2012-05-14T14:40:37-05:00 2011-06-30 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2010-07-01 310892356 FRIENDSHIP VILLAGE OF COLUMBUS OHIO INC FRIE 6148908282 5800 FOREST HILLS BLVD COLUMBUS OH 432312957 DAN SHIELDS 6148908282 2012-05-10 1 BERNIE OSTROWSKI 6148493000 2010 2016-02-24 21:20:13Z GREGORY LONGSWAY 5800 FOREST HILLS BLVD COLUMBUS OH 432312957 15579810 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 12 331 48 0 0 80042 147632 15910016 15166305 155866 232227 36871 33646 16182795 15579810 38700 39384 0 0 7636401 7623684 37570 19056 24097 9099998 7915783 16812669 15597907 -629874 -18097 27928483 26598164 33871252 32318041 -5942769 -5719877 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 13546428 15166305 FRIENDSHIP VILLAGE OF COLUMBUS, INC. CONSISTS OF 229 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 WITH RESIDENTS 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. 13546428 1 1 0 1 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 36 0 1 331 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 10.00 X X 0 0 0 MAX THOMPSON 5.00 X X 0 0 0 EDWARD SCHULTZ 5.00 X X 0 0 0 STEVE POTTER 5.00 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 PEG COX 5.00 X 0 0 0 KATHLEEN GUZLEY 5.00 X 0 0 0 SCOTT POWELL 5.00 X 0 0 0 DAN SHIELDS 50.00 X 134960 0 7978 JOE BUCKLEY 50.00 X 61000 0 0 195960 0 7978 1 0 0 0 MEDICAL MUTUAL BOX 298309-100 CLEVELAND OH 44193 HEALTH BENFITS SERVICES 677729 SYSCO FOOD SERVICES 2400 HARRISON ROAD COLUMBUS OH 43204 FOOD SERVICES 657740 REHABWORKS LLC PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 609236 LIFE CARE SERVICES LLC 400 LOCUST ST DES MOINES IA 50309 MANAGEMENT SERVICES 496813 OMNICARE PHARMACY PO BOX 701058 CINCINNATI OH 45270 PHARMACEUTICAL SERVICES 201710 12 147632 147632 APTS./SKILLED NURSING 623000 15166305 15166305 15166305 195639 195639 34064 34064 34064 34064 36398 190 36398 190 36588 36588 OTHER INCOME 900099 -418 -418 -418 15579810 15166305 0 265873 39384 39384 234253 234253 6198832 5516960 681872 37996 26977 11019 660598 587932 72666 492005 452645 39360 437277 437277 59121 59121 47725 47725 19056 19056 841785 681846 159939 348383 348383 1952793 1855153 97640 62180 60936 1244 1049233 1049233 23383 5378 18005 860938 860938 1400169 1356870 43299 113645 113645 FRANCHISE TAXES 394951 394951 BAD DEBT 160767 160767 RECRUITING 86460 86460 RESIDENT ACTIVITIES 34430 34430 CHARITABLE GIVING 5041 5041 37502 37502 15597907 13546428 2027382 24097 1000 730 820390 724626 1014924 1700460 49812 42385 46287 52484 28518 116197 39084741 21291026 18533939 17793715 2900013 2384579 1477428 746110 3056172 3036878 27928483 26598164 2997613 2216201 7922179 7966106 16555000 16070000 6396460 6065734 33871252 32318041 X -6194259 -6075655 251490 355778 -5942769 -5719877 27928483 26598164 X -18097 240989 X 0 1 0 X 0 X 29671 105904 14860 80042 147632 378109 16336550 16201613 15474309 15934979 15166305 79113756 16366221 16307517 15489169 16015021 15313937 79491865 0 0 0 79491865 317928 325683 110746 213953 229703 1198013 317928 325683 110746 213953 229703 1198013 76962 42374 38915 40919 -418 198752 16761111 16675574 15638830 16269893 15543222 80888630 0.98270 0.98170 0.01480 0.01510 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 720 0 0 0 720 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: MEMBERSHIP DUES IN THE AMOUNT OF $18,025 WERE PAID TO AOPHA AND LEADING AGE: 4% ($720) OF THE DUES RELATED TO LOBBYING. 527425 527425 33763406 18611657 15151749 2581938 1931509 650429 2211972 747860 1464112 17793715 ASSETS LIMITED AS TO USE HELD BY TRUSTEE 2579314 BOND ISSUANCE COSTS, NET 457564 3036878 REFUNDABLE ENTRANCE FEES 6065734 6065734 15579810 15597907 -18097 240989 240989 222892 15663863 240989 240989 15422874 156936 156936 15579810 15558523 0 15558523 39384 39384 15597907 PART XII, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 117,552. RECLASS OF HARDSHIP DISCOUNTS 39,384. PART XIII, LINE 4B - OTHER ADJUSTMENTS: RECLASS OF HARDSHIP DISCOUNTS 39,384. X X 1 DOUG ALLINGER 162 WEST COOKE COLUMBUS OH 43214 CONSULTING 0 0 19056 0 19056 OH 1 HARDSHIP DISCOUNTS 3 39384 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. 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 DIRECTOR DAN SHIELDS IS EMPLOYED BY LIFE CARE SERVICES. TOTAL COMPENSATION AND BENEFITS IN 2011 TOTALED $173,253. 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. 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. FORM 990, PART VI, SECTION C, LINE 18 FORM 990 AND FORM 1023 ARE AVAILABLE UPON REQUEST. 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: 240,989.