2019-05-15T14:55:00-05:00 2018-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2017-07-01 274219119 Benedictine Living Community of Mora BENE 7632310410 110 North 7th Street Mora MN 55051 Jennifer Gleason Chief Operating Officer 7632310410 2019-05-15 1 Deb Nelson CPA P01264758 6122536500 2019-05-14 8.39.233.11 2019-05-15 14:39:20 CD P B602D594AFD2B0B327E07A06F36CA6A7E42546D0 EFC25E59FA7409AE560978A003AFB9E955B778C6 2017 2019-02-21 02:37:17Z X St Clare Living Community of Mora Dennis Kamstra 110 North 7th Street Mora MN 55051 7188003 0 X N/A X 2010 MN Housing and long-term care facilities for the elderly 4 3 221 0 0 0 4802 0 7114987 7187496 1146 507 0 0 7120935 7188003 63514 13649 0 0 4026103 4386528 0 0 0 2762356 2705270 6851973 7105447 268962 82556 1425096 1455591 393373 1408213 1031723 47378 X None 0 1 5202180 13649 5933020 The organization provides skilled nursing care in a 65 bed facility. In the year ended 6/30/18, the facility provided 20,963 days of care. 924064 1226211 The organization provides assisted living care in a 35 bed facility. In the year ended 6/30/18, the facility provided 13,460 days of care. 9825 28265 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 6/30/18, the facility provided 9,929 days of care 6136069 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 34 0 1 221 0 0 0 0 0 0 0 0 0 0 0 X 4 3 1 1 1 0 1 1 1 1 0 0 0 1 0 0 0 0 1 0 MN X Brad Stedman CPA 7013563101 PO Box 656 West Fargo ND 58078 Robert Sundberg Board Chair 5.00 5.00 X X 0 0 0 Paul Sanders Board Member 5.00 5.00 X 0 0 0 Rod Pakonen Board Member 5.00 5.00 X 0 0 0 Dennis Kamstra President/CEO 1.00 40.00 X X 0 0 0 Jennifer Gleason Secretary/Treasurer/CFO 1.00 40.00 X 0 130000 0 0 130000 0 0 0 0 0 Benedictine Health System 1995 East Rum River Drive South Cambridge MN 55008 Management Services 346222 Living Services Foundation 3109 West 50th Street 133 Minneapolis MN 55410 Sponsorship Fees 103717 2 Resident and Assisted 623000 7147200 7147200 Management Revenue 541610 28265 28265 12031 12031 7187496 507 507 7188003 7187496 0 507 13649 13649 3486409 3251215 235194 67638 63075 4563 559597 521846 37751 272884 254475 18409 184768 184768 24291 24291 731925 403598 328327 11583 11583 179873 145851 34022 767282 767282 11394 1637 9757 91046 91046 179 179 94794 94794 65513 65513 Food Expenses 193818 193818 Bed Tax and Licenses 190572 190572 Pharmacy and Medical Ex 143032 143032 Bad Debt Expenses 445 445 14755 14755 7105447 6136069 969378 0 589482 288998 546261 786086 14451 85430 16857 5465 16857 1198 269437 277022 1425096 1455591 369785 715189 23588 17304 572347 0 103373 393373 1408213 X 988537 47378 43186 0 1031723 47378 1425096 1455591 X 82556 -28504 -1038397 X 0 0 0 X 17412 369330 11849 4802 403393 5957287 6085144 6480191 7114987 7187496 32825105 5974699 6454474 6492040 7119789 7187496 33228498 0 225250 370887 518096 703028 701717 2518978 225250 370887 518096 703028 701717 2518978 30709520 942 696 722 1146 507 4013 942 696 722 1146 507 4013 492616 104027 596643 6468257 6559197 6492762 7120935 7188003 33829154 0.90780 0.98170 0.00010 0.00010 X 0 1 X 16857 16857 16857 Amount Due From Affiliates 78619 Debt Service Reserve Fund 198403 277022 Other Liabilities 103373 103373 Part IV, Line 2b: The organization holds funds on behalf of its residents. 1 Scholarships 6 13649 Part I, Line 2: Benedictine Living Community of Mora 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. Form 990, Part III, line 3 Management services were historically provided by Benedictine Health System. As of 1/1/18, management services are provided by Living Services Foundation. This change did not change the services offered by the facility. 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 4 The governing documents were amended as of 1/1/18 making Living Services Foundation the sole member. The appointment of the board is now done by Living Services Foundation. 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 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. Form 990, Part XI, line 9: Ownership Change Adjustment -1,039,595. Change in Temporarily Restricted Net Assets 1,198. 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 living, and home health agency DE 4043470 3540952 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 1 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 Schedule R, Part 2: The organization's sole member was Benedictine Health Services from July 1, 2017 to December 31, 2017.