WIDOWS HOME OF DAYTON OHIO: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
WIDOWS HOME OF DAYTON OHIO (EIN 31-0641121)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-13
IRS object ID
201323179349300447
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-13T08:47:21-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN310210560EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BATTELLE & BATTELLE LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12000 WEST DOROTHY LANEAddressLine1
CityDAYTONCity
StateOHState
ZIP Code45439ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN310641121EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1WIDOWS HOME OF DAYTON OHIOBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlWIDONameControl
Phone9372521661Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line150 SOUTH FINDLAY STREETAddressLine1
CityDAYTONCity
StateOHState
ZIP Code45403ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameNANCY HINESName
TitlePRESIDENTTitle
Phone9372521661Phone
Date Signed2013-10-01DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKAREN O CRIMName
PTINP00368385PTIN
Phone9372980201Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonNANCY HINESNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line150 SOUTH FINDLAY STREETAddressLine1
CityDAYTONCity
StateOHState
ZIP Code45403ZIPCode
FieldValueIRS element (for citing)
Gross Receipts5456913GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.WIDOWSHOME.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1961YearFormation
State Legal DomicileOHStateLegalDomicile
Activity Or Mission DescriptionTHE PURPOSE OF THE WIDOWS HOME IS TO PROVIDE LONG-TERM CARE SERVICES TO ELDERLY INDIVIDUALS.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees171TotalNbrEmployees
Total Nbr Volunteers180TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year5739765ProgramServiceRevenuePriorYear
Program Service Revenue CY5453503ProgramServiceRevenueCY
Investment Income Prior Year-470InvestmentIncomePriorYear
Investment Income Current Year-1099InvestmentIncomeCurrentYear
Other Revenue Prior Year1150OtherRevenuePriorYear
Other Revenue Current Year3410OtherRevenueCurrentYear
Total Revenue Prior Year5740445TotalRevenuePriorYear
Total Revenue Current Year5455814TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year2721822SalariesEtcPriorYear
Salaries Etc Current Year2559740SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2914089OtherExpensePriorYear
Other Expenses Current Year2890539OtherExpensesCurrentYear
Total Expenses Prior Year5635911TotalExpensesPriorYear
Total Expenses Current Year5450279TotalExpensesCurrentYear
Revenues Less Expenses Prior Year104534RevenuesLessExpensesPriorYear
Revenues Less Expenses CY5535RevenuesLessExpensesCY
Total Assets BOY7485759TotalAssetsBOY
Total Assets EOY7465982TotalAssetsEOY
Total Liabilities BOY8417215TotalLiabilitiesBOY
Total Liabilities EOY8339303TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-931456NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-873321NetAssetsOrFundBalancesEOY
Mission DescriptionTHE PURPOSE OF THE WIDOWS HOME IS TO PROVIDE LONG-TERM CARE SERVICES TO ELDERLY INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense4509030Expense
Revenue5452404Revenue
DescriptionTHE WIDOWS HOME OF DAYTON, OHIO PROVIDES LONG-TERM NURSING AND RESIDENTIAL CARE, SHORT-TERM REHABILITATION, AND ADULT DAY PROGRAMS TO ELDERLY INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE HOME IS AN INNER-CITY FACILITY WITH 75 LICENSED BEDS.Description
Total Program Service Expense4509030TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees171NumberOfEmployees
Employment Tax Returns Filed0EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons0AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledOHStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1KRISTINA DIXONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9372521661TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line150 SOUTH FINDLAY STREETAddressLine1
CityDAYTONCity
StateOHState
ZIP Code45403ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
NANCY HINES
PRESIDENT0.50XX000
ROBERT PROPHATER
VICE PRESIDENT0.50XX000
MARILYN HOBACK
SECRETARY0.50XX000
JOAN FRANKS
TREASURER0.50XX000
ROBERT APPLEBAUM
BOARD MEMBER0.50X000
JANE CLIFTON
BOARD MEMBER0.50X000
LINDA ROEPKEN
BOARD MEMBER0.50X000
JEFF SORRELL
BOARD MEMBER0.50X000
KEITH VALIQUETTE
BOARD MEMBER0.50X000
ROSE WILDENHAUS
BOARD MEMBER0.50X000
KRISTINA DIXON
EXECUTIVE DIRECTOR32.00X8783100
FieldValueIRS element (for citing)
Total Reportable Comp From Org87831TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation0TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (3 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ALPHA & OMEGA STAFFING SOLUTIONS
6276 PLATTSBURG ROADS CHARLESTONOH45368THERAPY SERVICES471944
UNITED CHURCH HOMES MANAGEMENT
PO BOX 1806MARIONOH433011806MANAGEMENT SERVICES260250
BEEBER PHARMACIES
600 UNION BLVDENGLEWOODOH45322PHARMACY SERVICES166924
FieldValueIRS element (for citing)
Number Of Contractors GT100 K3NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MEDICARE/MEDICAID PAYM62300044186174418617
PRIVATE PAY RESIDENTS623000543779543779
HOSPICE CARE RESIDENTS623000470366470366
SENIOR ADULT DAY CARE6230002074120741
FieldValueIRS element (for citing)
Total Program Service Revenue5453503TotalProgramServiceRevenue

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other1099Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-1099Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-1099TotalRevenueColumn
Related Or Exempt Function Income-1099RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER INCOMEDescription
Business Code900099BusinessCode
Total Revenue Column3410TotalRevenueColumn
Exclusion$3,410ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue3410TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column5455814TotalRevenueColumn
Related Or Exempt Function Income5452404RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$3,410ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total87831Total
Management And General87831ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1748481Total
Program Services1680524ProgramServices
Management And General67957ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total162000Total
Program Services153752ProgramServices
Management And General8248ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total561428Total
Program Services524229ProgramServices
Management And General37199ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total166610Total
Management And General166610ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total800Total
Management And General800ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total9600Total
Management And General9600ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total14387Total
Management And General14387ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total267040Total
Program Services267040ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total379164Total
Program Services379164ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
HEALTH SERVICES11650411165041
BED TAX319122319122
ADMINISTRATION187394187394
DIETARY164399164399

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total216982Total
Program Services174881ProgramServices
Management And General42101ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total5450279Total
Program Services4509030ProgramServices
Management And General941249ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY79547BOY
EOY277235EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY779394BOY
EOY895918EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY4339BOY
EOY5744EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY44407BOY
EOY42354EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis10872213LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4662325LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6572991BOY
EOY6209888EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY5081BOY
EOY34843EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY7485759BOY
EOY7465982EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY452572BOY
EOY599139EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY4250348BOY
EOY3943457EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY17833BOY
EOY19085EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3696462BOY
EOY3777622EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8417215BOY
EOY8339303EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-931456BOY
EOY-873321EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-931456BOY
EOY-873321EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7485759BOY
EOY7465982EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses5535ReconcilationRevenueExpenses
Reconcilation Other Changes52598ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4420400CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5677102CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5768165CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5689985CurrentTaxYearMinus1Year
Current Tax Year5432762CurrentTaxYear
Total26988414Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4420400CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5677102CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5768165CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5689985CurrentTaxYearMinus1Year
Current Tax Year5432762CurrentTaxYear
Total26988414Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50926988414PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years47293CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years48939CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years49778CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year49778CurrentTaxYearMinus1Year
Current Tax Year20741CurrentTaxYear
Total216529Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years47293CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years48939CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years49778CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year49778CurrentTaxYearMinus1Year
Current Tax Year20741CurrentTaxYear
Total216529Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4467693CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5726041CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5817943CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5739763CurrentTaxYearMinus1Year
Current Tax Year5453503CurrentTaxYear
Total27204943Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99200PublicSupportPercentage509
Prior Year Support Percentage0.99030PriorYearSupportPercentage
Investment Income Percentage0.00800InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00970PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$0OtherActivitiesAmount
Total Lobbying Expenditures IIB0TotalLobbyingExpendituresIIB

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationA SMALL PORTION OF THE ORGANIZATION'S DUES PAID TO LEADINGAGE OHIO (FKA AOPHA) IS ALLOCABLE TO LOBBYING.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS
Explanation In Part XIIIXExplanationInPartXIII

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis131650OtherCostOrOtherBasis
Book Value131650BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8937837OtherCostOrOtherBasis
Depreciation3714794Depreciation
Book Value5223043BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1802726OtherCostOrOtherBasis
Depreciation947531Depreciation
Book Value855195BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6209888TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
ACCRUED EXPENSES$353,883
DEFERRED COST OF INTEREST RATE SWAP$284,015
FUNDS ADVANCED FROM WIDOWS HOME FOUNDATION - RELATED ORGANIZATION$3,139,724
FieldValueIRS element (for citing)
Total Of Amounts3777622TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 2B:RESIDENT SAVINGS ACCOUNTS ARE HELD IN A SEPARATE BANK ACCOUNT.
PART X, LINE 2:THE HOME AND THE FOUNDATION QUALIFY AS TAX-EXEMPT NON-PROFIT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR FEDERAL INCOME TAX IS REQUIRED. MANAGEMENT EVALUATED THE HOME AND THE FOUNDATION'S TAX POSITIONS AS OF DECEMBER 31, 2012 AND 2011 AND CONCLUDED THAT THEY HAVE TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE CONSOLIDATED FINANCIAL STATEMENTS. IN GENERAL, THE HOME AND FOUNDATION ARE NO LONGER SUBJECT TO FEDERAL, STATE, OR LOCAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2009.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF RIVERSIDEBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN316000133IssuerEIN
Date Issued2006-12-29DateIssued
Issue Price2500000IssuePrice
Description Of Purpose25 BED EXPANSIONDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Total Proceeds2500000TotalProceeds
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs0NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiled
Rebate Not Due Yet0RebateNotDueYet
Exception To Rebate0ExceptionToRebate
No Rebate Due0NoRebateDue
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs0WrittenProcToMonitorReqs

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 3UNITED CHURCH HOMES MANAGEMENT, INC. PROVIDES MANAGEMENT AND CONSULTING SERVICES, FINANCIAL MANAGEMENT, HUMAN RESOURCES, CENSUS AND BUSINESS DEVELOPMENT, MEDICARE BILLING SERVICES, AND SIMILAR MANAGEMENT SERVICES TO THE WIDOWS HOME OF DAYTON. THE ADMINISTRATOR OF THE WIDOWS HOME IS EMPLOYED BY UNITED CHURCH HOMES MANAGEMENT, INC. AND RECEIVES SALARY AND BENEFITS FROM THAT ORGANIZATION. THERE IS NO OWNERSHIP INTEREST IN UNITED CHURCH HOMES MANAGEMENT, INC. BY THE WIDOWS HOME OF DAYTON OR ANY OFFICERS OR BOARD MEMBERS OF THE WIDOWS HOME. THE MANAGEMENT CONTRACT WITH UNITED CHURCH HOMES MANAGEMENT, INC. WAS TERMINATED ON DECEMBER 31, 2012.
FORM 990, PART VI, SECTION A, LINE 8BCOMMITTEE MEETING MINUTES WERE NOT TAKEN. HOWEVER, THE DISCUSSIONS DURING COMMITTEE MEETINGS ARE REPORTED AT BOARD MEETINGS AND ARE DOCUMENTED IN THE BOARD MEETING MINUTES.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 WILL BE PROVIDED TO BOARD MEMBERS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CBOARD MEMBERS PROVIDE SELF-DISCLOSURE OF CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:CHANGE IN FAIR VALUE OF INTEREST RATE SWAP OBLIGATION 52,487. CHANGE IN CASH SURRENDER VALUE OF RESIDENT LIFE INSURANCE 111.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 2CTHE ORGANIZATION'S COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS HAS NOT CHANGED THAT PROCESS FROM THE PRIOR YEAR. THE FINANCIAL STATEMENTS ARE CONSOLIDATED WITH THE WIDOWS HOME FOUNDATION, A PUBLIC CHARITY WHOSE PURPOSE IS TO CONDUCT FUNDRAISING ACTIVITIES AND MANAGE THE ENDOWMENT FUNDS FOR THE BENEFIT OF THE WIDOWS HOME OF DAYTON.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1WIDOWS HOME FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line150 SOUTH FINDLAY STREETAddressLine1
CityDAYTONCity
StateOHState
ZIP Code45403ZIPCode
FieldValueIRS element (for citing)
EIN311584036EIN
Primary ActivitiesTO CONDUCT FUNDRAISING ACTIVITIES AND MANAGE ENDOWMENT FUNDS.PrimaryActivities
Legal Domicile StateOHLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusLINE 7PublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1WIDOWS HOME FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeETransactionType
Amount Involved3139724AmountInvolved
Method Of Amt DeterminationFAIR MARKET VALUEMethodOfAmtDetermination

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