2020-07-09T12:33:16-05:00 2019-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-07-01 274219119 Benedictine Living Community of Mora BENE 7632310410 110 North 7th Street Mora MN 55051 Jennifer Gleason Chief Operating Officer 7632310410 2020-07-09 1 Deb Nelson CPA P01264758 6122536500 2020-07-09 216.147.181.49 2020-07-09 11:07:52 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96 2018 2021-01-29 14:40:06Z St Clare Living Community of Mora Dennis Kamstra 110 North 7th Street Mora MN 55051 7493246 0 X N/A X 2010 MN Housing and long-term care facilities for the elderly 4 3 230 15 0 0 0 0 7187496 7493239 507 7 0 0 7188003 7493246 13649 3750 0 0 4386528 4969721 0 0 0 2705270 2762409 7105447 7735880 82556 -242634 1455591 1553807 1408213 1751449 47378 -197642 X None 1 0 5548775 3750 6261927 The organization provides skilled nursing care in a 65 bed facility. In the year ended 6/30/19, the facility provided 21,906 days of care. 1012305 1176758 The organization provides assisted living care in a 35 bed facility. In the year ended 6/30/19, the facility provided 12,249 days of care. 58838 54554 The organization provides management services to a 30 unit assisted living and memory care facility owned by the Housing and Redevelopment Authority of Mora. In the year ended 6/30/19, the facility provided 9,771 days of care 6619918 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 21 0 1 230 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 3 1 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 1 0 MN X Brad Stedman CPA 7013563101 PO Box 656 West Fargo ND 58078 Dennis Kamstra President/CEO 1.00 40.00 X X 0 142708 0 Robert Sundberg Board Chair 1.00 2.00 X X 0 0 0 Paul Sanders Board Member 1.00 2.00 X 0 0 0 Rod Pakonen Board Member 1.00 2.00 X 0 0 0 Jennifer Gleason Secretary/Treasurer/COO 15.00 40.00 X 0 175000 0 0 317708 0 0 0 1 0 Living Services Foundation 3109 West 50th Street 133 Minneapolis MN 55410 Management Fees 280138 Prime Time Healthcare LLC 15380 Weir St Omaha NE 68137 Agency Staffing 117205 2 Resident and Assisted 623000 7403269 7403269 Management Revenue 541610 54554 54554 35416 35416 7493239 7 7 7493246 7493239 0 7 3750 3750 3904927 3630984 273943 49517 46043 3474 694765 646025 48740 320512 298027 22485 373045 373045 3350 3350 685165 491180 193985 13406 13406 167193 123270 43923 766962 766962 15600 1469 14131 105621 105621 98 98 3413 3413 84087 84087 Bed Tax and Licenses 192565 192565 Food Expenses 184107 184107 Pharmacy and Medical Ex 126404 126404 Bad Debt Expenses 18254 18254 23139 23139 7735880 6619918 1115962 0 288998 238459 786086 936857 85430 146103 19197 4342 16857 14855 1198 277022 217533 1455591 1553807 715189 697002 17304 -2995 200000 572347 572659 103373 284783 1408213 1751449 X 47378 -197642 47378 -197642 1455591 1553807 -242634 -2386 0 X 0 0 0 X 369330 11849 4802 385981 6085144 6480191 7114987 7187496 7493239 34361057 6454474 6492040 7119789 7187496 7493239 34747038 0 370887 518096 703028 701717 719209 3012937 370887 518096 703028 701717 719209 3012937 31734101 696 722 1146 507 7 3078 696 722 1146 507 7 3078 104027 104027 6559197 6492762 7120935 7188003 7493246 34854143 0.91050 0.90780 0.00010 0.00010 X 0 1 X 19197 4342 14855 14855 Amount Due From Affiliates 19130 Debt Service Reserve Fund 198403 217533 Other Liabilities 284783 284783 Part IV, Line 2b: The organization holds funds on behalf of its residents. 0 0 0 0 0 0 0 0 0 Jennifer Gleason Secretary/Treasurer/COO 0 175000 0 0 0 0 0 0 0 0 0 175000 0 0 Part I, Line 3 The organization relied on a related organization that used one or more of these methods to establish compensation. Form 990, Part III, line 2 The organization began providing non-Medicare home health services during the fiscal year. Form 990, Part VI, Section A, line 2 Jennifer Gleason and Dennis Kamstra have a family relationship. Form 990, Part VI, Section A, line 3 The organization contracts with Living Services Foundation, a related organization, for management services. Form 990, Part VI, Section A, line 6 Living Services Foundation is the sole member. Form 990, Part VI, Section A, line 7a Living Services Foundation, as the sole member, shall appoint the Board and remove Directors at any time, with or without cause. Form 990, Part VI, Section A, line 7b The Corporation may not take any of the following actions without receiving Member approval in accordance with procedures established by the Corporation's Articles and Bylaws: (a) Substantially change the present or now intended nature of the Corporation's operations or its mission; (b) Amend the Articles of Incorporation or these Bylaws; (c) Voluntarily dissolve; (d) Incur long-term debt; (e) Mortgage or encumber any assets of the Corporation; (f) Sell, lease or otherwise dispose of all or substantially all of its property and assets; (g) Add or delete major services; (h) Purchase or acquire substantially all of the assets of another entity; (i) Merge, consolidate with any domestic or foreign organization or lease or sell more than fifty percent (50%) of the Corporation's property and assets to any entity in any one transaction or series of related transactions; (j) Prepay any indebtedness prior to the time for payment thereof as provided in the contract evidencing or creating such indebtedness; (k) Loan money or other assets to or guarantee the obligations of any person or entity; (l) Approve annual operating budgets, annual or long-range capital budgets, and nonbudgeted contracts entered into over $50,000; and (m) Approve any extraordinary compensation or bonus to any employee. Form 990, Part VI, Section A, line 8b The organization does not have a committee with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b Board members will review a completed electronic version of the Form 990 prior to filing. Form 990, Part VI, Section B, line 12c In connection with any actual or possible conflicts of interest, an Interested Person must disclose the existence of his or her Financial Interest and be given the opportunity to disclose all material facts relating to his or her Financial Interest to the directors or members of committees with board-delegated powers considering the proposed transaction or arrangement. After disclosure of the Financial Interest and all material facts, and after any discussion with the Interested Person, the Interested Person must leave the board (or committee) meeting while the Financial Interest is discussed and voted upon. The remaining board (or committee) members shall decide if a conflict of interest exists. An Interested Person may make a presentation at the board or committee meeting regarding the proposed transaction or arrangement, but after such presentation, the Interested Person shall leave the meeting during the discussion of, and the vote on, the proposed transaction or arrangement that results in the conflict of interest. The chairperson of the board (or committee) shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement. After exercising due diligence, the board (or committee) shall determine whether the Organization can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or entity that would not give rise to a conflict of interest. If a more advantageous transaction or arrangement is not reasonably attainable under the circumstances that would not give rise to a conflict of interest, the board (or committee) shall determine by a majority vote of the disinterested directors (or committee members), whether the transaction or arrangement is in the Organization's best interest and for its own benefit and whether the transaction is fair and reasonable to the Organization and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination. If the board (or committee) has reasonable cause to believe that a person subject to this policy has failed to disclose actual or possible conflicts of interest or failed to discharge his or her duties in accordance with Article III, it shall inform the person of the basis for such belief and afford the person an opportunity to explain the alleged failure. If, after hearing the response of the person and making such further investigation as may be warranted in the circumstances, the board (or committee) determines that the person has, in fact, failed to discharge his or her duties in accordance with this policy or to disclose an actual or possible conflict of interest, it shall take appropriate disciplinary and corrective action. Form 990, Part VI, Section B, line 15b The organization compensates the facility administrator, but all other top management officials are compensated by the sole member, Living Services Foundation. The administrator's compensation was determined by the individual's level of compensation with the previous owner. Form 990, Part VI, Section C, line 19 The organization makes its governing documents and financial statements available to the public upon request. Living Services Foundation Mora LLC 110 North 7th Street Mora MN 55051 263614974 Leasing of skilled nursing and assisted living facility DE 516610 4412438 Living Services Foundation Living Services Foundation Minneota LLC 700 North Monroe Street Minneota MN 56264 263614760 Operation of skilled nursing, assisted living, and home health agency DE 5460472 4007656 Living Services Foundation Living Services Foundation 3109 W 50th Street 133 Minneapolis MN 55410 411936717 Housing and long-term care facilities for the elderly MN 501(c)(3) Line 10 N/A 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0