2012-11-15T07:48:25-06:00 2011-12-31 310210560 BATTELLE & BATTELLE LLP 2000 WEST DOROTHY LANE DAYTON OH 45439 990 2011-01-01 310538523 FRIENDS BOARDING HOME-OHIO VALLEY YEARLY MTG RELIGIOUS SOCIETY OF FRIENDS FRIE 5138976050 514 W HIGH STREET PO BOX 677 WAYNESVILLE OH 45068 WENDY L WATERS-CONNELL 5138976050 2012-10-30 1 KAREN O CRIM P00368385 9372980201 2011 2016-02-24 21:20:13Z QUAKER HEIGHTS CARE COMMUNITY WENDY L WATERS-CONNELL 514 W HIGH STREET PO BOX 677 WAYNESVILLE OH 45068 9226713 0 X WWW.QUAKERHEIGHTS.ORG X 1904 OH OPERATE A NURSING HOME AND ASSISTED LIVING FACILITY AND PROVIDE MEDICAL CARE FOR THE ELDERLY 15013 14 147 50 0 0 0 0 8836929 9220077 5329 6636 0 0 8842258 9226713 0 0 0 0 5051181 5080757 0 0 0 3691036 3999321 8742217 9080078 100041 146635 11340499 11888474 8996211 9397551 2344288 2490923 THE OPERATION OF A NURSING HOME AND ASSISTED LIVING FACILITY AND PROVIDING MEDICAL CARE FOR THE ELDERLY RESIDENTS 0 0 7474601 9168808 CARE FOR ELDERLY - 98 BED NURSING HOME OPERATED IN ACCORDANCE WITH MEDICARE/MEDICAID REGULATIONS AND 60 UNIT ASSISTED LIVING FACILITY. INDEPENDENT LIVING FACILITIES - HOUSING UNITS PROVIDING INDEPENDENT LIVING MONITORED BY NURSING HOME STAFF AND PHYSICIANS AS NECESSARY. OFFICE CENTER - PROFESSIONAL AND MEDICAL OFFICES MAINTAINED FOR THE COMMUNITY AND STAFFED BY INDEPENDENT PROFESSIONALS. 7474601 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 55 0 147 1 0 0 0 0 0 0 0 0 0 0 X 15013 14 1 1 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X WENDY L WATERS-CONNELL 5138976050 514 W HIGH STREET WAYNESVILLE OH 45068 EUGENIA MILLS 1.00 X X 0 0 0 ALICE PALMER 1.00 X X 0 0 0 TOM ISAACS 1.00 X X 0 0 0 DOTTIE RYE 1.00 X X 0 0 0 TERRI KOLES 1.00 X X 0 0 0 RON KRONENBERGER- TO APR 2011 1.00 X X 0 0 0 SHARON JEWELL 1.00 X X 0 0 0 LONNY BURGER- TO APR 2011 1.00 X 0 0 0 GUS EDWARDS 1.00 X 0 0 0 CHARLES FEICHT- FROM APR 2011 1.00 X 0 0 0 DONNE HAYDEN 1.00 X 0 0 0 FRANK HUSS 1.00 X 0 0 0 EULA MCDERMOTT- TO APR 2011 1.00 X 0 0 0 WILSON PALMER- FROM APR 2011 1.00 X 0 0 0 PEG SCHORRECK 1.00 X 0 0 0 WARREN SHEEHAN- TO APR 2011 1.00 X 0 0 0 CHRISTINE SNYDER- FROM APR 2011 1.00 X 0 0 0 WILMA WATSON- FROM APR 2011 1.00 X 0 0 0 ERIC WOLFF 1.00 X 0 0 0 WENDY L WATERS-CONNELL 50.00 X 142020 0 7101 AMANDA YAUGER 50.00 X 102257 0 9948 244277 0 17049 2 0 0 0 CONCEPT REHAB INC 7150 GRANITE CIRCLE TOLEDO OH 43617 THERAPY 522123 HEALTHCARE SERVICES GROUP 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 DIETARY, HOUSEKEEPING, LAUNDRY CONTRACTO 248641 2 MEDICARE/MEDICAID PMTS 623000 4792947 4792947 PATIENT SERV. REVENUE 623000 4375861 4375861 RENTAL INCOME 623000 51269 51269 9220077 6636 6636 9226713 9168808 0 57905 149121 74561 74560 3787886 3390797 397089 858745 729933 128812 285005 242254 42751 50976 50976 138924 138924 190645 162048 28597 49869 49869 242144 57260 184884 224647 190950 33697 45749 38888 6861 6252 6252 463471 393950 69521 513571 436535 77036 140361 119306 21055 MEDICAL SUPPLIES 735912 735912 LICENSE FEES & FRANCHIS 404711 344004 60707 CONTRACTED SERVICES 263460 263460 FOOD/DIETARY SUPPLIES 232183 232183 296446 62560 233886 9080078 7474601 1605477 0 961059 1100741 224481 53089 119759 112089 12799107 6534267 6310241 6264840 593614 646758 3131345 3710957 11340499 11888474 680471 673685 18991 13232 7868971 8244740 427778 465894 8996211 9397551 X 2344288 2490923 2344288 2490923 11340499 11888474 146635 0 X X 0 1 1 X 1 1 X 7966641 8669620 8922060 8836929 9220077 43615327 7966641 8669620 8922060 8836929 9220077 43615327 0 0 0 43615327 44382 16582 44582 5329 6636 117511 44382 16582 44582 5329 6636 117511 29074 424 29498 8040097 8686202 8967066 8842258 9226713 43762336 0.99660 0.99570 0.00270 0.00360 X 0 1 12871 12871 9803875 3859381 5944494 2982361 2674886 307475 6264840 MEDICARE/MEDICAID RECEIVABLE 652634 MIP, INSURANCE, & REPAIR DEPOSITS 110597 RESERVE FOR REPLACEMENT 298429 FINANCING & BUILDING FEES 1586535 RESIDUAL RECEIPTS 1049530 RESIDENT FUNDS HELD BY QUAKER HEIGHTS 13232 3710957 DUE TO QUAKER HEIGHTS FOUNDATION 137622 DEFERRED REVENUE - SSA 323572 RENTAL DEPOSITS 4700 465894 PART IV, LINE 2B: FUNDS THE FACILITY IS REQUIRED BY THE STATE TO MAINTAIN AT THE RESIDENTS REQUEST. THIS MONEY BELONGS TO THE INDIVIDUAL RESIDENTS THEREFORE THERE IS AN OFFSETTING LIABILITY EQUAL TO THE ASSET ACCOUNT. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FRIENDS BOARDING HOME AND ITS RELATED ENTITY, QUAKER HEIGHTS FOUNDATION, INC., WERE ORGANIZED AS NOT-FOR-PROFIT CORPORATIONS AND HAVE SECURED TAX EXEMPT STATUS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. A PROVISION FOR INCOME TAXES IS NOT REQUIRED. THE SINGLE MEMBER ENTITY, QUAKER HEIGHTS, LLC, WAS FORMED TO HOLD TITLE TO THE NURSING HOME AND ASSISTED LIVING FACILITY PROPERTY AND EQUIPMENT. FORMATION OF THIS ENTITY WAS REQUIRED UNDER TERMS OF THE HUD-INSURED MORTGAGE. THE LLC IS A DISREGARDED ENTITY FOR FEDERAL AND STATE TAX PURPOSES AND IS REPORTED ON THE TAX RETURN OF FRIENDS BOARDING HOME. A PROVISION FOR INCOME TAXES IS NOT REQUIRED. WITH FEW EXCEPTIONS, THE ORGANIZATION'S FEDERAL INFORMATION RETURNS ARE NO LONGER SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE FOR YEARS BEFORE 2008. FORM 990, PART VI, SECTION A, LINE 2 ALICE PALMER AND WILSON PALMER HAVE A FAMILY RELATIONSHIP. AS PRESIDING CLERK OF THE BOARD OF THE FRIENDS HOME FOUNDATION, ALICE PALMER IS AN EX-OFFICIO MEMBER OF THIS ORGANIZATION'S BOARD. FORM 990, PART VI, SECTION A, LINE 3 DAYFIELD SENIOR SOLUTIONS, LLC PROVIDES ACCOUNTING SERVICES INCLUDING FINANCIAL REPORTING, COST REPORTING, BUDGET PREPARATION, ACCOUNTS RECEIVABLE AND ACCOUNTS PAYABLE SUPPORT. FORM 990, PART VI, SECTION A, LINE 7B THE FRIENDS HOME OF THE OHIO VALLEY YEARLY MEETING OF THE RELIGIOUS SOCIETY OF FRIENDS APPROVES MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR AND THE ORGANIZATION'S MANAGEMENT COMPANY (DAYFIELD SENIOR SOLUTIONS, LLC). A COPY IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY PRIOR TO FILING FORM 990 WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES A SIGNED WRITTEN CONFLICT OF INTEREST POLICY BY THE BOARD MEMBERS ON A YEARLY BASIS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS WILL CONDUCT A WRITTEN ASSESSMENT OF THE PERFORMANCE OF THE EXECUTIVE DIRECTOR ANNUALLY. THE BOARD OF DIRECTORS USES CRITERIA FROM THE AMERICAN ASSOCIATION OF HOMES AND SERVICES FOR THE AGING TO ESTABLISH COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 2B, DESCRIPTION OF FINANCIAL STATEMENT REPORTING: THE ORGANIZATION'S FINANCIAL STATEMENTS WERE AUDITED BY AN INDEPENDENT ACCOUNTANT ON A CONSOLIDATED BASIS WITH QUAKER HEIGHTS LLC (A DISREGARDED ENTITY) AND QUAKER HEIGHTS FOUNDATION, INC. FORM 990, PART XI, LINE 2C: THE ORGANIZATION'S COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. QUAKER HEIGHTS LLC 514 WEST HIGH STREET PO BOX 677 WAYNESVILLE OH 45068 310538523 OPERATE QUAKER HEIGHTS CARE COMMUNITY - NURSING HOME AND ASSISTED LIVING OH 9226713 11888474 N/A QUAKER HEIGHTS FOUNDATION PO BOX 232 WAYNESVILLE OH 45068 311575048 TO SUPPORT ACTIVITIES OF FRIENDS BOARDING HOME, INC. OH 501(C)(3) LINE 13, TYPE I N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0