2017-06-15T11:22:32-05:00 2016-09-30 411765929 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-10-01 410711592 St John Lutheran Home STJO 5077233200 201 S County RD 5 Springfield MN 56087 Joshua Jensen CEO 5077233200 2017-06-14 1 Deb Nelson CPA P00484560 9529446166 2017-06-14 2015 2021-01-29 14:40:06Z Joshua Jensen 201 S County RD 5 Springfield MN 56087 7644347 0 9386 X www.sjlhome.com X 1901 MN Skilled nursing care 10 10 308 165 0 0 0 0 6604670 7583924 25081 60423 0 0 6629751 7644347 11614 55365 0 0 4639700 4903931 0 0 0 2363449 2497810 7014763 7457106 -385012 187241 6858795 6997851 4220497 3926950 2638298 3070901 St. John's Circle of Care provides services and support that enable all who are within our Circle of Care the ability to thrive together. 0 0 6421124 55365 7583924 St. John Lutheran Home is a 85-bed nursing facility and 7-unit senior rental facility and a 26 unit housing with services facility. Home care services are provided to these facilities and to the community. The home also operates a licensed day care in furtherance of its purpose by providing intergenerational care to residents. This program enhances the well-being of the residents. 6421124 1 0 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 1 0 0 0 0 0 0 1 1 1 0 0 1 4 0 1 308 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 MN X Robert Lamote 5077233209 201 S County Road 5 Springfield MN 56087 Dan Olson Chair 2.00 1.00 X X 0 0 0 Sharon Beyer Vice Chair (thru Feb 2016) 1.00 1.00 X X 0 0 0 Randy Therkilsen Vice Chair (as of Feb 2016) 1.00 2.00 X X 0 0 0 Pat Renberg Treasurer 2.00 1.00 X X 0 0 0 Laurie Fredin Secretary 2.00 1.00 X X 0 0 0 Gilbert Anderson Director 1.00 2.00 X 0 0 0 Jo Schwartz Director 1.00 2.00 X 0 0 0 Ken Hemmingsen Jr Director 1.00 1.00 X 0 0 0 Gary Poortvliet Director 1.00 1.00 X 0 0 0 Sue Steinke Director 1.00 1.00 X 0 0 0 Paula Roiger Director 1.00 1.00 X 0 0 0 Joshua Jensen CEO 40.00 4.00 X 104519 0 0 Robert Lamote CFO 40.00 4.00 X 64139 0 0 168658 0 0 1 0 0 0 Pathway Health 2025 4th St White Bear Lake MN 55110 DON contract 167907 Aegis Therapies Inc PO Box 8103 Fort Smith AR 72902 therapy services 117655 2 Resident Revenue 623000 7029833 7029833 Day Care Revenue 624410 264681 264681 Other Revenue 900099 229530 229530 Management Fee Revenue 900099 59880 59880 7583924 60423 60423 7644347 7583924 0 60423 55365 55365 169923 169923 19021 19021 4177750 3959833 217917 25441 25260 181 214075 195163 18912 297721 271419 26302 2524 2524 23245 23245 268026 228406 39620 1533 762 771 481402 292473 188929 24817 3176 21641 347263 347263 22035 17350 4685 15993 8174 7819 72805 72805 441091 441091 55053 6521 48532 Dietary 292505 292505 Surcharge Tax 239275 239275 Medical Supplies 143458 143458 Bad Debt Expense 34460 34460 32325 6619 25706 7457106 6421124 1035982 0 128165 318040 103520 108522 512847 743787 31065 53053 14364755 8830557 5833263 5534198 249935 240251 6858795 6997851 632364 734358 3578457 3186478 9676 6114 4220497 3926950 X 2638298 3070901 2638298 3070901 6858795 6997851 X 187241 245362 X 0 1 X 1 0 X 7268154 6981056 6967617 6604670 7583924 35405421 7268154 6981056 6967617 6604670 7583924 35405421 0 245335 159932 126322 282343 205174 1019106 245335 159932 126322 282343 205174 1019106 34386315 57723 24963 19168 31791 60423 194068 57723 24963 19168 31791 60423 194068 7325877 7006019 6986785 6636461 7644347 35599489 0.96590 0.96980 0.00550 0.00580 X 1 10981 2402 6619 6764 1 X 6444 6444 10274272 5749539 4524733 3287633 2591037 696596 796406 489981 306425 5534198 X 7641945 0 7641945 2402 2402 7644347 7450487 0 7450487 6619 6619 7457106 Part IV, Line 1b: The St. John Lutheran Home Auxiliary is operated under the EIN of St. John Lutheran Home however the assets are not reported on Part X. Part IV, Line 2b: The Organization acts as custodian for the funds of the residents and holds tenant security deposits. These funds are included in cash and cash equivalents and trade accounts payable in the consolidated financial statements. Part X, Line 2: The Home 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 entity 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 net income that is derived from business activities that are unrelated to their exempt purpose. The Home has determined it is not subject to unrelated business income tax and files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. 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 consolidated 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. Part XI, Line 4b - Other Adjustments: Auxiliary Revenue not Included in Financial Statements 2,402. Part XII, Line 4b - Other Adjustments: Auxiliary Expenses not Included in Financial Statements 6,619. 1 LPN Course Scholarships 25 55365 Part I, Line 2: These scholarships are funded by the State of Minnesota program which builds the cost of the scholarships into our rates the 2nd year after the scholarships are granted. A City of Springfield 416005552 2006-09-12 4300000 Multifamily housing development 0 0 0 A 1677688 4300000 86000 4214000 2007 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 1 0 0 0 0 A 0 Schedule K, Part II, Line 1, Column A: The 2006 Revenue Note matures in 2026. The amount on Line 1 represents the amount of principal reduction of the underlying note payable to the financial institutions rather than actual retirement of bonds of the issue. Elizabeth Jensen Family member of an officer 19021 Reportable compensation paid to a family member of a current officer. 0 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 11 The CEO and CFO review a draft in detail and provide copies to the board. Form 990, Part VI, Section B, line 12c The policy currently covers board members and the CEO and CFO. Annual statements are reviewed by the CEO. If a board member has a conflict, that individual must refrain from voting on the matter. Form 990, Part VI, Section B, line 15 The CEO's performance is evaluated by the Board of Directors' Executive Committee. A summary of the evaluation is provided to the entire board. The board determines the CEO's salary using compensation reports provided by Aging Services of Minnesota and Lutheran Services in America. The CFO and other key employees receive the same wage increases as general staff. Based on the CEO's annual review and the same compensation reports, if an additional increase is warranted, the CEO makes a proposal for the board to act on. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy and financial statements would be made available to the public upon request. Each request would be reviewed on a case by case basis. Form 990, Part XI, line 9: Transfer from Related Party 241,145. Net Change in Auxiliary Assets 4,217. St John Lutheran Home Foundation 201 S County Road 5 Springfield MN 56087 363372067 Support St. John Lutheran Home MN 501(c)(3) Line 7 St John Lutheran Home 1 Cottonwood Ridge Apartments 712 E Cottonwood St Springfield MN 560871167 411889334 Elderly Housing MN 501(c)(3) Line 9 St John Lutheran Home 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1 St John Lutheran Home Foundation S 241145 Fair Market Value