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 311257250 MCV HEALTH CARE FACILITIES INC MCVH 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 11668165 0 X WWW.CHRISTIANBENEVOLENT.ORG X 1988 OH FOUNDED IN 1988, MCV HEALTH CARE FACILITIES 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. MCV HEALTH CARE FACILITIES' 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. 8 8 283 108 0 0 56188 99506 11281841 11238476 17886 -19915 202228 296592 11558143 11614659 107848 81974 0 0 5185430 5137763 0 0 0 6095380 5271649 11388658 10491386 169485 1123273 15487865 14491017 15764819 13644698 -276954 846319 SERVING WITH EXCELLENCE REFLECTING JESUS' COMPASSION. 0 0 8638760 81974 11524410 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. 8638760 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 1 0 0 1 28 0 1 283 1 0 0 0 0 0 0 0 0 0 0 X 8 8 1 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 TOM MOLL 1.00 X 0 0 0 PATRICK LARRICK 1.00 X 0 0 0 CHRISTINA FRANCIS 1.00 X 0 0 0 JONATHAN D SAMS 1.00 X 0 0 0 WAYNE MOCK 1.00 X X 0 0 0 RICHARD YOST 1.00 X X 0 0 0 KIMBERLI LAYER 1.00 X X 0 0 0 LARRY COLLINS 1.00 X X 0 0 0 J DONALD SAMS 5.00 35.00 X 0 107660 45000 LARRY MONROE 5.00 35.00 X 0 45549 0 ROGER SCHWARTZ 9.00 21.00 X 0 94209 0 BRIAN GIBBONEY 14.00 26.00 X 0 91066 0 0 338484 45000 0 0 1 0 REHAB CARE GROUP PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 381626 MIDWEST CHRISTIAN VILLAGES 200 N POSTVILLE DRIVE LINCOLN IL 62656 MANAGEMENT SERVICES 379900 KINDRED REHAB SERVICES PO BOX 277365 ATLANTA GA 303847365 THERAPY SERVICES 197540 HOME CARE PHARMACY PO BOX 715268 COLUMBUS OH 432715268 PHARMACY SERVICES 142171 4 81974 17532 99506 NURSING HOME FEES 532000 11238476 11238476 11238476 4399 4399 23162 1152 -23162 -1152 -24314 -24314 39850 29192 10658 10658 COMMUNITY FACILITY REVENUE 532000 139812 139812 RESIDENT REVENUE 999999 108879 108879 BAD DEBT RECOVERY 999999 37243 37243 285934 11614659 11524410 0 -9257 81974 81974 3926374 3643611 282763 39372 36537 2835 830101 770320 59781 341916 317292 24624 933184 933184 94934 94934 807623 699343 108280 61652 61652 653913 608139 45774 65736 65736 556094 517167 38927 4971 1410 3561 4263 4263 500999 465929 35070 726295 675454 50841 80893 80893 FOOD 474762 474762 LICENSES & FEES 302287 281127 21160 RESIDENT ACTIVITIES 2879 2879 FINES & PENALTIES 1164 1164 10491386 8638760 1852626 0 2500 2500 1351638 1300351 582800 793622 31340 31340 139443 52615 18503407 8412789 10574121 10090618 2806023 2219971 15487865 14491017 872854 798722 11045200 10715101 3846765 2130875 15764819 13644698 X -276954 846319 -276954 846319 15487865 14491017 1123273 0 X X 0 1 X 1 1 1 X 20839 39786 13763 56188 17532 148108 10377488 10621467 11026664 11463487 11606384 55095490 10398327 10661253 11040427 11519675 11623916 55243598 13763 13763 54035 54035 54035 13763 67798 55175800 30791 9035 5741 5386 4399 55352 30791 9035 5741 5386 4399 55352 167243 155888 323131 10596361 10826176 11046168 11525061 11628315 55622081 0.99200 0.98830 0.00100 0.00190 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2008 AMOUNT: $ 27,431. 2009 AMOUNT: $ 16,458. COMMUNITY FEE - 2008 AMOUNT: $ 139,812. 2009 AMOUNT: $ 139,430. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 843 843 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. 149498 149498 16335475 7059278 9276197 1633693 1106549 527144 384741 246962 137779 10090618 CONSTRUCTION IN PROGRESS 101194 DEFERRED LOAN COSTS 242098 SECURITY DEPOSIT & OTHER ESCROW ACCOUNTS 1876679 2219971 RELATED PARTY PAYABLE 1784420 RESIDENTS DEPOSITS 346455 2130875 X 11550829 0 11550829 63830 63830 11614659 10427556 -63830 -63830 10491386 0 10491386 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 4B - OTHER ADJUSTMENTS: RECLASS OF GIFT SHOP EXPENSE -29,192. RECLASS OF TELEPHONE AND TRANSPORTATION REVENUE 36,017. RECLASS OF GRANT EXPENSE 81,318. RECLASS OF LOSS ON SALE OF ASSETS -24,313. PART XII, LINE 2D - OTHER ADJUSTMENTS: RECLASS OF GIFT SHOP EXPENSE 29,192. RECLASS OF GRANT EXPENSE -81,318. RECLASS OF TELEPHONE REVENUE -31,017. RECLASS OF LOSS ON SALE OF ASSETS 24,313. INTERCOMPANY RECEIVABLE -5,000. 1 RESIDENT SUBSIDY 9 81974 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 MCV HEALTH CARE FACILITIES. A COMMITTEE HAS BEEN ESTABLISHED WHICH REVIEWS 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 2 BOARD DIRECTOR JONATHAN D. SAMS IS THE SON OF J. DONALD SAMS, THE PART-YEAR CEO FOR 2012. 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 OR 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. 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. MT HEALTHY CHRISTIAN HOME INC 8097 HAMILTON AVENUE CINCINNATI OH 45231 310714767 RETIREMENT SERVICES OH 501(C)(3) 509(A)(2) CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC 1 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 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 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 0 0 1 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC M 700000 FMV MASON CHRISTIAN VILLAGE INC O 299413 FMV MASON CHRISTIAN VILLAGE INC N 175812 FMV CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC C 81974 FMV CHRISTIAN BENEVOLENT ASSOCIATION OF GREATER CINCINNATI INC E 1777847 FMV MT HEALTHY CHRISTIAN HOME INC D 796128 FMV