MAPLE LAWN NURSING HOME INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MAPLE LAWN NURSING HOME INC (EIN 41-0870856)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-07-23
IRS object ID
201232059349300413
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)
Timestamp2012-07-23T09:17:29-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1220 SOUTH SIXTH STREET SUITE 300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN410870856EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MAPLE LAWN NURSING HOME INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMAPLNameControl
Phone5074252571Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1400 SEVENTH STREET NEAddressLine1
CityFULDACity
StateMNState
ZIP Code56131ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameARLAN SWANSON ADMINISTRATORName
TitleADMINISTRATORTitle
Phone5074252571Phone
Date Signed2012-07-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameGORDON J VETSCHName
Phone6123764500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonARLAN SWANSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1400 SEVENTH STREET NEAddressLine1
CityFULDACity
StateMNState
ZIP Code56131ZIPCode
FieldValueIRS element (for citing)
Gross Receipts4397110GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.MAPLELAWN.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1962YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees131TotalNbrEmployees
Total Nbr Volunteers110TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year6020ContributionsGrantsPriorYear
Contributions Grants Current Year7550ContributionsGrantsCurrentYear
Program Service Revenue Prior Year4242701ProgramServiceRevenuePriorYear
Program Service Revenue CY4358488ProgramServiceRevenueCY
Investment Income Prior Year16546InvestmentIncomePriorYear
Investment Income Current Year9308InvestmentIncomeCurrentYear
Other Revenue Prior Year26153OtherRevenuePriorYear
Other Revenue Current Year21764OtherRevenueCurrentYear
Total Revenue Prior Year4291420TotalRevenuePriorYear
Total Revenue Current Year4397110TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year2509946SalariesEtcPriorYear
Salaries Etc Current Year2491888SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year1602320OtherExpensePriorYear
Other Expenses Current Year1760107OtherExpensesCurrentYear
Total Expenses Prior Year4112266TotalExpensesPriorYear
Total Expenses Current Year4251995TotalExpensesCurrentYear
Revenues Less Expenses Prior Year179154RevenuesLessExpensesPriorYear
Revenues Less Expenses CY145115RevenuesLessExpensesCY
Total Assets BOY4241694TotalAssetsBOY
Total Assets EOY4292658TotalAssetsEOY
Total Liabilities BOY2599891TotalLiabilitiesBOY
Total Liabilities EOY2505740TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1641803NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1786918NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS IN AN INDIVIDUALIZED, DIGNIFIED AND HOMELIKE MANNER.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense4023993Expense
Grants0Grants
Revenue4357910Revenue
DescriptionMAPLE LAWN NURSING HOME, A CAMPUS OF LONG TERM CARE SERVICES:CAMPUS SERVICES INCLUDE: MAPLEVIEW ESTATES - 24 APARTMENTS FOR SENIORS WHO NEED LIGHT ASSISTANCE ALLOWING THEM TO MAINTAIN REASONABLY INDEPENDENT LIVES. THESE SERVICES INCLUDE A HIGH-QUALITY NOON MEAL AND ASSISTANCE FOR HOUSEKEEPING AND OTHER LIGHT TASKS. MAPLEWOOD COURT ASSISTED LIVING-15 APARTMENTS FOR SENIORS WHO NEED ASSISTANCE WITH ALL MEALS AND MEDICATIONS, BUT MAINTAIN INDEPENDENCE IN MANY OTHER CARE AREAS. MAPLE LAWN NURSING HOME-62 MEDICARE CERTIFIED SKILLED NURSING BEDS WHICH PROVIDE CARE FOR A BROAD SPECTRUM OF RESIDENTS WITH NEEDS FROM POST-ACUTE REHAB THERAPY TO MEMORY CARE. THE CAMPUS PROVIDED CARE FOR OVER 100 LOCAL INDIVIDUALS IN THIS RURAL COMMUNITY OF 1,300. NORMALLY APPROXIMATELY 150 DIFFERENT PERSONS ARE SERVED DURING EACH YEAR. MANY WOULD NOT BE ABLE TO FIND CARE ANYWHERE ELSE. THE ORGANIZATION HAS STEADILY GROWN AND IMPROVED DURING ITS 48 YEARS OF SERVICE TO THIS COMMUNITY - FILLING THIS COMMUNITY'S NEED FOR FINE QUALITY HOUSING AND HEALTH CARE SERVICES AND PROVIDING THEM IN AN INDIVIDUALIZED AND HOMELIKE MANNER.Description
Total Program Service Expense4023993TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
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 Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
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 Individuals0GrantsToIndividuals
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 Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109648NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees131NumberOfEmployees
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 Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ARLAN SWANSONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5074252571TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1400 SEVENTH STREET NEAddressLine1
CityFULDACity
StateMNState
ZIP Code56131ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (10 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
ELDEN GETTING
PRESIDENT1.00XX000
JERRILD STEINER
VICE PRESIDENT1.00XX000
MARCINE ELDER
SECRETARY1.00XX000
MARY FRAN BUSCH
DIRECTOR1.00X000
SHIRLEY BUSCHENA
DIRECTOR1.00X000
JEFF ZINS
DIRECTOR1.00X000
CLEONE RAMERTH
DIRECTOR1.00X000
DEAN MCNEAL
DIRECTOR1.00X000
RON JANSSEN
DIRECTOR1.00X000
ARLAN SWANSON
ADMINISTRATOR50.00X7876701521
FieldValueIRS element (for citing)
Total Reportable Comp From Org78767TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation1521TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
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 Line1PRAIRIE REHABILITATION SERVICES LLCBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11720 S CLIFF AVENUEAddressLine1
CitySIOUX FALLSCity
StateSDState
ZIP Code57103ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesCONTRACTED THERAPYDescriptionOfServices
Compensation216698Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions7550AllOtherContributions
Total Contributions7550TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
RESIDENT SERVICES62300034863033486303
APARTMENT RENTAL623000872185872185
FieldValueIRS element (for citing)
Total Program Service Revenue4358488TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column9308TotalRevenueColumn
Exclusion$9,308ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
MISCELLANEOUS INCOME6230008170$8,170
MEAL INCOME6230005976$5,976
BEAUTY SHOP INCOME6230003242$3,242

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column4376TotalRevenueColumn
Exclusion$4,376ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue21764TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column4397110TotalRevenueColumn
Related Or Exempt Function Income4358488RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$31,072ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total83104Total
Program Services83104ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total1989829Total
Program Services1983889ProgramServices
Management And General5940ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total283959Total
Program Services283145ProgramServices
Management And General814ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total134996Total
Program Services134609ProgramServices
Management And General387ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total390Total
Management And General390ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total31438Total
Management And General31438ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total322073Total
Program Services299079ProgramServices
Management And General22994ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total12409Total
Management And General12409ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total263406Total
Program Services238529ProgramServices
Management And General24877ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total42358Total
Management And General42358ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total149255Total
Program Services143964ProgramServices
Management And General5291ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total11834Total
Management And General11834ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total100773Total
Program Services96502ProgramServices
Management And General4271ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total224265Total
Program Services214760ProgramServices
Management And General9505ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total67885Total
Program Services65008ProgramServices
Management And General2877ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
FOOD262457262457
LICENSE SURCHARGE18251618249323
REPAIRS AND MAINTENANCE24463234261037
MISCELLANEOUS EXPENSE2222722227
BAD DEBT2008920089

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total22269Total
Program Services13028ProgramServices
Management And General9241ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total4251995Total
Program Services4023993ProgramServices
Management And General228002ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY0BOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY983626BOY
EOY977092EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY354272BOY
EOY522450EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY59633BOY
EOY75348EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis5959725LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3271886LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY2789901BOY
EOY2687839EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY39400BOY
EOY12117EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY14862BOY
EOY17812EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY4241694BOY
EOY4292658EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY331120BOY
EOY363389EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY2229617BOY
EOY2102334EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY15136BOY
EOY14967EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY24018BOY
EOY25050EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2599891BOY
EOY2505740EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1641803BOY
EOY1786918EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1641803BOY
EOY1786918EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4241694BOY
EOY4292658EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses145115ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
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 Years7778CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years6300CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3926CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6020CurrentTaxYearMinus1Year
Current Tax Year7550CurrentTaxYear
Total31574Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3979734CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4121994CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4322019CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4242701CurrentTaxYearMinus1Year
Current Tax Year4358488CurrentTaxYear
Total21024936Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years3987512CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4128294CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4325945CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4248721CurrentTaxYearMinus1Year
Current Tax Year4366038CurrentTaxYear
Total21056510Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years45627CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years122225CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years132885CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year80415CurrentTaxYearMinus1Year
Current Tax Year93455CurrentTaxYear
Total474607Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years45627CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years122225CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years132885CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year80415CurrentTaxYearMinus1Year
Current Tax Year93455CurrentTaxYear
Total474607Total
FieldValueIRS element (for citing)
Public Support Total50920581903PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16480CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11943CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6771CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16546CurrentTaxYearMinus1Year
Current Tax Year9308CurrentTaxYear
Total61048Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years16480CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11943CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years6771CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year16546CurrentTaxYearMinus1Year
Current Tax Year9308CurrentTaxYear
Total61048Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10181CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years26443CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years30385CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year26153CurrentTaxYearMinus1Year
Current Tax Year21764CurrentTaxYear
Total114926Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4014173CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4166680CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years4363101CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year4291420CurrentTaxYearMinus1Year
Current Tax Year4397110CurrentTaxYear
Total21232484Total
FieldValueIRS element (for citing)
Public Support Percentage5090.96940PublicSupportPercentage509
Prior Year Support Percentage0.97360PriorYearSupportPercentage
Investment Income Percentage0.00290InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00320PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUESGeneralExplanation

Schedule D IRS990ScheduleD

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

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4661605OtherCostOrOtherBasis
Depreciation2282737Depreciation
Book Value2378868BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis253746OtherCostOrOtherBasis
Depreciation67154Depreciation
Book Value186592BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1044374OtherCostOrOtherBasis
Depreciation921995Depreciation
Book Value122379BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2687839TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionASSET RETIREMENT OBLIGATIONDescription
Amount$25,050Amount
FieldValueIRS element (for citing)
Total Of Amounts25050TotalOfAmounts
Total Revenue4397110TotalRevenue
Total Expenses4251995TotalExpenses
Excess Or Deficit For Year145115ExcessOrDeficitForYear
Total Adjustments0TotalAdjustments
Excess Or Deficit Per FS145115ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt4397110TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal4397110RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9904397110TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt4251995TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal4251995ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9904251995TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 2B:RESIDENTS MAKE A SECURITY DEPOSIT WHEN THEY MOVE INTO THE FACILITIES. EACH RESIDENT RECEIVES THEIR SECURITY DEPOSIT, WITH INTEREST, WHEN THEY LEAVE THE FACILITIES. RESIDENT TRUSTS ARE SMALL AMOUNTS THAT RESIDENTS HOLD WITH MAPLE LAWN FOR MINOR EXPENSES AND FOR USE IN RESIDENT OUTINGS.
PART X:THE ORGANIZATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF FULDA MINNESOTABusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN416005177IssuerEIN
Date Issued2003-09-24DateIssued
Issue Price2865000IssuePrice
Description Of PurposeREFUND SERIES 1995 BONDS & FUND NEW CONSTRUCTION OF ASSISTED LIVING FACILITYDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired897055AmountRetired
Total Proceeds2865000TotalProceeds
Refunding Escrow1265000RefundingEscrow
Issuance Costs From Proceeds57000IssuanceCostsFromProceeds
Capital Expenditures1543000CapitalExpenditures
Year Of Subst Completion2004YearOfSubstCompletion
Current Refunding0CurrentRefunding
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
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

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 6THE MEMBERSHIP OF THE ORGANIZATION CONSISTS OF ANY PERSON (AGE 21 OR OLDER) OR ORGANIZATION DONATING $100 OR MORE FOR THE PURPOSE OF MEMBERSHIP TO THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE ORGANIZATION'S MEMBERS ELECT THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BTHE ORGANIZATION'S MEMBERS HAVE THE POWER TO AMEND ARTICLES AND BYLAWS AND TERMINATE MEMBERSHIPS.
FORM 990, PART VI, SECTION B, LINE 11MANAGEMENT PROVIDED INFORMATION FOR PREPARATION OF THE FORM 990. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AT A BOARD MEETING AND APPROVED PRIOR TO BEING FILED WITH THE IRS.
THE POLICY IS ANNUALLY REVIEWED AND SIGNED BY THE BOARD MEMBERS AND KEY STAFF MEMBERS. BOARD MEMBERS ARE REQUIRED TO SELF-DISCLOSE POTENTIAL OR REAL CONFLICTS OF INTEREST TO THE BOARD. IF A CONFLICT EXISTS THE INDIVIDUAL WILL NOT BE ALLOWED TO VOTE ON THE RELATED ISSUE. CONFLICTS ARE HANDLED ON A CASE BY CASE BASIS.FORM 990, PART VI, SECTION B, LINE 12C
THE BOARD USES COMPARATIVE DATA FROM THE LONG TERM CARE IMPERATIVE COMPENSATION REPORT WHEN DETERMINING THE ADMINISTRATOR'S SALARY. THIS WAS LAST COMPLETED IN 2011.FORM 990, PART VI, SECTION B, LINE 15A
THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19

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