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 (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)
Bethel Lutheran Nursing & Rehabilitation Center |
450230141 | 9 | Yes | 60,281 | 5,345 | |
| Total 1 | 60,281 | 5,345 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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): |
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| 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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part I, Line 11g, column vi: | The Other Support of $5,345 represents the donation of a two bedroom apartment and utilities for seven months in 2015 which was used to house locum tenant staff. |
| Schedule A, Section D, Line 3: | The Bethel Lutheran Foundation Board is comprised of five board members. Two of the five members are appointed from the Bethel Lutheran Nursing & Rehabilitation Center Board, the supported organization. In addition, the Administrator of Bethel Lutheran Nursing and Rehabilitation Center shall serve as ex-officio, non-voting member of the Foundation's board of directors. Because of the small size of the Board, all board members are actively involved in all functions of the Board. The Bethel Foundation Director also attends the monthly Bethel Lutheran Nursing and Rehabilitation Center Board meetings and presents a report prior to their monthly meetings. Dialog between the organizations is open and the Foundation's supporting relationship has functioned well since its inception in 1985. |
| Schedule A, Section E, Line 2a: | Bethel Lutheran Foundation owns 62 senior apartments in three separate facilities located in Williston, ND. The apartments are both market rate and Section 42 Low Income Housing Tax Credit (LIHTC) program. Our apartments also offer several options for food service to help assure proper nutrition for our tenants. It was important to include the LIHTC units in our mix of senior preferred apartments so that we could offer quality senior housing options in our community that were affordable. Williston has seen very large increases in market rate apartments in recent years due to the Bakken oil development. Bethel Foundation has kept our senior preferred apartments (including market rate) very affordable to our tenants. Many of the tenants we serve in our apartments would have been served by the nursing facility in the 1950, 60 & 70's. At that time there were no other options for seniors in our community other than Bethel Lutheran Nursing and Rehabilitation Center. Today more of these seniors are able to remain independent and un-institutionalized longer because of the senior living apartments. The activities of the Foundation are directly furthering the exempt purpose of the Bethel Lutheran Nursing and Rehabilitation Center in its truest meaning - ministering to the physical, spiritual, and emotional needs of each person. |
| Schedule A, Section E, Line 2b: | If the organization did not conduct the activities described in Section E, line 2a, the supported organization would have to directly undertake the activities of managing the endowment, providing housing for elderly, and grant making. The supported organization was formed to provide for healthcare needs of the region. The supported organization is providing for the healthcare needs of the region through the use of the organization and its activities. |
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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 1 | The Board of Directors may, by resolution adopted by two-thirds (2/3) of the total number of Directors, establish an Executive Committee of the Board of Directors of this Corporation and appoint two (2) or more Directors to serve on such Executive Committee, at least one of whom shall be the President of this Corporation. Except for the powers to amend the Articles of Incorporation, and the Bylaws of this Corporation, the Executive Committee shall have all of the powers and authority of the Board of Directors of this Corporation in the management of property, business, and affairs of this Corporation in the intervals between meetings of the Board of Directors, subject always to the direction and control of the Board of Directors. |
| Form 990, Part VI, Section A, line 6 | The membership of this corporation shall consist of the congregations of the Western North Dakota District of the American Lutheran Church or its successors, within the counties of Williams, Divide and McKenzie, in the State of North Dakota, who have taken congregational action to accept membership and given the Secretary of this corporation written notice of such action. |
| Form 990, Part VI, Section A, line 7a | The Board of Directors shall consist of at least three (3) members and no more than (9) members which shall be elected by the members of this Corporation at its annual meetings, except that at least two (2) shall be appointed by the Board of Directors of the Bethel Lutheran Nursing and Rehabilitation Center, Williston, North Dakota, a North Dakota corporation. Each Director shall serve for a term of three (3) years and no Director shall be eligible to serve more than two (2) successive three-year terms. At the first annual meeting of the Corporation, one director shall be elected for a term of one year, one Director for a term of two years and one Director shall be appointed for an initial term of three (3) years. At no time shall the Board of Directors of this Corporation include more than four (4) members who are employees, officers, or Directors of the Bethel Lutheran Nursing and Rehabilitation Center of Williston, North Dakota. The Administrator of the Bethel Lutheran Nursing and Rehabilitation Center shall serve as ex-officio, non-voting member of the Board of Directors. At least a majority of the Board members shall be members of Lutheran Congregations which are members of the Williston Conference of the Western North Dakota Synod of the Evangelical Lutheran Church in America. Board members shall be selected with due regard for gender, community diversity, geographic and racial representation, and for their interest in, and ability to offer leadership to the corporation. |
| Form 990, Part VI, Section B, line 11 | The 2015 Form 990 was reviewed by the Board of Directors before filing. |
| Form 990, Part VI, Section B, line 12c | The Board of Directors and all employees are covered by the conflict of interest policy. When a director or employee becomes aware that an issue, event or situation may involve a conflict of interest the director or employee shall make such conflict known to the Board of Directors or appropriate supervisor. In the case of a Board Member or the Director, the Board shall assess the conflict to see whether the conflict is detrimental to the organization. The Board shall take formal action which recognizes the nature of the conflict, a determination as to whether the conflict is detrimental to the organization, and instruction as to the appropriate action to be taken by the director or employee. |
| Form 990, Part VI, Section B, line 15a | To determine the Foundation Director's compensation, a subcommittee of the Board of Directors does a survey of comparable positions, reviews the Director's performance, and then makes a recommendation to the Board of Directors. There are no other officers or key employees. |
| Form 990, Part VI, Section C, line 19 | The governing documents, conflict of interest policy, and financial statements are available upon request. |
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