2017-09-26T14:08:12-05:00 2016-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2016-01-01 273111617 Boundary Waters Care Center BOUN 7635375700 200 W Conan St Ely MN 55731 Roger Pekuri President 7635375700 2017-08-28 1 Deb Nelson CPA P01264758 6122536500 2017-08-28 198.135.125.108 2017-08-28 13:23:39 CD P 6C9B1A35775087DBDB8A6D25ECA509C7F6C27838 3F9C168A740BFE5F5D76151F12AACC9E0EB7B57C 2016 2021-01-29 14:40:06Z Roger Pekuri 200 W Conan St Ely MN 55731 3593457 0 X www.boundarywaterscc.com X 2011 MN Provision of long term care for the elderly. 5 5 82 25 0 0 847 300 3016520 3555249 23 65 28190 37843 3045580 3593457 0 0 0 0 1526408 1974710 0 0 0 1280483 1344015 2806891 3318725 238689 274732 1246736 1397254 496041 401158 750695 996096 X Boundary Waters Care Center is committed to the core values of hospitality, stewardship, integrity, respect, and humor. These values, in addition to the significance and impact of the services we provide, determine our priorities, influence our decisions, and represent stability to those we serve. 0 0 2527799 3495792 Boundary Waters Care Center operates a 42-bed nursing facility for the elderly of Ely, Minnesota. The Care Center also provides services designated to meet the physical, social, and psychological needs of the residents. 96088 97300 Boundary Waters Care Center provides meal services to residents and a local non-profit organization through a meals on wheels program. The Care Center also provides dietary services, catering and activity services to the area hospital. 2623887 1 0 0 0 0 0 0 0 0 0 1 0 0 1 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 11 0 1 82 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 MN X Health Dimensions Group 7635375700 4400 Baker Road Suite 100 Minneapolis MN 55343 X Roger Pekuri President 1.00 X X 0 0 0 Joneene Lobe Vice President 1.00 X X 0 0 0 Betty Erickson Director 1.00 X 0 0 0 Mike Forsman Director 1.00 X 0 0 0 Tony Pecha Director 1.00 X 0 0 0 Shelley Solberg thru May Administrator 40.00 X 0 0 0 Adam Masloski from Aug Administrator 40.00 X 0 0 0 0 0 0 0 0 0 0 Health Dimensions Consulting Inc 4400 Baker Road Suite 100 Minneapolis MN 55343 management services 298739 Living Well Therapy 66 East Saint Marie Street Duluth MN 55803 therapy services 108968 Aramark Uniform Services 25259 Network Place Chicago IL 606731252 laundry services 101145 3 300 300 Net Patient Revenue 623000 3438941 3438941 Cafeteria 900099 96073 96073 Other Operating Revenu 900099 20235 20235 3555249 65 65 Debt Forgiveness 900099 37843 37843 37843 3593457 3593092 0 65 1654707 1531657 123050 200 200 180170 162699 17471 139633 122861 16772 268256 268256 36698 36698 12762 12762 168924 120130 48794 15421 15421 110673 81881 28792 40147 40147 81771 66146 15625 870 870 12308 100 12208 4332 4332 20624 20624 20357 20357 Medical Supplies 281675 281675 DHS Surcharge 115884 115884 153313 120230 33083 3318725 2623887 694838 0 119919 225166 272791 347065 22766 32937 316163 66457 260536 249706 570724 542380 1246736 1397254 197949 183535 4666 9125 4086 5073 289340 203425 496041 401158 X 184057 458789 566638 537307 750695 996096 1246736 1397254 X 274732 -29331 X 0 1 X 1 0 X 750 200 3124 847 300 5221 2805499 2540787 2882152 3016520 3555249 14800207 2806249 2540987 2885276 3017367 3555549 14805428 0 1029384 1013091 1148083 1067654 671346 4929558 1029384 1013091 1148083 1067654 671346 4929558 9875870 180 402 8 23 65 678 180 402 8 23 65 678 7683 28190 37843 73716 2814112 2541389 2885284 3045580 3593457 14879822 0.66370 0.00000 X Schedule A, Part III, Line 12, Explanation of Other Income: Miscellaneous Revenue - 2012 Amount: $ 7,683. Revenue from Debt Forgiveness - 2015 Amount: $ 28,190. 2016 Amount: $ 37,843. 0 1 X 215795 21362 194433 100368 45095 55273 249706 Contributed Use of Property 537307 Resident Trust Accounts 5073 542380 X 3618116 33171 29331 62502 3555614 37843 37843 3593457 3381227 62502 62502 3318725 0 3318725 Part IV, Line 2b: Boundary Waters Care Center acts as a custodian for the resident trust account. The funds are used to pay for the residents' personal expenses. Part X, Line 2: The Care Center is organized as a Minnesota not-for-profit 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 Care Center is required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS annually. In addition, the Care Center is subject to income tax on any net income that is derived from business activities that are unrelated to their exempt purpose. 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. 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. Part XI, Line 2d - Other Adjustments: Amortization of promise to give-leased space 29,331. Part XI, Line 4b - Other Adjustments: Gain from Debt Forgiveness Included in Revenue for Tax Reporting 37,843. Form 990, Part VI, Section A, line 3 Boundary Waters Care Center (BWCC) has entered into a contract with Health Dimensions Consulting, Inc. (dba Health Dimensions Group) for certain management services. Shelley Solberg received $64,040 in compensation for services as Administrator and Adam Masloski received $22,000 in compensation for services as Administrator. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The 990 is reviewed by the Financial Services Manager and the Senior Accountant of the management company. The 990 is also provided to Boundary Waters Care Center board for review and approval prior to filing. Form 990, Part VI, Section B, line 12c The organization provides annual training on the code of conduct, which includes the conflict of interest policy. The organization also has a compliance hotline in which any/all complaints are investigated. Board members and key employees are asked to complete a conflict of interest questionnaire annually. Form 990, Part VI, Section B, line 15a Health Dimensions Group (HDG) engages a third party on a periodic basis to conduct market analysis and to provide recommendations on compensation ranges for administrators. The Human Resources department coordinates this activity with the third party vendor, and provides financial recommendations to the HDG CEO. Administrators are not involved with any aspect of conducting market analysis, establishing compensation ranges or determining their respective salary. Form 990, Part VI, Section C, line 19 The governing documents and financial statements are available upon request. Form 990, Part XI, line 9: Amortization of promise to give-leased space -29,331.