BEULAH COMMUNITY NURSING HOME: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
BEULAH COMMUNITY NURSING HOME (EIN 45-0277390)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-03-15
IRS object ID
201410749349300506
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-03-15T10:11:08-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN450250958EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1914AddressLine1
CityBISMARCKCity
StateNDState
ZIP Code585021914ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN450277390EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Beulah Community Nursing HomeBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlBEULNameControl
Phone7018734322Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1118 22nd St NEAddressLine1
CityBeulahCity
StateNDState
ZIP Code58523ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKeith GendreauName
TitleAdministratorTitle
Phone7018734322Phone
Date Signed2014-03-06DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLisa Chaffee CPAName
PTINP00193453PTIN
Phone7012551091Phone
Date Prepared2014-03-03DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1Knife River Care CenterBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonKeith GendreauNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1118 22nd St NEAddressLine1
CityBeulahCity
StateNDState
ZIP Code58523ZIPCode
FieldValueIRS element (for citing)
Gross Receipts7556766GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.krcc-nd.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1960YearFormation
State Legal DomicileNDStateLegalDomicile
Activity Or Mission DescriptionDedicated to providing the best nursing home facility for our residents.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees201TotalNbrEmployees
Total Nbr Volunteers150TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year88938ContributionsGrantsPriorYear
Contributions Grants Current Year75165ContributionsGrantsCurrentYear
Program Service Revenue Prior Year7217539ProgramServiceRevenuePriorYear
Program Service Revenue CY7469219ProgramServiceRevenueCY
Investment Income Prior Year9710InvestmentIncomePriorYear
Investment Income Current Year12382InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year7316187TotalRevenuePriorYear
Total Revenue Current Year7556766TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4668884SalariesEtcPriorYear
Salaries Etc Current Year4635154SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3234316OtherExpensePriorYear
Other Expenses Current Year3046307OtherExpensesCurrentYear
Total Expenses Prior Year7903200TotalExpensesPriorYear
Total Expenses Current Year7681461TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-587013RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-124695RevenuesLessExpensesCY
Total Assets BOY11090091TotalAssetsBOY
Total Assets EOY10386639TotalAssetsEOY
Total Liabilities BOY10958203TotalLiabilitiesBOY
Total Liabilities EOY10411902TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY131888NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-25263NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionThe Beulah Community Nursing Home (DBA Knife River Care Center) is dedicated to providing the best nursing home facility for our present and future residents and to safeguard and preserve the dignity of the residents and their families without discrimination. Excellence is our standard and we will make every effort to always provide the tools and support the associates need to do their jobs. Our aim is to persist on being better tomorrow and every day thereafter. Leading the way to a new culture change, we will work boldly to become a world-class organization.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense7069439Expense
Revenue7469219Revenue
DescriptionBeulah 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.Description
Total Program Service Expense7069439TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10966NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees201NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Linda CzywczynskiBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7018733175TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1118 22nd St NEAddressLine1
CityBeulahCity
StateNDState
ZIP Code58523ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (8 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
Fred Stern
President1.00XX000
Bruce Schmidt
Vice-President1.00XX000
Mary Lou Horning
Secretary1.00XX000
Dena Kemmet
Director1.00X000
Dale Gilje
Director1.00X000
Michelle Anderson
Director1.00X000
Max Miller
Director1.00X000
Keith Gendreau
Administrator40.00X10039308633
FieldValueIRS element (for citing)
Total Reportable Comp From Org100393TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation8633TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
All Other Contributions75165AllOtherContributions
Total Contributions75165TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Resident Serv. Revenue62300074209177420917
Other Program Service6230004830248302
FieldValueIRS element (for citing)
Total Program Service Revenue7469219TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column12372TotalRevenueColumn
Exclusion$12,372ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other10Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other10Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column10TotalRevenueColumn
Exclusion$10ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column7556766TotalRevenueColumn
Related Or Exempt Function Income7469219RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$12,382ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total107633Total
Program Services10763ProgramServices
Management And General96870ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total3914993Total
Program Services3659047ProgramServices
Management And General255946ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total136541Total
Program Services127005ProgramServices
Management And General9536ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total192345Total
Program Services171158ProgramServices
Management And General21187ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total283642Total
Program Services259283ProgramServices
Management And General24359ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total3139Total
Management And General3139ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total36878Total
Management And General36878ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total3700Total
Program Services3700ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total693680Total
Program Services693680ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total3878Total
Management And General3878ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total312753Total
Program Services253368ProgramServices
Management And General59385ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total49135Total
Management And General49135ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total376596Total
Program Services376596ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total1303Total
Program Services83ProgramServices
Management And General1220ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total44126Total
Program Services27350ProgramServices
Management And General16776ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total366758Total
Program Services366758ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total679581Total
Program Services679581ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total61601Total
Program Services61601ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Food & Dietary233781233781
Medical & Pharmacy108559108559
Repairs & Maintenance6430064300
Other Resident Expenses3458286933713

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total-28043Total
Program Services-28043ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total7681461Total
Program Services7069439ProgramServices
Management And General612022ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY200BOY
EOY200EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY58938BOY
EOY133787EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY662020BOY
EOY524760EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY24046BOY
EOY19155EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY30812BOY
EOY32301EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis12209572LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec3470659LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY9337050BOY
EOY8738913EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY514273BOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY462752BOY
EOY937523EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11090091BOY
EOY10386639EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY856047BOY
EOY627666EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY8562BOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY8607203BOY
EOY8401244EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY44876BOY
EOY51813EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1441515BOY
EOY1331179EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY10958203BOY
EOY10411902EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-382385BOY
EOY-507080EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY514273BOY
EOY481817EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY131888BOY
EOY-25263EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11090091BOY
EOY10386639EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-124695ReconcilationRevenueExpenses
Reconcilation Other Changes-32456ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee0AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org170b1 AviXPubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years58685CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years111878CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years41261CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year88938CurrentTaxYearMinus1Year
Current Tax Year75165CurrentTaxYear
Total375927Total

Total170 Total170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years58685CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years111878CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years41261CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year88938CurrentTaxYearMinus1Year
Current Tax Year75165CurrentTaxYear
Total375927Total
FieldValueIRS element (for citing)
Amounts Subst Contributors Total42424AmountsSubstContributorsTotal
Public Support Total170333503PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10454CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5169CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years12764CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year5996CurrentTaxYearMinus1Year
Current Tax Year12372CurrentTaxYear
Total46755Total
FieldValueIRS element (for citing)
Total Support422682TotalSupport
Gross Receipts From Admissions Etc35426524GrossReceiptsFromAdmissionsEtc
Public Support Pertcentage1700.78900PublicSupportPertcentage170
Public Support Pertcent Prior Year0.86440PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170XThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS
Explanation In Part XIIIXExplanationInPartXIII

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis49707OtherCostOrOtherBasis
Book Value49707BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5548523OtherCostOrOtherBasis
Depreciation1194709Depreciation
Book Value4353814BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis6125754OtherCostOrOtherBasis
Depreciation2133936Depreciation
Book Value3991818BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis485588OtherCostOrOtherBasis
Depreciation142014Depreciation
Book Value343574BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings8738913TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
Deferred Financing Costs326938
Patronage Capital78003
Custodian Accounts50765
Interest in Net Assets of Knife River Care Center Foundation481817
FieldValueIRS element (for citing)
Total Book Value Other Assets937523TotalBookValueOtherAssets
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt7481766TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal7481766RevenueSubtotal
Other Revenues Not Included75000OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt75000RevenueNotRptdOnFinStmt
Total Revenue Per Form9907556766TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt7681461TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal7681461ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9907681461TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
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. The Care Center also acts as custodian for the Employees Christmas Club Fund and the Friends Club. Participating employees authorize the Care Center to withhold funds from the 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.
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.Description of Uncertain Tax Positions Under FIN 48:
Contributions Transferred From Foundation 75,000.Part XI, Line 4b - Other Adjustments:

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1City of Beulah North DakotaBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN450276796IssuerEIN
Date Issued2006-04-06DateIssued
Issue Price9230000IssuePrice
Description Of PurposeTo refund bonds issued 12/29/2005 and Knife River Care Center New Facility PDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Total Proceeds9230000TotalProceeds
Capitalized Interest390692CapitalizedInterest
Capital Expenditures8839308CapitalExpenditures
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs0NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiled
Rebate Not Due Yet0RebateNotDueYet
Exception To Rebate0ExceptionToRebate
No Rebate Due1NoRebateDue
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs0WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective Action0ProcToUndertkCorrectiveAction

Form990 Schedule K Part VI Form990ScheduleKPartVI (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Schedule K Part IV, Arbitrage, Line 2cDate Rebate Computation PerformedIssuer Name: City of Beulah, North Dakota Date the Rebate Computation was Performed: 04/06/2011
Part IV of Schedule KNo arbitrage calculation was performed since no bond proceeds were held for investment in reserve funds and all proceeds were spent within the temporary periods.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 6Membership: 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 7aMember Voting Rights: The members of the organization vote yearly to elect the board of directors.
Form 990, Part VI, Section A, line 8bCommittees - There are no committees in place that may act on behalf of the board.
Form 990, Part VI, Section B, line 11Form 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 12cProcedures 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 15aAdministrator 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 2012. 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 19The organization's governing documents, conflict of interest policy and financial statements are available if specifically requested.
Form 990, Part XI, line 9:Change in Interest in Assets of Foundation -32,456.Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Knife River Care Center Friends ClubBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1118 22nd St NEAddressLine1
CityBeulahCity
StateNDState
ZIP Code58523ZIPCode
FieldValueIRS element (for citing)
EIN450277390EIN
Primary ActivitiesStaff Special EventsPrimaryActivities
Legal Domicile StateNDLegalDomicileState
Total Income10961TotalIncome
EOY Assets12810EOYAssets
Direct Controlling Entity NAN/ADirectControllingEntityNA

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