2016-01-25T07:00:17-06:00 2015-06-30 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2014-07-01 410839343 DIVINE PROVIDENCE COMMUNITY HOME DIVI 5077943011 700 3RD AVENUE NW SLEEPY EYE MN 560851036 JAYNA GROEBNER ADMINISTRATOR 5077943011 2016-01-19 1 DEB NELSON CPA P01264758 6122536500 2016-01-19 2014 2016-04-25 22:37:26Z JAYNA GROEBNER 700 3RD AVENUE NW SLEEPY EYE MN 560851036 3184118 0 0928 X WWW.DIVINEPROVIDENCEHOME.ORG X 1960 MN PROVIDE PROFESSIONAL CARE AT THE HIGHEST LEVEL TO THE AGED AND PHYSICALLY IMPAIRED. 6 6 151 13 0 0 46709 46638 3475789 3111795 12985 11548 7063 7758 3542546 3177739 9538 0 0 0 2209244 2198395 0 0 0 1316134 1283912 3534916 3482307 7630 -304568 2513570 2284016 240791 316369 2272779 1967647 RELIGIOUS ORGANIZATION WHOSE PURPOSE IS THE CARE OF THE AGED AND PHYSICALLY IMPAIRED BY PROVIDING PROFESSIONAL CARE AT THE HIGHEST LEVEL. 0 0 3254922 0 3111795 DIVINE PROVIDENCE PROVIDES SERVICES TO SENIORS BY CREATING A HAVEN OF CHRISTIAN LOVE AND COMMITMENT THAT SPEAKS LOUDLY OF THE DIGNITY OF LIFE. THE 53 BED NURSING HOME PROVIDED 16,913 DAYS OF RESIDENT CARE. THIS INCLUDES PROFESSIONAL NURSING CARE, COORDINATED REHABILITATION SERVICES, DAILY MASS AND ROSARY, WEEKLY PROTESTANT SERVICES, NUTRITIOUS MEALS, AND ENGAGING ACTIVITIES. THE 21 SENIOR LIVING APARTMENTS PROVIDED HOUSING SERVICES FOR 25 TENANTS. THE PURPOSE IS TO HELP SENIORS WHO ARE CONTINUING LIFE'S JOURNEY WITH THE HELP OF FAMILY, FRIENDS, AND PROFESSIONALS IN ALL AREAS OF LONG TERM CARE. 3254922 1 1 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 0 1 151 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 1 0 1 0 0 0 1 1 1 1 1 1 1 0 0 MN X JAYNA GROEBNER 5077943011 700 THIRD AVENUE NW SLEEPY EYE MN 560851036 SR RITA BUTLER PRESIDENT 40.00 X X 0 0 0 SR BERNADINE UGOLINI VICE PRESIDENT 40.00 X X 0 0 0 SR DARLENE JOHNSON TREASURER 40.00 X X 0 0 0 SR MARY WALKER SECRETARY 40.00 X X 0 0 0 SR JANET KOSMAN DIRECTOR 40.00 X 0 0 0 SR MARY LYNN RAKOWSKI DIRECTOR 40.00 X 0 0 0 JAYNA GROEBNER ADMINISTRATOR 40.00 X 58375 0 2043 58375 0 2043 0 0 0 0 NEPCO INC 1001 FEEHANVILLE DRIVE MT PROSPECT IL 60056 GENERAL CONTRACTOR 440650 ONR 1101 SOUTH CAPITAL OF TEXAS HWY AUSTIN TX 78746 THERAPY SERVICES 108128 2 3531 4500 38607 4500 46638 NURSING HOME CARE 623000 2843775 2843775 SENIOR LIVING APARTMEN 623000 210969 210969 OTHER REVENUE 900099 57051 57051 3111795 11548 11548 5858 4500 1306 4552 4552 8279 5073 3206 3206 3177739 3111795 0 19306 61940 61940 1818145 1725122 93023 44128 41870 2258 140474 133633 6841 133708 122824 10884 100 100 17330 17330 236947 229994 6953 3738 3738 254053 240685 13368 108 108 307861 307861 1431 1431 12411 11476 935 322 322 130681 130681 48078 48078 NURSING FACILITY SURCHA 163270 163270 MEDICAL SUPPLIES 82979 82979 AUXILIARY 8499 8499 LICENSING AND PERMITS 7508 7508 8596 120 8476 3482307 3254922 227385 0 961661 397874 197674 166078 47933 41232 2977876 1774152 679915 1203724 608121 452922 18266 22186 2513570 2284016 177774 252025 35654 37927 18266 22186 9097 4231 240791 316369 X 2272779 1967647 2272779 1967647 2513570 2284016 X -304568 18 -582 X 0 1 X 0 0 X 48058 21702 55016 46709 46638 218123 3853679 3747713 3491233 3475789 3111795 17680209 22328 21522 19337 17245 14137 94569 3924065 3790937 3565586 3539743 3172570 17992901 0 895207 842533 799751 912254 848096 4297841 895207 842533 799751 912254 848096 4297841 13695060 19456 16281 13078 12985 11548 73348 19456 16281 13078 12985 11548 73348 3943521 3807218 3578664 3552728 3184118 18066249 0.75800 0.67420 0.00410 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 14598 18133 17551 15180 1 X 1510560 633516 877044 1325922 1042789 283133 141394 97847 43547 1203724 CAPITALIZED LEASE OBLIGATIONS 4231 4231 X 3168675 18 7745 7763 3160912 16827 16827 3177739 3473807 9051 9051 3464756 17551 17551 3482307 PART IV, LINE 1B: THE ORGANIZATION HOLDS ASSETS FOR THE AUXILIARY. PART IV, LINE 2B: THE HOME ACTS AS CUSTODIAN FOR THE FUNDS OF THE RESIDENTS AND HOLDS TENANT SECURITY DEPOSITS. PART X, LINE 2: THE HOME 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). THE HOME IS REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS ANNUALLY. IN ADDITION, THE HOME IS SUBJECT TO INCOME TAX ON ANY NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. THE HOME 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 FINANCIAL STATEMENTS. THE HOME 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. PART XI, LINE 2D - OTHER ADJUSTMENTS: DONATIONS FROM AUXILIARY INCLUDED ON THE FINANCIAL STATEMENTS. 7,745. PART XI, LINE 4B - OTHER ADJUSTMENTS: REVENUE FROM THE AUXILIARY NOT INCLUDED ON THE FINANCIAL STATEMENTS. 18,133. AUXILIARY FUNDRAISING EXPENSE MOVED FROM REVENUES TO EXPENSES -1,306. PART XII, LINE 2D - OTHER ADJUSTMENTS: AUXILIARY FUNDRAISING EXPENSE MOVED FROM REVENUES TO EXPENSES. 1,306. DONATIONS FROM AUXILIARY INCLUDED ON THE FINANCIAL STATEMENTS. 7,745. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES FROM THE AUXILIARY NOT INCLUDED ON THE FINANCIAL STATEMENTS. 17,551. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS ARE APPOINTED BY THE PROVINCIAL OF THE U.S.A. PROVINCE OF THE DAUGHTERS OF ST. MARY OF PROVIDENCE. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE A COMMITTEE WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE REQUIRED ANNUAL FORM 990 FILING IS COMPLETED FROM THE FINANCIAL RECORDS PROVIDED BY THE NON-PROFIT ORGANIZATION UPON COMPLETION OF AN ANNUAL AUDIT BY AN INDEPENDENT CPA. AFTER THE REVIEW BY THE BOARD, THE INFORMATION TAX RETURN FORMS ARE THEN SUBMITTED TO AN OFFICER FOR SIGNATURE AND SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY COVERS THE BOARD OF DIRECTORS AND PROHIBITS CONTRACTING FOR SERVICES WITH AGENCIES OWNED IN PART OR ENTIRELY BY PERSONS EMPLOYED BY DIVINE PROVIDENCE AND/OR RELATED TO MANAGERIAL EMPLOYEES, INCLUDING THE BOARD OF DIRECTORS. HOWEVER, SINCE DIVINE IS LOCATED IN THE SMALL TOWN OF SLEEPY EYE, AND SINCE THE CHOICE OF PROVIDERS IS LIMITED IN THIS RURAL SETTING, SUCH CONTRACTS MAY BE NECESSARY. THE BOARD OF DIRECTORS WOULD DETERMINE IF A CONFLICT EXISTS AND MAKE REVIEW OF THE TERMS. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS ANNUALLY DETERMINES THE ADMINISTRATOR'S COMPENSATION BASED ON COMPENSATION OF OTHER NURSING HOME ADMINISTRATORS IN SOUTHWESTERN MINNESOTA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES THESE DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: NET INCOME ON AUXILIARY NOT INCLUDED IN FINANCIAL STATEMENTS -582. THE DAUGHTERS OF ST MARY PROVIDENCE 4200 NORTH AUSTIN AVENUE CHICAGO IL 60634 510219736 CHARITY IL 501(C)(3) LINE 1 N/A 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0