STRATEGY STUDIO / PUBLIC DATA EXPLORER

PULASKI HEALTH FOUNDATION INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
PULASKI HEALTH FOUNDATION INC (EIN 23-7125454)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-15
IRS object ID
201223209349306827
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-15T14:47:18-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN381357951EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1750 TRADE CENTRE WAY STE 300AddressLine1
CityPORTAGECity
StateMIState
ZIP Code49002ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237125454EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PULASKI HEALTH FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPULANameControl
Phone5749463394Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1624 EAST 13TH STREETAddressLine1
CityWINAMACCity
StateINState
ZIP Code46996ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSCOTT FRITZName
TitlePRESIDENT/CHAIRMANTitle
Phone5749463394Phone
Date Signed2012-11-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCAROL LALONDE CPAName
PTINP00181637PTIN
Phone2695674500Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1PULASKI HEALTH CARE CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonSHARON MCKINLEYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1624 EAST 13TH STREETAddressLine1
CityWINAMACCity
StateINState
ZIP Code46996ZIPCode
FieldValueIRS element (for citing)
Gross Receipts4399629GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.PULASKIHEALTHCARECENTER.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1959YearFormation
State Legal DomicileINStateLegalDomicile
Activity Or Mission DescriptionAS A NOT-FOR-PROFIT, SKILLED NURSING FACILITY, PULASKI HEALTH CARE CENTER IS DEDICATED TO ENHANCING THE LIVES OF OLDER ADULTS THROUGH QUALITY HEALTH CARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees115TotalNbrEmployees
Total Nbr Volunteers37TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year3499ContributionsGrantsPriorYear
Contributions Grants Current Year3974ContributionsGrantsCurrentYear
Program Service Revenue Prior Year4075139ProgramServiceRevenuePriorYear
Program Service Revenue CY4359475ProgramServiceRevenueCY
Investment Income Prior Year9292InvestmentIncomePriorYear
Investment Income Current Year11346InvestmentIncomeCurrentYear
Other Revenue Prior Year34200OtherRevenuePriorYear
Other Revenue Current Year22117OtherRevenueCurrentYear
Total Revenue Prior Year4122130TotalRevenuePriorYear
Total Revenue Current Year4396912TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year2423535SalariesEtcPriorYear
Salaries Etc Current Year2659412SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1396768OtherExpensePriorYear
Other Expenses Current Year1564749OtherExpensesCurrentYear
Total Expenses Prior Year3820303TotalExpensesPriorYear
Total Expenses Current Year4224161TotalExpensesCurrentYear
Revenues Less Expenses Prior Year301827RevenuesLessExpensesPriorYear
Revenues Less Expenses CY172751RevenuesLessExpensesCY
Total Assets BOY3315271TotalAssetsBOY
Total Assets EOY3381655TotalAssetsEOY
Total Liabilities BOY1405032TotalLiabilitiesBOY
Total Liabilities EOY1298695TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1910239NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2082960NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO IMPROVE OUR COMMUNITY THROUGH HEALTH AND WELLNESS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense3686048Expense
Revenue4359475Revenue
DescriptionDIGNITY, QUALITY OF LIFE, AND PROFESSIONAL COMPETENCE - THIS IS THE FOUNDATION OF CARE YOU CAN EXPECT AT PULASKI HEALTH CARE CENTER (PHCC). WHEN A FAMILY MEMBER OR LOVED ONE IS NO LONGER ABLE TO CARE FOR HIMSELF OR HERSELF, WE OFFER COMFORTABLE, SECURE, LIFE CARE IN A SUPPORTIVE ENVIRONMENT. AS A NOT-FOR-PROFIT, SKILLED NURSING FACILITY, PHCC IS DEDICATED TO ENHANCING THE LIVES OF OLDER ADULTS THROUGH QUALITY HEALTH CARE. THE CENTER WAS DEVELOPED AND BUILT BY THE PULASKI HEALTH FOUNDATION, A NOT-FOR-PROFIT ORGANIZATION, WHOSE PRIMARY GOAL WAS TO DESIGN A FACILITY IN PULASKI COUNTY THAT PROVIDED SUPERIOR LONG-TERM CARE FOR OLDER ADULTS. PHCC OFFERS THE SERVICES OUR RESIDENTS NEED, INCLUDING SHORT-TERM RESTORATIVE SERVICES, MEDICARE SHORT STAY SERVICES, AND LONG-TERM CONTINUED CARE. THE COMPREHENSIVE CARE PROGRAM IS DESIGNED TO MEET THE DAILY LIVING NEEDS OF EACH RESIDENT. ALL OF OUR PROGRAMS INCLUDE 24-HOUR NURSING SERVICES, THERAPIES (PHYSICAL, OCCUPATIONAL, AND SPEECH), MEAL SERVICE, INCLUDING SPECIAL DIETS, ASSISTANCE WITH MEDICATION, PERSONAL HYGIENE, AND AMBULATION, SOCIAL SERVICES, ACTIVITIES AND RECREATION, LAUNDRY AND HOUSEKEEPING SERVICES. THE ORGANIZATION'S OCCUPANCY PERCENTAGE FOR THE YEAR ENDED DECEMBER 31, 2011 WAS 91%, WITH 58 LICENSED BEDS AVAILABLE. THE ORGANIZATION'S AVERAGE DAILY RESIDENT CENSUS WAS 53. THE ORGANIZATION'S PROGRAM SERVICE REVENUES APPROXIMATED $226 PER RESIDENT PER DAY.Description
Total Program Service Expense3686048TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109615NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees115NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledINStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SHARON K MCKINLEYBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5749463394TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1624 EAST 13TH STREETAddressLine1
CityWINAMACCity
StateINState
ZIP Code46996ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
SCOTT FRITZ
CHAIRMAN2.00XX000
LAURA BAILEY
VICE CHAIRMAN2.50XX000
LINDA MURPHY
SECRETARY0.50XX000
LIN MORRISON
TREASURER1.00XX000
JOHN GOBLE
BOARD MEMBER0.50X000
JIM PIERROU
BOARD MEMBER0.50X000
RITA MURRAY
BOARD MEMBER1.00X000
ROBERT LIZENBY
BOARD MEMBER (PARTIAL YEAR)1.00X000
SHARON MCKINLEY
ADMINISTRATOR50.00X6457606593
FieldValueIRS element (for citing)
Total Reportable Comp From Org64576TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation6593TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HEALTH CARE THERAPY SERVICES
1411 W COUNTY LINE RDGREENWOODIN46142THERAPY SERVICES280103
GORDON FOOD SERVICE
DEPT CH 10490PALATINEIL60055FOOD PURCHASES172045
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
All Other Contributions3974AllOtherContributions
Total Contributions3974TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionRESIDENT SERVICE REVENDescription
Business Code623000BusinessCode
Total Revenue Column4359475TotalRevenueColumn
Related Or Exempt Function Income4359475RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue4359475TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column13933TotalRevenueColumn
Exclusion$13,933ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other130Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other2717Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-2587Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-2587TotalRevenueColumn
Exclusion-$2,587ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
VENDING/CATERING INCOM90009913841$13,841
OTHER INCOME9000995717$5,717
BEAUTY/BARBER SHOP INC9000992559$2,559
FieldValueIRS element (for citing)
Total Other Revenue22117TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column4396912TotalRevenueColumn
Related Or Exempt Function Income4359475RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$33,463ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total71169Total
Management And General71169ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2165964Total
Program Services2033264ProgramServices
Management And General132700ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total257034Total
Program Services233611ProgramServices
Management And General23423ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total165245Total
Program Services150186ProgramServices
Management And General15059ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total11798Total
Management And General11798ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1361Total
Management And General1361ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total47225Total
Management And General47225ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total339967Total
Program Services317498ProgramServices
Management And General22469ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total9721Total
Management And General9721ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total47114Total
Management And General47114ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total27418Total
Management And General27418ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total103959Total
Program Services96682ProgramServices
Management And General7277ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total6990Total
Management And General6990ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total24863Total
Management And General24863ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total165149Total
Program Services147489ProgramServices
Management And General17660ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total39351Total
Management And General39351ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
NURSING SUPPLIES AND OT241698241698
PROVIDER TAXES181400181400
FOOD1711321631008032
BAD DEBT EXPENSE7359073590

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total72013Total
Program Services47530ProgramServices
Management And General24483ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total4224161Total
Program Services3686048ProgramServices
Management And General538113ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY500BOY
EOY500EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY633487BOY
EOY410548EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY397436BOY
EOY413150EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY375700BOY
EOY472518EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY15160BOY
EOY17509EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY35018BOY
EOY79336EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3693794LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2101668LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1613430BOY
EOY1592126EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY105311BOY
EOY290687EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY139229BOY
EOY105281EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3315271BOY
EOY3381655EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY211430BOY
EOY264318EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY8878BOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1184724BOY
EOY1034377EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1405032BOY
EOY1298695EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1809777BOY
EOY1982498EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY100462BOY
EOY100462EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1910239BOY
EOY2082960EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3315271BOY
EOY3381655EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses172751ReconcilationRevenueExpenses
Reconcilation Other Changes-30ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review1AccountantCompileOrReview
FS Audited0FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1918CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3254CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9501CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3499CurrentTaxYearMinus1Year
Current Tax Year3974CurrentTaxYear
Total22146Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3423161CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3707509CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3674150CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4075139CurrentTaxYearMinus1Year
Current Tax Year4359475CurrentTaxYear
Total19239434Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years15828CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years41217CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years29540CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17738CurrentTaxYearMinus1Year
Total104323Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3440907CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3751980CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3713191CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4096376CurrentTaxYearMinus1Year
Current Tax Year4363449CurrentTaxYear
Total19365903Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year140640CurrentTaxYearMinus1Year
Total140640Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year140640CurrentTaxYearMinus1Year
Total140640Total
FieldValueIRS element (for citing)
Public Support Total50919225263PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years36983CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years27374CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years25748CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16090CurrentTaxYearMinus1Year
Current Tax Year13933CurrentTaxYear
Total120128Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years36983CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years27374CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years25748CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16090CurrentTaxYearMinus1Year
Current Tax Year13933CurrentTaxYear
Total120128Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3882CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years208CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years38CurrentTaxYearMinus2Years
Total4128Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6240CurrentTaxYearMinus4Years
Current Tax Year Minus2 Years4854CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year14789CurrentTaxYearMinus1Year
Current Tax Year22117CurrentTaxYear
Total48000Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3488012CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3779562CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3743831CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4127255CurrentTaxYearMinus1Year
Current Tax Year4399499CurrentTaxYear
Total19538159Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98400PublicSupportPercentage509
Prior Year Support Percentage0.98270PriorYearSupportPercentage
Investment Income Percentage0.00610InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00740PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUEGeneralExplanation

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$199OtherActivitiesAmount
Total Lobbying Expenditures IIB199TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationTHE ORGANIZATION PAYS ANNUAL DUES TO THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING (AAHSA) AND THE INDIANA ASSOCIATION OF HOMES AND SERVICES FOR THE AGING (IAHSA). THE FOLLOWING PERCENTAGES OF THE ORGANIZATION'S DUES ARE EARMARKED FOR LOBBYING PURPOSES: AAHSA = 5.3%, IAHSA = 5.9%Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance4304BeginningOfYearBalance
Investment Earnings Or Losses-30InvestmentEarningsOrLosses
End Of Year Balance4274EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance3562BeginningOfYearBalance
Contributions250Contributions
Investment Earnings Or Losses549InvestmentEarningsOrLosses
Administrative Expenses57AdministrativeExpenses
End Of Year Balance4304EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2500BeginningOfYearBalance
Contributions500Contributions
Investment Earnings Or Losses584InvestmentEarningsOrLosses
Administrative Expenses22AdministrativeExpenses
End Of Year Balance3562EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Contributions2500Contributions
End Of Year Balance2500EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance1.00000BoardDesignatedEOYBalance
Endowments Held By Unrelated Orgs1EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis28875OtherCostOrOtherBasis
Book Value28875BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2437029OtherCostOrOtherBasis
Depreciation1374554Depreciation
Book Value1062475BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis69755OtherCostOrOtherBasis
Depreciation61069Depreciation
Book Value8686BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1134416OtherCostOrOtherBasis
Depreciation666045Depreciation
Book Value468371BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis23719OtherCostOrOtherBasis
Book Value23719BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1592126TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionTRADING SECURITIESDescription
Book Value290687BookValue
Method Of ValuationCMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities290687TotalOfBookValueSecurities
Total Revenue4396912TotalRevenue
Total Expenses4224161TotalExpenses
Excess Or Deficit For Year172751ExcessOrDeficitForYear
Other-$30OtherAmount
Total Adjustments-30TotalAdjustments
Excess Or Deficit Per FS172721ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt4399499TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal4399499RevenueSubtotal
Other Revenues Not Included-2587OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-2587RevenueNotRptdOnFinStmt
Total Revenue Per Form9904396912TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt4226748TotExpensesEtcAuditedFinclStmt
Other Expenses Included2587OtherExpensesIncluded
Expenses Not Rptd F9902587ExpensesNotRptdF990
Expenses Subtotal4224161ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9904224161TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 2B:THE ORGANIZATION HAS A RESIDENT TRUST ACCOUNT SET UP FOR RESIDENTS' PERSONAL FUNDS. RESIDENTS AND/OR THEIR AUTHORIZED REPRESENTATIVE ARE REQUIRED TO SIGN AN AUTHORIZATION FORM GIVING THE ORGANIZATION THE RIGHT TO MANAGE THE RESIDENTS' PERSONAL FUNDS WHILE HE OR SHE RESIDES AT THE FACILITY. RESIDENTS AND/OR THEIR AUTHORIZED REPRESENTATIVE RECEIVE QUARTERLY REPORTS THAT PROVIDE AN ACCOUNTING OF THE ACTIVITY DURING THAT PERIOD.
PART V, LINE 4:THE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUND IS TO SUPPORT THE ORGANIZATION'S ACTIVITIES.DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:
PART X:THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)3 OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN AND RECOGNIZE A TAX LIABILITY IF UNCERTAIN TAX POSITIONS ARE TAKEN THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN AND HAS CONCLUDED THAT THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS SUBJECT TO ROUTINE AUDITS BY TAXING AUTHORITIES; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE ORGANIZATION'S FEDERAL TAX RETURNS FOR THE YEARS ENDED PRIOR TO DECEMBER 31, 2008 ARE NO LONGER SUBJECT TO EXAMINATION.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:
CHANGE IN BENEFICIAL INTEREST -30.PART XI, LINE 8 - OTHER ADJUSTMENTS:
PART XII, LINE 4B: LOSS ON SALE OF FIXED ASSETS -2,587

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS REVIEWED IN DETAIL BY MANAGEMENT. THEN A COPY OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS PROVIDED TO EACH BOARD MEMBER AND REVIEWED WITH THE ORGANIZATION'S TAX ADVISORS AT A SCHEDULED BOARD MEETING PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12CANNUAL DISCLOSURE IS PROVIDED TO EACH OFFICER AND BOARD MEMBER (THE ORGANIZATION DOES NOT HAVE ANY KEY EMPLOYEES OR HIGHEST COMPENSATED EMPLOYEES). EACH BOARD MEMBER AND OFFICER COMPLETES AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. ONCE THE QUESTIONNAIRES ARE COMPLETED, THE ADMINISTRATOR REVIEWS THE RESPONSES AND DETERMINES WHETHER OR NOT THERE ARE ANY POTENTIAL CONFLICTS OF INTEREST. IF THERE IS A POTENTIAL CONFLICT OF INTEREST, THE ADMINISTRATOR AND THE BOARD PRESIDENT REVIEW THE CORRESPONDING ISSUE AND DETERMINE IF THERE IS AN ACTUAL CONFLICT OF INTEREST. IF AN ACTUAL CONFLICT OF INTEREST IS DETERMINED TO EXIST, THAT PERSON IS EXCLUDED FROM ANY DISCUSSIONS CONCERNING THE CONFLICTING ISSUE. ANY PURCHASES AND/OR BIDDING PROPOSALS ARE ALSO REVIEWED FOR ANY POTENTIAL CONFLICTS OF INTEREST PRIOR TO SUBMITTING BIDS OR MAKING PURCHASES. THE BOARD PRESIDENT ATTENDS THE BOARD MEETINGS AND ENSURES THAT COMPLIANCE WITH THESE GUIDELINES ARE FOLLOWED.
FORM 990, PART VI, SECTION B, LINE 15ATHE PROCESS FOR DETERMINING THE COMPENSATION OF THE ORGANIZATION'S ADMINISTRATOR INCLUDED A REVIEW AND APPROVAL BY THE BOARD PRESIDENT AND VICE PRESIDENT, WHO ARE BOTH INDEPENDENT. THE PRESIDENT AND VICE PRESIDENT USED MCKNIGHT'S CAREER GUIDE, WHICH INCLUDED AN AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING (AAHSA) NURSING HOME SALARY AND BENEFITS REPORT, AS WELL AS THE MYERS AND STAUFFER LC LONG TERM CARE COMPENSATION REPORT. THE INDIANA ASSOCIATION FOR THE HOMES AND SERVICES OF THE AGING'S SALARY AND WAGE SURVEY IS ALSO REFERENCED FOR THE DECISION PROCESSES. ONCE THE PRESIDENT AND VICE PRESIDENT DETERMINED THE COMPENSATION AMOUNT, THEY REPORTED THEIR FINDINGS AND DECISION TO THE FULL BOARD OF DIRECTORS AT A BOARD MEETING. THIS WAS DOCUMENTED IN THE BOARD MEETING MINUTES, AND WAS LAST DONE IN APRIL OF 2011 FOR THE ADMINISTRATOR'S SALARY.
FORM 990, PART VI, SECTION C, LINE 19A COPY OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 5:CHANGE IN BENEFICIAL INTEREST -30. TOTAL TO FORM 990, PART XI, LINE 5: -30.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2C:THE PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1PULASKI HOUSING ASSOCIATES INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1624 EAST 13TH STREETAddressLine1
CityWINAMACCity
StateINState
ZIP Code46996ZIPCode
FieldValueIRS element (for citing)
EIN352120172EIN
Primary ActivityAPARTMENT RENTALPrimaryActivity
Legal Domicile StateINLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1PULASKI HEALTH FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income-5ShareOfTotalIncome
Share Of EOY Assets70640ShareOfEOYAssets
Percentage Ownership0.75000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1RIVERWOOD COMMONSBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeATransactionType
Amount Involved9028AmountInvolved
Method Of Amt DeterminationBOOK VALUEMethodOfAmtDetermination