2021-05-14T11:42:35-05:00 2020-06-30 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2019-07-01 364343235 VILLA ST BENEDICT VILL 6308525360 1920 MAPLE AVENUE LISLE IL 60532 KEVIN RYMANOWSKI CFO 6308525360 2021-05-12 1 CHRISTOPHER STEINHOFF P01587351 6123764500 2021-05-12 2019 2022-09-23 18:48:47Z KATHY DICRISTINA 1920 MAPLE AVENUE LISLE IL 60532 15125736 0 X WWW.VILLASTBEN.ORG X 2000 MN COORDINATE ACTIVITES AND SERVICE OF FACILITIES FOR HEALTH CARE, EDUCATION, AND HOUSING FOR THE AGED AND SOCIAL SERVICES IN ACCORDANCE WITH THE CHARITABLE WORKS TRADITION OF THE ROMAN CATHOLIC CHURCH. 11 10 213 125 0 0 364806 50696 14171576 14788413 231576 239678 48923 46949 14816881 15125736 48101 0 0 0 5132099 5177857 0 0 0 8672960 8796861 13853160 13974718 963721 1151018 64531545 65527000 102651363 102155254 -38119818 -36628254 X SEE SCHEDULE O.THE CORPORATION WAS CREATED AND ORGANIZED TO OWN, MAINTAIN, OPERATE AND CONDUCT FACILITIES FOR THE LONG-TERM AND CONGREGATE CARE, AND ASSISTED AND INDEPENDENT LIVING TO THE ELDERLY IN A SINGLE CAMPUS COMMUNITY, AS WELL AS TO ASSIST AND COORDINATE ACTIVITIES AND SERVICE OF FACILITIES FOR HEALTH CARE, EDUCATION, AND HOUSING FOR THE AGED AND SOCIAL SERVICES IN ACCORDANCE WITH THE CHARITABLE WORKS TRADITION OF THE ROMAN CATHOLIC CHURCH. 0 0 10752114 0 14788413 OPERATION OF A CONTINUING CARE COMMUNITY IN LISLE, ILLINOIS FOR PERSONS 55 YEARS OF AGE OR OLDER, FOR THEIR SPOUSES OF ANY AGE, AND FOR PERSONS UNDER THE AGE OF 55 WHO ARE HANDICAPPED, WHICH INCLUDES 56 INDEPENDENT LIVING VILLAS, 140 INDEPENDENT LIVING APARTMENTS, 65 ASSISTED LIVING UNITS, AN UNDERGROUND PARKING STRUCTURE, AND RELATED COMMON AREAS. 10752114 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 1 0 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 0 1 0 0 0 1 10 0 1 213 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X KAREN SHERMAN 6308525360 1920 MAPLE AVE LISLE IL 60532 X JERRY CARLEY CEO OF BHS 1.00 39.00 X 0 611999 164837 KEVIN RYMANOWSKI TREASURER & CFO OF BHS 1.00 39.00 X X 0 403074 164300 KATHY DICRISTINA ADMINISTRATOR/CEO 40.00 0.00 X 0 232766 78084 PHYLLIS KRAMER DIR OF SALES & MARKETING 40.00 0.00 X 115995 0 0 JAY STERNS CHAIR 1.00 0.00 X X 0 0 0 SR HELEN JILEK VICE CHAIR 1.00 0.00 X X 0 0 0 ALICE SIMA SECRETARY 1.00 0.00 X X 0 0 0 SR MARY BRATRSOVSKY EX-OFFICIO 1.00 0.00 X 0 0 0 JEAN ELLIOTT DIRECTOR 1.00 0.00 X 0 0 0 SR JUDITH ANN HEBLE DIRECTOR 1.00 0.00 X 0 0 0 JO JERAK DIRECTOR 1.00 0.00 X 0 0 0 SR SHARON MARIE STOLA DIRECTOR 1.00 0.00 X 0 0 0 CHARLIE TOWNSEND DIRECTOR 1.00 0.00 X 0 0 0 JOHN VIDMAR DIRECTOR 1.00 0.00 X 0 0 0 115995 1247839 407221 1 0 1 0 BENEDICTINE HEALTH SYSTEM 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 MANAGEMENT SERVICES 610790 1 50696 50696 RESIDENT SERVICES 623000 13845085 13845085 AMORTIZATION OF ENT. F 623000 943328 943328 14788413 239678 239678 38362 0 38362 38362 38362 MISCELLANEOUS 900099 8587 8587 8587 15125736 14788413 0 286627 4295516 3117628 1177888 91793 66622 25171 479109 349435 129674 311439 226038 85401 608090 608090 3711 3711 38896 38896 468525 447140 21385 192048 192048 80641 11770 68871 76890 76890 1629351 1628623 728 5852 818 5034 25727 15886 9841 2576226 2576226 2415264 2204441 210823 126354 126354 EQUIPMENT RENTAL/MAINT. 258120 2510 255610 MINISTRY FEE 191329 191329 MEDICAL SUPPLY EXPENSE 76772 76772 MISCELLANEOUS 60773 4848 55925 -37708 23357 -61065 13974718 10752114 3222604 0 370520 607344 67929 10041 7017 8459 304245 299992 74638027 28485258 47190739 46152769 7480416 7748775 9110679 10699620 64531545 65527000 1098025 1220537 36234581 35663737 51967430 52800502 6728721 6728721 6622606 5741757 102651363 102155254 X -38484624 -37150402 364806 522148 -38119818 -36628254 64531545 65527000 X 1151018 183204 157342 X X 0 1 X 1 0 X 62736 59826 48876 316705 50696 538839 12913491 13774976 14057491 14171576 14788413 69705947 12976227 13834802 14106367 14488281 14839109 70244786 0 0 0 70244786 29270 58737 172335 272376 278040 810758 29270 58737 172335 272376 278040 810758 8123 8587 16710 13005497 13893539 14278702 14768780 15125736 71072254 0.98840 0.99170 0.01140 0.00820 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 70523407 25486614 45036793 3867410 2998644 868766 247210 247210 46152769 DEPOSITS FROM PROSPECTIVE RESIDENTS 98879 FUNDS HELD BY TRUSTEE 7454436 OTHER CURRENT ASSETS 540843 PREPAID LEASE, NET 2083314 INTEREST IN NET ASSETS OF AFFILIATED FOUNDATION 522148 10699620 AMOUNTS DUE TO AFFILIATES 5741757 5741757 X 15258244 183204 183204 15075040 50696 50696 15125736 13974718 0 13974718 0 13974718 PART IV, LINE 2B: REFUNDABLE ENTRANCE FEES PART X, LINE 2: TAX EXEMPT STATUS THE CORPORATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE IRC AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF IRC. THE CORPORATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE CORPORATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME, EXCISE, OR OTHER TAXES OR MAY JEOPARDIZE ITS TAX-EXEMPT STATUS. PART XI, LINE 4B - OTHER ADJUSTMENTS: TRANSFER FROM AFFILIATE 50,696. 0 0 0 0 0 0 0 0 0 JERRY CARLEY CEO OF BHS 0 471584 0 139725 0 690 0 126717 0 38120 0 776836 0 0 KEVIN RYMANOWSKI TREASURER & CFO OF BHS 0 335852 0 66540 0 682 0 136807 0 27493 0 567374 0 0 KATHY DICRISTINA ADMINISTRATOR/CEO 0 214715 0 18051 0 0 0 59809 0 18275 0 310850 0 0 PART I, LINE 3 BENEDICTINE HEALTH SYSTEM'S (EIN: 41-1531892) CEO AND CFO, JERRY CARLEY AND KEVIN RYMANOWSKI, SHARE THEIR TIME BETWEEN THE REPORTING ORGANIZATION AND RELATED ORGANIZATIONS. SEE SCHEDULE R FOR INFORMATION ON RELATED ORGANIZATIONS. THE CEO IS COMPENSATED BY BENEDICTINE HEALTH SYSTEM, A RELATED ORGANIZATION. THIS ORGANIZATION USES THE FOLLOWING TO SET CEO/ ADMINISTRATIVE COMPENSATION: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. WRITTEN EMPLOYMENT CONTRACT 4. COMPENSATION SURVEY OR STUDY 5. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE A ILLINOIS HEALTH FACILITATION 45203H3N0 2015-09-10 39030000 REFUND SERIES 2003 BONDS AND ESTABLISH DEBT SERVICE RESERVE FUND 0 0 0 A 1745000 39030000 3462192 34883312 684496 2015 1 0 1 1 A 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 FORM 990, PART VI, SECTION A, LINE 1 THE 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 3 THE CORPORATION CONTRACTS WITH BENEDICTINE HEALTH SYSTEM, A RELATED ORGANIZATION, FOR MANAGEMENT SERVICES. BENEDICTINE HEALTH SYSTEM EMPLOYED THE ADMINISTRATOR/CEO OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 6 BENEDICTINE HEALTH SYSTEM, A MINNESOTA NONPROFIT CORPORATION AND BENEDICTINE SISTERS OF THE SACRED HEART, AN ILLINOIS NONPROFIT CORPORATION ARE THE TWO MEMBERS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A BENEDICTINE SISTERS OF THE SACRED HEART (BSSH) AND BENEDICTINE HEALTH SYSTEM EACH HAVE THE AUTHORITY TO APPOINT FIVE MEMBERS TO BE VOTING DIRECTORS OF THE CORPORATION AND REMOVE SUCH MEMBERS, WITH OR WITHOUT CAUSE, AT ANY TIME. IN ADDITION THE CHIEF EXECUTIVE OFFICER OF BHS, OR DESIGNEE, AND THE PRESIDENT OF BSSH, OR DESIGNEE, SERVE AS EX-OFFICIO MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B BENEDICTINE SISTERS OF THE SACRED HEART AND BENEDICTINE HEALTH SYSTEM HAVE CERTAIN RESERVED POWERS RELATING TO THE ACTIVITIES OF THE CORPORATION AS SET OUT IN THE CORPORATION'S BY-LAWS. IN ADDITION, IN KEEPING WITH THE CORPORATION'S MISSION "TO ASSIST AND COORDINATE ACTIVITIES OF FACILITIES FOR HEALTH CARE, EDUCATION, AND CARE FOR THE AGED AND SOCIAL SERVICES IN ACCORDANCE WITH THE CHARITABLE WORKS TRADITION OF THE ROMAN CATHOLIC CHURCH", ALL ACTIVITIES OF THE CORPORATION ARE REQUIRED TO BE CARRIED OUT IN ACCORDANCE WITH THE CHARISMS OF THE BENEDICTINE SISTERS BENEVOLENT ASSOCIATION ("BSBA"), A CIVIL LAW CORPORATION FOR THE SISTERS OF ST. BENEDICT OF ST. SCHOLASTICA MONASTERY LOCATED IN DULUTH, MINNESOTA. FORM 990, PART VI, SECTION B, LINE 11B THE 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 12C ON 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 C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. OFFICER COMPENSATION BENEDICTINE HEALTH SYSTEM'S (EIN: 41-1531892) CEO AND CFO, JERRY CARLEY AND KEVIN RYMANOWSKI, SHARE THEIR TIME BETWEEN THE REPORTING ORGANIZATION AND RELATED ORGANIZATIONS. SEE SCHEDULE R FOR INFORMATION ON RELATED ORGANIZATIONS. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 157,342. FORM 990, PART XII, LINE 2C: BENEDICTINE HEALTH SYSTEM, A RELATED ORGANIZATION CONTRACTED FOR MANAGEMENT SERVICES OF THE ORGANIZATION, IS RESPONSIBLE FOR THE SELECTION AND OVERSIGHT OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ARROWHEAD SENIOR LIVING COMMUNITIES 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411978619 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BENEDICTINE CARE CENTERS 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411907571 NURSING HOMES MN 501(C)(3) LINE 10 BHS 0 BENEDICTINE HEALTH CENTER 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411381401 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BENEDICTINE HEALTH SYSTEM 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411531892 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 10 N/A 0 BENEDICTINE HEALTH SYSTEM FOUNDATION 503 E THIRD STREET DULUTH MN 55805 411513014 FUND DEVELOPMENT MN 501(C)(3) LINE 10 BHS 0 BENEDICTINE LIVING COMMUNITIES 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411639687 NURSING HOMES MN 501(C)(3) LINE 10 BHS 0 BLC - BISMARCK 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 264376543 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BLC - NEW LONDON 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 274218436 NURSING HOME WI 501(C)(3) LINE 10 BHS 0 BLC - WAHPETON 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 454274091 ASSISTED LIVING MN 501(C)(3) LINE 10 BHS 0 BLC - WINSTED 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 274219293 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BLC OF ST PETER 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 861113231 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BRIDGES CARE CENTER 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 262620983 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BSLC - ST PETER 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 272716531 ASSISTED LIVING MN 501(C)(3) LINE 10 BHS 0 CATHOLIC RESIDENTIAL SERVICES 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 390982340 NURSING HOME WI 501(C)(3) LINE 10 BHS 0 CERENITY CARE CENTER - WHITE BEAR LAKE 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411983267 NURSING HOME MN 501(C)(3) LINE 10 N/A 0 CERENITY SENIOR CARE 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 363517696 NURSING HOME MN 501(C)(3) LINE 10 N/A 0 CITY OF LAKES CARE CENTER 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411985663 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 ELLENDALE EVERGREEN PLACE 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411796445 ASSISTED LIVING MN 501(C)(3) LINE 10 BHS 0 KODA LIVING COMMUNITY 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411852273 NURSING HOME MN 501(C)(3) LINE 10 N/A 0 LIVING COMMUNITY OF ST JOSEPH 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 412011661 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 MADONNA MEADOWS OF ROCHESTER 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 470855891 ASSISTED LIVING MN 501(C)(3) LINE 10 BHS 0 MADONNA TOWERS OF ROCHESTER 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411809914 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 ROSEWOOD COURT 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 412011389 ASSISTED LIVING MN 501(C)(3) LINE 10 BHS 0 SAINT ANNE OF WINONA 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 410850791 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 ST GERTRUDE'S HEALTH CENTER 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411848720 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 STEEPLE POINTE SENIOR LIVING COMMUNITY 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411852273 ASSISTED LIVING MN 501(C)(3) LINE 10 BHS 0 VILLA ST VINCENT 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411352227 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 NAZARETH LIVING CENTER 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 431450394 NURSING FACILITY MO 501(C)(3) LINE 10 N/A 0 REGINA SENIOR LIVING 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 463700475 NURSING HOME MN 501(C)(3) LINE 10 BHS 0 BENEDICTINE GROUP SELF-INSURANCE ASSOCIATION 6499 UNIVERSITY AVE NE SUITE 300 MINNEAPOLIS MN 55432 411548753 WORKERS' COMPENSATION PROGRAM MN N/A S 0 0 0 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0