2014-04-28T19:21:42-07:00 2013-12-31 452838168 Templin Healthcare Accounting Services LLP PO Box 9 Dunlap IL 61525 990 2013-01-01 364137587 Coulterville Care Inc COUL 6184432395 1101 North Market Street Sparta IL 62286 Harold Joines Board President 6187582256 2014-04-30 0 Larry Templin P01696703 6303612868 2014-04-30 2013 2015-11-30 17:44:51Z Andrea McFadden 13138 State Route 13 Coulterville IL 62237 5133986 0 X X 1995 IL Long Term Health Care Facility 4 3 138 20 0 0 0 0 4889948 5125906 13493 1515 3646 6565 4907087 5133986 3025 413 0 0 2170777 2362624 0 0 0 3056946 2694838 5230748 5057875 -323661 76111 4297408 5292426 3895726 4814633 401682 477793 The mission of Coulterville Care Center is to create a caring and supportive environment for the people we serve and their families so that they are respected for their uniqueness and are encouraged to treat themselves and each other with kindness and respect. 0 0 4591404 413 5133986 Coulterville Care Inc was organized for religious charitable educational and scientific purposes. Specifically, the organization was organized to operate a 75 bed long term care health care fracility located in Coulterville Illinois. The facility consists of 75 skilled care beds. 0 0 0 4591404 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 9 0 1 138 1 0 0 0 0 0 0 X 4 3 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 IL X Howell Business Solutions 6184432395 1101 North Market Street Sparta IL 62286 Harold Joines President 0.5 0 X X 0 0 0 Kenneth Curry Secretary / Treasurer 0.5 0 X X 0 0 0 William Jarrett Board Member 0.5 0 X 0 0 0 William Mueller Board Member 0.5 0 X 0 0 0 Andrea McFadden Executive Director 40 0 X X 83403 0 4509 83403 0 4509 0 0 0 0 Select Rehabilitation PO Box 809056 Chicago IL 60680 Therapy 567435 Omnicare Inc 900 Omnicare Center 201 East Fourth Street Cincinnati OH 45202 Pharmacy 191918 2 0 Nursing Care Revenues 623000 5125906 5125906 0 0 0 0 0 0 5125906 1515 0 0 1515 0 0 0 0 0 0 0 0 0 0 0 0 Other Income 900099 6565 0 0 6565 0 0 0 0 6565 5133986 5125906 0 8080 0 0 413 413 0 0 0 0 83403 0 83403 0 0 0 0 0 1861512 1734337 127175 0 275038 245259 29779 0 142671 127224 15447 0 85000 0 85000 0 10304 0 10304 0 15000 0 15000 0 0 0 0 0 0 0 0 0 0 0 77618 77618 0 0 12786 0 12786 0 60131 60131 0 0 48673 48673 0 0 0 0 0 0 224587 224587 0 0 3999 0 3999 0 0 0 0 0 8819 0 8819 0 396261 396261 0 0 0 0 0 0 251454 251454 0 0 74759 0 74759 0 Therapy Expense 654251 654251 0 0 Food 205784 205784 0 0 Bad Debts 6117 6117 0 0 Provider Assessment 155445 155445 0 0 403850 403850 0 0 5057875 4591404 466471 0 1150 1000 89343 668105 916072 1386612 106675 187927 3335319 586537 2884168 2748782 300000 300000 4297408 5292426 661482 670147 2680 2676 200000 1130051 3031564 3011759 3895726 4814633 X 401682 477793 0 0 0 0 401682 477793 4297408 5292426 76111 0 0 0 0 0 X 1 X 0 1 0 X 4331206 4134109 4700309 4889948 5125906 23181478 4331206 4134109 4700309 4889948 5125906 23181478 23181478 3819 4340 441 13493 1515 23608 3819 4340 441 13493 1515 23608 10720 211728 2334 3646 6565 234993 4345745 4350177 4703084 4907087 5133986 23440079 0.98897 0.98802 0.00101 0.00162 X Schedule A, Part III, Line 12 Miscellaneous Income 0 0 0 0 4643 2321 2322 0 87416 24275 63141 0 190592 59302 131290 0 3052668 500639 2552029 2748782 Lease Deposit 300000 300000 0 Deferred Gain/Loss, net of amortization 21030 Capital Lease Obligation 2953736 Due to IDPH 31056 Resident Funds 5937 3011759 Linda Mueller Spouse of William Mueller 77226 Director of Nursing Wages 0 Vanda Welty Mother of Andrea McFadden 27301 CNA Wages 0 Donald McFadden Husband of Andrea McFadden 31240 Employee Wages 0 Misty Hewitt Family Member of Executive Director 3733 RN Wages 0 Form 990, Part VI, Section B, Line 11b The draft Form 990 is reviewed by the financial consultant for accuracy and made available to the entire Board. The final Form 990 is mailed to the President of the Board for review and signature. Form 990, Part VI, Section B, Line 12c Every year, disclosure forms are sent to the Board Members and Coulterville Care Center's one key employee to ensure that they are in compliance with the written conflict of interest policy. Form 990, Part VI, Section B, Line 15 Every year, the Organization's Board reviews data provided by a LTC association which provides comparative salary information. It also receives current competitive salary information from the local county nursing home. Based on this data, the Board annually revises and approves the salary of the Executive Director. No other officers or key employees are compensated. 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.