2017-11-02T14:35:15-07:00 2016-12-31 990 2016-01-01 411539761 ELIM HOMES INC ELIM 9522594500 7485 Office Ridge Circle Eden Prairie MN 553443690 Kathy Youngquist CFO 9522594500 2017-11-02 50.253.82.149 2016 2021-01-29 14:40:06Z Robert M Dahl 7485 Office Ridge Circle Eden Prairie MN 55344 51265396 0 X www.elimcare.org X 1985 MN Provide nursing home care and housing for the elderly. This includes programs and services specifically designed to meet the residents' primary needs for housing, healthcare (including in-house therapy) and nourishment. 5 5 1084 584 0 0 0 0 40347189 43774169 424429 686195 3158631 3480630 43930249 47940994 28319 28480 0 0 33449661 36582167 0 0 0 9346073 9523460 42824053 46134107 1106196 1806887 36082443 36137717 17731581 16516192 18350862 19621525 See Part I, Line 1 0 0 28325396 0 32815544 Elim Homes Inc. provides skilled long-term care services to the elderly, handicapped and other having specialized needs. The organization owns and operates four long-term care facilities in Princeton, MN (107 beds), Milaca, MN (86 beds), Watertown, MN (46 beds) and Fargo, ND (136 beds). Utilization by payor source was as follows: 58.4% Medicaid, 26.8% Private, 10.5% Medicare and 4.3% HMO. 9120872 0 9536346 Elim Homes, Inc. operates a therapy division (Progressive Rehabilitation Options) that provides physical, occupational and speech therapy to related organizations and other organizations located in Minnesota, North Dakota and Iowa. 899800 0 1065160 Elim Homes, Inc. operates an assisted living facility (Caley House) located in Princeton, MN. The facility has 30 units and occupancy was 96.3% in 2016. 274635 0 357119 Other program services include Adult Day Care and Elderly Independent Living. 274635 0 357119 38620703 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 74 0 1 1084 1 0 0 0 0 0 0 X 5 5 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X Kathy L Youngquist 9522594500 7485 Office Ridge Circle Eden Prairie MN 553443690 Pat Nuss Treasurer/Secretary and Director 0.15 0.47 X X 0 0 0 Stann Leff Vice Chairperson/Director 0.15 0.39 X X 0 0 0 Kevin Bergman Director 0.15 0.35 X 0 0 0 Dr Guy Tangedahl Director 0.15 0.23 X 0 0 0 Roland Peterson Director and Chairperson 0.15 0.47 X X 0 0 0 Ronald Sanford COO 15.22 25.77 X 244822 0 28016 Robert M Dahl President/CEO 15.22 26 X 388346 0 74313 Kathy L Youngquist CFO 14.99 25.59 X 234093 0 59852 Jeffrey Dagen V.P. Therapy Service 42.52 0 X 285039 0 77475 Angela Brown VP of Human Resources 13.5 22.67 X 130632 0 39062 Joan Graf Director of Accounting 15.50 26.04 X 221146 0 24469 Patricia Zahler Administrative Assistant 42.31 X 118863 0 43584 Christine Eilertson Director of Finance 16.19 27.19 X 132375 0 40433 Jeffrey Wipf VP of Information Technology 40 0 X 134521 0 27489 1889837 0 414693 19 0 1 0 CliftonLarsonAllen LLP 220 South Sixth Street Suite 300 Minneapolis MN 55402 Accounting Services 195059 Clinical Excellence Consortium 135 Fern Street North Cambridge MN 55008 Quality Improvement Consulting 108992 2 0 Nursing Home Services 623000 32815544 32815544 0 0 Therapy Services 621300 9536346 9536346 0 0 Assisted Living Services 623000 1065160 1065160 0 0 Adult Daycare Services 624100 257368 257368 0 0 Apartment Rental 531110 99751 99751 0 0 0 0 0 0 43774169 191306 0 0 191306 0 0 0 0 0 0 0 0 15237 0 0 0 15237 0 15237 0 0 15237 3811891 7400 3324024 378 487867 7022 494889 0 0 494889 Management Fee 541610 3463089 0 0 3463089 Miscellaneous Revenue 900099 2304 0 0 2304 0 0 0 0 3465393 47940994 43774169 0 4166825 28480 28480 0 0 0 0 0 0 1135337 0 1135337 0 0 0 0 0 28855059 25244954 3610105 0 878855 739792 139063 0 3585181 3017890 567291 0 2127735 1791059 336676 0 0 0 0 0 26799 0 26799 0 41087 0 41087 0 0 0 0 0 0 0 77548 0 77548 0 246406 196790 49616 0 179550 0 179550 0 569976 223260 346716 0 268592 0 268592 0 0 0 0 0 790763 751223 39540 0 226756 0 226756 0 0 0 0 0 34137 0 34137 0 464068 440865 23203 0 0 0 0 0 1872457 1778834 93623 0 108836 103393 5443 0 Supplies 2199275 2182696 16579 0 License Surcharge 675931 675931 0 0 Food 657107 657107 0 0 Maintenance Contracts/Purchased Services 472943 449296 23647 0 611229 339133 272096 0 46134107 38620703 7513404 0 2821096 5426535 1155733 1015077 0 0 4182321 4083429 0 0 0 0 0 0 0 0 144752 173932 44770452 28292176 17344281 16478276 6833974 4520033 0 0 0 0 0 0 3600286 4440435 36082443 36137717 5438595 5388244 0 0 0 0 11693331 10479375 0 0 0 0 0 0 0 0 599655 648573 17731581 16516192 X 18086713 19309685 264149 311840 0 0 18350862 19621525 36082443 36137717 X 1806887 -162896 0 0 0 -373328 X 0 1 X 1 0 X 37667719 39280216 40483943 40347189 43774169 201553236 37667719 39280216 40483943 40347189 43774169 201553236 0 0 0 0 0 0 201553236 158183 172378 197794 210378 206543 945276 158183 172378 197794 210378 206543 945276 2019098 2156113 2862927 3144845 3465393 13648376 39845000 41608707 43544664 43702412 47446105 216146888 0.93248 0.93654 0.00437 0.00440 X Schedule A, Part III, Line 12 Management Fee (2012-2016 respectively) $2,013,633, $2,149,633, $2,862,166, $3,137,372 & $3,463,089; Sale of Miscellaneous Minor Equipment (2012-2016 respectively) $524, $625, $761, $7,473 & $2,304; Cable TV Income (2012-2013 respectively) $4,941 & $5,855 0 443425 443425 0 32005000 18591184 13413816 0 332938 174420 158518 0 11207963 9022916 2185047 0 781126 503656 277470 16478276 Due from Affiliates 4284185 Inventory 32937 Interest Receivable 26200 Resident Trust Funds 55549 Security Deposits 26500 Deferred Development Costs 15064 4440435 0 Due to Affiliates 35367 Resident Trust Funds Payable 55549 Deferred Compensation Payable 396468 Asset Retirement Obligation 161189 648573 1 Guardian Angels of Elk River Inc 400 Evans Ave NW Elk River MN 55330 411459252 501(c)3 10200 0 To support the social ministry of providing quality care to seniors. Lyngblomsten Foundation 1415 Almond Ave St Paul MN 55108 363371887 501(c)3 5100 0 To support the social ministry of providing quality care to seniors. 2 0 Schedule I, Part I, Line 2 Due to the relatively low amounts of grants, the organization does not generally monitor the use of the grant funds. X 1 1 X X X X 0 1 0 0 0 1 1 0 0 Robert M Dahl President/CEO 346045 0 35963 0 6338 0 57895 0 16418 0 462659 0 34206 0 Ronald Sanford COO 213627 0 27405 0 3790 0 11442 0 16574 0 272838 0 272838 0 Kathy L Youngquist CFO 209945 0 22419 0 1729 0 38926 0 20926 0 293945 0 21949 0 Jeffrey Dagen V.P. Therapy Service 255827 0 27922 0 1290 0 64278 0 13197 0 362514 0 27847 0 Joan Graf Director of Accounting 108999 0 111547 0 600 0 17992 0 6477 0 245615 0 108875 0 Christine Eilertson Director of Finance 126899 0 4636 0 840 0 21717 0 18716 0 172808 0 4636 0 Angela Brown VP of Human Resources 119316 0 5900 0 5416 0 20488 0 18574 0 169694 0 4359 0 Patricia Zahler Administrative Assistant 105096 0 13767 0 0 0 18839 0 24745 0 162447 0 13192 0 Jeffrey Wipf VP of Information Technology 124001 0 5926 0 4594 0 6745 0 20744 0 162010 0 4734 0 Schedule J, Part I, Line 1a A set percentage is paid to the officers of the organization to help cover the taxes on personal auto usage. This amount is treated as a taxable benefit. Schedule J, Part I, Line 4 Certain officers of the organization participate in a 457(f) Deferred Compensation Plan. For 2016 the amount of deferred compensation was as follows: Robert Dahl $43,751, Kathy Youngquist $27,278, Jeffrey Dagen $24,405, Joan Graf $8,089, Christine Eilertson $15,106, Angela Brown $14,160. Schedule J, Part I, Line 6 R Dahl, R Sanford, K Youngquist, J Graf, C Eilertson, A Brown & J Wipf accrued incentive bonuses at 12/31/2016 that were contingent of the combined net income of the organization and its related organizations. J Dagen & P Zahler accrued incentive bonuses at 12/31/2016 that were contingent of the net income of a separate division within the organization. A City of Princeton 416005471 000000000 2003-05-13 9000000 Moratorium Construction projects 0 0 0 B Cass County 456002205 000000000 2010-12-16 6300000 Facility Renovations and refinancing of old debt 0 0 0 C City of Milaca 416005370 000000000 2011-04-28 1116522 Refinancing of 1996 issue 0 0 0 A 0 0 9000000 0 0 0 180000 0 0 8820000 0 0 2004 0 0 1 1 B 666977 0 6300000 0 0 0 126000 0 0 5507023 0 0 2012 1 0 1 1 C 1116522 0 1116522 0 0 0 0 0 0 0 0 0 2011 1 0 0 1 A 0 0 0 0 0 0 0 0 0 1 B 0 0 0 0 0 0 0 0 0 1 C 0 0 0 0 0 0 0 0 0 1 A 0 0 1 1 1 0 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 1 0 1 1 0 0 0 1 A 1 B 1 C 1 Schedule K, Part IV, Line 2c-05/13/2003 9,000,000 City of Princeton There were no investment earnings on any bond proceeds. No further calculations required. Schedule K, Part IV, Line 2c-12/16/2010 6,300,000 Cass County Rebate calculation done on 5/8/14. No rebate payable. No further calculations required. Schedule K, Part IV, Line 2c-04/28/2011 1,116,522 City of Milaca No calculation required. Shaun Seaburg Grandson-in-law of Board Member 86175 Wages 0 Form 990, Part VI, Section A, Line 6 Elim Care, Inc. is the sole member of Elim Homes, Inc. Form 990, Part VI, Section A, Line 7a Board Members of Elim Homes, Inc. are approved by the Elim Care, Inc. board. Form 990, Part VI, Section A, Line 7b Decisions of the Elim Homes, Inc. board are subject to approval by the Elim Care, Inc. board. Form 990, Part VI, Section B, Line 11b The Form 990 Tax Return and all related schedules were prepared by the Director of Finance. The Chief Financial Officer reviewed the return prior to signing. Board Members were able to review the From 990 prior to filing. Form 990, Part VI, Section B, Line 12c The organization annually requests a conflict of interest disclosure from each Board Member and officer. Also, annual questionnaires are sent out to get updates on new situations that may have arisen during the year. Form 990, Part VI, Section B, Line 15 The Board of Directors routinely retains the services of a compensation consultant to review the current wage and benefit levels of similar positions in similar organizations. The compensation committee uses this information to make a recommendation to the Board of Directors. Form 990, Part VI, Section C, Line 19 Governing documents, conflicts of interest policy and financial statements are generally not made available to the public. Form 990, Part XI, Line 9 Other Changes in Net Assets were as follows: $177,846 Contributions transferred from Elim Care, Inc. (a related organization); $(510,000) transfers to Elim Care Foundation (a related organization); $(7,000) transfer to Elim Care, Inc. (a related organization);$(34,174) Contribution Distributions Park Terrace Assisted Living Inc 7485 Office Ridge Circle Eden Prairie MN 55344 204063752 Senior Housing MN 501c3 9 N/A 0 New Harmony Care Center 7485 Office Ridge Circle Eden Prairie MN 55344 411821882 Nursing Home MN 501c3 9 N/A 0 Park View Care Center 7485 Office Ridge Circle Eden Prairie MN 55344 410855707 Nursing Home MN 501c3 9 N/A 0 Redeemer Residence Inc 7485 Office Ridge Circle Eden Prairie MN 55344 410711597 Nursing Home MN 501c3 9 N/A 0 Cornerstone Assisted Living of Plymouth Inc 7485 Office Ridge Circle Eden Prairie MN 55344 412013927 Senior Housing MN 501c3 9 N/A 0 Park Lane Apartments Inc 7485 Office Ridge Circle Eden Prairie MN 55344 410972384 Low Income Housing MN 501c3 9 N/A 0 Elim Children's Center Inc 7485 Office Ridge Circle Eden Prairie MN 55344 411974507 Child Daycare MN 501c3 9 N/A 0 Elim Care Inc 7485 Office Ridge Circle Eden Prairie MN 55344 411694818 Parent Company/Fundraising MN 501c3 7 N/A 0 Lake Ridge Care Center of Buffalo Inc 7485 Office Ridge Circle Eden Prairie MN 55344 200507069 Nursing Home/Senior Housing MN 501c3 9 N/A 0 Evangelical Retirement Homes Inc 7485 Office Ridge Circle Eden Prairie MN 55344 420868449 Nursing Home/Senior Housing IA 501c3 9 N/A 0 Elim Shores Inc 7485 Office Ridge Circle Eden Prairie MN 55344 411625095 Senior Housing MN 501c3 9 N/A 0 Newton Village Inc 7485 Office Ridge Circle Eden Prairie MN 55344 200044030 Senior Housing MN 501c3 9 N/A 0 Country Meadows of Milaca Inc 7485 Office Ridge Circle Eden Prairie MN 55344 201723948 Senior Housing MN 501c3 9 N/A 0 Pioneer House Assisted Living Inc 7485 Office Ridge Circle Eden Prairie MN 55344 411927112 Senior Housing MN 501c3 9 N/A 0 Village Assisted Living Inc 7485 Office Ridge Circle Eden Prairie MN 55344 262086933 Senior Housing MN 501c3 9 N/A 0 Elim Care Foundation 7485 Office Ridge Circle Eden Prairie MN 55344 411694817 Longterm Investing MN 501c3 11 N/A 0 Community Health Foundation of Wright County 7485 Office Ridge Circle Eden Prairie MN 55344 363546789 Fund Raising MN 501c3 7 N/A 0 Baptist Home Inc 7485 Office Ridge Circle Eden Prairie MN 55344 450232943 Nursing Home ND 501c3 9 N/A 0 The Baptist Apartments Inc 7485 Office Ridge Circle Eden Prairie MN 55344 450359794 Senior Housing ND 501c3 9 N/A 0 Haven Homes Inc 7485 Office Ridge Circle Eden Prairie MN 55344 416045816 Nursing Home/Senior Housing MN 501(c)3 9 N/A 0 Elim Senior Housing Inc 7485 Office Ridge Circle Eden Prairie MN 55344 810754064 Senior Housing MN 501(c)3 9 N/A 0 Elim Preferred Services Inc 7485 Office Ridge Circle Eden Prairie MN 55344 411681856 Medical Equipment and Supplies Sales MN N/A C 0 Preferred Senior Services Inc 7485 Office Ridge Circle Eden Prairie MN 55344 411942480 Management Services MN N/A C 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 0 1 1 1 Redeemer Residence Inc l 767584 Book Value Park View Care Center l 925974 Book Value