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  5. Central Todd County Care Center, Inc.

Central Todd County Care Center, Inc.

Company Details

Name: Central Todd County Care Center, Inc.
Jurisdiction: Minnesota
Legal type: Nonprofit Corporation (Domestic)
Status: Active / In Good Standing
Date formed: 12 Apr 1977 (48 years ago)
Company Number: 2b589f5e-b2d4-e011-a886-001ec94ffe7f
File Number: P-236
Registered Office Address: 406 E Highway 71, Clarissa, MN 56440, USA
ZIP code: 56440
County: Todd County
Place of Formation: Minnesota

Unique Entity ID

Unique Entity ID Expiration Date Physical Address Mailing Address
FR35X56812T9 2021-03-06 406 E HWY 71, CLARISSA, MN, 56440, 2000, USA PO BOX 38, CLARISSA, MN, 56440, USA

Business Information
URL www.clarissacarecenter.org
Division Name CENTRAL TODD COUNTY CARE CENTER INC
Congressional District 07
State/Country of Incorporation MN, USA
Activation Date 2020-03-23
Initial Registration Date 2019-12-04
Entity Start Date 1977-04-01
Fiscal Year End Close Date Sep 30

Service Classifications
NAICS Codes 623110, 623312

Points of Contacts
Electronic Business
Title PRIMARY POC
Name JASON POLOVICK
Role ADMINISTRATOR
Address 406 EAST HWY 71N, PO BOX 38, CLARISSA, MN, 56440, USA
Government Business
Title PRIMARY POC
Name JASON POLOVICK
Role ADMINISTRATOR
Address 406 EAST HWY 71N, PO BOX 38, CLARISSA, MN, 56440, USA
Past Performance Information not Available

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
CENTRAL TODD COUNTY CARE CENTER 401K PROFIT SHARING PLAN 2022 411299857 2024-02-28 CENTRAL TODD COUNTY CARE CENTER 85
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-10-09
Business code 623000
Sponsor’s telephone number 2187563636
Plan sponsor’s DBA name NAOMI STRUCK
Plan sponsor’s address P.O. BOX 38, CLARISSA, MN, 56440

Signature of
Role Plan administrator
Date 2024-02-28
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2024-02-28
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
CENTRAL TODD COUNTY CARE CENTER 401K PROFIT SHARING PLAN 2021 411299857 2023-02-20 CENTRAL TODD COUNTY CARE CENTER 76
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-10-09
Business code 623000
Sponsor’s telephone number 2187563636
Plan sponsor’s address P.O. BOX 38, CLARISSA, MN, 56440

Signature of
Role Plan administrator
Date 2023-02-20
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2023-02-20
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
CENTRAL TODD COUNTY CARE CENTER 401K PROFIT SHARING PLAN 2020 411299857 2021-12-31 CENTRAL TODD COUNTY CARE CENTER 82
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-10-09
Business code 623000
Sponsor’s telephone number 2187563636
Plan sponsor’s address P.O. BOX 38, CLARISSA, MN, 56440

Signature of
Role Plan administrator
Date 2021-12-31
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-12-31
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
CENTRAL TODD COUNTY CARE CENTER 401K PROFIT SHARING PLAN 2019 411299857 2021-02-23 CENTRAL TODD COUNTY CARE CENTER 83
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-10-09
Business code 623000
Sponsor’s telephone number 2187563636
Plan sponsor’s address P.O. BOX 38, CLARISSA, MN, 56440

Signature of
Role Plan administrator
Date 2021-02-23
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-02-23
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
CENTRAL TODD COUNTY CARE CENTER 401K PROFIT SHARING PLAN 2018 411299857 2020-02-14 CENTRAL TODD COUNTY CARE CENTER 84
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-10-09
Business code 623000
Sponsor’s telephone number 2187563636
Plan sponsor’s address P.O. BOX 38, CLARISSA, MN, 56440

Signature of
Role Plan administrator
Date 2020-02-14
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2020-02-14
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
CENTRAL TODD COUNTY CARE CENTER 401K PROFIT SHARING PLAN 2017 411299857 2019-02-21 CENTRAL TODD COUNTY CARE CENTER 90
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-10-09
Business code 623000
Sponsor’s telephone number 2187563636
Plan sponsor’s address P.O. BOX 38, CLARISSA, MN, 56440

Signature of
Role Plan administrator
Date 2019-02-21
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-02-21
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
CENTRAL TODD COUNTY CARE CENTER 401K PROFIT SHARING PLAN 2016 411299857 2018-02-15 CENTRAL TODD COUNTY CARE CENTER 91
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-10-09
Business code 623000
Sponsor’s telephone number 2187563636
Plan sponsor’s address P.O. BOX 38, CLARISSA, MN, 56440

Signature of
Role Plan administrator
Date 2018-02-15
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-02-15
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
CENTRAL TODD COUNTY CARE CENTER 401K PROFIT SHARING PLAN 2015 411299857 2017-03-08 CENTRAL TODD COUNTY CARE CENTER 88
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-10-09
Business code 623000
Sponsor’s telephone number 2187563636
Plan sponsor’s address P.O. BOX 38, CLARISSA, MN, 56440

Signature of
Role Plan administrator
Date 2017-03-08
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-03-08
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
CENTRAL TODD COUNTY CARE CENTER 401K PROFIT SHARING PLAN 2014 411299857 2016-02-22 CENTRAL TODD COUNTY CARE CENTER 67
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-10-09
Business code 623000
Sponsor’s telephone number 2187563636
Plan sponsor’s address P.O. BOX 38, CLARISSA, MN, 56440

Signature of
Role Plan administrator
Date 2016-02-18
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-02-18
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
CENTRAL TODD COUNTY CARE CENTER 401K PROFIT SHARING PLAN 2013 411299857 2014-12-31 CENTRAL TODD COUNTY CARE CENTER 70
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1991-10-09
Business code 623000
Sponsor’s telephone number 2187563636
Plan sponsor’s address P.O. BOX 38, CLARISSA, MN, 56440

Signature of
Role Plan administrator
Date 2014-12-31
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-12-31
Name of individual signing JASON POLOVICK
Valid signature Filed with authorized/valid electronic signature

President

Name Role Address
Larry Dickson President 37748 203RD AVE, CLARISSA, MN 56440–1005, USA

Filing

Filing Name Filing date
Annual Reinstatement - Nonprofit Corporation (Domestic) 2007-03-28
Registered Office and/or Agent - Nonprofit Corporation (Domestic) 2007-03-28
Involuntary Dissolution - Nonprofit Corporation (Domestic) 2005-09-20
Amendment - Nonprofit Corporation (Domestic) 2002-09-12
Nonprofit Corporation (Domestic) Restated Articles 1978-03-02
Original Filing - Nonprofit Corporation (Domestic) 1977-04-12
Nonprofit Corporation (Domestic) Business Name (Business Name: Central Todd County Care Center, Inc.) 1977-04-12

OSHA's Inspections within Industry

Inspection Nr Report ID Date Opened Site Address
314837147 0552700 2010-08-27 406 E HWY 71, CLARISSA, MN, 56440
Inspection Type Planned
Scope Complete
Safety/Health Safety
Close Conference 2010-08-27
Emphasis L: NURSING
Case Closed 2010-10-13

Violation Items
Citation ID 01001
Citaton Type Serious
Standard Cited 19100151 C
Issuance Date 2010-09-16
Abatement Due Date 2010-10-10
Current Penalty 840.0
Initial Penalty 1200.0
Nr Instances 3
Nr Exposed 3
Citation ID 01002
Citaton Type Serious
Standard Cited 5205086002
Issuance Date 2010-09-16
Abatement Due Date 2010-10-10
Current Penalty 700.0
Initial Penalty 1000.0
Nr Instances 1
Nr Exposed 4
14925283 0552700 1984-10-24 HWY 71 SO, CLARISSA, MN, 56440
Inspection Type Planned
Scope Complete
Safety/Health Safety
Close Conference 1984-10-24
Emphasis L: EM
Case Closed 1984-12-07

Violation Items
Citation ID 01001
Citaton Type Serious
Standard Cited 19100303 G02 I
Issuance Date 1984-10-30
Abatement Due Date 1984-11-02
Current Penalty 65.0
Initial Penalty 65.0
Nr Instances 1
Nr Exposed 1
Citation ID 02001
Citaton Type Other
Standard Cited 19100219 D01
Issuance Date 1984-10-30
Abatement Due Date 1984-11-02
Nr Instances 1
Nr Exposed 1
Citation ID 02002
Citaton Type Other
Standard Cited 19100132 A
Issuance Date 1984-10-30
Abatement Due Date 1984-11-02
Nr Instances 1
Nr Exposed 1

Tax Exempt

EIN Type of Organization Exempt Organization Status Address Ruling Date
41-1299857 Corporation Unconditional Exemption PO BOX 38, CLARISSA, MN, 56440-0038 1978-09
In Care of Name -
Group Exemption Number 0000
Subsection Charitable Organization, Educational Organization, Literary Organization, Organization to Prevent Cruelty to Animals, Organization to Prevent Cruelty to Children, Organization for Public Safety Testing, Religious Organization, Scientific Organization
Affiliation Independent - This code is used if the organization is an independent organization or an independent auxiliary (i.e., not affiliated with a National, Regional, or Geographic grouping of organizations).
Classification Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Deductibility Contributions are deductible.
Foundation Hospital or medical research organization 170(b)(1)(A)(iii)
Tax Period 2023-09
Asset 1,000,000 to 4,999,999
Income 5,000,000 to 9,999,999
Filing Requirement 990 (all other) or 990EZ return
PF Filing Requirement No 990-PF return
Accounting Period Sep
Asset Amount 3279580
Income Amount 5871241
Form 990 Revenue Amount 5871241
National Taxonomy of Exempt Entities -
Sort Name -

Publication 78 Data
Description Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions.
On Publication 78 Data List Yes
Deductibility Type of organization and use of contribution: A public charity. Deductibility Limitation: 50% (60% for cash contributions)

Copies of Returns (990, 990-EZ, 990-PF, 990-T)
Organization Name CENTRAL TODD COUNTY CARE CENTER INC
EIN 41-1299857
Tax Period 202109
Filing Type E
Return Type 990
File View File
Organization Name CENTRAL TODD COUNTY CARE CENTER INC
EIN 41-1299857
Tax Period 201909
Filing Type P
Return Type 990
File View File
Organization Name CENTRAL TODD COUNTY CARE CENTER INC
EIN 41-1299857
Tax Period 201909
Filing Type P
Return Type 990
File View File
Organization Name CENTRAL TODD COUNTY CARE CENTER INC
EIN 41-1299857
Tax Period 201809
Filing Type P
Return Type 990
File View File
Organization Name CENTRAL TODD COUNTY CARE CENTER INC
EIN 41-1299857
Tax Period 201709
Filing Type P
Return Type 990
File View File
Organization Name CENTRAL TODD COUNTY CARE CENTER INC
EIN 41-1299857
Tax Period 201609
Filing Type P
Return Type 990
File View File

Motor Carrier Census

USDOT Number Carrier Operation MCS-150 Form Date MCS-150 Mileage MCS-150 Year Power Units Drivers Operation Classification
4071458 Intrastate Non-Hazmat 2023-05-04 - - 1 1 Exempt For Hire, Priv. Pass. (Business)
Legal Name CENTRAL TODD COUNTY CARE CENTER INC
DBA Name -
Physical Address 406 HIGHWAY 71 E , CLARISSA, MN, 56440-2000, US
Mailing Address 406 HIGHWAY 71 E , CLARISSA, MN, 56440-2000, US
Phone (218) 756-3636
Fax (218) 756-2276
E-mail JPOLOVICK@CTCCCINC.COM

Safety Measurement System - All Transportation
Total Number of Inspections for the measurement period (24 months) 0
Driver Fitness BASIC Serious Violation Indicator No
Vehicle Maintenance BASIC Acute/Critical Indicator No
Unsafe Driving BASIC Acute/Critical Indicator No
Driver Fitness BASIC Roadside Performance measure value 0
Hours-of-Service (HOS) Compliance BASIC Roadside Performance measure value 0
Total Number of Driver Inspections for the measurment period 0
Vehicle Maintenance BASIC Roadside Performance measure value 0
Total Number of Vehicle Inspections for the measurement period 0
Controlled Substances and Alcohol BASIC Roadside Performance measure value 0
Unsafe Driving BASIC Roadside Performance Measure Value 0
Number of inspections with at least one Driver Fitness BASIC violation 0
Number of inspections with at least one Hours-of-Service BASIC violation 0
Total Number of Driver Inspections containing at least one Driver Out-of-Service Violation 0
Number of inspections with at least one Vehicle Maintenance BASIC violation 0
Total Number of Vehicle Inspections containing at least one Vehicle Out-of-Service violation 0
Number of inspections with at least one Controlled Substances and Alcohol BASIC violation 0
Number of inspections with at least one Unsafe Driving BASIC violation 0

Safety Measurement System - Passenger Transportation
Total Number of Inspections for the measurement period (24 months) 0
Driver Fitness BASIC Acute/Critical Indicator No
Driver Fitness BASIC Roadside Performance Percentile Less than 5 driver inspections
Vehicle Maintenance BASIC Acute/Critical Indicator No
Vehicle Maintenance BASIC Roadside Performance Percentile Less than 5 vehicle inspections
Controlled Substances and Alcohol BASIC Acute/Critical Indicator No
Unsafe Driving BASIC Acute/Critical Indicator No
Controlled Substances and Alcohol BASIC Roadside Performance Percentile 0%
Unsafe Driving BASIC Roadside Performance Percentile 0%
Driver Fitness BASIC Roadside Performance measure value 0
Hours-of-Service (HOS) Compliance BASIC Roadside Performance measure value 0
Total Number of Driver Inspections for the measurment period 0
Driver Fitness BASIC Roadside Performance Over Threshold Indicator No
Vehicle Maintenance BASIC Roadside Performance measure value 0
Total Number of Vehicle Inspections for the measurement period 0
Vehicle Maintenance BASIC Roadside Performance Over Threshold Indicator No
Controlled Substances and Alcohol BASIC Roadside Performance measure value 0
Unsafe Driving BASIC Roadside Performance Measure Value 0
Controlled Substances and Alcohol BASIC Roadside Performance Over Threshold Indicator No
Driver Fitness BASIC Indicator No
Number of inspections with at least one Driver Fitness BASIC violation 0
Number of inspections with at least one Hours-of-Service BASIC violation 0
Unsafe Driving BASIC Roadside Performance Over Threshold Indicator No
Total Number of Driver Inspections containing at least one Driver Out-of-Service Violation 0
Vehicle Maintenance BASIC Indicator No
Number of inspections with at least one Vehicle Maintenance BASIC violation 0
Total Number of Vehicle Inspections containing at least one Vehicle Out-of-Service violation 0
Controlled Substances and Alcohol BASIC Indicator No
Number of inspections with at least one Controlled Substances and Alcohol BASIC violation 0
Unsafe Driving Overall BASIC Indicator No
Number of inspections with at least one Unsafe Driving BASIC violation 0

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Date of last update: 09 Feb 2025

Sources: Minnesota's Official State Website

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