2014-11-17T15:25:26-06:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 1 BRONZE POINTE BELLEVILLE IL 62226 990 2013-01-01 341743836 NORTH SHORE RETIREMENT COMMUNITY NORT 4197988203 9400 NORTH SHORE BLVD LAKESIDE OH 43440 J CHRISTOPHER GREEN CFO 4197988203 2014-11-17 1 JEFF PARKER P00970069 6182331200 2013 2015-11-30 17:44:51Z J CHRISTOPHER GREEN 580 N SR 741 LEBANON OH 45036 4848624 0 X WWW.OTTERBEIN.ORG X 1993 OH OTTERBEIN NORTH SHORE IS A CONTINUING CARE RETIREMENT COMMUNITY THAT PROVIDES HOUSING AND SERVICES FOR OLDER ADULTS. GENEROUS DONATIONS 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 A SOLID REPUTATION AS A TRUSTED AND VALUABLE RESOURCE. BY PROVIDING INFOMRATION 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 TO OTTERBEIN NORTH SHORE RETIREMENT LIVING COMMUNITY BUT ALSO FOR A NUMBER OF ORGANIZATIONS AND CAUSES IN THE GREATER COMMUNITY. 16 16 96 57 0 0 193936 154317 4170597 4612210 41496 82097 0 0 4406029 4848624 0 0 0 0 1648356 1663049 0 0 0 2614469 2826428 4262825 4489477 143204 359147 10742217 10931293 10078310 9498388 663907 1432905 OUR MISSION - IN KEEPING WITH OUR UNITED METHODIST TRADITION WE SEEK TO ENHANCE THE QUALITY OF LIFE AND HOLISTIC GROWTH OF OLDER PERSONS. 0 0 3611490 4612210 OTTERBEIN NORTH SHORE PROVIDES A CONTINUUM OF CARE INCLUDING INDEPENDENT LIVING, ASSISTED LIVING, NURSING CARE, AND DEMENTIA CARE.REHABILITATION, SOCIAL SERVICES AND CHAPLAINCY SERVICES ARE AVAILABLE TO ALL RESIDENTS.LOCAL GROUPS SUCH AS THE VETERANS, CHURCH CIRCLES, COMMUNITY CIVIC GROUPS AND A HOST OF OTHERS USE OTTERBEIN AS A MEETING PLACE. IN ADDITION OTTERBEIN PROVIDES SPECIAL PROGRAMS AND EVENTS FOR THE COMMUNITY ON AN ONGOING BASIS. 3611490 1 1 0 0 0 0 0 0 0 0 1 1 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 0 1 0 0 0 1 27 0 96 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X J CHRISTOPHER GREEN 5139335400 580 NORTH SR 741 LEBANON OH 450368839 LYNN APP CHAIRPERSON 1.00 X 0 0 0 NEIL ALLEN DIRECTOR 1.00 X 0 0 0 CAROL EVERSON DIRECTOR 1.00 X 0 0 0 REV BRUCE BATCHELOR-GLADER DIRECTOR 1.00 X 0 0 0 JAMES STOUFFER JR DIRECTOR 1.00 X 0 0 0 DAVE GLASMIRE DIRECTOR 1.00 X 0 0 0 DICK HARTLEY RESIDENT REPRESENTATIVE 1.00 X 0 0 0 RUTH FREEH RESIDENT REPRESENTATIVE 1.00 X 0 0 0 HELEN ROFKAR DIRECTOR 1.00 X 0 0 0 TIM TAYLOR DIRECTOR 1.00 X 0 0 0 PHYLLIS LANE DIRECTOR 1.00 X 0 0 0 BARBARA STEPHENS-RICH DIRECTOR 1.00 X 0 0 0 BETH MCKEE DIRECTOR 1.00 X 0 0 0 BUD COX DIRECTOR 1.00 X 0 0 0 JOHN ENGLEBECK DIRECTOR 1.00 X 0 0 0 REV JUDY CLAYCOMB DIRECTOR 1.00 X 0 0 0 CAROL MORGAN DIRECTOR 1.00 X 0 0 0 BOB METHENY DIRECTOR 1.00 X 0 0 0 JILL HREBEN PRESIDENT/CEO 2.00 38.00 X 0 335426 15186 JAMES CHRIS GREEN VP FINANCE/CFO 2.00 38.00 X 0 220646 13812 0 556072 28998 0 0 1 0 CONCEPT REHAB 7150 GRANITE CIRCLE SUITE 200 TOLEDO OH 43617 THERAPY SERVICES 396866 1 154317 1440 154317 RESIDENTIAL SERVICE FE 623000 4514229 4514229 DEPARTMENTAL REVENUE 623000 97981 97981 4612210 68110 68110 13987 0 13987 13987 13987 4848624 4612210 0 82097 1297696 1063499 234197 107780 88329 19451 155905 108132 47773 101668 88508 13160 1238 1238 8487 8487 627921 433428 194493 307648 301112 6536 15659 1732 13927 245814 240592 5222 457899 448171 9728 38581 37761 820 CONTRACTED SERVICES 401740 401740 CORPORATE SERVICE FEES 258852 258852 REFUNDABLE LIFE USE FEE 86111 86111 OTHER ADMINISTRATION 37132 18545 18587 339346 293830 45516 4489477 3611490 877987 0 378941 377491 6222 5596 15439 21947 14117954 5449823 8746967 8668131 1294471 1520256 300177 337872 10742217 10931293 787770 782316 1392516 225667 6155218 5716436 1742806 2773969 10078310 9498388 X 467223 1196710 164976 193362 31708 42833 663907 1432905 10742217 10931293 X 359147 409851 X X 0 1 X 1 0 X 120798 107932 88703 193936 154317 665686 3868134 3700932 4031329 4170597 4612210 20383202 3988932 3808864 4120032 4364533 4766527 21048888 41015 1263 1175 45606 7665 96724 0 41015 1263 1175 45606 7665 96724 20952164 8031 71000 93966 39700 68110 280807 8031 71000 93966 39700 68110 280807 46196 46196 4043159 3879864 4213998 4404233 4834637 21375891 0.98020 0.98290 0.01310 0.01030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 574075 574075 11724446 4304211 7420235 1609382 1017915 591467 210051 127697 82354 8668131 OTHER SECURITIES 1520256 F 1520256 REFUNDABLE PORTION OF REFUNDABLE LIFE USE FEES 1422762 SPLIT-INTEREST AGREEMENT 42109 INTERCOMPANY PAYABLE 1309098 2773969 X PART X, LINE 2: THE ORGANIZATIONS, EXCEPT FOR OTTERBEIN SERVICE CORPORATION, QUALIFY AS TAX-EXEMPT CORPORATIONS DESCRIBED IN SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ORGANIZATIONS ARE NOT SUBJECT TO FEDERAL INCOME TAXES UNDER SECTION 501 (C)(3) OF THE CODE. THE ORGANIZATIONS ARE CLASSIFIED AS PUBLICLY SUPPORTED CHARITABLE ORGANIZATIONS UNDER THE CODE AND CONTRIBUTIONS TO THE ORGANIZATIONS QUALIFY AS CHARITABLE TAX DEDUCTIONS FOR THE CONTRIBUTOR. THE ENTITY FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE IRS. THE ORGANIZATIONS' 2012, 2011, AND 2010 TAX YEARS ARE OPEN FOR EXAMINATION BY THE IRS. OTTERBEIN SERVICE CORPORATION IS AN INACTIVE FOR-PROFIT CORPORATION, AND IS LIABLE FOR INCOME TAXES ON ITS TAXABLE INCOME. 1 X X X X 0 0 0 0 0 0 0 0 0 JILL HREBEN PRESIDENT/CEO 0 335426 0 0 0 0 0 0 0 15186 0 350612 0 0 JAMES CHRIS GREEN VP FINANCE/CFO 0 220646 0 0 0 0 0 0 0 13812 0 234458 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM IS PROVIDED TO AND REVIEWED BY THE CHIEF FINANCIAL OFFICER BEFORE IT 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 THE ANNUAL PROCEDURE OR WHEN THE INTEREST BECOMES RELEVANT TO A MATTER OF BOARD ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE 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. FORM 990, PART VI, SECTION C, LINE 18 UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF SPLIT INTEREST AGREEMENT -16,540. RELATED PARTY TRANSFERS OF UNRESTRICTED NET ASSETS CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 248,783. CHANGE IN MINIMUM PENSION LIABILITY 144,433. CHANGE IN UNREALIZED LOSS ON TRADING INVESTMENTS 33,175. FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES IN THE OVERSIGHT OR THE SELECTION OF AN INDEPENDENT ACCOUNTANT FROM THE PRIOR YEAR. OTTERBEIN HOMES 580 NORTH STATE ROUTE 741 LEBANON OH 45036 310549058 PARENT OH 501(C)(3) LINE 9 N/A 0 OTTERBEIN CRIDERSVILLE 100 RED OAK DRIVE CRIDERSVILLE OH 45806 341940884 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 9 N/A 0 OTTERBEIN PORTAGE VALLEY 20311 PEMBERVILLE ROAD PEMBERVILLE OH 43450 341193296 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 9 N/A 0 OTTERBEIN ST MARYS 11230 STATE ROUTE 364 ST MARYS OH 45885 341940880 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 9 N/A 0 OTTERBEIN LEBANON 585 NORTH STATE 741 LEBANON OH 45036 311743874 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 9 N/A 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0