2015-05-15T14:27:37-05:00 2014-09-30 410746749 CLIFTONLARSONALLEN LLP PO BOX 217 AUSTIN MN 55912 990 2013-10-01 410859697 ST MARK'S LUTHERAN HOME STMA 5074374594 400 15TH AVENUE SW AUSTIN MN 55912 BRAD JOHNSON BOARD PRESIDENT 5074374594 2015-05-07 1 TRENT FAST P00692704 5074347000 2013 2016-04-25 22:37:26Z CAMILLE RASMUSSEN 400 15TH AVENUE SW AUSTIN MN 55912 7330867 0 9386 X WWW.STMARKSAUSTINMN.ORG X 1963 MN ST. MARK'S IS DEDICATED TO PROVIDE A CONTINUUM OF SERVICES IN THE SPIRIT OF GOD'S LOVE. THESE SERVICES ARE DESIGNED TO PROMOTE PHYSICAL, EMOTIONAL, MENTAL, SOCIAL, AND SPIRITUAL HEALTH. 9 9 188 7 0 0 49076 26687 5660767 7217324 -3022 371 82516 86485 5789337 7330867 0 0 0 0 3555862 3880807 0 0 0 3380705 4501662 6936567 8382469 -1147230 -1051602 15423202 14562202 15443054 15788291 -19852 -1226089 ST. MARK'S IS DEDICATED TO PROVIDE A CONTINUUM OF SERVICES IN THE SPIRIT OF GOD'S LOVE. THESE SERVICES ARE DESIGNED TO PROMOTE PHYSICAL, EMOTIONAL, MENTAL, SOCIAL, AND SPIRITUAL HEALTH. 0 0 7619325 7217324 PROVISION OF HOUSING AND NURSING CARE TO THE ELDERLY BY OPERATING A 61-BED LICENSED NURSING FACILITY AND AN INDEPENDENT HOUSING PROJECT. 7619325 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 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 0 0 0 1 1 1 0 0 1 17 0 188 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 MN X ECUMEN SERVICES INC 6517664300 3530 LEXINGTON AVENUE N SHOREVIEW MN 551268164 BRAD JOHNSON PRESIDENT 1.00 X X 0 0 0 DANA MILLER SECRETARY 1.00 X X 0 0 0 MIKE GOSHA VICE PRESIDENT 1.00 X X 0 0 0 REV JEFF FORBES DIRECTOR 1.00 X 0 0 0 CATHIE SAYLES TREASURER 1.00 X X 0 0 0 PHIL GARDNER DIRECTOR 1.00 X 0 0 0 JOAN SKOV DIRECTOR 1.00 X 0 0 0 CHARLES MILLS DIRECTOR 1.00 X 0 0 0 STEVEN KIME DIRECTOR 1.00 X 0 0 0 LINDSAY STOLEN DIRECTOR 1.00 X 0 0 0 BRUCE HENDRICKS DIRECTOR 1.00 X 0 0 0 CHRIS SCHULZ ADMINISTRATOR 40.00 X 85253 0 10382 85253 0 10382 0 0 0 1 REHABCARE GROUP INC 7733 FORSYTH BLVD SUITE 1700 ST LOUIS MO 63105 THERAPY SERVICES 299289 ECUMEN SERVICES INC 3530 LEXINGTON AVENUE NORTH SHOREVIEW MN 55126 ADMINISTRATOR & OTHER CONSULTING 240000 STERLING DRUG 1601 STATE AVE NW OWATONNA MN 55060 PHARMACY SERVICES 199125 REINHARTS PO BOX 2858 LA CROSSE WI 54602 FOOD SERVICES 143318 MCKESSON PO BOX 630693 CINCINNATI OH 54263 SUPPLY SERVICES 111156 6 26687 26687 RESIDENT REVENUE 623000 5663149 5663149 SMA REVENUES 623000 1549819 1549819 LAUNDRY REVENUE 623000 4356 4356 7217324 371 371 MISCELLANEOUS INCOME 900099 57211 57211 BEAUTY SHOP INCOME 812900 17601 17601 EMPLOYEE/GUEST MEALS 900099 8818 8818 2855 2855 86485 7330867 7217324 0 86856 3223547 3090336 133211 141613 138868 2745 248311 242638 5673 267336 261364 5972 305703 305703 6428 6428 19713 19713 508986 497680 11306 18835 18835 52814 52814 351839 328276 23563 9163 641 8522 529 529 906058 906058 685859 685859 84022 7292 76730 CONTRACT MEALS 314703 314703 FOOD COST 227811 227811 PHARMACY 223445 223445 PATIENT CARE SUPPLIES 193411 193411 592343 500943 91400 8382469 7619325 763144 0 312391 132101 152005 38253 729672 925687 13221 16324 94008 95993 21927054 10207102 12278637 11719952 1317062 1105979 526206 527913 15423202 14562202 1225746 1365387 30449 17036 13900000 13796436 286859 609432 15443054 15788291 X -19852 -1226089 -19852 -1226089 15423202 14562202 X -1051602 -154635 X X 0 1 X 1 0 X 13340 383361 10990 41457 26687 475835 8112944 6077821 5172261 5660767 7214137 32237930 8126284 6461182 5183251 5702224 7240824 32713765 400000 17400 7619 425019 217204 217204 217204 400000 17400 7619 642223 32071542 5654 28538 10154 8379 371 53096 5654 28538 10154 8379 371 53096 209237 62247 82516 86485 440485 8131938 6698957 5255652 5793119 7327680 33207346 0.96580 0.97020 0.00160 0.00160 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 77063 77063 17965542 7037475 10928067 3884449 3169627 714822 11719952 BOND RESERVE ACCOUNTS 1105979 C 1105979 RESIDENT TRUST FUNDS 21739 TENANT SECURITY DEPOSITS 25184 NET PENSION LIABILITY - UNION 355741 ASSET RETIREMENT OBLIGATION 62614 DUE TO RELATED PARTY 144154 609432 X PART X, LINE 2: ST. MARK'S LUTHERAN HOME AND ITS AFFILIATE HAVE BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND STATE CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. ST. MARK'S LUTHERAN HOME AND AFFILIATE FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. NO LIABILITY HAS BEEN RECOGNIZED AS A RESULT OF THIS STANDARD. EACH ENTITY FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE IRS. THE 2011, 2012, AND 2013 TAX YEARS ARE OPEN FOR EXAMINATION BY THE IRS. 0 0 0 0 0 0 0 0 0 FORM 990, PART VII, LINE 5 ST. MARK'S LUTHERAN HOME DOES NOT PAY IT'S ADMINISTRATOR DIRECTLY, RATHER THE HOME IS PAYING THE ADMINISTRATOR THROUGH AN INDEPENDENT CONTRACTOR ARRANGEMENT WITH A MANAGEMENT COMPANY NAMED ECUMEN SERVICES, INC. THE HOME IS CONTRACTED TO PAY ECUMEN SERVICES, INC. FOR THE ADMINISTRATOR POSITION AND OTHER MANAGEMENT CONSULTING SERVICES. THE COMPENSATION INFORMATION ON FORM 990 IS THE AMOUNT OF COMPENSATION THAT ECUMEN PAID THE ADMINISTRATOR AND AS A RESULT THE COMPENSATION INFORMATION PROVIDED IS NOT THE AMOUNT THE HOME PAID TO ECUMEN UNDER THE MANAGEMENT CONTRACT ARRANGEMENT. PER THE IRS INSTRUCTIONS THE COMPENSATION INFORMATION IS FOR THE CALENDAR YEAR 2012. ECUMEN PREPARES A STUDY OF COMPARABLE SENIOR CARE FACILITIES OF SIMILAR SIZE TO DETERMINE THE COMPENSATION APPLICABLE FOR PROVIDING THE ADMINISTRATOR POSITION TO THE HOME. A HOUSING AND REDEVELOPMENT AUTHORITY AUSTIN MN 410983566 05225MBC2 2011-12-22 13332049 SEE PART VI 0 0 0 B HOUSING AND REDEVELOPMENT AUTHORITY AUSTIN MN 410983566 05225MBD0 2011-12-22 60000 SEE PART VI 0 0 0 A 5000 13332049 1021475 1271185 266800 9567015 1205574 1 0 1 1 B 60000 60000 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 SCHEDULE K, PART I, LINE A & B CONSTRUCT NEW FACILITY, RENOVATE EXISTING FACILITIES, REFINANCE EXISTING DEBT INCLUDING SERIES 2003 BONDS. (B DID NOT REFINANCE EXISTING DEBT) SCHEDULE K, PART V THE ORGANIZATION IS CONSIDERING ADOPTING THESE WRITTEN PROCEDURES. FORM 990, PART VI, SECTION A, LINE 3 ST. MARK'S LUTHERAN HOME DOES NOT PAY IT'S ADMINISTRATOR DIRECTLY, RATHER THE HOME IS PAYING THE ADMINISTRATOR THROUGH AN INDEPENDENT CONTRACTOR ARRANGEMENT WITH A MANAGEMENT COMPANY NAMED ECUMEN SERVICES, INC. THE HOME IS CONTRACTED TO PAY ECUMEN SERVICES, INC. FOR THE ADMINISTRATOR POSITION AND OTHER MANAGEMENT CONSULTING SERVICES. THE COMPENSATION INFORMATION ON FORM 990 IS THE AMOUNT OF COMPENSATION THAT ECUMEN PAID THE ADMINISTRATOR AND AS A RESULT THE COMPENSATION INFORMATION PROVIDED IS NOT THE AMOUNT THE HOME PAID TO ECUMEN UNDER THE MANAGEMENT CONTRACT ARRANGEMENT. PER THE IRS INSTRUCTIONS THE COMPENSATION INFORMATION IS FOR THE CALENDAR YEAR 2013. ECUMEN PREPARES A STUDY OF COMPARABLE SENIOR CARE FACILITIES OF SIMILAR SIZE TO DETERMINE THE COMPENSATION APPLICABLE FOR PROVIDING THE ADMINISTRATOR POSITION TO THE HOME. FORM 990, PART VI, SECTION B, LINE 11 A MOTION WAS PASSED BY THE BOARD OF DIRECTORS TO HAVE THE BOARD PRESIDENT REVIEW AND APPROVE THE FORM 990 BEFORE IT IS SIGNED AND SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND KEY EMPLOYEES ANNUALLY COMPLETE A SURVEY RELATED TO BUSINESS RELATIONSHIPS AND FAMILY MEMBERS THAT COULD, OR DO, CREATE A CONFLICT OF INTEREST. THESE ARE SUMMARIZED AND FILED ALONG WITH THE BOARD MEETING MINUTES. CONFLICTS OF INTEREST ARE DETERMINED BY A REVIEW OF THE POTENTIAL CONFLICTS BY THE ADMINISTRATOR AND THE BOARD OF DIRECTORS. IF A CONFLICT EXISTS, THEN THE CONFLICTED BOARD MEMBER OR KEY EMPLOYEE IS EXCLUDED FROM DISCUSSION AND VOTES RELATED TO ANY POTENTIAL OR EXISTING RELATIONSHIPS INVOLVING THE CONFLICT OF INTEREST. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST WAS INTENTIONALLY HIDDEN BY A BOARD MEMBER, THEN THE SITUATION WOULD BE INVESTIGATED AND THE BOARD MEMBER COULD BE SUSPENDED AND SUBJECT TO DISMISSAL. ADDITIONALLY, THE REMAINING BOARD MEMBERS AND KEY EMPLOYEES WILL REVIEW, FOR FAIRNESS, ALL TRANSACTIONS BACK TO THE TIME THE CONFLICT BECAME RELEVANT. IF A TRANSACTION APPEARS TO LACK ARMS-LENGTH, EITHER TO THE DETRIMENT OF THE ORGANIZATION, OR TO THE UNFAIR ADVANTAGE OF THE BOARD MEMBER, THEN ALL LEGAL REMEDIES WILL BE CONSIDERED. FORM 990, PART VI, SECTION B, LINE 15A ECUMEN SERVICES, INC. PREPARES A STUDY OF COMPARABLE SENIOR CARE FACILITIES OF SIMILAR SIZE TO DETERMINE THE COMPENSATION APPLICABLE FOR PROVIDING THE ADMINISTRATOR POSITION TO THE HOME. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE IN THE ADMINISTRATIVE OFFICE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN DEFINED BENEFIT PENSION PLAN -154,635. FORM 990, PART XII, LINE 2C THE ORGANIZATIONS BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS CONSOLIDATED FINANCIAL STATEMENTS AND THE SELECTION OF ITS INDEPENDENT ACCOUNTANT. ST MARK'S FOUNDATION INC 400 15TH AVENUE SW AUSTIN MN 55912 411374304 PROVISION OF BENEFITS AND SUPPORT TO ST. MARK'S LUTHERAN HOME MN 501(C)(3) 11A - TYPE I ST MARK'S LUTHERAN HOME 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ST MARK'S FOUNDATION E 189758 ACTUAL AMOUNT