2022-05-24T14:01:30-05:00 2021-09-30 420714325 RSM US LLP 30 S Wacker Drive Ste 3300 Chicago IL 60606 990 2020-10-01 363867476 Tabor Hills Health Care Facility Inc TABO 6307786677 1347 Crystal Avenue Naperville IL 60563 Frances Salinas Chief Executive Officer 6307786677 2022-05-23 1 Frances Salinas XXX-XX-XXXX Rebekuh Eley P01247672 3126343400 2022-05-23 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Frances Salinas 1347 Crystal Avenue Naperville IL 60563 13809692 0 X www.taborhills.org X 1992 IL Tabor Hills provides an extensive range of services and programs which enhances the well-being of residents living in our community. Tabor Hills' priority is meeting the needs of its residents using resources in a fiscally responsible manner, insuring the financial stability of the corporation. 12 10 213 9 0 0 641353 1750239 13004561 12055008 0 0 4977 4445 13650891 13809692 0 0 0 0 9302842 8900811 0 0 0 5496807 5183441 14799649 14084252 -1148758 -274560 16030774 16011372 6244211 4328370 9786563 11683002 Tabor Hills is committed to offering quality senior care by seeking to provide a safe and comfortable environment focused on dignity and self-determination. 0 0 13025889 12055008 Tabor Hills provides long-term skilled nursing care to its residents, inpatient and outpatient rehabilitation services, and offers outside activity and support to our seniors who prefer to live at home through our Senior Day Services program. Tabor provided care to 221 residents enrolled in the Medicare program during fiscal year 2021. Of these approximately 70% returned to the community, 20% returned or stayed on our campus, and 10% returned to the hospital or expired. Total days care for fiscal year 2021: 40,741 (Medicare Days 3,021, Public Aid Days 14,950) 13025889 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 126 0 1 213 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X Claudia Mendoza 6307786677 1347 Crystal Avenue Naperville IL 60563 Frances Salinas CEO 40.00 1.00 X X 219281 0 58861 Rima Bentulan Registered Nurse 40.00 0.00 X 142802 0 18986 Emelinda Lantin Registered Nurse 40.00 0.00 X 136740 0 13563 John Lawler Director of Environmental Services 45.00 0.00 X 124536 0 18111 Evelyn Mamparo Registered Nurse 40.00 0.00 X 126707 0 6581 Anthony J Harvat Executive Administrator 40.00 0.00 X 118937 0 1952 Robert Peiler Vice President 18.00 1.00 X X 10607 0 0 Gloria J Pindiak President 1.50 1.00 X X 0 0 0 James Hill Treasurer 1.50 1.00 X X 0 0 0 Lynda Filipello Secretary 1.50 1.00 X X 0 0 0 John Bozett Director 1.50 1.00 X 0 0 0 Angeline Bultas Director 1.50 1.00 X 0 0 0 John Eckman Director (Until Jan 2021) 1.50 1.00 X 0 0 0 James Kopriva Director 1.50 1.00 X 0 0 0 Judy Mayer Director 1.50 1.00 X 0 0 0 Dr Frank Michalek Director 1.50 1.00 X 0 0 0 Rena Strahorn Director 1.50 1.00 X 0 0 0 Aaron Troy Director 1.50 1.00 X 0 0 0 879610 0 118054 14 0 1 0 Grapetree Medical Staffing 2501 Boji Bend Drive Suite 100 Milford IA 51351 Nursing Services 281669 JM Hawkins Inc 800 Roosevelt Road Bldg B Suite Glen Ellyn IL 60137 Computer Services 138902 ShiftMed LLC 7925 Jones Branch Drive Suite 110 Mclean VA 22102 Nursing Services 137871 McKesson Medical-Surgical 9954 Mayland Drive Suite 5176A Henrico VA 23233 Pharmacy/Nursing Supplies 137131 Total Nurses Network 7026 W North Avenue 2W Chicago IL 60707 Nursing Services 119061 6 1750239 1750239 Resident Care 623311 12055008 12055008 12055008 Beautician and Barber 900099 4445 4445 4445 13809692 12055008 0 4445 X 160266 160266 7289586 6811040 478546 164419 164419 771264 771264 515276 515276 31885 31885 70774 70774 1424295 1424295 26067 26067 34384 34384 178577 178577 270451 216553 53898 8637 8637 3498 3498 118739 118739 804817 804817 291673 291673 Pharmacy & Supplies 580495 580495 Resident Food 427757 427757 Maint. & Repairs 364496 364496 Assess. Fees/Provider T 307711 307711 239185 223856 15329 14084252 13025889 1058363 0 1432501 1682150 91217 130523 28256980 14599968 14237115 13657012 269941 541687 16030774 16011372 886154 946459 68481 0 2835595 2619776 1580700 0 873281 762135 6244211 4328370 X 9786563 11683002 9786563 11683002 16030774 16011372 X -274560 2170999 X 0 1 X 0 0 X 641353 1750239 2391592 13299543 12186791 11976682 13004561 12055008 62522585 19002 4213 337 4977 4445 32974 13318545 12191004 11977019 13650891 13809692 64947151 0 0 0 64947151 13318545 12191004 11977019 13650891 13809692 64947151 1.00000 1.00000 0.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 574693 574693 21206160 9034449 12171711 2386820 1992587 394233 4089307 3572932 516375 13657012 Resident Credit Balances 759836 Due to Third Party Payor 2299 762135 X Part X, Line 2: Tabor Hills is classified by the Internal Revenue Service (IRS) as an organization exempt from income tax under Section 501(c)(3) of the Internal Revenue Code and is similarly classified by the Illinois Department of Revenue. Tabor Hills files a Form 990 (Return of Organization Exempt from Income Tax) annually. When the return is filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Unrelated business income (UBI) is reported on Form 990-T, as appropriate. The benefit of a tax position is recognized in the consolidated financial statements in the period during which, based on all available evidence, management believes that it is more likely than not that the position will be sustained upon examination, including the resolution of appeals or litigation processes, if any. Tax positions are not offset or aggregated with other positions. Tax positions that meet the "more likely than not" recognition threshold are measured as the largest amount of tax benefit that is more than 50% likely to be realized on settlement with the applicable taxing authority. The portion of the benefits associated with tax positions taken that exceeds the amount measured as described above is reflected as a liability for unrecognized tax benefits in the accompanying consolidated balance sheets along with any associated interest and penalties that would be payable to the taxing authorities upon examination. As of September 30, 2021 and 2020, there were no unrecognized tax benefits identified and recorded as liabilities. Form 990 filed by Tabor Hills is subject to examination by the IRS up to three years from the extended due date of each return. Form 990 filed by Tabor Hills is no longer subject to examination for the years ended September 30, 2017 and prior. X X X 0 0 0 0 0 0 0 0 0 Frances Salinas CEO 219281 0 0 0 0 0 37822 0 21039 0 278142 0 0 0 Rima Bentulan Registered Nurse 142802 0 0 0 0 0 0 0 18986 0 161788 0 0 0 Emelinda Lantin Registered Nurse 136740 0 0 0 0 0 5601 0 7962 0 150303 0 0 0 A Illinois Finance Authority - Series 2021 861091967 2021-03-31 2443100 Payment of Existing 2017 Bonds 0 0 0 A 109393 2443100 2443100 2032 0 0 0 1 A 0 0 0 0 1 0 1 A 0 1 0 0 0 0 0 0 1 A 1 Part I, Column (e): Series 2021: The total issue price of the the tax-exempt bond reported on Form 8038 was $11,000,000. The difference is reported on the Form 990 for Bohemian Home for the Aged (EIN: 36-2181959). Form 990, Part VI, Section A, line 6 The sole corporate member is Bohemian Home for the Aged. Form 990, Part VI, Section A, line 7a The sole corporate member, Bohemian Home for the Aged, has the power to elect individuals to the Board of Directors. Form 990, Part VI, Section A, line 7b The sole corporate member, Bohemian Home for the Aged, has all rights vested in members of a corporation under the Illinois General Not For Profit Corporation Act of 1986, as amended. Form 990, Part VI, Section B, line 11b The CEO and Board of Directors review Form 990 before filing. Form 990, Part VI, Section B, line 12c All Board of Directors must complete an annual disclosure statement in accordance with corporate compliance policy. The statements are reviewed by the Corporate Compliance Committee. Should a conflict arise, it is investigated, documented, and a corrective action is put into place. If necessary, this is reviewed by legal counsel. Form 990, Part VI, Section B, line 15 Compensation of the CEO and officers is determined by the Board of Directors based on annual performance appraisals, compensation data of comparable nonprofit organizations, and salary surveys specific to the healthcare industry. The annual performance evaluation is reviewed and signed by the Board Chair President. Form 990, Part VI, Section C, line 19 As part of Tabor Hills Health Care Facility, Inc.'s policy, all financial statements, 990 filings, governing documents, and corporate compliance policies are filed in the administrative offices and are available for public viewing upon request for the same period of disclosure as set forth in IRC Section 6104(d). Form 990, Part IX, line 11g Professional Fees: Program service expenses 1,424,295. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,424,295. Form 990, Part XI, line 9: Interorganization Transfers 1,770,320. Change in pension obligation liability 400,679. Bohemian Home for the Aged 1347 Crystal Avenue Naperville IL 60563 362181959 Housing and services for elderly independent living IL 501(c)(3) Line 10 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1