Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
Valley Memorial Foundation |
450392710 | Line 7 | Yes | 0 | 0 | |
| (B)
Valley Homes and Services |
450229071 | Line 9 | Yes | 1,530,703 | 0 | |
| (C)
4000 Valley Square Inc |
311558826 | Line 9 | Yes | 970,433 | 0 | |
Total 3
|
2,501,136 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part IV, Section A, Line 1 | Valley Memorial Homes bylaws indicate as part of its corporate purpose to promote the interest of other orginaztions formally affiliated with it which fall within the category of Section 501 (c )(3) of the Code. Valley Memorial Homes is the sole corporate member for both Valley Homes and Services and 4000 Valley Square. |
| Software ID: | 14000267 |
| Software Version: | v1.00 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, Line 9 | Kevin Beito, 1328 21st St NW, East Grand Forks, MN 56721; Bruce Newhouse, 27093 350th Ave SW, Fisher, MN 56723; Charles Johnson, 3008 Legend Lane, Grand Forks, ND 58201; Michael Porter, 6100 Kingsview Dr #105, Grand Forks, ND 58201; David Loer, 2250 Sunnyside Ct NW, East Grand Forks, MN 56721; Clark Piepkorn, 3021 Olson Drive, Grand Forks, ND 58201; Darlene Hanson, Box 9025 University Station, Grand Forks, ND 58202-9025; Cheryl Swanson, Alerus Center, 1200 S 42nd St, Grand Forks, ND 58201; Carol Snortland, 3802 Cherry St K-43, Grand Forks, ND 58201; Chad Erickson, 19274 445th Ave SW, East Grand Forks, MN 56721; Jeff Awes, 1025 Cottonwood St, Grand Forks, ND 58201; Arlet Phillips, 21512 400th Ave SW, East Grand Forks, MN 56721; Susan Larson, 867 7th Ave NE, Thompson, ND 58278-9334; Diane Lindseth, 1736 9th Ave NE, Thompson, ND 58278-9215; Sheryl Cariveau, 424 Crestwood Ct SE, East Grand Forks, MN 56721; Roger Stadstad, 2742 18th St NE, Manvel, ND 58256; Sharon Bakke, 2331 25th St NE, Mekinock, ND 58258; Lawrence Heuchert, 2230 7th Ave N., Grand Forks, ND 58203; Olive Weber, 4634 Belmont Road, Grand Forks, ND 58201; Sharon Gustafson, PO Box 204, Thompson, ND 58278; Susan Kuster, 313 7th Ave, Reynolds, ND 58275; Milt Kinzler, 2725 Knight Dr, Grand Forks, ND 58201; Marlys Kennedy, 608 Park Dr, Manvel, ND 58256; Gary Masilko, 210 Circle Hills Dr, Grand Forks, ND 58201; Arvin Kvasager, 2521 9th Ave N, Grand Forks, ND 58203; Ron Holte, PO Box 293, Thompson, ND 58278; Jacky Jones, PO Box 203, Oslo, MN 56744; Eunice Vold, 411 22nd Ave S, Grand Forks, ND 58201; Iola Kvasager, 2521 Oth Ave N, Grand Forks, ND 58203 |
| Form 990, Part VI, Section B, Line 11b | 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 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 electronically filed after Executive Committee approval. |
| Form 990, Part VI, Section B, Line 12c | The conflict of interest policy is stated in Article 8 of the bylaws. It is reviewed with board members at Board Orientation. Board members are presented the policy and sign off annually. |
| 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's CEO's salary compares with others of similar size and function. This survey provides the committee with a guage 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. Compensation for executive management includes performance appraisal completed by the President/CEO or their direct supervisors. Employees are eligible for annual inflationary increase to their base salary. The percentage is based upon the approved annual budget or other board approved changes. ND Long Term Care salary surveys are reviewed and adjustments are made to base salaries if the survey demonstrates underpayment compared to like sized organizations. |
| Form 990, Part VI, Section C, Line 18 | 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. |
| 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. |
| Software ID: | 14000267 |
| Software Version: | v1.00 |