2024-05-09T07:47:11-05:00 2023-06-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-07-01 364003095 HARBOR HOUSE HARB 4023434413 12809 W DODGE ROAD OMAHA NE 68154 DEVIN FOX CHAIR 4023434413 2024-05-08 1 DEVIN FOX 999009999 1 WENDY R COOLEY CPA P01523804 4023302660 2024-05-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z HOSPICE HOUSE LISA RUSSELL 7415 CEDAR STREET OMAHA NE 68124 8108595 0 X WWW.HOSPICEHOUSEOMAHA.ORG X 1994 NE TO PROVIDE CARE IN A HOMELIKE ENVIRONMENT TO THE TERMINALLY ILL. 15 15 0 124 0 0 4321025 4240055 2133647 2668606 199167 170412 293 288 6654132 7079361 0 0 0 0 2670100 2726722 0 0 130577 916509 1016020 3586609 3742742 3067523 3336619 8625092 12129606 394982 391490 8230110 11738116 X TO EMBRACE RESIDENTS LIVING WITH TERMINAL ILLNESSES AND THEIR FAMILIES AND FRIENDS WITH COMPASSIONATE CARE AND COMFORT, AND TO PROVIDE END OF LIFE EDUCATION IN THE COMMUNITY. 0 0 3265223 2668894 HARBOR HOUSE, D/B/A AS HOSPICE HOUSE - THE JOSIE HARPER RESIDENCE, OPERATES A LICENSED 26 BED RESIDENTIAL FACILITY WHICH PROVIDES 24-HOUR PROFESSIONAL CARE AND SUPERVISION TO SERVE THE SPIRITUAL, EMOTIONAL, AND PHYSICAL NEEDS OF TERMINALLY ILL RESIDENTS AND THEIR FAMILIES IN A HOME-LIKE SETTING IN ADDITION TO RESIDENTIAL LIVING SPACE. THE BUILDING ALSO INCLUDES CLASSROOMS, STORAGE, SHOWER FACILITIES FOR FAMILIES AND GUESTS, AND A RESOURCE LIBRARY. 3265223 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 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 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 1 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X THE ORGANIZATION 4023434413 12809 W DODGE ROAD OMAHA NE 68154 DEVIN FOX MD BOARD CHAIR 0.40 X X 0 0 0 SHARI FLOWERS MD VICE CHAIR 0.10 X X 0 0 0 WILLIAM DINSMOOR SECRETARY/TREASURER 0.20 X X 0 0 0 THERESA FRANCO DIRECTOR THRU 4/23 0.10 X 0 0 0 LISA SCHMITZ DIRECTOR 0.10 X 0 0 0 ROSEMARY LEBEDA DIRECTOR 0.10 X 0 0 0 HEATHER MORGAN MD DIRECTOR 0.10 X 0 0 0 YUNGPO BERNARD SU MD DIRECTOR 0.10 X 0 0 0 JACKIE THIELEN DIRECTOR THRU 12/22 0.10 X 0 0 0 JOSIE ABBOUD DIRECTOR 0.10 X 0 0 0 CAROLE PATRICK PHD DIRECTOR 0.10 X 0 0 0 MELISSA JOHNSON MD DIRECTOR THRU 3/23 0.10 X 0 0 0 KATHLEEN MCKILLIP MD DIRECTOR 0.10 X 0 0 0 TIMOTHY DORIUS MD DIRECTOR 0.10 X 0 0 0 TODD SAUER MD DIRECTOR 0.10 X 0 0 0 KELLI SAUCERMAN-HOWARD DIRECTOR THRU 3/23 0.10 X 0 0 0 FRANK LOCOCO DIRECTOR 0.10 X 0 0 0 BRYCE BRACKLE DIRECTOR 0.10 X 0 0 0 JAMES SUMMERFELT DIRECTOR 0.10 X 0 0 0 GARY GEORGE EXECUTIVE DIRECTOR THRU 3/23 40.00 X 122673 0 16497 LISA RUSSELL-DEVELOPMENT DIR EXECUTIVE DIRECTOR FROM 3/23 40.00 X 99716 0 25753 222389 0 42250 1 0 0 1 CHI HEALTH 12809 W DODGE ROAD OMAHA NE 68154 MANAGEMENT SERVICES 2934724 ALL MIDLANDS HEALTH SERVICES 515 N 87TH ST STE B OMAHA NE 68114 CONTRACT LABOR 171998 2 X 4240055 4240055 RESIDENT SERVICE REVENUE 623000 2668606 2668606 2668606 138804 138804 1060842 1029234 31608 31608 31608 VENDING MACHINE REVENUE 900099 288 288 288 7079361 2668894 0 170412 X 255102 140697 114405 1805977 1727041 74405 4531 56419 54592 1827 457353 417644 35341 4368 151871 129718 14880 7273 23166 23166 17270 17270 536850 536850 1500 1500 38221 23798 14423 91243 91243 1735 1735 99992 99992 24933 24933 DIETARY & CAFETERIA SUP 158912 158912 MEDICAL SUPPLIES 19893 19893 DUES & SUBSCRIPTIONS 2305 2305 3742742 3265223 346942 130577 250 250 630038 2731184 2925002 3380955 280971 371991 21945 22801 4037661 3089328 801133 948333 3929665 4674092 36088 0 8625092 12129606 101779 61662 293203 329828 394982 391490 X 4825310 7422572 3404800 4315544 8230110 11738116 8625092 12129606 3336619 171387 0 X X 0 1 X 1 0 X 693484 313059 616485 4321025 1635082 7579135 2370953 2170568 2231244 2133647 2668894 11575306 504 131395 172 293 132364 3064941 2615022 2847901 6454965 4303976 19286805 265285 29010 164725 475245 340875 1275140 0 265285 29010 164725 475245 340875 1275140 18011665 110878 120857 93529 122510 138804 586578 110878 120857 93529 122510 138804 586578 3175819 2735879 2941430 6577475 4442780 19873383 0.90630 0.91790 0.02950 0.02900 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3404800 930995 20251 4315544 76569 3333922 5691 3404800 71502 8320 3253 76569 207716 16682 152896 71502 57847 258613 108744 207716 0.00000 0.00348 0.99652 0 0 320000 320000 2468920 2277947 190973 103499 51549 51950 938941 759832 179109 206301 206301 948333 DUE TO MEMBER 329828 329828 X 7233478 171387 171387 7062091 17270 17270 7079361 3725472 0 3725472 17270 17270 3742742 PART V, LINE 4: TEMPORARILY AND PERMANENTLY RESTRICTED NET ASSETS ARE RESTRICTED TO FUND THE MAINTENANCE AND OPERATION OF THE FACILITY AND CREATE AN ENDOWMENT FUND, THE INCOME FROM WHICH WILL BE USED TO SUPPORT THE OPERATIONS OF THE FACILITY. PART X, LINE 2: THE ORGANIZATION ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. THE ORGANIZATION RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2023 AND 2022, THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 0 0 0 0 0 0 0 0 0 GARY GEORGE EXECUTIVE DIRECTOR THRU 3/23 122673 0 0 0 0 0 4408 0 12089 0 139170 0 0 0 LISA RUSSELL-DEVELOPMENT DIR EXECUTIVE DIRECTOR FROM 3/23 99716 0 0 0 0 0 3674 0 22079 0 125469 0 0 0 SCHEDULE J, PART I GARY GEORGE WAS THE EXECUTIVE DIRECTOR UNTIL MARCH 2023. LISA RUSSELL BECAME THE EXECUTIVE DIRECTOR OF THE HARBOR HOUSE IN MARCH 2023. BOTH ARE PAID BY CHI HEALTH, AN UNRELATED ORGANIZATION, THROUGH A COORDINATION OF SERVICES AGREEMENT. THE AMOUNT OF COMPENSATION EACH RECEIVED FOR THE CALENDAR YEAR ENDING DECEMBER 31, 2022 IS REPORTED ON PART VII. FORM 990 PART V, LINE 1A: AS PART OF THE COORDINATION OF SERVICES AGREEMENT WITH CHI HEALTH, CHI HEALTH PERFORMS THE ACCOUNTS PAYABLE FUNCTION FOR HARBOR HOUSE. HARBOR HOUSE REIMBURSES CHI HEALTH FOR VENDOR PAYMENTS, THEREFORE, NO FORMS 1099 ARE ISSUED BY HARBOR HOUSE. CHI HEALTH ISSUES THE FORMS 1099 AND COMPLIES WITH BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS. FORM 990 PART V, LINE 2A: EMPLOYEES OF THE ORGANIZATION ARE PAID BY CHI HEALTH, AN UNRELATED ORGANIZATION. THEREFORE NO FORMS W-2 ARE ISSUED BY HARBOR HOUSE. CHI HEALTH FILES ALL FORMS W-3, FORMS W-2S, AND ALL REQUIRED EMPLOYMENT TAX RETURNS. FORM 990, PART VI, SECTION A, LINE 2 THERESA FRANCO AND JAMES SUMMERFELT - BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 HARBOR HOUSE ENTERED INTO A COORDINATION OF SERVICES AGREEMENT WITH CHI HEALTH TO PERFORM AND MANAGE FINANCIAL SERVICES FOR A MONTHLY FEE. SERVICES INCLUDE BUT ARE NOT LIMITED TO FINANCIAL REPORTING, BUDGETING, BILLING AND COLLECTIONS AND FIXED ASSET MANAGEMENT. IN ADDITION TO FINANCIAL SERVICES, CHI HEALTH PROVIDES INFORMATION SYSTEMS SUPPORT, SECURITY, RISK MANAGEMENT AND CORPORATE COMPLIANCE, PURCHASING, MAINTENANCE AND VARIOUS OTHER SUPPORT SERVICES. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATE MEMBERS OF HARBOR HOUSE ARE CHI HEALTH, THE VISITING NURSE ASSOCIATION OF THE MIDLANDS, NEBRASKA METHODIST HOSPITAL AND THE NEBRASKA MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A EACH CORPORATE MEMBER WILL BE EQUALLY REPRESENTED ON THE BOARD OF DIRECTORS. THE NUMBER OF VOTING DIRECTORS SHALL BE NO LESS THAN FOUR (4), THE EXACT NUMBER TO BE DETERMINED FROM TIME TO TIME BY DECISION OF THE CORPORATE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B SUBJECT TO THE NEBRASKA NONPROFIT CORPORATION ACT AND OTHER APPLICABLE LAW, THE CORPORATE MEMBERS, BY UNANIMOUS AGREEMENT, SHALL HAVE THE POWER TO A) FIX THE NUMBER OF DIRECTORS OF THE CORPORATION B) APPROVE, AMEND, OR REPEAL THE BYLAWS OR ARTICLES OF INCORPORATION OF THE CORPORATION C) APPROVE THE MERGER, DISSOLUTION OR CONSOLIDATION OR REORGANIZATION OF THE CORPORATION D) APPROVE THE FORMATION OF OTHER ENTITIES BY THE CORPORATION E) APPROVE THE ACQUISITION, SALE, LEASE, TRANSFER OR OTHER ALIENATION OF SUBSTANTIALLY ALL OF THE PROPERTY OF THE CORPORATION, OTHER THAN IN THE USUAL AND REGULAR COURSE OF THE CORPORATIONS BUSINESS F) APPROVE DEBT INCURRED BY THE CORPORATION IN EXCESS OF $25,000 G) APPROVE THE LONG-RANGE FINANCIAL AND STRATEGIC PLAN FOR THE CORPORATION H) APPROVE ASSESSMENT UPON, OR REQUIRE CAPITAL CONTRIBUTIONS BY, THE CORPORATE MEMBERS I) APPROVE ANY DISTRIBUTIONS OF CAPITAL OR NET EARNINGS OF THE CORPORATION UPON EXERCISE OF ANY POWER DESCRIBED ABOVE, EACH CORPORATE MEMBER SHALL PROMPTLY DELIVER TO THE CORPORATION A DULY EXECUTED CERTIFICATE OR OTHER DOCUMENT EVIDENCING THE APPROVAL OF THAT EXERCISE OF POWER BY SUCH CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY HARBOR HOUSES'S FINANCE COMMITTEE. THE BOARD OF DIRECTORS ARE PROVIDED THE FORM 990 ELECTRONICALLY TO REVIEW AND ASK QUESTIONS PRIOR TO THE FILING. FORM 990, PART VI, SECTION B, LINE 12C HARBOR HOUSE HAS ADOPTED THE CONFLICT INVESTIGATION PROCESS OF CHI HEALTH. ANNUAL COMPLETION OF THE DISCLOSURE STATEMENT IS REQUIRED BY THE BOARD OF DIRECTORS. STATED DISCLOSURES ARE INVESTIGATED BY AN APPOINTED DISINTERESTED PERSON OR COMMITTEE THAT IS SELECTED BY THE CHAIRMAN OF THE BOARD. AFTER EXCERCISING DUE DILIGENCE, THE BOARD SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANAGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION. FINALLY, THE BOARD MAKES ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. IN CONFORMITY WITH SUCH DETERMINATION, AT ANY TIME A BOARD MEMBER MAY DECLARE A CONFLICT OF INTEREST AND RECUSE HIM/HERSELF FROM THE DISCUSSION. THE INDIVIDUAL IS ALSO REQUIRED TO DISCLOSE ANY KNOWN OR POSSIBLE CONFLICTS OF INTEREST THAT ARISE DURING THE CALENDAR YEAR. FORM 990, PART VI, SECTION C, LINE 19 HARBOR HOUSE HAS ADOPTED THE CONFLICT OF INTEREST POLICY OF CHI HEALTH, WHICH IS AVAILABLE TO THE PUBLIC AT WWW.CHIHEALTH.COM. HARBOR HOUSE DOES NOT MAKE THE GOVERNING DOCUMENTS OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. HOWEVER, THE ARTICLES OF INCORPORATION ARE AVAILABLE ONLINE THROUGH THE NEBRASKA SECRETARY OF STATE WEBSITE. FORM 990, PART IX, LINES 5-10: EMPLOYEES OF THE ORGANIZATION ARE PAID BY CHI HEALTH, AN UNRELATED ORGANIZATION. ACCORDINGLY, ALL PAYROLL AND RELATED EXPENSES, INCLUDING EMPLOYEE BENEFITS, ARE PAID BY CHI HEALTH. THE ORGANIZATION REIMBURSES CHI HEALTH ON A QUARTERLY BASIS. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 209,496. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 209,496. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 327,354. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 327,354. FORM 990 PART XII, LINE 2C: THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.