2011-11-11T15:21:44-06:00 2010-12-31 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2010-01-01 470384319 FLORENCE HOME FOR THE AGED FLOR 4028276000 7915 NORTH 30TH STREET OMAHA NE 68112 DEBRA L THACKER 4028276000 2011-10-26 1 JULIE M GERKEN 4023302660 2010 2016-03-07 17:11:31Z DEBRA L THACKER 7915 NORTH 30TH STREET OMAHA NE 68112 10850678 0 X WWW.MGI-SENIORS.ORG X 1906 NE PROVIDE CARE FOR THE ELDERLY 11 9 270 10 0 0 226624 208226 10515986 10561250 39218 31236 48109 49966 10829937 10850678 45774 56727 0 0 5299315 5512493 0 0 0 5739114 5457553 11084203 11026773 -254266 -176095 4454181 4282736 2330934 2261631 2123247 2021105 X TO PROVIDE A CONTINUUM OF QUALITY SERVICES AND PROGRAMS FOR SENIORS AND OTHER PERSONS NEEDING SPECIALIZED CARE. 0 0 5439265 56727 6261482 SKILLED NURSING CARE 2181602 2298693 ASSISTED LIVING CARE 2001301 1990182 ALZHEIMER'S ASSISTED LIVING CARE 56727 10894 OTHER SERVICES 56727 10894 9678895 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 16 0 1 270 1 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X DEBRA L THACKER CFO 4028276000 7915 NORTH 30TH STREET OMAHA NE 68112 X ROBERT A BLOECHLE 1.00 X X 0 0 0 STEPHANIE O'KEEFE 1.00 X X 0 0 0 LOIS HESS 2.00 X X 0 144000 8575 DEBRA L THACKER 2.00 X X 0 133140 22027 JULIE SCHULTZ 1.00 X 0 0 0 PHIL CHRISTENSEN 1.00 X 0 0 0 LYN M HOLLEY 1.00 X 0 0 0 JOHN JEANETTA 1.00 X 0 0 0 NANCY A MCCARTHY 1.00 X 0 0 0 YOLANDA SMITH 1.00 X 0 0 0 BETTY FOSTER 1.00 X 0 0 0 0 277140 30602 0 0 1 0 HEALTHCARE SERVICES GROUP SUITE 300 3220 TILLMAN DRIVE BENSALEM PA 19020 HSKPG/LNDRY/DIETARY 1396737 REHABVISIONS NATIONAL THERAPUETIC ASSOC 11623 ARBOR STREET OMAHA NE 68144 REHAB SERVICES 493721 2 205243 2983 208226 MEDICARE/MEDICAID PAYM 623000 8572911 8572911 PRIVATE PAY/INSURANCE 623000 1977450 1977450 MISCELLANEOUS INCOME 623000 8040 8040 VENDOR REBATES 623000 2849 2849 10561250 31236 31236 48073 48073 48073 48073 CAFETERIA & VENDING RE 623000 1893 1893 1893 10850678 10561250 0 81202 56727 56727 4729860 4385134 344726 327285 307201 20084 455348 422950 32398 681872 681872 25267 25267 21879 21879 2694601 2616547 78054 1047590 967563 80027 289013 289013 25870 16678 9192 8046 7862 184 23540 23540 279077 279077 211264 184108 27156 BAD DEBT & CHARITY CARE 114600 114600 DUES & SUBSCRIPTIONS 27442 3805 23637 MISCELLANEOUS 7492 4090 3402 11026773 9678895 1347878 0 38830 29028 374676 352918 772761 754739 35973 55067 72071 68710 8680915 6746383 2137320 1934532 1022550 1087742 4454181 4282736 792568 761621 1510000 1450000 28366 50010 2330934 2261631 X 151941 -24154 1040000 1040000 931306 1005259 2123247 2021105 4454181 4282736 X -176095 73953 X X 0 1 1 X 0 X 21872 7334 5621 6198 2983 44008 10873510 11663711 10872522 10515986 10561250 54486979 16482 21361 5687 6289 1893 51712 10911864 11692406 10883830 10528473 10566126 54582699 0 0 0 54582699 84934 99069 97165 80902 79309 441379 84934 99069 97165 80902 79309 441379 10996798 11791475 10980995 10609375 10645435 55024078 0.99200 0.99190 0.00800 0.00810 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 154347 154347 6379784 4945666 1434118 2041525 1735618 305907 105259 65099 40160 1934532 DEFERRED FINANCING COSTS, NET 82483 BENEFICIAL INTEREST IN PERPETUAL TRUST 1005259 1087742 ACCRUED INTEREST PAYABLE 3533 THIRD PARTY PAYOR SETTLEMENTS PAYABLE 24044 DUE TO AFFILIATES 22433 50010 10850678 11026773 -176095 73953 73953 -102142 10924631 73953 73953 10850678 0 10850678 11026773 0 11026773 0 11026773 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: MIDWEST GERIATRICS, INC., ROYALE OAKS HOUSE OF HOPE, GERIMED, INC., FLORENCE HOME AND SENIOR HEALTH FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THESE NOT-FOR-PROFIT CORPORATIONS HAVE EACH RECEIVED A DETERMINATION LETTER THAT THEY ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. UNIMED, INC. IS A TAXABLE CORPORATION. UNIMED, INC. HAS A NET OPERATING LOSS CARRYFORWARD AS OF DECEMBER 31, 2010 AND 2009, AVAILABLE FOR FEDERAL AND STATE INCOME TAX PURPOSES. THE ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2010, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 SENIOR HEALTH FOUNDATION 7915 NORTH 30TH STREET OMAHA NE 68112 470709560 501(C)(3) 56727 FINANCIAL ASSISTANCE FOR OPERATIONS 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: FLORENCE HOME FOR THE AGED MONITORS THE USE OF GRANTS BY GRANTING FUNDS ONLY TO LOCAL ORGANIZATIONS THAT ARE AFFILIATED THROUGH COMMON MANAGEMENT. X 0 0 0 0 0 0 0 0 0 LOIS HESS 0 144000 0 0 0 0 0 1962 0 6613 0 152575 0 0 DEBRA L THACKER 0 133140 0 0 0 0 0 1798 0 20229 0 155167 0 0 FORM 990, PART VI, SECTION B, LINE 11 ONCE THE FORM 990 AND RELATED SCHEDULES HAVE BEEN PREPARED, THE CONTROLLER AND THE CFO WILL REVIEW IT, MAKE ANY CHANGES AND ACCEPT THE DRAFT FORM 990. THE FINANCE COMMITTEE WILL THEN BE CONTACTED VIA E-MAIL THAT THE DRAFT FORM 990 IS READY FOR REVIEW AND ASK IF THEY WANT IT SENT OUT TO THEM OR IF THEY WILL BE COMING TO THE FACILITY TO REVIEW. ONCE 2/3 OF THE COMMITTEE HAVE REVIEWED AND ACCEPTED THE FORM 990, IT WILL BE FILED. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE ASKED TO REVIEW AND DISCLOSE ANY CONFLICTS OF INTERESTS THAT THEY MAY HAVE WITH FLORENCE HOME FOR THE AGED OPERATIONS. THEY ARE THEN ASKED TO SIGN A DOCUMENT INDICATING CONFLICTS, IF ANY. THE BOARD CHAIR IS THEN INFORMED OF ANY CURRENT CONFLICTS FOR CONSIDERATION IN FUTURE VOTING MATTERS OF THE BOARD. FORM 990, PART VI, LINE 15: FLORENCE HOME FOR THE AGED DOES NOT HAVE ANY OFFICERS THAT IT DIRECTLY COMPENSATES. MIDWEST GERIATRICS, INC., AN AFFILIATE OF FLORENCE HOME, COMPENSATES THE OFFICERS OF FLORENCE HOME AND THEREFORE, THE POLICY ON THE PROCESS FOR DETERMINING COMPENSATION OF MIDWEST GERIATRICS, INC. APPLIES TO THE COMPENSATION OF THE FOLLOWING PERSONS SERVING AS OFFICERS OF FLORENCE HOME. THE PROCESS IS UTILIZED BY THE EXECUTIVE COMMITTEE OF THE MIDWEST GERIATRICS, INC. BOARD ON AN ANNUAL BASIS. CHIEF EXECUTIVE OFFICER: LOIS HESS CHIEF FINANCIAL OFFICER: DEBRA THACKER THE PROCESS INCLUDES ALL OF THESE ELEMENTS: (1) REVIEW AND APPROVAL BY THE EXECUTIVE COMMITTEE OF MIDWEST GERIATRICS, INC.; (2) USE OF DATA AS TO COMPARABLE COMPENSATION; AND (3) CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING. 1. REVIEW AND APPROVAL. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF MIDWEST GERIATRICS, INC., PROVIDED THAT PERSONS WITH CONFLICTS OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT AT ISSUE ARE NOT INVOLVED IN THIS REVIEW AND APPROVAL. 2. USE OF DATA AS TO COMPARABLE COMPENSATION. THE COMPENSATION OF THE PERSON IS REVIEWED AND APPROVED USING DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS. 3. CONTEMPORANEOUS DOCUMENTATION AND RECORDING. THERE IS CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT. FORM 990, PART VI, SECTION C, LINE 19 UPON REQUEST A COPY OF THE REQUESTED DOCUMENT IS PROVIDED WITHIN 72 HOURS. AVERAGE HOURS PER WEEK FORM 990, PAGE 7, PART VII, LINE 1A: FLORENCE HOME FOR THE AGED DOES NOT HAVE ANY OFFICERS IT COMPENSATES DIRECTLY. THE CEO AND CFO ON THE FLORENCE HOME FOR THE AGED BOARD OF DIRECTORS ARE ACTUALLY EMPLOYEES OF AND COMPENSATED BY MIDWEST GERIATRICS, INC., AN AFFILIATE OF FLORENCE HOME FOR THE AGED, AND THEREFORE THE MAJORITY OF THEIR WORK WEEK IS ATTRIBUTED TO WORKING FOR MIDWEST GERIATRICS, INC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 73,953. FORM 990, PAGE 12, PART XII, LINE 2C: THE BOARD OF DIRECTORS OF MIDWEST GERIATRICS, INC ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. SENIOR HEALTH FOUNDATION 7915 N 30TH STREET OMAHA NE 68112 470709560 PROVIDE ASSISTANCE TO THE ELDERLY. NE 501(C)(3) 7 N/A 0 GERIMED 7915 N 30TH STREET OMAHA NE 68112 470727973 PHARMACEUTICAL SALES. NE 501(C)(3) 9 N/A 0 MIDWEST GERIATRICS INC 7915 N 30TH STREET OMAHA NE 68112 470727974 SUPPORT FLORENCE HOME AND RELATED ORANGIZATIONS THROUGH MANAGEMENT SERVICES. NE 501(C)(3) 11B TYPE II N/A 0 ROYALE OAKS HOUSE OF HOPE 4801 N 52ND STREET OMAHA NE 68104 260808357 SUPPORT FLORENCE HOME BY SERVICING A FHA-INSURED NON-RECOURSE LOAN. NE 501(C)(3) 11A TYPE I N/A 0 UNIMED 7915 N 30TH STREET OMAHA NE 68112 470759285 PHARMACEUTICAL SALES NE N/A C 0 1 1 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0