2012-11-13T09:11:44-06:00 2011-12-31 990 2011-01-01 341743836 NORTH SHORE RETIREMENT COMMUNITY NORT 4197988203 9400 NORTH SHORE BLVD LAKESIDE OH 43440 J Christopher Green 5139335400 2012-11-13 2011 2016-02-24 21:20:13Z J CHRISTOPHER GREEN 580 N SR 741 Lebanon OH 45036 4214048 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 donors 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 us a solid reputation as a trusted and valuable resource. By providing information 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 at Otterbein North Shore Retirement Living Community but also for a number of organizations and causes in the greater community. 11 11 98 15 0 0 107932 88703 3700932 4031329 65688 94016 0 0 3874552 4214048 0 0 0 0 1543756 1587940 0 0 0 2381497 2574530 3925253 4162470 -50701 51578 10567245 10392235 10051811 10005777 515434 386458 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 3389166 4031329 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. 3389166 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 0 1 23 0 1 98 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 OH X J CHRISTOPHER GREEN 5139335400 580 N SR 741 LEBANON OH 450368839 Jerry Phelps 1.00 X 0 0 0 Lynn App 1.00 X 0 0 0 Helen Rofkar 1.00 X 0 0 0 Jim Stouffer Jr 1.00 X 0 0 0 Rev Bruce Batchelor-Glader 1.00 X 0 0 0 Neil Allen 1.00 X 0 0 0 Phyllis Lane 1.00 X 0 0 0 Carol Everson 1.00 X 0 0 0 Tim Taylor 1.00 X 0 0 0 Carol Morgan 1.00 X 0 0 0 Bob Metheny 1.00 X 0 0 0 Jill Hreben 40.00 X 0 291250 16161 James Chris Green 40.00 X 0 217255 13249 0 508505 29410 0 0 1 0 Concept Rehab Inc 7150 Granite Circle Toledo OH 43617 Therapy Services 230029 1 88703 9198 88703 Resident Service Fees 623000 3940030 3940030 Departmental Revenue 623000 91299 91299 4031329 93966 93966 50 0 50 50 50 4214048 4031329 0 94016 1203894 948511 255383 53720 42324 11396 134366 75091 59275 195960 174177 21783 9953 9953 8936 8936 463749 379240 84509 313472 306373 7099 2124 331 1793 271021 264883 6138 410905 401599 9306 34417 33638 779 Nurse Agency Fees/Contr 268156 268156 Corporate Service Fees 250221 250221 Refundable Life Use Fee 248881 248881 Benevolent assistance 147361 147361 145334 98601 46733 4162470 3389166 773304 0 271474 301820 1618 2218 14573 21382 13455595 4623233 9042927 8832362 937679 929064 298974 305389 10567245 10392235 668659 751455 1303388 1242045 6686184 6627638 1393580 1384639 10051811 10005777 X -3536491 -3667399 4045200 4047132 6725 6725 515434 386458 10567245 10392235 X 51578 -180554 X X 0 1 1 X 0 X 202927 56758 120798 107932 88703 577118 3176801 3696774 3868134 3700932 4031329 18473970 3379728 3753532 3988932 3808864 4120032 19051088 9145 3510 41015 1263 1175 56108 0 9145 3510 41015 1263 1175 56108 18994980 125357 -3845 8031 71000 93966 294509 125357 -3845 8031 71000 93966 294509 46196 46196 3505085 3749687 4043159 3879864 4213998 19391793 0.97950 0.97810 0.01520 0.01430 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 574075 574075 11401211 3606189 7795022 1280005 914907 365098 200304 102137 98167 8832362 Other Securities 929064 F 929064 Refundable portion of refundable life use fees 201380 Split-interest agreement 41347 Deferred cost of interest rate swap 330286 Intercompany Payable 811626 1384639 4214048 4162470 51578 -180554 -180554 -128976 4214048 0 4214048 0 4214048 4162470 0 4162470 0 4162470 Description of Uncertain Tax Positions Under FIN 48: Part X: The Organization qualifies as a tax-exempt corporation described in Section 501(c)(3) of the Internal Revenue Code. Accordingly, the Organization is not subject to federal income taxes under Section 501(c)(3) of the Code. The Organization is classified as a publicly supported charitable organization under the Code and contributions to the Organization 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 Organization's 2010, 2009 and 2008 tax years are open for examination by the IRS. Part XI, Line 8 - Other Adjustments: change in fair value of interest rate swap -101510. change in value of split interest agreement -5654. Net Assets Released from Restriction 71174. Change in unrealized gains/losses -86889. change in minimum pension liablility -57675. Total to Schedule D, Part XI, Line 8: -180554. 1 X X X X X 0 0 0 0 0 0 0 0 0 Jill Hreben 0 291250 0 0 0 0 0 0 0 16161 0 307411 0 0 James Chris Green 0 217255 0 0 0 0 0 0 0 13249 0 230504 0 0 Form 990, Part VI, Section B, line 11 Form 990, Part VI, Section A, line 10: The 990's are prepared internally by a Senior Staff Accountant and the Controller. They are reviewed by the Chief Financial Officer and the external audit firm. Form 990, Part VI, Section B, line 12c 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 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 Form 990, Part VI Section C, line 19: The annual report is provided to the public which includes the audited financial statement summary. Form 990, Part VI, Section C, line 19 Form 990, Part VI, Section C, line 19: The governing documents and conflict of interest policy are available upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: change in fair value of interest rate swap -101510. change in value of split interest agreement -5654. Net Assets Released from Restriction 71174. Change in unrealized gains/losses -86889. change in minimum pension liablility -57675. Total to Form 990, Part XI, Line 5: -180554. Form 990, Page 12, 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) 509(a)(2) N/A 0 Otterbein Cridersville 100 Red Oak Drive Cridersville OH 45806 341940884 Retirement Living Community OH 501(c)(3) 509(a)(2) N/A 0 Otterbein Portage Valley 20311 Pemberville Rd Pemberville OH 43450 341193296 Retirement Living Community OH 501(c)(3) 509(a)(2) N/A 0 Otterbein St Marys 11230 State Route 364 St Marys OH 45885 341940880 Retirement Living Community OH 501(c)(3) 509(a)(2) N/A 0 Otterbein Lebanon 585 North State 741 Lebanon OH 45036 311743874 Retirement Living Community OH 501(c)(3) 509(a)(2) N/A 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 Otterbein Homes L 250221 Percentage of revenue