Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
IMMANUEL
Employer identification number
47-0733774
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
No
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
(A)
PACE IOWA
273635343
9
No
Yes
Yes
0
(B)
IMMANUEL RETIREMENT COMMUNITIES
470799118
9
Yes
Yes
Yes
0
(C)
IMMANUEL HOME AND COMMUNITY RESOURCES
272628802
9
Yes
Yes
Yes
0
(D)
PACE NEBRASKA
273635416
9
No
Yes
Yes
0
(E)
IMMANUEL LONG TERM CARE
462582783
9
No
Yes
Yes
0
Total
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
IMMANUEL
Employer identification number
47-0733774
Return Reference
Explanation
FORM 990, PART VII, SECTION B:
THE AMOUNTS PAID TO INDEPENDENT CONTRACTORS BY IMMANUEL AND RELATED ORGANIZATIONS ARE ALLOCATED TO EACH RESPECTIVE ORGANIZATION BASED ON THE AMOUNT OF SERVICES PROVIDED TO EACH ORGANIZATION. FOR PURPOSES OF REPORTING THE PAYMENTS ON PART VII OF FORM 990, THE ENTIRE AMOUNT OF COMPENSATION IS REPORTED ON THIS FORM 990 FOR IMMANUEL.
FORM 990, PART V, LINE 2A:
IMMANUEL IS THE SOLE MEMBER OF IMMANUEL RETIREMENT COMMUNITIES, IMMANUEL HOME AND COMMUNITY RESOURCES, IMMANUEL LONG TERM CARE, AND IMMANUEL COMMUNITY VISION FOUNDATION. IMMANUEL ISSUES THE FORM W-2 FOR THE ALL THE EMPLOYEES OF EACH OF THESE ORGANIZATIONS. BECAUSE IMMANUEL IS REIMBURSED FOR THE SALARIES AND BENEFITS OF THESE EMPLOYEES BY EACH OF THE ORGANIZATIONS, THE EXPENSES FOR THE SALARIES AND BENEFITS ARE REFLECTED ON EACH OF THE ORGANIZATION'S FORM 990 IN PART IX, STATEMENT OF FUNCTIONAL EXPENSES AND NOT ON IMMANUEL'S FORM 990, PART IX, LINE 7.
FORM 990, PART VI, SECTION A, LINE 7A
THE SYNOD COUNCIL OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA (ELCA) ELECTS ONE-THIRD OF THE DIRECTORS OF IMMANUEL AND MUST CONFIRM THE OTHER TWO-THIRDS OF ELECTED DIRECTORS BEFORE THEY TAKE OFFICE. ADDITIONALLY, THE BISHOP OF THE NEBRASKA SYNOD OF THE ELCA AND THE PRESIDENT/CEO OF IMMANUEL ARE BOTH VOTING EX OFFICIO MEMBERS OF THE BOARD.
FORM 990, PART VI, SECTION A, LINE 7B
THE SYNOD COUNCIL OF THE NEBRASKA SYNOD OF THE EVANGELICAL CHURCH IN AMERICA MUST APPROVE ANY AMENDMENT TO THE ARTICLES OR BYLAWS OF IMMANUEL. THEREFORE, ANY CHANGES TO THE GOVERNING DOCUMENTS THAT IMPACT THE GOVERNANCE OF THE ORGANIZATION MUST BE APPROVED BY THE SYNOD COUNCIL.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 IS PREPARED BY AN ACCOUNTING FIRM WITH THE ASSISTANCE OF THE CONTROLLER, AND IS THEN REVIEWED BY THE CFO AND THE CONTROLLER. COPIES OF THE REVIEWED RETURN ARE PROVIDED TO THE BOARD MEMBERS PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
THE CONFLICT OF INTEREST POLICY STATES THAT THE MEMBERS OF THE BOARD OF DIRECTORS MUST SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY AND DISCLOSE ALL CONFLICTS. THE GOVERNANCE COMMITTEE SHALL DECIDE WHAT ACTIONS NEED TO BE TAKEN CONCERNING ANY CONFLICTS. A BOARD MEMBER IS PROHIBITED FROM VOTING ON ANY BUSINESS RELATED TO ANY CONFLICT THE GOVERNANCE COMMITTEE HAS IDENTIFIED WITH RESPECT TO THAT BOARD MEMBER.
FORM 990, PART VI, SECTION B, LINE 15
IMMANUEL ANALYZES MARKET-BASED COMPENSATION STUDIES, REVIEWS JOB DESCRIPTIONS AND INTERVIEWS OUTSIDE HUMAN RESOURCE CONSULTANTS. COMPENSATION FOR THE CEO IS APPROVED BY THE BOARD OF DIRECTORS. COMPENSATION OF TOP MANAGEMENT PERSONNEL IS APPROVED BY THE CEO.
FORM 990, PART VI, SECTION C, LINE 19
IMMANUEL DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART IX, LINE 11G
CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 140,085. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 140,085. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 65,155. MANAGEMENT AND GENERAL EXPENSES 532,832. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 597,987.
FORM 990, PART IX, LINE 25:
IMMANUEL IS THE SOLE CORPORATE MEMBER OF IMMANUEL RETIREMENT COMMUNITIES (IRC), IMMANUEL HOME AND COMMUNITY RESOURCES (IHCR) AND SUBSIDIARIES, IMMANUEL LONG TERM CARE (ILTC) AND IMMANUEL COMMUNITY VISION FOUNDATION (ICVF); ALL NOT-FOR-PROFIT ORGANIZATIONS. IMMANUEL PROVIDES MANAGEMENT SERVICES, INCLUDING EXECUTIVE, ACCOUNTING AND HUMAN RESOURCES, TO ALL OF THESE ORGANIZATIONS. FOR THE YEAR ENDED JUNE 30, 2014, THE FOLLOWING ORGANIZATIONS REPORTED FUNCTIONAL EXPENSES AS FOLLOWS: IMMANUEL RETIREMENT COMMUNITIES: - PROGRAM SERVICE: $23,202,744 - MANAGEMENT & GENERAL: $5,673,301 IMMANUEL HOME & COMMUNITY RESOURCES: - PROGRAM SERVICE: $2,642,185 - MANAGEMENT & GENERAL: $202,914 PACE IOWA (SUBSIDIARY) - PROGRAM SERVICE: $7,087,985 - MANAGEMENT & GENERAL: $958,465 PACE NEBRASKA (SUBSIDIARY) - PROGRAM SERVICE: $4,795,092 - MANAGEMENT & GENERAL: $816,543 IMMANUEL LONG TERM CARE: - PROGRAM SERVICE: $3,039,574 - MANAGEMENT & GENERAL: $819,195 IMMANUEL COMMUNITY VISION FOUNDATION: - PROGRAM SERVICE: $6,158 - MANAGMENT & GENERAL: $86,989
FORM 990, PART XII, LINE 2C:
THE BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF IMMANUEL'S FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS DID NOT CHANGE FROM PRIOR YEARS.
SCHEDULE R, PART V, LINE 2(3)
ON APRIL 10, 2010 AND JUNE 19, 2014 TAX EXEMPT BONDS WERE ISSUED BY IMMANUEL RETIREMENT COMMUNITES, A SUPPORTED ORGANIZATION OF IMMANUEL. THE LIABILITY FOR THE BONDS IS REPORTED ON THE BALANCE SHEET OF IMMANUEL RETIREMENT COMMUNITIES. PURSUANT TO A MASTER TRUST INDENTURE, IMMANUEL AND IMMANUEL RETIREMENT COMMUNITIES (THE OBLIGATED GROUP) ARE JOINTLY AND SEVERALLY OBLIGATED TO MAKE DEBT SERVICE PAYMENTS ON THE 2010 AND 2014 SERIES HEALTH FACILITIES REVENUE BONDS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.