2012-08-15T13:36:47-05:00 2011-09-30 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2010-10-01 411263433 KNUTE NELSON KNUT 3207636653 420 12TH AVENUE EAST ALEXANDRIA MN 56308 MARK ANDERSON 3207636653 2012-08-14 1 KIM HUNWARDSEN CPA 6122536500 2012-08-14 2010 2016-02-24 21:20:13Z MARK ANDERSON 420 12TH AVENUE EAST ALEXANDRIA MN 56308 15918258 0 9386 X WWW.KNUTENELSON.ORG X 1969 MN OPERATION OF NURSING HOME 9 9 458 335 0 0 3000 0 15370181 15896197 38849 22061 0 0 15412030 15918258 45246 28919 0 0 9890143 10509722 0 0 955 5237662 4911091 15173051 15449732 238979 468526 42485395 47700053 28349372 32771559 14136023 14928494 X THE MISSION OF KNUTE NELSON IS TO PROVIDE A FULL CONTINUUM OF SERVICES FOR OLDER ADULTS TO ENHANCE THEIR QUALITY OF LIFE. OUR VISION IS TO BE THE RECOGNIZED LEADER OF QUALITY AND INNOVATIVE SERVICES FOR OLDER ADULTS. 0 0 13672761 28919 15896197 KNUTE NELSON, AN AFFILIATE OF EVANGELICAL LUTHERAN CHURCH OF AMERICA, PROVIDES A FULL CONTINUUM OF SERVICES FOR OLDER ADULTS TO ENHANCE THEIR QUALITY OF LIFE THROUGH A 140-BED SKILLED NURSING FACILITY, 59 ASSISTED LIVING UNITS, AND HOME CARE AGENCY. KNUTE NELSON HAS 350+ EMPLOYEES AND OVER 300 VOLUNTEERS MAKING IT ONE OF THE TOP TEN EMPLOYERS WITHIN THE CITY OF ALEXANDRIA. WITHIN THE SKILLED NURSING FACILITY, WE HAVE A SHORT-TERM STAY UNIT, REHABILITATION PROGRAM, CARE SUITES FOR END-OF-LIFE PROGRAMMING AND PROVIDE HOSPICE CARE IN PARTNERSHIP WITH LOCAL HOSPICE PROVIDERS FOR TERMINALLY-ILL RESIDENTS. WE ALSO HAVE A WELLNESS PROGRAM THAT PROVIDES CLASSES FOR RESIDENTS, ACTIVITIES, AND A CHAPLAINCY PROGRAM; ALL WHICH ENHANCE THEIR QUALITY OF LIVING. OUR CHAPLAINCY PROGRAM IS GUIDED BY CHRISTIAN PRINCIPLES. ALL FAITHS ARE CELEBRATED HERE AND OUR CHAPLAIN PROVIDES A WIDE RANGE OF SPIRITUAL CARE THROUGH WORSHIP SERVICE, BIBLE STUDY GROUPS, AND RESIDENT AND FAMILY SUPPORT. THE SKILLED NURSING FACILITY HAD 349 ADMISSIONS AND 358 DISCHARGES FROM 10/01/10 TO 09/30/11. AN INCREASING AREA OF FOCUS IS OUR SHORT-TERM STAY PROGRAM WHERE INDIVIDUALS WILL RECEIVE NECESSARY PHYSICAL, SPEECH, AND OCCUPATIONAL THERAPIES AND RETURN BACK TO THEIR HOME. KNUTE NELSON ACCEPTS ALL PAYOR SOURCES: MEDICARE, MEDICAID, INSURANCE, AND PRIVATE PAY. IF A RESIDENT IS UNABLE TO PAY FOR THEIR SERVICES, WE WILL WORK WITH THEM TO FIND A MEANS TO PAY FOR THEIR SERVICES AND HELP THEM FACILITATE THE APPLICATION PROCESS FOR MEDICAL ASSISTANCE THROUGH FAMILY MEMBERS, KNUTE NELSON AND DOUGLAS COUNTY SOCIAL SERVICES. THE GOAL OF THE KNUTE NELSON HOME CARE PROGRAM IS TO HELP INDIVIDUALS STAY IN THEIR OWN HOME AS LONG AS POSSIBLE. WE ARE ABLE TO HELP INDIVIDUALS OF ANY AGE WITH SKILLED NURSING SERVICES, PHYSICAL, SPEECH AND OCCUPATIONAL THERAPIES, IV THERAPY, WOUND CARE, PRIVATE DUTY NURSING, HOME HEALTH AIDE, OR ASSESSMENT AND MANAGEMENT OF THEIR MEDICAL NEEDS. WE SERVE INDIVIDUALS WITHIN A 100-MILE RADIUS OF ALEXANDRIA WITH BRANCH OFFICES IN MORRIS, ELBOW LAKE, LONG PRAIRIE, LITTLE FALLS, OLIVIA AND OSAKIS. OUR ASSISTED LIVING FACILITY, NELSON GABLES, PROMOTES INDEPENDENCE, SECURITY AND QUALITY OF LIFE. DAILY COFFEE HOUR, RESTAURANT STYLE MEAL PROGRAM, ACTIVE AGING WELLNESS CLASSES, PARTIES AND OUTINGS KEEP RESIDENTS AS ACTIVE AS THEY WISH TO BE. A 24-HOUR STAFF, UNDER THE DIRECTION OF A REGISTERED NURSE, IS READY TO OFFER ASSISTANCE WITH MEDICATION MANAGEMENT, MEDICATION ADMINISTRATION, BATHING, AND PERSONAL CARE.GRAND ARBOR, REGISTERED THROUGH KNUTE NELSON SENIOR LIVING CAMPUS, LLC, IS AN ENHANCED CONTINUING CARE RETIREMENT COMMUNITY THAT ENCOURAGES ACTIVE LIFESTYLES WITH A TOWN CENTER AND WELLNESS CENTER SET AMONG INDEPENDENT LIVING APARTMENTS; GENERAL AND HIGH ACUITY ASSISTED LIVING APARTMENTS; AND MEMORY CARE ASSISTED LIVING APARTMENTS. A 24-HOUR LICENSED STAFF, UNDER THE DIRECTION OF A REGISTERED NURSE, IS ABLE TO OFFER ASSISTANCE WITH MEDICATION MANAGEMENT, MEDICATION ADMINISTRATION, BATHING, AND OTHER PERSONAL CARES. 13672761 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 20 0 1 458 1 0 0 0 0 0 0 0 0 0 0 X 9 9 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X MARNIE GUGISBERG CFO 3207631164 420 12TH AVENUE EAST ALEXANDRIA MN 56308 X TOM ANDERSON 1.00 X X 0 0 0 RUTH NAGLE 1.00 X X 0 0 0 EILEEN EISER 1.00 X X 0 0 0 DENNIS SCHMIDT 1.00 X X 0 0 0 ROGER BLANK 1.00 X X 0 0 0 BILL LEUTHNER 1.00 X X 0 0 0 JAN LERVICK 1.00 X 0 0 0 DOUG HOUSKA 1.00 X 0 0 0 DEREK TROSVIG 1.00 X 0 0 0 KATHY NOHRE 1.00 X 0 0 0 YVONNE KINNEY-HOCKERT 1.00 X 0 0 0 JERRY HANSEN 1.00 X 0 0 0 MARK ANDERSON 35.00 X 128355 0 20472 MARNIE GUGISBERG 39.00 X 79973 0 8623 208328 0 29095 1 0 0 0 MARK LEE EXCAVATING 401 50TH AVE WEST ALEXANDRIA MN 56308 CONTRACTOR 738323 SENIOR HOUSING PARTNERS 2845 HAMLINE AVE NORTH ROSEVILLE MN 55113 DEVELOPER 690251 INNOVATIVE BUILDERS INC 2715 HIGHWAY 29 SOUTH SUITE 105 ALEXANDRIA MN 56308 CONTRACTOR 655754 POPE & ASSOCIATES 1255 ENERGY PARK DRIVE ST PAUL MN 55108 ARCHITECTS 238457 ADVANCED CONCRETE & MASONRY INC 9020 WYOMING AVE NORTH BROOKLYN PARK MN 55445 CONTRACTOR 157425 6 RESIDENT SERVICE REVEN 623000 15297852 15297852 OTHER REVENUE 900099 525302 525302 AUXILIARY AND COFFEE S 721000 73043 73043 15896197 22061 22061 15918258 15896197 0 22061 28919 28919 240499 240499 8472558 7950978 521580 96596 94623 1973 1033653 964954 68699 666416 610037 56379 20822 20822 18132 18132 406981 310715 96266 99711 98756 955 1268456 1069943 198513 662412 662412 165580 165580 22583 22583 353669 353669 1009343 1009343 161538 161538 SURCHARGE & PRE SCREEN 423558 423558 FOOD 127248 127248 LICENSES & PERMITS 50344 16892 33452 EDUCATION 38801 15806 22995 BAD DEBT 20907 20907 61006 12757 48249 15449732 13672761 1776016 955 1507344 2140092 1369727 1392841 1424 820 110093 58951 46418165 13303061 14885600 33115104 20859473 7005325 2695072 2951263 292500 275833 764162 759824 42485395 47700053 1472714 1651953 25189394 27762690 36164 37504 177308 130036 1473792 3189376 28349372 32771559 X 13043514 14928494 1092509 0 14136023 14928494 42485395 47700053 X 468526 323945 X 0 1 1 X 0 X 84294 99570 1393110 3000 1579974 12736009 14297953 15032966 15508181 15896197 73471306 12820303 14397523 16426076 15511181 15896197 75051280 0 0 0 75051280 206171 155822 60584 38773 22061 483411 206171 155822 60584 38773 22061 483411 13026474 14553345 16486660 15549954 15918258 75534691 0.99360 0.99060 0.00640 0.00940 X 0 1 2465190 2465190 15906128 9349562 6556566 4366410 3365418 1000992 23680437 588081 23092356 33115104 CAREVENTURES COOPERATIVE 5000 F INTEREST IN KNUTE NELSON FOUNDATION 2946263 F 2951263 INSURANCE RESERVE 144177 CONSTRUCTION PAYABLE 2969698 RESERVATION DEPOSITS 50500 NON-COMPETE AGREEMENT PAYABLE 25001 3189376 15918258 15449732 468526 67754 256191 323945 792471 15918258 0 15918258 0 15918258 15449732 0 15449732 0 15449732 PART IV, LINE 2B: THE ORGANIZATION ACTS AS A CUSTODIAN FOR THE FUNDS OF THE RESIDENTS OF THE HOME AND ASSISTED LIVING. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE CORPORATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND, AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX LIABILITIES IN INCOME TAX EXPENSE, IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN VALUE OF FOUNDATION 256,191. 1 SCHOLARSHIPS 18 28919 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: KNUTE NELSON MAKES PAYMENTS DIRECTLY TO THE SCHOOL AND DIRECTLY TO THE INDIVIDUALS, DEPENDING ON THE CIRCUMSTANCE. FOR PAYMENTS MADE DIRECTLY TO INDIVIDUALS, A RECEIPT MUST BE PROVIDED SHOWING BOOK OR TUITION EXPENSE BEFORE THE SCHOLARSHIP IS ISSUED. CITY OF ALEXANDRIA MINNESOTA 416004926 015185AL5 2010-07-08 19865000 BUILD SENIOR HOUSING CAMPUS 0 0 0 CITY OF ALEXANDRIA MINNESOTA 416004926 2006-06-08 4300000 ASSISTED LIVING FACILITY AND REFUND PRIOR BONDS ISSUED 7/15/95 0 0 0 CITY OF ALEXANDRIA MINNESOTA 416004926 2010-07-08 4500000 SKILLED NURSING FACILITY PROJECT 0 0 0 19866691 1670529 298127 570936 13028496 2647283 2011 0 0 0 1 588176 4300000 83118 3206140 1010742 2007 1 0 1 1 314134 4500000 4500000 2010 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 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE K, PART II, LINE 11(B): PAID TO REFUND PRIOR BONDS ISSUED JULY 17, 1995. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL INCLUDE THE CHAIR, THE VICE-CHAIR, THE PRESIDENT, THE TREASURER, THE SECRETARY AND SUCH OTHER INDIVIDUALS, IF ANY, AS MAY BE APPOINTED BY THE BOARD FROM TIME TO TIME. THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE BUSINESS OF THIS CORPORATION IN THE INTERVAL BETWEEN BOARD MEETINGS, AND THE EXECUTIVE COMMITTEE SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL HAVE SUCH OTHER DUTIES AS MAY BE PRESCRIBED BY THE BOARD FROM TIME TO TIME. FORM 990, PART VI, SECTION A, LINE 2 TOM ANDERSON AND EILEEN EISER HAVE A BUSINESS RELATIONSHIP. ROGER BLANK AND KATHY NOHRE HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP OF THE ORGANIZATION IS MADE UP OF FOURTEEN AREA LUTHERAN CHURCHES WHICH ARE ELECTED AS MEMBERS BY THE BOARD OF DIRECTORS OF THE ORGANIZATION. AT ALL TIMES, THE MAJORITY OF MEMBERS OF THE ORGANIZATION ARE REQUIRED TO BE CONGREGATIONS OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA, OR ITS SUCCESSOR. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S NOMINATING COMMITTEE, WHICH CONSISTS OF TWO VOTING DELEGATES OF MEMBERS ELECTED BY THE MEMBERS AT THE ANNUAL MEETING OF MEMBERS, THE PRESIDENT OF THE AUXILIARY/FRIENDS OF KNUTE, AND TWO DIRECTORS APPOINTED BY THE BOARD OF DIRECTORS, MAKES RECOMMENDATIONS FOR ELECTIONS TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS THEN ELECTED BY ITS MEMBERS AT AN ANNUAL MEETING. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS REVIEWED INITIALLY BY THE CFO AND CEO. THE FINANCE & AUDIT COMMITTEE THEN REVIEWS, PROVIDES A COPY TO THE BOARD OF DIRECTORS, AND MAKES A RECOMMENDATION TO THE BOARD OF DIRECTORS TO APPROVE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE IS REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM ANNUALLY. THE FORM IS REVIEWED INITIALLY BY THE PRESIDENT OF THE BOARD OF DIRECTORS AND THE CEO FOR POTENTIAL CONFLICTS. IF A CONFLICT EXISTS, IT IS REVIEWED BY THE BOARD OF DIRECTORS. ANY PERSON WITH A CONFLICT IS RESTRICTED FROM VOTING ON RELATED MATTERS. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD DETERMINES THE COMPENSATION OF THE CEO BASED ON COMPARABILITY DATA. THE CEO IS REVIEWED ANNUALLY BY THE EXECUTIVE BOARD WHICH THEN REPORTS BACK TO THE FULL BOARD OF DIRECTORS. THE DECISION IS NOTED IN THE BOARD MINUTES. THE CEO DETERMINES THE COMPENSATION OF THE CFO BASED ON COMPARABILITY DATA AND PRESENTS THIS INFORMATION TO THE EXECUTIVE TEAM OF THE BOARD OF DIRECTORS. THIS PROCESS TAKES PLACE ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VII: IN ADDITION TO THE HOURS SERVED ON KNUTE NELSON, THE ENTIRE BOARD OF DIRECTORS ALSO SERVES 1 HOUR PER WEEK AT KNUTE NELSON FOUNDATION, A RELATED ORGANIZATION. THE CEO AND CFO ALSO SERVE 5 HOURS AND 1 HOUR PER WEEK RESPECTIVELY TO KNUTE NELSON FOUNDATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 67,754. CHANGE IN VALUE OF FOUNDATION 256,191. TOTAL TO FORM 990, PART XI, LINE 5: 323,945. KNUTE NELSON SENIOR LIVING CAMPUS LLC 420 12TH AVENUE EAST ALEXANDRIA MN 56308 272940787 SENIOR HOUSING MN 102 31500886 KNUTE NELSON KNUTE NELSON FOUNDATION 420 12TH AVENUE EAST ALEXANDRIA MN 56308 411451486 FUNDRAISING MN 501(C)(3) LINE 11A, I N/A 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0 0 KNUTE NELSON FOUNDATION N 72719 GENERAL LEDGER