2024-11-10T17:26:18-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 10401 W INNOVATION DR STE 300 WAUWATOSA WI 53226 990 2023-01-01 391032234 MIRAVIDA LIVING INC MIRA 9202354653 225 N EAGLE ST OSHKOSH WI 54902 THERESA BERTRAM PRESIDENT & CEO 9202354653 2024-11-08 1 0 KRISTEN DONLEVY P01670215 4144761880 2024-11-08 2023 2024-10-15 13:58:12Z THERESA BERTRAM 225 N EAGLE ST OSHKOSH WI 54902 5385067 0 9386 X WWW.MIRAVIDALIVING.COM X 1966 WI MIRAVIDA LIVING INC PROVIDES MANAGEMENT SERVICES TO ITS SUBSIDIARIES, WHICH ARE BETHEL HOME INC, SIMEANNA APARTMENTS INC, SIMEANNA SOUTH INC, SIMEANNA III INC, CARMEL RESIDENCE INC, GABRIEL'S VILLA INC, MIRAVIDA LIVING FOUNDATION INC, AND EDEN REHABILITATION SUITES AND GREENHOUSE HOMES INC. 9 9 49 9 0 0 297679 802045 3063383 3180025 1507 7702 503284 742558 3865853 4732330 0 0 0 0 2682725 2753838 0 0 0 452352 513517 3135077 3267355 730776 1464975 10896104 12154418 806345 599684 10089759 11554734 MIRAVIDA LIVING INC IS A FAMILY OF HEALTHCARE AND RESIDENTIAL SERVICE ORGANIZATIONS COMMITTED TO PROVIDING QUALITY CARE AND ENRICHING OPPORTUNITIES TO THE AGING AND THOSE IN NEED IN A CARING, CHRISTIAN ENVIRONMENT. 0 0 2529289 0 3180025 MIRAVIDA LIVING PROVIDES MANAGEMENT SERVICES TO ITS SUBSIDIARIES, WHICH ARE BETHEL HOME, INC., SIMEANNA APARTMENTS, INC., SIMEANNA SOUTH, INC., SIMEANNA III, INC., CARMEL RESIDENCE, INC., GABRIEL'S VILLA, INC., MIRAVIDA LIVING FOUNDATION, INC., AND EDEN REHABILITATION SUITES AND GREEN HOUSE HOMES, INC. 514539 0 390195 MIRAVIDA LIVING OPERATES A PHARMACY WITHIN THE WALLS OF BETHEL HOME FOR THE BENEFIT OF ITS RESIDENTS. 3043828 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 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 1 0 0 0 1 4 0 1 49 1 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 1 1 0 X KIM MAKI 9202325238 225 N EAGLE ST OSHKOSH WI 54902 MARK BEECHER CHAIR 0.20 1.40 X X 0 0 0 NATE OLSON 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 STEW RIECKMAN BOARD MEMBER 0.20 1.40 X 0 0 0 JIM STAPEL BOARD MEMBER 0.20 1.40 X 0 0 0 THERESA BERTRAM PRESIDENT & CEO 4.50 35.50 X 393735 0 0 KARI HAWKINSON VP OF HUMAN RESOURCES 40.00 0.00 X 116610 0 0 KERRI SCHUELER PHARMICIST 40.00 0.00 X 149000 0 0 JOSH BORLAND FACILITIES OPERATIONS MANAGER 40.00 0.00 X 102090 0 0 761435 0 0 4 0 1 0 0 632125 169920 802045 MANAGEMENT FEE REVENUE 623990 3180025 3180025 3180025 2202 2202 5500 0 5500 5500 5500 1042932 652737 390195 390195 MISCELLANEOUS 611710 237551 237551 TRANSPORTATION REVENUE 900099 93262 93262 APARTMENT REVENUE 623990 18800 18800 2750 2750 352363 4732330 3570220 0 360065 761435 761435 1547881 1547881 93681 93681 195125 195125 155716 129066 26650 84996 84996 36018 36018 10663 10663 54331 54331 39893 5990 33903 42320 42320 45542 40167 5375 3498 2339 1159 2110 2110 64 64 111306 111306 29379 29379 MISCELLANEOUS EXPENSES 32227 32227 MEDICAL SUPPLIES 10236 10236 EMPLOYEE RELATIONS 9824 9824 EMPLOYEE UNIFORMS 1110 1110 3267355 3043828 223527 0 419476 126667 256011 486548 98995 98002 70468 93879 3068918 1100751 1892420 1968167 80416 82595 8078318 9298560 10896104 12154418 340690 366773 3648 462007 232911 806345 599684 X 10089759 11554734 10089759 11554734 10896104 12154418 1464975 0 X 0 1 X 1 0 X 103044 177477 603452 297679 169920 1351572 3856181 4031027 4055129 4064314 4222957 20229608 3959225 4208504 4658581 4361993 4392877 21581180 0 2267561 2581153 2532980 2620026 2660413 12662133 2267561 2581153 2532980 2620026 2660413 12662133 8919047 862 799 1483 1507 2202 6853 862 799 1483 1507 2202 6853 91249 69898 80315 94373 984488 1320323 4051336 4279201 4740379 4457873 5379567 22908356 0.38930 0.40950 0.00030 0.00020 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2019 AMOUNT: $ 2,249. 2020 AMOUNT: $ 2,565. 2021 AMOUNT: $ 3,400. 2022 AMOUNT: $ 2,130. 2023 AMOUNT: $ 237,551. APARTMENT REVENUE - 2019 AMOUNT: $ 2,365. 2020 AMOUNT: $ 10,715. 2021 AMOUNT: $ 10,450. 2022 AMOUNT: $ 11,600. 2023 AMOUNT: $ 18,800. MEAL INCOME - 2019 AMOUNT: $ 12. TRANSPORTATION REVENUE - 2019 AMOUNT: $ 56,226. 2020 AMOUNT: $ 50,543. 2021 AMOUNT: $ 61,265. 2022 AMOUNT: $ 79,893. 2023 AMOUNT: $ 93,262. CPE STUDENT SPONSORSHIP FEES - 2019 AMOUNT: $ 20,660. CPE TUITION - 2019 AMOUNT: $ 9,737. 2020 AMOUNT: $ 6,075. 2021 AMOUNT: $ 5,200. 2022 AMOUNT: $ 750. 2023 AMOUNT: $ 2,750. INTERCOMPANY TRANSFERS - 2023 AMOUNT: $ 632,125. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1483879 1483879 306812 196893 109919 40603 30052 10551 802345 563854 238491 435279 309952 125327 1968167 DUE FROM AFFILIATES 9298560 9298560 INTERCOMPANY PAYABLE 232911 232911 X PART X, LINE 2: THE ORGANIZATION FOLLOWS THE PROVISIONS OF THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE APPLICATION OF THE INCOME TAX STANDARD HAD NO IMPACT ON THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS. THE ORGANIZATION FILES INFORMATIONAL RETURNS AS A TAX-EXEMPT ORGANIZATION. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. X X 0 0 0 0 0 0 0 0 0 THERESA BERTRAM PRESIDENT & CEO 393735 0 0 0 0 0 0 0 0 0 393735 0 0 0 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 THE MEMBERSHIP CONSISTS OF EACH VOTING MEMBER OF THE CONGREGATION AFFILIATED WITH MIRAVIDA LIVING. AFFILIATED ORGANIZATIONS MAY BE FROM THE EVANGELICAL LUTHERAN CHURCH IN AMERICA, THE LUTHERAN CHURCH - MISSOURI SYNOD, OR OTHER LUTHERAN CONGREGATIONS WHO ARE INVITED TO BECOME MEMBERS AND WHO ARE ELECTED TO AFFILIATED CONGREGATION STATUS BY THE VOTING MEMBERSHIP. THE PASTOR(S) REGULARLY CALLED OR HIS/HER DESIGNEE(S) OF ANY AFFILIATED LUTHERAN CONGREGATION ARE ENTITLED TO ONE VOTE AT THE ORGANIZATION'S MEETINGS. IN ADDITION TO THESE VOTES, EACH CONGREGATION IS ENTITLED TO TWO VOTING LAY DELEGATES FOR THE FIRST 500 CONFIRMED MEMBERS AND ONE VOTING LAY DELEGATE FOR EACH ADDITIONAL 500 CONFIRMED MEMBERS OR MAJOR FRACTION THEREOF. EACH CONGREGATION HAS AT LEAST THREE TOTAL VOTES. FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER OF THE BOARD OF DIRECTORS IS ELECTED BY THE MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS REQUIRE APPROVAL OF THE MEMBERS. AMENDMENTS THAT RELATE TO AFFILIATION WITH THE EVANGELICAL LUTHERAN CHUCH IN AMERICA AND/OR RECOGNITION BY THE LUTHERAN CHURCH - MISSOURI SYNOD MUST ALSO BE APPROVED THE EVANGELICAL CHURCH IN AMERICA DIVISION FOR CHURCH IN SOCIETY AND/OR THE LUTHERAN CHURCH - MISSOURI SYNOD BOARD FOR HUMAN CARE MINISTRIES. 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 FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE 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 B, LINE 15 CEO COMPENSATION IS DETERMINED BY A COMMITTEE OF THE BOARD OF DIRECTORS. THE COMMITTEE CONSIDERS COMPARABLE DATA AND ECONOMIC CONDITIONS. THE DELIBERATIONS ARE RECORDED. COMPENSATION AND BENEFITS FOR OTHER OFFICERS AND KEY EMPLOYEES ARE REVIEWED ANNUALLY BY THE CEO. COMPARABLE INDUSTRY STANDARDS ARE CONSIDERED INCLUDING COMPENSATION AND BENEFIT INFORMATION PROVIDED BY LEADINGAGE WISCONSIN. DELIBERATIONS INCLUDE A REVIEW OF OBJECTIVES AND ACTUAL DELIVERABLES. THE PROCESS IS DOCUMENTED/MAINTAINED ELECTRONICALLLY. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. BETHEL HOME INC 225 N EAGLE ST OSHKOSH WI 54902 391209707 SKILLED NURSING FACILILTY WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 1 CARMEL RESIDENCE INC 220 N WESTFIELD ST OSHKOSH WI 54902 391448325 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 1 GABRIEL'S VILLA INC 215 N WESTFIELD ST OSHKOSH WI 54902 391857036 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 1 SIMEANNA APARTMENTS INC 155 N EAGLE ST OSHKOSH WI 54902 237148097 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 1 SIMEANNA SOUTH INC 145 N EAGLE ST OSHKOSH WI 54902 391238670 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 1 SIMEANNA III INC 151 N EAGLE ST OSHKOSH WI 54902 391270056 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 1 EDEN REHABILITATION SUITES & GREENHOUSE HOMES INC 3151 EDEN CT OSHKOSH WI 54902 900506872 SKILLED NURSING FACILITY WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 1 MIRAVIDA LIVING FOUNDATION INC 225 N EAGLE ST OSHKOSH WI 54902 010938793 FUNDRAISING WI 501(C)(3) LINE 12A, I MIRAVIDA LIVING INC 1 0 0 0 1 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 BETHEL HOME INC L ALLOCATION BETHEL HOME INC Q BOOK VALUE CARMEL RESIDENCE INC L ALLOCATION CARMEL RESIDENCE INC D BOOK VALUE CARMEL RESIDENCE INC E BOOK VALUE GABRIEL'S VILLA INC L ALLOCATION GABRIEL'S VILLA INC D BOOK VALUE GABRIEL'S VILLA INC E BOOK VALUE SIMEANNA APARTMENTS INC L ALLOCATION SIMEANNA APARTMENTS INC D BOOK VALUE SIMEANNA APARTMENTS INC E BOOK VALUE SIMEANNA SOUTH INC L ALLOCATION SIMEANNA SOUTH INC D BOOK VALUE SIMEANNA SOUTH INC E BOOK VALUE SIMEANNA III INC L ALLOCATION SIMEANNA III INC D BOOK VALUE SIMEANNA III INC E BOOK VALUE EDEN REHABILITATION SUITES & GREENHOUSE HOMES INC L ALLOCATION EDEN REHABILITATION SUITES & GREENHOUSE HOMES INC D BOOK VALUE EDEN REHABILITATION SUITES & GREENHOUSE HOMES INC E BOOK VALUE MIRAVIDA LIVING FOUNDATION INC E BOOK VALUE