2019-11-15T13:05:36-06:00 2018-12-31 593070669 MOORE STEPHENS LOVELACE PA 500 E BROWARD BLVD SUITE 1550 FORT LAUDERDALE FL 33394 990 2018-01-01 582476611 THE ALLIANCE FOUNDATION OF FLORIDA INC ALLI 7033597200 3989 CHAIN BRIDGE ROAD FAIRFAX VA 22030 ROBERT P HOSTLER PRESIDENT 7033597200 2019-11-15 1 NORMAN B NEAL CPA P00071411 9548478910 104.178.77.115 2019-11-15 12:36:55 ES P AA06F16595B971911646E1ABD4EF9FD1205D715B 7FC0E18F63597829422D687723989F114BEB8769 2018 2020-04-17 16:48:07Z ROBERT P HOSTLER 3989 CHAIN BRIDGE ROAD FAIRFAX VA 22030 17107494 0 X NONE X 1999 FL TO PROVIDE NURSING CARE AND HOUSING WHICH SATISFIES THE PHYSICAL, RECREATIONAL AND/OR EMOTIONAL NEEDS OF ELDERLY, LOW INCOME, MENTALLY OR PHYSICALLY CHALLENGED AND/OR DISABLED INDIVIDUALS. 3 3 565 3 0 0 0 0 15866279 15329776 0 0 1692285 1300848 17558564 16630624 0 0 0 0 9915959 9808499 0 0 0 7261300 7338643 17177259 17147142 381305 -516518 16162504 16534874 3782720 4671608 12379784 11863266 TO PROVIDE NURSING CARE AND HOUSING WHICH SATISFIES THE PHYSICAL, RECREATIONAL AND/OR EMOTIONAL NEEDS OF ELDERLY, LOW INCOME, MENTALLY OR PHYSICALLY CHALLENGED AND/OR DISABLED INDIVIDUALS. 0 0 14326566 15056687 SKILLED NURSING CARE AS DIRECTED BY PHYSICIANS AND APPROPRIATE CARE PLANS, AND ASSISTED LIVING HOUSING AND SERVICES TO RESIDENTS, COMPRISING 82,815 RESIDENT/BED-DAYS, IN TWO FLORIDA FACILITIES, INDIGO MANOR SNF/INDIGO PALMS AT THE MANOR ALF AND INDIGO PALMS, LLC. 259847 273089 OUTSIDE NURSING SERVICES - TO PROVIDE THERAPY STAFF AND/OR SERVICES TO ELDERLY, LOW INCOME, MENTALLY OR PHYSICALLY CHALLENGED AND/OR DISABLED INDIVIDUALS TO SATISFY THEIR PHYSICAL, RECREATIONAL AND/OR EMOTIONAL NEEDS AS MAY BE REQUIRED BY SUCH INDIVIDUAL'S PLAN OF TREATMENT, CARE PLAN AND/OR AS PRESCRIBED BY PHYSICIAN. 1237768 1300848 DURABLE MEDICAL EQUIPMENT - TO PROVIDE MEDICAL EQUIPMENT AND SERVICES TO ELDERLY, LOW INCOME, MENTALLY OR PHYSICALLY CHALLENGED AND/OR DISABLED INDIVIDUALS TO SATISFY THEIR PHYSICAL, RECREATIONAL AND/OR EMOTIONAL NEEDS AS MAY BE REQUIRED BY SUCH INDIVIDUAL'S PLAN OF TREATMENT, CARE PLAN AND/OR AS PRESCRIBED BY PHYSICIAN. 15824181 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 78 0 1 565 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 3 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X ROBERT P HOSTLER 7033597200 3989 CHAIN BRIDGE ROAD FAIRFAX VA 22030 X ROBERT P HOSTLER PRESIDENT 28.00 2.00 X X 0 0 0 JIM S PURDUM SECRETARY 38.00 2.00 X X 0 0 0 THOMAS K LEE DIRECTOR 38.00 2.00 X 0 0 0 0 0 0 0 0 0 0 PECK & ASSOCIATES 2430 S ATLANTIC AVE F DAYTONA BEACH FL 32118 CONSTRUCTION SERVICES 679511 ATKINSONS PHARMACY 1994 KINGSLEY AVE STE A ORANGE PARK FL 32073 PHARMACY SERVICES 341158 AEGIS THERAPIES INC 2601 NETWORK BLVD STE 102 FRISCO TX 75034 CONTRACTED SERVICES 336561 3 SKILLED NURSING AND ASSISTED LIVI 623000 15056687 15056687 OUTSIDE NURSING SERVICES 623000 273089 273089 15329776 1777718 476870 1300848 1300848 1300848 16630624 16630624 0 0 8577955 8422529 155426 9816 9816 535357 535357 685371 685371 800693 800693 78545 78545 63616 63616 875623 875623 10042 10042 222416 222416 210571 210571 1679514 1609280 70234 149425 149425 16094 16094 4679 4679 66806 66806 586018 586018 PATIENT EXPENSES 1131691 1087304 44387 FOOD 586151 476091 110060 SUPPLIES 379730 379730 PROVISION FOR DOUBTFUL 234000 234000 243029 243029 17147142 15824181 1322961 0 90686 44036 2326711 2675426 2573332 2412327 132093 164779 569948 465112 116077 104836 10727695 10742122 195910 391348 16162504 16534874 3000813 3267420 749326 1309161 32581 95027 3782720 4671608 X 0 0 0 0 12379784 11863266 12379784 11863266 16162504 16534874 -516518 0 X X 0 0 0 X 21599645 21812823 23964657 15866279 15329776 98573180 21599645 21812823 23964657 15866279 15329776 98573180 0 0 0 98573180 21599645 21812823 23964657 15866279 15329776 98573180 1.00000 1.00000 0.00000 X 0 1 X 110962 75834 35128 369000 309364 59636 89986 79914 10072 104836 INVESTMENTS - OTHER SECURITIES 10742122 C 10742122 UNEARNED REVENUE 29608 BANK OVERDRAFT 65419 95027 PART IV, LINE 2B: THE ORGANIZATION MAINTAINS A CUSTODIAL ACCOUNT FOR ITS RESIDENTS, AS APPLICABLE AND AS REQUESTED BY THE RESIDENT AND/OR HIS / HER DESIGNEE. RESIDENT FUNDS ARE DEPOSITED INTO THE CUSTODIAL ACCOUNT FROM VARIOUS SOURCES AND ARE DISBURSED FROM THE CUSTODIAL ACCOUNT, IN ACCORDANCE WITH AND AS REQUESTED BY THE RESIDENT AND/OR HIS / HER DESIGNEE. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS DELEGATED MANAGEMENT DUTIES TO FAIRFAX SENIOR LIVING COMPANY (FSLC), A RELATED FOR-PROFIT CORPORATION THAT IS WHOLLY OWNED BY THE CORPORATION. THE ORGANIZATION'S CHIEF FINANCIAL OFFICER POSITION IS AS AN EMPLOYEE OF THE MANAGEMENT COMPANY. FSLC PROVIDES OVERSIGHT MANAGEMENT SERVICE TO EACH OF THE COMPANIES. THERE ARE NO CONTRACTS OUTSIDE THE RELATED PARTY COMPANIES. THE OVERSIGHT AND MANAGEMENT OF INSURANCE, CASH FLOW, AND BANKING MATTERS ARE PROVIDED BY FSLC. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS AND/OR THE ORGANIZATIONS ADVISORY BOARD FOR PRESENTATION TO THE BOARD OF DIRECTORS, PRIOR TO ITS FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S BOARD OF DIRECTORS HAS ADOPTED A CONFLICT OF INTEREST POLICY AND REQUIRES DISCLOSURE OF CERTAIN INTERESTS (COLLECTIVELY, THE "COI POLICIES"). THE ORGANIZATION HAS DESIGNATED AND EMPLOYS CORPORATE AND REGIONAL RISK MANAGERS TO REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THE COI POLICIES. THE ORGANIZATION'S POLICIES AND PROCEDURES GOVERNING CONFLICTS OF INTEREST ARE PROVIDED TO ALL EMPLOYEES AT TIME OF EMPLOYMENT, AND THE ORGANIZATION MAINTAINS AND MONITORS A COMPLAINT AND COMPLIANCE HOTLINE. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S COMPENSATION OF THE CEO/PRESIDENT IS ESTABLISHED BASED ON CONSULTATION WITH AN INDEPENDENT CONSULTANT AND/OR THE USE OF DATA FROM COMPARABLE ORGANIZATION FROM COMPARABLE ORGANIZATIONS. APPROVAL OF THE CEO/PRESIDENT COMPENSATION IS GIVEN BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS ASSERTS ITS INDEPENDENCE WITH REGARDS TO APPROVAL OF THE CEO/PRESIDENT COMPENSATION. COMPENSATION OF OTHER OFFICERS, KEY EMPLOYEES AND OTHER SENIOR MANAGEMENT IS DELEGATED TO THE CEO/PRESIDENT, AS AUTHORIZED BY AND PURSUANT TO APPROVAL OF THE ORGANIZATION'S BOARD OF DIRECTORS AND IN CONSULTATION WITH THE CONTROLLER, INDEPENDENT CONSULTANT(S) AND/OR REVIEW OF COMPENSATION SURVEYS OF AND/OR FOR OTHER COMPARABLE ORGANIZATIONS AND/OR POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND ITS CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC THROUGH PUBLICLY ACCESSIBLE WEBSITES AND/OR UPON REQUEST, AS PERMITTED AND/OR REQUIRED BY STATE AND/OR FEDERAL LAW. FORM 990, PART XII, LINE 2C THE BOARD OF DIRECTORS HAS RESPONSIBILITY FOR OVERSIGHT OF THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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