2021-05-13T17:59:53-05:00 2020-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-07-01 411936717 Living Services Foundation LIVI 7632310410 3109 West 50th Street No 133 Minneapolis MN 55410 Jennifer Gleason Chief Operating Officer 7632310410 2021-05-13 1 Deb Nelson CPA P01264758 6122536500 2021-05-05 2019 2022-09-23 18:48:47Z Jennifer Gleason 3109 West 50th Street No 133 Minneapolis MN 55410 6993759 0 X www.lsfhealth.org X 1999 MN Housing and long-term care facilities for the elderly. 4 2 154 5 0 0 0 0 6066971 6992437 475 1322 0 0 6067446 6993759 2970 2990 0 0 2974587 3222848 0 0 0 2750169 3425381 5727726 6651219 339720 342540 9192649 9982737 11548921 11988789 -2356272 -2006052 X The Foundation is organized and shall be operated primarily to own, maintain, operate and conduct, directly or indirectly, housing and long-term care facilities for the elderly and to assist and coordinate activities of facilities for health care, social services, education and research, and do any and all other acts and things and exercise any and all other rights and powers which may be reasonably necessary, incidental, desirable or expedient in the accomplishment of such purposes. 0 1 5842508 2990 6992437 The organization owns and provides management oversight to the following wholly owned subsidiaries:Living Services Foundation/Minneota, LLC consists of a 57-bed skilled nursing facility and 33-unit assisted living facility located in Minneota, Minnesota. Living Services Foundation/Mora, LLC consists of a 65-bed skilled nursing facility, a 35-unit assisted living facility, and clinic space for LSF Mora, LLC, located in Mora, Minnesota. Benedictine Living Community of Mora operates the facilities owned by Living Services Foundation/Mora, LLC and manages a 30 unit assisted living building for a third party in Mora, MN.The organization operates Living Services Foundation - Minneota, Living Services Foundation/Mora, LLC and Benedictine Living Community of Mora. 5842508 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 11 0 1 154 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 2 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 MN X Jennifer Gleason 7632310410 3109 West 50th Street 133 Minneapolis MN 55410 Jennifer Gleason COO/Secretary/Treasurer 35.00 5.00 X 175000 0 0 Dennis Kamstra President/CEO/Board Member 39.00 1.00 X X 15625 0 0 Robert Sundberg Chair 5.00 1.00 X X 0 0 0 Rod Pakonen Board Member 5.00 1.00 X 0 0 0 Paul Sanders Board Member 5.00 1.00 X 0 0 0 190625 0 0 1 0 1 0 Prime Time Healthcare LLC 15380 Weir Street Omaha NE 68137 Supplemental Nursing Services 289469 1 Resident Service Reven 623000 5645242 5645242 Management Fee Revenue 541610 681534 681534 Lease Revenue 532000 528951 528951 136710 136710 6992437 1322 1322 6993759 6992437 0 1322 2990 2990 219916 140027 79889 2501250 2179460 321790 24887 23078 1809 278088 257948 20140 198707 184261 14446 298245 298245 32409 32409 39983 39983 339331 339331 29320 29320 252013 252013 14185 14185 200582 200582 64363 64363 18382 18382 631344 631344 384102 384102 66150 66150 Medical Expenses 532910 532910 Food 189209 189209 DHS Surcharge 154825 154825 Bad Debt Expenses 88774 88774 89254 89254 6651219 5842508 808711 0 261668 1537814 503104 353013 68332 56767 10298965 3641234 6973694 6657731 1385851 1377412 9192649 9982737 406058 390871 7406367 7193664 13550 10302 1400000 1400000 916126 970166 753676 1406820 1270110 11548921 11988789 X -2356272 -2006052 -2356272 -2006052 9192649 9982737 342540 7680 0 X X 0 0 0 X 10000 10000 4765024 6066971 6992437 17824432 4775024 6066971 6992437 17834432 0 1104721 1168220 1190975 3463916 1104721 1168220 1190975 3463916 14370516 875 475 1322 2672 875 475 1322 2672 4775899 6067446 6993759 17837104 0.80570 0.79030 0.00010 0.00010 X Schedule A, Part III: The organization made amendments to its governing documents and as of December 17, 2017 is no longer a supporting organization under IRC Section 509(a)(3). As such, the organization is completing Part III as publicly supported organization under IRC Section 509(a)(2) beginning with tax year 2017. 0 1 X 782122 782122 9002994 3134869 5868125 491849 484365 7484 22000 22000 0 6657731 Due To/From Affiliates 527367 Other Assets 28829 Bed Licenses 670000 Debt reserve fund 151216 1377412 Asset retirement obligation 25621 Due To/From Affiliates 1244489 1270110 Part IV, Line 2b: The Organization acts as custodian for the funds of the residents and holds tenant security deposits. These funds are included in cash and cash equivalents and current liabilities. X X X X 0 0 0 0 0 0 0 0 0 Jennifer Gleason COO/Secretary/Treasurer 175000 0 0 0 0 0 0 0 0 0 175000 0 0 0 A City of Mora 416005389 000000000 2009-04-30 6258382 To purchase a nursing & assisted living facility in Mora, MN. 0 0 0 B City of Mora 416005389 000000000 2013-09-06 4851795 Refinance a portion of Series 2009 notes issues in 4/30/2009. 0 0 0 C City of Minneota 416005373 000000000 2013-12-31 4397409 To purchase a nursing & assisted living facility in Minneota, MN. 0 0 0 A 4858382 6258382 6258382 2009 0 0 1 1 B 1057328 4851795 97035 5059 4749701 2013 1 0 1 1 C 996432 4397409 150000 34437 4212972 2013 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 0 0 1 0 0 0 1 C 0 0 0 0 1 0 0 0 1 A 1 B 1 C 1 Housing Alternatives Partnership (HAP) Board Member Robert Sundberg is a 50% owner of HAP Purchase of Assisted Living Facility X 1400000 1400000 0 1 1 1400000 Form 990, Part III, line 3 As a provider of skilled nursing and assisted living services, Living Services Foundation was greatly impacted by the COVID-19 pandemic. Staff made significant changes to our operation in line with CDC guidance, including revising visitation, dining and activity procedures, focus on infection control procedures, and shifts to staffing and other operations in line with a slowing of admissions in need of rehabilitation therapy. We continue to follow CDC guidance and anticipate that our operation will continue to be impacted by COVID-19 beyond fiscal year 2021. Form 990, Part VI, Section A, line 2 Dennis Kamstra and Jennifer Gleason have a family relationship. Form 990, Part VI, Section A, line 8b No committees are able to act on behalf of the board. Form 990, Part VI, Section B, line 11b An electronic draft of the Form 990 is distributed to the full board of directors for review and approval prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The Conflict of Interest policy is enforced and consistently monitored. An interested person must disclose the existence of their financial interest to the board considering the proposed transaction or arrangement. The remaining board members then determine if a conflict of interest exists. Corrective action is taken by the board of directors as deemed necessary when a conflict of interest is determined to have occurred. Disclosure of a conflict of interest would prevent that person from taking part in discussions or voting on related issues. Form 990, Part VI, Section B, line 15 The process for determining compensation for the CEO and COO is determined by a compensation survey and study. The compensation is then approved by the independent members of the Board of Directors. The last review took place during the summer of 2020. Form 990, Part VI, Section C, line 19 The Organization makes the governing documents and conflict of interest policy available upon request. Form 990, Part XII, Line 2b: The financial statements for Living Services Foundation/Minneota, LLC were audited for the year ending June 30, 2020. The combined financial statements for Living Services Foundation/Mora, LL and Benedictine Living Community of Mora were audited for the year ending June 30, 2020. Living Services Foundation Mora LLC 110 North 7th Street Mora MN 55051 263614974 Leasing of skilled nursing and assisted living facility. DE 517726 4202289 Living Services Foundation Living Services Foundation Minneota LLC 700 North Monroe Street Minneota MN 56264 263614760 Operation of skilled nursing, assisted lving, and home health agency. DE 5735344 4573240 Living Services Foundation Benedictine Living Community of Mora 110 North 7th Street Mora MN 55051 274219119 Skilled nursing care center and assisted living facility. MN 501(c)(3) Line 10 Living Services Foundation 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 Benedictine Living Community of Mora L 383289 General Ledger Benedictine Living Community of Mora Q 56264 General Ledger