2015-08-13T14:28:12-05:00 2014-09-30 411765929 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2013-10-01 410878215 ST OLAF RESIDENCE INC STOL 6125226561 2912 FREMONT AVENUE NORTH MINNEAPOLIS MN 55411 REV DALE HULME TREASURER 6125226561 2015-08-12 1 KIM HUNWARDSEN CPA P00484560 6122536500 2015-08-12 2013 2016-02-25 16:41:14Z MARY ANN HAMER 2912 FREMONT AVENUE NORTH MINNEAPOLIS MN 55411 7493326 0 X WWW.STOLAFCOMMUNITIES.ORG X 1962 MN LONG TERM CARE AND ASSISTED LIVING. 9 8 185 30 0 0 1286 8123 7255882 7441271 4893 8015 -16987 -29432 7245074 7427977 0 0 0 0 3738809 3848316 0 0 0 3768369 3837984 7507178 7686300 -262104 -258323 4385832 4341596 4817083 5085871 -431251 -744275 X DRAWING UPON OUR CHRISTIAN HERITAGE, THE MISSION OF ST. OLAF RESIDENCE IS TO PROVIDE QUALITY HOUSING, HEALTH CARE AND SUPPORTIVE SERVICES WITH DIGNITY AND RESPECT TO THOSE WHO NEED THEM.UNDER THE LEADERSHIP OF THE BOARD OF DIRECTORS, WE WILL BE FINANCIALLY SOUND, USE OUR BUILDINGS AND LAND TO THE BENEFIT OF THOSE WE SERVE, DEVELOP PARTNERSHIPS TO STRENGTHEN THE COMMUNITY, HAVE A STRONG DEVELOPMENT PROGRAM, AND CONTINUALLY RECOGNIZE OUR STAFF AS AN ASSET. IN THIS WAY, WE WILL IMPROVE THE QUALITY OF LIFE FOR THOSE WE SERVE THROUGH MEASURABLE STANDARDS. 0 0 6931547 0 7441271 ST. OLAF RESIDENCE, INC. (ST. OLAF) PROVIDES QUALITY HOUSING, HEALTH CARE, AND SUPPORTIVE SERVICES WITH DIGNITY AND RESPECT TO THOSE WHO NEED THEM. UNDER THE LEADERSHIP OF THE VOLUNTEER BOARD OF DIRECTORS, ST. OLAF RESIDENCE, INC. OPERATES ST. OLAF RESIDENCE, A 80-BED SKILLED NURSING FACILITY AND NORTH OAKS ON EMERSON, AN ATTACHED 48-UNIT ASSISTED LIVING FACILITY. EACH FACILITY PROVIDES 24 HOUR CARE 7 DAYS A WEEK. THE SKILLED NURSING FACILITY PROVIDED 25,571 RESIDENT DAYS OF CARE FOR THIS FISCAL YEAR OF OCTOBER THROUGH SEPTEMBER 2014.NORTH OAKS ON EMERSON, OUR ASSISTED LIVING FACILITY, PROVIDED OVER $3,300.00 IN CHARITY CARE SERVICES TO THE CLIENTS RESIDING IN THE BUILDING. ST. OLAF'S DIETARY DEPARTMENT CATERS MEALS FOR THE NORTHSIDE MEALS ON WHEELS PROGRAM WHICH DISTRIBUTES, ON AVERAGE, 2,645 MEALS PER MONTH. THESE MEALS ARE DISTRIBUTED TO HOME-BOUND RESIDENTS WITHIN OUR COMMUNITY. 6931547 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 10 0 1 185 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 1 0 0 1 1 0 1 1 0 0 0 1 1 1 1 0 1 0 0 MN X MARY ANN HAMER 6125226561 2912 FREMONT AVENUE NORTH MINNEAPOLIS MN 55411 ED ENSTROM VICE PRESIDENT/PRESIDENT 2.00 1.00 X X 0 0 0 LINDA HALCON PRESIDENT (THRU MAY 2014) 2.00 0.00 X X 0 0 0 REV TIM SOLBERG BOARD MEMBER/VICE PRESIDENT 2.00 0.00 X X 0 0 0 WILLIAM KONRARDY SECRETARY 2.00 0.00 X X 0 0 0 REV DALE HULME TREASURER 2.00 40.00 X X 0 12975 27248 JOHN HEMP BOARD MEMBER (THRU DEC 2013) 1.00 0.00 X 0 0 0 SCOTT LIEN BOARD MEMBER 1.00 0.00 X 0 0 0 JOANN ULM BOARD MEMBER 1.00 0.00 X 0 0 0 ALMOND CLEMENS BOARD MEMBER (FROM JAN 2014) 1.00 0.00 X 0 0 0 SHIRLEY DAVIS BOARD MEMBER (FROM JAN 2014) 1.00 0.00 X 0 0 0 PAMELAR MCCLENDON BOARD MEMBER (FROM JAN 2014) 1.00 0.00 X 0 0 0 DAVID USELMAN ADMINISTRATOR 40.00 0.00 X 0 0 0 0 12975 27248 0 0 0 0 NEW HORIZON FOODS INC PO BOX 860246 MINNEAPOLIS MN 55486 DIETARY SERVICES 911995 REHABCARE GROUP INC 7733 FORSYTH BLVD ST LOUIS MO 63105 THERAPY SERVICES 282054 ECUMEN 3530 LEXINGTON AVENUE NORTH SHOREVIEW MN 55126 MANAGEMENT 245614 PATHWAY HEALTH SERVICES INC 2025 4TH STREET WHITE BEAR LAKE MN 55110 NURSING SERVICES 115766 4 8123 8123 RESIDENT SERVICE REVEN 623000 7208610 7208610 MEALS AT HOME REVENUE 624200 162912 162912 CAFETERIA REVENUE 624200 4131 4131 65618 65618 7441271 8015 8015 35917 65349 -29432 -29432 -29432 7427977 7441271 0 -21417 X 3304238 2916129 388109 18038 15630 2408 246342 213910 32432 279698 250479 29219 168333 168333 30971 30971 796443 751299 45144 18361 18361 556524 514857 41667 307565 307565 4025 4025 17984 7265 10719 231338 231338 282086 282086 67462 67462 FOOD 900721 900721 SURCHARGE 225398 225398 BAD DEBTS EXPENSE 142620 142620 88153 82402 5751 7686300 6931547 754753 0 48597 0 1087933 1441990 93775 41837 8561640 6290663 2485661 2270977 370573 355244 127041 74593 172252 156955 4385832 4341596 911607 1238044 19791 37929 3680000 3590000 44738 35767 78341 58986 4623 77983 125145 4817083 5085871 X -458497 -771521 27246 27246 -431251 -744275 4385832 4341596 -258323 -54701 0 X 0 1 X 1 0 X 72621 1741 1687 1286 8123 85458 6754609 6743560 6986120 7255882 7441271 35181442 6827230 6745301 6987807 7257168 7449394 35266900 0 184668 259010 87900 616872 191688 1340138 184668 259010 87900 616872 191688 1340138 33926762 64566 38680 15798 37640 43932 200616 64566 38680 15798 37640 43932 200616 6891796 6783981 7003605 7294808 7493326 35467516 0.95660 0.96950 0.00570 0.00520 X 0 1 X 361971 361971 5628966 4404933 1224033 2504210 1826857 677353 66493 58873 7620 2270977 CAPITALIZED LEASE OBLIGATIONS 59971 LINE OF CREDIT 65174 125145 X 7493326 0 7493326 -65349 -65349 7427977 7751649 65349 65349 7686300 0 7686300 PART IV, LINE 2B: THE ORGANIZATION HOLDS FUNDS IN TRUST ON BEHALF OF THE RESIDENTS. PART X, LINE 2: THE RESIDENCE 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). THE RESIDENCE IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE RESIDENCE IS SUBJECT TO INCOME TAX ON ANY NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE RESIDENCE 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. THE RESIDENCE 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: RENTAL EXPENSES RECORDED IN EXPENSE FOR FINANCIAL STATEMENTS -65,349. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES INCLUDED IN REVENUE FOR TAX RETURN 65,349. A CITY OF MINNEAPOLIS 416005375 603908NJ9 2005-07-06 4150000 REFINANCE BONDS ISSUED 10/6/1993 AND CAPITAL UPDATES. 0 0 0 A 560000 4140129 305409 80925 400000 3356910 2007 1 0 1 1 A 0 0 0 0 0.01400 0.00000 0.01400 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF MINNEAPOLIS DATE THE REBATE COMPUTATION WAS PERFORMED: 07/01/2010 SCHEDULE K, PART II, LINE 3 THE AMOUNT REPORTED HERE IS THE ISSUE PRICE OF $4,150,000 LESS THE ORIGINAL ISSUE DISCOUNT OF $9,871. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION ENGAGES ECUMEN, AN UNRELATED MANAGEMENT COMPANY, FOR SERVICES PROVIDED BY DAVID USELMAN, ADMINISTRATOR. THE ADMINISTRATOR SUPERVISES THE CLINICAL AND ADMINISTRATIVE AFFAIRS FOR THE CAMPUS. THE ADMINISTRATOR DEVELOPS AND IMPLEMENTS POLICIES AND PROCEDURES TO COMPLY WITH FEDERAL, STATE AND LOCAL REQUIREMENTS AND TO FULFILL LICENSURE CERTIFICATION STANDARDS. THE ADMINISTRATOR HIRES, MONITORS AND DIRECTS THE ACTIVITIES OF SEVERAL DEPARTMENT HEADS REPORTING TO THIS POSITION. THIS POSITION CONTINUOUSLY ANALYZES DEPARTMENTAL OPERATIONS, EVALUATES THE ENVIRONMENT AND EQUIPMENT NECESSARY FOR EFFECTIVE FUNCTIONING AND IMPLEMENTS ANY NECESSARY PROCEDURAL CHANGE. THE ADMINISTRATOR DEVELOPS AND ENSURES CONFORMANCE WITH THE ANNUAL BUDGET. THE ADMINISTRATOR CONFERS WITH MEDICAL DIRECTOR AND OTHER CONSULTANTS AS NECESSARY AND REPORTS TO THE BOARD AND MANAGEMENT PARTNER. COMPENSATION PAID BY ECUMEN DURING CALENDAR YEAR 2013 WAS: DAVID USELMAN - $114,517 HEALTH DIMENSIONS GROUP REPLACED ECUMEN IN THIS CAPACITY IN DECEMBER OF 2014. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION SHALL HAVE ONE CLASS OF MEMBERS CONSISTING OF THE VOTING MEMBERS OF ST. OLAF LUTHERAN CHURCH OF MINNEAPOLIS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF ST. OLAF COMMUNITY CAMPUS, INC. MAY CONSIDER A RESOLUTION TO PERMIT THE DIRECTORS OF ST. OLAF COMMUNITY CAMPUS, INC. TO ELECT THE DIRECTORS OF THE CORPORATION. IF THE RESOLUTION IS APPROVED, THE DIRECTORS OF ST. OLAF COMMUNITY CAMPUS, INC. WILL ELECT THE DIRECTORS OF THE CORPORATION. IF THE RESOLUTION IS NOT APPROVED, THE DIRECTORS OF THE CORPORATION SHALL BE NOMINATED BY THE BOARD OF DIRECTORS AND ELECTED BY A MAJORITY OF MEMBERS PRESENT AT A DULY HELD MEETING OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE DIRECTOR AND FINANCIAL SERVICES MANAGER, BOTH OF HEALTH DIMENSIONS GROUP, THE MANAGEMENT COMPANY, AND THE BOARD PRESIDENT WILL REVIEW THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE COVERED BY THE POLICY. ALL POTENTIAL CONFLICTS ARE TO BE REVEALED TO THE DIRECTORS AND COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS WILL CONSIDER THE POTENTIAL CONFLICT. AFTER ALL FACTS RELATED TO THE POTENTIAL CONFLICT HAVE BEEN DISCLOSED, THE PERSON WITH THE POTENTIAL CONFLICT MUST LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION ENGAGED WITH ECUMEN, A MANAGEMENT COMPANY, BEGINNING MAY OF 2011 FOR THE SERVICES PROVIDED BY THE ADMINISTRATOR. THE ORGANIZATION RELIES ON THE MANAGEMENT COMPANY TO DETERMINE THE ADMINISTRATOR'S COMPENSATION. THE CONTRACT WITH THE MANAGEMENT COMPANY IS APPROVED BY THE BOARD. HEALTH DIMENSIONS GROUP REPLACED ECUMEN IN THIS CAPACITY IN DECEMBER OF 2014. 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. FORM 990, PART IX, LINE 11G NURSING SERVICES: PROGRAM SERVICE EXPENSES 95,111. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 95,111. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 47,252. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,252. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 608,936. MANAGEMENT AND GENERAL EXPENSES 45,144. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 654,080. ST OLAF COMMUNITY CAMPUS INC 2912 FREMONT AVENUE NORTH MINNEAPOLIS MN 55411 411648596 SUPPORT OF EXEMPT ORGANIZATIONS MN 501(C)(3) 7 N/A 0 ST OLAF CAMPUS FOUNDATION INC 2912 FREMONT AVENUE NORTH MINNEAPOLIS MN 55411 410984619 SUPPORT AFFILIATED ORGANIZATIONS MN 501(C)(3) 11, TYPE II N/A 0 ST OLAF LUTHERAN CHURCH 2901 EMERSON AVENUE NORTH MINNEAPOLIS MN 55411 410760822 CHURCH MN 501(C)(3) 1 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0