2023-06-20T14:17:11-05:00 2022-09-30 410746749 CLIFTONLARSONALLEN LLP 2689 COMMERCE DRIVE NW SUITE 201 ROCHESTER MN 55901 990 2021-10-01 411272572 CHOSEN VALLEY CARE CENTER INC CHOS 5078674220 1102 LIBERTY STREET SE CHATFIELD MN 55923 JOHN KELLY ADMINISTRATOR 5078674220 2023-05-30 1 JOHN KELLY 999009999 KATHERINE LUTZKE CPA P01760889 5072802300 2023-05-30 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JOHN KELLY 1102 LIBERTY STREET SE CHATFIELD MN 55923 10112661 0 X WWW.CHOSENVALLEYSENIORLIVING.COM X 1976 MN CHOSEN VALLEY CARE CENTER, INC. PROVIDES HOUSING AND NURSING CARE TO THE ELDERLY AND DISABLED. 10 10 183 16 0 0 1156100 448844 8141939 9632405 8431 9283 25002 22129 9331472 10112661 0 0 0 0 5126374 5801541 0 0 0 3294525 4001626 8420899 9803167 910573 309494 21385464 21153002 14637060 14095100 6748404 7057902 X THE CHOSEN VALLEY CARE CENTER AND APARTMENTS EXISTS TO EXPAND AND ENRICH THE LIVES OF OUR RESIDENTS THROUGH CHOICES IN RESIDENTIAL OPTIONS AND SUPPORTIVE SERVICES. THE ORGANIZATION CONSISTS OF A 78-BED SKILLED NURSING HOME, A 20-UNIT ASSISTED LIVING APARTMENT BUILDING AND A 15-UNIT INDEPENDENT LIVING APARTMENT BUILDING. 0 0 8127796 0 9632405 CHOSEN VALLEY CARE CENTER, INC. (THE CARE CENTER) IS A NONPROFIT CORPORATION WHICH OWNS AND OPERATES A 78-BED LICENSED NURSING FACILITY, A 15-UNIT RETIREMENT APARTMENT RESIDENCE, AND A 20-UNIT ASSISTED LIVING FACILITY LOCATED IN CHATFIELD, MINNESOTA. 8127796 1 1 0 0 0 0 0 0 1 0 1 0 0 0 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 30 0 183 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 0 1 0 0 0 0 1 1 1 1 1 1 0 0 MN X SUSAN MCCLIMON 5078674220 1102 LIBERTY ST SE CHATFIELD MN 55923 GARY BREN PRESIDENT 0.50 X X 0 0 0 MIKE THIEKE VICE PRESIDENT 0.50 X X 0 0 0 DAN HOLLERMANN TREASURER 0.50 X X 0 0 0 ANGIE BICKNESE SECRETARY 0.50 X X 0 0 0 MARY L ALLEN DIRECTOR 0.50 X 0 0 0 SHERYL BENNETT DIRECTOR 0.50 X 0 0 0 PAM HOLTE DIRECTOR 0.50 X 0 0 0 MIKE MULLEN DIRECTOR 0.50 X 0 0 0 MARY PATTEN DIRECTOR 0.50 X 0 0 0 MAUREEN RUSKELL DIRECTOR 0.50 X 0 0 0 LORI MAKKE DIRECTOR 0.50 X 0 0 0 TOM KEEFE DIRECTOR 0.50 X 0 0 0 CRAIG BACKEN ADMINISTRATOR - PART YEAR 40.00 X 49318 0 6528 JOHN KELLY ADMINISTRATOR 40.00 X 0 0 0 LISA VICKERMAN DIRECTOR OF CLINIC AND RESIDENT SERVICES 40.00 X 121843 0 7966 171161 0 14494 1 0 0 0 AEGIS THERAPIES INC 2601 NETWORK BLVD STE 102 FRISCO TX 75034 THERAPY SERVICES 584860 CASSIA 7171 OHMS LN EDINA MN 55439 BUSINESS SERVICES 163036 2 445474 3370 448844 RESIDENT REVENUE 623000 4606913 4606913 MEDICARE/MEDICAID PAYMENTS 623000 4513416 4513416 ASSISTED LIVING REVENUE 623000 512076 512076 9632405 9283 9283 MEAL REVENUE 623000 12666 12666 MISCELLANEOUS INCOME 900099 9463 9463 22129 10112661 9632405 0 31412 144150 144150 4683409 4254479 428930 53730 34133 19597 560432 356023 204409 359820 228581 131239 326764 323919 2845 10908 4684 6224 816736 757579 59157 267034 265856 1178 3935 2020 1915 24927 22643 2284 547987 45187 502800 688540 688540 78282 6162 72120 THERAPY EXPENSE 555032 555032 FOOD COSTS 304598 304598 LICENSES & PERMITS 230760 228721 2039 MISCELLANEOUS EXPENSE 81813 40922 40891 64310 8717 55593 9803167 8127796 1675371 0 3915811 3942358 520428 422144 1015468 1308968 39419 36845 21843089 7334389 14813045 14508700 1081293 933987 21385464 21153002 1407185 1017890 13169959 13011799 59916 65411 14637060 14095100 X 6748404 7057902 6748404 7057902 21385464 21153002 X 309494 4 X X 0 1 X 1 0 X 11451 660 20572 1156100 448844 1637627 7516108 7679582 7567962 8141939 9632405 40537996 7527559 7680242 7588534 9298039 10081249 42175623 0 1903590 1903590 1903590 1903590 40272033 8196 13269 9977 8431 9283 49156 8196 13269 9977 8431 9283 49156 18479 11410 -70613 25002 22129 6407 7554234 7704921 7527898 9331472 10112661 42231186 0.95360 0.99870 0.00120 0.00120 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 24078 24078 19243766 5624426 13619340 645635 273982 371653 1929610 1435981 493629 14508700 X 10112661 0 10112661 0 10112661 9803163 0 9803163 4 4 9803167 PART IV, LINE 2B: RESIDENT TRUST FUNDS AND RESIDENT SECURTITY DEPOSITS. PART X, LINE 2: THE CARE CENTER HAS BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND STATE CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THE CARE CENTER FOLLOWS THE INCOME TAX STANDARD FOR UNCERTAIN TAX POSITIONS. NO LIABILITY HAS BEEN RECOGNIZED BY THE CARE CENTER AS A RESULT OF THIS STANDARD. THE CARE CENTER FILES AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE INTERNAL REVENUE SERVICE. PART XII, LINE 4B - OTHER ADJUSTMENTS: ROUNDING 4. A CITY OF CHATFIELD 416005045 2019-10-23 13916722 CONSTRUCTION/EXPANSION, REFUND PRIOR NOTE, FUND A DEBT SERVICE RESERVE FUND 0 0 0 A 430000 13916722 808200 917614 2190383 267000 9733525 1 0 0 0 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS COMPRISED OF NATURAL PERSONS OF LEGAL AGE WHO RESIDE IN THE CHATFIELD, MINNESOTA, SCHOOL DISTRICT AND HAVE RESIDED THEREIN CONTINUOUSLY FOR (1) YEAR PRECEDING THEIR QUALIFICATIONS FOR MEMBERSHIP. FORM 990, PART VI, SECTION A, LINE 7A AT THE ANNUAL MEETING OF THE BOARD OF DIRECTORS, THE MEMBERS SHALL ELECT, BY MAJORITY VOTE, THE DIRECTOR'S WHO ARE TO SERVE ON THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS SHALL ELECT THE OFFICERS OF THE CORPORATION IN THE MANNER HEREIN AFTER PROVIDED. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD PRESIDENT WILL REVIEW AND PROVIDE THEIR SIGNATURE ON THE DOCUMENT AFTER COMPLETION BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS DESIGNED TO HELP DIRECTORS, OFFICERS, AND EMPLOYEES OF CHOSEN VALLEY CARE CENTER IDENTIFY SITUATIONS THAT PRESENT POTENTIAL CONFLICTS OF INTEREST AND TO PROVIDE CHOSEN VALLEY CARE CENTER WITH A PROCEDURE THAT, IF OBSERVED, WILL ALLOW A TRANSACTION TO BE TREATED AS VALID AND BINDING EVEN THOUGH A DIRECTOR, OFFICER, OR EMPLOYEE HAS OR MAY HAVE A CONFLICT OF INTEREST WITH RESPECT TO THE TRANSACTION. IN THE EVENT THERE IS AN INCONSISTENCY BETWEEN THE REQUIREMENTS AND PROCEDURES PRESCRIBED HEREIN AND THOSE IN FEDERAL OR STATE LAW, THE LAW SHALL CONTROL. THE CONFLICT OF INTEREST IS DEFINED AS A CONTRACT OR TRANSACTION BETWEEN CHOSEN VALLEY CARE CENTER AND AN ENTITY IN WHICH A RESPONSIBLE PERSON OR FAMILY MEMBER HAS A MATERIAL FINANCIAL INTEREST OR OF WHICH SUCH PERSON IS A DIRECTOR, OFFICER, AGENT, PARTNER, ASSOCIATE, TRUSTEE, PERSONAL REPRESENTATIVE, RECEIVER, GUARDIAN, CUSTODIAN, CONSERVATOR, OR OTHER LEGAL REPRESENTATIVE. EACH BOARD MEMBER AND KEY PERSONNEL ARE PROVIDED A CONFLICT OF INTEREST POLICY DOCUMENT ON AN ANNUAL BASIS , IN WHICH ANY POTENTIAL CONFLICTS ARE REPORTED. BEFORE THE BOARD OR COMMITTEE TAKE ACTION ON A CONTRACT OR TRANSACTION INVOLVING A CONFLICT OF INTEREST, A DIRECTOR OF COMMITTEE MEMBER HAVING A CONFLICT OF INTEREST AND WHO IS IN ATTENDANCE AT THE MEETING SHALL DISCLOSE ALL FACTS MATERIAL TO THE CONFLICT OF INTEREST, AND SUCH DISCLOSURE SHALL BE REFLECTED IN THE MINUTES OF THE MEETING. A PERSON WHO HAS A CONFLICT OF INTEREST WITH RESPECT TO A CONTRACT OR TRANSACTION THAT WILL BE VOTED ON AT A MEETING SHALL NOT BE COUNTED IN DETERMINING THE PRESENCE OF A QUORUM FOR PURPOSES OF THE VOTE. THE PERSON HAVING A CONFLICT OF INTEREST MAY NOT VOTE ON THE CONTRACT OR TRANSACTION AND SHALL NOT BE PRESENT IN THE MEETING ROOM WHEN THE VOTE IS TAKEN, UNLESS THE VOTE IS BY SECRET BALLOT. EACH RESPONSIBLE PERSON SHALL EXERCISE CARE NOT TO DISCLOSE CONFIDENTIAL INFORMATION ACQUIRED IN CONNECTION WITH SUCH STATUS OR INFORMATION THE DISCLOSURE OF WHICH MIGHT BE ADVERSE TO THE INTERESTS OF CHOSEN VALLEY CARE CENTER. FURTHERMORE, A RESPONSIBLE PERSON SHALL NOT DISCLOSE OR USE INFORMATION RELATING TO THE BUSINESS OF CHOSEN VALLEY CARE CENTER FOR THE PERSONAL PROFIT OR ADVANTAGE OF THE RESPONSIBLE PERSON OR FAMILY MEMBER. FORM 990, PART VI, SECTION B, LINE 15A THE ADMINISTRATOR'S SALARY IS DETERMINED BY REVIEW, DISCUSSION, AND APPROVAL BY THE BOARD OF DIRECTORS, AND IS VOTED UPON. THE BOARD OF DIRECTORS, WHEN DOING COMPARABILITY ON WAGES FOR THE ADMINISTRATOR, USES CLIFTON LARSON ALLEN AS THEIR SOURCE TO DETERMINE THE BEST AMOUNT NEEDED FOR THE LEVEL OF EDUCATION AND/OR EXPERIENCE FOR THE POSITION. A NEW ADMINISTRATOR WAS HIRED IN NOVEMBER OF 2021, AND STARTED JANUARY 3, 2022. THE PROCESS OF HIRING A NEW ADMINISTRATOR OCCURRED DURING THE MONTHS OF MAY 2021 UNTIL NOVEMBER OF 2021, WHEN THE ADMINISTRATOR ACCEPTED THE TERMS OF HIS CONTRACT. THE BOARD OF DIRECTORS MET ON MULTIPLE OCCASIONS TO DISCUSS THE TERMS AND WAGES OF THIS POSITION, AND WAS VOTED ON. THIS DISCUSSION IS REFLECTED IN THE BOARD OF DIRECTORS MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENT AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: ROUNDING 4. FORM 990, PART XII, LINE 2C: THE ORGANIZATION'S BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF ITS INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.