2013-05-13T15:43:10-05:00 2012-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-10-01 410870856 MAPLE LAWN NURSING HOME INC MAPL 5074252571 400 SEVENTH STREET BOX 278 FULDA MN 56131 ARLAN SWANSON ADMINISTRATOR 5074252571 2013-05-07 1 KOREY BOELTER P00047306 6123764500 2011 2016-02-24 21:20:13Z ARLAN SWANSON 400 SEVENTH STREET BOX 278 FULDA MN 56131 4593982 0 X WWW.MAPLELAWN.ORG X 1962 MN TO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS. 9 9 140 130 0 0 7550 18761 4358488 4546754 9308 10690 21764 17777 4397110 4593982 0 0 0 0 2491888 2411941 0 0 0 1760107 1858798 4251995 4270739 145115 323243 4292658 4481433 2505740 2371272 1786918 2110161 X TO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS IN AN INDIVIDUALIZED, DIGNIFIED, AND HOMELIKE MANNER. 0 0 4007210 0 4546754 MAPLE LAWN NURSING HOME, A CAMPUS OF LONG TERM CARE SERVICES:CAMPUS SERVICES INCLUDE: MAPLEVIEW ESTATES - 24 APARTMENTS FOR SENIORS WHO NEED LIGHT ASSISTANCE ALLOWING THEM TO MAINTAIN REASONABLY INDEPENDENT LIVES. THESE SERVICES INCLUDE A HIGH-QUALITY NOON MEAL AND ASSISTANCE FOR HOUSEKEEPING AND OTHER LIGHT TASKS. MAPLEWOOD COURT ASSISTED LIVING - 15 APARTMENTS FOR SENIORS WHO NEED ASSISTANCE WITH ALL MEALS AND MEDICATIONS, BUT MAINTAIN INDEPENDENCE IN MANY OTHER CARE AREAS. MAPLE LAWN NURSING HOME - 62 MEDICARE CERTIFIED SKILLED NURSING BEDS WHICH PROVIDE CARE FOR A BROAD SPECTRUM OF RESIDENTS WITH NEEDS FROM POST-ACUTE REHAB THERAPY TO MEMORY CARE. THE CAMPUS PROVIDES CARE FOR OVER 100 LOCAL INDIVIDUALS AT ANY POINT IN TIME, IN THIS RURAL COMMUNITY OF 1,300. NORMALLY APPROXIMATELY 180 DIFFERENT PERSONS ARE SERVED DURING EACH YEAR. MANY WOULD NOT BE ABLE TO FIND CARE ANYWHERE ELSE. THE ORGANIZATION HAS STEADILY GROWN AND IMPROVED DURING ITS 48 YEARS OF SERVICE TO THIS COMMUNITY - FILLING THIS COMMUNITY'S NEED FOR FINE QUALITY HOUSING AND HEALTH CARE SERVICES AND PROVIDING THEM IN AN INDIVIDUALIZED AND HOMELIKE MANNER. 4007210 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 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 44 0 140 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 0 0 MN X ARLAN SWANSON 5074252571 400 SEVENTH STREET NE FULDA MN 56131 ELDEN GETTING 1.00 X X 0 0 0 JERRILD STEINER 1.00 X X 0 0 0 MARCINE ELDER 1.00 X X 0 0 0 MARY FRAN BUSCH 1.00 X 0 0 0 SHIRLEY BUSCHENA 1.00 X 0 0 0 JEFF ZINS 1.00 X 0 0 0 CLEONE RAMERTH 1.00 X 0 0 0 DEAN MCNEAL 1.00 X 0 0 0 RON JANSSEN 1.00 X 0 0 0 ARLAN SWANSON 50.00 X 81412 0 1980 81412 0 1980 0 0 0 0 PRAIRIE REHABILITATION SERVICES LLC 1720 S CLIFF AVENUE SIOUX FALLS SD 57105 CONTRACTED THERAPY 221798 1 18761 18761 RESIDENT SERVICES 623000 3676074 3676074 APARTMENT RENTAL 623000 870680 870680 4546754 10690 10690 MISCELLANEOUS INCOME 623000 8728 8728 MEAL INCOME 623000 4770 4770 GARAGE REVENUE 623000 4279 4279 17777 4593982 4546754 0 28467 80970 80970 1930907 1925206 5701 17550 17500 50 241639 240954 685 140875 140476 399 320 320 35094 35094 437989 417108 20881 10641 10641 162628 137643 24985 132832 128179 4653 12785 12785 88273 84532 3741 198748 190325 8423 55594 53238 2356 FOOD 251234 251234 LICENSE SURCHARGE 180014 179998 16 MEDICAL SUPPLIES 127371 127371 BAD DEBT 85437 85437 79838 32476 47362 4270739 4007210 263529 0 977092 1409951 522450 348714 75348 53357 6104442 3464586 2687839 2639856 12117 6069 17812 23486 4292658 4481433 363389 360660 2102334 1967729 14967 16801 25050 26082 2505740 2371272 X 1786918 2110161 1786918 2110161 4292658 4481433 323243 0 X 0 1 1 X 0 X 6300 3926 6020 7550 18761 42557 4121994 4322019 4242701 4358488 4546754 21591956 4128294 4325945 4248721 4366038 4565515 21634513 0 122225 132885 80415 93455 183248 612228 122225 132885 80415 93455 183248 612228 21022285 11943 6771 16546 9308 10690 55258 11943 6771 16546 9308 10690 55258 26443 30385 26153 21764 17777 122522 4166680 4363101 4291420 4397110 4593982 21812293 0.96380 0.96940 0.00250 0.00290 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUES RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 4777041 2429478 2347563 254721 74505 180216 1072680 960603 112077 2639856 ASSET RETIREMENT OBLIGATION 26082 26082 4593982 4270739 323243 323243 4593982 0 4593982 0 4593982 4270739 0 4270739 0 4270739 PART IV, LINE 2B: RESIDENTS MAKE A SECURITY DEPOSIT WHEN THEY MOVE INTO THE FACILITIES. EACH RESIDENT RECEIVES THEIR SECURITY DEPOSIT, WITH INTEREST, WHEN THEY LEAVE THE FACILITIES. RESIDENT TRUSTS ARE SMALL AMOUNTS THAT RESIDENTS HOLD WITH MAPLE LAWN FOR MINOR EXPENSES AND FOR USE IN RESIDENT OUTINGS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CORPORATION HAS BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND MINNESOTA CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE STATUTES. THE CORPORATION'S ANNUAL TAX FILINGS ARE SUBJECT TO REVIEW BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE CORPORATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE CORPORATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OTHER TAXES. THE TAX FILINGS FOR THE YEARS 2009 THROUGH 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL OR STATE AUTHORITIES. CITY OF FULDA MINNESOTA 416005177 2003-09-24 2865000 REFUND SERIES 1995 BONDS & FUND NEW CONSTRUCTION OF ASSISTED LIVING FACILITY 0 0 0 1019744 2865000 1265000 57000 1543000 2004 0 1 1 1 0 0 0 0 1 0 1 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP OF THE ORGANIZATION CONSISTS OF ANY PERSON (AGE 21 OR OLDER) OR ORGANIZATION DONATING $100 OR MORE FOR THE PURPOSE OF MEMBERSHIP TO THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S MEMBERS ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S MEMBERS HAVE THE POWER TO AMEND ARTICLES AND BYLAWS AND TERMINATE MEMBERSHIPS. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT PROVIDED INFORMATION FOR PREPARATION OF THE FORM 990. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AT A BOARD MEETING AND APPROVED PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY IS ANNUALLY REVIEWED AND SIGNED BY THE BOARD MEMBERS AND KEY STAFF MEMBERS. BOARD MEMBERS ARE REQUIRED TO SELF-DISCLOSE POTENTIAL OR REAL CONFLICTS OF INTEREST TO THE BOARD. IF A CONFLICT EXISTS THE INDIVIDUAL WILL NOT BE ALLOWED TO VOTE ON THE RELATED ISSUE. CONFLICTS ARE HANDLED ON A CASE BY CASE BASIS. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD USES COMPARATIVE DATA FROM THE LONG TERM CARE IMPERATIVE COMPENSATION REPORT AND COMPARATIVE INFORMATION FROM A MAJOR ACCOUNTING FIRM WHEN DETERMINING THE ADMINISTRATOR'S SALARY. INFORMATION IS REVIEWED BY THE FULL BOARD AND DOCUMENTED IN THE MINUTES. THIS WAS LAST COMPLETED IN 2012. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.