2012-07-26T14:44:19-05:00 2011-09-30 CLIFTONLARSONALLEN LLP PO BOX 217 AUSTIN MN 55912 990 2010-10-01 410880871 GOOD SHEPHERD LUTHERAN HOME GOOD 5078647714 PO BOX 747 RUSHFORD MN 559710747 ED BERKLEY 5078647714 2012-07-03 1 TRENT FAST 5074347000 2012-07-03 2010 2016-02-24 21:20:13Z ED BERKLEY 3873 WEST 9TH WINONA MN 55987 5592961 0 X WWW.GOODSHEP-RUSHFORD.ORG X 1965 MN TO PROVIDE NURSING HOME CARE AND ASSISTED LIVING CARE SERVICES TO THE ELDERLY OF RUSHFORD, MINNESOTA AND THE SURROUNDING AREA AND ALSO TO PROVIDE CHILD CARE SERVICES FOR EMPLOYEES AND THE PUBLIC. 9 9 193 122 235189 0 77937 62520 5395059 5474338 53918 38785 18026 17215 5544940 5592858 0 0 0 0 3652132 3661635 0 0 0 1727419 1744960 5379551 5406595 165389 186263 3463082 3417812 1614157 1393321 1848925 2024491 TO PROVIDE NURSING HOME CARE AND ASSISTED LIVING CARE SERVICES TO THE ELDERLY OF RUSHFORD, MINNESOTA AND THE SURROUNDING AREA AND ALSO TO PROVIDE CHILD CARE SERVICES FOR EMPLOYEES AND THE PUBLIC. 0 0 4870956 5239149 TO PROVIDE NURSING HOME CARE AND ASSISTED LIVING CARE SERVICES TO THE ELDERLY AND YOUNG OF RUSHFORD, MINNESOTA AND THE SURROUNDING AREA THROUGH THE OPERATION OF A 75 BED NURSING HOME, 32 APARTMENT UNITS, A 15 UNIT ASSISTED LIVING FACILITY, AND CHILDCARE ALL LOCATED ON ONE CAMPUS. 4870956 1 1 0 0 0 0 0 0 0 1 0 0 1 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 8 0 1 193 1 1 1 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MN X RHONDA SPECE 5078647714 800 HOME STREET RUSHFORD MN 55971 ED BERKLEY 0.50 X X 0 0 0 JEANNE FELDMEIER 0.50 X X 0 0 0 STEVE GILSETH 0.50 X X 0 0 0 BARB MENSINK 0.50 X 0 0 0 RACHEL BOYUM 0.50 X 0 0 0 BILL GRINDLAND 0.50 X 0 0 0 LYLE MELDAHL 0.50 X 0 0 0 MERLE EVENSON 0.50 X 0 0 0 LYLE NELSON 0.50 X 0 0 0 TOM LINDH 40.00 X 65456 0 15349 RHONDA SPECE 40.00 X 44461 0 14698 109917 0 30047 0 0 0 0 THERAPY NETWORK 66 SHADY OAK CT WINONA MN 55987 THERAPY 328586 1 14500 48020 62520 MEDICARE/MEDICAID PMTS 623000 3344779 3344779 RESIDENT REVENUE 623000 1414060 1414060 APARTMENT REVENUE 623000 374194 374194 DAY CARE REVENUE 624410 308445 73256 235189 MGMT CONTRACT REVENUE 561000 25900 25900 6960 6960 5474338 38888 38888 103 -103 -103 -103 BEAUTY SHOP REVENUE 812900 11208 11208 GUEST/EMPLOYEE MEALS 900099 5467 5467 MISCELLANEOUS REVENUE 900099 540 540 17215 5592858 5239149 235189 56000 139964 139964 2619395 2484962 134433 28501 26426 2075 683004 630455 52549 190771 176251 14520 65061 65061 33653 31115 2538 5336 90 5246 195116 176891 18225 189846 189846 5173 5173 11272 8468 2804 50506 50506 206365 206365 68591 68591 THERAPY EXPENSE 354487 354487 FOOD COSTS 211125 211125 MEDICAL CARE SURCHARGE 211125 211125 OTHER MEDICAL EXPENSE 69656 69656 TAXES & LICENSES 22442 22442 45206 20746 24460 5406595 4870956 535639 0 37400 35511 555545 677839 494709 421728 19131 23665 21811 16213 6149609 4331394 1897770 1818215 174875 168942 261841 255699 3463082 3417812 292542 270986 1267472 1073861 54143 48474 1614157 1393321 X 1801903 1979773 47022 44718 1848925 2024491 3463082 3417812 X 186263 -10697 X X 0 1 1 X 0 X 79313 157363 84602 77937 62520 461735 4777525 4845202 5305135 5395059 5474338 25797259 4856838 5002565 5389737 5472996 5536858 26258994 77313 89666 61995 62387 48020 339381 1266790 1397411 1409697 1406636 1635290 7115824 1344103 1487077 1471692 1469023 1683310 7455205 18803789 14089 21553 31845 54977 38888 161352 14089 21553 31845 54977 38888 161352 17215 17215 4870927 5024118 5421582 5527973 5592961 26437561 0.71130 0.71400 0.00610 0.00540 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 31559 31559 4041164 2750946 1290218 1853278 1420811 432467 223608 159637 63971 1818215 GUARANTY FUND CERTIFICATE 117870 DEFERRED FINANCING COSTS 34792 LAND & MINERAL RIGHTS 8731 DUE FROM RELATED PARTY 44718 EQUITY IN COOPERATIVE 47299 OTHER ASSETS 2289 255699 RENTAL DEPOSITS 11286 RESIDENT TRUST FUND 4266 ASSET RETIREMENT OBLIGATION 32922 48474 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOME AND APARTMENTS HAVE BEEN GRANTED EXEMPT STATUS FROM FEDERAL AND STATE CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THE HOME AND APARTMENTS FOLLOW THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. NO LIABILITY HAS BEEN RECOGNIZED BY THE HOME OR APARTMENTS AS A RESULT OF THIS STANDARD. BOTH THE HOME AND APARTMENTS 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 THROUGH 2011 TAX YEARS OF THE HOME AND APARTMENTS ARE OPEN TO EXAMINATION BY THE IRS. FORM 990, PART VI, SECTION A, LINE 6 THE ELEVEN AREA EVANGELICAL LUTHERAN CHURCHES ARE MEMBERS OF THE LUTHERAN HOME. FORM 990, PART VI, SECTION A, LINE 7A THE ELEVEN EVANGELICAL LUTHERAN CHURCHES NOMINATE AND ELECT MEMBERS OF THE GOVERNING BODY AT THE ANNUAL MEETING. EACH CHURCH SENDS TWO REPRESENTATIVES TO THE ANNUAL MEETING TO VOTE ON BEHALF OF THEIR CONGREGATION. AT THE ANNUAL MEETING BUT PRIOR TO VOTING, EACH MEMBER REPRESENTATIVE IS ALLOWED TO NOMINATE NEW CANDIDATES FOR THE GOVERNING BODY TO BE PUT ON THE BALLOT. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO BEING FILED WITH THE IRS, A COPY OF FORM 990 AND RELATED SCHEDULES ARE REVIEWED BY THE BOARD PRESIDENT OR ACTING DIRECTOR AND THE CFO, INCLUDING A CONFIRMATION OF THE ACCURACY OF EVERY ANSWER AND OVERSIGHT OF THE APPROPRIATE DOCUMENTATION. UPON COMPLETION OF THE REVIEW, THE FORMS ARE REVIEWED AND VOTED ON AT A BOARD MEETING PRIOR TO SUBMITTAL TO THE IRS. THE ELECTED OFFICERS WILL SIGN THE FORMS WHERE NEEDED. FORM 990, PART VI, SECTION B, LINE 12C IF ANYONE REASONABLY BELIEVES THAT A POLICY, PRACTICE OR ACTIVITY OF GOOD SHEPHERD LUTHERAN SERVICES IS IN VIOLATION OF LAW, A WRITTEN COMPLAINT MUST BE FILED BY THE PERSON TO THEIR MANAGER, UP TO AND INCLUDING THE HUMAN RESOURCES DIRECTOR, ADMINISTRATOR OR A BOARD MEMBER OF GOOD SHEPHERD LUTHERAN SERVICES. FORM 990, PART VI, SECTION B, LINE 15A THE PROCESS FOR DETERMINING ADMINISTRATOR COMPENSATION IS REVIEWED ANNUALLY BY THE GOVERNING BODY. ALSO, THE BOARD WILL VOTE ON WHETHER TO APPROVE THE MINNESOTA COST OF LIVING ADJUSTMENT. IN THE CASE MINNESOTA DOES RECOMMEND A COST OF LIVING ADJUSTMENT, THE GOVERNING BODY WILL VOTE ON WHETHER TO APPROVE THE COST OF LIVING ADJUSTMENT FOR ALL EMPLOYEES OF THE HOME. THIS PROCESS WAS LAST CONDUCTED IN 2010 FOR ADMINISTRATOR COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE ALL MADE AVAILABLE TO THE PUBLIC IN THE ADMINISTRATIVE OFFICE AND ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -10,697. FORM 990, PART XII, LINE 2C: THE ORGANIZATIONS BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS CONSOLIDATED FINANCIAL STATEMENTS AND THE SELECTION OF ITS INDEPENDENT ACCOUNTANT. GOOD SHEPHERD SENIOR APARTMENTS PO BOX 747 RUSHFORD MN 55971 411757528 TO PROVIDE LOW INCOME HOUSING TO THE ELDERLY OR HANDICAPPED MN 501(C)(3) LINE 9 GOOD SHEPHERD LUTHERAN SERVICES 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 0 NO TRANSACTIONS OVER 50000