2018-11-15T15:30:02-06:00 2017-12-31 431594752 MUELLER PROST LC 7733 FORSYTH BLVD SUITE 1200 ST LOUIS MO 63105 990 2017-01-01 474341949 GRANT - PROGRESSIVE ELDERCARE SERVICES INC GRAN 8709422183 113 SOUTH BRIARWOOD DR SHERIDAN AR 72150 JODI DAVIS-LOGAN PRESIDENT 8709422183 2018-11-15 1 JEANETTE BAX-KURTZ P00096490 3148622070 2018-11-15 71.91.236.98 2018-11-15 08:54:32 CS P 8A49AFD2650A15773C838A67687DC14137420D22 8C32BF8975EE52E712EE0F7FFCB876BF204F01B2 2017 2019-02-21 02:37:17Z SHERIDAN HEALTHCARE AND REHABILITATION CENTER JODI DAVIS-LOGAN 113 SOUTH BRIARWOOD DR SHERIDAN AR 72150 6658096 0 X SHERIDANREHABCENTER.COM X 2015 AR TO FACILITATE COMPASSIONATE HEALTH CARE WITH CLINICAL QUALITY AND SERVICE EXCELLENCE IN A DIGNIFIED AND RESPECTFUL "HOME" ENVIRONMENT FOR ELDERS WHO REQUIRE LONG-TERM CARE SERVICES. 3 2 0 30 0 0 0 0 6694842 6657926 1 170 0 0 6694843 6658096 0 0 0 0 0 0 0 0 0 6369181 6557131 6369181 6557131 325662 100965 1360636 1958065 1229100 1725564 131536 232501 THE ORGANIZATION PROVIDES AFFORDABLE SKILLED NURSING AND REHABILATIVE CARE TO ILL, INFIRM, MEDICALLY DISABLED AND ELDERLY INDIVIDUALS IN A NON-TRADITIONAL LONG-TERM CARE ENVIRONMENT UTILIZING THE "CULTURE CHANGE OR "PERSON CENTERED" CARE MODEL. 0 0 6265150 6657926 THE ORGANIZATION ACTS IN CONCERT WITH PROGRESSIVE ELDERCARE SERVICES, INC. (PES, INC.) TO FORM A NETWORK OF NURSING FACILITIES TO SERVE AS LOCATIONS FOR PROMOTING, DEVELOPING AND ADMINISTERING "CULTURE CHANGE," PERSON-CENTERED, LONG-TERM CARE FOR ILL, INFIRM, MEDICALLY DISABLED AND ELDERLY INDIVIDUALS. THE "CULTURE CHANGE" MODEL OF CARE IS DESIGNED TO EMPOWER ELDERS AND STAFF TO PARTICIPATE IN THE ESTABLISHMENT OF PATHWAYS THAT RESULT IN A HIGH DEGREE OF CHOICE, AUTONOMY, DIGNITY AND SELF-DETERMINATION FOR THE ELDERS SERVED. IT IS ANTICIPATED THAT WITH CONCERTED EFFORTS THE ORGANIZATION WILL INCREASE THE AVAILABILITY AND QUALITY OF HEALTH CARE FOR ITS RESPECTIVE COMMUNITIES, RESULTING IN BETTER HEALTH OUTCOMES AND QUALITY OF LIFE FOR THE ELDERLY. IN 2017, THE ORGANIZATION SERVED 168 RESIDENTS. 6265150 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 20 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 2 0 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X TRENT UNRUH 3184438167 2230 S MACARTHUR DRIVE ALEXANDRIA LA 71301 X JODI DAVIS-LOGAN PRESIDENT, DIRECTOR 5.00 40.00 X X 0 69684 0 LEAH REYNOLDS DIRECTOR 5.00 X 0 0 0 JEFF LISENBEY DIRECTOR 5.00 X 0 0 0 0 69684 0 0 0 0 0 CAREPLUS STAFFING SERVICES LLC PO BOX 11592 ALEXANDRIA LA 71315 EMPLOYEE LEASING 2326000 PROCARE THERAPY SERVICES LLC PO BOX 12071 ALEXANDRIA LA 71315 REHABILITATION & ADMIN 728799 MASTER TEN 2230 S MACARTHUR ALEXANDRIA LA 71301 REAL ESTATE LESSOR 684095 ALLCARE PHARMACY 3002 W PINE STREET ARKADELPHIA AR 71923 PHARMACY SERVICES 185631 HEALTHCARE SERVICES GROUP 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 HOUSEKEEPING 181352 7 PATIENT CARE REVENUE 623000 6657926 6657926 6657926 170 170 6658096 6657926 0 170 222954 22295 200659 2238 2238 49700 49700 516282 516282 8521 8521 16753 16753 149054 149054 800929 761904 39025 2261 2261 12748 12748 312236 311877 359 CONTRACT LEASE EXPENSE 3720321 3720321 MEDICAL SUPPLIES 305995 305995 FOOD EXPENSE 214549 214549 BILLING SERVICES 54000 54000 168590 168590 6557131 6265150 291981 0 374854 723090 907793 1152399 8004 6586 97486 21746 66088 75740 3897 250 1360636 1958065 1134315 1722674 94785 2890 1229100 1725564 X 131536 232501 131536 232501 1360636 1958065 100965 0 X 1 X 0 0 0 X 2149181 6694842 6657926 15501949 2149181 6694842 6657926 15501949 7317 21951 29268 0 7317 21951 29268 15472681 1 170 171 1 170 171 2149181 6694843 6658096 15502120 0.99810 0.00000 X SCHEDULE A, PART III, SECTION B, LINE 14 THE ENTITY WAS CREATED ON JUNE 10, 2015. 8655 710 7945 81342 17801 63541 7489 3235 4254 75740 DUE TO PROGRESSIVE ELDERCARE SERVICES, INC. (PARENT) 2890 2890 X PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT ORGANIZATION THAT IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS OTHER THAN A PRIVATE FOUNDATION. THE ORGANIZATION HAS RECEIVED A LETTER OF DETERMINATION OF TAX EXEMPT STATUS WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION A, LINE 3 ADMINISTRATIVE DUTIES ARE DELEGATED TO A MANAGEMENT COMPANY, SOUTHERN ADMINISTRATIVE SERVICES, LLC. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S PARENT ENTITY, PROGRESSIVE ELDERCARE SERVICES, INC., IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD MEMBERS RECEIVE A COPY OF THE FORM 990 TO REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH DIRECTOR DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON:(A) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; (B)HAS READ AND UNDERSTANDS THE POLICY; (C)HAS AGREED TO COMPLY WITH THE POLICY; AND (D) UNDERSTANDS THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. TO ENSURE THE ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH CHARITABLE PURPOSES AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS TAX-EXEMPT STATUS, PERIODIC REVIEWS SHALL BE CONDUCTED. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DOES NOT EMPLOY ANY EMPLOYEES, BUT HAS AN AGREEMENT FOR THE ADMINISTRATOR AND ADDITIONAL SERVICES WITH ITS MEMBER, PROGRESSIVE ELDERCARE SERVICES, INC. PROGRESSIVE ELDERCARE SERVICES, INC. SETS COMPENSATION, AND THE ORGANIZATION'S INDEPENDENT DIRECTORS ACCEPT OR RATIFY THE SUBJECT EMPLOYMENT AGREEMENT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND ANNUAL FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VII, SECTION A JODI DAVIS-LOGAN, DIRECTOR OF THE ORGANIZATION, IS ALSO AN EMPLOYEE FOR PROGRESSIVE ELDERCARE SERVICES, INC. (PARENT). SHE IS NOT COMPENSATED FOR HER ROLE AS A DIRECTOR OF THE ORGANIZATION, BUT RECEIVES A SALARY FOR HER ROLE AS AN EMPLOYEE OF PROGRESSIVE ELDERCARE SERVICES, INC. PROGRESSIVE ELDERCARE SERVICES INC (PARENT) 38 WARNOCK SPRINGS ROAD MAGNOLIA AR 71753 273040964 FACILITATE THE OPERATION OF LONG-TERM CARE FACILITIES AR 501(C)(3) LINE 11 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0