TIESZEN MEMORIAL HOME INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- TIESZEN MEMORIAL HOME INC (EIN 46-0213759)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-07-12
- IRS object ID
- 201731939349301118
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-07-12T13:06:08-05:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 460393458 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WOHLENBERG RITZMAN & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1018 | AddressLine1Txt |
| City | YANKTON | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57078 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460213759 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TIESZEN MEMORIAL HOME | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TIES | BusinessNameControlTxt |
| Phone | 6056483611 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 312 EAST STATE ST | AddressLine1Txt |
| City | MARION | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57043 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PAUL ENGBRECHT | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6056483611 | PhoneNum |
| Signature | 2017-07-05 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KATHLEEN DOYLE | PreparerPersonNm |
| PTIN | P01322431 | PTIN |
| Phone | 6056654401 | PhoneNum |
| Preparation | 2017-07-04 | PreparationDt |
Filing Security Information FilingSecurityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| At Submission Creation Device Id | 3355132E7AB3A81741D8E9D5DADFF38F3AE1CC26 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 359CD5F3E2699F9862673E864F534ED490F3237E | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PAUL ENGBRECHT | PrincipalOfficerNm |
| Gross Receipts | $5,128,027 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.TIESZENHOME.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Legal Domicile State | SD | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE THE HIGHEST QUALITY OF CARE AND QUALITY OF LIFE FOR THE LONG AND SHORT TERM CARE RESIDENTS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 161 | TotalEmployeeCnt |
| Total Volunteers | 75 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $13,400 | PYContributionsGrantsAmt |
| CY Contributions Grants | $473 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,834,341 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,051,894 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,441 | PYInvestmentIncomeAmt |
| CY Investment Income | $42,202 | CYInvestmentIncomeAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $4,849,182 | PYTotalRevenueAmt |
| CY Total Revenue | $5,094,569 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,844,274 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,872,254 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,816,470 | PYOtherExpensesAmt |
| CY Other Expenses | $2,142,780 | CYOtherExpensesAmt |
| PY Total Expenses | $4,660,744 | PYTotalExpensesAmt |
| CY Total Expenses | $5,015,034 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $188,438 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $79,535 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,721,298 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,809,754 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $976,791 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $985,712 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,744,507 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,824,042 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE THE HIGHEST QUALITY OF CARE AND QUALITY OF LIFE FOR THE LONG AND SHORT TERM CARE RESIDENTS. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $4,534,438 | ExpenseAmt |
| Revenue | $5,051,894 | RevenueAmt |
| Desc | TIESZEN MEMORIAL HOME IS COMPRISED OF A 64-BED SKILLED NURSING HOME, A 16-BED ASSISTED LIVING FACILITY, A 4 UNIT APARTMENT COMPLEX, A 12 UNIT AND TWO 6 UNIT APARTMENT COMPLEXES IN MARION, SD AND A 14-BED ASSISTED LIVING FACILITY IN PARKER, SD. THE HOME PROVIDES LONG TERM NURSING HOME CARE AND HOME HEALTH CARE SERVICES. | Desc |
| Total Program Service Expenses | $4,534,438 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 3 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 161 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | false | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LAURA WILSON | PersonNm |
| Phone | 6056483611 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | BOX 209 | AddressLine1Txt |
| City | MARION | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57043 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (9 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|
| RAVILA BERENS | ||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $536 | $0 | $0 |
| JAMES A JONES | ||||||
| MEMBER | 1.00 | Yes (X) | $487 | $0 | $0 | |
| LAWRENCE ARBEITER | ||||||
| MEMBER | 1.00 | Yes (X) | $487 | $0 | $0 | |
| RICHARD LUKE | ||||||
| SEC/TREASURE | 1.00 | Yes (X) | Yes (X) | $487 | $0 | $0 |
| ROBERT LOOF | ||||||
| VICE PRESIDE | 1.00 | Yes (X) | Yes (X) | $487 | $0 | $0 |
| PAUL JOHNSON | ||||||
| MEMBER | 1.00 | Yes (X) | $487 | $0 | $0 | |
| JEFF COLE | ||||||
| MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | |
| LAURA M WILSON | ||||||
| ADMINISTRATO | 40.00 | Yes (X) | $85,640 | $0 | $6,210 | |
| PAUL ENGBRECHT | ||||||
| CEO | 20.00 | Yes (X) | $56,599 | $0 | $4,230 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $145,210 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $10,440 | TotalOtherCompensationAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PRAIRIE REHABILITATION | |||||
| 1720 S CLIFF AVE | SIOUX FALLS | SD | 57105 | THERAPY SERVICE | $284,728 |
| SYSCO LINCOLN | |||||
| 1700 CENTER PARK ROAD | LINCOLN | NE | 68512 | FOOD SERVICES | $213,000 |
| LPL CONSTRUCTION | |||||
| 204 E 32D STREET | MADISON | SD | 57043 | CONSTRUCTION | $149,577 |
| GRAPE TREE MEDICAL STAFFING | |||||
| 1003 23RD STREET | MILFORD | IA | 51351 | TEMPORARY STAFF | $135,052 |
| AVERA LONG-TERM PHARMACY | |||||
| 3820 POSTDAM AVE | SIOUX FALLS | SD | 57104 | RESIDENT PHARMA | $116,479 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $473 | AllOtherContributionsAmt |
| Total Contributions | $473 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| RESIDENT SERVICE REVENUES | 623000 | $4,744,002 | $4,744,002 |
| OTHER OPERATING REVENUE | 623000 | $307,892 | $307,892 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,051,894 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,011 | TotalRevenueColumnAmt |
| Exclusion | $5,011 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $70,649 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $33,458 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $37,191 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37,191 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $37,191 | RelatedOrExemptFuncIncomeAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,094,569 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,089,085 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $5,011 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $142,239 | TotalAmt |
| Management And General | $142,239 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,149,318 | TotalAmt |
| Program Services | $2,058,233 | ProgramServicesAmt |
| Management And General | $91,085 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,030 | TotalAmt |
| Program Services | $59,209 | ProgramServicesAmt |
| Management And General | $8,821 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $343,479 | TotalAmt |
| Program Services | $337,065 | ProgramServicesAmt |
| Management And General | $6,414 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $169,188 | TotalAmt |
| Program Services | $154,090 | ProgramServicesAmt |
| Management And General | $15,098 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $603 | TotalAmt |
| Management And General | $603 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,754 | TotalAmt |
| Management And General | $20,754 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $608,341 | TotalAmt |
| Program Services | $581,840 | ProgramServicesAmt |
| Management And General | $26,501 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,018 | TotalAmt |
| Program Services | $29,793 | ProgramServicesAmt |
| Management And General | $50,225 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,247 | TotalAmt |
| Management And General | $44,247 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $364,313 | TotalAmt |
| Program Services | $364,313 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,294 | TotalAmt |
| Management And General | $4,294 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,101 | TotalAmt |
| Program Services | $13,101 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $438,966 | TotalAmt |
| Program Services | $438,966 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,610 | TotalAmt |
| Management And General | $64,610 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| FOOD SERVICE | $210,086 | $210,086 |
| PROGRAM SUPPLIES | $183,704 | $183,704 |
| MEDICARE EXPENSES | $65,154 | $65,154 |
| BAD DEBT | $38,884 | $38,884 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,705 | TotalAmt |
| Management And General | $5,705 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,015,034 | TotalAmt |
| Program Services | $4,534,438 | ProgramServicesAmt |
| Management And General | $480,596 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $796,404 | BOYAmt |
| EOY | $640,933 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $358,423 | BOYAmt |
| EOY | $580,029 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,287 | BOYAmt |
| EOY | $26,191 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,493,884 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,970,867 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,480,036 | BOYAmt |
| EOY | $3,523,017 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,148 | BOYAmt |
| EOY | $39,584 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,721,298 | BOYAmt |
| EOY | $4,809,754 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $246,086 | BOYAmt |
| EOY | $263,669 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $707,008 | BOYAmt |
| EOY | $697,294 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,697 | BOYAmt |
| EOY | $24,749 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $976,791 | BOYAmt |
| EOY | $985,712 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,579,519 | BOYAmt |
| EOY | $3,653,361 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $164,988 | BOYAmt |
| EOY | $170,681 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,744,507 | BOYAmt |
| EOY | $3,824,042 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,721,298 | BOYAmt |
| EOY | $4,809,754 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $79,535 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,085 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,494 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,720 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,400 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $473 | CurrentTaxYearAmt |
| Total | $21,172 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,108,760 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,386,141 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,547,051 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,834,341 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,051,894 | CurrentTaxYearAmt |
| Total | $22,928,187 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,110,845 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,389,635 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,548,771 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,847,741 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,052,367 | CurrentTaxYearAmt |
| Total | $22,949,359 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $22,949,359 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $221,108 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,038 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,106 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,441 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,011 | CurrentTaxYearAmt |
| Total | $230,704 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $221,108 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,038 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,106 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,441 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,011 | CurrentTaxYearAmt |
| Total | $230,704 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $4,331,953 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,391,673 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $4,549,877 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,849,182 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $5,057,378 | CurrentTaxYearAmt |
| Total | $23,180,063 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99000 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98020 | PublicSupportPY509Pct |
| Investment Income CY | 0.01000 | InvestmentIncomeCYPct |
| Investment Income PY | 0.02000 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $96,521 | OtherCostOrOtherBasisAmt |
| Book Value | $96,521 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,652,188 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,821,820 | DepreciationAmt |
| Book Value | $2,830,368 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,537,356 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,992,533 | DepreciationAmt |
| Book Value | $544,823 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $207,819 | OtherCostOrOtherBasisAmt |
| Depreciation | $156,514 | DepreciationAmt |
| Book Value | $51,305 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,523,017 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | SECURITY DEPOSITS | Desc |
| Amt | $24,749 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $24,749 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $5,094,569 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $5,094,569 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $5,094,569 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,992,107 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $4,992,107 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $22,927 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $22,927 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $5,015,034 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 4, PART XII, LINE 4B | FormAndLineReferenceDesc |
| Explanation | PRIOR YEAR ADJUSTMENT TO INSURANCE EXPENSE 22,927 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 1, PART I, LINE 6 | ASSIST WITH ACTIVITIES DRIVERS FOR MEALS & WHEELS VISIT RESIDENTS |
| FORM 990, PAGE 6, PART VI, LINE 11B | REVIEWED BY CEO AND BOARD BEFORE FILING |
| FORM 990, PAGE 6, PART VI, LINE 12C | ANNUAL REVIEW BY BOARD |
| FORM 990, PAGE 6, PART VI, LINE 15A | CEO PREPARES AN ANNUAL BUDGET FOR THE OPERATION OF THE FACILITY FOR APPROVAL BY THE BOARD OF DIRECTORS |
| FORM 990, PAGE 6, PART VI, LINE 15B | CEO PREPARES AN ANNUAL BUDGET FOR THE OPERATION OF THE FACILITY FOR APPROVAL BY THE BOARD OF DIRECTORS |
| FORM 990, PAGE 6, PART VI, LINE 19 | ON REQUEST GUIDESTAR.COM |
| FORM 990, PART IX, LINE 11G | CONSULTANTS 19,848 0 0 CONTRACTED RN'S 79,568 0 0 THERAPY 284,482 0 0 MEDICARE BILLER 0 23,626 0 NURSING SUPERVISION 8,014 0 0 BOARD OF DIRECTORS 0 2,875 0 TEMPORARY STAFF 685 0 0 CONTRACTED CNAS 148,387 0 0 MEDICAL DIRECTOR 6,158 0 0 VA PHARMACY 30,498 0 0 MAINTENANCE CONTRACT 4,200 0 0 TOTAL 581,840 26,501 0 |
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