2016-11-14T10:24:43-06:00 2015-12-31 381357951 PLANTE & MORAN PLLC 250 S High St Suite 100 Columbus OH 43215 990 2015-01-01 311345871 JEWISH HOME OF CINCINNATI INC JEWI 5137543100 5467 CEDAR VILLAGE DRIVE MASON OH 45040 DAN FAGIN CEO 5137543100 2016-11-11 1 Bernie Ostrowski P00366367 6148493000 2015 2017-02-10 21:41:12Z CEDAR VILLAGE DAN FAGIN 5467 CEDAR VILLAGE DRIVE MASON OH 45040 25003701 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. 24 24 543 200 0 0 0 0 24236717 24999906 -4876 -6127 485333 3907 24717174 24997686 0 0 0 0 15634726 16831897 0 0 0 10819306 11770869 26454032 28602766 -1736858 -3605080 31304345 30917009 17675409 18701602 13628936 12215407 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. 1 0 20530527 0 21650980 OPERATION OF A 162 BED MEDICARE/MEDICAID LICENSED NURSING FACILITY AND A 172 BED LICENSED RESIDENTIAL FACILITY 1821454 0 1944342 OPERATION OF CEDAR VILLAGE HOME CARE, A NON-MEDICAL PRIVATE DUTY AIDE SERVICE 706120 0 899516 OPERATION OF HOSPICE 487203 0 505068 OPERATION OF CERTIFIED HOME HEALTH 487203 0 505068 23545304 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 62 0 1 543 1 0 0 0 0 0 0 0 0 X 24 24 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X JAN WOOLES 5137543100 5467 CEDAR VILLAGE DRIVE MASON OH 45040 BARB REED CHAIR 5.00 0.00 X X 0 0 0 BOBBY FISHER VICE CHAIR 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 BOARD MEMBER/SECRETARY (MAY 2015) 2.00 0.00 X X 0 0 0 MERRIE STILLPASS BOARD MEMBER/SECRETARY (END MAY 2015) 1.00 0.00 X X 0 0 0 MICHAEL KADETZ ASST TREASURER 1.00 0.00 X X 0 0 0 RACHEL SCHILD ASST SECRETARY 1.00 0.00 X X 0 0 0 ALTER PEERLESS MD BOARD MEMBER 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 BOARD MEMBER 1.00 0.00 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 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 JAN FRANKEL BOARD MEMBER (END MAY 2015) 1.00 1.00 X 0 0 0 JAN WOOLES CFO 40.00 10.00 X 173860 0 18359 LINTON SHARPNACK COO/INTERIM CEO (END JUNE 2015) 40.00 10.00 X 160017 0 27538 DAN FAGIN CEO (JUNE 2015) 40.00 10.00 X 139440 0 5953 JANET BOWLING DIRECTOR OF NURSING 40.00 0.00 X 117577 0 0 590894 0 51850 4 0 1 0 UNIDINE 1000 WASHINGTON STREET BOSTON MA 02118 DINING SERVICES 2908596 ENERVISE 10 KNOWLCREST DR CINCINNATI OH 45237 ENGINEERING SERVICES 487667 TURNBULL WAHLERT 5533 FAIR LANE CINCINNATI OH 45227 CONSTRUCTION SERVICES 233788 NURSE STAFFING OF CINCINNATI PO BOX 4729 WINTER PARK FL 327924729 STAFFING AGENCY 167009 DEDICATED NURSING ASSOCIATES INC 3875 FRANKLINTOWNE CT MURRYSVILLE PA 15668 STAFFING AGENCY 162403 7 RESIDENT REVENUE 623000 24945725 24945725 BARBER & BEAUTY SHOP 623000 54181 54181 24999906 -112 -112 6015 -6015 -6015 -6015 STORE REVENUE 446199 3907 3907 3907 24997686 24999906 0 -2220 599202 599202 12301949 10431690 1870259 225898 182977 42921 2786969 2257445 529524 917879 743482 174397 91943 91943 35692 35692 51673 51673 1535223 731061 804162 118399 114556 3843 1945552 1711552 234000 218468 166036 52432 1076087 925435 150652 105842 41942 63900 30739 30739 292183 251277 40906 1841780 1583931 257849 157900 142110 15790 DIETARY CONTRACT 3066738 3059160 7578 BED TAX 713983 713983 BAD DEBTS 488667 488667 28602766 23545304 5057462 0 1400 1400 914592 1210549 3115502 3228916 86307 100036 424689 289458 45800002 19893567 26552122 25906435 209733 180215 31304345 30917009 3276182 3876923 12325000 12325000 1519728 2019728 554499 479951 17675409 18701602 X 13628936 12215407 13628936 12215407 31304345 30917009 X -3605080 2191551 X X 0 1 X 1 0 X 354567 354567 20147829 21460400 24438841 24235086 24998518 115280674 20502396 21460400 24438841 24235086 24998518 115635241 0 0 0 115635241 143765 651 296405 522 -112 441231 143765 651 296405 522 -112 441231 238 2691 19067 2120 0 24116 61144 69655 -396061 483213 3907 221858 20707543 21533397 24358252 24720941 25002313 116322446 0.99410 0.98680 0.00380 0.01020 X 0 0 0 0 0 0 0 0 1 1780 1780 0 Part II-B, Line 1: $19,556 OF DUES WERE PAID IN 2015 TO LEADING AGE OHIO, $1,780 OF WHICH ARE RELATED TO LOBBYING ACTIVITIES. 6755934 -135124 301684 7429 6311697 6845046 176785 259360 6537 6755934 6651992 487160 280048 14058 6845046 6519200 252270 649541 761521 7498 6651992 5357001 94022 1070977 2800 6519200 0.00000 0.83100 0.16900 0 1 1 490667 490667 38487207 15931886 22555321 31216 5748 25468 4767790 3356679 1411111 2023122 599254 1423868 25906435 INTEREST RATE SWAP 479951 479951 Part V, Line 4: ENDOWMENTS WERE TRANSFERRED TO CEDAR VILLAGE FOUNDATION DURING 2011. X 1 1 X X X X 0 0 0 0 0 0 0 1 0 JAN WOOLES CFO 173610 0 0 0 250 0 0 0 18359 0 192219 0 0 0 LINTON SHARPNACK COO/INTERIM CEO (END JUNE 2015) 159767 0 0 0 250 0 0 0 27538 0 187555 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 III, line 2 A CERTIFIED HOME HEALTH DIVISION WAS STARTED ON DECEMBER 26, 2014. Form 990, Part VI, Section B, line 11 THE CFO 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 74,548. TRANSFERS TO/FROM CEDAR VILLAGE FOUNDATION 2,117,003. 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 11a, 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 2117003 FMV CEDAR VILLAGE FOUNDATION Q 199343 PAYROLL ALLOCATION CEDAR VILLAGE FOUNDATION L 73495 PAYROLL ALLOCATION CEDAR VILLAGE FOUNDATION A 3600 RENTAL CONTRACT