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ObjectId: 202023189349308432 - Submission: 2020-11-13
TIN: 31-0549058
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
19
Open to Public Inspection
Name of the organization
OTTERBEIN HOMES
Employer identification number
31-0549058
Part I
Identification of Disregarded Entities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
(1)
OTTERBEIN PERRYSBURG LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
20-5493322
DEVELOP & OPERATE SMALL HOUSE NEIGHBORHOODS - PROVIDING SKILLED NURSING CARE
OH
4,633,207
6,643,513
OTTERBEIN HOMES
(2)
OTTERBEIN MONCLOVA LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
20-5493287
DEVELOP & OPERATE SMALL HOUSE NEIGHBORHOODS - PROVIDING SKILLED NURSING CARE
OH
4,190,539
7,117,455
OTTERBEIN HOMES
(3)
OTTERBEIN CLEAR CREEK LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
26-0731207
DEVELOP & OPERATE SMALL HOUSE NEIGHBORHOODS - PROVIDING SKILLED NURSING CARE
OH
5,082,197
7,569,937
OTTERBEIN HOMES
(4)
OTTERBEIN MIDDLETOWN LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
26-0731330
DEVELOP & OPERATE SMALL HOUSE NEIGHBORHOODS - PROVIDING SKILLED NURSING CARE
OH
5,594,728
8,231,909
OTTERBEIN HOMES
(5)
OTTERBEIN HOLDINGS LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
20-5493357
REAL ESTATE HOLDING COMPANY
OH
0
0
OTTERBEIN HOMES
(6)
OTTERBEIN INDEPENDENT LIVING SERVICES LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
26-3554627
CLINIC
OH
1,007,318
174,232
OTTERBEIN HOMES
(7)
OTTERBEIN PROPERTIES LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
27-0543473
REAL ESTATE DEVELOPMENT
OH
0
0
OTTERBEIN HOMES
(8)
OTTERBEIN HOME HEALTH
580 N STATE ROUTE 741
LEBANON
,
OH
45036
27-1049483
HOME HEALTH SERVICES
OH
2,054,463
1,274,953
OTTERBEIN HOMES
(9)
OTTERBEIN MAINEVILLE LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
20-5952379
DEVELOP & OPERATE SMALL HOUSE NEIGHBORHOODS - PROVIDING SKILLED NURSING CARE
OH
5,011,914
7,531,746
OTTERBEIN HOMES
(10)
OTTERBEIN HOSPICE
580 N STATE ROUTE 741
LEBANON
,
OH
45036
46-1453798
HOSPICE SERVICES
OH
2,353,316
960,515
OTTERBEIN HOMES
(11)
OTTERBEIN BATAVIA
580 N STATE ROUTE 741
LEBANON
,
OH
45036
46-2718728
DEVELOP & OPERATE SMALL HOUSE NEIGHBORHOODS - PROVIDING SKILLED NURSING CARE
OH
5,017,482
8,855,135
OTTERBEIN HOMES
(12)
OTTERBEIN GAHANNA
580 N STATE ROUTE 741
LEBANON
,
OH
45036
46-2748595
DEVELOP & OPERATE SMALL HOUSE NEIGHBORHOODS - PROVIDING SKILLED NURSING CARE
OH
4,660,557
9,878,646
OTTERBEIN HOMES
(13)
OTTERBEIN NEW ALBANY
580 N STATE ROUTE 741
LEBANON
,
OH
45036
46-2726708
DEVELOP & OPERATE SMALL HOUSE NEIGHBORHOODS - PROVIDING SKILLED NURSING CARE
OH
4,764,913
9,603,860
OTTERBEIN HOMES
(14)
OTTERBEIN LOVELAND
580 N STATE ROUTE 741
LEBANON
,
OH
45036
46-2733350
DEVELOP & OPERATE SMALL HOUSE NEIGHBORHOODS - PROVIDING SKILLED NURSING CARE
OH
4,781,756
10,133,219
OTTERBEIN HOMES
(15)
OTTERBEIN BATAVIA REAL ESTATE LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1622556
HOLD REAL ESTATE
OH
0
0
OTTERBEIN HOMES
(16)
OTTERBEIN CLEAR CREEK REAL ESTATE LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1727490
HOLD REAL ESTATE
OH
0
0
OTTERBEIN HOMES
(17)
OTTERBEIN EXTENDED SERVICES LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1497005
HOLDING COMPANY
OH
0
0
OTTERBEIN HOMES
(18)
OTTERBEIN GAHANNA REAL ESTATE LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1582103
HOLD REAL ESTATE
OH
0
0
OTTERBEIN HOMES
(19)
OTTERBEIN LOVELAND REAL ESTATE LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1655560
HOLD REAL ESTATE
OH
0
0
OTTERBEIN HOMES
(20)
OTTERBEIN LSC LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1518504
HOLDING COMPANY
OH
0
0
OTTERBEIN HOMES
(21)
OTTERBEIN MAINEVILLE REAL ESTATE LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1690234
HOLD REAL ESTATE
OH
0
0
OTTERBEIN HOMES
(22)
OTTERBEIN MANAGEMENT LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1531268
PROVIDE MANAGEMENT SERVICES
OH
0
0
OTTERBEIN HOMES
(23)
OTTERBEIN MIDDLETOWN REAL ESTATE LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1705605
HOLD REAL ESTATE
OH
0
0
OTTERBEIN HOMES
(24)
OTTERBEIN MONCLOVA REAL ESTATE LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1671473
HOLD REAL ESTATE
OH
0
0
OTTERBEIN HOMES
(25)
OTTERBEIN NEW ALBANY REAL ESTATE LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1642781
HOLD REAL ESTATE
OH
0
0
OTTERBEIN HOMES
(26)
OTTERBEIN PERRYSBURG REAL ESTATE LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1600491
HOLD REAL ESTATE
OH
0
0
OTTERBEIN HOMES
(27)
OTTERBEIN REAL ESTATE LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1478545
HOLD REAL ESTATE
OH
0
0
OTTERBEIN HOMES
(28)
OTTERBEIN NEIGHBORHOODS LLC
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1745546
HOLDING COMPANY
OH
0
0
OTTERBEIN HOMES
Part II
Identification of Related Tax-Exempt Organizations.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
OTTENBEIN ST MARYS
11230 STATE ROUTE 364
ST MARYS
,
OH
45885
34-1940880
CONTINUING CARE RETIREMENT COMMUNITY
OH
501(C)(3)
LINE 10
OTTERBEIN HOMES
Yes
(2)
OTTERBEIN LEBANON
585 NORTH STATE ROUTE 741
LEBANON
,
OH
45036
31-1743874
CONTINUING CARE RETIREMENT COMMUNITY
OH
501(C)(3)
LINE 10
OTTERBEIN HOMES
Yes
(3)
OTTERBEIN NORTH SHORE
9400 NORTH SHORE BLVD
LAKESIDE
,
OH
43440
34-1743836
CONTINUING CARE RETIREMENT COMMUNITY
OH
501(C)(3)
LINE 10
OTTERBEIN HOMES
Yes
(4)
OTTERBEIN PORTAGE VALLEY
20311 PEMBERVILLE ROAD
PEMBERVILLE
,
OH
43450
34-1193296
CONTINUING CARE RETIREMENT COMMUNITY
OH
501(C)(3)
LINE 10
OTTERBEIN HOMES
Yes
(5)
OTTERBEIN CRIDERSVILLE
100 RED OAK DRIVE
CRIDERSVILLE
,
OH
45806
34-1940884
CONTINUING CARE RETIREMENT COMMUNITY
OH
501(C)(3)
LINE 10
OTTERBEIN HOMES
Yes
(6)
THE FRANKLIN UNITED METHODIST HOME INC DBA OTTERBEIN FRANKLIN
1070 WEST JEFFERSON STREET
FRANKLIN
,
IN
46131
35-0988712
CONTINUING CARE RETIREMENT COMMUNITY
IN
501(C)(3)
LINE 10
OTTERBEIN HOMES
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Page 2
Schedule R (Form 990) 2019
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
UNION VILLAGE DEVELOPMENT COMPANY
580 N STATE ROUTE 741
LEBANON
,
OH
45036
81-1563789
LAND DEVELOPMENT
OH
OTTERBEIN HOMES
C
195,000
12,932,697
100.000 %
Yes
Schedule R (Form 990) 2019
Page 3
Schedule R (Form 990) 2019
Page
3
Part V
Transactions With Related Organizations.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
No
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
Yes
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
No
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
Yes
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
Yes
o
Sharing of paid employees with related organization(s)
............................
1o
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
No
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
r
Other transfer of cash or property to related organization(s)
............................
1r
No
s
Other transfer of cash or property from related organization(s)
............................
1s
Yes
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
OTTERBEIN CRIDERSVILLE
L
700,884
PERCENTAGE OF REVENUE
(2)
OTTERBEIN LEBANON
L
2,431,908
PERCENTAGE OF REVENUE
(3)
OTTERBEIN ST MARYS
L
799,212
PERCENTAGE OF REVENUE
(4)
OTTERBEIN NORTH SHORE
L
344,616
PERCENTAGE OF REVENUE
(5)
OTTERBEIN PORTAGE VALLEY
L
661,944
PERCENTAGE OF REVENUE
(6)
THE FRANKLIN UNITED METHODIST HOME INC DBA OTTERBEIN FRANKLIN
L
1,450,752
PERCENTAGE OF REVENUE
(7)
OTTERBEIN NORTH SHORE
D
2,849,217
EOY ACCOUNT BALANCE
(8)
OTTERBEIN PORTAGE VALLEY
D
994,872
EOY ACCOUNT BALANCE
Schedule R (Form 990) 2019
Page 4
Schedule R (Form 990) 2019
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2019
Page 5
Schedule R (Form 990) 2019
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. (see instructions).
Return Reference
Explanation
Schedule R (Form 990) 2019
Additional Data
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