2022-04-20T08:18:28-05:00 2021-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2020-07-01 273635416 PACE NEBRASKA PACE 4028292900 1044 NORTH 115TH STREET NO 500 OMAHA NE 68154 SCOTT BEAR CHIEF FINANCIAL OFFICER 4028292900 2022-04-14 1 SCOTT BEAR 999009999 WENDY R COOLEY P01523804 4023302660 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z IMMANUEL PATHWAYS SCOTT BEAR 1044 NORTH 115TH STREET NO 500 OMAHA NE 68154 21840358 0 X WWW.IMMANUEL.COM X 2010 NE TO PROVIDE IN-HOME, RESIDENTIAL AND COMMUNITY-BASED HEALTH CARE AND RELATED SERVICES TO THE ELDERLY. 16 15 0 37 0 0 0 13100 20833091 21827168 -3781 -3538 0 0 20829310 21836730 0 0 0 0 5050566 4913108 0 0 0 14394913 16013838 19445479 20926946 1383831 909784 5441325 6312717 1915676 1877284 3525649 4435433 CHRIST-CENTERED SERVICE TO SENIORS, EACH OTHER AND THE COMMUNITY. 0 0 18971062 21827168 "PACE" STANDS FOR PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY. PACE PROGRAMS COORDINATE AND PROVIDE ALL NEEDED PREVENTIVE, PRIMARY, ACUTE AND LONG-TERM CARE SERVICES SO THAT OLDER INDIVIDUALS CAN CONTINUE LIVING IN THEIR HOMES AND COMMUNITIES. 18971062 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 84 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 16 15 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X KELLE SCOTT CONTROLLER 4028292933 1044 NORTH 115TH STREET SUITE 500 OMAHA NE 68154 X JANE TONNIGES CHAIR 0.30 2.80 X X 0 0 0 CINDY ALLOWAY VICE CHAIR 0.30 2.80 X X 0 0 0 CLARENCE NICHOLS SECRETARY/TREASURER 0.30 2.80 X X 0 0 0 GEORGE GRIEB MEMBER 0.30 2.80 X 0 0 0 BRUCE PLATH MEMBER 0.30 2.80 X 0 0 0 BISHOP BRIAN MAAS MEMBER 0.30 3.10 X 0 0 0 DELIGHT WREED BYRD MEMBER 0.30 3.10 X 0 0 0 REV E JON BENSON MEMBER 0.30 2.80 X 0 0 0 KRISTEN HOFFMAN MD MEMBER 0.30 3.10 X 0 0 0 RANDAL BURNS MEMBER 0.30 3.10 X 0 0 0 SCOTT HOWERTER MEMBER 0.30 2.80 X 0 0 0 JILL POWERS MEMBER 0.30 3.40 X 0 0 0 ANDREA SKOLKIN MEMBER 0.30 2.80 X 0 0 0 SUSAN OGBORN MEMBER 0.30 2.80 X 0 0 0 STEVEN BULLOCK MEMBER 0.30 2.80 X 0 0 0 DAN FRIEDLUND MEMBER 0.30 3.10 X 0 0 0 ERIC N GURLEY PRESIDENT & CEO 2.00 46.00 X 0 531151 230812 JULIE PALADINO-KAMINSKI SENIOR VP/COO 6.00 42.00 X 0 259681 30473 SCOTT BEAR VP & CFO 3.00 45.00 X 0 242758 57880 TAMMY SEALER SENIOR VP/CAO 2.00 46.00 X 0 257477 28292 ADAM VOSSEN MD PHYSICIAN 14.00 34.00 X 0 307060 37711 MARIA CHONG-RAMASUTE MD PHYSICIAN 20.00 20.00 X 0 221843 57007 RHONDA DISTEFANO VP OF CONSTRUCTION, FACILITIES MGMT 2.00 46.00 X 0 196606 17095 JENNIFER KNECHT VP OF MARKETING AND COMMUNICATIONS 2.00 46.00 X 0 193103 12875 DEVIN FOX MD MEDICAL DIRECTOR 4.00 44.00 X 0 261436 5851 0 2471115 477996 0 0 1 0 FLORENCE HOME FOR THE AGED 7915 N 30TH ST OMAHA NE 68112 MEDICAL SERVICES 2013068 CHI HEALTH IMMANUEL PO BOX 776215 CHICAGO IL 606776215 MEDICAL SERVICES 998238 MAPLE CREST HEALTH CENTER 2824 N 66TH AVE OMAHA NE 68104 MEDICAL SERVICES 536338 SOUTHVIEW HEIGHTS 5110 SOUTH 49TH ST OMAHA NE 68117 MEDICAL SERVICES 270403 VISITING NURSE HEALTH SERVICES 12565 W CENTER ROAD SUITE 100 OMAHA NE 68144 HOME SERVICES 265801 15 13100 13100 MEDICAID 623000 10908125 10908125 MEDICARE 623000 10036918 10036918 SENIOR SERVICE 623000 882125 882125 21827168 90 90 3628 -3628 -3628 -3628 21836730 21827168 0 -3538 3920835 3556973 363862 148530 135913 12617 568815 507305 61510 274928 252015 22913 1091579 1091579 18876 18876 990137 802128 188009 11639 11639 156719 123498 33221 2751 2751 163954 163954 209568 208949 619 471236 471236 91778 73576 18202 MEDICAL SERVICES 12080033 12080033 MEDICAL SUPPLIES 354468 354468 COVID-19 RELATED EXPENS 195553 116039 79514 FOOD 116707 109545 7162 58840 3791 55049 20926946 18971062 1955884 0 280209 150387 336416 297490 14468 11815 4533927 3560463 1369597 973464 3440635 4879561 5441325 6312717 1620576 1877284 295100 0 1915676 1877284 X 3525649 4435433 3525649 4435433 5441325 6312717 909784 0 X X 0 1 X 1 0 X 13100 13100 13709707 16910171 18813048 20833091 21827168 92093185 13709707 16910171 18813048 20833091 21840268 92106285 0 0 0 92106285 421 527 519 448 90 2005 421 527 519 448 90 2005 13710128 16910698 18813567 20833539 21840358 92108290 1.00000 1.00000 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2296005 1847712 448293 2180585 1684465 496120 57337 28286 29051 973464 DUE FROM IMMANUEL HOME AND COMMUNITY RESOURCES 4816761 THIRD PARTY PAYOR SETTLEMENTS 62800 4879561 X 21835026 0 21835026 1704 1704 21836730 20925242 0 20925242 1704 1704 20926946 PART X, LINE 2: THE COMPANY IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM 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 TAX-EXEMPT STATUS. THE COMPANY ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE COMPANY RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2021, THE COMPANY HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,704. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,704. 0 1 0 0 0 0 0 0 0 ERIC N GURLEY PRESIDENT & CEO 0 418187 0 100517 0 12447 0 210078 0 20734 0 761963 0 0 ADAM VOSSEN MD PHYSICIAN 0 306657 0 77 0 326 0 18196 0 19515 0 344771 0 0 SCOTT BEAR VP & CFO 0 188644 0 46734 0 7380 0 13300 0 44580 0 300638 0 0 JULIE PALADINO-KAMINSKI SENIOR VP/COO 0 200901 0 51134 0 7646 0 15740 0 14733 0 290154 0 0 TAMMY SEALER SENIOR VP/CAO 0 200947 0 48887 0 7643 0 15529 0 12763 0 285769 0 0 MARIA CHONG-RAMASUTE MD PHYSICIAN 0 219598 0 1750 0 495 0 13738 0 43269 0 278850 0 0 DEVIN FOX MD MEDICAL DIRECTOR 0 241092 0 20000 0 344 0 0 0 5851 0 267287 0 0 RHONDA DISTEFANO VP OF CONSTRUCTION, FACILITIES MGMT 0 162321 0 33358 0 927 0 10951 0 6144 0 213701 0 0 JENNIFER KNECHT VP OF MARKETING AND COMMUNICATIONS 0 158795 0 34177 0 131 0 11554 0 1321 0 205978 0 0 PART I, LINE 3 THE COMPENSATED OFFICERS ARE EMPLOYEES OF IMMANUEL, A RELATED ENTITY. THE BOARD'S EXECUTIVE COMMITTEE SERVES AS THE COMPENSATION COMMITTEE TO REVIEW AND APPROVE THE TOTAL COMPENSATION FOR ERIC GURLEY, AND TO APPROVE THE BONUS PLAN AND PAYOUT OF BONUSES TO THE LEADERSHIP TEAM. THE COMPENSATION COMMITTEE USES AN INDEPENDENT COMPENSATION CONSULTANT TO HELP SET SALARIES AND BENEFITS. A WRITTEN EMPLOYMENT CONTRACT IS USED FOR ERIC GURLEY. PART I, LINE 4B ERIC N. GURLEY, PRESIDENT AND CEO, IS A PARTICIPANT IN AN ENDORSEMENT SPLIT-DOLLAR LIFE INSURANCE PLAN AND A DEFERRED COMPENSATION PLAN WHICH IS INTENDED TO MEET THE REQUIREMENTS OF SECTIONS 409A AND 457(F). BOTH PLANS ARE SPONSORED BY IMMANUEL, MR. GURLEY'S EMPLOYER. AS OF DECEMBER 31, 2020, MR. GURLEY'S DEFERRED COMPENSATION ACCOUNT WAS CREDITED WITH $188,528. PREMIUMS OF $157,474 WERE PAID FOR THE ENDORSEMENT SPLIT-DOLLAR LIFE INSURANCE PLAN POLICY. UNDER THE PLAN, IMMANUEL ENDORSES TO MR. GURLEY THE RIGHT TO DESIGNATE A BENEFICIARY FOR THE PORTION OF THE DEATH BENEFIT IN EXCESS OF THE GREATER OF THE CASH SURRENDER VALUE OR PREMIUMS PAID. THE VALUE OF THAT RIGHT, WHICH WAS INCLUDED IN MR. GURLEY'S REPORTABLE COMPENSATION, WAS $3,441. AS OF JUNE 30, 2021, THE DEATH BENEFIT IN EXCESS OF PREMIUMS PAID WAS $2,840,477. PART I, LINE 6 THE ORGANIZATION DOES NOT PAY OR ACCRUE ANY COMPENSATION BASED ON THE REVENUES OR THE NET EARNINGS OF THE ORGANIZATION OR ANY RELATED ORGANIZATION. HOWEVER, A SMALL PERCENTAGE (LESS THAN 10%) OF THE BONUSES PAID TO ERIC GURLEY, ADAM VOSSEN, M.D., SCOTT BEAR, JULIE PALADINO-KAMINSKI, TAMMY SEALER, MARIA CHONG-RAMASUTE, M.D., DEVIN FOX, M.D., RHONDA DISTEFANO AND JENNIFER KNECHT IS BASED ON AN OPERATING MARGIN CALCULATION OF IMMANUEL AND RELATED TAX-EXEMPT ORGANIZATIONS. FORM 990, PART V, LINE 2A: INDIVIDUALS PERFORMING SERVICES FOR PACE NEBRASKA ARE EMPLOYEES OF IMMANUEL, A RELATED ENTITY. THEREFORE, IMMANUEL ISSUES THE FORM W-2 FOR THESE EMPLOYEES. BECAUSE PACE NEBRASKA REIMBURSES IMMANUEL FOR THE SALARIES AND BENEFITS OF THESE EMPLOYEES, THE EXPENSES FOR THEIR SALARIES AND BENEFITS ARE REFLECTED ON THIS RETURN IN PART IX, STATEMENT OF FUNCTIONAL EXPENSES. FORM 990, PART VI, SECTION A, LINE 2 ERIC N. GURLEY IS THE PRESIDENT AND CEO OF IMMANUEL, A SUPPORTING ORGANIZATION OF IMMANUEL HOME AND COMMUNITY RESOURCES, THE SOLE MEMBER OF PACE NEBRASKA. ALL COMPENSATED BOARD MEMBERS, OFFICERS AND EMPLOYEES ARE EMPLOYEES OF IMMANUEL. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT SERVICES ARE PROVIDED BY IMMANUEL HOME & COMMUNITY RESOURCES, THE ORGANIZATION'S SOLE MEMBER. MANAGEMENT AND DEVELOPMENT FEES ARE PAID TO IMMANUEL HOME & COMMUNITY RESOURCES BASED ON CONTRACTUAL AGREEMENT. FORM 990, PART VI, SECTION A, LINE 6 PACE NEBRASKA HAS ONE MEMBER, IMMANUEL HOME AND COMMUNITY RESOURCES. FORM 990, PART VI, SECTION A, LINE 7A IMMANUEL HOME AND COMMUNITY RESOURCES, PACE NEBRASKA'S SOLE MEMBER, HAS THE RIGHT TO APPOINT AND REMOVE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B IMMANUEL HOME AND COMMUNITY RESOURCES, PACE NEBRASKA'S SOLE MEMBER, MUST APPROVE ANY AMENDMENT AND INITIATE OR ADOPT AMENDMENTS TO THE ARTICLES OR BYLAWS OF PACE NEBRASKA. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN ACCOUNTING FIRM WITH THE ASSISTANCE OF THE CONTROLLER, AND IS THEN REVIEWED BY THE CFO AND THE CONTROLLER. COPIES OF THE REVIEWED RETURN ARE PROVIDED TO THE BOARD MEMBERS PRIOR TO FILING WITH IRS. FORM 990, PART VI, SECTION B, LINE 12C PACE NEBRASKA USES THE SAME POLICY AS IMMANUEL, A RELATED ORGANIZATION. THE POLICY STATES THAT THE BOARD OF DIRECTORS MUST SIGN THE CONFLICT OF INTEREST POLICY AND DISCLOSE ALL CONFLICTS ANNUALLY. THE GOVERNANCE COMMITTEE SHALL DECIDE WHAT ACTIONS NEED TO BE TAKEN CONCERNING ANY CONFLICTS. THE BOARD MEMBER IS PROHIBITED FROM VOTING ON ANY BUSINESS RELATED TO ANY CONFLICT THE GOVERNANCE COMMITTEE HAS IDENTIFIED. FORM 990, PART VI, SECTION B, LINE 15 PACE NEBRASKA DOES NOT HAVE A CEO, EXECUTIVE DIRECTOR OR TOP MANAGEMENT OFFICIAL OR ANY KEY EMPLOYEES THAT THE ORGANIZATION DIRECTLY COMPENSATES. THE ORGANIZATION REIMBURSES IMMANUEL, A RELATED ORGANIZATION, FOR PORTIONS OF THE SALARIES OF IMMANUEL EMPLOYEES WHO PROVIDE NEEDED SERVICES. THEREFORE, IT IS NOT NECESSARY TO HAVE A PROCESS TO DETERMINE COMPENSATION FOR THESE POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 PACE NEBRASKA DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII: ALL COMPENSATION AND BENEFITS SHOWN FOR DIRECTORS ARE PAID BY IMMANUEL, THE SPONSOR ORGANIZATION, FOR SERVICES PERFORMED FOR IMMANUEL OR OTHER RELATED ENTITIES. THE COMPENSATION IS NOT PAID FOR SERVICES IN CONNECTION WITH THE POSITION OF DIRECTOR FOR PACE NEBRASKA. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS OF PACE NEBRASKA ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM PRIOR YEARS. IMMANUEL 1044 NORTH 115TH STREET SUITE 500 OMAHA NE 68154 470733774 CORPORATE SUPPORT NE 501(C)(3) LINE 12B, II N/A 0 IMMANUEL RETIREMENT COMMUNITIES 1044 NORTH 115TH STREET SUITE 500 OMAHA NE 68154 470799108 ELDERLY HOUSING NE 501(C)(3) LINE 10 IMMANUEL 1 IMMANUEL COMMUNITY FOUNDATION 1044 NORTH 115TH STREET SUITE 500 OMAHA NE 68154 470624928 FUNDRAISING NE 501(C)(3) LINE 12C, III-FI SEE STATEMENT 1 IMMANUEL HOME AND COMMUNITY RESOURCES 1044 NORTH 115TH STREET SUITE 500 OMAHA NE 68154 272628802 ELDERLY SERVICES NE 501(C)(3) LINE 10 IMMANUEL 1 PACE IOWA 1044 NORTH 115TH STREET SUITE 500 OMAHA NE 68154 273635343 ELDERLY SERVICES NE 501(C)(3) LINE 10 IMMANUEL HOME & COMMUNITY RESOURCES 1 IMMANUEL AFFORDABLE INC 1044 NORTH 115TH STREET SUITE 500 OMAHA NE 68154 470831041 ELDERLY & LOW INCOME HOUSING NE 501(C)(3) LINE 10 IMMANUEL 1 IMMANUEL AFFORDABLE II INC 1044 NORTH 115TH STREET SUITE 500 OMAHA NE 68154 800016829 ELDERLY & LOW INCOME HOUSING NE 501(C)(3) LINE 10 IMMANUEL 1 IMMANUEL TRINITY AFFORDABLE INC 1044 NORTH 115TH STREET SUITE 500 OMAHA NE 68154 113742894 ELDERLY & LOW INCOME HOUSING NE 501(C)(3) LINE 10 IMMANUEL 1 IMMANUEL LONG TERM CARE 1044 NORTH 115TH STREET SUITE 500 OMAHA NE 68154 462582783 LONG-TERM HEALTH CARE SERVICES NE 501(C)(3) LINE 10 IMMANUEL 1 IMMANUEL COMMUNITY VISION FOUNDATION 1044 NORTH 115TH STREET SUITE 500 OMAHA NE 68154 462693844 SUPPORT NONPROFITS WHOSE MISSIONS ALIGN WITH IMMANUEL NE 501(C)(3) LINE 12B, II IMMANUEL 1 IRC II INC 1044 NORTH 115TH STREET SUITE 500 OMAHA NE 68154 812697102 ELDERLY HOUSING NE 501(C)(3) LINE 10 IMMANUEL 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 SCHEDULE R, PART II, IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS IMMANUEL COMMUNITY FOUNDATION'S DIRECTORS ARE SELECTED BY THE BOARDS OF DIRECTORS OF THE FOUR ORGANIZATIONS IT SUPPORTS; IMMANUEL RETIREMENT COMMUNITIES, IMMANUEL HOME AND COMMUNITY RESOURCES, IMMANUEL LONG TERM CARE, AND IRC II, INC. EACH OF THESE FOUR ORGANIZATIONS IS CONTROLLED BY THEIR SOLE MEMBER, IMMANUEL. SCHEDULE R, PART V, LINE 1A-S: IMMANUEL, A RELATED ENTITY, PAYS INVOICES FOR OPERATING EXPENSES ON BEHALF OF THE CORPORATION AND THE CORPORATION REIMBURSES IMMANUEL FOR AMOUNTS INCURRED. MOST, IF NOT ALL, INTERCOMPANY TRANSACTIONS ARE A RESULT OF THIS CENTRALIZED ACCOUNTING SYSTEM.