2015-11-11T09:09:13-06:00 2014-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2014-01-01 450228055 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY EVAN 6053623100 4800 WEST 57TH STREET BOX 5038 SIOUX FALLS SD 571175038 G GRANT TRIBBLE CFO & TREASURER 6053623100 2015-11-06 1 KACIE MCEWEN P01599614 6123764500 2014 2016-02-25 16:41:14Z X DAVID HORAZDOVSKY 4800 WEST 57TH STREET BOX 5038 SIOUX FALLS SD 571175038 1333439615 0 X WWW.GOOD-SAM.COM X 1922 ND TO SHARE GOD'S LOVE IN WORD AND DEED BY PROVIDING SHELTER AND SUPPORTIVE SERVICES TO OTHERS IN NEED. 15 9 27549 1127 2227734 -887354 19107739 16176540 945673734 951359389 2289662 -3556977 12706632 15626038 979777767 979604990 28646285 7967745 0 0 573413646 582739242 98791 0 3329345 377362169 405647249 979520891 996354236 256876 -16749246 1646887969 1596273747 887791517 841786329 759096452 754487418 X TO SHARE GOD'S LOVE IN WORD AND DEED BY PROVIDING SHELTER AND SUPPORTIVE SERVICES TO OLDER PERSONS AND OTHERS IN NEED, BELIEVING THAT "IN CHRIST'S LOVE, EVERYONE IS SOMEONE."(CONTINUED ON SCHEDULE O) 0 0 608202482 7967745 721595914 SKILLED NURSING SERVICES - REHABILITATION/SKILLED NURSING SERVICES HAVE BEEN AT THE CORE OF THE SOCIETY'S SERVICES OVER ITS 92-YEAR HISTORY. THE SOCIETY APPROACHES CARE FOR THOSE WE SERVE IN A "HOLISTIC" MANNER. IN THAT REGARD, 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 - AND THE NINTH LARGEST OVERALL - 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. STATISTICALLY, THE SOCIETY PROVIDED A TOTAL OF 3,486,255 SKILLED NURSING HOME DAYS OF CARE AND SERVICE IN 2014. THE SOCIETY CONTINUES TO REINVEST MUCH OF ITS REVENUE TO BUILD AND REVITALIZE ITS FACILITIES ON CAMPUSES THROUGHOUT THE COUNTRY. 55470638 0 65812599 ASSISTED LIVING SERVICES - ASSISTED LIVING SERVICES RESPOND TO THE SOCIETY'S RESIDENTS' NEEDS EACH DAY IN A "HOME-LIKE" ENVIRONMENT. IN 2014, THE SOCIETY PROVIDED 724,452 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, AND MEDICATION ASSISTANCE. COORDINATED SPIRITUAL AND SOCIAL PROGRAMS ARE OFFERED FOR THE TOTAL WELL-BEING OF THE RESIDENTS. 76962933 0 91311922 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 ITS CORPORATE STRATEGIC PLANNING.IN 2014, THE SOCIETY RECORDED 1,847,309 SENIOR LIVING DAYS OF SERVICE TO RESIDENTS THROUGHOUT THE COUNTRY. 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. 63648909 0 75515628 ACROSS MANY OF ITS SETTINGS, THE SOCIETY HAS MADE A SIGNIFICANT INVESTMENT AND COMMITMENT TO THE USE OF TECHNOLOGY IN THE VARIOUS LEVELS OF CARE THAT IT PROVIDES IN ITS SUITE OF SERVICES. MOST NOTABLY, A SENSOR TECHNOLOGY PROGRAM - CALLED LIVINGWELL@HOME - IS BEING ROLLED OUT THROUGHOUT THE SOCIETY'S LOCATIONS, INCLUDING IN THOUSANDS OF ITS CARE AND LIVING SPACES NATIONWIDE. THIS PROGRAM LEVERAGES TECHNOLOGY TO UNOBTRUSIVELY MONITOR RESIDENTS' DAILY LIVING BEHAVIORS AND ACTIVITIES, THUS ALLOWING THEM TO EXTEND AND EVEN CONTROL THEIR INDEPENDENCE WHILE GIVING COMFORT TO FAMILY MEMBERS WHO MAY NOT LIVE CLOSE BY.HOME HEALTH SERVICES - THE SOCIETY SERVED APPROXIMATELY 11,155 CLIENTS IN 2014 THROUGH HOME HEALTH SERVICES. HOME HEALTH SERVICES PROVIDE A RANGE OF OPTIONS INCLUDING VISITS BY PROFESSIONAL NURSES TO MEET MEDICAL CARE REQUIREMENTS TO HOMEMAKER VISITS THAT PROVIDE HOUSEKEEPING SERVICES. GENERALLY, THE HOME HEALTH SERVICES ARE PROVIDED TO SENIORS LIVING IN HOUSING OPERATED BY THE SOCIETY. RESIDENTS IN ASSISTED LIVING AND SENIOR LIVING SETTINGS MAY HAVE TEMPORARY NEED TO ACCESS THE SERVICES OF THE SOCIETY'S HOME HEALTH AGENCIES. THESE RESIDENTS MAY BE RECOVERING FROM SURGERY OR HAVE AN ILLNESS THAT TEMPORARILY PREVENTS THEM FROM PERFORMING A DAILY LIVING TASK. 63648909 0 75515628 804284962 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 1 0 0 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 0 0 1 X 2632 0 27549 1 1 1 1 CJ 0 0 0 1 1 0 0 0 0 0 X 15 9 0 0 0 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 IL KS KY ME MD MI MN MS NH NJ NM NY ND OH OK PA RI TN UT VA WA WI WV HI NC X G GRANT TRIBBLE CFO & TREASURER 6053623100 4800 W 57TH ST SIOUX FALLS SD 57108 DAVID J HORAZDOVSKY PRESIDENT & CEO 54.60 1.40 X X 728886 0 15094 NEIL GULSVIG CHAIRPERSON 3.30 1.40 X X 0 0 0 REV JOHN F HOLT FIRST VICE CHAIRPERSON 3.30 0.70 X X 0 0 0 CHRISTOPHER T JOHNSON MEMBER-EXECUTIVE COMMITTEE 3.30 0.70 X 0 0 0 JOHN RACEK MEMBER-EXECUTIVE COMMITTEE 3.30 0.70 X 0 0 0 DENNIS STENE MEMBER-EXECUTIVE COMMITTEE 3.30 0.70 X 0 0 0 CONNIE MARCH-CURTIS MEMBER-EXECUTIVE COMMITTEE 3.30 0.70 X 0 0 0 ELWIN BROWN MEMBER-EXECUTIVE COMMITTEE 3.30 0.70 X 0 0 0 KARI BERIT RAMLO GUSTAFSON FORMER DIRECTOR 3.30 0.70 X 0 0 0 DR GWEN WAGSTROM HALAAS DIRECTOR 3.30 0.70 X 0 0 0 DR LIANE M CONNELLY DIRECTOR 3.30 0.70 X 0 0 0 H THEODORE GRINDAL DIRECTOR 3.30 0.70 X 0 0 0 CARLA TROUT DIRECTOR 50.00 0.10 X 110548 0 28185 SHARON ST MARY DIRECTOR 50.00 0.10 X 151836 0 14952 GUY MATSON DIRECTOR 50.00 0.10 X 104899 0 34012 MICHAEL DEUTH DIRECTOR 50.00 0.10 X 116212 0 34792 MICHELLE JUFFER DIRECTOR 50.00 0.10 X 74451 0 29190 TERESA HILDEBRANDT DIRECTOR 50.00 0.10 X 104425 0 31305 PHILIP SAMUELSON DIRECTOR 50.00 0.10 X 105757 0 7388 CINDY MOEGENBURG EXECUTIVE VICE PRESIDENT 55.00 1.00 X 71694 0 1049 RAYE NAE NYLANDER EXECUTIVE VICE PRESIDENT,TREASURER 54.40 0.70 X 337025 0 15094 JOSEPH HERDINA ASSISTANT TREASURER 55.00 1.00 X 206651 0 26508 SYLVIA GAUSE SECRETARY 40.00 1.00 X 66014 0 17165 MISTY HAM-QUICK ASSISTANT SECRETARY 45.00 0.70 X 37543 0 20473 TOM SYVERSON EXECUTIVE VICE PRESIDENT 55.00 1.00 X 303773 0 26508 DEAN MERTZ VICE PRESIDENT 55.00 X 322277 0 15094 LINDA STUDER VICE PRESIDENT 55.00 X 178238 0 26508 SUSAN RAPER REGIONAL VICE PRESIDENT 55.00 X 184290 0 26311 TED BECKER REGIONAL VICE PRESIDENT 55.00 X 243299 0 15551 DAN FOSNESS REGIONAL VICE PRESIDENT 55.00 X 175298 0 17461 JAMES DROPPERS REGIONAL VICE PRESIDENT 55.00 X 168202 0 19850 DAN HAMES REGIONAL VICE PRESIDENT 55.00 X 167194 0 26508 RANDY FITZGERALD REGIONAL VICE PRESIDENT 55.00 X 185998 0 12733 PAT KELLY REGIONAL VICE PRESIDENT 55.00 X 178914 0 9007 RUSTAN WILLIAMS VICE PRESIDENT 55.00 X 319180 0 26484 THOMAS KAPUSTA VICE PRESIDENT 55.00 X 297355 0 14436 VICTORIA WALKER CHIEF MEDICAL OFFICER 55.00 X 233364 0 24992 MICHAEL HINSON REGIONAL VICE PRESIDENT 55.00 X 174158 0 14952 5347481 0 551602 78 0 1 0 AEGIS THERAPIES INC PO BOX 8103 FT SMITH AR 72902 CONTRACT THERAPY SERVICES 22641464 GUSTAFSON BUILDERS PO BOX 1376 RAPID CITY SD 57709 GENERAL CONTRACTOR - INCLUDES MATERIALS 7939583 BENSON-ORTH ASSOCIATES INC 15600 37TH AVENUE NORTH SUITE 100 PLYMOUTH MN 55446 GENERAL CONTRACTOR - INCLUDES MATERIALS 5592396 BRESTER CONSTRUCTION INC 1200 INFINITY COURT LINCOLN NE 68512 GENERAL CONTRACTOR - INCLUDES MATERIALS 5247612 INFINITY REHAB 25117 SW PARKWAY SUITE D WILSONVILLE OR 97070 CONTRACT THERAPY SERVICES 4762098 204 100171 129610 2584386 957073 12405300 322827 16176540 RESIDENT ROUTINE CARE 623000 856782746 856782746 ANCILLARY SERVICES 623000 77025573 77025573 SURCHARGE 623000 5825871 5825871 A/L ANCILLARY SERVICES 623000 3843110 3843110 RENT 623000 2898123 2898123 4983966 4983966 951359389 7073260 7073260 1809115 186905 0 0 1809115 186905 1996020 186905 1809115 314358565 28223590 309907315 43305077 4451250 -15081487 -10630237 -10630237 1410675 129610 436672 974003 974003 67860 53272 14588 14588 303510 132289 171221 171221 EMPLOYEE & GUEST MEALS 722210 6086385 863490 5222895 ADMINISTRATIVE SERVICES 561000 3956098 2689769 1266329 BARBER & BEAUTY SHOP 623990 750488 750488 1677235 97915 1579320 12470206 979604990 945408987 2227734 15791729 7560865 7560865 368266 368266 38614 38614 4814161 4814161 480609568 390274728 88350034 1984806 9980414 8121308 1818258 40848 48123554 39071630 8853038 198886 39211545 31907397 7143664 160484 2647634 2647634 528250 528250 142655 142655 79769919 73022865 6664750 82304 5196166 114 5184643 11409 10413385 63205 10276670 73510 11511818 11511818 38972497 38972497 8266406 4468267 3773873 24266 124825 124825 22103288 21822108 274348 6832 67372307 54717558 12347277 307472 14048116 11409415 2574589 64112 MEDICAL SUPPLIES 85148237 85148237 EQUIPMENT MAINTENANCE 18474887 15601242 2873588 57 LICENSE SURCHARGE 16950786 16950786 UNCOLLECTIBLE EXPENSE 10219829 10219829 13756244 -48301 13430186 374359 996354236 804284962 188739929 3329345 17633086 11772939 875503 805022 1636554 1455128 84442907 83614875 7833859 8869842 5787887 4010011 6313194 6795767 1917720023 973249869 920853475 944470154 481534929 405866749 4503441 4394302 71606588 78078699 4063283 3962454 39803263 42177805 1646887969 1596273747 92915623 102096478 4442080 4453226 582455000 491825048 95190838 97091726 33967522 84841183 12256 0 78808198 61478668 887791517 841786329 X 718000298 714322706 22385617 21358622 18710537 18806090 759096452 754487418 1646887969 1596273747 X -16749246 11269854 870358 X 0 1 X 1 1 1 X 10983028 11021275 16031754 19112946 16176540 73325543 911859071 945148214 934780394 945993052 952770064 4690550795 86533 88098 189519 366252 371370 1101772 922928632 956257587 951001667 965472250 969317974 4764978110 0 0 0 4764978110 9998217 9182093 8835266 9381581 9069280 46466437 9998217 9182093 8835266 9381581 9069280 46466437 1224976 1743415 9546162 8395068 10242472 31152093 934151825 967183095 969383095 983248899 988629726 4842596640 0.98400 0.98510 0.00960 0.01010 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: ADMINISTRATIVE SERVICES - 2010 AMOUNT: $ 1,928,306. 2011 AMOUNT: $ 1,740,083. 2012 AMOUNT: $ 2,718,788. 2013 AMOUNT: $ 2,559,371. 2014 AMOUNT: $ 2,689,769. GAINLOSS ON EXTINGUISHMENT OF DEBT - 2010 AMOUNT: $ -464,800. 2011 AMOUNT: $ 3,332. 2012 AMOUNT: $ -3,236,037. 2013 AMOUNT: $ -3,249,071. 2014 AMOUNT: $ -1,354,897. INTEREST RATE SWAP ADJUSTMENT - 2010 AMOUNT: $ -238,530. OTHER REVENUE - 2012 AMOUNT: $ 10,063,411. 2013 AMOUNT: $ 9,084,768. 2014 AMOUNT: $ 8,907,600. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 1 35275 0 0 1 320373 0 1 0 355648 0 PART II-B, LINE 1: ONE STAFF MEMBER IS DEVOTED FULL TIME TO PUBLIC POLICY ISSUES, INCLUDING LOBBYING 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 TWO PERCENT OF ONE AVERAGE STAFF MEMBERS' TIME IS DEVOTED TO THIS ACTIVITY. 0 1 X 2980000 -1109000 13000 -405000 2289000 1966000 617000 -3000 -400000 2980000 1508000 6000 14000 -438000 1966000 1077000 81000 -6000 356000 1508000 1348000 -16000 -255000 1077000 0.13900 0.05500 0.80600 0 0 60168876 60168876 1375417711 708145586 667272125 94559548 56481466 38078082 277869625 208622817 69246808 109704263 109704263 944470154 REAL ESTATE TAXES & OTHER LIABILITIES 13160736 UNAMORTIZED BOND PREMIUM 4171960 ANNUITIES PAYABLE 3108598 PAYABLE UNDER INVESTMENT LOAN AGREEMENT 23262238 NON-REFUNDABLE APARTMENT ENTRANCE FEES 17775136 61478668 X 974253301 3129415 3129415 971123886 8481104 8481104 979604990 990142278 -6043793 -6043793 996186071 168165 168165 996354236 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 HANDLED APPROPRIATELY. PART V, LINE 4: THE SOCIETY'S ENDOWMENT FUNDS WILL BE USED AS DIRECTED BY THE DONOR'S RESTRICTIONS OR THE BOARD'S DESIGNATION. PART X, LINE 2: TAX EXEMPT STATUS FOOTNOTE - THE SOCIETY'S U.S. DOMICILED ENTITIES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OR ARE PASS-THROUGH ENTITIES NOT SUBJECT TO TAX. GOOD SAMARITAN SOCIETY INSURANCE, LTD. IS AN EXEMPTED COMPANY UNDER THE COMPANIES LAW OF THE CAYMAN ISLANDS. THE SOCIETY FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES IN EVALUATING THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THIS 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 SOCIETY'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE SOCIETY IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE TAX RETURNS FOR THE YEARS 2011 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS FOR OPERATING PURPOSES 3,297,580. OTHER EXPENSES INCLUDED IN REVENUE -168,165. PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST INCOME 7,683,794. REALIZED GAIN ON SECURITIES 3,840,716. REALIZED LOSS ON SALE OF PROPERTY -15,081,487. LOSS ON EXTINGUISHMENT OF DEBT -1,354,897. T/R CONTRIBUTIONS 9,008,339. CONTRIBS FOR ENDOWMENT FUNDS & TRUSTS 200,129. REVENUE FROM DISCONTINUED OPERATIONS 4,806,745. SPECIAL EVENT FUNDRAISING EXPENSES -436,673. GAMING EXPENSES -53,273. COGS - GIFT SHOP EXPENSES -132,289. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 436,672. GAMING EXPENSES 53,273. COGS - GIFT SHOP EXPENSES 132,289. EXPENSES FROM DISCONTINUED OPS -6,666,027. PART XII, LINE 4B - OTHER ADJUSTMENTS: OTHER EXPENSES INCLUDED IN REVENUE 168,165. FORM 990, PART IV, LINE 2A PART IV, LINE 2A THE SOCIETY HAS HOUSING ENTRY FEES FOR ADMITTANCE INTO HOUSING UNITS AT VARIOUS LOCATIONS. THESE CONTRACTS FOR HOUSING ENTRY FEES VARY BY LOCATION, AND TYPICALLY HAVE VARYING REFUNDABLE PORTIONS UP TO 100% OF THESE ENTRY FEES. THE REFUNDABLE PORTIONS OF THE HOUSING ENTRY FEES ARE REFUNDABLE BASED UPON TIME RESTRICTIONS AND VACANCY OF THE HOUSING UNIT. THE NONREFUNDABLE PORTION OF THE HOUSING ENTRY 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. 1 0 0 0 0 0 0 0 0 0 SOUTH AMERICA OUR CONTRIBUTION TO THE EVANGELICAL LUTHERAN CHURCH IN COLOMBIA GOES TO SUPPORT THEIR WORK WITH ELDERS IN TWO LOCATIONS - SOACHA AND TUNJA. SPECIFICALLY, OUR CONTRIBUTION HELPS PROVIDE SHELTER, FOOD AND SOCIAL SERVICES FOR ABOUT 50 ELDERS IN SOACHA AND 30 ELDERS IN TUNJA. 38614 WIRE TRANSFERS 1 0 1 0 1 0 0 0 PART I, LINE 2: REGULAR CORRESPONDENCE IS RECEIVED FROM THE GRANTEE REGARDING THE PROGRESS OF THEIR INITIATIVES. BOWLING EVENT 84883 81522 3361 729 3359 268 16330 GOLF TOURNAMENT 59694 48088 11606 5058 3680 1319 151 1395708 1395708 405929 1540285 129610 1410675 729 8417 3948 423578 436672 974003 55827 45702 1504 1 1.00000 12033 2000 4066 1 67860 47702 4066 1504 53272 14588 FL MN 0 THE SOCIETY IS REGISTERED IN THE STATE OF MINNESOTA. IT IS NOT REQUIRED TO BE REGISTERED IN THE STATE OF FLORIDA SO IT HAS NOT REGISTERED IN THAT STATE. 0 1 0 1.00000 CHARLES HIATT 4800 WEST 57TH STREET SIOUX FALLS SD 57108 0 SEE PART IV FOR A LIST THE SOCIETY'S VARIOUS FACILITIES CONDUCT LIMITED CHARITABLE GAMING ACTIVITIES. EACH FACILITY'S ADMINISTRATOR OR EXECUTIVE DIRECTOR IS IN CHARGE OF THAT FACILITY'S CHARITABLE GAMING ACTIVITIES. THEY ARE:SUSAN JENSEN - ADMINISTRATOR - MAPLEWOOD, MN - $200DAREN RIFE - ADMINISTRATOR - WESTBROOK, MN - $248LUANN FOOS - EXECUTIVE DIRECTOR - KISSIMMEE, FL - $3,293NICOLE MATTSON - ADMINISTRATOR - ROBBINSDALE, MN - $140TIM SWOBODA - ADMINISTRATOR - ST. JAMES, MN - $225 X 0 SCHEDULE G, PART III, LINE 6, COLUMN C PERCENT OF VOLUNTEER LABOR THE SOCIETY'S VARIOUS FACILITIES CONDUCT LIMITED CHARITABLE GAMING ACTIVITIES AND EACH USES VOLUNTEER LABOR. EACH FACILITY REPORTED A DIFFERENT AMOUNT OF VOLUNTEER LABOR FOR THEIR GAMING ACTIVITIES, THEY ARE: SPECIALTY CARE - 10% MAPLEWOOD - 100% WESTBROOK - 50% 1 WORLD MISSION PRAYER LEAGUE 232 CLIFTON AVE MINNEAPOLIS MN 55403 410786986 501(C)(3) 14647 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. TEAM PO BOX 969 WHEATON IL 601890969 362169146 501(C)(3) 11348 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. SIOUX EMPIRE UNITED WAY 1000 N WEST AVE SUITE 120 SIOUX FALLS SD 57104 460233701 501(C)(3) 8000 CONTRIBUTION SON MINISTRIES INC 440 E ST NE LINTON IN 47441 452541252 501(C)(3) 7500 SOCIAL ACCOUNTABILITY GRANT MILLARD BUSINESS COMMUNITY FOUNDATION 705 SOUTH 153RD CIRCLE OMAHA NE 68154 273413949 501(C)(3) 5600 SOCIAL ACCOUNTABILITY GRANT THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION 4800 W 57TH ST SIOUX FALLS SD 57117 460422866 501(C)(3) 7288961 TO SUPPORT THE GENERAL OPERATIONS AND TRANSFER OF GIFTS TO BE HELD BY THE FOUNDATION. PROPHETSTOWN GOOD SAMARITIAN HOUSING INC 4800 W 57TH ST SIOUX FALLS SD 57117 460323943 501(C)(3) 36700 CONTRIBUTION TO ASSIST WITH OPERATIONS. SENIOR COMPANION FUND 1000 N WEST AVE SUITE 260 SIOUX FALLS SD 57104 460379180 501(C)(3) 15640 SUPPORT GENERAL OPERATIONS. 8 0 SCHOLARSHIPS 274 368266 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. 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 EXPENSES, THE SOCIETY REQUIRES RECEIPT OF PAYMENT BEFORE REIMBURSEMENT IS MADE TO THE EMPLOYEE. X X X X X X 1 0 0 0 0 0 0 0 0 DAVID J HORAZDOVSKY PRESIDENT & CEO 633322 0 0 0 95564 0 0 0 15939 0 744825 0 0 0 SHARON ST MARY DIRECTOR 102708 0 0 0 49128 0 0 0 15798 0 167634 0 0 0 MICHAEL DEUTH DIRECTOR 98046 0 0 0 18166 0 8284 0 27354 0 151850 0 0 0 RAYE NAE NYLANDER EXECUTIVE VICE PRESIDENT,TREASURER 259963 0 0 0 77062 0 0 0 15939 0 352964 0 0 0 JOSEPH HERDINA ASSISTANT TREASURER 158516 0 0 0 48135 0 0 0 27354 0 234005 0 0 0 TOM SYVERSON EXECUTIVE VICE PRESIDENT 240890 0 0 0 62883 0 0 0 27354 0 331127 0 0 0 DEAN MERTZ VICE PRESIDENT 244221 0 0 0 78056 0 0 0 15939 0 338216 0 0 0 LINDA STUDER VICE PRESIDENT 148337 0 0 0 29901 0 0 0 27354 0 205592 0 0 0 SUSAN RAPER REGIONAL VICE PRESIDENT 158867 0 0 0 25423 0 0 0 27157 0 211447 0 0 0 TED BECKER REGIONAL VICE PRESIDENT 127155 0 0 0 116144 0 0 0 16256 0 259555 0 0 0 DAN FOSNESS REGIONAL VICE PRESIDENT 126821 0 0 0 48477 0 0 0 18306 0 193604 0 0 0 JAMES DROPPERS REGIONAL VICE PRESIDENT 123439 0 0 0 44763 0 0 0 20695 0 188897 0 0 0 DAN HAMES REGIONAL VICE PRESIDENT 114857 0 0 0 52337 0 0 0 27354 0 194548 0 0 0 RANDY FITZGERALD REGIONAL VICE PRESIDENT 135216 0 0 0 50782 0 0 0 13579 0 199577 0 0 0 PAT KELLY REGIONAL VICE PRESIDENT 105709 0 0 0 73205 0 0 0 9853 0 188767 0 0 0 RUSTAN WILLIAMS VICE PRESIDENT 245931 0 0 0 73249 0 0 0 27329 0 346509 0 0 0 THOMAS KAPUSTA VICE PRESIDENT 233472 0 0 0 63883 0 0 0 15281 0 312636 0 0 0 VICTORIA WALKER CHIEF MEDICAL OFFICER 208442 0 0 0 24922 0 0 0 25837 0 259201 0 0 0 MICHAEL HINSON REGIONAL VICE PRESIDENT 147796 0 0 0 26362 0 0 0 15798 0 189956 0 0 0 PART I, LINE 4A TED BECKER LEFT THE ORGANIZATION AND RECEIVED SEVERANCE PAY OF $50,529 A COHFA 840752932 196474P46 2004-08-31 28168375 REFUNDED 1992-1993 AND 2004 BOND ISSUES 0 0 1 B COHFA 840752932 1964742TG 2005-11-15 64472262 REFUNDED 1995, 2003, AND 2005 BOND ISSUES 0 0 1 C COHFA 840752932 1964745B2 2006-10-31 108145790 REFUNDED 2000 AND 2001 BOND ISSUES 0 0 1 D COHFA 840752932 19648AFY6 2007-12-06 23830000 REFUNDED 2003 AND 2006 BOND ISSUES 0 0 1 A 4795000 28168375 2573959 420812 2004 1 0 1 1 B 9120000 64472262 4373983 1046025 8283287 2007 1 0 1 1 C 17410000 108145790 7987447 1365882 58112099 2008 1 1 1 1 D 23830000 476600 11006400 2009 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 0 1 0 0 NA 0 0 1 MBIA INC 13.000000000000 1 0 1 B 0 0 0 1 0 0 NA 0 0 1 AIG FINANCIAL PRODUCTS CORP 5.000000000000 1 0 1 C 0 0 0 1 0 0 NA 0 0 0 NA 0 0 1 D 0 0 0 1 1 0 NA 0 0 0 NA 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: COHFA DATE THE REBATE COMPUTATION WAS PERFORMED: 06/10/2014 ISSUER NAME: COHFA DATE THE REBATE COMPUTATION WAS PERFORMED: 08/16/2010 ISSUER NAME: COHFA DATE THE REBATE COMPUTATION WAS PERFORMED: 06/17/2011 ISSUER NAME: COHFA DATE THE REBATE COMPUTATION WAS PERFORMED: 06/11/2012 ISSUER NAME: COHFA DATE THE REBATE COMPUTATION WAS PERFORMED: 07/17/2013 A COHFA 840752932 19648ANT8 2008-12-11 28305000 REFUNDED 2004 BOND ISSUE 0 0 1 B COHFA 840752932 2011-12-08 60000000 REFUNDED 2011 BOND ISSUE 0 0 1 C COHFA 840752932 19648AYW9 2012-05-23 175711853 NONREFUNDING AND REFUNDED 1997, 1998, 2000, 2009 BOND ISSUES AND 2006 TERM L 0 0 1 D COHFA 840752932 19648AM44 2013-10-02 62441164 NONREFUNDING AND REFUNDED A PRIOR TAXABLE BOND ISSUE 0 0 1 A 26145000 28305000 565415 2008 1 0 1 1 B 4250000 60000000 300000 2011 1 0 1 1 C 1705000 175711853 15291365 2409249 35000000 791184 2013 1 1 0 1 D 62441164 6410896 1073664 16700000 1684067 2014 1 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 0 0 0 1 1 0 NA 0 0 0 NA 0 0 1 B 0 1 0 0 0 0 NA 0 0 0 NA 0 0 1 C 0 1 0 0 0 0 NA 0 0 0 NA 0 0 1 D 0 1 0 0 0 0 NA 0 0 0 NA 0 0 1 A 1 B 1 C 1 D 1 THOMAS FRASER FAMILY RELATIONSHIP - SON OF CINDY MOEGENBURG, OFFICER 55663 COMPENSATION 0 MICHAEL DROPPERS FAMILY RELATIONSHIP - SON OF JIM DROPPERS, KEY EMPLOYEE 46688 COMPENSATION 0 RYAN MERTZ FAMILY RELATIONSHIP - SON OF DEAN MERTZ, OFFICER 88361 COMPENSATION 0 HALEY SAMUELSON FAMILY RELATIONSHIP - WIFE OF PHILIP SAMUELSON, DIRECTOR 101759 COMPENSATION 0 DEBORAH HAMES FAMILY RELATIONSHIP - WIFE OF DAN HAMES, KEY EMPLOYEE 37536 COMPENSATION 0 KELLY HORAZDOVSKY FAMILY RELATIONSHIP - DAUGHTER OF DAVID HORAZDOVSKY, TELGSS PRESIDENT 58949 COMPENSATION 0 JACOB STUDER FAMILY RELATIONSHIP - SON OF LINDA STUDER, KEY EMPLOYEE 56717 COMPENSATION 0 KATHERYN STUDER FAMILY RELATIONSHIP - DAUGHTER-IN LAW OF LINDER STUDER, KEY EMPLOYEE 86496 COMPENSATION 0 BREANNA GOEMBEL FAMILY RELATIONSHIP - DAUGHTER OF LINDER STUDER, KEY EMPLOYEE 55913 COMPENSATION 0 GREG WILCOX FAMILY RELATIONSHIP - GRANDSON OF FOUNDER 198935 COMPENSATION 0 X 24 8630 FAIR MARKET VALUE X 1082 FAIR MARKET VALUE X 13893 FAIR MARKET VALUE X 9 107990 FAIR MARKET VALUE X 1 21650 FAIR MARKET VALUE X 76 5170 FAIR MARKET VALUE X 4 380 FAIR MARKET VALUE X MISCELLANEOUS ITEMS 758 164031 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): THE NUMBER IN COLUMN B RESPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART III, LINE 1 IN 2014, THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (THE SOCIETY) CELEBRATED ITS 92ND YEAR OF EXISTENCE SINCE ITS FOUNDING IN A SMALL NORTH DAKOTA COMMUNITY. AS THE SOCIETY RAPIDLY APPROACHES A CENTURY OF SERVICE, MISSION AND MINISTRY, ITS STRATEGIC AND OPERATIONAL WORK IS FOCUSED ON THE GOOD SAMARITAN SOCIETY WAY: - GUIDED BY OUR OBLIGATION (MISSION) TO SHARE GOD'S LOVE, THE SOCIETY IS CHALLENGED TO DO NOTHING LESS THAN TO BE OUTSTANDING IN BOTH OPERATIONS AND STRATEGY. - TO SHARE GOD'S LOVE, THE SOCIETY SEEKS OUT AND FINDS OPPORTUNITIES (OUR STRATEGIC DIRECTION) TO HELP IMPROVE WELL-BEING AND LET PEOPLE LEAD THE LIVES THEY WANT TO LIVE IN THE PLACES WHERE THEY WANT TO BE. - AND THE SOCIETY IS SUCCESSFUL WHEN IT ACHIEVES ITS OUTCOME (VISION) OF CREATING ENVIRONMENTS WHERE PEOPLE FEEL LOVED, VALUED AND AT PEACE. EVERY ONE OF OUR 20,000 STAFF MEMBERS HAS TRAINED IN THE GOOD SAMARITAN SOCIETY WAY. THE CHALLENGE OF MEETING PEOPLE'S NEEDS WHERE THEY ARE COMPELS AND PROPELS THE SOCIETY TO MEET THE CHALLENGES OF THE FUTURE. ALTHOUGH THE SOCIETY'S CONSTANCY AND CONSISTENCY OF MISSION HAS STAYED TRUE, THE ENVIRONMENT SURROUNDING THE ORGANIZATION HAS CHANGED GREATLY OVER THESE PAST 92 YEARS. WE STAND AT A CRITICAL JUNCTURE IN OUR NATION'S HISTORY, AS CONDITIONS OF OUR ECONOMY, DEMOGRAPHICS, SOCIETY AND CULTURE HAVE SEEN REVOLUTIONARY CHANGE. THE SOCIETY RECOGNIZES THESE CHANGING NEEDS AND DEMANDS AND STANDS READY TO SERVE PEOPLE'S NEEDS FOR THE NEXT 100 YEARS. FORM 990, PART V, LINE 7H GOOD SAMARITAN SOCIETY RECEIVED MULTIPLE VEHICLES DURING 2014 OF WHICH THEY FILED ONE FORM 1098-C AND NONE FOR THE OTHERS SO WE CHECKED NO TO THIS QUESTION ON THE FORM 990. FORM 990, PART VI, SECTION A, LINE 1 THE GOVERNING BODY DELEGATED BROAD AUTHORITY TO THE EXECUTIVE COMMITTEE OF THE BOARD TO ACT ON ITS BEHALF ON MATTERS THAT NEED ATTENTION WHEN THE BOARD IS NOT IN SESSION. ALL ACTIONS OF THE EXECUTIVE COMMITTEE ARE RATIFIED AT THE NEXT SCHEDULED BOARD MEETING. THE EXECUTIVE COMMITTEE IS COMPRISED OF THE FOLLOWING BOARD MEMBERS: CHAIRPERSON, FIRST VICE CHAIRPERSON, TWO OTHER MEMBERS, AND THE PRESIDENT. FORM 990, PART VI, SECTION A, LINE 6 THE FOLLOWING ARE ELIGIBLE VOTING MEMBERS OF THE SOCIETY BY VIRTUE OF THEIR RELATIONSHIP WITH THE SOCIETY: 1. ALL MEMBERS OF THE BOARD OF DIRECTORS OF THE SOCIETY WHO ARE MEMBERS OF A CHRISTIAN CHURCH. 2. ALL SOCIETY CORPORATE OFFICERS AND ASSISTANT OFFICERS WHO ARE MEMBERS OF A CHRISTIAN CHURCH. 3. ALL REGIONAL VICE PRESIDENTS WHO ARE MEMBERS OF A CHRISTIAN CHURCH. 4. ALL ADMINISTRATOR/EXECUTIVE DIRECTOR/EXECUTIVE MANAGER EMPLOYEES OF THE SOCIETY WHO ARE MEMBERS OF A CHRISTIAN CHURCH. 5. ALL MEMBERS OF EXECUTIVE LEADERSHIP WHO ARE MEMBERS OF A CHRISTIAN CHURCH. 6. ALL MEMBERS WHO ARE MEMBERS OF A CHRISTIAN CHURCH WHO WERE MEMBERS ON JANUARY 1, 2002, THE DAY OF THE ADOPTION OF THIS AMENDED BYLAW. HOWEVER, VOTING MEMBERSHIP FOR ALL SUCH MEMBERS UNDER THIS ARTICLE II. A. 6. SHALL CEASE, AFTER REASONABLE NOTICE, WHEN SUCH MEMBER FAILS TO VOTE AT THE ANNUAL METING OF THE SOCIETY FOR TWO CONSECUTIVE YEARS. 7. ALL MEMBERS OF THE BOARD OF DIRECTORS OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION WHO ARE MEMBERS OF A CHRISTIAN CHURCH. FORM 990, PART VI, SECTION A, LINE 7A VOTING MEMBERS ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS MUST APPROVE ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED AND APPROVED BY THE BOARD PRIOR TO ITS FILING. THE ORGANIZATION'S OFFICERS AND MANAGEMENT ARE AN INTEGRAL PART OF THE PREPARATION OF THE FORM 990. THEREFORE, THEY WILL HAVE AN ON-GOING REVIEW OF THE INFORMATION AS IT IS PREPARED FOR THE RETURN. 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 SOCIETY'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 SOCIETY 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 B, LINE 15 THE SOCIETY'S CEO'S TOTAL COMPENSATION PLAN IS DETERMINED BY THE EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE (EECC) OF THE BOARD OF DIRECTORS. AS PART OF THEIR RESPONSIBILITIES, THE EXECUTIVE EVALUATION AND COMPENSATION COMMITTEE SHALL REVIEW AND DETERMINE THE ANNUAL BASE SALARY LEVEL, EMPLOYEE AGREEMENTS IF AND WHEN APPROPRIATE, FRINGE BENEFITS, ANY COMPENSATION INCENTIVES AND SUPPLEMENTAL BENEFITS (THE "COMPENSATION") FOR THE PRESIDENT/CEO. THE COMMITTEE WILL USE BEST EFFORTS TO REVIEW AND DETERMINE THE COMPENSATION IN ACCORDANCE WITH THE IRS REBUTTABLE PRESUMPTION PROCEDURE UNDER IRC 4958. THE COMMITTEE INTENDS TO COMPLY WITH THIS PROCEDURE BY MEETING THE THREE GENERAL REQUIREMENTS LISTED BELOW: (1) THE COMPENSATION SHALL BE APPROVED IN ADVANCE BY THE COMMITTEE WITH NO COMMITTEE MEMBERS HAVING A CONFLICT OF INTEREST AS STATED UNDER IRC 4958. (2) THE DETERMINATION SHALL BE BASED UPON COMPARABLE DATA OF SIMILARLY SITUATED POSITIONS WITH DATA PREFERABLY PROVIDED BY AN OUTSIDE COMPENSATION CONSULTANT. (3) THE REVIEW AND DETERMINATION SHALL BE ADEQUATELY AND TIMELY DOCUMENTED. THE DOCUMENTATION SHALL BE IN SIMILAR FORM AND SUBSTANCE. THE EECC ALSO ENGAGES AN EXTERNAL CONSULTANT, AON-HEWITT TO HELP DETERMINE THE COMPENSATION PACKAGE FOR THE CEO. THE EXTERNAL CONSULTANT IS ENGAGED AS NEEDED BUT AT LEAST EVERY FIVE YEARS. SEE SCHEDULE J, PART 1, LINE 3 FOR ADDITIONAL DETAILS RELATED TO THE PRESIDENT/CEO POSITION. THE SOCIETY'S EMPLOYEE COMPENSATION PLAN IS REVIEWED BY THE EXECUTIVE LEADERSHIP TEAM. DURING THE REVIEW, THE COMPENSATION IS EVALUATED, UPDATED, AND RESET TO BE 100% COMPETITIVE AT THE 50TH PERCENTILE OF THE NATIONAL LABOR MARKET UTILIZING A NATIONALLY RECOGNIZED DATABASE. THE COMPENSATION PLAN INCLUDES ALL NATIONAL CAMPUS POSITIONS WITHIN THE SOCIETY, INCLUDING EXECUTIVE MANAGEMENT, KEY EMPLOYEES AND OFFICERS. THIS EMPLOYEE COMPENSATION PLAN WAS REVIEWED AND UPDATED BY AON-HEWITT AS THE OUTSIDE CONSULTANT. AON-HEWITT PROVIDED A WRITTEN REVIEW BASED UPON CURRENT MARKET CONDITIONS WHICH IS ON FILE. COMPENSATION WAS REVIEWED IN 2011 AND IMPLEMENTED IN 2012 FOR OTHER OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 THE SOCIETY'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. THE SOCIETY'S FINANCIAL STATEMENTS ARE AVAILABLE THROUGH ITS EXTERNAL WEBSITE. FORM 990, PART VI, SECTION A, LINE 1B EACH AND EVERY DAY THE SOCIETY'S TOP LOCAL LEADER POSITION AT ITS 200+ DECENTRALIZED LOCATIONS CARRYOUT THE SOCIETY'S MISSION BY ASSURING CARE AND SERVICES ARE PROVIDED TO THOSE MOST IN NEED. IN ORDER FOR THE SOCIETY'S BOARD TO STAY CONNECTED WITH ITS MISSION AND TO ASSURE ALL STRATEGIES HAVE LOCAL LEADERSHIP INPUT, THE SOCIETY'S BYLAWS REQUIRE 6 BOARD MEMBERS TO BE SELECTED FROM THE LOCAL LEADERSHIP. INDEPENDENT BOARD MEMBERS PERIODICALLY REVIEW THE BYLAWS FOR THE MAKEUP OF THE BOARD MEMBERS AND CONTINUE TO DETERMINE THAT IT IS EXTREMELY VALUABLE TO INCLUDE LOCAL LEADERSHIP BOARD REPRESENTATION TO PROVIDE THE INPUT FOR SETTING STRATEGIES FOR THE SOCIETY. THE SEVENTH NON-INDEPENDENT BOARD MEMBER IS THE CEO OF THE SOCIETY. FORM 990, PART XI, LINE 9: T/R TRANSFERS TO FOUNDATION FROM SOCIETY 543,996. T/R INCREASE IN INTEREST IN THE T/R NET ASSETS OF FOUNDATION 432,004. P/R DECREASE IN BENEFICIAL INTEREST IN PERPETUAL TRUST -109,000. P/R TRANSFERS TO FOUNDATION FROM SOCIETY -1,308,715. P/R INCREASE IN INTEREST IN THE P/R NET ASSETS OF FOUNDATION 1,313,715. ROUNDING -1,642. FORM 990, PAGE 1, BOX B EXPLANATION FOR AMENDED RETURN: THE TAXPAYER AMENDED FORM 990 TO PROPERLY EXCLUDE SERVICE LOCATIONS RELATED TO UNRELATED BUSINESS INCOME, RESULTING IN A DECREASE IN UBIT OF $61,714. THIS CHANGE AFFECTED FORM 990 PART I LINES 7A-B, PART III LINE 4, PART VIII LINE 11B, AND SCHEDULE A LINE 12. AH GOOD SAMARITAN HOUSING LLC 4800 W 57TH ST SIOUX FALLS SD 57108 SENIOR HOUSING SD 0 0 TELGSS GOOD SAMARITAN SOCIETY HCBS LLC 4800 W 57TH ST SIOUX FALLS SD 57108 364798232 SOLE MEMBER OF HOME AND COMMUNITY BASED SERVICES & HOSPICE LLC'S SD 0 0 TELGSS GOOD SAMARITAN SOCIETY HCBS-CHOICE LLC 4800 W 57TH ST SIOUX FALLS SD 57108 320454108 PROVIDE HOME AND COMMUNITY BASED SERVICES SD 0 0 GOOD SAMARITAN SOCIETY HCBS LLC GOOD SAMARITAN SOCIETY HCBS-BJC LLC 4800 W 57TH ST SIOUX FALLS SD 57108 383945118 PROVIDE HOSPICE SERVICES SD 0 0 GOOD SAMARITAN SOCIETY HCBS LLC GOOD SAMARITAN SOCIETY INC 4800 W 57TH ST SIOUX FALLS SD 57108 460349951 PROVIDE LOW-INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) 9 TELGSS 1 BOISE GOOD SAMARITAN HOUSING INC 4800 W 57TH ST SIOUX FALLS SD 57108 363370371 PROVIDE LOW-INCOME HOUSING TO ELDERLY AND DISABLED PERSONS SD 501(C)(3) PF TELGSS 1 LOVINGTON GOOD SAMARITAN HOUSING INC 4800 W 57TH ST SIOUX FALLS SD 57108 460392944 PROVIDE LOW-INCOME HOUSING TO 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