2012-10-31T12:00:32-05:00 2011-12-31 CROWE HORWATH LLP 70 West Madison Street Suite 700 Chicago IL 606024903 990 2011-01-01 010706736 AMERICAN EAGLE LIFECARE CORPORATION AMER 6152522305 3819 Hawk Crest Road Ann Arbor MI 48103 F SCOTT KELLMAN 2012-10-31 true Nicole Bencik P00756195 3128997000 2011 2016-02-24 21:20:13Z X F SCOTT KELLMAN 3819 Hawk Crest Road Ann Arbor MI 48103 68142267 false X N/A X 2002 TN THE ORGANIZATION OWNS AND OPERATES NURSING HOMES, SENIOR LIVING FACILITIES, ASSISTED LIVING FACILITIES AND RELATED FACILITIES, AND PROVIDES HEALTHCARE AND OTHER SERVICES TO THE ELDERLY AND INFIRM. 5 4 1567 225 6903 4903 10140 6124 50638367 56585641 90410 8092384 116549 190318 50855466 64874467 30300 40554 0 0 26410526 29110229 0 0 0 22139792 27112284 48580618 56263067 2274848 8611400 52731147 54890370 46363625 39911448 6367522 14978922 X THE ORGANIZATION ACQUIRES, OWNS, MAINTAINS AND OPERATES NURSING HOMES, HOSPITALS, SENIOR LIVING FACILITIES AND/OR ASSISTED LIVING FACILITIES AND RELATED FACILITIES PROVIDING HEALTH CARE OR OTHER SERVICES TO THE ELDERLY AND INFIRM OR DISABLED AND/OR DISADVANTAGED PERSONS THROUGHOUT THE UNITED STATES. (CONTINUED IN SCHEDULE O) true true 17660647 1074 19449701 THE ORGANIZATION PROVIDES A VARIETY OF LONG-TERM NURSING SERVICES AT THREE LOCATIONS IN WISCONSIN. SERVICES INCLUDE COMPREHENSIVE NURSING CARE, THERAPIES, DIETARY SERVICES, SOCIAL SERVICES, AND RESIDENT ACTIVITIES. ALL OF THE FACILITIES ARE CERTIFIED FOR MEDICARE AND MEDICAID. COLONIAL CENTER IS A 95 BED NURSING FACILITY LOCATED IN COLBY, WISCONSIN. KARMENTA CENTER IS A 103 BED NURSING FACILITY IN MADISON, WISCONSIN. BETHEL CENTER IS A 111 BED NURSING FACILITY LOCATED IN ARPIN, WISCONSIN. THESE FACILITIES PROVIDE SERVICES WITHOUT CHARGE, OR AT AMOUNTS LESS THAN ESTABLISHED RATES, TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE OR UNINSURED POLICIES. THE CRITERIA FOR CHARITY CARE TAKES INTO CONSIDERATION HEALTH & HUMAN SERVICES FEDERAL POVERTY GUIDELINES, FAMILY ASSETS, FAMILY SIZE, EMPLOYMENT STATUS, ORDINARY FAMILY EXPENSES, AND OTHER RELATED INFORMATION. THE COST OF CHARITY CARE, BASED UPON THE FACILITIES' COST-TO-CHARGE RATIO, PROVIDED BY THESE FACILITIES WAS APPROXIMATELY $40,931 IN 2011. 9854448 706 11121679 THE ORGANIZATION ALSO OPERATES A LICENSED NURSING HOME IN WEST ALLIS, WISCONSIN. THE ALLIS CARE CENTER PROVIDES CARE TO ELDERLY RESIDENTS, INCLUDING NURSING CARE, ANCILLARY SERVICES, SOCIAL SERVICES, AND OTHER SERVICES AS REQUIRED. THE FACILITY IS CERTIFIED FOR MEDICARE AND MEDICAID AND OPERATES WITH 152 BEDS. THIS FACILITY PROVIDE SERVICES WITHOUT CHARGE, OR AT AMOUNTS LESS THAN ESTABLISHED RATES, TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE OR UNINSURED POLICIES. THE CRITERIA FOR CHARITY CARE TAKES INTO CONSIDERATION HEALTH & HUMAN SERVICES FEDERAL POVERTY GUIDELINES, FAMILY ASSETS, FAMILY SIZE, EMPLOYMENT STATUS, ORDINARY FAMILY EXPENSES, AND OTHER RELATED INFORMATION. THE COST OF CHARITY CARE, BASED UPON THE FACILITY'S COST-TO-CHARGE RATIO, PROVIDED BY THIS FACILITY WAS APPROXIMATELY $15,631 IN 2011. 9195156 62 9578641 THE ORGANIZATION OPERATES A LICENSED NURSING HOME IN EAU CLAIRE, WISCONSIN. THE FACILITY PROVIDES CARE TO ELDERLY RESIDENTS, INCLUDING NURSING CARE, ANCILLARY SERVICES, SOCIAL SERVICES, AND OTHER SERVICES AS REQUIRED. THE FACILITY IS CERTIFIED FOR MEDICARE AND MEDICAID AND OPERATES WITH 161 BEDS. THIS FACILITY PROVIDE SERVICES WITHOUT CHARGE, OR AT AMOUNTS LESS THAN ESTABLISHED RATES, TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE OR UNINSURED POLICIES. THE CRITERIA FOR CHARITY CARE TAKES INTO CONSIDERATION HEALTH & HUMAN SERVICES FEDERAL POVERTY GUIDELINES, FAMILY ASSETS, FAMILY SIZE, EMPLOYMENT STATUS, ORDINARY FAMILY EXPENSES, AND OTHER RELATED INFORMATION. THE COST OF CHARITY CARE, BASED UPON THE FACILITY'S COST-TO-CHARGE RATIO, PROVIDED BY THIS FACILITY WAS APPROXIMATELY $58,459 IN 2011. 7824646 1512 8957013 THE ORGANIZATION PROVIDES A VARIETY OF SERVICES TO THE ELDERLY AT THREE LOCATIONS IN INDIANA. THE HOME PLACE OWNS AND OPERATES AN APARTMENT COMPLEX FOR THE ELDERLY AND IS LOCATED IN THE GREATER INDIANAPOLIS, INDIANA AREA. THE HOME PLACE CONTAINS 60 INDEPENDENT LIVING UNITS. SANDERS GLEN OPERATES AN ASSISTED LIVING FACILITY FOR THE ELDERLY AND IS LOCATED IN WESTFIELD, INDIANA. SANDERS GLEN CONTAINS 143 LICENSED ASSISTED LIVING BEDS CONTAINED IN 111 UNITS. MORNING BREEZE OPERATES A CONTINUING CARE RETIREMENT COMMUNITY (CCRC) IN GREENSBURG, INDIANA. MORNING BREEZE CONTAINS 18 INDEPENDENT LIVING VILLA HOMES, 30 LICENSED ASSISTED LIVING BEDS CONTAINED IN 25 UNITS, AND A 48 BED HEALTHCARE CENTER. THESE FACILITIES PROVIDE SERVICES WITHOUT CHARGE, OR AT AMOUNTS LESS THAN ESTABLISHED RATES, TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE OR UNINSURED POLICIES. THE CRITERIA FOR CHARITY CARE TAKES INTO CONSIDERATION HEALTH & HUMAN SERVICES FEDERAL POVERTY GUIDELINES, FAMILY ASSETS, FAMILY SIZE, EMPLOYMENT STATUS, ORDINARY FAMILY EXPENSES, AND OTHER RELATED INFORMATION. THE COST OF CHARITY CARE, BASED UPON THE FACILITIES' COST-TO-CHARGE RATIO, PROVIDED BY THESE FACILITIES WAS APPROXIMATELY $22,834 IN 2011. 5810674 0 7153685 THE ORGANIZATION OPERATES A LICENSED NURSING HOME IN WHITEHOUSE, TEXAS. THE OAKBROOK NURSING FACILITY (OAKBROOK) PROVIDES CARE TO ELDERLY RESIDENTS, INCLUDING NURSING CARE, ANCILLARY SERVICES, SOCIAL SERVICES, AND OTHER SERVICES AS REQUIRED. OAKBROOK OPERATES A 120 BED NURSING HOME. 37200 37200 333866 THE AMERICAN EAGLE PARENT COMPANY OWNS AND PROVIDES THIRD PARTY MANAGEMENT AND ADMINISTRATIVE SERVICES TO ITS FACILITY COMPANIES, WHICH ARE DISREGARDED ENTITIES OF THE PARENT COMPANY. 13672520 38712 16444564 50382771 true false false false false false false true false true false false false false true false false false false false false false false false false false true false true true false false false false false false false false false false false false false false true false false false false false true X 98 0 true 1567 true false false false false false false false false false false X 5 4 true true false false false false false true true false true true true true true true true true true false true true X F Scott Kellman 7342225264 3819 Hawk Crest Road Ann Arbor MI 48103 X BENJAMIN KELLMAN 2.00 X X 8750 0 0 F SCOTT KELLMAN 40.00 X X 840319 0 16376 KENT SYVERUD 2.00 X 35000 0 0 MARK MILLER 3.00 X 35000 0 0 RANDY RUTTA 2.00 X 35000 0 0 VIRGINIA S BURFORD 40.00 X 106410 0 54 1060479 0 16430 2 false true false MEDICAL REHABILITATION CENTERS LLC 1050 CHINOE RD SUITE 350 LEXINGTON KY 40502 MANAGEMENT SERVICES 4858609 GENESIS REHABILITATION SERVICES PO BOX 7247-6524 PHILADELPHIA PA 19170 THERAPY SERVICES 2010505 GREENFIELD REHABILITATION AGENCY INC 7517 W COLDSPRING ROAD GREENFIELD WI 53220 THERAPY SERVICES 854265 FUNCTIONAL PATHWAYS PO BOX 102426 ATLANTA GA 303682426 THERAPY SERVICES 791003 SELECT REHABILITATION INC PO BOX 809056 CHICAGO IL 60680 THERAPY SERVICES 773221 12 6124 6124 PATIENT SERVICE REVENUES 623000 56585641 56585641 0 0 0 0 56585641 60184 6903 53281 0 0 0 0 0 11300000 3267800 0 8032200 8032200 8032200 0 0 0 BEAUTY/BARBER SHOP 812900 15246 15246 MEALS/VENDING 900099 22986 22986 AIDES IN TRAINING/TRAINING REIMBURSEMENT 611710 8944 8944 143142 0 0 143142 190318 64874467 56594585 6903 8266855 40554 40554 0 0 0 970445 970445 7500 7500 23899921 23805618 94303 18146 18146 1944604 1936152 8452 2269613 2235005 34608 2639280 2485257 154023 255171 255171 190288 190288 0 0 0 8319234 6740721 1578513 312046 312046 3637405 2052007 1585398 88514 88514 0 3249517 3249517 213055 123777 89278 0 60211 58741 1470 2174663 2017879 156784 0 2085499 1790109 295390 599249 582219 17030 REVENUE ASSESSMENT FEES 1389322 1389322 MEDICAL/DIRECT CARE SUPPLIES 1515105 1515105 INDIGENT CARE/BAD DEBT 198601 198601 EMPLOYEE RECRUITMENT 78142 2032 76110 106982 53495 53487 0 56263067 50382771 5880296 0 0 7900 7900 7368872 15236307 4785460 4318715 474113 669404 40383461 9281767 34552357 31101694 0 0 1526798 1610664 579994 579994 3435653 1365692 52731147 54890370 5445633 5370756 22580000 11610000 39820 27169 18298172 22903523 0 0 46363625 39911448 X 6367522 14978922 6367522 14978922 52731147 54890370 8611400 0 X X true false true X false X 0 0 10649 10140 6124 26913 35564637 34596710 34188450 50638367 56585641 211573805 105527 -254495 26343 99736 181374 158485 0 0 35670164 34342215 34225442 50748243 56773139 211759203 0 0 0 0 0 0 0 0 211759203 378668 80851 67454 90410 60184 677567 0 378668 80851 67454 90410 60184 677567 0 0 0 18616 16813 8944 44373 36048832 34423066 34311512 50855466 56842267 212481143 0.99660 0.99530 0.00320 0.00450 X OTHER INCOME, SCHEDULE A, PART III, LINE 12, DESCRIPTION - AIDES IN TRAINING/TRAINING REIMBURSEMENT, COLUMN A - 0, COLUMN B - 0, COLUMN C - 18616, COLUMN D - 16813, COLUMN E - 8944, COLUMN F - 44373;, true 95358 1303240 1310151 88447 true 2601033 2601033 30480884 4977114 25503770 1422410 375055 1047355 5653059 3929598 1723461 226075 226075 31101694 0 0 Agent, trustee, custodian, or other intermediary arrangement Schedule D, Part IV, Line 1b SEE NARRATIVE FOR SCHEDULE D, PART IV, LINE 2B. Explanation of escrow agreement Schedule D, Part IV, Line 2b FOR PERSONAL PROTECTION, IT IS REQUESTED THAT MONEY NOT BE LEFT IN THE RESIDENTS' ROOMS. THE FACILITY MAY NOT REQUIRE RESIDENTS TO DEPOSIT THEIR PERSONAL FUNDS WITH THE FACILITY; HOWEVER, IF THE RESIDENT WISHES, AND UPON WRITTEN AUTHORIZATION OF A RESIDENT, THE FACILITY WILL WITHHOLD, SAFEGUARD, MANAGE, AND ACCOUNT FOR THE PERSONAL FUNDS OF THE RESIDENT DEPOSITED WITH THE FACILITY. ANY RESIDENT'S PERSONAL FUNDS IN EXCESS OF $50 ARE DEPOSITED IN AN INTEREST-BEARING ACCOUNT THAT IS SEPARATE FROM FACILITY FUNDS. THE FACILITY CREDITS ALL INTEREST EARNED ON THE RESIDENT'S FUNDS TO HIS OR HER ACCOUNT. A RESIDENT'S PERSONAL FUNDS THAT DO NOT EXCEED $50 ARE MAINTAINED IN A NON-INTEREST-BEARING ACCOUNT OR PETTY CASH FUND. THE FACILITY MAINTAINS A SYSTEM THAT ASSURES A COMPLETE AND SEPARATE ACCOUNTING OF EACH RESIDENT'S PERSONAL FUNDS ENTRUSTED TO THE FACILITY. THE FACILITY DEPOSITS THE PERSONAL NEEDS ALLOWANCE RETAINED BY ANY RESIDENT WHOSE CARE IS PAID FOR UNDER THE MEDICAID PROGRAM INTO THE RESIDENT'S ACCOUNT. THE FACILITY FURNISHES THE RESIDENT WITH A WRITTEN RECEIPT FOR ANY PERSONAL FUNDS OR PERSONAL PROPERTY RECEIVED BY THE FACILITY. RESIDENTS MAY ACCESS THEIR ACCOUNT DURING NORMAL BUSINESS HOURS; IF RESIDENTS NEED ACCESS TO THEIR MONEY AFTER HOURS OR DURING THE WEEKEND, THE BUSINESS OFFICE MANAGER OR ADMINISTRATOR IS CONTACTED AND ARRANGES FOR THE RESIDENTS TO RECEIVE THEIR FUNDS. THE INDIVIDUAL FINANCIAL RECORD IS AVAILABLE QUARTERLY ON REQUEST BY THE RESIDENT OR HIS OR HER LEGAL REPRESENTATIVE. AT LEAST EVERY THREE MONTHS, THE FACILITY FURNISHES THE RESIDENT OR THE RESIDENT'S REPRESENTATIVE WITH A COMPLETE STATEMENT OF ALL FUNDS AND OTHER PROPERTY HELD BY THE FACILITY, DETAILING THE AMOUNTS AND ITEMS RECEIVED, TOGETHER WITH THEIR SOURCES, DISPOSITION, AND THE DATE OF EACH TRANSACTION. FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 AS SINGLE MEMBER LIMITED LIABILITY COMPANIES, ALL INCOME IS INCLUDED IN THE TAXABLE INCOME OF THE INDIVIDUAL MEMBER; THUS, NO FEDERAL OR STATE INCOME TAXES ARE INCLUDED IN THESE FINANCIAL STATEMENTS. U.S. GAAP REQUIRES THAT A TAX POSITION IS RECOGNIZED AS A BENEFIT ONLY IF IT IS "MORE LIKELY THAT NOT" THAT THE TAX POSITION WOULD BE SUSTAINED IN A TAX EXAMINATION, WITH A TAX EXAMINATION BEING PRESUMED TO OCCUR. THE AMOUNT RECOGNIZED IS THE LARGEST AMOUNT OF TAX BENEFIT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED ON EXAMINATION. FOR TAX POSITIONS NOT MEETING THE "MORE LIKELY THAN NOT" TEST, NO TAX BENEFIT IS RECORDED. DUE TO ITS PASS-THROUGH STATUS, THE COMPANY IS NOT SUBJECT TO U.S. FEDERAL INCOME TAX OR STATE INCOME TAX. THE COMPANY IS NO LONGER SUBJECT TO EXAMINATION BY TAXING AUTHORITIES FOR YEARS BEFORE 2007. THE COMPANY DOES NOT EXPECT THE TOTAL AMOUNT OF UNRCOGNIZED TAX BENEFITS TO SIGNIFICANTLY CHANGE IN THE NEXT 12 MONTHS. THE COMPANY RECOGNIZES INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS IN INTEREST AND INCOME TAX EXPENSE, RESPECTIVELY. THE COMPANY HAS NO AMOUNTS ACCRUED FOR INTEREST OR PENALTIES AS OF DECEMBER 31, 2011. true EMERSON SCHOOL INC 5325 SCIO CHURCH ROAD ANN ARBOR MI 48103 237442766 501(C)(3) 7500 0 N/A N/A GENERAL OPERATIONS SUPPORT 1 0 Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 BOARD MEMBERS, OFFICERS, AND THE BOARD ADVISOR ARE ENCOURAGED TO SUBMIT RECOMMENDATIONS TO THE BOARD FOR CHARITABLE CONTRIBUTIONS TO SUPPORT OTHER WORTHY TAX EXEMPT ORGANIZATIONS ON AN ANNUAL BASIS. CHARITABLE DONATIONS FROM AMERICAN EAGLE LIFECARE CORPORATION AND ITS DISREGARDED ENTITIES TOTALED $40,554 FOR 2011. CONTRIBUTIONS MADE ARE UNRESTRICTED AND CAN BE USED IN ANY WAY THE DONEE ORGANIZATION SEES FIT TO FURTHER THEIR EXEMPT PURPOSE. X X X X X false false false false false false false false false F SCOTT KELLMAN 644975 0 195000 0 344 0 10228 0 6148 0 856695 0 0 0 WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710BBY7 2008-06-11 12000000 REFINANCE 11/01/2003 WISCONSIN BONDS FOR FACILITY ACQUISITION, ADDITIONS, AND IMPROVEMENTS false false false 390000 0 12000000 993275 0 0 0 0 0 2383148 8623577 0 2008 true false true true true true false false 0.0000 0.0000 0.0000 true false false false 0.0 true PACKERKISS SECURITIES 7.0 true false true X Procedures to take corrective action Schedule K, Part V THE BOARD HAS WRITTEN POLICIES AND PROCEDURES TO ENSURE COMPLIANCE WITH ALL FEDERAL TAX REQUIREMENTS. THE BOARD DISCUSSES ALL COMPLIANCE ISSUES AT MONTHLY MEETINGS AND CONSULTS PROFESSIONAL EXTERNAL COUNSEL IF NECESSARY. ORGANIZATION'S MISSION (CONTINUED FROM PART III) FORM 990, PART III, LINE 1 THE ORGANIZATION ALSO DEVELOPS AND DEPLOYS EDUCATIONAL PROGRAMS AND SUPPORTING RESEARCH IN THE AREA OF LEARNING SCIENCE AND INNOVATIVE EDUCATIONAL PROGRAMS AND TOOLS IN A VARIETY OF MEDIA FOR TRAINING AND EDUCATIONAL PURPOSES. New program services Form 990, Part III, Line 2 ON JULY 26, 2011, THE ORGANIZATION ACQUIRED AMERICAN EAGLE SANDERS GLEN, LLC TRANSFERRED ITS PROPERTY AND EQUIPMENT TO AE WESTFIELD FACILITY COMPANY, LLC, TO OWN ITS ASSISTED LIVING FACILITY LOCATED IN WESTFIELD, INDIANA. ALSO ON JULY 26, 2011, THE ORGANIZATION ACQUIRED AMERICAN EAGLE MORNING BREEZE, LLC TRANSFERRED ITS PROPERTY AND EQUIPMENT TO AE GREENSBURG FACILITY COMPANY, LLC, TO OWN ITS CONTINUING CARE RETIREMENT COMMUNITY LOCATED IN GREENSBURG, INDIANA. Significant changes in program services Form 990, Part III, Line 3 THE ORGANIZATION SOLD AE WHITEHOUSE FACILITY COMPANY, LLC ON JULY 1, 2011. Description of other program services Form 990, Part III, Line 4d THE ORGANIZATION PROVIDES A VARIETY OF SERVICES TO THE ELDERLY AT THREE LOCATIONS IN INDIANA. THE HOME PLACE OWNS AND OPERATES AN APARTMENT COMPLEX FOR THE ELDERLY AND IS LOCATED IN THE GREATER INDIANAPOLIS, INDIANA AREA. THE HOME PLACE CONTAINS 60 INDEPENDENT LIVING UNITS. SANDERS GLEN OPERATES AN ASSISTED LIVING FACILITY FOR THE ELDERLY AND IS LOCATED IN WESTFIELD, INDIANA. SANDERS GLEN CONTAINS 143 LICENSED ASSISTED LIVING BEDS CONTAINED IN 111 UNITS. MORNING BREEZE OPERATES A CONTINUING CARE RETIREMENT COMMUNITY (CCRC) IN GREENSBURG, INDIANA. MORNING BREEZE CONTAINS 18 INDEPENDENT LIVING VILLA HOMES, 30 LICENSED ASSISTED LIVING BEDS CONTAINED IN 25 UNITS, AND A 48 BED HEALTHCARE CENTER. THESE FACILITIES PROVIDE SERVICES WITHOUT CHARGE, OR AT AMOUNTS LESS THAN ESTABLISHED RATES, TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE OR UNINSURED POLICIES. THE CRITERIA FOR CHARITY CARE TAKES INTO CONSIDERATION HEALTH & HUMAN SERVICES FEDERAL POVERTY GUIDELINES, FAMILY ASSETS, FAMILY SIZE, EMPLOYMENT STATUS, ORDINARY FAMILY EXPENSES, AND OTHER RELATED INFORMATION. THE COST OF CHARITY CARE, BASED UPON THE FACILITIES' COST-TO-CHARGE RATIO, PROVIDED BY THESE FACILITIES WAS APPROXIMATELY $22,834 IN 2011. THE ORGANIZATION OPERATES A LICENSED NURSING HOME IN WHITEHOUSE, TEXAS. THE OAKBROOK NURSING FACILITY (OAKBROOK) PROVIDES CARE TO ELDERLY RESIDENTS, INCLUDING NURSING CARE, ANCILLARY SERVICES, SOCIAL SERVICES, AND OTHER SERVICES AS REQUIRED. OAKBROOK OPERATES A 120 BED NURSING HOME. THE AMERICAN EAGLE PARENT COMPANY OWNS AND PROVIDES THIRD PARTY MANAGEMENT AND ADMINISTRATIVE SERVICES TO ITS FACILITY COMPANIES, WHICH ARE DISREGARDED ENTITIES OF THE PARENT COMPANY. ANNUAL SUMMARY AND TRANSMITTAL OF U.S. INFORMATION RETURNS FORM 990, PART V, LINE 1A EACH OF THE DISREGARDED ENTITIES FILES A SEPARATE FORM 1096, AND THE NUMBER REPORTED IN BOX 3 OF EACH RESPECTIVE ENTITY IS AS FOLLOWS: AMERICAN EAGLE NURSING HOME COMPANY OF ARPIN, LLC (9); AMERICAN EAGLE NURSING HOME COMPANY OF COLBY, LLC (9); AMERICAN EAGLE NURSING HOME COMPANY OF MADISON, LLC (16); AMERICAN EAGLE NURSING HOME COMPANY OF EAU CLAIRE, LLC (10); AMERICAN EAGLE NURSING HOME COMPANY OF WHITEHOUSE, LLC (12); AMERICAN EAGLE GROUP - WISCONSIN (3); AMERICAN EAGLE GROUP - INDIANA (4); AMERICAN EAGLE HOME PLACE, LLC (1); AMERICAN EAGLE SANDERS GLEN, LLC (4); AMERICAN EAGLE MORNING BREEZE, LLC (10); LEXINGTON HEALTHCARE, LLC (11); AMERICAN EAGLE LIFECARE CORPORATION (9). TRANSMITTAL OF WAGE AND TAX STATEMENTS FORM 990, PART V, LINE 2A EACH OF THE DISREGARDED ENTITIES FILES A SEPARATE FORM W-3, AND THE NUMBER REPORTED FOR EACH RESPECTIVE ENTITY IS AS FOLLOWS: AMERICAN EAGLE NURSING HOME COMPANY OF ARPIN, LLC (198); AMERICAN EAGLE NURSING HOME COMPANY OF COLBY, LLC (187); AMERICAN EAGLE NURSING HOME COMPANY OF MADISON, LLC (187); AMERICAN EAGLE NURSING HOME COMPANY OF EAU CLAIRE, LLC (303); AMERICAN EAGLE NURSING HOME COMPANY OF WHITEHOUSE, LLC (268); AMERICAN EAGLE HOME PLACE, LLC (3); AMERICAN EAGLE SANDERS GLEN, LLC (69); AMERICAN EAGLE MORNING BREEZE, LLC (115); LEXINGTON HEALTHCARE, LLC (236); AMERICAN EAGLE LIFECARE CORPORATION (1). Family/business relationships amongst interested persons Form 990, Part VI, Section A, Line 2 F. SCOTT KELLMAN & BEN KELLMAN - FAMILY RELATIONSHIP Delegation of management duties Form 990, Part VI, Section A, Line 3 IN JULY 2010, THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT FOR LEXINGTON HEALTHCARE WITH MEDICAL REHABILITATION CENTERS, LLC, A KENTUCKY CORPORATION, FOR A TERM OF 15 YEARS, TO PROVIDE SUBSTANTIALLY ALL MANAGEMENT SERVICES FOR THE FACILITY FOR AN INITIAL MONTHLY FEE OF $42,920 PLUS PAYROLL COSTS OF EMPLOYEES OR CONSULTANTS OF THE FACILITY WHO ARE EMPLOYEES OF THE MANAGER. THE INITIAL MONTHLY FEE WILL BE ADJUSTED ANNUALLY BASED ON AN ANNUAL CHANGE IN THE CONSUMER PRICE INDEX. IN JANUARY 2010, THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT FOR THE CLAIREMONT NURSING AND REHABILITATION CENTER WITH MEDICAL REHABILITATION CENTERS, LLC, A KENTUCKY CORPORATION, FOR A TERM OF 15 YEARS, TO PROVIDE SUBSTANTIALLY ALL MANAGEMENT SERVICES FOR THE FACILITY FOR AN INITIAL MONTHLY FEE OF $42,850 PLUS PAYROLL COSTS OF EMPLOYEES OR CONSULTANTS OF THE FACILITY WHO ARE EMPLOYEES OF THE MANAGER. THE INITIAL MONTHLY FEE WILL BE ADJUSTED ANNUALLY BASED ON AN ANNUAL CHANGE IN THE CONSUMER PRICE INDEX. IN DECEMBER 2005, THE ORGANIZATION ENTERED INTO MANAGEMENT AGREEMENTS FOR EACH OF THE THREE INDIANA FACILITIES (THE HOME PLACE, SANDERS GLEN, AND MORNING BREEZE) WITH MEDICAL REHABILITATION CENTERS, INC., A KENTUCKY CORPORATION, FOR A TERM OF 15 YEARS, TO PROVIDE SUBSTANTIALLY ALL MANAGEMENT SERVICES FOR EACH FACILITY FOR AN INITIAL MONTHLY FEE OF $19,880 PLUS PAYROLL COSTS OF EMPLOYEES OR CONSULTANTS OF THE THREE FACILITIES WHO ARE EMPLOYEES OF THE MANAGER. THE INITIAL MONTHLY FEE HAS BEEN ADJUSTED ANNUALLY BASED ON AN ANNUAL CHANGE IN THE CONSUMER PRICE INDEX. IN NOVEMBER 2003 AND AMENDED AND RESTATED AS OF JUNE 1, 2008, EACH OF THE THREE WISCONSIN FACILITIES (COLONIAL, KARMENTA, AND BETHEL) ENTERED INTO A MANAGEMENT AGREEMENT WITH MEDICAL REHABILITATION CENTERS, INC., A KENTUCKY CORPORATION, FOR A TERM OF 15 YEARS, TO PROVIDE SUBSTANTIALLY ALL MANAGEMENT SERVICES FOR EACH FACILITY FOR AN INITIAL MONTHLY FEE OF $94,840 PLUS PAYROLL COSTS OF EMPLOYEES AND CONSULTANTS OF THE THREE FACILITIES WHO ARE EMPLOYEES OF THE MANAGER. THE INITIAL MONTHLY FEE HAS BEEN ADJUSTED ANNUALLY BASED ON AN ANNUAL CHANGE IN THE CONSUMER PRICE INDEX. IN SEPTEMBER 2005, THE OAKBROOK HEALTH CARE FACILITY ENTERED INTO A MANAGEMENT AGREEMENT WITH ATRIUM LIVING CENTERS OF TEXAS, INC. FOR A TERM OF NINE YEARS AND FOUR MONTHS. UNDER THE AGREEMENT, ATRIUM IS TO EXCLUSIVELY SUPERVISE, DIRECT, AND CONTROL THE MANAGEMENT AND OPERATION OF THE FACILITY FOR A MONTHLY FEE OF $22,000. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b A BOARD MEETING IS HELD (OCTOBER 2012) WHERE A COPY OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS PROVIDED TO EACH MEMBER OF THE GOVERNING BODY BEFORE THE RETURN IS FILED WITH THE IRS. Conflict of interest policy Form 990, Part VI, Section B, Line 12c ANNUAL CERTIFICATIONS ARE RECEIVED FROM ALL OFFICERS AND DIRECTORS TO DETERMINE WHETHER ANY POTENTIAL CONFLICTS OF INTEREST EXIST. THE BOARD OF DIRECTORS DISCUSS THE ANNUAL CERTIFICATIONS AT THE BOARD MEETINGS TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. IF A CONFLICT IS DETERMINED TO EXIST, THAT PERSON WOULD BE RECUSED FROM TAKING PART IN ANY DECISIONS CONCERNING THE CONFLICTING ISSUE. Process used to establish compensation of top management official Form 990, Part VI, Section B, Line 15a THE ORGANIZATION'S BOARD OF DIRECTORS REVIEWS AND APPROVES THE COMPENSATION FOR THE ORGANIZATION'S PRESIDENT AND CEO, F. SCOTT KELLMAN, ON AN ANNUAL BASIS. THE BOARD USES CURRENT MARKET DATA FOR COMPARABILITY AND DOCUMENTS THEIR DELIBERATION AND DECISION IN THE BOARD MEETING MINUTES; THIS PROCESS WAS LAST UNDERTAKEN DURING SEPTEMBER 2011. IN ADDITION, THE BOARD OF DIRECTORS OBTAINED COMPENSATION STUDIES PERFORMED BY THE REZNICK GROUP, L.C. IN JULY 2008, AND CROWE HORWATH LLP IN SEPTEMBER 2010, TO USE IN DETERMINING THE AMOUNT OF COMPENSATION FOR 2008 THROUGH 2011. THIS INFORMATION WAS DOCUMENTED IN THE BOARD MEETING MINUTES IN 2008 AND 2010 WHEN THE COMPENSATION STUDIES WERE REVIEWED. PROCESS USED TO ESTABLISH COMPENSATION OF OTHER OFFICERS/KEY EMPLOYEES FORM 990, PART VI, LINE 15B THE ORGANIZATION'S BOARD OF DIRECTORS REVIEWS AND APPROVES THE COMPENSATION FOR THE ORGANIZATION'S OTHER BOARD OFFICERS. THE BOARD OF DIRECTORS OBTAINED COMPENSATION STUDIES PERFORMED BY THE REZNICK GROUP, L.C. IN JULY 2008, AND CROWE HORWATH LLP IN SEPTEMBER 2010, TO USE IN DETERMINING THE AMOUNT OF COMPENSATION FOR 2008 THROUGH 2011. THE BOARD DISCUSSES THE COMPENSATION ANNUALLY AND COLLECTIVELY AGREES UPON COMPENSATION AMOUNTS FOR ALL BOARD OFFICERS. THIS INFORMATION IS DOCUMENTED IN THE BOARD MEETING MINUTES WHEN COMPENSATION IS REVIEWED; THIS PROCESS WAS LAST UNDERTAKEN DURING SEPTEMBER 2011. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES FORM 990, PART VII, SECTION A, LINE 1A VIRGINIA S. BURFORD, ADMINISTRATOR, IS PAID BY AMERICAN EAGLE NURSING HOME COMPANY OF WHITEHOUSE, LLC (EIN 20-2818234). F. SCOTT KELLMAN, PRESIDENT & CEO, IS PAID BY AMERICAN EAGLE LIFECARE CORPORATION (EIN 01-0706736). AUDITED/COMPILED FINANCIAL STATEMENTS FORM 990, PART XII, LINE 2B THE ORGANIZATION RECEIVES FIVE SEPARATE SETS OF AUDITED FINANCIAL STATEMENTS, EACH OF WHICH IS PREPARED IN ACCORDANCE WITH GAAP. THE FINANCIAL INFORMATION IS THEN COMBINED FOR PURPOSES OF THE FORM 990. ONE SET OF AUDITED FINANCIAL STATEMENTS, WHICH IS PREPARED ON A CONSOLIDATED BASIS, CONSISTS OF THE FOLLOWING WISCONSIN ENTITIES ("OBLIGATED GROUP"): AE ARPIN FACILITY COMPANY, LLC (EIN 81-0621902) AMERICAN EAGLE NURSING HOME COMPANY OF ARPIN, LLC (EIN 47-0924079) AE COLBY FACILITY COMPANY, LLC (EIN 81-0622276) AMERICAN EAGLE NURSING HOME COMPANY OF COLBY, LLC (EIN 68-0558136) AE MADISON FACILITY COMPANY , LLC (EIN 26-0070115) AMERICAN EAGLE NURSING HOME COMPANY OF MADISON, LLC (EIN 81-0621853) EACH OF THE FOLLOWING ENTITIES RECEIVES A SEPARATE SET OF AUDITED FINANCIAL STATEMENTS: AMERICAN EAGLE HOME PLACE, LLC (EIN 20-3295047) AE EAU CLAIRE FACILITY COMPANY, LLC (EIN: 26-3709653) AE WESTFIELD FACILITY COMPANY, LLC (EIN: 27-2784041) AE GREENSBURG FACILITY COMPANY, LLC (EIN: 27-2784104) THE FINANCIAL INFORMATION FOR EACH OF THE ABOVE ENTITIES, AS WELL AS THE ENTITIES LISTED BELOW THAT DO NOT RECEIVE AUDITED FINANCIAL STATEMENTS, IS ALSO INCLUDED IN A SINGLE FINANCIAL STATEMENT COMPILATION PREPARED BY THE ORGANIZATION'S INDEPENDENT AUDITORS. AMERICAN EAGLE LIFECARE CORPORATION (EIN: 01-0706736) AE WHITEHOUSE FACILITY COMPANY, LLC (EIN 20-2818309) AMERICAN EAGLE NURSING HOME COMPANY OF WHITEHOUSE, LLC (EIN 20-2818234) AMERICAN EAGLE NURSING HOME COMPANY OF EAU CLAIRE, LLC (EIN: 26-3709759) LEXINGTON HEALTHCARE, LLC (EIN: 20-1684547) AMERICAN EAGLE MORNING BREEZE, LLC (EIN: 20-3294992) AMERICAN EAGLE SANDERS GLEN, LLC (20-3294905) AE ARPIN FACILITY COMPANY LLC 8014 BETHEL ROAD ARPIN WI 54410 810621902 FACILITY COMPANY WI 379170 3094352 AMERICAN EAGLE LIFECARE CORPORATION AMERICAN EAGLE NURSING HOME COMPANY OF ARPIN LLC 8014 BETHEL ROAD ARPIN WI 54410 470924079 NURSING HOME WI 6637533 1296174 AMERICAN EAGLE LIFECARE CORPORATION AE COLBY FACILITY COMPANY LLC 702 WEST DOLF STREET COLBY WI 54421 810622276 FACILITY COMPANY WI 353099 2765658 AMERICAN EAGLE LIFECARE CORPORATION AMERICAN EAGLE NURSING HOME COMPANY OF COLBY LLC 702 WEST DOLF STREET COLBY WI 54421 680558136 NURSING HOME WI 4872937 648177 AMERICAN EAGLE LIFECARE CORPORATION AE MADISON FACILITY COMPANY LLC 4502 MILWAUKEE STREET MADISON WI 53714 260070115 FACILITY COMPANY WI 608731 5413047 AMERICAN EAGLE LIFECARE CORPORATION AMERICAN EAGLE NURSING HOME COMPANY OF MADISON LLC 4502 MILWAUKEE STREET MADISON WI 53714 810621853 NURSING HOME WI 7985270 2677368 AMERICAN EAGLE LIFECARE CORPORATION AE WHITEHOUSE FACILITY COMPANY LLC 107 STACEY DRIVE WHITEHOUSE TX 75791 202818309 FACILITY COMPANY TX 8169497 4317 AMERICAN EAGLE LIFECARE CORPORATION (THROUGH 7111) AMERICAN EAGLE NURSING HOME COMPANY OF WHITEHOUSE LLC 107 STACEY DRIVE WHITEHOUSE TX 75791 202818234 NURSING HOME TX 7193201 1909624 AMERICAN EAGLE LIFECARE CORPORATION AMERICAN EAGLE HOME PLACE LLC 6734 MILLSIDE DRIVE INDIANAPOLIS IN 46221 203295047 INDEPENDENT LIVING FACILITY IN 602238 2537879 AMERICAN EAGLE LIFECARE CORPORATION AMERICAN EAGLE SANDERS GLEN LLC 320 NORTH MERIDIAN STREET INDIANAPOLIS IN 46204 203294905 INDEPENDENT LIVING FACILITY IN 2732457 387252 AMERICAN EAGLE LIFECARE CORPORATION AMERICAN EAGLE MORNING BREEZE LLC 320 NORTH MERIDIAN STREET INDIANAPOLIS IN 46204 203294992 CONTINUING CARE RETIREMENT COMMUNITY IN 5670668 4097542 AMERICAN EAGLE LIFECARE CORPORATION AE EAU CLAIRE FACILITY COMPANY LLC 3819 HAWK CREST ANN ARBOR MI 48103 263709653 FACILITY COMPANY MI 839302 8309898 AMERICAN EAGLE LIFECARE CORPORATION AMERICAN EAGLE NURSING HOME COMPANY OF EAU CLAIRE LLC 2120 HEIGHTS DRIVE EAU CLAIRE WI 54701 263709759 NURSING HOME WI 9610544 1792271 AMERICAN EAGLE LIFECARE CORPORATION LEXINGTON HEALTHCARE LLC 9047 W GREENFIELD AVENUE WEST ALLIS WI 53214 201684547 NURSING HOME WI 11147159 3126303 AMERICAN EAGLE LIFECARE CORPORATION AE WESTFIELD FACILITY COMPANY LLC 320 NORTH MERIDIAN STREET IINDIANAPOLIS IN 46204 272784041 FACILITY COMPANY IN 177792 5743062 AMERICAN EAGLE LIFECARE CORPORATION AE GREENSBURG FACILITY COMPANY LLC 320 NORTH MERIDIAN STREET INDIANAPOLIS IN 46204 272784104 FACILITY COMPANY IN 282391 7602290 AMERICAN EAGLE LIFECARE CORPORATION