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COMMUNITY MEMORIAL HOME AT OSAKIS MINN INCORPORATED: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY MEMORIAL HOME AT OSAKIS MINN INCORPORATED (EIN 41-0870847)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-03-03
IRS object ID
201440629349301009
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-03-03T15:51:29-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN411765929EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1800 NICOLLET MALL STE 1300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code554027033ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN410870847EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HOME AT OSAKISBusinessNameLine1
Business Name Line2MINNESOTA INCORPORATEDBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlCOMMNameControl
Phone3208592142Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1410 WEST MAIN STREETAddressLine1
CityOSAKISCity
StateMNState
ZIP Code56360ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDAVID CARLSONName
TitleADMINISTRATORTitle
Phone3208592142Phone
Date Signed2014-02-18DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKIM HUNWARDSEN CPAName
PTINP00484560PTIN
Phone6122536500Phone
Date Prepared2014-02-18DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1GALEONBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAVID CARLSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1410 WEST MAIN STREETAddressLine1
CityOSAKISCity
StateMNState
ZIP Code56360ZIPCode
FieldValueIRS element (for citing)
Gross Receipts6457897GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.GALEONMN.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1961YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE THE ELDERLY, SICK AND INFIRMED WITH FACILITIES AND SERVICES TO MEET THEIR NEEDS.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees190TotalNbrEmployees
Total Nbr Volunteers52TotalNbrVolunteers
Total Gross UBI1307TotalGrossUBI
Net Unrelated Business Txbl Income-2026NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year245ContributionsGrantsPriorYear
Contributions Grants Current Year1085ContributionsGrantsCurrentYear
Program Service Revenue Prior Year5142881ProgramServiceRevenuePriorYear
Program Service Revenue CY5079833ProgramServiceRevenueCY
Investment Income Prior Year42709InvestmentIncomePriorYear
Investment Income Current Year105073InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year5185835TotalRevenuePriorYear
Total Revenue Current Year5185991TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year3800GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY3600GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year2966343SalariesEtcPriorYear
Salaries Etc Current Year2836980SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year2372026OtherExpensePriorYear
Other Expenses Current Year2246466OtherExpensesCurrentYear
Total Expenses Prior Year5342169TotalExpensesPriorYear
Total Expenses Current Year5087046TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-156334RevenuesLessExpensesPriorYear
Revenues Less Expenses CY98945RevenuesLessExpensesCY
Total Assets BOY9139805TotalAssetsBOY
Total Assets EOY9025328TotalAssetsEOY
Total Liabilities BOY5599470TotalLiabilitiesBOY
Total Liabilities EOY5397698TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY3540335NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY3627630NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense4596215Expense
Grants3600Grants
Revenue5079833Revenue
DescriptionCOMMUNITY MEMORIAL HOME AT OSAKIS, MINNESOTA, INCORPORATED, D/B/A GALEON (GALEON) OWNS AND OPERATES A 52-BED LICENSED NURSING FACILITY AND A WELLNESS AND THERAPY CENTER, AS WELL AS A 20-UNIT ASSISTED 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.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.Description
Total Program Service Expense4596215TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10968NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees190NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DAVID CARLSONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3208592142TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1410 WEST MAIN STREETAddressLine1
CityOSAKISCity
StateMNState
ZIP Code56360ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (10 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
NEIL JOHNSON
PRESIDENT2.000.10XX000
GEORGIA THESING
VICE PRESIDENT2.000.10XX000
JIM BACKES
TREASURER2.000.10XX000
JOHN TEMPLE
SECRETARY2.000.10XX000
JAN MOORE
BOARD MEMBER2.000.10X000
RON CALVERT
BOARD MEMBER2.000.10X000
RAY MARTHALER
BOARD MEMBER2.000.10X000
DON LARSEN
BOARD MEMBER2.000.10X000
IVY NOMELAND
BOARD MEMBER2.000.10X000
DAVID CARLSON
ADMINISTRATOR/CEO40.002.00X90361018046
FieldValueIRS element (for citing)
Total Reportable Comp From Org90361TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation18046TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1AEGIS THERAPIES INCBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 8103AddressLine1
CityFORT SMITHCity
StateARState
ZIP Code729028103ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesTHERAPY SERVICESDescriptionOfServices
Compensation254010Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions1085AllOtherContributions
Total Contributions1085TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
RESIDENT SERVICE REV.62311049552504955250
WELLNESS INCOME9000997899978999
OTHER REVENUE90009945584442771307
FieldValueIRS element (for citing)
Total Program Service Revenue5079833TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column49457TotalRevenueColumn
Exclusion$49,457ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1327522Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1271906Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities55616Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column55616TotalRevenueColumn
Exclusion$55,616ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column5185991TotalRevenueColumn
Related Or Exempt Function Income5078526RelatedOrExemptFunctionIncome
Unrelated Business Revenue1307UnrelatedBusinessRevenue
Exclusion$105,073ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total3600Total
Program Services3600ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total111587Total
Management And General111587ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total55565Total
Program Services55565ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total2184653Total
Program Services2031845ProgramServices
Management And General152808ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total52515Total
Program Services49719ProgramServices
Management And General2796ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total236949Total
Program Services227722ProgramServices
Management And General9227ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total195711Total
Program Services175229ProgramServices
Management And General20482ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total3525Total
Management And General3525ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total27060Total
Management And General27060ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total353769Total
Program Services346856ProgramServices
Management And General6913ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total32034Total
Management And General32034ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total550428Total
Program Services512455ProgramServices
Management And General37973ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total37925Total
Management And General37925ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total234598Total
Program Services234598ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total12081Total
Management And General12081ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total9387Total
Management And General9387ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total172869Total
Program Services172869ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total508048Total
Program Services508048ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total53690Total
Program Services53690ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
CAPITAL ALLOWANCE ADJUS146380146380
BAD DEBT EXPENSE5027350273
PRE-ADMISSION SCREENING1575515755
LICENSES AND REGISTRATI91489148

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total29496Total
Program Services11611ProgramServices
Management And General17885ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total5087046Total
Program Services4596215ProgramServices
Management And General490831ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY756138BOY
EOY853625EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY415205BOY
EOY289045EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY35201BOY
EOY26347EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis10317142LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4956375LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5840600BOY
EOY5360767EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1981655BOY
EOY2321856EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY111006BOY
EOY173688EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9139805BOY
EOY9025328EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY467542BOY
EOY431522EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY5106509BOY
EOY4871270EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY25419BOY
EOY31406EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY63500EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY5599470BOY
EOY5397698EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3540335BOY
EOY3627630EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY3540335BOY
EOY3627630EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9139805BOY
EOY9025328EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses98945ReconcilationRevenueExpenses
Reconciliation Unrealized Invest-11650ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years64558CurrentTaxYearMinus4Years
Current Tax Year Minus2 Years1055CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year245CurrentTaxYearMinus1Year
Current Tax Year1085CurrentTaxYear
Total66943Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5505269CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5260246CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5465252CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5141598CurrentTaxYearMinus1Year
Current Tax Year5078526CurrentTaxYear
Total26450891Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5569827CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5260246CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5466307CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5141843CurrentTaxYearMinus1Year
Current Tax Year5079611CurrentTaxYear
Total26517834Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years113698CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years137466CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years101938CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year200739CurrentTaxYearMinus1Year
Current Tax Year195441CurrentTaxYear
Total749282Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years113698CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years137466CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years101938CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year200739CurrentTaxYearMinus1Year
Current Tax Year195441CurrentTaxYear
Total749282Total
FieldValueIRS element (for citing)
Public Support Total50925768552PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years81484CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years48239CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years35355CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year39058CurrentTaxYearMinus1Year
Current Tax Year49457CurrentTaxYear
Total253593Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years81484CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years48239CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years35355CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year39058CurrentTaxYearMinus1Year
Current Tax Year49457CurrentTaxYear
Total253593Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years5651311CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5308485CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years5501662CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5180901CurrentTaxYearMinus1Year
Current Tax Year5129068CurrentTaxYear
Total26771427Total
FieldValueIRS element (for citing)
Public Support Percentage5090.96250PublicSupportPercentage509
Prior Year Support Percentage0.95760PriorYearSupportPercentage
Investment Income Percentage0.00950InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.01180PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS
Explanation In Part XIIIXExplanationInPartXIII

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis19972OtherCostOrOtherBasis
Book Value19972BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis8390011OtherCostOrOtherBasis
Depreciation3445761Depreciation
Book Value4944250BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1716403OtherCostOrOtherBasis
Depreciation1414502Depreciation
Book Value301901BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis190756OtherCostOrOtherBasis
Depreciation96112Depreciation
Book Value94644BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings5360767TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionWORKERS' COMPENSATION INSURANCE LIABILITYDescription
Amount$63,500Amount
FieldValueIRS element (for citing)
Total Of Amounts63500TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt5174341TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-11650NetUnrealizedGainsInvestments
Revenue Not Rptd F990-11650RevenueNotRptdF990
Revenue Subtotal5185991RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9905185991TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt5087046TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal5087046ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9905087046TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
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 $31,406 AS OF JUNE 30, 2013.
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 MAINTAINS EXEMPT STATUS UNDER GALEON'S EXEMPTION SINCE GALEON IS THE SOLE MEMBER OF GALEON COVERAGE, LLC. 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 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.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF OSAKIS MINNESOTABusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN416005443IssuerEIN
Date Issued2007-05-15DateIssued
Issue Price5878537IssuePrice
Description Of PurposeCONSTRUCTION PROJECT & REFUND 2002 REVENUE BONDS ISSUED 4-29-2002DescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired1007267AmountRetired
Total Proceeds5878537TotalProceeds
Capital Expenditures3500000CapitalExpenditures
Other Spent Proceeds2378537OtherSpentProceeds
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs0NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiled
Rebate Not Due Yet0RebateNotDueYet
Exception To Rebate1ExceptionToRebate
No Rebate Due0NoRebateDue
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs0WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective Action0ProcToUndertkCorrectiveAction

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonSUSAN MCCAUGHNNamePerson
FieldValueIRS element (for citing)
RelationshipSISTER OF BOARD PRESIDENT NEIL JOHNSONRelationship
Amount Of Transaction55565AmountOfTransaction
Description Of TransactionCOMPENSATIONDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanation
FORM 990, PART VI, SECTION A, LINE 6THE 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 7ATHE 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 8BTHERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD.
FORM 990, PART VI, SECTION B, LINE 11THE 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 12CEACH 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.
THE ADMINISTRATOR'S COMPENSATION IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE DISCUSSION AND APPROVAL OF COMPENSATION IS RECORDED IN THE BOARD MINUTES. AS THE ADMINISTRATOR RECEIVES THE SAME PERCENTAGE INCREASE IN SALARY AS ALL OTHER STAFF, COMPARABILITY DATA IS NOT GATHERED OUTSIDE OF THE ORGANIZATION.
FORM 990, PART VI, SECTION C, LINE 19THESE DOCUMENTS ARE NOT AVAILABLE TO THE GENERAL PUBLIC.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1GALEON COVERAGE LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1410 WEST MAIN STREETAddressLine1
CityOSAKISCity
StateMNState
ZIP Code56360ZIPCode
FieldValueIRS element (for citing)
EIN452848035EIN
Primary ActivitiesSELLING LONG-TERM CARE INSURANCEPrimaryActivities
Legal Domicile StateMNLegalDomicileState
Total Income1307TotalIncome
EOY Assets0EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HOME AT OSAKIS MINNESOTABusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1OSAKIS COMMUNITY MANORBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1410 W MAIN STREETAddressLine1
CityOSAKISCity
StateMNState
ZIP Code56360ZIPCode
FieldValueIRS element (for citing)
EIN411344854EIN
Primary ActivitiesLOW INCOME HOUSINGPrimaryActivities
Legal Domicile StateMNLegalDomicileState
Exempt Code Section501(C)(4)ExemptCodeSection
Public Charity StatusN/APublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HOME OF OSAKIS MINNESOTABusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org1ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg