2019-05-14T15:21:50-05:00 2018-06-30 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2017-07-01 311510768 SARAH MOORE HEALTH CARE CENTER INC SARA 7403629641 26 N UNION STREET DELAWARE OH 43015 ROBERT B STILLMAN CFO/TREASURER 7403629641 2019-05-13 1 BERNIE OSTROWSKI P00366367 6148493000 2019-05-09 67.59.56.31 2019-05-13 13:19:04 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 710E608B753FF23705D991DE9B0A45A0C58E6BDA 2017 2019-02-21 02:37:17Z LAURENCE C GUMINA 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 5632199 0 X SEE SCHEDULE O X 1997 OH SARAH MOORE HEALTH CENTER, INC. OPERATES A 47 BED SKILLED NURSING HOME FACILITY AND A 38 BED ASSISTED LIVING FACILITY. 6 4 0 16 0 0 0 0 4755886 5496034 166420 123120 0 13045 4922306 5632199 0 0 0 0 3290730 3591781 0 0 0 2843437 3239911 6134167 6831692 -1211861 -1199493 10145455 9935626 12161423 7812613 -2015968 2123013 TO PROVIDE ADULTS WITH CARING AND QUALITY SERVICES TOWARD THE ENHANCEMENT OF PHYSICAL, MENTAL AND SPIRITUAL WELL-BEING CONSISTENT WITH THE CHRISTIAN GOSPEL. 0 0 6096914 0 5496034 PROVIDED SKILLED CARE AND ASSISTED LIVING. 6096914 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 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 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X ROBERT B STILLMAN 6148887800 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 LAURENCE C GUMINA CHIEF EXECUTIVE OFFICER 1.00 39.00 X X 0 453831 24973 DANIEL O'CONNOR CHIEF OPERATING OFFICER 1.00 39.00 X X 0 358228 24973 DONALD G CHENOWETH DIRECTOR/ASST SECRETARY 2.00 4.00 X X 0 0 0 FREDERICK C SMITH III DIRECTOR/CHAIR 2.00 4.00 X X 0 0 0 KATHLEEN TUTTLE DIRECTOR/VICE CHAIR 2.00 4.00 X X 0 0 0 RICHARD LOWERY DIRECTOR/ASST TREASURER 2.00 4.00 X X 0 0 0 ROBERT STILLMAN CHIEF FINANCIAL OFFICER/TREASURER 1.00 39.00 X 0 285375 30053 DANA ULLOM-VUCELICH CHIEF HUMAN RESOURCES OFFICER 1.00 39.00 X 0 238458 14744 JOYCE MILLER CHIEF INFORMATION OFFICER 1.00 39.00 X 0 222843 21940 CONNIE TOSTEVIN CHIEF NURSING OFFICER 1.00 39.00 X 0 210174 15205 MARY C MCKENZIE CORP EXECUTIVE OF COMMUNICATION 1.00 39.00 X 0 174260 7758 MICHAELLA REES CORP EXEC OF BUSINESS DEVELOPMENT 1.00 39.00 X 0 152288 5782 WILLIAM RENNER CORP EXECUTIVE OF PLANNING/ANALYSIS 1.00 39.00 X 0 145372 25391 DANIEL HOLSTEIN CORPORATE EXECUTIVE OF FINANCE 1.00 39.00 X 0 147551 16479 MARK ROBERTS CHIEF EXECUTIVE OF PROJECT DEVELOPMENT 1.00 39.00 X 0 140693 21189 0 2529073 208487 0 0 1 0 FUNCTIONAL PATHWAYS OF TN LLC 10133 SHERRILL BLVD SUITE 200 KNOXVILLE TN 37932 THERAPY SERVICES 562849 COMMERCIAL REVISIONS CONSTRUCTION 6680 BUSCH BLVD COLUMBUS OH 43229 CONSTRUCTION 159885 OMNICARE PHARMACY 522 E HOUGHTON SUITE 102 WEST BRANCH MI 48661 PHARMACY SERVICES 131382 3 NURSING HOME/ASSISTED 623000 5496034 5496034 5496034 19579 19579 103541 0 103541 103541 103541 MEALS 900099 11733 11733 1312 1312 13045 5632199 5496034 0 136165 47520 47520 2862447 2645246 217201 51484 49140 2344 414343 395478 18865 215987 195885 20102 2002 2002 200 200 391244 391244 47817 17397 30420 545165 149785 395380 11079 11079 263659 263658 1 15440 15440 220 220 373999 373999 365539 365539 40994 40994 MEDICAL SUPPLIES 549039 549039 COST OF FOOD 259076 259076 FRANCHISE FEES 218726 218726 BAD DEBT 152767 152767 2945 2945 6831692 6096914 734778 0 475043 74494 386740 677897 10134 7602 8136120 1243959 7079058 6892161 1450715 1608300 743765 670000 0 5172 10145455 9935626 450716 414368 6805541 6494519 4905166 903726 12161423 7812613 X -2015968 2123013 -2015968 2123013 10145455 9935626 X -1199493 370504 4967970 X 0 1 X 1 0 X 2217 2217 4988554 2220098 4829433 4755886 5496034 22290005 4990771 2220098 4829433 4755886 5496034 22292222 0 0 0 22292222 20445 4391 62551 38392 19579 145358 20445 4391 62551 38392 19579 145358 30 11733 11763 5011216 2224519 4891984 4794278 5527346 22449343 0.99300 0.99150 0.00650 0.00850 X 258860 258860 6996215 917955 6078260 795621 305299 490322 85424 20705 64719 6892161 INTEREST RATE SWAP LIABILITY 871912 DEPOSITS 31814 903726 0 0 0 0 0 0 0 0 0 LAURENCE C GUMINA CHIEF EXECUTIVE OFFICER 0 453141 0 0 0 690 0 10800 0 14173 0 478804 0 0 DANIEL O'CONNOR CHIEF OPERATING OFFICER 0 338252 0 0 0 19976 0 10800 0 14173 0 383201 0 0 ROBERT STILLMAN CHIEF FINANCIAL OFFICER/TREASURER 0 284751 0 0 0 624 0 10800 0 19253 0 315428 0 0 DANA ULLOM-VUCELICH CHIEF HUMAN RESOURCES OFFICER 0 237969 0 0 0 489 0 9599 0 5145 0 253202 0 0 JOYCE MILLER CHIEF INFORMATION OFFICER 0 221993 0 0 0 850 0 9090 0 12850 0 244783 0 0 CONNIE TOSTEVIN CHIEF NURSING OFFICER 0 208992 0 0 0 1182 0 8402 0 6803 0 225379 0 0 MARY C MCKENZIE CORP EXECUTIVE OF COMMUNICATION 0 173276 0 0 0 984 0 7029 0 729 0 182018 0 0 MICHAELLA REES CORP EXEC OF BUSINESS DEVELOPMENT 0 152113 0 0 0 175 0 5324 0 458 0 158070 0 0 WILLIAM RENNER CORP EXECUTIVE OF PLANNING/ANALYSIS 0 145196 0 0 0 176 0 6138 0 19253 0 170763 0 0 DANIEL HOLSTEIN CORPORATE EXECUTIVE OF FINANCE 0 146824 0 0 0 727 0 5996 0 10483 0 164030 0 0 MARK ROBERTS CHIEF EXECUTIVE OF PROJECT DEVELOPME 0 139963 0 0 0 730 0 5849 0 15340 0 161882 0 0 A COUNTY OF DELAWAREOHIO 316400065 2016-12-01 7090000 REFINANCE PRIOR BONDS 0 0 0 A 504000 7090000 7090000 2009 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 1 MORGAN STANLEY CAP 25.000000000000 0 0 0 0 1 A 1 FORM 990, PART V, LINE 1A AND 2A ALL W-2S AND 1099S ARE ISSUED FROM A RELATED PARTY, OHIO LIVING, A COMMON PAYMASTER. FORM 990, PART VI, SECTION A, LINE 6 OHIO LIVING COMMUNITIES IS THE SOLE MEMBER OF SARAH MOORE HEALTH CARE CENTER, INC. AND SHALL HAVE AND EXERCISE ALL OF THE RIGHTS AND PRIVILEGES OF MEMBERS OF A NONPROFIT CORPORATION CONFERRED UNDER THE LAWS OF THE STATE OF OHIO. FORM 990, PART VI, SECTION A, LINE 7A DIRECTORS OF SARAH MOORE HEALTH CARE CENTER, INC. WILL BE APPOINTED BY THE SOLE MEMBER, OHIO LIVING COMMUNITIES, THROUGH ITS BOARD OF DIRECTORS, AT THE ANNUAL MEETING OF THE SOLE MEMBER. NOMINEES TO THE BOARD OF DIRECTORS OF SARAH MOORE HEALTH CARE CENTER, INC. WILL BE SELECTED AND APPOINTED BY THE OHIO LIVING COMMUNITIES BOARD OF DIRECTORS BASED UPON THEIR ABILITY TO CONTRIBUTE IN TERMS OF EXPERTISE AND TIME AND THEIR COMMITMENT TO THE OHIO LIVING MISSION STATEMENT. FORM 990, PART VI, SECTION A, LINE 7B THE CODE OF REGULATIONS OF SARAH MOORE HEALTH CARE CENTER, INC. MAY BE AMENDED BY A MAJORITY VOTE OF THE DIRECTORS PRESENT AT ANY MEETING AT WHICH THERE IS A QUORUM IN ATTENDANCE, PROVIDED NOTICE OF THE MEETING AND THE PROPOSED CHANGES IN THE CODE OF REGULATIONS HAVE BEEN GIVEN TO ALL DIRECTORS NO FEWER THAN TWENTY-ONE (21) DAYS IN ADVANCE OF SUCH A MEETING. THE ARTICLES OF INCORPORATION OF SARAH MOORE HEALTH CARE CENTER, INC. MAY ALSO BE AMENDED IN THE SAME MANNER. NOTWITHSTANDING THE FOREGOING, ALL AMENDMENTS TO THE CODE OF REGULATIONS AND THE ARTICLES OF INCORPORATION OF SARAH MOORE HEALTH CARE CENTER, INC. MUST BE RATIFIED BY OHIO LIVING COMMUNITIES AS SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B AFTER MANAGEMENT PERFORMS A DETAILED REVIEW OF THE DRAFT 990, THE ORGANIZATION DELEGATES THE REVIEW OF THE 990 TO A BOARD MEMBER WITH SUFFICIENT EXPERIENCE TO EVALUATE THE CONTENT CONTAINED THEREIN. THE MEMBER THEN REPORTS HIS/HER REVIEW FINDINGS TO THE BOARD AND FINANCE COMMITTEE. A DRAFT OF THE FORM 990 IS POSTED TO THE ONLINE BOARD PORTAL AND EACH BOARD MEMBER IS GRANTED ACCESS TO REVIEW AND COMMENT. THE FINAL ISSUED FORM 990 IS ALSO POSTED TO THE BOARD PORTAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C IN 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 BY THE REMAINING BOARD MEMBERS. 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. FORM 990, PART VI, SECTION B, LINE 15 THE CHIEF HUMAN RESOURCES OFFICER OF OHIO LIVING, A RELATED ENTITY, IN CONJUNCTION WITH THE OHIO LIVING EXECUTIVE COMPENSATION AND EVALUATION COMMITTEE (ECEC) OF THE BOARD OVERSEE THE COMPENSATION OF THE EXECUTIVE LEADERSHIP PERSONNEL. THE ECEC IS COMPRISED OF KEY BOARD MEMBERS WHO INCLUDE THE BOARD CHAIR FROM EACH SUBSIDIARY BOARD, THE BOARD CHAIR FROM THE OHIO LIVING PARENT BOARD, THE FINANCE, AUDIT, ETHICS & COMPLIANCE COMMITTEE CHAIR AND THE HUMAN RESOURCES COMMITTEE CHAIR. THE ECEC IS GOVERNED BY A CHARTER AND MEETS REGULARLY. RESOURCES USED BY THE ECEC INCLUDE MARKET SURVEYS AVAILABLE THROUGH HEALTHCARE, LONG-TERM CARE, HOSPICE AND HOME HEALTH DATA COLLECTION CLEARINGHOUSES, CONSULTANTS SUCH AS AON HEWITT AND OTHER AVAILABLE RESOURCES THAT ARE IN COMPLIANCE WITH ANTI-TRUST REGULATIONS. DECISIONS INVOLVING EXECUTIVE LEADERSHIP PAY IS DISCUSSED AND APPROVED DURING EXECUTIVE SESSIONS OF THE OHIO LIVING PARENT BOARD MEETINGS. THIS PROCESS IS UPDATED ANNUALLY AND REVIEWED THROUGHOUT THE YEAR DURING QUARTERLY MEETINGS. THE CEO, EXECUTIVE OFFICERS AND KEY EMPLOYEES ARE PAID FROM AND RECEIVE W-2'S FROM OHIO LIVING, AND ARE SUBJECT TO THE ABOVE PROCESS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: BOOK ENTRY TO CLOSE OUT CUMULATIVE INTERCOMPANY ACCOUNTS TO NET ASSETS 5,041,796. NON OPERATING EXPENSE -61. LOSS ON NURSING BED VALUE IMPAIRMENT -73,765. FORM 990, PAGE 1, LINE J: HTTPS://WWW.OHIOLIVING.ORG/COMMUNITIES/OHIO-LIVING-SARAH-MOORE/ OHIO LIVING FOUNDATION 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 311166164 SUPPORT OH 501(C)(3) LINE 12C, III-FI OHIO LIVING 1 OHIO LIVING 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 311340918 SUPPORT/PARENT OH 501(C)(3) LINE 12C, III-FI N/A 0 VINEYARD CONDOMINIUM ASSOCIATION 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 262702410 MANAGEMENT OH 501(C)(4) N/A OHIO LIVING COMMUNITIES 1 OHIO LIVING HOLDINGS 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 272564811 ADULT CARE OH 501(C)(3) LINE 11 OHIO LIVING 1 OHIO LIVING COMMUNITIES 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 344429863 ADULT CARE OH 501(C)(3) LINE 11 OHIO LIVING 1 OPRS DEVELOPMENT CORP 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 311166160 INACTIVE OH N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1