2013-06-26T13:56:49-07:00 2012-12-31 452838168 Templin Healthcare Accounting Services LLP PO Box 9 Dunlap IL 61525 990 2012-01-01 364137587 Coulterville Care Inc COUL 6184432395 1101 North Market Street Sparta IL 62286 Harold Joines 6187582256 2013-06-24 0 Larry Templin P01696703 6303612868 2013-06-21 2012 2016-02-24 21:20:13Z Andrea McFadden 13138 State Route 13 Coulterville IL 62237 4907087 0 X X 1995 IL Long Term Health Care Facility 4 3 138 15 0 0 0 0 4700309 4889948 441 13493 2334 3646 4703084 4907087 4498 3025 0 0 2203632 2170777 0 0 0 2471226 3056946 4679356 5230748 23728 -323661 4395184 4297408 3669833 3895726 725351 401682 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. 0 0 4698713 3025 4889948 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. 0 0 0 4698713 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 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 9 0 1 138 1 0 0 0 0 0 0 0 0 0 0 X 4 3 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 IL X Jennifer Robb 6184432395 1101 North Market Street Sparta IL 62286 Harold Joines 0.50 X X 0 0 0 Kenneth Curry 0.50 X X 0 0 0 William Jarrett 0.50 X 0 0 0 William Mueller 0.50 X 0 0 0 Andrea McFadden 40 X 78110 0 5304 78110 0 5304 0 0 0 0 Select Rehabilitation PO Box 809056 Chicago IL 60680 Therapy 602328 St Andrews Management Services 6633 Delmar Blvd St Louis MO 63130 Accounting & IT 138056 2 0 Nursing Care Revenue 623000 4889948 4889948 0 0 0 0 0 0 4889948 13493 0 0 13493 0 0 0 0 0 0 0 0 0 0 0 0 Other Income 900099 3646 0 0 3646 0 0 0 0 3646 4907087 4889948 0 17139 0 0 3025 3025 0 0 0 0 78110 0 78110 0 0 0 0 0 1672876 1557663 115213 0 0 0 0 0 265501 236190 29311 0 154290 137257 17033 0 131250 0 131250 0 10127 0 10127 0 25452 0 25452 0 0 0 0 0 0 0 0 0 0 0 63765 63765 0 0 18153 0 18153 0 64295 64295 0 0 38149 38149 0 0 0 0 0 0 199421 199421 0 0 3470 0 3470 0 0 0 0 0 14048 0 14048 0 392365 392365 0 0 0 0 0 0 216447 216447 0 0 89868 0 89868 0 Therapy Expense 676973 676973 0 0 Food 189612 189612 0 0 Bad Debt Expense 275858 275858 0 0 Provider Assessment 251634 251634 0 0 396059 396059 0 0 5230748 4698713 532035 0 1150 1150 224026 89343 933826 916072 138626 106675 3218046 333878 2997556 2884168 100000 300000 4395184 4297408 595720 661482 3024 2680 3071089 3231564 3669833 3895726 X 725351 401682 0 0 0 0 725351 401682 4395184 4297408 X -323661 0 0 0 0 -8 X 1 X 0 1 0 X 4201957 4331206 4134109 4700309 4889948 22257529 4201957 4331206 4134109 4700309 4889948 22257529 22257529 14363 3819 4340 441 13493 36456 14363 3819 4340 441 13493 36456 4952 10720 211728 2334 3646 233380 4221272 4345745 4350177 4703084 4907087 22527365 0.98802 0.9874 0.00162 0.0018 X Schedule A, Part III - Other Income Description: 2008 $4,952 2009 $10,720 2010 $211,728 2011 $2,334 2012 $3,646 0 0 0 0 4643 1393 3250 0 85158 11041 74117 0 75577 14601 60976 0 3052668 306843 2745825 2884168 Lease Deposit 300000 300000 Deferred Gain on sale of Asset 22235 Resident Credit Balances 12809 Lease Obligation 3196520 3231564 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 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