CARMEL RESIDENCE INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
CARMEL RESIDENCE INC (EIN 39-1448325)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-10-22
IRS object ID
201212969349300706
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-10-22T09:20:23-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1220 SOUTH SIXTH STREET SUITE 300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN391448325EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CARMEL RESIDENCE INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCARMNameControl
Phone9202325220Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1225 NORTH EAGLE STREETAddressLine1
CityOSHKOSHCity
StateWIState
ZIP Code54902ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKRIS KRENTZName
TitleINTERIM CEOTitle
Phone9202325220Phone
Date Signed2012-10-04DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameCORY RUTLEDGEName
PTINP01329381PTIN
Phone6123764500Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKRIS KRENTZNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1225 NORTH EAGLE STREETAddressLine1
CityOSHKOSHCity
StateWIState
ZIP Code54902ZIPCode
FieldValueIRS element (for citing)
Gross Receipts656967GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number9386GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.LUTHERANHOMES.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1988YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HOUSING FOR THE ELDERLY.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers17TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year4462ContributionsGrantsPriorYear
Contributions Grants Current Year1817ContributionsGrantsCurrentYear
Program Service Revenue Prior Year570334ProgramServiceRevenuePriorYear
Program Service Revenue CY586153ProgramServiceRevenueCY
Investment Income Prior Year33035InvestmentIncomePriorYear
Investment Income Current Year21574InvestmentIncomeCurrentYear
Other Revenue Prior Year44910OtherRevenuePriorYear
Other Revenue Current Year47423OtherRevenueCurrentYear
Total Revenue Prior Year652741TotalRevenuePriorYear
Total Revenue Current Year656967TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year177046SalariesEtcPriorYear
Salaries Etc Current Year201032SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year405658OtherExpensePriorYear
Other Expenses Current Year432651OtherExpensesCurrentYear
Total Expenses Prior Year582704TotalExpensesPriorYear
Total Expenses Current Year633683TotalExpensesCurrentYear
Revenues Less Expenses Prior Year70037RevenuesLessExpensesPriorYear
Revenues Less Expenses CY23284RevenuesLessExpensesCY
Total Assets BOY4440376TotalAssetsBOY
Total Assets EOY4306648TotalAssetsEOY
Total Liabilities BOY3429032TotalLiabilitiesBOY
Total Liabilities EOY3272020TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1011344NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1034628NetAssetsOrFundBalancesEOY
Mission DescriptionCARMEL 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense275480Expense
Grants0Grants
Revenue586153Revenue
DescriptionCARMEL RESIDENCE, INC., PROVIDES INDEPENDENT LIVING FACILITIES FOR THE ELDERLY. THE ENTITY HAS 80 INDEPENDENT LIVING UNITS.Description
Total Program Service Expense275480TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members15NbrVotingGoverningBodyMembers
Number Independent Voting Members15NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonKIM MAKINamePerson
Telephone Number9202325238TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1225 NORTH EAGLE STREETAddressLine1
CityOSHKOSHCity
StateWIState
ZIP Code54902ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
LOIS JAENKE
CHAIR1.50XX000
JIM STAPEL
VICE CHAIR1.50XX000
REVEREND KEMP JONES
SECRETARY1.50XX000
DR RICHARD AMES
BOARD MEMBER1.50X000
MARK BEECHER
BOARD MEMBER1.50X000
KATHLEEN BELLAIRE
BOARD MEMBER1.50X000
THOMAS DUNHAM
BOARD MEMBER1.50X000
DR JAN EDELSTEIN
BOARD MEMBER1.50X000
DR ROGER HEROLD
BOARD MEMBER1.50X000
REVEREND RICK HOPKINS
BOARD MEMBER1.50X000
REVEREND KAREN JEWELL
BOARD MEMBER1.50X000
GEORGE KONTOS
BOARD MEMBER1.50X000
JANE KUHN
BOARD MEMBER1.50X000
STEVE LAUTENSCHLAGER
BOARD MEMBER1.50X000
DR SUZANNE MARNOCHA
BOARD MEMBER1.50X000
DAVE KOCH
CHAIR (FORMER)1.50XX000
BRUCE BAIN
VICE CHAIR (FORMER)1.50XX000
REVEREND JOY MORTENSEN-WIEBE
SECRETARY (FORMER)1.50XX000
RICHARD CAMPBELL
BOARD MEMBER (FORMER)1.50X000
DENNIS WENDT
BOARD MEMBER (FORMER)1.50X000
BARBARA SKAAR
BOARD MEMBER (FORMER)1.50X000
CRAIG UBBELOHDE
PRESIDENT & CEO40.00X024255832171
RICHARD KERN
CORP. TREASURER & CFO40.00X0985209540
JULIE VANDENBERG
CORPORATE SECRETARY40.00X0671046574
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs408182TotalReportableCompFrmRltdOrgs
Total Other Compensation48285TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations922RelatedOrganizations
All Other Contributions895AllOtherContributions
Total Contributions1817TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
APARTMENT OPERATIONS623990535071535071
ENTRACE FEE REVENUES6239905108251082
FieldValueIRS element (for citing)
Total Program Service Revenue586153TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column21574TotalRevenueColumn
Exclusion$21,574ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real37247Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real37247Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column37247TotalRevenueColumn
Exclusion$37,247ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
LAUNDRY REVENUE9000998757$8,757
BEAUTY SHOP9000991205$1,205
MISCELLANEOUS REVENUE900099214$214
FieldValueIRS element (for citing)
Total Other Revenue10176TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column656967TotalRevenueColumn
Related Or Exempt Function Income586153RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$68,997ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total201032Total
Program Services94292ProgramServices
Management And General106740ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total26256Total
Management And General26256ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total4257Total
Management And General4257ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total27961Total
Program Services26461ProgramServices
Management And General1500ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total11284Total
Management And General11284ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total8977Total
Program Services231ProgramServices
Management And General8746ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2404Total
Management And General2404ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total132324Total
Program Services132324ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total468Total
Program Services137ProgramServices
Management And General331ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total193208Total
Management And General193208ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total18819Total
Program Services18819ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
RESIDENT EXPENSES34773477
MISCELLANEOUS EXPENSES24622462
FOOD729729
MEDICAL SUPPLIES2525

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total633683Total
Program Services275480ProgramServices
Management And General358203ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY73994BOY
EOY87357EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1757807BOY
EOY1525999EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY407BOY
EOY423EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY3826BOY
EOY53EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis6135911LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3446911LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2600208BOY
EOY2689000EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY3964BOY
EOY3964EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY170BOY
EOY-148EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4440376BOY
EOY4306648EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY11180BOY
EOY14575EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY608822BOY
EOY570016EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY2797672BOY
EOY2681049EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY11358BOY
EOY6380EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3429032BOY
EOY3272020EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1007380BOY
EOY1030664EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3964BOY
EOY3964EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1011344BOY
EOY1034628EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4440376BOY
EOY4306648EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses23284ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years115CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1978CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years2010CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4462CurrentTaxYearMinus1Year
Current Tax Year1817CurrentTaxYear
Total10382Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years507113CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years450228CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years377166CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year570334CurrentTaxYearMinus1Year
Current Tax Year586153CurrentTaxYear
Total2490994Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years507228CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years452206CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years379176CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year574796CurrentTaxYearMinus1Year
Current Tax Year587970CurrentTaxYear
Total2501376Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years7037CurrentTaxYearMinus3Years
Current Tax Year Minus1 Year41614CurrentTaxYearMinus1Year
Current Tax Year60579CurrentTaxYear
Total109230Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years7037CurrentTaxYearMinus3Years
Current Tax Year Minus1 Year41614CurrentTaxYearMinus1Year
Current Tax Year60579CurrentTaxYear
Total109230Total
FieldValueIRS element (for citing)
Public Support Total5092392146PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years142962CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years85168CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years92687CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year67700CurrentTaxYearMinus1Year
Current Tax Year58821CurrentTaxYear
Total447338Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years142962CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years85168CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years92687CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year67700CurrentTaxYearMinus1Year
Current Tax Year58821CurrentTaxYear
Total447338Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6842CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years9776CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9261CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10245CurrentTaxYearMinus1Year
Current Tax Year10176CurrentTaxYear
Total46300Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years657032CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years547150CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years481124CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year652741CurrentTaxYearMinus1Year
Current Tax Year656967CurrentTaxYear
Total2995014Total
FieldValueIRS element (for citing)
Public Support Percentage5090.79870PublicSupportPercentage509
Prior Year Support Percentage0.79550PriorYearSupportPercentage
Investment Income Percentage0.14940InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.16750PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: LAUNDRY REVENUE BEAUTY SHOP MISCELLANEOUS INCOMEGeneralExplanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis43875OtherCostOrOtherBasis
Book Value43875BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4951885OtherCostOrOtherBasis
Depreciation2720605Depreciation
Book Value2231280BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis137971OtherCostOrOtherBasis
Depreciation101518Depreciation
Book Value36453BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis997231OtherCostOrOtherBasis
Depreciation624788Depreciation
Book Value372443BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4949OtherCostOrOtherBasis
Book Value4949BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2689000TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO AFFILIATESDescription
Amount$6,380Amount
FieldValueIRS element (for citing)
Total Of Amounts6380TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
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. IN ADDITION RESIDENTS' CUSTODIAL ACCOUNTS CONSIST OF AMOUNTS ON DEPOSIT WITH CARMEL RESIDENCE BY RESIDENTS FOR SAFEKEEPING. THESE FUNDS CAN BE WITHDRAWN AT ANY TIME BY RESIDENTS.
PART X: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 2009 TO 2010 ARE OPEN TO EXAMINATION BY THOSE AUTHORITIES.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII

FieldValueIRS element (for citing)
Name PersonCRAIG UBBELOHDENamePerson
Base Compensation Filing Org0BaseCompensationFilingOrg
Comp Based On Related Orgs216397CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs20600BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs5561OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs7350DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs24821NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs274729TotalCompensationRelatedOrgs
Comp Report Prior990 Filing Org0CompReportPrior990FilingOrg
Comp Report Prior990 Related Orgs0CompReportPrior990RelatedOrgs

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
Return ReferencePART IIIReturnReference
ExplanationPART I, LINE 3: THE COMPENSATION OF THE PRESIDENT & CEO IS DETERMINED BY THE ORGANIZATION'S SOLE MEMBER, LUTHERAN HOMES OF OSHKOSH, INC.. THE FOLLOWING WERE USED BY LUTHERAN HOMES OF OSHKOSH, INC. TO ESTABLISH THE PRESIDENT & CEO'S COMPENSATION: 1. COMPENSATION COMMITTEE 2. COMPENSATION SURVEY OR STUDY 3. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEEExplanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 1THE 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 6LUTHERAN HOMES OF OSHKOSH, INC., IS THE SOLE MEMBER OF CARMEL RESIDENCE, INC.
FORM 990, PART VI, SECTION A, LINE 7ATHE 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 7BSTANDARD 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 11BEFORE IT WAS FILED, THE FORM 990 WAS REVIEWED BY THE CFO, THEN DISTRIBUTED TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR REVIEW.
FORM 990, PART VI, SECTION B, LINE 12CANNUALLY, 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 AND SUPERVISORY EMPLOYEES ARE INFORMED OF THE ORGANIZATION'S POLICY REGARDING RELATED PARTY TRANSACTIONS AND CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.
FORM 990, PART VII, SECTION AEACH OFFICER OF CARMEL RESIDENCE, INC., ALSO SERVES AS AN OFFICER OF ITS RELATED ORGANIZATIONS. SEE SCHEDULE R, PART II FOR A LIST OF THOSE RELATED ORGANIZATIONS. EACH OFFICER SERVES EACH ORGANIZATION DURING THE WEEK, FOR A TOTAL OF APPROXIMATELY 40 HOURS PER WEEK. EACH BOARD MEMBER OF CARMEL RESIDENCE, INC., ALSO SERVES ON THE BOARD OF DIRECTORS OF ITS RELATED ORGANIZATIONS. SEE SCHEDULE R, PART II FOR A LIST OF THOSE RELATED ORGANIZATIONS. EACH BOARD MEMBER SERVES EACH ORGANIZATION DURING THE WEEK, FOR A TOTAL OF APPROXIMATELY 1.5 HOURS PER WEEK.ALLOCATION OF TIME BETWEEN RELATED ORGANIZATIONS

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
LUTHERAN HOMES OF OSHKOSH INC
225 NORTH EAGLE STREETOSHKOSHWI54902391032234MANAGEMENT SERVICESWI501(C)(3)LINE 9N/A0
BETHEL HOME INC
225 NORTH EAGLE STREETOSHKOSHWI54902391209707SKILLED NURSING FACILITYWI501(C)(3)LINE 90LUTHERAN HOMES OF OSHKOSH INC
GABRIEL'S VILLA INC
225 NORTH EAGLE STREETOSHKOSHWI54902391857036ELDERLY HOUSINGWI501(C)(3)LINE 90LUTHERAN HOMES OF OSHKOSH INC
SIMEANNA APARTMENTS INC
225 NORTH EAGLE STREETOSHKOSHWI54902237148097ELDERLY HOUSINGWI501(C)(3)LINE 90LUTHERAN HOMES OF OSHKOSH INC
SIMEANNA SOUTH INC
225 NORTH EAGLE STREETOSHKOSHWI54902391238670ELDERLY HOUSINGWI501(C)(3)LINE 90LUTHERAN HOMES OF OSHKOSH INC
SIMEANNA III INC
225 NORTH EAGLE STREETOSHKOSHWI54902391270056ELDERLY HOUSINGWI501(C)(3)LINE 90LUTHERAN HOMES OF OSHKOSH INC
BETHEL FOUNDATION OF OSHKOSH INC
225 NORTH EAGLE STREETOSHKOSHWI54902010938793FUNDRAISINGWI501(C)(3)LINE 11A, I0LUTHERAN HOMES OF OSHKOSH INC
EDEN REHABILIATION SUITES AND GREENHOUSE HOMES INC
3151 EDEN COURTOSHKOSHWI54902900506872SKILLED NURSING FACILITYWI501(C)(3)LINE 90LUTHERAN HOMES OF OSHKOSH INC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

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