2013-11-14T10:04:03-06:00 2012-12-31 420714325 MCGLADREY LLP 117 E MAIN ST STE 210 GALESBURG IL 61401 990 2012-01-01 721568459 RESIDENTIAL ALTERNATIVES OF IOWA RESI 3093431550 285 SOUTH FARNHAM STREET GALESBURG IL 61401 IRWIN JANN 3093431550 2013-11-04 1 BEN MCMAHAN P00702421 3093428026 2012 2016-02-25 16:41:14Z IRWIN JANN 285 SOUTH FARNHAM STREET GALESBURG IL 61401 6686739 0 X N/A X 2003 IA TO PROVIDE & OPERATE NURSING AND ASSISTED LIVING FACILITIES FOR THE ELDERLY. 4 4 273 9 0 0 22258 15926 5318974 6670380 91 433 0 0 5341323 6686739 300 0 0 0 2824164 3149415 0 0 0 3380055 3932668 6204519 7082083 -863196 -395344 1253576 1265817 7950056 8357641 -6696480 -7091824 X THE MISSION OF THE ORGANIZATION IS ARTICULATED IN ITS ARTICLES OF INCORPORATION AS FOLLOWS:THE CORPORATION IS ORGANIZED AND SHALL BE OPERATED EXCLUSIVELY FOR CHARITABLE PURPOSES, INCLUDING, FOR SUCH PURPOSES, THE MAKING OF DISTRIBUTIONS TO ORGANIZATIONS THAT QUALIFY AS TAX-EXEMPT ORGANIZATIONS UNDER 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED OR CORRESPONDING SECTION OF ANY FUTURE FEDERAL TAX CODE. IN FURTHERANCE OF THESE PURPOSES, THE CORPORATION MAY BUILD, LEASE, ACQUIRE AND OTHERWISE OWN AND OPERATE HOUSING, NURSING FACILITIES, CONTINUOUS CARE RETIREMENT COMMUNITIES AND OTHER RELATED FACILITIES AND SERVICES FOR THE ELDERLY, MENTALLY RETARDED, MENTALLY ILL, DEVELOPMENTALLY DISABLED AND OTHER LIKE CONDITIONS WITHOUT REGARD TO RACE, RELIGION, COLOR, SEX, CREED OR NATIONAL ORIGIN OF SAID PERSONS. 0 0 6590001 6670380 ALL PROGRAM SERVICES RELATE TO PROVIDING AND OPERATING SKILLED NURSING FACILITIES, HEALTH CARE, ASSISTED AND SEMI-INDEPENDENT LIVING FACILITIES, AND OTHER RELATED SERVICES TO THE ELDERLY. 6590001 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 9 0 1 273 1 0 0 0 0 0 0 0 0 0 0 X 4 4 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 X X RON WILSON RFMS INC 3093431550 285 S FARNHAM ST GALESBURG IL 61401 X IRWIN JANN 1.00 1.00 X X 3000 0 0 JEFFREY SHAW 1.00 1.00 X X 4500 0 0 DOUG BIEDERSTEDT 1.00 1.00 X 4500 0 0 WILLIAM KEMPINERS 1.00 1.00 X 4500 0 0 RON WILSON RFMS INC 5.00 X 0 0 0 STACEY CREMEENS 40.00 X 120053 0 3937 136553 0 3937 1 0 0 0 RFMS INC 285 S FARNHAM ST GALESBURG IL 61401 ADMINISTRATIVE SERVICES 180000 1 15926 15926 PRIVATE PAY RESIDENT S 623000 3358373 3358373 MEDICARE & MEDICAID 623000 3303557 3303557 OTHER INCOME 623000 8450 8450 6670380 433 433 6686739 6670380 0 433 16500 16500 2678278 2590621 87657 8577 8296 281 209686 202823 6863 236374 228638 7736 218701 124831 93870 23737 23737 43020 43020 1749 1749 540842 540842 58093 52284 5809 54823 43545 11278 19138 15310 3828 1843749 1788793 54956 21069 18017 3052 3503 3153 350 15764 15764 62414 59293 3121 66931 58980 7951 SUPPLIES & SMALL EQUIP. 708888 708888 MEDICAID ASSESSMENT TAX 97868 97868 UNCOLLECTIBLE CHARGES 92887 92887 EQUIPMENT RENT & MAINT. 41473 41463 10 18019 6356 11663 7082083 6590001 492082 0 359210 1406 164487 576746 659679 59018 64657 809449 505935 237196 303514 20000 73480 1253576 1265817 809987 1064733 26406 1883 2500000 2500000 4613663 4791025 7950056 8357641 X -6696480 -7091824 -6696480 -7091824 1253576 1265817 -395344 0 X X 1 X 0 1 0 X 85257 99985 26993 22258 15926 250419 6716691 5621651 5160369 5318974 6670380 29488065 6801948 5721636 5187362 5341232 6686306 29738484 0 32912 115159 449253 244369 161675 1003368 32912 115159 449253 244369 161675 1003368 28735116 1535 20 24 91 433 2103 1535 20 24 91 433 2103 6803483 5721656 5187386 5341323 6686739 29740587 0.96620 0.97150 0.00010 0.00030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1749 1749 6590001 6591750 479588 119897 0 0 490659 456257 441272 479588 1867776 2801664 1868 1558 1648 1749 6823 122665 114064 110318 119897 466944 700416 282644 156167 126477 418794 309867 108927 108011 39901 68110 303514 THIRD-PARTY COST REPORT RECEIVABLE 73480 73480 RESIDENT SECURITY DEPOSITS 85023 DUE TO RESIDENTS, TRUST ACCTS 11076 REFUNDABLE RESIDENT ACCOUNTS 30941 AMOUNTS DUE TO THIRD-PARTY PAYORS 42361 STANDY LOAN AGREEMENT WITH RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC. 4621624 4791025 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THEREFORE, NO PROVISION HAS BEEN MADE FOR FEDERAL OR STATE INCOME TAXES. MANAGEMENT EVALUATED THE ORGANIZATION'S TAX POSITIONS AND CONCLUDED THAT THE ORGANIZATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF THIS GUIDANCE. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION RECEIVES SUPPORT SERVICES FROM LTC SUPPORT SERVICES, LLC, AN UNRELATED COMPANY. THESE SERVICES INCLUDE OVERSIGHT, TRAINING, REGULATORY COMPLIANCE, QUALITY ASSURANCE PROGRAMS, HUMAN RESOURCE SUPPORT, MARKETING AND MAINTENANCE. RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., IS A 12.5% OWNER OF LTC SUPPORT SERVICES, LLC. RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., IS RELATED TO RESIDENTIAL ALTERNATIVES OF IOWA, INC., THROUGH A COMMON BOARD OF DIRECTORS (SEE SCHEDULE R). THE REMAINING 87.5% OF LTC SUPPORT SERVICES, LLC., IS OWNED BY UNRELATED EXEMPT ORGANIZATIONS. THE ORGANIZATION ALSO HAS A NEGOTIATED ARMS LENGTH ADMINISTRATIVE SERVICES CONTRACT WITH RFMS, INC., AN UNRELATED COMPANY, TO OBTAIN SERVICES SUCH AS CASH MANAGEMENT, ACCOUNTING AND FINANCIAL REPORTING, PAYROLL AND EMPLOYEE BENEFITS, INFORMATION TECHNOLOGY, REGULATORY MATTERS, AND OTHER GENERAL BUSINESS AND FINANCIAL MANAGEMENT SERVICES AS REQUIRED. FORM 990, PART VI, SECTION B, LINE 11 EACH MEMBER OF THE BOARD OF DIRECTORS RECEIVES A PAPER COPY OF FORM 990 FOR THEIR REVIEW AND COMMENT PRIOR TO ITS FILING. THE BOARD ALSO REVIEWS IN DETAIL EACH FORM 990 FILED BY THE ORGANIZATION AT ITS REGULARLY SCHEDULED BOARD MEETINGS. ON AN ANNUAL BASIS, EACH BOARD MEMBER ATTENDS A TRAINING SESSION THAT PROVIDES UPDATES ON CURRENT EXEMPT ORGANIZATION TAX COMPLIANCE MATTERS. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO ATTEST TO THEIR COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. THE BOARD OF DIRECTORS REVIEWS ALL COMPLETED CONFLICT OF INTEREST STATEMENTS TO DETERMINE IF ANY CONFLICTS EXIST WHICH WOULD REQUIRE RESTRICTION ON PARTICIPATION IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN ANY TRANSACTION INVOLVING THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 18 A PAPER COPY OF FORM 990 IS PROVIDED UPON REQUEST. THE ORGANIZATION'S FORM 990 IS ALSO AVAILABLE VIA THE GUIDESTAR.ORG WEBSITE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC EXCEPT THROUGH PUBLIC FILING REQUIREMENTS. FORM 990, PART VII, SECTION A, COLUMN F RON WILSON IS EMPLOYED BY RFMS, INC., AN UNRELATED ORGANIZATION WHICH HAS AN ADMINISTRATIVE SERVICES CONTRACT WITH RESIDENTIAL ALTERNATIVES OF IOWA. THE TYPE OF SERVICES PROVIDED BY RFMS, INC., ARE DETAILED IN THE SCHEDULE O EXPLANATION ABOVE RELATIVE TO FORM 990, PART VI, SECTION A, LINE 3. RON WILSON IS THE CHIEF FINANCIAL OFFICER OF RFMS, INC. HIS COMPENSATION REPORTED ON HIS RFMS, INC. FORM W-2, BOX 5 FOR CALENDAR YEAR 2012 IS $174,379. THIS COMPENSATION AMOUNT HAS NOT BEEN PRORATED BASED ON TIME SPENT FOR EACH OF THE NINETEEN ORGANIZATIONS TO WHOM SERVICES ARE PROVIDED BY RFMS, INC. FORM 990, PART VII, SECTION A, COLUMN B: APPROXIMATELY ONE HALF OF THE AVERAGE HOURS PER WEEK ESTIMATED FOR EACH DIRECTOR AND OFFICER IS DEVOTED TO RELATED ORGANIZATIONS LISTED ON SCHEDULE R. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT OF THE COMPILATION AND SELECTION OF INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. CORALVILLE MANOR LLC 2332 LIBERTY DRIVE CORALVILLE IA 52241 300233914 OPERATES WINDMILL MANOR, A SKILLED NURSING FACILITY IA 5554916 1067105 N/A RESIDENTIAL ALTERNATIVES OF ILLINOIS INC 285 S FARNHAM ST GALESBURG IL 61401 371223846 OPERATES ELDERLY SKILLED NURSING,ASSISTED/INDEPNDENT LIVING FACILITIES IL 501(C)(3) LINE 9 N/A 0 RFMS INC MEDICAL BENEFIT PLAN TRUST 285 S FARNHAM ST GALESBURG IL 61401 367042729 MEDICAL, ST DISABILITY & DEATH BENEFITS FOR ELIGIBLE EMPLOYEES IL 501(C)(9) N/A 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RFMS INC MEDICAL BENEFIT PLAN TRUST R 81554 COST OF PREMIUMS SCHEDULE R, PART II: RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., IS RELATED TO RESIDENTIAL ALTERNATIVES OF IOWA ONLY BY SHARING A COMMON BOARD OF DIRECTORS. SCHEDULE R, PART II AND PART V: THE RFMS, INC. MEDICAL BENEFIT PLAN TRUST IS A SELF-INSURED BENEFIT PROGRAM FUNDED BY THE EMPLOYERS AND PARTICIPANTS WITHIN THE PLAN. PARTICIPANTS IN THE PLAN ARE CURRENT AND FORMER EMPLOYEES OF THE FOLLOWING SPONSORS: RFMS, INC., LTC SUPPORT SERVICES, LLC, COMMUNITY RESIDENTIAL CENTERS, INC., COMMUNITY LIVING OPTIONS, INC., FRANCES HOUSE, INC., UNLIMITED DEVELOPMENT, INC., KENSINGTON OF GALESBURG, INC., ACHIEVEMENT UNLIMITED, INC., CONCEPTS PLUS, INC., PINNACLE OPPORTUNITIES, INC., PIONEER CONCEPTS, INC., RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., RESIDENTIAL ALTERNATIVES OF IOWA, DESERT HEALTHCARE FACILITIES, INC., FLORIDA LIVING OPTIONS, INC., AND HIGHLAND ESTATES RESORT, LLC. NO TRUSTEE FEES OR MANAGEMENT FEES ARE PAID BY THE RFMS, INC. MEDICAL BENEFIT PLAN TRUST.