GABRIELS VILLA INC: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
GABRIELS VILLA INC (EIN 39-1857036)
Tax period
2022-01-01 to 2022-12-31
Filed
2023-09-29
IRS object ID
202302729349300030
Schema version
2022v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2023-09-29T14:49:47-05:00ReturnTs
Tax Period End2022-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line18215 GREENWAY BOULEVARD SUITE 600AddressLine1Txt
CityMIDDLETONCityNm
State AbbreviationWIStateAbbreviationCd
ZIP53562ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2022-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN391857036EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GABRIEL'S VILLA INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlGABRBusinessNameControlTxt
Phone9202354653PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1215 NORTH WESTFIELD STREETAddressLine1Txt
CityOSHKOSHCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54902ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTHERESA M BERTRAMPersonNm
Person TitlePRESIDENT & CEOPersonTitleTxt
Phone9202325228PhoneNum
Signature2023-09-28SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstTHERESAPersonFirstNm
Person LastBERTRAMPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info Curr0IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKIMBERLY ANDERSONPreparerPersonNm
PTINP00188889PTIN
Phone6086628600PhoneNum
Preparation2023-09-28PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerTHERESA M BERTRAMPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1215 NORTH WESTFIELD STREETAddressLine1Txt
CityOSHKOSHCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54902ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,782,074GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Group Exemption9386GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MIRAVIDALIVING.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1987FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionGABRIEL'S VILLA INC PROVIDES SUPERVISED CARE TO AGING PERSON IN OSHKOSH, WI AND THE SURROUNDING AREAS.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent10VotingMembersIndependentCnt
Total Employee63TotalEmployeeCnt
Total Volunteers10TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$296,531PYContributionsGrantsAmt
CY Contributions Grants$138,355CYContributionsGrantsAmt
PY Program Service Revenue$1,496,352PYProgramServiceRevenueAmt
CY Program Service Revenue$1,619,773CYProgramServiceRevenueAmt
PY Investment Income$1,482PYInvestmentIncomeAmt
CY Investment Income$2,153CYInvestmentIncomeAmt
PY Other Revenue$1,515PYOtherRevenueAmt
CY Other Revenue$21,793CYOtherRevenueAmt
PY Total Revenue$1,795,880PYTotalRevenueAmt
CY Total Revenue$1,782,074CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$1,385,954PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$1,286,317CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$716,350PYOtherExpensesAmt
CY Other Expenses$804,267CYOtherExpensesAmt
PY Total Expenses$2,102,304PYTotalExpensesAmt
CY Total Expenses$2,090,584CYTotalExpensesAmt
PY Revenues Less Expenses-$306,424PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$308,510CYRevenuesLessExpensesAmt
Total Assets BOY$1,922,027TotalAssetsBOYAmt
Total Assets EOY$1,585,460TotalAssetsEOYAmt
Total Liabilities BOY$340,989TotalLiabilitiesBOYAmt
Total Liabilities EOY$312,932TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,581,038NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,272,528NetAssetsOrFundBalancesEOYAmt
MissionGABRIEL'S VILLA IS PART OF A FAMILY OF HEALTHCARE AND RESIDENTIAL SERVICE ORGANIZATIONS COMMITTED TO PROVIDING QUALITY CARE AND LIFE ENRICHING OPPORTUNITIES TO THE AGING AND THOSE IN NEED IN A CARING, CHRISTIAN ENVIRONMENT.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$1,719,016ExpenseAmt
Revenue$1,619,773RevenueAmt
DescGABRIEL'S VILLA, INC. PROVIDES CARE TO AGING PERSONS IN OSHKOSH, WI. THE ENTITY HAS 40 ASSISTED LIVING UNITS AT ITS FACILITY.Desc
Total Program Service Expenses$1,719,016TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document4IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee63EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member10IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1KIM MAKIBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9202325238PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1225 N EAGLE STREETAddressLine1Txt
CityOSHKOSHCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54902ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerInd
MARK BOETTCHER
BOARD MEMBER0.201.40Yes (X)$0$0$0
DIANE LANGDON
BOARD MEMBER0.201.40Yes (X)$0$0$0
JASON LOWE
BOARD MEMBER0.201.40Yes (X)$0$0$0
DR PAULA MCNIEL
BOARD MEMBER0.201.40Yes (X)$0$0$0
DR LAURIE MULLER
BOARD MEMBER0.201.40Yes (X)$0$0$0
MARK BEECHER
CHAIR0.201.40Yes (X)$0$0$0Yes (X)
KATHY BERMINGHAM
VICE-CHAIR0.201.40Yes (X)$0$0$0Yes (X)
NATE OLSON
SECRETARY0.201.40Yes (X)$0$0$0Yes (X)
JAMIE BONELL
BOARD MEMBER0.201.40Yes (X)$0$0$0
STEW RIECKMAN
BOARD MEMBER0.201.40Yes (X)$0$0$0
THERESA BERTRAM
PRESIDENT & CEO4.0034.00$0$395,232$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$395,232TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Related Organizations$60,144RelatedOrganizationsAmt
Government Grants$78,211GovernmentGrantsAmt
Total Contributions$138,355TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
TENANT REVENUE531110$1,379,773$1,379,773
SERVICE REVENUE621610$240,000$240,000
FieldValueIRS element (for citing)
Total Program Service Revenue$1,619,773TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,153TotalRevenueColumnAmt
Exclusion$2,153ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
MISCELLANEOUS REVENUE900099$20,110$20,110
BEAUTY SHOP REVENUE900099$1,008$1,008
ASSESSMENT REVENUE900099$675$675
FieldValueIRS element (for citing)
Other Revenue Total$21,793OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,782,074TotalRevenueColumnAmt
Related Or Exempt Func Income$1,619,773RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$23,946ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,147,113TotalAmt
Program Services$939,145ProgramServicesAmt
Management And General$207,968ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$28,042TotalAmt
Program Services$22,958ProgramServicesAmt
Management And General$5,084ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$36,831TotalAmt
Program Services$30,154ProgramServicesAmt
Management And General$6,677ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$74,331TotalAmt
Program Services$60,855ProgramServicesAmt
Management And General$13,476ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$280,008TotalAmt
Program Services$280,008ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$20,738TotalAmt
Management And General$20,738ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$33,055TotalAmt
Program Services$32,482ProgramServicesAmt
Management And General$573ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$7,655TotalAmt
Management And General$7,655ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$116,192TotalAmt
Program Services$92,028ProgramServicesAmt
Management And General$24,164ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$10,642TotalAmt
Management And General$10,642ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$114,969TotalAmt
Program Services$114,969ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$12,851TotalAmt
Program Services$12,013ProgramServicesAmt
Management And General$838ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$102,762TotalAmt
Program Services$102,762ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$28,692TotalAmt
Program Services$28,692ProgramServicesAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MISC EXP$76,539$2,898$73,641
DONNOR RECOGNITION$112$112
GROUNDS SUPPLIES$52$52

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$2,090,584TotalAmt
Program Services$1,719,016ProgramServicesAmt
Management And General$371,568ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$269,616BOYAmt
EOY$93,763EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$612,655BOYAmt
EOY$358,341EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$58,174BOYAmt
EOY$72,052EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$1,848BOYAmt
EOY$1,848EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$4,145BOYAmt
EOY$1,576EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,488,262LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,508,580LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$973,289BOYAmt
EOY$979,682EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$2,300BOYAmt
EOY$78,198EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,922,027BOYAmt
EOY$1,585,460EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$128,081BOYAmt
EOY$121,905EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$83,411BOYAmt
EOY$119,671EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$129,497BOYAmt
EOY$71,356EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$340,989BOYAmt
EOY$312,932EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,581,038BOYAmt
EOY$1,272,528EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,581,038BOYAmt
EOY$1,272,528EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,922,027BOYAmt
EOY$1,585,460EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$308,510ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$113,116CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$296,531CurrentTaxYearMinus1YearAmt
Current Tax Year$138,355CurrentTaxYearAmt
Total$548,002TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,774,839CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,899,707CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,744,133CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,496,352CurrentTaxYearMinus1YearAmt
Current Tax Year$1,619,773CurrentTaxYearAmt
Total$8,534,804TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,774,839CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,899,707CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,857,249CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,792,883CurrentTaxYearMinus1YearAmt
Current Tax Year$1,758,128CurrentTaxYearAmt
Total$9,082,806TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,165,024CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,318,216CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,194,834CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,068,142CurrentTaxYearMinus1YearAmt
Current Tax Year$1,194,000CurrentTaxYearAmt
Total$5,940,216TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,165,024CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,318,216CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,194,834CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,068,142CurrentTaxYearMinus1YearAmt
Current Tax Year$1,194,000CurrentTaxYearAmt
Total$5,940,216TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$3,142,590PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$6,337CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,508CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,797CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,482CurrentTaxYearMinus1YearAmt
Current Tax Year$2,153CurrentTaxYearAmt
Total$23,277TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$6,337CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,508CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,797CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,482CurrentTaxYearMinus1YearAmt
Current Tax Year$2,153CurrentTaxYearAmt
Total$23,277TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years-$2,461CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years-$1,438CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years-$9,309CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,515CurrentTaxYearMinus1YearAmt
Current Tax Year$21,793CurrentTaxYearAmt
Total$10,100TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,778,715CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,905,777CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,853,737CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,795,880CurrentTaxYearMinus1YearAmt
Current Tax Year$1,782,074CurrentTaxYearAmt
Total$9,116,183TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.34470PublicSupportCY509Pct
Public Support PY5090.32690PublicSupportPY509Pct
Investment Income CY0.00260InvestmentIncomeCYPct
Investment Income PY0.00260InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$83,333OtherCostOrOtherBasisAmt
Book Value$83,333BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,959,214OtherCostOrOtherBasisAmt
Depreciation$2,373,497DepreciationAmt
Book Value$585,717BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$95,613OtherCostOrOtherBasisAmt
Depreciation$75,657DepreciationAmt
Book Value$19,956BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,350,102OtherCostOrOtherBasisAmt
Depreciation$1,059,426DepreciationAmt
Book Value$290,676BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$979,682TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
DUE FROM AFFILIATES$252,635
INTERCOMPANY RECEIVABLE-$181,279
FieldValueIRS element (for citing)
Total Liability$71,356TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationTHE ORGANIZATION FOLLOWS THE PROVISIONS OF THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THE INCOME TAX STANDARD HAD NO IMPACT ON THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION FILES INFORMATION RETURNS AS A TAX-EXEMPT ORGANIZATION. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonTHERESA BERTRAMPersonNm
TitlePRESIDENT & CEOTitleTxt
Base Compensation Filing Org$0BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$329,632CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$65,600BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$0DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$0DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$0TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$395,232TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 3FormAndLineReferenceDesc
ExplanationTHE COMPENSATION OF THE PRESIDENT & CEO IS DETERMINED BY THE ORGANIZATION'S SOLE MEMBER, MIRAVIDA LIVING, INC. THE FOLLOWING METHODS WERE USED BY MIRAVIDA LIVING, INC. TO ESTABLISH THE PRESIDENT & CEO'S COMPENSATION: 1. COMPENSATION SURVEY OR STUDY 2. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEEExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1ATHE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD OF DIRECTORS PLUS TWO OTHER MEMBERS OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL BE RESPONSIBLE FOR THE AGENDA FOR THE BOARD AND THE VOTING MEMBERSHIP MEETING. THIS COMMITTEE SHALL KEEP ITSELF INFORMED OF THE ENTIRE OPERATION OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS, AND SHALL EXECUTE SUCH ACTIONS AS MAY BE ASSIGNED TO IT BY THE BOARD. THE COMMITTEE SHALL ALSO CONCERN ITSELF WITH MATTERS NOT ASSIGNED TO OTHER COMMITTEES.
FORM 990, PART VI, SECTION A, LINE 6MIRAVIDA LIVING, INC., IS THE SOLE MEMBER OF GABRIEL'S VILLA, INC.
FORM 990, PART VI, SECTION A, LINE 7ATHE DIRECTORS OF GABRIEL'S VILLA, INC. ARE ELECTED BY THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC.
FORM 990, PART VI, SECTION A, LINE 7BMAJOR STANDARD OPERATING PROCEDURES, MAJOR POLICIES, AND PROGRAMS OF GABRIEL'S VILLA, INC. ARE SUBMITTED TO THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC. FOR APPROVAL AND IMPLEMENTATION. AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS REQUIRE THE APPROVAL OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC.
FORM 990, PART VI, SECTION B, LINE 11BBEFORE IT IS FILED, THE FORM 990 IS REVIEWED BY THE CEO, THEN DISTRIBUTED TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR REVIEW.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY, THE CORPORATE SECRETARY DISTRIBUTES A CONFLICT OF INTEREST FORM TO EACH MEMBER OF THE BOARD OF DIRECTORS AND VARIOUS COMMITTEE MEMBERS NOT ON THE BOARD THAT REQUIRES EACH TO IDENTIFY POTENTIAL CONFLICTS OR OTHER RELATED PARTY INTERESTS. THE REPORTS ARE REVIEWED BY THE SECRETARY AND CEO AND ANY CONFLICTS ARE BROUGHT TO THE BOARD'S ATTENTION. A MEMBER OF THE BOARD WHO HAS A CONFLICT OF INTEREST MAY NOT VOTE ON ANY SUCH ISSUE BEFORE THE BOARD. ANY QUESTION OF WHETHER THERE IS A CONFLICT IS RESOLVED BY THE BOARD OF DIRECTORS. IF THE BOARD OF DIRECTORS DETERMINES THAT A DIRECTOR HAS COMMITTED A SUBSTANTIAL VIOLATION OF THE CONFLICT OF INTEREST POLICY, THE INDIVIDUAL IS REMOVED FROM THE OFFICE OF DIRECTOR. IN ADDITION, ALL MANAGEMENT AND SUPERVISORY EMPLOYEES ARE INFORMED OF THE ORGANIZATION'S POLICY REGARDING RELATED PARTY TRANSACTIONS AND CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
MIRAVIDA LIVING INC
225 NORTH EAGLE STREETOSHKOSHWI54902391032234MANAGMENT SERVICESWI501(C)(3)LINE 10N/A0
BETHEL HOME INC
225 NORTH EAGLE STREETOSHKOSHWI54902391209707SKILLED NURSING FACILITYWI501(C)(3)LINE 100MIRAVIDA LIVING INC
CARMEL RESIDENCE INC
220 NORTH WESTFIELD STREETOSHKOSHWI54902391448325SENIOR HOUSINGWI501(C)(3)LINE 100MIRAVIDA LIVING INC
SIMEANNA APARTMENTS INC
155 NORTH EAGLE STREETOSHKOSHWI54902237148097SENIOR HOUSINGWI501(C)(3)LINE 100MIRAVIDA LIVING INC
SIMEANNA SOUTH INC
225 NORTH EAGLE STREETOSHKOSHWI54902391238670SENIOR HOUSINGWI501(C)(3)LINE 100MIRAVIDA LIVING INC
SIMEANNA III INC
225 NORTH EAGLE STREETOSHKOSHWI54902391270056SENIOR HOUSINGWI501(C)(3)LINE 100MIRAVIDA LIVING INC
MIRAVIDA LIVING FOUNDATION INC
225 NORTH EAGLE STREETOSHKOSHWI54902010938793FUNDRAISINGWI501(C)(3)LINE 12A, I0MIRAVIDA LIVING INC
EDEN REHABILIATION SUITES AND GREENHOUSE HOMES INC
3151 EDEN COURTOSHKOSHWI54904900506872SKILLED NURSING FACILITYWI501(C)(3)LINE 100MIRAVIDA LIVING INC
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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