PLYMOUTH PLACE INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
PLYMOUTH PLACE INC (EIN 36-2169165)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-14
IRS object ID
201203209349300715
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-14T15:25:02-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362169165EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PLYMOUTH PLACE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPLYMNameControl
Phone7083540340Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1315 N LAGRANGE ROADAddressLine1
CityLAGRANGE PARKCity
StateILState
ZIP Code60526ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDALE LILBURNName
TitleCEOTitle
Phone7083540340Phone
Date Signed2012-11-06DateSigned
Authorize Third PartyfalseAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Date Prepared2012-11-06DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDALE LILBURNNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1315 N LAGRANGE ROADAddressLine1
CityLAGRANGE PARKCity
StateILState
ZIP Code60526ZIPCode
FieldValueIRS element (for citing)
Gross Receipts26451721GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PLYMOUTHPLACE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1938YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionRETIREMENT HOME FOR SENIOR CITIZENSActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members14NbrIndependentVotingMembers
Total Nbr Employees389TotalNbrEmployees
Total Nbr Volunteers45TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year757704ContributionsGrantsPriorYear
Contributions Grants Current Year3573526ContributionsGrantsCurrentYear
Program Service Revenue Prior Year21144916ProgramServiceRevenuePriorYear
Program Service Revenue CY22586286ProgramServiceRevenueCY
Investment Income Prior Year211973InvestmentIncomePriorYear
Investment Income Current Year279552InvestmentIncomeCurrentYear
Other Revenue Prior Year3928OtherRevenuePriorYear
Other Revenue Current Year12357OtherRevenueCurrentYear
Total Revenue Prior Year22118521TotalRevenuePriorYear
Total Revenue Current Year26451721TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year8547335SalariesEtcPriorYear
Salaries Etc Current Year8884146SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year17892607OtherExpensePriorYear
Other Expenses Current Year17147043OtherExpensesCurrentYear
Total Expenses Prior Year26439942TotalExpensesPriorYear
Total Expenses Current Year26031189TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-4321421RevenuesLessExpensesPriorYear
Revenues Less Expenses CY420532RevenuesLessExpensesCY
Total Assets BOY144858463TotalAssetsBOY
Total Assets EOY139675900TotalAssetsEOY
Total Liabilities BOY173994287TotalLiabilitiesBOY
Total Liabilities EOY168605124TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-29135824NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-28929224NetAssetsOrFundBalancesEOY
Mission DescriptionRETIREMENT HOME FOR SENIOR CITIZENSMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense23427778Expense
Revenue22878195Revenue
DescriptionPLYMOUTH PLACE INC. IS A RETIREMENT HOME FOR SENIOR CITIZENS, PROVIDING MEDICAL CARE, HOUSING, MEALS AND OTHER ITEMS NECESSARY FOR THE MAINTENANCE AND HEALTH OF ITS RESIDENTS. AT YEAR END THE FACILITY HAD 314 OF 402 UNITS OCCUPIED.Description
Total Program Service Expense23427778TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109620NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees389NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members14NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDALE LILBURNNamePerson
Telephone Number7083540340TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1315 N LAGRANGE ROADAddressLine1
CityLAGRANGE PARKCity
StateILState
ZIP Code60526ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

Average Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationTitleTitleKey EmployeeKeyEmployee
BESHOAR WILMA
1.00X000
CONLIN DEAN
1.00X000
GAGE JAMES
1.00X000
GRUND CHARLES
1.00X000CHAIRMAN
GUTEKUNST RALPH
1.00X000
HARRIS MARK
1.00X000
HORTON DR LOREN
1.00X000
HAMBURGER DIANE
1.00X000
VOIGT MARY
1.00X000
POWERS RAYMOND
1.00X000
SUTHERLAND NANCY
1.00X000
TEEGARDEN TOM
1.00X000
WOLF REV DR RICHARD
1.00X000
LILBURN DALE
50.00188173037635CEOX
FieldValueIRS element (for citing)
Total Reportable Comp From Org188173TotalReportableCompFromOrg
Total Other Compensation37635TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensationAddress Line2AddressOfContractor/AddressUS/AddressLine2
SODEXHO INC
PO BOX 70060CHICAGOIL60673DIETARY SERVICE1762320
COMPREHENSIVE THERAPEUTICS LTD
3703 WEST LAKE AVEGLENVIEWIL60025NURSING THERAPY1056451SUITE 200
PROVIDENCE MANAGEMENT
18601 NORTH CREEK DRIVETINLEY PARKIL60477MANAGEMENT731273
OMNICARE OF NORTHERN ILLINOIS
PO BOX 641805CINCINNATTIOH45264PHARMACY631757
NOVASTAFF HEALTHCARE SERVICES
210 W 22ND STOAK BROOKIL60523NURSING SERVICE387964SUITE 121
FieldValueIRS element (for citing)
Number Of Contractors GT100 K11NumberOfContractorsGT100K
All Other Contributions3573526AllOtherContributions
Total Contributions3573526TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionSENIOR HOUSING, ASSISTANCEDescription
Business Code623000BusinessCode
Total Revenue Column22586286TotalRevenueColumn
Related Or Exempt Function Income22586286RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue22586286TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column279552TotalRevenueColumn
Related Or Exempt Function Income279552RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Total Revenue Column12357TotalRevenueColumn
Related Or Exempt Function Income12357RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue12357TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column26451721TotalRevenueColumn
Related Or Exempt Function Income22878195RelatedOrExemptFunctionIncome

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total188173Total
Management And General188173ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total6871880Total
Program Services6042994ProgramServices
Management And General828886ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total64361Total
Program Services52737ProgramServices
Management And General11624ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1241901Total
Program Services1047378ProgramServices
Management And General194523ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total517831Total
Program Services446925ProgramServices
Management And General70906ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total731273Total
Program Services494576ProgramServices
Management And General236697ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total80484Total
Management And General80484ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total82348Total
Management And General82348ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total484258Total
Management And General484258ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total20699Total
Management And General20699ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total120541Total
Management And General120541ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1227034Total
Program Services1227034ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total5051701Total
Program Services5051701ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3538498Total
Program Services3538498ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total191022Total
Management And General191022ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES1546317151706829249
NURSING - THERAPY11041171104117
NURSING - PHARMACY602223602223
CONSULTING SERVICES545889545889

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1820639Total
Program Services1756638ProgramServices
Management And General64001ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total26031189Total
Program Services23427778ProgramServices
Management And General2603411ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1431038BOY
EOY1845463EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4725176BOY
EOY2379104EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY241439BOY
EOY270429EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis129909814LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec19624513LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY113290530BOY
EOY110285301EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY21396281BOY
EOY21316020EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3773999BOY
EOY3579583EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY144858463BOY
EOY139675900EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2189190BOY
EOY2072075EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY69891845BOY
EOY75619946EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY101205000BOY
EOY90640000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY708252BOY
EOY273103EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY173994287BOY
EOY168605124EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-29189479BOY
EOY-28957337EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY53655BOY
EOY28113EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-29135824BOY
EOY-28929224EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY144858463BOY
EOY139675900EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses420532ReconcilationRevenueExpenses
Reconcilation Other Changes-213932ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewtrueAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years721742CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years780067CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1208665CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year757704CurrentTaxYearMinus1Year
Current Tax Year3573526CurrentTaxYear
Total7041704Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9270945CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11425909CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years18485983CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year21360817CurrentTaxYearMinus1Year
Current Tax Year22878195CurrentTaxYear
Total83421849Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years9992687CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12205976CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years19694648CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year22118521CurrentTaxYearMinus1Year
Current Tax Year26451721CurrentTaxYear
Total90463553Total
FieldValueIRS element (for citing)
Public Support Total50990463553PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years304386CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1375193CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years417984CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year211973CurrentTaxYearMinus1Year
Current Tax Year279552CurrentTaxYear
Total2589088Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years304386CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1375193CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years417984CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year211973CurrentTaxYearMinus1Year
Current Tax Year279552CurrentTaxYear
Total2589088Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10297073CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13581169CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years20112632CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year22330494CurrentTaxYearMinus1Year
Current Tax Year26731273CurrentTaxYear
Total93052641Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97220PublicSupportPercentage509
Prior Year Support Percentage0.97570PriorYearSupportPercentage
Investment Income Percentage0.03000InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.02000PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis85418OtherCostOrOtherBasis
Book Value85418BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis125487776OtherCostOrOtherBasis
Depreciation18144116Depreciation
Book Value107343660BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis398258OtherCostOrOtherBasis
Depreciation103078Depreciation
Book Value295180BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3938362OtherCostOrOtherBasis
Depreciation1377319Depreciation
Book Value2561043BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings110285301TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
RESIDENT DEPOSITS$344,854
UNAMORTIZED BOND DISCOUNT-$71,751
FieldValueIRS element (for citing)
Total Of Amounts273103TotalOfAmounts
Total Revenue26451721TotalRevenue
Total Expenses26031189TotalExpenses
Excess Or Deficit For Year420532ExcessOrDeficitForYear
Net Unrealized GL On Investments-213932NetUnrealizedGLOnInvestments
Total Adjustments-213932TotalAdjustments
Excess Or Deficit Per FS206600ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt26237789TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-213932NetUnrealizedGainsInvestments
Revenue Not Rptd F990-213932RevenueNotRptdF990
Revenue Subtotal26451721RevenueSubtotal
Total Revenue Per Form99026451721TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt26031189TotExpensesEtcAuditedFinclStmt
Expenses Subtotal26031189ExpensesSubtotal
Total Expenses Per Form99026031189TotalExpensesPerForm990

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonLILBURN DALENamePerson
Base Compensation Filing Org188173BaseCompensationFilingOrg
Deferred Comp Filing Org37635DeferredCompFilingOrg
Total Compensation Filing Org225808TotalCompensationFilingOrg

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Business Name Line2IssuerName/BusinessNameLine2Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
ILLINOIS FINANCE AUTHORITY
VARIABLE RATE DEMAND REVENUE BOND86109196745200BUE62005-12-0820000000CONSTRUCT REPLACEMENT FACILITYfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
VARIABLE RATE DEMAND REVENUE BOND86109196745200BUF32005-12-0868500000CONSTRUCT REPLACEMENT FACILITYfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
FIXED RATE DEMAND REVENUE BOND86109796745200BTZ12005-12-08885000CONTRUCT REPLACEMENT FACILITYfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
FIXED RATE DEMAND REVENUE BOND86109196745200BUA42005-12-081030000CONSTRUCT REPLACEMENT FACILITYfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCapital ExpendituresCapitalExpendituresCapitalized InterestCapitalizedInterest
3600002000000013389958563052008falsefalsetruetrue
5415500068500000250038623696122008falsefalsetruetrue63563948
885000219892008falsefalsetruetrue77689466147
1030000256542008falsefalsetruetrue91822976747

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyEngage Bond Counsel ContractsEngageBondCounselContractsAny Research AgreementsAnyResearchAgreementsEngage Bond Counsel ResearchEngageBondCounselResearchPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalsefalse

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
falsetruefalsefalsefalsefalse
falsetruefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Business Name Line2IssuerName/BusinessNameLine2Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
ILLINOIS FINANCE AUTHORITY
VARIABLE RATE DEMAND REVENUE BOND86109196745200BUE62005-12-0820000000CONSTRUCT REPLACEMENT FACILITYfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
VARIABLE RATE DEMAND REVENUE BOND86109196745200BUF32005-12-0868500000CONSTRUCT REPLACEMENT FACILITYfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
FIXED RATE DEMAND REVENUE BOND86109796745200BTZ12005-12-08885000CONTRUCT REPLACEMENT FACILITYfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
FIXED RATE DEMAND REVENUE BOND86109196745200BUA42005-12-081030000CONSTRUCT REPLACEMENT FACILITYfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCapital ExpendituresCapitalExpendituresCapitalized InterestCapitalizedInterest
3600002000000013389958563052008falsefalsetruetrue
5415500068500000250038623696122008falsefalsetruetrue63563948
885000219892008falsefalsetruetrue77689466147
1030000256542008falsefalsetruetrue91822976747

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyEngage Bond Counsel ContractsEngageBondCounselContractsAny Research AgreementsAnyResearchAgreementsEngage Bond Counsel ResearchEngageBondCounselResearchPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalsefalse

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
falsetruefalsefalsefalsefalse
falsetruefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITSFORM 990, PAGE 1, PART I, LINE 6THE VOLUNTEERS PERFORM MINIMAL TASKS IN ASSISTING THE RESIDENTS AT THE FACILITY.
MANAGEMENT DELEGATEDFORM 990, PAGE 6, PART VI, LINE 3PLYMOUTH PLACE HAS CONTRACTED WITH PROVIDENCE MANAGEMENT TO PROVIDE CFO AND REALTED ACCOUNTING SERVICES, IT SERVICES AND NURSING CENTER ADMINISTRATION.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BA DRAFT OF THE 990 IS PREPARED AND SUBMITTED TO THE CEO FOR INITIAL REVIEW. THE CEO PRESENTS TO THE FINANCE COMMITTEE A COPY OF THE 990 FOR THEIR REVIEW BEFORE FILING.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CTHE BOARD MEMBERS REVIEW AND UPDATE THEIR ANNUAL DISCLOSURE OF INTERESTS.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ATHE BOARD ANNUALLY RECEIVES AND REVIEWS THE COMPENSATION SURVEYS OF AAHSA & LSN.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19DOCUMENTS ARE AVAILABLE UPON REQUEST AT THE FACILITY OFFICE.

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