2013-08-12T11:25:58-05:00 2012-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-10-01 410845402 MINNEWASKA LUTHERAN HOME MINN 3202392217 605 MAIN STREET STARBUCK MN 56381 MURRAY FINGER 3202397121 2013-08-09 1 CORY RUTLEDGE P01329381 6123764500 2011 2016-02-24 21:20:13Z MURRAY FINGER 605 MAIN STREET STARBUCK MN 56381 4446685 0 X WWW.MCHS-HEALTHCARE.ORG X 1958 MN NURSING HOME - A COMMUNITY OF SERVICES, GROUNDED IN FAITH, PROVIDING PERSON CENTERED CARE. 9 9 188 75 0 0 35736 18589 4393422 4394214 13298 10687 76092 23195 4518548 4446685 8176 3144 0 0 3052953 2981833 0 0 0 1463810 1346480 4524939 4331457 -6391 115228 5257193 5225888 3115514 2953841 2141679 2272047 X A COMMUNITY OF SERVICES, GROUNDED IN FAITH, PROVIDING PERSON CENTERED CARE THAT ENCOURAGES ALL PEOPLE TO REACH THEIR HIGHEST POTENTIAL. 0 0 3902507 3144 4394214 MINNEWASKA LUTHERAN HOME, A 65-BED SKILLED NURSING FACILITY, PROMOTES HEALTH TO THE COMMUNITY BY PROVIDING SKILLED NURSING CARE AND PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES. ADDITIONAL PROGRAMS WHICH BENEFIT THE COMMUNITY INCLUDE:OUTPATIENT THERAPY SERVICES: MINNEWASKA LUTHERAN HOME PROVIDES PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY TO COMMUNITY MEMBERS IN NEED OF THESE SERVICES ALLOWING THEM TO RESUME THEIR NORMAL ACTIVITIES OF DAILY LIVING. MINNEWASKA LUTHERAN HOME IS GOVERNED BY A NINE PERSON INDEPENDENT BOARD MADE UP OF ONE AT-LARGE COMMUNITY LEADER AND EIGHT AREA CHURCH MEMBERS. THE BOARD HAS A HISTORY OF COMMITMENT TO ACTING WITH THE HIGHEST INTEGRITY AND HAS BEEN PROACTIVELY EVALUATING OPPORTUNITIES TO ENSURE THE ORGANIZATION CONTINUES TO OPERATE AT ITS MAXIMUM POTENTIAL FOR THE BENEFIT OF THE CLIENTS WE SERVE AND THE COMMUNITY. 1084 0 0 COMMUNITY OUTREACH EXERCISE PROGRAM: EXERCISE PROGRAM THAT STRESSES STRENGTH AND STABILITY. THIS PROGRAM IS OFFERED THREE TIMES PER WEEK TO COMMUNITY MEMBERS AT NO CHARGE. 0 0 0 ROAD TO AGING GRACEFULLY: FREE MONTHLY EDUCATION TO ANY PERSON IN THE COMMUNITY. ALL PROGRAMS RELATE TO THE MANAGEMENT OF CHRONIC DISEASES AND OTHER AGING HEALTH RELATED ISSUES. ALL INSTRUCTORS ARE LOCAL AND REGIONAL EXPERTS IN THEIR RELATED FIELD OFFERING THEIR SERVICES AT A REDUCED OR FREE CHARGE. 3903591 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 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 13 0 188 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 1 0 1 0 0 MN X BRIAN ENGLER 3202397121 605 MAIN STREET STARBUCK MN 56381 KAYO ASLAGSON 0.50 X X 0 0 0 LAURIS JOHNSHOY 0.50 X X 0 0 0 LONNIE ANDERSON 0.50 X X 0 0 0 ARNE STOEN 0.50 X X 0 0 0 KEITH NAIG 0.50 X 0 0 0 PATRICIA DINSMORE 0.50 X 0 0 0 WARREN HAGESTUEN 0.50 X 0 0 0 MARK SHUMANN 0.50 X 0 0 0 JOHN SAMUELSON 0.50 X 0 0 0 RONALD FEIGUM 0.50 X 0 0 0 ROBERT HENDRICKSON 0.50 X 0 0 0 DEBBIE SCHNEIDER 25.90 X 54590 0 5698 BRIAN ENGLER 17.40 X 40811 0 5436 MURRAY FINGER 32.00 X 0 0 0 95401 0 11134 0 0 0 0 0 4016 14573 18589 RESIDENT REVENUES 623000 4394214 4394214 4394214 10687 10687 MEALS REVENUE 722210 9334 9334 MISCELLANEOUS INCOME 900099 7194 7194 CABLE TV REVENUE 900099 6667 6667 23195 4446685 4394214 0 33882 3144 3144 114393 114393 2431902 2282765 149137 12975 11632 1343 235114 210781 24333 187449 168049 19400 2463 2463 24436 24436 50729 42387 8342 8409 8409 153450 138709 14741 29174 29174 115897 115897 9861 7000 2861 5520 5520 93599 93599 304800 304800 28173 28173 LICENSE SURCHARGE 189601 189601 MEDICAL SUPPLIES 160435 160435 FOOD 120297 120297 BEST AGE EXPENSES 12558 12558 37078 16912 20166 4331457 3903591 427866 0 25 25 1145667 1345267 476762 434583 21924 21771 7790334 4634102 3360217 3156232 116431 136365 2000 2000 78750 72498 55417 57147 5257193 5225888 286160 292868 5355 7870 2823999 2653103 3115514 2953841 X 2135800 2270448 5879 1599 2141679 2272047 5257193 5225888 X 115228 15140 X 0 1 1 X 0 X 21125 70475 26365 35736 18589 172290 4634617 4605776 4217590 4393422 4394214 22245619 4655742 4676251 4243955 4429158 4412803 22417909 5000 5000 1265531 1104105 1489768 1546737 1637269 7043410 1265531 1104105 1489768 1546737 1642269 7048410 15369499 23544 16839 17970 13298 10687 82338 23544 16839 17970 13298 10687 82338 103719 58508 76092 23195 261514 4679286 4796809 4320433 4518548 4446685 22761761 0.67520 0.69620 0.00360 0.00320 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME SPECIAL FUNDRAISING EVENTS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 228026 228026 6042200 3393689 2648511 124900 38515 86385 1395208 1201898 193310 3156232 PART IV, LINE 2B: RESIDENT DEPOSITS CONSIST OF RESIDENT TRUST FUNDS HELD BY THE ORGANIZATION FOR THE RESIDENTS OF THE HOME. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: FROM NOTE 1 TO THE ORGANIZATION'S FINANCIAL STATEMENTS: THE HOME, MHD, HOLLY RIDGE, AND HOME CARE HAVE ALL BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND STATE CORPORATE INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(A) AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) AND APPLICABLE STATE STATUTES. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES IN EVALUATING THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE INCOME TAX RETURNS OF THE ORGANIZATION IS SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE THE TAX-EXEMPT STATUS OF ANY OF ITS ENTITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. THE TAX RETURNS FOR THE FISCAL YEARS 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. CORA STOEN MOTHER OF BOARD MEMBER 58152 PAYMENTS TO MINNEWASKA LUTHERAN HOME FOR SERVICES RENDERED 0 CASSANDRA FEIGUM DAUGHTER IN LAW OF BOARD MEMBER 15733 COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF MINNEWASKA LUTHERAN HOME CONSIST OF CERTAIN CONGREGATIONS LOCATED IN THE GENERAL COMMUNITY OF STARBUCK, MINNESOTA. EACH MEMBER CONGREGATION MAY APPOINT ONE INDIVIDUAL TO ACT AS A DELEGATE ON ITS BEHALF. THE PRESENT MEMBERS ARE: FRON LUTHERAN CHURCH - STARBUCK, MINNESOTA MINEWASKA LUTHERAN CHURCH - STARBUCK, MINNESOTA ST. JOHN'S LUTHERAN CHURCH - STARBUCK, MINNESOTA IMMANUEL LUTHERAN CHURCH - STARBUCK, MINNESOTA INDHERRED LUTHERAN CHURCH - STARBUCK, MINNESOTA EAST ZION LUTHERAN CHURCH - STARBUCK, MINNESOTA WEST ZION LUTHERAN CHURCH - STARBUCK, MINNESOTA TRINITY LUTHERAN CHURCH - CYRUS, MINNESOTA FORM 990, PART VI, SECTION A, LINE 7A DIRECTORS ARE ELECTED BY A MAJORITY VOTE OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ARTICLES OF INCORPORATION AND/OR THE BYLAWS REQUIRE AN AFFIRMATIVE VOTE OF A MAJORITY OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WILL BE EMAILED TO THE BOARD PRIOR TO FILING WITH THE IRS. IT WILL THEN BE DISCUSSED IN DETAIL WITH MANAGEMENT AT THEIR AUGUST 28TH BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL DIRECTORS, PRINCIPAL OFFICERS, AND MEMBERS OF COMMITTEE WITH BOARD-DELEGATED POWERS. ANY INDIVIDUAL WITH AN ACTUAL OR POTENTIAL CONFLICT IS REQUIRED TO DISCLOSE ALL MATERIAL FACTS TO THE BOARD OR COMMITTEE. AFTER DISCLOSURE OF THE MATERIAL FACTS, THE REMAINING BOARD OR COMMITTEE MEMBERS DETERMINE BY MAJORITY VOTE WHETHER A CONFLICT EXISTS. IF IT IS DETERMINED THAT A CONFLICT EXISTS, THE BOARD OR COMMITTEE SEEKS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION IS NOT REASONABLY POSSIBLE, THE BOARD OR COMMITTEE DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. THE INDIVIDUAL MAY NOT BE PRESENT FOR A DISCUSSION OF, OR VOTE ON, WHETHER TO ENTER THE TRANSACTION. THE RELEVANT FACTS ARE DOCUMENTED IN THE MINUTES OF THE MEETING. ADDITIONALLY, BOARD MEMBERS ARE REQUIRED TO ANNUALLY SIGN STATEMENTS DISCLOSING EXISTING CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE ADMINISTRATOR'S COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS ANNUALLY. EVERY YEAR, THE ADMINISTRATOR PRESENTS A PROPOSAL FOR COMPENSATION TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS THEN USES A CURRENT SALARY SURVEY (DONE BY AGING SERVICES OF MN) TO COMPARE TO THE PROPOSAL AND THEN COMES TO A CONCLUSION ON WHAT THE COMPENSATION WILL BE. THIS IS THEN INCORPORATED IN THE BOARD MINUTES AND ADMINISTRATOR'S ANNUAL REVIEW. THE PROCESS LAST OCCURRED 12/15/10 FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 15,140. ALLOCATION OF TIME BETWEEN RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A THE OFFICERS OF MINNEWASKA LUTHERAN HOME ALSO SERVE AS THE OFFICERS OF THREE RELATED ORGANIZATIONS: MINNEWASKA HOME DEVELOPMENT, MINNEWASKA HOME CARE, AND HOLLY RIDGE MANOR. THE AVERAGE WEEKLY HOURS OF EACH OFFICER WERE SPENT AS FOLLOWS FOR THE YEAR ENDED SEPTEMBER 30, 2012. DEBBIE SCHNEIDER - ADMINISTRATOR: MINNEWASKA LUTHERAN HOME - 25.9 HOURS MINNEWASKA HOME CARE - 2.4 HOURS HOLLY RIDGE MANOR - 1.4 HOURS MINNEWASKA HOME DEVELOPMENT - 0.3 HOURS MURRAY FINGER - ADMINISTRATOR: MINNEWASKA LUTHERAN HOME - 32 HOURS MINNEWASKA HOME CARE - 5 HOURS HOLLY RIDGE MANOR - 3 HOURS BRIAN ENGLER - DIRECTOR OF FINANCE: MINNEWASKA LUTHERAN HOME - 17.39 HOURS MINNEWASKA HOME CARE - 11.89 HOURS HOLLY RIDGE MANOR - 2.39 HOURS MINNEWASKA HOME DEVELOPMENT - 0.32 HOURS THE BOARD MEMBERS OF MINNEWASKA LUTHERAN HOME ALSO SERVE AS THE BOARD MEMBERS OF THREE RELATED ORGANIZATIONS: MINNEWASKA HOME DEVELOPMENT, MINNEWASKA HOME CARE, AND HOLLY RIDGE MANOR. EACH BOARD MEMBER SERVES EACH ORGANIZATION FOR APPROXIMATELY 0.50 HOURS PER WEEK, OR FOR A TOTAL OF APPROXIMATELY 2.0 HOURS MONTHLY. MINNEWASKA HOME CARE 605 MAIN STREET STARBUCK MN 56381 331124162 HOME CARE MN 501(C)(3) 9 N/A 1 HOLLY RIDGE MANOR 500 HOLLY RIDGE DRIVE STARBUCK MN 56381 411649721 ASSISTED LIVING MN 501(C)(3) 11 - TYPE 2 N/A 1 MINNEWASKA HOME DEVELOPMENT 605 MAIN STREET STARBUCK MN 56381 411504339 FUNDRAISING MN 501(C)(3) 11 - TYPE 2 N/A 1 0 0 1 0 0 0 0 0 0 0 1 1 1 1 0 1 0 1