2011-05-13T09:38:31-05:00 2010-06-30 LARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2009-07-01 010729134 CLARE OAKS CLAR 6303721983 827 CARILLON DRIVE BARTLETT IL 60103 PAUL CLEMENS 6303721983 2011-05-13 1 Chad D Kunze CPA 3149254300 2009 2016-02-24 21:20:13Z Paul Clemens 827 CARILLON DRIVE BARTLETT IL 60103 19826294 0 X WWW.CLAREOAKS.COM X 2006 IL TO PROVIDE CONTINUING CARE AT A RETIREMENT COMMUNITY CONSISTING OF RESIDENTIAL, HEALTH, RECREATIONAL, SOCIAL, RELIGIOUS AND SPIRITUAL FACILITIES AND SERVICES, WHICH WILL SHARE, PROMOTE AND OPERATE IN ACCORDANCE WITH ETHICAL AND SPIRITUAL VALUES FOR THE ROMAN CATHOLIC RELIGIOUS INSTITUTE KNOWN AS THE SISTERS OF ST. JOSEPH OF THE THIRD ORDER OF ST. FRANCIS. 9 9 0 24 0 0 961653 4038347 11302080 14869035 374492 308060 184498 458028 12822723 19673470 0 0 6655301 7984083 0 0 17984650 18629164 24639951 26613247 -11817228 -6939777 121954520 113965034 138601932 137574117 -16647412 -23609083 TO PROVIDE CONTINUING CARE AT A RETIREMENT COMMUNITY CONSISTING OF RESIDENTIAL, HEALTH, RECREATIONAL, SOCIAL, RELIGIOUS AND SPIRITUAL FACILITIES AND SERVICES, WHICH WILL SHARE, PROMOTE AND OPERATE IN ACCORDANCE WITH ETHICAL AND SPIRITUAL VALUES FOR THE ROMAN CATHOLIC RELIGIOUS INSTITUTE KNOWN AS THE SISTERS OF ST. JOSEPH OF THE THIRD ORDER OF ST. FRANCIS. 0 0 22861626 15327063 Clare Oaks provides an assisted living facility as well as memory care services to older adults. It provides housing and supportive services by certified and licensed nursing staff including support for adl's, medication administration, onsite 24 hour security, dining, wellness programs, activities, transportation, health clinic, housekeeping, and a physical fitness venue.Clare Oaks provides an independent living facility that provides housing and supportive services including onsite 24 hour security, dining, wellness programs, activities, transportation, health clinic, housekeeping, and a physical fitness venue. Clare Oaks provides a skilled nursing facility that provides a 24 hour skilled nursing service (licensed in medicare and medicaid) in a modern healthcare center. The skilled nursing facility includes support for adl's, medication administration, onsite 24 hour security, dining, wellness programs, activities, transportation, a health clinic, housekeeping, and a physical fitness venue. 22861626 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IL X X Gigi Walker 6303721983 825 CARILLON DRIVE BARTLETT IL 60103 SISTER COLETTE WILCZYNSKI 1.00 X 0 0 0 DAN WALSH 1.00 X X 0 0 0 SISTER DENISE SEYMOUR 1.00 X 0 0 0 SISTER JEANNE CONZEMIUS 1.00 X X 0 0 0 MICHAEL D HOVDE JR 1.00 X X 0 0 0 SISTER MARCELLA NOWAKOWSKI 1.00 X 0 0 0 PAUL CLEMENS 1.00 X X 0 0 0 EDWARD TED OTTO 1.00 X 0 0 0 THERESE M MALM 1.00 X 0 0 0 Renee Cisewski 1.00 X 0 0 0 PAULA BARTOLOZZI 40.00 X 122984 0 0 122984 0 0 1 0 0 0 REHAB CARE Group Inc PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 1202964 The Weitz Company LLC 5901 THORNTON AVENUE DES MOINES IA 50321 CONSTRUCTION SERVICES 755029 CRSA MANAGEMENT 3350 PLAYERS CLUB PARKWAY STE 300 MEMPHIS TN 38125 MANAGEMENT SERVICES 544093 CRSA Employment Services Inc 3350 PLAYERS CLUB PARKWAY STE 300 MEMPHIS TN 38125 Payroll Processing 215896 Althoff Industries Inc 8001 S Route 31 Crystal Lake IL 60014 Mechanical, Electrical and Control Servi 192689 10 4038347 4038347 RESIDENT SERVICES 623000 14869035 14869035 14869035 281708 281708 179176 152824 26352 26352 26352 Miscellaneous 623000 458028 458028 458028 19673470 15327063 0 308060 122984 122984 6954380 6382763 571617 246313 246313 660406 478119 182287 1320383 601126 719257 211074 211074 39369 39369 71786 71786 242043 27072 214971 199002 199002 713434 713434 40185 34134 6051 18864 7722 11142 5897304 5856820 40484 4520709 4489675 31034 780317 780317 Supplies 2331979 2330639 1340 food 792942 792942 PHarmacy 546947 546947 Equipment Rental & Repa 339791 323202 16589 Bad Debt Expense 275209 275209 287826 237662 50164 26613247 22861626 3751621 0 281310 1169392 1017396 754648 2893212 2668710 792375 598175 15893 20357 198632 170915 96503376 7367259 95418944 89136117 10148868 8709919 11187890 10736801 121954520 113965034 5180491 3927650 24322564 29918155 106247473 100792045 2851404 2936267 138601932 137574117 X -16647412 -23609083 -16647412 -23609083 121954520 113965034 X 0 1 1 X 0 X 961653 4038347 5000000 1331000 976060 11302080 14869035 28478175 1331000 976060 12263733 18907382 33478175 0 0 0 33478175 18499 1895733 374492 308061 2596785 18499 1895733 374492 308061 2596785 7850 1280 77435 184498 458028 729091 7850 1350779 2949228 12822723 19673471 36804051 0.90960 0.85030 0.07060 0.13360 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 164221 164221 92906816 6184118 86722698 3432339 1183141 2249198 89136117 2006 AB EXTRAS DEBT SERVICE RESERV 4040845 F 2006 AB EXTRAS PROJECT FUND 482211 F 2006 A INTEREST ACCT - INTEREST FUND 251204 F 2006 B INTEREST ACCT - INTEREST FUND 26500 F 2006 A/B PROJECT FUND - EQUITY SUB 47421 F 2006C RESERVE ACCT - DEBT SERVICE R 2388848 F 2006D RESERVE ACCT - DEBT SERVICE R 732592 F 2006 C/D PROJECT FUND 581161 F 2006 D INTEREST ACCT - INTEREST FUND 28002 F 2006 C/D OPTIONAL REDEMPTION FUND 100000 F 2006 C/D PROJECT FUND - EQUITY SUB 31135 F 8709919 DEFERRED FINANCING COSTS 4929284 ENTRANCE DEPOSITS 706628 DEFERRED MARKETING/SELLING COSTS 4302316 CONSTRUCTION IN PROGRESS 798573 10736801 DEFERRED DEVELOPMENT FEES 499998 CURRENT DEFERRED ENTRANCE FEES 1650050 RESERVATION DEPOSITS 782219 Deferred Management Fees 4000 2936267 19673470 26613247 -6939777 3132 -572023 546997 -21894 -6961671 20223599 3132 546997 550129 19673470 0 19673470 26613247 0 26613247 0 26613247 Part X: Description of Uncertain Tax Positions Under FIN 48: The Organization qualifies as a tax-exempt organization described in Section 501 (c)(3) of the Internal Revenue Code. Accordingly, the Organization is not subject to federal income taxes under Section 501 (c)(3) of the Code. The Organization is classified as a publicly supported charitable organization under the Code and contributions to the Project qualifies as charitable tax deductions for the contributor. The entity files as a tax-exempt organization. Should that status be challenged in the future, all years since inception could be subject to review by the IRS. The Organizations income tax returns for the years 2007 through 2010 are subject to review and examination by the IRS. Part XI, Line 8 - Other Adjustments: Gain ON INTEREST RATE SWAP IN THE CURRENT YEAR: 546997. Part XII, Line 2d - Other Adjustments: Gain on Interest Rate Swap Agreement: 546997. ILLINOIS FINANCE AUTHORITY 861091967 45200BZR2 2006-07-19 56360000 CONSTRUCTION PROJECT OF CLARE OAKS 0 0 ILLINOIS FINANCE AUTHORITY 861091967 45200BZN1 2006-07-19 55968314 CONSTRUCTION PROJECT OF CLARE OAKS 0 0 56360000 3249442 612296 1127200 48832572 2008 0 0 1 1 55968314 5025177 529632 1118883 47537462 2008 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 1 0 1 1 Sovereign Bank Derivative 5.500000000000 0 0 0 0 0 0 0 0 0 Form 990, Part VI, Section A, line 3 LCS MANAGEMENT PROVIDES OVERSIGHT AND MANAGEMENT OF THE COMMUNITY. Form 990, Part VI, Section B, line 11 THE RETURN WILL BE DISTRIBUTED TO BOARD MEMBERS BY THE EXECUTIVE DIRECTOR FOR REVIEW AND COMMENTS. ANY QUESTIONS WILL BE DIRECTED TO THE FINANCE DIRECTOR AND WILL BE ADDRESSED WITH THE PREPARER. Form 990, Part VI, Section B, line 12c ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE AND SIGN A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE DISCLOSURE INCLUDES A STATEMENT THAT THE INDIVIDUAL WILL IMMEDIATELY REPORT ANY KNOWN PERSONAL OR BUSINESS RELATIONSHIP THAT EXISTS WITH AN ORGANIZATION/INDIVIDUAL DOING BUSINESS WITH CLARE OAKS, TO THE EXECUTIVE DIRECTOR AND THE PRESIDENT OF THE BOARD. ALL CONTRACTS AND AGREEMENTS ARE REVIEWED BY THE EXECUTIVE DIRECTOR AND THE CONTROLLER TO ASCERTAIN IF ANY RELATIONSHIP EXISTS BETWEEN THE CONTRACTOR AND ANY OFFICERS, DIRECTORS, OR KEY EMPLOYEES. Form 990, Part VI, Section B, line 15 CLARE OAKS HAS A PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S EXECUTIVE DIRECTOR AND OTHER KEY EMPLOYEES. IT IS DETERMINED BY THE MANAGEMENT COMPANY AND THEIR EXPERTISE. SALARY SURVEYS ARE COMPLETED TO ENSURE COMPENSATION IS IN LINE WITH THE MARKET. THE SALARIES ARE REVIEWED AND APPROVED ON AN ANNUAL BASIS. Form 990, Part VI, Section C, line 18 CLARE OAKS MAKES ITS FORM 990 AND FORM 1023 AVAILABLE FOR PUBLIC INSPECTION ON ANOTHER'S WEBSITE AS WELL AS UPON REQUEST. Form 990, Part VI, Section C, line 19 CLARE OAKS MAKES ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC VIA EMMA, CENTERS FOR MEDICARE AND MEDICAID SERVICES, AND THE ILLINOIS DIGITAL ARCHIVES. There were no changes to the oversight or selection processes from the prior year. FORM 990, PAGE 5, LINES 1A AND 2A FORM 1096 AND W-3 FOR EMPLOYEES CLARE OAKS IS Managed BY A MANAGEMENT COMPANY, CRSA/LCS. ALL EMPLOYEES ARE EMPLOYEES OF CRSA/LCS; THEREFORE NO FORM 1096 AND W-3 ARE FILED THROUGH CLARE OAKS. SCHEDULE K, PART I, LINE A, COLUMN (C) SEVERAL CUSIP NUMBERS THE BOND LISTED ON SCHEDULE K, LINE A INCLUDES TWO DIFFERENT BONDS WITH TWO DIFFERENT CUSIP NUMBERS. THE REVENUE BOND, SERIES 2006C'S CUSIP NUMBER IS 45200BZR2. THE REVENUE BOND, SERIES 2006D'S CUSIP NUMBER IS 45200BZS0. SCHEDULE K, PART I, LINE B, COLUMN (C) SEVERAL CUSIP NUMBERS THE BOND LISTED ON SCHEDULE K, LINE A INCLUDES THREE DIFFERENT BONDS WITH EIGHT DIFFERENT CUSIP NUMBERS. THE REVENUE BOND INCLUDES SERIES 2006A, SERIES 2006B-1, AND SERIES 2006B-2. THE BOND INCLUDES THE FOLLOWING CUSIP NUMBERS: 45200BZN1, 45200BZP6, 45200BZQ4, 45200BZK7, 45200BZK, 45200BZM, 45200BZP, AND 45200BZQ.