2017-11-15T14:21:51-06:00 2016-12-31 311543240 CBIZ MHM LLC 401 PLYMOUTH ROAD SUITE 200 PLYMOUTH MEETING PA 19462 990 2016-01-01 721150472 American Family Services Inc AMER 2257530864 PO Box 40018 Baton Rouge LA 70835 RICHARD T DASPIT SR president 2257530864 2017-11-15 1 Joseph G Sullivan P00360476 6108622249 96.90.32.117 2017-11-15 07:45:31 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 20087036E5B3FD96C17AC6BE1EF3A98CB42C38E1 2016 2017-02-10 21:41:12Z RICHARD T DASPIT SR 17617 S HARRELLS FERRY ROAD BATON ROUGE LA 70816 3385899 0 X www.afshealth.org X 1989 LA TO PROVIDE COMPREHENSIVE NURSING CARE SERVICES. 3 0 151 0 0 0 851 0 3414137 3378943 9 25 12635 6931 3427632 3385899 0 0 0 0 2500975 2430552 0 0 0 1738947 1621374 4239922 4051926 -812290 -666027 2726242 2483670 7350910 7774365 -4624668 -5290695 To serve the health and rehabilitation needs of the community and to improve the quality of life for each patient, resident, family member, visitor and co-worker. 0 0 3354368 3378943 AMERICAN FAMILY SERVICES WAS FORMED TO OWN AND OPERATE A 60 BEDNURSING FACILITY AND A 42 BED ASSISTED LIVING FACILITY IN NELSONIA, VIRGINIA, A RURAL COMMUNITY. 3354368 1 0 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 2 0 1 151 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 1 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 LA X X RICHARD T DASPIT SR 2257530864 17617 S HARRELLS FERRY ROAD BATON ROUGE LA 70816 RICHARD T DASPIT SR PRESIDENT 5.00 40.00 X X 0 193683 1500 G STUART MURPHY III TREASURER 5.00 30.00 X X 0 6000 0 LOUIS HERRERO vice president 5.00 40.00 X X 0 6000 0 lonnie peeler coo 5.00 40.00 X 0 163668 10500 cythia pittman cfo 5.00 40.00 X 0 135465 1500 michael peeler-smith cco 5.00 40.00 X 0 146390 1500 0 651206 15000 0 0 1 0 US FOOD INC 3682 COLLECTION CENTER DR CHICAGO IL 60693 FOOD SERVICE 190873 McKesson Medical PO Box 630693 Cincinnati OH 45263 Medical Supplies 132320 2 RESIDENT SERVICE REVEN 623000 3378943 3378943 3378943 25 25 VENDING MACHINE 623000 2657 2657 MEALS SOLD 623000 2105 2105 MISCELLANEOUS 623000 2035 2035 134 134 6931 3385899 3378943 0 6956 2010643 1813282 197361 241659 216089 25570 178250 162125 16125 350810 157017 193793 44695 44695 144344 100326 44018 3339 3339 37521 734 36787 399047 323308 75739 13888 754 13134 1411 53 1358 32048 25965 6083 158097 128090 30007 31785 31785 DIETARY SUPPLIES 172317 172317 OTHER SUPPLIES 70099 70099 MEDICAL SUPPLIES 66437 66437 PHARMA SUPPLIES 65572 65572 29964 20415 9549 4051926 3354368 697558 0 5050 59010 171856 233234 28166 19297 4164434 2836331 1463591 1328103 418757 196782 530715 530715 108107 116529 2726242 2483670 783672 527496 3128856 3063213 1129245 1250804 2309137 2932852 7350910 7774365 X -4624668 -5290695 -4624668 -5290695 2726242 2483670 -666027 0 X X 0 1 X 1 0 X 22643 3000 851 26494 3843648 3864197 3656312 3414137 3378943 18157237 3866291 3864197 3659312 3414988 3378943 18183731 0 0 0 18183731 1141 3532 66 9 25 4773 1141 3532 66 9 25 4773 6525 7726 18143 12635 6931 51960 3873957 3875455 3677521 3427632 3385899 18240464 0.99690 0.99680 0.00030 0.00030 X Part III, Line # 12 Miscellaneous income: 2011 : 9559 2012 : 6525 2013 : 7726 2014 : 18143 2015 : 12635 2016: 6931 157613 157613 3244394 2170065 1074329 109308 98876 10432 653119 567390 85729 1328103 ASSETS WHOSE USE IS LIMITED 196782 C 196782 DUE TO RELATED PARTY 2932852 2932852 X Part X, Line 2: AFS is a not-for-profit corporation and has been recognized as tax-exempt pursuant to Section 501(c)(3) of the Internal Revenue Code and, accordingly, no provision for income taxes has been provided. AFS accounts for the effects of any uncertain tax positions based on a "more likely than not" threshold to the recognition of the tax positions being sustained based on the technical merits of the position under scrutiny by the applicable taxing authority. If a tax position or positions are deemed to result in uncertainties of those positions, the unrecognized tax benefit is estimated based on a "cumulative probability assessment" that aggregates the estimated tax liability for all uncertain tax positions. Interest and penalties assessed, if any, are accrued as income tax expense. AFS has identified its tax status as a tax-exempt entity as a tax position; however, AFS has determined that such tax position does not result in an uncertainty requiring recognition. AFS BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO DECEMBER 31, 2013. 0 0 0 0 0 0 0 0 0 RICHARD T DASPIT SR PRESIDENT 0 193683 0 0 0 0 0 0 0 1500 0 195183 0 0 lonnie peeler coo 0 163668 0 0 0 0 0 0 0 10500 0 174168 0 0 form 990, schedule j, part ii wages were paid by foundation health services, inc. to the following: - Richard T. Daspit, Sr.: $193,683 - Lonnie Peeler : $163,668 A INDUSTRIAL DEVELOPMENT AUTHORITY OF ACCOMACK VA 2007-03-01 3585000 REFINANCE OF ORIGINAL BOND DEBT 0 0 0 A 360000 4565000 196782 580722 4565000 2007 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 Schedule K, Part I, Bond Issues Difference between Issue Price and Total Proceeds of Issue relate to 2006 Series B Taxable Bonds of $150,000, 2006 Series C Taxable Bonds of $425,000 and 2006 Series D Subordinated Bonds of $300,000. Form 990, Part VI, Section A, line 2 lonnie peeler, chief operating officer, and michael peeler-smith, chief compliance officer, are married. Form 990, Part VI, Section A, line 3 AMERICAN FAMILY SERVICES has an agreement with foundation health services, inc., sole member of AMERICAN FAMILY SERVICES, to provide management services including financial and accounting support services. Form 990, Part VI, Section B, line 11b The Form 990 is completed annually and copies are provided to the entire governing board as well as the president of the organization. At that time the president reviews the Form 990 with the board members. Any necessary changes are then updated on the form. Once all necessary changes are made and the president is in agreement with the board members on the finished Form 990, it is signed by the President, dated and submitted by the filing deadline. A copy of the approved Form 990 is provided to all of the officers, directors and trustees before the return is filed. Form 990, Part VI, Section B, line 12c The organization promulgates its conflict of interest policy to assure continued commitment to the integrity of its exempt purpose. To provide enforcement of the policy, a written disclosure of the policy is distributed to the employees and Board of Directors. Form 990, Part VI, Section B, line 15 The compensation of the individual is approved by an independent compensation committee of the organization, made up of independent board members. Form 990, Part VI, Section C, line 19 The organization will provide, upon in-person verbal or written request, documents relating to the governance, conflicts of interest and financial statements available to the public. form 990, part xii, line 2c for the current year, there has been no change to the audit oversight process or the selection of independent accountants. FOUNDATION HEALTH SERVICES INC PO BOX 40213 BATON ROUGE LA 70835 581745788 healthcare LA 501(c)(3) Line 10 N/A 0 BLUEBONNET HEALTHCARE INC PO Box 40018 BATON ROUGE LA 70835 781187099 HEALTHCARE LA 501(c)(3) Line 10 FHS 0 HUNTINGDON NURSING CENTER INC PO Box 40018 BATON ROUGE LA 70835 541759925 HEALTHCARE VA 501(c)(3) Line 10 FHS 0 Carrollwood Health Foundation Inc PO Box 40018 Baton Rouge LA 70825 721241847 finclservicesHEALTHCARE FL 501(c)(3) Line 12a, I FHS 0 Magnolia Healthcare Inc PO Box 40018 Baton Rouge LA 70835 721304946 HEALTHCARE MS 501(c)(3) Line 10 FHS 0 ROCK GLEN HEALTHCARE INC PO Box 40018 BATON ROUGE LA 70835 721277793 HEALTHCARE MD 501(c)(3) Line 10 FHS 0 COLONIAL HEALTHCARE INC PO Box 40018 BATON ROUGE LA 70835 721432537 INACTIVE MA 501(c)(3) Line 10 FHS 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0