2012-03-05T14:39:41-06:00 2011-09-30 CLIFTONLARSONALLEN LLP PO BOX 217 AUSTIN MN 55912 990 2010-10-01 411263434 KENYON SUNSET HOME KENY 5077896134 127 GUNDERSON BLVD KENYON MN 55946 DAVID VANDERGON 5077896134 2012-03-02 1 TRENT FAST 5074347000 2010 2016-02-24 21:20:13Z DAVID VANDERGON 127 GUNDERSON BLVD KENYON MN 55946 3673616 0 9386 X N/A X 1949 MN TO PROVIDE HOUSING AND NURSING SERVICES TO THE ELDERLY IN KENYON, MINNESOTA AND THE SURROUNDING AREA. 8 8 133 75 0 0 56926 27670 3419521 3471406 6261 3677 108046 170863 3590754 3673616 0 0 0 0 2038598 2148775 0 0 0 1466087 1556834 3504685 3705609 86069 -31993 3954499 3902223 2949612 2929329 1004887 972894 WE ARE A CHRISTIAN FAITH BASED NOT FOR PROFIT ORGANIZATION THAT EXTENDS THE MINISTRY OF CARING AND HEALING THROUGH A VARIETY OF QUALITY SERVICES FOR THE ELDERLY, FAMILIES, AND THE AREA COMMUNITIES. 0 0 3182471 3471406 KENYON SUNSET HOME- SINCE 1949, WE HAVE BEEN PROVIDING HOUSING AND NURSING SERVICES THROUGH OPERATION OF A 48-BED LICENSED NURSING FACILITY AND A 19-BED HOUSING WITH SERVICES FACILITY IN KENYON, MINNESOTA. THE HOME HAD 15,930 RESIDENT DAYS DURING 2011. ALSO, SEVENTEEN SERVICES WERE PROVIDED TO THE RESIDENTS OF THE HOUSING WITH SERVICES FACILITY. 3182471 1 1 0 1 0 1 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 34 0 1 133 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X DAVE VANDERGON 5077896134 127 GUNDERSON BLVD KENYON MN 55946 CAREY HJERMSTAD 1.00 X 0 0 0 PENNY ISAACSON 1.00 X 0 0 0 LARRY LEHMAN 1.00 X 0 0 0 JUDY PAVEK 1.00 X 0 0 0 BARNEY NESSETH 1.00 X 0 0 0 STEVE SVIGGUM 1.00 X 0 0 0 JIM DAVIS 1.00 X 0 0 0 MARLENE SYVERSON 1.00 X 0 0 0 DAVID VANDERGON 40.00 X 76564 0 304 DENISE BUDD 40.00 X 60271 0 3003 136835 0 3307 0 0 0 0 REHABCARE GROUP CONTRACT THERAPY DIVISIO PO BOX 503534 ST LOUIS MO 63105 THERAPIES 170093 HEALTH PARTNERS NW 3600 PO BOX 1450 MINNEAPOLIS MN 55485 HEALTH INSURANCE 141286 DHS MEDICAL CARE SURCHARGE 540 CEDAR ST ST PAUL MN 55101 SURCHARGE 135120 US FOODS NW 6059 PO BOX 1450 MINNEAPOLIS MN 55485 FOOD/SUPPLIES 122369 4 27670 27670 MEDICARE/MEDICAID PAYM 623000 1834313 1834313 RESIDENT REVENUE 623000 1589137 1589137 RENTAL REVENUE 623000 44604 44604 MISCELLANEOUS INCOME 623000 3352 3352 3471406 3677 3677 MISCELLANEOUS INCOME 900099 86418 86418 MEAL REVENUE 623000 67395 67395 DAY CARE REVENUE 623000 17050 17050 170863 3673616 3471406 0 174540 80269 80269 1763035 1638066 124969 6015 4565 1450 163249 124819 38430 136207 103578 32629 83642 54494 29148 468 468 14115 14115 346169 279659 66510 35720 35720 201921 170284 31637 144511 144511 1609 1609 19197 15434 3763 116976 116976 166702 166702 37858 2516 35342 FOOD COSTS 174226 174226 MINNESOTA SURCHARGE 135120 135120 REAL ESTATE TAXES 21938 21938 MISCELLANEOUS EXPENSE 14273 14273 MINOR EQUIPMENT 12538 12538 29851 15436 14415 3705609 3182471 523138 0 81450 75512 126131 91876 261773 271935 12761 11849 45644 43905 5459767 2345636 3204232 3114131 125373 181749 97135 111266 3954499 3902223 192623 232449 2420949 2377679 336040 319201 2949612 2929329 X 1004887 972894 1004887 972894 3954499 3902223 -31993 0 X X 0 1 1 X 0 X 224016 57320 23473 54288 25969 385066 3637864 3711392 3460096 3419521 3471406 17700279 3861880 3768712 3483569 3473809 3497375 18085345 224016 57320 23473 23470 28998 357277 903440 1320765 1392852 1323617 1234064 6174738 1127456 1378085 1416325 1347087 1263062 6532015 11553330 6530 8666 6746 5851 5378 33171 6530 8666 6746 5851 5378 33171 170863 170863 3868410 3777378 3490315 3479660 3673616 18289379 0.63170 0.64650 0.00180 0.00180 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 78 0 0 0 0 0 78 0 X 1 0.50 1 0 0 1 0 0.00 0 1 65505 65505 4535956 1734266 2801690 834369 611370 222999 23937 23937 3114131 RESIDENT DEPOSITS & TRUST FUNDS PAY 13707 ASSET RETIREMENT OBLIGATION 233170 DUE TO FOUNDATION 72324 319201 DESCRIPTION OF HOW ORGANIZATION REPORTS CONSERVATION EASEMENTS: PART II, LINE 9: FACILITY IS ADJACENT TO THE GUNDERSON HOUSE WHICH IS ON THE NATIONAL HISTORIC REGISTRY, AND COVENENTS APPLY TO RECENT PROPERTY DEVELOPMENTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: BOTH THE HOME AND THE FOUNDATION HAVE BEEN GRANTED EXEPMT STATUS RELATIVE TO FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)3 OF THE INTERNAL REVENUE CODE. THE HOME AND FOUNDATION FOLLOW THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. NO LIABILITY HAS BEEN RECOGNIZED BY THE HOME OR FOUNDATION AS A RESULT OF THIS STANDARD. THE HOME AND FOUNDATION FILE AS TAX-EXEMPT ORGANIZATIONS. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE IRS. THE 2008, 2009, AND 2010 TAX YEARS OF THE HOME AND FOUNDATION ARE OPEN FOR EXAMINATION BY THE IRS. 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. MEMBERS OF THE BOARD OF DIRECTORS ALSO REVIEW AND APPROVE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ADMINISTRATION WILL BE RESPONSIBLE TO COMMUNICATE THIS POLICY TO EACH OFFICER, DIRECTOR, AND TRUSTEE SERVING KSH OR ANY OF ITS SUBSIDIARIES AND OTHERS AS THEY ARE NEWLY APPOINTED TO SUCH RULES. IF THERE IS A PERSON WITH A CONFLICT OR POTENTIAL CONFLICT, THEY SHALL REFRAIN FROM VOTING OR OTHERWISE ATTEMPT TO EXERT ANY INFLUENCE OF KSH. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS DETERMINE AND REVIEW THE CEO. THE CEO, WITH THE HELP FROM THE BOARD DETERMINE'S AND REVIEWS THE OTHER KEY EMPLOYEES. THE LAST REVIEWS WERE IN 2011. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 2C: THE ORGANIZATIONS CONSOLIDATED FINANCIAL STATEMENTS ARE AUDITED ANNUALLY BY AN INDEPENDENT ACCOUNTANT, RECEIVING AN UNQUALIFIED OPINION AS OF AND FOR THE YEARS ENDED SEPTEMBER 30, 2011 AND 2010. THE ORGANIZATIONS BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS CONSOLIDATED FINANCIAL STATEMENTS AND THE SELECTION OF ITS INDEPENDENT ACCOUNTANT. KENYON SUNSET HOME FOUNDATION 127 GUNDERSON BLVD KENYON MN 55946 411694615 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11, TYPE II KENYON SUNSET HOME 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 ALL TRANSACTIONS WERE UNDER 50000 THEREFORE NOT REQUIRED TO BE DISCLOSED