2013-04-03T10:38:44-05:00 2012-06-30 450250958 EIDE BAILLY LLP PO BOX 1914 BISMARCK ND 585021914 990 2011-07-01 450277390 BEULAH COMMUNITY NURSING HOME BEUL 7018734322 118 22ND STREET NE BEULAH ND 58523 KEITH GENDREAU 7018734322 2013-03-27 1 LISA CHAFFEE CPA P00193453 7012551091 2013-02-12 2011 2016-02-25 16:41:14Z KNIFE RIVER CARE CENTER KEITH GENDREAU 118 22ND STREET NE BEULAH ND 58523 7316187 0 X WWW.KRCC-ND.ORG X 1960 ND DEDICATED TO PROVIDING THE BEST NURSING HOME FACILITY FOR OUR RESIDENTS. 7 7 208 150 0 0 41261 88938 7211669 7217539 12764 9710 0 0 7265694 7316187 0 0 0 0 4664049 4668884 0 0 0 3016049 3234316 7680098 7903200 -414404 -587013 11626630 11090091 10878085 10958203 748545 131888 X THE 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. 0 0 7274196 7217539 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. 7274196 1 1 0 0 0 0 0 0 1 0 1 0 0 0 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 0 1 3 0 1 208 1 0 0 0 0 0 0 0 0 0 0 X 7 7 1 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X LINDA CZYWCZYNSKI 7018734322 118 22ND ST NE BEULAH ND 58523 FRED STERN 1.00 X X 0 0 0 BRUCE SCHMIDT 1.00 X X 0 0 0 MARY LOU HORNING 1.00 X X 0 0 0 DENA KEMMET 1.00 X 0 0 0 DALE GILJE 1.00 X 0 0 0 MICHELLE ANDERSON 1.00 X 0 0 0 MAX MILLER 1.00 X 0 0 0 KEITH GENDREAU 40.00 X 108318 0 7579 108318 0 7579 1 0 0 0 0 88938 88938 RESIDENT SERV. REVENUE 623000 7153332 7153332 OTHER PROGRAM SERVICE 623000 64207 64207 7217539 5996 5996 3714 0 3714 3714 3714 7316187 7217539 0 9710 126708 12671 114037 3910190 3650257 259933 154182 141118 13064 195119 162128 32991 282685 256194 26491 2154 2154 27185 27185 1999 1999 806676 806676 6633 6633 342504 284104 58400 42791 42791 387066 387066 5473 1110 4363 32248 19957 12291 359375 359375 674278 674278 58007 58007 FOOD & DIETARY 239032 239032 MEDICAL & PHARMACEY 104263 104263 REPAIRS & MAINTENANCE 80138 80138 MISCELLANEOUS EXPENSES 31806 3135 28671 32688 32688 7903200 7274196 629004 0 200 200 33886 58938 709980 662020 30621 24046 39435 30812 12144673 2807623 9769427 9337050 543917 514273 499164 462752 11626630 11090091 657961 856047 36052 8562 8804927 8607203 44837 44876 1334308 1441515 10878085 10958203 X 204628 -382385 543917 514273 748545 131888 11626630 11090091 X -587013 -29644 X 0 1 0 X 0 X 629221 58685 111878 41261 88938 929983 629221 58685 111878 41261 88938 929983 81240 848743 17555 10454 5169 12764 5996 51938 981921 33377968 0.86440 0.90220 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 49707 49707 5498993 966478 4532515 485588 113410 372178 6110385 1727735 4382650 9337050 7316187 7903200 -587013 -29644 -29644 -616657 7247367 0 7247367 68820 68820 7316187 7903200 0 7903200 0 7903200 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 EMPLOYEE'S 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 990T) WITH THE IRS. IN ADDITIONS, 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. THE CARE CENTER'S FEDERAL FORM 990T FILINGS ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN INTEREST IN ASSETS OF FOUNDATION -29,644. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS TRANSFERRED FROM FOUNDATION 68,820. CITY OF BEULAH NORTH DAKOTA 450276796 2006-04-06 9230000 KNIFE RIVER CARE CENTER NEW FACILITY PROJECT 0 0 0 9230000 9230000 2008 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 1 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 WAYNE HOFFNER AND MARY LOU HORNING HAVE A BUSINESS RELATIONSHIP. 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 OR 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 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 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE IF SPECIFICALLY REQUESTED. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN INTEREST IN ASSETS OF FOUNDATION -29,644. TOTAL TO FORM 990, PART XI, LINE 5: -29,644. KNIFE RIVER CARE CENTER FRIENDS CLUB 118 22ND ST NE BEULAH ND 58523 450277390 STAFF SPECIAL EVENTS ND 8059 9278 N/A