2021-12-09T12:42:25-06:00 2021-06-30 470625816 LUTZ AND COMPANY PC 3320 JAMES ROAD SUITE 100 GRAND ISLAND NE 68803 990 2020-07-01 470378776 CHRISTIAN HOMES INC CHRI 3089954493 1923 WEST 4TH AVENUE HOLDREGE NE 68949 CHARLIE REESER CHAIRMAN 3089954493 2021-12-01 1 CHARLIE REESER 999009999 STEVEN K PLACKE P00078534 3083827850 2021-11-30 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CHARLIE REESER 1923 WEST 4TH AVENUE HOLDREGE NE 68949 9461244 0 X N/A X 1889 NE PROVIDE HOUSING AND SERVICES TO THE ELDERLY AND INFIRMED IN A MANNER THAT PROVIDES FOR THE PHYSICAL, MENTAL, SOCIAL, AND SPIRITUAL WELFARE OF THE RESIDENTS. 14 0 174 0 0 0 180192 1459436 7993489 7203629 -34522 46746 80886 493600 8220045 9203411 0 0 0 0 5543503 5992430 0 0 0 2722288 2961403 8265791 8953833 -45746 249578 10701788 11496342 9074476 9489801 1627312 2006541 PROVIDE HOUSING AND SERVICES TO THE ELDERLY AND INFIRMED IN A MANNER THAT PROVIDES FOR THE PHYSICAL, MENTAL, SOCIAL, AND SPIRITUAL WELFARE OF THE RESIDENTS. 0 0 8015257 7211432 NURSING HOME CARE AND ASSISTED LIVING FOR THE ELDERLY. 8015257 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 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 0 0 1 0 0 0 1 10 0 174 1 0 0 0 0 0 0 0 0 0 0 X 14 0 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 X CHERLYN HUNT 3089954493 1923 WEST 4TH AVE HOLDREGE NE 68949 X CHARLIE REESER CHAIRMAN 0.00 X X 0 0 0 REV TOM THOMPSON VICE-CHAIRMAN 0.00 X X 0 0 0 MARLYS ANDERSON SECRETARY 0.00 X X 0 0 0 DR MARK ADAM BOARD MEMBER 0.00 X 0 0 0 DR COLBY KINSER EX-OFFICIO 0.00 X 0 0 0 JEFF MOON BOARD MEMBER 0.00 X 0 0 0 CRAIG HADLEY BOARD MEMBER 0.00 X 0 0 0 TROY URBOM BOARD MEMBER 0.00 X 0 0 0 CHERLYN HUNT EXEC DIRECTOR 40.00 X 0 0 0 MATT SAMUELSON BOARD MEMBER 0.00 X 0 0 0 PASTOR DAVID BALLAST BOARD MEMBER 0.00 X 0 0 0 LOUIS STRYDOM BOARD MEMBER 0.00 X 0 0 0 RON HAFLICH BOARD MEMBER 0.00 X 0 0 0 JIM BOWEN BOARD MEMBER 0.00 X 0 0 0 0 0 0 0 0 0 0 MERITAIN HEALTH PO BOX 223881 PITTSBURGH PA 152502881 HEALTH BENEFITS 375147 INSPIRE REHAB 8181 ARISTA PL UNIT 100 BROOMFIELD CO 800217916 THERAPY SERVICES 194203 PRIME TIME HEALTHCARE LLC 15380 WEIR ST OMAHA NE 68137 AGENCY NURSING SERVICES 114980 3 1443982 15454 1459436 NURSING HOME - DHHS 623000 3022594 3022594 NURSING HOME - PRIVATE 623000 1966397 1966397 NURSING HOME - MEDICAR 623000 943047 943047 ASSISTED & INDEPENDENT 623000 927860 927860 ASSISTED & INDEPENDENT 623000 343731 343731 7203629 2280 2280 611523 134611 476912 476912 476912 126838 40850 90175 33047 36663 7803 44466 7803 36663 MEAL INCOME 623000 8479 8479 LAUNDRY REIMBURSEMENT 623000 5521 5521 MANAGEMENT FEES 623000 1458 1458 1230 1230 16688 9203411 7211432 0 532543 105483 105483 4360936 4092029 268907 1200625 872143 328482 325386 298203 27183 13064 13064 44819 44819 15946 1466 14480 72715 72715 9392 9392 92624 92624 439793 439793 649829 649829 126049 94831 31218 SUPPLIES 488630 488630 CONTRACT SERVICES 285448 285448 DIETARY SUPPLIES 262392 262392 UTILITIES 216151 216151 244551 212326 32225 8953833 8015257 938576 0 1665532 2020192 592070 578307 2293 2293 25550 26341 18837173 11736750 7653117 7100423 494103 1082901 269123 685885 10701788 11496342 712703 858835 258046 47535 8005648 8512260 98079 71171 9074476 9489801 X 1627312 2006541 1627312 2006541 10701788 11496342 249578 129651 0 X 0 1 X 1 0 X 162465 50854 146407 20491 15454 395671 7555084 7620725 7632195 7916466 7993489 38717959 7717549 7671579 7778602 7936957 8008943 39113630 0 0 0 39113630 92951 17447 6153 6404 2280 125235 92951 17447 6153 6404 2280 125235 27496 28534 24372 22987 16688 120077 7837996 7717560 7809127 7966348 8027911 39358942 0.99380 0.99270 0.00320 0.00390 X PART III, LINE 12 - OTHER INCOME DETAIL MEALS, MISCELLANEOUS, TRANSPORTATION AND LAUNDRY INCOME - $16,688 252102 61952 314054 33071 15259802 9117695 6175178 653058 2577188 2619055 611191 7100423 CASH SURRENDER VALUE OF LIFE INSURANCE 6418 DEBT SERVICE RESERVE FUND 678927 RESIDENT FUNDS 540 685885 SECURITY DEPOSITS 56239 CHRISOMA VILLA TRUST LIABILITY 14932 71171 9333062 129651 129651 9203411 0 9203411 8953833 0 8953833 0 8953833 PART X - FIN 48 FOOTNOTE THE ORGANIZATION 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 ORGANIZATION HAS BEEN DETERMINED BY THE INTERNATIONAL 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 THE YEARS ENDED JUNE 30, 2021 AND 2020. THE ORGANIZATION'S FORMS 990, RETURN OF ORGANIZATION EXEMPT FOR INCOME TAX, FOR THE YEARS ENDING JUNE 30, 2021, 2020, 2019, AND 2018 ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. A HOSPITAL AUTHORITY NO 1 OF PHELPS COUNTY 410777710 2010-10-27 10360000 REFUND PRIOR ISSUE 0 0 0 B HOSPITAL AUTHORITY NO 1 OF PHELPS COUNTY 2020 A & B 410777710 2020-09-01 7545000 REFUNDING OF PRIOR ISSUE 0 0 0 A 10360000 10363140 254329 586687 207200 5773731 3545273 1 0 0 1 B 7566962 430000 212056 1 0 0 1 A 0 1 0 0 1 0 0 0 0 B 0 1 0 0 1 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF MEMBERS AND THEIR RIGHTS BOARD MEMBERS ARE FIRST NOMINATED BY A NOMINATING COMMITTEE COMPRISED OF CURRENT BOARD MEMBERS. THEY ARE THEN ELECTED DURING THE YEARLY MIDWEST EVANGELICAL FREE CHURCH CONFERENCE. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS SUBJECT TO APPROVAL OF MEMBERS IF A LOAN REQUIRES THE PLEDING OF ASSETS, PERMISSION IS REQUIRED OF THE BOARD OF THE MIDWEST DISTRICT OF THE EVANGELICAL FREE CHURCH OF AMERICA. FORM 990, PART VI, SECTION B, LINE 11B ORGANIZATION'S PROCESS TO REVIEW FORM 990 THE EXECUTIVE DIRECTOR REVIEWS THE FORM 990 AND NOTIFIES THE PREPARER OF ANY CHANGES. THE FORM 990 IS AVAILABLE FOR REVIEW BY BOARD MEMBERS AT THEIR REQUEST. FORM 990, PART VI, SECTION B, LINE 12C ENFORCEMENT OF CONFLICTS POLICY THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION PROCESS FOR TOP OFFICIAL COMPARABILITY OF COMPENSATION FOR TOP MANAGEMENT OFFICIALS IS REVIEWED THROUGH AN INDEPENDENT CONSULTANT SPECIALIZING IN LONG-TERM CARE AS WELL AS BY AN INDUSTRY SURVEY CONDUCTED ON A STATE WIDE BASIS. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. MIDWEST DISTRICT OF THE EVANGELICAL 218 W 18TH ST KEARNEY NE 68845 410721672 CHURCH NE 501(C)(1) LINE 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0