2017-08-11T13:50:47-05:00 2016-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2015-10-01 410870856 MAPLE LAWN NURSING HOME INC MAPL 5074252571 400 SEVENTH STREET NE FULDA MN 56131 ARLAN SWANSON ADMINISTRATOR/CEO 5074252571 2017-08-11 1 EMILY SCHEEVEL P01814921 6123764500 2015 2021-01-29 14:40:06Z X MAPLE LAWN SENIOR CARE MAPLEWOOD COURT MAPLEWOOD ESTATES ARLAN SWANSON 400 SEVENTH STREET NE FULDA MN 56131 4755906 0 X WWW.MAPLELAWN.ORG X 1962 MN TO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS. 9 9 157 62 0 0 194906 6149 4348560 4592534 13443 12874 50109 144349 4607018 4755906 5822 13982 0 0 2734053 3029340 0 0 0 1752801 1955092 4492676 4998414 114342 -242508 4332574 3852139 2096278 1842983 2236296 2009156 X TO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS IN AN INDIVIDUALIZED, DIGNIFIED, AND HOMELIKE MANNER. 0 0 4562099 13982 4592534 MAPLE LAWN NURSING HOME IS A CAMPUS OF LONG TERM CARE SERVICES THAT INCLUDE:MAPLEVIEW ESTATES - 24 APARTMENTS FOR SENIORS WHO NEED LIGHT ASSISTANCE ALLOWING THEM TO MAINTAIN REASONABLY INDEPENDENT LIVES. THESE SERVICES INCLUDE A HIGH-QUALITY NOON MEAL AND ASSISTANCE FOR HOUSEKEEPING AND OTHER LIGHT TASKS. MAPLEWOOD COURT ASSISTED LIVING - 15 APARTMENTS FOR SENIORS WHO NEED ASSISTANCE WITH ALL MEALS AND MEDICATIONS, BUT MAINTAIN INDEPENDENCE IN MANY OTHER CARE AREAS. MAPLE LAWN NURSING HOME - 54 MEDICARE-CERTIFIED SKILLED NURSING BEDS THAT PROVIDE CARE FOR A BROAD SPECTRUM OF RESIDENTS WITH NEEDS FROM POST-ACUTE REHAB THERAPY TO MEMORY CARE. THE CAMPUS PROVIDES CARE FOR OVER 100 LOCAL INDIVIDUALS AT ANY POINT IN TIME, IN THIS RURAL COMMUNITY OF 1,300. APPROXIMATELY 180 DIFFERENT PERSONS ARE SERVED DURING EACH YEAR. MANY WOULD NOT BE ABLE TO FIND CARE ANYWHERE ELSE. THE ORGANIZATION HAS STEADILY GROWN AND IMPROVED DURING ITS 54 YEARS OF SERVICE TO THIS COMMUNITY - FILLING THIS COMMUNITY'S NEED FOR FINE QUALITY HOUSING AND HEALTH CARE SERVICES AND PROVIDING THEM IN AN INDIVIDUALIZED AND HOMELIKE MANNER. 4562099 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 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 0 0 0 0 0 1 48 0 157 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 1 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X ARLAN SWANSON 5074252571 400 NE SEVENTH STREET FULDA MN 56131 JERRILD STEINER PRESIDENT 1.00 X X 0 0 0 ELDEN GETTING VICE PRESIDENT 1.00 X X 0 0 0 MARCINE ELDER SECRETARY 1.00 X X 0 0 0 SHERRI BOEHNKE DIRECTOR 1.00 X 0 0 0 MARY FRAN BUSCH DIRECTOR (ROTATED OFF JAN. 2016) 1.00 X 0 0 0 BILL FUERSTENBERG DIRECTOR 1.00 X 0 0 0 RON JANSSEN DIRECTOR 1.00 X 0 0 0 LOUISE JOHNSON DIRECTOR 1.00 X 0 0 0 SHERRI LUNDEEN DIRECTOR 1.00 X 0 0 0 DEAN MCNEAL DIRECTOR 1.00 X 0 0 0 ARLAN SWANSON ADMINISTRATOR/CEO 50.00 X 92430 0 6975 92430 0 6975 0 0 0 0 PRAIRIE REHABILITATION SERVICES LLC 1720 S CLIFF AVE SIOUX FALLS SD 57105 CONTRACTED THERAPY 266275 US FOODS INC PO BOX 1450 MINNEAPOLIS MN 55485 FOOD SERVICES 223848 PRIME TIME HEALTH CARE LLC 14811 SHEPARD ST OMAHA NE 68138 STAFFING SERVICES 167265 3 6149 6149 RESIDENT SERVICES 623000 3704951 3704951 APARTMENT RENTAL 623000 887583 887583 4592534 12874 12874 MISCELLANEOUS INCOME 900099 69634 69634 INSURANCE PROCEEDS 900099 50000 50000 ANCILLARY SERVICES 623000 16310 16310 8405 8405 144349 4755906 4592534 0 157223 577 577 13405 13405 99406 9941 89465 2440126 2432861 7265 32310 32207 103 293776 292891 885 163722 163236 486 2232 2232 29539 29539 456022 455742 280 16186 16186 25029 25029 47109 47109 160502 154696 5806 235 235 2003 2003 40429 38716 1713 213368 204325 9043 36177 34644 1533 MISCELLANEOUS 310217 114737 195480 FOOD 228955 228955 MEDICAL SUPPLIES 216870 214968 1902 LICENSE SURCHARGE 170219 170198 21 4998414 4562099 436315 0 735630 113251 971349 484653 256549 266340 21642 37659 7195979 4289814 2302277 2906165 20072 17842 25055 26229 4332574 3852139 487263 379205 6005 1517 1554098 1394326 18258 15095 30654 52840 2096278 1842983 X 2218296 1992156 18000 17000 2236296 2009156 4332574 3852139 -242508 15368 0 X 0 1 X 1 0 X 18761 9628 27797 194906 6149 257241 4546754 4403279 4156634 4348560 4592534 22047761 9403 7405 9135 24715 50658 4565515 4422310 4191836 4552601 4623398 22355660 0 183248 315376 528492 294384 501472 1822972 183248 315376 528492 294384 501472 1822972 20532688 10690 5569 6455 13443 12874 49031 10690 5569 6455 13443 12874 49031 17777 17173 20844 40974 119634 216402 4593982 4445052 4219135 4607018 4755906 22621093 0.90770 0.92910 0.00220 0.00200 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUES INSURANCE PROCEEDS 0 1 X 4864595 3030006 1834589 280602 105904 174698 1310057 1153904 156153 740725 740725 2906165 ASSET RETIREMENT OBLIGATION 52840 52840 X 4771274 15368 15368 4755906 0 4755906 4998414 0 4998414 0 4998414 PART IV, LINE 2B: RESIDENTS MAKE A SECURITY DEPOSIT WHEN THEY MOVE INTO THE FACILITIES. EACH RESIDENT RECEIVES THEIR SECURITY DEPOSIT, WITH INTEREST, WHEN THEY LEAVE THE FACILITIES. RESIDENT TRUSTS ARE SMALL AMOUNTS THAT RESIDENTS HOLD WITH MAPLE LAWN FOR MINOR EXPENSES AND FOR USE IN RESIDENT OUTINGS. PART X, LINE 2: THE CORPORATION 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 STATUTES. THE CORPORATION BELIEVES IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE CORPORATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE CORPORATION'S ANNUAL TAX FILINGS ARE SUBJECT TO REVIEW BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE CORPORATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE CORPORATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OTHER TAXES. 1 SCHOLARSHIPS 6 13405 PART I, LINE 2: SCHOLARSHIP PAYMENTS ARE MADE DIRECTLY TO THE SCHOLARSHIP RECIPIENT'S COLLEGE TO ENSURE APPROPRIATE USE OF FUNDS. A CITY OF FULDA MINNESOTA 416005177 2012-10-01 1955150 REFUND SERIES 2003 BONDS (NURSING HOME PROJECT) 0 0 0 A 560824 1955150 1955150 2012 1 0 1 1 A 0 0 0 0 0 0 0 A 0 0 1 0 1 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 5 AN EMPLOYEE WRONGLY PURCHASED GIFT CARDS AND OTHER ITEMS THROUGH A VENDOR. APPROX. $150,000 WAS LOST. THE ORGANIZATION IMMEDIATELY TERMINATED THE EMPLOYEE AND SHE IS BEING PROSECUTED BY LOCAL LAW ENFORCEMENT. INSURANCE COVERED $50,000 OF THE LOSS. RESTITUTION WILL BE WORKED OUT WITH PROSECUTION. THE ORGANIZATION HAS CHANGED CRITICAL ACCOUNTING POLICY AND PROCEDURE AND INCREASED OVERSIGHT. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP OF THE ORGANIZATION CONSISTS OF ANY PERSON (AGE 21 OR OLDER) OR ORGANIZATION DONATING $100 OR MORE FOR THE PURPOSE OF MEMBERSHIP TO THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S MEMBERS ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S MEMBERS HAVE THE POWER TO AMEND THE ARTICLES AND BYLAWS AND TO TERMINATE MEMBERSHIPS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS AT A BOARD MEETING AND APPROVED PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY IS ANNUALLY REVIEWED AND SIGNED BY THE BOARD MEMBERS AND KEY STAFF MEMBERS. BOARD MEMBERS ARE REQUIRED TO SELF-DISCLOSE POTENTIAL OR REAL CONFLICTS OF INTEREST TO THE BOARD. IF A CONFLICT EXISTS THE INDIVIDUAL WILL NOT BE ALLOWED TO VOTE ON THE RELATED ISSUE. CONFLICTS ARE HANDLED ON A CASE BY CASE BASIS. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD USES COMPARATIVE DATA FROM THE LONG TERM CARE IMPERATIVE COMPENSATION REPORT AND COMPARATIVE INFORMATION FROM A MAJOR ACCOUNTING FIRM WHEN DETERMINING THE ADMINISTRATOR'S SALARY. INFORMATION IS REVIEWED BY THE FULL BOARD AND DOCUMENTED IN THE MINUTES. THIS WAS LAST COMPLETED IN 2012. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.