PLYMOUTH PLACE INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
PLYMOUTH PLACE INC (EIN 36-2169165)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-09-13
IRS object ID
201132569349300028
Schema version
2010v3.4
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)
Timestamp2011-09-13T14:53:00-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN362169165EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PLYMOUTH PLACE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPLYMNameControl
Phone7083540340Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1315 N LAGRANGE ROADAddressLine1
CityLAGRANGE PARKCity
StateILState
ZIP Code60526ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDALE LILBURNName
TitleCEOTitle
Phone7083540340Phone
Date Signed2011-09-12DateSigned
Authorize Third PartyfalseAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Date Prepared2011-09-13DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDALE LILBURNNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1315 N LAGRANGE ROADAddressLine1
CityLAGRANGE PARKCity
StateILState
ZIP Code60526ZIPCode
FieldValueIRS element (for citing)
Gross Receipts22118521GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PLYMOUTHPLACE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1938YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionRETIREMENT HOME FOR SENIOR CITIZENSActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees348TotalNbrEmployees
Total Nbr Volunteers45TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year1208665ContributionsGrantsPriorYear
Contributions Grants Current Year757704ContributionsGrantsCurrentYear
Program Service Revenue Prior Year18065489ProgramServiceRevenuePriorYear
Program Service Revenue CY21144916ProgramServiceRevenueCY
Investment Income Prior Year417984InvestmentIncomePriorYear
Investment Income Current Year211973InvestmentIncomeCurrentYear
Other Revenue Prior Year2510OtherRevenuePriorYear
Other Revenue Current Year3928OtherRevenueCurrentYear
Total Revenue Prior Year19694648TotalRevenuePriorYear
Total Revenue Current Year22118521TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year7749241SalariesEtcPriorYear
Salaries Etc Current Year8547335SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year18132069OtherExpensePriorYear
Other Expenses Current Year17892607OtherExpensesCurrentYear
Total Expenses Prior Year25881310TotalExpensesPriorYear
Total Expenses Current Year26439942TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-6186662RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-4321421RevenuesLessExpensesCY
Total Assets BOY152839934TotalAssetsBOY
Total Assets EOY144858463TotalAssetsEOY
Total Liabilities BOY178117267TotalLiabilitiesBOY
Total Liabilities EOY173994287TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-25277333NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-29135824NetAssetsOrFundBalancesEOY
Mission DescriptionRETIREMENT HOME FOR SENIOR CITIZENSMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense23476449Expense
Revenue21144916Revenue
DescriptionPLYMOUTH PLACE INC. IS A RETIREMENT HOME FOR SENIOR CITIZENS, PROVIDING MEDICAL CARE, HOUSING, MEALS AND OTHER ITEMS NECESSARY FOR THE MAINTENANCE AND HEALTH OF ITS RESIDENTS. AT YEAR END THE FACILITY HAD 303 OF 402 UNITS OCCUPIED.Description
Total Program Service Expense23476449TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109621NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees348NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicyfalseWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonDALE LILBURNNamePerson
Telephone Number7083540340TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1315 N LAGRANGE ROADAddressLine1
CityLAGRANGE PARKCity
StateILState
ZIP Code60526ZIPCode
FieldValueIRS element (for citing)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

Average Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationTitleTitleKey EmployeeKeyEmployee
BESHOAR WILMA
1.00X000
CONLIN DEAN
1.00X000
GLOWIAK STEVE
1.00X000
DUNN HARVEY
1.00X000
GRUND CHARLES
1.00X0001ST VICE CHA
HARRIS MARK
1.00X000
HORTON DR LOREN
1.00X000
JURIVICH DR DON
1.00X000
VOIGT MARY
1.00X000VICE PRESIDE
PLEIMLING STEVE
1.00X000CHAIRMAN
POWERS RAYMOND
1.00X000
SUTHERLAND NANCY
1.00X0002ND VICE CHA
TEEGARDEN TOM
1.00X000
WOLF REV DR RICHARD
1.00X000
GUTEKUNST RALPH
1.00X000PRESIDENT
LILBURN DALE
40.00170623034125CEOX
FieldValueIRS element (for citing)
Total Reportable Comp From Org170623TotalReportableCompFromOrg
Total Other Compensation34125TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensationAddress Line2AddressOfContractor/AddressUS/AddressLine2
SODEXHO INC
PO BOX 70060CHICAGOIL60673DIETARY SERVICE1791453
COMPREHENSIVE THERAPEUTICS LTD
3703 WEST LAKE AVEGLENVIEWIL60025NURSING THERAPY1269069SUITE 200
OMNICARE OF NORTHERN ILLINOIS
PO BOX 641805CINCINNATTIOH45264PHARMACY636215
PROVIDENCE MANAGEMENT
18601 NORTH CREEK DRIVETINLEY PARKIL60477MANAGEMENT621985
NOVASTAFF HEALTHCARE SERVICES
210 W 22ND STOAK BROOKIL60523NURSING SERVICE375935SUITE 121
FieldValueIRS element (for citing)
Number Of Contractors GT100 K13NumberOfContractorsGT100K
All Other Contributions757704AllOtherContributions
Total Contributions757704TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionSENIOR HOUSING, ASSISTANCEDescription
Business Code623000BusinessCode
Total Revenue Column21144916TotalRevenueColumn
Related Or Exempt Function Income21144916RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue21144916TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column211973TotalRevenueColumn
Related Or Exempt Function Income211973RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Total Revenue Column3928TotalRevenueColumn
Related Or Exempt Function Income3928RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue3928TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column22118521TotalRevenueColumn
Related Or Exempt Function Income21360817RelatedOrExemptFunctionIncome

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total170623Total
Management And General170623ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total6541566Total
Program Services5696871ProgramServices
Management And General844695ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total141426Total
Program Services115685ProgramServices
Management And General25741ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1201626Total
Program Services1029600ProgramServices
Management And General172026ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total492094Total
Program Services421621ProgramServices
Management And General70473ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total621985Total
Management And General621985ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total89528Total
Management And General89528ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total64600Total
Management And General64600ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total438678Total
Management And General438678ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total18729Total
Management And General18729ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1259799Total
Program Services1259799ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total5716545Total
Program Services5716545ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3607966Total
Program Services3607966ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total225639Total
Management And General225639ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES1434254139370640548
NURSING - THERAPY11727661172766
NURSING - PHARMACY640416640416
CONSULTING SERVICES639207639207
NURSING SERVICES492404492404

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1470091Total
Program Services1289863ProgramServices
Management And General180228ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total26439942Total
Program Services23476449ProgramServices
Management And General2963493ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY548765BOY
EOY1431038EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6914163BOY
EOY4725176EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY231569BOY
EOY241439EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis129376545LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec16086015LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY116312277BOY
EOY113290530EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY24864745BOY
EOY21396281EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3968415BOY
EOY3773999EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY152839934BOY
EOY144858463EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2300468BOY
EOY2189190EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY62332540BOY
EOY69891845EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY111785000BOY
EOY101205000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1699259BOY
EOY708252EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY178117267BOY
EOY173994287EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-25349038BOY
EOY-29189479EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY71705BOY
EOY53655EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-25277333BOY
EOY-29135824EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY152839934BOY
EOY144858463EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-4321421ReconcilationRevenueExpenses
Reconcilation Other Changes462930ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewtrueAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years689042CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years721742CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years780067CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1208665CurrentTaxYearMinus1Year
Current Tax Year757704CurrentTaxYear
Total4157220Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7987191CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9270945CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11425909CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year18485983CurrentTaxYearMinus1Year
Current Tax Year21360817CurrentTaxYear
Total68530845Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8676233CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9992687CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12205976CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19694648CurrentTaxYearMinus1Year
Current Tax Year22118521CurrentTaxYear
Total72688065Total
FieldValueIRS element (for citing)
Public Support Total50972688065PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years131859CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years304386CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1375193CurrentTaxYearMinus2Years
Total1811438Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years131859CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years304386CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1375193CurrentTaxYearMinus2Years
Total1811438Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years8808092CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10297073CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years13581169CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19694648CurrentTaxYearMinus1Year
Current Tax Year22118521CurrentTaxYear
Total74499503Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97570PublicSupportPercentage509
Prior Year Support Percentage0.96800PriorYearSupportPercentage
Investment Income Percentage0.02000InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.03000PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Disclosed Orgs Legal ControlfalseDisclosedOrgsLegalControl
Disclosed For Charitable PurposesfalseDisclosedForCharitablePurposes
Written Policy MonitoringfalseWrittenPolicyMonitoring
Sect170h Requirements SatisfiedfalseSect170hRequirementsSatisfied
Solicited Assets For SalefalseSolicitedAssetsForSale
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FSfalseIncludedOnFS
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RfalseAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis85418OtherCostOrOtherBasis
Book Value85418BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis125148863OtherCostOrOtherBasis
Depreciation14956852Depreciation
Book Value110192011BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis398258OtherCostOrOtherBasis
Depreciation84859Depreciation
Book Value313399BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis3713127OtherCostOrOtherBasis
Depreciation1044304Depreciation
Book Value2668823BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis30879OtherCostOrOtherBasis
Book Value30879BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings113290530TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
RESIDENT DEPOSITS$782,660
REFUNDABLE ENTRANCE PAYMENTS
FMV OF INTEREST RATE SWAP
CONSTRUCTION PAYABLES
UNAMORTIZED BOND DISCOUNT-$74,408
FieldValueIRS element (for citing)
Total Of Amounts708252TotalOfAmounts
Total Revenue22118521TotalRevenue
Total Expenses26439942TotalExpenses
Excess Or Deficit For Year-4321421ExcessOrDeficitForYear
Net Unrealized GL On Investments144850NetUnrealizedGLOnInvestments
Other$318,080OtherAmount
Total Adjustments462930TotalAdjustments
Excess Or Deficit Per FS-3858491ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt22581452TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments144850NetUnrealizedGainsInvestments
Other Revenues318081OtherRevenues
Revenue Not Rptd F990462931RevenueNotRptdF990
Revenue Subtotal22118521RevenueSubtotal
Total Revenue Per Form99022118521TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt26439943TotExpensesEtcAuditedFinclStmt
Other Expenses Included1OtherExpensesIncluded
Expenses Not Rptd F9901ExpensesNotRptdF990
Expenses Subtotal26439942ExpensesSubtotal
Total Expenses Per Form99026439942TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
RECONCILIATION OF CHANGES - OTHERSCHEDULE D, PAGE 4, PART XI, LINE 8UNREALIZED GAIN(LOSS) ON INTEREST RATE SWAP AGREEMENT 318,081 ROUNDING -1
REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHERSCHEDULE D, PAGE 4, PART XII, LINE 2DUNREALIZED GAIN(LOSS) ON INTEREST RATE SWAP AGREEMENT 318,081
EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHERSCHEDULE D, PAGE 4, PART XIII, LINE 2DROUNDING 1

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonLILBURN DALENamePerson
Base Compensation Filing Org170623BaseCompensationFilingOrg
Deferred Comp Filing Org34125DeferredCompFilingOrg
Total Compensation Filing Org204748TotalCompensationFilingOrg

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Business Name Line2IssuerName/BusinessNameLine2Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
ILLINOIS FINANCE AUTHORITY
FIXED RATE REVENUE BOND86109196745200BTY42005-12-08845000CONSTRUCT REPLACEMENT FACILITYfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
VARIABLE RATE DEMAND REVENUE BOND86109196745200BUE62005-12-0820000000CONSTRUCT REPLACEMENT FACILITYfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
VARIABLE RATE DEMAND REVENUE BOND86109196745200BUF32005-12-0868500000CONSTRUCT REPLACEMENT FACILITYfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
FIXED RATE DEMAND REVENUE BOND86109796745200BTZ12005-12-08885000CONTRUCT REPLACEMENT FACILITYfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount RetiredAmountRetired
84500062891219897494932008falsefalsetruetrue
200000001350984856305175842282008falsefalsetruetrue
6850000025009012369612635639482008falsefalsetruetrue44795000
88500065868219897768942008falsefalsetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
falsefalsefalsefalsefalsefalse
falsetruefalsefalsefalsefalse
falsetruefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Business Name Line2IssuerName/BusinessNameLine2Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
ILLINOIS FINANCE AUTHORITY
FIXED RATE REVENUE BOND86109196745200BTY42005-12-08845000CONSTRUCT REPLACEMENT FACILITYfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
VARIABLE RATE DEMAND REVENUE BOND86109196745200BUE62005-12-0820000000CONSTRUCT REPLACEMENT FACILITYfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
VARIABLE RATE DEMAND REVENUE BOND86109196745200BUF32005-12-0868500000CONSTRUCT REPLACEMENT FACILITYfalsefalsefalse
ILLINOIS FINANCE AUTHORITY
FIXED RATE DEMAND REVENUE BOND86109796745200BTZ12005-12-08885000CONTRUCT REPLACEMENT FACILITYfalsefalsefalse

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount RetiredAmountRetired
84500062891219897494932008falsefalsetruetrue
200000001350984856305175842282008falsefalsetruetrue
6850000025009012369612635639482008falsefalsetruetrue44795000
88500065868219897768942008falsefalsetruetrue

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
falsefalsefalsefalsefalsefalse
falsetruefalsefalsefalsefalse
falsetruefalsefalsefalsefalse
falsefalsefalsefalsefalsefalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITSFORM 990, PAGE 1, PART I, LINE 6THE VOLUNTEERS PERFORM MINIMAL TASKS IN ASSISTING THE RESIDENTS AT THE FACILITY.
MANAGEMENT DELEGATEDFORM 990, PAGE 6, PART VI, LINE 3PLYMOUTH PLACE HAS CONTRACTED WITH PROVIDENCE MANAGEMENT TO PROVIDE CFO AND REALTED ACCOUNTING SERVICES, IT SERVICES AND NURSING CENTER ADMINISTRATION.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11BA DRAFT OF THE 990 IS PREPARED AND SUBMITTED TO THE CEO FOR INITIAL REVIEW. THE CEO PRESENTS TO THE FINANCE COMMITTEE A COPY OF THE 990 FOR THEIR REVIEW BEFORE FILING.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CTHE BOARD MEMBERS REVIEW AND UPDATE THEIR ANNUAL DISCLOSURE OF INTERESTS.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ATHE BOARD ANNUALLY RECEIVES AND REVIEWS THE COMPENSATION SURVEYS OF AAHSA & LSN.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19DOCUMENTS ARE AVAILABLE UPON REQUEST AT THE FACILITY OFFICE.

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