2013-02-14T10:53:51-06:00 2012-09-30 410746749 CLIFTONLARSONALLEN LLP PO BOX 217 AUSTIN MN 55912 990 2011-10-01 410859697 ST MARK'S LUTHERAN HOME STMA 5074374594 400 15TH AVENUE SW AUSTIN MN 55912 BRAD JOHNSON 5074374594 2013-01-30 1 TRENT FAST P00692704 5074347000 2011 2016-03-07 17:11:31Z CHRIS SCHULZ 400 15TH AVENUE SW AUSTIN MN 55912 5309918 0 9386 X WWW.STMARKSAUSTINMN.ORG X 1963 MN ST. MARK'S IS DEDICATED TO PROVIDE A CONTINUUM OF SERVICES IN THE SPIRIT OF GOD'S LOVE. THESE SERVICES ARE DESIGNED TO PROMOTE PHYSICAL, EMOTIONAL, MENTAL, SOCIAL, AND SPIRITUAL HEALTH. 11 11 197 9 0 0 408769 20346 6077821 5172261 3130 -53468 209237 116513 6698957 5255652 0 0 0 0 4366299 3394444 0 0 0 3443216 2702743 7809515 6097187 -1110558 -841535 4248195 18015452 2327793 16941543 1920402 1073909 ST. MARK'S IS DEDICATED TO PROVIDE A CONTINUUM OF SERVICES IN THE SPIRIT OF GOD'S LOVE. THESE SERVICES ARE DESIGNED TO PROMOTE PHYSICAL, EMOTIONAL, MENTAL, SOCIAL, AND SPIRITUAL HEALTH. 0 0 5175590 5172261 PROVISION OF HOUSING AND NURSING CARE TO THE ELDERLY BY OPERATING A 61-BED LICENSED NURSING FACILITY AND AN INDEPENDENT HOUSING PROJECT. 5175590 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 16 0 197 1 0 0 0 0 0 0 0 0 0 0 X 11 11 1 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 MN X ECUMEN SERVICES INC 6517664300 3530 LEXINGTON AVENUE N SHOREVIEW MN 551268164 MARTY HELLE 1.00 X X 0 0 0 BRAD JOHNSON 1.00 X X 0 0 0 DANA MILLER 1.00 X X 0 0 0 MARK HAUGLAND 1.00 X X 0 0 0 MIKE GOSHA 1.00 X X 0 0 0 REV JEFF FORBES 1.00 X 0 0 0 CATHIE SAYLES 1.00 X X 0 0 0 PHIL GARDNER 1.00 X 0 0 0 GENE LEITER 1.00 X 0 0 0 JOAN SKOV 1.00 X 0 0 0 JACKIE HOLST 1.00 X 0 0 0 CHARLES MILLS 1.00 X 0 0 0 STEVEN KIME 1.00 X 0 0 0 BRUCE HENDRICKS 1.00 X 0 0 0 LINDSAY STOLEN 1.00 X 0 0 0 MIKE MILLER 40.00 X 40400 0 0 CHRIS SCHULZ 40.00 X 6033 0 0 46433 0 0 0 0 0 1 REHABCARE GROUP INC 7733 FORSYTH BLVD SUITE 1700 ST LOUIS MO 63105 THERAPY SERVICES 213714 ECUMEN SERVICES INC 3530 LEXINGTON AVENUE NORTH SHOREVIEW MN 551268164 ADMINISTRATOR & OTHER CONSULTING 188386 STERLING DRUG 1601 STATE AVE NW OWATONNA MN 55060 PHARMACY SERVICES 103964 MCKESSON PO BOX 630693 CINCINNATI OH 54263 SUPPLY SERVICES 103953 4 17400 2946 20346 RESIDENT REVENUE 623000 4766098 4766098 SMA REVENUES 623000 402503 402503 LAUNDRY REVENUE 623000 3660 3660 5172261 798 798 54266 -54266 -54266 -54266 MISCELLANEOUS INCOME 900099 129278 129278 BEAUTY SHOP INCOME 812900 17137 17137 EMPLOYEE/GUEST MEALS 900099 5109 5109 -35011 -35011 116513 5255652 5172261 0 63045 2740009 2408592 331417 160021 140818 19203 283675 249634 34041 210739 185450 25289 235717 235717 20839 20839 22150 22150 309645 303116 6529 14136 14136 25528 25528 324230 293495 30735 10653 224 10429 8572 8572 96993 96993 526028 526028 64316 3770 60546 FOOD COST 179227 179227 BED SURCHARGE 178518 178518 PATIENT CARE SUPPLIES 135015 135015 CONTRACT MEALS 124292 124292 426884 350418 76466 6097187 5175590 921597 0 297420 369581 402445 24010 425280 466199 11557 12030 53313 48044 17806164 9092661 2760019 8713503 7781309 298161 600776 4248195 18015452 497191 3134728 28213 40170 1447932 13400000 354457 366645 2327793 16941543 X 1920402 1073909 1920402 1073909 4248195 18015452 X -841535 -4958 X X 0 1 1 X 0 X 7247 10229 13340 383361 10990 425167 9216654 9469476 8112944 6077821 5172261 38049156 9223901 9479705 8126284 6461182 5183251 38474323 400000 17400 417400 217204 217204 217204 400000 17400 634604 37839719 22305 5316 5654 28538 10154 71967 22305 5316 5654 28538 10154 71967 209237 116513 325750 9246206 9485021 8131938 6698957 5309918 38872040 0.97340 0.97850 0.00190 0.00220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 77063 77063 7808530 6172011 1636519 3338858 2920650 418208 6581713 6581713 8713503 BOND RESERVE ACCOUNTS 7781309 C 7781309 RESIDENT TRUST FUNDS 25305 TENANT SECURITY DEPOSITS 11055 NET PENSION LIABILITY - UNION 245772 ASSET RETIREMENT OBLIGATION 84513 366645 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ST. MARK'S LUTHERAN HOME AND ITS AFFILIATE HAVE BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND STATE CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. ST. MARK'S LUTHERAN HOME AND AFFILIATE FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. NO LIABILITY HAS BEEN RECOGNIZED AS A RESULT OF THIS STANDARD. EACH ENTITY 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 ARE OPEN FOR EXAMINATION BY THE IRS. 0 0 0 0 0 0 0 0 0 SUPPLEMENTAL INFORMATION PART III ST. MARK'S LUTHERAN HOME DOES NOT PAY IT'S ADMINISTRATOR DIRECTLY, RATHER THE HOME IS PAYING THE ADMINISTRATOR THROUGH AN INDEPENDENT CONTRACTOR ARRANGEMENT WITH A MANAGEMENT COMPANY NAMED ECUMEN SERVICES, INC. THE HOME IS CONTRACTED TO PAY ECUMEN SERVICES, INC. FOR THE ADMINISTRATOR POSITION AND OTHER MANAGEMENT CONSULTING SERVICES. THE COMPENSATION INFORMATION ON FORM 990 IS THE AMOUNT OF COMPENSATION THAT ECUMEN PAID THE ADMINISTRATOR AND AS A RESULT THE COMPENSATION INFORMATION PROVIDED IS NOT THE AMOUNT THE HOME PAID TO ECUMEN UNDER THE MANAGEMENT CONTRACT ARRANGEMENT. PER THE IRS INSTRUCTIONS THE COMPENSATION INFORMATION IS FOR THE CALENDAR YEAR 2011. ECUMEN PREPARES A STUDY OF COMPARABLE SENIOR CARE FACILITIES OF SIMILAR SIZE TO DETERMINE THE COMPENSATION APPLICABLE FOR PROVIDING THE ADMINISTRATOR POSITION TO THE HOME. SUPPLEMENTAL INFORMATION PART III MICHAEL MILLER WAS PAID WAGES IN THE AMOUNT OF $40,400 AND CHIRS SCHULZ WAS PAID WAGES IN THE AMOUNT OF $6,033 FROM ECUMEN SERVICES, INC. HOUSING AND REDEVELOPMENT AUTHORITY AUSTIN MN 410983566 05225MBC2 2011-12-22 13332049 SEE PART VI 0 0 0 HOUSING AND REDEVELOPMENT AUTHORITY AUSTIN MN 410983566 05225MBD0 2011-12-22 60000 SEE PART VI 0 0 0 13332049 1021475 1271185 266800 9567015 1205574 2013 1 0 1 1 60000 3667 48469 7864 2013 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE K, PART I, LINE A & B DESCRIPTION OF PURPOSE CONSTRUCT NEW FACILITY, RENOVATE EXISTING FACILITIES, REFINANCE EXISTING DEBT INCLUDING SERIES 2003 BONDS. (B DID NOT REFINANCE EXISTING DEBT) FORM 990, PART VI, SECTION A, LINE 2 BRAD JOHNSON & DANA MILLER - BUSINESS RELATIONSHIP - BRAD & DANA ARE MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS. BOTH ARE MEMBERS OF THE ELK'S LODGE, AUSTIN, MN. FORM 990, PART VI, SECTION A, LINE 3 ST. MARK'S LUTHERAN HOME DOES NOT PAY IT'S ADMINISTRATOR DIRECTLY, RATHER THE HOME IS PAYING THE ADMINISTRATOR THROUGH AN INDEPENDENT CONTRACTOR ARRANGEMENT WITH A MANAGEMENT COMPANY NAMED ECUMEN SERVICES, INC. THE HOME IS CONTRACTED TO PAY ECUMEN SERVICES, INC. FOR THE ADMINISTRATOR POSITION AND OTHER MANAGEMENT CONSULTING SERVICES. THE COMPENSATION INFORMATION ON FORM 990 IS THE AMOUNT OF COMPENSATION THAT ECUMEN PAID THE ADMINISTRATOR AND AS A RESULT THE COMPENSATION INFORMATION PROVIDED IS NOT THE AMOUNT THE HOME PAID TO ECUMEN UNDER THE MANAGEMENT CONTRACT ARRANGEMENT. PER THE IRS INSTRUCTIONS THE COMPENSATION INFORMATION IS FOR THE CALENDAR YEAR 2011. ECUMEN PREPARES A STUDY OF COMPARABLE SENIOR CARE FACILITIES OF SIMILAR SIZE TO DETERMINE THE COMPENSATION APPLICABLE FOR PROVIDING THE ADMINISTRATOR POSITION TO THE HOME. FORM 990, PART VI, SECTION B, LINE 11 A MOTION WAS PASSED BY THE BOARD OF DIRECTORS TO HAVE THE BOARD PRESIDENT REVIEW AND APPROVE THE FORM 990 BEFORE IT IS SIGNED AND SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C 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 THE 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 DISCUSSION 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 TRANSACTIONS BACK TO THE TIME THE CONFLICT BECAME RELEVANT. 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 15A ECUMEN SERVICES, INC. PREPARES A STUDY OF COMPARABLE SENIOR CARE FACILITIES OF SIMILAR SIZE TO DETERMINE THE COMPENSATION APPLICABLE FOR PROVIDING THE ADMINISTRATOR POSITION TO THE HOME. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE IN THE ADMINISTRATIVE OFFICE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN DEFINED BENEFIT PENSION PLAN -4,958. TOTAL TO FORM 990, PART XI, LINE 5: -4,958. FORM 990, PART XII, 2C: THE ORGANIZATIONS BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS CONSOLIDATED FINANCIAL STATEMENTS AND THE SELECTION OF ITS INDEPENDENT ACCOUNTANT. ST MARK'S FOUNDATION INC 400 15TH AVENUE SW AUSTIN MN 55912 411374304 PROVISION OF BENEFITS AND SUPPORT TO ST. MARK'S LUTHERAN HOME MN 501(C)(3) 11A - TYPE I ST MARK'S LUTHERAN HOME 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 NO TRANSACTIONS OVER 50000