2017-03-01T12:44:16-06:00 2016-08-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2015-09-01 370794402 COMMUNITY RETIREMENT INC COMM 2175432103 423 S EBERHARDT DRIVE ARTHUR IL 619111224 RICK WEGER PRESIDENT 2175432103 2017-02-23 1 JEFF PARKER P00970069 3149254300 2015 2021-01-29 14:40:06Z THE ARTHUR HOME RICK WEGER 423 S EBERHARDT DRIVE ARTHUR IL 619111224 3748373 0 X WWW.EBERHARDTVILLAGE.ORG X 1962 IL TO PROVIDE SKILLED NURSING CARE AND INTERMEDIATE MEDICAL CARE TO ELDERLY 8 5 94 45 0 0 14415 31646 3544827 3688253 42 18 11440 28456 3570724 3748373 0 0 0 0 2017832 2056835 0 0 0 1479722 1735739 3497554 3792574 73170 -44201 5144290 5616806 2607209 3131697 2537081 2485109 TO PROVIDE SKILLED NURSING CARE AND INTERMEDIATE RESIDENT CARE TO THE ELDERLY. 0 0 3156303 3688253 COMMUNITY RETIREMENT INC OPERATES THE ARTHUR HOME, A NURSING HOME WHICH PROVIDES LICENSED SKILLED AND INTERMEDIATE MEDICAL CARE, PRIMARILY TO ELDERLY PATIENTS 3156303 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 10 0 94 1 0 0 0 0 0 0 0 0 0 0 X 8 5 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 IL X LASHELLE PLANK 2175432103 423 EBERHARDT DRIVE ARTHUR IL 61911 X HENRY D HERSHBERGER BOARD MEMBER 1.00 1.00 X 0 0 0 SAM PETTERSHEIM BOARD MEMBER 0.50 0.50 X 0 0 0 RICK WEGER PRESIDENT 15.00 15.00 X X 0 0 0 FRED HELMUTH BOARD MEMBER 0.50 0.50 X 0 0 0 SUE STOUT SECRETARY/TREASURER 0.50 0.50 X X 0 0 0 JOHN STEWART VICE PRESIDENT 2.00 2.00 X X 0 0 0 DANNY POWELL BOARD MEMBER 0.50 0.50 X 0 0 0 DEBORAH FAY BOARD MEMBER 0.50 0.50 X 0 0 0 ALVA MILLER PAST SECRETARY/TREASURER 0.50 0.50 X 0 0 0 0 0 0 0 0 0 0 ONR INC 1101 S CAPITAL OF TEXAS HWY BLDG AUSTIN TX 78746 THERAPY SERVICES 471505 1 31646 31646 NET SERVICE REVENUE 623000 3544253 3544253 RENT 623000 144000 144000 3688253 18 18 1394 0 1394 1394 1394 TRANSPORTATION INCOME 623000 17381 17381 MEAL INCOME 623000 8541 8541 EQUIPMENT RENTAL 623000 1140 1140 27062 3748373 3688253 0 28474 X 1808420 1610284 198136 15294 13618 1676 86324 76866 9458 146797 130713 16084 35322 35322 568763 492139 76624 10936 10936 188842 145952 42890 42728 2160 40568 72940 72940 15358 15358 75264 75264 76188 76188 55451 55451 FOOD 148617 148617 BAD DEBT EXPENSE 144351 5197 139154 PHARMACY 126446 126446 ASSESSMENT FEES/TAXES 101487 96346 5141 73046 28122 44924 3792574 3156303 636271 0 6342 3204 201879 234688 3249219 3616103 14969 18659 18516 12616 8398266 6959987 1483436 1438279 169929 293257 5144290 5616806 598026 744872 7343 7343 6042 2904 156001 282018 1754507 2005005 85290 89555 2607209 3131697 X 2212242 2158325 20388 14979 304451 311805 2537081 2485109 5144290 5616806 X -44201 7354 -15125 X X 0 1 X 1 0 X 13757 6947 7859 14415 31646 74624 3401721 3204114 3499046 3544827 3688253 17337961 3415478 3211061 3506905 3559242 3719899 17412585 0 1630212 1746776 2103485 1893296 2253395 9627164 1630212 1746776 2103485 1893296 2253395 9627164 7785421 13657 13681 35 2992 1412 31777 13657 13681 35 2992 1412 31777 34957 29466 40180 8448 27062 140113 3464092 3254208 3547120 3570682 3748373 17584475 0.44270 0.48080 0.00180 0.00250 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2011 AMOUNT: $ 34,957. 2012 AMOUNT: $ 29,466. 2013 AMOUNT: $ 4,222. 2014 AMOUNT: $ 759. 2015 AMOUNT: $ 0. TRANSPORTATION - 2013 AMOUNT: $ 21,829. 2014 AMOUNT: $ 1,113. 2015 AMOUNT: $ 17,381. MEALS - 2013 AMOUNT: $ 7,656. 2014 AMOUNT: $ 3,864. 2015 AMOUNT: $ 8,541. ACTIVITY - 2013 AMOUNT: $ 6,473. 2014 AMOUNT: $ 2,712. 2015 AMOUNT: $ 0. EQUIPMENT RENTAL - 2015 AMOUNT: $ 1,140. 0 1 X 264084 264084 7479871 6459587 1020284 1188 1128 60 653123 499272 153851 1438279 DUE FROM EBERHARDT VILLAGE (INTERCOMPANY) 293257 293257 ASSET RETIREMENT OBLIGATION 89555 89555 X PART IV, LINE 2B: THE ORGANIZATION MAINTAINS SAVINGS ACCOUNTS ON BEHALF OF CERTAIN NURSING FACILITY RESIDENTS. THE ORGANIZATION ACTS AS TRUSTEE OF THESE FUNDS WHICH ARE MAINTAINED FOR THE PERSONAL USE OF THOSE RESIDENTS. THE FUNDS ARE EXPENDED AT THE DIRECTION OF THE RESIDENTS. PART X, LINE 2: THE ORGANIZATIONS QUALIFY AS TAX-EXEMPT CORPORATIONS DESCRIBED IN SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ORGANIZATIONS ARE NOT SUBJECT TO FEDERAL INCOME TAXES UNDER SECTION 501 (C)(3) OF THE CODE. THE ORGANIZATIONS APPLY THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. THIS STANDARD CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE INCOME TAX STANDARD. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. FRED HELMUTH BOARD MEMBER LINE OF CREDIT X 40000 40000 0 1 1 SAM PETTERSHEIM BOARD MEMBER LINE OF CREDIT X 40000 40000 0 1 1 HENRY HERSHBERGER BOARD MEMBER LINE OF CREDIT X 40000 40000 0 1 1 FRED HELMUTH BOARD MEMBER LINE OF CREDIT X 150000 162018 0 1 1 282018 FORM 990, PART VI, SECTION A, LINE 6 THERE IS ONE CLASS OF SHAREHOLDER. FORM 990, PART VI, SECTION A, LINE 7A THE SHAREHOLDERS ELECT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 8B NO COMMITTEES OF GOVERNING BODY WITH AUTHORITY TO ACT ON ITS BEHALF. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 WAS PRESENTED TO BOARD FOR APPROVAL BEFORE FILING FORM 990, PART VI, SECTION B, LINE 12C IN A SMALL ORGANIZATION AND VILLAGE SUCH AS OURS, ADMINISTRATION AND THE BOARD KNOW ALL OF THE PEOPLE THAT WORK FOR US AND THEIR RELATIONSHIPS WITH THOSE THAT PROVIDE AND CONTRACT SERVICES WITH US. DEALING WITH POTENTIAL: OUR POLICY DICTATES THAT ALL POTENTIAL OR ACTUAL CONFLICTS ARE BROUGHT TO THE ATTENTION OF THE BOARD PRESIDENT AS SOON AS POSSIBLE SO THAT SAFEGUARDS CAN BE ESTABLISHED TO PROTECT ALL PARTIES. THE PRESIDENT MAY BRING THEM TO ALL THE BOARD MEMBER'S ATTENTION DURING A REGULAR MONTHLY BOARD MEETING FOR FURTHER DISCUSSION. COVERED: ALL EMPLOYEES AND BOARD MEMBERS, AND CLOSE RELATIVES AND HUSBANDS AND WIFE'S OF SAME. THE LEVEL OF DETERMINATION OF WHETHER A CONFLICT EXITS ARE MADE AND REVIEWED BY THE ADMINISTRATOR AND/OR BOARD PRESIDENT. RESTRICTIONS ARE DEEMED TO BE APPROPRIATE DEPENDING ON THE PARTICULAR SITUATION. WHEN THE CONFLICT IS IN THE BEST INTERESTS OF THE ORGANIZATION, NO OR LIMITED RESTRICTIONS ARE APPLIED. WHEN THE CONFLICT IS NOT IN THE BEST INTEREST OF THE ORGANIZATION, THE RELATIONSHIP IS TERMINATED WITH THE ORGANIZATION OR PERSON IN CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 OTHER THAN THE ADMINSTRATOR, SALARIES AND WAGES FOR THE REST OF OUR EMPLOYEES ARE DETERMINED BY THE ADMINISTRATOR. THESE ARE INCLUDED IN THE ANNUAL OPERATING BUDGET WHICH IS REVIEWED AND APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G CONSULTING: PROGRAM SERVICE EXPENSES 73,172. MANAGEMENT AND GENERAL EXPENSES 76,624. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 149,796. THERAPY SERVICES: PROGRAM SERVICE EXPENSES 418,967. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 418,967. FORM 990, PART XI, LINE 9: TRANSFER OF EQUITY -15,125. FORM 990, PART XII, LINE 2C: THE PROCESS IS CONSISTENT WITH PRIOR YEARS. EBERHARDT VILLAGE INC 431 WEST PALMER ARTHUR IL 61911 743091143 PROVIDE ASSISTED LIVING CARE TO SENIORS IL 501(C)(3) LINE 7 N/A 0 0 0 0 1 0 0 0 1 1 1 1 1 0 1 1 0 0 0 0