2018-08-15T07:31:23-05:00 2017-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2016-10-01 411733854 HIGHLAND MANOR INC HIGH 5072330800 1314 EIGHTH NORTH STREET NEW ULM MN 56073 CANDAS SCHOUVIELLER ADMINISTRATOR 5072330800 2018-08-13 1 CORY RUTLEDGE P01329381 6123764500 2016 2022-09-23 18:48:47Z OAK HILLS LIVING CENTER CANDAS SCHOUVIELLER 1314 EIGHTH NORTH STREET NEW ULM MN 56073 10748288 0 X WWW.OAKHILLSNEWULM.COM X 1958 MN HOUSING SERVICES FOR THE ELDERLY. 9 9 319 52 278041 82244 61918 82203 9595799 10224979 55240 65167 247366 330734 9960323 10703083 142010 199517 0 0 5774516 6259156 0 0 0 4055641 4185684 9972167 10644357 -11844 58726 13680681 13584796 8623417 8404158 5057264 5180638 X TO ENRICH AND SUPPORT THE LIVES OF THE ELDERS WE CARE FOR WITH EXCELLENCE, COMPASSION, RESPECT, AND COMPETENCE. 0 0 9491257 199517 10224979 HIGHLAND MANOR, INC, D.B.A. 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. 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 2017, OAK HILLS LIVING CENTER HAD 32,272 RESIDENT DAYS, AND HAD 94.06% 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 PROVIDES HOME HEALTH CARE TO NEW ULM AND THE SURROUNDING COMMUNITY. HOME CARE WAS CERTIFIED BY MEDICARE 7/21/2010. IN JULY 2013, OAK HILLS BEGAN CONTRACTING WITH VOA TO OFFER ADULT DAY SERVICES IN OUR FACILITY. 9491257 1 1 0 0 0 0 0 0 1 0 1 0 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 0 0 0 1 15 0 319 1 1 1 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 CANDAS SCHOUVIELLER 5072330800 1314 8TH N ST NEW ULM MN 56073 JULIE BAUMGARTNER PRESIDENT 0.50 0.50 X X 0 0 0 TOM HENDERSON VICE PRESIDENT 0.50 0.50 X X 0 0 0 PAUL GUNDERSON TREASURER 0.50 0.50 X X 0 0 0 COLLEEN SKILLINGS SECRETARY 0.50 0.50 X X 0 0 0 DENNIS FREDERICKSON BOARD MEMBER 0.50 0.50 X 0 0 0 DR JOAN KRIKAVA BOARD MEMBER 0.50 0.50 X 0 0 0 CHRIS JENSEN BOARD MEMBER 0.50 0.50 X 0 0 0 MAVIS PAUTZ BOARD MEMBER 0.50 0.50 X 0 0 0 ROBERT WISE BOARD MEMBER 0.50 0.50 X 0 0 0 DR JAY VANCURA BOARD MEMBER (THRU DEC 2016) 0.50 0.50 X 0 0 0 CANDAS SCHOUVIELLER ADMINISTRATOR 53.00 2.00 X 114128 0 27719 AMY BLOEDEL CHEIF FINANCIAL OFFICER 51.00 4.00 X 95684 0 19819 209812 0 47538 1 0 0 0 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 THERAPY SERVICES 663014 ALLINA NW 7710 PO BOX 9383 MINNEAPOLIS MN 55440 MEDICAL SERVICES 149303 THRIVEON 210 SOUTH 20TH STREET NEW ULM MN 56073 IT MANAGEMENT/COMPUTER SUPPORT SERVICES 139072 3 82203 82203 RESIDENT REVENUE 623000 10224979 10224979 10224979 65167 65167 12997 45205 -32208 -32208 REVENUE - CATERING 623000 282321 278041 4280 MEAL 623000 49634 49634 PHONE SERVICE 623000 25555 25555 5432 5432 362942 10703083 10224979 278041 117860 199517 199517 254057 254057 4891575 4393172 498403 66111 59499 6612 663774 597387 66387 383639 344406 39233 11126 11126 10820 10820 38862 38862 985310 976080 9230 34955 33255 1700 198958 112076 86882 145297 75700 69597 664808 611246 53562 22453 22453 27075 1501 25574 679349 644043 35306 4297 4297 UBIT TAXES 8633 8633 FOOD EXPENSE 469437 469437 MEDICAL SUPPLIES 371294 371294 LICENSE SURCHARGE 275214 273817 1397 237796 43684 194112 10644357 9491257 1153100 0 256203 259485 2453721 1521819 1360293 1342666 146760 158507 16832376 9052721 7916669 7779655 1057793 2144768 292100 346890 166428 30714 31006 13680681 13584796 620755 664175 8002662 7739983 8623417 8404158 X 4734450 4833748 322814 346890 5057264 5180638 13680681 13584796 58726 64648 0 X 0 1 X 1 0 X 22297 110419 67887 61918 82203 344724 8320737 8524535 8629846 9595799 10224979 45295896 8343034 8634954 8697733 9657717 10307182 45640620 0 58878 61619 78550 20370 64688 284105 58878 61619 78550 20370 64688 284105 45356515 34627 33684 4041 55240 65167 192759 34627 33684 4041 55240 65167 192759 7815 32764 27800 68380 83582 220341 98444 107181 110507 100604 97898 514634 8483920 8808583 8840081 9881941 10553829 46568354 0.97400 0.97530 0.00410 0.00400 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: TELEVISION - 2012 AMOUNT: $ 21,105. 2013 AMOUNT: $ 22,542. 2014 AMOUNT: $ 23,439. 2015 AMOUNT: $ 14. OTHER MISC REVENUE - 2012 AMOUNT: $ 32,857. 2013 AMOUNT: $ 39,338. 2014 AMOUNT: $ 36,818. 2015 AMOUNT: $ 47,318. 2016 AMOUNT: $ 30,987. MEAL INCOME - 2012 AMOUNT: $ 29,994. 2013 AMOUNT: $ 32,424. 2014 AMOUNT: $ 37,644. 2015 AMOUNT: $ 40,775. 2016 AMOUNT: $ 49,634. DELI REVENUE - 2012 AMOUNT: $ 14,488. 2013 AMOUNT: $ 12,877. 2014 AMOUNT: $ 12,606. 2015 AMOUNT: $ 12,497. 2016 AMOUNT: $ 12,997. CATERING REVENUE - 2016 AMOUNT: $ 4,280. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 27900 27900 10992152 4949117 6043035 614030 146642 467388 5198294 3956962 1241332 7779655 X 10788860 64649 59599 124248 10664612 38471 38471 10703083 10689562 45205 45205 10644357 0 10644357 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 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 IS ORGANIZED AS A MINNESOTA NONPROFIT 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 CENTER IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE CENTER IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE CENTER'S 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 TAX-EXEMPT 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 EXPENSE. PART XI, LINE 2D - OTHER ADJUSTMENTS: RELEASE FROM RESTRICTION 59,599. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 57,085. TEMP RESTRICTED INVESTMENT EARNINGS 26,591. DELI EXPENSE -45,205. PART XII, LINE 2D - OTHER ADJUSTMENTS: DELI EXPENSE 45,205. 1 SCHOLARSHIPS 71 196953 0 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 CITY OF NEW ULM 416005412 2004-07-14 5547000 REFUND CITY OF NEW ULM, MN HC REV BONDS SERIES '94 AND '95 0 0 0 B BROWN COUNTY 416005765 2008-12-31 6000000 IMPROVEMENTS TO SKILLED NURSING FACILITY 0 0 0 A 3144209 5547000 107346 5439654 2011 1 0 1 1 B 846072 6000000 120000 5239594 640406 2011 0 0 1 1 B 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 A 1 B 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 REVIEWS THE DRAFT 990 IN DETAIL AND PROVIDES 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. 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. 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 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 1