2014-08-06T17:00:53-05:00 2013-09-30 420714325 MCGLADREY LLP 117 E MAIN ST STE 210 GALESBURG IL 61401 990 2012-10-01 371079626 COMMUNITY LIVING OPTIONS INC COMM 3093431550 285 SOUTH FARNHAM STREET GALESBURG IL 61401 JOHN CROCK 3093431550 2014-07-31 1 BEN MCMAHAN P00702421 3093428026 2012 2015-11-30 17:44:51Z JOHN CROCK 285 SOUTH FARNHAM STREET GALESBURG IL 61401 38186173 0 X N/A X 1979 IL TO PROVIDE & OPERATE LONG-TERM CARE FACILITIES FOR THE DEVELOPMENTALLY DISABLED AND THE ELDERLY. 4 4 683 0 0 0 27916 35184 33360883 32794158 619562 586565 0 0 34008361 33415907 8530 8802 0 0 11479510 11811279 0 0 0 21622335 25279832 33110375 37099913 897986 -3684006 181144673 179997693 106697162 109271397 74447511 70726296 X THE MISSION OF THE ORGANIZATION IS ARTICULATED IN ITS ARTICLES OF INCORPORATION AS FOLLOWS:THE CORPORATION IS ORGANIZED EXCLUSIVELY FOR CHARITABLE PURPOSES AS DEFINED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. IN FURTHERANCE OF THOSE CHARITABLE PURPOSES, THE CORPORATION SHALL BE EMPOWERED TO BUILD, LEASE, ACQUIRE AND OTHERWISE OWN AND OPERATE RESIDENTIAL FACILITIES, NURSING FACILITIES AND OTHER RELATED FACILITIES AND SERVICES FOR THE ELDERLY, MENTALLY RETARDED, MENTALLY ILL, DEVELOPMENTALLY DISABLED AND OTHER LIKE CONDITIONS WITHOUT REGARD TO RACE, RELIGION, COLOR, SEX, CREED OR NATIONAL ORIGIN OF SAID PERSONS. THE CORPORATION WILL NOT ENGAGE IN THE PRACTICE OF MEDICINE NOR RENDER ANY LICENSED PROFESSIONAL SERVICES. 0 0 29765316 8802 32794158 ALL PROGRAM SERVICES RELATE TO PROVIDING AND OPERATING LONG-TERM CARE FACILITIES AND OTHER RELATED SERVICES TO THE DEVELOPMENTALLY DISABLED AND THE ELDERLY. THE ORGANIZATION OWNS 52 FACILITIES AND OPERATES A COMBINED TOTAL OF 544 BEDS WITHIN THOSE FACILITIES. 29765316 1 0 0 1 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 0 1 75 0 1 683 1 0 0 0 0 0 0 0 0 0 0 X 4 4 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 IL X X RON WILSON RFMS INC 3093431550 285 SOUTH FARNHAM GALESBURG IL 61401 X JOHN CROCK 2.00 X X 6750 0 0 JOHN THOMPSON 2.00 X X 7500 0 0 ROBERT MARSHALL 2.00 X 6000 0 0 MICHAEL WARTMAN 2.00 X 7500 0 0 RON WILSON RFMS INC 40.00 X 0 0 0 LAURA KELLY LTC SUPPORT 40.00 X 0 0 0 27750 0 0 0 0 0 0 RFMS INC 285 SOUTH FARNHAM ST GALESBURG IL 61401 ADMINISTRATIVE SERVICES 1177440 LTC SUPPORT SERVICES LLC 285 SOUTH FARNHAM ST GALESBURG IL 61401 SUPPORT SERVICES 824160 MCGLADREY LLP 5155 PAYSPHERE CIRCLE CHICAGO IL 60674 ACCOUNTING 536160 CRAIN MILLER & WERNSMAN LTD 623 EAST BROADWAY CENTRALIA IL 62801 LEGAL 148553 4 35184 35184 MEDICARE & MEDICAID 623000 18414103 18414103 FACILITY LEASE INCOME 623000 9782304 9782304 PRIVATE PAY RESIDENT S 623000 4164564 4164564 AID TRAINING 623000 433187 433187 32794158 401125 401125 4955706 4770266 185440 185440 185440 33415907 32794158 0 586565 8802 8802 24000 24000 9751709 9447734 303975 91671 88813 2858 1169643 1133184 36459 774256 750121 24135 2076595 1396604 679991 64840 64840 296917 296917 9079 9079 38644 38644 548244 548244 127104 114394 12710 232213 182601 49612 53553 42842 10711 2127546 2065082 62464 335273 327092 8181 176651 158986 17665 3701789 3590735 111054 5316006 5063126 252880 182313 182313 NOTE RECEIVABLE RESERVE 5299631 5299631 SUPPLIES & SMALL EQUIP. 2633765 2633765 MEDICAID ASSESSMENT TAX 1395055 1395055 DEBT EXTINGUISH LOSS 295123 295123 369491 302056 67435 37099913 29765316 7334597 0 3049072 3687879 2726175 6146086 11531210 2849169 623463 733937 171428846 38601962 126285729 132826884 13724434 10052779 1000000 1000000 19354135 19911447 2850455 2789512 181144673 179997693 2668302 2492397 137994 159546 97120014 95596962 6770852 11022492 106697162 109271397 X 74447511 70726296 74447511 70726296 181144673 179997693 -3684006 -37209 0 X X 0 1 X 1 0 X 14819 20337 26294 27916 35184 124550 32118777 31862221 31914736 33360883 32794158 162050775 32133596 31882558 31941030 33388799 32829342 162175325 0 0 0 162175325 479139 891797 814263 489263 401125 3075587 479139 891797 814263 489263 401125 3075587 32612735 32774355 32755293 33878062 33230467 165250912 0.98140 0.97760 0.01860 0.02240 X 9079 9079 29765316 29774395 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 8289 9826 10471 9079 37665 250000 250000 250000 250000 1000000 1500000 8479314 8479314 137196352 30114206 107082146 3188191 1244242 1943949 6866819 4939723 1927096 15698170 2303791 13394379 132826884 MEMBER INTEREST - LTC SUPPORT SERVICES, LLC 10000 C STANDBY LOAN AGREEMENT RECEIVABLE FROM UNRELATED 501(C)(3) ORGANIZATIONS 5990000 C RENT RECEIVABLE FROM UNLIMITED DEVELOPMENT, INC., A SUBSIDIARY 42831 C ESCROW DEPOSITS 589235 F DEPOSITS RESTRICTED FOR REPLACEMENT 4838594 F ADVANCE RECEIVABLE FROM KEOKUK VILLAGE CIRCLE, LTD., NFP, A SUBSIDIARY 8440787 C 19911447 CONSTRUCTION PAYABLE 9509177 ADVANCE PAYABLE TO UNLIMITED DEVELOPMENT, INC., A SUBSIDIARY 1513315 11022492 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OR SECTION 501(C)(2) OF THE INTERNAL REVENUE CODE. THEREFORE, NO PROVISION HAS BEEN MADE FOR FEDERAL OR STATE INCOME TAXES. MANAGEMENT EVALUATED THE ORGANIZATION'S TAX POSITIONS AND CONCLUDED THAT THE ORGANIZATION HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF THIS GUIDANCE. WITH FEW EXCEPTIONS, THE ORGANIZATION IS NO LONGER SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE FOR YEARS BEFORE 2009. 1 FLORIDA LIVING OPTIONS INC 851 WEST LUMSDEN ROAD BRANDON FL 33511 364467489 501(C)(3) 8401 FORGIVEN INTERST ON DEBT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANT FUNDS ARE ONLY GIVEN TO ORGANIZATIONS WHO CONFIRM THE USE OF SUCH MONIES IN THE UNITED STATES. THE GRANT TO FLORIDA LIVING OPTIONS, INC. REPRESENTS FORGIVEN INTEREST ON DEBT. FLORIDA LIVING OPTIONS, INC. IS A 501(C)(3) ORGANIZATION DOING BUSINESS AND LOCATED IN THE UNITED STATES. LTC SUPPORT SERVICES (LTC) A SINGLE DIRECTOR COMMON TO BOTH CLO & LTC IS JOHN CROCK. 895765 SUPPORT SERVICES IN THE AMOUNT OF $895,765 ARE PROVIDED BY LTC SUPPORT SERVICES, LLC., AS DESCRIBED IN SCHEDULE O RELATIVE TO PART VI, SECTION A, LINE 3. JOHN CROCK, WHO IS A DIRECTOR OF COMMUNITY LIVING OPTIONS, INC., AND LTC SUPPORT SERVICES, LLC, RECEIVED DIRECTOR'S FEES OF $0 FROM LTC SUPPORT SERVICES, LLC, FOR THE FISCAL YEAR ENDING SEPTEMBER 30, 2013. 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION RECEIVES SUPPORT SERVICES FROM LTC SUPPORT SERVICES, LLC, AN UNRELATED COMPANY. THESE SERVICES INCLUDE OVERSIGHT, TRAINING, REGULATORY COMPLIANCE, QUALITY ASSURANCE PROGRAMS, HUMAN RESOURCE SUPPORT, MARKETING AND MAINTENANCE. COMMUNITY LIVING OPTIONS, INC., OWNS 12.5% OF LTC SUPPORT SERVICES, LLC, AND UNLIMITED DEVELOPMENT, INC., (A SUBSIDIARY OF COMMUNITY LIVING OPTIONS, INC.) OWNS 12.5% OF LTC SUPPORT SERVICES, LLC. THE REMAINING 75% OF LTC SUPPORT SERVICES, LLC, IS OWNED BY UNRELATED EXEMPT ORGANIZATIONS. THE ORGANIZATION ALSO HAS A NEGOTIATED ARMS LENGTH ADMINISTRATIVE SERVICES CONTRACT WITH RFMS, INC., AN UNRELATED COMPANY, TO OBTAIN SERVICES SUCH AS CASH MANAGEMENT, ACCOUNTING AND FINANCIAL REPORTING, PAYROLL AND EMPLOYEE BENEFITS, INFORMATION TECHNOLOGY, REGULATORY MATTERS, AND OTHER GENERAL BUSINESS AND FINANCIAL MANAGEMENT SERVICES AS REQUIRED. FORM 990, PART VI, SECTION B, LINE 11 EACH MEMBER OF THE BOARD OF DIRECTORS RECEIVES A PAPER COPY OF FORM 990 FOR THEIR REVIEW AND COMMENT PRIOR TO ITS FILING. THE BOARD ALSO REVIEWS IN DETAIL EACH FORM 990 FILED BY THE ORGANIZATION AT ITS REGULARLY SCHEDULED BOARD MEETINGS. ON AN ANNUAL BASIS, EACH BOARD MEMBER ATTENDS A TRAINING SESSION THAT PROVIDES UPDATES ON CURRENT EXEMPT ORGANIZATION TAX COMPLIANCE MATTERS. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO ATTEST TO THEIR COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS. THE BOARD OF DIRECTORS REVIEWS ALL COMPLETED CONFLICT OF INTEREST STATEMENTS TO DETERMINE IF ANY CONFLICTS EXIST WHICH WOULD REQUIRE RESTRICTION ON PARTICIPATION IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN ANY TRANSACTIONS INVOLVING THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 18 A PAPER COPY OF FORM 990 IS PROVIDED UPON REQUEST. THE ORGANIZATION'S FORM 990 IS ALSO AVAILABLE VIA THE GUIDESTAR.ORG WEBSITE AND THROUGH THE ATTORNEY GENERAL'S OFFICE OF THE STATE OF ILLINOIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC EXCEPT THROUGH PUBLIC FILING REQUIREMENTS. FORM 990, PART VII, SECTION A, COLUMN F: RON WILSON IS EMPLOYED BY RFMS, INC., AN UNRELATED ORGANIZATION WHICH HAS AN ADMINISTRATIVE SERVICES CONTRACT WITH COMMUNITY LIVING OPTIONS, INC. THE TYPE OF SERVICES PROVIDED BY RFMS, INC., ARE DETAILED IN THE SCHEDULE O EXPLANATION ABOVE RELATIVE TO FORM 990, PART VI, SECTION A, LINE 3. RON WILSON IS THE CHIEF FINANCIAL OFFICER OF RFMS, INC. HIS COMPENSATION REPORTED ON HIS RFMS, INC. FORM W-2, BOX 5 FOR CALENDAR YEAR 2012 IS $174,379. RON WILSON'S COMPENSATION AMOUNT AND HOURS HAVE NOT BEEN PRORATED BASED ON TIME SPENT FOR EACH OF THE NINETEEN ORGANIZATIONS TO WHOM SERVICES ARE PROVIDED BY RFMS, INC. LAURA KELLY IS EMPLOYED BY LTC SUPPORT SERVICES, LLC, AN UNRELATED ORGANIZATION WHICH PROVIDES SUPPORT SERVICES TO COMMUNITY LIVING OPTIONS, INC. THE TYPE OF SERVICES PROVIDED BY LTC SUPPORT SERVICES, LLC ARE DETAILED IN THE SCHEDULE O EXPLANATION ABOVE RELATIVE TO FORM 990, PART VI, SECTION A, LINE 3. LAURA KELLY MANAGES THE OPERATIONS OF COMMUNITY LIVING OPTIONS, INC., AND OTHER DEVELOPMENTALLY DISABLED FACILITIES. HER COMPENSATION REPORTED ON HER LTC SUPPORT SERVICES, LLC FORM W-2, BOX 5 FOR CALENDAR YEAR 2012 IS $136,515. LAURA KELLY'S COMPENSATION AMOUNT AND HOURS HAVE NOT BEEN PRORATED BASED ON TIME SPENT FOR EACH OF THE THIRTEEN ORGANIZATIONS TO WHOM SERVICES ARE PROVIDED. FORM 990, PART VII, SECTION A, COLUMN B: APPROXIMATELY ONE HALF OF THE AVERAGE HOURS PER WEEK ESTIMATED FOR EACH DIRECTOR IS DEVOTED TO RELATED ORGANIZATIONS LISTED ON SCHEDULE R. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT OF THE AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART XII, LINE 2B: THE FINANCIAL STATEMENTS OF COMMUNITY LIVING OPTIONS, INC., WERE AUDITED AS PART OF THE CONSOLIDATED FINANCIAL REPORT ISSUED FOR COMMUNITY LIVING OPTIONS, INC. AND SUBSIDIARIES. MARION WILLIAMSON COUNTY PARKWAY LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 352259772 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 697792 14925643 N/A LEROY SOUTH BUCK LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 611485632 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 419108 4473120 N/A 2245 SEMINARY STREET LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 364568737 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 402532 4560923 N/A CENTRALIA EAST MCCORD LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 201313879 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 902825 8632911 N/A GALESBURG NORTH SEMINARY LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 201334252 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 807049 9028744 N/A PEKIN EL CAMINO LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 300330354 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 564058 7180455 N/A JERSEYVILLE NORTH STATE LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 383715772 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 836768 9257191 N/A SHELBYVILLE ROUTE 128 LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 201334393 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 491867 6514950 N/A PITTSFIELD LOWRY LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 201334359 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 487470 6609444 N/A ABINGDON WEST MARTIN LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 364560809 OWNS FACILITY OPERATED BY UNLIMITED DEVELOPMENT, INC. IL 180000 1463170 N/A MARYVILLE VADALABENE LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 201334411 NOT IN USE DURING FISCAL YEAR ENDING 9/30/2013 IL 0 0 N/A ELKO RUBY VISTA LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 272887649 OWNS FACILITY OPERATED BY UNRELATED 501(C)(3) ORGANIZATION NV 992407 20632210 N/A OCALA 33RD AVENUE LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 275109607 OWNS FACILITY OPERATED BY UNRELATED 501(C)(3) ORGANIZATION FL 789413 16709753 N/A LAKELAND HIGHLANDS ROAD FACILITY LLC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 275084554 OWNS FACILITY OPERATED BY UNRELATED 501(C)(3) ORGANIZATION FL 377550 8391036 N/A UNLIMITED DEVELOPMENT INC 285 SOUTH FARNHAM STREET GALESBURG IL 61401 364094409 OPERATES ELDERLY SKILLED NURSING,ASSISTED/INDEPNDENT LIVING FACILITIES IL 501(C)(3) LINE 9 N/A 1 KEOKUK VILLAGE CIRCLE LTD NFP 285 SOUTH FARNHAM STREET GALESBURG IL 61401 262341634 ACQUIRING & HOLDING TITLE TO PROPERTY; REMITTING ALL INCOME TO 501(C)(3) IL 501(C)(2) N/A 1 RFMS INC MEDICAL BENEFIT PLAN TRUST 285 SOUTH FARNHAM STREET GALESBURG IL 61401 367042729 MEDICAL, ST DISABILITY & DEATH BENEFITS FOR ELIGIBLE EMPLOYEES IL 501(C)(9) N/A 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 UNLIMITED DEVELOPMENT INC A 7423589 CASH TRANSACTION BASED ON FMV UNLIMITED DEVELOPMENT INC E 1513315 CASH TRANSACTION BASED ON FMV KEOKUK VILLAGE CIRCLE LTD NFP - (A 501(C)(2) ORGANIZATION) D 8440787 CASH TRANSACTION BASED ON FMV RFMS INC MEDICAL BENEFIT PLAN TRUST R 775758 COST OF PREMIUMS SCHEDULE R, PART II: UNLIMITED DEVELOPMENT, INC. AND KEOKUK VILLAGE CIRCLE, LTD., NFP, ARE SUBSIDIARIES OF COMMUNITY LIVING OPTIONS, INC. SCHEDULE R, PART V, LINE 1A: ALL AMOUNTS RECEIVED FROM UNLIMITED DEVELOPMENT, INC. AND KEOKUK VILLAGE CIRCLE, LTD., NFP, ARE RELATED TO THE ORGANIZATION'S EXEMPT PURPOSE. UNLIMITED DEVELOPMENT, INC., A 501(C)(3) SUBSIDIARY OF COMMUNITY LIVING OPTIONS, INC., FILES A SEPERATE FORM 990 AND REPORTED THESE ITEMS AS PROGRAM-RELATED EXPENSES ACCORDINGLY. KEOKUK VILLAGE CIRCLE, LTD., NFP, A 501(C)(2) SUBSIDIARY OF COMMUNITY LIVING OPTIONS, INC., FILES A SEPERATE FORM 990 AND REPORTED THESE ITEMS AS PROGRAM-RELATED EXPENSES ACCORDINGLY. NEITHER UNLIMITED DEVELOPMENT, INC. OR KEOKUK VILLAGE CIRCLE, LTD., NFP, REPORT ANY UNRELATED BUSINESS TAXABLE INCOME ON THEIR RESPECTIVE FORM 990, AND NEITHER ENTITY IS REQUIRED TO FILE FORM 990-T. SCHEDULE R, PART II AND PART V: THE RFMS, INC. MEDICAL BENEFIT PLAN TRUST IS A SELF-INSURED BENEFIT PROGRAM FUNDED BY THE EMPLOYERS AND PARTICIPANTS WITHIN THE PLAN. PARTICIPANTS IN THE PLAN ARE CURRENT AND FORMER EMPLOYEES OF THE FOLLOWING SPONSORS: RFMS, INC., LTC SUPPORT SERVICES, LLC, COMMUNITY RESIDENTIAL CENTERS, INC., COMMUNITY LIVING OPTIONS, INC., FRANCES HOUSE, INC., UNLIMITED DEVELOPMENT, INC., KENSINGTON OF GALESBURG, INC., ACHIEVEMENT UNLIMITED, INC., CONCEPTS PLUS, INC., PINNACLE OPPORTUNITIES, INC., PIONEER CONCEPTS, INC., RESIDENTIAL ALTERNATIVES OF ILLINOIS, INC., RESIDENTIAL ALTERNATIVES OF IOWA, DESERT HEALTHCARE FACILITIES, INC., FLORIDA LIVING OPTIONS, INC., AND HIGHLAND ESTATES RESORT, LLC. NO TRUSTEE FEES OR MANAGEMENT FEES ARE PAID BY THE RFMS, INC. MEDICAL BENEFIT PLAN TRUST. THE AMOUNT OF PREMIUMS RECEIVED BY THE RFMS, INC. MEDICAL BENEFIT PLAN TRUST IS FOR THE PLAN'S FISCAL YEAR ENDING OCTOBER 31, 2013.