Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (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 | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 27,805 | 459,570 | 1,265,490 | 68,728 | 142,765 | 1,964,358 |
| 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 | 17,543,824 | 16,457,430 | 15,454,372 | 19,527,859 | 22,611,494 | 91,594,979 |
| 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 | 17,571,629 | 16,917,000 | 16,719,862 | 19,596,587 | 22,754,259 | 93,559,337 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 93,559,337 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 17,571,629 | 16,917,000 | 16,719,862 | 19,596,587 | 22,754,259 | 93,559,337 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 994 | 1,958 | 36 | 165 | 3,153 | |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 994 | 1,958 | 36 | 165 | 3,153 | |
| 11 | Net income from unrelated business activities not included on 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.).. | 17,572,623 | 16,918,958 | 16,719,898 | 19,596,752 | 22,754,259 | 93,562,490 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2022 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2023. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART V, LINE 2A: | INDIVIDUALS PERFORMING SERVICES FOR IMMANUEL LONG TERM CARE ARE EMPLOYEES OF IMMANUEL, A RELATED ENTITY. THEREFORE, IMMANUEL ISSUES THE FORM W-2 FOR THESE EMPLOYEES. BECAUSE IMMANUEL LONG TERM CARE REIMBURSES IMMANUEL FOR THE SALARIES AND BENEFITS OF THESE EMPLOYEES, THE EXPENSES FOR THEIR SALARIES AND BENEFITS ARE REFLECTED ON THIS RETURN IN PART IX, STATEMENT OF FUNCTIONAL EXPENSES. |
| FORM 990, PART VI, SECTION A, LINE 1A | THE BOARD OF DIRECTORS MAY ESTABLISH AN EXECUTIVE COMMITTEE WHICH CONSISTS OF TWO OR MORE DIRECTORS AND MAY EXERCISE THE AUTHORITY OF THE BOARD OF DIRECTORS TO THE EXTENT PROVIDED IN THE RESOLUTION. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT ANY ACTION WHICH IT TAKES DOES NOT CONFLICT WITH THE POLICIES AND EXPRESS WISHES OF THE BOARD. THE EXECUTIVE COMMITTEE PRESENTS THE MINUTES OF ITS MEETINGS AND REPORTS AT THE NEXT SUCCEEDING MEETING OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 2 | THE OFFICERS AND HIGHEST COMPENSATED EMPLOYEES ARE CONSIDERED SENIOR LEADERSHIP AND ARE COMPENSATED BY IMMANUEL, A RELATED ORGANIZATION. THE BOARD MEMBERS ARE ALSO BOARD MEMBERS OF IMMANUEL THEREFORE THE OFFICERS AND BOARD MEMBERS HAVE A BUSINESS RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 4 | SECTION 4.2(D) OF THE BYLAWS WAS AMENDED. ONE OF THE DIRECTORS SHALL BE THE PERSON THEN SERVING AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE CORPORATION AND SHALL SERVE AS EX OFFICIO WITHOUT VOTE. |
| FORM 990, PART VI, SECTION A, LINE 6 | IMMANUEL LONG TERM CARE HAS ONE MEMBER, IMMANUEL, A NEBRASKA NONPROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | IMMANUEL, THE SOLE MEMBER OF IMMANUEL LONG TERM CARE, HAS THE RIGHT TO APPOINT AND REMOVE DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | IMMANUEL, IMMANUEL LONG TERM CARE'S SOLE MEMBER, MUST APPROVE ANY AMENDMENTS AND INITIATE OR ADOPT AMENDMENTS TO THE ARTICLES OR BYLAWS OF IMMANUEL LONG TERM CARE. |
| FORM 990, PART VI, SECTION B, LINE 11B | 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 | IMMANUEL LONG TERM CARE USES THE SAME POLICY AS IMMANUEL, A RELATED ORGANIZATION. THE POLICY STATES THAT THE BOARD OF DIRECTORS MUST SIGN THE CONFLICT OF INTEREST POLICY AND DISCLOSE ALL CONFLICTS. THE GOVERNANCE COMMITTEE SHALL DECIDE WHAT ACTIONS NEED TO BE TAKEN CONCERNING ANY CONFLICTS. THE BOARD MEMBERS ARE PROHIBITED FROM VOTING ON ANY BUSINESS RELATED TO ANY CONFLICT THE GOVERNANCE COMMITTEE HAS IDENTIFIED. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE OFFICERS ARE COMPENSATED BY IMMANUEL, A RELATED ORGANIZATION. 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 LONG TERM CARE DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART VII: | ALL COMPENSATION AND BENEFITS SHOWN FOR DIRECTORS ARE PAID BY IMMANUEL, A RELATED ORGANIZATION, FOR SERVICES PERFORMED FOR IMMANUEL, IMMANUEL LONG TERM CARE, OR OTHER RELATED ENTITIES. |
| FORM 990, PART IX, LINE 11G | OTHER FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 117,312. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 117,312. CONSULTING FEES: PROGRAM SERVICE EXPENSES 155,753. MANAGEMENT AND GENERAL EXPENSES 16,751. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 172,504. NURSING SERVICES: PROGRAM SERVICE EXPENSES 18,274. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,274. LAB TEST SERVICES: PROGRAM SERVICE EXPENSES 31,593. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,593. ONBOARDING SERVICES: PROGRAM SERVICE EXPENSES 165,218. MANAGEMENT AND GENERAL EXPENSES 204. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 165,422. PHARMACY SERVICES: PROGRAM SERVICE EXPENSES 450,672. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 450,672. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,025,608. MANAGEMENT AND GENERAL EXPENSES 154,857. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,180,465. RADIOLOGY SERVICES: PROGRAM SERVICE EXPENSES 22,536. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,536. LAUNDRY SERVICES: PROGRAM SERVICE EXPENSES 84,616. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 84,616. |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF DIRECTORS OF IMMANUEL LONG TERM CARE ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |