2013-11-15T06:37:02-06:00 2012-12-31 311543240 CBIZ MHM LLC 401 PLYMOUTH ROAD SUITE 200 PLYMOUTH MEETING PA 19462 990 2012-01-01 721150472 AMERICAN FAMILY SERVICES INC AMER 2257530864 PO BOX 40018 BATON ROUGE LA 70835 CYNTHIA PITTMAN 2257530864 2013-11-12 1 JOSEPH G SULLIVAN P00360476 6108622249 2012 2016-02-25 16:41:14Z RICHARD T DASPIT SR 17617 S HARRELLS FERRY ROAD BATON ROUGE LA 70816 3873957 0 8588 X WWW.AFSHEALTH.ORG X 1989 LA TO PROVIDE COMPREHENSIVE NURSING CARE SERVICES 4 4 153 0 0 0 0 22643 3780523 3843648 30 1141 9559 6525 3790112 3873957 0 0 0 0 2377072 2232729 0 0 0 1851109 1894368 4228181 4127097 -438069 -253140 3262741 3361561 5476655 5828615 -2213914 -2467054 TO PROVIDE COMPREHENSIVE NURSING CARE SERVICES 0 0 3672755 3843648 AMERICAN FAMILY SERVICES WAS FORMED TO ACQUIRE AND OWN A 60 BEDNURSING FACILITY AND TO CONSTRUCT AND OWN A 42 BED ASSISTED LIVINGFACILITY. 3672755 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 153 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 LA X CYNTHIA PITTMAN 2257530864 17617 S HARRELLS FERRY ROAD BATON ROUGE LA 70816 RICHARD T DASPIT SR 40.00 X X 0 200839 5376 G STUART MURPHY III 1.00 X X 0 6000 0 THOMAS ECHOLS 1.00 X X 0 6000 0 LOUIS HERRERO 1.00 X X 0 6000 0 CYNTHIA PITTMAN 40.00 X 0 118584 5376 MICHAEL SMITH 40.00 X 0 165044 5376 0 502467 16128 0 0 1 0 0 22643 22643 RESIDENT SERVICE REVEN 623000 3843648 3843648 3843648 1141 1141 VENDING MACHINE 623000 3026 3026 MISCELLANEOUS 623000 1725 1725 MEALS SOLD 623000 930 930 844 844 6525 3873957 3843648 0 7666 1897228 1688367 208861 177303 157784 19519 158198 140782 17416 498 443 55 43986 39144 4842 236014 210032 25982 892 794 98 2823 2512 311 151463 134789 16674 33380 29705 3675 230553 205172 25381 121103 107771 13332 58967 52475 6492 OTHER RESIDENT CARE SER 598423 532544 65879 OTHER DIETARY SERVICES 243183 216412 26771 ALL OTHER EXPENSES 62157 55314 6843 UTILITIES & MAINTENANCE 49332 43901 5431 61594 54814 6780 4127097 3672755 454342 0 7315 123999 262030 357095 22642 14473 3912007 2295438 1700231 1616569 362205 411229 0 908318 838196 3262741 3361561 360444 474283 3570000 3545000 950000 935000 596211 874332 5476655 5828615 X -2213914 -2467054 -2213914 -2467054 3262741 3361561 -253140 0 X X 0 1 X 1 0 X 100 480 100 22643 23323 3864624 4059815 3638432 3780523 3843648 19187042 3864724 4060295 3638532 3780523 3866291 19210365 0 0 0 19210365 3523 2578 229 30 1141 7501 3523 2578 229 30 1141 7501 71091 7874 8170 9559 6525 103219 3939338 4070747 3646931 3790112 3873957 19321085 0.99430 0.97170 0.00040 0.00090 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: VENDING REVENUE MEAL REVENUE MISCELLANEOUS BARBER BEAUTY FORGIVENESS OF DEBT LEGAL SETTLEMENT RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 157613 157613 3043727 1691939 1351788 83514 82682 832 627153 520817 106336 1616569 ASSETS WHOSE USE IS LIMITED 411229 C 411229 DEFERRED FINANCING FEES 239215 GOODWILL 530715 DEPOSITS 1500 ESTIMATED THIRD PARTY SETTLEMENT 66766 838196 DUE TO RELATED PARTY 874332 874332 X 51896233 48022276 48022276 3873957 0 3873957 58034454 53907357 53907357 4127097 0 4127097 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: AFS IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN PROVIDED. AFS ACCOUNTS FOR THE EFFECTS OF ANY UNCERTAIN TAX POSITIONS BASED ON A "MORE LIKELY THAN NOT" THRESHOLD TO THE RECOGNITION OF THE TAX POSITIONS BEING SUSTAINED BASED ON THE TECHNICAL MERITS OF THE POSITION UNDER SCRUTINY BY THE APPLICABLE TAXING AUTHORITY. IF A TAX POSITION OR POSITIONS ARE DEEMED TO RESULT IN UNCERTAINTIES OF THOSE POSITIONS, THE UNRECOGNIZED TAX BENEFIT IS ESTIMATED BASED ON A "CUMULATIVE PROBABILITY ASSESSMENT" THAT AGGREGATES THE ESTIMATED TAX LIABILITY FOR ALL UNCERTAIN TAX POSITIONS. INTEREST AND PENALTIES ASSESSED, IF ANY, ARE ACCRUED AS INCOME TAX EXPENSE. AFS HAS IDENTIFIED ITS TAX STATUS AS A TAX-EXEMPT ENTITY AS A TAX POSITION; HOWEVER, AFS HAS DETERMINED THAT SUCH TAX POSITION DOES NOT RESULT IN AN UNCERTAINTY REQUIRING RECOGNITION. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUES EARNED BY OTHER ORGANIZATIONS COMBINED WITH THE 50,672,777. ORGANIZATION FOR FINANCIAL STATEMENT PURPOSES LESS ELIMINATING ENTRIES INCLUDED IN FINANCIAL STATEMENTS -2,650,501. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES INCURRED BY OTHER ORGANIZATIONS COMBINED WITH THE 57,590,015. ORGANIZATION FOR FINANCIAL STATEMENT PURPOSES LESS ELIMINATING ENTRIES INCLUDED IN FINANCIAL STATEMENTS -3,682,658. 0 0 0 0 0 0 0 0 0 RICHARD T DASPIT SR 0 200839 0 0 0 0 0 0 0 5376 0 206215 0 0 MICHAEL SMITH 0 165044 0 0 0 0 0 0 0 5376 0 170420 0 0 PART I, LINE 3 SUPPLEMENTAL INFORMATION PART III WAGES WERE PAID BY FOUNDATION HEALTH SERVICES, INC. TO THE FOLLOWING INDIVIDUALS: - RICHARD T. DASPIT, SR. $200,839 - MICHAEL SMITH $165,044 A INDUSTRIAL DEVELOPMENT AUTHORITY OF ACCOMACK VA 2007-03-01 3585000 REFINANCE OF ORIGINAL BOND DEBT 0 0 0 A 40000 3545000 3585000 3585000 2007 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS COMPLETED ANNUALLY AND COPIES ARE PROVIDED TO THE ENTIRE GOVERNING BOARD AS WELL AS THE PRESIDENT OF THE ORGANIZATION. AT THAT TIME THE PRESIDENT REVIEWS THE FORM 990 WITH THE BOARD MEMBERS. ANY NECESSARY CHANGES ARE THEN UPDATED ON THE FORM. ONCE ALL NECESSARY CHANGES ARE MADE AND THE PRESIDENT IS IN AGREEMENT WITH THE BOARD MEMBERS ON THE FINISHED FORM 990, IT IS SIGNED BY THE CFO, DATED AND SUBMITTED BY THE FILING DEADLINE. A COPY OF THE APPROVED FORM 990 IS PROVIDED TO ALL OF THE OFFICERS, DIRECTORS AND TRUSTEES BEFORE THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION PROMULGATES ITS CONFLICT OF INTEREST POLICY TO ASSURE CONTINUED COMMITMENT TO THE INTEGRITY OF ITS EXEMPT PURPOSE. TO PROVIDE ENFORCEMENT OF THE POLICY, A WRITTEN DISCLOSURE OF THE POLICY IS DISTRIBUTED TO THE EMPLOYEES AND BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE INDIVIDUAL IS APPROVED BY AN INDEPENDENT COMPENSATION COMMITTEE OF THE ORGANIZATION, MADE UP OF INDEPENDENT BOARD MEMBERS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE, UPON IN-PERSON VERBAL OR WRITTEN REQUEST, DOCUMENTS RELATING TO THE GOVERNANCE, CONFLICTS OF INTEREST AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. AUDIT OVERSIGHT FORM 990, PART XII, LINE 2C FOR THE CURRENT YEAR, THERE HAS BEEN NO CHANGE TO THE AUDIT OVERSIGHT PROCESS OR THE SELECTION OF INDEPENDENT ACCOUNTANTS. FOUNDATION HEALTH SERVICES INC PO BOX 40213 BATON ROUGE LA 70835 581745788 HEALTHCARE LA 501(C)(3) LINE 9 N/A 0 BLUEBONNET HEALTHCARE INC PO BOX 40018 BATON ROUGE LA 70835 781187099 HEALTHCARE LA 501(C)(3) LINE 9 FHS 1 RAVENWOOD HEALTHCARE INC PO BOX 40018 BATON ROUGE LA 70835 721325018 HEALTHCARE MD 501(C)(3) LINE 9 FHS 1 HUNTINGDON NURSING CENTER INC PO BOX 40018 BATON ROUGE LA 70835 541759925 HEALTHCARE VA 501(C)(3) LINE 9 FHS 1 CARROLLWOOD HEALTH FOUNDATION INC PO BOX 40018 BATON ROUGE LA 70825 721241847 FINCLSERVICESHEALTHCARE FL 501(C)(3) LINE 11A, I FHS 1 MAGNOLIA HEALTHCARE INC PO BOX 40018 BATON ROUGE LA 70835 721304946 HEALTHCARE MS 501(C)(3) LINE 9 FHS 1 ROCK GLEN HEALTHCARE INC PO BOX 40018 BATON ROUGE LA 70835 721277793 HEALTHCARE MD 501(C)(3) LINE 9 FHS 1 COLONIAL HEALTHCARE INC PO BOX 40018 BATON ROUGE LA 70835 721432537 INACTIVE MA 501(C)(3) LINE 9 FHS 1 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0 FOUNDATION HEALTH SERVICES INC E 85000 FMV FOUNDATION HEALTH SERVICES INC M 3000 FMV FOUNDATION HEALTH SERVICES INC O 502467 FMV FOUNDATION HEALTH SERVICES INC P 9993 FMV