2013-05-10T15:38:09-05:00 2012-06-30 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2011-07-01 310892356 FRIENDSHIP VILLAGE OF COLUMBUS OHIO INC FRIE 6148908282 5800 FOREST HILLS BLVD COLUMBUS OH 432312957 GREGORY LONSWAY 6148908282 2013-04-29 1 BERNIE OSTROWSKI P00366367 6148493000 2011 2016-02-24 21:20:13Z GREGORY LONSWAY 5800 FOREST HILLS BLVD COLUMBUS OH 432312957 17201036 0 X WWW.FRIENDSHIPVILLAGEOH.COM X 1977 OH THE MISSION OF FRIENDSHIP VILLAGE OF COLUMBUS IS TO PROVIDE A LIFE CARE RETIREMENT COMMUNITY FOR PHYSICALLY AND FINANCIALLY QUALIFIED PERSONS ON A FISCALLY SOUND, NOT-FOR-PROFIT BASIS THAT ENHANCES THE DIGNITY, SECURITY, AND INDEPENDENCE OF RESIDENTS. 12 12 346 12 0 0 147632 53816 15166305 14885498 232227 168902 33646 72530 15579810 15180746 39384 32160 0 0 7623684 7806553 19056 0 15997 7915783 8793384 15597907 16632097 -18097 -1451351 26598164 26523219 32318041 33612908 -5719877 -7089689 X THE MISSION OF FRIENDSHIP VILLAGE OF COLUMBUS IS TO PROVIDE A LIFE CARE RETIREMENT COMMUNITY FOR PHYSICALLY AND FINANCIALLY QUALIFIED PERSONS ON A FISCALLY SOUND, NOT-FOR-PROFIT BASIS THAT ENHANCES THE DIGNITY, SECURITY, AND INDEPENDENCE OF RESIDENTS. 0 0 14409200 32160 14888098 SEE SCHEDULE OFRIENDSHIP VILLAGE OF COLUMBUS, INC. CONSISTS OF 224 APARTMENTS, A 80 BED SKILLED NURSING FACILITY AND A 63 BED ASSISTED LIVING FACILITY, SERVING OVER 300 RESIDENTS. FRIENDSHIP VILLAGE PROVIDES ITS RESIDENTS WITH A SECURE, COMFORTABLE ENVIRONMENT IN A WARM, FRIENDLY AND CONGENIAL ATMOSPHERE THAT ENCOURAGES PHYSICAL AND PSYCHOLOGICAL WELL-BEING, WORTH, AND INDIVIDUAL UNIQUENESS OF RESIDENTS, EMPLOYEES AND OTHERS. SINCE EVERYONE'S NEEDS ARE DIFFERENT, FRIENDSHIP VILLAGE OFFERS A VARIETY OF CARE LEVELS TO ITS RESIDENTS, SUCH AS SKILLED NURSING, INTERMEDIATE CARE, REHABILITATIVE THERAPIES, HOSPICE CARE, PERITONEAL DIALYSIS, SURGICAL WOUND CARE, AND RESPITE CARE. EVERY RESIDENT IS ASSURED OF CONSISTENT, HIGH QUALITY CARE 24 HOURS A DAY,EVERY DAY OF THE YEAR. FRIENDSHIP VILLAGE PROVIDES A HOUSEKEEPING STAFF THAT TAKES CARE OF DETAILS LIKE CLEANING AND WEEKLY LAUNDRY SERVICE.MAINTENANCE TEAMS ARE ON CALL 24 HOURS A DAY. THE HEALTH CARE CENTER OFFERS A VARIETY OF PLANNED CULTURAL, SOCIAL, RELIGIOUS, AND RECREATIONAL ACTIVITIES TO HELP RESIDENTS REMAIN AS ACTIVE AND INVOLVED AS POSSIBLE. FRIENDSHIP VILLAGE PROVIDES HOME-STYLE MEALS THREE TIMES A DAY AND CAN ACCOMMODATE ANY SPECIAL DIET. RIDGEWOOD TERRACE AT FRIENDSHIP VILLAGE OF COLUMBUS, OHIO INC. PROVIDES SPECIALIZED CARE FOR INDIVIDUALS LIVING WITH MEMORY DISORDERS. PROFESSIONALS WORK WITHRESIDENTS AND THEIR FAMILY MEMBERS TO PROVIDE THERAPEUTIC AND RECREATIONAL ACTIVITIES. EXTRA SAFETY PRECAUTIONS HAVE BEEN TAKEN TO INSURE THAT RESIDENTS WILL NOT INJURE THEMSELVES OR OTHERS. EMERGENCY CALL BUTTONS IN EVERY BEDROOM AND BATHROOM ASSURE THAT HELP IS AVAILABLE ANY TIME, DAY OR NIGHT. 14409200 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 1 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 0 0 0 1 42 0 1 346 1 0 0 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X OWEN YODER 6148908282 5800 FOREST HILLS BOULEVARD COLUMBUS OH 43231 JOSEPH FOLEY 5.00 X X 0 0 0 MAX THOMPSON 10.00 X X 0 0 0 EDWARD SCHULTZ 5.00 X X 0 0 0 SCOTT POWELL 5.00 X X 0 0 0 PHIL KOPPEL 5.00 X 0 0 0 HUGH ALLEN 5.00 X 0 0 0 FRANK SHEPHERD 5.00 X 0 0 0 JACKIE NUSSBAUM 5.00 X 0 0 0 KATHERINE KISKER 5.00 X 0 0 0 PAULETTE LUNEBORG 5.00 X 0 0 0 KATHLEEN GUZLEY 5.00 X 0 0 0 PAUL BAYLESS 5.00 X 0 0 0 DAN SHIELDS 50.00 X 210142 0 45771 JOE BUCKLEY 50.00 X 44049 0 2210 GREG LONSWAY 50.00 X 0 0 0 OWEN YODER 50.00 X 0 0 0 LORI SONTAG 50.00 X 9808 0 0 263999 0 47981 1 0 1 0 REHABWORKS LLC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 900094 SYSCO FOOD SERVICES 2400 HARRISON ROAD COLUMBUS OH 43204 FOOD SERVICES 716712 LIFE CARE SERVICES LLC 400 LOCUST ST DES MOINES IA 50309 MANAGEMENT SERVICES 603099 STEDMAN FLOOR COMPANY INC 420 LOWERY CT GROVEPORT OH 43125 FLOORING 299296 OMNICARE PHARMACY PO BOX 701058 CINCINNATI OH 45270 PHARMACY SERVICES 235855 7 53816 53816 APTS./SKILLED NURSING 623000 14885498 14885498 14885498 141819 141819 34059 0 34059 34059 34059 2047373 2020290 27083 27083 27083 ADJ TO INS BOND REV 900099 35871 35871 REFUND OF SALARIES 900099 2600 2600 38471 15180746 14888098 0 238832 32160 32160 289817 289817 6271016 5581204 689812 52101 36992 15109 702350 625092 77258 491269 451967 39302 456000 456000 108771 108771 83805 83805 1019499 825794 193705 370098 370098 1951868 1854275 97593 75771 74256 1515 1389304 1389304 69600 16008 53592 834210 834210 1451814 1451814 143578 143578 FRANCHISE TAXES 354791 354791 BAD DEBT 345482 345482 RECRUITING 97869 97869 RESIDENT ACTIVITIES 22175 22175 18749 2752 15997 16632097 14409200 2206900 15997 730 1000 724626 1597924 1700460 954300 42385 28633 52484 51687 116197 210527 39846595 22686429 17793715 17160166 2384579 2232238 746110 1085268 3036878 3201476 26598164 26523219 2216201 2617009 7966106 7991315 16070000 15560000 6065734 7444584 32318041 33612908 X -6075655 -7295442 355778 205753 -5719877 -7089689 26598164 26523219 X -1451351 81539 X 0 1 0 X 0 X 105904 14860 80042 147632 53816 402254 16201613 15474309 15934979 15166305 14885498 77662704 16307517 15489169 16015021 15313937 14939314 78064958 6375 6375 0 6375 6375 78058583 325683 110746 213953 229703 175878 1055963 325683 110746 213953 229703 175878 1055963 42374 38915 40919 -418 35871 157661 16675574 15638830 16269893 15543222 15151063 79278582 0.98460 0.98210 0.01330 0.01480 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 981 981 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: MEMBERSHIP DUES IN THE AMOUNT OF $10,675 AND $4,874 WERE PAID TO LEADING AGE OHIO AND LEADING AGE RESPECTIVELY. 8% (854) AND 2.6% (127) OF THE DUES RELATED TO LOBBYING ACTIVITY. 527425 527425 34296061 19810931 14485130 1308082 1062154 245928 3715027 1813344 1901683 17160166 BOND ISSUANCE COSTS, NET 415627 ASSETS LIMITED AS TO USE HELD BY TRUSTEE 2690849 INSURANCE RECOVERY RECEIVABLE 95000 3201476 REFUNDABLE ENTRANCE FEES 7444584 7444584 15180746 16632097 -1451351 81539 81539 -1369812 15230121 81539 81539 15148582 32164 32164 15180746 16599933 0 16599933 32164 32164 16632097 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: FRIENDSHIP VILLAGE OF COLUMBUS IS A NOT-FOR-PROFIT AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSANT TO SECTION 501(A) OF THE CODE. FVOC FILES ALL APPLICABLE FEDERAL, STATE, AND LOCAL INCOME TAX RETURNS. FVOC FEDERAL TAX RETURNS FOR THE YEARS ENDED PRIOR TO JUNE 30, 2009 ARE NO LONGER SUBJECT TO EXAMINATION. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY FVOC AND RECOGNIZE A TAX LIABILITY IF FVOC HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY FVOC AND HAS CONCLUDED THAT AS OF JUNE 30, 2012, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF HARDSHIP DISCOUNTS 32,160. MISCELLANEOUS 4. PART XIII, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF HARDSHIP DISCOUNTS 32,160. MISCELLANEOUS 4. 1 HARDSHIP DISCOUNTS 2 32160 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: POLICY: IT IS THE POLICY OF FRIENDSHIP VILLAGE OF COLUMBUS TO PROVIDE FINANCIAL ASSISTANCE TO RESIDENTS OF FRIENDSHIP VILLAGE OF COLUMBUS WHO DEMONSTRATE A FINANCIAL NEED. PURPOSE: TO PROVIDE FINANCIAL ASSISTANCE TO RESIDENTS WHO HAVE DEVELOPED A FINANCIAL NEED DUE TO UNFORESEEN OR UNCONTROLLABLE CIRCUMSTANCES. PROCEDURE: -EACH APPLICANT MUST SUBMIT A CURRENT FINANCIAL STATEMENT SHOWING ASSETS AND MONTHLY INCOME. -EACH APPLICATION WILL BE REVIEWED BY THE EXECUTIVE DIRECTOR AND A COMMITTEE OF THE BOARD OF TRUSTEES FOR APPROVAL UNDER THE GUIDELINES ADOPTED BY THE BOARD OF TRUSTEES. GUIDELINES: LEVEL OF FINANCIAL STANDING FOR DISCOUNT CONSIDERATION: A. ASSETS SINGLE PERSON: NOT MORE THAN $1,500 COUPLE: NOT MORE THAN $3,000 B. MONTHLY INCOME EACH PERSON: THE INCOME LEVEL AT WHICH FRIENDSHIP VILLAGE OF COLUMBUS WILL CONSIDER APPLICATIONS FOR HARDSHIP DISCOUNT IS DETERMINED BY WHETHER THE RESIDENT'S MONTHLY INCOME IS LESS THAN THE SUM OF THE FOLLOWING MONTHLY EXPENSE. 1. CHARGE FOR THE STANDARD SERVICE FEE PLUS 2. CHARGES FOR TWO EXTRA MEALS PER DAY PLUS 3. MEDICAL EXPENSE NOT COVERED BY MEDICARE OR INSURANCE OVER $35/MONTH PLUS 4. AN ALLOWANCE OF ONE HUNDRED DOLLARS ($100) PER MONTH FOR INCIDENTALS. C. BECAUSE OF THE EFFECT UPON OTHER RESIDENTS WHERE HARDSHIP DISCOUNT IS GRANTED THE FOLLOWING WILL BE USED IN CONSIDERING AN APPLICATION FOR DISCOUNT: 1. NO RESIDENT MAY WILLINGLY AND KNOWINGLY GIVE, TRANSFER OR CONVEY HIS/HER ASSETS OR PLEDGE THE INCOME THEREFROM TO ANY PERSON (I.E. RELATIVE BY BLOOD OR MARRIAGE, FRIEND OR INSTITUTION) DURING THE PERIOD OF TIME OF RESIDENCY AT FRIENDSHIP VILLAGE OF COLUMBUS. 2. THE EXECUTIVE DIRECTOR MAY, AT HIS DISCRETION, REQUIRE OF THE RESIDENT AN ACCOUNTING OF ASSETS STATED ON THE ENTRANCE APPLICATION IN ORDER TO DETERMINE THAT NO DELIBERATE DIVESTITURE HAS TAKEN PLACE. 3. IF DELIBERATE FALSIFICATION OF THE ENTRANCE APPLICATION OR DELIBERATE DIVESTITURE OF ASSETS HAS BEEN MADE, THE BOARD OF TRUSTEES MAY TERMINATE THE RESIDENCY AGREEMENT OF THAT RESIDENT FOR FAILURE TO MAKE ALL OR ANY PART OF THE PAYMENTS AS OUTLINED IN THE RESIDENCY AGREEMENT. 4. IF THE RESIDENT IS RESIDING IN A ONE OR TWO BEDROOM APARTMENT, THEY WILL BE REQUIRED TO RELOCATE TO AN ALCOVE UNIT WHEN ONE IS AVAILABLE. THE MOVE WILL TAKE PLACE WITHIN 90 DAYS OF THE HARDSHIP APPROVAL DATE. THE TRANSFER WILL BE IN ACCORDANCE WITH THE INTERNAL TRANSFER POLICY (OTHER THAN THE ENTRANCE FEE REFUND WILL BE PROVIDED THE RESIDENT AT THE TIME OF TRANSFER). D. REVIEW: 1. THE ADMINISTRATION MAY, AT ITS DISCRETION, REQUEST A REVISED CONFIDENTIAL FINANCIAL STATEMENT FROM ANY RESIDENT RECEIVING FINANCIAL ASSISTANCE WHEN IT IS FELT THERE IS A SIGNIFICANT CHANGE IN THEIR FINANCIAL STATUS. 2. A CURRENT CONFIDENTIAL FINANCIAL STATEMENT ON A FORM FURNISHED BY FRIENDSHIP VILLAGE OF COLUMBUS MUST BE RE-SUBMITTED IN THE MONTH OF JULY EACH YEAR FOR ALL RESIDENT NEEDING CONTINUED FINANCIAL ASSISTANCE. E. EMERGENCY CLAUSE: 1. THE BOARD OF TRUSTEES AUTHORIZES THE EXECUTIVE DIRECTOR TO GRANT UP TO A $150 ONE TIME DISCOUNT ON AN EMERGENCY BASIS WITHOUT BOARD APPROVAL PROVIDING THE APPLICANT MEETS THE ABOVE FINANCIAL GUIDELINES. 2. THE BOARD OF TRUSTEES AUTHORIZES THE EXECUTIVE DIRECTOR TO APPROVE DEFERRED PAYMENT OF MONTHLY SERVICE FEE FOR A PERIOD OF TIME UP TO 90 DAYS IN ORDER FOR A RESIDENT TO MAKE ADJUSTMENTS IN PERSONAL FINANCES TO BE ABLE TO MEET THE MONTHLY SERVICE PAYMENT. FURTHER AUTHORIZED DEFERRED PAYMENT OF MONTHLY SERVICE FEES MUST BE APPROVED BY THE BOARD OF TRUSTEES. 0 0 0 0 0 0 0 0 0 DAN SHIELDS 113161 0 36285 0 60696 0 33351 0 12420 0 255913 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 A MANAGEMENT CONTRACT TO OVERSEE DAILY OPERATIONS IS ADMINISTERED BY LIFE CARE SERVICES, INC. LIFE CARE SERVICES, INC. PROVIDES INFORMATION SYSTEMS, MARKETING, HUMAN RESOURCES, RISK MANAGEMENT, AND FINANCIAL SYSTEM SUPPORT UNDER THE CONTRACT AGREEMENT. THE EXECUTIVE DIRECTORS DAN SHIELDS AND GREG LONSWAY ARE EMPLOYED BY LIFE CARE SERVICES. TOTAL COMPENSATION AND BENEFITS IN 2012 TOTALED $161,091 AND 56,071 RESPECTIVELY. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR. AN ELECTRONIC COPY OF THE FORM IS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING, ALONG WITH A SUMMARY OF THE INCREASED FILING REQUIREMENTS BEGINNING IN 2008. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY AGREEMENT UPON ACCEPTANCE OF THE POSITION AS WELL AS ON AN ANNUAL BASIS AFTERWARD. ANNUALLY AT THE JUNE BOARD MEETING, THE POLICY IS REVIEWED BY THE PRESIDENT AND DISCLOSURE SHEETS ARE SIGNED BY EACH TRUSTEE AND KEPT ON FILE IN THE ADMINISTRATIVE FILE. THE PRESIDENT IS ALSO REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY AGREEMENT UPON ACCEPTANCE OF THE POSITION AS WELL AS ON AN ANNUAL BASIS AFTERWARD. THE BOARD MEMBERS ARE RESPONSIBLE TO REVIEW THE POLICY SIGNED BY THE PRESIDENT. IF NEW CONFLICTS ARISE, THE CONFLICT IS DISCLOSED IMMEDIATELY TO THE BOARD FOR DISCUSSION AT THE MONTHLY BOARD MEETING AND THE BOARD MEMBER WITH A CONFLICT OF INTEREST WOULD ABSTAIN FROM VOTING IN ANY RELATED MATTER. FORM 990, PART VI, SECTION B, LINE 15 MANAGEMENT PREPARES AND/OR REVIEWS THE ANNUAL PERFORMANCE REVIEW IN EACH INSTANCE FRIENDSHIP VILLAGE OF COLUMBUS HIRES A NEW EXECUTIVE DIRECTOR, DIRECTOR OF ACCOUNTING, OR ADMINISTRATIVE MEMBER. COMPENSATION FOR SIMILAR POSITIONS IS COMPILED AND COMPARED ON A REGIONAL AND NATIONAL LEVEL THROUGH AOPHA'S SALARY SURVEY TO MAINTAIN COMPETITIVE SALARIES WITHIN THE INDUSTRY. THE COMPENSATION DECISIONS OF THE EXECUTIVE DIRECTOR ARE DOCUMENTED IN THE EMPLOYEE FILE OF LCS AND THE DIRECTOR OF ACCOUNTING IS DOCUMENTED WITHIN THE HR DEPARTMENT OF FVOC. THE COMPENSATION PROCESS WAS LAST UNDERTAKEN DURING 2012. FORM 990, PART VI, SECTION C, LINE 19 BOOKS ARE KEPT IN THE RESIDENT LIBRARY, ADMINISTRATIVE OFFICE, AND FRIENDSHIP VILLAGE'S SYSTEMS NETWORK. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 81,539.