2012-05-15T14:06:21-05:00 2011-06-30 PLANTE & MORAN PLLC 65 EAST STATE STREET SUITE 600 COLUMBUS OH 43215 990 2010-07-01 311534051 HOLZER SENIOR CARE CENTER HOLZ 7404465060 380 COLONIAL DRIVE BIDWELL OH 45614 KENNETH PAYNE 7404465060 2012-05-15 1 BERNIE OSTROWSKI 6148493000 2010 2016-02-24 21:20:13Z SEE SCHEDULE O TERESA REMY-DETTY 100 JACKSON PIKE GALLIPOLIS OH 45631 9281144 0 X WWW.HOLZER.ORG X 1996 OH HOLZER SENIOR CARE CENTER IS A SKILLED NURSING FACILITY FOR THE CARE AND TREATMENT OF THE SICK, DISABLED, AND INJURED, PROVIDING CARING AND QUALITY SERVICES TOWARD THE ENHANCEMENT OF PHYSICAL AND MENTAL WELL-BEING WITHOUT REGARD TO THE PERSON'S FINANCIAL RESOURCES. 7 3 327 0 0 0 40600 14944 8985906 9159765 52466 9402 93098 97033 9172070 9281144 0 3287 0 0 5301250 5352142 0 0 0 3494911 3361409 8796161 8716838 375909 564306 15439992 15660599 9570056 9237997 5869936 6422602 X NONE 0 0 6543919 3287 9159765 SEE SCHEDULE OHOLZER SENIOR CARE CENTER IS A SEVENTY (70) BED FACILITY, GUIDED BY THE VISION OF QUALITY CARE AND OPTIMUM OUTCOME. IT IS COMMITTED TO IDENTIFY, UNDERSTAND AND RESPOND TO THE NEEDS OF THE RESIDENTS. HOLZER SENIOR CARE CENTER OFFERS:* A MEDICAL DIRECTOR* SKILLED NURSING CARE 24 HOURS PER DAY* REHABILITATION THERAPIES INCLUDING: PHYSICAL THERAPIES, OCCUPATIONAL THERAPIES, SPEECH THERAPY* SHORT AND LONG TERM PLACEMENT OF RESIDENTS* SOCIAL AND THERAPEUTIC ACTIVITIES* PROGRAM FOR HOSPICE PATIENTS* CHAPLAINCY SERVICES* DIETARY SERVICES WITH A QUALIFIED DIETITIAN* PERSONAL CARE (BEAUTICIAN & BARBER SERVICES)* ALL INCLUSIVE ROOM RATE* CABLE TVMEDICAL SUPPORT: HOLZER SENIOR CARE CENTER IS UNDER THE DIRECT SUPERVISION OF A MEDICAL DIRECTOR, WHO HELPS PROVIDE THE LATEST IN HIGH ACUITY CARE. RESIDENTS OF HOLZER SENIOR CARE CENTER MAY USE THE SERVICES OF THE CENTER'S MEDICAL DIRECTOR, OR CONTINUE UNDER THE DIRECT CARE OF THEIR OWN PHYSICIAN. A TRAINED STAFF, COMMITTED TO THE HIGHEST STANDARD IN CARING FOR THE RESIDENTS OF HOLZER SENIOR CARE CENTER IS ON DUTY TWENTY FOUR HOURS A DAY, EVERY DAY.REHABILITATION SERVICES: A COMPLETE RANGE OF REHABILITATION SERVICES IS OFFERED AT HOLZER SENIOR CARE CENTER, CONDUCTED BY REGISTERED THERAPISTS. PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES ARE AVAILABLE TO PROVIDE THE MOST THOROUGH REHABILITATION CARE TO RESIDENTS. A RESTORATIVE NURSING CARE PROGRAM IS AN ONGOING SERVICE TO THE CENTER RESIDENTS. THE WIDE RANGE OF SPECIALIZED THERAPY PROGRAMS ENABLES MANY RESIDENTS TO RESUME THEIR FORMER LIFESTYLES AS THEY BECOME MORE INDEPENDENT.NUTRITIONAL SERVICES: RESIDENTS AT HOLZER SENIOR CARE CENTER ENJOY NUTRITIONAL AND APPETIZING MEALS IN A COMFORTABLE AND ATTRACTIVE DINING SETTING. A REGISTERED DIETITIAN WHO SPECIALIZES IN MEETING EACH RESIDENT'S NEEDS PLANS THE MENUS. BED SIDE SERVICE IS AVAILABLE FOR THOSE RESIDENTS WHO ARE UNABLE TO GO TO THE DINING ROOM FOR THEIR MEALS. FAMILY AND FRIENDS WHO WISH TO DINE WITH THEIR LOVED ONES MAY ALSO PURCHASE A MEAL FOR A NOMINAL FEE.SOCIAL AND RECREATIONAL ACTIVITIES: THE OVERALL ACTIVITY PROGRAM AT HOLZER SENIOR CARE CENTER IS THERAPEUTICALLY DESIGNED BY A QUALIFIED AND EXPERIENCED ACTIVITIES COORDINATOR, WHO GIVES SPECIAL ATTENTION TO THE PHYSICAL, MENTAL, SPIRITUAL, AND SOCIAL NEEDS OF EACH RESIDENT. THERE IS SOMETHING FOR EVERYONE. AMONG THE MOST POPULAR EVENTS ARE THE GAMES, CRAFTS, SING-ALONGS, RELIGIOUS SERVICES, PICNICS, AND COMMUNITY OUTINGS. EACH RESIDENT IS ENCOURAGED TO PARTICIPATE IN WHATEVER ACTIVITIES PROVIDE THE MOST FULFILLMENT AND BEST SERVES HIS OR HER PERSONAL NEEDS.ACCOMMODATIONS: A COMFORTABLE HOME-LIKE SETTING CAN PLAY A MAJOR ROLE IN RESTORING HEALTH AND WELL-BEING. THE ROOMS AT HOLZER SENIOR CARE CENTER ARE SPACIOUS AND SUNNY WITH WINDOWS THAT BRING IN AN ABUNDANCE OF NATURAL LIGHT. RESIDENTS ARE ENCOURAGED TO DECORATE THEIR ROOMS WITH FAVORITE PERSONAL BELONGINGS, SUCH AS QUILTS, PILLOWS, AND PICTURES. THE ROOM RATE AT HOLZER SENIOR CARE CENTER IS AN ALL-INCLUSIVE RATE. NO ADDITIONAL CHARGES ARE MADE FOR PERSONAL GROOMING ITEMS OR LAUNDRY SERVICES. THE ATTRACTIVE SOLARIUM AREAS ARE ALWAYS AVAILABLE FOR THE ENJOYMENT OF THE RESIDENTS, THEIR FAMILIES AND FRIENDS. QUALITY OF LIFE: EVERY MEMBER OF THE STAFF AT HOLZER SENIOR CARE CENTER IS COMMITTED TO ADDRESSING AND MEETING THE NEEDS OF EACH RESIDENT ON A PERSONAL BASIS. THEY RESPECT EVERY RESIDENT'S RIGHT TO PRIVACY, DIGNITY AND TREATMENT AS AN INDIVIDUAL.DURING THE YEAR, HOLZER SENIOR CARE SERVED 24,820 PATIENT DAYS AND ASSISTED LIVING SERVED 29,200 PATIENT DAYS. 6543919 1 1 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 0 0 0 0 1 1 1 1 0 0 1 8 0 1 327 1 0 0 0 0 0 0 0 0 0 0 X 7 3 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X WILLIAM CRABTREE 7402880192 190 WATER ST SUITE 4 JACKSON OH 45640 X STEVE CHAPMAN CPA 1.00 X X 0 18750 0 ALAN STOCKMEISTER 1.00 X X 0 19000 0 PHIL A BOWMAN PARTIAL YR 1.00 X X 0 17750 0 RYAN SMITH 1.00 X X 0 19500 0 BRENT SAUNDERS 1.00 X 0 299928 0 VERLIN L SWAIN PARTIAL YR 1.00 X 0 19000 0 TERESA REMY DETTY 40.00 X X 177107 0 12488 WILLIAM CRABTREE 40.00 X X 89924 0 973 THOMAS TOPE 1.00 X 0 427722 0 PETE DETTY 40.00 X 59543 0 600 TERESA COFFEE 40.00 X 71328 0 5457 PEGGY WILLIAMS 40.00 X 76933 0 14515 KENNETH PAYNE 1.00 X 0 265766 8098 KEVIN YEAGER 40.00 X 0 0 0 474835 1087416 42131 1 1 1 0 REHABCARE GROUP PO BOX 503534 ST LOUIS MO 63150 THERAPY 413704 GORDON FOOD SERVICE DEPT 10490 PALATINE IL 60055 DIETARY SERVICES 124234 SKILLED CARE PHARMACY 6175 HI-TEK COURT MASON OH 45040 PHARMACY SERVICES 116600 3 14944 14944 PROGRAM SERVICES 623000 8609547 8609547 RESIDENT MEALS 623000 506683 506683 ADMISSION FEES 623000 43535 43535 9159765 9402 9402 OTHER MEALS & VENDING 623000 37652 37652 PHONE INCOME 623000 26344 26344 CABLE TV INCOME 623000 21812 21812 11225 11225 97033 9281144 9159765 0 106435 3287 3287 185255 185255 4083076 3143968 939108 481 370 111 780202 600756 179446 303128 233409 69719 5271 5271 69691 69691 428574 330002 98572 81028 81028 996988 767681 229307 395564 304584 90980 9159 9159 385601 296913 88688 408914 314864 94050 141451 108917 32534 OHIO BED TAX 306600 306600 RESIDENT SERVICES 76083 76083 BAD DEBT EXPENSE 39188 39188 EMPLOYEE EXPENSES 9331 9331 LICENSE FEES 3097 3097 4869 4869 8716838 6543919 2172919 0 1500 1500 918969 979752 623590 449607 10000 10000 107471 68933 13114307 4783178 8183655 8331129 517571 757246 4432080 4432080 645156 630352 15439992 15660599 1048509 1102719 7428416 7107853 1093131 1027425 9570056 9237997 X 5869936 6422602 5869936 6422602 15439992 15660599 X 564306 -11640 X X 0 1 1 X 0 X 40600 14944 55544 7481839 8033379 8836134 8985906 9159765 42497023 7481839 8033379 8836134 9026506 9174709 42552567 0 0 0 42552567 44079 63135 40554 52466 9402 209636 44079 63135 40554 52466 9402 209636 218079 126466 -14923 93098 97033 519753 7743997 8222980 8861765 9172070 9281144 43281956 0.98310 0.98250 0.00480 0.00510 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: GUEST MEALS BARBER & BEAUTY SERVICES VENDING MACHINES PHONE INCOME CABLE TV INCOME MISCELLANEOUS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 542107 542107 9388407 3658334 5730073 609049 104754 504295 1737701 962224 775477 837043 57866 779177 8331129 COST REPORT SETTLEMENTS 3141 RELATED PARTY PAYABLE 1024284 1027425 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE INTERNAL REVENUE SERVICE HAS RULED THAT THE SYSTEM IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AS A PUBLIC CHARITY DESCRIBED IN SECTION 509(A)(2); ACCORDINGLY, NO PROVISION FOR FEDERAL INCOME TAXES HAS BEEN MADE IN THE CONSOLIDATED FINANCIAL STATEMENTS. ALL OF THE SYSTEM'S SUBSIDIARIES, WITH THE EXCEPTION OF HOLZER VANGUARD, HAVE ALSO BEEN DETERMINED TO BE TAX EXEMPT BY THE INTERNAL REVENUE SERVICE. HOLZER VANGUARD IS A TAXABLE CORPORATION. IT FILES INCOME TAX RETURNS BASED ON ITS TAXABLE INCOME. FOR THE YEARS ENDED JUNE 30, 2011 AND 2010, FEDERAL INCOME TAXES WERE NOT SIGNIFICANT. THE SYSTEM FILES FEDERAL AND STATE TAX RETURNS AND IS NO LONGER SUBJECT TO FEDERAL, STATE, OR LOCAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE FISCAL YEAR 2008. 1 0 0 0 0 0 0 0 0 BRENT SAUNDERS 0 299928 0 0 0 0 0 0 0 0 0 299928 0 0 TERESA REMY DETTY 177107 0 0 0 0 0 0 0 12488 0 189595 0 0 0 THOMAS TOPE 0 0 0 0 0 427722 0 0 0 0 0 427722 0 0 KENNETH PAYNE 0 265766 0 0 0 0 0 0 0 8098 0 273864 0 0 PART I, LINE 4A DURING THE CALENDAR YEAR, THOMAS TOPE RECEIVED SEVERANCE PAY IN THE AMOUNT OF $427,722. UNDER THE TERMS OF THE SEVERANCE AGREEMENT, MR. TOPE WILL RECEIVE 100% OF BASE SALARY AND OTHER BENEFITS AS OF THE TERMINATION DATE, 7/1/09, THROUGH 1/1/11. HE WILL ALSO BE ENTITLED TO AN ANNUAL AUTO ALLOWANCE, PARTICIPATION IN THE HOSPITAL'S GROUP LIFE INSURANCE PLAN, QUARTERLY PAYMENTS DIRECTLY FROM THE HOSPITAL TO MR. TOPE IN AN AMOUNT EQUAL TO THE 457(F) CONTRIBUTION, AND OTHER PENSION PLAN PAYMENTS DIRECTLY FROM THE HOSPITAL TO MR. TOPE BASED ON THE MAXIMUM DEFFERAL ALLOWED. FOLLOWING THIS 18 MONTH PERIOD, MR. TOPE WILL ALSO RECEIVE AN AMOUNT EQUAL TO 22 WEEKS OF BASE SALARY, PLUS 4 WEEKS OF BASE SALARY AS ADDITIONAL RETIREMENT CONSIDERATION (BASED ON THE SALARY IN EFFECT AT THE TERMINATION DATE). SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: COMPENSATION PAID TO THE ORGANIZATION'S CEO IS ESTABLISHED BY A RELATED ORGANIZATION AND INCLUDES USE OF AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 6 HOLZER CONSOLIDATED HEALTH SYSTEMS IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B HOLZER SENIOR CARE CENTER'S DECISIONS THAT ARE MADE BY THEIR BOARD OF DIRECTORS CAN BE OVERRULED BY HOLZER CONSOLIDATED HEALTH SYSTEM'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE CONTROLLER AND THE CFO OF HOLZER CONSOLIDATED HEALTH SYSTEMS REVIEW FORM 990. A COPY WILL BE PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST STATEMENTS ARE COMPLETED ANNUALLY BY ALL OFFICERS, BOARD MEMBERS, AND EMPLOYEES, AND ARE REVIEWED BY THE CONFLICT OF INTEREST REVIEW COMMITTEE. MEMBERS OF THE BOARD ARE AWARE THAT THEY SHOULD DISCLOSE CONFLICTS WHEN THEY ARISE, AND MEMBERS ABSTAIN FROM PARTICIPATING IN DISCUSSIONS OR VOTING ON MATTERS WHERE A CONFLICT IS PRESENT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF OFFICERS IS BASED ON EXPERIENCE AND MARKET VALUE AS EVIDENCED BY COMPARABILITY DATA AND IS APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. OFFICER COMPENSATION DECISIONS THAT ARE MADE ARE DOCUMENTED IN THE EXECUTIVE COMMITTEE MEETING MINUTES. THE PROCESS WAS LAST UPDATED DECEMBER 2011. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PAGE 7, PART VII: THE FOLLOWING OFFICERS DEVOTED TIME TO HOLZER CONSOLIDATED HEALTH SYSTEMS: STEVE CHAPMAN 1 HRS ALAN A. STOCKMEISTER 1 HRS PHIL A. BOWMAN 1 HRS RYAN SMITH 1 HRS THE FOLLOWING TRUSTEE DEVOTED TIME TO HOLZER CONSOLIDATED HEALTH SYSTEMS: VERLIN L. SWAIN 1 HRS THE FOLLOWING OFFICERS DEVOTED TIME TO HOLZER HOSPITAL FOUNDATION: KENNETH PAYNE 40 HRS BRENT SAUNDERS 40 HRS THOMAS TOPE .8 HRS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PRIOR PERIOD ADJUSTMENTS: 17. CONTRIBUTION & GRANT FROM/TO HOLZER FOUNDATION NOT RECORDED ON FINANCIALS. -11,657. TOTAL TO FORM 990, PART XI, LINE 5: -11,640. FORM 990, PART XII, LINE 2C: THE AUDIT OVERSIGHT PROCESS AND THE PROCESS OF SELECTION OF AN INDEPENDENT ACCOUNTANT HAVE NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PAGE 1, LINE C: DOING BUSINESS AS: HOLZER ASSISTED LIVING - GALLIPOLIS HOLZER ASSISTED LIVING - JACKSON GALLIA HEALTH PARTNERS LLC 300 BRIARWOOD DR GALLIPOLIS OH 45631 311534051 ASSISTED LIVING OH 2108990 6161430 HOLZER SENIOR CARE CENTER JACKSON HEALTH PARTNERS LLC 101 MARKHAM DRIVE JACKSON OH 45640 311534051 ASSISTED LIVING OH 1653239 5130443 HOLZER SENIOR CARE CENTER HOLZER CONSOLIDATED HEALTH SYSTEMS 100 JACKSON PIKE GALLIPOLIS OH 45631 311156690 MANAGEMENT SERVICES OH 501(C)(3) LINE 11A, I N/A 0 HOLZER HOSPITAL FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 314379491 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER CONSOLIDATED HEALTH SYSTEMS 1 HOLZER MEDICAL CENTER - JACKSON 100 JACKSON PIKE GALLIPOLIS OH 45631 311724085 HEALTH CARE OH 501(C)(3) LINE 3 HOLZER CONSOLIDATED HEALTH SYSTEMS 1 HOLZER FOUNDATION 100 JACKSON PIKE GALLIPOLIS OH 45631 310927482 CONTINUING ADVANCEMENT OF HEALTH AND MEDICAL CARE OH 501(C)(3) LINE 7 HOLZER CONSOLIDATED HEALTH SYSTEMS 1 HOLZER CARDIOVASCULAR LLC 90 JACKSON PIKE GALLIPOLIS OH 45631 311780671 MEDICAL OH N/A HOLZER VANGUARD INC 100 JACKSON PIKE GALLIPOLIS OH 45631 311192567 STOCK HOLDING COMPANY OH N/A C 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 NONE GREATER THAN 50000