2018-11-12T16:05:01-06:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 1 BRONZE POINTE BELLEVILLE IL 62226 990 2017-01-01 341193296 OTTERBEIN PORTAGE VALLEY INC OTTE 4198337000 20311 PEMBERVILLE ROAD PEMBERVILLE OH 43450 J CHRISTOPHER GREEN CFO 5139335400 2018-11-10 1 JEFF PARKER P00970069 6182331200 2018-11-10 67.137.57.251 2018-11-10 09:00:34 CS P 4DC81AC5090E51A43603AD047BBA54151ACF830E B5C6689AE7AF5414E27E4467F9AB971DF3B0FBE3 2017 2019-02-21 02:37:17Z J CHRISTOPHER GREEN 580 N SR 741 LEBANON OH 45036 12779544 0 X WWW.OTTERBEIN.ORG X 1975 OH CONTINUING CARE RETIREMENT COMMUNITY THAT PROVIDES HOUSING AND SERVICES FOR OLDER ADULTS. 14 11 253 117 0 0 196185 159697 10533951 10284373 239801 504198 50223 231909 11020160 11180177 0 0 0 0 4080879 4061341 0 0 0 5798614 5775651 9879493 9836992 1140667 1343185 23061452 25768058 13538051 13932877 9523401 11835181 IN KEEPING WITH OUR UNITED METHODIST TRADITION WE SEEK TO ENHANCE THE QUALITY OF LIFE AND HOLISTIC GROWTH OF OLDER PERSONS. 0 0 8230066 10907090 OTTERBEIN PORTAGE VALLEY, INC. PROVIDES A CONTINUUM OF CARE INCLUDINGINDEPENDENT LIVING, ASSISTED LIVING, NURSING CARE, AND DEMENTIA CARE.REHABILITATION, SOCIAL SERVICES AND CHAPLAINCY SERVICES ARE AVAILABLETO ALL RESIDENTS.LOCAL GROUPS SUCH AS THE VETERANS, CHURCH CIRCLES, COMMUNITY CIVICGROUPS AND A HOST OF OTHERS USE OTTERBEIN AS A MEETING PLACE. INADDITION OTTERBEIN PROVIDES SPECIAL PROGRAMS AND EVENTS FOR THECOMMUNITY ON AN ONGOING BASIS. 83808 GENEROUS DONORS HAVE ESTABLISHED A BENEVOLENT CARE FUND WHICH OFFERS ASSISTANCE TO RESIDENTS WHO CANNOT PAY THE FULL COST OF CARE. OTTERBEIN'S RICH HERITAGE HAS EARNED US A SOLID REPUTATION AS A TRUSTED AND VALUABLE RESOURCE. BY PROVIDING INFORMATION AND SERVICES ON AGING ISSUES WE CONTINUE TO SERVE RESIDENTS, THEIR FAMILIES, AND THE SURROUNDING COMMUNITIES. OTTERBEIN RESIDENTS AND STAFF VOLUNTEER THEIR TIME AND TALENTS AT OTTERBEIN PORTAGE VALLEY RETIREMENT LIVING COMMUNITY BUT ALSO FOR A NUMBER OF ORGANIZATIONS AND CAUSES IN THE GREATER COMMUNITY. -622717 THE ORGANIZATION PROVIDES NURSING CARE TO RESIDENTS UNDER THE MEDICAID PROGRAM FOR WHICH THE COSTS TO PROVIDE SUCH CARE EXCEEDS REIMBURSEMENT. THE ORGANIZATION FUNDS THIS DIFFERENCE THROUGH ITS OPERATIONS. THE SHORTFALL IS NETTED WITH PROGRAM SERVICE REVENUE. 8313874 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 0 0 253 1 0 0 0 0 0 0 0 0 0 0 X 14 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X J CHRISTOPHER GREEN 5139335400 580 N SR 741 LEBANON OH 450368839 MARILYN BOWLUS SECRETARY 1.00 X X 0 0 0 KEN AULT CHAIRPERSON 1.00 X X 0 0 0 JILL WILSON PRESIDENT/CEO 2.00 38.00 X X 0 415663 23759 JAMES C GREEN CFO/TREASURER 2.00 38.00 X X 0 281685 19255 MEL MILLER BOARD CHAIR OF OTTERBEIN HOMES 1.00 5.00 X 0 0 0 VICTOR SCHUERMAN DIRECTOR 1.00 X 0 0 0 SUE DONALDSON DIRECTOR 1.00 X 0 0 0 JOAN HANKINS DIRECTOR 1.00 X 0 0 0 CHARLIE SHANFELT DIRECTOR 1.00 X 0 0 0 RUTH ANN MANGES DIRECTOR 1.00 X 0 0 0 TOM KYLLO DIRECTOR 1.00 X 0 0 0 JASON MILLER VP OF OPERATIONS 2.00 38.00 X X 0 313768 19023 ROGER MULLHOLAND DIRECTOR 1.00 X 0 0 0 BECKI SPANGLER DIRECTOR 1.00 X 0 0 0 0 1011116 62037 0 0 1 0 0 159697 5841 159697 RESIDENTIAL REVENUE & FEES 623000 10276038 10276038 DEPARTMENTAL REVENUE 623000 8335 8335 10284373 345684 345684 1757881 1556255 43112 201626 -43112 158514 158514 DIETARY 623000 142465 142465 BEAUTY AND BARBER 623000 41910 41910 ADMIN 623000 32020 32020 15514 15514 231909 11180177 10284373 0 736107 X 3111980 2890297 221683 280936 260923 20013 424976 394703 30273 243449 226107 17342 48149 48149 7821 7821 55249 55249 1000008 988393 11615 97030 97030 984410 863018 121392 75518 75518 760266 742898 17368 19038 17682 1356 198375 193843 4532 950034 928331 21703 49735 48599 1136 CORPORATE SERVICE FEES 648590 648590 REFUNDABLE LIFE USE FEE 620248 620248 BED DEBT/OTHER ADMIN 95482 95482 BENEVOLENT ASSISTANCE 83808 83808 81890 55024 26866 9836992 8313874 1523118 0 1109135 1145557 4866 4866 129989 21390 1558320 1614911 29519 31361 40935 43382 28386281 18570911 9998316 9815370 10190372 13091221 23061452 25768058 2286107 2311097 398124 344451 4629876 4047136 4866 4866 6219078 7225327 13538051 13932877 X 8547798 10586848 356275 431545 619328 816788 9523401 11835181 23061452 25768058 X 1343185 1047466 -78871 X X 0 1 X 1 0 X 61938 261643 207025 196185 159697 886488 9211197 9477217 9953566 10533951 10284373 49460304 9273135 9738860 10160591 10730136 10444070 50346792 2276 15116 5378 7776 10843 41389 0 2276 15116 5378 7776 10843 41389 50305403 241205 172999 242724 260288 345684 1262900 241205 172999 242724 260288 345684 1262900 59729 61112 50223 231909 402973 9514340 9971588 10464427 11040647 11021663 52012665 0.96720 0.97520 0.02430 0.02070 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: BEAUTY AND BARBER - 2014 AMOUNT: $ 46,287. 2015 AMOUNT: $ 48,937. 2016 AMOUNT: $ 37,790. 2017 AMOUNT: $ 41,910. HOUSEKEEPING - 2014 AMOUNT: $ 11,643. 2015 AMOUNT: $ 11,776. 2016 AMOUNT: $ 12,100. 2017 AMOUNT: $ 11,699. MISC - 2014 AMOUNT: $ 1,799. 2015 AMOUNT: $ 399. 2016 AMOUNT: $ 333. 2017 AMOUNT: $ 32,020. DIETARY - 2017 AMOUNT: $ 142,465. PLANT GROUNDS MAINT - 2017 AMOUNT: $ 3,815. 0 1 X 151422 151422 19704162 11729703 7974459 2149954 1897331 252623 6078010 4943877 1134133 302733 302733 9815370 REFUNDABLE PORTION OF REFUNDABLE LIFE USE FEES 7122834 SPLIT INTEREST AGREEMENT 102493 7225327 X PART IV, LINE 2B: RESIDENT FUNDS ARE DEPOSITS HELD UNDER A FIDUCIARY RESPONSIBILITY AND ARE REQUIRED BY STATE REGULATION. PART X, LINE 2: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE CONSOLIDATED FINANCIAL STATEMENTS. 0 0 0 0 0 0 0 0 0 JILL WILSON PRESIDENT/CEO 0 326088 0 89132 0 443 0 11209 0 12550 0 439422 0 0 JAMES C GREEN CFO/TREASURER 0 231996 0 46501 0 3188 0 6705 0 12550 0 300940 0 0 JASON MILLER VP OF OPERATIONS 0 255597 0 56844 0 1327 0 6473 0 12550 0 332791 0 0 PART I, LINE 3 THE PARENT ORGANIZATION, OTTERBEIN HOMES INC., USES THE FOLLOWING METHODS TO ESTABLISH COMPENSATION FOR THE CEO/EXECUTIVE DIRECTOR: COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FROM 990, PAGE 5, PART V, LINE 1A THE PARENT COMPANY, OTTERBEIN HOMES, (FEIN 31-0549058) PROCESSES ACCOUNTS PAYABLE PAYMENTS FOR ALL RELATED ENTITIES. AS A RESULT, THE ORGANIZATION IS UNABLE TO DETERMINE THE NUMBER OF 1099S REPORTED BY ENTITY. AS A RESULT, ALL 1099S ARE ISSUED AND REPORTED OUT OF THE PARENT COMPANY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM IS PROVIDED AND REVIEWED BY THE CHIEF FINANACIAL OFFICER BEFORE THE FORM IS FILED. A COMPLETE COPY OF THE 990 IS ALSO PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C IN ACCORDANCE WITH THE BY-LAWS, ANY POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY BOARD MEMBER, CORPORATE EXECUTIVE, EXECUTIVE DIRECTOR, OR ADMINISTRATIVE STAFF MEMBER, OR COMMITTEE MEMBERS, WHO ARE NOT MEMBERS OF THE BOARD OF TRUSTEES OF OTTERBEIN HOMES SHALL BE DISCLOSED TO THE BOARD AND MADE A MATTER OF RECORD, EITHER THROUGH AN ANNUAL PROCEDURE OR WHEN THE INTEREST BECOMES RELEVANT TO A MATTER OF BOARD ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE INDEPENDENT EXECUTIVE COMMITTEE OF THE OTTERBEIN HOMES BOARD OF TRUSTEES HAS THE RESPONSIBILITY FOR DETERMINING THE ANNUAL COMPENSATION FOR THE OFFICERS BY THE USE OF INDUSTRY SPECIFIC DATA SUCH AS SALARY SURVEYS FROM LEADING AGE AND LEADING AGE OHIO. THE SALARIES OF THE KEY EMPLOYEES ARE DETERMINED BY THE OFFICERS USING INDUSTRY COMPARATIVE DATA SUCH AS SALARY SURVEYS FROM LEADING AGE AND LEADING AGE OHIO. THE DELIBERATIONS AND DECISIONS REGARDING COMPENSATION ARE DOCUMENTED. THIS PROCESS WAS LAST PERFORMED IN 2017. FORM 990, PART VI, SECTION C, LINE 19 THE ANNUAL REPORT IS PROVIDED TO THE PUBLIC WHICH INCLUDES THE AUDITED FINANCIAL STATEMENT SUMMARY. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G NURSE AGENCY FEES/CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 988,393. MANAGEMENT AND GENERAL EXPENSES 11,615. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,000,008. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENT -37,655. CHANGE IN MINIMUM PENSION LIABILITY -41,216. FORM 990, PAGE 12, PART XII, LINE 2C THERE HAS BEEN NO CHANGE TO THE SELECTION OR OVERSIGHT PROCESS. FORM 990, PART X, PAGE 11, LINE 20 - TAX EXEMPT BOND LIABILITIES THE PARENT COMPANY, OTTERBEIN HOMES, HAS ALLOCATED A PORTION OF THE TAX EXEMPT BONDS THAT WERE ISSUED TO THE PARENT COMPANY. THE DETAILS OF THE TAX EXEMPT BONDS ISSUED TO OTTERBEIN HOMES ARE CONTAINED ON THE SCHEDULE K THAT IS FILED WITH THE FORM 990 FOR THE PARENT COMPANY (FEIN 31-0549058). THERE IS NO SCHEDULE K FOR THIS TAX RETURN. THIS TREATMENT IS CONSISTENT WITH PRIOR YEARS. OTTERBEIN PORTAGE VALLEY LLC 580 NORTH STATE ROUTE 741 LEBANON OH 45036 270512972 REAL ESTATE HOLDING COMPANY OH 151422 OTTERBEIN PORTAGE VALLEY OTTERBEIN HOMES 580 NORTH STATE ROUTE 741 LEBANON OH 45036 310549058 PARENT - RETIREMENT LIVING COMMUNITIES OH 501(C)(3) LINE 10 N/A 0 OTTERBEIN CRIDERSVILLE 100 RED OAK DRIVE CRIDERSVILLE OH 45806 341940884 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 10 OTTERBEIN HOMES 0 OTTERBEIN NORTH SHORE 9400 NORTH SHORE BLVD LAKESIDE OH 43440 341743836 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 10 OTTERBEIN HOMES 0 OTTERBEIN ST MARYS 11230 STATE ROUTE 364 ST MARYS OH 45885 341940880 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 10 OTTERBEIN HOMES 0 OTTERBEIN LEBANON 585 STATE ROUTE 741 LEBANON OH 45036 311743874 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 10 OTTERBEIN HOMES 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 0 0