2015-12-15T09:21:19-06:00 2015-06-30 450250958 EIDE BAILLY LLP PO BOX 1914 BISMARCK ND 585021914 990 2014-07-01 450277390 Beulah Community Nursing Home BEUL 7018733175 118 22nd St NE Beulah ND 58523 Keith Gendreau Administrator 7018733175 2015-11-25 1 Lisa Chaffee CPA P00193453 7012551091 2015-11-25 2014 2016-03-07 17:11:31Z Knife River Care Center Keith Gendreau 118 22nd St NE Beulah ND 58523 8565244 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 7 222 158 0 0 115715 104673 8094051 8455039 11955 5532 0 0 8221721 8565244 0 0 0 0 5116715 4989883 0 0 0 3139354 3589378 8256069 8579261 -34348 -14017 10039480 9868120 10092617 9632183 -53137 235937 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 7885709 8455039 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 meet State and Federal requirements for electronic health records, Knife River Care Center was able to qualify for a 1% loan through the Bank of North Dakota. While this isn't a grant, the 1% loan provides a more affordable method for Knife River Care Center to meet the State and Federal EMR mandates. KRCC continues to pay off this low interest EMR loan. Due to the proximity of oil fields in the Beulah area, Knife River Care Center is experiencing staffing shortages. The State provided a calculation method to determine how much money could be allocated to oil field long term care facilities. Knife River Care Center was fortunate to receive an amount based upon our census and area population of $49,431. These monies were earmarked to offset our extensive Contract Agency expense. 7885709 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 8 0 1 222 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 Fred Stern President 1.00 X X 0 0 0 Dena Kemmet Vice President 1.00 X X 0 0 0 Carla Borlaug Director thru 10/2014)/Secretary (as of 10/2014) 1.00 X X 0 0 0 Mary Lou Horning Secretary thru 10/2014)/Director (as of 10/2014) 1.00 X X 0 0 0 Michelle Anderson Director 1.00 X 0 0 0 Max Miller Director 1.00 X 0 0 0 Ed Boger Director (as of Oct 2014) 1.00 X 0 0 0 Dale Gilje Director (thru Oct 2014) 1.00 X 0 0 0 Keith Gendreau Administrator 40.00 X 113209 0 17272 113209 0 17272 1 0 0 0 0 49431 55242 104673 Resident Serv. Revenue 623000 8410350 8410350 Other Program Service 623000 44689 44689 8455039 4601 4601 931 0 931 931 931 8565244 8455039 0 5532 X 123211 12321 110890 4194731 3963740 230991 131771 122121 9650 223643 169039 54604 316527 293412 23115 13600 13600 28132 28132 2305 2305 1046952 1018414 28538 3719 3719 307418 254598 52820 60783 60783 383516 383516 3424 1459 1965 32423 15240 17183 338969 337854 1115 726882 726882 59510 59510 Food & Dietary 295298 295298 Medical & Pharmacy 103771 103771 Repairs & Maintenance 80364 80364 Bad Debt 33065 33065 69247 15105 54142 8579261 7885709 693552 0 200 200 89123 192751 605753 650100 28453 18842 47944 40846 12624376 4866119 8340329 7758257 927678 1207124 10039480 9868120 752976 735579 8188676 7968274 52233 50370 1098732 877960 10092617 9632183 X -541428 -555445 488291 791382 -53137 235937 10039480 9868120 X -14017 303091 X 0 1 X 0 0 X 41261 88938 75165 115715 104673 425752 41261 88938 75165 115715 104673 425752 534 425218 12764 5996 12372 11828 4601 47561 473313 38447517 0.89840 0.81340 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 49707 49707 5680130 1657409 4022721 6412206 3009784 3402422 482333 198926 283407 7758257 Deferred Financing Costs 293695 Patronage Capital 72684 Custodian Accounts 49363 Interest in Net Assets of Knife River Care Center Foundation 791382 1207124 X 8510524 0 8510524 54720 54720 8565244 8579261 0 8579261 0 8579261 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 $10,118 and $10,026 at June 30, 2015 and 2014. 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 $36,165 and $38,105 at June 30, 2015 and 2014. Funds held for the Friends Club totaled $3,080 at June 30, 2015 and $3,080 at June 30, 2014. 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. Part XI, Line 4b - Other Adjustments: Contributions Transferred From Foundation 54,720. A City of Beulah North Dakota 450276796 2006-04-06 9230000 To refund bonds issued 12/29/2005 and KRCC New Facility Project 0 0 0 A 1261726 9230000 390692 8839308 2008 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 1 0 0 0 0 A 0 Date Rebate Computation Performed Issuer Name: City of Beulah, North Dakota Date the Rebate Computation was Performed: 04/06/2011 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 11 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. 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 2015. 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 943,123. Management and general expenses 28,538. Fundraising expenses 0. Total expenses 971,661. Consultants: Program service expenses 75,291. Management and general expenses 0. Fundraising expenses 0. Total expenses 75,291. Form 990, Part XI, line 9: Change in Interest in Assets of Foundation 303,091. Knife River Care Center Friends Club 118 22nd St NE Beulah ND 58523 450277390 Staff Special Events ND 7603 11628 N/A