2014-08-13T13:05:20-05:00 2013-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-10-01 410845402 MINNEWASKA LUTHERAN HOME MINN 3202397121 605 MAIN STREET STARBUCK MN 56381 KAYO ASLAGSON 3202397121 2014-08-13 1 CORY RUTLEDGE P01329381 6123764500 2012 2015-11-30 17:44:51Z MURRAY FINGER 605 MAIN STREET STARBUCK MN 56381 4419465 0 X WWW.MCHS-HEALTHCARE.ORG X 1958 MN NURSING HOME - A COMMUNITY OF SERVICES, GROUNDED IN FAITH, PROVIDING PERSON CENTERED CARE. 9 7 186 70 0 0 18589 37807 4394214 4351067 10687 10598 23195 19993 4446685 4419465 3144 21031 0 0 2981833 2961650 0 0 0 1346480 1404708 4331457 4387389 115228 32076 5225888 5113727 2953841 2799551 2272047 2314176 X A COMMUNITY OF SERVICES, GROUNDED IN FAITH, PROVIDING PERSON CENTERED CARE THAT ENCOURAGES ALL PEOPLE TO REACH THEIR HIGHEST POTENTIAL. 1 1 3979709 21031 4351067 MINNEWASKA LUTHERAN HOME, A 65-BED SKILLED NURSING FACILITY, PROMOTES HEALTH TO THE COMMUNITY BY PROVIDING SKILLED NURSING CARE AND PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES. ADDITIONAL PROGRAMS WHICH BENEFIT THE COMMUNITY INCLUDE:OUTPATIENT THERAPY SERVICES: MINNEWASKA LUTHERAN HOME PROVIDES PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY TO COMMUNITY MEMBERS IN NEED OF THESE SERVICES ALLOWING THEM TO RESUME THEIR NORMAL ACTIVITIES OF DAILY LIVING. MINNEWASKA LUTHERAN HOME IS GOVERNED BY A NINE PERSON INDEPENDENT BOARD MADE UP OF ONE AT-LARGE COMMUNITY LEADER AND EIGHT AREA CHURCH MEMBERS. THE BOARD HAS A HISTORY OF COMMITMENT TO ACTING WITH THE HIGHEST INTEGRITY AND HAS BEEN PROACTIVELY EVALUATING OPPORTUNITIES TO ENSURE THE ORGANIZATION CONTINUES TO OPERATE AT ITS MAXIMUM POTENTIAL FOR THE BENEFIT OF THE CLIENTS WE SERVE AND THE COMMUNITY. 351 0 0 COMMUNITY OUTREACH EXERCISE PROGRAM: EXERCISE PROGRAM THAT STRESSES STRENGTH AND STABILITY. THIS PROGRAM IS OFFERED THREE TIMES PER WEEK TO COMMUNITY MEMBERS AT NO CHARGE. 0 0 0 ROAD TO AGING GRACEFULLY: FREE MONTHLY EDUCATION TO ANY PERSON IN THE COMMUNITY. ALL PROGRAMS RELATE TO THE MANAGEMENT OF CHRONIC DISEASES AND OTHER AGING HEALTH RELATED ISSUES. ALL INSTRUCTORS ARE LOCAL AND REGIONAL EXPERTS IN THEIR RELATED FIELD OFFERING THEIR SERVICES AT A REDUCED OR FREE CHARGE. 0 0 0 NO PLACE LIKE HOME: GOAL IS TO MAINTAIN LEVEL OF INDIVIDUALS HEALTH AFTER DISCHARGE TO REMAIN IN THEIR HOME SETTING WITHOUT NEEDING TO BE RETURNED TO THE NURSING HOME OR HOSPITAL. 3980060 1 1 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 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 14 0 186 1 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 0 1 0 0 MN X BRIAN ENGLER 3202397121 605 MAIN STREET STARBUCK MN 56381 KAYO ASLAGSON 0.50 1.50 X X 0 0 0 LAURIS JOHNSHOY 0.50 1.50 X X 0 0 0 LONNIE ANDERSON 0.50 1.50 X X 0 0 0 ARNE STOEN 0.50 1.50 X X 0 0 0 RONALD FIEGUM 0.50 1.50 X 0 0 0 WARREN HAGESTUEN 0.50 1.50 X 0 0 0 ROBERT HENDRICKSON 0.50 1.50 X 0 0 0 KEITH NAIG 0.50 1.50 X 0 0 0 ALICE REESE 0.50 1.50 X 0 0 0 JOHN SAMUELSON 0.50 1.50 X 0 0 0 DEBBIE SCHNEIDER 25.90 4.10 X 43351 0 2585 MURRAY FINGER 32.00 8.00 X 23218 0 0 BRIAN ENGLER 21.40 14.60 X 44327 0 4333 110896 0 6918 0 0 0 0 0 23677 14130 37807 RESIDENT REVENUES 623000 4351067 4351067 4351067 10598 10598 MEALS REVENUE 722210 11576 11576 CABLE TV REVENUE 900099 5266 5266 MISCELLANEOUS INCOME 900099 3151 3151 19993 4419465 4351067 0 30591 21031 21031 136261 136261 2411152 2285039 126113 13095 11746 1349 217823 195388 22435 183319 164438 18881 884 884 24737 24737 108998 100277 8721 18278 18278 148335 132178 16157 27637 27637 135992 135992 11554 6706 4848 2906 2906 87399 87399 294657 294657 29410 29410 LICENSE SURCHARGE 194603 194603 MEDICAL SUPPLIES 172883 172883 FOOD 124164 124164 DUES AND SUBCRIPTIONS 8020 8020 14251 7644 6607 4387389 3980060 407329 0 25 25 1345267 1068733 434583 519071 21771 22451 8144253 4922508 3156232 3221745 136365 152435 2000 2000 72498 66246 57147 61021 5225888 5113727 292868 316556 7870 6987 2653103 2476008 2953841 2799551 X 2270448 2312576 1599 1600 2272047 2314176 5225888 5113727 32076 10053 0 X 0 1 X 1 0 X 70475 26365 35736 18589 37807 188972 4605776 4217590 4393422 4394214 4351067 21962069 4676251 4243955 4429158 4412803 4388874 22151041 5000 5000 1104105 1489768 1546737 1637269 1610998 7388877 1104105 1489768 1546737 1642269 1610998 7393877 14757164 16839 17970 13298 10687 10598 69392 16839 17970 13298 10687 10598 69392 103719 58508 76092 23195 19993 281507 4796809 4320433 4518548 4446685 4419465 22501940 0.65580 0.67520 0.00310 0.00360 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME CABLE TV REVENUE MISCELLANEOUS INCOME MEALS REVENUE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 228026 228026 6357451 3618859 2738592 124900 45720 79180 1433876 1257929 175947 3221745 X PART IV, LINE 2B: RESIDENT DEPOSITS CONSIST OF RESIDENT TRUST FUNDS HELD BY THE ORGANIZATION FOR THE RESIDENTS OF THE HOME. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: FROM NOTE 1 TO THE ORGANIZATION'S FINANCIAL STATEMENTS: THE HOME, MHD, HOLLY RIDGE, AND HOME CARE HAVE ALL BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND STATE CORPORATE INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) AND APPLICABLE STATE STATUTES. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES IN EVALUATING THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE INCOME TAX RETURNS OF THE ORGANIZATION IS SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE THE TAX-EXEMPT STATUS OF ANY OF ITS ENTITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE TAX RETURNS FOR THE FISCAL YEARS 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. 1 SCHOLARSHIPS 3 21031 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: AFTER THE EMPLOYEE HAS BEEN APPROVED FOR A SCHOLARSHIP HE/SHE MUST PAY FOR ALL EXPENSES FOR EACH SEMESTER OF SCHOOL. AFTER EACH SEMESTER THE EMPLOYEE TURNS IN ALL ELIGIBLE EXPENSES UNDER THE SCHOLARSHIP AGREEMENT. REPORTS ARE RUN TO VERIFY THE EMPLOYEE MET THE REQUIRED HOURS FOR THE SAME DATES OF THE SEMESTER. ONCE THIS IS DONE IF THE EMPLOYEE HAS MET THE REQUIREMENTS HE/SHE IS REIMBURSED FOR THE ELIGIBLE EXPENSES. CORA STOEN MOTHER OF BOARD MEMBER 69629 PAYMENTS TO MINNEWASKA LUTHERAN HOME FOR SERVICES RENDERED 0 CASSANDRA FEIGUM DAUGHTER IN LAW OF BOARD MEMBER 12211 COMPENSATION 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 NEW PIPP PROGRAM STARTED 10/1/12 THROUGH THE STATE OF MINNESOTA CALLED "THERE'S NO PLACE LIKE HOME" CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 ENDED PIPP PROGRAM 9/30/12 THROUGH THE STATE OF MINNESOTA CALLED "FALLS REDUCTION AND PREVENTION" FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF MINNEWASKA LUTHERAN HOME CONSIST OF CERTAIN CONGREGATIONS LOCATED IN THE GENERAL COMMUNITY OF STARBUCK, MINNESOTA. EACH MEMBER CONGREGATION MAY APPOINT ONE INDIVIDUAL TO ACT AS A DELEGATE ON ITS BEHALF. THE PRESENT MEMBERS ARE: FRON LUTHERAN CHURCH - STARBUCK, MINNESOTA MINEWASKA LUTHERAN CHURCH - STARBUCK, MINNESOTA ST. JOHN'S LUTHERAN CHURCH - STARBUCK, MINNESOTA IMMANUEL LUTHERAN CHURCH - STARBUCK, MINNESOTA INDHERRED LUTHERAN CHURCH - STARBUCK, MINNESOTA EAST ZION LUTHERAN CHURCH - STARBUCK, MINNESOTA WEST ZION LUTHERAN CHURCH - STARBUCK, MINNESOTA TRINITY LUTHERAN CHURCH - CYRUS, MINNESOTA FORM 990, PART VI, SECTION A, LINE 7A DIRECTORS ARE ELECTED BY A MAJORITY VOTE OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ARTICLES OF INCORPORATION AND/OR THE BYLAWS REQUIRE AN AFFIRMATIVE VOTE OF A MAJORITY OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE MANAGEMENT WILL TEAM DISCUSS THE COMPLETED FORM 990 AT THE NEXT BOARD MEETING AFTER IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL DIRECTORS, PRINCIPAL OFFICERS, AND MEMBERS OF COMMITTEE WITH BOARD-DELEGATED POWERS. ANY INDIVIDUAL WITH AN ACTUAL OR POTENTIAL CONFLICT IS REQUIRED TO DISCLOSE ALL MATERIAL FACTS TO THE BOARD OR COMMITTEE. AFTER DISCLOSURE OF THE MATERIAL FACTS, THE REMAINING BOARD OR COMMITTEE MEMBERS DETERMINE BY MAJORITY VOTE WHETHER A CONFLICT EXISTS. IF IT IS DETERMINED THAT A CONFLICT EXISTS, THE BOARD OR COMMITTEE SEEKS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION IS NOT REASONABLY POSSIBLE, THE BOARD OR COMMITTEE DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. THE INDIVIDUAL MAY NOT BE PRESENT FOR A DISCUSSION OF, OR VOTE ON, WHETHER TO ENTER THE TRANSACTION. THE RELEVANT FACTS ARE DOCUMENTED IN THE MINUTES OF THE MEETING. ADDITIONALLY, BOARD MEMBERS ARE REQUIRED TO ANNUALLY SIGN STATEMENTS DISCLOSING EXISTING CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE ADMINISTRATOR'S COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS ANNUALLY. EVERY YEAR, THE ADMINISTRATOR PRESENTS A PROPOSAL FOR COMPENSATION TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS THEN USES A CURRENT SALARY SURVEY (DONE BY AGING SERVICES OF MN) TO COMPARE TO THE PROPOSAL AND THEN COMES TO A CONCLUSION ON WHAT THE COMPENSATION WILL BE. THIS IS THEN INCORPORATED IN THE BOARD MINUTES AND ADMINISTRATOR'S ANNUAL REVIEW. THE PROCESS LAST OCCURRED 12/15/10. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. MINNEWASKA HOME CARE 605 MAIN STREET STARBUCK MN 56381 331124162 HOME CARE MN 501(C)(3) 9 N/A 1 HOLLY RIDGE MANOR 500 HOLLY RIDGE DRIVE STARBUCK MN 56381 411649721 ASSISTED LIVING MN 501(C)(3) 11 - TYPE 2 N/A 1 MINNEWASKA HOME DEVELOPMENT 605 MAIN STREET STARBUCK MN 56381 411504339 FUNDRAISING MN 501(C)(3) 11 - TYPE 2 N/A 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 1