LYNGBLOMSTEN CARE CENTER INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- LYNGBLOMSTEN CARE CENTER INC (EIN 41-1310487)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-10-03
- IRS object ID
- 201802769349300510
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-10-03T08:26:27-05:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411310487 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LYNGBLOMSTEN CARE CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | LYNG | BusinessNameControlTxt |
| Phone | 6516462941 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1415 ALMOND AVENUE | AddressLine1Txt |
| City | ST PAUL | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55108 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRADLEY J JACOBSON | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 6516462941 | PhoneNum |
| Signature | 2018-09-25 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | CORY RUTLEDGE | PreparerPersonNm |
| PTIN | P01329381 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Preparation | 2018-09-25 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-09-25 | IPDt |
| IP Tm | 12:54:11 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 06C6282D018575128FE0891D0F3A4E057D2D2323 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 3018D2C7A8EF8E88940F980D8F52F9F97466C021 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2018-06-14 16:35:46Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEFF HEINECKE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1415 ALMOND AVENUE | AddressLine1Txt |
| City | ST PAUL | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $26,367,372 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 9386 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LYNGBLOMSTEN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1976 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE A MINISTRY OF COMPASSIONATE CARE AND INNOVATIVE SERVICES TO OLDER ADULTS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 14 | VotingMembersIndependentCnt |
| Total Employee | 563 | TotalEmployeeCnt |
| Total Volunteers | 916 | TotalVolunteersCnt |
| Total Gross UBI | $122,587 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$93,608 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $53,126 | PYContributionsGrantsAmt |
| CY Contributions Grants | $60,250 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $24,262,361 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $24,607,068 | CYProgramServiceRevenueAmt |
| PY Investment Income | $207,605 | PYInvestmentIncomeAmt |
| CY Investment Income | $248,945 | CYInvestmentIncomeAmt |
| PY Other Revenue | $249,221 | PYOtherRevenueAmt |
| CY Other Revenue | $203,296 | CYOtherRevenueAmt |
| PY Total Revenue | $24,772,313 | PYTotalRevenueAmt |
| CY Total Revenue | $25,119,559 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,303,622 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,993,372 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,367,550 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,201,684 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,846,101 | PYOtherExpensesAmt |
| CY Other Expenses | $6,140,170 | CYOtherExpensesAmt |
| PY Total Expenses | $24,517,273 | PYTotalExpensesAmt |
| CY Total Expenses | $26,335,226 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $255,040 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,215,667 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,953,866 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,036,666 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,643,194 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,792,805 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,310,672 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,243,861 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | INFLUENCED BY CHRIST, LYNGBLOMSTEN PROVIDES A MINISTRY OF COMPASSIONATE CARE AND INNOVATIVE SERVICES TO OLDER ADULTS IN ORDER TO PRESERVE AND ENHANCE THEIR QUALITY OF LIFE. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $23,341,938 | ExpenseAmt |
| Grant | $1,993,372 | GrantAmt |
| Revenue | $24,484,481 | RevenueAmt |
| Desc | THE LYNGBLOMSTEN CARE CENTER, A 237-BED SKILLED NURSING FACILITY, PROVIDES BOTH SHORT-TERM REHABILITATION AND LONG-TERM HEALTHCARE, INCLUDING SPECIALIZED CARE FOR ALZHEIMER'S DISEASE AND OTHER DEMENTIAS, PARKINSON'S DISEASE, AND PALLIATIVE CARE. IN 2017, 774 PERSONS RECEIVED CARE. CHAPLAINS, VOLUNTEERS, AND PROFESSIONAL STAFF ENSURE RESIDENTS RECEIVE QUALITY HEALTH CARE IN A DIGNIFIED MANNER. ALTHOUGH HEALTH ISSUES PREVENT THESE OLDER ADULTS FROM ENJOYING LIVING IN THEIR OWN HOMES, LYNGBLOMSTEN PROMOTES PERSON-CENTERED CARE, GIVING OLDER ADULTS AS MANY CHOICES AND COMFORTS OF HOME AS POSSIBLE. PROGRAMMING (INCLUDING THE ARTS) AND SOCIAL EVENTS ARE HOSTED TO ENHANCE THE LIVES OF THESE OLDER ADULTS AND THEIR FAMILIES. LYNGBLOMSTEN CONTINUED TO PARTICIPATE IN ALLINA'S NEXT GENERATION ACCOUNTABLE CARE ORGANIZATION (ACO), PROVIDING SKILLED CARE TO ELDERS IN THE ALLINA SYSTEM. ACOS ARE GROUPS OF DOCTORS, HOSPITALS, AND HEALTHCARE PROVIDERS THAT COORDINATE HIGH-QUALITY CARE FOR MEDICARE PATIENTS.IN 2017, LYNGBLOMSTEN'S COMMITMENT TO PROVIDING EXCELLENT CARE EARNED THE CARE CENTER A FIVE-STAR QUALITY RATING FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.LYNGBLOMSTEN CARE CENTER, INC. IS AFFILIATED WITH LYNGBLOMSTEN AND THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $152,011 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $122,587 | RevenueAmt |
| Desc | EMENUCHOICE IS THE WEB-BASED SOFTWARE TOOL DEVELOPED ORIGINALLY BY LYNGBLOMSTEN FOR IMPROVING ITS RESIDENT DINING EXPERIENCE. THE TOOL REDUCES COMMUNICATION BARRIERS FOR RESIDENT MEAL ORDERING WHILE ENABLING PERSON-CENTERED CHOICES, MAXIMIZING ACCURACY, STREAMLINING KITCHEN MEAL PREP, AND REDUCING WASTE. IN 2017, EMENUCHOICE WON BRONZE IN THE INNOVATOR OF THE YEAR AWARD CATEGORY AT THE NATIONAL MCKNIGHT'S TECHNOLOGY AWARDS. THE AWARD RECOGNIZES SENIOR CARE ORGANIZATIONS THAT USE TECHNOLOGY TO IMPROVE QUALITY OF CARE AND COST SAVINGS. EMENUCHOICE ALSO EXPANDED ITS CLIENT BASE FROM 12 TO 48 SITES LOCATED IN SEVEN STATES. ENHANCEMENTS MADE TO EMENUCHOICE IN 2017 ALLOWED INTEGRATION WITH RESIDEX ASSISTED LIVING SOFTWARE, IMPROVEMENTS TO BILLING TOOLS, THE ADDITION OF A LA CARTE PRICING, AND THE INCLUSION OF MEAL CREDIT FEATURES FOR CUSTOMERS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $23,493,949 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | Yes (1) | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 27 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 563 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 14 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRADLEY J JACOBSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6516325310 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1415 ALMOND AVENUE | AddressLine1Txt |
| City | ST PAUL | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55108 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (26 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| WILLIAM C SANDEN | ||||||||
| CHAIR (THRU NOV 2017) | 1.00 | 4.00 | Yes (X) | Yes (X) | $3,071 | $0 | $0 | |
| ANDREW LOWTHER | ||||||||
| CHAIR | 1.00 | 4.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| PAM DRAGSETH | ||||||||
| VICE CHAIR | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| WILLIAM STACEY | ||||||||
| TREASURER | 1.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JANE DANIELSON | ||||||||
| SECRETARY | 1.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JEFF HEINECKE | ||||||||
| PRESIDENT & CEO | 36.00 | 4.00 | Yes (X) | Yes (X) | $170,731 | $0 | $36,764 | |
| REV CARL BUETTEMEIER | ||||||||
| DIRECTOR (THRU MAY 2017) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID CHRISTIANSON | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DR ELIZABETH DETLIE | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| REV MARTY ERICSON | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DR LESLIE GRANT | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| REV JOY JOHNSON | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CHARLES NORTON | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BETCHEN OBERDORFER | ||||||||
| DIRECTOR (THRU MAY 2017) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHN PECK | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| THOMAS J SCHULTZ | ||||||||
| DIRECTOR (THRU MAY 2017) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JIM STENDER | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| REV PAM STOFFERAHN | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TRUPTI STORLI | ||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRADLEY J JACOBSON | ||||||||
| CFO | 36.00 | 4.00 | Yes (X) | $135,565 | $0 | $34,827 | ||
| BRENDA JOHNSON | ||||||||
| ADMINISTRATOR | 40.00 | Yes (X) | $132,097 | $0 | $32,384 | |||
| TODD FLIFLET | ||||||||
| CONTROLLER | 40.00 | $101,527 | $0 | $28,391 | Yes (X) | |||
| MATTHEW STENERSON | ||||||||
| CHIEF TECHNOLOGY OFFICER | 40.00 | $121,334 | $0 | $21,223 | Yes (X) | |||
| GREGORY WAINMAN | ||||||||
| DIRECTOR OF NURSING | 40.00 | $127,590 | $0 | $32,196 | Yes (X) | |||
| VIELKA SANCHEZ | ||||||||
| LPN | 40.00 | $117,046 | $0 | $28,139 | Yes (X) | |||
| MICHELLE MARTINSON | ||||||||
| RN CLINICAL MANAGER | 40.00 | $107,797 | $0 | $11,800 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,016,758 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $225,724 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PRO REHAB | |||||
| 200 LEWIS AVENUE SOUTH SUITE 210 | WATERTOWN | MN | 55388 | THERAPY | $809,488 |
| MERWIN LTC PHARMACY | |||||
| PO BOX 856706 | MINNEAPOLIS | MN | 55485 | PHARMACY | $431,085 |
| IDEACOM MID-AMERICA INCORPORATED | |||||
| 30 WEST WATER STREET | ST PAUL | MN | 55107 | TELEPHONE/COMMUNICATION | $365,410 |
| HORTY ELVING ASSOCIATES | |||||
| 332 MINNESOTA STREET SUITE W2000 | ST PAUL | MN | 55101 | ARCHITECTURE/ENGINEERING SERVICES | $119,066 |
| CLIFTONLARSONALLEN | |||||
| 220 SOUTH SIXTH STREET SUITE 300 | MINNEAPOLIS | MN | 55402 | FINANCIAL/CONSULTING | $103,033 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $60,250 | RelatedOrganizationsAmt |
| Total Contributions | $60,250 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| RESIDENT SERVICES | 623000 | $24,484,481 | $24,484,481 | |
| EMENUCHOICE | 541511 | $122,587 | $122,587 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $24,607,068 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $132,131 | TotalRevenueColumnAmt |
| Exclusion | $132,131 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,362,796 | SecuritiesAmt |
| Other | $1,831 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,244,210 | SecuritiesAmt |
| Other | $3,603 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $118,586 | SecuritiesAmt |
| Other | -$1,772 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $116,814 | TotalRevenueColumnAmt |
| Exclusion | $116,814 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MISCELLANEOUS REVENUE | 900099 | $87,209 | $87,209 |
| BEAUTY SHOP REVENUE | 900099 | $68,426 | $68,426 |
| SATELLITE TV REVENUE | 900099 | $22,790 | $22,790 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,871 | TotalRevenueColumnAmt |
| Exclusion | $24,871 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $203,296 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,119,559 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,484,481 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $122,587 | UnrelatedBusinessRevenueAmt |
| Exclusion | $452,241 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,580,000 | TotalAmt |
| Program Services | $1,580,000 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $413,372 | TotalAmt |
| Program Services | $413,372 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $545,439 | TotalAmt |
| Management And General | $545,439 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,702,482 | TotalAmt |
| Program Services | $12,799,230 | ProgramServicesAmt |
| Management And General | $903,252 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $342,714 | TotalAmt |
| Program Services | $320,025 | ProgramServicesAmt |
| Management And General | $22,689 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,534,171 | TotalAmt |
| Program Services | $2,316,038 | ProgramServicesAmt |
| Management And General | $218,133 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,076,878 | TotalAmt |
| Program Services | $952,100 | ProgramServicesAmt |
| Management And General | $124,778 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,820 | TotalAmt |
| Management And General | $14,820 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,940 | TotalAmt |
| Management And General | $11,940 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,328 | TotalAmt |
| Management And General | $62,328 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,102,403 | TotalAmt |
| Program Services | $1,005,493 | ProgramServicesAmt |
| Management And General | $96,910 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,578 | TotalAmt |
| Management And General | $16,578 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $600,519 | TotalAmt |
| Program Services | $414,066 | ProgramServicesAmt |
| Management And General | $186,453 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,212 | TotalAmt |
| Management And General | $108,212 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $424,061 | TotalAmt |
| Program Services | $380,450 | ProgramServicesAmt |
| Management And General | $43,611 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,273 | TotalAmt |
| Program Services | $35,659 | ProgramServicesAmt |
| Management And General | $26,614 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,960 | TotalAmt |
| Program Services | $1,758 | ProgramServicesAmt |
| Management And General | $202 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $808,570 | TotalAmt |
| Program Services | $724,871 | ProgramServicesAmt |
| Management And General | $83,699 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,689 | TotalAmt |
| Program Services | $31,122 | ProgramServicesAmt |
| Management And General | $3,567 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,147,183 | $1,147,183 | |
| FOOD | $678,198 | $678,198 | |
| LICENSE SURCHARGE | $667,155 | $667,155 | |
| BAD DEBT EXPENSE | $336,257 | $336,257 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,024 | TotalAmt |
| Program Services | $27,229 | ProgramServicesAmt |
| Management And General | $35,795 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,335,226 | TotalAmt |
| Program Services | $23,493,949 | ProgramServicesAmt |
| Management And General | $2,841,277 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,240,525 | BOYAmt |
| EOY | $1,553,271 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,634 | BOYAmt |
| EOY | $24,698 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,430,391 | BOYAmt |
| EOY | $2,625,487 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,714 | BOYAmt |
| EOY | $58,489 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $24,849,481 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $19,877,402 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,969,511 | BOYAmt |
| EOY | $4,972,079 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,440,867 | BOYAmt |
| EOY | $1,957,238 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $399,180 | BOYAmt |
| EOY | $399,180 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $429,044 | BOYAmt |
| EOY | $446,224 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,953,866 | BOYAmt |
| EOY | $12,036,666 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,482,217 | BOYAmt |
| EOY | $1,638,763 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $5,518 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,405 | BOYAmt |
| EOY | $52,726 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,572 | BOYAmt |
| EOY | $95,798 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,643,194 | BOYAmt |
| EOY | $1,792,805 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,256,932 | BOYAmt |
| EOY | $10,190,358 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $53,740 | BOYAmt |
| EOY | $53,503 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,310,672 | BOYAmt |
| EOY | $10,243,861 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,953,866 | BOYAmt |
| EOY | $12,036,666 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,215,667 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $148,856 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $565,513 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $206,707 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $181,690 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $53,126 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $60,250 | CurrentTaxYearAmt |
| Total | $1,067,286 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $18,949,573 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $19,857,394 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $19,949,802 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $24,262,361 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $24,607,068 | CurrentTaxYearAmt |
| Total | $107,626,198 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $19,515,086 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $20,064,101 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $20,131,492 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $24,315,487 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $24,667,318 | CurrentTaxYearAmt |
| Total | $108,693,484 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $108,693,484 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $71,821 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $132,639 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $181,871 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $228,068 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $132,131 | CurrentTaxYearAmt |
| Total | $746,530 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $71,821 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $132,639 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $181,871 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $228,068 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $132,131 | CurrentTaxYearAmt |
| Total | $746,530 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $266,119 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $181,469 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $225,851 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $249,221 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $203,295 | CurrentTaxYearAmt |
| Total | $1,125,955 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $19,853,026 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $20,378,209 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $20,539,214 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $24,792,776 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $25,002,744 | CurrentTaxYearAmt |
| Total | $110,565,969 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.98310 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98240 | PublicSupportPY509Pct |
| Investment Income CY | 0.00680 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00700 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | BEAUTY SHOP REVENUE SATELLITE TV REVENUE TELEPHONE REVENUE GUEST MEAL REVENUE MISCELLANEOUS REVENUE | ExplanationTxt |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $94,767 | OtherCostOrOtherBasisAmt |
| Book Value | $94,767 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,739,682 | OtherCostOrOtherBasisAmt |
| Depreciation | $17,206,993 | DepreciationAmt |
| Book Value | $3,532,689 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,777,368 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,597,023 | DepreciationAmt |
| Book Value | $1,180,345 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $237,664 | OtherCostOrOtherBasisAmt |
| Depreciation | $73,386 | DepreciationAmt |
| Book Value | $164,278 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,972,079 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| CAPITAL LEASE OBLIGATION | $12,922 |
| ASSET RETIREMENT OBLIGATION | $82,876 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $95,798 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 2B: | THE CORPORATION IS THE TRUSTEE OF VARIOUS RESIDENT FUNDS AND HAS A FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION OF THESE FUNDS. THESE FUNDS ARE ON DEPOSIT IN SEPARATE BANK ACCOUNTS. |
| PART X, LINE 2: | THE ORGANIZATION HAS BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND MINNESOTA CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THE ORGANIZATION FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LYNGBLOMSTEN FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1415 ALMOND AVENUE | AddressLine1Txt |
| City | ST PAUL | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 363371887 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $1,580,000 | CashGrantAmt |
| Purpose Of Grant | TO SUPPORT GENERAL OPERATIONS. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 53 | RecipientCnt |
| Cash Grant | $413,372 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | LYNGBLOMSTEN CARE CENTER MAKES INTERCOMPANY TRANSFERS TO RELATED ORGANIZATIONS. ALL RELATED ORGANIZATIONS ARE UNDER COMMON MANAGEMENT WHO REGULARLY MONITORS THE USE OF THESE FUNDS THROUGH THE INTERNAL FINANCIAL REPORTING PROCESS. LYNGBLOMSTEN SCHOLARSHIPS WILL BE AWARDED TO EMPLOYEES ENTERING AND/OR FURTHERING THEIR EDUCATION IN LONG TERM HEALTH CARE. THE FOLLOWING PROCEDURES MUST BE FOLLOWED IN ORDER TO RECEIVE SUCH A SCHOLARSHIP. 1. A FULLY COMPLETED APPLICATION PACKET MUST BE SUBMITTED TO HUMAN RESOURCES ON OR BEFORE PAYMENT OR THIRD PARTY BILLING FORMS WILL BE COMPLETED. 2. ALL EMPLOYEES EXCEPT THE ADMINISTRATOR ARE ELIGIBLE. 3. APPLICANT MUST BE CURRENTLY EMPLOYED BY LYNGBLOMSTEN AND HAVE COMPLETED 1040 HOURS OF SERVICE PRIOR TO APPLYING. IF EMPLOYMENT IS TERMINATED WITHIN 90 DAYS OF RECEIVING SCHOLARSHIP FUNDS, THEY MUST BE RETURNED TO LYNGBLOMSTEN. ALL FUNDS GRANTED MUST BE USED FOR STATED PURPOSE OF APPLICATION, OTHERWISE THEY MUST BE RETURNED TO LYNGBLOMSTEN. 4. APPLICANT MUST BE WORKING AN AVERAGE OF 10 HOURS PER WEEK THE 6 MONTH PERIOD PRIOR TO THE SEMESTER OR QUARTER FUNDS ARE APPLIED FOR. 5. APPLICANT MAY BE FROM ANY DEPARTMENT/PROGRAM WITHIN LYNGBLOMSTEN. 6. APPLICANT MUST BE ENROLLED IN AND/OR ACCEPTED IN AN EDUCATIONAL PROGRAM THAT WILL PREPARE THEM FOR POSITIONS COMMON TO LONG TERM CARE. 7. SCHOLARSHIPS MAY BE AWARDED FOR AMOUNTS COVERING FULL TUITION AND BOOK FEES FOR ALL APPLICANTS. 8. SCHOLARSHIPS MAY BE AWARDED MORE THAN ONCE PER YEAR, BUT A NEW APPLICATION PACKET MUST BE COMPLETED WITH EACH REQUEST FOR FUNDS. 9. AWARDED SCHOLARSHIP MONEY WILL BE SENT DIRECTLY TO THE INSTITUTION, WHEN POSSIBLE. 10. ALL SCHOLARSHIPS AWARDED BY LYNGBLOMSTEN ARE INTENDED FOR SCHOOL TUITION AND BOOKS ONLY. OTHER GRANTS AND SCHOLARSHIPS MUST BE AWARDED, PRIOR TO THE LYNGBLOMSTEN SCHOLARSHIP. IF LYNGBLOMSTEN SCHOLARSHIP DOLLARS ARE IN EXCESS, THEY MUST BE RETURNED TO LYNGBLOMSTEN IMMEDIATELY. FAILURE TO DO SO WILL RESULT IN REPAYMENT AND/OR DISCIPLINE UP TO AND INCLUDING TERMINATION. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JEFF HEINECKE | ||||||||||||||
| PRESIDENT & CEO | $162,813 | $0 | $2,937 | $0 | $4,981 | $0 | $7,216 | $0 | $29,548 | $0 | $207,495 | $0 | $0 | $0 |
| BRADLEY J JACOBSON | ||||||||||||||
| CFO | $131,092 | $0 | $4,473 | $0 | $0 | $0 | $5,794 | $0 | $29,033 | $0 | $170,392 | $0 | $0 | $0 |
| BRENDA JOHNSON | ||||||||||||||
| ADMINISTRATOR | $128,663 | $0 | $3,434 | $0 | $0 | $0 | $5,567 | $0 | $26,817 | $0 | $164,481 | $0 | $0 | $0 |
| GREGORY WAINMAN | ||||||||||||||
| DIRECTOR OF NURSING | $126,481 | $0 | $1,109 | $0 | $0 | $0 | $5,387 | $0 | $26,809 | $0 | $159,786 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAN SHAUGHNESSY | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BROTHER IN-LAW TO PRESIDENT/CEO | RelationshipDescriptionTxt |
| Transaction | $31,690 | TransactionAmt |
| Transaction | CONTRACT WORKER/CONSULTANT | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 2 | LYNGBLOMSTEN ROLLED OUT ITS DINING EXPERIENCE COORDINATOR PROGRAM IN EARLY 2017, PROVIDING HANDS-ON CUSTOMER-FOCUSED ASSISTANCE IN DINING ROOMS FOR BREAKFAST AND LUNCH. IN CONJUNCTION WITH THIS PROGRAM, NEW PLATES AND TABLE SETTINGS DEBUTED TO ENHANCE THE DINING EXPERIENCE FOR RESIDENTS. THE CARE CENTER BEGAN A PARTNERSHIP WITH METRO STATE AND THE MINNESOTA ALLIANCE FOR NURSING EDUCATION IN 2017. THROUGH THIS PARTNERSHIP, LYNGBLOMSTEN HOSTS NURSING STUDENTS FOR A CAPSTONE PRACTICUM EXPERIENCE AS THEY COMPLETE TRAINING TO BECOME REGISTERED NURSES THROUGH UNDERGRADUATE PROGRAMS. THE CARE CENTER ALSO HOSTS STUDENTS FOR THEIR LONG-TERM CARE CLINICAL ROTATION. |
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE IS MADE UP THE CHAIR, VICE CHAIR, TREASURER, AND SECRETARY OF THE BOARD ALONG WITH PRESIDENT/CEO OF THE CORPORATION. ALL ITEMS APPROVED BY THE EXECUTIVE COMMITTEE ARE REAFFIRMED BY THE FULL BOARD AT THEIR NEXT MEETING. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE BOARD OF DIRECTORS OF LYNGBLOMSTEN ARE THE MEMBERS OF LYNGBLOMSTEN CARE CENTER, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CORPORATE CONGREGATIONS SEND DELEGATES TO THE LYNGBLOMSTEN ANNUAL MEETING, WHO, AS MEMBERS OF LYNGBLOMSTEN, ELECT THE LYNGBLOMSTEN BOARD. THE BOARD OF DIRECTORS OF LYNGBLOMSTEN CARE CENTER CONSISTS SOLELY OF DULY ELECTED AND QUALIFIED MEMBERS OF THE BOARD OF DIRECTORS OF LYNGBLOMSTEN. ELECTION AS A DIRECTOR OF LYNGBLOMSTEN CONSTITUTES ELECTION AS A DIRECTOR OF LYNGBLOMSTEN CARE CENTER FOR THE SAME TERM. |
| FORM 990, PART VI, SECTION A, LINE 7B | CHANGES IN THE BYLAWS AND ARTICLES OF INCORPORATION REQUIRE MEMBERSHIP APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CEO, CFO, AND CONTROLLER REVIEW THE DOCUMENT, WHICH IS EMAILED TO THE FINANCE COMMITTEE OF THE BOARD PRIOR TO THEIR MEETING FOR REVIEW AND COMMENT. THE BOARD RECEIVES THE DOCUMENT PRIOR TO THEIR BOARD MEETING BY EMAIL. PAPER COPIES ARE AVAILABLE AT THE BOARD MEETING FOR FURTHER DISCUSSION AND BOARD APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | AN UPDATED CONFLICT OF INTEREST POLICY IS SIGNED BY ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES ANNUALLY. THIS POLICY IS MONITORED BY THE CORPORATE COMPLIANCE OFFICER AND IF ANY CONFLICTS OF INTERESTS EXIST THAT INDIVIDUAL IS EXCLUDED FROM PARTICIPATION AND VOTING ON RELATED TRANSACTIONS. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE LYNGBLOMSTEN BOARD'S EXECUTIVE COMMITTEE REVIEWS AND SETS THE CEO'S COMPENSATION ANNUALLY AND PERFORMS A COMPENSATION STUDY APPROXIMATELY EVERY 5 YEARS, LAST COMPLETED IN 2013. THE CEO SETS THE ANNUAL EVALUATION PROCESS FOR OTHER OFFICERS AND KEY EMPLOYEES AND THE LYNGBLOMSTEN CARE CENTER, INC. BOARD APPROVES THE ANNUAL BUDGET. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL DOCUMENTS ARE AVAILABLE UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EMENUCHOICE LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1415 ALMOND AVENUE | AddressLine1Txt |
| City | ST PAUL | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55108 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320473417 | EIN |
| Primary Activities | MAINTAINS, DEVELOPS, AND OFFERS WEB-BASED MEAL AND DIEATARY SOFTWARE PROGRAM | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Total Income | $122,587 | TotalIncomeAmt |
| End Of Year Assets | $106,671 | EndOfYearAssetsAmt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LYNGBLOMSTEN CARE CENTER INC | BusinessNameLine1Txt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| LYNGBLOMSTEN APARTMENTS INC | |||||||||||
| 1455 ALMOND AVE | ST PAUL | MN | 55108 | 411327121 | LOW INCOME SENIOR HOUSING | MN | 501(C)3 | LINE 10 | LYNGBLOMSTEN LYNGBLOMSTEN SENIOR HOUSING INC | 0 | |
| HERITAGE APARTMENTS INC | |||||||||||
| 1440 MIDWAY PARKWAY | ST PAUL | MN | 55108 | 411913420 | MARKET RATE SENIOR HOUSING, ASSISTED LIVING SERVIES | MN | 501(C)3 | LINE 10 | LYNGBLOMSTEN LYNGBLOMSTEN SENIOR HOUSING INC | 0 | |
| LYNGBLOMSTEN FOUNDATION | |||||||||||
| 1415 ALMOND AVE | ST PAUL | MN | 55108 | 363371887 | FUNDRAISING FOR LYNGBLOMSTEN | MN | 501(C)3 | LINE 7 | LYNGBLOMSTEN | 0 | |
| LYNGBLOMSTEN SERVICES INC | |||||||||||
| 1415 ALMOND AVE | ST PAUL | MN | 55108 | 411760448 | SENIOR CENTER, COMMUNITY SERVICES, HOME HEALTH | MN | 501(C)3 | LINE 10 | LYNGBLOMSTEN | 0 | |
| LYNGBLOMSTEN | |||||||||||
| 1415 ALMOND AVE | ST PAUL | MN | 55108 | 410693865 | MANAGEMENT OVERSIGHT SERVICES TO ALL LYNGBLOMSTEN ORGANIZATIONS | MN | 501(C)3 | LINE 10 | 0 | N/A | |
| LYNGBLOMSTEN SENIOR HOUSING INC | |||||||||||
| 1415 ALMOND AVE | ST PAUL | MN | 55108 | 411913422 | MANAGEMENT OVERSIGHT SERVICES TO LYNGBLOMSTEN APTS & HERITAGE APTS | MN | 501(C)3 | LINE 10 | LYNGBLOMSTEN | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |