2014-06-26T15:26:28-05:00 2013-12-31 593070669 MOORE STEPHENS LOVELACE PA 1201 SOUTH ORLANDO AVENUE SUITE 400 WINTER PARK FL 32789 990 2013-01-01 582476611 THE ALLIANCE FOUNDATION OF FLORIDA INC ALLI 7033597200 3989 CHAIN BRIDGE ROAD FAIRFAX VA 22030 ROBERT P HOSTLER PRESIDENT 7033597200 2014-06-26 1 MELANIE A MCPEAK P01346034 4077405400 2013 2015-11-30 17:44:51Z ROBERT P HOSTLER 3989 CHAIN BRIDGE ROAD FAIRFAX VA 22030 20835752 0 X NONE X 1999 FL TO PROVIDE NURSING CARE AND HOUSING WHICH SATISFIES THE PHYSICAL, RECREATIONAL AND/OR EMOTIONAL NEEDS OF ELDERLY, LOW INCOME, MENTALLY OR PHYSICALLY CHALLENGED AND/OR DISABLED INDIVIDUALS. 2 2 599 0 0 0 0 0 18303381 18490110 0 0 1394420 1903232 19697801 20393342 0 0 0 0 9962658 10203927 0 0 0 8972570 9196698 18935228 19400625 762573 992717 4825642 5752960 3187787 3122388 1637855 2630572 TO PROVIDE NURSING CARE AND HOUSING WHICH SATISFIES THE PHYSICAL, RECREATIONAL AND/OR EMOTIONAL NEEDS OF ELDERLY, LOW INCOME, MENTALLY OR PHYSICALLY CHALLENGED AND/OR DISABLED INDIVIDUALS. 0 0 16892019 17707419 SKILLED NURSING & ASSISTED LIVING CARE & HOUSING - TO PROVIDE NURSING CARE AND HOUSING TO RESIDENTS, COMPRISING 115,685 BED-DAYS, IN THREE FLORIDA FACILITIES, INDIGO PALMS, LLC, INDIGO PALMS OF MAITLAND, LLC AND INDIGO PALMS AT ASTORIA GARDENS, LLC. 395906 782691 OUTSIDE NURSING SERVICES - TO PROVIDE THERAPY STAFF AND/OR SERVICES TO ELDERLY, LOW INCOME, MENTALLY OR PHYSICALLY CHALLENGED AND/OR DISABLED INDIVIDUALS TO SATISFY THEIR PHYSICAL, RECREATIONAL AND/OR EMOTIONAL NEEDS AS MAY BE REQUIRED BY SUCH INDIVIDUAL'S PLAN OF TREATMENT, CARE PLAN AND/OR AS PRESCRIBED BY PHYSICIAN. 1015102 1903232 DURABLE MEDICAL EQUIPMENT - TO PROVIDE MEDICAL EQUIPMENT AND SERVICES TO ELDERLY, LOW INCOME, MENTALLY OR PHYSICALLY CHALLENGED AND/OR DISABLED INDIVIDUALS TO SATISFY THEIR PHYSICAL, RECREATIONAL AND/OR EMOTIONAL NEEDS AS MAY BE REQUIRED BY SUCH INDIVIDUAL'S PLAN OF TREATMENT, CARE PLAN AND/OR AS PRESCRIBED BY PHYSICIAN. 18303027 1 0 0 0 0 0 0 0 1 0 1 0 1 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 0 0 1 1 1 1 0 0 1 36 0 1 599 1 0 0 0 0 0 0 0 0 0 0 X 2 2 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X ROBERT P HOSTLER 7033597200 3989 CHAIN BRIDGE ROAD FAIRFAX VA 22030 ROBERT P HOSTLER PRESIDENT 28.00 2.00 X X 0 349297 34140 THOMAS K LEE DIRECTOR 2.00 X 0 1000 0 JIM S PURDUM SECRETARY 38.00 2.00 X 0 90222 15300 DAVID M BUSHEY CFO 38.00 2.00 X 0 138999 34140 RANDOLPH L KERNON ADMINISTRATOR 39.00 1.00 X 141371 3250 19325 141371 582768 102905 1 0 1 0 US FOODS 438 W KALEY ST ORLANDO FL 32806 FOOD 418232 GUARDIAN PHARMACY 10 AVIATOR WAY ORMOND BEACH FL 32174 DRUGS 253117 CARE AMERICA 210 N WESTMONTE ALTAMONTE SPRINGS FL 32714 DRUGS 195751 3 PRIVATE, INS & OTHER PMTS 623000 8808591 8808591 MEDICARE/MEDICAID PAYMENTS 623000 8379709 8379709 VETERAN'S ADMINISTRATION 623000 519119 519119 782691 782691 18490110 2345642 442410 1903232 1903232 1903232 20393342 20393342 0 0 8851310 8851310 18153 18153 479006 479006 855458 855458 977596 977596 51756 51756 1086245 1086245 140711 140711 1852436 1852436 181062 181062 68246 68246 334990 334990 1193415 1193415 SUPPLIES 913045 913045 FOOD 803621 803621 UTILITIES 690708 690708 MISCELLANEOUS 578003 578003 324864 324864 19400625 18303027 1097598 0 293658 579781 1285787 1363913 331956 494023 128651 162861 2948537 2118619 1086430 829918 1565550 2263029 2283 1731 131327 57704 4825642 5752960 2852838 2900677 58538 68868 276411 152843 3187787 3122388 X 0 0 0 0 1637855 2630572 1637855 2630572 4825642 5752960 992717 0 X X 1 X 0 1 0 X 17469719 18046287 19255434 19697801 20393342 94862583 17469719 18046287 19255434 19697801 20393342 94862583 0 0 0 94862583 7415 7415 7415 7415 17477134 18046287 19255434 19697801 20393342 94869998 0.99990 0.99990 0.00010 0.00010 X 0 1 X 818751 588299 230452 1871733 1344901 526832 258053 185419 72634 829918 DUE FROM DNS 631399 C DUE FROM IM HOLDINGS 164422 C DUE FROM INDIGO PALMS LLC 642974 C FAIRFAX SENIOR LIVING CO 824234 C 2263029 PART IV, LINE 2B: THE ORGANIZATION MAINTAINS A RESIDENT TRUST FUND FOR ITS RESIDENTS. RESIDENT FUNDS ARE DEPOSITED INTO THE TRUST FUND FROM VARIOUS SOURCES AND ARE DISBURSED FROM THE TRUST FUND, AS DIRECTED BY THE RESIDENT. X X X X 0 0 0 0 0 0 0 1 0 ROBERT P HOSTLER PRESIDENT 0 239619 0 0 0 109678 0 0 0 34140 0 383437 0 0 DAVID M BUSHEY CFO 0 138999 0 0 0 0 0 0 0 34140 0 173139 0 0 PART I, LINE 7 PERIODIC BONUSES ARE PAID, BASED ON OVERALL PERFORMANCE AND ASSESSMENTS BY PRESIDENT AND/OR COMPENSATION COMMITTEE AND AS AUTHORIZED BY BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS DELEGATED MANAGEMENT DUTIES TO FAIRFAX SENIOR LIVING (FSLC), A RELATED FOR-PROFIT CORPORATION THAT IS WHOLLY OWNED BY THE CORPORATION. THE ORGANIZATION'S CHIEF FINANCIAL OFFICER IS AN EMPLOYEE OF THE MANAGEMENT COMPANY. FSLC PROVIDES OVERSIGHT MANAGEMENT SERVICE TO EACH OF THE COMPANIES. THERE ARE NO CONTRACTS OUTSIDE THE RELATED PARTY COMPANIES. INSURANCE AND CASH FLOW/BANKING MATTERS ARE HANDLED BY FSLC. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 THAT IS PREPARED BY THE CONTROLLER IN CONSULTATION WITH THE PRESIDENT'S OFFICE IS SUBMITTED TO EXTERNAL ACCOUNTANTS FOR DETAILED REVIEW AND COMMENT BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S BOARD OF DIRECTORS HAS ADOPTED A CONFLICT OF INTEREST POLICY AND REQUIRES DISCLOSURE OF CERTAIN INTERESTS (COLLECTIVELY, THE "COI POLICIES"). THE ORGANIZATION HAS DESIGNATED AND EMPLOYS CORPORATE AND REGIONAL RISK MANAGERS TO REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THE COI POLICIES. THE ORGANIZATION'S POLICIES AND PROCEDURES GOVERNING CONFLICTS OF INTEREST ARE PROVIDED TO ALL EMPLOYEES AT TIME OF EMPLOYMENT, AND THE ORGANIZATION MAINTAINS AND MONITORS A COMPLAINT AND COMPLIANCE HOTLINE. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S COMPENSATION OF THE CEO/PRESIDENT IS ESTABLISHED BASED ON CONSULTATION WITH AN INDEPENDENT CONSULTANT AND THE USE OF DATA FROM COMPARABLE ORGANIZATIONS. APPROVAL OF THE CEO/PRESIDENT COMPENSATION IS GIVEN BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS INDEPENDENT WITH REGARDS TO APPROVAL OF THE CEO/PRESIDENT COMPENSATION. COMPENSATION OF OTHER OFFICERS, KEY EMPLOYEES AND OTHER SENIOR MANAGEMENT IS DELEGATED TO THE CEO/PRESIDENT, AS AUTHORIZED BY AND PURSUANT TO APPROVAL OF THE ORGANIZATION'S BOARD OF DIRECTORS, AND IN CONSULTATION WITH THE CONTROLLER, INDEPENDENT CONSULTANT(S) AND REVIEW OF COMPENSATION SURVEY(IES) OF OTHER COMPARABLE ORGANIZATIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND ITS CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC THROUGH PUBLICLY ACCESSIBLE WEBSITES AND/OR UPON REQUEST, AS PERMITTED AND/OR REQUIRED BY STATE AND/OR FEDERAL LAW. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS HAS RESPONSIBILITY FOR OVERSIGHT OF THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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