2021-11-12T07:15:13-06:00 2020-12-31 352123203 KSM BUSINESS SERVICES INC PO BOX 40857 INDIANAPOLIS IN 46240 990 2020-01-01 352187477 INDIANA MASONIC HOME INC INDI 3177366141 690 STATE STREET FRANKLIN IN 46131 MIKE SPENCER CEO 3177366141 2021-10-22 1 MIKE SPENCER 999009999 SCOTT A SCHUSTER P00019243 3175802000 2021-10-22 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z COMPASS PARK MIKE SPENCER 690 STATE STREET FRANKLIN IN 46131 19878981 0 X WWW.COMPASSPARK.ORG X 2003 IN TO SERVE THE CHARITABLE PURPOSE OF OPERATING THE CONTINUING CARE RETIREMENT COMMUNITY KNOWN AS THE INDIANA MASONIC HOME IN FRANKLIN, INDIANA. 19 17 451 17 340310 0 3835499 6421956 7221619 9208189 372067 362693 1367928 710035 12797113 16702873 0 0 0 0 6232936 5626138 0 0 0 4544398 7678244 10777334 13304382 2019779 3398491 104412370 115983648 42790034 50553302 61622336 65430346 X THE HOME IS A NONPROFIT ORGANIZATION OPERATED PRIMARILY FOR THE BENEFIT OF MEMBERS OF INDIANA MASONIC LODGES AND ORDER OF EASTERN STAR. THE HOME PROVIDES HOUSING, HEALTH CARE, AND OTHER RELATED SERVICES TO RESIDENTS THROUGH THE OPERATION OF A RETIREMENT FACILITY CONTAINING INDEPENDENT LIVING HOMES AND APARTMENTS, ASSISTED LIVING APARTMENTS, AND A HEALTH CARE FACILITY LOCATED IN FRANKLIN, INDIANA. 0 0 10344456 9208189 PROVIDE CARE FOR THE AGED. 10344456 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 1 36 0 1 451 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 19 17 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 IN X MIKE SPENCER 3173461404 690 STATE STREET FRANKLIN IN 46131 MIKE SPENCER CEO 40.00 X 243744 0 0 RICHARD J ELMAN GRAND SECRETARY 1.00 41.30 X X 0 99338 0 ERIC J VERMEULEN BOARD MEMBER 1.00 40.00 X 0 90000 0 JEFFREY K SAUNDERS BOARD CHAIRMAN 1.00 X X 0 0 0 GARY W BRINLEY TREASURER 1.00 6.00 X X 0 0 0 RODNEY A MANN VICE PRESIDENT 1.00 0.30 X X 0 0 0 JILL RICE BOARD MEMBER 1.00 X 0 0 0 RONALD L BUSKIRK BOARD MEMBER 1.00 X 0 0 0 RICHARD L LENTZ BOARD MEMBER 1.00 5.00 X 0 0 0 WILLIAM S REINERS BOARD MEMBER 1.00 X 0 0 0 PAUL C ST PIERRE BOARD MEMBER 1.00 X 0 0 0 WILLIAM J LUDLOW BOARD MEMBER 1.00 X 0 0 0 CARL E CULMANN BOARD MEMBER 1.00 0.30 X 0 0 0 KENNETH ROY BOARD MEMBER 1.00 41.00 X 0 0 0 DANIEL MARTIN BOARD MEMBER 1.00 5.30 X 0 0 0 MICHAEL H DAVIS BOARD MEMBER 1.00 X 0 0 0 DON R REYNOLDS II BOARD MEMBER 1.00 X 0 0 0 JERRY B MAPLE BOARD MEMBER 1.00 X 0 0 0 STEVEN A BATES BOARD MEMBER 1.00 X 0 0 0 ZACHARY R EHLERS BOARD MEMBER 1.00 X 0 0 0 243744 189338 0 1 0 1 0 STAR ENVIRONMENTAL INC 2215 ALVORD ST INDIANAPOLIS IN 46205 ENVIRONMENTAL 976108 GORDON FOOD SERVICE 3620 BETHANY ROAD INDIANAPOLIS IN 46268 FOOD SERVICES 581909 HTS IN X INC 1500 AMERICAN WAY SUITE 110 GREENWOOD IN 46143 THERAPY 567569 SHIEL SEXTON COMPANY INC 902 N CAPITAL AVENUE SUITE 200 INDIANAPOLIS IN 46204 CONSTRUCTION SERVICES 466087 MCGOWAN INSURANCE GROUP 355 INDIANA AVE SUITE 200 INDIANAPOLIS IN 46204 INSURANCE BROKERAGE 390298 14 428415 3603617 2389924 6421956 RESIDENCE SERVICES 623000 4065246 4065246 MANAGEMENT FEES 623000 1792818 1792818 HOME HEALTH CARE 623000 1680625 1680625 HEALTH CARE FACILITY 623000 1669500 1669500 9208189 163580 163580 3374471 3175358 199113 199113 199113 750 -750 -750 OTHER INCOME 623990 389955 19480 370475 DAYCARE INCOME 624410 320830 320830 710785 16702873 9208189 340310 732418 243744 243744 2765347 2211958 553389 4878 4878 1758344 1431557 326787 853825 778833 74992 65837 65837 75672 75672 41766 41766 213469 54530 158939 95970 95970 553927 186879 367048 65663 13813 51850 596004 486788 109216 75913 73223 2690 545930 447663 98267 160952 73067 87885 190277 190277 SNRC DEMOLITION EXPENSE 1768916 1768916 NON OPERATING EXPENSES 968291 897339 70952 MEDICAL FEES, DRUGS, & 740625 740625 FOOD SERVICES 527271 457306 69965 991761 717081 274680 13304382 10344456 2959926 0 1537144 4396363 196186 457492 65812 54921 130143 6623894 6167815 502301 456079 8086063 8548191 240001 240001 93784863 101700458 104412370 115983648 1600847 1253886 3785932 5009273 36243012 44108149 1160243 181994 42790034 50553302 X -31926174 -34765353 93548510 100195699 61622336 65430346 104412370 115983648 X 3398491 375312 34207 X X 0 1 X 1 0 X 4769063 17970296 4970913 3828426 6421956 37960654 8449007 6661785 7612889 7221619 9208189 39153489 13218070 24632081 12583802 11050045 15630145 77114143 3650638 15648772 3648604 2758651 3603617 29310282 481426 1837593 1110799 3311484 6741302 3650638 16130198 5486197 3869450 6915101 36051584 41062559 1876103 1951489 221775 166549 163580 4379496 384072 340310 724382 1876103 1951489 221775 550621 503890 5103878 8984 8984 84046 273856 261617 974872 370475 1964866 15178219 26857426 13067194 12584522 16504510 84191871 0.48770 0.48000 0.06060 0.07270 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: AUDIT ADJUSTMENT AND RECLASSIFICATIONS - 2019 AMOUNT: $ 672,273. OTHER INCOME - 2016 AMOUNT: $ 84,046. 2017 AMOUNT: $ 273,856. 2018 AMOUNT: $ 261,617. 2019 AMOUNT: $ 302,599. 2020 AMOUNT: $ 370,475. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5174078 4842415 331663 1449816 1325400 124416 456079 INTEREST IN NET ASSETS OF FOUNDATION 97675777 BENEFICIAL INTEREST IN TRUST 2486358 RECEIVABLE FROM DAVIESS COUNTY HOSPITAL 1538323 101700458 RESIDENT DEPOSITS 181994 181994 X 17037169 375312 750 376062 16661107 41766 41766 16702873 13263366 750 750 13262616 41766 41766 13304382 PART X, LINE 2: THE HOME IS EXEMPT FROM THE PAYMENT OF INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE THOUGH IT IS SUBJECT TO TAX ON INCOME UNRELATED TO ITS EXEMPT PURPOSE, UNLESS THAT INCOME IS OTHERWISE EXCLUDED BY THE INTERNAL REVENUE CODE. IN ADDITION, THE HOME HAS BEEN DETERMINED BY THE INTERNAL REVENUE SERVICE NOT TO BE A PRIVATE FOUNDATION WITHIN THE MEANING OF SECTION 509(A) OF THE INTERNAL REVENUE CODE. THERE WAS NO UNRELATED BUSINESS INCOME TAX FOR THE PERIOD ENDED DECEMBER 31, 2020 AND THE YEAR ENDED DECEMBER 31, 2019. THE HOME FILES U.S. FEDERAL AND STATE OF INDIANA INFORMATION RETURNS. IT IS NO LONGER SUBJECT TO U.S. FEDERAL AND STATE INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR FISCAL YEARS BEFORE 2017. MANAGEMENT BELIEVES THAT THE HOME'S INCOME TAX FILING POSITION WILL BE SUSTAINED ON AUDIT AND DOES NOT ANTICIAPTE ANY ADJUSTMENTS THAT WILL RESULT IN A MATERIAL CHANGE. PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM SPECIAL EVENT 750. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM SPECIAL EVENT 750. X 0 0 0 0 0 0 0 0 0 MIKE SPENCER CEO 243744 0 0 0 0 0 0 0 0 0 243744 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B MANAGEMENT WILL REVIEW THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C CEO SOLICITS INFORMATION ANNUALLY ON POTENTIAL CONFLICTS OF INTEREST. INFORMATION IS REVIEWED BY CEO AND PRESIDENT OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION IS DETERMINED USING COMPARABILITY DATA, APPROVED BY THE BOARD AND DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE UPON REQUEST. ANNUAL STATE DISCLOSURE STATEMENT IS AVAILABLE TO ALL POTENTIAL NEW RESIDENTS. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS -3,603,617. CHANGE IN INTEREST IN NET ASSETS OF THE FOUNDATION 10,070,027. CHANGE IN BENEFICIAL INTEREST IN TRUST 180,779. TRANSFER OF ASSETS TO INDIANA MASONIC HOME, INC. -6,612,982. FORM 990, PART XII, LINE 2C THE PROCESS HAD NOT CHANGED. FORM 990, PART VI, SECTION B, LINE 14 RECORD RETENTION AND DESTRUCTION POLICY MEDICAL RECORDS OF THE ORGANIZATION ARE GOVERNED BY A RETENTION AND STORAGE POLICY, AS WELL AS A CLOSED CHART POLICY. INDIANA MASONIC HOME FOUNDATION INC 525 N ILLINOIS ST INDIANAPOLIS IN 46204 351091997 PROVIDE SUPPORT TO THE INDIANA MASONIC HOME IN 501(C)(3) LINE 12D, III-O N/A 0 IMH REALTY INC 690 STATE STREET FRANKLIN IN 46131 364513246 PROVIDE PROPERTY TO ENSURE THE RESIDENTIAL AND MEDICAL CARE FOR THE ELDERLY IN 501(C)(2) N/A 0 GRAND LODGE FREE AND ACCEPTED MASONS OF THE STATE OF INDIANA 525 N ILLINOIS ST INDIANAPOLIS IN 46204 350300010 FRATERNAL ORGANIZATION IN 501(C)(8) & (C)(10) N/A 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 IMH REALTY I 6612982 FAIR MARKET VALUE INDIANA MASONIC HOME FOUNDATION C 3603617 CASH