2019-05-14T11:50:05-05:00 2018-06-30 450250958 EIDE BAILLY LLP 1730 BURNT BOAT LOOP STE100 BISMARCK ND 585030886 990 2017-07-01 450277390 Beulah Community Nursing Home BEUL 7018733175 118 22nd St NE Beulah ND 58523 Rosanne Schmidt Interim Administrator 7018733175 2019-05-13 1 Lisa Chaffee CPA P00193453 7012551091 2019-05-03 216.147.181.45 2019-05-13 12:55:55 CD P B602D594AFD2B0B327E07A06F36CA6A7E42546D0 38C0D8FF55FA272924E83028D6B9FABEF20E0653 2017 2019-02-21 02:37:17Z Knife River Care Center Rosanne Schmidt 118 22nd St NE Beulah ND 58523 8632711 0 X www.krcc-nd.org X 1960 ND To provide Family-centered compassionate care in a therapeutic and safe environment, where the goal is quality of life. 7 7 175 150 0 0 128578 81480 8442105 8547589 42011 3642 0 0 8612694 8632711 0 0 0 0 5140831 5197315 0 0 0 3794234 3884734 8935065 9082049 -322371 -449338 8753675 8123479 9518792 9342606 -765117 -1219127 Knife River Care Center is dedicated to the preservation of dignity and respect to those we serve and employ. With great compassion, we strive to make excellence our standard. 0 0 8366362 8547589 Beulah Community Nursing Home, d/b/a Knife River Care Center, is a licensed 86-bed Long Term Care Nursing Facility, which provides skilled nursing care to the elderly in the Beulah, North Dakota area. The facility also provides a variety of services, which include, but are not limited to, I.V. therapy, physical therapy, occupational therapy, speech therapy, tube feedings, tracheotomy care, and wound care. The facility provides 24-hour services of a Licensed Social Worker in order to meet the varying psychosocial needs of all residents. Knife River Care Center is a participant in the State and Federal Medicare and Medicaid programs. All costs incurred for the fiscal year were related to providing the necessary services to those individuals who required the support of a long term care facility. 8366362 1 1 0 0 0 0 0 0 1 0 1 0 0 1 0 1 1 0 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 0 1 0 0 0 0 1 7 0 1 175 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X Andrea Block 7018733174 118 22nd St NE Beulah ND 58523 Ed Boger President (thru Oct) 1.00 X X 0 0 0 Darrold Bertsch Director (July-Oct)/President (began Oct) 1.00 X X 0 0 0 Dena Kemmet Vice President 1.00 X X 0 0 0 Mary Lou Horning Secretary 1.00 X X 0 0 0 Max Miller Director (thru Oct) 1.00 X 0 0 0 Bonnie Krause Director 1.00 X 0 0 0 Bruce Mohl Director 1.00 X 0 0 0 Leanne Stiefel Director (began Oct) 1.00 X 0 0 0 Gary Emter Director (began Oct) 1.00 X 0 0 0 Keith Gendreau Administrator (thru May) 40.00 X 129741 0 9196 129741 0 9196 1 0 0 0 Primetime Healthcare PO Box 3544 Omaha NE 68103 Agency Costs 421897 Dakota Travel 1200 Collins Ave Mandan ND 58554 Agency Costs 393134 Medical Solutions 1010 N 102nd St Suite 300 Omaha NE 68114 Agency Costs 130984 3 81480 81480 Resident Service Reven 623000 8469045 8469045 Other Program Service 623000 78544 78544 8547589 697 697 2945 0 2945 2945 2945 8632711 8547589 0 3642 X 116646 11665 104981 4401176 4109437 291739 156960 146120 10840 192260 181287 10973 330273 301671 28602 5090 5090 47050 47050 2348 2348 1245572 1224729 20843 2961 2961 279363 218893 60470 45189 45189 467313 467313 8206 2337 5869 33070 16253 16817 286839 286839 728174 728174 62517 62517 Food/Supplement Expense 259944 259944 Bad Debt 169000 169000 Pharmacy Expense 102942 102942 Repairs & Maintenance 59192 59192 79964 18049 61915 9082049 8366362 715687 0 200 200 135689 154655 786416 767527 13872 9132 47121 57810 13660929 6951169 7325379 6709760 444998 424395 8753675 8123479 858354 889535 11476 15949 8055771 7795676 53418 54306 539773 587140 9518792 9342606 X -1068632 -1517970 303515 298843 -765117 -1219127 8753675 8123479 X -449338 -4672 X 0 1 X 0 0 X 115715 104673 438910 128578 81480 869356 115715 104673 438910 128578 81480 869356 1351 868005 11828 4601 8649 37339 697 63114 932470 42159796 0.93090 0.92030 X 0 1 X 49707 49707 6377346 2441230 3936116 6751543 4245773 2505770 482333 264166 218167 6709760 Patronage Capital 74870 Custodian Accounts 50682 Interest in NA of Fdtn 298843 424395 X 8632711 0 8632711 0 8632711 9082049 0 9082049 0 9082049 Part IV, Line 2b: The Care Center acts as custodian for the funds of the residents. These funds are included in cash and accounts payable in the financial statements. Resident trust funds totaled $10,543 and $10,543 at June 30, 2018 and 2017. The Care Center also acts as custodian for the employees' Christmas club fund. Participating employees authorize the Care Center to withhold funds from each paycheck which are deposited into a fund administered by the Care Center. These funds are included in cash and accrued expenses in the financial statements. The funds are distributed to participating employees in November each year. Funds held by the Care Center totaled $40,456 and $39,779 at June 30, 2018 and 2017. Funds held for the Friends Club totaled $3,307 at June 30, 2018 and $3,096 at June 30, 2018. Part X, Line 2: The Care Center is organized as a North Dakota nonprofit organization 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 Care Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Care Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Care Center 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 Care Center 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 Care Center 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. A City of Beulah North Dakota 450276796 2015-12-11 8705000 To refund bonds issued 04/06/2006 0 0 0 A 677671 8705000 174100 636718 7894182 2015 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0 0 0 A 0 0 0 0 1 0 0 0 0 A 0 Form 990, Part VI, Section A, line 6 Membership: The membership of Knife River Care Center (KRCC) shall be all persons over the age of 18 who are residing within Mercer county and adjacent counties in North Dakota, and family members of residents who are willing to assist the board of directors and officers of KRCC in the operation of KRCC. Form 990, Part VI, Section A, line 7a Member Voting Rights: The members of the organization vote yearly to elect the board of directors. Form 990, Part VI, Section A, line 8b Committees: There are no committees in place that may act on behalf of the board. Form 990, Part VI, Section B, line 11b Form 990 Review: Upon receipt of the draft Form 990, the organization will forward the draft to the board members for their review and comment prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Procedures for addressing the conflict of interest: The chairperson of the board or committee shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. After exercising due diligence, the board or committee shall determine whether Knife River Care Center can obtain a more advantageous transaction with reasonable efforts from a person or entity that would not give rise to a conflict of interest. If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the board or committee shall determine by majority vote of the disinterested directors whether the transaction or arrangement is in Knife River Care Center's best interest and for its own benefit, and whether the transaction is fair and reasonable to Knife River Care Center, and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. Violations of the Conflicts of Interest Policy: If the board or committee has reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose. If after hearing the response of the member and making such further investigation as may be warranted in the circumstances, the board or committee determines that the member has in fact failed to disclose an actual or possible conflict of interest, it shall take appropriate disciplinary and corrective action. Form 990, Part VI, Section B, line 15a Administrator compensation is determined by the independent board of directors. The board uses comparable data from the North Dakota Long Term Care Association in determining the amount of salary to be provided. The deliberation and decision is documented in the board meeting minutes. This process is done annually and was last completed in January of 2018. This same policy would be used with any other officers or key employees of the organization. At the time of filing, the Administrator serves as both the top financial official and the top management official within the organization. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy and financial statements are available if specifically requested. Form 990, Part IX, line 11g Contracted Services: Program service expenses 1,177,561. Management and general expenses 20,843. Fundraising expenses 0. Total expenses 1,198,404. Consultants: Program service expenses 26,168. Management and general expenses 0. Fundraising expenses 0. Total expenses 26,168. International Nurses Fees: Program service expenses 21,000. Management and general expenses 0. Fundraising expenses 0. Total expenses 21,000. Form 990, Part XI, line 9: Change in Interest in Assets of Foundation -4,672. Knife River Care Center Friends Club 118 22nd St NE Beulah ND 58523 450277390 Staff Special Events ND 3174 11497 N/A