2022-03-15T08:28:47-05:00 2021-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2020-07-01 113669999 MOSAIC MOSA 4028963884 4980 S 118TH ST LIND CENTER NO A OMAHA NE 68137 SCOTT HOFFMAN CHIEF FINANCIAL OFFICER 4028963884 2022-03-02 1 SCOTT HOFFMAN 999009999 WENDY R COOLEY P01523804 4023302660 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z SCOTT HOFFMAN 4980 S 118TH ST LIND CENTER NO A OMAHA NE 68137 281651274 0 X WWW.MOSAICINFO.ORG X 2003 NE EMBRACING GOD'S CALL, MOSAIC RELENTLESSLY PURSUES OPPORTUNITIES THAT EMPOWER PEOPLE. 16 16 6097 127 53623 0 4060183 10560753 248614863 269513083 11524735 667795 730548 873895 264930329 281615526 152005 325816 0 0 153970012 161750036 0 0 1791620 96648594 110130675 250770611 272206527 14159718 9408999 138785820 186268901 50831432 89750279 87954388 96518622 X EMBRACING GOD'S CALL, MOSAIC RELENTLESSLY PURSUES OPPORTUNITIES THAT EMPOWER PEOPLE. 0 0 139828569 156696947 COMMUNITY BASED SERVICES PROVIDED TO PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES ARE SERVICES THAT CAN EITHER BE ON-GOING OR INTERMITTENT SUCH AS RESPITE, FAMILY SUPPORT, FOSTER CARE, PHYSICAL THERAPIES, TRANSPORTATION, AND SUPPORTED EMPLOYMENT. MOSAIC SERVES APPROXIMATELY 4,327 INDIVIDUALS ACROSS THE UNITED STATES UNDER THIS SERVICE CATEGORY. 66013473 73977082 INTERMEDIATE CARE FACILITIES (ICF)--ICF SERVICES PROVIDE 24/7 SUPPORT FOR VERY MEDICALLY FRAGILE INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES. MOSAIC SERVES APPROXIMATELY 459 INDIVIDUALS ACROSS THE UNITED STATES UNDER THIS SERVICE CATEGORY. 16344489 18316225 DAY AND VOCATIONAL SERVICES ARE PROVIDED TO INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES IN A VARIETY OF WAYS INCLUDING SUPPORTED EMPLOYMENT, WORK ENCLAVES, VOCATIONAL TRAINING AND SOME SHELTERED WORKSHOPS. MOSAIC SERVES APPROXIMATELY 1,155 INDIVIDUALS ACROSS THE UNITED STATES UNDER THIS SERVICE CATEGORY. 18949239 325816 21235202 MISCELLANEOUS SERVICES PROVIDED TO INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. 18949239 325816 21235202 241135770 1 1 0 1 0 0 1 0 1 1 1 1 0 1 1 1 0 1 0 0 0 1 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 640 0 1 6097 1 1 1 1 BD 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 CO X X SCOTT HOFFMAN 4028963884 4980 SOUTH 118TH STREET OMAHA NE 68137 LINDA TIMMONS PRESIDENT AND CEO 39.70 0.30 X 609851 0 76219 SCOTT HOFFMAN TREASURER AND CFO 39.70 0.30 X 357875 0 38750 MARLIN WILKERSON SVP OF OPERATIONS 39.80 0.20 X 285805 0 50872 RENEE COUGHLIN SVP OF MISSION ADVANCEMENT 40.00 0.00 X 267535 0 53447 JOSEPH LYONS GENERAL COUNSEL 39.90 0.10 X 285863 0 28397 JON HANSON SVP STRATEGIC ALIGNMENT 40.00 0.00 X 239205 0 43216 PARKER MCKENNA SVP OF HUMAN RESOURCES 40.00 0.00 X 253799 0 26184 RAYMOND WALLACE ASSOCIATE VP OF FINANCE 40.00 0.00 X 220267 0 17503 MARY BETH O'NEILL VP OF OPERATIONS 40.00 0.00 X 198478 0 37535 MOLLY KENNIS VP OF OPERATIONS 40.00 0.00 X 194117 0 19755 CAROL MAU VP OF OPERATIONS 39.90 0.10 X 171333 0 37719 KRISTIN ROSSOW VP OF ACCOUNTING 37.50 2.50 X 175721 0 29484 KATIE KELLY VP OF INFORMATION TECHNOLOGY 40.00 0.00 X 187313 0 16592 ANDREA FERRUCCI VP OF OPERATIONS 40.00 0.00 X 170250 0 24892 SARAH KHALILI VP OF COMPLIANCE 40.00 0.00 X 148561 0 46104 MATTHEW SHEFFIELD SR DEVELOPMENT OFFICER 40.00 0.00 X 156980 0 34687 JENNIFFER LEDOUX VP OF OPERATIONS 40.00 0.00 X 174141 0 17147 HEATHER GUNN VP OF MISSION EXPANSION 40.00 0.00 X 174310 0 16178 PAULA BURTON VP OF HR OPERATIONS 40.00 0.00 X 164458 0 16029 BRENDA SOLOMON VP OF MARKETING & COMMUNICATION 40.00 0.00 X 146331 0 24713 DONNA GARST VP OF COMMUNITY RELATIONS 40.00 0.00 X 143067 0 15271 HASSAN SHALLA DIRECTOR OF TECHNOLOGY 40.00 0.00 X 141057 0 10040 THE REV DANIEL FOREHAND CHAIRPERSON 1.50 0.00 X X 0 0 0 JAMES J OLMSTED VICE CHAIRPERSON 1.50 0.00 X X 0 0 0 LINDA K BURT SECOND VICE CHAIRPERSON 1.50 0.00 X X 0 0 0 AKASH SETHI SECRETARY 1.50 0.00 X X 0 0 0 EDWARD L BARKER DIRECTOR 1.50 0.00 X 0 0 0 JAMES S BOWEN DIRECTOR 1.50 0.00 X 0 0 0 MICHAEL COOPER-WHITE DIRECTOR 1.50 0.00 X 0 0 0 ROBERT GRAULICH DIRECTOR 1.50 0.10 X 0 0 0 MEGAN GUSTAFSON DIRECTOR 1.50 0.00 X 0 0 0 PATRICIA A NIMTZ DIRECTOR 1.50 0.00 X 0 0 0 SANDRA SCOTT DIRECTOR 1.50 0.00 X 0 0 0 MICHELLE THOMPSON DIRECTOR 1.50 0.00 X 0 0 0 JAMES P TOTSCH DIRECTOR 1.50 0.00 X 0 0 0 LYNN FULLENKAMP DIRECTOR 1.50 0.00 X 0 0 0 KEITH HOHLY DIRECTOR 1.50 0.00 X 0 0 0 MICHA PROCHASKA DIRECTOR 1.50 0.00 X 0 0 0 4866317 0 680734 67 0 1 0 PJW NURSING CONSULTANTS LLC 150 TRUMBELL ST STE 3C HARTFORD CT 06103 NURSING SERVICES 346246 DDN CONSULTING SERVICES LLC PO BOX 185010 HAMDEN CT 06518 NURSING SERVICES 322017 KOLEY JESSEN 1125 S 103RD ST STE 800 OMAHA NE 68124 LEGAL SERVICES 229141 ONE SOURCE PO BOX 24148 OMAHA NE 68124 PRE-EMPLOYMENT SCREENING 217782 ALPHA REHABILITATION PC 920 E 56TH ST BLDG A KEARNEY NE 688478628 REHABILITATION 188348 22 62323 3711564 5812681 974185 10560753 MEDICARE/MEDICAID PMTS 624100 233827516 233827516 PROGRAM SERVICE REV. 624100 28528406 28528406 MANAGEMENT FEES 541610 6626096 6626096 RENTAL INCOME 532000 529510 529510 CONSULTING INCOME 541610 1555 1555 269513083 389140 53623 335517 9997 9997 187273 35748 151525 151525 151525 278655 0 278655 278655 278655 PURCHASING CARD REBATE 900099 101917 101917 INSURANCE PROCEEDS 900099 30000 30000 580456 580456 712373 281615526 270225456 53623 775694 X 138172 138172 187644 187644 4680240 4680240 129164696 114530799 13730155 903742 764462 741363 17797 5302 17448456 16167616 1251864 28976 9692182 8420886 1252296 19000 630864 480864 150000 142531 23987 118544 66342514 64411385 1729229 201900 8667258 7690306 975300 1652 12251109 11379650 856698 14761 2768345 2735604 28538 4203 343126 134139 195501 13486 1032008 437980 594028 9710860 8446678 1264182 2235692 2040272 195420 DUES & MEMBERSHIPS 1737069 270880 1439752 26437 BAD DEBT EXPENSE 118307 118307 CFR EXPENSE 18207 18207 4132785 3260102 468729 403954 272206527 241135770 29279137 1791620 35490585 52316058 2626919 5692159 24565677 31227864 1366290 1938325 109883022 74849305 35473883 35033717 15376324 25986029 7193542 18481302 16692600 15593447 138785820 186268901 23830623 36679010 1892216 11587897 20424592 20331529 2908625 8083370 1775376 13068473 50831432 89750279 X 87122186 95700876 832202 817746 87954388 96518622 138785820 186268901 X 9408999 7415 -852180 X X 0 1 X 1 1 1 X 6775651 7166036 5663266 4036298 10560753 34202004 223485812 221852846 235126706 248614863 269513083 1198593310 230261463 229018882 240789972 252651161 280073836 1232795314 3317 864 3928 1470 226 9805 0 3317 864 3928 1470 226 9805 1232785509 275533 314475 743051 780522 532787 2646368 79978 92943 112165 85688 53623 424397 355511 407418 855216 866210 586410 3070765 1066526 812919 675113 570234 712373 3837165 231683500 230239219 242320301 254087605 281372619 1239703244 0.99440 0.99430 0.00250 0.00240 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 1 1 0 0 1 54020 1 0 54020 0 PART II-B, LINE 1: DURING THE PAST YEAR, MOSAIC ENGAGED IN VARIOUS NON-PARTISAN ACTIVITIES TO INFLUENCE SPECIFIC LEGISLATION IMPACTING THE ORGANIZATION. MOSAIC ENGAGED ADVOCATES ON SOCIAL MEDIA ABOUT ISSUES IMPACTING THE ORGANIZATION, INCLUDING PROVIDING A LINK FOR ADVOCATES TO CONTACT THEIR MEMBERS OF CONGRESS. MOSAIC ADVERTISED ON SOCIAL MEDIA IN 2021. MOSAIC ALSO SENT CORRESPONDENCE TO PEOPLE AFFILIATED WITH THE ORGANIZATION INFORMING THEM ABOUT PREVAILING PUBLIC POLICY ISSUES IMPACTING THE ORGANIZATION AND PROVIDING CONTACT INFORMATION FOR MEMBERS OF CONGRESS. MOSAIC AS AN ORGANIZATION ENGAGED ITS MEMBERS OF CONGRESS THROUGH LETTERS, EMAILS, AND OFFICE VISITS. MOSAIC ALSO SENT A VARIETY OF ACTION ALERTS TO ITS ADVOCACY NETWORK. X X X 1 80.00 0 1 0 100.00 0 1 3457167 21726025 21382228 3800964 0 40344859 4139307 7685646 2102105 50067707 37178162 7157077 -539550 3450830 40344859 36312083 1689894 1853397 2677212 37178162 36379971 1618196 2591357 4277441 36312083 35983964 1341962 4036488 4982443 36379971 0.85903 0.00000 0.14097 0 1 1 4329194 4329194 81054366 55606552 25447814 1205320 998924 206396 11669863 9541072 2128791 11624279 8702757 2921522 35033717 110000 C BOND RESERVES 100000 F INVESTMENT IN BICO 13622018 C INVESTMENT IN SALES TYPE LEASE 12154011 C 25986029 AFFILIATE RECEIVABLES 9979744 MISCELLANEOUS RECEIVABLES 3084231 INTERUNIT RECEIVABLE 1624472 INVESTMENT IN PROPERTY 905000 15593447 REFUNDABLE FEES 17911 CRATS PAYABLE 478119 LIABILITY FOR PENSION BENEFITS 1259275 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 472865 LEASE LIABILITY 10812671 CASH SURRENDER VALUE OF LIFE INSURANCE 27632 13068473 X PART II, LINE 9: THE FINANCIAL STATEMENTS FOR MOSAIC AND ITS AFFILIATES DO NOT CONTAIN ANY INFORMATION REGARDING THE CONSERVATION EASEMENT. PART IV, LINE 1B: MOSAIC IS THE REPRESENTATIVE-PAYEE FOR THE PERSONAL FUNDS OF A NUMBER OF INDIVIDUALS IN SERVICE. MOSAIC DOES NOT OWN THE ACCOUNTS. IN PREVIOUS YEARS, THE ACCOUNTING FOR SUCH ACTIVITIES OCCURRED AT THE AGENCY LEVEL AND AN AGGREGATE ACCOUNTING OF SUCH SERVICES WAS NOT POSSIBLE. MOSAIC TRACKS ALL ACCOUNT ACTIVITIES, AND THE NUMBERS LISTED ON PART IV, LINES 1C - 1F ACCURATELY REFLECT THE AGGREGATE BALANCE OF THESE ACCOUNTS. PART V, LINE 4: THE ENDOWMENT FUNDS ARE INTENDED FOR SUPPORT OF MOSAIC'S LONG TERM COMMITMENT TO ITS MISSION AND FOR CAPITAL IMPROVEMENTS AND GENERAL OPERATIONS. THE ENDOWMENT FUNDS ARE HELD BY THE MOSAIC FOUNDATION. PART X, LINE 2: ALL CONSOLIDATED AFFILIATED ENTITIES, EXCEPT FOR MOSAIC HOUSING CORP V, INC., EASE-E MEDICAL, INC. (EASE-E) AND BICO ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OR 501(C)(2) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN MOSAIC'S TAX EXEMPT STATUS. LIVING INNOVATIONS SUPPORT SERVICES, LLC (LISS, LLC) ELECTED TO BE TAXED UNDER THE PROVISIONS OF SUBCHAPTER S AND IS CONSIDERED A DISREGARDED ENTITY UNDER THE INTERAL REVENUE CODE SINCE ITS SOLE MEMBER IS MOSAIC. MOSAIC WOULD BE RESPONSIBLE IF ANY FEDERAL INCOME TAXES WERE ASSESSED ON LISS, LLC'S INCOME. MOSAIC RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. SUCH TAX POSITIONS, WHICH ARE MORE THAN 50% LIKELY OF BEING REALIZED, ARE MEASURED AT THEIR HIGHEST VALUE. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. DURING 2021 AND 2020, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE FINANCIAL STATEMENTS OTHER THAN DESCRIBED PREVIOUSLY. 1 0 0 0 0 0 0 0 0 0 SUB-SAHARAN AFRICA SUPPORT DEVELOPMENT OF SERVICES FOR PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. CENTER-BASED AND IN-HOME SUPPORT FOR CHILDREN WITH DISABILITIES AND THEIR CAREGIVERS. 115644 WIRE TRANSFER 0 EUROPE BUILDING FOR SUMMER CAMP AND WHEELCHAIRS 72000 WIRE TRANSFER 0 2 0 1 0 1 0 0 0 PART III ACCOUNTING METHOD: 1 MOSAIC HOUSING CORPORATION I 4980 S 118TH STREET OMAHA NE 68137 363756911 501(C)(3) 7000 THE GRANT PROVIDED IS TO THE RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. MOSAIC HOUSING CORPORATION II 4980 S 118TH STREET OMAHA NE 68137 470773689 501(C)(3) 6000 THE GRANT PROVIDED IS TO THE RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. MOSAIC HOUSING CORPORATION XII 4980 S 118TH STREET OMAHA NE 68137 481297244 501(C)(3) 38807 THE GRANT PROVIDED IS TO THE RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. MOSAIC HOUSING CORPORATION XIX - WINFIELD 4980 S 118TH STREET OMAHA NE 68137 261710259 501(C)(3) 7000 THE GRANT PROVIDED IS TO THE RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. MOSAIC ILLINOIS HOUSING OF ROCKFORD I 4980 S 118TH STREET OMAHA NE 68137 204841856 501(C)(3) 9500 THE GRANT PROVIDED IS TO THE RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. MOSAIC ILLINOIS HOUSING I 4980 S 118TH STREET OMAHA NE 68137 202997161 501(C)(3) 22869 THE GRANT PROVIDED IS TO THE RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. OAKS OF DUNN COUNTY INC 4980 S 118TH STREET OMAHA NE 68137 311913323 501(C)(3) 33996 ROOF REPLACEMENT 7 0 PART I, LINE 2: GRANTS ARE PROVIDED TO RELATED ORGANIZATIONS TO FURTHER THEIR TAX EXEMPT FUNCTIONS. X 1 1 X X X X X X 0 0 0 0 0 0 0 0 0 LINDA TIMMONS PRESIDENT AND CEO 505617 0 100000 0 4234 0 38237 0 37982 0 686070 0 0 0 SCOTT HOFFMAN TREASURER AND CFO 300869 0 56001 0 1005 0 13088 0 25662 0 396625 0 0 0 MARLIN WILKERSON SVP OF OPERATIONS 254859 0 30000 0 946 0 16274 0 34598 0 336677 0 0 0 RENEE COUGHLIN SVP OF MISSION ADVANCEMENT 223192 0 43463 0 880 0 15465 0 37982 0 320982 0 0 0 JOSEPH LYONS GENERAL COUNSEL 259983 0 25000 0 880 0 16733 0 11664 0 314260 0 0 0 JON HANSON SVP STRATEGIC ALIGNMENT 218325 0 20000 0 880 0 14520 0 28696 0 282421 0 0 0 PARKER MCKENNA SVP OF HUMAN RESOURCES 227869 0 25000 0 930 0 14520 0 11664 0 279983 0 0 0 RAYMOND WALLACE ASSOCIATE VP OF FINANCE 213775 0 6278 0 214 0 5839 0 11664 0 237770 0 0 0 MARY BETH O'NEILL VP OF OPERATIONS 192680 0 5000 0 798 0 5599 0 31936 0 236013 0 0 0 MOLLY KENNIS VP OF OPERATIONS 181948 0 11500 0 669 0 5031 0 14724 0 213872 0 0 0 CAROL MAU VP OF OPERATIONS 158868 0 11500 0 965 0 4671 0 33048 0 209052 0 0 0 KRISTIN ROSSOW VP OF ACCOUNTING 171795 0 3265 0 661 0 4822 0 24662 0 205205 0 0 0 KATIE KELLY VP OF INFORMATION TECHNOLOGY 183846 0 2765 0 702 0 3705 0 12887 0 203905 0 0 0 ANDREA FERRUCCI VP OF OPERATIONS 164616 0 5000 0 634 0 0 0 24892 0 195142 0 0 0 SARAH KHALILI VP OF COMPLIANCE 141469 0 6500 0 592 0 4592 0 41512 0 194665 0 0 0 MATTHEW SHEFFIELD SR DEVELOPMENT OFFICER 150461 0 5765 0 754 0 4001 0 30686 0 191667 0 0 0 JENNIFFER LEDOUX VP OF OPERATIONS 153991 0 20000 0 150 0 4123 0 13024 0 191288 0 0 0 HEATHER GUNN VP OF MISSION EXPANSION 167913 0 5765 0 632 0 4514 0 11664 0 190488 0 0 0 PAULA BURTON VP OF HR OPERATIONS 158876 0 5000 0 582 0 3645 0 12384 0 180487 0 0 0 BRENDA SOLOMON VP OF MARKETING & COMMUNICATION 138349 0 7265 0 717 0 3713 0 21000 0 171044 0 0 0 DONNA GARST VP OF COMMUNITY RELATIONS 136530 0 6000 0 537 0 3607 0 11664 0 158338 0 0 0 HASSAN SHALLA DIRECTOR OF TECHNOLOGY 140292 0 765 0 0 0 0 0 10040 0 151097 0 0 0 PART I, LINE 1A EVERY EMPLOYEE CAN BE REIMBURSED UP TO $25 PER MONTH FOR GYM MEMBERSHIPS OR INITIATION FEES. THIS BENEFIT IS TREATED AS TAXABLE COMPENSATION TO THE EMPLOYEE. SCHEDULE J, PART II, COLUMN C: MOSAIC EVALUATES THE LIABILITY RELATED TO THEIR POSTRETIREMENT BENEFITS (SALARY AND HEALTH INSURANCE CONTINUATION) THROUGH AN ACTUARIAL REVIEW. THE ADJUSTMENT IS INCLUDED IN RETIREMENT AND OTHER DEFERRED COMPENSATION. A PUBLIC FINANCE AUTHORITY 273866124 000000000 2017-06-29 12188750 REFUND PRIOR ISSUES (1/28/03, 6/1/05, 3/12/10, 3/31/10, 4/14/10, 4/30/12). 0 0 0 B PUBLIC FINANCE AUTHORITY 273866124 000000000 2018-10-31 10101544 ACQUIRE FACILITY. REFUND PRIOR ISSUE (11/1/17 & 10/31/18). 0 0 0 C PUBLIC FINANCE AUTHORITY 273866124 000000000 2017-11-01 6740000 CONSTRUCT & IMPROVE FACILITY. REFUND PRIOR TAXABLE ISSUE (6/29/17). 0 0 0 A 5414935 12188750 187009 12001741 2012 1 0 1 1 B 797095 10101544 1800000 8301544 2018 1 1 1 1 C 1799200 6429296 6294309 134987 2021 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 1 1 0 0 0 0 B 0 0 1 1 1 0 0 0 0 C 0 0 1 1 1 0 0 0 0 A 0 B 0 C 0 SCHEDULE K, PART IV, ARBITRAGE, LINE 2C: (A) ISSUER NAME: PUBLIC FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 6/30/2021 (A) ISSUER NAME: PUBLIC FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 6/30/2021 (A) ISSUER NAME: PUBLIC FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 12/31/2019 NOTE: REGARDING THE REBATE COMPUTATION ON 6/30/2021 AND 12/31/2019: SINCE THE BOND PROCEEDS HAVE BEEN SPENT AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. SCHEDULE K PART II, COLUMN B, LINE 3: DIFFERENCES BETWEEN PART I, COLUMN (E) AND PART II, LINE 3 - THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) AS THIS DEBT WAS ISSUED ON A DRAW-DOWN BASIS AND THE TOTAL PRINCIPAL DRAWN WAS LESS THAN THE AMOUNT AVAILABLE. THE REMAINING PRINCIPAL WILL NOT BE DRAWN. FORM 990, PART VI, SECTION A, LINE 7A THE EVANGELICAL LUTHERAN CHURCH IN AMERICA APPOINTS THREE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B MOSAIC BOARD OF DIRECTORS MAY MAKE ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION WITHOUT OTHER APPROVAL WITH THE EXCEPTION OF SECTIONS 8 AND 10. AMENDMENTS TO SECTIONS 8 AND 10 OF THE ARTICLES OF INCORPORATION REQUIRE PRIOR WRITTEN CONSENT OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. SECTION 8 OF THE ARTICLES OF INCORPORATION SPECIFIES WHERE ASSETS WOULD BE TRANSFERRED UPON THE LIQUIDATION OF MOSAIC, AND SECTION 10 COVERS MOSAIC'S AFFILIATION WITH THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY THE ORGANIZATION'S OUTSIDE ACCOUNTING FIRM. THE CHIEF FINANCIAL OFFICER, THE ORGANIZATION'S OUTSIDE ACCOUNTING FIRM, AND THE CHIEF EXECUTIVE OFFICER REVIEW THE RETURN. THE FINANCE AND AUDIT COMMITTEE AND THE BOARD OF DIRECTORS ARE PROVIDED A COPY OF THE RETURN PRIOR TO FILING FORM 990. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, EACH BOARD DIRECTOR COMPLETES A CONFLICT OF INTEREST FORM AND SUBMITS IT TO THE CHAIRPERSON OF THE BOARD INTEGRITY COMMITTEE. ANY FINANCIAL CONFLICTS OF INTEREST ARE REPORTED TO THE CHIEF FINANCIAL OFFICER FOR REPORTING ON THE FORM 990. WITHIN 90 DAYS OF THEIR HIRE DATE, ALL STAFF COMPLETE A CONFLICT OF INTEREST FORM. STAFF ARE NOTIFIED ANNUALLY THEY MUST COMPLETE A NEW CONFLICT OF INTEREST FORM IF THERE HAVE BEEN ANY CHANGES SINCE THEY LAST SUBMITTED THE FORM. ALL REPORTED CONFLICTS OF INTEREST ARE REVIEWED BY HUMAN RESOURCES, OPERATIONS AND COMPLIANCE DEPARTMENTS. ANY CONFLICTS OF INTEREST OF THE CHIEF EXECUTIVE OFFICER ARE REPORTED TO THE BOARD OF DIRECTORS. CONFLICTS OF INTEREST OF SENIOR STAFF ARE REVIEWED BY THE SENIOR VICE PRESIDENT FOR HUMAN RESOURCES AND VICE PRESIDENT OF COMPLIANCE AND REPORTED TO THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER FOR REPORTING ON THE FORM 990. ANY NEW CONFLICTS OF INTEREST THAT ARISE DURING THE YEAR ARE REQUIRED TO BE REPORTED AT THAT TIME. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS ESTABLISHED AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE IS RESPONSIBLE FOR CONTRACTING WITH AN INDEPENDENT CONSULTANT WHICH SHALL: DOCUMENT COMPARABLE COMPENSATION LEVELS PAID TO EXECUTIVES WITH SIMILAR POSITIONS AND RESPONSIBILITIES WITHIN THE MARKET APPLICABLE TO EXECUTIVE RECRUITMENT, HELP THE COMMITTEE APPLY MOSAIC'S COMPENSATION PHILOSOPHY TO THE MARKET SURVEY DATA TO IDENTIFY SUPPORTABLE COMPENSATION LEVELS AND COMPENSATION RANGES, AND VERIFY IN ADVANCE THAT RESULTING COMPENSATION RANGES ARE REASONABLE COMPENSATION. THE COMPENSATION CONSULTANT WILL ALSO ADVISE AND OPINE ON BENEFIT DESIGN, BENEFIT OPTIONS, AND REASONABLENESS OF BENEFIT AMOUNTS AS ELEMENTS OF COMPENSATION. THE EXECUTIVE COMMITTEE WILL BE GUIDED BY THE CONSULTANT'S ANALYSIS AND EXPERTISE AND APPROVE THE COMPENSATION OF THE CEO, APPROVE THE COMPENSATION RANGES FOR OTHER OFFICERS AND KEY EMPLOYEES, AND REPORT ITS ACTIONS TO THE FULL BOARD. THE CEO, WORKING WITHIN SALARY RANGES APPROVED BY THE EXECUTIVE COMMITTEE, SETS THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. MINUTES, DOCUMENTATION OF INDEPENDENT CONSULTANT COMPARABILITY DATA AND RECOMMENDATIONS ARE MAINTAINED AS PART OF THE RECORD OF THE EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 INDIVIDUALS MAY REQUEST MOSAIC'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS THROUGH AN EMAIL REQUEST FORM AVAILABLE ON MOSAIC'S PUBLIC WEBSITE (WWW.MOSAICINFO.ORG). FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 272,185. MANAGEMENT AND GENERAL EXPENSES 1,334,531. FUNDRAISING EXPENSES 52,249. TOTAL EXPENSES 1,658,965. DAY/HOST SERVICES: PROGRAM SERVICE EXPENSES 64,055,425. MANAGEMENT AND GENERAL EXPENSES 12,007. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,067,432. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 83,775. MANAGEMENT AND GENERAL EXPENSES 382,691. FUNDRAISING EXPENSES 149,651. TOTAL EXPENSES 616,117. FORM 990, PART XI, LINE 9: POSTRETIREMENT BENEFIT RELATED CHANGES OTHER THAN NET PERIODIC COST 70,934. OTHER TRANSFER OF LIABILITIES -464,328. EQUITY TRANSFER TO MOSAIC SENIOR SERVICES, INC. -458,786. FORM 990, PART XII, LINE 2C: THE FINANCE AND AUDIT COMMITEE OVERSEES THE AUDIT & SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. 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