2017-08-14T14:44:47-05:00 2016-09-30 411765929 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-10-01 411263433 Knute Nelson KNUT 3207636653 420 12th Avenue East Alexandria MN 56308 Mark Anderson CEO 3207636653 2017-08-14 1 Deb Nelson CPA P01264758 6122536500 2017-08-14 2015 2021-01-29 14:40:06Z Mark Anderson 420 12th Avenue East Alexandria MN 56308 29392026 0 9386 X www.knutenelson.org X 1969 MN Operation of nursing home and senior services 9 9 721 275 254151 -138749 759755 304340 26477229 29006537 81590 81149 648000 0 27966574 29392026 21915 92574 0 0 18332246 20006701 0 0 26529 9873760 10083332 28227921 30182607 -261347 -790581 65107374 65788667 52915426 54198033 12191948 11590634 X The mission of Knute Nelson is to enrich the lives of everyone we serve. Our vision is to be the recognized leader of quality and innovative services for all stages of living. 0 0 26652239 92574 29006537 Knute Nelson, an affiliate of Evangelical Lutheran Church of America, provides a full continuum of services for older adults to enhance their quality of life through a 93-bed skilled nursing facility, 162 independent living apartments, 139 assisted living units, a home care agency, and a hospice agency.Knute Nelson has 600+ employees and over 275 volunteers making it one of the top five employers in Alexandria. Within the skilled nursing facility, we have a short-term rehab unit, rehabilitation program, and care suites for end-of-life programming. We also have a wellness program that provides classes for residents, activities, and a chaplaincy program; all which enhance their quality of living. Our chaplaincy program is guided by Christian principles. All faiths are celebrated here and our chaplain provides a wide range of spiritual care through worship service, bible study groups, and resident and family support.The skilled nursing facility has the capacity to serve 93 individuals with their short- and long-term nursing and therapy needs. An increasing area of focus is our short-term rehab center where individuals receive necessary physical, speech, and occupational therapies and return back to their home. Knute Nelson accepts all payor sources: Medicare, Medicaid, insurance, and private pay. If a resident is unable to pay for their services, we will work with them to find a means to pay for their services and help them facilitate the application process for medical assistance through family members, Knute Nelson and Doulas County social services. The goal of the Knute Nelson Home Care program is to help individuals stay in their own home as long as possible. We are able to help individuals of any age with skilled nursing services, physical, speech and occupational therapies, IV therapy, wound care, private duty nursing, home health aide, or assessment and management of their medical needs. We serve individuals throughout 29 counties throughout the West Central Region of Minnesota with offices located in Alexandria, Baxter, Morris, Elbow Lake, Fergus Falls, Long Prairie, Little Falls, Olivia, Park Rapids and Wadena. Knute Nelson Hospice cares for people with life-limiting illnesses utilizing a holistic approach, including medical, physical, emotional, social and spiritual care for patients and families. Hospice provides a wide range of services from skilled nursing, medication and pain management, home health aides, physical therapy, occupational therapy, social workers and Chaplain. Hospice is provided wherever the patient calls home--in their own homes, nursing facilities, or other housing locations. Bereavement services and follow-up care are also a part of the hospice program. Our assisted living facility, Nelson Gables, promotes independence, security and quality of life. Daily coffee hour, restaurant style meal program, active aging wellness classes, parties and outings keep residents as active as they wish to be. A 24-hour staff, under the direction of a registered nurse, is ready to offer assistance with medication management, medication administration, bathing, and personal care. Grand Arbor, registered through Knute Nelson Senior Living Campus, LLC, is an enhanced continuing care retirement community that encourages active lifestyles with a town center and wellness center set among independent living apartments; general and high acuity assisted living apartments; and memory care assisted living apartments. A 24-hour licensed staff, under the direction of a registered nurse, is able to offer assistance with medication management, medication administration, bathing, and other personal care. 26652239 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 52 0 1 721 1 1 1 0 0 0 0 0 0 0 0 0 X 9 9 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 MN X Marnie Gugisberg SrVPCFO 3207631164 420 12th Avenue East Alexandria MN 56308 Doug Houska Chair 1.00 0.00 X X 0 0 0 Richard MoenVice Chair as of Mar 2016)/Secretary (thru Feb 2016) 1.00 0.00 X X 0 0 0 Ruth Nagle Vice Chair (thru Feb 2016) 1.00 0.00 X X 0 0 0 Rick PaulsenSecretary as of Mar 2016)/Director (thru Feb 2016) 1.00 0.00 X X 0 0 0 David Wolf Treasurer 1.00 0.00 X X 0 0 0 Jan Lervick Director 1.00 0.00 X 0 0 0 Tim Bush Director 1.00 0.00 X 0 0 0 Derek Trosvig Director 1.00 0.00 X 0 0 0 Yvonne Kinney-Hockert Director (thru Feb 2016) 1.00 0.00 X 0 0 0 Deena Steffl Director (as of Mar 2016) 1.00 0.00 X 0 0 0 Kathryn Fischer Director (as of Mar 2016) 1.00 0.00 X 0 0 0 Mark Anderson President/CEO 35.00 5.00 X 206124 0 27028 Marnie Gugisberg SrVP/CFO 39.00 1.00 X 120508 0 21509 Angela Urman SrVP/COO 40.00 0.00 X 113857 0 20895 Katie Perry SrVP/Foundation Executive Director 20.00 20.00 X 103321 0 2064 543810 0 71496 4 0 1 0 Pope Architects Inc 1295 Bandana Blvd N Ste 200 St Paul MN 55108 Contractor 460917 XS Consulting Group Ltd 405 22nd Ave West Alexandria MN 56308 IT Contractor 396732 Big Stone Therapies Inc 309 Washington Ave Ortonville MN 56278 Therapy Contractor 171073 3 140318 164022 304340 Resident Service Revenue 623000 23194011 23194011 Sr Apt Rental Revenue 623000 4997261 4997261 Other Revenue 900099 751755 497604 254151 Auxiliary and Coffee Shop 721000 63510 63510 29006537 81149 81149 29392026 28752386 254151 81149 92574 92574 517907 493079 24828 15858700 14184653 1674047 145608 129459 16149 2265773 1989995 275778 1218713 1058337 158675 1701 27739 27739 36814 36814 24023 24023 1385679 1385679 186103 186103 1015797 829063 186734 908226 908226 926079 899006 27073 65067 49009 16058 1427924 1427924 2219417 2219417 242702 242702 Food 640291 640291 Medical Supplies 338882 338882 Surcharge & Pre Screen 248773 248773 Licenses & Permits 68206 21077 47129 321610 229874 91736 30182607 26652239 3503839 26529 2299589 1380109 2446748 3785709 972 976 187091 202952 73218276 23358906 32976272 49859370 22921743 5925523 2583483 2772678 255000 480000 1436476 1381350 65107374 65788667 2732731 3064450 49198446 48696991 187161 193739 65739 5248 731349 2237605 52915426 54198033 X 12191948 11590634 12191948 11590634 65107374 65788667 X -790581 21995 167272 X 0 1 X 1 0 X 5284 138619 1474630 759755 304340 2682628 18071000 21165007 24448046 26229717 28752386 118666156 18076284 21303626 25922676 26989472 29056726 121348784 0 0 0 121348784 90821 88326 80764 81590 81149 422650 90821 88326 80764 81590 81149 422650 648000 648000 18167105 21391952 26003440 27719062 29137875 122419434 0.99130 0.99070 0.00350 0.00330 X Schedule A, Part III, Line 12, Explanation of Other Income: Gain on Sale of Bed Licenses - 2014 Amount: $ 648,000. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 2465190 2465190 59028350 15965344 43063006 10339202 6499021 3840181 1385534 894541 490993 49859370 Insurance Reserve 269274 Construction Payable 1968331 2237605 X 29652038 400330 400330 29251708 140318 140318 29392026 30415946 233339 233339 30182607 0 30182607 Part IV, Line 2b: The organization acts as a custodian for the funds of the residents of the Skilled Nursing Facility and Assisted Living. Part X, Line 2: The Corporation is organized as a Minnesota not-for-profit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). Senior Living maintains exempt status under the Corporations's exemption since the Home is the sole member of Senior Living. The Corporation is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Corporation is subject to income tax on any net income that is derived from business activities that are unrelated to their exempt purpose. The Corporation files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Corporation believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and, as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Corporation would recognize future accrued interest and penalties related to unrecognized tax liabilities in income tax expense, if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Foundation revenue included in consolidated financial statements 400,330. Part XI, Line 4b - Other Adjustments: Transfer from related party reported in fund balance on financial statements 140,318. Part XII, Line 2d - Other Adjustments: Foundation expenses included in consolidated financial statements 233,339. 1 Scholarships 55 92574 Part I, Line 2: Knute Nelson makes payments directly to the school and directly to the individuals, depending on the circumstance. For payments made directly to individuals, a receipt must be provided showing book or tuition expense before the scholarship is issued. X X X 0 0 0 0 0 0 0 0 0 Mark Anderson President/CEO 206124 0 0 0 0 0 8634 0 18433 0 233191 0 0 0 A City of Alexandria Minnesota 416004926 015185AL5 2010-07-08 19865000 Build Senior Housing Campus 0 0 0 B City of Alexandria Minnesota 416004926 2006-06-08 4300000 Assisted Living Facility and Refund Prior Bonds Issued 7/17/95 0 0 0 C City of Alexandria Minnesota 416004926 2010-07-08 4500000 Skilled Nursing Facility Project 0 0 0 D Lakes Area Economic Development Authority 200299143 51206KAS9 2015-07-15 22905000 Build Senior Housing Campus - Series A Bonds 0 0 0 A 19865000 1505500 298127 397300 17664073 2012 0 0 1 1 B 1551266 4300000 113002 83118 3093138 1010742 2007 1 0 1 1 C 1611743 4500000 4500000 2010 0 0 1 1 D 22905000 1435592 1237925 458100 21011308 2016 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 1 0 1 0 0 0 0 C 0 0 1 0 1 0 0 0 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 Date Rebate Computation Performed Issuer Name: City of Alexandria, Minnesota Date the Rebate Computation was Performed: 07/01/2015 Form 990, Part VI, Section A, line 1 The Executive Committee shall include the Chair, Vice-Chair, President, Treasurer, Secretary and such other individuals, if any, as may be appointed by the board from time to time. The Executive Committee shall have the authority of the board in the management of the business of this corporation in the interval between board meetings, and the Executive Committee shall at all times be subject to the control and direction of the board. The Executive Committee shall have such other duties as may be prescribed by the board from time to time. Form 990, Part VI, Section A, line 4 The bylaws were updated to add another corporate church. Form 990, Part VI, Section A, line 6 The membership of the organization is made up of sixteen area churches that are primarily Lutheran which are elected as members by the Board of Directors of the organization. At all times, the majority of members of the organization are required to be congregations of the Evangelical Lutheran Church in America, or its successor. Form 990, Part VI, Section A, line 7a The organization's nominating committee, which consists of two voting delegates of members elected by the members at the annual meeting of members and two directors appointed by the Board of Directors, makes recommendations for elections to the Board of Directors. The Board of Directors is then elected by its members at an annual meeting. Form 990, Part VI, Section A, line 7b The amendment or restatement of the Articles of Incorporation or bylaws need to be approved by a majority of the directors and the voting member delegates. Form 990, Part VI, Section B, line 11 The return is reviewed initially by the CFO and CEO. The Finance & Audit committee then reviews, provides a copy to the Board of Directors, and makes a recommendation to the Board of Directors to approve the return. Form 990, Part VI, Section B, line 12c Each officer, director, and key employee is required to fill out a conflict of interest form annually. The form is reviewed initially by the President of the Board of Directors and the CEO for potential conflicts. If a conflict exists, it is reviewed by the Board of Directors. Any person with a conflict is restricted from voting on related matters. Form 990, Part VI, Section B, line 15 The Board determines the compensation of the CEO based on comparability data. The CEO is reviewed annually by the Executive Board which then reports back to the full Board of Directors. The decision is noted in the board minutes. The CEO determines the compensation of the CFO and COO based on comparability data and presents this information to the executive team of the Board of Directors. This process takes place on an annual basis. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available upon request. Form 990, Part XI, line 9: Change in Value of Foundation 167,272. Knute Nelson Senior Living Campus LLC 420 12th Avenue East Alexandria MN 56308 272940787 Senior Housing MN 5971298 51033144 Knute Nelson Knute Nelson Foundation 420 12th Avenue East Alexandria MN 56308 411451486 Fundraising MN 501(c)(3) Line 11a, I Knute Nelson 1 BEK Care LLC (dba Ethos Home Care) 2877 45th St S Suite 201 Fargo ND 58104 464681716 Home Care Agency ND Knute Nelson Related 21923 105228 0 1 0.33330 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 1 Knute Nelson Foundation C 140318 FMV BEK Care LLC Q 100000 General Ledger