2019-11-14T17:55:37-06:00 2019-06-30 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2018-07-01 311002846 WESTMINSTER VILLAGE WEST LAFAYETTE INC WEST 7654637546 2741 NORTH SALISBURY STREET WEST LAFAYETTE IN 47906 ROBERT PAHL BOARD PRESIDENT 7654637546 2019-11-12 1 JEFF PARKER P00970069 3149254300 67.137.57.251 2019-11-12 11:44:26 CS P DBE5E9100BD705C5801F05FB9419F1388E8E9FDA FCD06153B7C3F4186BBEFC76B30654521E54D624 2018 2020-04-17 16:48:07Z BENJAMIN BLANKENSHIP 2741 NORTH SALISBURY STREET WEST LAFAYETTE IN 47906 25501777 0 X WWW.WVWL.ORG X 1976 IN PROVIDES RESIDENTIAL FACILITIES DESIGNED TO MEET THE NEEDS OF THE ELDERLY. 9 9 482 131 0 0 163924 262783 20554838 21311598 116584 455516 950744 785662 21786090 22815559 0 0 0 0 11338163 10688830 0 0 0 14257913 14636649 25596076 25325479 -3809986 -2509920 86713906 85125266 91813131 93993399 -5099225 -8868133 X PROVIDES RESIDENTIAL FACILITIES DESIGNED TO MEET THE NEEDS OF THE ELDERLY AND PROVIDE FOR THE PHYSICAL, MENTAL AND FINANCIAL WELL BEING OF ITS RESIDENTS. FINANCIAL ASSISTANCE IS PROVIDED TO THOSE RESIDENTS UNABLE TO MEET THEIR LIVING EXPENSES. 0 0 22554459 21576598 WESTMINSTER VILLAGE WEST LAFAYETTE, INC. IS A NOT-FOR-PROFIT, LIFE PLAN COMMUNITY LOCATED IN WEST LAFAYETTE, INDIANA. FACILITIES INCLUDE 127 RESIDENTIAL UNITS (INDEPENDENT LIVING CENTER), 51 INDEPENDENT LIVING COTTAGES, 54 HYBRID HOMES, A 72 BED COMPREHENSIVE CARE FACILITY (THE HEALTH CENTER), AND A 76 BED ASSISTED LIVING FACILITY. WESTMINSTER'S PRIMARY PURPOSE IS THE PROVISION OF CONTINUING CARE SERVICES TO THE CITIZENS OF WEST LAFAYETTE, INDIANA AND THE SURROUNDING COMMUNITIES. -265000 THE VILLAGE PROVIDES CARE TO RESIDENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITHOUT CHARGE. THE KEY ELEMENT USED TO DETERMINE ELIGIBILITY IS THE RESIDENT'S INABILITY TO PAY THEIR MONTHLY CHARGES AS DOCUMENTED IN AN APPLICATION THAT REQUIRES THEM TO REPORT TOTAL MONTHLY INCOME AND TOTAL ASSETS AND IS APPROVED BY MANAGEMENT AND THE BOARD. BECAUSE THE VILLAGE DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE, THEY ARE NOT REPORTED AS REVENUE. THE VILLAGE HAS ESTIMATED ITS DIRECT AND INDIRECT COSTS OF PROVIDING FINANCIAL ASSISTANCE UNDER ITS FINANCIAL ASSISTANCE POLICY. BECAUSE ALL OF THE FINANCIAL ASSISTANCE PROVIDED DURING THE PERIOD WHERE IN THE SKILLED NURSING SETTING, MANAGEMENT ESTIMATED THAT THE COST OF PROVIDING FINANCIAL ASSISTANCE IS APPROXIMATELY EQUAL TO THE RATES BEING FOREGONE. USING THIS METHODOLOGY, THE VILLAGE HAS ESTIMATED THE COSTS FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THE VILLAGE'S FINANCIAL ASSISTANCE POLICY OF APPROXIMATELY $265,000 AND $424,000 FOR THE YEARS ENDED JUNE 30, 2019 AND 2018, RESPECTIVELY. THIS AMOUNT IS INCLUDED AS AN OFFSET TO RESIDENT SERVICES REVENUE. CONSISTENT WITH THE MISSION STATEMENT OF THE VILLAGE, THE VILLAGE IS COMMITTED TO PROVIDING PROGRAMS, SERVICES AND CONTRIBUTIONS (BOTH IN KIND AND FINANCIAL) THAT TARGET THE RESIDENT POPULATION AT THE VILLAGE, AS WELL AS TO BENEFIT THE BROADER COMMUNITY. IN ADDITION TO THE FINANCIAL ASSISTANCE, THE VILLAGE PROVIDES COMMUNITY SERVICES THAT INCLUDE, BUT ARE NOT LIMITED TO EDUCATIONAL PROGRAMS, TRANSPORTATION AND CHURCH RELATIONS ALL TARGETED TOWARDS ENHANCING THE QUALITY OF LIFE OF THE RESIDENTS. THE COST OF THESE PROGRAMS AND SERVICES ARE INCLUDED IN OPERATING EXPENSES. 22554459 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 1 35 0 482 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X RICK J FRALEY 7654637546 2741 NORTH SALISBURY WEST LAFAYETTE IN 47906 X ANDREW S GUTWEIN PRESIDENT (TERM ENDED 7/18) 6.00 X X 0 0 0 ROBERT PAHL PRESIDENT 5.00 X X 0 0 0 GLENN TOMPKINS TREASURER 5.00 X X 0 0 0 LOUIS CARR SECRETARY 5.00 X X 0 0 0 MARTHA CHISCON DIRECTOR (TERM ENDED 7/18) 3.00 X 0 0 0 BRAD DENO DIRECTOR 3.00 X 0 0 0 SANDRA FIGHTS VICE PRESIDENT 3.00 X X 0 0 0 BRET HAWKS DIRECTOR 3.00 X 0 0 0 LOIS WARK DIRECTOR 3.00 X 0 0 0 RICHARD L BARTHOLOMEW DIRECTOR 3.00 3.00 X 0 0 0 JANE SMITH DIRECTOR 3.00 X 0 0 0 VICKI GREGORY EXECUTIVE DIRECTOR (THRU 1/19) 40.00 X 0 0 0 BENJAMIN BLANKENSHIP EXECUTIVE DIRECTOR 40.00 X 0 0 0 0 0 0 0 0 0 0 LCS MANAGEMENT LLC 400 LOCUST ST SUITE 820 DES MOINES IA 503092334 MANAGEMENT SERVICES 1195448 REHABCARE GROUP PO BOX 503534 ST LOUIS MO 631503534 THERAPY SERVICES 998652 LAWN & SHRUB PO BOX 155 BUCK CREEK IN 479240155 LANDSCAPING 955867 KETTELHUT CONSTRUCTION 740 SAGAMORE PARKWAY LAFAYETTE IN 47905 CONSTRUCTION SERVICES 325317 HIGH QUALITY CONTRACTORS LLC 1024 LINDBERG ROAD WEST LAFAYETTE IN 47906 CONSTRUCTION SERVICES 234305 9 209254 53529 43510 262783 SERVICE FEES 623000 20272387 20272387 LIFE OCC. FEE AMORTIZATION 623000 1039211 1039211 21311598 72721 72721 3069013 2686218 382795 382795 382795 61879 0 61879 61879 GUEST ROOMS/MEALS 623000 279218 279218 RESIDENT SERVICES 623000 182031 182031 BEAUTY SALON INCOME 623000 142615 142615 119919 119919 723783 22815559 21311598 0 1241178 469078 469078 8230427 7571391 659036 126573 110160 16413 1211422 1054330 157092 651330 566868 84462 655692 630202 25490 47468 47468 59140 59140 2221436 2117472 103964 233620 233620 1077312 1009799 67513 226274 226274 1399849 1345429 54420 106259 58585 47674 1760750 1692300 68450 5043949 4847864 196085 315026 302779 12247 FOOD 1041045 1041045 RESIDENT ENTERTAINMENT 145938 145938 DUES AND SUBSCRIPTIONS 132065 20766 111299 EMPLOYEE RECRUITMENT 129644 23002 106642 41182 16529 24653 25325479 22554459 2771020 0 307098 440466 6909928 7692910 30453 7819 644252 651779 366218 444157 79091 85121 8751 9200 112930795 43191110 72519091 69739685 5528202 5770675 320822 283454 86713906 85125266 2179514 1104355 5702294 5599614 35305000 35305000 9525085 8752854 39101238 43231576 91813131 93993399 X -5156505 -8902779 57280 34646 -5099225 -8868133 86713906 85125266 X -2509920 -91027 -1167961 X X 0 1 X 1 0 X 184289 174270 239173 163924 262783 1024439 17940231 18804777 20265634 20554838 21311598 98877078 58793 61879 120672 18124520 18979047 20504807 20777555 21636260 100022189 0 0 0 100022189 100440 112305 75099 21686 72721 382251 100440 112305 75099 21686 72721 382251 633811 666759 662843 891951 723783 3579147 18858771 19758111 21242749 21691192 22432764 103983587 0.96190 0.96180 0.00370 0.00410 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: RESIDENT SERVICES - 2014 AMOUNT: $ 14,438. 2015 AMOUNT: $ 14,595. 2016 AMOUNT: $ 98,705. 2017 AMOUNT: $ 236,054. 2018 AMOUNT: $ 182,031. GUEST ROOMS/MEALS - 2014 AMOUNT: $ 265,118. 2015 AMOUNT: $ 255,483. 2016 AMOUNT: $ 290,341. 2017 AMOUNT: $ 285,068. 2018 AMOUNT: $ 279,218. OTHER INCOME - 2014 AMOUNT: $ 189,405. 2015 AMOUNT: $ 167,317. 2016 AMOUNT: $ 28,106. 2017 AMOUNT: $ 169,362. 2018 AMOUNT: $ 31,820. SALON - 2014 AMOUNT: $ 111,580. 2015 AMOUNT: $ 117,913. 2016 AMOUNT: $ 121,237. 2017 AMOUNT: $ 121,996. 2018 AMOUNT: $ 142,615. GENERAL STORE - 2014 AMOUNT: $ 53,270. 2015 AMOUNT: $ 53,940. 2016 AMOUNT: $ 58,452. INTERNET AND IT SERVICES - 2015 AMOUNT: $ 31,370. 2016 AMOUNT: $ 35,011. 2017 AMOUNT: $ 46,310. 2018 AMOUNT: $ 55,530. PARKING EQUIPMENT RENTAL - 2015 AMOUNT: $ 26,141. 2016 AMOUNT: $ 30,991. 2017 AMOUNT: $ 33,161. 2018 AMOUNT: $ 32,569. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2939505 2939505 92148808 34039089 58109719 7777686 4063899 3713787 10053967 5088122 4965845 10829 10829 69739685 RESIDENT DEPOSITS 261000 FAIR VALUE OF INTEREST RATE SWAPS 2455491 REFUNDABLE ADMISSION FEES 40515085 43231576 X 21556571 -91027 -1167961 -1258988 22815559 0 22815559 25325479 0 25325479 0 25325479 PART X, LINE 2: WESTMINSTER VILLAGE WEST LAFAYETTE, INC. TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE VILLAGE IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX EXEMPT STATUS AND IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. PART XI, LINE 2D - OTHER ADJUSTMENTS: INTEREST RATE SWAP -1,167,961. A INDIANA FINANCE AUTHORITY 351602316 2014-08-07 35305000 NEW CONSTRUCTION, RENOVATION OF EXISTING FACILITY 0 0 0 A 35305000 252896 488403 34563701 2016 0 0 1 1 A 0 1 1 1 0 0.00160 0.00160 1 0 1 A 0 1 0 0 1 0 0 0 1 A 1 PAGE 1, PART III, LINE 2 THE INSTITUTION DOES REGULARLY "LEASE OR MAKES LIVING UNITS AVAILABLE FOR USE BY THE ELDERLY AS PART OF ITS TAX EXEMPT MISSION. SCHEDULE K, PART III, LINE 7 THE BONDS ARE NOT PRIVATE ACTIVITY BONDS AS THEY DO NOT MEET THE PRIVATE BUSINESS USE TEST. BRAD DENO BOARD OF DIRECTORS MEMBER 325317 CONSTRUCTION SERVICES FOR THE FACILITY DURING THE YEAR 0 KINSEY FOSTER DAUGHTER OF BOARD MEMBER BRAD DENO 25549 EMPLOYEE 0 DON AND ALICE BARTHOLOMEW PARENTS OF BOARD MEMBER RICHARD BARTHOLOMEW 163100 RESIDENT RENTS/FEES 0 X 1 43510 FMV 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE VILLAGE IS MANAGED BY LCS UNDER AN AGREEMENT WITH AN EFFECTIVE DATE OF JUNE 11, 2014 UNTIL DECEMBER 31, 2019. UNDER THE TERMS OF THE AGREEMENT THERE IS A FIXED MONTHLY MANAGEMENT FEE OF $25,000. IN ADDITION TO THE FIXED MONTHLY FEE, LCS WILL BE PAID FOR AMOUNTS EXCEEDING 3% OF THE TOTAL FEE ELIGIBLE REVENUES OF THE FACILITY LESS THE FIXED FEE, NOT TO EXCEED $300,000 IN A GIVEN YEAR. THE TOTAL AMOUNTS PAID UNDER THE MANAGEMENT AGREEMENT RELATED TO THE FIXED MONTHLY FEE AND 3% OF TOTAL FEE ELIGIBLE REVENUES WERE APPROXIMATELY $600,000 AND $591,000 FOR THE YEARS ENDED JUNE 30, 2019 AND 2018, RESPECTIVELY. THE VILLAGE WILL ALSO REIMBURSE LCS FOR THE SALARIES AND BENEFITS OF THE EXECUTIVE DIRECTOR, THE HEALTH CENTER ADMINISTRATOR AND OTHER VARIOUS SERVICES, INCLUDING TRAVEL, MARKETING, AND MISCELLANEOUS REIMBURSABLE EXPENSES DURING THE CALENDAR YEAR, THE FOLLOWING INDIVIDUALS WERE COMPENSATED FOR PROVIDING SERVICES TO WESTMINSTER VILLAGE IN THE FOLLOWING AMOUNTS: VICKI GREGORY, EXECUTIVE DIRECTOR (THROUGH 1/19): $177,445 BENJAMIN BLANKENSHIP, EXECUTIVE DIRECTOR: $136,381 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS FULLY REVIEWED AND APPROVED BY THE FINANCE AND MANAGEMENT COMMITTEE OF THE BOARD OF DIRECTORS, AND THEN A COPY OF THE FORM 990 IS PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD OF DIRECTORS ARE REQUIRED TO REVIEW AND SIGN A CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. IF A POSSIBLE CONFLICT OF INTEREST DOES ARISE, THE ISSUE IS VOTED ON BY ALL BOARD MEMBERS THAT DO NOT HAVE AN INTEREST IN THE OUTCOME. FORM 990, PART VI, SECTION B, LINE 15 SALARY INFORMATION PROVIDED BY LIFE CARE SERVICES (LCS) IS USED FOR DETERMINING THE COMPENSATION OF ALL DIRECTOR POSITIONS. LCS REGIONAL HR STAFF AND DOM CONDUCT THE REVIEW FOR ALL DIRECTORS. THIS PROCESS WAS LAST CONDUCTED IN 2019. FORM 990, PART VI, SECTION C, LINE 19 ALTHOUGH NOT REQUIRED, THE ORGANIZATION WILL PROVIDE PHOTOCOPIES OF ITS FINANCIAL STATEMENTS TO ALL WHO REQUEST THEM. A COPY OF THE FINANCIAL STATEMENTS IS ALSO LOCATED IN THE WESTMINSTER VILLAGE LIBRARY. FORM 990, PART XI, LINE 9: UNREALIZED GAIN / (LOSS) ON SWAP -1,167,961. FORM 990, PAGE 12, PART XII, LINE 2C THE ORGANIZATION HAS A FINANCE AND MANAGEMENT COMMITTEE THAT IS RESPONSIBLE FOR OVERSIGHT OF THE AUDIT. THIS PRACTICE IS CONSISTENT WITH THE PRIOR YEARS. FORM 990, PAGE 7, PART VII AND PAGE 10, PART IX LINE 5 THE EXECUTIVE DIRECTOR AND HEALTH FACILITY ADMINISTRATOR'S (HFA) COMPENSATION IS PAID BY THE MANAGEMENT COMPANY AND REIMBURSED BY THE ORGANIZATION. THE MANAGEMENT COMPANY ISSUES THE W-2. AS A RESULT, COMPENSATION IS LISTED ON PAGE 10 LINE 5, BUT NOT INCLUDED ON PAGE 7. WESTMINSTER VILLAGE FOUNDATION OF WEST LAFAYETTE INDIANA INC 2741 N SALISBURY STREET WEST LAFAYETTE IN 47906 351537414 SUBSIDIZE EXEMPT ACTIVITIES IN 501(C)(3) LINE 12C, III-FI 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0