Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0052
2020
Open to Public Inspection
For calendar year 2020, or tax year beginning 01-01-2020 , and ending 12-31-2020
Name of foundation
CHARLES FORD MEMORIAL HOME INC
 
Number and street (or P.O. box number if mail is not delivered to street address)920 S MAIN STREET
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
NEW HARMONY, IN47631
A Employer identification number

45-5388556
B Telephone number (see instructions)

(812) 682-4675
C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$10,561,834J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 16,405
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 165,095 165,095 165,095
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 Click to see attachment 511,047
b Gross sales price for all assets on line 6a 1,693,385
7 Capital gain net income (from Part IV, line 2)...  
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule)....... Click to see attachment 1,238,008 209,965 1,238,008
12 Total. Add lines 1 through 11........ 1,930,555 375,060 1,403,103
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc.        
14 Other employee salaries and wages...... 968,745     968,745
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule)......... Click to see attachment 520 260 260  
b Accounting fees (attach schedule)....... Click to see attachment 15,030 7,515 7,515  
c Other professional fees (attach schedule)....        
17 Interest............... 534     534
18 Taxes (attach schedule) (see instructions)... Click to see attachment 80,285   3,436 76,849
19 Depreciation (attach schedule) and depletion... Click to see attachment 79,658    
20 Occupancy.............. 79,226     79,226
21 Travel, conferences, and meetings....... 836     836
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 599,971 23,668   576,303
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 1,824,805 31,443 11,211 1,702,493
25 Contributions, gifts, grants paid....... 0 0
26 Total expenses and disbursements. Add lines 24 and 25 1,824,805 31,443 11,211 1,702,493
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 105,750
b Net investment income (if negative, enter -0-) 343,617
c Adjusted net income (if negative, enter -0-)... 1,391,892
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2020)
Form 990-PF (2020)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.) 		Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............. 54,908 47,945 47,945
2 Savings and temporary cash investments.........      
3 Accounts receivable bullet38,896
Less: allowance for doubtful accounts bullet   45,405 38,896 38,896
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges.......... 9,938 4,296 4,296
10a Investments—U.S. and state government obligations (attach schedule) 200,000 Click to see attachment100,000 103,230
b Investments—corporate stock (attach schedule)....... 2,193,242 Click to see attachment2,047,918 3,857,263
c Investments—corporate bonds (attach schedule)....... 101,062 Click to see attachment106,660 102,093
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 2,434,420 Click to see attachment2,733,536 5,021,579
14 Land, buildings, and equipment: basis bullet2,716,421
Less: accumulated depreciation (attach schedule) bullet1,329,889 1,363,009 Click to see attachment1,386,532 1,386,532
15 Other assets (describe bullet) Click to see attachment5,936 Click to see attachment6,488  
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 6,407,920 6,472,271 10,561,834
Liabilities 17 Accounts payable and accrued expenses.......... 34,940 22,241
18 Grants payable.................    
19 Deferred revenue................. 404 273
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet) Click to see attachment458,681 Click to see attachment430,112
23 Total liabilities (add lines 17 through 22)......... 494,025 452,626
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions........... 5,913,895 6,019,645
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 5,913,895 6,019,645
30 Total liabilities and net assets/fund balances (see instructions). 6,407,920 6,472,271
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return) ...............
1
5,913,895
2
Enter amount from Part I, line 27a .....................
2
105,750
3
Other increases not included in line 2 (itemize) bullet
3
 
4
Add lines 1, 2, and 3 ..........................
4
6,019,645
5
Decreases not included in line 2 (itemize) bullet
5
 
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
6,019,645
Form 990-PF (2020)
Form 990-PF (2020)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)		 (b)
How acquired
P—Purchase
D—Donation 		(c)
Date acquired
(mo., day, yr.) 		(d)
Date sold
(mo., day, yr.)
1a
b
c
d
e
(e)
Gross sales price 		(f)
Depreciation allowed
(or allowable) 		(g)
Cost or other basis
plus expense of sale 		(h)
Gain or (loss)
(e) plus (f) minus (g)
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69 		(j)
Adjusted basis
as of 12/31/69 		(k)
Excess of col. (i)
over col. (j), if any
a
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2  
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
SECTION 4940(e) REPEALED ON DECEMBER 20, 2019 - DO NOT COMPLETE
1 Reserved
(a)
Reserved 		(b)
Reserved 		(c)
Reserved 		(d)
Reserved
2
Reserved...........................
2
3
Reserved...........................
3
4
Reserved...........................
4
5
Reserved...........................
5
6
Reserved...........................
6
7
Reserved...........................
7
8
Reserved,..........................
8
Form 990-PF (2020)
Form 990-PF (2020)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here Bullet and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b Reserved................................ 1 4,776
c All other domestic foundations enter 1.39% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2  
3 Add lines 1 and 2........................... 3 4,776
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 4,776
6 Credits/Payments:
a 2020 estimated tax payments and 2019 overpayment credited to 2020 6a 5,920
b Exempt foreign organizations—tax withheld at source...... 6b  
c Tax paid with application for extension of time to file (Form 8868)... 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 5,920
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 1,144
11 Enter the amount of line 10 to be: Credited to 2021 estimated taxBullet1,144 RefundedBullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletIN
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2020 or the taxable year beginning in 2020? See the instructions for Part XIV.
    If "Yes," complete Part XIV .............................
    9
    Yes
     
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletAMY KOCH Telephone no.bullet (812) 682-4675

    Located atbullet920 S MAIN STNEW HARMONYIN ZIP+4bullet47631
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2020, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country? .................
    16   No
    See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
    country bullet
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?...............
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).......
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ........
    1b
     
     
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2020?.............
    1c
     
     
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2020, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2020?.............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?......................
    b
    If "Yes," did it have excess business holdings in 2020 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2020.)..................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2020?
    4b
     
    No
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ......
    5b
     
     
    .........bullet
    c
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    8
    Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
    excess parachute payment during the year? .................
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    VICKI CAMPBELL PRESIDENT
    000.00     		0 0 0
    920 S MAIN ST
    NEW HARMONY,IN47631
    DR RICHARD DIEMER VICE PRESIDE
    000.00     		0 0 0
    920 S MAIN ST
    NEW HARMONY,IN47631
    PAUL ALLISON SECRETARY/TR
    000.00     		0 0 0
    920 S MAIN ST
    NEW HARMONY,IN47631
    DR MARIE OPATRNY PEASE DIRECTOR
    000.00     		0 0 0
    920 S MAIN ST
    NEW HARMONY,IN47631
    KAREN WALKER DIRECTOR
    000.00     		0 0 0
    920 S MAIN ST
    NEW HARMONY,IN47631
    TRENT VAN HAAFTEN DIRECTOR
    000.00     		0 0 0
    920 S MAIN ST
    NEW HARMONY,IN47631
    JOHN NORDGAUER DIRECTOR
    000.00     		0 0 0
    920 S MAIN ST
    NEW HARMONY,IN47631
    SHAWN WORMAN DIRECTOR
    000.00     		0 0 0
    920 S MAIN ST
    NEW HARMONY,IN47631
    ROSS VAUGHN DIRECTOR
    000.00     		0 0 0
    920 S MAIN ST
    NEW HARMONY,IN47631
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet  
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 7
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet  
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1 THE CORPORATION OPERATES AN ASSISTED LIVING FACILITY. 1,824,805
    2  
    3  
    4  
    Part IX-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1 N/A  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet  
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 8
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    8,907,831
    b
    Average of monthly cash balances.......................
    1b
    51,426
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    8,959,257
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
     
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
     
    3
    Subtract line 2 from line 1d.........................
    3
    8,959,257
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    134,389
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    8,824,868
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    441,243
    Part XI
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
     
    2a
    Tax on investment income for 2020 from Part VI, line 5......
    2a
     
    b
    Income tax for 2020. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
     
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
     
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4............................
    5
     
    6
    Deduction from distributable amount (see instructions).................
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
     
    Part XII
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    1,702,493
    b
    Program-related investments—total from Part IX-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
    103,174
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    1,805,667
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b. See instructions.................
    5
     
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    1,805,667
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2019     		(c)
    2019     		(d)
    2020
    1 Distributable amount for 2020 from Part XI, line 7  
    2 Undistributed income, if any, as of the end of 2020:
    a Enter amount for 2019 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2020:
    a From 2015......  
    b From 2016......  
    c From 2017......  
    d From 2018......  
    e From 2019......  
    fTotal of lines 3a through e........  
    4Qualifying distributions for 2020 from Part
    XII, line 4: bullet$ 1,805,667
    a Applied to 2019, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		 
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		 
    d Applied to 2020 distributable amount.....  
    e Remaining amount distributed out of corpus 1,805,667
    5 Excess distributions carryover applied to 2020.    
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 1,805,667
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		 
    e Undistributed income for 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		 
    f Undistributed income for 2020. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2021 ..........     		 
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		 
    8 Excess distributions carryover from 2015 not
    applied on line 5 or line 7 (see instructions) ...     		 
    9Excess distributions carryover to 2021.
    Subtract lines 7 and 8 from line 6a ......     		 
    10 Analysis of line 9:
    a Excess from 2016....  
    b Excess from 2017....  
    c Excess from 2018....  
    d Excess from 2019....  
    e Excess from 2020....  
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 10
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2020, enter the date of the ruling....... bullet
    2012-10-01
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2020 (b) 2019 (c) 2018 (d) 2017
    441,243 409,560 398,768 403,431 1,653,002
    b 85% of line 2a ......... 375,057 348,126 338,953 342,916 1,405,052
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		1,805,667 1,772,751 1,521,437 1,252,137 6,351,992
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		1,805,667 1,772,751 1,521,437 1,252,137 6,351,992
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		294,162 273,040 265,845 268,954 1,102,001
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 11
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    Total .................................bullet 3a  
    bApproved for future payment
    Total .................................bullet 3b  
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 12
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    aBREWERY STREET RENT     16 16,094  
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3 Interest on savings and temporary cash
    investments ...........     		         
    4 Dividends and interest from securities....     14 165,095  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6 Net rental income or (loss) from personal property          
    7 Other investment income.....     15 209,965  
    8 Gain or (loss) from sales of assets other than
    inventory ............     		        511,047
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aAMORTIZATION OF DEFERRED RE     		        131
    bMISCELLANEOUS         191,318
    cCHANGE IN FUTURE SERVICE OB         52,339
    dINCOME FROM GUESTS         8,602
    eINCOME - NEW RESIDENTS         654,155
    fLAUNDRY INCOME         8,666
    gSERVICE LEVEL INCOME         96,738
    12 Subtotal. Add columns (b), (d), and (e)..   391,154 1,522,996
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    1,914,150
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    11B AMOUNTS CONTRIBUTED BY THE RESIDENTS TO THE HOME TO MAINTAIN THE HOME AND PROVIDE FOOD AND SHELTER FOR THE RESIDENTS. AMORTIZATION OF THE ASSETS GIVEN TO THE HOME BY THE RESIDENTS UPON ENTRANCE TO THE HOME. IT IS AMORTIZED OVER THE LIFE EXPECTANCY OF EACH OF THE RESIDENTS. THIS INCOME IS USED TO PROVIDE FOOD AND SHELTER TO THE RESIDENTS. CHANGE IN THE LIABILITY TO PROVIDE FOOD, SHELTER AND MEDICAL CARE FOR THE REMAINING LIFETIME CARE RESIDENTS.
    Form 990-PF (2020)
    Form 990-PF (2020)
    Page 13
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below?
    See instructions.
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2020)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2020 AccountingFeesSchedule
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING 15,030 7,515 7,515  

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2020 DepreciationSchedule
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    ORIGINAL 1954-10-01 8,000 8,000 S/L 50.0000        
    ADDITIONS 1955-01-01 68,217 68,217 S/L 50.0000        
    ADDITIONS 1956-01-01 31,285 31,285 S/L 50.0000        
    ADDITIONS 1957-01-01 4,678 4,678 S/L 50.0000        
    ADDITIONS 1959-01-01 105 105 S/L 50.0000        
    ADDITIONS 1962-01-01 1,459 1,459 S/L 20.0000        
    ADDITIONS 1962-01-01 95 95 S/L 20.0000        
    ADDITIONS 1964-01-01 279 279 S/L 20.0000        
    DRIVEWAY 1969-01-01 703 703 S/L 20.0000        
    DRIVEWAY 1970-01-01 550 550 S/L 20.0000        
    ADDITION TO HOME 1972-01-01 251,742 251,742 S/L 40.0000        
    DRIVE 1972-01-01 9,500 9,500 S/L 10.0000        
    PAVING 1973-01-01 3,042 3,042 S/L 10.0000        
    AIR COMPRESSOR 1973-01-01 871 871 S/L 10.0000        
    COMPLETION OF ADDITION 1973-01-01 16,391 16,391 S/L 40.0000        
    HEATING AND AIR CONDITIONING 1974-07-01 1,018 1,018 S/L 20.0000        
    POSEYVILLE NURSERY-TREES 1974-01-01 208 208 S/L 20.0000        
    CLOSET 1976-05-01 717 717 S/L 20.0000        
    DOORS 1977-04-01 7,417 7,417 S/L 20.0000        
    HANDRAILS 1978-06-01 1,459 1,459 S/L 20.0000        
    NEW WING 1979-12-01 78,842 78,842 S/L 20.0000        
    NEW WING-1980 1980-12-01 154,178 154,178 S/L 20.0000        
    NEW WING 1980-12-01 30,957              
    LANDSCAPING 1985-06-01 1,641 1,641 S/L 20.0000        
    STAINED GLASS WINDOWS-SUNROOM 1985-06-01 2,682 2,682 S/L 20.0000        
    ELECTRICAL WORK 1985-06-01 1,936 1,936 S/L 20.0000        
    LANDSCPAING 1988-05-01 1,724 1,724 S/L 20.0000        
    ELECTRICAL WORK 1989-03-01 5,503 5,503 S/L 20.0000        
    ASPHALT DRIVEWAY 1997-07-31 4,271 4,271 S/L 20.0000        
    CHANDELIERS - PARLORS 1985-06-01 8,250 8,250 S/L 10.0000        
    CANDLE SCONCES 1985-06-01 454 454 S/L 10.0000        
    LIGHT FIXTURES 1986-01-01 298 298 S/L 10.0000        
    MATTRESS 1987-09-01 300 300 S/L 10.0000        
    FURNISHINGS & F. RES ROOM 1988-05-01 1,966 1,966 S/L 10.0000        
    MATTRESS & SPRINGS 1989-07-01 395 395 S/L 10.0000        
    CEILING FAN 1989-06-01 371 371 S/L 10.0000        
    NIGHT STAND & TABLE 1989-06-01 526 526 S/L 10.0000        
    BEDROOM SUIT 1989-09-01 1,503 1,503 S/L 10.0000        
    BEDROOM SUIT 1989-09-01 1,731 1,731 S/L 10.0000        
    MATTRESSES 1990-11-01 560 560 S/L 10.0000        
    NIGHT STAND 1992-03-06 208 208 S/L 10.0000        
    CHEST 1992-03-06 258 258 S/L 10.0000        
    MATTRESS 1992-09-01 257 257 S/L 10.0000        
    CEILING FANS-LIGHT 1985-06-01 1,280 1,280 S/L 10.0000        
    WINDOW A/C FOR NANCY'S OFFICE 1999-06-01 243 243 S/L 10.0000        
    BEDROOM FURNITURE 1974-11-01 939 939 S/L 10.0000        
    BEDROOM FURNITURE 1975-01-01 1,003 1,003 S/L 10.0000        
    BEDROOM FURNITURE 1975-09-01 1,100 1,100 S/L 10.0000        
    BEDROOM FURNITURE 1975-12-01 779 779 S/L 10.0000        
    BEDROOM FURNITURE 1976-12-01 1,392 1,392 S/L 10.0000        
    BEDROOM FURNITURE - ANNA LEWIS 1979-07-01 877 877 S/L 10.0000        
    SHOWER 1983-03-01 1,108 1,108 S/L 10.0000        
    BUFFETT & HUTCH 1985-05-01 4,730 4,730 S/L 10.0000        
    4 PC BEDROOM SUITE 1985-06-01 1,195 1,195 S/L 10.0000        
    BEDS 1985-06-01 220 220 S/L 10.0000        
    SETS MATTRESS & BOX SPRINGS 1985-06-01 1,200 1,200 S/L 10.0000        
    SETS MATTRESS & BOX SPRINGS 1985-06-01 1,200 1,200 S/L 10.0000        
    BROYHILL DRESSER & CHEST 1985-08-01 711 711 S/L 10.0000        
      1999-12-31                
    ADDITIONS 1971-01-01 1,152 1,152 S/L 5.0000        
    ADDITIONS 1972-01-01 7,757 7,757 S/L 5.0000        
    ADDITIONS 1973-01-01 3,351 3,351 S/L 5.0000        
    CEILING DIFFUSERS 1976-01-01 943 943 S/L 5.0000        
    DUMP CART 1978-11-01 157 157 S/L 5.0000        
    GENERATOR 1979-03-01 23,222 23,222 S/L 20.0000        
    DISHWASHER RACKS 1980-02-01 168 168 S/L 3.0000        
    STEEL WORK TABLE 1986-11-01 1,257 1,257 S/L 10.0000        
    SUMP PUMP 1988-07-01 357 357 S/L 10.0000        
    CIRC PUMP 1990-03-01 610 610 S/L 10.0000        
    BENTON-CIRCULATE PUMP & MOTOR 1991-01-01 1,285 1,285 S/L 10.0000        
    TILLER 1993-06-02 369 369 S/L 10.0000        
    ROOM AIR CONDITIONER UNIT 1997-03-31 1,826 1,826 S/L 10.0000        
    4 TON CARRIER AIR CONDITIONER 1997-05-05 1,870 1,870 S/L 10.0000        
    2 COOLING CHASIS 1998-01-27 3,400 3,400 S/L 10.0000        
    LIGHT FOR PARKING LOT 1999-12-15 373 373 S/L 10.0000        
    FIRE FILE & 2 CHAIRS 1972-01-01 570 570 S/L 10.0000        
    FILE CABINETS 1979-11-01 1,299 1,299 S/L 15.0000        
    FILE CABINET 1991-05-01 132 132 S/L 10.0000        
    FILE CABINET 1992-01-12 93 93 S/L 10.0000        
    3 END TABLES & 3 LAMPS 2000-12-05 670 670 S/L 10.0000        
    SCAFFOLDING 2000-03-21 350 350 S/L 10.0000        
    HEATING UNIT 2000-04-01 1,186 1,186 S/L 10.0000        
    3 HOT WATER HEATERS 2000-06-26 8,596 8,596 S/L 10.0000        
    CARRIER PKG TERMINAL A/C 2000-06-27 1,186 1,186 S/L 10.0000        
    CARRIER UNIT 2000-08-14 1,186 1,186 S/L 10.0000        
    INSTALLATION OF BATHROOM HEATER 2000-12-26 986 986 S/L 10.0000        
    3 FRONT GABLES COVERED W/ ALUMINUM FASCIA 2001-10-18 2,549 2,549 S/L 10.0000        
    GLIDER ROCKER 2001-12-31 240 240 S/L 10.0000        
    CROWN MOLDING FOR DINING ROOM 2002-12-12 101 101 S/L 10.0000        
    CULVERT FOR BACK ENTRANCE 2002-12-18 1,714 1,714 S/L 10.0000        
    ALARM SYSTEM 2002-06-21 2,562 2,562 S/L 10.0000        
    HEATING & COOLING UNITS FOR EAST CORRIDOR 2002-08-15 5,587 5,587 S/L 10.0000        
    SEWING MACHINE 2002-08-29 115 115 S/L 10.0000        
    LAUNDRY CART & COVER 2002-08-29 292 292 S/L 10.0000        
    HVAC SYSTEM FOR DINING ROOM 2002-12-20 3,660 3,660 S/L 10.0000        
    CABINETS FOR NURSES' STATION 2002-10-28 575 575 S/L 10.0000        
    CARPETING FOR WILMA JOYCE'S ROOM 2002-09-30 1,198 1,198 S/L 10.0000        
    CHAIR FOR WILMA JOYCE BAILEY 2002-10-01 564 564 S/L 10.0000        
    LIVING ROOM SUITE SHOW ROOM 2002-12-09 1,000 1,000 S/L 10.0000        
    BEDROOM SUITE, CHAIRS, LAMPS & TABLES 2002-12-09 3,255 3,255 S/L 10.0000        
    CABINETS IN PANTRY AND NURSES' STATION 2002-12-26 298 298 S/L 10.0000        
    OUTSIDE BENCH 2002-12-31 166 166 S/L 10.0000        
    KITCHEN LIGHTING 2002-12-31 1,109 1,109 S/L 10.0000        
    HEAT & A/C - SOUTH 2003-04-21 6,223 6,223 S/L 10.0000        
    HEAT & A/C - EAST/WEST 2003-04-21 8,358 8,358 S/L 10.0000        
    HEAT & A/C - NORTH 2003-04-21 6,193 6,193 S/L 10.0000        
    ELECTRICAL WORK FOR WALK IN FREEZER 2003-05-01 775 775 S/L 10.0000        
    BUILDING IMP FOR WALK-IN 2003-05-07 4,884 4,070 S/L 20.0000 244      
    BUILDING IMPROVEMENTS 2003-05-13 1,057 881 S/L 20.0000 53      
    HANDICAP RAMP 2003-07-19 2,237 1,836 S/L 20.0000 112      
    CULVERT AT BACK ENTRANCE 2003-09-10 16,994 13,878 S/L 20.0000 850      
    OFFICE CABINETS 2003-06-18 488 488 S/L 10.0000        
    WALK-IN FREEZER, SHELVING & WIRING 2003-05-01 13,631 13,631 S/L 10.0000        
    TRACER EX2 WHEELCHAIR 2003-01-02 422 422 S/L 10.0000        
    WATERPROOF BATH CHAIR 2003-03-26 265 265 S/L 10.0000        
    CABINETS FOR NURSE'S STATION 2003-05-01 913 913 S/L 10.0000        
    END TABLES 2003-06-02 298 298 S/L 10.0000        
    ECHO-IS2400 2003-02-24 240 240 S/L 10.0000        
    LANDSCAPING FRONT GARDEN 2003-10-01 3,131 3,131 S/L 10.0000        
    MIXER 2003-02-05 104 104 S/L 10.0000        
    BEAUTY SHOP EQUIPMENT 2003-02-05 1,007 1,007 S/L 10.0000        
    SHOWER CHAIRS 2003-06-30 250 250 S/L 10.0000        
    MATTRESS 2004-02-02 400 400 S/L 10.0000        
    LOCKED WALL MOUNTED BOX FOR RENT PMTS 2004-02-26 114 114 S/L 10.0000        
    STORAGE CABINET 2004-02-19 153 153 S/L 10.0000        
    SHOWER 2004-02-09 2,834 2,255 S/L 20.0000 142      
    SCREENS 2004-06-09 140 140 S/L 10.0000        
    GUTTERING & FASCIA 2004-07-29 1,500 1,156 S/L 20.0000 75      
    ELECTRICAL WORK - ADDITIONAL CIRCUITS 2004-07-11 1,097 850 S/L 20.0000 55      
    STORAGE BUILDING 2004-12-31 32,501 9,750 S/L 50.0000 650      
    HVAC FOR STORAGE BUILDING 2004-12-01 1,115 1,115 S/L 10.0000        
    INSTRUMENT TABLE FOR NURSING USE 2004-12-10 142 142 S/L 10.0000        
    CUSHIONS FOR OUTSIDE CHAIRS & GLIDDER 2004-07-09 442 442 S/L 10.0000        
    PORCH FURNITURE 2004-08-18 989 989 S/L 10.0000        
    PORCH FURNITURE 2004-08-02 738 738 S/L 10.0000        
    PORCH FURNITURE 2004-09-11 1,245 1,245 S/L 10.0000        
    PORCH FURNITURE 2004-10-12 425 425 S/L 10.0000        
    ADD'L COST IN STORAGE BUILDING 2005-02-21 306 91 S/L 50.0000 6      
    CARRIER HEATING & COOLING UNIT 2005-05-05 1,038 1,038 S/L 10.0000        
    TOILET SEAT FRAME & SAFETY SPACER 2005-11-17 356 356 S/L 10.0000        
    PORCH FURNITURE 2005-04-14 3,714 3,714 S/L 10.0000        
    OAK BENCH 2005-05-26 330 330 S/L 10.0000        
    4I ROUND LIFT SPACER W/DURAGUARD WHITE 2005-10-12 350 350 S/L 10.0000        
    HOLD UP BUTTON IN WALK-IN FREEZER 2005-05-16 384 384 S/L 10.0000        
    SECURITY CALL SYSTEM 2006-04-28 4,849 4,849 S/L 10.0000        
    FRONT ENTRY DOOR 2006-11-01 5,147 1,694 S/L 40.0000 129      
    PHONE SYSTEM 2006-09-15 3,278 3,278 S/L 10.0000        
    3 FILE CABINETS 2006-09-15 510 510 S/L 10.0000        
    FURNITURE FOR SUN PORCH 2006-09-18 4,026 4,026 S/L 10.0000        
    STAINLESS STEEL COUNTERS 2008-03-17 5,440 5,440 S/L 10.0000        
    CUB CADET MOWER 2008-04-17 2,700 2,700 S/L 7.0000        
    AUTOMATIC DOOR 2009-06-17 2,613 1,851 S/L 15.0000 174      
    HEATER & AC UNIT 2009-11-16 633 633 S/L 7.0000        
    VACCUM 2009-12-10 800 800 S/L 7.0000        
    ROOF 2009-10-07 104,651 52,980 S/L 20.0000 5,232      
    REFRIGERATOR 2010-02-16 2,750 2,704 S/L 10.0000 46      
    REFRIGERATOR FOR KITCHEN 2010-06-07 2,750 2,635 S/L 10.0000 115      
    16 SMOKE ALARMS 2010-07-28 1,072 1,072 S/L 5.0000        
    STOVE 2010-08-24 3,606 3,366 S/L 10.0000 240      
    FLAT SCREEN TV & DVD 2010-10-18 1,048 1,048 S/L 5.0000        
    FIREPLACE ENTERTAINMENT CENTER 2010-12-31 598 538 S/L 10.0000 60      
    GABEL REPAIRS & SCREENED PORCHES 2010-06-25 10,285 2,505 S/L 39.0000 264      
    CARPET IN ENTRANCE 2010-12-14 1,904 1,153 S/L 15.0000 127      
    ? 2011-09-12 952 793 S/L 10.0000 96      
    CARPET, ROOM 111 2011-09-12 520 433 S/L 10.0000 52      
    CARPET, ROOM 101 2011-09-29 934 771 S/L 10.0000 93      
    CARPET ROOM 122 2012-02-07 525 401 S/L 10.0000 52      
    CARPET ROOM 128 2012-02-27 788 601 S/L 10.0000 79      
    CARPET-HALLWAY 2012-10-16 1,421 1,030 S/L 10.0000 142      
    CARPET - ROOM 119 2013-01-21 534 347 S/L 10.0000 54      
    WALLS IN KITCHEN 2013-02-18 2,445 420 S/L 39.0000 61      
    CARPET - ROOM 114 2013-04-15 659 428 S/L 10.0000 66      
    COMPUTER 2013-11-26 749 749 S/L 5.0000        
    PLUMBING FOR HOT WATER SYSTEM 2013-05-06 5,898 977 S/L 39.0000 147      
    HOT WATER HEATER 2013-07-08 1,354 880 S/L 10.0000 136      
    REFRIGERATOR 2013-07-29 3,184 2,070 S/L 10.0000 318      
    MIXING LEVEL (HOT & COLD WATER) 2013-12-23 2,609 1,696 S/L 10.0000 261      
    GOLF CART 2013-09-23 4,795 3,117 S/L 10.0000 479      
    SPRINKLER SYSTEM 2014-12-08 57,510 49,808 S/L 7.0000 4,108      
    2014 BUILDING REMODEL 2014-12-01 139,479 17,580 S/L 39.0000 3,487      
    5 REFRIGERATORS 2014-10-23 827 827 S/L 5.0000        
    2 MEDICINE CABINETS, 3 TVS & 2 REFRIGERATORS 2014-12-29 1,267 1,267 S/L 5.0000        
    TV 2014-09-18 201 201 S/L 5.0000        
    MICROWAVE, REFRIGERATOR & BLINDS 2014-10-23 1,004 1,004 S/L 5.0000        
    BLINDS & MICROWAVE 2014-11-17 1,531 1,531 S/L 5.0000        
    WIRELESS CALL SYSTEM 2014-09-02 70,385 62,215 S/L 7.0000 5,028      
    STAINLESS STEEL SILVERWARE 2014-09-30 602 602 S/L 5.0000        
    CARPET 2014-12-22 2,681 2,681 S/L 5.0000        
    CHINA WARE 2014-10-13 1,889 1,889 S/L 5.0000        
    CURTAINS 2014-07-28 1,367 1,367 S/L 5.0000        
    CELL PHONE FOR NURSE CALL 2014-07-28 725 725 S/L 5.0000        
    3 MEDICINE CABINETS 2014-10-23 517 517 S/L 5.0000        
    SHOWER CURTAIN PACKAGES 2014-12-22 786 786 S/L 5.0000        
    ICE MACHINE 2014-04-14 2,095 1,889 S/L 7.0000 150      
    SPEED QUEEN COMMERCIAL DRYER 2014-02-24 566 566 S/L 5.0000        
    SPEED QUEEN COMMERCIAL DRYER 2014-03-10 742 742 S/L 5.0000        
    PTAC 7000 BTU 2014-11-17 781 781 S/L 5.0000        
    SPEED QUEEN COMMERCIAL DRYER 2014-11-25 551 551 S/L 5.0000        
    MATTRESS 2014-04-07 429 429 S/L 5.0000        
    5 TVS 2014-10-23 1,009 1,009 S/L 5.0000        
    DESK & FILE CABINETS 2015-10-22 4,374 3,645 S/L 5.0000 729      
    CHAIRS 2015-11-06 961 801 S/L 5.0000 160      
    PTC073E35AXXX 2015-01-05 738 738 S/L 5.0000        
    PTAC UNIT 7000 BTU 2015-02-09 718 706 S/L 5.0000 12      
    DISHES 2015-02-16 1,889 1,826 S/L 5.0000 63      
    WHIRLPOOL ELECTRIC DRYER 2015-03-02 638 617 S/L 5.0000 21      
    2 LOUNGE CHAIRS 2015-07-13 1,893 1,704 S/L 5.0000 189      
    AMANA PTAC 2015-10-05 759 645 S/L 5.0000 114      
    AMANA PTAC 2015-12-07 784 640 S/L 5.0000 144      
    SPRINKLER SYSTEM 2015-04-13 32,965 22,369 S/L 7.0000 4,709      
    WINDOW BLINDS 2015-03-16 1,918 1,822 S/L 5.0000 96      
    MEDICINE CABINETS & FRIDGES 2015-03-23 1,510 1,434 S/L 5.0000 76      
    SHELVING & TOILETS 2015-04-20 1,508 1,407 S/L 5.0000 101      
    MICROWAVES 2015-05-18 608 557 S/L 5.0000 51      
    MEDICINE CABINETS & FRIDGES 2015-06-01 1,197 1,097 S/L 5.0000 100      
    MICROWAVE & BLINDS 2015-07-13 814 733 S/L 5.0000 81      
    REFRIGERATOR 2015-07-20 225 199 S/L 5.0000 26      
    BUILDING IMPROVEMENTS 2015-12-15 139,019 14,555 S/L 39.0000 3,565      
    2 AIR CONDITIONERS 2015-12-15 9,671 1,013 S/L 39.0000 248      
    TV, MED CABINET, REFRIGERATORS 2016-06-30 708 495 S/L 5.0000 142      
    MAIN HALL A/C 2016-11-01 2,977 242 S/L 39.0000 76      
    WATER HEATER 2016-08-15 4,223 1,443 S/L 10.0000 422      
    LIFT RECLINER 2016-04-19 770 565 S/L 5.0000 154      
    OFFICE FURNITURE 2016-05-09 8,776 6,436 S/L 5.0000 1,755      
    FOLDING TABLES & CHAIRS 2016-07-18 586 401 S/L 5.0000 117      
    TV STAND/FIREPLACE 2016-08-29 520 347 S/L 5.0000 103      
    CARPET 2016-11-07 10,440 6,612 S/L 5.0000 2,088      
    BUILDING IMPROVEMENTS 2016-12-15 80,876 6,394 S/L 39.0000 2,074      
    WIRELESS KEYBOARD & STICK 2016-05-23 212 152 S/L 5.0000 43      
    COMPUTER FOR LIFE ENRICHMENT 2016-08-29 1,064 709 S/L 5.0000 213      
    WIRELESS NETWORK 2016-11-07 3,230 2,046 S/L 5.0000 646      
    5 AMANA PTAC'S 2016-11-07 3,550 2,248 S/L 5.0000 710      
    CHAIRS 2017-02-27 390 221 S/L 5.0000 78      
    RADIO/PHONE INTERFACE UNIT 2017-05-16 2,753 1,422 S/L 5.0000 551      
    SARA LIFT 2017-10-09 4,656 2,095 S/L 5.0000 931      
    CARPET 2017-10-09 11,472 5,162 S/L 5.0000 2,295      
    BUILDING IMPROVEMENTS 2017-11-20 86,536 4,623 S/L 39.0000 2,218      
    TV, CABINET, REFRIGERATOR 2017-03-28 571 314 S/L 5.0000 115      
    3 PTAC UNITS 2017-09-11 1,830 854 S/L 5.0000 366      
    DINING ROOM FURNISHINGS 2017-07-25 13,701 6,622 S/L 5.0000 2,740      
    CHAIRS & TV 2017-12-26 624 250 S/L 5.0000 124      
    FIRE ALARM PANEL 2017-12-15 4,812 2,005 S/L 5.0000 963      
    LIFT 2017-07-05 4,000 2,000 S/L 5.0000 800      
    WATER HEATER 2017-12-15 2,868 597 S/L 10.0000 287      
    TVS, REFRIGERATORS, MEDICINE CABINETS 2018-07-17 2,520 714 S/L 5.0000 504      
    NURSE COMPUTER, LE COMPUTER 2018-03-01 3,023 1,108 S/L 5.0000 605      
    ADMISSIONS LAPTOP 2018-08-16 1,506 402 S/L 5.0000 301      
    PAPER SHREDDER 2018-10-22 621 145 S/L 5.0000 124      
    PTAC 2018-02-27 630 231 S/L 5.0000 126      
    DRYER 2018-03-19 582 204 S/L 5.0000 116      
    BEAUTY SHOP CHAIR 2018-04-23 1,069 356 S/L 5.0000 214      
    WI-FI & EXTENDERS 2018-09-18 1,290 322 S/L 5.0000 258      
    PTAC 2018-10-30 710 166 S/L 5.0000 142      
    PTAC 2018-11-15 881 206 S/L 5.0000 176      
    CARDIAC MONITOR STAND 2018-11-19 2,045 443 S/L 5.0000 409      
    CARPET 2018-07-15 8,718 2,615 S/L 5.0000 1,744      
    TV, DVD, SHELF, CABLES 2018-10-22 535 125 S/L 5.0000 107      
    IMPROVEMENTS 2018-12-31 86,991 2,231 S/L 39.0000 2,230      
    TIME CLOCK 2018-12-31 510 102 S/L 5.0000 102      
    KORESEN FIRE & SECURITY 2019-12-31 1,532   S/L 39.0000 39      
    MASH WORKS 2019-12-31 2,414   S/L 39.0000 62      
    IMPROVEMENTS - SEE CARRYFORWARD 2019-12-31 196,021   S/L 39.0000 5,026      
    HOME IMPROV - SEE CARRYFORWARD 2019-12-31 60,075   S/L 39.0000 1,540      
    HOME FURNISHINGS (DETAIL CARRYFORWARD) 2019-12-26 62,777   S/L 10.0000 6,278      
    MEDLINE 2019-12-31 6,717   S/L 10.0000 672      
    COMPUTERS - SEE CARRYFORWARD 2019-08-27 5,713 381 S/L 5.0000 1,143      
    2 PTAC UNITS 2019-07-22 3,075 128 S/L 10.0000 308      
    RESIDENTS REFRIGERATORS 2019-07-22 1,025 43 S/L 10.0000 102      
    PTAC UNIT 2019-08-22 1,467 49 S/L 10.0000 147      
    TOUCHSCREEN LAPTOP 2020-04-14 1,192   S/L 5.0000 179      
    SURFACE BOOKS, OFFICE PRO 2020-05-12 4,235   S/L 5.0000 565      
    IPADS 2020-04-06 7,520   S/L 5.0000 1,128      
    CUB CADET ZERO TURN 2020ZT 1 42 MOWER 2020-06-01 2,199   S/L 5.0000 257      
    CAMERA 2020-09-08 3,910   S/L 5.0000 261      
    PATIO HEATERS 2020-10-19 1,437   S/L 5.0000 48      
    SUNROOM KEYPAD 2020-07-21 3,181   S/L 10.0000 133      
    IMPROVEMENTS 2020-12-31 61,783   S/L 39.0000        
    ARTWORK 2020-08-25 8,726   S/L 10.0000 291      
    PTAC UNIT 2020-04-06 768   S/L 10.0000 58      
    ELECTRONIC SCALE 2020-08-25 691   S/L 10.0000 23      
    PTAC & THERMOSTAT 2020-09-28 1,039   S/L 10.0000 26      
    WASHING MACHINE 2020-10-01 981   S/L 10.0000 25      
    PTAC 2020-12-14 694   S/L 10.0000 6      
    ROCKER RECLINER 2020-05-05 659   S/L 10.0000 44      
    ART & BLINDS 2020-11-19 1,160   S/L 10.0000 10      
    DECORATIONS 2020-03-09 3,000   S/L 10.0000 250      

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2020 GainLossSaleOtherAssetsSch
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Name Date Acquired How Acquired Date Sold Purchaser Name Gross Sales Price Basis Basis Method Sales Expenses Total (net) Accumulated Depreciation
    MORGAN STANLEY   PURCHASE     1,693,385 1,171,153     522,232  
    MORGAN STANLEY   PURCHASE       11,185     -11,185  

    TY 2020 InvestmentsCorpBondsSchedule
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Name of Bond End of Year Book Value End of Year Fair Market Value
    BONDS 106,660 102,093

    TY 2020 InvestmentsCorpStockSchedule
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Name of Stock End of Year Book Value End of Year Fair Market Value
    MUTUAL FUNDS 1,154,061 1,154,061
    STOCK 893,857 2,703,202

    TY 2020 InvestmentsGovtObligationsSch
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    US Government Securities - End of Year Book Value:

     
    US Government Securities - End of Year Fair Market Value:

     
    State & Local Government Securities - End of Year Book Value:


    100,000
    State & Local Government Securities - End of Year Fair Market Value:


    103,230


    TY 2020 InvestmentsOtherSchedule2
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    CASH EQUIVALENTS AT COST 463,392 463,392
    EXCHANGED TRADED FUNDS AT COST 2,166,659 4,454,702
    OTHER AT COST 103,485 103,485

    TY 2020 LandEtcSchedule2
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
      2,716,421 1,329,889 1,386,532 1,386,532


    TY 2020 LegalFeesSchedule
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL 520 260 260  


    TY 2020 OtherAssetsSchedule
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    POSEY COUNTY F.B. STOCK 91 91  
    RENT RECEIVABLE 1,203 1,336  
    INTEREST RECEIVABLE 4,592 2,577  
    ACCRUED EXISE TAXES 50 2,484  


    TY 2020 OtherExpensesSchedule
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EXPENSES        
    FOOD 92,494     92,494
    PAPER SUPPLIES - HOUSEKEEPING 4,551     4,551
    PAPER SUPPLIES-DIETARY 6,884     6,884
    SUNDRY SUPPLIES 2,066     2,066
    LINENS - HOUSEKEEPING 1,113     1,113
    MISCELLANEOUS HOME SUPPLIES 9,770     9,770
    LAUNDRY 1,922     1,922
    INSURANCE - HOME 36,771     36,771
    INSURANCE - RESIDENTS 843     843
    INSURANCE - EMPLOYEE 68,271     68,271
    WATER SOFTNERS 3,540     3,540
    REPAIRS & MAINTENANCE 184     184
    CASUAL LABOR 35,559     35,559
    FIRE/SAFETY CONTRACTORS 5,310     5,310
    OUTSIDE EQUIPMENT MAINTENANCE 1,027     1,027
    INSIDE EQUIPMENT MAINTENANCE 2,334     2,334
    MAINTENANCE - SUPPLIES 15,758     15,758
    CONSULTATIONS - HOME 15,623     15,623
    DIETARY CONSULTANT 2,011     2,011
    MEDICAL SUPPLIES 60,661     60,661
    EMPLOYEE EXPENSE 5,486     5,486
    DOCTORS & HOSPITALS 843     843
    OFFICE SUPPLIES 5,365     5,365
    POSTAGE 798     798
    ALLOWANCE TO GUESTS 5,149     5,149
    INTEREST PAID TO GUESTS 1,056     1,056
    VEHICLE REPAIR AND MAINTENANC 1,116     1,116
    MISCELLANEOUS EXPENSE 5,662     5,662
    MAGAZINES & SUBSCRIPTIONS 1,680     1,680
    BANK FEES - GENERAL FUND 23,668 23,668    
    BANK FEES - CHECKING ACCT 151     151
    EQUIPMENT RENTAL 1,360     1,360
    DISHWASHER RENTAL 975     975
    COPIER EXPENSE 8,118     8,118
    HOUSEKEEPING 6,001     6,001
    KITCHEN CLEANING SUPPLIES 6,430     6,430
    LIFE ENRICHMENT DIRECTOR EXPE 8,326     8,326
    MARKETING 83,684     83,684
    SPECIAL EVENTS 8,383     8,383
    ADVERTISING 5,429     5,429
    PENALTIES 665     665
    PAPER SUPPLIES-NURSING 3,924     3,924
    EDUCATION 2,479     2,479
    SMALL KITCHEN EQUIPMENT 1,160     1,160
    PROFESSIONAL DUES 2,104     2,104
    GENERATOR 685     685
    CLEANING SUPPLIES 10,100     10,100
    IT CONSULTANT 2,020     2,020
    IT SUPPLIES 2,874     2,874
    GASOLINE - VANS 1,295     1,295
    VAN LEASE 12,922     12,922
    YARD MAINTENANCE 3,910     3,910
    GARDEN 1,378     1,378
    PUBLIC RELATIONS 3,576     3,576
    MEDICAL EDUCATION & SEMINARS 543     543
    PAPER SUPPLIES-OTHER 242     242
    BEAUTICIAN PAYMENTS 31     31
    HELP WANTED 3,691     3,691


    TY 2020 OtherIncomeSchedule2
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    ROYALTY INCOME 209,965 209,965 209,965
    BREWERY STREET RENT 16,094   16,094
    AMORTIZATION OF DEFERRED REV. 131   131
    MISCELLANEOUS 191,318   191,318
    CHANGE IN FUTURE SERVICE OBLG 52,339   52,339
    INCOME FROM GUESTS 8,602   8,602
    INCOME - NEW RESIDENTS 654,155   654,155
    LAUNDRY INCOME 8,666   8,666
    SERVICE LEVEL INCOME 96,738   96,738


    TY 2020 OtherLiabilitiesSchedule
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Description Beginning of Year - Book Value End of Year - Book Value
    SECURITY DEPOSITS 56,857 71,877
    OBLIGATION FOR FUTURE SERVICE 373,248 320,909
    ACCRUED PAYROLL 22,742 30,648
    STATE/COUNTY WITHHOLDINGS 3,358 3,521
    UNEMPLOYMENT TAXES 52 260
    OTHER WITHHOLDINGS 684 552
    ACCRUED PAYROLL TAXES 1,740 2,345


    TY 2020 TaxesSchedule
    Name:
    CHARLES FORD MEMORIAL HOME INC
    EIN:
    45-5388556
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FICA/MEDICARE EXPENSE 75,271     75,271
    UNEMPLOYMENT TAXES 1,578     1,578
    EXCISE TAXES 3,436   3,436