2024-09-25T14:47:01-05:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2023-01-01 410802697 MOUNT OLIVET CAREVIEW HOME MOUN 6128275677 5517 LYNDALE AVENUE SOUTH MINNEAPOLIS MN 55419 TIMOTHY HOKANSON ADMINISTRATOR 6128275677 2024-09-24 1 0 JED CHENEY P01587750 6123764500 2024-09-24 2023 2024-08-08 14:25:15Z TIMOTHY HOKANSON 5517 LYNDALE AVENUE SOUTH MINNEAPOLIS MN 55419 26521325 0 X WWW.MTOLIVETHOMES.ORG X 1965 MN TO PROVIDE HIGH QUALITY LONG TERM CARE FOR RESIDENTS IN A LOVING AND CARING ENVIRONMENT. 14 14 397 25 0 0 440108 1288716 23688152 24380028 165009 204253 343471 648328 24636740 26521325 238405 106512 0 0 15453321 16649312 0 0 20923 9472468 9640231 25164194 26396055 -527454 125270 43487651 44840023 27862458 28099890 15625193 16740133 X TO PROVIDE HIGH QUALITY LONG TERM CARE FOR RESIDENTS IN A LOVING AND CARING ENVIRONMENT. 0 0 25268800 106512 24380028 MOUNT OLIVET CAREVIEW HOME (MOCH) IS A 155-BED SKILLED CARE FACILITY FEATURING MOSTLY DOUBLE ROOMS AND SOME SINGLE ROOMS. WE ALSO OFFER A 16-BED TRANSITIONAL CARE UNIT FOR PATIENTS WHO REQUIRE SHORT TERM SKILLED NURSING CARE OR DAILY REHABILITATION FOLLOWING A HOSPITALIZATION. IN ADDITION, WE PROVIDE A SECURED MEMORY UNIT FOR RESIDENTS COPING WITH LATE STAGES OF MEMORY LOSS, ALZHEIMER'S AND OTHER DEMENTIA-RELATED ILLNESSES. RESIDENTS ARE DEPENDENT ON THE NURSING STAFF TO ACCOMPLISH DAILY LIVING ACTIVITIES, INCLUDING DRESSING, GROOMING, BATHING, TOILETING, EATING, WALKING, AND TRANSFERRING. DAILY SERVICES ALSO INCLUDE OXYGEN AND IV THERAPY, AS NEEDED. ONSITE VISION, HEARING, DENTAL AND PODIATRY SERVICES ARE ALSO AVAILABLE. THREE NUTRITIOUS MEALS AND OTHER REFRESHMENTS ARE SERVED DAILY IN DINING ROOMS ON EACH FLOOR. FAMILY MEMBERS CAN ENJOY MEALS WITH THEIR LOVED ONE.SPACIOUS LOUNGES, OUTDOOR PATIOS, AND PRIVATE FAMILY AREAS MAKE THE FACILITY FEEL LIKE HOME. 25268800 1 1 0 0 0 0 0 0 1 1 1 0 1 1 1 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 26 0 1 397 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 1 1 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 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 SARA VANWINKLE BOARD MEMBER 0.30 0.60 X 0 0 0 TIMOTHY HOKANSON ADMINISTRATOR 38.00 2.00 X 262207 0 61525 SHARON FLACK CONTROLLER 38.00 2.00 X 156384 0 18510 PAM MOKANDU REGISTERED NURSE 40.00 0.00 X 144771 0 0 ROGER WHITE ASSOCIATE ADMINSTRATOR 20.00 20.00 X 170149 0 12164 ENOCK KEBATI REGISTERED NURSE 40.00 0.00 X 148299 0 8663 EVELYN OGETONTO REGISTERED NURSE 40.00 0.00 X 156596 0 11620 MEGHANN WAHL DIRECTOR OF NURSING 38.00 2.00 X 148427 0 1853 1186833 0 114335 27 0 1 0 MOUNT OLIVET HOME 5517 LYNDALE AVE S MINNEAPOLIS MN 55419 DIETARY SERVICES 2176292 CENTREX REHAB 8120 PENN AVE S STE 480 BLOOMINGTON MN 55431 REHABILITATION SERVICES 1732512 ATOMIC DATA 250 MARQUETTE AVE STE 225 MINNEAPOLIS MN 55401 IT SERVICES 489528 3 1179036 109680 1288716 RESIDENT SERVICES 623000 22251390 22251390 ANCILLARY SERVICES 623000 2128638 2128638 24380028 204253 204253 MISCELLANEOUS 900099 648259 648259 GUEST MEALS 722320 69 69 648328 26521325 24380028 0 852581 X 106512 106512 498626 323732 174894 13732475 13605171 123060 4244 1358705 1346572 12133 1059506 1038266 21240 40813 40813 58269 58269 3889024 3853831 33371 1822 41944 41944 223568 178373 44787 408 398901 388408 9178 1315 45345 45345 12672 12672 1088210 1052510 31225 4475 1656109 1601779 47520 6810 236399 228644 6783 972 PROGRAM SUPPLIES 1054172 1047176 6119 877 LICENSE SURCHARGE 436325 436325 MISCELLANEOUS EXPENSES 339004 339004 BAD DEBT 56086 56086 63390 5415 57975 26396055 25268800 1106332 20923 476913 1365295 3532370 3484513 106695 102666 45707049 16464120 30402710 29242929 6262350 0 75000 75000 1704314 2290892 927299 8278728 43487651 44840023 1107224 1095491 781804 23393532 22910125 35364 58930 3326338 3253540 27862458 28099890 X 14310287 15371072 1314906 1369061 15625193 16740133 43487651 44840023 125270 989670 0 X X 0 1 X 1 0 X 454037 1406875 3208708 440108 1288716 6798444 20042228 19616018 21283059 23688152 24380028 109009485 12718 2962 246 74 69 16069 20508983 21025855 24492013 24128334 25668813 115823998 50000 43000 93000 293078 293078 50000 336078 386078 115437920 177078 143937 161332 165009 204253 851609 177078 143937 161332 165009 204253 851609 617914 728579 611736 343323 648259 2949811 21303975 21898371 25265081 24636666 26521325 119625418 0.96500 0.96660 0.00710 0.00730 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE LOSS ON REFINANCING RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1095541 1095541 1095541 1095541 1095541 20409 20409 1095541 1095541 20388 20388 1095541 1095541 25219 25219 1095541 0.00000 1.00000 0.00000 0 1 1 46183 46183 38672686 11234271 27438415 756688 425387 331301 6207735 4804462 1403273 23757 23757 29242929 INVESTMENTS 39999 C AUGUSTANA CARE SERVICE 2250893 C 2290892 RESIDENT TRUST FUNDS 58930 BOND FUNDS 908355 INTEREST IN AFFILIATED FOUNDATION 7311443 8278728 DUE TO AFFILIATE 3253540 3253540 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 V, LINE 4: TO PROVIDE A PERMANENT SOURCE OF INCOME FOR CAPITAL, EQUIPMENT, EDUCATION, AND OTHER OPERATING PURPOSES. 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 EMPLOYEE LOAN FORGIVENESS 2 6200 TUITION REIMBURSMENT 30 88312 EMPLOYEE SCHOLARSHIPS 12 12000 PART I, LINE 2: SCHOLARSHIPS, TUITION REIMBURSEMENT, AND STUDENT LOAN FORGIVENESS PROGRAMS ARE AWARDED ANNUALLY THROUGH A PROGRAM ESTABLISHED BY THE ORGANIZATION'S DEVELOPMENT AND HUMAN RESOURCE TEAM. SCHOLARSHIP, TUITION REIMBURSEMENT, AND STUDENT LOAN FORGIVENESS RECIPIENTS ARE REQUIRED TO PROVIDE RECEIPTS TO DOCUMENT APPROPRIATE USE OF FUNDS. X X 0 0 0 0 0 0 0 0 0 TIMOTHY HOKANSON ADMINISTRATOR 185016 0 56393 0 20798 0 0 0 61525 0 323732 0 0 0 ROGER WHITE ASSOCIATE ADMINSTRATOR 163314 0 4235 0 2600 0 0 0 12164 0 182313 0 0 0 SHARON FLACK CONTROLLER 137836 0 3010 0 15538 0 0 0 18510 0 174894 0 0 0 EVELYN OGETONTO REGISTERED NURSE 132788 0 1308 0 22500 0 0 0 11620 0 168216 0 0 0 ENOCK KEBATI REGISTERED NURSE 148299 0 0 0 0 0 0 0 8663 0 156962 0 0 0 MEGHANN WAHL DIRECTOR OF NURSING 148427 0 0 0 0 0 0 0 1853 0 150280 0 0 0 A CITY OF ST LOUIS PARK 416005519 791748FP6 2016-05-31 26295000 SERIES 2016B AND C BONDS FOR MT. OLIVET CAREVIEW HOME CONSTRUCTION PROJECT 0 0 0 A 2835000 26295000 800000 525900 24802390 2018 0 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 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF ST. LOUIS PARK DATE THE REBATE COMPUTATION WAS PERFORMED: 06/14/2021 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 EXECUTVE COMMITEE, 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 ANY POTENTIAL CONFLICT OF INTEREST. DEPARTMENT HEADS MUST DISCLOSE THE EXISTENCE OF ANY POTENTIAL CONFLICT OF INTEREST AS SOON AS THEY ARE AWARE OF A POTENTIAL CONFLICT OF INTEREST AND NOT JUST ON THE ANNUAL DISCLOSURE. THE REPORTING AND TRACKING OF POTENTIAL CONFLICTS IS MONITORED BY THE APPOINTED COMPLIANCE OFFICER THROUGH RETAINING THE ANNUAL DISCLOSURES AND ANY POTENTIAL CONFLICTS THAT HAVE BEEN REPORTED. POTENTIAL CONFLICTED PARTIES 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, MANAGEMENT AGREEMENT OR ARRANGEMENT WHERE A CONFLICT EXISTS. IF A CONFLICT OF INTEREST IS FOUND THE BOARD SHALL DETERMINE WHETHER THE ORGANIZATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION, MANAGEMENT AGREEMENT OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A NON CONFLICTED PARTY, IF NONE IS FOUND THE THE DISINTERESTED BOARD WILL VOTE ON WHETHER TO PROCEED WITH THE ARRANGEMENT, MANAGEMENT AGREEMENT OR TRANSACTION. MINUTES OF THE BOARD OF DIRECTORS OR BOARD EXECUTIVE COMMITTEE WILL RECORD ALL PROCEEDINGS RELATED TO CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 ADMINISTRATOR AND CONTROLLER COMPENSATION IS REVIEWED AND APPROVED BY THE PRESIDENT AND VICE PRESIDENT OF THE BOARD. THE COMPENSATION OF THESE INDIVIDUALS WAS LAST COMPARED TO THE 2023 ELCA SALARY SURVEY. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2023. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G NURSING CONSULTANTS: PROGRAM SERVICE EXPENSES 136,448. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 136,448. SOCIAL SERVICES PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 10,808. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,808. ANCILLARY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,094,001. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,094,001. DIETARY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,178,093. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,178,093. LAUNDRY PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 6,046. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,046. MAINTENANCE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 428,435. MANAGEMENT AND GENERAL EXPENSES 12,710. FUNDRAISING EXPENSES 1,822. TOTAL EXPENSES 442,967. ADMIN PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 20,661. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,661. FORM 990, PART XII, LINE 2C: THE PROCESS OF SELECTING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. MOUNT OLIVET CAREVIEW HOME FOUNDATION LLC 5025 KNOX AVENUE SOUTH MINNEAPOLIS MN 55419 FOUNDATION MN 152817 7311443 MOUNT OLIVET CAREVIEW HOME MOUNT OLIVET HOME 5517 LYNDALE AVE S MINNEAPOLIS MN 55419 410838344 BOARD AND CARE MN 501(C)(3) LINE 10 SEE SCHEDULE R PART VII 1 MOUNT OLIVET DAY SERVICES 5601 LYNDALE AVE S MINNEAPOLIS MN 55419 411785649 CHILD & ADULT DAYCARE MN 501(C)(3) LINE 10 SEE SCHEDULE R PART VII 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 MOUNT OLIVET HOME P 2176292 ACTUAL AMOUNT MOUNT OLIVET HOME Q 304885 ACTUAL AMOUNT 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.