2020-11-16T08:42:16-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 8215 GREENWAY BOULEVARD SUITE 600 MIDDLETON WI 53562 990 2019-01-01 391857036 GABRIEL'S VILLA INC GABR 9202354653 215 NORTH WESTFIELD STREET OSHKOSH WI 54902 THERESA M BERTRAM PRESIDENT & CEO 9202325228 2020-11-13 1 KIMBERLY ANDERSON P00188889 6086628600 2020-11-13 67.137.57.251 2020-11-13 08:42:31 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 B9154812F2A1CFB042C171B4E7313471224972C2 2019 2021-01-29 14:40:06Z THERESA M BERTRAM 225 NORTH EAGLE STREET OSHKOSH WI 54902 1905777 0 9386 X WWW.MIRAVIDALIVING.COM X 1987 WI PROVIDE HOUSING FOR AGING PERSONS. 10 10 77 8 0 0 0 0 1774839 1899707 6337 7508 -2461 -1438 1778715 1905777 0 0 0 0 1188048 1238860 0 0 0 759800 712343 1947848 1951203 -169133 -45426 2593372 2374799 300152 227006 2293220 2147793 GABRIEL'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. 0 0 1680296 1899707 GABRIEL'S VILLA, INC. PROVIDES SUPERVISED CARE TO AGING PERSONS IN OSHKOSH, WI. THE ENTITY HAS 40 ASSISTED LIVING UNITS AT ITS FACILITY. 1680296 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 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 0 0 0 1 4 0 1 77 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X KIM MAKI 9202325238 225 NORTH EAGLE STREET OSHKOSH WI 54902 KAREN JACOBSON CHAIR 0.20 1.40 X X 0 0 0 MARY MURKEN VICE CHAIR 0.20 1.40 X X 0 0 0 LOIS JAENKE SECRETARY 0.20 2.90 X X 0 0 0 MARK BEECHER BOARD MEMBER 0.20 2.90 X 0 0 0 KATHY BERMINGHAM BOARD MEMBER 0.20 1.40 X 0 0 0 JAMIE BONELL BOARD MEMBER 0.20 1.40 X 0 0 0 REV JAN LAVAKE BOARD MEMBER 0.20 1.40 X 0 0 0 GLENN NELSON BOARD MEMBER 0.20 1.40 X 0 0 0 PEG OLSON BOARD MEMBER 0.20 1.40 X 0 0 0 STEW RIECKMAN BOARD MEMBER 0.20 1.40 X 0 0 0 THERESA BERTRAM PRESIDENT & CEO 4.00 34.00 X 0 361348 0 0 361348 0 0 0 1 0 0 TENANT REVENUE 531110 1677000 1677000 SERVICE REVENUE 621610 222707 222707 1899707 7508 7508 ASSESSMENT REVENUE 900099 1890 1890 MEAL REVENUE 900099 1778 1778 BEAUTY SHOP REVENUE 900099 1174 1174 -6280 -6280 -1438 1905777 1899707 0 6070 1084345 906665 177680 25809 21580 4229 64017 53527 10490 64689 54089 10600 250000 250000 350 350 19826 19826 29484 27484 2000 11076 11076 125605 106910 18695 15180 15180 109615 109615 1076 387 689 114948 114948 34994 34994 MAINTENANCE SUPPLIES 97 97 MISCELLANEOUS EXPENSES 92 0 92 1951203 1680296 270907 0 672570 403659 595932 603368 34548 59646 1848 1848 6568 106911 4322991 3182105 1182770 1140886 99136 58481 2593372 2374799 143698 116068 139656 109241 16798 1697 300152 227006 X 2293220 2147793 2293220 2147793 2593372 2374799 X -45426 -100001 X 0 1 X 1 0 X 560 560 1819874 1904050 1876870 1774839 1899707 9275340 1820434 1904050 1876870 1774839 1899707 9275900 0 1168183 1216786 1226633 1232118 1286123 6129843 1168183 1216786 1226633 1232118 1286123 6129843 3146057 5075 7343 1946 6337 7508 28209 5075 7343 1946 6337 7508 28209 2209 222 17803 -2461 -1438 16335 1827718 1911615 1896619 1778715 1905777 9320444 0.33750 0.34750 0.00300 0.00280 X 83333 83333 2959214 2182229 776985 90358 68803 21555 1184573 931073 253500 5513 5513 1140886 DUE TO BETHEL HOME INC 1697 1697 X PART X, LINE 2: THE 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. 0 0 0 0 0 0 0 0 0 THERESA BERTRAM PRESIDENT & CEO 0 321348 0 40000 0 0 0 0 0 0 0 361348 0 0 PART I, LINE 3 THE 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 COMMITTEE FORM 990, PART VI, SECTION A, LINE 1 THE 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 6 MIRAVIDA LIVING, INC., IS THE SOLE MEMBER OF GABRIEL'S VILLA, INC. FORM 990, PART VI, SECTION A, LINE 7A THE 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 7B MAJOR 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 11B BEFORE 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 12C ANNUALLY, 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 15 CEO 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 2019. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE UPON REQUEST AND IS ALSO AVAILABLE AT WWW.CANDID.ORG. THE ORGANIZATION'S FORM 1023 IS ALSO AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: INTERCOMPANY NET ASSET TRANSFER -100,001. MIRAVIDA LIVING INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391032234 MANAGMENT SERVICES WI 501(C)(3) LINE 10 N/A 0 BETHEL HOME INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391209707 SKILLED NURSING FACILITY WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 CARMEL RESIDENCE INC 220 NORTH WESTFIELD STREET OSHKOSH WI 54902 391448325 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA APARTMENTS INC 155 NORTH EAGLE STREET OSHKOSH WI 54902 237148097 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA SOUTH INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391238670 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA III INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391270056 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 MIRAVIDA LIVING FOUNDATION INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 010938793 FUNDRAISING WI 501(C)(3) LINE 12A, I MIRAVIDA LIVING INC 0 EDEN REHABILIATION SUITES AND GREENHOUSE HOMES INC 3151 EDEN COURT OSHKOSH WI 54904 900506872 SKILLED NURSING FACILITY WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 0 1 1 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 0