2016-11-14T11:57:27-06:00 2016-06-30 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2015-07-01 311002846 WESTMINSTER VILLAGE WEST LAFAYETTE INC WEST 7654637546 2741 NORTH SALISBURY STREET WEST LAFAYETTE IN 47906 ANDY GUTWEIN BOARD PRESIDENT 7654637546 2016-11-04 1 JEFF PARKER P00970069 3149254300 2015 2017-02-10 21:41:12Z VICKI GREGORY 2741 NORTH SALISBURY STREET WEST LAFAYETTE IN 47906 19981919 0 X N/A X 1976 IN PROVIDES RESIDENTIAL FACILITIES DESIGNED TO MEET THE NEEDS OF THE ELDERLY. 9 9 442 102 0 0 184289 174270 17940231 18804777 108210 162481 633811 666759 18866541 19808287 125191 0 0 0 8671735 10015508 0 0 0 9950411 10902037 18747337 20917545 119204 -1109258 68643269 87883392 67852544 90452877 790725 -2569485 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. 1 0 18537642 18804777 WESTMINSTER VILLAGE WEST LAFAYETTE, INC. IS A NOT-FOR-PROFIT, CONTINUING CARE RETIREMENT COMMUNITY LOCATED IN WEST LAFAYETTE, INDIANA. FACILITIES INCLUDE 130 RESIDENTIAL UNITS (INDEPENDENT LIVING CENTER), 49 INDEPENDENT LIVING COTTAGES, ONE 18 UNIT INDEPENDENT LIVING HYBRID HOME, 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.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 $206,000 AND $250,000 FOR THE YEARS ENDED JUNE 30, 2016 AND 2015, RESPECTIVELY. 18537642 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 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 29 0 442 1 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 WESTMINSTER VILLAGE WEST LAFAYETTE 7654637546 2741 NORTH SALISBURY WEST LAFAYETTE IN 47906 X PETER NEISEL MEMBER 3.00 X 0 0 0 LOIS WARK MEMBER 3.00 X 0 0 0 GLENN TOMPKINS TREASURER 5.00 X X 0 0 0 MARY ANNE SLOAN MEMBER 3.00 X 0 0 0 LOUIS CARR MEMBER 3.00 X 0 0 0 ROBERT PAHL VICE PRESIDENT 5.00 X X 0 0 0 STEVE HABBEN SECRETARY 5.00 X X 0 0 0 MARTHA CHISCON MEMBER 3.00 X 0 0 0 ANDREW S GUTWEIN PRESIDENT 6.00 X X 0 0 0 VICKI GREGORY EXECUTIVE DIRECTOR 40.00 X 0 0 0 BENJAMIN BLANKENSHIP HEALTH FACILITY ADMINISTRATOR 40.00 X 0 0 0 DAWN WALKER MARKETING DIRECTOR 40.00 X 146609 0 16619 146609 0 16619 1 0 1 0 KETTELHUT CONSTRUCTION 740 SAGAMORE PARKWAY LAFAYETTE IN 47905 CONSTRUCTION SERVICES 20259359 LCS MANAGEMENT LLC 400 LOCUST ST SUITE 820 DES MOINES IA 503092334 MANAGEMENT SERVICES 1130553 REHABCARE GROUP PO BOX 503534 ST LOUIS MO 631503534 THERAPY SERVICES 832820 LAWN & SHRUB PO BOX 155 BUCK CREEK IN 479240155 LANDSCAPING 752728 INTERDESIGN 141 EAST OHIO STREET INDIANAPOLIS IN 46204 ARCHITECTURAL SERVICES 238942 17 117054 57216 174270 SERVICE FEES 623000 17734151 17734151 LIFE OCC. FEE AMORTIZATION 623000 1070626 1070626 18804777 112305 112305 223808 173632 50176 50176 50176 GUEST ROOMS/MEALS 623000 255483 255483 OTHER INCOME 623000 167317 167317 BEAUTY SALON INCOME 623000 117913 117913 126046 126046 666759 19808287 18804777 0 829240 320817 239335 81482 7650816 6826046 824770 49933 46339 3594 1339723 1192460 147263 654219 580342 73877 597194 547894 49300 12681 12681 58008 58008 1619341 1566885 52456 216801 216801 978625 878150 100475 182718 182718 937999 901534 36465 94405 27219 67186 1031864 991750 40114 3512029 3375498 136531 282454 271474 10980 FOOD 989712 989712 EMPLOYEE RECRUITMENT 160610 160610 RESIDENT ENTERTAINMENT 126247 94154 32093 DUES AND SUBSCRIPTIONS 62355 62355 38994 8850 30144 20917545 18537642 2379903 0 621373 763243 9026575 8404760 60330 117244 500926 450878 125692 100527 74014 72190 47139 155518 106889084 34919232 52582720 71969852 4739031 4877658 865469 971522 68643269 87883392 3001878 3305048 27921934 32049488 7895382 28806410 24293680 19628528 4739670 6663403 67852544 90452877 X 703568 -2713556 87157 144071 790725 -2569485 68643269 87883392 X -1109258 -11971 -2238981 X X 0 1 X 1 0 X 113599 111641 111455 184289 174270 695254 10582729 14595094 15696124 17940231 18804777 77618955 10696328 14706735 15807579 18124520 18979047 78314209 0 0 0 78314209 3919 118975 89289 100440 112305 424928 3919 118975 89289 100440 112305 424928 483096 478194 491519 633811 666759 2753379 11183343 15303904 16388387 18858771 19758111 81492516 0.96100 0.96230 0.00520 0.00430 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: LAUNDRY - 2012 AMOUNT: $ 18,075. 2013 AMOUNT: $ 14,293. 2014 AMOUNT: $ 14,438. 2015 AMOUNT: $ 14,595. GUEST ROOMS/MEALS - 2012 AMOUNT: $ 172,555. 2013 AMOUNT: $ 214,775. 2014 AMOUNT: $ 265,118. 2015 AMOUNT: $ 255,483. OTHER INCOME - 2011 AMOUNT: $ 483,096. 2012 AMOUNT: $ 138,568. 2013 AMOUNT: $ 99,215. 2014 AMOUNT: $ 189,405. 2015 AMOUNT: $ 167,317. SALON - 2012 AMOUNT: $ 102,889. 2013 AMOUNT: $ 110,598. 2014 AMOUNT: $ 111,580. 2015 AMOUNT: $ 117,913. GENERAL STORE - 2012 AMOUNT: $ 46,107. 2013 AMOUNT: $ 52,638. 2014 AMOUNT: $ 53,270. 2015 AMOUNT: $ 53,940. INTERNET AND IT SERVICES - 2015 AMOUNT: $ 31,370. PARKING EQUIPMENT RENTAL - 2015 AMOUNT: $ 26,141. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2939505 2939505 73369573 27336055 46033518 6767181 3457301 3309880 8964197 4125876 4838321 14848628 14848628 71969852 RESIDENT DEPOSITS 1485921 FAIR VALUE OF INTEREST RATE SWAPS 5177482 6663403 X 17557335 -11971 -2238981 -2250952 19808287 0 19808287 20917545 0 20917545 0 20917545 PART X, LINE 2: THE VILLAGE QUALIFIES AS A TAX-EXEMPT CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE VILLAGE APPLIES 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. 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 -2,238,981. X X 0 0 0 0 0 0 0 1 0 DAWN WALKER MARKETING DIRECTOR 137922 0 8687 0 0 0 4452 0 12167 0 163228 0 0 0 PART I, LINE 7 THE ORGANIZATION PROVIDES BONUSES BASED UPON THE COMPANY'S FINANCIAL POSITION. A INDIANA FINANCE AUTHORITY 351602316 2014-08-07 35305000 NEW CONSTRUCTION, RENOVATION OF EXISTING FACILITY 0 0 0 A 35305000 589607 488403 27728400 6498590 2017 0 0 0 1 A 0 1 1 1 0 0.00160 0.00000 0.00160 1 0 1 A 0 1 0 0 1 0 0 0 1 A 1 SCHEDULE K, PAGE 1, PART II, LINE 17 THE ORGANIZATION DOES MAINTAIN ADEQUATE BOOKS AND RECORDS TO SUPPORT THE ALLOCATION OF PROCEEDS. HOWEVER, A FINAL ALLOCATION HAS YET TO BE MADE. 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. STEVE HABBEN BOARD OF DIRECTOR MEMBER & EXECUTIVE AT KETTELHUT CONSTRUCTION INC. 20259359 CONSTRUCTION SERVICES FOR THE FACILITY DURING THE YEAR. 0 FORM 990, PART III, LINE 2 ADDITIONAL WELLNESS PROGRAMMING WITH THE OPENING OF THE NEW FACILITY. 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, 2018. 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 $547,000 AND $502,000 FOR THE YEARS ENDED JUNE 30, 2016 AND 2015, RESPECTIVELY. THE VILLAGE WILL ALSO REIMBURSE LCS FOR THE SALARIES AND BENEFITS OF THE EXECUTIVE DIRECTOR, THE CONTROLLER, 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: $139,169 BENJAMIN BLANKENSHIP, HEALTH FACILITY ADMINSTRATOR: $118,794 FORM 990, PART VI, SECTION B, LINE 11 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. 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 LOSS ON SWAP -2,238,981. 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 11C, III-FI 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0