2022-11-04T13:36:42-05:00 2021-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2021-01-01 470384319 FLORENCE HOME FOR THE AGED FLOR 4028276000 7915 NORTH 30TH STREET OMAHA NE 68112 DEBRA L THACKER CFO 4028276000 2022-11-04 1 DEBRA THACKER 999009999 MEGAN L KOZIOL CPA P01544037 4023302660 2022-11-04 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z DEBRA L THACKER 7915 NORTH 30TH STREET OMAHA NE 68112 13264591 0 X WWW.OMAHASENIORCARE.ORG X 1906 NE PROVIDE CARE FOR THE ELDERLY 12 10 323 10 0 0 2286676 2573497 11592520 10621038 -70 0 61470 70056 13940596 13264591 217256 152784 0 0 6539593 6529432 0 0 0 6412061 6792769 13168910 13474985 771686 -210394 7129742 5548630 3170695 1772614 3959047 3776016 TO INSPIRE THE INDIVIDUALS WE SERVE TO LIVE LIFE TO THE FULLEST AS THEY AGE. 0 0 7850584 152784 6676104 SKILLED NURSING CARE 2646070 0 2572796 ALZHEIMER'S ASSISTED LIVING CARE 1322825 0 1372138 ASSISTED LIVING CARE 11819479 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 29 0 1 323 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X DEBRA L THACKER CFO 4028276000 7915 NORTH 30TH STREET OMAHA NE 68112 DEBRA L THACKER CFO 2.00 46.00 X X 0 196380 33103 LOIS JORDAN PRESIDENT / CEO 2.00 46.00 X X 0 197998 19075 STEPHANIE O'KEEFE CHAIRMAN 1.00 1.00 X X 0 0 0 KRISTIN PRATT SECRETARY / TREASURER 1.00 1.00 X X 0 0 0 ROBERT A BLOECHLE DIRECTOR 1.00 3.00 X 0 0 0 MARC BUTTERFIELD DIRECTOR 1.00 2.00 X 0 0 0 PHIL CHRISTENSEN DIRECTOR 1.00 2.00 X 0 0 0 DOUG EWALD DIRECTOR 1.00 2.00 X 0 0 0 MARK HIGGINS DIRECTOR 1.00 1.00 X 0 0 0 LYN M HOLLEY DIRECTOR 1.00 1.00 X 0 0 0 DAVE MCCUE DIRECTOR 1.00 0.00 X 0 0 0 REBECCA WESTER DIRECTOR 1.00 0.00 X 0 0 0 0 394378 52178 0 0 1 0 SHIFT KEY LLC 4228 N CENTRAL EXPY DALLAS TX 75206 NURSING SERVICES 428521 SELECT REHABILITATION LLC 1750 S 20TH ST LINCOLN NE 68502 REHAB SERVICES 362098 LAWRENCE RECRUITING SPECIALISTS PO BOX 310781 DESMOINES IA 50331 NURSING SERVICES 195952 TRI-STATE NURSING 3100 S LAKEPORT ST SIOUX CITY IA 51106 NURSING SERVICES 161356 FUSION MEDICAL STAFFING LLC 11808 GRANT ST STE 100 OMAHA NE 68164 NURSING SERVICES 154260 6 345219 2194387 33891 1129613 2573497 PRIVATE PAY/INSURANCE REVENUE 623000 7370547 7370547 MEDICARE/MEDICAID/VA PAYMENTS 623000 3201036 3201036 MISCELLANEOUS INCOME 623000 49455 49455 10621038 68604 0 68604 68604 68604 CAFETERIA & VENDING REVENUE 623000 958 958 GIFT SHOP RECEIPTS 623000 494 494 1452 13264591 10621038 0 70056 X 152784 152784 5471516 5200510 271006 59613 59613 567534 490226 77308 430769 392011 38758 1059444 1059444 35040 35040 44734 44734 2018957 2018957 19392 13190 6202 964133 951502 12631 829764 829764 12874 12874 5923 4628 1295 44774 44774 388907 388907 262847 176933 85914 MEDICAL SUPPLIES 1035961 1035961 BAD DEBT & CHARITY CARE 35561 35561 DUES & SUBSCRIPTIONS 34458 11284 23174 13474985 11819479 1655506 0 108023 83734 1991586 717501 935857 920370 606164 39701 65307 113358 8211230 5635149 2383828 2576081 1038977 1097885 7129742 5548630 900431 935212 864840 803111 1273158 132266 34291 3170695 1772614 X 2920070 2709676 1038977 1066340 3959047 3776016 7129742 5548630 -210394 27363 0 X X 0 1 X 1 1 1 X 897809 130733 190348 2286676 2573497 6079063 11715722 11577905 11453260 11592520 10619038 56958445 2046 2696 4552 2548 1452 13294 12615577 11711334 11648160 13881744 13193987 63050802 0 0 0 63050802 58100 57453 57760 58922 68604 300839 58100 57453 57760 58922 68604 300839 12673677 11768787 11705920 13940666 13262591 63351641 0.99530 0.99530 0.00470 0.00470 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 154347 154347 5777277 3929831 1847446 2029825 1582901 446924 249781 122417 127364 2576081 BENEFICIAL INTEREST IN PERPETUAL TRUST 1066340 ESTIMATED THIRD PARTY 31545 1097885 ACCRUED INTEREST PAYABLE 353 DUE TO AFFILIATES 33938 34291 X PART X, LINE 2: MIDWEST GERIATRICS, INC., ROYALE OAKS HOUSE OF HOPE, GERIMED, INC., FLORENCE HOME AND SENIOR HEALTH FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THESE NOT-FOR-PROFIT CORPORATIONS HAVE EACH RECEIVED A DETERMINATION LETTER THAT THEY ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. UNIMED, INC. IS A TAXABLE CORPORATION. UNIMED, INC. HAS A NET OPERATING LOSS CARRYFORWARD AS OF DECEMBER 31, 2021 AND 2020, AVAILABLE FOR FEDERAL AND STATE INCOME TAX PURPOSES. THE ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2021 AND 2020, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 MIDWEST GERIATRICS INC 7915 N 30TH STREET OMAHA NE 68112 470727974 501(C)(3) 68066 0 TO ASSIST WITH ONGOING NEEDS OF THE ORGANIZATION GERIMED 7915 N 30TH STREET OMAHA NE 68112 470727973 501(C)(3) 80000 0 TO ASSIST WITH ONGOING NEEDS OF THE ORGANIZATION 2 0 PART I, LINE 2: RECIPIENT PROVIDES INVOICES AND RECEIPTS AS DOCUMENTATION THAT THE GRANT FUNDS ARE USED FOR THEIR INTENDED PURPOSE. 0 0 0 0 0 0 0 0 0 DEBRA L THACKER CFO 0 196380 0 0 0 0 0 13000 0 20103 0 229483 0 0 LOIS JORDAN PRESIDENT / CEO 0 197998 0 0 0 0 0 5700 0 13375 0 217073 0 0 PART I, LINE 3 FLORENCE HOME FOR THE AGED DOES NOT HAVE ANY OFFICERS IT DIRECTLY COMPENSATES. MIDWEST GERIATRICS, INC., AN AFFILIATE OF FLORENCE HOME FOR THE AGED, COMPENSATES THE OFFICERS OF FLORENCE HOME FOR THE AGED. THEREFORE, THE POLICY ON THE PROCESS FOR DETERMINING COMPENSATION OF MIDWEST GERIATRICS, INC. OFFICERS APPLIES TO THE COMPENSATION OF THE FOLLOWING PERSONS SERVING AS OFFICERS OF FLORENCE HOME FOR THE AGED: CHIEF EXECUTIVE OFFICER: LOIS JORDAN CHIEF FINANCIAL OFFICER: DEBRA THACKER THE PROCESS IS UTILIZED BY THE EXECUTIVE COMMITTEE OF THE MIDWEST GERIATRICS, INC. FOR FURTHER EXPLANATION OF THE PROCESS SEE SCHEDULE O. X 100 845155 COST OR SELLING PRICE X CLINIC BUILDING SPACE 1 284458 FMV 0 0 0 PART I, COLUMN (B): DURING 2021, FLORENCE HOME RECIVED NON-CASH CONTRIBUTIONS OF PERSONAL PROTECTIVE EQUIPMENT AND TESTING KITS RELATED TO THE COVID-19 PANDEMIC ONE TO TWO TIMES PER WEEK THROUGHOUT THE YEAR. FORM 990, PART VI, SECTION A, LINE 7A MIDWEST GERIATRICS, INC., A RELATED ENTITY, HAS THE POWER TO ELECT ALL MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE ARTICLES AND BYLAWS OF FLORENCE HOME FOR THE AGED MAY BE AMENDED WITH THE AFFIRMATIVE VOTE OF TWO-THIRDS OF THE MEMBERS OF THE BOARD OF DIRECTORS OF MIDWEST GERIATRICS INC. FORM 990, PART VI, SECTION B, LINE 11B ONCE THE FORM 990 AND RELATED SCHEDULES HAVE BEEN PREPARED BY THE DIRECTOR OF FINANCE, THE CFO REVIEWS IT, MAKES ANY CHANGES AND ACCEPTS THE DRAFT FORM 990. THE FINANCE COMMITTEE WILL THEN BE INFORMED VIA E-MAIL THAT THE DRAFT FORM 990 IS READY FOR REVIEW AND ASKED IF THEY WANT IT SENT OUT TO THEM OR IF THEY WILL BE COMING TO THE FACILITY TO REVIEW. ONCE 2/3 OF THE FINANCE COMMITTEE MEMBERS HAVE REVIEWED AND ACCEPTED THE FORM 990, IT WILL BE FILED. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE ASKED TO REVIEW AND DISCLOSE ANY CONFLICTS OF INTERESTS THAT THEY MAY HAVE WITH FLORENCE HOME FOR THE AGED OPERATIONS. THEY ARE THEN ASKED TO SIGN A DOCUMENT INDICATING CONFLICTS, IF ANY. THE BOARD CHAIR IS THEN INFORMED OF ANY CURRENT CONFLICTS FOR CONSIDERATION IN FUTURE VOTING MATTERS OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 FLORENCE HOME FOR THE AGED DOES NOT HAVE ANY OFFICERS THAT IT DIRECTLY COMPENSATES. MIDWEST GERIATRICS, INC., AN AFFILIATE OF FLORENCE HOME, COMPENSATES THE OFFICERS OF FLORENCE HOME. THE POLICY ON THE PROCESS FOR DETERMINING COMPENSATION OF MIDWEST GERIATRICS, INC. OFFICERS APPLIES TO THE COMPENSATION OF THE FOLLOWING PERSONS SERVING AS OFFICERS OF FLORENCE HOME: CHIEF EXECUTIVE OFFICER: LOIS JORDAN CHIEF FINANCIAL OFFICER: DEBRA THACKER THE PROCESS IS UTILIZED BY THE EXECUTIVE COMMITTEE OF THE MIDWEST GERIATRICS, INC. BOARD ON AN ANNUAL BASIS. THE PROCESS INCLUDES ALL OF THESE ELEMENTS: (1) REVIEW AND APPROVAL BY THE EXECUTIVE COMMITTEE OF MIDWEST GERIATRICS, INC.; (2) USE OF OUTSIDE DATA AS TO COMPARABLE COMPENSATION; AND (3) CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING. 1. REVIEW AND APPROVAL. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF MIDWEST GERIATRICS, INC., PROVIDED THAT PERSONS WITH CONFLICTS OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT AT ISSUE ARE NOT INVOLVED IN THIS REVIEW AND APPROVAL. 2. USE OF OUTSIDE DATA AS TO COMPARABLE COMPENSATION. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED USING DATA REGARDING COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. 3. CONTEMPORANEOUS DOCUMENTATION AND RECORDING. THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT. FORM 990, PART VI, SECTION C, LINE 19 A COPY OF THE REQUESTED DOCUMENT IS PROVIDED WITHIN 72 HOURS UPON REQUEST. FORM 990, PART IX, LINE 11G DIETARY/HSKING: PROGRAM SERVICE EXPENSES 32,252. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,252. NURSING: PROGRAM SERVICE EXPENSES 1,364,864. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,364,864. THERAPY: PROGRAM SERVICE EXPENSES 361,786. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 361,786. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 260,055. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 260,055. FORM 990, PAGE 12, PART XII,LINE 2C: THE BOARD OF DIRECTORS SELECTS THE INDEPENDENT ACCOUNTANT AND HAS THE RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. UPON CONCLUSION OF THE AUDIT, THE INDEPENDENT ACCOUNTANT PRESENTS THE RESULTS OF THE AUDIT TO THE BOARD. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. SENIOR HEALTH FOUNDATION 7915 N 30TH STREET OMAHA NE 68112 470709560 PROVIDE ASSISTANCE TO THE ELDERLY NE 501(C)(3) LINE 7 MIDWEST GERIATRICS INC 1 GERIMED INC 7915 N 30TH STREET OMAHA NE 68112 470727973 PHARMACEUTICAL SALES NE 501(C)(3) LINE 10 MIDWEST GERIATRICS INC 1 MIDWEST GERIATRICS INC 7915 N 30TH STREET OMAHA NE 68112 470727974 SUPPORT FLORENCE HOME AND RELATED ORGANIZATIONS THROUGH MANAGEMENT SERVICES NE 501(C)(3) LINE 12B, II N/A 0 ROYALE OAKS HOUSE OF HOPE 4801 N 52ND STREET OMAHA NE 68104 260808357 SUPPORT FLORENCE HOME BY SERVICING A FHA-INSURED NON-RECOURSE LOAN NE 501(C)(3) LINE 12A, I MIDWEST GERIATRICS INC 1 EMPOWER HOME CARE 7915 N 30TH STREET OMAHA NE 68112 471713914 INACTIVE NE 501(C)(3) LINE 10 MIDWEST GERIATRICS INC 1 UNIMED INC 7915 N 30TH STREET OMAHA NE 68112 470759285 PHARMACEUTICAL SALES NE N/A C 1 MIDWEST HEALTH CARE ENTERPRISES 7915 N 30TH STREET OMAHA NE 68112 363672698 INACTIVE NE N/A C 1 CRISS-FLORENCE HOME TRUST P O BOX 0634 MILWAUKEE WI 53201 476143241 INVESTMENT MANAGEMENT WI FLORENCE HOME FOR THE AGED T 52972 1066340 1.00000 1 1 1 1 1 1 0 0 0 0 1 1 0 1 1 1 0 0 0 0 ROYALE OAKS HOUSE OF HOPE K 544774 FMV GERIMED INC M 402282 FMV GERIMED INC A 28620 FMV GERIMED INC B 80000 FMV