2012-03-14T21:53:56-05:00 2011-03-31 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 462400857 990 2010-04-01 352187477 INDIANA MASONIC HOME INC INDI 3177366141 690 STATE STREET FRANKLIN IN 46131 BRIAN LANE 3173461404 2012-03-08 1 SCOTT A SCHUSTER 3175802000 2012-03-08 2010 2016-02-24 21:20:13Z BRIAN LANE 690 STATE STREET FRANKLIN IN 46131 39195861 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 17 340 120 0 0 5716039 7247941 15695657 16623131 -187561 813427 14716 54783 21238851 24739282 0 0 0 0 10749877 10852945 0 0 0 9605331 10165940 20355208 21018885 883643 3720397 114433046 121224171 14208695 13420587 100224351 107803584 PROVIDE CARE FOR THE ELDERLY. 0 0 16960428 16129045 PROVIDE CARE FOR THE AGED 706684 494086 HOME HEALTHCARE 17667112 1 1 0 0 0 0 0 0 0 0 0 0 1 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 0 1 56 0 1 340 1 0 0 0 0 0 0 0 0 0 0 X 19 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 KEN WILLIS 1.00 X X 0 0 0 GREGORY WALBRIDGE 1.00 X 0 0 0 CLIFFORD HENDERSON 1.00 X 0 0 0 GEORGE E GALYEAN 1.00 X 0 0 0 MARK A GENUNG 1.00 X 0 0 0 LORETTA RIEHL 1.00 X 0 0 0 E DREW CARRELL 1.00 X 0 0 0 MICHAEL D BRUMBACK 1.00 X 0 0 0 LINVILLE D CONER 1.00 X 0 0 0 PHILIP C THRASHER 1.00 X 0 0 0 JEFFREY P ZARING 1.00 X 0 0 0 ROBERT R STEVENS 1.00 X 0 0 0 JAMES CHESNEY 1.00 X 0 0 0 RODNEY A MANN 1.00 X 0 0 0 GEORGE INGLES 1.00 X 0 0 0 DANIEL HALL 1.00 X 0 0 0 STEVE BURNSTEIN 1.00 X 0 0 0 RICHARD ELMAN 1.00 X X 0 77273 0 CHARLES F MARLOWE 1.00 X 0 0 0 BRIAN LANE 40.00 X 138874 0 6843 GREG LIMEBERRY 40.00 X 102960 0 1764 MICHAEL MALANDRAKIS 40.00 X 96202 0 9338 JOHN ROSE 40.00 X 110250 0 4850 448286 77273 22795 3 0 0 0 MEYER NAJEM CONSTRUCTION 13099 PARKSIDE DRIVE FISHERS IN 46038 CONSTRUCTION 4674789 MORRISON MANAGEMENT SPECIALISTS PO BOX 102289 ATLANTA GA 30348 FOOD SERVICE 2837877 ANTHEM BCBS IN GROUP PO BOX 105674 ATLANTA GA 30348 INSURANCE 1622880 THERACARE INC 9957 ALLISONVILLE RD FISHERS IN 46038 THERAPY 740104 MCGOWAN INSURANCE GROUP 10 W MARKET ST SUITE 1850 INDIANAPOLIS IN 46204 INSURANCE 522405 11 934443 18042 6295456 7247941 RESIDENCE SERVICES 623000 16129045 16129045 HOME HEALTH CARE 621610 494086 494086 16623131 345075 345075 32891 32891 32891 32891 14915178 14446826 468352 468352 468352 8773 18042 9753 -980 -980 OTHER INCOME 623990 22872 22872 22872 24739282 16623131 0 868210 241003 241003 7843718 7252709 591009 530290 73476 456814 1633553 1465441 168112 604381 542183 62198 254005 254005 9685 9685 109557 109557 154623 154623 164639 23723 140916 147931 147931 394879 83960 310919 61870 26017 35853 387154 387154 OUTSIDE SERVICES 4984014 4879211 104803 RESIDENT SUPPLIES AND A 1076529 1051659 24870 REPAIRS AND MAINTENANCE 964425 925237 39188 UTILITIES 960544 917179 43365 MEDICAL FEES, DRUGS, SU 330571 311224 19347 165514 115093 50421 21018885 17667112 3351773 0 2208462 1993442 2082625 1632267 132500 912097 1794345 1542032 31274 31274 118763 309020 9154825 10657126 6227361 2172220 92682891 101974693 114433046 121224171 2163542 2857330 6908435 6284705 5136718 4278552 14208695 13420587 X 7308253 5828410 92916098 101975174 100224351 107803584 114433046 121224171 X 3720397 3858836 X X 0 1 1 X 0 X 5129855 6483552 6101925 5716039 7247941 30679312 14007800 14439731 14485362 15695657 16623131 75251681 19137655 20923283 20587287 21411696 23871072 105930993 2998363 4185929 4312960 3737428 5648388 20883068 0 2998363 4185929 4312960 3737428 5648388 20883068 85047925 295107 210254 543822 396968 377966 1824117 295107 210254 543822 396968 377966 1824117 12696 35190 13142 20007 -980 80055 22872 22872 19445458 21168727 21144251 21828671 24270930 107858037 0.78850 0.93700 0.01690 0.01840 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 101974693 101974693 REFUNDABLE ADVANCE FEES 353250 RESIDENT DEPOSIT 90300 ACCRUED PENSION LIABILITY 3835002 4278552 24739282 21018885 3720397 820786 3038050 3858836 7579233 25729637 820786 578712 1399498 24330139 154623 254520 409143 24739282 20874015 9753 9753 20864262 154623 154623 21018885 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, 2011 AND 2010. 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 2008. PART XI, LINE 8 - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS -5,648,388. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION 15,021,903. MINIMUM PENSION LIABILITY ADJUSTMENT 89,225. TRANSFER OF ASSETS TO INDIANA MASONIC HOME, INC. -6,424,690. PART XII, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 568,959. EXPENSES FROM SPECIAL EVENT 9,753. PART XII, LINE 4B - OTHER ADJUSTMENTS: CHANGE IN TEMPORARILY RESTRICTED NET ASSETS-CONTRIBUTIONS 254,520. PART XIII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM SPECIAL EVENT 9,753. GOLF OUTING 26815 18042 8773 9753 26815 18042 8773 9753 9753 -980 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 GAINS ON INVESTMENTS: 820,786. NET ASSETS RELEASED FROM RESTRICTIONS -5,648,388. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION 15,021,903. MINIMUM PENSION LIABILITY ADJUSTMENT 89,225. TRANSFER OF ASSETS TO INDIANA MASONIC HOME, INC. -6,424,690. TOTAL TO FORM 990, PART XI, LINE 5: 3,858,836. 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 0 1 0 0 0 0 0 0 0 0 IMH REALTY J 6424690 FAIR MARKET VALUE INDIANA MASONIC HOME FOUNDATION C 5648388 CASH THIS RETURN IS BEING FILED BETWEEN MARCH 1, 2012 AND MARCH 30, 2012 AS DIRECTED BY THE IRS IN NOTICE 2012-4 BECAUSE ELECTRONIC FILING WAS NOT AVAILABLE JANUARY 1, 2012 THROUGH FEBRUARY 29, 2012. WE REQUEST THAT PENALTIES BE WAIVED BECAUSE IT WOULD BE INEQUITABLE TO IMPOSE A PENALTY ON US DUE TO THE UNUSUAL CIRCUMSTANCES REQUIRING US TO DELAY THE FILING OF THIS RETURN.