2013-09-03T10:46:03-05:00 2012-12-31 621046406 JOHNSON HICKEY & MURCHISON PC 651 E 4TH ST STE 200 CHATTANOOGA TN 37403 990 2012-01-01 581838041 THE SENIOR LIVING FOUNDATION INC SENI 7703999988 1530 DUNWOODY VILLAGE PKY NO 115 ATLANTA GA 303384138 WINSTON ALLEN PORTER III 7703999988 2013-08-20 BARRY R HUGGINS P00627334 4237560052 2012 2016-02-24 21:20:13Z WINSTON ALLEN PORTER III DUNWOODY VILLAGE PKWY 115 ATLANTA GA 30350 10219429 0 X N/A X 2008 GA THE ORGANIZATION WAS FORMED TO PROMOTE HEALTH BY OFFERING ELDERLY CITIZENS VIABLE CHOICES IN ALTERNATE LIVING ARRANGEMENTS DESIGNED TO MEET THEIR VARIOUS LEVELS OF NEEDS. 5 5 370 151 0 0 3395 2645 10771384 10195906 211 8654 31479 12224 10806469 10219429 0 0 0 0 5066964 5306997 0 0 0 5682141 5589787 10749105 10896784 57364 -677355 16384023 16333805 16181263 16855305 202760 -521500 THE ORGANIZATION WAS FORMED TO PROMOTE HEALTH BY PROVIDING ELDERLY CITIZENS VIABLE CHOICES IN ALTERNATE LIVING ARRANGEMENTS DESIGNED TO MEET THEIR 0 0 9981872 10208130 CARE FOR THE ELDERLY WHICH INCLUDES INTERMEDIATE OR SKILLED NURSING CARE, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY,AND EXTENSIVE ACTIVITIES PROGRAMMING. TOTAL PATIENT DAYS WERE 48,787 DURING THE YEAR ENDED 12/31/12. 9981872 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 13 0 1 370 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 1 0 GA X X THE SENIOR LIVING FOUNDATION INC 7703999988 1530 DUNWOODY VILLAGE PKY STE 115 ATLANTA GA 30338 DAVID MARVIN 1.00 X 0 0 0 CHUCK POWELL 1.00 X 0 0 0 STEVE PICKIN 1.00 X 0 0 0 CHRIS MORRISON 1.00 X 0 0 0 WINSTON ALLEN PORTER III 12.00 X 50000 0 0 50000 0 0 0 0 0 0 SELECT REHABILITATION 550 FRONTAGE ROAD SUITE 2415 NORTHFIELD IL 60093 THERAPY SERVICES 728446 CENTRAL HEALTH SYSTEMS LLC 1530 DUNWOODY VILLAGE PKWY ATLANTA GA 30338 MANAGEMENT FEES 450000 TRI-MED PHARMACY PO BOX 890985 CHARLOTTE NC 282890985 PHARMACY 375792 GORDON FOOD SERVICE DEPT CH 10490 PALATINE IL 600550490 FOOD SERVICES 326915 ENDURACARE PO BOX 53064 PHOENIX AZ 850723064 THERAPY SERVICES 253406 6 2645 2645 NET PATIENT REVENUE 623000 10195906 10195906 10195906 86 86 8568 0 8568 8568 8568 MEALS 623000 4150 4150 BEAUTY & BARBER 623000 4054 4054 HOME BASE REVENUE 623000 1980 1980 2040 2040 12224 10219429 10208130 0 8654 X 50000 50000 4333359 3943621 389738 39236 35707 3529 494762 447079 47683 389640 353325 36315 450000 405000 45000 4331 3898 433 8410 7569 841 1314372 1213963 100409 60673 60673 21562 9773 11789 272401 245118 27283 31856 28670 3186 7152 2933 4219 1135120 1021608 113512 262215 235994 26221 201932 181739 20193 DRUG AND MEDICAL SUPPLI 573208 573208 LICENSES AND PERMITS 376504 376504 RAW FOOD 353738 353738 BAD DEBT 288470 288470 227843 193282 34561 10896784 9981872 914912 0 355945 345762 39575 1132531 1076508 97754 99460 7334224 736493 6530610 6597731 8227608 8214344 16384023 16333805 761960 1079373 12363 12363 10363489 10363489 4251475 4179378 791976 1220702 16181263 16855305 X 202760 -524595 3095 202760 -521500 16384023 16333805 X -677355 -50000 3095 X 1 X 0 1 0 X 3395 2645 6040 9463447 10798761 10208130 30470338 9463447 10802156 10210775 30476378 0 0 0 30476378 175 211 86 472 175 211 86 472 9463622 10802367 10210861 30476850 1.00000 1.00000 0.00000 X 129651 129651 6840606 683844 6156762 317470 52649 264821 46497 46497 6597731 GOODWILL 8107191 NET DEFERRED FINANCING COSTS 88695 PATIENT TRUST FUNDS 18458 8214344 NOTE PAYABLE CROSSVILLE ASSOCIATES 93065 PATIENT TRUST FUNDS 18458 PROMISSARY NOTE 959179 NOTE PAYABLE WINSTON PORTER JR 50000 N/P RELATED PARTY 100000 1220702 A THE HEALTH AND EDUCATIONAL FACILITIES BOARD OF THE CITY OF CROSSVILLE TN 2010-02-01 10363489 PURCHASE OF NURSING HOME 0 0 0 A 10363489 10363489 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 CENTRAL HEALTH SYSTEMS LLC PART V 450000 MANAGEMENT FEES 0 PART IV SECTION (B) RELATIONSHIP BETWEEN INTERESTED PERSON AND THE ORGANIZATION WINSTON PORTER 99% OWNER IN CROSSVILLE ASSOCIATES LLC, IS THE FATHER OF THE MANAGING DIRECTOR WINSTON PORTER III. WINSTON PORTER OWNS 49% OF THE MANAGEMENT COMPANY WHO MANAGES THE NURSING HOME.WINSTON PORTER III DOES NOT CONTROL OR OWN THE MANAGEMENT COMPANY. WINSTON PORTER THE III DOES NOT PARTICIPATE IN THE EVALUATION OR SELECTION OF THE MANAGEMENT COMPANY WHICH OPERATES THE NURSING HOME.THE MANAGEMENT COMPANY OFFERS A STANDARD CONTRACT THAT IS SIMILAR TO OTHERS IN THE INDUSTRY. THE PROPERTY BID OUT MANAGEMENT AGREEMENTS TO INSURE THAT ANY MANAGEMENT AGREEMENT RATE THAT THE NONPROFIT PAYS ARE KEPT AT OR BELOW FAIR MARKET VALUE FOR SUCH SERVICES FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WILL BE REVIEWED BY THE BOARD BEFORE IT IS FILED FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE SIGNS A STATEMENT THAT HE HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY AND HAS READ AND UNDERSTANDS THE POLICY, AND AGREES TO COMPLY WITH THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS DETERMINED BY THE BOARD FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST. OTHER FEES FORM 990, PART IX, LINE 11G OTHER CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,213,963. MANAGEMENT AND GENERAL EXPENSES 100,409. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,314,372. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN TEMPORARY RESTRICTED ASSETS 3,095. SLF NO1 LLC 456 WAYNE AVENUE CROSSVILLE TN 38555 271506824 NURSING HOME TN -627013 15899123 THE SENIOR LIVING FOUNDATION INC SOLE MEMBER OF SLF NO1 LLC SLF NO1 LLC 456 WAYNE AVENUE CROSSVILLE TN 38555 271506824 NURSING HOME TN 501(C)3 LINE 9 THE SENIOR LIVING FOUNDATION INC SOLE MEMBER OF SLF NO1 LLC 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SLF#1 LLC C 50000 CASH