TIESZEN MEMORIAL HOME INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: TIESZEN MEMORIAL HOME INC (EIN 46-0213759)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-09-04
IRS object ID: 201302479349300485
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 O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-09-04T16:16:57-05:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	WOHLENBERG RITZMAN & CO LLC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 1018	AddressLine1
City	YANKTON	City
State	SD	State
ZIP Code	57078	ZIPCode

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

Filer Filer

Field	Value	IRS element (for citing)
EIN	460213759	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	TIESZEN MEMORIAL HOME	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	TIES	NameControl
Phone	6056483611	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	312 EAST STATE ST	AddressLine1
City	MARION	City
State	SD	State
ZIP Code	57043	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	PAUL ENGBRECHT	Name
Title	CEO	Title
Phone	6056483611	Phone
Date Signed	2013-08-31	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	KATHLEEN DOYLE	Name
Phone	6056654401	Phone
Date Prepared	2013-08-28	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	PAUL ENGBRECHT	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	312 EAST STATE ST	AddressLine1
City	MARION	City
State	SD	State
ZIP Code	57043	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	4334549	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.TIESZENHOME.COM	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
State Legal Domicile	SD	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE THE HIGHEST QUALITY OF CARE AND QUALITY OF LIFE FOR THE LONG AND SHORT TERM CARE RESIDENTS.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	7	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	7	NbrIndependentVotingMembers
Total Nbr Employees	163	TotalNbrEmployees
Total Nbr Volunteers	25	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	4692	ContributionsGrantsPriorYear
Contributions Grants Current Year	2085	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	3908995	ProgramServiceRevenuePriorYear
Program Service Revenue CY	4327507	ProgramServiceRevenueCY
Investment Income Prior Year	15787	InvestmentIncomePriorYear
Investment Income Current Year	-895	InvestmentIncomeCurrentYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	3929474	TotalRevenuePriorYear
Total Revenue Current Year	4328697	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	2260918	SalariesEtcPriorYear
Salaries Etc Current Year	2363384	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	1709928	OtherExpensePriorYear
Other Expenses Current Year	1679217	OtherExpensesCurrentYear
Total Expenses Prior Year	3970846	TotalExpensesPriorYear
Total Expenses Current Year	4042601	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-41372	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	286096	RevenuesLessExpensesCY
Total Assets BOY	4681933	TotalAssetsBOY
Total Assets EOY	4452370	TotalAssetsEOY
Total Liabilities BOY	1812402	TotalLiabilitiesBOY
Total Liabilities EOY	1299893	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	2869531	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	3152477	NetAssetsOrFundBalancesEOY
Mission Description	TO PROVIDE THE HIGHEST QUALITY OF CARE AND QUALITY OF LIFE FOR THE LONG AND SHORT TERM CARE RESIDENTS.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	3705686	Expense
Revenue	4325695	Revenue
Description	TIESZEN MEMORIAL HOME IS COMPRISED OF A 64-BED SKILLED NURSING HOME, A 16-BED ASSISTED LIVING FACILITY, A 4 UNIT APARTMENT COMPLEX, A 12 UNIT AND TWO 6 UNIT APARTMENT COMPLEXES IN MARION, SD AND A 14-BED ASSISTED LIVING FACILITY IN PARKER, SD. THE HOME PROVIDES LONG TERM NURSING HOME CARE AND HOME HEALTH CARE SERVICES.	Description
Total Program Service Expense	3705686	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	1	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	163	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	7	NbrVotingGoverningBodyMembers
Number Independent Voting Members	7	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	false	WhistleblowerPolicy
Document Retention Policy	false	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	LAURA WILSON	NamePerson
Telephone Number	6056483611	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	BOX 209	AddressLine1
City	MARION	City
State	SD	State
ZIP Code	57043	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation
RAVILA BERENS
SEC/TREAS	1.00	X	X	633	0	0
LAWRENCE ARBEITER
PRESIDENT	1.00	X	X	585	0	0
ROBERT LOOF
VICE PRESIDE	1.00	X	X	585	0	0
PAUL JOHNSON
MEMBER	1.00	X		585	0	0
RICHARD LUKE
MEMBER	1.00	X		536	0	0
JAMES A JONES
MEMBER	1.00	X		487	0	0
JEFF COLE
MEMBER	1.00	X		0	0	0
LAURA M WILSON
ADMINISTRATO	40.00		X	77884	0	6201
PAUL ENGBRECHT
CEO	20.00		X	55737	0	3606

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	137032	TotalReportableCompFromOrg
Total Other Compensation	9807	TotalOtherCompensation
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
All Other Contributions	2085	AllOtherContributions
Total Contributions	2085	TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	ExclusionExclusionAmount
RESIDENT SERVICE REVENUES	623000	4016398	4016398
APARTMENT RENTAL	623000	218747		$218,747
OTHER OPERATING REVENUE	623000	92362	92362

Field	Value	IRS element (for citing)
Total Program Service Revenue	4327507	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	2361	TotalRevenueColumn
Exclusion	$2,361	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Other	2596	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	5852	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Other	-3256	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	-3256	TotalRevenueColumn
Related Or Exempt Function Income	-3256	RelatedOrExemptFunctionIncome

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	4328697	TotalRevenueColumn
Related Or Exempt Function Income	4105504	RelatedOrExemptFunctionIncome
Exclusion	$221,108	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	137032	Total
Management And General	137032	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	1785900	Total
Program Services	1729759	ProgramServices
Management And General	56141	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	61629	Total
Program Services	52314	ProgramServices
Management And General	9315	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	233255	Total
Program Services	226669	ProgramServices
Management And General	6586	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	145568	Total
Program Services	128653	ProgramServices
Management And General	16915	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	9460	Total
Program Services	9460	ProgramServices

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	24577	Total
Management And General	24577	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	241584	Total
Program Services	234698	ProgramServices
Management And General	6886	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	50963	Total
Program Services	14251	ProgramServices
Management And General	36712	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	41448	Total
Program Services	6862	ProgramServices
Management And General	34586	ManagementAndGeneral

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	275564	Total
Program Services	275564	ProgramServices

Travel Travel

Field	Value	IRS element (for citing)
Total	3674	Total
Management And General	3674	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	42198	Total
Program Services	42198	ProgramServices

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	404985	Total
Program Services	404985	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	129499	Total
Program Services	125008	ProgramServices
Management And General	4491	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices
FOOD EXPENSE	206937	206937
NURSING SUPPLIES	83555	83555
PHARMACY	57220	57220
PROGRAM SUPPLIES, OTHER	48345	48345

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	59208	Total
Program Services	59208	ProgramServices

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	4042601	Total
Program Services	3705686	ProgramServices
Management And General	336915	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	100	BOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	605338	BOY
EOY	576992	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	371069	BOY
EOY	330377	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	1121	BOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	17954	BOY
EOY	26629	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	8835587	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	5317215	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	3686351	BOY
EOY	3518372	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	4681933	BOY
EOY	4452370	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	196049	BOY
EOY	253399	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	1593574	BOY
EOY	1027142	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	1240	BOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	21539	BOY
EOY	19352	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	1812402	BOY
EOY	1299893	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	2844091	BOY
EOY	3127037	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	25440	BOY
EOY	25440	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	2869531	BOY
EOY	3152477	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	4681933	BOY
EOY	4452370	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	286096	ReconcilationRevenueExpenses
Reconcilation Other Changes	-3150	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited

FS Audited Basis FSAuditedBasis

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

Field	Value	IRS element (for citing)
Audit Committee	true	AuditCommittee

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	2790	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	16200	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	3487	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4692	CurrentTaxYearMinus1Year
Current Tax Year	2085	CurrentTaxYear
Total	29254	Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	3680394	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	3866272	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4068113	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	3714338	CurrentTaxYearMinus1Year
Current Tax Year	4108760	CurrentTaxYear
Total	19437877	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	3683184	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	3882472	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4071600	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	3719030	CurrentTaxYearMinus1Year
Current Tax Year	4110845	CurrentTaxYear
Total	19467131	Total

Field	Value	IRS element (for citing)
Public Support Total509	19467131	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	11912	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1361	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4029	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	210444	CurrentTaxYearMinus1Year
Current Tax Year	221108	CurrentTaxYear
Total	448854	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	11912	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	1361	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4029	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	210444	CurrentTaxYearMinus1Year
Current Tax Year	221108	CurrentTaxYear
Total	448854	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	3695096	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	3883833	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4075629	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	3929474	CurrentTaxYearMinus1Year
Current Tax Year	4331953	CurrentTaxYear
Total	19915985	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.97750	PublicSupportPercentage509
Prior Year Support Percentage	0.98740	PriorYearSupportPercentage
Investment Income Percentage	0.02000	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.01000	PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509	X	ThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	96521	OtherCostOrOtherBasis
Book Value	96521	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	6526943	OtherCostOrOtherBasis
Depreciation	3653734	Depreciation
Book Value	2873209	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	2007489	OtherCostOrOtherBasis
Depreciation	1556610	Depreciation
Book Value	450879	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	204634	OtherCostOrOtherBasis
Depreciation	106871	Depreciation
Book Value	97763	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	3518372	TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	SECURITY DEPOSITS	Description
Amount	$19,352	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	19352	TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt	4325547	TotRevenueEtcAuditedFinclStmt
Revenue Subtotal	4325547	RevenueSubtotal
Other Revenues Not Included	3150	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	3150	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	4328697	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	4042601	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	4042601	ExpensesSubtotal
Total Expenses Per Form990	4042601	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

Field	Value	IRS element (for citing)
Identifier	REVENUE AMOUNTS INCLUDED ON RETURN - OTHER	Identifier
Return Reference	SCHEDULE D, PAGE 4, PART XI, LINE 4B	ReturnReference
Explanation	WA ST APTS PRIOR YEAR ADJUSTMENT 3,150 PRE 2012 ENTITY NOT INCLUDED IN AUDIT 0	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS	FORM 990, PAGE 1, PART I, LINE 6	ASSIST WITH ACTIVITIES
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	REVIEWED BY CEO AND BOARD BEFORE FILING
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	ANNUAL REVIEW BY BOARD
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	CEO PREPARES AN ANNUAL BUDGET FOR THE OPERATION OF THE FACILITY FOR APPROVAL BY THE BOARD OF DIRECTORS
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	CEO PREPARES AN ANNUAL BUDGET FOR THE OPERATION OF THE FACILITY FOR APPROVAL BY THE BOARD OF DIRECTORS
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	ON REQUEST
RECONCILIATION OF CHANGES - OTHER	FORM 990, PART XI, LINE 9	WA ST APTS PRIOR YEAR ADJUSTMENT -3,150 PRE 2012 ENTITY NOT INCLUDED IN AUDIT 0

TIESZEN MEMORIAL HOME INC: Form 990, tax year 2012

Return header ReturnHeader

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Preparer Firm US Address PreparerFirmUSAddress

Filer Filer

Name Name

US Address USAddress

Officer Officer

Preparer Preparer

Form 990 IRS990

Address Principal Officer US AddressPrincipalOfficerUS

The Books Are In Care Of TheBooksAreInCareOf

Address US AddressUS

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

Program Service Revenue ProgramServiceRevenue (3 entries)

Investment Income InvestmentIncome

Gross Amount Sales Assets GrossAmountSalesAssets

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Gain Or Loss GainOrLoss

Net Gain Or Loss Investments NetGainOrLossInvestments

Total Revenue TotalRevenue

Comp Current Officers Directors CompCurrentOfficersDirectors

Other Salaries And Wages OtherSalariesAndWages

Pension Plan Contributions PensionPlanContributions

Other Employee Benefits OtherEmployeeBenefits

Payroll Taxes PayrollTaxes

Fees For Services Management FeesForServicesManagement

Fees For Services Accounting FeesForServicesAccounting

Fees For Services Other FeesForServicesOther

Advertising Advertising

Office Expenses OfficeExpenses

Occupancy Occupancy

Travel Travel

Interest Interest

Depreciation Depletion DepreciationDepletion

Insurance Insurance

Other Expenses OtherExpenses (4 entries)

All Other Expenses AllOtherExpenses

Total Functional Expenses TotalFunctionalExpenses

Cash Non Interest Bearing CashNonInterestBearing

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Accounts Receivable AccountsReceivable

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Total Assets TotalAssets

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Other Liabilities OtherLiabilities

Total Liabilities TotalLiabilities

Unrestricted Net Assets UnrestrictedNetAssets

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FS Audited Basis FSAuditedBasis

Schedule A IRS990ScheduleA

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Total509 Total509

Gross Investment Income509 GrossInvestmentIncome509

Investment Income And UBTI InvestmentIncomeAndUBTI

Total Support Total TotalSupportTotal

Schedule D IRS990ScheduleD

Land Land

Buildings Buildings

Equipment Equipment

Other Land Buildings OtherLandBuildings

Other Liabilities OtherLiabilities

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

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