FURP.ORG / PUBLIC DATA EXPLORER

HEALTHEAST CARE CENTER-WHITE BEAR LAKE: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
HEALTHEAST CARE CENTER-WHITE BEAR LAKE (EIN 41-1983267)
Tax period
2020-07-01 to 2021-06-30
Filed
2022-05-15
IRS object ID
202201359349300535
Schema version
2020v4.2
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)
Return2022-05-15T11:45:19-05:00ReturnTs
Tax Period End2021-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1220 S 6TH STREET SUITE 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55402ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN411983267EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CERENITY CARE CENTER - WHITE BEAR LAKEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCEREBusinessNameControlTxt
Phone7633472200PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line16499 UNIVERSITY AVE NE SUITE 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55432ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKEVIN RYMANOWSKIPersonNm
Person TitleCFOPersonTitleTxt
Phone7633472200PhoneNum
Signature2022-05-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstKEVINPersonFirstNm
Person LastRYMANOWSKIPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCHRISTOPHER STEINHOFFPreparerPersonNm
PTINP01587351PTIN
Phone6123764500PhoneNum
Preparation2022-05-13PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerPAT MCDONALDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line16499 UNIVERSITY AVE NE SUITE 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55432ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$19,878,370GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CERENITYSENIORCARE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2000FormationYr
Legal Domicile StateMNLegalDomicileStateCd
Activity Or MissionTO ASSIST AND COORDINATE ACTIVITES OF, AND FACILITIES, FOR, HEALTH CARE, SOCIAL SERVICES, EDUCATION AND RESEARCH.ActivityOrMissionDesc
Voting Members Governing Body4VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee409TotalEmployeeCnt
Total Volunteers500TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$654,978PYContributionsGrantsAmt
CY Contributions Grants$679,949CYContributionsGrantsAmt
PY Program Service Revenue$20,275,941PYProgramServiceRevenueAmt
CY Program Service Revenue$19,141,159CYProgramServiceRevenueAmt
PY Investment Income$5,208PYInvestmentIncomeAmt
CY Investment Income$11,325CYInvestmentIncomeAmt
PY Other Revenue$13,582PYOtherRevenueAmt
CY Other Revenue$45,937CYOtherRevenueAmt
PY Total Revenue$20,949,709PYTotalRevenueAmt
CY Total Revenue$19,878,370CYTotalRevenueAmt
PY Grants And Similar Paid$107,746PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$128,130CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$12,215,670PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$12,010,696CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$6,937,841PYOtherExpensesAmt
CY Other Expenses$7,135,689CYOtherExpensesAmt
PY Total Expenses$19,261,257PYTotalExpensesAmt
CY Total Expenses$19,274,515CYTotalExpensesAmt
PY Revenues Less Expenses$1,688,452PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$603,855CYRevenuesLessExpensesAmt
Total Assets BOY$21,310,263TotalAssetsBOYAmt
Total Assets EOY$21,500,066TotalAssetsEOYAmt
Total Liabilities BOY$14,250,572TotalLiabilitiesBOYAmt
Total Liabilities EOY$13,797,422TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,059,691NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$7,702,644NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionCERENITY CARE CENTER -WBL IS ORGANIZED TO OWN, MAINTAIN, OPERATE, AND CONDUCT, DIRECTLY AND INDIRECTLY, HEALTH CARE FACILITIES FOR LONG TERM CARE AND CONGREGATE, ASSISTED AND INDEPENDENT HOUSING FOR THE ELDERLY, AND TO ASSIST AND COORDINATE ACTIVITIES OF, AND FACILITIES FOR, HEALTH CARE, SOCIAL SERVICES, EDUCATION, AND RESEARCH.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$15,107,705ExpenseAmt
Grant$128,130GrantAmt
Revenue$17,416,149RevenueAmt
DescOPERATION OF CERENITY CARE CENTER - WHITE BEAR LAKE, IS A 138 BED LONG-TERM FACILITY IN WHITE BEAR LAKE, MINNESOTA WHICH PROVIDES SKILLED NURSING CARE TO THE ELDERLY.THE FACILITY HAD 79.2% OCCUPANCY AND SERVED 703 INDIVIDUALS DURING THE FISCAL YEAR ENDING 6/30/2021.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,496,366ExpenseAmt
Grant$0GrantAmt
Revenue$1,725,010RevenueAmt
DescOPERATION OF WHITE BEAR LAKE ASSISTED LIVING CENTER, IS A 43 BED LONG-TERM CARE IN WHITE BEAR LAKE, MINNESOTA WHICH PROVIDES ASSISTED LIVING CARE TO THE ELDERLY.THE FACILITY HAD A 84.1% OCCUPANCY AND SERVED 56 INDIVIDUALS DURING THE FISCAL YEAR ENDING 6/30/2021.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$16,604,071TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document40IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee409EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members4GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1KEVIN RYMANOWSKI CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7636896107PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line16499 UNIVERSITY AVE NE SUITE 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55432ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
WILLIAM FOUSSARD
DIRECTOR1.001.00Yes (X)$0$0$0
JOAN GRZYWINSKI
DIRECTOR1.001.00Yes (X)$0$0$0
DAWN KSEPKA
DIRECTOR1.001.00Yes (X)$0$0$0
JONATHAN LUNDBERG
DIRECTOR1.001.00Yes (X)$0$0$0
JERRY CARLEY
DIRECTOR & CEO OF BHS1.0039.00$0$798,732$129,754Yes (X)
KEVIN RYMANOWSKI
DIRECTOR & CFO OF BHS1.0039.00$0$424,864$143,637Yes (X)
JENNIFER BRUHN
PRESIDENT39.001.00$0$184,714$29,177Yes (X)
PAT MCDONALD
ADMINISTRATOR40.000.00$0$160,764$29,435Yes (X)
FOLABOMI JOSEPH
RN40.000.00$110,873$0$10,184Yes (X)
JESSICA JOHNSON
RN40.000.00$103,084$0$16,807Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$213,957TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,569,074TotReportableCompRltdOrgAmt
Total Other Compensation$358,994TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K2IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
BENEDICTINE HEALTH SYSTEM
1995 E RUM RIVER DRIVE SCAMBRIDGEMN55008MANAGING COMPANY$1,332,041
US FOOD SERVICE NW 6059
BOA ATTN US FOODS 3682 COLLECTIONCHICAGOIL60693FOOD & CULINARY SUPPLIES$637,689
METRO NURSING STAFFING SERVICES LLC
6000 BASS LAKE RD SUITE 111CRYSTALMN55429TEMPORARY NURSE STAFFING$627,085
OMNICARE OF MINNESOTA INC - DETRIOT
DEPT 781668 PO BOX 78000DETROITMI482781668PHARMACY SERVICES$434,607
MCKESSON MEDICAL
PO BOX 630693CINCINNATIOH452630693MEDICAL SUPPLIES$250,640
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K8CntrctRcvdGreaterThan100KCnt
Related Organizations$72,325RelatedOrganizationsAmt
Government Grants$607,624GovernmentGrantsAmt
Total Contributions$679,949TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
RESIDENT SERVICES623000$17,408,608$17,408,608
ASSISTED LIVING623000$1,724,450$1,724,450
TELEPHONE REVENUE623000$7,541$7,541
MEAL REVENUE623000$560$560
FieldValueIRS element (for citing)
Total Program Service Revenue$19,141,159TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$11,325TotalRevenueColumnAmt
Exclusion$11,325ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$11,500RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$11,500RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$11,500TotalRevenueColumnAmt
Exclusion$11,500ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
MISCELLANEOUS900099$34,259$34,259
VENDING INCOME900099$178$178
FieldValueIRS element (for citing)
Other Revenue Total$34,437OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$19,878,370TotalRevenueColumnAmt
Related Or Exempt Func Income$19,141,159RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$57,262ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$82,401TotalAmt
Program Services$82,401ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$45,729TotalAmt
Program Services$45,729ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$9,511,030TotalAmt
Program Services$9,012,753ProgramServicesAmt
Management And General$498,277ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$226,361TotalAmt
Program Services$214,502ProgramServicesAmt
Management And General$11,859ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,501,723TotalAmt
Program Services$1,423,049ProgramServicesAmt
Management And General$78,674ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$771,582TotalAmt
Program Services$731,159ProgramServicesAmt
Management And General$40,423ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,213,428TotalAmt
Management And General$1,213,428ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$32,150TotalAmt
Management And General$32,150ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$8,221TotalAmt
Management And General$8,221ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,062,599TotalAmt
Program Services$926,564ProgramServicesAmt
Management And General$136,035ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$86,172TotalAmt
Management And General$86,172ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$122,398TotalAmt
Program Services$21,085ProgramServicesAmt
Management And General$101,313ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$564,282TotalAmt
Program Services$552,935ProgramServicesAmt
Management And General$11,347ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$20,856TotalAmt
Program Services$18,202ProgramServicesAmt
Management And General$2,654ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$366,460TotalAmt
Program Services$366,316ProgramServicesAmt
Management And General$144ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$754,153TotalAmt
Program Services$754,153ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$177,551TotalAmt
Management And General$177,551ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLY EXPENSE$1,927,616$1,927,616
SURCHARGE$388,470$388,470
BAD DEBTS$176,713$176,713
EDUCATION & TRAINING$86,265$85,855$410

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$148,355TotalAmt
Program Services$53,282ProgramServicesAmt
Management And General$95,073ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$19,274,515TotalAmt
Program Services$16,604,071ProgramServicesAmt
Management And General$2,670,444ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$3,709,276BOYAmt
EOY$3,536,286EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,547,810BOYAmt
EOY$2,655,543EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$128,438BOYAmt
EOY$190,270EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$31,610,357LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$17,289,163LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$14,195,154BOYAmt
EOY$14,321,194EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$729,585BOYAmt
EOY$796,773EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$21,310,263BOYAmt
EOY$21,500,066EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,841,387BOYAmt
EOY$2,126,727EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$336,000BOYAmt
EOY$239,478EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$11,905,926BOYAmt
EOY$11,311,775EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$55,814BOYAmt
EOY$45,115EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$111,445BOYAmt
EOY$74,327EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$14,250,572BOYAmt
EOY$13,797,422EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$6,692,614BOYAmt
EOY$7,296,469EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$367,077BOYAmt
EOY$406,175EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,059,691BOYAmt
EOY$7,702,644EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$21,310,263BOYAmt
EOY$21,500,066EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$603,855ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$39,098OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$20,523CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$28,021CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus1 Year$654,978CurrentTaxYearMinus1YearAmt
Current Tax Year$679,949CurrentTaxYearAmt
Total$1,383,471TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$17,116,339CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$18,650,811CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$19,433,979CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$20,275,941CurrentTaxYearMinus1YearAmt
Current Tax Year$19,141,159CurrentTaxYearAmt
Total$94,618,229TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$17,136,862CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$18,678,832CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$19,433,979CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$20,930,919CurrentTaxYearMinus1YearAmt
Current Tax Year$19,821,108CurrentTaxYearAmt
Total$96,001,700TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$96,001,700PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,977CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,396CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$15,161CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$16,208CurrentTaxYearMinus1YearAmt
Current Tax Year$22,825CurrentTaxYearAmt
Total$59,567TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,977CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$3,396CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$15,161CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$16,208CurrentTaxYearMinus1YearAmt
Current Tax Year$22,825CurrentTaxYearAmt
Total$59,567TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$2,544CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,582CurrentTaxYearMinus1YearAmt
Current Tax Year$34,407CurrentTaxYearAmt
Total$39,533TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$17,138,839CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$18,682,228CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$19,451,684CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$20,949,709CurrentTaxYearMinus1YearAmt
Current Tax Year$19,878,340CurrentTaxYearAmt
Total$96,100,800TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99900PublicSupportCY509Pct
Public Support PY5090.99950PublicSupportPY509Pct
Investment Income CY0.00060InvestmentIncomeCYPct
Investment Income PY0.00040InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME:FormAndLineReferenceDesc
ExplanationMISCELLANEOUS INCOME VENDING INCOMEExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,879,561OtherCostOrOtherBasisAmt
Book Value$1,879,561BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$24,468,555OtherCostOrOtherBasisAmt
Depreciation$12,908,742DepreciationAmt
Book Value$11,559,813BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,262,241OtherCostOrOtherBasisAmt
Depreciation$4,380,421DepreciationAmt
Book Value$881,820BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$14,321,194TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
ASSET RETIREMENT OBLIGATION$19,672
DUE TO AFFILIATES$54,655
FieldValueIRS element (for citing)
Total Liability$74,327TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:CARETAKER OF RESIDENT TRUST FUNDS AND SECURITY DEPOSITS IN A SEPARATE ACCOUNT.
PART X, LINE 2:TAX EXEMPT STATUS BHS 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'S 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 FILES ALL APPLICABLE RETURNS FOR ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1BENEDICTINE HEALTH SYSTEM FOUNDATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1503 EAST THIRD STREETAddressLine1Txt
CityDULUTHCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55805ZIPCd
FieldValueIRS element (for citing)
Recipient EIN411513014RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$82,401CashGrantAmt
Valuation Method UsedN/AValuationMethodUsedDesc
Non Cash AssistanceN/ANonCashAssistanceDesc
Purpose Of GrantGENERAL OPERATING SUPPORTPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeSCHOLARSHIP PROGRAMGrantTypeTxt
Recipient11RecipientCnt
Cash Grant$45,134CashGrantAmt
Valuation Method UsedN/AValuationMethodUsedDesc
Non Cash AssistanceN/ANonCashAssistanceDesc

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationCCC - WHITE BEAR LAKE OFFERS EMPLOYEES TUITION PAYMENT THROUGH AN EDUCATIONAL ASSISTANCE PLAN THAT COMPLIES WITH SECTION 127 OF THE INTERNAL REVENUE CODE AND THE MINNESOTA NURSING FACILITY EMPLOYEE SCHOLARSHIP FUND (BULLETIN #01-62-05). TO PROVIDE PAYMENT FOR EXPENSES INCURRED BY ELIGIBLE SENIOR CARE EMPLOYEES FOR THE SUCCESSFUL COMPLETION OF APPROVED COURSES THAT LEAD TO CAREER ADVANCEMENT WITHIN WHITE BEAR LAKE.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
JERRY CARLEY
DIRECTOR & CEO OF BHS$0$551,790$0$125,753$0$121,189$0$106,948$0$22,806$0$928,486$0$0
KEVIN RYMANOWSKI
DIRECTOR & CFO OF BHS$0$328,193$0$61,982$0$34,689$0$118,225$0$25,412$0$568,501$0$0
JENNIFER BRUHN
PRESIDENT$0$169,501$0$11,844$0$3,369$0$20,332$0$8,845$0$213,891$0$0
PAT MCDONALD
ADMINISTRATOR$0$123,294$0$18,713$0$18,757$0$15,345$0$14,090$0$190,199$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART III - ADDITIONAL INFORMATIONFormAndLineReferenceDesc
ExplanationBENEDICTINE HEALTH SYSTEM'S (EIN: 41-1531892) CEO AND CFO, JERRY CARLEY AND KEVIN RYMANOWSKI, SHARE THEIR TIME BETWEEN THE REPORTING ORGANIZATION AND RELATED ORGANIZATIONS. THE CEO IS COMPENSATED BY BENEDICTINE HEALTH SYSTEM, A RELATED ORGANIZATION. THIS ORGANIZATION USES THE FOLLOWING TO SET CEO/ ADMINISTRATIVE COMPENSATIONS: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. WRITTEN EMPLOYMENT CONTRACT 4. COMPENSATION SURVEY OR STUDY 5. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1CITY OF WHITE BEAR LAKEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN416005641BondIssuerEIN
Bond Issued2015-12-29BondIssuedDt
Issue Price$14,665,000IssuePriceAmt
PurposeREFUNDPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$3,092,584RetiredAmt
Total Proceeds$14,665,000TotalProceedsAmt
Capitalized Interest$500,626CapitalizedInterestAmt
Refunding Escrow$13,894,641RefundingEscrowAmt
Issuance Costs From Proceeds$269,733IssuanceCostsFromProceedsAmt
Substantial Completion2016SubstantialCompletionYr
Refunding Tax Exempt BondsYes (1)RefundingTaxExemptBondsInd
Refunding Taxable Bonds0RefundingTaxableBondsInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (1)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due YetYes (1)RebateNotDueYetInd
Exception To Rebate0ExceptionToRebateInd
No Rebate Due0NoRebateDueInd
Variable Rate IssueYes (1)VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (1)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (1)ProceduresCorrectiveActionInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 1THE EXECUTIVE COMMITTEE (COMPRISED OF THE CHAIR, VICE-CHAIR, BOARD SECRETARY, AND THE CHAIRS OF THE STANDING COMMITTEES) IS AUTHORIZED TO ACT ON BEHALF OF THE BOARD IN THE INTERVAL BETWEEN MEETINGS OF THE BOARD, PROVIDED, HOWEVER, THAT IT MAY NOT DETERMINATE MATTERS OF POLICY WITHOUT PRIOR SPECIFIC AUTHORIZATION OF THE BOARD.
FORM 990, PART VI, SECTION A, LINE 3THE CORPORATION CONTRACTS WITH BENEDICTINE HEALTH SYSTEM, A RELATED ORGANIZATION, FOR MANAGEMENT SERVICES. BENEDICTINE HEALTH SYSTEM EMPLOYED THE PRESIDENT/CEO OF THE CORPORATION AND THE ADMINISTRATORS OF THE FACILITY.
FORM 990, PART VI, SECTION A, LINE 6CERENITY SENIOR CARE, A MINNESOTA NONPROFIT CORPORATION, IS THE SOLE MEMBER OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7AEACH DIRECTOR OF THE CORPORATION IS APPOINTED BY THE VOTING MEMBERS IN ACCORDANCE WITH THE MEMBERSHIP AGREEMENT.
FORM 990, PART VI, SECTION A, LINE 7BCERENITY SENIOR CARE HAS CERTAIN RESERVED POWERS RELATING TO THE ACTIVITIES OF THE CORPORATION AS SET OUT IN THE CORPORATION'S BY-LAWS.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM WITH INFORMATION PROVIDED BY MANAGEMENT. THE RETURN WAS THEN REVIEWED BY THE CFO. AN ELECTRONIC COPY OF THE FORM 990 WAS DISTRIBUTED TO THE GOVERNING BODY PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO DISCLOSE ANY RELATIONSHIPS THAT CONSTITUTE OR MIGHT LEAD TO A CONFLICT OF INTEREST BY COMPLETING THE CONFLICT OF INTEREST AND GIFT DISCLOSURE STATEMENT. THE BHS COMPLIANCE DEPARTMENT WILL DISTRIBUTE THE STATEMENTS AND COLLECT AND MAINTAIN THE COMPLETED STATEMENTS. THE BHS COMPLIANCE MANAGER WILL REVIEW THE STATEMENTS AND PROVIDE A SUMMARY OF THE IDENTIFIED CONFLICTS OF INTEREST TO THE BHS CHIEF COMPLIANCE OFFICER, WHO WILL ALERT THE BHS CEO AND THE CHAIR OF THE BHS BOARD OF DIRECTORS TO ANY ITEMS OF CONCERN. AN "INTERESTED PERSON" IS ANY PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE SYSTEM, INCLUDING BUT NOT LIMITED TO A BOARD MEMBER, BOARD COMMITTEE MEMBER, OR OFFICER OR DIRECTOR OF BHS OR A FACILITY (SUCH AS FACILITY CEO/ADMINISTRATORS AND BHS SENIOR LEADERS AND DIRECTORS). FOR INTERESTED PERSONS WHO ARE EMPLOYEES (OTHER THAN THE BHS CEO), FOLLOWING DISCLOSURE OF THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST AND ALL MATERIAL FACTS,THE INTERESTED PERSON'S SUPERVISOR WILL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. FOR THE BHS CEO AND BOARD AND COMMITTEE MEMBERS, FOLLOWING DISCLOSURE OF THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST AND ALL MATERIAL FACTS, THE INTERESTED PERSON WILL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE REMAINING MEMBERS OF THE BOARD OR COMMITTEE DETERMINE IF A CONFLICT OF INTEREST EXISTS. THE INTERESTED PERSON MAY PARTICIPATE IN DELIBERATION REGARDING THE TRANSACTION IF THE APPLICABLE SUPERVISOR, BOARD, OR COMMITTEE DETERMINES A CONFLICT OF INTEREST DOES NOT EXIST. AN INTERESTED PERSON WHO HAS BEEN DETERMINED TO HAVE A CONFLICT OF INTEREST MAY NOT PARTICIPATE IN THE DELIBERATION OR DECISION REGARDING THE TRANSACTION OR ARRANGEMENT INVOLVING THE CONFLICT OF INTEREST AND MAY NOT BE PRESENT DURING SUCH DELIBERATION OR DECISION MAKING. THE INTERESTED PERSON MAY BE ALLOWED TO MAKE A PRESENTATION TO THE SUPERVISOR, BOARD, OR COMMITTEE CONSIDERING THE TRANSACTION OR ARRANGEMENT AS TO WHICH THE CONFLICT OF INTERESTS REFERS PRIOR TO THE DELIBERATION AND DECISION.
FORM 990, PART VI, SECTION B, LINE 15ACOMPENSATION FOR THE ORGANIZATION'S CEO IS DETERMINED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THIS COMMITTEE IS COMPRISED ENTIRELY OF INDEPENDENT DIRECTORS. THE COMPENSATION COMMITTEE REVIEWS DATA ON COMPENSATION PROVIDED TO INDIVIDUALS HOLDING COMPARABLE POSITIONS IN COMPARABLE ORGANIZATIONS IN ORDER TO ESTABLISH A REASONABLE COMPENSATION RANGE. THE DATA IS COLLECTED AND REVIEWED WITH THE COMPENSATION COMMITTEE BY AN INDEPENDENT CONSULTANT. BASED ON THE MARKET DATA AND IN LIGHT OF ANY SPECIFIC INDIVIDUAL BENEDICTINE HEALTH SYSTEM 41-1531892 QUALIFICATIONS, THE COMPENSATION COMMITTEE DETERMINES COMPENSATION. THE DELIBERATIONS AND DETERMINATIONS OF THE COMPENSATION COMMITTEE ARE RECORDED CONTEMPORANEOUSLY AND PROVIDED TO THE GOVERNING BODY FOR REVIEW. COMPENSATION FOR THE CFO, OTHER OFFICERS, AND OTHER KEY EMPLOYEES OF THE ORGANIZATION IS DETERMINED BY THE CEO.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
OFFICER COMPENSATIONBENEDICTINE HEALTH SYSTEM'S (EIN: 41-1531892) CEO AND CFO, JERRY CARLEY AND KEVIN RYMANOWSKI, SHARE THEIR TIME BETWEEN THE REPORTING ORGANIZATION AND THE FOLLOWING RELATED ORGANIZATIONS. SEE SCHEDULE R FOR INFORMATION ON RELATED ORGANIZATIONS.
FORM 990, PART XI, LINE 9:CHANGE IN INTEREST IN FOUNDATION 39,098.
FORM 990, PART XII, LINE 2C:THE BENEDICTINE HEALTH SYSTEM AUDIT/ FINANCE COMMITTEE OVERSEES THE SELECTION OF THE INDEPENDENT AUDITOR AND OVERSEES THE ANNUAL CONSOLIDATED AUDIT OF BENEDICTINE HEALTH SYSTEM AND AFFILIATES WHICH INCLUDES THE ORGANIZATION.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (29 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
BENEDICTINE HEALTH SYSTEM
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411531892SUPPORTING ORGANIZATIONMN501(C)(3)LINE 10N/A0
BENEDICTINE HEALTH SYSTEM FOUNDATION
503 E THIRD STREETDULUTHMN55805411513014FUND DEVELOPMENTMN501(C)(3)LINE 100BHS
BENEDICTINE CARE CENTERS
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411907571NURSING HOMESMN501(C)(3)LINE 10Yes (1)BHS
BENEDICTINE HEALTH CENTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411381401NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
CITY OF LAKES CARE CENTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411985663NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
BENEDICTINE LIVING COMMUNITIES
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411639687NURSING HOMESMN501(C)(3)LINE 10Yes (1)BHS
BLC OF ST PETER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432861113231NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
STEEPLE POINTE SEN LIVING COMMUNITY
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411852273NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
BRIDGES CARE CENTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432262620983NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
ELLENDALE EVERGREEN PLACE
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411796445ASSISTED LIVINGMN501(C)(3)LINE 10Yes (1)BHS
LIVING COMMUNITY OF ST JOSEPH
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432412011661NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
MADONNA MEADOWS OF ROCHESTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432470855891ASSISTED LIVINGMN501(C)(3)LINE 10Yes (1)BHS
MADONNA TOWERS OF ROCHESTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411809914NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
ROSEWOOD COURT
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432412011389ASSISTED LIVINGMN501(C)(3)LINE 10Yes (1)BHS
SAINT ANNE OF WINONA
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432410850791NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
ARROWHEAD SENIOR LIVING COMMUNITIES
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411978619NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
VILLA ST VINCENT
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411352227NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
BLC OF BISMARCK
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432264376543NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
NAZARETH LIVING CENTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432431450394NURSING FACILITYMN501(C)(3)LINE 10N/AYes (1)
BLC OF NEW LONDON
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432274218436NURSING HOMEWI501(C)(3)LINE 10Yes (1)BHS
BLC OF WINSTED
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432274219293NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
BSLC OF ST PETER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432272716531ASSISTED LIVINGMN501(C)(3)LINE 10Yes (1)BHS
BLC OF WAHPETON
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432454274091ASSISTED LIVINGMN501(C)(3)LINE 10Yes (1)BHS
CATHOLIC RESIDENTIAL SERVICES
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432390982340NURSING HOMEWI501(C)(3)LINE 10Yes (1)BHS
REGINA SENIOR LIVING
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432463700475NURSING HOMEMN501(C)(3)LINE 10Yes (1)BHS
KODA LIVING COMMUNITY
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432270705237NURSING HOMEMN501(C)(3)LINE 10N/AYes (1)
CERENITY SENIOR CARE
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411983267NURSING HOMEMN501(C)(3)LINE 10N/A0
ST GERTRUDE'S HEALTH CENTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411848720NURSING HOMEMN501(C)(3)LINE 100BHS
VILLA ST BENEDICT
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432364343235NURSING HOMEMN501(C)(3)LINE 10N/A0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1BENEDICTINE GROUP SELF-INSURANCE ASSOCIATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line16499 UNIVERSITY AVE NE SUITE 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55432ZIPCd
FieldValueIRS element (for citing)
EIN411548753EIN
Primary ActivitiesWORKERS' COMPENSATION PROGRAMPrimaryActivitiesTxt
Legal Domicile StateMNLegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Entity TypeSEntityTypeTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd