Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 10,140 | 6,124 | 7,035 | 1,752 | 559 | 25,610 |
| 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...... | 50,638,367 | 56,585,641 | 56,758,029 | 55,826,944 | 56,029,319 | 275,838,300 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 99,736 | 181,374 | 222,001 | 66,950 | 126,278 | 696,339 |
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | 50,748,243 | 56,773,139 | 56,987,065 | 55,895,646 | 56,156,156 | 276,560,249 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | 0 | 0 | 0 | 0 | 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 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | Public support (Subtract line 7c from line 6.) | 276,560,249 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 50,748,243 | 56,773,139 | 56,987,065 | 55,895,646 | 56,156,156 | 276,560,249 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 90,410 | 60,184 | 60,363 | 61,543 | 12,259 | 284,759 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 90,410 | 60,184 | 60,363 | 61,543 | 12,259 | 284,759 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 16,813 | 8,944 | 3,133 | 2,932 | 888 | 32,710 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 50,855,466 | 56,842,267 | 57,050,561 | 55,960,121 | 56,169,303 | 276,877,718 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part III, Line 12 Other Income | DESCRIPTION - AIDES IN TRAINING/TRAINING REIMBURSEMENT, COLUMN A - 16813.0, COLUMN B - 8944.0, COLUMN C - 3133.0, COLUMN D - 2932.0, COLUMN E - 888.0, COLUMN F - 32710.0; |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| CoreFormPartIII_PartIIILine4d Description of other program services | (Expenses $ 9,032,213 including grants of $ 0)(Revenue $ 10,697,390) THE ORGANIZATION ALSO OPERATES A LICENSED NURSING HOME IN WEST ALLIS, WISCONSIN. THE ALLIS CARE CENTER PROVIDES CARE TO ELDERLY RESIDENTS, INCLUDING NURSING CARE, ANCILLARY SERVICES, SOCIAL SERVICES, AND OTHER SERVICES AS REQUIRED. THE FACILITY IS CERTIFIED FOR MEDICARE AND MEDICAID AND OPERATES WITH 152 BEDS. THIS FACILITY PROVIDES SERVICES WITHOUT CHARGE, OR AT AMOUNTS LESS THAN ESTABLISHED RATES, TO PATIENTS WHO MEET THE CRITERIA OF ITS CHARITY CARE OR UNINSURED POLICIES. THE CRITERIA FOR CHARITY CARE TAKES INTO CONSIDERATION HEALTH & HUMAN SERVICES FEDERAL POVERTY GUIDELINES, FAMILY ASSETS, FAMILY SIZE, EMPLOYMENT STATUS, ORDINARY FAMILY EXPENSES, AND OTHER RELATED INFORMATION. THE COST OF CHARITY CARE, BASED UPON THE FACILITY'S COST-TO-CHARGE RATIO, PROVIDED BY THIS FACILITY WAS APPROXIMATELY $4,103 IN 2014. |
| CoreFormPartIII_PartIIILine4d Description of other program services | (Expenses $ 6,689,598 including grants of $ 0)(Revenue $ 7,245,882) THE ORGANIZATION OPERATES A LICENSED NURSING HOME IN WHITEHOUSE, TEXAS. THE OAKBROOK NURSING FACILITY (OAKBROOK) PROVIDES CARE TO ELDERLY RESIDENTS, INCLUDING NURSING CARE, ANCILLARY SERVICES, SOCIAL SERVICES, AND OTHER SERVICES AS REQUIRED. OAKBROOK OPERATES A 120 BED NURSING HOME. |
| CoreFormPartIII_PartIIILine4d Description of other program services | (Expenses $ 276,290 including grants of $ 0)(Revenue $ 289,605) THE ORGANIZATION PROVIDES A VARIETY OF SERVICES TO THE ELDERLY AT THREE LOCATIONS IN CHAGRIN FALLS, OHIO: THE ATRIUM AT HAMLET VILLAGE ASSISTED LIVING FACILITY, HAMLET MANOR SKILLED NURSING FACILITY, AND HAMLET VILLAGE - HILLSIDE INDEPENDENT LIVING SENIOR APARTMENTS. |
| CoreFormPartIII_PartIIILine4d Description of other program services | (Expenses $ 46,295 including grants of $ 0)(Revenue $ 0) THE AMERICAN EAGLE PARENT COMPANY OWNS AND PROVIDES THIRD PARTY MANAGEMENT AND ADMINISTRATIVE SERVICES TO ITS FACILITY COMPANIES, WHICH ARE DISREGARDED ENTITIES OF THE PARENT COMPANY. |
| Form 990, Part V, Line 1a ANNUAL SUMMARY AND TRANSMITTAL OF U.S. INFORMATION RETURNS | EACH OF THE DISREGARDED ENTITIES LISTED IN SCHEDULE R, PART I FILES A SEPARATE FORM 1096. THIS REPRESENTS THE TOTAL FOR ALL DISREGARDED ENTITIES. |
| Form 990, Part V, Line 2a TRANSMITTAL OF WAGE AND TAX STATEMENTS | EACH OF THE DISREGARDED ENTITIES LISTED IN SCHEDULE R, PART I FILES A SEPARATE FORM W-3. THIS REPRESENTS THE TOTAL FOR ALL DISREGARDED ENTITIES. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | BY RESOLUTIONS ADOPTED BY A MAJORITY OF THE DIRECTORS IN OFFICE, THE BOARD OF DIRECTORS MAY DESIGNATE FROM AMONG ITS MEMBERS ONE OR MORE EXECUTIVE COMMITTEES, EACH OF WHICH SHALL CONSIST OF TWO OR MORE DIRECTORS, WHICH EXECUTIVE COMMITTEE, TO THE EXTENT PROVIDED IN SUCH RESOLUTION, SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE AFFAIRS OF THE CORPORATION; BUT THE DESIGNATION OF ANY SUCH EXECUTIVE COMMITTEES AND THE DELEGATION THERETO OF AUTHORITY SHALL NOT OPERATE TO RELIEVE THE BOARD OF DIRECTORS, OR ANY INDIVIDUAL DIRECTOR, OF ANY RESPONSIBILITY IMPOSED UPON IT OF HIM BY LAW. |
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | F. SCOTT KELLMAN & BENJAMIN KELLMAN & DANIEL KELLMAN - Family relationship |
| Form 990, Part VI, Line 3 Delegation of management duties | The following organizations entered into management agreements with Medical Rehabilitation Centers, LLC D/B/A EXCEPTIONAL LIVING CENTERS, a Kentucky Corporation to provide substantially all management services for each facility. Managmeent fees include monthly fees plus payroll costs of employees or consultants of the facility who are employees of the manager. -Lexington Healthcare, LLC -American Eagle Nursing Home Company of Eau Claire, LLC -American Eagle Home Place, LLC -American Eagle Sanders Glen, LLC -American Eagle Morning Breeze, LLC -American Eagle Nursing Home Company of Arpin, LLC -American Eagle Nursing Home Company of Colby, LLC -American Eagle Nursing Home Company of Madison, LLC The Oakbrook Health Care Facility entered into a management agreement with Atrium Living Centers of Texas, Inc. Under the agreement, Atrium is to exclusively supervise, direct, and control the management and operation of the facility for a monthly fee. There are no current officers, directors, or highest compensated employees who were compensated by the management companies. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | A final draft of the Form 990, including all applicable schedules, is provided to each member of the governing body before the return is filed with the IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | Annual certifications are received from all officers and directors to determine whether any potential conflicts of interest exist. The board of directors discuss the annual certifications at the board meetings to determine whether an actual conflict of interest exists. If a conflict is determined to exist, that person would be recused from taking part in any decisions concerning the conflicting issue. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | The organization's board of directors reviews and approves the compensation for the organization's President and CEO, F. Scott Kellman, on an annual basis. The board uses current market data for comparability and documents their deliberation and decision in the board meeting minutes; this process was last undertaken during the fourth quarter 2014. In addition, the board of directors obtained compensation studies performed by the Reznick Group, L.C. in July 2008, and Crowe Horwath LLP in September 2010 and in 2013 to use in determining the amount of compensation for 2008 through 2014. This information was documented in the board meeting minutes in 2008, 2010 and 2013 when the compensation studies were reviewed. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | American Eagle Lifecare's Home office has one key employee other than its CEO. This employee, Elan Ruggill serves as a Senior Vice-President. In this capacity he analyses financial statements, supervises American Eagle's managers, and analyses and processes new investments. He is also responsible for our web sites and overseeing the capital repairs at our facilities. Mr. Ruggill's compensation was established after consideration of several factors including the following. *Compensation provided to employees with comparable levels of responsibility at enterprises similar in size and mission to American Eagle as reported in GuideStar Compensation studies and reports. *Discussions with executives from for profit entities in the senior living sector who employ individuals with similar skills and responsibilities to Mr. Ruggill. *Discussions with Mr. Ruggill regarding employment offers he had with other companies. *Consideration by the CEO of appropriate compensation for individuals at Mr. Ruggill's level derived from the CEO's experience as the COO, Chief investment officer, and CEO of public companies involved in the senior housing space. Discussions by the Board's Compensation Committee occurred regarding the above factors and Mr. Ruggill's ultimate compensation, though the Compensation Committee clearly delegated the ultimate decision regarding Mr. Ruggill's compensation to the CEO. |
| Form 990, Part VI, Line 19 Required documents available to the public | The organization's governing documents, conflict of interest policy, and financial statements are made available to the public upon request. |
| Form 990, Part VII, Section A Part VII, Section A | F. Scott Kellman, President & CEO, and Elan Ruggill, Senior Vice President, are paid by American Eagle LifeCare Corporation (EIN 01-0706736). Jordan Bruce, Executive Director, is paid by American Eagle Nursing Home Company of Eau Claire, LLC (EIN 26-3709759). Clare King, RN, is paid by Lexington Healthcare, LLC (EIN 20-1684547). The following board members and officers are paid by American Eagle LifeCare Corporation (EIN 01-0706736): BENJAMIN KELLMAN, VICE PRESIDENT RANDY RUTTA, BOARD MEMBER MARK MILLER, BOARD MEMBER DANIEL KELLMAN, BOARD MEMBER |
| Form 990, Part VIII, Line 11d Other Miscellaneous Revenue | Other - Total Revenue: 39858, Related or Exempt Function Revenue: 888, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 38970; Resident Council - Total Revenue: 1097, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 1097; |
| Form 990, Part IX, Line 11g Other Fees | CONTRACTED STAFF (NURSING, PHARMACIST, PSYCHOLOGIST, MEDICAL DIRECTOR - Total Expense: 7671809, Program Service Expense: 7360262, Management and General Expenses: 311547, Fundraising Expenses: ; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Other changes in net assets - -2431351; |
| Form 990, Part XII, Line 2b AUDITED/COMPILED FINANCIAL STATEMENTS | THE ORGANIZATION RECEIVES FIVE SEPARATE SETS OF AUDITED FINANCIAL STATEMENTS, EACH OF WHICH IS PREPARED IN ACCORDANCE WITH GAAP. THE FINANCIAL INFORMATION IS THEN COMBINED FOR PURPOSES OF THE FORM 990. ONE SET OF AUDITED FINANCIAL STATEMENTS, WHICH IS PREPARED ON A CONSOLIDATED BASIS, CONSISTS OF THE FOLLOWING WISCONSIN ENTITIES ("OBLIGATED GROUP"): AE ARPIN FACILITY COMPANY, LLC (EIN 81-0621902) AMERICAN EAGLE NURSING HOME COMPANY OF ARPIN, LLC (EIN 47-0924079) AE COLBY FACILITY COMPANY, LLC (EIN 81-0622276) AMERICAN EAGLE NURSING HOME COMPANY OF COLBY, LLC (EIN 68-0558136) AE MADISON FACILITY COMPANY , LLC (EIN 26-0070115) AMERICAN EAGLE NURSING HOME COMPANY OF MADISON, LLC (EIN 81-0621853) EACH OF THE FOLLOWING ENTITIES RECEIVES A SEPARATE SET OF AUDITED FINANCIAL STATEMENTS: AMERICAN EAGLE HOME PLACE, LLC (EIN 20-3295047) AE EAU CLAIRE FACILITY COMPANY, LLC (EIN 26-3709653) AE WESTFIELD FACILITY COMPANY, LLC (EIN 27-2784041) AE GREENSBURG FACILITY COMPANY, LLC (EIN 27-2784104) THE FINANCIAL INFORMATION FOR EACH OF THE ABOVE ENTITIES, AS WELL AS THE ENTITIES LISTED BELOW THAT DO NOT RECEIVE AUDITED FINANCIAL STATEMENTS, IS ALSO INCLUDED IN A SINGLE FINANCIAL STATEMENT COMPILATION PREPARED BY THE ORGANIZATION'S INDEPENDENT AUDITORS. AMERICAN EAGLE LIFECARE CORPORATION (EIN 01-0706736) AMERICAN EAGLE NURSING HOME COMPANY OF WHITEHOUSE, LLC (EIN 20-2818234) AMERICAN EAGLE NURSING HOME COMPANY OF EAU CLAIRE, LLC (EIN 26-3709759) LEXINGTON HEALTHCARE, LLC (EIN 20-1684547) AMERICAN EAGLE MORNING BREEZE, LLC (EIN 20-3294992) AMERICAN EAGLE SANDERS GLEN, LLC (EIN 20-3294905) AMERICAN EAGLE HAMLET HOLDING, LLC (EIN 46-3702281) HAMLET HEALTH CARE, LLC (EIN 37-1741674) HAMLET ASSISTED LIVING, LLC (EIN 61-1722029) HAMLET OPERATOR HOLDING, LLC (EIN 61-1740797) HAMLET HEALTH CARE OPERATOR, LLC (EIN 30-0799535) HAMLET ASSISTED LIVING, LLC (EIN 37-1742958) HAMLET HILLS, LLC (EIN 38-3915895) |
| Software ID: | 14000329 |
| Software Version: | 2014v1.0 |