2016-04-21T12:30:30-07:00 2015-06-30 990 2014-07-01 310986918 Friendship Village of Dublin Ohio Inc FRIE 6147641600 6000 Riverside Drive Dublin OH 43017 Jerry Kuyoth Executive Director 6147641600 2016-04-26 2014 2016-08-17 19:52:53Z Jerry Kuyoth 6000 Riverside Drive Dublin OH 43017 22219070 0 X www.fvdublin.org X 1979 OH SEE SCHEDULE O 16 16 398 367 0 0 106482 190993 19155577 19626689 1651585 2280742 25892 84351 20939536 22182775 12150 12150 0 8956345 8349144 0 82734 9104990 10370684 18073485 18731978 2866051 3450797 90280863 98514080 58359412 64396766 31921451 34117314 To enhance the quality of life for older adults. 0 0 15501102 12150 19643091 OPERATION OF A SKILLED NURSING FACILITY WHICH HAS 60 BEDS. OPERATION OF AN ASSISTED LIVING FACILITY WHICH HAS 46 APARTMENTS. ALSO PROVIDED NON-SKILLED HOME CARE TO RESIDENTS WHO CHOOSE FOR SUPPORT. 0 0 0 15501102 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 46 0 1 398 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X Friendship Village of Dublin c/o Craig Flickinger 6147641600 6000 Riverside Drive Dublin OH 43017 RONALD BACHMAN CHAIRMAN 3.00 X X 0 0 0 LAURA ECKLAR CHAIRMAN - ELECT 1.50 X X 0 0 0 CHARLES E ANSLEY TREASURER 1.50 X X 0 0 0 BRUCE PAIGE SECRETARY 1.50 X X 0 0 0 RICHARD BAKER DIRECTOR 1.00 X 0 0 0 CHEREE CLARK DIRECTOR 1.00 X 0 0 0 KEITH DEVOE III DIRECTOR 1.00 X 0 0 0 KAREN ICKES DIRECTOR 1 X 0 0 0 CAROL JENKINS DIRECTOR 1 X 0 0 0 OWEN JOHNSON DIRECTOR 1 X 0 0 0 SHAWN KARASARIDES DIRECTOR 1 X 0 0 0 JOAN MANTER DIRECTOR 1 X 0 0 0 RICHARD SCHROCK DIRECTOR 1 X 0 0 0 MARGARET TEAFORD DIRECTOR 1 X 0 0 0 BRUCE WALL DIRECTOR 1 X 0 0 0 JAMES WINFREE DIRECTOR 1 X 0 0 0 JERRY KUYOTH EXECUTIVE DIRECTOR 40.00 X 146082 0 17202 CRAIG FLICKINGER DIRECTOR OF FINANCE 40.00 X 93206 0 6450 DONALD PAUL DIRECTOR OF CULINARY SERVICES 40.00 X 134320 0 14383 373608 0 38035 2 0 1 0 REHAB CARE GROUP THERAPY 680 SOUTH FOURTH STREET LOUISVILLE KY 40202 THERAPY SERVICES 640304 LIFE CARE SERVICES 400 LOCUST STREET DES MOINES IA 50309 MGT CONSULTING SERVICES 351719 LIFE CARE SERVICES 400 LOCUST STREET DES MOINES IA 50309 MANAGEMENT FEE 336000 RUSCILLI CONSTRUCTION 2041 ARLINGATE COLUMBUS OH 43017 CONSTRUCTION SERVICE 269271 GLYNN DEVINS MARKETING & ADVERTISING 11230 COLLEGE BLVD OVERLAND PARK KS 66210 MARKETING SERVICES 252605 5 0 0 0 0 0 190993 0 190993 RESIDENCY SERVICES 531110 17004582 17004582 0 0 MEDICARE/MEDICAID SERVICES 531110 1701017 1701017 0 0 INSURANCE/HMO SERVICES 531110 495671 495671 0 0 HOME CARE SERVICES 621610 425419 425419 0 0 0 0 0 0 19626689 909495 0 0 909495 0 0 0 0 0 0 0 0 120646 0 36295 0 84351 0 84351 20195 0 64156 1388640 -17393 0 0 1388640 -17393 1371247 0 0 1371247 0 0 22182775 19646884 0 2344898 12150 12150 337182 337182 6553000 5808077 694649 50274 67386 46046 21340 788222 688026 100196 603354 533589 59710 10055 336000 336000 67326 67326 52100 52100 397881 397881 2907768 1910099 997669 139381 139381 1411086 1411086 0 28619 5239 23380 35599 25026 10573 897887 897887 2024094 1801445 202409 20240 245608 245608 FOOD 1308342 1308342 0 BAD DEBT EXPENSE 36000 36000 0 LETTER OF CREDIT FEE 180428 180428 0 LOSS ON EARLY RETIREMENT OF DEBT 299963 299963 0 2602 437 2165 18731978 15501102 3148142 82734 142877 150300 11398286 17114339 709675 714855 62049 70491 127685 211828 64597882 30396190 34996879 34201692 41028796 41792914 1386365 1639646 428251 2618015 90280863 98514080 1718662 2953675 26121891 25687846 25750000 30785000 4768859 4970245 58359412 64396766 X 31182235 33223416 739216 893898 0 0 31921451 34117314 90280863 98514080 X 3450797 -1335600 0 0 0 80666 X X 0 1 X 1 0 X 91404 96849 131272 106482 191993 618000 17859600 18253444 19083855 19155577 19626689 93979165 17951004 18350293 19215127 19262059 19818682 94597165 4165 4065 5010 5200 5750 24190 4165 4065 5010 5200 5750 24190 94572975 380791 538281 825887 1178151 1030141 3953251 380791 538281 825887 1178151 1030141 3953251 10427 10427 18342222 18888574 20041014 20440210 20848823 98560843 0.95954 0.9633 0.04011 0.0362 X Schedule A, Part III, Line 12 YEAR 2010 OTHER INCOME = $6,452 MEALS AND $3,975 MISCELLANEOUS INCOME 0 0 0 0 0 0 0 0 1 1225 1225 0 Schedule C, Part II-B, Line 1 PART II-B, LINE 1, LOBBYING ACTIVITIES: EXPLANATION: THE ORGANIZATION IS A MEMBER OF LEADING AGE OHIO; A PORTION OF DUES PAYMENTS TO LEADING AGE OHIO GOES TOWARD LOBBYING ACTIVITIES. MEMBERSHIP DUES IN THE AMOUNT OF $11,229 WERE PAID TO LEADING AGE OHIO: 7% ($786) OF THE DUES RELATED TO LOBBYING. MEMBERSHIP DUES IN THE AMOUNT OF $6,271 WERE PAID TO LEADING AGE NATIONAL: 7% ($439) OF THE DUES WERE RELATED TO LOBBYING. 759881 144459 22570 12150 20862 0 893898 606778 167817 2248 9000 7962 0 759881 570198 59835 2627 8000 17882 0 606778 499867 82997 3762 8000 8428 0 570198 428237 100460 7124 6000 29954 0 499867 0 0 1.00 0 0 0 3425126 3425126 0 53718676 25242125 28476551 0 0 0 0 0 4063844 2550353 1513491 0 3390236 2603712 786524 34201692 0 PROVISION FOR INTEREST RATE SWAP 668066 DEPOSITS 1321375 ENTRANCE FEE REFUNDS PAYABLE 227027 GIFT ANNUITY PAYABLE 261827 REFUNDABLE ENTRACE FEE - R.O.C. 2491950 4970245 X Schedule D, Part V, Line 4 PART V. LINE 4: EXPLANATION: THE FVD RESIDENTS' BENEVOLENT FUND WAS CREATED AS A PERMANENT FUND, ALLOWING FOR ONLY THE INTEREST INCOME TO BE SPENT. THE PRIMARY USE FOR THIS FUND IS TO PROVIDE REVENUE TO OFFSET THE COST FOR LIFE CARE RESIDENTS WHO HAVE OUTLIVED THEIR PERSONAL FINANCIAL MENAS. THE JOHN SCHWARCK SCHOLARSHIP FUND WAS CREATED TO SUPPORT SELECTED EMPLOYEES AND/OR THEIR LEGAL DEPENDENTS AS THEY SEEK A COLLEGE EDUCATION. THE FVD HEALTH SERVICES FUND WAS CREATED TO PROVIDE ADDITIONAL FINANCIAL RESOURCES TO HELP SECURE THE PRESENT AND FUTURE HEALTH AND COMFORT OF THE RESIDENTS. UNLESS OTHERWISE INDICATED, CONTRIBUTIONS TO THE FVD HEALTH SERVICES FUND WILL BE DIRECTED TOWARD PURCHASING SPECIALIZED EQUIPMENT, FACILITIES IMPROVEMENTS AND RELATED EXPENDITURES IN THE FOLLOWING AREAS: 1. HEALTH CENTER/LONG-TERM NURSING CARE 2. THE MEADOWS (ASSISTED LIVING/RESIDENTIAL CARE/MEMORY LOSS CARE) 3. HOME CARE SERVICES 4. WELLNESS CENTER Schedule D, Part X, Line 2 EXPLANATION: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE VILLAGE IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE VILLAGE IS NOT CURRENTLY UNDER EXAMINATION BY THE INTERNAL REVENUE SERVICE OR ANY STATE OR LOCAL TAX AUTHORITIES. THE VILLAGE'S FEDERAL TAX RETURNS FOR THE YEARS ENDED PRIOR TO JUNE 30, 2012 ARE NO LONGER SUBJECT TO EXAMINATION. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE VILLAGE AND RECOGNIZE A TAX LIABILITY IF THE VILLAGE HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT ANALYZED THE TAX POSITIONS TAKEN BY THE VILLAGE AND HAS CONCLUDED THAT AS OF JUNE 30, 2015, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLITED FINANCIAL STATEMENTS. 1 JOHN SCHWARCK SCHOLARSHIPS AWARDED TO THE EMPLOYEES OF FRIENDSHIP VILLAGE OF DUBLIN OHIO, INC. WHO ARE PURSUING A COLLEGE EDUCATION. 5 12150 0 Schedule I, Part I, Line 2 IT IS THE ROLE OF THE SCHOLARSHIP SELECTION COMMITTEE TO DETERMINE WHICH CANDIDATE(S) FROM A QUALIFITED POOL OF APPLICANTS WILL RECEIVE SCHOLARSHIPS IN ANY GIVEN YEAR. IT IS THE ROLE OF THE CHARITABLE GIVING ADVISORY COMMITTEE TO DETERMINE THE AGGREGATE AMOUNT TO BE DISTRIBUTED BY THE SCHOLARSHIP SELECTION COMMITTEE. THE COMMITTEE WILL REVIEW APPLICATIONS AND THE SCHOOLS LISTED TO DETERMINE ELIGIBILITY. FRIENDSHIP VILLAGE OF DUBLIN OHIO INC. FOLLOWS ITS JOHN SCHWARCK SCHOLARSHIP FUND SPENDING PROCEDURE THROUGHOUT THE ENTIRE PROCESS FROM SELECTION TO ISSUANCE OF FUNDS. FUNDS ARE ISSUED VIA A CHECK MADE PAYABLE TO BOTH THE RECIPIENT AND THE COLLEGE OR UNIVERSITY THEY ARE ATTENDING SO SCHOLARSHIPS ARE USED FOR THEIR INTENDED PURPOSES. Schedule I, Part III JOHN SCHWARCK SCHOLARSHIPS AWARDED TO THE EMPLOYEES OF FRIENDSHIP VILLAGE OF DUBLIN OHIO, INC. AND/OR THIER LEGAL DEPENDANTS WHO ARE PURSUING A COLLEGE EDUCATION. X X 0 0 0 0 0 0 0 0 0 JERRY KUYOTH EXECUTIVE DIRECTOR 140527 0 4287 0 1268 0 7436 0 9766 0 163284 0 0 0 A FRANKLIN COUNTY OHIO 316400067 353180GG1 2004-09-01 13805000 REFUND AND RETIRE THE OUTSTANDING PRINCIPAL AMOUNT OF THE 1997 REVENUE BOND 0 0 0 B FRANKLIN COUNTY OHIO 316400067 353180JQ6 2014-12-03 25004402 REFUND AND RETIRE THE OUTSTANDING PRINCIPAL OF THE 2004B REVENUE BONDS & FUND CONSTRUCTION COSTS OF 0 0 0 A 0 0 13805000 0 0 13418895 276000 98803 0 13418895 0 0 1991 1 0 1 1 B 0 0 25004650 0 0 17460000 500088 0 0 5755217 0 1289097 1 0 0 1 A 0 0 0 0 0.00 0.00 0.00 0 0 0 B 0 0 0 0 0 0 0 0 0 0 A 0 0 1 1 1 1 MORGAN STANLEY 17 0 0 0 0 0 B 0 1 1 0 0 0 0 0 0 A 0 B 0 Schedule K, Part I, Column a-09/01/2004 13,805,000 FRANKLIN COUNTY OHIO (A) ISSUER NAME: FRANKLIN COUNTY, OHIO Schedule K, Part I, Column a-12/03/2014 25,004,402 FRANKLIN COUNTY OHIO ISSUER NAME: FRANKLIN COUNTY, OHIO Schedule K, Part I, Column f-09/01/2004 13,805,000 FRANKLIN COUNTY OHIO (F) DESCRIPTION OF PURPOSE: REFUND AND RETIRE THE OUSTANDING PRINCIPAL AMOUNT OF THE 1997 REVENUE BONDS. Schedule K, Part I, Column f-12/03/2014 25,004,402 FRANKLIN COUNTY OHIO DESCRIPTION OF PURPOSE: REFUND AND RETIRE THE OUTSTANDING PRINCIPAL OF THE 2004B REVENUE BONDS AND FUND CONSTRUCTION COSTS OF CERTAIN INDEPENDENT LIVING VILLAS AND ROUTINE CAPITAL EXPENDITURES FOR 2014, 2015 AND 2016. Schedule K, Part II, Line 3-12/03/2014 25,004,402 FRANKLIN COUNTY OHIO ISSUE PRICE ($25,004,402) AND INVESTMENT EARNINGS ($248) Schedule K, Part III, Line 3a-12/03/2014 25,004,402 FRANKLIN COUNTY OHIO THE ORGANIZATION HAS ONE MANAGEMENT AGREEMENT WHICH HAS BEEN DETERMINED TO COMPLY WIHT REV. PROC. 97-13, AS MODIFIED BY REV. PROC. 2001-39, AND AMPLIFIED BY NOTICE 2014-67. Schedule K, Part III, Line 9-09/01/2004 13,805,000 FRANKLIN COUNTY OHIO WHILE THE ORGANIZATION HAS NOT ADOPTED WRITTEN POST ISSUANCE COMPLIANCE PROCDURES YET, THE ORGANZIATION IS IN THE PROCESS OF REVIEWING DRAFT PROCEDURES. Schedule K, Part III, Line 9-12/03/2014 25,004,402 FRANKLIN COUNTY OHIO WHILE THE ORGANIZATION HAS NOT ADOPTED WRITTEN POST ISSUANCE COMPLIANCE PRODURES YET, THE ORGANIZATION IS IN THE PROCESS OF REVIEWING DRAFT PROCEDURES. Schedule K, Part IV, Line 2c-09/01/2004 13,805,000 FRANKLIN COUNTY OHIO DATE THE REBATE COMPUTATION WAS PERFORMED: MAY 26, 2014. Schedule K, Part V-09/01/2004 13,805,000 FRANKLIN COUNTY OHIO WHILE THE ORGANIZATION HAS NOT ADOPTED WRITTEN POST ISSUANCE COMPLIANCE PROCEDURES YET, THE ORGANIZATION IS CURRENTLY REVIEWING DRAFT PROCEDURES. Schedule K, Part V-12/03/2014 25,004,402 FRANKLIN COUNTY OHIO WHILE THE ORGANIZATION HAS NOT ADOPTED WRITTEN POST ISSUANCE COMPLIANCE PROCEDURES YET, THE ORGANIZATION IS CURRENTLY REVIEWING DRAFT PROCEDURES. Form 990, Part I, Line 1 DESCRIPTION OF ORGANIZATION MISSION: PROVIDED 260 INDEPENDENT LIVING RESIDENCY APARTMENTS, 46 ASSISTED LIVING RESIDENCY APARTMENTS (INCLUDING 13 MEMORY LOSS UNITS), AND MAINTAINED A 60 BED SKILLED NURSING FACILITY. PROVIDED NON-SKILLED HOME HEALTH SERVICES TO OUR RESIDENTS. PROVIDED ACTIVITIES AND PROGRAMS, INCLUDING A WELLNESS CENTER, TO ENHANCE RESIDENT OVERALL HEALTH AND QUALITY OF LIFE. PROVIDED USE OF FACILITIES TO RESIDENT FAMILIES FOR FAMILY GATHERINGS, MEMORIAL SERVICES, AND TO VARIOUS AGED AND HEALTH ASSOCIATIONS FOR MEDICAL EVENTS AND EXHIBITS. Form 990, Part VI, Section A, Line 3 EXPLANATION: LIFE CARE SERVICES PROVIDES THE EXECUTIVE DIRECTOR FOR THE ORGANIZATION. JERRY KUYOTH SERVED AS EXECUTIVE DIRECTOR FOR FRIENDSHIP VILLAGE OF DUBLIN. LIFE CARE SERVICES WAS COMPENSATED BY THE VILLAGE DURING 2014 IN THE AMOUNT OF $163,284 FOR HIS SERVICES. IN ADDITION, LIFE CARE SERVICES PROVIDES ACCOUNTING SOFTWARE, CLINICAL SOFTWARE, IT SUPPORT, HUMAN RESOURCES, AND OTHER SUPPORT SERVICES. Form 990, Part VI, Section B, Line 11b EXPLANATION: THE FULL BOARD OF TRUSTEES RECEIVES A COPY FOR REVIEW PRIOR TO FILING BUT THE FINANCE AND INSURANCE COMMITTEE OF THE BOARD IS DELEGATED THE RESPONSIBILITY OF FULL REVIEW WITH THE EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE. Form 990, Part VI, Section B, Line 12c EXPLANATION: ALL CLASSES OF EMPLOYEES ARE INCLUDED IN THE CONFLICT OF INTEREST POLICY. TRAINING IS PROVIDED ANNUALLY TO ALL EMPLOYEES ON DISCLOSURE OF UNETHICAL PRACTICES AND POSITIVE WORKFORCE ENVIRONMENT. THIS PROCESS IS GOVERNED BY DEPARTMENT DIRECTORS AND THE EXECUTIVE DIRECTOR. SHOULD A CONFLICT OF INTEREST BE IDENTIFIED, IT IS DISCUSSED WITH THE EXECUTIVE DIRECTOR AND NECESSARY ACTION IS TAKEN TO ELIMINATE THE CONFLICT OF INTEREST. A QUESTIONNAIRE IS SENT TO ALL BOARD MEMBERS ANNUALLY IN DECEMBER AS WELL AS NEW BOARD MEMBERS IN THE FIRST MONTH THEY JOIN THE BOARD OF DIRECTORS REQUIRING A SIGNATURE OF THE FORM AND DISCLOSURE OF ANY CONFLICT OF INTEREST. THESE FORMS ARE MONITORED BY THE BOARD SECRETARY. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST ON A SPECIFIC ISSUE, THEY ABSTAIN FROM VOTING. Form 990, Part VI, Section B, Line 15 EXPLANATION: THE EXECUTIVE DIRECTOR IS EVALUATED ANNUALLY BY VARIOUS LEVELS WITHIN LIFE CARE SERVICES, INCLUDING HIS IMMEDIATE SUPERVISOR WHO IS AN LCS REGIONAL DIRECTOR. INPUT IS PROVIDED TO THE REGIONAL DIRECTOR FROM THE BOARD OF TRUSTEES AND OTHER KEY LEADERSHIP WITHIN THE VILLAGE. AS PART OF THE REVIEW PROCESS, LIFE CARE SERVICES PERFORMS INDUSTRY WIDE WAGE COMPARISON FOR COMPARABLE EXECUTIVE DIRECTOR POSITIONS IN SIMILAR SIZE AND FUNCTION ORGANIZATIONS. THE PROCESS INCLUDES SUBSTANTIATION OF THE DELIBERATION AND DECISION MAKING PROCESS. THE EVALUATION WAS LAST PERFORMED IN 2015. THE DEPARTMENT DIRECTORS ARE EVALUATED ANNUALLY BY THE EXECUTIVE DIRECTOR. A LEADING AGE SALARY AND BENEFITS SURVEY IS USED AS REFERENCE TO DETERMINE OFFICER COMPENSATION. COMPENSATION DECISIONS ARE REFLECTED IN THE FORMAL EVALUATION DOCUMENT. THIS PROCESS WAS LAST UNDERTAKEN IN 2015. Form 990, Part VI, Section C, Line 19 EXPLANATION: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC REVIEW BY APPOINTMENT AT 6000 RIVERSIDE DRIVE, DUBLIN, OHIO 43017. Form 990, Part XI, Line 9 NET UNREALIZED GAIN ON SWAP FAIR MARKET VALUE ADJUSTMENT ($128,014) AND GIFT ANNUITY PRESENT VALUE ADJUSTMENT (-$47,348). Form 990, Part XII, Line 2c EXPLANATION: THE ORGANIZATION HAS A FINANCE AND INSURANCE COMMITTEE WHICH OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND IS INVOLVED IN SELECTION OF THE INDEPENDENT ACCOUNTING FIRM WHICH COMPLETES THE AUDIT. POLICY REQUIRES AN EXECUTIVE SESSION POST AUDIT SUMMARY DISCUSSION IN WHICH THE COMMITTEE MEMBERS SPEAK WITH THE AUDITORS WITHOUT MANAGEMENT PRESENT. THERE IS NO CHANGE IN THE PROCESS FROM THE PREVIOUS YEAR. BIRCHTON LLC 6000 RIVERSIDE DRIVE DUBLIN OH 43017 HOLD AND DEVELOP REAL ESTATE OH 95725 1462612 FRIENDSHIP VILLAGE OF DUBLIN OHIO INC TRIANGLE HOUSING LLC 6000 RIVERSIDE DRIVE DUBLIN OH 43017 HOLD AND DEVELOP REAL ESTATE OH 0 0 BIRCHTON LLC FRIENDSHIP VILLAGE OF DUBLIN HOME CARE LLC 6000 RIVERSIDE DRIVE DUBLIN OH 43017 471284626 HOME CARE SERVICES OH 425419 201143 FRIENDSHIP VILLAGE OF DUBLIN OHIO INC FRIENDSHIP AT HOME LLC 6000 RIVERSIDE DRIVE DUBLIN OH 43017 474000431 PROVIDE CONTINUING CARE AT HOME FOR LOCAL SENIORS OH 0 417645 FRIENDSHIP VILLAGE OF DUBLIN OHIO INC