2019-11-01T13:34:39-05:00 2019-06-30 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2018-07-01 450277267 Lutheran Home of the Good Shepherd Inc LUTH 7019472944 1226 First Avenue North New Rockford ND 58356 Kim Jensrud Administrator 7019472944 2019-10-29 1 Lisa Chaffee CPA P00193453 7012398500 2019-10-29 216.147.181.45 2019-10-29 13:33:02 CD P 5A0D2E3E53F79CEC94D1A01C1036EDA8081E530F 3F1B4C4A1C1F32CA3CD03C05270CE62742EA9E6E 2018 2020-01-14 16:20:31Z Kim Jensrud 1226 First Avenue North New Rockford ND 58356 6300918 0 9386 X www.lhgs.org X 1958 ND Nursing facility attending to the residential, health, social and other needs of the elderly and their families in New Rockford, ND. 14 14 180 20 0 0 38370 16768 6827349 6217825 25690 66325 0 0 6891409 6300918 0 0 0 0 4603605 4443661 0 0 0 2610185 2358989 7213790 6802650 -322381 -501732 11194755 10444462 5462792 5194890 5731963 5249572 The mission of the Lutheran Home of the Good Shepherd shall be to provide, in the name of Christ, high-quality long-term care and other services and programs which address the needs of the senior citizen and special needs individual. 0 0 5594071 5895392 The Lutheran Home of the Good Shepherd is an 80-bed care facility with 74 skilled beds and 6 basic care beds that provides routine and ancillary services to its residents in a nondiscriminatory fashion without regard to ability to pay. The home reported 21,975 resident days related to skilled care beds or an occupancy rate of 81% for the recently ended fiscal year. The home reported 1,997 resident days related to basic care beds or an occupancy rate of 91%. 222692 237728 Heritage House is a 16-unit assisted living facility. The facility had an annual occupancy rate of 98%. 70167 84705 Westview Apartments, located in New Rockford, ND, is a 22-unit apartment building for low income individuals. The facility had an annual occupancy rate of 89%. 5886930 1 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 28 0 1 180 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Kim JensrudIrene Cudworth 7019472944 1226 First Avenue North New Rockford ND 58356 Sandy Rudolph President 2.50 X X 0 0 0 Dianne Allmaras Vice President 2.50 X X 0 0 0 Kathryn Fleming Secretary 2.50 X X 0 0 0 Stanley Kruger Treasurer 2.50 X X 0 0 0 Kathleen O'Connor Director 2.50 X 0 0 0 Jane Forde Director 2.50 X 0 0 0 Lona Lutz Director 2.50 X 0 0 0 Nancy Bollingberg Director 2.50 X 0 0 0 Elvie Jones Director 2.50 X 0 0 0 Jeff Labrensz Director 2.50 X 0 0 0 Travis Peterson Director 2.50 X 0 0 0 Bruce Gedrose Director 2.50 X 0 0 0 Dennis Swanson Director 2.50 X 0 0 0 Carol Wolkenhauer Director 2.50 X 0 0 0 Kim Jensrud Administrator 40.00 X 92081 0 14468 Irene Cudworth Accounting Office 40.00 X 56630 0 8903 148711 0 23371 0 0 0 0 Alliance Medical Staffing 5660 N 103rd St Omaha NE 68138 Travel Nurse & CNA services 204847 Prime Time Healthcare 14811 Shephard St Omaha NE 68138 Travel Nurse & CNA services 139350 2 16768 16768 Resident Service Reven 623000 6101235 6101235 Child Care 624410 49782 49782 Cafeteria 900099 29507 29507 37301 37301 6217825 66325 66325 6300918 6217825 0 66325 172476 172476 3542774 3213978 328796 68044 63182 4862 398671 357583 41088 261696 227452 34244 3894 3894 40288 40288 17409 11606 5803 588832 572061 16771 16867 153 16714 215429 123745 91684 49128 49128 227952 214517 13435 27376 18570 8806 236876 218986 17890 493099 461037 32062 51802 14991 36811 Food 246621 246621 Medical Supplies 109563 109563 Bad Debt Expense 20374 20374 13479 12511 968 6802650 5886930 915720 0 2534323 2044601 409536 309679 37571 37898 54020 32922 13852952 8618194 5664112 5234758 2495193 2784604 11194755 10444462 492967 476893 39897 37913 4929928 4680084 5462792 5194890 X 5717703 5249572 14260 0 5731963 5249572 11194755 10444462 -501732 19341 0 X 0 1 X 1 0 X 196163 268444 32794 38370 16768 552539 7081442 6810976 6750328 6827349 6217825 33687920 7277605 7079420 6783122 6865719 6234593 34240459 0 771421 703669 746540 886732 1273207 4381569 771421 703669 746540 886732 1273207 4381569 29858890 28104 56887 52714 25690 66325 229720 28104 56887 52714 25690 66325 229720 7305709 7136307 6835836 6891409 6300918 34470179 0.86620 0.88350 0.00670 0.00480 X 0 1 X 48885 48885 11747703 6926045 4821658 1887790 1585597 302193 168574 106552 62022 5234758 X 6320259 19341 19341 6300918 0 6300918 6802650 0 6802650 0 6802650 Part IV, Line 2b: The Home acts as custodian for the funds of the nursing facility residents. The Home also holds security deposits for tenants of the assisted living and apartments. These funds are included in cash and cash equivalents and accounts payable in the financial statements. Resident trust funds and tenant security deposits totaled $37,913 and $39,897 at June 30, 2019 and 2018. Part X, Line 2: The Home is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Home is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Home is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Home has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Home believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Home would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Form 990, Part VI, Section A, line 1 The Executive Committee consists of the President, Vice President, Treasurer and Secretary. They have the authority of the Board in the management of the affairs of the Corporation between meetings. Form 990, Part VI, Section A, line 6 Area churches are members of the organization and are all members of the same class. Form 990, Part VI, Section A, line 7a The member delegates vote for the Board of Directors at the annual meeting. Form 990, Part VI, Section B, line 11b The Administrator will review a draft copy of the Form 990 prior to presenting the draft Form 990 at a board meeting. The Form 990 will then be reviewed and approved by the Board of Directors prior to it being finalized and filed. Form 990, Part VI, Section B, line 12c Every October board members and officers of the organization are asked to disclose any potential conflicts. The Administrator reviews the forms and each potential conflict is taken to the board. The board will then determine whether or not the member with the potential conflict should be allowed to vote on the issue. If it is determined he or she should not be allowed to vote then they are asked to abstain from voting and leave the meeting. Form 990, Part VI, Section B, line 15a Annually the Executive Committee meets to evaluate the Administrator's performance and compensation. The committee makes recommendations that are brought to the full board. The full Board of Directors approves the Administrator's compensation. The Administrator's compensation is compared with administrators of similar sized nursing homes in North Dakota. This information is obtained from a survey put out by the North Dakota Long Term Care Association. The Administrator evaluates and approves the compensation of the Accounting Officer. The Accounting Officer and all other employees' compensation are based on a pay scale. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available upon request.