2012-11-15T10:27:42-06:00 2011-12-31 202122306 GBQ PARTNERS LLC 230 WEST STREET SUITE 700 COLUMBUS OH 432152663 990 2011-01-01 311358042 HERITAGE DAY HEALTH CENTERS HERI 6142360586 2335 NORTH BANK DRIVE COLUMBUS OH 43220 JOSEPH KASBERG 6142360586 2012-11-13 1 GBQ PARTNERS LLC P00631697 6142211120 2011 2016-02-24 21:20:13Z THOMAS SLEMMER 2335 NORTH BANK DRIVE COLUMBUS OH 43220 5679613 0 5048 X WWW.NATIONALCHURCHRESIDENCES.ORG X 1992 OH HERITAGE DAY HEALTH CENTERS PROVIDE COMPREHENSIVE ADULT DAY SERVICES TO ADULTS WITH COGNITIVE AND PHYSICAL IMPAIRMENT. 7 7 212 1364 61761 58099 408170 594360 4521741 4872981 73830 2162 79820 83605 5083561 5553108 0 0 0 0 3492129 3764282 0 0 89589 1785530 2347012 5277659 6111294 -194098 -558186 6278090 5867174 3671179 3818449 2606911 2048725 HERITAGE DAY HEALTH CENTERS PROVIDE COMPREHENSIVE ADULT DAY SERVICES TO ADULTS WITH COGNITIVE AND PHYSICAL IMPAIRMENTS. 0 0 4996339 4872981 PROVISION OF DAY SERVICES WHICH INCLUDES HEALTH MONITORING, EDUCATION AND MEDICATION ADMINISTRATION, PERSONAL CARE, THERAPEUTIC ACTIVITIES AND SOCIAL SERVICES INCLUDING REFERRAL, COUNSELING AND CAREGIVER SUPPORT. 4996339 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 12 0 1 212 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X X JOSEPH R KASBERG 6142360586 2335 NORTH BANK DRIVE COLUMBUS OH 43220 RONALD ADAMS 1.00 X 0 0 0 ALLEN RUPIPER 1.00 X 0 0 0 LEA BLACKBURN 1.00 X 0 0 0 PAUL BLOOMFIELD 1.00 X 0 0 0 STEPHEN RISH 1.00 X 0 0 0 A KENNETH PIERCE 1.00 X 0 0 0 FLOYD V JONES 1.00 X 0 0 0 JOSEPH R KASBERG 1.00 X 0 333984 48253 THOMAS W SLEMMER 1.00 X 0 640297 43861 ERICA DREWRY 40.00 X 103795 0 8861 DAVID A KAYUHA 1.00 X 0 236502 39980 JOSEPH B KUYOTH 1.00 X 0 253704 33964 103795 1464487 174919 1 0 1 0 LIFECARE ALLIANCE 1699 W MOUND STREET COLUMBUS OH 43223 MEALS 275429 SPEEDWAY PO BOX 740587 CINCINNATI OH 45274 GASOLINE 239491 BUS SERVICE 3153 LAMB AVENUE COLUMBUS OH 43219 BUS REPAIRS 123280 3 41209 141829 411322 594360 GRANTS & SERVICE CONTR 623990 4323142 4323142 CLIENT FEES 623990 549839 549839 4872981 1412 1412 208860 125255 83605 83605 61761 21844 2000 1250 750 750 750 5553108 4872981 61761 24006 112656 94248 16226 2182 2856130 2389422 411363 55345 507008 420775 82366 3867 288488 280734 2461 5293 307436 307436 11177 5053 6124 23835 23835 429429 399768 8043 21618 23369 9998 13371 8965 8965 240905 240905 24260 7244 17016 1760 1760 128998 127116 1882 305396 277916 27480 80780 78119 2661 TRANSPORTATION 323959 323959 REPAIRS & MAINTENANCE 202328 197610 4718 SUPPLIES & EQUIPMENT 109111 91712 16399 1000 BAD DEBT 47992 21030 26962 77312 20005 57023 284 6111294 4996339 1025366 89589 459481 280956 10700 0 614099 832931 42541 53106 6887258 2284097 4820789 4603161 226399 104081 97020 6278090 5867174 289914 593040 3310000 3170000 63942 48086 7323 7323 3671179 3818449 X 2313344 1766150 293567 282575 2606911 2048725 6278090 5867174 -558186 0 X X 0 1 1 X 0 X 3389532 3759348 4822951 4929911 5467341 22369083 3389532 3759348 4822951 4929911 5467341 22369083 22369083 83441 63327 235181 216876 210272 809097 23178180 0.96510 0.96810 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 293567 130105 141097 282575 380427 134900 221760 293567 348196 108610 76379 380427 534821 72358 258983 348196 0 0 648266 648266 3457505 1105539 2351966 1327336 400521 926815 639910 190644 449266 814241 587393 226848 4603161 RENTAL DEPOSITS 7323 7323 5553108 6111294 -558186 -558186 5626121 73013 73013 5553108 0 5553108 6184307 73013 73013 6111294 0 6111294 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ORGANIZATION HAS SEVERAL TEMPORARILY RESTRICTED NET ASSET FUNDS. THESE INCLUDE THE CAPITAL CAMPAIGN FUND AND THE OHIO DEPARTMENT OF TRANSPORTATION VANS FUND. THE CAPITAL CAMPAIGN FUND IS RESTRICTED TO THE EXPENSES RELATED TO THE PURCHASE AND RENOVATION OF THE LIVINGSTON AVENUE CENTER. THE OHIO DEPARTMENT OF TRANSPORTATION FUND IS RELATED TO THE ELEVEN TRANSPORTATION VANS THAT HAVE BEEN SUBSTANTIALLY FUNDED THROUGH FEDERAL GRANT MONIES FROM THE OHIO DEPARTMENT OF TRANSPORTATION (ODOT). ODOT HAS EIGHT LIENS REMAINING ON THE VANS. IN THE EVENT OF EARLY DISPOSAL, THE VANS CONTRIBUTED TO THE ORGANIZATION HAVE RESTRICTIONS AND REQUIREMENTS FOR THEIR OPERATION AND USE. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION ANNUALLY EVALUATES FOR UNCERTAINTY IN INCOME TAX POSITIONS, WHICH INCLUDES AN ANALYSIS OF WHETHER TAX POSITIONS THE ORGANIZATION TAKES WITH REGARD TO A PARTICULAR ITEM OF INCOME OR DEDUCTION WOULD MEET THE DEFINITION OF AN UNCERTAIN TAX POSITION. AS OF DECEMBER 31, 2011, IRS FORM 990 FILING YEARS 2007 AND PRIOR ARE CLOSED. MANAGEMENT BELIEVES THERE ARE NO UNCERTAIN TAX POSITIONS FOR THE ORGANIZATION. X X X X X X 0 1 0 0 0 0 0 0 0 JOSEPH R KASBERG 0 213767 0 95000 0 25217 0 35204 0 13049 0 382237 0 0 THOMAS W SLEMMER 0 478600 0 158000 0 3697 0 33064 0 10797 0 684158 0 0 DAVID A KAYUHA 0 179306 0 56000 0 1196 0 27009 0 12971 0 276482 0 0 JOSEPH B KUYOTH 0 189484 0 62000 0 2220 0 31095 0 2869 0 287668 0 0 SUPPLEMENTAL INFORMATION PART III NATIONAL CHURCH RESIDENCES, A RELATED ORGANIZATION, ESTABLISHES THE TOP MANAGEMENT OFFICIALS' COMPENSATION. THE FOLLOWING METHODS WERE USED BY NATIONAL CHURCH RESIDENCES TO ESTABLISH COMPENSATION LEVELS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FRANKLIN COUNTY OHIO 316400067 353180GX4 2007-03-15 2500000 TO FINANCE THE ACQUISION & BUILDING IMPROVEMENTS OF THE KARL PLAZA BUILDING 1 0 0 FRANKLIN COUNTY OHIO 316400067 353180FP2 2002-02-15 1325000 TO FINANCE THE ACQUISION & IMPROVEMENTS OF THE LIVINGSTON AVENUE LOCATION 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 0 0 0 0 0 0 0 0 X 2 72634 FAIR MARKET VALUE 0 1 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION SHALL, AT ALL TIMES, BE NATIONAL CHURCH RESIDENCES. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OR TRUSTEES SHALL HAVE THE APPROVAL OF THE BOARD OF TRUSTEES OF NATIONAL CHURCH RESIDENCES. FORM 990, PART VI, SECTION A, LINE 7B NATIONAL CHURCH RESIDENCES IS REQUIRED TO APPROVE THE SELECTION OF THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11 THE 990 RETURN IS MADE AVAILABLE TO THE BOARD PRIOR TO FILING. AN OFFICER REVIEWS THE 990 RETURN PRIOR TO SIGNATURE. FORM 990, PART VI, SECTION B, LINE 12C ANY DIRECTOR, EXECUTIVE OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS IS COVERED UNDER THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. ANY PERSON COVERED UNDER THIS POLICY MUST DISCLOSE THE EXISTENCE OF A CONFLICT AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF BOARD COMMITTEES. ALL DIRECTORS AND OFFICERS SHALL ALSO REVIEW AND SIGN THE CONFLICT OF INTEREST DISCLOSURE STATEMENT ON AN ANNUAL BASIS, IDENTIFYING FAMILY MEMBERS, POSSIBLE RELATED BUSINESSES, AND INVESTMENTS AND PROMPTLY REPORT ANY CHANGES TO THE CHAIRPERSON THAT OCCUR THROUGHOUT THE YEAR. IF A CONFLICT EXISTS, PARTICIPATION AND VOTING RIGHT RESTRICTIONS ARE IMPOSED. FORM 990, PART VI, SECTION B, LINE 15 FOLLOWING AN ESTABLISHED EXECUTIVE COMPENSATION POLICY, THE HUMAN RESOURCE COMMITTEE REVIEWS AND APPROVES SALARIES OF ALL OFFICERS AND REPORTS TO THE EXECUTIVE COMMITTEE ON THEIR ACTION. THE COMMITTEES BASE THE SALARY DECISIONS ON SURVEY DATA FROM COMPARABLE ORGANIZATIONS, USE OF AN INDEPENDENT COMPENSATION CONSULTANT AND ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE. THE COMPENSATION POLICY REVIEW WAS LAST PERFORMED IN 2011. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE PROVIDED UPON REQUEST AND THROUGH A SECURED WEBSITE. FORM 990, PART XII, LINE 2C THE ORGANIZATION HAS AN AUDIT COMMITTEE WHICH OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND IS INVOLVED IN SELECTION OF THE INDEPENDENT ACCOUNTANT WHICH COMPLETES THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VII THOMAS W. SLEMMER, JOSEPH B. KUYOTH, JR., JOSEPH R. KASBERG, AND DAVID KAYUHA WORK AN ESTIMATED 40-50 TOTAL HOURS A WEEK ON THE SOLE MEMBER, NATIONAL CHURCH RESIDENCES, AND ITS AFFILIATES. FORM 990, SCHEDULE R, PART II THE RELATED TAX EXEMPT ORGANIZATIONS ARE ALL MEMBERS OF GROUP EXEMPTION #5048. 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