2011-08-10T13:36:08-05:00 2010-12-31 BATTELLE & BATTELLE LLP 2000 WEST DOROTHY LANE DAYTON OH 45439 990 2010-01-01 310641121 WIDOWS HOME OF DAYTON OHIO WIDO 9372521661 50 SOUTH FINDLAY STREET DAYTON OH 45403 WILLIAM G DEAS 9372521661 2011-08-09 1 KAREN O CRIM 9372980201 2010 2016-02-24 21:20:13Z WILLIAM G DEAS 50 SOUTH FINDLAY STREET DAYTON OH 45403 5818980 0 X WWW.WIDOWSHOME.ORG X 1961 OH THE PURPOSE OF THE WIDOWS HOME IS TO PROVIDE LONG-TERM CARE SERVICES TO ELDERLY INDIVIDUALS. 10 10 181 85 0 0 0 0 5726041 5817943 0 0 0 1037 5726041 5818980 0 0 0 0 2763531 2839919 0 0 0 3016925 3100474 5780456 5940393 -54415 -121413 8106933 7830247 9013146 8861176 -906213 -1030929 THE PURPOSE OF THE WIDOWS HOME IS TO PROVIDE LONG-TERM CARE SERVICES TO ELDERLY INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. 0 0 4824682 5817943 THE WIDOWS HOME OF DAYTON, OHIO PROVIDES LONG-TERM NURSING AND RESIDENTIAL CARE, SHORT-TERM REHABILITATION, AND ADULT DAY PROGRAMS TO ELDERLY INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. THE HOME IS AN INNER-CITY FACILITY WITH 75 LICENSED BEDS. 4824682 1 0 0 1 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 24 0 181 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 1 0 0 0 OH X UNITED CHURCH HOMES MANAGEMENT 7403824885 170 EAST CENTER ST MARION OH 433011806 X BILL DEAS 1.00 X X 0 0 0 SUSAN MOLL 0.50 X X 0 0 0 ROBERT APPLEBAUM 0.50 X 0 0 0 GAIL MODDEMAN 0.50 X 0 0 0 ROSE WILDENHAUS 0.50 X 0 0 0 JANE CLIFTON 0.50 X 0 0 0 MARILYN HOBACK 0.50 X X 0 0 0 ANNE VEGHTE 0.50 X 0 0 0 NANCY HINES 0.50 X 0 0 0 ROBERT PROPHATER 0.50 X 0 0 0 MICHAEL D FREEMAN 40.00 X 0 0 0 0 0 0 0 0 0 1 ALPHA & OMEGA STAFFING SOLUTIONS 6276 PLATTSBURG ROAD SOUTH CHARLESTON OH 45368 THERAPY SERVICES 486243 UNITED CHURCH HOMES MANAGEMENT INC 170 EAST CENTER STREET MARION OH 433011806 MANAGEMENT SERVICES CONTRACT 389307 BEEBERS PHARMACIES PO BOX 715268 COLUMBUS OH 432715268 PHARMACY SERVICES 168486 GORDON FOOD SERVICE PO BOX 22544 GRAND RAPIDS MI 49501 FOOD SERVICES 154029 4 MEDICARE/MEDICAID PAYM 623000 4440835 4440835 LIFE CARE RESIDENTS 623000 819259 819259 PRIVATE PAY RESIDENTS 623000 508071 508071 SENIOR ADULT DAY CARE 623000 49778 49778 5817943 OTHER INCOME 900099 1037 1037 1037 5818980 5817943 0 1037 92891 92891 1995585 1927493 68092 179363 173122 6241 572080 519354 52726 296416 296416 1933 1933 17400 17400 21392 21392 322681 322681 393856 393856 HEALTH SERVICES 1089911 1089911 BED TAX 329805 329805 DIETARY 185720 185720 ADMINISTRATION 166476 166476 UTILITIES 164712 131770 32942 110172 80775 29397 5940393 4824682 1115711 0 158681 145385 614592 698922 9230 5722 28629 41126 10831995 3900717 7284824 6931278 10977 7814 8106933 7830247 547980 628188 4873246 4567897 14830 9331 3577090 3655760 9013146 8861176 X -906213 -1030929 -906213 -1030929 8106933 7830247 X -121413 -3303 X X 0 1 1 X 0 X 3143297 3111990 4420400 5677102 5768165 22120954 3143297 3111990 4420400 5677102 5768165 22120954 0 0 0 22120954 49337 44818 47293 48939 49778 240165 49337 44818 47293 48939 49778 240165 3192634 3156808 4467693 5726041 5817943 22361119 0.98930 0.98830 0.01070 0.01170 X 0 0 0 0 0 0 0 0 1 0 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: A SMALL PORTION OF THE ORGANIZATION'S DUES PAID TO LEADINGAGE OHIO (FKA AOPHA) IS ALLOCABLE TO LOBBYING. 0 1 131650 131650 8939009 3124373 5814636 1761336 776344 984992 6931278 ACCRUED EXPENSES 338535 DEFERRED COST OF INTEREST RATE SWAP 334199 FUNDS ADVANCED FROM WIDOWS HOME FOUNDATION - RELATED ORGANIZATION 2983026 3655760 PART IV, LINE 2B: RESIDENT SAVINGS ACCOUNTS ARE HELD IN A SEPARATE BANK ACCOUNT. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOME AND THE FOUNDATION QUALIFY AS TAX-EXEMPT NON-PROFIT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR FEDERAL INCOME TAX IS REQUIRED. MANAGEMENT EVALUATED THE HOME AND THE FOUNDATION'S TAX POSITIONS AS OF DECEMBER 31, 2010 AND 2009 AND CONCLUDED THAT THEY HAVE TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE CONSOLIDATED FINANCIAL STATEMENTS. IN GENERAL, THE HOME AND FOUNDATION ARE NO LONGER SUBJECT TO FEDERAL, STATE, OR LOCAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2007. 0 0 0 0 0 0 0 0 0 SUPPLEMENTAL INFORMATION PART III MICHAEL D. FREEMAN, ADMINISTRATOR OF THE WIDOWS HOME OF DAYTON, OHIO, IS EMPLOYED BY UNITED CHURCH HOMES MANAGEMENT, INC., AN UNRELATED ORGANIZATION. HIS REPORTABLE COMPENSATION WAS $75,523 PER FORM W-2 BOX 5. HE RECEIVED A RETIREMENT PLAN CONTRIBUTION ($1,250), HEALTH INSURANCE ($12,674), AND OTHER NONTAXABLE BENEFITS - SECTION 125 PLAN ($3,444) FROM THE UNRELATED MANAGEMENT COMPANY. THERE IS NO OWNERSHIP INTEREST IN UNITED CHURCH HOMES MANAGEMENT, INC. BY THE WIDOWS HOME OF DAYTON OR ANY OFFICERS OR BOARD MEMBERS OF THE WIDOWS HOME OF DAYTON, OHIO. CITY OF RIVERSIDE 316000133 2003-12-29 2500000 25 BED EXPANSION 0 0 0 2500000 2008 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 UNITED CHURCH HOMES MANAGEMENT, INC. PROVIDES MANAGEMENT AND CONSULTING SERVICES, FINANCIAL MANAGEMENT, HUMAN RESOURCES, CENSUS AND BUSINESS DEVELOPMENT, MEDICARE BILLING SERVICES, AND SIMILAR MANAGEMENT SERVICES TO THE WIDOWS HOME OF DAYTON. THE ADMINISTRATOR OF THE WIDOWS HOME IS EMPLOYED BY UNITED CHURCH HOMES MANAGEMENT, INC. AND RECEIVES SALARY AND BENEFITS FROM THAT ORGANIZATION. THERE IS NO OWNERSHIP INTEREST IN UNITED CHURCH HOMES MANAGEMENT, INC. BY THE WIDOWS HOME OF DAYTON OR ANY OFFICERS OR BOARD MEMBERS OF THE WIDOWS HOME. FORM 990, PART VI, SECTION A, LINE 8B COMMITTEE MEETING MINUTES WERE NOT TAKEN. HOWEVER, THE DISCUSSIONS DURING COMMITTEE MEETINGS ARE REPORTED AT BOARD MEETINGS AND ARE DOCUMENTED IN THE BOARD MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WILL BE PROVIDED TO BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS PROVIDE SELF-DISCLOSURE OF CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP -3,464. CHANGE IN OBLIGATION TO PROVIDE FUTURE CARE 161. TOTAL TO FORM 990, PART XI, LINE 5: -3,303. FORM 990, PART XI, LINE 2C THE ORGANIZATION'S COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS HAS NOT CHANGED THAT PROCESS FROM THE PRIOR YEAR. THE FINANCIAL STATEMENTS ARE CONSOLIDATED WITH THE WIDOWS HOME FOUNDATION, A PUBLIC CHARITY WHOSE PURPOSE IS TO CONDUCT FUNDRAISING ACTIVITIES AND MANAGE THE ENDOWMENT FUNDS FOR THE BENEFIT OF THE WIDOWS HOME OF DAYTON. WIDOWS HOME FOUNDATION 50 SOUTH FINDLAY STREET DAYTON OH 45403 311584036 TO CONDUCT FUNDRAISING ACTIVITIES AND MANAGE ENDOWMENT FUNDS. OH 501(C)(3) LINE 7 N/A 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 WIDOWS HOME FOUNDATION E 2983026 FAIR MARKET VALUE