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 411649721 HOLLY RIDGE MANOR INC HOLL 3202394775 500 HOLLY RIDGE DRIVE STARBUCK MN 56381 KAYO ASLAGSON 3202394775 2014-08-13 1 CORY RUTLEDGE P01329381 6123764500 2012 2015-11-30 17:44:51Z MURRAY FINGER 500 HOLLY RIDGE DRIVE STARBUCK MN 56381 386010 0 X WWW.MCHS-HEALTHCARE.ORG X 1989 MN A COMMUNITY OF SERVICES GROUNDED IN FAITH, PROVIDING PERSON CENTERED CARE. 9 7 0 10 0 0 867 380 274464 347309 110 101 37457 38220 312898 386010 0 0 0 0 194833 206258 0 0 0 164423 175530 359256 381788 -46358 4222 493918 501841 35985 39686 457933 462155 X A COMMUNITY OF SERVICES, GROUNDED IN FAITH, PROVIDING PERSON CENTERED CARE THAT ENCOURAGES ALL PEOPLE TO REACH THEIR HIGHEST POTENTIAL. 0 0 368956 0 347309 HOLLY RIDGE MANOR IS A 20-UNIT HOUSING FACILITY OFFERING BOTH ONE AND TWO BEDROOM APARTMENTS TO THE COMMUNITY MEMBERS IT SERVES. HOLLY RIDGE MANOR PROVIDES BOTH INDEPENDENT HOUSING AND ASSISTED LIVING HOUSING AND SERVICES FOR SENIORS AND THOSE NOT CAPABLE OF LIVING INDEPENDENTLY OF OTHERS IN A SAFE AND SECURE SETTING. HOLLY RIDGE MANOR OFFERS DAILY EXERCISE PROGRAMS AS WELL AS THE ASSISTANCE WITH ACTIVITIES OF DAILY LIVING. HOLLY RIDGE MANOR ALSO OFFERS UP TO THREE MEALS DAILY, HOUSEKEEPING SERVICES AND SKILLED NURSING SERVICES SPECIFIC TO EACH CLIENTS NEEDS. HOLLY RIDGE MANOR 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. 368956 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 0 0 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 0 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 FEIGUM 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 1.40 28.60 X 0 43351 2585 MURRAY FINGER 3.00 37.00 X 0 23218 0 BRIAN ENGLER 2.40 33.60 X 0 44327 4333 0 110896 6918 0 0 0 0 0 380 380 RESIDENT REVENUE 623000 347309 347309 347309 101 101 MEALS REVENUE 722210 32884 32884 GARAGE RENTAL 812930 4200 4200 BEAUTY SHOP 812900 1040 1040 96 96 38220 386010 347309 0 38321 185291 178487 6804 6825 6574 251 14142 13623 519 3254 3254 3483 3483 5204 2768 2436 2616 2616 51741 51741 1982 1982 51208 51208 9726 9726 FOOD 37863 37863 RESIDENT SUPPLIES 4560 4560 MISCELLANEOUS 2681 2681 LICENSES AND TAXES 672 672 540 334 206 381788 368956 12832 0 76679 123823 4814 9228 1280859 919277 405204 361582 7221 7208 493918 501841 1229 1883 6500 6500 28256 31303 35985 39686 X 457933 462155 457933 462155 493918 501841 4222 0 X 0 1 X 1 0 X X X X 0 0 0 MINNEWASKA LUTHERAN HOME 410845402 9 0 1 1 0 1 0 0 1 X 24500 24500 1071740 743843 327897 184619 175434 9185 361582 RELATED PARTY PAYABLES 31303 31303 X PART IV, LINE 2B: THE FACILITY HAS A SEPARATE BANK ACCOUNT TO HOLD THE FUNDS WHILE THE RESIDENT IS LIVING AT HOLLY RIDGE. WHEN THE RESIDENT VACATES THE APARTMENT HOLLY RIDGE REFUND THE SECURITY DEPOSIT PLUS INTEREST CALCULATED BASED ON STATE OF MINNESOTA RULES LESS ANY FORFEITURES FOR REPAIRS, IF ANY WITHIN 30 DAYS OF TURNING IN THE KEYS. 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 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF HOLLY RIDGE MANOR 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 MINNEWASKA 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 OR THE BYLAWS REQUIRE AN AFFIRMATIVE VOTE OF A MAJORITY OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE MANAGEMENT TEAM WILL DISCUSS THE COMPLETED FROM 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 C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. MINNEWASKA LUTHERAN HOME 605 MAIN STREET STARBUCK MN 56381 410845402 SKILLED NURSING FACILITY MN 501(C)(3) 9 N/A 0 MINNEWASKA HOME CARE 500 HOLLY RIDGE STARBUCK MN 56381 331124162 HOME CARE MN 501(C)(3) 9 N/A 0 MINNEWASKA HOME DEVELOPMENT 605 MAIN STREET STARBUCK MN 56381 411504339 FUNDRAISING MN 501(C)(3) 11 - TYPE 2 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0