2013-11-12T14:48:54-06:00 2013-06-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2012-07-01 113669999 MOSAIC MOSA 4028963884 4980 SOUTH 118TH ST LIND CENTER NO A OMAHA NE 68137 CYNTHIA L SCHROEDER 4028963884 2013-11-07 1 JULIE M GERKEN P00400882 4023302660 2012 2016-02-24 21:20:13Z CYNTHIA L SCHROEDER 4980 SOUTH 118TH ST LIND CENTER NO A OMAHA NE 68137 213023447 0 X WWW.MOSAICINFO.ORG X 2003 NE EMBRACING GOD'S CALL TO SERVE IN THE WORLD, MOSAIC ADVOCATES FOR PEOPLE WITH INTELLECTUAL DISABILITIES AND PROVIDES OPPORTUNITIES FOR THEM TO ENJOY A FULL LIFE. 13 13 7900 0 67279 0 11987089 7504201 191867535 200856466 712147 150581 4522813 3867703 209089584 212378951 249129 2461110 0 0 144706934 152782888 0 0 0 58238531 59929048 203194594 215173046 5894990 -2794095 106985926 107546734 47592113 50675365 59393813 56871369 X EMBRACING GOD'S CALL TO SERVE IN THE WORLD, MOSAIC ADVOCATES FOR PEOPLE WITH INTELLECTUAL DISABILITIES AND PROVIDES OPPORTUNITIES FOR THEM TO ENJOY A FULL LIFE. 0 0 62000026 63665791 INTERMEDIATE CARE FACILITIES (ICF)--ICF SERVICES PROVIDE 24/7 SUPPORT FOR VERY MEDICALLY FRAGILE INDIVIDUALS WITH INTELLECTUAL OR DEVELOPMENTAL DISABILITIES. MOSAIC SERVES APPROXIMATELY 480 INDIVIDUALS ACROSS THE UNITED STATES UNDER THIS SERVICE CATEGORY. 105058973 107881610 COMMUNITY BASED SERVICES PROVIDED TO PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES ARE SERVICES THAT CAN EITHER BE ON-GOING OR INTERMITTENT SUCH AS RESPITE, FAMILY SUPPORT, FOSTER CARE, PHYSICAL THERAPIES, TRANSPORTATION, AND SUPPORTED EMPLOYMENT. MOSAIC SERVES APPROXIMATELY 2,670 INDIVIDUALS ACROSS THE UNITED STATES UNDER THIS SERVICE CATEGORY. 17566334 18038291 DAY AND VOCATIONAL SERVICES ARE PROVIDED TO INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES IN A VARIETY OF WAYS INCLUDING SUPPORTED EMPLOYMENT, WORK ENCLAVES, VOCATIONAL TRAINING AND SOME SHELTERED WORKSHOPS. MOSAIC SERVES APPROXIMATELY 1,630 INDIVIDUALS ACROSS THE UNITED STATES UNDER THIS SERVICE CATEGORY. 10975883 2461110 11270774 MISCELLANEOUS SERVICES PROVIDED TO INDIVIDUALS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. 10975883 2461110 11270774 195601216 1 1 0 1 0 0 1 0 1 1 1 0 0 1 1 1 0 1 0 0 0 1 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 1 0 1 0 1 642 0 1 7900 1 1 1 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 AZ TN UT X X CYNTHIA L SCHROEDER 4028963884 4980 SOUTH 118TH STREET OMAHA NE 68137 MAX MILLER 1.50 0.00 X X 0 0 0 JAMES ZILS 1.50 0.00 X X 0 0 0 LISA NAGSTAD 1.50 0.00 X X 0 0 0 KATHY PATRICK 1.50 0.00 X X 0 0 0 KEITH HOHLY 1.50 0.00 X 0 0 0 DR JOE DERDZINKSI 1.50 0.00 X 0 0 0 KATHLEEN BENTON 1.50 0.00 X 0 0 0 DR DOUGLAS HILLMAN 1.50 0.00 X 0 0 0 REV DANETTE JOHNS 1.50 0.00 X 0 0 0 JOSEPH TURKOWSKI 1.50 0.00 X 0 0 0 CHARLES WALKER 1.50 0.00 X 0 0 0 CAROL MILLER 1.50 0.00 X 0 0 0 SUSAN FLACK 1.50 0.00 X 0 0 0 LINDA TIMMONS 39.90 0.10 X 438402 0 31676 CINDY SCHROEDER 39.80 0.20 X 395814 0 31811 RAUL SALDIVAR 40.00 0.00 X 302534 0 31676 PAM BENNER 40.00 0.00 X 168256 0 25447 KEITH SCHMODE 39.90 0.10 X 231598 0 28988 DONNA WERNER 40.00 0.00 X 165025 0 26398 DEAN WILSON 38.00 2.00 X 212543 0 14061 KEITH COURIER 40.00 0.00 X 169269 0 36676 MARLIN WILKERSON 40.00 0.00 X 137384 0 14676 TAMMY WESTFALL 40.00 0.00 X 135988 0 14676 NANCY DAVIS 40.00 0.00 X 135400 0 14676 DAVID JACOX 40.00 0.00 X 378775 0 11736 2870988 0 282497 27 1 1 0 BENEVON 4528 8TH AVE NE STE 1A SEATTLE WA 98105 FUNDRAISING 777601 ADP INC PO BOX 842875 BOSTON MA 022842875 PAYROLL SERVICES 368174 ORACLE AMERICA INC PO BOX 203448 DALLAS TX 753203448 SOFTWARE SUPPORT 335337 RW SORENSEN CONSTRUCTION 2500 W 24TH STREET KEARNEY NE 68845 CONSTRUCTION SERVCIES 292234 LAMBRECHT GLASS STUDIO INC 715 S 12TH STREET OMAHA NE 68102 CONSTRUCTION SERVCIES 250800 10 7362239 141962 7504201 MEDICARE/MEDICAID PAYM 624100 194450196 194450196 PROGRAM SERVICE REVENU 624100 5116287 5116287 RENTAL INCOME 532000 1017564 1017564 MANAGEMENT FEES 541610 272419 272419 200856466 135576 135576 167514 491987 147246 497250 20268 -5263 15005 15005 CONSULTING INCOME 541610 2738281 2738281 FARM REVENUE 900099 618276 618276 PURCHASING CARD REBATE 900099 139890 139890 371256 303977 67279 3867703 212378951 204656890 67279 150581 2315734 2315734 145376 145376 1877625 979922 897703 109807 109807 116922233 107153865 9768368 519240 340834 178406 24655778 22969435 1686343 8698205 7980788 717417 231707 231707 190458 190458 6928 6928 19256657 17595469 1661188 15211607 13880963 1330644 9185263 8800747 384516 3857357 2843733 1013624 58693 96 58597 1237091 1180898 56193 5013594 4358615 654979 2015177 1990118 25059 OTHER EXPENSES 1537677 1251676 286001 CFR EXPENSE 1005778 1005778 DUES & MEMBERSHIPS 727364 406544 320820 FARM EXPENSE 296363 296363 97334 97334 215173046 195601216 19571830 0 10302933 17232928 1493657 1502341 20867938 20251849 2131403 1993298 113816409 62185097 53211398 51631312 8725418 5087257 10253179 9847749 106985926 107546734 16545464 17940066 320460 1020910 26041173 22766081 4685016 8948308 47592113 50675365 X 58609925 56093076 783888 778293 59393813 56871369 106985926 107546734 -2794095 271651 0 X X 0 1 X 1 1 1 X 2141757 2500657 4423726 11987089 7504201 28557430 198102971 179757724 190885502 191867535 200856466 961470198 200244728 182258381 195309228 203854624 208360667 990027628 2380 2231 3964 5012 3536 17123 0 2380 2231 3964 5012 3536 17123 990010505 210743 105807 228597 268804 135576 949527 67279 67279 210743 105807 228597 268804 202855 1016806 3685816 3664948 3274356 4522813 3800424 18948357 204141287 186029136 198812181 208646241 212363946 1009992791 0.98020 0.97980 0.00100 0.00140 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 1 0 0 1 56994 1 0 56994 0 X X X 1 80.00 0 0 0 1 0 100.00 0 1 1 1 0 34764985 2848409 3247117 6546591 34313920 37485223 2919416 1425808 7065462 34764985 31346898 1919339 5843950 1624964 37485223 26463411 3159195 3043881 1319589 31346898 30337771 1724683 -4010130 1588913 26463411 0.86880 0.10940 0.02180 0 1 1 6805543 6805543 80292381 41685153 38607228 1985079 1489740 495339 11963737 9727484 2236253 12769669 9282720 3486949 51631312 AFFILIATE RECEIVABLES 3794262 MISCELLANEOUS RECEIVABLES 844514 INTERUNIT RECEIVABLE 360972 INVESTMENT ESCROW ACCOUNT 809483 INTANGIBLE ASSETS 4038518 9847749 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS- MEDICAID 6254103 REFUNDABLE FEES 575037 CRATS PAYABLE 884054 LIABILITY FOR PENSION BENEFITS 1237355 INTEREST RATE SWAP, NET -2241 8948308 X 232384748 271651 19734146 20005797 212378951 0 212378951 234907192 19734146 19734146 215173046 0 215173046 DESCRIPTION OF HOW ORGANIZATION REPORTS CONSERVATION EASEMENTS: PART II, LINE 9: THE FINANCIAL STATEMENTS FOR MOSAIC AND ITS AFFILIATES DO NOT CONTAIN ANY INFORMATION REGARDING THE CONSERVATION EASEMENT. PART IV, LINE 1B: MOSAIC IS THE REPRESENTATIVE-PAYEE FOR THE PERSONAL FUNDS OF A NUMBER OF INDIVIDUALS IN SERVICE. MOSAIC DOES NOT OWN THE ACCOUNTS. THE ACCOUNTING FOR SUCH ACTIVITIES OCCURS AT THE AGENCY LEVEL AND AN AGGREGATE ACCOUNTING OF SUCH SERVICES IS NOT POSSIBLE. MOSAIC ALSO DOES NOT TRACK THE BALANCES OF THE ACCOUNTS WHICH ARE OWNED BY RESIDENTS OF ITS FACILITIES. $1 IS ENTERED ON PART IV, LINE 1C AND F BECAUSE THE ACTUAL TOTAL IS NOT KNOWN. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS ARE INTENDED FOR SUPPORT OF MOSAIC'S LONG TERM COMMITMENT TO ITS MISSION AND FOR CAPITAL IMPROVEMENTS AND GENERAL OPERATIONS. THE ENDOWMENT FUNDS ARE HELD BY THE MOSAIC FOUNDATION. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ALL CONSOLIDATED AFFILIATED ENTITIES, EXCEPT FOR MOSAIC HOUSING CORP V, INC. BETHPHAGE RESIDENTIAL SERVICES, AND EASE-E MEDICAL, INC. 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. IN GENERAL, SUCH STANDARDS REQUIRE MOSAIC TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. MOSAIC IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR THE YEARS ENDED PRIOR TO JUNE 30, 2010. 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 2013 AND 2012, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS OTHER THAN DESCRIBED PREVIOUSLY. PART XI, LINE 2D - OTHER ADJUSTMENTS: ELIMINATION OF INTERNAL MANAGEMENT FEES 19,734,146. PART XII, LINE 2D - OTHER ADJUSTMENTS: ELIMINATION OF INTERNAL MANAGEMENT FEES 19,734,146. 0 0 0 0 0 0 0 0 0 0 EUROPE SUPPORT DEVELOPMENT OF SERVICES FOR PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. RESIDENTIAL & VOCATIONAL SUPPORT FOR CHILDREN WITH DISABILITIES WHO FORMERLY LIVED IN STATE-RUN INSTITUTIONS. 80000 WIRE TRANSFER SUB-SAHARAN AFRICA SUPPORT DEVELOPMENT OF SERVICES FOR PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. CENTER-BASED AND IN-HOME SUPPORT FOR CHILDREN WITH DISABILITIES AND THEIR CAREGIVERS. 41000 WIRE TRANSFER EUROPE SUPPORT DEVELOPMENT OF SERVICES FOR PEOPLE WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. 24376 WIRE TRANSFER 3 0 0 0 1 0 0 0 X X X 0 THE GEIS GROUP 684 DILLON DRIVE OMAHA NE 68131 CONSULTING 0 0 13624 0 BENEVON 4528 8TH AVE SUITE 1A SEATTLE WA 98105 CONSULTING & TRAINING 0 0 779588 0 793212 AL AZ AR CA CO CT DC FL GA IL KS KY LA ME MD MA MN NM OK OR RI TN UT WA WI 1 MOSAIC HOUSING CORPORATION IV 4980 S 118 ST OMAHA NE 68137 911823422 501(C)(3) 67935 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION V 4980 S 118 ST OMAHA NE 68137 470805545 646074 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION V 4980 S 118 ST OMAHA NE 68137 470805545 134124 CURRENT YEAR PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION VII 4980 S 118 ST OMAHA NE 68137 470828015 501(C)(3) 43985 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION VIII 4980 S 118 ST OMAHA NE 68137 470828012 501(C)(3) 50947 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION XII 4980 S 118 ST OMAHA NE 68137 481297244 501(C)(3) 93389 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION XII 4980 S 118 ST OMAHA NE 68137 481297244 501(C)(3) 6715 CURRENT YEAR PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION XIII 4980 S 118 ST OMAHA NE 68137 421626679 501(C)(3) 4841 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION XIII 4980 S 118 ST OMAHA NE 68137 421626679 501(C)(3) 5000 CURRENT YEAR PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION XIV 4980 S 118 ST OMAHA NE 68137 204417891 501(C)(3) 43772 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION XV 4980 S 118 ST OMAHA NE 68137 205765691 501(C)(3) 186564 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION XVI 4980 S 118 ST OMAHA NE 68137 205765731 501(C)(3) 232480 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION XVII 4980 S 118 ST OMAHA NE 68137 261710013 501(C)(3) 110840 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION XVIII 4980 S 118 ST OMAHA NE 68137 261710184 501(C)(3) 90756 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION XIX 4980 S 118 ST OMAHA NE 68137 261710259 501(C)(3) 117359 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION XX 4980 S 118 ST OMAHA NE 68137 264555206 501(C)(3) 101950 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC HOUSING CORPORATION XXII 4980 S 118 ST OMAHA NE 68137 273483415 501(C)(3) 231261 CURRENT YEAR PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC ILLINOIS HOUSING 1 4980 S 118 ST OMAHA NE 68137 202997161 501(C)(3) 10000 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC ILLINOIS HOUSING 2 4980 S 118 ST OMAHA NE 68137 204417645 501(C)(3) 16618 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. MOSAIC ILLINOIS HOUSING OF ROCKFORD 1 4980 S 118 ST OMAHA NE 68137 204841856 501(C)(3) 111624 PRIOR YEARS PAYMENTS - THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. 16 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE GRANT PROVIDED IS TO A RELATED ORGANIZATION TO FURTHER ITS TAX EXEMPT FUNCTION. THE BOARDS OF EACH ORGANIZATION REVIEW AND APPROVE THE GRANTS MADE EACH YEAR. SCHEDULE I, PART II DURING THE YEAR MOSAIC CHANGED THE REPORTING ON PAYMENTS TO RELATED ENTITIES. IN THE PAST PAYMENTS WERE TREATED AS AN INVESTMENT IN THE ENTITY. HOWEVER, THE MONEY WAS A GRANT MADE TO THE ENTITY. THEREFORE, IN THE CURRENT YEAR WE HAVE REPORTED THE GRANTS THAT WERE MADE IN THE PAST AND THE CURRENT YEAR. THE SCHEDULE I, PART II ACCOUNTS IF THE GRANT IS A CURRENT YEAR PAYMENT OR A HISTORICAL PAYMENT. THE TOTAL HISTORICAL PAYMENTS EXPENSED AS GRANTS IN THE CURRENT FISCAL YEAR IS $1,938,634. GRANTS PAID IN THE CURRENT YEAR TOTAL $377,100. X 1 1 X X X X X X 1 0 0 0 0 0 0 0 0 LINDA TIMMONS 415824 0 10000 0 12578 0 17000 0 14676 0 470078 0 0 0 CINDY SCHROEDER 331427 0 62251 0 2136 0 17135 0 14676 0 427625 0 0 0 RAUL SALDIVAR 296085 0 5000 0 1449 0 17000 0 14676 0 334210 0 0 0 PAM BENNER 167383 0 0 0 873 0 10771 0 14676 0 193703 0 0 0 KEITH SCHMODE 220178 0 7500 0 3920 0 14312 0 14676 0 260586 0 0 0 DONNA WERNER 159083 0 5000 0 942 0 11722 0 14676 0 191423 0 0 0 DEAN WILSON 135999 0 750 0 75794 0 0 0 14061 0 226604 0 0 0 KEITH COURIER 168174 0 250 0 845 0 22000 0 14676 0 205945 0 0 0 MARLIN WILKERSON 132939 0 3600 0 845 0 0 0 14676 0 152060 0 0 0 TAMMY WESTFALL 125143 0 10000 0 845 0 0 0 14676 0 150664 0 0 0 NANCY DAVIS 134507 0 0 0 893 0 0 0 14676 0 150076 0 0 0 DAVID JACOX 373831 0 2412 0 2532 0 0 0 11736 0 390511 0 0 0 PART I, LINE 1A EVERY EMPLOYEE CAN BE REIMBURSED UP TO $25 PER MONTH TO USE ON HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES. PART I, LINE 4A DEAN WILSON RECEIVED SEVERANCE PAYMENTS OF $74,048. A HOSPITAL AUTHORITY 2 DOUGLAS COUNTY NE REVENUE BOND SERIES 2008 521440796 2008-08-01 2625000 PURCHASE OF RESIDENTIAL REAL ESTATE 0 1 0 B HOSPITAL AUTHORITY 1 KEARNEY COUNTY NE REVENUE BOND SERIES 2003 476006477 2003-01-21 2100000 PURCHASE OF RESIDENTIAL REAL ESTATE 0 1 0 C CITY OF GARDEN CITY KANSAS ECONOMIC DEVELOPMENT REVENUE BONDS SERIES 2005 486009982 2005-06-01 833000 PURCHASE OF RESIDENTIAL REAL ESTATE 0 1 0 D NEBRASKA INVESTMENT FINANCE AUTHORITY SERIES 2010 470613449 2010-04-14 7000000 CONSTRUCTION OF RESIDENTIAL REAL ESTATE 0 1 0 A 2625000 53734 2625000 2008 0 0 0 0 B 2100000 2100000 2003 0 0 0 0 C 833000 833000 2005 0 0 0 0 D 7000000 27000 7000000 2010 0 0 0 0 A 0 0 0 0 1 0 1 B 0 0 0 0 1 0 1 C 0 0 0 0 1 0 1 D 0 0 0 0 1 0 1 A 0 0 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 C 0 0 0 0 0 0 0 0 1 D 0 0 0 0 0 0 0 0 1 A HOSPITAL AUTHORITY 1 KEARNEY COUNTY NE REVENUE BOND SERIES 2010 476006477 2010-03-31 3500000 REMODELING OF RESIDENTIAL REAL ESTATE 0 1 0 B HOSPITAL AUTHORITY 1 GAGE COUNTY NE REVENUE BOND SERIES 2010 470785499 2010-03-12 1800000 REMODELING OF RESIDENTIAL REAL ESTATE 0 1 0 C IOWA FINANCE AUTHORITY REVENUE BONDS SERIES 2012 521699886 2012-05-11 3200000 ACQUISITION & REMODEL OF RESIDENTIAL REAL ESTATE 0 1 0 A 3500000 10000 3500000 2010 0 0 0 0 B 1800000 6000 1800000 2010 0 0 0 0 C 3200000 3200000 2012 0 0 0 0 A 0 0 0 0 1 0 1 B 0 0 0 0 1 0 1 C 0 0 0 0 1 0 1 A 0 0 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 C 0 0 0 0 1 1 WELLS FARGO 15.000000000000 1 0 0 0 1 KATIE GIVENS EMPLOYED BY MOSAIC, HER STEP-MOTHER IS CFO AND SENIOR VICE PRESIDENT 109807 WAGES 0 FORM 990, PART VI, SECTION A, LINE 7A THE EVANGELICAL LUTHERAN CHURCH IN AMERICA APPOINTS ONE MEMBER OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B MOSAIC BOARD OF DIRECTORS MAY MAKE ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION WITHOUT OTHER APPROVAL WITH THE EXCEPTION OF SECTIONS 8, 10 AND 11. AMENDMENTS TO SECTION 8, 10 AND 11 OF THE ARTICLES OF INCORPORATION REQUIRE PRIOR WRITTEN CONSENT OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. FORM 990, PART VI, SECTION B, LINE 11 EACH DECEMBER, THE SENIOR VICE PRESIDENT FOR HUMAN RESOURCES AND CHIEF INTEGRITY OFFICER IDENTIFY THE DISQUALIFIED PERSONS BASED ON INFORMATION FILED IN EACH KEY EMPLOYEE'S ANNUAL CONFLICT OF INTEREST FORM. THE VP OF HR SOLUTIONS AND VP OF FINANCIAL OPERATIONS REVIEW THE SALARY AND BENEFIT INFORMATION REQUIRED FOR ALL DIRECTORS, OFFICERS, KEY EMPLOYEES AND DISQUALIFIED PERSONS AND PREPARE A SCHEDULE FOR REVIEW BY THE SVP OF HUMAN RESOURCES AND SENIOR VICE PRESIDENT AND CHIEF FINANCIAL OFFICER. A REVIEW OF ALL INTERNATIONAL, LOBBYING AND UNRELATED BUSINESS ACTIVITIES IS COMPLETED BY THE CHIEF FINANCIAL OFFICER AND VP OF FINANCIAL OPERATIONS WITH RELEVANT STAFF. FORM 990 IS PREPARED BY THE ORGANIZATION'S OUTSIDE ACCOUNTING FIRM. THE CHIEF FINANCIAL OFFICER, THE ORGANIZATION'S OUTSIDE ACCOUNTING FIRM, AND THE CHIEF EXECUTIVE OFFICER REVIEW THE RETURN. THE FINANCE AND AUDIT COMMITTEE AND THE BOARD OF DIRECTORS ARE PROVIDED A COPY OF THE RETURN 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 BOARD GOVERNANCE RISK AND INTEGRITY COMMITTEE. ANY FINANCIAL CONFLICTS OF INTEREST ARE REPORTED TO THE CHIEF FINANCIAL OFFICER FOR REPORTING ON THE FORM 990. ON AN ANNUAL BASIS ALL STAFF COMPLETE A CONFLICT OF INTEREST FORM IN CONJUNCTION WITH THEIR ANNUAL EVALUATION. ALL CONFLICTS OF INTEREST ARE REVIEWED BY HUMAN RESOURCES. ANY CONFLICTS OF INTEREST OF THE CHIEF EXECUTIVE OFFICER ARE REPORTED TO THE BOARD OF DIRECTORS. CONFLICTS OF INTEREST OF SENIOR STAFF ARE REVIEWED BY THE SENIOR VICE PRESIDENT FOR HUMAN RESOURCES AND CHIEF INTEGRITY OFFICER AND REPORTED TO THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER FOR REPORTING ON THE FORM 990. 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 THE BOARD OF DIRECTORS ESTABLISHED A COMPENSATION COMMITTEE. THE COMPENSATION 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 COMPENSATION 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 COMPENSATION 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 COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 MOSAIC HAS AVAILABLE ON ITS PUBLIC WEBSITE (WWW.MOSAICINFO.ORG) THE ABILITY FOR INDIVIDUALS TO REQUEST THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS THROUGH AN EMAIL REQUEST FORM. FORM 990, PART XII, LINE 2C: THE FINANCE AND AUDIT COMMITEE OVERSEES THE AUDIT & SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MOSAIC FOUNDATION 4980 S 118 ST OMAHA NE 68137 363837360 FUND RAISING AND INVESTMENT ASSET MANAGEMENT NE 501(C)(3) 9 N/A 1 THE OAKS OF DUNN COUNTY 4980 S 118 ST OMAHA NE 68137 391913323 SENIOR LIVING SERVICES WI 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION I 4980 S 118 ST OMAHA NE 68137 363756911 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION II 4980 S 118 ST OMAHA NE 68137 470773689 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION III 4980 S 118 ST OMAHA NE 68137 470788396 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION IV 4980 S 118 ST OMAHA NE 68137 911823422 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION VII 4980 S 118 ST OMAHA NE 68137 470828015 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION VIII 4980 S 118 ST OMAHA NE 68137 470828012 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION IX 4980 S 118 ST OMAHA NE 68137 742838413 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION X 4980 S 118 ST OMAHA NE 68137 742908789 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION XI 4980 S 118 ST OMAHA NE 68137 311706640 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION XII 4980 S 118 ST OMAHA NE 68137 481297244 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION XIII 4980 S 118 ST OMAHA NE 68137 421626679 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION XIV 4980 S 118 ST OMAHA NE 68137 204417891 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION XV 4980 S 118 ST OMAHA NE 68137 205765691 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION XVI 4980 S 118 ST OMAHA NE 68137 205765731 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION XVII 4980 S 118 ST OMAHA NE 68137 261710013 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION XVIII 4980 S 118 ST OMAHA NE 68137 261710184 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION XIX 4980 S 118 ST OMAHA NE 68137 261710259 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION XX 4980 S 118 ST OMAHA NE 68137 264555206 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC ILLINOIS HOUSING 1 4980 S 118 ST OMAHA NE 68137 202997161 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC ILLINOIS HOUSING 2 4980 S 118 ST OMAHA NE 68137 204417645 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC ILLINOIS HOUSING OF MACOMB 1 4980 S 118 ST OMAHA NE 68137 204841909 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC ILLINOIS HOUSING OF ROCKFORD 1 4980 S 118 ST OMAHA NE 68137 204841856 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC VEBA 4980 S 118 ST OMAHA NE 68137 363831874 EMPLOYEE WELFARE BENEFIT PLAN NE 501(C)(9) N/A N/A 1 MOSAIC HOUSING CORPORATION XXII 4980 S 118 ST OMAHA NE 68137 273483415 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 MOSAIC HOUSING CORPORATION XXI 4980 S 118 ST OMAHA NE 68137 264555313 LOW INCOME HOUSING NE 501(C)(3) 9 N/A 1 BETHPHAGE RESIDENTIAL PARTNERSHIP 4980 S 118 ST OMAHA NE 68137 470805544 LOW INCOME HOUSING NE N/A MOSAIC RESIDENTIAL SERVICES OF NEBRASKA LLC 4980 S 118 ST OMAHA NE 68137 271695051 LOW INCOME HOUSING NE N/A EASE-E MEDICAL INC 380 SKYLAND DR SUITE A PENROSE CO 81240 470842353 SALE OF MEDICAL EQUIPMENT AND SUPPLIES NE N/A C 3852079 875574 1.00000 0 MOSAIC HOUSING CORPORATION V 4980 S 118 ST OMAHA NE 68137 470805545 LOW INCOME HOUSING NE N/A C 1483183 1.00000 0 BICO 4980 S 118 ST OMAHA NE 68137 CAPTIVE INSURANCE BD N/A C 14546358 1.00000 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 EASE-E MEDICAL EQUIPMENT D 510000 FMV THE MOSAIC FOUNDATION C 7362239 FMV BICO M 4902446 FMV THE MOSAIC VEBA M 18551199 FMV EASE-E MEDICAL EQUIPMENT A 67279 FMV MOSAIC HOUSING CORPORATION IV B 67935 FMV MOSAIC HOUSING CORPORATION V B 772998 FMV MOSAIC HOUSING CORPORATION VII B 43985 FMV MOSAIC HOUSING CORPORATION VIII B 50947 FMV MOSAIC HOUSING CORPORATION XII B 93389 FMV MOSAIC HOUSING CORPORATION XIV B 43772 FMV MOSAIC HOUSING CORPORATION XIX B 117359 FMV MOSAIC HOUSING CORPORATION XV B 186564 FMV MOSAIC HOUSING CORPORATION XVI B 232480 FMV MOSAIC HOUSING CORPORATION XVII B 107652 FMV MOSAIC HOUSING CORPORATION XVIII B 90756 FMV MOSAIC HOUSING CORPORATION XX B 101950 FMV MOSAIC HOUSING CORPORATION XXII B 6806 FMV MOSAIC ILLINOIS HOUSING 1 B 10000 FMV MOSAIC ILLINOIS HOUSING 2 B 16618 FMV MOSAIC ILLINOIS HOUSING OF ROCKFORD 1 B 111624 FMV MOSAIC HOUSING CORPORATION XIII B 4841 FMV