2024-05-21T13:08:48-05:00 2023-08-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2022-09-01 410706155 AMERICAN BAPTIST HOMES OF THE MIDWEST AMER 9529413175 14850 SCENIC HEIGHTS ROAD 125 EDEN PRAIRIE MN 55344 LARS JOHNSON CFO 9529413175 2024-05-20 1 LARS JOHNSON 999009999 1 JOHN MELZAREK P02080879 6123764500 2024-05-16 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z ANNETTE GREELY 14850 SCENIC HEIGHTS ROAD 125 EDEN PRAIRIE MN 55344 91109816 0 X WWW.ABHOMES.NET X 1930 MN TO PROVIDE NURSING HOME CARE AND HOUSING TO LOW INCOME, ELDERLY, AND DISABLED PERSONS. 15 14 1930 265 0 0 9707057 9641394 73069761 78476320 1198550 484996 132744 290447 84108112 88893157 0 0 0 0 45437274 48903024 0 0 0 37743013 39994779 83180287 88897803 927825 -4646 100709718 96954773 161432454 156325923 -60722736 -59371150 X TO PROVIDE NURSING HOME CARE AND HOUSING TO LOW INCOME, ELDERLY, AND DISABLED PERSONS. 0 0 78554035 0 78476320 SKILLED NURSING FACILITIES: THE SKILLED NURSING FACILITIES OF THE OBLIGATED GROUP (INCLUDING BOARD & CARE AND BASIC CARE UNITS) PROVIDE HEALTH CARE AND CONVALESCENT TREATMENT PRIMARILY FOR IN-PATIENT ELDERLY PERSONS, INCLUDING THOSE ADMITTED AS AN INTERMEDIATE STEP AFTER HOSPITALIZATION AND BEFORE RETURNING TO THEIR HOMES, AS WELL AS THOSE ADMITTED FOR LONG-TERM RESIDENCY. THE SKILLED NURSING FACILITIES ARE LICENSED UNDER THE REGULATIONS OF THE STATE IN WHICH THEY OPERATE, AND ARE CERTIFIED AS NURSING FACILITIES UNDER BOTH THE STATE MEDICAID AND FEDERAL MEDICARE PROGRAMS. CERTIFICATION REQUIRES THAT THE FACILITIES PROVIDE CONTINUOUS REGISTERED NURSE SUPERVISION AND SPECIFIC RATIOS OF NURSING PERSONNEL PER RESIDENT.THE SKILLED NURSING FACILITY RESIDENTS RECEIVE 24-HOUR NURSING CARE, ALL MEALS (AND SPECIAL DIETS AS REQUIRED) AND SUCH DRUGS AND THERAPY AS MAY BE PRESCRIBED BY THE RESIDENT'S PHYSICIAN. THREE BALANCED MEALS ARE PROVIDED TO EACH RESIDENT DAILY, IN THE RESIDENT'S ROOM OR AT A CENTRAL DINING LOCATION. LIGHT SNACKS ARE PROVIDED DURING THE DAY AND AT BEDTIME. EACH SKILLED NURSING FACILITY IS ADMINISTERED ON LOCATION BY A FULL-TIME ADMINISTRATOR LICENSED BY THE STATE. A DIRECTOR OF NURSING SERVICES, WHO IS A CERTIFIED NURSE, IS RESPONSIBLE FOR SUPERVISING THE REGISTERED NURSES, LICENSED PRACTICAL NURSES AND REGISTERED NURSING ASSISTANTS WORKING AT THE SKILLED NURSING FACILITIES. SOCIAL SERVICE PROGRAMS ARE PROVIDED BY SOCIAL WORKERS UNDER THE SUPERVISION OF A LICENSED STAFF MEMBER OR GUIDED BY A CONSULTING SOCIAL WORKER AND ASSISTED BY VOLUNTEER AUXILIARY GROUPS. EACH OF THE SKILLED NURSING FACILITIES HAS A CONSULTING PHYSICIAN ON CALL WHO IS AVAILABLE TO THE RESIDENTS AT THE FACILITY. IN ADDITION, THE SKILLED NURSING FACILITIES ARRANGE WITH HOSPITALS FOR TRANSFER OF RESIDENTS BETWEEN THE FACILITIES AND HOSPITALS WHEN NECESSARY.THE SKILLED NURSING FACILITIES PROVIDE RESIDENT ROOMS DESIGNED PRINCIPALLY FOR TWO BEDS, BUT ALSO INCLUDE SOME ONE-BED ROOMS. EACH SKILLED NURSING FACILITY CONTAINS ONE OR MORE DINING ROOMS, ONE OR MORE RECREATION AREAS, DAY ROOMS, THERAPY AREA, AND FULLY-EQUIPPED KITCHEN AND LAUNDRY FACILITIES. ALL SKILLED NURSING FACILITIES HAVE APPROVED FIRE DETECTION AND ALARM SYSTEMS. EACH SKILLED NURSING FACILITY PROVIDES A BEAUTY AND BARBER SHOP ON LOCATION.ASSISTED LIVING FACILITIES: THE ASSISTED LIVING FACILITIES ARE DESIGNED AND OPERATED TO ALLOW SENIOR ADULTS TO LIVE AND ENJOY AN INDEPENDENT LIFESTYLE IN A SECURE AND CONVENIENT COMMUNITY ATMOSPHERE. FULL-TIME PROFESSIONAL MANAGERS PROVIDE ASSISTANCE TO RESIDENTS. A NURSE CALL SYSTEM MONITORED 24 HOURS DAILY PUTS THE RESIDENTS IN CONTACT WITH NURSING SERVICE STAFF. DAILY HOUSEKEEPING, INCLUDED IN THE COST OF RENT, HELPS THE RESIDENTS WITH CLEANING CHORES AND PROVIDES AN OPPORTUNITY FOR FACILITY STAFF TO MONITOR THE WELL-BEING OF THE RESIDENTS. SOCIAL AND ACTIVITY PROGRAMS PROVIDE RESIDENTS WITH THE OPPORTUNITY TO FULLY ENJOY THE FACILITIES AND ARE DESIGNED TO MEET THE SOCIAL AND EMOTIONAL NEEDS OF THE RESIDENTS. ADDITIONAL SERVICES PROVIDED INCLUDE: PHYSICAL THERAPY, TRANSPORTATION, LAUNDRY SERVICES AND BLOOD PRESSURE CHECKS. MEAL SERVICE IS INCLUDED IN THE MONTHLY FEE FOR THE ASSISTED LIVING FACILITIES. INDEPENDENT LIVING COMMUNITIES: THE INDEPENDENT LIVING COMMUNITIES OFFER A CONTINUUM OF SERVICES ON A CAMPUS SETTING. THESE INDEPENDENT LIVING FACILITIES ARE DESIGNED AND OPERATED TO ALLOW SENIOR ADULTS TO LIVE AND ENJOY AN INDEPENDENT LIFESTYLE IN A SECURE AND CONVENIENT COMMUNITY ATMOSPHERE. FULL-TIME PROFESSIONAL MANAGERS PROVIDE ASSISTANCE TO RESIDENTS. THE OBLIGATED GROUP'S INDEPENDENT LIVING COMMUNITIES PROVIDE OR ASSIST IN ARRANGEMENTS FOR ADDITIONAL SERVICES SUCH AS VISITING NURSES, CHORE SERVICES, OR OTHER PERSONAL NEED SERVICES. ALL INDEPENDENT LIVING SETTINGS HAVE A PLANNED ACTIVITY PROGRAM, A VARIETY OF MEAL PLANS AVAILABLE, WEEKLY HOUSEKEEPING AND TRANSPORTATION SERVICES PROVIDED. SPECIALIZED PROGRAMS FOR HEALTH AND WELLNESS ARE ALSO AVAILABLE FOR A NOMINAL FEE OR WILL BE AVAILABLE SOON. VISITOR QUARTERS ARE AVAILABLE FOR FAMILY MEMBERS AND MEALS MAY BE PURCHASED FOR VISITORS AS NEEDED. AN EMERGENCY CALL SYSTEM MONITORED 24 HOURS DAILY PUTS THE RESIDENTS IN CONTACT WITH EMERGENCY MEDICAL SERVICES. GROUP HOMES FOR DEVELOPMENTALLY DISABLED (CREST SERVICES): CREST SERVICES, A DIVISION OF ABHM, PROVIDES RESIDENTIAL SERVICES TO PERSONS WITH DISABILITIES IN IOWA AND MINNESOTA. THE MAJORITY OF THE INDIVIDUALS SERVED ARE THOSE WITH A PRIMARY DIAGNOSIS OF MENTAL RETARDATION, OTHERS MAY HAVE SOME TYPE OF BRAIN INJURY OR OTHER TYPE OF DEVELOPMENTAL DISABILITY. SERVICES ARE PROVIDED IN A VARIETY OF SETTINGS INCLUDING THE INDIVIDUAL'S OWN APARTMENT UNDER THE HOME AND COMMUNITY BASED SERVICES (HCBS) PROGRAM OR A SMALL GROUP HOME SETTING WITH TWO TO FOUR INDIVIDUALS (TYPICALLY, A MODESTLY SIZED HOME LOCATED IN A RESIDENTIAL NEIGHBORHOOD). CREST SERVICES DOES MAINTAIN ONE LARGER GROUP HOME SERVING FIFTEEN INDIVIDUALS IN OTTUMWA, IOWA. THE CREST SERVICES STAFF WORKS IN CONJUNCTION WITH THE PRIMARY CONSUMER, THEIR FAMILY, THE MEDICAL TEAM, AND COUNTY AND STATE SOCIAL SERVICE STAFF TO PROVIDE TAILORED SERVICES FOR THE INDIVIDUAL. SERVICES PROVIDED INCLUDE HEALTH CARE AND ASSISTANCE WITH ACTIVITIES OF DAILY LIVING (BATHING, GROOMING, DRESSING, ETC.), DEVELOPMENT OF JOB OR SOCIAL SKILLS, RECREATIONAL ACTIVITIES, BUDGETING AND BASIC FINANCIAL PLANNING. RESPITE SERVICES ARE ALSO PROVIDED AS NEEDED. THE PRIMARY FUNDING SOURCE IS THROUGH CERTIFICATION IN THE HCBS WAIVER PROGRAMS, WHICH WAIVES THE COST OF CERTAIN HEALTHCARE SERVICES, ALTHOUGH THERE ARE SEVERAL WAIVER PROGRAMS FUNDED WITH FEDERAL DOLLARS, I.E., MENTAL RETARDATION, BRAIN INJURY, ELDERLY. PERSONS WITH A DEVELOPMENTAL DISABILITY (DD), OTHER THAN MENTAL RETARDATION (EXCLUDING MENTAL ILLNESS) ARE SERVED UNDER THE COUNTY PAID CHAPTER 24 CERTIFIED PROGRAMS IN BOTH IOWA AND MINNESOTA. MINNESOTA PROVIDES A PARENTING PROGRAM FOR FAMILIES IN NEED OF TRAINING AND SUPPORT IN ORDER TO KEEP FAMILIES INTACT USING COUNTY FUNDING.JUST AS ABHM SEEKS TO FULFILL OUR MISSION THROUGH THOSE WE SERVE, WE ALSO UNDERSTAND THAT MISSION CALLS US TO CONTRIBUTE TO THE GREATER COMMUNITIES IN WHICH WE LIVE AND WORK. THIS DUAL COMMITMENT BOTH DESCRIBES OUR PAST AND DEFINES OUR FUTURE BY REINFORCING THE CORE PRINCIPLES AND FAITH THAT GUIDE OUR WORK.THE INFORMATION THAT FOLLOWS IS A DETAILED DESCRIPTION OF THE COMMUNITY INVOLVEMENT DURING FISCAL YEAR 2023 BY ABHM, ITS CONTINUING CARE RETIREMENT COMMUNITIES, NURSING HOMES, AND AFFORDABLE HOUSING RETIREMENT COMMUNITIES. ELM CREST: USE OF MCKEE COMMUNITY ROOM FOR COMMUNITY EVENTS (MEETINGS, CHURCH, MEMORY WALK), ALZHEIMER'S FUNDRAISER, MINISTERIAL ASSOCIATION MEETINGS AT ELM CREST, MEALS ON WHEELS, TRANSPORT RESIDENTS FOR LOCAL APPOINTMENTS, AND STAFF SERVING ON BOARDS OUTSIDE OF ELM CREST. MAPLE CREST: ABUSE AND NEGLECT TRAINING, CLOTHING AND QUILTS FOR RESIDENTS, PROVIDED EDUCATIONAL ACTIVITIES FOR AREA PROFESSIONALS, VETERAN'S DAY DINNER, VOLUNTEER APPRECIATION TEA, RELIGIOUS SERVICES FOR NON-RESIDENTS, ALZHEIMER'S FUNDRAISER, SUPPORT TO AMERICAN LEGION, SUBSIDIZED MEALS TO NON-RESIDENTS, USE OF COMMUNITY FOR MEETING SPACE, SUPPORT STAFF TO OTHER AGENCIES, THANKSGIVING AND CHRISTMAS BASKETS. THORNE CREST: RELIGIOUS AND MEMORIAL SERVICE FOR NON-RESIDENTS, HEALTH CARE TALK SERIES, VARIOUS PRESENTATIONS FOR NON-RESIDENTS, CAREGIVER GROUP FOR FREEBORN COUNTY, ALZHEIMER'S FUNDRAISER, CPR COURSES, HISTORICAL LECTURE SERIES, SALE OF BETHLEHEM OLIVE WOOD COLLECTIVE, AND USE OF COMMUNITY FOR MEETING SPACE FOR VARIOUS GROUPS.TRAIL RIDGE: OSHER LIFE LONG LEARNING, INTERNSHIPS WITH LOCAL HIGH SCHOOLS, LISTEN AND LEARN SEMINARS FOR COMMUNITY, EDUCATIONAL PRESENTATIONS FOR THE COMMUNITY, CHURCH STUDY GROUPS, PARKINSON'S ASSOCIATION ANNUAL MEETING, USE OF POOL FOR SWIM AMERICA, ANNUAL PARRISH NURSE MEETING, USE OF COMMUNITY FOR MEETING SPACE, SALUTE TO VETERANS, STAFF SERVING ON BOARDS OUTSIDE OF TRAIL RIDGE, VISUAL SUPPORT GROUP, COMMUNITY PICNIC, GUEST MEALS FOR VARIOUS EVENTS, RELIGIOUS SERVICE FOR NON-RESIDENTS. TUDOR OAKS: VARIOUS PRESENTATIONS FOR NON-RESIDENTS, ART DISPLAY SHOWS, DEMENTIA SUPPORT GROUP, VOTING SITE, DONATIONS TO LOCAL CHARITIES, WELLNESS CENTER GUEST USE, RELIGIOUS SERVICES, ALZHEIMER'S FUNDRAISER, JAMMIN' ON MAIN STREET, PROVIDED FREE SPACE FOR BANK, MEMORIAL SERVICES, USE OF COMMUNITY SPACE FOR MEETING SPACE. 78554035 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 279 0 1 1930 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 14 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 MN X LARS JOHNSON - CHIEF FINANCIAL OFFICER 9522531459 14850 SCENIC HEIGHTS ROAD 125 EDEN PRAIRIE MN 55344 JEFF HONGSLO PRESIDENT/CEO (THRU MAY 2023) 28.00 12.00 X X 367893 0 36910 SHANNA ECKBERG VP OPERATIONS 40.00 0.00 X 240385 0 8476 MELISSA ZYGARLICKE TREASURER & CFO (THRU MAR 2023) 28.00 12.00 X 205518 0 9783 ANDREA BLATNIK SECRETARY & VP OF HUMAN RESOURCES 28.00 12.00 X 182282 0 4338 JAMES BLACKWOOD DIRECTOR OF IT 40.00 0.00 X 146900 0 15092 DEBRA JERANEK CLINICAL DIRECTOR 40.00 0.00 X 150398 0 3269 EUGENIE AHOUNOU ADMINISTRATOR 40.00 0.00 X 163793 0 14379 CHRISTINA KOTZ DIRECTOR OF REIMBURSEMENT 40.00 0.00 X 148337 0 16833 ANNETTE GREELY PRESIDENT/CEO 28.00 12.00 X X 0 0 0 LARS JOHNSON TREASURER & CFO 28.00 12.00 X 0 0 0 BRUCE WHITAKER BOARD CHAIR 1.00 4.00 X 0 0 0 ASHLEY FORD VICE BOARD CHAIR (THRU DEC 2022) 1.00 4.00 X 0 0 0 GEORGE KILLIAN VICE BOARD CHAIR 1.00 4.00 X 0 0 0 RYAN ALLEN BOARD MEMBER 1.00 4.00 X 0 0 0 JANIS BERRY BOARD MEMBER 1.00 4.00 X 0 0 0 ROGER DAVIDSON BOARD MEMBER (THRU NOV 2022) 1.00 4.00 X 0 0 0 MARSHA DENNISTON BOARD MEMBER 1.00 4.00 X 0 0 0 JUDY FONS BOARD MEMBER 1.00 4.00 X 0 0 0 JIM JOHNSON BOARD MEMBER 1.00 4.00 X 0 0 0 DOROTHY JOHNSON CASELLI BOARD MEMBER (THRU DEC 2022) 1.00 4.00 X 0 0 0 GREG MAMULA BOARD MEMBER 1.00 4.00 X 0 0 0 RUTH NEIMAN BOARD MEMBER 1.00 4.00 X 0 0 0 TIM O'BRIEN BOARD MEMBER 1.00 4.00 X 0 0 0 MARSHALL PETERS BOARD MEMBER (THRU DEC 2022) 1.00 4.00 X 0 0 0 DAVE RUSSELL BOARD MEMBER 1.00 4.00 X 0 0 0 DEBBIE SETLOCK BOARD MEMBER 1.00 4.00 X 0 0 0 BRUCE VAN DER BEEK BOARD MEMBER 1.00 4.00 X 0 0 0 STEVEN VAN OSTRAN BOARD MEMBER (THRU DEC 2022) 1.00 4.00 X 0 0 0 ANNE WAGONER FORD BOARD MEMBER (THRU JAN 2023) 1.00 4.00 X 0 0 0 1605506 0 109080 20 0 1 0 GRAPE TREE MEDICAL STAFFING INC PO BOX 5340 SIOUX FALLS SD 57117 STAFFING 2274541 MAXIM HEALTHCARE SERVICES INC 12558 COLLECTIONS CENTER DR CHICAGO IL 60693 STAFFING 2037970 AMH STAFFING AGENCY LLC 9925 COUNTY RD 63 PLANTERSVILLE AL 36758 STAFFING 1704794 SELECT REHABILITATION LLC PO BOX 735913 DALLAS TX 75373 THERAPY 1695524 PRIME TIME HEALTHCARE LLC PO BOX 3544 OMAHA NE 68103 STAFFING 928317 88 8961090 474617 205687 9641394 RESIDENT REVENUE 623000 71679664 71679664 MANAGEMENT FEES 623990 5329329 5329329 ACCOMMODATION FEES 623990 780589 780589 OTHER RESIDENT SERVICES 623990 686738 686738 78476320 469855 469855 212783 212783 1712695 306322 2216659 0 -503964 306322 -197642 -197642 MISCELLANEOUS 900099 210512 210512 INSURANCE PROCEEDS 900099 52472 52472 TV/TELEPHONE 516100 20847 20847 6616 6616 290447 88893157 78476320 0 775443 X 775154 775154 41042998 40091081 951917 243376 242938 438 3856727 3837128 19599 2984769 2979396 5373 3467826 3467826 22794 22794 129437 129437 68593 68593 9256025 8348502 907523 863010 103262 759748 2368117 1402989 965128 341033 341033 3461653 2758444 703209 1443188 499422 943766 172978 73819 99159 6423422 6233289 190133 6035891 5857229 178662 709013 707737 1276 FOOD 2853678 2814190 39488 MEDICAL SUPPLIES 810168 810168 0 REPAIR/MAINTENANCE 386258 372408 13850 PHARMACY 367857 367857 0 813838 279022 534816 88897803 78554035 10343768 0 2639039 3020194 2000 0 4134564 4829765 457663 357970 155572845 88324517 70382081 67248328 14184678 11571916 5000 5000 80000 8904693 9841600 100709718 96954773 12181475 10014406 0 491598 93263570 91281637 145259 123494 4924882 5122222 50917268 49292566 161432454 156325923 X -60897399 -59523956 174663 152806 -60722736 -59371150 100709718 96954773 X -4646 586187 -126847 896892 X X 0 1 X 1 1 1 X 146071 1165132 3173943 9658810 9847091 23991047 68574909 71277878 68882836 73069761 78476320 360281704 68720980 72443010 72056779 82728571 88323411 384272751 0 0 0 384272751 377798 379290 356023 551556 682638 2347305 377798 379290 356023 551556 682638 2347305 198174 145283 348971 180992 290447 1163867 69296952 72967583 72761773 83461119 89296496 387783923 0.99090 0.99150 0.00610 0.00560 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS - 2018 AMOUNT: $ 174,763. 2019 AMOUNT: $ 133,054. 2020 AMOUNT: $ 335,589. 2021 AMOUNT: $ 153,632. 2022 AMOUNT: $ 210,512. MAINTENANCE - 2018 AMOUNT: $ 6,350. 2019 AMOUNT: $ 1,494. 2020 AMOUNT: $ 895. 2021 AMOUNT: $ 1,192. 2022 AMOUNT: $ 2,092. POSTAGE/PHOTOCOPIES - 2018 AMOUNT: $ 4,626. 2019 AMOUNT: $ 3,965. 2020 AMOUNT: $ 3,042. 2021 AMOUNT: $ 2,909. 2022 AMOUNT: $ 4,524. TV/TELEPHONE - 2018 AMOUNT: $ 22,435. 2019 AMOUNT: $ 26,770. 2020 AMOUNT: $ 24,445. 2021 AMOUNT: $ 23,259. 2022 AMOUNT: $ 20,847. INSURANCE GAINS/LOSSES - 2018 AMOUNT: $ -10,000. 2019 AMOUNT: $ -20,000. 2020 AMOUNT: $ -15,000. 2022 AMOUNT: $ 52,472. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1259124 1259124 120550259 63021972 57528287 7187076 5090843 2096233 25389372 20005012 5384360 1187014 206690 980324 67248328 SECURITY DEPOSITS 123494 BOND FUNDS 9718106 9841600 REFUNDABLE ACCOMMODATION FEES 48993936 RESERVE FOR GIFT ANNUITIES 55593 ASSET RETIREMENT OBLIGATION 210228 DUE TO RELATED PARTIES -782281 FUTURE SERVICE OBLIGATION 815090 49292566 X PART IV, LINE 2B: THE ORGANIZATION IS THE TRUSTEE OF VARIOUS TRUST FUNDS ON BEHALF OF THE RESIDENTS. PART X, LINE 2: THE ORGANIZATION FOLLOWS THE STANDARD FOR CONTINGENCIES IN EVALUATING THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THIS STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. X X X X X 0 0 0 0 0 0 0 0 0 JEFF HONGSLO PRESIDENT/CEO (THRU MAY 2023) 367893 0 0 0 0 0 6100 0 30810 0 404803 0 0 0 SHANNA ECKBERG VP OPERATIONS 237385 0 3000 0 0 0 0 0 8476 0 248861 0 0 0 MELISSA ZYGARLICKE TREASURER & CFO (THRU MAR 2023) 202518 0 3000 0 0 0 4222 0 5561 0 215301 0 0 0 ANDREA BLATNIK SECRETARY & VP OF HUMAN RESOURCES 179282 0 3000 0 0 0 3659 0 679 0 186620 0 0 0 JAMES BLACKWOOD DIRECTOR OF IT 146900 0 0 0 0 0 3060 0 12032 0 161992 0 0 0 DEBRA JERANEK CLINICAL DIRECTOR 144398 0 6000 0 0 0 3062 0 207 0 153667 0 0 0 EUGENIE AHOUNOU ADMINISTRATOR 142793 0 21000 0 0 0 3494 0 10885 0 178172 0 0 0 CHRISTINA KOTZ DIRECTOR OF REIMBURSEMENT 112712 0 35625 0 0 0 3239 0 13594 0 165170 0 0 0 PART I, LINE 5 BONUSES ARE PAID OUT TO DIRECTORS AT THE INDIVIDUAL COMMUNITIES IF THEIR FINANCIAL PERFORMANCE DURING THE YEAR EXCEEDS THE BUDGET. A COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648AQ99 2013-12-30 36885233 REMODEL AND CONSTRUCTION ADDITIONS TO EXISTING COMMUNITIES 0 0 0 B CITY OF HAYWARD MINNESOTA 410241036 421306AC5 2014-05-21 11127341 REMODEL AND CONSTRUCTION ADDITIONS TO EXISTING COMMUNITY 0 0 0 C COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648A5R2 2016-01-22 5849720 REMODEL AND CONSTRUCTION ADDITIONS TO EXISTING COMMUNITIES 0 0 0 D WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97712DZF6 2017-09-14 47524519 REFUND BONDS ISSUED ON 8/1/07, AND ADVANCE REFUND BONDS ISSUED ON 12/23/09. 0 0 0 A 627983 36885233 9859245 3748640 737705 29349142 2015 0 0 1 1 B 1270000 11127341 1949621 1101351 222546 9000557 2015 0 0 1 1 C 632827 5849720 1288097 403851 116993 4794300 2017 0 0 1 1 D 5538938 47524519 3844192 26812120 892090 17078827 2017 1 1 1 1 A 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: COLORADO HEALTH FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 06/18/2019 ISSUER NAME: CITY OF HAYWARD, MINNESOTA DATE THE REBATE COMPUTATION WAS PERFORMED: 06/25/2019 ISSUER NAME: COLORADO HEALTH FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 03/06/2020 ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 08/29/2022 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPOSED OF THE CHAIR, THE VICE CHAIR, THE PRESIDENT/CEO OF THE CORPORATION AND THREE ADDITIONAL DIRECTORS. THE EXECUTIVE COMMITTEE SHALL EXERCISE ALL OF THE POWERS OF THE BOARD OF DIRECTORS, BUT ONLY DURING THE INTERVAL BETWEEN MEETINGS OF THE BOARD OF DIRECTORS. ANY ACTIONS OF THE EXECUTIVE COMMITTEE SHALL BE REPORTED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING BOARD MEMBERS HAVE A FAMILY RELATIONSHIP: ANNE WAGONER FORD AND ASHLEY FORD (COUSINS). FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY THE ORGANIZATION'S PUBLIC ACCOUNTING FIRM BASED ON INFORMATION PROVIDED BY THE ORGANIZATION'S MANAGEMENT. ONCE A DRAFT OF THE FILING WAS AVAILABLE, THE FINANCE COMMITTEE REVIEWED THE FORM 990 AT THEIR QUARTERLY MEETING PRIOR TO FILING. THEY RECEIVED COPIES OF THE DRAFT AND THE DETAIL WAS REVIEWED AT THAT TIME. COPIES OF THE 990 WERE THEN PROVIDED TO BOARD MEMBERS BEFORE IT WAS FILED. FORM 990, PART VI, SECTION B, LINE 12C A CONFLICT OF INTEREST FORM IS SIGNED BY ALL BOARD DIRECTORS, ADMINISTRATORS, HOME OFFICE DIRECTORS, AND VICE PRESIDENTS. AT THAT TIME, ANY POTENTIAL CONFLICT OF INTEREST IS NOTED ON THE FORM. THE INFORMATION IS GIVEN TO THE CEO, BOARD PRESIDENT AND AUDIT COMMITTEE CHAIR. AT THAT TIME, ANY POTENTIAL CONFLICTS ARE REVIEWED. IF A CONFLICT EXISTS, THE CONFLICTED INDIVIDUAL EITHER HAS TO CORRECT THE CONFLICT OF INTEREST OR MUST ABSTAIN FROM PARTICIPATION REGARDING THE CONFLICT OF INTEREST TOPIC. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS HAS A MANAGEMENT REVIEW COMMITTEE THAT REVIEWS THE CEO'S COMPENSATION. THE COMMITTEE DETERMINES ANY COMPENSATION ADJUSTMENTS TO THE CEO. THE CEO, EXECUTIVE DIRECTORS AND OTHER TOP MANAGEMENT POSITIONS ARE COMPARED TO THE MOST RECENT CEMO STUDY TO DETERMINE HOW THEIR COMPENSATION COMPARES TO PEER ORGANIZATIONS. THE CEO DETERMINES ANY COMPENSATION ADJUSTMENTS TO SENIOR MANAGEMENT. THIS PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OTHER SERVICES: PROGRAM SERVICE EXPENSES 8,348,502. MANAGEMENT AND GENERAL EXPENSES 907,523. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,256,025. FORM 990, PART XI, LINE 9: CHANGE IN OBLIGATION TO PROVIDE FUTURE SERVICES 896,892. FORM 990, PART XII, LINE 2C: THE PROCESS FOR THE OVERSIGHT OF THE AUDIT AND SELECTION OF AN ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. BAPTIST HOME ASSOCIATION OF THE ROCKY MOUNTAINS 14850 SCENIC HEIGHTS RD 125 EDEN PRAIRIE MN 55344 840528764 PROVIDE HOUSING AND CARE FOR THE ELDERLY CO 501(C)(3) LINE 10 ABHM 1 RESIDENCES AT FRANKLIN PARK INC 14850 SCENIC HEIGHTS RD 125 EDEN PRAIRIE MN 55344 840630940 HOUSING FOR LOW-INCOME SENIORS CO 501(C)(4) N/A ABHM BHARM 1 AMERICAN BAPTIST HOMES OF THE MIDWEST FOUNDATION 14850 SCENIC HEIGHTS RD 125 EDEN PRAIRIE MN 55344 411803304 PHILANTHROPY MN 501(C)(3) LINE 12A, I ABHM 1 BAPTIST HOME ASSOC OF THE ROCKY MOUNTAINS - AFFILIATES 14850 SCENIC HEIGHTS RD 125 EDEN PRAIRIE MN 55344 742755828 HOUSING AND CARE FOR THE ELDERLY CO 501(C)(3) LINE 10 ABHM BHARM 1 THE CROSSING AT TUDOR OAKS 14850 SCENIC HEIGHTS RD 125 EDEN PRAIRIE MN 55344 203346875 INACTIVE MN 501(C)(3) LINE 10 ABHM 1 DENVER APARTMENTS PARTNERS LLC 1535 FRANKLIN STREET DENVER CO 80218 261776678 HOUSING FOR LOW-INCOME SENIORS NE N/A 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 AMERICAN BAPTIST HOMES OF THE MIDWEST - FOUNDATION Q 102196 ACTUAL COST BAPTIST HOMES ASSOCIATION OF THE ROCKY MOUNTAINS Q 451 ACTUAL COST RESIDENCE AT FRANKLIN PARK INC E 8961090 AMOUNT DUE RESIDENCE AT FRANKLIN PARK INC D 2673235 ACTUAL COST BAPTIST HOMES ASSOCIATION OF THE ROCKY MOUNTAINS AFFILIATES D 1944862 AMOUNT OWED BAPTIST HOMES ASSOCIATION OF THE ROCKY MOUNTAINS AFFILIATES E 1475331 AMOUNT DUE BAPTIST HOMES ASSOCIATION OF THE ROCKY MOUNTAINS AFFILIATES Q 1092108 ACTUAL COST