2020-10-26T15:46:32-05:00 2019-12-31 861065772 DELOITTE TAX LLP 50 SOUTH SIXTH STREET SUITE 2800 MINNEAPOLIS MN 55402 990 2019-01-01 460422866 THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION EVAN 6053623100 PO BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 BILL MARLETTE CFO & TREASURER 6053331000 2020-10-26 1 CHRIS MESKIMEN P01314196 6123974000 206.208.222.33 2020-10-26 15:45:54 CD P 870A371766499EB154DBF25C859883350D8D389B E5BC8B5E57121AB33B8A1607D3C50835A925FFE9 2019 2021-01-29 14:40:06Z X BOBBIE TIBBETTS 2335 EAST 60TH ST N SIOUX FALLS SD 57104 31724755 0 X WWW.GOOD-SAM.COM/FOUNDATION X 1992 MN PROVIDING SUPPORT, ASSISTANCE, AND AID FOR THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (ELGSS). 15 11 0 8 0 0 5867281 2894201 0 0 15027120 2374048 0 46170 20894401 5314419 2306126 7657056 0 0 1334129 1278403 0 0 492739 365355 325223 4005610 9260682 16888791 -3946263 69950141 93022429 108584 2573403 69841557 90449026 THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION ("FOUNDATION") EXISTS TO ENCOURAGE PHILANTHROPHY IN SUPPORT OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (SOCIETY) IN PROVIDING SHELTER AND SUPPORTIVE SERVICES TO OLDER PERSONS AND OTHERS IN NEED. 0 0 7657056 7657056 0 THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION ("FOUNDATION") SUPPORTS THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY ("SOCIETY") IN ITS EFFORTS TO CREATE ENVIRONMENTS WHERE PEOPLE FEEL LOVED, VALUED AND AT PEACE. THE FOUNDATION RAISES FUNDS IN SUPPORT OF THE SOCIETY'S EFFORTS TO TRANSFORM THE AGING EXPERIENCE IN AMERICA AND SEEKS "DONORS" WHO ARE INSPIRED TO SUPPORT THE JOURNEY. FUTHERMORE, THE FOUNDATION ENSURES THESE DONATIONS ARE USED WHERE THEY CAN HAVE THE GREATEST IMPACT ON THE BENEFICIARIES OF THE SOCIETY'S EFFORTS. 7657056 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 11 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN AL AK AR CA CO CT DC FL GA HI IL X BILL MARLETTE CFO TREASURER 6053331000 2301 EAST 60TH STREET SIOUX FALLS SD 57104 X THOMAS VAN WYHE CHAIRPERSON 1.90 0.00 X X 0 0 0 DUANE ANDERSON DIRECTOR 1.90 0.00 X 0 0 0 RANDY BURY DIRECTOR 1.90 58.10 X 0 1145407 110405 BRIAN DAVIDSON DIRECTOR 1.90 50.00 X 0 108634 6564 MARGARET HEGGE DIRECTOR 1.90 0.00 X 0 0 0 SUSAN KLIMEK DIRECTOR 1.90 0.00 X 0 0 0 MARTY MOORE DIRECTOR 1.90 0.00 X 0 0 0 KAREN MOUSEL DIRECTOR 1.90 50.00 X 0 101764 13005 JAY NEWTON-SMALL DIRECTOR 1.90 0.00 X 0 0 0 FRED PITZL DIRECTOR 1.90 50.00 X 0 103374 21433 KATHIE REED DIRECTOR 1.90 0.00 X 0 0 0 SEBASTIAN SILEN DIRECTOR 1.90 0.00 X 0 0 0 CHARLES SPIEDEL DIRECTOR 1.90 0.00 X 0 0 0 BOB STACKHOUSE DIRECTOR 1.90 0.00 X 0 0 0 JOHANNAH TORKELSON DIRECTOR 1.90 0.00 X 0 0 0 JOANN KUNKEL CHIEF FINANCIAL OFFICER 0.42 59.58 X 0 1333149 135506 SUZIE O'MEARA PRESIDENT 55.00 0.00 X 0 294747 14350 BOBBIE TIBBETTS VP SANFORD HEALTH FOUNDATION 5.00 55.00 X 0 390875 27571 JAMES KREKELBERG FORMER OFFICER ASSISTANT TREASURER 10.00 45.00 X 0 183078 19832 THOMAS KAPUSTA THRU 119 FORMER OFFICER SECRETARY 0.00 45.00 X 0 737181 19549 0 4398209 368215 0 1 1 0 0 2894201 36861 2894201 1488982 1488982 27295402 26410336 885066 885066 885066 BAD DEBT RECOVERY 525990 36170 36170 ALL OTHER REVENUE 525990 10000 10000 46170 5314419 0 0 2420218 7646922 7646922 10134 10134 1265869 791316 474553 12534 12534 15796 15796 99469 97186 2283 3630 3630 16370 16130 240 128664 113001 15663 3633 3633 10746 10746 DUES AND MEMBERSHIPS 45552 45552 SALES TAX 1111 1111 OTHER SUPPLIES 752 752 BOOKS AND SUBSCRIPTIONS 284 284 -784 -784 9260682 7657056 1110887 492739 49590 46255 19440428 99331 988115 0 54262 41444 23564 12818 50436559 87709101 0 4166809 69950141 93022429 15729 238625 167489 92855 2167289 108584 2573403 X 49931346 55124700 19910211 35324326 69841557 90449026 69950141 93022429 X -3946263 2113818 22439914 X 0 1 X 1 0 X X 1 TELGSS 450228055 10 1 2672670 0 1 2672670 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 22010503 1579419 20431084 22334312 525687 472618 376878 22010503 20300182 714333 1514302 194505 22334312 19072814 650428 757308 180368 20300182 19029280 148048 18886 123400 19072814 0.00000 1.00000 0.00000 0 0 54262 41444 12818 12818 ANNUITIES PAYABLE 2167289 2167289 X PART IV, LINE 2B: THE ORGANIZATION MANAGES CUSTODIAL ACCOUNTS OWNED BY RELATED ORGANIZATIONS WITH THE FUNDS BALANCE CO-MINGLED WITH OTHER INVESTMENT ASSETS OF THE ORGANIZATION. THE USE OF THE FUNDS BALANCE WILL BE OVERSEEN AND EXPENDED BY THE OWNER. PART V, LINE 4: THE FOUNDATION'S ENDOWMENT FUNDS ARE DESIGNATED AS DIRECTED BY THE DONOR'S RESTRICTIONS. PRIOR TO 2019, SCH D INCLUDED BOARD DESIGNATED AND TEMPORARILY RESTRICTED ASSETS. THE CONTRIBUTIONS ON LINE 2 INCLUDE A DECREASE OF $5,704,338 FOR THIS CHANGE. 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 FOUNDATION DID NOT HAVE AN INCOME TAX LIABILITY AT DECEMBER 31, 2019; HOWEVER, SOME RELATED ORGANIZATIONS HAVE ESTABLISHED RESERVES. 1 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 4800 W 57TH STREET SIOUX FALLS SD 57108 450228055 501(C)(3) 2672670 GIFTS TRANSFERRED TO THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY. 1 0 SCHOLARSHIPS 15 10134 0 PART I, LINE 2: THE FOUNDATION COMMUNICATES A LIST OF RESTRICTIONS TO EACH CENTER AT THE TIME OF DISTRIBUTION. THE ADMINSTRATOR AT EACH LOCATION IS RESPONSIBLE FOR ENSURING THAT THE FUNDS ARE USED IN ACCORDANCE WITH THE FOUNDATION'S DIRECTION. THE ORGANIZATION PROVIDES SCHOLARSHIPS TO EMPLOYEES OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY WHO ARE ENROLLED IN A QUALIFIED EDUCATION PROGRAM. THE ORGANIZATION PAYS THE SCHOLARSHIP DIRECTLY TO THE EDUCATION INSTITUTION WHERE THE EMPLOYEE IS ENROLLED. IF THE EMPLOYEE HAS ALREADY PAID THE EXPENSES, THE ORGANIZATION REQUIRES RECEIPT OF PAYMENT BEFORE REIMBURSEMENT IS MADE TO THE EMMPLOYEE. 1 1 0 0 0 0 0 0 0 RANDY BURY DIRECTOR 0 857021 0 128500 0 159886 0 103080 0 7325 0 1255812 0 0 JOANN KUNKEL CHIEF FINANCIAL OFFICER 0 1018824 0 145204 0 169121 0 111720 0 23786 0 1468655 0 0 SUZIE O'MEARA PRESIDENT 0 206179 0 37049 0 51519 0 0 0 14350 0 309097 0 0 BOBBIE TIBBETTS VP SANFORD HEALTH FOUNDATION 0 335336 0 11777 0 43762 0 0 0 27571 0 418446 0 0 JAMES KREKELBERG FORMER OFFICER ASSISTANT TREASURER 0 180147 0 2139 0 792 0 0 0 19832 0 202910 0 0 THOMAS KAPUSTA THRU 119 FORMER OFFICER SECRETARY 0 49381 0 365 0 687435 0 0 0 19549 0 756730 0 0 PART I, LINE 1A CERTAIN ITEMS LISTED ON LINE 1 A ARE PROVIDED BY RELATED ORGANIZATIONS. PART I, LINE 3 THE EXECUTIVE COMPENSATION COMMITTEE OF THE SANFORD BOARD OF TRUSTEES DIRECTLY ENGAGES A NATIONALLY RECONGIZED 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 2019. PART I, LINES 4A-B PART I, LINE 4A: THE FOLLOWING INDIVIDUAL PARTICIPATED IN A SEVERANCE ARRANGEMENT AND RECEIVED PAYMENTS DURING THE YEAR: THOMAS KAPUSTA $687,287 PART I, LINE 4B: CERTAIN EXECUTIVES PARTICIPATE IN A DEFINED CONTRIBUTION SERP PLAN. X 1 2500 FAIR MARKET VALUE X 125 FAIR MARKET VALUE X 5251 FAIR MARKET VALUE X 1 300 FAIR MARKET VALUE X 17 718 FAIR MARKET VALUE X 1 1760 FAIR MARKET VALUE X OTHER - EQUIPMENT 35 16837 FAIR MARKET VALUE X OTHER - PERSONAL 14 6153 FAIR MARKET VALUE X OTHER - GIFT 28 3217 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): THE AMOUNTS REPORTED ON PART I, COLUMN B REPRESENT THE NUMBER OF CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE EMPLOYEES OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN OR ITS RELATED ORGANIZATIONS. MANY OF THESE EMPLOYEES ALSO SERVE ON OTHER RELATED ENTITIES BOARDS OR HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER THAT SPAN THE ORGANIZATION AS A WHOLE: RANDY BURY,BRIAN DAVIDSON, KAREN MOUSEL, FRED PITZL, JOANN KUNKEL, BOBBIE TIBBETTS AND SUZIE O'MEARA. FORM 990, PART VI, SECTION A, LINE 6 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY IS THE SOLE MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF THE CORPORATION IS APPOINTED BY THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD OF DIRECTORS HAS FULL AND COMPLETE RESPONSIBILITY FOR MAINTAINING PROPERTY, AFFAIRS AND BUSINESS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED INTERNALLY BY THE TAX DEPARTMENT AND REVIEWED BY EXECUTIVE MANAGEMENT. AN EXTERNAL ACCOUNTING FIRM REVIEWS THE RETURN. BEFORE THE RETURN IS FILED, A COMPLETE COPY IS PROVIDE 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 THE 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 AS THE PARENT ORGANIZATION DOES HAVE A PROCESS FOR DETERMINING COMPENSATION OF THE PERSONS LISTED ON PART VII SECTION A, INCLUDING A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, REVIEW OF COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION FOR SUCH COMPENSATION. THE EXECUTIVE COMPENSATION COMMITTEE OF THE SANFORD BOARD OF TRUSTEES DIRECTLY 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 2019. 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 XI, LINE 9: TRANSFER FROM RELATED TAX EXEMPT ORG FOR PAYROLL AND OPERATING EXPENSES 4,618,459. PERM RESTRICTED NET ASSET RECLASSES (ENDOWMENTS) FROM SOCIETY 708,582. TEMP RESTRICTED NET ASSET RECLASS (DONOR-RESTRICTED GIFTS) FROM SOCIETY 9,485,604. TRANSFER OF PERM RESTRICTED BENEFICIAL INTEREST FROM SOCIETY 4,166,809. TRANSFER OF RESTRICTED 2019 ACTIVITY FROM SOCIETY 3,459,524. TRANSFER OF TEMP RESTRICTED NET ASSETS FROM PROSPERA 936. SANFORD P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 271218956 SUPPORTING ORGANIZATION ND 501(C)(3) 12-II 0 SANFORD HEALTH FOUNDATION P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 363297853 FOUNDATION SD 501(C)(3) 12-II SANFORD HEALTH 1 F-M AMBULANCE SERVICE INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 450344371 EMT ND 501(C)(4) SANFORD NORTH 1 SANFORD HEALTH FOUNDATION NORTH P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 450398104 FOUNDATION ND 501(C)(3) 7 SANFORD NORTH 1 SANFORD HEALTH FOUNDATION HILLSBORO P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 363542187 FOUNDATION ND 501(C)(3) 7 SANFORD HEALTH NETWORK NORTH 1 SANFORD HEALTH FOUNDATION WEST P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 450397196 FOUNDATION ND 501(C)(3) 7 SANFORD BISMARCK 1 SANFORD HEART OF AMERICA HEALTH PLAN P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 450346132 INSURANCE ND 501(C)(4) SANFORD HEALTH PLAN 1 SANFORD HEALTH FOUNDATION THIEF RIVER FALLS P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 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SD 501(C)(3) 10 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 GOOD SAMARITAN HOLDINGS LLC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 752979560 DEVELOPMENT OF SENIOR HOUSING AND ASSISTED LIVING SERVICES SD 501(C)(3) 12-I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 GOOD SAMARITAN SOCIETY INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 460349951 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) 12-I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 GRANTS GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 460439511 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) 10 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 GREELEY GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 460456087 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) 10 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 HASTINGS GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 460434693 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) 10 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 HASTINGS VILLAGE GARDENS GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 271212446 LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP SD 501(C)(3) 12-I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 HOWARD LAKE GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 364885253 PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS SD 501(C)(3) 10 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 INDIANOLA COUNTY GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 461328052 LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP SD 501(C)(3) 12-I THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 1 INVER GROVE HEIGHTS GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 760789504 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