2012-07-23T09:17:29-05:00 2011-09-30 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-10-01 410870856 MAPLE LAWN NURSING HOME INC MAPL 5074252571 400 SEVENTH STREET NE FULDA MN 56131 ARLAN SWANSON ADMINISTRATOR 5074252571 2012-07-13 1 GORDON J VETSCH 6123764500 2010 2016-02-24 21:20:13Z ARLAN SWANSON 400 SEVENTH STREET NE FULDA MN 56131 4397110 0 X WWW.MAPLELAWN.ORG X 1962 MN TO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS. 9 9 131 110 0 0 6020 7550 4242701 4358488 16546 9308 26153 21764 4291420 4397110 0 0 0 0 2509946 2491888 0 0 0 1602320 1760107 4112266 4251995 179154 145115 4241694 4292658 2599891 2505740 1641803 1786918 X TO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS IN AN INDIVIDUALIZED, DIGNIFIED AND HOMELIKE MANNER. 0 0 4023993 0 4357910 MAPLE 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. 4023993 1 0 0 0 0 0 0 1 0 1 0 0 0 1 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 48 0 131 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 0 0 MN X X ARLAN SWANSON 5074252571 400 SEVENTH STREET NE FULDA MN 56131 ELDEN GETTING 1.00 X X 0 0 0 JERRILD STEINER 1.00 X X 0 0 0 MARCINE ELDER 1.00 X X 0 0 0 MARY FRAN BUSCH 1.00 X 0 0 0 SHIRLEY BUSCHENA 1.00 X 0 0 0 JEFF ZINS 1.00 X 0 0 0 CLEONE RAMERTH 1.00 X 0 0 0 DEAN MCNEAL 1.00 X 0 0 0 RON JANSSEN 1.00 X 0 0 0 ARLAN SWANSON 50.00 X 78767 0 1521 78767 0 1521 0 0 0 0 PRAIRIE REHABILITATION SERVICES LLC 1720 S CLIFF AVENUE SIOUX FALLS SD 57103 CONTRACTED THERAPY 216698 1 7550 7550 RESIDENT SERVICES 623000 3486303 3486303 APARTMENT RENTAL 623000 872185 872185 4358488 9308 9308 MISCELLANEOUS INCOME 623000 8170 8170 MEAL INCOME 623000 5976 5976 BEAUTY SHOP INCOME 623000 3242 3242 4376 4376 21764 4397110 4358488 0 31072 83104 83104 1989829 1983889 5940 283959 283145 814 134996 134609 387 390 390 31438 31438 322073 299079 22994 12409 12409 263406 238529 24877 42358 42358 149255 143964 5291 11834 11834 100773 96502 4271 224265 214760 9505 67885 65008 2877 FOOD 262457 262457 LICENSE SURCHARGE 182516 182493 23 REPAIRS AND MAINTENANCE 24463 23426 1037 MISCELLANEOUS EXPENSE 22227 22227 BAD DEBT 20089 20089 22269 13028 9241 4251995 4023993 228002 0 0 983626 977092 354272 522450 59633 75348 5959725 3271886 2789901 2687839 39400 12117 14862 17812 4241694 4292658 331120 363389 2229617 2102334 15136 14967 24018 25050 2599891 2505740 X 1641803 1786918 1641803 1786918 4241694 4292658 145115 0 X 0 1 1 X 0 X 7778 6300 3926 6020 7550 31574 3979734 4121994 4322019 4242701 4358488 21024936 3987512 4128294 4325945 4248721 4366038 21056510 0 45627 122225 132885 80415 93455 474607 45627 122225 132885 80415 93455 474607 20581903 16480 11943 6771 16546 9308 61048 16480 11943 6771 16546 9308 61048 10181 26443 30385 26153 21764 114926 4014173 4166680 4363101 4291420 4397110 21232484 0.96940 0.97360 0.00290 0.00320 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUES 0 1 4661605 2282737 2378868 253746 67154 186592 1044374 921995 122379 2687839 ASSET RETIREMENT OBLIGATION 25050 25050 4397110 4251995 145115 0 145115 4397110 0 4397110 0 4397110 4251995 0 4251995 0 4251995 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. CITY OF FULDA MINNESOTA 416005177 2003-09-24 2865000 REFUND SERIES 1995 BONDS & FUND NEW CONSTRUCTION OF ASSISTED LIVING FACILITY 0 0 0 897055 2865000 1265000 57000 1543000 2004 0 1 1 1 0 0 0 0 1 0 1 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE 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 7A THE ORGANIZATION'S MEMBERS ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S MEMBERS HAVE THE POWER TO AMEND ARTICLES AND BYLAWS AND TERMINATE MEMBERSHIPS. FORM 990, PART VI, SECTION B, LINE 11 MANAGEMENT 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. FORM 990, PART VI, SECTION B, LINE 12C 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 15A 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 C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.