2014-05-12T10:04:49-05:00 2013-06-30 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2012-07-01 310986918 FRIENDSHIP VILLAGE OF DUBLIN OHIO INC FRIE 6147641600 6000 RIVERSIDE DRIVE DUBLIN OH 43017 JERRY KUYOTH 6147641600 2014-05-07 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2015-11-30 17:44:51Z JERRY KUYOTH 6000 RIVERSIDE DRIVE DUBLIN OH 43017 21015775 0 X WWW.FVDUBLIN.ORG X 1979 OH PROVIDED 254 INDEPENDENT LIVING RESIDENCY APARTMENTS, 46 ASSISTED LIVING RESIDENCY APARTMENTS (INCLUDING 13 MEMORY LOSS UNITS), AND MAINTAINED A 60 BED SKILLED NURSING FACILITY. PROVIDED HOME HEALTH SERVICES TO OUR RESIDENCES. 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. 16 16 409 41 0 0 96849 131272 18253444 19069356 470047 1716505 17546 23026 18837886 20940159 8000 9000 0 0 8287403 8321038 0 0 122206 8053250 8375511 16348653 16705549 2489233 4234610 77085693 82589394 56828658 56745054 20257035 25844340 TO ENHANCE THE QUALITY OF LIFE FOR OLDER ADULTS. 0 0 13949804 9000 19078257 OPERATION OF HEALTH CENTER, A SKILLED NURSING FACILITY, WHICH HAS 60 BEDS. OPERATION OF ASSISTED LIVING FACILITY, WHICH HAS 46 APARTMENTS. PROVIDED HOME HEALTH SERVICES TO ALL RESIDENTS. 13949804 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 18 0 1 409 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 0 1 1 1 1 0 1 1 0 OH X CRAIG FLICKINGER 6147641600 6000 RIVERSIDE DRIVE DUBLIN OH 43017 KATHLEEN MCGINNIS 3.00 0.00 X 0 0 0 CHARLES E ANSLEY 1.50 0.00 X X 0 0 0 KATHIE CHESTNUT 1.00 0.00 X 0 0 0 BRIGGS HAMOR 1.00 0.00 X 0 0 0 OWEN JOHNSON 1.00 0.00 X 0 0 0 WILLIAM JN KONIEWICH 1.00 0.00 X X 0 0 0 CHARLES B STEARNS 1.00 0.00 X 0 0 0 MARGARET TEAFORD 1.00 0.00 X 0 0 0 JAMES WINFREE 1.00 0.00 X 0 0 0 DR BRUCE WALL 1.00 0.00 X 0 0 0 RONALD BACHMAN 3.00 0.00 X X 0 0 0 KEITH DEVOE III 1.00 0.00 X 0 0 0 LAURA ECKLAR 1.00 0.00 X 0 0 0 KAREN ICKES 1.00 0.00 X 0 0 0 CAROL JENKINS 1.00 0.00 X 0 0 0 RICHARD SCHROCK 1.00 0.00 X 0 0 0 G ROBERT BOWERS 3.00 0.00 X X 0 0 0 CHRISTOPHER SCOTT 1.00 0.00 X 0 0 0 JOHN A SCHWARCK 40.00 0.00 X 173558 0 59611 JOHN LOFTUS 40.00 0.00 X 111450 0 6277 CHARLES S DEROUSIE 1.00 0.00 X 0 0 0 BRUCE PAIGE 1.00 0.00 X 0 0 0 DON PAUL 40.00 0.00 X 157570 0 7837 442578 0 73725 3 0 1 0 RUSCILLI CONSTRUCTION 2041 ARLINGATE COLUMBUS OH 43017 CONSTRUCTION SERVICES 1741111 GLYNN DEVINS MARKETING & ADVERTISING SRV 11230 COLLEGE BLVD OVERLAND PARK KS 66210 MARKETING SERVICES 356582 REHAB CARE GROUP THERAPY 680 SOUTH FOURTH STREET LOUISVILLE KY 40202 THERAPY SERVICES 352786 LIFE CARE SERVICES 400 LOCUST STREET DES MOINES IA 50309 MANAGEMENT FEES 307000 LIFE CARE SERVICES 400 LOCUST STREET DES MOINES IA 50309 MGT CONSULTING SERVICES 299391 10 131272 131272 RESIDENCY SERVICES 531110 17382540 17382540 MEDICARE/MEDICAID PMTS 531110 1686816 1686816 19069356 743349 743349 97037 74011 23026 23026 8901 14125 973350 1411 0 1605 973350 -194 973156 973156 20940159 19078257 0 1730630 9000 9000 328709 328709 6634730 5839505 721856 73369 41336 17410 23926 798956 712830 85084 1042 517307 457165 54739 5403 353104 353104 38837 38837 61044 61044 147470 147470 618781 580194 38587 1467894 1147291 320603 1532010 1352990 161577 17443 41048 30744 10304 23475 14144 9331 335097 335097 1685762 1488775 177793 19194 242362 173860 68502 FOOD 1256992 1256992 LETTER OF CREDIT FEE 429921 429921 BAD DEBT EXPENSE 70377 70377 RECRUITING 49673 18978 30695 21664 14531 1378 5755 16705549 13949804 2633539 122206 123112 91125 15316397 7560022 768683 1321982 67427 64822 57755 186304 59761538 27140334 30189935 32621204 26889122 37470451 676466 1029758 2996796 2243726 77085693 82589394 2091869 1776201 22335856 23084991 27285000 26535000 5115933 5348862 56828658 56745054 X 19784825 25310377 212399 533963 259811 0 20257035 25844340 77085693 82589394 X 4234610 949004 403691 X X 0 1 X 1 0 X 43501 140730 91404 96849 131272 503756 16922002 17196081 17859600 18253444 19083855 89314982 16965503 17336811 17951004 18350293 19215127 89818738 4075 4600 4415 4315 5260 22665 0 4075 4600 4415 4315 5260 22665 89796073 899728 538584 380791 538281 825887 3183271 899728 538584 380791 538281 825887 3183271 333014 15569 10427 359010 18198245 17890964 18342222 18888574 20041014 93361019 0.96180 0.95570 0.03410 0.04000 X 0 0 0 0 0 0 0 0 1 1376 1376 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: MEMBERSHIP DUES WERE PAID TO LEADING AGE (FORMERLY AOPHA). OF THESE DUES, $1,376 WERE RELATED TO LOBBYING ACTIVITIES. 570198 59835 2627 8000 17882 606778 499868 82996 3762 8000 8428 570198 428237 100460 7124 6000 29954 499867 329472 101369 10181 4500 8285 428237 295564 42964 13783 4500 18339 329472 0.00000 0.00000 1.00000 0 0 1331528 1331528 46970991 21141504 25829487 3705195 1762276 1942919 7753824 4236554 3517270 32621204 PROVISION FOR INTEREST RATE SWAP AGREEMENT 931456 GIFT ANNUITY PAYABLE 320329 ADVANCE ENDOWMENT CONTRACTS & DEPOSITS 439188 ENDOWMENT REFUNDS PAYABLE 388150 REFUNDABLE ENDOWMENTS - R.O.C. 2276350 INTERCOMPANY PAYABLE 993389 5348862 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: 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 MEANS. THE JOHN SCHWARCK SCHOLARSHIP FUND WAS CREATED TO SUPPORT SELECTED EMPLOYEES AND/OR THEIR LEGAL DEPENDENTS AS THEY SEEK A COLLEGE EDUCATION. THE FVD MEMORIAL FUND EXISTS TO PROVIDE REVENUE TO PURCHASE ITEMS OF BENEFIT TO RESIDENTS THROUHOUT THE VILLAGE. 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: -HEALTH CENTER/LONG-TERM NURSING CARE -THE MEADOWS (ASSISTED LIVING/RESIDENTIAL CARE/MEMORY LOSS CARE) -HOME SERVICES -WELLNESS CENTER DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: 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, 2010 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 HAS ANALYZED THE TAX POSITIONS TAKEN BY THE VILLAGE AND HAS CONCLUDED THAT AS OF JUNE 30, 2013, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. 1 JOHN SCHWARCK SCHOLARSHIPS AWARDED TO THE EMPLOYEES OF FREINDSHIP VILLAGE OF DUBLIN OHIO INC. WHO ARE PERSUING A COLLEGE EDUCATION. 4 9000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: IT IS THE ROLE OF THE SCHOLARSHIP SELECTION COMMITTEE TO DETERMINE WHICH CANDIDATE(S) FROM A QUALIFIED POOL OF APPLICANTS WILL RECEIVE SCHOLARSHIPS IN ANY GIVEN YEAR. IT IS THE ROLE OF THE CHARITABLE GIVING ADVISORY COMMITTEE (CGAC) 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. X X 0 0 0 0 0 0 0 0 0 JOHN A SCHWARCK 145102 0 27085 0 1371 0 34711 0 24900 0 233169 0 0 0 DON PAUL 140865 0 0 0 16705 0 751 0 7086 0 165407 0 0 0 A FRANKLIN COUNTY OHIO 316400067 353180GG1 2004-09-01 13805000 REFUND AND RETIRE THE OUTSTANDING PRINCIPAL AMOUNT OF THE 1997 REVENUE BONDS 0 0 0 B FRANKLIN COUNTY OHIO 316400067 353180GH9 2004-12-01 19820000 FUND CONSTRUCTION OF THE 51-UNIT INDEPENDENT-LIVING WING 0 0 0 A 13805000 13418895 276000 98803 13418895 1991 1 0 1 1 B 20278452 384274 141852 19307000 2006 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 1 1 MORGAN STANLEY 17.000000000000 0 0 0 0 0 B 0 0 1 0 1 0 0 0 0 A 0 B 0 PART I, COLUMN F CONTINUATION ISSUED ON 10/08/97. PART III, LINE 3A, COLUMN B THE ORGANIZATION HAS ONE MANAGEMENT AGREEMENT WHICH HAS BEEN DETERMINED TO COMPLY WITH REV. PROC. 97-13, AS MODIFIED BY REV. PROC. 2001-39. PART III, LINE 9, COLUMN A & B WHILE THE ORGANIZATION DOES NOT HAVE WRITTEN POST ISSUANCE COMPLIANCE PROCEDURES YET, THE ORGANIZATION PLANS TO CONSULT WITH BOND COUNSEL REGARDING THE DRAFTING OF SUCH PROCEDURES. PART IV, LINE 1, COLUMN A & B WHILE REBATE CALCULATIONS HAVE NOT BEEN COMPLETED YET, THE ORGANIZATION PLANS TO HIRE A REBATE ANALYST TO COMPLETE SUCH CALCULATIONS. PART IV, LINE 2B, COLUMN A & B WHILE REBATE CALCULATIONS HAVE NOT BEEN COMPLETED YET, IT IS LIKELY THAT THE BOND ISSUES QUALIFIED FOR AN EXCEPTION TO REBATE TO BE DETERMINED BY THE REBATE ANALYST. PART IV, LINE 7, COLUMN A & B WHILE THE ORGANIZATION DOES NOT HAVE WRITTEN POST ISSUANCE COMPLIANCE PROCEDURES YET, THE ORGANIZATION PLANS TO CONSULT WITH BOND COUNSEL REGARDING THE DRAFTING OF SUCH PROCEDURES. PART V WHILE THE ORGANIZATION DOES NOT HAVE WRITTEN POST ISSUANCE COMPLIANCE PROCEDURES YET, THE ORGANIZATION PLANS TO CONSULT WITH BOND COUNSEL REGARDING THE DRAFTING OF SUCH PROCEDURES. FORM 990, PART VI, SECTION A, LINE 3 LIFE CARE SERVICES PROVIDES THE EXECUTIVE DIRECTOR FOR THE ORGANIZATION AS WELL AS THE MARKETING DIRECTOR. IN ADDITION, LIFE CARE SERVICES PROVIDES ACCOUNTING SOFTWARD, IT SUPPORT, HUMAN RESOURCES, AND OTHER SUPPORT SERVICES. FORM 990, PART VI, SECTION B, LINE 11 ONLY THE CHAIR OF THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES IS GIVEN A COPY OF THE FORM 990 TO REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C 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. A QUESTIONNAIRE IS SENT TO ALL BOARD MEMBERS ANNUALLY IN DECEMBER AS WELL AS TO 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. THIS PROCESS IS GOVERNED BY DEPARTMENT MANAGERS 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. 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 THE EXECUTIVE DIRECTOR IS EVALUATED ANNUALLY BY VARIOUS MANAGEMENT LEVELS WITHIN LIFE CARE SERVICES, TO INCLUDE HIS IMMEDIDATE SUPERVIOSR, THE LCS REGIONAL DIRECTOR. LCS PERFORMS AN INDUSTRY WIDE WAGE COMPARISON FOR COMPARABLE EXECUTIVE DIRECTOR POSITIONS IN SIMILAR SIZE AND FUNCTION FACILITIES, AS PART OF THEIR REVIEW PROCESS. EVALUATIONS INCLUDE INPUT FROM VARIOUS LEVELS WITHIN THE FRIENDSHIP VILLAGE OF DUBLIN BOARD OF DIRECTORS. THE BOARD CHAIRMAN IS SPECIFICALLY ASKED FOR INPUT DURING THE EVALUATION PROCESS. THE PROCESS INCLUDED COMTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THIS PROCESS WAS LAST UNDERTAKEN IN 2013. THE CONTROLER IS EVALUATED ANNUALLY BY THE EXECUTIVE DIRECTOR. A LEADING AGE SALARY AND BENEFITS SURVEY IS USED AS A REFERENCE TO DETERMINE OFFICER COMPENSATION. COMPENSATION DECISIONS ARE REFLECTED IN THE FORMAL EVALUATION DOCUMENT. THIS PROCESS WAS LAST UNDERTAKEN IN 2013. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC REVIEW BY APPOINTMENT AT 6000 RIVERSIDE DR, DUBLIN, OH 43017. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: NET UNREALIZED LOSS ON SWAP FMV ADJUSTMENT 403,691. PART XII, LINE 2C THE ORGANIZATION HAS AN AUDIT COMMITTEE WHICH OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND IS INVOLVED IN SELECTION OF THE INDEPENDENT ACCOUNTANTS WHICH COMPLETE THE AUDIT. POLICY REQUIRES THE EXECUTIVE DIRECTOR AND CONTROLLER TO LEAVE THE ROOM WHILE THE AUDIT COMMITTEE DISCUSSES THE AUDIT RESULTS WITH THE INDEPENDENT ACCOUNTANTS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. BIRCHTON LLC 6000 RIVERSIDE DRIVE DUBLIN OH 43017 HOLD AND DEVELOP REAL ESTATE OH 82538 1088327 FRIENDSHIP VILLAGE OF DUBLIN OHIO INC