FURP.ORG / PUBLIC DATA EXPLORER

BENEDICTINE LIVING COMMUNITY OWATONNA: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
BENEDICTINE LIVING COMMUNITY OWATONNA (EIN 27-0705237)
Tax period
2018-07-01 to 2019-06-30
Filed
2020-07-15
IRS object ID
202011979349307566
Schema version
2018v3.2
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)
Return2020-07-15T18:42:22-05:00ReturnTs
Tax Period End2019-06-30TaxPeriodEndDt

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 Begin2018-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN270705237EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1KODA LIVING COMMUNITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlKODABusinessNameControlTxt
Phone7633472200PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line16499 UNIVERSITY AVENUE NE NO 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55432ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKEVIN RYMANOWSKIPersonNm
Person TitleCFOPersonTitleTxt
Phone7633472200PhoneNum
Signature2020-07-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCHRISTOPHER STEINHOFFPreparerPersonNm
PTINP01587351PTIN
Phone6123764500PhoneNum
Preparation2020-07-12PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address67.137.57.251IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-07-13IPDt
IP Tm08:45:56IPTm
IP TimezoneCDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id0F8E070079B3822AD2CB83B8DB3E34CBC54CDB6EAtSubmissionCreationDeviceId
At Submission Filing Device Id8DF0D5A1DBF8E44DE93554FEEDBEEE801640FE4CAtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeYes (X)AddressChangeInd
Principal OfficerDAVID VANDERGONPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line16499 UNIVERSITY AVENUE NE NO 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55432ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$11,831,584GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.KODALIVINGCOMMUNITY.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2009FormationYr
Legal Domicile StateMNLegalDomicileStateCd
Activity Or MissionBY WORKING TOGETHER, OUR MISSION IS TO INTEGRATE A CONTINUUM OF SERVICES WITH GENUINE COMPASSIONATE CARE FOR OUR COMMUNITIES.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee268TotalEmployeeCnt
Total Volunteers35TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$3,218,729PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$10,969,942PYProgramServiceRevenueAmt
CY Program Service Revenue$11,823,775CYProgramServiceRevenueAmt
PY Investment Income-$3,210,910PYInvestmentIncomeAmt
CY Investment Income-$20,635CYInvestmentIncomeAmt
PY Other Revenue$4,720,380PYOtherRevenueAmt
CY Other Revenue$6,538CYOtherRevenueAmt
PY Total Revenue$15,698,141PYTotalRevenueAmt
CY Total Revenue$11,809,678CYTotalRevenueAmt
PY Grants And Similar Paid$33,757PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$54,716CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$6,874,033PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$7,121,522CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$5,255,902PYOtherExpensesAmt
CY Other Expenses$4,265,584CYOtherExpensesAmt
PY Total Expenses$12,163,692PYTotalExpensesAmt
CY Total Expenses$11,441,822CYTotalExpensesAmt
PY Revenues Less Expenses$3,534,449PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$367,856CYRevenuesLessExpensesAmt
Total Assets BOY$16,070,717TotalAssetsBOYAmt
Total Assets EOY$15,701,742TotalAssetsEOYAmt
Total Liabilities BOY$15,935,892TotalLiabilitiesBOYAmt
Total Liabilities EOY$15,130,971TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$134,825NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$570,771NetAssetsOrFundBalancesEOYAmt
MissionBY WORKING TOGETHER, OUR MISSION IS TO INTEGRATE A CONTINUUM OF SERVICES WITH GENUINE COMPASSIONATE CARE FOR OUR COMMUNITIES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$8,377,228ExpenseAmt
Grant$54,716GrantAmt
Revenue$10,109,044RevenueAmt
DescKODA LIVING COMMUNITY OPERATES A 79 BED SKILLED NURSING FACILITY IN OWATONNA, MN CALLED KODA LIVING COMMUNITY.THE FACILITIES COMBINED HAD 97% OCCUPANCY AT THE END OF THE FISCAL YEAR 6/30/2019 AND SERVED 321 INDIVIDUALS.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,420,975ExpenseAmt
Grant$0GrantAmt
Revenue$1,714,731RevenueAmt
DescOPERATION OF PARK PLACE, IS A 50 UNIT CONGREGATE CARE AND ASSISTED LIVING FACILITY IN OWATONNA, MINNESOTA.THE FACILITY HAD AN AVERAGE OCCUPANCY OF 93% AND SERVED 67 INDIVIDUALS DURING THE FISCAL YEAR ENDING 6/30/2019.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$9,798,203TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
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 With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document47IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee268EmployeeCnt
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 Members9GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
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 CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonKEVIN RYMANOWSKI CFOPersonNm
Phone7636896107PhoneNum

US Address USAddress

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

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
JERRY CARLEY
CEO OF BHS1.0039.00Yes (X)$0$493,059$136,483
KEVIN RYMANOWSKI
SECRETARY/TREASURER1.0039.00Yes (X)$0$360,445$87,709Yes (X)
CHRIS BOLDT
DIRECTOR1.0039.00$0$208,995$58,226Yes (X)
DAVID VANDERGON
CEO / ADMINISTRATOR40.000.00Yes (X)$0$108,394$31,732Yes (X)
CAROL ZETAH
CHAIR1.000.00Yes (X)$0$0$0Yes (X)
TOM SHEA
VICE CHAIR1.000.00Yes (X)$0$0$0Yes (X)
SANDRA MILLER
DIRECTOR1.000.00$0$0$0Yes (X)
LOIS NELSON
DIRECTOR1.000.00$0$0$0Yes (X)
JIM OBERG
DIRECTOR1.0039.00$0$0$0Yes (X)
RICHARD SLIETER
DIRECTOR1.000.00$0$0$0Yes (X)
BILL THOMPSON
DIRECTOR1.000.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,170,893TotReportableCompRltdOrgAmt
Total Other Compensation$314,150TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K5IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
BENEDICTINE HEALTH SYSTEM
6499 UNIVERSITY AVENUE NE SUITE300MINNEAPOLISMN55432MANAGEMENT SERVICES$690,251
RTG MEDICAL
1005 E 23RD STREETFREMONTNE68025TEMP NURSING STAFFING$122,155
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
SKILLED NURSING623000$11,796,439$11,796,439
MEAL REVENUE623000$16,061$16,061
PHONE, CABEL, INTERNET REVENUE623000$11,275$11,275
FieldValueIRS element (for citing)
Total Program Service Revenue$11,823,775TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,271TotalRevenueColumnAmt
Exclusion$1,271ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$21,906OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$21,906OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$21,906TotalRevenueColumnAmt
Exclusion-$21,906ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUS INCOMEDesc
Business900099BusinessCd
Total Revenue Column$6,538TotalRevenueColumnAmt
Exclusion$6,538ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$6,538OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$11,809,678TotalRevenueColumnAmt
Related Or Exempt Func Income$11,823,775RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$14,097ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$47,584TotalAmt
Program Services$47,584ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$7,132TotalAmt
Program Services$7,132ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$5,752,149TotalAmt
Program Services$5,223,205ProgramServicesAmt
Management And General$528,944ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$64,669TotalAmt
Program Services$58,722ProgramServicesAmt
Management And General$5,947ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$886,523TotalAmt
Program Services$805,002ProgramServicesAmt
Management And General$81,521ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$418,181TotalAmt
Program Services$379,727ProgramServicesAmt
Management And General$38,454ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$690,251TotalAmt
Management And General$690,251ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$20,771TotalAmt
Management And General$20,771ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$18,225TotalAmt
Management And General$18,225ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$482,993TotalAmt
Program Services$441,975ProgramServicesAmt
Management And General$41,018ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$32,763TotalAmt
Program Services$32,763ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$57,198TotalAmt
Program Services$11,226ProgramServicesAmt
Management And General$45,972ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$471,238TotalAmt
Program Services$465,401ProgramServicesAmt
Management And General$5,837ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$43,639TotalAmt
Program Services$29,829ProgramServicesAmt
Management And General$13,810ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$2,863TotalAmt
Program Services$623ProgramServicesAmt
Management And General$2,240ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$321,393TotalAmt
Program Services$321,393ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$537,123TotalAmt
Program Services$537,123ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$121,696TotalAmt
Program Services$121,696ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLY EXPENSE$446,761$446,761
FOOD$332,217$332,217
LEASE EXPENSE$317,152$296,982$20,170
SURCHARGE$222,385$222,385

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$146,916TotalAmt
Program Services$16,457ProgramServicesAmt
Management And General$130,459ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$11,441,822TotalAmt
Program Services$9,798,203ProgramServicesAmt
Management And General$1,643,619ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$116,180BOYAmt
EOY$435,149EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,495,779BOYAmt
EOY$1,411,198EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$94,434BOYAmt
EOY$86,459EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$13,757,989LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,307,474LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$12,917,813BOYAmt
EOY$12,450,515EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$893,869BOYAmt
EOY$800,000EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$552,642BOYAmt
EOY$518,421EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$16,070,717BOYAmt
EOY$15,701,742EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$908,251BOYAmt
EOY$753,827EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$14,133,856BOYAmt
EOY$13,619,589EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$39,233BOYAmt
EOY$19,991EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$385,552BOYAmt
EOY$293,662EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$469,000BOYAmt
EOY$374,107EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$69,795EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,935,892BOYAmt
EOY$15,130,971EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$95,021BOYAmt
EOY$462,877EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$39,804BOYAmt
EOY$107,894EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$134,825BOYAmt
EOY$570,771EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$16,070,717BOYAmt
EOY$15,701,742EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$367,856ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$68,090OtherChangesInNetAssetsAmt
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$9,449CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$82,251CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$40,372CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$3,218,729CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$3,350,801TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,907,285CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,805,472CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$10,948,086CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$10,969,942CurrentTaxYearMinus1YearAmt
Current Tax Year$11,823,775CurrentTaxYearAmt
Total$50,454,560TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,916,734CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,887,723CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$10,988,458CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$14,188,671CurrentTaxYearMinus1YearAmt
Current Tax Year$11,823,775CurrentTaxYearAmt
Total$53,805,361TotalAmt

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$53,805,361PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$133CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$231CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,083CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,603CurrentTaxYearMinus1YearAmt
Current Tax Year$1,271CurrentTaxYearAmt
Total$4,321TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$133CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$231CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,083CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,603CurrentTaxYearMinus1YearAmt
Current Tax Year$1,271CurrentTaxYearAmt
Total$4,321TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$4,720,380CurrentTaxYearMinus1YearAmt
Current Tax Year$6,538CurrentTaxYearAmt
Total$4,726,918TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$7,916,867CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$8,887,954CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$10,989,541CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$18,910,654CurrentTaxYearMinus1YearAmt
Current Tax Year$11,831,584CurrentTaxYearAmt
Total$58,536,600TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.91920PublicSupportCY509Pct
Public Support PY5090.91590PublicSupportPY509Pct
Investment Income CY0.00010InvestmentIncomeCYPct
Investment Income PY0.00010InvestmentIncomePYPct
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
ExplanationINCOME FROM FORGIVEN DEBT - 2017 AMOUNT: $ 4,720,380. MISCELLANEOUS INCOME - 2018 AMOUNT: $ 6,538.ExplanationTxt

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$710,000OtherCostOrOtherBasisAmt
Book Value$710,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,447,123OtherCostOrOtherBasisAmt
Depreciation$490,228DepreciationAmt
Book Value$10,956,895BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$708,000OtherCostOrOtherBasisAmt
Depreciation$106,200DepreciationAmt
Book Value$601,800BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$892,866OtherCostOrOtherBasisAmt
Depreciation$711,046DepreciationAmt
Book Value$181,820BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$12,450,515TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO AFFILIATESDesc
Amt$69,795Amt
FieldValueIRS element (for citing)
Total Liability$69,795TotalLiabilityAmt
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:INCOME TAXES KODA LIVING COMMUNITY HAS BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND MINNESOTA CORPORATE INCOME TAXES UNDER SECTION 501 (C) (3) OF THE INTERNAL REVENUE CODE. KODA LIVING COMMUNITY 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. KODA LIVING COMMUNITY INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. KODA LIVING COMMUNITY IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. KODA LIVING COMMUNITY FILES ALL APPLICABLE RETURNS FOR ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OF EXCISE OR OTHER TAXES. THE TAX RETURNS FOR THE FISCAL YEARS 2012 THROUGH 2014 REMAIN OPEN TO EXAMINATION BY FEDERAL, LOCAL AND STATE AUTHORITIES.

Schedule I IRS990ScheduleI

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

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1TxtAddress Line2USAddress/AddressLine2TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtValuation Method UsedValuationMethodUsedDescNon Cash AssistanceNonCashAssistanceDescPurpose Of GrantPurposeOfGrantTxt
BENEDICTINE HEALTH SYSTEM
6499 UNIVERSITY AVENUE NE SUITE 300300MINNEAPOLISMN55432411531892501(C)(3)$27,164N/AN/ACAPITAL FUND/SUPPORT
BENEDICTINE HEALTH SYSTEM FOUNDATION
503 E THIRD ST STE 400DULUTHMN55805411513014501(C)(3)$20,420N/AN/AGENERAL OPERATING SUPPORT
FieldValueIRS element (for citing)
Total501c3 Org2Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeSCHOLARSHIPSGrantTypeTxt
Recipient7RecipientCnt
Cash Grant$7,132CashGrantAmt
Non Cash Assistance$0NonCashAssistanceAmt
Valuation Method UsedN/AValuationMethodUsedDesc
Non Cash AssistanceN/ANonCashAssistanceDesc

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationKODA LIVING COMMUNITY 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. TRANSFERS BETWEEN RELATED ORGANIZATIONS ARE ACCOUNTED FOR IN INTERNAL FINANCIAL STATEMENTS, OF WHICH ALL ARE UNDER COMMON CONTROL.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 (3 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
CEO OF BHS$0$450,000$0$0$0$43,059$0$99,000$0$37,483$0$629,542$0$0
KEVIN RYMANOWSKI
SECRETARY/TREASURER$0$295,734$0$36,609$0$28,102$0$61,741$0$25,968$0$448,154$0$0
CHRIS BOLDT
DIRECTOR$0$192,256$0$13,138$0$3,601$0$36,826$0$21,400$0$267,221$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 (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
STEELE COUNTY MN
A4160059012017-12-28$9,581,263REFUNDING000
CITY OF OWATONNA MN
B4160054442017-12-28$4,809,545REFUNDING BOND000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdRetiredRetiredAmtTotal ProceedsTotalProceedsAmtRefunding EscrowRefundingEscrowAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtSubstantial CompletionSubstantialCompletionYrRefunding Tax Exempt BondsRefundingTaxExemptBondsIndRefunding Taxable BondsRefundingTaxableBondsIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintInd
A$469,265$9,581,263$9,581,263$116,66920170Yes (1)Yes (1)Yes (1)
B$235,559$4,809,54520170Yes (1)Yes (1)Yes (1)

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A000000Yes (1)
B000000Yes (1)

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A000Yes (1)0000Yes (1)
B000Yes (1)0000Yes (1)

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (1)
BYes (1)

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
OFFICER COMPENSATIONBENEDICTINE 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 VI, SECTION A, LINE 3THE CORPORATION CONTRACTS WITH BENEDICTINE HEALTH SYSTEM, A RELATED ORGANIZATION, OR MANAGEMENT SERVICES. BENEDICTINE HEALTH SYSTEM EMPLOYED THE ADMINISTRATOR/CEO OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 6BENEDICTINE HEALTH SYSTEM, 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 BENEDICTINE HEALTH SYSTEM.
FORM 990, PART VI, SECTION A, LINE 7BTHE FOLLOWING ACTIONS OF THIS CORPORATION ARE RESERVED TO THE MEMBERS WHICH MAY ONLY ACT ON UNANIMOUS APPROVAL OF THE MEMBERS. GOVERNING INSTRUMENTS. MERGER, CONSOLIDATION, LIQUIDATION, DISOLUTION. ISSUANCE AND TRANSFER OF MEMBERBERSHIP INTEREST. DISTRUIBTIONS.
FORM 990, PART VI, SECTION B, LINE 11BAN ELECTRONIC COPY OF THE FORM 990 WAS DISTRIBUTED 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 C, LINE 19NOT AVAILABLE TO PUBLIC
FORM 990, PART XI, LINE 9:CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 68,090.
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 Disregarded Entities IdDisregardedEntitiesGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1PARK PLACE SENIOR LIVING LLCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line16499 UNIVERSITY AVE NE SUITE 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55432ZIPCd
FieldValueIRS element (for citing)
EIN384050146EIN
Primary ActivitiesASSISTED LIVINGPrimaryActivitiesTxt
Legal Domicile StateMNLegalDomicileStateCd
Total Income$1,715,681TotalIncomeAmt
End Of Year Assets$0EndOfYearAssetsAmt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1KODA LIVING COMMUNITYBusinessNameLine1Txt

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (31 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 100BHS
BENEDICTINE HEALTH CENTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411381401NURSING HOMEMN501(C)(3)LINE 100BHS
CITY OF LAKES CARE CENTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411985663NURSING HOMEMN501(C)(3)LINE 100BHS
BENEDICTINE LIVING COMMUNITIES
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411639687NURSING HOMESMN501(C)(3)LINE 100BHS
BLC OF ST PETER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432861113231NURSING HOMEMN501(C)(3)LINE 100BHS
STEEPLE POINTE SENIOR LIVING COMMUNITY
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411852273NURSING HOMEMN501(C)(3)LINE 100BHS
BRIDGES CARE CENTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432262620983NURSING HOMEMN501(C)(3)LINE 100BHS
ELLENDALE EVERGREEN PLACE
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411796445ASSISTED LIVINGMN501(C)(3)LINE 100BHS
LIVING COMMUNITY OF ST JOSEPH
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432412011661NURSING HOMEMN501(C)(3)LINE 100BHS
MADONNA MEADOWS OF ROCHESTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432470855891ASSISTED LIVINGMN501(C)(3)LINE 100BHS
MADONNA TOWERS OF ROCHESTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411809914NURSING HOMEMN501(C)(3)LINE 100BHS
ROSEWOOD COURT
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432412011389ASSISTED LIVINGMN501(C)(3)LINE 100BHS
SAINT ANNE OF WINONA
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432410850791NURSING HOMEMN501(C)(3)LINE 100BHS
ARROWHEAD SENIOR LIVING COMMUNITIES
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411978619NURSING HOMEMN501(C)(3)LINE 100BHS
ST GERTRUDE'S HEALTH CENTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411848720NURSING HOMEMN501(C)(3)LINE 100BHS
BLC OF BISMARCK
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432264376543NURSING HOMEMN501(C)(3)LINE 100BHS
NAZARETH LIVING CENTER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432431450394NURSING FACILITYMN501(C)(3)LINE 10N/A0
BLC OF NEW LONDON
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432274218436NURSING HOMEWI501(C)(3)LINE 100BHS
BLC OF WINSTED
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432274219293NURSING HOMEMN501(C)(3)LINE 100BHS
BSLC OF ST PETER
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432272716531ASSISTED LIVINGMN501(C)(3)LINE 100BHS
BLC OF RED WING
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432454929398NURSING HOMEMO501(C)(3)LINE 100BHS
BLC OF WAHPETON
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432454274091ASSISTED LIVINGMN501(C)(3)LINE 100BHS
CATHOLIC RESIDENTIAL SERVICES
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432390982340NURSING HOMEWI501(C)(3)LINE 100BHS
REGINA SENIOR LIVING
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432463700475NURSING HOMEMN501(C)(3)LINE 100BHS
BLC OF BYRON
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432471538777NURSING HOMEMN501(C)(3)LINE 100BHS
CERENITY SENIOR CARE
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411983267NURSING HOMEMN501(C)(3)LINE 10N/A0
CERENITY CARE CENTER - WHITE BEAR LAKE
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411983267NURSING HOMEMN501(C)(3)LINE 10N/A0
VILLA ST BENEDICT
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432364343235NURSING HOMEMN501(C)(3)LINE 10N/A0
VILLA ST VINCENT
6499 UNIVERSITY AVE NE SUITE 300MINNEAPOLISMN55432411352227NURSING HOMEMN501(C)(3)LINE 100BHS
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
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 OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd