2023-11-13T11:52:39-06:00 2022-12-31 381357951 PLANTE & MORAN PLLC 750 TRADE CENTRE WAY STE 300 PORTAGE MI 49002 990 2022-05-01 383236052 CLARK RETIREMENT COMMUNITY FOUNDATION CLAR 6164521568 1551 FRANKLIN STREET SE GRAND RAPIDS MI 495063331 ROGER E WEIDEMAN II DIRECTOR & CFO 6164521568 2023-11-08 1 ROGER WEIDEMAN II 999009999 0 AMY CIMINELLO P00796388 2695674500 2023-11-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ROGER E WEIDEMAN II 1551 FRANKLIN STREET SE GRAND RAPIDS MI 495063331 4542729 0 X CLARKRETIREMENT.ORG X 1995 MI TO RECEIVE AND ADMINISTER FUNDS TO FURTHER THE MISSION OF CLARK RETIREMENT COMMUNITY, INC. 25 22 0 25 0 0 1480951 797529 0 0 337337 3718412 58664 -13073 1876952 4502868 1044696 325524 0 0 0 0 36000 0 0 426529 490630 1507225 816154 369727 3686714 12810786 12633263 398271 323597 12412515 12309666 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 586805 325524 0 RECEIVED AND ADMINISTERED FUNDS FOR THE SUPPORT OF CLARK RETIREMENT COMMUNITY, INC. RESIDENTS REPRESENTING A TOTAL OF $852,000 IN BENEVOLENCE CARE BROKEN DOWN AS FOLLOWS: (1) MEDICAID $620,000 (2) ASSISTED LIVING $232,000. 586805 1 1 0 0 0 0 0 0 0 1 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 17 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 25 22 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 BRIAN ELLIS CHAIR 1.00 7.50 X X 0 0 0 JOHN WERT BOARD TRUSTEE 1.00 0.00 X 0 0 0 BONNIE MILLER BOARD TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM MILLARD VICE CHAIR 1.00 0.00 X X 0 0 0 JOHN ABBOTT BOARD TRUSTEE 1.00 0.00 X 0 0 0 DR PRISCILLA KIMBOKO CHAIR SECRETARY 1.00 0.00 X X 0 0 0 SCOTT WEBB BOARD TRUSTEE 1.00 0.00 X 0 0 0 BRIAN PANGLE PRESIDENT 1.00 41.00 X X 0 233815 28405 KATHY HOLT BOARD TRUSTEE 1.00 0.00 X 0 0 0 CHAD SUTLIFFE BOARD TRUSTEE 1.00 0.00 X 0 0 0 JILL VANWYK BOARD TRUSTEE 1.00 0.00 X 0 0 0 PAT WARING BOARD TRUSTEE 1.00 0.00 X 0 0 0 MARK CUSTER BOARD TRUSTEE 1.00 0.00 X 0 0 0 JOHN FITZGERALD BOARD TRUSTEE 1.00 0.00 X 0 0 0 ROBERT HUFF TREASURER 1.00 0.00 X X 0 0 0 GINNY POSTMA BOARD TRUSTEE 1.00 0.00 X 0 0 0 KATHY LAIDLAW BOARD TRUSTEE 1.00 0.00 X 0 0 0 MIKE LLOYD BOARD TRUSTEE 1.00 0.00 X 0 0 0 MICHELE MCISAAC BOARD TRUSTEE 1.00 0.00 X 0 0 0 JACK NICHOLS BOARD TRUSTEE 1.00 0.00 X 0 0 0 MIKE RAYMOND BOARD TRUSTEE 1.00 0.00 X 0 0 0 MIKE NOVAKOSKI BOARD TRUSTEE 1.00 0.00 X 0 0 0 JUDY WELCH BOARD TRUSTEE 1.00 0.00 X 0 0 0 JOHN DATTILO CEO 2.00 56.00 X X 0 363620 37901 ROGER WEIDEMAN II CFO 2.00 56.00 X X 0 334250 35922 0 931685 102228 0 0 1 0 0 128457 669072 797529 68258 68258 60177 3589977 0 0 60177 3589977 3650154 3650154 26788 128457 39861 -13073 -13073 4502868 0 0 3705339 X 325524 325524 26017 26017 184987 154809 30178 24607 23468 1139 12057 10 12047 119 81 38 829 271 558 RESTRICTED GIFTS 162380 51878 110502 LICENSES/MEMBERSHIP FEE 9239 7688 1551 ACTIVITIES FUND 500 500 CORPORATE FEES 479 399 80 69416 22177 47239 816154 586805 229349 0 256912 171572 509765 391966 264 167 6410316 6439517 5510851 5629944 122775 0 12810786 12633263 5658 48206 392613 275391 398271 323597 X 3490529 4635959 8921986 7673707 12412515 12309666 12810786 12633263 X 3686714 -154829 -3634734 X X 0 1 X 1 0 X X 1 CLARK RETIREMENT COMMUNITY INC 381366932 10 1 325524 0 1 325524 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 2341696 1313 2343009 1889307 452389 2341696 1823523 65784 1889307 1795485 28038 1823523 1720903 74582 1795485 0.00000 1.00000 0.00000 0 0 0 5629944 F 5629944 ANNUITIES 210269 DUE TO AFFILIATES 65122 275391 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 155245 128457 26788 2085 13692 17543 6541 155245 128457 26788 2085 13692 17543 6541 39861 -13073 1 CLARK RETIREMENT INC 1551 FRANKLIN ST SE GRAND RAPIDS MI 49506 381366932 501(C)(3) 325524 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 0 0 0 0 0 0 0 0 JOHN DATTILO CEO 0 323620 0 40000 0 0 0 16957 0 20944 0 401521 0 0 ROGER WEIDEMAN II CFO 0 299250 0 35000 0 0 0 15282 0 20640 0 370172 0 0 BRIAN PANGLE PRESIDENT 0 233815 0 0 0 0 0 13229 0 15176 0 262220 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. 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 THE ORGANIZATION'S PRESIDENT/CEO/CFO ARE COMPENSATED BY A RELATED PARTY WHO USES THE FOLLOWING METHODS TO DETERMINE HIS COMPENSATION: - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OTHER ORGANIZATION - COMPENSATION SURVEY OR STUDY - APPROVAL BY BOARD OR COMPENSATION COMMITTEE 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 IX, LINE 11G PROFESSIONAL SERVICE FEES: PROGRAM SERVICE EXPENSES 154,809. MANAGEMENT AND GENERAL EXPENSES 30,178. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 184,987. FORM 990, PART XI, LINE 9: INHERENT CONTRIBUTIONS FROM AFFILIATIONS -3,634,734. FORM 990, PART XII, LINE 2B: EFFECTIVE FEBRUARY 1, 2022, THE CLARK RETIREMENT ORGANIZATION HAD A CHANGE IN OWNERSHIP. AS A RESULT, AN AUDIT WAS PERFORMED FOR THE PERIOD MAY 1, 2021 THROUGH JANUARY 31, 2022. THE PERIOD FEBRUARY 1, 2022 THROUGH DECEMBER 31, 2022 IS INCLUDED IN BHI SENIOR LIVINGS CONSOLIDATED AUDIT. 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