2013-11-14T17:59:36-06:00 2012-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2012-01-01 311510768 SARAH MOORE HEALTH CARE CENTER INC SARA 7403629641 26 N UNION STREET DELAWARE OH 43015 TIM CHESSER 7403629641 2013-11-13 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2016-02-24 21:20:13Z KATHIE WILL 26 N UNION STREET DELAWARE OH 43015 4779004 0 X SARAHMOOREHOME.COM X 1997 OH SARAH MOORE HEALTH CENTER, INC. OPERATES A 32 BED SKILLED NURSING HOME FACILITY AND A 44 BED ASSISTED LIVING FACILITY. 9 9 141 0 0 0 6689 34641 4758085 4716993 25876 27370 -89258 0 4701392 4779004 0 0 0 0 2802438 2701565 0 0 0 2291516 2257087 5093954 4958652 -392562 -179648 10984693 10897633 13146555 14961188 -2161862 -4063555 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 4294251 0 4716993 PROVIDED SKILLED CARE AND ASSISTED LIVING. 4294251 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 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 0 0 0 1 3 0 1 141 1 0 0 0 0 0 0 0 0 0 0 X 9 9 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 OH X KATHIE WILL 7403629641 26 N UNION STREET DELAWARE OH 43015 DEBORAH MARTIN 1.00 0.00 X X 0 0 0 TIM CHESSER 1.00 0.00 X X 0 0 0 CHESTER HAMMOND 1.00 0.00 X X 0 0 0 JERRY EDMONDS 1.00 0.00 X X 0 0 0 DON CHENOWETH 1.00 0.00 X 0 0 0 BILL WILLIAMS 1.00 0.00 X 0 0 0 MARY LOU WALDRON 1.00 0.00 X 0 0 0 DARLENE BARNES 1.00 0.00 X 0 0 0 MARILYN SHEETS 1.00 0.00 X 0 0 0 RONALD J WHITE 40.00 0.00 X 163837 0 0 KATHIE WILL 50.00 10.00 X 12321 0 0 176158 0 0 1 0 1 0 FUNCTIONAL PATHWAYS 614 MABRY HOOD RD NW KNOXVILLE TN 37932 THERAPY 397622 1 34641 34641 NURSING HOME/ASSISTED 623000 4716993 4716993 4716993 27370 27370 4779004 4716993 0 27370 X 176158 176158 2211099 2009638 201461 106870 106870 207438 207438 2375 2375 8560 8560 562991 562991 167 167 87218 87218 19825 19825 364045 364045 10132 10132 5804 5804 395967 304466 91501 302891 302891 61200 61200 FOOD 222131 222131 MEDICAL SUPPLIES 108683 108683 REPAIRS & MAINTENANCE 69098 69098 BAD DEBT 36000 36000 4958652 4294251 664401 0 121784 51300 289338 375862 511087 4915 4915 72999 22603 10532281 2181934 8634425 8350347 1320072 1799954 165298 157427 10984693 10897633 553592 372687 7805965 8006801 4786998 6581700 13146555 14961188 X -2161862 -4063555 -2161862 -4063555 10984693 10897633 -179648 171741 -1893786 0 X X 1 X 0 1 0 X 4060 1143955 62185 6689 34641 1251530 2565349 3474902 4350702 4668827 4716993 19776773 2569409 4618857 4412887 4675516 4751634 21028303 0 0 0 21028303 16574 1635 28799 25876 18810 91694 16574 1635 28799 25876 18810 91694 2585983 4620492 4441686 4701392 4770444 21119997 0.99570 0.99630 0.00430 0.42000 X 208750 208750 9418466 1612919 7805547 848341 521687 326654 56724 47328 9396 8350347 INTERCOMPANY PAYABLE 4683323 INTEREST RATE SWAP LIABILITY 1898377 6581700 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: NO PROVISION HAS BEEN MADE FOR INCOME TAXES SINCE THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER CODE SECTION 501(C)(3) AND ARE CLASSIFIED AS OTHER THAN A PRIVATE FOUNDATION BY THE INTERNAL REVENUE SERVICE. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE ORGANIZATION, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2012, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS NOT CURRENTLY UNDER EXAMINATION BY THE INTERNAL REVENUE SERVICE OR ANY STATE OR LOCAL TAX AUTHORITIES. THE ORGANIZATION'S FEDERAL TAX RETURNS FOR THE YEARS ENDED PRIOR TO DECEMBER 31, 2009 ARE NO LONGER SUBJECT TO EXAMINATION. 0 0 0 0 0 0 0 0 0 RONALD J WHITE 163837 0 0 0 0 0 0 0 0 0 163837 0 0 0 A COUNTY OF DELAWARE 316400065 245872AH9 2007-09-13 8905000 REFURBISH/ADD BEDS 0 0 0 A 8905000 203000 5649000 2009 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 1 1 0 0 0 0 0 A 1 FORM 990, PART VI, SECTION A, LINE 2 SARAH MOORE EMPLOYED ONE OF THE ADMINISTRATOR'S SONS IN HUMAN RESOURCES. HE OBTAINED HIS NURSING HOME ADMINISTRATOR'S LICENSE AND HIS POSITION WAS ASST. ADMINISTRATOR. HE WAS EMPLOYED FOR A PORTION OF 2012. SARAH MOORE ALSO EMPLOYED ONE OF THE ADMINISTRATOR'S SONS IN MARKETING. HE WAS EMPLOYED FOR A PORTION OF 2012. FORM 990, PART VI, SECTION B, LINE 11 THE ADMINISTRATOR AND CHAIRMAN OF THE BOARD REVIEW THE FORM 990 AND THEN PROVIDE ELECTRONIC COPIES OF THE FORM 990 TO ALL BOARD MEMBERS PRIOR TO FILING. 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. 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. OTHER FEES FORM 990, PART IX, LINE 11G OXYGEN, THERAPY, AND PHARMACY FEES: PROGRAM SERVICE EXPENSES 485,270. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 485,270. ADMINISTRATIVE FEES: PROGRAM SERVICE EXPENSES 33,856. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 33,856. RETIREMENT AND OTHER FEES: PROGRAM SERVICE EXPENSES 43,865. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 43,865. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD FUNCTIONS AS THE ORGANIZATION'S AUDIT COMMITTEE, WHICH OVERSEES A REVIEW OF THE FINANCIAL STATEMENTS AND IS INVOLVED IN THE SELECTION OF THE INDEPENDENT ACCOUNTANT WHICH COMPLETES THE REVIEW. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SARAH MOORE HOME 47 EAST WILLIAMS ST DELAWARE OH 43015 314379575 ASSISTED LIVING OH 501(C)(3) 509(A)(1) SARAH MOORE HEALTH CARE CENTER INC 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0