2017-11-13T11:07:42-06:00 2016-12-31 420714325 RSM US LLP 801 NICOLLET MALL SUITE 1100 MINNEAPOLIS MN 55402 990 2016-01-01 410977369 LUTHER HAVEN LUTH 3202696517 1109 EAST HIGHWAY 7 MONTEVIDEO MN 56265 ANN NORDSTROM ACCOUNTANT 3202696517 2017-11-09 1 TODD A JACKSON P00092672 6123324300 108.171.131.186 2017-11-09 17:54:07 CS P 01563F10D6676BDC9B96404AA3206AA292B808E6 5AB5DFEC54AF030231DDAA57F2AFD57D98013E0B 2016 2017-02-10 21:41:12Z JAMES FLAHERTY 1109 EAST HIGHWAY 7 MONTEVIDEO MN 56265 7898453 0 X N/A X 1971 MN PROVIDE SERVICES TO THE ELDERLY AND DISABLIED IN THE MONTEVIDEO AND THE SOUTHWEST AREA OF MINNESOTA. WE CARE FOR THE TOTAL PERSON AND PROVIDE LONG TERM CARE AND SHORT REHAB SERVICES. 11 11 211 75 0 0 3107 147646 6353109 7739186 10472 -6161 0 0 6366688 7880671 14346 27015 0 0 4470566 5429709 0 0 0 2168033 2459229 6652945 7915953 -286257 -35282 5349859 5481789 1194423 1295901 4155436 4185888 X LUTHER HAVEN WAS ESTABLISHED AND ORGANIZED TO CARE FOR THE ELDERLY AND DISABLED IN MONTEVIDEO AND IN THE SOUTHWEST MINNESOTA DISTRICT OF THE ELCA. ITS PURPOSE IS TO SERVE THE ELDERLY AND DISABLED AND TO PROMOTE THEIR PHYSICAL, SOCIAL, EMOTIONAL, AND SPIRITUAL NEEDS IN A CHRISTIAN ATMOSPHERE. NO PERSON BECAUSE OF RACE, COLOR, CREED, RELIGION, NATIONAL ORIGIN, SEX, MARITAL STATUS, STATUS WITH REGARD TO MEDICAL ASSISTANCE, DISABILITY, SEXUAL ORIENTATION, MEMBERSHIP OR ACTIVITY IN A LOCAL COMMISSION OR VETERAN STATUS SHALL BE BARRED ADMISSION FROM LUTHER HAVEN. 0 0 3435139 6647508 NURSING DEPARTMENT WITH A BUDGET OF 3 MILLION IS OUR LARGEST DEPT. IT EMPLOYEES APPROXIMATELY 100 EMPLOYEES. WE PROVIDE LONG AND SHORT STAY CARE. A FULL LINE OF REHAB SERVICES PROMOTE MAXIMUM RESIDENT HEALTH AND RETURN TO COMMUNITY. WE ARE LICENSED FOR 90 BEDS. ALSO ON THE CAMPUS IS COPPER GLEN, ASSISTED LIVING AND THE MONTEVIDEO-CHIPPEWA COUNTY HOSPITAL AND MEDICAL CENTER. ALL BUILDINGS ARE CONNECTED AND CERTAIN SERVICES ARE SHARED FOR COST SHARING AND COST SAVINGS. WE ARE CERTIFIED WITH MEDICARE AND MEDICAID AND LICENSED WITH THE MINNESOTA DEPARTMENT OF HEALTH. 968175 461081 DIETARY IS RESPONSIBLE FOR FOOD SERVICE FOR THE CARE CENTER, COPPER GLEN ASSISTED LIVING AND THE CHIPPEWA COUNTY-MONTEVIDEO HOSPIAL AND MEDICAL CENTER. MEALS SERVED INCLUDE RESIDENTS, PATIENTS AND GUEST. SPECIAL DIET REQUIREMENTS ARE MET WITH THE DIRECTION OF OUR DIETICIAN AND STAFF. MEAL SERVICE TO LUTHER HAVEN TOTALED 91,034, COPPER GLEN 21,675, HOSPITAL 9,425. 663503 626753 COPPER GLEN IS A LICENSED CLASS F ASSISTED LIVING. COPPER GLEN IS DESIGNED AS AN APARTMENT STYLE COMPLEX WITH SERVICES AVAILABLE TO ASSIST THE TENANTS TO AGE IN A HOME ENVIRONMENT. PROGRAM SERVICES ARE INTENDED TO BRIDGE THE GAP BETWEEN INDEPENDENT LIVING AND THE CARE CENTER. SERVICES PROVIDED INCLUDE: MEALS, BATHING, HOUSEKEEPING, MAINTENANCE, LAUNDRY, REGISTERED NURSE SUPERVISION STAFFING 16 HOURS PER DAY WITH STAFF AVAILABLE DURING THE NIGHT SHIFT FROM THE CARE CENTER. ALSO PROVIDED IS ALA CARTE SERVICES: CENTRAL STORAGE OF MEDICATIONS, MEDICATION ADMINISTRATION AND MANAGEMENT. VOLUNTEERS AND LOCAL PASTORAL ORGANIZATION PROVIDE WORSHIP SERVICES. 2238880 27015 OTHER SERVICES INCLUDE ADMINISTRATION, PLANT OPERATIONS, LAUNDRY, HOUSEKEEPING, CHAPLAINCY, ACTIVITIES, SOCIAL SERVICES AND SHARED SERVICES. LUTHER HAVEN ALSO PROVIDES SCHOLARSHIPS TO EMPLOYEES, HELPING TO ADVANCE THEIR CAREER IN THE LONG-TERM CARE FIELD. 2238880 27015 7305697 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 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 0 0 0 0 1 29 0 1 211 1 0 0 0 0 0 1 1 0 0 0 0 X 11 11 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X ANN NORDSTROM 3202696517 1109 EAST HIGHWAY 7 MONTEVIDEO MN 56265 DON SNELL VICE PRESIDENT 1.00 X X 0 0 0 GREG MULDER CHAIR 1.00 X X 0 0 0 TERRI VIEN VICE CHAIR 1.00 X X 0 0 0 JACQUE PETERS SECRETARY 1.00 X X 0 0 0 RICHARD CHRISTENSON DIRECTOR 1.00 X 0 0 0 CAROL ARENDS DIRECTOR 1.00 X 0 0 0 JUDY TEBEEST DIRECTOR 1.00 X 0 0 0 KARLA SCHWENDEMANN DIRECTOR 1.00 X 0 0 0 TOM SAUE DIRECTOR 1.00 X 0 0 0 SANDY HODGE DIRECTOR 1.00 X 0 0 0 BONNIE HANSON DIRECTOR 1.00 X 0 0 0 JAMES FLAHERTY PRESIDENT/TREASURER/ADMINISTRATOR 40.00 X 113129 0 975 113129 0 975 1 0 0 0 BIG STONE THERAPY 309 WASHINGTON AVE ORTONVILLE MN 56278 PHYSICAL, OCCUPATIONAL AND SPEECH THERAP 323177 US FOODS 9605 54TH AVE NORTH PLYMOUTH MN 55442 FOOD SERVICE 217379 2 147646 147646 RESIDENT ROOM, BOARD, 900099 6647508 6647508 THERAPY 900099 652732 652732 SHARED SERVICES REVENU 900099 196363 196363 OTHER REVENUE 900099 123411 119567 3844 PHARMACY SERVICES 900099 119172 119172 7739186 11621 11621 17782 -17782 -17782 -17782 7880671 7735342 0 -2317 74 74 26941 26941 115193 115193 4780807 4193535 587272 11825 10289 1536 158852 139659 19193 363032 363032 2291 2291 37001 37001 530072 530072 10296 9781 515 57064 57064 5473 5473 276534 276534 313274 313274 SUPPLIES 671725 671725 REPAIRS AND MAINTENANCE 238121 238121 UTILITIES 229768 229768 PROVISION FOR BAD DEBT 14080 14080 73530 71790 1740 7915953 7305697 610256 0 551097 441506 1898010 1830910 398885 677811 42794 43581 66120 79961 9445977 7037957 2392953 2408020 5349859 5481789 630295 819468 564128 476433 1194423 1295901 X 4132474 4164313 22962 21575 4155436 4185888 5349859 5481789 -35282 65734 0 X 0 1 X 1 0 X 67734 5350 5315 3107 147646 229152 5609765 5591106 5692349 6348405 7735342 30976967 5677499 5596456 5697664 6351512 7882988 31206119 0 0 0 31206119 26903 17729 13737 12777 11621 82767 26903 17729 13737 12777 11621 82767 789249 768846 805720 4704 3844 2372363 6493651 6383031 6517121 6368993 7898453 33661249 0.92710 0.90200 0.00250 0.00360 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 43917 43917 7348481 5377303 1971178 1869751 1660654 209097 183828 183828 2408020 7950107 65734 65734 7884373 -3702 -3702 7880671 7919655 0 7919655 -3702 -3702 7915953 PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 14,080. LOSS ON DISPOSAL -17,782. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT 14,080. LOSS ON DISPOSAL -17,782. 1 SCHOLARSHIPS 14 26941 0 PART I, LINE 2: LUTHER HAVEN HAS A NURSING FACILITY SCHOLARSHIP FUND. EMPLOYEES MUST MEET CERTAIN ELIGIBILITY REQUIREMENTS. SCHOLARSHIP PARTICIPANTS MUST PERSONALLY TURN IN ALL ALLOWABLE EXPENSES. DIRECT BILLINGS FROM THE COLLEGE ARE NOT ACCEPTED. SCHOLARSHIP APPLICATIONS AND REIMBURSEMENT ARE PROCESSED BY ACCOUNTING AFTER BEING APPROVED BY THE DEPARTMENT MANAGER, ADMINISTRATOR OR HUMAN RESOURCES. ACCOUNTING VERIFIES AND TRACKS YEARLY PAYMENTS FOR REPORT PURPOSES. PAYMENTS ARE MADE DIRECTLY TO THE EMPLOYEE. THE APPLICANT MUST COMPLETE THE SCHOLARSHIP REIMBURSEMENT FORM ATTACHING AN ITEMIZED DETAILED BILLING OF THE ALLOWABLE EXPENSES WITH RECEIPTS SHOWING THEIR PAYMENT IN FULL. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP OF LUTHER HAVEN CONSISTS OF CONGREGATIONS OF CHRISTIAN CHURCHES WHICH HAVE APPLIED FOR SUCH MEMBERSHIP AND BEEN APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE ADMINISTRATOR AND BOOKKEEPER BEFORE PROVIDING A COPY TO OUR BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C FIRST MEETING FOLLOWING THE ANNUAL MEETING THE CONFLICT OF INTEREST AND WHISTLEBLOWER POLICIES ARE REVIEWED. IT IS THE RESPONSIBILITY OF THE BOARD MEMBER TO STATE IF THEY FEEL THEY HAVE A CONFLICT OF INTEREST ON A VOTING MATTER. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION USES TWO SALARY SURVEYS, ONE FROM AGING SERVICES OF MINNESOTA AND ANOTHER FROM MEDISOTA, A NON-PROFIT GROUP. THE COMPENSATION AND BENEFIT SURVEY IS FOR HEALTH CARE FACILITIES IN THE SOUTHWEST REGION OF MINNESOTA. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D).