2024-11-10T17:27:03-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 10401 W INNOVATION DR STE 300 WAUWATOSA WI 53226 990 2023-01-01 391270056 SIMEANNA III INC SIME 9202354653 151 N EAGLE ST OSHKOSH WI 54902 THERESA M BERTRAM PRESIDENT & CEO 9202325228 2024-11-08 1 0 KRISTEN DONLEVY P01670215 4144761880 2024-11-08 2023 2024-10-15 13:58:12Z THERESA M BERTRAM 151 N EAGLE ST OSHKOSH WI 54902 587777 0 9386 X WWW.MIRAVIDALIVING.COM X 1978 WI TO PROVIDE HOUSING FOR AGING PERSONS. 9 9 0 9 0 0 0 0 533053 575906 215 402 10563 11469 543831 587777 0 0 0 0 201511 223392 0 0 0 346300 372000 547811 595392 -3980 -7615 1229164 1108993 825065 712507 404099 396486 TO PROVIDE QUALITY CARE AND LIFE ENRICHING OPPORTUNITIES TO THE AGING AND THOSE IN NEED IN A CARING, CHRISTIAN ENVIRONMENT. 0 0 473868 0 575906 SIMEANNA III, INC. OFFERS APARTMENT STYLE LIVING FOR AGING PERSONS. THE FACILITY CONTAINS 78 UNITS; ALL UNITS QUALIFY UNDER SECTION 8 OF THE HUD REGULATIONS. 473868 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 1 1 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 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X KIM MAKI 9202325238 225 N EAGLE ST OSHKOSH WI 54902 THERESA BERTRAM PRESIDENT & CEO 4.50 33.50 X X 0 393735 0 MARK BEECHER CHAIR 0.20 1.40 X X 0 0 0 NATE OLSEN VICE-CHAIR 0.20 1.40 X X 0 0 0 JAMIE BONELL SECRETARY 0.20 1.40 X X 0 0 0 MARK BOETTCHER BOARD MEMBER 0.20 1.40 X 0 0 0 DIANE LANGDON BOARD MEMBER 0.20 1.40 X 0 0 0 JASON LOWE BOARD MEMBER 0.20 1.40 X 0 0 0 DR PAULA MCNIEL BOARD MEMBER 0.20 1.40 X 0 0 0 JIM STAPEL BOARD MEMBER 0.20 1.40 X 0 0 0 STEW RIECKMAN BOARD MEMBER 0.20 1.40 X 0 0 0 0 393735 0 0 0 1 0 0 RESIDENT REVENUE 623990 575906 575906 575906 402 402 LAUNDRY REVENUE 623000 6749 6749 AIR CONDITIONING RENTA 623000 4720 4720 11469 587777 575906 0 11871 223392 124908 98484 53329 53329 10927 10927 40929 37827 3102 575 575 18533 10954 7579 84399 84399 16672 16326 346 26712 26712 104775 104775 12675 12675 DUES & SUBSCRIPTIONS 1963 1963 MISCELLANEOUS 511 511 595392 473868 121524 0 31222 14372 2824 6881 3992914 3625599 364975 367315 2151 2151 827992 718274 1229164 1108993 2235 2218 31477 33651 699931 639104 91422 37534 825065 712507 X 404099 396486 404099 396486 1229164 1108993 -7615 2 0 X 0 1 X 1 1 1 X 537118 554091 546643 533053 575906 2746811 537118 554091 546643 533053 575906 2746811 0 115446 115966 111736 114303 123319 580770 115446 115966 111736 114303 123319 580770 2166041 385 242 192 215 204 1238 385 242 192 215 204 1238 12387 12121 17980 10563 11469 64520 549890 566454 564815 543831 587579 2812569 0.77010 0.76730 0.00040 0.00050 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: LAUNDRY COIN - 2019 AMOUNT: $ 7,555. 2020 AMOUNT: $ 7,041. 2021 AMOUNT: $ 6,621. 2022 AMOUNT: $ 6,209. 2023 AMOUNT: $ 6,749. BEAUTY SHOP REVENUE - 2019 AMOUNT: $ 272. 2020 AMOUNT: $ 60. OTHER INCOME - 2021 AMOUNT: $ 6,519. 2022 AMOUNT: $ 488. AIR CONDITIONING RENTAL - 2019 AMOUNT: $ 4,560. 2020 AMOUNT: $ 5,020. 2021 AMOUNT: $ 4,840. 2022 AMOUNT: $ 3,866. 2023 AMOUNT: $ 4,720. 0 1 X 64065 64065 3032170 2853913 178257 273260 179604 93656 253300 222228 31072 370119 369854 265 367315 TENANT SECURITY DEPOSITS 44989 ESCROW DEPOSITS 7611 REPLACEMENT RESERVE 427765 RESIDUAL RECEIPTS RESERVE 237909 718274 DUE TO/FROM AFFILIATES 37534 37534 X 587777 0 587777 0 587777 595392 0 595392 0 595392 PART IV, LINE 2B: TENANT DEPOSITS HELD IN TRUST: HUD REGULATIONS REQUIRE THAT SECURITY DEPOSITS BE MAINTAINED IN A SEPARATE ACCOUNT IN THE NAME OF THE PROJECT. TOTAL FUNDS IN THIS ACCOUNT ARE REQUIRED TO EQUAL OR EXCEED THE AGGREGATE OF ALL THE PROJECT'S SECURITY DEPOSIT OBLIGATIONS. THE DEPOSITS AND RESERVES LISTED ABOVE ARE INVESTED IN CASH AND A CERTIFICATE OF DEPOSIT. PART X, LINE 2: THE PROJECT HAS EVALUATED ITS TAX POSITIONS AND DETERMINED IT HAS NO UNCERTAIN TAX POSITIONS AT DECEMBER 31, 2023. 0 0 0 0 0 0 0 0 0 THERESA BERTRAM PRESIDENT & CEO 0 393735 0 0 0 0 0 0 0 0 0 393735 0 0 PART I, LINE 3 THE COMPENSATION OF THE PRESIDENT & CEO IS DETERMINED BY THE ORGANIZATION'S SOLE MEMBER, MIRAVIDA LIVING, INC. THE FOLLOWING METHODS WERE USED BY MIRAVIDA LIVING, INC. TO ESTABLISH THE PRESIDENT & CEO'S COMPENSATION: 1. COMPENSATION SURVEY OR STUDY 2. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD OF DIRECTORS PLUS TWO OTHER MEMBERS OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL BE RESPONSIBLE FOR THE AGENDA FOR THE BOARD AND VOTING MEMBERSHIP MEETINGS. THIS COMMITTEE SHALL KEEP ITSELF INFORMED OF THE ENTIRE OPERATION OF THE CORPORATION AND ITS SUBSIDIARY CORPORATIONS, AND SHALL EXECUTE SUCH ACTIONS AS MAY BE ASSIGNED TO IT BY THE BOARD. THE COMMITTEE SHALL ALSO CONCERN ITSELF WITH MATTERS NOT ASSIGNED TO OTHER COMMITTEES. FORM 990, PART VI, SECTION A, LINE 6 MIRAVIDA LIVING, INC. IS THE SOLE MEMBER OF SIMEANNA III, INC. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS OF SIMEANNA III, INC. ARE ELECTED BY THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC. FORM 990, PART VI, SECTION A, LINE 7B MAJOR STANDARD OPERATING PROCEDURES, MAJOR POLICIES, AND PROGRAMS OF SIMEANNA III, INC. ARE SUBMITTED TO THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC. FOR APPROVAL AND IMPLEMENTATION. AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS REQUIRE THE APPROVAL OF THE BOARD OF DIRECTORS OF THE SOLE MEMBER, MIRAVIDA LIVING, INC. FORM 990, PART VI, SECTION B, LINE 11B BEFORE IT WAS FILED, THE FORM 990 WAS REVIEWED BY THE CEO, THEN DISTRIBUTED TO EACH MEMBER OF THE BOARD OF DIRECTORS TO REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CORPORATE SECRETARY DISTRIBUTES A CONFLICT OF INTEREST FORM TO EACH MEMBER OF THE BOARD OF DIRECTORS AND VARIOUS COMMITTEE MEMBERS NOT ON THE BOARD THAT REQUIRES EACH TO IDENTIFY POTENTIAL CONFLICTS OR OTHER RELATED PARTY INTERESTS. THE REPORTS ARE REVIEWED BY THE SECRETARY AND CEO AND ANY CONFLICTS ARE BROUGHT TO THE BOARD'S ATTENTION. A MEMBER OF THE BOARD WHO HAS A CONFLICT OF INTEREST MAY NOT VOTE ON ANY SUCH ISSUE BEFORE THE BOARD. ANY QUESTION OF WHETHER THERE IS A CONFLICT IS RESOLVED BY THE BOARD OF DIRECTORS. IF THE BOARD OF DIRECTORS DETERMINES THAT A DIRECTOR HAS COMMITTED A SUBSTANTIAL VIOLATION OF THE CONFLICT OF INTEREST POLICY, THE INDIVIDUAL IS REMOVED FROM THE OFFICE OF DIRECTOR. IN ADDITION, ALL MANAGEMENT AND SUPERVISORY EMPLOYEES ARE INFORMED OF THE ORGANIZATION'S POLICY REGARDING RELATED PARTY TRANSACTIONS AND CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. MIRAVIDA LIVING INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391032234 MANAGEMENT SERVICES WI 501(C)(3) LINE 10 N/A 0 BETHEL HOME INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391209707 SKILLED NURSING FACILITY WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 CARMEL RESIDENCE INC 220 NORTH WESTFIELD STREET OSHKOSH WI 54902 391448325 ELDERLY HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 GABRIEL'S VILLA INC 215 NORTH WESTFIELD STREET OSHKOSH WI 54902 391857036 ELDERLY HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA APARTMENTS INC 155 NORTH EAGLE STREET OSHKOSH WI 54902 237148097 ELDERLY HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA SOUTH INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391238670 ELDERLY HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 MIRAVIDA LIVING FOUNDATION INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 010938793 FUNDRAISING WI 501(C)(3) LINE 12A, I MIRAVIDA LIVING INC 0 EDEN REHABILITATION SUITES AND GREENHOUSE HOMES INC 3151 EDEN COURT OSHKOSH WI 54904 900506872 SKILLED NURSING FACILITY WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 0 0