2012-04-16T09:15:58-05:00 2011-08-31 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2010-09-01 370794402 COMMUNITY RETIREMENT INC DBA THE ARTHUR HOME COMM 2175432103 423 S EBERHARDT DRIVE ARTHUR IL 619111224 GALE PEARCE 2175432103 2012-04-16 1 CHAD KUNZE 3149254300 2010 2016-02-24 21:20:13Z GALE PEARCE 423 S EBERHARDT DRIVE ARTHUR IL 619111224 3859725 0 X WWW.EBERHARDTVILLAGE.ORG X 1962 IL TO PROVIDE SKILLED NURSING CARE AND INTERMEDIATE MEDICAL CARE TO ELDERLY 7 7 123 60 0 0 33595 35903 3630295 3800193 13745 13784 10698 9845 3688333 3859725 0 0 0 0 2113530 2023215 0 0 0 1451620 1592075 3565150 3615290 123183 244435 2414911 2723951 523919 588824 1890992 2135127 TO PROVIDE SKILLED NURSING CARE AND INTERMEDIATE RESIDENT CARE TO ELDERLY. 0 0 3217134 3800193 COMMUNITY RETIREMENT INC OPERATES THE ARTHUR HOME, A NURSING HOME WHICH PROVIDES LICENSED SKILLED AND INTERMEDIATE MEDICAL CARE, PRIMARILY TO ELDERLY PATIENTS 3217134 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 3 0 1 123 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 IL X DAVID EVERSOLE ADMINISTRATOR 2175432103 423 EBERHARDT DRIVE ARTHUR IL 61911 HENRY D HERSCHBERGER 1.50 X X 0 0 0 GALE PEARCE 32.00 X X 0 0 0 RICK WEGER 1.50 X 0 0 0 ALVA MILLER 1.50 X X 0 0 0 FRED HELMUTH 1.50 X 0 0 0 RICHARD BUCKLER 1.50 X 0 0 0 SUE STOUT 1.50 X 0 0 0 DAVID EVERSOLE 40.00 X 46635 24988 0 46635 24988 0 0 0 0 0 ONR INC 1101 S CAPITAL OF TEXAS HWY BLDG AUSTIN TX 78746 THERAPY 312360 1 35903 35903 NET SERVICE REVENUE 623000 3800193 3800193 3800193 13609 13609 175 175 175 175 MEAL INCOME 623000 5089 5089 MISCELLANEOUS INCOME 623000 4542 4542 ACTIVITY INCOME 623000 214 214 9845 3859725 3800193 0 23629 46635 46635 1750290 1647567 102723 90683 83146 7537 135607 124336 11271 30766 30766 5937 5937 282659 226435 56224 65057 57571 7486 6554 6554 8474 8474 78650 78650 149788 149788 THERAPY SERVICES 512228 512228 FOOD 145860 145860 PHARMACY 86990 86990 MISCELLANEOUS 82611 21786 60825 ASSESSMENT FEES 52207 52207 84294 22096 62198 3615290 3217134 398156 0 10001 6096 90430 171614 1102308 1375652 9379 9050 13584 11175 1520653 1105876 432950 414777 756259 735587 2414911 2723951 514763 580027 9156 8797 523919 588824 X 1571194 1814169 4300 5760 315498 315198 1890992 2135127 2414911 2723951 X 244435 -300 X X 0 1 1 X 0 X 6976 18988 32862 33595 35903 128324 3327500 3326528 3311474 3630295 3800193 17395990 3334476 3345516 3344336 3663890 3836096 17524314 0 1126502 1203855 1627619 1601972 1647143 7207091 1126502 1203855 1627619 1601972 1647143 7207091 10317223 10483 19800 13380 13841 13609 71113 10483 19800 13380 13841 13609 71113 16798 10002 9845 36645 3344959 3365316 3374514 3687733 3859550 17632072 0.58510 0.60860 0.00400 0.00430 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 60067 60067 977569 804786 172783 409404 236171 173233 73613 64919 8694 414777 DUE FROM EBERHARDT VILLAGE 735587 735587 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATIONS QUALIFY AS TAX-EXEMPT CORPORATIONS DESCRIBED IN SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ORGANIZATIONS ARE NOT SUBJECT TO FEDERAL INCOME TAXES UNDER SECTION 501 (C)(3) OF THE CODE. THE ORGANIZATIONS ARE CLASSIFIED AS A PUBLICLY SUPPORTED CHARITABLE ORGANIZATION UNDER THE CODE AND CONTRIBUTIONS TO THE ORGANIZATIONS QUALIFY AS CHARITABLE TAX DEDUCTIONS FOR THE CONTRIBUTOR. THE ENTITIES FILE AS TAX EXEMPT ORGANIZATIONS. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE IRS. THE ORGANIZATIONS' INCOME TAX RETURNS FOR THE YEARS 2007 THROUGH 2010 ARE SUBJECT TO REVIEW AND EXAMINATION BY THE IRS. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED TO GREENCROFT RETIREMENT COMMUNITIES. FORM 990, PART VI, SECTION A, LINE 6 THERE IS ONE CLASS OF SHAREHOLDER. FORM 990, PART VI, SECTION A, LINE 7A THE SHAREHOLDERS ELECT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 8B NO COMMITTEES OF GOVERNING BODY WITH AUTHORITY TO ACT ON ITS BEHALF. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 WAS PRESENTED TO BOARD FOR APPROVAL BEFORE FILING FORM 990, PART VI, SECTION B, LINE 12C MONITORING:IN A SMALL ORGANIZATION AND VILLAGE SUCH AS OURS, ADMINISTRATION AND THE BOARD KNOW ALL OF THE PEOPLE THAT WORK FOR US AND THEIR RELATIONSHIPS WITH THOSE THAT PROVIDE AND CONTRACT SERVICES WITH US. DEALING WITH POTENTIAL: OUR POLICY DICTATES THAT ALL POTENTIAL OR ACTUAL CONFLICTS ARE BROUGHT TO THE ATTENTION OF THE BOARD PRESIDENT AS SOON AS POSSIBLE SO THAT SAFEGUARDS CAN BE ESTABLISHED TO PROTECT ALL PARTIES. THE PRESIDENT MAY BRING THEM TO ALL THE BOARD MEMBER'S ATTENTION DURING A REGULAR MONTHLY BOARD MEETING FOR FURTHER DISCUSSION. COVERED: ALL EMPLOYEES AND BOARD MEMBERS, AND CLOSE RELATIVES AND HUSBANDS AND WIFE'S OF SAME. THE LEVEL OF DETERMINATION OF WHETHER A CONFLICT EXITS ARE MADE AND REVIEWED BY THE ADMINISTRATOR AND/OR BOARD PRESIDENT. RESTRICTIONS ARE DEEMED TO BE APPROPRIATE DEPENDING ON THE PARTICULAR SITUATION. WHEN THE CONFLICT IS IN THE BEST INTERESTS OF THE ORGANIZATION, NO OR LIMITED RESTRICTIONS ARE APPLIED. WHEN THE CONFLICT IS NOT IN THE BEST INTEREST OF THE ORGANIZATION, THE RELATIONSHIP IS TERMINATED WITH THE ORGANIZATION OR PERSON IN CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS WAS USED TO DETERMINE THE COMPENSATION FOR BOTH THE ADMINISTRATOR AND COO DURING 2010. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATMENTS ARE NOT AVAILABLE TO THE PUBLIC CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -300. FORM 990, PART XII, LINE 2C THE PROCESS IS CONSISTENT WITH PRIOR YEARS. EBERHARDT VILLAGE INC 431 WEST PALMER ARTHUR IL 61911 743091143 PROVIDE ASSISTED LIVING CARE TO SENIORS IL 501C3 509A2 N/A 0 0 0 0 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 EBERHARDT VILLAGE INC D 578764 BALANCE OF LOC GUARANTEED