2014-05-15T11:38:01-05:00 2013-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-07-01 411704381 ST THERESE FOUNDATION INC STTH 7635315000 8000 BASS LAKE ROAD NEW HOPE MN 55428 MIKE WARDEN 7635315000 2014-05-08 1 JEFF VRIEZE P01273590 6123764500 2012 2015-11-30 17:44:51Z BARB RODE 8000 BASS LAKE ROAD NEW HOPE MN 55428 15960415 0 X WWW.STTHERESEMN.ORG X 1991 MN PROVIDING FUNDRAISING, PLANNING, AND OTHER SUPPORT TO AFFILIATED ORGANIZATIONS. 18 18 0 34 0 0 3054690 2785369 606165 3485199 237045 335582 -15612 17882 3882288 6624032 65692 64188 0 0 761368 3080261 0 0 47605 180046 1705401 1007106 4849850 2875182 1774182 17549980 25118305 9822175 15497875 7727805 9620430 X PROVIDING FUNDRAISING, PLANNING, AND OTHER SUPPORT TO AFFILIATED ORGANIZATIONS. 0 0 278137 64188 0 FROM THE VERY BEGINNING, ST. THERESE HAS TAKEN PRIDE IN THE FACT THAT IT HAS ALWAYS BEEN A GOOD MEMBER OF THE COMMUNITY. AS A NON-PROFIT ORGANIZATION, ST. THERESE STRIVES TO HELP OTHERS WITHIN OUR IMMEDIATE NEIGHBORHOOD AND BEYOND. WE BELIEVE IT IS ALSO IMPORTANT TO COMMUNICATE OUR OUTREACH AND SUPPORT OF THE GREATER COMMUNITY AS PART OF OUR MISSION.DOCUMENTING THIS WORK IS AN ESSENTIAL ELEMENT FOR EARNING PUBLIC TRUST AND VALIDATING OUR STATUS AS A NON-PROFIT ORGANIZATION. ACTIVITIES FOR THE 2012-2013 FISCAL YEAR ARE LISTED BELOW:ST. THERESE PROVIDED OVER $2.5 MILLION DOLLARS OF FREE CARE AS A RESULT OF MEDICAID REIMBURSEMENT AND STATE ALLOWED RATES NOT COVERING THE ENTIRE COST OF CARE. APPROXIMATELY 44% OF OUR RESIDENTS PARTICIPATE IN THE MEDICAID PROGRAM. IN ADDITION, ANOTHER 35% OF OUR RESIDENTS PAY FOR THEIR CARE ON THEIR OWN. FOR BOTH OF THESE GROUPS, THE AMOUNT WE ARE REIMBURSED OR ARE ALLOWED TO CHARGE IS $28 A DAY LESS THAN THE ACTUAL COST OF PROVIDING THE CARE. IF WE WERE TO MAKE CUTS TO RECOVER THESE EXPENSES, WE WOULD COMPROMISE CARE OF OUR RESIDENTS.TO FOSTER EDUCATION AND HELP TRAIN FUTURE LEADERS IN OUR INDUSTRY, WE CONTRIBUTE $22,500 A YEAR TO THE UNIVERSITY OF WISCONSIN - EAU CLAIRE TO SPONSOR A STUDENT ADMINISTRATOR.ST. THERESE IS A HOST FOR SOCIAL WORKER STUDENTS FROM THE UNIVERSITY OF MINNESOTA TWIN CITIES CAMPUS.SPIRITUAL CARE IS AT THE CENTER OF OUR MISSION. OUR EXTENSIVE PASTORAL CARE SERVICES INCLUDE STAFF, LITURGICAL COSTS, MUSIC AND MUCH MORE. THIS VITAL PROGRAM IS PARTIALLY PAID FOR BY DONATIONS TO ST. THERESE.OUR STAFF RECRUITED BLOOD DONORS FOR THE AMERICAN RED CROSS. STAFF MEMBERS VOLUNTEERED THEIR TIME AND BLOOD FOR THIS WORTHY CAUSE.OUR STAFF PARTICIPATED IN TRADE AND PROFESSIONAL ASSOCIATION TO EXPAND THEIR SKILLS AND TO ADVOCATE FOR SOCIAL FAIRNESS. THIS IS ALSO A WAY WE CAN SHARE OUR EXPERIENCES AND KNOWLEDGE TO BENEFIT OTHERS.ST. THERESE HAS A CHARITABLE PROGRAM CALLED OUR CARING FUND THAT CAN BE ACCESSED TO ASSIST PEOPLE WITH SERVICES IF THEY HAVE TO APPLY FOR WAIVERED SERVICES AND OTHER SUPPORTED SERVICES. DURING FY 2011-2012, THE CARING FUND ASSISTED $22,212 IN FINANCIAL NEED TO OUR PEOPLE. ST. THERESE EMPLOYEES WERE AWARDED OVER $11,780 IN SCHOLARSHIPS THROUGH THE ST. THERESE FOUNDATION'S WHITE ROSE SCHOLARSHIP. THE SCHOLARSHIP PROVISED THE OPPORTUNITY FOR STAFF TO CONTINUE THEIR EDUCATION AND IMPROVE THEIR KNOWLEDGE ON CARING FOR OLDER ADULTS. TENANTS AND STAFF MEMBERS IN OUR COMMUNITIES HOLD A FOOD DRIVE VARIOUS TIMES THROUGHOUT THE YEAR TO HELP FAMILIES IN NEED IN OUR SURROUNDING COMMUNITIES. 2843870 2281744 OXBOW LAKE CARE CENTER, LLC WAS CREATED TO OWN AND OPERATE THE 64-UNIT CARE SUITES WHICH IS LICENSED AS A SKILLED NURSING FACILITY ON THE EXISTING CAMPUS OF OXBOW LAKE (CARE SUITES). THE FACILITY OPENED AND BEGAN OPERATIONS IN OCTOBER 2012 AND WAS CERTIFIED FOR ADMISSIONS OF MEDICARE AND MEDICAID RESIDENTS IN JULY 2013. 889614 0 1203455 ST. THERESE AT HOMES SOLUTIONS, LLC PROVIDES PRIVATE DUTY HOME CARE SERVICES TO THE SURROUNDING COMMUNITY. 4011621 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 5 0 0 0 0 0 0 1 1 1 1 0 0 0 1 0 X 18 18 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X DEBORAH BORDER 7635315035 8000 BASS LAKE ROAD NEW HOPE MN 55428 KAYE FOLEY 1.00 2.00 X X 0 0 0 DR CHRISTOPHER DOWNEY 1.00 1.00 X X 0 0 0 MARY ORTIZCAZARIN 1.00 1.00 X X 0 0 0 DAVID M HOFFMANN 1.00 1.00 X X 0 0 0 JOSEPH AMBERGMD 1.00 1.00 X 0 0 0 PATRICK J BORAN 1.00 1.00 X 0 0 0 FR MICHAEL BYRON 1.00 X 0 0 0 JERRY J CHOROMANSKI 1.00 1.00 X 0 0 0 LYNN CHOROMANSKI PH D 1.00 1.00 X 0 0 0 WM CHRISTOPHER DOWNEY MD 1.00 1.00 X 0 0 0 RICHARD G FABER 1.00 X 0 0 0 FR JOSEPH GILLESPIE 1.00 1.00 X 0 0 0 STEPHEN G IMHOLTE 1.00 1.00 X 0 0 0 DAVID KRENN 1.00 X 0 0 0 JANE MCCROSSAN 1.00 1.00 X 0 0 0 SR KAREN SAMES 1.00 1.00 X 0 0 0 RICHARD D THEILMANN 1.00 X 0 0 0 C DWIGHT TOWNES MD 1.00 1.00 X 0 0 0 MICHAEL VARPNESS 1.00 X 0 0 0 PAUL VOGEL 1.00 X 0 0 0 BARBARA RODE 8.00 32.00 X 0 204155 6871 MIKE WARDEN 10.00 30.00 X 0 129786 2799 JOHN LEBLANC 20.00 20.00 X 102728 0 25260 DINAH MARTIN 40.00 X 103389 0 6881 206117 333941 41811 2 0 1 0 0 172257 2000000 613112 380 2785369 RESIDENT REVENUE 623000 2281744 2281744 CAREGIVER/CNA SERVICES 623000 1203455 1203455 3485199 167669 167669 9462871 9294958 167913 167913 167913 41282 172257 41425 -143 -143 MEAL INCOME 900099 11435 11435 TELEPHONE 900099 5866 5866 MISCELLANEOUS 900099 724 724 18025 6624032 3485199 0 353464 64188 64188 2754005 2282395 471610 5560 4504 1056 132385 112527 19858 188311 160064 28247 69196 69196 22392 2510 19882 51314 51176 138 76582 46080 30502 2433 2433 268580 191607 30747 46226 7595 7595 106579 105266 1313 11809 4189 7620 2553 2553 269931 266606 3325 414862 405809 9053 36134 34215 1919 ASSOCIATION DUES 124076 117966 6110 FOOD 113516 111906 231 1379 MISCELLANEOUS 54481 3113 51368 EQUIPMENT LEASE 47500 47500 25868 25868 4849850 4011621 790624 47605 265919 2874579 48058 1048191 132304 174867 13142 93584 14102643 457851 11871263 13644792 4618351 6005042 419942 1069391 181001 207859 17549980 25118305 1753495 283451 10041 7225294 13197226 2400 2410 840986 2004747 9822175 15497875 X 6617506 8802686 1068840 422834 41459 394910 7727805 9620430 17549980 25118305 X 1774182 156558 -38114 X 0 1 X 1 0 X 335864 364396 481946 3054690 2613112 6850008 335864 364396 481946 3054690 2613112 6850008 283627 6566381 170117 162341 142994 153144 167669 796265 10 18025 18035 7664308 4403245 0.85670 0.82200 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 689800 599997 10052 10052 1289797 354147 335653 2889 2889 689800 324447 29700 22177 22177 354147 257180 67267 12448 12448 324447 100000 157180 1718 1718 257180 0.70000 0.30000 0.00000 1 0 618214 618214 11554216 217399 11336817 41968 5596 36372 1828245 234856 1593389 60000 60000 13644792 DUE TO AFFILIATES 2004747 2004747 X PART IV, LINE 2B: RESIDENT TRUST FUNDS ARE RESIDENT'S FUNDS HELD BY OXBOW LAKE CARE CENTER, LLC IN A SEGREGATED BANK ACCOUNT FOR THE USE BY RESIDENTS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE USED TO FURTHER THE MISSION OF ST. THERESE HOME, INC. AND ST. THERESE AT OXBOW LAKE, INC., WHICH INCLUDES PROVIDING HOUSING, NURSING CARE AND PASTORAL CARE TO THE ELDERLY. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION HAS BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND MINNESOTA CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE FEDERAL INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION IN THE U.S. FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME, EXCISE OR OTHER TAXES OR MAY JEOPARDIZE ITS TAX-EXEMPT STATUS. THE TAX RETURNS FOR THE YEARS 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. ASSOCIATE DINNER 146549 133752 12797 12977 530 9798 GOLF EVENT 48700 38505 10195 5460 7665 1 18290 18290 4995 213539 172257 41282 18437 530 22458 41425 -143 1 ST THERESE HOME INC 8000 BASS LAKE ROAD NEW HOPE MN 55428 410888641 501(C)(3) 56316 GENERAL OPERATING SUPPORT ST THERESE AT OXBOW LAKE INC 8000 BASS LAKE ROAD NEW HOPE MN 55428 205835911 501(C)(3) 5651 GENERAL OPERATING SUPPORT 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ALL GRANTS ARE MADE TO RELATED ORGANIZATIONS THAT ARE UNDER COMMON MANAGEMENT WHO REGULARLY MONITOR THE ACTIVITIES, REVENUES AND EXPENDITURES OF THE RELATED ORGANIZATIONS. 0 0 0 0 0 0 0 0 0 BARBARA RODE 0 193155 0 11000 0 0 0 5759 0 1112 0 211026 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3 THE CEO'S COMPENSATION IS DETERMINED BY ST. THERESE HOME, INC., AN AFFILIATED ORGANIZATION. ST. THERESE HOME, INC. USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE CEO: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. COMPENSATION SURVEY OR STUDY 4. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE A CITY OF BROOKLYN PARK MINNESOTA 416008804 2011-07-19 10000000 FACILITY EXPANSION PROJECT 0 0 0 B CITY OF CHAMPLIN MINNESOTA 416007831 2011-07-19 3320000 FACILITY EXPANSION PROJECT 0 0 0 A 92467 10000000 71576 532570 9467430 2012 0 0 1 1 B 30305 3320000 3424 3320000 2012 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 A 0 B 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE IS ENTIRELY COMPOSED OF THE GOVERNING BODY MEMBERS. THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE BUSINESS OF THIS CORPORATION IN THE INTERVAL BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, AND THE EXECUTIVE COMMITTEE SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 2 JERRY J. CHOROMANSKI AND LYNN CHOROMANSKI - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVIEWED AND APPROVED BY THE FINANCE COMMITTEE AND BOARD OF DIRECTORS PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL DIRECTORS, OFFICERS AND KEY MANAGEMENT EMPLOYEES ARE ANNUALLY REQUIRED TO DISCLOSE ANY CONFLICTS OF INTEREST. THE DISCLOSURES ARE REPORTED TO THE BOARD OF DIRECTORS. INDIVIDUALS HAVING MATERIAL CONFLICTS OF INTEREST ARE ASKED TO REFRAIN FROM VOTING ON ANY ACTION THAT MAY BE INFLUENCED BY THE CONFLICT. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE PROVIDED TO THE BOND TRUSTEE, WHO DISTRIBUTES THEM TO THE ELECTRONIC MUNICIPAL MARKET ACCESS SYSTEM. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: T/R NET ASSETS RELEASED -750,929. NET ASSETS RELEASED FOR CAPITAL PURCHASES 663,342. P/R NET ASSETS RELEASED -38,114. NET ASSETS RELEASED FROM RESTRICTION 87,587. OXBOW LAKE CARE CENTER LLC 8000 BASS LAKE ROAD NEW HOPE MN 55428 273308934 SKILLED NURSING FACILITY MN 2300870 16811975 ST THERESE FOUNDATION INC ST THERESE AT HOME SOLUTIONS LLC 8000 BASS LAKE ROAD NEW HOPE MN 55428 454049467 PRIVATE DUTY HOME SERVICES MN 1203455 605953 ST THERESE FOUNDATION INC ST THERESE HOME INC 8000 BASS LAKE ROAD NEW HOPE MN 55428 410888641 HOUSING & NURSING CARE FOR THE ELDERLY MN 501(C)(3) 9 ST THERESE FOUNDATION INC 1 ST THERESE AT OXBOW LAKE INC 8000 BASS LAKE ROAD NEW HOPE MN 55428 205835911 HOUSING & NURSING CARE FOR THE ELDERLY MN 501(C)(3) 7 ST THERESE FOUNDATION INC 1 0 1 1 0 0 0 1 0 0 0 0 1 1 1 1 1 0 1 0 ST THERESE HOME INC B 56316 CASH TRANSFER ST THERESE HOME INC C 1000000 EQUITY TRANSFER ST THERESE AT OXBOW LAKE INC C 1000000 EQUITY TRANSFER