2018-10-30T13:55:52-05:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2017-01-01 460422866 THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION EVAN 6053623100 4800 WEST 57TH STREET BOX 5038 SIOUX FALLS SD 571175038 G GRANT TRIBBLE TREASURER 6053623100 2018-10-23 1 KACIE MCEWEN P01599614 6123764500 2018-10-23 67.137.57.251 2018-10-23 14:14:58 CD P 9E4ACA9A3A5583693B49D79FC84C6D308F7C5743 3B8AD87D3D4D2D1864CA6013C36879B94F3F1DCF 2017 2019-02-21 02:37:17Z SUZIE O'MEARA HERNES 4800 WEST 57TH STREET BOX 5038 SIOUX FALLS SD 571175038 15630325 0 X N/A X 1992 MN PROVIDING SUPPORT, ASSISTANCE, AND AID FOR THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (ELGSS). 12 8 0 13 0 0 4018418 4787170 0 0 2417710 6222080 0 0 6436128 11009250 2093030 2420740 0 0 1376610 1510563 85548 66108 1454895 378891 405615 3934079 4403026 2502049 6606224 62248561 70419613 105958 105404 62142603 70314209 X 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. WE RAISE FUNDS IN SUPPORT OF THE SOCIETY'S EFFORTS TO TRANSFORM THE AGING EXPERIENCE IN AMERICA AND SEEK "DONORS" WHO ARE INSPIRED TO JOIN OUR JOURNEY. FURTHERMORE, THE FOUNDATION ENSURES THESE DONATIONS ARE USED WHERE THEY CAN HAVE THE GREATEST IMPACT ON THE BENEFICIARIES OF THE SOCIETY'S EFFORTS. 0 0 2420740 2420740 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. WE RAISE FUNDS IN SUPPORT OF THE SOCIETY'S EFFORTS TO TRANSFORM THE AGING EXPERIENCE IN AMERICA AND SEEK "DONORS" WHO ARE INSPIRED TO JOIN OUR JOURNEY. FURTHERMORE, THE FOUNDATION ENSURES THESE DONATIONS ARE USED WHERE THEY CAN HAVE THE GREATEST IMPACT ON THE BENEFICIARIES OF THE SOCIETY'S EFFORTS. 2420740 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 8 0 0 1 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 KS KY ME MD MI MS NV NH NM NY NC ND OH OK OR PA RI TN UT VA WA WV WI X G GRANT TRIBBLE TREASURER 6053623100 4800 W 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 DARRELL SCHMITH CHAIR 0.60 0.00 X X 0 0 0 DAVID J HORAZDOVSKY CHAIR (THROUGH JUNE 2017) / DIRECTOR 0.60 54.50 X X 0 779485 21494 THOMAS VAN WYHE VICE CHAIR 0.60 0.00 X X 0 0 0 H THEODORE GRINDAL VICE CHAIR (THROUGH JUNE 2017 ) 0.60 4.10 X X 0 0 0 DUANE ANDERSON DIRECTOR 0.60 0.00 X 0 0 0 BRIAN DAVIDSON DIRECTOR 0.60 50.00 X 0 103190 18287 JOYCE FJELLAND DIRECTOR 0.60 0.00 X 0 0 0 MYRA PEABODY GOSSENS DIRECTOR (THROUGH JUNE 2017) 0.60 0.00 X 0 0 0 MARGARET HEGGE DIRECTOR 0.60 0.00 X 0 0 0 ELLIOTT LAWS DIRECTOR (THROUGH JUNE 2017) 0.60 0.00 X 0 0 0 DAVID LERSETH DIRECTOR (THROUGH JUNE 2017) 0.60 0.00 X 0 0 0 KAREN MOUSEL DIRECTOR 0.60 50.00 X 0 79964 19943 JAY NEWTON-SMALL DIRECTOR 0.60 0.00 X 0 0 0 FRED PITZEL DIRECTOR 0.60 50.00 X 0 100370 190 GALE POLLOCK DIRECTOR (THROUGH NOVEMBER 2017) 0.60 0.00 X 0 0 0 KATHIE REED DIRECTOR 0.60 0.00 X 0 0 0 SEBASTIAN SILEN DIRECTOR 0.60 0.00 X 0 0 0 WALTER WOODS PRESIDENT (THROUGH OCTOBER 2017) 55.00 0.10 X 0 186383 5971 SUZIE O'MEARA PRESIDENT 55.00 0.10 X 0 136256 30769 G GRANT TRIBBLE TREASURER 0.60 54.50 X 0 343571 28768 JAMES KREKELBERG ASSISTANT TREASURER 0.60 54.50 X 0 211931 18145 THOMAS KAPUSTA SECRETARY 0.60 54.50 X 0 331655 21468 MISTY HAM-QUICK ASSISTANT SECRETARY (THROUGH JUNE 2017) 0.60 45.00 X 0 47455 16138 LINDSEY OLSON ASSISTANT SECRETARY 0.60 45.00 X 0 40842 21259 0 2361102 202432 0 0 1 0 0 4283333 503837 4787170 1267249 1267249 9575906 4621075 4954831 4954831 4954831 11009250 0 0 6222080 2390127 2390127 30613 30613 1510563 231257 1279306 66108 66108 99692 99692 14849 14849 55664 51418 4246 119186 18706 100480 64050 62965 1085 10746 10746 LICENSE & FEES 17651 17651 DUES 11019 10936 83 STAFF DEVELOPMENT 8731 5165 3566 OTHER EXPENSES 3583 3583 444 423 21 4403026 2420740 527391 1454895 37112 39652 16147925 22436951 0 3000 54262 19952 45055 34310 46018469 47905700 62248561 70419613 16254 10810 89704 94594 105958 105404 X 43954957 50241627 3103591 4274194 15084055 15798388 62142603 70314209 62248561 70419613 6606224 1565382 0 X 0 1 X 1 0 X X 1 TELGSS 450228055 10 1 2386111 0 1 2386111 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 20300182 714333 1514302 194505 22334312 19072814 650428 757308 180368 20300182 19029280 148048 18886 123400 19072814 17270657 1313277 855533 410187 19029280 16069481 490240 1062091 351155 17270657 0.10760 0.70740 0.18500 0 0 54262 19952 34310 34310 GIFT ANNUITY OBLIGATIONS 91594 DUE TO RELATED PARTY 3000 94594 X 8291299 1565382 1565382 6725917 4283333 4283333 11009250 2016915 0 2016915 2386111 2386111 4403026 PART V, LINE 4: THE FOUNDATION'S ENDOWMENT FUNDS ARE USED AS DIRECTED BY THE DONOR'S RESTRICTIONS OR THE BOARD'S DESIGNATION. PART X, LINE 2: THE FOUNDATION IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE FOUNDATION 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 FOUNDATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE FOUNDATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. PART XI, LINE 4B - OTHER ADJUSTMENTS: GIFTS TRANSFERRED FROM AFFILIATE 725,551. EXPENSES PAID BY AFFILIATE 3,557,782. PART XII, LINE 4B - OTHER ADJUSTMENTS: GIFTS TRANSFERRED TO AFFILIATE 2,345,768. INVESTMENTS TRANSFERRED TO AFFILIATE 40,343. X X X X X X X 1 THE NUMAD GROUP PO BOX 230 HERMOSA SD 57744 CONSULTING SERVICES ON NATIONAL ANNUAL GIVING 0 0 38418 -38418 SUMPTION AND WYLAND 8180 S HAWTHORNE AVE SIOUX FALLS SD 57104 CAPACITY BUILDING CONSULTING FOR THE FOUNDATION 0 0 27690 -27690 66108 -66108 AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY 1 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY 4800 W 57TH ST SIOUX FALLS SD 57108 450228055 501(C)(3) 2386111 GIFTS TRANSFERRED TO THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY. 1 0 SCHOLARSHIPS 34 30613 PART I, LINE 2: THE FOUNDATION COMMUNICATES A LIST OF RESTRICTIONS TO EACH CENTER AT THE TIME OF DISTRIBUTION. THE ADMINISTRATOR 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 EMPLOYEE. 0 0 0 0 0 0 0 0 0 DAVID J HORAZDOVSKY CHAIR (THROUGH JUNE 2017) / DIRECTOR 0 681167 0 0 0 98318 0 0 0 21151 0 800636 0 0 WALTER WOODS PRESIDENT (THROUGH OCTOBER 2017) 0 143117 0 0 0 43266 0 0 0 6353 0 192736 0 0 SUZIE O'MEARA PRESIDENT 0 128777 0 0 0 7479 0 0 0 30426 0 166682 0 0 G GRANT TRIBBLE TREASURER 0 310373 0 0 0 33198 0 0 0 28425 0 371996 0 0 JAMES KREKELBERG ASSISTANT TREASURER 0 144089 0 0 0 67842 0 0 0 17802 0 229733 0 0 THOMAS KAPUSTA SECRETARY 0 250310 0 0 0 81345 0 0 0 21125 0 352780 0 0 PART I, LINE 3 THE COMPENSATION OF THE FOUNDATION'S PRESIDENT IS DETERMINED BY THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY, THE FOUNDATION'S SOLE MEMBER. THE FOLLOWING WERE USED BY THE SOCIETY TO DETERMINE THE PRESIDENT'S COMPENSATION: 1. COMPENSATION SURVEY OR STUDY FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE OF THE BOARD SHALL CONSIST OF THE CHAIRPERSON, VICE CHAIRPERSON, SOCIETY PRESIDENT/CHIEF EXECUTIVE OFFICER, FOUNDATION PRESIDENT, AUDIT COMMITTEE CHAIR, AND THE GOVERNANCE/NOMINATING COMMITTEE CHAIR. NO EMPLOYEE OF THE SOCIETY, EXCEPT THE SOCIETY PRESIDENT/CHIEF EXECUTIVE OFFICER AND THE FOUNDATION PRESIDENT, MAY SERVE ON THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE OF THE BOARD SHALL BE CHAIRED BY THE VICE CHAIRPERSON WHEN THE CHAIRPERSON IS ABSENT FOR ANY REASON. THE POWERS AND DUTIES OF THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS SHALL BE: A. TO HAVE FULL AUTHORITY TO ACT BETWEEN MEETINGS OF THE BOARD UPON MATTERS WHICH, IN THE JUDGMENT OF THE COMMITTEE, ARE OF SUCH A NATURE AS TO REQUIRE ACTION PRIOR TO THE NEXT REGULAR MEETING OF THE BOARD BUT DO NOT REQUIRE CALLING OF A SPECIAL MEETING OF THE BOARD. B. TO DEVELOP ADMINISTRATIVE RULES FOR THE IMPLEMENTATION OF THE ARTICLES OF INCORPORATION AND BYLAWS AS AND WHEN NEEDED. C. TO CREATE AN EXECUTIVE SUB-COMMITTEE TO EVALUATE THE PERFORMANCE OF THE FOUNDATION PRESIDENT. D. ANY ACTION TAKEN BY THE COMMITTEE INVOLVING EXERCISE OF THE POWERS OF THE BOARD SHALL BE REPORTED PROMPTLY TO THE BOARD, AND RATIFIED BY THE BOARD AT THE NEXT MEETING OF THE BOARD FOLLOWING SUCH ACTION. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATIONS BYLAWS WERE AMENDED AS FOLLOWS IN APRIL 2017: THE PRESIDENT/CEO OF THE SOCIETY SHALL BE EX-OFFICIO MEMBERS. THE CEO OF THE SOCIETY INSTEAD OF THE CHAIRPERSON OF THE SOCIETY'S BOARD SHALL BE ELIGIBLE TO SERVE ON THE FOUNDATION BOARD OF DIRECTORS. THE BOARD SHALL ELECT FROM ITS OWN MEMBERSHIP, A CHAIRPERSON AND A VICE CHAIRPERSON, UNLESS OTHERWISE DETERMINED BY THE MEMBER. NO EMPLOYEE OF THE SOCIETY OR THE CORPORATION MAY SERVE IN THESE POSITIONS. IT IS THE EXPECTATION THAT THE VICE CHAIRPERSON SHALL BE THE NEXT SELECTED PERSON TO SUCCEED THE THEN CURRENT CHAIRPERSON. A BOARD TERM LENGTH OF THREE YEARS WAS ESTABLISHED AND IS LIMITED TO TWO (2) SUCCESSIVE FULL TERMS BUT MAY BE RE-ELECTED AFTER AN ABSENCE OF AT LEAST ONE (1) YEAR. AN EXECUTIVE COMMITTEE OF THE BOARD WAS ESTABLISHED. FORM 990, PART VI, SECTION A, LINE 6 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY IS THE SOLE MEMBER OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY BOARD OF DIRECTORS APPROVES THE BOARD MEMBER APPOINTMENTS OF THE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7B THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY BOARD OF DIRECTORS APPROVES THE BOARD MEMBER APPOINTMENTS OF THE FOUNDATION AND ANY AMENDMENTS TO THE BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B ACCOUNTANTS WITH THE FOUNDATION REVIEWED THE 990 IN DETAIL PRIOR TO IT BEING SUBMITTED. ANY QUESTIONS WERE RESOLVED WITH THE TREASURER AND/OR PRESIDENT OF THE ORGANIZATION PRIOR TO THE 990 BEING FILED. A COPY OF THE 990 WAS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY PRIOR TO THE 990 BEING FILED FOR THEIR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS AND DIRECTORS ARE REQUIRED TO ANNUALLY DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. ALL POTENTIAL DIRECTOR CONFLICTS ARE INVESTIGATED BY THE FOUNDATION'S CHIEF LEGAL OFFICER. THE CHIEF LEGAL OFFICER REPORTS HIS FINDINGS TO THE BOARD CHAIR. THE BOARD ULTIMATELY DETERMINES WHETHER OR NOT AN ACTUAL CONFLICT OF INTEREST EXISTS AND THE REMEDIAL STEPS NECESSARY BASED UPON SUCH LEGAL OPINION. THE FOUNDATION HAS A CONFLICT OF INTEREST POLICY THAT COVERS SUBSTANTIALLY ALL EMPLOYEES. ALL EMPLOYEES ARE REQUIRED TO REPORT ANY POTENTIAL CONFLICTS TO THE APPROPRIATE INDIVIDUAL AS INDICATED IN THE POLICY. ALL POTENTIAL CONFLICTS ARE INVESTIGATED TO DETERMINE IF A CONFLICT EXISTS. IF APPROVAL IS GIVEN TO PROCEED WITH THE ACTION, A COPY OF THE APPROVAL IS DOCUMENTED IN THE EMPLOYEE'S PERSONNEL FILE. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. 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