2015-02-12T10:34:29-06:00 2014-03-31 420714325 MCGLADREY LLP 117 E MAIN ST STE 210 GALESBURG IL 61401 990 2014-01-01 721568459 RESIDENTIAL ALTERNATIVES OF IOWA RESI 3093431550 285 SOUTH FARNHAM STREET GALESBURG IL 61401 IRWIN JANN PRESIDENT 3093431550 2015-02-05 1 BEN MCMAHAN P00702421 3093428026 2014 2016-03-07 17:11:31Z X IRWIN JANN 285 SOUTH FARNHAM STREET GALESBURG IL 61401 10809974 0 X N/A X 2003 IA TO PROVIDE & OPERATE NURSING AND ASSISTED LIVING FACILITIES FOR THE ELDERLY. X 0 0 0 9 0 0 18581 6288 7491377 10803669 576 17 0 0 7510534 10809974 0 0 0 0 3696453 936802 0 0 0 4419381 1088955 8115834 2025757 -605300 8784217 2177965 0 9875089 0 -7697124 0 X THE MISSION OF THE ORGANIZATION IS ARTICULATED IN ITS ARTICLES OF INCORPORATION AS FOLLOWS:THE CORPORATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES, INCLUDING, FOR SUCH PURPOSES, THE MAKING OF DISTRIBUTIONS TO ORGANIZATIONS THAT QUALIFY AS TAX-EXEMPT ORGANIZATIONS UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED OR CORRESPONDING SECTION OF ANY FUTURE FEDERAL TAX CODE. IN FURTHERANCE OF THESE PURPOSES, THE CORPORATION MAY BUILD, LEASE, ACQUIRE AND OTHERWISE OWN AND OPERATE HOUSING, NURSING FACILITIES, CONTINUOUS CARE RETIREMENT COMMUNITIES AND OTHER RELATED FACILITIES AND SERVICES FOR THE ELDERLY, MENTALLY RETARDED, MENTALLY ILL, DEVELOPMENTALLY DISABLED AND OTHER LIKE CONDITIONS WITHOUT REGARD TO RACE, RELIGION, COLOR, SEX, CREED OR NATIONAL ORIGIN OF SAID PERSONS. 0 0 1909807 10803669 ALL PROGRAM SERVICES RELATE TO PROVIDING AND OPERATING SKILLED NURSING FACILITIES, HEALTH CARE, ASSISTED AND SEMI-INDEPENDENT LIVING FACILITIES, AND OTHER RELATED SERVICES TO THE ELDERLY. THE ORGANIZATION OPERATED 3 FACILITIES WITH A COMBINED TOTAL OF 207 BEDS UNTIL THE ORGANIZATION MERGED WITH ITS BROTHER/SISTER 501(C)(3) ORGANIZATION, RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., ON MARCH 31, 2014. 1909807 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 X 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 X X RON WILSON RFMS INC 3093431550 285 S FARNHAM ST GALESBURG IL 61401 X IRWIN JANN PRESIDENT 1.00 1.00 X X 1500 0 0 JEFFREY SHAW SECRETARY 1.00 1.00 X X 1500 0 0 DOUG BIEDERSTEDT DIRECTOR 1.00 1.00 X 1500 0 0 WILLIAM KEMPINERS DIRECTOR 1.00 1.00 X 1500 0 0 JOHN KNIERY DIRECTOR 1.00 1.00 X 1500 0 0 7500 0 0 0 0 0 0 0 6288 6288 DEBT FORGIVENESS GAIN 623000 8706744 8706744 MEDICARE & MEDICAID 623000 1122964 1122964 PRIVATE PAY RESIDENT SERVICES 623000 961905 961905 OTHER INCOME 623000 12056 12056 10803669 17 17 10809974 10803669 0 17 7500 7500 811803 784684 27119 2315 2238 77 51098 49391 1707 64086 61945 2141 56585 32637 23948 730 730 192062 192062 2038 1834 204 13610 10793 2817 9579 7663 1916 461860 448192 13668 5164 5153 11 997 897 100 5962 5962 22395 19865 2530 SUPPLIES & SMALL EQUIP. 243298 243298 MEDICAID ASSESSMENT TAX 32249 32249 UNCOLLECTIBLE CHARGES 18285 18285 EQUIPMENT RENT & MAINT. 14785 14774 11 9356 2132 7224 2025757 1909807 115950 0 X 177929 0 1629 0 0 1531575 0 0 0 0 0 99648 0 0 343744 0 0 0 0 0 23440 0 2177965 0 999958 39096 2500000 6336035 0 9875089 0 X -7697124 0 -7697124 0 2177965 0 X 8784217 -1087093 X X 0 1 X 1 0 X 26993 22258 15926 18581 6288 90046 5160369 5318974 6670380 7491377 10803669 35444769 5187362 5341232 6686306 7509958 10809957 35534815 0 449253 244369 161675 53009 908306 449253 244369 161675 53009 908306 34626509 24 91 433 576 17 1141 24 91 433 576 17 1141 5187386 5341323 6686739 7510534 10809974 35535956 0.97440 0.96630 0.00000 0.00000 X SCHEDULE A, PART III - COLUMN (E) THE ORGANIZATION'S CURRENT TAX YEAR IS A SHORT YEAR (JANUARY 1, 2014 - MARCH 31, 2014), DUE TO THE ORGANIZATION'S DISSOLUTION UPON MERGER WITH ITS 501(C)(3) BROTHER/SISTER ORGANIZATION, RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC (EIN: 37-1223846). SEE ATTACHED PLAN AND AGREEMENT OF MERGER DOCUMENT EFFECTIVE MARCH 31, 2014. 0 0 1909807 1909807 245490 61373 0 0 441272 479588 530123 245490 1696473 2544710 1648 1749 1730 5127 110318 119897 132531 61373 424119 636179 0 X PART X, LINE 2: FRANCES HOUSE, INC. AND SUBSIDIARIES ARE EXEMPT FROM INCOME TAXES UNDER SECTIONS 501(C)(3) OR 501(C)(2) OF THE INTERNAL REVENUE CODE. THEREFORE, NO PROVISION HAS BEEN MADE FOR FEDERAL OR STATE INCOME TAXES. MANAGEMENT EVALUATED THE ORGANIZATION'S TAX POSITIONS AND CONCLUDED THAT THE ORGANIZATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF THIS GUIDANCE. WITH FEW EXCEPTIONS, THE ORGANIZATION IS NO LONGER SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE FOR YEARS BEFORE 2010. NET ACCOUNTS RECEIVABLE 2014-03-31 1595832 BOOK VALUE AT DATE OF DISTRIBUTION 371223846 RESIDENTIAL ALTERNATIVES OF ILLINOIS INC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 501(C)(3) PREPAID EXPENSES 2014-03-31 50326 BOOK VALUE AT DATE OF DISTRIBUTION 371223846 RESIDENTIAL ALTERNATIVES OF ILLINOIS INC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 501(C)(3) INVESTMENTS 2014-03-31 61646 FAIR MARKET VALUE AT DATE OF DISTRIBUTION 371223846 RESIDENTIAL ALTERNATIVES OF ILLINOIS INC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 501(C)(3) BUILDINGS AND LEASEHOLD IMPROVEMENTS 2014-03-31 137006 NET BOOK VALUE AT DATE OF DISTRIBUTION 371223846 RESIDENTIAL ALTERNATIVES OF ILLINOIS INC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 501(C)(3) EQUIPMENT, FURNITURE AND FIXTURES 2014-03-31 163958 NET BOOK VALUE AT DATE OF DISTRIBUTION 371223846 RESIDENTIAL ALTERNATIVES OF ILLINOIS INC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 501(C)(3) VEHICLES 2014-03-31 42780 NET BOOK VALUE AT DATE OF DISTRIBUTION 371223846 RESIDENTIAL ALTERNATIVES OF ILLINOIS INC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 501(C)(3) ACCOUNTS PAYABLE AND ACCRUED EXPENSES ASSUMED BY RECIPIENT 2014-03-31 -932750 BOOK VALUE AT DATE OF DISTRIBUTION 371223846 RESIDENTIAL ALTERNATIVES OF ILLINOIS INC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 501(C)(3) RESIDENT SECURITY DEPOSIT LIABILITIES ASSUMED BY RECIPIENT 2014-03-31 -88825 BOOK VALUE AT DATE OF DISTRIBUTION 371223846 RESIDENTIAL ALTERNATIVES OF ILLINOIS INC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 501(C)(3) 0 0 0 0 1 1 1 1 0 PART I, LINE 2E: PERSON(S) INVOLVED: COMMON BOARD OF DIRECTORS PART I, LINE 2E: EXPLANATION OF INVOLVEMENT: RESIDENTIAL ALTERNATIVES OF IOWA WAS A BROTHER/SISTER ORGANIZATION TO RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. PRIOR TO THEIR MERGER EFFECTIVE MARCH 31, 2014. BOTH ORGANIZATIONS SHARED A COMMON BOARD OF DIRECTORS WHO REMAINED THE DIRECTORS OF RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. AFTER THE MERGER. FORM 990, PART V, LINES 1A AND 2A: THE ORGANIZATION IS FILING FOR A SHORT YEAR AND NO CALENDAR YEAR ENDED WITHIN ITS TAX YEAR. FORM 990, PART VI THE ORGANIZATION ENTERED INTO A PLAN AND AGREEMENT OF MERGER WITH ITS BROTHER/SISTER 501(C)(3) ORGANIZATION, RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., EFFECTIVE MARCH 31, 2014. THE AGREEMENT MERGED RESIDENTIAL ALTERNATIVES OF IOWA AND RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. INTO A SINGLE CORPORATION, WITH RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. BEING THE SURVIVING CORPORATION OF THE MERGER. RESIDENTIAL ALTERNATIVES OF IOWA AND RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. HAVE ALWAYS SHARED A COMMON BOARD OF DIRECTORS. SEE SCHEDULE N AND THE ATTACHED AGREEMENT OF MERGER DOCUMENT FOR ADDITIONAL DETAILS. FORM 990, PART VI, SECTION A, LINE 1 DURING THE TAX YEAR, THE ORGANIZATION HAD FIVE INDEPENDENT VOTING MEMBERS OF THE GOVERNING BODY WHO ARE LISTED ON FORM 990, PART VII, SECTION A. AS OF MARCH 31, 2014, RESIDENTIAL ALTERNATIVES OF IOWA WAS DISSOLVED UPON MERGER INTO ITS BROTHER/SISTER 501(C)(3) ORGANZIATION, RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. AND RESIDENTIAL ALTERNATIVES OF IOWA SHARED A COMMON BOARD OF DIRECTORS ALL OF WHOM REMAINED ON THE RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. BOARD OF DIRECTORS AFTER THE MERGER. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION RECEIVES SUPPORT SERVICES FROM LTC SUPPORT SERVICES, LLC, AN UNRELATED COMPANY. THESE SERVICES INCLUDE OVERSIGHT, TRAINING, REGULATORY COMPLIANCE, QUALITY ASSURANCE PROGRAMS, HUMAN RESOURCE SUPPORT, MARKETING AND MAINTENANCE. RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., IS A 12.5% OWNER OF LTC SUPPORT SERVICES, LLC. RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., IS RELATED TO RESIDENTIAL ALTERNATIVES OF IOWA, INC., THROUGH A COMMON BOARD OF DIRECTORS (SEE SCHEDULE R). THE REMAINING 87.5% OF LTC SUPPORT SERVICES, LLC., IS OWNED BY UNRELATED EXEMPT ORGANIZATIONS. THE ORGANIZATION ALSO HAS A NEGOTIATED ARMS LENGTH ADMINISTRATIVE SERVICES CONTRACT WITH RFMS, INC., AN UNRELATED COMPANY, TO OBTAIN SERVICES SUCH AS CASH MANAGEMENT, ACCOUNTING AND FINANCIAL REPORTING, PAYROLL AND EMPLOYEE BENEFITS, INFORMATION TECHNOLOGY, REGULATORY MATTERS, AND OTHER GENERAL BUSINESS AND FINANCIAL MANAGEMENT SERVICES AS REQUIRED. FORM 990, PART VI, SECTION B, LINE 11 EACH MEMBER OF THE BOARD OF DIRECTORS RECEIVES A PAPER COPY OF FORM 990 FOR THEIR REVIEW AND COMMENT PRIOR TO ITS FILING. THE BOARD ALSO REVIEWS IN DETAIL EACH FORM 990 FILED BY THE ORGANIZATION AT ITS REGULARLY SCHEDULED BOARD MEETINGS. ON AN ANNUAL BASIS, EACH BOARD MEMBER ATTENDS A TRAINING SESSION THAT PROVIDES UPDATES ON CURRENT EXEMPT ORGANIZATION TAX COMPLIANCE MATTERS. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO ATTEST TO THEIR COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. THE BOARD OF DIRECTORS REVIEWS ALL COMPLETED CONFLICT OF INTEREST STATEMENTS TO DETERMINE IF ANY CONFLICTS EXIST WHICH WOULD REQUIRE RESTRICTION ON PARTICIPATION IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN ANY TRANSACTION INVOLVING THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 18 A PAPER COPY OF FORM 990 IS PROVIDED UPON REQUEST. THE ORGANIZATION'S FORM 990 IS ALSO AVAILABLE VIA THE GUIDESTAR.ORG WEBSITE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC EXCEPT THROUGH PUBLIC FILING REQUIREMENTS. FORM 990, PART VII, SECTION A, COLUMN B: APPROXIMATELY ONE HALF OF THE AVERAGE HOURS PER WEEK ESTIMATED FOR EACH DIRECTOR AND OFFICER IS DEVOTED TO RELATED ORGANIZATIONS LISTED ON SCHEDULE R. FORM 990, PART X: THE BALANCE SHEET FOR RESIDENTIAL ALTERNATIVES OF IOWA AS OF THE END OF THE YEAR IS ZERO, SINCE THE ORGANIZATION WAS DISSOLVED UPON MERGER OF ALL NET ASSETS INTO RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. EFFECTIVE MARCH 31, 2014. RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. WAS A 501(C)(3) BROTHER/SISTER ORGANIZATION TO RESIDENTIAL ALTERNATIVES OF IOWA AND IS THE SURVIVING CORPORATION AFTER THE MERGER. FORM 990, PART XI, LINE 9: ASSETS MERGED INTO RESIDENTIAL ALTERNATIVES OF IL, INC. (EIN: 37-1223846) -1,029,973. MERGER ADJUSTMENT RELATED TO ACCUMULATED DEPRECIATION -57,120. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT OF THE AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART XII, LINE 2B: THE FINANCIAL STATEMENTS OF RESIDENTIAL ALTERNATIVES OF IOWA, WERE AUDITED AS PART OF THE CONSOLIDATED FINANCIAL REPORT ISSUED FOR FRANCES HOUSE, INC., AND SUBSIDIARIES. CORALVILLE MANOR LLC 2332 LIBERTY DRIVE CORALVILLE IA 52241 300233914 OPERATES WINDMILL MANOR, A SKILLED NURSING FACILITY IA 1805294 0 N/A RESIDENTIAL ALTERNATIVES OF ILLINOIS INC 285 S FARNHAM ST GALESBURG IL 61401 371223846 OPERATES ELDERLY SKILLED NURSING,ASSISTED/INDEPNDENT LIVING FACILITIES IL 501(C)(3) LINE 9 N/A 0 RFMS INC MEDICAL BENEFIT PLAN TRUST 285 S FARNHAM ST GALESBURG IL 61401 367042729 MEDICAL, ST DISABILITY & DEATH BENEFITS FOR ELIGIBLE EMPLOYEES IL 501(C)(9) N/A 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 SCHEDULE R, PART II: RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., IS RELATED TO RESIDENTIAL ALTERNATIVES OF IOWA ONLY BY SHARING A COMMON BOARD OF DIRECTORS. RESIDENTIAL ALTERNATIVES OF IOWA WAS A BROTHER/SISTER ORGANIZATION TO RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. UNTIL MARCH 31, 2014, WHEN RESIDENTIAL ALTERNATIVES OF IOWA WAS DISSOLVED UPON MERGER WITH RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. SEE PLAN AND AGREEMENT OF MERGER DOCUMENT ATTACHED. RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., IS A SUBSIDIARY OF FRANCES HOUSE, INC. THE RFMS, INC. MEDICAL BENEFIT PLAN TRUST IS A SELF-INSURED BENEFIT PROGRAM FUNDED BY THE EMPLOYERS AND PARTICIPANTS WITHIN THE PLAN. PARTICIPANTS IN THE PLAN ARE CURRENT AND FORMER EMPLOYEES OF THE FOLLOWING SPONSORS: RFMS, INC., LTC SUPPORT SERVICES, LLC, COMMUNITY RESIDENTIAL CENTERS, INC., COMMUNITY LIVING OPTIONS, INC., SMSLC, LLC, FRANCES HOUSE, INC., UNLIMITED DEVELOPMENT, INC., KENSINGTON OF GALESBURG, INC., ACHIEVEMENT UNLIMITED, INC., CONCEPTS PLUS, INC., PINNACLE OPPORTUNITIES, INC., PIONEER CONCEPTS, INC., RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., RESIDENTIAL ALTERNATIVES OF IOWA, DESERT HEALTHCARE FACILITIES, INC., FLORIDA LIVING OPTIONS, INC., AND HIGHLAND ESTATES RESORT, LLC. PLAN ASSETS ARE HELD IN A VOLUNTARY EMPLOYEES' BENEFIT ASSOCIATION (VEBA) TRUST. NO TRUSTEE FEES OR MANAGEMENT FEES ARE PAID BY THE RFMS, INC. MEDICAL BENEFIT PLAN TRUST.