Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 748 | 26,566 | 43,080 | 66,633 | 137,027 | |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | 19,478,191 | 20,251,189 | 23,262,590 | 25,380,036 | 28,271,463 | 116,643,469 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 1,310 | 1,310 | ||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | 19,478,939 | 20,277,755 | 23,305,670 | 25,446,669 | 28,272,773 | 116,781,806 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 116,781,806 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 19,478,939 | 20,277,755 | 23,305,670 | 25,446,669 | 28,272,773 | 116,781,806 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,747,629 | 2,722,645 | 1,780,436 | 1,923,945 | 1,738,288 | 9,912,943 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 1,747,629 | 2,722,645 | 1,780,436 | 1,923,945 | 1,738,288 | 9,912,943 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 359,978 | 259,532 | 360,769 | 966,362 | 656,633 | 2,603,274 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 21,586,546 | 23,259,932 | 25,446,875 | 28,336,976 | 30,667,694 | 129,298,023 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
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| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | GARAGE FEES - 2013 AMOUNT: $ 14,706. 2014 AMOUNT: $ 10,736. 2015 AMOUNT: $ 16,669. 2016 AMOUNT: $ 102,395. 2017 AMOUNT: $ 51,032. GUEST ROOM - 2013 AMOUNT: $ 38,207. 2014 AMOUNT: $ 31,710. 2015 AMOUNT: $ 34,826. 2016 AMOUNT: $ 35,993. 2017 AMOUNT: $ 34,444. BEAUTY AND BARBER SHOP - 2013 AMOUNT: $ 17,047. 2014 AMOUNT: $ 16,267. 2015 AMOUNT: $ 17,905. 2017 AMOUNT: $ 9,016. MISCELLANEOUS - 2013 AMOUNT: $ 154,690. 2014 AMOUNT: $ 46,795. 2015 AMOUNT: $ 31,972. 2016 AMOUNT: $ 327,184. 2017 AMOUNT: $ 132,588. LAUNDRY - 2013 AMOUNT: $ 36,320. 2014 AMOUNT: $ 31,753. 2015 AMOUNT: $ 38,068. 2016 AMOUNT: $ 34,847. 2017 AMOUNT: $ 43,414. MEAL INCOME - 2013 AMOUNT: $ 99,008. 2014 AMOUNT: $ 122,271. 2015 AMOUNT: $ 221,329. 2016 AMOUNT: $ 465,943. 2017 AMOUNT: $ 386,139. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | MANAGEMENT OF THE VILLAGE IS PERFORMED BY PERSONNEL EMPLOYED BY FV MANAGEMENT, LLC, WHICH IS OWNED 100% AS A DISREGARDED ENTITY BY FV SERVICES, LLC, A RELATED NOT-FOR-PROFIT. FV MANAGEMENT LLC'S RESPONSIBILITIES INCLUDE RECRUITING AND EMPLOYING THE EXECUTIVE DIRECTOR, AS WELL AS HR, IT, FINANCE AND MARKETING FUNCTIONS; SUPERVISING THE LICENSING, EQUIPPING, AND STAFFING OF THE VILLAGE; PREPARING ANNUAL BUDGETS; ESTABLISHING AND OPERATING A SYSTEM OF FINANCIAL CONTROLS FOR THE VILLAGE, INCLUDING COMPARATIVE ANALYSES WITH OTHER FACILITIES; SUPERVISING THE DELIVERY OF HEALTH CARE SERVICES WHICH MEET THE GUIDLINES OF THE FEDERAL MEDICARE (TITLE XVIII) PROGRAM; AND OVERSEEING THE FOOD SERVICE AND QUALITY OF ACCOMMODATIONS PROVIDED BY THE VILLAGE. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE ORGANIZATION'S ARTICLES OF INCOPORATION WERE AMENDED TO INCLUDE FV SERVICES, INC AS THE CORPORATION'S SOLE MEMBER AND TO IDENTIFY THE POWERS RESERVED TO THE MEMBER. THE AMENDED BY-LAWS ALSO AMENDED THE NUMBER OF DIRECTORS ON THE BOARD FROM TWENTY TO BE NOT LESS THAN FIVE AND NOT MORE THAN SEVEN. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE CORPORATION'S SOLE MEMBER IS FV SERVICES, INC. (THE "MEMBER"). |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBER HAS RESERVED THE POWER TO APPOINT THE CHAIRPERSON OF THE BOARD OF DIRECTORS OF THE CORPORATION. ALSO, ALL DIRECTORS ARE APPOINTED BY THE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE POWERS RESERVED TO THE MEMBER IS AS FOLLOWS: ESTABLISH, MODIFY, AND INTERPRET MISSION AND VISION STATEMENTS FOR THE CORPORATION AND THE SYSTEM; ESTABLISH THE DEBT LIMITS OF, AND DEBT GUIDELINES FOR THE CORPORATION; SELECT THE AUDITOR FOR THE CORPORATION AND THE SYSTEM; ESTABLISH GUIDELINES FOR TRANSFERRING OR ENCUMBERING ASSETS OF THE CORPORATION FOR FINANCINGS INCLUDING TAX-EXEMPT BONDS; APPROVE THE FORMATION OR ACQUISITION OF LEGAL ENTITIES BY THE CORPORATION; APPROVE THE SALE, TRANSFER, DISPOSITION OF, OR SUBSTANTIAL CHANGE TO THE USE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; APPROVE A DIVESTITURE, MERGER, DISSOLUTION, REORGANIZATION, CLOSING, OR CONSOLIDATION INVOLVING THE CORPORATION; APPROVE A CHANGE TO THE MEMBER OF THE CORPORATION; AMEND THE ARTICLES, BYLAWS, AND OTHER GOVERNANCE DOCUMENTS, AS APPLICABLE, FOR THE CORPORATION; APPROVE DEBT OF THE CORPORATION TO FINANCE CAPITAL PROJECTS AND OPERATING CAPITAL; APPROVE POLICIES AND PROCEDURES, INCLUDING OPERATIONAL POLICIES CONSISTENT WITH MISSION AND STRATEGY, AND FURTHER INCLUDING POLICIES FOR PROVIDER CREDENTIALING, QUALITY, AND PATIENT SAFETY (AS APPLICABLE), FOR THE CORPORATION; APPOINT THE PRESIDENT OF THE CORPORATION AND ESTABLISH CORE COMPETENCIES, ANNUAL PERFORMANCE OBJECTIVES AND COMPENSATION FOR THE PRESIDENT; APPOINT AN EXECUTIVE DIRECTOR FOR THE FACILITIES OF THE CORPORATION AND APPROVE COMPENSATION POLICIES AND GUIDELINES FOR SUCH PERSON; APPOINT THE CHAIRPERSON OF THE BOARD OF DIRECTORS OF THE CORPORATION; APPROVE PERSONS FOR APPLICABLE C LEVEL POSITIONS (E.G., CEO, CFO, CCO, CHRO) OF THE CORPORATION, IF ANY, AS WELL AS COMPENSATION POLICIES AND GUIDELINES FOR SUCH PERSONS; APPROVE AN ANNUAL BUDGET FOR THE CORPORATION; APPROVE STRATEGIC PLANS OF THE CORPORATION; APPROVE FORMS OF ANY RESIDENT CONTRACTS FOR THE CORPORATION; AND DETERMINE WHETHER TO SETTLE ANY CLAIMS ASSERTED AGAINST THE CORPORATION AND APPROVE TERMS OF ANY SETTLEMENT. |
| FORM 990, PART VI, SECTION B, LINE 11B | CLA WILL PRESENT A DRAFT TO BOARD FINANCIAL COMMITTEE WHICH WILL THEN REVIEW AND PRESENT TO FULL BOARD FOR FINAL APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST POLICY ANNUALLY. |
| FORM 990, PART VI, SECTION B, LINE 15 | TO DETERMINE SALARIES, EVERY TWO YEARS THE MANAGEMENT COMPANY HIRES AN INDEPENDENT COMPANY TO PREPARE A SALARY SURVEY AND COMPARE THOSE SALARIES WITH THE SALARIES THAT ARE ACTUALLY BEING PAID. THIS SURVEY COMPRISES DATA OF COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. THE LAST SURVEY WAS 2018. THIS IS THEN REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE TO DETERMINE APPROPRIATE SALARIES. THIS COMMITTEE IS COMPRISED OF ONLY INDEPENDENT BOARD MEMBERS. CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING FOR DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT ARE KEPT. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XII, LINE 2C | PROCESSES HAVE NOT CHANGED FROM PRIOR YEARS. |
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| Software Version: |