2021-11-10T12:22:26-06:00 2021-06-30 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2020-07-01 351282401 NATIONAL FELLOWSHIP BRETHREN RETIREMENT NATI 5743726200 337 GRACE VILLAGE DR WINONA LAKE IN 46590 JUSTIN KIMBRELL CEO 5743726200 2021-11-10 1 JUSTIN KIMBRELL 999009999 ANGELA N CRAWFORD CPA P00573197 3176334705 2021-11-10 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z GRACE VILLAGE RETIREMENT COMMUNITY JUSTIN KIMBRELL 337 GRACE VILLAGE DR WINONA LAKE IN 46590 3820759 0 X GRACEVILLAGE.ORG X 1974 IN GRACE VILLAGE'S MISSION IS TO ENABLE OLDER ADULTS TO LIVE TO THEIR FULLEST POTENTIAL IN THE SECURITY OF A CHRISTIAN COMMUNITY. 11 11 30 50 0 0 77706 80937 3303708 3008832 49092 145234 4737 192718 3435243 3427721 0 0 0 0 1017119 935857 0 0 25511 2321728 1626792 3338847 2562649 96396 865072 10395811 10579802 10920509 10119856 -524698 459946 GRACE VILLAGE'S MISSION IS TO ENABLE OLDER ADULTS TO LIVE TO THEIR FULLEST POTENTIAL IN THE SECURITY OF A CHRISTIAN COMMUNITY. GRACE VILLAGE OFFERS INDEPENDENT LIVING OPTIONS THAT INCLUDE MEALS AND NURSING SERVICES WHEN NEEDED. 0 0 1805359 3008832 GRACE VILLAGE OFFERS INDPENDENT LIVING OPTIONS THAT INCLUDE MEALS AND NURSING SERVICES WHEN NEEDED. GRACE VILLAGE ALSO OFFERS THERAPY SERVICES AND IN HOME NON-MEDICAL SERVICES AS NEEDED. 1805359 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 30 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 0 0 IN X SONDREA HAMILTON VP AND CFO 5743726200 337 GRACE VILLAGE DR WINONA LAKE IN 46590 CHAD HUMMEL BOARD MEMBER JUL-DEC'21/CHAIR JAN-JUN'21 0.50 0.50 X X 0 0 0 ADAM LENON SECRETARY & TREASURER 0.50 0.50 X X 0 0 0 DENNIS DUNCAN BOARD MEMBER 0.50 0.50 X 0 0 0 GLENN HALL BOARD MEMBER-TERM BEGAN JAN'21 0.50 0.50 X 0 0 0 CHUCK JOSEY BOARD MEMBER 0.50 0.50 X 0 0 0 DAVID KOONTZ BOARD MEMBER 0.50 0.50 X 0 0 0 DAN LEININGER BOARD MEMBER-TERM BEGAN JAN'21 0.50 0.50 X 0 0 0 MARK MCCOLLOM BOARD MEMBER 0.50 0.50 X 0 0 0 NATHAN MUELLER BOARD MEMBER 0.50 0.50 X 0 0 0 JENNIFER PIERCE BOARD MEMBER-TERM BEGAN JAN'21 0.50 0.50 X 0 0 0 DALE ROBBINS BOARD MEMBER-TERM BEGAN JAN'21 0.50 0.50 X 0 0 0 PASTOR MATT ELLIOTT BOARD MEMBER-TERM ENDED DEC'21 0.50 0.50 X 0 0 0 GARY HAMMAN CHAIR-TERM ENDED DEC'21 0.50 0.50 X X 0 0 0 GARY HERBRUCK VICE CHAIR-TERM ENDED OCT'20 0.50 0.50 X X 0 0 0 RON REDPATH BOARD MEMBER-TERM ENDED DEC'20 0.50 0.50 X 0 0 0 MATTHEW TEEVAN BOARD MEMBER-TERM ENDED OCT'20 0.50 0.50 X 0 0 0 JUSTIN KIMBRELL CEO 28.00 12.00 X 0 90673 3702 SONDREA HAMILTON CFO 28.00 12.00 X 110657 0 7978 110657 90673 11680 1 0 0 0 0 80937 80937 NET PATIENT AND RESIDE 623000 2045381 2045381 DEFERRED LIFE LEASE 623000 663451 663451 RENT INCOME FROM GRACE 623000 300000 300000 3008832 8195 8195 147917 382160 135434 257604 12483 124556 137039 137039 192718 192718 192718 3427721 3008832 0 337952 118635 118635 529609 413669 115940 10359 6610 3749 203998 130179 73819 73256 46747 26509 31915 31915 97526 72015 25511 25314 25314 56920 40091 16829 348051 308762 39289 359 235 124 185825 167242 18583 761939 685745 76194 86932 86932 OTHER EXP 22666 5529 17137 DUES & SUB. 9345 550 8795 2562649 1805359 731779 25511 78380 1550356 362300 129660 9000 3000 8849 313612 16518 14374 33498 5279 24572895 16262088 9172834 8310807 389623 252714 324809 0 10395811 10579802 153912 133283 6314236 5863540 3879299 3758444 573062 364589 10920509 10119856 X -525935 453972 1237 5974 -524698 459946 10395811 10579802 X 865072 6167 113405 X X 0 1 X 1 0 X 125311 34431 28045 77706 80937 346430 2851823 3141982 3267431 3303708 3008832 15573776 2977134 3176413 3295476 3381414 3089769 15920206 0 0 0 15920206 32721 32108 21351 21092 8195 115467 32721 32108 21351 21092 8195 115467 6626 8473 5145 4737 192718 217699 3016481 3216994 3321972 3407243 3290682 16253372 0.97950 0.97100 0.00710 0.02750 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 147948 147948 22287925 14668134 7619791 2112914 1593954 518960 24108 24108 8310807 DEPOSITS 27430 RENT CREDITS 112460 INTEREST RATE SWAP LIABILITY 204897 LOAN INSURANCE COSTS -8342 DEFERRED COMPENSATION PLAN OBLIGATI 28144 364589 X 3547293 6167 113405 119572 3427721 0 3427721 2562649 0 2562649 0 2562649 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THEIR ORGANIZATIONS AND RECOGNIZE A TAX LIABILITY IF THEY HAVE TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY GRACE AND NATIONAL FELLOWSHIP AND HAS CONCLUDED THAT AS OF JUNE 30, 2021 AND 2020, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ORGANIZATIONS ARE SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: GAIN/LOSS ON INTEREST RATE SWAP 113,405. FORM 990, PART VI, SECTION B, LINE 11B THE CFO ASSISTS BLUE & CO., LLC IN PREPARATION OF THE 990 BEFORE IT IS FILED. THE CFO REVIEWS THE FORM 990 BEFORE IT IS FILED. BLUE & CO. FILES THE FORM 990 ONCE FINAL APPROVAL IS RECEIVED FROM THE CFO. THE CEO AND FULL BOARD ARE GIVEN A COPY OF THE FORM 990 UPON COMPLETION OF THE PREPARATION AND FILING. FORM 990, PART VI, SECTION B, LINE 12C GRACE VILLAGE TRIES TO AVOID SITUATIONS THAT COULD POTENTIALLY BE SEEN AS CONFLICTS OF INTEREST. IF A CONFLICT IS FOUND, IT IS DEALT WITH ON A CASE BY CASE BASIS, AND THE BOARD OF DIRECTORS MAKES A DECISION AS TO MATERIALITY OF THE CONFLICT, AND WHETHER TO TERMINATE TRANSACTIONS WITH PARTIES THAT HAVE A CONFLICT OF INTEREST. CONFLICTS OF INTEREST ARE MONITORED AND DEALT WITH AT EVERY LEVEL OF THE ORGANIZATION, FROM HOURLY EMPLOYEES, TO SALARIED EMPLOYEES, TO BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 15A THE CEO'S SALARY IS PAID BY A RELATED ORGANIZATION AND IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS OF THAT ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST FORM 990, PART XI, LINE 9: GAIN/LOSS ON INTEREST RATE SWAP 113,405. FORM 990, PART XII, LINE 2C THE PROCESS FOR FOR SELECTION OF INDEPENDENT ACCOUNTANT AND OVERSIGHT OF SUCH PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. GRACE VILLAGE HEALTHCARE FACILITY INC 337 GRACE VILLAGE DRIVE WINONA LAKE IN 46590 351447417 NURSING HOME/ASSISTED LIVING FACILITY IN 501C3 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 0 1 0 GRACE VILLAGE HEALTHCARE FACILITY INC J 300000 GRACE VILLAGE HEALTHCARE FACILITY INC M 297118