MAPLE LAWN NURSING HOME INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: MAPLE LAWN NURSING HOME INC (EIN 41-0870856)
Tax period: 2012-10-01 to 2013-09-30
Filed: 2014-06-19
IRS object ID: 201431709349300603
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
Form 990
Schedule A
Schedule D
Schedule K
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2014-06-19T08:03:27-05:00	Timestamp
Tax Period End Date	2013-09-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	410746749	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	CLIFTONLARSONALLEN LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	220 SOUTH SIXTH STREET SUITE 300	AddressLine1
City	MINNEAPOLIS	City
State	MN	State
ZIP Code	55402	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-10-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	410870856	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	MAPLE LAWN NURSING HOME INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	MAPL	NameControl
Phone	5074252571	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	400 SEVENTH STREET BOX 278	AddressLine1
City	FULDA	City
State	MN	State
ZIP Code	56131	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	ARLAN SWANSON ADMINISTRATOR	Name
Title	ADMINISTRATOR	Title
Phone	5074252571	Phone
Date Signed	2014-06-05	DateSigned
Authorize Third Party	1	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	KOREY BOELTER	Name
PTIN	P00047306	PTIN
Phone	6123764500	Phone

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2015-11-30 17:44:51Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	ARLAN SWANSON	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	400 SEVENTH STREET BOX 278	AddressLine1
City	FULDA	City
State	MN	State
ZIP Code	56131	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	4445052	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.MAPLELAWN.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1962	YearFormation
State Legal Domicile	MN	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	9	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	9	NbrIndependentVotingMembers
Total Nbr Employees	141	TotalNbrEmployees
Total Nbr Volunteers	110	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	18761	ContributionsGrantsPriorYear
Contributions Grants Current Year	9628	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	4546754	ProgramServiceRevenuePriorYear
Program Service Revenue CY	4403279	ProgramServiceRevenueCY
Investment Income Prior Year	10690	InvestmentIncomePriorYear
Investment Income Current Year	5569	InvestmentIncomeCurrentYear
Other Revenue Prior Year	17777	OtherRevenuePriorYear
Other Revenue Current Year	26576	OtherRevenueCurrentYear
Total Revenue Prior Year	4593982	TotalRevenuePriorYear
Total Revenue Current Year	4445052	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	2411941	SalariesEtcPriorYear
Salaries Etc Current Year	2460686	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	1858798	OtherExpensePriorYear
Other Expenses Current Year	1783536	OtherExpensesCurrentYear
Total Expenses Prior Year	4270739	TotalExpensesPriorYear
Total Expenses Current Year	4244222	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	323243	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	200830	RevenuesLessExpensesCY
Total Assets BOY	4481433	TotalAssetsBOY
Total Assets EOY	4468719	TotalAssetsEOY
Total Liabilities BOY	2371272	TotalLiabilitiesBOY
Total Liabilities EOY	2157728	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	2110161	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	2310991	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	TO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS IN AN INDIVIDUALIZED, DIGNIFIED, AND HOMELIKE MANNER.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	4026341	Expense
Grants	0	Grants
Revenue	4403279	Revenue
Description	MAPLE LAWN NURSING HOME IS A CAMPUS OF LONG TERM CARE SERVICES, WHICH INCLUDE:MAPLEVIEW ESTATES - 24 APARTMENTS FOR SENIORS WHO NEED LIGHT ASSISTANCE ALLOWING THEM TO MAINTAIN REASONABLY INDEPENDENT LIVES. THESE SERVICES INCLUDE A HIGH-QUALITY NOON MEAL AND ASSISTANCE FOR HOUSEKEEPING AND OTHER LIGHT TASKS. MAPLEWOOD COURT ASSISTED LIVING - 15 APARTMENTS FOR SENIORS WHO NEED ASSISTANCE WITH ALL MEALS AND MEDICATIONS, BUT MAINTAIN INDEPENDENCE IN MANY OTHER CARE AREAS. MAPLE LAWN NURSING HOME - 62 MEDICARE CERTIFIED SKILLED NURSING BEDS WHICH PROVIDE CARE FOR A BROAD SPECTRUM OF RESIDENTS WITH NEEDS FROM POST-ACUTE REHAB THERAPY TO MEMORY CARE. THE CAMPUS PROVIDES CARE FOR OVER 100 LOCAL INDIVIDUALS AT ANY POINT IN TIME, IN THIS RURAL COMMUNITY OF 1,300. APPROXIMATELY 180 DIFFERENT PERSONS ARE SERVED DURING EACH YEAR. MANY WOULD NOT BE ABLE TO FIND CARE ANYWHERE ELSE. THE ORGANIZATION HAS STEADILY GROWN AND IMPROVED DURING ITS 48 YEARS OF SERVICE TO THIS COMMUNITY - FILLING THIS COMMUNITY'S NEED FOR FINE QUALITY HOUSING AND HEALTH CARE SERVICES AND PROVIDING THEM IN AN INDIVIDUALIZED AND HOMELIKE MANNER.	Description
Total Program Service Expense	4026341	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	0	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	0	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	1	CreditCounseling
Term Or Permanent Endowments	0	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	0	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	1	ReportFin48Footnote
Independent Audit Financial Stmt	1	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	0	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	0	Hospital
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	0	ScheduleJRequired
Tax Exempt Bonds	1	TaxExemptBonds
Invest Tax Exempt Bonds	0	InvestTaxExemptBonds
Escrow Account	0	EscrowAccount
On Behalf Of Issuer	0	OnBehalfOfIssuer
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	0	DisregardedEntity
Related Entity	0	RelatedEntity
Related Org Controlled Entity	0	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	24	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Number Of Employees	141	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	0	UnrelatedBusinessIncome
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	9	NbrVotingGoverningBodyMembers
Number Independent Voting Members	9	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	1	MembersOrStockholders
Election Of Board Members	1	ElectionOfBoardMembers
Decisions Subject To Approval	1	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	0	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	MN	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	ARLAN SWANSON	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	5074252571	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	400 SEVENTH STREET NE	AddressLine1
City	FULDA	City
State	MN	State
ZIP Code	56131	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (10 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation
JERRILD STEINER
PRESIDENT	1.00	X	X	0	0	0
ELDEN GETTING
VICE PRESIDENT	1.00	X	X	0	0	0
MARCINE ELDER
SECRETARY	1.00	X	X	0	0	0
MARY FRAN BUSCH
DIRECTOR	1.00	X		0	0	0
SHIRLEY BUSCHENA
DIRECTOR	1.00	X		0	0	0
JEFF ZINS
DIRECTOR	1.00	X		0	0	0
CLEONE RAMERTH
DIRECTOR	1.00	X		0	0	0
DEAN MCNEAL
DIRECTOR	1.00	X		0	0	0
RON JANSSEN
DIRECTOR	1.00	X		0	0	0
ARLAN SWANSON
ADMINISTRATOR	50.00		X	82398	0	2000

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	82398	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	2000	TotalOtherCompensation
Number Individuals GT100 K	0	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	0	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	PRAIRIE REHABILITATION SERVICES LLC	BusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	1720 S CLIFF AVE	AddressLine1
City	SIOUX FALLS	City
State	SD	State
ZIP Code	57105	ZIPCode

Field	Value	IRS element (for citing)
Description Of Services	CONTRACTED THERAPY	DescriptionOfServices
Compensation	208343	Compensation

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	1	NumberOfContractorsGT100K
All Other Contributions	9628	AllOtherContributions
Total Contributions	9628	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
RESIDENT SERVICES	623000	3550495	3550495
APARTMENT RENTAL	623000	852784	852784

Field	Value	IRS element (for citing)
Total Program Service Revenue	4403279	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	5569	TotalRevenueColumn
Exclusion	$5,569	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
MISCELLANEOUS INCOME	623000	17173	$17,173
MEAL INCOME	623000	5012	$5,012
GARAGE REVENUE	623000	4391	$4,391

Field	Value	IRS element (for citing)
Total Other Revenue	26576	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	4445052	TotalRevenueColumn
Related Or Exempt Function Income	4403279	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$32,145	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	86008	Total
Program Services	86008	ProgramServices

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	2020641	Total
Program Services	2015050	ProgramServices
Management And General	5591	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	212762	Total
Program Services	212197	ProgramServices
Management And General	565	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	141275	Total
Program Services	140900	ProgramServices
Management And General	375	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	36258	Total
Management And General	36258	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	421557	Total
Program Services	397338	ProgramServices
Management And General	24219	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	11487	Total
Management And General	11487	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	297186	Total
Program Services	273078	ProgramServices
Management And General	24108	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	145207	Total
Program Services	139988	ProgramServices
Management And General	5219	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	19899	Total
Management And General	19899	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	66832	Total
Program Services	64000	ProgramServices
Management And General	2832	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	207190	Total
Program Services	198409	ProgramServices
Management And General	8781	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	47148	Total
Program Services	45150	ProgramServices
Management And General	1998	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
FOOD	234104	234104
LICENSE SURCHARGE	181712	181693	19
MISCELLANEOUS EXPENSE	52892		52892
REPAIRS AND MAINTENANCE	24159	23135	1024

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	37905	Total
Program Services	15291	ProgramServices
Management And General	22614	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	4244222	Total
Program Services	4026341	ProgramServices
Management And General	217881	ManagementAndGeneral
Fundraising	0	Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	1409951	BOY
EOY	1548999	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	348714	BOY
EOY	362447	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	53357	BOY
EOY	22068	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	6166588	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	3663477	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	2639856	BOY
EOY	2503111	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	6069	BOY
EOY	24532	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	23486	BOY
EOY	7562	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	4481433	BOY
EOY	4468719	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	360660	BOY
EOY	278459	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	1967729	BOY
EOY	1834968	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	16801	BOY
EOY	16497	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	26082	BOY
EOY	27804	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	2371272	BOY
EOY	2157728	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	2110161	BOY
EOY	2310991	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	2110161	BOY
EOY	2310991	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	4481433	BOY
EOY	4468719	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	200830	ReconcilationRevenueExpenses
Reconcilation Other Changes	0	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Separate	X	FinancialStatementSeparate

Field	Value	IRS element (for citing)
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	X	PubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	3926	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	6020	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	7550	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	18761	CurrentTaxYearMinus1Year
Current Tax Year	9628	CurrentTaxYear
Total	45885	Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4322019	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	4242701	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4358488	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4546754	CurrentTaxYearMinus1Year
Current Tax Year	4403279	CurrentTaxYear
Total	21873241	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4325945	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	4248721	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4366038	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4565515	CurrentTaxYearMinus1Year
Current Tax Year	4412907	CurrentTaxYear
Total	21919126	Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Amts From Subst Contributors AmtsFromSubstContributors

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	132885	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	80415	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	93455	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	183248	CurrentTaxYearMinus1Year
Current Tax Year	315375	CurrentTaxYear
Total	805378	Total

Support From DQ Ps Etc SupportFromDQPsEtc

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	132885	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	80415	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	93455	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	183248	CurrentTaxYearMinus1Year
Current Tax Year	315375	CurrentTaxYear
Total	805378	Total

Field	Value	IRS element (for citing)
Public Support Total509	21113748	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	6771	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	16546	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	9308	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	10690	CurrentTaxYearMinus1Year
Current Tax Year	5569	CurrentTaxYear
Total	48884	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	6771	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	16546	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	9308	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	10690	CurrentTaxYearMinus1Year
Current Tax Year	5569	CurrentTaxYear
Total	48884	Total

Other Income509 OtherIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	30385	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	26153	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	21764	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	17777	CurrentTaxYearMinus1Year
Current Tax Year	26576	CurrentTaxYear
Total	122655	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	4363101	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	4291420	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4397110	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4593982	CurrentTaxYearMinus1Year
Current Tax Year	4445052	CurrentTaxYear
Total	22090665	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.95580	PublicSupportPercentage509
Prior Year Support Percentage	0.96380	PriorYearSupportPercentage
Investment Income Percentage	0.00220	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.00250	PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509	X	ThirtyThreePercntTestsCY509
General Explanation	SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUES MEAL INCOME GARAGE REVENUE	GeneralExplanation

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Agent Trustee Etc	0	AgentTrusteeEtc
Included On FS	1	IncludedOnFS
Explanation In Part XIII	X	ExplanationInPartXIII

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	4783063	OtherCostOrOtherBasis
Depreciation	2579583	Depreciation
Book Value	2203480	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	254721	OtherCostOrOtherBasis
Depreciation	81897	Depreciation
Book Value	172824	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1128804	OtherCostOrOtherBasis
Depreciation	1001997	Depreciation
Book Value	126807	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	2503111	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	ASSET RETIREMENT OBLIGATION	Description
Amount	$27,804	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	27804	TotalOfAmounts
Footnote In Part XIII	X	FootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt	4445052	TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F990	0	RevenueNotRptdF990
Revenue Subtotal	4445052	RevenueSubtotal
Revenue Not Rptd On Fin Stmt	0	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	4445052	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	4244222	TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	4244222	ExpensesSubtotal
Expenses Not Rptd On Fin Stmt	0	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	4244222	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

Return ReferenceReturnReference	ExplanationExplanation	IdentifierIdentifier
PART IV, LINE 2B:	RESIDENTS MAKE A SECURITY DEPOSIT WHEN THEY MOVE INTO THE FACILITIES. EACH RESIDENT RECEIVES THEIR SECURITY DEPOSIT, WITH INTEREST, WHEN THEY LEAVE THE FACILITIES. RESIDENT TRUSTS ARE SMALL AMOUNTS THAT RESIDENTS HOLD WITH MAPLE LAWN FOR MINOR EXPENSES AND FOR USE IN RESIDENT OUTINGS.
PART X, LINE 2:	THE CORPORATION HAS BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND MINNESOTA CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE STATUTES. THE CORPORATION'S ANNUAL TAX FILINGS ARE SUBJECT TO REVIEW BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE CORPORATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE CORPORATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OTHER TAXES. THE TAX FILINGS FOR THE YEARS 2010 THROUGH 2012 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL OR STATE AUTHORITIES.	DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	CITY OF FULDA MINNESOTA	BusinessNameLine1

Field	Value	IRS element (for citing)
Issuer EIN	416005177	IssuerEIN
Date Issued	2012-10-01	DateIssued
Issue Price	1955150	IssuePrice
Description Of Purpose	REFUND SERIES 2003 BONDS	DescriptionOfPurpose
Defeased	0	Defeased
On Behalf Of Issuer	0	OnBehalfOfIssuer
Pool Financing	0	PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Amount Retired	120182	AmountRetired
Total Proceeds	1955150	TotalProceeds
Working Capital Expenditures	1955150	WorkingCapitalExpenditures
Year Of Subst Completion	2012	YearOfSubstCompletion
Current Refunding	1	CurrentRefunding
Advance Refunding	0	AdvanceRefunding
Final Allocation Made	1	FinalAllocationMade
Adequate Books And Recds Maintaind	1	AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedProperty
Any Lease Arrangements	0	AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty	0	MngmentCntrctBondFinancdPrprty
Any Research Agreements	0	AnyResearchAgreements
Bond Iss Meet Prvt Security Pay Test	0	BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs	0	NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiled
Rebate Not Due Yet	1	RebateNotDueYet
Exception To Rebate	0	ExceptionToRebate
No Rebate Due	0	NoRebateDue
Variable Rate Issue	1	VariableRateIssue
Hedge Identified In Books And Recds	0	HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGIC
Gross Proceeds Invested	0	GrossProceedsInvested
Written Proc To Monitor Reqs	0	WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Proc To Undertk Corrective Action	0	ProcToUndertkCorrectiveAction

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReference	ExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 6	THE MEMBERSHIP OF THE ORGANIZATION CONSISTS OF ANY PERSON (AGE 21 OR OLDER) OR ORGANIZATION DONATING $100 OR MORE FOR THE PURPOSE OF MEMBERSHIP TO THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	THE ORGANIZATION'S MEMBERS ELECT THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	THE ORGANIZATION'S MEMBERS HAVE THE POWER TO AMEND ARTICLES AND BYLAWS AND TERMINATE MEMBERSHIPS.
FORM 990, PART VI, SECTION B, LINE 11	MANAGEMENT PROVIDED INFORMATION FOR PREPARATION OF THE FORM 990. A COPY OF THE FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS AT A BOARD MEETING AND APPROVED PRIOR TO BEING FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	THE POLICY IS ANNUALLY REVIEWED AND SIGNED BY THE BOARD MEMBERS AND KEY STAFF MEMBERS. BOARD MEMBERS ARE REQUIRED TO SELF-DISCLOSE POTENTIAL OR REAL CONFLICTS OF INTEREST TO THE BOARD. IF A CONFLICT EXISTS THE INDIVIDUAL WILL NOT BE ALLOWED TO VOTE ON THE RELATED ISSUE. CONFLICTS ARE HANDLED ON A CASE BY CASE BASIS.
FORM 990, PART VI, SECTION B, LINE 15A	THE BOARD USES COMPARATIVE DATA FROM THE LONG TERM CARE IMPERATIVE COMPENSATION REPORT AND COMPARATIVE INFORMATION FROM A MAJOR ACCOUNTING FIRM WHEN DETERMINING THE ADMINISTRATOR'S SALARY. INFORMATION IS REVIEWED BY THE FULL BOARD AND DOCUMENTED IN THE MINUTES. THIS WAS LAST COMPLETED IN 2012.
FORM 990, PART VI, SECTION C, LINE 19	THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.