2011-11-11T15:03:13-07:00 2011-06-30 990 2010-07-01 450448164 VALLEY MEMORIAL HOMES VALL 7017877912 2900 14th Ave S Grand Forks ND 58201 Greg Hanson 7017877905 2011-11-14 2010 2016-03-07 17:11:31Z Greg Hanson 2900 14th Ave S Grand Forks ND 58201 1920987 0 X www.valleymemorial.org X 1997 ND To provide management, nursing, chaplaincy and other support services to related healthcare entities. 31 30 898 50 0 0 0 0 1761911 1920987 0 0 0 0 1761911 1920987 0 0 0 0 1343065 1448742 0 0 0 418846 472245 1761911 1920987 0 0 781416 726608 763986 709178 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 1630158 0 1630158 Management support services including Administration, Finance, IT, Human Resources and Transportation. 158867 0 158867 Skilled Nursing Facility Support Services including Nursing/Admissions and Medical Records. 131962 0 131962 Chaplaincy services provided to related long term care facilities: skilled nursing, assisted living and basic care. 0 0 0 1920987 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 0 1 9 0 1 898 1 0 0 0 0 0 0 0 0 0 0 0 0 X 31 30 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 1 0 ND X Lorilee Bott 7017877912 2900 14th Ave S Grand Forks ND 58201 John Halstenson 0 X 0 0 0 Charles Johnson 0 X 0 0 0 Muriel Stadstad 0 X 0 0 0 Kevin Beito 0 X 0 0 0 Dorothy Johnson 0 X 0 0 0 Arlet Phillips 0 X 0 0 0 Marlyce Ballingrud 0 X 0 0 0 Donna Frohlich 0 X 0 0 0 Elizabeth York 0 X 0 0 0 Susan Larson 0 X 0 0 0 Jeff Awes 0 X 0 0 0 Diane Lindseth 0 X 0 0 0 Terry Stadstad 0 X 0 0 0 Gerry Eggers 0 X 0 0 0 Lawrence Heuchert 0 X 0 0 0 Olive Weber 0 X 0 0 0 Brenda Gjelsness 0 X 0 0 0 Arvin Kvasager 0 X 0 0 0 Gordon Thompson 0 X 0 0 0 Myrna Dahlstrom 0 X 0 0 0 LeRoy Bergquist 0 X 0 0 0 Eunice Vold 0 X 0 0 0 Sheryl Cariveau 0 X 0 0 0 Alfred Fiebiger 0 X 0 0 0 Marlys Kennedy 0 X 0 0 0 Donna Larson 0 X 0 0 0 Mike Weisenberger 0 X 0 0 0 Bruce Newhouse 0 X 0 0 0 Michael Porter 0 X 0 0 0 Dawn Botsford 0 X 0 0 0 Greg Hanson 40 X X 167826 0 0 Lorilee Bott 40 X 98774 0 0 266600 0 0 1 0 1 0 Industrial Contract Services PO Box 13158 Grand Forks ND 58201 Construction Services for Valley Homes and Services 945235 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 819723 C&R Laundry 1010 N 5th Street Grand Forks ND 58201 Laundry Purchased Services for Valley Homes and Services and 4000 Valley Square Inc 263490 Widseth Smith Nolting 2715 Washington Street Grand Forks ND 58201 Architectural & Engineering Services for Valley Homes and Services 132474 Simplex Grinnel Dept Ch 10320 Palantine IL 600550320 Install & Maintaince of Nurse Call $ Fire Alarm System for skilled nursing facilities 101505 5 0 1920987 1920987 0 0 1920987 0 0 0 0 0 1920987 1920987 0 0 266600 266600 0 0 912812 912812 0 0 45671 45671 0 0 121662 121662 0 0 101997 101997 0 0 2569 2569 0 0 3274 3274 0 0 1118 1118 0 0 27864 27864 0 0 19475 19475 0 0 7355 7355 0 0 9209 9209 0 0 2345 2345 0 0 59247 59247 0 0 20385 20385 0 0 Other Supplies-Chapl./Transp/Med Rec 21004 21004 0 0 Purchased Services-Chapl/Admin/IT 202665 202665 0 0 Repairs/Maintenance 8274 8274 0 0 Dues/Subscr/PR/Recruit/Empl Exp 55183 55183 0 0 32278 32278 0 0 1920987 1920987 0 0 426648 474865 399 399 200154 81952 578939 409547 154215 169392 781416 726608 192671 196353 571315 512825 763986 709178 X 17430 17430 0 0 0 0 17430 17430 781416 726608 0 0 X 0 0 0 X X 0 0 0 Valley Memorial Foundation 450392710 Line 7 1 1 1 0 Valley Homes and Services 450229071 Line 9 1 1 1 1125771 4000 Valley Square Inc 311558826 Line 9 1 1 1 795216 3 1920987 0 0 0 0 0 0 0 0 0 0 0 0 578939 409547 169392 0 0 0 0 169392 0 Vehicle Loan 69873 Intercompany Payable 442952 512825 SchD_P10_S00_L00 Schedule D, Part X Other liabilities include Vehicle Loan and Intercompany Payable. 4000 Valley Square Inc and Valley Homes and Services transferred money prior to 6/30/2011 to cover related payroll expenses for payroll processed by Valley Memorial Homes on 7/1/2011. X X X 0 0 0 0 0 1 1 0 0 Greg Hanson 164299 0 5625 0 4804 0 0 0 -6902 0 167826 0 176453 0 SchJ_P01_S00_L06 Schedule J, Part I, Line 6 Incentive compensation plan, in addition to base salary, is determined based upon strategic goals and the organization's and related organizations' performance. F990_P06_S0A_L09 Form 990, Part VI, Section A, Line 9 Following are the mailing addresses for the Board of Directors Executive Committee: Mike Weisenberger, 2248 43rd Ave S., Grand Forks, ND 58201; Bruce Newhouse, 27093 350th Ave SW, Fisher, MN 56723; Dawn Botsford, 707 Reeves Drive, 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; Kevin Beito, 1328 21st St NW, East Grand Forks, MN 56721. Following are the mailing addresses for all other Directors: Dorothy Johnson, PO Box 248, Emerado, ND 58228; Marlyce Ballingrud, 423 N 3rd St, Grand Forks, ND 58203; Elizabeth York, 175 Columbia Road, Grand Forks, ND 58203; Jeff Awes, 1025 Cottowood St, 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; Diane Lindseth, 1736 9th Ave NE, Thompson, ND 58278; 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 Belmont Road, Grand Forks, ND 58201; Brenda Gjelsness, 781 1st Ave NE, Reynolds, ND 58275; Marlys Kennedy, 608 Park Drive, Manvel, ND 58256; Arvin Kvasager, 2521 9th ave N, Grand Forks, ND 58203; Gordon Thompson, 691 9th Street NE, Thompson, ND 58278; 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_L11a Form 990, Part VI, Section B, Line 11a 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 in November. The CFO explains any changes, specifically reviews Part VI and answers any questions. The Form 990 is filed after Executive Committee approval. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c 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 compares with others of similar size and function. This survey provides the committee with a gauge when it considers changes in base compensation. The committee then reviews the organization's performance and strategic plan goals to develop an incentive compensation plan in addition to the base salary. The board budgets a specific amount of executive compensation to be used as an incentive. Based upon performance, the CEO may earn up to 100% of budgeted incentive compensation, if earned, based upon the agreed formula in certain areas. Compensation for key employees/executive management team include a performance appraisal completed by the President/CEO of Valley Memorial Homes. Employees are eligible for an annual inflationary increase to their base salary, the percentage is based upon the approved annual budget. ND Long Term Care Salary Surveys are reviewed and adjustments are made to base salaries if the survey demonstrates an underpayment compared to like sized operations for certain positions. The President/CEO and key employees/executive management sets goals annually. Incentive compensation is awarded, if earned, based upon the agreed formula for performance in certain areas. 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 Skilled Nursing Facility, Assisted Living, Basic Care ND 501 (c) 3 Line 9 N/A 0 4000 Valley Square Inc 4000 24th Ave S Grand Forks ND 58201 311558826 Skilled Nursing Facility, Assisted Living, and 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 0 1 0 0 Valley Homes and Services p 1125771 Actual expenses direct cost or allocated. 4000 Valley Square Inc p 795216 Actual expenses direct cost or allocated. SchR_P05_S00_L02 Schedule R, Part V, Line 2 The amounts involved in transaction "m" sharing of facilities, equipment etc. and transaction "n" sharing of paid employees are included in the amount for transaction "p". 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.