2015-11-16T16:53:12-06:00 2014-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2014-01-01 311510768 SARAH MOORE HEALTH CARE CENTER INC SARA 7403629641 26 N UNION STREET DELAWARE OH 43015 ROBERT B STILLMAN CFO & TREASURER, OPRS 7403629641 2015-11-16 1 BERNIE OSTROWSKI P00366367 6148493000 2014 2016-02-25 16:41:14Z ROBERT B STILLMAN 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 5466073 0 X SARAHMOOREHOME.COM X 1997 OH SARAH MOORE HEALTH CENTER, INC. OPERATES A 32 BED SKILLED NURSING HOME FACILITY AND A 58 BED ASSISTED LIVING FACILITY. 10 9 204 18 0 0 3424 2217 4464296 4988554 143292 121679 0 0 4611012 5112450 0 0 0 0 2530096 2811006 0 0 0 2380924 2557867 4911020 5368873 -300008 -256423 11723496 9579652 9247459 9444889 2476037 134763 SARAH MOORE IS COMMITTED TO PRESERVING THE DIGNITY AND PRIDE OF OUR RESIDENTS WHILE PROVIDING THEM WITH COMFORTABLE AND SAFE HOUSING WITH LOVING, PERSONAL CARE AND COMPASSION. 0 0 4671535 0 5089788 PROVIDED SKILLED CARE AND ASSISTED LIVING. 4671535 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 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 27 0 204 1 0 0 0 0 0 0 0 0 0 0 X 10 9 0 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 OH X ROBERT B STILLMAN 6148887800 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 DONALD G CHENOWETH SARAH MOORE REPRESENTATIVE 1.00 2.00 X 0 0 0 DANIEL W GORONZY DIRECTOR/ASSITANT SECRETARY 1.00 4.00 X X 0 0 0 DR WILLIAM J CLEARY JR MEMBER AT LARGE 1.00 2.00 X X 0 0 0 LAURENCE C GUMINA PRESIDENT/CEO - OPRS 1.00 39.00 X X 0 453025 28897 TED W KARCHNER RESIDENT REPRESENTATIVE 1.00 2.00 X 0 0 0 DEBORAH MARTIN CHAIRMAN (THRU AUGUST 2014) 1.00 0.00 X X 0 0 0 TIM CHESSER VICE CHAIRMAN (THRU AUGUST 2014) 1.00 0.00 X X 0 0 0 CHESTER HAMMOND BOARD TREASURER (THRU AUGUST 2014) 1.00 0.00 X X 0 0 0 GERRY EDMONDS BOARD SECRETARY (THRU AUGUST 2014) 1.00 0.00 X X 0 0 0 DR SUZANNE F KIEWIT PHD MEMBER AT LARGE 1.00 2.00 X 0 0 0 WILLIAM C LEITER OPRS BOARD REPRESENTATIVE 1.00 4.00 X X 0 0 0 RICHARD LOWERY MEMBER AT LARGE 1.00 2.00 X 0 0 0 MARK MATSON MEMBER AT LARGE 1.00 2.00 X 0 0 0 FREDERICK C SMITH III OPRS BOARD REPRESENTATIVE 1.00 4.00 X X 0 0 0 KATHLEEN TUTTLE OPRS BOARD REPRESENTATIVE 1.00 4.00 X X 0 0 0 BILL WILLIAMS BOARD MEMBER (THRU AUGUST 2014) 1.00 0.00 X 0 0 0 MARY LOU WALDRON BOARD MEMBER (THRU AUGUST 2014) 1.00 0.00 X 0 0 0 DARLENE BARNES BOARD MEMBER (THRU AUGUST 2014) 1.00 0.00 X 0 0 0 MARILYN SHEETS BOARD MEMBER (THRU AUGUST 2014) 1.00 0.00 X 0 0 0 KATHIE WILL ADMINISTRATOR (THRU AUGUST) 40.00 0.00 X 0 123907 0 ROBERT STILLMAN TREASURER/CFO 2.00 38.00 X 0 280003 19576 DANIEL O'CONNOR PRESIDENT - OPRS COMMUNITIES 2.00 38.00 X 0 313732 11467 KENNETH KEMPER VICE PRESIDENT - DEVELOPMENT 2.00 38.00 X 0 287478 30014 DANA ULLOM-VUCELICH VICE PRESIDENT - HUMAN RESOURCES 2.00 38.00 X 0 219659 29524 JOYCE MILLER-EVANS VICE PRESIDENT - INFORMATION SYSTEMS 2.00 38.00 X 0 203206 26616 MARY C MCKENZIE VICE PRESIDENT - MARKETING 2.00 38.00 X 0 167442 14861 CONNIE TOSTEVIN VP OF NURSING AND CLINICAL SERVICES 2.00 38.00 X 0 163586 16041 0 2212038 176996 0 0 1 0 FUNCTIONAL PATHWAYS 614 MABRY HOOD RD NW KNOXVILLE TN 37932 THERAPY 305046 LEADERSTAT 1322 B MANNING PKWY POWELL OH 43065 STAFFING 103572 2 2217 2217 NURSING HOME/ASSISTED 623000 4988554 4988554 4988554 20445 20445 454857 353623 101234 101234 101234 5112450 5089788 0 20445 2493824 2140996 352828 128957 118640 10317 188225 175049 13176 24857 24857 89223 89223 403869 403869 5622 5622 61034 7857 53177 8947 8947 434551 434551 7643 7643 1532 1532 324505 324505 364384 364384 49538 49538 FOOD 264567 264567 BAD DEBT 242110 242110 MEDICAL SUPPLIES 148842 148842 BANK FEES 80478 80478 46165 46165 5368873 4671535 697338 0 138300 357119 582291 437191 4915 0 9746 13125 10097883 3572974 9099195 6524909 1726190 1331023 0 879841 162859 36444 11723496 9579652 435699 293734 7850000 7355000 961760 1796155 9247459 9444889 X 2476037 134763 2476037 134763 11723496 9579652 X -256423 -61948 -2022903 X 0 0 0 X 62185 6689 34641 3424 2217 109156 4350702 4668827 4716993 4464296 4988554 23189372 4412887 4675516 4751634 4467720 4990771 23298528 0 0 0 23298528 28799 25876 18810 56627 20445 150557 28799 25876 18810 56627 20445 150557 4441686 4701392 4770444 4524347 5011216 23449085 0.99360 0.99430 0.00640 0.00570 X 340000 340000 5577645 1681663 3895982 3560711 1686187 1874524 619527 205124 414403 6524909 INTEREST RATE SWAP LIABILITY 1541155 INTERCOMPANY PAYABLE 255000 1796155 0 0 0 0 0 0 0 0 0 LAURENCE C GUMINA PRESIDENT/CEO - OPRS 0 452745 0 0 0 280 0 9882 0 19015 0 481922 0 0 ROBERT STILLMAN TREASURER/CFO 0 279733 0 0 0 270 0 0 0 19576 0 299579 0 0 DANIEL O'CONNOR PRESIDENT - OPRS COMMUNITIES 0 312824 0 0 0 908 0 10972 0 495 0 325199 0 0 KENNETH KEMPER VICE PRESIDENT - DEVELOPMENT 0 285104 0 0 0 2374 0 10961 0 19053 0 317492 0 0 DANA ULLOM-VUCELICH VICE PRESIDENT - HUMAN RESOURCES 0 219229 0 0 0 430 0 9198 0 20326 0 249183 0 0 JOYCE MILLER-EVANS VICE PRESIDENT - INFORMATION SYSTEMS 0 202406 0 0 0 800 0 7582 0 19034 0 229822 0 0 MARY C MCKENZIE VICE PRESIDENT - MARKETING 0 166523 0 0 0 919 0 7656 0 7205 0 182303 0 0 CONNIE TOSTEVIN VP OF NURSING AND CLINICAL SERVICES 0 162999 0 0 0 587 0 7163 0 8878 0 179627 0 0 PART I, LINE 3 SARAH MOORE HEALTH CARE CENTER, INC. 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 A COUNTY OF DELAWARE OHIO 316400065 245872AH9 2007-09-13 8905000 REFURBISH/ADD BEDS; REFINANCE PRIOR BONDS 0 0 0 A 1295000 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 EFFECTIVE AUGUST 1, 2014, OPRS COMMUNITIES (OPRSC) BECAME THE SOLE MEMBER OF SARAH MOORE HEALTH CARE CENTER, INC. PURSUANT TO A CONSUMMATED MEMBER SUBSTITUTION AGREEMENT WHEREBY OPRSC REPLACED THE EXISTING BOARD OF DIRECTORS AS THE MEMBER OF SARAH MOORE. FORM 990, PART VI, SECTION A, LINE 6 OPRS 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, OPRS 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 OPRS COMMUNITIES BOARD OF DIRECTORS 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 EFFECTIVE AUGUST 1, 2014, OPRSC BECAME THE SOLE MEMBER OF SARAH MOORE HEALTH CARE CENTER, INC. PURSUANT TO A CONSUMMATED MEMBER SUBSTITUTION AGREEMENT WHEREBY OPRSC REPLACED THE EXISTING BOARD OF DIRECTORS AS THE MEMBER OF SARAH MOORE. FORM 990, PART VI, SECTION B, LINE 11 ON AUGUST 1, 2014, THE REPORTING ORGANIZATION HAD BEEN ACQUIRED BY OPRS COMMUNITIES AND THE BOARD OF THE REPORTING ENTITY HAD BEEN DISSOLVED. OPRS COMMUNITIES HAS IMPLEMENTED A PROCESS, GOING FORWARD, WHICH INCLUDES THE RELEASE OF THE FORM 990 TO THE OPRS COMMUNITIES BOARD FOR THEIR REVIEW. THE CEO AND CFO OF OPRS COMMUNITIES HAVE APPROVED THIS PROCESS. A DRAFT OF THE FORM 990 IS POSTED TO THE ONLINE BOARD PORTAL PRIOR TO FILING AND EACH BOARD MEMBER IS GRANTED ACCESS TO REVIEW AND COMMENT. DUE TO TIMING OF PREPARATION, COMPLICATED BY SOLE MEMBER SUBSTITUTION DURING THE TAX REPORTING YEAR, AND NEED TO FILE BY EXTENSION DUE DATE, OPRSC STANDARD PROCESS WAS NOT ABLE TO BE IMPLEMENTED. CFO/TREASURER OF OPRSC BOARD APPROVED THE TRANSITION YEAR PROCESS. 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. 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 ALTHOUGH A POLICY IS NOT YET IN PLACE FOR THE REVIEW OF OFFICER COMPENSATION, THE BOARD HAS BEEN INFORMED OF SUCH PRACTICES AND IS WORKING TOWARDS DEVELOPING A POLICY, WHICH WOULD INCLUDE INDEPENDENT APPROVAL, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DECISION-MAKING 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 -290,365. REVALUATION OF ASSETS DUE TO OPRSC ACQUISTION -1,732,538. OHIO PRESBYTERIAN RETIREMENT SERVICES FOUNDATION 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 311166164 SUPPORT OH 501(C)(3) LINE 11B, II OPRS 1 OHIO PRESBYTERIAN RETIREMENT SERVICES 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) OPRSC 1 SENIOR INDEPENDENCE 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 272564811 ADULT CARE OH 501(C)(3) LINE 9 OPRS 1 OPRS COMMUNITIES 1001 KINGSMILL PARKWAY COLUMBUS OH 43229 344429863 ADULT CARE OH 501(C)(3) LINE 9 OPRS 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 1 0 1 OPRS COMMUNITIES S 365175 CASH TRANSACTION