2014-07-29T10:05:17-05:00 2013-12-31 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2013-01-01 261087740 Bethany on 42nd BETH 7012393000 201 South University Drive Fargo ND 58103 Shawn Stuhaug President/CEO 7012393000 2014-07-22 1 LISA CHAFFEE CPA P00193453 7012398500 2014-07-22 2013 2015-11-30 17:44:51Z Shawn Stuhaug 201 South University Drive Fargo ND 58103 12791976 0 X www.bethanynd.org X 2007 ND Provide long term care services 11 10 0 168 0 0 300383 2302373 9645689 10463391 -1382 1004 24778 25032 9969468 12791800 0 0 0 0 5176649 5636690 0 0 0 4782820 4992022 9959469 10628712 9999 2163088 26973808 33787283 24405597 29140744 2568211 4646539 X To provide living opportunities in a senior community shaped by Christian values. 0 0 9826061 10463391 Bethany on 42nd operates as a charitable organization consistent with the requirements of Internal Revenue Code Section 501(c)(3). Bethany on 42nd provides long term care services including skilled nursing care, transitional care services, and senior housing with services. Bethany on 42nd does not discriminate against individuals in the admissions process or in the delivery of care with regard to ability to pay for services. The Organization's cash reserves are generally applied to expansion and replacement of existing facilities and equipment, amortization of mortgages, improvement in resident care, training and education, and community benefit activities. The governing board of Bethany on 42nd is made up of prominent leaders in the Fargo-Moorhead community. Volunteerism - coordinates a volunteer program that included 100 volunteers giving 5,750 hours of service, providing mental stimulation and emotional support to Bethany on 42's 118 residents and patients. Volunteers included members of sponsoring churches, experience works program volunteers, and many student volunteers from the community's schools - elementary, middle, high schools and colleges.Assessment and referral services - our staff help to refer individuals needing long term care services to the appropriate agency in the community. Bethany on 42nd's licensed social workers provide guidance with medical assistance applications for residents/families.Community support - Bethany on 42nd provides meeting room space and accommodations for non-profit organizations and community groups. Several of our resident activity programs are open to community members. Facility space is open to use by outside groups for meetings, performances, activities, funeral/memorials services, music recitals, etc. Meals are provided for family members of Bethany on 42nd residents at a reduced cost. Bethany on 42nd organizes employee participation in fundraising activities for United Way and the Alzheimer's Association. There are also representatives from Bethany on 42nd on non-profit boards and civic organizations that work to improve the quality of life in the Fargo-Moorhead area. Bethany's President/CEO serves on HERO's (Health Equipment Recycling Organization) Board of Directors and the Fargo Dome Finance Committee. He also serves on various committees of the North Dakota Long Term Care Association (NDLTCA). The Senior Executive of Resident Care serves as Director of Region VI of the National Association of Directors of Nursing Association (NADONA), Resident Issues Committee of the NDLTCA, and as a NCLEX test reviewer/item review for the National Boards of Nursing. Bethany's Chief Financial Officer serves on the board of Hospice of the Red River Valley and the Funding/Reimbursement Committee of the NDLTCA. The Senior Executive of Medicare/Contracted Services serves on the board for the (NADONA). Bethany's Senior Executive of Support Services is on the Dietetics Advisory Committee for North Dakota State University. The Senior Executive of Housing/Assisted Living is a Board member of the Fargo West Rotary service club, serves as the Assisted Living Director at Large on the NDLTCA Board, represents North Dakota as a State Leader for NCAL (National Center for Assisted Living), and serves on the NCAL Quality and Non-Profit Committees. The Senior Executive of Development and Community Relations serves on the Education Committee and chairs the Senior Level Task Force for the Association of Lutheran Development Executives. Bethany's Director of Bethany Personal Care Services is on the Advisory Board for the North Dakota State University Nursing program and the Senior Executive of Resident Care is on the NADONA membership committee.The following is specific information relating to Bethany on 42nd's care provided:Bethany on 42nd Skilled/TCU Care - services provided, 65 nursing home beds: 23,664 days of care, and 13 TCU beds: 4,294 days of care. Total Skilled/TCU employee hours - 257,498. (Total Expenses = 9,100,491)Bethany Gables - senior housing with services, 40 units - 13,902 days of care and 14,186 employee hours (total expenses = 1,177,504) 9826061 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 25 0 1 0 0 0 0 0 0 0 0 0 0 0 X 11 10 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X Jane Kelly 7012393226 201 South University Drive Fargo ND 58103 X Martha Leclerc Chair (Jan-Mar) 1.00 3.00 X X 0 0 0 Lloyd Smith Vice Chair(Jan-Mar)/Chair 1.00 3.00 X X 0 0 0 John Hertsgaard Trustee (Jan-Mar)/Vice Chair 1.00 3.00 X X 0 0 0 Roger Olson Trustee (Jan-Mar)/Treas 1.00 3.00 X X 0 0 0 Jean Bokinskie Trustee (Jan-Mar)/Secretary 1.00 3.00 X X 0 0 0 Janice Nelson Treasurer (Apr-Dec) 1.00 3.00 X X 0 0 0 David Glatt Secretary (Jan-Mar)/Trustee 2.00 4.00 X X 3720 8280 0 Shannon Charpentier Trustee 1.00 3.00 X 0 0 0 Harriette McCaul Trustee 1.00 3.00 X 0 0 0 Paul Wilson Trustee (Jan-Mar) 1.00 3.00 X 0 0 0 Jerilynn Brantner-Adams Trustee 1.00 3.00 X 0 0 0 Al Erickson Trustee (Apr-Dec) 1.00 3.00 X 0 0 0 Stacie Heiden Trustee (Apr-Dec) 1.00 3.00 X 0 0 0 Linda O'Halloran Trustee (Apr-Dec) 1.00 3.00 X 0 0 0 Shawn Stuhaug President/CEO 2.00 48.00 X 0 214193 28449 Jane Kelly CFO 3.00 47.00 X 0 163834 16124 3720 386307 44573 0 0 1 1 Meinecke Johnson Co PO Box 2643 Fargo ND 58108 Expansion General Contractor 4815155 RehabCare Group Inc PO Box 503534 St Louis MO 631503534 Contract Therapy 591488 YHR Partners 420 Main Ave Moorhead MN 56560 Design of 42nd Skilled Expansion 133750 3 2296293 6080 2302373 Resident Service Rev 623000 10112638 10112638 Other Income 900099 350753 350753 10463391 1180 1180 25032 0 25032 25032 25032 176 -176 -176 -176 12791800 10463391 0 26036 3720 3720 4695522 4348605 346917 59209 50369 8840 533333 490304 43029 344906 319455 25451 62591 62591 962913 962913 706385 532822 173563 490245 490245 48033 48033 30006 25197 4809 970588 970588 1238604 1238604 126530 126530 Medical Supplies 334104 334104 Bad Debt Expense 11102 11102 Memberships 10633 10633 288 288 10628712 9826061 802651 0 782879 1865405 826825 794634 88845 86778 91995 101133 33631418 4604106 23816786 29027312 236057 151297 1130421 1760724 26973808 33787283 723431 1895021 15483838 18823624 3804 3500 18491 420232 411179 7755801 8007420 24405597 29140744 X 2332154 4495242 236057 151297 2568211 4646539 26973808 33787283 X 2163088 -84760 X 0 1 X 1 0 X 917669 1992 224894 300383 2302373 3747311 6900816 9449579 9645689 10463391 36459475 917669 6902808 9674473 9946072 12765764 40206786 0 237586 173925 89059 500570 237586 173925 89059 500570 39706216 19281 30153 25753 25032 100219 19281 30153 25753 25032 100219 917669 6922089 9704626 9971825 12790796 40307005 0.98510 0.98150 0.00250 0.00240 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 897206 897206 21599273 3165844 18433429 2913233 1201641 1711592 8221706 236621 7985085 29027312 Bed Licenses 1385000 Deferred Financing Costs 375724 1760724 Related Party Payable 2084240 Related Entity Note Payable 5923180 8007420 X 10183704 0 10183704 2608096 2608096 12791800 10277989 -350723 -350723 10628712 0 10628712 Part IV, Line 2b: The Organization acts as custodian for the funds of the residents. These funds are included in cash and cash equivalents and a corresponding liability is included in accounts payable-trade in the financial statements. Resident trust funds totaled $3,804 at December 31, 2013 and December 31, 2012. Part X, Line 2: Bethany on 42nd is a North Dakota nonprofit corporations located in Fargo, North Dakota and has been recognized by the Internal Revenue Service as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the organization is subject to income tax on net income that is derived from business activities that are unrelated to their exempt purpose. The organization has determined they are not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS. Bethany on 42nd 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 consolidated financial statements. Bethany on 42nd 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 recorded in fund balance for financial statement 2,257,373. Sales revenue recorded in expenses for financial statement 350,723. Part XII, Line 2d - Other Adjustments: Sales revenue recorded in expenses for financial statement -350,723. 0 0 0 0 0 0 0 0 0 Shawn Stuhaug President/CEO 0 176802 0 37391 0 0 0 7183 0 21397 0 242773 0 0 Jane Kelly CFO 0 139512 0 24322 0 0 0 6681 0 9550 0 180065 0 0 Part I, Line 3 The CEO is paid by a related organization using comparability data; however, the Board of the related organization also serves as the Board of the filing organization. A Cass County North Dakota 456002205 2010-10-01 16000000 Construct & Equip Retirement Living Campus 0 0 0 B Cass County North Dakota 456002205 2012-08-28 3000000 Construct & Equip 38 Skilled Nursing Bed Addition & Small Kitchen Facility 0 0 0 A 16000000 137143 15862857 2010 0 0 1 1 B 3000000 59755 2940245 2013 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 1 0 0 0 0 A 0 B 0 Meinecke Johnson Co Board Member Roger Olson is an officer of Meinecke Johnson Co 4815155 General Contractor Expenses for Expansion 0 Form 990, Part VI, Section A, line 2 The CEO and CFO both have a business relationship with each other and all of the Board Members, as the CEO and CFO are employed by another related nonprofit of which the board members serve as well. The Board serves all of the related organizations listed on Schedule R. Form 990, Part VI, Section A, line 6 Bethany Homes, Inc. is the sole member of the Corporation. Form 990, Part VI, Section A, line 7a The Board of Directors is elected at the annual meeting of the Board of Trustees of the Member. The Member has the right to fill any vacancies that occur during the year. The Member may also remove any directors with or without cause. Form 990, Part VI, Section A, line 7b The following actions by the Board of Directors require the approval of the Board of Trustees of the Member: - Establishment of annual operating budget - Sale, lease or encumbrance of any corporation real property - Unbudgeted capital expenditures exceeding amounts for which the President/CEO is specifically authorized to approve Form 990, Part VI, Section A, line 8b There are no committees with the broad authority to act on behalf of the governing board. Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the CFO and CEO and then provided to the Finance Committee for their review and approval. A draft copy of the Form 990 is provided to the board prior to filing. Form 990, Part VI, Section B, line 12c Board officers and directors, as well as officers of the Organization, complete a conflict of interest questionnaire on an annual basis. The Board reviews the conflicts to determine if a conflict exists. The individual with the conflict is required to abstain from voting if the conflict comes up in the board meeting where a decision needs to be made. This is a standing agenda item at each board meeting. Form 990, Part VI, Section B, line 15 Compensation for the CEO is paid by a related organization. The related organization has a process for determining compensation that includes review by the independent board using comparability data and substantiation of the deliberation and decision. The CFO compensation is paid by a related organization. The related organization has a process that includes review by the CEO and Executive Committee using comparability data. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available upon request. Form 990, Part VII, Section A: David Glatt serves as a board member 1 hour per week. He serves an additional two total hours per week as a Medical Director for Bethany on 42nd and American Lutheran Homes. Compensation shown on Part VII, Column D is compensation paid to Sanford Health for his services as Medical Director to Bethany on 42nd. Compensation shown on Part VII, Column E is compensation paid to Sanford Health for his services as Medical Director to American Lutheran Homes, Inc. Form 990, Part XI, line 9: Decrease in Interest in Bethany Homes, Inc -84,760. American Lutheran Homes Inc 201 S University Drive Fargo ND 58103 450274012 Long-term care services, assisted living, independent living ND 501(c)(3) Line 9 Bethany Homes Inc 1 Bethany Home Health Care 201 S University Drive Fargo ND 58103 450433045 Promotion of health ND 501(c)(3) Line 9 Bethany Homes Inc 1 Bethany Homes Inc 201 S University Drive Fargo ND 58103 450394181 Fundraising ND 501(c)(3) Line 9 N/A 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 American Lutheran Homes Inc P 7582283 General Ledger Bethany Homes Inc C 131000 General Ledger American Lutheran Homes Inc C 2165293 General Ledger