SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2018
Open to Public
Inspection
Name of the organization
OTTERBEIN ST MARYS
 
Employer identification number

34-1940880
Return Reference Explanation
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 REPORTED BY ENTITY. AS A RESULT, ALL 1099S ARE ISSUED AND REPORTED OUT OF THE PARENT COMPANY.
FORM 990, PART VI, SECTION B, LINE 11B THE FORM IS PROVIDED TO AND REVIEWED BY THE CHIEF FINANCIAL OFFICER BEFORE THE FORM IS FILED. A COMPLETE COPY OF THE 990 IS ALSO PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW 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 ADMINITRATIVE 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 DOCUMENTED. THIS PROCESS WAS LAST PERFORMED IN 2018.
FORM 990, PART VI, SECTION C, LINE 19 THE ANNUAL REPORT IS PROVIDED TO THE PUBLIC WHICH INCLUDES THE AUDITED FINANCIAL STATEMENT SUMMARY. THE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G NURSING AGENCY FEES/CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 1,273,988. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,273,988. OTHER SERVICES: PROGRAM SERVICE EXPENSES 161,567. MANAGEMENT AND GENERAL EXPENSES 10,382. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 171,949.
FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENT -173,576. CHANGE IN MINIMUM PENSION LIABILITY 153,304.
FORM 990, PAGE 12, PART XII, LINE 2 THE SELECTION AND OVERSIGHT PROCESS HAS NOT CHANGED.
FORM 990, PART X, PAGE 11, LINE 20 - TAX-EXEMPT BOND LIABILITIES THE PARENT COMPANY, OTTERBEIN HOMES, HAS ALLOCATED A PORTION OF THE TAX EXEMPT BONDS THAT WERE ISSUED TO THE PARENT COMPANY. THE DETAILS OF THE TAX EXEMPT BONDS ISSUED TO OTTERBEIN HOMES ARE CONTAINED ON THE SCHEDULE K THAT IS FILED WITH THE FORM 990 FOR THE PARENT COMPANY (FEIN 31-0549058). THERE IS NO SCHEDULE K FOR THIS TAX RETURN. THIS TREATMENT IS CONSISTENT WITH PRIOR YEARS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2018


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