NATIONAL FELLOWSHIP BRETHREN RETIREMENT HOMES INCORPORATED: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
NATIONAL FELLOWSHIP BRETHREN RETIREMENT HOMES INCORPORATED (EIN 35-1282401)
Tax period
2010-07-01 to 2011-06-30
Filed
2011-11-15
IRS object ID
201143199349305569
Schema version
2010v3.2
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)
Timestamp2011-11-15T13:00:19-06:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

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 Signed2011-11-15DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1GRACE VILLAGE RETIREMENT COMMUNITYBusinessNameLine1

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

FieldValueIRS element (for citing)
Business Name Line1SAME AS C ABOVEBusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1337 Grace Village DriveAddressLine1
CityWinona LakeCity
StateINState
ZIP Code46590ZIPCode
FieldValueIRS element (for citing)
Gross Receipts2803710GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
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 Employees25TotalNbrEmployees
Total Nbr Volunteers50TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year46024ContributionsGrantsPriorYear
Contributions Grants Current Year72163ContributionsGrantsCurrentYear
Program Service Revenue Prior Year2278989ProgramServiceRevenuePriorYear
Program Service Revenue CY2374060ProgramServiceRevenueCY
Investment Income Prior Year50831InvestmentIncomePriorYear
Investment Income Current Year46454InvestmentIncomeCurrentYear
Other Revenue Prior Year308546OtherRevenuePriorYear
Other Revenue Current Year311033OtherRevenueCurrentYear
Total Revenue Prior Year2684390TotalRevenuePriorYear
Total Revenue Current Year2803710TotalRevenueCurrentYear
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 Year676039SalariesEtcPriorYear
Salaries Etc Current Year721271SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year38033TotalFundrsngExpCurrentYear
Other Expense Prior Year1526707OtherExpensePriorYear
Other Expenses Current Year2270959OtherExpensesCurrentYear
Total Expenses Prior Year2202746TotalExpensesPriorYear
Total Expenses Current Year2992230TotalExpensesCurrentYear
Revenues Less Expenses Prior Year481644RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-188520RevenuesLessExpensesCY
Total Assets BOY14257481TotalAssetsBOY
Total Assets EOY14813137TotalAssetsEOY
Total Liabilities BOY10667011TotalLiabilitiesBOY
Total Liabilities EOY10815425TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3590470NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3997712NetAssetsOrFundBalancesEOY
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 ChangefalseSignificantChange
Expense1430704Expense
Revenue2803710Revenue
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 Expense1430704TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundstrueDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingtrueCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiestrueReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
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
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees25NumberOfEmployees
Employment Tax Returns FiledfalseEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
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

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Sondrea HamiltonBusinessNameLine1
FieldValueIRS element (for citing)
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 WeekAverageHoursPerWeekOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeIndividual Trustee Or DirectorIndividualTrusteeOrDirector
SONDREA HAMILTON
CFO40X5558200
JEFFRY CARROL
CEO40X14399700X
ARDEN WARNER
RESIDENT REPRESENTATIVE1000X
GARY HERBRUCK
MEMBER1000X
MARK YOUNG
MEMBER1000X
DAVID PHELPS
MEMBER1000X
DAVID KOONTZ
MEMBER1000X
HAROLD GATLIN
MEMBER1000X
DON FLUKE
MEMBER1000X
JO DISBRO
MEMBER1000X
JESSE DEBOEST
MEMBER1000X
RON HENRY
SECRETARY1000X
RON REDPATH
FINANCE CHAIR1000X
CRAIG SNOW
VICE CHAIR1000X
STEVEN BARRETT
CHAIR1000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org199579TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1TL JACKSON CONSTRUCTION INCBusinessNameLine1

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
Compensation680957Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions72163AllOtherContributions
Total Contributions72163TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
RESIDENT SERVICE62300019287851928785
DEFERRED (LIFE LEASE)445275445275

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Program Service Revenue2374060TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column46454TotalRevenueColumn
Related Or Exempt Function Income46454RelatedOrExemptFunctionIncome

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real305400Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real305400Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column305400TotalRevenueColumn
Related Or Exempt Function Income305400RelatedOrExemptFunctionIncome

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities0Securities
Other0Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
APPLICATION FEES90009940004000
MISCIELLANEOUS90009916331633

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue5633TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2803710TotalRevenueColumn
Related Or Exempt Function Income2731547RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total57681Total
Management And General57681ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total474491Total
Program Services319847ProgramServices
Management And General117216ManagementAndGeneral
Fundraising37428Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total10785Total
Program Services10224ProgramServices
Management And General561ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total133188Total
Program Services112035ProgramServices
Management And General21153ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total45126Total
Program Services40162ProgramServices
Management And General4513ManagementAndGeneral
Fundraising451Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total45794Total
Program Services45794ProgramServices

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total4078Total
Management And General4078ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1190Total
Management And General1190ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total34351Total
Management And General34197ManagementAndGeneral
Fundraising154Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total19090Total
Program Services2125ProgramServices
Management And General16965ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total7799Total
Program Services3070ProgramServices
Management And General4729ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total286349Total
Program Services286349ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total2227Total
Program Services493ProgramServices
Management And General1734ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total654Total
Management And General654ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total97666Total
Management And General97666ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total695247Total
Management And General695247ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total42282Total
Management And General42282ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
RESIDENT CARE367940367940
BUILDING MAINTENANCE8878388783
LOSS ON INTEREST RATE SWAP423627423627
DEBT FORGIVENESS153882153882

All Other Expenses AllOtherExpenses

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

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total2992230Total
Program Services1430704ProgramServices
Management And General1523493ManagementAndGeneral
Fundraising38033Fundraising

Total Joint Costs TotalJointCosts

FieldValueIRS element (for citing)
Total0Total

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY297914BOY
EOY203188EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4214BOY
EOY7838EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY38580BOY
EOY25505EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY63716BOY
EOY17591EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis22993469LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec10587110LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY11799486BOY
EOY12406359EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY1839068BOY
EOY1936758EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY214503BOY
EOY215898EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY14257481BOY
EOY14813137EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY127574BOY
EOY269344EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY4986768BOY
EOY5159474EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY5226928BOY
EOY5017778EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY35800BOY
EOY35800EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY91142BOY
EOY56500EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY198799BOY
EOY276529EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY10667011BOY
EOY10815425EOY

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3466899BOY
EOY3963417EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY123571BOY
EOY34295EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3590470BOY
EOY3997712EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY14257481BOY
EOY14813137EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-188520ReconcilationRevenueExpenses
Reconcilation Other Changes595762ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewtrueAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years56973CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years75051CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years42955CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year46024CurrentTaxYearMinus1Year
Current Tax Year72163CurrentTaxYear
Total293166Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2236027CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2429222CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2418775CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2278989CurrentTaxYearMinus1Year
Current Tax Year2374060CurrentTaxYear
Total11737073Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2293000CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2504273CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2461730CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2325013CurrentTaxYearMinus1Year
Current Tax Year2446223CurrentTaxYear
Total12030239Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
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 Total50912030239PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years413515CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years327647CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years364873CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year353831CurrentTaxYearMinus1Year
Current Tax Year351854CurrentTaxYear
Total1811720Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years413515CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years327647CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years364873CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year353831CurrentTaxYearMinus1Year
Current Tax Year351854CurrentTaxYear
Total1811720Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years32992CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years16404CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7856CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5546CurrentTaxYearMinus1Year
Current Tax Year5633CurrentTaxYear
Total68431Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2739507CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years2848324CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2834459CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2684390CurrentTaxYearMinus1Year
Current Tax Year2803710CurrentTaxYear
Total13910390Total
FieldValueIRS element (for citing)
Public Support Percentage5090.86480PublicSupportPercentage509
Prior Year Support Percentage0.85560PriorYearSupportPercentage
Investment Income Percentage0.13020InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.13856PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART IV - EXPLANATION FOR OTHER INCOME, SCHEDULE A, PART III, LINE 12, APPLICATION FEES 4000 MISCELLANEOUS INCOME 1633,GeneralExplanation

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 C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Exmpt Function Expenditures0TotalExmptFunctionExpenditures
Total Lobbying Expenditures IIB0TotalLobbyingExpendituresIIB
Non Ded Lobby Political Total0NonDedLobbyPoliticalTotal

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Number Funds Held72163NumberFundsHeld
Disclosed Orgs Legal ControltrueDisclosedOrgsLegalControl
Disclosed For Charitable PurposestrueDisclosedForCharitablePurposes
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FStrueIncludedOnFS

Land Land

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

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis19830359OtherCostOrOtherBasis
Depreciation8682280Depreciation
Book Value11148079BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Book Value0BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1862967OtherCostOrOtherBasis
Depreciation1517558Depreciation
Book Value345409BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1174195OtherCostOrOtherBasis
Depreciation387272Depreciation
Book Value786923BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings12406359TotalOfBookValueLandBuildings

Financial Derivatives FinancialDerivatives

FieldValueIRS element (for citing)
Book Value1936758BookValue
Method Of ValuationFMethodOfValuation

Closely Held Equity Interests CloselyHeldEquityInterests

FieldValueIRS element (for citing)
Book Value0BookValue
FieldValueIRS element (for citing)
Total Of Book Value Securities1936758TotalOfBookValueSecurities
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
WAIT LIST DEPOSITS$6,500
REFUNDABLE PORTION LIFE LEASE DEPOSITS$176,793
SECURITY DEPOSITS$93,236
FieldValueIRS element (for citing)
Total Of Amounts276529TotalOfAmounts
Total Revenue2803710TotalRevenue
Total Expenses2992230TotalExpenses
Excess Or Deficit For Year-188520ExcessOrDeficitForYear
Other$0OtherAmount
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS-188520ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt2803710TotRevenueEtcAuditedFinclStmt
Other Revenues0OtherRevenues
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal2803710RevenueSubtotal
Other Revenues Not Included0OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9902803710TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt2992230TotExpensesEtcAuditedFinclStmt
Other Expenses Included0OtherExpensesIncluded
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal2992230ExpensesSubtotal
Other Expenses Not Included0OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9902992230TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierExplanation of escrow agreementIdentifier
Return ReferenceSchedule D, Part IV, Line 2bReturnReference
ExplanationTHE 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
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)
Amount Retired0AmountRetired
Amount Bond Defeased0AmountBondDefeased
Total Proceeds6157TotalProceeds
Amount In Reserve Fund0AmountInReserveFund
Capitalized Interest0CapitalizedInterest
Refunding Escrow0RefundingEscrow
Issuance Costs From Proceeds56847IssuanceCostsFromProceeds
Credit Enhancement0CreditEnhancement
Working Capital Expenditures0WorkingCapitalExpenditures
Capital Expenditures0CapitalExpenditures
Other Spent Proceeds0OtherSpentProceeds
Amount Unspent0AmountUnspent
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 Others0.0000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.0000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.0000TotalPrivateBusinessUse
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 11bCFO 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
Other changes in net assets or fund balancesForm 990, Part XI, Line 5NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - 595762;

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

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