GABRIELS VILLA INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
GABRIELS VILLA INC (EIN 39-1857036)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-15
IRS object ID
202213199349325866
Schema version
2021v4.2
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)
Return2022-11-15T16:44:30-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

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 Begin2021-01-01TaxPeriodBeginDt

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
Signature2022-11-14SignatureDt
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

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKIMBERLY ANDERSONPreparerPersonNm
PTINP00188889PTIN
Phone6086628600PhoneNum
Preparation2022-11-14PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerTHERESA M BERTRAMPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1225 N EAGLE STAddressLine1Txt
CityOSHKOSHCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54902ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$1,795,880GrossReceiptsAmt
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 MissionPROVIDE HOUSING FOR AGING PERSONS.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee75TotalEmployeeCnt
Total Volunteers10TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$113,116PYContributionsGrantsAmt
CY Contributions Grants$296,531CYContributionsGrantsAmt
PY Program Service Revenue$1,744,133PYProgramServiceRevenueAmt
CY Program Service Revenue$1,496,352CYProgramServiceRevenueAmt
PY Investment Income$5,797PYInvestmentIncomeAmt
CY Investment Income$1,482CYInvestmentIncomeAmt
PY Other Revenue-$9,309PYOtherRevenueAmt
CY Other Revenue$1,515CYOtherRevenueAmt
PY Total Revenue$1,853,737PYTotalRevenueAmt
CY Total Revenue$1,795,880CYTotalRevenueAmt
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$1,412,701PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$1,385,954CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$701,367PYOtherExpensesAmt
CY Other Expenses$716,350CYOtherExpensesAmt
PY Total Expenses$2,114,068PYTotalExpensesAmt
CY Total Expenses$2,102,304CYTotalExpensesAmt
PY Revenues Less Expenses-$260,331PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$306,424CYRevenuesLessExpensesAmt
Total Assets BOY$2,327,827TotalAssetsBOYAmt
Total Assets EOY$1,922,027TotalAssetsEOYAmt
Total Liabilities BOY$440,365TotalLiabilitiesBOYAmt
Total Liabilities EOY$340,989TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,887,462NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,581,038NetAssetsOrFundBalancesEOYAmt
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$1,769,799ExpenseAmt
Revenue$1,496,352RevenueAmt
DescGABRIEL'S VILLA, INC. PROVIDES SUPERVISED CARE TO AGING PERSONS IN OSHKOSH, WI. THE ENTITY HAS 40 ASSISTED LIVING UNITS AT ITS FACILITY.Desc
Total Program Service Expenses$1,769,799TotalProgramServiceExpensesAmt
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 Stmt0ConsolidatedAuditFinclStmtInd
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 Document3IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee75EmployeeCnt
Employment Tax Returns Filed0EmploymentTaxReturnsFiledInd
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 Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
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 CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
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 NORTH 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
PAULA MCNIEL
BOARD MEMBER0.201.40Yes (X)$0$0$0
MARY MURKEN
CHAIR0.201.40Yes (X)$0$0$0Yes (X)
MARK BEECHER
VICE CHAIR0.202.90Yes (X)$0$0$0Yes (X)
KATHY BERMINGHAM
BOARD MEMBER0.201.40Yes (X)$0$0$0
JAMIE BONELL
BOARD MEMBER0.201.40Yes (X)$0$0$0
GLENN NELSON
SECRETARY0.201.40Yes (X)$0$0$0Yes (X)
PEG OLSON
BOARD MEMBER0.201.40Yes (X)$0$0$0
STEW RIECKMAN
BOARD MEMBER0.201.40Yes (X)$0$0$0
NATE OLSON
BOARD MEMBER0.201.40Yes (X)$0$0$0
LAURIE MULLER
BOARD MEMBER0.201.40Yes (X)$0$0$0
THERESA BERTRAM
PRESIDENT & CEO4.0034.00$0$389,617$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$389,617TotReportableCompRltdOrgAmt
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
Government Grants$296,531GovernmentGrantsAmt
Total Contributions$296,531TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
TENANT REVENUE531110$1,306,422$1,306,422
SERVICE REVENUE621610$189,930$189,930
FieldValueIRS element (for citing)
Total Program Service Revenue$1,496,352TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,482TotalRevenueColumnAmt
Exclusion$1,482ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
BEAUTY SHOP REVENUE900099$960$960
ASSESSMENT REVENUE900099$540$540
MEAL REVENUE900099$15$15
FieldValueIRS element (for citing)
Other Revenue Total$1,515OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,795,880TotalRevenueColumnAmt
Related Or Exempt Func Income$1,496,352RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$2,997ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$1,224,823TotalAmt
Program Services$997,928ProgramServicesAmt
Management And General$226,895ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$32,066TotalAmt
Program Services$26,126ProgramServicesAmt
Management And General$5,940ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$51,524TotalAmt
Program Services$41,979ProgramServicesAmt
Management And General$9,545ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$77,541TotalAmt
Program Services$63,177ProgramServicesAmt
Management And General$14,364ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

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

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$1,552TotalAmt
Management And General$1,552ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$17,108TotalAmt
Management And General$17,108ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$24,724TotalAmt
Program Services$21,956ProgramServicesAmt
Management And General$2,768ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$3,464TotalAmt
Program Services$3,464ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$104,224TotalAmt
Program Services$87,030ProgramServicesAmt
Management And General$17,194ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$17,994TotalAmt
Management And General$17,994ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$98,305TotalAmt
Program Services$98,305ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$10,747TotalAmt
Program Services$10,322ProgramServicesAmt
Management And General$425ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$110,409TotalAmt
Program Services$110,409ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$29,095TotalAmt
Program Services$29,095ProgramServicesAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescMISC EXPDesc
Total$18,720TotalAmt
Management And General$18,720ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$2,102,304TotalAmt
Program Services$1,769,799ProgramServicesAmt
Management And General$332,505ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$536,339BOYAmt
EOY$269,616EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$611,047BOYAmt
EOY$612,655EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$75,980BOYAmt
EOY$58,174EOYAmt

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$4,494BOYAmt
EOY$4,145EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$4,379,107LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,405,818LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,047,583BOYAmt
EOY$973,289EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$50,536BOYAmt
EOY$2,300EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$2,327,827BOYAmt
EOY$1,922,027EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$152,234BOYAmt
EOY$128,081EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$189,600BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$98,531BOYAmt
EOY$83,411EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$129,497EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$440,365BOYAmt
EOY$340,989EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,887,462BOYAmt
EOY$1,581,038EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,887,462BOYAmt
EOY$1,581,038EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,327,827BOYAmt
EOY$1,922,027EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$306,424ReconcilationRevenueExpnssAmt
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 Minus1 Year$113,116CurrentTaxYearMinus1YearAmt
Current Tax Year$296,531CurrentTaxYearAmt
Total$409,647TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,876,870CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,774,839CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,899,707CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,744,133CurrentTaxYearMinus1YearAmt
Current Tax Year$1,086,101CurrentTaxYearAmt
Total$8,381,650TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,876,870CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,774,839CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,899,707CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,857,249CurrentTaxYearMinus1YearAmt
Current Tax Year$1,382,632CurrentTaxYearAmt
Total$8,791,297TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,226,633CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,232,118CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,286,123CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,194,834CurrentTaxYearMinus1YearAmt
Current Tax Year$968,300CurrentTaxYearAmt
Total$5,908,008TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,226,633CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,232,118CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,286,123CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,194,834CurrentTaxYearMinus1YearAmt
Current Tax Year$968,300CurrentTaxYearAmt
Total$5,908,008TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$2,883,289PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,946CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,337CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,508CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,797CurrentTaxYearMinus1YearAmt
Current Tax Year$1,482CurrentTaxYearAmt
Total$23,070TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,946CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$6,337CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$7,508CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,797CurrentTaxYearMinus1YearAmt
Current Tax Year$1,482CurrentTaxYearAmt
Total$23,070TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$17,803CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years-$2,461CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years-$1,438CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year-$9,309CurrentTaxYearMinus1YearAmt
Current Tax Year$1,515CurrentTaxYearAmt
Total$6,110TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,896,619CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,778,715CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,905,777CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,853,737CurrentTaxYearMinus1YearAmt
Current Tax Year$1,385,629CurrentTaxYearAmt
Total$8,820,477TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.32690PublicSupportCY509Pct
Public Support PY5090.33770PublicSupportPY509Pct
Investment Income CY0.00260InvestmentIncomeCYPct
Investment Income PY0.00310InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests PY509Yes (X)ThirtyThrPctSuprtTestsPY509Ind

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$2,314,329DepreciationAmt
Book Value$644,885BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$90,358OtherCostOrOtherBasisAmt
Depreciation$73,350DepreciationAmt
Book Value$17,008BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,246,202OtherCostOrOtherBasisAmt
Depreciation$1,018,139DepreciationAmt
Book Value$228,063BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$973,289TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
DUE FROM AFFILIATES$51,286
DEFERRED GOVERNMENTAL GRANTS$78,211
FieldValueIRS element (for citing)
Total Liability$129,497TotalLiabilityAmt
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$329,617CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$0BonusFilingOrganizationAmount
Bonus Related Organizations$60,000BonusRelatedOrganizationsAmt
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$389,617TotalCompensationRltdOrgsAmt
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 (8 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 VOTING MEMBERSHIP MEETINGS. 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 WAS FILED, THE FORM 990 WAS 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 B, LINE 15CEO COMPENSATION IS DETERMINED BY A COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE CONSIDERS COMPARABLE DATA AND ECONOMIC CONDITIONS. THE DELIBERATIONS ARE RECORDED. COMPENSATION AND BENEFITS FOR OTHER OFFICERS AND KEY EMPLOYEES ARE REVIEWED ANNUALLY BY THE CEO. COMPARABLE INDUSTRY STANDARDS ARE CONSIDERED INCLUDING COMPENSATION AND BENEFIT INFORMATION PROVIDED BY LEADINGAGE WISCONSIN. DELIBERATIONS INCLUDE A REVIEW OF OBJECTIVES AND ACTUAL DELIVERABLES. PROCESS IS DOCUMENTED/MAINTAINED ELECTRONICALLY. THESE PROCESSES LAST OCCURRED IN 2020.
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 OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
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 Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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