2011-04-05T16:29:29-05:00 2010-09-30 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2009-10-01 237296950 ANNANDALE CARE CENTER ANNA 3202743737 500 PARK STREET EAST ANNANDALE MN 55302 John Nelson 3202743737 2011-03-28 1 LISA CHAFFEE CPA 7012398500 2011-03-21 2009 2016-02-24 21:20:13Z JOHN NELSON 500 PARK STREET EAST ANNANDALE MN 55302 7208578 0 X WWW.AHCSMN.ORG X 1973 MN SKILLED NURSING SERVICES AND ASSISTED LIVING SERVICES 8 7 209 107 0 0 7580 100743 6824180 7093527 26375 14308 0 6858135 7208578 19992 0 0 3664515 3757931 0 0 2836698 3129810 6521205 6887741 336930 320837 12699272 12328074 10591512 9899477 2107760 2428597 QUALITY CARE AND SERVICES THAT SHAPE THE FUTURE FOR THE DYNAMIC NEEDS OF THE PEOPLE IN OUR AREA. 1 0 6304517 7093527 THE 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. 6304517 1 1 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 1 209 1 0 0 0 0 0 0 0 0 0 8 7 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 1 1 0 1 0 MN X DEB REITMEIER 3202742578 500 PARK STREET EAST ANNANDALE MN 55302 JOHN NELSON 39.70 X X 137632 0 1123 MARK D MILLER 0.10 X X 0 0 0 SHARON PETERSON 0.10 X X 0 0 0 ROGER MILLNER 0.10 X 0 0 0 KATHY GRUYS 0.10 X 0 0 0 JERRY WOLFSTELLER 0.10 X 0 0 0 JACK DRISTE 0.10 X 0 0 0 MYRON MORRIS 0.10 X 0 0 0 DEBRA REITMEIER 38.00 X 74515 0 11478 212147 0 12601 1 0 0 0 REHABVISIONS 11623 ARBOR ST STE 201 OMAHA NE 68144 PT, OT AND SLP 499572 1 100743 100743 RESIDENT REVENUE 623000 6924624 6924624 OTHER REVENUE 900099 113437 113437 Wellness Center 713940 55466 55466 7093527 14308 14308 7208578 7093527 0 14308 237903 237903 3108667 3058004 50663 130738 119465 11273 280623 256426 24197 12801 12801 20250 20250 709551 667151 42400 7144 7144 640715 581868 58847 17003 17003 407233 342276 64957 4659 2149 2510 16319 15325 994 529407 529407 557609 557609 1947 1947 DHS Surcharge 168900 168900 Dues & Subscriptions 18885 18885 Licenses 8708 225 8483 Miscellaneous 8679 5712 2967 6887741 6304517 583224 0 1120499 1698322 774917 731785 384313 367168 11639864 3858899 8192365 7780965 2220124 1741487 7054 8347 12699272 12328074 1226694 682085 31732 10709 9300000 9170000 33086 36683 10591512 9899477 X 2107760 2428597 2107760 2428597 12699272 12328074 X 0 1 0 X 0 X 8553 12421 3474 7580 100743 132771 5051844 5366741 5575740 6824180 7093527 29912032 5060397 5379162 5579214 6831760 7194270 30044803 0 42630 239929 50240 80381 81144 494324 42630 239929 50240 80381 81144 494324 29550479 40910 55233 53848 26375 14308 190674 40910 55233 53848 26375 14308 190674 5101307 5434395 5633062 6858135 7208578 30235477 0.97730 0.00630 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 69516 69516 9787173 2842158 6945015 1390783 852572 538211 392392 164169 228223 7780965 7208578 6887741 Part IV, Line 2b: ANNANDALE CARE CENTER ACTS AS CUSTODIAN FOR FUNDS OF IT'S RESIDENTS. Part X: Description of Uncertain Tax Positions Under FIN 48: 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. 1 Scholarships- Education 11 18885 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule 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. ECONOMIC DEVELOPMENT AUTHORITY OF THE CITY OF ANNANDALE MN 416004935 2007-11-07 9296182 QUALIFIED 501(C)(3) NONHOSPITAL BOND-95% OR MORE USED FOR CAPITAL EXPEND. 0 0 9296182 4235652 186000 1 1 0 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 Form 990, Part III, line 2 New Program Services WELLNESS 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 7a THE BOARD OF DIRECTORS IS ELECTED ANNUALLY BY THE BOARD OF DIRECTORS OF ANNANDALE HEALTH AND COMMUNITY SERVICES. Form 990, Part VI, Section A, line 7b THE 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 8b THERE 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 11 A 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 12c THERE 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 15b EACH 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 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE NOT MADE PUBLICLY AVAILABLE. FORM 990, PART VII JOHN 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. ANNANDALE HEALTH AND COMMUNITY SERVICES 500 PARK STREET E ANNANDALE MN 55302 411820760 OVERSIGHT MN 501(c)(3) 7 N/A HEARTLAND TRANSIT 500 PARK STREET E ANNANDALE MN 55302 411820763 INACTIVE CORPORATION MN 501(c)(3) 7 ANNANDALE HEALTH AND COMMUNITY SERVICES ANNANDALE CONGREGATE HOUSING 500 PARK STREET E ANNANDALE MN 55302 363566531 INDEPENDENT LIVING MN 501(c)(3) 11a ANNANDALE HEALTH AND COMMUNITY SERVICES 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0