2015-02-10T08:27:35-06:00 2014-09-30 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2013-10-01 237296950 ANNANDALE CARE CENTER ANNA 3202743737 500 PARK STREET EAST ANNANDALE MN 55302 Debra Reitmeier Administrator/President 3202743737 2015-02-09 1 Lisa Chaffee CPA P00193453 7012398500 2015-02-09 2013 2016-02-25 16:41:14Z Debra Reitmeier 500 PARK STREET EAST ANNANDALE MN 55302 7610150 0 X WWW.AHCSMN.ORG X 1973 MN Skilled nursing services and assisted living services 7 7 218 62 0 0 1500 9505 7345286 7446654 87724 146887 0 0 7434510 7603046 20944 19984 0 0 3761067 3991264 0 0 0 3182239 3273383 6964250 7284631 470260 318415 12833418 13083443 9344049 9269692 3489369 3813751 X Quality care and services that shape the future for the dynamic needs of the people in our area. 0 0 6739859 19984 7446654 The Organization operates a 60 bed skilled nursing facility, a 26 unit assisted living building (a.k.a. Centennial Villa Assisted Living), a 39 unit memory care facility and a wellness center which opened in October 2009. It not only provides services to the elderly population in Annandale but also to those in other area communities which helps the individual to remain in the same geographical area of their former residence. The skilled nursing facility has an excellent therapy program that is available to its residents who are in need of rehabilitation services. It also has an outpatient program that treats those from the Annandale community and the surrounding area. It is because of its onsite therapy program that it has become the first choice for most when they require rehabilitation services following a surgery in order to return home safely. The assisted living building serves as a pleasant transition for those who need additional help that is not readily available in their own home but are still independent enough that they don't require the services of a skilled nursing facility. The memory loss unit is much more appropriate for those who suffer from Alzheimer's and/or severe dementia than a skilled nursing facility. The environment is controlled and setup to meet each resident's needs relating to their specific illness. The wellness center has a therapy/exercise swim pool, exercise class studio and an exercise equipment room developed to serve the wellness needs of those 50 years of age and older - both within the campus and the outside community. 6739859 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 1 218 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 1 1 0 0 0 MN X Debra Reitmeier 3202742579 500 Park Street East Annandale MN 55302 Sharon Peterson Chairman (Apr-Sept) 0.10 0.20 X X 0 0 0 Roger Millner Chairman(Oct-Mar)/Director(Apr-Sept) 0.10 0.20 X X 0 0 0 Kathy Gruys Secretary/Treasurer 0.10 0.20 X X 0 0 0 Mark Miller Director (Nov-Mar) 0.10 X 0 0 0 Jerry Wolfsteller Director (Nov-Mar) 0.10 0.30 X 0 0 0 Julie Hastings City Liaison 0.10 0.30 X 0 0 0 Ed Skomoroh Director 0.10 0.30 X 0 0 0 Jack Driste Director 0.10 0.20 X 0 0 0 Myron Morris Director (Apr-Sept) 0.10 0.20 X 0 0 0 Debra Reitmeier Administrator/President 38.00 2.00 X 112294 0 15431 112294 0 15431 1 0 0 0 Rehabvisions 11623 Arbor St Ste 201 Omaha NE 68144 PT, OT AND SLP 586870 1 9505 9505 Resident Revenue 623000 7244153 7244153 Other Supporting Reven 900099 129775 129775 Wellness Center 713940 72726 72726 7446654 153121 153121 870 7104 -6234 -6234 -6234 7603046 7446654 0 146887 X 19984 19984 130696 130696 3350237 3233977 116260 638 638 238857 237537 1320 270836 252759 18077 16547 16547 23125 23125 847384 795863 51521 8423 8423 179710 120402 59308 20124 20124 356993 292622 64371 8284 2641 5643 15095 13610 1485 501092 501092 556984 556984 1150 1150 Meals/Food 274305 274305 Medical Supplies 234826 234826 DHS Surcharge 168900 168900 Dues & Subscriptions 15737 15737 44704 34357 10347 7284631 6739859 544772 0 1657974 1246881 693490 735345 302640 286390 11951351 5541765 6784100 6409586 3387514 4394303 7700 10938 12833418 13083443 548274 621116 8735000 8575000 60775 73576 9344049 9269692 X 3489369 3813751 3489369 3813751 12833418 13083443 318415 5967 0 X 0 1 X 0 0 X 100743 19946 8045 1500 9505 139739 7093527 7306450 6998865 7345286 7446654 36190782 7194270 7326396 7006910 7346786 7456159 36330521 0 81144 138844 87365 63804 101024 472181 81144 138844 87365 63804 101024 472181 35858340 14308 39015 121724 88342 153121 416510 14308 39015 121724 88342 153121 416510 7208578 7365411 7128634 7435128 7609280 36747031 0.97580 0.97940 0.01130 0.00800 X 0 1 X 69516 69516 10129164 4481497 5647667 1358008 782450 575558 394663 277818 116845 6409586 X 7609013 5967 5967 7603046 0 7603046 7284631 0 7284631 0 7284631 Part IV, Line 2b: Annandale Care Center acts as custodian for funds of its residents. Part X, Line 2: recognized by the Internal Revenue Service as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Organization, Care Center, and Congregate are annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization, Care Center, and Congregate are subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization, Care Center, and Congregate have determined they are not subject to unrelated business income tax and have not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Organization, Care Center, and Congregate believes that they have appropriate support for any tax positions taken affecting their annual filing requirements, and as such, do not have any uncertain tax positions that are material to the financial statements. The Organization, Care Center, and Congregate will recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 Scholarships- Education 6 19841 Part I, Line 2: Scholarships are awarded to employees who work an average of 20 hours a week or more and who are enrolled in a program of study related to long term care. Recipients are selected by a committee on a quarterly basis. Funds are disbursed upon receiving a copy of the recipient's tuition/fees statement and/or receipts for purchases of required textbooks. The guidelines for this program are in accordance with those set forth by the MN Department of Human Services' Nursing Facility Scholarship Program. A Economic Development Authority of the City of Annandale MN 416004935 035724AV5 2007-11-02 9296182 See Sch K,Part VI 0 0 0 A 725000 9296182 265134 272429 186000 4609396 4235652 2009 1 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 Date Rebate Computation Performed Issuer Name: Economic Development Authority of the City of Annandale, MN Date the Rebate Computation was Performed: 12/21/2012 Schedule K Supplental Information Part I, Item (f) Description of Purpose continued: Construction of memory care facility, renovation and addition to the nursing facility, and to refund bonds issued. Refunded bonds issued June 14, 1999 and August 1, 2003 Form 990, Part VI, Section A, line 1 The President does not have voting rights. Form 990, Part VI, Section A, line 7a The Board of Directors is elected annually by the Board of Directors of Annandale Health and Community Services. Form 990, Part VI, Section A, line 7b The following must be approved by the Board of Directors of Annandale Health and Community Services: ** Budget - Changes in budget of over $10,000 - Expenditures of over $10,000 - Sales of assets of over $10,000 - Changes to the bylaws The following must be approved by the President of the Annandale Health and Community Service Board: - Changes in the budget of over $5,000 but less than $10,000 - Expenditures of over $5,000 but less than $10,000 - Sales of assets of over $5,000 but less than $10,000 Form 990, Part VI, Section A, line 8b There are no committees that can act on behalf of the Board. Committees must come back to the full Board to make a final decision. Form 990, Part VI, Section B, line 11 A draft copy of the Form 990 will be mailed out to members of the Board prior to the filing date. Also, the Administrator/President will review a draft copy of the Form 990 before it is filed. Form 990, Part VI, Section B, line 12c There is no annual form or disclosure that is used to uncover conflicts of interest; however, individuals are required to disclose conflicts of interest based on an "honor-system." Anyone who can influence the actions of the Corporation is covered by the policy. This includes Board Members, key employees, officers, and employees. The Board reviews and determines when and if a conflict exists. If a conflict exists, Board Members are not allowed to vote on the issue in conflict. All conflicts of interest are documented in the Board Meeting minutes. Form 990, Part VI, Section B, line 15 Each year, the Corporation finds out what the increase in rates will be. The increase in rates is allocated proportionately across the board to all employees. The budget is also determined by the increase in rates and the Board of Directors approves the budget. Form 990, Part VI, Section C, line 19 The Organization makes it governing documents and conflict of interest policy available upon request. The financial statements are not made publicly available. Form 990, Part IX, line 11g Purchased Service Fees: Program service expenses 795,863. Management and general expenses 51,521. Fundraising expenses 0. Total expenses 847,384. Annandale Health and Community Services 500 Park Street East Annandale MN 55302 411820760 Oversight MN 501(c)(3) Line 7 N/A 0 Heartland Transit 500 Park Street East Annandale MN 55302 411820763 Inactive Corporation MN 501(c)(3) Line 7 Annandale Health and Community Services 0 Annandale Congregate Housing 500 Park Street East Annandale MN 55302 363566531 Independent Living MN 501(c)(3) Line 11a, I Annandale Health and Community Services 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0