2013-11-14T15:46:19-06:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 1 BRONZE POINTE BELLEVILLE IL 62226 990 2012-01-01 341743836 NORTH SHORE RETIREMENT COMMUNITY NORT 4197988203 9400 NORTH SHORE BLVD LAKESIDE OH 43440 J CHRISTOPHER GREEN 4197988203 2013-11-14 1 CHAD KUNZE P00639380 6182331200 2012 2016-02-25 16:41:14Z J CHRISTOPHER GREEN 580 N SR 741 LEBANON OH 45036 4406029 0 X WWW.OTTERBEIN.ORG X 1993 OH OTTERBEIN NORTH SHORE IS A CONTIUING CARE RETIREMENT COMMUNITY THAT PROVIDES HOUSING AND SERVICES FOR OLDER ADULTS. GENEROUS DONATIONS HAVE ESTABLISHED A BENEVOLENT CARE FUND WICH OFFERS ASSISTANCE TO RESIDENTS WHO CANNOT PAY THE FULL COST OF CARE. OTTERBEIN'S RICH HERITAGE HAS EARNED A SOLID REPUTATION AS A TRUSTED AND VALUABLE RESOURCE. BY PROVIDING INFOMRATION AND SERVICES ON AGING ISSUES, WE CONTINUE TO SERVE RESIDENTS, THEIR FAMILIES AND THE SURROUNDING COMMUNITIES. OTTERBEIN RESIDENTS AND STAFF VOLUNTEER THEIR TIME AND TALENTS TO OTTERBEIN NORTH SHORE RETIREMENT LIVING COMMUNITY BUT ALSO FOR A NUMBER OF ORGANIZATIONS AND CAUSES IN THE GREATER COMMUNITY. 19 19 86 15 0 0 88703 193936 4031329 4170597 94016 41496 0 0 4214048 4406029 0 0 0 0 1587940 1648356 0 0 0 2574530 2614469 4162470 4262825 51578 143204 10392235 10742217 10005777 10078310 386458 663907 OUR MISSION - IN KEEPING WITH OUR UNITED METHODIST TRADITION WE SEEK TO ENHANCE THE QUALITY OF LIFE AND HOLISTIC GROWTH OF OLDER PERSONS. 0 0 3322462 4170597 OTTERBEIN NORTH SHORE PROVIDES A CONTINUUM OF CARE INCLUDING INDEPENDENT LIVING, ASSISTED LIVING, NURSING CARE, AND DEMENTIA CARE.REHABILITATION, SOCIAL SERVICES AND CHAPLAINCY SERVICES ARE AVAILABLE TO ALL RESIDENTS.LOCAL GROUPS SUCH AS THE VETERANS, CHURCH CIRCLES, COMMUNITY CIVIC GROUPS AND A HOST OF OTHERS USE OTTERBEIN AS A MEETING PLACE. IN ADDITION OTTERBEIN PROVIDES SPECIAL PROGRAMS AND EVENTS FOR THE COMMUNITY ON AN ONGOING BASIS. 3322462 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 18 0 86 1 0 0 0 0 0 0 0 0 0 0 X 19 19 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X J CHRISTOPHER GREEN 5139335400 580 NORTH SR 741 LEBANON OH 450368839 LYNN APP 1.00 X 0 0 0 NEIL ALLEN 1.00 X 0 0 0 CAROL EVERSON 1.00 X 0 0 0 REV BRUCE BATCHELOR-GLADER 1.00 X 0 0 0 JAMES STOUFFER JR 1.00 X 0 0 0 MILLARD MEAD 1.00 X 0 0 0 DAVE GLASMIRE 1.00 X 0 0 0 DICK HARTLEY 1.00 X 0 0 0 DON YAUSSY 1.00 X 0 0 0 HELEN ROFKAR 1.00 X 0 0 0 TIM TAYLOR 1.00 X 0 0 0 PHYLLIS LANE 1.00 X 0 0 0 MARY COFFEE 1.00 X 0 0 0 BARBARA STEPHENS-RICH 1.00 X 0 0 0 BETH MCKEE 1.00 X 0 0 0 BUD COX 1.00 X 0 0 0 JOHN ENGLEBECK 1.00 X 0 0 0 REV JUDY CLAYCOMB 1.00 X 0 0 0 CAROL MORGAN 1.00 X 0 0 0 BOB METHENY 1.00 X 0 0 0 JILL HREBEN 2.00 38.00 X 0 324103 19337 JAMES CHRIS GREEN 2.00 38.00 X 0 226879 9602 0 550982 28939 0 0 1 0 CONCEPT REHAB 7150 GRANITE CIRCLE SUITE 200 TOLEDO OH 43617 THERAPY SERVICES 255784 RICHARD R KNEISLEY 345 NORTH POPLAR STREET PORT CLINTON OH 43452 CONSTRUCTION SERVICES 134125 2 193936 40671 193936 RESIDENTIAL SERVICE FE 623000 4067503 4067503 DEPARTMENTAL REVENUE 623000 103094 103094 4170597 39700 39700 1796 0 1796 1796 1796 4406029 4170597 0 41496 1292097 1076769 215328 74844 62371 12473 176964 147473 29491 104451 87044 17407 668 668 8390 8390 539961 472424 67537 262380 251659 10721 6458 5382 1076 265904 255039 10865 429882 412317 17565 29922 28699 1223 NURSE AGENCY FEES 279915 279915 CORPORATE SERVICE FEES 265861 265861 REFUNDABLE LIFE USE FEE 232195 232195 OTHER ADMINISTRATION 106743 106743 186190 11175 175015 4262825 3322462 940363 0 301820 378941 2218 6222 21382 15439 13800081 5053114 8832362 8746967 1294471 929064 305389 300177 10392235 10742217 751455 787770 1242045 1392516 6627638 6155218 1384639 1742806 10005777 10078310 X -3667399 467223 4047132 164976 6725 31708 386458 663907 10392235 10742217 X 143204 72095 62150 X X 0 1 X 1 0 X 56758 120798 107932 88703 193936 568127 3696774 3868134 3700932 4031329 4170597 19467766 3753532 3988932 3808864 4120032 4364533 20035893 3510 41015 1263 1175 45606 92569 0 3510 41015 1263 1175 45606 92569 19943324 -3845 8031 71000 93966 39700 208852 -3845 8031 71000 93966 39700 208852 46196 46196 3749687 4043159 3879864 4213998 4404233 20290941 0.98290 0.97810 0.01030 0.01520 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 574075 574075 11575888 3948408 7627480 1449814 990000 459814 200304 114706 85598 8746967 REFUNDABLE PORTION OF REFUNDABLE LIFE USE FEES 225875 SPLIT-INTEREST AGREEMENT 54146 DEFERRED COST OF INTEREST RATE SWAP 248783 INTERCOMPANY PAYABLE 1214002 1742806 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATIONS, EXCEPT FOR OTTERBEIN SERVICE CORPORATION, QUALIFY AS TAX-EXEMPT CORPORATIONS DESCRIBED IN SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ORGANIZATIONS ARE NOT SUBJECT TO FEDERAL INCOME TAXES UNDER SECTION 501 (C)(3) OF THE CODE. THE ORGANIZATIONS ARE CLASSIFIED AS PUBLICLY SUPPORTED CHARITABLE ORGANIZATIONS UNDER THE CODE AND CONTRIBUTIONS TO THE ORGANIZATIONS QUALIFY AS CHARITABLE TAX DEDUCTIONS FOR THE CONTRIBUTOR. THE ENTITY FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE IRS. THE ORGANIZATIONS' 2011, 2010, AND 2009 TAX YEARS ARE OPEN FOR EXAMINATION BY THE IRS. OTTERBEIN SERVICE CORPORATION IS AN INACTIVE FOR-PROFIT CORPORATION, AND IS LIABLE FOR INCOME TAXES ON ITS TAXABLE INCOME. 1 X X X X 0 0 0 0 0 0 0 0 0 JILL HREBEN 0 324103 0 0 0 0 0 0 0 19337 0 343440 0 0 JAMES CHRIS GREEN 0 226879 0 0 0 0 0 0 0 9602 0 236481 0 0 X 1 40671 MARKET VALUE 1 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM IS PROVIDED TO AND REVIEWED BY THE CHIEF FINANCIAL OFFICER DEFORE IT IS FILED. A COMPLETE COPY OF THE 990 IS ALSO PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C IN ACCORDANCE WITH THE BY-LAWS, ANY POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY BOARD MEMBER, CORPORATE EXECUTIVE, EXECUTIVE DIRECTOR, OR ADMINISTRATIVE STAFF MEMBER, OR COMMITTEE MEMBERS, WHO ARE NOT MEMBERS OF THE BOARD OF TRUSTEES OF OTTERBEIN HOMES SHALL BE DISCLOSED TO THE BOARD AND MADE A MATTER OF RECORD, EITHER THROUGH THE ANNUAL PROCEDURE OR WHEN THE INTEREST BECOMES RELEVANT TO A MATTER OF BOARD ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE OTTERBEIN HOMES BOARD OF TRUSTEES HAS THE RESPONSIBILITY FOR DETERMINING THE ANNUAL COMPENSATION FOR THE OFFICERS BY THE USE OF INDUSTRY SPECIFIC DATA SUCH AS SALARY SURVEYS FROM LEADING AGE AND LEADING AGE OHIO. THE SALARIES OF THE KEY EMPLOYEES ARE DETERMINED BY THE OFFICERS USING INDUSTRY COMPARATIVE DATA SUCH AS SALARY SURVEYS FROM LEADING AGE AND LEADING AGE OHIO. FORM 990, PART VI, SECTION C, LINE 18 UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF SPLIT INTEREST AGREEMENT -24,470. RELATED PARTY TRANSFERS OF UNRESTRICTED NET ASSETS 52,546. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP 81,502. CHANGE IN MINIMUM PENSION LIABILITY -47,428. FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES IN THE OVERSIGHT OR THE SELECTION OF AN INDEPENDENT ACCOUTANT FROM THE PRIOR YEAR. OTTERBEIN HOMES 580 NORTH STATE ROUTE 741 LEBANON OH 45036 310549058 PARENT OH 501(C)(3) LINE 9 N/A 0 OTTERBEIN CRIDERSVILLE 100 RED OAK DRIVE CRIDERSVILLE OH 45806 341940884 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 9 N/A 0 OTTERBEIN PORTAGE VALLEY 20311 PEMBERVILLE ROAD PEMBERVILLE OH 43450 341193296 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 9 N/A 0 OTTERBEIN ST MARYS 11230 STATE ROUTE 364 ST MARYS OH 45885 341940880 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 9 N/A 0 OTTERBEIN LEBANON 585 NORTH STATE 741 LEBANON OH 45036 311743874 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 9 N/A 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0