2013-11-14T11:28:16-06:00 2012-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2012-01-01 470384319 FLORENCE HOME FOR THE AGED FLOR 4028276000 7915 NORTH 30TH STREET OMAHA NE 68112 DEBRA L THACKER 4028276000 2013-11-13 1 JULIE M GERKEN P00400882 4023302660 2012 2016-02-24 21:20:13Z DEBRA L THACKER 7915 NORTH 30TH STREET OMAHA NE 68112 10226481 0 X WWW.OMAHASENIORCARE.ORG X 1906 NE PROVIDE CARE FOR THE ELDERLY 12 10 257 15 0 0 338561 479359 10034375 9654918 17011 51888 40755 37864 10430702 10224029 21316 4386 0 0 4983196 4817995 0 0 0 5467665 5252632 10472177 10075013 -41475 149016 3523421 3862067 2006322 2407052 1517099 1455015 X TO PROVIDE A CONTINUUM OF QUALITY SERVICES AND PROGRAMS FOR SENIORS AND OTHER PERSONS NEEDING SPECIALIZED CARE. 0 0 6062887 4386 6607382 SKILLED NURSING CARE 813228 886492 ASSISTED LIVING CARE 1971944 2148860 ALZHEIMER'S ASSISTED LIVING CARE 10631 12184 OTHER SERVICES 10631 12184 8858690 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 20 0 1 257 1 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X DEBRA L THACKER CFO 4028276000 7915 NORTH 30TH STREET OMAHA NE 68112 ROBERT A BLOECHLE 1.00 3.00 X X 0 0 0 BETTY G FOSTER PHD 1.00 3.00 X X 0 0 0 LOIS JORDAN 2.00 40.00 X X 0 154083 8092 DEBRA L THACKER 2.00 40.00 X X 0 143403 21801 JULIE SCHULTZ SELF 1.00 0.00 X 0 0 0 PHIL CHRISTENSEN 1.00 2.00 X 0 0 0 LYN M HOLLEY 1.00 0.00 X 0 0 0 JOHN JEANETTA 1.00 0.00 X 0 0 0 NANCY A MCCARTHY 1.00 0.00 X 0 0 0 JULIE MONACO 1.00 0.00 X 0 0 0 MARC BUTTERFIELD 1.00 0.00 X 0 0 0 GLENN TREMBLEY 1.00 0.00 X 0 0 0 0 297486 29893 0 0 1 0 HEALTHCARE SERVICES GROUP SUITE 300 3220 TILLMAN DRIVE BENSALEM PA 19020 DIETARY 732245 HALLMARK REHABILITATION 27442 PORTOLA PARKWAY SUITE 200 FOOTHILL RANCH CA 92610 REHAB SERVICES 529359 UNLIMITED OPPORTUNITY INC DBA JANA-KING 14821 W 95TH STREET LENEXA KS 66215 HSKP/LAUNDRY 324352 3 449299 30060 479359 MEDICARE/MEDICAID PAYMENTS 623000 7840860 7840860 PRIVATE PAY/INSURANCE REVENUE 623000 1801874 1801874 MISCELLANEOUS INCOME 623000 9508 9508 VENDOR REBATES 623000 2676 2676 9654918 50640 50640 36517 0 36517 36517 36517 3700 2452 1248 1248 1248 CAFETERIA & VENDING REVENUE 623000 1347 1347 1347 10224029 9654918 0 89752 X 4386 4386 4095065 3866159 228906 378782 350013 28769 344148 325291 18857 777168 777168 16869 16869 28603 28603 2090047 2004779 85268 11247 4526 6721 568463 555340 13123 607977 607977 19012 19012 24105 24105 19536 19536 343792 343792 MEDICAL SUPPLIES 379932 379932 DIETARY-FOOD 193492 193492 BAD DEBT & CHARITY CARE 98400 98400 MISCELLANEOUS 50767 50767 23222 11183 12039 10075013 8858690 1216323 0 18204 17975 155212 224680 855057 1059086 21839 14804 40167 39771 7839250 6469783 1346360 1369467 1086582 1136284 3523421 3862067 605949 1059528 1385000 1320000 15373 27524 2006322 2407052 X -506899 -611513 1040000 1040000 983998 1026528 1517099 1455015 3523421 3862067 X 149016 42530 -253630 X X 0 1 X 1 0 X 5621 6198 2983 3643 30060 48505 10872522 10515986 10561250 10034375 9654918 51639051 5687 6289 1893 3345 1347 18561 10883830 10528473 10566126 10041363 9686325 51706117 0 0 0 51706117 97165 80902 79309 57708 87157 402241 97165 80902 79309 57708 87157 402241 10980995 10609375 10645435 10099071 9773482 52108358 0.99230 0.99230 0.00770 0.00770 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 154347 154347 5532683 4596879 935804 2023326 1795419 227907 128894 77485 51409 1369467 DEFERRED FINANCING COSTS, NET 72684 BENEFICIAL INTEREST IN PERPETUAL TRUST 1026528 THIRD PARTY PAYOR SETTLEMENTS RECEIVABLE 37072 1136284 ACCRUED INTEREST PAYABLE 3205 DUE TO AFFILIATES 24319 27524 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: MIDWEST GERIATRICS, INC., ROYALE OAKS HOUSE OF HOPE, GERIMED, INC., 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, 2012 AND 2011, 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, 2012, 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, 2009. 0 0 0 0 0 0 0 0 0 LOIS JORDAN 0 154083 0 0 0 0 0 0 0 8092 0 162175 0 0 DEBRA L THACKER 0 143403 0 0 0 0 0 0 0 21801 0 165204 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. 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 B, LINE 11 ONCE THE CONTROLLER HAS PREPARED THE FORM 990 AND RELATED SCHEDULES, THE CFO WILL REVIEW IT, MAKE ANY CHANGES AND ACCEPT THE DRAFT FORM 990. THE FINANCE COMMITTEE WILL THEN BE CONTACTED VIA E-MAIL THAT THE DRAFT FORM 990 IS READY FOR REVIEW AND ASK IF THEY WANT IT SENT OUT TO THEM OR IF THEY WILL BE COMING TO THE FACILITY TO REVIEW. ONCE 2/3 OF THE COMMITTEE 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. 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 AND THEREFORE, THE POLICY ON THE PROCESS FOR DETERMINING COMPENSATION OF MIDWEST GERIATRICS, INC. APPLIES TO THE COMPENSATION OF THE FOLLOWING PERSONS SERVING AS OFFICERS OF FLORENCE HOME. THE PROCESS IS UTILIZED BY THE EXECUTIVE COMMITTEE OF THE MIDWEST GERIATRICS, INC. BOARD ON AN ANNUAL BASIS. CHIEF EXECUTIVE OFFICER: LOIS JORDAN CHIEF FINANCIAL OFFICER: DEBRA THACKER THE PROCESS INCLUDES ALL OF THESE ELEMENTS: (1) REVIEW AND APPROVAL BY THE EXECUTIVE COMMITTEE OF MIDWEST GERIATRICS, INC.; (2) USE OF 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 DATA AS TO COMPARABLE COMPENSATION. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED USING DATA AS TO 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 UPON REQUEST A COPY OF THE REQUESTED DOCUMENT IS PROVIDED WITHIN 72 HOURS. OTHER FEES FORM 990, PART IX, LINE 11G HSKP/LNDRY/DIETARY: PROGRAM SERVICE EXPENSES 1,056,597. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,056,597. REHAB SERVICES: PROGRAM SERVICE EXPENSES 529,359. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 529,359. OTHER: PROGRAM SERVICE EXPENSES 418,823. MANAGEMENT AND GENERAL EXPENSES 85,268. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 504,091. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: IMPAIRMENT LOSS -253,630. 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 N/A 0 GERIMED 7915 N 30TH STREET OMAHA NE 68112 470727973 PHARMACEUTICAL SALES. NE 501(C)(3) 9 N/A 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 N/A 0 UNIMED 7915 N 30TH STREET OMAHA NE 68112 470759285 PHARMACEUTICAL SALES NE N/A C 0 0 1 1 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0