FURP.ORG / PUBLIC DATA EXPLORER

MT HEALTHY CHRISTIAN HOME INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MT HEALTHY CHRISTIAN HOME INC (EIN 31-0714767)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-08-12
IRS object ID
201322249349302447
Schema version
2012v2.1
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)
Timestamp2013-08-12T16:28:11-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN381357951EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line165 EAST STATE ST STE 600AddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43215ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN310714767EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MT HEALTHY CHRISTIAN HOME INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMTHENameControl
Phone5139315000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line18097 HAMILTON AVENUEAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45231ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBRIAN GIBBONEYName
TitleCOOTitle
Phone5139315000Phone
Date Signed2013-08-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBERNIE OSTROWSKIName
PTINP00366367PTIN
Phone6148493000Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonBRIAN GIBBONEYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line18097 HAMILTON AVENUEAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45231ZIPCode
FieldValueIRS element (for citing)
Gross Receipts9392816GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CHRISTIANBENEVOLENT.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1964YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionFOUNDED IN 1964, THE ORGANIZATION IS A NOT-FOR-PROFIT PROVIDER OF RETIREMENT SERVICES, OFFERING A VARIETY OF LIVING STYLES, FROM RESIDENTIAL LIVING APARTMENTS, ASSISTED LIVING AND SKILLED NURSING CARE. THE ORGANIZATION'S MISSION IS TO PROVIDE SECURE, QUALITY LIVING IN A CHRISTIAN ENVIRONMENT, DIRECTED ESPECIALLY TO PERSONS IN THEIR RETIREMENT YEARS. THE ORGANIZATION'S MINISTRY SERVES OVER 150 OLDER ADULTS. OUR SERVICES ARE DEDICATED TO THE ENHANCEMENT OF THE SPIRITUAL, PHYSICAL, SOCIAL, CULTURAL AND EMOTIONAL WELL-BEING OF EACH RESIDENT IN AN ENVIRONMENT THAT RECOGNIZES AND PROMOTES PERSONAL DIGNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees244TotalNbrEmployees
Total Nbr Volunteers79TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year23530ContributionsGrantsPriorYear
Contributions Grants Current Year93946ContributionsGrantsCurrentYear
Program Service Revenue Prior Year9894723ProgramServiceRevenuePriorYear
Program Service Revenue CY9296800ProgramServiceRevenueCY
Investment Income Prior Year8583InvestmentIncomePriorYear
Investment Income Current Year-104095InvestmentIncomeCurrentYear
Other Revenue Prior Year11504OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year9938340TotalRevenuePriorYear
Total Revenue Current Year9286651TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year40141GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY48626GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5081758SalariesEtcPriorYear
Salaries Etc Current Year4846126SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3924655OtherExpensePriorYear
Other Expenses Current Year4176913OtherExpensesCurrentYear
Total Expenses Prior Year9046554TotalExpensesPriorYear
Total Expenses Current Year9071665TotalExpensesCurrentYear
Revenues Less Expenses Prior Year891786RevenuesLessExpensesPriorYear
Revenues Less Expenses CY214986RevenuesLessExpensesCY
Total Assets BOY8481211TotalAssetsBOY
Total Assets EOY8358761TotalAssetsEOY
Total Liabilities BOY15350072TotalLiabilitiesBOY
Total Liabilities EOY8497438TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-6868861NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-138677NetAssetsOrFundBalancesEOY
Mission DescriptionSERVING WITH EXCELLENCE REFLECTING JESUS' COMPASSION.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7632384Expense
Grants48626Grants
Revenue9296800Revenue
DescriptionNURSING CARE SERVICE PROGRAMS INCLUDE SEMI-PRIVATE ROOMS AND A LIMITED NUMBER OF PRIVATE ROOMS, ASSISTED LIVING AND RESPITE CARE WITH ALL THE AMENITIES OF RESIDENTIAL LIVING IN A PRIVATE/SHARED OCCUPANCY STUDIO. CHARGES ARE BASED ON INDIVIDUAL ASSESSMENTS TO DEVELOP PERSONALIZED CARE AND SERVICE. RESIDENTIAL SERVICES INCLUDE A FULL CALENDAR OF LIFE ENRICHING RELIGIOUS (CHAPEL AND PASTORAL CARE), SOCIAL AND EDUCATIONAL PROGRAMS, SERVICES AND ACTIVITIES. SERVICES INCLUDE WEEKLY HOUSEKEEPING, LAUNDRY, MAINTENANCE, UTILITIES, TRASH REMOVAL, AND DINING CONSISTING OF THREE MEALS A DAY.Description
Total Program Service Expense7632384TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109624NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees244NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ROBIN DIETZBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5138001674TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line18097 HAMILTON AVENUEAddressLine1
CityCINCINNATICity
StateOHState
ZIP Code45231ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (13 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelated
ROD HURON
SECRETARY & DIRECTOR1.00XX000
DAVID PHILLIPS
VICE CHAIR & DIRECTOR1.00XX000
ROBERT WALSH
CHAIR & DIRECTOR1.00XX000
JAMES PLUNKETT
TREASURER & DIRECTOR1.00XX000
PHYLLIS J SANDERS
DIRECTOR1.00X000
LUDMILA GRACANIN
DIRECTOR1.00X000
KITTY GARNER
MEMBER AT LARGE/DIRECTOR1.00X000
BEVERLY YOUNG
DIRECTOR1.00X000
MARK SPARKS
DIRECTOR1.00X000
J DONALD SAMS
CEO (PART YEAR)4.00X01076604500036.00
ROGER SCHWARTZ
CFO12.00X094209018.00
BRIAN GIBBONEY
COO16.00X091066024.00
LARRY MONROE
CEO (PART YEAR)4.00X045549036.00
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs338484TotalReportableCompFrmRltdOrgs
Total Other Compensation45000TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (4 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MIDWEST CHRISTIAN VILLAGES
200 N POSTVILLE DRIVELINCOLNIL62656MANAGEMENT SERVICES370549
REHAB CARE GROUP INC
PO BOX 503534ST LOUISMO63150THERAPY SERVICES301612
KINDRED REHAB SERVICES
PO BOX 277365ATLANTAGA303847365THERAPY SERVICES164128
OMNICARE INC
100 EAST RIVERCENTER BLVDCOVINGTONKY41011PHARMACY SERVICES127572
FieldValueIRS element (for citing)
Number Of Contractors GT100 K4NumberOfContractorsGT100K
Related Organizations48626RelatedOrganizations
All Other Contributions45320AllOtherContributions
Total Contributions93946TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionRESIDENT REVENUEDescription
Business Code532000BusinessCode
Total Revenue Column9296800TotalRevenueColumn
Related Or Exempt Function Income9296800RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue9296800TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2070TotalRevenueColumn
Exclusion$2,070ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other106165Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-106165Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-106165TotalRevenueColumn
Exclusion-$106,165ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9286651TotalRevenueColumn
Related Or Exempt Function Income9296800RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$104,095ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total48626Total
Program Services48626ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3658386Total
Program Services3402299ProgramServices
Management And General256087ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total40768Total
Program Services37914ProgramServices
Management And General2854ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total818826Total
Program Services761508ProgramServices
Management And General57318ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total328146Total
Program Services305176ProgramServices
Management And General22970ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total643136Total
Management And General643136ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total57721Total
Management And General57721ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total757066Total
Program Services593353ProgramServices
Management And General163713ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total57154Total
Program Services57154ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total498965Total
Program Services464037ProgramServices
Management And General34928ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total33002Total
Management And General33002ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total428201Total
Program Services398227ProgramServices
Management And General29974ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total22882Total
Program Services12473ProgramServices
Management And General10409ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total4533Total
Management And General4533ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total238750Total
Program Services238750ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total423502Total
Program Services393857ProgramServices
Management And General29645ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total72209Total
Management And General72209ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
FOOD381242381242
LICENSES & FEES28894326871720226
BAD DEBT EXPENSE242824242824
DEFERRED BOND COSTS1131711317

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total15466Total
Program Services14910ProgramServices
Management And General556ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9071665Total
Program Services7632384ProgramServices
Management And General1439281ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY442663BOY
EOY1259225EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1778062BOY
EOY1011512EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY1835000BOY
EOY214491EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY10273BOY
EOY10273EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY50917BOY
EOY62848EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis10279226LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6714604LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3569468BOY
EOY3564622EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY794828BOY
EOY2235790EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8481211BOY
EOY8358761EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1087178BOY
EOY757654EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY6069934BOY
EOY5978580EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY8192960BOY
EOY1761204EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY15350072BOY
EOY8497438EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-6868861BOY
EOY-138677EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-6868861BOY
EOY-138677EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8481211BOY
EOY8358761EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses214986ReconcilationRevenueExpenses
Reconcilation Other Changes6515198ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement BothXFinancialStatementBoth
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years58613CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7176CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2404CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year23530CurrentTaxYearMinus1Year
Current Tax Year45320CurrentTaxYear
Total137043Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8305472CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8611527CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9024667CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9867109CurrentTaxYearMinus1Year
Current Tax Year9340315CurrentTaxYear
Total45149090Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8364085CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8618703CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9027071CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9890639CurrentTaxYearMinus1Year
Current Tax Year9385635CurrentTaxYear
Total45286133Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year40141CurrentTaxYearMinus1Year
Total40141Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years50295CurrentTaxYearMinus2Years
Total50295Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years50295CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year40141CurrentTaxYearMinus1Year
Total90436Total
FieldValueIRS element (for citing)
Public Support Total50945195697PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8469CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4149CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2485CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8583CurrentTaxYearMinus1Year
Current Tax Year2070CurrentTaxYear
Total25756Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8469CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4149CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2485CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8583CurrentTaxYearMinus1Year
Current Tax Year2070CurrentTaxYear
Total25756Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year6515208CurrentTaxYear
Total6515208Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8372554CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8622852CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9029556CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9899222CurrentTaxYearMinus1Year
Current Tax Year15902913CurrentTaxYear
Total51827097Total
FieldValueIRS element (for citing)
Public Support Percentage5090.87200PublicSupportPercentage509
Prior Year Support Percentage0.99700PriorYearSupportPercentage
Investment Income Percentage0.00050InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00090PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: FORGIVENESS OF DEBT - 2012 AMOUNT: $ 6,515,208.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 C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$628OtherActivitiesAmount
Total Lobbying Expenditures IIB628TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationA PORTION OF DUES PAYMENTS TO LEADING AGE ARE RELATED TO LOBBYING ACTIVITIES. THE AMOUNT ABOVE REPRESENTS 7% OF LEADING AGE DUES IN 2012.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis161975OtherCostOrOtherBasis
Book Value161975BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8280053OtherCostOrOtherBasis
Depreciation5417412Depreciation
Book Value2862641BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1509671OtherCostOrOtherBasis
Depreciation1024327Depreciation
Book Value485344BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis327527OtherCostOrOtherBasis
Depreciation272865Depreciation
Book Value54662BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3564622TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
SECURITY DEPOSIT AND OTHER ESCROW ACCOUNTS1928123
DEFERRED COSTS191667
REFUNDABLE DEPOSITS116000
FieldValueIRS element (for citing)
Total Book Value Other Assets2235790TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
RESIDENT DEPOSITS$360,018
RELATED PARTY PAYABLE$1,401,186
FieldValueIRS element (for citing)
Total Of Amounts1761204TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt15859462TotRevenueEtcAuditedFinclStmt
Other Revenues6515208OtherRevenues
Revenue Not Rptd F9906515208RevenueNotRptdF990
Revenue Subtotal9344254RevenueSubtotal
Other Revenues Not Included-57603OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-57603RevenueNotRptdOnFinStmt
Total Revenue Per Form9909286651TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt9129268TotExpensesEtcAuditedFinclStmt
Other Expenses Included57603OtherExpensesIncluded
Expenses Not Rptd F99057603ExpensesNotRptdF990
Expenses Subtotal9071665ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9909071665TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X, LINE 2:NO PROVISION HAS BEEN MADE FOR INCOME TAXES SINCE THE ASSOCIATION AND ITS CONTROLLED NOT-FOR-PROFIT ENTITIES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER CODE SECTION 501(C)(3) AND IS CLASSIFIED AS OTHER THAN A PRIVATE FOUNDATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ASSOCIATION, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE ASSOCIATION IS NOT CURRENTLY UNDER EXAMINATION BY THE INTERNAL REVENUE SERVICE OR ANY STATE OR LOCAL TAX AUTHORITIES. THE ASSOCIATION'S FEDERAL TAX RETURNS FOR THE YEARS ENDED PRIOR TO DECEMBER 31, 2009 ARE NO LONGER SUBJECT TO EXAMINATION.
PART XI, LINE 2D - OTHER ADJUSTMENTS:RECLASS OF PHARMACY AND OTHER MEDICAL SUPPLIES RECLASS OF FOREGIVENESS OF DEBT 6,515,208.
PART XI, LINE 4B - OTHER ADJUSTMENTS:RECLASS OF GRANT EXPENSE 48,376. RECLASS OF LOSS ON SALE OF ASSETS -105,979.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RECLASS OF GRANT AND TELEPHONE EXPENSE -48,376. RECLASS OF LOSS ON SALE OF ASSETS 105,979.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantRESIDENT SUBSIDYTypeOfGrant
Number Of Recipients5NumberOfRecipients
Amount Of Cash Grant48626AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: A RESIDENT OR THEIR FAMILY CAN SUBMIT A REQUEST TO THE ORGANIZATION FOR SUBSIDY OF THEIR RENT AT MT. HEALTHY CHRISTIAN HOME. A COMMITTEE HAS BEEN ESTABLISHED WHICH WILL REVIEW THE APPLICANT'S CIRCUMSTANCES AND WILL DETERMINE WHETHER ASSISTANCE WILL BE GRANTED BASED ON SPECIFIC CRITERIA. THE COMMITTEE HAS A RESTRICTION ON THE AMOUNT OF FUNDS TO USE FOR SUBSIDY PURPOSES, WHICH WILL ONLY BE EXCEEDED IN THE CASE OF RESIDENTS WHO WERE GRANDFATHERED IN UNDER PREVIOUS ARRANGEMENTS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonJ DONALD SAMSNamePerson
TitleCEO (PART YEAR)Title
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs107660CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs45000NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs152660TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 1AReturnReference
ExplanationJ. DONALD SAMS RECEIVED A HOUSING ALLOWANCE IN THE AMOUNT OF $45,000 IN 2012. THIS IS TAXABLE COMPENSATION.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3THE MANAGEMENT SERVICES ARE PROVIDED BY MIDWEST CHRISTIAN VILLAGES. MIDWEST CHRISTIAN VILLAGES PROVIDES AN EXECUTIVE DIRECTOR FOR THE CAMPUS, AS WELL AS OPERATIONS, ACCOUNTING, BILLING, AND OTHER SUPPORT.
FORM 990, PART VI, SECTION A, LINE 6THE RELATED TAX-EXEMPT ORGANIZATION, CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI, INC. ("CBA"), IS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7ACBA, THE MEMBER OF THE FILING ORGANIZATION, HAS THE RIGHT TO ELECT OR APPOINT ONE OF MORE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY, WHETHER PERIODICALLY, OR AS VACANCIES ARISE, OR OTHERWISE.
FORM 990, PART VI, SECTION A, LINE 7BCBA, THE MEMBER OF THE FILING ORGANIZATION, HAS THE RIGHT TO APPROVE OR RATIFY DECISIONS OF THE ORGANIZATION'S GOVERNING BODY SUCH AS APPROVAL OF THE GOVERNING BODY'S DECISION TO DISSOLVE THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 8BWITH THE EXCEPTION OF THE DEVELOPMENT COMMITTEE, INDIVIDUAL COMMITTEES DO NOT CONTEMPORANEOUSLY DOCUMENT MEETINGS HELD OR WRITTEN ACTIONS UNDERTAKEN DURING THE YEAR. ACTIONS OF THE ANNUAL NOMINATING COMMITTEE ARE DOCUMENTED IN THE GOVERNING BODY'S MINUTES.
FORM 990, PART VI, SECTION B, LINE 11THE CONTROLLER AND COO REVIEW THE FORM 990 AND THEN WILL PROVIDE ELECTRONIC COPIES OF THE FORM 990 TO ALL BOARD MEMBERS PRIOR TO FILING. MAJOR POINTS OF THE FORM ARE ADDRESSED WITH THE BOARD EITHER VIA EMAIL OR AT THE CLOSEST BOARD MEETING DATE.
FORM 990, PART VI, SECTION B, LINE 12COFFICERS AND DIRECTORS REVIEW AND SIGN THE CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS. IT IS THE RESPONSIBILITY OF OFFICERS AND DIRECTORS TO DISCLOSE THE EXISTENCE OF A CONFLICT AND SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF THE CONFLICT IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THOSE WITH CONFLICTS ARE SUBJECT TO VOTING AND PARTICIPATION RESTRICTIONS.
FORM 990, PART VI, SECTION B, LINE 15ATHE BOARD OF DIRECTORS OF A RELATED ORGANIZATION, CHRISTIAN BENEVOLENT ASSOCIATON OF GREATER CINCINNATI, INC., DETERMINES THE CEO'S COMPENSATION THROUGH USE OF REVIEW BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DECISION. THE PROCESS WAS LAST COMPLETED IN 2012.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:FOREGIVENESS OF DEBT BY CBA OF GREATER CINCINNATI, INC. 6,515,198.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2C:CHRISTIAN BENEVOLENT ASSOCIATION, A RELATED ORGANIZATION HAS AN AUDIT COMMITTEE WHICH OVERSEES AUDIT OF THE FINANCIAL STATEMENTS AND IS INVOLVED IN THE SELECTION OF THE INDEPENDENT ACCOUNTANT WHICH COMPLETES THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC
8097 HAMILTON AVENUECINCINNATIOH45231310675610MANAGEMENT/SUPPORT SERVICES FOR RELATED TAX-EXEMPT RETIREMENT COMMUNITIESOH501(C)(3)509(A)(1)N/A0
MASON CHRISTIAN VILLAGE INC
8097 HAMILTON AVENUECINCINNATIOH45231311173965RETIREMENT SERVICESOH501(C)(3)509(A)(2)1CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC
MCV HEALTH CARE FACILITIES INC
8097 HAMILTON AVENUECINCINNATIOH45231311257250RETIREMENT SERVICESOH501(C)(3)509(A)(2)1CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC
CHRISTIAN BENEVOLENT ASSOCIATION FOUNDATION FOR THE AGING INC
8097 HAMILTON AVENUECINCINNATIOH45231311413825FUNDRAISING & FINANCIAL SUPPORT FOR CBA OF GREATER CINCINNATIOH501(C)(3)509(A)(3)1CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC
M490000FMV
CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC
E1186695FMV
MCV HEALTH CARE FACILITIES INC
E796128FMV
CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC
S6515198FMV