2014-08-15T09:58:05-05:00 2013-12-31 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2013-01-01 800015864 LEGACY SENIOR SERVICES LEGA 7635375700 14416 SPRING LAKE ROAD MINNETONKA MN 55345 ERIC LUNDE PRESIDENT 7635375700 2014-08-15 1 SARAH VOGT CPA P00978242 6122536500 2014-08-12 2013 2015-11-30 17:44:51Z WAUKESHA SPRINGS HEALTH & REHAB CENTER ERIC LUNDE 14416 SPRING LAKE ROAD MINNETONKA MN 55345 46620698 0 X N/A X 2001 MN TO OPERATE SKILLED NURSING FACILITIES AND SENIOR HOUSING COMMUNITIES THAT PROVIDE FOR THE LONG-TERM CARE OF THE AGED, INFIRMED, INJURED AND SICK. 5 5 1218 596 143416 37606 905228 42518 44006479 46573131 9393 5049 0 0 44921100 46620698 40987 35828 0 0 24906956 25977834 40373 41898 41898 19040820 19850869 44029136 45906429 891964 714269 20604252 20661735 14995387 14338601 5608865 6323134 X LEGACY SENIOR SERVICES' MISSION IS TO CREATE COMMUNITIES OF DIGNITY, PASSION, AND RESPECT FOR ADULTS AND TO PARTNER WITH OTHER NOT FOR PROFIT ORGANIZATIONS ACROSS THE COUNTRY. THROUGH ITS EFFORTS, LEGACY SENIOR SERVICES SEEKS TO PROVIDE BROAD CONTINUUMS OF CARE TO PROMOTE HEALTH, MIND, AND SPIRIT OF THOSE WE SERVE. 0 0 38388565 35828 46573131 LEGACY SENIOR SERVICES IS A MINNESOTA CORPORATION THAT OPERATES A 170 BED SKILLED NURSING FACILITY IN WAUKESHA, WISCONSIN, CALLED WAUKESHA SPRINGS HEALTH & REHABILITATION CENTER. WAUKESHA SPRINGS HEALTH & REHABILITATION CENTER HAD AN AVERAGE DAILY CENSUS OF 127 RESIDENTS DURING 2013. LEGACY SENIOR SERVICES IS ORGANIZED TO OWN AND OPERATE FACILITIES WITH THE INTENT OF HOUSING ELDERLY AND OTHER VULNERABLE PERSONS AND MEETING THEIR HEALTHCARE, RESIDENTIAL, PHYSICAL AND SOCIAL NEEDS. LEGACY SENIOR SERVICES IS THE SOLE MEMBER OF SEVEN OTHER LIMITED LIABILITY COMPANIES WHICH OPERATE AS SKILLED NURSING, ASSISTED LIVING, AND/OR INDEPENDENT LIVING FACILITIES AS FOLLOWS: -LSS OF MADISON, LLC, A 90 BED SKILLED NURSING FACILITY LOCATED IN MADISON, WISCONSIN. LSS OF MADISON, LLC HAD AN AVERAGE DAILY CENSUS OF 81 DURING 2013.-LSS OF FRAZEE, LLC, A 74 BED SKILLED NURSING FACILITY AND A 19 UNIT ASSISTED LIVING FACILITY LOCATED IN FRAZEE, MINNESOTA AND A 15 UNIT ASSISTED LIVING FACILITY LOCATED IN VERGAS, MINNESOTA. LSS OF FRAZEE, LLC HAD AN AVERAGE DAILY CENSUS OF 100 DURING 2013.-LSS OF MARYCREST, LLC, A 138 UNIT ASSISTED LIVING FACILITY LOCATED IN DENVER, COLORADO. LSS OF MARYCREST, LLC HAD AN AVERAGE DAILY CENSUS OF 134 DURING 2013.-LSS OF SHEBOYGAN, LLC, A 140 BED SKILLED NURSING FACILITY LOCATED IN SHEBOYGAN, WISCONSIN. LSS OF SHEBOYGAN, LLC HAD AN AVERAGE DAILY CENSUS OF 109 DURING 2013.-LSS OF TRAVERSE, LLC, A 49 BED SKILLED NURSING FACILITY AND A 20 UNIT INDEPENDENT LIVING FACILITY LOCATED IN WHEATON, MINNESOTA. LSS OF TRAVERSE, LLC HAD AN AVERAGE DAILY CENSUS OF 64 DURING 2013.-LSS OF WADENA, LLC, A 75 BED SKILLED NURSING FACILITY AND A 32 UNIT INDEPENDENT LIVING FACILITY LOCATED IN WADENA, MINNESOTA. LSS OF WADENA, LLC HAD AN AVERAGE DAILY CENSUS OF 93 DURING 2013.-LSS HOME HEALTH AND HOSPICE, LLC, PROVIDES HOSPICE, HOME HEALTH AND NURSING SERVICES IN WADENA, MINNESOTA.ALL OF THE SKILLED NURSING FACILITIES ARE MEDICARE AND MEDICAID CERTIFIED. 38388565 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 127 0 1 1218 1 1 1 0 0 0 0 0 0 0 0 0 X 5 5 0 1 1 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 MN X HEALTH DIMENSIONS GROUP 7635375700 4400 BAKER ROAD STE 100 MINNEAPOLIS MN 55343 ERIC LUNDE PRESIDENT/TREASURER 8.00 X X 10500 0 0 ROGER GREEN SECRETARY 1.00 X X 4300 0 0 CHAR SAMUELSON DIRECTOR 1.00 X 4300 0 0 ROBERT BECK DIRECTOR 1.00 X 2800 0 0 JOEL JENSEN DIRECTOR 1.00 X 2800 0 0 MEGAN SIMPSON 913-1213 ADMINISTRATOR - LSS OF MADISON 40.00 X 0 0 0 ED BRADY 113-913 ADMIN LSS OF SHEBOYGAN & LSS OF MADISON 40.00 X 60894 0 0 JENNIFER JOHNSON 113-513 ADMINISTRATOR - LSS OF MADISON 40.00 X 0 0 0 ANDREW HUHTA 213-1213 ADMINISTRATOR - LSS OF FRAZEE 40.00 X 0 0 0 GRANT BRANDON 113-213 ADMINISTRATOR - LSS OF FRAZEE 40.00 X 25695 0 0 RICHARD BLANCHARD ADMINISTRATOR - LSS OF WADENA 40.00 X 0 0 0 DANIEL PETERSON ADMIN. - LSS HOME HEALTH & HOSPICE 40.00 X 0 0 0 JULIE CALLENDER ADMINISTRATOR - LSS OF MARYCREST 40.00 X 0 0 0 CHELSY STATTELMAN ADMINISTRATOR - LSS OF TRAVERSE 40.00 X 0 0 0 DENNIS VIDETIC 613-1213 ADMINISTRATOR - LSS OF SHEBOYGAN 40.00 X 0 0 0 BARTON SMITH ADMINISTRATOR WAUKESHA SPRINGS HEALTH & REHAB 40.00 X 0 0 0 111289 0 0 0 0 0 0 HEALTH DIMENSIONS CONSULTING INC 4400 BAKER ROAD MINNEAPOLIS MN 55343 MGMT FEES, ADMIN. SALARIES, CONSULTING 3055762 HDG-WI LLC 4400 BAKER ROAD MINNEAPOLIS MN 55343 MANAGEMENT FEES 1735831 BSG MAINTENANCE INC PO BOX 165 NEWBURG WI 53060 LAUNDRY & HOUSEKEEPING SERVICES 972908 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 THERAPY SERVICES 748516 PRO REHAB 200 LEWIS AVE S 210 WATERTOWN MN 55388 THERAPY SERVICES 641246 8 42518 42518 RESIDENT SERVICE REVENUE 623000 46030073 46030073 MISCELLANEOUS REVENUE 900099 543058 399642 143416 46573131 5049 5049 46620698 46429715 143416 5049 35828 35828 111289 111289 20656057 18771583 1884474 63036 57046 5990 3296812 2983534 313278 1850640 1674784 175856 2533813 2533813 200578 200578 109562 109562 41898 41898 2072038 1854550 217488 188673 14358 174315 1510901 1230311 280590 252753 23061 229692 3737475 3667618 69857 97047 77965 19082 114886 15969 98917 540185 540185 917663 917663 650730 20474 630256 MEDICAL SUPPLIES 3082965 3082965 FOOD 1538722 1538722 MN DHS SURCHARGE/WI PRO 1373370 1373370 BAD DEBT EXPENSE 251684 251684 677824 508579 169245 45906429 38388565 7475966 41898 1875276 1996048 39200 36782 51845 1000 4694003 4567226 19426 19426 169350 485073 18007639 4697273 13544768 13310366 833 209551 245814 20604252 20661735 5440389 5212800 193140 4078934 3832665 191487 166034 4829471 4603856 455106 330106 14995387 14338601 X 5608865 6323134 5608865 6323134 20604252 20661735 714269 0 X 0 1 X 1 0 X 14754 38914 91071 905228 42518 1092485 38965370 39732833 40765252 43891737 46429715 209784907 38980124 39771747 40856323 44796965 46472233 210877392 0 0 0 210877392 8064 9116 1858 9393 5049 33480 8064 9116 1858 9393 5049 33480 38988188 39780863 40858181 44806358 46477282 210910872 0.99980 0.99970 0.00020 0.00030 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1413200 1413200 12708468 2880815 9827653 855362 855362 2649901 1779043 870858 380708 37415 343293 13310366 X 46620698 0 46620698 0 46620698 45906429 0 45906429 0 45906429 PART IV, LINE 2B: THE ORGANIZATION ACTS AS CUSTODIAN FOR THE FUNDS OF THE RESIDENTS OF THE NURSING FACILITIES AND HOLDS TENANT SECURITY DEPOSITS FOR TENANTS OF THE ASSISTED LIVING FACILITIES. PART X, LINE 2: LEGACY SENIOR SERVICES IS ORGANIZED AS A MINNESOTA NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). EACH OF THE CONTROLLED LIMITED LIABILITY CORPORATIONS MAINTAINS EXEMPT STATUS UNDER LEGACY SENIOR SERVICES' EXEMPTION SINCE LEGACY SENIOR SERVICES IS THE SOLE MEMBER OF EACH ENTITY. THE ORGANIZATION IS REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS ANNUALLY. IN ADDITION, THE ORGANIZATION IS SUBJECT TO INCOME TAX ON ANY NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. THE ORGANIZATION FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. THE ORGANIZATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING FILING REQUIREMENTS, AND, AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE, IF SUCH INTEREST AND PENALTIES ARE INCURRED. X X X X 1 MULLEN COMPANY LLC 4825 S AMMONS ST 127 DENVER CO 80123 GRANT WRITING AND FUND SOLICITATION 0 36595 41898 -5303 36595 41898 -5303 CO MN 1 SCHOLARSHIPS 57 35828 PART I, LINE 2: THE ORGANIZATION PROVIDES FUNDS UNDER SCHOLARSHIP AND TUITION ASSISTANCE PROGRAMS FOR ITS EMPLOYEES. EMPLOYEES MUST MEET CERTAIN CRITERIA TO QUALIFY. THE ORGANIZATION EITHER REIMBURSES THE EMPLOYEE FOR EDUCATIONAL EXPENSES OR PAYS THE EDUCATIONAL INSTITUTION DIRECTLY. A CITY OF FRAZEE MN 416005174 2007-08-01 4850000 HEALTH CARE FACILITY ACQUISITION IN FRAZEE, MN 0 0 0 A 1017335 4882400 133384 4749016 2008 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 1 0 0 0 0 A 0 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF FRAZEE, MN DATE THE REBATE COMPUTATION WAS PERFORMED: 09/11/2012 SCHEDULE K SUPPLENTAL INFORMATION THE AMOUNT REPORTED AS BONDS RETIRED FOR THE PRIVATELY PLACED TAX-EXEMPT REVENUE NOTES IS THE ORIGINAL ISSUE PRICE LESS THE OUTSTANDING PRINCIPAL BALANCE OF THE UNDERLYING BANK LOAN AS OF THE END OF THE SCHEDULE K REPORTING PERIOD. SCHEDULE K, PART II, LINES 3 AND 10: THESE AMOUNTS INCLUDE INTEREST EARNED DURING THE CONSTRUCTION PERIOD. SCHEDULE K, PART III, LINE 9: THE ORGANIZATION DOES NOT HAVE A FORMAL BOARD ADOPTED POLICY, BUT THE ORGANIZATION DOES ENSURE POST-ISSUANCE COMPLIANCE THROUGH THEIR MANAGEMENT PRACTICES AND PROCEDURES. FORM 990, PART VI, SECTION A, LINE 3 LEGACY SENIOR SERVICES HAS A MANAGEMENT AGREEMENT WITH HEALTH DIMENSIONS CONSULTING, INC. (DBA HEALTH DIMENSIONS GROUP) OR HDG-WI, LLC TO PROVIDE MANAGEMENT SERVICES TO LEGACY SENIOR SERVICES AND THE FOLLOWING WHOLLY OWNED SINGLE-MEMBER LLC'S: LSS OF MADISON, LLC; LSS OF SHEBOYGAN, LLC; LSS OF FRAZEE, LLC; LSS OF TRAVERSE, LLC, LSS OF MARYCREST, LLC; LSS OF WADENA, LLC, AND LSS HOME HEALTH AND HOSPICE, LLC. THE FOLLOWING INDIVIDUALS PROVIDED SERVICES AS ADMINISTRATORS OF THE FACILITIES THAT INCLUDED DAY TO DAY MANAGEMENT OF FUNCTIONAL OPERATIONS, MANAGEMENT OF FACILITY PERSONNEL, AND EXECUTION OF POLICIES GOVERNING FACILITY OPERATIONS. MEGAN SIMPSON (9/13-12/13) LSS OF MADISON, LLC $29,500 ED BRADY (6/13-9/13) LSS OF MADISON, LLC $25,164 JENNIFER JOHNSON (1/13-5/13) LSS OF MADISON, LLC $37,459 ANDREW HUHTA (2/13-12/13) LSS OF FRAZEE, LLC $59,043 GRANT BRANDON (1/13-2/13) LSS OF FRAZEE, LLC $25,695 RICHARD BLANCHARD LSS OF WADENA, LLC $75,128 DANIEL PETERSON LSS HOME HEALTH & HOSPICE, LLC $91,962 JULIE CALLENDER LSS OF MARYCREST, LLC $92,975 CHELSY STATTELMAN LSS OF TRAVERSE, LLC $64,374 DENNIS VIDETIC (6/13-12/13) LSS OF SHEBOYGAN, LLC $52,367 ED BRADY (1/13-5/13) LSS OF SHEBOYGAN, LLC $35,729 BARTON SMITH WAUKESHA SPRINGS HEALTH & REHAB $108,884 FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION'S BYLAWS WERE AMENDED TO INCREASE THE NUMBER OF BOARD MEMBERS AND ESTABLISH TERM PROCEDURES. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS NO COMMITTEES. THE FULL BOARD HANDLES ALL MEETINGS. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED BY THE MANAGER OF FINANCIAL SERVICES AND THE VICE PRESIDENT OF FINANCIAL SERVICES OF THE MANAGEMENT COMPANY PRIOR TO FILING. THE 990 IS ALSO PROVIDED TO THE LEGACY SENIOR SERVICES BOARD FOR REVIEW AND APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY COVERS ALL BOARD DIRECTORS AND OFFICERS OF THE ORGANIZATION. INDIVIDUALS ARE REQUIRED TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST TO THE BOARD OF DIRECTORS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE BOARD OF DIRECTORS DETERMINES WHETHER OR NOT A CONFLICT EXISTS. IF THE INDIVIDUAL WITH A CONFLICT IS A BOARD MEMBER, THE REMAINING BOARD MEMBERS DETERMINE WHETHER A CONFLICT EXISTS. IF AN INDIVIDUAL HAS A CONFLICT OF INTEREST, THEY MUST LEAVE THE MEETING WHILE THE TRANSACTION OR AGREEMENT IS DISCUSSED AND VOTED UPON. FORM 990, PART VI, SECTION B, LINE 15 THE ADMINISTRATORS' COMPENSATION IS DETERMINED BY AN UNRELATED MANAGEMENT COMPANY, HEALTH DIMENSIONS GROUP. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. LSS OF MADISON LLC 110 BELMONT ROAD MADISON WI 53714 201209404 NURSING HOME WI 7415870 1635940 LEGACY SENIOR SERVICES LSS OF SHEBOYGAN LLC 3014 ERIE AVENUE SHEBOYGAN WI 53081 208658381 NURSING HOME WI 8618752 3481364 LEGACY SENIOR SERVICES LSS OF FRAZEE LLC 219 W MAPLE AVENUE FRAZEE MN 56544 208729268 NURSING HOME & ASSISTED LIVING MN 6161660 5380702 LEGACY SENIOR SERVICES LSS OF MARYCREST 2850 COLUMBINE ROAD DENVER CO 80221 262181659 ASSISTED LIVING CO 3808815 6636942 LEGACY SENIOR SERVICES LSS OF TRAVERSE LLC 303 7TH STREET SOUTH WHEATON MN 56296 273274611 NURSING HOME & INDEPENDENT LIVING MN 3387176 436882 LEGACY SENIOR SERVICES LSS OF WADENA LLC 201 SHADY LANE DRIVE WADENA MN 56482 454632615 NURSING HOME & INDEPENDENT LIVING MN 5435507 1879141 LEGACY SENIOR SERVICES LSS HOME HEALTH & HOSPICE LLC 201 SHADY LANE DRIVE WADENA MN 56482 454700887 HOME HEALTH AND HOSPICE AGENCY MN 1604561 369894 LEGACY SENIOR SERVICES