2020-07-15T18:48:45-05:00 2019-06-30 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2018-07-01 274218436 BENEDICTING LIVING COMMUNITY OF NEW LOND DBA GRACE LIV COM OF GLEN OAKS BENE 7636891162 6499 UNIVERSITY AVENUE NE NO 300 MINNEAPOLIS MN 55432 KEVIN RYMANOWSKI CFO 7636891162 2020-07-13 1 CHRISTOPHER STEINHOFF P01587351 6123764500 2020-07-13 67.137.57.251 2020-07-13 12:36:47 CD P 3083F1BEA7161E24D29E899F714FC8EB6E1BBB36 8DF0D5A1DBF8E44DE93554FEEDBEEE801640FE4C 2018 2021-01-29 14:40:06Z X KEVIN RYMANOWSKI 6499 UNIVERSITY AVENUE NE NO 300 MINNEAPOLIS MN 55432 5408878 0 0928 X WWW.BHSHEALTH.ORG X 2010 MN OUR MISSION IS TO WITNESS TO GOD'S LOVE BY PROVIDING COMPASSIONATE, QUALITY CARE WITH SPECIAL CONCERN FOR THE UNDERSERVED AND THOSE IN NEED. 3 0 145 25 0 0 28554 607 5275935 5403893 1306 1706 0 2672 5305795 5408878 40362 30965 0 0 3027283 3307650 0 0 0 2238773 2070264 5306418 5408879 -623 -1 1043480 812182 1032058 800791 11422 11391 X BENEDICTINE LIVING COMMUNITY OF NEW LONDON IS A CATHOLIC ORGANIZATION ENTRUSTED WITH ADVANCING THE HEALTH CARE MINISTRY OF THE BENEDICTINE SISTERS OF DULUTH, MINNESOTA. OUR MISSION IS TO WITNESS TO GOD'S LOVE BY PROVIDING COMPASSIONATE, QUALITY CARE WITH SPECIAL CONCERN FOR THE UNDERSERVED AND THOSE IN NEED. 0 0 3724684 30965 4167321 OPERATION OF BLC OF NEW LONDON, DBA GRACE LIVING COMMUNITY OF GLEN OAKS, IS A 52 BED LONG-TERM CARE FACILITY IN NEW LONDON, MINNESOTA WHICH PROVIDES SKILLED NURSING CARE TO THE ELDERLY.THE FACILITY HAD 76.5% OCCUPANCY AND SERVED 96 INDIVIDUALS DURING THE FISCAL YEAR ENDING 6/30/19. 984809 0 1236572 OPERATION OF GRACE LIVING COMMUNITY OF GLEN OAKS SENIOR LIVING - ASSISTED LIVING, IS A 47 UNIT FACILITY IN NEW LONDON, MINNESOTA.THE FACILITY HAD 94.3% OCCUPANCY AND SERVED 65 INDIVIDUALS DURING THE FISCAL YEAR ENDING 6/30/19. 4709493 1 0 0 0 0 0 0 0 1 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 23 0 1 145 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 0 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 MN X KEVIN RYMANOWSKI CFO 7636896107 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 JERRY CARLEY CEO OF BHS 1.00 39.00 X X 0 493059 136483 KEVIN RYMANOWSKI CFO OF BHS 1.00 39.00 X X 0 360445 87709 ANDREW OPSAHL VP OF BHS 1.00 39.00 X X 0 224720 62780 JAMES INGERSOLL CEO ADMIN 40.00 0.00 X 0 98294 29933 0 1176518 316905 0 0 1 0 CURA HOSPITALITY LLC PO BOX 743676 ATLANTA GA 303743676 CULINARY SERVICES 487904 BENEDICTINE HEALTH SYSTEM 6499 UNIVERSITY AVENUE NE SUITE 30 MINNEAPOLIS MN 55432 MANAGING COMPANY 368551 2 607 607 RESIDENT SERVICES 623000 5403893 5403893 5403893 1706 1706 MISCELLANEOUS REVENUE 900099 2672 2672 2672 5408878 5403893 0 4378 24809 24809 6156 6156 2692959 2463355 229604 33078 33078 391780 391780 189833 189833 368551 368551 3353 3353 2325 2325 374823 351429 23394 10801 10801 29590 17545 12045 329724 309460 20264 14704 7468 7236 -436 30 -466 190525 190525 65508 65508 FOOD 171311 171311 MEDICAL SUPPLY EXPENSE 163786 158939 4847 BUILDING LEASE 158667 158667 SURCHARGE 146788 146788 40244 12011 28233 5408879 4709493 699386 0 558520 447496 398092 285068 3282 17665 504095 504095 6748 0 76838 61953 1043480 812182 936359 700223 28018 30999 67681 69569 1032058 800791 X 0 0 11422 11391 11422 11391 1043480 812182 X -1 -30 X X 0 1 X 1 0 X 1242373 2582 28554 607 1274116 4715401 4638876 4898214 5275935 5403893 24932319 5957774 4638876 4900796 5304489 5404500 26206435 0 0 0 26206435 402 245 704 1306 1706 4363 402 245 704 1306 1706 4363 83310 127344 2672 213326 6041486 4639121 5028844 5305795 5408878 26424124 0.99180 0.99190 0.00020 0.00010 X 0 1 X 388881 388881 0 7600 7600 0 107614 107614 0 0 CONSTRUCTION FUNDS 32772 FUNDS HELD UNDER BOND INDENTURE 29181 61953 X PART IV, LINE 2B: CARETAKER OF RESIDENT TRUST FUNDS AND SECURITY DEPOSITS IN A SEPARATE ACCOUNT. PART X, LINE 2: TAX EXEMPT STATUS BHS HAS BEEN DETERMINED TO QUALIFY AS A TAX-EXEMPT CHARITABLE, EDUCATIONAL, AND SCIENTIFIC ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ALSO HAS BEEN DETERMINED TO BE EXEMPT FROM STATE INCOME TAX. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES IN EVALUATING THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE ORGANIZATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE ORGANIZATION FILES ALL APPLICABLE RETURNS FOR ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES. 1 BENEDICTINE HEALTH SYSTEMS 1995 E RUM RIVER DRIVE S CAMBRIDGE MN 55008 411531892 501(C)3 24809 0 N/A N/A CAPITAL FUND/SUPPORT 1 0 SCHOLARSHIPS 6 6156 0 N/A N/A PART I, LINE 2: BENEDICTINE LIVING COMMUNITY OF NEW LONDON OFFERS EMPLOYEES TUITION PAYMENT THROUGH AN EDUCATIONAL ASSISTANCE PLAN THAT COMPLIES WITH SECTION 127 OF THE INTERNAL REVENUE CODE AND THE MINNESOTA NURSING FACILITY EMPLOYEE SCHOLARSHIP FUND (BULLETIN #01-62-05). TO PROVIDE PAYMENT FOR EXPENSES INCURRED BY ELIGIBLE SENIOR CARE EMPLOYEES FOR THE SUCCESSFUL COMPLETION OF APPROVED COURSES THAT LEAD TO CAREER ADVANCEMENT. TRANSFERS BETWEEN RELATED ORGANIZATIONS ARE ACCOUNTED FOR IN INTERNAL FINANCIAL STATEMENTS, OF WHICH ALL ARE UNDER COMMON CONTROL. 0 0 0 0 0 0 0 0 0 JERRY CARLEY CEO OF BHS 0 450000 0 0 0 43059 0 99000 0 37483 0 629542 0 0 KEVIN RYMANOWSKI CFO OF BHS 0 295734 0 36609 0 28102 0 61741 0 25968 0 448154 0 0 ANDREW OPSAHL VP OF BHS 0 183738 0 14739 0 26243 0 52714 0 10066 0 287500 0 0 PART III - ADDITIONAL INFORMATION BENEDICTINE HEALTH SYSTEM'S (EIN: 41-1531892) CEO AND CFO, JERRY CARLEY AND KEVIN RYMANOWSKI, SHARE THEIR TIME BETWEEN THE REPORTING ORGANIZATION AND RELATED ORGANIZATIONS. THE CEO IS COMPENSATED BY BENEDICTINE HEALTH SYSTEM, A RELATED ORGANIZATION. THIS ORGANIZATION USES THE FOLLOWING TO SET CEO/ ADMINISTRATIVE COMPENSATIONS: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. WRITTEN EMPLOYMENT CONTRACT 4. COMPENSATION SURVEY OR STUDY 5. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. OFFICER COMPENSATION BENEDICTINE HEALTH SYSTEM'S (EIN: 41-1531892) CEO AND CFO, JERRY CARLEY AND KEVIN RYMANOWSKI, SHARE THEIR TIME BETWEEN THE REPORTING ORGANIZATION AND RELATED ORGANIZATIONS. SEE SCHEDULE R FOR INFORMATION ON RELATED ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 3 THE CORPORATION CONTRACTS WITH BENEDICTINE HEALTH SYSTEM, A RELATED ORGANIZATION FOR MANAGEMENT SERVICES. BENEDICTINE HEALTH SYSTEM EMPLOYED THE ADMINISTRATOR/CEO OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 6 BENEDICTINE HEALTH SYSTEM, A MINNESOTA NONPROFIT CORPORATION, IS THE SOLE MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A EACH DIRECTOR OF THE CORPORATION IS APPOINTED BY BENEDICTINE HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B BENEDICTINE HEALTH SYSTEM HAS CERTAIN RESERVED POWERS RELATING TO THE ACTIVITIES OF THE CORPORATION AS SET OUT IN THE CORPORATION'S BY-LAWS. IN ADDITION, IN KEEPING WITH THE CORPORATION'S MISSION "TO ASSIST AND COORDINATE ACTIVITIES OF FACILITIES FOR HEALTH CARE, EDUCATION, AND CARE FOR THE AGED AND SOCIAL SERVICES IN ACCORDANCE WITH THE CHARITABLE WORKS TRADITION OF THE ROMAN CATHOLIC CHURCH", ALL ACTIVITIES OF THE CORPORATION ARE REQUIRED TO BE CARRIED OUT IN ACCORDANCE WITH THE CHARISMS OF THE BENEDICTINE SISTERS BENEVOLENT ASSOCIATION ("BSBA"), A CIVIL LAW CORPORATION FOR THE SISTERS OF ST. BENEDICT OF ST. SCHOLASTICA MONASTERY LOCATED IN DULUTH, MINNESOTA. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY MANAGEMENT. WHEN A DRAFT OF THE RETURN IS AVAILABLE, AN ELECTRONIC COPY OF THE FORM 990 WAS DISTRIBUTED TO THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO DISCLOSE ANY RELATIONSHIPS THAT CONSTITUTE OR MIGHT LEAD TO A CONFLICT OF INTEREST BY COMPLETING THE CONFLICT OF INTEREST AND GIFT DISCLOSURE STATEMENT. THE BHS COMPLIANCE DEPARTMENT WILL DISTRIBUTE THE STATEMENTS AND COLLECT AND MAINTAIN THE COMPLETED STATEMENTS. THE BHS COMPLIANCE MANAGER WILL REVIEW THE STATEMENTS AND PROVIDE A SUMMARY OF THE IDENTIFIED CONFLICTS OF INTEREST TO THE BHS CHIEF COMPLIANCE OFFICER, WHO WILL ALERT THE BHS CEO AND THE CHAIR OF THE BHS BOARD OF DIRECTORS TO ANY ITEMS OF CONCERN. AN "INTERESTED PERSON" IS ANY PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE SYSTEM, INCLUDING BUT NOT LIMITED TO A BOARD MEMBER, BOARD COMMITTEE MEMBER, OR OFFICER OR DIRECTOR OF BHS OR A FACILITY (SUCH AS FACILITY CEO/ADMINISTRATORS AND BHS SENIOR LEADERS AND DIRECTORS). FOR INTERESTED PERSONS WHO ARE EMPLOYEES (OTHER THAN THE BHS CEO), FOLLOWING DISCLOSURE OF THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST AND ALL MATERIAL FACTS, THE INTERESTED PERSON'S SUPERVISOR WILL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. FOR THE BHS CEO AND BOARD AND COMMITTEE MEMBERS, FOLLOWING DISCLOSURE OF THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST AND ALL MATERIAL FACTS, THE INTERESTED PERSON WILL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE REMAINING MEMBERS OF THE BOARD OR COMMITTEE DETERMINE IF A CONFLICT OF INTEREST EXISTS. THE INTERESTED PERSON MAY PARTICIPATE IN DELIBERATION REGARDING THE TRANSACTION IF THE APPLICABLE SUPERVISOR, BOARD, OR COMMITTEE DETERMINES A CONFLICT OF INTEREST DOES NOT EXIST. AN INTERESTED PERSON WHO HAS BEEN DETERMINED TO HAVE A CONFLICT OF INTEREST MAY NOT PARTICIPATE IN THE DELIBERATION OR DECISION REGARDING THE TRANSACTION OR ARRANGEMENT INVOLVING THE CONFLICT OF INTEREST AND MAY NOT BE PRESENT DURING SUCH DELIBERATION OR DECISION MAKING. THE INTERESTED PERSON MAY BE ALLOWED TO MAKE A PRESENTATION TO THE SUPERVISOR, BOARD, OR COMMITTEE CONSIDERING THE TRANSACTION OR ARRANGEMENT AS TO WHICH THE CONFLICT OF INTERESTS REFERS PRIOR TO THE DELIBERATION AND DECISION. FORM 990, PART VI, SECTION C, LINE 19 NOT AVAILABLE TO PUBLIC FORM 990, PART XI, LINE 9: CHANGE IN TEMPORARILY RESTRICTED NET ASSETS -30. FORM 990, PART XII, LINE 2C: THE BENEDICTINE HEALTH SYSTEM AUDIT/ FINANCE COMMITTEE OVERSEES THE SELECTION OF THE INDEPENDENT AUDITOR AND OVERSEES THE ANNUAL CONSOLIDATED AUDIT OF BENEDICTINE HEALTH SYSTEM AND AFFILIATES WHICH INCLUDES THE ORGANIZATION. BENEDICTINE HEALTH SYSTEM 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 411531892 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 10 N/A 0 BENEDICTINE HEALTH CENTER 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 411381401 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BENEDICTINE CARE CENTERS 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 411907571 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BENEDICTINE LIVING COMMUNITIES 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 411639687 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BLC OF ST PETER 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 861113231 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 STEEPLE POINTE SENIOR LIVING COMMUNITY 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 411852273 ASSISTED LIVING MN 501(C)(3) LINE 10 BHS 0 CERENITY SENIOR CARE 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 363517696 NURSING HOME MN 501(C)(3) LINE 10 N/A 0 CERENITY CARE CENTER - WHITE BEAR LAKE 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 411983267 NURSING HOME MN 501(C)(3) LINE 10 N/A 0 BENEDICTINE HEALTH SYSTEM FOUNDATION 503 E THIRD ST SUITE 400 DULUTH MN 55805 411513014 FUND DEVELOPMENT MN 501(C)(3) LINE 10 BHS 0 LIVING COMMUNITY OF ST JOSEPH 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 412011661 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 MADONNA TOWERS OF ROCHESTER 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 411809914 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 SAINT ANNE OF WINONA 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 410850791 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 ST GERTRUDE'S HEALTH CENTER 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 411848720 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 ARROWHEAD SENIOR LIVING COMMUNITIES 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 411978619 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BLC OF WINSTED 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 274219293 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BLC OF BISMARCK 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 264376543 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BLC OF WAHPETON 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 454274091 ASSISTED LIVING MN 501(C)(3) LINE 10 BHS 0 BLC OF RED WING 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 454929398 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 KODA LIVING COMMUNITY 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 270705237 NURSING HOME MN 501(C)(3) LINE 10 N/A 0 BRIDGES CARE CENTER 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 262620983 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BSLC OF ST PETER 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 272716531 ASSISTED LIVING MN 501(C)(3) LINE 10 BHS 0 CATHOLIC RESIDENTIAL SERVICES 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 390982340 NURSING HOME WI 501(C)(3) LINE 10 BHS 0 ROSEWOOD COURT 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 412011389 ASSISTED LIVING MN 501(C)(3) LINE 10 BHS 0 MADONNA MEADOWS OF ROCHESTER 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 470855891 ASSISTED LIVING MN 501(C)(3) LINE 10 BHS 0 NAZARETH LIVING CENTER 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 431450394 NURSING HOME MO 501(C)(3) LINE 10 N/A 0 VILLA ST BENEDICT 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 364343235 NURSING HOME MN 501(C)(3) LINE 10 N/A 0 VILLA ST VINCENT 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 411352227 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 REGINA SENIOR LIVING 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 463700475 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 ELLENDALE EVERGREEN PLACE 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 411796445 ASSISTED LIVING MN 501(C)(3) LINE 10 BHS 0 BLC OF BYRON 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 471538777 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 CITY OF LAKES CARE CENTER 6499 UNIVERSITY AVENUE NE SUITE 300 MINNEAPOLIS MN 55432 411985663 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 LIVING SERVICES FOUNDATION 900 LONG LAKE RD STE 130 NEW BRIGHTON MN 55112 411936717 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0