2013-11-14T10:52:11-06:00 2012-12-31 450250958 EIDE BAILLY LLP 200 EAST 10TH ST PO BOX 5125 SIOUX FALLS SD 571175125 990 2012-01-01 460225023 BETHESDA OF BERESFORD BETH 6057632050 606 WEST CEDAR BERESFORD SD 57004 PATRICK BERRY 6057632050 2013-11-13 1 LAURIE HANSON P00851848 6053391999 2013-11-12 2012 2016-02-25 16:41:14Z PATRICK BERRY 606 WEST CEDAR BERESFORD SD 57004 4086696 0 9386 X WWW.BETHESDASD.COM X 1971 SD ELDERLY HOUSING AND CARE. 9 9 123 39 0 0 6014 8634 3956944 3891544 20924 20952 -2793 -3812 3981089 3917318 0 0 0 0 2183928 2311497 0 0 0 1140989 1116816 3324917 3428313 656172 489005 4847922 4981550 891718 540474 3956204 4441076 BETHESDA OF BERESFORD IS A CHRISTIAN COMMUNITY DEDICATED TO THE ART OF HEALING AND THE JOY OF CARING. 0 0 3124725 3891544 THE ORGANIZATION PROVIDES FACILITIES AND SERVICES FOR THE ELDERLY THROUGH THE OPERATION OF A 66-BED SKILLED NURSING AND 6-BED ASSISTED LIVING FACILITY. THE ORGANIZATION ALSO PROVIDES FACILITIES AND SERVICES THROUGH THE OPERATION OF A 16-UNIT ELDERLY APARTMENT COMPLEX AND AN OUTPATIENT THERAPY DEPARTMENT. THE FACILITY OPERATES A "LIFE-LINE" TO THE SURROUNDING COMMUNITY, WHICH PROVIDES A SAFER ENVIRONMENT AT HOME FOR THE ELDERLY IN THE AREA. THE FACILITY IS OPERATED TO MEET THE HEALTH AND HOUSING NEEDS OF ITS RESIDENTS. NUMBER OF RESIDENT DAYS 21,925; NUMBER OF ADMISSIONS 86. 3124725 1 0 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 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 1 123 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 0 1 0 0 X PATRICK BERRY 6057632050 606 WEST CEDAR BERESFORD SD 57004 MIKE MCGILL 0.30 X X 0 0 0 LAURA ARCHAMBEAU 0.30 X X 0 0 0 PASTOR CARLA NELSON 0.30 X X 0 0 0 PASTOR GREG MYMOE 0.30 X X 0 0 0 CLAIR ANTONSON 0.30 X X 0 0 0 DON YOUNG 0.30 X X 0 0 0 ELMER HAMMER 0.30 X 0 0 0 ANITA GIRARD 0.30 X 0 0 0 MARLOW CHRISTENSEN 0.30 X 0 0 0 DONALD ABRAHAM 0.30 X 0 0 0 PASTOR MATT STYLES 0.30 X 0 0 0 PHYLLIS STERNQUIST 0.30 X 0 0 0 WAYNE AKLAND 0.30 X 0 0 0 THOMAS V RICHTER 40.00 X 98193 0 13704 98193 0 13704 0 0 0 1 SANFORD HEALTH 600 W CEDAR ST BERESFORD SD 57004 ADMINISTRATION 273344 1 8634 8634 RESIDENT SERVICE REVEN 623000 3876529 3876529 OTHER REVENUE 900099 15015 15015 3891544 24867 24867 2600 6412 -3812 -3812 -3812 159051 159184 3782 -133 -3782 -3915 -3915 3917318 3891544 0 17140 112389 112389 1903564 1825892 77672 11221 10163 1058 141252 127935 13317 143071 135781 7290 25687 25687 20217 20217 212472 212472 8523 2363 6160 69385 49294 20091 121255 121255 3896 2564 1332 14964 13670 1294 13964 13964 216047 216047 26237 26237 FOOD AND DIETARY COST 190032 190032 MEDICAL SUPPLIES 146314 146314 REPAIRS AND MAINTENANCE 27274 27274 MEMBERSHIP DUES 10847 10847 9702 3468 6234 3428313 3124725 303588 0 1797148 1571702 144051 160738 10495 13133 10363 13074 5953824 3464360 2617850 2489464 453367 238460 234670 29555 45402 4847922 4981550 194468 180614 680000 345000 17250 14860 891718 540474 X 3956204 4441076 3956204 4441076 4847922 4981550 489005 -4133 0 X 0 1 X 0 0 X 41836 12908 102603 6014 8634 171995 3447712 3749209 3892485 3956944 3891544 18937894 3489548 3762117 3995088 3962958 3900178 19109889 0 678669 799187 747019 776777 1160008 4161660 678669 799187 747019 776777 1160008 4161660 14948229 30149 30966 26672 22708 27467 137962 30149 30966 26672 22708 27467 137962 3519697 3793083 4021760 3985666 3927645 19247851 0.77660 0.79820 0.00720 0.00820 X 0 1 X 86713 86713 4697470 2642349 2055121 1027133 730654 296479 142508 91357 51151 2489464 X 3917318 0 3917318 0 3917318 3428313 0 3428313 0 3428313 PART IV, LINE 2B: THE ESCROW ACCOUNT LIABILITY IS INCLUDED ON THE BALANCE SHEET. PART X LINE 21 INCLUDES SECURITY DEPOSITS AND FUNDS HELD FOR NURSING HOME RESIDENTS FOR ANCILLARY PURCHASES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOME AND FOUNDATION BELIEVE THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIRMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOME AND FOUNDATION 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. 0 0 0 0 0 0 0 0 0 THOMAS V RICHTER 98193 0 0 0 0 0 3996 0 10199 0 112388 0 0 0 SUPPLEMENTAL INFORMATION PART III THOMAS V. RICHTER, CEO, IS COMPENSATED BY SANFORD HEALTH NETWORK, 1305 W. 18TH STREET, SIOUX FALLS, SD 57117-5039, AN UNRELATED MANAGEMENT COMPANY. A CITY OF BERESFORD 466000010 083720AV4 2010-05-21 1094076 REFINANCE BONDS ISSUED AUGUST 27, 2003. 0 0 0 A 749076 1094076 112198 21880 959998 2010 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS A MANAGEMENT CONTRACT WITH SANFORD HEALTH NETWORK. THE ADMINISTRATOR, TOM RICHTER, IS AN EMPLOYEE OF SANFORD HEALTH. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE ORGANIZATION CONSIST OF 13 LUTHERAN CHURCHES. THERE IS ONLY ONE CLASS OF MEMBERS. FORM 990, PART VI, SECTION A, LINE 7A ALL MEMBERS HAVE THE SAME VOTING RIGHTS. THE MEMBERS ROLE IS TO ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B CHANGES TO BYLAWS REQUIRE APPROVAL OF THE MEMBERS. FORM 990, PART VI, SECTION A, LINE 8B BETHESDA OF BERESFORD DOES NOT UTILIZE COMMITTEES IN CONJUNCTION WITH ITS BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 THE ADMINISTRATOR REVIEWS FORM 990 AND DISTRIBUTES COPIES TO BOARD MEMBERS PRIOR TO ITS SUBMISSION. FORM 990, PART VI, SECTION B, LINE 12C PERSONS COVERED BY THE POLICY INCLUDE EVERY BOARD MEMBER, EVERY MEMBER OF ANY BOARD COMMITTEE, ALL OFFICERS OF THE HOME, AND ALL MANAGEMENT PERSONNEL OF THE HOME. COVERED MEMBERS ARE REQUIRED TO SIGN THE CONFLICT OF INTEREST STATEMENT EACH YEAR. THE ADMINISTRATOR RECEIVES AND REVIEWS ALL OF THE ANNUAL CONFLICT OF INTEREST STATEMENTS WHICH LIST ANY AND ALL FINANCIAL AND CONFLICTING INTERESTS. THE CHAIRMAN OF THE BOARD IS THEN FAMILIARIZED WITH ALL DISCLOSURES IN CASE A CONFLICT ARISES, AND THE VICE CHAIRMAN OF THE BOARD IS FAMILIARIZED WITH THE CHAIRMAN'S DISCLOSURE. IF A CONFLICT ARISES, THE BOARD CHAIR, BOARD COMMITTEE OR THE BOARD MAY ASK THE INTERESTED PERSON TO LEAVE THE MEETING DURING DISCUSSIONS OF THE MATTER, AND THE BOARD MUST APPROVE THE MATTER BY A MAJORITY VOTE, NOT INCLUDING A VOTE OF THE INTERESTED PERSON. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION HAS ONE OFFICER WHO IS PAID BY ANOTHER ORGANIZATION. SANFORD HEALTH USES A NATIONAL COMPENSATION SURVEY ALONG WITH A PERFORMANCE REVIEW. SANFORD HEALTH REVIEWS THE COMPENSATION SURVEY AND PERFORMANCE EVALUATION WITH THE BOARD OF DIRECTORS TO DETERMINE PROPER COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOESN'T MAKE THESE DOCUMENTS AVAILABLE TO THE PUBLIC.