2015-07-28T12:28:32-05:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2014-01-01 800276405 ASSUMPTION COMMUNITY SERVICES INC ASSU 3206853693 715 1ST STREET NORTH COLD SPRING MN 56320 LINDSEY SAND ADMINISTRATOR 3206853693 2015-07-22 1 EMILY SCHEEVEL P01814921 6123764500 2014 2016-02-25 16:41:14Z LINDSEY SAND 715 1ST STREET NORTH COLD SPRING MN 56320 341864 0 X WWW.ASSUMPTIONHOME.COM X 2008 MN PROVIDE A CONTINUUM OF HEALTH AND RESIDENTIAL SERVICES IN A CHRISTIAN ENVIRONMENT. 11 11 0 93 0 0 477734 146448 194618 195367 48 49 -759 0 671641 341864 4690 7484 0 0 225581 243747 0 0 0 100989 111367 331260 362598 340381 -20734 174781 173355 155468 174776 19313 -1421 OUR DEFINING GOAL IS TO PROMOTE QUALITY OF LIFE BY SERVING OLDER ADULTS WITH RESPECTFUL RECOGNITION OF EACH PERSON'S PRIVACY, DIGNITY, AND WORTH; AND TO PROVIDE A CHRISTIAN ENVIRONMENT FOR ALL, REGARDLESS OF RACE, CREED, OR COLOR. 0 0 265209 7484 195367 COMMUNITY HEALTH SERVICES PROVIDES CLASS A HOME CARE, TRANSPORTATION, HOMEMAKING CHORE SERVICE, HOME MODIFICATIONS, AND OTHER HEALTH RELATED PROGRAMS. 265209 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 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 1 0 0 0 1 3 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X BRENDA WELLER 3206853693 715 1ST STREET NORTH COLD SPRING MN 56320 REV MATTHEW LUFT SECOND VICE PRESIDENT/CEO 1.00 2.00 X X 0 0 0 LARRY SELL SECRETARY 1.00 2.00 X X 0 0 0 CHAD MIDDENDORF TREASURER 1.00 2.00 X X 0 0 0 SISTER MIRIAM ARDOLF DIRECTOR 1.00 2.00 X 0 0 0 VIVIAN BACKES DIRECTOR 1.00 2.00 X 0 0 0 ROXANNE DORWEILER DIRECTOR 1.00 2.00 X 0 0 0 ADAH EBELING DIRECTOR 1.00 2.00 X 0 0 0 DON EIKMEIER DIRECTOR 1.00 2.00 X 0 0 0 RICHARD KRUEGER DIRECTOR 1.00 2.00 X 0 0 0 ROD PAUSER DIRECTOR 1.00 2.00 X 0 0 0 DOROTHY PFLIPSEN DIRECTOR 1.00 2.00 X 0 0 0 SISTER JUDY SCHAFFER DIRECTOR 1.00 2.00 X 0 0 0 SHARON WENNER DIRECTOR 1.00 2.00 X 0 0 0 MIKE ROTH DIRECTOR 1.00 2.00 X 0 0 0 GREG FLINT DIRECTOR 1.00 2.00 X 0 0 0 JAN LUTHENS ADMINISTRATOR 5.00 35.00 X 0 93462 11192 0 93462 11192 0 0 0 0 0 80000 66448 146448 SKILLED NURSING REVENU 623000 181319 181319 MEALS ON WHEELS 624210 14048 14048 195367 49 49 341864 195367 0 49 7484 7484 205871 136475 69396 19663 12018 7645 18213 9746 8467 3475 3475 20897 20897 5906 5221 685 3087 1379 1708 15125 15125 16957 16957 5780 856 4924 FOOD COSTS 21981 21981 TRAINING 10324 10324 SUPPLIES 4023 3647 376 MEMBERSHIP/ASSOCIATION 2038 2038 1774 1061 713 362598 265209 97389 0 56872 18910 28054 17086 337 211 89518 137148 174781 173355 120518 162552 34950 12224 155468 174776 X 19313 -1421 19313 -1421 174781 173355 -20734 0 X 0 0 0 X 57098 55737 63345 477734 146448 800362 48384 140639 180915 194618 195367 759923 105482 196376 244260 672352 341815 1560285 0 0 0 1560285 59 145 105 48 49 406 59 145 105 48 49 406 960 1411 782 3153 105541 197481 245776 673182 341864 1563844 0.99770 0.99720 0.00030 0.00030 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: GAMBLING INCOME - 2012 AMOUNT: $ 1,411. 2013 AMOUNT: $ 782. NAIL CLINIC INCOME - 2011 AMOUNT: $ 960. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 DUE FROM AFFILIATE 137148 137148 DUE TO AFFILIATES 12224 12224 1 TRI-COUNTY ACTION PROGRAM INC 1210 23RD AVENUE SOUTH PO BOX 683 WAITE PARK MN 56387 416049739 501(C)(3) 7484 GRANT 1 0 PART I, LINE 2: THE ORGANIZATION MAINTAINS RECORDS TO SUBSTANTIATE THE AMOUNT OF GRANTS OR ASSISTANCE, THE GRANTEES' ELIGIBILITY FOR THE GRANTS OR ASSITANCE, AND THE SELECTION CRITERIA USED TO AWARD THE GRANTS OR ASSISTANCE. FORM 990, PART VI, SECTION A, LINE 1 DIFFERENCES IN VOTING RIGHTS: THREE DIRECTORS - THE PASTOR AND TWO TRUSTEES OF ST. BONIFACE CATHOLIC CHURCH, COLD SPRING, MN - ALSO SERVE AS MEMBERS OF THE ORGANIZATION. AS MEMBERS, THESE THREE INDIVIDUALS HAVE THE POWER TO PROPOSE AND VOTE ON THE APPOINTMENT OF THE OTHER EIGHT DIRECTORS. ADDITIONALLY, THESE SAME THREE DIRECTORS/MEMBERS HAVE THE POWER TO DISCHARGE ANY DIRECTOR THROUGH A MAJORITY VOTE OF THE FIVE MEMBERS. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE CORPORATION SHALL BE AS FOLLOWS: 1. THE BISHOP OF THE DIOCESE OF SAINT CLOUD, OR THE PERSON WHO, IN HIS STEAD, EXERCISES ORDINARY JURISDICTION OVER THE SPIRITUAL AND TEMPORAL AFFAIRS OF THE DIOCESE OF SAINT CLOUD, IN ACCORDANCE WITH THE LEGISLATION OF THE ROMAN CATHOLIC CHURCH; 2. THE VICAR GENERAL OF THE DIOCESE OF SAINT CLOUD, WHO HAS BEEN APPOINTED TO BE A MEMBER EX-OFFICIO OF THE CORPORATION OF THE DIOCESE OF SAINT CLOUD. IN THE EVENT OF THE A VACANCY IN THE OFFICE OF THE BISHOP, IN THOSE CASES IN WHICH THE VICAR GENERAL'S OFFICE CEASES, THEN AND IN SUCH EVENT THE PERSON WHO WAS THE VICAR GENERAL, CONTINUE TO BE A MEMBER EX-OFFICIO OF THIS CORPORATION WITH ALL THE RIGHTS AND POWERS INCIDENT THERETO, BUT HIS MEMBERSHIP SHALL CEASE AT ONCE WHEN THE OFFICE OF VICAR GENERAL HAS BEEN FILLED; 3. THE PASTOR OF THE CHURCH OF SAINT BONIFACE, COLD SPRING, MINNESOTA; 4. TWO (2) TRUSTEES WHO ARE MEMBERS OF THE CHURCH OF SAINT BONIFACE, COLD SPRING, MINNESOTA, WHICH HAVE BEEN ELECTED BY THE MEMBERSHIP OF THE CORPORATION. THERE SHALL ONLY BE ONE CLASS OF MEMBERS OF THE CORPORATION AND EACH MEMBER SHALL BE ENTITLED TO ONE VOTE ON ALL ACTIONS THAT COME BEFORE THE MEMBERSHIP OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE CORPORATION SHALL BE RESPONSIBLE FOR THE BUSINESS AND AFFAIRS OF THE CORPORATION. THEY DELEGATE GOVERNANCE TO A BOARD OF DIRECTORS AND DAY-TO-DAY OPERATIONS TO THE ADMINISTRATION OF THE FACILITY. THE NUMBER OF DIRECTORS SHALL BE AT LEAST ELEVEN (11) IN NUMBER AND SHALL CONSIST OF THE FOLLOWING INDIVIDUALS: 1. THE PASTOR OF THE CHURCH OF SAINT BONIFACE, COLD SPRING, MINNESOTA, 2. TWO (2) TRUSTEES WHO ARE MEMBERS OF THE CHURCH OF SAINT BONIFACE, COLD SPRING, MINNESOTA, WHICH HAVE BEEN ELECTED BY THE MEMBERSHIP OF THE CORPORATION; AND, 3. AT LEAST EIGHT (8) OTHER ADULT PERSONS. IN ADDITION TO THESE ABOVE NAMED INDIVIDUALS WHO SHALL NUMBER AT LEAST ELEVEN (11), THE ADMINISTRATOR OF ASSUMPTION HOME SHALL SERVE AS AN EX-OFFICIO MEMBER OF THE BOARD OF DIRECTORS WITHOUT VOTE. THE BOARD OF DIRECTORS SHALL BE ELECTED BY THE MEMBERS OF THE CORPORATION AND SHALL SERVE IN THAT CAPACITY AT THE PLEASURE OF THE MEMBERS IN THE MANNER AND FOR THE TERM SPECIFIED IN THE BY-LAWS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENT OF THE ARTICLES OF INCORPORATION AND TO THE BYLAWS SHALL BY THE MAJORITY VOTE OF ALL THE MEMBERS OF THE CORPORATION AFTER A MAJORITY VOTE OF THE ENTIRE MEMBERSHIP OF THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS SHALL, PRIOR TO THE ANNUAL MEETING OF THE CORPORATION'S MEMBERSHIP, PROVIDE TO EACH OF THE CORPORATION'S MEMBERS NOTICE OF EACH BYLAW AMENDMENT ADOPTED BY THE BOARD OF DIRECTORS SINCE THE PREVIOUS ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 11 THE 990 WAS PREPARED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM AND WAS REVIEWED BY BOTH THE ADMINISTRATOR AND THE DIRECTOR OF FINANCE. AFTER THEIR REVIEW, THE 990 WAS PROVIDED TO THE BOARD OF DIRECTORS, WHO REVIEWED AND APPROVED IT, PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL OFFICERS AND MEMBERS OF THE BOARD OF DIRECTORS. THE ADMINISTRATOR ANNUALLY REVIEWS THE BOARD MEMBERS' ASSOCIATIONS FOR CONFLICTS OF INTEREST. THE BOARD OF DIRECTORS ANNUALLY REVIEWS THE ADMINISTRATOR'S ASSOCIATIONS FOR CONFLICTS OF INTEREST. IF A CONFLICT ARISES, DEPENDING ON THE CIRCUMSTANCES, THE CONFLICTED INDIVIDUAL ABSTAINS FROM VOTING, STEPS DOWN FROM THE BOARD OR TERMINATES THEIR ASSOCIATION WITH THE OTHER PARTY. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. ASSUMPTION HOME INC 715 NORTH 1ST STREET COLD SPRING MN 56320 410873335 NURSING HOME MN 501(C)(3) 9 N/A 0 PIONEER HOUSING DEVELOPMENT INC 200 8TH AVENUE NORTH COLD SPRING MN 56320 411367392 HOUSING MN 501(C)(3) 9 N/A 0 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 1 1 0 0