Form990-PF

Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Nonexempt Charitable Trust
Treated as a Private Foundation
Note. The foundation may be able to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0052
2010
For calendar year 2010, or tax year beginning 10-01-2010 , and ending 09-30-2011
G
Check all that apply:
Name of foundation
TRI-CITY CARE INC
 

Number and street (or P.O. box number if mail is not delivered to street address)15 FIRST STREET   Room/suite
City or town, state, and ZIP code
STANLEY, ND58784
A Employer identification number

45-0382997
B Telephone number (see page 10 of the instructions)

(701) 628-2990
C bullet
D 1. bullet
H Check type of organization:
2. bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$804,749J Accounting method:
 
(Part I, column (d) must be on cash basis.)
E bullet
F bullet
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see page 11 of the instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 14,668
2 Check bullet
3 Interest on savings and temporary cash investments 601 601 601
4 Dividends and interest from securities......      
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10  
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)... 0
8 Net short-term capital gain......... 0
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule)....... Click to see attachment 2,629,241 0 2,629,241
12 Total. Add lines 1 through 11........ 2,644,510 601 2,629,842
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 55,039 0 0 55,039
14 Other employee salaries and wages...... 1,562,680 0 1,562,680 0
15 Pension plans, employee benefits....... 316,756 0 310,186 6,570
16a Legal fees (attach schedule)......... Click to see attachment 600 0 0 600
b Accounting fees (attach schedule)....... Click to see attachment 23,701 0 0 23,701
c Other professional fees (attach schedule).... Click to see attachment 72,743 0 0 72,743
17 Interest...............        
18 Taxes (attach schedule) (see page 14 of the instructions)        
19 Depreciation (attach schedule) and depletion... Click to see attachment 28,210 0 28,210
20 Occupancy.............. 71,875 0 59,477 12,398
21 Travel, conferences, and meetings....... 16,626 0 0 16,626
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 504,427 0 399,042 102,781
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 2,652,657 0 2,359,595 290,458
25 Contributions, gifts, grants paid........ 0 0
26 Total expenses and disbursements. Add lines 24 and 25 2,652,657 0 2,359,595 290,458
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -8,147
b Net investment income (if negative, enter -0-) 601
c Adjusted net income (if negative, enter -0-)... 270,247
For Privacy Act and Paperwork Reduction Act Notice, see page 30 of the instructions.
Cat. No. 11289X Form 990-PF (2010)
Form 990-PF (2010)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)		 Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing...............      
2 Savings and temporary cash investments.......... 392,512 295,886 295,886
3 Accounts receivable bullet195,826
Less: allowance for doubtful accounts bullet13,000 176,668 182,826 182,826
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use...............      
9 Prepaid expenses and deferred charges........... 15,009 20,098 20,098
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)........      
c Investments—corporate bonds (attach schedule)........      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)........... 47,395 Click to see attachment12,984 12,984
14 Land, buildings, and equipment: basis bullet1,518,411
Less: accumulated depreciation (attach schedule) bullet1,225,456 224,807 Click to see attachment292,955 292,955
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 856,391 804,749 804,749
Liabilities 17 Accounts payable and accrued expenses.......... 475,411 441,944
18 Grants payable...................    
19 Deferred revenue..................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)...... 26,461 Click to see attachment18,319
22 Other liabilities (describe bullet) Click to see attachment483,505 Click to see attachment481,619
23 Total liabilities (add lines 17 through 22).......... 985,377 941,882
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................... -128,986 -137,133
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds.........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see page 17 of the
instructions).................... -128,986 -137,133
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 856,391 804,749
Part III Analysis of Changes in Net Assets or Fund Balances
1 Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree
with end-of-year figure reported on prior year’s return)............... 1 -128,986
2 Enter amount from Part I, line 27a...................... 2 -8,147
3 Other increases not included in line 2 (itemize) bullet 3 0
4 Add lines 1, 2, and 3.......................... 4 -137,133
5 Decreases not included in line 2 (itemize) bullet 5 0
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30.. 6 -137,133
Form 990-PF (2010)
Form 990-PF (2010)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.) 		(b) How acquired
P—Purchase
D—Donation 		(c) Date acquired
(mo., day, yr.) 		(d) Date sold
(mo., day, yr.)
1a
b
c
d
e
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2  
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see pages 13 and 17 of the instructions).
If (loss), enter -0- in Part I, line 8 . . . . . . . . . . . . . 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)

If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If “Yes,” the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in) 		(b)
Adjusted qualifying distributions 		(c)
Net value of noncharitable-use assets 		(d)
Distribution ratio
(col. (b) divided by col. (c))
2009 223,469 333,546 0.669980
2008 176,955 229,674 0.770462
2007 199,757 358,010 0.557965
2006 166,043 696,220 0.238492
2005      
2 Total of line 1, column (d) ...................... 2 2.236899
3 Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years. . . 		3 0.559225
4 Enter the net value of noncharitable-use assets for 2010 from Part X, line 5..... 4 327,434
5 Multiply line 4 by line 3....................... 5 183,109
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6 6
7 Add lines 5 and 6......................... 7 183,115
8 Enter qualifying distributions from Part XII, line 4.............. 8 290,458
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See
the Part VI instructions on page 18.
Form 990-PF (2010)
Form 990-PF (2010)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a Bulletand enter “N/A” on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 6
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2............................ 3 6
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-). 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 6
6 Credits/Payments:
a 2010 estimated tax payments and 2009 overpayment credited to 2010 6a  
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 0
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 6
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2011 estimated taxBullet   Refunded Bullet 11  
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of
the instructions for definition)?.............................
1b
 
No
If the answer is “Yes” to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If “Yes,” attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If “Yes,” attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If “Yes,” has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If “Yes,” attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If “Yes,” complete Part II, col. (c), and Part XV.
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see page 19 of the
    instructions)bulletND
    b
    If the answer is “Yes” to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If “No,” attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2010 or the taxable year beginning in 2010 (see instructions for Part XIV on
    page 27)? If “Yes,” complete Part XIV...........................
    9
    Yes
     
    10
    Did any persons become substantial contributors during the tax year? If “Yes,” attach a schedule listing their names and addresses.
    10
     
    No
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see page 20 of the instructions) .......
    11
     
    No
    12
    Did the foundation acquire a direct or indirect interest in any applicable insurance contract before August 17, 2008?
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletBRITTA ENGET Telephone no.bullet (701) 628-2990
    Located atbulletPO BOX 423STANLEYND ZIP+4bullet58784
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16
    At any time during calendar year 2010, did the foundation have an interest in or a signature or other authority over
    a bank, securities, or other financial account in a foreign country? .................
    16
     
    No
    See page 20 of the instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes", enter the name of the foreign country bullet  
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 5
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the “Yes” column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?.........................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?.................
    (6) Agree to pay money or property to a government official? (Exception. Check “No”
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).........
    b
    If any answer is “Yes” to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance (see page 20 of the instructions)?...
    1b
     
    No
    .........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2010?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2010, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2010?...............
    If “Yes,” list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer “No” and attach statement—see page 20 of the instructions.) .........
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business
    enterprise at any time during the year?.....................
    b
    If “Yes,” did it have excess business holdings in 2010 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2010.)....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2010?
    4b
     
    No
    5a
    During the year did the foundation pay or incur any amount to:
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?...............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see page 22 of the instructions)...
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?........
    b
    If any answer is “Yes” to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see page 22 of the instructions)?
    5b
     
     
    .........bullet
    c
    If the answer is “Yes” to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?............
    If “Yes,” attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay
    premiums on a personal benefit contract?....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    If “Yes” to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 6
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see page 22 of the instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to
    employee benefit plans
    and deferred compensation     		(e) Expense account,
    other allowances
    PATTY HERSEL PRESIDENT
    1.00     		0 0 0
    15 FIRST STREET
    STANLEY,ND58784
    JODI OBERT VICE PRESIDENT
    1.00     		0 0 0
    15 FIRST STREET
    STANLEY,ND58784
    ANITA ROHDE SECRETARY THROUGH 1/31/11
    1.00     		0 0 0
    15 FIRST STREET
    STANLEY,ND58784
    JENNY SMITH DIRECTOR; SECRETARY
    1.00     		0 0 0
    15 FIRST STREET
    STANLEY,ND58784
    DOUGLAS DOWNIE DIRECTOR
    1.00     		0 0 0
    15 FIRST STREET
    STANLEY,ND58784
    COREY RICE DIRECTOR
    1.00     		0 0 0
    15 FIRST STREET
    STANLEY,ND58784
    COLLEEN REESE DIRECTOR
    1.00     		0 0 0
    15 FIRST STREET
    STANLEY,ND58784
    COLLEEN ROHDE DIRECTOR THROUGH 8/22/11
    1.00     		0 0 0
    15 FIRST STREET
    STANLEY,ND58784
    TODD HEIDBREDER DIRECTOR THROUGH 3/28/11
    1.00     		0 0 0
    15 FIRST STREET
    STANLEY,ND58784
    SUZI ANDERSON DIRECTOR THROUGH 1/31/11
    1.00     		0 0 0
    15 FIRST STREET
    STANLEY,ND58784
    CHERYL EVENSOLD EXECUTIVE DIRECTOR
    40.00     		55,039 6,570 0
    15 FIRST STREET
    STANLEY,ND58784
    2 Compensation of five highest-paid employees (other than those included on line 1—see page 23 of the instructions).
    If none, enter “NONE.”
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    JERROLYN WIRTZ INDVIDUAL PROG. COOR
    40.00     		59,593 6,787 0
    15 FIRST STREET
    STANLEY,ND58784
    TRUDY BERGSTROM DIRECT SERVICE PROVI
    60.00     		54,351 6,682 0
    15 FIRST STREET
    STANLEY,ND58784
    ROBIN OMAR RESIDENTIAL COORDINA
    50.00     		50,416 6,176 0
    15 FIRST STREET
    STANLEY,ND58784
    Total number of other employees paid over $50,000...................bullet 3
    3 Five highest-paid independent contractors for professional services (see page 23 of the instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1 TRI-CITY CARE INC. PROVIDES VOCATIONAL SERVICES AND RESIDENTIAL OPPORTUNITIES FOR DEVELOPMENTALLY DISABLED INDIVIDUALS IN MOUNTRAIL AND WILLIAMS COUNTIES. TRI-CITY HELPS ASSIST INDIVIDUALS IN ATTAINING THEIR MAXIMUM LEVEL OF INDEPENDENCE THROUGH THE PROVISION OF THE RESIDENTIAL, VOCATIONAL, AND GENERIC SUPPORT SERVICES. DISABLED INDIVIDUALS ARE PROVIDED INDIVIDUALIZED COMPREHENSIVE SUPPORT AND SERVICES TO HELP ENABLE THEM TO MEET THEIR PERSONAL GOALS AND BE INCLUDED IN THE COMMUNITY. 2,288,662
    2 SUPPORT SERVICES OF PRODUCTION PROGRAMS FOCUS ON EMPLOYMENT ACTIVITIES FOR THE DISABLED. TRAINED STAFF PROVIDE SUPPORT TO DISABLED PEOPLE IN THE PROGRAM TO ASSIST THEM IN TRAINING FOR JOBS SO THAT THE DISABLED MAY HAVE A MORE PRODUCTIVE ROLE IN THE COMMUNITY. 70,933
    3  
    4  
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 7
    Part IX-B
    Summary of Program-Related Investments (see page 23 of the instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See page 24 of the instructions.
    3  
    Total. Add lines 1 through 3...........................bullet0
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
    see page 24 of the instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    0
    b
    Average of monthly cash balances.......................
    1b
    332,420
    c
    Fair market value of all other assets (see page 24 of the instructions)............
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    332,420
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) ..............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d..........................
    3
    332,420
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ............................
    4
    4,986
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    327,434
    6
    Minimum investment return. Enter 5% of line 5...................
    6
    16,372
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
     
    2a
    Tax on investment income for 2010 from Part VI, line 5......
    2a
     
    b
    Income tax for 2010. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
     
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
     
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4.............................
    5
     
    6
    Deduction from distributable amount (see page 25 of the instructions)...........
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1.................................
    7
     
    Part XII
    Qualifying Distributions (see page 25 of the instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    290,458
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes................................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    290,458
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b (see page 26 of the instructions)............
    5
    6
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4...............
    6
    290,452
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 8
    Part XIII
    Undistributed Income (see page 26 of the instructions)
    (a)
    Corpus     		(b)
    Years prior to 2009     		(c)
    2009     		(d)
    2010
    1 Distributable amount for 2010 from Part XI, line 7  
    2 Undistributed income, if any, as of the end of 2010:
    a Enter amount for 2009 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2010:
    a From 2005.......  
    b From 2006.......  
    c From 2007.......  
    d From 2008.......  
    e From 2009.......  
    fTotal of lines 3a through e.........  
    4Qualifying distributions for 2010 from Part
    XII, line 4: bullet$  
    a Applied to 2009, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see page 26 of the instructions)    		  
    c Treated as distributions out of corpus (Election
    required—see page 26 of the instructions)...     		 
    d Applied to 2010 distributable amount.....  
    e Remaining amount distributed out of corpus  
    5 Excess distributions carryover applied to 2010.    
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5  
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		 
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		 
    d Subtract line 6c from line 6b. Taxable
    amount—see page 27 of the instructions ...     		 
    e Undistributed income for 2009. Subtract line
    4a from line 2a. Taxable amount—see page 27
    of the instructions ...........     		 
    f Undistributed income for 2010. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2011 ..........     		 
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see page 27
    of the instructions) ...........     		 
    8Excess distributions carryover from 2005 not
    applied on line 5 or line 7 (see page 27 of the
    instructions) .............     		 
    9Excess distributions carryover to 2011.
    Subtract lines 7 and 8 from line 6a ......     		 
    10 Analysis of line 9:
    a Excess from 2006....  
    b Excess from 2007....  
    c Excess from 2008....  
    d Excess from 2009....  
    e Excess from 2010....  
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 9
    Part XIV
    Private Operating Foundations (see page 27 of the instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2010, enter the date of the ruling.......bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2010 (b) 2009 (c) 2008 (d) 2007
    16,372 16,677 11,484 17,901 62,434
    b 85% of line 2a ......... 13,916 14,175 9,761 15,216 53,069
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		290,458 223,480 176,967 199,809 890,714
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ....     		0 0 0 0 0
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		290,458 223,480 176,967 199,809 890,714
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets” alternative test—enter:
    (1) Value of all assets ...... 2,030,205 2,053,801 1,885,277 1,794,863 7,764,146
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		 1,762,541 1,659,506 1,645,703 1,607,728 6,675,478
    b “Endowment” alternative test— enter 2⁄3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		        0
    c “Support” alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		        0
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		        0
    (3) Largest amount of support
    from an exempt organization    		         0
    (4) Gross investment income         0
    Part XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see page 27 of the instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 10
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    Total .................................bullet 3a 0
    bApproved for future payment
    Total ..................................bullet 3b 0
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 11
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See page 28 of
    the instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    aRESIDENT PAYMENTS         2,499,547
    bPRODUCTION AND CONTRACTED SERVICES         80,202
    cOTHER REVENUE         22,846
    dBAD DEBT RECOVERY         26,646
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3Interest on savings and temporary cash investments     14 601  
    4 Dividends and interest from securities....          
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8Gain or (loss) from sales of assets other than inventory          
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e).. 0 601 2,629,241
    13Total. Add line 12, columns (b), (d), and (e)...................
    132,629,842
    (See worksheet in line 13 instructions on page 28 to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the organization’s exempt purposes (other than by providing funds for such purposes). (See
    page 28 of the instructions.)
    1A TRI-CITY CARE PROVIDES RESIDENTIAL HOUSING AND DAY ACTIVITIES TO DEVELOPMENTALLY DISABLED INDIVIDUALS.
    1C TRI-CITY CARE SUPERVISES A PROGRAM WHICH ALLOWS DEVELOPMENTALLY DISABLED INDIVIDUALS TO HAVE EMPLOYMENT OPPORTUNITIES THEREBY ENHANCING THE INDEPENDENCE OF THE PARTICIPANTS AND ALLOWING THEM TO HAVE A MORE PRODUCTIVE ROLE IN THE COMMUNITY.
    1D MISCELLANEOUS PROCEEDS ARE USED TO BETTER SERVE THE RESIDENTS.
    1E RECOVERY OF ACCOUNTS RECEIVABLE THAT HAD PREVIOUSLY BEEN WRITTEN OFF AS BAD DEBT.
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 12
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section
    Yes
    No
    501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash....................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements............................
    1b(4)
     
    No
    (5) Loans or loan guarantees..............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is “Yes,” complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........
    b
    If “Yes,” complete the following schedule.
    (a) Name of organization (b) Type of organization (c) Description of relationship
    SignHere
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer or fiduciary) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    Signature of officer or trustee Date Title
    PaidPreparersUseOnly Preparer's SignatureBullet Date PTIN
    Firm's namebullet



    Firm's addressbullet







         		Firm's EINbullet
    Phone no.
    Form 990-PF (2010)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2010 AccountingFeesSchedule
    Name:
    TRI-CITY CARE INC
    EIN: 45-0382997
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 23,701 0 0 23,701

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2010 DepreciationSchedule
    Name:
    TRI-CITY CARE INC
    EIN: 45-0382997
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    85BUILDING 2005-09-01 17,043 3,409 SL 25.000000000000 682 0 682  
    86REMODELING 2005-09-01 1,800 360 SL 25.000000000000 72 0 72  
    87ROOFING 2006-05-01 1,822 804 SL 10.000000000000 182 0 182  
    88GENERAL REMODEL 2006-05-01 6,900 1,219 SL 25.000000000000 276 0 276  
    89PLUMBING 2006-05-01 4,236 936 SL 20.000000000000 212 0 212  
    90HEATING 2006-05-01 4,290 1,263 SL 15.000000000000 286 0 286  
    91ELECTRICAL 2006-05-01 4,904 1,203 SL 18.000000000000 272 0 272  
    72BUILDING 1987-09-01 141,271 141,271 SL 25.000000000000 0 0 0  
    73REMODELING 1987-09-01 3,105 3,104 SL 22.000000000000 0 0 0  
    74SHINGLES 2002-09-01 8,187 6,619 SL 10.000000000000 819 0 819  
    110A/C CONDENSER 2007-06-30 1,934 280 SL 25.000000000000 77 0 77  
    120FENCE 2010-08-31 3,200 27 SL 10.000000000000 320 0 320  
    127HAND RAILS 2010-07-31 2,194 24 SL 15.000000000000 146 0 146  
    33BUILDING 1987-09-01 139,603 139,603 SL 25.000000000000 0 0 0  
    34REMODELING 1987-09-01 4,205 4,204 SL 22.000000000000 0 0 0  
    35ALARMS 1987-09-01 2,750 2,750 SL 22.000000000000 0 0 0  
    36SPRINKLERS 1987-09-01 3,500 3,500 SL 22.000000000000 0 0 0  
    37SHINGLES 2000-07-01 9,843 9,843 SL 10.000000000000 0 0 0  
    38RAIN GUTTERS 2005-09-01 1,300 434 SL 15.000000000000 87 0 87  
    39HAND RAILS 2005-11-01 2,362 774 SL 15.000000000000 157 0 157  
    40FIRE WALL IN GARAGE 2006-04-01 2,000 360 SL 25.000000000000 80 0 80  
    114FURNACE 2009-09-30 4,950 330 SL 15.000000000000 330 0 330  
    1BUILDING - TCC 1989-08-01 338,264 338,264 SL 25.000000000000 0 0 0  
    3REMODELING 1996-04-01 668 350 SL 25.000000000000 27 0 27  
    4REMODELING 2002-05-01 6,925 3,887 SL 15.000000000000 462 0 462  
    5STEEL CAR PORT 2004-05-01 33,156 11,062 SL 20.000000000000 1,658 0 1,658  
    6ROOF COVERING 2005-05-01 5,000 2,708 SL 10.000000000000 500 0 500  
    126AUTOMATIC DOORS 2010-09-30 4,715   SL 10.000000000000 472 0 472  
    54REMODELING 1987-09-01 4,351 4,351 SL 22.000000000000 0 0 0  
    55ALARMS 1987-09-01 2,750 2,750 SL 22.000000000000 0 0 0  
    56SPRINKLERS 1987-09-01 3,500 3,500 SL 22.000000000000 0 0 0  
    57SHINGLES 2001-07-01 8,693 8,039 SL 10.000000000000 654 0 654  
    58SPRINKLERS 2005-08-01 1,700 351 SL 25.000000000000 68 0 68  
    59HAND RAILS 2005-11-01 2,580 846 SL 15.000000000000 172 0 172  
    60FIRE WALL IN GARAGE 2006-04-01 2,100 378 SL 25.000000000000 84 0 84  
    97BUILDING 1985-09-01 142,290 142,290 SL 25.000000000000 0 0 0  
    115WINDOWS 2009-09-23 4,037 202 SL 20.000000000000 202 0 202  
    119FENCE 2010-08-31 4,250 35 SL 10.000000000000 425 0 425  
    100SPECIAL ASSESSMENTS 1989-08-01 5,879 5,879 SL 10.000000000000 0 0 0  
    96SPECIALS 1987-09-01 2,313 2,313 SL 10.000000000000 0 0 0  
    15FENCE 1994-05-01 549 549 SL 10.000000000000 0 0 0  
    16DISHWASHER 1995-01-01 380 380 SL 10.000000000000 0 0 0  
    17RECLINER 1995-01-01 736 736 SL 10.000000000000 0 0 0  
    18COMPUTER 1995-06-01 1,649 1,649 SL 10.000000000000 0 0 0  
    19FLOOR SCRUBBER 1996-10-01 825 825 SL 10.000000000000 0 0 0  
    20COMPUTER 1998-02-01 3,198 3,198 SL 5.000000000000 0 0 0  
    21PAPER SHEDDER 1998-08-01 2,149 2,149 SL 5.000000000000 0 0 0  
    22COMPUTER 1999-05-01 3,579 3,579 SL 5.000000000000 0 0 0  
    24TWO COMPUTERS 2000-05-01 3,752 3,752 SL 5.000000000000 0 0 0  
    25COMPUTER 2001-01-01 1,318 1,318 SL 5.000000000000 0 0 0  
    26COMPUTER 2001-03-01 2,220 2,220 SL 5.000000000000 0 0 0  
    27COMPUTER 2002-05-01 2,267 2,267 SL 5.000000000000 0 0 0  
    28DOORS AUTOMATIC 2003-12-01 5,316 3,450 SL 10.000000000000 532 0 532  
    29SAVIN 2545 COPIER 2006-07-01 4,000 3,400 SL 5.000000000000 600 0 600  
    31RED VAN-1991 1994-05-01 2,702 2,702 SL 4.000000000000 0 0 0  
    32BUICK-1999 2003-04-01 6,600 6,600 SL 4.000000000000 0 0 0  
    101EQUIPMENT - DEPRECIATED 1991-02-01 141,043 141,043 SL 10.000000000000 0 0 0  
    108LAPTOP COMPUTER 2007-08-08 1,401 1,401 SL 3.000000000000 0 0 0  
    118CARPET 2009-09-30 1,462 292 SL 5.000000000000 292 0 292  
    125PHONE SYSTEM 2010-09-14 4,077 34 SL 10.000000000000 408 0 408  
    128FORD EXPLORER 2009-12-14 33,469 6,961 SL 4.000000000000 8,367 0 8,367  
    76CARPET 1992-02-01 1,786 1,786 SL 10.000000000000 0 0 0  
    77LINOLEUM 1993-09-01 1,144 1,144 SL 10.000000000000 0 0 0  
    78CHAIRS 1994-07-01 1,121 1,121 SL 10.000000000000 0 0 0  
    79LINOLEUM 1994-12-01 1,567 1,567 SL 10.000000000000 0 0 0  
    80DISHWASHER 1994-10-01 365 365 SL 10.000000000000 0 0 0  
    81105' FENCE 1999-08-01 1,300 963 SL 15.000000000000 87 0 87  
    82WATER HEATER 1999-12-01 1,348 1,348 SL 10.000000000000 0 0 0  
    83AIR COMPRESSOR 2000-07-01 1,900 1,301 SL 15.000000000000 127 0 127  
    84CARPET 2001-05-01 1,585 1,585 SL 5.000000000000 0 0 0  
    104EQUIPMENT- DEPRECIATED 1991-10-01 35,974 35,974 SL 10.000000000000 0 0 0  
    105FIRE ALARM SYSTEM 2007-09-26 4,215 1,265 SL 10.000000000000 422 0 422  
    109VINYL FLOORING 2007-06-08 1,400 467 SL 10.000000000000 140 0 140  
    117VINYL FLOORING 2009-09-30 3,654 365 SL 10.000000000000 365 0 365  
    1222 FURNACES 2010-09-30 4,040   SL 25.000000000000 162 0 162  
    123WATER HEATER 2009-12-31 1,591 119 SL 10.000000000000 159 0 159  
    124AIR CONDITIONER 2010-09-30 3,058   SL 25.000000000000 122 0 122  
    41CARPET 1992-03-01 1,786 1,786 SL 10.000000000000 0 0 0  
    42DISHWASHER 1993-12-01 669 669 SL 10.000000000000 0 0 0  
    45LINOLEUM 1995-06-01 2,216 2,216 SL 10.000000000000 0 0 0  
    46COMPRESSOR 1995-08-01 827 827 SL 10.000000000000 0 0 0  
    47WATER HEATER 1995-08-01 1,296 1,296 SL 10.000000000000 0 0 0  
    48TRIPLE LOUNGE 1996-07-01 1,161 1,161 SL 10.000000000000 0 0 0  
    49CARPET 1996-09-01 633 633 SL 10.000000000000 0 0 0  
    50FENCE 2002-06-01 2,544 1,415 SL 15.000000000000 170 0 170  
    51VINYL FLOORING 2002-10-01 2,423 1,937 SL 10.000000000000 242 0 242  
    52VINYL FLOORING 2003-05-01 1,081 792 SL 10.000000000000 108 0 108  
    53SPRINKLER IN CLOSETS 2004-08-01 2,037 495 SL 25.000000000000 81 0 81  
    9900 GRAY VAN 2003-06-01 8,155 8,155 SL 4.000000000000 0 0 0  
    102EQUIPMENT - DEPRECIATED 1992-03-01 34,748 34,748 SL 10.000000000000 0 0 0  
    107FIRE ALARM SYSTEM 2007-09-26 4,215 1,265 SL 10.000000000000 422 0 422  
    113AIR CONDITIONER 2008-08-01 2,650 230 SL 25.000000000000 106 0 106  
    116VINYL FLOORING 2009-09-30 5,836 584 SL 10.000000000000 584 0 584  
    62LINOLEUM 1993-07-01 1,828 1,828 SL 10.000000000000 0 0 0  
    64LINOLEUM 1993-09-01 784 784 SL 10.000000000000 0 0 0  
    66AC COMPRESSOR 1994-09-01 2,676 2,676 SL 10.000000000000 0 0 0  
    67CARPET 1994-12-01 1,732 1,732 SL 10.000000000000 0 0 0  
    68HOTPOINT RANGE 1995-04-01 429 429 SL 10.000000000000 0 0 0  
    69WATER HEATER 1996-09-01 1,309 1,309 SL 10.000000000000 0 0 0  
    70CARPET 1998-09-01 3,254 3,254 SL 5.000000000000 0 0 0  
    71CARPET 2003-08-01 1,645 1,645 SL 5.000000000000 0 0 0  
    103EQUIPMENT - DEPRECIATED 1993-02-01 34,505 34,505 SL 10.000000000000 0 0 0  
    106FIRE ALARM SYSTEM 2007-09-26 4,215 1,265 SL 10.000000000000 422 0 422  
    1212 FURNACES 2010-03-31 4,272 85 SL 25.000000000000 171 0 171  
    92LAND 2005-09-01 1,800     0 % 0 0 0  
    93LAND 1987-09-01 11,060     0 % 0 0 0  
    94LANDSCAPING 1987-09-01 2,130 2,130 SL 10.000000000000 0 0 0  
    98LAND 1987-09-01 11,559     0 % 0 0 0  
    2LAND 1989-08-01 22,778     0 % 0 0 0  
    95LAND 1987-09-01 9,935     0 % 0 0 0  
    143NEW SEWER SERVICE 2011-03-02 12,663   SL 20.000000000000 369 0 369  
    135NEW SIDING & WINDOWS 2010-11-30 14,886   SL 10.000000000000 1,241 0 1,241  
    142CUPBOARDS 2011-07-16 5,139   SL 10.000000000000 86 0 86  
    134NEW SIDING & WINDOWS 2010-11-30 16,804   SL 10.000000000000 1,400 0 1,400  
    140CUPBOARDS 2011-07-16 5,138   SL 10.000000000000 86 0 86  
    129BALLASTS 2011-05-13 7,801   SL 10.000000000000 325 0 325  
    136NEW SIDING 2010-11-30 17,369   SL 10.000000000000 1,447 0 1,447  
    141CUPBOARDS 2011-07-16 5,139   SL 10.000000000000 86 0 86  
    130MEDICINE CART 2011-05-19 1,500   SL 10.000000000000 50 0 50  
    144EXPRESSO MACHINE 2011-07-26 2,875   SL 5.000000000000 96 0 96  
    133MEDICINE CART 2011-05-19 1,000   SL 10.000000000000 33 0 33  
    139FIRE ALARM PANELS 2011-06-24 1,533   SL 10.000000000000 38 0 38  
    131MEDICINE CART 2011-05-19 1,000   SL 10.000000000000 33 0 33  
    137FIRE ALARM PANEL 2011-06-24 1,533   SL 10.000000000000 38 0 38  
    132MEDICINE CART 2011-05-19 1,000   SL 10.000000000000 33 0 33  
    138FIRE ALARM PANELS 2011-06-24 1,533   SL 10.000000000000 38 0 38  

    TY 2010 InvestmentsOtherSchedule2
    Name:
    TRI-CITY CARE INC
    EIN: 45-0382997
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    MONEY MARKET FUNDS AT COST 4,926 4,926
    CERTIFICATE OF DEPOSIT AT COST 8,058 8,058

    TY 2010 LandEtcSchedule2
    Name:
    TRI-CITY CARE INC
    EIN: 45-0382997
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    LAND 59,262 0 59,262 59,262
    BUILDINGS 1,029,507 864,406 165,101 165,101
    FURNISHINGS AND EQUIPMENT 429,642 361,050 68,592 68,592


    TY 2010 LegalFeesSchedule
    Name:
    TRI-CITY CARE INC
    EIN: 45-0382997
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES 600 0 0 600


    TY 2010 MortgagesAndNotesPayableSch 
    Name:
    TRI-CITY CARE INC
    EIN: 45-0382997
    Total Mortgage Amount:  

    Item No. 1
    Lender's Name PRAIRIE MOTORS INC
    Lender's Title  
    Relationship to Insider NONE
    Original Amount of Loan 32568
    Balance Due 18319
    Date of Note 2009-12
    Maturity Date 2013-12
    Repayment Terms MONTHLY INSTALLMENTS
    Interest Rate 0.000000000000
    Security Provided by Borrower VEHICLE
    Purpose of Loan VEHICLE LEASE
    Description of Lender Consideration  
    Consideration FMV  


    TY 2010 OtherExpensesSchedule
    Name:
    TRI-CITY CARE INC
    EIN: 45-0382997
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    SUPPLIES 106,384 0 29,877 76,507
    POSTAGE AND FREIGHT 3,700 0 0 3,700
    FOOD 61,108 0 61,108 0
    INSURANCE 23,273 0 16,491 6,782
    DUES & SUBSCRIPTIONS 2,480 0 0 2,480
    TRANSPORTATION OF CLIENTS 32,802 0 32,802 0
    MISCELLANEOUS 4,145 0 0 4,145
    PRODUCTION COSTS 45,896 0 45,896 0
    REPAIRS 60,593 0 60,593 0
    LEISURE & RECREATION 10,349 0 10,349 0
    PROVIDER ASSESSMENT 141,926 0 141,926 0
    ADVERTISING 9,167 0 0 9,167
    FEES AND PENALTIES 2,604 0 0 0


    TY 2010 OtherIncomeSchedule2
    Name:
    TRI-CITY CARE INC
    EIN: 45-0382997
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    RESIDENT PAYMENTS 2,499,547   2,499,547
    PRODUCTION AND CONTRACTED SERVICES 80,202   80,202
    OTHER REVENUE 22,846   22,846
    BAD DEBT RECOVERY 26,646   26,646


    TY 2010 OtherLiabilitiesSchedule
    Name:
    TRI-CITY CARE INC
    EIN: 45-0382997
    Description Beginning of Year - Book Value End of Year - Book Value
    ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 483,505 481,619


    TY 2010 OtherProfessionalFeesSchedule
    Name:
    TRI-CITY CARE INC
    EIN: 45-0382997
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    CONSULTANTS 72,743 0 0 72,743