2013-11-14T17:01:11-06:00 2012-12-31 751386677 BROWN GRAHAM & COMPANY 9005 MOUNTAIN RIDGE RD SUITE 240 AUSTIN TX 78759 990 2012-01-01 741459599 WESLEYAN HOMES INC WESL 5128681205 PO BOX 486 GEORGETOWN TX 78627 JOHN KLUBERG 5128681205 2013-11-14 1 SHANNON ANDRE P00288382 5122578078 2013-11-14 2012 2016-02-24 21:20:13Z JOHN KLUBERG PO BOX 486 GEORGETOWN TX 78627 20470889 0 X WWW.WESLEYANHOMES.ORG X 1955 TX TO PROVIDE RETIREMENT, ASSISTED LIVING AND NURSING HOME ACCOMMODATIONS TO RESIDENTS. 33 32 516 250 0 0 167702 5000 17774272 20237692 14765 20948 159298 207249 18116037 20470889 0 123449 0 0 10743251 11444713 0 0 198703 7222925 7397090 17966176 18965252 149861 1505637 36226024 37350810 25361589 24957100 10864435 12393710 X TO BE THE PREMIER PROVIDER OF SUPPORTIVE CARE AND SERVICES IN CENTRAL TEXAS, OPEN TO ALL SENIOR ADULTS. THE ORGANIZATION VALUES FAITH, COMPASSION, WELLNESS, AFFORDABILITY, EXCELLENCE, PROFESSIONALISM AND CHOICE. THE VISION OF WESLEYAN HOMES, INC. IS TO BE A FAITH-BASED MINISTRY PROVIDING COMFORT AND CARE FOR RESIDENTS AND THEIR FAMILIES IN A PLACE CALLED HOME. 0 0 18013875 123449 20237692 WESLEYAN HOMES, INC. CURRENTLY PROVIDES HOSPICE SERVICES AND OPERATES THREE FACILITIES LOCATED IN GEORGETOWN, TEXAS: (1) THE WESLEYAN AT ESTRELLA INDEPENDENT LIVING, A 124-UNIT INDEPENDENT LIVING RETIREMENT COMMUNITY, PROVIDING HOUSING, DIETARY AND OTHER RELATED SERVICES; (2) THE WESLEYAN AT ESTRELLA ASSISTED LIVING, A 60-UNIT ASSISTED LIVING RETIREMENT COMMUNITY, PROVIDING CERTIFIED MEMORY CARE SERVICES; AND (3) THE WESLEYAN AT SCENIC, A 222-BED LICENSED NURSING FACILITY, PROVIDING TWENTY-FOUR HOURS PER DAY SKILLED NURSING CARE, HOSPICE, AND OTHER RELATED SERVICES. THESE PROFESSIONAL PATIENT CARE AND BENEFITS ARE PREOVIDED REGARDLESS OF FINANCIAL CONSIDERATIONS AND QUALIFICATIONS. THE WESLEYAN AT ESTRELLA INDEPENDENT LIVING, THE WESLEYAN AT ESTRELLA ASSISTED LIVING, AND THE WESLEYAN AT SCENIC WERE HOME TO 644 OLDER ADULTS IN 2012. 18013875 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 57 0 1 516 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 33 32 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 X JOHN KLUBERG 5128681205 1811 NORTH AUSTIN AVE STE 201 GEORGETOWN TX 78626 BISHOP MIKE LOWRY 1.00 X 0 0 0 DR BOB SOULEN 1.00 X 0 0 0 DR DOUG BENOLD 1.00 X 0 0 0 DR ERIC MCKINNEY 1.00 X 0 0 0 MR STEVE MCIVER 1.00 X 0 0 0 MR BILL CONNOR 1.00 X 5735 0 0 MR ED KOMANDOSKY 1.00 X 0 0 0 MR ERROL WENDLAND 1.00 X 0 0 0 MR GEORGE BRIGHTWELL 1.00 X 0 0 0 MR PAT STROMAN 1.00 X 0 0 0 MR TOM FORBES 1.00 X 0 0 0 MRS JACKIE RANDALL 1.00 X 0 0 0 MRS JEANNINE FAIRBURN 1.00 X 0 0 0 MRS LINDA GUSNOWSKI 1.00 X 0 0 0 MRS PATTY LEE 1.00 X 0 0 0 MS CYNTHIA RIVES 1.00 X 0 0 0 MS DORRIS ROSS 1.00 X 0 0 0 REV ARCYNTHIA LOUIE 1.00 X 0 0 0 REV DEBRA CRUMPTON 1.00 X 0 0 0 REV JIM CHANDLER 1.00 X 0 0 0 REV LARA WHITLEY 1.00 X 0 0 0 REV NANCY WOODS 1.00 X 0 0 0 REV RANKIN KOCH 1.00 X 0 0 0 REV TRAVIS FRANKLIN 1.00 X 0 0 0 MS CORLISS MCBRIDE 1.00 X 0 0 0 REV STEPHEN SCHMIDT 1.00 X 0 0 0 REV RON BELLOMY 1.00 X 0 0 0 DR STEVE LANGFORD 1.00 X 0 0 0 MR RICHARD LA CAGNINA 1.00 X 0 0 0 DR DALE SCHULTZ 1.00 X 0 0 0 MR JOHN KLUBERG 40.00 X 105072 0 14132 MR GENE LAWHON 1.00 X 0 0 0 MR BILL BOOTH 1.00 X 0 0 0 MR CHRIS SPENCE 40.00 X 174795 0 18713 MRS NANCY BENOLD 1.00 X 0 0 0 285602 0 32845 4 0 1 0 SELECT REHABILITATION INC 550 FRONTAGE RD STE 2415 NORTHFIELD IL 60093 REHAB 1085299 BRATH INC 600 IH 35 S ROUNDROCK TX 78681 CONSTRUCTION 624988 US FOODS PO BOX 841587 DALLAS TX 75284 FOOD 528067 STUDIO SIX 336 S CONGRESS STE 165 AUSTIN TX 78704 INTERIOR DESIGN 315644 BEN E KEITH FOODS 5505 KAEPA COURT SAN ANTONIO TX 78218 FOOD 312305 10 5000 5000 ROUTINE PATIENT CARE S 623000 19289608 19289608 PROCEEDS FROM SALE OF MEDICAID BE 900099 733200 733200 BARBER/BEAUTY SHOP 812900 141856 141856 OTHER SERVICES 812900 73028 73028 20237692 20948 20948 GAIN-INVESTMENT IN RRG 900099 207249 207249 207249 20470889 20237692 0 228197 123449 123449 298580 298580 9181498 8846408 235490 99600 267040 248229 14914 3897 991770 889801 89528 12441 705825 666370 34332 5123 16764 8074 8690 20875 20875 1389249 1378714 9928 607 53869 51203 866 1800 329972 238329 36510 55133 801618 766290 23561 11767 38004 32854 5150 673221 673221 1234915 1234915 214821 214821 DIETARY 1117839 1117839 NURSING DEPT AND THERAP 646699 646699 REPAIRS & MAINTENANCE 353678 351129 275 2274 HOUSEKEEPING 238997 238997 266569 265658 911 18965252 18013875 752674 198703 1046472 1490736 69253 69397 2797864 3244916 32624 29462 37107854 8352671 28650953 28755183 271920 299991 2655256 2808904 356767 310692 344915 341529 36226024 37350810 455544 386187 24020200 23612961 885845 957952 25361589 24957100 X 10864435 12393710 10864435 12393710 36226024 37350810 1505637 23638 0 X X 0 1 X 1 0 X 230000 65686 96282 126702 5000 523670 16510003 16489480 17314219 17686726 19504492 87504920 16740003 16555166 17410501 17813428 19509492 88028590 0 0 0 88028590 792649 521092 1421150 14765 20948 2770604 792649 521092 1421150 14765 20948 2770604 17532652 17076258 18831651 17828193 19530440 90799194 0.96950 0.93240 0.03050 0.06760 X 1174676 20962 126131 11296 1310473 1175859 10670 -500 11353 1174676 1074000 10068 102728 10937 1175859 888965 36257 153305 4527 1074000 1320680 28913 -441512 19116 888965 0.96000 0.03000 0.01000 0 1 1 2027969 2027969 31334864 6322367 25012497 3716964 2030304 1686660 28057 28057 28755183 INVESTMENT IN RRG 1724757 C INVESTMENTS & RESTR CASH 1084147 F 2808904 ACCRUED COMPENSATION & EMPLOYEE BENEFITS 843029 ACCRUED INTEREST 53535 COMMUNITY FEE DEPOSIT 46974 RELATED PARTY PAYABLE - WESLEYAN HOMES FOUNDATION 14414 957952 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE BENEVOLENT ENDOWMENT FUND COMPOSES APPROXIMATELY 72% OF THE ENDOWMENT BALANCE AND IS INTENDED TO GENERATE INCOME TO HELP COVER THE ACTUAL COSTS OF CARE FOR CERTAIN RESIDENTS IN EXCESS OF THEIR MEDICAID REIMBURSEMENT OR PERSONAL ABILITY TO PAY. THE REMAINING ENDOWMENT BALANCE IS IN A GENERAL ENDOWMENT FUND INTENDED TO GENERATE INCOME TO SUPPORT CHARITABLE CARE, CAPITAL IMPROVEMENTS, SERVICES, AND PROGRAMMING OF THE ORGANIZATION. 1 WESLEYAN HOMES FOUNDATION PO BOX 486 GEORGETOWN TX 78627 900085021 501(C)(3) 123449 DONATION TO RESERVE INVESTMENT ACCOUNTS MAINTAINED BY THIS RELATED ORGANIZATION WHICH SUPPORTS WESLEYAN HOMES, INC. 1 X X 0 0 0 0 0 0 0 1 0 MR CHRIS SPENCE 161535 0 10000 0 3260 0 9900 0 8813 0 193508 0 0 0 PART I, LINE 7 DISCRETIONARY CHRISTMAS BONUSES WERE PAID TO ALL EMPLOYEES. A HFDC OF CENTRAL TEXAS INC 371453424 2009-10-07 25462000 SEE PART V 0 0 0 A 2011 0 0 1 0 A 0 0 0 0 0 0 0 A 0 1 0 0 1 0 0 0 0 SCH K, PART II, LINE 3 VARIANCE EXPLAINATION THE VARIANCE OF $601,035 BETWEEN ISSUE PRICE AND TOTAL PROCEEDS OF ISSUE IS DUE TO UNSPENT FUNDS ON PROMISSORY NOTE (WESLEYAN HOMES, INC.) SERIES 2009B RELATING TO CONSTRUCTION AND OTHER ALLOWABLE COSTS FOR THE ASSISTED LIVING FACILITY. FORM 990, PART VI, SECTION A, LINE 2 THE CHAIRWOMAN, NANCY BENOLD, IS THE DAUGHTER-IN-LAW OF DR. DOUG BENOLD, LAITY MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE BOARD, CEO AND CFO PRIOR TO FILING. THE RETURN IS REVIEWED FOR ACCURACY WITH ANY CHANGES BEING DISCUSSED AND SUBMITTED TO BROWN, GRAHAM & COMPANY. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO ALL MEMBERS AND OFFICERS OF THE BOARD OF TRUSTEES AS WELL AS KEY MANAGEMENT EMPLOYEES. UPON DATE OF EMPLOYMENT OR APPOINTMENT ONTO BOARD, THESE INDIVIDUALS MUST SIGN A CONFLICT OF INTEREST STATEMENT STATING THAT THEY HAVE READ AND ARE FAMILIAR WITH THE BYLAWS AND, IN PARTICULAR, ARTICLE 6.6 REGARDING CONFLICT OF INTEREST, AND THAT THEY WILL COMPLY WITH REQUIREMENT TO REPORT, IN WRITING, ANY APPARENT CONFLICT OF INTEREST TO THE BOARD CHAIR. THE BOARD CHAIR IN CONSULTATION WITH APPROPRIATE BOARD MEMBERS AND KEY MANAGEMENT WILL DETERMINE IF A CONFLICT EXISTS AND DETERMINE APPROPRIATE RESTRICTIONS ON A CASE-BY-CASE BASIS FOR AN INDIVIDUAL WITH A CONFLICT OF INTEREST. THE CONFLICT OF INTEREST POLICY WAS REVIEWED AND UPDATED STATEMENTS WERE SIGNED BY ALL BOARD MEMBERS DURING A 2012 BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 15 THE SALARIES FOR THE CEO AND OTHER KEY EMPLOYEES ARE SET BY THE EXECUTIVE COMMITTEE OF THE BOARD EACH OCTOBER FOR THE FOLLOWING YEAR. EACH COMMITTEE MEMBER IS PROVIDED WITH THE SALARY HISTORY OF EACH OF THESE EMPLOYEES SINCE HIS/HER EMPLOYMENT DATE. THE HUMAN RESOURCE MANAGER PARTICIPATES EACH YEAR IN THE SALARY SURVEYS FOR AAHSA AND TAHSA (AMERICAN ASSOC. OF HOMES AND SERVICE FOR THE AGING, AND THE TEXAS ASSOCIATION OF HOMES AND SERVICES FOR THE AGING). THE RESULTS OF THESE SURVEYS ARE PROVIDED TO THE CEO TO PRESENT TO THE EXECUTIVE COMMITTEE. THE CEO DISCUSSES EACH EMPLOYEE'S STRENGTHS, WEAKNESSES, ACCOMPLISHMENTS, AND OVERALL PERFORMANCE WITH THIS COMMITTEE. THE COMMITTEE TAKES ALL OF THIS INFORMATION, ALONG WITH THEIR PERCEPTION OF THE EMPLOYEE BASED ON THEIR OWN INTERACTIONS, AND DETERMINES, BY EMPLOYEE, THE SALARY ADJUSTMENT TO BE MADE. THEN, THE CEO LEAVES THE MEETING, AND THE COMMITTEE GOES THROUGH THE SAME PROCEDURE TO EVALUATE HIM. THE BOARD CHAIR GATHERS ALL OF THE INFORMATION ON RAISES AND SIGNS OFF. THE DOCUMENTATION IS THEN FORWARDED TO THE CFO FOR PROCESSING AFTER THE LAST PAYROLL OF THE YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST FROM MANAGEMENT. OVERSIGHT OF THE AUDIT FORM 990, PART XIII,LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. WESLEYAN HOMES PROPERTIES PO BOX 486 GEORGETOWN TX 78627 900085004 ACQUIRING, HOLDING TITLE TO, CONSTRUCTING & MAINTAINING REAL PROPERTY TX 501(C)(3) LINE 11A, I WESLEYAN HOMES INC 0 WESLEYAN HOMES FOUNDATION PO BOX 486 GEORGETOWN TX 78627 900085021 PROVIDE SUPPORT FOR WESLEYAN HOMES INC TX 501(C)(3) LINE 11A, I WESLEYAN HOMES INC 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 WESLEYAN HOMES FOUNDATION C 164927 FMV OF CHARITABLE CARE PROVIDED WESLEYAN HOMES FOUNDATION B 123449 FMV OF CASH DONATION