2014-05-15T11:15:36-05:00 2013-06-30 410746749 CLIFTONLARSONALLEN LLP 1301 W 22ND ST STE 1100 OAK BROOK IL 60523 990 2012-07-01 010729134 CLARE OAKS CLAR 6303721983 827 CARILLON DRIVE BARTLETT IL 60103 PAUL CLEMENS 6303721983 2014-05-07 1 ROBERT J NOWAK CPA MST P00527435 6305738600 2012 2015-11-30 17:44:51Z PAUL CLEMENS 827 CARILLON DRIVE BARTLETT IL 60103 19148056 0 X WWW.CLAREOAKS.COM X 2006 IL CLARE OAKS IS AN ENDURING COMMUNITY THAT SUPPORTS A FULLER AND FREER LIFE. 7 7 367 25 0 0 0 0 18431667 18439420 51544 503 740236 708133 19223447 19148056 0 0 0 0 8220495 8425527 0 0 0 14288213 12787430 22508708 21212957 -3285261 -2064901 40297581 42852763 140877174 126289823 -100579593 -83437060 CLARE OAKS, A CONTINUING CARE RETIREMENT COMMUNITY, EXISTS TO NOURISH, CELEBRATE AND ENHANCE THE MIND, BODY AND SPIRIT. 0 0 16985271 19147553 CLARE OAKS IS A CONTINUING RETIREMENT COMMUNITY (CCRC) PROVIDING LIVING ARRANGEMENTS AND SERVICES TO PERSONS 62 YEARS OF AGE AND OLDER. CAMPUS WIDE SERVICES INCLUDE DINING, ACTIVITIES, MAINTENANCE, HOUSEKEEPING, WELLNESS PROGRAMS, SUPPORTIVE SERVICES AND 24 HOUR SECURITY. THE INDEPENDENT LIVING AREA (164 RESIDENCES) OFFERS A VARIETY OF PRIVATE LIVING ARRANGEMENTS, A FITNESS CENTER, LIBRARY, MINI MART, COMPUTER ROOM AND TRANSPORTATION. THE ASSISI HEALTH CARE CENTER OFFERS LONG TERM SKILLED CARE AND SHORT TERM REHABILITATION SERVICES. LICENSED STAFF IN THE ASSISTED LIVING (17 SUITES), MEMORY SUPPORT (16 SUITES) AND SKILLED NURSING NEIGHBORHOODS (120 ROOMS) PROVIDE COURTEOUS SERVICE, HOSPITALITY, DIGNITY AND RESPECT TO ALL IN OUR CARE. 16985271 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 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 0 0 0 0 0 0 1 52 0 1 367 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X X GIGI WALKER 6303721983 825 CARILLON DRIVE BARTLETT IL 60103 SISTER COLETTE WILCZYNSKI 1.00 X 0 0 0 MICHAEL D HOVDE JR 1.00 X X 0 0 0 TOM BROD 1.00 X 0 0 0 SISTER JEANNE CONZEMIUS 1.00 X 0 0 0 MAUREEN TAUS 1.00 X 0 0 0 SISTER MARCELLA NOWAKOWSKI 1.00 X 0 0 0 PAUL CLEMENS 1.00 X X 0 0 0 RICHARD SCHUTT 1.00 X 0 0 0 THERESE M MALM 1.00 X X 0 0 0 WILLIAM KEANE 40.00 X 118535 0 0 JEANNENE WALKER 40.00 X 132023 0 0 MICHELLE HART-CARLSON 40.00 X 118739 0 0 MARTIN JENSEN 40.00 X 107889 0 0 BETH WELCH 40.00 X 0 0 0 477186 0 0 4 0 0 0 UNGARETTI & HARRIS LLP 70 WEST MADISON STREET SUITE 3500 CHICAGO IL 60602 LEGAL - GENERAL AND BANKRUPTCY RELATED 1904198 REHAB CARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 THERAPY PROVIDER 1515482 ALVAREZ & MARSAL 600 MADISON AVENUE 8TH FLOOR NEW YORK NY 10022 LEGAL - BANKRUPTCY RELATED 1225789 PHARMERICA INC PO BOX 409251 ATLANTA GA 30384 PHARMACY PROVIDER 649044 SYSCO FOOD SERVICES PO BOX 5037 DES PLAINES IL 60017 FOOD PROVIDER 558283 22 RESIDENT SERVICES 623000 18439420 18439420 18439420 503 503 ENTRANCE FEE AMORTIZATION 623000 708133 708133 708133 19148056 19147553 0 503 7594047 6523680 1070367 87932 87932 743548 516642 226906 1230454 597481 632973 173447 173447 52727 52727 401622 401622 329404 168223 161181 132297 132297 888721 888721 17499 6738 10761 24955 20096 4859 1592023 1592023 1887703 1887703 884220 233338 650882 SUPPLIES 2027114 2027082 32 FOOD 828644 828644 PHARMACY 748730 748730 EQUIPMENT AND REPAIRS 547777 547038 739 1020093 346405 673688 21212957 16985271 4227686 0 2049427 2018777 2316634 81910 2069514 2264169 47397 136103 25237 24783 571501 1576362 33149578 11250019 22381653 21899559 2686650 8519037 8149568 6332063 40297581 42852763 5660268 2117622 32357834 31734593 99839033 89348469 3020039 3089139 140877174 126289823 X -100579593 -83437060 -100579593 -83437060 40297581 42852763 X -2064901 3 19207431 X X 0 1 X 1 0 X 961653 4038347 460 5000460 11302080 14869035 19190735 18134777 18439420 81936047 12263733 18907382 19191195 18134777 18439420 86936507 0 0 0 86936507 374492 308061 175005 51544 503 909605 374492 308061 175005 51544 503 909605 184498 458028 506178 1037126 708133 2893963 12822723 19673471 19872378 19223447 19148056 90740075 0.95810 0.93200 0.01000 0.03760 X 211164 211164 32938414 11250019 21688395 21899559 DEFERRED FINANCING COSTS 3218972 DEFERRED MARKETING/SELLING COSTS 3113091 6332063 CURRENT DEFERRED ENTRANCE FEES 2600000 RESERVATION DEPOSITS 489139 3089139 X 19148059 3 3 19148056 0 19148056 21212957 0 21212957 0 21212957 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION QUALIFIES AS A TAX-EXEMPT ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). ACCORDINGLY, THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE IRC. THE ORGANIZATION IS CLASSIFIED AS A PUBLICLY SUPPORTED CHARITABLE ORGANIZATION UNDER THE IRC AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFIES AS CHARITABLE TAX DEDUCTIONS FOR THE CONTRIBUTOR. THE ENTITY FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE INTERNAL REVENUE SERVICE (IRS). THE ORGANIZATION'S INCOME TAX RETURNS FOR THE YEARS 2009 THROUGH 2012 ARE SUBJECT TO REVIEW AND EXAMINATION BY THE IRS. A ILLINOIS FINANCE AUTHORITY 861091967 45200BZR2 2006-07-19 56360000 CONSTRUCTION PROJECT OF CLARE OAKS 0 0 0 B ILLINOIS FINANCE AUTHORITY 861091967 45200BZN1 2006-07-19 55968314 CONSTRUCTION PROJECT OF CLARE OAKS 0 0 0 C ILLINOIS FINANCE AUTHORITY 861091967 45203HNK4 2012-12-31 8000000 REFINANCE OF SERIES 2006 BONDS 0 0 0 D ILLINOIS FINANCE AUTHORITY 861091967 45203HNL2 2012-12-31 4000000 REFINANCE OF SERIES 2006 BONDS 0 0 0 A 56360000 56360000 56360000 0 0 1 1 B 55968314 55968314 55968314 0 0 1 1 C 8000000 2147786 100422 5751792 1 0 1 1 D 4000000 1470098 1579901 950000 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 SCHEDULE K PART IV, ARBITRAGE, LINE 2C DATE REBATE COMPUTATION PERFORMED ISSUER NAME: ILLINOIS FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2012 ISSUER NAME: ILLINOIS FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2012 A ILLINOIS FINANCE AUTHORITY 861091967 45203HNM0 2012-12-31 2000000 REFINANCE OF SERIES 2006 BONDS 0 0 0 B ILLINOIS FINANCE AUTHORITY 861091967 45203HNN8 2012-12-31 39991094 REFINANCE OF SERIES 2006 BONDS 0 0 0 C ILLINOIS FINANCE AUTHORITY 861091967 45203HNP3 2012-12-31 25006410 REFINANCE OF SERIES 2006 BONDS 0 0 0 D ILLINOIS FINANCE AUTHORITY 861091967 45203HNQ1 2001-12-31 5001282 REFINANCE OF SERIES 2006 BONDS 0 0 0 A 2000000 2000000 1 0 1 1 B 39991094 39991094 1 0 1 1 C 25006410 25006410 1 0 1 1 D 5001282 5001282 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 A ILLINOIS FINANCE AUTHORITY 861091967 45203HNR9 2012-12-31 5001282 REFINANCE OF SERIES 2006 BONDS 0 0 0 A 5001282 5001282 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 3 CLARE OAKS HAS DELEGATED CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF OFFICERS, DIRECTORS, AND KEY EMPLOYEES TO LIFE CARE SERVICES (LCS), A MANAGEMENT COMPANY. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WILL BE DISTRIBUTED TO BOARD MEMBERS BY THE EXECUTIVE DIRECTOR FOR REVIEW AND COMMENTS. ANY QUESTIONS WILL BE DIRECTED TO THE FINANCE DIRECTOR AND WILL BE ADDRESSED WITH THE PREPARER. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE AND SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE DISCLOSURE INCLUDES A STATEMENT THAT THE INDIVIDUAL WILL IMMEDIATELY REPORT ANY KNOWN PERSONAL OR BUSINESS RELATIONSHIP THAT EXISTS WITH AN ORGANIZATION/INDIVIDUAL DOING BUSINESS WITH CLARE OAKS, TO THE EXECUTIVE DIRECTOR AND THE PRESIDENT OF THE BOARD. ALL CONTRACTS AND AGREEMENTS ARE REVIEWED BY THE EXECUTIVE DIRECTOR AND THE DIRECTOR OF FINANCE TO ASCERTAIN IF ANY RELATIONSHIP EXISTS BETWEEN THE CONTRACTOR AND ANY OFFICERS, DIRECTORS, OR KEY EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 15 LIFE CARE SERVICES (MANAGEMENT COMPANY UTILIZED BY CLARE OAKS) HAS A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES THAT INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. DURING THE CURRENT YEAR LIFE CARE SERVICES HAS USED THIS PROCESS TO DETERMINE THE COMPENSATION OF THE EXECUTIVE DIRECTOR AND HEALTHCARE ADMINISTRATOR. FORM 990, PART VI, SECTION C, LINE 18 CLARE OAKS MAKES ITS FORM 990 AVAILABLE FOR PUBLIC INSPECTION ON ANOTHER'S WEBSITE (I.E. GUIDESTAR) WITH FORM 1023 BEING MADE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 CLARE OAKS MAKES ITS GOVERNING DOCUMENTS,CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: BANKRUPTCY FILING EXPENSE -2,032,117. ADEQUATE PROTECTION PAYMENT EXPENSE -1,536,529. DIP LOAN EXPENSE -521,500. GAIN ON RESTRUCTURING OF LONG-TERM DEBT 23,297,577. FORM 990, PART XII, LINE 2C THE ORGANIZATION'S BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.