2018-11-08T07:32:03-06:00 2017-12-31 310800053 CLARK SCHAEFER HACKETT & CO 14 EAST MAIN ST SUITE 500 SPRINGFIELD OH 45502 990 2017-01-01 310538523 THE FRIENDS HOME OF THE OH VALLEY YEARLY MTG OF THE RELIGIOUS SOC OF FRIENDS INC FRIE 5138976050 514 W HIGH STREET PO BOX 677 WAYNESVILLE OH 45068 SYDNEY MCBRIDE EXECUTIVE DIRECTOR 5138976050 2018-11-06 1 MATTHEW SHROYER P00737986 9373992000 2018-11-06 107.198.169.116 2018-11-06 19:12:46 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 37AE4FB04CC3C859C04812217BCAEDDE34C66B0F 2017 2019-02-21 02:37:17Z QUAKER HEIGHTS CARE COMMUNITY SYDNEY MCBRIDE 514 W HIGH STREET PO BOX 677 WAYNESVILLE OH 45068 7775173 0 X WWW.QUAKERHEIGHTS.ORG X 1904 OH OPERATE A NURSING HOME AND ASSISTED LIVING FACILITY AND PROVIDE MEDICAL CARE FOR THE ELDERLY. 13 13 147 10 0 0 31700 51015 7802725 7721739 565075 2419 0 0 8399500 7775173 0 0 0 0 3403699 3309593 0 0 0 5100543 4698713 8504242 8008306 -104742 -233133 12935664 12546336 11020573 10864378 1915091 1681958 THE OPERATION OF A NURSING HOME AND ASSISTED LIVING FACILITY AND PROVIDING MEDICAL CARE FOR THE ELDERLY RESIDENTS. 0 0 5433867 6209667 NURSING HOME: CARE FOR ELDERLY - NURSING HOME OPERATED IN ACCORDANCE WITH MEDICARE/MEDICAID REGULATIONS CONSISTING OF 70 BEDS. 897683 1399103 ASSISTED LIVING : CARE FOR ELDERLY - 60 UNIT ASSISTED LIVING FACILITY OPERATED IN ACCORDANCE WITH MEDICARE/MEDICAID REGULATIONS. 38568 56081 INDEPENDENT LIVING FACILITIES - HOUSING UNITS PROVIDING INDEPENDENT LIVING MONITORED BY NURSING HOME STAFF AND PHYSICIANS AS NECESSARY. OFFICE CENTER- PROFESSIONAL AND MEDICAL OFFICES MAINTAINED FOR THE COMMUNITY AND STAFFED BY INDEPENDENT PROFESSIONALS. 6370118 1 0 0 0 0 0 0 0 1 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 36 0 1 147 1 0 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X SYDNEY MCBRIDE 5138976050 514 W HIGH STREET WAYNESVILLE OH 45068 TOM ISAACS PRESIDING CLERK 1.00 X X 0 0 0 LEANNE MONTGOMERY ASSISTANT PRESIDING CLERK 1.00 X X 0 0 0 WILSON PALMER TREASURER 1.00 X X 0 0 0 SHARON JEWEL ASSISTANT TREASURER 1.00 1.00 X X 0 0 0 PEG SCHORRECK RECORDING CLERK 1.00 X X 0 0 0 GUS EDWARDS TRUSTEE 1.00 X 0 0 0 CHUCK FEICHT TRUSTEE 1.00 X 0 0 0 FRANK HUSS TRUSTEE 1.00 X 0 0 0 DONNE HAYDEN TRUSTEE 1.00 X 0 0 0 LINDA WILSON TRUSTEE 1.00 X 0 0 0 CHRISTINE SNYDER TRUSTEE 1.00 X 0 0 0 WILMA WATSON TRUSTEE 1.00 X 0 0 0 ERIC WOLFF TRUSTEE 1.00 X 0 0 0 WENDY L WATERS-CONNELL CHIEF EXECUTIVE OFFICER 40.00 X 104810 0 0 SYDNEY MCBRIDE CHIEF DEVELOPMENT OFFICER 40.00 X 63308 0 0 WOODIE DAVIS JR DIRECTOR OF MAINTENANCE 40.00 X 179243 0 0 347361 0 0 2 0 0 0 HQ INNOVATIONS LLC 125 TROTTER LOAN MONROE OH 45050 BUILDING RENOVATIONS 896919 HEALTHCARE SERVICES GROUP 3220 TILLMAN DR SUITE 300 BENSALEM PA 19020 DIETARY AND HOUSEKEEPING SERVICES 804267 CONCEPT REHAB INC 7150 GRANITE CIRCLE TOLEDO OH 43617 THERAPY SERVICES 693675 KETTCOR 4301 LYONS RD MIAMISBURG OH 45342 PHARMACY 194602 DAYFIELD SENIOR SOLUTIONS LLC 609 WOODSIDE DR SUITE C ENGLEWOOD OH 45322 ACCOUNTING/BILLING SERVICES 123238 5 51015 51015 MEDICARE/MEDICAID PMTS 623000 6623010 6623010 RESIDENT SERVICE REVEN 623000 1041841 1041841 RENTAL INCOME 623000 56888 56888 7721739 2419 2419 7775173 7664851 0 59307 347361 173681 173680 2546104 2170282 375822 189669 161219 28450 226459 192490 33969 9864 9864 141239 141239 376411 319949 56462 25477 25477 281597 30574 251023 194720 165512 29208 64777 55060 9717 2498 2498 516167 438742 77425 554341 471190 83151 147838 125662 22176 MEDICAL SUPPLIES 1129197 1129197 CONTRACTED SERVICES 634346 634346 LICENSE FEES AND FRANCH 327033 277978 49055 MISCELLANEOUS EXPENSE 168608 24236 144372 124600 124600 8008306 6370118 1638188 0 494708 452308 728728 834222 63578 44037 17119769 7686236 8694485 9433533 701835 724637 2252330 1057599 12935664 12546336 795088 887379 12078 12381 9439125 9284271 774282 680347 11020573 10864378 X 1883391 1650258 31700 31700 1915091 1681958 12935664 12546336 -233133 0 X X 0 1 X 1 1 1 X 47800 13874 13112 31700 51015 157501 9120369 8424699 8094947 7802725 7721739 41164479 9168169 8438573 8108059 7834425 7772754 41321980 0 0 0 41321980 2261 11203 18463 6223 2419 40569 2261 11203 18463 6223 2419 40569 9170430 8449776 8126522 7840648 7775173 41362549 0.99900 0.99900 0.00100 0.00100 X 0 1 X 12871 12871 14130074 5463098 8666976 2976824 2223138 753686 9433533 PEACE CHURCH RISK RETENTION GROUP 724637 F 724637 MIP, INSURANCE, & REPAIR DEPOSITS 52390 RESERVE FOR REPLACEMENT 393423 RESIDUAL RECEIPTS 518495 RESIDENT FUNDS HELD BY QUAKER HEIGHTS 12381 DUE FROM AFFILIATES 80910 1057599 DUE TO QUAKER HEIGHTS FOUNDATION 118278 DEFERRED REVENUE - SSA 490219 RENTAL DEPOSITS 19460 OTHER LIABILITIES 52390 680347 X PART IV, LINE 2B: FUNDS THE FACILITY IS REQUIRED BY THE STATE TO MAINTAIN AT THE RESIDENTS' REQUEST. THIS MONEY BELONGS TO THE INDIVIDUAL RESIDENTS; THEREFORE, THERE IS AN OFFSETTING LIABILITY EQUAL TO THE ASSET ACCOUNT. PART X, LINE 2: THE FRIENDS HOME AND ITS RELATED ENTITY, QUAKER HEIGHTS FOUNDATION, INC., WERE ORGANIZED AS NOT-FOR-PROFIT CORPORATIONS AND HAVE SECURED TAX EXEMPT STATUS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A PROVISION FOR INCOME TAXES IS NOT REQUIRED. THE SINGLE MEMBER ENTITY, QUAKER HEIGHTS, LLC, WAS FORMED TO HOLD TITLE TO THE NURSING HOME AND ASSISTED LIVING FACILITY PROPERTY AND EQUIPMENT. FORMATION OF THIS ENTITY WAS REQUIRED UNDER THE TERMS OF THE HUD-INSURED MORTGAGE. THE LLC IS A DISREGARDED ENTITY FOR FEDERAL AND STATE TAX PURPOSES AND IS REPORTED ON THE TAX RETURN OF FRIENDS HOME. A PROVISION FOR INCOME TAXES IS NOT REQUIRED. 0 0 0 0 0 0 0 0 0 WOODIE DAVIS JR DIRECTOR OF MAINTENANCE 59243 0 120000 0 0 0 0 0 0 0 179243 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 DAYFIELD SENIOR SOLUTIONS, LLC PROVIDES ACCOUNTING SERVICES INCLUDING FINANCIAL REPORTING, COST REPORTING, BUDGET PREPARATION, ACCOUNTS RECEIVABLE AND ACCOUNTS PAYABLE SUPPORT. FORM 990, PART VI, SECTION A, LINE 7B THE FRIENDS HOME OF THE OHIO VALLEY YEARLY MEETING OF THE RELIGIOUS SOCIETY OF FRIENDS APPROVES MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE CHIEF EXECUTIVE OFFICER AND THE ORGANIZATION'S MANAGMENT COMPANY (DAYFIELD SENIOR SOLUTIONS, LLC). A COPY IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BOARD PRIOR TO FILING FORM 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES A SIGNED WRITTEN CONFLICT OF INTEREST POLICY BY THE BOARD MEMBERS ON A YEARLY BASIS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF TRUSTEES WILL CONDUCT A WRITTEN ASSESSMENT OF THE PERFORMANCE OF THE CHIEF EXECUTIVE OFFICER ANNUALLY. THE BOARD OF TRUSTEES USES CRITERIA FROM "LEADING AGE" TO ESTABILISH COMPENSATION. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 2B, DESCRIPTION OF FINANCIAL STATEMENT REPORTING THE ORGANIZATION'S FINANCIALS STATEMENTS WERE AUDITED BY AN INDEPENDENT ACCOUNTANT ON A CONSOLIDATED BASIS WITH QUAKER HEIGHTS, LLC (A DISREGARDED ENTITY) AND QUAKER HEIGHTS FOUNDATION, INC. QUAKER HEIGHTS LLC 514 WEST HIGH STREET WAYNESVILLE OH 45068 310538523 OPERATE QUAKER HEIGHTS CARE COMMUNITY - NURSING HOME AND ASSISTED LIVING OH N/A QUAKER HEIGHTS FOUNDATION 514 WEST HIGH STREET WAYNESVILLE OH 45068 311575048 TO SUPPORT ACTIVITIES OF QUAKER HEIGHTS CARE COMMUNITY. OH 501(C)(3) LINE 12A, I N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0