2018-03-06T11:08:23-06:00 2017-06-30 450250958 EIDE BAILLY LLP 1730 BURNT BOAT LOOP STE100 BISMARCK ND 585030886 990 2016-07-01 450277390 Beulah Community Nursing Home BEUL 7018733175 118 22nd St NE Beulah ND 58523 Keith Gendreau Administrator 7018733175 2018-02-28 1 Lisa Chaffee CPA P00193453 7012551091 2018-02-28 8.39.233.74 2018-02-28 13:40:36 CS P 38C0D8FF55FA272924E83028D6B9FABEF20E0653 6F0323CC6DBEDCE0B82B8C3F86A795665AB13256 2016 2021-01-29 14:40:06Z Knife River Care Center Keith Gendreau 118 22nd St NE Beulah ND 58523 8612694 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 7 192 150 0 0 438910 128578 8621012 8442105 9161 42011 0 0 9069083 8612694 0 0 0 0 5166294 5140831 0 0 0 4093605 3794234 9259899 8935065 -190816 -322371 9345499 8753675 9678465 9518792 -332966 -765117 X 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 8205100 8442105 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.In order to assure safety for Maintenance and Housekeeping staff, we found it was imperative to purchase a scissor lift. The ceilings at KRCC have 30 foot ceiling sections, and using regular ladders presents huge risk factors. The scissor lift also allows Maintenance to change outdoor light fixtures and access the roof. The Ergo Grant money was received through Workforce Safety Insurance Ergonomic Initiative Program.The Ergonomic Initiative Program offered through Workforce Safety Insurance also provided KRCC the ability to purchase sit to stand workstations for several of our employees. This provides the proper equipment for those employees whose duties involve a great deal of desk duties. The sit to stand workstations provide the opportunity to stretch and change positions in an ergonomic manner.The Ergonomic Initiative Program offered through Workforce Safety Insurance also provided KRCC the opportunity to purchase an EZ Way 800 Pound Smart Stand, including all the necessary equipment for lift operations. In order to accommodate for a bariatric resident, we must ensure we have the proper equipment to safely care for the resident as well as provide safety for the staff caring for the bariatric resident. 8205100 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 11 0 1 192 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 Linda Czywczynski 7018733175 118 22nd St NE Beulah ND 58523 Ed Boger President 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 1.00 X 0 0 0 Bonnie Krause Director (as of Oct) 1.00 X 0 0 0 Bruce Mohl Director (as of Oct) 1.00 X 0 0 0 Darold Bertsch Director (as of Oct) 1.00 X 0 0 0 Keith Gendreau Administrator 40.00 X 112222 0 14030 112222 0 14030 1 0 0 0 Prime Time Healthcare LLC c/o American Natl Bank PO Box 3544 Omaha NE 68103 Agency Nursing 449250 Dakota Travel Nurse Inc 1200 Collins Ave Manadan ND 58554 Agency Nursing 357952 Medical Solutions 1010 102 Street Suite 300 Omaha NE 68114 Agency Nursing 223415 3 11413 117165 128578 Resident Serv. Revenue 623000 8413492 8413492 Other Program Service 623000 28613 28613 8442105 37339 37339 4672 0 4672 4672 4672 8612694 8442105 0 42011 X 140771 14077 126694 4290796 4024803 265993 144650 134106 10544 241303 217439 23864 323311 295359 27952 3827 3827 38635 38635 2675 2675 1291520 1259971 31549 3185 3185 312127 239292 72835 56626 56626 468440 468440 5972 2295 3677 27860 10467 17393 289058 288119 939 728239 728239 61983 61983 Food/Supplement Expense 276380 276380 Pharmacy Expense 98846 98846 Repairs & Maintenance 64521 64521 Bad Debt 7778 7778 56562 12985 43577 8935065 8205100 729965 0 200 200 413762 135689 618770 786416 20411 13872 53756 47121 13601017 6275638 7702880 7325379 535720 444998 9345499 8753675 824660 858354 7307 11476 8307305 8055771 50232 53418 488961 539773 9678465 9518792 X -746261 -1068632 413295 303515 -332966 -765117 9345499 8753675 X -322371 -109780 X 0 1 X 0 0 X 75165 115715 104673 438910 128578 863041 75165 115715 104673 438910 128578 863041 863041 12372 11828 4601 8649 37339 74789 937830 41081426 0.92030 0.94990 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 49707 49707 6358370 2173307 4185063 6710607 3862049 2848558 482333 240282 242051 7325379 Patronage Capital 89350 Custodian Accounts 52133 Interest in NA of Fdtn 303515 444998 X 8612694 0 8612694 0 8612694 8935065 0 8935065 0 8935065 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 $10,183 and $10,083 at June 30, 2017 and 2016. The Care Center also acts as custodian for the Employee's Christmas Club Fund and the Friends Club. Participating employees of the Christmas Club 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 $38,870 and $36,150 at June 30, 2017 and 2016. Funds held for the Friends Club totaled $3,080 at June 30, 2017 and $3,080 at June 30, 2016. 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 649229 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 2017. 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 1,234,396. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,234,396. Consultants : Program service expenses 25,575. Management and general expenses 0. Fundraising expenses 0. Total expenses 25,575. Contracted Services : Program service expenses 0. Management and general expenses 31,549. Fundraising expenses 0. Total expenses 31,549. Form 990, Part XI, line 9: Change in Interest in Assets of Foundation -109,780. Knife River Care Center Friends Club 118 22nd St NE Beulah ND 58523 450277390 Staff Special Events ND 3971 11390 N/A