2018-02-15T08:55:54-06:00 2017-03-31 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 462400857 990 2016-04-01 352187477 INDIANA MASONIC HOME INC INDI 3177366141 690 STATE STREET FRANKLIN IN 46131 MIKE SPENCER EXECUTIVE DIRECTOR 3177366141 2018-02-13 1 SCOTT A SCHUSTER P00019243 3175802000 2018-02-13 64.132.79.19 2018-02-13 13:59:04 ES P 019CA3EE3F2C8A78E48DEC9828FFDFDF32C798E7 019CA3EE3F2C8A78E48DEC9828FFDFDF32C798E7 2016 2021-01-29 14:40:06Z MIKE SPENCER 690 STATE STREET FRANKLIN IN 46131 16184316 0 X WWW.INDIANAMASONS.ORG/IMH X 2003 IN TO SERVE THE CHARITABLE PURPOSE OF OPERATING THE CONTINUING CARE RETIREMENT COMMUNITY KNOWN AS THE INDIANA MASONIC HOME IN FRANKLIN, INDIANA. 19 17 360 40 0 0 9011011 4769063 8003403 8449007 -154561 423604 1654625 1819383 18514478 15461057 0 0 0 0 4751469 5611665 0 0 0 10139712 8345065 14891181 13956730 3623297 1504327 108138130 106696975 9629661 11416230 98508469 95280745 TO SERVE THE CHARITABLE PURPOSE OF OPERATING THE CONTINUING CARE RETIREMENT COMMUNITY KNOWN AS THE INDIANA MASONIC HOME IN FRANKLIN, INDIANA. 0 0 10876478 10150361 PROVIDE CARE FOR THE AGED 10876478 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 84 0 1 360 1 0 0 0 0 0 0 0 0 0 0 X 19 17 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 IN X MIKE SPENCER 3177366141 690 STATE STREET FRANKLIN IN 46131 WILLIAM A REINERS GRAND MASTER 1.00 40.00 X X 0 0 0 CAREY B CARTER DEPUTY GRAND MASTER 1.00 5.00 X X 0 0 0 RODNEY A MANN SENIOR GRAND WARDEN 1.00 5.00 X X 0 0 0 RICHARD J ELMAN GRAND SECRETARY 1.00 40.00 X X 92644 0 0 RANDALL HAMMOND BOARD MEMBER 1.00 X 0 0 0 KENNETH WILLIS BOARD MEMBER 1.00 X 0 0 0 JERALD MILLER BOARD MEMBER 1.00 X 0 0 0 JEFFREY P ZARING BOARD MEMBER 1.00 40.00 X 113858 0 0 JEFFREY K SAUNDERS BOARD MEMBER 1.00 X 0 0 0 ALRED BROTHERS JR BOARD MEMBER 1.00 X 0 0 0 MICHAEL DEMPSEY BOARD MEMBER 1.00 X 0 0 0 CHRISTOPHER THOMAS BOARD MEMBER 1.00 X 0 0 0 LORETTA RIEHL OES BOARD MEMBER 1.00 X 0 0 0 DENNIS SHEETS BOARD MEMBER 1.00 X 0 0 0 GARY W BRINLEY BOARD MEMBER 1.00 X 0 0 0 CHRISTOPHER L COX BOARD MEMBER 1.00 X 0 0 0 RONALD L BUSKIRK BOARD MEMBER 1.00 X 0 0 0 RICHARD L LENTZ BOARD MEMBER 1.00 X 0 0 0 GARY W LEWIS BOARD MEMBER 1.00 X 0 0 0 MIKE SPENCER EXECUTIVE DIRECTOR 40.00 X 186247 0 7096 MIKE HAYDEN CFO 40.00 X 135686 0 2439 528435 0 9535 3 0 1 0 SHIEL SEXTON 902 N CAPITOL AVE INDIANAPOLIS IN 46204 CONSTUCTION CONTRACTOR 9156591 ANTHEM BLUE CROSS AND BLUE SHIELD 120 MONUMENT CIRCLE INDIANAPOLIS IN 46204 HEALTHCARE 2164285 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 FOOD SERVICE 1073726 THERACARE 9957 ALLISONVILLE ROAD FISHERS IN 46038 THERAPY SERVICES 723537 HLC HOLDINGS LLC 18 ONEAL STREET ROME GA 30165 INVESTMENT 652178 24 864638 23250 3650638 230537 4769063 RESIDENCE SERVICES 623000 4525704 4525704 MANAGEMENT SERVICES 623000 3186922 3186922 MANAGEMENT FEES 623000 736381 736381 8449007 140049 140049 1736054 0 1736054 1736054 1701354 34700 998127 714572 283555 283555 283555 7970 23250 8687 -717 -717 OTHER INCOME 623990 58666 58666 TAX REFUND 623990 25380 25380 84046 15461057 10150361 0 541633 X 351166 351166 3857601 3154452 703149 33174 20964 12210 915649 686275 229374 454075 340327 113748 99978 99978 80784 80784 34376 34376 404799 159759 245040 138152 138152 264569 32284 232285 125678 3100 122578 16937 4211 12726 518326 518326 349313 349313 ALLOCATION FOR FRATERNA 2074617 2074617 BAD DEBT EXPENSE 1255118 1255118 UTILITIES 796511 733845 62666 REPAIRS AND MAINTENANCE 768040 588941 179099 1417867 1166107 251760 13956730 10876478 3080252 0 1533199 1524002 5721714 579808 185158 31274 48697 128017 92106 10079834 8631877 1829502 1447957 5927406 6313850 92387210 97085205 108138130 106696975 3018324 1942933 5231659 4346876 3700000 1379678 1426421 9629661 11416230 X 1677665 -862044 94884886 94078719 1945918 2064070 98508469 95280745 108138130 106696975 X 1504327 244718 -4976769 X X 0 1 X 1 0 X 4962539 17046628 5044977 9011011 4769063 40834218 15299964 13469078 14594427 8003403 8449007 59815879 20262503 30515706 19639404 17014414 13218070 100650097 3511780 15665192 3837820 7835817 3650638 34501247 0 3511780 15665192 3837820 7835817 3650638 34501247 66148850 363667 315494 207868 1688560 1876103 4451692 363667 315494 207868 1688560 1876103 4451692 21749 235104 303248 127416 84046 771563 20647919 31066304 20150520 18830390 15178219 105873352 0.62480 0.64320 0.04200 0.02570 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2012 AMOUNT: $ 21,749. 2013 AMOUNT: $ 235,104. 2014 AMOUNT: $ 303,248. 2015 AMOUNT: $ 127,416. 2016 AMOUNT: $ 84,046. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7716278 6447477 1268801 2363556 2184400 179156 1447957 INTEREST IN NET ASSETS OF FOUNDATION 94008762 BENEFICIAL INTEREST IN TRUST 2100463 RECIEVABLE FROM DAVIESS COUNTY HOSPITAL 975980 97085205 RESIDENT DEPOSIT 173843 REFUNDABLE ADVANCE FEES 478819 CAPITAL LEASE OBLIGATION 773759 1426421 X 15680086 244718 8687 253405 15426681 34376 34376 15461057 13931041 8687 8687 13922354 34376 34376 13956730 PART X, LINE 2: THE HOME IS EXEMPT FROM THE PAYMENT OF INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND SIMILAR PROVISIONS OF INDIANA TAX LAWS. THEREFORE, NO PROVISION OR LIABILITY FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. IN ADDITION, THE HOME HAS BEEN DETERMINED BY THE INTERNAL 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 MARCH 31, 2017 AND 2016. THE HOME FILES U.S. FEDERAL AND STATE OF INDIANA INFORMATION RETURNS. IT IS NO LONGER SUBJECT TO U.S. FEDERAL AND STATE INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR FISCAL YEARS BEFORE 2014. PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM SPECIAL EVENT 8,687. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM SPECIAL EVENT 8,687. GOLF OUTING 31220 23250 7970 8687 31220 23250 7970 8687 8687 -717 X 0 0 0 0 0 0 0 0 0 MIKE SPENCER EXECUTIVE DIRECTOR 186247 0 0 0 0 0 0 0 7096 0 193343 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT WILL REVIEW THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C REVIEW NOTATIONS ON CONFLICT OF INTEREST POLICY AND DISCUSS AND RESOLVE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS APPROVED BY THE BOARD FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST. ANNUAL STATE DISCLOSURE STATEMENT THAT IS AVAILABLE TO ALL POTENTIAL NEW RESIDENTS. FORM 990, PART IX, LINE 24E OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 392,523. MANAGEMENT AND GENERAL EXPENSES 146,742. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 539,265. HOME SUPPLIES & LAUNDRY: PROGRAM SERVICE EXPENSES 315,230. MANAGEMENT AND GENERAL EXPENSES 12,156. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 327,386. MISCELLANEOUS: PROGRAM SERVICE EXPENSES 156,717. MANAGEMENT AND GENERAL EXPENSES 60,420. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 217,137. RESIDENT SUPPLIES AND ALLOWANCES: PROGRAM SERVICE EXPENSES 169,638. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 169,638. MEDICAL FEES, DRUGS, SUPPLIES: PROGRAM SERVICE EXPENSES 84,043. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 84,043. EQUIPMENT RENTAL & LEASING: PROGRAM SERVICE EXPENSES 47,956. MANAGEMENT AND GENERAL EXPENSES 32,442. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,398. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS -3,650,638. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION 8,558,122. CHANGE IN BENEFICIAL INTEREST IN TRUST 126,215. TRANSFER OF ASSETS TO INDIANA MASONIC HOME, INC. -10,010,468. FORM 990, PART XII, LINE 2C THE PROCESS HAD NOT CHANGED. FORM 990, PART VI, SECTION B, LINE 14 RECORD RETENTION AND DESTRUCTION POLICY MEDICAL RECORDS OF THE ORGANIZATION ARE GOVERNED BY A RETENTION AND STORAGE POLICY, AS WELL AS A CLOSED CHART POLICY. INDIANA MASONIC HOME FOUNDATION INC 525 N ILLINOIS ST INDIANAPOLIS IN 46204 351091997 PROVIDE SUPPORT TO THE INDIANA MASONIC HOME IN 501(C)(3) LINE 12D, III-O 0 IMH REALTY INC 690 STATE STREET FRANKLIN IN 46131 364513246 PROVIDE PROPERTY TO ENSURE THE RESIDENTIAL AND MEDIAL CARE FOR THE ELDERLY IN 501(C)(2) 0 GRAND LODGE 525 N ILLINOIS ST INDIANAPOLIS IN 46204 350300010 FRATERNAL ORGANIZATION IN 501(C)(10) 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 IMH REALTY I 10010468 FAIR MARKET VALUE INDIANA MASONIC HOME FOUNDATION C 3650638 CASH