2012-05-15T12:20:51-05:00 2011-06-30 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2010-07-01 010729134 CLARE OAKS CLAR 6303721983 827 CARILLON DRIVE BARTLETT IL 60103 PAUL CLEMENS 6303721983 2012-05-11 1 CHAD D KUNZE CPA 3149254300 2010 2016-02-24 21:20:13Z WILLIAM KEANE 827 CARILLON DRIVE BARTLETT IL 60103 19872378 0 X WWW.CLAREOAKS.COM X 2006 IL TO CREATE AN INTIMATE RETIREMENT COMMUNITY TO SERVE EVERY ASPECT OF A PERSON: MIND, BODY, AND SPIRIT. TO HAVE AN INSPIRING ENVIRONMENT WHERE RESIDENTS WOULD LIVE IN CLOSE HARMONY WITH EACH OTHER AND CONTINUE TO GROW AS INDIVIDUALS AND AS A COMMUNITY THROUGH INDEPENDENT LIVING, ASSISTED LIVING, SKILLED NURSING, REHABILITATION, AND MEMORY CARE. 9 9 0 49 0 0 4038347 460 14869035 19190735 308060 175005 458028 506178 19673470 19872378 0 0 0 0 7984083 7656016 0 0 0 18629164 19960590 26613247 27616606 -6939777 -7744228 113965034 107391705 137574117 137189299 -23609083 -29797594 X TO PROVIDE CONTINUING CARE AT A RETIREMENT COMMUNITY CONSISTING OF RESIDENTIAL, HEALTH, RECREATIONAL, SOCIAL, RELIGIOUS AND SPIRITUAL FACILITIES AND SERVICES, WHICH WILL SHARE, PROMOTE AND OPERATE IN ACCORDANCE WITH ETHICAL AND SPIRITUAL VALUES FOR THE ROMAN CATHOLIC RELIGIOUS INSTITUTE KNOWN AS THE SISTERS OF ST. JOSEPH OF THE THIRD ORDER OF ST. FRANCIS. 0 0 23382130 19696913 CLARE OAKS PROVIDES AN ASSISTED LIVING FACILITY AS WELL AS MEMORY CARE SERVICES TO OLDER ADULTS. IT PROVIDES HOUSING AND SUPPORTIVE SERVICES BY CERTIFIED AND LICENSED NURSING STAFF INCLUDING SUPPORT FOR ADL'S, MEDICATION ADMINISTRATION, ONSITE 24 HOUR SECURITY, DINING, WELLNESS PROGRAMS, ACTIVITIES, TRANSPORTATION, HEALTH CLINIC, HOUSEKEEPING, AND A PHYSICAL FITNESS VENUE.CLARE OAKS PROVIDES AN INDEPENDENT LIVING FACILITY THAT PROVIDES HOUSING AND SUPPORTIVE SERVICES INCLUDING ONSITE 24 HOUR SECURITY, DINING, WELLNESS PROGRAMS, ACTIVITIES, TRANSPORTATION, HEALTH CLINIC, HOUSEKEEPING, AND A PHYSICAL FITNESS VENUE. CLARE OAKS PROVIDES A SKILLED NURSING FACILITY THAT PROVIDES A 24 HOUR SKILLED NURSING SERVICE (LICENSED IN MEDICARE AND MEDICAID) IN A MODERN HEALTHCARE CENTER. THE SKILLED NURSING FACILITY INCLUDES SUPPORT FOR ADL'S, MEDICATION ADMINISTRATION, ONSITE 24 HOUR SECURITY, DINING, WELLNESS PROGRAMS, ACTIVITIES, TRANSPORTATION, A HEALTH CLINIC, HOUSEKEEPING, AND A PHYSICAL FITNESS VENUE. 23382130 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 85 0 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X X GIGI WALKER 6304834730 825 CARILLON DRIVE BARTLETT IL 60103 SISTER COLETTE WILCZYNSKI 0.50 X 0 0 0 DAN WALSH 0.50 X X 0 0 0 SISTER DENISE SEYMOUR 0.50 X 0 0 0 RENEE CISEWSKI 0.50 X 0 0 0 MICHAEL D HOVDE JR 0.50 X X 0 0 0 SISTER MARCELLA NOWAKOWSKI 0.50 X 0 0 0 PAUL CLEMENS 0.50 X X 0 0 0 EDWARD TED OTTO 0.50 X 0 0 0 THERESE M MALM 0.50 X 0 0 0 PAULA BARTOLOZZI 40.00 X 135560 0 0 135560 0 0 1 0 0 0 REHAB CARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 1153425 THE WEITZ COMPANY LLC 5901 THORNTON AVE DES MOINES IA 50321 CONSTRUCTION SERVICES 877973 PHARMERICA INC PO BOX 409251 ATLANTA GA 30384 PHARMACY SERVICES 667975 US FOOD SERVICE INC PO BOX 98420 CHICAGO IL 60693 FOOD 467137 MIDVALLEY STAFFING INC 5N441 RAUKRIAD ST SUITE 102 WAYNE IL 60184 NURSE STAFFING 376058 20 460 460 RESIDENT SERVICES 623000 19190735 19190735 19190735 136412 136412 38593 38593 38593 38593 MISCELLANEOUS 623000 506178 506178 506178 19872378 19696913 0 175005 135560 135560 6603749 5749467 854282 233010 233010 683697 453563 230134 1792395 790936 1001459 257413 257413 104093 104093 117563 117563 218347 121686 96661 259869 259869 855231 855231 21579 7562 14017 27943 22331 5612 5898416 5857925 40491 4455442 4424856 30586 704194 199361 504833 SUPPLIES 2693546 2692906 640 PHARMACY 958042 958042 FOOD 630033 630033 BAD DEBT 357381 0 357381 EQUIPMENT RENTAL 327281 325192 2089 281822 188946 92876 27616606 23382130 4234476 0 1169392 2142795 754648 141549 2668710 2126645 598175 198400 20357 27359 170915 70533 98215909 11205354 89136117 87010555 8709919 6713222 0 10736801 8960647 113965034 107391705 3927650 3837127 29918155 31627095 100792045 98890490 2936267 2834587 137574117 137189299 X -23609083 -29797594 -23609083 -29797594 113965034 107391705 X -7744228 1555717 X 0 0 0 X 961653 4038347 460 5000460 1331000 976060 11302080 14869035 19227335 47705510 1331000 976060 12263733 18907382 19227795 52705970 0 0 0 52705970 18499 1895733 374492 308061 175005 2771790 18499 1895733 374492 308061 175005 2771790 1280 77435 184498 458028 469578 1190819 1350779 2949228 12822723 19673471 19872378 56668579 0.93010 0.85060 0.04890 0.13360 X 176825 176825 94583604 9362365 85221239 3455480 1842989 1612491 87010555 DEFERRED FINANCING COSTS 4767224 ENTRANCE DEPOSITS 34901 DEFERRED MARKETING/SELLING COSTS 3905907 CONSTRUCTION IN PROGRESS 252615 8960647 DEFERRED DEVELOPMENT FEES 499998 CURRENT DEFERRED ENTRANCE FEES 1758350 RESERVATION DEPOSITS 576239 2834587 ILLINOIS FINANCE AUTHORITY 861091967 45200BZR2 2006-07-19 56360000 CONSTRUCTION PROJECT OF CLARE OAKS 0 0 0 ILLINOIS FINANCE AUTHORITY 861091967 45200BZN1 2006-07-19 55968314 CONSTRUCTION PROJECT OF CLARE OAKS 0 0 0 56360000 3121688 1127200 983833 2294707 48832572 2008 0 0 1 1 55968314 4044125 1118883 3270844 47537462 2008 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 1 SOVEREIGN BANK 0.500000000000 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 CLARE OAKS HAS DELEGATED CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER THE DIRECT SUPERVISION OF OFFICERS, DIRECTORS, AND KEY EMPLOYEES TO LCS, A MANAGEMENT COMPANY. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN WILL BE DISTRIBUTED TO BOARD MEMBERS BY THE EXECUTIVE DIRECTOR FOR REVIEW AND COMMENTS. ANY QUESTIONS WILL BE DIRECTED TO THE FINANCE DIRECTOR AND WILL BE ADDRESSED WITH THE PREPARER. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE AND SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE DISCLOSURE INCLUDES A STATEMENT THAT THE INDIVIDUAL WILL IMMEDIATELY REPORT ANY KNOWN PERSONAL OR BUSINESS RELATIONSHIP THAT EXISTS WITH AN ORGANIZATION/INDIVIDUAL DOING BUSINESS WITH CLARE OAKS, TO THE EXECUTIVE DIRECTOR AND THE PRESIDENT OF THE BOARD. ALL CONTRACTS AND AGREEMENTS ARE REVIEWED BY THE EXECUTIVE DIRECTOR AND THE CONTROLLER TO ASCERTAIN IF ANY RELATIONSHIP EXISTS BETWEEN THE CONTRACTOR AND ANY OFFICERS, DIRECTORS, OR KEY EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 15 CLARE OAKS HAS A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES THAT INCLUDES A REVIEW AND APROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. DURING THE CURRENT YEAR CLARE OAKS HAS USED THIS PROCESS TO DETERMINE THE COMPENSATION OF THE EXECUTIVE DIRECTOR AND HEALTHCARE ADMINISTRATOR. FORM 990, PART VI, SECTION C, LINE 18 CLARE OAKS MAKES ITS FORM 990 AND FORM 1023 AVAILABLE FOR PUBLIC INSPECTION ON ANOTHER'S WEBSITE AS WELL AS UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 CLARE OAKS MAKES ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC VIA EMMA, CENTERS FOR MEDICARE AND MEDICAID SERVICES, AND THE ILLINOIS DIGITAL ARCHIVES. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PRIOR PERIOD ADJUSTMENTS: 356,773. LOSS ON INTEREST RATE SWAP IN THE CURRENT YEAR 1,198,944. TOTAL TO FORM 990, PART XI, LINE 5: 1,555,717.