SJL HEALTH SYSTEMS INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- SJL HEALTH SYSTEMS INC (EIN 43-1710785)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-08-30
- IRS object ID
- 202122429349300622
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-08-30T09:17:49-05:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 371106622 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Ginoli & Company LtdCPA's | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7625 N University Ste A | AddressLine1Txt |
| City | Peoria | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 616148303 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 431710785 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SJL HEALTH SYSTEMS INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SJLH | BusinessNameControlTxt |
| Phone | 3096918113 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 W TRAILCREEK DR | AddressLine1Txt |
| City | PEORIA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 616141862 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BECKY STOKES | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 3096918113 | PhoneNum |
| Signature | 2021-08-26 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | BECKY | PersonFirstNm |
| Person Last | STOKES | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL REMMELECPA | PreparerPersonNm |
| PTIN | P00444163 | PTIN |
| Phone | 3096712350 | PhoneNum |
| Preparation | 2021-08-26 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | BECKY STOKES | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 W TRAILCREEK DR | AddressLine1Txt |
| City | PEORIA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61614 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,751,863 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2000 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | OPERATION OF A SKILLED NURSING CENTER | ActivityOrMissionDesc |
| Voting Members Governing Body | 3 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 102 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,330,021 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $3,582,303 | CYProgramServiceRevenueAmt |
| PY Investment Income | $117 | PYInvestmentIncomeAmt |
| CY Investment Income | $77 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $169,483 | CYOtherRevenueAmt |
| PY Total Revenue | $3,330,138 | PYTotalRevenueAmt |
| CY Total Revenue | $3,751,863 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,536,587 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,354,677 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,734,872 | PYOtherExpensesAmt |
| CY Other Expenses | $2,486,156 | CYOtherExpensesAmt |
| PY Total Expenses | $3,271,459 | PYTotalExpensesAmt |
| CY Total Expenses | $3,840,833 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $58,679 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$88,970 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,094,708 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,684,319 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,614,086 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,292,667 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$2,519,378 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$2,608,348 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE CARE FOR THE ELDERLY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,114,727 | ExpenseAmt |
| Revenue | $3,751,863 | RevenueAmt |
| Desc | OPERATION OF A SKILLED NURSING CENTER | Desc |
| Total Program Service Expenses | $3,114,727 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 11 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 102 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 3 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | 0 | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicyInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARK B PETERSEN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3096918113 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 830 W TRAILCREEK DR | AddressLine1Txt |
| City | PEORIA | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 61614 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (3 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|
| MICHAEL KUHL | |||||
| PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 |
| THOMAS HAMMERTON | |||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 |
| BECKY STOKES | |||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REHABCARE GROUP INC | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | CONTRACT THERAPY DIVISION PO BOX 50 | AddressLine1Txt |
| City | ST LOUIS | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 631503534 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | THERAPY SERVICES | ServicesDesc |
| Compensation | $245,987 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE | 623000 | $3,575,942 | $3,575,942 |
| RESIDENT SERVICES | 623000 | $6,361 | $6,361 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $3,582,303 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $77 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $77 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | COVID related CARES AC | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $169,483 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $169,483 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $169,483 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,751,863 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $3,751,863 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,254,081 | TotalAmt |
| Program Services | $1,173,656 | ProgramServicesAmt |
| Management And General | $80,425 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,596 | TotalAmt |
| Program Services | $94,145 | ProgramServicesAmt |
| Management And General | $6,451 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,143 | TotalAmt |
| Management And General | $47,143 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,765 | TotalAmt |
| Management And General | $8,765 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $691 | TotalAmt |
| Management And General | $691 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,459 | TotalAmt |
| Management And General | $1,459 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,814 | TotalAmt |
| Management And General | $9,814 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $276 | TotalAmt |
| Management And General | $276 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,043 | TotalAmt |
| Program Services | $157,043 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $111,879 | TotalAmt |
| Program Services | $111,879 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| NURSING SERVICES | $742,714 | $742,714 | |
| PURCHASED SERVICES | $326,075 | $326,075 | |
| MANAGEMENT FEE | $214,000 | $214,000 | |
| PROVIDER BED TAX | $155,602 | $155,602 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $710,695 | TotalAmt |
| Program Services | $353,613 | ProgramServicesAmt |
| Management And General | $357,082 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,840,833 | TotalAmt |
| Program Services | $3,114,727 | ProgramServicesAmt |
| Management And General | $726,106 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $593,674 | BOYAmt |
| EOY | $220,278 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,419,992 | BOYAmt |
| EOY | $1,363,173 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,727 | BOYAmt |
| EOY | $13,727 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $4,643,837 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,064,200 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $668,811 | BOYAmt |
| EOY | $579,637 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $398,504 | BOYAmt |
| EOY | $507,504 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,094,708 | BOYAmt |
| EOY | $2,684,319 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $697,026 | BOYAmt |
| EOY | $1,022,594 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,566,589 | BOYAmt |
| EOY | $2,276,696 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,350,471 | BOYAmt |
| EOY | $1,993,377 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,614,086 | BOYAmt |
| EOY | $5,292,667 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$2,519,378 | BOYAmt |
| EOY | -$2,608,348 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$2,519,378 | BOYAmt |
| EOY | -$2,608,348 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,094,708 | BOYAmt |
| EOY | $2,684,319 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$88,970 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,726,323 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,835,566 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,138,793 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,330,021 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,751,786 | CurrentTaxYearAmt |
| Total | $15,782,489 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,726,323 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,835,566 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,138,793 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,330,021 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,751,786 | CurrentTaxYearAmt |
| Total | $15,782,489 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $15,782,489 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $112 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $89 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $115 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $117 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $77 | CurrentTaxYearAmt |
| Total | $510 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $112 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $89 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $115 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $117 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $77 | CurrentTaxYearAmt |
| Total | $510 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,726,435 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,835,655 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,138,908 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,330,138 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,751,863 | CurrentTaxYearAmt |
| Total | $15,782,999 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 1.00000 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99990 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00010 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $13,500 | InvestmentCostOrOtherBasisAmt |
| Book Value | $13,500 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $3,369,652 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $2,813,829 | DepreciationAmt |
| Book Value | $555,823 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $1,207,112 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $1,203,037 | DepreciationAmt |
| Book Value | $4,075 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $53,573 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $47,334 | DepreciationAmt |
| Book Value | $6,239 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $579,637 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ASSETS LIMITED AS TO USE | $478,403 |
| PREPAID EXPENSES | $29,101 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $507,504 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (6 entries)
| DescDesc | AmtAmt |
|---|---|
| ACCRUED PAYROLL | $176,103 |
| INTEREST PAYABLE | $12,857 |
| DUE TO AFFILIATES | $351,000 |
| OTHER LIABILITIES | $29,646 |
| ACCRUED MANAGEMENT FEES | $744,606 |
| CARES FUNDING | $679,165 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,993,377 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $3,751,863 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $3,751,863 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $3,751,863 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $3,840,833 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $3,840,833 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $3,840,833 | TotalExpensesPerForm990Amt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 3 | Management company operates the nursing home facility. |
| Form 990, Part VI, Section A, line 8a | No official meetings were held and no written actions were needed by the governing body. |
| Form 990, Part VI, Section A, line 8b | There were no committees with authority to act on behalf of the governing body. |
| Form 990, Part VI, Section B, line 11b | A draft copy of the Form 990 along with a copy of the audited financial statements are given to management to review. These are compared and any changes, if any, that are needed will be done at their request. |
| Form 990, Part VI, Section B, line 15 | The top management official is the Administrator of the nursing home. They are compensated at the same level of various other nursing home admistrators with the same responsibilites. All key employee salaries are set at the comparable rates with other nursing homes. |
| Form 990, Part VI, Section C, line 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC. |
| Form 990, Part IX, line 24e | MISC. ADMIN. EXPENSES: Program service expenses 0. Management and general expenses 142,651. Fundraising expenses 0. Total expenses 142,651. FOOD: Program service expenses 135,434. Management and general expenses 0. Fundraising expenses 0. Total expenses 135,434. OPERATIONS & MAINTENANCE: Program service expenses 0. Management and general expenses 130,431. Fundraising expenses 0. Total expenses 130,431. SUPPLIES: Program service expenses 102,786. Management and general expenses 0. Fundraising expenses 0. Total expenses 102,786. ADMINISTRATOR SALARY: Program service expenses 0. Management and general expenses 84,000. Fundraising expenses 0. Total expenses 84,000. PROPERTY & LIABILITY INSURANCE: Program service expenses 75,694. Management and general expenses 0. Fundraising expenses 0. Total expenses 75,694. WORKMEN'S COMPENSATION: Program service expenses 27,847. Management and general expenses 0. Fundraising expenses 0. Total expenses 27,847. EQUIPMENT RENTAL: Program service expenses 8,291. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,291. OTHER DIETARY: Program service expenses 3,561. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,561. |
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