2012-11-13T14:45:52-06:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2011-07-01 364335178 WASHINGTON AND JANE SMITH HOME WASH 7734747300 2320 WEST 113TH PLACE NO 1335 CHICAGO IL 60643 RAY MARNERIS 7734747350 2012-11-12 1 CHAD KUNZE P00639380 3149254300 2011 2016-02-24 21:20:13Z SMITH SENIOR LIVING KEVIN MCGEE 2320 WEST 113TH PLACE NO 1335 CHICAGO IL 60643 22068039 0 X WWW.SMITHSENIORLIVING.ORG X 1999 IL THE 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. 11 11 74 11 0 0 0 0 4002668 4984300 1459373 1814708 0 0 5462041 6799008 463548 434403 0 0 3427365 4233556 0 0 0 744113 932527 4635026 5600486 827015 1198522 43007742 41848098 5074314 4183759 37933428 37664339 X THE MISSION OF SMITH SENIOR LIVING IS TO ENRICH THE LIVES OF SENIOR ADULTS THROUGH THE HIGHEST QUALITY OF SERVICES. THE ORGANIZATION'S CHARITABLE PURPOSE IS TO PROVIDE MANAGEMENT, PLANNING, FINANCIAL AND ADMINISTRATIVE SERVICES (SEE SCHEDULE O) EXCLUSIVELY TO ITS RELATED CCRC ORGANIZATIONAL AFFILIATES. 0 0 2447060 2611743 SMITH SENIOR LIVING PROVIDES MANAGEMENT, PLANNING, FINANCIAL AND ADMINISTRATIVE SERVICES EXCLUSIVELY TO ITS RELATED CONTINUING CARE RETIREMENT COMMUNITY ORGANIZATIONAL AFFILIATES. 2396847 2372557 SMITH SENIOR LIVING IS THE SOLE MEMBER OF SMITH CARES, LLC, A STAFFING HOLDING COMPANY. SMITH CARES PROVIDES PROFESSIONAL STAFF TO THE AFFILIATED COMPANIES OF SMITH CROSSING AND SMITH VILLAGE WHEN THE INDIVIDUALS ARE SHARED BETWEEN THE TWO AFFILIATE ORGANIZATIONS. 434403 434403 MONIES PROVIDED BY DONATION TO THE ORGANIZATION ARE A SHARING OF EARNINGS ON THE ORIGINAL ENDOWMENT CREATED BY EMILIE SMITH. THE BOARD HAS DESIGNATED THAT 4% OF THE VALUE OF THE ENDOWMENT BE CONTRIBUTED EACH YEAR TO SMITH VILLAGE FOR CHARITABLE CARE. 5278310 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 8 0 1 74 1 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X RAY MARNERIS 7734747350 2320 WEST 113TH PLACE CHICAGO IL 60643 ROBERT A BERGHOFF 3.00 X X 0 0 0 GEORGE A PETRAITIS 3.00 X X 0 0 0 ALLEN K FLAGLER 1.00 X 0 0 0 THOMAS L HOGAN 1.00 X 0 0 0 WILLIAM H HUNDING 3.00 X 0 0 0 STEVEN J MURPHY 2.00 X 0 0 0 KARYN PETTIGREW 1.00 X 0 0 0 KAY E THURN 2.00 X 0 0 0 ANDREW J ANELLO 3.00 X 0 0 0 THOMAS E CHOMICZ 3.00 X 0 0 0 HUGH J AHERN 1.00 X 0 0 0 MICHAEL A FLYNN 37.50 X 182020 0 31355 RAYMOND J MARNERIS 37.50 X 83042 0 15801 MEAGAN ROHAN 1.00 X 19200 0 738 ROBERT A BOEHM 37.50 X 115801 0 12044 DEBORAH HART 0.50 X 108493 0 9905 508556 0 69843 3 1 1 0 BLUE CROSS BULE SHIELD 25550 NETWORK PLACE CHICAGO IL 60673 HEALTH INSURANCE 1358601 HUB INTERNATIONAL MIDWEST 15174 COLLECTIONS CENTER DRIVE CHICAGO IL 60693 INSURANCE BROKER 277615 NHRMA MUTUAL INSURANCE PO BOX 17062 URBANA IL 61803 WORKMAN COMPENSATION INSURANCE 261620 CROWE HORWATH LLP PO BOX 145415 CINCINNATI OH 45250 AUDITORS 135545 SHEILA KING PO BOX 10425 CHICAGO IL 60610 PUBLIC RELATIONS SERVICES 134439 6 MANAGEMENT FEE 541610 2611691 2611691 AGENCY FEE 623000 2372557 2372557 MISCELLANEOUS SUPPORT 623990 52 52 4984300 948460 948460 16135279 15269031 866248 866248 866248 6799008 4984300 0 1814708 434403 434403 489356 489356 3041765 3041765 90521 90521 347676 347676 264238 264238 29162 29162 95417 95417 52508 52508 103627 76747 26880 111207 91307 19900 122135 35302 86833 82241 82241 85054 85054 22541 11058 11483 83311 83311 105515 105515 38907 9752 29155 TAXES AND FEES 902 902 5600486 5278310 322176 0 139060 459379 481215 0 6527727 5065330 170300 126128 962162 540398 519749 421764 29173282 27447305 1410229 1258738 4586180 7069454 43007742 41848098 451443 476641 3072938 3707118 1549933 0 5074314 4183759 X 26029629 26158901 11037132 10638771 866667 866667 37933428 37664339 43007742 41848098 X 1198522 -1467611 X X 0 1 1 X 0 X X X 0 0 0 WJS - SMITH VILLAGE 362167948 9 1 1 1 434403 WJS - SMITH CROSSING 364333423 9 1 1 1 0 2 434403 11903799 -85920 434403 121962 11505438 10274728 2092619 463548 11903799 9837732 870994 418398 15600 10274728 10661483 -418068 405683 9837732 0.08000 0.92000 0 0 462924 185170 277754 499238 355228 144010 421764 DUE FROM AFFILIATES 6263792 DEPOSITS 805662 7069454 6799008 5600486 1198522 -1467611 -1467611 -269089 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE EARNINGS ON THE ASSETS OF THE ENDOWMENT FUND HAVE BEEN DESIGNATED TO SUPPORT THE CHARITABLE CARE ACTIVITIES OF SMITH VILLAGE DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. 1 WASHINGTON AND JANE SMITH COMMUNITY-BEVERLY 2320 WEST 113TH PLACE CHICAGO IL 60643 362167948 501(C)(3) 434403 0 N/A N/A CHARITABLE CARE ACTIVITIES 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE GRANTED FUNDS ARE NOT RESTRICTED AS TO USE AND ARE FOR CHARITABLE CARE OPERATIONS. THE GRANT WAS MADE TO A RELATED TAX-EXEMPT ORGANIZATION AND MANAGEMENT ENSURES THE FUNDS ARE USED TO SUPPORT THE ORGANIZATION'S EXEMPT PURPOSE. X X X 0 0 0 0 0 0 0 0 0 MICHAEL A FLYNN 171245 0 0 0 10775 0 7473 0 23882 0 213375 0 0 0 RAYMOND J MARNERIS 80267 0 0 0 2775 0 4922 0 10879 0 98843 0 0 0 ROBERT A BOEHM 100628 0 0 0 15173 0 4570 0 7474 0 127845 0 0 0 DEBORAH HART 43273 0 0 0 65220 0 2031 0 7874 0 118398 0 0 0 FORM 990, PART VI FORM 990, PART VII, SECTION A THE CEO AND CFO REPORTED ON PART VII DEVOTE APPROXIAMATELY 12 HOURS A WEEK TO SMITH VILLAGE AND SMITH CROSSING, BOTH OF WHICH ARE RELATED TAX-EXEMPT ORGANIZATIONS. THE FOLLOWING TRUSTEES EACH DEVOTE APPROXIMATELY 1 TO 3 HOURS A WEEK TO SMITH VILLAGE, A RELATED TAX-EXEMPT ORGANIZATION. HUGH AHERN ROBERT BERGHOFF THOMAS CHOMICZ ALLEN FLAGLER THOMAS HOGAN WILLIAM HUNDING STEVEN MURPHY GEORGE PETRAITIS KARYN PETTIGREW THE FOLLOWING TRUSTEES EACH DEVOTE APPROXIMATELY 1 TO 3 HOURS A WEEK TO SMITH CROSSING, A RELATED TAX-EXEMPT ORGANIZATION. ANDREW ANELLO ROBERT BERGHOFF THOMAS CHOMICZ STEVEN MURPHY KAY THURN FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION MADE CHANGES TO THE BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATIONS 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 12C ANNUALLY 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 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 15 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 19 FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,467,611. AUDIT COMMITTEE & FINANCIAL STATEMENT OVERSIGHT FORM 990, PAGE 12, PART XII, LINE 2C THIS PROCESS IS CONSISTENT WITH THE PRIOR YEAR. SMITH CARES LLC 2320 WEST 113TH PLACE CHICAGO IL 60643 262018889 STAFFING IL -24291 180392 SMITH SENIOR LIVING WJS - SMITH VILLAGE 2320 WEST 113TH PLACE CHICAGO IL 60643 362167948 CCRC IL 501(C)(3) LINE 9 SMITH SENIOR LIVING 1 WJS - SMITH CROSSING 10501 EMILIE LANE ORLAND PARK IL 60467 364333423 CCRC IL 501(C)(3) LINE 9 SMITH SENIOR LIVING 1 0 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 WASHINGTON AND JANE SMITH COMMUNITY - BEVERLY B 434403 COST WASHINGTON AND JANE SMITH COMMUNITY - BEVERLY D 2065330 COST WASHINGTON AND JANE SMITH COMMUNITY - ORLAND PARK D 3000000 COST WASHINGTON AND JANE SMITH COMMUNITY - BEVERLY D 1500000 COST WASHINGTON AND JANE SMITH COMMUNITY - BEVERLY K 3150651 COST WASHINGTON AND JANE SMITH COMMUNITY - ORLAND PARK K 1823641 COST WASHINGTON AND JANE SMITH COMMUNITY - BEVERLY J 46680 COST