2023-11-01T08:39:38-05:00 2023-06-30 470625816 LUTZ AND COMPANY PC 3320 JAMES ROAD SUITE 100 GRAND ISLAND NE 68803 990 2022-07-01 470397679 MIDWEST COVENANT HOME INC MIDW 4027642711 615 E 9TH ST STROMSBURG NE 686660367 DAN CRAMER BOARD PRESIDENT 4027545993 2023-10-27 1 DAN CRAMER 999009999 0 STEVEN K PLACKE P00078534 3083827850 2023-10-27 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DAN CRAMER 615 SEMINARY STREET STROMSBURG NE 68666 6699631 0 X WWW.MIDWESTCOVENANTHOME.ORG X 1957 NE NURSING HOME CARE AND ASSISTED LIVING FOR THE ELDERLY. 11 11 112 5 0 0 349667 187618 5275432 5832485 35259 49535 151503 161322 5811861 6230960 0 0 0 0 3128059 3729911 0 0 19131 2908956 2961962 6037015 6691873 -225154 -460913 6762105 5995763 3834872 3562266 2927233 2433497 NURSING HOME CARE AND ASSISTED LIVING FOR THE ELDERLY. 0 0 6285429 5993555 NURSING HOME CARE AND ASSISTED LIVING FOR THE ELDERLY. 6285429 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 27 0 1 112 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 X X SHEILA BJERRUM 4027642711 615 E 9TH STREET STROMSBURG NE 68666 X DAN CRAMER PRESIDENT 0.00 X X 0 0 0 BONNIE SCHREIBER DIRECTOR-AT-LARGE 0.00 X 0 0 0 ROBERT SMALL VICE-PRESIDENT 0.00 X X 0 0 0 PHIL BURKE DIRECTOR-AT-LARGE 0.00 X 0 0 0 RICHARD BOROVIAK DIRECTOR-AT-LARGE 0.00 X 0 0 0 CHERI GIANNOU TREASURER 0.00 X X 0 0 0 JILL CRAIG SECRETARY/CONFERENCE LIASO 0.00 X X 0 0 0 TIMOTHY MCIVOR DIRECTOR-AT-LARGE 0.00 X 0 0 0 GRACE GERRARD DIRECTOR-AT-LARGE 0.00 X 0 0 0 TAMARA HUTSELL DIRECTOR-AT-LARGE 0.00 X 0 0 0 SUSAN COOKSLEY DIRECTOR-AT-LARGE 0.00 X 0 0 0 BRIAN JOHNSON CONFERENCE SUPERINTENDENT 0.00 X 0 0 0 0 0 0 0 0 0 0 MAXIM HEALTHCARE STAFFING SERVICES 9239 WEST CENTER ROAD SUITE 100 OMAHA NE 68124 AGENCY STAFFING 271553 ONESTAFF MEDICAL LLC PO BOX 3544 OMAHA NE 68103 AGENCY STAFFING 161252 FUSION MEDICAL STAFFING LLC PO BOX 30131 OMAHA NE 68103 AGENCY STAFFING 137397 FUNCTION FOREVER THERAPIES 1005 FARNUM STREET ST PAUL NE 68873 THERAPY SERVICES 110504 CARIANT HEALTH PARTNERS 11623 ARBOR STREET SUITE 100 OMAHA NE 68144 AGENCY STAFFING 109065 5 67559 120059 187618 PRIVATE PAY RESIDENTS 623000 2143719 2143719 MEDICAID/DHHS 623000 2027764 2027764 ASSISTED LIVING 623000 1021653 1021653 MEDICARE 623000 579733 579733 POLK COUNTY SENIOR SER 623000 59616 59616 5832485 8970 8970 170576 20522 150054 150054 150054 488714 448149 40565 40565 40565 EMPLOYEE & GUEST MEALS 623000 7487 7487 MISCELLANEOUS 623000 3529 3529 CROP INCOME 623000 250 250 2 2 11268 6230960 5993555 0 49787 3127474 2915532 211942 419706 386401 33305 182731 170303 12428 19134 19134 12994 11997 997 7371 7371 114715 101446 13269 162731 162731 15868 14764 1104 140437 140437 387548 387548 139720 95453 44267 NURSING AGENCY 1016805 1016805 SUPPLIES 316491 316491 CONSULTANTS 222282 222282 FOOD 221925 221925 183941 121314 43496 19131 6691873 6285429 387313 19131 760775 427465 254980 216357 475519 373521 34686 0 13758269 8779939 5236055 4978330 90 90 6762105 5995763 463875 330380 3320847 3213534 50150 18352 3834872 3562266 X 2927233 2433497 2927233 2433497 6762105 5995763 -460913 -32823 0 X 0 1 X 1 0 X 14168 26208 897985 349667 187618 1475646 4290254 4148270 3792648 5242496 5832485 23306153 500 500 750 250 250 2250 4304922 4174978 4691383 5592413 6020353 24784049 0 0 0 24784049 14497 13191 8970 36658 14497 13191 8970 36658 11018 11018 4304922 4174978 4705880 5605604 6040341 24831725 0.99810 0.99260 0.00150 0.00740 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 63809 63809 12272245 7691338 4580907 1422215 1088601 333614 4978330 RESIDENT CARE ADVANCES 18352 18352 X 6198137 -32823 -32823 6230960 0 6230960 6691873 0 6691873 0 6691873 PART X, LINE 2: THE HOME IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND, THEREFORE, HAS MADE NO PROVISION FOR FEDERAL INCOME TAXES IN THE ACCOMPANYING FINANCIAL STATEMENTS. IN ADDITION, THE HOME HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE NOT TO BE A "PRIVATE FOUNDATION" WITHIN THE MEANING OF SECTION 509(A) OF THE INTERNAL REVENUE CODE. THERE WAS NO UNRELATED BUSINESS INCOME FOR 2023 OR 2022. THE HOME IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY FEDERAL, STATE, OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE JUNE 30, 2020. FORM 990, PART VI, SECTION B, LINE 11B ORGANIZATION'S PROCESS TO REVIEW FORM 990: BOARD RECEIVES A COPY OF FORM 990 TO REVIEW BEFORE IT IS FILED. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT HAVE A CONFLICT OF INTEREST POLICY.