2021-11-10T08:37:01-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 475 REGENCY PARK SUITE 175 OFALLON IL 62269 990 2020-01-01 430654862 LUTHERAN SENIOR SERVICES LUTH 3149689313 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 CHAD SNEED SENIOR VP FINANCE 3149689313 2021-11-09 1 CHAD SNEED XXX-XX-XXXX JEFF PARKER P00970069 6182331200 2021-11-09 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z GARRY ANDERSON 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 506854079 0 X WWW.LSSLIVING.ORG X 1863 MO FAITH BASED ORGANIZATION WHICH PROVIDES A NETWORK OF SUPPORTIVE SERVICES FOR OLDER ADULTS. SEE BELOW FOR SUMMARY OF LSS CONSOLIDATED OPERATIONS. 14 14 3369 774 0 0 3553004 13585585 173260002 156584886 2866268 5436166 1446765 2158591 181126039 177765228 28037 22624 0 0 103282081 105945876 0 0 0 88099487 85967234 191409605 191935734 -10283566 -14170506 599827596 611349192 591941753 620232533 7885843 -8883341 TO PROVIDE A NETWORK OF SUPPORTIVE SERVICES THAT MEET THE NEEDS OF OLDER ADULTS AT ALL INCOME LEVELS IN ORDER TO LIVE OUT OUR MISSION OF "OLDER ADULTS LIVING LIFE TO THE FULLEST". 0 0 162439556 22624 159959315 OPERATIONS FOR FIVE LIFE PLAN COMMUNITIES THAT OFFER A CONTINUUM OF CARE THAT INCLUDES INDEPENDENT LIVING, ASSISTED LIVING, MEMORY CARE, AND SKILLED NURSING, THE MAJORITY OF WHICH ARE MEDICARE/MEDICAID CERTIFIED. IN ADDITION, OPERATIONS OF ONE ASSISTED LIVING AND ONE SKILLED NURSING FACILITY NOT ASSOCIATED WITH A CCRC. A TOTAL OF 3,275 UNITS ARE OFFERED WITH A SUSTAINED OCCUPANCY RATE EXCEEDING 92%. MORE THAN 3,300 CLIENTS ARE SERVED ANNUALLY. 7153769 0 7020148 A VARIETY OF HOME COMMUNITY BASED SERVICES FOR OLDER ADULTS WHO REMAIN IN THEIR OWN HOMES, INCLUDING MEDICARE CERTIFIED HOME HEALTH, PRIVATE DUTY HOME HEALTH SERVICES, HOSPICE SERVICES AND THREE PROGRAMS IN PARTNERSHIP WITH THE UNITED WAY: OUTREACH SOCIAL SERVICES, THE GOOD NEIGHBOR PROGRAM, AND VOLUNTEER MONEY MANAGEMENT. 0 0 -10394577 A BENEVOLENT CARE FUND EXISTS TO PROVIDE FINANCIAL ASSISTANCE TO RESIDENTS OR CLIENTS WHO OUTLIVE THEIR ABILITY TO PAY.TOTAL BENEVOLENT CARE ASSISTANCE PROVIDED WAS $10,394,577, OF WHICH, $10,394,577 IS OFFSETTING PROGRAM SERVICE REVENUE. THERE WAS ADDITIONAL BENEVOLENT CARE ASSISTANCE PROVIDED BY OTHER ENTITIES WITHIN THE LUTHERAN SENIOR SERVICES AFFILIATED GROUP BRINGING THE TOTAL TO APPROXIMATELY $12,291,000. 169593325 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 311 0 3369 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X CHAD SNEED 3149689313 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 JEFFREY L DUNN CHAIRPERSON 0.20 2.00 X X 0 0 0 DR F MATTHEW KUHLMANN SECRETARY 0.20 2.00 X X 0 0 0 REV ROY CHRISTELL BOARD MEMBER 0.20 2.00 X 0 0 0 DIANE R DROLLINGER BOARD MEMBER 0.20 2.00 X 0 0 0 JOHN A KOMLOS BOARD MEMBER 0.20 2.00 X 0 0 0 HARRY MUELLER BOARD MEMBER 0.20 2.00 X 0 0 0 GARY OLSON BOARD MEMBER (TERM ENDED 3/20) 0.20 2.00 X 0 0 0 LISA J SOMBART BOARD MEMBER 0.20 2.00 X 0 0 0 SHERRI C STRAND BOARD MEMBER 0.20 2.00 X 0 0 0 PAUL N TICE VICE CHAIRPERSON 0.20 2.00 X X 0 0 0 DAVID ANDERSON BOARD MEMBER 0.20 2.00 X 0 0 0 JULIE BANTLE BOARD MEMBER 0.20 2.00 X 0 0 0 REV DR TRAVIS J SCHOLL BOARD MEMBER 0.20 2.00 X 0 0 0 NORMAN TOON BOARD MEMBER 0.20 2.00 X 0 0 0 DAN BROWN ASSISTANT SECRETARY 0.20 2.00 X X 0 0 0 JOHN KOTOVSKY CHIEF MISSION OFFICER 26.00 14.00 X 934367 0 12160 GARRY ANDERSON PRESIDENT/CEO 26.00 14.00 X 323868 0 33909 LISA NORWINE CHIEF ADVANCEMENT OFFICER 26.00 14.00 X 218487 0 34330 RITA VICARY VP OF MARKETING COMM AND SALES 26.00 14.00 X 199421 0 7847 VALERIE COOPER VP OF OPER & EXEC DIRECTOR 26.00 14.00 X 193943 0 30258 CHAD SNEED SENIOR VP OF FINANCE 26.00 14.00 X 182324 0 33539 KENT KIRKWOOD EXECUTIVE DIRECTOR 40.00 0.00 X 175811 0 18365 COLLEEN BOTTENS VP SUPPORT SERC & EX DIR 26.00 14.00 X 172141 0 29532 MIKE RASO EXECUTIVE DIRECTOR 26.00 14.00 X 168183 0 16177 LISA WILLIAMS SR VP OF WORKFORCE EXCELLENCE 26.00 14.00 X 167586 0 28748 BEN CAFFEY EX DIR OF SALES GROWTH & STRATEGY 26.00 14.00 X 158967 0 8155 BRIAN REINHOLD VP OF RISK/SAFETY/COMPLIANCE 26.00 14.00 X 157966 0 33368 DREW REDMAN EXECUTIVE DIRECTOR 26.00 14.00 X 153110 0 17018 TAMMY HEMPEN EXECUTIVE DIRECTOR 40.00 0.00 X 149772 0 12510 LYNN SPRIGGS EXECUTIVE DIRECTOR 40.00 0.00 X 149035 0 14568 JOSH KING VP OF INFORMATION TECHNOLOGY 26.00 14.00 X 148880 0 31149 DAVID CARTER EX DIR OF HOME CARE SERVICES 26.00 14.00 X 145785 0 20777 BECKY ZIMMER EX DIR OF PLANNED GIVING 26.00 14.00 X 126550 0 6176 PAUL OGIER SENIOR ADVISOR 26.00 14.00 X 274149 0 10622 RACHEL LITTLE DIR OF CLINICAL COMPLIANCE 26.00 14.00 X 152495 0 2469 TODD YOUNG NETWORK DIRECTOR 26.00 14.00 X 148273 0 6766 DAVID LUETHY DIR OF PROCUREMENT 26.00 14.00 X 142253 0 3497 LISA BULCZAK DIR OF PHYSICAL ASSETS & CAP PROJ 26.00 14.00 X 140844 0 4515 4784210 0 416455 64 0 1 0 BSI CONSTRUCTORS INC 6767 SOUTHWEST AVENUE ST LOUIS MO 63143 CONSTRUCTION CONTRACTOR 28686448 SYMBRIA REHAB 28100 TORCH PARKWAY WARRENVILLE IL 60555 THERAPY SERVICES 3712077 MEDICAL DIAGNOSTIC LABORATORIES LLC 2439 KUSER RD HAMILTON TOWNSHIP NJ 08690 LABORATORY TESTING SERVICES 2786100 OMNICARE 100 E RIVERCENTER BLVD COVINGTON KY 41101 PHARMACY SERVICES 1358668 CONEXUS MEDSTAFF 11750 KATY FREEWAY SUITE 750 HOUSTON TX 77079 STAFFING SERVICES 810149 33 4769470 8816115 105582 13585585 LIFE PLAN COMMUNITIES REVENUE 623000 139437016 139437016 MANAGEMENT FEES 623000 15315634 15315634 HOME COMMUNITY BASED SERVICES REV 623000 7020148 7020148 AMORTIZATION OF ENTRANCE FEES 623000 4306665 4306665 DEVELOPMENT FEES 623000 900000 900000 -10394577 -10394577 156584886 3194783 3194783 526766 526766 883425 120092 763333 763333 763333 330478588 132349 328743634 152686 1734954 -20337 1714617 1714617 56958 72439 -15481 -15481 MEAL INCOME 623000 665713 665713 BARBER AND BEAUTY 623000 376040 376040 TRANSPORTATION 623000 105638 105638 263348 263348 1410739 177765228 156584886 0 7594757 22624 22624 4573770 4573770 82951776 71272703 11679073 427746 427746 11888786 11262439 626347 6103798 5159434 944364 10376040 10235893 140147 226875 85486 141389 163105 33455 129650 37239 37239 209284 209284 13396298 12588278 808020 624708 592680 32028 8391868 8033814 358054 2120954 2036799 84155 5880625 5615593 265032 373294 279994 93300 14899 5249 9650 11258112 9885671 1372441 23305155 22713517 591638 2017410 1928370 89040 DIETARY 6133493 6129772 3721 PHARMACY EXPENSES 751040 751040 BAD DEBT EXPENSE 409360 409360 PROVIDER TAX 73907 73907 203568 123408 80160 191935734 169593325 22342409 0 1613722 1471338 22203074 40322106 6601048 5947018 526277 1284901 366281 599875 1552391 1656676 583703766 221657301 344591133 362046465 216223397 191784385 937366 1009856 432603 437644 1960000 1960000 2820304 2828928 599827596 611349192 32823548 36897224 17166064 20131928 365728177 363064374 52935 117277 176171029 200021730 591941753 620232533 X 7885843 -8883341 7885843 -8883341 599827596 611349192 X -14170506 -45168 -2553510 X X 0 1 X 1 0 X 2183527 1636708 3064113 3553004 13585586 24022938 154439385 156030233 165559258 173260002 156584886 805873764 27057 31127 94700 56958 209842 156622912 157693998 168654498 176907706 170227430 830106544 344111 330344 288038 144445 1106938 0 344111 330344 288038 144445 1106938 828999606 3566475 2790612 3294275 5032968 4604974 19289304 3566475 2790612 3294275 5032968 4604974 19289304 2807153 2521286 1296860 1067855 1410739 9103893 162996540 163005896 173245633 183008529 176243143 858499741 0.96560 0.96490 0.02250 0.02160 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MEAL INCOME - 2016 AMOUNT: $ 580,094. 2017 AMOUNT: $ 650,430. 2020 AMOUNT: $ 665,713. TRANSPORTATION - 2016 AMOUNT: $ 97,758. 2017 AMOUNT: $ 69,165. 2018 AMOUNT: $ 100,550. 2019 AMOUNT: $ 146,310. 2020 AMOUNT: $ 105,638. TELEPHONE - 2016 AMOUNT: $ 9,000. 2017 AMOUNT: $ 8,509. 2018 AMOUNT: $ 7,369. 2019 AMOUNT: $ 4,914. 2020 AMOUNT: $ 6,525. MISCELLANEOUS - 2016 AMOUNT: $ 554,815. 2017 AMOUNT: $ 253,590. 2018 AMOUNT: $ 35,707. 2019 AMOUNT: $ 8,793. 2020 AMOUNT: $ 42,978. GIFT SHOP - 2016 AMOUNT: $ 28,208. MAINTENANCE - 2016 AMOUNT: $ 30,951. 2017 AMOUNT: $ 49,696. 2018 AMOUNT: $ 64,140. 2019 AMOUNT: $ 23,775. 2020 AMOUNT: $ 35,856. LAUNDRY - 2016 AMOUNT: $ 708,055. 2017 AMOUNT: $ 725,086. 2018 AMOUNT: $ 286,684. 2019 AMOUNT: $ 1,890. 2020 AMOUNT: $ 3,438. HOUSEKEEPING - 2016 AMOUNT: $ 6,941. 2017 AMOUNT: $ 10,931. 2018 AMOUNT: $ 3,401. 2019 AMOUNT: $ 3,005. 2020 AMOUNT: $ 2,819. GUEST ROOM - 2016 AMOUNT: $ 68,260. 2017 AMOUNT: $ 81,187. 2018 AMOUNT: $ 79,848. 2019 AMOUNT: $ 76,499. 2020 AMOUNT: $ 29,387. GARAGE FEES - 2016 AMOUNT: $ 51,244. 2017 AMOUNT: $ 52,095. 2018 AMOUNT: $ 98,586. 2019 AMOUNT: $ 101,706. 2020 AMOUNT: $ 104,402. CHAPEL - 2016 AMOUNT: $ 23,779. 2017 AMOUNT: $ 19,955. 2018 AMOUNT: $ 305. BARBER AND BEAUTY - 2016 AMOUNT: $ 619,386. 2017 AMOUNT: $ 573,425. 2018 AMOUNT: $ 614,411. 2019 AMOUNT: $ 648,871. 2020 AMOUNT: $ 376,040. ACTIVITIES - 2016 AMOUNT: $ 28,662. 2017 AMOUNT: $ 27,217. 2018 AMOUNT: $ 5,859. 2019 AMOUNT: $ 4,847. 2020 AMOUNT: $ 1,394. PNC REWARDS - 2019 AMOUNT: $ 47,245. 2020 AMOUNT: $ 36,549. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 37239 37239 0 PART II-B, LINE 1: THE ORGANIZATION UTILIZES THE SERVICES OF A LOBBYIST TO KEEP THE ORGANIZATION ABREAST OF LEGISLATIVE ACTS PERTAINING TO THE ORGANIZATION'S INDUSTY AND OCCASIONALLY HAVE EMPLOYEES ATTEND HEARINGS TO SPEAK ABOUT INDUSTRY ISSUES. ALSO, THE ORGANIZATION PAYS MEMBERSHIP DUES TO MISSOURI HEALTH CARE ASSOCIATION, OF WHICH, A PORTION IS RELATED TO LOBBYING. 0 1 X 23793692 23793692 496959971 186310641 310649330 22706559 12786333 9920226 36555364 22560327 13995037 3688180 3688180 362046465 REFUNDABLE ADMISSION FEES 189533391 RESIDENT DEPOSITS 7083166 INTEREST RATE SWAP AGREEMENT 3405173 200021730 X PART IV, LINE 2B: RESIDENT FUNDS ARE HELD BY THE ORGANIZATION FOR THE BENEFIT OF THE RESIDENT. PART X, LINE 2: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. 1 NURSING SCHOLARSHIP 8 18424 WEBSTER CHILD CARE 3 4200 PART I, LINE 2: TO QUALIFY FOR NURSING SCHOLARSHIP, AN EMPLOYEE MUST BE RECOMMENDED BY THEIR SUPERVISOR. THIS IS FORWARDED THROUGH THE CARE CENTER ADMINISTRATOR FOR APPROVAL OF THE AMOUNT OF ASSISTANCE. TO QUALIFY FOR WEBSTER CHILD CARE, AN EMPLOYEE AT LACLEDE GROVES (LG) MUST BE FULL TIME WHO HAS WORKED FOR 6 MONTHS OR MORE WITH NO DISCIPLINARY PROBLEMS ON FILE. THE EMPLOYEE WOULD THEN SUBMIT A FINANCIAL APPLICATION INCLUDING TWO EARNINGS STATEMENTS TO WEBSTER CHILD CARE (WCC). WCC REVIEWS THE APPLICATION AND ASSURES THE EMPLOYEE MEETS LG EMPLOYMENT REQUIREMENTS. IF APPROVED, AMOUNT WILL DEPEND UPON THE AMOUNT OWED FOR CHILD CARE (NUMBER OF DAYS A WEEK AND CHILD'S AGE DETERMINES COST) AND THE EMPLOYEES NEED PER THEIR FINANCIAL APPLICATION. IF APPROVED FOR ASSISTANCE, WCC DETERMINES AMOUNT UNITED WAY WILL PAY, AMOUNT GRANT FROM LSS WILL PAY AND REMAINING AMOUNT EMPLOYEE WILL PAY. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 JOHN KOTOVSKY CHIEF MISSION OFFICER 350588 0 550152 0 33627 0 6442 0 5718 0 946527 0 0 0 GARRY ANDERSON PRESIDENT/CEO 282974 0 39249 0 1645 0 25911 0 7998 0 357777 0 0 0 PAUL OGIER SENIOR ADVISOR 171662 0 54201 0 48286 0 5051 0 5571 0 284771 0 0 0 LISA NORWINE CHIEF ADVANCEMENT OFFICER 199160 0 18416 0 911 0 24357 0 9973 0 252817 0 0 0 VALERIE COOPER VP OF OPER & EXEC DIRECTOR 193693 0 0 0 250 0 23213 0 7045 0 224201 0 0 0 CHAD SNEED SENIOR VP OF FINANCE 181971 0 0 0 353 0 23590 0 9949 0 215863 0 0 0 RITA VICARY VP OF MARKETING COMM AND SALES 153147 0 45500 0 774 0 4016 0 3831 0 207268 0 0 0 COLLEEN BOTTENS VP SUPPORT SERC & EX DIR 171801 0 0 0 340 0 22491 0 7041 0 201673 0 0 0 LISA WILLIAMS SR VP OF WORKFORCE EXCELLENCE 166607 0 0 0 979 0 23206 0 5542 0 196334 0 0 0 KENT KIRKWOOD EXECUTIVE DIRECTOR 159394 0 15593 0 824 0 12824 0 5541 0 194176 0 0 0 BRIAN REINHOLD VP OF RISK/SAFETY/COMPLIANCE 157839 0 0 0 127 0 23122 0 10246 0 191334 0 0 0 MIKE RASO EXECUTIVE DIRECTOR 148220 0 19500 0 463 0 13380 0 2797 0 184360 0 0 0 JOSH KING VP OF INFORMATION TECHNOLOGY 148780 0 0 0 100 0 20754 0 10395 0 180029 0 0 0 DREW REDMAN EXECUTIVE DIRECTOR 150188 0 2829 0 93 0 10000 0 7018 0 170128 0 0 0 BEN CAFFEY EX DIR OF SALES GROWTH & STRATEGY 141977 0 16880 0 110 0 3368 0 4787 0 167122 0 0 0 DAVID CARTER EX DIR OF HOME CARE SERVICES 129836 0 15860 0 89 0 13075 0 7702 0 166562 0 0 0 LYNN SPRIGGS EXECUTIVE DIRECTOR 145697 0 2837 0 501 0 10738 0 3830 0 163603 0 0 0 TAMMY HEMPEN EXECUTIVE DIRECTOR 146814 0 2788 0 170 0 12222 0 288 0 162282 0 0 0 TODD YOUNG NETWORK DIRECTOR 148153 0 0 0 120 0 2899 0 3867 0 155039 0 0 0 RACHEL LITTLE DIR OF CLINICAL COMPLIANCE 152313 0 0 0 182 0 2181 0 288 0 154964 0 0 0 PART I, LINE 1A JOHN R. KOTOVSKY HAS A HOUSING ALLOWANCE RELATED TO HIS PASTORAL DUTIES THAT IS INCLUDED IN HIS OTHER REPORTABLE COMPENSATION. PART I, LINE 4B DEPOSITS MADE INTO ACCOUNTS BY ORGANIZATION: GARY ANDERSON - SEC 457(B) PLAN - $20,000 LISA NORWINE - SEC 457(B) PLAN - $20,000 LISA WILLIAMS - SEC 457(B) PLAN - $20,000 KENT KIRKWOOD SEC 457(B) PLAN - $10,000 TAMMY HEMPEN SEC 457(B) PLAN - $10,000 LYNN SPRIGGS SEC 457(B) PLAN - $10,000 DAVID CARTER SEC 457(B) PLAN - $10,000 MIKE RASO SEC 457(B) PLAN - $10,000 DREW REDMAN SEC 457(B) PLAN - $10,000 CHAD SNEED - SEC 457(B) PLAN - $20,000 BRIAN REINHOLD - SEC 457(B) PLAN - $20,000 JOSH KING - SEC 457(B) PLAN - $20,000 VALERIE COOPER - SEC 457(B) PLAN - $20,000 COLLEEN BOTTENS - SEC 457(B) PLAN - $20,000 JOHN KOTOVSKY - SEC 457(F) PLAN - $986,706 PAUL OGIER - SEC 457(F) PLAN - $26,184 GARY ANDERSON - SEC 457(F) PLAN - $24,249 LISA NORWINE - SEC 457(F) PLAN - $18,416 PAYMENTS RECEIVED FROM PLAN: PAUL OGIER - SEC 457(B) PLAN - $27,920 JOHN KOTOVSKY - SEC 457(B) PLAN - $27,612 PAUL OGIER - SEC 457(F) PLAN - $18,968 SCHEDULE J PART II LUTHERAN SENIOR SERVICES IS A LARGE COMPLEX ORGANIZATION THAT IS COMPRISED OF 18 SEPARATE LEGAL ENTITIES, EACH OF WHICH FILES ITS OWN TAX RETURN. DUE TO THE REQUIREMENTS FOR COMPLETING THESE 990'S (WHICH ARE FILED BY 15 OF THE 18 LSS ENTITIES), SOME OF THE INFORMATION CONTAINED WITHIN THE FORM, SUCH AS REVENUE AND EXPENSES, IS RELATED ONLY TO THAT PARTICULAR ENTITY. HOWEVER, SOME OF THE INFORMATION, SUCH AS EXECUTIVE COMPENSATION, RELATES TO THE ENTIRE ORGANIZATION. TO HELP MAKE THIS INFORMATION MORE MEANINGFUL, THE FOLLOWING PARAGRAPH PROVIDES A SUMMARY OF THE OVERALL OPERATIONS OF LSS. LUTHERAN SENIOR SERVICES IS A NOT FOR PROFIT ORGANIZATION OWNED BY 104 LUTHERAN CHURCHES AND WAS INITIALLY FOUNDED IN 1858. LUTHERAN SENIOR SERVICES OPERATES TEN SENIOR LIVING COMMUNITIES SERVING OVER 3,000 OLDER ADULTS, EIGHT AFFORDABLE HOUSING COMMUNITIES SERVING OVER 570 OLDER ADULTS AND A VARIETY OF IN HOME SERVICES PROGRAMS SERVING OVER 5,000 OLDER ADULTS. IN 2020, LSS HAD TOTAL OPERATING INCOME OF APPROXIMATELY $227,000,000, PROVIDED APPROXIMATELY $12,291,000 IN BENEVOLENT CARE, HAD NEARLY 28,000 VOLUNTEER HOURS AND EMPLOYED 18 CHAPLAINS. A HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF STATE OF MISSOURI 431178966 60635HM55 2011-09-29 47187481 CAPITAL IMPROVEMENTS TO LUTHERAN SENIOR SERVICES 0 0 0 B HEALTH & EDUCATIONAL FACILITIES AUTHORITY OF STATE OF MISSOURI SERIES 2014A 431178966 60635HS26 2014-06-04 84146040 REFUNDING OF 2004 BONDS AND CAPITAL IMPROVEMENTS 0 0 0 C HEALTH & EDUCATIONAL FACILITIES AUTHORITY OF STATE OF MISSOURI SER 2014B 431178966 2014-06-04 50000000 REFUNDING OF 2008 BONDS 0 0 0 D HEALTH & EDUCATIONAL FACILITIES AUTHORITY OF STATE OF MISSOURI SERIES 2016A 431178966 60635HU56 2016-01-29 58320378 ACQUISITION OF MASON POINTE AND OTHER LSS CAPITAL PROJECTS 0 0 0 A 8595000 47452221 871285 751862 5541743 40287331 2013 0 0 1 1 B 7235000 84658512 3866287 1293330 284416 745123 54739476 23729880 2016 1 0 1 1 C 30000000 50000000 50000000 2015 1 0 1 1 D 3840000 58386615 3409829 952321 851018 1895 50625563 2545989 2017 0 0 1 1 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 D 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 1 0 0 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF STATE OF MISSOU DATE THE REBATE COMPUTATION WAS PERFORMED: 09/29/2013 ISSUER NAME: HEALTH & EDUCATIONAL FACILITIES AUTHORITY OF STATE OF MISSOURI DATE THE REBATE COMPUTATION WAS PERFORMED: 06/01/2019 SCHEDULE K, ENTITY 1, PAGE 1, PART I, LINE (A), COLUMN (F) THE CAPITAL IMPROVEMENTS BENEFITTED LUTHERAN SENIOR SERVICES, HEISINGER LUTHERAN HOME, LUTHERAN RETIREMENT CENTER ASSOCIATION, AND MERIDIAN VILLAGE ASSOCIATION III. AS SUCH, A PORTION OF THE BOND DEBT LIABILITY HAS BEEN ALLOCATED TO THOSE ENTITIES ON THEIR RESPECTIVE FORMS 990, PART X, PAGE 11, LINE 20. THE PARENT ORGANIZATION HAS ELECTED TO FILE ALL APPLICABLE SCHEDULE K REPORTING ON ITS RETURN SO THERE IS NO SCHEDULE K REPORTING ON ANY RETURN EXCEPT THE PARENT ENTITY. SCHEDULE K, ENTITY 2, PAGE 1, PART I, LINE C, COLUMN F - PURPOSE TO REFUND SERIES 2000 BONDS ISSUED 12/21/2000, 2010 BONDS ISSUED 10/14/2010, PARTIALLY REFUND 2014B BONDS ISSUED 8/14/2015, 2014C BONDS ISSUED 2/5/2015 AND 2014D BONDS ISSUED 2/1/2016 SCHEDULE K, ENTITY 2, PAGE 1, PART I, LINE C, COLUMN E - ISSUE PRICE ISSUE PRICE LISTED ON 8038 PART III LINE 21 IS $151,834,192, WHICH INCLUDES $20,000,000 OF REISSUED 2014B BONDS. THESE BONDS ARE ALREADY RECORDED ON SCHEDULE K AND AS A RESULT, HAVE BEEN EXCLUDED FROM THE ISSUE PRICE OF THIS ISSUANCE. SCHEDULE K, PAGE 1, ENTITY 1, PART II, LINE 3, COLUMN A PROCEEDS DIFFERS FROM ISSUANCE PRICE DUE TO INCLUSION OF ACCUMULATED INTEREST INCOME THROUGH 12/31/20 OF $264,740. SCHEDULE K, PAGE 1, ENTITY 1, PART II, LINE 3, COLUMN B PROCEEDS DIFFERS FROM ISSUANCE PRICE DUE TO INCLUSION OF ACCUMULATED INTEREST INCOME THROUGH 12/31/20 OF $512,472. SCHEDULE K, PAGE 1, ENTITY 1, PART II, LINE 3, COLUMN D PROCEEDS DIFFERS FROM ISSUANCE PRICE DUE TO INCLUSION OF ACCUMULATED INTEREST INCOME THROUGH 12/31/20 OF $66,237. SCHEDULE K, PAGE 1, ENTITY 2, PART II, LINE 3, COLUMN A PROCEEDS DIFFERS FROM ISSUANCE PRICE DUE TO INCLUSION OF ACCUMULATED INTEREST INCOME THROUGH 12/31/20 OF $437,446. SCHEDULE K, ENTITY 1, PAGE 1, PART II, LINE 4, COLUMN (A) - RESERVE FUNDS THE TOTAL AMOUNT OF GROSS PROCEEDS IN RESERVE FUNDS AT 12/31/20 EQUALS $3,617,317. THIS AMOUNT IS REDUCED BY $96,032, WHICH REPRESENTS THE DIFFERENCE BETWEEN CURRENT MARKET VALUE OF DEBT RESERVE FUNDS AND THE INITIAL FUNDING AMOUNT AND $2,650,000, WHICH REPRESENTS AN LSS EQUITY CONTRIBUTION. SCHEDULE K, ENTITY 1, PAGE 1, PART II, LINE 4, COLUMN (B) - RESERVE FUNDS THE TOTAL AMOUNT OF GROSS PROCEEDS IN RESERVE FUNDS AT 12/31/20 EQUALS $5,669,296. THIS AMOUNT IS REDUCED BY $86,958, WHICH REPRESENTS THE DIFFERENCE BETWEEN CURRENT MARKET VALUE OF DEBT RESERVE FUNDS AND THE INITIAL FUNDING AMOUNT, $1,541,208, WHICH REPRESENTS FUNDS NOT FROM DEBT PROCEEDS SINCE IT WAS A REFUNDING ISSUE. SCHEDULE K, ENTITY 1, PAGE 1, PART II, LINE 4, COLUMN (D) - RESERVE FUNDS THE TOTAL AMOUNT OF GROSS PROCEEDS IN RESERVE FUNDS AT 12/31/20 EQUALS $3,409,829. THIS AMOUNT IS REDUCED BY $2,550,000, WHICH REPRESENTS AN LSS EQUITY CONTRIBUTION. A HEALTH & EDUCATIONAL FACILITIES AUTHORITY OF STATE OF MISSOURI SER 2016B&C 431178966 60635HZ85 2016-11-04 123622927 REFUNDING OF SERIES 2006, 2007A, 2007B, AND 2007C BONDS AND CAPITAL PROJECTS 0 0 0 B HEALTH & EDUCATIONAL FACILITIES AUTHORITY OF STATE OF MISSOURI SER 2019A 431178966 60635H2S7 2019-02-25 96498029 CAPITAL IMPROVEMENTS TO LUTHERAN SENIOR SERVICES 0 0 0 C HEALTH & EDUCATIONAL FACILITIES AUTHORITY OF STATE OF MISSOURI SER 2019C 431178966 60635H3E7 2019-11-05 131834192 SEE SUPPLEMENTAL INFORMATION IN PART VI 0 0 0 A 12475000 124060373 782691 1941885 1561698 286004 36000000 83336653 2017 1 1 0 1 B 96498029 1527650 8904110 405000 144248 85517021 2020 0 0 0 0 C 131834192 1265448 130568744 2019 1 0 0 0 A 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 B 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 C 0 1 1 1 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 1 1 PNC BANK NATIONAL ASSOCIATION 6.000000000000 0 0 0 0 1 A 1 B 1 C 1 X 12 105582 FMV 0 0 0 FORM 990, PAGE 1, PART I CONTINUATION LUTHERAN SENIOR SERVICES IS A LARGE COMPLEX ORGANIZATION THAT IS COMPRISED OF 18 SEPARATE LEGAL ENTITIES, EACH OF WHICH FILES ITS OWN TAX RETURN. DUE TO THE REQUIREMENTS FOR COMPLETING THESE 990'S (WHICH ARE FILED BY 15 OF THE 18 LSS ENTITIES), SOME OF THE INFORMATION CONTAINED WITHIN THE FORM, SUCH AS REVENUE AND EXPENSES, IS RELATED ONLY TO THAT PARTICULAR ENTITY. HOWEVER, SOME OF THE INFORMATION, SUCH AS EXECUTIVE COMPENSATION, RELATES TO THE ENTIRE ORGANIZATION. TO HELP MAKE THIS INFORMATION MORE MEANINGFUL, THE FOLLOWING PARAGRAPH PROVIDES A SUMMARY OF THE OVERALL OPERATIONS OF LSS. LUTHERAN SENIOR SERVICES IS A NOT FOR PROFIT ORGANIZATION OWNED BY 104 LUTHERAN CHURCHES AND WAS INITIALLY FOUNDED IN 1858. LUTHERAN SENIOR SERVICES OPERATES TEN SENIOR LIVING COMMUNITIES SERVING OVER 3,000 OLDER ADULTS, EIGHT AFFORDABLE HOUSING COMMUNITIES SERVING OVER 570 OLDER ADULTS AND A VARIETY OF IN HOME SERVICES PROGRAMS SERVING OVER 5,000 OLDER ADULTS. IN 2020, LSS HAD TOTAL OPERATING INCOME OF APPROXIMATELY $227,000,000, PROVIDED APPROXIMATELY $12,291,000 IN BENEVOLENT CARE, HAD NEARLY 28,000 VOLUNTEER HOURS AND EMPLOYED 18 CHAPLAINS. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE CORPORATION (THE "MEMBERS") SHALL BE THOSE LUTHERAN CONGREGATIONS LOCATED WITHIN A RADIUS OF APPROXIMATELY 150 MILES FROM ST. LOUIS MISSOURI, WHICH APPLY FOR AND ARE ADMITTED INTO MEMBERSHIP IN ACCORDANCE WITH THESE BYLAWS. FOR PURPOSES OF THESE BYLAWS, "LUTHERAN CONGREGATION" SHALL REFER TO A MEMBER CONGREGATION OF EITHER THE LUTHERAN CHURCH-MISSOURI SYNOD OR THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BOARD MEMBERS ARE ELECTED BY ASSOCIATED CHURCHES. FORM 990, PART VI, SECTION A, LINE 7B THE MERGER (OTHER THAN A MERGER IN WHICH THE CORPORATION IS THE SURVIVING ENTITY), DISSOLUTION, OR SALE OR DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, OF THE ASSETS, OF THE CORPORATION SHALL REQUIRE THE VOTE OF THE LESSER OF TWO-THIRDS OF THE MEMBERS OF THE CORPORATION PRESENT AT A DULY CALLED AND CONVENED MEETING OF THE MEMBERS AND A MAJORITY OF ALL OF THE MEMBERS. THE MEMBERS MAY AT ANY TIME AND FOR WHATEVER REASON OR CAUSE, AS THEY MAY DEEM BEST IN THEIR SOLE DISCRETION, REMOVE ANY VOTING DIRECTOR BY A TWO-THIRDS MAJORITY VOTE OF ALL THE MEMBERS PRESENT AT A DULY CALLED AND CONVENED MEETING OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE GOVERNING BODY IS PROVIDED A COPY OF THE FORM 990 FOR REVIEW PRIOR TO FILING. APPROVAL OF THE FORM 990 IS DELEGATED TO THE AUDIT COMMITTEE OF THE GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES WILL DISCLOSE A CONFLICT OF INTEREST ON THE "CONFLICT OF INTEREST FORM" IN THE FOLLOWING SITUATIONS AND IN OTHER CIRCUMSTANCES WHICH HE/SHE THINKS MIGHT CAUSE A CONFLICT BETWEEN HIS/HER PERSONAL INTERESTS AND HIS/HER FIDUCIARY DUTY: FINANCIAL INTERESTS, INSIDE INFORMATION, CONFLICTING INTEREST OTHER THAN FINANCIAL, GIFTS AND FAVORS. THE FOLLOWING LSS EMPLOYEES ARE REQUIRED TO SIGN A "CONFLICT OF INTEREST FORM" ANNUALLY: PRESIDENT, CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER/TREASURER, VICE PRESIDENT OF CONSTRUCTION AND IT, VICE PRESIDENT OF HUMAN RESOURCES, ALL DIRECTORS, ADMINISTRATORS AND ASSISTANT ADMINISTRATORS. THE CORPORATE COMPLIANCE OFFICER FOLLOWS UP WITH ANY CONFLICTS OF INTERESTS AND DOCUMENTS THE RESOLUTIONS OF THE CONFLICTS. THESE FORMS ARE KEPT BY THE CORPORATE COMPLIANCE OFFICE. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS ESTABLISHED A SEPARATE COMPENSATION COMMITTEE CHARGED WITH PERFORMING AN ANNUAL PERFORMANCE REVIEW OF THE CEO AND REVIEWING THE CEO'S COMPENSATION PACKAGE. THE COMPENSATION COMMITTEE ENGAGED A THIRD-PARTY GLOBAL HUMAN CAPITAL CONSULTING FIRM TO: (1) DEVELOP AN ANNUAL CEO PERFORMANCE REVIEW PROCESS, INCLUDING A NEW EVALUATION FORM, AND (2) DEVELOP A COMPENSATION PACKAGE BASED ON ITS KNOWLEDGE OF SIMILARLY SIZED NON-PROFIT ORGANIZATIONS IN ORDER TO ENSURE THAT THE COMPENSATION PAID TO THE CEO IS REASONABLE. ALL MEMBERS OF THE BOARD COMPLETE AN ANNUAL EVALUATION, WHICH THE COMPENSATION COMMITTEE SUMMARIZES AND REVIEWS. THE COMPENSATION COMMITTEE THEN MAKES A RECOMMENDATION TO THE FULL BOARD OF DIRECTORS FOR ANY COMPENSATION ADJUSTMENTS. FORM 990, PART VI, SECTION C, LINE 19 ALTHOUGH NOT A REQUIREMENT, THE ORGANIZATION PROVIDES PHOTOCOPIES OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND OTHER DOCUMENTS TO ALL WHO REQUEST ONE OR MORE OF THE ITEMS. FORM 990, PART XI, LINE 9: NET PERIODIC PENSION COST -340,747. CHANGE IN VALUE OF INTEREST RATE SWAP -1,812,807. OTHER CHANGES IN PLAN ASSETS AND BENEFIT OBLIGATIONS -906,841. MACKENZIE PLACE HTC 506,885. FORM 990, PART XII, LINE 2C THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT. THIS PROCESS IS CONSISTENT WITH PRIOR YEARS. FORM 990, PAGE 10, PART IX, LINE 11A THE MANAGEMENT FEE EXPENSE REPRESENTS ONLY INTERCOMPANY CHARGES THAT ARE OFFSET BY MANAGEMENT FEE REVENUES INCLUDED IN PROGRAM SERVICE REVENUES ON PAGE 9. MACKENZIE PLACE LIHTC GP LLC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 272136187 DEVELOPMENT & MANAGEMENT OF SENIOR LIVING FACILITIES MO 31 520 LUTHERAN SENIOR SERVICES DUNN ROAD MANOR LIHTC GP LLC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 474889447 DEVELOPMENT & MANAGEMENT OF SENIOR LIVING FACILITIES MO 30 608 LUTHERAN SENIOR SERVICES LUTHERAN SENIOR SERVICES ENDOWMENT FUND 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 431818832 SENIOR LIVING MO 501(C)(3) LINE 12A, I LUTHERAN SENIOR SERVICES 1 HALLS FERRY MANOR 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 431660879 SENIOR LIVING MO 501(C)(3) LINE 10 N/A 0 DUNN ROAD MANOR INC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 431874215 SENIOR LIVING MO 501(C)(3) LINE 10 N/A 0 ROSE HILL HOUSE INC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 431736720 SENIOR LIVING MO 501(C)(3) LINE 10 N/A 0 ROSE HILL HOUSE II INC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 201889216 SENIOR LIVING MO 501(C)(3) LINE 10 N/A 0 HILLTOP MANOR ASSOCIATION INC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 020667342 SENIOR LIVING MO 501(C)(3) LINE 10 N/A 0 WESTFIELD MANOR ASSOCIATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 020568032 SENIOR LIVING IL 501(C)(3) LINE 10 N/A 0 MERIDIAN VILLAGE ASSOCIATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 371415588 SENIOR LIVING IL 501(C)(3) LINE 10 LUTHERAN SENIOR SERVICES 1 COLE COUNTY LUTHERAN HOME ASSOCIATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 431147326 SENIOR LIVING MO 501(C)(3) LINE 10 LUTHERAN SENIOR SERVICES 1 LUTHERAN RETIREMENT CENTER ASSOCIATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 371199021 SENIOR LIVING MO 501(C)(3) LINE 10 LUTHERAN SENIOR SERVICES 1 LUTHERAN HILLSIDE VILLAGE INC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 370818454 SENIOR LIVING MO 501(C)(3) LINE 10 LUTHERAN SENIOR SERVICES 1 LUTHERAN HILLSIDE VILLAGE FOUNDATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 371371314 SENIOR LIVING MO 501(C)(3) LINE 7 LUTHERAN SENIOR SERVICES 1 MACKENZIE PLACE 202 - II - 45-4000626 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 454000626 SENIOR LIVING MO 501(C)(3) LINE 10 N/A 0 MACKENZIE PLACE 202 - 27-3777863 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 273777863 SENIOR LIVING MO 501(C)(3) LINE 10 N/A 0 PROVIDENT GROUP INC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 300134496 DEVELOPMENT & MANAGEMENT OF SENIOR LIVING FACILITIES MO LUTHERAN SENIOR SERVICES C 149801 1.00000 1 0 0 1 1 1 0 0 0 0 0 0 1 0 1 1 0 1 0 0 LUTHERAN SENIOR SERVICES ENDOWMENT FUND C 4769470 G/L DETAIL COLE COUNTY LUTHERAN HOME ASSOCIATION L 625205 G/L DETAIL MERIDIAN VILLAGE ASSOCIATION L 1122402 G/L DETAIL LUTHERAN RETIREMENT CENTER ASSOCIATION L 1218092 G/L DETAIL LUTHERAN HILLSIDE VILLAGE L 1443963 G/L DETAIL LUTHERAN RETIREMENT CENTER ASSOCIATION D 48160375 G/L DETAIL MERIDIAN VILLAGE ASSOCIATION D 34471849 G/L DETAIL COLE COUNTY LUTHERAN HOME ASSOCIATION D 16331110 G/L DETAIL LUTHERAN HILLSIDE VILLAGE D 49691388 G/L DETAIL