2012-08-13T09:35:39-05:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-01-01 390838135 ODD FELLOW REBEKAH HOME ASSOCIATION INC ODDF 9205937000 1207 SOUTH JACKSON STREET GREEN BAY WI 54301 TRUDEY PETERSON 9205937000 2012-08-07 1 GORDON J VETSCH P00047306 6123764500 2011 2016-02-24 21:20:13Z TRUDEY PETERSON 1207 SOUTH JACKSON STREET GREEN BAY WI 54301 8834861 0 X WWW.OFRHA.ORG X 1889 WI ELDERLY AND DISABLED HOUSING AND HEALTH SERVICES 8 8 171 30 0 0 1134 5329 6143788 5998621 278290 309958 0 0 6423212 6313908 0 0 0 0 4041417 4015869 0 0 0 1956995 2221030 5998412 6236899 424800 77009 13468671 14957342 5286613 7128854 8182058 7828488 ELDERLY AND DISABLED HOUSING AND HEALTH SERVICES AT OR BELOW THE LOW/LOW-MEDIAN RATES FOR OUR CONSUMER AREA. INCLUDES UNDER FUNDED CARE FOR LOW INCOME COUNTY PLACED TENANTS. 0 0 4424753 0 5129140 ODD FELLOW HOMEAN 82-BED SKILLED NURSING AND REHABILITATION FACILITY FOR THE ELDERLY OF BROWN COUNTY, WISCONSIN AND THE SURROUNDING AREA. A FOUR STAR CMS PROGRAM, WITH THE MAJORITY OF THE CLIENTS BEING MEDICAID UNDERFUNDED. REHAB SEES A LARGE PERCENTAGE OF OUR CLIENTS RETURNING TO THEIR HOMES. 582103 0 720220 REBEKAH HAVENA 20-BED CERTIFIED RESIDENTIAL CARE APARTMENT COMPLEX, IN GREEN BAY, WISCONSIN. SENIOR PRIVATE APARTMENTS WITH 24-HOUR SERVICES PROVIDED, TO ALLOW INDEPENDENCE, CHOICE AND QUALITY OF LIFE IN A SAFE ENVIRONMENT. COUNTY FUNDING HELPS COVER TENANTS WITHOUT FUNDS FOR SERVICES. 498403 0 149261 FRIENDSHIP PLACEA 36-BED MEMORY CARE COMMUNITY BASED RESIDENTIAL FACILITY. 5505259 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 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 0 0 1 0 0 0 0 1 24 0 1 171 1 0 0 0 0 0 0 0 0 0 0 X 8 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X TRUDEY PETERSON 9205937000 1207 SOUTH JACKSON STREET GREEN BAY WI 54301 TOM REED 1.00 X X 0 0 0 PATRICIA MOTT 1.00 X X 0 0 0 BONNIE OLSON 1.00 X X 0 0 0 SHARON CUNNINGHAM 1.00 X 0 0 0 LOREN CUNNINGHAM 1.00 X 0 0 0 RICHARD PROULX 1.00 X 0 0 0 ROBERTA BIERHALS 1.00 X 0 0 0 JOHN OLSEN 1.00 X 0 0 0 SHIRLEY REED 1.00 X 0 0 0 BEV KAPPEL 1.00 X 0 0 0 LINDA ENGSTROM 1.00 X 0 0 0 TRUDEY PETERSON 40.00 X 136414 0 11376 JAMIE STROHSCHEIN 32.00 X 65240 0 8766 JENNIFER KLASEN 40.00 X 6600 0 0 208254 0 20142 1 0 0 0 VALLEY BAY THERAPY INC 3305C NORTH BALLARD ROAD APPLETON WI 54911 CONTRACTED THERAPY 373084 1 5329 5329 RESIDENCY FEES 623000 5919079 5919079 AUXILIARY REVENUES 623000 79542 79542 5998621 110958 110958 2695270 24683 2394304 126649 300966 -101966 199000 199000 6313908 5998621 0 309958 228396 1478 226918 3188717 2948710 240007 59445 54971 4474 290774 266553 24221 248537 215840 32697 50729 50729 552433 519908 32525 53433 52291 1142 261520 211709 49811 257191 251697 5494 13715 13715 176006 172246 3760 438744 429371 9373 67472 66031 1441 BED TAX 167280 167280 FOOD 143854 143854 MISCELLANEOUS 27635 27635 DUES & SUBSCRIPTIONS 7698 7698 3320 3320 6236899 5505259 731640 0 801492 273662 27639 67285 391110 545836 73625 84440 14494785 4208629 8015652 10286156 4103281 3646944 55872 53019 13468671 14957342 1130946 389598 4150307 6733028 5360 6228 5286613 7128854 X 8046355 7692785 135703 135703 8182058 7828488 13468671 14957342 X 77009 -430579 X 0 1 1 X 0 X 2433 1400 5897 1134 5329 16193 5463469 5718644 5997500 6143788 5998621 29322022 5465902 5720044 6003397 6144922 6003950 29338215 0 251203 290946 306687 692132 787555 2328523 251203 290946 306687 692132 787555 2328523 27009692 92439 82280 109411 112854 110958 507942 92439 82280 109411 112854 110958 507942 2382 -18129 -15747 5558341 5804706 6094679 6257776 6114908 29830410 0.90540 0.92220 0.01700 0.01720 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME FROM VARIOUS SOURCES LOSS ON DEBT REFINANCING 0 1 135703 -14467 -14467 135703 135703 15326 15326 135703 135703 25513 25513 135703 135703 135703 1.00000 0 0 244464 244464 12645678 3086066 9559612 88224 60009 28215 1453069 1002336 450733 63350 60218 3132 10286156 6313908 6236899 77009 -430579 -430579 -353570 5998621 0 5998621 315287 315287 6313908 6236899 0 6236899 0 6236899 PART IV, LINE 2B: RESIDENT TRUST FUNDS ARE OFFERED TO ALL RESIDENTS AT ODD FELLOW HOME. THE FUNDS ARE NOT CO-MINGLED WITH ANY OTHER ORGANIZATION FUNDS. ONLY THE RESIDENT OR THE RESIDENTS AUTHORIZED INDIVIDUAL MAY ACCESS THESE FUNDS. RESIDENTS RECIEVE AT LEAST A QUARTERLY STATEMENT OF THEIR FUND ACTIVITY. FUNDS ARE KEPT IN AN INTEREST BEARING ACCOUNT. RESIDENTS WITH ACCOUNT BALANCES ABOVE $50 WILL EARN INTEREST AT THE CURRENT BANK RATE. STAFF HANDLING THE FUNDS WILL BE BONDED. THE BOND BENEFICIARY IS THE STATE OF WISCONSIN. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TO SUPPORT THE HEALTH CARE SERVICES AT ODD FELLOW HOME. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR UNCERTAIN TAX POSITIONS AND NO LIABILITY IS RECOGNIZED BY THE ORGANIZATION BY APPLICATION OF THIS STANDARD. THE ORGANIZATION FILES INFORMATIONAL RETURNS AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE IRS. THE ORGANIZATION'S 2008, 2009, AND 2010 TAX YEARS ARE OPEN TO EXAMINATION BY THE IRS. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS 5,329. INVESTMENT INCOME 411,924. LOSS ON DISPOSAL OF PROPERTY -101,966. WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 2010-08-01 7075000 NEW CONSTRUCTION AND REFINANCE EXISTING BOND AND DEBT 0 0 0 341972 7075000 89314 57061 5292654 1635971 2011 0 0 1 1 0 0 0 0 1 1 1 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE BOARD PRESIDENT HAS THE AUTHORITY TO BREAK A TIE VOTE. FORM 990, PART VI, SECTION A, LINE 2 LOREN CUNNINGHAM AND SHARON CUNNINGHAM - FAMILY RELATIONSHIP TOM REED AND SHIRLEY REED - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION HAS TWO CLASSES OF MEMBERS: 1. ALL THIRD-DEGREE ODD FELLOWS IN GOOD STANDING IN THE STATE OF WISCONSIN. 2. ALL REBEKAHS IN GOOD STANDING IN THE STATE OF WISCONSIN. FORM 990, PART VI, SECTION A, LINE 7A CORPORATE MEMBERS IN GOODSTANDING VOTE FOR ALL BOARD POSITIONS. FORM 990, PART VI, SECTION A, LINE 7B ARTICLES OR INCORPORATION AND BYLAWS ARE SUBJECT TO MEMBERSHIP APPROVAL FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED AT A BOARD MEETING. COPIES ARE MAILED TO ALL BOARD MEMBERS PRIOR TO THE MEETING WITH THE AGENDA. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS THE BOARD OF DIRECTORS AND KEY MANAGEMENT STAFF. THE CEO REVIEWS ALL IDENTIFIED OR SUSPECTED CONFLICTS AND REPORTS THEM TO THE FULL BOARD OF DIRECTORS. ANY ONE WITH A CONFLICT IS NOT ALLOWED TO DISCUSS OR VOTE IN RELATED ACTIONS. FORM 990, PART VI, SECTION B, LINE 15 THE CEO'S COMPENSATION IS APPROVED ANNUALLY BY THE BOARD OF DIRECTORS. THE PROCESS INCLUDES REVIEWING SALARIES IN COMPARISON TO LOCAL WAGE PREVALENCE RATES AND LEADING AGE WISCONSIN WAGE SURVEY BASED ON THE LONG TERM CARE HEALTH INDUSTRY. THE PROCESS WAS LAST UNDERTAKEN FOR THE CEO IN OCTOBER, 2011. OTHER EMPLOYEES SALARIES ARE COMPARED TO LEADING AGE WISCONSIN AND LOCAL LONG TERM CARE DATABASES. THE OTHER EMPLOYEES SALARIES ARE APPROVED BY THE CEO BASED ON DIRECTIVE OF PERCENTAGE INCREASE AND COMPARISON RANGE THE BOARD OF DIRECTORS WANTS TO MEET. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE POSTED IN FACILITIES, NEWSLETTERS, ANNUAL REPORTS AND IN CONTRACT PARTICIPATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -430,579. THE GRAND LODGE OF THE STATE OF WI INDEP ORDER OF ODD FELLOWS 490 TYROLIAN DRIVE GREEN BAY WI 54302 390366558 FRATERNAL SOCIETY WI 501(C)(8) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0