2013-01-14T15:36:08-06:00 2012-08-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2011-09-01 370794402 COMMUNITY RETIREMENT INC COMM 2175432103 423 S EBERHARDT DRIVE ARTHUR IL 619111224 GALE PEARCE 2175432103 2013-01-14 1 JEFF PARKER P00970069 3149254300 2011 2016-03-07 17:11:31Z THE ARTHUR HOME GALE PEARCE 423 S EBERHARDT DRIVE ARTHUR IL 619111224 3473416 0 X WWW.EBERHARDTVILLAGE.ORG X 1962 IL TO PROVIDE SKILLED NURSING CARE AND INTERMEDIATE MEDICAL CARE TO ELDERLY 7 7 117 165 0 0 35903 20730 3800193 3401721 13784 12046 9845 36919 3859725 3471416 0 0 0 0 2023215 2033947 0 0 0 1592075 1589836 3615290 3623783 244435 -152367 2723951 2661805 588824 666255 2135127 1995550 TO PROVIDE SKILLED NURSING CARE AND INTERMEDIATE RESIDENT CARE TO ELDERLY. 0 0 3199570 3401721 COMMUNITY RETIREMENT INC OPERATES THE ARTHUR HOME, A NURSING HOME WHICH PROVIDES LICENSED SKILLED AND INTERMEDIATE MEDICAL CARE, PRIMARILY TO ELDERLY PATIENTS 3199570 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 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 0 1 2 0 1 117 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 IL X LINDA BUTLER 2175432103 423 EBERHARDT DRIVE ARTHUR IL 61911 X HENRY D HERSCHBERGER 2.00 X 0 0 0 GALE PEARCE 30.00 X X 0 0 0 RICK WEGER 4.00 X X 0 0 0 ALVA MILLER 1.00 X X 0 0 0 FRED HELMUTH 1.00 X 0 0 0 SUE STOUT 1.00 X 0 0 0 JOHN STEWART 1.00 X 0 0 0 0 0 0 0 0 0 0 GORDON FOOD SERVICE 10901 38TH ST KENOSHA WI 60055 FOOD SALES 226140 ONR INC 1101 S CAPITAL OF TEXAS HWY BLDG AUSTIN TX 78746 THERAPY 217337 COVENTRY OF ILLINOIS PO BOX 7141 LONDON KY 40742 EMPLOYEE HEALTH INSURANCE 206627 3 20730 20730 NET SERVICE REVENUE 623000 3401721 3401721 3401721 13657 13657 1962 0 1962 1962 1962 389 2000 -1611 -1611 -1611 TRANSPORTATION INCOME 623000 17860 17860 MISCELLANEOUS INCOME 623000 6110 6110 MEAL INCOME 623000 5892 5892 5095 5095 34957 3471416 3401721 0 48965 1827059 1712153 114906 70372 65946 4426 136516 127930 8586 74238 74238 28434 28434 3207 3207 268673 207264 61409 61143 54916 6227 8919 8919 8751 8751 75064 75064 150563 150563 THERAPY SERVICES 367829 367829 ASSESSMENT FEES 160337 160337 FOOD 159176 159176 MISCELLANEOUS 99558 20672 78886 123944 88969 34975 3623783 3199570 424213 0 6096 20979 171614 35989 1375652 1463422 9050 9133 11175 13995 1585535 1182163 414777 403372 735587 714915 2723951 2661805 580027 608885 8797 7343 50027 588824 666255 X 1814169 1659430 5760 8132 315198 327988 2135127 1995550 2723951 2661805 X -152367 12790 X X 0 1 1 X 0 X 18988 32862 33595 35903 13757 135105 3326528 3311474 3630295 3800193 3401721 17470211 3345516 3344336 3663890 3836096 3415478 17605316 0 1203855 1627619 1601972 1647143 1630212 7710801 1203855 1627619 1601972 1647143 1630212 7710801 9894515 19800 13380 13841 13609 13657 74287 19800 13380 13841 13609 13657 74287 16798 10002 9845 34957 71602 3365316 3374514 3687733 3859550 3464092 17751205 0.55740 0.58510 0.00420 0.00400 X 60067 60067 1008453 832615 175838 1188 178 1010 442214 281101 161113 73613 68269 5344 403372 DUE FROM EBERHARDT VILLAGE 714915 714915 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 ARE CLASSIFIED AS A PUBLICLY SUPPORTED CHARITABLE ORGANIZATION UNDER THE CODE AND CONTRIBUTIONS TO THE ORGANIZATIONS QUALIFY AS CHARITABLE TAX DEDUCTIONS FOR THE CONTRIBUTOR. THE ENTITIES FILE AS TAX EXEMPT ORGANIZATIONS. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE IRS. THE ORGANIZATIONS' INCOME TAX RETURNS FOR THE YEARS 2008 THROUGH 2011 ARE SUBJECT TO REVIEW AND EXAMINATION BY THE IRS. FRED HELMUTH LINE OF CREDIT X 50000 50027 0 1 1 50027 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 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 12,790. 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 0 0 1 0 0 1 1 0 0 0 0 EBERHARDT VILLAGE INC D 578764 BALANCE OF LOC GUARANTEED