ANNANDALE CARE CENTER: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
ANNANDALE CARE CENTER (EIN 23-7296950)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-04-05
IRS object ID
201120959349300012
Schema version
2009v1.7
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)
Timestamp2011-04-05T16:29:29-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14310 17TH AVE S PO BOX 2545AddressLine1
CityFARGOCity
StateNDState
ZIP Code581082545ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237296950EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ANNANDALE CARE CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlANNANameControl
Phone3202743737Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 PARK STREET EASTAddressLine1
CityANNANDALECity
StateMNState
ZIP Code55302ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJohn NelsonName
TitleADMINISTRATOR/PRESIDENTTitle
Phone3202743737Phone
Date Signed2011-03-28DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLISA CHAFFEE CPAName
Phone7012398500Phone
Date Prepared2011-03-21DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOHN NELSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1500 PARK STREET EASTAddressLine1
CityANNANDALECity
StateMNState
ZIP Code55302ZIPCode
FieldValueIRS element (for citing)
Gross Receipts7208578GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.AHCSMN.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1973YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionSKILLED NURSING SERVICES AND ASSISTED LIVING SERVICESActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees209TotalNbrEmployees
Total Nbr Volunteers107TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year7580ContributionsGrantsPriorYear
Contributions Grants Current Year100743ContributionsGrantsCurrentYear
Program Service Revenue Prior Year6824180ProgramServiceRevenuePriorYear
Program Service Revenue CY7093527ProgramServiceRevenueCY
Investment Income Prior Year26375InvestmentIncomePriorYear
Investment Income Current Year14308InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year6858135TotalRevenuePriorYear
Total Revenue Current Year7208578TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year19992GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year3664515SalariesEtcPriorYear
Salaries Etc Current Year3757931SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2836698OtherExpensePriorYear
Other Expenses Current Year3129810OtherExpensesCurrentYear
Total Expenses Prior Year6521205TotalExpensesPriorYear
Total Expenses Current Year6887741TotalExpensesCurrentYear
Revenues Less Expenses Prior Year336930RevenuesLessExpensesPriorYear
Revenues Less Expenses CY320837RevenuesLessExpensesCY
Total Assets BOY12699272TotalAssetsBOY
Total Assets EOY12328074TotalAssetsEOY
Total Liabilities BOY10591512TotalLiabilitiesBOY
Total Liabilities EOY9899477TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2107760NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2428597NetAssetsOrFundBalancesEOY
Mission DescriptionQUALITY CARE AND SERVICES THAT SHAPE THE FUTURE FOR THE DYNAMIC NEEDS OF THE PEOPLE IN OUR AREA.MissionDescription
Significant New Program Services1SignificantNewProgramServices
Significant Change0SignificantChange
Expense6304517Expense
Revenue7093527Revenue
DescriptionTHE ORGANIZATION OPERATES A 60 BED SKILLED NURSING FACILITY, A 26 UNIT ASSISTED LIVING BUILDING (AKA CENTENNIAL VILLA ASSISTED LIVING), A 39 UNIT MEMORY CARE FACILITY AND A WELLNESS CENTER WHICH JUST OPENED IN OCTOBER 2009. IT NOT ONLY PROVIDES SERVICES TO THE ELDERLY POPULATION IN ANNANDALE BUT ALSO TO THOSE IN OTHER AREA COMMUNITIES WHICH HELPS THE INDIVIDUAL TO REMAIN IN THE SAME GEOGRAPHICAL AREA OF THEIR FORMER RESIDENCE. THE SKILLED NURSING FACILITY HAS AN EXCELLENT THERAPY PROGRAM THAT IS AVAILABLE TO ITS RESIDENTS WHO ARE IN NEED OF REHABILITATION SERVICES. IT ALSO HAS AN OUTPATIENT PROGRAM THAT TREATS THOSE FROM THE ANNANDALE COMMUNITY AND THE SURROUNDING AREA. IT IS BECAUSE OF ITS ONSITE THERAPY PROGRAM THAT IT HAS BECOME THE FIRST CHOICE FOR MOST WHEN THEY REQUIRE REHABILITATION SERVICES FOLLOWING A SURGERY IN ORDER TO RETURN HOME SAFELY. THE ASSISTED LIVING BUILDING SERVES AS A PLEASANT TRANSITION FOR THOSE WHO NEED ADDITIONAL HELP THAT IS NOT READILY AVAILABLE IN THEIR OWN HOME BUT ARE STILL INDEPENDENT ENOUGH THAT THEY DON'T REQUIRE THE SERVICES OF A SKILLED NURSING FACILITY. THE MEMORY LOSS UNIT IS MUCH MORE APPROPRIATE FOR THOSE WHO SUFFER FROM ALZHEIMER'S AND/OR SEVERE DEMENTIA THAN A SKILLED NURSING FACILITY. THE ENVIRONMENT IS CONTROLLED AND SETUP TO MEET EACH RESIDENT'S NEEDS RELATING TO THEIR SPECIFIC ILLNESS. THE WELLNESS CENTER HAS A THERAPY/EXERCISE SWIM POOL, EXERCISE CLASS STUDIO AND AN EXERCISE EQUIPMENT ROOM DEVELOPED TO SERVE THE WELLNESS NEEDS OF THOSE 50 YEARS OF AGE AND OLDER - BOTH WITHIN THE CAMPUS AND THE OUTSIDE COMMUNITY.Description
Total Program Service Expense6304517TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
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 Individuals1GrantsToIndividuals
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 Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10962NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees209NumberOfEmployees
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
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons0AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DEB REITMEIERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3202742578TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1500 PARK STREET EASTAddressLine1
CityANNANDALECity
StateMNState
ZIP Code55302ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
JOHN NELSON
ADMINISTRATOR/PRESIDENT39.70XX13763201123
MARK D MILLER
VICE PRESIDENT/CHAIRMAN0.10XX000
SHARON PETERSON
SECRETARY/TREASURER0.10XX000
ROGER MILLNER
DIRECTOR0.10X000
KATHY GRUYS
DIRECTOR0.10X000
JERRY WOLFSTELLER
DIRECTOR0.10X000
JACK DRISTE
DIRECTOR0.10X000
MYRON MORRIS
DIRECTOR0.10X000
DEBRA REITMEIER
CONTROLLER/ASST. ADMINISTR38.00X74515011478
FieldValueIRS element (for citing)
Total Reportable Comp From Org212147TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation12601TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
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 Line1REHABVISIONSBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line111623 ARBOR ST STE 201AddressLine1
CityOMAHACity
StateNEState
ZIP Code68144ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesPT, OT AND SLPDescriptionOfServices
Compensation499572Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions100743AllOtherContributions
Total Contributions100743TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
RESIDENT REVENUE62300069246246924624
OTHER REVENUE900099113437113437
Wellness Center7139405546655466
FieldValueIRS element (for citing)
Total Program Service Revenue7093527TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column14308TotalRevenueColumn
Exclusion$14,308ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column7208578TotalRevenueColumn
Related Or Exempt Function Income7093527RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$14,308ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total237903Total
Management And General237903ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3108667Total
Program Services3058004ProgramServices
Management And General50663ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total130738Total
Program Services119465ProgramServices
Management And General11273ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total280623Total
Program Services256426ProgramServices
Management And General24197ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total12801Total
Management And General12801ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total20250Total
Management And General20250ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total709551Total
Program Services667151ProgramServices
Management And General42400ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total7144Total
Management And General7144ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total640715Total
Program Services581868ProgramServices
Management And General58847ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total17003Total
Management And General17003ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total407233Total
Program Services342276ProgramServices
Management And General64957ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total4659Total
Program Services2149ProgramServices
Management And General2510ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total16319Total
Program Services15325ProgramServices
Management And General994ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total529407Total
Program Services529407ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total557609Total
Program Services557609ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1947Total
Management And General1947ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
DHS Surcharge168900168900
Dues & Subscriptions1888518885
Licenses87082258483
Miscellaneous867957122967

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total6887741Total
Program Services6304517ProgramServices
Management And General583224ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1120499BOY
EOY1698322EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY774917BOY
EOY731785EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY384313BOY
EOY367168EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis11639864LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3858899LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8192365BOY
EOY7780965EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY2220124BOY
EOY1741487EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY7054BOY
EOY8347EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY12699272BOY
EOY12328074EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1226694BOY
EOY682085EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY31732BOY
EOY10709EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY9300000BOY
EOY9170000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY33086BOY
EOY36683EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY10591512BOY
EOY9899477EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2107760BOY
EOY2428597EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2107760BOY
EOY2428597EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12699272BOY
EOY12328074EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee0AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 Years8553CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years12421CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3474CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year7580CurrentTaxYearMinus1Year
Current Tax Year100743CurrentTaxYear
Total132771Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5051844CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5366741CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5575740CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6824180CurrentTaxYearMinus1Year
Current Tax Year7093527CurrentTaxYear
Total29912032Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5060397CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5379162CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5579214CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6831760CurrentTaxYearMinus1Year
Current Tax Year7194270CurrentTaxYear
Total30044803Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years42630CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years239929CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years50240CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year80381CurrentTaxYearMinus1Year
Current Tax Year81144CurrentTaxYear
Total494324Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years42630CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years239929CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years50240CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year80381CurrentTaxYearMinus1Year
Current Tax Year81144CurrentTaxYear
Total494324Total
FieldValueIRS element (for citing)
Public Support Total50929550479PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years40910CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years55233CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years53848CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year26375CurrentTaxYearMinus1Year
Current Tax Year14308CurrentTaxYear
Total190674Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years40910CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years55233CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years53848CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year26375CurrentTaxYearMinus1Year
Current Tax Year14308CurrentTaxYear
Total190674Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5101307CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5434395CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5633062CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6858135CurrentTaxYearMinus1Year
Current Tax Year7208578CurrentTaxYear
Total30235477Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97730PublicSupportPercentage509
Investment Income Percentage0.00630InvestmentIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

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

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis69516OtherCostOrOtherBasis
Book Value69516BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis9787173OtherCostOrOtherBasis
Depreciation2842158Depreciation
Book Value6945015BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1390783OtherCostOrOtherBasis
Depreciation852572Depreciation
Book Value538211BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis392392OtherCostOrOtherBasis
Depreciation164169Depreciation
Book Value228223BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7780965TotalOfBookValueLandBuildings
Tot Revenue Etc Audited Fincl Stmt7208578TotRevenueEtcAuditedFinclStmt
Tot Expenses Etc Audited Fincl Stmt6887741TotExpensesEtcAuditedFinclStmt

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Part IV, Line 2b:ANNANDALE CARE CENTER ACTS AS CUSTODIAN FOR FUNDS OF IT'S RESIDENTS.
Part X:ANNANDALE CARE CENTER UNDERGOES AN ANNUAL ANALYSIS OF ITS VARIOUS TAX POSITIONS, ASSESSING THE LIKELIHOOD OF THOSE POSITIONS BEING UPHELD UPON EXAMINATION WITH RELEVANT TAX AUTHORITIES, AS DEFINED BY ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA. ANNANDALE CARE CENTER BELIEVES THAT IT IS COMPLIANT WITH ALL IRS TAX REGULATIONS, AND AS OF SEPTEMBER 30, 2010 AND 2009, HAS NOT RECORDED A TAX LIABILITY FOR A TAX UNCERTAINTY. ANNANDALE CARE CENTER WILL RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX LIABILITIES IN INCOME TAX EXPENSE, IF INCURRED. UNDER NORMAL CIRCUMSTANCES, ANNANDALE CARE CENTER IS NO LONGER SUBJECT TO FEDERAL AND STATE TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2007.Description of Uncertain Tax Positions Under FIN 48:

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantScholarships- EducationTypeOfGrant
Number Of Recipients11NumberOfRecipients
Amount Of Cash Grant18885AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: Scholarships are awarded to employees who work an average of 20 hours a week or more and who are enrolled in program of study related to long term care. Recipients are selected by a committee on a quarterly basis. Funds are disbursed upon receiving a copy of the recipient's tuition/fees statement and/or receipts for purchases of required textbooks. The guidelines for this program are in accordance with those set forth by the MN Department of Human Services' Nursing Facility Scholarship Program.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1ECONOMIC DEVELOPMENT AUTHORITY OF THE CITY OF ANNANDALE MNBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN416004935IssuerEIN
Date Issued2007-11-07DateIssued
Issue Price9296182IssuePrice
Description Of PurposeQUALIFIED 501(C)(3) NONHOSPITAL BOND-95% OR MORE USED FOR CAPITAL EXPEND.DescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds9296182TotalProceeds
Amount Defeased4235652AmountDefeased
Issuance Costs From Proceeds186000IssuanceCostsFromProceeds
Current Refunding1CurrentRefunding
Advance Refunding1AdvanceRefunding
Final Allocation Made0FinalAllocationMade
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
Bond Counsel Routinely Engaged0BondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
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 (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Form 990, Part III, line 2New Program ServicesWELLNESS CENTER OPENED OCTOBER 2009. WELLNESS CENTER WITH THERAPY/EXERCISE SWIM POOL, EXERCISE CLASS STUDIO AND EXERCISE EQUIPMENT ROOM DEVELOPED TO SERVE THE WELLNESS NEEDS OF THOSE 50 YEARS OF AGE AND OLDER - BOTH WITHIN THE CAMPUS AND THE OUTSIDE COMMUNITY.
Form 990, Part VI, Section A, line 7aTHE BOARD OF DIRECTORS IS ELECTED ANNUALLY BY THE BOARD OF DIRECTORS OF ANNANDALE HEALTH AND COMMUNITY SERVICES.
Form 990, Part VI, Section A, line 7bTHE FOLLOWING MUST BE APPROVED BY THE BOARD OF DIRECTORS OF ANNANDALE HEALTH & COMMUNITY SERVICE: **BUDGET -CHANGES IN BUDGET OF OVER $10,000 -EXPENDITURES OF OVER $10,000 -SALES OF ASSETS OF OVER $10,000 -CHANGES TO THE BYLAWS THE FOLLOWING MUST BE APPROVED BY THE PRESIDENT OF THE ANNANDALE HEALTH & COMMUNITY SERVICE BOARD: -CHANGES IN THE BUDGET OF OVER $5,000 BUT LESS THAN $10,000 -EXPENDITURES OF OVER $5,000 BUT LESS THAN $10,000 -SALES OF ASSETS OF OVER $5,000 BUT LESS THAN $10,000
Form 990, Part VI, Section A, line 8bTHERE ARE NO COMMITTEES THAT CAN ACT ON BEHALF OF THE BOARD. COMMITTEES MUST COME BACK TO THE FULL BOARD TO MAKE A FINAL DECISION.
Form 990, Part VI, Section B, line 11A DRAFT COPY OF THE FORM 990 WILL BE MAILED OUT TO MEMBERS OF THE BOARD PRIOR TO THE FILING DATE. ALSO THE CONTROLLER/ASSISTANT ADMINISTRATOR, AND THE ADMINISTRATOR/PRESIDENT WILL REVIEW A DRAFT COPY OF THE 990 BEFORE IT IS FILED.
Form 990, Part VI, Section B, line 12cTHERE IS NO ANNUAL FORM OR DISCLOSURE THAT IS USED TO UNCOVER CONFLICTS OF INTEREST; HOWEVER INDIVIDUALS ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST BASED ON AN "HONOR-SYSTEM." ANYONE WHO CAN INFLUENCE THE ACTIONS OF THE CORPORATION IS COVERED BY THE POLICY. THIS INCLUDES BOARD MEMBERS, KEY EMPLOYEES, OFFICERS, AND EMPLOYEES. THE BOARD REVIEWS AND DETERMINES WHEN AND IF A CONFLICT EXISTS. IF A CONFLICT EXISTS, BOARD MEMBERS ARE NOT ALLOWED TO VOTE ON THE ISSUE IN CONFLICT. ALL CONFLICTS OF INTEREST ARE DOCUMENTED IN THE MINUTES OF THE BOARD MEETING MINUTES.
Form 990, Part VI, Section B, line 15bEACH YEAR, THE CORPORATION FINDS OUT WHAT THE INCREASE IN RATES WILL BE. THE INCREASE IN RATES IS ALLOCATED PROPORTIONATELY ACROSS THE BOARD TO ALL EMPLOYEES. THE BUDGET IS ALSO DETERMINED BY THE INCREASE IN RATES AND THE BOARD OF DIRECTORS APPROVES THE BUDGET.
Form 990, Part VI, Section C, line 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE NOT MADE PUBLICLY AVAILABLE.
FORM 990, PART VIIJOHN NELSON DEVOTES .3 HOURS PER WEEK TO ANNANDALE CONGREGATE HOUSING SERVICES, A RELATED ORGANIZATION. DEBRA REITMEIER DEVOTES 2 HOURS PER WEEK TO ANNANDALE CONGREGATE HOUSING SERVICES, A RELATED ORGANIZATION. MARK MILLER DEVOTES .1 HOURS PER WEEK TO ANNANDALE CONGREGATE HOUSING SERVICES, A RELATED ORGANIZATION. SHARON PETERSON DEVOTES .1 HOURS PER WEEK TO ANNANDALE CONGREGATE HOUSING SERVICES, A RELATED ORGANIZATION.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNABusiness Name Line1DirectControllingEntityName/BusinessNameLine1
ANNANDALE HEALTH AND COMMUNITY SERVICES
500 PARK STREET EANNANDALEMN55302411820760OVERSIGHTMN501(c)(3)7N/A
HEARTLAND TRANSIT
500 PARK STREET EANNANDALEMN55302411820763INACTIVE CORPORATIONMN501(c)(3)7ANNANDALE HEALTH AND COMMUNITY SERVICES
ANNANDALE CONGREGATE HOUSING
500 PARK STREET EANNANDALEMN55302363566531INDEPENDENT LIVINGMN501(c)(3)11aANNANDALE HEALTH AND COMMUNITY SERVICES
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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