2012-05-14T13:09:31-05:00 2011-09-30 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-10-01 410845402 MINNEWASKA LUTHERAN HOME MINN 3202392217 605 MAIN STREET STARBUCK MN 56381 BRIAN ENGLER 3202397121 2012-05-10 1 6123764500 2010 2016-02-24 21:20:13Z BRIAN ENGLER 605 MAIN STREET STARBUCK MN 56381 4518548 0 X WWW.MCHS-HEALTHCARE.ORG X 1958 MN NURSING HOME - A COMMUNITY OF SERVICES, GROUNDED IN FAITH, PROVIDING PERSON CENTERED CARE. 9 8 196 70 0 0 26365 35736 4217590 4393422 17970 13298 58508 76092 4320433 4518548 1413 8176 0 0 3022775 3052953 0 0 0 1461468 1463810 4485656 4524939 -165223 -6391 5431022 5257193 3279160 3115514 2151862 2141679 X A COMMUNITY OF SERVICES, GROUNDED IN FAITH, PROVIDING PERSON CENTERED CARE THAT ENCOURAGES ALL PEOPLE TO REACH THEIR HIGHEST POTENTIAL. 0 0 4081932 8176 4393422 MINNEWASKA LUTHERAN HOME, A 64-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. 1246 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. 4083178 1 1 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 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 13 0 1 196 1 0 0 0 0 0 0 0 0 0 0 X 9 8 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 STONE 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 PATRICIA PEDERSON 0.50 X 0 0 0 PATRICIA PEDERSON 0.50 X 0 0 0 DEBBIE SCHNEIDER 26.90 X 57648 0 13692 BRIAN ENGLER 18.50 X 43718 0 4912 101366 0 18604 0 0 0 0 0 24601 11135 35736 RESIDENT REVENUES 623000 4393422 4393422 4393422 13298 13298 MISCELLANEOUS INCOME 900099 76092 76092 76092 4518548 4393422 0 89390 8176 8176 118163 118163 2434725 2278903 155822 302956 270442 32514 197109 175955 21154 595 595 25025 25025 179932 160410 19522 14186 14186 393179 378944 14235 34366 34366 128566 128566 9310 6533 2777 1174 1174 99022 99022 311001 311001 25795 25795 LICENSE SURCHARGE 188469 188469 MISCELLANEOUS EXPENSE 40632 15647 24985 BEST AGE EXPENSES 12558 12558 4524939 4083178 441761 0 25 25 368682 471833 502373 476762 21148 21924 7695771 4335554 3596746 3360217 799366 790265 2000 2000 85002 78750 55680 55417 5431022 5257193 286102 286160 3586 5355 2989472 2823999 3279160 3115514 X 2145995 2135800 5867 5879 2151862 2141679 5431022 5257193 X -6391 -3792 X 0 1 1 X 0 X 48853 21125 70475 26365 35736 202554 4316453 4634617 4605776 4217590 4393422 22167858 4365306 4655742 4676251 4243955 4429158 22370412 0 1172863 1265531 1104105 1489768 1546737 6579004 1172863 1265531 1104105 1489768 1546737 6579004 15791408 569 23544 16839 17970 13298 72220 569 23544 16839 17970 13298 72220 1000 103719 58508 76092 239319 4366875 4679286 4796809 4320433 4518548 22681951 0.69620 0.72080 0.00320 0.00300 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 228026 228026 5950238 3167439 2782799 124900 31311 93589 1392607 1136804 255803 3360217 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 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 [MINNEWASKA LUTHERAN HOME, MINNEWASKA HOME DEVELOPMENT, HOLLY RIDGE MANOR, AND MINNEWAKSA HOME CARE] ARE 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 2008 TO 2010 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. 1 SCHOLARSHIPS 3 8176 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: AFTER THE EMPLOYEE HAS BEEN APPROVED FOR A SCHOLARSHIP HE/SHE MUST PAY FOR ALL EXPENSES FOR EACH SEMESTER OF SCHOOL. AFTER EACH SEMESTER THE EMPLOYEE TURNS IN ALL ELIGIBLE EXPENSES UNDER THE SCHOLARSHIP AGREEMENT. REPORTS ARE RUN TO VERIFY THE EMPLOYEE MET THE REQUIRED HOURS FOR THE SAME DATES OF THE SEMESTER. ONCE THIS IS DONE IF THE EMPLOYEE HAS MET THE REQUIREMENTS HE/SHE IS REIMBURSED FOR THE ELIGIBLE EXPENSES. CORA STOEN MOTHER OF BOARD MEMBER 58075 PAYMENTS TO MINNEWASKA LUTHERAN HOME FOR SERVICES RENDERED 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 MANAGEMENT TEAM DISCUSSED THE COMPLETED FROM 990 AT A BOARD MEETING BEFORE IT WAS FILED. 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 LOSSES ON INVESTMENTS: -3,792. 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, 2011. DEBBIE SCHNEIDER - ADMINISTRATOR: MINNEWASKA LUTHERAN HOME - 26.9 HOURS MINNEWASKA HOME CARE - 2.5 HOURS HOLLY RIDGE MANOR - 1.4 HOURS MINNEWASKA HOME DEVELOPMENT - 0.3 HOURS BRIAN ENGLER - DIRECTOR OF FINANCE: MINNEWASKA LUTHERAN HOME - 18.5 HOURS MINNEWASKA HOME CARE - 12.6 HOURS HOLLY RIDGE MANOR - 2.5 HOURS MINNEWASKA HOME DEVELOPMENT - 0.3 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 500 HOLLY RIDGE DRIVE STARBUCK MN 56381 331124162 HOME CARE MN 501(C)(3) 9 MINNEWASKA LUTHERAN HOME 1 HOLLY RIDGE MANOR 500 HOLLY RIDGE DRIVE STARBUCK MN 56381 411649721 ASSISTED LIVING MN 501(C)(3) 11 - TYPE 2 MINNEWASKA LUTHERAN HOME 1 MINNEWASKA HOME DEVELOPMENT 605 MAIN STREET STARBUCK MN 56381 411504339 FUNDRAISING MN 501(C)(3) 11 - TYPE 2 MINNEWASKA LUTHERAN HOME 1 0 0 1 0 0 0 0 0 0 0 1 1 1 1 0 1 0 1