2019-07-01T10:30:49-05:00 2018-09-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2017-10-01 416051127 MOTHER OF MERCY MOTH 3208452195 230 CHURCH AVE BOX 676 ALBANY MN 563070676 PAUL GAEBE ADMINISTRATOR & CEO 3208452195 2019-06-18 1 MICHAEL J PETERSON CPA P01833529 2187224705 2019-06-12 4.30.113.218 2019-06-18 14:18:58 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 E433C82216CF4B1B7B2D83A781BC20530CAF3EA5 2017 2019-02-21 02:37:17Z PAUL GAEBE 230 CHURCH AVE BOX 676 ALBANY MN 563070676 9852101 0 X WWW.MOTHEROFMERCYMN.ORG X 1966 MN TO PROVIDE HOUSING AND NURSING CARE TO THE ELDERLY. 11 11 291 11 0 0 38739 22355 8665954 9775068 1780 5382 51294 49296 8757767 9852101 0 37232 0 0 5608561 6369962 0 0 0 3498089 3448138 9106650 9855332 -348883 -3231 11547632 11273578 7784908 7514085 3762724 3759493 X IT IS OUR MISSION AS PROFESSIONALS TO PROVIDE THE BEST QUALITY OF LIFE FOR THOSE ENTRUSTED TO US. WE ARE A COMMUNITY OF CONCERNED PROFESSIONALS WORKING TOGETHER TO PROVIDE THE BEST QUALITY OF LIFE FOR THOSE ENTRUSTED TO US. WE ACCOMPLISH THIS MISSION BY MAINTAINING HIGH STANDARDS OF CARE FOR ALL, IN A HOME-LIKE ATMOSPHERE, WHICH ADDRESSES THEIR PHYSICAL, EMOTIONAL, AND SPIRITUAL NEEDS. WE ENCOURAGE RESIDENTS AND FAMILIES TO PARTICIPATE IN MAKING DECISIONS ABOUT THEIR DAILY ROUTINES AND ASK FOR RESIDENT AND FAMILY INVOLVEMENT IN SOCIAL ACTIVITIES. 0 0 8826579 37232 9755558 THE ORGANIZATION OPERATES A 73 BED SKILLED NURSING FACILITY FOR THE PURPOSE OF PROVIDING CARE TO PERSONS IN NEED OF NURSING SERVICES AND RENDERS AID, CARE, AND GENERAL HEALTH CARE SERVICES TO ITS RESIDENTS WHO ARE ELDERLY, SICK, AND/OR HAVE DEMENTIA. THE ORGANIZATION ALSO OPERATES A 69 UNIT APARTMENT COMPLEX AT NEAR CAPACITY TO PROVIDE HOUSING FOR INDEPENDENT, ASSISTED LIVING AND MEMORY CARE TENANTS. THE SKILLED NURSING FACILITY HAD 24,379 RESIDENT DAYS DURING FISCAL YEAR 2018. THE ORGANIZATION ALSO MANAGES OPERATIONS OF TWO SENIOR CITIZENS HOUSING PROJECTS AT NEAR CAPACITY FOR LOW-INCOME SENIOR CITIZENS. 8826579 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 7 0 291 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X MARK DOUVIER 3208452195 230 CHURCH AVENUE ALBANY MN 56307 JACKIE ATKINSON DIRECTOR 0.30 0.60 X 0 0 0 ELMER KOHORST DIRECTOR 0.30 0.60 X 0 0 0 DERRICK MEYER DIRECTOR 0.30 0.60 X 0 0 0 REV STEVEN OLSON DIRECTOR 0.30 0.60 X 0 0 0 JUDY SCHULTE DIRECTOR 0.30 0.60 X 0 0 0 PAUL TOMCZIK DIRECTOR 0.30 0.60 X 0 0 0 FR EDWARD VEBELON OSB DIRECTOR 0.30 0.60 X 0 0 0 MARK KNAPP PRESIDENT 0.30 0.90 X X 0 0 0 TOM BAUMGARTNER VICE-PRESIDENT 0.30 0.60 X X 0 0 0 FR BRAD JENNIGES OSB SECRETARY 0.30 0.90 X X 0 0 0 JANET SALK TREASURER 0.30 0.60 X X 0 0 0 DEAN MCDEVITT ADMINISTRATOR & CEO 2.00 38.00 X 87969 0 26151 MARK DOUVIER CHIEF FINANCIAL OFFICER 2.00 38.00 X 0 0 0 GREGORY JOHNSON CHIEF FINANCIAL OFFICER 2.00 38.00 X 61911 0 1899 149880 0 28050 0 0 0 0 REHAB CARE GROUP INC PO BOX 503534 ST LOUIS MO 63150 MEDICARE RESIDENTS REHABILITATION 336491 FOOD SERVICES OF AMERICA PO BOX 9174 MINNEAPOLIS MN 55480 DIETARY FOOD SERVICES 236199 ELIM PREFERRED SERVICES 3500 HOLLY LANE PLYMOUTH MN 55447 DIETARY SUPPLIES SERVICES 157627 MARCO BUSINESS PRODUCTS 4510 HEATHERWOOD ROAD ST CLOUD MN 56301 IT SERVICES 151627 4 22355 22355 RESIDENT/TENTANT REVEN 623000 9589728 9589728 MEAL INCOME 623990 74677 43543 31134 DAY CARE CENTER RENTAL 531110 46760 46760 AFFILIATE MANAGEMENT F 541610 43036 43036 BEAUTY SHOP REVENUE 900099 16067 16067 4800 4800 9775068 5382 5382 49296 49296 49296 9852101 9739134 0 90612 37232 37232 180904 180904 5044760 4750119 294641 56900 55919 981 558477 533157 25320 528921 483434 45487 50577 50577 494155 494155 49929 49929 371555 307590 63965 181081 181081 317265 186151 131114 5868 5868 32265 27511 4754 198482 198482 683360 683360 DIETARY FOOD COSTS 325368 325368 MEDICARE PT/OT EXPENSE 323387 323387 MEDICAL CARE SURCHARGE 205495 205495 DRUG EXPENSE 84528 84528 124823 124823 9855332 8826579 1028753 0 356 356 486228 507921 830020 1037378 7672 37550 18121089 8696237 9964712 9424852 104840 33329 153804 232192 11547632 11273578 596656 664949 3757752 3457451 40252 39282 3307063 3307063 83185 45340 7784908 7514085 X 3742511 3739280 20213 20213 3762724 3759493 11547632 11273578 -3231 0 X X 0 1 X 1 0 X 12210 328144 54930 38739 22355 456378 6779912 6593783 7830897 8630402 9739134 39574128 35964 58770 54772 86846 85230 321582 6828086 6980697 7940599 8755987 9846719 40352088 0 0 0 40352088 30606 11153 7240 1780 5382 56161 30606 11153 7240 1780 5382 56161 6858692 6991850 7947839 8757767 9852101 40408249 0.99860 0.99800 0.00140 0.00200 X 0 0 0 0 0 0 0 0 1 5447 5447 0 PART II-B, LINE 1: THE ORGANIZATION IS A MEMBER OF LEADING AGE MN (PREVIOUSLY KNOWN AS AGING SERVICES OF MINNESOTA). A PORTION OF MEMBERSHIP DUES IS USED FOR LOBBYING. THE LEADING AGE MN ADVOCATES FOR SENIORS, CAREGIVERS AND PROVIDERS WHO SERVE OLDER ADULTS IN ALL PLACES THEY CALL HOME. LEADING AGE ADVOCACY THROUGHOUT STATE LEGISLATURE IS SUPPORTED BY SOUND RESEARCH, MEANINGFUL DATA AND KNOWLEDGEABLE EXPERTS. 0 1 X 397451 397451 13873942 6049282 7824660 3660522 2611529 1048993 189174 35426 153748 9424852 CAPITAL LEASES 45340 45340 10303374 467697 467697 9835677 16424 16424 9852101 10306605 467697 467697 9838908 16424 16424 9855332 PART IV, LINE 2B: THE ORGANIZATION IS THE TRUSTEE OF RESIDENT AND EMPLOYEE FUNDS AND HAS FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION AND DISTRIBUTION OF THESE FUNDS FOR RESIDENTS AND EMPLOYEES OF THE ORGANIZATION. PART XI, LINE 2D - OTHER ADJUSTMENTS: INTER-COMPANY ELIMINATIONS 467,697. PART XI, LINE 4B - OTHER ADJUSTMENTS: RELATED PARTY EXPENSES - REIMBURSED AS GRANT 16,424. PART XII, LINE 2D - OTHER ADJUSTMENTS: INTER-COMPANY ELIMINATIONS 467,697. PART XII, LINE 4B - OTHER ADJUSTMENTS: RELATED PARTY EXPENSES - REIMBURSED AS GRANT 16,424. 1 EMPLOYEE SCHOLARSHIPS 22 37232 A CITY OF ALBANY MN HEALTH CARE FACILITY REVENUE BONDS SERIES 2013 416004921 2013-10-16 5018000 FACILITY EXPANSION OF MOTHER OF MERCY NURSING HOME 0 0 0 A 1454665 5018000 4917475 100360 165 2009 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS 5 INDIVIDUALS THAT SERVE AS MEMBERS OF THE CORPORATION. THE MEMBERS ARE THE BISHOP OF THE DIOCESE OF ST. CLOUD, MN, THE VICAR GENERAL OF THE DIOCESE, THE PASTOR OF THE CHURCH OF THE SEVEN DOLORS IN ALBANY, MN, AND TWO LAY PEOPLE SELECTED BY UNANIMOUS VOTE OF THE THREE RELIGIOUS MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE CORPORATION APPOINT THE BOARD OF DIRECTORS OF THE ORGANIZATION AND REMOVE ANY MEMBER THEREFROM, WITH OR WITHOUT CAUSE. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS MAKES DECISIONS THAT THE MEMBERS OF THE CORPORATION THEN HAVE THE RESPONSIBILITY FOR: APPROVE A MERGER OR DISSOLUTION OF THE CORPORATION; APPROVE THE ACQUISTION, SALE, LEASE, EXCHANGE, MORTGAGE, ENCUMBRANCE, OR OTHER DISPOSITION OF THE ASSETS OF THE CORPORATION WITHIN THE LIMITS SET BY CURRENT CHURCH LEGISLATION; AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION; AND MAKE AND AMEND BYLAWS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE COMPLETED FORM 990 IS PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO SUBMISSION TO INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT IS APPLIED WHEN THE ORGANIZATION IS IN THE PROCESS OF ENTERING INTO A TRANSACTION OR CONTRACT. ANNUALLY A CONFLICT OF INTEREST STATEMENT IS FILLED OUT BY THE BOARD MEMBERS, IT IS REVIEWED WHEN THESE TRANSACTIONS OCCUR. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON SHALL HAVE A DUTY TO DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND ALL RELATED MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL RELATED MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD, OFFICER OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT EXISTS. AFTER INTEREST IS DETERMINED, THE INTERESTED PERSON HAS THE OPPORTUNITY TO MAKE A SHORT PRESENTATION AT THE BOARD MEETING. THE BOARD WILL APPOINT A DISINTERESTED PERSON OR GROUP TO EXPLORE ALTERNATIVES TO AVOID ANY CONFLICT. IF THERE IS NO OPTION FOR AVOIDING CONFLICT, THE BOARD SHALL DETERMINE BY MAJORITY VOTE IF THE TRANSACTION SHOULD BE ENTERED INTO. THE INTERESTED PERSON SHALL BE REMOVED FROM THE VOTING PROCESS. THE ORGANIZATION ALSO HAS A POLICY FOR EMPLOYEES. THE CONFLICT OF INTEREST POLICY IS INITIALLY MONITORED BY THE DIRECTOR OF LICENSURES AND TRAINING DURING AN EMPLOYEE'S ORIENTATION. THE COMPLIANCE OFFICER THEN ANNUALLY MONITORS THE POLICY DURING THE ANNUAL BENEFITS STAFF MEETING. IF A CONFLICT OF INTEREST ARISES, IT IS INVESTIGATED BY THE COMPLIANCE OFFICER, AND IF DEEMED A CONFLICT, THE EMPLOYEE MUST CEASE/DIVEST OF THAT CONFLICT OR BE TERMINATED. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION FOLLOWS THE SENIOR NURSING FACILITY COMPENSATION GUIDE TO DETERMINE COMPENSATION FOR THE CEO AND TOP MANAGEMENT ANNUALLY. THE BOARD OF DIRECTORS REVIEWS THE ANNUAL PERFORMANCE EVALUATION AND SALARY REVIEW FOR FINAL APPROVAL OF COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION HAS THE FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS AVAILABLE IN THEIR FRONT LOBBY FOR REVIEW. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MOTHER OF MERCY DEVELOPMENT LLC 230 CHURCH AVE ALBANY MN 56307 273818447 ELDERLY HOUSING DEVELOPMENT: ASSISTED LIVING, INDEPENDENT LIVING MN 94 4036167 MOTHER OF MERCY CAMPUS OF CARE MERCY MANOR 334 GOLF VIEW DRIVE ALBANY MN 56307 411805317 HUD SUBSIDIZED LOW INCOME ELDERLY HOUSING MN 501(C)(3) LINE 9 MOTHER OF MERCY 1 MERCY MANOR II 332 GOLF VIEW DRIVE ALBANY MN 56307 202155820 HUD SUBSIDIZED LOW INCOME ELDERLY HOUSING MN 501(C)(3) LINE 9 MOTHER OF MERCY 1 MOTHER OF MERCY FOUNDATION 230 CHURCH AVE ALBANY MN 56307 411992053 FUND-RAISING ENTITY TO SUPPORT MOTHER OF MERCY MN 501(C)(3) LINE 11A, I MOTHER OF MERCY 1 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 MOTHER OF MERCY FOUNDATION O 54589 ACTUAL COST