NATIONAL FELLOWSHIP BRETHREN RETIREMENT HOMES INCORPORATED: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
NATIONAL FELLOWSHIP BRETHREN RETIREMENT HOMES INCORPORATED (EIN 35-1282401)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-02-11
IRS object ID
201100429349300805
Schema version
2009v1.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-02-11T09:00:04-06:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN351282401EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1NATIONAL FELLOWSHIP BRETHREN RETIREMENT HOMES INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNATINameControl
Phone5743726200Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1337 GRACE VILLAGE DRIVEAddressLine1
CityWINONA LAKECity
StateINState
ZIP Code46590ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSONDREA HAMILTONName
TitleCFOTitle
Date Signed2011-02-10DateSigned
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1GRACE VILLAGE RETIREMENT COMMUNITYBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonSAME AS C ABOVENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1337 GRACE VILLAGE DRIVEAddressLine1
CityWINONA LAKECity
StateINState
ZIP Code46590ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2684390GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteGRACEVILLAGE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1974YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionGRACE VILLAGE'S MISSION IS TO ENABLE OLDER ADULTS TO LIVE TO THEIR FULLEST POTENTIAL IN THE SECURITY OF A CHRISTIAN COMMUNITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees23TotalNbrEmployees
Total Nbr Volunteers50TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year42955ContributionsGrantsPriorYear
Contributions Grants Current Year46024ContributionsGrantsCurrentYear
Program Service Revenue Prior Year2418775ProgramServiceRevenuePriorYear
Program Service Revenue CY2278989ProgramServiceRevenueCY
Investment Income Prior Year61873InvestmentIncomePriorYear
Investment Income Current Year50831InvestmentIncomeCurrentYear
Other Revenue Prior Year310856OtherRevenuePriorYear
Other Revenue Current Year308546OtherRevenueCurrentYear
Total Revenue Prior Year2834459TotalRevenuePriorYear
Total Revenue Current Year2684390TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year423037SalariesEtcPriorYear
Salaries Etc Current Year676039SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year42054TotalFundrsngExpCurrentYear
Other Expense Prior Year1660669OtherExpensePriorYear
Other Expenses Current Year1526707OtherExpensesCurrentYear
Total Expenses Prior Year2083706TotalExpensesPriorYear
Total Expenses Current Year2202746TotalExpensesCurrentYear
Revenues Less Expenses Prior Year750753RevenuesLessExpensesPriorYear
Revenues Less Expenses CY481644RevenuesLessExpensesCY
Total Assets BOY14374681TotalAssetsBOY
Total Assets EOY14257481TotalAssetsEOY
Total Liabilities BOY11004279TotalLiabilitiesBOY
Total Liabilities EOY10667011TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3370402NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3590470NetAssetsOrFundBalancesEOY
Mission DescriptionGRACE VILLAGE'S MISSION IS TO ENABLE OLDER ADULTS TO LIVE TO THEIR FULLEST POTENTIAL IN THE SECURITY OF A CHRISTIAN COMMUNITY. GRACE VILLAGE OFFERS INDEPENDENT LIVING OPTIONS THAT INCLUDE MEALS AND NURSING SERVICES WHEN NEEDED.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense2491331Expense
Grants0Grants
Revenue2684390Revenue
DescriptionGRACE VILLAGE OFFERS INDEPENDENT LIVING OPTIONS THAT INCLUDE MEALS AND NURSING SERVICES WHEN NEEDED. GRACE VILLAGE ALSO OFFERS THERAPY SERVICES AND IN HOME NON-MEDICAL SERVICES AS NEEDED.Description
Total Program Service Expense2491331TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundstrueDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingtrueCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109613NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees23NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSONDREA HAMILTONNamePerson
Telephone Number5743726498TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1337 GRACE VILLAGE DRIVEAddressLine1
CityWINONA LAKECity
StateINState
ZIP Code46590ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
ARDEN WARNER
RESIDENT REPRESENTATIVE1X000
GARY HERBRUCK
MEMBER1X000
MARK YOUNG
MEMBER1X000
DAVID PHELPS
MEMBER1X000
DAVID KOONTZ
MEMBER1X000
HAROLD GATLIN
MEMBER1X000
DON FLUKE
MEMBER1X000
JO DISBRO
MEMBER1X000
JESSE DEBOEST
MEMBER1X000
RON HENRY
SECRETARY1X000
RON REDPATH
FINANCE CHAIR1X000
CRAIG SNOW
VICE CHAIR1X000
STEVEN BARRETT
CHAIR1X000
JEFFRY CARROL
CEO4014069700XXX
SONDREA HAMILTON
CFO405828900XX
FieldValueIRS element (for citing)
Total Reportable Comp From Org198986TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonTL JACKSON CONSTRUCTION INCNamePerson

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line111273 N SYRACUSE-WEBSTER ROADAddressLine1
CitySYRACUSECity
StateINState
ZIP Code46567ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesCONSTRUCTIONDescriptionOfServices
Compensation627484Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Federated Campaigns0FederatedCampaigns
Membership Dues0MembershipDues
Fundraising Events0FundraisingEvents
Related Organizations0RelatedOrganizations
Government Grants0GovernmentGrants
All Other Contributions46024AllOtherContributions
Noncash Contributions0NoncashContributions
Total Contributions46024TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
RESIDENT SERVICE623000187922518792250$0
DEFERRED (LIFE LEASE)6230003997643997640$0
000$0
000$0
000$0

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue2278989TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column50831TotalRevenueColumn
Related Or Exempt Function Income50831RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real303000Real
Personal0Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real303000Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column303000TotalRevenueColumn
Related Or Exempt Function Income303000RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities0Securities
Other0Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities0Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities0Securities
Other0Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events0GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events0CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses0FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming0GrossIncomeGaming
Gaming Direct Expenses0GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory0GrossSalesOfInventory
Cost Of Goods Sold0CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
APPLICATION FEES900099440044000$0
AVIARY UPKEEP900099114611460$0
000$0

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Related Or Exempt Function Income0RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue5546TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2684390TotalRevenueColumn
Related Or Exempt Function Income2638366RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total70853Total
Program Services0ProgramServices
Management And General70853ManagementAndGeneral
Fundraising0Fundraising

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total452379Total
Program Services307062ProgramServices
Management And General111618ManagementAndGeneral
Fundraising33699Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total7302Total
Program Services4915ProgramServices
Management And General2108ManagementAndGeneral
Fundraising279Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total101736Total
Program Services98961ProgramServices
Management And General1575ManagementAndGeneral
Fundraising1200Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total43769Total
Program Services29325ProgramServices
Management And General9629ManagementAndGeneral
Fundraising4815Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total61053Total
Program Services61053ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total
Fundraising0Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total7953Total
Program Services0ProgramServices
Management And General7953ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total300Total
Program Services0ProgramServices
Management And General300ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total29571Total
Program Services0ProgramServices
Management And General27510ManagementAndGeneral
Fundraising2061Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total13364Total
Program Services1929ProgramServices
Management And General11435ManagementAndGeneral
Fundraising0Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total8195Total
Program Services3635ProgramServices
Management And General4560ManagementAndGeneral
Fundraising0Fundraising

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total241357Total
Program Services241357ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total4200Total
Program Services1561ProgramServices
Management And General2639ManagementAndGeneral
Fundraising0Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1545Total
Program Services388ProgramServices
Management And General1157ManagementAndGeneral
Fundraising0Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total83924Total
Program Services0ProgramServices
Management And General83924ManagementAndGeneral
Fundraising0Fundraising

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total645703Total
Program Services0ProgramServices
Management And General645703ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total54910Total
Program Services0ProgramServices
Management And General54910ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
RESIDENT CARE30871630871600
BUILDING MAINTENANCE659166591600
0000
0000
0000

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2202746Total
Program Services1124818ProgramServices
Management And General1035874ManagementAndGeneral
Fundraising42054Fundraising

Total Joint Costs TotalJointCosts

FieldValueIRS element (for citing)
Total0Total
Program Services0ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY867075BOY
EOY297914EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5248BOY
EOY4214EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY31159BOY
EOY38580EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY67348BOY
EOY63716EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis21704034LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec9904548LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY11327679BOY
EOY11799486EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1807217BOY
EOY1839068EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY268955BOY
EOY214503EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY14374681BOY
EOY14257481EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY195461BOY
EOY127574EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY4806123BOY
EOY4986768EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY5619378BOY
EOY5226928EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY17900BOY
EOY35800EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY30185BOY
EOY91142EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY335232BOY
EOY198799EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY11004279BOY
EOY10667011EOY

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3275504BOY
EOY3466899EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY94898BOY
EOY123571EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3370402BOY
EOY3590470EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY14374681BOY
EOY14257481EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewtrueAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2
Total Number Of Supported Orgs0TotalNumberOfSupportedOrgs

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years43405CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years56973CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years75051CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year42955CurrentTaxYearMinus1Year
Current Tax Year46024CurrentTaxYear
Total264408Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1898765CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2236027CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2429222CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2418775CurrentTaxYearMinus1Year
Current Tax Year2278989CurrentTaxYear
Total11261778Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1942170CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2293000CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2504273CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2461730CurrentTaxYearMinus1Year
Current Tax Year2325013CurrentTaxYear
Total11526186Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total
FieldValueIRS element (for citing)
Public Support Total50911526186PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years406777CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years413515CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years327647CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year364873CurrentTaxYearMinus1Year
Current Tax Year353831CurrentTaxYear
Total1866643Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years406777CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years413515CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years327647CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year364873CurrentTaxYearMinus1Year
Current Tax Year353831CurrentTaxYear
Total1866643Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years0CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years0CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years0CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year0CurrentTaxYearMinus1Year
Current Tax Year0CurrentTaxYear
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years15788CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years32992CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years16404CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7856CurrentTaxYearMinus1Year
Current Tax Year5546CurrentTaxYear
Total78586Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2364735CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2739507CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2848324CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2834459CurrentTaxYearMinus1Year
Current Tax Year2684390CurrentTaxYear
Total13471415Total
FieldValueIRS element (for citing)
Public Support Percentage5090.8556PublicSupportPercentage509
Investment Income Percentage0.13856InvestmentIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Number Funds Held46024NumberFundsHeld
Disclosed Orgs Legal ControltrueDisclosedOrgsLegalControl
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FStrueIncludedOnFS

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis125948OtherCostOrOtherBasis
Book Value125948BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis18674580OtherCostOrOtherBasis
Depreciation8137130Depreciation
Book Value10537450BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis0OtherCostOrOtherBasis
Depreciation0Depreciation
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis1834453OtherCostOrOtherBasis
Depreciation1434080Depreciation
Book Value400373BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis0InvestmentCostOrOtherBasis
Other Cost Or Other Basis1069053OtherCostOrOtherBasis
Depreciation333338Depreciation
Book Value735715BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings11799486TotalOfBookValueLandBuildings

Financial Derivatives FinancialDerivatives

FieldValueIRS element (for citing)
Book Value1839068BookValue
Method Of ValuationFMethodOfValuation

Closely Held Equity Interests CloselyHeldEquityInterests

FieldValueIRS element (for citing)
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Securities1839068TotalOfBookValueSecurities

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
WAIT LIST DEPOSITS$5,000
REFUNDABLE PORTION LIFE LEASE DEPOSITS$91,106
SECURITY DEPOSITS$102,693
FieldValueIRS element (for citing)
Total Of Amounts198799TotalOfAmounts
Total Revenue2684390TotalRevenue
Total Expenses2202746TotalExpenses
Excess Or Deficit For Year481644ExcessOrDeficitForYear
Net Unrealized GL On Investments0NetUnrealizedGLOnInvestments
Donated Services And Facilities0DonatedServicesAndFacilities
Investment Expenses0InvestmentExpenses
Prior Period Adjustments0PriorPeriodAdjustments
Other-$288,585OtherAmount
Total Adjustments-288585TotalAdjustments
Excess Or Deficit Per FS193059ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt2684390TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments0NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities0DonatedSrvcAndUseOfFacilities
Recoveries Of Prior Year Grants0RecoveriesOfPriorYearGrants
Other Revenues0OtherRevenues
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal2684390RevenueSubtotal
Investment Expenses Not Included0InvestmentExpensesNotIncluded
Other Revenues Not Included0OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9902684390TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2491331TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities0DonatedServicesUseOfFacilities
Prior Year Adjustments0PriorYearAdjustments
Losses Reported0LossesReported
Other Expenses Included0OtherExpensesIncluded
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal2491331ExpensesSubtotal
Investment Expenses Not Included20InvestmentExpensesNotIncluded2
Other Expenses Not Included0OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9902491331TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Explanation of escrow agreementSchedule D, Part IV, Line 2bTHE ORGANIZATION HAS AN ESCROW ACCOUNT AND AGREEMENT WITH A LOCAL BANK. GRACE VILLAGE DEPOSITS MONEY RECEIVED BY FUTURE RESIDENTS FOR LIFE LEASE DEPOSITS INTO THIS ACCOUNT. THE MONEY IS HELD IN THE ESCROW ACCOUNT UNTIL THE RESIDENT OFFICIALLY MOVES IN TO GRACE VILLAGE AND BECOMES A RESIDENT OF GRACE VILLAGE.
Other changes in net assetsSchedule D, Part XI, Line 8DEBT FORGIVENESS - -288585; OTHER - 0; TOTAL - -288585

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation RequiredtrueSubstantiationRequired
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1TOWN OF WINONA LAKE INDIANABusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN356001423IssuerEIN
CUSIP Number975204AG3CUSIPNumber
Date Issued2006-05-23DateIssued
Issue Price6157000IssuePrice
Description Of PurposeREFINANCE PRIOR ISSUES AND BUIL NEW SNF WHICH NUMBERS WILL BE REFLECTED ON RELATED COMPANY'S 990DescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds6157TotalProceeds
Amount In Reserve Fund0AmountInReserveFund
Amount Defeased0AmountDefeased
Amount Unspent0AmountUnspent
Issuance Costs From Proceeds56847IssuanceCostsFromProceeds
Working Capital Expenditures0WorkingCapitalExpenditures
Capital Expenditures0CapitalExpenditures
Current RefundingfalseCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtyfalseMngmentCntrctBondFinancdPrprty
Any Research AgreementsfalseAnyResearchAgreements
Bond Counsel Routinely EngagedtrueBondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others0.000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.000TotalPrivateBusinessUse
Post Issuance Compliance ProcdrstruePostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T FiledtrueForm8038TFiled
Variable Rate IssuetrueVariableRateIssue
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds
Term Of Hedge0.0TermOfHedge
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC
Term Of GIC0.0TermOfGIC
Exception To RebatetrueExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Classes of members or stockholdersForm 990, Part VI, Section A, Line 6BOARD MEMBERS APPROVE SIGNIFICANT DECISIONS OF MANAGEMENT.
Members or stockholders electing members of governing bodyForm 990, Part VI, Section A, Line 7aBOARD MEMBERS APPROVE SIGNIFICANT DECISIONS OF MANAGEMENT. ALSO BOARD MEMBERS ELECT AND VOTE ON NEW BOARD MEMBERS.
Decisions requiring approval by members or stockholdersForm 990, Part VI, Section A, Line 7bEXTRAORDINARY CAPITAL PROJECTS AND OTHER FINANCIAL AND STRATEGIC DECISIONS HAVE TO BE APPROVED BY THE BOARD OF DIRECTORS/MEMBERS.
Review of form 990 by governing bodyForm 990, Part VI, Section B, Line 11ACFO PREPARES 990. CEO REVIEWS 990 BEFORE IT IS FILED. THE FULL BOARD IS GIVEN A COPY OF THE 990 UPON COMPLETION OF PREPARATION AND FILING.
Conflict of interest policyForm 990, Part VI, Section B, Line 12cGRACE VILLAGE TRIES TO AVOID SITUATIONS THAT COULD POTENTIALLY BE SEEN AS A CONFLICTS OF INTEREST. IF A CONFICT IS FOUND, IT IS DEALT WITH ON A CASE BY CASE BASIS, AND THE BOARD OF DIRECTORS MAKES A DECISION AS TO MATERIALITY OF THE CONFLICT, AND WHETHER TO TERMINATE TRANSACTIONS WITH PARTIES THAT HAVE A CONFLICT OF INTEREST. CONFLICTS OF INTEREST ARE MONITORED AND DEALT WITH AT EVERY LEVEL OF THE ORGANIZATION, FROM HOURLY EMPLOYEES, TO SALARIED EMPLOYEES, TO BOARD MEMBERS.
Public DisclosureForm 990, Part VI, Section C, Line 19UPON REQUEST
35-1282401NATIONAL FELLOWSHIP BRETHREN RETIREMENT HOMES, INC.SCHEDULE K - PART I - COLUMN (E): THE ISSUE PRICE DOES NOT MATCH THE AMOUNT THAT IS ON FORM 8038 BECAUSE THIS BOND ISSUE WAS TO BENEFIT TWO SEPARATE LEGAL ENTITIES. THE ENTITIES OPERATE AS ONE COMPANY, BUT ONLY 47% OF THE BOND ISSUE WAS FOR NATIONAL FELLOWSHIP BRETHREN RET. HOMES. THE AMOUNT ON LINE A, COLUMN (E) OF $6,157,000 REPRESENTS 47% OF THE TOTAL BOND ISSUE OF $13,100,000. THIS TAX RETURN IS BEING FILED AFTER THE DEADLINE OF NOVEMBER 15, 2010. THE COMPANY FILED FOR AN EXTENSION AND THE EXTENSION WAS APPROVED. I HAVE INCLUDED A COPY OF THE APPROVAL WITH THE RETURN.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1GRACE VILLAGE HEALTHCARE FACILITY INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1337 GRACE VILLAGE DRIVEAddressLine1
CityWINONA LAKECity
StateINState
ZIP Code46590ZIPCode
FieldValueIRS element (for citing)
EIN351447417EIN
Primary ActivitiesNURSING HOME/ASSISTED LIVING FACILITYPrimaryActivities
Legal Domicile StateINLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status9PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
GRACE VILLAGE HEALTHCARE FACILITY INC
I300000
GRACE VILLAGE HEALTHCARE FACILITY INC
M
GRACE VILLAGE HEALTHCARE FACILITY INC
N500000

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