2014-06-19T08:03:27-05:00 2013-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-10-01 410870856 MAPLE LAWN NURSING HOME INC MAPL 5074252571 400 SEVENTH STREET BOX 278 FULDA MN 56131 ARLAN SWANSON ADMINISTRATOR 5074252571 2014-06-05 1 KOREY BOELTER P00047306 6123764500 2012 2015-11-30 17:44:51Z ARLAN SWANSON 400 SEVENTH STREET BOX 278 FULDA MN 56131 4445052 0 X WWW.MAPLELAWN.ORG X 1962 MN TO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS. 9 9 141 110 0 0 18761 9628 4546754 4403279 10690 5569 17777 26576 4593982 4445052 0 0 0 0 2411941 2460686 0 0 0 1858798 1783536 4270739 4244222 323243 200830 4481433 4468719 2371272 2157728 2110161 2310991 X TO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS IN AN INDIVIDUALIZED, DIGNIFIED, AND HOMELIKE MANNER. 0 0 4026341 0 4403279 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. 4026341 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 24 0 141 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X ARLAN SWANSON 5074252571 400 SEVENTH STREET NE FULDA MN 56131 JERRILD STEINER 1.00 X X 0 0 0 ELDEN GETTING 1.00 X X 0 0 0 MARCINE ELDER 1.00 X X 0 0 0 MARY FRAN BUSCH 1.00 X 0 0 0 SHIRLEY BUSCHENA 1.00 X 0 0 0 JEFF ZINS 1.00 X 0 0 0 CLEONE RAMERTH 1.00 X 0 0 0 DEAN MCNEAL 1.00 X 0 0 0 RON JANSSEN 1.00 X 0 0 0 ARLAN SWANSON 50.00 X 82398 0 2000 82398 0 2000 0 0 0 0 PRAIRIE REHABILITATION SERVICES LLC 1720 S CLIFF AVE SIOUX FALLS SD 57105 CONTRACTED THERAPY 208343 1 9628 9628 RESIDENT SERVICES 623000 3550495 3550495 APARTMENT RENTAL 623000 852784 852784 4403279 5569 5569 MISCELLANEOUS INCOME 623000 17173 17173 MEAL INCOME 623000 5012 5012 GARAGE REVENUE 623000 4391 4391 26576 4445052 4403279 0 32145 86008 86008 2020641 2015050 5591 212762 212197 565 141275 140900 375 36258 36258 421557 397338 24219 11487 11487 297186 273078 24108 145207 139988 5219 19899 19899 66832 64000 2832 207190 198409 8781 47148 45150 1998 FOOD 234104 234104 LICENSE SURCHARGE 181712 181693 19 MISCELLANEOUS EXPENSE 52892 52892 REPAIRS AND MAINTENANCE 24159 23135 1024 37905 15291 22614 4244222 4026341 217881 0 1409951 1548999 348714 362447 53357 22068 6166588 3663477 2639856 2503111 6069 24532 23486 7562 4481433 4468719 360660 278459 1967729 1834968 16801 16497 26082 27804 2371272 2157728 X 2110161 2310991 2110161 2310991 4481433 4468719 200830 0 X 0 1 X 1 0 X 3926 6020 7550 18761 9628 45885 4322019 4242701 4358488 4546754 4403279 21873241 4325945 4248721 4366038 4565515 4412907 21919126 0 132885 80415 93455 183248 315375 805378 132885 80415 93455 183248 315375 805378 21113748 6771 16546 9308 10690 5569 48884 6771 16546 9308 10690 5569 48884 30385 26153 21764 17777 26576 122655 4363101 4291420 4397110 4593982 4445052 22090665 0.95580 0.96380 0.00220 0.00250 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUES MEAL INCOME GARAGE REVENUE 0 1 X 4783063 2579583 2203480 254721 81897 172824 1128804 1001997 126807 2503111 ASSET RETIREMENT OBLIGATION 27804 27804 X 4445052 0 4445052 0 4445052 4244222 0 4244222 0 4244222 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. A CITY OF FULDA MINNESOTA 416005177 2012-10-01 1955150 REFUND SERIES 2003 BONDS 0 0 0 A 120182 1955150 1955150 2012 1 0 1 1 A 0 0 0 0 0 0 0 A 0 1 0 0 1 0 0 0 0 A 0 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.