2020-10-16T11:04:50-05:00 2019-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2019-01-01 410977369 LUTHER HAVEN LUTH 3202696517 1109 EAST HIGHWAY 7 MONTEVIDEO MN 56265 JUSTIN HUGHES ADMINISTRATOR 3202696517 2020-10-12 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-10-12 216.54.158.12 2020-10-12 11:59:34 CD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2019 2021-01-29 14:40:06Z JUSTIN HUGHES 1109 EAST HIGHWAY 7 MONTEVIDEO MN 56265 9436819 0 X WWW.LUTHERHAVEN-MN.ORG X 1971 MN PROVIDE SERVICES TO THE ELDERLY AND DISABLED IN THE MONTEVIDEO AND THE SOUTHWEST AREA OF MINNESOTA WE CARE FOR THE TOTAL PERSON AND PROVIDE LONG TERM CARE AND SHORT REHAB SERVICES. 11 11 235 81 0 0 6283 2349 8690788 9418311 124967 1600 3312 4356 8825350 9426616 23974 55892 0 0 5823036 5814833 0 0 0 2767219 2796648 8614229 8667373 211121 759243 4925611 5797429 859849 836596 4065762 4960833 X LUTHER HAVEN WAS ESTABLISHED AND ORGANIZED TO CARE FOR THE ELDERLY AND DISABLED IN MONTEVIDEO AND IN THE SOUTHWEST MINNESOTA DISTRICT OF THE ELCA. ITS PURPOSE IS TO SERVE THE ELDERLY AND DISABLED AND TO PROMOTE THEIR PHYSICAL, SOCIAL, EMOTIONAL, AND SPIRITUAL NEEDS IN A CHRISTIAN ATMOSPHERE. NO PERSON BECAUSE OF RACE, COLOR, CREED, RELIGION, NATIONAL ORIGIN, SEX, MARITAL STATUS, STATUS WITH REGARD TO MEDICAL ASSISTANCE, DISABILITY, SEXUAL ORIENTATION, MEMBERSHIP OR ACTIVITY IN A LOCAL COMMISSION OR VETERAN STATUS SHALL BE BARRED ADMISSION FROM LUTHER HAVEN. 0 0 7297600 55892 8646856 CARE CENTER:NURSING DEPARTMENT WITH A BUDGET OF 3 MILLION IS OUR LARGEST DEPARTMENT. IT EMPLOYS APPROXIMATELY 100 EMPLOYEES. WE PROVIDE LONG AND SHORT STAY CARE AND A FULL LINE OF REHAB SERVICES TO PROMOTE MAXIMUM RESIDENT HEALTH AND RETURN TO COMMUNITY. WE ARE LICENSED FOR 90 BEDS. ALSO, ON THE CAMPUS IS COPPER GLEN, ASSISTED LIVING AND THE MONTEVIDEO-CHIPPEWA COUNTY HOSPITAL AND MEDICAL CENTER. ALL BUILDINGS ARE CONNECTED, AND CERTAIN SERVICES ARE SHARED FOR COST SHARING AND COST SAVINGS. WE ARE CERTIFIED WITH MEDICARE AND MEDICAID AND LICENSED WITH THE MINNESOTA DEPARTMENT OF HEALTH. 672789 0 771455 COPPER GLEN:COPPER GLEN IS A LICENSED CLASS F ASSISTED LIVING FACILITY. COPPER GLEN IS DESIGNED AS AN APARTMENT STYLE COMPLEX WITH SERVICES AVAILABLE TO ASSIST THE TENANTS TO AGE IN A HOME ENVIRONMENT. PROGRAM SERVICES ARE INTENDED TO BRIDGE THE GAP BETWEEN INDEPENDENT LIVING AND THE CARE CENTER. SERVICES PROVIDED INCLUDE MEALS, BATHING, HOUSEKEEPING, MAINTENANCE, LAUNDRY, AND REGISTERED NURSE SUPERVISION STAFFING. ALSO PROVIDED IS ALA CARTE SERVICES, CENTRAL STORAGE OF MEDICATIONS, MEDICATION ADMINISTRATION AND MANAGEMENT. VOLUNTEERS AND A LOCAL PASTORAL ORGANIZATION PROVIDE WORSHIP SERVICES. 7970389 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 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 1 44 0 235 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 1 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X ANN NORDSTROM 3202696517 1109 EAST HIGHWAY 7 MONTEVIDEO MN 56265 JUSTIN HUGHES PRESIDENT/TREASURER/ADMINISTRATOR 40.00 X 79451 0 8061 ANN NORDSTROM FINANCE DIRECTOR 40.00 X 61688 0 13184 DON SNELL VICE PRESIDENT 1.00 X X 0 0 0 MICHAEL LUND CHAIR 1.00 X X 0 0 0 KALIN EVENSON VICE CHAIR 1.00 X X 0 0 0 AMANDA WOLLSCHLAGER SECRETARY 1.00 X 0 0 0 SHELLY BEDNAR DIRECTOR 1.00 X 0 0 0 JEROME FRAGODT DIRECTOR 1.00 X 0 0 0 BROCK MADSEN DIRECTOR 1.00 X 0 0 0 BRETT OPDAHL DIRECTOR 1.00 X 0 0 0 DIANE OSTLIE DIRECTOR 1.00 X 0 0 0 TOM SAUE DIRECTOR (THRU APRIL) 1.00 X 0 0 0 KARLA SCHWENDEMANN DIRECTOR (THRU APRIL) 1.00 X 0 0 0 JUDY TEBEEST DIRECTOR 1.00 X 0 0 0 CHUCK VIEN DIRECTOR 1.00 X 0 0 0 141139 0 21245 0 0 0 0 BIG STONE THERAPIES INC 500 CROSS STREET BIG STONE CITY SD 57216 PT/OT/ST THERAPY SERVICES 399883 US FOODS INC NW 6010 MINNEAPOLIS MN 554856010 FOOD SERVICE 266481 ALL TEMPRARIES MIDWEST 4200 CENTRAL AVE NE COLUMBIA HEIGHTS MN 55421 STAFFING AGENCY 116364 HGA SDS 12-1861 MINNEAPOLIS MN 554861861 ARCHITECTURAL SERVICES 112828 4 2349 2349 RESIDENT ROOM AND BOAR 623000 8120432 8120432 THERAPY 623000 794350 794350 SHARED SERVICES 623000 217540 217540 OTHER SERVICES 623000 193311 193311 PHARMACY SERVICES 446110 92678 92678 9418311 11803 11803 10203 -10203 -10203 -10203 GUEST MEALS 900099 4356 4356 4356 9426616 9418311 0 5956 55892 55892 162384 162384 4669141 4478520 190621 41092 41092 568496 544315 24181 373720 346810 26910 15325 15325 23933 800 23133 743894 733291 10603 520 520 64767 21562 43205 19462 19462 225885 225885 17117 12235 4882 6023 6023 271196 228324 42872 61144 61144 SUPPLIES 786196 786196 SURCHARGE 253350 253350 REPAIRS AND MAINTENANCE 250473 208480 41993 BAD DEBT EXPENSE 27614 27614 29749 29749 8667373 7970389 696984 0 487816 1161095 285438 301548 782194 860896 43581 43581 63266 60407 9491281 7078943 2436581 2412338 814475 945304 12260 12260 4925611 5797429 527118 589579 30420 30301 302311 216716 859849 836596 X 4042535 4936331 23227 24502 4065762 4960833 4925611 5797429 759243 135828 0 X 0 1 X 1 0 X 3107 147646 2248 6283 2349 161633 4704 3844 3539 3312 4356 19755 6348405 7735342 7603257 8690788 9418311 39796103 6356216 7886832 7609044 8700383 9425016 39977491 0 0 0 39977491 12777 11621 10291 9294 11803 55786 12777 11621 10291 9294 11803 55786 6368993 7898453 7619335 8709677 9436819 40033277 0.99860 0.99840 0.00140 0.00160 X 0 1 X 43917 43917 7612643 5688077 1924566 1624118 1390866 233252 210603 210603 2412338 9561169 135828 135828 9425341 1275 1275 9426616 8667373 0 8667373 0 8667373 PART IV, LINE 2B: THE ORGANIZATION IS THE TRUSTEE OF RESIDENT FUNDS AND HAS A FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION AND DISTRIBUTION OF THESE FUNDS FOR RESIDENTS OF THE SKILLED NURSING FACILITY. SECURITY DEPOSITS ADVANCED BY TENANTS OF COPPER GLEN ARE ALSO HELD IN TRUST BY THE ORGANIZATION. THE ORGANIZATION RECORDS THE AMOUNT ADVANCED BY THE RESIDENTS AND TENANTS AS LIABILITIES IN THE ACCOMPANYING BALANCE SHEETS. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS WITH DONOR RESTRICTIONS 1,275. 1 SCHOLARSHIPS 17 55892 PART I, LINE 2 LUTHER HAVEN HAS A NURSING FACILITY SCHOLARSHIP FUND. EMPLOYEES MUST MEET CERTAIN ELIGIBILITY REQUIREMENTS. SCHOLARSHIP PARTICIPANTS MUST PERSONALLY TURN IN ALL ALLOWABLE EXPENSES. DIRECT BILLINGS FROM THE COLLEGE ARE NOT ACCEPTED. SCHOLARSHIP APPLICATIONS AND REIMBURSEMENTS ARE PROCESSED BY ACCOUNTING AFTER BEING APPROVED BY THE DEPARTMENT MANAGER, ADMINISTRATOR OR HUMAN RESOURCES. ACCOUNTING VERIFIES AND TRACKS YEARLY PAYMENTS FOR REPORT PURPOSES. PAYMENTS ARE MADE DIRECTLY TO THE EMPLOYEE. THE APPLICANT MUST COMPLETE THE SCHOLARSHIP REIMBURSEMENT FORM BY ATTACHING AN ITEMIZED DETAILED BILLING OF THE ALLOWABLE EXPENSES WITH RECEIPTS SHOWING THEIR PAYMENT IN FULL. FORM 990, PART VI, SECTION A, LINE 2 BOARD DIRECTOR CHUCK VIEN IS THE BROTHER IN-LAW OF MICHAEL LUND BOARD DIRECTOR/OFFICER. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP OF LUTHER HAVEN CONSISTS OF CONGREGATIONS OF CHRISTIAN CHURCHES WHICH HAVE APPLIED FOR SUCH MEMBERSHIP AND HAVE BEEN APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS REVIEWED BY THE ADMINISTRATOR AND FINANCE DIRECTOR BEFORE PROVIDING A COPY TO OUR BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE RESPONSIBILITY OF EVERY BOARD MEMBER TO STATE IF THEY FEEL THEY HAVE A CONFLICT OF INTEREST ON A VOTING MATTER. UNDER ANY TRANSACTION BETWEEN THE CORPORATION AND BOARD MEMBER, FULL DISCLOSURE MUST BE MADE TO THE BOARD OF DIRECTORS OR COMMITTEE BEFORE APPROVAL. THAT BOARD MEMBER OR COMMITTEE MEMBER SHALL NOT VOTE, AND THE MEETING MINUTES SHOULD REFLECT THE BOARD MEMBER OR COMMITTEE MEMBER ABSTAINED FROM VOTING. EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY AND UNDERSTANDS THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION USES TWO SALARY SURVEYS, ONE FROM AGING SERVICES OF MINNESOTA AND ANOTHER FROM MEDISOTA, A NON-PROFIT GROUP. THE COMPENSATION AND BENEFIT SURVEY IS FOR HEALTH CARE FACILITIES IN THE SOUTHWEST REGION OF MINNESOTA. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D).