WISCONSIN ILLINOIS SENIOR HOUSING INC: Form 990, tax year 2021
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- Organization
- WISCONSIN ILLINOIS SENIOR HOUSING INC (EIN 36-4016275)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-05-26
- IRS object ID
- 202221469349301002
- Schema version
- 2021v4.2
- 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 B
- Schedule D
- Schedule I
- Schedule J
- Schedule K
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-26T09:55:38-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 810385940 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANDERSON ZURMUEHLEN & CO PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 748 | AddressLine1Txt |
| City | BUTTE | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59703 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 364016275 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN ILLINOIS SENIOR HOUSING INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WISC | BusinessNameControlTxt |
| Phone | 3039800611 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13185 W GREEN MOUNTAIN DR | AddressLine1Txt |
| City | LAKEWOOD | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 80228 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ANDREW KERWIN | PersonNm |
| Person Title | CHAIR | PersonTitleTxt |
| Phone | 2627288167 | PhoneNum |
| Signature | 2022-05-24 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | ANDREW | PersonFirstNm |
| Person Last | KERWIN | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MEGAN E CONNORS CPA | PreparerPersonNm |
| PTIN | P01372761 | PTIN |
| Phone | 4067820451 | PhoneNum |
| Preparation | 2022-05-24 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ANDREW KERWIN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13185 W GREEN MOUNTAIN DRIVE | AddressLine1Txt |
| City | LAKEWOOD | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 80228 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $64,600,281 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WISCONSINILLINOISSENOIRHOUSING.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1994 | FormationYr |
| Legal Domicile State | IL | LegalDomicileStateCd |
| Activity Or Mission | SKILLED NURSING AND ASSISTED LIVING FACILITIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 1698 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,606,056 | PYContributionsGrantsAmt |
| CY Contributions Grants | $8,319,659 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $51,382,067 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $53,582,875 | CYProgramServiceRevenueAmt |
| PY Investment Income | $125,857 | PYInvestmentIncomeAmt |
| CY Investment Income | $450,689 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$94,123 | PYOtherRevenueAmt |
| CY Other Revenue | -$29,625 | CYOtherRevenueAmt |
| PY Total Revenue | $57,019,857 | PYTotalRevenueAmt |
| CY Total Revenue | $62,323,598 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $29,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $35,651,625 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $36,466,005 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $21,977,014 | PYOtherExpensesAmt |
| CY Other Expenses | $23,759,850 | CYOtherExpensesAmt |
| PY Total Expenses | $57,628,639 | PYTotalExpensesAmt |
| CY Total Expenses | $60,254,855 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$608,782 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,068,743 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $80,528,492 | TotalAssetsBOYAmt |
| Total Assets EOY | $74,404,734 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $72,957,666 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $64,889,269 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,570,826 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,515,465 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE PRIMARY PURPOSE IS TO PROVIDE SKILLED NURSING AND ASSISTED LIVING FACILITIES FOR AGED INDIVIDUALS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $39,657,196 | ExpenseAmt |
| Grant | $29,000 | GrantAmt |
| Revenue | $42,114,824 | RevenueAmt |
| Desc | WISCONSIN ILLINOIS SENIOR HOUSING, INC.(WISH) OWNS AND OPERATES SKILLED NURSING FACILITIES. THE SKILLED NURSING FACILITIES CONSIST OF: EAST TROY MANOR--50 BED FACILITY, EDGERTON CARE CENTER--61 BED FACILITY, FAIR OAKS HEALTH CENTER--51 BED FACILITY, GENEVA LAKE MANOR--60 BED FACILITY, WILD ROSE MANOR--50 BED FACILITY, HOLTON MANOR--60 BED FACILITY, INGLESIDE MANOR--70 BED SKILLED NURSING, MONTELLO CARE CENTER--50 BED FACILITY, AND MAPLE RIDGE CARE CENTER--75 BED FACILITY. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $12,404,809 | ExpenseAmt |
| Revenue | $11,438,426 | RevenueAmt |
| Desc | WISH ALSO OWNS AND OPERATES ASSISTED AND INDEPENDENT LIVING FACILITIES. THESE FACILITIES CONSIST OF: INGLEHAVEN--16 BED COMMUNITY BASED RESIDENTIAL FACILITY, INGLEWOOD--24 BED RESIDENTIAL CARE APARTMENT COMPLEX, THE RESIDENCES ON FOREST LANE--16 BED COMMUNITY BASED RESIDENTIAL FACILITY, THE VILLAS AT MAPLE RIDGE--14 BED COMMUNITY BASED RESIDENTIAL FACILITY, BELL TOWER RESIDENCES--90 BED COMMUNITY BASED RESIDENTIAL FACILITY, AND AND THE WELLINGTON HOMES WHICH CONSIST OF SIX COMMUNITY BASED RESIDENTIAL FACILITIES WITH A COMBINED TOTAL OF 164 BEDS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $52,062,005 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 76 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1698 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | IL | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CINDY DEMOYE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3039800611 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13185 W GREEN MOUNTAIN DRIVE | AddressLine1Txt |
| City | LAKEWOOD | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 80228 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| LORRIE DUPONT | |||||||
| TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ANDREW KERWIN | |||||||
| CHAIR | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MIRIAM GEHLER | |||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NICHOLAS LYNN | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RAJEEV KUMAR | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KAREN CARRIG | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KERI GERLACH | |||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JACLYN SCHLICK | |||||||
| RN | 40.00 | $121,787 | $0 | $1,537 | Yes (X) | ||
| JESSICA KUHART | |||||||
| ADMINISTRATOR | 40.00 | $118,843 | $0 | $3,644 | Yes (X) | ||
| ALISA PALMER | |||||||
| DIRECTOR OF NURSING | 40.00 | $129,613 | $0 | $0 | Yes (X) | ||
| CHARLEAN ADAMS | |||||||
| DIRECTOR OF OPERATIONS | 40.00 | $155,247 | $0 | $0 | Yes (X) | ||
| LACY CALKINS | |||||||
| DIRECTOR OF CLINICAL OPERA | 40.00 | $120,295 | $0 | $5,773 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $645,785 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $10,954 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 13 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CARRIAGE HEALTHCARE INC | |||||
| 13185 WEST GREEN MOUNTAIN DRIVE | LAKEWOOD | CO | 80228 | MANAGEMENT FEES AND REIMBURSABLE EXPENSE | $2,943,059 |
| MARTIN BROTHERS | |||||
| PO BOX 69 | CEDAR FALLS | IA | 50613 | MEDICAL SUPPLIES | $1,331,000 |
| LEADERSTAT | |||||
| 1322 B MANNING PKWY | POWELL | OH | 43065 | STAFFING AGENCY | $981,778 |
| WISCONSIN DEPARTMENHT OF HEALTH SERVICES | |||||
| PO BOX 93594 | MILWAUKEE | WI | 532930594 | BED TAXES | $893,213 |
| OMNICARE | |||||
| PO BOX 78000 | DETROIT | MI | 482781668 | PHARMACY, MEDICAL SUPPLIES, & CONSULTATI | $837,621 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 20 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $7,894,146 | GovernmentGrantsAmt |
| All Other Contributions | $425,513 | AllOtherContributionsAmt |
| Total Contributions | $8,319,659 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| RESIDENT CARE REVENUE-SNF | 623000 | $40,216,364 | $40,216,364 |
| RESIDENT CARE REVENUE-CBRF/RCAC | 623000 | $11,438,426 | $11,438,426 |
| ANCILLARY REVENUE | 623000 | $1,205,376 | $1,205,376 |
| MISC. PATIENT BENEFIT REVENUE | 623000 | $722,709 | $722,709 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $53,582,875 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $119,810 | TotalRevenueColumnAmt |
| Exclusion | $119,810 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $291,485 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $321,110 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$29,625 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$29,625 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$29,625 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,286,452 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,955,573 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $330,879 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $330,879 | TotalRevenueColumnAmt |
| Exclusion | $330,879 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $62,323,598 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $53,553,250 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $450,689 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,000 | TotalAmt |
| Program Services | $29,000 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,072,432 | TotalAmt |
| Program Services | $25,988,275 | ProgramServicesAmt |
| Management And General | $3,084,157 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,574 | TotalAmt |
| Program Services | $72,938 | ProgramServicesAmt |
| Management And General | $18,636 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,882,093 | TotalAmt |
| Program Services | $4,107,538 | ProgramServicesAmt |
| Management And General | $774,555 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,419,906 | TotalAmt |
| Program Services | $2,166,413 | ProgramServicesAmt |
| Management And General | $253,493 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,070,488 | TotalAmt |
| Program Services | $2,070,488 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $238,840 | TotalAmt |
| Management And General | $238,840 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,712 | TotalAmt |
| Management And General | $256,712 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,760 | TotalAmt |
| Management And General | $25,760 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $328,545 | TotalAmt |
| Program Services | $302,509 | ProgramServicesAmt |
| Management And General | $26,036 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,265 | TotalAmt |
| Management And General | $124,265 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,817 | TotalAmt |
| Management And General | $43,817 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,916,938 | TotalAmt |
| Program Services | $2,664,793 | ProgramServicesAmt |
| Management And General | $252,145 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $239,627 | TotalAmt |
| Program Services | $81,472 | ProgramServicesAmt |
| Management And General | $158,155 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,726,224 | TotalAmt |
| Program Services | $2,726,224 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,533,038 | TotalAmt |
| Program Services | $2,533,038 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $707,296 | TotalAmt |
| Program Services | $676,123 | ProgramServicesAmt |
| Management And General | $31,173 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $4,563,326 | $4,559,553 | $3,773 |
| PURCHASED SERVICES AND | $3,219,430 | $3,004,606 | $214,824 |
| BUSINESS TAXES | $961,076 | $961,076 | |
| BAD DEBT EXPENSE | $580,105 | $580,105 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,224,363 | TotalAmt |
| Program Services | $1,079,035 | ProgramServicesAmt |
| Management And General | $1,145,328 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,254,855 | TotalAmt |
| Program Services | $52,062,005 | ProgramServicesAmt |
| Management And General | $8,192,850 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,830,429 | BOYAmt |
| EOY | $3,984,205 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $198,669 | BOYAmt |
| EOY | $212,036 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,709,984 | BOYAmt |
| EOY | $6,335,936 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,117 | BOYAmt |
| EOY | $35,312 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,823 | BOYAmt |
| EOY | $22,823 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $330,814 | BOYAmt |
| EOY | $473,956 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $77,997,548 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $26,401,470 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,012,634 | BOYAmt |
| EOY | $51,596,078 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,812,588 | BOYAmt |
| EOY | $4,861,144 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,452,504 | BOYAmt |
| EOY | $4,032,007 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,059 | BOYAmt |
| EOY | $96,098 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,022,871 | BOYAmt |
| EOY | $2,755,139 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,528,492 | BOYAmt |
| EOY | $74,404,734 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,716,253 | BOYAmt |
| EOY | $6,403,930 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,756,998 | BOYAmt |
| EOY | $1,168,617 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,229,455 | BOYAmt |
| EOY | $37,229,455 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,034,422 | BOYAmt |
| EOY | $20,004,119 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,104,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,538 | BOYAmt |
| EOY | $83,148 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,957,666 | BOYAmt |
| EOY | $64,889,269 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,570,826 | BOYAmt |
| EOY | $9,515,465 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,570,826 | BOYAmt |
| EOY | $9,515,465 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $80,528,492 | BOYAmt |
| EOY | $74,404,734 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,068,743 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$123,645 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$459 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $53,981 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $52,097 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $2,831,110 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $5,606,056 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $8,319,659 | CurrentTaxYearAmt |
| Total | $16,862,903 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $50,525,114 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $50,324,523 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $53,859,187 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $51,382,067 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $53,582,875 | CurrentTaxYearAmt |
| Total | $259,673,766 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $50,579,095 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $50,376,620 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $56,690,297 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $56,988,123 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $61,902,534 | CurrentTaxYearAmt |
| Total | $276,536,669 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $276,536,669 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $269,253 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $280,254 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $411,142 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $367,333 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $411,295 | CurrentTaxYearAmt |
| Total | $1,739,277 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $269,253 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $280,254 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $411,142 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $367,333 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $411,295 | CurrentTaxYearAmt |
| Total | $1,739,277 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $50,848,348 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $50,656,874 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $57,101,439 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $57,355,456 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $62,313,829 | CurrentTaxYearAmt |
| Total | $278,275,946 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99370 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99470 | PublicSupportPY509Pct |
| Investment Income CY | 0.00630 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00530 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,571,037 | OtherCostOrOtherBasisAmt |
| Book Value | $4,571,037 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $73,426,511 | OtherCostOrOtherBasisAmt |
| Depreciation | $26,401,470 | DepreciationAmt |
| Book Value | $47,025,041 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $51,596,078 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| RESTRICTED BOND RESERVES | $4,016,007 | F |
| CERTIFICATES OF DEPOSIT | $16,000 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $4,032,007 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RESIDENT TRUST ACCOUNTS | Desc |
| Amt | $83,148 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $83,148 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $61,593,300 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$123,645 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$605,860 | OtherRevenueAmt |
| Revenue Not Reported | -$729,505 | RevenueNotReportedAmt |
| Revenue Subtotal | $62,322,805 | RevenueSubtotalAmt |
| Other Revenues Not Included | $793 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $793 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $62,323,598 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $59,648,500 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$469 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$469 | ExpensesNotReportedAmt |
| Expenses Subtotal | $59,648,969 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $605,886 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $605,886 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $60,254,855 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | FOOTNOTE 1 TO THE FINANCIAL STATEMENTS STATES MANAGEMENT HAS REVIEWED ITS OPERATIONS FOR UNCERTAIN TAX POSITIONS AND HAS DETERMINED NO UNCERTAIN TAX POSITIONS EXIST. |
| PART XI, LINE 2D | ADJUSTMENT (1) -$580,100 - PROVISION FOR BAD DEBT IS PRESENTED IN PATIENT REVENUES FOR FINANCIAL REPORTING PRESENTATION. ADJUSTMENT (2) -$25,760 - PAYMENT OF INVESTMENT MANAGEMENT FEES IS PRESENTED NET OF INVESTMENT REVENUES FOR FINANCIAL REPORTING PRESENTATION. |
| PART XI, LINE 4B | ADJUSTMENT (1) $793 ROUNDING DIFFERENCE. |
| PART XII, LINE 2D | ADJUSTMENT (1) $-469 ROUNDING TO THE AUDITED FINANCIAL STATEMENTS. |
| PART XII, LINE 4B | ADJUSTMENT (1) $580,105 - PROVISION FOR BAD DEBT IS PRESENTED IN PATIENT REVENUES FOR FINANCIAL REPORTING PRESENTATION. ADJUSTMENT (2) $21 - THE DISCONTINUED SEGMENT'S TOTAL EXPENSES ARE INCLUDED IN EXPENSES ON THE FORM 990. ADJUSTMENT (3) $25,760 - PAYMENT OF INVESTMENT MANAGEMENT FEES IS PRESENTED NET OF INVESTMENT REVENUES FOR FINANCIAL REPORTING PRESENTATION. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARRIAGE HEALTHCARE COMPANIES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13185 WEST GREEN MOUNTAIN DRIVE | AddressLine1Txt |
| City | LAKEWOOD | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 80228 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 841593283 | RecipientEIN |
| Cash Grant | $29,000 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | RISING STAR SCHOLARSHIP PROGRAM | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | WISCONSIN ILLINOIS SENIOR HOUSING, INC. PROVIDED A GRANT TO CARRIAGE HEALTHCARE COMPANIES, INC. FOR THEIR RISING STAR SCHOLARSHIP PROGRAM. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CHARLEAN ADAMS | PersonNm |
| Title | DIRECTOR OF OPERATIONS | TitleTxt |
| Base Compensation Filing Org | $155,247 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $155,247 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (4 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| A | 391337855 | 97712DP42 | 2018-08-30 | $3,695,000 | REFINANCE AND IMPROVEMENTS OF ASSISTED LIVING FACILITIES | 0 | 0 | 0 |
| WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| B | 391337855 | 97712DP59 | 2018-08-30 | $3,735,000 | REFINANCE AND IMPROVEMENTS OF ASSISTED LIVING FACILITIES | 0 | 0 | 0 |
| WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| C | 391337855 | 97712DP67 | 2018-08-30 | $4,780,000 | REFINANCE AND IMPROVEMENTS OF ASSISTED LIVING FACILITIES | 0 | 0 | 0 |
| WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| D | 391337855 | 97712DP75 | 2018-08-30 | $21,360,000 | REFINANCE AND IMPROVEMENTS OF ASSISTED LIVING FACILITIES | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (4 entries)
| Bond ReferenceBondReferenceCd | Substantial CompletionSubstantialCompletionYr | Refunding Tax Exempt BondsRefundingTaxExemptBondsInd | Refunding Taxable BondsRefundingTaxableBondsInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|
| A | 2018 | Yes (1) | 0 | 0 | Yes (1) |
| B | 2018 | Yes (1) | 0 | 0 | Yes (1) |
| C | 2018 | Yes (1) | 0 | 0 | Yes (1) |
| D | 2018 | Yes (1) | 0 | 0 | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (4 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| C | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| D | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (4 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| C | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| D | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (4 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
| C | 0 |
| D | 0 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 391337855 | BondIssuerEIN |
| Bond Issued | 2019-04-30 | BondIssuedDt |
| Issue Price | $3,659,455 | IssuePriceAmt |
| Purpose | ACQUISITION OF BELL TOWER RESIDENCES AND RENOVATION OF FACILITIES | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Refunding Tax Exempt Bonds | 0 | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | 0 | ProceduresCorrectiveActionInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION HAS ENGAGED CARRIAGE HEALTHCARE INC. (CHC) TO PROVIDE MANAGEMENT SERVICES THROUGH NOVEMBER 30, 2021. CHC IS AN INDEPENDENT "FOR PROFIT ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE BOARD HAS DESIGNATED THE CHAIRMAN SIGN THE 990 ON BEHALF OF THE BOARD. ALL BOARD MEMBERS REVIEW AND APPROVE FORM 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE POLICY IS MONITORED THROUGH THE CORPORATE COMPLIANCE PROGRAM. REPORTS ARE PROVIDED TO THE BOARD ON AN ANNUAL BASIS. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION AND MANAGEMENT COMPANY AGREEMENTS ARE REVIEW BY INDEPENDENT BOARD MEMBERS ON AN ANNUAL BASIS. COMPARABLE DATA IS OBTAINED IN ORDER TO ESTABLISH REASONABLE AMOUNTS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION WILL PROVIDE DOCUMENTS UPON WRITTEN REQUEST TO THE COMPANY. |
| FORM 990, PART XI, LINE 9: | ROUNDING ADJUSTMENTS -459. |
| FORM 990 - LINE 2C SCHEDULE XI | THE ENTIRE BOARD REVIEWS AND HAS RESPONSIBILITY FOR THE FINANCIAL STATEMENTS. THIS POLICY IS UNCHANGED FROM PRIOR YEARS. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELL TOWER RESIDENCES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1500 ODAY STREET | AddressLine1Txt |
| City | MERRILL | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54452 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391672100 | EIN |
| Primary Activities | ASSISTED LIVING FACILITY. 501(C)(3) STATUS APPLIED FOR IN 2019. | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TRANSITIONS AT HOME INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 13185 W GREEN MOUNTAIN ROAD | AddressLine1Txt |
| City | LAKEWOOD | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 80228 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 205835453 | EIN |
| Primary Activities | HOME HEALTH CARE | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 10 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WISCONSIN ILLINOIS SENIOR HOUSING INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| TRANSITIONS AT HOME INC | ||
| D | $350,764 | REVIEW OF GENERAL LEDGER |
| TRANSITIONS AT HOME INC | ||
| L | $9,830 | REVIEW OF GENERAL LEDGER |
| TRANSITIONS AT HOME INC | ||
| J | $25,800 | REVIEW OF LEASE AGREEMENT |
| TRANSITIONS AT HOME INC | ||
| M | $117,116 | REVIEW OF GENERAL LEDGER |