SJL HEALTH SYSTEMS INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization: SJL HEALTH SYSTEMS INC (EIN 43-1710785)
Tax period: 2015-01-01 to 2015-12-31
Filed: 2016-06-28
IRS object ID: 201611809349300786
Schema version: 2015v2.1
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
Form 990
Schedule A
Schedule D
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2016-06-28T14:13:33-05:00	ReturnTs
Tax Period End	2015-12-31	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	2015-01-01	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 WEST TRAILCREEK DRIVE	AddressLine1Txt
City	PEORIA	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	61614	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	BECKY STOKES	PersonNm
Person Title	TREASURER	PersonTitleTxt
Phone	3096918113	PhoneNum
Signature	2016-06-22	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	MICHAEL REMMELECPA	PreparerPersonNm
PTIN	P00444163	PTIN
Phone	3096712350	PhoneNum
Preparation	2016-06-17	PreparationDt

Field	Value	IRS element (for citing)
Tax	2015	TaxYr
Build TS	2016-09-27 15:27:22Z	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	$3,676,870	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	4	VotingMembersGoverningBodyCnt
Voting Members Independent	4	VotingMembersIndependentCnt
Total Employee	131	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	$4,042,996	PYProgramServiceRevenueAmt
CY Program Service Revenue	$3,676,483	CYProgramServiceRevenueAmt
PY Investment Income	$1,341	PYInvestmentIncomeAmt
CY Investment Income	$387	CYInvestmentIncomeAmt
PY Other Revenue	$5,868,105	PYOtherRevenueAmt
CY Other Revenue	$0	CYOtherRevenueAmt
PY Total Revenue	$9,912,442	PYTotalRevenueAmt
CY Total Revenue	$3,676,870	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	$2,122,400	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$1,685,184	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$2,153,417	PYOtherExpensesAmt
CY Other Expenses	$1,701,489	CYOtherExpensesAmt
PY Total Expenses	$4,275,817	PYTotalExpensesAmt
CY Total Expenses	$3,386,673	CYTotalExpensesAmt
PY Revenues Less Expenses	$5,636,625	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$290,197	CYRevenuesLessExpensesAmt
Total Assets BOY	$2,487,661	TotalAssetsBOYAmt
Total Assets EOY	$2,458,611	TotalAssetsEOYAmt
Total Liabilities BOY	$5,468,005	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$5,148,758	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	-$2,980,344	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	-$2,690,147	NetAssetsOrFundBalancesEOYAmt
Mission	TO PROVIDE CARE FOR THE ELDERLY.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$2,857,586	ExpenseAmt
Revenue	$3,676,870	RevenueAmt
Desc	OPERATION OF A SKILLED NURSING CENTER	Desc
Total Program Service Expenses	$2,857,586	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
Temp Or Permanent Endowments	0	TempOrPermanentEndowmentsInd
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	Yes (1)	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 With Officer Ent	0	BusinessRlnWithOfficerEntInd
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	12	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	131	EmployeeCnt
Employment Tax Returns Filed	0	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
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Form8899 Filedind	0	Form8899Filedind
Form1098 C Filed	0	Form1098CFiledInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	4	GoverningBodyVotingMembersCnt
Independent Voting Member	4	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 (4 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
MICHAEL A AHEARN
DIRECTOR AT LARGE	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 (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
MARTIN BROS
406 VIKING ROAD	CEDAR FALLS	IA	50613	FOOD SUPPLY VENDOR	$171,043
REHAB CARE GROUP INC
PO BOX 503534	ST LOUIS	MO	63150	THERAPY SERVICES	$150,455
OMNICARE
PO BOX 78000	DETROIT	MI	48278	PHARMACY	$147,173

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	3	CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE	623000	$3,215,413	$3,215,413
RESIDENT SERVICES	623000	$461,070	$461,070

Field	Value	IRS element (for citing)
Total Program Service Revenue	$3,676,483	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$387	TotalRevenueColumnAmt
Related Or Exempt Func Income	$387	RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$3,676,870	TotalRevenueColumnAmt
Related Or Exempt Func Income	$3,676,870	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	$1,560,957	TotalAmt
Program Services	$1,530,533	ProgramServicesAmt
Management And General	$30,424	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$124,227	TotalAmt
Program Services	$124,227	ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$10,445	TotalAmt
Management And General	$10,445	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$2,560	TotalAmt
Management And General	$2,560	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$2,118	TotalAmt
Management And General	$2,118	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$7,213	TotalAmt
Management And General	$7,213	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$283	TotalAmt
Management And General	$283	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$182,762	TotalAmt
Program Services	$182,762	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$165,366	TotalAmt
Program Services	$165,366	ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Management And GeneralManagementAndGeneralAmt	Program ServicesProgramServicesAmt
MANAGEMENT FEE	$249,600	$249,600
NURSING SERVICES	$185,693		$185,693
PROVIDER BED TAX	$165,011		$165,011
OPERATIONS & MAINTENANC	$149,206	$149,206

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$581,232	TotalAmt
Program Services	$503,994	ProgramServicesAmt
Management And General	$77,238	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,386,673	TotalAmt
Program Services	$2,857,586	ProgramServicesAmt
Management And General	$529,087	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$82,139	BOYAmt
EOY	$25,747	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$554,945	BOYAmt
EOY	$651,393	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	$4,621,244	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$3,521,491	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$1,023,430	BOYAmt
EOY	$1,099,753	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$813,420	BOYAmt
EOY	$667,991	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$2,487,661	BOYAmt
EOY	$2,458,611	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$1,340,755	BOYAmt
EOY	$613,158	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$3,001,068	BOYAmt
EOY	$2,924,471	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,126,182	BOYAmt
EOY	$1,611,129	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$5,468,005	BOYAmt
EOY	$5,148,758	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	-$2,980,344	BOYAmt
EOY	-$2,690,147	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	-$2,980,344	BOYAmt
EOY	-$2,690,147	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$2,487,661	BOYAmt
EOY	$2,458,611	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$290,197	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)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

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	$8,366,881	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$9,129,464	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$7,815,968	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$4,042,996	CurrentTaxYearMinus1YearAmt
Current Tax Year	$3,676,483	CurrentTaxYearAmt
Total	$33,031,792	TotalAmt

Total509 Total509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$8,366,881	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$9,129,464	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$7,815,968	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$4,042,996	CurrentTaxYearMinus1YearAmt
Current Tax Year	$3,676,483	CurrentTaxYearAmt
Total	$33,031,792	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	$33,031,792	PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$351	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$868	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$38,374	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$1,341	CurrentTaxYearMinus1YearAmt
Current Tax Year	$387	CurrentTaxYearAmt
Total	$41,321	TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$351	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$868	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$38,374	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$1,341	CurrentTaxYearMinus1YearAmt
Current Tax Year	$387	CurrentTaxYearAmt
Total	$41,321	TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$8,367,232	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$9,130,332	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$7,854,342	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$4,044,337	CurrentTaxYearMinus1YearAmt
Current Tax Year	$3,676,870	CurrentTaxYearAmt
Total	$33,073,113	TotalAmt

Field	Value	IRS element (for citing)
Public Support CY509	0.99880	PublicSupportCY509Pct
Public Support PY509	0.99890	PublicSupportPY509Pct
Investment Income CY	0.00120	InvestmentIncomeCYPct
Investment Income PY	0.00110	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	$3,352,141	InvestmentCostOrOtherBasisAmt
Depreciation	$2,336,365	DepreciationAmt
Book Value	$1,015,776	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$1,202,030	InvestmentCostOrOtherBasisAmt
Depreciation	$1,146,333	DepreciationAmt
Book Value	$55,697	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$53,573	InvestmentCostOrOtherBasisAmt
Depreciation	$38,793	DepreciationAmt
Book Value	$14,780	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$1,099,753	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDesc	Book ValueBookValueAmt
DEFERRED FINANCING COSTS	$252,581
ASSETS LIMITED AS TO USE	$375,757
PREPAID EXPENSES	$39,653

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$667,991	TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDesc	AmtAmt
ACCRUED PAYROLL	$267,685
INTEREST PAYABLE	$15,061
DUE TO AFFILIATES	$351,000
OTHER LIABILITIES	$977,383

Field	Value	IRS element (for citing)
Total Liability	$1,611,129	TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt	$3,676,870	TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported	$0	RevenueNotReportedAmt
Revenue Subtotal	$3,676,870	RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt	$0	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$3,676,870	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$3,386,673	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$3,386,673	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$3,386,673	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 11	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	FOOD: Program service expenses 139,218. Management and general expenses 0. Fundraising expenses 0. Total expenses 139,218. PURCHASED SERVICES: Program service expenses 131,042. Management and general expenses 0. Fundraising expenses 0. Total expenses 131,042. SUPPLIES: Program service expenses 116,314. Management and general expenses 0. Fundraising expenses 0. Total expenses 116,314. MISC. ADMIN. EXPENSES: Program service expenses 0. Management and general expenses 77,238. Fundraising expenses 0. Total expenses 77,238. WORKMEN'S COMPENSATION: Program service expenses 58,411. Management and general expenses 0. Fundraising expenses 0. Total expenses 58,411. PROPERTY & LIABILITY INSURANCE: Program service expenses 46,173. Management and general expenses 0. Fundraising expenses 0. Total expenses 46,173. OTHER DIETARY: Program service expenses 7,209. Management and general expenses 0. Fundraising expenses 0. Total expenses 7,209. EQUIPMENT RENTAL: Program service expenses 5,027. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,027. TRAINING: Program service expenses 600. Management and general expenses 0. Fundraising expenses 0. Total expenses 600.