	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$10,473,880	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$10,722,634	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$9,620,951	CurrentTaxYearMinus1YearAmt
Current Tax Year	$5,338,287	CurrentTaxYearAmt
Total	$46,467,888	TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$74,048	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$15,035	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$8,106	CurrentTaxYearMinus2YearsAmt
Total	$97,189	TotalAmt

Total509 Total509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$10,756,283	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$10,718,229	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$10,844,867	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$11,301,355	CurrentTaxYearMinus1YearAmt
Current Tax Year	$5,372,722	CurrentTaxYearAmt
Total	$48,993,456	TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus3 Years	$11,184	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$3,022	CurrentTaxYearMinus2YearsAmt
Total	$14,206	TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus3 Years	$11,184	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$3,022	CurrentTaxYearMinus2YearsAmt
Total	$14,206	TotalAmt

Field	Value	IRS element (for citing)
Public Support Total509	$48,979,250	PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$15,087	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$19,681	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$18,014	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$20,206	CurrentTaxYearMinus1YearAmt
Current Tax Year	$34,236	CurrentTaxYearAmt
Total	$107,224	TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$15,087	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$19,681	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$18,014	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$20,206	CurrentTaxYearMinus1YearAmt
Current Tax Year	$34,236	CurrentTaxYearAmt
Total	$107,224	TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$10,771,370	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$10,737,910	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$10,862,881	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$11,321,561	CurrentTaxYearMinus1YearAmt
Current Tax Year	$5,406,958	CurrentTaxYearAmt
Total	$49,100,680	TotalAmt

Field	Value	IRS element (for citing)
Public Support CY509	0.99750	PublicSupportCY509Pct
Public Support PY509	0.99810	PublicSupportPY509Pct
Investment Income CY	0.00220	InvestmentIncomeCYPct
Investment Income PY	0.00160	InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509	Yes (X)	ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$75,430	OtherCostOrOtherBasisAmt
Book Value	$75,430	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$11,558,815	OtherCostOrOtherBasisAmt
Depreciation	$8,310,301	DepreciationAmt
Book Value	$3,248,514	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,344,653	OtherCostOrOtherBasisAmt
Depreciation	$1,880,363	DepreciationAmt
Book Value	$464,290	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$3,788,234	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

Field	Value	IRS element (for citing)
Desc	RESIDENT TRUST	Desc
Amt	$1,089	Amt

Field	Value	IRS element (for citing)
Total Liability	$1,089	TotalLiabilityAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART III, LINE 3	THE SKILLED NURSING FACILITY PROGRAM WAS CEASED ON 9/30/2020.
FORM 990, PART VI, SECTION A, LINE 3	THE ORGANIZATION USED A MANAGEMENT COMPANY, PEER SERVICES, INC., TO PERFORM MANAGEMENT AND OTHER DUTIES BEGINNING IN OCTOBER 2020. BILL SCHARBACH, EXECUTIVE DIRECTOR OF THE ORGANIZATION, WAS COMPENSATED BY PEER SERVICES, INC. TOTAL FEES PAID TO THE MANAGEMENT COMPANY FOR SERVICES PROVIDED TO THE ORGANIZATION, INCLUDING THE EXECUTIVE DIRECTOR POSITION, DURING THE REPORTING PERIOD WERE $231,823.
FORM 990, PART VI, SECTION B, LINE 11B	THE DRAFT OF THE FORM 990 IS DISTRIBUTED TO THE BOARD MEMBERS. THE BOARD DESIGNATES AND ASSIGNS ONE OF ITS QUALIFIED MEMBERS TO REVIEW THE RETURN. UPON RESOLUTION OF QUESTIONS AND ISSUES, AND APPROVAL BY THAT DESIGNATED BOARD MEMBER, THE BOARD APPROVES THE RETURN FOR FILING.
FORM 990, PART VI, SECTION B, LINE 12C	ONGOING CONSIDERATION OF ANY EXISTING OR POTENTIAL BOARD MEMBERS, EMPLOYEES, VENDORS, VOLUNTEERS AND OTHER BUSINESS CONNECTIONS WITH POSSIBLE CONFLICTS IN MIND BY ALL EXISTING BOARD MEMBERS AND KEY EMPLOYEES.
FORM 990, PART VI, SECTION B, LINE 15	THE BOARD OF DIRECTORS CAREFULLY CONSIDERS SELECTION AND SALARY FOR THE CHIEF EXECUTIVE OFFICER/EXECUTIVE DIRECTOR, INCLUDING COMPARING TO CURRENT MARKET QUALIFICATIONS AND COMPENSATION. THE CHIEF EXECUTIVE OFFICER IS NOT COMPENSATED FOR SERVICE ON THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 18	THE ORGANIZATION MAKES ITS FORM 1023 AND FORM 990 AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19	THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, WHISTLEBLOWER POLICY, AND ANNUAL FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:	ADJUSTMENT DUE TO DISCONTINUED OPERATIONS AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS RECEIVABLES OF THE SKILLED NURSING FACILITY PROGRAM -377,402.