2011-05-16T10:26:17-05:00 2010-09-30 LARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2009-10-01 410870856 MAPLE LAWN NURSING HOME INC MAPL 5074252571 400 7th St NE FULDA MN 56131 Arlan Swanson Administrator 5074252571 2011-05-13 1 Gordon J Vetsch 6123764500 2009 2016-02-24 21:20:13Z Arlan Swanson 400 7th St NE FULDA MN 56131 4291420 0 X www.maplelawn.org X 1962 MN TO PROVIDE FINE QUALITY HEALTHCARE, HOUSING AND SUPPORT SERVICES FOR AREA SENIORS. 9 9 138 115 0 0 3926 6020 4322019 4242701 6771 16546 30385 26153 4363101 4291420 0 0 2430701 2509946 0 0 1678339 1602320 4109040 4112266 254061 179154 4183701 4241694 2721052 2599891 1462649 1641803 To provide fine quality healthcare, housing and support services for area seniors in an individualized, dignified and homelike manner. 0 0 3876434 4242701 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. 3876434 1 0 0 0 0 0 0 1 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 1 14 0 1 138 1 0 0 0 0 0 0 0 0 0 9 9 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 0 1 0 0 0 MN X X Arlan Swanson 5074252571 400 7th St NE FULDA MN 56131 jerrild STEINER 1.00 X X 0 0 0 JEFF ZINS 1.00 X X 0 0 0 MARCINE ELDER 1.00 X X 0 0 0 Dean VANOORT 1.00 X 0 0 0 DELL GOEDTKE 1.00 X 0 0 0 dean mcneal 1.00 X 0 0 0 mary fran busch 1.00 X 0 0 0 shirley buschena 1.00 X 0 0 0 elden getting 1.00 X 0 0 0 ARLAN SWANSON 40.00 X 81552 0 1811 81552 0 1811 0 0 0 0 PRAIRIE REHABILITATION SERVICES LLC 1720 S Cliff Avenue Sioux Falls SD 57103 contracted therapy 257651 1 6020 6020 RESIDENT SERVICES 623000 3399892 3399892 APARTMENT RENTAL 623000 842809 842809 4242701 16546 16546 other income 623000 26153 26153 26153 4291420 4242701 0 42699 83363 83363 1951258 1945295 5963 20709 20648 61 329501 328535 966 125115 124748 367 31911 31911 295459 294783 676 264490 234968 29522 146003 140858 5145 8708 8708 104424 99998 4426 208415 199582 8833 58014 55555 2459 food 224589 224589 License surcharge 175804 175804 miscellaneous expense 49555 7058 42497 Repairs and Maintenance 21974 11039 10935 pre-admission screening 12974 12974 4112266 3876434 235832 0 327340 231732 367578 751894 462677 354272 61703 59633 5864805 3074904 2910406 2789901 42424 39400 11573 14862 4183701 4241694 328060 331120 2352499 2229617 17681 15136 22812 24018 2721052 2599891 X 1462649 1641803 1462649 1641803 4183701 4241694 X 0 1 1 X 0 X 14224 7778 6300 3926 6020 38248 3776746 3979734 4121994 4322019 4242701 20443194 3790970 3987512 4128294 4325945 4248721 20481442 0 45627 122225 132885 80415 381152 45627 122225 132885 80415 381152 20100290 13613 16480 11943 6771 16546 65353 13613 16480 11943 6771 16546 65353 5643 10181 26443 30385 26153 98805 3810226 4014173 4166680 4363101 4291420 20645600 0.97360 0.99310 0.00320 0.00290 X Schedule A, Part II, Line 12, Explanation of Other Income: MISCELLANEOUS REVENUES 0 1 4656781 2129557 2527224 243178 60074 183104 964846 885273 79573 2789901 asset retirement obligation 24018 24018 4291420 4112266 179154 0 179154 4291420 0 4291420 0 4291420 4112266 0 4112266 0 4112266 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. City of Fulda minnesota 416005177 2003-09-24 2865000 refund prior issue bonds and fund new construction 0 0 2865000 57000 1543000 2004 0 1 1 1 0 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 B, line 11 Management provided information for preparation of the Form 990. A copy of the Form 990 is electronically provided to the Board of Directors 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 C, line 19 The governing documents, conflict of interest policy, and financial statements are made available to the public upon request.