CARMEL RESIDENCE INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CARMEL RESIDENCE INC (EIN 39-1448325)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-14
IRS object ID
201143189349302404
Schema version
2010v3.4
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)
Timestamp2011-11-14T09:32:22-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LARSONALLEN 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 Date2010-01-01TaxPeriodBeginDate

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)
NameRICH KERNName
TitleCFOTitle
Phone9202325220Phone
Date Signed2011-11-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone6123764500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCRAIG UBBELOHDENameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1225 NORTH EAGLE STREETAddressLine1
CityOSHKOSHCity
StateWIState
ZIP Code54902ZIPCode
FieldValueIRS element (for citing)
Gross Receipts652741GrossReceipts
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 Volunteers15TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2010ContributionsGrantsPriorYear
Contributions Grants Current Year4462ContributionsGrantsCurrentYear
Program Service Revenue Prior Year377166ProgramServiceRevenuePriorYear
Program Service Revenue CY570334ProgramServiceRevenueCY
Investment Income Prior Year56367InvestmentIncomePriorYear
Investment Income Current Year33035InvestmentIncomeCurrentYear
Other Revenue Prior Year45581OtherRevenuePriorYear
Other Revenue Current Year44910OtherRevenueCurrentYear
Total Revenue Prior Year481124TotalRevenuePriorYear
Total Revenue Current Year652741TotalRevenueCurrentYear
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 Year219356SalariesEtcPriorYear
Salaries Etc Current Year177046SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year408039OtherExpensePriorYear
Other Expenses Current Year405658OtherExpensesCurrentYear
Total Expenses Prior Year627395TotalExpensesPriorYear
Total Expenses Current Year582704TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-146271RevenuesLessExpensesPriorYear
Revenues Less Expenses CY70037RevenuesLessExpensesCY
Total Assets BOY4551951TotalAssetsBOY
Total Assets EOY4440376TotalAssetsEOY
Total Liabilities BOY3610644TotalLiabilitiesBOY
Total Liabilities EOY3429032TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY941307NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1011344NetAssetsOrFundBalancesEOY
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
Expense253098Expense
Revenue570815Revenue
DescriptionCARMEL RESIDENCE, INC., PROVIDES INDEPENDENT LIVING FACILITIES FOR THE ELDERLY. THE ENTITY HAS 78 INDEPENDENT LIVING UNITS.Description
Total Program Service Expense253098TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
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 With10960NumberFormsTransmittedWith1096
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
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonRICH KERNNamePerson
Telephone Number9202325220TelephoneNumber

Address US AddressUS

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

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
DAVE KOCH
CHAIR1.50XX000
BRUCE BAIN
VICE CHAIR1.50XX000
REV JOY MORTENSEN-WIEBE
SECRETARY1.50XX000
DR RICHARD AMES
BOARD MEMBER1.50X000
MARK BEECHER
BOARD MEMBER1.50X000
RICHARD CAMPBELL
BOARD MEMBER1.50X000
DR ROGER HEROLD
BOARD MEMBER1.50X000
LOIS JAENKE
BOARD MEMBER1.50X000
REV KAREN JEWEL
BOARD MEMBER1.50X000
REV KEMP JONES
BOARD MEMBER1.50X000
GEORGE KONTOS
BOARD MEMBER1.50X000
JANE KUHN
BOARD MEMBER1.50X000
STEVE LAUTENSCHLAGER
BOARD MEMBER1.50X000
DENNIS WENDT
BOARD MEMBER1.50X000
BARBARA SKAAR
BOARD MEMBER1.50X000
CRAIG UBBELOHDE
PRESIDENT & CEO40.00X023390436877
RICHARD KERN
CORP. TREASURER & CFO40.00X09655610298
JULIE VANDENBERG
CORPORATE SECRETARY40.00X0636057656
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs394065TotalReportableCompFrmRltdOrgs
Total Other Compensation54831TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Related Organizations4462RelatedOrganizations
Total Contributions4462TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
APARTMENT OPERATIONS623990518997518997
ENTRACE FEE REVENUES6239905133751337
FieldValueIRS element (for citing)
Total Program Service Revenue570334TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column33035TotalRevenueColumn
Exclusion$33,035ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real34665Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real34665Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column34665TotalRevenueColumn
Exclusion$34,665ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
LAUNDRY COIN9000998394$8,394
BEAUTY SHOP9000991370$1,370
MISCELLANEOUS REVENUE900099481$481
FieldValueIRS element (for citing)
Total Other Revenue10245TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column652741TotalRevenueColumn
Related Or Exempt Function Income570334RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$77,945ExclusionAmount

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total177039Total
Program Services83703ProgramServices
Management And General93336ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7Total
Management And General7ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total19872Total
Management And General19872ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total5225Total
Management And General5225ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total26987Total
Program Services25341ProgramServices
Management And General1646ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total13542Total
Management And General13542ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total7099Total
Management And General7099ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total808Total
Management And General808ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total123100Total
Program Services123100ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total813Total
Program Services75ProgramServices
Management And General738ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total183439Total
Management And General183439ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total18945Total
Program Services18945ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServices
RESIDENT EXPENSES38693869
MISCELLANEOUS EXPENSES1837251812
FOOD116116
MEDICAL SUPPLIES66

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total582704Total
Program Services253098ProgramServices
Management And General329606ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY71727BOY
EOY73994EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1816949BOY
EOY1757807EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY8372BOY
EOY407EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY4352BOY
EOY3826EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis5853911LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3253703LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2644577BOY
EOY2600208EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY3964BOY
EOY3964EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2010BOY
EOY170EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4551951BOY
EOY4440376EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY10690BOY
EOY11180EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY597971BOY
EOY608822EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY2988018BOY
EOY2797672EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY13965BOY
EOY11358EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3610644BOY
EOY3429032EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY937343BOY
EOY1007380EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3964BOY
EOY3964EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY941307BOY
EOY1011344EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4551951BOY
EOY4440376EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses70037ReconcilationRevenueExpenses
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 Years5375CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years115CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years1978CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year2010CurrentTaxYearMinus1Year
Current Tax Year4462CurrentTaxYear
Total13940Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years528535CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years507113CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years450228CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year377166CurrentTaxYearMinus1Year
Current Tax Year570334CurrentTaxYear
Total2433376Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years533910CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years507228CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years452206CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year379176CurrentTaxYearMinus1Year
Current Tax Year574796CurrentTaxYear
Total2447316Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years7037CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17747CurrentTaxYearMinus1Year
Current Tax Year39807CurrentTaxYear
Total64591Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years7037CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17747CurrentTaxYearMinus1Year
Current Tax Year39807CurrentTaxYear
Total64591Total
FieldValueIRS element (for citing)
Public Support Total5092382725PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years113308CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years142962CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years85168CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year92687CurrentTaxYearMinus1Year
Current Tax Year67700CurrentTaxYear
Total501825Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years113308CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years142962CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years85168CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year92687CurrentTaxYearMinus1Year
Current Tax Year67700CurrentTaxYear
Total501825Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10001CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6842CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years9776CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9261CurrentTaxYearMinus1Year
Current Tax Year10245CurrentTaxYear
Total46125Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years657219CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years657032CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years547150CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year481124CurrentTaxYearMinus1Year
Current Tax Year652741CurrentTaxYear
Total2995266Total
FieldValueIRS element (for citing)
Public Support Percentage5090.79550PublicSupportPercentage509
Prior Year Support Percentage0.80150PriorYearSupportPercentage
Investment Income Percentage0.16750InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.17300PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: LAUNDRY COIN 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 Basis4774796OtherCostOrOtherBasis
Depreciation2588208Depreciation
Book Value2186588BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis902326OtherCostOrOtherBasis
Depreciation570330Depreciation
Book Value331996BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis132914OtherCostOrOtherBasis
Depreciation95165Depreciation
Book Value37749BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2600208TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDUE TO AFFILIATESDescription
Amount$11,358Amount
FieldValueIRS element (for citing)
Total Of Amounts11358TotalOfAmounts

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 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 2007 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 Orgs209966CompBasedOnRelatedOrgs
Bonus Filing Org0BonusFilingOrg
Bonus Related Orgs20000BonusRelatedOrgs
Other Compensation Filing Org0OtherCompensationFilingOrg
Other Compensation Related Orgs3938OtherCompensationRelatedOrgs
Deferred Comp Filing Org0DeferredCompFilingOrg
Deferred Comp Related Orgs12125DeferredCompRelatedOrgs
Nontaxable Benefits Filing Org0NontaxableBenefitsFilingOrg
Nontaxable Benefits Related Orgs24752NontaxableBenefitsRelatedOrgs
Total Compensation Filing Org0TotalCompensationFilingOrg
Total Compensation Related Orgs270781TotalCompensationRelatedOrgs
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)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 1THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD OF DIRECTORS PLUS TWO OTHER MEMEBERS 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 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 11THE 990 WAS COMPLETED BY AN INDEPENDENT FIRM AND WAS REVIEWED BY THE CFO. BEFORE IT WAS FILED, IT WAS DISTRIBUTED TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR REVIEW.
ANNUALLY, 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 B, LINE 12C
THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
ALLOCATION OF TIME BETWEEN RELATED ORGANIZATIONSEACH 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.FORM 990, PART VII, SECTION A

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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