2012-07-16T16:24:08-05:00 2011-09-30 CLIFTONLARSONALLEN LLP PO BOX 217 AUSTIN MN 55912 990 2010-10-01 416031905 MAPLETON COMMUNITY HOME MAPL 5075243315 301 TROENDLE STREET MAPLETON MN 56065 ROXANNE GOSSON 5075243155 2012-07-10 1 TRENT FAST 5074347000 2010 2016-02-24 21:20:13Z ROXANNE GOSSON 301 TROENDLE STREET MAPLETON MN 56065 3649746 0 X N/A X 1962 MN TO PROVIDE THE ELDERLY WITH HOUSING AND NURSING FACILITIES WITH REHABILITATIVE CARE 11 11 149 20 0 0 9733 10699 3424925 3618260 20527 -2617 9937 9668 3465122 3636010 0 0 0 0 2228939 2345215 0 0 1179 1124221 1144832 3353160 3490047 111962 145963 3270223 7802903 788030 5174747 2482193 2628156 THE PURPOSE OF MAPLETON COMMUNITY HOME, INC. IS TO PROVIDE ELDERLY AND HANDICAPPED PEOPLE WITH HOUSING FACILITIES AND NURSING SERVICES; TO MEET THE PHYSICAL, SOCIAL AND PSYCHOLOGICAL NEEDS OF THE RESIDENTS; AND TO CONTRIBUTE TO THE RESIDENT'S HEALTH, SECURITY, AND HAPPINESS. 0 0 3133332 3618260 MAPLETON COMMUNITY HOME IS A RESIDENCE FOR 65 INDIVIDUALS NEEDING SKILLED NURSING CARE. THE HOME SERVES MEDICARE PART A, PART B, MEDICAL ASSISTANCE AND PRIVATE PAYING INDIVIDUALS. THE HOME OFFERS OUTPATIENT REHAILITATION FOR THE COMMUNITY AND DAILY ACTIVITIES FOR THE RESIDENTS. A SOCIAL WORKER IS ON STAFF FOR EMOTIONAL NEEDS AND THE NURSING DEPARTMENT STAFFS BETWEEN 3.2 AND 3.5 HOURS PER DAY. 3133332 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3 0 1 149 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 1 1 0 MN X ROXANNE GOSSON 5075243155 301 TROENDLE ST PO BOX 307 MAPLETON MN 56065 BRUCE SELLERS 0.50 X 0 0 0 JAN BRINDLEY 0.50 X 0 0 0 GINA MASSOP 0.50 X 0 0 0 JEANETTE BRANDT 0.50 X 0 0 0 NANCY DOERING 0.50 X 0 0 0 KATHI REID 0.50 X 0 0 0 ERIK LEAGJELD 0.50 X 0 0 0 SHARON GRUNZKE 0.50 X 0 0 0 MARY JACOBSEN 0.50 X 0 0 0 LARUE STALOCH 0.50 X 0 0 0 BRUCE BEYER 0.50 X 0 0 0 JOHN HOLLERICH 0.50 X 0 0 0 ROXANNE GOSSON 40.00 X 77439 0 2005 77439 0 2005 0 0 0 0 REHABCARE GROUP PO BOX 503534 ST LOUIS MO 63150 REHAB SERVICES 149945 WELSH CONSTRUCTION LLC 4350 BAKER ROAD SUITE 400 MINNETONKA MN 55343 CONSTRUCTION 115798 2 10699 10699 MEDICARE/MEDICAID PAYM 623000 1956754 1956754 RESIDENT REVENUE 623000 1661506 1661506 3618260 11119 11119 13736 -13736 -13736 -13736 VENDING INCOME 623000 5467 5467 GUEST/EMPLOYEE MEAL RE 623000 3707 3707 MISCELLANEOUS INCOME 623000 494 494 9668 3636010 3618260 0 7051 79444 79444 1960300 1878999 81301 59873 54789 5084 81305 74898 6407 164293 151346 12947 8306 8306 23888 23888 39405 32603 6802 18848 18848 197082 172072 25010 131897 131897 3589 3589 11996 3830 8166 25135 25135 135980 135980 43270 43270 SPECIAL ASSESSMENTS 182975 182975 THERAPY EXPENSE 151782 151782 FOOD COSTS 121409 121409 MISCELLANEOUS EXPENSE 9746 9746 PRE-ADMISSION SCREENING 9576 9576 29948 15617 13152 1179 3490047 3133332 355536 1179 422423 430745 868163 3433295 239406 182683 16831 22021 6096144 2559051 1705526 3537093 17874 197066 3270223 7802903 161251 1229747 626779 3945000 788030 5174747 X 2482193 2615028 13128 2482193 2628156 3270223 7802903 145963 0 X 0 1 0 X 0 X 16883 11563 12729 9733 10699 61607 3455384 3696619 3634867 3424925 3618260 17830055 3472267 3708182 3647596 3434658 3628959 17891662 0 1425060 1339380 1431240 1558656 1543293 7297629 1425060 1339380 1431240 1558656 1543293 7297629 10594033 28356 33452 25133 21414 11119 119474 28356 33452 25133 21414 11119 119474 9668 9668 3500623 3741634 3672729 3456072 3649746 18020804 0.58790 0.60170 0.00660 0.00770 X 55314 55314 2894633 1738967 1155666 1043121 773794 269327 2103076 46290 2056786 3537093 3636010 3490047 145963 0 145963 3636010 0 3636010 0 3636010 3490047 0 3490047 0 3490047 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOME HAS BEEN GRANTED EXEMPT STATUS FROM FEDERAL AND STATE CORPORATE INCOME TAXES UNDER SECTION 502 (C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THE HOME FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. NO LIABILITY HAS BEEN RECOGNIZED BY THE HOME AS A RESULT OF THIS STANDARD. THE HOME 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 2008 THROUGH 2011 TAX YEARS OF THE HOME ARE OPEN FOR EXAMINATION BY THE IRS. CITY OF MAPLETON MN 416005347 565468AES 2011-05-19 3945000 SEE PART IV 0 0 0 3945000 311238 257521 78900 3009582 2012 1 0 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO BEING FILED WITH THE IRS, A COPY OF THE IRS FORM 990 AND RELATED SCHEDULES ARE REVIEWED BY THE ADMINISTRATOR, INCLUDING A CONFIRMATION OF THE ACCURACY OF EVERY ANSWER AND OVERSIGHT OF APPROPRIATE CHANGES. UPON COMPLETION OF THE ADMINISTRATOR'S REVIEW, THE FORMS ARE REVIEWED AND APPROVED AT A BOARD MEETING PRIOR TO SUBMITTAL TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND KEY 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 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 DISCUSSIONS 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 PAST TRANSACTIONS INVOLVING THE CONFLICT OF INTERESTS. 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 15 THE PROCESS USED TO SET THE ADMINISTRATOR'S ANNUAL SALARY IS BASED ON A COMBINATION OF COMPARISON TO COMPARABLE ORGANIZATIONS THROUGH USE OF OUR TRADE ORGANIZATION'S ANNUAL COMPENSATION SURVEY AND ATTAINMENT IN THE CURRENT YEAR OF PREDEFINED PERFORMANCE OBJECTIVES SET FOR THE ADMINISTRATOR PERSONALLY AND THE ORGANIZATION. ALSO, THE STATE OF MINNESOTA HAS IN MOST YEARS GIVEN COMPENSATION ADJUSTMENTS TO EMPLOYEES AND WE HAVE ALSO CONSIDERED THIS AMOUNT IN DETERMINING TOP MANAGEMENT COMPENSATION. THIS PROCESS IS PERFORMED BY THE BOARD. THIS PROCESS IS COMPLETED PRIOR TO DECEMBER 15TH EACH YEAR AND WAS LAST APPROVED AT THE DECEMBER 22, 2008 BOARD MEETING. FORM 990, PART VI, SECTION C, LINE 19 CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST.