2013-11-07T08:45:11-06:00 2012-12-31 341411715 DA BAGNOLA & COMPANY INC 4800 MUNSON STREET NW NORTH CANTON OH 44718 990 2012-01-01 340777664 ST LUKE LUTHERAN HOME FOR THE AGING STLU 3304992486 220 APPLEGROVE STREET NE NORTH CANTON OH 447201610 RONALD DERRY CFO 3304992486 2013-11-07 1 P01205115 3304992486 2012 2016-03-07 17:11:31Z RONALD E DERRY 220 APPLEGROVE STREET NE NORTH CANTON OH 447201610 14824112 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 4 408 72 0 0 20188 24312 15219639 14791906 9741 7894 0 0 15249568 14824112 350000 155164 0 0 9170768 8741491 0 0 0 4725397 5012404 14246165 13909059 1003403 915053 15716533 16595376 9842628 9806418 5873905 6788958 ST LUKE LUTHERAN HOME PROVIDES FAITH BASED SERVICES TO ENRICH THE LIVES OF OLDER ADULTS. LONG TERM NURSING CARE FOR THE AGING. 0 0 13909059 14791906 PROGRAM SERVICE - LONG TERM CARE FOR THE AGING 13909059 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 34 0 1 408 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 JOHN SPIELER 40.00 X X 221772 0 8914 ANDREW MCNULTY 0.00 X X 0 0 0 CAROL BROWER 0.00 X X 0 0 0 DIANE DIEHL 0.00 X X 0 0 0 JIM THIESE 0.00 X 0 0 0 221772 0 8914 1 0 1 0 THERAPY PARTNERS OF OHIO 16600 SPRAGUE RD STE 365 MIDDLEBURG HEIGHTS OH 44130 PURCHASED SERVICE-THERAPY 518231 PREMIER THERAPY 701 SHARON ROAD BEAVER PA 15009 PURCHASED SERVICE-THERAPY 515255 MCKESSON MEDICAL SUPPLY INC PO BOX 630693 CINCINNATI OH 45274 SUPPLIES - MEDICAL 245548 OMNICARE INC PO BOX 715268 COLUMBUS OH 43271 SUPPLIES - MEDICAL 192823 4 24312 24312 MEDICARE/MEDICAID PAYMENTS 9484961 9484961 RESIDENT SERVICE REVENUE 5306945 5306945 14791906 7894 7894 14824112 14791906 0 7894 155164 155164 221772 221772 7024357 7024357 90836 90836 869595 869595 534931 534931 26766 26766 43000 43000 107206 107206 11327 11327 166003 166003 64204 64204 550474 550474 21650 21650 1304 1304 230505 230505 497988 497988 142195 142195 PURCHASED SERVICE - THE 1064163 1064163 BED FRANCHISE FEE 857956 857956 SUPPLIES - MEDICAL 498415 498415 FOOD COSTS 497324 497324 231924 231924 13909059 13909059 0 0 1580 1580 5680141 5744589 2730224 3927929 88957 91269 122645 115812 15467567 10468073 5360478 4999494 1706298 1706860 26210 7843 15716533 16595376 500677 598849 8370052 8166270 971899 1041299 9842628 9806418 X 5873905 6788958 5873905 6788958 15716533 16595376 915053 0 X 0 1 X 1 0 X 34490 38528 18679 20188 24312 136197 15678734 15876640 16051304 15219639 14791906 77618223 15713224 15915168 16069983 15239827 14816218 77754420 0 0 0 77754420 47993 7999 8032 9741 7894 81659 47993 7999 8032 9741 7894 81659 15761217 15923167 16078015 15249568 14824112 77836079 0.99900 0.99820 0.00100 0.00180 X 18616 18616 11165916 7020934 4144982 4246606 3447139 799467 36429 36429 4999494 ACCRUED & WITHHELD TAXES 123699 ACCRUED VACATION 332257 ACCRUED PAYROLL 340398 GOVERNMENT MANDATED FEES 217609 OTHER 27336 1041299 14880433 56321 56321 14824112 0 14824112 13965380 56321 56321 13909059 0 13909059 1 ST LUKE FOUNDATION 220 APPLEGROVE STREET NE NORTH CANTON OH 44720 341407996 501(C)(3) 150000 LONG-TERM CARE SLLC-MINERVA 220 APPLEGROVE STREET NE NORTH CANTON OH 44720 263108193 501(C)(3) 5164 LONG-TERM CARE 2 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: TO ASSIST ST. LUKE FOUNDATION IN MAKING DISTRIBUTIONS TO ORGANIZATIONS THAT QUALIFY AS EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) AND PROVIDE SUPPORT TO LONG-TERM CARE. X X 0 0 0 0 0 0 0 0 0 JOHN SPIELER 220343 0 0 0 1429 0 3409 0 5505 0 230686 0 0 0 A CITY OF NORTH CANTON OHIO 346002037 2012-08-22 8278150 HEALTHCARE FACILITIES REVENUE BONDS 0 0 0 A 8278150 8188798 89352 2012 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 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 FOUNDATION B 150000 ST LUKE LUTHERAN COMMUNITY - MINERVA B 5164