2018-11-12T15:28:50-06:00 2017-12-31 362985770 SELDEN FOX LTD 619 ENTERPRISE DRIVE OAK BROOK IL 605238835 990 2017-01-01 362212706 MENDOTA LUTHERAN HOME MEND 8155397439 500 SIXTH STREET MENDOTA IL 613421796 ERICA FALK ADMINISTRATOR 8155397439 2018-11-09 1 PAUL J ROZEK P00542258 6309541400 50.201.115.82 2018-11-09 09:15:24 CS P 846F90749364CC804ED7A8FED8B9859DAA5069A5 BB4FD3E8EB55B61BFC583FFD2DDC348D3381C070 2017 2019-02-21 02:37:17Z ERICA FALK 500 SIXTH STREET MENDOTA IL 613421796 5851874 0 X WWW.MLH500.COM X 1953 IL TO ESTABLISH, MAINTAIN, AND OPERATE A NURSING HOME AS WELL AS A HOME FOR THE AGED. MENDOTA LUTHERAN HOME IS AFFILIATED WITH THE EVANGELICAL LUTHERAN CHURCH IN AMERICA, A NON-PROFIT ORGANIZATION. 9 9 188 24 0 0 119662 67148 5647418 5750484 28509 34242 4794 0 5800383 5851874 0 0 0 0 4269709 3911325 0 0 0 2330389 2255713 6600098 6167038 -799715 -315164 5187613 5333505 1454828 1532836 3732785 3800669 TO ESTABLISH, MAINTAIN, AND OPERATE A NURSING HOME AS WELL AS A HOME FOR THE AGED. MENDOTA LUTHERAN HOME IS AFFILIATED WITH THE EVANGELICAL LUTHERAN CHURCH IN AMERICA, A NON-PROFIT ORGANIZATION. 0 0 5581832 5750484 MENDOTA LUTHERAN HOME IS LICENSED BY THE ILLINOIS DEPARTMENT OF PUBLIC HEALTH TO PROVIDE SKILLED, INTERMEDIATE, AND SHELTERED CARE NURSING HOME SERVICES TO ELDERLY RESIDENTS. DURING 2017, MENDOTA LUTHERAN HOME PROVIDED THESE SERVICES TO APROXIMATELY 69 RESIDENTS ON A DAILY BASIS. SUPPORT TO CARE FOR THESE RESIDENTS INCLUDES INVESTMENT INCOME, PUBLIC ASSISTANCE, AS WELL AS DONATIONS FROM AREA CHURCHES, ORGANIZATIONS, AND INDIVIDUALS. 5581832 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 18 0 1 188 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 1 1 1 1 0 X ERICA FALK - ADMINISTRATOR 8155397439 500 SIXTH STREET MENDOTA IL 613421796 GRETA BATES PRESIDENT 1.00 X X 0 0 0 REV TAMMY ANDERSON VICE PRESIDENT 1.00 X X 0 0 0 JOHN NIELSON TREASURER 1.00 X X 0 0 0 DAVID JONES SECRETARY 1.00 X X 0 0 0 EDWARD BOCK DIRECTOR 1.00 X 0 0 0 REV ANNE HOFLEN DIRECTOR 1.00 X 0 0 0 LAMBERT LEONARD DIRECTOR 1.00 X 0 0 0 LORRAINE LOOMIS DIRECTOR 1.00 X 0 0 0 TIM MUNSON DIRECTOR 1.00 X 0 0 0 MICHELLE URNIKIS ADMINISTRATOR 40.00 X 78420 0 5669 78420 0 5669 0 0 0 0 AEGIS THERAPIES PO BOX 8103 FORT SMITH AZ 72902 THERAPY 524531 US FOODSERVICE 1829 SOLUTION CENTER CHICAGO IL 60677 FOOD SERVICE 275303 MEDLINE INDUSTRIES INC DEPT CH 1440 PALATINE IL 60055 MEDICAL SUPPLIES 180066 OMNICARE INC PO BOX 78000 DETRIOT MI 48278 PERSCRIPTIONS 107481 1 67148 67148 NURSING HOME 623000 5750484 5750484 5750484 34242 34242 5851874 5750484 0 34242 84089 84089 3141651 2927454 214197 28913 26239 2674 422348 383293 39055 234324 212970 21354 135930 82137 53793 14143 653 13490 141197 127077 14120 141247 128377 12870 5827 3900 1927 2857 2857 52731 52731 240918 216826 24092 70657 54576 16081 ANCILLARY SERVICES 711936 711936 SUPPLIES 405603 391391 14212 ASSESSMENT FEES 193264 193264 BAD DEBT 55236 55236 84167 63646 20521 6167038 5581832 585206 0 85408 92985 602026 586887 39395 32462 97183 80036 8840103 6404275 2633569 2435828 1730032 2105307 5187613 5333505 547148 496094 0 202078 851341 775827 56339 58837 1454828 1532836 X 2368139 1793019 11294 554801 1353352 1452849 3732785 3800669 5187613 5333505 -315164 383048 0 X 0 1 X 1 0 X 1364646 1350 292036 755575 10 902447 1742286 11171 125607 506703 7715 1364646 1471879 303958 -990 32572 -11 1742286 1434773 10027 107457 64742 15636 1471879 1664383 33954 291764 543130 12198 1434773 0.39000 0.61000 0 0 564941 564941 6107854 4583958 1523896 2167308 1820317 346991 2435828 INTEREST AND DIVIDENDS RECEIVABLE 8595 INVESTMENTS 12735 BENEFICIAL INTEREST - INV POOL 49560 SETTLEMENT - MEDICARE 10461 INVESTMENT - INSURANCE COMPANY 21552 BENEFICIAL INTEREST - PERP TRUST 1099947 ASSETS INVESTED FOR ENDOWMENT PURPOSES 902457 2105307 ASSESSMENT TAX - HFS 58837 58837 6234922 383048 383048 5851874 0 5851874 6167038 0 6167038 0 6167038 PART V, LINE 4: MENDOTA LUTHERAN HOME'S ENDOWMENT CONSISTS OF TWO INDIVIDUAL FUNDS ESTABLISHED FOR DIFFERENT PURPOSES. ON THE FIRST ENDOWMENT, THE DIVIDENDS RECEIVED ARE APPROPRIATED AND SPENT AS PART OF GENERAL OPERATIONS. UNREALIZED GAINS CAN BE USED IN THE GENERAL OPERATIONS ONCE APPROPRIATED BY MENDOTA LUTHERAN HOME'S BOARD OF DIRECTORS. ON THE SECOND ENDOWMENT, 90% OF THE INCOME EARNED IS TO BE USED FOR EMPLOYEE SERVICE AWARDS ON AN ANNUAL BASIS. THE REMAINING 10% OF INCOME IS TO BE RETAINED FOR ACCOUNT GROWTH AND INFLATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS DISTRIBUTED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL BEFORE SUBMISSION TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS ANNUALLY EVALUATES THE ADMINISTRATOR AND DETERMINES COMPENSATION ADJUSTMENTS BASED ON BOTH PERFORMANCE, INDUSTRY STANDARDS, AND BUDGETARY CONSTRAINTS. THE ADMINISTRATOR EVALUATES ALL OTHER EMPLOYEES OF MENDOTA LUTHERAN HOME AND DETERMINES COMPENSATION BASED ON PERFORMANCE, INDUSTRY STANDARDS AND BUDGETARY CONSTRAINTS. FORM 990, PART VI, SECTION C, LINE 19 MENDOTA LUTHERAN HOME MAKES GOVERNING DOCUMENTS, CONFLICTS OF INTEREST STATEMENTS, FINANCIAL STATEMENTS, AND TAX RETURNS AVAILABLE TO THE GENERAL PUBLIC UPON WRITTEN REQUEST.