2024-11-04T16:37:44-06:00 2023-12-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2023-01-01 383236052 CLARK RETIREMENT COMMUNITY FOUNDATION CLAR 6164521568 1551 FRANKLIN STREET SE GRAND RAPIDS MI 495063331 ROGER E WEIDEMAN II DIRECTOR & CFO 6164521568 2024-11-01 1 0 AMY CIMINELLO P00796388 2695674500 2024-11-01 2023 2024-10-15 13:58:12Z ROGER E WEIDEMAN II 1551 FRANKLIN STREET SE GRAND RAPIDS MI 495063331 962612 0 X CLARKRETIREMENT.ORG X 1995 MI TO RECEIVE AND ADMINISTER FUNDS TO FURTHER THE MISSION OF CLARK RETIREMENT COMMUNITY, INC. 23 20 0 25 0 0 797529 584262 0 0 3718412 273054 -13073 66696 4502868 924012 325524 136946 0 0 0 0 0 0 0 490630 727177 816154 864123 3686714 59889 12633263 13618540 323597 267229 12309666 13351311 X FOR CLARK RETIREMENT COMMUNUITY, INC., BUILD ENDOWMENT FUNDS FOR BENEVOLENT CARE, CAPITAL NEEDS AND COMMUNITY NEEDS, SPONSOR SPECIAL ACTIVITIES AND PROGRAMS FOR THE COMMUNITY AT LARGE RELATING TO THE HEALTH CARE AND WELFARE OF SENIOR CITIZENS AND THE ELDERLY, RAISE FUNDS THROUGH ANNUAL DRIVES, PLANNED GIVING, AND SPECIAL EVENTS, COORDINATE ALL PUBLIC RELATIONS ACTIVITIES WITH THE LOCAL COMMUNITY AND PUBLICATIONS ON BEHALF OF CLARK RETIREMENT COMMUNITY, INC., AND IMPROVE THE RELATIONSHIP BETWEEN CLARK RETIREMENT COMMUNITY, INC., AND THE UNITED METHODIST CHURCH. 0 0 713001 136946 0 RECEIVED AND ADMINISTERED FUNDS FOR THE SUPPORT OF CLARK RETIREMENT COMMUNITY, INC. RESIDENTS REPRESENTING A TOTAL OF $568,000 IN BENEVOLENCE CARE BROKEN DOWN AS FOLLOWS: (1) MEDICAID $438,000 (2) ASSISTED AND INDEPENDENT LIVING $130,000. 713001 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 23 20 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MI X JIM STAHL 5137822687 11100 SPRINGFIELD PIKE CINCINNATI OH 45246 PERCELL SMITH BOARD TRUSTEE - VP OP - CLARK/BHI 1.00 41.00 X X 0 89231 9087 ROGER WEIDEMAN II BOARD TRUSTEE - CFO - BHI 2.00 56.00 X X 0 358586 46241 JOHN DATTILO BOARD TRUSTEE - CEO - BHI 2.00 56.00 X X 0 404814 47927 JUDY WELCH BOARD TRUSTEE 1.00 0.00 X 0 0 0 MIKE NOVAKOSKI BOARD TRUSTEE 1.00 0.00 X 0 0 0 MIKE RAYMOND BOARD TRUSTEE 1.00 0.00 X 0 0 0 JACK NICHOLS BOARD TRUSTEE 1.00 0.00 X 0 0 0 MICHELE MCISAAC BOARD TRUSTEE 1.00 0.00 X 0 0 0 MIKE LLOYD BOARD TRUSTEE 1.00 0.00 X 0 0 0 KATHY LAIDLAW BOARD TRUSTEE 1.00 0.00 X 0 0 0 GINNY POSTMA BOARD TRUSTEE 1.00 0.00 X 0 0 0 ROBERT HUFF BOARD TRUSTEE - TREASURER 1.00 0.00 X X 0 0 0 JOHN FITZGERALD BOARD TRUSTEE 1.00 0.00 X 0 0 0 MARK CUSTER BOARD TRUSTEE - VICE CHAIR 1.00 0.00 X X 0 0 0 PAT WARING BOARD TRUSTEE - CHAIR 1.00 0.00 X X 0 0 0 JILL VANWYK BOARD TRUSTEE 1.00 0.00 X 0 0 0 CHAD SUTLIFFE BOARD TRUSTEE 1.00 0.00 X 0 0 0 KATHY HOLT BOARD TRUSTEE 1.00 0.00 X 0 0 0 DR PRISCILLA KIMBOKO BOARD TRUSTEE - SECRETARY 1.00 0.00 X X 0 0 0 JOHN ABBOTT BOARD TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM MILLARD BOARD TRUSTEE 1.00 0.00 X 0 0 0 BONNIE MILLER BOARD TRUSTEE - EMERITUS 1.00 0.00 X 0 0 0 JOHN WERT BOARD TRUSTEE - EMERITUS 1.00 0.00 X 0 0 0 0 852631 103255 0 0 1 0 0 22450 561812 584262 129909 129909 143145 0 143145 143145 143145 105296 22450 38600 66696 66696 924012 0 0 339750 136946 136946 58073 58073 69926 65188 4738 34168 34168 1849 14 1835 2039 372 1667 695 361 334 RESTRICTED GIFTS 294468 250122 44346 ALLOCATED WAGES 167404 142193 25211 TEMPORARY RESTRICTED FU 49773 42277 7496 ACTUARIAL ADJUSTMENTS 19996 16985 3011 28786 24375 4411 864123 713001 151122 0 171572 315090 391966 227514 264 7316 6439517 7324293 5629944 5744327 12633263 13618540 48206 0 275391 267229 323597 267229 X 4635959 3146724 7673707 10204587 12309666 13351311 12633263 13618540 X 59889 830913 150843 X X 0 1 X 1 0 X X 1 CLARK RETIREMENT COMMUNITY INC 381366932 10 1 136946 0 1 136946 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2343009 38676 781571 3163256 2341696 1313 2343009 1889307 452389 2341696 1823523 65784 1889307 1795485 28038 1823523 0.00000 1.00000 0.00000 0 0 0 5744327 F 5744327 ANNUITIES 196107 DUE TO AFFILIATES 71122 267229 PART V, LINE 4: THE ENDOWMENT FUNDS ARE USED TO HELP TO CREATE A COMMUNITY OF DIGNITY, COMPASSION AND RESPECT CENTERED ON THE LIVES OF OLDER ADULTS AND THOSE WHO CARE FOR THEM. GOLF OUTING 127746 22450 105296 1000 33820 3780 127746 22450 105296 1000 33820 3780 38600 66696 1 CLARK RETIREMENT INC 1551 FRANKLIN ST SE GRAND RAPIDS MI 49506 381366932 501(C)(3) 136946 0 N/A N/A PROGRAM ASSISTANCE 1 0 PART I, LINE 2: FUNDS ARE TRANSFERRED TO RELATED TAX-EXEMPT ORGANIZATIONS AND MONITORED INTERNALLY. 0 1 0 0 0 0 0 0 0 JOHN DATTILO BOARD TRUSTEE - CEO - BHI 0 364814 0 40000 0 0 0 17549 0 30378 0 452741 0 0 ROGER WEIDEMAN II BOARD TRUSTEE - CFO - BHI 0 323586 0 35000 0 0 0 16268 0 29973 0 404827 0 0 PART I, LINE 3 METHODS USED TO DETERMINE COMPENSATION: COMPENSATION PAID BY BHI RETIREMENT COMMUNITIES IS DETERMINED BY THE REVIEW AND APPROVAL OF THE BHI SENIOR LIVING BOARD WHICH INCLUDES CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. PART I, LINE 4B NONQUALIFIED RETIREMENT PLAN: A 457(F) DEFERRED COMPENSATION PLAN WAS SET UP FOR JOHN DATILLO AND ROGER WEIDEMAN IN APRIL OF 2019. JOHN DATILLO'S PLAN BEGINS VESTING IN 2031 AND ROGER WEIDEMAN'S PLAN BEGINS VESTING IN 2034. FORM 990, PART VI, SECTION A, LINE 6 CLARK RETIREMENT COMMUNITY, INC. IS THE SOLE MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A CLARK RETIREMENT COMMUNITY, INC., THE SOLE MEMBER, HAS THE ABILITY TO APPOINT BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATION'S BOARD OF TRUSTEES MAY NOT UNDERTAKE THE FOLLOWING ACTIONS WITHOUT THE APPROVAL OF CLARK RETIREMENT COMMUNITY, INC., THE SOLE MEMBER: A) CHANGE THE CORPORATION'S STRATEGIC PLANS OR PURPOSES; B) AMEND THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS; C) SELL, TRANSFER OR DISPOSE OF THE CORPORATION'S ASSETS OR INVESTMENTS, OR CAUSE THE CORPORATION TO PURCHASE ASSETS OR MAKE AN INVESTMENT, IN A SINGLE TRANSACTION OR SERIES OF INTEGRATED TRANSACTIONS WITH A VALUE IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE MEMBER'S BOARD; D) ADOPT THE CORPORATION'S ANNUAL CAPITAL AND OPERATING BUDGETS AND APPROVE DEVIATIONS FROM LINE ITEMS IN THE BUDGET IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE MEMBER BOARD; E) INCUR OR GUARANTEE DEBT OF THE CORPORATION IN EXCESS OF AN AMOUNT ESTABLISHED FROM TIME TO TIME BY THE MEMBER BOARD; F) APPOINT OR REMOVE THE MEMBERS OF THE CORPORATION'S BOARD OF TRUSTEES; G) APPROVE THE CORPORATION'S PARTICIPATION IN ANY NEW JOINT VENTURE WITH A PERSON OR ENTITY NOT CONTROLLED DIRECTLY OR INDIRECTLY BY THE MEMBER, WHETHER SUCH ACTIVITIES ARE CONDUCTED THROUGH THE USE OF A CORPORATION, PARTNERSHIP, OR OTHER FORM OF ORGANIZATION; AND H) APPROVE ANY MATERIAL CHANGE IN THE CORPORATION'S INVESTMENT POLICY. FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF THE ORGANIZATION'S FORM 990 PRIOR TO THE FILING OF THE RETURN IS MADE BY AN OFFICER OF THE MANAGING AGENT OF THE ORGANIZATION. THE FORM 990 IS ALSO REVIEWED BY THE BOARD OF DIRECTORS AND AN INDEPENDENT ACCOUNTING FIRM PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, THE BOARD IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST DOCUMENT. THESE DOCUMENTS ARE REVIEWED ANNUALLY TO ENSURE COMPLIANCE. WHEN A CONFLICT OF INTEREST IS IDENTIFIED, THE INDIVIDUAL WITH THE CONFLICT OF INTEREST WITH CLARK RETIREMENT COMMUNITY CAN NOT INFLUENCE IN ANY WAY AND MUST ABSTAIN FROM VOTING ON ANY OUTCOME RELATED TO THE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 REVIEW OF EXECUTIVE DIRECTOR AND MANAGEMENT COMPENSATION: SUGGESTED COMPENSATION FOR EVERY OFFICER, CORPORATE STAFF MEMBER, DIRECTOR OF NURSING, AND CHAPLAIN IS PRESENTED AT THE BEGINNING OF THE YEAR TO THE EXECUTIVE COMMITTEE OF THE BOARD WHERE IT IS REVIEWED AND/OR APPROVED. THE COMPENSATION REVIEW WAS CONDUCTED BY THE EXECUTIVE COMMITTEE OF BOARD OF DIRECTORS DURING THE FIRST QUARTER OF THE YEAR. THE OFFICERS ARE COMPENSATED THROUGH A RELATED ORGANIZATION, BHI RETIREMENT COMMUNITIES. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ADDITIONALLY, PORTIONS OF THE FINANCIAL STATEMENTS ARE INCLUDED IN THE ANNUAL DISCLOSURE STATEMENT. FORM 990, PART XI, LINE 9: INHERENT CONTRIBUTIONS FROM AFFILIATIONS 150,843. FORM 990, PART XII, LINE 2C: THERE HAS BEEN NO CHANGE IN PROCESS FROM THE PRIOR YEAR. CLARK RETIREMENT COMMUNITY INC 1551 FRANKLIN SE GRAND RAPIDS MI 495063331 381366932 LONG-TERM CARE FACILITY MI 501(C)(3) LINE 10 BHI SENIOR LIVING 1 CLARK RETIREMENT SERVICES COMPANY 1551 FRANKLIN STREET SE GRAND RAPIDS MI 495063331 842692761 SUPPORTING ORGANIZATION MI 501(C)(3) LINE 12B, II BHI SENIOR LIVING INC 1 BHI FOUNDATION 8330 ALLISON POINTE TRAIL STE 300 INDIANAPOLIS IN 46250 351680796 SENIOR LIVING IN 501(C)(3) LINE 12A, I BHI SENIOR LIVING INC 1 BHI RETIREMENT COMMUNITIES INC 8330 ALLISON POINTE TRAIL STE 300 INDIANAPOLIS IN 46250 260262903 SENIOR LIVING IN 501(C)(3) LINE 12A, I BHI SENIOR LIVING INC 1 WESLEY MANOR INC 8330 ALLISON POINTE TRAIL STE 300 INDIANAPOLIS IN 46250 351020934 SENIOR LIVING IN 501(C)(3) LINE 10 BHI RETIREMENT COMMUNITIES INC 1 PRAIRIE LANDING COMMUNITY INC 8330 ALLISON POINTE TRAIL STE 300 INDIANAPOLIS IN 46250 262053830 SENIOR LIVING IN 501(C)(3) LINE 10 BHI RETIREMENT COMMUNITIES INC 1 FOUR SEASONS VILLAS INC 8330 ALLISON POINTE TRAIL STE 300 INDIANAPOLIS IN 46250 311011187 SENIOR LIVING IN 501(C)(3) LINE 10 BHI SENIOR LIVING INC 1 HOOSIER MANOR INC 8330 ALLISON POINTE TRAIL STE 300 INDIANAPOLIS IN 46250 311011190 SENIOR LIVING IN 501(C)(3) LINE 10 BHI SENIOR LIVING INC 1 BHI SENIOR LIVING INC 8330 ALLISON POINTE TRAIL SUITE 300 INDIANAPOLIS IN 46250 350931432 SENIOR LIVING IN 501(C)(3) LINE 10 N/A 0 MAPLE KNOLL COMMUNITIES INC 11100 SPRINGFIELD DRIVE CINCINNATI OH 45246 310544277 SENIOR LIVING OH 501(C)(3) LINE 10 BHI RETIREMENT COMMUNITIES INC 1 MAPLE KNOLL FOUNDATION 11100 SPRINGFIELD DRIVE CINCINNATI OH 45246 881290177 SENIOR LIVING OH 501(C)(3) LINE 7 BHI RETIREMENT COMMUNITIES INC 1 WESLEY MANOR SOUTHSIDE LP 1555 N MARKET STREET FRANKFORT IN 46041 RETIRE LIVING IN N/A 0 1 SLDEVELOPMENT INC 8330 ALLISON POINTE TRAIL STE 300 INDIANAPOLIS IN 46250 452664455 GOLF COURSE IN N/A C 1 BHI HOME CARE INC 8330 ALLISON POINTE TRAIL STE 300 INDIANAPOLIS IN 46250 475160712 HOME CARE IN N/A C 1 1546 SHERMAN STREET LLC 1551 FRANKLIN STREET SE GRAND RAPIDS MI 49506 843920830 INVESTMENT COMPANY MI N/A C 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0