2021-11-10T13:32:10-06:00 2021-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2020-07-01 205765691 MOSAIC HOUSING CORP XV - COUNCIL BLUFFS MOSA 4028963884 4980 SOUTH 118TH STREET OMAHA NE 68137 KRISTIN ROSSOW PRESIDENT 4028963884 2021-11-09 1 KRISTIN ROSSOW 999009999 WENDY R COOLEY P01523804 4023302660 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z KRISTIN ROSSOW 4980 SOUTH 118TH STREET OMAHA NE 68137 93788 0 X WWW.MOSAICINFO.ORG X 2006 NE THE ORGANIZATION PROVIDES LOW INCOME HOUSING IN ACCORDANCE WITH HUD SECTION 811 GUIDELINES. 3 3 0 4 0 0 41945 44117 55631 49557 104 114 0 0 97680 93788 0 0 0 0 0 0 0 0 0 178787 180824 178787 180824 -81107 -87036 1564186 1482359 11413 16622 1552773 1465737 THE ORGANIZATION PROVIDES LOW INCOME HOUSING IN ACCORDANCE WITH HUD SECTION 811 GUIDELINES. 0 0 157693 49557 THE ORGANIZATION PROVIDES LOW INCOME HOUSING IN ACCORDANCE WITH HUD SECTION 811 GUIDELINES. 157693 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 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 2 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 3 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X KRISTIN ROSSOW 4028963884 4980 S 118 STREET OMAHA NE 68137 DEANNA WAGNER CHAIRPERSON 0.10 2.30 X X 0 0 0 BARBARA PETSKA VICE CHAIRPERSON 0.10 2.30 X X 0 0 0 JENNIFER DOAN DIRECTOR 0.10 2.30 X 0 0 0 CYNTHIA WEBER DIRECTOR THRU 01/21 0.10 2.30 X 0 0 0 KRISTIN ROSSOW PRESIDENT 0.10 39.90 X 0 175721 29484 GREG PASKACH TREASURER/SECRETARY 0.10 39.90 X 0 102236 19128 0 277957 48612 0 0 1 0 0 44117 44117 RENTAL INCOME 531110 49557 49557 49557 114 114 93788 49557 0 114 X 7723 7723 152 152 8794 8794 26835 26835 5234 2030 3204 33410 33410 37 37 88925 88925 6493 6493 3221 3221 180824 157693 23131 0 9053 2192 1863 4627 2370903 966918 1492910 1403985 60360 71555 1564186 1482359 6799 11323 4614 5299 11413 16622 X 54360 -32676 1498413 1498413 1552773 1465737 1564186 1482359 -87036 0 X X 0 1 X 1 1 1 X 28306 38203 44002 41945 44117 196573 57875 49744 58720 55631 49557 271527 86181 87947 102722 97576 93674 468100 0 0 0 468100 38 66 138 104 114 460 38 66 138 104 114 460 86219 88013 102860 97680 93788 468560 0.99900 0.99750 0.00100 0.00090 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 54000 54000 2295555 948007 1347548 21348 18911 2437 1403985 TENANT SECURITY DEPOSITS 4260 DUE TO AFFILIATE 1039 5299 X 93788 0 93788 0 93788 180824 0 180824 0 180824 PART X, LINE 2: THE FOLLOWING FOOTNOTE IS TAKEN FROM THE CONSOLIDATED FINANCIAL STATEMENTS: ALL CONSOLIDATED AFFILIATED ENTITIES, EXCEPT FOR MOSAIC HOUSING CORP V, INC. AND EASE-E MEDICAL, INC., 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. 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 CONSOLIDATED FINANCIAL STATEMENTS OTHER THAN DESCRIBED PREVIOUSLY. 0 0 0 0 0 0 0 0 0 KRISTIN ROSSOW PRESIDENT 0 171795 0 3265 0 661 0 4822 0 24662 0 205205 0 0 PART I, LINE 3 KRISTIN ROSSOW IS PAID BY MOSAIC, A RELATED ORGANIZATION. MOSAIC'S BOARD AND COMPENSATION COMMITTEE USE AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, AND A COMPENSATION SURVEY IN ESTABLISHING HER COMPENSATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OR DIRECTORS FOR MOSAIC, A RELATED ENTITY, APPOINTS BOARD MEMBERS FOR THIS ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM. IT IS REVIEWED BY THE PRESIDENT AND TREASURER OF THE ORGANIZATION AND THEN SHARED WITH THE BOARD OF DIRECTORS PRIOR TO THE FORM 990 BEING ELECTRONICALLY FILED. FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER AND OFFICER ANNUALLY COMPLETES A CONFLICT OF INTEREST FORM. THE FORM IS PROVIDED TO MOSAIC'S SENIOR VP OF HUMAN RESOURCES FOR REVIEW AND POSSIBLE REPORTING TO MOSAIC'S BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES AVAILABLE TO THE PUBLIC, UPON REQUEST, ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS. FORM 990, PART IX, LINE 11G REPAIRS CONTRACT: PROGRAM SERVICE EXPENSES 9,120. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,120. GROUNDS CONTRACT: PROGRAM SERVICE EXPENSES 9,063. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,063. FIRE SYSTEM MONITORING & INSPECTION: PROGRAM SERVICE EXPENSES 5,239. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,239. HOUSEKEEPING: PROGRAM SERVICE EXPENSES 242. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 242. PEST CONTROL CONTRACT: PROGRAM SERVICE EXPENSES 2,688. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,688. OTHER SERVICE FEES: PROGRAM SERVICE EXPENSES 483. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 483. FORM 990, PART XII, LINE 2C: THE BOARD ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION PROCESS OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MOSAIC 4980 S 118 STREET OMAHA NE 68137 113669999 SERVICES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES NE 501(C)(3) LINE 10 N/A 0 THE MOSAIC FOUNDATION INC 4980 S 118 STREET OMAHA NE 68137 363837360 FUNDRAISING & INVESTMENT ASSET MANAGEMENT NE 501(C)(3) LINE 12A, I MOSAIC 1 OAKS OF DUNN COUNTY INC 4980 S 118 STREET OMAHA NE 68137 391913323 SENIOR LIVING SERVICES WI 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP I 4980 S 118 STREET OMAHA NE 68137 363756911 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP II 4980 S 118 STREET OMAHA NE 68137 470773689 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP IV 4980 S 118 STREET OMAHA NE 68137 911823422 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP VII 4980 S 118 STREET OMAHA NE 68137 470828015 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP VIII 4980 S 118 STREET OMAHA NE 68137 470828012 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP IX 4980 S 118 STREET OMAHA NE 68137 742838413 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP X 4980 S 118 STREET OMAHA NE 68137 742908789 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XI 4980 S 118 STREET OMAHA NE 68137 311706640 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XII 4980 S 118 STREET OMAHA NE 68137 481297244 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XIII 4980 S 118 STREET OMAHA NE 68137 421626679 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XIV - ROCKFORD 4980 S 118 STREET OMAHA NE 68137 204417891 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XVI - FARMINGTON 4980 S 118 STREET OMAHA NE 68137 205765731 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XVII - BEATRICE 4980 S 118 STREET OMAHA NE 68137 261710013 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XVIII - OSCEOLA-WAUKON 4980 S 118 STREET OMAHA NE 68137 261710184 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XIX - WINFIELD 4980 S 118 STREET OMAHA NE 68137 261710259 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XX - GARDEN CITY 4980 S 118 STREET OMAHA NE 68137 264555206 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XXI - MEMPHIS 4980 S 118 STREET OMAHA NE 68137 264555313 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XXII - LOGAN 4980 S 118 STREET OMAHA NE 68137 273483415 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORPORATION XXIII - AUSTIN 4980 S 118 STREET OMAHA NE 68137 710875364 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC ILLINOIS HOUSING I 4980 S 118 STREET OMAHA NE 68137 202997161 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC ILLINOIS HOUSING II 4980 S 118 STREET OMAHA NE 68137 204417645 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC ILLINOIS HOUSING AT MACOMB I 4980 S 118 STREET OMAHA NE 68137 204841909 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC ILLINOIS HOUSING OF ROCKFORD I 4980 S 118 STREET OMAHA NE 68137 204841856 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC EMPLOYEE WELFARE BENEFIT PLAN 4980 S 118 STREET OMAHA NE 68137 383831874 EMPLOYEE WELFARE BENEFIT PLAN NE 501(C)(9) N/A MOSAIC 1 MOSAIC SENIOR SERVICES INC 4980 S 118 STREET OMAHA NE 68137 831746407 SENIOR LIVING SERVICES AZ 501(C)(3) LINE 12A, I MOSAIC 1 MOSAIC RESIDENTIAL SERVICES OF NEBRASKA LLC 4980 S 118 ST OMAHA NE 68137 271695051 LOW INCOME HOUSING NE N/A 0 0 EASE-E MEDICAL INC 731 SOUTH 8TH STREET CANON CITY CO 81212 470842353 SALE OF MEDICAL EQUIPMENT AND SUPPLIES NE N/A C 1 MOSAIC HOUSING CORPORATION V 4980 S 118 ST OMAHA NE 68137 470805545 LOW INCOME HOUSING NE N/A C 1 BICO 4980 S 118 ST OMAHA NE 68137 CAPTIVE INSURANCE BD N/A C 1 CHARITABLE REMAINDER TRUSTS (3) INVESTMENT MANAGEMENT NE N/A T 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0