2011-01-13T07:28:13-06:00 2010-08-31 JONES NALE & MATTINGLY PLC 642 SOUTH FOURTH AVENUE SUITE 300 LOUISVILLE KY 40202 990 2009-09-01 510155793 NAZARETH LITERARY & BENEVOLENT INSTITUTION NAZARETH HOME NAZA 5024599681 2000 NEWBURG ROAD LOUISVILLE KY 40205 KEVIN WHEATLEY 5024599681 2011-01-10 1 DENNIS G MARTIN 5025830248 2009 2016-02-24 21:20:13Z KEVIN WHEATLEY 2000 NEWBURG ROAD LOUISVILLE KY 40205 13573045 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 12 360 50 0 0 23896 29506 13183121 13409500 494 859 840000 133180 14047511 13573045 0 0 9107791 8889592 0 0 5497596 5136979 14605387 14026571 -557876 -453526 26304043 25805074 803769 758326 25500274 25046748 SEE PREVIOUS STATEMENT, PART I. 0 0 12448322 13542680 NURSING HOME PROVIDING SKILLED, INTERMEDIATE, AND PERSONAL CARE SERVICES AS WELL AS ANCILLARY SERVICES TO THE RESIDENTS. 12448322 1 1 0 0 0 0 0 0 0 1 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 1 21 0 0 360 1 0 0 0 0 0 0 0 0 0 0 0 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 lynn fieldhouse X 0 0 0 theresa batliner X 0 0 0 rev william hammer X 0 0 0 susan thomas 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 JENNIFER HARTLAGE X 0 0 0 Mary haynes 40.00 X X 110596 0 10027 kevin wheatley 40.00 X 91950 0 1843 SANDRA KING 40.00 X 87644 0 5430 290190 0 17300 1 0 0 0 anthem blue cross blue shield 9901 linn station rd louisville KY 40223 group health insurance 1049016 healthcare therapy services 1411 w country line rd suite a greenwood IN 46142 rehab/therapy 950618 medcare pharmacy 350 aristocrat dr florence KY 41042 pharmacy services 597550 SYSCO CORPORATION - LOUISVILLE 7705 NATIONAL TPKE LOUISVILLE KY 40214 FOOD SUPPLIES 413308 LOUISVILLE GAS & ELECTRIC 820 W BROADWAY LOUISVILLE KY 40202 ELECTRICITY/GAS 261225 7 29506 29506 NET PATIENT SERVICE RE 623000 13409500 13409500 13409500 859 859 scn subsidy 623000 133180 133180 133180 13573045 13542680 0 859 7278247 6639617 638630 73488 58344 15144 1010718 952940 57778 527139 480459 46680 1473 1473 21832 21832 22146 22146 17144 17144 981564 932486 49078 89025 89025 SUPPLIES 1666231 1593679 72552 purchased services 1357734 1332806 24928 provider tax 372463 372463 PLANT & EQUIPMENT REPAI 365665 365665 EDUCATION 41587 28985 12602 200115 46197 153918 14026571 12448322 1578249 0 495272 1097700 1241956 1023249 88524 24787 36160175 12500837 24478291 23659338 26304043 25805074 803769 758326 803769 758326 X 25500274 25046748 25500274 25046748 26304043 25805074 X 0 1 1 X 0 X 23896 29506 53402 11449348 12256608 12265791 13183121 13409500 62564368 11449348 12256608 12265791 13207017 13439006 62617770 0 0 0 62617770 19584 15242 31595 24390 30365 121176 11468932 12271850 12297386 13231407 13469371 62738946 0.99810 0.99830 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 32484891 9867153 22617738 3535448 2513400 1022047 139836 120284 19553 23659338 13573045 14026571 -453526 0 -453526 13573045 0 13573045 0 13573045 14026571 0 14026571 0 14026571 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 Form 990, Part VII Contact Addresses for Officers, Directors, Etc elizabeth rapp - 101 south fifth street, louisville, KY 40202. lynn fieldhouse - 2700 national city tower, louisville, KY 40202. theresa batliner - 462 s. fourth street, louisville, KY 40202. rev. william hammer - po box 548, bardstown, KY 40004. susan thomas - 3436 illinois avenue, louisville, KY 40213. nick ising - 1324 e. washington street, louisville, KY 40206. judy raley - po box 187, nazareth, KY 40048. JACQUELINE ACETO - 1990 newburg rd, louisville, KY 40205. MARY ZEHNDER - 80 VILLAGE DRIVE APT 28, NAZARETH, KY 40048. ZACH STERNS, M.D. - 3 AUDUBON PLAZA DRIVE, SUITE 220, LOUIsville, KY 40217. MICHAEL D. LUSH - 4801 ELMCROFT LANE, LOUISVILLE, KY 40241. JENNIFER HARTLAGE - 2427 GLENMARY AVENUE, LOUISVILLE, KY 40204. 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.