2018-05-14T10:37:41-05:00 2017-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2016-07-01 411936717 Living Services Foundation LIVI 7632310410 3109 West 50th Street No 133 Minneapolis MN 55410 Jennifer Gleason Chief Operating Officer 7632310410 2018-05-14 1 Deb Nelson CPA P01264758 6122536500 2018-05-07 2016 2022-09-23 18:48:47Z X Dennis Kamstra 3109 West 50th Street No 133 Minneapolis MN 55410 5585331 0 X www.lsfdn.org X 1999 MN To support subsidiaries of Benedictine Health System. X 5 4 107 0 0 0 0 0 7349513 5580675 575673 4656 0 0 7925186 5585331 3478 7043 0 0 2967296 3456430 0 0 0 7103234 2657675 10074008 6121148 -2148822 -535817 30939425 10480390 37924240 12844879 -6984815 -2364489 X The Foundation is organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of the subsidiaries of Benedictine Living Community of Winsted, Benedictine Living Community of New London, Benedictine Living Community of Mora, Benedictine Living Community of Wahpeton, and Benedictine Living Community of Byron. 0 1 5654461 7043 5580675 The organization owns and provides management oversight to the following wholly owned subsidiaries:Living Services Foundation/Minneota, LLC consists of a 67-bed skilled nursing facility and 33-unit assisted living facility located in Minneota, Minnesota. Living Services Foundation/New London, LLC consists of a 62-bed licensed nursing facility, 36-unit attached apartment center and a 12-unit attached assisted living building located in New London, Minnesota. This facility went into receivership September 2016. Living Services Foundation/Winsted, LLC consists of a 70-bed licensed nursing facility and a 16-unit attached memory care assisted living building located in Winsted, Minnesota. This facility went into receivership August 2016. Living Services Foundation/Mora, LLC consists of a 80-bed skilled nursing facility, a 35-unit assisted living facility and clinic space located in Mora, Minnesota. The organization operates Living Services Foundation - Minneota, but leases the other facilities through the wholly owned subsidiaries to Benedictine Living Community of New London, Benedictine Living Community of Winsted, Benedictine Living Community of Mora, and Benedictine Living Community of Wahpeton and Benedictine Living Community of Byron. 5654461 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 1 1 1 0 0 0 1 19 0 1 107 1 0 0 0 0 0 0 0 0 0 0 X 5 4 1 0 0 0 0 1 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 Robert Sundberg Chair 5.00 0.00 X X 0 0 0 Rod Pakonen Board Member 5.00 0.00 X 0 0 0 Kevin Rymanowski Board Member (thru Aug 2016) 3.00 2.00 X 0 0 0 Paul Sanders Board Member 5.00 0.00 X 0 0 0 Jack L'Heureux Board Member (as of Aug 2016) 3.00 2.00 X 0 0 0 Dennis Kamstra CEO 40.00 0.00 X X 160000 0 3522 Jennifer Gleason COO/Secretary/Treasurer 40.00 0.00 X 130000 0 14088 290000 0 17610 2 0 1 0 Big Stone 450 Eastvold Ave Ortonville MN 56278 Therapy 472725 A 'Viands 1751 County B Rd W 300 St Paul MN 55113 Food Services 223454 2 Resident Service Reven 623000 4606542 4606542 Lease Revenue 532000 813247 813247 160886 160886 5580675 4656 4656 5585331 5580675 0 4656 2043 2043 5000 5000 228244 72361 155883 2803483 2685894 117589 13634 12446 1188 239794 228192 11602 171275 156350 14925 68538 68538 95259 95259 46100 46100 21592 21592 175451 175451 6123 6123 212573 212573 34878 34878 69517 69517 861631 861631 532288 532288 64334 64334 DHS Surcharge 188605 188605 Food 142181 142181 Bad Debt Expense 45848 45848 92757 91054 1703 6121148 5654461 466687 0 128931 83339 1719932 437284 2841895 570000 58346 82703 10144693 2530485 24733436 7614208 1456885 1692856 30939425 10480390 1494926 599571 35117078 9287418 16358 15249 245000 245000 282500 677338 243105 202654 525273 1817649 37924240 12844879 X -6984815 -2364489 -6984815 -2364489 30939425 10480390 X -535817 216622 4939521 X 0 0 0 X X 2 Benedictine Living Community of Mora 274219119 10 1 566649 0 Benedictine Health System 411531892 1 1 0 0 2 566649 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 Part IV, Section A, Line 5a: Benedictine Living Community of Winsted (EIN 27-4219293) and Benedictine Living Community of New London (EIN 27-4218436) were removed as supported organizations due to the cancellation of the leased property agreements with BHS. LSF has amended its governing documents for this change. Part IV, Section A, Line 11: Benedictine Health System is a Type III Functionally Integrated Supporting Organization and is also recognized within the IRS Group Ruling for Catholic organizations under IRC Section 170(b)(1)(A)(i). Part IV, Section D, Line 3: Benedictine Health System's CEO appoints one of the Foundation's board members. For fiscal year ended June 30, 2017 this was filled by Kevin Rymanowski through August 2016 and then Jack L'Heureux as of August 2016. In addition to service on the Foundation's Board, the appointed individual(s) serve in officer positions with BHS and the Supported Organizations. The appointed individual(s) is actively engaged as a board member in the Foundation's governance and participates in decisions and discussions at the board level and with the Foundation's leadership in all aspects of the Foundation's management and use of its income and assets for the benefit of BHS and the Supported Organizations. In this manner, the Supported organizations have a significant voice in the Foundation's management and use of its income and assets. Part IV, Section E, Line 2a: The Foundation holds title to and manages properties used by the Supported Organizations in furtherance of their exempt purposes of providing senior housing and long-term care services with special concern for the underserved and those in need of such services. The Supported Organizations each use the respective properties to provide housing to seniors and offer supportive long-term care services. Part IV, Section E, Line 2b: If these facilities were not owned and managed by the Foundation, the Supported Organizations would own and manage such facilities itself because these activities are critical to the Supported Organizations' ability to carry out their own activities in furtherance of their mission and purposes. Because the Supported Organizations would otherwise conduct these same activities if they were not performed by the Foundation, the Foundation's activities represent an integral part of the activities of the Supported Organizations. 0 1 X 780122 780122 8913405 1713754 7199651 429166 798764 -369598 22000 17967 4033 7614208 Due To/From Affiliates 843741 Other Assets 28829 Bed Licenses 670000 Debt reserve fund 150286 1692856 Asset retirement obligation 22279 Due To/From Parent Company 688161 Due To/From Affiliates 1107209 1817649 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 X 0 0 0 0 0 0 0 0 0 Dennis Kamstra CEO 160000 0 0 0 0 0 0 0 3522 0 163522 0 0 0 A City of Mora 416005389 2009-04-30 6258382 To purchase a nursing & assisted living facility in Mora, MN. 0 0 0 B City of Mora 416005389 2013-09-06 4851795 Refinance a portion of Series 2009 notes issues in 4/30/2009. 0 0 0 C City of Minneota 416005373 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 629979 4851795 97035 5059 4749701 2013 1 0 1 1 C 332976 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 Schedule K, Part I: Bonds for the City of Spicer and the City of Winsted are not reported as the entities with the oustanding debt went into receivership on September 1, 2016 and August 23, 2016, respectively. Robert Sundberg Board Member Capital improvements to skilled nursing facility. X 120000 120000 0 1 1 Paul S and Gretchen M Sanders Revocable Trust Entity owned by Board Member Capital improvements to skilled nursing facility. X 125000 125000 0 1 1 245000 62-bed licensed nursing facility, 36-unit attached apartment center, and 12-unit attached assisted living building 2016-09-01 -1868931 see statement 306567607 LSF New London LLC in Receivership co Cordes & Company 5299 DTC Blvd Ste 600 Greenwood Village CO 80111 Grantor Trust 70-bed licensed nursing facility and 16-unit attached memory care assisted living building 2016-08-23 -3070590 see statement 326468648 LSF Winsted LLC in Receivership co Cordes & Company 5299 DTC Blvd Ste 600 Greenwood Village CO 80111 Grantor Trust 0 0 0 0 Schedule N, Part II, Line 1 - New London Receivership: LSF New London LLC was placed in receivership on September 1, 2016, arising out of a Court Order. Cordes & Company is acting as Receiver and managing the Receivership Estate. A money judgement was awarded in favor of the plaintiff for $8,648,675 plus interest for default of the loan agreement and mortgage. The amount reported in column (c) represents the net assets that were removed from LSF's books and placed in receivership. Schedule N, Part II, Line 1 - Winsted Receivership: LSF Winsted LLC was placed in receivership on August 23, 2016, arising out of a Court Order. Cordes & Company is acting as Receiver and managing the Receivership Estate. A money judgement was awarded in favor of the plaintiff for $16,236,121 plus interest for default of the loan agreement and mortgage. The amount reported in column (c) represents the net assets that were removed from LSF's books and placed in receivership. Form 990, Part III, line 3 Operations in New London and Winsted were placed in receivership in September and August of 2016, respectively. Refer to Schedule N for additional details. Form 990, Part VI, Section A, line 2 Dennis Kamstra and Jennifer Gleason have a family relationship. Form 990, Part VI, Section A, line 7a Benedictine Health Systems may appoint one board member with voting rights. 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 2014. 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 XI, line 9: New London & Winsted Placed in Receivership - See Schedule N 4,939,521. Living Services Foundation Mora LLC 110 North 7th Street Mora MN 55051 263614974 Leasing of skilled nursing and assisted living facility. DE 623873 4882461 Living Services Foundation Living Services Foundation New London LLC 100 Glen Oaks Drive New London MN 56273 204504668 Leasing of skilled nursing, assisted and independent living facility. DE 67152 0 Living Services Foundation Living Services Foundation Winsted LLC 551 4th Street North Winsted MN 55395 208684862 Leasing of skilled nursing and assisted living facility. DE 217181 0 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 4677126 3835463 Living Services Foundation Benedictine Living Community of Winsted 1995 East Rum River Drive South Cambridge MN 55008 274219293 Skilled nursing care center and memory care assisted living MN 501(c)(3) Line 10 Benedictine Health Systems 0 Benedictine Living Community of New London 1995 East Rum River Drive South Cambridge MN 55008 274218436 Skilled nursing care center, assisted living, and senior apartments. MN 501(c)(3) Line 10 Benedictine Health Systems 0 Benedictine Living Community of Mora 1995 East Rum River Drive South Cambridge MN 55008 274219119 Skilled nursing care center and assisted living facility. MN 501(c)(3) Line 10 Benedictine Health Systems 0 Benedictine Health System 1995 East Rum River Drive South Cambridge MN 55008 411531892 Health Care System MN 501(c)(3) Line 12c, III-FI 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 Schedule R, Part II: Benedictine Living Community of Winsted and Benedictine Living Community of New London were removed as supported organizations during the fiscal year. Refer to Schedule A for additional details. Schedule R, Part I: Living Services Foundation New London and Living Services Foundation Winsted went into receivership during the fiscal year. Refer to Schedule N for additional details.