2020-03-05T09:02:59-06:00 2019-06-30 381357951 PLANTE & MORAN PLLC 27400 NORTHWESTERN HIGHWAY SOUTHFIELD MI 48034 990 2018-07-01 351986767 OAK GROVE CHRISTIAN RETIREMENT VILLAGE INC OAKG 2199877005 221 WEST DIVISION ROAD DEMOTTE IN 46310 SCOTT MARTIN VP OF FINANCE 2199877005 2020-02-18 1 DAVID LOWENTHAL P00378651 2483522500 2020-02-18 67.59.56.33 2020-02-18 13:48:18 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 DF303116002C04F1BB1570DF7ACB4F93053CE256 2018 2020-09-22 18:59:49Z ROSEMARY WEEKS 221 WEST DIVISION ROAD DEMOTTE IN 46310 5204939 0 X WWW.OAKGROVECRV.COM X 1999 IN OAK GROVE CHRISTIAN RETIREMENT VILLAGE PROVIDES HOUSING AND CARE FOR THE AGED IN AN ATMOSPHERE OF CHRISTIAN FELLOWSHIP WITH OTHERS. CHARITY CARE FYE JUNE 30, 2019 AMOUNTED TO $1,050,024. 9 9 182 16 0 0 3802023 12815 5055714 5025652 825 -4320 60276 65396 8918838 5099543 19000 21000 0 0 3507457 4009889 0 0 0 1271238 1116650 4797695 5147539 4121143 -47996 14051516 14368338 6874555 7161548 7176961 7206790 X WE HONOR GOD BY PROVIDING A VIBRANT CHRISTIAN COMMUNITY, DEDICATED TO SERVICE EXCELLENCE, WHERE RESIDENTS ARE CARED FOR WITH LOVE, DIGNITY, AND RESPECT. 0 0 4531479 21000 5085652 OAK GROVE CHRISTIAN RETIREMENT VILLAGE (OG) IS A NON-PROFIT COMMUNITY BENEFIT CORPORATION THAT PROVIDES CONTINUING CARE RETIREMENT COMMUNITY (CCRC) SERVICES TO 90 RESIDENTS. OG PROVIDES CCRC SERVICES INCLUDING INDEPENDENT LIVING, ASSISTED LIVING (39 UNITS), AND SKILLED NURSING CARE (59 BEDS). INDEPENDENT LIVING RESIDENTS PAY A LIFE-LEASE ENTRY FEE TO OCCUPY THE RESIDENCE AND PAY A MONTHLY SERVICE FEE FOR SERVICES RENDERED. ASSISTED LIVING AND SKILLED NURSING RESIDENTS PAY A MONTHLY OR DAILY FEE FOR SERVICES RENDERED. ADDITIONALLY, THEY HAVE SOME 'A LA CARTE' FEES FOR INCIDENTALS AND SUPPLIES. RESIDENTS WHO DO NOT MISUSE THEIR ASSETS MAY BE ELIGIBLE FOR SUPPORT FROM OG IF THEIR ASSETS RUN OUT. OVER 50% OF TOTAL REVENUES WERE USED TO PROVIDE COMMUNITY BENEFITS, WHICH INCLUDES THE FOLLOWING AMOUNTS: INDIGENT CARE/CHARITY CARE - $1,050,024, MEDICARE WRITE-OFFS - $2,592,527. 4531479 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 19 0 1 182 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X SCOTT MARTIN 5745374000 1721 GREENCROFT BLVD GOSHEN IN 46526 DAN WALSTRA CHAIR 1.00 0.00 X X 0 0 0 ROBERT KAPER CHAIR (PART YEAR) 1.00 0.00 X X 0 0 0 JOEL SCHURMAN VICE CHAIR 1.00 0.00 X X 0 0 0 WESLEY VAN BRUGGEN BOARD MEMBER 1.00 0.00 X 0 0 0 NEIL BULT BOARD MEMBER 1.00 0.00 X 0 0 0 RON FIELDHOUSE BOARD MEMBER 1.00 0.00 X 0 0 0 DON HOEKSTRA BOARD MEMBER 1.00 0.00 X 0 0 0 JOHN ROORDA BOARD MEMBER 1.00 0.00 X 0 0 0 DONNA HAMSTRA BOARD MEMBER 1.00 0.00 X 0 0 0 KARL VAN KEPPEL BOARD MEMBER 1.00 0.00 X 0 0 0 OLIVER DORN BOARD MEMBER (PART YEAR) 1.00 0.00 X 0 0 0 ROSEMARY WEEKS PRESIDENT 40.00 0.00 X 0 129694 20631 DALE SHENK ASSISTANT TREASURER 0.40 17.80 X 0 130184 16223 KATHY BREWTON SECRETARY (PART YEAR) 1.00 42.70 X 0 136302 33692 RYDELL BONTRAGER SECRETARY 1.00 42.70 X 0 113091 37719 SCOTT MARTIN TREASURER 1.00 42.60 X 0 42592 600 AIMEE RIEMKE ASSISTANT SECRETARY 0.20 39.40 X 0 91309 45016 0 643172 153881 0 0 1 0 HEALTHCARE THERAPY SERVICES INC 1411 WEST COUNTY LINE RD GREENWOOD IN 46142 THERAPY SERVICES 985485 INTERDESIGN GROUP INC PO BOX 72336 CLEVELAND OH 44192 DESIGN SERVICES 200475 IMPACT INTERIORS GROUP 13355 10TH AVE N SUITE 108 PLYMOUTH MN 55441 DESIGN SERVICES 176226 HAMSTRA BUILDERS 12028 N 200 WEST WHEATFIELD IN 46392 CONSTRUCTION SERVICES 168711 4 12815 12815 CONTRACT LABOR 561000 3870099 3870099 BUILDING USE 531390 825000 825000 MANAGEMENT FEES 541610 323593 323593 RESIDENT SERVICES 623000 6960 6960 5025652 1076 1076 60000 60000 100000 105396 -5396 -5396 -5396 MISCELLANEOUS REVENUE 900099 5396 5396 5396 5099543 5085652 0 1076 21000 21000 3191525 3046804 144721 111573 106514 5059 474860 453327 21533 231931 221414 10517 327068 327068 3004 3004 34717 34717 63505 24611 38894 2575 2575 5065 486 4579 224 224 257637 257637 355033 355033 48145 40923 7222 DUES, LICENSE & SUBS. 7201 7201 REPAIRS & MAINTENANCE 3523 916 2607 RESIDENT EVENTS 2803 2803 BAD DEBTS 2590 2590 3560 3560 5147539 4531479 616060 0 300 301 1263391 1579066 1041803 745170 38761 38149 14031331 5868677 7089578 8162654 4617683 3842998 14051516 14368338 387663 781037 15000 15000 6356664 6252886 115228 112625 6874555 7161548 X 3153660 4143278 4023301 3063512 7176961 7206790 14051516 14368338 X -47996 77825 X X 0 1 X 1 1 1 X 2582 1396 813 3802023 12815 3819629 6256624 6018811 5445403 5115714 5085652 27922204 69589 33982 0 0 0 103571 6328795 6054189 5446216 8917737 5098467 31845404 0 209960 543571 898505 147143 936381 2735560 209960 543571 898505 147143 936381 2735560 29109844 576 638 0 825 1076 3115 576 638 825 1076 3115 10710 992 1983 276 5396 19357 6340081 6055819 5448199 8918838 5104939 31867876 0.91350 0.93080 0.00010 0.00010 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS 396000 396000 9649891 4018139 5631752 34900 24934 9966 2443018 1803750 639268 1507522 21854 1485668 8162654 DEPOSITS RESERVE 785860 BENEFICIAL INTEREST IN GREENCROFT FOUNDATION 3057138 3842998 DUE TO AFFILIATE 91324 ACCRUED INTEREST PAYABLE 21301 112625 5177368 77825 77825 5099543 0 5099543 5147539 0 5147539 0 5147539 PART XI, LINE 2D - OTHER ADJUSTMENTS: BENEFICIAL INTEREST ACTIVITY 77,825. 1 GREENCROFT COMMUNITIES FOUNDATION INC PO BOX 819 GOSHEN IN 46527 237126990 501(C)(3) 21000 N/A N/A TO SUPPORT ITS CHARITABLE PURPOSE 1 0 PART I, LINE 2: THE ORGANIZATION MAKES GRANTS TO RELATED ORGANIZATIONS. GRANTS MADE ARE UNRESTRICTED AND CAN BE USED IN ANY WAY THE RECIPIENT SEES FIT TO FURTHER ITS TAX-EXEMPT PURPOSE. 0 0 0 0 0 0 0 0 0 ROSEMARY WEEKS PRESIDENT 0 119028 0 10270 0 396 0 8000 0 12631 0 150325 0 0 KATHY BREWTON SECRETARY (PART YEAR) 0 132906 0 3000 0 396 0 8300 0 25392 0 169994 0 0 RYDELL BONTRAGER SECRETARY 0 110001 0 3000 0 90 0 5000 0 32719 0 150810 0 0 SCHEDULE J, PART I THIS ENTITY RELIED ON A RELATED ORGANIZATION THAT USED THE FOLLOWING METHODS TO ESTABLISH COMPENSATION FOR THE PRESIDENT/CEO: 1. COMPENSATION SURVEY OR STUDY 2. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION IS UNDER A MANAGEMENT/AFFILIATION CONTRACT WITH GREENCROFT RETIREMENT COMMUNITIES, INC. (GRC), A RELATED TAX-EXEMPT ORGANIZATION. ACCORDING TO THE AGREEMENT, GRC HAS THE SOLE AND EXCLUSIVE RIGHT TO SUPERVISE, MANAGE, AND OPERATE THE ORGANIZATION'S FACILITY ("THE FACILITY"). IN ADDITION, GRC HAS THE SOLE CONTROL AND DISCRETION WITH REGARD TO THE OPERATION AND MANAGEMENT OF THE FACILITY FOR ALL CUSTOMARY PURPOSES, AS WELL AS THE RIGHT TO DETERMINE ALL OPERATING POLICIES AFFECTING OR CONCERNING THE APPEARANCE AND MAINTENANCE STANDARDS OF OPERATION, AND ANY OTHER MATTER AFFECTING THE FACILITY OR THE OPERATION THEREOF. THE AGREEMENT TERMINATES IN JUNE 2028. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS ONE MEMBER, GREENCROFT RETIREMENT COMMUNITIES, INC. (GRC), THAT IS ALSO A RELATED TAX-EXEMPT ORGANIZATION. THE RESERVED POWERS OF THE SOLE MEMBER ARE AS FOLLOWS: 1. APPROVAL TO ANY CHANGES IN CORPORATE MISSION, WHICH MAY BE PROPOSED BY THE ORGANIZATION, BUT WHICH SHALL BECOME EFFECTIVE ONLY UPON APPROVAL OF GRC 2. APPROVAL OF NOMINATED CANDIDATES TO SERVE AS DIRECTOR OF THE ORGANIZATION 3. THE CREATION OR DISCONTINUATION OF PROGRAMS OR SERVICES OFFERED BY THE ORGANIZATION 4. AMENDMENTS TO THE BYLAWS AND ARTICLES OF INCORPORATION 5. APPROVAL OR THE ADOPTION OF THE ANNUAL BUDGET 6. APPROVAL OF NON-BUDGETED CONTRACTS AND/OR NON-BUDGETED PURCHASES OF OVER $50,000 7. THE INCURRENCE OF INDEBTEDNESS OF OVER $500,000 8. THE SALE OF REAL ESTATE 9. THE DONATION OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ORGANIZATION'S ASSETS 10. ANY MERGER OR CONSOLIDATION WITH ANY OTHER ORGANIZATION, OR THE PARTIAL OR TOTAL DISSOLUTION OF THE ORGANIZATION 11. THE CREATION OF SUBSIDIARY CORPORATIONS, LLCS, PARTNERSHIPS, OR OTHER ENTERPRISES 12. THE ACQUISITION OF CONTROLLING INTERESTS IN ANOTHER ENTITY 13. THE APPOINTMENT OF THE PRESIDENT/CEO, CFO, SECRETARY, AND TREASURER OF THE CORPORATION (BUT NOT THE OFFICERS OF THE BOARD OF DIRECTORS) 14. THE REMOVAL OF THE CHAIR OF THE BOARD OF DIRECTORS, WITH OR WITHOUT CAUSE 15. THE REMOVAL OF MEMBERS OF THE BOARD OF DIRECTORS, WITH OR WITHOUT CAUSE NOTWITHSTANDING THESE RESERVED POWERS, THE MEMBER HAS NO FINANCIAL OBLIGATIONS OR RESPONSIBILITIES FOR ANY ACTIONS OF THE ORGANIZATION BY REASON OF SERVING AS A MEMBER. FORM 990, PART VI, SECTION A, LINE 7A SEE NARRATIVE FOR PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION A, LINE 7B SEE NARRATIVE FOR PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION B, LINE 11B A FINAL DRAFT OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS PRESENTED BY OUR TAX ADVISORS TO THE ORGANIZATION'S AUDIT COMMITTEE AT A REGULARLY SCHEDULED MEETING. A COPY OF THE FINAL DRAFT IS THEN PROVIDED TO EACH BOARD MEMBER PRIOR TO ITS FILING. THIS ALLOWS THE BOARD OF DIRECTORS AND MANAGEMENT TO REVIEW AND PROVIDE COMMENTS AND EXPLANATIONS REGARDING THE FORM. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND OFFICERS ARE REQUIRED TO ANNUALLY DISCLOSE ANY CONFLICTS OF INTEREST THEY MAY HAVE WITH THE ORGANIZATION. THE TREASURER REVIEWS EACH POLICY STATEMENT SIGNED BY THESE INDIVIDUALS TO DETERMINE IF ANY CONFLICTS HAVE OCCURRED AND NEED TO BE BROUGHT TO THE ATTENTION OF THE BOARD. IF CONFLICT ARISES, THE RESPECTIVE BOARD MEMBER WILL ABSTAIN HIM/HERSELF FROM ANY RELATED DISCUSSION, VOTE OR SIMILAR ACTION ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 OAK GROVE'S (OG) PHILOSOPHY IS TO COMPENSATE TEAM MEMBERS IN A FAIR MANNER FOR THE WORTH OF WORK PROVIDED WITHIN THE CURRENT MARKET VALUE RANGE FOR EACH POSITION IN THE ORGANIZATION. OG CONDUCTS PERIODIC REVIEW OF THE MARKET TO DEVELOP AVERAGE WAGES FOR POSITIONS WITHIN OAK GROVE. OAK GROVE STARTS EMPLOYEES THAT MEET THE MINIMUM REQUIREMENTS FOR THE POSITION AT/OR NEAR THE STARTING WAGE. WE MAKE ADJUSTMENTS TO THE STARTING WAGE BASED ON YEARS OF EXPERIENCE IN THAT SPECIFIC POSITION. OUR COMPENSATION PHILOSOPHY FOR STAFF OF OUR ORGANIZATION IS BASED ON VARIOUS TIERS. THE FIRST TIER IS GENERAL STAFF. WE HAVE HIRED AN OUTSIDE CONSULTANT TO DEVELOP A COMPENSATION SYSTEM FOR ALL OF OAK GROVE'S POSITIONS. THE CONSULTANTS DEVELOPED A SYSTEM WITH WAGE SCALES THAT USE THE MARKETPLACE AVERAGE FOR KEY POSITIONS AS THE STARTING POINT FOR THE SCALES. THE WAGES SCALES HAVE A MINIMUM, A 25TH PERCENTILE, A 50TH PERCENTILE (AVERAGE) A 75TH PERCENTILE AND A MAXIMUM. WE STRIVE TO KEEP OUR AVERAGE FOR POSITIONS AT THE MID-POINT OF A RANGE DEVELOPED BY OUR CONSULTANTS. PERIODICALLY WE HIRE A CONSULTANT TO UPDATE THE MARKETPLACE AVERAGE FOR SEVERAL KEY POSITIONS. THE CONSULTANT WILL USE AREA MARKETPLACE DATA, LEADINGAGE DATA, AND OTHER INDUSTRY DATA TO DEVELOP THE AVERAGE. OUR COMPENSATION PHILOSOPHY FOR MANAGEMENT AND EXECUTIVE STAFF (DIRECTORS AND VICE PRESIDENT) OF OUR ORGANIZATION IS SLIGHTLY DIFFERENT. THE SECOND TIER IS MANAGEMENT STAFF. THE WAGE SCALE SYSTEM IS THE SAME FOR OUR STAFF. HOWEVER, OUR POLICY STATES THAT DIRECTORS ARE LIKE OTHER STAFF AND CAN EARN UP TO THE 100TH PERCENTILE OF THE RANGE FOR THEIR POSITION. OUR THIRD TIER IS VICE PRESIDENT STAFF. THE WAGE SCALE SYSTEM IS THE SAME FOR OUR STAFF. HOWEVER, THERE IS ONE DIFFERENCE. THE POLICY STATES THAT VICE PRESIDENTS CAN EARN UP TO THE 85TH PERCENTILE OF THE RANGE FOR THEIR POSITION. THE RANGE USES THE MEDIAN AS THE MID-POINT NOT THE AVERAGE. GENERALLY THE MEDIAN IS BELOW THE AVERAGE. THE OVERALL COMPENSATION POLICY AND THE VP COMPENSATION POLICY ARE APPROVED BY THE GREENCROFT COMMUNITIES (GC) BOARD OF DIRECTORS. THE OAK GROVE (OG) BOARD REVIEWS THE COMPENSATION POLICIES. ANNUALLY THE GC BOARD AND THE OG BOARD REVIEW THE COMPENSATION OF THEIR RESPECTIVE EXECUTIVE TEAMS. THEY COMPARE CURRENT WAGES WITH NATIONAL DATA PROVIDED BY LEADINGAGE (FORMERLY THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING - AAHSA). THE BOARDS REVIEW THE CURRENT WAGE, THE PERCENTILE RANKING OF THE EMPLOYEE IN HIS/HER RESPECTIVE RANGE AND THE MEDIAN OF THE MARKETPLACE COMPARED TO THE MID-POINT OF THE EMPLOYEE'S RANGE. THE BOARDS DOCUMENT THESE MEETINGS AND ACTIONS TAKEN IN THEIR BOARD MINUTES. THE OG BOARD HAS REVIEWED THE BASE WAGE AND THE VARIABLE PAY FOR THE PRESIDENT OF OAK GROVE. IN THE FISCAL YEAR 2019 THIS POSITION WAS AT THE 72ND PERCENTILE OF THE RANGE FOR THIS POSITION IN BASE COMPENSATION. THIS PROCESS WAS LAST PERFORMED IN FISCAL YEAR 2019. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. FORM 990, PART XI, LINE 9: BENEFICIAL INTEREST ACTIVITY 77,825. FORM 990, PART XII, LINE 2C: THE AUDIT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. GREENCROFT CENTRAL MANOR INC PO BOX 819 GOSHEN IN 46527 356047318 HOUSING IN 501(C)(3) LINE 10 GREENCROFT RETIREMENT COMMUNITIES INC 1 GREENCROFT COMMUNITIES FOUNDATION INC PO BOX 819 GOSHEN IN 46527 237126990 FUNDRAISING IN 501(C)(3) LINE 7 GREENCROFT RETIREMENT COMMUNITIES INC 1 GREENCROFT GOSHEN INC PO BOX 819 GOSHEN IN 46527 351270709 HEALTHCARE IN 501(C)(3) LINE 10 GREENCROFT RETIREMENT COMMUNITIES INC 1 GREENCROFT MANOR III INC PO BOX 819 GOSHEN IN 46527 351431475 HOUSING IN 501(C)(3) LINE 10 GREENCROFT RETIREMENT COMMUNITIES INC 1 GREENCROFT MANOR II INC PO BOX 819 GOSHEN IN 46527 351377430 HOUSING IN 501(C)(3) LINE 10 GREENCROFT RETIREMENT COMMUNITIES INC 1 GREENCROFT MIDDLEBURY INC PO BOX 819 GOSHEN IN 46527 300036865 HOUSING IN 501(C)(3) LINE 10 GREENCROFT RETIREMENT COMMUNITIES INC 1 GREENCROFT RETIREMENT COMMUNITIES INC PO BOX 819 GOSHEN IN 46527 300036587 MANAGEMENT IN 501(C)(3) LINE 12C, III-FI N/A 0 GREENCROFT HOME HEALTH SERVICES INC PO BOX 819 GOSHEN IN 46527 351606010 HOME HEALTH IN 501(C)(3) LINE 10 GREENCROFT RETIREMENT COMMUNITIES INC 1 HAVEN HUBBARD HOMES INC DBA HAMILTON GROVE 31869 CHICAGO TRAIL NEW CARLISLE IN 46552 350870110 HEALTHCARE IN 501(C)(3) LINE 10 GREENCROFT RETIREMENT COMMUNITIES INC 1 SOUTHFIELD VILLAGE INC 6450 MIAMI CIRCLE SOUTH BEND IN 46614 351866553 HEALTHCARE IN 501(C)(3) LINE 10 GREENCROFT RETIREMENT COMMUNITIES INC 1 WALNUT HILLS RETIREMENT COMMUNITIES INC PO BOX 129 WALNUT CREEK OH 44687 351317338 HEALTHCARE IN 501(C)(3) LINE 10 GREENCROFT RETIREMENT COMMUNITIES INC 1 CHICAGO TRAIL VILLAGE INC 31869 CHICAGO TRAIL NEW CARLISLE IN 46552 310990629 HOUSING IN 501(C)(3) LINE 10 HAVEN HUBBARD HOMES INC DBA HAMILTON GROVE 1 MENNONITE HEALTH SERVICES 234 S MAIN STREET SUITE A GOSHEN IN 46526 231421919 HEALTHCARE IN 501(C)(3) LINE 10 N/A 0 EDGEWATER PLACE INC 11351 LAFAYETTE PLAIN CITY ROAD PLAIN CITY OH 43064 823596152 HEALTHCARE IN 501(C)(3) LINE 10 GREENCROFT RETIREMENT COMMUNITIES INC 1 GREENCROFT MANAGEMENT INC PO BOX 819 GOSHEN IN 46527 270259652 MANAGEMENT SERVICES IN N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 1 GREENCROFT RETIREMENT COMMUNITIES INC M 339068 ACTUAL COST