2020-06-09T12:48:42-05:00 2019-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-01-01 410873335 Assumption Home Inc ASSU 3206853693 715 North 1st Street Cold Spring MN 56320 Jan Luthens Administrator 3206853693 2020-05-22 1 Deb Nelson CPA P01264758 6122536500 2020-05-22 216.147.181.49 2020-05-22 14:59:10 CD P C57B3A1A47BD965C768274F1A391ACA80AAD5CDF F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96 2019 2021-01-29 14:40:06Z Jan Luthens 715 North 1st Street Cold Spring MN 56320 9303185 0 X www.assumptionhome.org X 1963 MN Provide a continuum of health and residential services in a Christian environment. 12 11 266 84 0 0 97305 87484 8897951 9136050 44616 79651 0 0 9039872 9303185 37013 33749 0 0 5242809 5416392 0 0 0 3618796 3632027 8898618 9082168 141254 221017 20689965 20372866 16602886 15902822 4087079 4470044 X To provide a continuum of quality care in a Christian manner that honors the dignity of the members of our local community. 0 0 6949835 33749 7762536 Assumption Home, Inc. operates an 82-bed long-term health care facility in Cold Spring, MN which provides care to residents on a daily basis. Assumption Home is renowned for being a Christian health care facility that strives to provide long term and rehabilitative care for older adults. Assumption Home is a single story structure, conveniently located in the center of Cold Spring and is bordered by numerous picturesque scenes including a garden, park, and the middle school playground. Assumption Home offers the older adult and their families numerous services and aspects of medical care including several rounding onsite primary physicians, numerous consulting physicians including an audiologist and podiatrist, and a local pharmacy to provide medications. Assumption Home is also able to coordinate your loved one's care with other clinics and medical professions as needed. 1322515 1373514 The organization also operates Assumption Court, a 59-unit apartment complex providing congregate housing and has a Housing and Services license that enables its tenants to purchase additional personal care services. 8272350 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 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 1 27 0 1 266 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 0 MN X Brenda Weller 3206853693 715 North 1st Street Cold Spring MN 56320 Rev Matthew Luft Second VP/CEO 1.00 2.00 X X 0 0 0 Larry Sell Secretary 1.00 2.00 X X 0 0 0 Chad Middendorf Treasurer 1.00 2.00 X X 0 0 0 Sister Ardella Kvamme Director (thru July 2019) 1.00 2.00 X 0 0 0 Melissa Rowe Director 1.00 2.00 X 0 0 0 Father Isaiah Frederick Director 1.00 2.00 X 0 0 0 Dorothy Pflipsen Director (thru July 2019) 1.00 2.00 X 0 0 0 Sharon Wenner Director 1.00 2.00 X 0 0 0 Cheri Eickhoff Director (as of August 2019) 1.00 2.00 X 0 0 0 Greg Flint Director 1.00 2.00 X 0 0 0 Terri Larison Director (as of August 2019) 1.00 2.00 X 0 0 0 Kelly Springer Director 1.00 2.00 X 0 0 0 Nicole Holthaus Director 1.00 2.00 X 0 0 0 Harry Bertram Director 1.00 2.00 X 0 0 0 Lindsey SandAdministrator (thru October 2019) 38.00 2.00 X 104697 0 2543 Jan Luthens Administrator (as of November 2019) 38.00 2.00 X 15770 0 473 Brenda Weller Director of Finance 38.00 2.00 X 80289 0 16927 200756 0 19943 1 0 0 0 RehabCare 7733 Forsyth Blvd Ste 1700 St Louis MO 63105 Therapy 275015 Pro Rehab 200 Lewis Ave S Ste 210 Watertown MN 55388 Therapy 128160 2 87484 87484 Resident Services 623000 7535280 7535280 Apartment 623000 866343 866343 Other Service Income 900099 559311 559311 Management Fees 900099 175116 175116 9136050 72643 72643 7008 0 7008 7008 7008 9303185 9136050 0 79651 33749 33749 220700 220700 59800 59800 4300299 4161685 138614 76311 71048 5263 401700 372991 28709 357582 332639 24943 7991 7991 22455 22455 15210 15210 711464 555541 155923 80793 80793 264092 161434 102658 31905 31905 424636 423643 993 12784 12784 19631 19631 552283 550319 1964 708836 706315 2521 100999 100640 359 Medical Supplies 312513 312513 Nursing Home Surcharge 233993 233993 Bad Debt Expenses 49977 49977 Licenses Permits and Fe 15261 15261 67204 66482 722 9082168 8272350 809818 0 934174 1046525 613290 626086 71142 50071 26027992 11285731 12046390 14742261 6766017 3552736 258952 355187 20689965 20372866 1330848 931883 15196055 14886006 75983 84933 16602886 15902822 X 4087079 4470044 4087079 4470044 20689965 20372866 X 221017 194948 -33000 X 0 1 X 1 0 X 35999 53923 82247 97305 87484 356958 7705686 8701243 8968563 8988672 9136050 43500214 7741685 8755166 9050810 9085977 9223534 43857172 0 94816 228886 175241 247856 263304 1010103 94816 228886 175241 247856 263304 1010103 42847069 47310 35284 60955 72915 72643 289107 47310 35284 60955 72915 72643 289107 7788995 8790450 9111765 9158892 9296177 44146279 0.97060 0.97680 0.00650 0.00580 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 653383 653383 18374105 8906542 9467563 2660097 2263729 396368 4340407 115460 4224947 14742261 X 9498133 194948 194948 9303185 0 9303185 9082168 0 9082168 0 9082168 Part IV, Line 2b: The Organization acts as custodian for the funds of residents of the nursing facility and holds tenant security deposits from residents of Assumption Court. A portion of the security deposit may be refunded back to the resident upon termination of the lease assuming certain conditions have been met. The Organization records these deposits, plus 1% simple interest, as a liability. Part X, Line 2: The Organization is organized as a Minnesota non-profit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on any net income that is derived from business activities that are unrelated to its exempt purpose. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 Scholarships 40 33749 Part I, Line 2: Assumption Home participates with the Minnesota Department of Human Services Nursing Facility (NF) employee scholarship funds program. After it is determined that an employee has met the requirements of the NF program the award will be given based on job performance (reference of the employees performance evaluation and/or corrective actions), participation in facility committees, additional training/education the employee has completed throughout the past year, etc. The award documentation will be submitted to billing for payment along with a copy of the tuition statement from the employee. A City of Cold Spring Minnesota 416005064 193014BD8 2013-06-21 5400078 Refund bonds issued 3/31/2005 0 0 0 B City of Cold Spring Minnesota 416005064 193014BV8 2017-02-28 7310000 Refund Bonds issued 10/29/08 0 0 0 C City of Cold Spring Minnesota 416005064 193014CJ4 2018-09-20 3831686 Construction 0 0 0 A 510078 5400078 450641 108002 4839017 1 0 1 1 B 555000 7310000 146200 7163800 1 0 1 1 C 3831686 238500 76633 3516553 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 A 1 B 1 C 1 Date Rebate Computation Performed Issuer Name: City of Cold Spring Minnesota Date the Rebate Computation was Performed: 03/10/2018 Karilyn Lund Daughter of Chad Middendorf, Board Member 59800 The individual is compensated as an employee of the organization. Mr. Middendorf is not involved in employment discussions or in determining compensation. 0 WealthCare Inc Chad Middendorf, Board Member >35% Owner 111267 The organization contracts with WealthCare, Inc. for workers compensation insurance. The organization reviewed fees and services from other comparable entities and found WealthCare, Inc. to be the best provider for the service based on lower fees. Mr. Middendorf refrained from all discussions and voting on the matter, as required in the organization's conflict of interest policy. 0 Form 990, Part VI, Section A, line 6 The members of the corporation shall be as follows: 1. The Bishop of the Diocese of Saint Cloud or the person, who in his stead, exercises ordinary jurisdiction over the spiritual and temporal affairs of the Diocese of Saint Cloud in accordance with the legislation of the Roman Catholic Church; 2. The Vicar General of the Diocese of Saint Cloud, who has been appointed to be a member ex-officio of the corporation of the Diocese of Saint Cloud. In the event of a vacancy in the office of the Bishop, in those cases in which the Vicar General's office ceases, then and in such event the person who was the Vicar General, continues to be a member ex-officio of this corporation with all the rights and powers included thereto, but his membership shall cease at once when the Office of Vicar General has been filled; 3. The Pastor of the Church of Saint Boniface, Cold Spring, Minnesota; and 4. Two (2) trustees who are members of the Church of Saint Boniface, Cold Spring, Minnesota, which have been elected by the membership of the corporation; There shall be only one class of members of the corporation and each member shall be entitled to one vote on all actions that come before the membership of the corporation. Form 990, Part VI, Section A, line 7a The Board of Directors shall be elected by the members of the corporation. Form 990, Part VI, Section A, line 7b The members reserve the following functions: 1. Appoint the Board of Directors and remove any member with or without cause; 2. Approve a merger or dissolution of the organization; 3. Amendment of the Articles of Incorporation; and 4. Support and assess the Roman Catholic identify and mission of the organization and verify adherence to the Ethical and Religious Directives for Catholic Health Care Services now current or hereafter amended, as recommended by the Bishop of the Diocese of St. Cloud. Form 990, Part VI, Section A, line 8b The organization does not have a committee with the authority to act on behalf of the organization. Form 990, Part VI, Section B, line 11b The Form 990 is prepared by an independent public accounting firm and is reviewed by both the Administrator and the Director of Finance. After their review, the Form 990 is provided to the Board of Directors, who review and approve it prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The organization's conflict of interest policy applies to all officers and members of the Board of Directors. The Administrator annually reviews the Board Members' associations for conflicts of interest. The Board of Directors annually reviews the Administrator's associations for conflicts of interest. If a conflict arises, depending on the circumstances, the conflicted individual abstains from voting, steps down from the Board, or terminates the association with the other party. Form 990, Part VI, Section B, line 15a The Board of Directors uses comparability Data annually to ensure fair compensation. The Minnesota Nursing Facility pay survey data and market rates are used in determining compensation. The last review was performed in 2019. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available upon request. Form 990, Part XI, line 9: Forgiveness of Debt -33,000. Pioneer Housing Development Inc 200 8th Avenue North Cold Spring MN 56320 411367392 housing MN 501(c)(3) Line 10 N/A 0 Assumption Community Services 615 1st St North Cold Spring MN 56320 800276405 home care services MN 501(c)(3) Line 10 N/A 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 1 0