MANOR GROVE INCORPORATED: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MANOR GROVE INCORPORATED (EIN 43-0679177)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-01-31
IRS object ID
201440319349300004
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-01-31T08:26:57-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN430765316EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1RUBINBROWN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1ONE NORTH BRENTWOODAddressLine1
CitySAINT LOUISCity
StateMOState
ZIP Code63105ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN430679177EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MANOR GROVE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMANONameControl
Phone3149650864Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1711 SOUTH KIRKWOOD ROADAddressLine1
CityST LOUISCity
StateMOState
ZIP Code63122ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameROSE LANKFORDName
TitleADMINISTRATORTitle
Phone3149650864Phone
Date Signed2014-01-07DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJOHN E BUTLERName
PTINP00325554PTIN
Phone3142903300Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonROSE LANKFORDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1711 SOUTH KIRKWOOD RDAddressLine1
CityST LOUISCity
StateMOState
ZIP Code63122ZIPCode
FieldValueIRS element (for citing)
Gross Receipts8723204GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.MANORGROVE.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1907YearFormation
State Legal DomicileMOStateLegalDomicile
Activity Or Mission DescriptionTO PRESERVE THE QUALITY OF LIFE THROUGH COMPASSIONATE, EXPERT CARE FROM A HIGHLY SKILLED MULTIDISCIPLINARY TEAM.ActivityOrMissionDescription
Nbr Voting Members Governing Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members16NbrIndependentVotingMembers
Total Nbr Employees248TotalNbrEmployees
Total Nbr Volunteers35TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year24842ContributionsGrantsPriorYear
Contributions Grants Current Year39771ContributionsGrantsCurrentYear
Program Service Revenue Prior Year8498127ProgramServiceRevenuePriorYear
Program Service Revenue CY8531340ProgramServiceRevenueCY
Investment Income Prior Year167224InvestmentIncomePriorYear
Investment Income Current Year67637InvestmentIncomeCurrentYear
Other Revenue Prior Year-21763OtherRevenuePriorYear
Other Revenue Current Year-45648OtherRevenueCurrentYear
Total Revenue Prior Year8668430TotalRevenuePriorYear
Total Revenue Current Year8593100TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5407693SalariesEtcPriorYear
Salaries Etc Current Year5680909SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2793371OtherExpensePriorYear
Other Expenses Current Year2735995OtherExpensesCurrentYear
Total Expenses Prior Year8201064TotalExpensesPriorYear
Total Expenses Current Year8416904TotalExpensesCurrentYear
Revenues Less Expenses Prior Year467366RevenuesLessExpensesPriorYear
Revenues Less Expenses CY176196RevenuesLessExpensesCY
Total Assets BOY11708671TotalAssetsBOY
Total Assets EOY11922176TotalAssetsEOY
Total Liabilities BOY1373416TotalLiabilitiesBOY
Total Liabilities EOY1241966TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY10335255NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY10680210NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO PRESERVE THE QUALITY OF LIFE THROUGH COMPASSIONATE, EXPERT CARE FROM A HIGHLY SKILLED MULTIDISCIPLINARY TEAM. WE RECOGNIZE THAT GOOD PEOPLE MAKE THE DIFFERENCE AND ARE THE KEY TO PROVIDING QUALITY CARE TO RESIDENTS WHO COME TO US FOR LONG-TERM CARE. WE ASSIST RESIDENTS IN ACHIEVING THEIR HIGHEST POSSIBLE LEVEL OF PHYSICAL, PSYCHOSOCIAL AND SPIRITUAL POTENTIAL, ALWAYS WORKING TO PROTECT AND ENHANCE THEIR DIGNITY. WE SEEK TO CONTINUALLY IMPROVE THE SERVICES WE PROVIDE TO STAY CURRENT WITH THE CHANGING ENVIRONMENT AND TO MAINTAIN A HOME-LIKE ATMOSPHERE FOR OUR FAMILY OF RESIDENTS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7123272Expense
Revenue8541310Revenue
DescriptionOWNING AND OPERATING A LICENSED 117-BED SKILLED NURSING FACILITYLOCATED IN ST. LOUIS, MISSOURI. RENOVATIONS FROM FISCAL YEAR 2008ADDED A THERAPY ROOM AS WELL AS 14 ROOMS FOR MEDICARE RESIDENTS.MANOR GROVE'S HOME-LIKE ENVIRONMENT ASSURES PEACE OF MIND FORRESIDENTS AND THEIR FAMILIES.Description
Total Program Service Expense7123272TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109644NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees248NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members16NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure0WrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ROZA KOYENBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3149650864TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1711 SOUTH KIRKWOOD ROADAddressLine1
CityST LOUISCity
StateMOState
ZIP Code63122ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
STEVE DODSON
PRESIDENT1.00XX000
TODD CLEVELAND
MEMBER1.00X000
SHEILA EATON
SECRETARY1.00XX000
CAROL BICKEL
MEMBER1.00X000
DIANE KEEFE
MEMBER1.00X000
LARRY KING
MEMBER1.00X000
MILLIE MOULDER
MEMBER1.00X000
E LEE POTTS
TREASURER1.00XX000
BRIAN REINHOLD
VICE PRESIDENT1.00XX000
PAUL E ROBERTS
CONTROLLER1.00XX000
ANNE ROEHM
MEMBER1.00X000
SCOTT VOLDING
MEMBER1.00X000
BOB BRUCKNER
MEMBER1.00X000
ANNE STUCKEL
MEMBER1.00X000
BOB GRUENEWALD
MEMBER1.00X000
GEORGE ROLBY
MEMBER1.00X000
ROZA KOYEN
ACCOUNTANT40.00X4850807639
KAREN MLEDBETTER
ADMINISTRATOR40.00X8603606628
ROSE LANKFORD
ADMINISTRATOR40.00X7314507308
FieldValueIRS element (for citing)
Total Reportable Comp From Org207689TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation21575TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ALLIANCE REHAB
1520 KENSINGTON ROADOAK BROOKIL60523THERAPY279491
MIDWEST STAFFING SOLUTIONS LLC
PO BOX 823461PHILADELPHIAPA19182STAFFING252554
MEDLINE INDUSTRIES INC
DEPT CH 14400PALATINEIL60055MEDICAL SUPPLIES241633
US FOOD SERVICEALLEN DIVISION
PO BOX 504854ST LOUISMO63150FOOD SERVICE184943
GUIDEONE INSURANCE
PO BOX 14599DES MONIESIA50306INSURANCE162289
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Fundraising Events23290FundraisingEvents
All Other Contributions16481AllOtherContributions
Noncash Contributions20800NoncashContributions
Total Contributions39771TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionELDERLY CAREDescription
Business Code623000BusinessCode
Total Revenue Column8531340TotalRevenueColumn
Related Or Exempt Function Income8531340RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue8531340TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column67870TotalRevenueColumn
Exclusion$67,870ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real62486Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real49638Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real12848Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column12848TotalRevenueColumn
Exclusion$12,848ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other900Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other1133Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-233Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-233TotalRevenueColumn
Exclusion-$233ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events7795GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events23290CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses76667FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-68872TotalRevenueColumn
Exclusion-$68,872ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory3072GrossSalesOfInventory
Cost Of Goods Sold2666CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column406TotalRevenueColumn
Exclusion$406ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code623990BusinessCode
Total Revenue Column9970TotalRevenueColumn
Related Or Exempt Function Income9970RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue9970TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column8593100TotalRevenueColumn
Related Or Exempt Function Income8541310RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$12,019ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total205680Total
Management And General205680ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4330931Total
Program Services4164670ProgramServices
Management And General166261ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total33867Total
Program Services6773ProgramServices
Management And General27094ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total461559Total
Program Services398350ProgramServices
Management And General63209ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total648872Total
Program Services369757ProgramServices
Management And General279115ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total7017Total
Management And General7017ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total64184Total
Management And General64184ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total21699Total
Management And General21699ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total92817Total
Program Services33495ProgramServices
Management And General59322ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total60639Total
Program Services49340ProgramServices
Management And General11299ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total1247Total
Program Services249ProgramServices
Management And General998ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total227967Total
Program Services216569ProgramServices
Management And General11398ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total425Total
Program Services312ProgramServices
Management And General113ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total6820Total
Program Services5798ProgramServices
Management And General1022ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total12120Total
Management And General12120ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total381648Total
Program Services374015ProgramServices
Management And General7633ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total225082Total
Program Services45016ProgramServices
Management And General180066ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES635930635930
CONTRACTED SERVICES3635963625911005
RENTAL AND MAINTENANCE258285111981146304
FOOD254956254956

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total121563Total
Program Services93470ProgramServices
Management And General28093ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total8416904Total
Program Services7123272ProgramServices
Management And General1293632ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY19148BOY
EOY14708EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2382050BOY
EOY1814748EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY228949BOY
EOY293541EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY32649BOY
EOY39984EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY178074BOY
EOY68556EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis13836320LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6552601LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY7493349BOY
EOY7283719EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1032032BOY
EOY2086802EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY319383BOY
EOY319564EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY23037BOY
EOY554EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11708671BOY
EOY11922176EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY592379BOY
EOY553243EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY781037BOY
EOY688723EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1373416BOY
EOY1241966EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10335255BOY
EOY10680210EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11708671BOY
EOY11922176EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses176196ReconcilationRevenueExpenses
Reconcilation Other Changes168759ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years97103CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years44884CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years477718CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year38113CurrentTaxYearMinus1Year
Current Tax Year39771CurrentTaxYear
Total697589Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6133094CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6573054CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8514895CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8520002CurrentTaxYearMinus1Year
Current Tax Year8541310CurrentTaxYear
Total38282355Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year63386CurrentTaxYear
Total63386Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6230197CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6617938CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8992613CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8558115CurrentTaxYearMinus1Year
Current Tax Year8644467CurrentTaxYear
Total39043330Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years393378CurrentTaxYearMinus2Years
Total393378Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years393378CurrentTaxYearMinus2Years
Total393378Total
FieldValueIRS element (for citing)
Public Support Total50938649952PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years152875CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years107731CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years45505CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year48142CurrentTaxYearMinus1Year
Current Tax Year80718CurrentTaxYear
Total434971Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years152875CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years107731CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years45505CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year48142CurrentTaxYearMinus1Year
Current Tax Year80718CurrentTaxYear
Total434971Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year10867CurrentTaxYear
Total10867Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years12393CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years8171CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22097CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year41047CurrentTaxYearMinus1Year
Current Tax Year88895CurrentTaxYear
Total172603Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6395465CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6733840CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9060215CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8647304CurrentTaxYearMinus1Year
Current Tax Year8824947CurrentTaxYear
Total39661771Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97450PublicSupportPercentage509
Prior Year Support Percentage0.97260PriorYearSupportPercentage
Investment Income Percentage0.01100InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.01390PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis418080OtherCostOrOtherBasis
Book Value418080BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis11168231OtherCostOrOtherBasis
Depreciation5064246Depreciation
Book Value6103985BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1130847OtherCostOrOtherBasis
Depreciation661077Depreciation
Book Value469770BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1119162OtherCostOrOtherBasis
Depreciation827278Depreciation
Book Value291884BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7283719TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
RESIDENT SECRUITY DEPOSITS$446,600
LONG TERM NOTES PAYABLE$242,123
FieldValueIRS element (for citing)
Total Of Amounts688723TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt8808272TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments168759NetUnrealizedGainsInvestments
Other Revenues58533OtherRevenues
Revenue Not Rptd F990227292RevenueNotRptdF990
Revenue Subtotal8580980RevenueSubtotal
Investment Expenses Not Included12120InvestmentExpensesNotIncluded
Revenue Not Rptd On Fin Stmt12120RevenueNotRptdOnFinStmt
Total Revenue Per Form9908593100TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt8463317TotExpensesEtcAuditedFinclStmt
Other Expenses Included58533OtherExpensesIncluded
Expenses Not Rptd F99058533ExpensesNotRptdF990
Expenses Subtotal8404784ExpensesSubtotal
Investment Expenses Not Included212120InvestmentExpensesNotIncluded2
Expenses Not Rptd On Fin Stmt12120ExpensesNotRptdOnFinStmt
Total Expenses Per Form9908416904TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 2D - OTHER ADJUSTMENTS:THIS AMOUNT REPRESENTS SPECIAL EVENT EXPENDITURES REPORTED 55,867. ON THE FINANCIAL STATEMENT AS EXPENSES. THIS AMOUNT REPRESENTS COST OF INVENTORY REPORTED 2,666. ON THE FINANCIAL STATEMENT AS EXPENSES.
PART XII, LINE 2D - OTHER ADJUSTMENTS:THIS AMOUNT REPRESENTS SPECIAL EVENT EXPENDITURES REPORTED 55,867. ON THE 990. SECTION VIII, LINE 8B AS PART OF DIRECT EXPENSES. THIS AMOUNT REPRESENTS COST OF INVENTORY REPORTED 2,666. ON THE 990, SECTION VIII, LINE 10B AS PART OF COST OF GOODS SOLD..

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1SOUP'S ONNameOfEvent1
Gross Receipts Event131085GrossReceiptsEvent1
Charitable Contributions Event123290CharitableContributionsEvent1
Gross Revenue Event17795GrossRevenueEvent1
Rent Facility Costs Event14609RentFacilityCostsEvent1
Food And Beverage Event120800FoodAndBeverageEvent1
Other Direct Expenses Event151258OtherDirectExpensesEvent1
Gross Receipts Total31085GrossReceiptsTotal
Charitable Contributions Total23290CharitableContributionsTotal
Gross Revenue Total Events7795GrossRevenueTotalEvents
Rent Facility Costs Total Events4609RentFacilityCostsTotalEvents
Food And Beverage Total Events20800FoodAndBeverageTotalEvents
Other Direct Expenses Total Events51258OtherDirectExpensesTotalEvents
Direct Expense Summary Events76667DirectExpenseSummaryEvents
Net Income Summary-68872NetIncomeSummary

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonJENNIFER LANKFORDNamePerson
FieldValueIRS element (for citing)
RelationshipFAMILY RELATIONSHIP WITH ROSE LANKFORD, ADMINISTRATOR AS SHOWN IN PART VIIRelationship
Amount Of Transaction36537AmountOfTransaction
Description Of TransactionEMPLOYMENTDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE ADMINISTRATOR WILL REVIEW THE PREPARED FORM 990. THE BOARD WILL REVIEW AND APPROVE THE 990 DURING THEIR FIRST MEETING AFTER THE 990 HAS BEEN PREPARED. BOARD MEMBERS WILL BE ABLE TO VOICE ANY COMMENTS OR CONCERNS, DECIDE IF ANY CHANGES NEED TO BE MADE.
FORM 990, PART VI, SECTION B, LINE 12CDIRECTORS OF THE BOARD ARE COVERED UNDER THE CONFLICT OF INTEREST POLICY. IF THE ADMINISTRATOR OR THE BOARD MEMBER SUSPECTS A CONFLICT OF INTEREST, IT IS DISCLOSED AT THE NEXT BOARD MEETING. THE BOARD MEMBERS DISCUSS THE ISSUES AND ACCEPT OR DENY THE TRANSACTION. THE DISCLOSURE, DISCUSSION, AND DECISION HAPPEN BEFORE THE TRANSACTION OCCURS. NO RESTRICTIONS HAVE BEEN IMPOSED SO FAR.
FORM 990, PART VI, SECTION B, LINE 15AMANAGEMENT REVIEWS COMPENSATION TO VERIFY AMOUNTS ARE COMPARABLE TO OTHER ENTITIES IN THE SAME REGION AND SIZE AMONG OTHER FACTORS. BOARD OF DIRECTORS REVIEW AND APPROVE COMPENSATION FOR THE ADMINISTRATOR.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION HAS MADE GOVERNING DOCUMENTS, THEIR CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST.
PART VI, SECTION B QUESTION 16BTHE ORGANIZATION DOES NOT CURRENTLY HAVE A POLICY IN PLACE FOR THE MONITORING OF THIS INVESTMENT. DURING THE 2011 TAX YEAR SCN, INC. CONVERTED FROM A NON PROFIT ORGANIZATION TO A FOR PROFIT ORGANIZATION WITH FIVE MEMBERS, ALL OF WHICH ARE 501(C)(3) ORGANIZATIONS. SCN, INC. HAS BEEN ORGANIZED TO ENABLE ITS MEMBERS TO TAKE ADVANTAGE OF GROUP DISCOUNTS WHEN PURCHASING SUPPLIES NEEDED FOR OPERATION OF THEIR NURSING HOME AND SKILLED-NURSING FACILITIES.INVESTMENT IN SCN, INC.
FORM 990, PART XI, LINE 9:UNREALIZED GAINS 168,759.CHANGES IN NET ASSETS OR FUND BALANCES:

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