2017-11-06T10:39:00-06:00 2016-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2016-01-01 460225023 BETHESDA OF BERESFORD BETH 6057632050 606 WEST CEDAR BERESFORD SD 57004 CHERILYN HALLAWAY ADMINISTRATOR 6057632050 2017-10-11 1 LAURIE HANSON P00851848 6053391999 2017-10-11 198.135.124.107 2017-10-11 11:59:39 CD P 974248CA41D94A414E643A61057C2CD568A63DD6 EF8011075554CB02D1779489BD3504755D118D03 2016 2018-03-14 21:41:22Z CHERILYN HALLAWAY 606 WEST CEDAR BERESFORD SD 57004 4094947 0 9386 X WWW.BETHESDASD.COM X 1971 SD ELDERLY HOUSING AND CARE. 9 9 133 50 0 0 0 17495 3814233 4047104 29922 26197 0 0 3844155 4090796 0 1550 0 0 2588595 2462658 0 0 0 1878724 1856039 4467319 4320247 -623164 -229451 4246921 3976164 436624 339904 3810297 3636260 BETHESDA OF BERESFORD IS A CHRISTIAN COMMUNITY DEDICATED TO THE ART OF HEALING AND THE JOY OF CARING. 0 0 3920145 1550 4047104 THE ORGANIZATION PROVIDES FACILITIES AND SERVICES FOR THE ELDERLY THROUGH THE OPERATION OF A 67-BED SKILLED NURSING AND 4-BED ASSISTED LIVING FACILITY. THE ORGANIZATION ALSO PROVIDES FACILITIES AND SERVICES THROUGH THE OPERATION OF A 16-UNIT ELDERLY APARTMENT COMPLEX AND AN OUTPATIENT THERAPY DEPARTMENT. THE FACILITY OPERATES A "LIFE-LINE" TO THE SURROUNDING COMMUNITY, WHICH PROVIDES A SAFER ENVIRONMENT AT HOME FOR THE ELDERLY IN THE AREA. THE FACILITY IS OPERATED TO MEET THE HEALTH AND HOUSING NEEDS OF ITS RESIDENTS. NUMBER OF RESIDENT DAYS 22,382; NUMBER OF ADMISSIONS 45. 3920145 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 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 1 1 0 1 133 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 0 X CHERILYN HALLAWAY 6057632050 606 WEST CEDAR BERESFORD SD 57004 X DON LERSETH CHAIRPERSON 0.30 X X 0 0 0 CINDY MUHLENKORT CHAIRPERSON AT LARGE (BEGAN APRIL 16) 0.30 X X 0 0 0 WAYNE AKLAND VICE-CHAIRPERSON 0.30 X X 0 0 0 CLAIRE ANTONSON SECRETARY/TREASURER 0.30 X X 0 0 0 ELMER HAMMER DIRECTOR 0.30 X 0 0 0 JOHN FAHLBERG AT LARGE DIRECTOR 0.30 X 0 0 0 DRDONALD ABRAHAM DIRECTOR 0.30 X 0 0 0 PASTOR MATT STYLES DIRECTOR 0.30 X 0 0 0 PASTOR STEVE MARTENS DIRECTOR 0.30 X 0 0 0 SCOTT LARSON ADMINISTRATOR 20.00 X 0 0 0 0 0 0 0 0 0 0 SANFORD HEALTH PO BOX 5074 SIOUX FALLS SD 57117 ADMINISTRATION 361279 AVERA EDUCATION & STAFFING 1000 W 4TH ST 9 YANKTON SD 57078 TEMP STAFFING 198876 US FOODS 9399 WEST HIGGINS ROAD SUITE 500 ROSEMONT IL 60018 DIETARY 164448 TRI-STATE NURSING 3100 S LAKEPORT ST SIOUX CITY IA 51106 TEMP STAFFING 137921 4 17495 17495 RESIDENT SERVICE REVEN 623000 3803592 3803592 OTHER REVENUE 900099 243512 243512 4047104 30348 30348 4151 -4151 -4151 -4151 4090796 4047104 0 26197 X 1550 1550 2141546 2051788 89758 6861 6573 288 153047 146632 6415 161204 154685 6519 107535 107535 7150 7150 763742 763742 15382 15382 82747 59209 23538 114354 114354 2035 1718 317 11390 11199 191 214769 214769 93563 93563 FOOD AND DIETARY COST 177273 177273 MEDICAL SUPPLIES 176264 176264 REPAIRS AND MAINTENANCE 39770 39770 MEMBERSHIP DUES 5524 5524 44541 619 43922 4320247 3920145 400102 0 411732 121345 303170 412199 18991 14023 6260269 4318883 2102751 1941386 1410277 1487211 4246921 3976164 418540 323470 18084 16434 436624 339904 X 3810297 3636260 3810297 3636260 4246921 3976164 X -229451 50301 5113 X 0 1 X 1 0 X 8634 7192 5369 0 17495 38690 3891544 3984670 4030819 3814233 4047104 19768370 3900178 3991862 4036188 3814233 4064599 19807060 0 1160009 715744 819329 698864 868530 4262476 1160009 715744 819329 698864 868530 4262476 15544584 27467 27174 26954 37899 30348 149842 27467 27174 26954 37899 30348 149842 3927645 4019036 4063142 3852132 4094947 19956902 0.77890 0.78270 0.00750 0.00720 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 86713 86713 7920 4640054 3372988 1274986 1373019 836003 537016 152563 109892 42671 1941386 X 4141097 50301 50301 4090796 0 4090796 4320247 0 4320247 0 4320247 PART IV, LINE 2B: THE ESCROW ACCOUNT LIABILITY IS INCLUDED ON THE BALANCE SHEET. PART X LINE 21 INCLUDES FUNDS HELD FOR NURSING HOME RESIDENTS FOR ANCILLARY PURCHASES AND TENANT SECURITY DEPOSITS. PART X, LINE 2: THE HOME IS ORGANIZED AS A SOUTH 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, THEY ARE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE HOME HAS DETERMINED THEY ARE 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 IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIRMENTS, 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 3 THE ORGANIZATION HAS A MANAGEMENT CONTRACT WITH SANFORD HEALTH NETWORK. THE ADMINISTRATOR, SCOTT LARSON, IS AN EMPLOYEE OF SANFORD HEALTH. HE RECEIVED COMPENSATION IN THE FOLLOWING AMOUNTS FOR HIS SERVICES TO THE ORGANIZATION: SALARY OF $67,922 AND BENEFITS OF $11,393. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE ORGANIZATION CONSIST OF 13 LUTHERAN CHURCHES. THERE IS ONLY ONE CLASS OF MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A ALL MEMBERS HAVE THE SAME VOTING RIGHTS. THE MEMBERS' ROLE IS TO ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B CHANGES TO BYLAWS REQUIRE APPROVAL OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 8B BETHESDA OF BERESFORD DOES NOT UTILIZE COMMITTEES IN CONJUNCTION WITH ITS BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE ADMINISTRATOR REVIEWS FORM 990 PRIOR TO ITS SUBMISSION. THE BOARD MEMBERS WILL REVIEW THE FORM 990 PRIOR TO ITS SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C PERSONS COVERED BY THE POLICY INCLUDE EVERY BOARD MEMBER, EVERY MEMBER OF ANY BOARD COMMITTEE, ALL OFFICERS OF THE HOME, AND ALL MANAGEMENT PERSONNEL OF THE HOME. COVERED MEMBERS ARE REQUIRED TO SIGN THE CONFLICT OF INTEREST STATEMENT EACH YEAR. THE ADMINISTRATOR RECEIVES AND REVIEWS ALL OF THE ANNUAL CONFLICT OF INTEREST STATEMENTS WHICH LIST ANY AND ALL FINANCIAL AND CONFLICTING INTERESTS. THE CHAIRPERSON OF THE BOARD IS THEN FAMILIARIZED WITH ALL DISCLOSURES IN CASE A CONFLICT ARISES, AND THE VICE CHAIRPERSON OF THE BOARD IS FAMILIARIZED WITH THE CHAIRPERSON'S DISCLOSURE. IF A CONFLICT ARISES, THE BOARD CHAIRPERSON, BOARD COMMITTEE OR THE BOARD MAY ASK THE INTERESTED PERSON TO LEAVE THE MEETING DURING DISCUSSIONS OF THE MATTER, AND THE BOARD MUST APPROVE THE MATTER BY A MAJORITY VOTE, NOT INCLUDING A VOTE OF THE INTERESTED PERSON. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION HAS ONE OFFICER WHO IS PAID BY A MANAGEMENT COMPANY, SANFORD HEALTH. SANFORD HEALTH USES A NATIONAL COMPENSATION SURVEY ALONG WITH A PERFORMANCE REVIEW. SANFORD HEALTH REVIEWS THE COMPENSATION SURVEY AND PERFORMANCE EVALUATION WITH THE BOARD OF DIRECTORS TO DETERMINE PROPER COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G DON SALARY AND BENEFITS: PROGRAM SERVICE EXPENSES 108,021. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 108,021. NURSE TEMPS: PROGRAM SERVICE EXPENSES 44,249. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 44,249. NURSE AIDE TEMPS: PROGRAM SERVICE EXPENSES 476,561. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 476,561. PROFESSIONAL FEES/NURSING: PROGRAM SERVICE EXPENSES 9,449. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,449. MED/A LABS/PROCEDURES: PROGRAM SERVICE EXPENSES 6,105. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,105. CONTRACTED SERVICES/THERAPY: PROGRAM SERVICE EXPENSES 50,742. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,742. DIETARY CONSULTANT: PROGRAM SERVICE EXPENSES 9,345. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,345. CONTRACT SERVICE PAYMENTS: PROGRAM SERVICE EXPENSES 56,042. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 56,042. CONTRACT SERVICE/INN: PROGRAM SERVICE EXPENSES 3,132. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,132. RESIDENT PURCHASES: PROGRAM SERVICE EXPENSES 96. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 96. FORM 990, PART XI, LINE 9: EQUITY TRANSFER FROM BETHESDA OF BERESFORD FOUNDATION 5,113.