2016-04-01T16:54:48-05:00 2015-08-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2014-09-01 370794402 COMMUNITY RETIREMENT INC COMM 2175432103 423 S EBERHARDT DRIVE ARTHUR IL 619111224 RICK WEGER PRESIDENT 2175432103 2016-03-30 1 JEFF PARKER P00970069 3149254300 2014 2016-08-17 19:52:53Z THE ARTHUR HOME RICK WEGER 423 S EBERHARDT DRIVE ARTHUR IL 619111224 3570724 0 X WWW.EBERHARDTVILLAGE.ORG X 1962 IL TO PROVIDE SKILLED NURSING CARE AND INTERMEDIATE MEDICAL CARE TO ELDERLY 7 6 133 78 0 0 8409 14415 3498320 3544827 35 42 42476 11440 3549240 3570724 0 0 0 0 1879627 2017832 0 0 0 1627381 1479722 3507008 3497554 42232 73170 3224922 5144290 1333091 2607209 1891831 2537081 TO PROVIDE SKILLED NURSING CARE AND INTERMEDIATE RESIDENT CARE TO ELDERLY. 0 0 3010561 3544827 COMMUNITY RETIREMENT INC OPERATES THE ARTHUR HOME, A NURSING HOME WHICH PROVIDES LICENSED SKILLED AND INTERMEDIATE MEDICAL CARE, PRIMARILY TO ELDERLY PATIENTS 3010561 1 0 0 0 0 0 0 0 1 0 1 0 0 0 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 7 0 133 1 0 0 0 0 0 0 0 0 0 0 X 7 6 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 PETERSHEIM BOARD MEMBER 0.50 0.50 X 0 0 0 RICK WEGER PRESIDENT 15.00 15.00 X X 0 0 0 ALVA MILLER SECRETARY/TREASURER 0.50 0.50 X X 0 0 0 FRED HELMUTH BOARD MEMBER 0.50 0.50 X 0 0 0 SUE STOUT BOARD MEMBER 0.50 0.50 X 0 0 0 JOHN STEWART VICE PRESIDENT 2.00 2.00 X 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 343276 1 14415 14415 NET SERVICE REVENUE 623000 3450375 3450375 RENT 623000 94452 94452 3544827 42 42 2992 0 2992 2992 2992 MEAL INCOME 623000 3864 3864 ACTIVITY INCOME 623000 2712 2712 TRANSPORTATION INCOME 623000 1113 1113 759 759 8448 3570724 3544827 0 11482 X 1784926 1595781 189145 89219 79765 9454 143687 128461 15226 2539 2539 32878 32878 451605 385937 65668 20841 20841 249651 196012 53639 33781 2160 31621 67350 67350 15786 15786 59660 59660 92763 92763 33071 33071 FOOD 156852 156852 ASSESSMENT FEES/TAXES 121324 113942 7382 PHARMACY 84061 84061 MISCELLANEOUS 37449 352 37097 20111 14394 5717 3497554 3010561 486993 0 1314 6342 128589 201879 2016807 3249219 13712 14969 20200 18516 8366022 6882586 338812 1483436 705488 169929 3224922 5144290 866563 598026 7343 7343 6042 159185 156001 300000 1754507 0 85290 1333091 2607209 X 1533262 2212242 41122 20388 317447 304451 1891831 2537081 3224922 5144290 X 73170 -12996 585076 X X 0 1 X 1 0 X 35903 13757 6947 7859 14415 78881 3800193 3401721 3204114 3499046 3544827 17449901 3836096 3415478 3211061 3506905 3559242 17528782 0 1647143 1630212 1746776 2103485 1893296 9020912 1647143 1630212 1746776 2103485 1893296 9020912 8507870 13609 13657 13681 35 2992 43974 13609 13657 13681 35 2992 43974 9845 34957 29466 40180 8448 122896 3859550 3464092 3254208 3547120 3570682 17695652 0.48080 0.49990 0.00250 0.00310 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2010 AMOUNT: $ 9,845. 2011 AMOUNT: $ 34,957. 2012 AMOUNT: $ 29,466. 2013 AMOUNT: $ 4,222. 2014 AMOUNT: $ 759. TRANSPORTATION - 2013 AMOUNT: $ 21,829. 2014 AMOUNT: $ 1,113. MEALS - 2013 AMOUNT: $ 7,656. 2014 AMOUNT: $ 3,864. ACTIVITY - 2013 AMOUNT: $ 6,473. 2014 AMOUNT: $ 2,712. 0 1 X 264084 264084 7477415 6406367 1071048 1188 891 297 623335 475328 148007 1483436 ASSET RETIREMENT OBLIGATION 85290 85290 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 150000 156001 0 1 1 156001 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 MONITORING: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 54,202. MANAGEMENT AND GENERAL EXPENSES 65,668. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 119,870. THERAPY SERVICES: PROGRAM SERVICE EXPENSES 331,735. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 331,735. FORM 990, PART XI, LINE 9: TRANSFER OF BUILDING 600,000. TRANSFER OF EQUITY -14,924. 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 9 N/A 0 0 0 0 1 0 0 0 1 1 1 1 1 0 1 1 0 0 0 0