ReturnofOrganization ExemptFromIncomeTax ,n„...

,I -

AMENDED RETURN

^---^ Return of Organization Exempt From Income Tax

I

ONE No. 1545.M?

,n„ 990 Under section 501 (0), 527 , or 4947(x)(1) of the Internal Revenue Code (except private foundations) 013

oaparunema the rrauwy ► Do not enter Social Security numbers on this form as It may be made public. a

inu nat ttmenue senw Ille Information about Form 000 and Its Instructions Is at wwwirs.govfibrm990.

A For the 2013 calendar year, or tax year beginning , 2013 , and ending , 20

C Name of organization D Employer tdentiflcatlon number

B u"Gei°e1ei61 PRESENCE LIFE CONNECTIONS 37-1127787

.°+". Doing Buebness AsWro•Number and street (or P.O. box Nmai Is not delhered to street address)

I

Roomisulte E Telephone number

om.i,.un 19065 HICKORY CREEK DRIVE STE. 310 (708) 478- 7900

IX I ,•A-1°M MOKENA, IL 60448 G Grossnxetpts $ 102,605,133.q "W^o•^ F Name and address of prhtdpal cMcar. SANDRA BRUCE P44 u returnMIS a MW b Yes X Noo.^v

19065 HICKORY CREEK DRIVE MOKENA, IL 60448 x(b) A,..e.m«awwr.n Yes NoI Tacmemptstatus X 501(e 3 1 501 ( c ) ( ) Insertno.) 4947(e 1 or 1 527 n 'No, a1la, awc (eaeheeucle..)

J Webefe : ► HTTP://WWW.PROVENA.ORG/SENIORS Hit.) Group awMftonwoea ►K Fmm nfemwnimlko. X rn,^1Nn IT-01 A on 7Fk nfhn. ► 1 1 QQ7 U s,.e.nn..,.,Anmb.n. Tr.

T.,mi,r„ City or town, state or province , country, and LP or foreign postal code

BE- Summary

I Briefly describe the organization 's mission or most significant activities: PROVIDES CARE TO THE ELDERLY IN-------------------------------------------

COMMUNITIES PRIMARILY IN NORTHERN AND CENTRAL ILLINOIS THROUGH

CARE AND SENIOR RESIDENTIAL PROPERTIES IT OWNS AND OPERATES

2

_ __---------- -------------

Check this box ► if the organization discontinued Its operations or disposed of more tha----------------n 25% of its net assets.

--------------

a 3 Number of voting members of the governing body (Part VI, line 1a) ..... ...... .. ... 3 3.4.

4 Number of independent voting members of the governing body (Part VI, line 1b) . ......

..

. ......... 11.

5 Total number of Individuals employed In calendar year 2013 (Part V, line 2a),

.

5 2,391.

8 Total number of volunteers (estimate If necessary) ..........

.

. .......... 6 110.

7a Total unrelated business revenue from Part Vill, 7a 262,924.i

!b Net unrelated business taxable Income from F 990-T. ^, , .. .. • • . - .. 7b 191,467.

L"

PrlorYear Current Year

8 Contributions and grants (Part VIII, line 1h), O, 3, 832, 305. 965, 230.

9

t

Program service revenue (Part Vill, Una 29) , ?Q1^ 1 106,131, 412. 98, 517, 912.

10 Investment Income (Part VIII. ooiumn (A), Tines 3, , , , , ,

k

436, 242. 804, 189.

11 Other revenue (Part VIII, column (A), Ones 5, 6d,^ 9 2, 545, 053. 2, 284, 194.

12 Total revenue - add lines 8 throw h 11 must uilP1 , - "1A)1QWQn) 112,945,012. 102,571,525.

13 Grants and similar amounts paid (Part IX, column _7771. 0 0

14 Benefits paid to or for members (Part IX, column (A), One 4) .............. 0 0

15 Salaries, other compensation , employee benefits (Part IX, column (A), lines 5.10), .... S9,106,968. '59,090,3.78.

118a Professional fundralsing fees (Part IX, column (A). One 11e) . , 0 0

b Total fundralsing expenses (Part IX, column (D), One 25) p- 0 -----------

- --17 Other expenses (Part IX, column (A), tines 11a-11d, 11f.24e) , , -- -- -- 47,194,784. 47,914,377o

18 Total expenses . Add lines 13-17 (must equal Part IX, column (A), line 25) ........ 106, 301, 752. 107, 004, 555 .

19 Revenue less expenses. Subtract line 18 from line 12 ........ .... ....... . 6,643,260. -4,433,030.

Beginning of Current Year End of Year

20 Total assets (Part X. line 18 ) .... , . ... , 92,640,91?. 93,674,903.

21 Total Ilabildies (Pen X, Una 28 ) ..... . .... . .. 15, 590, 831. 24, 890, 287.

z 22 Net assets or fund balances . Subtract line 21 from One 20 . 77, 050, 086. 68,784,616.

SI nature BlockUnder penalbes

o=13.I declare Iftath-h ave examined this return. Including accompanying schedules and atatemen (s. and to the beat of my knowledge and belle(, U Is

true, correct , and Dec larattlon f pr paler (other than after) Is based on ail Information of which preparer has any knowledge.

Sign1 7

Sig nature of o car Date

HerePAN-I cil- a, AJ Si ST4

Type or print name and We

PaidMOLLIE P. LONGHOUSE ,

Prepare.

Use Only Firm's name LLP

Firmbeddress i wilST sna Bc are. So o toMay the IRS discuss this return with the preparer shown above? (see lnstructt

For Paperwork Reduction Act Notice, sec the separate Instructions.

,SASEtete 1,000

5FV159 1802 V 13-

PRESENCE LIFE CONNECTIONS 37-1127787

Form 990 ( 2013)

Statement of Program Service Accomplishments

Check if Schedule 0 contains a response or note to any line in this Part III . .. .

I Briefly describe the organization's mission-

ATTACHMENT 1

2 Did the organization undertake any significant program services during the year which were not listed on theprior Form 990 or 990-EZ? ,,,,,,,,,,,,,,,,, q No

If "Yes," describe these new services on Schedule 0

3 Did the organization cease conducting , or make significant changes in how it conducts, any programservices? .......................................... q Yes q No

If "Yes," describe these changes on Schedule O.4 Describe the organization 's program service accomplishments for each of its three largest program services , as measured by

expenses . Section 501 ( c)(3) and 501 ( c)(4) organizations are required to report the amount of grants and allocations to others,the total expenses , and revenue , if any, for each program service reported.

4a (Code : ) ( Expenses $ 92,719,839 . including grants of $ ) (Revenue $ 81,100, 932 )PRESENCE LIFE CONNECTIONS PROVIDES NURSING CARE FOR LONG-TERM

RESIDENTS WHO NEED ASSISTANCE WITH ACTIVITIES OF DAILY LIVING.

4b (Code : ) ( Expenses $ 5,416,321 including grants of $ ) (Revenue $ 4,307,034 )PRESENCE LIFE CONNECTIONS OPERATES 17 LONG-TERM CARE SENIOR

RESIDENTIAL AND COMMUNITY-BASED SERVICE CAMPUSES. FACILITIES ARE

LOCATED IN NORTHERN ILLINOIS WITH ONE LOCATION IN INDIANA.

4c (Code : ) ( Expenses $ 7, 489, 668. including grants of $ ) (Revenue $ 11, 866, 277 )

PRESENCE LIFE CONNECTIONS OPERATES A PHARMACY IN KANKAKEE, IL THAT

IS ONLY AVAILABLE TO ITS RESIDENTS.

0

4d Other program services ( Describe in Schedule 0 .) ATTACHMENT 2

(Expenses $ 1,288 , 094 inc l uding gra nts of $ 0 ) ( Revenue $ 1,243,6694e Total program service expenses ► 106,913,922.

3E10202000 Form 990 (2013)

5FV159 1802 V 13-7.15 444395 PAGE 2


Form 990 (2013)

jjE3M Checklist of Required Schedules

Yes No

I Is the organization described in section 501 ( c)(3) or 4947 (a)(1) (other than a private foundation )? If "Yes,"

complete Schedule A . .. . .. . . ... . . . . ...... ... .. . .. . . . . . . .. . ... . . . .. .. . .

2 Is the organization required to complete Schedule B, Schedule of Contributors (see instructions )? . .. ... . . .

3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to

candidates for public office? If "Yes," complete Schedule C, Part I .......................... .

4 Section 501 ( c)(3) organizations . Did the organization engage in lobbying activities , or have a section 501(h)

election in effect during the tax year? If "Yes," complete Schedule C, Part 11 ....... ............. . .

5 Is the organization a section 501 ( c)(4), 501 ( c)(5), or 501 ( c)(6) organization that receives membership dues,

assessments , or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,

Part lll ..........................................................

6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors

have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If

"Yes,"complete Schedule D, Part I . . . . . . . .. ... .. . ... .. .. . . . . . .. . . . .. . .. . ... . .

7 Did the organization receive or hold a conservation easement , including easements to preserve open space,

the environment, historic land areas , or historic structures? If "Yes,"complete Schedule D, Part II . .. . ... . . .

8 Did the organization maintain collections of works of art, historical treasures , or other similar assets? If "Yes,"

complete Schedule D, Part Ill . . . . . . . .. .. .... .... . . . . . . . . .. . . . .. . .. .. .. .. . .

9 Did the organization report an amount in Part X, line 21, for escrow or custodial account liability; serve as a

custodian for amounts not listed in Part X , or provide credit counseling , debt management , credit repair, or

debt negotiation services? If "Yes," complete Schedule D, Part IV . .. . .. . . . .. . . . . .. . . . . . .. . . .10 Did the organization , directly or through a related organization , hold assets in temporarily restricted

endowments, permanent endowments, or quasi -endowments? If "Yes," complete Schedule D, Part V . .... . .

11 If the organization ' s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI,

VII, VIII, IX, or X as applicable.

a Did the organization report an amount for land, buildings , and equipment in Part X , line 102 If "Yes,"

complete Schedule D, Part VI . . . .. . . .. .. . ... . . ... . .. . .. . . . . . . .. . .. . . . . ... . .

b Did the organization report an amount for investments-other securities in Part X, line 12 that is 5% or more

of its total assets reported in Part X, line 16' If "Yes," complete Schedule D, Part VII . . . .. . . . .. .. .. . . .

c Did the organization report an amount for investments - program related in Part X , line 13 that is 5% or more

of its total assets reported in Part X , line 16? If "Yes,"complete Schedule D, Part VIII . . . . . . .. .. . . .... .

d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets

reported in Part X , line 16? If "Yes," complete Schedule D, Part IX . .. . .. . . . . . . . . . .. ... . .... .

e Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X

f Did the organization 's separate or consolidated financial statements for the tax year include a footnote that addresses

the organization 's liability for uncertain tax positions under FIN 48 (ASC 740) ? If "Ves, " complete Schedule D, Part X . .

12a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes,"

complete Schedule D, Parts XI and XII . . . . .. . .. .. . . . . . . . . . . . . . . . . .. . . . .. . . . ... .

b Was the organization included in consolidated , independent audited financial statements for the tax year? If "Yes," and if

the organization answered "No" to line 12a, then completing Schedule D, Parts XI and Xll is optional . . . . . . . . . . . . . .

13 Is the organization a school described in section 170 ( b)(1)(A)(u )' If "Yes,"complete Schedule E . .. . . . . .. .

14 a Did the organization maintain an office , employees , or agents outside of the United States?............ .

b Did the organization have aggregate revenues or expenses of more than $ 10,000 from grantmaking,

fundraising, business , investment , and program service activities outside the United States , or aggregate

foreign investments valued at $100 , 000 or mores If "Yes," complete Schedule F, Parts I and IV .. .. .. . ... .

15 Did the organization report on Part IX , column (A), line 3 , more than $5 , 000 of grants or other assistance to or

for any foreign organization? If "Yes," complete Schedule F, Parts II and IV . .. . . .. . . .. . . . . .. . ... .

16 Did the organization report on Part IX , column (A), line 3 , more than $5 , 000 of aggregate grants or other

assistance to or for foreign individuals ? If "Yes,"complete Schedule F, Parts 111 and IV . . . . . . . .. .. . ... .

17 Did the organization report a total of more than $ 15,000 of expenses for professional fundraising services on

Part IX , column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) . . . . . . . ... .

18 Did the organization report more than $15 , 000 total of fundraising event gross income and contributions on

Part VIII , lines 1 c and 8a? If "Yes," complete Schedule G, Part Il ... . . . . . . . . . . . . . . . . .. .. . ... .

19 Did the organization report more than $15 , 000 of gross income from gaming activities on Part VIII, line 9a?

If "Yes," complete Schedule G, Part 111 . .. . . . . .. ... . . ... . .. . . . . . . . .. . . . . .. .. . ... .

20 a Did the organization operate one or more hospital facilities? If "Yes,"complete Schedule H . . . . .. . . . . . . .

b If "Yes" to line 20a , did the organization attach a copy of its audited financial statements to this return? . .

JSA

3E1021 1 000

5FV159 1802 V 13-7. 15 444395

I X

2 X

3 X

4 X

5 X

6 X

7 X

8 X

9 X

6

10

11i11a X

11b X

11c X

11d X

11e X

11f X

12a X

12b X

13 X

14a X

14b X

15 X

16 X

17 X

18 X

19 X

t0a X

i!0b

Form 990 (2013)

PAGE 3


Form 990 (2013) Page

jj^v Checklist of Required Schedules (continued)Yes No

21 Did the organization report more than $5,000 of grants or other assistance to any domestic organization or

government on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts 1 and 11 . . . . . . ... ...... 21 X

22 Did the organization report more than $5,000 of grants or other assistance to individuals in the United States

on Part IX, column (A), line 2? If "Yes,"complete Schedule 1, Parts I and 111 ........ .............. 22 X

23 Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the

organization's current and former officers, directors, trustees, key employees, and highest compensated

employees? If "Yes," complete Schedule J ......... .................. ........... 23 X

24 a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than

$100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes," answer lines 24b

through 24d and complete Schedule K If "No," go to line 25a ................. ............ 24a X

b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception....... 24b

c Did the organization maintain an escrow account other than a refunding escrow at any time during the year

to defease any tax-exempt bonds? ................................ .......... 24c

d Did the organization act as an "on behalf or issuer for bonds outstanding at any time during the year? ...... 24d

25a Section 501(c)(3) and 501(c)(4) organizations . Did the organization engage in an excess benefit transaction

with a disqualified person during the year" If "Yes," complete Schedule L, Part I . . . . .. . . . .. .. . . . ... 25a X

b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior

year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?

If "Yes,"complete Schedule L, Part ( .. . .. .. . ... .. . . .. ... . .. . . . .. . . . .. . .. . .. . 25b X

26 Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payable to any

current or former officers, directors, trustees, key employees, highest compensated employees, or

disqualified persons? If so, complete Schedule L, Part II , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 26 X

27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee,2

substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled

entity or family member of any of these persons? If "Yes," complete Schedule L, Part Ill . . . . . . .. . . . .... 27 X

28 Was the organization a party to a business transaction with one of the following parties (see Schedule L,

Part IV instructions for applicable filing thresholds, conditions, and exceptions).

a A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ....... 28a X

b A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete

Schedule L, Part IV . . ... . .... . .. . . .. . . . . . . . . . . . .. . .. . .. . . . . . . . .. . .. .. 28b X

c An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof)

was an officer, director, trustee, or direct or indirect owner? If "Yes,"complete Schedule L, Part IV. ... .. . .. 28c X

29 Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M 29 X

30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified

conservation contributions? If "Yes,"complete Schedule M . . . . . . . .. .. . .. ... . . . . .. . .. .... 30 X

31 Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,

Part I......................................................... 31 X

32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes,"

complete Schedule N, Part 11 . ... .. . .. . .. . . . . . . .. . .. ... . .. . . . .. . . . ... . . . . 32 X

33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations

sections 301 7701-2 and 301.7701-3' If "Yes,"complete Schedule R, Part I . .. . .. . . . . . . .. .. . . .. 33 X

34 Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part ll, Ill,

or IV, and Part V, line 1 . .. . . . ... .. . .. . . . ... . . . ... . . . .. . .. . .. . .. . .. . . . .. 34 X

35 a Did the organization have a controlled entity within the meaning of section 512(b)(13)? .. . . . . . . . .. . . 35a X

b If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a

controlled entity within the meaning of section 512(b)(13)? If "Yes,"complete Schedule R, Part V, line 2, , , , 35b

36 Section 501(c )( 3) organizations . Did the organization make any transfers to an exempt non-charitable

related organization? If "Yes," complete Schedule R, Part V, line 2 . .. . .. . .. .. . . . . . . . .. . .. . . 36 X

37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization

and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R,

Part W ......................................................... 37 X

38 Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11 b and

4

19? Note . All Form 990 filers are required to complete Schedule 0 . 38 1 X

Form 990 (2013)

JSA

3E1030 1 000

5FV159 1802 V 13-7. 15 444395 PAGE 4


Form 990 ( 2013)

giEM Statements Regarding Other IRS Filings and Tax Compliance

Check if Schedule 0 contains a response or note to any line in this Part V .........

1a Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable......... 1a 246

b Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable......... 1 b 0 M1^

c Did the organization comply with backup withholding rules for reportable payments to vendors and

reportable gaming (gambling) winnings to prize winners' ......... ....................... 1c

2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax

Statements, filed for the calendar year ending with or within the year covered by this return . 2a 2, 3 91

b If at least one is reported on line 2a, did the organization file all required federal employment tax returns'? 2b

Note . If the sum of lines 1 a and 2a is greater than 250, you may be required to e-file (see instructions) ... . ... 7

3a Did the organization have unrelated business gross income of $1,000 or more during the year? , , , , , , , , 3a

b If "Yes," has it filed a Form 990-T for this year? If "No" to line 3b, provide an explanation in Schedule 0 ... . , , 3b

4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority

over, a financial account in a foreign country (such as a bank account, securities account, or other financial

account)? . .. .. .. .. ..... .. .. .. ... .. .. .. ... .. 4a

b If "Yes," enter the name of the foreign country 01--------------------------------------------

See instructions for filing requirements for Form TD F 90-22 1, Report of Foreign Bank and Financial Accounts.

5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ... .. . 5a

b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? 5b

c If "Yes" to line 5a or 5b, did the organization file Form 8886-T? .. . . .. . . . .. . ... . . .... . .. . . 5c

6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the

organization solicit any contributions that were not tax deductible as charitable contributions? .... . .. .. .. 6a

b If "Yes," did the organization include with every solicitation an express statement that such contributions or

gifts were not tax deductible? ........... ................ ............. .... . 6b

7 Organizations that may receive deductible contributions under section 170(c).

a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods

and services provided to the payor? . _ .... 7a

b If "Yes," did the organization notify the donor of the value of the goods or services provided? . .... . . .. , 7b

c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was

required to file Form 8282? . .. . .. . .. .. . .. ... . . .. . . . .. . . . .. . .... . . . . .. 7c

d If "Yes," indicate the number of Forms 8282 filed during the year . . . . .. . . . .. . ... 7d

e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? 7e

f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? .... 7f

g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? 7

h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? 7h

8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting

organizations . Did the supporting organization, or a donor advised fund maintained by a sponsoring

organization, have excess business holdings at any time during the year? , , , , , , , , , , , , , , , , , , , , , 8

9 Sponsoring organizations maintaining donor advised funds.

a Did the organization make any taxable distributions under section 4966? ..................... . . 9a

b Did the organization make a distribution to a donor, donor advisor, or related person? , , , , , , , , , , , , , , , , 9b

10 Section 501(c )( 7) organizations . Enter:

a Initiation fees and capital contributions included on Part VIII, line 12 . . . . .. . .. .. . 10a

b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities . . 10b

11 Section 501(c )( 12) organizations . Enter.

a Gross income from members or shareholders . .. . . . . .. . . . . . . .. . . . . .. . 11 a

b Gross income from other sources (Do not net amounts due or paid to other sources

against amounts due or received from them.) .............. . ........... 11 b

12a Section 4947( a)(1) non -exempt charitable trusts . Is the organization filing Form 990 in lieu of Form 1041? 12a

b If "Yes," enter the amount of tax-exempt interest received or accrued during the year . . . . 12b

13 Section 501(c )( 29) qualified nonprofit health insurance issuers.

a Is the organization licensed to issue qualified health plans in more than one state? . .. . ... ..... . . . .. 13a

Note . See the instructions for additional information the organization must report on Schedule 0

b Enter the amount of reserves the organization is required to maintain by the states in which

the organization is licensed to issue qualified health plans , , , , , , , , , , , , , , , , , 13b

c Enter the amount of reserves on hand . . . .. . . . . .. . . . . .. . . . . . . . . . . . . . 13c

14a Did the organization receive any payments for indoor tanning services during the tax year? ....... . . . . ,K -v.... " L..... A 4:1..d .. C...... 7'ln •w -- ...w....w............0 It "w-_ " ___..:J.. __ .....J..-... C.... ... n..f...J..L. r

T

• ^L

14a

Yes No

^_s

X

X

X

X

X

X

X

X

X

X

X

X

X

3E1040 1000 Form 990 (2013)

5FV159 1802 V 13-7.15 444395 PAGE 5

I

. Form 990 ( 2013 ) PRESENCE LIFE CONNECTIONS 37-1127787

Governance, Management , and Disclosure For each "Yes " response to lines 2 through 7b below, and for a "No"response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.

Check if Schedule 0 contains a response or note to any line in this Part VI . . . . . . . . . .. . . .. .. . ... . . . n

Section A. Governing Body and ManagementYes No

1a Enter the number of voting members of the governing body at the end of the tax year .... 1a 1

If there are material differences in voting rights among members of the governing body, or if the governing

body delegated broad authority to an executive committee or similar committee, explain in Schedule 0

b Enter the number of voting members included in line 1a, above, who are independent ..... 1b 1

2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with

any other officer, director, trustee, or key employee? ................. ............... 2 X

3 Did the organization delegate control over management duties customarily performed by or under the direct

supervision of officers, directors, or trustees, or key employees to a management company or other person? . . 3 X

4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?. . . . . . 4 X

5 Did the organization become aware during the year of a significant diversion of the organization's assets?.... 5 X

6 Did the organization have members or stockholders? . . ....... .. . .. . . . . .. . . .. .. . . ... . 6 X

7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint

one or more members of the governing body? .................. ..... . ............ 7a X

b Are any governance decisions of the organization reserved to (or subject to approval by) members,

stockholders, or persons other than the governing body? .................. .. .......... 7b X

8 Did the organization contemporaneously document the meetings held or written actions undertaken during

the year by the following.

a The governing body? . .. ........ ............................. .......... 8a X

b Each committee with authority to act on behalf of the governing body's . . .. . . . .. . . . . . . .. . . . . . 86 X

9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached atthe org anization's mailing address? If 'Yes," provide the names and addresses in Schedule 0 . 9 X

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.Yes No

10a Did the organization have local chapters, branches, or affiliates? ..... . . .. . . . .. . . . . . . .. . . .. 10a X

b If "Yes," did the organization have written policies and procedures governing the activities of such chapters,

affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? . . . 10b X

11 a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? . 11 a X

b Describe in Schedule 0 the process, if any, used by the organization to review this Form 990

12a Did the organization have a written conflict of interest policy? If "No,"go to line 13 . . . . . . . . ... . . .. . 12a X

b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give

rise to conflicts? .. .. .. .. .. .... ... .. .... .. 12b X

c Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes,"

describe in Schedule 0 how this was done ... . .................................. 12c X

13 Did the organization have a written whistleblower policy? . .. ...... ... .. . . . . .. . . . . . . . .. . 13 X

14 Did the organization have a written document retention and destruction policy? ... . ........... ... 14 X

15 Did the process for determining compensation of the following persons include a review and approval by

independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

a The organization's CEO, Executive Director, or top management official . .. .. . . . . . . . .. . . . . . . . . 15a X

b Other officers or key employees of the organization . .. .. . . ..... .. .. . . .. . . . . .. . .. .. . . 1511b X

If "Yes" to line 15a or 15b, describe the process in Schedule 0 (see instructions).

16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement

with a taxable entity during the year? . . . . . . . .. .. . .. . . .... . . .. . . . . . . . . . . . .. . . . . 16a X

b If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate itsparticipation in joint venture arrangements under applicable federal tax law, and take steps to safeguard theorganization's exempt status with respect to such arrangements? 16b

Section C. Disclosure

17 List the states with which a copy of this Form 990 is required to be filed

18 Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable ), 990, and 990 -T (Section 501(c)(3)s only)available for public ins ection Indicate how you made these available . Check all that apply

Own website LJ Another's website Q Upon request Other (explain in Schedule 0)

19 Describe in Schedule 0 whether ( and if so , how) the organization made its governing documents , conflict of interest policy, and

financial statements available to the public during the tax year.

20 State the name , physical address , and telephone number of the person who possesses the books and records of theorganization ' 'PATRICK QUINN 9223 WEST ST FRANCIS ROAD FRANKFORT, IL 60423 - 8334 815-806-2328

JSA Form 990 (2013)

3E1042 1 000

5FV159 1802 V 13-7. 15 444395 PAGE 6

Form 990(2013} PRESENCE LIFE CONNECTIONS 37-1127787 Page7

Compensation of Officers , Directors , Trustees , Key Employees , Highest Compensated Employees, andIndependent Contractors

Check if Schedule 0 contains a response or note to any line in this Part VII ...................... q

Section A. Officers, Directors , Trustees , Key Employees , and Highest Compensated Employees1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within theorganization's tax year

• List all of the organization' s current officers, directors, trustees (whether individuals or organizations), regardless of amount ofcompensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid

• List all of the organization' s current key employees, if any. See instructions for definition of "key employee "• List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)

who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from theorganization and any related organizations

• List all of the organization 's former officers, key employees, and highest compensated employees who received more than$100,000 of reportable compensation from the organization and any related organizations.

• List all of the organization' s former directors or trustees that received, in the capacity as a former director or trustee of theorganization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order. individual trustees or directors, institutional trustees; officers; key employees, highestcompensated employees; and former such persons

q Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee

(C)

(A) (B) Position ( D) (E) (F)

Name and Title Average (do not check more than one Reportable Reportable Estimatedhours per box, unless person is both an compensation compensation from amount ofweek ( list an officer and a director/trustee ) from related other

hours for o o ^ m = -, the organizations ccom pensationrelated a n SE ^Z B,5

o , °I organization (W-2/1099-MISC) from the

organizations I 3 °c y m (W-2/ 1099- MISC) organization

below dotted S °- o m oand related

line) CDm 3 organizations2

N

13C

cDC D

J

NCL

1 THOMAS E. SMITH 1.00

DIRECTOR - TREASURER .00 X X 0 0

f2)JO-NN COSTANTINO _ 00

DIRECTOR .00 X 0 0

GOMZ _ 00

DIRECTOR - SECRETARY

-

.00 X X 0 0

j4JCONNIES. MARCH _ 00

PRESIDENT/CEO/DIRECTOR .00 X X 575,067. 0 79,922

I5)THERESA KWIATKOWSKI _ 00

DIRECTOR .00 X 0 0

ig}NANCY T. DOWD---------------------------

1.00---

DIRECTOR 2.00 X 0 0

-17)FLORIDA FREEMAN--

1.00

DIRECTOR .00 X 0

18JSR_MARIE MASON _ 00

DIRECTOR - CHAIR .00 X X 0 0

i9JSALLIEMILLER _ 00

DIRECTOR - VICE CHAIR .00 X X 0

10 NHS

DIRECTOR .00 X 0

111)U-JOS--------------------

-

DIRECTOR .00 X 0

112)C------------------

_ 00

DIRECTOR .00 X 0 0

(13)LAWRENCE R _ PANKAU M . D . 0 0

DIRECTOR .00 X 0 260,746. 11,759

(14)PAULSKIEM _ 00

DIRECTOR .00 X 485,624. 82,322.

,s,, Form 990 (2013)

3E1041 1 000

5FV159 1802 V 13-7.15 444395 PAGE 7


Form 990 ( 2013)

• ORM Section A. Officers . Directors . Trustees. Kev Emolovees . and Hiahest Comoensated Emnlovees /continued)

(A) (B) (C) (D) (E) (F)Name and title Average Position Reportable Reportable Estimated

hours per (do not check more than one compensation compensation from amount ofweek ( list any box, unless person is both an from related other

hours for officer and a director/trustee the or anizations compensationrelated ' 3 m o organization

g

W-2/1099 - MISC from theorganaabans a< m m o m 9 ( W-2/1099 -MISC) organizationbelow dotted 0 3o

, am and related

line) ° 2 dis

3 organizations

2CD

0

CL

15) CRAIG CULVER-----------------------------------

20.00- ------VP DEVELOPMENT 20.00 X 212,151. 0 15,358.

16) DAVID HOWARD---------------------------------

20.00- ------VP OF OPERATIONS 20.00 X 157,538. 0 12,923.

17) KATHY DENNIS- ------------------ 20.00------

VP CLINICAL OPERATIONS 20.00 X 180,697. 0 26,462.

18) WENDELL PROVOST-----------------------------------

20.00-- -----VP OF HR, RISK & FACILITIES 20.00 X 215,757. 0 26,929.

19) MIKE GORDON----------------------------------

- 20.00

VP FINANCE & CFO 20.00 X 258,354. 0 18,072.

20) SUSAN ENRIGHT----------------------------------

- 20.00

VP HOME HEALTH & HOSPICE 20.00 X 186,909. 0 22,640.

21) NANCY GARCIA-----------------------------------

20.00-- -----VP MISSION SERVICES 20.00 X 139,489. 0 16,503.

22) PETER GOSCHY----------------------------------- 20.00-- -----

VP NURSING HOME OPERATIONS 20.00 X 206,743. 0 17,406.

23) ANTHONY FILER23)-ANTHONY 20.00

CFO, TREASURER 20.00 X 0 878,902. 172,661.

24) JEANNIE FREY----------------------------------

20.00------

SYS SR VP LEGAL, SECRETARY 20.00 X 0 653,365. 116,587.

25) MICHAEL BORN----------------------------------

- 40 _00

PHARMACY DIRECTOR 0 X 154,870. 0 20,090.

lb Sub -total ► 575, 067. 746, 370. 174,003.

c Total from continuation sheets to Part VII , Section A . . . . .. . . . . . . . ► 2, 193, 215. 1, 532, 267. 534,796.

d Total add lines lb and 1c . . . . .. . .. ... .. . .. . .. . .. . . . . . ► 2, 768, 282. 2, 278, 637. 708, 799.

2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 ofreportable compensation from the organization ► 24

;YesNo

3 Did the organization list any former officer , director, or trustee, key employee, or highest compensatedemployee on line la? If "Yes,"complete Schedule J for such individual . .. . .. . .. .. . . .. . . . . . . .. . . 3

4 For any Individual listed on line la , Is the sum of reportable compensation and other compensation from theorganization and related organizations greater than $150,000? If "Yes," complete Schedule J for suchindividual .......................................................... 4

5 Did any person listed on line la receive or accrue compensation from any unrelated organization or individualfor services rendered to the org anization? If "Yes,"com lete Schedule J for such person 5 X

Section B. Independent Contractors

1 Complete this table for your five highest compensated independent contractors that received more than $100,000 ofcompensation from the organization . Report compensation for the calendar year ending with or within the organization's taxyear.

(A)Name and business address

(B)Description of services

(C)Compensation

ATTACHMENT 3

2 Total number of independent contractors ( including but not limited to those listed above ) who receivedmore than $100 , 000 in compensation from the organization ► 9

Form yy u (2013)3E1055 7 000

5FV159 1802 V 13-7.15 444395 PAGE 8


Form 990(2013) Page 8

MUM Section A Officers. Directors . Trustees. Kev Emolovees . and Highest Comnensated Emnlovees fcnntinuedl

(A) (B) (C) (D) (E) (F)Name and title Average Position Reportable Reportable Estimated

hours per (do not check more than one compensation compensation from amount ofweek ( let any box , unless person is both an from related other

hours for officer and a director/trustee the or anizations compensationrelated a

0^

(Do3 , 0 org anization

gW-2/1099-MISC from the

organizations_5a 0 m

11.o CID (W -2/1099 -MISC) organization

below dotted ? 3D,^ w

and related

line)1

° 3 organizations2 in

in m0

m'

CDCL

26) LYNDA OLINSKI----------------------------------

40 .00-

DIRECTOR OF ACCOUNTING 0 X 127,054. 0 17,483.

27) CRAIG PROKUPEK----------------------------------

20.00

ADMINISTRATOR 20.00 X 114,249. 0 17,383.

28) NELIA LUBANG----------------------------------

40.00-

LPN X 120,870. 0 16,591.

29) MARK FEDYK----------------------------------

40.00

DIRECTOR OF DATA INTEGRATION 0 X 118,534. 0 17,708.

---------------------------------- ------

---------------------------------- ------

---------------------------------- ------

---------------------------------- ------

---------------------------------- ------

---------------------------------- ------

---------------------------------- ------

1 b Sub - total ►c Total from continuation sheets to Part VII , Section A . .. . . . . . . . . .. ►d Total add lines 1b and 1c ►

2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 ofreportable compensation from the organization ► 24

No

3 Did the organization list any former officer, director, or trustee, key employee, or highest compensatedemployee on line la? If "Yes," complete Schedule J for such individual . . . . .. . .. .. . . . . . . . .. ... . .. 3 X

4 For any individual listed on line la, is the sum of reportable compensation and other compensation from the 77 71,=organization and related organizations greater than $150,000? If "Yes," complete Schedule J for suchindividual ........................................................... 4 X

5 Did any person listed on line la receive or accrue compensation from any unrelated organization or individualfor services rendered to the org anization? If "Yes,"com lete Schedule J for such per-son , 5 X

Section B. Independent Contractors

1 Complete this table for your five highest compensated independent contractors that received more than $100,000 ofcompensation from the organization. Report compensation for the calendar year ending with or within the organization's taxyear

(A) (B) (C)Name and business address Description of services Compensation

2 Total number of independent contractors (including but not limited to those listed above) who receivedmore than $100,000 in compensation from the organization ►

3'1055 1 000 Forth J̀`JU (2013)

5FV159 1802 V 13-7.15 444395 PAGE 9

Form 990 (2013) PRESENCE LIFE CONNECTIONS 37-1127787 Page 9

.Statement of Revenue

Check if Schedule 0 contains a response or note to any line in this Part VIII , ......... n

(A) (B) (C) (D)Total revenue Related or Unrelated Revenue

exempt business excluded from taxfunction revenue under sectionsrevenue 512-514

la Federated campaigns . . . . . . la

60 b Membership dues . . . . . . . . . lbE

c Fundraising events . . . . . . . . . I c

d Related organizations . . . . . . 1 d

o y e Government grants (contributions) . le

f All other contributions, gifts, grants,

p and similar amounts not included above if 965 , 230

o g Noncash contributions included in lines la-1 f $

10 ................. .h Total. Add lines la-1f . ► 96s 230.

Business Codem

2a NET PATIENT REV 900099 40,535 595 40,535 , 595

b MEDICARE/MEDICAID PAYMENTS 900099 57,982,317. 57,982 317

Vc

ton dE e

o f All other program service revenue . . . . .

9 Total. Add lines 2a-2f . .......... ►...... . 98 , 517 , 912

3 Investment income (including dividends, interest, and

other similar amounts) . . . . . . . . . . . . . . . . . . . ► 804,189 804,189

4 Income from investment of tax-exempt bond proceeds . . . ► 0

............... •5 Royalties . . . . . . . . ► o(i) Real (u) Personal

6a Gross rents . .. . .. .

b Less rental expenses . .

c Rental income or (loss) . .

d Net rental income or (loss ) . ► 0i) Securities( (n) Other

7a Gross amount from sales ofassets other than inventory

b Less cost or other basis

and sales expenses . . .

c Gain or (loss) . .. . . . .d Net gain or (loss) . . . . . . . . . . . . . ► 0

4) 8a Gross income from fundraising

C events (not including $

4) of contributions reported on line 1c)Ir See Part IV, line 18 . . . . . . . . . . . a 91 , 64711-

b Less direct expenses . . . . . . . . . . b 33 , 608.

0 C Net income or (loss) from fundraising events . . ► 58 , 039. 58,039

9a Gross income from gaming activities

See Part IV, line 19 . . . . . . . . . . . a

b Less direct expenses . . . . . . . . . . b

c Net income or (loss) from gaming activities . . ► 0

10a Gross sales of inventory, less

returns and allowances . . . . . . . . . a

b Less cost of goods sold . . . . . . . . . bc Net income or (loss) from sales of inventory . . ► a

Miscellaneous Revenue Business Code

11a CHILD CARE 900099 594 , 342 594 , 342

b OTHER CARE FEES (HOUSING) 900099 302 , 784 302 , 784

C CAFE 900099 288 , 798 288 798.

d All other revenue . . . . . . . . . . . . . 900099 1 , 040 , 231 262 , 924 777 , 307

e Total. Add lines 11a-11d . . . . . . . . . . . . . . . . . ► 2 226 155

12 Total revenue. See instructions 102 571 525 98 517 912 262 , 924 2 , 825 , 459.

JSA3E1051 1 000

5FV159 1802

Form 990 (2013)

V 13-7 .15 444395 PAGE 10

Form 990 (2p13) PRESENCE LIFE CONNECTIONS 37-1127787 Page 10

Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns All other organizations must complete column (A)

Check if Schedule 0 contains a response or note to any line in this Part IX

Do not include amounts reported on lines 6b, 7b,86, 96, and 10b of Part Vlll.

( A)Total expenses

(B)Program service

expenses

(C)Management andgeneral expenses

(D)Fundraisingexpenses

1 Grants and other assistance to governments and

organizations in the United States See Part IV, line 21

2 Grants and other assistance to individuals in

the United States See Part IV, line 22 . . . . . .

3 Grants and other assistance to governments,

organizations, and individuals outside the

United States See Part IV, lines 15 and 16, ,

4 Benefits paid to or for members . . . . . . . ,

5 Compensation of current officers, directors,

trustees , and key employees . .. . .. . . 1, 887, 850. 1, 887, 850.

6 Compensation not included above , to disqualified

persons (as defined under section 4958 ( f)(1)) and

persons described in section 4958(c)(3)(B)

7 Other salaries and wages. , , , 44,242,018. 44,151,285. 90,733.

8 Pension plan accruals and contributions (include section

401(k ) and 403(b) employer contributions) . . . . . 1 , 592, 147. 1, 588, 467. 3,680.

9 Other employee benefits . . . .. . . .. . 7, 843, 570. 7, 837, 537. 6,033.

10 Payroll taxes . .. . . . . . . . . . . 3, 524, 593. 3, 519, 320. 5,273.

11 Fees for services (non-employees)

a Management , , , , , , , , , , , , , , , , , 3, 277, 593. 3, 276, 149. 1,444.

b Legal . . . . . . . . . . . . . . . . . . . 13,442. 13,442.

c Accounting ,,,,,,,,,,,,,,,,,,

d Lobbying . . . . . . . . . . . . . . . . . . .

e Professional fundraising services See Part IV, line 17.

f Investment management fees . . . . . . . . ,

9 Other ( if line 11g amount exceeds 10% of line 25, column

(A) amount, list line 11g eienses on Schedule 0) . . . . .

12 Advertising and promotion . . . . . . . . . . ,

13 Office expenses . . . . . . . . . . . . . . . .

14 Information technology . . . . . . . . . . . .

15 Royalties . . . . . . . . . . . . . . . . . . .

16 Occupancy .. . . . . . . . .. . .. . . .

.

4, 371, 008. 4, 363, 362. 7,646.

17 Travel . . . . . . . . . . . . . . . . . . . .

18 Payments of travel or entertainment expenses

for any federal, state, or local public officials

19 Conferences, conventions, and meetings . . . .

20 Interest . . . . . . . . . . . . . . . . . . . 2,240,264 . 2,240,264.

21 Payments to affiliates . . . . . . . . . . . . . . 687, 104. 687,104.

22 Depreciation, depletion, and amortization . . 4, 945, 095. 4, 944, 184. 911.

23 Insurance . .. .. . . .. .. . .. . .. . 1, 370, 191. 1,370,191.

24 Other expenses Itemize expenses not covered

above ( List miscellaneous expenses in line 24e If

line 24e amount exceeds 10% of line 25 , column

(A) amount, list line 24e expenses on Schedule 0)

aSUPPLIES_&_DRUGS_____________ 11,701,975. 11,700,595. 1,380.

bPURCHASED_SERVICES ___________ 11, 484, 655. 11, 476, 446. 8, 209.

cFOOO ________________________ 3,118,441. 3,117,891. 550.

dFEDERAL_ STATE _TAX __________ -36,404. -36,404.

e All other expenses _________________ 4, 741, 013. 4, 739, 835. 1,178.

25 Total functional ex pe nses . Add lines 1 through 24e 07, 004, 555. 106, 913, 922. 90,633.26 Joint costs . Complete this line only if the

organization reported in column (B) joint costsfrom a combined educational campaign andfundraising solicitation Check here ► Q Iffollowing SOP 98-2 (ASC 958-720) . ,

JsA Form 990 (2013)3121052 1.000

5FV159 1802 V 13-7. 15 444395 PAGE 11


Form 990 (2013) Page 11

Balance Sheet

Check if Schedule 0 contains a response or note to any line in this Part X .................... .(A) (B)

Beginning of year End of year

1 Cash - non-interest-bearing ... ... . . . . ..... . ......... 0 1 0

2 Savings and temporary cash investments . , 13, 364, 734. 2 11,929,771.

3 Pledges and grants receivable , net . . . . ............ . .... . . 0 3 0

4 Accounts receivable , net . . . . .. . 19,126,354. 4 14, 395, 217.

5 Loans and other receivables from current and former officers , directors,

trustees , key employees, and highest compensated employees

.

Complete Part II of Schedule L . .. ....... . ... 5 06 Loans and other receivables from other disqualified persons (as defined under section

4958 (f)(1)), persons described in section 4958(c)(3)(B), and contributing employersand sponsoring organizations of section 501 ( c)(9) voluntary employees ' beneficiaryorganizations (see instructions) Complete Part II of Schedule L . . . .

.

6 0

m 7 Notes and loans receivable, net .................... 7 0(AU)Q 8 Inventories for sale or use ............................ 652 , 763. 8 800,313.

9 Prepaid expenses and deferred charges . .. . . . . .. . . . .. 116, 184. 9 360, 388.

10a Land , buildings , and equipment cost or

other basis . Complete Part VI of Schedule D 10a 121,954,802.

b Less : accumulated depreciation .. . . .. . . . 10b 66, 527 , 815. 49, 927 , 294. 10c 55, 426, 987.

1 1 Investments - publicly traded securities .. . . .. . . . .. . .. . . . . . 8, 439, 317. 11 9,511,568.

12 Investments - other securities See Part IV, line 11 , , , , , , , , , , , , , 12 0

13 Investments - program -related See Part IV, line 11 , , , , , , , , , , , , 13 0

14 Intangible assets . . . .. . ... .. . .. . . . . . . . .. . .. . .. . . 14 0

15 Other assets See Part IV, line 11 , , . 1,014,271. 15 1, 250, 659.

16 Total assets . Add lines 1 throw h 15 must a ual line 34 2, 640, 917. 16 93, 674, 903.

17 Accounts payable and accrued expenses 1, 963, 536. 17 14, 201, 825.

18 Grants payable 18 0

19 Deferred revenue 310, 431. 19 203, 567.

20 Tax-exempt bondliabdRies 20 0

21 Escrow or custodial account liability. Complete Part IV of Schedule D 21 0

22 Loans and other payables to current and former officers , directors,

trustees , key employees , highest compensated employees, and

.

disqualified persons. Complete Part li of Schedule L 22 0

23 Secured mortgages and notes payable to unrelated third parties 1, 036, 325. 23 967, 424.

24 Unsecured notes and loans payable to unrelated third parties 24 0

25 Other liabilities ( including federal income tax, payables to related third

parties , and other liabilities not included on lines 17-24). Complete Part X

of Schedule D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2, 280, 539. 25 9, 517, 471.

26 Total liabilities . Add lines 17 through 25 5, 590, 831. 26 24, 890, 287.

Organizations that follow SFAS 117 (ASC 958 ), check here ► X andcomplete lines 27 through 29, and lines 33 and 34.

V

27 Unrestricted net assets 73 , 031, 131. 27 67 , 342, 840.

28 Temporarily restricted net assets . .. ... . ... .. .. . .. . . . . . . 775 , 691.3, 28 1, 198 , 512 .

29 Permanently restricted net assets . . . ... . . .. .. .. . .. . 243, 264. 29 243 , 264 .

Organizations that do not follow SFAS 117 (ASC 958), check here El andcomplete lines 30 through 34.

30 Capital stock or trust principal, or current funds

.

31 Paid - in or capital surplus , or land , budding , or equipment fund 31

a 32 Retained earnings , endowment , accumulated income, or other funds

33 Total net assets or fund balances 7, 050, 086. 33 68 , 784 , 616 .

34 Total liabilities and net assets/fund balances . 2, 640, 917. 34 93,674,903.

Form 990 (2013)

JSA3E 1053 1 000

5FV159 1802 V 13-7 .15 444395 PAGE 12


Form 990 ( 2013) Page 12

Reconciliation of Net Assets

Check if Schedule 0 contains a response or note to any line in this Part XI ............ ....... x

1 Total revenue (must equal Part VIII, column (A), line 12) ....................... 1 102,571,525.

2 Total expenses (must equal Part IX , column (A), line 25) .. .. .. ... ..... . . .. . . . . . 2 107,004,555.

3 Revenue less expenses . Subtract line 2 from line 1 .. .. .. . .. . .. ..... . . . . . . .. . 3 -4, 433, 030.

4 Net assets or fund balances at beginning of year ( must equal Part X, line 33, column (A)) ..... 4 77,050,086.

5 Net unrealized gains ( losses ) on investments . ... ... .. .. . ... ...... . . . . . .. . 5 401,338.

6 Donated services and use of facilities ................................. 6 0

7 Investment expenses . . . . . . . .. .. . .. . .... .. .... ....... .. . .. . .. . . 7 0

8 Prior period adjustments ..................................... ... 8 0

9 Other changes in net assets or fund balances (explain in Schedule 0) ...... ..... . 9 -4,233,778.

10 Net assets or fund balances at end of year . Combine lines 3 through 9 ( must equal Part X, line33 , column B 10 68, 784, 616.

Financial Statements and ReportingCheck if Schedule 0 contains a response or note to any line in this Part XII ............ ...... .

Yes No

I Accounting method used to prepare the Form 990 : q Cash El Accrual q Other

If the organization changed its method of accounting from a prior year or checked "Other," explain in

Schedule O.

2a Were the organization ' s financial statements compiled or reviewed by an independent accountants 2a X

If "Yes," check a box below to indicate whether the financial statements for the year were compiled or

reviewed on a separate basis , consolidated basis, or both:

q Separate basis q Consolidated basis q Both consolidated and separate basis

b Were the organization ' s financial statements audited by an independent accountant? .............. 2b X

If "Yes," check a box below to indicate whether the financial statements for the year were audited on ase crate basis , consolidated basis , or both-

Separate basis Consolidated basis q Both consolidated and separate basis _

c If "Yes" to line 2a or 2b , does the organization have a committee that assumes responsibility for oversight

of the audit , review , or compilation of its financial statements and selection of an independent accountant? 2c X

If the organization changed either its oversight process or selection process during the tax year, explain in

Schedule O.

3a As a result of a federal award , was the organization required to undergo an audit or audits as set forth in

the Single Audit Act and OMB Circular A-133 ... . .. . .... ...... . .. . ... . . . . . . . . .. . 3a X

b If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo therequired audit or audits , explain why in Schedule 0 and describe any steps taken to undergo such audits. 3b

Form 990 (2013)

JSA

3E 1054 1 000

5FV159 1802 V 13-7.15 444395 PAGE 13

SCHEDULE A Public Charity Status and Public Support OMB No 1545-0047

(Form 990 or 990-EZ) Complete if the organization is a section 501(c)(3) organization or a section20 134947(a)(1) nonexempt charitable trust.

Department of the Treasury ► Attach to Form 990 or Form 990-EZ. ODen to Public

Internal Revenue Service I about Schedule A (Form 990 or 990-EZ) and its instructions Is at www.irs.gov/form990. Inspection

Name of the organization Employer identification number


Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is, (For lines 1 through 11, check only one box)

I A church, convention of churches, or association of churches described in section 170 (b)(1)(A)(i).

2 A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

3 A hospital or a cooperative hospital service organization described in section 170 (b)(1)(A)(iii).

4 A medical research organization operated in conjunction with a hospital described in section 170(b )(1)(A)(iii). Enter the

hospital's name, city, and state:

5 An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170 (b)(1)(A)(iv). (Complete Part II )

6 H A federal, state, or local government or governmental unit described in section 170 (b)(1)(A)(v).

7 An organization that normally receives a substantial part of its support from a governmental unit or from the general public

described in section 170 (b)(1)(A)(vi). (Complete Part II.)

8 A community trust described in section 170 (b)(1)(A)(vi). (Complete Part II )

9 X An organization that normally receives: (1) more than 331/3%of Its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 331/3 %Of Its

support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509 (a)(2). (Complete Part III.)

10 B An organization organized and operated exclusively to test for public safety See section 509 ( a)(4).

11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the

purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2) See section

509(a )(3). Check the box that describes the type of supporting organization and complete lines 11 a through 11 h

a Type I b Type II c Type III-Functionally integrated d Type III-Non-functionally integrated

e By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons

other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1)

or section 509(a)(2).

If If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting

organization, check this box _ .......

g Since August 17, 2006, has the organization accepted any gift or contribution from any of the

following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (it) and Yes No

(iii) below, the governing body of the supported organization? .. . ... .. . .. . . . . .. . ... . . . 11g(i)

(ii) A family member of a person described in (I) above? 119(ii)

(iii) A 35% controlled entity of a person described in (i) or (it) above? 1lgllil)

h Provide the followina information about the suDDorted oroanlzation(s)

(i) Name of supportedorganization

(it) EIN (iii) Type of organization(described on lines 1 -9

above or IRC section(see instructions ))

(lv) is theorganization Lncol (1) listed in

Ydam, ;8

(v) Did you notifythe organization

in cot (I) of yoursupport?

(vi) Is theorganization in

col (1) organizedm the U S ?

(vii) Amount of monetarysupport

Yes No Yes No Yes No

(A)

(B)

(C)

(D)

(E)

Total

For Paperwork Reduction Act Notice , see the Instructions for Schedule A (Form 990 or 990-EZ) 2013Form 990 or 990-EZ.

JSA

3E1210 1 000

5FV159 1802 V 13-7.15 444395 PAGE 14


Schedule A ( Form 990 or 990-EZ ) 2013 Page 2

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170 ( b)(1)(A)(vi)(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify underPart III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public SuooortCalendar year (or fiscal year beginning in) ► (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total

1 Gifts, grants, contributions, andmembership fees received (Do notinclude any "unusual grants ") . . . . . .

2 Tax revenues levied for theorganization's benefit and either paidto or expended on its behalf . . . . . . .

3 The value of services or facilitiesfurnished by a governmental unit to theorganization without charge . . . . . .

4 Total. Add lines 1 through 3 . . . . . . .

5 The portion of total contributions byeach person (other than agovernmental unit or publiclysupported organization) included online 1 that exceeds 2% of the amountshown on line 11, column (f). . . . . . .

6 Public support. Subtract line 5 from line 4

section B. Total 5uorort

Calendar year (or fiscal year beginning in) ►

7 Amounts from line 4 . . . . . . . . .

8 Gross income from interest, dividends,payments received on securities loans,rents, royalties and income from similarsources . .. .. . . . . .. . . . . . .

9 Net income from unrelated businessactivities, whether or not the businessis regularly carried on . . . . . . . . . .

10 Other income Do not include gain orloss from the sale of capital assets(Explain in Part IV) . . . . . . . . . . .

11 Total support. Add lines 7 through 10 . .

(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total

12 Gross receipts from related activities, etc (see instructions) . .. . . .. . . .. . .. . . . . . . . . . . .. 12

13 First five years . If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)organization, check this box and stop here ►n

Section C . Computation of Public Support Percentage

14 Public support percentage for 2013 (line 6, column (f) divided by line 1 1 , column (f)) . .. . .. 14 %15 Public support percentage from 2012 Schedule A, Part II, line 14 . . . . . . . . . .. . .. . .. . 15 %16a 33113 % support test - 2013 . If the organization did not check the box on line 13, and line 14 Is 331/3%or more, check

this box and stop here . The organization qualifies as a publicly supported organization ......... ........... ► q

b 33113% support test - 2012 . If the organization did not check a box on line 13 or 16a, and line 15 is 331/3%or more,check this box and stop here . The organization qualifies as a publicly supported organization . . . ... . .. . . . .. . . . ► q

17a 10%-facts-and - circumstances test - 2013 . If the organization did not check a box on line 13, 16a, or 16b, and line 14 is10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here . Explain inPart IV how the organization meets the "facts -and-circumstances" test The organization qualifies as a publicly supportedorganization ...... ... ................. ........ ............ ............... ► q

b 10%-facts -and-circumstances test - 2012 . If the organization did not check a box on line 13, 16a, 16b, or 17a, and line15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publiclysupported organization . ..... ..... ............. .... ............. ....... ....... ► q

18 Private foundation . If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and seeinstructions q

Schedule A (Forrn 990 or 990-EZ) 2013

JSA

3E1220 1 000

5FV159 1802 V 13-7. 15 444395 PAGE 15


Schedule A (Form 990 or 990-EZ) 2013 Page 3

Support Schedule for Organizations Described in Section 509(a)(2)

(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II.If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Suooort

Calendar year (or fiscal year beginning in ) ► (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total

1 Gifts , grants, contributions , and membership fees

received ( Do not include any "unusual grants " ) 3, 398, 988. 977,833 1,025,624 777,932 965,230 7 , 145 , 607

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 89 , 935403 84, 294, 929 87,821,832 106, 131 412 98 , 517 , 912 466 , 701 , 488

3 Gross receipts from activities that are not an

unrelated trade or business under section 513 794,261 684,138 768 , 350 694 , 769 2,941,518

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 , , , , , , ,

.

94 , 128,652 85, 956, 900 89, 615, 806 107, 609 113 99 483, 142 476 788, 613

7a Amounts included on lines 1, 2, and 3

received from disqualified persons . . . . 0b 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

8 Public support (Subtract line 7c from

line 6 476 , 788 , 613

Section B . Total SupportCalendar year ( or fiscal year beginning In) ►

9 Amounts from line 6. . . . . . . . . . .10a Gross income from interest, dividends,

payments received on securities loans,rents, royalties and income from similarsources . .. . . . . . . . . . . . . .

b Unrelated business taxable income (less

section 511 taxes) from businesses

acquired after June 30, 1975 , , , , , ,

c Add lines 1 Oa and 1 Ob

11 Net income from unrelated businessactivities not included in line 10b,whether or not the business is regularlycarried on • • • • • • • • • • • • .

12 Other income Do not include gain or

loss from the sale of capital assets

(Explain in Part IV) ATC$ 1. . . . . .

13 Total support . (Add lines 9, 10c, 11,

and 12)

(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total

94,128,652 85,956,900 89,615,806 107,604,113 99,483,142 476 788,613

278 , 232 361,048 251,756 436 , 042 804 , 189 2,131 267

43,561 73,477 57 , 825 77 , 739 252 , 602

321 , 793 434 , 525 309 581 . 513,781 804 , 189 2 , 383 , 869

0

2 , 186 , 245 2 , 185 , 302 1 , 667 , 984 1 , 607 , 041 1 , 255 , 256 8 , 901 , 828

96 , 636 , 690 88 , 576 , 727 91 , 593 , 371 109 , 724 , 935 101 , 542 , 587 488 , 074 , 310

14 First five years . If the Form 990 is for the organization 's first, second , third, fourth , or fifth tax year as a section 501(c)(3)

organization , check this box and stop here . 10.F-1............................................. .

Section C . Computation of Public Support Percentage

15 Public support percentage for 2013 ( line 8, column ( f) divided by line 13 , column (f)) .15 97.69%

16 Public support percentage from 2012 Schedule A, Part III , line 15 . 16 97.72%

Section D . Computation of Investment Income Percentage

17 Investment income percentage for 2013 ( line 10c , column ( f) divided byline 13 , column (f)) , , , , , , , , , , 17 .49%

18 Investment income percentage from 2012 Schedule A, Part III , line 17 , , • , , , , , , , , , , , , , , , , , 18 .43%

19a 331 /3% support tests - 2013 . If the organization did not check the box on line 14, and line 15 is more than 331 13%, and line

17 is not more than 331 /3%, check this box and stop here . The organization qualifies as a publicly supported organization ► EX

b 331 /3% support tests - 2012 . If the organization did not check a box on line 14 or line 19a , and line 16 is more than 331 /30/0, and

line 18 is not more than 331 /3%, check this box and stop here . The organization qualifies as a publicly supported organization 10.

20 Private foundation . If the organization did not check a box on line 14, 19a , or 19b , check this box and see instructions 10- R

000Schedule A (Form 990 or 990 •EZ) 2013

15FV159 1802 V 13-7.15 444395 PAGE 16


Schedule A ( Form 990 or990-EZ) 2013 Page 4

Supplemental Information . Provide the explanations required by Part II, line 10; Part II, line 17a or 17b;

and Part III, line 12 . Also complete this part for any additional information . ( See instructions).

ATTACHMENT 1

SCHEDULE A, PART III - OTHER INCOME

DESCRIPTION 2009

PURCHASE REBATES

OTHER CARE FEES ( HOUSING)

CAFE

X RAY

LAUNDRY

BEAUTY SHOP

OTHER

TOTALS

2010 2011 2012 2013 TOTAL

17,320. 27,566 25,259 70,145

413,802 408 ,650 302,784 1,125,236

375,912 344, 817 288,798 1,009,527

139,670 134,818 113,620 388,108

65,154 63,752 60,827 189,733

105,022 128,300 112,027. 345,349

551,104

1 , 6L7, aaa

499,138

1 907 flat

351,941

1 7GS 7Sg

1,402,183

nS7'indal

JSA

3E1225 2 000

5FV159 1802

Schedule A (Form 990 or 990.EZ) 2013

V 13-7.15 444395 PAGE 17

SCHEDULE D(Form 990)

Department of the TreasuryInternal Revenue Service

Name of the organization

Supplemental Financial Statements► Complete if the organization answered "Yes," to Form 990,

Part IV, line 6, 7, 8, 9, 10 , 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.

► Attach to Form 990.

► Information about Schedule D (Form 990 ) and its instructions is at www.lrs.gov/fonn990.

PRESENCE LIFE CONNECTIONS

OMB No 1545-0047

2013

Employer Identification number

37-1127787

j Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.Complete if the organization answered "Yes" to Form 990, Part IV , line 6.

Donor advised funds I (b) Funds and other accounts

1 Total number at end of year . .. . .. . . . . .

2 Aggregate contributions to (during year) . .. .

3 Aggregate grants from (during year) . .. ... .

4 Aggregate value at end of year.... .. ... .

5 Did the organization inform all donors and donor advisors in writing that the assets held in donor advised

funds are the organization's property, subject to the organization's exclusive legal control? ... . . .. .. .. q Yes q No

6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used

only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose

conferrin im permissible p rivate benefit? q Yes q No

Conservation Easements . Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

1 Pur ose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e g , recreation or education) B Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

2 Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservationeasement on the last day of the tax year

Held at the End of the Tax Year

a Total number of conservation easements ......... .................. 2a

b Total acreage restricted by conservation easements . . . . . . . . . ... . .. .. .... 2b

c Number of conservation easements on a certified historic structure included in (a) . . . .. 2c

d Number of conservation easements included in (c) acquired after 8/17/06, and not on a

historic structure listed in the National Register . . . . . . . . . . . . ... . .. .. ... . . 2d

3 Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the

tax year ► _________________

4 Number of states where property subject to conservation easement is located ► _________________

5 Does the organization have a written policy regarding the periodic monitoring, inspection, handling of

violations, and enforcement of the conservation easements it holds? . .. ... . .... . .. . . . . .. . . . q Yes q No

6 Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year

7 Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year

8 Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)

(I) and section 170(h)(4)(B)(ii)? . . . . . . . . . . . . . . . .. . . . . .. . ... . . ... ... .. . . .. .. . q Yes q No

9 In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and

balance sheet, and include, if applicable, the text of the footnote to the organization's financial statements that describes the

organization's accounting for conservation easements.

Organizations Maintaining Collections of Art, Historical Treasures , or Other Similar Assets.Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

1a If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheetworks of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance ofpublic service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

b If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheetworks of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance ofpublic service, provide the following amounts relating to these items:

(i) Revenues included in Form 990, Part VIII, line 1 . . . . .. . . . .. . ... . .. .. . .. . . . . . . ► $ _ _ _ _ _ _ _ _ _ _ _ _ _

(ii) Assets included in Form 990, Part X . . . . . . . . . . . . . . . .. . ... . .. .. . .. .. . .. . ► $ _ _ _ _ _ _ _ _ _ _ _ _ _

2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the

following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

a Revenues included in Form 990, Part VIII, line 1 . . . . . . . .. . . ... . .. . .. ..... .. .. .. ► $ _ _ _ _ _ _ _ _ _ _ _ _ _b Assets included in Form 990, Part X ► $

For Paperwork Reduction Act Notice , see the Instructions for Form 990 . Schedule D ( Form 990) 2013JSA3E1268 2 000

5FV159 1802 V 13-7.15 444395 PAGE 23


Schedule D (Form 990) 2013 Page 2

Organizations Maintaining Collections of Art, Historical Treasures , or Other Similar Assets (continued)

3 Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of itscollection items (check all that apply):

a Public exhibition d H Loan or exchange programs

b Scholarly research e Other-------------------------------------

c Preservation for future generations

4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part

XIII

5 During the year, did the organization solicit or receive donations of art, historical treasures, or other similar

assets to be sold to raise funds rather than to be maintained as part of the organization's collection? . Yes No

Escrow and Custodial Arrangements . Complete if the organization answered "Yes" to Form 990, Part IV, line 9,or reported an amount on Form 990, Part X, line 21.

Ia Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not

included on Form 990, Part X? , , , , , q Yes q Nob If "Yes," explain the arrangement in Part XIII and complete the following table,

Amount

c Beginning balance ... . .. . . . .. . .. . . . . .. . .. . .. . .. .... Icd Additions during the year .. . . . . . . . . . . .. . .. . . . . .. ... . .. 1d

e Distributions during the year ... ... ..... .................. lef Ending balance . . . ... . .. . . . . . . . . . .. . .. . .. . . . .. .... if

2a Did the organization include an amount on Form 990, Part X, line 21? . , Yes Nob If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII. ,

W.M Endowment Funds . CorDlete if the organization answered "Yes" to Form 990. Part IV. line 10.

Ia Beginning of year balance .. .

b Contributions . .. . . . . . . . .

c Net investment earnings, gains,

and losses ........... .

d Grants or scholarships . . . . . .

e Other expenditures for facilities

and programs ... ...... . .

f Administrative expenses ... . .

g End of year balance....... .

(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back

2 Provide the estimated percentage of the current year end balance (line 1 g, column (a)) held as.a Board designated or quasi-endowment jo. %

b Permanent endowment

c Temporarily restricted endowment j %

The percentages in lines 2a, 2b, and 2c should equal 100%.

3a Are there endowment funds not in the possession of the organization that are held and administered for the

organization by Yes No(i) unrelated organizations . . . . . . . . . .. . .. ....... ..... .... . .. . .. . . . . . . . . . . . 3a(i)

(ii) related organizations ............................................... . 3a(ii)

b If "Yes" to 3a(il), are the related organizations listed as required on Schedule R? . .. . .. . . . . .. . . . . . 3b

4 Describe in Part XIII the intended uses of the organization's endowment funds

[EM I-and, Buildin gs, and Equipment.CorDlete if the oraanlzafion answered "Yes" to Form 990. Part IV. line 11a. See Form 990. Part X. line 10.

Description of property (a) Cost or other basis(investment)

( b) Cost or other basis(other )

(c) Accumulateddepreciation

(d) Book value

Ia Land . .. . . . . . . . . . . . . . . . . . . 3,883, 356. 3, 883, 356.

b Buildings .. . . . . . .. . . . . . . . . . 90,705, 424. 50, 014, 139. 40, 691, 285.

c Leasehold improvements.. . . .. . .. 2, 176, 549. 1, 803, 540. 373, 009.

d Equipment . . . . . . . . . . . . . . . 22,364, 361. 14, 710, 136. 7, 654, 225.

e Other . . .. ... .. ... . . . .. . 2, 825, 112. 2, 825, 112.

Total . Add lines 1 a through 1 e. (Column (d) must equal Form 990, Part X, column (B), line 10(c)). ► 55, 426, 987.

Schedule D (Form 990) 2013

JSA3E 1269 2 000

5FV159 1802 V 13-7. 15 444395 PAGE 24



Investments - Other Securities.

Complete if the organization answered "Yes" to Form 990, Part IV, line 11 b. See Form 990, Part X, line 12.

(a) Description of security or category (b) Book value (c) Method of valuation(including name of security) Cost or end-of-year market value

(1) Financial derivatives . . ............. . .

(2) Closely-held equity interests , , , , , , , , , , , , ,

(3) Other(A)

-------------------------------------(B)

-------------------------------------(C)

-------------------------------------(D)

-------------------------------------(E)

-------------------------------------(F)

-------------------------------------(G)

-------------------------------------

Total (Column (b) must equal Form 990, Part X, col (B) line 12) ►

Investments - Program Related.Complete if the organization answered "Yes" to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment ( b) Book value (c) Method of valuationCost or end-of-year market value

(1)

(2)

(3)

(4)

(5)

(6)

(7)(8)

(9)Total . (Column (b) must equal Form 990, Part X, col (B) line 13 ) ►

ji^ Other Assets.Complete if the organization answered "Yes" to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description (b) Book value

(1)

(2)

(3)

(4)

(5)

(6)

(7)(8)

(9)Total . (Column (b) must equal Form 990, Part X, col. (B) line 15) . . ►rj^ utner Liabilities.

Complete if the organization answered "Yes" to Form 990, Part IV, line 1le or 11f. See Form 990, Part X,line 25.

1. (a) Description of liability (b) Book value

1 Federal income taxes

( 2 ) RESIDENT DEPOSITS 312,252.

( 3 ) DUE TO AFFILIATES .8,069,941.

(4 ) DEFERRED COMPENSATION 510,572.

( 5 ) OTHER CURRENT LIABILITIES 185,962.

( 6 ) CONDITIONAL ASSET RETIREMENT 438,744.

( 7 )

( 8 )

(9)

Total. (Column (b) must equal Form 990, Part X, col. (B) line 25) ► 9,517,471.1

2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports theorganization 's liability for uncertain tax positions under FIN 48 (ASC 740) Check h ere i f t h e text o f the footnote has been provi ded i n Part XIII njSA3E12701000 Schedule D (Form 990) 2013

5FV159 1802 V 13-7.15 444395 PAGE 25



Reconciliation of Revenue per Audited Financial Statements With Revenue per Return.

Complete if the organization answered "Yes" to Form 990, Part IV, line 12a.

1 Total revenue, gains, and other support per audited financial statements . .. . . . .. . . . ..... 1

2 Amounts included on line 1 but not on Form 990, Part VIII, line 12.

a Net unrealized gains on investments . . . 2a

b Donated services and use of facilities ...................... 2b

c Recoveries of prior year grants . .. 2c

d Other (Describe in Part XIII.) 2d

e Add lines 2a through 2d 2e

3 Subtract line 2e from line I . . . . .. . .. .. . . . ... . .. . .. . . . . . . . . .. ... 3

4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:

a Investment expenses not included on Form 990, Part VIII, line 7b . , . . . .. 4a

b Other (Describe in Part XIII.) 4b

c Add lines 4a and 4b c

5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part line 12.) 5

Reconciliation of Expenses per Audited Financial Statements With Expenses per Return.Complete if the organization answered "Yes" to Form 990, Part IV, line 12a.

I Total expenses and losses per audited financial statements .. .. . 1.. .. ..2 Amounts included on line 1 but not on Form 990, Part IX, line 25

a Donated services and use of facilities

..

2a

...........

......................b Prior year adjustments 2b..............................c Other losses 2c...................................d Other (Describe In Part XIII) 2d...........................e Add lines 2a through 2d 2e...........................................

3 Subtract line 2e from line I . . . . .. . .. .. . . . ... . .. . . . . . . . . .. . .. .. 3

4 Amounts included on Form 990, Part IX, line 25, but not on line 1:

a Investment expenses not included on Form 990, Part VIII, line 7b 4a

b Other (Describe in Part XIII.) 4b

c Add lines 4a and 4b c

5 Total expenses Add lines 3 and 4c. (This must equal Form 990, Part line 18). 5

Supplemental Information.Provide the descriptions required for Part II, lines 3, 5, and 9, Part III, lines la and 4, Part IV, lines lb and 2b; Part V, line 4; Part X, line2; Part XI, lines 2d and 4b, and Part XII, lines 2d and 4b Also complete this part to provide any additional information

SEE PAGE 5--------------------------------------------------------------------------------------------

JSA Schedule D (Forth 990) 2013

3E1271 1 000

5FV159 1802 V 13-7. 15 444395 PAGE 26

Schedule D,(Form990)2013 PRESENCE LIFE CONNECTIONS 37-1127787 Page5

Supplemental Information (continued)

SUPPLEMENTAL INFORMATION

PRESENCE HEALTH RECOGNIZES THE TAX BENEFIT FROM AN UNCERTAIN TAX POSITION

ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE

SUSTAINED ON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE

TECHNICAL MERITS OF THE POSITION. AS OF DECEMBER 31, 2013 AND 2012,

PRESENCE HEALTH DOES NOT HAVE ANY LIABILITIES FOR UNRECOGNIZED TAX

BENEFITS.

Schedule D (Form 990) 2013

JSA

3E1226 1 000

5FV159 1802 V 13-7.15 444395 PAGE 27

Supplemental Information Regarding Fundraising or Gaming Activities OMB No 1545-0047

SCHEDULE G Complete if the organization answered 'Yes " to Form 990 , Part IV, lines 17 , 18, or 19, or if the2@13(Form 990 or 990-EZ)

organization entered more than $15,000 on Form 990-EZ, line 6a.

► Attach to Form 990 or Form 990-EZ OpenDepartment of the TreasuryInternal Revenue Service ► Information about Schedule G (Form 990 or 990 -EZ) and its instructions is at wwwdrs.govIform990. InspectionAName of the organization Employer Identification number


Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.Form 990-EZ filers are not required to complete this part.

1 Indicate whether the organization raised funds through an of the following activities. Check all that apply

a Mail solicitations e Solicitation of non-government grants

b Internet and email solicitations f Solicitation of government grants

c Phone solicitations g Special fundraising events

d In-person solicitations

2a Did the organization have a written or oral agreement with any individual (including officers, directors, trusteesor key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? q Yes q No

b If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to becompensated at least $5,000 by the organization

() Name and address mdi^dualor

andentity

(( fundrfundr

aisser) (H ) Activit yf) y

(ii) Did fundraiser havecustod y or control ofy

contributions?

0v) Gross receiptsfrom activity

(v) Amount paid to( or retained by)

fundraiser listed incol (1)

(vi) Amount paid to( or retained by)organization

Yes No

1

2

3

4

5

6

7

8

9

10

Total ►3 List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from

registration or licensing.

Paperwork Reduction Act Notice , see the Instructions for Form 990 or 990-ELJSA3E1281 1 000

5FV159 1802 V 13-7.15

Schedule G (Form 990 or 990-EZ) 2013

444395 PAGE 28


Schedule G (Form 990 or 990-EZ) 2013 Page 2

Fundraising Events . Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more

than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b List events with

gross receipts greater than $5,000.

e)

C

(a) Event #1 (b) Event #2

GOLF OUTING MARCH MANIA

(event type ) ( event type)

70,811. 8,054

(c) Other events (d) Total events2 . (add col (a) through

(total number)col (c))

12,782.1 1 Gross receipts

2 Less Contributions

3 Gross income (line 1 minus

line 2 ) ................

4 Cash prizes ............. .

5 Noncash prizes......... .. .

to6 Rent/facility costs . .. . . . . . .

CCDCLX 7 Food and beverages • , • , • • • • ,UN

8 Entertainment . . . . .. . . . .. .

70,811.1 8,054 12,782.

91,647.

91,647.

9 Other direct expenses , , , , , , , , 1 29,180.1 3,026. 1 1,402.1 33,608.

10 Direct expense summary Add lines 4 through 9 in column (d) • • • • , . • . . , .. . . , . ► 33,608.

11 Net income summary Subtract line 10 from line 3, column (d) . ► 58, 039.

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19 , or reported morethan $15 ,000 on Form 990-EZ , line 6a.

(a) Bingo (b) Pull tabslmstant (c) Other gaming (d) Total gaming (addbingo/progressroe bingo col (a) through col (c))

a,

1 Gross revenue ,

U) 2 Cash prizesU)C

3 Noncash prizesXw

a 4 Rent/facility costsQ ........

5 Other direct expenses ,

Yes U Yes %

H

Yes %

6 Volunteer labor No No No

7 Direct expense summary Add lines 2 through 5 in column (d) ►

8 Net gaming income summary . Subtract line 7 from line 1, column (d) ................. ►

9 Enter the state(s) in which the organization operates gaming activities:

a Is the organization licensed to operate gaming activities in each of these states? . .. . . . . . . .. . . . .. Yes Nob If "No," explain.

10 a Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? ... Yes Nob If "Yes," explain:


JSA

3E1282 7 000

5FV159 1802 V 13-7.15 444395 PAGE 29


Schedule G ( Form 990 or990-EZ) 2013 Page 3

11 Does the organization operate gaming activities with nonmembers? .. . . . .. . . .. . .... .. . . . . . . L-1 Yes No

12 Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? .................................. . q Yes q No

13 Indicate the percentage of gaming activity operated in.

a The organization's facility . .. . . . . .. .. . .. . . . . .. . .. . .. . . . . ... . . ... . . 13a %

b An outside facility . .. . .. . . . . . .. . . .. . . .. .. . .. . .. .. . .. ... . .. .. . . .. 13b %

14 Enter the name and address of the person who prepares the organization's gaming/special events books andrecords:

Name ►----------------------------------------------------------------------------------

Address ►--------------------------------------------------------------------------------

15a Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . .. . ... .. . . . .. . . . . .. . .. . .. . .. .. . . . ... . .. ... . .. .. .. . . .. . . q Yes O No

b If "Yes," enter the amount of gaming revenue received by the organization ► $ --------------- and the

amount of gaming revenue retained by the third party ► $----------------

c If "Yes," enter name and address of the third party

Name ► ----------------------------------------------------------------------------------

Address ►--------------------------------------------------------------------------------

16 Gaming manager information

Name

Gaming manager compensation ► $---------------

Description of services provided ►---------------------------------------------------------------

q Director/officer q Employee q Independent contractor

17 Mandatory distributions.

a Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . .. . .. .. .. . . .. . .. . .. . . . . .. . . . .. . .. . . . . .. . q Yes q No

b Enter the amount of distributions required under state law to be distributed to other exempt organizations

or spent in the organization's own exempt activities during the tax year ► $

EMEW Supplemental Information . Provide the explanation required by Part I, line 2b, columns (iii) and (v), andPart III, lines 9, 9b, 1 Ob, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide anyadditional information (see instructions).


SSA

3E 1503 2 000

5FV159 1802 V 13-7.15 444395 PAGE 30

SCHEDULE J Compensation Information(Form 990 )

For certain Officers , Directors , Trustees , Key Employees, and HighestCompensated Employees

► Complete if the organization answered "Yes" to Form 990, Part IV, line 23.

Department of the Treasury ► Attach to Form 990. ► See separate instructions.

Interval Revenue Service ► Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No 1545-0047

2013



uestions Reaardina Com

1a Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form

990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax indemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

No

b If any of the boxes on line 1a are checked, did the organization follow a written policy regarding payment _or reimbursement or provision of all of the expenses described above? If "No," complete Part III toexplain ................. .. ................................. lb

2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all

directors, trustees, and officers, including the CEO/Executive Director, regarding the items checked in line

la? ........................................................... 2

3 Indicate which, if any, of the following the filing organization used to establish the compensation of theorganization's CEO/Executive Director. Check all that apply Do not check any boxes for methods used by arelated organization to establish compensation of the CEO/Executive Director, but explain in Part III

.

X Compensation committee Written employment contract

X Independent compensation consultant X Compensation survey or studyx Form 990 of other organizations X Approval by the board or compensation committee

4 During the year, did any person listed in Form 990, Part VII, Section A, line 1 a, with respect to the filingorganization or a related organization:

a Receive a severance payment or change-of-control payment? , , , , , , , , , , , , , , , , , , , , , , , , , , 4a X

b Participate in, or receive payment from, a supplemental nonqualified retirement plan? , , , , , , , , , , , 4b X

c Participate in, or receive payment from, an equity-based compensation arrangement?, , , , , , , , , , , , , 4c X

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only section 501(c)(3) and 501(c)(4) organizations must complete lines 5-9.

5 For persons listed in Form 990, Part VII, Section A, line 1 a, did the organization pay or accrue any

compensation contingent on the revenues of:

a The organization? ......... .......................................... 5a X

b Any related organization? , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 5b X

If "Yes" to line 5a or 5b, describe in Part III.

6 For persons listed in Form 990, Part VII, Section A, line 1 a, did the organization pay or accrue any

compensation contingent on the net earnings of.

a The organization? .... ... .. ...... .................................... 6a X

b Any related organization?,,,,,,,, ,,,,,,,, ,,, 6b X

If "Yes" to line 6a or 6b, describe in Part III.

7 For persons listed in Form 990, Part VII, Section A, line la, did the organization provide any non-fixed

payments not described in lines 5 and 6? If "Yes," describe in Part III , , , , , , , , , , 7 X

8 Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject

to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe

in Part III ........................................................ 8 X

9 If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described inRegulations section 53.4958-6(c)? ... . ................... ................... 9

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J (Form 990) 2013

JSA

3E1290 1 000

5FV159 1802 V 13-7. 15 444395 PAGE 31


Schedule J (Form 990) 2013 Page 2

Officers , Directors , Trustees , Key Employees, and Highest Compensated Employees . Use duplicate copies if additional space is needed.-jjjF

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (I) and from related organizations, described in theinstructions, on row (II). Do not list any individuals that are not listed on Form 990, Part VII.

Note . The sum of columns (B)(i)-(III) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line la, applicable column (D) and (E) amounts for thatindividual

(B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and (D ) Nontaxable (E) Total of columns (F) Compensation

(A) Name and Title (I) Base ( II) Bonus & incentive (III) Otherother deferred benefits (B)(i)-(D) reported as deferred in

compensation compensation reportable compensation prior Form 990

compensation

CONNIE S. MARCH (i) 349,721.------------

56,306.------------

169,040.------------

66,000.-------------

13,922.-------------

654,989.-------------

18,887.----------- -

1 PRESIDENT /CEO/DIRECTOR -0

CRAIG CULVER (i) 148,150.------------

29,881.------------

34,120.------------ -------------

15,358.-------------

227,509.---------- -

C2 VP DEVELOPMENT

- - ------------0

DAVID HOWARD (i) 129,418.------------

16,043.------------

12,077.------------

12,411.-------------

512.- -

170,461. C3 VP OF OPERATIONS

01 )- ---------- ------------- ------------

KATHY DENNIS (i) 153,793.------------

25,197.------------

1,707.------------

11,669.-------------

14,793.--- -

207,159. C4 VP CLINICAL OPERATIONS

- -------- ------------- ------------C

WENDELL PROVOST (i) 176,303.------------

30,322.------------

9,132.------------

13,840.-------------

13,089. 242,686. C5 VP OF HR, RISK S FACILITIES

------------- ------------- ------------C

MIKE GORDON (i) 198,456.------------

19,670.------------

40,228.------------ -------------

18,072.-------------

276,426.---------

C6 VP FINANCE & CFO

---- ------------C

SUSAN ENRIGHT (i) 155,281.------------

25,216.------------

6,412.------------

11,404.-------------

11,236.-------------

209,549.------- -

C7 VP HOME HEALTH & HOSPICE

- ---- ------------C

NANCY GARCIA (i) 108,132.------------

20,682.------------

10,675.------------

6,825.-------------

9,678.-------------

155,992.- -

08 VP MISSION SERVICES

- ---------- ------------0

LAWRENCE R. PANKAU, M.D (I)------------ ------------ ------------ ------------- - - -

09 DIRECTOR 168, 669. 92,077. 8,177.

- - -------3,582.

------------272, 505.

------------C

PETER GOSCHY (i) 182,937.------------

23,806.------------ ------------

10,004.-------------

7,402.-------------

224,149.-------------

C------------

10 VP NURSING HOME OPERATIONS 0

MICHAEL BORN (i) 132,927.------------

16,791.------------

5,152.------------

8,594.-------------

11,496.-------------

174,960.-------------

0------------

11PHARMACY DIRECTOR 0

PAUL SKIEM (i)------------ ------------ ------------ - - - =

0

12DIRECTOR 355, 428. 130, 196.

-- - -------76,560.

--- ---------5,762.

-------------567, 946. 0

ANTHONY FILER (i)------------ ------------ ------------ ------------- ------------- ---------

C13SYSTEM CFO, TREASURER 629, 462. 139, 487. 109, 953. 146,954 . 25,707.

----1, 051, 563.

-------------0

JEANNIE FREY (i)----------- ------------ ------------ ------------- ------------- -------------

014SYS SR VP LEGAL, SECRETARY 466, 882. 186, 483. 108, 779. 7,808. 769, 952.

-------------0

1S

(I)

0

------------ ------------ ------------ ------------- ------------- ------------- -------------

6

(I)----------- ------------ ------------

- - - - - - - - - - - - - - - - - - - -

-

- - - - -

------------- -------------

JSA3E1291 1 000

Schedule J (Form 990) 2013

5FV159 1802 V 13-7.15 444395 PAGE 32


Schedule J ( Form 990 ) 2013 Page 3

Supplemental informationComplete this part to provide the information, explanation, or descriptions required for Part I, lines 1 a, 1 b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.Also complete this part for any additional information.

Schedule J (Form 990) 2013

JSA

3E 1505 1 000

5FV159 1802 V 13-7.15 444395 PAGE 33

SCHEDULE 0(Form 990 or 990-EZ)

Department of the TreasuryInternal Revenue Service

Supplemental Information to Form 990 or 990-EZComplete to provide information for responses to specific questions on

Form 990 or 990-EZ or to provide any additional information.to Form 990 or 990-EZ.

OMB No 154 5-00 4 7

2013

Name of the organrzation Employer identification number


AMENDED RETURN

THE ORIGINALLY FILED FORM 990 INCORRECTLY INCLUDED THE FINANCIAL DATA

(REVENUE, EXPENSES, AND BALANCE SHEET ITEMS) OF ARTHUR MERKLE-CLARA

KNIPPRATH NURSING HOME ("MERKLE") (EIN: 36-2841358) WHICH IS A SEPARATE

LEGAL ENTITY AND FILES A SEPARATE FORM 990.

THE AMENDED FORM 990 CORRECTLY EXCLUDES MERKLE AND ACCURATELY REPRESENTS

THE FINANCIAL DATA OF THE PRESENCE LIFE CONNECTIONS LEGAL ENTITY.

IN OCTOBER 2013, PRESENCE LIFE CONNECTIONS ACQUIRED CONTROL OF MERKLE

THROUGH A CORPORATE MEMBERSHIP SUBSTITUTION BECOMING MERKLE'S SOLE

CORPORATE MEMBER.

THE FOLLOWING PARTS AND SCHEDULES WERE AMENDED:

FORM 990, PART I, CURRENT YEAR COLUMN LINES 8 - 22

FORM 990, PART III, 4A AND 4E

FORM 990, PART VIII

FORM 990, PART IX

FORM 990, PART X

FORM 990, PART XI

SCHEDULE A, PART III

SCHEDULE D, PART VI

SCHEDULE 0

FORM 990 PART VI SECTION A, QUESTIONS 6

PRESENCE PRV HEALTH IS THE SOLE MEMBER OF PRESENCE LIFE CONNECTIONS.

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule 0 (Form 990 or 990 -EZ) (2013)

JSA3E1227 1 000

5FV159 1802 V 13-7.15 444395 PAGE 34

Schedule O (Form 990 or 990-EZ) 2013 Page 2



FORM 990 PART VI SECTION A, QUESTIONS 7A & 7B

PRESENCE LIFE CONNECTIONS' PARENT ORGANIZATION, PRESENCE PRV HEALTH,

APPOINTS THE BOARD MEMBERS OF PRESENCE LIFE CONNECTIONS.

FORM 990 PART VI SECTION A, QUESTION 11B

THE DATA AND INFORMATION NECESSARY TO PREPARE THE FORM 990 WAS COMPILED

BY PRESENCE LIFE CONNECTIONS. KPMG, AS EXTERNAL TAX PREPARERS, USED THIS

INFORMATION TO PREPARE THE FORM 990, WHICH IS REVIEWED BY THE PRESENCE

HEALTH LEGAL DEPARTMENT. THE FINAL FORM 990 IS PROVIDED TO THE

CORPORATION'S BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING.

FORM 990 PART VI SECTION B, QUESTIONS 12A, 12B, & 12C

THE CONFLICT OF INTEREST POLICY IS MONITORED BY THE PRESENCE LIFE

CONNECTIONS COMPLIANCE OFFICER. PURSUANT TO THE POLICY, AN ANNUAL

CONFLICT OF INTEREST QUESTIONNAIRE, AIMED AT DETERMINING ANY FAMILY AND

BUSINESS RELATIONSHIP TRANSACTIONS OR OTHER TRANSACTIONS THAT MAY POSE A

POTENTIAL CONFLICT, IS DISTRIBUTED TO ALL COVERED PERSONS (I.E., BOARD

MEMBERS, OFFICERS AND EXECUTIVE LEADERSHIP OR KEY EMPLOYEES). COVERED

PERSONS ARE REQUIRED TO COMPLETE THE QUESTIONNAIRE AND DISCLOSE REAL OR

POTENTIAL CONFLICTS AT THE TIME WHEN SUCH CONFLICTS ARISE. WHEN SOMEONE

BECOMES A COVERED PERSON AND ANNUALLY THEREAFTER, EACH COVERED PERSON IS

REQUIRED TO SIGN A STATEMENT AFFIRMING THAT HE/SHE: (1) HAS RECEIVED A

COPY OF THE CONFLICT OF INTEREST POLICY;(2) HAS READ THE POLICY AND

UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS

OF THE POLICY, INCLUDING COMPLETING THE CONFLICT OF INTEREST

QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE FINANCE

JSA Schedule 0 (Form 990 or 990-EZ) 2013

3E1228 1 000

5FV159 1802 V 13-7.15 444395 PAGE 35

Schedule 0 (Form 990 or 990-EZ) 2013 Page 2

Name of the organization Employer Identification number


AND ADMINISTRATION DEPARTMENT . THE PROCEDURES FOR ADDRESSING ANY CONFLICT

OF INTEREST INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING: (1) THE

CONFLICTING INTEREST IS FULLY DISCLOSED TO THE BOARD; (2) THE INTERESTED

PERSON RESPONDS TO FACTUAL QUESTIONS RELATED TO THE SUBSTANCE OF THE

TRANSACTION OR ARRANGEMENT BEING CONSIDERED, AFTER WHICH HE/SHE SHALL

LEAVE THE MEETING; (3) THE PERSON WITH THE CONFLICT OF INTEREST IS

EXCLUDED FROM THE DISCUSSION AND APPROVAL OF SUCH TRANSACTION; (4)

ALTERNATIVES TO THE PROPOSED TRANSACTION ARE INVESTIGATED, COMPETITIVE

BIDS OR COMPARABLE VALUATIONS ARE OBTAINED; (5) ANY CONFLICTING ISSUES

DURING THE COURSE OF A BOARD MEETING WHICH CANNOT BE RESOLVED IS REFERRED

TO THE GOVERNANCE COMMITTEE; AND (6) THE TRANSACTION OR ACTION MUST BE

APPROVED BY A MAJORITY OF DISINTERESTED PERSONS.

FORM 990 PART VI SECTION B, QUESTIONS 15A & 15B

THE COMPENSATION COMMITTEE OR OTHER AUTHORIZED COMMITTEE OF THE BOARD,

NONE OF WHICH HAVE A CONFLICT OF INTEREST WITH RESPECT TO THE

COMPENSATION ARRANGEMENT, WAS ACCOUNTABLE FOR SETTING REASONABLE

COMPENSATION PACKAGES FOR THE CEO AND KEY EMPLOYEES. THE COMMITTEE

DEVELOPED, CONSISTENT WITH PRESENCE HOSPITAL PRV'S PHILOSOPHY AND

PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN

DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR THE

CEO AND KEY EMPLOYEES.

THE COMMITTEE ALSO REVIEWED APPROPRIATE COMPARABILITY DATA PREPARED BY AN

INDEPENDENT CONSULTANT THAT UTILIZED NATIONAL NONPROFIT COMPENSATION

SURVEYS IN DETERMINING THE CEO'S AND KEY EMPLOYEES' COMPENSATIONS. THE

COMMITTEE'S WRITTEN RECORDS INCLUDE THE (1) TERMS OF THE ARRANGEMENT WITH

JSA

3E 1228 1 000

5FV159 1802

Schedule 0 (Form 990 or 990 -EZ) 2013

V 13-7 .15 444395 PAGE 36

Schedule O (Form 990 or990-EZ)2013 Page 2



THE DISQUALIFIED PERSON (INCLUDING THE DATE THE ARRANGEMENT WAS

APPROVED); AND (2) A DESCRIPTION OF THE COMPARABLE DATA RELIED ON BY THE

COMMITTEE. KEY DELIBERATIONS OF THE COMMITTEE, INCLUDING: (A) THE TERMS

OF THE TRANSACTION THAT WAS APPROVED AND THE DATE IT WAS APPROVED; (B)

THE MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING DEBATE ON THE

TRANSACTION THAT WAS APPROVED AND THOSE WHO VOTED ON IT; (C) THE

COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMMITTEE AND HOW THE

DATA WAS OBTAINED; AND (D) ANY ACTIONS TAKEN WITH RESPECT TO

CONSIDERATION OF THE TRANSACTION BY ANYONE WHO IS OTHERWISE A MEMBER OF

THE COMMITTEE BUT WHO HAD A CONFLICT OF INTEREST WITH RESPECT TO THE

TRANSACTION ARE ALSO DOCUMENTED IN MINUTES, WHICH ARE APPROVED AT THE

NEXT COMMITTEE MEETING.

FORM 990 PART VI SECTION C, QUESTION 19

GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL

STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.

FORM 990 PART XI, LINE 5

CHANGE IN NET ASSETS

TRANSFERS TO AFFILIATES

TOTAL CHANGES IN NET ASSETS

(4,233,778)

(4,233,778)

JSA

3E1228 1 000

5FV159 1802

Schedule 0 ( Form 990 or 990-EZ) 2013

V 13-7.15 444395 PAGE 37

Schedule O (Form 990 or 990-EZ) 2013 Page 2



ATTACHMENT 1

FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION

PRESENCE LIFE CONNECTIONS PROVIDES CARE TO THE ELDERLY AND OWNS AND

OPERATES 11 NURSING HOMES, FOUR INDEPENDENT LIVING FACILITIES, FOUR

ASSISTED LIVING FACILITIES, TWO ADULT DAYCARE CENTERS, TWO COMMUNITY

SERVICE FACILITIES, ONE CHILD CARE CENTER, AND ONE OUTPATIENT

PHARMACY IN NORTHERN AND CENTRAL ILLINOIS AND INDIANA.

FORM 990, PART III, LINE 4D - OTHER PROGRAM SERVICES

DAY CARE

TOTALS

ATTACHMENT 2

EXPENSES REVENUE

1,288,094. 1,243,669.

1,288,094. 1,243,669.

ATTACHMENT 3

990, PART VII- COMPENSATION OF THE FIVE HIGHEST PAID IND. CONTRACTORS

NAME AND ADDRESS DESCRIPTION OF SERVICES COMPENSATION

SELECT REHABILITATION, INC. THERAPY SERVICES 8,377,765.

550 FRONTAGE ROAD, SUITE 2415

NORTHFIELD, IL 60093

SCANDROLI CONSTRUCTION CORP CONSTRUCTION 1,193,549.

823 N MADISON ST

ROCKFORD, IL 61107

SHAWNEE CONSTRUCTION & ENGINEERING CONSTRUCTION 2,111,532.

7701 OPPORTUNITY DR.

FORT WAYNE, IN 46825

SCRIPTFLEET GREAT LAKES DELIVERY SERVICE 263,624.

P.O. BOX 2513

ORLANDO, FL 32802

LAMP, INC. CONSTRUCTION 2,144,959.

460 N. GROVE AVE.

ELGIN, IL 60123

SSA Schedule 0 (Form 990 or 990 -EZ) 2013

3E1228 1 000

5FV159 1802 V 13-7.15 444395 PAGE 38

0


SCHEDULE R Related Organizations and Unrelated Partnerships(Form 990) 'Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.

► Attach to Form 990. ► See separate instructions.Department of the Treasury

Internal Revenue Service 10, Information about Schedule R (Form 990) and its instructions is at www.irs.gov1form990.


- OMB No 1545-0047

X013•.•

Inspection

mployer Identification number

37-112 7787

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) (b) (C) (d ) ( e) (f)Name , address , and EIN (if applicable ) of disregarded entity Primary activity Legal domicile (state Total income Endof-year assets Direct controlling

or foreign country) entity

_(ii PRESENCE HEALTHMGMT SERV ORG., LLC 46_3100255- ------------------------

7435 WEST TALCOTT AVENUE CHICAGO, IL 60631 HEALTH MGMT IL 0 0 PRHCC

46_3111349_C21

-

PRESENCE HEALTH PARTNERS,LLC---

------

-

9223 W. ST. FRANCIS ROAD FRANKFORT, IL 60423- ----- MGD CARE CONT IL 0 0 PR HOSP PRV

_C31 VERMILLION COUNTY SURGERY CENTER, LLC 80-0811427

26 W. NEWELL DANVILLE, IL 61834 MEDICAL SERV. IL 0 0 PR HOSP PRV

4- -------------------------------------------------------

-5 --------------------------------------------------------

_(61 ........................................................

Identitication of Related Tax-Exempt Organizations Complete it the organization answered "Yes" on Form 990, Part IV, line 34 because it hadone or more related tax-exempt organizations during the tax year.

(a) (b) (c) (d) (a) (I) (g)Name , address , and EIN of related organization Primary acti vity Legal domicile ( state Exempt Code sect ion Public chanty status Direct controlling Section 512(b)(13)

or foreign country ) ( if section 501 (c)(3)) entitycontrolledentity?

Yes NoPRESENCE HEALTH NETWORK 36-1649520

-`-------------------------------------------200 SOUTH WACKER CHICAGO , IL 60606 HEALTH CARE IL 501 (C) (3) 3 N/A X

( 2 MEDICARE VALUE PARTNERS 36-3495969---------------------------------------------

100 NORTH RIVER ROAD DES PLAINES , IL 60016 HEALTH CARE IL 501 (C) (3) 3 PRHCC X_( 31 PRESENCE HOLY FAMILY MEDICAL CENTER 36-2439318`-------------------------------------------

100 NORTH RIVER ROAD DES PLAINES , IL 60016 HEALTH CARE IL 501 (C) (3) 3 PRHCC X41 MOUNT LORETTO NURSING HOME , INC 14-1363014

-^-----------------------------------------302 SMART HILL ROAD AMSTERDAM , NY 12010 SENIOR LIVING NY 501 (C) (3) 3 RMNY X

I 5 PRESENCE OUR LADY-RESURRECTION MED CTR 36 -2644178--------------------------------------------5645 WEST ADDISON STREET CHICAGO , IL 60634 HEALTH CARE IL 501(C)(3) 3 PRHCC X

-/6

L1 PRESENCE PRV HEALTH 36-3366652

` ------------------------------------------99223 W. ST FRANCIS ROAD FRANKFORT , IL 60423 HEALTH CARE IL 501(C)(3) 11 PHN X

/7 1 PRESENCE CARE 8 HOME 46-048358718927 HICKORY CREEK DRIVE 0300 MOKENA , IL 60448 HEALTH CARE IL 1 501(C)(3) 9 PLC X

For Paperwork Reduction Act Notice , see the Instructions for Form 990.

JSA3E1307 1 000

5FV159 1802 V 13-7.15 444395

Schedule R (Form 990) 2013

PAGE 39


SCHEDULE R Related Organizations and Unrelated Partnerships(Form 990) "Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.

► Attach to Form 990. ► See separate instructions.Department of the Treasury ► Information about Schedule R (Form 990) and its instructions is at www.irs.gov1form990.Interned Revenue Service


OMB No 1545-0047

X013Open to Publ ic

Inspection

mployer Identification number

37-1127787

M Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a)Name , address , and EIN ( tf applicable) of disregarded entity

(b)Primary activity

(c)Legal domicile (stateor foreign country)

(d)Total income

(e)End-of-year assets

(f)Direct controlling

entity

211- -------------------------------------------------------

3- -------------------------------------------------------

4- -------------------------------------------------------

5-

UMMU Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it hadone or more related tax-exempt organizations during the tax year.

(a) (b) (C) (d ) ( e) (0 (g)Name , address , and EIN of related organization Primary activity Legal domicile ( state Exempt Code section Public charity status Direct controlling Section 512(b)(13)


Yes NoI 1 PRESENCE HOME CARE 46-0483581

----------------------------------------18927 HICKORY CREEK DRIVE #300 MOKENA, IL 60448 HEALTH CARE IL 501 (C) (3) 9 PLC X

_c2i HOSPITALS PRV 36-4195126

-------------------------------------------9223 W ST. FRANCIS ROAD FRANKFORT , IL 60423 HEALTH CARE IL 501 (C) (3) 3 PPRVH X( 3 LAVERNA TERRACE HOUSING CORPORATION 36-3438977-`------------------------------------------

18927 HICKORY CREEK DRIVE #300 MOKENA , IL 60448 SENIOR LIVING IL 501 (C) (3) 9 PHPRV X_C41 PROVENA SELF-INSURANCE TRUST 36-2987310

-------------------------------------------9223 W ST FRANCIS ROAD FRANKFORT , IL 60423 INSURANCE IL 501 (C) (3) 9 PPRVH X

5 PRESENCE BEHAVIORAL HEALTH 36-2709982

1820 SOUTH 25TH AVENUE BROADVIEW , IL 60155 HEALTH CARE IL 501 (C) (3) 3 PHS X( 6 1 PRESENCE AMBULATORY SERVICES 36-4286236-- ------------------------------------------

100 NORTH RIVER ROAD DES PLAINES , IL 60016 HEALTH CARE IL 501 (C) (3) 3 PRHCC X_C71 PRESENCE HEALTH FND BRD OF TRUSTEES 36-3330929

200 SOUTH WACKER CHICAGO , IL 60606 FUNDRAISING IL 501 (C) (3) 7 PRHCC Xi-or raperworK Keauction Act Notice , see the instructions Tor I-orm 99u.

SSA3E 1307 1 000

5FV159 1802 V 13-7.15 444395


PAGE 40


SCHEDULE R Related Organizations and Unrelated Partnerships OMB No 1545-0047

(Form 990) ►Complete if the organization answered "Yes" on Form 990 , Part IV , line 33 , 34, 35b, 36, or 37. 2O 13

► Attach to Form 990 . ► See separate instructions.Department of the Treasury • ' ' ' -

10,Internal Revenue Service Information about Schedule R (Form 990 ) and its instructions is at www.irs.gov/form990.

Name of the organization Employer Identification number


M Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a)Name , address , and EIN (d applicable ) of disregarded entity

(b)Primary activity

(C)Legal domicile ( stateor foreign country)

(d)Total Income

(e)End-of-year assets

(1)Direct controlling

entity

1- -

21- -------------------------------------------------------

3- -------------------------------------------------------

4

5- -------------------------------------------------------

I W Identification of Related Tax-Exempt Organizations Complete it the organization answered "Yes" on Form 990, Part IV, line 34 because it hadone or more related tax-exempt organizations during the tax year.

(a) (b) (c) (d ) ( e) (f) (g)Name , address, and EIN of related organization Primary activity Legal domicile (state Exempt Code sect ion Public charity status Direct controlling Section 512(b)(13)

or foreign country) (if section 501 (c )( 3)) entitycontrolledentity?

Yes NoI 1 PRESENCE RHC CORPORATION 36-2235165_`---- ----------------------------------------

_SO200 UTH WACKER CHICAGO , IL 60606 PARENT CORP IL 501 (C) (3) 3 PHN X

(21 RRESENCE HOME CARE SERVICES36-2893936

_`--------------------------------------------5747 WEST DEMPSTER MORTON GROVE , IL 60053 HOME CARE IL 501 (C) (3) 3 PRHCC X

3 PRESENCE RESURRECTION MEDICAL CENTER 36-3330926-« ------------------------------------- -- -7 Z3 5̂ WFEgi TALCOTTWEST TALCOTT AVENUE CHICAGO, IL 60631 HEALTH CARE IL 501 (C) (3) 3 PRHCC X_C41 RESURRECTION NURSING HOME , INC 14-1348691------ -- -------------------------------------

90 NORTH MAIN STREET CASTLETON, NY 12033 NURSING NY 501 (C) (3) 3 RMNY XPRESENCE RHC SENIOR SERVICES 23-7061646------------------------------------------100 NORTH RIVER ROAD DES PLAINES , IL 60016 NURSING IL 501 (C) (3) 3 PRHCC X

_C61 PRESENCE HEALTHCARE SERVICES 36-3330928

---------------------------------100 NORTH RIVER ROAD DES PLAINES , IL 60016 HEALTH CARE IL 501 (C) (3) 3 PRHCC XI 7 PRESENCE SAINT FRANCIS HOSPITAL 36-2167800

355 RIDGE AVENUE EVANSTON , IL 60202 HEALTH CARE IL 501 (C) (3) 3 PRHCC X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

JSA

3E1307 1 000

5FV159 1802 V 13-7.15 444395


PAGE 41

SCHEDULE R(Form 990)

Department of the Treasury

Internal Revenue Service

Name of the organization


OMB No 1545-0047

2013•. . PLIbliC

Inspection

mpioyer Identification number

37-1127787

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a)Name, address, and EIN (tf applicable) of disregarded entity

(b)Primary activity

(c)Legal domicile (stateor foreign country)

(d)Total Income

(0)End-of-year assets

(nDirect controlling

entity

-------------------------------------------------------

21-

.

31-

.

41- -------------------------------------------------------

5- -------------------------------------------------------

giMa Identification of Related Tax-Exempt Organizations Complete If the organization answered "Yes" on Form 990, Part IV, line 34 because it hadone or more related tax-exempt organizations during the tax year.

( a) (b) (c) (d) (e) (f) (g)Name, address , and EIN of related organization Primary activity Legal domicile (state Exempt Code sect ion Public charity status Direct controlling Section 512(b)(13)


Yes NoST FRANCIS HOSPITAL AUX OF EVANSTON 36-6143349

- ------------------------------------- -5 RIDGE AVENUE EVANSTON , IL 6020235 FUNDRAISING IL 501 (C) (3) 7 PSFH X( 2 PRESENCE SAINTS MARY & -ELIZABETH MED CTR 36-2171079

------------ -------------2233 WEST DIVISION STREET CHICAGO , IL 60622 HEALTH CARE IL 501 (C) (3) 3 PRHCC X_( 31 PRESENCE SAINT JOSPEH HOSPITAL CHICAGO 36 -3200170

-_ ------------------ -------------- -NCO NORTH LAKE SHORE DRIVE CHICAGO , IL 60657 HEALTH CARE IL 501 (C) (3) 3 PRHCC X

4 PRESENCE NAZARETHVILLE 36-2801392-300 NORTH RIVER ROAD DES PLAINE S IL 60016 NURSING IL 501 (C) (3) 11, TYPE II PRHC SNR SRV X

5 ARTHUR MERKLE-CLARA KNIPPRATH NURSING HO 36-2841358-^Z------------------------------------------1190 E 2900 N ROAD CLIFTON , IL 60927 NURSING IL 501 (C) (3) 9 PLC X

6

_(7!____________________________________________

For vaperworK Keauction ACT Notice , see The Instructions for Norm `duu.

JSA

3121307 1 000

5FV159 1802 V 13-7.15


Related Organizations and Unrelated Partnerships'Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.

► Attach to Form 990. ► See separate instructions.

► Information about Schedule R (Form 990 ) and its instructions is at www.irs.gov/form990.

444395


PAGE 42


Schedule R (Form 990 ) 2013 Page 2

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34because it had one or more related organizations treated as a partnership during the tax year.

(a) (b) (c) (d) (a) (0 (g) (h) (1) U) (k)Name, address , and EIN of Primary activity Legal Direct controlling Predominant Share of total Share of end-of- 01.o..oo- Code V-UBI General or Percentage

related organ iz ation domicile entity income (related,c related ,

income year assets .m^e.., amount in box 20 managing ownershipor(state exclluded

uded from of Schedule K-1 partner?foreign tax under ( Form 1065)country) sections 512-514)

Yes N. Yes No

1 BE LMONT HARLEM SURD, 41 _2237162

CHICAGO , IL 60634 MEDICAL SERVICE IL RESUR SERVICES RELATED X X

J?L RES. HLTH _SLEEP_C 26 _1519627

LOMBARD , IL 60148 MEDICAL SERVICE IL RESUR SERVICES RELATED X X

(3L RES. HLTH _SLEEP_C 26_1519556


^4) RES. NLTH_SLEEP_C L 26 _1519667


(5) RES_ HLTH _ LEEP_C 26_2189763


JsLALVERNO LAB 20-3240648_

HAMMOND , IN 46324 LAB SERVICE IN RESUR SERVICES RELATED X X

^7L ALVERNO I.AB 20 _3 240698____

HAMMOND , IN 46325 LAB SERVICE IN PROVENA VENTURE RELATED X X

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV,line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) (b) (c) (d ) ( e) (f) (g) (h) (I)Name , address , and EIN of related organization Primary activity Legal domicile Direct controlling Type of entity Share of total Share of Percen- Section

(state or foreign entity (C corp, S Corp, or income end -of-year assets tags512(b)(13

country) trust ) ownershipcontrolledsold 7

Yes No

L_ GILBRAITH INSURANCE SPC, LTD_______________________

68 W BAY ROAD , P 0 BOX 1109 GRAND CAYMAN , CJ INSURANCE CJ PRHCC FOREIGN CORP 0 0 X

PROVENA HEALTH ASSURANCE SIC-_______________ 98_0420054 _

----------------

23 LIME TREE BAY AVE PO BOX 1051 GRAND CAYMAN , CJ INSURANCE CJ PPRVH FOREIGN CORP 0 0 X

(3), PRESENCE PROPERTIES INC __________________ 36_3520630

9223 W ST FRANCIS ROAD FRANKFORT , IL 60423 MEDICAL IL PPRVH C CORP 0 0 X

L PRESENCE SERVICE CORPORATION ___________---- 6_4319359 _------------

9223 W S. FRANCIS ROAD FRANKFORT IL 60423 MEDICAL IL PHPRV C CORP 0 0 X

(SL PRESENCE VENTURES , INC. ___________________ 37_1168085 _

9223 W ST. FRANCIS ROAD FRANKFORT , IL 60423 MEDICAL IL PPRVH C CORP 0 0 X

^sL RESURRECTION--

ED---ICAL CENTER AUXILIARY _________ 36_109825 _

----------------

745 WEST TALCOTT AVENUE CHICAGO , IL 60631 FUNDRAISING IL PR MED CTR C CORP 0 0 X

7 RESURRECTION MINISTRIES OF NEW YORK _______ 4_1720816

90 NORTH MAIN STREET CASTLETON , NY 12033 PARENT CORP NY PRHCC C CORP 0 0 X

JSA Schedule R (Form 990) 20133E1308 1 000

5FV159 1802 V 13-7.15 444395 PAGE 43


Schedule R (Form 990) 2013 Page 2

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34because it had one or more related organizations treated as a partnership during the tax year.

(a) (b) (c) (d) (o) (f) (g) (h ) (I) 0) (k)Name , address, and EIN of Primary activity

yLeg al Direct controlling

gPredominant Share of total Share of end -of- o.o.w.>.. Cade V-UBI General or Percentage

related organization domicile entity income ( related ,c d

income year assets .mue.., amount in box 20 manag ing ownershipor(state deedd frfrexclluu om of Schedule K-1 partner?

foreign tax under (Form 1065)country) sections 512-514)

Yes No Yes No

-01L --------------------

2-- --------------------

3-- --------------------

- -(4)---------------------

(5)--- --------------------

-6

--------------------

7

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV,line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

( a)Name , address , and EIN of related organization

(b)Primary activity

(c)Legal dom i cile

(state or foreign

country)

(d )Direct controlling

entity

(e)Type of entity

(C corp , S corp, or

trust)

(f)Share of total

income

(g)Share of

end -of-year assets

(h)Percen-

tape

ownership

(1)Section

512(b)(13

anti ?

Yes No

D ----------- -- - 36_3974620 _1 PRESENCE HEALH---CARE PREFE

--RRE---- ---------- --

100 NORTH RIVER ROAD DES PLAINES , IL 60016 GD CARE CONTRACT L RHCC CORP 0 0 X

j2 ) --------------------------------------------

L--------------------------------------------

--a --------------------------------------------

!SL--------------------------------------------

--s --------------------------------------------

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

JsA Schedule R (Form 990) 20133E1308 1 000

5FV159 1802 V 13-7.15 444395 PAGE 44

16


Schedule R (Form 990) 2013 page 3 '

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note . Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule. Yes No

I During the tax year , did the organization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?a Receipt of ( i) interest ( ii) annuities (iii) royalties or ( iv) rent from a controlled entity , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,,,,,,,, , , , ,,,, 1a X

b Gift, grant , or capital contribution to related organization ( s) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,, , , , , , , , , , , 1 b Xc Gift, grant , or capital contribution from related organization ( s) .... . . . . . . . . . . . . . .. . . . . . . . . . . .............. . .... . ...... 1c X

d Loans or loan guarantees to or for related organization(s) ... . . . . . . . . .. . .... . . . . . . . . . . .. . . ...... . . . . ........ ....... 1 d X

e Loans or loan guarantees by related organization ( s), , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,, , ,,, , , , ,,,,,, ,,,,,,,,, 1 e X

f Dividends from related organization ( s), ,,, , , , , , , , , , , , , , , , , , , , , , , , , , , ,,,,,,, , , , ,, , , , , ,,,,,,,,, If

g Sale of assets to related organization (s) , , , , , , , , , , ,, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,,,,,,,,,,,, , ,, ,,,,,,,,,, 1 X

h Purchase of assets from related organization (s) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,,, , , , ,, , , , , , , , , , , ,, 1 h X

I Exchange of assets with related organization (s) ,, , , , , , , , , , , , , ,, , ,, , , , , , , , , , , ,,, , , , , , , , , , ,,,, ,,,,,,,, 11 X

J Lease of facilities , equipment , or other assets to related organization (s) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,,,,,,,,,, , ,, , 1' X

k Lease of facilities, equipment, or other assets from related organization(s) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,,, , , , , , , ,, , , XI Performance of services or membership or fundraising solicitations for related organization(s) 11m Performance of services or membership or fundraising solicitations by related organization(s)

.1k

X

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) , , , , , , , ,, , , , , , , , , , , , , , , , , , , , , , , , , , , , ,,,, .In Xo Sharing of paid employees with related organization(s) . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . .. 1o X

p Reimbursement paid to related organization (s) for expenses . .............. .11 X

q Reimbursement paid by related organization ( s) for expenses ..!.q X

r Other transfer of cash or property to related organization (s) , , , 1r X

s Other transfer of cash or property from related organization (s). 1s X

2 If the answer to any of the above is "Yes." see the instructions for information an who must comnlPte this line inchidinn cnverarl rplatinnchinc nnrl trancactinn throchrild

(a)Name of related organization

(b)Transaction

type (a-s)

(o)Amount involved

(d)Method of determining

amount involved

1

( 2 )

( 3 )

(4)

( 5 )

( 6 )

JsA Schedule R (Form 990) 2013

3E1309 1 000

5FV159 1802 V 13-7.15 444395 PAGE 45


Schedule R ( Form 990 ) 2013 Page 4

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assetsor gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships

( a)

Name, address , and EIN of entity

(b)

Primary actmty

(°)

Leg el domicile

(state or foreign

country)

(d)

Predominant

income (related

unrelated, excluded

from tax under

(a)

Are all partners

section

501(c)( 3)

organizations?

(})

Share of

total income

(9)

Share of

end-of- year

assets

(h )

Disproportlonete

etloccOoro7

( I)

Code V-UBI

amount in box 20

of Schedule K-1

(Form 1065)

U)

General or

managing

partner?

(k)

Percentag eownership

sect i on 512 - 514) Yes No Yes No Yes No

(^)----------------------------

^?L-------------------------

!3L-------------------------

(a^----------------------------

(5)----------------------------

s-- -------------------------

Z)--------------------------

8-- -------------------------

L-------------------------

0-01-------------------------

0-11-------------------------

1131-------------------------

L'L41-------------------------

-------------------------

Ll61-------------------------

SSA Schedule R (Form 990) 2013

3E1310 1 000

5FV159 1802 V 13-7.15 444395 PAGE 46


Schedule R ( Form 990) 2013 Page 5

JjM= Supplemental InformationComplete this part to provide additional information for responses to questions on Schedule R (seeinstructions).

SCHEDULE R, PART III

LISTED BELOW ARE THE COMPLETE NAMES AND STREET ADDRESSES FOR PART III:

1) BELMONT HARLEM SURGERY CENTER; 3101 NORTH HARLEM

2) RES. HLTH SLEEP C.- CHICAGO NORTHWEST; 665 WEST NORTH AVE.

3) RES. HLTH SLEEP C.- EVANSTON; 665 WEST NORTH AVE.

4) RES. HLTH SLEEP C.- LINCOLN PK; 665 WEST NORTH AVE.

5) RES. HLTH SLEEP C.- RIV FOREST; 665 WEST NORTH AVE.

6) ALVERNO CLINICAL LABS, LLC; 2434 INTERSTATE PLAZA DRIVE

7) ALVERNO CLINICAL LABS, LLC; 2435 INTERSTATE PLAZA DRIVE


3E1510 1 000

5FV159 1802 V 13-7.15 444395 PAGE 47

ReturnofOrganization ExemptFromIncomeTax ,n„...

Documents

Transcript of ReturnofOrganization ExemptFromIncomeTax ,n„...