2024-11-10T17:26:37-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 10401 W INNOVATION DR STE 300 WAUWATOSA WI 53226 990 2023-01-01 391238670 SIMEANNA SOUTH INC SIME 9202354653 145 N EAGLE ST OSHKOSH WI 54902 THERESA BERTRAM PRESIDENT & CEO 9202325228 2024-11-08 1 0 KRISTEN DONLEVY P01670215 4144761880 2024-11-08 2023 2024-10-15 13:58:12Z THERESA BERTRAM 145 N EAGLE ST OSHKOSH WI 54902 505715 0 9386 X WWW.MIRAVIALIVING.COM X 1986 WI TO PROVIDE HOUSING FOR THE AGING. 9 9 0 9 0 0 0 0 465298 495168 -1333 2069 8192 8478 472157 505715 0 0 0 0 183607 195624 0 0 0 248505 260286 432112 455910 40045 49805 1028077 1080715 48512 51345 979565 1029370 TO PROVIDE QUALITY CARE AND LIFE-ENRICHING OPPORTUNITIES TO THE AGING, AND THOSE IN NEED IN A CARING, CHRISTIAN ENVIRONMENT. 0 0 340470 0 495168 SIMEANNA SOUTH, INC. OFFERS APARTMENT STYLE LIVING FOR AGING PERSONS. THE FACILITY CONTAINS 61 UNITS; 60 OF THE UNITS QUALIFY UNDER SECTION 8 OF THE HUD REGULATIONS, AND 1 UNIT IS EXEMPT. 340470 1 0 0 0 0 0 0 0 1 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 0 0 0 1 2 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 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 STEW RIECKMAN BOARD MEMBER 0.20 1.40 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 THERESA BERTRAM PRESIDENT & CEO 4.00 34.00 X 0 393735 0 0 393735 0 0 0 1 0 0 APARTMENT OPERATIONS 623990 495168 495168 495168 2069 2069 LAUNDRY 900099 4998 4998 AIR CONDITIONER RENTAL 900099 3160 3160 MISCELLANEOUS 900099 320 320 8478 505715 495168 0 10547 195624 97296 98328 55271 48996 6275 20696 20574 122 595 595 5204 5204 2612 2612 97044 96204 840 346 346 6 6 50763 50763 7757 7757 MOTOR VEHICLE 9837 9837 GROUNDS FEES 5223 5223 DUES & INSPECTIONS 2638 2638 EQUIPMENT RENTAL & REPA 1169 1169 1125 7 1118 455910 340470 115440 0 143680 129743 230578 230828 2200 6194 2899979 2394641 447342 505338 204277 208612 1028077 1080715 2083 2901 22315 22106 24114 26338 48512 51345 X 979565 1029370 979565 1029370 1028077 1080715 49805 0 X 0 1 X 1 0 X 462218 478001 471383 465298 495168 2372068 462218 478001 471383 465298 495168 2372068 0 165362 179709 171383 165298 191739 873491 165362 179709 171383 165298 191739 873491 1498577 259 5511 1872 -1333 2069 8378 259 5511 1872 -1333 2069 8378 9274 8411 8083 8192 8478 42438 471751 491923 481338 472157 505715 2422884 0.61850 0.62750 0.00350 0.00270 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: LAUNDRY REVENUE - 2019 AMOUNT: $ 5,649. 2020 AMOUNT: $ 4,951. 2021 AMOUNT: $ 4,643. 2022 AMOUNT: $ 4,854. 2023 AMOUNT: $ 4,998. MISCELLANEOUS REVENUE - 2020 AMOUNT: $ 100. 2022 AMOUNT: $ 370. 2023 AMOUNT: $ 320. AIR CONDITIONER RENTAL - 2019 AMOUNT: $ 3,625. 2020 AMOUNT: $ 3,360. 2021 AMOUNT: $ 3,440. 2022 AMOUNT: $ 2,968. 2023 AMOUNT: $ 3,160. 0 1 X 50000 50000 1522722 209812 1312910 270285 1520340 -1250055 1056972 664489 392483 505338 TENANT DEPOSITS HELD IN TRUST 31348 REPLACEMENT RESERVES 177264 208612 DUE TO AFFILIATES 26338 26338 X PART IV, LINE 2B: TENANT SECURITY DEPOSITS; HUD REGULATIONS REQUIRE TENANT SECURITY DEPOSITS TO 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. 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. 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 SOUTH INC. FORM 990, PART VI, SECTION A, LINE 7A THE DIRECTORS OF SIMEANNA SOUTH 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 SOUTH NC 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 FOR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE CORPORATE SECRETARY DISTRIBUTES A CONFLICT OF INTEREST FOR 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 18 THE ORGANIZATION'S FORM 990 IS AVAILABLE UPON REQUEST AND IS ALSO AVAILABLE AT WWW.CANDID.ORG. THE ORGANIZATION'S FORM 1023 IS ALSO AVAILABLE UPON REQUEST. 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 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 GABRIEL'S VILLA INC 215 NORTH WESTFIELD STREET OSHKOSH WI 54902 391857036 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA APARTMENTS INC 155 NORTH EAGLE STREET OSHKOSH WI 54902 237148097 SENIOR HOUSING WI 501(C)(3) LINE 10 MIRAVIDA LIVING INC 0 SIMEANNA III INC 225 NORTH EAGLE STREET OSHKOSH WI 54902 391270056 SENIOR 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 0 1 0 1 1 1 1 1 0 0