2019-08-01T12:35:28-05:00 2018-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2017-10-01 410845402 MINNEWASKA LUTHERAN HOME MINN 3202392217 PO BOX 40 STARBUCK MN 56381 KAYO ASLAGSON BOARD CHAIR 3202392217 2019-07-23 1 CORY RUTLEDGE P01329381 6123764500 67.137.57.251 2019-07-23 15:14:04 CD P 00BE1F513142CA66DA2C367DB88293381486700F 9DCB77BB5DA20F06DC527A2BE3898FDA4E15C9A7 2017 2019-02-21 02:37:17Z CHRISTOPHER KNOLL PO BOX 40 STARBUCK MN 56381 4281265 0 X WWW.MCHS-HEALTHCARE.ORG X 1958 MN NURSING HOME - A COMMUNITY OF SERVICES, GROUNDED IN FAITH, PROVIDING PERSON CENTERED CARE. 10 10 180 75 0 0 57780 27192 4115945 4185818 8367 8955 29510 59300 4211602 4281265 68871 37109 0 0 2885581 3168858 0 0 0 1408357 1586144 4362809 4792111 -151207 -510846 6653443 14345894 4254187 11977446 2399256 2368448 X A COMMUNITY OF SERVICES, GROUNDED IN FAITH, PROVIDING PERSON CENTERED CARE THAT ENCOURAGES ALL PEOPLE TO REACH THEIR HIGHEST POTENTIAL. 1 0 3539323 37109 3555643 MINNEWASKA LUTHERAN HOME, A 41-BED SKILLED NURSING FACILITY, PROMOTES HEALTH TO THE COMMUNITY BY PROVIDING SKILLED NURSING CARE AND PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY SERVICES. ADDITIONAL PROGRAMS WHICH BENEFIT THE COMMUNITY INCLUDE: OUTPATIENT THERAPY SERVICES: MINNEWASKA LUTHERAN HOME PROVIDES PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY TO COMMUNITY MEMBERS IN NEED OF THESE SERVICES ALLOWING THEM TO RESUME THEIR NORMAL ACTIVITIES OF DAILY LIVING. MINNEWASKA LUTHERAN HOME IS GOVERNED BY A TEN PERSON INDEPENDENT BOARD MADE UP OF ONE AT-LARGE COMMUNITY LEADER AND NINE CHURCH MEMBERS FROM THE STARBUCK, MN AND HOFFMAN, MN AREAS. THE BOARD HAS A HISTORY OF COMMITMENT TO ACTING WITH THE HIGHEST INTEGRITY AND HAS BEEN PROACTIVELY EVALUATING OPPORTUNITIES TO ENSURE THE ORGANIZATION CONTINUES TO OPERATE AT ITS MAXIMUM POTENTIAL FOR THE BENEFIT OF THE CLIENTS WE SERVE AND THE COMMUNITIES WE SERVE. 373894 0 586198 GLACIAL TRAILS MEMORY CARE OPERATES A 16-UNIT MEMORY CARE ASSISTING LIVING FACILITY SERVING RESIDENTS OF STARBUCK AND THE SURROUNDING AREA. 178900 0 43977 HOFFMAN SENIOR LIVING OPERATES A 10-UNIT ASSISTED LIVING FACILTY AND A 10-UNIT MEMORY CARE ASSISTED LIVING FACILITY SERVING RESIDENTS OF HOFFMAN AND THE SURROUNDING AREA. 0 0 0 COMMUNITY OUTREACH EXERCISE PROGRAM: EXERCISE PROGRAM THAT STRESSES STRENGTH AND STABILITY. THIS PROGRAM IS OFFERED THREE TIMES PER WEEK TO COMMUNITY MEMBERS AT NO CHARGE. 0 0 0 THE STAFF RETENTION, RECRUITMENT AND RESIDENT SATISFACTION PROJECT IS BASED ON IMPROVING EMPLOYEE RECRUITMENT, RETENTION & TURNOVER. CONTINUITY OF STAFF HAS A DIRECT EFFECT ON QUALITY OF RESIDENT CARE. THE LONGER THE EMPLOYEE WORKS WITH A RESIDENT, THE MORE HE OR SHE GETS TO KNOW THE UNIQUE NEEDS & COMMUNICATION STRATEGIES OF THE RESIDENT. STABLE STAFFING BETTER ALLOWS THE RESIDENT TO FORM A MEANINGFUL RELATIONSHIP WITH HIS OR HER CAREGIVER, WHICH IN TURN, RESULTS IN BETTER CARE. ADDRESSING STAFFING DEFICIENCIES IS OFTEN ACCOMPLISHED WITH OVERTIME & INCREASES IN PATIENT LOAD, BOTH OF WHICH DECREASE QUALITY OF CARE & INCREASE NEGATIVE CLINICAL OUTCOMES. IMPROVEMENTS IN RETENTION & TURNOVER CAN ALSO BE A SUBSTANTIAL FINANCIAL SAVINGS TO FACILITIES. 0 0 0 4092117 1 1 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 19 0 180 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 0 1 0 0 MN X CAROLINE HENDREN 3202392217 605 MAIN STREET STARBUCK MN 56381 KAYO ASLAGSON CHAIR 0.50 1.50 X X 0 0 0 LAURIS JOHNSHOY VICE CHAIR 0.50 1.50 X X 0 0 0 JOHN SAMUELSON SECRETARY 0.50 1.50 X X 0 0 0 ARNE STOEN TREASURER 0.50 1.50 X X 0 0 0 PETER BRANDT DIRECTOR 0.50 1.50 X 0 0 0 RONALD FEIGUM DIRECTOR 0.50 1.50 X 0 0 0 WARREN HAGESTUEN DIRECTOR 0.50 1.50 X 0 0 0 ROBERT HENDRICKSON DIRECTOR 0.50 1.50 X 0 0 0 ALICE REESE DIRECTOR 0.50 1.50 X 0 0 0 STAN STARK DIRECTOR 0.50 1.50 X 0 0 0 CHRISTOPHER KNOLL ADMINISTRATOR 37.00 3.00 X 84258 0 18244 BRIAN ENGLER DIRECTOR OF FINANCE (THRU APRIL 2018) 29.00 11.00 X 68899 0 6213 CAROLINE HENDREN DIRECTOR OF FINANCE 29.00 11.00 X 0 0 0 153157 0 24457 0 0 0 0 PROREHAB 200 LEWIS AVE S STE 210 WATERTOWN MN 55388 PHYSICAL & OCCUPATIONAL SERVICES 143805 1 16346 10846 27192 RESIDENT REVENUES 623000 4185818 4185818 4185818 8955 8955 MISCELLANEOUS INCOME 900099 49196 49196 MEALS REVENUE 722210 10104 10104 59300 4281265 4185818 0 68255 37109 37109 176468 176468 2500870 2132944 367926 9745 8606 1139 289241 250612 38629 192534 166743 25791 14043 14043 32841 32841 181939 163798 18141 24403 23720 683 162320 147372 14948 54648 54648 143777 143777 13129 7204 5925 4311 2488 1823 128132 128132 315646 315646 31559 29922 1637 MEDICAL SUPPLIES 150321 150321 FOOD 147466 147466 LICENSE SURCHARGE 123449 123449 MISCELLANEOUS EXPENSE 24390 24390 33770 33770 4792111 4092117 699994 0 82693 545286 845196 552896 400335 418688 31853 29797 18380249 7529083 3446676 10851166 190642 199211 2000 2000 1654048 1746850 6653443 14345894 955682 574297 9329 28339 3242795 10840546 46381 534264 4254187 11977446 X 2397650 2366840 1606 1608 2399256 2368448 6653443 14345894 X -510846 1852 478186 X 0 1 X 1 1 1 X 47370 55641 11493 57780 27192 199476 4285328 4215836 3999500 4115945 4185818 20802427 4332698 4271477 4010993 4173725 4213010 21001903 0 1573236 1543752 1080566 1715332 889244 6802130 1573236 1543752 1080566 1715332 889244 6802130 14199773 12948 12013 7858 8367 8955 50141 12948 12013 7858 8367 8955 50141 28697 19785 471816 29510 59300 609108 4374343 4303275 4490667 4211602 4281265 21661152 0.65550 0.62630 0.00230 0.00240 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME CABLE TV REVENUE MISCELLANEOUS INCOME MEALS REVENUE SALE OF BEDS 0 1 X 364199 364199 15777661 5762690 10014971 124900 81594 43306 2113489 1684799 428690 10851166 DUE FROM RELATED ORGANIZATIONS 464610 BOND FUND 192206 CONSTRUCTION FUND 571660 COST OF ISSUANCE FUND 27242 SECURITY DEPOSITS 2492 MINNEWASKA PROJECT 378428 OTHER ASSETS 110212 1746850 DUE TO RELATED PARTY 534264 534264 X PART IV, LINE 2B: RESIDENT DEPOSITS CONSIST OF RESIDENT TRUST FUNDS HELD BY THE ORGANIZATION FOR THE RESIDENTS OF THE HOME. THE FACILITY HAS A SEPARATE BANK ACCOUNT TO HOLD THE FUNDS WHILE THE RESIDENT IS LIVING AT GLACIAL TRAILS. WHEN THE RESIDENT VACATES THE APARTMENT, GLACIAL TRAILS REFUNDS THE SECURITY DEPOSIT PLUS INTEREST CALCULATED BASED ON STATE OF MINNESOTA RULES LESS ANY FORFEITURES FOR REPAIRS, IF ANY WITHIN 30 DAYS OF TURNING IN THE KEYS. PART X, LINE 2: FROM NOTE 1 TO THE ORGANIZATION'S FINANCIAL STATEMENTS: THE HOME, MHD, HOLLY RIDGE, AND HOME CARE HAVE ALL BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND STATE CORPORATE INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) AND APPLICABLE STATE STATUTES. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE THE TAX-EXEMPT STATUS OF ANY OF ITS ENTITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. 1 SCHOLARSHIPS 22 37109 PART I, LINE 2: FOR THE DHS SCHOLARSHIPS, THE ORGANIZATION WILL PAY FOR THE NAR CLASS AND TEST FOR THE POTENTIAL EMPLOYEE. FOR ANY OTHER ELIGIBLE DHS SCHOLARSHIP THE EMPLOYEE WILL GO TO THE HR DIRECTOR AND COMPLETE A FORM, THE EMPLOYEE THEN SIGNS THAT FORM ALONG WITH THE HR DIRECTOR AND THE ADMINISTRATOR. A COPY OF THAT FORM IS THEN GIVEN TO THE DIRECTOR OF FINANCE. ONCE THE EMPLOYEE COMPLETES A SEMESTER IN THE PROGRAM THEY HAVE APPLIED FOR THAT EMPLOYEE WILL THEN COMPLETE A SCHOLARSHIP REQUEST FORM AND GIVE COPIES OF ALL INFORMATION RELATING TO THE DATES OF THE SEMESTER AND ALL CHARGES. THE EMPLOYEE WILL ALSO COMPLETE THE DHS MILEAGE AND/OR DAY CARE SHEETS FOR THE RELATED TIME PERIOD OF THE SEMESTER. AFTER THE EMPLOYEE HAS COMPLETED THAT FORM THE DIRECTOR OF FINANCE WILL RUN A PAYROLL TIME CLOCK HISTORY REPORT FOR THE EXACT DATES OF THE SEMESTER TO VERIFY THAT THE EMPLOYEE MET THE 10 HOUR MINIMUM HOURS/WK REQUIREMENT. IF THAT HAS BEEN MET THEN THE DIRECTOR OF FINANCE WILL CUT AN A/P CHECK TO THE EMPLOYEE FOR ALL ELIGIBLE EXPENSES. FORM 990, PART III, LINE 2 HOFFMAN SENIOR LIVING BEGAN OPERATIONS ON 7/16/18. HOFFMAN SENIOR LIVING OPERATED A 10-UNIT ASSISTED LIVING FACILTY AND A 10-UNIT MEMORY CARE ASSISTED LIVING FACILITY SERVING RESIDENTS OF HOFFMAN AND THE SURROUNDING AREA. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF MINNEWASKA LUTHERAN HOME CONSIST OF CERTAIN CONGREGATIONS LOCATED IN THE GENERAL COMMUNITY OF STARBUCK, MINNESOTA AND HOFFMAN, MN. EACH MEMBER CONGREGATION MAY APPOINT ONE INDIVIDUAL TO ACT AS A DELEGATE ON ITS BEHALF. THE PRESENT MEMBERS ARE: FRON LUTHERAN CHURCH - STARBUCK, MINNESOTA MINEWASKA LUTHERAN CHURCH - STARBUCK, MINNESOTA ST. JOHN'S LUTHERAN CHURCH - STARBUCK, MINNESOTA IMMANUEL LUTHERAN CHURCH - STARBUCK, MINNESOTA INDHERRED LUTHERAN CHURCH - STARBUCK, MINNESOTA EAST ZION LUTHERAN CHURCH - STARBUCK, MINNESOTA WEST ZION LUTHERAN CHURCH - HANCOCK, MINNESOTA TRINITY LUTHERAN CHURCH - CYRUS, MINNESOTA MESSIAH LUTHERAN CHURCH - HOFFMAN, MINNESOTA FORM 990, PART VI, SECTION A, LINE 7A DIRECTORS ARE ELECTED BY A MAJORITY VOTE OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ARTICLES OF INCORPORATION AND/OR THE BYLAWS REQUIRE AN AFFIRMATIVE VOTE OF A MAJORITY OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B DUE TO THE DELAY IN GETTING THE CHECKLISTS SUBMITTED, THE MANAGEMENT TEAM AND BOARD MEMBERS WILL DISCUSS THE COMPLETED AND SUBMITTED FORM 990 AT THE AUGUST 29, 2019 BOARD MEETING AFTER THE RETURN IS FILED. THE REVIEW WILL BE LEAD BY CAROLINE HENDREN, DIRECTOR OF FINANCE, AND CHRISTOPHER KNOLL, ADMINISTRATOR. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL DIRECTORS, PRINCIPAL OFFICERS, AND MEMBERS OF COMMITTEE WITH BOARD-DELEGATED POWERS. ANY INDIVIDUAL WITH AN ACTUAL OR POTENTIAL CONFLICT IS REQUIRED TO DISCLOSE ALL MATERIAL FACTS TO THE BOARD OR COMMITTEE. AFTER DISCLOSURE OF THE MATERIAL FACTS, THE REMAINING BOARD OR COMMITTEE MEMBERS DETERMINE BY MAJORITY VOTE WHETHER A CONFLICT EXISTS. IF IT IS DETERMINED THAT A CONFLICT EXISTS, THE BOARD OR COMMITTEE SEEKS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION IS NOT REASONABLY POSSIBLE, THE BOARD OR COMMITTEE DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. THE INDIVIDUAL MAY NOT BE PRESENT FOR A DISCUSSION OF, OR VOTE ON, WHETHER TO ENTER THE TRANSACTION. THE RELEVANT FACTS ARE DOCUMENTED IN THE MINUTES OF THE MEETING. ADDITIONALLY, BOARD MEMBERS ARE REQUIRED TO ANNUALLY SIGN STATEMENTS DISCLOSING EXISTING CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE ADMINISTRATOR'S COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS ANNUALLY. EVERY YEAR, THE ADMINISTRATOR PRESENTS A PROPOSAL FOR COMPENSATION TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS THEN USES A CURRENT SALARY SURVEY (DONE BY LEADINGAGE OF MN) TO COMPARE TO THE PROPOSAL AND THEN COMES TO A CONCLUSION ON WHAT THE COMPENSATION WILL BE. THIS IS THEN INCORPORATED IN THE BOARD MINUTES AND ADMINISTRATOR'S ANNUAL REVIEW. THE PROCESS LAST OCCURRED AUGUST 1, 2015. 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 XI, LINE 9: GAIN ON INVESTMENT IN SUBSIDARY 23,428. ROUNDING -3. HOLLY RIDGE NET ASSETS TRANSFERRED 454,761. MINNEWASKA HOME CARE PO BOX 40 STARBUCK MN 56381 331124162 HOME CARE MN 501(C)(3) LINE 10 N/A 1 HOLLY RIDGE MANOR PO BOX 40 STARBUCK MN 56381 411649721 ASSISTED LIVING MN 501(C)(3) LINE 12B, II MINNEWASKA LUTHERAN HOME 1 MINNEWASKA HOME DEVELOPMENT PO BOX 40 STARBUCK MN 56381 411504339 FUNDRAISING MN 501(C)(3) LINE 12B, II N/A 1 MINNEWASKA PROJECT LLC (DBA MINNEWASKA APARTMENTS) 27634 STATE HIGHWAY 28 STARBUCK MN 56381 411983249 SUBSIDIZED APARTMENT COMPLEX MN 27251 382251 0 0 0.99000 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 1