Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
|||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 8,290 | 64,375 | 53,533 | 9,870 | 8,204 | 144,272 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | 10,516,999 | 10,993,169 | 11,693,581 | 11,236,989 | 12,517,679 | 56,958,417 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 44,361 | 55,696 | 55,518 | 52,712 | 50,321 | 258,608 |
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 6 | Total. Add lines 1 through 5. | 10,569,650 | 11,113,240 | 11,802,632 | 11,299,571 | 12,576,204 | 57,361,297 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | Public Support (Subtract line 7c from line 6.) | 57,361,297 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 10,569,650 | 11,113,240 | 11,802,632 | 11,299,571 | 12,576,204 | 57,361,297 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 147,174 | 256,506 | 516,828 | 316,882 | 265,991 | 1,503,381 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 147,174 | 256,506 | 516,828 | 316,882 | 265,991 | 1,503,381 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | 6,569 | 0 | 0 | 0 | 0 | 6,569 |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 10,723,393 | 11,369,746 | 12,319,460 | 11,616,453 | 12,842,195 | 58,871,247 |




| Facts And Circumstances Test |
|---|
| Explanation |
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| OTHER INCOME, SCHEDULE A, PART III, LINE 12, DESCRIPTION - OTHER INCOME, COLUMN A - 6569, COLUMN B - 0, COLUMN C - 0, COLUMN D - 0, COLUMN E - 0, COLUMN F - 6569;, |
| Software ID: | 11000230 |
| Software Version: | v2011.1.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART III, LINE 1 | (CONTINUED FROM PART III) EACH RESIDENT IS RECOGNIZED AS A UNIQUE INDIVIDUAL WHO SEEKS AND DESERVES TO REACH HIS OR HER OPTIMAL POTENTIAL. OUR HEALTHCARE TEAM IS DEDICATED TO PROVIDING SERVICES THAT ARE CREATIVE AND INNOVATIVE, ALLOWING OUR RESIDENTS TO ACHIEVE THE HIGHEST QUALITY OF LIFE. |
| Review of form 990 by governing body | Form 990, Part VI, Section B, Line 11b | THE FORM 990 IS REVIEWED IN DETAIL BY THE EXECUTIVE DIRECTOR, CFO, AND THE PRESIDENT OF THE BOARD. AFTER ANY CHANGES AND / OR QUESTIONS ARE ADDRESSED, THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE GOVERNING BODY AT A REGULARLY SCHEDULED BOARD MEETING PRIOR TO FILING WITH THE IRS. |
| Conflict of interest policy | Form 990, Part VI, Section B, Line 12c | ALL MEMBERS OF THE BOARD OF DIRECTORS AND DEPARTMENT HEADS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. THE CFO AND THE EXECUTIVE DIRECTOR REVIEW ALL STAFF CONFLICT OF INTEREST STATEMENTS FOR POTENTIAL CONFLICTS AND THE PRESIDENT OF THE BOARD OF DIRECTORS REVIEWS ALL BOARD CONFLICT OF INTEREST STATEMENTS FOR POTENTIAL CONFLICTS. THE BOARD PRESIDENT MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. IF A CONFLICT OF INTEREST EXISTS WITH A BOARD MEMBER, THE INTERESTED PERSON WILL ABSTAIN FROM VOTING ON DECISIONS RELATED TO THE CONFLICT OF INTEREST AT THE BOARD AND COMMITTEE LEVELS. CURRENTLY THE CONFLICT OF INTEREST POLICY IS WITH THE FACILITY'S ATTORNEY AND IS BEING REVIEWED FOR ANY NECESSARY CHANGES. |
| WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY | FORM 990, PART VI, LINE 14 | ALTHOUGH THE ORGANIZATION DOES NOT HAVE A FORMAL WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY, IT DOES HAVE AN INFORMAL PROCEDURE THAT IS CURRENTLY FOLLOWED. IN ADDITION, THE ORGANIZATION IS IN THE PROCESS OF HAVING A FORMAL WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY CREATED AND PUT IN PLACE. |
| Process used to establish compensation of top management official | Form 990, Part VI, Section B, Line 15a | THE BOARD'S PERSONNEL COMMITTEE USES COMPARABILITY DATA, INCLUDING COMPENSATION SURVEYS AND FORMS 990 OF OTHER ORGANIZATIONS, TO DETERMINE AND PROPOSE A REASONABLE COMPENSATION AMOUNT FOR THE EXECUTIVE DIRECTOR. NEXT, THE BOARD OR DIRECTORS REVIEWS THE PERSONNEL COMMITTEE'S FINDINGS AND APPROVES THE PROPOSED AMOUNT OF COMPENSATION. THE REVIEW AND APPROVAL IS DOCUMENTED IN THE BOARD MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN 2011. |
| PROCESS USED TO ESTABLISH COMPENSATION OF OFFICERS/KEY EMPLOYEES | FORM 990, PART VI, LINE 15B | COMPENSATION OF THE OTHER OFFICERS IS DETERMINED BY THE EXECUTIVE DIRECTOR AND DOCUMENTED IN EMPLOYEE FILES. THIS PROCESS IS UNDERTAKEN ANNUALLY. |
| Governing documents, conflict of interest policy and financial statements available to the public | Form 990, Part VI, Section C, Line 19 | FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO THE INTERNAL REVENUE CODE (IRC) SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. |
| Other changes in net assets or fund balances | Form 990, Part XI, Line 5 | NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - 43597; |
| Software ID: | 11000230 |
| Software Version: | v2011.1.0 |