2022-08-15T13:18:36-05:00 2021-09-30 410746749 CLIFTONLARSONALLEN LLP 201 N RIVERFRONT DR SUITE 300 MANKATO MN 56001 990 2020-10-01 411733854 HIGHLAND MANOR INC HIGH 5072230800 1314 EIGHTH NORTH STREET NEW ULM MN 56073 ADAM BACK DIRECTOR OF FINANCE 5072330805 2022-08-10 1 ADAM BACK 999009999 JOSH SHERBURNE P02039400 5073868800 2022-08-10 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z OAK HILLS LIVING CENTER ADAM BACK 1314 EIGHTH NORTH STREET NEW ULM MN 56073 13516029 0 X WWW.OAKHILLSNEWULM.COM X 1958 MN HOUSING SERVICES FOR THE ELDERLY. 9 9 324 18 384349 3386 399042 1450391 11043511 11145623 96030 499190 344448 366759 11883031 13461963 119391 113349 0 0 6942893 6987593 0 0 31656 4264034 5412503 11326318 12513445 556713 948518 13823573 14106207 7888408 7065756 5935165 7040451 X TO ENRICH AND SUPPORT THE LIVES OF THE ELDERS WE CARE FOR WITH EXCELLENCE, COMPASSION, RESPECT, AND COMPETENCE. 0 0 11280708 113349 11145623 HIGHLAND MANOR, INC, (DBA: OAK HILLS LIVING CENTER) IS A 94-BED SKILLED NURSING FACILITY. OAK HILLS LIVING CENTER WAS BUILT IN 1995 WITH 28 PRIVATE ROOMS AND 33 DOUBLE ROOMS. AN ATTACHED 16-UNIT ASSISTED LIVING APARTMENT COMPLEX WAS ADDED AT THIS TIME. OAK HILLS APPLIED FOR AND WAS APPROVED FOR THE MORATORIUM EXCEPTION PROJECT AND EMBARKED ON A $6,000,000 ADDITION AND RENOVATION PROJECT. THE END RESULT IS 22 ADDITIONAL PRIVATE ROOMS BRINGING THE TOTAL TO 50, AND 5 DISTINCT HOUSEHOLDS OF 16 TO 22 RESIDENTS EACH WITH A LIVING ROOM, DINING ROOM, AND KITCHEN. OAK HILLS IS THE ONLY NURSING HOME IN NEW ULM. OAK HILLS LIVING CENTER OFFERS OTHER SERVICES INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND SPEECH THERAPY, AND OPERATES A SHORT-STAY REHAB WING FOR RESIDENTS WHO PLAN TO MOVE ON TO ANOTHER LEVEL OF SERVICE. IN 2021, OAK HILLS LIVING CENTER HAD 93.8% OCCUPANCY. OAK HILLS LIVING CENTER ALSO PROVIDES SERVICES TO RESIDENTS OF OAK VIEW APARTMENTS, WHICH IS A 16 UNIT HUD-ASSISTANCE LIVING FACILITY. OAK HILLS ALSO PROVIDED HOME HEALTH CARE TO NEW ULM AND THE SURROUNDING COMMUNITY UNTIL THIS ACTIVITY WAS CEASED ON AUGUST 1, 2019. IN JULY 2013, OAK HILLS BEGAN CONTRACTING WITH VOA TO OFFER ADULT DAY SERVICES IN OUR FACILITY. OAK HILLS CEASED ADULT DAY OPERATIONS ON APRIL 2020 DUE TO COVID-19. 11280708 1 1 0 0 0 0 0 0 1 0 1 1 0 0 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 1 1 0 0 1 10 0 324 1 1 1 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 1 1 1 0 MN X ADAM BACK 5072330805 1314 8TH ST NEW ULM MN 56073 CHRIS JENSEN PRESIDENT 0.50 0.50 X X 0 0 0 JAY VANCURA VICE PRESIDENT 0.50 0.50 X X 0 0 0 COLLEEN SKILLINGS SECRETARY 0.50 0.50 X X 0 0 0 PAUL GUNDERSON TREASURER 0.50 0.50 X X 0 0 0 DR JOAN KIRKIVA DIRECTOR 0.50 0.50 X 0 0 0 BETSY PIESER DIRECTOR 0.50 0.50 X 0 0 0 MARK FURTH DIRECTOR 0.50 0.50 X 0 0 0 BARB DIETZ DIRECTOR 0.50 0.50 X 0 0 0 DANIELLE MARTI DIRECTOR 0.50 0.50 X 0 0 0 CANDAS SCHOUVIELLER ADMINISTRATOR 40.00 2.00 X 111845 0 35191 ADAM BACK DIRECTOR OF FINANCE 40.00 2.00 X 77922 0 25827 189767 0 61018 1 0 0 0 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 THERAPY SERVICES 574284 THRIVEON 210 SOUTH 20TH STREET NEW ULM MN 56073 IT SERVICES 177983 ALLINA NW 7710 PO BOX 9383 MINNEAPOLIS MN 55440 MEDICAL SERVICES 157100 3 90297 1360094 1450391 RESIDENT REVENUE 623000 11145623 11145623 11145623 499190 499190 23458 54066 -30608 -30608 CATERING REVENUE 722320 384349 384349 MISCELLANOUS INCOME 623000 11101 11101 VENDING MACHINE 623000 1917 1917 397367 13461963 11145623 384349 481600 X 113349 113349 250786 250786 5594786 5218823 375963 81648 78875 2773 626988 528217 98771 433385 390612 42773 43593 43593 3619 3619 33975 33975 1632918 1632918 18293 18293 312120 234234 77886 155864 149868 5996 417439 334987 82452 1586 1586 3625 3625 217266 217266 734637 734637 5708 5708 FOOD EXPENSE 600980 600980 MEDICAL SUPPLIES 525471 525471 LICENSE SURCHARGE 283322 275162 8160 MISCELLANEOUS 234774 215187 19587 187313 28536 127121 31656 12513445 11280708 1201081 31656 284474 664397 3464207 2578257 1274286 1048803 94544 119947 19031962 11727962 6832338 7304000 1313882 1487090 527472 846046 32370 57667 13823573 14106207 622545 809049 284134 4000 5992863 6235951 17066 16756 971800 7888408 7065756 X 5407693 6194405 527472 846046 5935165 7040451 13823573 14106207 948518 156768 0 X X 0 1 X 1 0 X 82203 161154 121028 399042 1450391 2213818 10224979 10363168 10914114 11043511 11525586 54071358 10307182 10524322 11035142 11442553 12975977 56285176 90297 90297 64688 37339 102027 64688 37339 90297 192324 56092852 65167 67391 71084 96030 499190 798862 65167 67391 71084 96030 499190 798862 83582 50807 4706 5777 4386 149258 97898 75823 67353 55069 36476 332619 10553829 10718343 11178285 11599429 13516029 57565915 0.97440 0.97980 0.01390 0.00660 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER MISC REVENUE - 2016 AMOUNT: $ 30,987. 2017 AMOUNT: $ 20,514. 2018 AMOUNT: $ 13,128. 2019 AMOUNT: $ 19,969. 2020 AMOUNT: $ 11,101. MEAL INCOME - 2016 AMOUNT: $ 49,634. 2017 AMOUNT: $ 7,129. 2018 AMOUNT: $ 1,775. 2019 AMOUNT: $ 834. DELI REVENUE - 2016 AMOUNT: $ 12,997. 2017 AMOUNT: $ 48,180. 2018 AMOUNT: $ 49,337. 2019 AMOUNT: $ 31,766. 2020 AMOUNT: $ 23,458. CATERING REVENUE - 2016 AMOUNT: $ 4,280. VENDING MACHINE INCOME - 2018 AMOUNT: $ 3,113. 2019 AMOUNT: $ 2,500. 2020 AMOUNT: $ 1,917. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 27900 27900 12314593 8044491 4270102 218958 103695 115263 5797815 3579776 2218039 672696 672696 7304000 INVESTMENT IN FOUNDATION 846046 C 846046 X PART IV, LINE 2B: THE CENTER HOLDS SECURITY DEPOSITS THAT ARE REQUIRED TO BE PAID UPON ENTRANCE INTO THE FACILITY, BY THE RESIDENT, TO COVER ANY UNEXPECTED DAMAGE TO THE UNIT. THIS AMOUNT IS PAID BACK TO THE RESIDENT ONCE ALL PROPER DEDUCTIONS (IF NECESSARY) ARE REMOVED FROM THE ORGINAL DEPOSIT FOR DAMAGES THAT HAVE BEEN INCURRED ON THE UNIT. THE CENTER HOLDS MONEY FOR THE RESIDENTS IN RESIDENT TRUST ACCOUNTS. THESE ACCOUNTS ACT LIKE CHECKING ACCOUNTS FOR THE RESIDENT AND ARE IN CUSTODY OF THE FACILITY. THE MONEY IS DUE BACK TO RESIDENT IF THE RESIDENT IS TO MOVE OUT AT ANYTIME. BOTH SECURITY DEPOSITS AND RESIDENT TRUSTS MONIES ARE HELD IN SEPARATE ACCOUNTS BY THE FACILITY. PART X, LINE 2: THE CENTER AND APARTMENTS ARE ORGANIZED AS MINNESOTA NONPROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). EACH ENTITY IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE CENTER AND APARTMENTS ARE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. THE CENTER'S AND THE APARTMENTS' ANNUAL TAX FILINGS ARE SUBJECT TO REVIEW BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE CENTER IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAXEXEMPT STATUS. THE CENTER HAS INCOME FROM ACTIVITIES CONSIDERED UNRELATED TO ITS 501(C)(3) STATUS. INCOME TAXES ARE RECORDED AT THE PREVAILING STATUTORY RATES AND ARE INCLUDED IN OPERATING EXPENSES. 1 SCHOLARSHIPS 51 112315 0 N/A N/A PART I, LINE 2: OAK HILLS LIVING CENTER HAS A SCHOLARSHIP PROGRAM AVAILABLE TO EMPLOYEES WHO WORK MORE THAN 20 HOURS PER WEEK AND ARE ENROLLED IN A NURSING PROGRAM (RN OR LPN). THE ORGANIZATION PAYS THE SCHOOL DIRECTLY AND REQUIRES THE SCHOOL TO SUBMIT A CLASS SCHEDULE WITH THE TUITION BILL. IN ADDITION, THE SCHOOL MUST SUBMIT A COPY OF THE SCHOLARSHIP RECIPIENT'S GRADES WHEN THE CLASS IS COMPLETED. A BROWN COUNTY 416005765 2021-03-31 6400000 IMPROVEMENTS TO SKILLED NURSING FACILITY 0 0 0 A 134574 6400000 2011 0 0 1 1 A 0 0 1 0 1 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO OTHER COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE ADMINISTRATOR REVIEWED THE DRAFT 990 IN DETAIL AND PROVIDED A COPY TO THE BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS AND DIRECTORS ARE COVERED BY THE POLICY. THE ADMINISTRATOR OR BOARD OF DIRECTORS DETERMINES WHETHER A CONFLICT EXISTS. THESE POTENTIAL CONFLICTS ARE REVIEWED AT THE BOARD MEETING. IF A CONFLICT ARISES WITH A BOARD MEMBER, THEY ARE ASKED TO REMOVE THEMSELVES FROM DISCUSSION AND VOTE. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING THE COMPENSATION OF THE ADMINISTRATOR IS AS FOLLOWS: THE BOARD OF DIRECTORS IS GIVEN A COPY OF THE AGING SERVICES SALARY SURVEY INFORMATION FOR THE PURPOSE OF DETERMINING FAIR COMPENSATION FOR THE ADMINISTRATOR. THIS PROCESS IS DONE ON AN ANNUAL BASIS. THE PROCESS FOR DETERMINING THE COMPENSATION OF THE OTHER EMPLOYEES IS AS FOLLOWS. THE ADMINISTRATOR IS GIVEN A COPY OF THE AGING SERVICES SALARY SURVEY INFORMATION FOR THE PURPOSE OF DETERMINING FAIR COMPENSATION FOR ALL OTHER EMPLOYEES OF THE ORGANIZATION AND MAKES A RECOMMENDATION TO THE BOARD OF DIRECTORS. THIS PROCESS IS DONE ON AN ANNUAL BASIS. THE REVIEW OF COMPENSATION DELIBERATION IS DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PHARMACY CONSULTANT: PROGRAM SERVICE EXPENSES 14,034. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,034. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,418,611. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,418,611. MEDICARE SUPPLIES: PROGRAM SERVICE EXPENSES 200,273. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 200,273. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNT HAS NOT CHANGED FROM THE PRIOR YEAR. OAK VIEW APARTMENTS INC 1314 EIGHTH N STREET NEW ULM MN 56073 411992121 ELDERLY HOUSING MN 501(C)(3) LINE 10 HIGHLAND MANOR INC 1 OAK HILLS MEMORIAL FOUNDATION 1314 EIGHTH N STREET NEW ULM MN 56073 411733850 FUND SUPPORT MN 501(C)(3) LINE 7 HIGHLAND MANOR INC 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0 OAK HILLS MEMORIAL FOUNDATION C 203813 FMV