2019-05-15T14:55:18-05:00 2018-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2017-07-01 411936717 Living Services Foundation LIVI 7632310410 3109 West 50th Street No 133 Minneapolis MN 55410 Jennifer Gleason Chief Operating Officer 7632310410 2019-05-15 1 Deb Nelson CPA P01264758 6122536500 2019-05-15 8.39.233.203 2019-05-15 14:38:58 CD P D8A1E5117AA53286D53F57459EBB2DE5C7CA50FC F9BEE9501A3B4F00F190E63700B8BF2BC70C7B96 2017 2019-02-21 02:37:17Z Dennis Kamstra 3109 West 50th Street No 133 Minneapolis MN 55410 4775899 0 X www.lsfdn.org X 1999 MN Housing and long-term care facilities for the elderly 4 3 131 0 0 0 0 10000 5580675 4765024 4656 875 0 0 5585331 4775899 7043 996 0 0 3456430 2847858 0 0 0 2657675 2236105 6121148 5084959 -535817 -309060 10480390 9477165 12844879 12143129 -2364489 -2665964 X The Foundation is organized and shall be operated primarily to own, maintain, operate and conduct, directly or indirectly, housing and long-term care facilities for the elderly and to assist and coordinate activities of facilities for health care, social services, education and research, and do any and all other acts and things and exercise any and all other rights and powers which may be reasonably necessary, incidental, desirable or expedient in the accomplishment of such purposes. 1 0 4612045 996 4765024 The organization owns and provides management oversight to the following wholly owned subsidiaries:Living Services Foundation/Minneota, LLC consists of a 67-bed skilled nursing facility and 33-unit assisted living facility located in Minneota, Minnesota. Living Services Foundation/Mora, LLC consists of a 65-bed skilled nursing facility, a 35-unit assisted living facility located in Mora, Minnesota. Benedictine Living Community of Mora operates the facilities owned by Living Services Foundation/Mora, LLC and manages a 30 unit assisted living building for a third party in Mora, MN.The organization operates Living Services Foundation - Minneota, Living Services Foundation/Mora, LLC and Benedictine Living Community of Mora. 4612045 1 1 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 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 19 0 1 131 1 0 0 0 0 0 0 0 0 0 0 X 4 3 1 0 1 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 MN X Jennifer Gleason 7632310410 3109 West 50th Street 133 Minneapolis MN 55410 Robert Sundberg Chair 5.00 5.00 X X 0 0 0 Rod Pakonen Board Member 5.00 5.00 X 0 0 0 Paul Sanders Board Member 5.00 5.00 X 0 0 0 Jack L'Heureux Board Member (thru Dec 2017) 5.00 0.00 X 0 0 0 Dennis Kamstra CEO 40.00 1.00 X X 0 0 0 Jennifer Gleason COO/Secretary/Treasurer 40.00 1.00 X 130000 0 0 130000 0 0 1 0 0 0 Big Stone 450 Eastvold Ave Ortonville MN 56278 Therapy 653807 A 'Viands 1751 County B Rd W 300 St Paul MN 55113 Food Services 324766 Prime Time Healthcare LLC 14811 Shepard Street Omaha NE 68138 Agency Staffing Service 108035 3 10000 10000 Resident Service Reven 623000 4048659 4048659 Lease Revenue 532000 528031 528031 Management Fee Revenue 541610 184768 184768 3566 3566 4765024 875 875 4775899 4765024 0 875 996 996 227500 76250 151250 2204627 2042314 162313 19846 17287 2559 220377 191965 28412 175508 152881 22627 17168 17168 88585 88585 99423 99423 25259 25259 189575 189575 6879 6879 185476 185476 36206 36206 52783 52783 627739 627739 400809 400809 65474 65474 DHS Surcharge 188605 188605 Food 113795 113795 Bad Debt Expenses 42511 42511 95818 95818 5084959 4612045 472914 0 83339 114427 437284 441854 570000 570000 82703 53304 10147442 3024629 7614208 7122813 1692856 1174767 10480390 9477165 599571 803322 9287418 9018141 15249 10315 245000 245000 677338 508250 202654 287571 1817649 1270530 12844879 12143129 X -2364489 -2665964 -2364489 -2665964 10480390 9477165 -309060 7585 0 X 0 0 0 X 10000 10000 4765024 4765024 4775024 4775024 0 1104721 1104721 1104721 1104721 3670303 875 875 875 875 4775899 4775899 0.76850 0.00020 X Schedule A, Part III: The organization made amendments to its governing documents and as of December 17, 2017 is no longer a supporting organization under IRC Section 509(a)(3). As such, the organization is completing Part III as publicly supported organization under IRC Section 509(a)(2) for tax year 2017. 0 1 X 780122 780122 8913405 1923622 6989783 431915 968846 -536931 22000 132161 -110161 7122813 Due To/From Affiliates 346353 Other Assets 28829 Bed Licenses 670000 Debt reserve fund 129585 1174767 Asset retirement obligation 23393 Due To/From Affiliates 1247137 1270530 Part IV, Line 2b: The Organization acts as custodian for the funds of the residents and holds tenant security deposits. These funds are included in cash and cash equivalents and current liabilities. A City of Mora 416005389 2009-04-30 6258382 To purchase a nursing & assisted living facility in Mora, MN. 0 0 0 B City of Mora 416005389 2013-09-06 4851795 Refinance a portion of Series 2009 notes issues in 4/30/2009. 0 0 0 C City of Minneota 416005373 2013-12-31 4397409 To purchase a nursing & assisted living facility in Minneota, MN. 0 0 0 A 4858382 6258382 6258382 2009 0 0 1 1 B 770183 4851795 97035 5059 4749701 2013 1 0 1 1 C 352015 4397409 150000 34437 4212972 2013 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 0 0 1 0 0 0 1 C 0 0 0 0 1 0 0 0 1 A 1 B 1 C 1 Robert Sundberg Board Member Capital improvements to skilled nursing facility. X 120000 120000 0 1 1 Paul S and Gretchen M Sanders Revocable Trust Entity owned by Board Member Capital improvements to skilled nursing facility. X 125000 125000 0 1 1 245000 Form 990, Part III, line 2 Operation of Benedictine Living Community of Mora (dba St. Clare Living Community of Mora) on 1/1/18. Form 990, Part VI, Section A, line 2 Dennis Kamstra and Jennifer Gleason have a family relationship. Form 990, Part VI, Section A, line 4 The organization amended its articles of incorporation and by-laws to revise the process by which directors are appointed. The organization no longer has members. The organization is no longer a supporting organization of the Benedictine Health Services and Benedictine Living Services of Mora. Form 990, Part VI, Section A, line 8b No committees are able to act on behalf of the board. Form 990, Part VI, Section B, line 11b An electronic draft of the Form 990 is distributed to the full board of directors for review and approval prior to filing with the IRS. Form 990, Part VI, Section B, line 12c The Conflict of Interest policy is enforced and consistently monitored. An interested person must disclose the existence of their financial interest to the board considering the proposed transaction or arrangement. The remaining board members then determine if a conflict of interest exists. Corrective action is taken by the board of directors as deemed necessary when a conflict of interest is determined to have occurred. Disclosure of a conflict of interest would prevent that person from taking part in discussions or voting on related issues. Form 990, Part VI, Section B, line 15 The process for determining compensation for the CEO and COO is determined by a compensation survey and study. The compensation is then approved by the independent members of the Board of Directors. The last review took place during the summer of 2014. Due to significant strain on the Organization's cash flow, the CEO elected to not receive compensation for his services during calendar year 2017. The Board of Directors was involved in this decision but no formal board action was taken. Payment of compensation to the CEO resumed during 2018. Form 990, Part VI, Section C, line 19 The Organization makes the governing documents and conflict of interest policy available upon request. Living Services Foundation Mora LLC 110 North 7th Street Mora MN 55051 263614974 Leasing of skilled nursing and assisted living facility. DE 517326 4754006 Living Services Foundation Living Services Foundation Minneota LLC 700 North Monroe Street Minneota MN 56264 263614760 Operation of skilled nursing, assisted lving, and home health agency. DE 4043470 3540952 Living Services Foundation Benedictine Living Community of Mora 1995 East Rum River Drive South Cambridge MN 55008 274219119 Skilled nursing care center and assisted living facility. MN 501(c)(3) Line 10 Living Services Foundation 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 Benedictine Living Community of Mora J 517067 General Ledger Benedictine Living Community of Mora L 184768 General Ledger