2013-05-10T15:48:21-05:00 2012-06-30 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2011-07-01 310986918 FRIENDSHIP VILLAGE OF DUBLIN OHIO INC FRIE 6147641600 6000 RIVERSIDE DRIVE DUBLIN OH 43017 JOHN A SCHWARCK 6147641600 2013-05-09 1 BERNIE OSTROWSKI P00366367 6148493000 2011 2016-02-24 21:20:13Z JOHN A SCHWARCK 6000 RIVERSIDE DRIVE DUBLIN OH 43017 18891802 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. 15 15 403 40 0 0 121888 96849 17859600 18253444 823074 470047 23930 17546 18828492 18837886 30484 8000 0 0 7913313 8287403 0 0 126616 7734160 8053250 15677957 16348653 3150535 2489233 73566620 77085693 55422170 56828658 18144450 20257035 TO ENHANCE THE QUALITY OF LIFE FOR OLDER ADULTS. 0 0 13743532 8000 18262293 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. 13743532 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 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 0 1 82 0 1 403 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 1 1 0 OH X JOHN LOFTUS 6147641600 6000 RIVERSIDE DRIVE DUBLIN OH 43017 G ROBERT BOWERS 3.00 X X 0 0 0 WILLIAM JN KONIEWICH 3.00 X X 0 0 0 RONALD J BACHMAN 1.50 X X 0 0 0 CHARLES ANSLEY 1.00 X 0 0 0 GEORGE ARNOLD 1.00 X 0 0 0 KATHIE CHESTNUT 1.00 X 0 0 0 KEITH DEVOE 1.00 X 0 0 0 LAURA ECKLAR 1.00 X 0 0 0 JOHN GOFF 1.00 X 0 0 0 BRIGGS HAMOR 1.00 X 0 0 0 OWEN JOHNSON 1.00 X 0 0 0 KATHLEEN MCGINNIS 1.00 X 0 0 0 CHRISTOPHER SCOTT 1.00 X 0 0 0 CHARLES STEARNS 1.00 X 0 0 0 MARGARET TEAFORD 1.00 X 0 0 0 DR BRUCE WALL 1.00 X 0 0 0 JAMES WINFREE 1.00 X 0 0 0 CHARLES S DEROUSIE 1.00 X 0 0 0 JOHN A SCHWARCK 40.00 X 148053 0 54213 JOHN LOFTUS 40.00 X 99884 0 13846 DONALD M PAUL 40.00 X 125959 0 15490 373896 0 83549 2 0 1 0 RUSCILLI CONSTRUCTION 2041 ARLINGATE COLUMBUS OH 43017 CONSTRUCTION SERVICES 936262 LIFE CARE SERVICES 400 LOCUST ST DES MOINES IA 50309 MGT. CONSULTATIVE SERVICES 290137 LIFE CARE SERVICES 400 LOCUST ST DES MOINES IA 50309 MANAGEMENT 285141 PHYSICAL THERAPY CONSULTIVE SERVICES 1223 NEIL AVE COLUMBUS OH 43201 PHYSICAL, OCCUPATIONAL THERAPY 266648 AJ GALLAGHER 5229 PAYSPHERE CIRCLE CHICAGO IL 60674 INSURANCE BROKER 221194 13 96849 96849 RESIDENCY SERVICES 531110 16719001 16719001 MEDICARE/MEDICAID PMTS 531110 1534443 1534443 18253444 470911 470911 67370 49824 17546 17546 8849 8697 3228 0 4092 3228 -4092 -864 -864 18837886 18262293 0 478744 8000 8000 316683 316683 6521363 5759319 687790 74254 61790 50379 11411 867811 774591 91497 1723 519756 463655 50625 5476 334159 334159 74144 74144 71250 71250 120742 120742 680697 648215 32482 1478066 1189893 288173 1391900 1229252 146800 15848 33910 28753 5157 22514 13937 8577 351396 351396 1580658 1395953 166708 17997 220906 156762 64144 FOOD 1203811 1203811 LETTER OF CREDIT FEE 442274 442274 RECRUITING 21284 13735 7549 CHARITABLE GIVING 11318 11318 14221 13607 614 16348653 13743532 2478505 126616 96280 123112 20181583 15316397 715802 768683 71773 67427 68095 57755 55661395 25471460 28162619 30189935 20596101 26889122 677509 676466 2996858 2996796 73566620 77085693 4960020 2091869 19573594 22335856 28005000 27285000 2883556 5115933 55422170 56828658 X 17705747 19784825 196995 212399 241708 259811 18144450 20257035 73566620 77085693 X 2489233 -376648 X X 0 1 1 X 0 X 54137 43501 140730 91404 96849 426621 16195455 16922002 17196081 17859600 18253444 86426582 16249592 16965503 17336811 17951004 18350293 86853203 3475 4075 4600 4415 4315 20880 0 3475 4075 4600 4415 4315 20880 86832323 1273080 899728 538584 380791 538281 3630464 1273080 899728 538584 380791 538281 3630464 13175 333014 15569 10427 372185 17535847 18198245 17890964 18342222 18888574 90855852 0.95570 0.93860 0.04000 0.05560 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 654 654 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: MEMBERSHIP DUES WERE PAID TO LEADING AGE (FORMERLY AOPHA). OF THESE DUES, $654 WERE RELATED TO LOBBYING ACTIVITIES. 499868 82996 3762 8000 8428 570198 428237 100460 7124 6000 29954 499868 329472 101369 10181 4500 8285 428237 295564 42964 13783 4500 18339 329472 0.00000 0.00000 1.00000 0 0 753331 753331 43717623 19688723 24028900 11190441 5782737 5407704 30189935 GIFT ANNUITY PAYABLE 323574 ADVANCE ENDOWMENT CONTRACTS & DEPOSITS 416975 ENDOWMENT REFUNDS PAYABLE 309327 REFUNDABLE ENDOWMENTS - R.O.C. 2068910 PROVISION FOR INTEREST RATE SWAP AGREEMENT 1335147 INTERCOMPANY PAYABLE 662000 5115933 18837886 16348653 2489233 38778 -14530 -400896 -376648 2112585 18538217 38778 -399610 -360832 18899049 -61163 -61163 18837886 16357906 9253 9253 16348653 0 16348653 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE FVD RESIDENTS' BENEVOLENT FUND WAS CREATED AS A TERM 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: THE INTERNAL REVEVENUE 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, 2009 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, 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. PART XI, LINE 8 - OTHER ADJUSTMENTS: NET UNREALIZED LOSS ON SWAP FMV ADJUSTMENT -400,896. PART XII, LINE 2D - OTHER ADJUSTMENTS: UNREALIZED LOSS ON SWAP FMV -400,896. LOSSES ON RESTRICTED INVESTMENTS -1,559. ANNUITY PAYMENTS IN EXCESS OF INTEREST EARNED -1,950. RECLASSIFIED RENTAL EXPENSES 5,161. OTHER MISCELLANEOUS -366. PART XII, LINE 4B - OTHER ADJUSTMENTS: LOSS ON SALE OF FIXED ASSETS -4,092. OTHER EXPENSES -3,875. PRESENT VALUE ADJUSTMENT OF ENDOWMENT ANNUITY PAYABLE -61,893. BIRCHTON, LLC NET GAIN NOT INCLUDED IN FINANCIAL STATEMENTS 8,697. PART XIII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON SALE OF FIXED ASSETS 4,092. RECLASSIFIED RENTAL EXPENSES 5,161. 1 JOHN SCHWARCK SCHOLARSHIPS AWARDED TO THE EMPLOYEES OF FRIENDSHIP VILLAGE OF DUBLIN OHIO INC. WHO ARE PERSUING A COLLEGE EDUCATION. 4 8000 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 X 0 0 0 0 0 0 0 0 0 JOHN A SCHWARCK 125820 0 22233 0 0 0 0 0 54213 0 202266 0 0 0 FRANKLIN COUNTY OHIO 353180GG1 2004-09-01 13805000 REFUND AND RETIRE THE OUTSTANDING PRINCIPAL AMOUNT OF THE 1997 REVENUE BONDS 0 0 0 FRANKLIN COUNTY OHIO 353180GH9 2004-12-01 19820000 FUND CONSTRUCTION OF THE 51-UNIT INDEPENDENT-LIVING WING 0 0 0 13805000 13404209 400791 1991 1 0 1 1 19820000 513000 19307000 2006 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 1 1 1 MORGAN STANLEY 17.000000000000 0 0 0 0 0 1 1 0 0 0 0 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 SOFTWARE, 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 IMMEDIATE SUPERVISOR, 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 EARLY 2012. THE CONTROLLER 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 MAY OF 2012. 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 5: NET UNREALIZED GAINS ON INVESTMENTS: 38,778. PRIOR PERIOD ADJUSTMENTS: -14,530. NET UNREALIZED LOSS ON SWAP FMV ADJUSTMENT -400,896. TOTAL TO FORM 990, PART XI, LINE 5: -376,648. FORM 990, 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. BIRCHTON LLC 6000 RIVERSIDE DRIVE DUBLIN OH 43017 HOLD AND DEVELOP REAL ESTATE OH 53360 741177 N/A