NATIONAL FELLOWSHIP BRETHREN RETIREMENT HOMES INCORPORATED: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
NATIONAL FELLOWSHIP BRETHREN RETIREMENT HOMES INCORPORATED (EIN 35-1282401)
Tax period
2015-07-01 to 2016-06-30
Filed
2016-11-15
IRS object ID
201623209349304312
Schema version
2015v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-11-15T10:05:47-06:00ReturnTs
Tax Period End2016-06-30TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2015-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN351282401EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1National Fellowship Brethren Retirement Homes IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlNATIBusinessNameControlTxt
Phone5743726200PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1337 Grace Village DriveAddressLine1Txt
CityWinona LakeCityNm
State AbbreviationINStateAbbreviationCd
ZIP46590ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSondrea HamiltonPersonNm
Person TitleCFOPersonTitleTxt
Signature2016-11-15SignatureDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1Grace Village Retirement CommunityBusinessNameLine1Txt

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Same as C aboveBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1337 Grace Village DriveAddressLine1Txt
CityWinona LakeCityNm
State AbbreviationINStateAbbreviationCd
ZIP46590ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$3,138,705GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addressgracevillage.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1974FormationYr
Legal Domicile StateINLegalDomicileStateCd
Activity Or MissionGrace Village's mission is to enable older adults to live to their fullest potential in the security of a Christian community.ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee37TotalEmployeeCnt
Total Volunteers84TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$108,019PYContributionsGrantsAmt
CY Contributions Grants$78,029CYContributionsGrantsAmt
PY Program Service Revenue$2,648,346PYProgramServiceRevenueAmt
CY Program Service Revenue$2,725,873CYProgramServiceRevenueAmt
PY Investment Income$31,851PYInvestmentIncomeAmt
CY Investment Income$31,803CYInvestmentIncomeAmt
PY Other Revenue$303,000PYOtherRevenueAmt
CY Other Revenue$303,000CYOtherRevenueAmt
PY Total Revenue$3,091,216PYTotalRevenueAmt
CY Total Revenue$3,138,705CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$821,991PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$984,709CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$27,937CYTotalFundraisingExpenseAmt
PY Other Expenses$2,513,767PYOtherExpensesAmt
CY Other Expenses$2,037,251CYOtherExpensesAmt
PY Total Expenses$3,335,758PYTotalExpensesAmt
CY Total Expenses$3,021,960CYTotalExpensesAmt
PY Revenues Less Expenses-$244,542PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$116,745CYRevenuesLessExpensesAmt
Total Assets BOY$12,828,352TotalAssetsBOYAmt
Total Assets EOY$12,800,795TotalAssetsEOYAmt
Total Liabilities BOY$11,677,663TotalLiabilitiesBOYAmt
Total Liabilities EOY$11,252,607TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,150,689NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,548,188NetAssetsOrFundBalancesEOYAmt
MissionGrace Village's mission is to enable older adults to live to their fullest potential in the security of a Christian community. Grace Village offers independent living options that include meals and nursing services when needed.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
DescGRACE VILLAGE OFFERS INDEPENDENT LIVING OPTIONS THAT INCLUDE MEALS AND NURSING SERVICES WHEN NEEDED. GRACE VILLAGE ALSO OFFERS THERAPY SERVICES AND IN HOME NON-MEDICAL SERVICES AS NEEDED.Desc
Total Program Service Expenses$0TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingYes (true)CreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgYes (true)TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee37EmployeeCnt
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldINStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Sondrea HamiltonBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5743726498PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1337 Grace Village DriveAddressLine1Txt
CityWinona LakeCityNm
State AbbreviationINStateAbbreviationCd
ZIP46590ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
Don Fluke
Member1.0Yes (X)$0$0$0
Gary Herbruck
Vice Chair1.0Yes (X)$0$0$0
Matt Elliott
Member1.0Yes (X)$0$0$0
Bettina Dunn
Member1.0Yes (X)$0$0$0
Jesse DeBoest
Treasurer1.0Yes (X)$0$0$0
Ron Henry
Secretary1.0Yes (X)$0$0$0
Cynthia Sission
Member1.0Yes (X)$0$0$0
Ron Redpath
Finance Chair1.0Yes (X)$0$0$0
David Phelps
Chair1.0Yes (X)$0$0$0
Harold Gatlin
Member1.0Yes (X)$0$0$0
Gary Hamman
Member1.0Yes (X)$0$0$0
Dennis Duncan
Member1.0Yes (X)$0$0$0
Matthew Teevan
Member1.0Yes (X)$0$0$0
Jeffry Carroll
CEO40.0$0$173,922$45,14340.0Yes (X)Yes (X)Yes (X)
Sondrea Hamilton
CFO40.0$91,012$0$25,072Yes (X)Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$91,012TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$173,922TotReportableCompRltdOrgAmt
Total Other Compensation$70,215TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Aumsbaugh IncBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line11032 W Depoy DrAddressLine1Txt
CityColumbia CityCityNm
State AbbreviationINStateAbbreviationCd
ZIP46725ZIPCd
FieldValueIRS element (for citing)
ServicesCarpentryServicesDesc
Compensation$171,180CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
All Other Contributions$78,029AllOtherContributionsAmt
Noncash Contributions$3,036NoncashContributionsAmt
Total Contributions$78,029TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Resident Service$2,269,297$2,269,297
Deferred (Life Lease)$456,576$456,576

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$2,725,873TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$31,803TotalRevenueColumnAmt
Related Or Exempt Func Income$31,803RelatedOrExemptFuncIncomeAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$303,000RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$303,000RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$303,000TotalRevenueColumnAmt
Related Or Exempt Func Income$303,000RelatedOrExemptFuncIncomeAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,138,705TotalRevenueColumnAmt
Related Or Exempt Func Income$3,060,676RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$91,012TotalAmt
Management And General$91,012ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$638,256TotalAmt
Program Services$547,128ProgramServicesAmt
Management And General$63,826ManagementAndGeneralAmt
Fundraising$27,302FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$18,710TotalAmt
Program Services$16,839ProgramServicesAmt
Management And General$1,871ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$173,256TotalAmt
Program Services$142,144ProgramServicesAmt
Management And General$31,112ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$63,475TotalAmt
Program Services$56,493ProgramServicesAmt
Management And General$6,347ManagementAndGeneralAmt
Fundraising$635FundraisingAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$28,000TotalAmt
Program Services$28,000ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,148TotalAmt
Program Services$0ProgramServicesAmt
Management And General$1,148ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$57,628TotalAmt
Management And General$57,628ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$17,849TotalAmt
Program Services$2,359ProgramServicesAmt
Management And General$15,490ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$18,724TotalAmt
Program Services$7,239ProgramServicesAmt
Management And General$11,485ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$305,521TotalAmt
Program Services$305,521ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$2,173TotalAmt
Program Services$1,383ProgramServicesAmt
Management And General$790ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$1,007TotalAmt
Program Services$505ProgramServicesAmt
Management And General$502ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$155,898TotalAmt
Management And General$155,898ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$800,849TotalAmt
Management And General$800,849ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$51,045TotalAmt
Management And General$51,045ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
resident care$349,450$349,450
building maintenance$97,657$97,657
debt forgiveness$116,919$116,919
gain on value of life insurance$33,383$33,383

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
Program Services$0ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$3,021,960TotalAmt
Program Services$1,671,637ProgramServicesAmt
Management And General$1,322,386ManagementAndGeneralAmt
Fundraising$27,937FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$274,920BOYAmt
EOY$161,988EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$127,342BOYAmt
EOY$56,703EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$16,132BOYAmt
EOY$16,303EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$56,462BOYAmt
EOY$54,874EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$24,533,002LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$13,185,773LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$11,186,264BOYAmt
EOY$11,347,229EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,143,732BOYAmt
EOY$1,140,198EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$23,500BOYAmt
EOY$23,500EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$12,828,352BOYAmt
EOY$12,800,795EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$180,681BOYAmt
EOY$154,046EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$7,159,271BOYAmt
EOY$7,079,255EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$4,249,726BOYAmt
EOY$3,945,439EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$87,985BOYAmt
EOY$73,867EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$11,677,663BOYAmt
EOY$11,252,607EOYAmt

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,150,284BOYAmt
EOY$1,545,288EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$405BOYAmt
EOY$2,900EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,150,689BOYAmt
EOY$1,548,188EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$12,828,352BOYAmt
EOY$12,800,795EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$116,745ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewYes (true)AccountantCompileOrReviewInd

Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$46,488CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$64,843CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$35,252CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$108,019CurrentTaxYearMinus1YearAmt
Current Tax Year$78,029CurrentTaxYearAmt
Total$332,631TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,379,952CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,469,283CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,700,150CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,648,346CurrentTaxYearMinus1YearAmt
Current Tax Year$2,725,873CurrentTaxYearAmt
Total$12,923,604TotalAmt

Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Govt Furn Srvc Fclts Vl509 GovtFurnSrvcFcltsVl509Grp

FieldValueIRS element (for citing)
Total$0TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,426,440CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,534,126CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$2,735,402CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,756,365CurrentTaxYearMinus1YearAmt
Current Tax Year$2,803,902CurrentTaxYearAmt
Total$13,256,235TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$13,256,235PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$366,355CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$334,998CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$327,790CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$334,851CurrentTaxYearMinus1YearAmt
Current Tax Year$334,803CurrentTaxYearAmt
Total$1,698,797TotalAmt

Post1975 UBTI Post1975UBTIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$366,355CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$334,998CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$327,790CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$334,851CurrentTaxYearMinus1YearAmt
Current Tax Year$334,803CurrentTaxYearAmt
Total$1,698,797TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$0CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$0CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$0CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$0CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$0TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$2,792,795CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$2,869,124CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,063,192CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$3,091,216CurrentTaxYearMinus1YearAmt
Current Tax Year$3,138,705CurrentTaxYearAmt
Total$14,955,032TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.8864PublicSupportCY509Pct
Public Support PY5090.8823PublicSupportPY509Pct
Investment Income CY0.1136InvestmentIncomeCYPct
Investment Income PY0.1174InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule A, Part III, Line 12 Other IncomeFormAndLineReferenceDesc
ExplanationDESCRIPTION - , COLUMN A - , COLUMN B - , COLUMN C - , COLUMN D - , COLUMN E - , COLUMN F - 0; DESCRIPTION - , COLUMN A - , COLUMN B - , COLUMN C - , COLUMN D - , COLUMN E - , COLUMN F - 0;ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee EtcfalseAgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabfalseInclEscrowCustodialAcctLiabInd

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$0BeginningYearBalanceAmt
End Year Balance$0EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$0BeginningYearBalanceAmt
End Year Balance$0EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$0BeginningYearBalanceAmt
End Year Balance$0EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$0BeginningYearBalanceAmt
End Year Balance$0EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$0BeginningYearBalanceAmt
End Year Balance$0EndYearBalanceAmt

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$193,948OtherCostOrOtherBasisAmt
Book Value$193,948BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$21,011,205OtherCostOrOtherBasisAmt
Depreciation$11,150,894DepreciationAmt
Book Value$9,860,311BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,924,452OtherCostOrOtherBasisAmt
Depreciation$1,330,663DepreciationAmt
Book Value$593,789BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,403,397OtherCostOrOtherBasisAmt
Depreciation$704,216DepreciationAmt
Book Value$699,181BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$11,347,229TotalBookValueLandBuildingsAmt

Closely Held Equity Interests CloselyHeldEquityInterestsGrp

FieldValueIRS element (for citing)
Book Value$1,140,198BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$1,140,198TotalBookValueSecuritiesAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
Wait List Deposits$3,700
Refundable Portion Life Lease Deposits$36,040
Payroll Taxes$0
Security Deposits$34,127
FieldValueIRS element (for citing)
Total Liability$73,867TotalLiabilityAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Jeffry CarrollBusinessNameLine1Txt
FieldValueIRS element (for citing)
TitleCEOTitleTxt
Base Compensation Filing Org$0BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$173,922CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$0DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$24,000DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$21,143NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$0TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$219,065TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Line 11b Review of form 990 by governing bodyCFO prepares 990. CEO reviews 990 before it is filed. The full board is given a copy of the 990 upon completion of preparation and filing.
Form 990, Part VI, Line 12c Conflict of interest policyCFO prepares 990. CEO reviews 990 before it is filed. The full board is given a copy of the 990 upon completion of preparation and filing.
Form 990, Part VI, Line 19 Required documents available to the publicUpon Request

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1GRACE VILLAGE HEALTHCARE FACILITY INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1337 GRACE VILLAGE DRIVEAddressLine1Txt
CityWINONA LAKECityNm
State AbbreviationINStateAbbreviationCd
ZIP46590ZIPCd
FieldValueIRS element (for citing)
EIN351447417EIN
Primary ActivitiesNURSING HOME/ASSISTED LIVING FACILITYPrimaryActivitiesTxt
Legal Domicile StateINLegalDomicileStateCd
Exempt Code Section501(c)(3ExemptCodeSectionTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationfalseControlledOrganizationInd

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