2023-11-15T11:45:42-06:00 2022-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-01-01 270241402 TABITHA ALF REAL ESTATE HOLDING INC TABI 4024837671 4720 RANDOLPH ST LINCOLN NE 68510 BRIAN SHANKS CHIEF FINANICAL OFFICER 4024837671 2023-11-14 1 BRIAN SHANKS 999009999 1 WENDY R COOLEY CPA P01523804 4023302660 2023-11-13 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z JOYCE EBMEIER 4720 RANDOLPH ST LINCOLN NE 68510 698992 0 X WWW.TABITHA.ORG X 2009 NE ACQUIRING, CONSTRUCTING, LEASING, AND OWNING AN ASSISTED LIVING PROJECT FOR THE BENEFIT OF TABITHA, INC. 3 1 0 1 0 0 0 0 0 698266 484 726 660866 0 661350 698992 0 0 0 0 0 0 0 0 0 946206 923082 946206 923082 -284856 -224090 7372633 6798386 9998341 9778069 -2625708 -2979683 NONE 0 0 923082 698266 ACQUIRING, CONSTRUCTING, LEASING, AND OWNING AN ASSISTED LIVING PROJECT FOR THE BENEFIT OF TABITHA, INC. 923082 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 1 1 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X AIMEE BAUMANN 4024837671 4720 RANDOLPH STREET LINCOLN NE 68510 CHRISTINA HINRICHS PRESIDENT & CEO 0.10 50.90 X X 0 583653 34830 BRIAN SHANKS SECRETARY/TREASURER & CFO 0.10 55.90 X X 0 230201 5985 RENEE SJULIN CHAIR 0.10 0.70 X X 0 0 0 0 813854 40815 0 0 1 0 0 ASSISTED LIVING LEASE 531110 698266 698266 698266 726 726 698992 698266 0 726 277121 277121 585542 585542 56669 56669 REPAIRS AND MAINTENANCE 3750 3750 923082 923082 0 0 285993 60368 153679 213116 38045 36675 13660772 7907138 6244061 5753634 650855 734593 7372633 6798386 568 568 9997773 9777501 9998341 9778069 X -2625708 -2979683 -2625708 -2979683 7372633 6798386 X -224090 -129885 X 0 1 X 1 1 1 X X 1 TABITHA INC 470377998 10 1 225000 0 1 225000 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 12961139 7328690 5632449 699633 578448 121185 5753634 ESCROW DEPOSITS 78304 RESERVE FOR REPLACEMENT 656289 734593 X 698992 0 698992 0 698992 923082 0 923082 0 923082 PART X, LINE 2: TABITHA ALF REAL ESTATE HOLDING, INC. (TAREH) ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC TOPIC 740, INCOME TAXES. TAREH RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2022, TAREH HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 0 0 0 0 0 0 0 0 0 CHRISTINA HINRICHS PRESIDENT & CEO 0 446376 0 136250 0 1027 0 9150 0 28026 0 620829 0 0 BRIAN SHANKS SECRETARY/TREASURER & CFO 0 199508 0 29080 0 1613 0 5985 0 2014 0 238200 0 0 PART I, LINE 3 THE PRESIDENT & CEO IS COMPENSATED BY TABITHA, INC., A RELATED ORGANIZATION THAT IS THE SOLE MEMBER OF TABITHA ALF REAL ESTATE HOLDING, INC. TABITHA, INC. USES ONE OR MORE OF THE METHODS ON LINE 3 TO ESTABLISH COMPENSATION. FORM 990, PART VI, SECTION A, LINE 2 THE OFFICERS AND BOARD MEMBER HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF TABITHA ALF REAL ESTATE HOLDING, INC. IS TABITHA, INC. FORM 990, PART VI, SECTION A, LINE 7A THE PRESIDENT & CEO AND CHIEF FINANCIAL OFFICER OF TABITHA, INC., THE SOLE MEMBER, ARE EX-OFFICIO MEMBERS OF THE BOARD OF DIRECTORS WITH VOICE AND VOTE. THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS ARE ELECTED BY TABITHA, INC. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AND THE BOARD OF DIRECTORS OF TABITHA, INC. BEFORE FILING WITH THE IRS. THE PRESIDENT & CEO AND CFO REVIEW THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, DIRECTOR AND COMMITTEE MEMBER SHALL FILE ANNUALLY WITH THE SECRETARY A CONFLICT OF INTEREST STATEMENT AND DISCLOSURE STATEMENT IN A FORM ADOPTED BY THE BOARD, WHICH STATEMENT SHALL BECOME A PART OF THE RECORDS OF THE CORPORATION. THE STATEMENT AFFIRMS EACH PERSON A) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; B) HAS READ AND UNDERSTANDS THE POLICY; C) HAS AGREED TO COMPLY WITH THE POLICY; D) UNDERSTANDS THE ORGANIZATION IS CHARITABLE AND MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OF MORE OF ITS TAX-EXEMPT PURPOSES TO MAINTAIN ITS FEDERAL TAX EXEMPTION. EACH PERSON WHO FILES SHALL NOTIFY THE SECRETARY OF ANY PERTINENT CHANGES IN THE STATEMENT DURING THE COURSE OF THE YEAR. IN THE EVENT A QUESTION COMES BEFORE THE BOARD OR A STANDING OR SPECIAL COMMITTEE IN WHICH A DIRECTOR OR COMMITTEE MEMBER HAS A RECORDED OR UNRECORDED CONFLICT, THE DIRECTOR OR COMMITTEE MEMBER SHALL STATE THE EXISTENCE AND NATURE OF THE CONFLICT FOR THE RECORD AND SHALL REFRAIN FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 THE PRESIDENT & CEO AND CFO ARE COMPENSATED BY TABITHA, INC., A RELATED ORGANIZATION THAT IS THE SOLE MEMBER OF TABITHA ALF REAL ESTATE HOLDING, INC. TABITHA, INC. HAS PROCESSES IN PLACE TO REVIEW COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: TRANSFER TO AFFILIATE -225,000. TRANSFER FROM AFFILIATE 95,115. TABITHA INC 4720 RANDOLPH STREET LINCOLN NE 68510 470377998 ELDER CARE SERVICES NE 501(C)(3) LINE 10 N/A 0 THE TABITHA FOUNDATION 4720 RANDOLPH STREET LINCOLN NE 68510 470636199 FUNDRAISING AND SUPPORT TO TABITHA, INC. NE 501(C)(3) LINE 12A, I TABITHA INC 0 TABITHA GRAND ISLAND INC 3940 EWOLDT STREET GRAND ISLAND NE 68803 843824792 ELDER CARE SERVICES NE 501(C)(3) LINE 10 TABITHA INC 0 TABITHA HOME HEALTH CARE & HOSPICE 1044 NORTH 115TH STREET SUITE 200 OMAHA NE 68154 873957968 HOME HEALTH CARE AND HOSPICE NE N/A 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0 1 1