SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
Gibault Care Inc
d/b/a McGivney Health Care Center
Employer identification number

35-2139972
Return Reference Explanation
Form 990, Part VI, Section A, line 2 Line 2 explanation - Business Relationship - Michele Madley, President/CEO of Gibault Care, Inc. is also President/CEO of a related party - Gibault, Inc.; Amy Atchley, Treasurer of Gibault Care, Inc. is also the Chief Financial Officer of Gibault, Inc. and maintains the accounting for Gibault Care, Inc. and related companies of Gibault, Inc., Gibault Venture, Inc. and Gibault Foundation, Inc.; Kathy Bradbury, Secretary of Gibault Care, Inc. is also the Secretary of the related companies: Gibault Ventures, Inc. and Gibault, Inc. Additionally, board members James Funk, Fred Schmits, and Robert Lynch were also board members of a related company - Gibault, Inc. Additionally, board members Jeff Guenther and Robert Lynch are also a board members of Gibault Foundation, Inc., a related company.
Form 990, Part VI, Section A, line 3 Line 3 explanation - Through issuance of management contract, Gibault Care, Inc. obtains management services from a related company - Gibault, Inc. Services include accounting and administrative functions, as well as operational support, when needed.
Form 990, Part VI, Section B, line 11b Line 11b Explanation - Form 990 was not provided to the board; however, a review was performed by the Chief Financial Officer (CFO) of Gibault, Inc.(a related party) - who maintains the accounting records for this entity.
Form 990, Part VI, Section B, line 12c On an annual basis, employees are required to complete a conflict of interest disclosure statement, which is maintained in their personnel file. Employees signoff on the disclosure statement. The company's administrator monitors disclosures and addresses issues as they arise.
Form 990, Part VI, Section B, line 15 Compensation for the Organization's officers is determined by a board committee which uses salary data for comparable organizations.
Form 990, Part VI, Section C, line 19 Chief Financial Officer of Gibault, Inc.(a related company) maintains all pertinent documents which may be obtained upon request.
Part XII, Line 2c The Organization is included in the consolidated financial statements of Gibault, Inc. Gibault, Inc. has an audit committee who has responsibility for the consolidated financial statements. The audit committee also oversees the selection of the independent auditors. There were no changes in the process for the selection of an independent accountant for the audit.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


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