2015-09-29T11:56:26-05:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2014-01-01 391448325 CARMEL RESIDENCE INC CARM 9202354653 220 NORTH WESTFIELD STREET OSHKOSH WI 54902 THERESA M BERTRAM PRESIDENT & CEO 9202325220 2015-09-15 1 KIMBERLY ANDERSON CPA P00188889 6123764500 2014 2016-04-25 22:37:26Z X THERESA M BERTRAM 225 NORTH EAGLE STREET OSHKOSH WI 54902 776645 0 9386 X WWW.LUTHERANHOMES.COM X 1988 WI TO PROVIDE HOUSING FOR AGING PERSONS. 14 14 0 28 0 0 9309 4751 596279 717352 11536 7236 44554 47306 661678 776645 0 0 0 0 201628 192659 0 0 0 444325 481580 645953 674239 15725 102406 4218108 4232427 3123820 3035733 1094288 1196694 CARMEL RESIDENCE, INC., IS PART OF A FAMILY OF HEALTHCARE AND RESIDENTIAL SERVICE ORGANIZATIONS COMMITTED TO PROVIDING QUALITY CARE AND LIFE ENRICHING OPPORTUNITIES TO THE AGING AND THOSE IN NEED IN A CARING, CHRISTIAN ENVIRONMENT. 0 0 517171 717352 CARMEL RESIDENCE, INC., PROVIDES INDEPENDENT LIVING FACILITIES FOR AGING PERSONS. THE ENTITY HAS 75 INDEPENDENT LIVING UNITS. 517171 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 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 6 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X X KIM MAKI 9202325238 225 NORTH EAGLE STREET OSHKOSH WI 54902 LOIS JAENKE CHAIR 0.20 1.40 X X 0 0 0 JIM STAPEL VICE CHAIR 0.20 1.40 X X 0 0 0 DR JAN EDELSTEIN SECRETARY 0.20 1.40 X X 0 0 0 MARK BEECHER BOARD MEMBER 0.20 1.40 X 0 0 0 KATHLEEN BELLAIRE BOARD MEMBER 0.20 1.40 X 0 0 0 THOMAS DUNHAM BOARD MEMBER 0.20 1.40 X 0 0 0 KAREN FREDRICK BOARD MEMBER 0.20 1.40 X 0 0 0 DR ROGER HEROLD BOARD MEMBER 0.20 1.40 X 0 0 0 REV RICK HOPKINS BOARD MEMBER 0.20 1.40 X 0 0 0 REV KAREN JEWELL BOARD MEMBER 0.20 1.40 X 0 0 0 GEORGE KONTOS BOARD MEMBER 0.20 1.40 X 0 0 0 JANE KUHN BOARD MEMBER 0.20 1.40 X 0 0 0 DR SUZANNE MARNOCHA BOARD MEMBER 0.20 1.40 X 0 0 0 WAYNE MUELLER BOARD MEMBER 0.20 1.40 X 0 0 0 THERESA BERTRAM PRESIDENT & CEO 4.50 36.00 X 0 236623 11424 JULIE VANDENBERG CORPORATE SECRETARY 4.50 36.00 X 0 67920 5891 0 304543 17315 0 0 1 0 0 4751 4751 APARTMENT OPERATIONS 623990 625633 625633 ENTRANCE FEE REVENUES 623990 91719 91719 717352 7236 7236 38818 0 38818 38818 38818 LAUNDRY REVENUE 900099 6498 6498 BEAUTY SHOP REVENUE 900099 1614 1614 MISCELLANEOUS 900099 376 376 8488 776645 717352 0 54542 192659 92900 99759 35648 35648 4867 4867 29836 28080 1756 1219 1219 10183 10183 559 559 136986 136986 1586 1586 234398 234398 21013 21013 RESIDENT EXPENSES 3077 3077 FOOD 41 41 MEDICAL SUPPLIES 22 22 2145 2145 674239 517171 157068 0 50220 41519 1461848 1543916 1478 437 847 6691206 4049462 2700598 2641744 3964 3964 4218108 4232427 13216 12855 561464 534294 2540809 2453911 8331 34673 3123820 3035733 X 1090324 1192730 3964 3964 1094288 1196694 4218108 4232427 102406 0 X X 0 1 X 1 0 X 4462 1817 5994 9309 4751 26333 570334 586153 570274 596279 717352 3040392 574796 587970 576268 605588 722103 3066725 0 41614 60579 53858 169497 173701 499249 41614 60579 53858 169497 173701 499249 2567476 67700 58821 52513 47191 46054 272279 67700 58821 52513 47191 46054 272279 10245 10176 8771 8899 8488 46579 652741 656967 637552 661678 776645 3385583 0.75840 0.81140 0.08040 0.10320 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: LAUNDRY REVENUE - 2010 AMOUNT: $ 8,394. 2011 AMOUNT: $ 8,757. 2012 AMOUNT: $ 8,419. 2013 AMOUNT: $ 7,276. 2014 AMOUNT: $ 6,498. BEAUTY SHOP - 2010 AMOUNT: $ 1,370. 2011 AMOUNT: $ 1,205. 2014 AMOUNT: $ 1,614. MISCELLANEOUS INCOME - 2010 AMOUNT: $ 481. 2011 AMOUNT: $ 214. 2012 AMOUNT: $ 352. 2013 AMOUNT: $ 1,623. 2014 AMOUNT: $ 376. 0 1 X 43875 43875 5004557 3111982 1892575 146271 120847 25424 1496503 816633 679870 2641744 DUE TO AFFILIATES 7909 LEASE PAYABLE 26764 34673 X PART IV, LINE 2B: CARMEL RESIDENCE OFFERS RESIDENTS THREE ENTRANCE OPTIONS UPON RESIDENCY. THE RESIDENT(S) MAY CHOOSE TO MAKE A NON-INTEREST-BEARING ENTRANCE DEPOSIT, WHICH IS REFUNDABLE AT 90% WITHIN 90 DAYS OF TERMINATION OF OCCUPANCY TO THE RESIDENT OR THEIR PERSONAL REPRESENTATIVE. THE SECOND OPTION REQUIRES A NONREFUNDABLE DEPOSIT OF 10% OF THE ENTRANCE FEE, AND THE THIRD OPTION REQUIRES A REFUNDABLE SECURITY DEPOSIT EQUAL TO ONE MONTH'S RENT. UNTIL RECOGNIZED AS REVENUE, NON-REFUNDABLE SECURITY DEPOSITS ARE REPORTED IN FORM 990, PART X, LINE 19 AS DEFERRED REVENUE. REFUNDABLE DEPOSITS ARE REPORTED IN FORM 990, PART X, LINE 21 AS ESCROW ACCOUNTS. PART X, LINE 2: THE ORGANIZATION'S NINE NONPROFIT CORPORATIONS ARE EXEMPT FROM INCOME TAXES PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THESE ENTITIES ARE NOT PRIVATE FOUNDATIONS, AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS CHARITABLE TAX DEDUCTIONS BY THE CONTRIBUTOR. THE ORGANIZATION FOLLOWS THE PROVISIONS OF THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THE INCOME TAX STANDARD HAD NO IMPACT ON THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION FILES INFORMATIONAL RETURNS AS A TAX-EXEMPT ORGANIZATION. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE INFORMATIONAL RETURNS FOR THE YEARS 2011 TO 2013 ARE OPEN TO EXAMINATION BY THOSE AUTHORITIES. 0 0 0 0 0 0 0 0 0 THERESA BERTRAM PRESIDENT & CEO 0 199573 0 37050 0 0 0 7018 0 4406 0 248047 0 0 PART I, LINE 3 THE COMPENSATION OF THE PRESIDENT & CEO IS DETERMINED BY THE ORGANIZATION'S SOLE MEMBER, LUTHERAN HOMES OF OSHKOSH, INC. THE FOLLOWING METHODS WERE USED BY LUTHERAN HOMES OF OSHKOSH, INC. TO ESTABLISH THE PRESIDENT & CEO'S COMPENSATION: 1. COMPENSATION SURVEY OR STUDY 2. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD OF DIRECTORS PLUS TWO OTHER MEMBERS OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL BE RESPONSIBLE FOR THE AGENDA FOR THE BOARD AND VOTING MEMBERSHIP MEETINGS. THIS COMMITTEE SHALL KEEP ITSELF INFORMED OF THE ENTIRE OPERATION OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS, AND SHALL EXECUTE SUCH ACTIONS AS MAY BE ASSIGNED TO IT BY THE BOARD. THE COMMITTEE SHALL ALSO CONCERN ITSELF WITH MATTERS NOT ASSIGNED TO OTHER COMMITTEES. FORM 990, PART VI, SECTION A, LINE 3 ALL OF CARMEL RESIDENCE, INC.'S MANAGEMENT, INCLUDING EXECUTIVE MANAGEMENT, IS PROVIDED BY LUTHERAN HOMES OF OSHKOSH, INC., THE SOLE MEMBER AND CONTROLLING ORGANIZATION OF CARMEL RESIDENCE, INC. FORM 990, PART VI, SECTION A, LINE 6 LUTHERAN HOMES OF OSHKOSH, INC., IS THE SOLE MEMBER OF CARMEL RESIDENCE, INC. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS OF CARMEL RESIDENCE, INC. ARE ELECTED BY THE BOARD OF DIRECTORS OF THE SOLE MEMBER, LUTHERAN HOMES OF OSHKOSH, INC. FORM 990, PART VI, SECTION A, LINE 7B MAJOR STANDARD OPERATING PROCEDURES, MAJOR POLICIES, AND PROGRAMS OF CARMEL RESIDENCE, INC. ARE SUBMITTED TO THE BOARD OF DIRECTORS OF THE SOLE MEMBER, LUTHERAN HOMES OF OSHKOSH, INC. FOR APPROVAL AND IMPLEMENTATION. AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS REQUIRE THAT APPROVAL OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER, LUTHERAN HOMES OF OSHKOSH, INC. FORM 990, PART VI, SECTION B, LINE 11 BEFORE IT WAS FILED, THE FORM 990 WAS REVIEWED BY THE CEO, THEN DISTRIBUTED TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CORPORATE SECRETARY DISTRIBUTES A CONFLICT OF INTEREST FORM TO EACH MEMBER OF THE BOARD OF DIRECTORS AND VARIOUS COMMITTEE MEMBERS NOT ON THE BOARD THAT REQUIRES EACH TO IDENTIFY POTENTIAL CONFLICTS OR OTHER RELATED PARTY INTERESTS. THE REPORTS ARE REVIEWED BY THE SECRETARY AND CEO AND ANY CONFLICTS ARE BROUGHT TO THE BOARD'S ATTENTION. A MEMBER OF THE BOARD WHO HAS A CONFLICT OF INTEREST MAY NOT VOTE ON ANY SUCH ISSUE BEFORE THE BOARD. ANY QUESTION OF WHETHER THERE IS A CONFLICT IS RESOLVED BY THE BOARD OF DIRECTORS. IF THE BOARD OF DIRECTORS DETERMINES THAT A DIRECTOR HAS COMMITTED A SUBSTANTIAL VIOLATION OF THE CONFLICT OF INTEREST POLICY, THE INDIVIDUAL IS REMOVED FROM THE OFFICE OF DIRECTOR. IN ADDITION, ALL MANAGEMENT AND SUPERVISORY EMPLOYEES ARE INFORMED OF THE ORGANIZATION'S POLICY REGARDING RELATED PARTY TRANSACTIONS AND CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 CEO COMPENSATION IS DETERMINED BY A COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE CONSIDERS COMPARABLE DATA AND ECONOMIC CONDITIONS. THE DELIBERATIONS ARE RECORDED. OTHER OFFICER AND SENIOR MANAGEMENT SALARIES ARE DETERMINED BY THE CEO, WITHOUT CONFLICT, IN CONJUNCTION WITH HUMAN RESOURCES MANAGER AND ARE BASED ON COMPARABLE DATA, PERFORMANCE MEASURES, AND OTHER ECONOMIC CONDITIONS. THIS PROCESS LAST OCCURRED IN 2014 FOR THE CEO AND FOR ALL OTHER OFFICERS AND SENIOR MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE UPON REQUEST AND IS ALSO AVAILABLE AT WWW.GUIDESTAR.ORG. THE ORGANIZATION'S FORM 1023 IS ALSO AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S PROCESSES HAVE NOT CHANGED FROM THE PRIOR YEAR. LUTHERAN HOMES OF OSHKOSH INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391032234 MANAGEMENT SERVICES WI 501(C)(3) LINE 9 N/A 0 BETHEL HOME INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391209707 SKILLED NURSING FACILITY WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 GABRIEL'S VILLA INC 215 NORTH WESTFIELD STREET OSHKOSH WI 54902 391857036 SENIOR HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 SIMEANNA APARTMENTS INC 155 NORTH EAGLE STREET OSHKOSH WI 54902 237148097 SENIOR HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 SIMEANNA SOUTH INC 145 NORTH EAGLE STREET OSHKOSH WI 54902 391238670 SENIOR HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 SIMEANNA III INC 151 NORTH EAGLE STREET OSHKOSH WI 54902 391270056 SENIOR HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 BETHEL FOUNDATION OF OSHKOSH INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 010938793 FUNDRAISING WI 501(C)(3) LINE 11A, I LUTHERAN HOMES OF OSHKOSH INC 0 EDEN REHABILIATION SUITES AND GREENHOUSE HOMES INC 3151 EDEN COURT OSHKOSH WI 54902 900506872 SKILLED NURSING FACILITY WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 0 0 1 1 1 0 0 0 0 1 1 0 1 1 1 1 1 0 0