2020-11-10T09:11:55-06:00 2019-12-31 861065772 DELOITTE TAX LLP 50 S 6TH STREET MINNEAPOLIS MN 55402 990 2019-01-01 450228055 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY EVAN 6053623100 PO BOX 5039 RTE 5218 SIOUX FALLS SD 571175039 BILL MARLETTE CFO & TREASURER 6053331000 2020-11-10 1 CHRIS MESKIMEN P01314196 6123974000 206.208.222.33 2020-11-10 09:11:13 CS P 870A371766499EB154DBF25C859883350D8D389B E5BC8B5E57121AB33B8A1607D3C50835A925FFE9 2019 2021-01-29 14:40:06Z X RANDY BURY 4800 W 57TH ST SIOUX FALLS SD 57108 1153513361 0 X WWW.GOOD-SAM.COM X 1922 ND DEDICATED TO SHARING GOD'S LOVE THROUGH THE WORK OF HEALTH, HEALING AND COMFORT. 14 9 27364 3472 -2020062 0 13345039 7572687 975042383 931240540 45289664 11436779 13175724 14148138 1046852810 964398144 6650181 1428847 0 0 586602075 572779797 0 0 1397075 459420323 464395592 1052672579 1038604236 -5819769 -74206092 1606272602 1563553743 967137392 240266985 639135210 1323286758 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 702851030 1428847 757720441 SKILLED NURSING SERVICES - REHABILITATION/SKILLED NURSING SERVICES HAVE BEEN AT THE CORE OF THE SOCIETY'S SERVICES OVER ITS 97-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.STATISTALLY, THE SOCIETY PROVIDED A TOTAL OF 2,577,457 SKILLED NURSING HOME DAYS OF CARE AND SERVICE IN 2019. THE SOCIETY CONTINUES TO REINVEST MUCH OF ITS REVENUE TO BUILD AND REVITALIZE ITS FACILITIES ON CAMPUSES THROUGHOUT THE COUNTRY. 98145035 0 102516001 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 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, LARGE COMMON KITCHENS; 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. 75121837 0 74697954 ASSISTED LIVING SERVICES - ASSISTED LIVING SERVICES RESPOND TO THE SOCIETY'S RESIDENTS' NEEDS EACH DAY IN A "HOME-LIKE" ENVIRONMENT. IN 2019, THE SOCIETY PROVIDED 1,780,909 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. 168960933 0 1634279 HOME HEALTH SERVICES - THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY OFFERS LICENSED HOME HEALTH CARE, HOSPICE AND SERVICES@HOME (PRIVATE DUTY) SERVICES IN 18 STATES. OUR HOME HEALTH CARE AGENCIES SERVICED APPROXIMATELY 13,769 CLIENTS IN 2019. 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 CARE FOR 1,158 PATIENTS IN 2019. THE SERVICES PROVIDED INCLUDE 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, PROVIDED CARE FOR 3,012 CLIENTS IN 2019. SERVICES@HOME 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. 168960933 0 1634279 1045078835 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 1 1 0 0 1 0 0 1 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 0 0 1 2171 0 1 27364 1 1 1 1 CJ 0 0 0 1 1 0 0 0 1 0 0 0 X 14 9 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 AL AK AR CA CO CT DC FL GA HI IL KS KY LA ME MD MI MN MS NV NH NJ NM NY NC ND OH OK PA RI TN UT WA VA WV WI X BILL MARLETTE CFO & TREASURER 6053331000 2301 EAST 60TH STREET SIOUX FALLS SD 57104 DALE THOMPSON CHAIRPERSON 3.30 0.10 X X 0 0 0 ALAN GARD VICE CHAIRPERSON 3.30 0.10 X X 0 0 0 GWEN HALAAS UNTIL 619 VICE CHAIRPERSON 3.30 0.10 X X 0 0 0 DAVID AUSTAD DIRECTOR 3.30 0.10 X 0 0 0 REBECCA BOLLIG UNTIL 1219 DIRECTOR 50.00 0.10 X 118995 0 22283 DAVID BRECHTELSBAUER BEG 619 DIRECTOR 3.30 0.10 X 0 0 0 NORVAL BUCKNEBERG DIRECTOR 3.30 0.10 X 0 0 0 PATRICIA CAMERO DIRECTOR 50.00 0.10 X 148808 0 15282 JAVIER ESPINOSA DIRECTOR 50.00 0.10 X 104173 0 13079 MARNIE HERRMANN BEG 619 DIRECTOR 3.30 0.10 X 0 0 0 KELBY KRABBENHOFT DIRECTOR 3.30 56.70 X 0 3088308 14171 KELBY KRABBENHOFT DEF COMP DIRECTOR 3.30 56.70 X 0 0 1081296 HEATHER KRZMARZICK UNTIL 1119 DIRECTOR 50.00 0.10 X 136824 0 17138 LEE LAAVEG UNTIL 619 DIRECTOR 3.30 0.10 X 0 0 0 LISA MELBY DIRECTOR 50.00 0.10 X 141237 0 8065 SCOTT PETERSEN DIRECTOR 3.30 0.10 X 0 0 0 TIMOTHY PHILLIPPE UNTIL 319 DIRECTOR 3.30 0.10 X 0 0 0 JOHN RACEK UNTIL 619 DIRECTOR 3.30 0.10 X 0 0 0 DINA ROBINSON UNTIL 1119 DIRECTOR 50.00 0.10 X 120270 0 16177 DARRELL SCHMITH BEG 619 DIRECTOR 3.30 0.10 X 0 0 0 JILL SCHUMANN DIRECTOR 3.30 0.10 X 0 0 0 ERIC VANDEN HULL VICE PRESIDENT - FINANCE 50.00 5.00 X 0 447915 29711 RANDY BURY PRESIDENT & CEO 58.10 1.90 X 0 1145407 110405 NATHAN SCHEMA BEG 619 VICE PRESIDENT - OPERATIONS 54.90 0.10 X 199828 0 24576 RUSTAN WILLIAMS VICE PRESIDENT - 1ST 55.00 0.00 X 436898 0 26065 VICTORIA WALKER CHIEF MEDICAL OFFICER 55.00 0.00 X 268099 0 25245 JULIE RIEKEN STAFF NURSE-RN 99.04 0.00 X 264021 0 13717 DONALD THOMPSON REGIONAL VICE PRESIDENT 55.00 0.00 X 319291 0 11417 TERRY PARKER MANAGER, NATIONAL AH PROPERTIES 55.00 0.00 X 223084 0 8630 DAVID J HORAZDOVSKY FORMER OFFICER & CEO 54.96 0.04 X 312166 798288 31548 BERGEN J PETERSON FORMER OFFICER EXEC VP 53.40 1.60 X 392441 0 20752 THOMAS SYVERSON FORMER OFFICER EXEC VP 53.12 1.88 X 341279 0 29960 THOMAS KAPUSTA FORMER OFFICER SECRETARY (THRU 1/19) 58.83 1.17 X 737181 0 19549 JAN RITTER FORMER KEY EMPLOYEE VP - HR 55.00 0.00 X 270130 0 26571 LINDA STUDER FORMER KEY EMPLOYEE VP - OPERATIONS 55.00 0.00 X 256294 0 17704 DUSTIN SCHOLZ FORMER KEY EMPLOYEE REGIONAL VP 55.00 0.00 X 158360 0 20854 SUSAN RAPER FORMER KEY EMPLOYEE REGIONAL VP 55.00 0.00 X 365920 0 21741 JAMES DROPPERS FORMER KEY EMPLOYEE REGIONAL VP 54.90 0.10 X 178486 0 20000 DAN HAMES FORMER KEY EMPLOYEE REGIONAL VP 55.00 0.00 X 171906 0 22887 KIMBERLY JOHANSEN FORMER HIGH COMP VP HOME COMM SVCS 55.00 0.00 X 205561 0 21075 5871252 5479918 1689898 190 1 1 0 AEGIS THERAPIES INC PO BOX 936653 ATLANTA GA 311936653 THERAPY CONTRACT SERVICES 24165821 DOHN CONSTRUCTION INC 2642 MIDPOINT DR FORT COLLINS CO 80525 GENERAL CONTRACTOR 3590007 BELFOR USA GROUP INC 185 OAKLAND AVE SUITE 150 BIRMINGHAM MI 48009 GENERAL CONTRACTOR 1021520 CONVERGINT TECHNOLOGIES LLC 1651 WILKENING RD SCHAUMBURG IL 60173 HEALTHCARE SECURITY 970254 BUILDPRO 299 MARKET STSUITE 220 SADDLE BROOK NJ 07663 GENERAL CONTRACTOR 750886 82 393748 2672670 523172 3983097 144162 7572687 LTC - ROOM REVENUE 623000 651861354 651861354 LTC - THERAPY SERVICES 623000 167422382 167422382 HCBS REVENUE 623000 51365922 51365922 ANCILLARY & PHARMACY 623000 42032737 42032737 SURCHARGE 623000 6874413 6874413 11683732 11683732 931240540 5553898 5553898 4738276 74525 0 0 4738276 74525 4812801 74525 4738276 172498067 22262450 167261922 21615714 5236145 646736 5882881 5882881 75285 393748 184255 -108970 -108970 10332 53326 -42994 -42994 ADMINISTRATIVE SERVICE 561000 5253610 3528363 1725247 CAFETERIA/VENDING 722514 3222704 3222704 EMPLOYEE & GUEST MEALS 722514 1008739 331782 676957 2248 -4077091 4079339 9487301 964398144 892810691 -2020062 66034828 740374 740374 663009 663009 25464 25464 1086735 1038198 45996 2541 3642365 3479685 154162 8518 469204163 448248013 19858915 1097235 8919978 8332101 518980 68897 47315511 42231347 5079007 5157 42611045 43974565 -1528389 164869 43587 43587 834482 552567 281915 636410 211498 424912 144165 144165 99251387 92591928 6659607 -148 7117200 3937777 3174912 4511 8234796 7249250 983343 2203 6001114 1418221 4582893 41033418 41043149 -9731 6862173 6613522 247945 706 1935363 1895385 39270 708 23129517 23129517 70189669 70189557 112 11471168 7379846 4091322 LOSS ON EXTINGUISHMENT 76423055 76423055 MEDICAL SUPPLIES 72594975 71457112 1104747 33116 MINNESOTA CARE TAX 15635220 15635220 UNCOLLECTIBLE EXPENSE 8556787 8151984 404803 14301106 68422904 -54130560 8762 1038604236 1045078835 -7871674 1397075 16648006 69969817 714950 669146 299483 93256745 88088081 12978261 12830247 3034814 2764580 4528932 2413448 2268346401 1128391752 985507068 1139954649 370839415 214234968 3822994 98541787 4986807 13054457 27642000 3045690 0 1606272602 1563553743 107136477 85485387 4671110 4950078 427611292 0 122435662 143144785 235108801 -9989 530206 0 69643844 6696724 967137392 240266985 X 599767518 1323049860 39367692 236898 639135210 1323286758 1606272602 1563553743 X -74206092 8881139 749476501 X 0 1 X 1 1 1 X 10478332 14047566 13962657 13345039 7572687 59406281 958776405 983921587 978517457 975042383 833953581 4730211413 363494 351192 313503 309104 10332 1347625 969618231 998320345 992793617 988696526 841536600 4790965319 2432420 2062341 2386111 2189986 2672670 11743528 0 2432420 2062341 2386111 2189986 2672670 11743528 4779221791 7892300 12386594 12536105 11331116 107653658 151799773 7892300 12386594 12536105 11331116 107653658 151799773 7220485 13559113 13318418 6950594 11582648 52631258 984731016 1024266052 1018648140 1006978236 960772906 4995396350 0.95670 0.97920 0.03040 0.01060 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 1 65865 0 0 1 398152 0 0 464017 0 PART II-B, LINE 1: ONE STAFF MEMBER IS DEVOTED FULL TIME TO PUBLIC POLICY ISSUES INCLUDING ADVOCACY ACTIVITIES. AN OUTSIDE REPRESENTATIVE IS ALSO ENGAGED TO ASSIST WITH COORDINATING THIS ACTIVITY. SEVERAL STAFF MEMBERS AND RESIDENTS WRITE LETTERS TO ELECTED OFFICIALS WHICH PROVIDE BACKGROUND AND EXPRESS RECOMMENDED POSITIONS ON SPECIFIC ISSUES. IN ADDITION, PERIODIC CORRESPONDENCE AND PERSONAL VISITS OCCUR BETWEEN STAFF MEMBERS AND ELECTED OFFICIALS TO ADVOCATE PARTICULAR POSITIONS ON ISSUES. IT IS ESTIMATED THAT 2% OF ONE AVERAGE STAFF MEMBERS' TIME IS DEVOTED TO THIS ACTIVITY. 0 1 X 1951000 1795375 155625 2265000 43000 -236000 121000 1951000 2406000 205000 346000 2265000 2388000 16000 26000 24000 2406000 2289000 -1000 181000 81000 2388000 0.00000 1.00000 0.00000 0 0 141697370 141697370 1674947287 837044565 837902722 113439895 69638058 43801837 286563176 221709129 64854047 51698673 51698673 1139954649 DEFERRED LEASE EXPENSE LIABILITY 5449 OPERATING LEASE PAYABLE - LT 544459 OTHER NON-CURRENT LIABILITIES 6146816 6696724 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 SOCIETY'S ENDOWMENT FUNDS ARE USED AS DIRECTED BY THE DONOR'S RESTRICTIONS OR THE BOARD'S DESIGNATION. 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 AN INCOME TAX LIABILITY AT DECEMBER 31, 2019; HOWEVER, SOME RELATED ORGANIZATIONS HAVE ESTABLISHED RESERVES. 1 SOUTH AMERICA 0 0 GRANTS TO ORGANIZATION 25464 0 0 0 0 0 0 25464 0 25464 SOUTH AMERICA OUR CONTRIBUTION TO THE EVANGELICAL LUTHERAN CHURCH IN COLUMBIA GOES TO SUPPORT THEIR WORK WITH ELDERS IN TWO LOCATIONS - SOACHA AND TUNJA. SPECIFICALLY, OUR CONTRIBUTIONS HELPS PROVIDE SHELTER, FOOD AND SOCIAL SERVICES FOR ABOUT 50 ELDERS IN SOACHA AND 30 ELSERS IN TUNJA. 25464 WIRE TRANSFERS 0 1 0 1 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 III ACCOUNTING METHOD: BRAINERD BETHANY BOWL FUNDRAISER 54246 54246 741 6019 210 650 7782 GRAND SCANDIA GOLF BENEFIT 48280 35369 12911 250 1220 4709 4244 180 98 366507 304133 62374 158250 469033 393748 75285 250 1961 10728 4454 650 166212 184255 -108970 1 SIOUX EMPIRE UNITED WAY 1000 N WEST AVE 120 SIOUX FALLS SD 57104 460233701 501(C)(3) 40568 PROVIDING FUNDS TO HELP CHILDREN, VULNERABLE ADULTS, AND PEOPE IN CRISIS. WORLD MISSION PRAYER LEAGUE 232 CLIFTON AVE MINNEAPOLIS MN 55403 410786986 501(C)(3) 15018 MISSIONARY WORK OF PROVIDING FUNDS TO SUPPORT LAMB HOSPITAL IN BANGLADESH. TEAM PO BOX 1986 GRAPEVINE TX 760991986 362169146 501(C)(3) 14641 MISSIONARY WORK OF PROVIDING FUNDS TO SUPPORT KARANDA MISSION HOSPITAL IN ZIMBABWE. 3 0 SCHOLARSHIPS 439 663009 PART III, COLUMN A: THE SOCIETY PROVIDES SCHOLARSHIPS TO EMPLOYEES WHO ARE ENROLLED IN A QUALIFIED EDUCATION PROGRAM. THE SOCIETY PAYS THE SCHOLARSHIP DIRECTLY TO THE EDUCATIONAL INSTITUTION WHERE THE EMPLOYEE IS ENROLLED. IF AN EMPLOYEE HAS ALREADY PAID THE EXPENSE, THE SOCIETY REQUIRES RECEIPT OF PAYMENT BEFORE REIMBURSEMENT IS MADE TO THE EMPLOYEE. 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 II, LINE 1, COLUMN (H): NAME OF ORGANIZATION OR GOVERNMENT: WORLD MISSION PRAYER LEAGUE (H) PURPOSE OF GRANT OR ASSISTANCE: CONTRIBUTIONS SUPPORT THE WORK OF LAMB HOSPITAL IN BANGLADESH. SPECIFICALLY, OUR CONTRIBUTIONS SUPPORT THE "POOR FUND" WHICH IS MONEY USED FOR OPERATIONS AND MEDICINE FOR THOSE PATIENTS WHO HAVE LITTLE OR NO MONEY. THE CONTRIBUTIONS ARE ALSO USED TO SUPPORT THE WORK OF THE CHAPLAINS IN THE HOSPITAL. NAME OF ORGANIZATION OR GOVERNMENT: TEAM (H) PURPOSE OF GRANT OR ASSISTANCE: CONTRIBUTIONS SUPPORT THE WORK OF THE KARANDA MISSION HOSPITAL IN ZIMBABWE. SPECIFICALLY, OUR CONTRIBUTION HELPS PROVIDE MEDICAL SUPPLIES, MEDICINE, AND GENERAL HOSPITAL COSTS FOR THIS MISSION HOSPITAL WHICH IS LOCATED ABOUT 4 HOURS FROM HARARE, THE CAPITAL OF ZIMBABWE. X 1 1 X X X X 1 1 1 0 0 0 0 0 0 PATRICIA CAMERO DIRECTOR 146122 0 1894 0 792 0 0 0 15282 0 164090 0 0 0 KELBY KRABBENHOFT DIRECTOR 0 2606133 0 402500 0 79675 0 0 0 14171 0 3102479 0 0 KELBY KRABBENHOFT DEF COMP DIRECTOR 0 0 0 0 0 0 0 1081296 0 0 0 1081296 0 0 HEATHER KRZMARZICK UNTIL 1119 DIRECTOR 135108 0 1608 0 108 0 0 0 17138 0 153962 0 0 0 ERIC VANDEN HULL VICE PRESIDENT - FINANCE 0 350348 0 50300 0 47267 0 0 0 29711 0 477626 0 0 RANDY BURY PRESIDENT & CEO 0 857021 0 128500 0 159886 0 103080 0 7325 0 1255812 0 0 NATHAN SCHEMA BEG 619 VICE PRESIDENT - OPERATIONS 182843 0 16877 0 108 0 0 0 24576 0 224404 0 0 0 RUSTAN WILLIAMS VICE PRESIDENT - 1ST 114973 0 917 0 321008 0 0 0 26065 0 462963 0 0 0 VICTORIA WALKER CHIEF MEDICAL OFFICER 264879 0 3040 0 180 0 0 0 25245 0 293344 0 0 0 JULIE RIEKEN STAFF NURSE-RN 73755 0 16894 0 173372 0 0 0 13717 0 277738 0 0 0 DONALD THOMPSON REGIONAL VICE PRESIDENT 153964 0 1415 0 163912 0 0 0 11417 0 330708 0 0 0 TERRY PARKER MANAGER, NATIONAL AH PROPERTIES 95157 0 909 0 127018 0 0 0 8630 0 231714 0 0 0 DAVID J HORAZDOVSKY FORMER OFFICER & CEO 309576 578499 2346 107500 244 112289 0 0 20545 11003 332711 809291 0 0 BERGEN J PETERSON FORMER OFFICER EXEC VP 13556 0 379 0 378506 0 0 0 20752 0 413193 0 0 0 THOMAS SYVERSON FORMER OFFICER EXEC VP 337055 0 3642 0 582 0 0 0 29960 0 371239 0 0 0 THOMAS KAPUSTA FORMER OFFICER SECRETARY (THRU 1/19) 49381 0 365 0 687435 0 0 0 19549 0 756730 0 0 0 JAN RITTER FORMER KEY EMPLOYEE VP - HR 228197 0 37662 0 4271 0 0 0 26571 0 296701 0 0 0 LINDA STUDER FORMER KEY EMPLOYEE VP - OPERATIONS 252856 0 2902 0 536 0 0 0 17704 0 273998 0 0 0 DUSTIN SCHOLZ FORMER KEY EMPLOYEE REGIONAL VP 156383 0 1857 0 120 0 0 0 20854 0 179214 0 0 0 SUSAN RAPER FORMER KEY EMPLOYEE REGIONAL VP 164477 0 1435 0 200008 0 0 0 21741 0 387661 0 0 0 JAMES DROPPERS FORMER KEY EMPLOYEE REGIONAL VP 176302 0 1581 0 603 0 0 0 20000 0 198486 0 0 0 DAN HAMES FORMER KEY EMPLOYEE REGIONAL VP 169616 0 2014 0 276 0 0 0 22887 0 194793 0 0 0 KIMBERLY JOHANSEN FORMER HIGH COMP VP HOME COMM SVCS 202226 0 2493 0 842 0 0 0 21075 0 226636 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. PART I, LINES 4A-C PART I, LINE 4A: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A SEVERANCE ARRANGEMENT AND RECEIVED PAYMENTS DURING THE YEAR: THOMAS KAPUSTA $687,287 TERRY PARKER $126,930 BERGEN PETERSON $378,425 SUSAN RAPER $198,686 DONALD THOMPSON $163,211 RUSTAN WILLIAMS $320,766 PART I, LINE 4B: CERTAIN EXECUTIVES PARTICIPATE IN A DEFINED CONTRIBUTION SERP PLAN. PART I, LINE 4C: CERTAIN EXECUTIVES PARTICIPATE IN A KEYSOP PLAN. MICHAEL DROPPERS FAMILY RELATIONSHIP - SON OF JAMES DROPPERS, FORMER KEY EMPLOYEE 62904 COMPENSATION 0 BREANNA GOEMBEL FAMILY RELATIONSHIP - DAUGHTER OF LINDA STUDER, FORMER KEY EMPLOYEE 63436 COMPENSATION 0 DEBORAH HAMES FAMILY RELATIONSHIP - WIFE OF DAN HAMES, FORMER KEY EMPLOYEE 71384 COMPENSATION 0 KELLIE SCHOLZ FAMILY RELATIONSHIP - WIFE OF DUSTIN SCHOLZ, FORMER KEY EMPLOYEE 63396 COMPENSATION 0 ROGER SCHOLZ FAMILY RELATIONSHIP - FATHER OF DUSTIN SCHOLZ, FORMER KEY EMPLOYEE 29960 COMPENSATION 0 MARY ELLEN SCHOLZ FAMILY RELATIONSHIP - MOTHER OF DUSTIN SCHOLZ, FORMER KEY EMPLOYEE 24594 COMPENSATION 0 JACOB STUDER FAMILY RELATIONSHIP - SON OF LINDA STUDER, FORMER KEY EMPLOYEE 64931 COMPENSATION 0 KATHERYN STUDER FAMILY RELATIONSHIP - DAUGHTER-IN-LAW TO LINDA STUDER, FORMER KEY EMPLOYEE 33130 COMPENSATION 0 CLAUDIA ESPINOSA FAMILY RELATIONSHIP - WIFE OF JAVIER ESPINOSA, DIRECTOR 52190 COMPENSATION 0 NATALIA ESPINOSA FAMILY RELATIONSHIP - DAUGHTER OF JAVIER ESPINOSA, DIRECTOR 35691 COMPENSATION 0 GREG KRZMARZICK FAMILY RELATIONSHIP - HUSBAND OF HEATHER KRZMARZICK, DIRECTOR 125813 COMPENSATION 0 CANDICE MEIER FAMILY RELATIONSHIP - DAUGHTER OF DINA ROBINSON, DIRECTOR 31397 COMPENSATION 0 CHELSI TEEL FAMILY RELATIONSHIP - DAUGHTER OF DINA ROBINSON, DIRECTOR 32717 COMPENSATION 0 CASSIDY THOMPSON FAMILY RELATIONSHIP - DAUGHTER OF DINA ROBINSON, DIRECTOR 11512 COMPENSATION 0 GREG WILCOX FAMILY RELATIONSHIP - GRANDSON OF FOUNDER 136621 COMPENSATION 0 X 5 5178 FAIR MARKET VALUE X 1338 FAIR MARKET VALUE X 5792 FAIR MARKET VALUE X 2 17577 FAIR MARKET VALUE X 42 7552 FAIR MARKET VALUE X 1 86 FAIR MARKET VALUE X MISCELLANEOUS 280 73646 FAIR MARKET VALUE X MOBILE HOME 1 25000 FAIR MARKET VALUE X EQUIPMENT 11 7993 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): COLUMN B REPRESENTS 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 SOCIETY, AND 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: REBECCA BOLLIG, PATRICIA CAMERO, JAVIER ESPINOSA, KELBY KRABBENHOFT, HEATHER KRZMARZICK, LISA MELBY, DINA ROBINSON, NATHAN SCHEMA, ERIC VANDEN HULL AND RANDY BURY. FORM 990, PART VI, SECTION A, LINE 4 THE SOCIETY CHANGED THEIR ARTICLES OF INCORPORATION TO ALLOW FOR TWO MEMBERSHIP CLASSES, INCLUDING SANFORD AS THE CLASS A MEMBER. BYLAW CHANGES INCLUDED REDUCED BOARD SIZE, REVISED APPOINTMENT PROCESS FOR THE SOCIETY BOARD OF DIRECTORS, RESERVED POWERS TO SANFORD AND CHANGES TO THE ROLE OF THE SOCIETY PRESIDENT. 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 SANFORD BOARD OF TRUSTEES 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 SANFORD BOARD OF TRUSTEES: (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. AN EXTERNAL ACCOUNTING FIRM REVIEWS 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 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: REFINANCE OF EXISTING DEBT 692,720,093. TRANSFER FROM RELATED TAX-EXEMPT ORG FOR PAYROLL AND OPERATING EXPENSES 70,726,055. NET ASSETS RELEASED FOR PPE 3,850,872. PERM RESTRICTED NET ASSET RECLASSES TO RELATED ENTITY -708,582. TEMP RESTRICTED NET ASSET RECLASSES TO RELATED ENTITY -9,485,604. PERM RESTRICTED BENEFICIAL INTREST RECLASSES TO RELATED ENTITY -4,166,809. 2019 RESTRICTED ACTIVITY RECLASSED TO RELATED ENTITY -3,459,524. SCHEDULE K THE SOCIETY'S BONDS WERE ADVANCED REFUNDED IN JUNE 2019 WITH SANFORD'S BRIDGE LOAN TO PRESERVE ACQUISITION FINANCING. IN NOVEMBER 2019, THE BRIDGE LOAN WAS REFINANCED WITH TAXABLE AND TAX-EXEMPT BONDS OF SANFORD (PARENT COMPANY). 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