2017-02-15T15:56:32-06:00 2016-03-31 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 462400857 990 2015-04-01 352187477 INDIANA MASONIC HOME INC INDI 3177366141 690 STATE STREET FRANKLIN IN 46131 MIKE SPENCER EXECUTIVE DIRECTOR 3177366141 2017-02-14 1 SCOTT A SCHUSTER P00019243 3175802000 2017-02-14 2015 2021-01-29 14:40:06Z MIKE SPENCER 690 STATE STREET FRANKLIN IN 46131 27584826 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 17 340 75 0 0 5076332 9011011 14594427 8003403 744759 -154561 286516 1654625 20702034 18514478 0 0 0 0 8900839 4751469 0 0 0 8528185 10139712 17429024 14891181 3273010 3623297 120120550 108138130 7561847 9629661 112558703 98508469 X TO SERVE THE CHARITABLE PURPOSE OF OPERATING THE CONTINUING CARE RETIREMENT COMMUNITY KNOWN AS THE INDIANA MASONIC HOME IN FRANKLIN, INDIANA. 0 1 10984656 8003403 PROVIDE CARE FOR THE AGED 10984656 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 74 0 1 340 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 HAYDEN 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 0 89188 0 GEORGE A INGLES JR BOARD MEMBER 1.00 0.30 X 0 0 0 KENNETH WILLIS BOARD MEMBER 1.00 0.30 X 0 0 0 DANIEL J BARENIE BOARD MEMBER 1.00 0.30 X 0 0 0 JEFFREY P ZARING BOARD MEMBER 1.00 40.00 X 0 107712 0 JEFFREY K SAUNDERS BOARD MEMBER 1.00 X 0 0 0 MICHAEL D BARKER II BOARD MEMBER 1.00 X 0 0 0 GARY C SEINHARDT BOARD MEMBER 1.00 X 0 0 0 TIMOTHY T LONG 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 ROB DEVRIES CFO (THRU SEPT. 2015) 40.00 X 81564 0 12959 MIKE SPENCER EXECUTIVE DIRECTOR 40.00 X 111438 0 7219 MIKE HAYDEN CFO 40.00 X 48320 0 967 241322 196900 21145 1 0 0 0 SHIEL SEXTON 902 N CAPITOL AVE INDIANAPOLIS IN 46204 CONSTUCTION CONTRACTOR 5730342 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30368 FOOD SERVICE 2013974 THERACARE 9957 ALLISONVILLE ROAD FISHERS IN 46038 THERAPY SERVICES 914856 BROWNING DAY MULLINS DIERDORF ARCHITECTS 626 N ILLINOIS ST INDIANAPOLIS IN 46204 ARCHITECTURE 803770 PHARMERICA PO BOX 409251 ATLANTA GA 30384 PHARMACY SERVICES 366163 5 660675 14114 7835817 500405 9011011 RESIDENCE SERVICES 623000 4272210 4272210 MANAGEMENT SERVICES 623000 3103639 3103639 MANAGEMENT FEES 623000 627554 627554 8003403 158181 158181 1530379 0 1530379 1530379 1530379 8750116 9062858 -312742 -312742 -312742 4320 14114 7490 -3170 -3170 OTHER INCOME 623990 127416 127416 127416 18514478 8003403 0 1500064 313035 313035 3332307 2642997 689310 29632 20512 9120 834394 805733 28661 242101 143474 98627 171814 171814 101396 101396 37002 37002 466150 34025 432125 104087 104087 193223 19232 173991 101301 2942 98359 27648 4387 23261 576100 576100 364667 364667 OUTSIDE SERVICES 1851312 1769562 81750 BAD DEBT EXPENSE 1767369 821764 945605 ALLOCATION FOR FRATERNA 1760000 1760000 UTILITIES 1179262 968922 210340 1438381 1310919 127462 14891181 10984656 3906525 0 999737 1533199 6343465 5721714 3033173 579808 31274 31274 167794 128017 9970598 8141096 0 1829502 6293274 5927406 852346 102399487 92387210 120120550 108138130 1779362 3018324 5322135 5231659 460350 1379678 7561847 9629661 X 3789299 1677665 106654225 94884886 2115179 1945918 112558703 98508469 120120550 108138130 X 3623297 -55994 1265094 -18882631 X X 0 1 X 1 0 X 8634423 4962539 17046628 5044977 9011011 44699578 15260272 15299964 13469078 14594427 8003403 66627144 23894695 20262503 30515706 19639404 17014414 111326722 6518562 3511780 15665192 3837820 7835817 37369171 0 6518562 3511780 15665192 3837820 7835817 37369171 73957551 383384 363667 315494 207868 1688560 2958973 383384 363667 315494 207868 1688560 2958973 4253 21749 235104 303248 127416 691770 24282332 20647919 31066304 20150520 18830390 114977465 0.64320 0.68930 0.02570 0.01370 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2011 AMOUNT: $ 4,253. 2012 AMOUNT: $ 21,749. 2013 AMOUNT: $ 235,104. 2014 AMOUNT: $ 303,248. 2015 AMOUNT: $ 127,416. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7610767 6038015 1572752 2359831 2103081 256750 1829502 INTEREST IN NET ASSETS OF FOUNDATION 89101279 BENEFICIAL INTEREST IN TRUST 1974248 RECIEVABLE FROM DAVIESS COUNTY HOSPITAL 1311683 92387210 RESIDENT DEPOSIT 118823 REFUNDABLE ADVANCE FEES 304841 CAPITAL LEASE OBLIGATION 956014 1379678 X 18428972 -55994 7490 -48504 18477476 37002 37002 18514478 14861669 7490 7490 14854179 37002 37002 14891181 PART X, LINE 2: THE HOME IS EXEMPT FROM THE PAYMENT OF INCOME TAXES UNDER SECTIONS 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, 2016 AND 2015. 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 2013. PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM SPECIAL EVENT 7,490. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM SPECIAL EVENT 7,490. GOLF OUTING 18434 14114 4320 7490 18434 14114 4320 7490 7490 -3170 FORM 990, PART III, LINE 3 IN MAY 2015, INDIANA MASONIC HOME ENTERED INTO AN AGREEMENT WITH DAVIESS COUNTY HOSPITAL TO TRANSFER OPERATION OF ITS HEALTH CARE FACILITY FROM HOME TO DAVIESS. FORM 990, PART VI, SECTION B, LINE 11 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 XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS -3,981,357. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION -7,173,776. CHANGE IN BENEFICIAL INTEREST IN TRUST -168,828. TRANSFER OF ASSETS TO INDIANA MASONIC HOME, INC. -7,558,670. 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 11A, I 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)(8) & (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 7558670 FAIR MARKET VALUE INDIANA MASONIC HOME FOUNDATION C 7835817 CASH