2023-11-03T11:13:11-05:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2022-01-01 410838344 MOUNT OLIVET HOME MOUN 6128275677 5517 LYNDALE AVENUE SOUTH MINNEAPOLIS MN 55419 TIMOTHY HOKANSON ADMINISTRATOR 6128275677 2023-10-23 1 TIMOTHY HOKANSON 999009999 0 JED CHENEY P01587750 6123764500 2023-10-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TIMOTHY HOKANSON 5517 LYNDALE AVENUE SOUTH MINNEAPOLIS MN 55419 11667781 0 X WWW.MTOLIVETHOMES.ORG X 1960 MN TO PROVIDE HIGH QUALITY LONG TERM CARE FOR RESIDENTS IN A LOVING AND CARING ENVIRONMENT. 14 14 193 20 0 0 467828 248284 9911034 11331213 44415 45589 46076 42695 10469353 11667781 55323 19255 0 0 6365652 6743010 0 0 0 3368398 3753127 9789373 10515392 679980 1152389 14203856 14333348 2623547 1981981 11580309 12351367 X TO PROVIDE HIGH QUALITY LONG TERM CARE FOR RESIDENTS IN A LOVING AND CARING ENVIRONMENT. 0 0 9970193 19255 11331213 MOUNT OLIVET HOME (MOH) IS A 92-BED SEMI-INDEPENDENT LIVING FACILITY FEATURING PRIVATE ROOMS WITH PRIVATE BATHROOMS. WE ALSO OFFER A SECURED MEMORY CARE UNIT FOR RESIDENTS COPING WITH THE EARLY STAGES OF MEMORY LOSS, ALZHEIMER'S AND OTHER DEMENTIA-RELATED ILLNESSES. RESIDENTS FURNISH THEIR ROOMS WITH FAVORITE POSSESSIONS. RESIDENTS ARE INDEPENDENT WITH ACTIVITIES OF DAILY LIFE, INCLUDING DRESSING, GROOMING, EATING, WALKING, TRANSFERRING AND TOILETING. ASSISTANCE WITH MEDICATION ADMINISTRATION AND BATHING IS AVAILABLE. ONSITE VISION, HEARING, DENTAL AND PODIATRY SERVICES ARE ALSO AVAILABLE. THREE NUTRITIOUS MEALS AND OTHER REFRESHMENTS ARE SERVED DAILY IN THE MAIN FLOOR DINING ROOM. RESIDENTS LIVING IN THE MEMORY CARE UNIT EAT IN A DINING ROOM LOCATED IN THE UNIT. FAMILY MEMBERS CAN ENJOY MEALS WITH THEIR LOVED ONE IN EITHER LOCATION. SPACIOUS LOUNGES, OUTDOOR PATIOS, AND PRIVATE FAMILY AREAS MAKE THE FACILITY FEEL LIKE HOME. 9970193 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 193 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 0 0 0 MN X X SHARON FLACK 6128275677 5517 LYNDALE AVENUE SOUTH MINNEAPOLIS MN 55419 KURT HALVA PRESIDENT 2.00 4.00 X X 0 0 0 CHRISTINE BENT VICE PRESIDENT 0.30 0.60 X X 0 0 0 GORDON VETSCH TREASURER 0.30 0.60 X X 0 0 0 RUTH JARCHO SECRETARY 0.30 0.60 X X 0 0 0 MARTHA ARNESON BOARD MEMBER 0.30 0.60 X 0 0 0 MARK BEESE BOARD MEMBER 0.30 0.60 X 0 0 0 DAVID CARLSON BOARD MEMBER 0.30 0.60 X 0 0 0 EILEEN CARTWRIGHT BOARD MEMBER 0.30 0.60 X 0 0 0 JOHN KUEHN BOARD MEMBER 0.30 0.60 X 0 0 0 DAVID LOSE BOARD MEMBER 0.30 0.60 X 0 0 0 TRUDY OLSON BOARD MEMBER 0.30 0.60 X 0 0 0 GREG PAGE BOARD MEMBER 0.30 0.60 X 0 0 0 WILLIAM TELLEEN BOARD MEMBER 0.30 0.60 X 0 0 0 PETER YOUNGDAHL BOARD MEMBER 0.30 0.60 X 0 0 0 TIMOTHY HOKANSON ADMINISTRATOR 1.00 39.00 X 0 201471 53942 SHARON FLACK CONTROLLER 1.00 39.00 X 0 154214 11304 SAMUEL TARR REGISTERED NURSE 40.00 0.00 X 120156 0 2403 WILSON OBUNGA NURSE MANAGER 40.00 0.00 X 115292 0 21087 235448 355685 88736 2 0 1 0 0 220961 27323 248284 RESIDENT SERVICES 623000 9231519 9231519 DIETARY INCOME 623000 2099694 2099694 11331213 45589 45589 28878 0 28878 28878 28878 MISC INCOME 900099 10289 10289 CAFETERIA & GUEST MEALS 722514 3646 3646 BEAUTY SHOP REIMBURSEMENT 900099 -118 -118 13817 11667781 11331213 0 88284 19255 19255 5612009 5525726 86283 66600 61879 4721 604887 561000 43887 459514 426942 32572 8307 8307 38871 38871 869704 775162 94542 34111 34111 26587 26587 64533 64533 209863 209863 59449 59449 505316 505316 138146 138146 FOOD 1331054 1331054 PROGRAM SUPPLIES 313317 313317 MISCELLANEOUS 95513 95513 LICENSES 27577 27577 30779 15507 15272 10515392 9970193 545199 0 3196309 2464087 2513220 3746535 37291 40332 13266090 7020815 6282440 6245275 2056221 1711434 118375 125685 14203856 14333348 671815 463710 1918064 1476203 33668 42068 2623547 1981981 X 11494917 12349572 85392 1795 11580309 12351367 14203856 14333348 1152389 -381331 0 X X 0 1 X 1 0 X 29871 32235 533196 467828 248284 1311414 8285900 9745157 9670760 9911034 11331213 48944064 16476 20429 16623 12090 10216 75834 8332247 9797821 10220579 10390952 11589713 50331312 0 997202 933178 683921 1011246 1031062 4656609 997202 933178 683921 1011246 1031062 4656609 45674703 50963 76301 72460 78171 74467 352362 50963 76301 72460 78171 74467 352362 386 350 220 230 10289 11475 8383596 9874472 10293259 10469353 11674469 50695149 0.90100 0.89890 0.00700 0.00670 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 185074 185074 10651977 5327580 5324397 129297 28822 100475 2299742 1664413 635329 6245275 X PART IV, LINE 2B: THE ORGANIZATION IS THE TRUSTEE OF VARIOUS RESIDENT FUNDS AND HAS A FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION AND DISTRIBUTION OF THESE FUNDS FOR THE RESIDENTS. THESE FUNDS ARE ON DEPOSIT IN A SEPARATE BANK ACCOUNT. PART X, LINE 2: THE INTERNAL REVENUE SERVICE HAS CLASSIFIED THE ENTITIES AS TAX-EXEMPT ORGANIZATIONS UNDER THE PROVISIONS OF INTERNAL REVENUE CODE SECTION 501(C)(3). THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES IN EVALUATING UNCERTAIN TAX POSITIONS. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER ITEMS. 1 TUITION REIMBURSEMENT 5 14255 SCHOLARSHIPS 5 5000 PART I, LINE 2: THE SCHOLARSHIPS AND TUITION REIMBURSEMENT PROGRAMS ARE AWARDED ANNUALLY THROUGH A PROGRAM ESTABLISHED BY THE ORGANIZATION'S DEVELOPMENT AND HUMAN RESOURCE TEAM. SCHOLARSHIP AND TUITION REIMBURSEMENT RECIPIENTS ARE REQUIRED TO PROVIDE RECEIPTS TO DOCUMENT APPROPRIATE USE OF FUNDS. 0 0 0 0 0 0 0 0 0 TIMOTHY HOKANSON ADMINISTRATOR 0 178055 0 3226 0 20190 0 0 0 53942 0 255413 0 0 SHARON FLACK CONTROLLER 0 135614 0 3291 0 15309 0 0 0 11304 0 165518 0 0 PART I, LINE 3 THE ADMINISTRATOR'S COMPENSATION IS DETERMINED BY MOUNT OLIVET CAREVIEW HOME. THE FOLLOWING WERE USED BY MOUNT OLIVET CAREVIEW HOMES IN DETERMINING THE ADMINISTRATOR'S COMPENSATION: 1. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE A CITY OF ST LOUIS PARK MINNESOTA 416005519 791748FL5 2016-04-29 4335000 REFUNDING SERIES 2011 AND 2006 PRIOR ISSUE. 0 0 0 A 2815000 4335000 65025 4269975 2016 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CONSISTS OF THE PRESIDENT, VICE PRESIDENT, TREASURER AND SECRETARY OF THE BOARD OF DIRECTORS. OTHER PERSONS MAY BE ELECTED OR APPOINTED BY THE BOARD, BUT UNDER NO CIRCUMSTANCES MAY THE EXECUTIVE COMMITTEE EXCEED SEVEN MEMBERS. THE EXECUTIVE COMMITTEE, IN THE INTERIM BETWEEN MEETINGS OF THE BOARD, EXERCISES THE POWERS OF THE BOARD IN ACCORDANCE WITH THE GENERAL POLICY OF THE ORGANIZATION AND THE BOARD. THE EXECUTIVE COMMITTEE IS SUBJECT AT ALL TIMES TO THE DIRECTION AND CONTROL OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE OPTION TO VIEW A DRAFT 990 IS PROVIDED TO SELECT REPRESENTATIVES OF THE BOARD OF DIRECTORS FOR DETAIL REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C DEPARTMENT HEADS ARE REQUIRED TO COMPLETE AN ANNUAL STATEMENT THAT INCLUDES A DUTY TO DISCLOSE. DEPARTMENT HEADS MUST DISCLOSE THE EXISTENCE OF ANY POTENTIAL CONFLICT OF INTEREST AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE ADMINISTRATOR. THE ADMINISTRATOR WILL REPORT MATERIAL FACTS TO THE BOARD OF DIRECTORS OR THE BOARD EXECUTIVE COMMITTEE FOR DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS. INDIVIDUALS WITH POTENTIAL CONFLICTS OF INTEREST MAY NOT BE PRESENT DURING THE DISCUSSION NOR VOTE ON THE TRANSACTION OR ARRANGEMENT WHERE A CONFLICT EXISTS. THE MINUTES OF THE BOARD OF DIRECTORS OR BOARD EXECUTIVE COMMITTEE WILL RECORD ALL PROCEEDINGS RELATED TO CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE PROCESS OF SELECTING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. MOUNT OLIVET HOME FOUNDATION LLC 5025 KNOX AVE S MINNEAPOLIS MN 55419 FOUNDATION MN 38330 1711434 MOUNT OLIVET HOME MOUNT OLIVET CAREVIEW HOME 5517 LYNDALE AVENUE SOUTH MINNEAPOLIS MN 55419 410802697 SKILLED NURSING FACILITY MN 501(C)(3) LINE 10 SEE SCHEDULE R PART VII 1 MOUNT OLIVET DAY SERVICES 5601 LYNDALE AVENUE SOUTH MINNEAPOLIS MN 55419 411785649 CHILD & ADULT DAYCARE MN 501(C)(3) LINE 10 SEE SCHEDULE R PART VII 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 MOUNT OLIVET CAREVIEW HOME Q 2061825 ACTUAL COST MOUNT OLIVET DAY SERVICES Q 37887 ACTUAL COST MOUNT OLIVET CAREVIEW HOME P 264143 ACTUAL COST MOUNT OLIVET DAY SERVICES J 4878 ACTUAL COST SCHEDULE R, PART II MOUNT OLIVET CAREVIEW HOME, MOUNT OLIVET HOME, AND MOUNT OLIVET DAY SERVICES EACH HAVE IDENTICAL BOARDS OF DIRECTORS. ALTHOUGH NONE OF THE ORGANIZATIONS' BYLAWS GIVES ONE ORGANIZATION CONTROL OVER THE OTHERS, EACH ORGANIZATION MEETS THE IRS' DEFINITION OF CONTROL FOR BOTH OF THE OTHER ORGANIZATIONS.