2014-01-31T10:51:34-06:00 2013-03-31 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 462400857 990 2012-04-01 352187477 INDIANA MASONIC HOME INC INDI 3177366141 690 STATE STREET FRANKLIN IN 46131 DAWN WENDEL 3173461404 2014-01-27 1 SCOTT A SCHUSTER P00019243 3175802000 2014-01-27 2012 2015-11-30 17:44:51Z DAWN WENDEL 690 STATE STREET FRANKLIN IN 46131 26753834 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. 18 17 348 70 0 0 8634423 4962539 15260272 15299964 1405398 590835 26524 33170 25326617 20886508 0 0 0 0 11699910 10724016 0 0 0 9653031 8607281 21352941 19331297 3973676 1555211 112931439 121647620 13354840 12827232 99576599 108820388 TO SERVE THE CHARITABLE PURPOSE OF OPERATING THE CONTINUING CARE RETIREMENT COMMUNITY KNOWN AS THE INDIANA MASONIC HOME IN FRANKLIN, INDIANA. 0 0 16173728 15257987 PROVIDE CARE FOR THE AGED 330076 41977 HOME HEALTHCARE 16503804 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 46 0 1 348 1 0 0 0 0 0 0 0 0 0 0 X 18 17 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 IN X LYNN AUFFART 3177366141 690 STATE STREET FRANKLIN IN 46131 GREGORY C WALBRIDGE 0.50 X 0 0 0 GEORGE A INGLES JR 0.50 X X 0 0 0 MARK A GENUNG 0.50 X 0 0 0 RICHARD J ELMAN 0.50 X X 0 82129 0 KENNETH E WILLIS JR 0.50 X 0 0 0 CHARLES F MARLOWE 0.50 X 0 0 0 MICHAEL D BRUMBACK 0.50 X 0 0 0 ROBERT R STEVENS 0.50 X X 0 0 0 ERIC RUCKERSFELDT 0.50 X 0 0 0 JAMES THOMAS 0.50 X 0 0 0 LORETTA RIEHL 0.50 X 0 0 0 RODNEY A MANN 0.50 X 0 0 0 E DREW CARREL 0.50 X 0 0 0 LINVILLE D CONER 0.50 X 0 0 0 STEVEN GATEWOOD 0.50 X 0 0 0 GEORGE GALYEAN 0.50 X 0 0 0 PHIL THRASHER 0.50 X 0 0 0 LARRY BROWN 0.50 X 0 0 0 BRIAN LANE 40.00 X 156166 0 25550 GREG LIMEBERRY 40.00 X 104463 0 0 260629 82129 25550 2 0 1 0 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 303682289 FOOD SERVICE 2763077 THERACARE INC 9957 ALLISONVILLE RD FISHERS IN 46038 THERAPY 786344 LIFE CARE SERVICES CAPITAL SQUARE 400 LOCUST DES MOINES IA 503092334 MANAGEMENT SERVICES 740234 MCGOWAN INSURANCE GROUP 355 INDIANA SQUARE SUITE 200 INDIANAPOLIS IN 462041705 LIABILITY INSURANCE 571430 DUKE ENERGY 1000 E MAIN ST PLAINFIELD IN 46168 UTILITIES 558503 15 922220 22942 3511780 505597 4962539 RESIDENCE SERVICES 623000 15257987 15257987 HOME HEALTH CARE 621610 41977 41977 15299964 351191 351191 12476 0 12476 12476 12476 6099193 5859549 239644 239644 239644 6722 22942 7777 -1055 -1055 OTHER INCOME 623990 21749 21749 21749 20886508 15299964 0 624005 269613 269613 7538606 6988664 549942 577157 434983 142174 1689878 1576139 113739 648762 561756 87006 508973 508973 87883 87883 78709 78709 95586 95586 200022 146657 53365 110806 110806 123306 45733 77573 16695 6829 9866 402409 85259 317150 OUTSIDE SERVICES 3625269 3587950 37319 UTILITIES 1073302 999196 74106 REPAIRS AND MAINTENANCE 804069 768274 35795 MEDICAL FEES, DRUGS, SU 642198 610663 31535 838054 691701 146353 19331297 16503804 2827493 0 1056308 2075466 894320 1246667 1551637 930902 31274 31274 145870 138067 7106963 7500650 4194281 4425226 97950786 105299368 112931439 121647620 1907150 1464427 5689360 5666168 5758330 5696637 13354840 12827232 X 1614003 3509203 97962596 103385002 1926183 99576599 108820388 112931439 121647620 X 1555211 411876 1812838 5463864 X X 0 1 X 1 0 X 6101925 5716039 7247941 8634423 4962539 32662867 14485362 15695657 16623131 15260272 15299964 77364386 20587287 21411696 23871072 23894695 20262503 110027253 4312960 3737428 5648388 6518562 3511780 23729118 5400 5400 4312960 3737428 5648388 6518562 3517180 23734518 86292735 543822 396968 377966 383384 363667 2065807 543822 396968 377966 383384 363667 2065807 13142 20007 -980 -980 -1055 30134 22872 4253 21749 48874 21144251 21828671 24270930 24281352 20646864 112172068 0.76930 0.76570 0.01840 0.01700 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2010 AMOUNT: $ 22,872. 2011 AMOUNT: $ 4,253. 2012 AMOUNT: $ 21,749. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 INTEREST IN NET ASSETS OF FOUNDATION 103342716 BENEFICIAL INTEREST IN TRUSTS 1956652 105299368 REFUNDABLE ADVANCE FEES 1014619 ACCRUED PENSION LIABILITY 4584605 RESIDENTIAL DEPOSITS 97413 5696637 X 21136079 411876 7777 419653 20716426 95586 74496 170082 20886508 19168999 7777 7777 19161222 95586 74489 170075 19331297 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOME IS EXEMPT FROM THE PAYMENT OF INCOME TAXES UNDER SECTION 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, 2013 AND 2012. THE HOME FILES U.S. FEDERAL AND STATE OF INDIANA INFORMATION RETURNS. IT IS NO LONGER SUBJECT TO U.S. FEDERAL AND STATE TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM SPECIAL EVENT 7,777. PART XI, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN TEMPORARILY RESTRICTED NET ASSETS-CONTRIBUTIONS 7. CONTRA ACCOUNT CLASSIFIED AS REVENUE ON BOOKS NOT TAX 74,489. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM SPECIAL EVENT 7,777. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRA ACCOUNT CLASSIFIED AS REVENUE ON BOOKS NOT TAX 74,489. GOLF OUTING 29664 22942 6722 7777 29664 22942 6722 7777 7777 -1055 X X X X 1 0 0 0 0 0 0 0 0 BRIAN LANE 130800 0 25366 0 0 0 0 0 25550 0 181716 0 0 0 PART I, LINE 4A GREG LIMEBERRY RECEIVED $12,118 IN SEVERANCE PAYMENTS IN FYE 2013. FORM 990, PART VI, SECTION A, LINE 3 EXECUTIVE DIRECTOR BRIAN LANE IS AN EMPLOYEE OF LIFE CARE SERVICES, AN OUTSITE MANAGEMENT COMPANY WHICH MANAGES, OPERATES AND MAINTAINS THE INDIANA MASONIC HOME 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 THE EXECUTIVE DIRECTOR IS AN EMPLOYEE OF THE OUTSIDE MANAGEMENT COMPANY. HIS SALARY IS DETERMINED BY THE MANAGEMENT COMPANY. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST. ANNUAL STATE DISCLOSURE STATEMENT THAT IS AVAILABLE TO ALL POTENTIAL NEW RESIDENTS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS -3,511,780. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION 8,903,710. MINIMUM PENSION LIABILITY ADJUSTMENT 400,087. TRANSFER OF ASSETS TO INDIANA MASONIC HOME, INC. -471,967. CHANGE IN BENEFICIAL INTEREST IN TRUST 143,814. 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) 509(A)(3) 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)(10) 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 IMH REALTY I 471967 FAIR MARKET VALUE INDIANA MASONIC HOME FOUNDATION C 3511780 CASH