2013-08-01T13:35:54-05:00 2012-12-31 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2012-01-01 450274012 American Lutheran Homes Inc AMER 7012393000 201 South University Drive Fargo ND 58103 Shawn Stuhaug 7012393000 2013-07-30 1 LISA CHAFFEE CPA P00193453 7012398500 2013-07-30 2012 2016-02-24 21:20:13Z Bethany On University Shawn Stuhaug 201 South University Drive Fargo ND 58103 18459240 0 X www.bethanynd.org X 1959 ND Provide long term care services 11 11 985 200 0 0 14396 5643 18526794 18431542 -1354 19143 -542 -564 18539294 18455764 0 129151 0 0 11482107 12105707 0 0 0 5403767 5715852 16885874 17950710 1653420 505054 25861572 26535130 13134998 13303502 12726574 13231628 X To provide living opportunities in a senior community shaped by Christian values. 0 0 15912734 129151 18431542 Service to the communityAmerican Lutheran Homes, Inc. (ALH) operates as a charitable organization consistent with the requirements of Internal Revenue Code Section 501(c)(3). ALH provides long term care services including skilled nursing care, assisted living, basic care and independent senior housing. ALH does not discriminate against individuals in the admissions process or in the delivery of care with regard to ability to pay for services. The assisted living facilities operated by ALH primarily serve low-income elderly residents. 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 ALH is made up of leaders in the Fargo-Moorhead business community. Consistent with its charitable mission, ALH provides community benefit to the area served. In 2012, community benefit activities included:- Speaker's bureau services - provides free educational sessions to agencies and individuals in the community on topics such as: From Independent Living to Skilled Care - A LTC Overview 10 Things You Want To Know About Nursing Homes Early Dementia Care HIPAA - Protecting Information About You The A, B, C, D's Of Medicare Seniors and Spirituality Managing Your Resources - Estate Planning Activity With A Purpose Volunteerism - The Rewards Of Giving Yourself- Groups to which our speaker's bureau presented information included service clubs, churches, parish nurse groups, and senior centers.- Endings and Beginnings - a support group for family members dealing with a loved one diagnosed with Alzheimer's disease - Provides virtual dementia / sensitivity training to employees and community members. This training program teaches participants about the challenges and frustrations of an elderly nursing home resident in managing day-to-day tasks and activities. Participants learn through active involvement in a simulation exercise what is it like to be challenged by issues like hearing impairment, deteriorating vision, dementia, loss of control of their environment, communication difficulties, etc.- Volunteerism - coordinates a volunteer program that included approximately 200 volunteers giving over 11,500 hours of service, providing mental stimulation and emotional support to ALH's 352 elderly residents. 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.- Tuition assistance - ALH recognizes that to continuously improve the Organization's value to our community and our residents, to encourage life-long learning among employees and to achieve an "employer of choice" status, it is in our best interest to provide opportunities that will assist eligible employees in pursuing formal, healthcare-related educational opportunities. ALH administers two internal scholarship programs, funded by donations. These programs provide schlarship opportunities to Bethany employees pursuing nursing education.- School Partnerships - ALH works with area nursing and other healthcare-related programs to provide on-site training opportunities for students. In 2012, we had approximately 400 nursing students complete clinical experiences at our facility. We provide a CNA training program for individuals in the Fargo-Moorhead community interested in pursuing a career as a nursing assistant. We also provided clinical site experience for an outside CNA training program and dietetic students, and internship opportunities for students in social worker programs, LTC administration and pre-med students for observation of Alzheimer's residents. We hosted visiting students from several higher education classes including: gender and aging class from North Dakota State University (NDSU) Department of Human Development; long term care planning class from NDSU's interior design program; Concordia College class from the long term care administration program.- Assessment and referral services - our staff help to refer individuals needing long term care services to the appropriate agency in the community. ALH licensed social workers provide guidance with medical assistance applications for residents/families.- Through in-kind gifts of equipment and other materials, ALH helps support the work of the following agencies: Project HERO Dakota Boys' and Girls' Ranch New Life Center Rape and Abuse Crisis Center YWCA programs- Community support - ALH provides meeting room space and accommodations for non-profit organizations and community groups. Several of our resident activity programs are open to community members. In 2012, these activities included an outdoor concert, carnival, special Christmas events, and several food festivals. ALH also supports and sponsors the Northern Plains Conference on Aging and Disability, as well as sponsoring the RSVP+ program. 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 ALH residents at a reduced cost.- Other - in addition to the activities above, ALH also organizes employee participation in fundraising activities for Cass-Clay United Way and the Alzheimer's Association. There are also representatives from ALH on non-profit boards and civic organizations that work to improve the quality of life in the Fargo-Moorhead area. ALH's President/CEO serves on HERO's (Health Equipment Recycling Organization) Board of Directors and the Fargo Dome Finance Committee. He also serves as the Region VI director on the board of the North Dakota Long Term Care Association. ALH's Chief Financial Officer serves on the board of Hospice of the Red River Valley. The Senior Executive of Medicare/Contracted Services serves on the board for the National Association of Directors of Nursing Association (NADONA). ALH'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, and represents North Dakota as a State Leader for NCAL (National Center for Assisted Living). ALH'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 ALHs' care provided:Bethany on University skilled care - services provided, 172 nursing home beds: 62,493 days of care and 544,003 employee hours (total expenses including management and general = 14,234,076)Bethany Towers I - assisted living services, 14 beds - 3,508 days of care; basic care services, 39 beds - 13,130 days of care. BT I had 38,085 employee hours (total expenses including management and general = 1,469,573)Bethany Towers II - assisted living services, 90 units - 30,376 days of care and 18,242 employee hours (total expenses including management and general = 1,658,793)Bethany Kinder House Independent Senior Housing, 35 units - 10,189 days of care and 2,829 employee hours (total expenses including management and general = 331,696) 15912734 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 31 0 1 985 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X Jane Kelly 7012393226 201 South University Drive Fargo ND 58103 X Mary Johnson 1.00 3.00 X X 0 0 0 Martha Leclerc 1.00 3.00 X X 0 0 0 Lloyd Smith 1.00 3.00 X X 0 0 0 Janice Nelson 1.00 3.00 X X 0 0 0 David Glatt 2.00 4.00 X X 8256 3744 0 Shannon Charpentier 1.00 3.00 X 0 0 0 Neal Eriksmoen 1.00 3.00 X 0 0 0 Robin Pratt 1.00 3.00 X 0 0 0 Harriet McCaul 1.00 3.00 X 0 0 0 Paul Wilson 1.00 3.00 X 0 0 0 Jerilynn Brantner-Adams 1.00 3.00 X 0 0 0 Jean Bokinskie 1.00 3.00 X 0 0 0 John Hertsgaard 1.00 3.00 X 0 0 0 Roger Olson 1.00 3.00 X 0 0 0 Shawn Stuhaug 23.00 27.00 X 216507 0 9640 Jane Kelly 25.00 25.00 X 151811 0 25357 376574 3744 34997 2 0 1 1 RehabCare Group Inc PO Box 503534 St Louis MO 631503534 Contract Therapy 402815 1 3000 2643 5643 Resident Service Reven 623000 18431542 18431542 18431542 22619 22619 3476 -3476 -3476 -3476 Other review 900099 -564 -564 -564 18455764 18431542 0 18579 129151 129151 411809 8256 403553 9751613 9135765 615848 159026 141496 17530 1047654 912875 134779 735605 665124 70481 120035 120035 6000 6000 493506 493506 1781508 1371941 409567 552669 552669 33873 33873 77243 60584 16659 160468 160468 1170297 1170297 216854 216854 Medical Supplies 494101 494101 Recognition of Asset Re 400000 400000 Bad Debt Expense 182628 182628 Memberships 26670 26670 17950710 15912734 2037976 0 4496683 5463059 1420537 1374355 6231813 6081272 155092 158950 189022 192177 29428533 19700378 10383060 9728155 661636 686673 846624 849710 1477105 2000779 25861572 26535130 2420854 2727176 9228733 8832126 31581 36857 773133 742234 335718 263109 344979 702000 13134998 13303502 X 12726574 13231628 12726574 13231628 25861572 26535130 505054 0 X 0 1 X 1 0 X 19846 428364 192964 14396 5643 661213 16195912 17242225 17409120 18526794 18431542 87805593 16215758 17670589 17602084 18541190 18437185 88466806 0 0 0 88466806 96611 21661 14720 20555 22619 176166 96611 21661 14720 20555 22619 176166 110069 -542 -564 108963 16312369 17692250 17726873 18561203 18459240 88751935 0.99680 0.99340 0.00200 0.00520 X 0 1 X 1474772 1474772 20419677 14730133 5689544 6699313 4593209 2106104 834771 377036 457735 9728155 Related Party Receivables 1748209 Deferred Financing Costs 23070 Bed Licenses 229500 2000779 Related Entity Note Payable 302000 Asset Remediation Obligation 400000 702000 X 18455764 0 18455764 0 18455764 17950710 0 17950710 0 17950710 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 $36,857 and $31,581 at December 31, 2012 and 2011. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Bethany on University is a North Dakota nonprofit corporation 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 Taxes (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 have not filed an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS. Bethany 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. Bethany 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. 1 Bethany on 42nd 201 S University Drive Fargo ND 58103 261087740 501(c)(3) 129151 Capital Campaign for Building Project; further exempt purpose 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The Organization provides funds to related organizations to help further their exempt purposes and can regularly monitor the use of the funds due to the relationship. X X X X 0 0 0 0 0 0 0 1 0 David Glatt 8256 3744 0 0 0 0 0 0 0 0 8256 3744 0 0 Shawn Stuhaug 176348 0 40159 0 0 0 7078 0 2694 0 226279 0 0 0 Jane Kelly 126811 0 25000 0 0 0 6403 0 19060 0 177274 0 0 0 Part I, Line 7 CEO and CFO received a bonus as determined by the Board of Directors. The bonus is based on review of performance and progress related to a specific work plan. Supplemental Information Part III In conjuction with Bethany on 42nd, a related organization, American Lutheran Homes, Inc. has an agreement with Sanford Health for Medical Director services provided by David Glatt. Compensation noted in Schedule J Part II is the fee paid to Sanford Health for his services provided to American Lutheran Homes, Inc. A Cass County North Dakota 456002205 2004-12-31 4607000 Refunding Revenue Bonds-Series 2004A to Refund 1996, 1998, 2001 Bonds 0 0 0 B Cass County North Dakota 456002205 2010-10-01 6400000 Construct & Equip Retirement Living Campus 0 0 0 A 4607000 38881 4568119 2004 1 0 1 1 B 6400000 54857 6345143 2010 0 0 1 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 0 B 0 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 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 The Executive Committee of the board meets to determine the compensation of the President/CEO. Compensation is determined by gathering comparable data, including salary surveys, personal contacts, 990 data, and evaluating criteria such as knowledge/experience, longevity, job performance, etc. Every three to five years, a consultant is brought in to assist in the evaluation process to test for fairness and reasonableness of compensation levels. Consultant involvement was last implemented in 2011. The Executive Committee reviews the data and recommends the compensation package, which is reviewed and approved at the full board level. The process for determining compensation for the President/CEO is implemented on an annual basis. The President/CEO determines the CFO compensation in the same manner the Executive Committee determines compensation for the President/CEO. The President/CEO also reviews the information with the Executive Committee. The process for determining compensation for the CFO is implemented on an annual basis. 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 American Lutheran Homes, Inc. Compensation shown on Part VII, Column E is compensation paid to Sanford Health for his services as Medical Director to Bethany on 42nd. 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 on 42nd 201 S University Drive Fargo ND 58103 261087740 Long-term care services/Assisted living/Independent living 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 1 1 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 0 Bethany on 42nd B 129151 General Ledger Bethany on 42nd Q 7803467 General Ledger Bethany Homes Inc Q 272746 General Ledger Bethany Home Health Care Q 614175 General Ledger Bethany Home Health Care N General Ledger Bethany Homes Inc E Bethany Homes Inc C