HOLZER SENIOR CARE CENTER: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- HOLZER SENIOR CARE CENTER (EIN 31-1534051)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-15
- IRS object ID
- 201311359349306156
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-15T13:36:24-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381357951 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 65 EAST STATE STREET SUITE 600 | AddressLine1 |
| City | COLUMBUS | City |
| State | OH | State |
| ZIP Code | 43215 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311534051 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER SENIOR CARE CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HOLZ | NameControl |
| Phone | 7404465060 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 380 COLONIAL DRIVE | AddressLine1 |
| City | BIDWELL | City |
| State | OH | State |
| ZIP Code | 45614 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KENNETH PAYNE | Name |
| Title | CFO | Title |
| Phone | 7404465060 | Phone |
| Date Signed | 2013-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BERNIE OSTROWSKI | Name |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEE SCHEDULE O | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | TERESA REMY-DETTY | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 9161202 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.HOLZER.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1996 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | HOLZER SENIOR CARE CENTER IS A SKILLED NURSING FACILITY FOR THE CARE AND TREATMENT OF THE SICK, DISABLED, AND INJURED, PROVIDING CARING AND QUALITY SERVICES TOWARD THE ENHANCEMENT OF PHYSICAL AND MENTAL WELL-BEING WITHOUT REGARD TO THE PERSON'S FINANCIAL RESOURCES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 0 | NbrIndependentVotingMembers |
| Total Nbr Employees | 327 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 14944 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 9159765 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 9059058 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 9402 | InvestmentIncomePriorYear |
| Investment Income Current Year | 6039 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 97033 | OtherRevenuePriorYear |
| Other Revenue Current Year | 96105 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 9281144 | TotalRevenuePriorYear |
| Total Revenue Current Year | 9161202 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 3287 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5352142 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5185603 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3361409 | OtherExpensePriorYear |
| Other Expenses Current Year | 3422659 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 8716838 | TotalExpensesPriorYear |
| Total Expenses Current Year | 8608262 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 564306 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 552940 | RevenuesLessExpensesCY |
| Total Assets BOY | 15660599 | TotalAssetsBOY |
| Total Assets EOY | 15866274 | TotalAssetsEOY |
| Total Liabilities BOY | 9237997 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8890732 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6422602 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6975542 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | WE WILL ENCOURAGE WELLNESS AND STRIVE TO IMPROVE THE HEALTH STATUS OF THE PEOPLE AND COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 6308847 | Expense |
| Grants | 0 | Grants |
| Revenue | 9059058 | Revenue |
| Description | SEE SCHEDULE OHOLZER SENIOR CARE CENTER IS A SEVENTY (70) BED FACILITY, GUIDED BY THE VISION OF QUALITY CARE AND OPTIMUM OUTCOME. IT IS COMMITTED TO IDENTIFY, UNDERSTAND AND RESPOND TO THE NEEDS OF THE RESIDENTS. HOLZER SENIOR CARE CENTER OFFERS:* A MEDICAL DIRECTOR* SKILLED NURSING CARE 24 HOURS PER DAY* REHABILITATION THERAPIES INCLUDING: PHYSICAL THERAPIES, OCCUPATIONAL THERAPIES, SPEECH THERAPY* SHORT AND LONG TERM PLACEMENT OF RESIDENTS* SOCIAL AND THERAPEUTIC ACTIVITIES* PROGRAM FOR HOSPICE PATIENTS* CHAPLAINCY SERVICES* DIETARY SERVICES WITH A QUALIFIED DIETITIAN* PERSONAL CARE (BEAUTICIAN & BARBER SERVICES)* ALL INCLUSIVE ROOM RATE* CABLE TVMEDICAL SUPPORT: HOLZER SENIOR CARE CENTER IS UNDER THE DIRECT SUPERVISION OF A MEDICAL DIRECTOR, WHO HELPS PROVIDE THE LATEST IN HIGH ACUITY CARE. RESIDENTS OF HOLZER SENIOR CARE CENTER MAY USE THE SERVICES OF THE CENTER'S MEDICAL DIRECTOR, OR CONTINUE UNDER THE DIRECT CARE OF THEIR OWN PHYSICIAN. A TRAINED STAFF, COMMITTED TO THE HIGHEST STANDARD IN CARING FOR THE RESIDENTS OF HOLZER SENIOR CARE CENTER IS ON DUTY TWENTY FOUR HOURS A DAY, EVERY DAY.REHABILITATION SERVICES: A COMPLETE RANGE OF REHABILITATION SERVICES IS OFFERED AT HOLZER SENIOR CARE CENTER, CONDUCTED BY REGISTERED THERAPISTS. PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES ARE AVAILABLE TO PROVIDE THE MOST THOROUGH REHABILITATION CARE TO RESIDENTS. A RESTORATIVE NURSING CARE PROGRAM IS AN ONGOING SERVICE TO THE CENTER RESIDENTS. THE WIDE RANGE OF SPECIALIZED THERAPY PROGRAMS ENABLES MANY RESIDENTS TO RESUME THEIR FORMER LIFESTYLES AS THEY BECOME MORE INDEPENDENT.NUTRITIONAL SERVICES: RESIDENTS AT HOLZER SENIOR CARE CENTER ENJOY NUTRITIONAL AND APPETIZING MEALS IN A COMFORTABLE AND ATTRACTIVE DINING SETTING. A REGISTERED DIETITIAN WHO SPECIALIZES IN MEETING EACH RESIDENT'S NEEDS PLANS THE MENUS. BED SIDE SERVICE IS AVAILABLE FOR THOSE RESIDENTS WHO ARE UNABLE TO GO TO THE DINING ROOM FOR THEIR MEALS. FAMILY AND FRIENDS WHO WISH TO DINE WITH THEIR LOVED ONES MAY ALSO PURCHASE A MEAL FOR A NOMINAL FEE.SOCIAL AND RECREATIONAL ACTIVITIES: THE OVERALL ACTIVITY PROGRAM AT HOLZER SENIOR CARE CENTER IS THERAPEUTICALLY DESIGNED BY A QUALIFIED AND EXPERIENCED ACTIVITIES COORDINATOR, WHO GIVES SPECIAL ATTENTION TO THE PHYSICAL, MENTAL, SPIRITUAL, AND SOCIAL NEEDS OF EACH RESIDENT. THERE IS SOMETHING FOR EVERYONE. AMONG THE MOST POPULAR EVENTS ARE THE GAMES, CRAFTS, SING-ALONGS, RELIGIOUS SERVICES, PICNICS, AND COMMUNITY OUTINGS. EACH RESIDENT IS ENCOURAGED TO PARTICIPATE IN WHATEVER ACTIVITIES PROVIDE THE MOST FULFILLMENT AND BEST SERVES HIS OR HER PERSONAL NEEDS.ACCOMMODATIONS: A COMFORTABLE HOME-LIKE SETTING CAN PLAY A MAJOR ROLE IN RESTORING HEALTH AND WELL-BEING. THE ROOMS AT HOLZER SENIOR CARE CENTER ARE SPACIOUS AND SUNNY WITH WINDOWS THAT BRING IN AN ABUNDANCE OF NATURAL LIGHT. RESIDENTS ARE ENCOURAGED TO DECORATE THEIR ROOMS WITH FAVORITE PERSONAL BELONGINGS, SUCH AS QUILTS, PILLOWS, AND PICTURES. THE ROOM RATE AT HOLZER SENIOR CARE CENTER IS AN ALL-INCLUSIVE RATE. NO ADDITIONAL CHARGES ARE MADE FOR PERSONAL GROOMING ITEMS OR LAUNDRY SERVICES. THE ATTRACTIVE SOLARIUM AREAS ARE ALWAYS AVAILABLE FOR THE ENJOYMENT OF THE RESIDENTS, THEIR FAMILIES AND FRIENDS. QUALITY OF LIFE: EVERY MEMBER OF THE STAFF AT HOLZER SENIOR CARE CENTER IS COMMITTED TO ADDRESSING AND MEETING THE NEEDS OF EACH RESIDENT ON A PERSONAL BASIS. THEY RESPECT EVERY RESIDENT'S RIGHT TO PRIVACY, DIGNITY AND TREATMENT AS AN INDIVIDUAL.DURING THE YEAR, HOLZER SENIOR CARE SERVED 25,417 PATIENT DAYS AND ASSISTED LIVING SERVED 31,755 PATIENT DAYS. | Description |
| Total Program Service Expense | 6308847 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 7 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 327 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 0 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAM CRABTREE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7402880192 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 190 WATER ST SUITE 4 | AddressLine1 |
| City | JACKSON | City |
| State | OH | State |
| ZIP Code | 45640 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| STEVE CHAPMAN CPA | ||||||
| CHAIRMAN | 1.00 | X | X | 0 | 15500 | 0 |
| ALAN STOCKMEISTER | ||||||
| VICE CHAIRMAN | 1.00 | X | X | 0 | 16000 | 0 |
| RYAN SMITH | ||||||
| TREASURER | 1.00 | X | X | 0 | 16000 | 0 |
| BRENT SAUNDERS | ||||||
| PRES/CEO-HCHS | 1.00 | X | 0 | 306199 | 3531 | |
| TERESA REMY DETTY | ||||||
| VP, LTC DIVISION | 40.00 | X | X | 0 | 167104 | 9024 |
| WILLIAM CRABTREE | ||||||
| CONTROLLER, LTC DIVISION | 40.00 | X | X | 0 | 90674 | 4280 |
| THOMAS TOPE | ||||||
| TRUSTEE, FORMER PRES/CEO-HCHS | 1.00 | X | 0 | 188527 | 0 | |
| PAT CONNERS | ||||||
| TRUSTEE | 1.00 | X | 0 | 356206 | 0 | |
| PETE DETTY | ||||||
| EXEC DIRECTOR, HALJ (PART YEAR) | 40.00 | X | 56793 | 0 | 2750 | |
| TERESA COFFEE | ||||||
| ADMINISTRATOR, HSCC | 40.00 | X | 71328 | 0 | 0 | |
| PEGGY WILLIAMS | ||||||
| EXEC DIRECTOR, HALG | 40.00 | X | 71422 | 0 | 2600 | |
| KENNETH PAYNE | ||||||
| CFO-HCHS | 1.00 | X | 0 | 260363 | 0 | |
| DR WAYNE MUNRO | ||||||
| CEO/CHAIRMAN OF BOARD OF GOVENORS | 40.00 | X | 0 | 576417 | 0 | |
| TIM HACKWORTH | ||||||
| EXEC DIRECTOR, HALJ (PART YEAR) | 40.00 | X | 0 | 63529 | 3014 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 199543 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2056519 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 25199 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (3 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| UNITED HEALTHCARE | |||||
| 9200 WORTHINGTON ROAD | WESTERVILLE | OH | 43082 | HEALTH COVERAGE | 478779 |
| REHABCARE GROUP | |||||
| PO BOX 503534 | ST LOUIS | MO | 63150 | THERAPY | 446215 |
| SKILLED CARE PHARMACY | |||||
| 6175 HI-TEK COURT | MASON | OH | 45040 | PHARMACY SERVICES | 131975 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 3 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PROGRAM SERVICES | 623000 | 8386980 | 8386980 |
| RESIDENT MEALS | 623000 | 597828 | 597828 |
| ADMISSION FEES | 623000 | 74250 | 74250 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 9059058 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6039 | TotalRevenueColumn |
| Exclusion | $6,039 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MEALS & VENDING | 623000 | 37043 | $37,043 |
| PHONE INCOME | 623000 | 25808 | $25,808 |
| CABLE TV INCOME | 623000 | 21543 | $21,543 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11711 | TotalRevenueColumn |
| Exclusion | $11,711 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 96105 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9161202 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9059058 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $102,144 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 204926 | Total |
| Management And General | 204926 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3855356 | Total |
| Program Services | 2968624 | ProgramServices |
| Management And General | 886732 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1204 | Total |
| Program Services | 927 | ProgramServices |
| Management And General | 277 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 818346 | Total |
| Program Services | 630126 | ProgramServices |
| Management And General | 188220 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 305771 | Total |
| Program Services | 235444 | ProgramServices |
| Management And General | 70327 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 197883 | Total |
| Management And General | 197883 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3227 | Total |
| Management And General | 3227 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40691 | Total |
| Management And General | 40691 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 355118 | Total |
| Program Services | 273441 | ProgramServices |
| Management And General | 81677 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75752 | Total |
| Management And General | 75752 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 991285 | Total |
| Program Services | 763289 | ProgramServices |
| Management And General | 227996 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 158 | Total |
| Program Services | 122 | ProgramServices |
| Management And General | 36 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 403223 | Total |
| Program Services | 310482 | ProgramServices |
| Management And General | 92741 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15686 | Total |
| Management And General | 15686 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 368276 | Total |
| Program Services | 283573 | ProgramServices |
| Management And General | 84703 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 441393 | Total |
| Program Services | 339873 | ProgramServices |
| Management And General | 101520 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 117483 | Total |
| Program Services | 90462 | ProgramServices |
| Management And General | 27021 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| OHIO BED TAX | 278535 | 278535 |
| RESIDENT SERVICES | 78488 | 78488 |
| BAD DEBT EXPENSE | 31361 | 31361 |
| EMPLOYEE EXPENSES | 16031 | 16031 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8069 | Total |
| Program Services | 8069 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8608262 | Total |
| Program Services | 6308847 | ProgramServices |
| Management And General | 2299415 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1500 | BOY |
| EOY | 1500 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 979752 | BOY |
| EOY | 1447733 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 449607 | BOY |
| EOY | 323231 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10000 | BOY |
| EOY | 10000 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68933 | BOY |
| EOY | 49587 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 13339815 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 5219045 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8331129 | BOY |
| EOY | 8120770 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 203260 | BOY |
| EOY | 204106 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4432080 | BOY |
| EOY | 4432080 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1184338 | BOY |
| EOY | 1277267 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15660599 | BOY |
| EOY | 15866274 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1102719 | BOY |
| EOY | 1021280 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7107853 | BOY |
| EOY | 6769967 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1027425 | BOY |
| EOY | 1099485 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9237997 | BOY |
| EOY | 8890732 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6422602 | BOY |
| EOY | 6975542 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6422602 | BOY |
| EOY | 6975542 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15660599 | BOY |
| EOY | 15866274 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 552940 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | 40600 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 14944 | CurrentTaxYearMinus1Year |
| Total | 55544 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 8033379 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 8836134 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 8985906 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 9159765 | CurrentTaxYearMinus1Year |
| Current Tax Year | 9059058 | CurrentTaxYear |
| Total | 44074242 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 8033379 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 8836134 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 9026506 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 9174709 | CurrentTaxYearMinus1Year |
| Current Tax Year | 9059058 | CurrentTaxYear |
| Total | 44129786 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 44129786 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 63135 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 40554 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 52466 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 9402 | CurrentTaxYearMinus1Year |
| Current Tax Year | 6039 | CurrentTaxYear |
| Total | 171596 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 63135 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 40554 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 52466 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 9402 | CurrentTaxYearMinus1Year |
| Current Tax Year | 6039 | CurrentTaxYear |
| Total | 171596 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 126466 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | -14923 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 93098 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 97033 | CurrentTaxYearMinus1Year |
| Current Tax Year | 96105 | CurrentTaxYear |
| Total | 397779 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 8222980 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 8861765 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 9172070 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 9281144 | CurrentTaxYearMinus1Year |
| Current Tax Year | 9161202 | CurrentTaxYear |
| Total | 44699161 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.98730 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.98310 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00380 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00480 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
| General Explanation | SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: GUEST MEALS BARBER & BEAUTY SERVICES VENDING MACHINES PHONE INCOME CABLE TV INCOME MISCELLANEOUS | GeneralExplanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 542107 | OtherCostOrOtherBasis |
| Book Value | 542107 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 9388407 | OtherCostOrOtherBasis |
| Depreciation | 3994440 | Depreciation |
| Book Value | 5393967 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 772801 | OtherCostOrOtherBasis |
| Depreciation | 126739 | Depreciation |
| Book Value | 646062 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1893870 | OtherCostOrOtherBasis |
| Depreciation | 1032323 | Depreciation |
| Book Value | 861547 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 742630 | OtherCostOrOtherBasis |
| Depreciation | 65543 | Depreciation |
| Book Value | 677087 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 8120770 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| BOND ISSUE COSTS | 77563 |
| INTERCOMPANY RECEIVABLE | 582831 |
| ASSETS LIMITED AS TO USE | 616873 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 1277267 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| COST REPORT SETTLEMENT PAYABLE | $1,141 |
| INTERCOMPANY PAYABLE | $1,098,344 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1099485 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE SYSTEM AND RECOGNIZE A TAX LIABILITY IF THE SYSTEM HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE SYSTEM AND HAS CONCLUDED THAT AS OF JUNE 30, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE SYSTEM IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE SYSTEM FILES FEDERAL AND STATE TAX RETURNS AND BELIEVES IT IS NO LONGER SUBJECT TO FEDERAL, STATE, OR LOCAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE FISCAL YEAR 2009. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRENT SAUNDERS | |||||||||||||
| 0 | 306199 | 0 | 0 | 0 | 0 | 0 | 3531 | 0 | 0 | 0 | 309730 | 0 | 0 |
| TERESA REMY DETTY | |||||||||||||
| 0 | 167104 | 0 | 0 | 0 | 0 | 0 | 9024 | 0 | 0 | 0 | 176128 | 0 | 0 |
| THOMAS TOPE | |||||||||||||
| 0 | 0 | 0 | 0 | 0 | 188527 | 0 | 0 | 0 | 0 | 0 | 188527 | 0 | 0 |
| PAT CONNERS | |||||||||||||
| 0 | 356206 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 356206 | 0 | 0 |
| KENNETH PAYNE | |||||||||||||
| 0 | 206813 | 0 | 53550 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 260363 | 0 | 0 |
| DR WAYNE MUNRO | |||||||||||||
| 0 | 576417 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 576417 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINES 4A-B | SCHEDULE J, PART I, LINE 4A: DURING THE CALENDAR YEAR, THOMAS TOPE RECEIVED SEVERANCE PAY IN THE AMOUNT OF $188,527. UNDER THE TERMS OF THE SEVERANCE AGREEMENT MR. TOPE WILL RECEIVE 100% OF BASE SALARY AND OTHER BENEFITS AS OF THE TERMINATION DATE, 7/1/09, THROUGH 1/1/11. HE WILL ALSO BE ENTITLED TO AN ANNUAL AUTO ALLOWANCE, PARTICIPATION IN THE HOSPITAL'S GROUP LIFE INSURANCE PLAN, QUARTERLY PAYMENTS DIRECTLY FROM THE HOSPITAL TO MR. TOPE IN AN AMOUNT EQUAL TO THE 457(F) CONTRIBUTION, AND OTHER PENSION PLAN PAYMENTS DIRECTLY FROM THE HOSPITAL TO MR. TOPE BASED ON THE MAXIMUM DEFFERAL ALLOWED. FOLLOWING THIS 18 MONTH PERIOD, MR. TOPE WILL ALSO RECEIVE AN AMOUNT EQUAL TO 22 WEEKS OF BASE SALARY, PLUS 4 WEEKS OF BASE SALARY AS ADDITIONAL RETIREMENT CONSIDERATION (BASED ON THE SALARY IN EFFECT AT THE TERMINATION DATE). SCHEDULE J, PART I, LINE 4B: BRENT SAUNDERS PARTICIPATED IN A 457(F) PLAN AND HAD CONTRIBUTIONS OF $134,623. THESE CONTRIBUTIONS WERE RECEIVED IN 2012 (MARCH AND JUNE). | |
| PART III | PART I, LINE 3: COMPENSATION PAID TO THE ORGANIZATION'S CEO IS ESTABLISHED BY A RELATED ORGANIZATION AND INCLUDES USE OF AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | HOLZER HEALTH SYSTEM IS THE SOLE MEMBER OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | HOLZER SENIOR CARE CENTER'S DECISIONS THAT ARE MADE BY THEIR BOARD OF DIRECTORS CAN BE OVERRULED BY HOLZER HEALTH SYSTEM'S BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CONTROLLER AND THE CFO OF HOLZER HEALTH SYSTEM REVIEW FORM 990. A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY BY ALL OFFICERS, BOARD MEMBERS, AND EMPLOYEES, AND ARE REVIEWED BY THE CONFLICT OF INTEREST REVIEW COMMITTEE. MEMBERS OF THE BOARD ARE AWARE THAT THEY SHOULD DISCLOSE CONFLICTS WHEN THEY ARISE, AND MEMBERS ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON MATTERS WHERE A CONFLICT IS PRESENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION OF OFFICERS IS BASED ON EXPERIENCE AND MARKET VALUE AS EVIDENCED BY COMPARABILITY DATA AND IS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. OFFICER COMPENSATION DECISIONS THAT ARE MADE ARE DOCUMENTED IN THE EXECUTIVE COMMITTEE MEETING MINUTES. THE PROCESS WAS LAST UPDATED DECEMBER 2012. |
| FORM 990, PART VI, SECTION C, LINE 18 | FORM 1023 AND 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PAGE 7, PART VII: | THE FOLLOWING TRUSTEES AND OFFICERS DEVOTED TIME TO RELATED ORGANIZATIONS: ALAN STOCKMEISTER 1-2 HOURS BRENT SAUNDERS 40-50 HOURS KENNETH PAYNE 40-50 HOURS NIRMAL DUTTA 1-2 HOURS RYAN SMITH 1-2 HOURS STEVEN CHAPMAN 1-2 HOURS THOMAS TOPE 1-2 HOURS WAYNE MUNRO 40-50 HOURS |
| FORM 990, PART XI, LINE 2C: | THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. |
| FORM 990, PAGE 1, LINE C: | DOING BUSINESS AS: HOLZER ASSISTED LIVING - GALLIPOLIS HOLZER ASSISTED LIVING - JACKSON |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| GALLIA HEALTH PARTNERS LLC | |||||||||
| 300 BRIARWOOD DR | GALLIPOLIS | OH | 45631 | 311534051 | ASSISTED LIVING | OH | 2152767 | 6200676 | HOLZER SENIOR CARE CENTER |
| JACKSON HEALTH PARTNERS LLC | |||||||||
| 101 MARKHAM DRIVE | JACKSON | OH | 45640 | 311534051 | ASSISTED LIVING | OH | 1785626 | 5110476 | HOLZER SENIOR CARE CENTER |
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| HOLZER HEALTH SYSTEM | |||||||||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 311156690 | MANAGEMENT SERVICES | OH | 501(C)(3) | LINE 11A, I | N/A | 0 | |
| HOLZER HOSPITAL FOUNDATION | |||||||||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 314379491 | HEALTH CARE | OH | 501(C)(3) | LINE 3 | 1 | HOLZER HEALTH SYSTEM | |
| HOLZER MEDICAL CENTER - JACKSON | |||||||||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 311724085 | HEALTH CARE | OH | 501(C)(3) | LINE 3 | 1 | HOLZER HEALTH SYSTEM | |
| HOLZER FOUNDATION | |||||||||||
| 100 JACKSON PIKE | GALLIPOLIS | OH | 45631 | 310927482 | CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE | OH | 501(C)(3) | LINE 7 | 1 | HOLZER HEALTH SYSTEM | |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER CARDIOVASCULAR LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 90 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311780671 | EIN |
| Primary Activity | MEDICAL | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HOLZER VANGUARD INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 JACKSON PIKE | AddressLine1 |
| City | GALLIPOLIS | City |
| State | OH | State |
| ZIP Code | 45631 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311192567 | EIN |
| Primary Activity | STOCK HOLDING COMPANY | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NONE GREATER THAN 50000 | BusinessNameLine1 |