2018-11-12T09:35:26-06:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2017-01-01 370818454 LUTHERAN HILLSIDE VILLAGE INC C/O LUTHERAN SENIOR SERVICES LUTH 3149689313 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 PAUL J OGIER CFO 3149689313 2018-11-08 1 JEFF PARKER P00970069 3149254300 67.137.57.251 2018-11-08 14:54:02 CS P 4DC81AC5090E51A43603AD047BBA54151ACF830E 48DF7E18B51ED0D4ADE189227F60937B8E503023 2017 2019-02-21 02:37:17Z JOHN KOTOVSKY 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 31009435 0 X WWW.LSSLIVING.ORG X 1960 IL FAITH BASED ORGANIZATION WHICH PROVIDES A NETWORK OF SUPPORTIVE SERVICES FOR OLDER ADULTS. SEE BELOW FOR SUMMARY OF LSS CONSOLIDATED OPERATIONS. 11 10 325 223 0 0 436771 352764 16062050 18197180 259062 455684 343450 285474 17101333 19291102 0 0 0 0 8133982 9511517 0 0 0 11683302 13133292 19817284 22644809 -2715951 -3353707 62097730 67412697 88301061 97086242 -26203331 -29673545 X TO ADDRESS AND MEET THE NEEDS OF AGED PERSONS, INCLUDING HOUSING, HEALTHCARE, AND FINANCIAL SECURITY. 0 0 19063151 18197180 OPERATION OF A CONTINUING CARE RETIREMENT COMMUNITY THAT OFFERS A CONTINUUM OF CARE THAT INCLUDES 126 INDEPENDENT LIVING APARTMENTS, 48 PATIO HOMES, 63 ASSISTED LIVING UNITS, 20 ASSISTED LIVING MEMORY CARE UNITS AND 87 SKILLED NURSING BEDS, WHICH INCLUDE 18 MEDICAID CERTIFIED BEDS. BENEVOLENT CARE ASSISTANCE IS ALSO PROVIDED, WHICH INCLUDES MEDICAID CONTRACTUAL ALLOWANCES. TOTAL BENEVOLENT CARE ASSISTANCE PROVIDED WAS $453,084, OF WHICH, $453,084 IS OFFSETTING PROGRAM SERVICE REVENUE.THE CORPORATION'S RESIDENTIAL FACILITIES AND PROGRAMS ARE SPECIFICALLY DESIGNED TO MEET AND MAINTAIN ITS AGED RESIDENTS PHYSICAL AND EMOTIONAL WELL-BEING, AS WELL AS MEET THEIR RECREATIONAL, SOCIAL, AND RELIGIOUS NEEDS. 19063151 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 325 1 0 0 0 0 0 0 0 0 0 0 X 11 10 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X PAUL OGIER 3149689313 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 DEAN HEINZMANN CHAIRPERSON OF THE BOARD 1.00 X X 0 0 0 JEFFREY BAILEY TREASURER 1.00 X X 0 0 0 REV JOHN BATES BOARD MEMBER 1.00 X 0 0 0 DR JAMES BAUER BOARD MEMBER 1.00 X 0 0 0 REV KARL ECKHOFF BOARD MEMBER 1.00 X 0 0 0 AJ QUERCIAGROSSA BOARD MEMBER 1.00 X 0 0 0 PEPPER BAUER BOARD MEMBER 1.00 X 0 0 0 MICHAEL JONES BOARD MEMBER 1.00 X 0 0 0 LISA MACK BOARD MEMBER 1.00 X 0 0 0 BOB MUELLER BOARD MEMBER 1.00 1.00 X 0 0 0 JOHN KOTOVSKY PRESIDENT AND CEO 1.00 40.00 X X 0 1050200 46530 RICHARD MOORE BOARD MEMBER (TERM ENDED 5/17) 1.00 X 0 0 0 TOM PILAT BOARD MEMBER (TERM ENDED 5/17) 1.00 X 0 0 0 GARY SETTERLUND BOARD MEMBER (TERM ENDED 5/17) 1.00 X 0 0 0 PAUL J OGIER CHIEF FINANCIAL OFFICER 1.00 40.00 X 0 322766 71708 MARK W SCHOEDEL CHIEF DEVELOPMENT OFFICER 1.00 40.00 X 0 227405 53743 DALE KREIENKAMP VP OF HUMAN RESOURCES 1.00 40.00 X 0 226759 50684 GARY ANDERSON CHIEF OPERATING OFFICER 1.00 40.00 X 0 214229 13454 CARLA BAUM REGIONAL VICE PRESIDENT 1.00 40.00 X 0 181791 6276 ILLA DAVID CHIEF INFORMATION OFFICER 1.00 40.00 X 0 83572 3293 KAREN LARSON REGIONAL VICE PRESIDENT 1.00 40.00 X 0 174286 5947 MIKE RASO REGIONAL VICE PRESIDENT 1.00 40.00 X 0 156316 10655 LISA NORWINE CHIEF ADVANCEMENT OFFICER 1.00 40.00 X 0 171267 14966 JOSH KING VP OF INFORMATION TECHNOLOGY 1.00 40.00 X 0 106393 12535 SHELLY HEIDEN EXECUTIVE DIRECTOR 40.00 X 0 116317 8480 RITA VICARY ADMIN OF MARKETING & SALES 1.00 40.00 X 0 156233 13263 CHAD SNEED CONTROLLER 1.00 40.00 X 0 148900 10410 TODD YOUNG NETWORK DIRECTOR 1.00 40.00 X 0 123402 16919 BRIAN REINHOLD DIRECTOR OF RISK MANAGEMENT & CORP COMPLIANCE 1.00 40.00 X 0 117801 10793 JEFF BROWN SENIOR ARCHITECT 1.00 40.00 X 0 127894 7108 0 3705531 356764 0 0 1 0 SM WILSON & CO 2185 HAMPTON AVE ST LOUIS MO 63139 CONSTRUCTION IMPROVEMENTS 2404115 LUTHERAN SENIOR SERVICES 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 MANAGEMENT SERVICES 1268495 SYMBRIA REHAB 28100 TORCH PARKWAY WARRENVILLE IL 60555 REHABILITATION 677472 CRAFT CONSTRUCTION LLC 4171 YOSEMITE AVE S ST LOUIS MN 55416 CONSTRUCTION IMPROVEMENTS 417270 OMNICARE EAST FOURTH STREET CINCINNATI OH 45202 PHARMACY SOLUTIONS 201356 8 294166 58598 352764 RESIDENT SERVICE FEES 623000 17567849 17567849 AMORTIZATION OF ENTRANCE FEES 623000 629331 629331 18197180 175359 175359 11998658 11520823 197510 477835 -197510 280325 280325 12296 0 12296 12296 MEALS 623000 104011 104011 BEAUTY & BARBER 623000 57227 57227 MISCELLANEOUS 623000 45049 45049 66891 66891 273178 19291102 18197180 0 741158 124797 124797 7764070 7226069 538001 72202 66136 6066 970642 889092 81550 579806 531092 48714 1268495 1268495 22898 22898 8025 8025 8676 8676 1766441 1717827 48614 56203 56203 944419 697318 247101 43521 43521 1048972 1009400 39572 49398 41870 7528 52670 52030 640 2029987 1953407 76580 3920973 3773057 147916 159171 153166 6005 FOOD/DIETARY 884627 884627 BAD DEBT EXPENSE 665251 665251 MISCELLANEOUS EXPENSE 135796 291 135505 DESIGNATED EXPENSE 54741 54741 13028 13028 22644809 19063151 3581658 0 X 50170 334451 0 6047533 1490699 957480 60000 0 49873 55513 70723 50212 94833618 41449953 53964296 53383665 6411969 6571775 0 12068 62097730 67412697 1697214 1258767 2388699 2605417 53477613 51238574 30737535 41983484 88301061 97086242 X -26274843 -29745057 66512 66512 5000 5000 -26203331 -29673545 62097730 67412697 -3353707 -116507 0 X X 0 1 X 1 0 X 426808 454134 532778 436771 352764 2203255 14601130 15135044 16133630 16062050 18197180 80129034 15027938 15589178 16666408 16498821 18549944 82332289 0 0 0 82332289 201731 229065 185934 156848 175359 948937 201731 229065 185934 156848 175359 948937 439371 305304 317781 343450 285474 1691380 15669040 16123547 17170123 16999119 19010777 84972606 0.96890 0.96550 0.01120 0.01150 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2013 AMOUNT: $ 23,491. 2014 AMOUNT: $ 14,925. 2015 AMOUNT: $ 13,260. 2016 AMOUNT: $ 42,867. 2017 AMOUNT: $ 45,049. BEAUTY BARBER - 2013 AMOUNT: $ 69,673. 2014 AMOUNT: $ 60,413. 2015 AMOUNT: $ 60,924. 2016 AMOUNT: $ 57,664. 2017 AMOUNT: $ 57,227. MEALS - 2013 AMOUNT: $ 87,474. 2014 AMOUNT: $ 87,139. 2015 AMOUNT: $ 99,976. 2016 AMOUNT: $ 101,894. 2017 AMOUNT: $ 104,011. TRANSPORTATION - 2013 AMOUNT: $ 10,459. 2014 AMOUNT: $ 15,992. 2015 AMOUNT: $ 15,564. 2016 AMOUNT: $ 20,442. 2017 AMOUNT: $ 16,472. GENERAL STORE - 2013 AMOUNT: $ 12,773. 2014 AMOUNT: $ 13,548. 2015 AMOUNT: $ 12,161. 2016 AMOUNT: $ 14,348. 2017 AMOUNT: $ 12,296. HOUSEKEEPING LAUNDRY - 2013 AMOUNT: $ 9,958. 2014 AMOUNT: $ 9,419. 2015 AMOUNT: $ 7,794. 2016 AMOUNT: $ 7,154. 2017 AMOUNT: $ 7,278. GUEST ROOM - 2013 AMOUNT: $ 24,015. 2014 AMOUNT: $ 27,320. 2015 AMOUNT: $ 29,810. 2016 AMOUNT: $ 27,605. 2017 AMOUNT: $ 27,459. REAL ESTATE TAX INCOME - 2013 AMOUNT: $ 201,528. 2014 AMOUNT: $ 76,548. 2015 AMOUNT: $ 78,292. 2016 AMOUNT: $ 71,476. 2017 AMOUNT: $ 15,682. 369068 369068 89108025 38990260 50117765 5356525 2459693 2896832 53383665 RESIDENT DEPOSITS 458878 REFUNDABLE RESIDENCY FEES 25990170 DUE TO LUTHERAN SENIOR SERVICES 15534436 41983484 X PART X, LINE 2: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. 0 1 0 0 0 0 0 0 0 JOHN KOTOVSKY PRESIDENT AND CEO 0 388404 0 0 0 661796 0 30320 0 16210 0 1096730 0 0 PAUL J OGIER CHIEF FINANCIAL OFFICER 0 291690 0 0 0 31076 0 55500 0 16208 0 394474 0 0 MARK W SCHOEDEL CHIEF DEVELOPMENT OFFICER 0 191947 0 0 0 35458 0 46988 0 6755 0 281148 0 0 DALE KREIENKAMP VP OF HUMAN RESOURCES 0 193672 0 0 0 33087 0 44437 0 6247 0 277443 0 0 GARY ANDERSON CHIEF OPERATING OFFICER 0 208782 0 0 0 5447 0 6696 0 6758 0 227683 0 0 CARLA BAUM REGIONAL VICE PRESIDENT 0 178457 0 0 0 3334 0 1899 0 4377 0 188067 0 0 KAREN LARSON REGIONAL VICE PRESIDENT 0 172499 0 0 0 1787 0 3216 0 2731 0 180233 0 0 MIKE RASO REGIONAL VICE PRESIDENT 0 153188 0 0 0 3128 0 6281 0 4374 0 166971 0 0 LISA NORWINE CHIEF ADVANCEMENT OFFICER 0 166351 0 0 0 4916 0 3338 0 11628 0 186233 0 0 RITA VICARY ADMIN OF MARKETING & SALES 0 127735 0 24750 0 3748 0 6517 0 6746 0 169496 0 0 CHAD SNEED CONTROLLER 0 147006 0 0 0 1894 0 6037 0 4373 0 159310 0 0 PART I, LINE 3 THE PARENT ORGANIZATION, LUTHERAN SENIOR SERVICES, USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR. PART I, LINE 4B DEPOSITS MADE INTO ACCOUNTS BY ORGANIZATION: JOHN KOTOVSKY - SEC 457(F) PLAN - $20,000 PAUL OGIER - SEC 457(F) PLAN - $20,000 MARK SCHOEDEL - SEC 457(F) PLAN - $20,000 DALE KREIENKAMP - SEC 457(F) PLAN - $20,000 PAUL OGIER - SEC 457(B) PLAN - $24,812 MARK SCHOEDEL - SEC 457(B) PLAN - $17,736 DALE KREIENKAMP - SEC 457(B) PLAN - $17,164 PAYMENTS RECEIVED FROM PLAN: JOHN KOTOVSKY - SEC 457(F) PLAN - $26,956 PAUL OGIER - SEC 457(F) PLAN - $29,159 MARK SCHOEDEL - SEC 457(F) PLAN - $29,690 PAUL OGIER - SEC 457(B) PLAN - $39,070 JOHN KOTOVSKY - SEC 457(B) PLAN - $632,134 (1 TIME PYMT BASED ON 10 YEARS OF SERVICE) DALE KREIENKAMP - SEC 457(B) PLAN - $47,199 MARK SCHOEDEL - SEC 457(B) PLAN - $22,724 FORM 990, PART I, LINE 1 LUTHERAN SENIOR SERVICES IS A LARGE COMPLEX ORGANIZATION THAT IS COMPRISED OF 19 SEPARATE LEGAL ENTITIES, EACH OF WHICH FILES ITS OWN TAX RETURN. DUE TO THE REQUIREMENTS FOR COMPLETING THESE 990'S (WHICH ARE FILED BY 16 OF THE 19 LSS ENTITIES), SOME OF THE INFORMATION CONTAINED WITHIN THE FORM, SUCH AS REVENUE AND EXPENSES, IS RELATED ONLY TO THAT PARTICULAR ENTITY. HOWEVER, SOME OF THE INFORMATION, SUCH AS EXECUTIVE COMPENSATION, RELATES TO THE ENTIRE ORGANIZATION. TO HELP MAKE THIS INFORMATION MORE MEANINGFUL, THE FOLLOWING PARAGRAPH PROVIDES A SUMMARY OF THE OVERALL OPERATIONS OF LSS. LUTHERAN SENIOR SERVICES IS A NOT FOR PROFIT ORGANIZATION OWNED BY 104 LUTHERAN CHURCHES AND WAS INITIALLY FOUNDED IN 1858. LUTHERAN SENIOR SERVICES OPERATES TEN SENIOR LIVING COMMUNITIES SERVING OVER 3,000 OLDER ADULTS, EIGHT AFFORDABLE HOUSING COMMUNITIES SERVING OVER 570 OLDER ADULTS AND A VARIETY OF IN HOME SERVICES PROGRAMS SERVING OVER 5,000 OLDER ADULTS. IN 2017, LSS HAD TOTAL OPERATING INCOME OF APPROXIMATELY $213,000,000, PROVIDED APPROXIMATELY $12,062,000 IN BENEVOLENT CARE, HAD OVER 71,000 VOLUNTEER HOURS, AND EMPLOYED 16 CHAPLAINS. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES MANAGEMENT DUTIES INCLUDING SUPERVISING PERSONNEL, OPERATION, AND BUDGETING TO LUTHERAN SENIOR SERVICES, THE PARENT COMPANY. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BOARD MEMBERS ARE ELECTED BY THE SOLE MEMBER, LUTHERAN SENIOR SERVICES. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS NOT PROVIDED TO THE ORGANIZATION'S GOVERNING BODY PRIOR TO BEING FILED. HOWEVER, REVIEW AND APPROVAL OF THE FORM 990 WAS DELEGATED TO THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS OF THE PARENT ORGANIZATION, LUTHERAN SENIOR SERVICES, PRIOR TO BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES WILL DISCLOSE A CONFLICT OF INTEREST ON THE "CONFLICT OF INTEREST FORM" IN THE FOLLOWING SITUATIONS AND IN OTHER CIRCUMSTANCES WHICH HE/SHE THINKS MIGHT CAUSE A CONFLICT BETWEEN HIS/HER PERSONAL INTERESTS AND HIS/HER FIDUCIARY DUTY: FINANCIAL INTERESTS, INSIDE INFORMATION, CONFLICTING INTEREST OTHER THAN FINANCIAL, GIFTS AND FAVORS. THE FOLLOWING LSS EMPLOYEES ARE REQUIRED TO SIGN A "CONFLICT OF INTEREST FORM" ANNUALLY: PRESIDENT, CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER/TREASURER, VICE PRESIDENT OF CONSTRUCTION AND IT, VICE PRESIDENT OF HUMAN RESOURCES, ALL DIRECTORS, ADMINISTRATORS AND ASSISTANT ADMINISTRATORS. THE CORPORATE COMPLIANCE OFFICER FOLLOWS UP WITH ANY CONFLICTS OF INTERESTS AND DOCUMENTS THE RESOLUTIONS OF THE CONFLICTS. THESE FORMS ARE KEPT BY THE CORPORATE COMPLIANCE OFFICE. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION DID NOT COMPENSATE ANY OFFICERS, DIRECTORS OR KEY EMPLOYEES. THE COMPENSATION PROCESS USED BY THE PARENT ORGANIZATION, LUTHERAN SENIOR SERVICES, IS AS FOLLOWS: THE BOARD OF DIRECTORS ESTABLISHED A SEPARATE COMPENSATION COMMITTEE CHARGED WITH PERFORMING AN ANNUAL PERFORMANCE REVIEW OF THE CEO AND REVIEWING THE CEO'S COMPENSATION PACKAGE. THE COMPENSATION COMMITTEE ENGAGED A THIRD-PARTY GLOBAL HUMAN CAPITAL CONSULTING FIRM TO: (1) DEVELOP AN ANNUAL CEO PERFORMANCE REVIEW PROCESS, INCLUDING A NEW EVALUATION FORM, AND (2) DEVELOP A COMPENSATION PACKAGE BASED ON ITS KNOWLEDGE OF SIMILARLY SIZED NON-PROFIT ORGANIZATIONS IN ORDER TO ENSURE THAT THE COMPENSATION PAID TO THE CEO IS REASONABLE. ALL MEMBERS OF THE BOARD COMPLETE AN ANNUAL EVALUATION, WHICH THE COMPENSATION COMMITTEE SUMMARIZES AND REVIEWS. THE COMPENSATION COMMITTEE THEN MAKES A RECOMMENDATION TO THE FULL BOARD OF DIRECTORS FOR ANY COMPENSATION ADJUSTMENTS. FORM 990, PART VI, SECTION C, LINE 19 ALTHOUGH NOT A REQUIREMENT, THE ORGANIZATION PROVIDES PHOTOCOPIES OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, FINANCIAL STATEMENTS, AND OTHER DOCUMENTS TO ALL WHO REQUEST ONE OR MORE OF THESE ITEMS. FORM 990, PART X, PAGE 11, LINE 20 - LIABILITIES / TAX EXEMPT BONDS THE PARENT COMPANY, LUTHERAN SENIOR SERVICES, HAS ALLOCATED A PORTION OF THE 2016 TAX EXEMPT BONDS THAT WERE ISSUED TO THE PARENT COMPANY TO THIS ORGANIZATION. THE DETAILS OF THE 2016 TAX EXEMPT BONDS ISSUED TO LUTHERAN SENIOR SERVICES ARE CONTAINED ON THE SCHEDULE K THAT IS FILED WITH THE FORM 990 FOR THE PARENT COMPANY (FEIN 43-0654862). AS A RESULT, THERE IS NO SCHEDULE K FOR THIS TAX RETURN. FORM 990, PART XII, LINE 2C THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT. THIS PROCESS IS CONSISTENT WITH THE PRIOR YEARS. FORM 990, PART V, LINE 2 AND PART IX, LINES 7, 8, 9, AND 10 THE ORGANIZATION'S PAYROLL IS PROCESSED WITH LUTHERAN SENIOR SERVICES, THE PARENT COMPANY. FORMS W-3 AND W-2 WERE NOT ISSUED BY LUTHERAN HILLSIDE VILLAGE, INC. AS OF DECEMBER 31, 2017. THE ORGANIZATION DID PAY THE SALARIES, EMPLOYMENT TAXES, AND EMPLOYEE BENEFITS FOR THE ORGANIZATION'S EMPLOYEES. AS OF DECEMBER 31, 2017 THE ORGANIZATION HAD 325 FULL-TIME EMPLOYEES. LUTHERAN SENIOR SERVICES 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 430654862 SENIOR LIVING MO 501(C)(3) LINE 11 N/A 0 LUTHERAN HILLSIDE VILLAGE FOUNDATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 371371314 SENIOR LIVING IL 501(C)(3) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1