2024-08-07T15:23:50-05:00 2023-09-30 410746749 CLIFTONLARSONALLEN LLP 201 N RIVERFRONT DR SUITE 300 MANKATO MN 56001 990 2022-10-01 416031905 MAPLETON COMMUNITY HOME MAPL 5075243315 301 TROENDLE STREET MAPLETON MN 56065 ROXANNE GOSSON ADMINISTRATOR 5075243155 2024-07-24 1 0 JOSH SHERBURNE P02039400 5073868800 2024-07-24 2022 2024-08-08 14:25:15Z ROXANNE GOSSON 301 TROENDLE STREET MAPLETON MN 56065 7873631 0 X WWW.MAPLETONCOMMUNITYHOME.COM X 1962 MN TO PROVIDE THE ELDERLY WITH HOUSING AND NURSING FACILITIES WITH REHABILITATIVE CARE 9 9 130 10 0 0 957543 819439 6535801 6899722 39595 152296 1769 2174 7534708 7873631 0 0 0 0 3946291 3775127 0 0 0 2503980 2751664 6450271 6526791 1084437 1346840 9174323 10255653 4066486 3800973 5107837 6454680 THE PURPOSE OF MAPLETON COMMUNITY HOME, INC. IS TO PROVIDE ELDERLY AND HANDICAPPED PEOPLE WITH HOUSING FACILITIES AND NURSING SERVICES; TO MEET THE PHYSICAL, SOCIAL AND PSYCHOLOGICAL NEEDS OF THE RESIDENTS; AND TO CONTRIBUTE TO THE RESIDENT'S HEALTH, SECURITY, AND HAPPINESS. 0 0 5652016 0 6899722 MAPLETON COMMUNITY HOME IS A RESIDENCE FOR 60 INDIVIDUALS NEEDING SKILLED NURSING CARE. THE HOME SERVES MEDICARE PART A, PART B, MEDICAL ASSISTANCE AND PRIVATE PAYING INDIVIDUALS. THE HOME OFFERS OUTPATIENT REHABILITATION FOR THE COMMUNITY AND DAILY ACTIVITIES FOR THE RESIDENTS. A SOCIAL WORKER IS ON STAFF FOR EMOTIONAL NEEDS AND THE NURSING DEPARTMENT STAFFS 24 HOURS PER DAY. THE ORGANIZATION HAS A 20 UNIT ASSISTED LIVING FACILITY ADJOINING THE NURSING HOME. 5652016 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 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 6 0 130 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 0 1 0 0 MN X ROXANNE GOSSON 5075243315 301 TROENDLE ST SW MAPLETON MN 56065 RICK GIRARD CHAIR 0.50 X X 0 0 0 MARVIN KIMM VICE CHAIR 0.50 X X 0 0 0 DAWN HENGEL DIRECTOR 0.50 X 0 0 0 BENJAMIN HONSEY DIRECTOR 0.50 X 0 0 0 CINDY WISHART DIRECTOR 0.50 X 0 0 0 JERRY GRAF DIRECTOR 0.50 X 0 0 0 KAREN FRANK DIRECTOR 0.50 X 0 0 0 MARILYN STEVENS DIRECTOR 0.50 X 0 0 0 OWEN DICKEY DIRECTOR 0.50 X 0 0 0 ROXANNE GOSSON ADMINISTRATOR 40.00 X 133864 0 8848 133864 0 8848 1 0 0 0 BRUNTON CONSTRUCTION 225 BELGRADE AVE NORTH MANKATO MN 56003 CONSTRUCTION OF FAITH ENRICHMENT CENTER 601700 NURZEE INC 7845 BROOKLYN BLVD SUITE 210 BROOKLYN PARK MN 55445 CNA, LPN, RN POOL STAFF 530802 AEGIS THERAPIES INC PO BOX 936653 ATLANTA GA 311936653 PATIENT THERAPY SERVICES 283624 CLIFTON LARSON ALLEN PO BOX 776376 CHICAGO IL 60677 ACCOUNTING & AUDITING SERVICES 102132 4 808631 10808 819439 RESIDENT REVENUE 623000 3323920 3323920 MEDICARE/MEDICAID PAYM 623000 3129718 3129718 APARTMENT REVENUE 623000 446084 446084 6899722 152296 152296 GUEST/EMPLOYEE MEAL RE 623000 2058 2058 MISCELLANEOUS INCOME 623000 116 116 2174 7873631 6899722 0 154470 132408 132408 2945956 2741707 204249 129440 115284 14156 336319 299538 36781 231004 205741 25263 1207 1207 70690 70690 83132 48371 34761 36466 36466 432472 230849 201623 253649 253649 2728 2728 587817 583871 3946 133850 133850 313858 313858 74416 74416 THERAPY EXPENSE 285023 285023 FOOD COSTS 216668 216668 SPECIAL ASSESSMENTS 154825 154825 MISCELLANEOUS EXPENSE 34963 27457 7506 69900 41325 28575 6526791 5652016 874775 0 40821 81518 4253767 4834216 1024540 982516 66704 49738 10136985 5829552 3788259 4307433 232 232 9174323 10255653 366032 323827 365616 232995 3323524 3234526 11314 9625 4066486 3800973 X 5072902 6419745 34935 34935 5107837 6454680 9174323 10255653 X 1346840 3 X 0 1 X 1 0 X 6620 54241 1015912 957543 819439 2853755 6442756 6369714 6037701 6535801 6899722 32285694 6449376 6423955 7053613 7493344 7719161 35139449 0 1685935 1588030 803365 956680 679616 5713626 1685935 1588030 803365 956680 679616 5713626 29425823 55984 34023 16762 44312 152296 303377 55984 34023 16762 44312 152296 303377 10873 3673 3319 1769 2174 21808 6516233 6461651 7073694 7539425 7873631 35464634 0.82970 0.80430 0.00860 0.00540 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 55314 55314 6141015 4692901 1448114 3940656 1136651 2804005 4307433 SECURITY DEPOSITS 9625 9625 X 7875949 0 7875949 -2318 -2318 7873631 6529109 0 6529109 -2318 -2318 6526791 PART X, LINE 2: THE ORGANIZATION HAS 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 ORGANIZATION FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. NO LIABILITY HAS BEEN RECOGNIZED BY THE ORGANIZATION AS A RESULT OF THIS STANDARD. THE ORGANIZATION FILES AS A TAX-EXEMPT ORGANIZATION. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT -2,318. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT -2,318. A CITY OF MAPLETON MN 416005347 565468AF2 2019-05-01 3650000 REFINANCE DEBT 0 0 0 A 310000 3650000 113000 130250 3406750 2012 1 0 1 1 A 0 0 0 0 1.00000 1.00000 0 0 0 A 0 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES THAT HAVE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO BEING FILED WITH THE IRS, A COPY OF THE IRS FORM 990 AND RELATED SCHEDULES ARE REVIEWED BY THE ADMINISTRATOR, INCLUDING A CONFIRMATION OF THE ACCURACY OF EVERY ANSWER AND OVERSIGHT OF APPROPRIATE CHANGES. UPON COMPLETION OF THE ADMINISTRATOR'S REVIEW, THE FORMS ARE REVIEWED AND APPROVED AT A BOARD MEETING PRIOR TO SUBMITTAL TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND KEY EMPLOYEES ANNUALLY COMPLETE A SURVEY RELATED TO BUSINESS RELATIONSHIPS AND FAMILY MEMBERS THAT COULD, OR DO, CREATE A CONFLICT OF INTEREST. THESE ARE SUMMARIZED AND FILED ALONG WITH BOARD MEETING MINUTES. CONFLICTS OF INTEREST ARE DETERMINED BY A REVIEW OF THE POTENTIAL CONFLICTS BY THE ADMINISTRATOR AND THE BOARD OF DIRECTORS. IF A CONFLICT EXISTS, THEN THE CONFLICTED BOARD MEMBER OR KEY EMPLOYEE IS EXCLUDED FROM DISCUSSIONS AND VOTES RELATED TO ANY POTENTIAL OR EXISTING RELATIONSHIPS INVOLVING THE CONFLICT OF INTEREST. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST WAS INTENTIONALLY HIDDEN BY A BOARD MEMBER, THEN THE SITUATION WOULD BE INVESTIGATED AND THE BOARD MEMBER COULD BE SUSPENDED AND SUBJECT TO DISMISSAL. ADDITIONALLY, THE REMAINING BOARD MEMBERS AND KEY EMPLOYEES WILL REVIEW, FOR FAIRNESS, ALL PAST TRANSACTIONS INVOLVING THE CONFLICT OF INTERESTS. IF A TRANSACTION APPEARS TO LACK ARMS-LENGTH, EITHER TO THE DETRIMENT OF THE ORGANIZATION, OR TO THE UNFAIR ADVANTAGE OF THE BOARD MEMBER, THEN ALL LEGAL REMEDIES WILL BE CONSIDERED. FORM 990, PART VI, SECTION B, LINE 15A THE PROCESS USED TO SET THE ADMINISTRATOR'S ANNUAL SALARY IS BASED ON A COMBINATION OF COMPARISON TO COMPARABLE ORGANIZATIONS THROUGH THE USE OF OUR TRADE ORGANIZATION'S ANNUAL COMPENSATION SURVEY AND ATTAINMENT IN THE CURRENT YEAR OF PREDEFINED PERFORMANCE OBJECTIVES SET FOR THE ADMINISTRATOR PERSONALLY AND THE ORGANIZATION. ALSO THE STATE OF MINNESOTA HAS IN MOST YEARS GIVEN COMPENSATION ADJUSTMENTS TO EMPLOYEES AND WE HAVE ALSO CONSIDERED THIS AMOUNT IN DETERMINING TOP MANAGEMENT COMPENSATION. THIS PROCESS IS PERFORMED BY THE BOARD. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2023. FORM 990, PART VI, SECTION C, LINE 19 CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: ROUNDING 3.