STRATEGY STUDIO / PUBLIC DATA EXPLORER

OHIO LIVING SARAH MOORE: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
OHIO LIVING SARAH MOORE (EIN 31-1510768)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-14
IRS object ID
201313189349307181
Schema version
2012v2.1
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

FieldValueIRS element (for citing)
Timestamp2013-11-14T17:59:36-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN381357951EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1PLANTE & MORAN PLLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line165 EAST STATE ST STE 600AddressLine1
CityCOLUMBUSCity
StateOHState
ZIP Code43215ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN311510768EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SARAH MOORE HEALTH CARE CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSARANameControl
Phone7403629641Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line126 N UNION STREETAddressLine1
CityDELAWARECity
StateOHState
ZIP Code43015ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTIM CHESSERName
TitleVICE CHAIRMANTitle
Phone7403629641Phone
Date Signed2013-11-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameBERNIE OSTROWSKIName
PTINP00366367PTIN
Phone6148493000Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKATHIE WILLNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line126 N UNION STREETAddressLine1
CityDELAWARECity
StateOHState
ZIP Code43015ZIPCode
FieldValueIRS element (for citing)
Gross Receipts4779004GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteSARAHMOOREHOME.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1997YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionSARAH MOORE HEALTH CENTER, INC. OPERATES A 32 BED SKILLED NURSING HOME FACILITY AND A 44 BED ASSISTED LIVING FACILITY.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees141TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year6689ContributionsGrantsPriorYear
Contributions Grants Current Year34641ContributionsGrantsCurrentYear
Program Service Revenue Prior Year4758085ProgramServiceRevenuePriorYear
Program Service Revenue CY4716993ProgramServiceRevenueCY
Investment Income Prior Year25876InvestmentIncomePriorYear
Investment Income Current Year27370InvestmentIncomeCurrentYear
Other Revenue Prior Year-89258OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year4701392TotalRevenuePriorYear
Total Revenue Current Year4779004TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year2802438SalariesEtcPriorYear
Salaries Etc Current Year2701565SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2291516OtherExpensePriorYear
Other Expenses Current Year2257087OtherExpensesCurrentYear
Total Expenses Prior Year5093954TotalExpensesPriorYear
Total Expenses Current Year4958652TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-392562RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-179648RevenuesLessExpensesCY
Total Assets BOY10984693TotalAssetsBOY
Total Assets EOY10897633TotalAssetsEOY
Total Liabilities BOY13146555TotalLiabilitiesBOY
Total Liabilities EOY14961188TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-2161862NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-4063555NetAssetsOrFundBalancesEOY
Mission DescriptionSARAH MOORE IS COMMITTED TO PRESERVING THE DIGNITY AND PRIDE OF OUR RESIDENTS WHILE PROVIDING THEM WITH COMFORTABLE AND SAFE HOUSING WITH LOVING, PERSONAL CARE AND COMPASSION.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense4294251Expense
Grants0Grants
Revenue4716993Revenue
DescriptionPROVIDED SKILLED CARE AND ASSISTED LIVING.Description
Total Program Service Expense4294251TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10963NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees141NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1KATHIE WILLBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7403629641TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line126 N UNION STREETAddressLine1
CityDELAWARECity
StateOHState
ZIP Code43015ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
DEBORAH MARTIN
CHAIRMAN1.000.00XX000
TIM CHESSER
VICE CHAIRMAN1.000.00XX000
CHESTER HAMMOND
BOARD TREASURER1.000.00XX000
JERRY EDMONDS
BOARD SECRETARY1.000.00XX000
DON CHENOWETH
BOARD MEMBER1.000.00X000
BILL WILLIAMS
BOARD MEMBER1.000.00X000
MARY LOU WALDRON
BOARD MEMBER1.000.00X000
DARLENE BARNES
BOARD MEMBER1.000.00X000
MARILYN SHEETS
BOARD MEMBER1.000.00X000
RONALD J WHITE
ADMINISTRATOR (PART YEAR)40.000.00X16383700
KATHIE WILL
INTERIM ADMINISTRATOR (PART YEAR)50.0010.00X1232100
FieldValueIRS element (for citing)
Total Reportable Comp From Org176158TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1FUNCTIONAL PATHWAYSBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1614 MABRY HOOD RD NWAddressLine1
CityKNOXVILLECity
StateTNState
ZIP Code37932ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesTHERAPYDescriptionOfServices
Compensation397622Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions34641AllOtherContributions
Total Contributions34641TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNURSING HOME/ASSISTEDDescription
Business Code623000BusinessCode
Total Revenue Column4716993TotalRevenueColumn
Related Or Exempt Function Income4716993RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue4716993TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column27370TotalRevenueColumn
Exclusion$27,370ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column4779004TotalRevenueColumn
Related Or Exempt Function Income4716993RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$27,370ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total176158Total
Management And General176158ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2211099Total
Program Services2009638ProgramServices
Management And General201461ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total106870Total
Program Services106870ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total207438Total
Program Services207438ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total2375Total
Management And General2375ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total8560Total
Management And General8560ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total562991Total
Program Services562991ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total167Total
Management And General167ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total87218Total
Management And General87218ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total19825Total
Management And General19825ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total364045Total
Program Services364045ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total10132Total
Management And General10132ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total5804Total
Management And General5804ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total395967Total
Program Services304466ProgramServices
Management And General91501ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total302891Total
Program Services302891ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total61200Total
Management And General61200ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
FOOD222131222131
MEDICAL SUPPLIES108683108683
REPAIRS & MAINTENANCE6909869098
BAD DEBT3600036000

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total4958652Total
Program Services4294251ProgramServices
Management And General664401ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY121784BOY
EOY51300EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY289338BOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY375862BOY
EOY511087EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY4915BOY
EOY4915EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY72999BOY
EOY22603EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis10532281LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2181934LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8634425BOY
EOY8350347EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1320072BOY
EOY1799954EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY165298BOY
EOY157427EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY10984693BOY
EOY10897633EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY553592BOY
EOY372687EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY7805965BOY
EOY8006801EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY4786998BOY
EOY6581700EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY13146555BOY
EOY14961188EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-2161862BOY
EOY-4063555EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-2161862BOY
EOY-4063555EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10984693BOY
EOY10897633EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-179648ReconcilationRevenueExpenses
Reconciliation Unrealized Invest171741ReconciliationUnrealizedInvest
Reconcilation Prior Adjustment-1893786ReconcilationPriorAdjustment
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review1AccountantCompileOrReview

Accountant Compile Or Review Basis AccountantCompileOrReviewBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
FS Audited0FSAudited
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4060CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1143955CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years62185CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6689CurrentTaxYearMinus1Year
Current Tax Year34641CurrentTaxYear
Total1251530Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2565349CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3474902CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4350702CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4668827CurrentTaxYearMinus1Year
Current Tax Year4716993CurrentTaxYear
Total19776773Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2569409CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4618857CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4412887CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4675516CurrentTaxYearMinus1Year
Current Tax Year4751634CurrentTaxYear
Total21028303Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50921028303PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16574CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1635CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years28799CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year25876CurrentTaxYearMinus1Year
Current Tax Year18810CurrentTaxYear
Total91694Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16574CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1635CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years28799CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year25876CurrentTaxYearMinus1Year
Current Tax Year18810CurrentTaxYear
Total91694Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2585983CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4620492CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4441686CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4701392CurrentTaxYearMinus1Year
Current Tax Year4770444CurrentTaxYear
Total21119997Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99570PublicSupportPercentage509
Prior Year Support Percentage0.99630PriorYearSupportPercentage
Investment Income Percentage0.00430InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.42000PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis208750OtherCostOrOtherBasis
Book Value208750BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis9418466OtherCostOrOtherBasis
Depreciation1612919Depreciation
Book Value7805547BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis848341OtherCostOrOtherBasis
Depreciation521687Depreciation
Book Value326654BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis56724OtherCostOrOtherBasis
Depreciation47328Depreciation
Book Value9396BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings8350347TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
INTERCOMPANY PAYABLE$4,683,323
INTEREST RATE SWAP LIABILITY$1,898,377
FieldValueIRS element (for citing)
Total Of Amounts6581700TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X, LINE 2:ReturnReference
ExplanationNO PROVISION HAS BEEN MADE FOR INCOME TAXES SINCE THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER CODE SECTION 501(C)(3) AND ARE CLASSIFIED AS OTHER THAN A PRIVATE FOUNDATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS NOT CURRENTLY UNDER EXAMINATION BY THE INTERNAL REVENUE SERVICE OR ANY STATE OR LOCAL TAX AUTHORITIES. THE ORGANIZATION'S FEDERAL TAX RETURNS FOR THE YEARS ENDED PRIOR TO DECEMBER 31, 2009 ARE NO LONGER SUBJECT TO EXAMINATION.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonRONALD J WHITENamePerson
TitleADMINISTRATOR (PART YEAR)Title
Base Compensation Filing Org163837BaseCompensationFilingOrg
Comp Based On Related Orgs0CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs0BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs0OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs0DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs0NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org163837TotalCompensationFilingOrg
Total Compensation Related Orgs0TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1COUNTY OF DELAWAREBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN316400065IssuerEIN
CUSIP Number245872AH9CUSIPNumber
Date Issued2007-09-13DateIssued
Issue Price8905000IssuePrice
Description Of PurposeREFURBISH/ADD BEDSDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Total Proceeds8905000TotalProceeds
Issuance Costs From Proceeds203000IssuanceCostsFromProceeds
Capital Expenditures5649000CapitalExpenditures
Year Of Subst Completion2009YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs1NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiled
Rebate Not Due Yet0RebateNotDueYet
Exception To Rebate0ExceptionToRebate
No Rebate Due0NoRebateDue
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds1HedgeIdentifiedInBooksAndRecds
Superintegrated Hedge0SuperintegratedHedge
Hedge Terminated0HedgeTerminated
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs0WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective Action1ProcToUndertkCorrectiveAction

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2SARAH MOORE EMPLOYED ONE OF THE ADMINISTRATOR'S SONS IN HUMAN RESOURCES. HE OBTAINED HIS NURSING HOME ADMINISTRATOR'S LICENSE AND HIS POSITION WAS ASST. ADMINISTRATOR. HE WAS EMPLOYED FOR A PORTION OF 2012. SARAH MOORE ALSO EMPLOYED ONE OF THE ADMINISTRATOR'S SONS IN MARKETING. HE WAS EMPLOYED FOR A PORTION OF 2012.
FORM 990, PART VI, SECTION B, LINE 11THE ADMINISTRATOR AND CHAIRMAN OF THE BOARD REVIEW THE FORM 990 AND THEN PROVIDE ELECTRONIC COPIES OF THE FORM 990 TO ALL BOARD MEMBERS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CIN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, ALL INTERESTED PERSONS (DIRECTOR, OFFICER, ETC.) MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST/CONFLICT AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST/CONFLICT AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. IN ADDITION, EACH INTERESTED PERSON SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS READ, UNDERSTANDS, AND IS IN COMPLIANCE WITH THE POLICY.
ALTHOUGH A POLICY IS NOT YET IN PLACE FOR THE REVIEW OF OFFICER COMPENSATION, THE BOARD HAS BEEN INFORMED OF SUCH PRACTICES AND IS WORKING TOWARDS DEVELOPING A POLICY, WHICH WOULD INCLUDE INDEPENDENT APPROVAL, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DECISION-MAKING PROCESS.
FORM 990, PART VI, SECTION C, LINE 19THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11GOXYGEN, THERAPY, AND PHARMACY FEES: PROGRAM SERVICE EXPENSES 485,270. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 485,270. ADMINISTRATIVE FEES: PROGRAM SERVICE EXPENSES 33,856. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,856. RETIREMENT AND OTHER FEES: PROGRAM SERVICE EXPENSES 43,865. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,865.OTHER FEES
FORM 990, PART XII, LINE 2C:THE FINANCE COMMITTEE OF THE BOARD FUNCTIONS AS THE ORGANIZATION'S AUDIT COMMITTEE, WHICH OVERSEES A REVIEW OF THE FINANCIAL STATEMENTS AND IS INVOLVED IN THE SELECTION OF THE INDEPENDENT ACCOUNTANT WHICH COMPLETES THE REVIEW. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1SARAH MOORE HOMEBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line147 EAST WILLIAMS STAddressLine1
CityDELAWARECity
StateOHState
ZIP Code43015ZIPCode
FieldValueIRS element (for citing)
EIN314379575EIN
Primary ActivitiesASSISTED LIVINGPrimaryActivities
Legal Domicile StateOHLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status509(A)(1)PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1SARAH MOORE HEALTH CARE CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org1ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg