BELGRADE NURSING HOME: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- BELGRADE NURSING HOME (EIN 41-0919107)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-07-29
- IRS object ID
- 202222109349300907
- Schema version
- 2020v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-07-29T09:45:43-05:00 | ReturnTs |
| Tax Period End | 2021-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410919107 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELGRADE NURSING HOME | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BELG | BusinessNameControlTxt |
| Phone | 3202548215 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 340 | AddressLine1Txt |
| City | BELGRADE | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56312 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | STEPHANIE FISCHER | PersonNm |
| Person Title | ADMINISTRATOR | PersonTitleTxt |
| Phone | 3202548215 | PhoneNum |
| Signature | 2022-07-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | STEPHANIE | PersonFirstNm |
| Person Last | FISCHER | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2022-07-20 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | STEPHANIE FISCHER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 340 | AddressLine1Txt |
| City | BELGRADE | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56312 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $3,073,292 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c | Yes (X) | Organization501cInd |
| Website Address | HTTPS://WWW.NURSINGHOMESITE.COM/BELGRADE_NURSING_ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1967 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | OUR MISSION IS TO PROVIDE THE HIGHEST LEVEL OF TOTAL CARE POSSIBLE WITH EMPHASIS ON SOCIAL, EMOTIONAL, AND SPIRITUAL NEEDS, AS WELL AS THE PHYSICAL NEEDS OF OUR RESIDENTS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 81 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $112,318 | PYContributionsGrantsAmt |
| CY Contributions Grants | $196,403 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,109,781 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,846,138 | CYProgramServiceRevenueAmt |
| PY Investment Income | $615 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$6,267 | PYOtherRevenueAmt |
| CY Other Revenue | $4,918 | CYOtherRevenueAmt |
| PY Total Revenue | $3,216,447 | PYTotalRevenueAmt |
| CY Total Revenue | $3,047,459 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $1,764,874 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $1,715,621 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,431,573 | PYOtherExpensesAmt |
| CY Other Expenses | $1,311,838 | CYOtherExpensesAmt |
| PY Total Expenses | $3,196,447 | PYTotalExpensesAmt |
| CY Total Expenses | $3,027,459 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $20,000 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $20,000 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $991,065 | TotalAssetsBOYAmt |
| Total Assets EOY | $768,003 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $547,022 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $303,960 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $444,043 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $464,043 | NetAssetsOrFundBalancesEOYAmt |
| Mission | OUR MISSION IS TO PROVIDE THE HIGHEST LEVEL OF TOTAL CARE POSSIBLE WITH EMPHASIS ON SOCIAL, EMOTIONAL, AND SPIRITUAL NEEDS, AS WELL AS THE PHYSICAL NEEDS OF OUR RESIDENTS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $2,628,860 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $2,846,138 | RevenueAmt |
| Desc | BELGRADE NURSING HOME IS A 5 STAR LICENSED SKILLED NURSING FACILITY. THE FACILITY HAS 44 LICENSED BEDS WITH AN AVERAGE DAILY CENSUS OF 26. THE FACILITY PROVIDES SHORT-TERM AND LONG-TERM CARE SERVICES THAT INCLUDE OUTPATIENT THERAPY, ADULT DAY SERVICES, AND RESPITE CARE. WE PRIDE OURSELVES ON EXCELLENT QUALITY OF CARE. | Desc |
| Total Program Service Expenses | $2,628,860 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | 0 | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 11 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 81 | EmployeeCnt |
| Employment Tax Returns Filed | 0 | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 3202548215 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 340 | AddressLine1Txt |
| City | BELGRADE | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56312 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (6 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|
| STEPHANIE FISCHER | ||||||
| ADMINISTRATOR | 40.00 | Yes (X) | $81,421 | $0 | $5,610 | |
| SANDRA WESTABY | ||||||
| PRESIDENT & CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| TRUDY LIESER | ||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |
| LOWELL HOLLEN | ||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |
| JIM LEMMER | ||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |
| ANN WINGER | ||||||
| DIRECTOR | 0.50 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $81,421 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $5,610 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRIME TIME HEALTHCARE LLC | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 15380 WEIT ST | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 68137 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | NURSING SERVICES | ServicesDesc |
| Compensation | $261,741 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $196,403 | GovernmentGrantsAmt |
| Total Contributions | $196,403 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | RESIDENT REVENUE | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $2,846,138 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,846,138 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,846,138 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $27,027 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $25,833 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,194 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,194 | TotalRevenueColumnAmt |
| Exclusion | $1,194 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,724 | TotalRevenueColumnAmt |
| Exclusion | $3,724 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $3,724 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,047,459 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,846,138 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $4,918 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,346 | TotalAmt |
| Program Services | $16,242 | ProgramServicesAmt |
| Management And General | $70,104 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,360,622 | TotalAmt |
| Program Services | $1,360,622 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $268,653 | TotalAmt |
| Program Services | $261,213 | ProgramServicesAmt |
| Management And General | $7,440 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,017 | TotalAmt |
| Management And General | $2,017 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,413 | TotalAmt |
| Management And General | $46,413 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,512 | TotalAmt |
| Management And General | $25,512 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $451,670 | TotalAmt |
| Program Services | $451,670 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,352 | TotalAmt |
| Management And General | $22,352 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,149 | TotalAmt |
| Program Services | $80,476 | ProgramServicesAmt |
| Management And General | $57,673 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,206 | TotalAmt |
| Program Services | $128,149 | ProgramServicesAmt |
| Management And General | $1,057 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,564 | TotalAmt |
| Management And General | $1,564 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,439 | TotalAmt |
| Management And General | $14,439 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,089 | TotalAmt |
| Program Services | $1,089 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,561 | TotalAmt |
| Program Services | $22,849 | ProgramServicesAmt |
| Management And General | $2,712 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,243 | TotalAmt |
| Management And General | $34,243 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $125,260 | $13,284 | $111,976 |
| SURCHARGE | $123,860 | $123,860 | |
| FOOD | $71,148 | $71,148 | |
| EQUIPMENT RENTAL | $68,937 | $68,937 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,418 | TotalAmt |
| Program Services | $29,321 | ProgramServicesAmt |
| Management And General | $1,097 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,027,459 | TotalAmt |
| Program Services | $2,628,860 | ProgramServicesAmt |
| Management And General | $398,599 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $457,120 | BOYAmt |
| EOY | $234,716 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,852 | BOYAmt |
| EOY | $49,146 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $318,629 | BOYAmt |
| EOY | $334,073 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,171 | BOYAmt |
| EOY | $29,539 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $776,626 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $665,925 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $131,448 | BOYAmt |
| EOY | $110,701 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,845 | BOYAmt |
| EOY | $9,828 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $991,065 | BOYAmt |
| EOY | $768,003 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $331,269 | BOYAmt |
| EOY | $242,927 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,999 | BOYAmt |
| EOY | $23,279 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,754 | BOYAmt |
| EOY | $37,754 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $547,022 | BOYAmt |
| EOY | $303,960 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $444,043 | BOYAmt |
| EOY | $464,043 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $444,043 | BOYAmt |
| EOY | $464,043 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $991,065 | BOYAmt |
| EOY | $768,003 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $20,000 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $23,600 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus1 Year | $112,318 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $196,403 | CurrentTaxYearAmt |
| Total | $332,321 | TotalAmt |
Tax Rev Levied Orgnztnl Bnft509 TaxRevLeviedOrgnztnlBnft509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,195,003 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,361,316 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,108,608 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,109,781 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $2,846,138 | CurrentTaxYearAmt |
| Total | $15,620,846 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,218,603 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,361,316 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,108,608 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,222,099 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,042,541 | CurrentTaxYearAmt |
| Total | $15,953,167 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $382,488 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $370,443 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $397,631 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $385,853 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $406,275 | CurrentTaxYearAmt |
| Total | $1,942,690 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $382,488 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $370,443 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $397,631 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $385,853 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $406,275 | CurrentTaxYearAmt |
| Total | $1,942,690 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $14,010,477 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $38 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $672 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $21,485 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15,426 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $27,027 | CurrentTaxYearAmt |
| Total | $64,648 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $38 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $672 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $21,485 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $15,426 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $27,027 | CurrentTaxYearAmt |
| Total | $64,648 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $48,566 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $5,895 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $10,916 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,635 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,724 | CurrentTaxYearAmt |
| Total | $70,736 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,267,207 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,367,883 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,141,009 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,239,160 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $3,073,292 | CurrentTaxYearAmt |
| Total | $16,088,551 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.87080 | PublicSupportCY509Pct |
| Investment Income CY | 0.00400 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $158,636 | OtherCostOrOtherBasisAmt |
| Depreciation | $102,286 | DepreciationAmt |
| Book Value | $56,350 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $560,033 | OtherCostOrOtherBasisAmt |
| Depreciation | $505,682 | DepreciationAmt |
| Book Value | $54,351 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $57,957 | OtherCostOrOtherBasisAmt |
| Depreciation | $57,957 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $110,701 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | THIRD PARTY SETTLEMENT | Desc |
| Amt | $37,754 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $37,754 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $3,073,292 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $25,833 | OtherRevenueAmt |
| Revenue Not Reported | $25,833 | RevenueNotReportedAmt |
| Revenue Subtotal | $3,047,459 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $3,047,459 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $3,053,292 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $25,833 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $25,833 | ExpensesNotReportedAmt |
| Expenses Subtotal | $3,027,459 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $3,027,459 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 25,833. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 25,833. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF THE 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | A SIGNIFICANT TRANSACTION, OR A TRANSACTION THAT REQUIRES CONTRACTUAL ARRANGEMENT, WILL, AT THE OPTION OF THE BOARD, BE SUBJECT TO LEGAL REVIEW FOR COMPLIANCE WITH CONFLICT OF INTEREST REQUIREMENTS. IN THE EVENT OF A CONFLICT OF INTEREST BY A MEMBER OF THE BOARD OF DIRECTORS, THE MEMBERS IN THE POTENTIAL CONFLICT WILL REFRAIN FROM VOTING ON MATTERS THAT COULD RESULT IN A CONFLICT OF INTEREST OF THEIR PERSONAL INTEREST AND THAT OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD ANNUALLY REVIEWS AND APPROVES THE COMPENSATION OF THE ADMINISTRATOR. DURING THE REVIEW COMPARABILITY DATA FROM THE STATE IS TAKEN INTO ACCOUNT ALONG WITH THE BUDGET AVAILABLE. |
| FORM 990, PART VI, SECTION C, LINE 19 | FORM 990 IS MADE AVAILABLE TO PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | NURSING SERVICES: PROGRAM SERVICE EXPENSES 312,136. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 312,136. THERAPY SERVICES: PROGRAM SERVICE EXPENSES 122,563. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 122,563. DIETICIAN SERVICES: PROGRAM SERVICE EXPENSES 2,453. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,453. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 14,518. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,518. |
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