2018-05-10T10:49:06-05:00 2017-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2017-01-01 800276405 Assumption Community Services Inc ASSU 3206853693 615 1st Street North Cold Spring MN 56320 Lindsey Sand Administrator 3206853693 2018-05-10 1 Deb Nelson CPA P01264758 6122536500 2018-05-10 2017 2022-09-23 18:48:47Z Lindsey Sand 615 1st Street North Cold Spring MN 56320 272876 0 X www.assumptionhome.org X 2008 MN Provide a continuum of health and residential services in a Christian environment. 12 12 0 105 0 0 82966 58670 157121 214206 0 0 132000 0 372087 272876 0 0 0 0 257007 278903 0 0 0 115848 96860 372855 375763 -768 -102887 61555 136576 63733 138641 -2178 -2065 X To provide a continuum of quality care in a Christian manner that honors the dignity of the members of our local community. 0 0 361984 214206 Community Health Services provides an array of services, from home delivered meals to community support services and caregiver support. During 2017 the organization provided the following services:Transportation: 1,234 rides / 1,016 hoursHomemaking/chore service: 70 hours /29 home visitsCaregiver Consulting: 307 hours / 135 home visitsSupport Planning: 464 hours / 268 home visitsFriendly Visiting: 52 hours / 20 home visitsCaregiver Education: 2 sessions of 6 classes, 19 people servedSupport Group: 5 sessions, 10 people servedRespite: 218 hours / 68 home visitsMeals on Wheels: 4,129 meals servedHome Health Care: 33 patients served 361984 1 1 0 0 0 0 0 0 0 0 1 0 0 0 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 1 0 0 0 1 X 6 0 1 0 0 0 0 0 0 0 0 0 0 0 X 12 12 1 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 MN X Brenda Weller 3206853693 715 North 1st Street Cold Spring MN 56320 Rev Matthew Luft Second VP/CEO 1.00 2.00 X X 0 0 0 Larry Sell Secretary 1.00 2.00 X X 0 0 0 Chad Middendorf Treasurer 1.00 2.00 X X 0 0 0 Sister Miriam Ardolf Director - thru Oct 2017 1.00 2.00 X 0 0 0 Richard Krueger Director - thru July 2017 1.00 2.00 X 0 0 0 Rod Pauser Director - thru July 2017 1.00 2.00 X 0 0 0 Dorothy Pflipsen Director 1.00 2.00 X 0 0 0 Sharon Wenner Director 1.00 2.00 X 0 0 0 Mike Roth Director 1.00 2.00 X 0 0 0 Greg Flint Director 1.00 2.00 X 0 0 0 Angela Neisinger Director 1.00 2.00 X 0 0 0 Sister Ardella Kvamme Director 1.00 2.00 X 0 0 0 Melissa Rowe Director 1.00 2.00 X 0 0 0 Father Isaiah Frederick Director 1.00 2.00 X 0 0 0 Kelly Warren Director 1.00 2.00 X 0 0 0 Lindsey Sand Administrator 1.00 39.00 X 0 87914 2637 Brenda Weller Director of Finance 1.00 39.00 X 0 76566 14695 0 164480 17332 0 0 0 0 0 58670 58670 Skilled Nursing Revenu 623000 191877 191877 Meals on Wheels 624210 22329 22329 214206 272876 214206 0 0 230639 222048 8591 3134 3017 117 27322 26304 1018 17808 17145 663 3300 3300 27667 27667 1813 1813 7992 7902 90 17034 17034 2704 2704 288 288 5770 5770 Food 27871 27871 Dues 1550 1550 Licenses and Permits 871 871 375763 361984 13779 0 3454 5622 57681 127466 214 277 3453 288 0 3165 206 46 61555 136576 20288 24749 43445 113892 63733 138641 X -2178 -2065 -2178 -2065 61555 136576 X -102887 103000 X 0 0 0 X 477734 146448 96234 82966 58670 862052 194618 195367 189762 157121 214205 951073 672352 341815 285996 240087 272875 1813125 0 64820 33740 38392 136952 64820 33740 38392 136952 1676173 48 49 37 134 48 49 37 134 106000 132000 103000 341000 672400 341864 392033 372087 375875 2154259 0.77810 0.83350 0.00010 0.00010 X Schedule A, Part III, Line 12, Explanation of Other Income: Forgiveness of debt - 2015 Amount: $ 106,000. 2016 Amount: $ 132,000. 2017 Amount: $ 103,000. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3453 288 3165 3165 Due to Affiliates 113892 113892 Form 990, Part V, Line 2 and Part IX, Lines 7-10: Assumption Home, Inc., a related tax-exempt organization, employs all individuals and is responsible for filing all required federal employment tax returns. Payroll expenses are allocated to Assumption Community Services and reported on the appropriate lines in Part IX. Form 990, Part VI, Section A, line 2 The Administrator and Director of Finance are employed by Assumption Home, Inc., a related tax-exempt organization. Members of the board are also board members of Assumption Home, Inc. Therefore, a business relationship exists between these individuals. Form 990, Part VI, Section A, line 3 Assumption Home, Inc., a related tax-exempt organization, is the management agent for the organization. Related party receivables are recorded for expenses paid on behalf of Assumption Community Services. The receivable balance has no set repayment terms and interest is not added to the balance. During December 31, 2017, $103,000 of receivables were written off by Assumption Home, Inc. The remaining balance was $113,846. Form 990, Part VI, Section A, line 6 The members of the corporation shall be as follows: 1. The Bishop of the Diocese of Saint Cloud or the person, who in his stead, exercises ordinary jurisdiction over the spiritual and temporal affairs of the Diocese of Saint Cloud in accordance with the legislation of the Roman Catholic Church; 2. The Vicar General of the Diocese of Saint Cloud, who has been appointed to be a member ex-officio of the corporation of the Diocese of Saint Cloud. In the event of a vacancy in the office of the Bishop, in those cases in which the Vicar General's office ceases, then and in such event the person who was the Vicar General, continues to be a member ex-officio of this corporation with all the rights and powers included thereto, but his membership shall cease at once when the Office of Vicar General has been filled; 3. The Pastor of the Church of Saint Boniface, Cold Spring, Minnesota; and 4. Two (2) trustees who are members of the Church of Saint Boniface, Cold Spring, Minnesota, which have been elected by the membership of the corporation.The members of the corporation shall be as follows: There shall be only one class of members of the corporation and each member shall be entitled to one vote on all actions that come before the membership of the corporation. Form 990, Part VI, Section A, line 7a The Board of Directors shall be elected by the members of the corporation. Form 990, Part VI, Section A, line 7b The members reserve the following functions: 1. Appoint the Board of Directors and remove any member with or without cause; 2. Approve a merger or dissolution of the organization; 3. Amendment of the Articles of Incorporation; and 4. Support and assess the Roman Catholic identify and mission of the organization and verify adherence to the Ethical and Religious Directives for Catholic Health Care Services now current or hereafter amended, as recommended by the Bishop of the Diocese of St. Cloud. Form 990, Part VI, Section A, line 8b The organization does not have a committee with the authority to act on behalf of the governing board. Form 990, Part VI, Section B, line 11b The Form 990 is prepared by an independent public accounting firm and is reviewed by both the Administrator and the Director of Finance. After their review, the Form 990 is provided to the Board of Directors, who review and approve it prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The organization's conflict of interest policy applies to all officers and members of the Board of Directors. The Administrator annually reviews the Board Members' associations for conflicts of interest. The Board of Directors annually reviews the Administrator's associations for conflicts of interest. If a conflict arises, depending on the circumstances, the conflicted individual abstains from voting, steps down from the Board, or terminates the association with the other party. Form 990, Part VI, Section B, line 15 The organization does not pay compensation to its officers, directors, or key employees. The organization's officers are compensated by a related organization. Form 990, Part VI, Section C, line 19 The governing documents, financial statements, and conflict of interest policy are available upon request. Form 990, Part XI, line 9: Forgivenes of Debt 103,000. Assumption Home Inc 715 N 1st Street Cold Spring MN 56320 410873335 Nursing home MN 501(c)(3) Line 10 N/A 0 Pioneer Housing Development Inc 200 8th Avenue North Cold Spring MN 56320 411367392 Housing MN 501(c)(3) Line 10 N/A 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 1 0 1