COUNTRY CARE CENTER CORPORATION: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: COUNTRY CARE CENTER CORPORATION (EIN 42-1295331)
Tax period: 2012-07-01 to 2013-06-30
Filed: 2013-10-30
IRS object ID: 201343039349301279
Schema version: 2012v2.0
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 D
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-10-30T14:34:40-07:00	Timestamp
Tax Period End Date	2013-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	MUXFELDT ASSOCIATES CPA PC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	2309 B CHATBURN AVE	AddressLine1
City	HARLAN	City
State	IA	State
ZIP Code	51537	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	421295331	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	COUNTRY CARE CENTER CORPORATION	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	COUN	NameControl
Phone	7127443453	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 351	AddressLine1
City	HARLAN	City
State	IA	State
ZIP Code	515370351	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	PAT DAVITT	Name
Title	PRESIDENT	Title
Phone	7127443453	Phone
Date Signed	2013-10-30	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	MUXFELDT ASSOCIATES CPA PC	Name
Phone	7127553366	Phone

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	PAT DAVITT	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	LOCAL	AddressLine1
City	HARLAN	City
State	IA	State
ZIP Code	51537	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	966209	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	N/A	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1987	YearFormation
State Legal Domicile	IA	StateLegalDomicile
Activity Or Mission Description	RESIDENTIAL CARE FACILITY	ActivityOrMissionDescription
Nbr Voting Members Governing Body	7	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	7	NbrIndependentVotingMembers
Total Nbr Employees	25	TotalNbrEmployees
Total Nbr Volunteers	0	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Current Year	41000	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	892600	ProgramServiceRevenuePriorYear
Program Service Revenue CY	917203	ProgramServiceRevenueCY
Investment Income Prior Year	836	InvestmentIncomePriorYear
Investment Income Current Year	201	InvestmentIncomeCurrentYear
Other Revenue Prior Year	14358	OtherRevenuePriorYear
Other Revenue Current Year	7805	OtherRevenueCurrentYear
Total Revenue Prior Year	907794	TotalRevenuePriorYear
Total Revenue Current Year	966209	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Current Year	0	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	891687	OtherExpensePriorYear
Other Expenses Current Year	911903	OtherExpensesCurrentYear
Total Expenses Prior Year	891687	TotalExpensesPriorYear
Total Expenses Current Year	911903	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	16107	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	54306	RevenuesLessExpensesCY
Total Assets BOY	567417	TotalAssetsBOY
Total Assets EOY	584433	TotalAssetsEOY
Total Liabilities BOY	107569	TotalLiabilitiesBOY
Total Liabilities EOY	70280	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	459848	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	514153	NetAssetsOrFundBalancesEOY
Mission Description	RESIDENTIAL CARE FACILITY	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	911903	Expense
Revenue	966209	Revenue
Description	RESIDENTIAL CARE	Description
Total Program Service Expense	911903	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	false	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	false	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	25	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Excess Business Holdings	false	ExcessBusinessHoldings
Taxable Distributions	false	TaxableDistributions
Distribution To Donor	false	DistributionToDonor
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	7	NbrVotingGoverningBodyMembers
Number Independent Voting Members	7	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	false	ConflictOfInterestPolicy
Whistleblower Policy	false	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	COUNTRY CARE CENTER CORPORATION	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	7127443453	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	PO BOX 351	AddressLine1
City	HARLAN	City
State	IA	State
ZIP Code	515370351	ZIPCode

Field	Value	IRS element (for citing)
No Listed Persons Compensated	X	NoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (7 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Institutional TrusteeInstitutionalTrustee
PAT DAVITT
PRESIDENT AND TREASURER	1.00	X
ROGER DAVIDSON
VICE PRESIDENT	1.00	X
JOYCE RODENBORN
DIRECTOR	1.00	X	X
DAVE SWINTON
DIRECTOR	1.00	X
MARY JOHNSON
SECRETARY	1.00	X
KRIS OLSON-HARMON
DIRECTOR	1.00	X
CALLA POLDBERG
DIRECTOR	1.00	X

Field	Value	IRS element (for citing)
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
All Other Contributions	41000	AllOtherContributions
Total Contributions	41000	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	RESIDENTIAL CARE	Description
Business Code	999999	BusinessCode
Total Revenue Column	917203	TotalRevenueColumn

Field	Value	IRS element (for citing)
Total Program Service Revenue	917203	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	201	TotalRevenueColumn

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	1586	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	1586	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	1586	TotalRevenueColumn
Related Or Exempt Function Income	1586	RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MISC INCOME	999999	6219	6219
GAIN ON SALE OF ASSETS	999999

Field	Value	IRS element (for citing)
Total Other Revenue	6219	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	966209	TotalRevenueColumn
Related Or Exempt Function Income	925209	RelatedOrExemptFunctionIncome

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	28295	Total
Program Services	28295	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Other Expenses OtherExpenses (3 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices
ADMINISTRATIVE EXPENSES	318514	318514
DIETARY EXPENSES	108606	108606
PROPERTY MAINTENANCE	111149	111149

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	345339	Total
Program Services	345339	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	911903	Total
Program Services	911903	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	193941	BOY
EOY	250573	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	75000	BOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	28770	BOY
EOY	29129	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	185	BOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	4201	BOY
EOY	3520	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	36684	BOY
EOY	4060	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	625739	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	328588	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	228636	BOY
EOY	297151	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	567417	BOY
EOY	584433	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	107569	BOY
EOY	70280	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	107569	BOY
EOY	70280	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	459848	BOY
EOY	514153	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	459848	BOY
EOY	514153	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	567417	BOY
EOY	584433	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	54306	ReconcilationRevenueExpenses
Reconcilation Other Changes	-1	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	true	AccountantCompileOrReview
FS Audited	true	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
Audit Committee	false	AuditCommittee
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org170b1 Avi	X	PubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Field	Value	IRS element (for citing)
Current Tax Year	1	CurrentTaxYear
Total	1	Total

Total170 Total170

Field	Value	IRS element (for citing)
Current Tax Year	1	CurrentTaxYear
Total	1	Total

Field	Value	IRS element (for citing)
Public Support Total170	1	PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	3015	CurrentTaxYearMinus4Years
Total	3015	Total

Field	Value	IRS element (for citing)
Total Support	3016	TotalSupport
Public Support Pertcentage170	0.00030	PublicSupportPertcentage170
Public Support Pertcent Prior Year	0.05980	PublicSupportPertcentPriorYear
Private Foundation170	X	PrivateFoundation170
Public Support Total509	0	PublicSupportTotal509
Public Support Percentage509	0	PublicSupportPercentage509
Investment Income Percentage	0	InvestmentIncomePercentage

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	625739	OtherCostOrOtherBasis
Depreciation	328588	Depreciation
Book Value	297151	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	297151	TotalOfBookValueLandBuildings

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifier	ExplanationExplanation
Pt VI, Line 11b	BOARD OF DIRECTORS
Pt VI, Line 11b	BOARD OF DIRECTORS
Form 990EZ, Part II, Line 24	ACCOUNTS RECEIVABLE - NET OTHER RECEIVABLES INVENTORIES PREPAIDS INVESTMENTS
Form 990EZ, Part II, Line 26	ACCOUNTS PAYABLE & ACCRUED EXPENSES
Form 990, Part IX, Line 24f	RESIDENT CARE 70440. 70440. 0. 0. UTILITIES 61362. 61362. 0. 0. RESIDENT ACTIVITIES 213537. 213537. 0. 0.