2014-11-17T10:33:12-06:00 2013-12-31 310210560 BATTELLE RIPPE KINGSTON LLP 2000 WEST DOROTHY LANE DAYTON OH 45439 990 2013-01-01 310538523 FRIENDS BOARDING HOME-OHIO VALLEY YEARLY MTG RELIGIOUS SOCIETY OF FRIENDS FRIE 5138976050 514 W HIGH STREET PO BOX 677 WAYNESVILLE OH 45068 WENDY L WATERS-CONNELL EXECUTIVE DIRECTOR 5138976050 2014-10-29 1 KAREN O CRIM P00368385 9372980201 2013 2015-11-30 17:44:51Z QUAKER HEIGHTS CARE COMMUNITY WENDY L WATERS-CONNELL 514 W HIGH STREET PO BOX 677 WAYNESVILLE OH 45068 9170430 0 X WWW.QUAKERHEIGHTS.ORG X 1904 OH OPERATE A NURSING HOME AND ASSISTED LIVING FACILITY AND PROVIDE MEDICAL CARE FOR THE ELDERLY 13 13 126 137 0 0 0 47800 9058490 9120369 2844 2261 0 0 9061334 9170430 0 0 0 0 4439142 4679976 0 0 0 4346335 4606690 8785477 9286666 275857 -116236 12022654 12041479 9255874 9390935 2766780 2650544 THE OPERATION OF A NURSING HOME AND ASSISTED LIVING FACILITY AND PROVIDING MEDICAL CARE FOR THE ELDERLY RESIDENTS 0 0 7571385 9068139 CARE FOR ELDERLY - 98 BED NURSING HOME OPERATED IN ACCORDANCE WITH MEDICARE/MEDICAID REGULATIONS AND 60 UNIT ASSISTED LIVING FACILITY. 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. 7571385 1 1 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 81 0 126 0 0 0 0 0 0 0 0 0 X 13 13 1 1 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X WENDY L WATERS-CONNELL 5138976050 514 W HIGH STREET WAYNESVILLE OH 45068 EUGENIA MILLS PRESIDING CLERK/CLERK OF EXECUTIVE COMMITTEE 1.00 X X 0 0 0 TOM ISAACS ASSISTANT PRESIDING CLERK 1.00 X X 0 0 0 PEG SCHORRECK RECORDING CLERK/CLERK BOARD GOVERNANCE C 1.00 X X 0 0 0 WILSON PALMER TREASURER/CLERK FINANCE & AUDIT COMMITTEE 1.00 X X 0 0 0 SHARON JEWELL ASSISTANT TREASURER 1.00 X X 0 0 0 GUS EDWARDS TRUSTEE 1.00 X 0 0 0 CHARLES FEICHT TRUSTEE 1.00 X 0 0 0 DONNE HAYDEN TRUSTEE 1.00 X 0 0 0 FRANK HUSS TRUSTEE 1.00 X 0 0 0 LEANNE MONTGOMERY 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 ALICE PALMER TRUSTEE (TO 5/2013) 1.00 X 0 0 0 WENDY L WATERS-CONNELL EXECUTIVE DIRECTOR 50.00 5.00 X 130211 0 9760 130211 0 9760 1 0 0 0 CONCEPT REHAB INC 7150 GRANITE CIRCLE TOLEDO OH 43617 THERAPY SERVICES 750034 PROACTIVE RX 24395 VISTA POINT LN DANA POINT CA 92629 PHARMACY CONSULTING/PHARMACEUTICALS 169318 DAYFIELD SENIOR SOLUTIONS LLC 7200 POE AVENUE SUITE 100 DAYTON OH 45414 ACCOUNTING SERVICES/CONSULTING/CONTRACTE 126782 3 47800 47800 MEDICARE/MEDICAID PMTS 623000 4622089 4622089 PATIENT SERV. REVENUE 623000 4446050 4446050 RENTAL INCOME 623000 52230 52230 9120369 2261 2261 9170430 9068139 0 54491 139970 69985 69985 3675187 3177529 497658 587408 499297 88111 277411 235799 41612 35670 35670 153430 153430 464576 394890 69686 51197 51197 239903 35675 204228 186868 158838 28030 28640 24344 4296 9972 9972 316341 268890 47451 529567 450132 79435 127365 108260 19105 MEDICAL SUPPLIES 1024414 1024414 CONTRACTED SERVICES 714306 714306 LICENSE FEES & FRANCHIS 432891 367957 64934 BAD DEBTS 193600 193600 97950 41069 56881 9286666 7571385 1715281 0 707745 547805 39015 113572 80818 76636 13583025 7500043 6241040 6082982 720807 746496 4233229 4473988 12022654 12041479 620464 869267 11853 11774 8098478 7943808 525079 566086 9255874 9390935 X 2766780 2609145 41399 2766780 2650544 12022654 12041479 -116236 0 X X 0 0 1 1 X 47800 47800 8922060 8836929 9220077 9088056 9120369 45187491 8922060 8836929 9220077 9088056 9168169 45235291 0 0 0 45235291 44582 5329 6636 2844 2261 61652 44582 5329 6636 2844 2261 61652 424 424 8967066 8842258 9226713 9090900 9170430 45297367 0.99860 0.99830 0.00140 0.00170 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 12871 12871 10330097 4947499 5382598 3240057 2552544 687513 6082982 PEACE CHURCH RISK RETENTION GROUP 646879 F FRIENDS MUTUAL HEALTH GROUP 69000 F UST 30617 F 746496 MEDICARE/MEDICAID RECEIVABLE 937735 MIP, INSURANCE, & REPAIR DEPOSITS 44052 RESERVE FOR REPLACEMENT 427243 FINANCING & BUILDING FEES 1434514 RESIDUAL RECEIPTS 1501248 RESIDENT FUNDS HELD BY QUAKER HEIGHTS 11524 DUE FROM AFFILITATES 117672 4473988 DUE TO QUAKER HEIGHTS FOUNDATION 148846 DEFERRED REVENUE - SSA 412460 RENTAL DEPOSITS 4780 566086 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 BOARDING 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 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 BOARDING HOME. A PROVISION FOR INCOME TAXES IS NOT REQUIRED. WITH FEW EXCEPTIONS, THE ORGANIZATION'S FEDERAL INFORMATION RETURNS ARE NO LONGER SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE FOR YEARS BEFORE 2010. FORM 990, PART VI, SECTION A, LINE 2 ALICE PALMER AND WILSON PALMER HAVE A FAMILY RELATIONSHIP. AS PRESIDING CLERK OF THE BOARD OF THE FRIENDS HOME FOUNDATION, ALICE PALMER IS AN EX-OFFICIO MEMBER OF THIS ORGANIZATION'S BOARD. THIS SITUATION EXISTED UNTIL MAY 2013 WHEN ALICE PALMER WAS NO LONGER A MEMBER OF THE FRIENDS HOME FOUNDATION BOARD. 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 11 FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR AND THE ORGANIZATION'S MANAGEMENT COMPANY (DAYFIELD SENIOR SOLUTIONS, LLC). A COPY IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY 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 DIRECTORS WILL CONDUCT A WRITTEN ASSESSMENT OF THE PERFORMANCE OF THE EXECUTIVE DIRECTOR ANNUALLY. THE BOARD OF DIRECTORS USES CRITERIA FROM "LEADING AGE" (FKA THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING) TO ESTABLISH COMPENSATION. 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 FINANCIAL STATEMENTS WERE AUDITED BY AN INDEPENDENT ACCOUNTANT ON A CONSOLIDATED BASIS WITH QUAKER HEIGHTS LLC (A DISREGARDED ENTITY) AND QUAKER HEIGHTS FOUNDATION, INC. FORM 990, PART XI, LINE 2C: 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. QUAKER HEIGHTS LLC 514 WEST HIGH STREET PO BOX 677 WAYNESVILLE OH 45068 310538523 OPERATE QUAKER HEIGHTS CARE COMMUNITY - NURSING HOME AND ASSISTED LIVING OH N/A QUAKER HEIGHTS FOUNDATION PO BOX 232 WAYNESVILLE OH 45068 311575048 TO SUPPORT ACTIVITIES OF FRIENDS BOARDING HOME, INC. OH 501(C)(3) LINE 13, TYPE I N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0