GABRIELS VILLA INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
GABRIELS VILLA INC (EIN 39-1857036)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-10-22
IRS object ID
201242969349300509
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)
Timestamp2012-10-22T09:19:19-05:00Timestamp
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)
EIN391857036EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1GABRIEL'S VILLA INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGABRNameControl
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 Receipts1692993GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Group Exemption Number9386GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.LUTHERANHOMES.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1987YearFormation
State Legal DomicileWIStateLegalDomicile
Activity Or Mission DescriptionPROVIDE ASSISTED LIVING TO THE ELDERLY.ActivityOrMissionDescription
Nbr Voting Members Governing Body15NbrVotingMembersGoverningBody
Nbr Independent Voting Members15NbrIndependentVotingMembers
Total Nbr Employees47TotalNbrEmployees
Total Nbr Volunteers15TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year11232ContributionsGrantsPriorYear
Contributions Grants Current Year10273ContributionsGrantsCurrentYear
Program Service Revenue Prior Year1632361ProgramServiceRevenuePriorYear
Program Service Revenue CY1670852ProgramServiceRevenueCY
Investment Income Prior Year8057InvestmentIncomePriorYear
Investment Income Current Year6410InvestmentIncomeCurrentYear
Other Revenue Prior Year4888OtherRevenuePriorYear
Other Revenue Current Year5458OtherRevenueCurrentYear
Total Revenue Prior Year1656538TotalRevenuePriorYear
Total Revenue Current Year1692993TotalRevenueCurrentYear
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 Year942626SalariesEtcPriorYear
Salaries Etc Current Year952611SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year551925OtherExpensePriorYear
Other Expenses Current Year592519OtherExpensesCurrentYear
Total Expenses Prior Year1494551TotalExpensesPriorYear
Total Expenses Current Year1545130TotalExpensesCurrentYear
Revenues Less Expenses Prior Year161987RevenuesLessExpensesPriorYear
Revenues Less Expenses CY147863RevenuesLessExpensesCY
Total Assets BOY2578691TotalAssetsBOY
Total Assets EOY2546980TotalAssetsEOY
Total Liabilities BOY1561080TotalLiabilitiesBOY
Total Liabilities EOY1388928TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1017611NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1158052NetAssetsOrFundBalancesEOY
Mission DescriptionGABRIEL'S VILLA 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
Expense1093411Expense
Grants0Grants
Revenue1670877Revenue
DescriptionGABRIEL'S VILLA PROVIDES SUPERVISED CARE TO THE ELDERLY IN OSHKOSH, WI. THE ENTITY HAS 39 ASSISTED LIVING UNITS.Description
Total Program Service Expense1093411TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
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 With109611NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees47NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
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

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1KIM MAKIBusinessNameLine1
FieldValueIRS element (for citing)
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 JEWEL
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 Organizations7926RelatedOrganizations
All Other Contributions2347AllOtherContributions
Total Contributions10273TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
TENANT REVENUE53111015250071525007
SERVICE REVENUE621610145845145845
FieldValueIRS element (for citing)
Total Program Service Revenue1670852TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column6410TotalRevenueColumn
Exclusion$6,410ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
BEAUTY SHOP REVENUE9000991955$1,955
MICELLANEOUS REVENUE9000991465$1,465
LAUNDRY REVENUE9000991202$1,202

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column836TotalRevenueColumn
Exclusion$836ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue5458TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column1692993TotalRevenueColumn
Related Or Exempt Function Income1670852RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$11,868ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total812924Total
Program Services645438ProgramServices
Management And General167486ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total23560Total
Program Services18706ProgramServices
Management And General4854ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total65282Total
Program Services51832ProgramServices
Management And General13450ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total50845Total
Program Services40369ProgramServices
Management And General10476ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total25656Total
Management And General25656ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total6225Total
Management And General6225ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total13334Total
Management And General13334ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total19066Total
Program Services13979ProgramServices
Management And General5087ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total10487Total
Management And General10487ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total124029Total
Program Services99821ProgramServices
Management And General24208ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total348Total
Management And General348ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total110647Total
Program Services109587ProgramServices
Management And General1060ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total3276Total
Program Services196ProgramServices
Management And General3080ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total73556Total
Program Services73556ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total165968Total
Management And General165968ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total35503Total
Program Services35503ProgramServices

Other Expenses OtherExpenses

FieldValueIRS element (for citing)
DescriptionMICELLANEOUS EXPENSESDescription
Total4424Total
Program Services4424ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1545130Total
Program Services1093411ProgramServices
Management And General451719ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY382952BOY
EOY330132EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY429781BOY
EOY535336EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5834BOY
EOY32272EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY5152BOY
EOY52EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis3783337LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2176330LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1703725BOY
EOY1607007EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY11422BOY
EOY4000EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY39810BOY
EOY33838EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY15BOY
EOY4343EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY2578691BOY
EOY2546980EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY108527BOY
EOY116303EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY1321370BOY
EOY1156726EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY106441BOY
EOY103826EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY24742BOY
EOY12073EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1561080BOY
EOY1388928EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1006189BOY
EOY1154052EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY11422BOY
EOY4000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1017611BOY
EOY1158052EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2578691BOY
EOY2546980EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses147863ReconcilationRevenueExpenses
Reconcilation Other Changes-7422ReconcilationOtherChanges
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 Minus3 Years1418CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7996CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year11232CurrentTaxYearMinus1Year
Current Tax Year10273CurrentTaxYear
Total30919Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1390573CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1536402CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1572964CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1632361CurrentTaxYearMinus1Year
Current Tax Year1670852CurrentTaxYear
Total7803152Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1390573CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1537820CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1580960CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1643593CurrentTaxYearMinus1Year
Current Tax Year1681125CurrentTaxYear
Total7834071Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years819553CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years906895CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years935587CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year986311CurrentTaxYearMinus1Year
Current Tax Year1010585CurrentTaxYear
Total4658931Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years819553CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years906895CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years935587CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year986311CurrentTaxYearMinus1Year
Current Tax Year1010585CurrentTaxYear
Total4658931Total
FieldValueIRS element (for citing)
Public Support Total5093175140PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years33827CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22052CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8194CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8057CurrentTaxYearMinus1Year
Current Tax Year6410CurrentTaxYear
Total78540Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years33827CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22052CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years8194CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8057CurrentTaxYearMinus1Year
Current Tax Year6410CurrentTaxYear
Total78540Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3150CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years13896CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4289CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4888CurrentTaxYearMinus1Year
Current Tax Year5458CurrentTaxYear
Total31681Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1427550CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years1573768CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1593443CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1656538CurrentTaxYearMinus1Year
Current Tax Year1692993CurrentTaxYear
Total7944292Total
FieldValueIRS element (for citing)
Public Support Percentage5090.39970PublicSupportPercentage509
Prior Year Support Percentage0.40270PriorYearSupportPercentage
Investment Income Percentage0.00990InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.01250PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: ALA CARTE SERVICES BEAUTY SHOP REVENUE ASSESSMENT FEES LAUNDRY COIN MISCELLANEOUS INCOMEGeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

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

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis83333OtherCostOrOtherBasis
Book Value83333BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2866902OtherCostOrOtherBasis
Depreciation1617597Depreciation
Book Value1249305BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis69351OtherCostOrOtherBasis
Depreciation50455Depreciation
Book Value18896BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis745150OtherCostOrOtherBasis
Depreciation508278Depreciation
Book Value236872BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis18601OtherCostOrOtherBasis
Book Value18601BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings1607007TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO AFFILIATESDescription
Amount$12,073Amount
FieldValueIRS element (for citing)
Total Of Amounts12073TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 2B:RESIDENTS' CUSTODIAL ACCOUNTS CONSIST OF AMOUNTS ON DEPOSIT WITH GABRIEL'S VILLA, INC. 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 (9 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 GABRIEL'S VILLA, INC.
FORM 990, PART VI, SECTION A, LINE 7ATHE DIRECTORS OF GABRIEL'S VILLA, 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 GABRIEL'S VILLA, 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 THE 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 XI, LINE 5:CHANGE IN INVESTMENT IN FOUNDATION -7,422. TOTAL TO FORM 990, PART XI, LINE 5: -7,422.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART VII, SECTION AEACH OFFICER OF GABRIEL'S VILLA, 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 GABRIEL'S VILLA, 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 STREETOSHKOSHWI54902391032234MANAGMENT SERVICESWI501(C)(3)LINE 9N/A0
BETHEL HOME INC
225 NORTH EAGLE STREETOSHKOSHWI54902391209707SKILLED NURSING FACILITYWI501(C)(3)LINE 90LUTHERAN HOMES OF OSHKOSH INC
CARMEL RESIDENCE INC
225 NORTH EAGLE STREETOSHKOSHWI54902391448325ELDERLY 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 Org1GiftGrantOrCapContrFrOtherOrg
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 Org0OtherTransferFromOtherOrg

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