2011-09-30T08:02:20-05:00 2010-12-31 MOORE STEPHENS LOVELACE PA 14400 NW 77TH COURT SUITE 306 MIAMI LAKES FL 330161507 990 2010-01-01 232856813 HEARTHSTONE SENIOR COMMUNITIES INC HEAR 5618017600 1675 PALM BEACH LAKES BLVD NO 900 WEST PALM BEACH FL 33401 HARRY DILLON MADONNA 5618017600 2011-09-30 1 KARIN E VICKERS 3058199555 2010 2016-03-07 17:11:31Z HARRY DILLON MADONNA TWO BALA CYNWYD PLAZA SUITE 300 BALA CYNWYD PA 19004 93183447 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 1861 44 0 0 23541 0 87581437 93084571 44935 43040 0 55836 87649913 93183447 100 1567850 0 0 40303394 41332527 0 0 0 43684944 47299771 83988438 90200148 3661475 2983299 31808545 35550558 6351457 6689171 25457088 28861387 X 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. 0 0 71576443 93140407 THE ORGANIZATION PROVIDES NUMEROUS ACTIVITIES AND PROGRAMS INCORPORATING AND PROMOTING FAMILY ACTIVITIES AND INVOLVEMENT WITH RESIDENTS AND STAFF. THESE ACTIVITIES PROMOTE A NORMALIZED CARE ENVIRONMENT. 71576443 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 1 0 0 0 0 1 0 0 0 0 0 1 349 0 1 1861 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 1 1 X FISCAL SERVICES GROUP LLC CO JOHN BRANNAN 4149088000 111 WEST MICHIGAN STREET 9TH FLOOR MILWAUKEE WI 53203 HARRY DILLON MADONNA 10.00 X X 0 0 0 ANN MULLEN 1.00 X 10000 0 0 SANDRA OLIVER 1.00 X 10000 0 0 JOHN S SEAL JR 1.00 X 10000 0 0 BRIAN M WYATT 1.00 X 8000 0 0 KAREN T SOEHNER 40.00 X 118063 0 3991 LYNDA K LOVELL 40.00 X 109991 0 8515 MELISSA A FIJALKOWSKI 40.00 X 104259 0 7950 RICHARD A NATHANS 40.00 X 100428 0 4061 470741 0 24517 10 0 0 0 AEGIS THERAPIES INC PO BOX 277365 ATLANTA GA 30384 PHYSICAL THERAPY 8178304 HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DRIVE STE 300 BENSALEM PA 19020 HOUSEKEEPING AND LAUNDRY 2392652 BRIGID HEALTH MANAGEMENT LLC 1675 PALM BEACH LAKES BLVD SUITE WEST PALM BEACH FL 33401 MANAGEMENT 1248211 ELEUS HEALTH MANAGEMENT LLC 1675 PALM BEACH LAKES BLVD SUITE WEST PALM BEACH FL 33401 MANAGEMENT 1212692 THEMIS HEALTH MANAGEMENT LLC 1675 PALM BEACH LAKES BLVD SUITE WEST PALM BEACH FL 33401 MANAGEMENT 787309 5 RESIDENT SERVICE REVEN 623000 93084571 93084571 93084571 43040 43040 OTHER INCOME 623000 55836 55836 55836 93183447 93140407 0 43040 1567850 1567850 38000 38000 36206522 33353260 2853262 2229807 1913883 315924 2858198 2628433 229765 3964123 3964123 2630852 16883 2613969 79104 79104 142678 26868 115810 7937869 7937869 168125 24726 143399 5664 511 5153 38152 38152 628833 628833 1781020 696910 1084110 CONTRACT SERVICES 16224008 10286242 5937766 BAD DEBT 3870003 3870003 PHARMACY 2606194 2606194 FOOD 2072287 2008295 63992 EQUIPMENT RENTAL 1642358 1525769 116589 3508501 2351642 1156859 90200148 71576443 18623705 0 7487356 6008270 8019976 8959254 1706128 793802 7076586 1857765 4878256 5218821 9716829 14570411 31808545 35550558 5815692 6091992 535765 597179 6351457 6689171 X 25457088 28861387 25457088 28861387 31808545 35550558 X 2983299 421000 X X 0 1 1 X 0 X 727 9378 23541 33646 74346697 75984363 79318070 87581437 93084572 410315139 74346697 75985090 79327448 87604978 93084572 410348785 0 0 0 410348785 308563 581697 222229 44935 43040 1200464 308563 581697 222229 44935 43040 1200464 460000 395000 72000 55836 982836 75115260 76961787 79621677 87649913 93183448 412532085 0.99470 0.99370 0.00290 0.00390 X 1 553169 111756 441413 0 4872231 1205766 3666465 2204355 651999 1552356 5218821 INVESTMENT IN CAPTIVE 2445000 ASSETS WHOSE USE IS LIMITED 11094047 AMOUNTS HELD BY LENDER UNDER REVOLVING LINE OF CREDIT 1031364 14570411 DUE TO AFFILIATES 31883 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 565296 597179 93183447 90200148 2983299 421000 421000 3404299 93604447 421000 421000 93183447 0 93183447 90200148 0 90200148 0 90200148 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 ACTS ONLY AS A CUSTODIAN. 1 FLORIDA HEALTH CARE ASSOCIATION 307 WEST PARK AVENUE TALLAHASSEE FL 32301 591229583 501(C)(6) 67500 0 CONTRIBUTION FRONT LINE FOUNDATION FOR LONG-TERM CARE 435 SCRANTON CARBONDALE HIGHWAY SCRANTON PA 18508 311779620 501(C)(3) 1500000 0 CONTRIBUTION 2 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE MANAGING AGENT OF THE ORGANIZATION, AIRAMID HEALTH MANAGEMENT,LLC, 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. THE ORGANIZATION HAS ASKED FRONTLINE FOUNDATION FOR LONG TERM CARE TO NOTIFY THEM AS TO WHAT THE GRANT MONEY IS BEING USED FOR BEFORE FUNDS ARE SPENT. MATURE CARE INSURANCE CO AN ENTITY OF WHICH A CURRENT OFFICER/DIRECTOR SERVES AS A DIRECTOR. 1711285 INS. PREMS. 1 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 MANAGEMENT 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 MANAGEMENT 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 421,000. 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 1675 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33401 263410674 NURSING FL 0 0 HEARTHSTONE SENIOR COMMUNITIES INC BAY CENTER REHABILITATION CENTER LLC 1675 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33401 263411018 NURSING FL 0 0 HEARTHSTONE SENIOR COMMUNITIES INC BOCA CIEGA REHABILITATION CENTER LLC 1675 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33401 263411147 NURSING FL 0 0 HEARTHSTONE SENIOR COMMUNITIES INC CLEARWATER REHABILITATION CENTER LLC 1675 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33401 263419520 NURSING FL 0 0 HEARTHSTONE SENIOR COMMUNITIES INC EGRET COVE REHABILITATION CENTER LLC 1675 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33401 263411425 NURSING FL 0 0 HEARTHSTONE SENIOR COMMUNITIES INC EMERALD COAST REHABILITATION CENTER LLC 1675 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33401 263411532 NURSING FL 0 0 HEARTHSTONE SENIOR COMMUNITIES INC GROVES REHABILITATION CENTER LLC 1675 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33401 263411666 NURSING FL 0 0 HEARTHSTONE SENIOR COMMUNITIES INC LAKELAND HILLS REHABILITATION CENTER LLC 1675 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33401 263411839 NURSING FL 0 0 HEARTHSTONE SENIOR COMMUNITIES INC TARPON REHABILITATION CENTER LLC 1675 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33401 263411945 NURSING FL 0 0 HEARTHSTONE SENIOR COMMUNITIES INC UNIVERSITY EAST REHABILITATION CENTER LLC 1675 PALM BEACH LAKES BLVD WEST PALM BEACH FL 33401 263412167 NURSING FL 0 0 HEARTHSTONE SENIOR COMMUNITIES INC