2020-11-13T09:35:05-06:00 2019-12-31 560574444 CHERRY BEKAERT LLP 222 SECOND AVE SOUTH STE 1240 NASHVILLE TN 37201 990 2019-01-01 621533400 THE BLAKEFORD AT GREEN HILLS BLAK 6156659505 11 BURTON HILLS BLVD NASHVILLE TN 37215 AL GRIFFIN CFO 6156659505 2020-11-11 1 SARA G MOON P00034774 6153836592 184.80.143.82 2020-11-11 11:35:55 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 2FF319B3CE2B43652A7ED6DCC0B88F842DF00A82 2019 2021-01-29 14:40:06Z BRIAN BARNES 11 BURTON HILLS BLVD NASHVILLE TN 37215 38798094 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. 11 11 332 12 0 0 0 27573 16095321 17683453 880174 1799488 0 0 16975495 19510514 0 0 0 0 7678528 8923027 0 0 0 9663610 9825748 17342138 18748775 -366643 761739 52300208 53726448 70427241 70147790 -18127033 -16421342 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 18141764 17683453 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 629 PERSONS SERVED IN 2019. 18141764 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 46 0 1 332 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 1 1 1 0 TN X AL GRIFFIN 6156653745 11 BURTON HILLS BLVD NASHVILLE TN 37215 ARIE NETTLES BOARD MEMBER 1.00 X 0 0 0 BARBARA CANNON BOARD MEMBER 1.00 X 0 0 0 DR KEITH MEADOR BOARD MEMBER 1.00 X 0 0 0 JIM CROWELL TREASURER/SECRETARY 1.00 X X 0 0 0 JOEY HARWELL BOARD MEMBER 1.00 X 0 0 0 JOHN LOWRY BOARD MEMBER 1.00 X 0 0 0 LAURA BETH BROWN BOARD MEMBER 1.00 X 0 0 0 LUKE GREGORY CHAIRMAN (JAN-OCT) 1.00 X X 0 0 0 MARK VANDIVER BOARD MEMBER 1.00 X 0 0 0 MARY CLARE PYRON BOARD MEMBER 1.00 X 0 0 0 TAMMY BOEHMS BOARD MEMBER 1.00 X 0 0 0 DAVID GREGORY BOARD MEMBER 1.00 X 0 0 0 AL GRIFFIN CFO 40.00 X 120123 0 8461 ALLISON GRIFFITH COO 40.00 X 124266 0 9046 BRIAN BARNES CEO 40.00 X 248455 0 6417 SARAH BISHOP SALES AND MARKETING DIRECT 40.00 X 139484 0 4811 LAKECIA HARPER HEALTH SERVICE ADMINISTRAT 40.00 X 109578 0 8387 JANE KELLEY ED-LIVEWELL & BLAKEFORD AT 40.00 X 105365 0 4850 KELLEY ANDERSON EMPLOYEE 40.00 X 108281 0 8154 JASON VARNER EMPLOYEE 40.00 X 108480 0 0 1064032 0 50126 10 0 1 0 REHAB CARE INC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 1005826 TURENNE PHARMEDCO 355 INDUSTRIAL PARK BLVD MONTGOMERY AL 36117 MEDICAL SUPPLIES 346302 MARTIN & ZERFOSS INC 6730 CHARLOTTE PIKE NASHVILLE TN 37209 INSURANCE SERVICES 228178 JOHN RICHARDSON 7853 OLD CHARLOTTE PIKE NASHVILLE TN 37209 MAINTENANCE & RENOVATION 212051 4 27573 27573 RESIDENT SERVICES REVENUE 623000 17588125 17588125 SHARED INCOME (THE BLAKEFORD AT H 623000 95328 95328 17683453 641609 641609 20445159 300 19287580 0 1157579 300 1157879 1157879 19510514 17683453 0 1799488 X 456048 273629 182419 7109395 7038301 71094 107134 89993 17141 641239 538641 102598 609211 603119 6092 16446 1316 15130 52615 19994 32621 2270166 2270166 600263 528796 71467 1233715 1220591 13124 30916 15458 15458 1165062 1153411 11651 2172039 2150319 21720 187659 174523 13136 SUPPLIES 1905975 1886915 19060 LICENSES, PERMITS & FEE 123362 122128 1234 DUES & SUBSCRIPTIONS 65330 52264 13066 OTHER 2200 2200 18748775 18141764 607011 0 2752674 4794694 3684084 3759329 741676 798688 34458 24367 142175 398300 56277839 29072543 27728184 27205296 6605182 5389972 10609842 11355802 1933 0 52300208 53726448 2038119 2463531 42576138 42700924 25669995 24813567 142989 169768 70427241 70147790 X -18127033 -16421342 -18127033 -16421342 52300208 53726448 X 761739 961538 -17586 X 0 1 X 1 0 X 27573 27573 18456205 16229048 20471887 16095321 17683753 88936214 18456205 16229048 20471887 16095321 17711326 88963787 0 0 0 88963787 443633 403087 405795 543780 641609 2437904 443633 403087 405795 543780 641609 2437904 18899838 16632135 20877682 16639101 18352935 91401691 0.97330 0.97610 0.02670 0.02390 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3613159 3613159 40281055 19430947 20850108 1315510 1209977 105533 10043311 8431619 1611692 1024804 1024804 27205296 FIXED INCOME SECURITIES 11355802 F 11355802 REFUNDABLE CUSTOMER DEPOSITS 169768 169768 X 20454466 961538 961538 19492928 17586 17586 19510514 18748775 0 18748775 0 18748775 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 INTERNAL REVENUE CODE. IT IS NOT CONSIDERED A PRIVATE FOUNDATION. THE BLAKEFORD AT GREEN HILLS CORPORATION IS A 501(C)(3) ORGANIZATION WHICH IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. BLAKEFORD AT HOME, INC. HAS BEEN CLASSIFIED AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(4) OF THE INTERNAL REVENUE CODE 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 INTERNAL REVENUE CODE. LIVEWELL BY BLAKEFORD, INC. IS A 501(C)(3) ORGANIZATION WHICH IS EXEMPT FROM FEDERAL INCOME TAXES PURSUANT TO SECTION 509(A) OF THE INTERNAL REVENUE CODE. 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 FIFTY PERCENT LIKELY OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE COMPANY DOES NOT BELIEVE THERE ARE ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2019. ADDITIONALLY, THE COMPANY HAS NOT RECOGNIZED ANY TAX RELATED INTEREST AND PENALTIES IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 4B THE BOOK TAX ADJUSTMENT REPRESENTS THE DIFFERENCE IN REVENUES AS A RESULT OF THE ADOPTION OF FASB ASU NO. 2012-01, HEALTHCARE ENTITIES: CONTINUING CARE RETIREMENT COMMUNITIES - REFUNDABLE ADVANCE FEES FOR FINANCIAL STATEMENT PURPOSES ONLY. THE ACCOUNTING METHOD CHANGE HAS NOT BEEN ADOPTED FOR 990 PURPOSES. PART XI, LINE 4B - OTHER ADJUSTMENTS: BOOK/TAX ADJUSTMENT 17,586. X X X 0 0 0 0 0 0 0 0 0 BRIAN BARNES CEO 241255 0 7200 0 0 0 0 0 6417 0 254872 0 0 0 A NASHVILLE TN GOVERNMENT 626139016 592041UF2 2012-08-09 30808458 REVENUE REFUNDING & IMPROVEMENT 0 0 0 A 28115276 30808458 614669 2077013 2012 1 0 1 1 A 0 0 0 0 0 0 0 A 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. FORM 990, PART IX, LINE 11G PLANT OPERATIONS SERVICES: PROGRAM SERVICE EXPENSES 119,884. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 119,884. NURSING SERVICES: PROGRAM SERVICE EXPENSES 314,830. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 314,830. REHABILITATION SERVICES: PROGRAM SERVICE EXPENSES 951,554. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 951,554. GENERAL & ADMIN (OTHER): PROGRAM SERVICE EXPENSES 218,188. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 218,188. RESIDENTIAL SERVICES: PROGRAM SERVICE EXPENSES 654,633. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 654,633. ASSISTED LIVING SERVICES: PROGRAM SERVICE EXPENSES 11,077. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,077. FORM 990, PART XI, LINE 9: BOOK/TAX ADJUSTMENT -17,586. FORM 990, PART XI, LINE 9 - BOOK/TAX ADJUSTMENT THE BOOK TAX ADJUSTMENT REPRESENTS THE DIFFERENCE IN REVENUES AS A RESULT OF THE ADOPTION OF FASB ASU NO. 2012-01, HEALTHCARE ENTITIES: CONTINUING CARE RETIREMENT COMMUNITIES - REFUNDABLE ADVANCE FEES FOR FINANCIAL STATEMENT PURPOSES ONLY. THE ACCOUNTING METHOD CHANGE HAS NOT BEEN ADOPTED FOR 990 PURPOSES. 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