2020-07-09T15:49:30-05:00 2019-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2018-07-01 470391515 GOOD SHEPHERD LUTHERAN COMMUNITY GOOD 4024264663 2242 WRIGHT STREET BLAIR NE 68008 SHARON COLLING CEO/ADMINISTRATOR 4024264663 2020-07-08 1 MARC D BEHRENS P01543366 4023302660 163.116.133.115 2020-07-08 09:27:17 CD P 269B3A6CFEBE93A73A929783B6584231D56B63A4 606148D43A08485A4B3CE148BC63DC11C84FD005 2018 2021-01-29 14:40:06Z SHARON COLLING 2242 WRIGHT STREET BLAIR NE 68008 5559982 0 9386 X WWW.GOODSHEPHERDBLAIR.COM X 1961 NE THE MISSION OF GOOD SHEPHERD LUTHERAN COMMUNITY IS TO SERVE THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF GOD'S PEOPLE IN A MANNER OF LOVE, DIGNITY AND RESPECT REFLECTIVE OF JESUS CHRIST, THE GOOD SHEPHERD. 7 7 129 17 0 0 27022 18172 4801534 4913732 85614 140132 117644 64134 5031814 5136170 0 0 0 0 3507692 2990325 0 0 14435 3362763 3670147 6870455 6660472 -1838641 -1524302 5415338 4394791 2215237 2717173 3200101 1677618 THE MISSION OF GOOD SHEPHERD LUTHERAN COMMUNITY IS TO SERVE THE SOCIAL, PHYSICAL, AND SPIRITUAL NEEDS OF GOD'S PEOPLE IN A MANNER OF LOVE, DIGNITY AND RESPECT REFLECTIVE OF JESUS CHRIST, THE GOOD SHEPHERD. 0 0 5089778 4347961 GOOD SHEPHERD LUTHERAN COMMUNITY OPERATES A 84-BED SKILLED NURSING FACILITY FOR ELDERLY, INVALID AND INDIGENT PERSONS, WHICH OFFERS PRIVATE AND SEMI-PRIVATE ROOMS, AS WELL AS A SECURED MEMORY SUPPORT UNIT. 443583 602009 GOOD SHEPHERD LUTHERAN COMMUNITY OPERATES A 12-UNIT ASSISTED LIVING FACILITY FOR ELDERLY, INVALID AND INDIGENT PERSONS, AND A 24-UNIT INDEPENDENT LIVING APARTMENT COMPLEX FOR ELDERLY PERSONS. 5533361 1 0 0 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 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 0 0 1 1 0 0 0 1 14 0 1 129 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X TERESA HILLMAN OFFICE MANAGER 4024264663 2242 WRIGHT STREET BLAIR NE 68008 PASTOR SEAN TYLER PRESIDENT 1.00 1.00 X X 0 0 0 DAVE LADWIG VICE PRESIDENT 1.00 1.00 X X 0 0 0 NANCY KRUSE TREASURER 1.00 1.00 X X 0 0 0 JUDY HANSEN SECRETARY 1.00 1.00 X X 0 0 0 JANE HEINRICH PRESIDENT THRU 10/2018 1.00 1.00 X X 0 0 0 KEN MCELHOSE VICE PRESIDENT THRU 10/2018 1.00 1.00 X X 0 0 0 SANDY MCMULLEN TREASURER THRU 10/2018 1.00 1.00 X X 0 0 0 ANNE CLAUSEN MEMBER 1.00 1.00 X 0 0 0 DIANNA OLSON MEMBER 1.00 1.00 X 0 0 0 MARVIN HEISE MEMBER 1.00 1.00 X 0 0 0 JOHN TIMMERMIER MEMBER THRU 10/2018 1.00 1.00 X 0 0 0 JOSEPH M ROMSHEK CEO/ADMINISTRATOR 39.00 1.00 X 78359 0 6954 MARY POWELL CEO/ADMINISTRATOR THRU 12/2018 39.00 1.00 X 88756 0 0 TERESA HILLMAN OFFICE MANAGER 39.00 1.00 X 67917 0 11260 235032 0 18214 2 0 0 0 INFINITY REHAB 25117 SW PARKWAY AVE WILSONVILLE OR 97070 THERAPY SERVICES 279352 LANTERN HEALTH SERVICES 10430 N 152ND CT WAVERLY NE 68462 CONSULTING SERVICES 236155 MEDICAL STAFFING NETWORK 13057 W CENTER RD SUITE 24 OMAHA NE 68144 NURSING STAFFING AGENCY 186976 SYSCO LINCOLN 900 KINGBIRD RD LINCOLN NE 68521 FOOD SERVICE 146596 TMS DESIGN SERVICES 10208 L ST STE 1 OMAHA NE 68127 NURSING STAFFING AGENCY 108996 5 18172 18172 MEDICARE/MEDICAID PAYM 623000 3198688 3198688 PRIVATE PAY PATIENT RE 623000 1715044 1715044 4913732 14272 14272 549672 413582 10230 136090 -10230 125860 125860 MISCELLANEOUS INCOME 900099 34828 34828 GUEST AND VISITOR MEAL 900099 19756 19756 RESIDENT HAIR CARE 900099 8140 8140 1410 1410 64134 5136170 4949970 0 168028 X 253245 88756 164489 2251619 2159646 82792 9181 280821 268540 11213 1068 204640 176536 27484 620 31620 795 30825 68430 5200 63230 1061763 560299 501464 23751 2493 18050 3208 373727 349152 24217 358 183600 179248 4352 3634 2017 1617 6191 1272 4919 438152 432640 5512 158621 33942 124679 MEDICAL SUPPLIES 891785 890005 1780 FOOD SUPPLIES 193979 193787 192 BAD DEBTS 183991 183991 DUES & SUBSCRIPTIONS 37435 2506 34929 13468 2536 10932 6660472 5533361 1112676 14435 598976 410854 461205 491341 23808 23808 11837 15449 11220094 8222611 3398314 2997483 533069 326705 338145 61424 117711 5415338 4394791 870153 1244499 830720 1001647 291651 185854 222713 285173 2215237 2717173 X 3063631 1610292 136470 67326 3200101 1677618 5415338 4394791 -1524302 1819 0 X X 0 1 X 1 0 X 36745 163737 119277 27022 18172 364953 5918760 5820737 6159300 4801534 4913732 27614063 66370 53637 98827 37957 256791 6021875 6038111 6377404 4866513 4931904 28235807 1150 1150 60 385 2745 14001 2827 16828 1150 15151 2827 60 385 19573 28216234 67701 61828 62124 39274 14272 245199 67701 61828 62124 39274 14272 245199 677725 677725 6089576 6099939 7117253 4905787 4946176 29158731 0.96770 0.96790 0.00840 0.00940 X 136470 1500 312 70956 67326 131184 1500 3786 136470 121191 1500 8493 131184 123971 1500 -4280 121191 127875 1500 -5404 123971 0.00000 1.00000 0.00000 0 0 11500 11500 9248949 6700841 2548108 1597467 1233138 364329 362178 288632 73546 2997483 ELCA ENDOWMENT FUND POOLED TRUST FUND A 338145 F 338145 LINE OF CREDIT 272473 REFUNDABLE ADVANCES 12700 285173 X 4953998 1819 1819 4952179 183991 183991 5136170 6476481 0 6476481 183991 183991 6660472 PART V, LINE 4: THE COMMUNITY HOLDS ENDOWMENT FUNDS FOR SUPPORT OF ITS PROGRAMS. PART X, LINE 2: THE COMMUNITY IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL AND NEBRASKA STATE 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 THE COMMUNITY'S TAX EXEMPT STATUS. THE COMMUNITY ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE COMMUNITY RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2019 AND 2018, THE COMMUNITY HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 183,991. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 183,991. A HOSPITAL AUTHORITY NO 1 OF WASHINGTON COUNTY NEBRASKA 521441599 NONEAVAIL 2003-08-07 1794683 RETIRE OTHER OUTSTANDING DEBT & CONSTRUCTION OF ASSISTED LIVING FACILITY 0 0 0 A 1620792 1794683 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 1 0 0 0 0 A 0 FORM 990, PART VI, SECTION B, LINE 11B THE OFFICE MANAGER AND/OR CEO/ADMINISTRATOR WILL REVIEW THE RETURN, NOTIFY THE TAX PREPARER OF APPROVAL AND THE RETURN WILL BE SUBMITTED TO THE IRS. THE RETURN WILL BE DISCUSSED AT A MONTHLY BOARD OF DIRECTORS MEETING AND THE OFFICE MANAGER AND/OR CEO/ADMINISTRATOR WILL BE AVAILABLE FOR DISCUSSION AND QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS MONITORED ON AN ONGOING BASIS IN SEVERAL WAYS. FIRST, ANNUALLY ALL STAFF MEMBERS ARE REQUIRED TO ATTEND TRAINING SESSIONS ON REPORTING FRAUD AND ABUSE AS WELL AS ANNUALLY FILL OUT A SELF-DISCLOSURE FORM INDICATING ANY WRONGDOING OR KNOWN CONFLICTS. ALSO, BEFORE EMPLOYMENT, POTENTIAL EMPLOYEES ARE SCREENED (1) THROUGH BACKGROUND CHECKS AND (2) BY THE CEO/ADMINISTRATOR FOR POTENTIAL CONFLICTS OF INTEREST. GOOD SHEPHERD LUTHERAN COMMUNITY ALSO PARTNERS WITH EIGHT LUTHERAN "CORPORATE" CHURCHES WHO PROVIDE MEMBERS FOR THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS DETERMINES THE CEO/ADMINISTRATOR'S ANNUAL COMPENSATION PACKET THROUGH A WRITTEN ANNUAL REVIEW PROCESS AND AN INDEPENDENT VOTE. THE CEO/ADMINISTRATOR GENERALLY RECEIVES A PERCENTAGE INCREASE ANNUALLY. ALL OTHER COMPENSATION INCREASES ARE APPROVED BY DEPARTMENT SUPERVISORS AND THE ADMINISTRATOR, WHICH ARE THEN PLACED IN THE BUDGET. THE BOARD OF DIRECTORS APPROVES THE BUDGET ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE MADE AVAILABLE UPON REQUEST AND AT GOOD SHEPHERD LUTHERAN COMMUNITY'S ANNUAL PUBLIC MEETING, WHICH IS HELD THE THIRD THURSDAY IN OCTOBER EACH YEAR. FORM 990, PART IX, LINE 11G CONTRACT SERVICE FEES: PROGRAM SERVICE EXPENSES 560,299. MANAGEMENT AND GENERAL EXPENSES 501,464. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,061,763. FORM 990, PART XI LINE 2C: THE BOARD OF DIRECTORS TAKES RESPONSIBLITY FOR CHOOSING THE INDEPENDENT ACCOUNTANT AND FOR THE AUDIT OF THE FINANCIAL STATEMENTS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. GOOD SHEPHERD ASSISTED LIVING CORPORATION 2242 WRIGHT STREET BLAIR NE 68008 470819116 ELDERLY APARTMENTS NE 501(C)(3) LINE 7 GOOD SHEPHERD LUTHERAN COMMUNITY 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 0