2013-05-14T08:50:39-05:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 1301 W 22ND ST STE 1100 OAK BROOK IL 60523 990 2011-07-01 010729134 CLARE OAKS CLAR 6303721983 827 CARILLON DRIVE BARTLETT IL 60103 PAUL CLEMENS 6303721983 2013-04-05 1 ROBERT J NOWAK CPA MST P00527435 6305738600 2011 2016-02-24 21:20:13Z PAUL CLEMENS 827 CARILLON DRIVE BARTLETT IL 60103 19300561 0 X WWW.CLAREOAKS.COM X 2006 IL TO CREATE AN INTIMATE RETIREMENT COMMUNITY TO SERVE EVERY ASPECT OF A PERSON: MIND, BODY, AND SPIRIT. TO HAVE AN INSPIRING ENVIRONMENT WHERE RESIDENTS WOULD LIVE IN CLOSE HARMONY WITH EACH OTHER AND CONTINUE TO GROW AS INDIVIDUALS AND AS A COMMUNITY THROUGH INDEPENDENT LIVING, ASSISTED LIVING, SKILLED NURSING, REHABILITATION, AND MEMORY CARE. 9 9 0 29 0 0 460 0 19190735 18431667 175005 51544 506178 740236 19872378 19223447 0 0 0 0 7656016 8220495 0 0 0 19960590 14288213 27616606 22508708 -7744228 -3285261 107391705 40297581 137189299 140877174 -29797594 -100579593 X TO PROVIDE CONTINUING CARE AT A RETIREMENT COMMUNITY CONSISTING OF RESIDENTIAL, HEALTH, RECREATIONAL, SOCIAL, RELIGIOUS AND SPIRITUAL FACILITIES AND SERVICES, WHICH WILL SHARE, PROMOTE AND OPERATE IN ACCORDANCE WITH ETHICAL AND SPIRITUAL VALUES FOR THE ROMAN CATHOLIC RELIGIOUS INSTITUTE KNOWN AS THE SISTERS OF ST. JOSEPH OF THE THIRD ORDER OF ST. FRANCIS. 0 0 19030001 19171903 CLARE OAKS PROVIDES AN ASSISTED LIVING FACILITY AS WELL AS MEMORY CARE SERVICES TO OLDER ADULTS. IT PROVIDES HOUSING AND SUPPORTIVE SERVICES BY CERTIFIED AND LICENSED NURSING STAFF INCLUDING SUPPORT FOR ADL'S, MEDICATION ADMINISTRATION, ONSITE 24 HOUR SECURITY, DINING, WELLNESS PROGRAMS, ACTIVITIES, TRANSPORTATION, HEALTH CLINIC, HOUSEKEEPING, AND A PHYSICAL FITNESS VENUE.CLARE OAKS PROVIDES AN INDEPENDENT LIVING FACILITY THAT PROVIDES HOUSING AND SUPPORTIVE SERVICES INCLUDING ONSITE 24 HOUR SECURITY, DINING, WELLNESS PROGRAMS, ACTIVITIES, TRANSPORTATION, HEALTH CLINIC, HOUSEKEEPING, AND A PHYSICAL FITNESS VENUE. CLARE OAKS PROVIDES A SKILLED NURSING FACILITY THAT PROVIDES A 24 HOUR SKILLED NURSING SERVICE (LICENSED IN MEDICARE AND MEDICAID) IN A MODERN HEALTHCARE CENTER. THE SKILLED NURSING FACILITY INCLUDES SUPPORT FOR ADL'S, MEDICATION ADMINISTRATION, ONSITE 24 HOUR SECURITY, DINING, WELLNESS PROGRAMS, ACTIVITIES, TRANSPORTATION, A HEALTH CLINIC, HOUSEKEEPING, AND A PHYSICAL FITNESS VENUE. 19030001 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 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 0 1 85 0 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 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 SISTER DENISE SEYMOUR 1.00 X 0 0 0 SISTER JEANNE CONZEMIUS 1.00 X X 0 0 0 DAN WALSH 1.00 X X 0 0 0 SISTER MARCELLA NOWAKOWSKI 1.00 X 0 0 0 PAUL CLEMENS 1.00 X X 0 0 0 EDWARD TED OTTO 1.00 X 0 0 0 THERESE M MALM 1.00 X 0 0 0 WILLIAM KEANE 40.00 X X 0 0 0 JEANNENE WALKER 40.00 X 113992 0 0 MICHELLE HART-CARLSON 40.00 X 110496 0 0 MARYCON TATE 40.00 X 102265 0 0 326753 0 0 3 0 0 0 REHAB CARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 2592026 PHARMERICA INC PO BOX 409251 ATLANTA GA 30384 PHARMACY SERVICES 1183575 SYSCO FOOD SERVICES PO BOX 5037 DES PLAINES IL 60017 FOOD 364392 MIDVALLEY STAFFING 5N441 RAILROAD ST SUITE 102 WAYNE IL 60184 AGENCY NURSING STAFFING 334331 US FOOD SERVICE INC PO BOX 98420 CHICAGO IL 60693 FOOD 292103 20 RESIDENT SERVICES 623000 18431667 18431667 18431667 128658 128658 77114 -77114 -77114 -77114 ENTRANCE FEE AMORTIZAT 623000 740236 740236 740236 19223447 19171903 0 51544 326753 326753 6991753 6321294 670459 184287 184287 717702 494022 223680 1399431 717517 681914 96227 96227 78663 78663 99687 99687 242044 146379 95665 149026 149026 844045 844045 22266 8193 14073 21598 14496 7102 2712941 2712941 3117452 3117452 653005 200557 452448 SUPPLIES 2147864 2146971 893 PHARMACY 796897 796897 FOOD 779705 779705 EQUIPMENT AND REPAIRS 352170 346117 6053 775192 304752 470440 22508708 19030001 3478707 0 2142795 2049427 141549 2316634 2126645 2069514 198400 47397 27359 25237 70533 571501 32254102 9872449 87010555 22381653 6713222 2686650 8960647 8149568 107391705 40297581 3837127 5660268 31627095 32357834 98890490 99839033 2834587 3020039 137189299 140877174 X -29797594 -100579593 -29797594 -100579593 107391705 40297581 X -3285261 -67496738 X 0 0 0 X 961653 4038347 460 5000460 976060 11302080 14869035 19190735 18134777 64472687 976060 12263733 18907382 19191195 18134777 69473147 0 0 0 69473147 1895733 374492 308061 175005 51544 2804835 1895733 374492 308061 175005 51544 2804835 77435 184498 458028 506178 1037126 2263265 2949228 12822723 19673471 19872378 19223447 74541247 0.93200 0.85100 0.03760 0.13370 X 178534 178534 32075568 9872449 22203119 22381653 DEFERRED FINANCING COSTS 4605164 ENTRANCE DEPOSITS 34905 DEFERRED MARKETING/SELLING COSTS 3509499 8149568 CURRENT DEFERRED ENTRANCE FEES 2600000 RESERVATION DEPOSITS 420039 3020039 19223447 22508708 -3285261 22257 -67518995 -67496738 -70781999 19245704 22257 22257 19223447 0 19223447 22508708 0 22508708 0 22508708 PART XI, LINE 8 - OTHER ADJUSTMENTS: GAIN ON INTEREST RATE SWAP IN THE CURRENT YEAR 892,635. BANKRUPTCY FILING EXPENSE -3,336,896. ADEQUATE PROTECTION PAYMENT EXPENSE -1,884,169. DIP LOAN EXPENSE -630,500. PRIOR PERIOD ADJUSTMENT - FIXED ASSET IMPAIRMENT -62,560,065. TOTAL TO SCHEDULE D, PART XI, LINE 8: -67,518,995. ILLINOIS FINANCE AUTHORITY 861091967 45200BZR2 2006-07-19 56360000 CONSTRUCTION PROJECT OF CLARE OAKS 0 0 0 ILLINOIS FINANCE AUTHORITY 861091967 45200BZN1 2006-07-19 55968314 CONSTRUCTION PROJECT OF CLARE OAKS 0 0 0 56360000 0 0 1 1 55968314 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 1 SOVEREIGN BANK 0 0 0 0 0 0 0 0 0 0 0 X 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 CONTROLLER TO ASCERTAIN IF ANY RELATIONSHIP EXISTS BETWEEN THE CONTRACTOR AND ANY OFFICERS, DIRECTORS, OR KEY EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 15 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 CLARE OAKS 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 AND FORM 1023 AVAILABLE FOR PUBLIC INSPECTION ON ANOTHER'S WEBSITE AS WELL AS 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 5: NET UNREALIZED GAINS ON INVESTMENTS: 22,257. GAIN ON INTEREST RATE SWAP IN THE CURRENT YEAR 892,635. BANKRUPTCY FILING EXPENSE -3,336,896. ADEQUATE PROTECTION PAYMENT EXPENSE -1,884,169. DIP LOAN EXPENSE -630,500. PRIOR PERIOD ADJUSTMENT - FIXED ASSET IMPAIRMENT -62,560,065. TOTAL TO FORM 990, PART XI, LINE 5: -67,496,738.