2011-05-16T07:44:54-05:00 2010-06-30 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2009-07-01 310986918 FRIENDSHIP VILLAGE OF DUBLIN OHIO INC FRIE 6147641600 6000 RIVERSIDE DRIVE DUBLIN OH 43017 JOHN A SCHWARCK 6147641600 2011-05-17 1 6148493000 2009 2016-02-24 21:20:13Z JOHN A SCHWARCK 6000 RIVERSIDE DRIVE DUBLIN OH 43017 18527828 0 X WWW.FVDUBLIN.ORG X 1979 OH PROVIDED 255 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. 16 16 402 26 0 0 43501 140730 16921565 17196081 -413178 1115006 325332 56395 16877220 18508212 4500 4500 0 7807507 7955766 0 82960 7254614 7538723 15066621 15498989 1810599 3009223 69750953 72744461 59459706 59612566 10291247 13131895 TO ENHANCE THE QUALITY OF LIFE FOR OLDER ADULTS. 0 0 12952891 4500 17205288 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. 12952891 1 1 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 77 0 1 402 1 0 0 0 0 0 0 0 0 0 16 16 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 KATHLEEN MCGINNIS 3.00 X X 0 0 0 G ROBERT BOWERS 3.00 X X 0 0 0 CHARLES E ANSLEY 1.50 X X 0 0 0 GEORGE J ARNOLD 1.00 X 0 0 0 J CHRISTOPHER SCOTT 1.00 X 0 0 0 KATHIE CHESNUT 1.00 X 0 0 0 CHEREE CLARK 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 WILLIAM JN KONIEWICH 1.00 X 0 0 0 FRED B MILLER 1.00 X 0 0 0 PATRICIA M SCHWIRIAN 1.00 X 0 0 0 CHARLES B STEARNS 1.00 X 0 0 0 MARGARET TEAFORD 1.00 X 0 0 0 JAMES WINFREE 1.00 X 0 0 0 DR BRUCE WALL 1.00 X 0 0 0 CHARLES S DEROUSIE 1.00 X 0 0 0 JOHN A SCHWARCK 40.00 X 146725 0 60091 JOHN LOFTUS 40.00 X 96311 0 13114 DONALD M PAUL 40.00 X 115667 0 14740 358703 0 87945 2 0 1 0 LIFE CARE SERVICES CAPITAL SQUARE DES MOINES IA 50309 MGT. CONSULTIVE SERVICES 277948 LIFE CARE SERVICES CAPITAL SQUARE DES MOINES IA 50309 MANAGEMENT 267996 PHYSICAL THERAPY CONSULTIVE SERVICES 1223 NEIL AVE COLUMBUS OH 43201 PHYSICAL, OCCUPATIONAL THERAPY 228460 VORYS SATER SEYMOUR PEASE PO BOX 73487 CLEVELAND OH 44193 LEGAL SERVICES 128198 JMM ARCHITECTS 4685 LARWELL DRIVE COLUMBUS OH 43220 ARCHITECTURAL SERVICES 104937 5 140730 140730 RESIDENCY SERVICES 531110 15634849 15634849 MEDICARE/MEDICAID PMTS 531110 1561232 1561232 17196081 478215 478215 60369 19543 40826 40826 9207 31619 635864 1000 73 635864 927 636791 636791 OTHER INCOME 900099 15569 15569 15569 18508212 17205288 0 1162194 4500 4500 273453 273453 6222228 5572214 583852 66162 57286 47416 9870 914405 844269 68643 1493 488394 424072 59299 5023 545944 545944 49225 49225 55440 55440 70778 70778 268708 227957 40751 2391783 2209393 182390 1743066 1330534 412532 32444 27019 5425 16835 11132 5703 426296 426296 1546792 1546792 224263 159150 65113 LETTER OF CREDIT FEE 83128 83128 RECRUITING 31013 25862 5151 BAD DEBT 13157 13157 CHARITABLE GIVING 10282 10282 29569 29569 15498989 12952891 2463138 82960 42419 74296 27407275 30610514 1121801 697406 70850 66177 43140 237054 51506518 22377318 29995394 29129200 7559919 8343290 380000 514000 13241 22560 3116914 3049964 69750953 72744461 4750741 5085002 20067276 20557558 31355000 30695000 3286689 3275006 59459706 59612566 X 9883630 12711339 168856 187175 238761 233381 10291247 13131895 69750953 72744461 X 0 1 1 X 0 X 181496 76292 54137 43501 140730 496156 11966284 15053583 16195455 16922002 17196081 77333405 12147780 15129875 16249592 16965503 17336811 77829561 135535 23517 3475 4075 4600 171202 0 135535 23517 3475 4075 4600 171202 77658359 616531 1176801 1273080 899728 538584 4504724 616531 1176801 1273080 899728 538584 4504724 10512 10569 13175 333014 15569 382839 12774823 16317245 17535847 18198245 17890964 82717124 0.93880 0.93670 0.05450 0.05830 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 439 0 0 0 439 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: THE ORGANIZATION IS A MEMBER OF AOPHA; A PORTION OF DUES PAYMENTS TO AOPHA GOES TOWARD LOBBYING ACTIVITIES. 329472 101369 10181 4500 8285 428237 295564 42964 13783 4500 18339 329472 0.00000 0.00000 1.00000 0 0 753331 753331 42725054 17371555 25353499 8028133 5005763 3022370 29129200 GIFT ANNUITY PAYABLE 336164 ADVANCE ENDOWMENT CONTRACTS & DEPOSITS 293610 ENDOWMENT REFUNDS PAYABLE 171992 REFUNDABLE ENDOWMENTS - R.O.C. 2473240 3275006 18508212 15498989 3009223 146491 -315066 -168575 2840648 18294207 146491 -316389 -169898 18464105 44107 44107 18508212 15502618 3629 3629 15498989 0 15498989 Part V, Line 4: Description of Intended Use of Endowment Funds: THE FVD RESIDENTS' BENEVOLENT FUND WAS CREATED AS A PERMANENT 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 Part XI, Line 8 - Other Adjustments: NET UNREALIZED LOSS ON SWAP FMV ADJUSTMENT: -315066. Part XII, Line 2d - Other Adjustments: UNREALIZED LOSS ON SWAP FMV: -315066. RESTRICTED INVESTMENT INCOME: -3406. INTEREST EARNED IN EXCESS OF ANNUITY PAYMENTS: -2473. RECLASSIFIED RENTAL EXPENSES: 4556. Part XII, Line 4b - Other Adjustments: GAIN ON SALE OF FIXED ASSETS: 927. RESTRICTED CONTRIBUTIONS: 42703. PRESENT VALUE ADJUSTMENT OF ENDOWMENT ANNUITY PAYABLE: -31143. BIRCHTON, LLC NET GAIN NOT INCLUDED IN FINANCIAL STATEMENTS: 31620. Part XIII, Line 2d - Other Adjustments: GAIN REPORTED ON LINE 8: -927. RECLASSIFIED RENTAL EXPENSES: 4556. X X 0 0 0 0 0 0 0 0 0 JOHN A SCHWARCK 120624 0 24966 0 1135 0 39092 0 20999 0 206816 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 FRANKLIN COUNTY OHIO 353180GH9 2004-12-01 19820000 FUND CONSTRUCTION OF THE 51-UNIT INDEPENDENT-LIVING WING 0 0 13805000 13404209 400791 1991 1 0 1 1 19820000 513000 19307000 2006 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 0 1 1 1 MORGAN STANLEY 17.000000000000 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 SOFTWARD, 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. 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 REQUIRING 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 THE LIFE CARE SERVICES REGIONAL DIRECTOR & BOARD OF TRUSTEES. LOCAL WAGE AND SALARY SURVEYS ARE USED WHEN EVALUATING AMOUNTS OF INCREASES DURING THE BUDGET PREPARATION PROCESS. THE BOARD FINANCE COMMITTEE REVIEWS AND APPROVES BUDGETED INCREASES ANNUALLY AS PART OF THEIR ANNUAL BUDGET REVIEW. COMPENSATION DECISIONS ARE REFLECTED IN THE MINUTES OF THE FINANCE COMMITTEE MEETINGS. A BOARD COMMITTEE REVIEWS THE COMPENSATION GRANTED TO THE EXECUTIVE DIRECTOR IN ADDITION TO THE REGIONAL DIRECTOR OF LCS, HIS IMMEDIATE SUPERVISOR. THIS PROCESS WAS LAST UNDERTAKEN IN EARLY 2011. 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. FORM 990, PART XI, LINE 2C THE ORGANIZATION HAS AN AUDIT COMMITTEE WHICH OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND IS INVOLVED IN SELECTION OF THE INDEPENDENT ACCOUNTANT WHICH COMPLETES THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. BIRCHTON LLC 6000 RIVERSIDE DRIVE DUBLIN OH 43017 HOLD AND DEVELOP REAL ESTATE OH 46607 481778 N/A