2012-11-15T13:47:26-06:00 2011-12-31 593070669 MOORE STEPHENS LOVELACE PA 311 PARK PLACE BLVD SUITE 100 CLEARWATER FL 33759 990 2011-01-01 232856813 HEARTHSTONE SENIOR COMMUNITIES INC HEAR 2153466454 TWO BALA CYNWYD PLAZA NO 300 BALA CYNWYD PA 19004 HOWARD JAFFE 5618017600 2012-11-15 1 MELANIE A MCPEAK P01346034 7275314477 2011 2016-02-24 21:20:13Z X HOWARD JAFFE TWO BALA CYNWYD PLAZA NO 300 BALA CYNWYD PA 19004 95237871 0 X N/A X 1996 FL THE ENTITY IS ORGANIZED AND OPERATED FOR THE PROVISION OF SHORT AND LONG-TERM STAYS OFFERING POST ACUTE AND REHABILITATION SERVICES. THE ORGANIZATION PROVIDES THESE SERVICES BY PROVIDING ROOM AND BOARD, NURSING SERVICES, HEALTHCARE, THERAPY, RESIDENT SERVICES AND SECURITY AT AN AFFORABLE COST. THE ORGANIZATION STRIVES TO PROVIDE OPEN, DIVERSE, AND CARING ENVIRONMENTS FOR RESIDENTS, FAMILY MEMBERS AND STAFF. 5 4 1745 44 0 0 0 30000 93084571 95173969 43040 27767 55836 6135 93183447 95237871 1567850 6030150 0 0 41332527 40909877 0 0 0 47299771 46017599 90200148 92957626 2983299 2280245 35550558 43883578 6689171 12741946 28861387 31141632 X SEE SCHEDULE O.TO OPERATE ONE OR MORE NURSING HOMES OR PROVIDE OTHER HOUSING FOR THE ELDERLY AND DEVELOP MEDICAL PROGRAMS FOR THE CARE OF THE ELDERLY AND TO EDUCATE AND TRAIN HEALTHCARE PERSONNEL IN THE PROPER CARE OF THE ELDERLY. 0 0 82836939 95180104 THE ORGANIZATION OPERATES 11 SKILLED NURSING FACILITIES, WITH A COMBINED CAPACITY OF 1240 BEDS, DEDICATED AND COMMITTED TO PROVIDING REHABILITATION AND SHORT AND LONG TERM NURSING AND MEDICAL CARE OF PATIENTS AND RESIDENTS. THE ORGANIZATION PROVIDES NUMEROUS ACTIVITIES AND PROGRAMS INCORPORATING AND PROMOTING FAMILY ACTIVITIES AND INVOLVEMENT WITH RESIDENTS AND STAFF. THESE ACTIVITIES PROMOTE A NORMALIZED ENVIRONMENT. 82836939 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 164 0 1 1745 1 0 0 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X KANE FINANCIAL SERVICES CO AARON FETTES 5612234188 1675 PALM BEACH LAKES BLVD STE 800 WEST PALM BEACH FL 33401 HARRY DILLON MADONNA 6.40 X X 46610 0 978 ANN MULLEN 1.00 X 8000 0 0 SANDRA OLIVER 1.00 X 8000 0 0 JOHN S SEAL JR 1.00 X 8000 0 0 BRIAN M WYATT 1.00 X 8000 0 0 LYNDA K LOVELL 40.00 X 107306 0 7544 MELISSA A FIJALKOWSKI 40.00 X 112600 0 7032 298516 0 15554 2 0 0 0 AEGIS THERAPIES INC PO BOX 277365 ATLANTA GA 30384 REHABILITATION 8355419 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DRIVE STE 300 BENSALEM PA 19020 HOUSEKEEPING AND LAUNDRY 2414081 ELEUS HEALTH SERVICES LLC 1675 PALM BEACH LAKES BLVD SUITE WEST PALM BEACH FL 33401 CONSULTING 1068037 BRIGID HEALTH SERVICES LLC 1675 PALM BEACH LAKES BLVD SUITE WEST PALM BEACH FL 33401 CONSULTING 1013189 KANNON HEALTH SERVICES LLC 1675 PALM BEACH LAKES BLVD SUITE WEST PALM BEACH FL 33401 CONSULTING 666945 23 30000 30000 RESIDENT SERVICE REVEN 623000 95173969 95173969 95173969 27767 27767 OTHER REVENUE 623000 6135 6135 6135 95237871 95180104 0 27767 6030150 6030150 79588 79588 35956719 33070294 2886425 57423 38065 19358 1698012 1477028 220984 3118135 2874950 243185 4760504 1908423 2852081 1071756 28053 1043703 62715 62715 12602296 12341544 260752 107647 34734 72913 459684 25656 434028 308698 53876 254822 7985687 7088885 896802 165481 15219 150262 6386 462 5924 23560 23560 790770 750868 39902 1763411 1733077 30334 STATE QUALITY ASSESSMEN 6594837 6594837 PHARMACY 2685672 2685672 FOOD 2066342 2032523 33819 BAD DEBT 1424700 1424700 3137453 2604363 533090 92957626 82836939 10120687 0 2171606 905018 3836664 3856601 8959254 9433249 793802 1389719 9333149 2648535 5218821 6684614 14570411 21614377 35550558 43883578 6091992 5892910 6000000 597179 849036 6689171 12741946 X 28861387 31141632 28861387 31141632 35550558 43883578 2280245 0 X X 0 1 1 X 0 X 727 9378 23541 30000 63646 75984363 79318070 87581437 93084572 95180104 431148546 75985090 79327448 87604978 93084572 95210104 431212192 0 0 0 431212192 581697 222229 44935 43040 27767 919668 581697 222229 44935 43040 27767 919668 395000 72000 55836 6135 528971 76961787 79621677 87649913 93183448 95244006 432660831 0.99670 0.99470 0.00210 0.00290 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 441413 46790 488203 0 6617122 1648392 4968730 2716027 1000143 1715884 6684614 INVESTMENT IN CAPTIVE 2445000 AMOUNTS HELD BY LENDER UNDER REVOLVING LINE OF CREDIT 766185 REAL ESTATE TAX ESCROW 3629389 REPLACEMENT RESERVE 2623803 RENT RESERVE 650000 CAPITAL IMPROVEMENTS 5500000 RESTRICTED CASH 6000000 21614377 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 849036 849036 95237871 92957626 2280245 2280245 97817936 2580065 2580065 95237871 0 95237871 95537691 2580065 2580065 92957626 0 92957626 PART IV, LINE 1B: THE ORGANIZATION OFFERS CASH MANAGEMENT SERVICES TO ITS RESIDENTS. THESE FUNDS REMAIN THE SOLE PROPERTY OF THE RESIDENTS AND ARE DISBURSED AS REQUESTED. THE ORGANIZATION HAS A FIDUCIARY DUTY OF ACCOUNTABILITY FOR THESE FUNDS AND REMAINS ONLY A CUSTODIAN. PART XII, LINE 2D - OTHER ADJUSTMENTS: REVENUE ON FINANCIALS REPORTED AS EXPENSE ON 990 2,580,065. PART XIII, LINE 2D - OTHER ADJUSTMENTS: REVENUE ON FINANCIALS REPORTED AS EXPENSE ON 990 2,580,065. 1 FLORIDA HEALTH CARE ASSOCIATION 307 WEST PARK AVENUE TALLAHASSEE FL 32301 591229583 501(C)(6) 30000 GENERAL SUPPORT FRONTLINE SENIOR CARE INC 1313 N MARKET STREET STE 5100 WILMINGTON DE 19801 274202010 501(C)(3) 6000000 GENERAL SUPPORT 1 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE CONSULTING COMPANY OF THE ORGANIZATION IS ON THE STEERING COMMITTEE OF THE FLORIDA HEALTHCARE ASSOCIATION (FHCA). THE ORGANIZATION HAS ASKED FHCA TO NOTIFY THEM AS TO WHAT THE GRANT MONEY IS BEING USED FOR BEFORE THE FUNDS ARE SPENT. DISBURSEMENTS FROM THE FUNDS ARE REVIEWED AND APPROVED BY A PAC ATTORNEY WHO VERIFIES THE EXPENDITURE IS ONE PERMITTED UNDER IRS REGULATIONS GOVERNING 501(C)(3) TAX EXEMPT ENTITIES. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE BOARD PRESIDENT AND THE CONSULTING COMPANY. THE RETURN IS PROVIDED TO ALL VOTING BOARD MEMBERS BEFORE IT IS FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATIONS CONFLICT OF INTEREST POLICY IS CONTAINED IN THE EMPLOYEE HANDBOOK. THE POLICY EXTENDS TO THE ORGANIZATION'S OFFICERS AND DIRECTORS. THE ORGANIZATION'S BOARD OF DIRECTORS MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY THROUGH ITS ANNUAL DISCLOSURE PROCESS. THE BOARD REVIEWS ACTUAL CONFLICTS THAT ARE IDENTIFIED AND PROHIBITS OFFICERS AND DIRECTORS FROM VOTING ON MATTERS WHERE ACTUAL CONFLICTS EXIST. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS HAS THE AUTHORITY TO FIX THE COMPENSATION OF THE ORGANIZATION'S EXECUTIVE DIRECTOR AS WELL AS OTHER OFFICERS AND KEY EMPLOYEES. THE COMPENSATION LEVELS ARE SET BASED ON CONSULTATION WITH THE CONSULTING COMPANY. ALL PARTIES ARE INDEPENDENT WITH RESPECT TO THE COMPENSATION DECISIONS. COMPENSATION LEVELS ARE SET BASED ON CURRENT MARKET CONDITIONS, THE ECONOMY AND FUNDING SOURCES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. OVERSIGHT OF AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT: FORM 990, PART XI, LINE 2C THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT IS ASSUMED BY THE GOVERNING BODY. THIS PROCESS HAS NOT CHANGED IN ANY WAY FROM THE PRIOR YEAR. BARTOW REHABILITATION CENTER LLC 2055 EAST GEORGIA STREET BARTOW FL 33830 263410674 NURSING FL 8676055 2775220 HEARTHSTONE SENIOR COMMUNITIES INC BAY CENTER REHABILITATION CENTER LLC 1336 ST ANDREWS BLVD PANAMA CITY FL 32405 263411018 NURSING FL 11652096 3903419 HEARTHSTONE SENIOR COMMUNITIES INC BOCA CIEGA REHABILITATION CENTER LLC 1414 59TH STREET SOUTH GULFPORT FL 33707 263411147 NURSING FL 8831236 2049824 HEARTHSTONE SENIOR COMMUNITIES INC CLEARWATER REHABILITATION CENTER LLC 1270 TURNER STREET CLEARWATER FL 33756 263419520 NURSING FL 9365636 2280006 HEARTHSTONE SENIOR COMMUNITIES INC EGRET COVE REHABILITATION CENTER LLC 550 62ND STREET SOUTH ST PETERSBURG FL 33707 263411425 NURSING FL 9996544 2632704 HEARTHSTONE SENIOR COMMUNITIES INC EMERALD COAST REHABILITATION CENTER LLC 114 3RD STREET SOUTH EAST FT WALTON BEACH FL 32548 263411532 NURSING FL 9374781 1993600 HEARTHSTONE SENIOR COMMUNITIES INC GROVES REHABILITATION CENTER LLC 512 SOUTH 11TH STREET LAKE WALES FL 33853 263411666 NURSING FL 10446997 2424194 HEARTHSTONE SENIOR COMMUNITIES INC LAKELAND HILLS REHABILITATION CENTER LLC 610 EAST BELLA VISTA DRIVE LAKELAND FL 33805 263411839 NURSING FL 8822687 2192543 HEARTHSTONE SENIOR COMMUNITIES INC TARPON REHABILITATION CENTER LLC 515 CHESAPEAKE DRIVE TARPON SPRINGS FL 34689 263411945 NURSING FL 9272023 2138693 HEARTHSTONE SENIOR COMMUNITIES INC UNIVERSITY EAST REHABILITATION CENTER LLC 991 EAST NEW YORK AVENUE DELAND FL 33274 263412167 NURSING FL 4402864 1069404 HEARTHSTONE SENIOR COMMUNITIES INC UNIVERSITY WEST REHABILITATION CENTER LLC 545 WEST EUCLID AVENUE DELAND FL 32720 263412294 NURSING FL 4396951 949702 HEARTHSTONE SENIOR COMMUNITIES INC MATURE CARE INSURANCE CO PO BOX 64 SUITE C12 MARKET PLACE PROVIDENCIALES TK BWI 251900526 INSURANCE TK N/A C 245935 11621563 0.28910 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0