2025-11-17T12:47:39-06:00 2024-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2024-01-01 341137582 OTTERBEIN GREEN HILLS INC OTTE 4197241225 6557 US HIGHWAY 68 S WEST LIBERTY OH 43357 J CHRISTOPHER GREEN CFO 4197241225 2025-11-17 1 1 AMBER HAMILTON P01251012 3149254300 2025-11-17 2024 2025-03-06 01:10:19Z X J CHRISTOPHER GREEN 3855 LOWER MARKET STREET SUITE 300 LEBANON OH 45036 10485663 0 X HTTPS://OTTERBEIN.ORG/FIND-A-LOCATION/GREEN-HILLS X 1972 OH CONTINUING CARE RETIREMENT COMMUNITY THAT PROVIDES HOUSING AND SERVICES FOR OLDER ADULTS. 15 12 344 10 0 0 2281355 905093 9736685 9157615 47792 51631 124224 371324 12190056 10485663 0 0 0 0 7350121 5453825 0 0 0 5247320 6703723 12597441 12157548 -407385 -1671885 9204929 7741010 9284346 9492312 -79417 -1751302 INSPIRED BY FAITH, WE STRIVE TO ENRICH INDIVIDUAL LIFE JOURNEYS FOR ALL. 0 0 10442333 0 9089342 OTTERBEIN GREEN HILLS, INC ROVIDES PERSONAL CARE AND LONG-TERM RESIDENCY TO ELDERLY MEN AND WOMEN. CARE INCLUDES BUT IS NOT LIMITED TO BATHING, DRESSING, GROOMING, MOBILITY AND ADMINISTRATION OF MEDICATION. ACCOMODATIONS INCLUDE ASSISTED LIVING AND CONGREGATE CARE APARTMENTS AND SKILLED OR LONG-TERM CARE NURSING ROOMS. THE ORGANIZATION PROVIDESCHARITABLE CARE TO RESIDENTS WITH LIMITED FINANCIAL MEANS AND WHO HAVE NO FAMILY OR FRIENDS TO CARE FOR THEM. IN ADDITION, THE ORGANIZATION FINANCIALLY SUPPORTS THOSE WHO HAVE OUTLIVED THEIR FINANCIAL ASSETS DURING THEIR RESIDENCY AT THE FACILITY, BUT WHO DO NOT MEET MEDICAID REQUIREMENTS. 92145 68273 ADULT DAY SERVICES FOR INDIVIDUALS WHO REQUIRE SUPERVISION WITH THE ACTIVITIES OF DAILY LIVING ALONG WITH A WIDE RANGE OF HEALTH AND WELLNESS SERVICES. 10534478 1 1 0 0 0 0 0 0 1 0 1 0 0 1 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 0 1 0 0 0 1 X 0 0 344 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 12 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X J CHRISTOPHER GREEN 4197241225 3855 LOWER MARKET STREET SUITE 300 LEBANON OH 45036 JOHN BODIN BOARD CHAIR 1.00 3.00 X X 0 0 0 ALEX DYE DIRECTOR 1.00 2.00 X 0 0 0 COLTON LOWRY DIRECTOR 1.00 3.00 X 0 0 0 GRACE LEICHTY DIRECTOR (TERM ENDED) 1.00 3.00 X 0 0 0 JOAN HAUSHALTER SECRETARY 1.00 3.00 X X 0 0 0 MATT CHAMBERLAIN SECRETARY (TERM ENDED) 1.00 3.00 X X 0 0 0 RICK GILDOW TREASURER 1.00 2.00 X X 0 0 0 STEVE GODWIN DIRECTOR 1.00 2.00 X 0 0 0 TOM SIMON DIRECTOR 1.00 3.00 X 0 0 0 VALERIE JONES DIRECTOR 1.00 3.00 X 0 0 0 JILL WILSON PRESIDENT/CEO 1.00 39.00 X X 0 725336 22531 JASON MILLER VP SR - LSC 1.00 39.00 X X 0 484061 26770 JAMES C GREEN CFO/TREASURER 1.00 39.00 X X 0 437456 24430 TONY BURTCHIN DIRECTOR 1.00 3.00 X 0 0 0 MANDY GOBLE DIRECTOR 1.00 3.00 X 0 0 0 NANCY KNIGHT DIRECTOR 1.00 3.00 X 0 0 0 DEBBIE ELLIS DIRECTOR 1.00 3.00 X 0 0 0 MICHAEL RAY PAST PRESIDENT/CEO 31.00 9.00 X 184405 0 7685 AMBER SWORDS AVP FINANCE 31.00 9.00 X 124528 23692 5730 DIANA DEFIBAUGH RN 40.00 0.00 X 149640 0 255 DALE TWYEFFORT DIRECTOR OF NURSING 40.00 0.00 X 100815 0 0 559388 1670545 87401 4 0 1 0 0 704998 200095 905093 RESIDENT SERVICES 623000 8819342 8819342 MANAGEMENT SERVICES 561000 270000 270000 ADULT DAY SERVICES 623990 68273 68273 9157615 51631 51631 MEAL REVENUE 623000 221830 221830 MISCELLANEOUS REVENUE 623000 40541 40541 TRANSPORTATION 623000 35508 35508 73445 73445 371324 10485663 9157615 0 422955 X 346040 346040 4307901 3632763 675138 49491 39123 10368 406373 330378 75995 344020 282165 61855 73202 73202 41150 41150 2836956 2785110 51846 63932 63932 194418 140495 53923 395861 387253 8608 280894 274786 6108 14969 8348 6621 213641 208996 4645 657830 643526 14304 226999 222063 4936 FOOD 442086 442086 FRANCHISE FEE 420888 420888 DIETARY AND MEDICAL SUP 374669 374669 BAD DEBTS 279892 279892 186336 61937 124399 12157548 10534478 1623070 0 146714 140331 21365 28649 2451128 1381874 161006 83412 20992974 15613370 5614440 5379604 12358 6518 797918 720622 9204929 7741010 1088805 678986 4152 788 8088383 8130547 103006 681991 9284346 9492312 X -110049 -1781934 30632 30632 -79417 -1751302 9204929 7741010 -1671885 0 X X 0 1 X 1 0 X 1338212 181320 2329059 2281355 905093 7035039 10500587 9185916 9523057 9736685 9157615 48103860 330782 330782 11838799 9367236 11852116 12018040 10393490 55469681 0 0 0 55469681 13343 10147 3243 47792 51631 126156 13343 10147 3243 47792 51631 126156 883542 188855 190075 124224 40541 1427237 12735684 9566238 12045434 12190056 10485662 57023074 0.97280 0.96820 0.00220 0.00160 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLAENOUS - 2020 AMOUNT: $ 787,542. 2021 AMOUNT: $ 92,855. 2022 AMOUNT: $ 94,075. 2023 AMOUNT: $ 28,224. 2024 AMOUNT: $ 40,541. PAYMENTS FROM AFFILIATES - 2020 AMOUNT: $ 96,000. 2021 AMOUNT: $ 96,000. 2022 AMOUNT: $ 96,000. 2023 AMOUNT: $ 96,000. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 22919 22919 12797743 8641642 4156101 1881981 1620815 261166 6244838 5350913 893925 45493 45493 5379604 MORTGAGE ESCROW DEPOSITS 100439 INTERCOMPANY 328504 RESERVE 291679 720622 DEPOSITS 93470 INTERCOMPANY 588521 681991 X PART IV, LINE 2B: RESIDENT FUNDS ARE DEPOSITS HELD UNDER A FIDUCIARY RESPONSIBILITY AND ARE REQUIRED BY STATE REGULATION. PART X, LINE 2: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE CONSOLIDATED FINANCIAL STATEMENTS. X X X 0 1 0 0 0 0 0 0 0 JILL WILSON PRESIDENT/CEO 0 482796 0 123797 0 118743 0 19450 0 3081 0 747867 0 0 JASON MILLER VP SR - LSC 0 358556 0 58834 0 66671 0 12369 0 14401 0 510831 0 0 JAMES C GREEN CFO/TREASURER 0 324852 0 50849 0 61755 0 13264 0 11166 0 461886 0 0 MICHAEL RAY PAST PRESIDENT/CEO 184405 0 0 0 0 0 7581 0 104 0 192090 0 0 0 AMBER SWORDS AVP FINANCE 104528 23692 20000 0 0 0 4541 0 1189 0 130258 23692 0 0 PART I, LINE 3 AFTER A SINGLE MEMBER SUBSTITUTION, OTTERBEIN HOMES ASSUMED RESPONSIBILITY FOR COMPENSATION POLICIES. CEO COMPENSATION IS NOW DETERMINED THROUGH A COMPENSATION COMMITTEE, A COMPENSATION SURVEY, BOARD OR COMMITTEE APPROVAL AND DOCUMENTED IN A WRITTEN EMPLOYMENT CONTRACT. PART I, LINE 4B 457(F) CONTRIBUTIONS: JILL WILSON $118,300 JASON MILLER $65,359 CHRIS GREEN $58,766 FORM 990, PAGE 5, PART V, LINE 1A THE PARENT COMPANY, OTTERBEIN HOMES, (FEIN 31-0549058) PROCESSES ACCOUNTS PAYABLE PAYMENTS FOR ALL RELATED ENTITIES. AS A RESULT, THE ORGANIZATION IS UNABLE TO DETERMINE THE NUMBER OF 1099S NOR INDEPENDENT CONTRACTORS PAID OVER $100K FOR SERVICES BY ENTITY. AS A RESULT, ALL 1099S AND INDEPENDENT CONTRACTORS PAID OVER $100K ARE ISSUED AND REPORTED OUT OF THE PARENT COMPANY. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS AUTHORIZED TO ACT FOR THE BOARD OF DIRECTORS BETWEEN REGULAR AND/OR CALLED SESSIONS OF THE BOARD. THE EXECUTIVE COMMITTEE HAS AUTHORITY TO MAKE ALL DECISIONS WITHOUT HAVING TO WAIT AND BRING THE ACTION TO THE FULL BOARD. FORM 990, PART VI, SECTION A, LINE 4 THE GOVERNING DOCUMENTS WERE AMENDED TO CHANGE THE NAME OF THE CORPORATION AND SUBSTITUTE THE SOLE CORPORATE MEMBER TO OTTERBEIN LSC, LLC. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS OTTERBEIN LSC, LLC. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OF THE BOARD OF DIRECTORS SHALL BE ELECTED BY THE MEMBER OF THE CORPORATION UPON NOMINATION BY THE CORPORATION'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING CORPORATE POWERS AND ACTIONS MAY ONLY BE TAKEN WITH THE APPROVAL OF THE MEMBER AFTER GIVING CONSIDERATION TO THE CONCERNS OF THE BOARD OF DIRECTORS: 1. THE DETERMINATION AND ADOPTION OF THE CORPORATION'S ANNUAL OPERATING AND CAPITAL BUDGETS. 2. THE EXPENDITURES FOR NON-BUDGETED ITEMS IN EXCESS OF $25,000 3. DETERMINING CORPORATION ADMINISTRATIVE AND OPERATING STAFF COMPENSATION AND BENEFITS. 4. DETERMINING ALL BUILDING PROGRAMS AND THE MAKING OF CERTIFICATE OF NEED APPLICATIONS 5. DETERMINING TO ADD OR TERMINATE ANY SERVICES 6. THE EXECUTION OF ANY CONTRACT OR AGREEMENT FOR FINANCIAL COMMITMENTS IN EXCESS OF THAT APPROVED IN THE ANNUAL BUDGET 7. THE APPOINTMENT OF AUDITORS AND LEGAL COUNSEL 8. EMPLOYING, EVALUATING, DISCIPLINING OR DISCHARGING THE PRESIDENT AND/OR TREASURER OF THE CORPORATION 9. THE ADOPTION OF LONG-RANGE PLANS AND MANAGEMENT OBJECTIVES, INCLUDING THE EXECUTION OF ANY AGREEMENT WITH CONSORTIUMS, ALLIANCES OR OTHER ORGANIZATIONS. 10. TAKING MEMBERSHIP IN OR JOINING ANY ORGANIZATION 11. THE SALE, LEASE, MORTGAGING, ENCUMBERING. LEASE OR OTHER DISPOSITION OF ANY REAL PROPERTY OR ANY PERSONAL PROPERTY OF A VALUE IN EXCESS OF $10,000 12. THE MANAGEMENT AND ADMINISTRATION OF ALL LEGAL MATTERS INVOLVING THE CORPORATION 13. THE MANAGEMENT AND ADMINISTRATION OF ALL INSURANCE FOR THE CORPORATION 14. THE ESTABLISHMENT OF UNIFORM EMPLOYMENT PRACTICES AND POLICIES 15. THE DEVELOPMENT AND IMPLEMENTATION OF MARKETING, PUBLIC RELATIONS AND FUNDRAISING EFFORTS ON BEHALF OF THE CORPORATION WITHOUT PRIOR NOTIFICATION TO AND APPROVAL FROM AN OFFICER OF THE MEMBER UNLESS APPROVED IN THE ANNUAL BUDGET 16. THE ASSUMPTION OR ISSUANCE OF ANY LONG-TERM OR SHORT-TERM DEBT IN EXCESS OF AN AMOUNT DETERMINED FROM TIME TO TIME BY THE MEMBER 17. THE APPROVAL OF ANY VOLUNTARY MERGER OR CONSOLIDATION OF THE CORPORATION OF THE SALE, ASSIGNMENT, MORTGAGING, ENCUMBERING, PLEDGING, LEASING OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION OR THE TRANSFER OF CONTROL OF THE CORPORATION. 18. THE AMENDMENT OF THE ARTICLES OF INCORPORATION OR THE CODE OF REGULATIONS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM IS REVIEWED AND APPROVED BY THE CHIEF FINANCIAL OFFICER BEFORE IT IS FILED. A COMPLETE COPY OF THE 990 IS ALSO PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C IN ACCORDANCE WITH THE BY-LAWS, ANY POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY BOARD MEMBER, CORPORATE EXECUTIVE, EXECUTIVE DIRECTOR, OR ADMINISTRATIVE STAFF MEMBER, OR COMMITTEE MEMBERS, WHO ARE NOT MEMBERS OF THE BOARD OF TRUSTEES OF OTTERBEIN HOMES SHALL BE DISCLOSED TO THE BOARD AND MADE A MATTER OF RECORD, EITHER THROUGH AN ANNUAL PROCEDURE OR WHEN THE INTEREST BECOMES RELEVANT TO A MATTER OF BOARD ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE INDEPENDENT EXECUTIVE COMMITTEE OF THE OTTERBEIN HOMES BOARD OF TRUSTEES HAS THE RESPONSIBILITY FOR DETERMINING THE ANNUAL COMPENSATION FOR THE OFFICERS BY THE USE OF INDUSTRY SPECIFIC DATA SUCH AS SALARY SURVEYS FROM LEADING AGE AND LEADING AGE OHIO. THE SALARIES OF THE KEY EMPLOYEES ARE DETERMINED BY THE OFFICERS USING INDUSTRY COMPARATIVE DATA SUCH AS SALARY SURVEYS FROM LEADING AGE AND LEADING AGE OHIO. THE DELIBERATIONS AND DECISIONS REGARDING COMPENSATION ARE DOCUMENT FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 39,209. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 39,209. REHAB & THERAPY SERVICES: PROGRAM SERVICE EXPENSES 690,226. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 690,226. REPAIRS AND MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 568,546. MANAGEMENT AND GENERAL EXPENSES 12,637. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 581,183. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,511,082. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,511,082. BARBER & BEAUTY: PROGRAM SERVICE EXPENSES 15,256. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,256. FORM 990, PAGE 12, PART XII, LINE 2C THE OVERSIGHT AND SELECTION PROCESS NOW FOLLOWS THAT OF ITS PARENT COMPANY, OTTERBEIN HOMES. OTTERBEIN HOMES 3855 LOWER MARKET STREET SUITE 300 LEBANON OH 45036 310549058 PARENT - RETIREMENT LIVING COMMUNITIES OH 501(C)(3) LINE 10 N/A 0 OTTERBEIN AT GRANVILLE 2158 COLUMBUS ROAD GRANVILLE OH 43023 311657346 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 10 OTTERBEIN HOMES 0 THE FRANKLIN UNITED METHODIST HOME INC 1070 WEST JEFFERSON ST FRANKLIN IN 46131 350988712 RETIREMENT LIVING COMMUNITY IN 501(C)(3) LINE 10 OTTERBEIN HOMES 0 OTTERBEIN PORTAGE VALLEY 20311 PEMBERVILLE ROAD PEMBERVILLE OH 43450 341193296 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 10 OTTERBEIN HOMES 0 NORTH SHORE RETIREMENT COMMUNITY 9400 NORTHSHORE BLVD LAKESIDE OH 43440 341743836 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 10 OTTERBEIN HOMES 0 OTTERBEIN ST MARYS 11230 STATE ROUTE 364 ST MARYS OH 45885 341940880 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 10 OTTERBEIN HOMES 0 OTTERBEIN CRIDERSVILLE 100 RED OAK DRIVE CRIDERSVILLE OH 45806 341940884 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 10 OTTERBEIN HOMES 0 SUNSET RETIREMENT COMMUNITIES INC 4040 INDIAN ROAD TOLEDO OH 43606 344428230 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 10 OTTERBEIN HOMES 0 OTTERBEIN GREEN HILLS COMMUNITY INC 6557 US HIGHWAY 68 S WEST LIBERTY OH 43357 341325781 SUPPORTING ORGANIZATION OH 501(C)(3) LINE 12B, II OTTERBEIN HOMES 0 WEST LIBERTY HOMES INC 6557 US HIGHWAY 68 S WEST LIBERTY OH 43357 346708015 RETIREMENT LIVING COMMUNITY OH 501(C)(3) LINE 10 OTTERBEIN HOMES 0 OTTERBEIN GREEN HILLS FOUNDATION 6557 US HIGHWAY 68 S WEST LIBERTY OH 43357 272566073 SUPPORTING ORGANIZATION OH 501(C)(3) LINE 12B, II OTTERBEIN HOMES 0 0 0 1 1 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0