2023-08-16T09:06:53-05:00 2022-12-31 450250958 Eide Bailly LLP 1730 Burnt Boat Loop Ste 100 Bismarck ND 585030886 990 2022-01-01 261087740 Bethany on 42nd BETH 7012393000 201 South University Drive Fargo ND 58103 Shawn Stuhaug President/CEO 7012393000 2023-08-16 1 Shawn Stuhaug 999009999 1 Lisa Chaffee CPA P00193453 7012551091 2023-08-17 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Shawn Stuhaug 201 South University Drive Fargo ND 58103 22954782 0 X www.bethanynd.org X 2007 ND Provide long term care services 10 10 0 140 0 0 598149 54004 18933417 19565514 7677 -16054 31473 3351150 19570716 22954614 118450 0 0 0 10327726 11423597 0 0 0 7763094 8549896 18209270 19973493 1361446 2981121 42982371 45131106 32577209 31941330 10405162 13189776 X To provide living opportunities in a senior community shaped by Christian values. 0 0 17949778 19565514 Bethany 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, assisted living, and 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, improvements in resident care, training and education, and community benefit activities.Continued on Schedule O...The governing board of Bethany on 42nd is made up of leaders in the Fargo-Moorhead business community. Consistent with its charitable mission, ALH provides community benefit to the area served. In 2022, community benefit activities included:*Speaker's Bureau Services - free educational sessions to agencies and individuals in the community on topics such as:o Bethany on the Growo Advance Directive Educationo Careers in Long Term Careo Early Dementia Careo Activities with a Purposeo The A, B, C & Ds of Medicareo Facing our Later Days in Faitho Managing Your Resources Estate Planning o Volunteerism The Rewards of Giving Yourself*Groups to which our Speaker's Bureau presented information included service clubs, churches, and senior centers. No sessions were scheduled in 2022 due to the COVID-19 pandemic.*Volunteerism - coordinates a volunteers program that included 140 volunteers giving over 9,500 hours of service, providing mental stimulation and emotional support to Bethany on 42nd's 214 elderly residents. Volunteers included members of sponsoring churches, Experience Works program volunteers, Mom's Teach, business groups, and many student volunteers from the community's schools elementary, middle, high schools, and colleges.*Scholarship programs and student loan repayment bonus opportunities - Bethany on 42nd recognizes that to continuously improve the organization's value to our community and our residents, to encourage life-long learning among employees, and to achieve an "employer of choice" status, it is in our best interest to provide opportunities to assist eligible employees in pursuing formal, healthcare-related education.*School partnerships - Bethany on 42nd works with area nursing and other healthcare-related programs to provide on-site training opportunities for students. In 2022, we had 98 nursing students complete clinical experiences at our facility. We provide a CNA training program for individuals in the Fargo-Moorhead community interested in pursuing a career as a nursing assistant. We also provide clinical site experience for an outside CNA training program, CPR training, and CNA testing and "test-out" classes. Other school partnerships include learning opportunities for dietetic students, and internship opportunities for students in social work, dietetics, activities, and LTC administration programs. *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 - generalo Bethany on 42nd provides meeting room space and accommodations for non-profit organizations and community groups. o Facility space is open to use by outside groups for meetings, performances, activities, funeral/memorial services, music recitals and other programs.o Bethany on 42nd organizes employee participation in fundraising activities for Cass-Clay United Way and the Alzheimer's Association.o Recognizes the contributions to and the impact senior have had on the community by sponsoring the annual Senior of the Year awards program.*Community Support - leadership representatives from Bethany on 42nd serve on non-profit boards and civic organizations that work to improve the quality of life in the Fargo-Moorhead area:o President/CEO - serves on the BEK Care (dba Ethos) board of directors, and various committees of the North Dakota Long Term Care Association (NDLTCA). Also serves on the board of ShareHouse, Fargo.o Chief Financial Officer - serves on the BEK Care board of directors, and the Funding and Reimbursement Committee of the NDLTCAo Senior Executive of Resident Care - serves on the FM Clinical & Academic Collaborative, Great Plains & Lake Superior Quality Innovation Network, Resident Issues Committee of the NDLTCA, the Ethos Advisory Committee, and as a NCLEX test reviewer/item reviewer for the National Board of Nursing. She also serves as an interviewer for the NDSU BSN nursing program/application process.o Senior Executive of Human Resources - serves on a panel for the MState New American program, the Ethos Advisory Committee, and the Find the Good Life recruiter network (a collaborative group working to recruit future workers to North Dakota)o Senior Executive of Housing/Assisted Living - serves as a board member of the Fargo West Rotary service club, Basic Care Director at Large for the NDLTCA, and serves on the National Center for Assisted Living (NCAL) Not-For-Profit Committee.o Senior Executive of Development & Community Relations - serves on the Public Affairs Committee of the Fargo- Moorhead-West Fargo Chamber of Commerce. He also serves on the Ethos Advisory Committee, and with the Coalition of Service Providers for the Elderly.*Bethany on 42nd's care provided:o Bethany on 42nd Skilled - 116 skilled beds, with 42,222 days of care. Total Skilled employee hours 346,367. Total expenses including management and general: $17,176,224.o Bethany Gables, senior housing with services - 40 apartments, 13,614 days of care, and 14,992 employee hours. Total expenses including management and general: $1,242,306.o Bethany Grace Pointe - 58 senior housing apartments. Days of service totaled 20,642, employee hours totaled 1,694, and total expenses including management and general were $1,401,683. 17949778 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 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 1 1 1 0 0 1 X 38 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 10 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X Kaye Angus 7014788906 201 South University Drive Fargo ND 58103 Charlotte Rusch Chair 1.00 3.00 X X 0 0 0 Jack Rydell Vice Chair 1.00 3.00 X X 0 0 0 Mary Johnson Treasurer (thru March) 1.00 3.00 X X 0 0 0 Paulette Amundson Treasurer (as of April) 1.00 3.00 X X 0 0 0 Lianne Rockstad Secretary 1.00 3.00 X X 0 0 0 Bruce Davidson Trustee 1.00 3.00 X 0 0 0 Neal Eriksmoen Trustee 1.00 3.00 X 0 0 0 Martha Leclerc Trustee 1.00 3.00 X 0 0 0 Dan Beauchamp Trustee 1.00 3.00 X 0 0 0 Ben Carlsrud Trustee 1.00 3.00 X 0 0 0 David Glatt Trustee (thru August) 1.00 3.00 X 0 0 0 Shawn Stuhaug President/CEO 18.00 32.00 X 0 323894 18128 Jane Kelly CFO (thru September) 18.00 32.00 X 0 175053 15119 Kaye Angus CFO (as of August) 18.00 32.00 X 0 82593 16064 Dawn Hummel Sr. Executive of Resident 22.00 28.00 X 0 155050 6202 0 736590 55513 0 0 1 0 Blue Stone Therapy 4319 NW Urbandale Dr Urbandale IA 50322 Contracted Therapy 719939 Prime Time Healthcare LLC 15380 Weir St Omaha NE 68137 Contracted Nursing 123587 Eide Bailly LLP PO Box 2545 Fargo ND 58108 Accounting Services 115613 3 1360 42644 10000 54004 Resident Service Revenue 623000 19404104 19404104 Supporting Revenue 900099 161410 161410 19565514 -15886 -15886 33268 0 33268 33268 33268 168 -168 -168 -168 Employee Retention Credit 900099 3317882 3317882 3317882 22954614 22883396 0 17214 9617131 8899967 717164 172829 149501 23328 931136 844431 86705 702501 649949 52552 19358 19358 11950 11950 1541969 1541969 15012 15012 1605928 898579 707349 7379 7379 1061299 1061299 92013 92013 29264 25550 3714 933691 922184 11507 2205661 2179869 25792 201869 201869 Medical Supplies 540090 540090 Recruitment 148337 143928 4409 Bad Debt Expense 121029 121029 Memberships 14598 14598 449 449 19973493 17949778 2023715 0 4780562 5390691 1881563 4928412 181668 168719 236928 302616 54904869 23423540 33192982 31481329 1323668 1421028 1385000 1438311 42982371 45131106 1141720 1468997 25346494 24168474 115683 122352 407133 393497 5566179 5788010 32577209 31941330 X 10405162 13189776 10405162 13189776 42982371 45131106 X 2981121 -196507 X 0 1 X 1 0 X 2834 3555 879069 598149 54004 1537611 17585556 18095351 18695969 18933417 19565514 92875807 17588390 18098906 19575038 19531566 19619518 94413418 0 0 0 94413418 50285 77206 74178 36963 17382 256014 50285 77206 74178 36963 17382 256014 3317882 3317882 17638675 18176112 19649216 19568529 22954782 97987314 0.96350 0.99690 0.00260 0.00310 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 392624 12620 -275 404969 324339 33070 35215 392624 0.00000 0.53820 0.46180 0 1 1 2452898 1038193 3491091 41691040 16494587 25196453 7229024 5583366 1645658 2493714 1345587 1148127 31481329 Related Party Payable 1799477 Related Entity Note Payable 3935222 Right of Use Liability 53311 5788010 X 22801340 0 22801340 153274 153274 22954614 19820219 0 19820219 153274 153274 19973493 Part IV, Line 2b: The Organization acts as custodian for the funds of the residents, as well as apartment security deposits. These funds are included in cash and cash equivalents and a corresponding liability is included in accounts payable-trade in the financial statements. Resident trust funds totaled $23,240 and $23,092 at December 31, 2022 and 2021. Apartment security deposits totaled $99,112 and $92,591 at December 31, 2022 and 2021. Part V, Line 4: A related organization, Bethany Homes, Inc., holds and administers the endowments. The endowments are used to benefit Bethany on 42nd. Part X, Line 2: Bethany on 42nd 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 consolidated 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 4b - Other Adjustments: Dining Services Revenue Recorded in Expenses for Financial Statement 153,274. Part XII, Line 4b - Other Adjustments: Dining Services Revenue Recorded in Revenue on Form 990 153,274. 0 0 0 0 0 0 0 0 0 Shawn Stuhaug President/CEO 0 282373 0 41521 0 0 0 11628 0 6620 0 342142 0 0 Jane Kelly CFO (thru September) 0 156591 0 18462 0 0 0 7272 0 7927 0 190252 0 0 Dawn Hummel Sr. Executive of Resident 0 145050 0 10000 0 0 0 6202 0 96 0 161348 0 0 Part I, Line 3 The CEO is paid by a related exempt organization using comparability data; however, the Board of the related exempt organization also serves as the Board of the filing organization. A Cass County North Dakota 456002205 000000000 2010-10-01 16000000 Construct & Equip Retirement Living Campus 0 0 0 B Cass County North Dakota 456002205 000000000 2012-08-28 3000000 Construct & Equip 38 Skilled Nursing Bed Addition & Small Kitchen Facility 0 0 0 C City of Harwood North Dakota 450371534 000000000 2015-05-18 7410000 Construction of independent living addition 0 0 0 D City of Argusville North Dakota 450310938 000000000 2015-05-18 7410000 Refinance 2012 mortgage note payable and special assessments 0 0 0 A 5665590 16000000 137143 15862857 2010 0 0 1 1 B 805523 3000000 59755 2940245 2013 0 0 1 1 C 1256680 7410000 32000 7378000 2016 0 0 1 1 D 1620247 7410000 32000 3309589 4068411 2016 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 0 1 0 0 0 0 B 0 0 1 0 1 0 0 0 0 C 0 0 1 0 1 0 0 0 0 D 0 0 1 0 1 0 0 0 0 A 0 B 0 C 0 D 0 Form 990, Part V, Line 2a: Individuals working for Bethany on 42nd are employed by a related organization, American Lutheran Homes, Inc. Form 990, Part VI, Section A, line 2 The CEO and CFO both have a business relationship with each other and all of the Board Members, as the CEO and CFO are employed by another related nonprofit of which the board members serve as well. The Board serves all of the related nonprofit organizations listed on Schedule R. Form 990, Part VI, Section A, line 6 Bethany Homes, Inc. is the sole member of the Corporation. Form 990, Part VI, Section A, line 7a The 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 7b The 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 A, line 8b There are no committees with the broad authority to act on behalf of the governing board. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by the CFO and CEO and then provided to the Board for review prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Board 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. The related organization has a process for determining compensation that includes review by the independent board using comparability data and substantiation of the deliberation and decision. The CFO compensation is paid by a related organization. The related organization has a process that includes review by the CEO and Executive Committee using comparability data. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available upon request. Form 990, Part XI, line 9: Intercompany Transfers -196,507. American Lutheran Homes Inc 201 S University Drive Fargo ND 58103 450274012 Long-term care services, assisted living, basic care ND 501(c)(3) Line 11 Bethany Homes Inc 1 Bethany Home Health Care 201 S University Drive Fargo ND 58103 450433045 Promotion of health ND 501(c)(3) Line 11 Bethany Homes Inc 1 Bethany Homes Inc 201 S University Drive Fargo ND 58103 450394181 Fundraising ND 501(c)(3) Line 11 N/A 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 Bethany Homes Inc R 196507 General Ledger American Lutheran Homes Inc P 15010702 General Ledger