2011-11-14T09:32:22-06:00 2010-12-31 LARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-01-01 391448325 CARMEL RESIDENCE INC CARM 9202325220 225 NORTH EAGLE STREET OSHKOSH WI 54902 RICH KERN 9202325220 2011-11-09 1 6123764500 2010 2016-02-24 21:20:13Z CRAIG UBBELOHDE 225 NORTH EAGLE STREET OSHKOSH WI 54902 652741 0 9386 X WWW.LUTHERANHOMES.COM X 1988 WI TO PROVIDE HOUSING FOR THE ELDERLY. 15 15 0 15 0 0 2010 4462 377166 570334 56367 33035 45581 44910 481124 652741 0 0 0 0 219356 177046 0 0 0 408039 405658 627395 582704 -146271 70037 4551951 4440376 3610644 3429032 941307 1011344 CARMEL 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. 0 0 253098 570815 CARMEL RESIDENCE, INC., PROVIDES INDEPENDENT LIVING FACILITIES FOR THE ELDERLY. THE ENTITY HAS 78 INDEPENDENT LIVING UNITS. 253098 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 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 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X X RICH KERN 9202325220 225 NORTH EAGLE STREET OSHKOSH WI 54902 DAVE KOCH 1.50 X X 0 0 0 BRUCE BAIN 1.50 X X 0 0 0 REV JOY MORTENSEN-WIEBE 1.50 X X 0 0 0 DR RICHARD AMES 1.50 X 0 0 0 MARK BEECHER 1.50 X 0 0 0 RICHARD CAMPBELL 1.50 X 0 0 0 DR ROGER HEROLD 1.50 X 0 0 0 LOIS JAENKE 1.50 X 0 0 0 REV KAREN JEWEL 1.50 X 0 0 0 REV KEMP JONES 1.50 X 0 0 0 GEORGE KONTOS 1.50 X 0 0 0 JANE KUHN 1.50 X 0 0 0 STEVE LAUTENSCHLAGER 1.50 X 0 0 0 DENNIS WENDT 1.50 X 0 0 0 BARBARA SKAAR 1.50 X 0 0 0 CRAIG UBBELOHDE 40.00 X 0 233904 36877 RICHARD KERN 40.00 X 0 96556 10298 JULIE VANDENBERG 40.00 X 0 63605 7656 0 394065 54831 0 0 1 0 0 4462 4462 APARTMENT OPERATIONS 623990 518997 518997 ENTRACE FEE REVENUES 623990 51337 51337 570334 33035 33035 34665 34665 34665 34665 LAUNDRY COIN 900099 8394 8394 BEAUTY SHOP 900099 1370 1370 MISCELLANEOUS REVENUE 900099 481 481 10245 652741 570334 0 77945 177039 83703 93336 7 7 19872 19872 5225 5225 26987 25341 1646 13542 13542 7099 7099 808 808 123100 123100 813 75 738 183439 183439 18945 18945 RESIDENT EXPENSES 3869 3869 MISCELLANEOUS EXPENSES 1837 1812 25 FOOD 116 116 MEDICAL SUPPLIES 6 6 582704 253098 329606 0 71727 73994 1816949 1757807 8372 407 4352 3826 5853911 3253703 2644577 2600208 3964 3964 2010 170 4551951 4440376 10690 11180 597971 608822 2988018 2797672 13965 11358 3610644 3429032 X 937343 1007380 3964 3964 941307 1011344 4551951 4440376 70037 0 X 0 1 1 X 0 X 5375 115 1978 2010 4462 13940 528535 507113 450228 377166 570334 2433376 533910 507228 452206 379176 574796 2447316 0 7037 17747 39807 64591 7037 17747 39807 64591 2382725 113308 142962 85168 92687 67700 501825 113308 142962 85168 92687 67700 501825 10001 6842 9776 9261 10245 46125 657219 657032 547150 481124 652741 2995266 0.79550 0.80150 0.16750 0.17300 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: LAUNDRY COIN BEAUTY SHOP MISCELLANEOUS INCOME 0 1 43875 43875 4774796 2588208 2186588 902326 570330 331996 132914 95165 37749 2600208 DUE TO AFFILIATES 11358 11358 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. 0 0 0 0 0 0 0 0 0 CRAIG UBBELOHDE 0 209966 0 20000 0 3938 0 12125 0 24752 0 270781 0 0 SUPPLEMENTAL INFORMATION PART III PART 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 COMMITTEE FORM 990, PART VI, SECTION A, LINE 1 THE 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 6 LUTHERAN HOMES OF OSHKOSH, INC., IS THE SOLE MEMBER OF CARMEL RESIDENCE, INC. FORM 990, PART VI, SECTION A, LINE 7A THE 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 7B STANDARD 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 11 THE 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. FORM 990, PART VI, SECTION B, LINE 12C 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 C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. ALLOCATION OF TIME BETWEEN RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A EACH 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. LUTHERAN HOMES OF OSHKOSH INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391032234 MANAGEMENT SERVICES WI 501(C)(3) LINE 9 N/A 0 BETHEL HOME INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391209707 SKILLED NURSING FACILITY WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 GABRIEL'S VILLA INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391857036 ELDERLY HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 SIMEANNA APARTMENTS INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 237148097 ELDERLY HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 SIMEANNA SOUTH INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391238670 ELDERLY HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 SIMEANNA III INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391270056 ELDERLY HOUSING WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 BETHEL FOUNDATION OF OSHKOSH INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 010938793 FUNDRAISING WI 501(C)(3) LINE 11A, I LUTHERAN HOMES OF OSHKOSH INC 0 EDEN REHABILIATION SUITES AND GREENHOUSE HOMES INC 3151 EDEN COURT OSHKOSH WI 54902 900506872 SKILLED NURSING FACILITY WI 501(C)(3) LINE 9 LUTHERAN HOMES OF OSHKOSH INC 0 0 0 0 1 1 0 0 0 1 1 0 1 1 1 1 1 0 1