WASHINGTON AND JANE SMITH COMMUNITY BEVERLY: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
WASHINGTON AND JANE SMITH COMMUNITY BEVERLY (EIN 36-2167948)
Tax period
2011-07-01 to 2012-06-30
Filed
2012-11-13
IRS object ID
201213189349303426
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)
Timestamp2012-11-13T14:45:52-06:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN470746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1600 WASHINGTON AVENUE SUITE 1800AddressLine1
CityST LOUISCity
StateMOState
ZIP Code63101ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362167948EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WASHINGTON AND JANE SMITH COMMUNITY - BEVERLYBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWASHNameControl
Phone7734747300Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12320 WEST 113TH PLACEAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60643ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameRAY MARNERIS CFOName
TitleCFOTitle
Phone7734747350Phone
Date Signed2012-11-12DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCHAD KUNZEName
PTINP00639380PTIN
Phone3149254300Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1SMITH VILLAGEBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonKEVIN MCGEENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12320 WEST 113TH PLACEAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60643ZIPCode
FieldValueIRS element (for citing)
Gross Receipts19489633GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.SMITHVILLAGE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1926YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionTHE MISSION OF SMITH VILLAGE IS TO ENRICH THE LIVES OF SENIOR ADULTS. (SEE SCHEDULE O) THROUGH THE OPERATION OF A CONTINUING CARE RETIREMENT COMMUNITY OFFERING THE HIGHEST QUALITY OF SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees295TotalNbrEmployees
Total Nbr Volunteers237TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year711632ContributionsGrantsPriorYear
Contributions Grants Current Year579840ContributionsGrantsCurrentYear
Program Service Revenue Prior Year17566248ProgramServiceRevenuePriorYear
Program Service Revenue CY17962469ProgramServiceRevenueCY
Investment Income Prior Year174050InvestmentIncomePriorYear
Investment Income Current Year498014InvestmentIncomeCurrentYear
Other Revenue Prior Year127181OtherRevenuePriorYear
Other Revenue Current Year126944OtherRevenueCurrentYear
Total Revenue Prior Year18579111TotalRevenuePriorYear
Total Revenue Current Year19167267TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year505625GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY400611GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6117933SalariesEtcPriorYear
Salaries Etc Current Year6005065SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year12677433OtherExpensePriorYear
Other Expenses Current Year13196507OtherExpensesCurrentYear
Total Expenses Prior Year19300991TotalExpensesPriorYear
Total Expenses Current Year19602183TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-721880RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-434916RevenuesLessExpensesCY
Total Assets BOY71848674TotalAssetsBOY
Total Assets EOY72134138TotalAssetsEOY
Total Liabilities BOY70563513TotalLiabilitiesBOY
Total Liabilities EOY71349697TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1285161NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY784441NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSMITH VILLAGE WAS INCORPORATED FOR THE CHARITABLE PURPOSE OF PROVIDING INDEPENDENT LIVING, ASSISTED LIVING, AND NURSING CARE SERVICES TO MEN AND WOMEN THROUGH THE OPERATION OF A CONTINUING CARE RETIREMENT COMMUNITY. (SEE SCHEDULE O) LOCATED IN BEVERLY, ILLINOIS. WITHIN THE COMMUNITY, SMITH VILLAGE OPERATES A 152 INDEPENDENT LIVING UNITS, 82 BED ASSISTED LIVING, 39 BED SKILLED MEMORY SUPPORT, AND 61 BED SKILLED NURSING FACILITY LICENSED BY THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH (IDPH). ALL 100 SKILLED NURSING BEDS ARE CERTIFIED FOR PARTICIPATION IN THE MEDICARE AND MEDICAID PROGRAMS. SMITH VILLAGE IS SUBJECT TO PERIODIC REGULATORY INSPECTIONS PERFORMED BY IDPH.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense8891318Expense
Revenue9826620Revenue
DescriptionTHE ORGANIZATION PROVIDES RETIREMENT HOUSING AND HEALTH CARE SERVICES TO SENIORS AGED 62 AND OLDER IN A CONTINUING CARE RETIREMENT COMMUNITY SETTING. SMITH VILLAGE OPERATES A 100 BED SKILLED NURSING CARE UNIT. SERVICES PROVIDED INCLUDE 24-HOUR NURSING CARE AND REHABILITATION SERVICES. ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS WERE $294,903 OF SERVICES FOR THESE TWO GOVERNMENTAL SPONSORED PROGRAMS. THE COMMUNITY ALSO PROVIDED $270,553 IN HEALTH CARE DISCOUNTS TO ITS RESIDENTS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense5269846Expense
Revenue3393443Revenue
DescriptionTHE ORGANIZATION PROVIDES RETIREMENT HOUSING AND HEALTH CARE SERVICES TO SENIORS AGED 62 AND OLDER IN A CONTINUING CARE RETIREMENT COMMUNITY SETTING. WITHIN THE COMMUNITY, SMITH VILLAGE OPERATES 152 INDEPENDENT LIVING APARTMENTS. SMITH VILLAGE BEGAN OPERATION OF THESE UNITS IN NOVEMBER 2007. NOT ALL UNITS WERE OCCUPIED AS OF THE END OF THE FYE 2012. RESIDENTS RECEIVE DISCOUNTED SERVICES IN HEALTHCARE SHOULD THEY REQUIRE TRANSITION TO ASSISTED LIVING OR INTO SKILLED CARE. RESIDENTS WHO OUTLIVE THEIR FINANCIAL RESOURCES CAN APPLY FOR SUPPORT THROUGH THE CHARITABLE CARE FUNDS OF SMITH VILLAGE.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense2934820Expense
Grants400611Grants
Revenue3801172Revenue
DescriptionTHE ORGANIZATION PROVIDES RETIREMENT HOUSING AND HEALTH CARE SERVICES TO SENIORS AGED 62 AND OLDER IN A CONTINUING CARE RETIREMENT COMMUNITY SETTING. SMITH VILLAGE OPERATES A 82 UNIT ASSISTED LIVING CENTER. SERVICES INCLUDE PROVISION OF ASSISTANCE TO INDIVIDUALS WHO CAN NO LONGER LIVE INDEPENDENTLY AND NEED ASSISTANCE WITH AT LEAST THREE ACTIVITIES OF DAILY LIVING SUCH AS EATING, BATHING, DRESSING, MEDICATIONS, ETC. INDIVIDUALS RESIDING IN ASSISTED LIVING WHO HAVE OUTLIVED THEIR FINANCIAL RESOURCES ARE FURTHER SUPPORTED BY THE CHARITABLE CARE FUNDS OF SMITH VILLAGE. DURING FYE 2012, $400,611 IN CHARITABLE SERVICES WERE PROVIDED TO RESIDENTS IN ASSISTED LIVING.Description

Activity Other ActivityOther (2 entries)

ExpenseExpenseRevenueRevenueDescriptionDescription
351064839073THE ORGANIZATION PROVIDES BASE PACKAGES OF SERVICES TO RESIDENTS WITHIN A SET MONTHLY OR DAILY FEE STRUCTURE. RESIDENTS CAN CHOOSE TO SECURE ADDED SERVICES FOR ADDITIONAL FEES IN AREAS SUCH AS BEAUTY AND BARBER SERVICES, ADDITIONAL DINING OPTIONS, UNDERGROUND PARKING, TECHNOLOGY SERVICES, AND SPECIAL EVENT PARTICIPATION.
192845THE ORGANIZATION OWNS AND OPERATES A 17 UNIT APARTMENT BUILDING RESTRICTED TO SENIOR ADULTS. THESE UNITS PROVIDE AFFORDABLE HOUSING ALTERNATIVES WITHOUT ANY OF THE SERVICES PROVIDED WITHIN THE SCOPE OF THE CONTINUING CARE RETIREMENT COMMUNITY.
FieldValueIRS element (for citing)
Total Of Other Program Service Exp351064TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev1031918TotalOfOtherProgramServiceRev
Total Program Service Expense17447048TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds1InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109616NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees295NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1RAY MARNERISBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7734747350TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12320 WEST 113TH PLKACEAddressLine1
CityCHICAGOCity
StateILState
ZIP Code60643ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
GEORGE E PETRAITIS
SECRETARY2.00XX000
ALLEN K FLAGLER
TRUSTEE1.00X000
THOMAS L HOGAN
TRUSTEE1.00X000
STEVEN J MURPHY
TRUSTEE2.00X000
KARYN PETTIGREW
TRUSTEE1.00X000
WILLIAM H HUNDING
PRESIDENT3.00XX000
HUGH J AHERN
TRUSTEE1.00X000
ROBERT BERGHOFF
TRUSTEE1.00X000
THOMAS E CHOMICZ
TRUSTEE2.00X000
MICHAEL A FLYNN
PRESIDENT/CEO12.00X018202031355
RAYMOND J MARNERIS
TREASURER/CFO12.00X08304215821
MEAGAN ROHAN
SECRETARY1.00X192000738
KEVIN MCGEE
EXECUTIVE DIRECTOR37.50115835027637X
EDUARDO TORRES
DIRECTOR OF NURSING37.5011659505932X
DEBORAH HART
FORMER CFO0.0001084939905X
FieldValueIRS element (for citing)
Total Reportable Comp From Org251630TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs373555TotalReportableCompFrmRltdOrgs
Total Other Compensation91388TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MORRISON SENIOR DINING
PO BOX 102289ATLANTAGA30268DINING SERVICES1775423
WASHINGTON & JANE SMITH HOME
2320 W 113TH PLACECHICAGOIL60643MANAGEMENT SERVICES1704714
WASHINGTON & JANE SMITH HOME
2320 W 113TH PLACECHICAGOIL60643NURSING SERVICES1445937
ALLIANCE REHAB
1520 KENSINGTON ROADOAKBROOKIL60523CONTRACT REHAB SERVICES1080698
ALLIANCE PHARMACY
1520 KENSINGTON ROADOAKBROOKIL60523CONTRACT PHARMACY289421
FieldValueIRS element (for citing)
Number Of Contractors GT100 K10NumberOfContractorsGT100K
Related Organizations434403RelatedOrganizations
All Other Contributions145437AllOtherContributions
Total Contributions579840TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NURSING CARE SERVICES62300082902658290265
ASSISTED LIVING SERVCE62300042017834201783
INDEPENDENT LIVING SER62300031228903122890
ANCILLARY SERVICES62300018069091806909
ENTRANCE FEES RECOGNIZ623000275023275023

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column265599TotalRevenueColumn
Related Or Exempt Function Income265599RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue17962469TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column91493TotalRevenueColumn
Exclusion$91,493ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column286601TotalRevenueColumn
Exclusion$286,601ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real207767Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real80823Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real126944Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column126944TotalRevenueColumn
Related Or Exempt Function Income90684RelatedOrExemptFunctionIncome
Exclusion$36,260ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities361463Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities241543Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities119920Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column119920TotalRevenueColumn
Exclusion$119,920ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column19167267TotalRevenueColumn
Related Or Exempt Function Income18053153RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$534,274ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total400611Total
Program Services400611ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total256410Total
Program Services256410ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4726462Total
Program Services4726462ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total74251Total
Program Services74251ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total581093Total
Program Services581093ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total366849Total
Program Services366849ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1704714Total
Management And General1704714ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total70434Total
Program Services70434ProgramServices

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total325Total
Management And General325ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4929766Total
Program Services4764660ProgramServices
Management And General165106ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total213738Total
Program Services19944ProgramServices
Management And General193794ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total394602Total
Program Services335346ProgramServices
Management And General59256ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total27838Total
Program Services11002ProgramServices
Management And General16836ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total703083Total
Program Services703083ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total34093Total
Program Services22918ProgramServices
Management And General11175ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2367437Total
Program Services2367437ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2353604Total
Program Services2353604ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total128050Total
Program Services124121ProgramServices
Management And General3929ManagementAndGeneral

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionTAXES AND FEESDescription
Total268823Total
Program Services268823ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total19602183Total
Program Services17447048ProgramServices
Management And General2155135ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY500BOY
EOY500EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1289607BOY
EOY978115EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1073630BOY
EOY918630EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY73360BOY
EOY81228EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis71243816LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec13013345LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY60018507BOY
EOY58230471EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY268838BOY
EOY3499838EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY4477466BOY
EOY4781968EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4646766BOY
EOY3643388EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY71848674BOY
EOY72134138EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2251640BOY
EOY2697068EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1613214BOY
EOY1662746EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY39569456BOY
EOY38867323EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY162955BOY
EOY256444EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY26966248BOY
EOY27866116EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY70563513BOY
EOY71349697EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1219321BOY
EOY724825EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY65840BOY
EOY59616EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1285161BOY
EOY784441EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY71848674BOY
EOY72134138EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-434916ReconcilationRevenueExpenses
Reconcilation Other Changes-65804ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years840816CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years661412CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years587517CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year711632CurrentTaxYearMinus1Year
Current Tax Year579840CurrentTaxYear
Total3381217Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10857229CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12778937CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14236810CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17644749CurrentTaxYearMinus1Year
Current Tax Year17962469CurrentTaxYear
Total73480194Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years11698045CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13440349CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14824327CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year18356381CurrentTaxYearMinus1Year
Current Tax Year18542309CurrentTaxYear
Total76861411Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years435576CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years413248CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years459114CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year506563CurrentTaxYearMinus1Year
Current Tax Year400611CurrentTaxYear
Total2215112Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years435576CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years413248CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years459114CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year506563CurrentTaxYearMinus1Year
Current Tax Year400611CurrentTaxYear
Total2215112Total
FieldValueIRS element (for citing)
Public Support Total50974646299PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years600523CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years192554CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years220365CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year222730CurrentTaxYearMinus1Year
Current Tax Year432210CurrentTaxYear
Total1668382Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years600523CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years192554CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years220365CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year222730CurrentTaxYearMinus1Year
Current Tax Year432210CurrentTaxYear
Total1668382Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years167573CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years64519CurrentTaxYearMinus3Years
Total232092Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years12466141CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13697422CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years15044692CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year18579111CurrentTaxYearMinus1Year
Current Tax Year18974519CurrentTaxYear
Total78761885Total
FieldValueIRS element (for citing)
Public Support Percentage5090.94770PublicSupportPercentage509
Prior Year Support Percentage0.94070PriorYearSupportPercentage
Investment Income Percentage0.02120InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.02350PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: VARIOUS SMALL ITEMSGeneralExplanation

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 C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$8,633OtherActivitiesAmount
Total Lobbying Expenditures IIB8633TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationTHE EXPENSES DETAILED ABOVE REPRESENT AN ALLOCATION OF MEMBERSHIP DUES TO LSN ASSOCIATION.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance11903799BeginningOfYearBalance
Investment Earnings Or Losses-85920InvestmentEarningsOrLosses
Grants Or Scholarships434403GrantsOrScholarships
Other Expenditures121962OtherExpenditures
End Of Year Balance11261514EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance10274728BeginningOfYearBalance
Investment Earnings Or Losses2092619InvestmentEarningsOrLosses
Grants Or Scholarships463548GrantsOrScholarships
End Of Year Balance11903799EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance9837732BeginningOfYearBalance
Investment Earnings Or Losses870994InvestmentEarningsOrLosses
Grants Or Scholarships418398GrantsOrScholarships
Administrative Expenses15600AdministrativeExpenses
End Of Year Balance10274728EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance10661483BeginningOfYearBalance
Investment Earnings Or Losses-418068InvestmentEarningsOrLosses
Grants Or Scholarships405683GrantsOrScholarships
End Of Year Balance9837732EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.07000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.93000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1674140OtherCostOrOtherBasis
Book Value1674140BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis66051240OtherCostOrOtherBasis
Depreciation11182263Depreciation
Book Value54868977BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3518436OtherCostOrOtherBasis
Depreciation1831082Depreciation
Book Value1687354BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings58230471TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionFIXED INCOME - GICSDescription
Book Value4781968BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities4781968TotalOfBookValueSecurities

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
BOND ISSUANCE COSTS, NET1141053
COST OF ACQUIRING INITIAL CONTINUING-CARE CONTRACTS, NET1774182
DUE FROM AFFILIATES728153
FieldValueIRS element (for citing)
Total Book Value Other Assets3643388TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
REFUNDABLE ENTRANCE FEES$21,478,839
OTHER CURRENT LIABILITIES$13,830
REFUNDABLE RESERVATION DEPOSITS$538,764
NOTE PAYABLE TO AFFILIATE$5,834,683
FieldValueIRS element (for citing)
Total Of Amounts27866116TotalOfAmounts
Total Revenue19167267TotalRevenue
Total Expenses19602183TotalExpenses
Excess Or Deficit For Year-434916ExcessOrDeficitForYear
Net Unrealized GL On Investments-65804NetUnrealizedGLOnInvestments
Total Adjustments-65804TotalAdjustments
Excess Or Deficit Per FS-500720ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt18781674TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-65804NetUnrealizedGainsInvestments
Other Revenues80822OtherRevenues
Revenue Not Rptd F99015018RevenueNotRptdF990
Revenue Subtotal18766656RevenueSubtotal
Other Revenues Not Included400611OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt400611RevenueNotRptdOnFinStmt
Total Revenue Per Form99019167267TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt19282394TotExpensesEtcAuditedFinclStmt
Other Expenses Included80822OtherExpensesIncluded
Expenses Not Rptd F99080822ExpensesNotRptdF990
Expenses Subtotal19201572ExpensesSubtotal
Other Expenses Not Included400611OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt400611ExpensesNotRptdOnFinStmt
Total Expenses Per Form99019602183TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 2B:RESIDENTS CAN ELECT TO USE THE ORGANIZATION FOR THE MANAGEMENT OF THEIR FUNDS THROUGH THE RESIDENT TRUST ACCOUNTS. THERE IS NO UPPER LIMIT ON AMOUNTS THAT CAN BE ACCEPTED. RESIDENTS AUTHORIZE THE ORGANIZATION TO UTILIZE THEIR FUNDS TO PAY FOR ITEMS AS NEEDED. ALL FUNDS ARE HELD SEPARATELY FROM CORPORATE FUNDS, BUT COMMINGLED WITH OTHER RESIDENTS' FUNDS. INTEREST IS PAID ON A PASS-THROUGH BASIS FROM BANKING INSTITUTIONS. NO ADDITIONAL FEES ARE INCURRED FOR RESIDENTS TO UTILIZE THIS TRUST FUND ARRANGEMENT.
PART V, LINE 4:THE ENDOWMENT FUND IS HELD BY WASHINGTON AND JANE SMITH HOME D/B/A SMITH SENIOR LIVING (SSL), A RELATED TAX-EXEMPT ORGANIZATION. SSL DISBURSES FUNDS AS NEEDED WITHIN THE GUIDELINES OF THE ENDOWMWNT FUND. THE EARNINGS ON THE ASSETS OF THE ENDOWMENT FUND HAVE BEEN DESIGNATED TO SUPPORT THE CHARITABLE CARE ACTIVITIES OF SMITH VILLAGE.DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:
PART X:THE ORGANIZATION QUALIFIES AS A TAX-EXEMPT CORPORATION DESCRIBED IN SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX EXEMPT STATUS. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE IRS. THE ORGANIZATION'S 2011, 2010, AND 2009 TAX YEARS ARE OPEN FOR EXAMINATION BY THE IRS.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:
RENTAL REVENUE EXPENSES 80,822.PART XII, LINE 2D - OTHER ADJUSTMENTS:
CHARITABLE CARE 400,611.PART XII, LINE 4B - OTHER ADJUSTMENTS:
RENTAL REVENUE EXPENSES 80,822.PART XIII, LINE 2D - OTHER ADJUSTMENTS:
CHARITABLE CARE 400,611.PART XIII, LINE 4B - OTHER ADJUSTMENTS:

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantCHARITABLE CARETypeOfGrant
Number Of Recipients32NumberOfRecipients
Amount Of Cash Grant400611AmountOfCashGrant
Amount Of Non Cash Assistance0AmountOfNonCashAssistance
Method Of ValuationN/AMethodOfValuation
Description Of Non Cash AssistanceN/ADescriptionOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: THE ORGANIZATION'S CHARITABLE SUPPORT PROGRAM HAS TWO COMPONENTS. IN SEVERAL INSTANCES, THE ORGANIZATION HAS AGREED TO PROVIDE A FIXED AMOUNT PER MONTH IN CHARITABLE SUPPORT WITH THE EXPECTATION THAT THE INDIVIDUAL IS THEN RESPONSIBLE FOR THE BALANCE OF THEIR MONTHLY BILL. THE SECOND COMPONENT DESIGN IS WHEN AN INDIVIDUAL HAS ESSENTIALLY RUN OUT OF ASSETS AND THE ORGANIZATION CONTINUES TO PROVIDE ALL THE REQUIRED SERVICES WITH CHARITABLE CARE.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MICHAEL A FLYNN
01712450001077507473023882021337500
RAYMOND J MARNERIS
08026700027750494201087909886300
KEVIN MCGEE
1098140006021048180228190143472000
EDUARDO TORRES
110968000562704501014310122527000
DEBORAH HART
043273000652200203107874011839800

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePART I, LINE 3ReturnReference
ExplanationTHE ORGANIZATION RELIES ON SMITH SENIOR LIVING (SSL), A RELATED TAX-EXEMPT ORGANIZATION TO DETERMINE THE COMPENSATION OF THE ORGANIZATIONS TOP MANAGEMENT OFFICIALS. THE COMPENSATION COMMITTEE OF SSL EVALUATES AND ESTABLISHES COMPENSATION AND REVIEWS PROTOCOL FOR THE ORGANIZATIONS CEO AND CFO. ANNUAL COMPENSATION COMPARISONS TO INDUSTRY PROFESSIONALS ARE GATHERED AND REVIEWED ON AN ANNUAL BASIS. DECISIONS ARE DOCUMENTED IN THE COMPENSATION COMMITTEE MEETING MINUTES.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1ILLINOIS FINANCE AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN861091967IssuerEIN
CUSIP Number45200BVN5CUSIPNumber
Date Issued2005-12-29DateIssued
Issue Price61805000IssuePrice
Description Of PurposeRE-DEVELOPED CAMPUS INTO A CCRCDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired23185000AmountRetired
Total Proceeds63046169TotalProceeds
Amount In Reserve Fund4639852AmountInReserveFund
Capitalized Interest3706008CapitalizedInterest
Issuance Costs From Proceeds1111028IssuanceCostsFromProceeds
Credit Enhancement250181CreditEnhancement
Capital Expenditures47790073CapitalExpenditures
Other Spent Proceeds5549027OtherSpentProceeds
Year Of Subst Completion2006YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements1AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty1MngmentCntrctBondFinancdPrprty
Engage Bond Counsel Contracts1EngageBondCounselContracts
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00360PrcntgePrvtBusinessUseByOthers
Total Private Business Use0.00360TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds1HedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1LASALLE BANKBusinessNameLine1
Business Name Line2NATIONALBusinessNameLine2
FieldValueIRS element (for citing)
Term Of Hedge4.000000000000TermOfHedge
Superintegrated Hedge0SuperintegratedHedge
Hedge Terminated0HedgeTerminated
Gross Proceeds Invested In GIC1GrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

FieldValueIRS element (for citing)
Business Name Line1NATIXISBusinessNameLine1
FieldValueIRS element (for citing)
Term Of GIC40.000000000000TermOfGIC
Regulatory Safe Harbor Satisfied1RegulatorySafeHarborSatisfied
Exception To Rebate0ExceptionToRebate
FieldValueIRS element (for citing)
Fed Tax Requirements ComplianceXFedTaxRequirementsCompliance

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3THE ORGANIZATION HAS AN AGREEMENT WITH SMITH SENIOR LIVING TO OVERSEE AND MANAGE ITS DAY-TO-DAY OPERATIONS. THE INITIAL TERM OF THIS AGREEMENT WAS FOR A PERIOD OF ONE (1) YEAR. THIS AGREEMENT RENEWS ANNUALLY THEREAFTER UNLESS TERMINATED IN ACCORDANCE WITH OTHER TERMS AND CONDITIONS CONTAINED THEREIN. FURTHERMORE, CERTAIN SUBORDINATION AND DEFERRAL PROVISIONS APPLY IN CONNECTION WITH PAYMENT OF COMPENSATION TO SMITH SENIOR LIVING. UNDER THE TERMS OF THE AGREEMENT, THE ORGANIZATION MUST COMPENSATE SMITH SENIOR LIVING FOR MANAGEMENT SERVICES RENDERED. THE AGREEMENT ALSO CONTAINS A PROVISION TO COMPENSATE SMITH SENIOR LIVING FOR SUPPLEMENTAL SERVICES IT MAY PROVIDE ABOVE AND BEYOND THOSE ENUMERATED IN THE AGREEMENT. IN ADDITION, THE ORGANIZATION MUST PAY SMITH SENIOR LIVING AN ADDITIONAL SUM ON A MONTHLY BASIS AS REIMBURSEMENT FOR SMITH SENIOR LIVING'S OVERHEAD EXPENSES RELATED TO THE ORGANIZATION. EXPENSES INCURRED BY THE ORGANIZATION UNDER THIS AGREEMENT WERE $1,707,714.
FORM 990, PART VI, SECTION A, LINE 4THE ORGANIZATION MADE SIGNIFICANT CHANGES TO THEIR BYLAWS IN THE CURRENT YEAR.
FORM 990, PART VI, SECTION A, LINE 6SMITH VILLAGE HAS A SINGLE CLASS OF VOTING MEMBERS AND THE SOLE MEMBER OF THAT CLASS IS SMITH SENIOR LIVING, A RELATED ILLINOIS TAX-EXEMPT ORGANIZATION, WHICH SHALL CONTINUE FROM YEAR-TO-YEAR AS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE ORGANIZATION MUST HAVE APPROVAL OF ITS SOLE MEMBER, SMITH SENIOR LIVING, BEFORE ELECTING OR REMOVING ANY OF THE ORGANIZATION'S TRUSTEES AND OFFICERS.
FORM 990, PART VI, SECTION A, LINE 7BTHE ORGANIZATION SHALL NOT TAKE ANY OF THE FOLLOWING ACTIONS WITHOUT THE APPROVAL OF THE SOLE MEMBER: (1) AMENDMENT OF THE ARTICLES OF INCORPORATION OF THIS CORPORATION. (2) AMENDMENT OF THE BYLAWS OF THIS CORPORATION. (3) MERGER, CONSOLIDATION OR DISSOLUTION OF THIS CORPORATION. (4) THE CREATION OF ANY SUBSIDIARIES OR AFFILIATES OF THIS CORPORATION. (5) ADOPTION OF THE BUSINESS PLAN APPROVED ANNUALLY BY THE BOARD OF TRUSTEES OF THIS CORPORATION. (6) ADOPTION OF THE ANNUAL BUDGET APPROVED BY THIS CORPORATION AND ANY ACTIONS TAKEN BY THIS CORPORATION WHICH WOULD OR COULD INVOLVE EXPENDITURES WHICH EXCEED ONE HUNDRED AND TEN PERCENT (110%) OF THE APPROVED BUDGETED AMOUNTS FOR SUCH EXPENDITURES. (7) THE SELECTION OF BANKING AFFILIATIONS, ACCOUNTING FIRMS OR LEGAL COUNSEL, AS WELL AS APPROVAL OF THE ENGAGEMENT OF ANY CONSULTANTS NOT SPECIFICALLY PROVIDED IN AN APPROVED BUDGET. (8) THE SELECTION AND RETENTION OF THE EXECUTIVE DIRECTOR OF THIS CORPORATION. (9) THE MAKING OF CAPITAL EXPENDITURES OR SALE OF ANY CAPITAL ASSETS BY THIS CORPORATION IN EXCESS OF FIFTY THOUSAND DOLLARS ($50,000) UNLESS PROVIDED IN THE ANNUAL BUDGET. (10) THE SELECTION OF THE MANNER AND LOCATION OF INVESTMENT OF ANY FUNDS. (11) THE EXTENSION OF ANY LOANS BY OR ANY BORROWING BY THIS CORPORATION. THE CEO AND CFO, EMPLOYEES OF SMITH SENIOR LIVING WHICH IS A RELATED TAX-EXEMPT ORGANIZATION, REPORTED ON PART VII DEVOTE APPROXIMATELY 12 HOURS PER WEEK TO SMITH VILLAGE. THE FOLLOWING TRUSTEES EACH DEVOTE APPROXIMATELY 1 TO 3 HOURS A WEEK TO SMITH VILLAGE. HUGH AHERN ROBERT BERGHOFF THOMAS CHOMICZ ALLEN FLAGLER THOMAS HOGAN WILLIAM HUNDING STEVEN MURPHY GEORGE PETRAITIS KARYN PETTIGREW
FORM 990, PART VI, SECTION B, LINE 11THE ORGANIZATION'S INTERNAL MANAGEMENT AND THE FINANCE COMMITTEE REVIEWS THE RETURN WITH ITS PAID TAX PREPARER. AFTER REVIEW, COPIES OF THE FULL FORM 990 ARE PRESENTED TO ALL TRUSTEES AND REVIEWED AT A BOARD MEETING PRIOR TO FILING THE RETURN WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY ALL TRUSTEES AND KEY PERSONNEL ARE REQUIRED TO COMPLETE A DISCLOSURE FOR CONFLICTS OF INTEREST. THE DISCLOSURES ARE REVIEWED BY THE CFO WHO DETERMINES IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS. IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS THE TRUSTEE IS REQUIRED TO RECUSE THEMSELVES FROM ANY VOTING, DELIBERATION, OR DECISION ON THE TRANSACTION AT THE BOARD LEVEL. FURTHERMORE, ALL VENDOR PAYMENT ACTIVITY IS REVIEWED BY THE CFO FOR VENDORS THAT MAY BE RELATED TO THE FILING ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 15THE ORGANIZATION RELIES ON SMITH SENIOR LIVING (SSL), A RELATED TAX-EXEMPT ORGANIZATION TO DETERMINE THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS. THE COMPENSATION COMMITTEE OF SSL EVALUATES AND ESTABLISHES COMPENSATION AND REVIEWS PROTOCOL FOR THE ORGANIZATION'S CEO AND CFO. ANNUAL COMPENSATION COMPARISONS TO INDUSTRY PROFESSIONALS ARE GATHERED AND REVIEWED ON AN ANNUAL BASIS. DECISIONS ARE DOCUMENTED IN THE COMPENSATION COMMITTEE MEETING MINUTES. THE LAST COMPENSATION REVIEW WAS COMPLETED IN 2012. THE CEO OF SSL DETERMINES THE ANNUAL COMPENSATION OF ALL OTHER OFFICERS, WITH THE EXCEPTION OF THE CFO, BY COMPARING THE COMPENSATION OF EACH OFFICER AND KEY EMPLOYEES TO PROFESSIONALS PERFORMING SIMILAR SERVICES IN SIMILAR INDUSTRIES ON AN ANNUAL BASIS. THE LAST COMPENSATION REVIEW WAS COMPLETED IN 2012.
FORM 990, PART VI, SECTION C, LINE 19ANNUALLY ALL TRUSTEES AND KEY PERSONNEL ARE REQUIRED TO COMPLETE A DISCLOSURE FOR CONFLICTS OF INTEREST. THE DISCLOSURES ARE SUMMARIZED BY THE CFO AND REVIEWED BY THE GOVERNANCE COMMITTEE WHO DETERMINES IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS. IF A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS THE TRUSTEE IS REQUIRED TO RECUSE THEMSELVES FORM ANY VOTING. DELIBERATION, OR DECISION ON THE TRANSACTION AT THE BOARD LEVEL. FURTHERMORE, ALL VENDOR PAYMENT ACTIVITY IS REVIEWED BY THE CFO FOR VENDORS THAT MAY BE RELATED TO THE FILING ORGANIZATION.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -65,804.CHANGES IN NET ASSETS OR FUND BALANCES:
AUDIT COMMITTEE AND FINANCIAL STATEMENT OVERSIGHTTHIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.FORM 990, PAGE 12, PART XII, LINE 2C

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
WJS - SMITH SENIOR LIVING
2320 WEST 113TH PLACECHICAGOIL60643364335178MANAGEMENTIL501(C)(3)LINE 11A, IN/A0
WJS - SMITH CROSSING
10501 EMILIE LANEORLAND PARKIL60467364333423CCRCIL501(C)(3)LINE 90SSL
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
SMITH SENIOR LIVING
E2065330COST
SMITH SENIOR LIVING
E1500000COST
SMITH SENIOR LIVING
C434403COST
SMITH SENIOR LIVING
I46680COST
SMITH SENIOR LIVING
L3150651COST

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