ANNANDALE CARE CENTER: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
ANNANDALE CARE CENTER (EIN 23-7296950)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-05-24
IRS object ID
201201459349300405
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-24T09:06:59-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14310 17TH AVE S PO BOX 2545AddressLine1
CityFARGOCity
StateNDState
ZIP Code581082545ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237296950EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ANNANDALE CARE CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlANNANameControl
Phone3202743737Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 PARK STREET EASTAddressLine1
CityANNANDALECity
StateMNState
ZIP Code55302ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDEBRA REITMEIERName
TitleADMINISTRATOR/PRESIDENTTitle
Phone3202743737Phone
Date Signed2012-05-10DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLISA CHAFFEE CPAName
Phone7012398500Phone
Date Prepared2012-05-10DatePrepared
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDEBRA REITMEIERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1500 PARK STREET EASTAddressLine1
CityANNANDALECity
StateMNState
ZIP Code55302ZIPCode
FieldValueIRS element (for citing)
Gross Receipts7366911GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.AHCSMN.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1973YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionSKILLED NURSING SERVICES AND ASSISTED LIVING SERVICESActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees202TotalNbrEmployees
Total Nbr Volunteers60TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year100743ContributionsGrantsPriorYear
Contributions Grants Current Year19946ContributionsGrantsCurrentYear
Program Service Revenue Prior Year7093527ProgramServiceRevenuePriorYear
Program Service Revenue CY7306450ProgramServiceRevenueCY
Investment Income Prior Year14308InvestmentIncomePriorYear
Investment Income Current Year40335InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year7208578TotalRevenuePriorYear
Total Revenue Current Year7366731TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY20156GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year3757931SalariesEtcPriorYear
Salaries Etc Current Year3724295SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3129810OtherExpensePriorYear
Other Expenses Current Year3180413OtherExpensesCurrentYear
Total Expenses Prior Year6887741TotalExpensesPriorYear
Total Expenses Current Year6924864TotalExpensesCurrentYear
Revenues Less Expenses Prior Year320837RevenuesLessExpensesPriorYear
Revenues Less Expenses CY441867RevenuesLessExpensesCY
Total Assets BOY12328074TotalAssetsBOY
Total Assets EOY12470879TotalAssetsEOY
Total Liabilities BOY9899477TotalLiabilitiesBOY
Total Liabilities EOY9633185TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2428597NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2837694NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionQUALITY CARE AND SERVICES THAT SHAPE THE FUTURE FOR THE DYNAMIC NEEDS OF THE PEOPLE IN OUR AREA.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense6324766Expense
Grants20156Grants
Revenue7306450Revenue
DescriptionTHE ORGANIZATION OPERATES A 60 BED SKILLED NURSING FACILITY, A 26 UNIT ASSISTED LIVING BUILDING (A.K.A. CENTENNIAL VILLA ASSISTED LIVING), A 39 UNIT MEMORY CARE FACILITY AND A WELLNESS CENTER WHICH JUST OPENED IN OCTOBER 2009. IT NOT ONLY PROVIDES SERVICES TO THE ELDERLY POPULATION IN ANNANDALE BUT ALSO TO THOSE IN OTHER AREA COMMUNITIES WHICH HELPS THE INDIVIDUAL TO REMAIN IN THE SAME GEOGRAPHICAL AREA OF THEIR FORMER RESIDENCE. THE SKILLED NURSING FACILITY HAS AN EXCELLENT THERAPY PROGRAM THAT IS AVAILABLE TO ITS RESIDENTS WHO ARE IN NEED OF REHABILITATION SERVICES. IT ALSO HAS AN OUTPATIENT PROGRAM THAT TREATS THOSE FROM THE ANNANDALE COMMUNITY AND THE SURROUNDING AREA. IT IS BECAUSE OF ITS ONSITE THERAPY PROGRAM THAT IT HAS BECOME THE FIRST CHOICE FOR MOST WHEN THEY REQUIRE REHABILITATION SERVICES FOLLOWING A SURGERY IN ORDER TO RETURN HOME SAFELY. THE ASSISTED LIVING BUILDING SERVES AS A PLEASANT TRANSITION FOR THOSE WHO NEED ADDITIONAL HELP THAT IS NOT READILY AVAILABLE IN THEIR OWN HOME BUT ARE STILL INDEPENDENT ENOUGH THAT THEY DON'T REQUIRE THE SERVICES OF A SKILLED NURSING FACILITY. THE MEMORY LOSS UNIT IS MUCH MORE APPROPRIATE FOR THOSE WHO SUFFER FROM ALZHEIMER'S AND/OR SEVERE DEMENTIA THAN A SKILLED NURSING FACILITY. THE ENVIRONMENT IS CONTROLLED AND SETUP TO MEET EACH RESIDENT'S NEEDS RELATING TO THEIR SPECIFIC ILLNESS. THE WELLNESS CENTER HAS A THERAPY/EXERCISE SWIM POOL, EXERCISE CLASS STUDIO AND AN EXERCISE EQUIPMENT ROOM DEVELOPED TO SERVE THE WELLNESS NEEDS OF THOSE 50 YEARS OF AGE AND OLDER - BOTH WITHIN THE CAMPUS AND THE OUTSIDE COMMUNITY.Description
Total Program Service Expense6324766TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10962NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees202NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons0AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1MOLLY LAUDENBACHBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3202742578TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1500 PARK STREET EASTAddressLine1
CityANNANDALECity
StateMNState
ZIP Code55302ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
JOHN NELSON
ADMINISTRATOR/PRESIDENT39.70XX13924601188
MARK D MILLER
VICE PRESIDENT/CHAIRMAN0.10XX000
SHARON PETERSON
SECRETARY/TREASURER0.10XX000
ROGER MILLNER
DIRECTOR0.10X000
KATHY GRUYS
DIRECTOR0.10X000
JERRY WOLFSTELLER
DIRECTOR0.10X000
SHELLY JONAS
DIRECTOR0.10X000
ED SKOMOROH
DIRECTOR0.10X000
MYRON MORRIS
DIRECTOR (THRU 03/31/11)0.10X000
JACK DRISTE
DIRECTOR (THRU 12/31/10)0.10X000
DEBRA REITMEIER
CONTROLLER/ASST ADMINISTRATOR38.00X82872013844
FieldValueIRS element (for citing)
Total Reportable Comp From Org222118TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation15032TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1REHABVISIONSBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line111623 ARBOR ST STE 201AddressLine1
CityOMAHACity
StateNEState
ZIP Code68144ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesPT, OT AND SLPDescriptionOfServices
Compensation597664Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions19946AllOtherContributions
Total Contributions19946TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
RESIDENT REVENUE62300071149067114906
OTHER SUPPORTING REVEN900099124608124608
WELLNESS CENTER7139406693666936
FieldValueIRS element (for citing)
Total Program Service Revenue7306450TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column39015TotalRevenueColumn
Exclusion$39,015ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other1500Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other180Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other1320Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1320TotalRevenueColumn
Exclusion$1,320ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column7366731TotalRevenueColumn
Related Or Exempt Function Income7306450RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$40,335ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total20156Total
Program Services20156ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total241148Total
Management And General241148ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3075029Total
Program Services2993409ProgramServices
Management And General81620ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1250Total
Management And General1250ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total165705Total
Program Services163196ProgramServices
Management And General2509ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total241163Total
Program Services218634ProgramServices
Management And General22529ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total2699Total
Management And General2699ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total21180Total
Management And General21180ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total809934Total
Program Services753714ProgramServices
Management And General56220ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total6921Total
Management And General6921ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total634384Total
Program Services582622ProgramServices
Management And General51762ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total17205Total
Management And General17205ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total354171Total
Program Services295005ProgramServices
Management And General59166ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total2655Total
Program Services859ProgramServices
Management And General1796ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total11777Total
Program Services10427ProgramServices
Management And General1350ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total522728Total
Program Services522728ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total556514Total
Program Services556514ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1947Total
Management And General1947ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
DHS SURCHARGE168900168900
DUES & SUBSCRIPTIONS1889618896
BAD DEBT EXPENSE1376313763
LICENSES90799079

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total27660Total
Program Services24839ProgramServices
Management And General2821ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total6924864Total
Program Services6324766ProgramServices
Management And General600098ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1698322BOY
EOY1815210EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY731785BOY
EOY819391EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY367168BOY
EOY356431EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis11659452LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4390033LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY7780965BOY
EOY7269419EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1741487BOY
EOY2203531EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY8347BOY
EOY6897EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12328074BOY
EOY12470879EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY682085BOY
EOY565317EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY10709BOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY9170000BOY
EOY9030000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY36683BOY
EOY37868EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY9899477BOY
EOY9633185EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2428597BOY
EOY2837694EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2428597BOY
EOY2837694EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12328074BOY
EOY12470879EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses441867ReconcilationRevenueExpenses
Reconcilation Other Changes-32770ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee0AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years12421CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3474CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years7580CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year100743CurrentTaxYearMinus1Year
Current Tax Year19946CurrentTaxYear
Total144164Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5366741CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5575740CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6824180CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7093527CurrentTaxYearMinus1Year
Current Tax Year7306450CurrentTaxYear
Total32166638Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5379162CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5579214CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6831760CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7194270CurrentTaxYearMinus1Year
Current Tax Year7326396CurrentTaxYear
Total32310802Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years239929CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years50240CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years80381CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year81144CurrentTaxYearMinus1Year
Current Tax Year138844CurrentTaxYear
Total590538Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years239929CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years50240CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years80381CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year81144CurrentTaxYearMinus1Year
Current Tax Year138844CurrentTaxYear
Total590538Total
FieldValueIRS element (for citing)
Public Support Total50931720264PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years55233CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years53848CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years26375CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year14308CurrentTaxYearMinus1Year
Current Tax Year39015CurrentTaxYear
Total188779Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years55233CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years53848CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years26375CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year14308CurrentTaxYearMinus1Year
Current Tax Year39015CurrentTaxYear
Total188779Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5434395CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5633062CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6858135CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7208578CurrentTaxYearMinus1Year
Current Tax Year7365411CurrentTaxYear
Total32499581Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97600PublicSupportPercentage509
Prior Year Support Percentage0.97730PriorYearSupportPercentage
Investment Income Percentage0.00580InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00630PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis69516OtherCostOrOtherBasis
Book Value69516BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis9787173OtherCostOrOtherBasis
Depreciation3267884Depreciation
Book Value6519289BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1389303OtherCostOrOtherBasis
Depreciation914968Depreciation
Book Value474335BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis413460OtherCostOrOtherBasis
Depreciation207181Depreciation
Book Value206279BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7269419TotalOfBookValueLandBuildings

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 2B:ANNANDALE CARE CENTER ACTS AS CUSTODIAN FOR FUNDS OF ITS RESIDENTS.
PART X:THE ORGANIZATIONS BELIEVE THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE ORGANIZATIONS WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPS- EDUCATIONTypeOfGrant
Number Of Recipients6NumberOfRecipients
Amount Of Cash Grant20156AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: SCHOLARSHIPS ARE AWARDED TO EMPLOYEES WHO WORK AN AVERAGE OF 20 HOURS A WEEK OR MORE AND WHO ARE ENROLLED IN PROGRAM OF STUDY RELATED TO LONG TERM CARE. RECIPIENTS ARE SELECTED BY A COMMITTEE ON A QUARTERLY BASIS. FUNDS ARE DISBURSED UPON RECEIVING A COPY OF THE RECIPIENT'S TUITION/FEES STATEMENT AND/OR RECEIPTS FOR PURCHASES OF REQUIRED TEXTBOOKS. THE GUIDELINES FOR THIS PROGRAM ARE IN ACCORDANCE WITH THOSE SET FORTH BY THE MN DEPARTMENT OF HUMAN SERVICES' NURSING FACILITY SCHOLARSHIP PROGRAM.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1ECONOMIC DEVELOPMENT AUTHORITY OF THE CITY OF ANNANDALE MNBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN416004935IssuerEIN
CUSIP Number035728AV5CUSIPNumber
Date Issued2007-11-02DateIssued
Issue Price9296182IssuePrice
Description Of PurposeQUALIFIED 501(C)(3) NONHOSPITAL BOND-95% OR MORE USED FOR CAPITAL EXPEND.DescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds9296182TotalProceeds
Amount In Reserve Fund265134AmountInReserveFund
Issuance Costs From Proceeds186000IssuanceCostsFromProceeds
Capital Expenditures4609396CapitalExpenditures
Other Spent Proceeds4235652OtherSpentProceeds
Current Refunding1CurrentRefunding
Advance Refunding1AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
IdentifierSCHEDULE K SUPPLENTAL INFORMATIONIdentifier
ExplanationPART I, ITEM (F) DESCRIPTION OF PURPOSE CONTINUTED: REFUNDED BONDS ISSUED JUNE 14, 1999 AND AUGUST 1, 2003Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 2SHELLY JONAS AND ROGER MILLNER HAVE A FAMILY RELATIONSHIP.
FORM 990, PART VI, SECTION A, LINE 7ATHE BOARD OF DIRECTORS IS ELECTED ANNUALLY BY THE BOARD OF DIRECTORS OF ANNANDALE HEALTH AND COMMUNITY SERVICES.
FORM 990, PART VI, SECTION A, LINE 7BTHE FOLLOWING MUST BE APPROVED BY THE BOARD OF DIRECTORS OF ANNANDALE HEALTH AND COMMUNITY SERVICES: ** BUDGET - CHANGES IN BUDGET OF OVER $10,000 - EXPENDITURES OF OVER $10,000 - SALES OF ASSETS OF OVER $10,000 - CHANGES TO THE BYLAWS THE FOLLOWING MUST BE APPROVED BY THE PRESIDENT OF THE ANNANDALE HEALTH AND COMMUNITY SERVICE BOARD: - CHANGES IN THE BUDGET OF OVER $5,000 BUT LESS THAN $10,000 - EXPENDITURES OF OVER $5,000 BUT LESS THAN $10,000 - SALES OF ASSETS OF OVER $5,000 BUT LESS THAN $10,000
FORM 990, PART VI, SECTION A, LINE 8BTHERE ARE NO COMMITTEES THAT CAN ACT ON BEHALF OF THE BOARD. COMMITTEES MUST COME BACK TO THE FULL BOARD TO MAKE A FINAL DECISION.
FORM 990, PART VI, SECTION B, LINE 11A DRAFT COPY OF THE FORM 990 WILL BE MAILED OUT TO MEMBERS OF THE BOARD PRIOR TO THE FILING DATE. ALSO, THE CONTROLLER AND THE ADMINISTRATOR/PRESIDENT WILL REVIEW A DRAFT COPY OF THE FORM 990 BEFORE IT IS FILED.
THERE IS NO ANNUAL FORM OR DISCLOSURE THAT IS USED TO UNCOVER CONFLICTS OF INTEREST; HOWEVER, INDIVIDUALS ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST BASED ON AN "HONOR-SYSTEM." ANYONE WHO CAN INFLUENCE THE ACTIONS OF THE CORPORATION IS COVERED BY THE POLICY. THIS INCLUDES BOARD MEMBERS, KEY EMPLOYEES, OFFICERS, AND EMPLOYEES. THE BOARD REVIEWS AND DETERMINES WHEN AND IF A CONFLICT EXISTS. IF A CONFLICT EXISTS, BOARD MEMBERS ARE NOT ALLOWED TO VOTE ON THE ISSUE IN CONFLICT. ALL CONFLICTS OF INTEREST ARE DOCUMENTED IN THE BOARD MEETING MINUTES.FORM 990, PART VI, SECTION B, LINE 12C
FORM 990, PART VI, SECTION B, LINE 15: EACH YEAR, THE CORPORATION FINDS OUT WHAT THE INCREASE IN RATES WILL BE. THE INCREASE IN RATES IS ALLOCATED PROPORTIONATELY ACROSS THE BOARD TO ALL EMPLOYEES. THE BUDGET IS ALSO DETERMINED BY THE INCREASE IN RATES AND THE BOARD OF DIRECTORS APPROVES THE BUDGET.
THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE NOT MADE PUBLICLY AVAILABLE.FORM 990, PART VI, SECTION C, LINE 19
THE FOLLOWING INDIVIDUALS LISTED IN PART VII DEVOTED TIME TO ANNANDALE CONGREGATE HOUSING, A RELATED ORGANIZATION: JOHN NELSON: .3 HOURS PER WEEK DEBRA REITMEIER: 2 HOURS PER WEEK MARK MILLER: .1 HOURS PER WEEK SHARON PETERSON: .1 HOURS PER WEEK THE FOLLOWING INDIVIDUALS LISTED IN PART VII DEVOTED .2 HOURS PER WEEK TO ANNANDALE HEALTH AND COMMUNITY SERVICES, A RELATED ORGANIZATION: MARK MILLER, SHARON PETERSON, ROGER MILLNER, KATHY GRUYS, JERRY WOLFSTELLER, SHELLY JONAS, AND ED SKOMORAHFORM 990, PART VII:
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -32,770.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
ANNANDALE HEALTH AND COMMUNITY SERVICES
500 PARK STREET EASTANNANDALEMN55302411820760OVERSIGHTMN501(C)(3)LINE 7N/A0
HEARTLAND TRANSIT
500 PARK STREET EASTANNANDALEMN55302411820763INACTIVE CORPORATIONMN501(C)(3)LINE 70ANNANDALE HEALTH AND COMMUNITY SERVICES
ANNANDALE CONGREGATE HOUSING
500 PARK STREET EASTANNANDALEMN55302363566531INDEPENDENT LIVINGMN501(C)(3)LINE 11A, I0ANNANDALE HEALTH AND COMMUNITY SERVICES
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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