2023-08-11T11:21:45-05:00 2022-09-30 410746749 CLIFTONLARSONALLEN LLP 201 N RIVERFRONT DR SUITE 300 MANKATO MN 56001 990 2021-10-01 410959382 STEWARTVILLE NURSING HOME INC STEW 5075334288 120 FOURTH STREET NE STEWARTVILLE MN 55976 JENNIFER NOGOSEK ADMINISTRATOR 5075334288 2023-07-28 1 JENNIFER NOGOSEK 999009999 JOSH SHERBURNE P02039400 5073868800 2023-07-28 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JENNIFER NOGOSEK 120 FOURTH STREET NE STEWARTVILLE MN 55976 6522267 0 X WWW.STEWARTVILLECARECENTER.COM X 1969 MN PROVIDE NURSING HOME CARE & SENIOR HOUSING SERVICES TO THE ELDERLY OF STEWARTVILLE, MN 7 7 130 8 0 0 1003189 280157 5678149 6241827 176330 283 0 0 6857668 6522267 0 0 0 0 3856278 3593052 0 0 0 2361806 2686324 6218084 6279376 639584 242891 3315151 3060059 2275403 1773461 1039748 1286598 TO PROVIDE NURSING HOME CARE AND SENIOR INDEPENDENT HOUSING SERVICES TO THE ELDERLY OF STEWARTVILLE, MN AND THE SURROUNDING AREA. 0 0 5531292 0 6241827 STEWARTVILLE NURSING HOME, INC. (ORGANIZATION) OPERATES STEWARTVILLE CARE CENTER, STEWARTVILLA SENIOR HOUSING, ROOT RIVER ESTATES, SENIOR VAN SERVICES, AND GARDEN COTTAGES. THESE ENTITIES PROVIDE SERVICES TO THE ELDERLY THROUGH THE OPERATION OF AN 85-BED LICENSED NURSING HOME (58 BEDS ACTIVE), SENIOR HOUSING, ASSISTED LIVING UNITS AND VAN SERVICES, ALL LOCATED IN STEWARTVILLE, MINNESOTA. THE MARKET FOR THE ORGANIZATION'S SERVICES IS LIMITED TO SOUTHEASTERN MINNESOTA. BY ITS NATURE, THE ORGANIZATION'S OPERATIONS AND LABOR INTENSIVE. THE ORGANIZATION'S SOURCE OF LABOR IS ALSO GENERALLY LIMITED TO THE SOUTHEASTERN MINNESOTA MARKET. 5531292 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 10 0 130 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 MN X JENNIFER NOGOSEK 5075334288 120 4TH ST NE STEWARTVILLE MN 55976 JARETT JONES PRESIDENT 0.50 X X 0 0 0 MARGARET NELSON VICE PRESIDENT 0.50 X X 0 0 0 CONNIE GRISIM SECRETARY 0.50 X X 0 0 0 DAVID THOMPSON DIRECTOR 0.50 X 0 0 0 BRUCE TRULSON DIRECTOR 0.50 X 0 0 0 LAURA NORDSTROM DIRECTOR 0.50 X 0 0 0 DICK UPTAGRAFFT DIRECTOR 0.50 X 0 0 0 EUGENE GUSTASON ADMINISTRATOR 40.00 X 130485 0 12000 130485 0 12000 1 0 0 0 HEALTHCARE SERVICES GROUP PO BOX 829677 PHILADELPHIA PA 19020 HOUSEKEEPING SERVICES 557903 AEGIS THERAPIES PO BOX 936653 ATLANTA GA 31193 PT, OT, ST THERAPY SERVICES 289532 2 272431 7726 280157 RESIDENT REVENUE 623000 5762268 5762268 APARTMENT REVENUE 623000 474644 474644 OTHER SERVICE REVENUE 623000 4915 4915 6241827 283 283 6522267 6241827 0 283 X 142485 142485 2770244 2590765 179479 23850 21465 2385 434078 390670 43408 222395 200155 22240 4936 4936 53559 53559 775897 761576 14321 8272 8272 9319 9319 267757 267757 8563 8563 51954 51954 399387 399387 63512 63512 MISCELLANEOUS EXPENSE 429441 307128 122313 FOOD AND SUPPLIES 249514 230360 19154 MAINTENANCE AND REPAIRS 166235 166235 UTILITIES 134521 134521 63457 63457 6279376 5531292 748084 0 328351 241671 28137 28145 499906 631887 134887 59918 31738 12519974 10608987 2209953 1910987 229 53770 215631 3315151 3060059 480615 457134 166363 0 1584829 1259673 43596 56654 2275403 1773461 X 1039748 1286598 1039748 1286598 3315151 3060059 242891 3959 0 X X 0 1 X 1 0 X 7426 2665 1003189 280157 1293437 6256906 6716936 6133142 5678149 6241827 31026960 6256906 6724362 6135807 6681338 6521984 32320397 0 0 0 32320397 3457 1799 5769 3320 283 14628 3457 1799 5769 3320 283 14628 129741 101767 231508 6390104 6827928 6141576 6684658 6522267 32566533 0.99240 0.98760 0.00040 0.00050 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 58354 58354 6387276 5700336 686940 4081655 3148612 933043 1536373 1339945 196428 456316 420094 36222 1910987 TENANT SECURITY DEPOSITS 48813 RESIDENTS' TRUST AGREEMENT 10662 FAMILY COUNCIL FUND 2481 LEASE AGREEMENT - BOND FUNDS 153675 215631 FAMILY COUNCIL FUNDS 2475 RESIDENTS' TRUST FUNDS 10662 TENANTS' SECURITY DEPOSITS 43517 56654 X 6522267 0 6522267 0 6522267 6279376 0 6279376 0 6279376 PART X, LINE 2: THE ORGANIZATION HAS BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND MINNESOTA CORPORATE INCOME TAXES UNDER CODE SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. NO LIABILITY HAS BEEN RECOGNIZED BY THE ORGANIZATION AS A RESULT OF THIS STANDARD. THE ORGANIZATION'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO BEING FILED WITH THE IRS, A COPY OF THE IRS FORM 990 AND RELATED SCHEDULES ARE REVIEWED BY THE ADMINISTRATOR, INCLUDING A CONFIRMATION OF THE ACCURACY OF EVERY ANSWER AND OVERSIGHT OF APPROPRIATE CHANGES. UPON COMPLETION OF THE ADMINISTRATOR'S REVIEW, A COPY OF THE 990 WAS APPROVED BY THE BOARD PRIOR TO SUBMITTAL TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND KEY EMPLOYEES ANNUALLY COMPLETE A SURVEY RELATED TO BUSINESS RELATIONSHIPS AND FAMILY MEMBERS THAT COULD, OR DO, CREATE A CONFLICT OF INTEREST. THESE ARE SUMMARIZED AND FILED ALONG WITH BOARD MEETING MINUTES. CONFLICTS OF INTEREST ARE DETERMINED BY A REVIEW OF THE POTENTIAL CONFLICTS BY THE ADMINISTRATOR AND BOARD OF DIRECTORS. IF A CONFLICT EXISTS, THEN THE CONFLICTED BOARD MEMBER OF KEY EMPLOYEE IS EXCLUDED FROM DISCUSSIONS AND VOTES RELATED TO ANY POTENTIAL OR EXISTING RELATIONSHIPS INVOLVING THE CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE PROCESS USED TO SET THE ADMINISTRATOR'S ANNUAL SALARY IS BASED ON A COMBINATION OF COMPARISON TO COMPARABLE ORGANIZATIONS THROUGH USE OF OUR TRADE ORGANIZATION'S ANNUAL COMPENSATION SURVEY AND ATTAINMENT IN THE CURRENT YEAR OF PREDEFINED PERFORMANCE OBJECTIVES SET FOR THE ADMINISTRATOR PERSONALLY AND THE ORGANIZATION. ALSO, THE STATE OF MINNESOTA HAS IN MOST YEARS DETERMINED AN AMOUNT OF PAY INCREASE, IF ANY, THAT CAN BE GIVEN TO EMPLOYEES AND WE HAVE ALSO CONSIDERED THIS AMOUNT IN DETERMINING TOP MANAGEMENT COMPENSATION. THIS PROCESS IS PERFORMED BY THE BOARD AND DOCUMENTED IN THE PRIVATE BOARD MINUTES & EMPLOYEE PERSONNEL FILE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACTED NURSING: PROGRAM SERVICE EXPENSES 6,120. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,120. CONSULTING: PROGRAM SERVICE EXPENSES 25,248. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,248. DIETICIAN CONSULTANT: PROGRAM SERVICE EXPENSES 3,555. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,555. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 726,653. MANAGEMENT AND GENERAL EXPENSES 14,321. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 740,974. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT.