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 370987659 FAIR HAVENS CHRISTIAN HOME FAIR 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 19589878 0 X WWW.CHRISTIANHOMES.ORG X 1975 IL TO PROVIDE QUALITY CARE FOR THE AGED IN A CHRISTIAN ENVIRONMENT. 14 14 506 422 0 0 48014 48642 16746451 19296131 149550 145134 100043 98803 17044058 19588710 0 0 0 0 8359256 9198556 0 0 0 9017650 9729011 17376906 18927567 -332848 661143 32452532 31969806 20902569 19669771 11549963 12300035 X THE MISSION OF FAIR HAVENS CHRISTIAN HOME 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 16152088 19300795 FAIR HAVENS CHRISTIAN HOMES, INC. PROVIDES QUALITY CARE OF SENIORS IN A CHRISTIAN ENVIRONMENT. THE CAMPUS HAS A SKILLED NURSING FACILITY WITH 67,763 PATIENT DAYS OF SERVICE DURING THE YEAR, AND AN ASSISTED LIVING FACILITY PROVIDED 14,833 ASSISTED PATIENT DAYS. 52 RESIDENTS WERE SERVED IN THE INDEPENDENT LIVING APARTMENTS. 16152088 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 32 0 506 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 IL X MIDWEST CHRISTIAN VILLAGES 3145877903 622 EMERSON RD SUITE 310 ST LOUIS MO 63141 JIMMY BLALOCK 0.30 2.00 X 0 0 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 JAMES S FRASURE MD 0.30 2.00 X 0 1000 0 MAURINE COLLETT 0.30 2.00 X 0 750 0 TERRY GOODNER 0.30 2.00 X X 0 1250 0 NICHOLAS A FILING 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 PATRICIA LINCOLN 0.30 2.00 X 0 1000 0 MARK A BEHRENDS 0.30 2.00 X 0 1000 0 VICTOR S WILLIAMS 0.30 2.00 X 0 0 0 BILLIE LASH 0.30 2.00 X 0 750 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 GREG WITTE 0.00 40.00 X 0 155776 12340 ROBERT VINCENT 0.00 40.00 X 0 147266 6840 MICHAEL CARDENAS 2.00 38.00 X 0 159743 6840 JODI NYLIN 2.00 38.00 X 0 179154 4500 0 1883284 88220 1 0 1 0 KINDRED REHAB SERVICES PO BOX 277365 ATLANTA GA 303847365 THERAPY SERVICES 2218838 LEADERSTAT 1322 B MANNING PARKAWAY POWELL OH 43065 CONSULTING 141870 FERRY & ASSOCIATES 217 SO SEVENTH ST SPRINGFIELD IL 62701 ARCHITECTS 106046 3 48642 48642 NURSING HOME OPERATIONS (NET OF C 623000 16798916 16798916 ASSISTED LIVING 623990 1743770 1743770 INDEPENDENT RETIREMENT APARTMENTS 623990 753445 753445 19296131 84149 84149 62153 0 1168 62153 -1168 60985 60985 BEAUTY AND BARBER 900099 50020 50020 CABLE TV 900099 23194 23194 MISCELLANEOUS 900099 13331 4664 8667 12258 12258 98803 19588710 19300795 0 239273 X 7191636 6600038 591598 1452080 1332629 119451 554840 509198 45642 1230165 1230165 13204 13204 2440293 2399799 40494 70898 20974 49924 1340480 1229528 110952 36702 36702 648878 648878 18818 9164 9654 5703 4221 1482 918009 918009 1224641 1224641 233429 233429 RAW FOOD 596153 596153 MISCELLANEOUS 470802 3921 466881 PURCHASED SERVICES 406323 406323 BAD DEBT EXPENSE 39700 713 38987 34813 14470 20343 18927567 16152088 2775479 0 3282251 8031 1391483 4911036 2882425 2422914 32323 29791 23348 45370 31400675 11507815 20918624 19892860 1586423 1768225 226447 215125 2109208 2676454 32452532 31969806 2296583 2061621 646790 423588 15090212 14775447 527509 530082 2341475 1879033 20902569 19669771 X 11547665 12295679 2298 4356 11549963 12300035 32452532 31969806 661143 88929 0 X X 0 1 X 1 0 X 51397 56576 89976 94435 48642 341026 12953711 13491078 14015760 16746451 19300795 76507795 13005108 13547654 14105736 16840886 19349437 76848821 0 0 0 76848821 165948 138123 53271 93229 84149 534720 165948 138123 53271 93229 84149 534720 93504 100149 106408 100093 94139 494293 13264560 13785926 14265415 17034208 19527725 77877834 0.98680 0.98420 0.00690 0.00880 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 857423 37514 894937 816017 41406 857423 780775 35242 816017 782155 -1380 780775 815662 -33507 782155 1.00000 0 0 414454 414454 27412642 9174377 18238265 3573579 2333438 1240141 19892860 ACCRUED INTEREST RECEIVABLE 10950 RESIDENT TRUST 29058 OTHER NON-CURRENT ASSETS 7893 BOND FUND 1113606 ENDOWMENT FUND 894937 CONSTRUCTION IN PROGRESS 620010 2676454 DUE TO AUXILIARY 3430 CURRENT PORTION OF REFUNDABLE ENTRANCE FEE 321600 REFUNDABLE ENTRANCE FEES 1550338 SECURITY DEPOSITS PAYABLE 3665 1879033 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 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 MICHAEL CARDENAS 0 159743 0 0 0 0 0 0 0 6840 0 166583 0 0 JODI NYLIN 0 143885 0 15000 0 20269 0 0 0 4500 0 183654 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 ILLINOIS FINANCE AUTHORITY 861091967 45200B6K9 2007-06-28 37578378 REFINANCE 0 0 0 B ILLINOIS FINANCE AUTHORITY 861091967 45200F5E5 2010-07-29 24614950 REFINANCE SERIES 2007C AND FUND CONSTRUCTION PROJECTS 0 0 0 A 719900 8643027 891835 161056 2971794 4618342 2010 1 0 1 1 B 77054 4626048 518163 92521 2387224 1628141 2012 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 SCHEDULE K PART IV, ARBITRAGE, LINE 2C DATE REBATE COMPUTATION PERFORMED ISSUER NAME: ILLINOIS FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 06/28/2012 PROCEEDS OF 2007 BOND ISSUANCE: THE PROCEEDS OF THE 2007A, 2007B AND 2007C BONDS WERE USED TO REFUND THE $4,775,000 SERIES 1989A BONDS OF BENSENVILLE HOME SOCIETY, REFUND THE $17,100,000 SERIES 1995A BONDS OF LIFELINK CORPORATION OBLIGATED GROUP, REFUND THE $18,410,000 SERIES 1998 BONDS OF LIFELINK CORPORATION OBLIGATED GROUP, REFUND THE $1,920,000 SERIES 2002 BONDS OF LEWIS MEMORIAL CHRISTIAN VILLAGE, AND REFUND THE $6,800,000 SERIES 2004 BONDS OF FAIR HAVENS CHRISTIAN HOME. PROCEEDS OF 2010 BOND ISSUANCE: THE PROCEEDS OF THE 2010 BOND ISSUANCE WAS FOR THE BENEFIT OF: CHRISTIAN HOMES, INC 37-0841562 $4,545,361 FAIR HAVENS CHRISTIAN HOME, INC 37-0987659 $4,626,048 LEWIS MEMORIAL CHRISTIAN VILLAGE 51-0173104 $5,352,230 MIDWEST SENIOR MINISTRIES, INC. 20-1053401 $10,091,311 PROCEEDS OF 2007 BOND ISSUANCE: THE PROCEEDS OF THE 2007 BOND ISSUANCE WAS FOR THE BENEFIT OF: CHRISTIAN HOMES, INC. 37-0841562 $6,388,324 FAIR HAVENS CHRISTIAN HOME, INC. 37-0987659 $8,643,027 LEWIS MEMORIAL CHRISTIAN VILLAGE 51-0173104 $4,885,189 MIDWEST SENIOR MINISTRIES, INC. 20-1053401 $17,661,838 SCH K, PART II, LINE 7: FAIR HAVEN CHRISTIAN HOME HAS ELECTED TO AMORTIZE THE ISSUANCE COST OVER THE LIFE OF THE BOND. THIS HAS LED TO A DIFFERENCE BETWEEN THE ISSUED 8038 AND THE BOOK VALUE OF ISSUANCE COST. SCH K, PART III, LINE 5: MIDWEST SENIOR MINISTRIES, A RELATED ORGANIZATION LISTED ON SCHEDULE R, LEASES OFFICE SPACE TO THREE UNRELATED NONPROFIT ORGANIZATIONS. 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 ELECTRONICALLY SENT TO THEM 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. 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. OTHER FEES FORM 990, PART IX, LINE 11G PROFESSIONAL FEES/CONSULTANTS: PROGRAM SERVICE EXPENSES 2,399,799. MANAGEMENT AND GENERAL EXPENSES 40,494. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,440,293. AUDIT COMMITTEE OVERSIGHT & REVIEW FORM 990, PAGE 12, PART XII, LINE 2C THE ORGANIZATION HAS NOT CHANGED ITS PROCESS 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 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 CHICAGOLAND CHRISTIAN VILLAGE 6685 E 117TH ST CROWN POINT IN 46307 311114614 SKILLED NURSING FACILITY & RETIREMENT APARTMENTS IN 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 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