2013-04-12T09:50:34-05:00 2012-06-30 411765929 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2011-07-01 410870847 COMMUNITY MEMORIAL HOME AT OSAKIS MINNESOTA INCORPORATED COMM 3208592142 410 WEST MAIN STREET OSAKIS MN 56360 DAVID CARLSON 3208592142 2013-02-11 1 KIM HUNWARDSEN CPA P00484560 6122536500 2013-02-11 2011 2016-03-07 17:11:31Z GALEON DAVID CARLSON 410 WEST MAIN STREET OSAKIS MN 56360 5185835 0 X WWW.GALEONMN.COM X 1961 MN TO PROVIDE THE ELDERLY, SICK AND INFIRMED WITH HOUSING FACILITIES AND SERVICES TO MEET THEIR PHYSICAL, SOCIAL AND PSYCHOLOGICAL NEEDS. 9 8 178 35 1283 -2755 1055 245 5465252 5142881 56683 42709 0 0 5522990 5185835 5500 3800 0 0 2987284 2966343 0 0 0 2465824 2372026 5458608 5342169 64382 -156334 9549304 9139805 5803786 5599470 3745518 3540335 X THE ORGANIZATION'S MISSION IS TO PROVIDE THOSE IN NEED OF OUR SERVICES WITH THE BEST QUALITY OF CARE THAT WE ARE CAPABLE OF WITHIN A CARING, COMFORTABLE AND SUPPORTIVE ENVIRONMENT; TO AFFORD EACH RESIDENT AND TENANT THE OPPORTUNITY TO ACHIEVE THE HIGHEST POSSIBLE QUALITY OF LIFE; AND TO OFFER ALL WHO PASS THROUGH OUR DOORS INCREASING OPPORTUNITY FOR WELLNESS, CHOICE, PRIVACY, DIGNITY, AND SERVICE ACCESS AND AFFORDABILITY. 0 0 4842885 3800 5141598 COMMUNITY MEMORIAL HOME AT OSAKIS, MINNESOTA, INCORPORATED, D/B/A GALEON (GALEON) OWNS AND OPERATES A 52-BED LICENSED NURSING FACILITY AND A WELLNESS AND THERAPY CENTER, AS WELL AS A 20-UNIT ASSISTED LIVING FACILITY (TERRACE HEIGHTS), A 25-UNIT ASSISTED LIVING FACILITY (WEST VIEW) AND A 20-UNIT MEMORY CARE ASSISTED LIVING FACILITY (BRIDGEWELL). GALEON COVERAGE, LLC (GALEON LLC), A MINNESOTA LIMITED LIABILITY COMPANY FORMED ON SEPTEMBER 1, 2011, IS ORGANIZED FOR THE PURPOSE OF SELLING LONG-TERM CARE INSURANCE IN THE OSAKIS AND SURROUNDING AREAS. GALEON EXECUTED A LOANED EMPLOYEE AGREEMENT WITH GALEON COVERAGE, LLC TO PROVIDE CONTRACTED SERVICES ON BEHALF OF GALEON, LLC BY ONE OR MORE EMPLOYEES OF GALEON. GALEON IS THE SOLE MEMBER OF GALEON, LLC.IN ADDITION, COMMUNITY MEMORIAL HOME MANAGES THE OPERATION OF OSAKIS COMMUNITY MANOR APARTMENTS THAT DEDICATES 24 UNITS OF HOUSING TO INDEPENDENT SENIORS, MOST OF WHOM QUALIFY FOR RENTAL ASSISTANCE. THROUGHOUT THESE VARIOUS LOCATIONS, WHICH ARE EITHER CONNECTED TO OR IN CLOSE PROXIMITY TO COMMUNITY MEMORIAL HOME, PROGRAMS HAVE BEEN DEVELOPED TO ASSIST OLDER ADULTS WITH PHYSICAL CARE, REHABILITATION, NUTRITION, STRENGTH RESTORATION, MOBILITY, AND MEDICATION MANAGEMENT. ADDITIONAL SERVICES SUPPORTING THESE CORE PROGRAMS ARE IN PLACE TO FOSTER EACH RESIDENT'S SOCIAL, EMOTIONAL, MENTAL, SPIRITUAL, AND VOCATIONAL GROWTH AND DEVELOPMENT. 4842885 1 0 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 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 1 9 0 1 178 1 1 1 0 0 0 0 0 0 0 0 0 X 9 8 1 0 0 0 1 1 0 1 0 0 0 1 1 1 1 0 1 0 0 0 MN X DAVID CARLSON 3208592142 410 WEST MAIN STREET OSAKIS MN 56360 X NEIL JOHNSON 2.00 X X 0 0 0 GEORGIA THESING 2.00 X X 0 0 0 JIM BACKES 2.00 X X 0 0 0 JOHN TEMPLE 2.00 X X 0 0 0 JAN MOORE 2.00 X 0 0 0 RON CALVERT 2.00 X 0 0 0 RAY MARTHALER 2.00 X 0 0 0 DON LARSEN 2.00 X 0 0 0 IVY NOMELAND 2.00 X 0 0 0 DAVID CARLSON 40.00 X 90427 0 16095 90427 0 16095 0 0 0 0 REHAB CARE GROUP INC PO BOX 503534 ST LOUIS MO 631503534 THERAPY SERVICES 335690 1 245 245 RESIDENT SERVICE REV. 623110 5001531 5001531 WELLNESS INCOME 900099 93977 93977 OTHER REVENUE 900099 47373 46090 1283 5142881 39058 39058 3651 0 3651 3651 3651 5185835 5141598 1283 42709 3800 3800 111800 111800 2354665 2197050 157615 55922 52672 3250 263495 252928 10567 180461 162114 18347 1271 1271 30381 30381 382522 375841 6681 35074 35074 569694 532059 37635 22652 22652 231221 231221 14581 14581 10608 10608 250166 250166 524928 524928 62783 62783 CAPITAL ALLOWANCE ADJUS 160455 160455 PRE-ADMISSION SCREENING 14555 14555 LICENSES, PERMITS, DUES 10472 10472 BAD DEBT EXPENSE 10428 10428 40235 11885 28350 5342169 4842885 499284 0 861019 756138 447225 415205 41442 35201 10295729 4455129 6339750 5840600 1742512 1981655 117356 111006 9549304 9139805 473822 467542 5305023 5106509 24941 25419 5803786 5599470 X 3745518 3540335 3745518 3540335 9549304 9139805 X -156334 -48849 X 0 1 1 X 0 X 102438 64558 1055 245 168296 4540090 5505269 5260246 5465252 5141598 25912455 4642528 5569827 5260246 5466307 5141843 26080751 0 252463 113698 137466 101938 200739 806304 252463 113698 137466 101938 200739 806304 25274447 108292 81484 48239 35355 39058 312428 108292 81484 48239 35355 39058 312428 4750820 5651311 5308485 5501662 5180901 26393179 0.95760 0.95160 0.01180 0.01640 X 0 1 19972 19972 8376087 3070133 5305954 1708914 1307783 401131 190756 77213 113543 5840600 PART IV, LINE 2B: GALEON ACTS AS A CUSTODIAN FOR THE FUNDS OF THE RESIDENTS AND HOLDS TENANT SECURITY DEPOSITS. RESIDENT TRUST FUNDS AND TENANT SECURITY DEPOSITS TOTALED $25,419 AND $24,941 AT JUNE 30, 2012 AND 2011. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: GALEON IS ORGANIZED AS A MINNESOTA NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). GALEON COVERAGE, LLC MAINTAINS EXEMPT STATUS UNDER GALEON'S EXEMPTION SINCE GALEON IS THE SOLE MEMBER OF GALEON COVERAGE, LLC. GALEON IS REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS ANNUALLY. IN ADDITION, GALEON IS SUBJECT TO INCOME TAX ON ANY NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. GALEON BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND, AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. GALEON WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE, IF SUCH INTEREST AND PENALTIES ARE INCURRED. 1 SCHOLARSHIPS 5 3800 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: AN APPLICATION PROCESS IS REQUIRED TO BE COMPLETED BY THOSE THAT ARE SEEKING TO FURTHER THEIR NURSING CAREER. AFTER VERIFICATION THAT THE APPLICANTS ARE ENROLLED IN QUALIFIED COURSES USED TO FURTHER THEIR NURSING CAREER WE AWARD THEM SCHOLARSHIP GRANTS. THESE SCHOLARSHIP GRANTS ARE AWARDED ON A QUARTERLY BASIS. CITY OF OSAKIS MINNESOTA 416005443 2007-05-15 5878537 CONSTRUCTION PROJECT & REFUND 2002 REVENUE BONDS ISSUED 4-29-2002 0 0 0 5878537 3500000 2378537 2008 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 SUSAN MCCAUGHN SISTER OF BOARD PRESIDENT NEIL JOHNSON 58325 COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 2 DAVID CARLSON, NEIL JOHNSON, GEORGIA THESING, JIM BACKES, JOHN TEMPLE, JAN MOORE, RON CALVERT, RAY MARTHALER, AND IVY NOMELAND ALL SERVE AS OFFICERS OR DIRECTORS OF GALEON COVERAGE, LLC, A RELATED ORGANIZATION. A BUSINESS RELATIONSHIP EXISTS BETWEEN THESE INDIVIDUALS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO CLASSES OF MEMBERS. A PERSON WHO HAS CONTRIBUTED $100 OR MORE IS A LIFETIME MEMBER. A PERSON WHO HAS CONTRIBUTED $25 IS ENTITLED TO A ONE-YEAR MEMBERSHIP. ANYONE WHO HAS PAID AN ANNUAL MEMBERSHIP FOR FOUR YEARS BECOMES A LIFETIME MEMBER WHEN THE FOURTH PAYMENT HAS BEEN MADE. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S BOARD OF DIRECTORS IS ELECTED BY ITS MEMBERS AT THE ANNUAL MEETING. EACH MEMBER RECEIVES ONE VOTE. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS REVIEWED BY THE BUSINESS MANAGER AND ADMINISTRATOR PRIOR TO FILING. THE RETURN IS THEN SENT TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE ANNUALLY COMPLETES A CONFLICT OF INTEREST FORM. DISCLOSURES REGARDING ANY POTENTIAL CONFLICTS OF INTEREST ARE SUBMITTED TO THE ADMINISTRATOR. THE ADMINISTRATOR REVIEWS AND DETERMINES IF A CONFLICT OF INTEREST DOES EXIST. IF THERE IS A CONFLICT,THE INDIVIDUAL WILL REMOVE HIMSELF OR HERSELF FROM THE DISCUSSION AND/OR VOTING ON RELATED MATTERS. THE ADMINISTRATOR'S COMPENSATION IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE DISCUSSION AND APPROVAL OF COMPENSATION IS RECORDED IN THE BOARD MINUTES. AS THE ADMINISTRATOR RECEIVES THE SAME PERCENTAGE INCREASE IN SALARY AS ALL OTHER STAFF, COMPARABILITY DATA IS NOT GATHERED OUTSIDE OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE NOT AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART VII, SECTION A: IN ADDITION TO THE HOURS SERVED AT COMMUNITY MEMORIAL HOME, NEIL JOHNSON, GEORGIA THESING, JIM BACKES, JOHN TEMPLE, JAN MOORE, RON CALVERT, RAY MARTHALER, AND IVY NOMELAND ALSO SERVED AN ADDITIONAL ONE-TENTH OF AN HOUR PER WEEK AT GALEON COVERAGE, LLC, A RELATED ORGANIZATION. DAVID CARLSON DEVOTES AN ADDITIONAL 2 HOURS PER WEEK TO GALEON COVERAGE, LLC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -48,849. GALEON COVERAGE LLC 410 WEST MAIN STREET OSAKIS MN 56360 452848035 SELLING LONG-TERM CARE INSURANCE MN 1283 0 COMMUNITY MEMORIAL HOME AT OSAKIS MINNESOTA OSAKIS COMMUNITY MANOR 410 W MAIN STREET OSAKIS MN 56360 411344854 LOW INCOME HOUSING MN 501(C)(4) N/A COMMUNITY MEMORIAL HOME OF OSAKIS MINNESOTA 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 OSAKIS COMMUNITY MANOR L GENERAL LEDGER