BETA

HOLLY RIDGE MANOR INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
HOLLY RIDGE MANOR INC (EIN 41-1649721)
Tax period
2013-10-01 to 2014-09-30
Filed
2015-08-05
IRS object ID
201512179349300906
Schema version
2013v4.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2015-08-05T11:59:26-05:00ReturnTs
Tax Period End2014-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1220 SOUTH SIXTH STREET SUITE 300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN411649721EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1HOLLY RIDGE MANOR INCBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlHOLLBusinessNameControlTxt
Phone3202394775PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 HOLLY RIDGE DRIVEAddressLine1
CitySTARBUCKCity
StateMNState
ZIP Code56381ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKAYO ASLAGSONPersonNm
Person TitleBOARD CHAIRPersonTitleTxt
Phone3202394775PhoneNum
Signature2015-07-29SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCORY RUTLEDGEPreparerPersonNm
PTINP01329381PTIN
Phone6123764500PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerCHRISTOPHER KNOLLPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 HOLLY RIDGE DRIVEAddressLine1
CitySTARBUCKCity
StateMNState
ZIP Code56381ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$424,800GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MCHS-HEALTHCARE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1989FormationYr
Legal Domicile StateMNLegalDomicileStateCd
Activity Or MissionA COMMUNITY OF SERVICES GROUNDED IN FAITH, PROVIDING PERSON CENTERED CARE.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers10TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$380PYContributionsGrantsAmt
CY Contributions Grants$1,296CYContributionsGrantsAmt
PY Program Service Revenue$347,309PYProgramServiceRevenueAmt
CY Program Service Revenue$382,264CYProgramServiceRevenueAmt
PY Investment Income$101PYInvestmentIncomeAmt
CY Investment Income$113CYInvestmentIncomeAmt
PY Other Revenue$38,220PYOtherRevenueAmt
CY Other Revenue$41,127CYOtherRevenueAmt
PY Total Revenue$386,010PYTotalRevenueAmt
CY Total Revenue$424,800CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$206,258PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$217,178CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$175,530PYOtherExpensesAmt
CY Other Expenses$190,381CYOtherExpensesAmt
PY Total Expenses$381,788PYTotalExpensesAmt
CY Total Expenses$407,559CYTotalExpensesAmt
PY Revenues Less Expenses$4,222PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$17,241CYRevenuesLessExpensesAmt
Total Assets BOY$501,841TotalAssetsBOYAmt
Total Assets EOY$523,524TotalAssetsEOYAmt
Total Liabilities BOY$39,686TotalLiabilitiesBOYAmt
Total Liabilities EOY$44,128TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$462,155NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$479,396NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionA COMMUNITY OF SERVICES, GROUNDED IN FAITH, PROVIDING PERSON CENTERED CARE THAT ENCOURAGES ALL PEOPLE TO REACH THEIR HIGHEST POTENTIAL.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$391,148ExpenseAmt
Grant$0GrantAmt
Revenue$382,264RevenueAmt
DescHOLLY RIDGE MANOR IS A 20-UNIT HOUSING FACILITY OFFERING BOTH ONE AND TWO BEDROOM APARTMENTS TO THE COMMUNITY MEMBERS IT SERVES. HOLLY RIDGE MANOR PROVIDES BOTH INDEPENDENT HOUSING AND ASSISTED LIVING HOUSING AND SERVICES FOR SENIORS AND THOSE NOT CAPABLE OF LIVING INDEPENDENTLY OF OTHERS IN A SAFE AND SECURE SETTING. HOLLY RIDGE MANOR OFFERS DAILY EXERCISE PROGRAMS AS WELL AS THE ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. HOLLY RIDGE MANOR ALSO OFFERS UP TO THREE MEALS DAILY, HOUSEKEEPING SERVICES AND SKILLED NURSING SERVICES SPECIFIC TO EACH CLIENTS NEEDS. HOLLY RIDGE MANOR IS GOVERNED BY A NINE PERSON INDEPENDENT BOARD MADE UP OF ONE AT-LARGE COMMUNITY LEADER AND EIGHT AREA CHURCH MEMBERS. THE BOARD HAS A HISTORY OF COMMITMENT TO ACTING WITH THE HIGHEST INTEGRITY AND HAS BEEN PROACTIVELY EVALUATING OPPORTUNITIES TO ENSURE THE ORGANIZATION CONTINUES TO OPERATE AT ITS MAXIMUM POTENTIAL FOR THE BENEFIT OF THE CLIENTS WE SERVE AND THE COMMUNITY.Desc
Total Program Service Expenses$391,148TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document2IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BRIAN ENGLERBusinessNameLine1
FieldValueIRS element (for citing)
Phone3202397121PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1605 MAIN STREETAddressLine1
CitySTARBUCKCity
StateMNState
ZIP Code56381ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
KAYO ASLAGSON
CHAIR0.501.50Yes (X)Yes (X)$0$0$0
LAURIS JOHNSHOY
VICE CHAIR0.501.50Yes (X)Yes (X)$0$0$0
JOHN SAMUELSON
SECRETARY0.501.50Yes (X)Yes (X)$0$0$0
ARNE STOEN
TREASURER0.501.50Yes (X)Yes (X)$0$0$0
LONNIE ANDERSON
DIRECTOR0.501.50Yes (X)$0$0$0
RONALD FEIGUM
DIRECTOR0.501.50Yes (X)$0$0$0
WARREN HAGESTUEN
DIRECTOR0.501.50Yes (X)$0$0$0
ROBERT HENDRICKSON
DIRECTOR0.501.50Yes (X)$0$0$0
ALICE REESE
DIRECTOR0.501.50Yes (X)$0$0$0
JIM BROICH
ADMINISTRATOR2.0038.00Yes (X)$0$0$0
MURRAY FINGER
ADMINISTRATOR1.5038.50Yes (X)$0$79,320$287
CHRISTOPHER KNOLL
ADMINISTRATOR2.0038.00Yes (X)$0$0$0
BRIAN ENGLER
DIRECTOR OF FINANCE4.0036.00Yes (X)$0$48,860$4,762
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$128,180TotReportableCompRltdOrgAmt
Total Other Compensation$5,049TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
All Other Contributions$1,296AllOtherContributionsAmt
Total Contributions$1,296TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescRESIDENT REVENUEDesc
Business623000BusinessCd
Total Revenue Column$382,264TotalRevenueColumnAmt
Related Or Exempt Func Income$382,264RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$382,264TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$113TotalRevenueColumnAmt
Exclusion$113ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$4,128RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$4,128RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,128TotalRevenueColumnAmt
Exclusion$4,128ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
MEALS REVENUE722210$35,843$35,843
BEAUTY SHOP812900$1,020$1,020
OTHER INCOME900099$136$136
FieldValueIRS element (for citing)
Other Revenue Total$36,999OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$424,800TotalRevenueColumnAmt
Related Or Exempt Func Income$382,264RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$41,240ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$192,018TotalAmt
Program Services$183,631ProgramServicesAmt
Management And General$8,387ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$10,505TotalAmt
Program Services$10,046ProgramServicesAmt
Management And General$459ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$14,655TotalAmt
Program Services$14,015ProgramServicesAmt
Management And General$640ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$3,459TotalAmt
Program Services$3,459ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$3,338TotalAmt
Program Services$3,338ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$6,735TotalAmt
Program Services$4,235ProgramServicesAmt
Management And General$2,500ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$4,152TotalAmt
Management And General$4,152ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$58,610TotalAmt
Program Services$58,610ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$1,649TotalAmt
Program Services$1,649ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$50,308TotalAmt
Program Services$50,308ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$10,854TotalAmt
Program Services$10,854ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
FOOD$41,946$41,946
RESIDENT SUPPLIES$4,976$4,976
MISCELLANEOUS$2,555$2,555
LICENSES AND TAXES$1,200$1,200

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$599TotalAmt
Program Services$326ProgramServicesAmt
Management And General$273ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$407,559TotalAmt
Program Services$391,148ProgramServicesAmt
Management And General$16,411ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$123,823BOYAmt
EOY$166,286EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$9,228BOYAmt
EOY$11,726EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,308,166LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$969,585LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$361,582BOYAmt
EOY$338,581EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$7,208BOYAmt
EOY$6,931EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$501,841BOYAmt
EOY$523,524EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,883BOYAmt
EOY$895EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$6,500BOYAmt
EOY$6,250EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$31,303BOYAmt
EOY$36,983EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$39,686BOYAmt
EOY$44,128EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$462,155BOYAmt
EOY$479,396EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$462,155BOYAmt
EOY$479,396EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$501,841BOYAmt
EOY$523,524EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$17,241ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type2Yes (X)SupportingOrgType2Ind
CertificationYes (X)CertificationInd
IRS Written DeterminationYes (X)IRSWrittenDeterminationInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MINNEWASKA LUTHERAN HOMEBusinessNameLine1
FieldValueIRS element (for citing)
EIN410845402EIN
Organization Type9OrganizationTypeDesc
Governing Document Listed0GoverningDocumentListedInd
Supported Org NotifiedYes (1)SupportedOrgNotifiedInd
US OrganizedYes (1)USOrganizedInd
Support$0SupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$24,500OtherCostOrOtherBasisAmt
Book Value$24,500BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,084,277OtherCostOrOtherBasisAmt
Depreciation$791,699DepreciationAmt
Book Value$292,578BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$199,389OtherCostOrOtherBasisAmt
Depreciation$177,886DepreciationAmt
Book Value$21,503BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$338,581TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescRELATED PARTY PAYABLESDesc
Amt$36,983Amt
FieldValueIRS element (for citing)
Total Liability$36,983TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:THE FACILITY HAS A SEPARATE BANK ACCOUNT TO HOLD THE FUNDS WHILE THE RESIDENT IS LIVING AT HOLLY RIDGE. WHEN THE RESIDENT VACATES THE APARTMENT HOLLY RIDGE REFUNDS THE SECURITY DEPOSIT PLUS INTEREST CALCULATED BASED ON STATE OF MINNESOTA RULES LESS ANY FORFEITURES FOR REPAIRS, IF ANY WITHIN 30 DAYS OF TURNING IN THE KEYS.
PART X, LINE 2:FROM NOTE 1 TO THE ORGANIZATION'S FINANCIAL STATEMENTS: THE HOME, MHD, HOLLY RIDGE, AND HOME CARE HAVE ALL BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND STATE CORPORATE INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) AND APPLICABLE STATE STATUTES. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE THE TAX-EXEMPT STATUS OF ANY OF ITS ENTITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE INCOME TAX RETURNS OF HOME, MHD, HOLLY RIDGE, AND HOME CARE FOR THE FISCAL YEARS 2011 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6THE MEMBERS OF HOLLY RIDGE MANOR CONSIST OF CERTAIN CONGREGATIONS LOCATED IN THE GENERAL COMMUNITY OF STARBUCK, MINNESOTA. EACH MEMBER CONGREGATION MAY APPOINT ONE INDIVIDUAL TO ACT AS A DELEGATE ON ITS BEHALF. THE PRESENT MEMBERS ARE: FRON LUTHERAN CHURCH - STARBUCK, MINNESOTA MINNEWASKA LUTHERAN CHURCH - STARBUCK, MINNESOTA ST. JOHN'S LUTHERAN CHURCH - STARBUCK, MINNESOTA IMMANUEL LUTHERAN CHURCH - STARBUCK, MINNESOTA INDHERRED LUTHERAN CHURCH - STARBUCK, MINNESOTA EAST ZION LUTHERAN CHURCH - STARBUCK, MINNESOTA WEST ZION LUTHERAN CHURCH - HANCOCK, MINNESOTA TRINITY LUTHERAN CHURCH - CYRUS, MINNESOTA
FORM 990, PART VI, SECTION A, LINE 7ADIRECTORS ARE ELECTED BY A MAJORITY VOTE OF THE MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7BAMENDMENTS TO THE ARTICLES OF INCORPORATION OR THE BYLAWS REQUIRE AN AFFIRMATIVE VOTE OF A MAJORITY OF THE MEMBERS.
FORM 990, PART VI, SECTION B, LINE 11THE MANAGEMENT TEAM WILL DISCUSS THE COMPLETED F0RM 990 AT THE JULY 29, 2015 BOARD MEETING BEFORE IT IS FILED.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL DIRECTORS, PRINCIPAL OFFICERS, AND MEMBERS OF COMMITTEE WITH BOARD-DELEGATED POWERS. ANY INDIVIDUAL WITH AN ACTUAL OR POTENTIAL CONFLICT IS REQUIRED TO DISCLOSE ALL MATERIAL FACTS TO THE BOARD OR COMMITTEE. AFTER DISCLOSURE OF THE MATERIAL FACTS, THE REMAINING BOARD OR COMMITTEE MEMBERS DETERMINE BY MAJORITY VOTE WHETHER A CONFLICT EXISTS. IF IT IS DETERMINED THAT A CONFLICT EXISTS, THE BOARD OR COMMITTEE SEEKS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION IS NOT REASONABLY POSSIBLE, THE BOARD OR COMMITTEE DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. THE INDIVIDUAL MAY NOT BE PRESENT FOR A DISCUSSION OF, OR VOTE ON, WHETHER TO ENTER THE TRANSACTION. THE RELEVANT FACTS ARE DOCUMENTED IN THE MINUTES OF THE MEETING. ADDITIONALLY, BOARD MEMBERS ARE REQUIRED TO ANNUALLY SIGN STATEMENTS DISCLOSING EXISTING CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
MINNEWASKA LUTHERAN HOME
605 MAIN STREETSTARBUCKMN56381410845402SKILLED NURSING FACILITYMN501(C)(3)9N/AYes (1)
MINNEWASKA HOME CARE
605 MAIN STREETSTARBUCKMN56381331124162HOME CAREMN501(C)(3)9N/AYes (1)
MINNEWASKA HOME DEVELOPMENT
605 MAIN STREETSTARBUCKMN56381411504339FUNDRAISINGMN501(C)(3)11 - TYPE 2N/AYes (1)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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