2015-04-02T16:21:55-05:00 2014-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-07-01 411704381 ST THERESE FOUNDATION INC STTH 7635315000 8000 BASS LAKE ROAD NEW HOPE MN 55428 MIKE WARDEN CHIEF FINANCIAL OFFICER 7635315000 2015-03-18 1 JEFF VRIEZE P01273590 6123764500 2013 2016-03-07 17:11:31Z BARB RODE 8000 BASS LAKE ROAD NEW HOPE MN 55428 17074907 0 X WWW.STTHERESEMN.ORG X 1991 MN PROVIDING FUNDRAISING, PLANNING, AND OTHER SUPPORT TO AFFILIATED ORGANIZATIONS. 19 19 0 42 0 0 2785369 2661609 3485199 6924201 335582 544051 17882 54597 6624032 10184458 64188 57388 0 0 3080261 4554420 0 0 52449 1705401 3390451 4849850 8002259 1774182 2182199 25118305 27199115 15497875 15191610 9620430 12007505 X PROVIDING FUNDRAISING, PLANNING, AND OTHER SUPPORT TO AFFILIATED ORGANIZATIONS. 1 0 268709 50783 0 SAINT THERESE IS A NONPROFIT FAITH-BASED ORGANIZATION THAT HAS FOCUSED ON THE WELL-BEING OF INDIVIDUALS SINCE IT OPENED IN 1968. WE PROVIDE SECURE, STRESS-FREE LIVING AND THE VERY BEST IN SENIOR CARE AND HOUSING WITH A COMMITMENT TO EACH INDIVIDUAL. SAINT THERESE OFFERS A TRUE CONTINUUM OF PROGRAMS AND SERVICES THAT ARE AVAILABLE IN YOUR OWN HOME OR IN ONE OF OUR COMMUNITY SETTINGS. SAINT THERESE SERVES THE TWIN CITIES METRO AREA WITH CAMPUSES LOCATED IN NEW HOPE, BROOKLYN PARK, SHOREVIEW, AND COMING SOON TO WOODBURY. TO LEARN MORE VISIT WWW.STTHERESEMN.ORG. 5526962 6605 5715850 SAINT THERESE AT OXBOW LAKEA MASTER-PLANNED COMMUNITY OFFERING HIGH QUALITY CARE AND SERVICES, THE SAINT THERESE AT OXBOW LAKE CAMPUS SERVES INDIVIDUALS AT EVERY STAGE IN THE AGING PROCESS. OLDER ADULTS WILL FIND THE DIGNIFIED CARE AND SUPPORT THEY DESERVE IN A WARM AND COMFORING ENVIRONMENT.LONG TERM CARE - 34 PRIVATE SUITESMEMORY CARE - 13 PRIVATE SUITESTRANSITIONAL CARE - 17 PRIVATE SUITESSAINT THERESE AT OXBOW LAKE BELONGS TO THE SAINT THERESE ORGANIZATIONS THAT ALSO INCLUDES:-SAINT THERESE OF NEW HOPE-SAINT THERESE AT ST. ODILIA-AT HOME SOLUTIONS BY SAINT THERESE-SAINT THERESE REHAB-SAINT THERESE FOUNDATION 973197 0 1208351 AT HOME SOLUTIONS BY SAINT THERESEAT HOME SOLUTIONS BY SAINT THERESE CAN GIVE CAREGIVERS AND THEIR LOVED ONES THE EXTRA SUPPORT THEY NEED IN THEIR OWN HOME - FROM SIMPLE ERRANDS AND MEDICATION REMINDERS TO SKILLED NURSING AND DEMENTIA CARE. AT HOME SOLUTIONS BY SAINT THERESE IS AVAILABLE FROM 2 TO 24 HOURS A DAY TO SERVE INDIVIDUALS AS THEY AGE IN PLACE.AT HOME SOLUTIONS BY SAINT THERESE BELONGS TO THE SAINT THERESE ORGANIZATION THAT ALSO INCLUDES:-SAINT THERESE AT OXBOW LAKE-SAINT THERESE AT ST. ODILIA-SAINT THERESE OF NEW HOPE-SAINT THERESE REHAB-SAINT THERESE FOUNDATION 6768868 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 7 0 0 0 0 0 0 0 1 1 0 0 0 0 X 19 19 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X STEVE BODE 9522832213 8000 BASS LAKE ROAD NEW HOPE MN 55428 KAYE FOLEY CHAIR 1.00 2.00 X X 0 0 0 PATRICK J BORAN VICE CHAIR 1.00 1.00 X X 0 0 0 JANE MCCROSSAN SECRETARY 1.00 1.00 X X 0 0 0 DAVID M HOFFMANN TREASURER 1.00 0.00 X X 0 0 0 JOSEPH AMBERGMD DIRECTOR 1.00 1.00 X 0 0 0 FR MICHAEL BYRON DIRECTOR 1.00 X 0 0 0 LYNN CHOROMANSKI PH D DIRECTOR 1.00 1.00 X 0 0 0 WM CHRISTOPHER DOWNEY MD DIRECTOR/FORMER VICE CHAIR 1.00 1.00 X X 0 0 0 RICHARD G FABER DIRECTOR 1.00 X 0 0 0 FR JOSEPH GILLESPIE DIRECTOR 1.00 1.00 X 0 0 0 DAVID KRENN DIRECTOR 1.00 X 0 0 0 CRAIG LEITER DIRECTOR 1.00 X 0 0 0 JENNIFER SHALTZ DIRECTOR 1.00 X 0 0 0 PATRICK L TAFFE DIRECTOR 1.00 1.00 X 0 0 0 RICHARD D THEILMANN DIRECTOR 1.00 X 0 0 0 C DWIGHT TOWNES MD DIRECTOR 1.00 1.00 X 0 0 0 MICHAEL VARPNESS DIRECTOR 1.00 X 0 0 0 PAUL VOGEL DIRECTOR 1.00 X 0 0 0 KATHRYN WORNSON DIRECTOR 1.00 1.00 X 0 0 0 SR KAREN SAMES DIRECTOR (THRU FEBRUARY 2014) 1.00 1.00 X 0 0 0 JERRY CHOROMANSKI DIRECTOR (THRU AUGUST 2013) 1.00 1.00 X 0 0 0 BARBARA RODE PRESIDENT & CEO 8.00 32.00 X 0 225609 12142 MIKE WARDEN CFO 10.00 30.00 X 0 162496 4471 JOHN LEBLANC FOUNDATION DIRECTOR 40.00 0.00 X 109226 0 14722 109226 388105 31335 1 0 1 0 0 119970 2242404 299235 2661609 RESIDENT REVENUE 623000 5715850 5715850 CAREGIVER/CNA SERVICES 623000 1208351 1208351 6924201 248189 248189 7145957 6850095 295862 295862 295862 40916 119970 40354 562 562 MEAL INCOME 722210 35875 35875 TELEPHONE 900099 10110 10110 MISCELLANEOUS 900099 8050 8050 54035 10184458 6924201 0 598648 57388 57388 3974948 3512220 462728 12340 10856 1484 281566 239331 42235 285566 242731 42835 202005 202005 13720 1196 12524 19000 19000 61033 60893 140 715590 659999 55591 256733 256733 156934 90336 17437 49161 7897 7897 402369 400291 2078 11526 5077 6449 3511 258 3253 575455 568366 7089 564022 552324 11698 61082 59147 1935 FOOD 171314 167337 690 3287 MEDICAL SUPPLIES 133194 133194 MISCELLANEOUS 12285 4079 8206 LICENSES 12019 12019 10762 3845 6916 1 8002259 6768868 1180942 52449 2874579 1575519 1048191 1050292 174867 646033 93584 108195 15566863 1001327 13644792 14565536 6005042 6850095 1069391 1798847 207859 604598 25118305 27199115 283451 296423 10041 53119 13197226 12892030 2410 1580 2004747 1948458 15497875 15191610 X 8802686 11024779 422834 585946 394910 396780 9620430 12007505 25118305 27199115 X 2182199 256325 -51449 X 0 1 X 1 0 X 364396 481946 3054690 2613112 2661609 9175753 364396 481946 3054690 2613112 2661609 9175753 363201 8812552 162341 142994 153144 167669 248189 874337 18025 54035 72060 10122150 11299779 0.87060 0.85670 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME FROM VARIOUS SOURCES - 2012 AMOUNT: $ 18,025. 2013 AMOUNT: $ 54,035. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1289797 146864 -1291 1435370 689800 599997 10052 10052 1289797 354147 335653 2889 2889 689800 324447 29700 22177 22177 354147 257180 67267 12448 12448 324447 0.73000 0.27000 0.00000 1 0 618214 618214 11731327 510371 11220956 71800 17877 53923 1890312 473079 1417233 1255210 1255210 14565536 DUE TO AFFILIATES 1610302 LEASE DEPOSITS 338156 1948458 X PART IV, LINE 2B: RESIDENT TRUST FUNDS ARE RESIDENT'S FUNDS HELD BY OXBOW LAKE CARE CENTER, LLC IN A SEGREGATED BANK ACCOUNT FOR THE USE BY RESIDENTS. PART V, LINE 4: ENDOWMENT FUNDS ARE USED TO FURTHER THE MISSION OF ST. THERESE HOME, INC. AND ST. THERESE AT OXBOW LAKE, INC., WHICH INCLUDES PROVIDING HOUSING, NURSING CARE AND PASTORAL CARE TO THE ELDERLY. 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 FEDERAL INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION IN THE U.S. FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME, EXCISE OR OTHER TAXES OR MAY JEOPARDIZE ITS TAX-EXEMPT STATUS. THE TAX RETURNS FOR THE YEARS 2011 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. ASSOCIATE DINNER 99130 84955 14175 10774 160 9155 GOLF EVENT 43171 35015 8156 4016 40 9583 1 18585 18585 645 75 5906 160886 119970 40916 15435 275 24644 40354 562 1 ST THERESE HOME INC 8000 BASS LAKE ROAD NEW HOPE MN 55428 410888641 501(C)(3) 48523 GENERAL OPERATING SUPPORT 1 0 PART I, LINE 2: ALL GRANTS ARE MADE TO RELATED ORGANIZATIONS THAT ARE UNDER COMMON MANAGEMENT WHO REGULARLY MONITOR THE ACTIVITIES, REVENUES AND EXPENDITURES OF THE RELATED ORGANIZATIONS. 0 0 0 0 0 0 0 0 0 BARBARA RODE PRESIDENT & CEO 0 206683 0 18926 0 0 0 11954 0 188 0 237751 0 0 MIKE WARDEN CFO 0 136527 0 25969 0 0 0 4096 0 375 0 166967 0 0 PART I, LINE 3 THE CEO'S COMPENSATION IS DETERMINED BY ST. THERESE HOME, INC., AN AFFILIATED ORGANIZATION. ST. THERESE HOME, INC. USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE CEO: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. COMPENSATION SURVEY OR STUDY 4. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE A CITY OF BROOKLYN PARK MINNESOTA 416008804 2011-07-19 10000000 FACILITY EXPANSION PROJECT 0 0 0 B CITY OF CHAMPLIN MINNESOTA 416007831 2011-07-19 3320000 FACILITY EXPANSION PROJECT 0 0 0 A 321646 10000000 532570 9467430 2012 0 0 1 1 B 106324 3320000 3320000 2012 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 A 1 B 1 FORM 990, PART III, LINE 2 ST. THERESE OF WOODBURY, LLC WAS CREATED IN AUGUST 2013 TO OWN AND OPERATE A FUTURE DEVELOPMENT CONSISTING OF A FULL CONTINUUM OF CARE SENIOR COMMUNITY. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS ENTIRELY COMPOSED OF THE GOVERNING BODY MEMBERS. THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE BUSINESS OF THIS CORPORATION IN THE INTERVAL BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, AND THE EXECUTIVE COMMITTEE SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 2 JERRY J. CHOROMANKSI AND LYNN CHOROMANSKI - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVIEWED AND APPROVED BY THE FINANCE COMMITTEE AND BOARD OF DIRECTORS PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL DIRECTORS, OFFICERS AND KEY MANAGEMENT EMPLOYEES ARE ANNUALLY REQUIRED TO DISCLOSE ANY CONFLICTS OF INTEREST. THE DISCLOSURES ARE REPORTED TO THE BOARD OF DIRECTORS. INDIVIDUALS HAVING MATERIAL CONFLICTS OF INTEREST ARE ASKED TO REFRAIN FROM VOTING ON ANY ACTION THAT MAY BE INFLUENCED BY THE CONFLICT. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE PROVIDED TO THE BOND TRUSTEE, WHO DISTRIBUTES THEM TO THE ELECTRONIC MUNICIPAL MARKET ACCESS SYSTEM. FORM 990, PART XI, LINE 9: P/R NET ASSETS RELEASED -64,415. P/R NET ASSETS ROUNDING VARIANCE PER AUDIT 3,705. T/R CHANGE IN PLEDGE BALANCE 9,261. OXBOW LAKE CARE CENTER LLC 8000 BASS LAKE ROAD NEW HOPE MN 55428 273308934 SKILLED NURSING FACILITY MN 5792401 15471580 ST THERESE FOUNDATION INC ST THERESE AT HOME SOLUTIONS LLC 8000 BASS LAKE ROAD NEW HOPE MN 55428 454049467 PRIVATE DUTY HOME SERVICES MN 1208351 659479 ST THERESE FOUNDATION INC ST THERESE AT WOODBURY LLC 8000 BASS LAKE ROAD NEW HOPE MN 55428 463330004 SENIOR CARE COMMUNITY MN 0 2363796 ST THERESE FOUNDATION INC ST THERESE HOME INC 8000 BASS LAKE ROAD NEW HOPE MN 55428 410888641 HOUSING & NURSING CARE FOR THE ELDERLY MN 501(C)(3) 9 ST THERESE FOUNDATION INC 1 ST THERESE AT OXBOW LAKE INC 8000 BASS LAKE ROAD NEW HOPE MN 55428 205835911 HOUSING & NURSING CARE FOR THE ELDERLY MN 501(C)(3) 7 ST THERESE FOUNDATION INC 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 0 ST THERESE HOME INC B 2242404 EQUITY TRANSFER