Mendota Lutheran Home Bk 20-02769: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
Mendota Lutheran Home Bk 20-02769 (EIN 36-2212706)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-05-13
IRS object ID
201601349349302015
Schema version
2015v2.1
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

FieldValueIRS element (for citing)
Return2016-05-13T09:43:07-05:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Jeremy M Brune CPABusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12508 Riverwalk DriveAddressLine1Txt
CityPlainfieldCityNm
State AbbreviationILStateAbbreviationCd
ZIP60586ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN362212706EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Mendota Lutheran HomeBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMENDBusinessNameControlTxt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 Sixth StreetAddressLine1Txt
CityMendotaCityNm
State AbbreviationILStateAbbreviationCd
ZIP613421796ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonRev Anne HoflenPersonNm
Person TitleAdministratorPersonTitleTxt
Phone8155397439PhoneNum
Signature2016-05-13SignatureDt
Discuss With Paid PreparerfalseDiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonJeremy M Brune CPAPreparerPersonNm
PTINP01425038PTIN
Phone7798753979PhoneNum
Preparation2016-05-13PreparationDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2016-09-27 15:27:22ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Gross Receipts$6,924,555GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.mlh500.comWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1953FormationYr
Legal Domicile StateILLegalDomicileStateCd
Activity Or MissionTo 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 North America, a non-profit organization.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee208TotalEmployeeCnt
Total Volunteers24TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$87,437PYContributionsGrantsAmt
CY Contributions Grants$366,054CYContributionsGrantsAmt
PY Program Service Revenue$7,256,532PYProgramServiceRevenueAmt
CY Program Service Revenue$6,544,724CYProgramServiceRevenueAmt
PY Investment Income$18,162PYInvestmentIncomeAmt
CY Investment Income$13,777CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$7,362,131PYTotalRevenueAmt
CY Total Revenue$6,924,555CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$4,777,356PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$4,381,031CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$25,452CYTotalFundraisingExpenseAmt
PY Other Expenses$2,707,769PYOtherExpensesAmt
CY Other Expenses$2,573,354CYOtherExpensesAmt
PY Total Expenses$7,485,125PYTotalExpensesAmt
CY Total Expenses$6,954,385CYTotalExpensesAmt
PY Revenues Less Expenses-$122,994PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$29,830CYRevenuesLessExpensesAmt
Total Assets BOY$5,803,598TotalAssetsBOYAmt
Total Assets EOY$5,787,568TotalAssetsEOYAmt
Total Liabilities BOY$1,305,593TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,366,169TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$4,498,005NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,421,399NetAssetsOrFundBalancesEOYAmt
MissionTo 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 North America, a non-profit organization.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$6,421,617ExpenseAmt
DescMendota 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 2015, Mendota Lutheran Home provided these services to approximately 90 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.Desc
Total Program Service Expenses$6,421,617TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredfalseScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityfalseRelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Transaction With Control EntfalseTransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document26IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee208EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Form8899 FiledindfalseForm8899Filedind
Form1098 C FiledfalseForm1098CFiledInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcfalseRegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldILStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonJon RagsdalePersonNm
Phone8155397439PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 Sixth StreetAddressLine1Txt
CityMendotaCityNm
State AbbreviationILStateAbbreviationCd
ZIP613421796ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeInd
Rev Kevin Weeks
President1.000.00Yes (X)Yes (X)$0$0$0
Rev Tammy Anderson
Vice President1.000.00Yes (X)Yes (X)$0$0$0
John Nielsen
Treasurer1.000.00Yes (X)Yes (X)$0$0$0
Greta Bates
Secretary1.000.00Yes (X)Yes (X)$0$0$0
Lorraine Loomis
Trustee1.000.00Yes (X)$0$0$0
Rev Anne Hoflen
Trustee1.000.00Yes (X)$0$0$0
Tim Munson
Trustee1.000.00Yes (X)$0$0$0
Edward Block
Trustee1.000.00Yes (X)$0$0$0
David Jones
Trustee1.000.00Yes (X)$0$0$0
Jon Ragsdale
Administrator40.000.00$82,679$0$12,997Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$82,679TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$12,997TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KfalseTotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Aegis Therapies
PO Box 8103Fort SmithAR72902Therapy$523,618
US FoodService
1829 Solution CenterChicagoIL606771088Food Service$339,948
Medline Industries
Dept CH 14400PalatineIL600554400Medical Supplies$180,548
Ben Admin Services
17475 Jovanna DrHomewoodIL60430Insurance$228,549
Professional Healthcare Staffing
PO Box 594PontiacIL61764Staffing$196,877
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K10CntrctRcvdGreaterThan100KCnt
All Other Contributions$366,054AllOtherContributionsAmt
Total Contributions$366,054TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescNursing HomeDesc
Business623000BusinessCd
Total Revenue Column$6,544,724TotalRevenueColumnAmt
Related Or Exempt Func Income$6,544,724RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$6,544,724TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$13,777TotalRevenueColumnAmt
Related Or Exempt Func Income$13,777RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,924,555TotalRevenueColumnAmt
Related Or Exempt Func Income$6,558,501RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$82,927TotalAmt
Management And General$82,927ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,626,491TotalAmt
Program Services$3,388,323ProgramServicesAmt
Management And General$238,168ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$35,978TotalAmt
Program Services$32,864ProgramServicesAmt
Management And General$3,114ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$366,687TotalAmt
Program Services$334,946ProgramServicesAmt
Management And General$31,741ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$268,948TotalAmt
Program Services$246,283ProgramServicesAmt
Management And General$22,665ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$330,668TotalAmt
Program Services$288,901ProgramServicesAmt
Management And General$41,767ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$34,927TotalAmt
Program Services$8,263ProgramServicesAmt
Management And General$1,212ManagementAndGeneralAmt
Fundraising$25,452FundraisingAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$123,293TotalAmt
Program Services$105,832ProgramServicesAmt
Management And General$17,461ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$148,068TotalAmt
Program Services$140,760ProgramServicesAmt
Management And General$7,308ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$6,972TotalAmt
Program Services$4,334ProgramServicesAmt
Management And General$2,638ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$3,388TotalAmt
Program Services$3,388ProgramServicesAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$25,367TotalAmt
Management And General$25,367ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$283,665TotalAmt
Program Services$283,665ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$68,184TotalAmt
Program Services$57,930ProgramServicesAmt
Management And General$10,254ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Supplies$475,265$460,687$14,578
Ancillary Services$754,509$754,509
Assessment Fees$212,778$212,778
Bad Debt$7,841$7,841

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$98,429TotalAmt
Program Services$90,313ProgramServicesAmt
Management And General$8,116ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$6,954,385TotalAmt
Program Services$6,421,617ProgramServicesAmt
Management And General$507,316ManagementAndGeneralAmt
Fundraising$25,452FundraisingAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$873,695BOYAmt
EOY$748,148EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$41,269BOYAmt
EOY$43,183EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$110,299BOYAmt
EOY$112,722EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$8,731,899LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$5,898,639LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$2,962,213BOYAmt
EOY$2,833,260EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,816,122BOYAmt
EOY$2,050,255EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$5,803,598BOYAmt
EOY$5,787,568EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$612,996BOYAmt
EOY$647,951EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$630,050BOYAmt
EOY$645,050EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$62,547BOYAmt
EOY$73,168EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,305,593BOYAmt
EOY$1,366,169EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,171,969BOYAmt
EOY$2,820,087EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$10,342BOYAmt
EOY$303,958EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,315,694BOYAmt
EOY$1,297,354EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$4,498,005BOYAmt
EOY$4,421,399EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,803,598BOYAmt
EOY$5,787,568EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$29,830ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$46,776NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
ChurchYes (X)ChurchInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,471,879BeginningYearBalanceAmt
Contributions$303,958ContributionsAmt
Investment Earnings Or Losses-$990InvestmentEarningsOrLossesAmt
Other Expenditures$32,572OtherExpendituresAmt
Administrative Expenses-$11AdministrativeExpensesAmt
End Year Balance$1,742,286EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,434,773BeginningYearBalanceAmt
Contributions$10,027ContributionsAmt
Investment Earnings Or Losses$107,457InvestmentEarningsOrLossesAmt
Other Expenditures$64,742OtherExpendituresAmt
Administrative Expenses$15,636AdministrativeExpensesAmt
End Year Balance$1,471,879EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,664,383BeginningYearBalanceAmt
Contributions$33,954ContributionsAmt
Investment Earnings Or Losses$291,764InvestmentEarningsOrLossesAmt
Other Expenditures$543,130OtherExpendituresAmt
Administrative Expenses$12,198AdministrativeExpensesAmt
End Year Balance$1,434,773EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,693,743BeginningYearBalanceAmt
Contributions$308,838ContributionsAmt
Investment Earnings Or Losses$271,776InvestmentEarningsOrLossesAmt
Other Expenditures$592,068OtherExpendituresAmt
Administrative Expenses$17,906AdministrativeExpensesAmt
End Year Balance$1,664,383EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.08000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.75000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.17000TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgYes (true)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$564,941OtherCostOrOtherBasisAmt
Book Value$564,941BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,021,223OtherCostOrOtherBasisAmt
Depreciation$4,312,728DepreciationAmt
Book Value$1,708,495BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,145,735OtherCostOrOtherBasisAmt
Depreciation$1,585,911DepreciationAmt
Book Value$559,824BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$2,833,260TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (9 entries)

DescDescBook ValueBookValueAmt
Interest and Dividends Receivable$6,534
Contributions Receivable$291,492
Investments$214,255
Beneficial Interest - Inv Pool$40,329
Settlement - Medicare$22,898
Other Assets$2,401
Assets Whose Use is Limited$506,270
Investment - Insurance Company$21,552
Beneficial Interst - Perp Trust$944,524
FieldValueIRS element (for citing)
Total Book Value Other Assets$2,050,255TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
Accrued Interest$1,860
Assessment Tax - HFS$65,939
Settlement - Medicaid$5,369
FieldValueIRS element (for citing)
Total Liability$73,168TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$6,924,555TotalRevEtcAuditedFinclStmtAmt
Revenue Subtotal$6,924,555RevenueSubtotalAmt
Total Revenue Per Form990$6,924,555TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$6,954,385TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$6,954,385ExpensesSubtotalAmt
Total Expenses Per Form990$6,954,385TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Endowment funds intended uses (Part V, line 4)The unrestricted board designated fund has an account balance of $140,974 at December 31, 2015. These funds were set aside by the Board of Directors to be utilized by Mendota Lutheran Home to provide educational scholarships to its employees.A more detailed explanation of the unrestricted board designated fund can be found in Note (12) of the audited financial statements of Mendota Lutheran Home. Temporarily restricted contributions represent various donations made to Mendota Lutheran Home during 2015 that were directed by the donors to be utilized for specific purposes or carry time restrictions for usage. The temporarily restricted balance at December 31, 2015 was $303,958. The restrictions on this balance is designated for the following uses: nursing and activity progrmas, food pantry, scholarship funds, and time restrictions for receipt.A more detailed explanation of temporarily restricted contributions can be found in Note (13) of the audited financial statements of Mendota Lutheran Home. The permanently restricted endowment fund has an account balance of $1,297,354 at December 31, 2015. The permanently restricted endowment fund is derived from three bequests that have specific intended uses. The primary uses of the interest and investment income income derived from these funds is specified to be utilized for on-going operations of the facility with a portion directed to provide service funds to the employees of the organization.A more detailed explanation of the unrestricted board designated fund can be found in Note (14) of the audited financial statements of Mendota Lutheran Home.
Footnote for uncertain tax position under FIN 48 (Part X)Generally Accepted Accounting Principles prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of tax positions taken or expected to be taken in tax returns. The amount recognized is measured as the largest amount of benefit that is more likely that not of being realized upon settlement. Mendota Lutheran Home has determined that it does not have any significant risks related to income tax expense and therefore no amounts were reserved for uncertain tax positions as of December 31, 2015.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990 governing body review Part VI line 11The Form 990 will be distributed to the Board of Directors for review and approval before submission to the Internal Revenue Service.
CEO executive director top management comp Part VI line 15aThe Board of Directors annually evaluates the Administrator and determines compensation adjustments based on both performance,industry standards, and budgetary constraints.
Other officer or key employee compensation Part VI line 15bThe Administrator evaluates all other employees of Mendota Lutheran Home and determines compensation based on performance, industry standards, and budgetary constraints.
Governing documents etc available to public Part VI line 19Mendota Lutheran Home makes governing documents, conflicts of interest statements, financial statements, and tax returns availabile to the public upon written request.
General explanation attachmentCertain reclassifications were made in regards to the presentation of prior year financial statement groupings (2014) to be consistent with the financial statement groupings for 2015. These reclassifications had no effect on reported results of operations or net assets for the year ending December 31, 2014.These reclassifications were incorporated into the completion of the prior year amounts reported within the 2015 Form 990.

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