2018-11-08T14:45:15-06:00 2017-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2017-01-01 470384319 FLORENCE HOME FOR THE AGED FLOR 4028276000 7915 NORTH 30TH STREET OMAHA NE 68112 DEBRA L THACKER CFO 4028276000 2018-11-01 1 MEGAN L KOZIOL P01544037 4023302660 209.34.201.180 2018-11-01 13:39:59 CD P B319C935D5CD5DD24452FA9CD51ABCBD1A9C8C2C B319C935D5CD5DD24452FA9CD51ABCBD1A9C8C2C 2017 2019-02-21 02:37:17Z DEBRA L THACKER 7915 NORTH 30TH STREET OMAHA NE 68112 12674562 0 X WWW.OMAHASENIORCARE.ORG X 1906 NE PROVIDE CARE FOR THE ELDERLY 16 14 330 15 0 0 1026349 897809 10173382 10095562 419 -5677 299105 1680665 11499255 12668359 98717 88923 0 0 5202002 5540687 0 0 0 5889690 5950123 11190409 11579733 308846 1088626 3977450 5240539 1834045 1940111 2143405 3300428 TO PROVIDE A CONTINUUM OF QUALITY SERVICES AND PROGRAMS FOR SENIORS AND OTHER PERSONS NEEDING SPECIALIZED CARE. 0 0 6363873 88923 7498062 SKILLED NURSING CARE 2485888 2928930 ALZHEIMER'S ASSISTED LIVING CARE 1093791 1288730 ASSISTED LIVING CARE 9943552 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 22 0 1 330 1 0 0 0 0 0 0 0 0 0 0 X 16 14 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X DEBRA L THACKER CFO 4028276000 7915 NORTH 30TH STREET OMAHA NE 68112 PHIL CHRISTENSEN CHAIRMAN 1.00 3.00 X X 0 0 0 BETTY G FOSTER PHD SECRETARY / TREASURER 1.00 3.00 X X 0 0 0 ROBERT A BLOECHLE DIRECTOR 1.00 3.00 X 0 0 0 MARC BUTTERFIELD DIRECTOR 1.00 1.00 X 0 0 0 LEROY PETERSON DIRECTOR 1.00 X 0 0 0 DOUG EWALD DIRECTOR 1.00 2.00 X 0 0 0 PAUL FALKOWSKI DIRECTOR 1.00 X 0 0 0 MARK HIGGINS DIRECTOR 1.00 1.00 X 0 0 0 LYN M HOLLEY DIRECTOR 1.00 X 0 0 0 NANCY A MCCARTHY DIRECTOR 1.00 1.00 X 0 0 0 DAVE MCCUE DIRECTOR 1.00 1.00 X 0 0 0 JULIE MONACO DIRECTOR 1.00 X 0 0 0 STEPHANIE O'KEEFE DIRECTOR 1.00 X 0 0 0 KRISTIN PRATT DIRECTOR 1.00 1.00 X 0 0 0 LOIS JORDAN PRESIDENT / CEO 2.00 48.00 X X 0 186944 10903 DEBRA L THACKER CFO 2.00 48.00 X X 0 185521 20910 0 372465 31813 0 0 1 0 HEALTHCARE SERVICES GROUP SUITE 300 3220 TILLMAN DRIVE BENSALEM PA 19020 DIETARY 1132220 GENESIS REHABILITATION SERVICES PO BOX 821322 PHILADELPHIA PA 19182 REHAB SERVICES 233194 REHAB CARE 7733 FORSYTH BLVD STE 1700 ST LOUIS MO 63105 REHAB SERVICES 191190 3 763308 28984 105517 897809 MEDICARE/MEDICAID PAYMENTS 623000 6663881 6663881 PRIVATE PAY/INSURANCE REVENUE 623000 3413704 3413704 MISCELLANEOUS INCOME 623000 17977 17977 10095562 176 176 57924 0 57924 57924 57924 350 6203 -5853 -5853 -5853 INSURANCE PROCEEDS 623000 1620160 1620160 CAFETERIA & VENDING REVENUE 623000 2046 2046 VENDOR REBATES 623000 535 535 1622741 12668359 11715722 0 54828 X 88923 88923 4692017 4318908 373109 492720 456282 36438 355950 330100 25850 913608 913608 8863 8863 37000 37000 2507703 2383608 124095 34854 24427 10427 257295 209640 47655 830396 830396 16260 16260 9839 6604 3235 29160 29160 213199 213199 111080 74049 37031 MEDICAL SUPPLIES 632047 632047 BAD DEBT & CHARITY CARE 219000 219000 MISCELLANEOUS 110555 106437 4118 DUES & SUBSCRIPTIONS 19264 4512 14752 11579733 9943552 1636181 0 932 7679 262491 1144014 1162698 1087955 339467 279867 43879 36832 6661573 5006042 1207719 1655531 960264 1028661 3977450 5240539 753221 1007866 976916 901816 103908 30429 1834045 1940111 X 1183141 2271767 960264 1028661 2143405 3300428 3977450 5240539 1088626 68397 0 X X 0 1 X 1 0 X 477880 93840 212830 1026349 897809 2708708 10614353 10870835 10535687 10413730 11715722 54150327 12530 1101 1273 2114 2046 19064 11104763 10965776 10749790 11442193 12615577 56878099 0 0 0 56878099 85358 88496 56257 56792 58100 345003 85358 88496 56257 56792 58100 345003 11190121 11054272 10806047 11498985 12673677 57223102 0.99400 0.99310 0.00600 0.00690 X 154347 154347 4506452 3670395 836057 1549099 1248422 300677 451675 87225 364450 1655531 BENEFICIAL INTEREST IN PERPETUAL TRUST 1028661 1028661 ACCRUED INTEREST PAYABLE 3431 DUE TO AFFILIATES 26998 30429 X PART X, LINE 2: MIDWEST GERIATRICS, INC., ROYALE OAKS HOUSE OF HOPE, GERIMED, INC., EMPOWER HOME CARE, FLORENCE HOME AND SENIOR HEALTH FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THESE NOT-FOR-PROFIT CORPORATIONS HAVE EACH RECEIVED A DETERMINATION LETTER THAT THEY ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. UNIMED, INC. IS A TAXABLE CORPORATION. UNIMED, INC. HAS A NET OPERATING LOSS CARRYFORWARD AS OF DECEMBER 31, 2017 AND 2016, AVAILABLE FOR FEDERAL AND STATE INCOME TAX PURPOSES. THE ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2017 AND 2016, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 MIDWEST GERIATRICS INC 7915 N 30TH STREET OMAHA NE 68112 470727974 501(C)(3) 54745 TO ASSIST WITH ONGOING NEEDS OF THE ORGANIZATION ROYALE OAKS HOUSE OF HOPE 4801 N 52ND STREET OMAHA NE 68104 260808357 501(C)(3) 28984 TO ASSIST WITH ONGOING NEEDS OF THE ORGANIZATION SENIOR HEALTH FOUNDATION 7915 N 30TH STREET OMAHA NE 68112 470709560 501(C)(3) 5194 TO ASSIST WITH ONGOING NEEDS OF THE ORGANIZATION 3 0 PART I, LINE 2: RECIPIENT PROVIDES INVOICES AND RECEIPTS AS DOCUMENTATION THAT THE GRANT FUNDS ARE USED FOR THEIR INTENDED PURPOSE. 0 0 0 0 0 0 0 0 0 LOIS JORDAN PRESIDENT / CEO 0 186944 0 0 0 0 0 0 0 10903 0 197847 0 0 DEBRA L THACKER CFO 0 185521 0 0 0 0 0 0 0 20910 0 206431 0 0 PART I, LINE 3 FLORENCE HOME FOR THE AGED DOES NOT HAVE ANY OFFICERS IT DIRECTLY COMPENSATES. MIDWEST GERIATRICS, INC., AN AFFILIATE OF FLORENCE HOME FOR THE AGED, COMPENSATES THE OFFICERS OF FLORENCE HOME FOR THE AGED. THEREFORE, THE POLICY ON THE PROCESS FOR DETERMINING COMPENSATION OF MIDWEST GERIATRICS, INC. OFFICERS APPLIES TO THE COMPENSATION OF THE FOLLOWING PERSONS SERVING AS OFFICERS OF FLORENCE HOME FOR THE AGED: CHIEF EXECUTIVE OFFICER: LOIS JORDAN CHIEF FINANCIAL OFFICER: DEBRA THACKER THE PROCESS IS UTILIZED BY THE EXECUTIVE COMMITTEE OF THE MIDWEST GERIATRICS, INC. FOR FURTHER EXPLANATION OF THE PROCESS SEE SCHEDULE O. FORM 990, PART VI, SECTION A, LINE 7A MIDWEST GERIATRICS, INC., A RELATED ENTITY, HAS THE POWER TO ELECT ALL MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE ARTICLES AND BYLAWS OF FLORENCE HOME FOR THE AGED MAY BE AMENDED WITH THE AFFIRMATIVE VOTE OF TWO-THIRDS OF THE MEMBERS OF THE BOARD OF DIRECTORS OF MIDWEST GERIATRICS INC. FORM 990, PART VI, SECTION B, LINE 11B ONCE THE FORM 990 AND RELATED SCHEDULES HAVE BEEN PREPARED BY THE VP OF FINANCIAL SERVICES, THE CFO REVIEWS IT, MAKES ANY CHANGES AND ACCEPTS THE DRAFT FORM 990. THE FINANCE COMMITTEE WILL THEN BE INFORMED VIA E-MAIL THAT THE DRAFT FORM 990 IS READY FOR REVIEW AND ASKED IF THEY WANT IT SENT OUT TO THEM OR IF THEY WILL BE COMING TO THE FACILITY TO REVIEW. ONCE 2/3 OF THE FINANCE COMMITTEE MEMBERS HAVE REVIEWED AND ACCEPTED THE FORM 990, IT WILL BE FILED. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE ASKED TO REVIEW AND DISCLOSE ANY CONFLICTS OF INTERESTS THAT THEY MAY HAVE WITH FLORENCE HOME FOR THE AGED OPERATIONS. THEY ARE THEN ASKED TO SIGN A DOCUMENT INDICATING CONFLICTS, IF ANY. THE BOARD CHAIR IS THEN INFORMED OF ANY CURRENT CONFLICTS FOR CONSIDERATION IN FUTURE VOTING MATTERS OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 FLORENCE HOME FOR THE AGED DOES NOT HAVE ANY OFFICERS THAT IT DIRECTLY COMPENSATES. MIDWEST GERIATRICS, INC., AN AFFILIATE OF FLORENCE HOME, COMPENSATES THE OFFICERS OF FLORENCE HOME. THE POLICY ON THE PROCESS FOR DETERMINING COMPENSATION OF MIDWEST GERIATRICS, INC. OFFICERS APPLIES TO THE COMPENSATION OF THE FOLLOWING PERSONS SERVING AS OFFICERS OF FLORENCE HOME: CHIEF EXECUTIVE OFFICER: LOIS JORDAN CHIEF FINANCIAL OFFICER: DEBRA THACKER THE PROCESS IS UTILIZED BY THE EXECUTIVE COMMITTEE OF THE MIDWEST GERIATRICS, INC. BOARD ON AN ANNUAL BASIS. THE PROCESS INCLUDES ALL OF THESE ELEMENTS: (1) REVIEW AND APPROVAL BY THE EXECUTIVE COMMITTEE OF MIDWEST GERIATRICS, INC.; (2) USE OF OUTSIDE DATA AS TO COMPARABLE COMPENSATION; AND (3) CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING. 1. REVIEW AND APPROVAL. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF MIDWEST GERIATRICS, INC., PROVIDED THAT PERSONS WITH CONFLICTS OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT AT ISSUE ARE NOT INVOLVED IN THIS REVIEW AND APPROVAL. 2. USE OF OUTSIDE DATA AS TO COMPARABLE COMPENSATION. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED USING DATA REGARDING COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. 3. CONTEMPORANEOUS DOCUMENTATION AND RECORDING. THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT. FORM 990, PART VI, SECTION C, LINE 19 A COPY OF THE REQUESTED DOCUMENT IS PROVIDED WITHIN 72 HOURS UPON REQUEST. FORM 990, PART IX, LINE 11G DIETARY/HSKING/LAUNDRY: PROGRAM SERVICE EXPENSES 1,220,180. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,220,180. NURSING: PROGRAM SERVICE EXPENSES 597,519. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 597,519. THERAPY: PROGRAM SERVICE EXPENSES 410,125. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 410,125. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 155,784. MANAGEMENT AND GENERAL EXPENSES 124,095. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 279,879. FORM 990, PAGE 12, PART XII,LINE 2C: THE BOARD OF DIRECTORS OF MIDWEST GERIATRICS, INC ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. SENIOR HEALTH FOUNDATION 7915 N 30TH STREET OMAHA NE 68112 470709560 PROVIDE ASSISTANCE TO THE ELDERLY NE 501(C)(3) LINE 7 MIDWEST GERIATRICS INC 1 GERIMED INC 7915 N 30TH STREET OMAHA NE 68112 470727973 PHARMACEUTICAL SALES NE 501(C)(3) LINE 10 MIDWEST GERIATRICS INC 1 MIDWEST GERIATRICS INC 7915 N 30TH STREET OMAHA NE 68112 470727974 SUPPORT FLORENCE HOME AND RELATED ORANGIZATIONS THROUGH MANAGEMENT SERVICES NE 501(C)(3) LINE 12B, II N/A 0 ROYALE OAKS HOUSE OF HOPE 4801 N 52ND STREET OMAHA NE 68104 260808357 SUPPORT FLORENCE HOME BY SERVICING A FHA-INSURED NON-RECOURSE LOAN NE 501(C)(3) LINE 12A, I MIDWEST GERIATRICS INC 1 EMPOWER HOME CARE 7915 N 30TH STREET OMAHA NE 68112 471713914 PROVIDE NON-MEDICAL HOME CARE TO THE ELDERLY NE 501(C)(3) LINE 10 MIDWEST GERIATRICS INC 1 UNIMED INC 7915 N 30TH STREET OMAHA NE 68112 470759285 PHARMACEUTICAL SALES NE N/A C 1 MIDWEST HEALTH CARE ENTERPRISES 7915 N 30TH STREET OMAHA NE 68112 363672698 INACTIVE NE N/A C 1 CRISS-FLORENCE HOME TRUST P O BOX 0634 MILWAUKEE WI 53201 476143241 INVESTMENT MANAGEMENT WI FLORENCE HOME FOR THE AGED T 52520 1028661 1.00000 1 1 1 1 1 1 0 0 0 0 1 1 0 1 1 1 0 0 0 0 ROYALE OAKS HOUSE OF HOPE K 544876 FMV CRISS-FLORENCE HOME TRUST C 52520 FMV SENIOR HEALTH FOUNDATION C 66392 FMV GERIMED INC M 385336 FMV GERIMED INC C 225000 FMV GERIMED INC A 26400 FMV