2013-08-14T09:02:28-05:00 2012-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-10-01 411463801 PRESBYTERIAN HOMES HOUSING & ASSISTED LIVING INC PRES 6516316120 2845 NORTH HAMLINE AVENUE ROSEVILLE MN 55113 MARK MEYER 6516316120 2013-08-13 1 TERRANCE O'REILLY P00068340 6123764500 2011 2016-02-24 21:20:13Z DAN LINDH 2845 NORTH HAMLINE AVENUE ROSEVILLE MN 55113 70044625 0 X WWW.PRESHOMES.ORG X 1984 MN TO ENRICH THE LIVES OF OLDER ADULTS THROUGH SERVICES & COMMUNITIES THAT REFLECT THE LOVE OF GOD. 3 1 6686 237 -1091881 -3772255 12765952 202678 48877339 52832701 379672 2508182 -85874 -621468 61937089 54922093 6405669 281424 0 0 23895360 28762791 0 45725 1543689 18807971 20581311 49109000 49671251 12828089 5250842 152779261 169473999 91819244 103263140 60960017 66210859 THE MISSION OF PRESBYTERIAN HOMES HOUSING & ASSISTED LIVING, INC. IS TO ENRICH THE LIVES OF OLDER ADULTS THROUGH SERVICES AND COMMUNITIES THAT REFLECT THE LOVE OF GOD. 0 0 37367374 281424 52832701 PRESBYTERIAN HOMES HOUSING & ASSISTED LIVING, INC. OPERATES SEVERAL SENIOR HOUSING FACILITIES IN MINNESOTA. CAMPUSES IN SPRING PARK, MN CONSISTS OF 145 BED SKILLED NURSING FACILITY, 52 TRADITIONAL ASSISTED LIVING APARTMENTS, 18 MEMORY CARE SPECIFIC ASSISTED LIVING APARTMENTS, 165 INDEPENDENT SENIOR LIVING APARTMENTS, AND 125 MULTIFAMILY EMPLOYEE HOUSING APARTMENTS. A 93 UNIT SENIOR INDEPENDENT APARTMENT BUILDING IS LOCATED IN LITTLE CANADA, MN. ANOTHER CAMPUS IN PLYMOUTH, MN CONSISTS OF 24 MEMORY CARE SPECIFIC ASSISTED LIVING APARTMENTS, 28 TRADITIONAL ASSISTED LIVING APARTMENTS, AND 68 INDEPENDENT SENIOR LIVING APARTMENTS. IN CAMBRIDGE, MN IS A 115 BED SKILLED NURSING FACILITY. 37367374 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 6686 1 1 1 0 0 0 0 0 0 0 0 0 X 3 1 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X HEIDI PETERSON 6516316162 2845 HAMLINE AVENUE NORTH ROSEVILLE MN 55113 SCOTT WEICHT 1.00 X 0 0 0 DAN LINDH 40.00 X X 541112 0 98853 MARK MEYER 40.00 X X 299540 0 16678 JOHN MEHRKENS 40.00 X 237199 0 14662 SHARON KLEFSAAS 40.00 X 245580 0 12398 KAREN MCKENNA 40.00 X 219810 0 7051 MARTHA HURR ERTL 40.00 X 211286 0 6339 DEBORAH BLACK 40.00 X 194749 0 14685 JERRY HUDSON 40.00 X 163240 0 9045 JANNA SEVERANCE 40.00 X 227610 0 10990 MICHAEL BINGHAM 40.00 X 206657 0 13479 CATHY BERGLAND 40.00 X 203199 0 10492 2749982 0 214672 28 1 1 0 SIRIUS COMPUTER SOLUTIONS INC PO BOX 202289 DALLAS TX 75320 IT SERVICES 472000 FRATTALONE COMPANIES INC 3205 SPRUCE STREET ST PAUL MN 55117 SITE WORK PROJECTS 372831 API HEALTHCARE PO BOX 270327 HARTFORD WI 53027 TIMEKEEPING/SCHEDULING SOFTWARE 368783 THE ULTIMATE SOFTWARE GROUP 1485 NORTH PARK DRIVE WESTON FL 33326 PAYROLL PROCESSING SOFTWARE 314251 MAVO SYSTEMS 4330 CENTERVILLE ROAD WHITE BEAR LAKE MN 55110 ENVIRONMENTAL CONTRACTOR 289970 14 202678 202678 RESIDENT SERVICES 623990 30048019 30048019 MANAGEMENT 541610 12439027 12216533 222494 DESIGN & PROCUREMENT 541900 10345655 7749913 2595742 52832701 4278676 4278676 2327396 3275404 -948008 -948008 -886243 -61765 10040948 11811442 -1770494 -1770494 -2695404 924910 46404 35686 10718 10718 MISCELLANEOUS INCOME 900099 673996 673996 MEALS REVENUE 900099 484964 484964 CHILDCARE INCOME 900001 385835 385835 -1228973 -328470 -900503 315822 54922093 50014465 -1091881 5796831 275000 275000 6424 6424 1684281 1684281 22492893 20108869 1336093 1047931 356319 296361 44514 15444 2971032 2471095 371161 128776 1258266 1046537 157191 54538 170305 83596 86709 104242 48371 55871 45725 45725 374146 274727 69339 30080 251872 63929 100091 87852 569643 193278 337302 39063 354597 192010 148909 13678 1761827 1670057 91770 91987 22643 69344 117389 115871 1518 2527992 2527992 3043716 3043716 -224763 13533 -238296 DESIGN AND PROCUREMENT 5883573 5883573 CULINARY EXPENSE 1490894 1490894 NURSING 1294701 1294701 MA SURCHARGE/LICENSE 927443 723455 203988 1841747 1404315 356830 80602 49671251 37367374 10760188 1543689 -1116207 -11777588 7702249 8659333 215883 357451 127051952 21880781 74155920 105171171 21259774 5829549 2471006 1644112 48090636 59589971 152779261 169473999 4868497 6622002 13758143 41741301 2932582 3300059 62402933 38349725 7857089 13250053 91819244 103263140 X 60960017 66210859 60960017 66210859 152779261 169473999 5250842 0 X 0 1 1 X 0 X 422579 1970366 12765952 202678 15361575 24280903 28123038 30981061 48877339 50014465 182276806 24280903 28545617 32951427 61643291 50217143 197638381 0 0 0 197638381 2667525 257692 2894040 2966684 4514935 13300876 2667525 257692 2894040 2966684 4514935 13300876 448278 208579 600696 1257553 26948428 28803309 36293745 64818554 55332774 212196810 0.93140 0.94320 0.06270 0.06150 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME GENERAL STORE SALES RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 34875324 34875324 56934343 12971268 43963075 3290336 1343445 1946891 15157305 7401570 7755735 16794644 164498 16630146 105171171 INVESTMENTS IN AFFILIATES 8907386 AFFILIATE RECEIVABLES 44578880 OTHER ASSETS 6103705 59589971 WORKERS COMPENSATION & OTHER 3907374 DUE TO AFFILIATES 7632241 RESIDENT NOTES 1710438 13250053 PART IV, LINE 2B: THE REPAIRS AND REPLACEMENT RESERVES AND THE RESIDENT NOTES ARE REPORTED AS LONG TERM ASSET AND LIABILITY, RESPECTIVELY ON THE CONSOLIDATED STATEMENTS OF THE FINANCIAL POSITION. AT EACH OF THE FACILITIES, THE CONTRACTS WITH THE RESIDENTS LIMIT THE TOTAL AMOUNT OF DEPOSITS THAT THE ORGANIZATION MUST RETURN AT ANY ONE TIME. THE MAXIMUM AMOUNTS AT EACH OF THE FACILITIES RANGE FROM $100 TO $2,000. IF AT ANY TIME THE NET AMOUNT IT HAS RETURNED TO FORMER RESIDENTS EXCEEDS THE AMOUNT THAT IT HAS RECEIVED FROM NEW TENANTS BY THE APPLICABLE MAXIMUM AMOUNT, THE ORGANIZATION IS NOT REQUIRED TO REFUND ADDITIONAL DEPOSITS UNTIL NEW DEPOSITS ARE COLLECTED BRINING THE AMOUNT OWED UNDER MAXIMUM AMOUNT. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION AND ITS AFFILIATES ARE GENERALLY EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE SECTIONS OF THE STATES STATUTES; CONSEQUENTLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES. HOWEVER,THERE ARE IMMATERIAL AMOUNTS OF UNRELATED BUSINESS INCOME IN CERTAIN AFFILIATES THAT ARE TAXABLE. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES IN EVALUATING UNCERTAIN TAX POSITIONS. THE ORGANIZATION FILES INFORMATION RETURNS AS A TAX-EXEMPT ORGANIZATION.SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE IRS. THE ORGANIZATION'S TAX RETURNS FOR THE 2009, 2010, AND 2011 FISCAL YEARS ARE OPEN TO EXAMINATION BY THE IRS. X X X X X 1 QUENTIN HIETPAS 1333 RIVERSIDE LANE MENDOTA HEIGHTS MN 55118 FUNDRAISING 0 70448 45725 24723 70448 45725 24723 MN IA WI 1 SHEPHERD'S PATH SENIOR HOUSING INC 2845 HAMLINE AVE N ROSEVILLE MN 55113 300225161 501(C)(3) 275000 TO SUPPORT GENERAL OPERATIONS 1 0 SCHOLARSHIPS 4 6424 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: EMPLOYED BY PHS FOR AT LEAST ONE YEAR, WORK AN AVERAGE OF 20 HOURS A WEEK, MAINTAINED AN EXCELLENT WORK RECORD, PROOF OF ACCEPTANCE OR ENROLLMENT IN A LPN/RN PROGRAM, ENDORSEMENT OF THEIR CLINICAL ADMINISTRATOR/DIRECTOR OF HOMECARE AND ADMINISTRATOR, AND SELECTED BY CORPORATE HUMAN RESOURCES. SCHEDULE I, PART II EXPLANATION: THE TRANSFER TO RELATED ORGANIZATIONS IS TRACKED THROUGH PHHAL'S INTERNAL FINANCIAL REPORTING PROCESS BECAUSE BOTH ENTITIES ARE UNDER COMMON MANAGEMENT. X X X X 0 0 0 0 0 0 0 0 0 DAN LINDH 541112 0 0 0 0 0 91233 0 7620 0 639965 0 0 0 MARK MEYER 299540 0 0 0 0 0 8986 0 7692 0 316218 0 0 0 JOHN MEHRKENS 237199 0 0 0 0 0 7116 0 7546 0 251861 0 0 0 SHARON KLEFSAAS 245580 0 0 0 0 0 7367 0 5031 0 257978 0 0 0 KAREN MCKENNA 219810 0 0 0 0 0 6594 0 457 0 226861 0 0 0 MARTHA HURR ERTL 211286 0 0 0 0 0 6339 0 0 0 217625 0 0 0 DEBORAH BLACK 194749 0 0 0 0 0 5842 0 8843 0 209434 0 0 0 JERRY HUDSON 163240 0 0 0 0 0 4897 0 4148 0 172285 0 0 0 JANNA SEVERANCE 227610 0 0 0 0 0 6828 0 4162 0 238600 0 0 0 MICHAEL BINGHAM 206657 0 0 0 0 0 6828 0 6651 0 220136 0 0 0 CATHY BERGLAND 203199 0 0 0 0 0 6096 0 4396 0 213691 0 0 0 CITY OF SPRING PARK MN 416008586 2010-06-03 28000000 REFINANCE AND FINANCE NEW CONSTRUCTION 0 0 0 CITY OF MORA MN 416005389 2006-12-28 7580000 FINANCE ACQUISITION OF SNF 0 0 0 CITY OF CAMBRIDGE MN 416005029 2006-12-28 1000000 FINANCE ACQUISITION OF SNF 0 0 0 CITY OF LITTLE CANADA MN 410973960 2010-12-09 5765000 REFINANCE EXISTING DEBT 0 0 0 137249 25667440 224917 14140730 11301793 2012 1 0 0 1 580000 7580000 386663 140000 7053337 2006 0 0 1 1 1000000 1000000 2006 0 0 1 1 290000 5765000 241103 115300 5408597 2010 1 0 1 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 1 X SCHEDULE K, PART II, COLUMN A, LINE 3 THE TOTAL PROCEEDS OF $25,667,440 INCLUDED ON LINE 3 IN PART II, COLUMN A IS DIFFERENT THAN THE ISSUE PRICE OF $28,000,000 INCLUDED IN PART I, LINE A, COLUMN E BECAUSE THE ORGANIZATION DID NOT DRAW DOWN ALL AVAILABLE FUNDS OF THIS DEBT ISSUANCE. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF PRESBYTERIAN HOMES HOUSING & ASSISTED LIVING, INC. IS PRESBYTERIAN HOMES AND SERVICES. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE ORGANIZATION ELECT THE MEMBERS OF THE GOVERNING BODY, BUT NOT IF THE PERSONS ON THE GOVERNING BODY ARE THE ORGANIZATION'S ONLY MEMBERS OR THEIR DELEGATES. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION'S FORM 990 IS PROVIDED TO VOTING MEMBERS OF THE GOVERNING BODY PRIOR TO FILING WITH THE IRS. OFFICERS AND MANAGEMENT OF THE ORGANIZATION HAVE BEEN INVOLVED IN THE PREPARATION OF THE FORM 990 AND HAVE REVIEWED IT THROUGHOUT THE PROCESS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION OBTAINS ANNUALLY WRITTEN DISCLOSURES FROM GOVERNING BODY MEMBERS, OFFICERS, AND KEY EMPLOYEES. MANAGEMENT AND OFFICERS REVIEW THESE DISCLOSURES AND EVALUATE WHETHER THE INTEREST COULD RESULT IN A CONFLICT AND THEN TAKE THE NECESSARY STEPS TO REMEDIATE ANY SUCH CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE PRESBYTERIAN HOMES & SERVICES BOARD OF DIRECTORS IS RESPONSIBLE FOR THE GOVERNANCE AND STRUCTURE OF COMPENSATION PLANS AND FOR ENSURING REGULATORY COMPLIANCE OF THESE PLANS. CEO, SENIOR MANAGEMENT, EXECUTIVES AND OFFICERS' COMPENSATION SYSTEMS ARE MANAGED BY THE EXECUTIVE COMMITTEE AND PRESBYTERIAN HOMES & SERVICES BOARD OF DIRECTORS. SYSTEMS ARE REVIEWED MANUALLY AND THE ORGANIZATION ENGAGES AN EXTERNAL INDEPENDENT COMPENSATION CONSULTANT TO PROVIDE A FAIR MARKET VALUE OPINION. THE TARGET FOR TOTAL COMPENSATION FOR EXECUTIVE STAFF WHO MEET PERFORMANCE EXPECTATIONS IS SET AT 105% OF THE MIDPOINT IN EACH RESPECTIVE MARKET PRICE PAY RANGE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. SHARING OF HOURS FORM 990, PART VII, SECTION A OFFICERS AND KEY EMPLOYEES SHARE THEIR HOURS BETWEEN THE ORGANIZATION AND ITS RELATED ORGANIZATIONS. SENIOR HOUSING PARNERS LLC 2845 HAMLINE AVE N ROSEVILLE MN 55113 411862251 SENIOR HOUSING CONSTRUCTION PROJECT DEVELOPMENT AND MANAGEMENT MN 3670207 6739878 PHHAL SENIOR LIFESTYLE DESIGN LLC 2845 HAMLINE AVE N ROSEVILLE MN 55113 203078661 SENIOR HOUSING INTERIOR DESIGN MN 6769370 2044047 PHHAL PLYMOUTH SENIOR HOUSING LLC 2845 HAMLINE AVE N ROSEVILLE MN 55113 412011416 CARE OF THE ELDERLY MN 5285477 17184136 PHHAL PHS1221 NICOLLET LLC 2845 HAMLINE AVE N ROSEVILLE MN 55113 203811321 COMMERCIAL OFFICE PROPERTY MN 1339294 0 PHHAL PHSCAMBRIDGE CARE CENTER LLC 2845 HAMLINE AVE N ROSEVILLE MN 55113 205698161 CARE OF THE ELDERLY MN 6004462 10807438 PHHAL PHS LAKE MINNETONKA LLC 2845 HAMLINE AVE N ROSEVILLE MN 55113 272377256 CARE OF THE ELDERLY MN 19987765 31339546 PHHAL PHS MANAGEMENT LLC 2845 HAMLINE AVE N ROSEVILLE MN 55113 275496089 SENIOR HOUSING AND RELATED ORGANIZATIONS MANAGEMENT SERVICES MN 13950704 23261249 PHHAL PHS MAYFIELD LLC 2845 HAMLINE AVE N ROSEVILLE MN 55113 273708705 CARE 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