2013-11-13T09:49:21-07:00 2013-06-30 990 2012-07-01 450448164 VALLEY MEMORIAL HOMES VALL 7017877912 2900 14th Ave S Grand Forks ND 58201 Greg Hanson 7017877905 2013-10-13 2012 2016-02-24 21:20:13Z Greg Hanson 2900 14th Ave S Grand Forks ND 58201 2243601 0 X www.valleymemorial.org X 1997 ND To provide management, nursing, chaplaincy and other support services to related healthcare entities. 34 33 0 50 0 0 0 0 2038650 2243601 0 0 0 0 2038650 2243601 0 0 0 0 1549740 1651508 0 0 0 488910 592093 2038650 2243601 0 0 495391 547695 477961 530265 17430 17430 Valley Memorial Homes provides compassionate care and service from a Christian perspective to enhance the quality of life for those we serve. 0 0 1839389 0 1839389 Management support services including the following: Administration, Finance, IT, Human Resources and Transportation. Providing services to related organizations, who combined serve up to 520 residents and tenants on a daily basis and employee nearly 700 employees. 252635 252635 Skilled Nursing Facility Support Services including Nursing-Admissions and Medical Records for up to 330 skilled residents a day. 151577 0 151577 Chaplaincy services provided to related long term care facilities: skilled nursing, assisted living and basic care. 0 0 0 2243601 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 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 1 0 0 0 1 7 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 34 33 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 0 X Lorilee Bott 7017877912 2900 14th Ave S Grand Forks ND 58201 Bruce Newhouse 0 0 X 0 0 0 Charles Johnson 0 0 X 0 0 0 Muriel Stadstad 0 0 X 0 0 0 Marlyce Ballingrud 0 0 X 0 0 0 Donna Frohlich 0 0 X 0 0 0 Elizabeth York 0 0 X 0 0 0 Susan Larson 0 0 X 0 0 0 Jeff Awes 0 0 X 0 0 0 Diane Lindseth 0 0 X 0 0 0 Terry Stadstad 0 0 X 0 0 0 Gerry Eggers 0 0 X 0 0 0 Lawrence Heuchert 0 0 X 0 0 0 Olive Weber 0 0 X 0 0 0 Brenda Gjelsness 0 0 X 0 0 0 Arvin Kvasager 0 0 X 0 0 0 Gordon Thompson 0 0 X 0 0 0 Myrna Dahlstrom 0 0 X 0 0 0 LeRoy Bergquist 0 0 X 0 0 0 Eunice Vold 0 0 X 0 0 0 Sheryl Cariveau 0 0 X 0 0 0 Alfred Fiebiger 0 0 X 0 0 0 Marlys Kennedy 0 0 X 0 0 0 Donna Larson 0 0 X 0 0 0 John Halstenson 0 0 X 0 0 0 Dorothy Johnson 0 0 X 0 0 0 Arlet Phillips 0 0 X 0 0 0 Marlys Kennedy 0 0 X 0 0 0 Gary Masilko 0 0 X 0 0 0 Milt Kinzler 0 0 X 0 0 0 Mike Weisenberger 0 0 X X 0 0 0 Kevin Beito 0 0 X X 0 0 0 Michael Porter 0 0 X X 0 0 0 Dawn Botsford 0 0 X X 0 0 0 Greg Hanson 40 0 X X 187711 0 20018 Lorilee Bott 40 0 X 115966 0 5700 Garth Rydland 0 40 X 0 112928 10654 303677 112928 36372 3 0 1 0 Altru Health Systems PO Box 13780 Grand Forks ND 58201 Contracted Therapies and Chaplaincy Service for Valley Homes and Services and 4000 Valley Square Inc 1190738 C&R Laundry 1010 N 5th Street Grand Forks ND 58201 Laundry Purchased Services for Valley Homes and Services and 4000 Valley Square Inc 296293 Widseth Smith Nolting 2850 24th Ave S Suite 201 Grand Forks ND 58201 Architectural & Engineering Services for Valley Homes and Services 232844 Industrical Contract Services PO Box 13158 Grand Forks ND 582083158 General Contractor - construction/remodeling 250346 Networking Specialists 2397 Demers Ave Suite D Grand Forks ND 58201 IT - Managed Services, Support and Equipment 199173 6 0 2243601 2243601 0 0 2243601 0 0 0 0 0 2243601 2243601 0 0 303677 303677 1022719 1022719 68308 68308 154212 154212 102592 102592 1420 1420 8150 8150 25500 25500 30956 30956 34814 34814 31612 31612 11484 11484 11233 11233 3018 3018 50322 50322 23781 23781 Purchased Services-Chapl/IT 241810 241810 0 0 Other Supplies-Trans, Chap, MR 30146 30146 0 0 Repairs/Maint-Transp 16922 16922 0 0 Dues, subsc, empl exp 43632 43632 0 0 27293 27293 0 0 2243601 2243601 0 0 183378 304049 6080 3977 399 399 140966 66512 669207 515622 164568 153585 19173 495391 547695 372712 392361 105249 137904 477961 530265 X 17430 17430 0 0 0 0 17430 17430 495391 547695 0 0 0 0 0 0 X 0 0 0 X X 0 0 0 Valley Memorial Foundation 450392710 Line 7 1 1 0 Valley Homes and Services 450229071 Line 9 1 1 1389127 4000 Valley Square Inc 311558826 Line 9 1 1 854474 3 2243601 0 0 0 0 0 0 0 0 0 0 0 0 669207 515622 153585 0 0 0 0 153585 Note Payable 60770 457 B Plan 19173 Intercompany Payable 57961 137904 SchD_P10_S00_L01 Schedule D, Part X, Line 1 Other liabilities include Vehicle Loans, 457 B Plan, and Intercompany Payable. 4000 Valley Square and Valley Homes and Services transferred money prior to 6/30/2013 to cover related expenses that were processed after 7/1/2013. 0 1 0 0 0 0 0 0 0 Greg Hanson 182911 0 0 0 4800 0 8413 0 11605 0 207729 0 6176 SchJ_P01_S00_L04 Schedule J, Part I, Line 4 President/CEO participated in 457B plan with Employee Contribution/Deduction of $1673 and Employer Contribution of $1673. F990_P06_S0A_L09 Form 990, Part VI, Section A, Line 9 Mike Weisenberger, 2248 43rd Ave S, Grand Forks, ND58201; Kevin Beito, 1328 21st St NW, East Grand Forks, MN 56721; Dawn Botsford, 707 Reeves Dr, Grand Forks, ND 58201; Michael Porter, 6100 Kings View Dr #105, Grand Forks, ND 58201; John Halstenson, 2300 Library Circle, Grand Forks, ND 58201; Charles Johnson, 3008 Legend Lane, Grand Forks, ND 58201; Muriel Stadstad, 1774 22nd Ave NE, Grand Forks, ND 58203; Bruce Newhouse, 27093 350th Ave SW, Fisher, MN 56723; Dorothy Johnson, PO Box 248, Emerado, ND 58228; Marlyce Ballingrud, 423 N 3rd St, Grand Forks, ND 58203; Elizabeth York, 175 Columbia Rd, Grand Forks, ND 58201; Jeff Awes, 1025 Cottonwood Street, Grand Forks, ND 58201; Arlet Phillips, 21512 400th Ave SW, East Grand Forks, MN 56721; Donna Frohlich, 1135 McKinley Ave, Grand Forks, ND 58201; Susan Larson, 867 7th Ave NE, Thompson, ND 58278-9334; Diane Lindseth, 1736 9th Ave NE, Thompson, ND 58278-9215; Sheryl cariveau, 424 Crestwood Ct SE, East Grand Forks, MN 56721; Terry Stadstad, 1774 22nd Ave NE, Grand Forks, ND 58203; Alfred Fiebiger, 2535 23rd Ave NE, Mekinock, ND 58258; Gerry Eggers, 14 James Circle SE, East Grand Forks, MN 56721; Lawrence Heuchert, 2230 7th Ave N, Grand Forks, ND 58203; Olive Weber, 4634 Belmount Road, Grand Forks, ND 58201; Sharon Gustafson, PO Box 204, Thompson, ND 58278; Brenda Gjelsness, 781 1st Ave NE, Reynolds, ND 58275; Milt Kinzler, 2725 Knight Dr, Grand Forks, ND 58201; Marlys Kennedy, 608 Park Dr, Manvel, ND 58256; Gary Masilko, 210 Circle Hills Dr, Grand Forks, ND 58201; Arvin Kvasager, 2521 9th Ave N., Grand Forks, ND 58203; Gordon Thompson, 691 9th St NE, Thompson, ND 58278-9333; Myrna Dahlstrom, PO Box 100, Oslo, MN 56744; LeRoy Bergquist, Box 158 Reynolds, ND 58275; Eunice Vold, 411 22nd Ave S., Grand Forks, ND 58201; Donna Larson, 1821 4th St N., Grand Forks, ND 58203 F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The CFO with the assistance of the President/CEO prepares the Form 990. A draft of the Form 990 and all applicable schedules are sent to the Board of Directors' Executive Committee for their review prior to a meeting held the first Thursday of November. The CFO explains any changes, specifically reviews Part VI and answers any questions. The Form 990 is electronically filed after Executive Committee approval. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The conflict of interest policy is stated in Article 8 of the bylaws. It is reviewed with board members at Board Orientation. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 The President/CEO's compensation is determined as follows. The compensation committee reviews the ND Long Term Care Association's state compensation survey each year to assess how Valley Memorial Homes' CEO's salary comparies with others of similar size and function. This survey provides the committee with a gauge when it considers changes in base compensation. Most years the committee then reviews the organization's performance and strategic plan goals to develop an incentive compensation plan in addition to the base salary. Due to cuts in reimbursement the previous year, there was no incentive compensation budgeted in this fiscal year for performance in 2011-2012. Incentive compensation program is budgeted to be reinstated in the upcoming year. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Valley Memorial Homes' governing documents, conflict of interest policy and financial statements are available upon request. Requests should be made to the CFO at Valley Memorial Homes' corporate office, located at Valley Eldercare Center, 2900 14th Ave S, Grand Forks, ND 58201 between the hours of 8:30-4:30 Monday through Friday. Valley Homes and Services 2900 14th Ave S Grand Forks ND 58201 450229071 Sk Nursing Fac, Asst Liv, Basic Care ND 501 (c) 3 Line 9 N/A 0 4000 Valley Square Inc 4000 24th Ave S Grand Forks ND 58201 311558826 Sk Nursing Fac, Asst Liv, & Housing ND 501 (c) 3 Line 9 N/A 0 Valley Memorial Foundation 2900 14th Ave S Grand Forks ND 58201 450392710 Seek and accept gifts to support LTC facilities ND 501 (c) 3 Line 7 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 Valley Homes and Services q 1389127 Actual expenses - Direct Costs or Allocated. 4000 Valley Square Inc q 854474 Actual expenses - Direct Cost or Allocated. SchR_P05_S00_L02 Schedule R, Part V, Line 2 The amounts involved in transaction "m", "n" and "o" are included in transaction "q". Valley Memorial Homes' expenses are direct costed or allocated to Valley Homes and Services and 4000 Valley Square Inc. based upon allocation methodologies prescribed by the ND Department of Human Services.