2013-08-12T16:28:11-05:00 2012-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2012-01-01 310714767 MT HEALTHY CHRISTIAN HOME INC MTHE 5139315000 8097 HAMILTON AVENUE CINCINNATI OH 45231 BRIAN GIBBONEY 5139315000 2013-08-07 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2016-02-24 21:20:13Z BRIAN GIBBONEY 8097 HAMILTON AVENUE CINCINNATI OH 45231 9392816 0 X WWW.CHRISTIANBENEVOLENT.ORG X 1964 OH FOUNDED 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. 9 9 244 79 0 0 23530 93946 9894723 9296800 8583 -104095 11504 0 9938340 9286651 40141 48626 0 0 5081758 4846126 0 0 0 3924655 4176913 9046554 9071665 891786 214986 8481211 8358761 15350072 8497438 -6868861 -138677 SERVING WITH EXCELLENCE REFLECTING JESUS' COMPASSION. 0 0 7632384 48626 9296800 NURSING 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. 7632384 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 1 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 1 1 0 0 0 1 24 0 1 244 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 OH X ROBIN DIETZ 5138001674 8097 HAMILTON AVENUE CINCINNATI OH 45231 ROD HURON 1.00 X X 0 0 0 DAVID PHILLIPS 1.00 X X 0 0 0 ROBERT WALSH 1.00 X X 0 0 0 JAMES PLUNKETT 1.00 X X 0 0 0 PHYLLIS J SANDERS 1.00 X 0 0 0 LUDMILA GRACANIN 1.00 X 0 0 0 KITTY GARNER 1.00 X 0 0 0 BEVERLY YOUNG 1.00 X 0 0 0 MARK SPARKS 1.00 X 0 0 0 J DONALD SAMS 4.00 36.00 X 0 107660 45000 ROGER SCHWARTZ 12.00 18.00 X 0 94209 0 BRIAN GIBBONEY 16.00 24.00 X 0 91066 0 LARRY MONROE 4.00 36.00 X 0 45549 0 0 338484 45000 0 0 1 0 MIDWEST CHRISTIAN VILLAGES 200 N POSTVILLE DRIVE LINCOLN IL 62656 MANAGEMENT SERVICES 370549 REHAB CARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 301612 KINDRED REHAB SERVICES PO BOX 277365 ATLANTA GA 303847365 THERAPY SERVICES 164128 OMNICARE INC 100 EAST RIVERCENTER BLVD COVINGTON KY 41011 PHARMACY SERVICES 127572 4 48626 45320 93946 RESIDENT REVENUE 532000 9296800 9296800 9296800 2070 2070 106165 -106165 -106165 -106165 9286651 9296800 0 -104095 48626 48626 3658386 3402299 256087 40768 37914 2854 818826 761508 57318 328146 305176 22970 643136 643136 57721 57721 757066 593353 163713 57154 57154 498965 464037 34928 33002 33002 428201 398227 29974 22882 12473 10409 4533 4533 238750 238750 423502 393857 29645 72209 72209 FOOD 381242 381242 LICENSES & FEES 288943 268717 20226 BAD DEBT EXPENSE 242824 242824 DEFERRED BOND COSTS 11317 11317 15466 14910 556 9071665 7632384 1439281 0 442663 1259225 1778062 1011512 1835000 214491 10273 10273 50917 62848 10279226 6714604 3569468 3564622 794828 2235790 8481211 8358761 1087178 757654 6069934 5978580 0 0 8192960 1761204 15350072 8497438 X -6868861 -138677 -6868861 -138677 8481211 8358761 X 214986 6515198 X X 0 1 X 1 1 1 X 58613 7176 2404 23530 45320 137043 8305472 8611527 9024667 9867109 9340315 45149090 8364085 8618703 9027071 9890639 9385635 45286133 40141 40141 50295 50295 50295 40141 90436 45195697 8469 4149 2485 8583 2070 25756 8469 4149 2485 8583 2070 25756 6515208 6515208 8372554 8622852 9029556 9899222 15902913 51827097 0.87200 0.99700 0.00050 0.00090 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: FORGIVENESS OF DEBT - 2012 AMOUNT: $ 6,515,208. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 628 628 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF DUES PAYMENTS TO LEADING AGE ARE RELATED TO LOBBYING ACTIVITIES. THE AMOUNT ABOVE REPRESENTS 7% OF LEADING AGE DUES IN 2012. 161975 161975 8280053 5417412 2862641 1509671 1024327 485344 327527 272865 54662 3564622 SECURITY DEPOSIT AND OTHER ESCROW ACCOUNTS 1928123 DEFERRED COSTS 191667 REFUNDABLE DEPOSITS 116000 2235790 RESIDENT DEPOSITS 360018 RELATED PARTY PAYABLE 1401186 1761204 X 15859462 6515208 6515208 9344254 -57603 -57603 9286651 9129268 57603 57603 9071665 0 9071665 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. 1 RESIDENT SUBSIDY 5 48626 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE 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. X 1 1 0 0 0 0 0 0 0 0 0 J DONALD SAMS 0 107660 0 0 0 0 0 0 0 45000 0 152660 0 0 PART I, LINE 1A J. DONALD SAMS RECEIVED A HOUSING ALLOWANCE IN THE AMOUNT OF $45,000 IN 2012. THIS IS TAXABLE COMPENSATION. FORM 990, PART VI, SECTION A, LINE 3 THE 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 6 THE 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 7A CBA, 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 7B CBA, 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 8B WITH 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 11 THE 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 12C OFFICERS 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 15A THE 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 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FOREGIVENESS OF DEBT BY CBA OF GREATER CINCINNATI, INC. 6,515,198. 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. CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC 8097 HAMILTON AVENUE CINCINNATI OH 45231 310675610 MANAGEMENT/SUPPORT SERVICES FOR RELATED TAX-EXEMPT RETIREMENT COMMUNITIES OH 501(C)(3) 509(A)(1) N/A 0 MASON CHRISTIAN VILLAGE INC 8097 HAMILTON AVENUE CINCINNATI OH 45231 311173965 RETIREMENT SERVICES OH 501(C)(3) 509(A)(2) CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC 1 MCV HEALTH CARE FACILITIES INC 8097 HAMILTON AVENUE CINCINNATI OH 45231 311257250 RETIREMENT SERVICES OH 501(C)(3) 509(A)(2) CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC 1 CHRISTIAN BENEVOLENT ASSOCIATION FOUNDATION FOR THE AGING INC 8097 HAMILTON AVENUE CINCINNATI OH 45231 311413825 FUNDRAISING & FINANCIAL SUPPORT FOR CBA OF GREATER CINCINNATI OH 501(C)(3) 509(A)(3) CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC 1 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 0 1 0 1 CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC M 490000 FMV CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC E 1186695 FMV MCV HEALTH CARE FACILITIES INC E 796128 FMV CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC S 6515198 FMV