NATIONAL FELLOWSHIP BRETHREN RETIREMENT HOMES INCORPORATED: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
NATIONAL FELLOWSHIP BRETHREN RETIREMENT HOMES INCORPORATED (EIN 35-1282401)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-03-28
IRS object ID
201310879349300626
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-03-28T15:00:21-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN351282401EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1NATIONAL FELLOWSHIP BRETHREN RETIREMENT HOMES INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNATINameControl
Phone5743726200Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1337 Grace Village DriveAddressLine1
CityWinona LakeCity
StateINState
ZIP Code46590ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSONDREA HAMILTONName
TitleCFOTitle
Date Signed2013-03-28DateSigned
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1GRACE VILLAGE RETIREMENT COMMUNITYBusinessNameLine1

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

FieldValueIRS element (for citing)
Business Name Line1SAME AS C ABOVEBusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1337 Grace Village DriveAddressLine1
CityWinona LakeCity
StateINState
ZIP Code46590ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2792795GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteGRACEVILLAGE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1974YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionGRACE VILLAGE'S MISSION IS TO ENABLE OLDER ADULTS TO LIVE TO THEIR FULLEST POTENTIAL IN THE SECURITY OF A CHRISTIAN COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees26TotalNbrEmployees
Total Nbr Volunteers20TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year72163ContributionsGrantsPriorYear
Contributions Grants Current Year46488ContributionsGrantsCurrentYear
Program Service Revenue Prior Year2374060ProgramServiceRevenuePriorYear
Program Service Revenue CY2376752ProgramServiceRevenueCY
Investment Income Prior Year46454InvestmentIncomePriorYear
Investment Income Current Year62755InvestmentIncomeCurrentYear
Other Revenue Prior Year311033OtherRevenuePriorYear
Other Revenue Current Year306800OtherRevenueCurrentYear
Total Revenue Prior Year2803710TotalRevenuePriorYear
Total Revenue Current Year2792795TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year721271SalariesEtcPriorYear
Salaries Etc Current Year743766SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year53768TotalFundrsngExpCurrentYear
Other Expense Prior Year2270959OtherExpensePriorYear
Other Expenses Current Year2393003OtherExpensesCurrentYear
Total Expenses Prior Year2992230TotalExpensesPriorYear
Total Expenses Current Year3136769TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-188520RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-343974RevenuesLessExpensesCY
Total Assets BOY14813137TotalAssetsBOY
Total Assets EOY14208978TotalAssetsEOY
Total Liabilities BOY10815425TotalLiabilitiesBOY
Total Liabilities EOY10741588TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3997712NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3467390NetAssetsOrFundBalancesEOY
Mission DescriptionGRACE VILLAGE'S MISSION IS TO ENABLE OLDER ADULTS TO LIVE TO THEIR FULLEST POTENTIAL IN THE SECURITY OF A CHRISTIAN COMMUNITY. GRACE VILLAGE OFFERS INDEPENDENT LIVING OPTIONS THAT INCLUDE MEALS AND NURSING SERVICES WHEN NEEDED.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
DescriptionGRACE VILLAGE OFFERS INDEPENDENT LIVING OPTIONS THAT INCLUDE MEALS AND NURSING SERVICES WHEN NEEDED. GRACE VILLAGE ALSO OFFERS THERAPY SERVICES AND IN HOME NON-MEDICAL SERVICES AS NEEDED.Description
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundstrueDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingtrueCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees26NumberOfEmployees
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Sondrea HamiltonBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5743726498TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1337 Grace Village DriveAddressLine1
CityWinona LakeCity
StateINState
ZIP Code46590ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
CRAIG SNOW
CHAIR1.00X000
DAVID KOONTZ
MEMBER1.00X000
DAVID PHELPS
MEMBER1.00X000
DON FLUKE
MEMBER1.00X000
DR WILLIAM REMINGTON
MEMBER1.00X000
GARY HERBRUCK
VICE CHAIR1.00X000
HAROLD GATLIN
MEMBER1.00X000
JESSE DEBOEST
TREASURER1.00X000
JO DISBRO
MEMBER1.00X000
MARK YOUNG
MEMBER1.00X000
MATT ELLIOTT
MEMBER1.00X000
RON HENRY
SECRETARY1.00X000
RON REDPATH
FINANCE CHAIR1.00X000
JEFFRY CARROL
CEO40.0001354830XX
SONDREA HAMILTON
CFO40.005811100X
FieldValueIRS element (for citing)
Total Reportable Comp From Org58111TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs135483TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions46488AllOtherContributions
Total Contributions46488TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
RESIDENT SERVICE62300019662431966243
DEFERRED (LIFE LEASE)410509410509

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue2376752TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column62755TotalRevenueColumn
Related Or Exempt Function Income62755RelatedOrExemptFunctionIncome

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real303600Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real303600Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column303600TotalRevenueColumn
Related Or Exempt Function Income303600RelatedOrExemptFunctionIncome

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities0Securities
Other0Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionAPPLICATION FEESDescription
Business Code900099BusinessCode
Total Revenue Column3200TotalRevenueColumn
Related Or Exempt Function Income3200RelatedOrExemptFunctionIncome

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue3200TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2792795TotalRevenueColumn
Related Or Exempt Function Income2746307RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total58172Total
Management And General58172ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total464406Total
Program Services339996ProgramServices
Management And General71110ManagementAndGeneral
Fundraising53300Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total6665Total
Program Services6154ProgramServices
Management And General511ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total167712Total
Program Services146152ProgramServices
Management And General21560ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total46811Total
Program Services41662ProgramServices
Management And General4681ManagementAndGeneral
Fundraising468Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total44554Total
Program Services44554ProgramServices

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total470Total
Management And General470ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1855Total
Management And General1855ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total27751Total
Management And General27751ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total15035Total
Program Services850ProgramServices
Management And General14185ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total16864Total
Program Services5216ProgramServices
Management And General11648ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total274813Total
Program Services274813ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total2352Total
Program Services725ProgramServices
Management And General1627ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total553Total
Program Services168ProgramServices
Management And General385ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total157981Total
Management And General157981ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total732842Total
Management And General732842ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total38055Total
Management And General38055ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
RESIDENT CARE348450348450
BUILDING MAINTENANCE9001690016
LOSS ON INTEREST RATE SWAP111854111854
DEBT FORGIVENESS529558529558

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total3136769Total
Program Services1828314ProgramServices
Management And General1254687ManagementAndGeneral
Fundraising53768Fundraising

Total Joint Costs TotalJointCosts

FieldValueIRS element (for citing)
Total0Total

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY203188BOY
EOY133336EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7838BOY
EOY72777EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY25505BOY
EOY28185EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY17591BOY
EOY18840EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis23531088LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec11307032LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY12406359BOY
EOY12224056EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1936758BOY
EOY1528804EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY215898BOY
EOY202980EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY14813137BOY
EOY14208978EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY269344BOY
EOY192830EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY5159474BOY
EOY5378974EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY5017778BOY
EOY4799228EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY35800BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY56500BOY
EOY66006EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY276529BOY
EOY304550EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY10815425BOY
EOY10741588EOY

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3963417BOY
EOY3458060EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY34295BOY
EOY9330EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3997712BOY
EOY3467390EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY14813137BOY
EOY14208978EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-343974ReconcilationRevenueExpenses
Reconcilation Other Changes-186348ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewtrueAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years75051CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years42955CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years46024CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year72163CurrentTaxYearMinus1Year
Current Tax Year46488CurrentTaxYear
Total282681Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2429222CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2418775CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2278989CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2374060CurrentTaxYearMinus1Year
Current Tax Year2379952CurrentTaxYear
Total11880998Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2504273CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2461730CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2325013CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2446223CurrentTaxYearMinus1Year
Current Tax Year2426440CurrentTaxYear
Total12163679Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total
FieldValueIRS element (for citing)
Public Support Total50912163679PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years327647CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years364873CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years353831CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year351854CurrentTaxYearMinus1Year
Current Tax Year366355CurrentTaxYear
Total1764560Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years327647CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years364873CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years353831CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year351854CurrentTaxYearMinus1Year
Current Tax Year366355CurrentTaxYear
Total1764560Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16404CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7856CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5546CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5633CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total35439Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2848324CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2834459CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2684390CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2803710CurrentTaxYearMinus1Year
Current Tax Year2792795CurrentTaxYear
Total13963678Total
FieldValueIRS element (for citing)
Public Support Percentage5090.87100PublicSupportPercentage509
Prior Year Support Percentage0.86480PriorYearSupportPercentage
Investment Income Percentage0.12640InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.13020PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART IV - EXPLANATION FOR OTHER INCOME, PART IV, APPLICATION FEES 3200,GeneralExplanation
General ExplanationOTHER INCOME, SCHEDULE A, PART III, LINE 12, <OTHERINCOME> <INCOME> <DESCRIPTION /> <COLUMNA>16404</COLUMNA> <COLUMNB>7856</COLUMNB> <COLUMNC>5546</COLUMNC> <COLUMND>5633</COLUMND> <COLUMNE /> <COLUMNF>35439</COLUMNF> </INCOME> <INCOME> <DESCRIPTION /> <COLUMNA /> <COLUMNB /> <COLUMNC /> <COLUMND /> <COLUMNE /> <COLUMNF>0</COLUMNF> </INCOME> </OTHERINCOME>,GeneralExplanation
General ExplanationOTHER INCOME, SCHEDULE A, PART III, LINE 12, DESCRIPTION - , COLUMN A - 16404, COLUMN B - 7856, COLUMN C - 5546, COLUMN D - 5633, COLUMN E - , COLUMN F - 35439; DESCRIPTION - , COLUMN A - , COLUMN B - , COLUMN C - , COLUMN D - , COLUMN E - , COLUMN F - 0;,GeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Number Funds Held46488NumberFundsHeld
Disclosed Orgs Legal ControltrueDisclosedOrgsLegalControl
Disclosed For Charitable PurposestrueDisclosedForCharitablePurposes
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FStrueIncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis125948OtherCostOrOtherBasis
Book Value125948BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis20289149OtherCostOrOtherBasis
Depreciation9255712Depreciation
Book Value11033437BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1955249OtherCostOrOtherBasis
Depreciation1600927Depreciation
Book Value354322BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1160742OtherCostOrOtherBasis
Depreciation450393Depreciation
Book Value710349BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings12224056TotalOfBookValueLandBuildings

Financial Derivatives FinancialDerivatives

FieldValueIRS element (for citing)
Book Value0BookValue
Method Of ValuationFMethodOfValuation

Closely Held Equity Interests CloselyHeldEquityInterests

FieldValueIRS element (for citing)
Book Value1528804BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities1528804TotalOfBookValueSecurities
Federal Income Tax Liability1610FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
WAIT LIST DEPOSITS$4,500
REFUNDABLE PORTION LIFE LEASE DEPOSITS$221,685
SECURITY DEPOSITS$72,989
PAYROLL TAXES$3,766
FieldValueIRS element (for citing)
Total Of Amounts304550TotalOfAmounts
Total Revenue2792795TotalRevenue
Total Expenses3136769TotalExpenses
Excess Or Deficit For Year-343974ExcessOrDeficitForYear
Other$0OtherAmount
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS-343974ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt2792795TotRevenueEtcAuditedFinclStmt
Other Revenues0OtherRevenues
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal2792795RevenueSubtotal
Other Revenues Not Included0OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9902792795TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt3136769TotExpensesEtcAuditedFinclStmt
Other Expenses Included0OtherExpensesIncluded
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal3136769ExpensesSubtotal
Other Expenses Not Included0OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9903136769TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierExplanation of escrow agreementIdentifier
Return ReferenceSchedule D, Part IV, Line 2bReturnReference
ExplanationTHE ORGANIZATION HAS AN ESCROW ACCOUNT AND AGREEMENT WITH A LOCAL BANK. GRACE VILLAGE DEPOSITS MONEY RECEIVED BY FUTURE RESIDENTS FOR LIFE LEASE DEPOSITS INTO THIS ACCOUNT. THE MONEY IS HELD IN THE ESCROW ACCOUNT UNTIL THE RESIDENT OFFICIALLY MOVES IN TO GRACE VILLAGE AND BECOMES A RESIDENT OF GRACE VILLAGE.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1TOWN OF WINONA LAKE INDIANABusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN356001423IssuerEIN
CUSIP Number975204AG3CUSIPNumber
Date Issued2006-05-23DateIssued
Issue Price6157000IssuePrice
Description Of PurposeREFINANCE PRIOR ISSUES AND BUIL NEW SNF WHICH NUMBERS WILL BE REFLECTED ON RELATED COMPANY'S 990DescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired0AmountRetired
Amount Bond Defeased0AmountBondDefeased
Total Proceeds6157TotalProceeds
Amount In Reserve Fund0AmountInReserveFund
Capitalized Interest0CapitalizedInterest
Refunding Escrow0RefundingEscrow
Issuance Costs From Proceeds56847IssuanceCostsFromProceeds
Credit Enhancement0CreditEnhancement
Working Capital Expenditures0WorkingCapitalExpenditures
Capital Expenditures0CapitalExpenditures
Other Spent Proceeds0OtherSpentProceeds
Amount Unspent0AmountUnspent
Current RefundingfalseCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind
FieldValueIRS element (for citing)
Form990 Schedule K Part IIIForm990ScheduleKPartIII

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Variable Rate IssuetrueVariableRateIssue
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds
Term Of Hedge0.0TermOfHedge
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC
Term Of GIC0.0TermOfGIC

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Classes of members or stockholdersForm 990, Part VI, Section A, Line 6BOARD MEMBERS APPROVE SIGNIFICANT DECISIONS OF MANAGEMENT.
Members or stockholders electing members of governing bodyForm 990, Part VI, Section A, Line 7aBOARD MEMBERS APPROVE SIGNIFICANT DECISIONS OF MANAGEMENT. ALSO BOARD MEMBERS ELECT AND VOTE ON NEW BOARD MEMBERS.
Decisions requiring approval by members or stockholdersForm 990, Part VI, Section A, Line 7bEXTRAORDINARY CAPITAL PROJECTS AND OTHER FINANCIAL AND STRATEGIC DECISIONS HAVE TO BE APPROVED BY THE BOARD OF DIRECTORS/MEMBERS.
Review of form 990 by governing bodyForm 990, Part VI, Section B, Line 11bCFO PREPARES 990. CEO REVIEWS 990 BEFORE IT IS FILED. THE FULL BOARD IS GIVEN A COPY OF THE 990 UPON COMPLETION OF PREPARATION AND FILING.
Conflict of interest policyForm 990, Part VI, Section B, Line 12cGRACE VILLAGE TRIES TO AVOID SITUATIONS THAT COULD POTENTIALLY BE SEEN AS A CONFLICTS OF INTEREST. IF A CONFICT IS FOUND, IT IS DEALT WITH ON A CASE BY CASE BASIS, AND THE BOARD OF DIRECTORS MAKES A DECISION AS TO MATERIALITY OF THE CONFLICT, AND WHETHER TO TERMINATE TRANSACTIONS WITH PARTIES THAT HAVE A CONFLICT OF INTEREST. CONFLICTS OF INTEREST ARE MONITORED AND DEALT WITH AT EVERY LEVEL OF THE ORGANIZATION, FROM HOURLY EMPLOYEES, TO SALARIED EMPLOYEES, TO BOARD MEMBERS.
Governing documents, conflict of interest policy and financial statements available to the publicForm 990, Part VI, Section C, Line 19UPON REQUEST
Other changes in net assets or fund balancesForm 990, Part XI, Line 5NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -186348;
35-1282401SCHEDULE K - PART I - COLUMN (E):THE ISSUE PRICE DOES NOT MATCH THE AMOUNT THAT IS ON FORM 8038 BECAUSE THIS BOND ISSUE WAS TO BENEFIT TWO SEPARATE LEGAL ENTITIES. THE ENTITIES OPERATE AS ONE COMPANY, BUT ONLY 47% OF THE BOND ISSUE WAS FOR NATIONAL FELLOWSHIP BRETHREN RET. HOMES. THE AMOUNT ON LINE A, COLUMN (E) OF $6,157,000 REPRESENTS 47% OF THE TOTAL BOND ISSUE OF $13,100,000.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1GRACE VILLAGE HEALTHCARE FACILITY INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1337 GRACE VILLAGE DRIVEAddressLine1
CityWINONA LAKECity
StateINState
ZIP Code46590ZIPCode
FieldValueIRS element (for citing)
EIN351447417EIN
Primary ActivitiesNURSING HOME/ASSISTED LIVING FACILITYPrimaryActivities
Legal Domicile StateINLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status9PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

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