2015-02-06T14:39:33-06:00 2014-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2013-07-01 273635343 PACE IOWA PACE 4028292900 5858 WENNINGHOFF ROAD NO 2 OMAHA NE 68134 DAN FRIEDLUND EXECUTIVE VICE PRESIDENT & CFO 4028292900 2015-02-06 1 BARBARA J FAJEN P00400874 4023302660 2013 2016-03-07 17:11:31Z IMMANUEL PATHWAYS ERIC N GURLEY 6757 NEWPORT AVENUE SUITE 200 OMAHA NE 68152 5960658 0 X WWW.IMMANUELCOMMUNITIES.COM X 2010 NE TO PROVIDE IN-HOME, RESIDENTIAL AND COMMUNITY-BASED HEALTH CARE AND RELATED SERVICES TO THE ELDERLY. 14 13 0 17 0 0 4832 0 4159015 5960356 488 302 0 0 4164335 5960658 0 0 0 0 2410235 2865367 0 0 0 4089154 5181083 6499389 8046450 -2335054 -2085792 3484926 3287308 8364520 10252694 -4879594 -6965386 CHRIST-CENTERED SERVICE TO SENIORS AND EACH OTHER. 0 0 7087985 5960356 "PACE" STANDS FOR PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY. PACE PROGRAMS COORDINATE AND PROVIDE ALL NEEDED PREVENTITIVE, PRIMARY, ACUTE AND LONG-TERM CARE SERVICES SO THAT OLDER INDIVIDUALS CAN CONTINUE LIVING IN THEIR COMMUNITIES. 7087985 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 50 0 1 0 0 0 0 0 0 0 0 0 0 0 X 14 13 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X MARY ANDERSON CONTROLLER 4028292933 5858 WENNINGHOFF ROAD STE 2 OMAHA NE 68134 X REV CARMALA ADERMAN CHAIR 0.30 2.50 X X 0 0 0 DAVID MUSSMAN VICE CHAIR 0.30 2.50 X X 0 0 0 MIKE WILLIAMS SECRETARY/TREASURER 0.30 2.50 X X 0 0 0 REV DR DENNIS ANDERSON MEMBER 0.30 2.50 X 0 0 0 REV DR DAVID DEFREESE MEMBER 0.30 2.50 X 0 0 0 LAURA FENDER MEMBER 0.30 2.50 X 0 0 0 REV MARK GRORUD MEMBER 0.30 2.50 X 0 0 0 GUILLERMO BILL HUERTA MD MEMBER 0.30 2.50 X 0 0 0 SUZANNE HRUZA MD MEMBER 0.30 2.50 X 0 0 0 DAVID JACOX MEMBER 0.30 2.50 X 0 0 0 BISHOP BRIAN MASS MEMBER 0.30 2.50 X 0 0 0 MARK WATERSTRAAT MEMBER 0.30 2.50 X 0 0 0 DELIGHT WREED BYRD MEMBER 0.30 2.50 X 0 0 0 ANTHONY SCIOLI MEMBER (7/1/13 - 11/12/13) 0.30 2.50 X 0 0 0 RUTH HENRICHS MEMBER (7/1/13 - 12/31/13) 0.30 2.50 X 0 0 0 TOM GARVEY MEMBER (7/1/13 - 3/31/14) 0.30 2.50 X 0 0 0 ERIC N GURLEY PRESIDENT/CEO 2.00 45.00 X X 0 396069 145634 DAN FRIEDLUND EXECUTIVE VP/CFO 3.00 45.00 X 0 191570 0 TAMMY SEALER SENIOR VICE PRESIDENT/CAO 2.00 46.00 X 0 136477 26500 ANDREW FISHER SENIOR VICE PRESIDENT/COO 5.00 42.00 X 0 134645 26455 MARK A WILES MD PHYSICIAN 32.00 13.00 X 0 166810 14855 STEVE HESS VP/DIR OF HOME/COMMUNITY S 10.00 30.00 X 0 136773 14804 ROXANN M ROGERS MEYER VP/DIR OF MARKETING & COMM 4.00 42.00 X 0 128212 32807 DEBRA J WELK VP/DIR OF HEALTH CARE SERVICES 5.00 42.00 X 0 119600 26244 MARY J ANDERSON CORPORATE CONTROLLER 4.00 44.00 X 0 109795 34261 0 1519951 321560 1 0 1 0 ALEGENT CREIGHTON HEALTH MERCY HOSPITAL 800 MERCY DRIVE COUNCIL BLUFFS IA 51501 MEDICAL & HEALTH CARE 616401 VISITING NURSE HEALTH SERVICES 12565 W CENTER ROAD STE 100 OMAHA NE 68144 HOME HEALTH CARE SERVICES 196946 2 MEDICAID 623000 3239857 3239857 MEDICARE 623000 2471621 2471621 SENIOR SERVICE 623000 248878 248878 5960356 302 302 5960658 5960356 0 302 2303147 2039101 264046 67960 60169 7791 331569 273593 57976 162691 144840 17851 302222 302222 352 352 10470 10470 329683 269080 60603 54664 54664 109791 93322 16469 1240 1240 260192 221163 39029 120381 105144 15237 447924 380735 67189 381535 324305 57230 132944 113002 19942 MEDICAL SERVICES 2724861 2724861 MEDICAL SUPPLIES 142283 142283 FOOD 103057 103057 BAD DEBT EXPENSE 33056 33056 26428 5610 20818 8046450 7087985 958465 0 344044 188965 201023 266870 57058 27751 3710884 907162 2882801 2803722 3484926 3287308 500044 865014 7864476 9387680 8364520 10252694 X -4879594 -6965386 -4879594 -6965386 3484926 3287308 -2085792 0 X X 0 1 X 1 0 X 40037 4832 44869 782374 4159015 5960356 10901745 822411 4163847 5960356 10946614 0 0 0 10946614 2 1130 488 302 1922 2 1130 488 302 1922 2 823541 4164335 5960658 10948536 X 2163915 457756 1706159 1511831 436602 1075229 35138 12804 22334 2803722 SUBORDINATED NOTE PAYABLE TO IMMANUEL HOME & COMMUNITY RESOURCES 8853102 LINE OF CREDIT 534578 9387680 X 5960658 0 5960658 0 5960658 8046450 0 8046450 0 8046450 PART X, LINE 2: THE COMPANY IS A NOT-FOR-PROFIT CORPOARTION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX-EXEMPT STATUS. THE COMPANY ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE COMPANY RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2014, THE COMPANY HAD NO UNCERTAIN TAX POSITIONS ACCRUED. WITH FEW EXCEPTIONS, THE COMPANY IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR FISCAL YEARS ENDING BEFORE JUNE 30, 2011. 0 1 0 0 0 0 0 0 0 ERIC N GURLEY PRESIDENT/CEO 0 300299 0 87930 0 7840 0 117028 0 28606 0 541703 0 0 DAN FRIEDLUND EXECUTIVE VP/CFO 0 142414 0 49156 0 0 0 0 0 0 0 191570 0 0 TAMMY SEALER SENIOR VICE PRESIDENT/CAO 0 107734 0 28670 0 73 0 8361 0 18139 0 162977 0 0 ANDREW FISHER SENIOR VICE PRESIDENT/COO 0 105730 0 25000 0 3915 0 0 0 26455 0 161100 0 0 MARK A WILES MD PHYSICIAN 0 166660 0 0 0 150 0 0 0 14855 0 181665 0 0 STEVE HESS VP/DIR OF HOME/COMMUNITY S 0 130419 0 5924 0 430 0 6425 0 8379 0 151577 0 0 ROXANN M ROGERS MEYER VP/DIR OF MARKETING & COMM 0 106007 0 21722 0 483 0 7952 0 24855 0 161019 0 0 PART I, LINE 3 THE COMPENSATED OFFICERS ARE EMPLOYEES OF IMMANUEL, A RELATED ENTITY. THE BOARD'S EXECUTIVE COMMITTEE SERVES AS THE COMPENSATION COMMITTEE TO REVIEW AND APPROVE THE TOTAL COMPENSATION FOR ERIC GURLEY, AND TO APPROVE THE BONUS PLAN AND PAYOUT OF BONUSES TO THE LEADERSHIP TEAM. THE COMPENSATION COMMITTEE USES AN INDEPENDENT COMPENSATION CONSULTANT TO HELP SET SALARIES AND BENEFITS. WRITTEN EMPLOYMENT CONTRACTS ARE USED FOR ERIC GURLEY AND DAN FRIEDLUND. PART I, LINE 4B ERIC N. GURLEY, PRESIDENT AND CEO, IS A PARTICIPANT IN AN ENDORSEMENT SPLIT-DOLLAR LIFE INSURANCE PLAN AND A DEFERRED COMPENSATION PLAN WHICH IS INTENDED TO MEET THE REQUIREMENTS OF SECTIONS 409A AND 457(F). BOTH PLANS ARE SPONSORED BY IMMANUEL, A RELATED TAX EXEMPT ENTITY AND MR. GURLEY'S EMPLOYER. THROUGH DECEMBER 31, 2013, MR. GURLEY'S DEFERRED COMPENSATION ACCOUNT WAS CREDITED WITH $99,375. PREMIUMS OF $157,474 WERE PAID FOR THE ENDORSEMENT SPLIT-DOLLAR LIFE INSURANCE PLAN POLICY. UNDER THE PLAN, IMMANUEL ENDORSES TO MR. GURLEY THE RIGHT TO DESIGNATE A BENEFICIARY FOR THE PORTION OF THE DEATH BENEFIT IN EXCESS OF THE GREATER OF THE CASH SURRENDER VALUE OR PREMIUMS PAID. THE VALUE OF THAT RIGHT, WHICH WAS INCLUDED IN MR. GURLEY'S REPORTABLE COMPENSATION, WAS $2,803. AS OF JUNE 30, 2014, THE DEATH BENEFIT IN EXCESS OF PREMIUMS PAID WAS $3,497,637. PART I, LINE 6 THE ORGANIZATION DOES NOT PAY OR ACCRUE ANY COMPENSATION BASED ON THE REVENUES OR THE NET EARNINGS OF THE ORGANIZATION OR ANY RELATED ORGANIZATION. HOWEVER, A SMALL PERCENTAGE (LESS THAN 10%) OF THE BONUSES PAID TO ERIC GURLEY, DAN FRIEDLUND, TAMMY SEALER, ANDREW FISHER, ROXANNE ROGERS MEYER, DEBRA WELK AND MARY ANDERSON IS BASED ON AN OPERATING MARGIN CALCULATION OF IMMANUEL AND RELATED TAX-EXEMPT ORGANIZATIONS. A SMALL PERCENTAGE (LESS THAN 10%) OF THE BONUSES PAID TO STEVE HESS IS BASED ON AN OPERATING MARGIN CALCULATION OF IMMANUEL HOME AND COMMUNITY RESOURCES. FORM 990, PART V, LINE 2A: INDIVIDUALS PERFORMING SERVICES FOR PACE IOWA ARE EMPLOYEES OF IMMANUEL, A RELATED ENTITY. THEREFORE, IMMANUEL ISSUES THE FORM W-2 FOR THESE EMPLOYEES. BECAUSE PACE IOWA REIMBURSES IMMANUEL FOR THE SALARIES AND BENEFITS OF THESE EMPLOYEES, THE EXPENSES FOR THEIR SALARIES AND BENEFITS ARE REFLECTED ON THIS RETURN IN PART IX, STATEMENT OF FUNCTIONAL EXPENSES. FORM 990, PART VI, SECTION A, LINE 2 ERIC N. GURLEY IS THE PRESIDENT AND CEO OF IMMANUEL, A SUPPORTING ORGANIZATION OF IMMANUEL HOME AND COMMUNITY RESOURCES, THE SOLE MEMBER OF PACE IOWA. ALL COMPENSATED BOARD MEMBERS, OFFICERS AND EMPLOYEES ARE EMPLOYEES OF IMMANUEL. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT SERVICES ARE PROVIDED BY IMMANUEL HOME & COMMUNITY RESOURCES, THE ORGANIZATION'S SOLE MEMBER. MANAGEMENT AND DEVELOPMENT FEES ARE PAID TO IMMANUEL HOME & COMMUNITY RESOURCES BASED ON CONTRACTUAL AGREEMENT. FORM 990, PART VI, SECTION A, LINE 6 PACE IOWA HAS ONE MEMBER, IMMANUEL HOME AND COMMUNITY RESOURCES. FORM 990, PART VI, SECTION A, LINE 7A IMMANUEL HOME AND COMMUNITY RESOURCES, PACE IOWA'S SOLE MEMBER, HAS THE RIGHT TO APPOINT AND REMOVE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B IMMANUEL HOME AND COMMUNITY RESOURCES, PACE IOWA'S SOLE MEMBER, MUST APPROVE ANY AMENDMENT AND INITIATE OR ADOPT AMENDMENTS TO THE ARTICLES OR BYLAWS OF PACE IOWA. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY AN ACCOUNTING FIRM WITH THE ASSISTANCE OF THE CONTROLLER, AND IS THEN REVIEWED BY THE CFO AND THE CONTROLLER. COPIES OF THE REVIEWED RETURN ARE PROVIDED TO THE BOARD MEMBERS PRIOR TO FILING WITH IRS. FORM 990, PART VI, SECTION B, LINE 12C PACE IOWA USES THE SAME POLICY AS IMMANUEL, A RELATED ORGANIZATION. THE POLICY STATES THAT THE BOARD OF DIRECTORS MUST SIGN THE CONFLICT OF INTEREST POLICY AND DISCLOSE ALL CONFLICTS. THE GOVERNANCE COMMITTEE SHALL DECIDE WHAT ACTIONS NEED TO BE TAKEN CONCERNING ANY CONFLICTS. THE BOARD MEMBER IS PROHIBITED FROM VOTING ON ANY BUSINESS RELATED TO ANY CONFLICT THE GOVERNANCE COMMITTEE HAS IDENTIFIED. FORM 990, PART VI, SECTION C, LINE 19 PACE IOWA DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VII: BOARD MEMBER COMPENSATION: ALL COMPENSATION AND BENEFITS SHOWN FOR DIRECTORS ARE PAID BY IMMANUEL, THE SPONSOR ORGANIZATION, FOR SERVICES PERFORMED FOR IMMANUEL OR OTHER RELATED ENTITIES. THE COMPENSATION IS NOT PAID FOR SERVICES IN CONNECTION WITH THE POSITION OF DIRECTOR FOR PACE IOWA. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS OF PACE IOWA ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM PRIOR YEARS. FORM 990, PART VI, SECTION B, LINE 15: PACE IOWA DOES NOT HAVE A CEO, EXECUTIVE DIRECTOR OR TOP MANAGEMENT OFFICIAL OR ANY KEY EMPLOYEES THE ORGANIZATION DIRECTLY COMPENSATES. THE ORGANIZATION REIMBURSES IMMANUEL, A RELATED ORGANIZATION, FOR PORTIONS OF THE SALARIES OF IMMANUEL EMPLOYEES WHO PROVIDE NEEDED SERVICES. THEREFORE, IT IS NOT NECESSARY TO HAVE A PROCESS TO DETERMINE COMPENSATION FOR THESE POSITIONS. IMMANUEL 5858 WENNINGHOFF RD OMAHA NE 68134 470733774 CORPORATE SUPPORT NE 501(C)(3) LINE 11B, II N/A 0 IMMANUEL RETIREMENT COMMUNITIES 5858 WENNINGHOFF RD OMAHA NE 68134 470799108 ELDERLY HOUSING NE 501(C)(3) LINE 9 IMMANUEL 0 IMMANUEL COMMUNITY FOUNDATION 5858 WENNINGHOFF RD OMAHA NE 68134 470624928 FUNDRAISING NE 501(C)(3) LINE 11C, III-FI IMMANUEL - SEE STATEMENT 0 IMMANUEL HOME AND COMMUNITY RESOURCES 5858 WENNINGHOFF RD OMAHA NE 68134 272628802 ELDERLY SERVICES NE 501(C)(3) LINE 9 IMMANUEL 0 PACE-NEBRASKA 5858 WENNINGHOFF RD OMAHA NE 68134 273635416 ELDERLY SERVICES NE 501(C)(3) LINE 9 IMMANUEL HOME & COMMUNITY RESOURCES 0 IMMANUEL AFFORDABLE INC 5858 WENNINGHOFF RD OMAHA NE 68134 470831041 ELDERLY & LOW INCOME HOUSING NE 501(C)(3) LINE 9 IMMANUEL 0 IMMANUEL AFFORDABLE II INC 5858 WENNINGHOFF RD OMAHA NE 68134 800016829 ELDERLY & LOW INCOME HOUSING NE 501(C)(3) LINE 9 IMMANUEL 0 IMMANUEL TRINITY AFFORDABLE INC 5858 WENNINGHOFF RD OMAHA NE 68134 113742894 ELDERLY & LOW INCOME HOUSING NE 501(C)(3) LINE 9 IMMANUEL 0 IMMANUEL LONG TERM CARE 5858 WENNINGHOFF RD OMAHA NE 68134 462582783 LONG-TERM HEALTH CARE SERVICES NE 501(C)(3) LINE 9 IMMANUEL 0 IMMANUEL COMMUNITY VISION FOUNDATION 5858 WENNINGHOFF RD OMAHA NE 68134 462693844 SUPPORT RELATED ENTITIES PURPOSES NE 501(C)(3) LINE 11B, II IMMANUEL 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 1 0 0 0 SCHEDULE R, PART II, IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS IMMANUEL COMMUNITY FOUNDATION'S DIRECTORS ARE SELECTED BY THE BOARDS OF DIRECTORS OF THE THREE ORGANIZATIONS IT SUPPORTS; IMMANUEL RETIREMENT COMMUNITIES, IMMANUEL HOME AND COMMUNITY RESOURCES, AND IMMANUEL LONG TERM CARE. EACH OF THESE THREE ORGANIZATIONS IS CONTROLLED BY THEIR SOLE MEMBER, IMMANUEL.