2021-11-15T11:08:36-06:00 2020-12-31 560574444 CHERRY BEKAERT LLP 222 SECOND AVE SOUTH STE 1240 NASHVILLE TN 37201 990 2020-01-01 621533400 THE BLAKEFORD AT GREEN HILLS BLAK 6156659505 11 BURTON HILLS BLVD NASHVILLE TN 37215 AL GRIFFIN CFO 6156659505 2021-11-12 1 AL GRIFFIN 999009999 SARA G MOON P00034774 6153836592 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z BRIAN BARNES 11 BURTON HILLS BLVD NASHVILLE TN 37215 28645330 0 X WWW.BLAKEFORD.COM X 1992 TN PROVIDE QUALITY LIFESTYLE OPTIONS AND SERVICES TO SENIOR ADULTS THAT ENCOURAGE INDEPENDENCE, INDIVIDUALITY AND PRIVACY, WHILE CREATING BOTH ECONOMIC VALUE AND LIFE ENRICHMENT OPPORTUNITIES FOR ALL THOSE WE SERVE. 12 12 214 13 0 0 27573 1906316 17683453 16146582 1799488 881413 0 0 19510514 18934311 0 0 0 0 8923027 9486434 0 0 0 9825748 9587723 18748775 19074157 761739 -139846 53726448 95842522 70147790 112857968 -16421342 -17015446 PROVIDE QUALITY LIFESTYLE OPTIONS AND SERVICES TO SENIOR ADULTS THAT ENCOURAGE INDEPENDENCE, INDIVIDUALITY AND PRIVACY, WHILE CREATING BOTH ECONOMIC VALUE AND LIFE ENRICHMENT OPPORTUNITIES FOR ALL THOSE WE SERVE. 0 0 18237779 16146582 THE ORGANIZATION PROVIDES LONG TERM CARE FACILITIES IN THE STATE OF TENNESSEE, SPECIFICALLY DESIGNED TO MEET THE PHYSICAL, SOCIAL & PSYCHOLOGICAL NEEDS OF ELDERLY AND INFIRM PERSONS, INCLUDING BUT NOT LIMITED TO HOUSING, BUILDINGS, STRUCTURES, EQUIPMENT, FURNISHINGS, PROGRAMS AND RELATED HEALTH AND OTHER SERVICES CONTRIBUTING TO THEIR HEALTH, SECURITY, HAPPINESS, AND PHYSICAL AND MENTAL WELL-BEING. THERE WERE APPROXIMATELY 401 PERSONS SERVED IN 2020. 18237779 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 31 0 1 214 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 TN X AL GRIFFIN 6156653745 11 BURTON HILLS BLVD NASHVILLE TN 37215 BARBARA CANNON CHAIR 1.00 X X 0 0 0 LAURA BETH BROWN VICE CHAIR 1.00 X X 0 0 0 JIM CROWELL TREASURER/SECRETARY 1.00 X X 0 0 0 TAMMY BOEHMS BOARD MEMBER 1.00 X 0 0 0 FRED EWING BOARD MEMBER 1.00 X 0 0 0 DR DAVID GREGORY BOARD MEMBER 1.00 X 0 0 0 JOHN LOWRY BOARD MEMBER 1.00 X 0 0 0 DR ARIE NETTLES BOARD MEMBER 1.00 X 0 0 0 MARY CLARE PYRON BOARD MEMBER 1.00 X 0 0 0 MARK T VANDIVER BOARD MEMBER 1.00 X 0 0 0 CHRIS WAS BOARD MEMBER 1.00 X 0 0 0 JOSEPH W HARWELL BOARD MEMBER 1.00 X 0 0 0 KEITH MEADOR BOARD MEMBER 1.00 X 0 0 0 BRIAN BARNES CEO 35.30 4.70 X 315700 0 19346 ALLISON GRIFFITH COO 35.30 4.70 X 129733 0 6414 AL GRIFFIN CFO 35.30 4.70 X 124555 0 9954 LAKECIA HARPER HEALTH SERVICE ADMINISTRAT 40.00 X 122165 0 6443 SARAH BISHOP SALES AND MARKETING DIRECTOR 40.00 X 158047 0 9650 JANE KELLEY ED-LIVEWELL & BLAKEFORD AT HOME 0.00 40.00 X 108387 0 2168 MYRTESA LAWRENCE EMPLOYEE 40.00 X 103222 0 1528 1061809 0 55503 7 0 1 0 MARTIN & ZERFOSS INC 6730 CHARLOTTE PIKE NASHVILLE TN 37209 INSURANCE SERVICES 673893 REHAB CARE INC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 669291 TURENNE PHARMEDCO 355 INDUSTRIAL PARK BLVD MONTGOMERY AL 36117 MEDICAL SUPPLIES 222731 JOHN RICHARDSON 7853 OLD CHARLOTTE PIKE NASHVILLE TN 37209 MAINTENANCE & RENOVATION 149741 4 1891141 15175 1906316 RESIDENT SERVICES REVENUE 623000 16034886 16034886 SHARED INCOME (THE BLAKEFORD AT H 623000 111696 111696 16146582 530635 530635 10059797 2000 9711019 0 348778 2000 350778 350778 18934311 16146582 0 881413 534533 320720 213813 7281971 7209151 72820 113971 95736 18235 989600 831264 158336 566359 560695 5664 14536 1163 13373 64245 24413 39832 1630721 1630721 994343 842913 151430 1128939 1116837 12102 14810 7405 7405 1092611 1081685 10926 2131294 2109981 21313 227523 211596 15927 SUPPLIES 1743691 1726254 17437 COVID-19 RELATED EXPENS 302037 241630 60407 LICENSES, PERMITS & FEE 164084 162443 1641 DUES & SUBSCRIPTIONS 78587 62870 15717 302 302 19074157 18237779 836378 0 4794694 3385950 3759329 43260302 798688 657435 24367 39000 398300 317561 60770238 31163166 27205296 29607072 5389972 6306886 11355802 12268316 53726448 95842522 2463531 2525706 42700924 42780197 24813567 66795288 169768 756777 70147790 112857968 X -16421342 -17015446 -16421342 -17015446 53726448 95842522 -139846 -454258 0 X 0 1 X 1 0 X 27573 1906316 1933889 16229048 20471887 16095321 17683753 16146582 86626591 16229048 20471887 16095321 17711326 18052898 88560480 0 0 0 88560480 403087 405795 543780 641609 530635 2524906 403087 405795 543780 641609 530635 2524906 16632135 20877682 16639101 18352935 18583533 91085386 0.97230 0.97330 0.02770 0.02670 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3613159 3613159 40666236 21092826 19573410 1315510 1229018 86492 10234024 8841322 1392702 4941309 4941309 29607072 FIXED INCOME SECURITIES 12268316 F 12268316 REFUNDABLE CUSTOMER DEPOSITS 548022 INTEREST RATE SWAP 208755 756777 X 18480053 -454258 -454258 18934311 0 18934311 19074157 0 19074157 0 19074157 PART X, LINE 2: BLAKEFORD, INC. IS A 501(C)(3) ORGANIZATION WHICH IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 509(A) OF THE IRC. IT IS NOT CONSIDERED A PRIVATE FOUNDATION. BGH IS A 501(C)(3) ORGANIZATION WHICH IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE IRC. BAH HAS BEEN CLASSIFIED AS A TAXEXEMPT ORGANIZATION UNDER SECTION 501(C)(4) OF THE IRC AND, THEREFORE, IS NOT SUBJECT TO FEDERAL INCOME TAX. BLAKEFORD ASSISTED LIVING AND HEALTH CENTER, INC. IS A 501(C)(3) ORGANIZATION WHICH IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 509(A) OF THE IRC. LIVEWELL BY BLAKEFORD, INC. IS A 501(C)(3) ORGANIZATION WHICH IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 509(A) OF THE IRC. OTHER AFFILIATES CONSISTING OF BLAKEFORD DEVELOPMENT SERVICES, INC. AND BLAKEFORD MANAGEMENT SERVICES, INC. ARE CORPORATIONS SUBJECT TO CORPORATE AND STATE INCOME TAX ON TAXABLE INCOME, IF ANY. THE COMPANY FOLLOWS FASB ASC GUIDANCE THAT CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THIS GUIDANCE PRESCRIBES A MINIMUM PROBABILITY THRESHOLD THAT A TAX POSITION MUST MEET BEFORE A FINANCIAL STATEMENT BENEFIT IS RECOGNIZED. THE MINIMUM THRESHOLD IS DEFINED AS A TAX POSITION THAT IS MORE LIKELY THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPLICABLE TAXING AUTHORITY, INCLUDING RESOLUTION OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT TO BE RECOGNIZED IS MEASURED AS THE LARGEST AMOUNT OF BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE COMPANY DOES NOT BELIEVE THERE ARE ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2020. ADDITIONALLY, THE COMPANY HAS NOT RECOGNIZED ANY TAX RELATED INTEREST AND PENALTIES IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. X X X 0 0 0 0 0 0 0 0 0 BRIAN BARNES CEO 259200 0 56500 0 0 0 9670 0 9676 0 335046 0 0 0 SARAH BISHOP SALES AND MARKETING DIRECTOR 114547 0 0 0 43500 0 2350 0 7300 0 167697 0 0 0 A NASHVILLE TN GOVERNMENT 626139016 592041UF2 2012-08-09 30808458 REVENUE REFUNDING & IMPROVEMENT 1 0 0 B NASHVILLE TN GOVERNMENT 626139016 592041YU5 2020-11-19 48565000 IMPROVEMENT 0 0 0 A 23310000 30808458 614669 2077013 2012 1 0 1 1 B 45235737 3599087 3000000 315000 38321650 2022 0 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 A 0 PART III, LINE 9 AND PART IV, LINES 1, 2B, 2C & 7 - AS A RESULT OF TAX SOFTWARE LIMITATIONS THE FOLLOWING LINES HAVE BEEN ANSWERED "NO". HOWEVER, THE FOLLOWING LINES DO NOT REQUIRE A RESPONSE: PART III, LINE 9 PART IV, LINE 1, 2B, 2C, AND 7 FORM 990, PART VI, SECTION B, LINE 11B THE 990 WILL BE REVIEWED BY FINANCE COMMITTEE & MANAGEMENT BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, EACH BOARD MEMBER IS REQUIRED TO FILL OUT A CONFLICT OF INTEREST DISCLOSURE FORM. IF A CONFLICT ARISES THE BOARD WILL TAKE THE APPROPRIATE ACTION TO REMEDY THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE & BOARD OF DIRECTORS REVIEWS AND APPROVES THE CEO'S COMPENSATION. THE CEO WORKS WITH HUMAN RESOURCES ON EMPLOYEE'S COMPENSATION TO ENSURE THAT COMPETITIVE SALARIES ARE OFFERED UTILIZING MARKET COMPARISONS. A FINANCE COMMITTEE OF THE BOARD OFFERS INPUT ON THE COMPENSATION PACKAGES OF OFFICERS AND KEY EMPLOYEES, HOWEVER, THE CEO HAS FULL DISCRETION. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. BLAKEFORD INC 11 BURTON HILLS BLVD NASHVILLE TN 37215 300119044 SUPPORT ORGANIZATION TN 501(C)(3) LINE 12B, II N/A 0 BLAKEFORD ASSTD LIVING HEALTH CENTER 11 BURTON HILLS BLVD NASHVILLE TN 37215 300119048 DORMANT TN 501(C)(3) LINE 10 BLAKEFORD INC 0 BLAKEFORD AT HOME INC 11 BURTON HILLS BLVD NASHVILLE TN 37215 461354013 HOME HEALTCARE TN 501(C)(4) THE BLAKEFORD AT GREEN HILLS 1 LIVEWELL BY BLAKEFORD INC 11 BURTON HILLS BLVD NASHVILLE TN 372156298 464780380 HOME HEALTCARE TN 501(C)(3) LINE 10 BLAKEFORD INC 0 BLAKEFORD DEVELOPMENT SERVICES INC 11 BURTON HILLS BLVD NASHVILLE TN 37215 208591698 DEV. CO. RETIREMENT COMMUNITY TN N/A C 0 BLAKEFORD MANAGEMENT SERVICES INC 11 BURTON HILLS BLVD NASHVILLE TN 37215 208591838 MGMT. CO. FOR SENIOR HOUSING TN N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0