2016-10-17T11:05:08-05:00 2015-12-31 341630230 RW CORWIN & COMPANY INC PO BOX 6901218 HIGH STREET WADSWORTH OH 442820690 990 2015-01-01 310641121 WIDOWS HOME OF DAYTON OHIO WIDO 9372521661 50 SOUTH FINDLAY STREET DAYTON OH 45403 KEITH VALIQUETTE PRESIDENT 9372521661 2016-09-30 1 RW CORWIN COMPANY INC P01209087 3303361004 2016-09-30 2015 2017-02-10 21:41:12Z KEITH VALIQUETTE 50 SOUTH FINDLAY STREET DAYTON OH 45403 6322642 0 X WWW.WIDOWSHOME.ORG X 1961 OH THE PURPOSE OF THE WIDOWS HOME IS TO PROVIDE LONG-TERM CARE SERVICES TO ELDERLY INDIVIDUALS. 10 10 160 63 0 0 461959 42452 6153676 6088203 69052 54009 -221 1077 6684466 6185741 0 0 0 0 2627589 2594776 0 0 0 3879352 3659516 6506941 6254292 177525 -68551 8611278 8192367 4382359 4121440 4228919 4070927 THE PURPOSE OF THE WIDOWS HOME IS TO PROVIDE LONG-TERM CARE SERVICES TO ELDERLY INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. 0 0 6254292 6143289 THE WIDOWS HOME OF DAYTON, OHIO PROVIDES LONG-TERM NURSING AND RESIDENTIAL CARE, SHORT-TERM REHABILITATION, AND ADULT DAY PROGRAMS TO ELDERLY INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE HOME IS AN INNER-CITY FACILITY WITH 75 LICENSED BEDS. 6254292 1 1 0 0 0 1 0 0 1 0 1 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 22 0 160 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 1 0 0 0 OH X THE ORGANIZATION 9372521661 50 S FINDLAY STREET DAYTON OH 45403 X KEITH VALIQUETTE PRESIDENT 0.50 X X 0 0 0 LINDA ROEPKEN VICE PRESIDENT 0.50 X X 0 0 0 JANE CLIFTON SECRETARY 0.50 X X 0 0 0 ELIZABETH WARDECKE TREASURER 0.50 X X 0 0 0 ROBERT PROPHATER BOARD MEMBER 0.50 X 0 0 0 MARILYN HOBACK BOARD MEMBER 0.50 X 0 0 0 NANCY HINES BOARD MEMBER 0.50 X 0 0 0 JEFF SORRELL BOARD MEMBER 0.50 X 0 0 0 TIMOTHY P BETE BOARD MEMBER 0.50 X 0 0 0 KIMBERLY ANDREWS BOARD MEMBER 0.50 X 0 0 0 0 0 0 0 0 0 0 CHS THERAPY 7261 ENGLE ROAD MIDDLEBURG HEIGHTS OH 44130 THERAPY SERVICES 487235 ALPHA-OMEGA 6276 PLATTSBURGH RD SOUTH CHARLESTON OH 45368 THERAPY SERVICES 163292 2 660 41792 42452 ROOM AND BOARD 623000 5395929 5395929 ANCILLARY REVENUE 623000 2276925 2276925 ADDITIONAL REVENUE 623000 17249 17249 CONTRACTUAL ALLOWANCES 623000 -1601900 -1601900 6088203 60256 60256 130654 136901 -6247 -6247 -6247 PASSTHROUGH FROM K-1 900099 1077 1077 1077 6185741 6143289 0 0 X 2176369 2176369 226435 226435 191972 191972 110000 110000 14493 14493 14500 14500 54399 54399 12081 12081 11756 11756 546 546 166042 166042 360811 360811 85081 85081 DIRECT CARE THERAPIES 700640 700640 TAXES 335310 335310 DIETARY/FOOD 281595 281595 BAD DEBT EXPENSE 275185 275185 1237077 1237077 6254292 6254292 0 0 460458 330367 108520 639252 829243 165774 41015 10790342 5677283 5264707 5113059 1247022 1152430 753410 613399 80655 4334 8611278 8192367 423837 435299 3603700 3405600 12316 13645 342506 266896 4382359 4121440 X 4043458 4070307 185461 620 4228919 4070927 8611278 8192367 X -68551 -108289 16725 2123 X 0 0 0 X 486602 42452 529054 5689985 5432762 5719309 6153676 6088202 29083934 5689985 5432762 5719309 6640278 6130654 29612988 0 0 0 29612988 49778 20741 69052 66784 206355 49778 20741 69052 66784 206355 72089 -221 1077 72945 5739763 5453503 5791398 6709109 6198515 29892288 0.99070 0.99110 0.00690 0.00640 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2 660 660 0 0 0 0 12316 1329 13645 1 X 131650 131650 8027073 4075435 3951638 514531 152703 361828 1350492 1100312 250180 766596 348833 417763 5113059 DODGE AND COX INCOME 156696 F HOTCHKIS & WILEY FUNDS 49905 F ISHARES S&P PREFERRED STOCK INDEX FUND 19425 F OPPENHEIMER INTL BOND FUND 25622 F TCW FDS INC 40666 F AMERICAN CENTURY MID CAP VALUE 78872 F GUGGENHEIM FRONTIER MARKETS EFT 12722 F EUROPACIFIC GROWTH FUND 172275 F FIDELITY ADV NEW INSIGHTS 125359 F ISHARES TR SMALL CAP INDEX FUND 45704 F LAZARD EMERGING MARKETS PORT 93167 F MORGAN STANLEY FUND MIDCAP 85211 F T ROWE PRICE EQUITY INCOME FUND 135059 F T ROWE PRICE NEW HORIZON FUND 45510 F ROYCE FUND 48620 F WISDOM TRUST EMG MARKETS SMALL CAP 15882 F ANDARKO PETROLEUM 291 F CISCO SYSTEMS 570 F EXPRESS SCRIPTS 874 F 1152430 BUCKEYE OVERPAYMENTS 61489 BONDS - INTEREST RATE SWAP VALUE 205407 266896 X 6219397 34733 34733 6184664 1077 1077 6185741 6254292 0 6254292 0 6254292 PART IV, LINE 2B: RESIDENT SAVINGS ACCOUNTS ARE HELD IN A SEPERATE BANK ACCOUNT. PART X, LINE 2: WIDOWS HOME OF DAYTON, OHIO IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOME IS NOT LONGER SUBJECT TO FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2012. PART XI, LINE 2D - OTHER ADJUSTMENTS: SWAP VALUATION 34,733. PART XI, LINE 4B - OTHER ADJUSTMENTS: CPAN 1,077. PART X LINE 25 BUCKEYE OVERPAYMENT $61,489 BOND INTEREST RATE SWAP VALUE $205,407 A CITY OF RIVERSIDE 316000133 2006-12-29 2500000 25 BED EXPANSION 0 0 0 A 2500000 2008 0 0 1 1 A 0 0 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 8B COMMITTEE MEETING MINUTES WERE NOT TAKEN. HOWEVER, THE DISCUSSIONS DURING COMMITTEE MEETINGS ARE REPORTED AT BOARD MEETINGS AND ARE DOCUMENTED IN THE BOARD MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WILL BE PROVIDED TO BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS PROVIDE SELF-DISCLOSURE OF CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 24E DRUGS/PHARMACY: PROGRAM SERVICE EXPENSES 220,496. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 220,496. MEDICAL SUPPLIES: PROGRAM SERVICE EXPENSES 138,777. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 138,777. REPAIRS/MAINTENANCE: PROGRAM SERVICE EXPENSES 135,455. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 135,455. UTILITIES: PROGRAM SERVICE EXPENSES 126,489. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 126,489. SEQUESTER REDUCTION: PROGRAM SERVICE EXPENSES 92,043. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 92,043. DEL MAR FOUNDATION GRANT EXPENSE: PROGRAM SERVICE EXPENSES 88,018. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 88,018. WORKERS' COMPENSATION: PROGRAM SERVICE EXPENSES 78,990. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 78,990. LEASED EQUIPMENT: PROGRAM SERVICE EXPENSES 52,758. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 52,758. RESTRICTED FUNDS - ENERGY UPGRADE EXPENSE: PROGRAM SERVICE EXPENSES 34,837. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 34,837. INCONTINENCE SUPPLIES: PROGRAM SERVICE EXPENSES 34,060. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 34,060. DATA SERVICES: PROGRAM SERVICE EXPENSES 30,205. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,205. HOUSEKEEPING SUPPLIES: PROGRAM SERVICE EXPENSES 22,963. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,963. AMBULANCE: PROGRAM SERVICE EXPENSES 20,038. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,038. PAYROLL PROCESSING FEES: PROGRAM SERVICE EXPENSES 18,316. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,316. TELEPHONE: PROGRAM SERVICE EXPENSES 16,458. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,458. MEDICAL MINOR EQUIPMENT: PROGRAM SERVICE EXPENSES 16,027. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,027. CABLE: PROGRAM SERVICE EXPENSES 13,449. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,449. PHYSICIAN: PROGRAM SERVICE EXPENSES 13,077. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,077. HOUSEKEEPING/TEMP: PROGRAM SERVICE EXPENSES 12,862. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,862. SUPPLIES: PROGRAM SERVICE EXPENSES 12,482. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,482. DUES, LICENSE & SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 12,278. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,278. PERSONAL CARE SUPPLIES: PROGRAM SERVICE EXPENSES 9,888. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,888. RESIDENT ACTIVITIES: PROGRAM SERVICE EXPENSES 6,939. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,939. PRE-EMPLOYMENT EXPENSES: PROGRAM SERVICE EXPENSES 4,648. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,648. TRAINING/SEMINARS: PROGRAM SERVICE EXPENSES 4,630. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,630. HOFFMAN FUND GRANT EXPENSE: PROGRAM SERVICE EXPENSES 4,600. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,600. DIETICIANS FEES: PROGRAM SERVICE EXPENSES 3,937. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,937. BANK SERVICE CHARGES: PROGRAM SERVICE EXPENSES 3,695. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,695. ADMIN: PROGRAM SERVICE EXPENSES 2,541. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,541. MEALS AND ENTERTAINMENT: PROGRAM SERVICE EXPENSES 2,118. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,118. CHARITABLE CONTRIBUTIONS: PROGRAM SERVICE EXPENSES 1,100. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,100. BEAUTY & BARBER SUPPLIES: PROGRAM SERVICE EXPENSES 928. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 928. RESTRICTED DONATIONS - ACTIVITIES EXPENSE: PROGRAM SERVICE EXPENSES 597. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 597. LEGACY OF LOVE GRANT EXPENSE: PROGRAM SERVICE EXPENSES 541. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 541. ANIMAL SUPPLIES: PROGRAM SERVICE EXPENSES 533. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 533. LABORATORY EXPENSE: PROGRAM SERVICE EXPENSES 234. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 234. LATE CHARGES: PROGRAM SERVICE EXPENSES 70. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 70. FORM 990, PART XI, LINE 9: PASSTHROUGH FROM K-1 1,077. CHANGE IN RESTRICTED NET ASSETS 1,046.