2015-08-17T11:57:01-05:00 2014-09-30 592213319 SUPLEE SHEA CRAMER & ROCKLEIN PA 800 SOUTH OSPREY AVENUE SARASOTA FL 342367834 990 2013-10-01 650850574 SHADY REST CARE PAVILION INC SHAD 2399318406 2310 NORTH AIRPORT ROAD FORT MYERS FL 33907 WESTON EDWARDS PRESIDENT 2399318406 2015-08-14 1 THOMAS R CRAMER P00456445 9413663600 2013 2016-04-25 22:37:26Z PAGE REHABILITATION AND HEALTHCARE CENTER WESTON EDWARDS 2310 N AIRPORT RD FORT MYERS FL 33907 15546713 0 X N/A X 1998 FL OPERATION OF A SKILLED NURSING FACILITY 8 8 389 60 0 0 0 0 15135824 15488599 6912 4478 63125 53636 15205861 15546713 0 0 0 0 10117136 10029435 0 0 0 4943981 5265150 15061117 15294585 144744 252128 8113078 8821974 1753929 2210697 6359149 6611277 TO PROVIDE SKILLED NURSING CARE. 0 0 15294585 0 15542235 PROVIDE SKILLED NURSING CARE 15294585 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 48 0 1 389 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 1 0 FL X FONDA POTTS 2399318406 2310 NORTH AIRPORT ROAD FT MYERS FT MYERS FL 33907 ROBERT L MURRAY CHAIR 2.00 X X 0 0 0 ROBERT MCCURDY VICE - CHAIR 2.00 X X 0 0 0 TRICIA M MOLZOW SECRETARY 2.00 X X 0 0 0 SHEILA CARLSON TREASURER 2.00 X X 0 0 0 ARIE J VANDUIJN DIRECTOR 1.00 X 0 0 0 SANDRA WHARTON DIRECTOR 1.00 X 0 0 0 JO STECHER DIRECTOR 1.00 X 0 0 0 ALBERT WINCHELL DIRECTOR 1.00 X 0 0 0 WESTON R EDWARDS PRESIDENT/CEO 25.00 X 157394 0 11875 FONDA POTTS CFO 40.00 X 123254 0 10013 280648 0 21888 2 0 1 0 EVERGREEN REHABILITATION LLC 136 ST MATTHEWS AVE SUITE 300 LOUISVILLE KY 40207 THERAPY SERVICES 1070742 OMNICARE INC PO BOX 715268 COLUMBUS OH 43271 PATIENT PHARMACEUTICAL SERVICES 564340 2 RESIDENT REVENUE 623000 15488599 15488599 15488599 4478 4478 OTHER INCOME 623000 53636 53636 53636 15546713 15542235 0 4478 293257 293257 7961274 7961274 173366 173366 1106753 1106753 494785 494785 38942 38942 25939 25939 111776 111776 8627 8627 510000 510000 28528 28528 6619 6619 151675 151675 PURCHASED SERVICES 1867124 1867124 OTHER SUPPLIES 1684900 1684900 OTHER SERVICES 678668 678668 OTHER RENTALS 100956 100956 51396 51396 15294585 15294585 0 0 712061 945970 306680 306458 2065082 2307247 104166 100319 30092 39861 4894997 5122119 8113078 8821974 608046 978836 288076 288076 857807 943785 1753929 2210697 X 6359149 6611277 6359149 6611277 8113078 8821974 252128 0 X 0 1 X 1 0 X 15205349 15541384 14582283 15135824 15488599 75953439 15205349 15541384 14582283 15135824 15488599 75953439 0 0 0 75953439 12395 8681 9213 6912 4478 41679 12395 8681 9213 6912 4478 41679 54241 48232 42962 63125 53635 262195 15271985 15598297 14634458 15205861 15546712 76257313 0.99600 0.99560 0.00050 0.00090 X 0 1 0 0 0 0 1 9305 0 0 9305 0 PART II-B, LINE 1: REPRESENTATIVES OF THE ORGANIZATION DID ENGAGE IN LOBBYING ACTIVITIES. DURING THE STATE OF FLORIDA LEGISLATIVE SESSION, SOME FACILITY MANAGEMENT AND FAMILY MEMBERS TRAVELED TO TALLAHASSEE TO MEET WITH LEGISLATORS AND PARTICIPATED IN LOBBY WEDNESDAYS SPONSORED BY FHCA. TOTAL EXPENSES WERE $9,305 WHICH INCLUDED EXPENSES FOR TRAVEL, LODGING, AND MEALS OF $4,641 AND PAID MANAGEMENT TIME OF APPROXIMATELY $4,664. 1 X 0 ACCOUNTS RECEIVABLE - OTHER 96810 DUE FROM SHADY REST FOUNDATION, INC. 4021560 DUE FROM PAGE HEALTHCARE, INC. 61955 DUE FROM ALL ABOUT HOME CARE, INC. 867839 DEPOSITS 39000 DUE FROM MEDCIAD 34955 5122119 ACCRUED EXPENSES 902376 DUE TO MEDICARE 41409 943785 15546713 0 15546713 0 15546713 15294585 0 15294585 0 15294585 PART IV, LINE 2B: THE ORGANIZATION HAS A RESIDENT PERSONAL FUNDS ACCOUNT REQUIRED BY REGULATION FOR SKILLED NURSING HOME FACILITIES. THE BALANCE IN THE FUND AT 9/30/14 WAS $40,934. THE INDIVIDUAL ACCOUNTS CAN BE ESTABLISHED BY RESIDENTS AND FUNDS ARE HELD UNTIL THEY ARE EITHER WITHDRAWN BY THE RESIDENT OR DISTRIBUTED TO THE RESIDENT OR PERSONAL REPRESENTATIVE UPON DEATH OR DISCHARGE FROM THE FACILITY. THE FACILITY HOLDS THE FUNDS IN AN INTEREST-BEARING BANK ACCOUNT DETERMINED BY THE FACILITY AND INTEREST IS ALLOCATED MONTHLY TO THE INDIVIDUAL ACCOUNTS. X X X 0 0 0 0 0 0 0 0 0 WESTON R EDWARDS PRESIDENT/CEO 144139 0 0 0 13255 0 7207 0 4668 0 169269 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 AN INDEPENDENT ACCOUNTING FIRM PREPARES THE FORM 990 AND RETURNS THE DRAFT TO MANAGEMENT OF THE ORGANIZATION. MANAGEMENT CHECKS THE RETURN AND HAS ANY SUGGESTED CHANGES MADE BEFORE DISTRIBUTING IT TO THE BOD MEMBERS. THE RETURN IS SENT TO ALL BOD MEMBERS WITH THEIR MONTHLY BOARD PACKETS SO THAT THE RETURN CAN BE REVIEWED BEFORE THE MONTHLY BOD MEETING. AT THE MEETING, AN OVERVIEW OF THE RETURN IS PROVIDED AND ANY QUESTIONS ARE ANSWERED. AFTER THE BOARD MEETING, THE 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS TO DETERMINE COMPENSATION FOR THE CEO (TOP MANAGEMENT OFFICIAL) IS DIRECTED BY THE EXECUTIVE COMMITTEE OF THE BOD. THE EVALUATION IS DONE AFTER THE FINANCIAL AUDIT IS COMPLETED EACH FISCAL YEAR AND REPRESENTS MEASURABLE JOB PERFORMANCE STANDARDS. A REFERENCE BOOK, NURSING HOME SALARY AND BENEFITS REPORT, IS ORDERED EACH YEAR AND IS USED AS A BENCHMARK FOR ALL LEVELS OF MANAGEMENT AND STAFF FOR HIRING AND MARKET FACTOR INCREASES. IN ADDITION, MARKET FACTOR SURVEYS ARE CONDUCTED ANNUALLY BY THE HUMAN RESOURCES DEPARTMENT AND DATA IS OBTAINED FROM SIMILAR ORGANIZATIONS IN OUR GEOGRAPHIC AREA. OTHER OFFICERS OR KEY EMPLOYEES ARE EVALUATED ANNUALLY IN WRITING ACCORDING TO THEIR JOB DESCRIPTIONS BY THEIR SUPERVISORS. IF MERIT INCREASES ARE BEING GIVEN TO MANAGERS, THE MERIT INCREASES ARE GIVEN ACCORDING TO A SCALE OF POINTS EARNED AND USING THE SAME PERCENTAGE INCREASES AS ALL STAFF AND MANAGEMENT RECEIVE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION HAS CERTAIN GOVERNANCE INFORMATION AVAILABLE THROUGH THE CORPORATE FILING WITH THE STATE AND THE REPORTING CONTAINED IN THE 990. IN ADDITION, THE ANNUAL FINANCIAL AUDIT IS AVAILABLE AND DISTRIBUTED TO INTERESTED PARTIES (INSURANCE COMPANIES, BANKS, ETC.) IN ANY ADMINISTRATIVE MEETING OF THE ORGANIZATION, A FINANCIAL UPDATE IS PROVIDED. EACH MONTH IN FAMILY COUNCIL, A FINANCIAL REPORT IS GIVEN TO THE FAMILIES THAT ATTEND. THE PRESIDENT/CEO IS INTERVIEWED ROUTINELY BY THE NEWS MEDIA IN REGARD TO REIMBURSEMENT ISSUES, AND SHARES FINANCIAL INFORMATION REGARDING THE FINANCIAL IMPACT ON THE ORGANIZATION. AS FAR AS THE ANNUAL AHCA SURVEY INFORMATION, IT IS BOTH AVAILABLE IN THE FACILITY LOBBY FOR INTERESTED PARTIES AND POSTED ON THE MEDICARE.GOV WEBSITE. SHADY REST FOUNDATION INC 2310 N AIRPORT ROAD FORT MYERS FL 33907 300274280 PROVIDE A FACILITY AND SUPPORT TO SHADY REST CARE PAVILION, INC. FL 501(C)(3) 7 N/A 0 ALL ABOUT HOME CARE INC 2310 N AIRPORT ROAD FORT MYERS FL 33907 208542270 PROVIDE HOME HEALTH SERVICES FL 501(C)(3) 3 N/A 0 PAGE HEALTHCARE INC 2310 N AIRPORT ROAD FORT MYERS FL 33907 208542312 PROVIDE MANAGEMENT SERVICES TO RELATED ORGANIZATIONS FL 501(C)(3) 11 N/A 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 SHADY REST FOUNDATION INC K 510000 SHADY REST FOUNDATION INC P 367560 ALL ABOUT HOME CARE INC Q 228783 SHADY REST FOUNDATION INC D 4021560 ALL ABOUT HOME CARE INC D 867839 PAGE HEALTHCARE INC D 61955 PAGE HEALTHCARE INC P 15427