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CITY OF LAKES CARE CENTER: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CITY OF LAKES CARE CENTER (EIN 41-1985663)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-07
IRS object ID
201211289349301386
Schema version
2010v3.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-07T12:28:02-07:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN411985663EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CITY OF LAKES CARE CENTERBusinessNameLine1
Business Name Line2dba BENEDICTINE HEALTH CENTER OF MPLSBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlCITYNameControl
Phone7636891162Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11995 E RUM RIVER DRIVE SAddressLine1
CityCAMBRIDGECity
StateMNState
ZIP Code55008ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKEVIN RYMANOWSKIName
TitleCFOTitle
Date Signed2012-05-07DateSigned
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDAVID BRENNANNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11995 E RUM RIVER DRIVE SAddressLine1
CityCAMBRIDGECity
StateMNState
ZIP Code55008ZIPCode
FieldValueIRS element (for citing)
Gross Receipts11120021GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
All Affiliates IncludedfalseAllAffiliatesIncluded
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web Sitewww.bhcminneapolis.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2000YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionOur mission is to witness to God's love by providing compassionate, quality care with special concern for the underserved and those in need.ActivityOrMissionDescription
Nbr Voting Members Governing Body3NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
Total Nbr Employees151TotalNbrEmployees
Total Nbr Volunteers10TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year5008ContributionsGrantsPriorYear
Contributions Grants Current Year8500ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10984203ProgramServiceRevenuePriorYear
Program Service Revenue CY11108799ProgramServiceRevenueCY
Investment Income Prior Year9833InvestmentIncomePriorYear
Investment Income Current Year2722InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year10999044TotalRevenuePriorYear
Total Revenue Current Year11120021TotalRevenueCurrentYear
Grants And Similar Amnts CY467562GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6103291SalariesEtcPriorYear
Salaries Etc Current Year5904165SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year3748120OtherExpensePriorYear
Other Expenses Current Year3750628OtherExpensesCurrentYear
Total Expenses Prior Year9851411TotalExpensesPriorYear
Total Expenses Current Year10122355TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1147633RevenuesLessExpensesPriorYear
Revenues Less Expenses CY997666RevenuesLessExpensesCY
Total Assets BOY8686250TotalAssetsBOY
Total Assets EOY9823671TotalAssetsEOY
Total Liabilities BOY4568298TotalLiabilitiesBOY
Total Liabilities EOY4543679TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY4117952NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY5279992NetAssetsOrFundBalancesEOY
Mission DescriptionCity of Lakes Care Center, dba Benedictine Heatlh Center of Minneapolis is a Catholic organization entrusted with advancing the health care ministry of the Benedictine Sisters of Duluth, Minnesota. Our mission is to witness to God's love by providing compassionate, quality care with special concern for the underserved and those in need.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense8958929Expense
Revenue11108799Revenue
DescriptionOperation of Benedictine Health Center - Minnapolis, is a 110 bed long-term care in Minneapolis, Minnesota which provides skilled nursing care to the elderly.The facility had a 87% occupancy and served 193 individuals during the fiscal year ending 6/30/11.Description
Total Program Service Expense8958929TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingtrueCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109615NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees151NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Form990-T FiledfalseForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Form8886 T FiledfalseForm8886TFiled
Non Deductible ContributionsfalseNonDeductibleContributions
Non Deductible DisclosurefalseNonDeductibleDisclosure
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Quid Pro Quo DisclosurefalseQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Form8899 FiledfalseForm8899Filed
Form1098 C FiledfalseForm1098CFiled
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Form720 FiledfalseForm720Filed
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members3NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Policies Reference ChaptersfalsePoliciesReferenceChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonKEVIN RYMANOWSKI CFONamePerson
Telephone Number7636891162TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11995 E RUM RIVER DRIVE SAddressLine1
CityCAMBRIDGECity
StateMNState
ZIP Code55008ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (4 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
STEVE CHIES
Vice President40.00XX032123859425
KEVIN RYMANOWSKI
CFO & Tres/Sec.40.00XX027041746886
DAVID BRENNAN
CEO / ADMIN40.00X013410032795
DALE THOMPSON
CEO & PRES.40.00XX0571536109913
FieldValueIRS element (for citing)
Total Reportable Comp Frm Rltd Orgs1297291TotalReportableCompFrmRltdOrgs
Total Other Compensation249019TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
BENEDICTINE HEALTH SYSTEM
1995 E RUM RIVER DRIVE SCAMBRIDGEMN55008MANAGING COMPANY728288
AVIANDS
1751 W COUNTY RD BROSEVILLEMN55113DIETARY SERVICES297402
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Government Grants8500GovernmentGrants
Total Contributions8500TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionRESIDENT SERVICESDescription
Business Code623000BusinessCode
Total Revenue Column11108799TotalRevenueColumn
Related Or Exempt Function Income11108799RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue11108799TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2722TotalRevenueColumn
Exclusion$2,722ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11120021TotalRevenueColumn
Related Or Exempt Function Income11108799RelatedOrExemptFunctionIncome
Exclusion$2,722ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total467562Total
Program Services467562ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total0Total

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4749962Total
Program Services4469522ProgramServices
Management And General280440ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total88568Total
Program Services82811ProgramServices
Management And General5757ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total679772Total
Program Services635587ProgramServices
Management And General44185ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total385863Total
Program Services360782ProgramServices
Management And General25081ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total728288Total
Management And General728288ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total11569Total
Management And General11569ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total7749Total
Management And General7749ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total1306Total
Program Services1306ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total817357Total
Program Services787738ProgramServices
Management And General29619ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total458870Total
Program Services458870ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total6706Total
Program Services3596ProgramServices
Management And General3110ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total4817Total
Program Services2470ProgramServices
Management And General2347ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total222617Total
Program Services222617ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total82603Total
Program Services82603ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
SURCHARGE309650309650
PURCHASED SERVICES569269569269
PROFESSIONAL FEES8065080650
FOOD223607223607
Bad Debts8677586775

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total138795Total
Program Services113514ProgramServices
Management And General25281ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total10122355Total
Program Services8958929ProgramServices
Management And General1163426ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1754276BOY
EOY2685503EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
EOY0EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1514574BOY
EOY1795100EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
EOY0EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY9863BOY
EOY9713EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis5741447LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1528958LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4299778BOY
EOY4212489EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY163769BOY
EOY152342EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY943990BOY
EOY968524EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY8686250BOY
EOY9823671EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY734936BOY
EOY870587EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY3783735BOY
EOY3606671EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY48736BOY
EOY65478EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY891BOY
EOY943EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY4568298BOY
EOY4543679EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4102699BOY
EOY5254194EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY15253BOY
EOY25798EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY4117952BOY
EOY5279992EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY8686250BOY
EOY9823671EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses997666ReconcilationRevenueExpenses
Reconcilation Other Changes164374ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired
Federal Grant Audit PerformedfalseFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1809CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years7692CurrentTaxYearMinus3Years
Current Tax Year Minus1 Year5008CurrentTaxYearMinus1Year
Current Tax Year8500CurrentTaxYear
Total23009Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10438264CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10435164CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10841812CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10984203CurrentTaxYearMinus1Year
Current Tax Year11108799CurrentTaxYear
Total53808242Total

Gross Receipts From Non UBI GrossReceiptsFromNonUBI

FieldValueIRS element (for citing)
Total0Total

Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509

FieldValueIRS element (for citing)
Total0Total

Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt

FieldValueIRS element (for citing)
Total0Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10440073CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10442856CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10841812CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10989211CurrentTaxYearMinus1Year
Current Tax Year11117299CurrentTaxYear
Total53831251Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total50953831251PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years53837CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years38244CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14106CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9833CurrentTaxYearMinus1Year
Current Tax Year2722CurrentTaxYear
Total118742Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Total0Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years53837CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years38244CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years14106CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year9833CurrentTaxYearMinus1Year
Current Tax Year2722CurrentTaxYear
Total118742Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Total0Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Total0Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years10493910CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years10481100CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years10855918CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10999044CurrentTaxYearMinus1Year
Current Tax Year11120021CurrentTaxYear
Total53949993Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99780PublicSupportPercentage509
Prior Year Support Percentage0.99730PriorYearSupportPercentage
Investment Income Percentage0.00220InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00270PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FStrueIncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis300000OtherCostOrOtherBasis
Book Value300000BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis4433058OtherCostOrOtherBasis
Depreciation783342Depreciation
Book Value3649716BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis16295OtherCostOrOtherBasis
Depreciation10100Depreciation
Book Value6195BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis992094OtherCostOrOtherBasis
Depreciation735516Depreciation
Book Value256578BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings4212489TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
Rounding2
OTHER LIMITED USE ASSET25797
DEBT SERVICE RESERVE FUND474947
BOND FUND AND ESCROW DEPOISTS467778
FieldValueIRS element (for citing)
Total Book Value Other Assets968524TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionASSET RETIREMENTDescription
Amount$943Amount
FieldValueIRS element (for citing)
Total Of Amounts943TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part XPart X : FIN48 FootnoteTax Exempt StatusBHS has been determined to qualify as a tax-exempt charitable, educational, and scientific organization under Section 501 (c)(3) of the Internal Revenue Code and also has been determined to be exempt from state income tax. The Organization follows the accounting standard for contingencies in evaluating the accounting for uncertainty in income taxes recognized in an entity's financial statements. The 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 Organization income tax returns are subject to review and examination by federal, state, and local authorities. The Organization is not aware of any activities that would jeopardize its tax-exempt status. The Organization is not aware of any activities that are subject to tax on unrelated business income or excise or other taxes. The tax returns for the fiscal years 2008 to 2010 are open to examination by federal, local, and state authorities.
Part XI, Line 8Part XI, Line 8: Other Changes in Net Assets or Fund BalancesWorkers Comp Surplus $153829 Change in Interest in Net Assets of Affiliated Foundation $10545
Part IV, Line 2bPart IV, Line 2b: Explanation of escrow account liabilityCARETAKER OF RESIDENT TRUST FUNDS IN A SEPARATE ACCOUNT.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistancePurpose Of GrantPurposeOfGrant
BHS FOUNDATION
503 E THIRD STDULUTHMN55805411513014501 (C) 3125190SUPPORT
BENEDICTINE HEALTH SYS
1995 E RUM RIVER DRIVE SCAMBRIDGEMN55008411531892501 (C) 34550430CAPITAL FUND / SUPPORT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierGrantmaker's Description of How Grants are UsedIdentifier
ExplanationTRANSFERS BETWEEN RELATED ORGANIZATIONS ARE ACCOUNTED FOR IN INTERNAL FINANCIAL STATEMENTS, OF WHICH ALL ARE UNDER COMMON CONTROL.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException
Rebuttable Presumption ProcedurefalseRebuttablePresumptionProcedure

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

Comp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
STEVE CHIES
229840477934360549537988838066349537
KEVIN RYMANOWSKI
2116494441514353281961869031730328196
DAVID BRENNAN
1087991856567363254325216689532543
DALE THOMPSON
451161120375946421527168144994642

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Series 2004 A Health Care Facilities Rev BondsBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN416005375IssuerEIN
CUSIP Number60374QAD6CUSIPNumber
Date Issued2004-11-01DateIssued
Issue Price4737453IssuePrice
Description Of PurposeSEE PART VDescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer
Pool FinancingfalsePoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired850000AmountRetired
Total Proceeds4737453TotalProceeds
Amount In Reserve Fund429737AmountInReserveFund
Issuance Costs From Proceeds192716IssuanceCostsFromProceeds
Capital Expenditures4115000CapitalExpenditures
Year Of Subst Completion2004YearOfSubstCompletion
Current RefundingfalseCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtyfalseMngmentCntrctBondFinancdPrprty
Any Research AgreementsfalseAnyResearchAgreements
Post Issuance Compliance ProcdrstruePostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T FiledfalseForm8038TFiled
Variable Rate IssuefalseVariableRateIssue
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC
Regulatory Safe Harbor SatisfiedfalseRegulatorySafeHarborSatisfied
Exception To RebatefalseExceptionToRebate

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
ExplanationUSE OF PROCEEDS - PURSUANT TO THE LOAN AGREEMENT, ALL PROCEEDS FROM THE SALE OF SERIES 2004 BONDS WILL BE LOANED TO CITY OF LAKES TO FINANCE THE ACQUISITION, EQUIPPING AND RENOVATION OF THE PROJECT - RELOCATION OF ITS OPERATIONS FROM PRIOR FACILITY TO A NEW FACILITY, FUND A DEBT SERVICE FUND AND PAY CERTAIN COSTS OF ISSUING THE SERIES 2004 BONDS.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
OFFICIER COMPENSATIONDALE THOMPSON CEO, STEVE CHIES VP, AND KEVIN RYMANOWSKI CFO OF BENEDICTINE HEALTH SYSTEM 41-1531892 SHARE THEIR TIME BETWEEN THE REPORTING ORGANIZATION AND THE FOLLOWING RELATED ORGANIZATIONS.ARROWHEAD SENIOR LIVING COMMUNITY41-1978619BENEDICTINE CARE CENTERS41-1907571BENEDICTINE HEALTH CENTER41-1381401BENEDICTINE HEALTH SYSTEM 41-1531892BENEDICTINE HEALTH SYSTEM FOUNDATION41-1513014BENEDICTINE LIVING COMMUNITIES41-1639687BENEDICTINE LIVING COMMUNITIES -BISMARCK INC.26-4376543BENEDICTINE LIVING COMMUNITY OF MORA27-4219119BENEDICTINE LIVING COMMUNITY OF NEW LONDON27-4218436BENEDICTINE LIVING COMMUNITY OF SPOONER45-0700468BENEDICTINE LIVING COMMUNITY OF ST. PETER86-1113231BENEDICTINE LIVING COMMUNITY OF WINSTED27-4219293BENEDICTINE SENIOR LIVING COMMUNITY OF ST PETER27-2716531BRIDGES CARE COMMUNITY26-2620983CENERITY SENIOR CARE36-3517696CERENITY CARE CENTER - WHITE BEAR LAKE41-1983267CITY OF LAKES CARE CENTER41-1985663ELLENDALE EVERGREEN PLACE, INC41-1796445LIVING COMMUNITY OF ST. JOSEPH41-2011661MADONNA MEADOWS OF ROCHESTER47-0855891MADONNA TOWERS OF ROCHESTER, INC41-1809914NAZARETH LIVING CENTER43-1450394ROSEWOOD COURT41-2011389SAINT ANNE OF WINONA41-0850791ST. GERTRUDE'S HEALTH CENTER41-1848720STEELE COUNTY COMMUNITIES FOR A LIFETIME INC27-0705237STEEPLE POINTE SENIOR LIVING COMMUNITY41-1852273TEKAWITHA NURSING CENTER, INC41-1809912VILLA ST. BENEDICT36-4343235VILLA ST. VINCENT 41-1352227
Form 990, Part VI, Line 19: Other Organization Documents Publicly AvailableNOT AVAILABLE TO PUBLICForm 990, Part VI, Line 19
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of ConflictsThis Corporation shall not enter into any contract or transaction with (a) its Director or officer or a member of the family of a Director or an officer; (b) a director or officer of a related organization (within the meaning of Minnesota Statutes, section 317A.011, Subd. 18) or a member of the family of a director or officer of a related organization; or (c) an organization in or of which this Corporation's Director or officer is a director, officer or legal representative or has a material financial interest; unless the material facts as to the contract or transaction and as to the director's or officer's interest are fully disclosed or known to the Board of Directors, and the Board of Directors authorizes, approves, or ratifies the contract or transaction in good faith by the affirmative vote (without counting any interested Director) of a majority of the entire Board of Directors, at a meeting at which there is a quorum without counting any interested Director. For purposes of these Bylaws, "member of the family" of a director or officer shall mean a spouse, parent, child, spouse of a child, brother, sister, or spouse of a brother or sister, of the director or officer. Failure to comply with the provisions of this section shall not invalidate any contract or transaction to which this Corporation is a party. The provisions of this section shall not apply to any contracts or transaction between or among BHS and its Subsidiaries.Form 990, Part VI, Line 12c
Form 990, Part VI, Line 11: Form 990 Review ProcessAN ELECTRONIC COPY OF THE FORM 990 WAS DISTRIBUTED PRIOR TO FILING.Form 990, Part VI, Line 11
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing BodyEach Director of the Corporation is appointed by Benedictine Health System.Form 990, Part VI, Line 7a
Form 990, Part VI, Line 6: Explanation of Classes of Members or ShareholderBenedictine Health System, a Minnesota nonprofit corporation, is the sole member of the Corporation.Form 990, Part VI, Line 6
Form 990, Part VI, Line 3: Description of Delegated Duties to Management CompanyThe Corporation contracts with Benedictine Health System, a related organization, for Management Services. Benedictine Health System employed the Administrator/CEO of the CorporationForm 990, Part VI, Line 3

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (19 entries)

EINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
BENEDICTINE LIVING COMMUNITY OF WINSTED
274219293NURSING HOMEMN501 (C) 39BHSfalse
BENEDICTINE LIVING COMM OF SPOONER
450700468NURSING HOMEMN501 (C) 39BHSfalse
BENEDICTINE LIVING COMMUNITY OF NEW LOND
274218436NURSING HOMEMN501 (C) 39BHSfalse
BENEDICTINE LIVING COMMUNITY OF MORA
274219119NURSING HOMEMN501 (C) 39BHSfalse
ARROWHEAD SENIOR LIV COM
411978619NURSING HOMEMN501 (C) 39BHSfalse
Tekakwitha Living Center
411809912NURSING HOMEMN501 (C) 39BHSfalse
St Gertrudes Health & Rehab
411848720NURSING HOMEMN501 (C) 39BHSfalse
Saint Anne of Winona
410850791NURSING HOMEMN501 (C) 39BHSfalse
Madonna Towers of Rochester
411809914NURSING HOMEMN501 (C) 39BHSfalse
Living Community of St Joseph
412011661NURSING HOMEMN501 (C) 39BHSfalse
BHS FOUNDATION
411513014SUPPORTING ORGMN501 (C) 311BHSfalse
Cerenity Care Cen- White Bear Lake
411983267NURSING HOMEMN501 (C) 39BHSfalse
Cerenity Senior Care
363517696NURSING HOMEMN501 (C) 39BHSfalse
Benedictine Senior Liv at Steeple Point
411852273NURSING HOMEMN501 (C) 39BHSfalse
Benedictine Living Com of St Peter
861113231NURSING HOMEMN501 (C) 39BHSfalse
Benedictine Living Communities
411639687NURSING HOMEMN501 (C) 39BHSfalse
BENEDICTINE CARE CENTERS
411907571NURSING HOMEMN501 (C) 39BHSfalse
BENEDICTINE HEALTH CENTER
411381401NURSING HOMEMN501 (C) 39BHSfalse
BENEDICTINE HEALTH SYSTEM
411531892SUPPORTIN ORGMN501 (C) 311falseN/A
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg