2016-05-13T14:39:38-05:00 2015-06-30 381357951 PLANTE & MORAN PLLC 65 E STATE STREET SUITE 600 COLUMBUS OH 43215 990 2014-07-01 272564811 SENIOR INDEPENDENCE SENI 6148887800 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 ROBERT B STILLMAN CFO/TREASURER 6148887800 2016-05-13 1 BERNIE OSTROWSKI P00366367 6148493000 2014 2016-08-17 19:52:53Z LAURENCE C GUMINA 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 39684493 0 X WWW.SENIORINDEPENDENCE.ORG X 2010 OH SENIOR INDEPENDENCE'S MISSION IS TO SERVE OLDER ADULTS WHO CHOOSE TO REMAIN HOME BY PROVIDING SERVICES THAT WILL HELP THEM LIVE SAFELY AND SUCCESSFULLY IN THEIR OWN HOMES, WHEREVER THAT HOME MAY BE. OUR MOST SIGNIFICANT ACTIVITIES INCLUDE PROVIDING HOME CARE, HOME HEALTH CARE, HOSPICE AND ADULT DAY CARE SERVICES. 11 10 796 134 0 0 0 0 39302168 39594966 0 0 156198 89527 39458366 39684493 0 0 0 0 28020081 27265151 0 0 0 17357854 19117073 45377935 46382224 -5919569 -6697731 11391127 9696372 2613804 2659508 8777323 7036864 X OUR MISSION IS TO EXTEND AND ENHANCE THE INDEPENDENCE AND WELL BEING OF OLDER ADULTS AND BUILD THE CAPACITY OF FAMILY MEMBERS, COMMUNITIES, AND ORGANIZATIONS TO CARE FOR THEM AT HOME. 0 0 22111110 0 20444136 HOME HEALTH CARE AND HOME CARE - SI OFFERS PARTICIPANTS HOME HEALTH CARE SERVICES INCLUDING SKILLED NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, HOME HEALTH AIDE, SOCIAL WORK SERVICES, AND MEDICINE ADMINISTRATION. SI ALSO OFFERS HOME CARE SERVICES INCLUDING PERSONAL CARE ASSISTANCE, TRANSPORTATION, LIGHT HOUSEKEEPING AND MEAL PREPARATION. 13693217 0 15872837 HOSPICE - SI DELIVERS HOSPICE CARE TO PATIENTS IN THEIR HOMES, IN THE HOME OF A FAMILY MEMBER, IN A RETIREMENT OR ASSISTED LIVING APARTMENT, IN A NURSING FACILITY, OR IN A HOSPICE CENTER. SI SPECIALIZES IN GERIATRIC CARE AND PROVIDES THE PATIENTS AND THEIR FAMILIES' PAIN MANAGEMENT, SYMPTOM CONTROL, COUNSELING, EDUCATION, BEREAVEMENT SUPPORT, AND SPIRITUAL SUPPORT. 2673811 0 1851044 ADULT DAY CENTERS - PARTICIPANTS MAY ENJOY A VARIETY OF ACTIVITIES AT SI-OPERATED FACILITIES. SERVICES INCLUDE TRANSPORTATION, ASSISTANCE WITH ACTIVITIES OF DAILY LIVING INCLUDING BATHING, NUTRITIOUS MEALS AND SNACKS, ARRANGEMENTS FOR THERAPIES, NURSING OBSERVATIONS, STIMULATING ACTIVITIES, AND INDIVIDUALIZED CARE PLAN. SI OPERATED EIGHT ADULT DAY CENTERS IN OHIO DURING FISCAL YEAR 2015. 1120803 0 1426949 OTHER - SERVICES INCLUDING SENIOR CENTER, TRANSPORTATION AND RESIDENT SERVICE COORDINATOR. 1120803 0 1426949 39598941 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 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 1 1 1 0 0 1 0 0 796 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OH X X ROBERT B STILLMAN 6148887800 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 LAURENCE C GUMINA PRESIDENT/CEO - OPRS 10.00 30.00 X X 0 453025 30809 RICHARD A KRIEGER DIRECTOR/ASSISTANT TREASURER 2.00 2.00 X X 0 0 0 JOHN A PETERSON DIRECTOR/CHAIR 2.00 2.00 X X 0 0 0 BARBARA E RILEY DIRECTOR/VICE CHAIR 2.00 2.00 X X 0 0 0 AMY J ROSCOE DIRECTOR/ASSISTANT SECRETARY 2.00 2.00 X X 0 0 0 SANDRA R BYERS DIRECTOR 2.00 0.00 X 0 0 0 DEBORAH D SAMPSEL DIRECTOR 2.00 0.00 X 0 0 0 DR WILLIAM THOMAS SCOTT DIRECTOR 2.00 0.00 X 0 0 0 STEVEN JOHNSTON DIRECTOR 2.00 2.00 X 0 0 0 ED SNELZ DIRECTOR 2.00 0.00 X 0 0 0 BRETT WINGART DIRECTOR 2.00 0.00 X 0 0 0 RICHARD BOYSON PRESIDENT SENIOR INDEPENDENCE (THRU MAY) 40.00 0.00 X 0 223190 23448 ROBERT STILLMAN TREASURER/CFO 10.00 30.00 X 0 280003 19576 DANIEL O'CONNOR COO/PRESIDENT - COMMUNITIES 19.00 21.00 X 0 313732 17205 JOYCE MILLER-EVANS VP - INFORMATION SYSTEMS 10.00 30.00 X 0 203206 29991 DANA ULLOM-VUCELICH VP - HUMAN RESOURCES 10.00 30.00 X 0 219659 34276 CONNIE TOSTEVIN VP OF NURSING AND CLINICAL SERVICES 10.00 30.00 X 0 163586 19862 WENDY KISER EXEC DIRECTOR - TOLEDO SI 40.00 0.00 X 0 129751 4397 DANIEL HOLSTEIN CORPORATE CONTROLLER 10.00 30.00 X 0 133871 26347 WILLIAM RENNER VP - OPERATIONAL PLANNING 5.00 35.00 X 0 131386 31387 CHERYLL HAFLETT PHYSICAL THERAPIST 40.00 0.00 X 0 146977 10217 ROGER WOHLWEND HOSPICE MEDICAL DIRECTOR - TOLEDO 40.00 0.00 X 0 194737 0 KENNETH KEMPER FORMER OFFICER 0.00 40.00 X 0 287478 35751 0 2880601 283266 0 1 1 0 PROGRESSIVE THERAPY PO BOX 611 HOLLAND OH 43528 THERAPY SERVICE 1811627 HOSPISCRIPT SERVICES LLC PO BOX 933273 ATLANTA GA 311933273 PHARMACY SERVICES 992339 HOMECARE HOMEBASE LLC 6688 N CENTRAL EXPRESSWAY SUITE 1 DALLAS TX 75206 SOFTWARE SERVICES 977790 THERAPY SUPPORT INC 2803 N OAK GROVE AVE SPRINGFIELD MO 658034976 THERAPY SERVICE 679265 DAYTON PHYSICAL THERAPY HOME CARE INC 7700 PARAGON RD SUITE C DAYTON OH 45459 THERAPY SERVICE 491640 19 PATIENT SERVICES 623000 39066097 39066097 ADMINISTRATIVE SERVICES 561000 528869 528869 39594966 MEALS 900099 89527 89527 89527 39684493 39594966 0 89527 X 769745 769745 21327553 19628482 1699071 280018 254765 25253 3267351 2979822 287529 1620484 1500484 120000 390348 390348 32422 32422 6191859 5096211 1095648 234395 218763 15632 1290295 1257707 32588 838953 838953 665560 425408 240152 1652751 1617751 35000 121078 121078 458563 188680 269883 207391 207391 BAD DEBT EXPENSE 2614444 2614444 MEDICAL SUPPLIES/DRUGS 2539914 2539914 ALLOCATED CORP OVERHEAD 1648934 1648934 COST OF FOOD 164208 164208 65958 65958 46382224 39598941 6783283 0 200 200 9547099 7291903 37464 65853 5090397 2836772 1779187 2253625 27177 84791 11391127 9696372 2613804 2639508 0 20000 2613804 2659508 X 8777323 7036864 8777323 7036864 11391127 9696372 X -6697731 4957272 X 0 1 X 1 0 X 335092 257044 592136 42166949 41657747 40697914 39302168 39594966 203419744 879537 682215 71453 156198 89527 1878930 43381578 42597006 40769367 39458366 39684493 205890810 0 0 0 205890810 43381578 42597006 40769367 39458366 39684493 205890810 X 935835 237134 698701 30563 26309 4254 3536367 2137031 1399336 587632 436298 151334 2253625 0 0 0 0 0 0 0 0 0 LAURENCE C GUMINA PRESIDENT/CEO - OPRS 0 402745 0 50000 0 280 0 11794 0 19015 0 483834 0 0 RICHARD BOYSON PRESIDENT SENIOR INDEPENDENCE (THRU MAY) 0 223003 0 0 0 187 0 2372 0 21076 0 246638 0 0 ROBERT STILLMAN TREASURER/CFO 0 259733 0 20000 0 270 0 0 0 19576 0 299579 0 0 DANIEL O'CONNOR COO/PRESIDENT - COMMUNITIES 0 282824 0 30000 0 908 0 16710 0 495 0 330937 0 0 JOYCE MILLER-EVANS VP - INFORMATION SYSTEMS 0 202406 0 0 0 800 0 10957 0 19034 0 233197 0 0 DANA ULLOM-VUCELICH VP - HUMAN RESOURCES 0 219229 0 0 0 430 0 13950 0 20326 0 253935 0 0 CONNIE TOSTEVIN VP OF NURSING AND CLINICAL SERVICES 0 162999 0 0 0 587 0 10984 0 8878 0 183448 0 0 DANIEL HOLSTEIN CORPORATE CONTROLLER 0 133439 0 0 0 432 0 9176 0 17171 0 160218 0 0 WILLIAM RENNER VP - OPERATIONAL PLANNING 0 131237 0 0 0 149 0 8896 0 22491 0 162773 0 0 CHERYLL HAFLETT PHYSICAL THERAPIST 0 146725 0 0 0 252 0 3300 0 6917 0 157194 0 0 ROGER WOHLWEND HOSPICE MEDICAL DIRECTOR - TOLEDO 0 194737 0 0 0 0 0 0 0 0 0 194737 0 0 KENNETH KEMPER FORMER OFFICER 0 285104 0 0 0 2374 0 16698 0 19053 0 323229 0 0 PART I, LINE 3: SENIOR INDEPENDENCE RELIED ON A RELATED ORGANIZATION (OHIO PRESBYTERIAN RETIREMENT SERVICES) THAT USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -FORM 990 OF OTHER ORGANIZATIONS -COMPENSATION SURVEY OR STUDY -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 6 OHIO PRESBYTERIAN RETIREMENT SERVICES (OPRS), AN OHIO NONPROFIT CORPORATION, IS THE SOLE MEMBER OF SENIOR INDEPENDENCE 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 SENIOR INDEPENDENCE WILL BE APPOINTED BY THE SOLE MEMBER, OHIO PRESBYTERIAN RETIREMENT SERVICES (OPRS), THROUGH ITS BOARD OF DIRECTORS, AT THE ANNUAL MEETING OF THE SOLE MEMBER. NOMINEES TO THE BOARD OF DIRECTORS OF SENIOR INDEPENENCE WILL BE SELECTED AND APPOINTED BY OPRS BASED UPON THEIR ABILITY TO CONTRIBUTE IN TERMS OF EXPERTISE AND TIME AND THEIR COMMITMENT TO THE OPRS MISSION STATEMENT. FORM 990, PART VI, SECTION A, LINE 7B THE CODE OF REGULATIONS OF SENIOR INDEPENENCE 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 SENIOR INDEPENENCE MAY ALSO BE AMENDED IN THE SAME MANNER. NOTWITHSTANDING THE FOREGOING, ALL AMENDMENTS TO THIS CODE OF REGULATIONS AND THE ARTICLES OF INCORPORATION OF SENIOR INDEPENDENCE MUST BE RATIFIED BY OPRS 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 REVIEW FINDINGS, IF ANY, TO THE BOARD AND FINANCE COMMITTEE. A FINAL 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 THE BOARD INQUIRES ABOUT CONFLICTS PRIOR TO EACH MEETING. ANNUALLY A WRITTEN DISCLOSURE IS CIRCULATED. IN ORDER TO CONTINUE SERVING, A MEMBER MUST COMPLETE THE WRITTEN DISCLOSURE. THE CORPORATE SECRETARY REVIEWS DISCLOSURES FOR CONFLICTS OF INTEREST. IF A CONFLICT ARISES, MEMBERS MUST RESOLVE THE CONFLICT OR BE REMOVED FROM SERVICE. THE GOVERNING BOARD AND ALL EMPLOYEES OF OPRS ARE BOUND BY THE CONFLICT OF INTEREST POLICY. THE CORPORATE SECRETARY IS RESPONSIBLE FOR DETERMINING IF A CONFLICT OF INTEREST EXISTS. IF A CONFLICT OF INTEREST ARISES OR IS DISCOVERED, THE INDIVIDUAL WITH THE CONFLICT MUST EITHER RESOLVE THE CONFLICT OF INTEREST OR MUST NOT SERVE IN THE MATTER WHICH GIVES RISE TO THE CONFLICT. ANY MEMBERS INVOLVED IN A VOTING MATTER WHO HAVE A CONFLICT OF INTEREST WITH RESPECT TO THAT VOTING MATTER MUST EXCUSE THEMSELVES BY NOT VOTING ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE CHIEF HUMAN RESOURCES OFFICER OF OPRS, A RELATED ENTITY, IN CONJUNCTION WITH THE OPRS 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 OPRS 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 OPRS 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 OPRS COMMUNITIES, AND ARE SUBJECT TO THE ABOVE PROCESS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED UPON WRITTEN REQUEST. FORM 990, PART IX, LINE 11G PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 2,094,013. MANAGEMENT AND GENERAL EXPENSES 450,198. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,544,211. OCCUPATIONAL THERAPY: PROGRAM SERVICE EXPENSES 809,080. MANAGEMENT AND GENERAL EXPENSES 173,946. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 983,026. SPEECH THERAPY: PROGRAM SERVICE EXPENSES 164,067. MANAGEMENT AND GENERAL EXPENSES 35,273. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 199,340. INPATIENT CONTRACTS: PROGRAM SERVICE EXPENSES 1,317,036. MANAGEMENT AND GENERAL EXPENSES 283,153. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,600,189. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 712,015. MANAGEMENT AND GENERAL EXPENSES 153,078. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 865,093. FORM 990, PART XI, LINE 9: TRANSFERRED PROGRAM FUNDS FROM OPRS FOUNDATION 281,048. BOOK ENTRY TO CLOSE OUT CUMULATIVE INTERCOMPANY ACCOUNTS TO NET ASSETS 4,676,224. OHIO PRESBYTERIAN RETIREMENT SERVICES 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 311340918 SUPPORT/PARENT OH 501(C)(3) LINE 11B, II N/A 0 OPRS COMMUNITIES 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 344429863 ADULT CARE OH 501(C)(3) LINE 9 OPRS 1 VINEYARD CONDOMINIUM ASSOCIATION 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 262702410 MANAGEMENT OH 501(C)(4) N/A OPRS COMMUNITIES 1 OHIO PRESBYTERIAN RETIREMENT SERVICES FOUNDATION 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 311166164 SUPPORT OH 501(C)(3) LINE 11B, II OPRS 1 SARAH MOORE HEALTH CARE CENTER INC 26 N UNION STREET DELAWARE OH 43015 311510768 SKILLED CARE/ASSISTED LIVING OH 501 C (3) LINE 9 OPRS COMMUNITIES 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 1 0 0 1 0 1 1 OHIO PRESBYTERIAN RETIREMENT SERVICES FOUNDATION S 602156 CASH TRANSACTION