2017-11-13T17:08:35-06:00 2016-12-31 621073578 FRASIER DEAN & HOWARD PLLC 3310 West End Ave Ste 550 Nashville TN 37203 990 2016-01-01 621533400 The Blakeford at Green Hills BLAK 6156659505 11 Burton Hills Blvd Nashville TN 37215 AL GRIFFIN CFO 6156659505 2017-11-11 1 Sara G Moon P00034774 6153836592 X 207.201.223.148 2017-11-11 15:50:24 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 681165C3F411A5C91A132F4457263660CFEA6D09 2016 2017-02-10 21:41:12Z Van Cluck 11 Burton Hills Blvd Nashville TN 37215 18512107 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. 14 14 284 14 0 0 0 0 18456205 16229048 446613 384047 0 0 18902818 16613095 180499 118485 0 0 7647747 7932174 0 0 0 9702019 9061058 17530265 17111717 1372553 -498622 53031520 50699017 72009775 69172091 -18978255 -18473074 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 16566333 118485 16229048 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 647 PERSONS SERVED IN 2016. 16566333 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 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 65 0 1 284 1 0 0 0 0 0 0 0 0 0 0 X 14 14 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 LUKE GREGORY Chairman 1.00 X X 0 0 0 DAVID PRICE Treasurer 1.00 X X 0 0 0 BARBARA CANNON BOARD MEMBER 0.50 X 0 0 0 JIM CROWELL BOARD MEMBER 0.50 X 0 0 0 MARY HERBERT KELLY BOARD MEMBER 0.50 X 0 0 0 GAYLE VANCE BOARD MEMBER 0.50 X 0 0 0 DR KEITH MEADOR BOARD MEMBER 0.50 X 0 0 0 JOHN LOWRY BOARD MEMBER 0.50 X 0 0 0 Laura Beth Brown BOARD MEMBER 0.50 X 0 0 0 Arie Nettles BOARD MEMBER 0.50 X 0 0 0 MARK VANDIVER BOARD MEMBER 0.50 X 0 0 0 Carol Cubillo-Seals BOARD MEMBER 0.50 X 0 0 0 MARY CLARE PYRON BOARD MEMBER 0.50 X 0 0 0 Joey Harwell Board Member 0.50 X 0 0 0 ALLISON GRIFFITH COO 40.00 X 111746 0 7649 VAN CLUCK CEO 40.00 X 202789 0 12191 AL GRIFFIN CFO 40.00 X 96003 0 3412 SARAH BISHOP Sales and Marketing Direct 40.00 X 112931 0 3669 523469 0 26921 3 0 1 0 REHAB CARE INC PO BOX 503534 ST LOUIS MO 63150 Therapy SERVICES 1053337 JOHN RICHARDSON 7853 OLD CHARLOTTE PIKE NASHVILLE TN 37209 Construction 221375 Brightview Landscapes 3630 Solutions Center Chicago IL 60677 Landscaping 102096 3 RESIDENT SERVICES REVENUE 623000 16032608 16032608 Shared Income (The Blakeford at H 623000 196440 196440 16229048 403087 403087 1879972 1899012 -19040 -19040 -19040 16613095 16229048 0 384047 118485 118485 410538 246322 164216 6337838 6273611 64227 110861 92922 17939 494945 414855 80090 577992 572135 5857 1568727 1540575 28152 537659 469942 67717 1273529 1259482 14047 42256 21129 21127 1272387 1259663 12724 1946230 1926768 19462 169890 157998 11892 SUPPLIES 2063186 2042554 20632 LICENSES, PERMITS & FEE 105457 104402 1055 DUES & SUBSCRIPTIONS 81236 64989 16247 OTHER 501 501 17111717 16566333 545384 0 5214984 4709911 4879733 3531456 1275064 741717 497684 250000 22476 26592 278183 178135 51736884 22748128 28640916 28988756 5786498 6138221 5829170 6126496 606812 7733 53031520 50699017 2405393 1917875 40550783 39726775 28615331 27267851 438268 259590 72009775 69172091 X -18978255 -18473074 -18978255 -18473074 53031520 50699017 X -498622 502915 500888 X 0 1 X 1 0 X 25000 25000 17007866 17233028 17825890 18456205 16229048 86752037 17007866 17233028 17850890 18456205 16229048 86777037 0 0 0 86777037 468018 303283 388979 443633 403087 2007000 468018 303283 388979 443633 403087 2007000 22701 22701 17498585 17536311 18239869 18899838 16632135 88806738 0.97710 0.97620 0.02260 0.02360 X 3613159 3613159 37232744 14307007 22925737 1221791 1123686 98105 8903715 7317435 1586280 765475 765475 28988756 FIXED INCOME SECURITIES 6126496 F 6126496 REFUNDABLE CUSTOMER DEPOSITS 259590 259590 X 17616898 502915 502915 17113983 -500888 -500888 16613095 17111717 0 17111717 0 17111717 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 Financial Accounting Standards Board Accounting Standards Codification ("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. Tax years that remain open for examination include years ended December 31, 2013 through December 31, 2016. The Company does not believe there are any uncertain tax positions at December 31, 2016. 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 -500,888. 1 SKILLED NURSING CARE 2 118485 SKILLED NURSING CARE Part I, Line 2: The two residents who qualify for this assistance both have a specified contract that states that once the individual has moved into a higher level of care, the individuals would release the deposits that were set aside when they moved to The Blakeford at Green Hills to supplement the cost of their care. Once their deposits have been exhausted the organization waives all of their living expenses until the resident leaves the facility. X X X 0 0 0 0 0 0 0 0 0 VAN CLUCK CEO 167564 0 35225 0 0 0 6889 0 5302 0 214980 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 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 XI, line 9: BOOK/TAX ADJUSTMENT 500,888. 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 AGING SERVICES NETWORK INC 11 BURTON HILLS BLVD NASHVILLE TN 37215 208591773 HOME CARE SVC TN N/A C 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 LIVEWELL BY BLAKEFORD INC D 250000 CASH