2015-08-10T15:41:58-05:00 2014-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2014-01-01 470384319 FLORENCE HOME FOR THE AGED FLOR 4028276000 7915 NORTH 30TH STREET OMAHA NE 68112 DEBRA L THACKER CFO 4028276000 2015-08-05 1 BARBARA J FAJEN P00400874 4023302660 2014 2016-04-25 22:37:26Z DEBRA L THACKER 7915 NORTH 30TH STREET OMAHA NE 68112 11054272 0 X WWW.OMAHASENIORCARE.ORG X 1906 NE PROVIDE CARE FOR THE ELDERLY 14 12 249 5 0 0 477880 93840 10612025 10832973 32112 48024 53937 79435 11175954 11054272 88216 273880 0 0 5118617 5166441 0 0 0 5262957 5578744 10469790 11019065 706164 35207 4372650 4135276 2150185 1897541 2222465 2237735 TO PROVIDE A CONTINUUM OF QUALITY SERVICES AND PROGRAMS FOR SENIORS AND OTHER PERSONS NEEDING SPECIALIZED CARE. 0 0 6473102 273880 7337814 SKILLED NURSING CARE 1015958 0 1032729 ASSISTED LIVING CARE 2186728 0 2500292 ALZHEIMER'S ASSISTED LIVING CARE 9675788 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 18 0 1 249 1 0 0 0 0 0 0 0 0 0 0 X 14 12 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 X DEBRA L THACKER CFO 4028276000 7915 NORTH 30TH STREET OMAHA NE 68112 PHIL CHRISTENSEN CHAIRMAN 1.00 3.00 X X 0 0 0 BETTY G FOSTER PHD SECRETARY / TREASURER 1.00 3.00 X X 0 0 0 ROBERT A BLOECHLE DIRECTOR 1.00 3.00 X 0 0 0 MARC BUTTERFIELD DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL CANTRELL DIRECTOR 1.00 0.00 X 0 0 0 PAUL FALKOWSKI DIRECTOR 1.00 0.00 X 0 0 0 MITCHELL D HIATT DIRECTOR 1.00 0.00 X 0 0 0 MARK HIGGINS DIRECTOR 1.00 1.00 X 0 0 0 LYN M HOLLEY DIRECTOR 1.00 0.00 X 0 0 0 NANCY A MCCARTHY DIRECTOR 1.00 1.00 X 0 0 0 JULIE MONACO DIRECTOR 1.00 0.00 X 0 0 0 STEPHANIE O'KEEFE DIRECTOR 1.00 0.00 X 0 0 0 LOIS JORDAN PRESIDENT / CEO 2.00 47.00 X X 0 170467 9010 DEBRA L THACKER CFO 2.00 47.00 X X 0 159532 22964 0 329999 31974 0 0 1 0 HEALTHCARE SERVICES GROUP SUITE 300 3220 TILLMAN DRIVE BENSALEM PA 19020 DIETARY 719993 HALLMARK REHABILITATION 27442 PORTOLA PARKWAY SUITE 200 FOOTHILL RANCH CA 92610 REHAB SERVICES 650032 UNLIMITED OPPORTUNITY INC DBA JANA-KING 14821 W 95TH STREET LENEXA KS 66215 HSKP/LAUNDRY 322763 3 82588 11252 93840 MEDICARE/MEDICAID PAYMENTS 623000 8820300 8820300 PRIVATE PAY/INSURANCE REVENUE 623000 2009527 2009527 MISCELLANEOUS INCOME 623000 3146 3146 10832973 48024 48024 40472 0 40472 40472 40472 SETTLEMENTS AND ASSESMENTS 623000 35509 35509 VENDOR REBATES 623000 2353 2353 CAFETERIA & VENDING REVENUE 623000 1101 1101 38963 11054272 10870835 0 89597 X 273880 273880 4371492 4127392 244100 409129 380600 28529 385820 364096 21724 865814 865814 25795 25795 35720 35720 2168525 2071412 97113 17232 9862 7370 298686 281574 17112 567904 567904 17822 17822 32013 32013 19932 19932 203649 203649 111568 111568 MEDICAL SUPPLIES 540444 540444 DIETARY-FOOD 318127 318127 MISCELLANEOUS 208704 208704 BAD DEBT & CHARITY CARE 126000 126000 20809 20809 11019065 9675788 1343277 0 900 930 858184 756630 1021681 986118 45829 25921 44946 30753 6099209 4921023 1197614 1178186 1203496 1156738 4372650 4135276 881527 679230 1250000 1180000 18658 38311 2150185 1897541 X 1134651 1172698 1087814 1065037 2222465 2237735 4372650 4135276 X 35207 -22777 2840 X X 0 1 X 1 0 X 2983 3643 30060 477880 93840 608406 10561250 10034375 9654918 10614353 10870835 51735731 1893 3345 1347 12530 1101 20216 10566126 10041363 9686325 11104763 10965776 52364353 0 0 0 52364353 79309 57708 87157 85358 88496 398028 79309 57708 87157 85358 88496 398028 10645435 10099071 9773482 11190121 11054272 52762381 0.99250 0.99250 0.00750 0.00750 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 154347 154347 4063099 3385705 677394 1758518 1454931 303587 123245 80387 42858 1178186 DEFERRED FINANCING COSTS, NET 62884 BENEFICIAL INTEREST IN PERPETUAL TRUST 1065037 THIRD PARTY PAYOR SETTLEMENTS RECEIVABLE 28817 1156738 ACCRUED INTEREST PAYABLE 3699 DUE TO AFFILIATES 34612 38311 X PART X, LINE 2: MIDWEST GERIATRICS, INC., ROYALE OAKS HOUSE OF HOPE, GERIMED, INC., EMPOWER HOME CARE, FLORENCE HOME AND SENIOR HEALTH FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THESE NOT-FOR-PROFIT CORPORATIONS HAVE EACH RECEIVED A DETERMINATION LETTER THAT THEY ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. UNIMED, INC. IS A TAXABLE CORPORATION. UNIMED, INC. HAS A NET OPERATING LOSS CARRYFORWARD AS OF DECEMBER 31, 2014 AND 2013, AVAILABLE FOR FEDERAL AND STATE INCOME TAX PURPOSES. THE ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2014, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. THE ORGANIZATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS ENDED PRIOR TO DECEMBER 31, 2011. 1 MIDWEST GERIATRICS INC 7915 N 30TH STREET OMAHA NE 68112 470727974 501(C)(3) 269000 TO ASSIST WITH ONGOING NEEDS OF THE ORGANIZATION. 1 0 PART I, LINE 2: RECIPIENT PROVIDES INVOICES AND RECEIPTS AS DOCUMENTATION THAT THE GRANT FUNDS ARE USED FOR THEIR INTENDED PURPOSE. 0 0 0 0 0 0 0 0 0 LOIS JORDAN PRESIDENT / CEO 0 170467 0 0 0 0 0 0 0 9010 0 179477 0 0 DEBRA L THACKER CFO 0 159532 0 0 0 0 0 0 0 22964 0 182496 0 0 PART I, LINE 3 FLORENCE HOME FOR THE AGED DOES NOT HAVE ANY OFFICERS IT DIRECTLY COMPENSATES. MIDWEST GERIATRICS, INC., AN AFFILIATE OF FLORENCE HOME FOR THE AGED, COMPENSATES THE OFFICERS OF FLORENCE HOME FOR THE AGED. THEREFORE, THE POLICY ON THE PROCESS FOR DETERMINING COMPENSATION OF MIDWEST GERIATRICS, INC. OFFICERS APPLIES TO THE COMPENSATION OF THE FOLLOWING PERSONS SERVING AS OFFICERS OF FLORENCE HOME FOR THE AGED: CHIEF EXECUTIVE OFFICER: LOIS JORDAN CHIEF FINANCIAL OFFICER: DEBRA THACKER THE PROCESS IS UTILIZED BY THE EXECUTIVE COMMITTEE OF THE MIDWEST GERIATRICS, INC. FOR FURTHER EXPLANATION OF THE PROCESS SEE SCHEDULE O. FORM 990, PART VI, SECTION A, LINE 7A MIDWEST GERIATRICS, INC., A RELATED ENTITY, HAS THE POWER TO ELECT ALL MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE ARTICLES AND BYLAWS OF FLORENCE HOME FOR THE AGED MAY BE AMENDED WITH THE AFFIRMATIVE VOTE OF TWO-THIRDS OF THE MEMBERS OF THE BOARD OF DIRECTORS OF MIDWEST GERIATRICS INC. FORM 990, PART VI, SECTION B, LINE 11 ONCE THE FORM 990 AND RELATED SCHEDULES HAVE BEEN PREPARED BY THE VP OF FINANCIAL SERVICES, THE CFO REVIEWS IT, MAKES ANY CHANGES AND ACCEPTS THE DRAFT FORM 990. THE FINANCE COMMITTEE WILL THEN BE INFORMED VIA E-MAIL THAT THE DRAFT FORM 990 IS READY FOR REVIEW AND ASKED IF THEY WANT IT SENT OUT TO THEM OR IF THEY WILL BE COMING TO THE FACILITY TO REVIEW. ONCE 2/3 OF THE FINANCE COMMITTEE MEMBERS HAVE REVIEWED AND ACCEPTED THE FORM 990, IT WILL BE FILED. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE ASKED TO REVIEW AND DISCLOSE ANY CONFLICTS OF INTERESTS THAT THEY MAY HAVE WITH FLORENCE HOME FOR THE AGED OPERATIONS. THEY ARE THEN ASKED TO SIGN A DOCUMENT INDICATING CONFLICTS, IF ANY. THE BOARD CHAIR IS THEN INFORMED OF ANY CURRENT CONFLICTS FOR CONSIDERATION IN FUTURE VOTING MATTERS OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 FLORENCE HOME FOR THE AGED DOES NOT HAVE ANY OFFICERS THAT IT DIRECTLY COMPENSATES. MIDWEST GERIATRICS, INC., AN AFFILIATE OF FLORENCE HOME, COMPENSATES THE OFFICERS OF FLORENCE HOME. THE POLICY ON THE PROCESS FOR DETERMINING COMPENSATION OF MIDWEST GERIATRICS, INC. OFFICERS APPLIES TO THE COMPENSATION OF THE FOLLOWING PERSONS SERVING AS OFFICERS OF FLORENCE HOME: CHIEF EXECUTIVE OFFICER: LOIS JORDAN CHIEF FINANCIAL OFFICER: DEBRA THACKER THE PROCESS IS UTILIZED BY THE EXECUTIVE COMMITTEE OF THE MIDWEST GERIATRICS, INC. BOARD ON AN ANNUAL BASIS. THE PROCESS INCLUDES ALL OF THESE ELEMENTS: (1) REVIEW AND APPROVAL BY THE EXECUTIVE COMMITTEE OF MIDWEST GERIATRICS, INC.; (2) USE OF OUTSIDE DATA AS TO COMPARABLE COMPENSATION; AND (3) CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING. 1. REVIEW AND APPROVAL. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF MIDWEST GERIATRICS, INC., PROVIDED THAT PERSONS WITH CONFLICTS OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT AT ISSUE ARE NOT INVOLVED IN THIS REVIEW AND APPROVAL. 2. USE OF OUTSIDE DATA AS TO COMPARABLE COMPENSATION. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED USING DATA REGARDING COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. 3. CONTEMPORANEOUS DOCUMENTATION AND RECORDING. THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT. FORM 990, PART VI, SECTION C, LINE 19 A COPY OF THE REQUESTED DOCUMENT IS PROVIDED WITHIN 72 HOURS UPON REQUEST. FORM 990, PART IX, LINE 11G HSKP/LNDRY/DIETARY: PROGRAM SERVICE EXPENSES 1,042,756. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,042,756. REHAB SERVICES: PROGRAM SERVICE EXPENSES 650,032. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 650,032. OTHER: PROGRAM SERVICE EXPENSES 378,624. MANAGEMENT AND GENERAL EXPENSES 97,113. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 475,737. FORM 990, PART XI, LINE 9: TRANSFER FROM AFFILIATE 2,840. FORM 990, PAGE 12, PART XII,LINE 2C: THE BOARD OF DIRECTORS OF MIDWEST GERIATRICS, INC ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. SENIOR HEALTH FOUNDATION 7915 N 30TH STREET OMAHA NE 68112 470709560 PROVIDE ASSISTANCE TO THE ELDERLY NE 501(C)(3) 7 MIDWEST GERIATRICS INC 0 GERIMED INC 7915 N 30TH STREET OMAHA NE 68112 470727973 PHARMACEUTICAL SALES NE 501(C)(3) 9 MIDWEST GERIATRICS INC 0 MIDWEST GERIATRICS INC 7915 N 30TH STREET OMAHA NE 68112 470727974 SUPPORT FLORENCE HOME AND RELATED ORANGIZATIONS THROUGH MANAGEMENT SERVICES NE 501(C)(3) 11B TYPE II N/A 0 ROYALE OAKS HOUSE OF HOPE 4801 N 52ND STREET OMAHA NE 68104 260808357 SUPPORT FLORENCE HOME BY SERVICING A FHA-INSURED NON-RECOURSE LOAN NE 501(C)(3) 11A TYPE I MIDWEST GERIATRICS INC 0 EMPOWER HOME CARE 7915 N 30TH STREET OMAHA NE 68112 471713914 PROVIDE NON-MEDICAL HOME CARE TO THE ELDERLY NE 501(C)(3) 9 MIDWEST GERIATRICS INC 0 UNIMED INC 7915 N 30TH STREET OMAHA NE 68112 470759285 PHARMACEUTICAL SALES NE N/A C 0 MIDWEST HEALTH CARE ENTERPRISES 7915 N 30TH STREET OMAHA NE 68112 363672698 INACTIVE NE N/A C 0 CRISS-FLORENCE HOME TRUST P O BOX 0634 MILWAUKEE WI 53201 476143241 INVESTMENT MANAGEMENT WI FLORENCE HOME FOR THE AGED T 47559 1065037 1.00000 1 0 1 1 0 1 0 0 0 0 1 1 0 0 1 1 0 0 0 1