2013-03-04T08:37:09-06:00 2012-09-30 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2011-10-01 237296950 ANNANDALE CARE CENTER ANNA 3202743737 500 PARK STREET EAST ANNANDALE MN 55302 DEBRA REITMEIER 3202743737 2013-02-21 1 LISA CHAFFEE CPA P00193453 7012398500 2013-02-21 2011 2016-03-07 17:11:31Z DEBRA REITMEIER 500 PARK STREET EAST ANNANDALE MN 55302 7129417 0 X WWW.AHCSMN.ORG X 1973 MN SKILLED NURSING SERVICES AND ASSISTED LIVING SERVICES 7 7 215 58 0 0 19946 8045 7306450 6998865 40335 122327 0 0 7366731 7129237 20156 20247 0 0 3724295 3636323 0 0 0 3180413 3276237 6924864 6932807 441867 196430 12470879 12560494 9633185 9508429 2837694 3052065 X QUALITY CARE AND SERVICES THAT SHAPE THE FUTURE FOR THE DYNAMIC NEEDS OF THE PEOPLE IN OUR AREA. 0 0 6321101 20247 6998865 THE ORGANIZATION OPERATES A 60 BED SKILLED NURSING FACILITY, A 26 UNIT ASSISTED LIVING BUILDING (A.K.A. CENTENNIAL VILLA ASSISTED LIVING), A 39 UNIT MEMORY CARE FACILITY AND A WELLNESS CENTER WHICH OPENED IN OCTOBER 2009. IT NOT ONLY PROVIDES SERVICES TO THE ELDERLY POPULATION IN ANNANDALE BUT ALSO TO THOSE IN OTHER AREA COMMUNITIES WHICH HELPS THE INDIVIDUAL TO REMAIN IN THE SAME GEOGRAPHICAL AREA OF THEIR FORMER RESIDENCE. THE SKILLED NURSING FACILITY HAS AN EXCELLENT THERAPY PROGRAM THAT IS AVAILABLE TO ITS RESIDENTS WHO ARE IN NEED OF REHABILITATION SERVICES. IT ALSO HAS AN OUTPATIENT PROGRAM THAT TREATS THOSE FROM THE ANNANDALE COMMUNITY AND THE SURROUNDING AREA. IT IS BECAUSE OF ITS ONSITE THERAPY PROGRAM THAT IT HAS BECOME THE FIRST CHOICE FOR MOST WHEN THEY REQUIRE REHABILITATION SERVICES FOLLOWING A SURGERY IN ORDER TO RETURN HOME SAFELY. THE ASSISTED LIVING BUILDING SERVES AS A PLEASANT TRANSITION FOR THOSE WHO NEED ADDITIONAL HELP THAT IS NOT READILY AVAILABLE IN THEIR OWN HOME BUT ARE STILL INDEPENDENT ENOUGH THAT THEY DON'T REQUIRE THE SERVICES OF A SKILLED NURSING FACILITY. THE MEMORY LOSS UNIT IS MUCH MORE APPROPRIATE FOR THOSE WHO SUFFER FROM ALZHEIMER'S AND/OR SEVERE DEMENTIA THAN A SKILLED NURSING FACILITY. THE ENVIRONMENT IS CONTROLLED AND SETUP TO MEET EACH RESIDENT'S NEEDS RELATING TO THEIR SPECIFIC ILLNESS. THE WELLNESS CENTER HAS A THERAPY/EXERCISE SWIM POOL, EXERCISE CLASS STUDIO AND AN EXERCISE EQUIPMENT ROOM DEVELOPED TO SERVE THE WELLNESS NEEDS OF THOSE 50 YEARS OF AGE AND OLDER - BOTH WITHIN THE CAMPUS AND THE OUTSIDE COMMUNITY. 6321101 1 1 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 0 0 0 0 0 0 0 1 0 0 0 0 1 2 0 1 215 1 0 0 0 0 0 0 0 0 0 0 X 7 7 1 0 1 0 0 1 1 1 0 0 0 1 1 0 1 1 1 0 0 0 MN X MOLLY LAUDENBACH 3202741476 500 PARK STREET EAST ANNANDALE MN 55302 X SHARON PETERSONCHAIR AS OF 412 0.10 X X 0 0 0 MARK D MILLERCHAIR THRU 312 0.10 X X 0 0 0 KATHY GRUYS 0.10 X X 0 0 0 JERRY WOLFSTELLER 0.10 X 0 0 0 SHELLY JONAS 0.10 X 0 0 0 ED SKOMOROH 0.10 X 0 0 0 JACK DRISTE 0.10 X 0 0 0 ROGER MILLNER 0.10 X 0 0 0 DEBRA REITMEIERADMINPRESFROM 112 38.00 X 83226 0 14251 JOHN NELSON ADMINISTRATOR 39.70 X 145999 0 1236 229225 0 15487 1 0 0 0 REHABVISIONS 11623 ARBOR ST STE 201 OMAHA NE 68144 PT, OT AND SLP 618984 1 8045 8045 RESIDENT REVENUE 623000 6825055 6825055 OTHER SUPPORTING REVEN 900099 114596 114596 WELLNESS CENTER 713940 59214 59214 6998865 121724 121724 783 180 603 603 603 7129237 6998865 0 122327 20247 20247 265696 265696 2975368 2952143 23225 1375 1375 145557 145557 248327 227262 21065 2229 2229 20220 20220 942130 855637 86493 16173 16173 150635 91588 59047 13076 13076 353110 293167 59943 4039 2144 1895 12969 7517 5452 516087 516087 551814 551814 1069 1069 MEDICAL SUPPLIES 463223 463223 DHS SURCHARGE 168900 168900 DUES & SUBSCRIPTIONS 21199 21199 BAD DEBT EXPENSE 2307 2307 37057 23508 13549 6932807 6321101 611706 0 1815210 2118156 819391 806676 356431 334231 11802696 4846184 7269419 6956512 2203531 2339567 6897 5352 12470879 12560494 565317 589474 9030000 8885000 37868 33955 9633185 9508429 X 2837694 3052065 2837694 3052065 12470879 12560494 X 196430 17941 X 0 1 0 X 0 X 3474 7580 100743 19946 8045 139788 5575740 6824180 7093527 7306450 6998865 33798762 5579214 6831760 7194270 7326396 7006910 33938550 0 50240 80381 81144 138844 87365 437974 50240 80381 81144 138844 87365 437974 33500576 53848 26375 14308 39015 121724 255270 53848 26375 14308 39015 121724 255270 5633062 6858135 7208578 7365411 7128634 34193820 0.97970 0.97600 0.00750 0.00580 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 69516 69516 9806216 3693453 6112763 1312489 910256 402233 614475 242475 372000 6956512 PART IV, LINE 2B: ANNANDALE CARE CENTER ACTS AS CUSTODIAN FOR FUNDS OF ITS RESIDENTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: COMMUNITY SERVICES, CARE CENTER, AND CONGREGATE ARE ORGANIZED AS MINNESOTA NONPROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE ORGANIZATIONS ARE ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE ORGANIZATIONS ARE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE ORGANIZATIONS HAVE DETERMINED THEY ARE NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAVE NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. THE ORGANIZATIONS BELIEVE THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE ORGANIZATIONS 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- EDUCATION 8 20247 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SCHOLARSHIPS ARE AWARDED TO EMPLOYEES WHO WORK AN AVERAGE OF 20 HOURS A WEEK OR MORE AND WHO ARE ENROLLED IN A PROGRAM OF STUDY RELATED TO LONG TERM CARE. RECIPIENTS ARE SELECTED BY A COMMITTEE ON A QUARTERLY BASIS. FUNDS ARE DISBURSED UPON RECEIVING A COPY OF THE RECIPIENT'S TUITION/FEES STATEMENT AND/OR RECEIPTS FOR PURCHASES OF REQUIRED TEXTBOOKS. THE GUIDELINES FOR THIS PROGRAM ARE IN ACCORDANCE WITH THOSE SET FORTH BY THE MN DEPARTMENT OF HUMAN SERVICES' NURSING FACILITY SCHOLARSHIP PROGRAM. ECONOMIC DEVELOPMENT AUTHORITY OF THE CITY OF ANNANDALE MN 416004935 035728AV5 2007-11-02 9296182 SEE SCH K,PART VI 0 0 0 340000 9296182 265134 272429 186000 4609396 4235652 2009 1 1 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 SCHEDULE K SUPPLENTAL INFORMATION PART I, ITEM (F) DESCRIPTION OF PURPOSE CONTINUED: CONSTRUCTION OF MEMORY CARE FACILITY, RENOVATION AND ADDITION TO THE NURSING FACILITY, AND TO REFUND BONDS ISSUED. REFUNDED BONDS ISSUED JUNE 14, 1999 AND AUGUST 1, 2003 FORM 990, PART VI, SECTION A, LINE 1 THE PRESIDENT DOES NOT HAVE VOTING RIGHTS. FORM 990, PART VI, SECTION A, LINE 2 SHELLY JONAS AND ROGER MILLNER HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S BYLAWS WERE AMENDED TO CHANGE THE PRESIDENT TO A NON-VOTING MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS IS ELECTED ANNUALLY BY THE BOARD OF DIRECTORS OF ANNANDALE HEALTH AND COMMUNITY SERVICES. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING MUST BE APPROVED BY THE BOARD OF DIRECTORS OF ANNANDALE HEALTH AND COMMUNITY SERVICES: ** BUDGET - CHANGES IN BUDGET OF OVER $10,000 - EXPENDITURES OF OVER $10,000 - SALES OF ASSETS OF OVER $10,000 - CHANGES TO THE BYLAWS THE FOLLOWING MUST BE APPROVED BY THE PRESIDENT OF THE ANNANDALE HEALTH AND COMMUNITY SERVICE BOARD: - CHANGES IN THE BUDGET OF OVER $5,000 BUT LESS THAN $10,000 - EXPENDITURES OF OVER $5,000 BUT LESS THAN $10,000 - SALES OF ASSETS OF OVER $5,000 BUT LESS THAN $10,000 FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES THAT CAN ACT ON BEHALF OF THE BOARD. COMMITTEES MUST COME BACK TO THE FULL BOARD TO MAKE A FINAL DECISION. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY OF THE FORM 990 WILL BE MAILED OUT TO MEMBERS OF THE BOARD PRIOR TO THE FILING DATE. ALSO, THE CONTROLLER AND THE ADMINISTRATOR/PRESIDENT WILL REVIEW A DRAFT COPY OF THE FORM 990 BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THERE IS NO ANNUAL FORM OR DISCLOSURE THAT IS USED TO UNCOVER CONFLICTS OF INTEREST; HOWEVER, INDIVIDUALS ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST BASED ON AN "HONOR-SYSTEM." ANYONE WHO CAN INFLUENCE THE ACTIONS OF THE CORPORATION IS COVERED BY THE POLICY. THIS INCLUDES BOARD MEMBERS, KEY EMPLOYEES, OFFICERS, AND EMPLOYEES. THE BOARD REVIEWS AND DETERMINES WHEN AND IF A CONFLICT EXISTS. IF A CONFLICT EXISTS, BOARD MEMBERS ARE NOT ALLOWED TO VOTE ON THE ISSUE IN CONFLICT. ALL CONFLICTS OF INTEREST ARE DOCUMENTED IN THE BOARD MEETING MINUTES. EACH YEAR, THE CORPORATION FINDS OUT WHAT THE INCREASE IN RATES WILL BE. THE INCREASE IN RATES IS ALLOCATED PROPORTIONATELY ACROSS THE BOARD TO ALL EMPLOYEES. THE BUDGET IS ALSO DETERMINED BY THE INCREASE IN RATES AND THE BOARD OF DIRECTORS APPROVES THE BUDGET. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE NOT MADE PUBLICLY AVAILABLE. FORM 990, PART VII: THE FOLLOWING INDIVIDUALS LISTED IN PART VII DEVOTED TIME TO ANNANDALE CONGREGATE HOUSING, A RELATED ORGANIZATION: JOHN NELSON: THREE TENTHS OF AN HOUR PER WEEK DEBRA REITMEIER: TWO HOURS PER WEEK MARK MILLER: ONE TENTH OF AN HOUR PER WEEK SHARON PETERSON: ONE TENTH OF AN HOUR PER WEEK ED SKOMOROH: ONE TENTH OF AN HOUR PER WEEK JERRY WOLFSTELLER: ONE TENTH OF AN HOUR PER WEEK SHELLY JONAS: ONE TENTH OF AN HOUR PER WEEK THE FOLLOWING INDIVIDUALS LISTED IN PART VII DEVOTED TWO TENTHS OF AN HOUR PER WEEK TO ANNANDALE HEALTH AND COMMUNITY SERVICES, A RELATED ORGANIZATION: MARK MILLER, SHARON PETERSON, KATHY GRUYS, JERRY WOLFSTELLER, SHELLY JONAS, JACK DRISTE, AND ED SKOMOROH CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 17,941. ANNANDALE HEALTH AND COMMUNITY SERVICES 500 PARK STREET EAST ANNANDALE MN 55302 411820760 OVERSIGHT MN 501(C)(3) LINE 7 N/A 0 HEARTLAND TRANSIT 500 PARK STREET EAST ANNANDALE MN 55302 411820763 INACTIVE CORPORATION MN 501(C)(3) LINE 7 ANNANDALE HEALTH AND COMMUNITY SERVICES 0 ANNANDALE CONGREGATE HOUSING 500 PARK STREET EAST ANNANDALE MN 55302 363566531 INDEPENDENT LIVING MN 501(C)(3) LINE 11A, I ANNANDALE HEALTH AND COMMUNITY SERVICES 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0