2013-11-14T13:58:26-06:00 2012-12-31 410746749 CliftonLarsonAllenLLP 5001 Spring Valley Road Suite 600W Dallas TX 75244 990 2012-01-01 510190369 Presbyterian Village North PRES 2143559001 8600 Skyline Drive Dallas TX 75243 Steve Kearney 2143559001 2013-11-14 1 Troy Langsdale P00847944 9723835700 2012 2016-02-25 16:41:14Z Godwin Dixon 6100 Colwell Blvd Suite 225 Irving TX 75039 36600096 0 X www.presbyterianvillagenorth.org X 1980 TX Presbyterian Village North (PVN), as a member of the Presbyterian Communities and Services family of non-profit organizations, pledges to enrich the lives of those it serves by providing exceptional care and services in a faith-based culture. PVN, a continuing care retirement community founded in 1980 and located on 63 beautiful, garden-like acres, provides a full range of residential choices and care options, including residential living, assisted living, skilled nursing, rehabilitation, and Alzheimer's, dementia, and other long-term care. 5 5 664 275 0 0 1386682 1706467 31991712 33622231 84751 87954 -36027 1183444 33427118 36600096 564097 663229 0 0 17666378 18658859 0 0 0 14212471 13848134 32442946 33170222 984172 3429874 83623224 85378962 29977961 29082003 53645263 56296959 X Presbyterian Village North (PVN), as a member of the Presbyterian Communities and Services family of non-profit organizations, pledges to enrich the lives of those it serves by providing exceptional care and services in a faith-based culture. PVN, a continuing care retirement community founded in 1980 and located on 63 beautiful, garden-like acres, provides a full range of residential choices and care options, including residential living, assisted living, skilled nursing, rehabilitation, and Alzheimer's, dementia, and other long-term care. 0 0 15299321 458496 18057779 Provide skilled nursing, alzheimer's and dementia care to our community residents and Medicare patients. We served about 771 unduplicated patients in 2012. 4449415 2979486 Provide rehabilitation and outpatient therapy to the Dallas Metroplex. 3498768 8465629 Retirement and other related services in 2012. 3140558 204733 4119337 We provided assisted living services to 91 unduplicated residents in 2012. 3140558 204733 4119337 26388062 1 1 0 0 0 0 0 1 0 0 1 0 0 1 1 1 0 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 0 0 0 1 178 0 664 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Steve Pukish CPA 2144131540 6100 Colwell Blvd STE 225 Irving TX 75039 Cynthia Hudgins 1.00 1.00 X X 0 0 0 Dr Lisa Clark 1.00 1.00 X X 0 0 0 Al Cloud 1.00 0.00 X X 0 0 0 Phil Wentworth 1.00 1.00 X 0 0 0 Bruce Jamieson 1.00 0.00 X 0 0 0 Godwin Dixon 10.00 30.00 X 0 298140 27405 Teresa Whittington 10.00 30.00 X 0 158984 21972 Elizabeth Nicole Gann 10.00 30.00 X 0 165335 0 Brenda Terry 10.00 30.00 X 0 171268 13464 Mark Havrilka 10.00 30.00 X 0 129461 15283 Ann McKinley 10.00 30.00 X 0 103925 10745 Ron Kelly 40.00 0.00 X 158214 0 19560 Charles Bobbitt 40.00 0.00 X 118275 0 7600 Mary Bean 40.00 0.00 X 103115 0 4607 379604 1027113 120636 3 0 1 0 Salus Solutions LLC 7330 Fern Ave Suite 502 Shreveport LA 71105 Contract Labor 1540519 K-Tech Roofing Co Inc 6240 Mulberry Lane Midlothian TX 76065 Construction Contractor 880983 Olicon Inc 1801 Royal Ln Suite 700 Dallas TX 75229 Construction Contractor 524406 Pi Architects Inc 3500 Jefferson St 303 Austin TX 78731 Architect 394270 John Kerrigan 5558 Edlen Dr Dallas TX 75220 Construction Contractor 271036 9 1621334 85133 1706467 Resident Revenue 623000 33622231 33622231 33622231 87254 87254 700 0 700 700 700 Insurance Settlement 900099 1004546 1004546 Other Income 900099 178898 178898 1183444 36600096 33622231 0 1271398 663229 663229 158214 158214 14440315 13318283 1122032 102956 97856 5100 2903493 2677888 225605 1053881 980937 72944 2071662 2071662 31801 31801 51379 51379 1990201 1990201 34010 150 33860 216827 177157 39670 448470 282661 165809 1438110 1438110 83200 69195 14005 106049 106049 2442797 2442797 286776 286776 Supplies 3063585 3025446 38139 Outside Services 799302 596880 202422 Housekeeping and Mainte 379709 376976 2733 All Other Expenses 287861 248103 39758 116395 116395 33170222 26388062 6782160 0 4812350 -261491 8500000 14456169 1504041 2738823 414924 281064 123201 75542837 49796764 25694811 25746073 1002173 0 41694925 42295123 83623224 85378962 5258247 2431123 11889516 13689343 12220000 12220000 610198 741537 29977961 29082003 X 17845708 19454043 31371195 32395057 4428360 4447859 53645263 56296959 83623224 85378962 3429874 -778178 0 X X 0 1 X 1 0 X 958192 896235 971478 1386682 1706467 5919054 27271530 30655785 32237121 31991712 33622231 155778379 28229722 31552020 33208599 33378394 35328698 161697433 0 0 0 161697433 369472 140738 159274 84751 87254 841489 369472 140738 159274 84751 87254 841489 556573 -36027 1183444 1703990 28599194 31692758 33924446 33427118 36599396 164242912 0.98450 0.98710 0.00510 0.00940 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 153370 X X 0 2799895 2799895 43443027 23987800 19455227 5265556 4989886 275670 20043096 17260959 2782137 3991263 3558119 433144 25746073 Deposits 1039 Investment in PC&S Foundation 35087099 Due from Related Parties 5592184 CIP 1461431 Collections of Art 153370 42295123 Asset Retirement Obligation 639778 Security Deposits 101759 741537 X Part III, Line 4: Collection of Porcelain Figurines - Birds. As a retirement and nursing community, these items enrich the lives of those we serve. They were donated to exhibit for their beauty and to improve the environment our residents live in. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Organization's income tax returns are subject to review and examination by federal, state, and local authorities. The Organization is not aware of any activities that would jeopardize its tax-exempt status. The Organization reports any activities that are subject to tax on unrelated business income or excise or other taxes and files all proper returns related to these activities. The information tax returns for the years 2009 to 2012 are open to examination by federal, state, and local authorities. 1 Supplemental Assistance 12 663229 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The organization provides assistance to residents of its CCRC campus who reach financial hardship and are unable to pay a portion of their monthly fees. An application for assistance is completed and submitted to the Executive Director and committee for review and approval prior to providing assistance. The resident's financial circumstances are periodically reviewed to determine if the resident still qualifies for assistance. X X X 1 0 0 0 0 0 0 0 0 Godwin Dixon 0 298140 0 0 0 0 0 0 0 27405 0 325545 0 0 Teresa Whittington 0 158984 0 0 0 0 0 0 0 21972 0 180956 0 0 Elizabeth Nicole Gann 0 165335 0 0 0 0 0 0 0 0 0 165335 0 0 Brenda Terry 0 171268 0 0 0 0 0 0 0 13464 0 184732 0 0 Ron Kelly 158214 0 0 0 0 0 0 0 19560 0 177774 0 0 0 Part I, Line 4a Per Form 990, Schedule J, Part 1, Line 4a, Elizabeth Nicole Gann received a severance payment in the amount of $61,334. Form 990, Part VI, Section A, line 3 On 5/1/2008, Presbyterian Communities & Services was formed to provide management and shared services to Presbyterian Village North and other affiliated organizations. Form 990, Part VI, Section B, line 11 The 990 is reviewed by management to review and correct prior to submitting to the Finance Committee of the Board for review. Management meets with the Finance Committee, along with the outside preparer, to discuss the 990 return and recommends changes, if any. After the 990 has been finalized and approved by the Finance Committee, it is submitted to the Board of Directors for their review prior to sending to the IRS. Form 990, Part VI, Section B, line 12c We have a compliance officer (CO) who review all transactions of the organization that may result in a conflict of interest. The CO determines if the transaction would result in undue influence as a result of the relationship and not be pursued. The CO reports all conflicts of interest to the Board of Directors. Form 990, Part VI, Section B, line 15 The Board has a compensation committee that reviews the current compensation compared to like entities and makes recommendations to the Board for changes in compensation. The Board also uses an outside consultatnt to review compensation, independent of the compensation committee. Form 990, Part VI, Section C, line 19 These documents are available at the site, based on written request. Form 990, Part XII, Line 2c The organization does have a committee that assumes responsibility for oversight of the audit, and the neither the oversight process nor the selection process has changed during the filing year. Presbyterian Village North Foundation 8600 Skyline Drive Dallas TX 75243 752022746 Foundation for PVN TX 501(c)(3) PF Presbyterian Communities & Services 0 Presbyterian Communities and Services 6100 Colwell Blvd Ste 225 Irving TX 75039 261459224 Shared Services/Management TX 501(c)(3) Line 11b, II N/A 0 Grace Presbyterian Ministries 550 E Ann Arbor Ave Dallas TX 75216 751094140 CCRC TX 501(c)(3) Line 7 Presbyterian Communities & Services 0 Presbyterian Communities and Services Foundation 6100 Colwell Blvd Ste 225 Irving TX 75039 751910084 Foundation for Affiliates TX 501(c)(3) Line 7 Presbyterian Communities & Services 0 Faith Presbyterian Providers Inc 4350 Sigma Rd Suite 400 Dallas TX 75244 383800779 Pallative/Hospice Services TX 501(c)(3) Line 9 Presbyterian Communities & Services 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0