2014-11-05T13:11:37-06:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-01-01 450228055 THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY EVAN 6053623100 4800 WEST 57TH STREET BOX 5038 SIOUX FALLS SD 571175038 RAYE NAE NYLANDER CFO & TREASURER 6053623100 2014-11-05 1 TERRANCE O'REILLY P00068340 6123764500 2013 2015-11-30 17:44:51Z DAVID HORAZDOVSKY 4800 WEST 57TH STREET BOX 5038 SIOUX FALLS SD 571175038 1420287292 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. 16 9 27259 1890 1999744 -868124 16031754 19107739 934323931 945673734 5293474 2289662 13029599 12706632 968678758 979777767 4409710 28646285 0 0 571782028 573413646 0 98791 3462920 380576090 377362169 956767828 979520891 11910930 256876 1607297528 1646887969 856534151 887791517 750763377 759096452 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 612565422 28646285 728582901 SKILLED NURSING SERVICES - REHABILITATION/SKILLED NURSING SERVICES HAVE BEEN AT THE CORE OF THE SOCIETY'S SERVICES OVER ITS 91-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 3,482,396 SKILLED NURSING HOME DAYS OF CARE AND SERVICE IN 2013. THE SOCIETY CONTINUES TO REINVEST MUCH OF ITS REVENUE TO BUILD AND REVITALIZE ITS FACILITIES ON CAMPUSES THROUGHOUT THE COUNTRY. 54449343 0 64761835 ASSISTED LIVING SERVICES - ASSISTED LIVING SERVICES RESPOND TO THE SOCIETY'S RESIDENTS' NEEDS EACH DAY IN A "HOME-LIKE" ENVIRONMENT. IN 2013, THE SOCIETY PROVIDED 711,608 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. 75008334 0 89214617 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 2013, THE SOCIETY RECORDED 1,745,592 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. 56402644 0 67085083 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 10,628 CLIENTS IN 2013 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. 56402644 67085083 798425743 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 1 1 0 1 1 1 0 1 1 1 1 0 0 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 1 2550 0 1 27259 1 1 1 1 CJ 0 0 0 1 1 0 0 0 1 0 X 16 9 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 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 RAYE NAE NYLANDER CFO & TREASURER 6053623100 4800 W 57TH ST SIOUX FALLS SD 57108 DAVID J HORAZDOVSKY PRESIDENT & CEO 55.00 1.00 X X 680057 0 14411 NEIL GULSVIG CHAIRPERSON 3.30 1.30 X X 0 0 0 PATRICIA K HAUGEN CHAIRPERSON 3.30 1.30 X X 0 0 0 REV JOHN F HOLT FIRST VICE CHAIRPERSON 3.30 0.60 X X 0 0 0 CHRISTOPHER T JOHNSON DIRECTOR 3.30 0.60 X 0 0 0 ELWIN BROWN DIRECTOR 3.30 0.60 X 0 0 0 LORI L BUSSLER DIRECTOR 50.00 0.10 X 81504 0 30535 REV ANDREA DEGROOT-NESDAHL DIRECTOR 3.30 0.10 X 0 0 0 KARI BERIT RAMLO GUSTAFSON DIRECTOR 3.30 0.10 X 0 0 0 TERESA HILDEBRANDT DIRECTOR 50.00 0.10 X 96077 0 29384 PHILIP SAMUELSON DIRECTOR 50.00 0.10 X 97967 0 6842 MICHELE JUFFER DIRECTOR 50.00 0.10 X 72767 0 27778 DR GWEN WAGSTROM HALAAS DIRECTOR 3.30 0.10 X 0 0 0 DR LIANE M CONNELLY DIRECTOR 3.30 0.10 X 0 0 0 JOANNA RANDALL DIRECTOR 50.00 0.10 X 132839 0 6197 SHARON ST MARY DIRECTOR 50.00 0.10 X 144014 0 14383 MICHAEL DEUTH DIRECTOR 50.00 0.10 X 120281 0 25212 H THEODORE GRINDAL DIRECTOR 3.30 0.10 X 0 0 0 JACK MOORMAN DIRECTOR 3.30 0.10 X 0 0 0 GUY MATSON DIRECTOR 50.00 0.10 X 98864 0 32280 JOHN RACEK DIRECTOR 3.30 0.10 X 0 0 0 CINDY MOEGENBURG EXECUTIVE VICE PRESIDENT 55.00 1.00 X 315265 0 14383 RAYE NAE NYLANDER EXECUTIVE VICE PRESIDENT,TREASURER 55.00 1.00 X 327807 0 14383 JOSEPH HERDINA ASSISTANT TREASURER 55.00 1.00 X 192077 0 25212 SYLVIA GAUSE SECRETARY 40.00 1.00 X 63253 0 17322 MISTY HAM-QUICK ASSISTANT SECRETARY 45.00 1.00 X 36685 0 17059 DEAN MERTZ VP - WORKFORCE SYSTEMS 55.00 X 300824 0 14383 TOM SYVERSON VP - OPERATIONS 55.00 X 190835 0 25212 ALAN HIEB VP - OPERATIONS 55.00 X 188666 0 24712 PAT KELLY DIRECTOR OF OPERATIONS 55.00 X 174028 0 8880 SUSAN RAPER DIRECTOR OF OPERATIONS 55.00 X 168546 0 25212 TED BECKER DIRECTOR OF OPERATIONS 55.00 X 178090 0 14383 DAN FOSNESS DIRECTOR OF OPERATIONS 55.00 X 170661 0 16637 JAMES DROPPERS DIRECTOR OF OPERATIONS 55.00 X 158202 0 25212 DAN HAMES DIRECTOR OF OPERATIONS 55.00 X 152500 0 25212 RUSTAN WILLIAMS CHIEF INFO. OFFICER 55.00 X 286839 0 25212 THOMAS KAPUSTA CHIEF LEGAL OFFICER 55.00 X 287339 0 13883 DANNY HANSON DIRECTOR OF OPERATIONS 55.00 X 176883 0 14383 RANDY FITZGERALD DIRECTOR OF OPERATIONS 55.00 X 181422 0 12091 MICHAEL HINSON DIRECTOR OF OPERATIONS 55.00 X 175307 0 14383 5249599 0 535176 67 0 1 0 AEGIS THERAPIES INC PO BOX 8103 FT SMITH AR 72902 CONTRACT THERAPY SERVICES 22494592 KRAUS-ANDERSON CONSTRUCTION 8625 RENDOVA STREET NE CIRCLE PINES MN 55014 GENERAL CONTRACTOR - INCLUDES MATERIALS 10724334 GUSTAFSON BUILDERS PO BOX 1376 RAPID CITY SD 57709 GENERAL CONTRACTOR - INCLUDES MATERIALS 9676713 INFINITY REHAB 25117 SW PARKWAY SUITE D WILSONVILLE OR 97070 CONTRACT THERAPY SERVICES 4087320 REHABCARE GROUP INC BOX 503534 ST LOUIS MO 631503534 CONTRACT THERAPY SERVICES 3870708 208 1211847 1207538 16688354 1324447 19107739 RESIDENT ROUTINE CARE 623000 860790989 860790989 ANCILLARY SERVICES 623000 70396045 70396045 SURCHARGE 623000 6596967 6596967 RENT 623000 2833327 2833327 A/L ANCILLARY SERVICES 623000 1378074 1378074 3678332 3678332 945673734 7317539 7317539 1917441 146601 0 0 1917441 146601 2064042 146601 1917441 394076875 40966981 381077112 58994621 12999763 -18027640 -5027877 -5027877 319318 266966 52352 52352 67888 50211 17677 17677 298364 120615 177749 177749 EMPLOYEE & GUEST MEALS 722210 5860180 624628 5235552 ADMINISTRATIVE SERVICES 561000 3824100 2559371 1264729 MISCELLANEOUS 900099 1411233 12387 1398846 -700701 98000 -798701 10394812 979777767 943323300 1999744 15346984 28201455 28201455 405703 405703 39127 39127 4597029 4597029 475774308 390546860 83190380 2037068 9929927 8166489 1721289 42149 43779631 35924042 7667828 187761 39332751 32347718 6818080 166953 2188874 2188874 441662 441662 166339 166339 98791 98791 77171761 69592068 7450260 129433 5041149 -55 5034406 6798 10262487 52610 10145910 63967 8888032 8888032 34644310 34644310 7380989 3738402 3620681 21906 142786 142786 20979328 20752796 220335 6197 66745933 55273897 11158209 313827 20017303 16576805 3346380 94118 MEDICAL SUPPLIES 85108440 85108440 EQUIPMENT MAINTENANCE 18545230 15761442 2783788 LICENSE SURCHARGE 17250326 17250326 UNCOLLECTIBLE EXPENSE 8477893 8477893 -6090673 -20553721 14169096 293952 979520891 798425743 177632228 3462920 12108446 17633086 1062453 875503 617803 1636554 87110609 84442907 41132516 7833859 6248117 5787887 6334373 6313194 1855094597 934241122 901205625 920853475 478975029 481534929 4279840 4503441 46421540 71606588 443200 4063283 21357977 39803263 1607297528 1646887969 90019982 92915623 4550373 4442080 570151813 582455000 88070433 95190838 41484684 33967522 41000 12256 62215866 78808198 856534151 887791517 X 715012588 718000298 18377094 22385617 17373695 18710537 750763377 759096452 1607297528 1646887969 X 256876 6728720 1347479 X 0 1 X 1 1 1 X 8940807 10983028 11021275 16031754 19112946 66089810 904602868 911859071 945148214 934780394 946359304 4642749851 96790 86533 88098 189519 366252 827192 913640465 922928632 956257587 951001667 965838502 4709666853 0 0 0 4709666853 11053276 9998217 9182093 8835266 9381581 48450433 11053276 9998217 9182093 8835266 9381581 48450433 1927402 1224976 1743415 9546162 8395068 22837023 926621143 934151825 967183095 969383095 983615151 4780954309 0.98510 0.98640 0.01010 0.01030 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: ADMINISTRATIVE SERVICES - 2009 AMOUNT: $ 2,006,702. 2010 AMOUNT: $ 1,928,306. 2011 AMOUNT: $ 1,740,083. 2012 AMOUNT: $ 2,718,788. 2013 AMOUNT: $ 2,559,371. GAINLOSS ON EXTINGUISHMENT OF DEBT - 2009 AMOUNT: $ -79,300. 2010 AMOUNT: $ -464,800. 2011 AMOUNT: $ 3,332. 2012 AMOUNT: $ -3,236,037. 2013 AMOUNT: $ -3,249,071. INTEREST RATE SWAP ADJUSTMENT - 2010 AMOUNT: $ -238,530. OTHER REVENUE - 2012 AMOUNT: $ 10,063,411. 2013 AMOUNT: $ 9,084,768. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 1 40641 0 0 1 359204 0 1 399845 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 1966000 617000 -3000 -400000 2980000 1508000 6000 14000 -438000 1966000 1077000 81000 -6000 356000 1508000 1348000 -16000 -255000 1077000 1277000 51000 -25000 -45000 1348000 0.03500 0.41400 0.55100 0 0 60030121 60030121 1350600288 679337072 671263216 91503862 53475205 38028657 271202135 201428845 69773290 81758191 81758191 920853475 REAL ESTATE TAXES & OTHER LIABILITIES 13192446 UNAMORTIZED BOND PREMIUM 5126933 ANNUITIES PAYABLE 3126758 PAYABLE UNDER INVESTMENT LOAN AGREEMENT 39741077 NON-REFUNDABLE APARTMENT ENTRANCE FEES 17620984 78808198 X 964178799 5125151 5125151 959053648 20724119 20724119 979777767 970196872 -9324018 -9324018 979520890 0 979520890 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 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS FOR OPERATING PURPOSES 5,119,944. INTERCOMPANY TRANSACTION 5,207. PART XI, LINE 4B - OTHER ADJUSTMENTS: INTEREST INCOME 8,256,100. REALIZED GAIN ON SECURITIES 12,061,202. REALIZED LOSS ON SALE OF PROPERTY -18,027,640. LOSS ON EXTINGUISHMENT OF DEBT -3,249,071. T/R CONTRIBUTIONS 13,703,391. CONTRIBS FOR ENDOWMENT FUNDS & TRUSTS 1,003,923. REVENUE FROM DISCONTINUED OPERATIONS 7,414,006. SPECIAL EVENT FUNDRAISING EXPENSES -266,966. GAMING EXPENSES -50,211. COGS - GIFT SHOP EXPENSES -120,615. ROUNDING PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 266,966. GAMING EXPENSES 50,211. COGS - GIFT SHOP EXPENSES 120,615. EXPENSES FROM DISCONTINUED OPS -9,767,017. INTERCOMPANY TRANSACTION 5,207. 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. 39127 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. X X X X X X X 1 RTS CONSULTING 9727 DORSET LANE EDEN PRAIRIE MN 55347 CAMPAIGN CONSULTATION 0 13378 75998 -62620 CLIFTONLARSONALLEN 200 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 554021436 ASSISTANCE WITH GRANT APPLICATION 0 0 22793 -22793 13378 98791 -85413 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 GOLF TOURNAMENT 34807 34807 1100 7735 BOWLING EVENT 74428 74428 12525 96 210083 210083 245606 319318 319318 1100 265866 266966 52352 63723 47522 1533 1 0.71000 4165 653 503 1 67888 48175 503 1533 50211 17677 FL MN 0 THE SOCIETY IS REGISTERED IN THE STATE OF MINNESOTA. THEY ARE NOT REQUIRED TO BE REGISTERED IN THE STATE OF FLORIDA SO THEY HAVE NOT REGISTERED IN THAT STATE. 0 1 0 1.00000 CHARLES HIATT 4800 WEST 57TH STREET PO BOX 5038 SIOUX FALLS SD 571175038 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 - $194DAREN RIFE - ADMINISTRATOR - WESTBROOK, MN - $220SHARON ST. MARY- ADMINISTRATOR - ROBBINSDALE, MN - $252LUANN FOOS - EXECUTIVE DIRECTOR - KISSIMMEE, FL - $3,197 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 HOURS MAPLEWOOD - 100% WESTBROOK - 10% 1 WORLD MISSION PRAYER LEAGUE 232 CLIFTON AVE MINNEAPOLIS MN 55403 410786986 501(C)(3) 23957 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) 34068 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 100 N WEST AVE SUITE 120 SIOUX FALLS SD 57104 460233701 501(C)(3) 7250 CONTRIBUTION GOOD SAMARITAN SOCIETY INC 4800 W 57TH ST SIOUX FALLS SD 57108 460349951 501(C)(3) 11811 17470 FMV PAYMENT OF INSURANCE AND SETTLEMENTS CONTRIBUTIONS TO ASSIST WITH OPERATIONS BOISE GOOD SAMARITAN HOUSING INC 4800 W 57TH ST SIOUX FALLS SD 57108 363370371 501(C)(3) 0 6698 FMV PAYMENT OF INSURANCE PREMIUMS CONTRIBUTIONS TO ASSIST WITH OPERATIONS KEARNEY GOOD SAMARITAN HOUSING INC 4800 W 57TH ST SIOUX FALLS SD 57108 460421846 501(C)(3) 12114 CONTRIBUTIONS TO ASSIST WITH OPERATIONS LOVINGTON GOOD SAMARITAN HOUSING INC 4800 W 57TH ST SIOUX FALLS SD 57108 460392994 501(C)(3) 0 410071 BOOK FORGIVENESS OF DEBT FORGIVENESS OF DEBT GRANTS GOOD SAMARITAN HOUSING INC 4800 W 57TH ST SIOUX FALLS SD 57108 460439511 501(C)(3) 8038 156890 BOOK FORGIVENESS OF DEBT (154,223) AND PAYMENT OF INSURANCE PREMIUMS (2,667) FORGIVENESS OF DEBT AND CONTRIBUTIONS TO ASSIST WITH OPERATIONS POSTVILLE COMMUNITY SUPPORT 116 EAST MILITARY ROAD POSTVILLE IA 52162 810650895 501(C)(3) 6000 SOCIAL ACCOUNTABILITY GRANT LENNOX ELEMENTARY 305 WEST 5TH AVENUE LENNOX SD 57039 466000220 TAX EXEMPT SCHOOL DI 5000 SOCIAL ACCOUNTABILITY GRANT CROSSROADS RESCUE MISSION 1404 EAST 49TH STREET KEARNEY NE 68847 470700215 501(C)(3) 5000 SOCIAL ACCOUNTABILITY GRANT MESILLA VALLEY COMMUNITY OF HOPE 999 WEST AMADOR AVENUE LAS CRUCES NM 88005 850410134 501(C)(3) 5060 SOCIAL ACCOUNTABILITY GRANT INTERFAITH MINISTRIES OF DENTON INC 1109 NORTH ELM STREET DENTON TX 76201 752442459 501(C)(3) 5000 SOCIAL ACCOUNTABILITY GRANT ALLAMAKEE COUNTY ECONOMIC DEVELOPMENT 101 WEST MAIN WAUKON IA 52172 421352802 501(C)(3) 14100 SOCIAL ACCOUNTABILITY GRANT AND CONTRIBUTION MOUNTAIN LAKE ASSEMBLY OF GOD CHURCH PO BOX 532 MOUNTAIN LAKE MN 56159 416087406 501(C)(3) 0 35699 BOOK BUILDING AND LAND THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY IS A 501(C)(3) NONPROFIT CORPORATION WHOSE PURPOSES INCLUDE: TO ENGAGE IN WORK OF A CHARITABLE AND RELIGIOUS NATURE BY PARTICIPATION IN ANY CHARITABLE OR RELIGIOUS ACTIVITY DESIGNED AND CARRIED ON TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. THE DONATION OF THIS PROPERTY TO ANOTHER 501(C)(3) ENTITY WILL BENEFIT AND PROMOTE THE GENERAL HEALTH OF THE COMMUNITY IN WHICH IT IS LOCATED. THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION 4800 W 57TH ST SIOUX FALLS SD 57117 460422866 501(C)(3) 27437229 TO SUPPORT THE GENERAL OPERATIONS AND TRANSFER OF GIFTS TO BE HELD BY THE FOUNDATION. 16 0 SCHOLARSHIPS 275 405703 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. 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FORM 990, PART III, LINE 1 IN 2013, THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (THE SOCIETY) CELEBRATED ITS 91ST 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 21,000 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 91 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 VI, SECTION A, LINE 1 THE GOVERNING BODY DELEGATED BOARD 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 4 THE SOCIETY'S BYLAWS WERE UPDATED IN MARCH 2013 TO INCLUDE A CLAUSE IN ARTICLE V, BOARD OF DIRECTORS. AS OF MARCH 22, 2013, THE BOARD SHALL HAVE THE AUTHORITY TO SUSPEND A BOARD MEMBER FOR CAUSE. 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 DIRECTORS OF OPERATIONS 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 15A THE SOCIETY'S EMPLOYEE COMPENSATION PLAN IS REVIEWED AND UPDATED EVERY FIVE YEARS BY AN EXTERNAL CONSULTANT. 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 POSITIONS WITHIN THE SOCIETY, INCLUDING EXECUTIVE MANAGEMENT, KEY EMPLOYEES AND OFFICERS. FOR POSITIONS OTHER THAN THE PRESIDENT/CEO, THE RECOMMENDATIONS BY THE EXTERNAL CONSULTANT ARE REVIEWED AND APPROVED BY THE PRESIDENT/CEO OF THE SOCIETY. FOR THE PRESIDENT/CEO POSITION, THE RECOMMENDATIONS ARE APPROVED BY THE BOARD OF DIRECTORS. SEE SCHEDULE J, PART I, LINE 3 FOR ADDITIONAL DETAILS RELATED TO THE PRESIDENT/CEO POSITION. THIS EMPLOYEE COMPENSATION PLAN WAS REVIEWED AND UPDATED BY TOWERS WATSON AS THE OUTSIDE CONSULTANT. TOWERS WATSON PROVIDED A WRITTEN REVIEW BASED UPON CURRENT MARKET CONDITIONS WHICH IS ON FILE. COMPENSATION WAS REVIEWED IN 2012 AND IMPLEMENTED IN 2013 FOR THE PRESIDENT/CEO. 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 440,757. T/R INCREASE IN INTEREST IN THE T/R NET ASSETS OF FOUNDATION 577,845. P/R INCREASE IN BENEFICIAL INTEREST IN PERPETUAL TRUST 223,000. P/R TRANSFERS TO FOUNDATION FROM SOCIETY -386,921. P/R INCREASE IN INTEREST IN THE P/R NET ASSETS OF FOUNDATION 490,240. ROUNDING 2,558. 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