2016-01-28T14:03:24-06:00 2015-06-30 411765929 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2014-07-01 410870847 COMMUNITY MEMORIAL HOME AT OSAKIS MINNESOTA INCORPORATED COMM 3208592142 410 WEST MAIN STREET OSAKIS MN 56360 DAVID CARLSON ADMINISTRATOR 3208592142 2016-01-20 1 DEB NELSON CPA P01264758 6122536500 2016-01-20 2014 2016-04-25 22:37:26Z GALEON DAVID CARLSON 410 WEST MAIN STREET OSAKIS MN 56360 5175298 0 X WWW.GALEONMN.COM X 1961 MN TO PROVIDE THE ELDERLY, SICK AND INFIRMED WITH FACILITIES AND SERVICES TO MEET THEIR NEEDS. 9 8 189 51 19 0 200 308383 4830769 4772150 70867 94765 0 0 4901836 5175298 5300 2000 0 0 2876565 2860619 0 0 0 2108921 2208546 4990786 5071165 -88950 104133 8998861 8668980 5322996 4959446 3675865 3709534 X THE ORGANIZATION'S MISSION IS TO PROVIDE THOSE IN NEED OF OUR SERVICES WITH THE BEST QUALITY OF CARE THAT WE ARE CAPABLE OF WITHIN A CARING, COMFORTABLE AND SUPPORTIVE ENVIRONMENT; TO AFFORD EACH RESIDENT AND TENANT THE OPPORTUNITY TO ACHIEVE THE HIGHEST POSSIBLE QUALITY OF LIFE; AND TO OFFER ALL WHO PASS THROUGH OUR DOORS INCREASING OPPORTUNITY FOR WELLNESS, CHOICE, PRIVACY, DIGNITY, AND SERVICE ACCESS AND AFFORDABILITY. 0 1 4471190 2000 4772150 COMMUNITY MEMORIAL HOME AT OSAKIS, MINNESOTA, INCORPORATED, D/B/A GALEON (GALEON) OWNS AND OPERATES A 50-BED LICENSED NURSING FACILITY AND A WELLNESS AND THERAPY CENTER, AS WELL AS A 20-UNIT INDEPENDENT LIVING FACILITY (TERRACE HEIGHTS), A 25-UNIT ASSISTED LIVING FACILITY (WEST VIEW) AND A 20-UNIT MEMORY CARE ASSISTED LIVING FACILITY (BRIDGEWELL). GALEON COVERAGE, LLC (GALEON LLC), A MINNESOTA LIMITED LIABILITY COMPANY FORMED ON SEPTEMBER 1, 2011, IS ORGANIZED FOR THE PURPOSE OF PROVIDING LONG-TERM CARE INSURANCE IN THE OSAKIS AND SURROUNDING AREAS. GALEON EXECUTED A LOANED EMPLOYEE AGREEMENT WITH GALEON COVERAGE, LLC TO PROVIDE CONTRACTED SERVICES ON BEHALF OF GALEON, LLC BY ONE OR MORE EMPLOYEES OF GALEON. GALEON IS THE SOLE MEMBER OF GALEON, LLC. GALEON COVERAGE, LLC WAS FULLY DISSOLVED IN FEBRUARY 2015. IN ADDITION, COMMUNITY MEMORIAL HOME MANAGES THE OPERATION OF OSAKIS COMMUNITY MANOR APARTMENTS THAT DEDICATES 24 UNITS OF HOUSING TO INDEPENDENT SENIORS, MOST OF WHOM QUALIFY FOR RENTAL ASSISTANCE. THROUGHOUT THESE VARIOUS LOCATIONS, WHICH ARE EITHER CONNECTED TO OR IN CLOSE PROXIMITY TO COMMUNITY MEMORIAL HOME, PROGRAMS HAVE BEEN DEVELOPED TO ASSIST OLDER ADULTS WITH PHYSICAL CARE, REHABILITATION, NUTRITION, STRENGTH RESTORATION, MOBILITY, AND MEDICATION MANAGEMENT. ADDITIONAL SERVICES SUPPORTING THESE CORE PROGRAMS ARE IN PLACE TO FOSTER EACH RESIDENT'S SOCIAL, EMOTIONAL, MENTAL, SPIRITUAL, AND VOCATIONAL GROWTH AND DEVELOPMENT. 4471190 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 0 1 11 0 1 189 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 0 1 1 0 0 MN X DAVID CARLSON 3208592142 410 WEST MAIN STREET OSAKIS MN 56360 NEIL JOHNSON PRESIDENT 2.00 0.10 X X 0 0 0 GEORGIA THESING VICE PRESIDENT 2.00 0.10 X X 0 0 0 JIM BACKES TREASURER 2.00 0.10 X X 0 0 0 JOHN TEMPLE SECRETARY 2.00 0.10 X X 0 0 0 JAN MOORE BOARD MEMBER 2.00 0.10 X 0 0 0 DON LARSEN BOARD MEMBER 2.00 0.10 X 0 0 0 IVY NOMELAND BOARD MEMBER 2.00 0.10 X 0 0 0 SANDRA BENSON BOARD MEMBER 2.00 0.10 X 0 0 0 BERNIE KOSTRZEWSKI BOARD MEMBER 2.00 0.10 X 0 0 0 DAVID CARLSON ADMINISTRATOR/CEO 40.00 2.00 X 103688 0 24119 103688 0 24119 1 0 0 0 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 729028103 THERAPY SERVICES 314642 RJ MECHANICAL PO BOX 373 MORA MN 55051 CONTRACTOR 271000 2 308383 308383 RESIDENT SERVICE REV. 623110 4662763 4662763 WELLNESS INCOME 900099 73235 73235 OTHER REVENUE 900099 36152 36133 19 4772150 46734 46734 48031 0 48031 48031 48031 5175298 4772131 19 94765 2000 2000 132336 132336 38296 38296 2217319 2090622 126697 48567 46511 2056 251055 247093 3962 173046 155980 17066 8419 8419 64753 64753 390477 382333 8144 58810 58810 244352 206535 37817 38780 19734 19046 248895 248895 56386 56386 16524 16524 156055 156055 449321 449321 33608 33608 FOOD 183737 183737 CAPITAL ALLOWANCE ADJUS 140750 140750 BAD DEBT EXPENSE 34390 34390 LICENSES AND REGISTRATI 9264 9264 74025 35330 38695 5071165 4471190 599975 0 783119 438683 36153 291587 384450 18816 29946 10912777 5848736 5136544 5064041 2505713 2526989 263082 188718 8998861 8668980 504133 460196 4627758 4375706 31868 40206 159237 83338 5322996 4959446 X 3675865 3709534 3675865 3709534 8998861 8668980 104133 -70464 0 X 0 1 X 1 0 X 1055 245 1085 200 308383 310968 5465252 5141598 5078526 4830715 4772150 25288241 5466307 5141843 5079611 4830915 5080533 25599209 0 101938 200739 195441 289529 284019 1071666 101938 200739 195441 289529 284019 1071666 24527543 35355 39058 49457 59571 46734 230175 35355 39058 49457 59571 46734 230175 5501662 5180901 5129068 4890486 5127267 25829384 0.94960 0.95550 0.00890 0.00890 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 8756290 4125465 4630825 1941759 1589474 352285 214728 133797 80931 5064041 WORKERS' COMPENSATION INSURANCE LIABILITY 83338 83338 X 5104834 -70464 -70464 5175298 0 5175298 5071165 0 5071165 0 5071165 PART IV, LINE 2B: GALEON ACTS AS A CUSTODIAN FOR THE FUNDS OF THE RESIDENTS AND HOLDS TENANT SECURITY DEPOSITS. RESIDENT TRUST FUNDS AND TENANT SECURITY DEPOSITS TOTALED $40,206 AS OF JUNE 30, 2015. PART X, LINE 2: GALEON IS ORGANIZED AS A MINNESOTA NOT-FOR-PROFIT 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). GALEON COVERAGE, LLC MAINTAINED EXEMPT STATUS UNDER GALEON'S EXEMPTION SINCE GALEON IS THE SOLE MEMBER OF GALEON COVERAGE, LLC. GALEON COVERAGE, LLC DISSOLVED IN FEBRUARY 2015. GALEON IS REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS ANNUALLY. IN ADDITION, GALEON IS SUBJECT TO INCOME TAX ON ANY NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. GALEON HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990-T) WITH THE IRS. GALEON 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 FINANCIAL STATEMENTS. GALEON 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. A CITY OF OSAKIS MINNESOTA 416005443 2007-05-15 5878537 CONSTRUCTION PROJECT & REFUND 2002 REVENUE BONDS ISSUED 4-29-2002 0 0 0 A 1502831 5878537 3500000 2378537 2008 1 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 SUSAN MCCAUGHN SISTER OF BOARD PRESIDENT NEIL JOHNSON 38296 COMPENSATION 0 FORM 990, PART III, LINE 3 GALEON COVERAGE, LLC WAS FULLY DISSOLVED IN FEBRUARY 2015. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS TWO CLASSES OF MEMBERS. A PERSON WHO HAS CONTRIBUTED $100 OR MORE IS A LIFETIME MEMBER. A PERSON WHO HAS CONTRIBUTED $25 IS ENTITLED TO A ONE-YEAR MEMBERSHIP. ANYONE WHO HAS PAID AN ANNUAL MEMBERSHIP FOR FOUR YEARS BECOMES A LIFETIME MEMBER WHEN THE FOURTH PAYMENT HAS BEEN MADE. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S BOARD OF DIRECTORS IS ELECTED BY ITS MEMBERS AT THE ANNUAL MEETING. EACH MEMBER RECEIVES ONE VOTE. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS REVIEWED BY THE BUSINESS MANAGER AND ADMINISTRATOR PRIOR TO FILING. THE RETURN IS THEN SENT TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE ANNUALLY COMPLETES A CONFLICT OF INTEREST FORM. DISCLOSURES REGARDING ANY POTENTIAL CONFLICTS OF INTEREST ARE SUBMITTED TO THE ADMINISTRATOR. THE ADMINISTRATOR REVIEWS AND DETERMINES IF A CONFLICT OF INTEREST DOES EXIST. IF THERE IS A CONFLICT,THE INDIVIDUAL WILL REMOVE HIMSELF OR HERSELF FROM THE DISCUSSION AND/OR VOTING ON RELATED MATTERS. FORM 990, PART VI, SECTION B, LINE 15A THE ADMINISTRATOR'S PERFORMANCE AND COMPENSATION (INCLUDING BENEFITS) IS MONITORED BY THE BOARD OF DIRECTOR'S EXECUTIVE COMMITTEE. CONCERNS ARE SHARED WITH THE ENTIRE BOARD OF DIRECTORS AT REGULAR MONTHLY MEETINGS. THE BOARD MAINTAINS AN AWARENESS OF ADMINISTRATOR COMPENSATION IN RELATIONSHIP TO COMPARATIVE DATA GATHERED FROM AGING SERVICES OF MN AND SELECTED REGIONAL LONG-TERM CARE ORGANIZATIONS. ALTHOUGH HE/SHE WILL RECEIVE THE SAME WAGE INCREASES THAT ARE AFFORDED THE GENERAL STAFF OF GALEON, THE ADMINISTRATOR'S SALARY AND BENEFITS ARE REVIEWED AND ADJUSTED, AS NECESSARY, WHEN COMPARATIVE COMPENSATION ISSUES ARISE. SUCH ISSUES WILL BE BROUGHT TO THE ATTENTION OF THE EXECUTIVE COMMITTEE BY THE ADMINISTRATOR FOR CONSIDERATION BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE NOT AVAILABLE TO THE GENERAL PUBLIC. GALEON COVERAGE LLC 410 WEST MAIN STREET OSAKIS MN 56360 452848035 SELLING LONG-TERM CARE INSURANCE MN 19 0 COMMUNITY MEMORIAL HOME AT OSAKIS MINNESOTA OSAKIS COMMUNITY MANOR 410 W MAIN STREET OSAKIS MN 56360 411344854 LOW INCOME HOUSING MN 501(C)(4) N/A COMMUNITY MEMORIAL HOME OF OSAKIS MINNESOTA 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0