2012-03-26T12:57:32-05:00 2011-08-31 JONES NALE & MATTINGLY PLC 642 SOUTH FOURTH AVENUE SUITE 300 LOUISVILLE KY 40202 990 2010-09-01 510155793 NAZARETH LITERARY & BENEVOLENT INSTITUTION NAZARETH HOME NAZA 5024599681 2000 NEWBURG ROAD LOUISVILLE KY 40205 KEVIN WHEATLEY 5024599681 2012-03-26 1 DENNIS G MARTIN 5025830248 2010 2016-02-24 21:20:13Z KEVIN WHEATLEY 2000 NEWBURG ROAD LOUISVILLE KY 40205 15140348 0 X N/A X BRANCH 1976 KY TO SERVE ALL THOSE WHO NEED LONG TERM NURSING CARE AND REHABILITATION SERVICES IN THE SPIRIT OF JESUS AND THE TRADITION OF ITS SPONSOR, THE SISTERS OF CHARITY OF NAZARETH. 12 12 358 50 0 0 29506 90705 13409500 13774912 859 267 133180 1274464 13573045 15140348 0 0 0 0 8889592 9389410 0 0 0 5136979 5497200 14026571 14886610 -453526 253738 25805074 26312076 758326 1011590 25046748 25300486 SEE PREVIOUS STATEMENT, PART I. 0 0 13266756 15049376 NURSING HOME PROVIDING SKILLED, INTERMEDIATE, AND PERSONAL CARE SERVICES AS WELL AS ANCILLARY SERVICES TO THE RESIDENTS. 13266756 1 1 0 0 0 0 0 0 0 1 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 0 0 0 0 0 0 0 0 0 0 0 0 1 19 0 358 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 0 1 1 1 0 X KEVIN WHEATLEY 5024599681 2000 NEWBURG ROAD LOUISVILLE KY 40205 ELIZABETH RAPP X 0 0 0 REV JERRY EIFLER X 0 0 0 NICK ISING X 0 0 0 JUDY RALEY X 0 0 0 JACQUELINE ACETO X 0 0 0 MARY ZEHNDER X 0 0 0 ZACH STERNS MD X 0 0 0 MICHAEL D LUSH X 0 0 0 THERESA BATLINER X 0 0 0 MARY HAYNES 40.00 X X 117827 0 11443 KEVIN WHEATLEY 40.00 X 93383 0 2521 SANDRA KING 40.00 X 86338 0 6103 297548 0 20067 1 0 0 0 ANTHEM BLUE CROSS BLUE SHIELD 9901 LINN STATION RD LOUISVILLE KY 40223 GROUP HEALTH INSURANCE 700937 HEALTHCARE THERAPY SERVICES 1411 W COUNTRY LINE RD SUITE A GREENWOOD IN 46142 REHAB/THERAPY 605931 MEDCARE PHARMACY 350 ARISTOCRAT DR FLORENCE KY 41042 PHARMACY SERVICES 403023 WAKER MECHANICAL CONTRACTORS 1400 WEST JEFFERSON STREET LOUISVILLE KY 40203 HVAC SYSTEMS 342208 SYSCO CORPORATION - LOUISVILLE 7705 NATIONAL TPKE LOUISVILLE KY 40214 FOOD SUPPLIES 281660 5 90705 90705 NET PATIENT SERVICE RE 623000 13774912 13774912 13774912 267 267 SCN SUBSIDY 623000 1274464 1274464 1274464 15140348 15049376 0 267 7729163 7049287 679876 88277 68144 20133 1018320 968696 49624 553650 504787 48863 5891 5891 32090 32090 20148 20148 17798 17752 46 994754 945017 49737 85835 85835 SUPPLIES 1795869 1729439 66430 PURCHASED SERVICES 1460410 1441049 19361 PLANT & EQUIPMENT REPAI 466962 466962 PROVIDER TAX 367354 367354 EDUCATION 33033 23007 10026 217056 52616 164440 14886610 13266756 1619854 0 1097700 1229414 1023249 1361054 24787 20248 37196952 13495592 23659338 23701360 25805074 26312076 758326 1011590 758326 1011590 X 25046748 25300486 25046748 25300486 25805074 26312076 253738 0 X X 0 1 1 X 0 X 29643 23896 29506 90705 173750 12256608 12265791 13183121 13409500 13774912 64889932 12256608 12295434 13207017 13439006 13865617 65063682 0 0 0 65063682 15242 31595 24390 30365 90972 192564 12271850 12327029 13231407 13469371 13956589 65256246 0.99700 0.99810 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 33340891 10659691 22681200 3706825 2709684 997141 149236 126217 23019 23701360 15140348 14886610 253738 0 253738 15140348 0 15140348 0 15140348 14886610 0 14886610 0 14886610 SUBSEQUENT EVENT FORM 990, PART I, LINE 22 EFFECTIVE SEPTEMBER 1, 2011, NAZARETH LITERARY AND BENEVOLENT INSTITUTION (NLBI) CONVEYED TO NAZARETH HOME, INC, THE ASSETS AND OPERATIONS OF THE FACILITY OPERATED AS NAZARETH HOME. THE BUILDING AND IMPROVEMENTS CURRENTLY CARRIED BY NAZARETH HOME WILL BE TRANSFERRED TO NLBI AND LEASED ALONG WITH THE LAND ON WHICH THE BUILDING STANDS TO NAZARETH HOME, INC. NAZARETH HOME,INC. WILL FILE FORM 990 FOR THE YEAR BEGINNING SEPTEMBER 1, 2011 AND ENDING AUGUST 31, 2012 TO REPORT THE OPERATIONS OF NAZARETH HOME. AS A RESULT, THIS RETURN WILL CONSTITUTE A FINAL RETURN BEING FILED UNDER THE NAME OF NAZARETH LITERARY & BENEVOLENT INSTITUTION NAZARETH HOME. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WILL BE REVIEWED BY THE FINANCE COMMITTEE BEFORE FILING FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY AND DISCLOSURE STATEMENT ARE FURNISHED TO BOARD MEMBERS ANNUALLY TO BE COMPLETED AND SIGNED BY THE BOARD MEMBER. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES IS DETERMINED BY AN ANNUAL REVIEW OF JOB GRADES AND CURRENT COMPARABLE INDUSTRY STANDARDS. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS CAN BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC FORM 990, PART VII ELIZABETH RAPP - 101 SOUTH FIFTH STREET, LOUISVILLE, KY 40202. REV. JERRY EIFLER - 572 UPLAND ROAD, LOUISVILLE, KY 40206. NICK ISING - 1324 E. WASHINGTON STREET, LOUISVILLE, KY 40206. JUDY RALEY - PO BOX 187, NAZARETH, KY 40048. JACQUELINE ACETO - 2002 NEWBURG ROAD, LOUISVILLE, KY 40205. MARY ZEHNDER - 3309 WILLOW WAY, LOUISVILLE, KY 40218. ZACH STERNS, M.D. - 3 AUDOBON PLAZA DRIVE SUITE 420, LOUISVILLE, KY 40217. MICHAEL D. LUSH - 4801 ELMCROFT LANE, LOUISVILLE, KY 40241. THERESA BATLINER - 462 SOUTH FOURTH STREET, LOUISVILLE, KY 40202. FORM 990, PART XI, LINE 2C: THE NAZARETH HOME ADVISORY BOARD HAS A FINANCE COMMITTEE WHICH ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS. NLBI APPOINTS/SELECTS THE AUDITOR FOR NAZARETH HOME AFTER CONSULATION WITH THE NAZARETH HOME ADVISORY BOARD FINANCE COMMITTEE.