2013-02-11T12:43:01-06:00 2012-03-31 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 462400857 990 2011-04-01 352187477 INDIANA MASONIC HOME INC INDI 3177366141 690 STATE STREET FRANKLIN IN 46131 BRIAN LANE 3173461404 2013-02-11 1 SCOTT A SCHUSTER P00019243 3175802000 2013-02-01 2011 2016-02-25 16:41:14Z BRIAN LANE 690 STATE STREET FRANKLIN IN 46131 37591525 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. 19 18 402 120 0 0 7247941 8634423 16623131 15260272 813427 1405398 54783 26524 24739282 25326617 0 0 0 0 10852945 11699910 0 0 0 10165940 9653031 21018885 21352941 3720397 3973676 121224171 112931439 13420587 13354840 107803584 99576599 TO SERVE THE CHARITABLE PURPOSE OF OPERATING THE CONTINUING CARE RETIREMENT COMMUNITY KNOWN AS THE INDIANA MASONIC HOME IN FRANKLIN, INDIANA. 0 0 17106006 14947054 PROVIDE CARE FOR THE AGED 712748 313218 HOME HEALTHCARE 17818754 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 0 1 59 0 1 402 1 0 0 0 0 0 0 0 0 0 0 X 19 18 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 1.00 X X 0 0 0 GEORGE A INGLES JR 1.00 X 0 0 0 MARK A GENUNG 1.00 X 0 0 0 RICHARD J ELMAN 1.00 X X 0 79763 0 KENNETH E WILLIS JR 1.00 X 0 0 0 CHARLES F MARLOWE 1.00 X 0 0 0 JEFFREY P ZARING 1.00 X 0 0 0 MICHAEL D BRUMBACK 1.00 X 0 0 0 ROBERT R STEVENS 1.00 X 0 0 0 JAMES L CHESNEY 1.00 X 0 0 0 GEORGE E GALYEAN 1.00 X 0 0 0 LORETTA RIEHL 1.00 X 0 0 0 RODNEY A MANN 1.00 X 0 0 0 E DREW CARREL 1.00 X 0 0 0 LINVILLE D CONER 1.00 X 0 0 0 PHILIP C THRASHER 1.00 X 0 0 0 STEVE BURNSTEIN 1.00 X 0 0 0 DANIEL L HALL 1.00 X 0 0 0 CLIFFORD G HENDERSON 1.00 X 0 0 0 BRIAN LANE 40.00 X 153596 0 21883 GREG LIMEBERRY 40.00 X 102622 0 0 256218 79763 21883 2 0 1 0 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30348 FOOD SERVICE 2914929 MEYER NAJEM CONSTRUCTION 13099 PARKSIDE DRIVE FISHERS IN 46038 CONSTRUCTION 2452748 ANTHEM BCBS IN GROUP PO BOX 105674 ATLANTA GA 30348 INSURANCE 2064248 THERACARE INC 9957 ALLISONVILLE RD FISHERS IN 46038 THERAPY 700921 LIFE CARE SERVICES CAPITAL SQUARE 400 LOCUST DES MOINES IA 50309 MANAGEMENT SERVICES 583218 17 941034 18050 7675339 8634423 RESIDENCE SERVICES 623000 14947054 14947054 HOME HEALTH CARE 621610 313218 313218 15260272 360133 360133 23251 0 23251 23251 23251 13300393 12255128 1045265 1045265 1045265 8800 18050 9780 -980 -980 OTHER INCOME 623990 4253 4253 4253 25326617 15260272 0 1431922 268318 268318 8515506 7779400 736106 394177 55399 338778 1903047 1666427 236620 618862 559483 59379 379938 379938 154731 154731 66102 66102 135068 135068 143742 114287 29455 140486 140486 262822 112752 150070 21524 8306 13218 388407 69117 319290 OUTSIDE SERVICES 3720733 3704888 15845 REPAIRS AND MAINTENANCE 1337229 1271857 65372 UTILITIES 1151988 1062497 89491 MEDICAL FEES, DRUGS, SU 703228 697234 5994 1047033 717107 329926 21352941 17818754 3534187 0 1993442 1056308 1632267 894320 912097 0 1542032 1551637 31274 31274 309020 145870 10657126 7106963 2172220 4194281 101974693 97950786 121224171 112931439 2857330 1907150 6284705 5689360 4278552 5758330 13420587 13354840 X 5828410 1614003 101975174 97962596 107803584 99576599 121224171 112931439 X 3973676 -12200661 X X 0 1 1 X 0 X 6483552 6101925 5716039 7247941 8634423 34183880 14439731 14485362 15695657 16623131 15260272 76504153 20923283 20587287 21411696 23871072 23894695 110688033 4185929 4312960 3737428 5648388 6518561 24403266 0 4185929 4312960 3737428 5648388 6518561 24403266 86284767 210254 543822 396968 377966 383384 1912394 210254 543822 396968 377966 383384 1912394 35190 13142 20007 -980 -980 66379 22872 4253 27125 21168727 21144251 21828671 24270930 24281352 112693931 0.76570 0.78850 0.01700 0.01690 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 INTEREST IN NET ASSETS OF FOUNDATION 97950786 97950786 REFUNDABLE ADVANCE FEES 1009500 RESIDENT DEPOSIT 83343 ACCRUED PENSION LIABILITY 4665487 5758330 25326617 21352941 3973676 -1363415 -10837246 -12200661 -8226985 23826585 -1363415 94346 -1269069 25095654 135068 95895 230963 25326617 21227653 9780 9780 21217873 135068 135068 21352941 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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, 2012 AND 2011. 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 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS -6,518,562. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION 2,494,655. MINIMUM PENSION LIABILITY ADJUSTMENT -4,130,921. TRANSFER OF ASSETS TO INDIANA MASONIC HOME, INC. -2,682,418. TOTAL TO SCHEDULE D, PART XI, LINE 8: -10,837,246. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 84,566. EXPENSES FROM SPECIAL EVENT 9,780. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN TEMPORARILY RESTRICTED NET ASSETS-CONTRIBUTIONS 95,895. PART XIII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM SPECIAL EVENT 9,780. GOLF OUTING 26850 18050 8800 9780 26850 18050 8800 9780 9780 -980 X X X 0 0 0 0 0 0 0 0 0 BRIAN LANE 153596 0 0 0 0 0 0 0 21883 0 175479 0 0 0 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 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,363,415. NET ASSETS RELEASED FROM RESTRICTIONS -6,518,562. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION 2,494,655. MINIMUM PENSION LIABILITY ADJUSTMENT -4,130,921. TRANSFER OF ASSETS TO INDIANA MASONIC HOME, INC. -2,682,418. TOTAL TO FORM 990, PART XI, LINE 5: -12,200,661. 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 1 0 0 0 0 0 0 0 0 0 0 IMH REALTY H 2682418 FAIR MARKET VALUE INDIANA MASONIC HOME FOUNDATION C 6518561 CASH