Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
IMMANUEL RETIREMENT COMMUNITIES |
470799118 | Yes | 0 | 0 | ||
| (B)
IMMANUEL HOME AND COMMUNITY RESOURCES |
272628802 | Yes | 925,000 | 0 | ||
| (C)
IMMANUEL LONG TERM CARE |
462582783 | No | 12,440 | 0 | ||
Total 3
|
937,440 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART I, LINE 11G: | IMMANUEL PROVIDES MANAGEMENT SERVICES, INCLUDING EXECUTIVE, ACCOUNTING, INFORMATION TECHNOLOGY, COMPLIANCE AND HUMAN RESOURCES TO ITS SUPPORTED ORGANIZATIONS: IMMANUEL RETIREMENT COMMUNITIES, IMMANUEL HOME AND COMMUNITY RESOURCES AND SUBSIDIARIES, AND IMMANUEL LONG TERM CARE. |
| SCHEDULE A, PART IV, SECTION A, LINE 1: | IMMANUEL LONG TERM CARE WAS FORMED IN 2013 AND IS NOT CURRENTLY LISTED SEPARATELY BY NAME IN THE ORGANIZATION'S GOVERNING DOCUMENTS. THE ARTICLES OF INCORPORATION, WHICH WERE LAST RESTATED IN 2012, LIST TWO SUPPORTED ORGANIZATIONS BY NAME AND ALSO PROVIDE THAT IMMANUEL WILL SUPPORT "OTHER ORGANIZATIONS OF WHICH THE CORPORATION IS THE SOLE MEMBER, SO LONG AS SUCH ENTITIES ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED". THE ARTICLES EXPLAIN THAT SUCH OTHER ORGANIZATIONS MUST BE EXEMPT UNDER 501(A) "BY VIRTUE OF BEING ORGANIZATIONS DESCRIBED IN 501(C)(3) OF THE CODE AND ARE NOT PRIVATE FOUNDATIONS BY VIRTUE OF HAVING QUALIFIED UNDER SECTION 509(A)(1) OR 509(A)(2) OF THE CODE". IMMANUEL IS THE SOLE MEMBER OF IMMANUEL LONG TERM CARE, EIN 46-2582783. IMMANUEL LONG TERM CARE IS A 501(C)(3) ORGANIZATION WHICH HAS QUALIFIED FOR PUBLIC CHARITY STATUS UNDER 509(A)(2). CONSISTENT WITH BOARD ACTIONS AND INTENT, IMMANUEL LONG TERM CARE IS A SUPPORTED ORGANIZATION OF IMMANUEL. |
| SCHEDULE A, PART IV, SECTION A, LINE 6: | IMMANUEL SUPPORTS THE MISSIONS OF IMMANUEL RETIREMENT COMMUNITIES, IMMANUEL HOME AND COMMUNITY RESOURCES, AND IMMANUEL LONG TERM CARE OF WHICH IT IS THE SOLE MEMBER. THE ORGANIZATION MAKES CHARITABLE CONTRIBUTIONS, INVESTS FUNDS, DEVELOPS SENIOR PROGRAMS, DEVELOPS FUNDING OPPORTUNITIES AND INVESTS IN AFFORDABLE PROJECTS FOR SENIORS. THE SUPPORT PROVIDED TO THE VARIOUS ORGANIZATIONS LISTED ON SCHEDULE I FURTHERS THE EXEMPT PURPOSE AND MISSION OF IMMANUEL BY RESPONDING TO NEEDS IN COMMUNITY HEALTH AND SUPPORTING THE MINISTRY OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VII, SECTION B: | THE AMOUNTS PAID TO INDEPENDENT CONTRACTORS BY IMMANUEL AND RELATED ORGANIZATIONS ARE REPORTED BY IMMANUEL IN PART VII, SECTION B, BUT ARE ALLOCATED TO EACH RESPECTIVE ORGANIZATION FOR PURPOSES OF REPORTING ON PART IX, LINE 11. THE ALLOCATION IS BASED ON THE AMOUNT OF SERVICES PROVIDED TO EACH ORGANIZATION. |
| 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 ALL THE EMPLOYEES, INCLUDING THE OFFICERS, OF EACH OF THESE ORGANIZATIONS. BECAUSE IMMANUEL IS REIMBURSED FOR THE SALARIES AND BENEFITS OF THESE EMPLOYEES AND OFFICERS BY EACH OF THE ORGANIZATIONS, THE EXPENSES FOR THE REIMBURSED SALARIES AND BENEFITS ARE REFLECTED ON EACH OF THE ORGANIZATIONS' FORM 990 IN PART IX, STATEMENT OF FUNCTIONAL EXPENSES, LINES 5-7, AND NOT ON IMMANUEL'S FORM 990, PART IX, LINES 5-7. |
| 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 134,830. MANAGEMENT AND GENERAL EXPENSES 178,476. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 313,306. OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 23,931. MANAGEMENT AND GENERAL EXPENSES 673,742. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 697,673. HIRING COSTS: PROGRAM SERVICE EXPENSES 6,543. MANAGEMENT AND GENERAL EXPENSES 308,386. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 314,929. |
| 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, INFORMATION TECHNOLOGY, COMPLIANCE AND HUMAN RESOURCES, TO ALL OF THESE ORGANIZATIONS. FOR THE YEAR ENDED JUNE 30, 2015, THE FOLLOWING ORGANIZATIONS REPORTED FUNCTIONAL EXPENSES AS FOLLOWS: IMMANUEL RETIREMENT COMMUNITIES: - PROGRAM SERVICE: $24,078,065 - MANAGEMENT & GENERAL: $4,788,320 IMMANUEL HOME & COMMUNITY RESOURCES: - PROGRAM SERVICE: $2,697,284 - MANAGEMENT & GENERAL: $384,458 PACE IOWA (SUBSIDIARY) - PROGRAM SERVICE: $9,221,937 - MANAGEMENT & GENERAL: $1,111,546 PACE NEBRASKA (SUBSIDIARY) - PROGRAM SERVICE: $7,693,244 - MANAGEMENT & GENERAL: $908,745 IMMANUEL LONG TERM CARE: - PROGRAM SERVICE: $19,481,767 - MANAGEMENT & GENERAL: $3,551,218 IMMANUEL COMMUNITY VISION FOUNDATION: - PROGRAM SERVICE: $76,948 - MANAGMENT & GENERAL: $275,296 |
| FORM 990, PART XI, LINE 9: | GAIN ON TERMINATION OF INTEREST IN JOINT OPERATING AGREEMENT 7,564,002. |
| 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. |
| FORM 990, PART XI, LINE 9: | ON 10-31-12, IMMANUEL ENTERED INTO AN AGREEMENT WITH CATHOLIC HEALTH INITIATIVES (CHI) TO RESIGN ITS MEMBERSHIP IN ALEGENT AND IMMANUEL MEDICAL CENTER ENTITIES AND TO TERMINATE ITS INTEREST IN THE JOINT OPERATING AGREEMENT (JOA) BETWEEN IMMANUEL MEDICAL CENTER AND ALEGENT CREIGHTON HEALTH - BERGAN MERCY HEALTH SYSTEM. IN ACCORDANCE WITH THE JOINT OPERATING AGREEMENT, APPRAISALS WERE CONDUCTED TO DETERMINE THE JOA TERMINATION PAYMENT FROM CHI TO IMMANUEL. IN FISCAL YEAR 2013, IMMANUEL RECEIVED A PAYMENT IN THE AMOUNT OF $553,669,500. DURING FISCAL YEAR 2015, IMMANUEL RECEIVED THE FINAL DISBURSEMENT OF FUNDS TOTALING $7,564,002 REPRESENTING THE FINAL MATERIAL ADJUSTMENT TO THE ACTUAL CLOSING DATE NET BALANCE SHEET AMOUNT. |
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