2017-05-11T15:30:14-05:00 2016-06-30 381357951 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2015-07-01 311510768 SARAH MOORE HEALTH CARE CENTER INC SARA 7403629641 26 N UNION STREET DELAWARE OH 43015 ROBERT B STILLMAN CFO/TREASURER 7403629641 2017-05-09 1 BERNIE OSTROWSKI P00366367 6148493000 2017-05-09 2015 2021-01-29 14:40:06Z LAURENCE C GUMINA 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 4891984 0 X WWW.SARAHMOOREHOME.COM X 1997 OH SARAH MOORE HEALTH CENTER, INC. OPERATES A 32 BED SKILLED NURSING HOME FACILITY AND A 53 BED ASSISTED LIVING FACILITY. 6 4 163 9 0 0 0 0 2220098 4829433 4391 62551 30 0 2224519 4891984 0 0 0 0 1376277 3081864 0 0 0 1110897 2414101 2487174 5495965 -262655 -603981 9518161 9616131 9352370 9601058 165791 15073 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 5041416 0 4829433 PROVIDED SKILLED CARE AND ASSISTED LIVING. 5041416 1 0 0 0 0 0 0 0 0 0 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 0 0 163 1 0 0 0 0 0 0 0 0 0 0 X 6 4 0 0 1 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 455944 29738 DANIEL O'CONNOR CHIEF OPERATING OFFICER 1.00 39.00 X X 0 327753 21822 FREDERICK C SMITH III BOARD CHAIR 2.00 4.00 X X 0 0 0 KATHLEEN TUTTLE BOARD VICE CHAIR 2.00 4.00 X X 0 0 0 RICHARD LOWERY BOARD ASST. TREASURER 2.00 4.00 X X 0 0 0 DONALD G CHENOWETH BOARD ASST. SECRETARY 2.00 2.00 X X 0 0 0 ROBERT STILLMAN CHIEF FINANCIAL OFFICER/TREASURER 1.00 39.00 X 0 282631 19325 DANA ULLOM-VUCELICH CHIEF HUMAN RESOURCES OFFICER 1.00 39.00 X 0 228473 30217 JOYCE MILLER CHIEF INFORMATION OFFICER 1.00 39.00 X 0 199075 26429 CONNIE TOSTEVIN CHIEF NURSING OFFICER 1.00 39.00 X 0 191002 18660 KENNETH KEMPER CORP EXEC PROJECT DEVELOPMENT 1.00 39.00 X 0 276084 29826 MARY C MCKENZIE CORP EXEC OF COMMUNICATIONS 1.00 39.00 X 0 165158 15262 DANIEL HOLSTEIN CORPORATE EXECUTIVE OF FINANCE 1.00 39.00 X 0 137324 24633 WILLIAM RENNER CORP EXEC OF OPERATIONAL PLANNING 1.00 39.00 X 0 125216 27611 MARION RICHARDSON CORP EXEC-COMPLIANCE/HIPPA PRIVACY 1.00 39.00 X 0 123130 20832 0 2511790 264355 0 0 1 0 0 NURSING HOME/ASSISTED 623000 4829433 4829433 4829433 62551 62551 4891984 4829433 0 62551 45777 45777 2483770 2340253 143517 355483 338077 17406 196834 182192 14642 6330 6330 6783 6783 439352 439352 53716 53716 149027 38637 110390 19981 19981 372309 372309 10604 10604 5222 5222 304416 304416 317738 317738 20181 20181 FOOD 251468 251468 MEDICAL SUPPLIES 219096 219096 BOND FEES 165851 165851 BAD DEBT 60683 60683 11344 11344 5495965 5041416 454549 0 353921 488960 217281 284382 28179 37529 6919925 546219 6565762 6373706 1273712 1243918 879841 987645 199465 199991 9518161 9616131 401187 408789 0 4594 7610000 7355000 1341183 1832675 9352370 9601058 X 165791 15073 165791 15073 9518161 9616131 X -603981 -96211 549474 X 0 1 X 1 0 X 34641 3424 2217 40282 4716993 4464296 4988554 2220098 4829433 21219374 4751634 4467720 4990771 2220098 4829433 21259656 0 0 0 21259656 18810 56627 20445 4391 62551 162824 18810 56627 20445 4391 62551 162824 30 30 4770444 4524347 5011216 2224519 4891984 21422510 0.99240 0.99410 0.00760 0.00590 X 258860 258860 6116387 416506 5699881 465740 121219 344521 78938 8494 70444 6373706 INTEREST RATE SWAP LIABILITY 1832675 1832675 0 0 0 0 0 0 0 0 0 LAURENCE C GUMINA CHIEF EXECUTIVE OFFICER 0 405664 0 50000 0 280 0 10587 0 19151 0 485682 0 0 DANIEL O'CONNOR CHIEF OPERATING OFFICER 0 278919 0 30000 0 18834 0 10600 0 11222 0 349575 0 0 ROBERT STILLMAN CHIEF FINANCIAL OFFICER/TREASURER 0 257351 0 25000 0 280 0 0 0 19325 0 301956 0 0 DANA ULLOM-VUCELICH CHIEF HUMAN RESOURCES OFFICER 0 213043 0 15000 0 430 0 9392 0 20825 0 258690 0 0 JOYCE MILLER CHIEF INFORMATION OFFICER 0 198301 0 0 0 774 0 8280 0 18149 0 225504 0 0 CONNIE TOSTEVIN CHIEF NURSING OFFICER 0 174901 0 15000 0 1101 0 7767 0 10893 0 209662 0 0 KENNETH KEMPER CORP EXEC PROJECT DEVELOPMENT 0 273798 0 0 0 2286 0 10600 0 19226 0 305910 0 0 MARY C MCKENZIE CORP EXEC OF COMMUNICATIONS 0 163344 0 0 0 1814 0 6363 0 8899 0 180420 0 0 DANIEL HOLSTEIN CORPORATE EXECUTIVE OF FINANCE 0 132875 0 4000 0 449 0 5782 0 18851 0 161957 0 0 WILLIAM RENNER CORP EXEC OF OPERATIONAL PLANNING 0 125072 0 0 0 144 0 5340 0 22271 0 152827 0 0 A COUNTY OF DELAWAREOHIO 316400065 245872AH9 2007-09-13 8905000 REFURBISH/ADD BEDS; REFINANCE PRIOR BONDS 0 0 0 A 1550000 8905000 167617 148895 5648488 2940000 2009 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 1 MORGAN STANLEY CAP 25.000000000000 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: COUNTY OF DELAWARE,OHIO DATE THE REBATE COMPUTATION WAS PERFORMED: 05/02/2013 FORM 990, PART VI, SECTION A, LINE 4 THE BOARD STRUCTURE WAS AMENDED IN AN EFFORT TO ENABLE MORE EFFICIENT GOVERNANCE BY ELIMINATING CERTAIN DUPLICATION OF EFFORTS. ACCORDINGLY, THE MINIMUM NUMBER OF BOARD MEMBERS WAS DECREASED AND AMENDED TO REFLECT AS SUCH IN THE GOVERNING DOCUMENTS. 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 11 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 (EXCLUDING THE FOUNDATION PRESIDENT), AND KEY EMPLOYEES ARE PAID FROM AND RECEIVE W-2'S FROM OHIO LIVING COMMUNITIES, 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: CHANGE IN FAIR VALUE OF SWAP AGREEMENT -491,492. BOOK ENTRY TO CLOSE OUT CUMULATIVE INTERCOMPANY ACCOUNTS TO NET ASSETS 1,040,966. OHIO LIVING FOUNDATION 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 311166164 SUPPORT OH 501(C)(3) LINE 11B, II OHIO LIVING 1 OHIO LIVING 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 311340918 SUPPORT/PARENT OH 501(C)(3) LINE 11B, II 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 9 OHIO LIVING 1 OHIO LIVING COMMUNITIES 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 344429863 ADULT CARE OH 501(C)(3) LINE 9 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 0 0 1 1 1 OHIO LIVING COMMUNITIES Q 2188205 CASH TRANSFER OHIO LIVING COMMUNITIES R 4657614 CASH TRANSFER OHIO LIVING COMMUNITIES S 300000 CASH TRANSFER OHIO LIVING COMMUNITIES O 2554064 CASH TRANSFER