2024-11-07T11:51:12-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 121 WEST BRIDGE STREET OWATONNA MN 55060 990 2023-01-01 391819072 AMERICAN LUTHERAN COMMUNITY SERVICES INC AMER 7158323003 915 ELM STREET MENOMONIE WI 54751 AMY DUHR CEO 7158323003 2024-11-06 1 1 JUSTIN HARTERT P02236744 5074467100 2024-11-06 2023 2024-10-15 13:58:12Z AUTUMN VILLAGE AMY DUHR 915 ELM STREET MENOMONIE WI 54751 1606386 0 X WWW.AMERICANLUTHERANHOMES.COM X 1995 WI PROVIDE HOUSING AND ASSISTED LIVING SERVICES FOR ELDERLY AND PERMANENTLY DISABLED PERSONS. 8 8 34 10 0 0 0 10000 1260751 1540435 141 20055 2975 35896 1263867 1606386 0 0 0 0 702708 737825 0 0 0 562801 737624 1265509 1475449 -1642 130937 3239714 3322537 1284911 1236797 1954803 2085740 TO PROVIDE SENIORS WITH PERSONALIZED ASSISTANCE IN A COMFORTABLE ENVIRONMENT THAT ENHANCES INDEPENDENCE, PRIVACY, AND DIGNITY. 0 0 1230168 0 1540435 AUTUMN VILLAGE OPERATES A RESIDENTIAL CARE FACILITY IN MENOMONIE, WISCONSIN WHICH BLENDS SENIOR INDEPENDENT LIVING APARTMENTS WITH SUPPORTIVE SERVICES. AUTUMN VILLAGE IS A 40-BED SENIOR APARTMENT COMPLEX AND PROVIDED 12,195 DAYS OF RESIDENT CARE IN 2023. THE GOAL OF AUTUMN VILLAGE IS TO OFFER RESIDENTS SECURITY, PRIVACY, SOCIAL OPPORTUNITIES, AND MORE. 1230168 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 6 0 34 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 8 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 1 1 0 X GRACE LUTHERAN FOUNDATION 7158323003 PO BOX 287 EAU CLAIRE WI 54702 X LINDA LARSON PRESIDENT 1.00 1.00 X X 0 0 0 BARB VADNAIS SECRETARY 1.00 1.00 X X 0 0 0 DAVID LARSON VICE PRESIDENT 1.00 1.00 X X 0 0 0 RITA LEE TREASURER 1.00 1.00 X 0 0 0 ANITA REID DIRECTOR 1.00 1.00 X 0 0 0 KRIS JENSON DIRECTOR 1.00 1.00 X 0 0 0 JOANNE ERICKSON DIRECTOR 1.00 1.00 X 0 0 0 BARB EIDAHL DIRECTOR 1.00 1.00 X 0 0 0 AMY DUHR CEO 1.00 39.00 X 0 0 0 JAMIE LARSON COO 1.00 39.00 X 0 0 0 0 0 0 0 0 0 0 0 10000 10000 ASSISTED LIVING CARE 623000 1540435 1540435 1540435 20055 20055 DIRECT CARE WORKFORCE 900099 24191 24191 MISCELLANEOUS INCOME 900099 11043 11043 TRANSPORTATION INCOME 900099 662 662 35896 1606386 1540435 0 55951 643177 583916 59261 2800 2433 367 41625 36163 5462 50223 43632 6591 71548 71548 344 344 16356 16356 41885 15685 26200 7857 7857 7782 7672 110 28422 28422 79814 79814 400 111 289 2454 2454 20902 20902 105577 105577 17163 17163 PURCHASED MEALS 257533 257533 BAD DEBT EXPENSE 31755 31755 REPAIRS AND MAINTENANCE 28420 28420 SUPPLIES 15736 14685 1051 3676 1870 1806 1475449 1230168 245281 0 1695112 1807367 48019 33302 1520 3004 3577989 2548597 1130280 1029392 364783 449472 3239714 3322537 77943 86736 38955 24176 64911 68226 746867 647002 356235 410657 1284911 1236797 X 1954803 2085740 1954803 2085740 3239714 3322537 130937 0 X X 0 1 X 1 0 X 540 10754 138821 0 10000 160115 1396733 1420462 1205369 1260751 1540435 6823750 1397273 1431216 1344190 1260751 1550435 6983865 0 796440 796440 796440 796440 6187425 6239 76 41 141 20055 26552 2975 2975 6239 76 41 3116 20055 29527 0 0 0 0 35896 35896 1403512 1431292 1344231 1263867 1606386 7049288 0.87770 0.99900 0.00420 0.00100 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2023 AMOUNT: $ 11,043. DIRECT CARE WORKFORCE - 2023 AMOUNT: $ 24,191. TRANSPORTATION INCOME - 2023 AMOUNT: $ 662. 0 1 X 3117607 2164072 953535 460382 384525 75857 1029392 SECURITY DEPOSITS 65411 ASSETS HELD BY AMERICAN LUTHERAN HOMES, INC 384061 449472 DUE TO AMERICAN LUTHERAN COMMUNITY SERVICES, INC. 410657 410657 PART IV, LINE 2B: THE ORGANIZATION HOLDS, IN TRUST, SECURITY DEPOSITS ADVANCED BY THE RESIDENTS OF THE APARTMENTS AND CONSIDERS THESE ASSETS LIMITED AS TO USE. SECURITY DEPOSITS ARE REFUNDABLE UPON VACANCY. FORM 990, PART VI, SECTION A, LINE 3 AUTUMN VILLAGE HAS ENTERED INTO A MANAGEMENT SERVICES AGREEMENT WITH GRACE LUTHERAN FOUNDATION, INC. (GRACE), A NON-PROFIT, RELIGIOUS BASED SENIOR HEALTHCARE SERVICES ORGANIZATION BASED IN EAU CLAIRE, WISCONSIN. UNDER THIS AGREEMENT, GRACE PROVIDES GENERAL ADMINISTRATIVE, CONSULTING, ACCOUNTING, HUMAN RESOURCES, AND FACILITY MANAGEMENT SERVICES TO AUTUMN VILLAGE. UNDER THE MANAGEMENT AGREEMENT, GRACE IS ALSO RESPONSIBLE FOR THE SELECTION AND REVIEW OF THE ADMINISTRATOR OF AUTUMN VILLAGE. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF AUTUMN VILLAGE ARE THE PASTORS AND CONGREGATIONS THAT BELONG TO THE AMERICAN LUTHERAN CHURCH AND SPONSOR THE ACTIVITES OF AUTUMN VILLAGE. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD MEMBERS ARE ELECTED BY THE CONGREGATIONS OF THE SPONSORING CHURCHES AND AT A MINIMUM MUST INCLUDE THE PASTOR OF ONE OF THESE CONGREGATIONS. FORM 990, PART VI, SECTION A, LINE 7B ANY DECISIONS ON THE CHANGES IN THE STRUCTURE OR THE GOVERNING DOCUMENTS OF AUTUMN VILLAGE MUST BE APPROVED BY THE AMERICAN LUTHERAN CHURCH. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 WAS PROVIDED TO THE GOVERNING BODY AND MANAGEMENT FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION ANNUALLY REVIEWS UPDATED CONFLICT OF INTEREST STATEMENTS FROM MEMBERS OF THE BOARD OF DIRECTORS. ANY NOTED CONFLICTS ARE DISCUSSED, AND DURING THE YEAR, IF CONFLICTS ARE NOTED DURING VOTES, THOSE CONFLICTING MEMBERS ABSTAIN FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 AUTUMN VILLAGE'S EXECUTIVE LEVEL EMPLOYEES AND KEY EMPLOYEES ARE PROVIDED UNDER THE MANAGEMENT SERVICES AGREEMENT WITH GRACE LUTHERAN FOUNDATION (A NOT-FOR PROFIT ORGANIZATION WHICH SPECIALIZES IN SKILLED NURSING, LONG-TERM CARE, AND HOUSING SERVICES FOR ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY). THE CONTRACT IS A TEN-YEAR TERM THAT WAS EFFECTIVE JANUARY 1, 2020. THE BOARD OF DIRECTORS OF AUTUMN VILLAGE REVIEWS THE CONTRACT TERMS TO ENSURE THAT QUALITY SERVICES ARE BEING ACHIEVED AT THE LOWEST POSSIBLE COST FOR THE PROGRAMS BEING PROVIDED. THE BOARD ALSO CONSULTS WITH OTHER WISCONSIN NURSING HOME ASSOCIATION MEMBERS TO ENSURE THAT THE AMOUNTS BEING PAID ARE CONSISTENT FOR ADMINISTRATIVE SERVICES PAID THROUGHOUT THE REGION. THE PROCESS DESCRIBED HERE WAS LAST COMPLETED IN 2020. FORM 990, PART VI, SECTION C, LINE 19 AUTUMN VILLAGE MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT ITS BUSINESS LOCATION. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. AMERICAN LUTHERAN HOMES INC 915 EAST ELM STREET MENOMONIE WI 54751 390806814 SKILLED NURSING FACILITY WI 501(C)(3) LINE 10 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0