2012-08-09T09:13:58-05:00 2011-09-30 MCGLADREY LLP 117 E MAIN ST STE 210 GALESBURG IL 61401 990 2010-10-01 371079626 COMMUNITY LIVING OPTIONS INC COMM 3093431550 285 SOUTH FARNHAM STREET GALESBURG IL 61401 JOHN CROCK 3093431550 2012-08-02 1 BEN MCMAHAN 3093428026 2010 2016-02-24 21:20:13Z JOHN CROCK 285 SOUTH FARNHAM STREET GALESBURG IL 61401 34027507 0 X N/A X 1979 IL TO PROVIDE & OPERATE LONG-TERM CARE FACILITIES FOR THE DEVELOPMENTALLY DISABLED AND THE ELDERLY. 5 5 665 0 0 0 20337 26294 31862221 31914736 549278 1529266 0 0 32431836 33470296 1519620 37792 0 0 11082057 11255743 0 0 0 18550794 17902371 31152471 29195906 1279365 4274390 139346827 143172852 70470955 70245487 68875872 72927365 X THE MISSION OF THE ORGANIZATION IS ARTICULATED IN ITS ARTICLES OF INCORPORATION AS FOLLOWS:THE CORPORATION IS ORGANIZED EXCLUSIVELY FOR CHARITABLE PURPOSES AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. IN FURTHERANCE OF THOSE CHARITABLE PURPOSES, THE CORPORATION SHALL BE EMPOWERED TO BUILD, LEASE, ACQUIRE AND OTHERWISE OWN AND OPERATE RESIDENTIAL FACILITIES, NURSING FACILITIES 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. THE CORPORATION WILL NOT ENGAGE IN THE PRACTICE OF MEDICINE NOR RENDER ANY LICENSED PROFESSIONAL SERVICES. 0 0 26979086 37792 31914736 ALL PROGRAM SERVICES RELATE TO PROVIDING AND OPERATING LONG-TERM CARE FACILITIES AND OTHER RELATED SERVICES TO THE DEVELOPMENTALLY DISABLED AND THE ELDERLY. 26979086 1 0 0 1 0 0 0 0 0 1 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 0 1 73 0 1 665 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 0 0 0 0 0 IL X X RON WILSON RFMS INC 3093431550 285 SOUTH FARNHAM GALESBURG IL 61401 X JOHN CROCK 2.00 X X 3000 0 0 JOHN THOMPSON 2.00 X X 4000 0 0 HOWARD LEHMANN 2.00 X 3000 0 0 ROBERT MARSHALL 2.00 X 3000 0 0 MICHAEL WARTMAN 2.00 X 3000 0 0 RON WILSON RFMS INC 10.00 X 0 0 116562 LAURA KELLY LTC SUPPORT 13.30 X 0 0 119192 16000 0 235754 0 0 0 0 RFMS INC 285 SOUTH FARNHAM ST GALESBURG IL 61401 ADMINISTRATIVE SERVICES 1177440 MCGLADREY & PULLEN LLP 5155 PAYSPHERE CIRCLE CHICAGO IL 60674 ACCOUNTING 450990 LTC SUPPORT SERVICES LLC 285 SOUTH FARNHAM ST GALESBURG IL 61401 SUPPORT SERVICES 432017 POLSINELLI SHUGHART PO BOX 878681 KANSAS CITY MO 641878681 LEGAL 163507 4 26294 26294 MEDICARE & MEDICAID 623000 19257670 19257670 FACILITY LEASE INCOME 623000 8398072 8398072 PRIVATE PAY RESIDENT S 623000 4037180 4037180 AID TRAINING 623000 186273 186273 OTHER INCOME 623000 35541 35541 31914736 814263 814263 272214 1000000 272663 284548 -449 715452 715003 715003 33470296 31914736 0 1529266 37792 37792 23600 23600 9252982 8959953 293029 88619 85813 2806 1121657 1086136 35521 768885 744535 24350 1960800 1293744 667056 151781 151781 443598 443598 9826 9826 33032 16516 16516 415569 413064 2505 88909 80018 8891 218953 171418 47535 57409 45927 11482 1966274 1909811 56463 300158 296398 3760 160344 144310 16034 3763980 3651060 112920 4146481 3946466 200015 145136 123366 21770 SUPPLIES & SMALL EQUIP. 2425950 2425950 MEDICAID ASSESSMENT TAX 1279520 1279520 EQUIPMENT RENT & MAINT. 202338 202294 44 SUBSCRIPTIONS & FEES 71593 35796 35797 RESIDENT VACATIONS 27267 13634 13633 33453 15565 17888 29195906 26979086 2216820 0 1593143 2334299 2916349 9071915 5916909 4279101 447451 474186 120253896 29571886 93878464 90682010 7590581 14433980 25023857 19208131 1980073 2689230 139346827 143172852 2802628 3071107 162451 29000 67475876 67145380 30000 0 70470955 70245487 X 68875872 72927365 68875872 72927365 139346827 143172852 X 4274390 -222897 X X 0 1 1 X 0 X 19220 10704 14819 20337 26294 91374 31462768 31863930 32118777 31862221 31914736 159222432 31481988 31874634 32133596 31882558 31941030 159313806 0 0 0 159313806 1252302 1016833 479139 891797 814263 4454334 1252302 1016833 479139 891797 814263 4454334 32734290 32891467 32612735 32774355 32755293 163768140 0.97280 0.96880 0.02720 0.03120 X 9826 9826 26979086 26988912 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 9634 9177 8289 9826 36926 250000 250000 250000 250000 1000000 1500000 4628431 4628431 104835883 22922551 81913332 2143442 727316 1416126 6155125 3889512 2265613 2491015 2032507 458508 90682010 MEMBER INTEREST - LTC SUPPORT SERVICES, LLC 10000 C STANDBY LOAN AGREEMENT RECEIVABLE FROM UNRELATED 501(C)(3) ORGANIZATIONS 6323576 C ADVANCE RECEIVABLE FROM UNLIMITED DEVELOPMENT, INC., A SUBSIDIARY 612220 C RENT RECEIVABLE FROM UNLIMITED DEVELOPMENT, INC., A SUBSIDIARY 119178 C ESCROW DEPOSITS 575657 F REPLACEMENT AND REPAIR RESERVES 2226982 F ADVANCE RECEIVABLE FROM KEOKUK VILLAGE CIRCLE, LTD., NFP, A SUBSIDIARY 9340518 C 19208131 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OR SECTION 501(C)(2) 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. WITH FEW EXCEPTIONS, THE ORGANIZATION IS NO LONGER SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE FOR YEARS BEFORE 2007. 1 YMCA OF KNOX COUNTY 1324 W CARL SANDBURG DR GALESBURG IL 61401 370661260 501(C)(3) 25000 GENERAL SUPPORT FLORIDA LIVING OPTIONS INC 851 WEST LUMSDEN ROAD BRANDON FL 33511 364467489 501(C)(3) 12792 FORGIVEN INTERST ON DEBT 2 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANT FUNDS ARE ONLY GIVEN TO ORGANIZATIONS WHO CONFIRM THE USE OF SUCH MONIES IN THE UNITED STATES. THE GRANT TO FLORIDA LIVING OPTIONS, INC. REPRESENTS FORGIVEN INTEREST ON DEBT. FLORIDA LIVING OPTIONS, INC. IS A 501(C)(3) ORGANIZATION DOING BUSINESS AND LOCATED IN THE UNITED STATES. LTC SUPPORT SERVICES (LTC) A SINGLE DIRECTOR COMMON TO BOTH CLO & LTC IS JOHN CROCK. 783360 MANAGEMENT SERVICES IN THE AMOUNT OF $783,360 ARE PROVIDED BY LTC SUPPORT SERVICES, LLC., AS DESCRIBED IN SCHEDULE O RELATIVE TO PART VI, SECTION A, LINE 3. JOHN CROCK, WHO IS A DIRECTOR OF COMMUNITY LIVING OPTIONS, INC., AND LTC SUPPORT SERVICES, LLC, RECEIVED DIRECTOR'S FEES OF $1,000 FROM LTC SUPPORT SERVICES, LLC, FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2011. 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION RECEIVES MANAGEMENT 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. COMMUNITY LIVING OPTIONS, INC., OWNS 12.5% OF LTC SUPPORT SERVICES, LLC, AND UNLIMITED DEVELOPMENT, INC., (A SUBSIDIARY OF COMMUNITY LIVING OPTIONS, INC.) OWNS 12.5% OF LTC SUPPORT SERVICES, LLC. THE REMAINING 75% 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 TRANSACTIONS 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 AND THROUGH THE ATTORNEY GENERAL'S OFFICE OF THE STATE OF ILLINOIS. 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 VI, SECTION B, LINES 10A AND 10B: THE ORGANIZATION HAS NO LOCAL CHAPTERS, BRANCHES, OR AFFILIATES. HOWEVER, THE ORGANIZATION DOES HAVE DISREGARDED ENTITIES, WHICH ARE PROPERLY DISCLOSED IN SCHEDULE R, PART I. 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 COMMUNITY LIVING OPTIONS, INC. 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., AND THE COMPENSATION REPORTED IN COLUMN F REPRESENTS 100% OF THE WAGES AS REPORTED ON HIS RFMS, INC. FORM W-2, BOX 5 FOR CALENDAR YEAR 2010. THE COMPENSATION AMOUNT HAS NOT BEEN PRORATED BASED ON TIME SPENT PER ORGANIZATION. LAURA KELLY IS EMPLOYED BY LTC SUPPORT SERVICES, LLC, AN UNRELATED ORGANIZATION WHICH PROVIDES MANAGEMENT SERVICES TO COMMUNITY LIVING OPTIONS, INC., AS DETAILED IN THE SCHEDULE O EXPLANATION ABOVE RELATIVE TO FORM 990, PART VI, SECTION A, LINE 3. LAURA KELLY MANAGES THE DEVELOPMENTALLY DISABLED OPERATIONS OF COMMUNITY LIVING OPTIONS, INC. THE COMPENSATION REPORTED IN COLUMN F REPRESENTS 100% OF THE WAGES REPORTED ON HER LTC SUPPORT SERVICES, LLC, FORM W-2, BOX 5 FOR CALENDAR YEAR 2010. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -222,897. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT OF THE AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART XII, LINE 2B: THE FINANCIAL STATEMENTS OF COMMUNITY LIVING OPTIONS, INC., WERE AUDITED AS PART OF THE CONSOLIDATED FINANCIAL REPORT ISSUED FOR COMMUNITY LIVING OPTIONS, INC. AND SUBSIDIARIES. MARION WILLIAMSON COUNTY PARKWAY LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 352259772 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 846906 10544856 N/A LEROY SOUTH BUCK LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 611485632 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 419127 4647370 N/A 2245 SEMINARY STREET LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 364568737 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 468814 4947587 N/A CENTRALIA EAST MCCORD LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 201313879 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 965417 9253428 N/A GALESBURG NORTH SEMINARY LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 201334252 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 823078 9564893 N/A PEKIN EL CAMINO LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 300330354 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 668377 7743226 N/A JERSEYVILLE NORTH STATE LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 383715772 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 878564 10296636 N/A SHELBYVILLE ROUTE 128 LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 201334393 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 565448 5920583 N/A PITTSFIELD LOWRY LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 201334359 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 548438 6466447 N/A ABINGDON WEST MARTIN LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 364560809 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 180000 1634404 N/A MARYVILLE VADALABENE LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 201334411 NOT IN USE DURING FISCAL YEAR ENDING 9/30/2011 IL 0 0 N/A ELKO RUBY VISTA LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 272887649 NOT IN USE DURING FISCAL YEAR ENDING 9/30/2011 NV 0 0 N/A OCALA 33RD AVENUE LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 275109607 NOT IN USE DURING FISCAL YEAR ENDING 9/30/2011 FL 0 0 N/A LAKELAND HIGHLANDS ROAD FACILITY LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 275084554 NOT IN USE DURING FISCAL YEAR ENDING 9/30/2011 FL 0 0 N/A UNLIMITED DEVELOPMENT INC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 364094409 OPERATES ELDERLY SKILLED NURSING,ASSISTED/INDEPNDENT LIVING FACILITIES IL 501(C)(3) LINE 9 N/A 1 KEOKUK VILLAGE CIRCLE LTD NFP 285 SOUTH FARNHAM STREET GALESBURG IL 61401 262341634 ACQUIRING & HOLDING TITLE TO PROPERTY; REMITTING ALL INCOME TO 501(C)(3) IL 501(C)(2) N/A 1 RFMS INC MEDICAL BENEFIT PLAN TRUST 285 SOUTH FARNHAM STREET GALESBURG IL 61401 367042729 MEDICAL, ST DISABILITY & DEATH BENEFITS FOR ELIGIBLE EMPLOYEES IL 501(C)(9) N/A 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 UNLIMITED DEVELOPMENT INC A 8143792 CASH TRANSACTION BASED ON FMV UNLIMITED DEVELOPMENT INC D 612220 CASH TRANSACTION BASED ON FMV KEOKUK VILLAGE CIRCLE LTD NFP - (A 501(C)(2) ORGANIZATION) D 9340518 CASH TRANSACTION BASED ON FMV RFMS INC MEDICAL BENEFIT PLAN TRUST Q 713978 COST OF PREMIUMS SCHEDULE R, PART II: UNLIMITED DEVELOPMENT, INC. AND KEOKUK VILLAGE CIRCLE, LTD., NFP, ARE SUBSIDIARIES OF COMMUNITY LIVING OPTIONS, INC. SCHEDULE R, PART V, LINE 1A: ALL AMOUNTS RECEIVED FROM UNLIMITED DEVELOPMENT, INC. AND KEOKUK VILLAGE CIRCLE, LTD., NFP, ARE RELATED TO THE ORGANIZATION'S EXEMPT PURPOSE. UNLIMITED DEVELOPMENT, INC., A 501(C)(3) SUBSIDIARY OF COMMUNITY LIVING OPTIONS, INC., FILES A SEPERATE FORM 990 AND REPORTED THESE ITEMS AS PROGRAM-RELATED EXPENSES ACCORDINGLY. KEOKUK VILLAGE CIRCLE, LTD., NFP, A 501(C)(2) SUBSIDIARY OF COMMUNITY LIVING OPTIONS, INC., FILES A SEPERATE FORM 990 AND REPORTED THESE ITEMS AS PROGRAM-RELATED EXPENSES ACCORDINGLY. NEITHER UNLIMITED DEVELOPMENT, INC. OR KEOKUK VILLAGE CIRCLE, LTD., NFP, REPORT ANY UNRELATED BUSINESS TAXABLE INCOME ON THEIR RESPECTIVE FORM 990, AND NEITHER ENTITY IS REQUIRED TO FILE FORM 990-T. 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.