2020-08-14T08:50:39-05:00 2019-09-30 410746749 CLIFTONLARSONALLEN LLP 121 WEST BRIDGE STREET OWATONNA MN 55060 990 2018-10-01 410826784 LUTHER MEMORIAL HOME LUTH 5076423271 221 6TH STREET SW MADELIA MN 56062 LARRY PASSEL ADMINISTRATOR 5076423271 2020-08-12 1 MATT GOLDADE P01313858 5074467100 2020-08-12 67.137.57.251 2020-08-12 10:53:37 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 6BCE17CF531EE5E889DFF9A1732B3E9930A5A1A9 2018 2020-11-06 18:47:13Z LARRY PASSEL 221 6TH STREET SW MADELIA MN 56062 4418486 0 X N/A X 1958 MN TO PROVIDE 24-HOUR SKILLED NURSING CARE, ROOM & BOARD, DIETARY SERVICES, HOUSEKEEPING/LAUNDRY, REHABILITATIVE THERPAY, ACTIVITY PROGRAMMING, SPIRITUAL SERVICES, BEAUTY/BARBER SERVICES, AND SOCIAL SERVICES IN A PROFESSIONAL AND HOME-LIKE ENVIRONMENT. 9 9 130 50 0 0 172697 109032 3794723 4185334 607 54377 72025 69743 4040052 4418486 159476 19975 0 0 2401952 2473202 0 0 0 1469354 1763740 4030782 4256917 9270 161569 2637607 2650956 977910 829690 1659697 1821266 TO PROVIDE SUPPORTIVE, REHABILITATIVE CARE TO MEET THE PHYSICAL, SPIRITUAL, AND EMOTIONAL NEEDS OF THE PEOPLE WE SERVE. 0 0 3605280 19975 4185334 TO PROVIDE 24-HOUR SKILLED NURSING CARE, ROOM & BOARD, DIETARY SERVICES, HOUSEKEEPING/LAUNDRY, REHABILITATIVE THERAPIES, ACTIVITY PROGRAMMING, SPIRITUAL SERVICES, BEAUTY/BARBER SERVICES, AND SOCIAL SERVICES IN A PROFESSIONAL MANNER AND HOME-LIKE ENVIRONMENT. 3605280 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 9 0 130 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 0 0 0 1 0 0 0 MN X LARRY PASSEL 5076423271 503 BENZEL AVENUE MADELIA MN 56062 DENNIS SWENSON CHAIRMAN 0.50 X X 855 0 0 BETH GOODBURN VICE CHAIRMAN 0.50 X X 635 0 0 AMY CHLEBORAD SECRETARY 0.50 X X 600 0 0 COLLEEN JACOBS TREASURER 0.50 X X 850 0 0 MARY FEDER DIRECTOR 0.50 X 600 0 0 CALVIN HANSON DIRECTOR 0.50 X 635 0 0 RYAN VISHER DIRECTOR 0.50 X 630 0 0 CHARLES OLSON DIRECTOR 0.50 X 675 0 0 JANETTE ABRAHAM DIRECTOR 0.50 X 0 0 0 DAWN CAMPELL ADMINISTRATOR 40.00 X 70838 0 1300 76318 0 1300 0 0 0 0 MARTIN BROTHERS PO BOX 69 CEDAR FALLS IA 50613 FOOD VENDOR 203985 LSI CONSULTING LLC 108 8TH STREET NW WASECA MN 56093 MGMT/CONSULTING SERVICES 192022 REHABCARE GROUP PO BOX 503534 ST LOUIS MO 63150 PHYSICAL, OCCUPATIONAL & SPEECH THERAPY 182096 3 109032 109032 RESIDENT REVENUE 623000 3820610 3820610 MEDICARE/MEDICAID PMTS 623000 364724 364724 4185334 54377 54377 59481 59481 MISCELLANEOUS INCOME 900099 8011 8011 GUEST/EMPLOYEE MEALS 623000 1244 1244 BEAUTY SHOP 623000 1007 1007 10262 4418486 4185334 0 124120 19975 19975 71218 71218 2120249 2091494 28755 116088 110287 5801 165647 157365 8282 156988 156988 1193 1193 22748 22748 308627 285423 23204 43343 43343 76833 32771 44062 152651 152651 3264 2746 518 20042 12735 7307 22005 22005 119044 119044 52895 52895 SUPPLIES 238081 238081 FOOD COSTS 184209 184209 DHS MEDICAL CARE SURCHA 145911 145911 MISCELLANEOUS 97082 9821 87261 118824 20762 98062 4256917 3605280 651637 0 351736 177162 268694 275422 429304 606147 2194 1232 34364 30721 5318030 3757758 1551315 1560272 2637607 2650956 488431 354469 3046 4557 486433 470664 977910 829690 X 1659697 1821266 1659697 1821266 2637607 2650956 161569 0 X X 0 1 X 1 0 X 17879 33625 1 147393 68474 267372 3577259 3739102 3675734 3794723 4185334 18972152 9088 3219 10262 22569 3595138 3772727 3684823 3945335 4264070 19262093 17879 28942 147393 68474 262688 1536729 1867473 2104025 1995970 2173906 9678103 1554608 1896415 2104025 2143363 2242380 9940791 9321302 228188 119285 115077 94717 154416 711683 228188 119285 115077 94717 154416 711683 34959 22063 57022 3858285 3914075 3799900 4040052 4418486 20030798 0.46530 0.46920 0.03550 0.04510 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 8889 8889 3884664 2663222 1221442 1424477 1094536 329941 1560272 X PART IV, LINE 2B: RESIDENT TRUST ACCOUNTS PART X, LINE 2: THE HOME AND FOUNDERS FUND HAVE BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND STATE CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THE HOME AND FOUNDERS FUND FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. NO LIABILITY HAS BEEN RECOGNIZED BY THE HOME OR FOUNDERS FUND AS A RESULT OF THIS STANDARD. BOTH THE HOME AND FOUNDERS FUND FILE AS TAX-EXEMPT ORGANIZATIONS. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE IRS. 1 LUTHER MEMORIAL HOME FOUNDERS FUND 221 6TH STREET SW MADELIA MN 56062 411472019 501(C)(3) 19975 TO HELP FUND THE LUTHER MEMORIAL HOME FOUNDERS FUND. PART I, LINE 2: THE CLOSE RELATIONSHIP THE HOME HAS WITH THE FOUNDERS FUND (A RELATED ENTITY) ALLOWS THEM TO MONITOR THE FUNDS. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP OF THE CORPORATION SHALL CONSIST OF THE PASTORS AND THE VOTING MEMBERS OF SUCH CONGREGATIONS WITHIN THE EVANGELICAL LUTHERAN CHURCH OF AMERICA OR ITS SUCCESSORS AS HAVE ELECTED TO BECOME MEMBERS IN ACCORDANCE WITH THE TERMS OF SECTION 1 OF THE BYLAWS. FORM 990, PART VI, SECTION A, LINE 7A CANDIDATES FOR OPEN BOARD POSITONS ARE SELECTED BY A NOMINATING COMMITTEE TO BE ELECTED BY THE MEMBERSHIP AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION A, LINE 7B THE BYLAWS OF THE CORPORATION MAY BE AMENDED, ADOPTED, OR REPEALED AT ANY MEETING OF THE MEMBERSHIP OR AT A SPECIAL MEETING OF THE MEMBERSHIP UPON DUE NOTICE CALLED FOR THE EXPRESSLY STATED PURPOSE BY THE AFFIRMATIVE VOTE OF A MAJORITY OF THE AUTHORIZED VOTING MEMBERSHIP. AMENDMENTS TO THE ARTICLES OF INCORPORATION MAY BE MADE BY A MAJORITY VOTE THE DIRECTORS AND BY A TWO-THIRDS VOTE OF A QUORUM OF THE MEMBERS AT ANY REGULAR OR SPECIAL MEETING, SUBJECT HOWEVER, TO PROPER NOTICE AND PROCEDURE AS PROVIDED BY THE STATE OF MINNESOTA. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE IRS FORM 990 AND RELATED SCHEDULES ARE REVIEWED BY ADMINISTRATION. THE BOARD MEMBERS WILL BE INFORMED OF THE AVAILABILITY OF THE DOCUMENT FOR THEIR REVIEW BY ADMINISTRATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATIONS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE ORGANIZATIONS BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS CONSOLIDATED FINANCIAL STATEMENTS AND THE SELECTION OF ITS INDEPENDENT ACCOUNTANT. LUTHER MEMORIAL HOME FOUNDERS FUND 221 6TH STREET SW MADELIA MN 56062 411472019 ENDOWMENT MANAGEMENT & ADMINISTRATION MN 501(C)(3) 12B, II LUTHER MEMORIAL HOME 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 LUTHER MEMORIAL HOME FOUNDERS FUND B 19975 ACTUAL AMOUNT LUTHER MEMORIAL HOME FOUNDERS FUND C 109032 ACTUAL AMOUNT