FURP.ORG / PUBLIC DATA EXPLORER

SJL HEALTH SYSTEMS INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
SJL HEALTH SYSTEMS INC (EIN 43-1710785)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-06-28
IRS object ID
201231809349300328
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)
Timestamp2012-06-28T13:05:26-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN371106622EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Ginoli & Company LtdCPA'sBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line17625 N University Ste AAddressLine1
CityPeoriaCity
StateILState
ZIP Code616148303ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN431710785EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SJL HEALTH SYSTEMS INCBusinessNameLine1
Business Name Line2D/B/A PRAIRIE ROSE HEALTH CARE CENTERBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlSJLHNameControl
Phone3096918113Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1830 WEST TRAILCREEK DRIVEAddressLine1
CityPEORIACity
StateILState
ZIP Code61614ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBRAD BARKLEYName
TitleTREASURERTitle
Phone3096918113Phone
Date Signed2012-06-26DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameMICHAEL REMMELECPAName
PTINP00444163PTIN
Phone3096712350Phone
Date Prepared2012-06-25DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonBRAD BARKLEYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1830 W TRAILCREEK DRAddressLine1
CityPEORIACity
StateILState
ZIP Code61614ZIPCode
FieldValueIRS element (for citing)
Gross Receipts8367232GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2000YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionOPERATION OF A SKILLED NURSING CENTERActivityOrMissionDescription
Nbr Voting Members Governing Body4NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees184TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year8721792ProgramServiceRevenuePriorYear
Program Service Revenue CY8366881ProgramServiceRevenueCY
Investment Income Prior Year2015InvestmentIncomePriorYear
Investment Income Current Year351InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year8723807TotalRevenuePriorYear
Total Revenue Current Year8367232TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4801390SalariesEtcPriorYear
Salaries Etc Current Year4990097SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4596227OtherExpensePriorYear
Other Expenses Current Year4912949OtherExpensesCurrentYear
Total Expenses Prior Year9397617TotalExpensesPriorYear
Total Expenses Current Year9903046TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-673810RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1535814RevenuesLessExpensesCY
Total Assets BOY8630529TotalAssetsBOY
Total Assets EOY8486481TotalAssetsEOY
Total Liabilities BOY11773005TotalLiabilitiesBOY
Total Liabilities EOY13164771TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-3142476NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-4678290NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE CARE FOR THE ELDERLY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7360453Expense
Revenue8367232Revenue
DescriptionOPERATION OF A SKILLED NURSING CENTERDescription
Total Program Service Expense7360453TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
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 Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
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 Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees184NumberOfEmployees
Employment Tax Returns Filed0EmploymentTaxReturnsFiled
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
Form8899 Filed0Form8899Filed
Form1098 C Filed0Form1098CFiled
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members4NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body0MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy0ConflictOfInterestPolicy
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
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 Line1LARRY TEMPLINBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3096918113TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1830 W TRAILCREEK DRAddressLine1
CityPEORIACity
StateILState
ZIP Code61614ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (4 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
MICHAEL KUHL
PRESIDENT1.00X000
THOMAS HUMMERTON
SECRETARY1.00X000
BRAD BARKLEY
TREASURER1.00X000
MICHAEL A AHEARN
DIRECTOR AT LARGE1.00X000
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
REHAB CARE GROUP INC
PO BOX 503534ST LOUISMO63150THERAPY SERVICES556767
PETERSEN HEALTH CARE
830 WEST TRAILCREEK DRPEORIAIL61614MANAGEMENT SERVICES481400
MARTIN BROS
406 VIKING ROADCEDER FALLSIA50613FOOD SUPPLY VENDOR394342
MCKESSON MEDICAL SERVICES
ONE POSE STREETSAN FRANCISCOCA94104MEDICAL SERVICES223826
OMNICARE
100 EAST RIVER CENTER BLVDCOVINGTONKY41011PHARMACEUTICAL SERVICES200710
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE62300083513938351393
RESIDENT SERVICES6230001548815488
FieldValueIRS element (for citing)
Total Program Service Revenue8366881TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column351TotalRevenueColumn
Related Or Exempt Function Income351RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column8367232TotalRevenueColumn
Related Or Exempt Function Income8367232RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4584959Total
Program Services4280200ProgramServices
Management And General304759ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total405138Total
Program Services405138ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total27835Total
Management And General27835ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total114777Total
Management And General114777ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total12435Total
Management And General12435ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total14633Total
Management And General14633ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total4721Total
Management And General4721ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total674586Total
Program Services674586ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total415271Total
Program Services415271ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
PURCHASED SERVICES557387557387
MANAGEMENT FEE481400481400
NURSING SERVICES439878439878
MISC. PAYROLL TAXES AND390265390265

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1779761Total
Program Services1145380ProgramServices
Management And General634381ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9903046Total
Program Services7360453ProgramServices
Management And General2542593ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY359597BOY
EOY82502EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY894702BOY
EOY1812367EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY32153BOY
EOY32153EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis8680574LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3628571LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5397759BOY
EOY5052003EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1946318BOY
EOY1507456EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8630529BOY
EOY8486481EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1197557BOY
EOY1989309EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY8178977BOY
EOY8123582EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY630000BOY
EOY630000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1766471BOY
EOY2421880EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY11773005BOY
EOY13164771EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-3142476BOY
EOY-4678290EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-3142476BOY
EOY-4678290EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8630529BOY
EOY8486481EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-1535814ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3687087CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6381343CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8514227CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8721792CurrentTaxYearMinus1Year
Current Tax Year8366881CurrentTaxYear
Total35671330Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3687087CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6381343CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8514227CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8721792CurrentTaxYearMinus1Year
Current Tax Year8366881CurrentTaxYear
Total35671330Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50935671330PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5976CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4094CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2707CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2015CurrentTaxYearMinus1Year
Current Tax Year351CurrentTaxYear
Total15143Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5976CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4094CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2707CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2015CurrentTaxYearMinus1Year
Current Tax Year351CurrentTaxYear
Total15143Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3693063CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6385437CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8516934CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8723807CurrentTaxYearMinus1Year
Current Tax Year8367232CurrentTaxYear
Total35686473Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99960PublicSupportPercentage509
Prior Year Support Percentage0.99920PriorYearSupportPercentage
Investment Income Percentage0.00040InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00080PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis487408InvestmentCostOrOtherBasis
Book Value487408BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis6565377InvestmentCostOrOtherBasis
Depreciation2404112Depreciation
Book Value4161265BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1627789InvestmentCostOrOtherBasis
Depreciation1224459Depreciation
Book Value403330BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5052003TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
DEFERRED FINANCING COSTS757144
ASSETS LIMITED AS TO USE686415
PREPAID EXPENSES63897
FieldValueIRS element (for citing)
Total Book Value Other Assets1507456TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
ACCRUED PAYROLL$485,778
INTEREST PAYABLE$394,713
DUE TO AFFILIATES$351,000
DUE TO TUTERA HEALTH CARE$458,743
OTHER LIABILITES$731,646
FieldValueIRS element (for citing)
Total Of Amounts2421880TotalOfAmounts
Total Revenue8367232TotalRevenue
Total Expenses9903046TotalExpenses
Excess Or Deficit For Year-1535814ExcessOrDeficitForYear
Excess Or Deficit Per FS-1535814ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt8367232TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal8367232RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9908367232TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt9903046TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal9903046ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9909903046TotalExpensesPerForm990

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF GARY INDIANA SERIES A & BBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN356001040IssuerEIN
CUSIP Number582065598CUSIPNumber
Date Issued2008-10-01DateIssued
Issue Price5100000IssuePrice
Description Of PurposePURCHASE OF FACILITYDescriptionOfPurpose
Defeased1Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property1OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 8aNo official meetings were held and no written actions were needed by the governing body.
Form 990, Part VI, Section A, line 8bThere were no committees with authority to act on behalf of the governing body.
Form 990, Part VI, Section B, line 11A draft copy of the Form 990 along with a copy of the audited financial statements are given to management to review. These are compared and any changes, if any, that are needed will be done at their request.
Form 990, Part VI, Section B, line 15The top management official is the Administrator of the nursing home. They are compensated at the same level of various other nursing home admistrators with the same responsibilites. All key employee salaries are set at the comparable rates with other nursing homes.
Form 990, Part VI, Section C, line 19NO DOCUMENTS AVAILABLE TO THE PUBLIC.
Form 990, Part X, line 24eOPERATIONS & MAINTENANCE: Program service expenses 0. Management and general expenses 369,775. Fundraising expenses 0. Total expenses 369,775. FOOD: Program service expenses 340,294. Management and general expenses 0. Fundraising expenses 0. Total expenses 340,294. PROVIDER BED TAX: Program service expenses 338,538. Management and general expenses 0. Fundraising expenses 0. Total expenses 338,538. SUPPLIES: Program service expenses 293,782. Management and general expenses 0. Fundraising expenses 0. Total expenses 293,782. BAD DEBT EXPENSE: Program service expenses 0. Management and general expenses 132,899. Fundraising expenses 0. Total expenses 132,899. MISC. ADMIN. EXPENSES: Program service expenses 0. Management and general expenses 131,707. Fundraising expenses 0. Total expenses 131,707. PROPERTY & LIABILITY INSURANCE: Program service expenses 92,568. Management and general expenses 0. Fundraising expenses 0. Total expenses 92,568. WORKMEN'S COMPENSATION: Program service expenses 62,059. Management and general expenses 0. Fundraising expenses 0. Total expenses 62,059. EQUIPMENT RENTAL: Program service expenses 9,748. Management and general expenses 0. Fundraising expenses 0. Total expenses 9,748. OTHER DIETARY: Program service expenses 8,113. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,113. TRAINING: Program service expenses 188. Management and general expenses 0. Fundraising expenses 0. Total expenses 188. MISC. EXPENSES: Program service expenses 90. Management and general expenses 0. Fundraising expenses 0. Total expenses 90.All Other Functional Expenses