2019-11-08T07:09:25-06:00 2018-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-01-01 273111617 Boundary Waters Care Center BOUN 7635375700 200 W Conan St Ely MN 55731 Roger Pekuri President 7635375700 2019-09-18 1 Deb Nelson CPA P01264758 6122536500 2019-09-03 199.116.169.90 2019-09-18 16:08:19 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC EFC25E59FA7409AE560978A003AFB9E955B778C6 2018 2020-03-31 21:24:44Z Roger Pekuri 200 W Conan St Ely MN 55731 3547033 0 X www.boundarywaterscc.com X 2011 MN Provision of long term care for the elderly. 5 5 99 25 0 0 0 0 3434283 3511821 877 574 36233 34638 3471393 3547033 0 0 0 0 2054056 2023838 0 0 0 1310673 1378458 3364729 3402296 106664 144737 1366584 1385001 287191 185682 1079393 1199319 X Boundary Waters Care Center is committed to the core values of hospitality, stewardship, integrity, respect, and humor. These values, in addition to the significance and impact of the services we provide, determine our priorities, influence our decisions, and represent stability to those we serve. 0 0 2802269 3444691 Boundary Waters Care Center operates a 42-bed nursing facility for the elderly of Ely, Minnesota. The Care Center also provides services designated to meet the physical, social, and psychological needs of the residents. 101768 101768 Boundary Waters Care Center provides meal services to residents and a local non-profit organization through a meals on wheels program. The Care Center also provides dietary services, catering and activity services to the area hospital. 2904037 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 15 0 1 99 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 MN X Health Dimensions Group 7635375700 4400 Baker Road Suite 100 Minneapolis MN 55343 X Roger Pekuri President 1.00 X X 0 0 0 Joneene Lobe Vice President 1.00 X X 0 0 0 Betty Erickson Director 1.00 X 0 0 0 Mike Forman Director 1.00 X 0 0 0 Tony Pecha Director 1.00 X 0 0 0 Adam Masloski Executive Director 40.00 X 0 0 0 0 0 0 0 0 0 0 Aramark Uniform Services 25259 Network Place Chicago IL 606731252 Laundry Services 297669 Health Dimensions Consulting Inc 12900 Whitewater Dr Suite 201 Minnetonka MN 55343 Management Services 103985 2 Net Patient Revenue 623000 3393415 3393415 Cafeteria 900099 96366 96366 Other Operating Revenu 900099 22040 22040 3511821 574 574 Debt Forgiveness 900099 34638 34638 34638 3547033 3546459 0 574 1736258 1667760 68498 142724 138053 4671 144856 133169 11687 263626 263626 6498 6498 14620 14620 222801 206636 16165 16241 16241 105356 89879 15477 41687 41687 93258 83123 10135 1947 1947 3715 3715 1127 1046 81 26808 24881 1927 25073 23271 1802 Medical Supplies and Fo 279827 279827 DHS Surcharge 118230 118230 157644 138162 19482 3402296 2904037 498259 0 290602 286532 256735 322401 29237 22451 375404 115842 272380 259562 517630 494055 1366584 1385001 157356 161161 14635 0 3690 4926 111510 19595 287191 185682 X 565453 710190 513940 489129 1079393 1199319 1366584 1385001 X 144737 -24811 X 0 1 X 1 0 X 3124 847 300 0 0 4271 2882152 3016520 3555249 3434283 3511821 16400025 2885276 3017367 3555549 3434283 3511821 16404296 0 1148083 1067654 671346 1332712 1311272 5531067 1148083 1067654 671346 1332712 1311272 5531067 10873229 8 23 65 877 574 1547 8 23 65 877 574 1547 28190 37843 36233 34638 136904 2885284 3045580 3593457 3471393 3547033 16542747 0.65730 0.65650 0.00010 0.00010 X Schedule A, Part III, Line 12, Explanation of Other Income: Miscellaneous Revenue - Revenue from Debt Forgiveness - 2015 Amount: $ 28,190. 2016 Amount: $ 37,843. 2017 Amount: $ 36,233. 2018 Amount: $ 34,638. 0 1 X 248341 45871 202470 127063 69971 57092 259562 Contributed Use of Property 489129 Resident Trust Accounts 4926 494055 X 3567391 30185 24811 54996 3512395 34638 34638 3547033 3457292 54996 54996 3402296 0 3402296 Part IV, Line 2b: The Care Center acts as a custodian for the funds of the residents of the Care Center. These funds are included as an asset and a corresponding liability in the accompanying balance sheets. Part X, Line 2: The Care Center is organized as a Minnesota 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). The Care Center is required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Care Center is subject to income tax on any net income that is derived from business activities that are unrelated to its exempt purpose. The Care Center 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. The Care Center 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. Part XI, Line 2d - Other Adjustments: Amortization of promise to give-leased space 24,811. Part XI, Line 4b - Other Adjustments: Gain from Debt Forgiveness Included in Revenue for Tax Reporting 34,638. Form 990, Part VI, Section A, line 3 Boundary Waters Care Center (BWCC) has entered into a contract with Health Dimensions Consulting, Inc. (dba Health Dimensions Group) for certain management services. Adam Masloski received $77,872 in compensation for services as Administrator. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The 990 is reviewed by the Financial Services Manager and the Senior Accountant of the management company. The 990 is also provided to Boundary Waters Care Center board for review and approval prior to filing. Form 990, Part VI, Section B, line 12c The organization provides annual training on the code of conduct, which includes the conflict of interest policy. The organization also has a compliance hotline in which any/all complaints are investigated. Board members and key employees are asked to complete a conflict of interest questionnaire annually. The board determines if a conflict of interest is present. If a conflict is identified, the impacted individual must abstain from voting. Form 990, Part VI, Section B, line 15a Health Dimensions Group (HDG) engages a third party on a periodic basis to conduct market analysis and to provide recommendations on compensation ranges for administrators. The Human Resources department coordinates this activity with the third party vendor, and provides financial recommendations to the HDG CEO. Administrators are not involved with any aspect of conducting market analysis, establishing compensation ranges or determining their respective salary. Form 990, Part VI, Section C, line 19 The governing documents and financial statements are available upon request. Form 990, Part XI, line 9: Amortization of Promise to Give-Leased Space -24,811.