ANNANDALE CARE CENTER: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
ANNANDALE CARE CENTER (EIN 23-7296950)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-04-21
IRS object ID
201411119349300406
Schema version
2012v2.1
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)
Timestamp2014-04-21T08:48:31-05:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN450250958EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14310 17TH AVE S PO BOX 2545AddressLine1
CityFARGOCity
StateNDState
ZIP Code581082545ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237296950EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ANNANDALE CARE CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlANNANameControl
Phone3202743737Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 PARK STREET EASTAddressLine1
CityANNANDALECity
StateMNState
ZIP Code55302ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDebra ReitmeierName
TitleAdministrator/PresidentTitle
Phone3202743737Phone
Date Signed2014-03-31DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLisa Chaffee CPAName
PTINP00193453PTIN
Phone7012398500Phone
Date Prepared2014-03-31DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDebra ReitmeierNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1500 PARK STREET EASTAddressLine1
CityANNANDALECity
StateMNState
ZIP Code55302ZIPCode
FieldValueIRS element (for citing)
Gross Receipts7435914GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.AHCSMN.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1973YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionSkilled nursing services and assisted living servicesActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees218TotalNbrEmployees
Total Nbr Volunteers60TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year8045ContributionsGrantsPriorYear
Contributions Grants Current Year1500ContributionsGrantsCurrentYear
Program Service Revenue Prior Year6998865ProgramServiceRevenuePriorYear
Program Service Revenue CY7345286ProgramServiceRevenueCY
Investment Income Prior Year122327InvestmentIncomePriorYear
Investment Income Current Year87724InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year7129237TotalRevenuePriorYear
Total Revenue Current Year7434510TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year20247GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY20944GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year3636323SalariesEtcPriorYear
Salaries Etc Current Year3761067SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3276237OtherExpensePriorYear
Other Expenses Current Year3182239OtherExpensesCurrentYear
Total Expenses Prior Year6932807TotalExpensesPriorYear
Total Expenses Current Year6964250TotalExpensesCurrentYear
Revenues Less Expenses Prior Year196430RevenuesLessExpensesPriorYear
Revenues Less Expenses CY470260RevenuesLessExpensesCY
Total Assets BOY12560494TotalAssetsBOY
Total Assets EOY12833418TotalAssetsEOY
Total Liabilities BOY9508429TotalLiabilitiesBOY
Total Liabilities EOY9344049TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3052065NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3489369NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionQuality care and services that shape the future for the dynamic needs of the people in our area.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense6426737Expense
Grants20944Grants
Revenue7345286Revenue
DescriptionThe 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.Description
Total Program Service Expense6426737TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees218NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons0AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Debra ReitmeierBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3202742579TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1500 Park Street EastAddressLine1
CityAnnandaleCity
StateMNState
ZIP Code55302ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (10 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
Sharon Peterson
Chairman (Oct-Mar)0.100.20XX000
Roger Millner
Chairman (Apr-Sept)0.100.20XX000
Kathy Gruys
Secretary/Treasurer0.100.20XX000
Mark Miller
Director0.100.00X000
Jerry Wolfsteller
Director0.100.30X000
Shelly Jonas
Director (Oct-Jan)0.100.30X000
Julie Hastings
Director (Feb-Sept)0.100.30X000
Ed Skomoroh
Director0.100.30X000
Jack Driste
Director0.100.20X000
Debra Reitmeier
Administrator/President38.002.00X110954017673
FieldValueIRS element (for citing)
Total Reportable Comp From Org110954TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation17673TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1RehabvisionsBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line111623 Arbor St Ste 201AddressLine1
CityOmahaCity
StateNEState
ZIP Code68144ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesPT, OT AND SLPDescriptionOfServices
Compensation702208Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions1500AllOtherContributions
Total Contributions1500TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Resident Revenue62300071695697169569
Other Supporting Reven900099116852116852
Wellness Center7139405886558865
FieldValueIRS element (for citing)
Total Program Service Revenue7345286TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column88342TotalRevenueColumn
Exclusion$88,342ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other786Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other1404Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-618Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-618TotalRevenueColumn
Exclusion-$618ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column7434510TotalRevenueColumn
Related Or Exempt Function Income7345286RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$87,724ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total20944Total
Program Services20944ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total122887Total
Management And General122887ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3127546Total
Program Services3004180ProgramServices
Management And General123366ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1375Total
Management And General1375ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total258265Total
Program Services253976ProgramServices
Management And General4289ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total250994Total
Program Services233072ProgramServices
Management And General17922ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total10914Total
Management And General10914ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total22851Total
Management And General22851ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total889986Total
Program Services821226ProgramServices
Management And General68760ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total3496Total
Management And General3496ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total139330Total
Program Services88261ProgramServices
Management And General51069ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total17958Total
Management And General17958ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total366234Total
Program Services307833ProgramServices
Management And General58401ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total6776Total
Program Services3557ProgramServices
Management And General3219ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total13365Total
Program Services10382ProgramServices
Management And General2983ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total508471Total
Program Services508471ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total532025Total
Program Services532025ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1039Total
Management And General1039ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies449611449611
DHS Surcharge168900168900
Dues & Subscriptions1396413964
Bad Debt Expense22862286

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total35033Total
Program Services22013ProgramServices
Management And General13020ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total6964250Total
Program Services6426737ProgramServices
Management And General537513ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2118156BOY
EOY1657974EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY806676BOY
EOY693490EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY334231BOY
EOY302640EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis12097201LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec5313101LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY6956512BOY
EOY6784100EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2339567BOY
EOY3387514EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY5352BOY
EOY7700EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12560494BOY
EOY12833418EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY589474BOY
EOY548274EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY8885000BOY
EOY8735000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY33955BOY
EOY60775EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY9508429BOY
EOY9344049EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3052065BOY
EOY3489369EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3052065BOY
EOY3489369EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12560494BOY
EOY12833418EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses470260ReconcilationRevenueExpenses
Reconciliation Unrealized Invest-32956ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee0AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years7580CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years100743CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years19946CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year8045CurrentTaxYearMinus1Year
Current Tax Year1500CurrentTaxYear
Total137814Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6824180CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7093527CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7306450CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6998865CurrentTaxYearMinus1Year
Current Tax Year7345286CurrentTaxYear
Total35568308Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6831760CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7194270CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7326396CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7006910CurrentTaxYearMinus1Year
Current Tax Year7346786CurrentTaxYear
Total35706122Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years80381CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years81144CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years138844CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year87365CurrentTaxYearMinus1Year
Current Tax Year63804CurrentTaxYear
Total451538Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years80381CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years81144CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years138844CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year87365CurrentTaxYearMinus1Year
Current Tax Year63804CurrentTaxYear
Total451538Total
FieldValueIRS element (for citing)
Public Support Total50935254584PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years26375CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14308CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years39015CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year121724CurrentTaxYearMinus1Year
Current Tax Year88342CurrentTaxYear
Total289764Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years26375CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years14308CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years39015CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year121724CurrentTaxYearMinus1Year
Current Tax Year88342CurrentTaxYear
Total289764Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years6858135CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7208578CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7365411CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7128634CurrentTaxYearMinus1Year
Current Tax Year7435128CurrentTaxYear
Total35995886Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97940PublicSupportPercentage509
Prior Year Support Percentage0.97970PriorYearSupportPercentage
Investment Income Percentage0.00800InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00750PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS
Explanation In Part XIIIXExplanationInPartXIII

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis69516OtherCostOrOtherBasis
Book Value69516BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis9825623OtherCostOrOtherBasis
Depreciation4112583Depreciation
Book Value5713040BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1301206OtherCostOrOtherBasis
Depreciation929801Depreciation
Book Value371405BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis900856OtherCostOrOtherBasis
Depreciation270717Depreciation
Book Value630139BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings6784100TotalOfBookValueLandBuildings
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt7401554TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-32956NetUnrealizedGainsInvestments
Revenue Not Rptd F990-32956RevenueNotRptdF990
Revenue Subtotal7434510RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9907434510TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt6964250TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal6964250ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9906964250TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part IV, Line 2b:Annandale Care Center acts as custodian for funds of its residents.
Part X, Line 2:Community Services, Care Center, and Congregate are organized as Minnesota nonprofit corporations and have been recognized by the Internal Revenue Service as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Organizations are annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organizations are subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organizations 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 Organizations believe 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 Organizations 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.Description of Uncertain Tax Positions Under FIN 48:

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantScholarships- EducationTypeOfGrant
Number Of Recipients5NumberOfRecipients
Amount Of Cash Grant20944AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, 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.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Economic Development Authority of the City of Annandale MNBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN416004935IssuerEIN
CUSIP Number035724AV5CUSIPNumber
Date Issued2007-11-02DateIssued
Issue Price9296182IssuePrice
Description Of PurposeSee Sch K,Part VIDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired565000AmountRetired
Total Proceeds9296182TotalProceeds
Amount In Reserve Fund265134AmountInReserveFund
Capitalized Interest272429CapitalizedInterest
Issuance Costs From Proceeds186000IssuanceCostsFromProceeds
Capital Expenditures4609396CapitalExpenditures
Other Spent Proceeds4235652OtherSpentProceeds
Year Of Subst Completion2009YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding1AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs0NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiled
Rebate Not Due Yet0RebateNotDueYet
Exception To Rebate0ExceptionToRebate
No Rebate Due1NoRebateDue
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs0WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective Action0ProcToUndertkCorrectiveAction

Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Schedule K Part IV, Arbitrage, Line 2cDate Rebate Computation PerformedIssuer Name: Economic Development Authority of the City of Annandale, MN Date the Rebate Computation was Performed: 12/21/2012
Schedule K Supplental InformationPart 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

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 1The President does not have voting rights.
Form 990, Part VI, Section A, line 7aThe Board of Directors is elected annually by the Board of Directors of Annandale Health and Community Services.
Form 990, Part VI, Section A, line 7bThe 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 8bThere 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 11A 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 12cThere 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.
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 19The 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 11gPurchased Service Fees: Program service expenses 821,226. Management and general expenses 68,760. Fundraising expenses 0. Total expenses 889,986.Other Fees

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Annandale Health and Community Services
500 Park Street EastAnnandaleMN55302411820760OversightMN501(c)(3)Line 7N/A0
Heartland Transit
500 Park Street EastAnnandaleMN55302411820763Inactive CorporationMN501(c)(3)Line 70Annandale Health and Community Services
Annandale Congregate Housing
500 Park Street EastAnnandaleMN55302363566531Independent LivingMN501(c)(3)Line 11a, I0Annandale Health and Community Services
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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