2021-05-17T12:43:11-05:00 2020-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2019-07-01 831746407 MOSAIC SENIOR SERVICES INC MOSA 4028963884 4980 S 118TH ST LIND CENTER NO A OMAHA NE 68137 SCOTT HOFFMAN CHIEF FINANCIAL OFFICER 4028963884 2021-05-12 1 WENDY R COOLEY P01523804 4023302660 2019 2022-09-23 18:48:47Z SCOTT HOFFMAN 4980 S 118TH ST LIND CENTER NO A OMAHA NE 68137 16572941 0 X WWW.SOREO.COM X 2018 AZ MOSAIC SENIOR SERVICES IS PRIMARILY FUNDED THROUGH MEDICAID AND PROVIDES DIRECT CARE SERVICES TO INDIVIDUALS WITH VARYING NEEDS. SERVICES ARE INDIVIDUALIZED TO MEET THE NEEDS OF THE INDIVIDUAL, ALLOWING THEM TO REMAIN AT HOME AND TO WORK AND PARTICIPATE IN ACTIVITIES IN THEIR COMMUNITY. 5 0 0 0 0 0 0 496642 9009381 16076299 0 0 12669 0 9022050 16572941 0 0 0 0 932153 1457549 0 0 0 7226439 13609823 8158592 15067372 863458 1505569 12706471 12128188 11843013 9376604 863458 2751584 NONE 0 0 13771048 16076299 MOSAIC SENIOR SERVICES IS PRIMARILY FUNDED THROUGH MEDICAID AND PROVIDES DIRECT CARE SERVICES TO INDIVIDUALS WITH VARYING NEEDS. SERVICES ARE INDIVIDUALIZED TO MEET THE NEEDS OF THE INDIVIDUAL, ALLOWING THEM TO REMAIN AT HOME AND TO WORK AND PARTICIPATE IN ACTIVITIES IN THEIR COMMUNITY. 13771048 1 1 0 0 0 0 0 0 0 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 1 0 0 0 1 12 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X SCOTT HOFFMAN 4028963884 4980 SOUTH 118TH STREET OMAHA NE 68137 LINDA TIMMONS PRESIDENT 0.10 39.90 X X 0 616682 160451 SCOTT HOFFMAN TREASURER 0.10 39.90 X X 0 314488 62501 MARLIN WILKERSON DIRECTOR 0.10 39.90 X 0 256430 47270 MIKE LYONS SECRETARY 0.10 39.90 X X 0 261853 29051 JEN ZAJICEK DIRECTOR 0.10 39.90 X 0 128066 21602 0 1577519 320875 0 0 1 0 0 496642 496642 PROGRAM SERVICE REVENUE 624100 15977695 15977695 98604 98604 16076299 16572941 16076299 0 0 X 1243292 1243292 4387 4387 94102 94102 115768 115768 1133410 1133410 10360358 10197444 162914 23215 23215 301206 301206 132455 132455 13033 13033 328620 328620 975733 975733 81669 81669 BAD DEBT EXPENSE 238662 238662 MISCELLANEOUS EXPENSE 10746 10746 DUES, SUBSCRIPTIONS, LI 10716 10716 15067372 13771048 1296324 0 2706 176818 1396250 211715 2088400 2907310 8114 59946 28840 47371 31106 9161600 8800440 2030 799 12706471 12128188 1743667 697845 10099346 8678759 11843013 9376604 X 863458 2751584 863458 2751584 12706471 12128188 X 1505569 382557 X X 0 1 X 1 0 X X X 1 MOSAIC 113669999 10 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 49664 28840 20824 10282 10282 31106 DUE TO MOSAIC 1730806 LOAN PAYABLE TO AFFILIATE 6947953 8678759 X PART X, LINE 2: ALL CONSOLIDATED AFFILIATED ENTITIES, EXCEPT FOR MOSAIC HOUSING CORP V, INC., EASE-E MEDICAL, INC. AND BICO, LTD. ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OR 501(C)(2) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN MOSAIC'S TAX EXEMPT STATUS. MOSAIC RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. SUCH TAX POSITIONS, WHICH ARE MORE THAN 50% LIKELY OF BEING REALIZED, ARE MEASURED AT THEIR HIGHEST VALUE. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. DURING 2020 AND 2019, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS OTHER THAN DESCRIBED PREVIOUSLY. 0 0 0 0 0 0 0 0 0 LINDA TIMMONS PRESIDENT 0 487403 0 125000 0 4279 0 124663 0 35788 0 777133 0 0 SCOTT HOFFMAN TREASURER 0 273299 0 40000 0 1189 0 38213 0 24288 0 376989 0 0 MARLIN WILKERSON DIRECTOR 0 235505 0 20000 0 925 0 13252 0 34018 0 303700 0 0 MIKE LYONS SECRETARY 0 241018 0 20000 0 835 0 17387 0 11664 0 290904 0 0 SCHEDULE J, PART I, LINE 3: THE SALARIES OF LINDA TIMMONS AND SCOTT HOFFMAN ARE PAID FROM A RELATED ORGANIZATION, MOSAIC. MS. TIMMONS SERVES AS CEO OF MOSAIC. MR. HOFFMAN SERVES AS CFO OF MOSAIC. THE SALARY FOR MS. TIMMONS IS SET BY THE MOSAIC EXECUTIVE COMMITTEE AND MOSAIC BOARD OF DIRECTORS. MR. HOFFMAN'S SALARY IS SET BY THE CEO OF MOSAIC WORKING WITHIN THE SALARY RANGES ESTABLISHED BY THE EXECUTIVE COMMITTEE. MOSAIC'S BOARD AND EXECUTIVE COMMITTEE USE AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, AND A COMPENSATION SURVEY IN ESTABLISHING THE COMPENSATION OF THE PRESIDENT AND CEO OF MOSAIC AND GUIDELINES FOR OTHER KEY STAFF. SCHEDULE J, PART II, COLUMN C: MOSAIC EVALUATES THE LIABILITY RELATED TO THEIR POSTRETIREMENT BENEFITS (SALARY AND HEALTH INSURANCE CONTINUATION) THROUGH AN ACTUARIAL REVIEW. THE ADJUSTMENT IS INCLUDED IN RETIREMENT AND OTHER DEFERRED COMPENSATION. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION SHALL HAVE ONE MEMBER, MOSAIC, A NEBRASKA NON-PROFIT PUBLIC BENEFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE MOSAIC BOARD OF DIRECTORS APPOINTS OR ELECTS MOSAIC SENIOR SERVICES' BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION REQUIRE APPROVAL BY A MAJORITY OF THE MOSAIC BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY MOSAIC SENIOR SERVICE'S OUTSIDE INDEPENDENT AUDIT FIRM. THE RETURN IS REVIEWED BY MOSAIC SENIOR SERVICE'S TREASURER AND THE OUTSIDE INDEPENDENT AUDIT FIRM. A COPY IS SHARED WITH THE BOARD OF DIRECTORS PRIOR TO FILING FORM 990. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, EACH BOARD DIRECTOR COMPLETES A CONFLICT OF INTEREST FORM AND SUBMITS IT TO THE CHAIRPERSON OF THE MOSAIC BOARD INTEGRITY COMMITTEE. ANY FINANCIAL CONFLICTS OF INTEREST ARE REPORTED TO THE CHIEF FINANCIAL OFFICER/TREASURER FOR REPORTING ON THE FORM 990, IF APPROPRIATE. ANY NEW CONFLICTS OF INTEREST THAT ARISE DURING THE YEAR ARE REQUIRED TO BE REPORTED AT THAT TIME. FORM 990, PART VI, SECTION B, LINE 15 MOSAIC SENIOR SERVICES DOES NOT HAVE ANY EMPLOYEES, AND THEREFORE, THERE IS NOT AN ESTABLISHED PROCESS FOR DETERMINING COMPENSATION OF OFFICERS OR OTHER EMPLOYEES. THE FOLLOWING IS THE PROCEDURE USED BY MOSAIC, MOSAIC SENIOR SERVICES' SOLE MEMBER: THE BOARD OF DIRECTORS ESTABLISHED AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE IS RESPONSIBLE FOR: CONTRACTING WITH AN INDEPENDENT CONSULTANT TO DOCUMENT COMPARABLE COMPENSATION LEVELS PAID TO EXECUTIVES WITH SIMILAR POSITIONS AND RESPONSIBILITIES IN SIMILAR ORGANIZATIONS, HELPING THE COMMITTEE APPLY MOSAIC'S COMPENSATION PHILOSOPHY TO THE MARKET SURVEY DATA TO IDENTIFY SUPPORTABLE COMPENSATION LEVELS AND COMPENSATION RANGES, AND OPINING IN ADVANCE THAT RESULTING COMPENSATION RANGES ARE REASONABLE COMPENSATION. THE COMPENSATION CONSULTANT WILL ALSO ADVISE AND OPINE ON BENEFIT DESIGN, BENEFIT OPTIONS, AND REASONABLENESS OF BENEFIT AMOUNTS AS ELEMENTS OF COMPENSATION. THE EXECUTIVE COMMITTEE WILL ADOPT A COMPENSATION PHILOSOPHY FOR OFFICERS AND KEY EMPLOYEES GUIDED BY THE CONSULTANT'S INFORMATION AND USE THE COMPENSATION PHILOSOPHY TO APPROVE THE COMPENSATION OF THE CEO, APPROVE THE COMPENSATION RANGES FOR OTHER OFFICERS AND KEY EMPLOYEES, AND REPORT ITS ACTIONS TO THE FULL BOARD. THE CEO, WORKING WITHIN SALARY RANGES APPROVED BY THE EXECUTIVE COMMITTEE, SETS THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. MINUTES, DOCUMENTATION OF INDEPENDENT CONSULTANT COMPARABILITY DATA AND RECOMMENDATIONS ARE MAINTAINED AS PART OF THE RECORD OF THE EXECUTIVE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 MOSAIC SENIOR SERVICES DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 162,914. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 162,914. CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 72,913. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 72,913. CONTRACTED INDIVIDUAL CARE SERVICES: PROGRAM SERVICE EXPENSES 9,855,143. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,855,143. SUPPORTED, RESPITE, AND OTHER PROVIDER: PROGRAM SERVICE EXPENSES 269,388. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 269,388. FORM 990, PART XI, LINE 9: OTHER TRANSFER OF LIABILITIES 382,557. FORM 990, PART XII, LINE 2C: THE MOSAIC FINANCE AND AUDIT COMMITEE OVERSEES THE AUDIT & SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MOSAIC 4980 S 118 STREET OMAHA NE 68137 113669999 SERVICES FOR INDIVIDUALS WITH INTELLECTUAL DISABILITIES NE 501(C)(3) LINE 10 N/A 0 MOSAIC FOUNDATION 4980 S 118 STREET OMAHA NE 68137 363837360 FUNDRAISING & INVESTMENT ASSET MANAGEMENT NE 501(C)(3) LINE 12A, I MOSAIC 1 OAKS OF DUNN COUNTY INC 4980 S 118 STREET OMAHA NE 68137 391913323 SENIOR LIVING SERVICES WI 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP I 4980 S 118 STREET OMAHA NE 68137 363756911 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP II 4980 S 118 STREET OMAHA NE 68137 470773689 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP IV 4980 S 118 STREET OMAHA NE 68137 911823422 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP VII 4980 S 118 STREET OMAHA NE 68137 470828015 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP VIII 4980 S 118 STREET OMAHA NE 68137 470828012 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP IX 4980 S 118 STREET OMAHA NE 68137 742838413 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP X 4980 S 118 STREET OMAHA NE 68137 742908789 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XI 4980 S 118 STREET OMAHA NE 68137 311706640 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XII 4980 S 118 STREET OMAHA NE 68137 481297244 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XIII 4980 S 118 STREET OMAHA NE 68137 421626679 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XIV - ROCKFORD 4980 S 118 STREET OMAHA NE 68137 204417891 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XV - COUNCIL BLUFFS 4980 S 118 STREET OMAHA NE 68137 205765691 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XVI - FARMINGTON 4980 S 118 STREET OMAHA NE 68137 205765731 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XVII - BEATRICE 4980 S 118 STREET OMAHA NE 68137 261710013 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XVIII - OSCEOLA-WAUKON 4980 S 118 STREET OMAHA NE 68137 261710184 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XIX - WINFIELD 4980 S 118 STREET OMAHA NE 68137 261710259 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XX - GARDEN CITY 4980 S 118 STREET OMAHA NE 68137 264555206 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XXI - MEMPHIS 4980 S 118 STREET OMAHA NE 68137 264555313 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORP XXII - LOGAN 4980 S 118 STREET OMAHA NE 68137 273483415 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC HOUSING CORPORATION XXIII - AUSTIN 4980 S 118 STREET OMAHA NE 68137 710875364 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC ILLINOIS HOUSING I 4980 S 118 STREET OMAHA NE 68137 202997161 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC ILLINOIS HOUSING II 4980 S 118 STREET OMAHA NE 68137 204417645 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC ILLINOIS HOUSING AT MACOMB I 4980 S 118 STREET OMAHA NE 68137 204841909 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC ILLINOIS HOUSING OF ROCKFORD I 4980 S 118 STREET OMAHA NE 68137 204841856 LOW INCOME HOUSING NE 501(C)(3) LINE 10 MOSAIC 1 MOSAIC EMPLOYEE WELFARE BENEFIT PLAN 4980 S 118 STREET OMAHA NE 68137 383831874 EMPLOYEE WELFARE BENEFIT PLAN NE 501(C)(9) N/A MOSAIC 1 MOSAIC RESIDENTIAL SERVICES OF NEBRASKA LLC 4980 S 118 ST OMAHA NE 68137 271695051 LOW INCOME HOUSING NE N/A EASE-E MEDICAL INC 731 SOUTH 8TH STREET CANON CITY CO 81212 470842353 SALE OF MEDICAL EQUIPMENT AND SUPPLIES NE N/A C 1 MOSAIC HOUSING CORPORATION V 4980 S 118 ST OMAHA NE 68137 470805545 LOW INCOME HOUSING NE N/A C 1 BICO 4980 S 118 ST OMAHA NE 68137 CAPTIVE INSURANCE BD N/A C 1 CHARITABLE REMAINDER TRUSTS (3) INVESTMENT MANAGEMENT NE N/A T 1 0 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0