2024-05-02T08:03:55-05:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2023-01-01 411273346 MISSION FARM NURSING HOME INC MISS 7635593123 3401 E MEDICINE LAKE BLVD PLYMOUTH MN 55441 WILLIAM MONCRIEF ADMINISTRATOR 7635593123 2024-04-29 1 WILLIAM MONCRIEF 999009999 0 JOHN MELZAREK P02080879 6123764500 2024-04-24 2 AAL1 IAL1 2023 2023-04-26 12:10:37Z WILLIAM MONCRIEF 3401 E MEDICINE LAKE BLVD PLYMOUTH MN 55441 8316314 0 X N/A X 1976 MN OPEN IN 1964 AS THE ONLY SKILLED-CARE FACILITY IN MINNESOTA EXCLUSIVELY FOR MEN, MISSION NURSING HOME PROVIDES SHORT-TERM AND LONG-TERM CARE FOR UP TO 65 RESIDENTS WHO MAY BE EXPERIENCING A VARIETY OF PHYSICAL AND BEHAVIORAL HEALTH ISSUES. SERVICES INCLUDE SKILLED NURSING CARE, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES, NUTRITION ASSISTANCE, AND SOCIAL AND RECREATIONAL ACTIVITIES TO HELP RESIDENTS ATTAIN THE OPTIMUM QUALITY OF LIFE. 16 16 98 16 0 0 1200898 274147 7184994 7894286 21790 76257 -5 11267 8407677 8255957 0 0 0 0 4066119 4975537 0 0 0 3574004 3498693 7640123 8474230 767554 -218273 5026395 5049743 1117039 1358661 3909356 3691082 WE PROVIDE A HOME THAT REAFFIRMS THE DIGNITY AND SELF WORTH OF MEN, WHO EXPERIENCE PHYSICAL OR BEHAVIORAL HEALTH CHALLENGES, THROUGH COMPASSIONATE, SUPPORTIVE AND REHABILITATIVE CARE. 0 0 7463299 0 7894286 MISSION FARM NURSING HOME, INC. OPERATES A 65 BED SKILLED LONG-TERM CARE FACILITY WHERE IT PROVIDES PROFESSIONAL CARE SERVICES TO ITS RESIDENTS. THE LONG-TERM CARE FACILITY HAD AN OCCUPANCY RATE OF 83.8% IN 2023 BY PROVIDING 19,878 RESIDENT DAYS OF CARE. 7463299 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 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 1 0 0 0 1 18 0 1 98 1 0 0 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X WILLIAM MONCRIEF ADMINISTRATOR 7635593123 3401 E MEDICINE LAKE BLVD PLYMOUTH MN 55441 ISAIAH KEBWARO RN 40.00 0.00 X 220700 0 0 WILLIAM MONCRIEF ADMINISTRATOR 40.00 0.00 X 142124 0 12207 DIANA MOSE RN 40.00 0.00 X 134940 0 0 WANDA BRADLEY SCHEDULER/TMA 40.00 0.00 X 114463 0 13165 DONNA EVJEN DON 40.00 0.00 X 113663 0 24217 KATHRYN DANIELS CEO 5.00 40.00 X 0 168636 18936 TAMARA FALLON CHAIR 1.00 2.00 X X 0 0 0 CLAUDIA AURAND 1ST VICE CHAIR 0.88 1.75 X X 0 0 0 JOEL BARKER 2ND VICE CHAIR 0.88 1.75 X X 0 0 0 DENNIS H WOLD TREASURER 0.88 1.75 X X 0 0 0 ERIC GUSTAFSON SECRETARY 0.88 1.75 X X 0 0 0 STACEY L BILLY DIRECTOR 0.75 1.50 X X 0 0 0 CYNTHIA BOBO DIRECTOR 0.75 1.50 X 0 0 0 TERESA DETERMAN DIRECTOR 0.75 1.50 X 0 0 0 SAHAR ERICKSON DIRECTOR 0.75 1.50 X 0 0 0 KELLY KIWUS DIRECTOR 0.75 1.50 X 0 0 0 PETER MANNIX DIRECTOR 0.75 1.50 X 0 0 0 ELLEN C MEYER DIRECTOR 0.75 1.50 X 0 0 0 ANDREA NETTLES DIRECTOR 0.75 1.50 X 0 0 0 MARY SENKBEIL DIRECTOR 0.75 1.50 X 0 0 0 WENDY SPAULDING DIRECTOR 0.75 1.50 X 0 0 0 ANDREW WHITMAN DIRECTOR 0.75 1.50 X 0 0 0 725890 168636 68525 8 0 1 0 NEW HORIZON 2670 106TH STREET SUITE 140 DES MOINES IA 50322 DIETARY SERVICES 500816 FAVOR HEALTHCARE STAFFING 5876 QUILLEY AVE NE OTSEGO MN 553306689 STAFFING SERVICES 391834 RAYCO CONSTRUCTION INC 3030 GRANADA AVE N OAKDALE MN 55128 STAFFING SERVICES 291100 POWERBACK REHABILITATION 101 EAST STATE STREET KENNET SQUARE PA 19348 STAFFING SERVICES 254957 ZELLNER SENIOR HEALTH 522 HACKMORE DR EAGANN MN 55123 STAFFING SERVICES 144223 6 271437 2710 274147 RESIDENT SERVICES 623000 7601390 7601390 RES SVCS CONTRACTED 623000 292896 292896 7894286 6420 6420 106226 36389 69837 69837 69837 26338 23968 2370 2370 MISCELLANEOUS 900099 7177 7177 MEALS 722210 1720 1720 8897 8255957 7894286 0 87524 X 4189431 4037782 151649 3714 3580 134 468884 454835 14049 313508 297833 15675 61798 61798 43719 43719 1587455 1258122 329333 713 713 24794 24794 153122 153122 109579 107716 1863 4701 401 4300 7176 7176 1928 1895 33 211390 207797 3593 213816 210181 3635 FOOD & PROGRAM SUPPLIES 416872 416872 PROGRAM EXPENSES 251016 251016 MEDICAL SURCHARGE 182975 182975 BAD DEBT 167619 167619 60020 32294 27726 8474230 7463299 1010931 0 304567 646110 5555 0 1974677 2002076 112122 98064 7190182 4945856 2083930 2244326 495905 0 49639 59167 5026395 5049743 871453 918987 49639 59167 67701 0 128246 380507 1117039 1358661 X 3909356 3691082 3909356 3691082 5026395 5049743 -218273 -1 0 X X 0 1 X 1 0 X 725 1615150 278371 1200898 274147 3369291 7400122 6360734 4995902 7184994 7894286 33836038 29142 34023 28014 20992 6420 118591 7429989 8009907 5302287 8406884 8174853 37323920 0 0 0 37323920 19675 15718 16453 20992 28058 100896 19675 15718 16453 20992 28058 100896 456 7431 2 7177 15066 7449664 8026081 5326171 8427878 8210088 37439882 0.99690 0.99730 0.00270 0.00250 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLAENOUS - 2020 AMOUNT: $ 456. 2021 AMOUNT: $ 7,431. 2022 AMOUNT: $ 2. 2023 AMOUNT: $ 7,177. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 44234 44234 6116071 4552776 1563295 1029877 393080 636797 2244326 DUE TO RELATED PARTIES 355194 THIRD PARTY SETTLEMENTS -6076 CAPITAL LEASE OBLIGATIONS 31389 380507 X 8004941 -251016 -251016 8255957 0 8255957 8223214 0 8223214 251016 251016 8474230 PART IV, LINE 2B: THE ORGANIZATION ACTS AS A CUSTODIAN OF FUNDS WHICH ARE HELD IN TRUST FOR PERSONAL USE BY ITS RESIDENTS. PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE MINNESOTA STATUTES. CONSEQUENTLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES. 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 TAXES. PART XI, LINE 2D - OTHER ADJUSTMENTS: CONTRACTED THERAPY SERVICE EXPENSES -251,016. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRACTED THERAPY SERVICE EXPENSES 251,016. 0 0 0 0 0 0 0 0 0 ISAIAH KEBWARO RN 220700 0 0 0 0 0 0 0 0 0 220700 0 0 0 WILLIAM MONCRIEF ADMINISTRATOR 142124 0 0 0 0 0 0 0 12207 0 154331 0 0 0 KATHRYN DANIELS CEO 0 168636 0 0 0 0 0 6800 0 12136 0 187572 0 0 PART I, LINE 3 THE CHIEF EXECUTIVE OFFICER IS PAID BY A RELATED ORGANIZATION WHICH IS RESPONSIBLE FOR REVIEWING AND APPROVING THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER. THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS SUBJECT TO TWO LEVELS OF REVIEW BY THE RELATED ORGANIZATION'S BOARD OF DIRECTORS, THE EXECUTIVE COMMITTEE AND THE FULL BOARD. COMPENSATION SURVEY/STUDY AND FORM 990'S OF OTHER ORGANIZATIONS ARE USED IN ESTABLISHING THE CHIEF EXECUTIVE OFFICER'S COMPENSATION. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE IS COMPOSED OF THE ELECTED OFFICERS OF THE CORPORATION AND THE CHIEF EXECUTIVE OFFICER. THE CHIEF EXECUTIVE OFFICER HAS NO VOTE. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF BUSINESS OF THE COPRORATION IN THE INTERVAL BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, AND THE EXECUTIVE COMMITTEE AT TIMES IS SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED BY THE FINANCE COMMITTEE AND BY THE BOARD OF DIRECTORS PRIOR TO BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL DISCLOSURE OF ANY INTERESTS THAT COULD GIVE RISE TO CONFLICTS IS DOCUMENTED AT THE BOARD OF DIRECTOR'S ANNUAL MEETING IN APRIL. REVIEW AND APPROVAL BY THE BOARD OF DIRECTORS IS REQUIRED FOR ANY CONTRACT OR TRANSACTION INVOLVING AN OFFICER OR DIRECTOR. DIRECTORS AND OFFICERS WITH A POTENTIAL CONFLICT OF INTEREST ARE REQUIRED TO BE REMOVED FROM DELIBERATIONS AND DISCUSSIONS RELATED TO SUCH TRANSACTIONS. FORM 990, PART VI, SECTION B, LINE 15 THE CHIEF EXECUTIVE OFFICER IS PAID BY A RELATED ORGANIZATION, WHICH IS RESPONSIBLE FOR REVIEWING AND APPROVING THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER. THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS SUBJECT TO TWO LEVELS OF REVIEW BY THE RELATED ORGANIZATION'S BOARD OF DIRECTORS, THE EXECUTIVE COMMITTEE, AND THE FULL BOARD, AND IS BASED UPON COMPARABLE SALARY DATA FROM TWO INDEPENDENT SOURCES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER SERVICES: PROGRAM SERVICE EXPENSES 1,258,122. MANAGEMENT AND GENERAL EXPENSES 329,333. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,587,455. FORM 990. PART XII, LINE 2C. NO CHANGE IN THE SELECTION PROCESS OF AN INDEPENDENT ACCOUNTANT IN THE CURRENT YEAR. MISSION INC PROGRAMS 3409 EAST MEDICINE LAKE BLVD PLYMOUTH MN 55441 410693952 SOCIAL SERVICES MN 501(C)(3) LINE 10 N/A 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 MISSIONS INC O 99642 CASH TRANSACTION MISSIONS INC D 185059 CASH TRANSACTION