2017-08-15T06:46:15-05:00 2016-12-31 593070669 MOORE STEPHENS LOVELACE PA 255 S ORANGE AVENUE SUITE 600 ORLANDO FL 32801 990 2016-01-01 592555812 LIFE CARE PONTE VEDRA INC LIFE 9042731701 1000 VICARS LANDING WAY PONTE VEDRA BEACH FL 32082 D BRUCE JONES CEO 9042731701 2017-08-15 1 HARRY E HARP CPA P00176471 4077405400 64.132.121.122 2017-08-15 07:41:10 ED P A6970DBB2853E0D2E5FB43C562937A4824D79D77 A6970DBB2853E0D2E5FB43C562937A4824D79D77 2016 2021-01-29 14:40:06Z VICAR'S LANDING D BRUCE JONES 1000 VICARS LANDING WAY PONTE VEDRA BEACH FL 32082 21022617 0 X WWW.VICARSLANDING.COM X 1983 FL TO PROVIDE FOR THE HOUSING, PHYSICAL, EMOTIONAL, RECREATIONAL, SOCIAL, RELIGIOUS, HEALTH CARE AND FINANCIAL SECURITY NEEDS OF THE RESIDENTS OF VICAR'S LANDING. 8 8 460 138 0 0 359184 422637 19970508 20644045 562233 -59291 0 -298731 20891925 20708660 150000 10956 5864 53825 8775802 9267559 0 0 0 11408070 13003777 20339736 22336117 552189 -1627457 70818144 68848657 107089544 105861651 -36271400 -37012994 TO PROVIDE FOR THE HOUSING, PHYSICAL, EMOTIONAL, RECREATIONAL, SOCIAL, RELIGIOUS, HEALTH CARE AND FINANCIAL SECURITY NEEDS OF THE RESIDENTS OF VICAR'S LANDING. 0 0 19222357 10956 20644045 THE RETIREMENT COMMUNITY CONSISTS OF 227 INDEPENDENT RESIDENTIAL UNITS, 38 ASSISTED LIVING UNITS, AND A 60-BED SKILLED NURSING CENTER. THE ORGANIZATION OPERATES UNDER THE "CONTINUING CARE" CONCEPT IN WHICH RESIDENTS ENTER INTO AN OCCUPANCY AGREEMENT, WHICH REQUIRES PAYMENT OF A ONE-TIME ENTRANCE FEE AND A MONTHLY SERVICE FEE. GENERALLY, THESE PAYMENTS ENTITLE RESIDENTS TO THE USE AND PRIVILEGE OF VICAR'S LANDING FOR LIFE, INCLUDING CERTAIN NURSING SERVICES IN THE ORGANIZATION'S SKILLED NURSING FACILITY. THE OCCUPANCY AGREEMENT DOES NOT ENTITLE THE RESIDENTS TO AN INTEREST IN THE REAL ESTATE OR ANY PROPERTY OWNED BY THE ORGANIZATION. 19222357 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 39 0 1 460 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X D BRUCE JONES 9042731701 1000 VICARS LANDING WAY PONTE VEDRA BEACH FL 32082 MARK BONNER CHAIR 4.00 2.00 X X 0 0 0 JOHN STROM VICE CHAIR 1.00 3.00 X X 0 0 0 JUDITH HAM BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL HARVICK BOARD MEMBER 1.00 2.00 X 0 0 0 BRUCE BARBER BOARD MEMBER 1.00 0.00 X 0 0 0 TOM REEDER BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERT K OHNO BOARD MEMBER 1.00 0.00 X 0 0 0 D BRUCE JONES CHIEF EXECUTIVE OFFICER 15.00 25.00 X 0 200608 25293 DALE PIRKLE CHIEF OPERATING OFFICER 20.00 20.00 X 0 144269 8331 CANDACE BOWLING CHIEF FINANCIAL OFFICER 20.00 20.00 X 0 119633 12039 THERESA CROSBY DIRECTOR OF MARKETING 40.00 0.00 X 129866 0 5589 KENDALL BRYAN JR DIRECTOR OF HEALTH SERVICES 40.00 0.00 X 118038 0 4556 247904 464510 55808 2 0 1 0 ABACUS CONTRACTING LLC 1008 LORING AVE SUITE 29 ORANGE PARK FL 32073 CONSTRUCTION SERVICES 660829 DUVAL ASPHLAT 7544 PHILLIPS HWY JACKSONVILLE FL 32256 CONSTRUCTION SERVICES 281539 VALLEY CREST LANDSCAPING PO BOX 404083 ATLANTA GA 30384 LANDSCAPING SERVICES 267622 SIMPLEXGRINNELL 10255 FORTUNE PKWY JACKSONVILLE FL 32256 FIRE ALARM/SAFETY UPGRADES AND MONITORIN 241438 JAX HOME HEALTH INC 9191 RG SKINNER PARKWAY JACKSONVILLE FL 32256 MEMBER PAYMENT/PASSTHROUGH 217363 14 422637 422637 MONTHLY SERVICE FEES 623000 12682608 12682608 EARNED ENTRANCE FEEES 623000 3258962 3258962 SKILLED NURSING CENTER 623000 2436046 2436046 ASSISTED LIVING FACILITY 623000 1612202 1612202 HOME HEALTH 623000 654227 654227 20644045 254666 254666 313957 -313957 -313957 -313957 INTEREST RATE SWAP 900000 -57639 -57639 REPURCHASE OF BONDS 900000 -241092 -241092 -298731 20708660 20644045 0 -358022 10956 10956 53825 53825 7586393 6431048 1155345 146188 123925 22263 992626 841457 151169 542352 521503 20849 161347 161347 37921 37921 68308 68308 75794 75794 291866 107946 183920 287677 287677 1884037 1884037 40069 3931 36138 40194 15525 24669 1191998 1025828 166170 5606497 4824925 781572 500786 430974 69812 DIETARY COSTS 1239021 1239021 MAINTENANCE & REPAIRS 1134964 1131582 3382 SUPPLIES 352104 334003 18101 TRANSPORTATION 41008 41008 50186 56761 -6575 22336117 19222357 3113760 0 260447 271499 3268205 4207963 552706 367495 81138 84943 452992 585519 86619172 38239511 51139808 48379661 5135043 7002019 9927805 7949558 70818144 68848657 1642477 1110650 71950166 73455068 31774007 29671470 1722894 1624463 107089544 105861651 X -36271400 -37012994 -36271400 -37012994 70818144 68848657 -1627457 885863 0 X X 0 1 X 1 0 X 401096 208425 410666 359184 422637 1802008 20904634 18821989 18805200 19970508 20644045 99146376 21305730 19030414 19215866 20329692 21066682 100948384 0 0 0 100948384 489639 380107 361774 262521 254666 1748707 489639 380107 361774 262521 254666 1748707 21795369 19410521 19577640 20592213 21321348 102697091 0.98300 0.98000 0.01700 0.02000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3191859 3191859 66138561 30408133 35730428 15778654 7254458 8524196 1510098 576920 933178 48379661 CASH AND CASH EQUIVALENTS 1629833 F COMMON STOCKS 2660866 F FIXED INCOME - NONGOVERNMENT OBLIGATIONS 1622675 F FIXED INCOME - EQUITIES 1088641 F ACCRUED INTEREST 4 F 7002019 ASSETS WHOSE USE IS LIMITED 7949558 7949558 ENTRANCE FEE AND WAIT LIST DEPOSITS 777556 RELATED PARTY PAYABLE 52888 ENTRANCE FEE REFUND PAYABLE 736380 INTEREST RATE SWAP 57639 1624463 21755550 885863 885863 20869687 71862 -232889 -161027 20708660 22497144 232889 232889 22264255 71862 71862 22336117 PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON REPURCHASE OF BONDS -241,091. UNRESTRICTED CONTRIBUTIONS 8,202. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON REPURCHASE OF BONDS 241,091. UNRESTRICTED CONTRIBUTIONS -8,202. 1 ST JOHNS COUNTY COUNCIL ON AGING 180 MARINE STREET ST AUGUSTINE FL 32084 591525829 10956 TO DEVELOP DAY PROGRAM IN PONTE VEDRA BEACH 0 0 0 0 0 0 0 0 0 D BRUCE JONES CHIEF EXECUTIVE OFFICER 0 200608 0 0 0 0 0 0 0 25293 0 225901 0 0 DALE PIRKLE CHIEF OPERATING OFFICER 0 144269 0 0 0 0 0 0 0 8331 0 152600 0 0 A ST JOHNS COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY 2016-11-17 15725000 SEE SUPPLEMENTAL INFORMATION 0 0 0 B ST JOHNS COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY 2014-01-01 8000000 SEE SUPPLEMENTAL INFORMATION 0 0 0 C ST JOHNS COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY 2014-01-01 8000000 SEE SUPPLEMENTAL INFORMATION 0 0 0 A 15725000 1016428 361875 1200026 13146672 2016 1 0 1 1 B 703750 8000000 642851 365550 6991599 2014 0 0 1 1 C 703750 8000000 507747 7492253 2014 0 0 1 1 A 0 1 0 0 1 0 0 0 0 B 0 0 0 1 0 0 0 0 0 C 0 0 0 1 0 0 0 0 0 A 1 B 0 C 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: ST. JOHNS COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/12/2014 ISSUER NAME: ST. JOHNS COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/12/2014 SCHEDULE K, ROW A, PART I(F) PURPOSE OF SERIES 2016 BONDS: IN NOVEMBER 2016, THE ST. JOHNS COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY ISSUED ON BEHALF OF THE ORGANIZATION $15,725,000 HEALTH CARE REVENUE AND REVENUE REFUNDING BONDS (THE "SERIES 2016 BONDS") TO REFUND THE SERIES 2007 BONDS, PAY FOR CERTAIN CAPITAL IMPROVEMENTS, AND PAY CERTAIN COSTS OF ISSUING THE SERIES 2016 BONDS. THE SERIES 2016 BONDS ARE COLLATERALIZED BY ASSETS IN TRUST, A MORTGAGE ON THE PROPERTY AND EQUIPMENT, AND GROSS REVENUES OF THE ORGANIZATION. SCHEDULE K, ROW A ADDITIONAL INFORMATION RELATED TO BOND ISSUANCE: ST. JOHNS COUNTY INDUSTRIAL DEVELOPMENT AUTHORITY REVENUE REFUNDING BONDS, SERIES 2016, PRINCIPAL AND INTEREST PAYMENTS ON THE SERIES 2016 BONDS ARE PAYABLE MONTHLY THROUGH MATURITY IN FEBRUARY 2037. THE SERIES 2016 BONDS HAVE AN ANNUAL VARIABLE INTEREST RATE EQUAL TO THE SUM OF 65% OF LIBOR PLUS 1.23% (1.6875% AT DECEMBER 31, 2016), WITH A TENDER OF OUTSTANDING PRINCIPAL AND ACCRUED INTEREST EXERCISABLE BY THE REGISTERED OWNER IN FEBRUARY 2027. THE ORGANIZATION ENTERED INTO A VARIABLE-TO-FIXED INTEREST RATE SWAP AGREEMENT TO EFFECTIVELY FIX THE ANNUAL INTEREST RATE ON THE SERIES 2016 BONDS AT 2.76%. SCHEDULE K, PART I(C) INFORMATION PERTAINING TO CUSIP OF 2016 SERIES BOND ISSUE: THE SERIES 2016 BOND ISSUE CONSISTS OF THE FOLLOWING: CUSIP NO. CUSIP NO. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS LIFE CARE PASTORAL SERVICES, INC. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATION'S SOLE MEMBER, LIFE CARE PASTORAL SERVICES, INC., HAS THE POWER TO ELECT ALL BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE APPROVAL OF THE SOLE MEMBER, LIFE CARE PASTORAL SERVICES, INC., SHALL BE REQUIRED FOR A NUMBER OF ACTIONS BY THE BOARD, AS WRITTEN WITHIN THE ORGANIZATION'S BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B COPY OF FORM 990 IS PROVIDED TO THE GOVERNING BODY FOR REVIEW BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THERE IS A YEARLY REVIEW AT THE BOARD LEVEL WHERE EACH BOARD MEMBER SIGNS A CONFLICT OF INTEREST POLICY AND DECLARES ANY CONFLICT. ADDITIONALLY, THERE IS A CONFLICT OF INTEREST POLICY IN THE EMPLOYEE HANDBOOK, AND IT IS REVIEWED WITH THE DEPARTMENT HEADS ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION COMMITTEE OF THE BOARD REVIEWS ACCOMPLISHMENTS AGAINST OBJECTIVES AND DETERMINES THE COMPENSATION OF CEO, EXECUTIVE DIRECTOR, TOP MANAGEMENT OFFICIALS & KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C OVERSIGHT OF AUDIT: THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS HAS RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. LIFE CARE ST JOHNS INC 1000 VICARS LANDING WAY PONTE VEDRA BEACH FL 32082 593474627 CCRC FL 501(C)(3) LINE 10 N/A 0 LIFE CARE PASTORAL SERVICES INC 1000 VICARS LANDING WAY PONTE VEDRA BEACH FL 32082 593480191 HOLDING ORGANIZATION FL 501(C)(3) LINE 12A, I N/A 0 LCPS MANAGEMENT INC 1000 VICARS LANDING WAY PONTE VEDRA BEACH FL 32082 593474336 MGMT SERVICES FL 501(C)(3) LINE 12C, III-FI N/A 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0