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BETHANY ON 42ND: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
BETHANY ON 42ND (EIN 26-1087740)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-08-27
IRS object ID
201232409349300253
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-27T08:39:31-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN450250958EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14310 17TH AVE S PO BOX 2545AddressLine1
CityFARGOCity
StateNDState
ZIP Code581082545ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN261087740EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Bethany on 42ndBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlBETHNameControl
Phone7012393000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1201 South University DriveAddressLine1
CityFargoCity
StateNDState
ZIP Code58103ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameShawn StuhaugName
TitlePresident/CEOTitle
Phone7012393000Phone
Date Signed2012-08-20DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKIM C HUNWARDSENName
PTINP00484560PTIN
Phone7012398500Phone
Date Prepared2012-08-20DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonShawn StuhaugNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1201 South University DriveAddressLine1
CityFargoCity
StateNDState
ZIP Code58103ZIPCode
FieldValueIRS element (for citing)
Gross Receipts9704626GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.bethanynd.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2007YearFormation
State Legal DomicileNDStateLegalDomicile
Activity Or Mission DescriptionProvide long term care servicesActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers108TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1992ContributionsGrantsPriorYear
Contributions Grants Current Year224894ContributionsGrantsCurrentYear
Program Service Revenue Prior Year6900816ProgramServiceRevenuePriorYear
Program Service Revenue CY9449579ProgramServiceRevenueCY
Investment Income Prior Year-331InvestmentIncomePriorYear
Investment Income Current Year-718InvestmentIncomeCurrentYear
Other Revenue Prior Year19237OtherRevenuePriorYear
Other Revenue Current Year29228OtherRevenueCurrentYear
Total Revenue Prior Year6921714TotalRevenuePriorYear
Total Revenue Current Year9702983TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year4331420SalariesEtcPriorYear
Salaries Etc Current Year5087365SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4134334OtherExpensePriorYear
Other Expenses Current Year4689856OtherExpensesCurrentYear
Total Expenses Prior Year8465754TotalExpensesPriorYear
Total Expenses Current Year9777221TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1544040RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-74238RevenuesLessExpensesCY
Total Assets BOY27750443TotalAssetsBOY
Total Assets EOY26987148TotalAssetsEOY
Total Liabilities BOY24867407TotalLiabilitiesBOY
Total Liabilities EOY24366468TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2883036NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2620680NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTo provide living opportunities in a senior community shaped by Christian values.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense8968060Expense
Revenue9449579Revenue
DescriptionBethany on 42nd operates as a charitable organization consistent with the requirements of Internal Revenue Code Section 501(c)(3). Bethany on 42nd provides long term care services including skilled nursing care, transitional care services, assisted living, and independent senior housing. Bethany on 42nd does not discriminate against individuals in the admissions process or in the delivery of care with regard to ability to pay for services. The Organization's cash reserves are generally applied to expansion and replacement of existing facilities and equipment, amortization of mortgages, improvement in resident care, training and education, and community benefit activities. The governing board of Bethany on 42nd is made up of prominent leaders in the Fargo-Moorhead community. Volunteerism - coordinates a volunteer program that included 108 volunteers giving 1,770 hours of service, providing mental stimulation and emotional support to ALH's 118 residents and patients. Volunteers included members of sponsoring churches, experience works program volunteers, and many student volunteers from the community's schools - elementary, middle, high schools and colleges.Assessment and referral services - our staff help to refer individuals needing long term care services to the appropriate agency in the community. Bethany on 42nd's licensed social workers provide guidance with medical assistance applications for residents/families.Community support - Bethany on 42nd provides meeting room space and accommodations for non-profit organizations and community groups. Several of our resident activity programs are open to community members. Facility space is open to use by outside groups for meetings, performances, activities, funeral/memorials services, music recitals, etc. Meals are provided for family members of Bethany on 42nd residents at a reduced cost. Bethany on 42nd organizes employee participation in fundraising activities for United Way and the Alzheimer's Association. There are also representatives from Bethany on 42nd on non-profit boards and civic organizations that work to improve the quality of life in the Fargo-Moorhead area. Bethany's President/CEO is a director on the Lakeland Mental Health non-profit board and the Fargo Dome Finance Committee. He also serves as the Region VI Director on the Board of the North Dakota Long Term Care Association. Bethany's CFO serves on the Board of Hospice of the Red River Valley. The Senior Executive of Medicare/contracted services is on the board of Handi-Wheels, a non-profit organization, and also serves on the board of the North Dakota Nurse Leadership Council. Bethany's Senior Executive of Resident Care is on the Resident Issues Committee of the ND Long Term Care Association; the Partners Investing in Nursing consortium, and the Care Transitions Focus Group, a collaborative project with Sanford Health Systems.The following is specific information relating to Bethany on 42nd's care provided:Bethany on 42nd Skilled/TCU Care - services provided, 65 nursing home beds: 23,629 days of care, and 13 TCU beds: 4,320 days of care. Bethany on 42nd Skilled/TCU operations served approximately 370 individuals in 2011. Total Skilled/TCU employee hours - 243,364. (Total Expenses = 8,615,963)Bethany Gables - senior housing with services, 40 units - 11,890 days of care and 13,555 employee hours (total expenses = 1,161,255)Description
Total Program Service Expense8968060TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10969NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Jane KellyBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7012393226TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1201 South University DriveAddressLine1
CityFargoCity
StateNDState
ZIP Code58103ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
Robert McConn
Chair (Jan-March)1.00XX000
Mary Johnson Vice Chair Jan-Mar
Chair (April-Dec)1.00XX000
Martha Leclerc Treasurer Jan-Mar
Vice Chair (April-Dec)1.00XX000
Lloyd Smith Secretary Jan-Mar
Treasurer (April-Dec)1.00XX000
Janice Nelson TrusteeJan-March
Secretary (April-Dec)1.00XX000
Shannon Charpentier
Trustee1.00X000
Neal Eriksmoen
Trustee1.00X000
David Glatt
Trustee3.00X374400
Robin Pratt
Trustee1.00X000
HARRIETTE MCCAUL
Trustee1.00X000
Paul Wilson
Trustee1.00X000
Jerilynn Brantner-Adams
Trustee (April-Dec)1.00X000
Shawn Stuhaug
President/CEO23.00X01993137806
Jane Kelly
CFO20.00X015104519796
FieldValueIRS element (for citing)
Total Reportable Comp From Org3744TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs350358TotalReportableCompFrmRltdOrgs
Total Other Compensation27602TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources1CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1RehabCareBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 503534AddressLine1
CitySt LouisCity
StateMOState
ZIP Code631503534ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesContract TherapyDescriptionOfServices
Compensation629760Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Related Organizations206000RelatedOrganizations
All Other Contributions18894AllOtherContributions
Total Contributions224894TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Resident Service Reven62300094383449438344
Other Income9000991123511235
FieldValueIRS element (for citing)
Total Program Service Revenue9449579TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column925TotalRevenueColumn
Exclusion$925ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real29228Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real29228Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column29228TotalRevenueColumn
Exclusion$29,228ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other1643Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-1643Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-1643TotalRevenueColumn
Exclusion-$1,643ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column9702983TotalRevenueColumn
Related Or Exempt Function Income9449579RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$28,510ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3744Total
Program Services3744ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4307112Total
Program Services3936420ProgramServices
Management And General370692ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total39348Total
Program Services29932ProgramServices
Management And General9416ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total424682Total
Program Services389378ProgramServices
Management And General35304ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total312479Total
Program Services285479ProgramServices
Management And General27000ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total22344Total
Management And General22344ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total757356Total
Program Services757356ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total706918Total
Program Services502208ProgramServices
Management And General204710ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total440297Total
Program Services440297ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total27289Total
Program Services22287ProgramServices
Management And General5002ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1016958Total
Program Services1016958ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1197277Total
Program Services1197277ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total124685Total
Management And General124685ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies368730368730
Bad Debt Expense1566615666
Memberships1000810008
Flood Expense23282328

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9777221Total
Program Services8968060ProgramServices
Management And General809161ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY136008BOY
EOY874259EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1173712BOY
EOY916884EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY73485BOY
EOY84333EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY67790BOY
EOY77561EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis25882938LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec2200380LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY24747733BOY
EOY23682558EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY486643BOY
EOY298525EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1065072BOY
EOY1053028EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY27750443BOY
EOY26987148EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY649298BOY
EOY646455EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY16000000BOY
EOY15766928EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY351372BOY
EOY347423EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY7866737BOY
EOY7605662EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY24867407BOY
EOY24366468EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2396393BOY
EOY2322155EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY486643BOY
EOY298525EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2883036BOY
EOY2620680EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY27750443BOY
EOY26987148EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-74238ReconcilationRevenueExpenses
Reconcilation Other Changes-188118ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years3644075CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years917669CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1992CurrentTaxYearMinus1Year
Current Tax Year224894CurrentTaxYear
Total4788630Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year6900816CurrentTaxYearMinus1Year
Current Tax Year9449579CurrentTaxYear
Total16350395Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years3644075CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years917669CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6902808CurrentTaxYearMinus1Year
Current Tax Year9674473CurrentTaxYear
Total21139025Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year237586CurrentTaxYearMinus1Year
Current Tax Year173925CurrentTaxYear
Total411511Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year237586CurrentTaxYearMinus1Year
Current Tax Year173925CurrentTaxYear
Total411511Total
FieldValueIRS element (for citing)
Public Support Total50920727514PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year19281CurrentTaxYearMinus1Year
Current Tax Year30153CurrentTaxYear
Total49434Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year19281CurrentTaxYearMinus1Year
Current Tax Year30153CurrentTaxYear
Total49434Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years3644075CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years917669CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year6922089CurrentTaxYearMinus1Year
Current Tax Year9704626CurrentTaxYear
Total21188459Total
FieldValueIRS element (for citing)
First5 Years509XFirst5Years509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis768055OtherCostOrOtherBasis
Book Value768055BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis21539711OtherCostOrOtherBasis
Depreciation1525646Depreciation
Book Value20014065BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2650207OtherCostOrOtherBasis
Depreciation559683Depreciation
Book Value2090524BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis924965OtherCostOrOtherBasis
Depreciation115051Depreciation
Book Value809914BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings23682558TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Related Party Payable$1,373,849
Related Entity Note Payable$6,231,813
FieldValueIRS element (for citing)
Total Of Amounts7605662TotalOfAmounts
Total Revenue9702983TotalRevenue
Total Expenses9777221TotalExpenses
Excess Or Deficit For Year-74238ExcessOrDeficitForYear
Other-$188,118OtherAmount
Total Adjustments-188118TotalAdjustments
Excess Or Deficit Per FS-262356ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt9491211TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal9491211RevenueSubtotal
Other Revenues Not Included211772OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt211772RevenueNotRptdOnFinStmt
Total Revenue Per Form9909702983TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt9777221TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal9777221ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9909777221TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48:Part X:Bethany 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. Bethany 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 8 - Other Adjustments:Decrease in Interest in Bethany Homes, Inc -188,118.
Part XII, Line 4b - Other Adjustments:Contributions recorded in fund balance for financial statement 211,772.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
David Glatt
37440000000003744000
Shawn Stuhaug
016032303899000074910447020725100
Jane Kelly
01246440264010006172013730017094700

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSupplemental InformationIdentifier
Return ReferencePart IIIReturnReference
ExplanationPart I, Line 3: The President/CEO is paid by a related organization which has a process in place for establishing compensation using methods identified in question 3. In conjuction with American Lutheran Homes, Inc. a related organization, Bethany on 42nd has an agreement with Sanford Health for Medical Director services provided by David Glatt. Compensation noted in Schedule J Part II is the fee paid to Sanford Health for his services provided to Bethany on 42nd.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Cass County North DakotaBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN456002205IssuerEIN
Date Issued2010-10-01DateIssued
Issue Price16000000IssuePrice
Description Of PurposeHousing and Health Care Facility Revenue BondsDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds16000000TotalProceeds
Issuance Costs From Proceeds137143IssuanceCostsFromProceeds
Capital Expenditures15862857CapitalExpenditures
Year Of Subst Completion2010YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 2The CEO and CFO have a business relationship with all the board members, as the CEO and CFO are employed by another related nonprofit of which the board members serve as well.
Form 990, Part VI, Section A, line 6Bethany Homes, Inc. is the sole member of the Corporation.
Form 990, Part VI, Section A, line 7aThe Board of Directors is elected at the annual meeting of the Board of Trustees of the Member. The member has the right to fill any vacancies that occur during the year. The Member may also remove any directors with or without cause.
Form 990, Part VI, Section A, line 7bThe following actions by the Board of Directors require the approval of the Board of Trustees of the Member: - Establishment of annual operating budget - Sale, lease or encumbrance of any corporation real property - Unbudgeted capital expenditures exceeding amounts for which the President/CEO is specifically authorized to approve
Form 990, Part VI, Section B, line 11The Form 990 is reviewed by the CFO and CEO and then provided to the Finance Committee for their review and approval. A draft copy of the Form 990 is provided to the board prior to filing.
Form 990, Part VI, Section B, line 12cBoard officers and directors, as well as officers of the Organization, complete a conflict of interest questionnaire on an annual basis. The Board reviews the conflicts to determine if a conflict exists. The individual with the conflict is required to abstain from voting if the conflict comes up in the board meeting where a decision needs to be made. This is a standing agenda item at each board meeting.
Form 990, Part VI, Section B, Line 15: Compensation for the CEO is paid by a related organization. That Organization has a process for determining compensation that includes review by the independent board using comparability data and substantiation of the deliberation and decision.
Form 990, Part VI, Section C, line 19The Organization's governing documents, conflict of interest policy, and financial statements are available upon request.
FORM 990, PART VIIThe CEO and CFO are compensated by American Lutheran Homes, Inc. for their services provided to Bethany on 42nd and other related entities. The CEO serves approximately 27 hours per week to other related entities. The CFO services approximately 30 hours per week to other related entities. All board members serve American Lutheran Homes, Inc. and Bethany Homes, Inc. an additional 1 hour per week for each entity. The following individuals serve Bethany Home Health Care, Inc. an additional 1 hour per week: Neal Ericksmoen, Janice Nelson, Shannon Charpentier, Robin Pratt, and Harriette McCaul. David Glatt serves as a board member 1 hour per week. He serves an additional two hours per week as a Medical Director. Compensation shown on Part VII is compensation paid to Sanford Health for his services as Medical Director to Bethany on 42nd.
Form 990, Part XI, line 5:Decrease in Interest in Bethany Homes, Inc -188,118. Total to Form 990, Part XI, Line 5: -188,118.Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
American Lutheran Homes Inc
201 S University DriveFargoND58103450274012long-term care servicesND501(c)(3)9Bethany Homes Inc1
Bethany Home Health Care Inc
201 S University DriveFargoND58103450433045promotion of healthND501(c)(3)9Bethany Homes Inc1
Bethany Homes Inc
201 S University DriveFargoND58103450394181fundraisingND501(c)(3)9Bethany Homes Inc1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org1SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
American Lutheran Homes Inc
E423120General Ledger
American Lutheran Homes Inc
O7476779General Ledger
Bethany Homes Inc
C206000Cash Value