Coulterville Care Inc: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: Coulterville Care Inc (EIN 36-4137587)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-08-10
IRS object ID: 201232239349300418
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
Form 990
Schedule A
Schedule D
Schedule L
Schedule N
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-08-10T08:27:20-05:00	Timestamp
Tax Period End Date	2011-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BKD LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	211 N BROADWAY SUITE 600	AddressLine1
City	ST LOUIS	City
State	MO	State
ZIP Code	631022733	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	364137587	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Coulterville Care Inc	BusinessNameLine1

Field	Value	IRS element (for citing)
In Care Of Name	% MR GREG ELLIOTT	InCareOfName
Name Control	COUL	NameControl
Phone	6187582256	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	6633 Delmar Blvd	AddressLine1
City	St Louis	City
State	MO	State
ZIP Code	63130	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	HAROLD JOINES	Name
Title	PRESIDENT	Title
Date Signed	2012-08-08	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Phone	3142315544	Phone

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Andrea McFadden	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	13138 State Route 13	AddressLine1
City	Coulterville	City
State	IL	State
ZIP Code	62237	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	7755752	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	N/A	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1995	YearFormation
State Legal Domicile	IL	StateLegalDomicile
Activity Or Mission Description	LONG-TERM HEALTH CARE FACILITY	ActivityOrMissionDescription
Termination Or Contraction	X	TerminationOrContraction
Nbr Voting Members Governing Body	4	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	3	NbrIndependentVotingMembers
Total Nbr Employees	146	TotalNbrEmployees
Total Nbr Volunteers	15	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	0	ContributionsGrantsPriorYear
Contributions Grants Current Year	0	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	4134109	ProgramServiceRevenuePriorYear
Program Service Revenue CY	4700309	ProgramServiceRevenueCY
Investment Income Prior Year	4340	InvestmentIncomePriorYear
Investment Income Current Year	441	InvestmentIncomeCurrentYear
Other Revenue Prior Year	211728	OtherRevenuePriorYear
Other Revenue Current Year	2334	OtherRevenueCurrentYear
Total Revenue Prior Year	4350177	TotalRevenuePriorYear
Total Revenue Current Year	4703084	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	5888	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	4498	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	2021039	SalariesEtcPriorYear
Salaries Etc Current Year	2203632	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	2287509	OtherExpensePriorYear
Other Expenses Current Year	2471226	OtherExpensesCurrentYear
Total Expenses Prior Year	4314436	TotalExpensesPriorYear
Total Expenses Current Year	4679356	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	35741	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	23728	RevenuesLessExpensesCY
Total Assets BOY	4682272	TotalAssetsBOY
Total Assets EOY	4395184	TotalAssetsEOY
Total Liabilities BOY	3980649	TotalLiabilitiesBOY
Total Liabilities EOY	3669833	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	701623	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	725351	NetAssetsOrFundBalancesEOY
Mission Description	NONE	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	4247229	Expense
Grants	4498	Grants
Revenue	4700309	Revenue
Description	COULTERVILLE CARE, INC. WAS ORGANIZED FOR RELIGIOUS, CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES. SPECIFICALLY, THE ORGANIZATION WAS ORGANIZED TO OPERATE A 75-BED LONG-TERM HEALTH CARE FACILITY LOCATED IN COULTERVILLE, IL. THE FACILITY CONSISTS OF 75 SKILLED CARE BEDS.	Description
Total Program Service Expense	4247229	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	true	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	true	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	13	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	146	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	4	NbrVotingGoverningBodyMembers
Number Independent Voting Members	3	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	IL	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	MR GREG ELLIOTT	NamePerson
Telephone Number	3147260111	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	6633 DELMAR	AddressLine1
City	ST LOUIS	City
State	MO	State
ZIP Code	63130	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (5 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation
KENNETH CURRY
SECRETARY/TREASURER	0.5	X	X	0	0	0
WILLIAM JARRETT
BOARD MEMBER	0.5	X		0	0	0
WILLIAM MUELLER
BOARD MEMBER	0.5	X		0	0	0
HAROLD JOINES
PRESIDENT	0.5	X	X	0	0	0
ANDREA MCFADDEN
EXECUTIVE DIRECTOR	40.0		X	71093	0	5503

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	71093	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	5503	TotalOtherCompensation
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
SELECT REHABILITATION
PO BOX 809056	CHICAGO	IL	60680	PHYSICAL THERAPY	467651
ST ANDREWS MANAGEMENT SERVICES
6633 DELMAR BLVD	ST LOUIS	MO	63130	ACCOUNTING & IT	150541

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	2	NumberOfContractorsGT100K
Total Contributions	0	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
ROUTINE SERVICE	621110	3186460	3186460
PHARMACY	446110	186154	186154
PHYSICAL THERAPY	621110	550920	550920
OCCUPATIONAL THERAPY	621110	492180	492180
SPEECH THERAPY	621110	284595	284595

Field	Value	IRS element (for citing)
Total Program Service Revenue	4700309	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	441	TotalRevenueColumn
Exclusion	$441	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Other	3052668	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	3052668	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	OTHER INCOME	Description
Business Code	900099	BusinessCode
Total Revenue Column	2334	TotalRevenueColumn
Exclusion	$2,334	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	2334	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	4703084	TotalRevenueColumn
Related Or Exempt Function Income	4700309	RelatedOrExemptFunctionIncome
Exclusion	$2,775	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	0	Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	4498	Total
Program Services	4498	ProgramServices

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	76596	Total
Program Services	0	ProgramServices
Management And General	76596	ManagementAndGeneral
Fundraising	0	Fundraising

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	1726443	Total
Program Services	1630116	ProgramServices
Management And General	96327	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	0	Total

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	112179	Total
Program Services	106721	ProgramServices
Management And General	5458	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	288414	Total
Program Services	261552	ProgramServices
Management And General	26862	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	120000	Total
Program Services	120000	ProgramServices

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	20157	Total
Management And General	20157	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	26213	Total
Management And General	26213	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	61947	Total
Program Services	61947	ProgramServices

Advertising Advertising

Field	Value	IRS element (for citing)
Total	15139	Total
Management And General	15139	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	283228	Total
Program Services	237214	ProgramServices
Management And General	46014	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	36474	Total
Program Services	36474	ProgramServices

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	208370	Total
Program Services	208370	ProgramServices

Travel Travel

Field	Value	IRS element (for citing)
Total	4067	Total
Management And General	4067	ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	24399	Total
Management And General	24399	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	325363	Total
Program Services	325363	ProgramServices

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	210312	Total
Program Services	206520	ProgramServices
Management And General	3792	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	79187	Total
Management And General	79187	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices
PHYSICAL THERAPY	231108	231108
FOOD EXPENSE	194391	194391
OCCUPATIONAL THERAPY	206859	206859
BAD DEBT	167005	167005

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	257007	Total
Program Services	249091	ProgramServices
Management And General	7916	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	4679356	Total
Program Services	4247229	ProgramServices
Management And General	432127	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	1300	BOY
EOY	1150	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	824387	BOY
EOY	224026	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	400841	BOY
EOY	933826	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	75334	BOY
EOY	138626	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	3113782	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	116226	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	2922473	BOY
EOY	2997556	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	277600	BOY
EOY	0	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	180337	BOY
EOY	100000	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	4682272	BOY
EOY	4395184	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	631707	BOY
EOY	595720	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	3061	BOY
EOY	3024	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	3260000	BOY
EOY	0	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	74952	BOY
EOY	0	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	10929	BOY
EOY	3071089	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	3980649	BOY
EOY	3669833	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	701623	BOY
EOY	725351	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	701623	BOY
EOY	725351	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	4682272	BOY
EOY	4395184	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	23728	ReconcilationRevenueExpenses
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	true	AccountantCompileOrReview
FS Audited	false	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Separate	X	FinancialStatementSeparate
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	X	PubliclySupportedOrg509a2

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4052618	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	4201957	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4331206	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4134109	CurrentTaxYearMinus1Year
Current Tax Year	4700309	CurrentTaxYear
Total	21420199	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4052618	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	4201957	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4331206	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4134109	CurrentTaxYearMinus1Year
Current Tax Year	4700309	CurrentTaxYear
Total	21420199	Total

Field	Value	IRS element (for citing)
Public Support Total509	21420199	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	17060	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	14363	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	3819	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4340	CurrentTaxYearMinus1Year
Current Tax Year	441	CurrentTaxYear
Total	40023	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	17060	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	14363	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	3819	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4340	CurrentTaxYearMinus1Year
Current Tax Year	441	CurrentTaxYear
Total	40023	Total

Other Income509 OtherIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4208	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	4952	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	10720	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	211728	CurrentTaxYearMinus1Year
Current Tax Year	2334	CurrentTaxYear
Total	233942	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4073886	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	4221272	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4345745	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4350177	CurrentTaxYearMinus1Year
Current Tax Year	4703084	CurrentTaxYear
Total	21694164	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.98737	PublicSupportPercentage509
Prior Year Support Percentage	0.98622	PriorYearSupportPercentage
Investment Income Percentage	0.00185	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.00233	PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509	X	ThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amts		ArtPublicExhibitionAmts
Held Works Of Art Amts		HeldWorksOfArtAmts
Current Year Minus3 Years		CurrentYearMinus3Years

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	0	OtherCostOrOtherBasis
Book Value	0	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	4643	OtherCostOrOtherBasis
Depreciation	464	Depreciation
Book Value	4179	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	44077	OtherCostOrOtherBasis
Depreciation	1348	Depreciation
Book Value	42729	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	11697	OtherCostOrOtherBasis
Depreciation	1348	Depreciation
Book Value	10349	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	3053365	OtherCostOrOtherBasis
Depreciation	113066	Depreciation
Book Value	2940299	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	2997556	TotalOfBookValueLandBuildings
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescription	AmountAmount
RESIDENT CREDIT BALANCES	$13,466
LEASE OBLIGATION	$3,034,183
DEFERRED GAIN ON SALE OF ASSET	$23,440

Field	Value	IRS element (for citing)
Total Of Amounts	3071089	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	FIN 48 DISCLOSURE	Identifier
Return Reference	SCHEDULE D, PART XIV	ReturnReference
Explanation	MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.	Explanation

Schedule L IRS990ScheduleL

Field	Value	IRS element (for citing)
Total Balance Due	0	TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationship	Amount Of TransactionAmountOfTransaction	Description Of TransactionDescriptionOfTransaction	Sharing Of RevenuesSharingOfRevenues
Linda Mueller spouse of William Mu
family member of board	72362	employed as a dir. of nursing	false
Vanda Welty mother of A McFadden
family member of exe. dir	24725	employed as a cna	false
Donald McFadden husband of A McFa
family member of exe. dir	26339	employee salary	false

Schedule N IRS990ScheduleN

Field	Value	IRS element (for citing)
Liquidation Table		LiquidationTable

Disposition Table DispositionTable

Field	Value	IRS element (for citing)
Description Of Asset	LAND, BUILDING, EQUIPMENT	DescriptionOfAsset
Date Of Distribution	2011-06-15	DateOfDistribution
FMV Of Asset	3052668	FMVOfAsset
Method Of FMV Determination	NET BOOK VALUE	MethodOfFMVDetermination
EIN	271954207	EIN
Name Person	SOUTHERN HEALTH CARE LLC	NamePerson

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1115 BIRCH LANE	AddressLine1
City	SPARTA	City
State	IL	State
ZIP Code	62286	ZIPCode

Field	Value	IRS element (for citing)
IRC Section	LLC	IRCSection

Field	Value	IRS element (for citing)
Director Of Successor2	false	DirectorOfSuccessor2
Employee Of Successor2	false	EmployeeOfSuccessor2
Owner Of Successor2	false	OwnerOfSuccessor2
Receive Compensation2	false	ReceiveCompensation2

Form990 Schedule N Part III Form990ScheduleNPartIII

Field	Value	IRS element (for citing)
Identifier	SALE OF ASSETS	Identifier
Return Reference	PART II, LINE 1	ReturnReference
Explanation	DURING THE YEAR, THE ORGANIZATION ENTERED INTO AN AGREEMENT TO SELL THEIR EXISTING LAND, BUILDING, AND EQUIPMENT. THE PROCEEDS WERE USED TO RETIRE ALL EXISTING DEBT. THE ASSETS WERE THEN LEASED BACK FROM THE BUYER FOR A TERM OF 10 YEARS WITH AN OPTION TO RENEW FOR A SECOND TERM OF 10 YEARS.	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
REVIEW PROCESS	FORM 990, PART VI, SECTION B, QUESTION 11	THE DRAFT FORM 990 IS REVIEWED BY THE FINANCIAL CONSULTANT FOR ACCURACY AND MADE AVAILABLE TO THE ENTIRE BOARD. THE FINAL FORM 990 IS MAILED TO THE PRESIDENT OF THE BOARD FOR REVIEW AND SIGNATURE.
COMPLIANCE WITH CONFLICT OF INTEREST POLICY	FORM 990, PART VI, SECTION B, LINE 12C	EVERY YEAR, DISCLOSURE FORMS ARE SENT TO BOARD MEMBERS AND CCC'S ONE KEY EMPLOYEE TO ENSURE EVERYONE SIGNS OFF THAT THEY ARE IN COMPLIANCE WITH CCC'S WRITTEN CONFLICT OF INTEREST POLICY.
PROCESS FOR DETERMINING COMPENSATION	FORM 990, PART VI, SECTION B, LINE 15A/B	EVERY YEAR, THE CCC BOARD REVIEWS DATA PROVIDED BY AN LTC ASSOCIATION. IT PROVIDES COMPARATIVE SALARY INFORMATION. IT ALSO RECEIVES CURRENT, COMPARATIVE SALARY DATA FROM THE LOCAL COUNTY NURSING HOME. BASED ON THIS DATA, THE CCC BOARD ANNUALLY REVISES AND APPROVES THE SALARY OF THE EXECUTIVE DIRECTOR. NO OTHER OFFICERS OR KEY EMPLOYEES ARE COMPENSATED.
PROCESS FOR MAKING DOCUMENTS AVAILABLE TO PUBLIC	FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.