2015-09-24T15:39:38-05:00 2014-12-31 431594752 MUELLER PROST LC 7733 FORSYTH BLVD SUITE 1200 ST LOUIS MO 63105 990 2014-01-01 273042765 PROGRESSIVE ELDERCARE SERVICES - DREW INC PROG 8703670044 1052 OLD WARREN ROAD MONTICELLO AR 71655 VICKIE DONALDSON PRESIDENT 8703670044 2015-09-22 1 JEANETTE BAX-KURTZ P00096490 3148622070 2015-09-22 2014 2016-03-07 17:11:31Z BELLE VIEW ESTATES REHABILITATION AND CARE CENTER VICKIE DONALDSON 1052 OLD WARREN ROAD MONTICELLO AR 71655 4589138 0 X WWW.BELLEVIEWESTATESREHAB.COM X 2010 AR TO FACILITATE COMPASSIONATE HEALTH CARE WITH CLINICAL QUALITY AND SERVICE EXCELLENCE IN A DIGNIFIED AND RESPECTFUL "HOME" ENVIRONMENT FOR ELDERS WHO REQUIRE LONG-TERM CARE SERVICES. 3 2 0 13 0 0 0 128065 4914722 4461069 68 4 0 0 4914790 4589138 600 50 0 0 0 0 0 0 0 5154270 4561824 5154870 4561874 -240080 27264 1306686 1229493 1629717 1525260 -323031 -295767 THE ORGANIZATION PROVIDES AFFORDABLE SKILLED NURSING AND REHABILATIVE CARE TO ILL, INFIRM, MEDICALLY DISABLED AND ELDERLY INDIVIDUALS IN A NON-TRADITIONAL LONG-TERM CARE ENVIRONMENT UTILIZING THE "CULTURE CHANGE" OR "PERSON CENTERED" CARE MODEL. 0 0 4364321 50 4461069 THE ORGANIZATION ACTS IN CONCERT WITH PROGRESSIVE ELDERCARE SERVICES, INC. (PES, INC.) TO FORM A NETWORK OF NURSING FACILITIES TO SERVE AS LOCATIONS FOR PROMOTING, DEVELOPING AND ADMINISTERING "CULTURE CHANGE", PERSON-CENTERED, LONG-TERM CARE FOR ILL, INFIRM, MEDICALLY DISABLED AND ELDERLY INDIVIDUALS. THE "CULTURE CHANGE" MODEL OF CARE IS DESIGNED TO EMPOWER ELDERS AND STAFF TO PARTICIPATE IN THE ESTABLISHMENT OF PATHWAYS THAT RESULT IN A HIGH DEGREE OF CHOICE, AUTONOMY, DIGNITY AND SELF-DETERMINATION FOR THE ELDERS SERVED. IT IS ANTICIPATED THAT WITH CONCERTED EFFORTS THE ORGANIZATION WILL INCREASE THE AVAILABILITY AND QUALITY OF HEALTH CARE FOR ITS RESPECTIVE COMMUNITIES, RESULTING IN BETTER HEALTH OUTCOMES AND QUALITY OF LIFE FOR THE ELDERLY. IN 2014 THE ORGANIZATION SERVED 179 RESIDENTS. 4364321 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 35 0 0 0 0 0 0 0 0 0 0 0 0 X 3 2 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X BRUCE MELDER 3184438167 1052 OLD WARREN ROAD MONTICELLO AR 71655 X GARY MEGGS DIRECTOR 5.00 X 0 0 0 CAROLYN ANDREWS DIRECTOR 5.00 X 0 0 0 LISA M HENSLEY FORMER PRESIDENT, DIRECTOR 0.90 7.10 X X 0 91611 5110 VICKIE DONALDSON PRESIDENT, DIRECTOR 4.10 32.60 X X 0 48105 0 0 139716 5110 0 0 0 0 CAREPLUS STAFFING SOLUTIONS LLC PO BOX 11592 ALEXANDRIA LA 71315 EMPLOYEE LEASING 2049000 MLD PROPERTIES LLC 3405 SALTERBECK STREET STE 200 MT PLEASANT SC 29466 REAL ESTATE LESSOR 462779 PROCARE THERAPY SERVICES LLC PO BOX 12071 ALEXANDRIA LA 71315 REHABILITATION & THERAPY SERVICES 454997 PROGRESSIVE ELDERCARE SERVICES INC 38 WARNOCK SPRINGS ROAD MAGNOLIA AR 71753 ADMINISTRATOR LEASING 176586 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 HOUSEKEEPING 157035 5 128065 128065 PATIENT CARE REVENUE 623000 4460027 4460027 OTHER RESIDENT CARE RE 623000 1042 1042 4461069 4 4 4589138 4461069 0 4 X 50 50 5466 5466 51300 51300 459717 459717 14394 14394 11371 11371 589051 561111 27940 3316 3316 25318 25318 299209 298636 573 CONTRACT LEASE EXPENSE 2503358 2503358 MEDICAL SUPPLIES 331597 331597 GENERAL AND ADMINISTRAT 129651 12965 116686 BILLING SERVICES 54000 54000 84076 83022 1054 4561874 4364321 197553 0 1524 1524 286306 276080 729545 471025 2912 163961 297246 229928 66233 106984 163695 15454 19923 1306686 1229493 1167837 1525260 461880 1629717 1525260 X -323031 -295767 -323031 -295767 1306686 1229493 27264 0 X 0 0 0 X 16265 128065 144330 1590224 5494764 4993788 4914722 4461069 21454567 1590224 5494764 5010053 4914722 4589134 21598897 12129 12129 4659 857 3474 8990 16788 857 3474 21119 21577778 1 2 68 4 75 1 2 68 4 75 1590224 5494765 5010055 4914790 4589138 21598972 X SCHEDULE A, PART III, SECTION B, LINE 14 THE ENTITY WAS CREATED ON JULY 14TH, 2010. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 60592 4918 55674 150591 49494 101097 18745 11821 6924 163695 FORM 990, PART VI, SECTION A, LINE 3 ADMINISTRATIVE DUTIES ARE DELEGATED TO A MANAGEMENT COMPANY, SOUTHERN ADMINISTRATIVE SERVICES, LLC. FORM 990, PART VI, SECTION B, LINE 11 THE BOARD MEMBERS RECEIVE A COPY OF THE FORM 990 TO REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION PROVIDES EACH DIRECTOR WITH A COPY OF THE COMPANY'S CONFLICT OF INTEREST POLICY AND PROVIDES AMPLE OPPORTUNITY AT ITS MEETINGS IN WHICH A POTENTIAL CONFLICT COULD ARISE FOR A DIRECTOR TO DISCLOSE A POTENTIAL CONFLICT FOR EVALUATION. FURTHER, IN PREPARATION FOR ITS MEETINGS, THE ORGANIZATION CLOSELY SCRUTINIZES EACH OF ITS AGENDA ITEMS TO EVALUATE THE POSSIBILITY OF A POTENTIAL CONFLICT OF INTEREST AND WILL RAISE THE ISSUE WHEN KNOWN. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH DIRECTOR DELEGATED POWER IS REQUIRED TO ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON: (A) HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) HAS AGREED TO COMPLY WITH THE POLICY AND (D) UNDERSTANDS THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. FINALLY, THE ORGANIZATION CONDUCTS PERIODIC REVIEWS OF THE REASONABLENESS OF ALL COMPENSATION ARRANGEMENTS AND WHETHER ALL ARRANGEMENTS WITH THIRD PARTIES COMPLY WITH THE ORGANIZATIONS WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENTS FOR GOODS AND SERVICES, FURTHER CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT OR IN AN EXCESS BENEFIT TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION DOES NOT EMPLOY ANY KEY EMPLOYEES, BUT HAS AN AGREEMENT FOR THE ADMINISTRATOR AND ADDITIONAL SERVICES WITH ITS MEMBER, PROGRESSIVE ELDERCARE SERVICES, INC. PROGRESSIVE ELDERCARE SERVICES, INC. SETS COMPENSATION, AND THE ORGANIZATION'S INDEPENDENT DIRECTORS ACCEPT OR RATIFIY THE SUBJECT EMPLOYMENT AGREEMENT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND ANNUAL FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VII, SECTION A LISA HENSLEY, FORMER DIRECTOR OF THE ORGANIZATION, AND VICKIE DONALDSON, DIRECTOR OF THE ORGANIZATION, WERE ALSO EMPLOYEES OF PROGRESSIVE ELDERCARE SERVICES, INC. (PARENT). THEY WERE NOT COMPENSATED FOR THEIR ROLE AS DIRECTOR OF THE ORGANIZATION, BUT THEY RECEIVED A SALARY FOR THEIR ROLE AS AN EMPLOYEE OF PROGRESSIVE ELDERCARE SERVICES, INC. FORM 990, PART IX, LINE 11G NURSING AND SPECIALIST FEES: PROGRAM SERVICE EXPENSES 126,769. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 126,769. DATA FEES: PROGRAM SERVICE EXPENSES 86,427. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 86,427. QUALITY ASSURANCE FEE: PROGRAM SERVICE EXPENSES 246,521. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 246,521. PROGRESSIVE ELDERCARE SERVICES INC (PARENT) 38 WARNOCK SPRINGS ROAD MAGNOLIA AR 71753 273040964 FACILITATE THE OPERATION OF LONG-TERM CARE FACILITIES AR 501(C)(3) LINE 9 N/A 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 PROGRESSIVE ELDERCARE SERVICES INC M 77114 CASH