2015-11-13T13:42:05-06:00 2014-12-31 341411715 DA BAGNOLA & COMPANY INC 4800 MUNSON STREET NW NORTH CANTON OH 44718 990 2014-01-01 340777664 ST LUKE LUTHERAN HOME FOR THE AGING STLU 3304992486 220 APPLEGROVE STREET NE NORTH CANTON OH 447201610 RONALD DERRY CFO OFFICER 3304992486 2015-11-12 1 P01205115 3304992486 2014 2016-04-25 22:37:26Z RONALD E DERRY 220 APPLEGROVE STREET NE NORTH CANTON OH 447201610 15645193 0 9386 X WWW.STLUKELUTHERANCOMMUNITY.ORG X 1954 OH ST LUKE LUTHERAN HOME PROVIDES FAITH-BASED SERVICES TO ENRICH THE LIVES OF OLDER ADULTS. LONG TERM NURSING CARE FOR THE AGING. 4 4 404 44 0 0 18262 11256 15637951 15014880 25516 95556 108269 34924 15789998 15156616 98712 24000 0 0 9010087 9099361 0 0 0 5207574 5281263 14316373 14404624 1473625 751992 18002738 19260317 9725878 10246873 8276860 9013444 ST LUKE LUTHERAN HOME PROVIDES FAITH-BASED SERVICES TO ENRICH THE LIVES OF OLDER ADULTS. LONG TERM NURSING CARE FOR THE AGING. 0 0 14404624 15049804 PROGRAM SERVICE - LONG TERM NURSING CARE FOR THE AGING 14404624 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 41 0 1 404 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X RONALD E DERRY 3304998341 220 APPLEGROVE STREET NE NORTH CANTON OH 44720 ANDREW MCNULTY PRESIDENT 0.00 X X 0 0 0 CAROL BROWER VICE PRESIDENT 0.00 X X 0 0 0 DIANE DIEHL SECRETARY/TREASURER 0.00 X X 0 0 0 ROBERT HESSEL TRUSTEE 0.00 X 0 0 0 JOHN SPIELER EXECUTIVE DIRECTOR 40.00 X 256556 0 10248 256556 0 10248 1 0 1 0 PREMIER THERAPY 701 SHARON ROAD BEAVER PA 15009 PURCHASED SERVICE-THERAPY 1041224 MCKESSON MEDICAL SUPPLY INC PO BOX 630693 CINCINNATI OH 45274 SUPPLIES - MEDICAL 253558 OMNICARE INC PO BOX 78000 DETROIT MI 48278 SUPPLIES - MEDICAL 206952 3 11256 11256 MEDICARE/MEDICAID PAYMENTS 9287854 9287854 RESIDENT SERVICE REVENUE 5727026 5727026 15014880 75239 75239 508144 750 488577 0 19567 750 20317 20317 WORKERS' COMPENSATION REFUND 36556 36556 OHIO AGING SERVICES NETWORK LLC ( -1632 -1632 34924 15156616 15049804 0 95556 24000 24000 256556 256556 7001288 7001288 78479 78479 1218029 1218029 545009 545009 40314 40314 47500 47500 46353 46353 17724 17724 157351 157351 107375 107375 565028 565028 6355 6355 1518 1518 204311 204311 575335 575335 142531 142531 PURCHASED SERVICE - THE 1043996 1043996 BED FRANCHISE FEE 889024 889024 SUPPLIES - MEDICAL 603809 603809 FOOD COSTS 553116 553116 279623 279623 14404624 14404624 0 0 635 635 5294860 6714106 3997424 2606688 800000 650000 90181 100688 99295 111305 17731005 11379753 4950776 6351252 1151439 1196247 1618128 1529396 18002738 19260317 697125 1015720 7830630 8050126 1198123 1181027 9725878 10246873 X 8276860 9013444 8276860 9013444 18002738 19260317 751992 -15408 0 X 0 1 X 1 0 X 18679 20188 24312 18262 11256 92697 16051304 15219639 14791906 15746220 15049804 76858873 16069983 15239827 14816218 15764482 15061060 76951570 0 0 0 76951570 8032 9741 7894 25516 75239 126422 8032 9741 7894 25516 75239 126422 16078015 15249568 14824112 15789998 15136299 77077992 0.99840 0.99920 0.00160 0.00080 X 509683 509683 11260000 7609199 3650801 4618730 3770554 848176 1342592 1342592 6351252 ACCRUED & WITHHELD TAXES 197699 ACCRUED VACATION 350301 ACCRUED PAYROLL 380177 GOVERNMENT MANDATED FEES 224452 OTHER 28398 1181027 15188262 31646 31646 15156616 0 15156616 14451678 31646 15408 47054 14404624 0 14404624 PART XII, LINE 2D - OTHER ADJUSTMENTS: NET UNREALIZED LOSSES ON INVESTMENTS 1 SLLC-MINERVA 220 APPLEGROVE STREET NE NORTH CANTON OH 44720 263108193 501(C)(3) 24000 0 LONG-TERM CARE 1 0 PART I, LINE 2: TO ASSIST ST. LUKE LUTHERAN COMMUNITY - MINERVA AND PROVIDE SUPPORT TO LONG-TERM CARE. X X 0 0 0 0 0 0 0 0 0 JOHN SPIELER EXECUTIVE DIRECTOR 254180 0 0 0 2376 0 3862 0 6386 0 266804 0 0 0 A CITY OF NORTH CANTON OHIO 346002037 2012-08-22 8278150 HEALTHCARE FACILITIES REVENUE BONDS 0 0 0 B CITY OF NORTH CANTON OHIO 346002037 2014-09-01 7500000 HEALTHCARE FACILITIES REVENUE BONDS 0 0 0 A 8278150 8188798 89352 2012 1 0 1 1 B 7500000 117233 437903 6944864 2015 0 0 0 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 B 0 0 0 0 1 0 0 0 0 A 0 B 0 FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE RETURN IS PROVIDED FIRST TO MANAGEMENT AND THEN TO THE BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL CONFLICT OF INTEREST STATEMENTS ARE COMPLETED AND SIGNED BY EACH DIRECTOR, OFFICER, AND KEY EMPLOYEE. ALL KNOWN POTENTIAL CONFLICTS ARE LISTED AND SHARED WITH THE BOARD OF DIRECTORS. SHOULD A DECISION COME TO THE BOARD INVOLVING ONE OF THE STATED CONFLICTS, THE INDIVIDUAL WILL FOLLOW THE WRITTEN CONFLICT OF INTEREST POLICY AND DISCLOSE HIS OR HER CONFLICT, PROVIDE ANY INFORMATION DESIRED BY THE BOARD, AND RECUSE HIM OR HERSELF FROM THE MEETING FOR THE DELIBERATIONS AND THE VOTE ON THE MATTER INVOLVING THE CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 A SURVEY IS CONDUCTED OF REGIONAL LONG-TERM CARE POSITIONS. SALARIES ARE BASED ON COMPARATIVE POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE WATERFORD AT ST LUKE 201 HOLL ROAD NORTH CANTON OH 44720 341719940 INDEPENDENT LIVING OH 501(C)(3) 9 N/A 0 ST LUKE FOUNDATION 220 APPLEGROVE STREET NE NORTH CANTON OH 44720 341407996 LONG-TERM CARE OH 501(C)(3) 9 N/A 0 ST LUKE LUTHERAN COMMUNITY 220 APPLEGROVE STREET NE NORTH CANTON OH 44720 030483120 LONG-TERM CARE OH 501(C)(3) 9 N/A 0 ST LUKE LUTHERAN COMMUNITY - BELDEN VILLAGE 220 APPLEGROVE STREET NE NORTH CANTON OH 44720 200970588 LONG-TERM CARE OH 501(C)(3) 9 N/A 0 ST LUKE LUTHERAN COMMUNITY - MASSILLON 220 APPLEGROVE STREET NE NORTH CANTON OH 44720 030483116 LONG-TERM CARE OH 501(C)(3) 9 N/A 0 ST LUKE LUTHERAN COMMUNITY - PORTAGE LAKES 220 APPLEGROVE STREET NE NORTH CANTON OH 44720 030483122 LONG-TERM CARE OH 501(C)(3) 9 N/A 0 ST LUKE LUTHERAN COMMUNITY - MINERVA 220 APPLEGROVE STREET NE NORTH CANTON OH 44720 263108193 LONG-TERM CARE OH 501(C)(3) 9 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ST LUKE LUTHERAN COMMUNITY - MINERVA B 24000