2025-11-05T10:13:28-06:00 2024-12-31 410746749 CLIFTONLARSONALLEN LLP 10401 W INNOVATION DR STE 300 WAUWATOSA WI 53226 990 2024-01-01 420896119 FAITH LUTHERAN HOME FAIT 6417325511 914 DAVIDSON DRIVE OSAGE IA 50461 SCOTT HALBACH ADMINISTRATOR 6417325511 2025-11-03 1 1 KRISTEN DONLEVY P01670215 4144761880 2025-10-28 2024 2025-03-06 01:10:19Z SCOTT HALBACH 914 DAVIDSON DRIVE OSAGE IA 50461 6318181 0 X FAITHLUTHERANHOMEOSAGE.COM X 1964 IA PROVIDE A PLEASANT, HOME-LIKE ATMOSPHERE AND ENRICHING PROGRAM SERVICES. 13 13 114 15 0 0 436482 49910 5549953 5900703 4942 18247 0 20655 5991377 5989515 0 6000 0 0 3200368 3787216 0 0 0 2938706 2238929 6139074 6032145 -147697 -42630 3796209 3567862 2750361 2524817 1045848 1043045 TO PROVIDE A FACILITY WHICH HAS A PLEASANT AND HOME-LIKE ATMOSPHERE AND ALSO PROVIDE AND MADE AVAILABLE AN ENRICHING PROGRAM OF SERVICES THAT APPLY TO THE NEEDS OF THE RESIDENTS. 0 0 5473845 6000 5900703 FAITH LUTHERN HOME CORPORATION PROVIDES HOUSING AND NECESSARY MEDICAL CARE FOR INDIVIDUALS REQUIRING NURSING HOME CARE. THEY ALSO PROVIDE ASSISTED LIVING FOR THE ELDERLY AND DISABLED PEOPLE. 5473845 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 20 0 1 114 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 1 0 0 0 1 0 0 1 0 0 0 1 1 1 1 0 1 1 0 0 X SCOTT HALBACH 6417325511 914 DAVIDSON DRIVE OSAGE IA 50461 SCOTT HALBACH ADMINISTRATOR & SECRETARY 40.00 X 113242 0 40863 LEANNA TROGE PRESIDENT 1.00 X X 0 0 0 MARK PENNY VICE PRESIDENT 1.00 X X 0 0 0 DALE TOBBERT TREASURER 1.00 X X 0 0 0 BONNIE BLAKE DIRECTOR 1.00 X 0 0 0 NORMA BRUNNER DIRECTOR 1.00 X 0 0 0 KELCI FARMER DIRECTOR 1.00 X 0 0 0 NIKOLE GAST DIRECTOR 1.00 X 0 0 0 BOB KLEMESRUD DIRECTOR 1.00 X 0 0 0 NANCY KLEMESRUD DIRECTOR 1.00 X 0 0 0 CAROL MENNENGA DIRECTOR 1.00 X 0 0 0 JEFF ROSENBERG DIRECTOR 1.00 X 0 0 0 LEROY STEWARD DIRECTOR 1.00 X 0 0 0 KEN SWENSON DIRECTOR 1.00 X 0 0 0 113242 0 40863 1 0 1 0 BLUESTONE THERAPY 2830 100TH ST STE 100 URBANDALE IA 50322 THERAPY SERVICES 337337 GRAPETREE MEDICAL STAFFING 2501 BOJI BEND DR STE 100 MILFORD IA 51351 MEDICAL STAFFING 200938 2 5258 44652 49910 PATIENT REVENUE 623000 4969387 4969387 ASSISTED LIVING REVENU 623000 577505 577505 INDEPENDENT LIVING REV 623000 353661 353661 MEALS 623000 105 105 ADMINISTRATIVE CONSULT 623000 45 45 5900703 20600 20600 326313 327256 1410 -943 -1410 -2353 -2353 OTHER REVENUE 900099 20655 20655 20655 5989515 5900703 0 38902 6000 6000 154297 30860 123437 2789272 2701023 88249 36634 36634 548472 524977 23495 258541 216228 42313 704 704 42666 42666 404241 381728 22513 1372 1372 48978 2491 46487 115549 6600 108949 274800 274800 32 32 1562 570 992 37774 37774 171800 171800 68755 23974 44781 FOOD & DPRT. SUPPLIES 939922 939922 QUALITY ASSURANCE FEE 95124 95124 BAD DEBT 7665 7665 27985 15643 12342 6032145 5473845 558300 0 340423 419579 856657 730105 281731 235774 6000 6000 10843 11218 4261414 2105631 2284816 2155783 15739 9403 3796209 3567862 710231 546329 1528223 1554082 511907 424406 2750361 2524817 X 1036243 1033440 9605 9605 1045848 1043045 3796209 3567862 -42630 39827 0 X X 0 1 X 1 0 X 49589 19551 22670 436482 49910 578202 5689557 4709759 4673149 5549953 5900703 26523121 5739146 4729310 4695819 5986435 5950613 27101323 60112 60112 1527398 1527398 1587510 1587510 25513813 14376 28523 30529 4742 20600 98770 14376 28523 30529 4742 20600 98770 56681 20655 77336 5753522 4757833 4783029 5991177 5991868 27277429 0.93530 0.99670 0.00360 0.00330 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISC INCOME - 2022 AMOUNT: $ 52,191. 2024 AMOUNT: $ 20,655. BAD DEBT RECOVERY - 2022 AMOUNT: $ 4,490. 7082 7082 3390537 1517094 1873443 856770 588537 268233 7025 7025 2155783 RESIDENT DEPOSITS 415003 LEASE OBLIGATION 9403 424406 6030752 39827 39827 5990925 -1410 -1410 5989515 6033555 1410 1410 6032145 0 6032145 PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF FIXED ASSETS -1,410. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF FIXED ASSETS 1,410. 1 SCHOLARSHIP 3 6000 0 N/A N/A PART I, LINE 2: THE FOLLOWING ARE THE CRITERIA REQUIRED TO APPLY FOR THE SCHOLARSHIP FUND: -MUST WORK DIRECTLY ON FAITH HOME CAMPUS EITHER THROUGH FAITH LUTHERAN HOME INC. -MUST BE ATTENDING OR PLAN TO ATTEND A COLLEGE, UNIVERSITY, OR SCHOOL WITH THE PURPOSE TO FURTHER THEIR HEALTHCARE EDUCATION AND CAREER. -MUST MAINTAIN A GPA OF 2.0 OR GREATER. -A PREFERENCE WILL BE GIVEN TO ANY PERSON WHO WORKED AT FAITH HOME CAMPUS BETWEEN 2010 AND FEBRUARY 2020. -PREFERENCE WILL BE GIVEN TO APPLICANTS PURSUING A HIGHER DEGREE THAN THEY CURRENTLY HAVE, BUT APPLICANTS MAY APPLY IF THEY WISH TO GET A SPECIALIZATION IF IT APPLIES TOWARDS THEIR WORK I.E. A RN GETTING A SPECIALIZATION IN GERIATRICS. X 0 0 0 0 0 0 0 0 0 SCOTT HALBACH ADMINISTRATOR & SECRETARY 113242 0 0 0 0 0 17500 0 23363 0 154105 0 0 0 JERRY AND LADONNA GUNDERSON SCOTT HALBACH'S MOTHER & STEPFATHER 60112 NURSING FEES 0 FORM 990, PART VI, SECTION A, LINE 2 DIRECTORS BOB KLEMESRUD AND NANCY KLEMESRUD HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP CONSISTS OF THE VOTING MEMBERS OF LUTHERAN CONGREGATIONS IN MITCHELL COUNTY, IOWA, VOTING TO PARTICIPATE AND OF OTHER LUTHERAN CONGREGATIONS THAT BECOME MEMBERS BY INVITATION OF THIS CORPORATION. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B FORM 990 IS PREPARED BY THE ORGANIZATION'S INDEPENDENT ACCOUNTANT WITH INFORMATION PROVIDED BY MANAGEMENT. THE BOARD MEMBERS REVIEW THE 990 AT THE BOARD MEETING AND VOTE TO APPROVE. FORM 990, PART VI, SECTION B, LINE 12C FAITH LUTHERAN HOME CORPORATION MONITORS THEIR EMPLOYEE'S COMPLIANCE WITH THE CONLICT OF INTEREST POLICY THROUGH ANNUAL REVIEWS AND THROUGH INVESTIGATIONS OF ANY ALLEGATIONS OF POTENTIAL CONFLICTS OF INTEREST. ANNUALLY, EMPLOYEES AND DIRECTORS MUST FILE AN ANNUAL DISCLOSURE STATEMENT. IN DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS, THE AUDIT COMMITTEE SHALL CONSIDER WHETHER THE POTENTIAL CONFLICT OF INTEREST WOULD CAUSE A TRANSACTION ENTERED INTO BY THE CORPORATION TO RAISE QUESTIONS OF BIAS, INAPPROPRIATE USE OF THE CORPORATION'S ASSETS, OR ANY OTHER IMPROPRIETY. IF THE AUDIT COMMITTEE DETERMINES THAT THERE IS A CONFLICT OF INTEREST, IT SHALL REFER THE MATTER TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS SHALL DETERMINE IF A CONFLICT OF INTEREST EXISTS. THE DIRECTOR, OFFICER OR KEY PERSON SHALL NOT BE PRESENT FOR DELIBERATION OR VOTE ON THE MATTER AND MUST NOT ATTEMPT TO INFLUENCE IMPROPERLY THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS DETERMINES THE SALARY OF THE ADMINISTRATORS BY DOING AN AREA MARKET SURVEY OF OTHER NURSING HOMES IN THE AREA. THEY COMPARE SALARIES, BENEFITS AND EXPERIENCE OF THE OTHER ADMINISTRATORS AND FROM THIS SURVEY AND DISCUSSIONS THEY DETERMINE AND SET THE ADMINISTRATORS SALARY FOR FAITH LUTHERAN HOME CORPORATION. THE DOCUMENTATION OF THE DELIBERATION AND DECISION ARE RECORDED IN THE BOARD MINUTES. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2025. FORM 990, PART VI, SECTION C, LINE 19 FAITH LUTHERAN HOME CORPORATION MAKES ALL OF THEIR GOVERNING DOCUMENTS, POLICIES, FINANCIAL STATEMENTS AND FORM 990 TAX RETURN AVAILABLE AT ANY TIME TO THE PUBLIC IN THE ADMINISTRATIVE OFFCES LOCATED AT 914 DAVIDSON DRIVE OSAGE, IA 50461. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR.