Coulterville Care Inc: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: Coulterville Care Inc (EIN 36-4137587)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-06-26
IRS object ID: 201341839349300049
Schema version: 2012v2.0
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
Form 990
Schedule A
Schedule D
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-06-26T13:56:49-07:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	452838168	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Templin Healthcare Accounting Services LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	PO Box 9	AddressLine1
City	Dunlap	City
State	IL	State
ZIP Code	61525	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	364137587	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Coulterville Care Inc	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	COUL	NameControl
Phone	6184432395	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1101 North Market Street	AddressLine1
City	Sparta	City
State	IL	State
ZIP Code	62286	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Harold Joines	Name
Title	Board President	Title
Phone	6187582256	Phone
Date Signed	2013-06-24	DateSigned
Authorize Third Party	0	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	Larry Templin	Name
PTIN	P01696703	PTIN
Phone	6303612868	Phone
Date Prepared	2013-06-21	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Andrea McFadden	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	13138 State Route 13	AddressLine1
City	Coulterville	City
State	IL	State
ZIP Code	62237	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	4907087	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1995	YearFormation
State Legal Domicile	IL	StateLegalDomicile
Activity Or Mission Description	Long Term Health Care Facility	ActivityOrMissionDescription
Nbr Voting Members Governing Body	4	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	3	NbrIndependentVotingMembers
Total Nbr Employees	138	TotalNbrEmployees
Total Nbr Volunteers	15	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	0	ContributionsGrantsPriorYear
Contributions Grants Current Year	0	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	4700309	ProgramServiceRevenuePriorYear
Program Service Revenue CY	4889948	ProgramServiceRevenueCY
Investment Income Prior Year	441	InvestmentIncomePriorYear
Investment Income Current Year	13493	InvestmentIncomeCurrentYear
Other Revenue Prior Year	2334	OtherRevenuePriorYear
Other Revenue Current Year	3646	OtherRevenueCurrentYear
Total Revenue Prior Year	4703084	TotalRevenuePriorYear
Total Revenue Current Year	4907087	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	4498	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	3025	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	2203632	SalariesEtcPriorYear
Salaries Etc Current Year	2170777	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	2471226	OtherExpensePriorYear
Other Expenses Current Year	3056946	OtherExpensesCurrentYear
Total Expenses Prior Year	4679356	TotalExpensesPriorYear
Total Expenses Current Year	5230748	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	23728	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-323661	RevenuesLessExpensesCY
Total Assets BOY	4395184	TotalAssetsBOY
Total Assets EOY	4297408	TotalAssetsEOY
Total Liabilities BOY	3669833	TotalLiabilitiesBOY
Total Liabilities EOY	3895726	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	725351	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	401682	NetAssetsOrFundBalancesEOY
Mission Description	The mission of Coulterville Care Center is to create a caring and supportive environment for the people we serve and their families so that they are respected for their uniqueness and are encouraged to treat themselves and each other with kindness and respect.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	4698713	Expense
Grants	3025	Grants
Revenue	4889948	Revenue
Description	Coulterville Care Inc was organized for religious charitable educational and scientific purposes. Specifically, the organization was organized to operate a 75 bed long term care health care fracility located in Coulterville Illinois. The facility consists of 75 skilled care beds.	Description
Total Of Other Program Service Exp	0	TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt	0	TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev	0	TotalOfOtherProgramServiceRev
Total Program Service Expense	4698713	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	1	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	0	ReportFin48Footnote
Independent Audit Financial Stmt	0	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	0	Hospital
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	0	ScheduleJRequired
Tax Exempt Bonds	0	TaxExemptBonds
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	1	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	9	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	138	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	4	NbrVotingGoverningBodyMembers
Number Independent Voting Members	3	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	0	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	IL	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	Jennifer Robb	NamePerson
Telephone Number	6184432395	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1101 North Market Street	AddressLine1
City	Sparta	City
State	IL	State
ZIP Code	62286	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (5 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation
Harold Joines
President	0.50	X	X	0	0	0
Kenneth Curry
Secretary / Treasurer	0.50	X	X	0	0	0
William Jarrett
Board Member	0.50	X		0	0	0
William Mueller
Board Member	0.50	X		0	0	0
Andrea McFadden
Executive Director	40		X	78110	0	5304

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	78110	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	5304	TotalOtherCompensation
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	0	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Select Rehabilitation
PO Box 809056	Chicago	IL	60680	Therapy	602328
St Andrews Management Services
6633 Delmar Blvd	St Louis	MO	63130	Accounting & IT	138056

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	2	NumberOfContractorsGT100K
Total Contributions	0	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	Nursing Care Revenue	Description
Business Code	623000	BusinessCode
Total Revenue Column	4889948	TotalRevenueColumn
Related Or Exempt Function Income	4889948	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	4889948	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	13493	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$13,493	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	0	Real
Personal	0	Personal

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	0	Securities
Other	0	Other

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	Other Income	Description
Business Code	900099	BusinessCode
Total Revenue Column	3646	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$3,646	ExclusionAmount

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	3646	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	4907087	TotalRevenueColumn
Related Or Exempt Function Income	4889948	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$17,139	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	3025	Total
Program Services	3025	ProgramServices

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	78110	Total
Program Services	0	ProgramServices
Management And General	78110	ManagementAndGeneral
Fundraising	0	Fundraising

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	1672876	Total
Program Services	1557663	ProgramServices
Management And General	115213	ManagementAndGeneral
Fundraising	0	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	265501	Total
Program Services	236190	ProgramServices
Management And General	29311	ManagementAndGeneral
Fundraising	0	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	154290	Total
Program Services	137257	ProgramServices
Management And General	17033	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	131250	Total
Program Services	0	ProgramServices
Management And General	131250	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	10127	Total
Program Services	0	ProgramServices
Management And General	10127	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	25452	Total
Program Services	0	ProgramServices
Management And General	25452	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total
Fundraising	0	Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	63765	Total
Program Services	63765	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	18153	Total
Program Services	0	ProgramServices
Management And General	18153	ManagementAndGeneral
Fundraising	0	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	64295	Total
Program Services	64295	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	38149	Total
Program Services	38149	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	199421	Total
Program Services	199421	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	3470	Total
Program Services	0	ProgramServices
Management And General	3470	ManagementAndGeneral
Fundraising	0	Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	14048	Total
Program Services	0	ProgramServices
Management And General	14048	ManagementAndGeneral
Fundraising	0	Fundraising

Interest Interest

Field	Value	IRS element (for citing)
Total	392365	Total
Program Services	392365	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total
Program Services	0	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	216447	Total
Program Services	216447	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	89868	Total
Program Services	0	ProgramServices
Management And General	89868	ManagementAndGeneral
Fundraising	0	Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices
Therapy Expense	676973	676973
Food	189612	189612
Bad Debt Expense	275858	275858
Provider Assessment	251634	251634

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	396059	Total
Program Services	396059	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	5230748	Total
Program Services	4698713	ProgramServices
Management And General	532035	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	1150	BOY
EOY	1150	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	224026	BOY
EOY	89343	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	933826	BOY
EOY	916072	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	138626	BOY
EOY	106675	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	3218046	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	333878	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	2997556	BOY
EOY	2884168	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	100000	BOY
EOY	300000	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	4395184	BOY
EOY	4297408	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	595720	BOY
EOY	661482	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	3024	BOY
EOY	2680	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	3071089	BOY
EOY	3231564	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	3669833	BOY
EOY	3895726	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	725351	BOY
EOY	401682	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	725351	BOY
EOY	401682	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	4395184	BOY
EOY	4297408	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	-323661	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	0	ReconciliationUnrealizedInvest
Reconcilation Donated Services	0	ReconcilationDonatedServices
Reconcilation Invest Expenses	0	ReconcilationInvestExpenses
Reconcilation Prior Adjustment	0	ReconcilationPriorAdjustment
Reconcilation Other Changes	-8	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	1	AccountantCompileOrReview

Accountant Compile Or Review Basis AccountantCompileOrReviewBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
FS Audited	0	FSAudited
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	X	PubliclySupportedOrg509a2

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4201957	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	4331206	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4134109	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4700309	CurrentTaxYearMinus1Year
Current Tax Year	4889948	CurrentTaxYear
Total	22257529	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4201957	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	4331206	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4134109	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4700309	CurrentTaxYearMinus1Year
Current Tax Year	4889948	CurrentTaxYear
Total	22257529	Total

Field	Value	IRS element (for citing)
Public Support Total509	22257529	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	14363	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	3819	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4340	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	441	CurrentTaxYearMinus1Year
Current Tax Year	13493	CurrentTaxYear
Total	36456	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	14363	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	3819	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4340	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	441	CurrentTaxYearMinus1Year
Current Tax Year	13493	CurrentTaxYear
Total	36456	Total

Other Income509 OtherIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4952	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	10720	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	211728	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	2334	CurrentTaxYearMinus1Year
Current Tax Year	3646	CurrentTaxYear
Total	233380	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4221272	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	4345745	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4350177	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4703084	CurrentTaxYearMinus1Year
Current Tax Year	4907087	CurrentTaxYear
Total	22527365	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.98802	PublicSupportPercentage509
Prior Year Support Percentage	0.9874	PriorYearSupportPercentage
Investment Income Percentage	0.00162	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.0018	PriorYrInvestIncomePercentage
Thirty Three Percnt Tests PY509	X	ThirtyThreePercntTestsPY509
General Explanation	Schedule A, Part III - Other Income Description: 2008 $4,952 2009 $10,720 2010 $211,728 2011 $2,334 2012 $3,646	GeneralExplanation

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	0	OtherCostOrOtherBasis
Book Value	0	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	4643	OtherCostOrOtherBasis
Depreciation	1393	Depreciation
Book Value	3250	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	85158	OtherCostOrOtherBasis
Depreciation	11041	Depreciation
Book Value	74117	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	75577	OtherCostOrOtherBasis
Depreciation	14601	Depreciation
Book Value	60976	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	3052668	OtherCostOrOtherBasis
Depreciation	306843	Depreciation
Book Value	2745825	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	2884168	TotalOfBookValueLandBuildings

Other Assets OtherAssets

Field	Value	IRS element (for citing)
Description	Lease Deposit	Description
Book Value	300000	BookValue

Field	Value	IRS element (for citing)
Total Book Value Other Assets	300000	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescription	AmountAmount
Deferred Gain on sale of Asset	$22,235
Resident Credit Balances	$12,809
Lease Obligation	$3,196,520

Field	Value	IRS element (for citing)
Total Of Amounts	3231564	TotalOfAmounts

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
Linda Mueller
Spouse of William Mueller - board member	71948	Director of Nursing wages	0
Vanda Welty
Mother of Andrea McFadden - Executive Director	26844	CNA wages	0
Donald McFadden
Husband of Andrea McFadden - Executive Director	29760	Employee wages	0
Misty Hewitt
Family Member of Exec Dir	1883	RN wages	0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
F990_P06_S0B_L11b	Form 990, Part VI, Section B, Line 11b	The draft form 990 is reviewed by the financial consultant for accuracy and made available to the entire board. The final form 990 is mailed to the president of the board for review and signature.
F990_P06_S0B_L12c	Form 990, Part VI, Section B, Line 12c	Every year, disclosure forms are sent to the board members and Coulterville Care Center's one key employee to ensure everyone signs off that they are in compliance with the written conflict of interest policy.
F990_P06_S0B_L15	Form 990, Part VI, Section B, Line 15	Every year, the Coulterville Care Center board reviews data provided by an LTC association which provides comparative salary information. It also receives current, comparative salary data from the local county nursing home. Based on this data, the board annually revises and approves the salary of the Executive Director. No other officers or key employees are compensated.
F990_P06_S0C_L19	Form 990, Part VI, Section C, Line 19	The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request.
F990_P11_S00_L09	Form 990, Part XI, Line 9	Rounding