2019-11-15T13:00:42-06:00 2018-12-31 560574444 CHERRY BEKAERT LLP 222 SECOND AVE SOUTH STE 1240 NASHVILLE TN 37201 990 2018-01-01 621533400 THE BLAKEFORD AT GREEN HILLS BLAK 6156659505 11 BURTON HILLS BLVD NASHVILLE TN 37215 AL GRIFFIN CFO 6156659505 2019-11-15 1 SARA G MOON P00034774 6153836592 40.137.115.169 2019-11-15 10:38:54 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 88D7A88AFC1BC15DCE619246A085D52B39BEAA6C 2018 2020-03-31 21:24:44Z BRIAN BARNES 11 BURTON HILLS BLVD NASHVILLE TN 37215 21410341 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. 13 13 286 13 0 0 0 0 20471887 16095321 790855 880174 0 0 21262742 16975495 0 0 0 0 7778672 7678528 0 0 0 9298604 9663610 17077276 17342138 4185466 -366643 54931478 52300208 72114746 70427241 -17183268 -18127033 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 16809751 16095321 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 552 PERSONS SERVED IN 2018. 16809751 1 0 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 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 49 0 1 286 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 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 CAROL CUBILLO-SEALS BOARD MEMBER 1.00 X 0 0 0 DAVID PRICE TREASURER/SECRETARY 1.00 X 0 0 0 DR KEITH MEADOR BOARD MEMBER 1.00 X 0 0 0 GAYLE VANCE 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 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 MARY HERBERT KELLY 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 122077 0 5438 ALLISON GRIFFITH COO 40.00 X 131173 0 9340 BRIAN BARNES CEO 40.00 X 81538 0 0 SARAH BISHOP SALES AND MARKETING DIRECT 40.00 X 138653 0 4282 LAKECIA HARPER HEALTH SERVICE ADMINISTRATOR 40.00 X 108226 0 8422 JANE KELLEY ED-LIVEWELL & BLAKEFORD AT HOME 40.00 X 107919 0 1565 SHAWN CLARK EMPLOYEE 40.00 X 101377 0 10066 KELLEY ANDERSON EMPLOYEE 40.00 X 126848 0 8718 917811 0 47831 7 0 0 0 REHAB CARE INC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 933858 TURENNE PHARMEDCO 355 INDUSTRIAL PARK BLVD MONTGOMERY AL 36117 MEDICAL SUPPLIES 258575 JOHN RICHARDSON 7853 OLD CHARLOTTE PIKE NASHVILLE TN 37209 MAINTENANCE & RENOVATION 183022 MARTIN & ZERFOSS INC 6730 CHARLOTTE PIKE NASHVILLE TN 37209 INSURANCE SERVICES 156104 4 RESIDENT SERVICES REVENUE 623000 16006833 16006833 SHARED INCOME (THE BLAKEFORD AT H 623000 88488 88488 16095321 543780 543780 4771240 4434846 336394 336394 336394 16975495 16095321 0 880174 X 308492 185095 123397 6205369 6143315 62054 93650 78666 14984 525140 441118 84022 545877 540418 5459 35994 2880 33114 47892 18199 29693 2307773 2307773 538114 469398 68716 1185328 1172775 12553 34412 17206 17206 1205062 1193011 12051 2137310 2115937 21373 168224 156448 11776 SUPPLIES 1813149 1795018 18131 LICENSES, PERMITS & FEE 105326 104273 1053 DUES & SUBSCRIPTIONS 84026 67221 16805 OTHER 1000 1000 17342138 16809751 532387 0 8369800 2752674 3303886 3684084 906317 741676 29038 34458 116495 142175 54617630 26889446 28717511 27728184 7086218 6605182 6397380 10609842 4833 1933 54931478 52300208 2137156 2038119 43361340 42576138 26486423 25669995 129827 142989 72114746 70427241 X -17183268 -18127033 -17183268 -18127033 54931478 52300208 X -366643 -1148694 571572 X 0 1 X 1 0 X 25000 25000 17825890 18456205 16229048 20471887 16095321 89078351 17850890 18456205 16229048 20471887 16095321 89103351 0 0 0 89103351 388979 443633 403087 405795 543780 2185274 388979 443633 403087 405795 543780 2185274 18239869 18899838 16632135 20877682 16639101 91288625 0.97610 0.97890 0.02390 0.02110 X 3613159 3613159 39694379 17693218 22001161 1315510 1182559 132951 9600241 8013669 1586572 394341 394341 27728184 FIXED INCOME SECURITIES 10609842 F 10609842 REFUNDABLE CUSTOMER DEPOSITS 142989 142989 X 16398373 -1148694 -1148694 17547067 -571572 -571572 16975495 17342138 0 17342138 0 17342138 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, 2018. 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 -571,572. 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 COMPENSATION 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 100,278. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 100,278. NURSING SERVICES: PROGRAM SERVICE EXPENSES 468,578. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 468,578. REHABILITATION SERVICES: PROGRAM SERVICE EXPENSES 851,408. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 851,408. GENERAL & ADMIN (OTHER): PROGRAM SERVICE EXPENSES 193,714. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 193,714. RESIDENTIAL SERVICES: PROGRAM SERVICE EXPENSES 687,988. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 687,988. ASSISTED LIVING SERVICES: PROGRAM SERVICE EXPENSES 5,807. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,807. FORM 990, PART XI, LINE 9: BOOK/TAX ADJUSTMENT 571,572. 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 11 N/A 0 BLAKEFORD ASSTD LIVING HEALTH CENTER 11 BURTON HILLS BLVD NASHVILLE TN 37215 300119048 DORMANT TN 501(C)(3) PF N/A 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 9 N/A 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