2013-09-27T09:45:26-05:00 2012-12-31 450250958 EIDE BAILLY LLP PO BOX 1914 BISMARCK ND 585021914 990 2012-01-01 450347147 St Luke's Home STLU 7014835000 242 West 10th Street Dickinson ND 58601 Dennis Goebel 7014835000 2013-09-25 1 Lisa Chaffee CPA P00193453 7012551091 2013-09-25 2012 2016-02-25 16:41:14Z Dennis Goebel 242 West 10th Street Dickinson ND 58601 8450463 0 9386 X www.stlukeshome.com X 1953 ND St. Luke's Home and its assisted living facility, Park Avenue Villa, exist to provide a continuum of quality care to God's people, creating a compassionate, comfortable, and family oriented atmosphere, striving to enhance the dignity and respect of each person we serve. 10 10 275 125 0 0 152168 553500 6905019 7871676 -43024 -214860 1460 25114 7015623 8235430 1000 0 0 0 4806897 5110186 0 0 0 2954780 3467098 7762677 8577284 -747054 -341854 14197250 17395734 12355979 15896317 1841271 1499417 X St. Luke's Home and its assisted living facility, Park Avenue Villa, exist to provide a continuum of quality care to God's people, creating a compassionate, comfortable, and family oriented atmosphere, striving to enhance the dignity and respect of each person we serve. 0 0 7778965 7871676 St. Luke's Home is an 84 bed nursing home and a 38-unit assisted living facility located in Dickinson, ND. St. Luke's Home was organized in 1957 by the American Lutheran Church and the congregations in the southwestern part of North Dakota. The purpose, at the time, was to provide nursing care for the comfort and well-being of the chronically ill, of the aged and of the infirm of the area, regardless of race, color or creed. As nursing home services continued to evolve, St. Luke's became Medicare/Medicaid certified and today offers a wide range of services including a full range of Therapy services, Hospice, IV Therapy, and Tube Feeding as well as Respite Care. While we continue to serve those in need, plans are in place to transition from the "nursing home" model to person centered care in a new atmosphere which will reinvigorate and emphasize retention of dignity and quality of life for those we serve. 7778965 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 1 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 0 1 0 0 0 1 11 0 1 275 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 1 1 0 1 0 0 0 0 1 1 1 1 1 1 0 0 X Dennis Goebel 7014835000 242 West 10th Street Dickinson ND 58601 CB Haas 0.40 0.30 X X 0 0 0 Jim Ozbun 0.40 0.30 X X 0 0 0 Steven Schou 0.40 0.30 X X 0 0 0 Val Mack 0.40 0.30 X X 0 0 0 Shauna Greenwood 0.40 0.30 X 0 0 0 Mike Reichert 0.50 0.40 X 0 0 0 Cheryl Lantz 0.40 0.30 X 0 0 0 Todd Otto 0.40 0.30 X 0 0 0 Jan Fields 0.40 0.30 X 0 0 0 Tim Priebe 0.40 0.30 X 0 0 0 Karen Boulden 40.00 0.30 X 58195 0 8841 Dennis Goebel 40.00 0.30 X 66705 0 5166 124900 0 14007 0 0 0 0 0 550500 3000 553500 Patient Service Rev. 623000 7065667 7065667 Resident Rental Rev. 623000 785032 785032 20977 20977 7871676 173 173 25114 25114 215033 -215033 -215033 -215033 8235430 7871676 0 -189746 139395 139395 4397488 4180807 216681 39576 35337 4239 210054 202826 7228 323673 294559 29114 20566 20566 57025 57025 824298 655633 168665 16968 562 16406 310835 222545 88290 24987 24987 319251 319251 13439 10522 2917 11066 11066 414206 414206 658683 658683 Food Expense 348923 348923 Medical Supplies 219479 219479 Medicare Expenses 76153 76153 Repairs 53873 33336 20537 97346 95077 2269 8577284 7778965 798319 0 12289 12691 340767 356596 574738 638671 34354 31100 34307 36473 19475920 4288800 12027473 15187120 491397 433342 681925 699741 14197250 17395734 1185107 1489251 7995 2180000 2045000 49715 53863 8930843 12291843 10314 8365 12355979 15896317 X 1841271 1499417 1841271 1499417 14197250 17395734 -341854 0 X X 0 1 X 0 1 1 X 4369 209589 92038 152168 553500 1011664 6182573 6603360 6797600 6905019 7871676 34360228 6186942 6812949 6889638 7057187 8425176 35371892 0 66873 304017 293465 364075 219426 1247856 66873 304017 293465 364075 219426 1247856 34124036 7901 5567 8114 4668 25287 51537 7901 5567 8114 4668 25287 51537 6194843 6818516 6897752 7061855 8450463 35423429 0.96330 0.96440 0.00150 0.00150 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 41627 41627 10607256 3290827 7316429 1604340 865030 739310 7222697 132943 7089754 15187120 X Part IV, Line 2b: The resident trust fund is an account set up to keep private funds for each of our residents to use for personal matters. Upon admission they are given the opportunity to deposit money of their own into an account that we track for them. This money is kept in the office and can be accessed whenever they want. We keep a certain amount available for withdrawals and the rest is deposited into an interest bearing account. The interest is divided between the accounts, based on the amount earned and the amount each resident has in their account. Upon discharge, the balance, including interest, is refunded. The resident trust funds totaled $53,863 and $49,715 at December 31, 2012 and 2011. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: St. Luke's Home is organized as a North Dakota nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). St. Luke's Home is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, St. Luke's Home is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS. St. Luke's Home 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. St. Luke's Home would recognize future accrued interest and penalties related to unrecognized tax liabilities in income tax expense if such interest and penalties are incurred. A City of Dickinson 456002055 25325NBH6 2005-06-16 2891038 Refinance revenue bonds issed 5/21/1997 0 0 0 A 850000 2891038 56203 2834835 2006 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 A 0 Form 990, Schedule K, Part II, Line 11: The Line 11 "Other spent proceeds" were used to fully refund the prior issue on May 1, 2006. Form 990, Schedule K, Part IV, Line 2c: As of 05/01/10 a five year calculation was done and at that time there was no rebate due. Form 990, Part VI, Section A, line 6 The Corporation shall have one member. Dickinson St. Luke's Homes, Inc., a North Dakota nonprofit corporation, shall be the sole member of the Corporation. Form 990, Part VI, Section A, line 7a Ten directors shall be appointed by Dickinson St. Luke's Homes, Inc., to serve one-year terms, with unlimited succession. Form 990, Part VI, Section A, line 8b There are no committees with authority to act on behalf of the governing board. Form 990, Part VI, Section B, line 11 The administrator and legal advisor will review a draft of the full Form 990 before it is finalized. In addition, a public disclosure copy of the Form 990 will be provided to the board of directors for their review and comment prior to its filing with the IRS. Form 990, Part VI, Section B, line 12c The organization annually re-adopts a conflict of interest policy. Any perceived conflict of interest on the part of a board member shall be disclosed to the Board of Directors prior to the board's decision on the issue to which the perceived conflict relates. When such a disclosure has been made and acknowledged, and the board has concurred that a conflict of interest exists, the board member involved shall abstain from voting on the issue. The board member shall refrain from participating in the discussion other than to provide factual information about the applicant, organization or vendor in question. Any abstentions from voting will be recorded in the minutes of the meeting. Form 990, Part VI, Section B, line 15a Annually, a committee performs an evaluation of the compensation and sends evaluation forms to the Board of Directors. They compile the responses and review area wages provided by the ND Long Term Care Association. The Board of Directors votes on the compensation amounts. A vote is conducted during each filing year. This process is documented in the meeting minutes. Form 990, Part VI, Section C, line 19 The organization does not make its governing documents, conflict of interest policy, or financial statements available to the public. Form 990, Part XII, Line 2c: The entire board of directors assumes the responsibility for oversight of the audit. St Luke's Home Foundation 242 10th Street West Dickinson ND 58601 450409966 To raise funds to support the activities of St. Luke's Home ND 501(c)(3) Line 11b, II Dickinson St Luke's Home Inc 0 Dickinson St Luke's Home Inc 242 10th Street West Dickinson ND 58601 450409965 Support in establishing, operating, & maintaining retirement & nursing homes ND 501(c)(3) Line 11b, II N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1