2013-05-15T12:10:58-05:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-07-01 411936717 LIVING SERVICES FOUNDATION LIVI 7632310410 900 LONG LAKE ROAD NO 130 NEW BRIGHTON MN 55112 JENNIFER KAMSTRA 7632310410 2013-05-14 1 MIKE PRIGGE P00749265 6123764500 2011 2016-02-24 21:20:13Z DENNIS KAMSTRA 900 LONG LAKE ROAD NO 130 NEW BRIGHTON MN 55112 2667742 0 X WWW.LSFDN.ORG X 1999 MN TO SUPPORT SUBSIDIARIES OF BENEDICTINE HEALTH SYSTEM. 5 1 2 1 0 0 238620 92200 10517064 1000 4879 36591 1325424 2537951 12085987 2667742 321945 0 0 0 6362454 335421 0 0 0 6342748 3475237 13027147 3810658 -941160 -1142916 34180217 33567590 34723033 35253322 -542816 -1685732 X THE FOUNDATION IS ORGANIZED AND OPERATED EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF THE SUBSIDIARIES OF BENEDICTINE HEALTH SYSTEM: BENEDICTINE LIVING COMMUNITY OF WINSTED, BENEDICTINE LIVING COMMUNITY OF NEW LONDON, BENEDICTINE LIVING COMMUNITY OF MORA, AND BENEDICTINE LIVING COMMUNITY OF WAHPETON, ALL MINNESOTA NONPROFIT CORPORATIONS THAT ARE DESCRIBED IN SECTIONS 501(C)(3) AND 509(A)(1) (COLLECTIVELY, THE "BENEFICIARY ORGANIZATIONS"). 1 0 3373572 0 1000 SUBSTANTIALLY ALL OF THE FOUNDATION'S ACTIVITIES SHALL CONSIST OF HOLDING TITLE TO AND MANAGING PROPERTIES USED BY THE BENEFICIARY ORGANIZATIONS IN FURTHERANCE OF THEIR EXEMPT PURPOSES OF PROVIDING SENIOR HOUSING AND LONG-TERM CARE SERVICES WITH SPECIAL CONCERN FOR THE UNDERSERVED AND THOSE IN NEED OF SUCH SERVICES. THE FOUNDATION MAY DO ANY AND ALL OTHER ACTS AND THINGS AND EXERCISE ANY AND ALL OTHER RIGHTS AND POWERS WHICH MAY BE REASONABLY NECESSARY, INCIDENTAL, DESIRABLE OR EXPEDIENT IN THE ACCOMPLISHMENT OF SUCH PURPOSES AND ACTIVITIES, BUT THE FOUNDATION'S ACTIVITIES ARE LIMITED TO THOSE THAT ARE FOR THE BENEFIT OF AND PERFORM THE FUNCTIONS OF ITS BENEFICIARY ORGANIZATIONS. 3373572 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 9 0 2 1 0 0 0 0 0 0 0 0 0 0 0 X 5 1 1 0 1 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X JENNIFER KAMSTRA 7632100410 900 LONG LAKE ROAD SUITE 130 NEW BRIGHTON MN 55112 DENNIS KAMSTRA 40.00 X X 231125 0 21413 ROD PAKONEN 5.00 X 27000 0 0 KEVIN RYMANOWSKI 5.00 X 0 0 0 PAUL SANDERS 5.00 X X 27000 0 0 ROBERT SUNDBERG 5.00 X 27000 0 0 JENNIFER KAMSTRA 40.00 X 90075 0 4103 402200 0 25516 1 0 1 0 CLIFTONLARSONALLEN 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 ACCOUNTING SERVICES 113683 1 92200 92200 RESIDENT REVENUE 623000 1000 1000 1000 36591 36591 2248028 0 2248028 2248028 2248028 MANAGEMENT FEES 623990 149068 149068 DEVELOPMENT REVENUE 623990 52020 52020 88835 88835 289923 2667742 1000 0 2574542 318816 45130 273686 16605 16605 2043014 1948411 94603 1387141 1322909 64232 12022 11465 557 REPAIRS & MAINTENANCE 29052 29052 MISCELLANEOUS 4008 4008 3810658 3373572 437086 0 61991 83554 13568 192047 1698 478988 310041 117661 121661 33516717 5012656 27369979 28504061 1198681 1359963 4747302 3186612 34180217 33567590 1915504 1395152 25501855 25314132 7252584 8488294 53090 55744 34723033 35253322 X -542816 -1685732 -542816 -1685732 34180217 33567590 -1142916 0 X 0 1 1 X 0 X X X 0 0 0 BLC OF WINSTED 274219293 9 1 1 1 952665 BLC OF NEW LONDON 274218436 9 1 1 1 952665 BLC OF MORA 274219119 9 1 1 1 952665 BLC OF WAHPETON 454274091 9 1 1 1 952664 4 3810659 1697656 1697656 27785838 4053613 23732225 1934083 904098 1029985 2099140 54945 2044195 28504061 BOND FUNDS 3186612 3186612 ASSET RETIREMENT OBLIGATION 55744 55744 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3); CONSEQUENTLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES IN EVALUATING UNCERTAIN TAX POSITIONS. THE ORGANIZATION FILES INFORMATION RETURNS AS A TAX-EXEMPT ORGANIZATION. SHOULD THAT STATUS BE CHALLENGED IN THE FUTURE, ALL YEARS SINCE INCEPTION COULD BE SUBJECT TO REVIEW BY THE INTERNAL REVENUE SERVICE (IRS). THE ORGANIZATION'S RETURNS FOR TAX YEARS PRIOR TO 2009 ARE NO LONGER OPEN TO EXAMINATION BY THE IRS. X X X X 0 0 0 0 0 0 0 0 0 DENNIS KAMSTRA 231125 0 0 0 0 0 0 0 21413 0 252538 0 0 0 CITY OF SPICER 204504668 84844VAJ4 2006-12-28 9850000 FINANCE ACQUISITION 0 0 0 CITY OF WINSTED 416005652 975574AQ7 2010-09-16 16505000 REFINANCE SERIES 2008 NOTES AND FUND CONSTRUCTION OF MEMORY CARE FACILITY 0 0 0 80519 9460519 712522 294354 8453643 2007 0 1 1 1 16112135 1311331 8308071 322243 6170490 2011 1 0 0 1 1 0 0 0 1 1 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 CITY OF SPICER SERIES 2006 BONDS INCLUDE A DISCOUNT OF 139,481 WHICH IS THE DIFFERENCE BETWEEN THE ISSUE PRICE INCLUDED IN PART I, LINE A, COLUMN E AND PART II, LINE 3, COLUMN A. CITY OF WINSTED SERIES 2010 BONDS INCLUDE A DISCOUNT OF 392,865 WHICH IS THE DIFFERENCE BETWEEN THE ISSUE PRICE INCLUDED IN PART I, LINE B, COLUMN E AND PART II, LINE 3, COLUMN B. NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 A 32-UNIT ASSISTED LIVING FACILITY WAS OPENED IN OCTOBER 2012 LOCATED IN WAHPETON, NORTH DAKOTA. FORM 990, PART VI, SECTION A, LINE 2 DENNIS KAMSTRA AND JENNIFER KAMSTRA - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 4 ADDITION OF BENEDICTINE LIVING COMMUNITY OF WAHPETON TO THE BENEFICIARY ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 7A BENEDICTINE HEALTH SYSTEMS MAY APPOINT ONE BOARD MEMBER. FORM 990, PART VI, SECTION B, LINE 11 ALL MEMBERS OF THE BOARD RECEIVE AN ELECTRONIC DRAFT AND ARE GIVEN THE OPPORTUNITY TO REVIEW THE 990 AND GIVE APPROVAL PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS ENFORCED AND CONSISTENTLY MONITORED. AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THEIR FINANCIAL INTEREST TO THE BOARD CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING BOARD MEMBERS THEN DETERMINE IF A CONFLICT OF INTEREST EXISTS. CORRECTIVE ACTION IS TAKEN BY THE BOARD OF DIRECTORS AS DEEMED NECESSARY WHEN A CONFLICT OF INTEREST IS DETERMINED TO HAVE OCCURRED. FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION FOR OFFICERS IS DETERMINED BY A COMPENSATION SURVEY AND STUDY THAT IS DONE ANNUALLY WITH THE LAST REVIEW TAKING PLACE IN 2011. THE COMPENSATION MUST THEN BE APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES AVAILABLE TO THE PUBLIC THEIR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS UPON REQUEST. LIVING SERVICES FOUNDATIONMORA LLC 110 NORTH 7TH STREET MORA MN 55051 263614974 SKILLED NURSING FACILITY, ASSISTED LIVING FACILITY DE 436617 6204034 LIVING SERVICES FOUNDATION LIVING SERVICES FOUNDATIONNEW LONDON LLC 100 GLEN OAKS DRIVE NEW LONDON MN 56273 204504668 SKILLED NURSING FACILITY, ASSISTED LIVING, INDEPENDENT LIVING DE 754672 8753993 LIVING SERVICES FOUNDATION LIVING SERVICES FOUNDATIONWINSTED LLC 551 4TH STREET NORTH WINSTED MN 55395 208684862 SKILLED NURSING FACILITY, ASSISTED LIVING FACILITY DE 1223311 15910875 LIVING SERVICES FOUNDATION LIVING SERVICES FOUNDATIONWAHPETON LLC 711 14TH AVE NORTH WAHPETON MN 58075 453638196 ASSISTED LIVING FACILITY DE 95758 2258473 LIVING SERVICES FOUNDATION