2024-11-08T08:42:37-06:00 2023-12-31 346565596 ERNST & YOUNG US LLP 155 N WACKER DRIVE CHICAGO IL 60606 990 2023-01-01 450228055 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY EVAN 6053623100 PO BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 NICHOLAS OLSON EVP, CFO 6053331000 2024-11-08 1 0 JESS WAGENER P01622613 3128792000 2023 2024-10-15 13:58:12Z NATHAN SCHEMA 4800 W 57TH ST SIOUX FALLS SD 57108 1055264614 0 X WWW.GOOD-SAM.COM X 1922 ND DEDICATED TO SHARING GOD'S LOVE THROUGH THE WORK OF HEALTH, HEALING AND COMFORT. 8 7 18000 150 1693678 0 23047294 15850892 984586960 911306536 16785980 11546880 12412408 14573496 1036832642 953277804 4006 2136909 0 0 549840663 544592111 0 0 1042 535358067 438349122 1085202736 985078142 -48370094 -31800338 1222802084 1105454446 221838214 193170490 1000963870 912283956 X THE MISSION OF THE GOOD SAMARITAN SOCIETY - TO SHARE GOD'S LOVE THROUGH THE WORK OF HEALTH, HEALING AND COMFORT - IS A LOCAL MISSION. IT PLAYS OUT IN HUNDREDS OF HOMETOWNS ACROSS AMERICA EVERY DAY. 0 0 659870543 2136909 684958909 SKILLED NURSING SERVICES - REHABILITATION/SKILLED NURSING SERVICES HAVE BEEN AT THE CORE OF THE SOCIETY'S SERVICES OVER ITS 100-YEAR HISTORY. THE SOCIETY APPROACHES CARE FOR THE SPIRITUAL, EMOTIONAL AND SOCIAL DIMENSIONS OF OUR SKILLED NURSING RESIDENTS IS AS IMPORTANT AS THE PHYSICAL CARE THAT IS PROVIDED TO SOCIETY RESIDENTS EVERY HOUR OF EVERY DAY. SERVICES PROVIDED IN SOCIETY SKILLED NURSING FACILITIES INCLUDE COMPREHENSIVE PROFESSIONAL NURSING CARE; REHABILITATION SERVICES; AS WELL AS A HIGH QUALITY OF RELATED SERVICES SUCH AS DIETARY, RECREATIONAL AND OTHER ACTIVITIES; MEDICATION ADMINISTRATION; AND OTHER SERVICES THAT MEET THE HOLISTIC NEEDS OF THOSE THE SOCIETY IS CALLED TO SERVE. THE SOCIETY IS THE LARGEST NOT-FOR-PROFIT PROVIDER OF REHABILITATION/SKILLED NURSING SERVICES IN THE UNITED STATES. BUT SIZE IS NOT THE SOCIETY'S OBJECTIVE. INSTEAD, SEEKING TO MEET THE NEEDS OF "OLDER PERSONS AND OTHERS IN NEED" TO IMPROVE THEIR WELL-BEING - AS THEY DEFINE IT - REMAINS PARAMOUNT. STATISTICALLY, THE SOCIETY PROVIDED A TOTAL OF 2,010,186 SKILLED NURSING HOME DAYS OF CARE AND SERVICE IN 2023. THE SOCIETY CONTINUES TO REINVEST MUCH OF ITS REVENUE TO BUILD AND REVITALIZE ITS FACILITIES ON CAMPUSES THROUGHOUT THE COUNTRY. 82922227 0 94241886 HOUSING WITH SERVICES - ALSO REFERRED TO AS INDEPENDENT OR SENIOR HOUSING, HOUSING WITH SERVICES HAS BEEN A GROWING PART OF THE SOCIETY'S MINISTRY FOR MANY YEARS. WITH ABOUT 10,000 PEOPLE RETIRING EACH AND EVERY DAY IN THE UNITED STATES - AND WITH EVER-INCREASING NUMBERS OCCURRING IN FUTURE YEARS - THE PROVISION OF SENIOR LIVING/HOUSING WILL TAKE ON INCREASING IMPORTANCE IN YEARS TO COME. THE SOCIETY RECOGNIZES THIS GROWTH AND HAS MADE EXPANSION OF SENIOR LIVING SERVICES AND LOCATIONS A MAJOR PART OF THIS CORPORATE STRATEGIC PLANNING. CAMPUSES FEATURE ATTRACTIVE GROUNDS; A VARIETY OF COMMON SPACE AND MULTI-PURPOSE ROOMS FOR RESIDENT AND FAMILY INTERACTION AND COMMUNITY GATHERINGS; LIBRARIES AND READING ROOMS; DINING SERVICES; CABLE TV AND PHONE SERVICE; AND THE AVAILABILITY OF COMPUTER/INTERNET SERVICES TO ALLOW AND ENCOURAGE ELECTRONIC CONNECTIVITY WITH FAMILY AND FRIENDS. FURTHER, VARIOUS SENIOR LEARNING OPPORTUNITIES ARE PROVIDED ON SENIOR LIVING CAMPUSES IN ADDITION TO THE SPIRITUAL AND SOCIAL PROGRAMS OFFERED IN REHABILITATION/SKILLED NURSING SERVICES AND ASSISTED LIVING. 89860581 0 87203800 ASSISTED LIVING SERVICES - ASSISTED LIVING SERVICES RESPOND TO THE SOCIETY'S RESIDENTS' NEEDS EACH DAY IN A "HOME-LIKE" ENVIRONMENT. IN 2023, THE SOCIETY PROVIDED 1,441,277 RESIDENT DAYS IN ASSISTED LIVING LOCATIONS. THIS IMPORTANT LEVEL OF CARE PROVIDES A VITAL, INTERMEDIATE LEVEL OF CARE FOR INDIVIDUALS WHO ARE NEITHER ABLE TO LIVE INDEPENDENTLY NOR ARE IN NEED OF SKILLED NURSING SERVICES. THE LIST OF SERVICES PROVIDED IN SOCIETY ASSISTED LIVING FACILITIES HIGHLIGHTS AN ENVIRONMENT THAT PROVIDES FOR THE HOLISTIC CARE OF ITS RESIDENTS. SERVICES INCLUDE THREE NUTRITIOUS MEALS A DAY, HOUSEKEEPING, LAUNDRY SERVICE, 24-HOUR STAFFING (IN ADDITION TO EMERGENCY CALL SYSTEMS), SCHEDULED TRANSPORTATION, SPIRITUAL SERVICES, AND MEDICATION ASSISTANCE. COORDINATED SPIRITUAL AND SOCIAL PROGRAMS ARE OFFERED FOR THE TOTAL WELL-BEING OF THE RESIDENTS. 41661824 0 47769034 HOME HEALTH SERVICES - THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY OFFERS LICENSED HOME HEALTH CARE, HOSPICE AND SERVICES@HOME (PRIVATE DUTY) SERVICES IN 18 STATES. THESE AGENCIES PROVIDE SKILLED HEALTH CARE IN A CLIENT'S HOME. SKILLED CARE INCLUDES PROFESSIONAL NURSING CARE, HOME HEALTH AIDE ASSISTANCE, SOCIAL SERVICES AND THERAPISTS TO MEET THE SKILLED-MEDICAL NEEDS OF THE CLIENT. WE PROVIDE CLINICAL SUPERVISION AND TREATMENT FOR THE PERSON ON A SHORT-TERM OR INTERMITTENT BASIS TO MEET HIS OR HER MEDICAL AND PERSONAL NEEDS.THE LICENSED HOSPICE AGENCIES AND GENERAL INPATIENT UNIT PROVIDED SERVICES INCLUDING PHYSICIAN, PROFESSIONAL NURSE, MEDICAL SOCIAL WORKER, CHAPLAIN, BEREAVEMENT SERVICE, HOME HEALTH AIDE, VOLUNTEERS AND THERAPY AS DIRECTED BY THE PATIENT'S CARE PLAN. THE COMPASSIONATE, LOVING CARE AT THE END OF A PERSON'S LIFE PROVIDES THE PATIENT AND THEIR FAMILIES WITH THE SUPPORT AND CARE NEEDED TO MEET THE GOALS OF CARE.SERVICES@HOME, OUR PRIVATE DUTY AGENCIES, TAILORS SERVICES TO SUPPORT SENIORS, WHICH ALLOWS THEM THE CHOICE TO REMAIN HOME WHILE RECEIVING THE COMPASSIONATE CARE AND SERVICES NEEDED. THESE SERVICES INCLUDE MEAL PREPARATION, HOUSEKEEPING, COMPANIONSHIP, PERSONAL HYGIENE AND GROOMING, BATHING, EXERCISE, RESPITE CARE, MEMORY CARE, TRANSPORTATION, APPOINTMENT ESCORT, MEDICATION REMINDERS AND MORE. 41661824 0 47769034 874315175 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 1 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 148 0 1 18000 1 1 1 1 CJ 0 0 0 0 0 0 0 0 0 0 X 8 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 AK AR CA CO DC FL GA HI IL KS KY MI MN MS NV NM ND OH OR TN WA WV WI X NICHOLAS OLSON EVP CFO 6053331000 2301 EAST 60TH STREET SIOUX FALLS SD 57104 X MICHELLE BRUHN TREASURER (END 6/23) 1.00 59.00 X 0 3526262 105043 MATT HOCKS DIRECTOR 0.50 59.50 X 0 2082393 267738 BILL MARLETTE INTERIM TREASURER (BEG 6/23) 1.00 59.00 X 0 1306330 378 NATHAN SCHEMA PRESIDENT & CEO 58.10 1.90 X 0 850439 143523 ERIC VANDEN HULL FORMER OFFICER - VP, FINANCE 0.00 60.00 X 0 569890 44085 JULIE RIEKEN STAFF NURSE - RN 111.84 0.00 X 394987 0 26933 AIMEE MIDDLETON VP, OPERATIONS 55.00 0.00 X 0 372945 40531 THOMAS SYVERSON FORMER OFFICER - EVP 5.00 50.00 X 0 349366 42301 JOEL FLUIT VP, FINANCE 55.00 0.00 X 0 355009 28055 RANDY BURY FORMER PRESIDENT & CEO-SEE SCH J 0.00 0.00 X 0 283920 0 ROSE NTAMBWE NURSING ASSISTANT 115.73 0.00 X 238270 0 22351 ANNERIS ZACHMAN STAFF NURSE - RN 77.85 0.00 X 246013 0 12756 DUSTIN SCHOLZ FORMER KEY EMPLOYEE - REGIONAL VP 55.00 0.00 X 0 195242 41540 BOAKAI KAMARA SR NURSING ASSISTANT 79.96 0.00 X 197226 0 59 JACKLINE OIGO STAFF NURSE - RN 56.55 0.00 X 194244 0 2477 SCOTT PETERSEN DIRECTOR, CHAIRPERSON (END 6/23) 3.30 0.10 X X 0 0 0 DARRELL SCHMITH VICE CHAIR(END 6/23),CHAIR(BEG 6/23) 3.30 0.10 X X 0 0 0 LINDA NORMAN DIRECTOR, VICE CHAIR (BEG 6/23) 3.30 0.10 X X 0 0 0 DAVID AUSTAD DIRECTOR 3.30 0.10 X 0 0 0 DAVID BRECHTELSBAUER DIRECTOR (END 11/23) 3.30 0.10 X 0 0 0 DEAN BRESCIANI PHD DIRECTOR 3.30 0.10 X 0 0 0 NORVAL BUCKNEBERG DIRECTOR (END 6/23) 3.30 0.10 X 0 0 0 THOMAS KOOP DIRECTOR 3.30 0.10 X 0 0 0 HELEN MELLAND DIRECTOR 3.30 0.10 X 0 0 0 1270740 9891796 777770 363 1 1 0 FOCUSONE SOLUTIONS LLC 1010 N 102ND ST SUITE 300 OMAHA NE 68114 NURSING POOL SERVICES 30934739 OLYMPUS RETIREMENT LIVING LLC 2205 E RIVERSIDE DR SUITE 100 EAGLE ID 83616 NURSING POOL SERVICES 14972959 SELECT REHABILITATION INC PO BOX 809056 CHICAGO IL 606809056 CONTRACT THERAPY SERVICES 3501324 MORRISON COMMUNITY LIVING 400 N RIDGE RD SUITE 600 SANDY SPRINGS GA 30350 DIETARY SERVICES 2511308 GRAPETREE MEDICAL STAFFING LLC 2501 BOJI BEND DR SUITE 100 MILFORD IA 51351 NURSING POOL SERVICES 2398875 72 7555729 7385783 909380 15850892 LTC - ROOM REVENUE 623000 645933982 645933982 LTC - THERAPY SERVICES 623000 170518951 170518951 HCBS REVENUE 623000 38824500 38824500 ANCILLARY & PHARMACY 623000 38517035 38517035 ALL OTHER PROGRAM SERV 623000 11553112 11868660 -315548 5958956 5958956 0 911306536 705016 705016 6559683 1785 0 0 6559683 1785 6561468 1785 6559683 112828674 101986810 10841864 10841864 10841864 ADMINISTRATIVE SERVICE 561000 4348160 2549760 1798400 CAFETERIA/VENDING 722514 3236425 3236425 EMPLOYEE & GUEST MEALS 722514 210826 210826 216617 216617 8012028 953277804 914173629 1693678 21559605 2122620 2122620 14289 14289 9400537 9356823 43714 1526343 1519245 7098 431930639 430407390 1523249 15421966 15409970 11996 47483390 47265745 217645 38829236 38740623 88613 118015 118015 105308 105308 148988 148988 354027 354027 71 71 87458741 70480141 16978600 2264022 2264022 7573420 7810524 -237104 47683681 46894736 788945 8636976 8632088 4888 1125284 1125284 23020457 21829335 1191122 47313923 44647797 2666126 15179163 14889385 289778 PURCHASED SERVICES FROM 85154405 85154405 MEDICAL SUPPLIES 64605893 64605893 PROVIDER CARE TAXES 15491578 15491578 UNCOLLECTIBLE EXPENSE 15159870 14796850 363020 16955300 16010837 943421 1042 985078142 874315175 110761925 1042 13553955 8585011 2306800 2828436 132930450 88743032 8030401 1108474 3282176 1780445 726151 338913 1639462201 701837712 984606925 937624489 5627818 10297298 0 21137999 18477120 45929929 40340708 1222802084 1105454446 56126889 51568323 3627980 6268272 150961709 121380039 369943 333927 10751693 13619929 221838214 193170490 X 1000963870 912283956 1000963870 912283956 1222802084 1105454446 X -31800338 -594 -56878982 X 0 1 X 1 1 1 X 7572687 97147346 30984170 23047294 15850892 174602389 833953581 925626155 919511974 984515367 911622084 4575229161 10332 10332 841536600 1022773501 950496144 1007562661 927472976 4749841882 2672670 6036084 8708754 0 2672670 6036084 8708754 4741133128 107653658 4051102 4068877 4422723 7266484 127462844 107653658 4051102 4068877 4422723 7266484 127462844 619174 619174 11582648 7841756 7698887 6270213 6002802 39396306 960772906 1034666359 962883082 1018255597 940742262 4917320206 0.96420 0.96320 0.02590 0.02640 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ADMINISTRATIVE SERVICES OTHER REVENUE EMPLOYEE GUEST MEALS CAFETERIA/VENDING RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 263951 0 1 90076 354027 0 PART II-B, LINE 1: THE FILING ORGANIZATION HAS MEMBERSHIPS IN THE ALBUQUERQUE ECONOMIC DEVELOPMENT, BISMARCK MANDAN CHAMBER EDC, CARE PROVIDERS OF MN, CATHOLIC HEALTH ASSOCIATION OF US, CHAMBER OF COMMERCE GF/EGF, CHAMBER OF COMMERCE MINOT, CO ASSISTED LIVING ASSOC, EUGENE AREA CHAMBER OF COMMERCE, FLORIDA HEALTHCARE ASSOCIATION, FLORIDA MANUFACTURED HOUSING ASSOCIATION, FT COLLINS CHAMBER OF COMMERCE, GREATER SF CHAMBER OF COMMERCE, HEALTH CARE ASSOCIATION HI, HEALTH POLICY CONSORTIUM, HI HOSPITAL EDUCATION & RESEARCH, IA HEALTHCARE ASSOCIATOIN, IDAHO HEALTH CARE ASSOCIATION, IOWA HOSPITAL ASSOCIATION, LEADINGAGE AZ, LEADINGAGE CO, LEADINGAGE KS, LEADINGAGE TX, LEADINGAGE WI, NATIONAL HOSPICE & PALLIATIVE CARE ORGANIZATION, NE HEALTH CARE ASSOC, NEBRASKA ASSOCIATION FOR HOME HEALTHCARE & HOSPICE, NEW MEXICO ASSOCIATION FOR HOME & HOSPICE CARE, NM HEALTH CARE ASSOCIATION, NORTH DAKOTA LONG TERM CARE ASSOCIATION, NORTH DAKOTA PETROLIUM COUNCIL, OH HEALTH CARE ASSOCIATION, OR HEALTH CARE ASSOCIATION, SD HEALTH CARE ASSOCIATION, SOCIETY FOR POST-ACUTE & LTC MEDICINE, SOUTH DAKOTA ASSOCIATION OF HEALTHCARE ORGANIZATION, TN HEALTH CARE ASSOCIATION, TX ASSOCIATION OF HOME CARE & HOSPICE, WA HEALTH CARE ASSOCIATION, AND WV HEALTH CARE ASSOCIATION . A PERCENTAGE OF MEMBERSHIP DUES PAID TO THESE ORGANIZATIONS RELATE TO LOBBYING EXPENSES. IN ADDITION, THE ORGANIZATION EMPLOYS CERTAIN INDIVIDUALS, AND CONTRACTS WITH VARIOUS LOBBYISTS, TO MONITOR LEGISLATIVE ACTS IMPORTANT TO ALL GOOD SAMARITAN SOCIETY ENTITIES ON BOTH STATE AND NATIONAL LEVELS. OCCASIONALLY, EMPLOYEES SEND MAILINGS TO LEGISLATORS ON ISSUES THAT MAY AFFECT LONG TERM CARE OR POST-ACUTE ISSUES. 0 1 X 20862373 9958 -147531 4509935 16214865 21824287 11330 -751575 221669 20862373 21167839 366880 395606 106038 21824287 20586709 623431 42301 21167839 23961503 3374794 20586709 0.00000 1.00000 0.00000 0 1 1 70449057 70449057 1004183057 542864006 461319051 1339248 1234629 104619 173977234 119989754 53987480 389513605 37749323 351764282 937624489 LIABILITIES HELD FOR SALE 2086484 ENVIRONMENTAL REMEDIATION LIABILITY 6021431 DEFERRED COMPENSATION 3342813 OTHER LIABILITIES 2169201 13619929 X PART IV, LINE 2B: AS SET FORTH BY FEDERAL AND STATE REGULATIONS, THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (SOCIETY) PROVIDES RESIDENT TRUST ACCOUNT (RTA) SERVICES FOR RESIDENTS. THESE RTA FUNDS ARE NOT COMMINGLED WITH SOCIETY FUNDS, ARE ACCESSIBLE FOR RESIDENTS' USE, HAVE DETAILED ACCOUNTING RECORDS MAINTAINED ON AN INDIVIDUAL RESIDENT BASIS, AND FOLLOW BOTH FEDERAL AND STATE REGULATIONS REGARDING THE HANDLING AND DOCUMENTATION OF ACTIVITY. AS RTA FUNDS ARE HELD IN TRUST FOR RESIDENTS, A RESIDENT MAY AUTHORIZE THAT THEIR RTA FUNDS BE RETURNED TO THE RESIDENT OR THEIR DESIGNEE (REPRESENTATIVE PAYEE, FINANCIAL POWER OF ATTORNEY, GUARDIAN, ETC.) AT ANY TIME. ADDITIONALLY, WHEN A RESIDENT IS DISCHARGED FROM A FACILITY, THEIR RTA FUNDS ARE RETURNED TO THE RESIDENT OR THEIR AUTHORIZED DESIGNEE. IF A RESIDENT EXPIRES WITH RTA FUNDS ON HAND, SPECIFIC STATE REGULATIONS ALONG WITH STATE AND/OR FEDERAL AGENCIES GUIDELINES ARE REVIEWED TO ENSURE THESE RTA FUNDS ARE MANAGED APPROPRIATELY. THE SOCIETY HAS HOUSING ENTRANCE FEES FOR ADMITTANCE INTO HOUSING UNITS AT VARIOUS LOCATIONS. THESE CONTRACTS FOR HOUSING ENTRANCE FEES VARY BY LOCATION, AND TYPICALLY HAVE VARYING REFUNDABLE PORTIONS UP TO 100% OF THESE ENTRANCE FEES. THE REFUNDABLE PORTIONS OF THE HOUSING ENTRANCE FEES ARE REFUNDABLE BASED UPON TIME RESTRICTIONS AND VACANCY OF THE HOUSING UNIT. THE NONREFUNDABLE PORTION OF THE HOUSING ENTRANCE FEES ARE RECORDED AS DEFERRED REVENUE AND AMORTIZED INTO INCOME OVER THE LIFE EXPECTANCY OF THE RESIDENT AND FULLY RECOGNIZED WHEN THE RESIDENT VACATES ITS UNIT. THE SOCIETY RECORDS A CURRENT PORTION OF HOUSING ENTRANCE FEES THAT IS EXPECTED TO BE REFUNDED IN THE NEXT YEAR. PART V, LINE 4: THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION HOLDS ENDOWMENT FUNDS ON BEHALF OF THE FILING ORGANIZATION TO BE USED AS DIRECTED BY THE DONOR'S RESTRICTIONS OR THE BOARD'S DESIGNATION FOR ASSISTANCE IN ACTIVITIES AND PROVIDING FOR THE GOOD SAMARITAN SOCIETY'S SERVICES. PART X, LINE 2: CERTAIN CONTROLLED CORPORATIONS ARE SUBJECT TO INCOME TAXES. DEFERRED INCOME TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE DIFFERENCES BETWEEN THE FINANCIAL AND INCOME TAX REPORTING BASIS OF ASSETS AND LIABILITIES BASED ON ENACTED TAX RATES AND LAWS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION. THE DEFERRED INCOME TAX PROVISION OR BENEFIT GENERALLY REFLECTS THE NET CHANGE IN DEFERRED INCOME TAX ASSETS AND LIABILITIES DURING THE YEAR. THE CURRENT INCOME TAX PROVISIONS REFLECTS THE TAX CONSEQUENCES OF REVENUES AND EXPENSES CURRENTLY TAXABLE OR DEDUCTIBLE ON VARIOUS INCOME TAX RETURNS FOR THE YEAR REPORTED. THE SOCIETY DID NOT HAVE AN INCOME TAX LIABILITY AT DECEMBER 31, 2023; HOWEVER, SOME RELATED ORGANIZATIONS HAVE ESTABLISHED RESERVES. 1 SOUTH AMERICA 0 0 GRANTS TO ORGANIZATION 14289 0 0 0 0 0 0 14289 0 14289 SOUTH AMERICA SHELTER, FOOD, & SOCIAL SERVICES SUPPORT TO ELDERS IN SOACHA & TUNJA 14289 WIRE TRANSFERS 0 1 0 0 0 1 0 0 0 PART I, LINE 2: THE SOCIETY PROVIDES GRANTS TO ORGANIZATIONS TO SUPPORT VARIOUS CAUSES EACH YEAR. GENERAL CORRESPONDENCE WITH THE RECIPIENTS OF THESE GRANTS IS USED WHEN NEEDED WHILE MONITORING THE USE OF THE GRANTED MONIES. PART I, LINE 3: EXPENDITURES ARE ACCOUNTED FOR ON THE ACCRUAL BASIS OF ACCOUNTING. PART II, LINE 1 ACCOUNTING METHOD: EXPENDITURES ARE ACCOUNTED FOR ON THE ACCRUAL BASIS OF ACCOUNTING. 1 DEUEL AREA DEVELOPMENT INC PO BOX 647 CLEAR LAKE SD 57226 264033911 501 (C) (3) 0 1306140 OTHER - VMG HEALTH VALUATIONS REAL ESTATE SEE FORM 990, PAGE 2, PART III CITY OF MOTT 202 E 3RD ST PO BOX 116 MOTT ND 58646 456002131 501 (C) (3) 0 814980 OTHER - VMG HEALTH VALUATIONS REAL ESTATE SEE FORM 990, PAGE 2, PART III 2 0 PART I, LINE 2: THE ADMINSTRATOR AT EACH LOCATION IS RESPONSIBLE FOR ENSURING THAT THE FUNDS ARE USED IN ACCORDANCE WITH THE GOOD SAMARITAN SOCIETY'S DIRECTION. PART I, LINE 2 THE SOCIETY PROVIDES GRANTS TO ORGANIZATIONS TO SUPPORT VARIOUS CAUSES EACH YEAR. GENERAL CORRESPONDANCE WITH THE RECIPIENTS OF THESE GRANTS IS USED WHEN NEEDED WHILE MONITORING THE USE OF THE GRANTED MOINES. 1 1 0 0 0 1 1 0 0 MICHELLE BRUHN TREASURER (END 6/23) 0 517911 0 185400 0 2822951 0 88278 0 16765 0 3631305 0 430889 MATT HOCKS DIRECTOR 0 1450706 0 363092 0 268595 0 232735 0 35003 0 2350131 0 0 BILL MARLETTE INTERIM TREASURER (BEG 6/23) 0 856004 0 0 0 450326 0 0 0 378 0 1306708 0 0 NATHAN SCHEMA PRESIDENT & CEO 0 623111 0 126242 0 101086 0 110994 0 32529 0 993962 0 0 ERIC VANDEN HULL FORMER OFFICER - VP, FINANCE 0 447084 0 65051 0 57755 0 16500 0 27585 0 613975 0 0 JULIE RIEKEN STAFF NURSE - RN 83284 0 0 0 311703 0 16500 0 10433 0 421920 0 0 0 AIMEE MIDDLETON VP, OPERATIONS 0 309593 0 26657 0 36695 0 12640 0 27891 0 413476 0 0 THOMAS SYVERSON FORMER OFFICER - EVP 0 348034 0 300 0 1032 0 16500 0 25801 0 391667 0 0 JOEL FLUIT VP, FINANCE 0 306492 0 9104 0 39413 0 15962 0 12093 0 383064 0 0 RANDY BURY FORMER PRESIDENT & CEO-SEE SCH J 0 0 0 0 0 283920 0 0 0 0 0 283920 0 0 ROSE NTAMBWE NURSING ASSISTANT 45166 0 0 0 193104 0 11997 0 10354 0 260621 0 0 0 ANNERIS ZACHMAN STAFF NURSE - RN 69808 0 5300 0 170905 0 2027 0 10729 0 258769 0 0 0 DUSTIN SCHOLZ FORMER KEY EMPLOYEE - REGIONAL VP 0 174024 0 0 0 21218 0 9128 0 32412 0 236782 0 0 BOAKAI KAMARA SR NURSING ASSISTANT 32801 0 6058 0 158367 0 0 0 59 0 197285 0 0 0 JACKLINE OIGO STAFF NURSE - RN 69905 0 10300 0 114039 0 2388 0 89 0 196721 0 0 0 PART I, LINE 1A FIRST CLASS OR CHARTER TRAVEL - FIRST CLASS TRAVEL OR CHARTER TRAVEL IS PROVIDED FOR INDIVIDUALS AS NEEDED AND AS COST APPROPRIATE, IN ACCORDANCE WITH WRITTEN POLICIES. THESE COSTS ARE NOT INCLUDED IN THE W-2'S OF THE INDIVIDUALS AS THEY ARE INCURRED FOR BUSINESS PURPOSES OF THE SOCIETY. CERTAIN ITEMS LISTED ON LINE 1A ARE PROVIDED BY RELATED ORGANIZATIONS. PART I, LINE 3 SANFORD ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND EXECUTIVES OF THE ORGANIZATION, INCLUDING THE CEO, AND TO REPORT THE FINDINGS TO THEM FOR DELIBERATION AND ACTION. THE DELIBERATIONS AND ACTIONS ARE RECORDED IN THE MINUTES OF THE SANFORD BOARD OF TRUSTEES. THE MOST RECENT STUDY WAS COMPLETED IN 2023. PART I, LINES 4A-B LINE 4A - SEVERANCE OR CHANGE OF CONTROL UPON HIRE OR PROMOTION, SELECT OFFICERS AND KEY EMPLOYEES SIGN AN EXECUTIVE SEVERANCE AGREEMENT (THE "AGREEMENT"). THE AGREEMENT PROVIDES THAT THE EXECUTIVE WILL RECEIVE A MULTIPLE OF HIS OR HER SALARY (BASED ON YEARS OF SERVICE OR POSITION) AS A PAYMENT IN THE EVENT OF A DEFINED SEPARATION EVENT, WHICH CAN INCLUDE AN INVOLUNTARY SEPARATION OR AN EMPLOYEE VOLUNTARILY LEAVING FOR A DEFINED CONTRACTUAL REASON. EXECUTIVES MAY ALSO QUALIFY FOR A PAYMENT FOR SATISFYING A NON-COMPETE. FINAL SEPARATION PAYMENTS MIGHT VARY FROM THE AMOUNT PROVIDED IN THE AGREEMENT AS A RESULT OF NEGOTIATIONS SURROUNDING POST-SEPARATION OBLIGATIONS AND INCENTIVES (THE "SEPARATION" PAYMENT). LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS SANFORD SPONSORS NONQUALIFIED RETIREMENT PLANS FOR SELECT OFFICERS OR KEY EMPLOYEES. CERTAIN OF THE BELOW OFFICERS OR KEY EMPLOYEES WERE PAID AS A RESULT OF A VESTING EVENT. LINES 4A AND 4B - PAYMENTS THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE OR CHANGE OF CONTROL PAYMENTS AND/OR SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: MICHELLE BRUHN: SEPARATION..................................$2,157,592 NONQUALIFIED RETIREMENT PLAN.................$576,899 TOTAL.......................................$2,734,491 BILL MARLETTE: NON-COMPETE..................................$436,802 RANDY BURY: NON-COMPETE..................................$283,920 KELLIE SCHOLZ FAMILY RELATIONSHIP - DUSTIN SCHOLZ 68745 EMPLOYMENT 0 ANGELA VANDEN HULL FAMILY RELATIONSHIP - ERIC VANDEN HULL 67353 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE EMPLOYEES OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY OR ITS RELATED ORGANIZATIONS. MANY OF THESE EMPLOYEES ALSO SERVE ON OTHER RELATED ORGANIZATION BOARDS OR HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER THAT SPAN THE ORGANIZATION AS A WHOLE: MATT HOCKS, AIMEE MIDDLETON, NATHAN SCHEMA, JOEL FLUIT, MICHAEL ROGERS, MICHELLE BRUHN, AND BILL MARLETTE. FORM 990, PART VI, SECTION A, LINE 6 ON JANUARY 1, 2019, SANFORD BECAME THE CLASS A CORPORATE MEMBER OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY. AT THAT TIME, THE EXISTING MEMBERSHIP OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (THE "SOCIETY") BECAME THE CLASS B MEMBER THAT RETAINED THE ABILITY TO RECOMMEND MEMBERS OF THE SOCIETY BOARD OF DIRECTORS FOR APPOINTMENT BY THE CLASS A CORPORATE MEMBER, SANFORD. THE SOCIETY BOARD OF DIRECTORS ADMINISTERS THE AFFAIRS OF THE SOCIETY, INCLUDING BUDGET DEVELOPMENT AND PROVIDING ADVICE AND CONSENT TO SANFORD IN SELECTING AND EVALUATING THE SOCIETY PRESIDENT. SOME ACTIONS OF THE SOCIETY BOARD OF DIRECTORS REQUIRE APPROVAL OF THE SANFORD BOARD OF TRUSTEES (SEE PART VI, LINE 7B). FORM 990, PART VI, SECTION A, LINE 7A THE CLASS A CORPORATE MEMBER, SANFORD, APPOINTS THE BOARD MEMBERS FOR THE BOARD OF DIRECTORS OF THE SOCIETY. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS OF THE SOCIETY BOARD OF DIRECTORS MUST BE APPROVED BY THE CLASS A CORPORATE MEMBER, SANFORD: (1) APPROVAL OF THE SOCIETY'S ANNUAL AND LONG-TERM STRATEGIC PLANS; (2) APPROVAL OF THE SOCIETY'S ANNUAL OPERATING AND CAPITAL BUDGET AND FINANCIAL FORECAST; (3) MERGER, CONSOLIDATION, DISSOLUTION, SALE OF SUBSTANTIALLY ALL OF SOCIETY'S ASSETS, OR ANY OF THE SAME ACTIONS WITH RESPECT TO ANY SOCIETY SUBSIDIARY TO THE EXTENT SUCH TRANSACTION WOULD REPRESENT SUBSTANTIALLY ALL OF THE SOCIETY'S ASSETS; (4) AMENDMENT, MODIFICATION OR TERMINATION OF THE ARTICLES OF INCORPORATION OR BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED INTERNALLY BY THE TAX DEPARTMENT AND REVIEWED BY EXECUTIVE MANAGEMENT. THE TAX DEPARTMENT PREPARES RETURN HIGHLIGHTS AND KEY DISCLOSURES FOR THE EXECUTIVE MANAGEMENT TEAM. AN EXTERNAL ACCOUNTING FIRM REVIEWS AND SIGNS THE RETURN. BEFORE THE RETURN IS FILED, A COMPLETE COPY IS PROVIDED TO THE CURRENT BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C THE ANNUAL CONFLICT OF INTEREST DISCLOSURE PROCESS IS MANAGED BY THE CHIEF COMPLIANCE OFFICER (CCO). THE CCO IS RESPONSIBLE FOR ASSURING THAT ALL COMPLETED FORMS ARE RETURNED IN A TIMELY AND COMPLETE MANNER. CONFLICT OF INTEREST QUESTIONNAIRES ARE SENT TO SYSTEM TRUSTEES, MEMBERS OF THE GOVERNING BOARDS OF SUBSIDIARY ENTITIES, OFFICERS, AND KEY EMPLOYEES FOR ALL ENTITIES SUBJECT TO THE IRS FORM 990 FILINGS. THE DISCLOSURES ARE SUMMARIZED FOR REVIEW BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES, PURSUANT TO POLICY. THIS REVIEW ALLOWS: 1) THE BOARD TO ACQUIRE AN AWARENESS OF FINANCIAL RELATIONSHIPS OF BOARD MEMBERS AND KEY MANAGEMENT EMPLOYEES AND CAN INVOKE THE RECUSAL PROCESS ON A CASE-BY-CASE BASIS IF POTENTIAL CONFLICTS ARE IMPLICATED IN BOARD DECISIONS AND DELIBERATIONS, AND, 2) GIVES THE BOARD THE OPPORTUNITY TO SEEK ADDITIONAL INFORMATION AND CLARIFICATION ABOUT DISCLOSURES TO DETERMINE POTENTIAL CONFLICTS OF INTEREST, AND HOW TO MANAGE THEM. FORM 990, PART VI, SECTION B, LINE 15 SANFORD HAS A PROCESS FOR DETERMINING COMPENSATION OF THE PERSONS LISTED ON PART VII, SECTION A. THIS INCLUDES A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, REVIEW OF COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION FOR SUCH COMPENSATION. SANFORD ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND EXECUTIVES OF THE ORGANIZATION, INCLUDING THE CEO, AND TO REPORT THE FINDINGS TO THEM FOR DELIBERATION AND ACTION. THE DELIBERATIONS AND ACTIONS ARE RECORDED IN THE MINUTES OF THE SANFORD BOARD OF TRUSTEES. THE MOST RECENT STUDY WAS COMPLETED IN 2023. FORM 990, PART VI, SECTION C, LINE 19 ALTHOUGH THE ORGANIZATION DOES NOT MAINTAIN A WEBSITE WHERE THE PUBLIC CAN ACCESS THESE DOCUMENTS, IT WOULD RESPOND INDIVIDUALLY TO ANY REQUESTS OR INQUIRIES FROM THE PUBLIC FOR THESE DOCUMENTS. FORM 990, PART VII THE SANFORD BOARD OF TRUSTEES HAS ULTIMATE GOVERNANCE RESPONSIBILITIES FOR EACH MAJOR OPERATION ENTITY WITHIN SANFORD. IN ADDITION, A BOARD OF DIRECTORS IS ESTABLISHED FOR EACH MAJOR OPERATING ENTITY. THIS BOARD HAS SPECIFIC RESPONSIBILITIES DELEGATED FROM THE BOARD OF TRUSTEES. GENERALLY THESE RESPONSIBILITIES ARE RELATED TO THE OVERSIGHT OF THE DAY TO DAY OPERATIONS OF THAT ENTITY. FORM 990, PART XI, LINE 9: HERITAGE DISTRIBUTION -1,754,214. CASH SWEEP FOR POOLED INVESTMENTS TO SANFORD PARENT -57,644,887. DIVIDEND FROM CAPTIVE INS TO GSS 2,000,000. OTHER CHANGE IN NET ASSETS 520,119. 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