2017-11-14T13:23:14-06:00 2016-12-31 381357951 PLANTE & MORAN PLLC 250 S High St Suite 100 Columbus OH 43215 990 2016-01-01 311345871 JEWISH HOME OF CINCINNATI INC JEWI 5137543100 5467 CEDAR VILLAGE DRIVE MASON OH 45040 DAN FAGIN CEO 5137543100 2017-11-14 1 Bernie Ostrowski P00366367 6148493000 2017-11-07 67.59.56.32 2017-11-14 08:16:09 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 F51046F0BD5714FDBFEEE435C204D6AFFC186FF5 2016 2017-02-10 21:41:12Z CEDAR VILLAGE DAN FAGIN 5467 CEDAR VILLAGE DRIVE MASON OH 45040 23838876 0 X WWW.CEDARVILLAGE.ORG X 1997 OH CEDAR VILLAGE PROVIDES RESIDENTS OF THE GREATER CINCINNATI COMMUNITY WITH THE HIGHEST QUALITY HEALTHCARE, SENIOR RESIDENTIAL AND COMMUNITY SERVICES, IN KEEPING WITH JEWISH VALUES. THE MISSION OF CEDAR VILLAGE IS THAT AGING WILL BE AN ENRICHING AND A FULFILLING EXPERIENCE. 26 26 591 190 0 0 0 0 24999906 23834624 -6127 -83734 3907 4214 24997686 23755104 0 0 0 0 16831897 16278571 0 0 0 11770869 12327711 28602766 28606282 -3605080 -4851178 30917009 29452948 18701602 19147530 12215407 10305418 X CEDAR VILLAGE PROVIDES RESIDENTS OF THE GREATER CINCINNATI COMMUNITY WITH THE HIGHEST QUALITY HEALTHCARE, SENIOR RESIDENTIAL AND COMMUNITY SERVICES, IN KEEPING WITH JEWISH VALUES. THE MISSION OF CEDAR VILLAGE IS THAT AGING WILL BE AN ENRICHING AND A FULFILLING EXPERIENCE. 0 0 20747912 0 20844989 OPERATION OF A 162 BED MEDICARE/MEDICAID LICENSED NURSING FACILITY AND A 172 BED LICENSED RESIDENTIAL FACILITY 1861753 0 2071309 OPERATION OF CEDAR VILLAGE HOME CARE, A NON-MEDICAL PRIVATE DUTY AIDE SERVICE 363890 0 542509 OPERATION OF HOSPICE 451059 0 375808 OPERATION OF CERTIFIED HOME HEALTH 451059 0 375808 23424614 1 0 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 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 1 1 0 0 1 55 0 1 591 1 0 0 0 0 0 0 0 0 X 26 26 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X VALERIE HOADLEY 5137543100 5467 CEDAR VILLAGE DRIVE MASON OH 45040 BARB REED CHAIR 5.00 0.00 X X 0 0 0 BOBBY FISHER VICE CHAIR/BOARD MEMBER 1.50 0.00 X X 0 0 0 BOB ROSEN TREASURER/IMMEDIATE PAST CHAIR 3.00 0.00 X X 0 0 0 JIM ELLIS ASST TREASURER/SECRETARY 2.00 0.00 X X 0 0 0 MERRIE STILLPASS BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL KADETZ ASST TREASURER 1.00 0.00 X X 0 0 0 RACHEL SCHILD ASST SECRETARY 1.50 0.00 X X 0 0 0 ALTER PEERLESS MD BOARD MEMBER (END MAY 2016) 1.00 0.00 X 0 0 0 BOB APPLEBAUM BOARD MEMBER 1.00 0.00 X 0 0 0 ANDREW SHOTT BOARD MEMBER 3.00 2.00 X 0 0 0 JAY PRICE BOARD MEMBER 2.00 2.00 X 0 0 0 JOSH SHAPIRO BOARD MEMBER 1.00 0.00 X 0 0 0 KEN COHEN BOARD MEMBER 1.00 0.00 X 0 0 0 MARK MOSKOWITZ BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL KRINER BOARD MEMBER 1.00 0.00 X 0 0 0 PATTI HELDMAN SECRETARY 1.50 0.00 X X 0 0 0 PAULA JARNICKI BOARD MEMBER 1.00 0.00 X 0 0 0 RICHARD GOLDFARB MD BOARD MEMBER 1.00 0.00 X 0 0 0 STEVE GUTTER BOARD MEMBER 1.00 0.00 X 0 0 0 GARY BLACHMAN BOARD MEMBER/VICE CHAIR 1.00 0.00 X 0 0 0 STEVEN PERLMAN MD BOARD MEMBER 1.00 0.00 X 0 0 0 BETSY RABKIN MD BOARD MEMBER 1.00 0.00 X 0 0 0 ORLY RUMBERG BOARD MEMBER 1.00 0.00 X 0 0 0 CAROL LESHNER BOARD MEMBER 1.00 0.00 X 0 0 0 DIANA STEWART BOARD MEMBER 1.00 0.00 X 0 0 0 MIKE KATCHMAN BOARD MEMBER 1.00 0.00 X 0 0 0 OSCAR JARNICKI BOARD MEMBER 1.00 0.00 X 0 0 0 JAN WOOLES CFO 40.00 10.00 X 184018 0 11275 DAN FAGIN CEO 40.00 10.00 X 264712 0 10069 LINTON SHARPNACK COO (UNTIL 2/15) 40.00 0.00 X 81346 0 1897 EVA SPIEGEL DIRECTOR OF NURSING 40.00 0.00 X 113602 0 0 LIZ VOGEL DIRECTOR OF MARKETING 40.00 0.00 X 106433 0 0 MIKE MOBLEY COO (AFTER 2/15) 40.00 0.00 X 141477 0 5749 891588 0 28990 5 0 1 0 UNIDINE 1000 WASHINGTON STREET BOSTON MA 02118 DINING SERVICES 2974912 OMNICARE PO BOX 78000 DETROIT MI 48278 PHARMACY 606037 ENERVISE 10 KNOWLCREST DR CINCINNATI OH 45237 ENGINEERING SERVICES 481735 RAY ST CLAIR ROOFING 3810 PORT UNION RD FAIRFIELD OH 45014 CONSTRUCTION 288327 MCKESSON PO BOX 630693 CINCINNATI OH 45263 MEDICAL SUPPLIES 273080 11 RESIDENT REVENUE 623000 23658600 23658600 JOINT VENTURE REVENUE 623000 123292 123292 BARBER & BEAUTY SHOP 623000 52732 52732 23834624 38 38 83772 -83772 -83772 -83772 STORE REVENUE 446199 4214 4214 4214 23755104 23834624 0 -79520 756403 113681 642722 12248781 10270066 1978715 235268 188214 47054 2222585 1778068 444517 815534 652427 163107 60668 60668 57117 57117 103735 103735 1689648 817588 872060 139307 124288 15019 1917518 1721216 196302 258459 196429 62030 1047194 900587 146607 65619 25597 40022 15628 15628 301084 258932 42152 1893992 1628833 265159 161476 145328 16148 Dietary Contract 3104527 3091621 12906 BAD DEBTS 785645 785645 FRANCHISE TAXES 726094 726094 28606282 23424614 5181668 0 1400 1400 1210549 1143869 3228916 2698544 100036 103448 289458 174610 46773257 21519018 25906435 25254239 180215 76838 30917009 29452948 3876923 4480010 12325000 12325000 2019728 2006980 479951 335540 18701602 19147530 X 12215407 10305418 12215407 10305418 30917009 29452948 X -4851178 2941189 X X 0 1 X 1 0 X 21460400 23438841 24235086 24998518 23834615 117967460 21460400 23438841 24235086 24998518 23834615 117967460 0 0 0 117967460 651 296405 522 -112 38 297504 651 296405 522 -112 38 297504 2691 19067 2120 23878 69655 -396061 483213 3907 4214 164928 21533397 23358252 24720941 25002313 23838867 118453770 0.99590 0.99410 0.00250 0.00380 X 0 0 0 0 0 0 0 0 1 1812 1812 0 Part II-B, Line 1: $19,914 OF DUES WERE PAID IN 2016 TO LEADING AGE OHIO, $1,812 OF WHICH ARE RELATED TO LOBBYING ACTIVITIES. 6311697 212355 230033 16965 6277054 6755934 -135124 301684 7429 6311697 6845046 176785 259360 6537 6755934 6651992 487160 280048 14058 6845046 6519200 252270 649541 761521 7498 6651992 0.00000 0.84700 0.15300 0 1 1 490667 490667 39131055 17310934 21820121 31216 7895 23321 5590485 3494255 2096230 1529834 705934 823900 25254239 INTEREST RATE SWAP 335540 335540 Part V, Line 4: ENDOWMENTS WERE TRANSFERRED TO CEDAR VILLAGE FOUNDATION DURING 2011. X 1 1 X X X 0 0 0 0 0 0 0 1 0 JAN WOOLES CFO 183768 0 0 0 250 0 0 0 11275 0 195293 0 0 0 DAN FAGIN CEO 261700 0 0 0 3012 0 0 0 10069 0 274781 0 0 0 Part I, Line 1a DAN FAGIN, CEO RECEIVES $46.15 A PAY PERIOD FOR DUES AT THE JCC. THIS IS TREATED AS TAXABLE COMPENSATION. Part I, Line 7 THE CEO'S BONUS IS DETERMINED BASED UPON HAVING MET GOALS WHICH ARE ESTABLISHED AT THE BEGINNING OF THE YEAR. THE AMOUNT OF THE BONUS IS DETERMINED ONCE THE GOALS ARE ACHIEVED AND FINANCIAL RESULTS ARE FINALIZED. A CITY OF MASON 316001070 2010-07-23 12325000 ECONOMIC DEVELOPMENT REVENUE AND REFUNDING REVENUE BONDS 0 0 0 A 12325000 240000 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 1 0 0 0 0 A 0 Form 990, Part VI, Section B, line 11b THE CONTROLLER REVIEWS THE FORM 990 AND DISTRIBUTES AN ELECTRONIC COPY OF THE FORM TO ALL BOARD MEMBERS VIA E-MAIL PRIOR TO FILING. Form 990, Part VI, Section B, line 12c THE CONFLICT OF INTEREST POLICY COVERS ALL MEMBERS OF THE GOVERNING BODY. BOARD MEMBERS ARE REQUIRED TO SIGN CONFLICT OF INTEREST STATEMENTS ANNUALLY. NEW BOARD MEMBERS COMPLETE A CONFLICT OF INTEREST STATEMENT WHEN THEY FIRST JOIN. BOARD MEMBERS ARE FULLY AWARE TO DISCLOSE CONFLICTS WHEN THEY INITIALLY ARISE. THE CEO ROUTINELY REVIEWS RELATIONSHIPS FOR CONFLICTS OF INTEREST AND RESEARCHES AND ADDRESSES ANY POTENTIAL CONFLICTS. POTENTIAL CONFLICTS MUST BE DISCLOSED TO THE CEO. PROTECTIVE STEPS TAKEN IN THE CASE OF A CONFLICT OF INTEREST INCLUDE REQUIRING THE INDIVIDUAL TO REFRAIN FROM BEING INVOLVED IN ANY RELATED DECISIONS MADE BY CEDAR VILLAGE OR TO ELIMINATE THE CONFLICT OF INTEREST BY DISPOSING OF THEIR INTEREST IN THE OTHER PARTY. Form 990, Part VI, Section B, line 15 CEO COMPENSATION IS SET BY THE COMPENSATION COMMITTEE OF THE BOARD USING THE AJAS AND OTHER SALARY SURVEYS. THE PROCESS IS COMPLETED AND DOCUMENTED ANNUALLY IN THE COMPENSATION COMMITTEE MEETING MINUTES. OTHER KEY EMPLOYEES' SALARIES ARE SET BY THE CEO, WHO WAS DELEGATED THIS AUTHORITY BY THE BOARD AND WHO IS INDEPENDENT RELATED TO THESE COMPENSATION ARRANGEMENTS. LEADING AGE SALARY SURVEYS AND OTHERS ARE USED BY THE HUMAN RESOURCES DEPARTMENT IN ORDER TO DETERMINE INDUSTRY COMPENSATION. THE LAST CEO COMPENSATION PROCESS WAS COMPLETED IN 2015, WITH THE ASSISTANCE OF A RECRUITING FIRM, WHEN THE CEO WAS HIRED. Form 990, Part VI, Section C, line 19 THE GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part XI, line 9: CHANGE IN MARKET VALUE OF SWAP AGREEMENT 144,411. TRANSFERS TO/FROM CEDAR VILLAGE FOUNDATION 2,796,778. FORM 990, PART XII, LINE 2C: AS IN PRIOR YEARS, THE FINANCE COMMITTEE PERFORMED THE FUNCTIONS OF AN AUDIT COMMITTEE. CEDAR VILLAGE FOUNDATION 5467 CEDAR VILLAGE DR MASON OH 45040 272598846 RELATED PARTY SUPPORT THROUGH INVESTMENT MANAGEMENT AND FUNDRAISING OH 501(c)(3) Line 12a, I JEWISH HOME OF CINCINNATI INC 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 CEDAR VILLAGE FOUNDATION S 2796787 FMV CEDAR VILLAGE FOUNDATION Q 247166 PAYROLL ALLOCATION CEDAR VILLAGE FOUNDATION L 67463 PAYROLL ALLOCATION CEDAR VILLAGE FOUNDATION A 3600 RENTAL CONTRACT