2015-01-30T11:17:00-06:00 2014-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-07-01 410876706 LUTHERAN CARE CENTER LUTH 3206329211 1200 1ST AVENUE NORTHEAST LITTLE FALLS MN 56345 HERMAN JOHANNES BOARD PRESIDENT 3206329211 2015-01-23 1 KURT BENNION P01469618 6123764500 2013 2016-03-07 17:11:31Z SCOT ALLEN 1200 1ST AVENUE NORTHEAST LITTLE FALLS MN 56345 7438576 0 X WWW.LUTHERANCARECENTER.COM X 1964 MN PROVISION OF LONG TERM CARE SERVICES TO THE ELDERLY. 7 7 123 75 0 0 185 0 4400106 2360062 122 172839 0 319647 4400413 2852548 0 0 0 0 2083235 1060452 0 0 0 2178448 1181518 4261683 2241970 138730 610578 4105609 2543859 5858997 3677303 -1753388 -1133444 X TO PROVIDE QUALITY CARE AND SERVICES TO OUR RESIDENTS EMPHASIZING THE WHOLE PERSON: MEDICALLY, SPIRITUALLY AND SOCIALLY. 0 1 2107748 0 2360062 LUTHERAN CARE CENTER, INC., OPERATES A 55-BED NURSING FACILITY AND A 42-BED CONGREGATE HOUSING AND ASSISTED LIVING FACILITY FOR THE ELDERLY OF THE LITTLE FALLS, MINNESOTA AREA. THE ORGANIZATION ALSO PROVIDES SERVICES DESIGNATED TO MEET THE PHYSICAL, SOCIAL, AND PSYCHOLOGICAL NEEDS OF THE RESIDENTS.LUTHERAN CARE CENTER AND BRIDGEWAY ESTATES WERE SOLD TO ST. FRANCIS HEALTH SERVICES OF MORRIS, INC. ON 12/31/13. OPERATIONS CEASED AS OF THIS DATE, HOWEVER THE COMPANY WAS NOT DISSOLVED UNTIL 10/15/14. 2107748 1 0 0 0 0 0 0 0 1 0 1 0 0 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 0 1 1 0 0 0 0 1 25 0 123 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X SCOT ALLEN 3206329211 1200 1ST AVENUE NORTHEAST LITTLE FALLS MN 56345 HERMAN JOHANNES BOARD CHAIR 1.00 X X 0 0 0 GENE BLIESE BOARD VICE CHAIR 0.50 X X 0 0 0 CAROLYN ILGEN BOARD SECRETARY 0.50 X X 0 0 0 ELAINE ASMUS DIRECTOR 0.50 X 0 0 0 TERRI HOLMGREN DIRECTOR 0.50 X 0 0 0 ROBERT HOLZ DIRECTOR 0.50 X 0 0 0 HARRY MILLER DIRECTOR 0.50 X 0 0 0 SCOT ALLEN ADMINISTRATOR 40.00 X 79057 0 0 79057 0 0 0 0 0 0 REHABCARE GROUP PO BOX 503534 ST LOUIS MO 63150 THERAPY SERVICES 256815 1 PATIENT REVENUES 623000 2311787 2311787 OTHER INCOME 623000 48275 48275 2360062 32 32 4758835 4586028 172807 172807 172807 DEBT FORGIVENESS 900099 319647 319647 319647 2852548 2360062 0 492486 46613 46613 923522 920699 2823 23540 23469 71 66777 66577 200 9493 9493 28356 28356 12 12 222864 184845 38019 6302 6302 9752 9752 97055 94923 2132 4524 3200 1324 3254 165 3089 180368 172720 7648 88715 84953 3762 160799 159522 1277 FOOD 147008 147008 PROGRAM SUPPLIES 82921 82391 530 LICENSES & SURCHARGES 80244 77412 2832 SUPPLIES AND MINOR EQUI 40991 40432 559 18860 2819 16041 2241970 2107748 134222 0 43733 84867 469745 25145 37195 125311 2849097 914634 3078309 1934463 128030 0 348597 374073 4105609 2543859 878761 616641 3034363 3035071 22916 25591 1911444 0 11513 0 5858997 3677303 X -1753388 -1133444 -1753388 -1133444 4105609 2543859 610578 9366 0 X 0 0 0 X 1451 53 11047 185 12736 4881867 4838445 4518867 4400106 2360062 20999347 4883318 4838498 4529914 4400291 2360062 21012083 0 121639 467055 643869 137598 1370161 121639 467055 643869 137598 1370161 19641922 261 244 85 122 32 744 261 244 85 122 32 744 319647 319647 4883579 4838742 4529999 4400413 2679741 21332474 0.92080 0.93490 0.00000 0.00010 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: DEBT FORGIVENESS 0 1 X 33985 33985 2736277 889020 1847257 78835 25614 53221 1934463 RESIDENT TRUST FUNDS 25591 REPAIR & REPLACEMENT FUND 51363 BOND FUND 158290 RESERVE FUND 138829 374073 PART IV, LINE 2B: THE ORGANIZATION ACTS AS A CUSTODIAN FOR THE FUNDS OF THE CARE CENTER'S RESIDENTS AND HOLDS SECURITY DEPOSITS OF BRIDGEWAY TENANTS. LAND, BUILDING & EQUIPMENT 2013-12-31 4600000 SALES PRICE 411484416 ST FRANCIS HEALTH SERVICES OF MORRIS INC 801 NEVADA AVENUE MORRIS MN 56267 501(C)(3) ACCOUNTS RECEIVABLE 2013-12-31 158835 NET REALIZABLE VALUE 411484416 ST FRANCIS HEALTH SERVICES OF MORRIS INC 801 NEVADA AVENUE MORRIS MN 56267 501(C)(3) 0 1 0 0 PART II, LINE 2E: PERSON(S) INVOLVED: SCOT ALLEN PART II, LINE 2E: EXPLANATION OF INVOLVEMENT: SCOTT ALLEN WAS THE ADMINISTRATOR FOR LUTHERAN CARE CENTER THROUGH 12/31/13 AND BEGAN EMPLOYMENT WITH ST. FRANCIS HEALTH SERVICES ON 1/1/14. FORM 990, PART III, LINE 3 LUTHERAN CARE CENTER AND BRIDGEWAY ESTATES WERE SOLD TO ST. FRANCIS HEALTH SERVICES OF MORRIS, INC. ON 12/31/13. OPERATIONS CEASED AS OF THIS DATE, HOWEVER THE COMPANY WAS NOT DISSOLVED UNTIL 10/15/14. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE CHAIR, THE VICE CHAIR AND THE SECRETARY. THE EXECUTIVE COMMITTEE IS RESPONSIBLE FOR THE EVALUATION OF THE PERFORMANCE OF THE BOARD OF DIRECTORS AND MANAGEMENT. IT FUNCTIONS AS THE BOARD BETWEEN MEETING OF THE BOARD FOR MATTERS NOT PREVIOUSLY RESERVED TO THE FULL BOARD OR DELEGATED TO ANOTHER COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVIEWED AND APPROVED BY THE BOARD PRESIDENT AND THE ON-SITE ADMINISTRATOR; A COPY OF THE 990 WAS THEN PROVIDED TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C LUTHERAN CARE CENTER'S CONFLICT OF INTEREST POLICY COVERS THE COMPANY BOARD OF DIRECTORS, COMMITTEE MEMBERS AND FAMILY MEMBERS. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, ANY DIRECTOR MUST IMMEDIATELY DISCLOSE IN WRITING TO THE CHAIRPERSON OF THE COMPANY BOARD OF DIRECTORS AND TO THE MEMBERS OF THE COMMITTEE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST. AFTER DISCLOSURE OF ALL MATERIAL FACTS AND AFTER ANY DISCUSSION WITH THE DIRECTOR, THE REMAINING DIRECTORS DISCUSS, AND DETERMINE BY A MAJORITY VOTE, WHETHER A CONFLICT OF INTEREST EXISTS. FORM 990, PART VI, SECTION C, LINE 19 LUTHERAN CARE CENTER'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. ITS CONFLICT OF INTEREST POLICY IS NOT OPEN TO THE PUBLIC. BRIDGEWAY ESTATES LLC 1200 1ST AVENUE NE LITTLE FALLS MN 56345 275375167 ASSISTED LIVING & CONGREGATE HOUSING MN 428326 2146682 LUTHERAN CARE CENTER