2013-10-30T14:52:26-05:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-01-01 391448325 CARMEL RESIDENCE INC CARM 9202354653 225 NORTH EAGLE STREET OSHKOSH WI 54902 THERESA M BERTRAM 9202325220 2013-10-23 1 CORY RUTLEDGE P01329381 6123764500 2012 2016-02-25 16:41:14Z THERESA M BERTRAM 225 NORTH EAGLE STREET OSHKOSH WI 54902 705303 0 9386 X WWW.LUTHERANHOMES.COM X 1988 WI TO PROVIDE HOUSING FOR AGING PERSONS. 15 15 0 15 0 0 1817 5994 586153 570274 21574 63892 47423 46736 656967 686896 0 0 0 0 201032 197038 0 0 0 432651 445923 633683 642961 23284 43935 4306648 4003083 3272020 2924520 1034628 1078563 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 268014 0 570274 CARMEL RESIDENCE, INC., PROVIDES INDEPENDENT LIVING FACILITIES FOR AGING PERSONS. THE ENTITY HAS 76 INDEPENDENT LIVING UNITS. 268014 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 7 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X KIM MAKI 9202325238 225 NORTH EAGLE STREET OSHKOSH WI 54902 LOIS JAENKE 0.20 1.40 X X 0 0 0 JIM STAPEL 0.20 1.40 X X 0 0 0 DR JAN EDELSTEIN 0.20 1.40 X X 0 0 0 KAREN FREDRICK 0.20 1.40 X 0 0 0 MARK BEECHER 0.20 1.40 X 0 0 0 KATHLEEN BELLAIRE 0.20 1.40 X 0 0 0 THOMAS DUNHAM 0.20 1.40 X 0 0 0 WAYNE MUELLER 0.20 1.40 X 0 0 0 DR ROGER HEROLD 0.20 1.40 X 0 0 0 REV RICK HOPKINS 0.20 1.40 X 0 0 0 REV KAREN JEWELL 0.20 1.40 X 0 0 0 GEORGE KONTOS 0.20 1.40 X 0 0 0 JANE KUHN 0.20 1.40 X 0 0 0 DR SUZANNE MARNOCHA 0.20 1.40 X 0 0 0 REV KEMP JONES 0.20 1.40 X X 0 0 0 DR RICHARD AMES 0.20 1.40 X 0 0 0 STEVE LAUTENSCHLAGER 0.20 1.40 X 0 0 0 JULIE VANDENBERG 4.50 36.00 X 0 67679 9147 CRAIG UBBELOHDE 4.50 36.00 X 0 80601 7554 RICHARD KERN 4.50 36.00 X 0 53168 4307 0 201448 21008 0 0 0 0 B KOTTKE CONSTRUCTION 581 4TH STREET FOND DU LAC WI 54935 CONSTRUCTION SERVICES 119447 1 5994 5994 APARTMENT OPERATIONS 623990 533603 533603 ENTRANCE FEE REVENUES 623990 36671 36671 570274 14548 14548 37965 0 37965 37965 37965 67751 18407 49344 49344 49344 LAUNDRY REVENUE 900099 8419 8419 MISCELLANEOUS REVENUE 900099 352 352 8771 686896 570274 0 110628 197002 86530 110472 36 36 17472 17472 4802 4802 27566 26016 1550 14046 14046 10459 10459 2778 2778 135797 135797 1092 233 859 209641 209641 18078 18078 RESIDENT EXPENSES 2832 2832 MISCELLANEOUS EXPENSES 1142 1142 FOOD 218 218 642961 268014 374947 0 87357 22666 1525999 1300346 423 414 53 2958 6272449 3601975 2689000 2670474 3964 3964 -148 2261 4306648 4003083 14575 12201 570016 507431 2681049 2401631 6380 3257 3272020 2924520 X 1030664 1074599 3964 3964 1034628 1078563 4306648 4003083 43935 0 X 0 1 X 1 0 X 1978 2010 4462 1817 5994 16261 450228 377166 570334 586153 570274 2554155 452206 379176 574796 587970 576268 2570416 0 7037 41614 60579 53858 163088 7037 41614 60579 53858 163088 2407328 85168 92687 67700 58821 52513 356889 85168 92687 67700 58821 52513 356889 9776 9261 10245 10176 8771 48229 547150 481124 652741 656967 637552 2975534 0.80900 0.79870 0.11990 0.14940 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: LAUNDRY REVENUE BEAUTY SHOP MISCELLANEOUS INCOME 0 1 X 43875 43875 5004557 2812177 2192380 139846 108300 31546 1075134 681498 393636 9037 9037 2670474 DUE TO AFFILIATES 3257 3257 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE ENTITY IS NOT A PRIVATE FOUNDATION, AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS CHARITABLE TAX DEDUCTIONS BY THE CONTRIBUTOR. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARDS FOR CONTINGENCIES IN EVALUATING UNCERTAIN TAX POSITIONS. 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 2008 TO 2011 ARE OPEN TO EXAMINATION BY THOSE AUTHORITIES. 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'S MANAGEMENT, INCLUDING EXECUTIVE MANAGEMENT, IS PROVIDED BY LUTHERAN HOMES OF OSHKOSH, THE SOLE MEMBER AND CONTROLLING ORGANIZATION OF CARMEL RESIDENCE. 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 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. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST IS REQUIRED TO DISCLOSE THE MATERIAL FACTS BEFORE THE BOARD DISCUSSES THE ISSUE. 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 EMPLOYEES ARE INFORMED OF THE ORGANIZATION'S POLICY REGARDING RELATED PARTY TRANSACTIONS AND CONFLICTS OF INTEREST. 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 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. 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 225 NORTH EAGLE STREET OSHKOSH WI 54902 391857036 SENIOR HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 SIMEANNA APARTMENTS INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 237148097 SENIOR HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 SIMEANNA SOUTH INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391238670 SENIOR HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 SIMEANNA III INC 225 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