2015-11-13T14:28:06-06:00 2014-12-31 621073578 FRASIER DEAN & HOWARD PLLC 3310 WEST END AVE STE 550 NASHVILLE TN 37203 990 2014-01-01 621533400 THE BLAKEFORD AT GREEN HILLS BLAK 6156659505 11 BURTON HILLS BLVD NASHVILLE TN 37215 AL GRIFFIN CFO 6156659505 2015-11-13 1 SARA G MOON P00034774 6153836592 X 2014 2016-04-25 22:37:26Z VAN CLUCK 11 BURTON HILLS BLVD NASHVILLE TN 37215 21205397 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. 11 11 296 12 0 0 0 25000 18083505 17825890 996090 418972 0 0 19079595 18269862 169184 244604 0 0 7522792 7996400 0 0 0 9073317 9072651 16765293 17313655 2314302 956207 52471727 52012864 71933111 71170739 -19461384 -19157875 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 16603932 244604 17825890 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 552 PERSONS SERVED IN 2014. 16603932 1 1 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 67 0 1 296 1 0 0 0 0 0 0 0 0 0 0 X 11 11 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 JAMES VANDIVER 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 CYNTHIA MORIN BOARD MEMBER 0.00 X 0 0 0 LOUIS TODD BOARD MEMBER 0.00 X 0 0 0 JUDY SWEENEY BOARD MEMBER 0.00 X 0 0 0 MARK VANDIVER BOARD MEMBER 0.50 X 0 0 0 ALLISON GRIFFITH CAO 50.00 X 97564 0 6621 VAN CLUCK CEO 50.00 X 188879 0 11268 DOUG SMITH CFO 50.00 X 155054 0 11184 SARAH BISHOP MARKETING DIRECTOR 50.00 X 119968 0 3376 561465 0 32449 3 0 1 0 REHAB CARE INC PO BOX 503534 ST LOUIS MO 63150 REHAB SERVICES 1068638 JOHN RICHARDSON 7853 OLD CHARLOTTE PIKE NASHVILLE TN 37209 PAINTING 206380 MOORE MEDIA 1016 MONROE LANE BRENTWOOD TN 37027 ADVERTISING/MARKETING 150593 BEN POUNDERS 939 WOODLAND ST NASHVILLE TN 37206 MAINTENANCE 116019 THE BRICKMAN GROUP LTD LLC 431 ATLAS DRIVE NASHVILLE TN 37211 LANDSCAPING 113594 5 25000 25000 RESIDENT SERVICES REVENUE 623000 17825890 17825890 17825890 388979 388979 2965528 2935535 29993 29993 29993 18269862 17825890 0 418972 244604 244604 561465 336879 224586 6079724 6017222 62502 91459 76479 14980 614381 513751 100630 649371 642695 6676 29639 2371 27268 50360 19137 31223 1399365 1399365 521041 460076 60965 1277766 1264026 13740 137907 68954 68953 1314387 1301243 13144 1789903 1772004 17899 319233 296887 22346 SUPPLIES 2099358 2078364 20994 DUES & SUBSCRIPTIONS 118372 94698 23674 LICENSES, PERMITS & FEE 14320 14177 143 OTHER 1000 1000 17313655 16603932 709723 0 5565566 4510441 5289818 5449303 1032785 966825 326456 502362 19973 22476 54083 128197 51767767 23684577 28168978 28083190 5716370 5831357 5646499 5881491 651199 637222 52471727 52012864 1847365 1819018 39401293 39417012 30123207 29374269 561246 560440 71933111 71170739 X -19461384 -19157875 -19461384 -19157875 52471727 52012864 X 956207 180779 -833477 X 0 1 X 1 0 X 25000 25000 15597982 17406048 17007866 17233028 17825890 85070814 15597982 17406048 17007866 17233028 17850890 85095814 0 849 849 849 849 85094965 171321 518912 468018 303283 388979 1850513 171321 518912 468018 303283 388979 1850513 22701 22701 15769303 17924960 17498585 17536311 18239869 86969028 0.97850 0.97430 0.02130 0.03010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3613159 3613159 35269735 12311146 22958589 1306131 1080203 225928 11318487 10293228 1025259 260255 260255 28083190 FIXED INCOME SECURITIES 5881491 F 5881491 REFUNDABLE CUSTOMER DEPOSITS 560440 560440 X 17617164 180779 180779 17436385 833477 833477 18269862 17313655 0 17313655 0 17313655 PART X, LINE 2: 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. IT IS NOT CONSIDERED A PRIVATE FOUNDATION. 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. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS NECESSARY. 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, 2011 THROUGH DECEMBER 31, 2014. THE COMPANY DOES NOT BELIEVE THERE ARE ANY UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2014. ADDITIONALLY, THE COMPANY HAS NOT RECOGNIZED ANY TAX RELATED INTEREST AND PENALTIES IN THE ACCOMPANYING 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 833,477. 1 SKILLED NURSING CARE 3 244604 SKILLED NURSING CARE PART I, LINE 2: THE THREE 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 156079 0 32800 0 0 0 0 0 11268 0 200147 0 0 0 DOUG SMITH CFO 128154 0 26900 0 0 0 0 0 11184 0 166238 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 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 11 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 -833,477. 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 BLAKEFORD AT HOME INC D 294625 CASH