SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
St Luke's Home
 
Employer identification number

45-0347147
Return Reference Explanation
Form 990, Part VI, Section A, line 6 The Corporation shall have one member. Dickinson St. Luke's Homes, Inc., a North Dakota nonprofit corporation, shall be the sole member of the Corporation.
Form 990, Part VI, Section A, line 7a Ten directors shall be appointed by Dickinson St. Luke's Homes, Inc., to serve one-year terms, with unlimited succession.
Form 990, Part VI, Section A, line 8b There are no committees with authority to act on behalf of the governing board.
Form 990, Part VI, Section B, line 11 The administrator and legal advisor will review a draft of the full Form 990 before it is finalized. In addition, a public disclosure copy of the Form 990 will be provided to the board of directors for their review and comment prior to its filing with the IRS.
Form 990, Part VI, Section B, line 12c The organization annually re-adopts a conflict of interest policy. Any perceived conflict of interest on the part of a board member shall be disclosed to the Board of Directors prior to the board's decision on the issue to which the perceived conflict relates. When such a disclosure has been made and acknowledged, and the board has concurred that a conflict of interest exists, the board member involved shall abstain from voting on the issue. The board member shall refrain from participating in the discussion other than to provide factual information about the applicant, organization or vendor in question. Any abstentions from voting will be recorded in the minutes of the meeting.
Form 990, Part VI, Section B, line 15a Annually, a committee performs an evaluation of the compensation and sends evaluation forms to the Board of Directors. They compile the responses and review area wages provided by the ND Long Term Care Association. The Board of Directors votes on the compensation amounts. A vote is conducted during each filing year. This process is documented in the meeting minutes.
Form 990, Part VI, Section C, line 19 The organization does not make its governing documents, conflict of interest policy, or financial statements available to the public.
Form 990, Part XII, Line 2c: The entire board of directors assumes the responsibility for oversight of the audit.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

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