2013-12-18T10:48:06-06:00 2013-06-30 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2012-07-01 311114614 CHICAGOLAND CHRISTIAN VILLAGE CHIC 3145877903 622 EMERSON RD NO 310 ST LOUIS MO 63141 SUSAN MCGHEE 3145877903 2013-12-17 1 JEFF PARKER P00970069 3149254300 2012 2016-02-25 16:41:14Z SUSAN MCGHEE 622 EMERSON RD NO 310 ST LOUIS MO 63141 11159123 0 X WWW.CHRISTIANHOMES.ORG X 1980 IN TO PROVIDE QUALITY CARE FOR THE AGED IN A CHRISTIAN ENVIRONMENT. 14 14 436 102 0 0 67314 86502 11915571 10336733 33791 198341 89854 535608 12106530 11157184 0 0 0 0 6366249 5662475 0 0 0 6444817 5897071 12811066 11559546 -704536 -402362 13834276 13478787 26791786 26840321 -12957510 -13361534 X THE MISSION OF CHICAGOLAND CHRISTIAN VILLAGE IS TO CREATE AN EXCITING LIFESTYLE AND TO PROVIDE HIGH QUALITY CARE FOR SENIORS ON A CONTINUUM OF CARE CAMPUS. PROVIDING CARE IN A CHRISTIAN ENVIRONMENT PROVIDES A UNIQUE OPPORTUNITY TO MEET THE NEEDS OF SENIORS PHYSICALLY, MENTALLY, AND SPIRITUALLY. OUR COMMITMENT TO EXCELLENCE IS MOTIVATED BY OUR CHRISTIAN BELIEF THAT ALL ARE PRECIOUS IN THE SIGHT OF GOD. 0 0 10013092 10807364 CHICAGOLAND CHRISTIAN VILLAGE PROVIDES QUALITY CARE FOR THE AGED IN A CHRISTIAN ENVIRONMENT. THE CAMPUS INCLUDES OPERATION OF A SKILLED NURSING FACILITY WITH 46,637 PATIENT DAYS OF SERVICE, OPERATION OF AN INDEPENDENT RETIREMENT COMMUNITY WITH AN AVERAGE OF 17 INDEPENDENT LIVING UNITS OCCUPIED, AND OPERATION OF A SENIOR LIVING APARTMENT BUILDING WITH AN AVERAGE OF 43 SENIOR APARTMENT UNITS OCCUPIED DURING THE YEAR. 10013092 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 22 0 436 1 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X MIDWEST CHRISTIAN VILLAGES 3145877903 622 EMERSON RD SUITE 310 ST LOUIS MO 63141 MARK A BEHRENDS 0.30 2.00 X 0 1000 0 JIMMIE BLALOCK 0.30 2.00 X 0 0 0 MAURINE COLLETT 0.30 2.00 X 0 750 0 ROBERT CROSBY 0.30 2.00 X X 0 1000 0 BILLY D CARTER 0.30 2.00 X X 0 1000 0 RANDY CLARK 0.30 2.00 X 0 1000 0 NICHOLAS A FILING 0.30 2.00 X 0 1000 0 JAMES FRASURE MD 0.30 2.00 X 0 1000 0 TERRY GOODNER 0.30 2.00 X X 0 1250 0 BILIE W LASH 0.30 2.00 X 0 750 0 PATRICIA M LINCOLN 0.30 2.00 X 0 1000 0 MARYLYN ROWE 0.30 2.00 X 0 1000 0 RONALD F SEWELL 0.30 2.00 X X 0 1000 0 VICTOR S WILLIAMS 0.30 2.00 X 0 0 0 TIMOTHY PHILLIPPE 2.00 38.00 X 0 422709 6840 SUSAN MCGHEE 2.00 38.00 X 0 216605 12840 SHERRY GUTERMUTH 2.00 38.00 X 0 189051 12840 MARK LONGENECKER 2.00 38.00 X 0 220152 12840 JOHN RUPKEY 2.00 38.00 X 0 181078 12340 JODI NYLIN 2.00 38.00 X 0 179154 4500 MICHAEL CARDENAS 2.00 38.00 X 0 159743 6840 GREG WITTE 0.00 40.00 X 0 155776 12340 ROBERT VINCENT 0.00 40.00 X 0 147266 6840 0 1883284 88220 1 0 1 0 KINDRED REHAB SERVICES INC PO BOX 277365 ATLANTA GA 30384 THERAPY SERVICES 1021452 1 86502 86502 NURSING HOME OPERATIONS (NET OF C 623000 10142544 10142544 INDPENDENT RETIREMENT APARTMENTS 623000 194189 194189 10336733 199054 199054 1226 0 1939 1226 -1939 -713 -713 MISCELLANEOUS 900099 366789 360366 6423 REIMBURSEMENTS 900099 110265 110265 BARBER & BEAUTY 900099 58546 58546 8 8 535608 11157184 10807364 0 263318 4562593 4280394 282199 707670 663900 43770 392212 367953 24259 730392 730392 43508 43508 975080 958775 16305 18295 18295 599418 507178 92240 29825 29825 429938 392129 37809 12039 4938 7101 2314 1003 1311 1260833 1260833 813683 813683 142950 142950 RAW FOOD 379149 379149 PURCHASED SERVICES 203629 203629 BAD DEBT 198734 198734 MISCELLANEOUS 31554 29104 2450 25730 7474 18256 11559546 10013092 1546454 0 1262827 186793 1298775 29351 28524 23311 17085 23579771 12636128 11501090 10943643 202250 192138 815447 811829 13834276 13478787 1051294 993540 706346 556178 6600000 6395000 0 15519409 14650500 2914737 4245103 26791786 26840321 X -12971905 -13385588 14395 24054 -12957510 -13361534 13834276 13478787 -402362 -1662 0 X X 0 1 X 1 0 X 51789 38848 36852 67314 86502 281305 13017072 12553653 12710830 11915571 10336733 60533859 13068861 12592501 12747682 11982885 10423235 60815164 0 0 0 60815164 85145 56029 32816 32697 199054 405741 85145 56029 32816 32697 199054 405741 91977 55679 74557 89854 535608 847675 13245983 12704209 12855055 12105436 11157897 62068580 0.97980 0.98750 0.00650 0.00460 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: BARBER AND BEAUTY SHOP - 2008 AMOUNT: $ 38,209. 2009 AMOUNT: $ 36,848. 2010 AMOUNT: $ 40,946. 2011 AMOUNT: $ 41,922. 2012 AMOUNT: $ 58,546. CABLE TV - 2008 AMOUNT: $ 437. 2009 AMOUNT: $ 17. VENDING - 2008 AMOUNT: $ 1,090. 2011 AMOUNT: $ 366. 2012 AMOUNT: $ 8. MISCELLANEOUS - 2008 AMOUNT: $ 8,061. 2009 AMOUNT: $ 18,814. 2010 AMOUNT: $ 33,611. 2011 AMOUNT: $ 43,222. ACTIVITY - 2008 AMOUNT: $ 44,180. 2011 AMOUNT: $ 1. 2012 AMOUNT: $ 4,795. DISCOUNTS - 2011 AMOUNT: $ 4,343. 2012 AMOUNT: $ 2,103. REMIBURSEMENTS - 2012 AMOUNT: $ 110,265. MANAGEMENT FEES - 2012 AMOUNT: $ 359,891. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 52197 4286 56483 49676 2521 52197 47531 2145 49676 47614 -83 47531 49655 -2041 47614 1.00000 0 0 205479 205479 20917145 10641945 10275200 2457147 1994183 462964 10943643 RESIDENT TRUST 26576 ENTRANCE DEPOSITS 17886 ENDOWMENT FUND 56483 BOND FUNDS 710650 ACCRUED INTEREST RECEIVABLE 234 811829 SECURITY DEPOSIT PAYABLE 80003 CURRENT PORTION OF REFUNDABLE ENTRANCE FEES 237400 REFUNDABLE ENTRANCE FEES 919178 OTHER LIABILITIES 10902 INTERCOMPANY PAYABLE 191 CASH OVERDRAFT - INTERCOMPANY PAYABLES 2997429 4245103 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ORGANIZATION HOLDS FUNDS IN ENDOWMENT DESIGNATED BY THE BOARD OF DIRECTORS TO BE USED FOR RESIDENT CARE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION QUALIFIES AS A TAX-EXEMPT CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ORGANIZATION IS NOT SUBJECT TO FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE CODE. THE ORGANIZATION IS CLASSIFIED AS A PUBLICLY-SUPPORTED CHARITABLE ORGANIZATION UNDER THE CODE AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS A CHARITABLE TAX DEDUCTION FOR THE CONTRIBUTOR. THE ORGANIZATION FOLLOWS 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. IT ALSO PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THIS STANDARD HAS NO IMPACT ON THE ORGANIZATIONS' FINANCIAL STATEMENTS. THE ORGANIZATIONS' INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE THEIR TAX-EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES OTHER THAN WHAT IS ALREADY BEING REPORTED. THE TAX RETURNS FOR THE YEARS 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. X 1 1 X X X X 1 0 0 0 0 0 0 0 0 TIMOTHY PHILLIPPE 0 373209 0 49500 0 0 0 0 0 6840 0 429549 0 0 SUSAN MCGHEE 0 216605 0 0 0 0 0 0 0 12840 0 229445 0 0 SHERRY GUTERMUTH 0 163304 0 21000 0 4747 0 0 0 12840 0 201891 0 0 MARK LONGENECKER 0 177455 0 40000 0 2697 0 0 0 12840 0 232992 0 0 JOHN RUPKEY 0 147408 0 28000 0 5670 0 0 0 12340 0 193418 0 0 JODI NYLIN 0 143885 0 15000 0 20269 0 0 0 4500 0 183654 0 0 MICHAEL CARDENAS 0 159743 0 0 0 0 0 0 0 6840 0 166583 0 0 GREG WITTE 0 132936 0 21500 0 1340 0 0 0 12340 0 168116 0 0 ROBERT VINCENT 0 132845 0 10000 0 4421 0 0 0 6840 0 154106 0 0 PART I, LINE 1A TIMOTHY PHILLIPPE RECEIVED A HOUSING ALLOWANCE OF $16,478 AND ROBERT VINCENT RECEIVED A HOUSING ALLOWANCE OF $25,480. PART I, LINE 4A JODI NYLIN RECEIVED TAXABLE SEVERANCE PAYMENT OF $20,269. A CITY OF CROWN POINT INDIANA 356000997 228484BZ3 2007-07-17 7155000 REFINANCE 0 0 0 A 555000 7155000 707486 252369 1082178 5112967 2010 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 SCHEDULE K PART IV, ARBITRAGE, LINE 2C DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF CROWN POINT, INDIANA DATE THE REBATE COMPUTATION WAS PERFORMED: 06/28/2012 2007D BOND ISSUANCE: ON JULY 16, 2007, THE CHI OBLIGATED GROUP ISSUED THE SERIES 2007D BONDS AT A TOTAL VALUE OF $7,155,000 UNDER THE NEWLY FORMED MASTER TRUST INDENTURE. THE PROCEEDS FROM THESE BONDS WERE USED TO REFINANCE THE SERIES 1993 BONDS ISSUED BY THE CITY OF CROWN POINT, INDIANA, TO FUND THE DEBT SERVICE RESERVE AND THE PROJECT FUND, AND TO PAY THE UNDERWRITER'S DISCOUNT. SCH K, PART II, LINE 7: CHICAGOLAND CHRISTIAN VILLAGE HAS ELECTED TO AMORTIZE THE ISSUANCE COST OVER THE LIFE OF THE BOND. THIS HAS LED TO A DIFFERENCE BETWEEN THE AMOUNT LISTED PER THE 8038 AND THE CURRENT BOOK VALUE OF ISSUANCE COST. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES MANAGEMENT DUTIES INCLUDING SUPERVISING PERSONNEL, OPERATIONS, AND BUDGETING TO MIDWEST CHRISTIAN VILLAGES, A MANAGEMENT COMPANY AND RELATED EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD GETS A DRAFT OF THE 990 SENT TO THEM ELECTRONICALLY FOR REVIEW PRIOR TO SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST STATEMENT IS INCLUDED IN THE EMPLOYEE HANDBOOK WHICH EVERY EMPLOYEE IS GIVEN A COPY OF AND SIGNS AN ACKNOWLEDGEMENT FOR ON THEIR FIRST DAY OF EMPLOYMENT. IF A VIOLATION OCCURS EMPLOYEES CAN REPORT DIRECTLY TO THEIR SUPERVISOR OR USE THE 800 NUMBERS WHICH ARE POSTED AT EACH LOCATION. VIOLATIONS ARE INVESTIGATED BY INDIVIDUALS AT THE VICE PRESIDENT LEVEL AND AT LEAST TWO INDIVIDUALS WOULD MAKE THE FINAL DETERMINATION AS TO THE APPROPRIATE ACTION TO BE TAKEN. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION PARTICIPATES IN SEVERAL (MINIMUM OF 3) INDUSTRY SPECIFIC, EXECUTIVE SALARY SURVEYS EACH YEAR TO HELP DETERMINE COMPETITIVENESS OF OUR EXECUTIVE AND SENIOR MANAGEMENT POSITIONS. THE SALARIES ARE DISCUSSED AND REVIEWED BY THE PRESIDENT AND VICE PRESIDENT OF HUMAN RESOURCES. IF A NEW HIRE IS BEING CONSIDERED FOR AN EXECUTIVE LEVEL POSITION, IT MAY ALSO BE DISCUSSED WITH THE BOARD. IN 2010, THE ORGANIZATION ESTABLISHED A COMPENSATION COMMITTEE OF THE BOARD HEADED BY A PERSON WHOSE ENTIRE CAREER WAS IN HUMAN RESOURCES AND INCLUDES THE ORGANIZATION'S VICE PRESIDENT OF HUMAN RESOURCES AS WELL AS A FEW OTHER BOARD MEMBERS. OTHER OFFICERS' AND KEY EMPLOYEES' SALARIES ARE DETERMINED BASED ON A REVIEW AND PARTICIPATION IN SEVERAL INDUSTRY SPECIFIC SALARY SURVEYS, WHICH PROVIDE DATA ON OTHER EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION POSTS ITS FINANCIAL STATEMENTS ON ITS WEBSITE MONTHLY. FINANCIAL STATEMENTS CAN ALSO BE OBTAINED ON REQUEST. AUDIT COMMITTEE OVERSIGHT & REVIEW FORM 990, PAGE 12, PART XII, LINE 2C THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. CHRISTIAN HOMES INC 200 N POSTVILLE DR LINCOLN IL 62656 370841562 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS IL 501(C)(3) LINE 9 N/A 0 FAIR HAVENS CHRISTIAN HOMES 1790 S FAIRVIEW AVE DECATUR IL 62521 370987659 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS IL 501(C)(3) LINE 9 N/A 0 LEWIS MEMORIAL CHRISTIAN VILLAGE 3400 W WASHINGTON ST SPRINGFIELD IL 62711 510173104 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS IL 501(C)(3) LINE 9 N/A 0 HOOSIER CHRISTIAN VILLAGE 621 S SUGAR ST BROWNSTOWN IN 47220 237423749 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS IN 501(C)(3) LINE 9 N/A 0 SPRING RIVER CHRISTIAN VILLAGE 201 S NORTHPARK LANE JOPLIN MO 64801 431341462 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS MO 501(C)(3) LINE 9 N/A 0 RISEN SON CHRISTIAN VILLAGE 3000 RISEN SON BLVD COUNCIL BLUFFS IA 51503 421279738 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS IA 501(C)(3) LINE 9 N/A 0 VILLAGE CHRISTIAN PARKE 675 SOUTH FORD RD ZIONSVILLE IN 46077 311172227 RETIREMENT APARTMENTS IN 501(C)(3) LINE 9 N/A 0 MIDWEST SENIOR MINISTRIES 111 E WASHINGTON BENSENVILLE IL 60106 201053401 SKILLED NURSING FACILITY, RETIREMENT APARTMENTS & PHARMACY IL 501(C)(3) LINE 9 N/A 0 MIDWEST CHRISTIAN VILLAGES 200 N POSTVILLE DR LINCOLN IL 62656 260275009 MGMT NURSING AND RETIREMENT COMMUNITIES IL 501(C)(3) LINE 9 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0