2013-02-14T15:09:19-06:00 2012-09-30 410746749 CLIFTONLARSONALLEN LLP PO BOX 217 AUSTIN MN 55912 990 2011-10-01 416031905 MAPLETON COMMUNITY HOME MAPL 5075243315 301 TROENDLE STREET MAPLETON MN 56065 ROXANNE GOSSON 5075243155 2013-01-24 1 TRENT FAST P00692704 5074347000 2011 2016-03-07 17:11:31Z ROXANNE GOSSON 301 TROENDLE STREET MAPLETON MN 56065 3655973 0 X N/A X 1962 MN TO PROVIDE THE ELDERLY WITH HOUSING AND NURSING FACILITIES WITH REHABILITATIVE CARE 11 11 155 65 0 0 10699 2550 3618260 3634259 -2617 11433 9668 7731 3636010 3655973 0 0 0 0 2345215 2444839 0 0 3123 1144832 1635070 3490047 4079909 145963 -423936 7802903 6461176 5174747 4256956 2628156 2204220 THE PURPOSE OF MAPLETON COMMUNITY HOME, INC. IS TO PROVIDE ELDERLY AND HANDICAPPED PEOPLE WITH HOUSING FACILITIES AND NURSING SERVICES; TO MEET THE PHYSICAL, SOCIAL AND PSYCHOLOGICAL NEEDS OF THE RESIDENTS; AND TO CONTRIBUTE TO THE RESIDENT'S HEALTH, SECURITY, AND HAPPINESS. 0 0 3651682 3634259 MAPLETON COMMUNITY HOME IS A RESIDENCE FOR 65 INDIVIDUALS NEEDING SKILLED NURSING CARE. THE HOME SERVES MEDICARE PART A, PART B, MEDICAL ASSISTANCE AND PRIVATE PAYING INDIVIDUALS. THE HOME OFFERS OUTPATIENT REHAILITATION FOR THE COMMUNITY AND DAILY ACTIVITIES FOR THE RESIDENTS. A SOCIAL WORKER IS ON STAFF FOR EMOTIONAL NEEDS AND THE NURSING DEPARTMENT STAFFS 24 HOURS PER DAY. DURING JANUARY, 2012 THE ORGANIZATION COMPLETED THE CONSTRUCTION OF AND PLACED INTO SERVICE A 20 UNIT ASSISTED LIVING FACILITY ADJOINING THE NURSING FACILITY. 3651682 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 0 155 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 MN X ROXANNE GOSSON 5075243155 301 TROENDLE ST PO BOX 307 MAPLETON MN 56065 BRUCE SELLERS 0.50 X 0 0 0 BILL DALY 0.50 X 0 0 0 GINA MASSOP 0.50 X 0 0 0 JEANETTE BRANDT 0.50 X 0 0 0 NANCY DOERING 0.50 X 0 0 0 KATHI REID 0.50 X 0 0 0 SHARON GRUNZKE 0.50 X 0 0 0 MARY JACOBSEN 0.50 X 0 0 0 DAVID PROEHL 0.50 X 0 0 0 JULIE JOHNSON 0.50 X 0 0 0 PAUL LANDSTEINER 0.50 X 0 0 0 JAN BRINDLEY 0.50 X 0 0 0 ROXANNE GOSSON 40.00 X 84991 0 5608 84991 0 5608 0 0 0 0 REHABCARE GROUP PO BOX 503534 ST LOUIS MO 63150 REHAB SERVICES 173560 1 2550 2550 MEDICARE/MEDICAID PAYM 623000 1797957 1797957 RESIDENT REVENUE 623000 1752470 1752470 APARTMENT REVENUE 623000 83832 83832 3634259 11433 11433 VENDING INCOME 623000 4404 4404 GUEST/EMPLOYEE MEAL RE 623000 3089 3089 MISCELLANEOUS INCOME 623000 238 238 7731 3655973 3634259 0 19164 86678 86678 2038173 1955433 82740 58508 54654 3854 93630 87421 6209 167850 156504 11346 5026 5026 23365 23365 40779 33644 7135 63233 63233 235628 207376 28252 150802 150802 4318 4318 15962 4703 11259 199542 199542 293304 293304 45563 45563 SPECIAL ASSESSMENTS 172491 172491 THERAPY EXPENSE 172304 172304 FOOD COSTS 135836 135836 PRE-ADMISSION SCREENING 15314 15314 61603 27668 30812 3123 4079909 3651682 425104 3123 430745 223901 3433295 1217019 182683 252929 22021 37421 7385194 2846670 3537093 4538524 197066 191382 7802903 6461176 1229747 292101 3945000 3964855 5174747 4256956 X 2615028 2191092 13128 13128 2628156 2204220 7802903 6461176 -423936 0 X X 0 1 1 X 0 X 11563 12729 9733 10699 2550 47274 3696619 3634867 3424925 3618260 3634259 18008930 3708182 3647596 3434658 3628959 3636809 18056204 0 1339380 1431240 1558656 1543293 855684 6728253 1339380 1431240 1558656 1543293 855684 6728253 11327951 33452 25133 21414 11119 11433 102551 33452 25133 21414 11119 11433 102551 9668 7731 17399 3741634 3672729 3456072 3649746 3655973 18176154 0.62320 0.58790 0.00560 0.00660 X 55314 55314 5906691 1836437 4070254 1423189 1010233 412956 4538524 3655973 4079909 -423936 -423936 3655973 0 3655973 0 3655973 4079909 0 4079909 0 4079909 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION HAS BEEN GRANTED EXEMPT STATUS FROM FEDERAL AND STATE CORPORATE INCOME TAXES UNDER SECTION 501 (C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. NO LIABILITY HAS BEEN RECOGNIZED BY THE ORGANIZATION AS A RESULT OF THIS STANDARD. THE ORGANIZATION FILES 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 2009, 2010 AND 2011 TAX YEARS OF THE ORGANIZATION ARE OPEN FOR EXAMINATION BY THE IRS. CITY OF MAPLETON MN 416005347 565468AES 2011-05-19 3945000 SEE PART VI 0 0 0 3945000 311238 257521 198961 2632000 2012 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 THE PROCEEDS WERE USED TO CONSTRUCT A NEW SENIOR APARTMENT COMPLEX AND REMODEL THE EXISTING NURSING FACILITY AND WAS ALSO USED TO PAY OFF EXISTING DEBT OF THE NURSING FACILITY. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO BEING FILED WITH THE IRS, A COPY OF THE IRS FORM 990 AND RELATED SCHEDULES ARE REVIEWED BY THE ADMINISTRATOR, INCLUDING A CONFIRMATION OF THE ACCURACY OF EVERY ANSWER AND OVERSIGHT OF APPROPRIATE CHANGES. UPON COMPLETION OF THE ADMINISTRATOR'S REVIEW, THE FORMS ARE REVIEWED AND APPROVED AT A BOARD MEETING PRIOR TO SUBMITTAL TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND KEY EMPLOYEES ANNUALLY COMPLETE A SURVEY RELATED TO BUSINESS RELATIONSHIPS AND FAMILY MEMBERS THAT COULD, OR DO, CREATE A CONFLICT OF INTEREST. THESE ARE SUMMARIZED AND FILED ALONG WITH BOARD MEETING MINUTES. CONFLICTS OF INTEREST ARE DETERMINED BY A REVIEW OF THE POTENTIAL CONFLICTS BY THE ADMINISTRATOR AND THE BOARD OF DIRECTORS. IF A CONFLICT EXISTS, THEN THE CONFLICTED BOARD MEMBER OR KEY EMPLOYEE IS EXCLUDED FROM DISCUSSIONS AND VOTES RELATED TO ANY POTENTIAL OR EXISTING RELATIONSHIPS INVOLVING THE CONFLICT OF INTEREST. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST WAS INTENTIONALLY HIDDEN BY A BOARD MEMBER, THEN THE SITUATION WOULD BE INVESTIGATED AND THE BOARD MEMBER COULD BE SUSPENDED AND SUBJECT TO DISMISSAL. ADDITIONALLY, THE REMAINING BOARD MEMBERS AND KEY EMPLOYEES WILL REVIEW, FOR FAIRNESS, ALL PAST TRANSACTIONS INVOLVING THE CONFLICT OF INTERESTS. IF A TRANSACTION APPEARS TO LACK ARMS-LENGTH, EITHER TO THE DETRIMENT OF THE ORGANIZATION, OR TO THE UNFAIR ADVANTAGE OF THE BOARD MEMBER, THEN ALL LEGAL REMEDIES WILL BE CONSIDERED. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS USED TO SET THE ADMINISTRATOR'S ANNUAL SALARY IS BASED ON A COMBINATION OF COMPARISON TO COMPARABLE ORGANIZATIONS THROUGH USE OF OUR TRADE ORGANIZATION'S ANNUAL COMPENSATION SURVEY AND ATTAINMENT IN THE CURRENT YEAR OF PREDEFINED PERFORMANCE OBJECTIVES SET FOR THE ADMINISTRATOR PERSONALLY AND THE ORGANIZATION. ALSO, THE STATE OF MINNESOTA HAS IN MOST YEARS GIVEN COMPENSATION ADJUSTMENTS TO EMPLOYEES AND WE HAVE ALSO CONSIDERED THIS AMOUNT IN DETERMINING TOP MANAGEMENT COMPENSATION. THIS PROCESS IS PERFORMED BY THE BOARD AND WAS LAST APPROVED AT THE JUNE 25, 2012 BOARD MEETING. FORM 990, PART VI, SECTION C, LINE 19 CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S BOARD OF DIRECTORS ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF ITS INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.