TY 2021 Form 990

(A) Name and business address	(B) Description of services	(C) Compensation
HEALTHWIN, 20531 DARDEN RD SOUTH BEND,IN46637	THERAPY SERVICE	449,753
DJ CONSTRUCTION, 3414 ELKHART RD GOSHEN,IN46526	CONSTRUCTION	264,426
HOWARD CUSTOM ENTERPRISES, 21420 JOHNSON RD SOUTH BEND,IN46614	CONSTRUCTION	226,805
DAVE TALBOOM LAWNCARE, 26981 KLINE TRAIL SOUTH BEND,IN46614	LAWN CARE	207,844
MONARCH TEXTILE RENTAL SERVICES INC, 812 WILBER ST SOUTH BEND,IN46628	LAUNDRY SERVICE	190,158
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 5

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

HOLY CROSS VILLAGE AT NOTRE DAME INC

Employer identification number

35-2084623

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .	81,938	428,966	1,142,280	1,065,272	704,733	3,423,189
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	12,903,181	13,616,239	13,505,204	13,475,614	14,605,083	68,105,321
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....	279,390	189,785	173,697	129,925	341,059	1,113,856
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...						0
5	The value of services or facilities furnished by a governmental unit to the organization without charge						0
6	Total. Add lines 1 through 5	13,264,509	14,234,990	14,821,181	14,670,811	15,650,875	72,642,366
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.)						72,642,366

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...	13,264,509	14,234,990	14,821,181	14,670,811	15,650,875	72,642,366
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..	181,298	251,337	210,695	145,347	125,792	914,469
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.						0
c	Add lines 10a and 10b.	181,298	251,337	210,695	145,347	125,792	914,469
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.						0
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..						0
13	Total support. (Add lines 9, 10c, 11, and 12.)..	13,445,807	14,486,327	15,031,876	14,816,158	15,776,667	73,556,835

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

98.757 %

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

98.620 %

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

1.243 %

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

1.000 %

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
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)
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):
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 0.015 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 0.035	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

HOLY CROSS VILLAGE AT NOTRE DAME INC

Employer identification number

35-2084623

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization HOLY CROSS VILLAGE AT NOTRE DAME INC

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization HOLY CROSS VILLAGE AT NOTRE DAME INC		Employer identification number 35-2084623

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization HOLY CROSS VILLAGE AT NOTRE DAME INC			Employer identification number 35-2084623
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

HOLY CROSS VILLAGE AT NOTRE DAME INC

Employer identification number

35-2084623

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	113,215	85,007	86,000	85,555	82,443
b	Contributions ...	20			500
c	Net investment earnings, gains, and losses	-12,875	37,005	-993	4,143	7,239
d	Grants or scholarships ...		8,797		4,198	4,127
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......	100,360	113,215	85,007	86,000	85,555

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

Yes

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....
b	Buildings ....	41,433,745	23,507,009	17,926,736
c	Leasehold improvements	4,597,755	3,939,435	658,320
d	Equipment ....	23,278,486	17,390,107	5,888,379
e	Other .....	752,247	187,720	564,527
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				25,037,962

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	38,314,835
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	17,084,406
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-549,991
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	1,918,328
e	Add lines 2a through 2d .....................			2e	1,368,337
3	Subtract line 2e from line 1..................			3	15,716,069
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	18,642
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c	18,642
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	15,734,711

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	18,587,680
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................			2e
3	Subtract line 2e from line 1...................			3	18,587,680
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	18,642
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c	18,642
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	18,606,322

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PART V, LINE 4	ENDOWMENT FUNDS ARE HELD BY THE COMMUNITY FOUNDATION OF ST. JOSEPH COUNTY FOR THE BENEFIT OF HOLY CROSS VILLAGE AT NOTRE DAME. THE ENDOWMENT FUNDS ARE INTENDED TO PROVIDE FUNDING TO SUPPORT HOLY CROSS VILLAGE AT NOTRE DAME'S MISSION AND TAX-EXEMPT PURPOSE.
ASC 740 FOOTNOTE	Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements.
SCHEDULE D, PART XI, LINE 2D	CHANGE IN BENEFICIAL INTEREST $ 198,954 GAIN ON INTEREST RATE SWAP VALUATION $1,719,374 TOTAL $1,918,328

Schedule D (Form 990) 2021

Additional Data

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- TIN:

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

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
HOLY CROSS VILLAGE AT NOTRE DAME INC

Employer identification number
35-2084623

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	INDIANA FINANCE AUTHORITY	35-1602316	000000000	11-24-2015	25,965,000	REFUND 2006A AND CONSTRUCT/REMODEL		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	5,686,255
2 Amount of bonds legally defeased ..............	0
3 Total proceeds of issue ..................	26,544,350
4 Gross proceeds in reserve funds .............	0
5 Capitalized interest from proceeds .............	0
6 Proceeds in refunding escrows ...............	0
7 Issuance costs from proceeds ...............	380,178
8 Credit enhancement from proceeds .............	0
9 Working capital expenditures from proceeds .............	0
10 Capital expenditures from proceeds .............	950,927
11 Other spent proceeds .............	25,213,245
12 Other unspent proceeds .............	0
13 Year of substantial completion .............	2019
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........	X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.100 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............	1.100 %
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........	X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....	X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........	0
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........	0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation
SCHEDULE K, PART IV, LINE 2C	11/01/2018
SCHEDULE K, PART II, LINE 3	TOTAL PROCEEDS OF THE ISSUE INCLUDE PAR, PLUS TRANSFERRED PROCEEDS. PLUS INVESTMENT EARNINGS. TOTAL PROCEEDS OF THE ISSUE EXCEED THE ISSUE PRICE OF THE SERIES 2015 BOND, THE DIFFERENCE IS DUE TO INVESTMENT EARNINGS. EARNINGS ARE INCLUDED IN THE TOTAL PROCEEDS OF THE ISSUE.
SCHEDULE K, PART II, LINE 4	SERIES 2015 BONDS DO NOT HAVE A DEBT SERVICE RESERVE REQUIREMENT. THE SERIES 2015 BONDS WERE PRIVATELY PLACED.
SCHEDULE K, PART II, LINE 11	OTHER SPENT PROCEEDS MAINLY INCLUDE SERIES 2015 PROCEEDS AND INTEREST EARNINGS THAT WERE USED TO CURRENT REFUND AND/OR ADVANCE REFUND SERIES 2006 BONDS.
SCHEDULE K, PART IV, LINE 2B	THE SERIES 2015 BONDS QUALIFY AS A MULTIPURPOSE ISSUE WITH A CURRENT REFUNDING PORTION, ADVANCE REFUNDING PORTION, AND A NEW MONEY PORTION. THE CURRENT REFUNDING PORTION WOULD HAVE QUALIFIED FOR THE 6 MONTH SPENDING EXCEPTION AND WOULD HAVE BEEN EXEMPT FROM THE ARBITRAGE REBATE CALCULATION. THE ADVANCE REFUNDING PORTION AND THE NEW MONEY PORTION ARE SUBJECT TO ARBITRAGE REBATE COMPLIANCE SINCE SUCH PROCEEDS DID NOT QUALIFY FOR A SPENDING EXCEPTION. HOLY CROSS VILLAGE AT NOTRE DAME, INC. HAS HIRED AN INDEPENDENT FIRM TO REVIEW THE SERIES 2015 BONDS ANNUALLY FOR ARBITRACE COMPLIANCE PURPOSES USING NOVEMBER 1ST AS THE SELECTED BOND YEAR.
SCHEDULE K, PART IV, LINE 2C	ISSUER NAME: INDIANA FINANCE AUTHORITY THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 11/01/2018 A REBATE COMPUTATION WAS PERFORMED FOR THE SERIES 2015 BOND ISSUE IN NOVEMBER 2018. THE RESULT OF THIS COMPUTATION WAS THAT NO REBATE AMOUNT WAS DUE FOR THE REBATE PERIOD. BASED UPON INFORMATION PROVIDED, IT WAS DETERMINED BY COUNSEL THAT ALL PROCEEDS HAD BEEN FULLY EXPENDED, THUS THIS REBATE COMPUTATION IS THE FINAL COMPUTATION NEEDED FOR THIS ISSUE UNTIL THE FINAL PAYMENT ON THE BONDS HAS BEEN MADE. AS SUCH, SCHEDULE K. PART IV, LINE 2C HAS BEEN MARKED AS'YESTHE DATE PROVIDED IS NOVEMBER 1, 2018.
SCHEDULE K, PART IV, LINE 3	THE INTEREST RATES ON THE SERIES 2015 BONDS TO MATURITY WERE UNKNOWN ON THE DATE OF ISSUANCE. THEREFORE, THE SERIES 2015 BONDS ARE TREATED AS A VARIABLE RATE ISSUE AND THE YIELD FOR SUCH BONDS WILL BE CALCULATED SEPARATELY FOR EACH COMPUTATION PERIOD. THE "APPLICABLE MARGINSPREAD COMPONENT WAS USED TO DETERMINE THF YIELD ON THE SERIES 2015 BONDS DURING THE FIRST INSTALLMENT COMPUTATION PERIOD AND SUCH YIELD WAS USED BY BOND COUNSEL IN THEIR DETERMINATION THAT THE SERIES 2015 BONDS WERE NOT ARBITRAGE BONDS AND THAT THE SERIES 2015 PROCEEDS HELD IN THE DEFEASANCE ESCROW FUND WERE YIELD RESTRICTED.
SCHEDULE K, PART IV, LINE 4B	HOLY CROSS VILLAGE AT NOTRE DAME, INC. DID ENTER INTO AN INTEREST RATE SWAP AGREEMENT FOR THE SERIES 2015 BONDS, HOWEVER. SUCH HEDGE WAS NOT TREATED AS A QUALIFIED HEDGE FOR FEDERAL TAX PURPOSES.
SCHEDULE K, PART IV, LINE 5A	LINES 5A-5D: THE SERIES 2015 ESCROW FUND WAS INVESTED IN VARIOUS "OPEN MARKET SECURITIES". HOLY CROSS VILLAGE AT NOTRE DAME, INC. HIRED AN INDEPENDENT BIDDING AGENT TO TO RECEIVE BIDS FOR THE OPEN MARKET SECURITIES AND MET THE SAFE HARBOR REQUIREMENTS AS DEFINED WITHIN THE U.S. TREASURY REGULATIONS.

Schedule K (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

HOLY CROSS VILLAGE AT NOTRE DAME INC

Employer identification number

35-2084623

Return Reference	Explanation
FORM 990, PART VI, LINE 1A	THE BOARD, BY RESOLUTION OF A MAJORITY OF DIRECTORS, MAY APPOINT ONE OR MORE STANDING OR SPECIAL COMMITTEES AS NEEDED. THE BOARD SHALL APPOINT THE EXECUTIVE COMMITTEE, WHICH SHALL BE A STANDING COMMITTEE. MEMBERS OF THE BOARD SHALL BY APPOINTED BY THE BOARD OR CHAIRPERSON, SUBJECT TO THE APPROVAL OF THE BOARD. EACH COMMITTEE AUTHORIZED TO EXERCISE ANY POWER OF THE BOARD (OPPOSED TO ADVISORY COMMITTEES) SHALL HAVE AT LEAST 2 DIRECTORS AND MAY CONSIST OF PERSONS OTHER THAN DIRECTORS, PROVIDED AT LEAST A MAJORITY OF COMMITTEE MEMBERS ARE DIRECTORS. THE EXECUTIVE COMMITTEE SHALL BE A STANDING COMMITTEE AND SHALL HAVE AND EXERCISE ALL POWERS OF THE BOARD, SUBJECT TO LIMITATIONS SET FORTH IN THE BY LAWS, BETWEEN BOARD MEETINGS. THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRPERSON, PRESIDENT, AND 2 OTHER DIRECTORS SELECTED BY THE CHAIRMAN AND SUBJECT TO APPROVAL OF THE BOARD. ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE WITHIN THE SCOPE OF ITS AUTHORITY SHALL BE CONSIDERED THE ACTIONS OF THE BOARD.
FORM 990, PART VI, SECTION A, LINE 3	TRINITY SENIOR SERVICES MANAGEMENT, INC. (TSSM) PROVIDES MANAGEMENT SERVICES TO THE ORGANIZATION, INCLUDING CLINICAL QUALITY, FINANCIAL OVERSIGHT, HUMAN RESOURCES, MARKETING AND COMPLIANCE, ALONG WITH SUPPORT FOR OTHER MANAGEMENT AREAS OF THE ORGANIZATION. TSSM PROVIDES THESE SERVICES CONSISTENT WITH THE ORGANIZATION'S MISSION, VISION, STRATEGIC PLAN, ANNUAL GOALS, OPERATING BUDGETS AND CAPITAL PLAN, ALL FOR WHICH THE ORGANIZATION HAS OVERSIGHT AND APPROVAL AUTHORITY.
FORM 990, PART VI, SECTION A, LINE 6	THE BROTHERS OF HOLY CROSS, A RELATED TAX EXEMPT ORGANIZATION, IS THE SOLE CORPORATE MEMBER OF HOLY CROSS VILLAGE AT NOTRE DAME, INC.
FORM 990, PART VI, SECTION A, LINE 7A	THE BROTHERS OF HOLY CROSS HAS THE POWER TO APPOINT AND REMOVE MEMBERS OF THE BOARD, INCLUDING THE CHAIRPERSON.
FORM 990, PART VI, SECTION A, LINE 7B	THE BROTHERS OF HOLY CROSS HAS THE FOLLOWING ADDITIONAL RESERVED POWERS: 1 - WORK WITH THE BOARD OF DIRECTORS TO REVIEW, CONSULT, AND APPROVE ANY CHANGES OR DEVIATIONS FROM THE MISSION AND VALUES OF HOLY CROSS VILLAGE AT NOTRE DAME, INC. 2 - APPROVE ANNUAL BUDGETS AND SIMILARLY DEVELOPED BOARD OF DIRECTOR DOCUMENTS 3 - APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION, BYLAWS, AND SIMILAR GOVERNING DOCUMENTS 4 - APPOINT AND REMOVE DIRECTORS TO THE BOARD 5 - APPOINT AND REMOVE CHAIRPERSON AND PRESIDENT BASED UPON RECOMMENDATION OF THE BOARD 6 - APPROVE ANY MERGER, CONSOLIDATION, DISSOLUTION, OR LIQUIDATION OF HOLY CROSS VILLAGE AT NOTRE DAME, INC. 7 - APPROVE PURCHASE, SALE, DONATION, LEASE, MORTGAGE OR OTHER ACQUISITION, DISPOSITION OR ENCUMBRANCE OF ASSETS, EXCEPT TRANSACTIONS WITHIN LIMITS DELEGATED TO HOLY CROSS VILLAGE AT NOTRE DAME, INC. OR PREVIOUSLY APPROVED AS PART OF A STRATEGIC AND FINANCIAL PLAN. 8 - APPROVE ESTABLISHMENT, TERMINATION, TRANSFER OR OTHER ACQUISITION OR DISPOSITION OF ANY MAJOR MINISTRY OR SIMILAR PROGRAM 9 - APPROVE CREATION OF ANY NEW AFFILIATE OR AFFILIATION OF HOLY CROSS VILLAGE AT NOTRE DAME, INC. WITH ANOTHER ENTITY 10 - APPROVE INCURRENCE OF DEBT TO OTHER ENTITIES OR THE GUARANTY OR DEBT OF OTHERS FOR THE AMOUNTS IN EXCESS OF THE MEMBER SPECIFIED LIMITS, EXCEPT FOR ANY TRANSACTIONS PREVIOUSLY APPROVED AS PART OF A STRATEGIC AND FINANCIAL PLAN. 11 - ESTABLISH DOLLAR LIMITS WITH HOLY CROSS VILLAGE AT NOTRE DAME, INC. MAY AUTHORIZE FINANCIAL EXPENDITURES, INCLUDING CONRACTS INVOLVING EXPENDITURES. 12 - ESTABLISH DOLLAR LIMITS WHICH HOLY CROSS VILLAGE AT NOTRE DAME MAY AUTHORIZE LITIGATION SETTLEMENTS OR RELEASE OR CANCEL ANY CLAIM OF ACTION AGAINST ANOTHER PARTY.
FORM 990, PART VI, SECTION B, LINE 11B	HOLY CROSS VILLAGE MANAGEMENT REVIEWED A DRAFT OF THE FORM 990 & 990T IN DETAIL. A FINAL DRAFT OF THE 990 & 990T, INCLUDING ALL APPLICABLE SCHEDULES, WAS THEN DISTRIBUTED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS. FORMAL ACCEPTANCE OF THE DRAFT OF THE 990 & 990T IS DOCUMENTED.
FORM 990, PART VI, SECTION B, LINE 12C	A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO THE BOARD MEMBERS ANNUALLY. THE COMPLETED FORMS ARE REVIEWED FOR POTENTIAL CONFLICTS. IF A CONFLICT IS NOTED, THE MEMBER IS EXCUSED FROM VOTING ON ANY ISSUE RELATED TO THE CONFLICT. THE CONFLICT OF INTEREST POLICY AND QUESTIONNAIRE IS ALSO PART OF THE HOLY CROSS VILLAGE ANNUAL REVIEW POLICY FOR ALL EMPLOYEES.
FORM 990, PART VI, SECTION B, LINE 15A & 15B	HCV HAS AN EXECUTIVE COMPENSATION COMMITTEE THAT REVIEWS TOP EXECUTIVE LEVEL COMPENSATION EVERY TWO YEARS FOR INCREASES. DUE TO TURNOVER IN TOP EXECUTIVES NO INCREASES HAVE BEEN ESTABLISHED, HOWEVER THE BOARD APPROVED THE COMPENSATION OFFERED TO EACH EXECUTIVE. COMP REVIEWS ARE PLANNED FOR ANNIVERSARY DATES OF THESE EXECUTIVES.
FORM 990, PART VI, SECTION C, LINE 19	HOLY CROSS VILLAGE AT NOTRE DAME INC.'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST IN AN ELECTRONIC PDF FILE OR PRINTED PAPER FORMAT.
FORM 990, PART XI, LINE 9	CHANGE IN BENEFICIAL INTEREST $ 198,954 GAIN ON INTEREST RATE SWAP VALUATION $1,719,374 TOTAL $1,918,328
FORM 990 PART IX LINE 11G	DESCRIPTION:THERAPY TOTAL FEES:392491
FORM 990 PART IX LINE 11G	DESCRIPTION:DINING SERVICES TOTAL FEES:2131575
FORM 990 PART IX LINE 11G	DESCRIPTION:PLANT REPAIRS & MAINT. TOTAL FEES:380043
FORM 990 PART IX LINE 11G	DESCRIPTION:HUMAN RESOURCES TOTAL FEES:77290
FORM 990 PART IX LINE 11G	DESCRIPTION:AGENCY TOTAL FEES:444521
FORM 990 PART IX LINE 11G	DESCRIPTION:CONSULTANT TOTAL FEES:16282
FORM 990 PART IX LINE 11G	DESCRIPTION:LAUNDY & HOUSEKEEPING TOTAL FEES:204739
FORM 990 PART IX LINE 11G	DESCRIPTION:TRANSPORTATION TOTAL FEES:7507
FORM 990 PART IX LINE 11G	DESCRIPTION:MEDICAL SERVICES TOTAL FEES:25296
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER TOTAL FEES:101576

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

HOLY CROSS VILLAGE AT NOTRE DAME INC

Employer identification number

35-2084623

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)BROTHERS OF HOLY CROSS INC 54515 SR 933 N PO BOX 460 NOTRE DAME,IN465560460 35-0868938	RELIGIOUS ORD	IN	501(C)(3)	1	CONG OF HC		No
(2)HOLY CROSS VILLAGE FOUNDATION INC 54515 SR 933 N PO BOX 303 NOTRE DAME,IN465560303 26-3861889	SUPPORT HCV	IN	501(C)(3)	12 TYPE II	BROTH OF HC		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: AN INTERDEPENDENT COMMUNITY ENERGIZED BY HOLY CROSS SPIRITUALITY AND HOSPITALITY, AND DEDICATED TO PROVIDING A NURTURING ENVIRONMENT FOCUSED ON DIGNITY AND RESPECT.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	194
6	Total number of volunteers (estimate if necessary) .............	6	25
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	159,555
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,065,272	704,733
9	Program service revenue (Part VIII, line 2g) .........	13,475,614	14,700,864
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	501,762	-79,587
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	332,795	408,701
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	15,375,443	15,734,711
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	6,209,785	6,724,225
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	4,538	0
b	Total fundraising expenses (Part IX, column (D), line 25) 54,666
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	11,403,472	11,882,097
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	17,617,795	18,606,322
19	Revenue less expenses. Subtract line 18 from line 12.......	-2,242,352	-2,871,611
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	38,111,514	35,912,391
21	Total liabilities (Part X, line 26).............	61,532,243	60,836,394
22	Net assets or fund balances. Subtract line 21 from line 20.....	-23,420,729	-24,924,003

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 7,434,160 including grants of $ ) (Revenue $ 8,930,298 )
	INDEPENDENT AND ASSISTED LIVING: HOLY CROSS VILLAGE AT NOTRE DAME (HOLY CROSS VILLAGE) PROVIDES A COMPREHENSIVE SELECTION OF RESIDENTIAL LIVING OPTIONS SUPPORTED BY A FULL CONTINUUM OF ON-SITE HEALTH CARE. INDEPENDENT LIVING RESIDENTS ENJOY AN ACTIVE LIFESTYLE, COMPLEMENTED BY SUPERIOR SERVICES AND AMENITIES. PLUS, THEY HAVE THE ASSURANCE OF ON-SITE QUALITY HEALTH CARE, IF EVER NEEDED, AT AN AFFORDABLE, PREDICTABLE COST. HOLY CROSS VILLAGE IS AN INTERDEPENDENT COMMUNITY ENERGIZED BY HOLY CROSS SPIRITUALITY AND HOSPITALITY, AND DEDICATED TO PROVIDING A NURTURING ENVIRONMENT FOCUSED ON DIGNITY AND RESPECT. HOLY CROSS VILLAGE GOES BEYOND WHAT'S EXPECTED TO OFFER A LIFESTYLE THAT ALLOWS RESIDENTS TO LIVE AS INDEPENDENTLY AS POSSIBLE, WHILE STAYING CLOSE TO FAMILY, FRIENDS, AND THE BEST CARE AVAILABLE. RESIDENTS HAVE PEACE OF MIND KNOWING THEIR FUTURES ARE SECURE, WHICH IS SOMETHING THEY WILL VALUE AS MUCH TODAY AS THEY WILL TOMORROW. HOLY CROSS VILLAGE IS ALSO A LICENSED ASSISTED LIVING COMMUNITY, AND OUR ASSISTED LIVING APARTMENTS ALLOW FOR PRIVACY AND INDEPENDENCE. IF RESIDENTS REQUIRE ASSISTANCE WITH ACTIVITIES OF DAILY LIVING, OUR COMPREHENSIVE RANGE OF SUPPORTIVE SERVICES IS DESIGNED TO FIT THEIR NEEDS, AND OUR CARING STAFF IS AVAILABLE 24 HOURS A DAY TO ASSIST THEM. DURING THE YEAR ENDED JUNE 30, 2022 THE ORGANIZATION PROVIDED SERVICES TO 201 RESIDENTS IN AN INDEPENDENT LIVING SETTING WITH 154 APARTMENTS AND VILLAS, AS WELL AS 45 RESIDENTS IN AN ASSISTED LVING SETTING WITH 46 APARTMENTS.

4b	(Code: ) (Expenses $ 6,949,416 including grants of $ 687,836 ) (Revenue $ 6,015,844 )
	SKILLED NURSING AND MEMORY CARE: HOLY CROSS VILLAGE IS LICENSED BY THE STATE DEPARTMENT OF HEALTH AS A CONTINUING CARE RETIREMENT COMMUNITY (CCRC) AND A SKILLED NURSING FACILITY. SERVICES ARE RESIDENT-CENTERED AND ARE FOCUSED ON LONG-TERM HEALTH CARE NEEDS AND/OR DIRECTED TO INDIVIDUALS THAT ARE RECOVERING FROM A BRIEF ILLNESS AND NEED TO REBUILD STRENGTH. REHABILITATION SERVICES ARE DELIVERED IN A RESIDENT-CENTERED PROGRAM THAT IS FOCUSED ON ACHIEVING POSITIVE OUTCOMES. RESIDENTS RECEIVE 24-HOUR NURSING SUPERVISION AND RESTORATIVE THERAPIES THAT ARE PHYSICIAN DIRECTED. THE ONSITE REHABILITATION CENTER DELIVERS PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES AS WELL AS OTHER SPECIALIZED SERVICES TO MEET REHABILITATION NEEDS. MEMORY CARE ACCOMMODATIONS ARE OFFERED IN A SECURED ENVIRONMENT DESIGNED TO MEET THE NEEDS OF SENIORS WITH ALZHEIMER'S, DEMENTIA, AND OTHER MEMORY LOSS. INDIVIDUALS WHO NEED HELP WITH DAY TO-DAY LIVING RECEIVE SPECIAL ENCOURAGEMENT TO ADD MEANING AND FULFILLMENT TO THEIR LIVES. SERVICES ARE TAILORED SPECIFICALLY TO EACH RESIDENT WHILE SUPPORTING A HEALTHY LIFESTYLE IN A SECURED AREA THAT HAS ACCESS TO A COURTYARD AND VIEWS OF A WOODED AREA. CERITIFIED NURSING ASSISTANTS PROVIDE STANDBY AND HANDS ON ASSISTANCE WITH BATHING, GROOMING AND ESCORTS. RESIDENTS ARE ENCOURAGED TO CONTINUE ACTIVITIES THEY LOVE AND ENJOY. A WIDE RANGE OF LIFE ENRICHING ACTIVITIES ARE PLANNED FOR RESIDENTS EACH DAY THAT ARE TARGETED TO RAISE SPIRITS, STIMULATE MINDS AND PROMOTE HAPPINESS. DURING THE YEAR ENDED JUNE 30, 2022, THE ORGANIZATION PROVIDED SERVICES TO 197 RESIDENTS IN A NURSING SETTING WITH 38 BEDS AND A NURSING DEMENTIA CENTER WITH 12 ROOMS.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses14,383,576

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)		(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) ELIZABETH HUGE...................................................................... CFO	40.0 ................. 1.0		X	126,456	0	7,863
(2) EDWARD SMITH LEFT 322...................................................................... VP AND GENERAL MANAGER	40.0 ................. 1.0		X	125,984	0	1,125
(3) JACK MUELLER...................................................................... EXECUTIVE ADMINISTRATOR	40.0 ................. 0.0		X	86,055	0	5,366
(4) MAUREEN MILLER...................................................................... CHAIRPERSON	1.0 ................. 0.0	X	X	0	0	0
(5) FR JAMES LACKENMIER CSC...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0	0
(6) BR CHESTER FREEL CSC...................................................................... TREASURER	1.0 ................. 0.0	X	X	0	0	0
(7) LINDA PASKIEWICZ...................................................................... SECRETARY	1.0 ................. 0.0	X	X	0	0	0
(8) BR KENNETH HADERS CSC...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0	0
(9) BR HAROLD EHLINGER CSC...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0	0
(10) BR LAWRENCE SKITZKI CSC...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0	0
(11) SHARON KEANE...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0	0
(12) MARK NEFF...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0	0

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	338,495	0	14,354

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	687,836

f	All other contributions, gifts, grants, and similar amounts not included above		1f	16,897

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		704,733

		Business Code
2a	INDEPENDENT AND ASSISTED LIVING	623000	8,589,239	8,589,239
b	NURSING SERVICES	623000	6,015,844	6,015,844
c	DINING, CAFETERIA & SNACK SHOP	900099	41,056	41,056
d	REBATES, REFUNDS & PURCHASE DISCOUNTS	900099	54,725	54,725
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		14,700,864

3 Investment income (including dividends, interest, and othersimilar amounts) ......			121,924			121,924
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		3,868	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	3,868	6c
d	Net rental income or (loss).......			3,868			3,868
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		2,483,000	7a
b	Less: cost or other basis and sales expenses		2,684,511	7b
c	Gain or (loss)		-201,511	7c
d	Net gain or (loss).........			-201,511			-201,511
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	SECURITY SERVICES		561612	404,833	245,278	159,555
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			404,833
12	Total revenue. See instructions.....			15,734,711	14,946,142	159,555	-75,719

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	0
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	335,153	158,855	176,298
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	5,041,753	3,862,426	1,130,071	49,256
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	245,839	234,732	9,385	1,722
9	Other employee benefits .......	711,928	479,241	232,687
10	Payroll taxes ...........	389,552	294,289	91,575	3,688
11	Fees for services (non-employees):
a	Management ......	644,785		644,785
b	Legal .........	51,133		51,133
c	Accounting ...........	101,424		101,424
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	18,642		18,642
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	3,781,320	3,515,967	265,353
12	Advertising and promotion ....	22,561	22,561
13	Office expenses .......	55,349	13,005	42,344
14	Information technology ......	194,416	1,346	193,070
15	Royalties ..	0
16	Occupancy ...........	1,472,001	1,464,773	7,228
17	Travel ............	62,715		62,715
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	11,042	8,629	2,413
20	Interest ...........	806,449		806,449
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	2,913,602	2,893,207	20,395
23	Insurance ...	214,335		214,335
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	PATIENT SUPPLIES	1,370,917	1,370,917
b	OTHER EXPENSES	161,406	63,628	97,778
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	18,606,322	14,383,576	4,168,080	54,666
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			33,008	1	65,203
2	Savings and temporary cash investments .........			2,850,992	2	3,279,978
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			414,582	4	410,037
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			43,708	8	42,969
9	Prepaid expenses and deferred charges ......			99,144	9	44,453
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	70,062,233
b	Less: accumulated depreciation	10b	45,024,271	26,898,381	10c	25,037,962
11	Investments—publicly traded securities .			6,639,878	11	5,553,261
12	Investments—other securities. See Part IV, line 11 .....			1,053,946	12	970,763
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			77,875	15	507,765
16	Total assets. Add lines 1 through 15 (must equal line 33)...			38,111,514	16	35,912,391

17	Accounts payable and accrued expenses .....	1,761,316	17	2,242,814
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	21,161,814	20	20,278,745
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	38,609,113	25	38,314,835
26	Total liabilities. Add lines 17 through 25..	61,532,243	26	60,836,394

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	-24,474,675	27	-25,894,766
28	Net assets with donor restrictions ...........	1,053,946	28	970,763
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	-23,420,729	32	-24,924,003
33	Total liabilities and net assets/fund balances ........	38,111,514	33	35,912,391