2016-11-08T10:40:03-06:00 2015-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-01-01 800015864 Legacy Senior Services LEGA 7635375700 14416 Spring Lake Road Minnetonka MN 55345 Eric Lunde President 7635375700 2016-11-07 1 Deb Nelson CPA P01264758 6122536500 2016-11-07 2015 2017-02-10 21:41:12Z Waukesha Springs Health & Rehab Center Eric Lunde 14416 Spring Lake Road Minnetonka MN 55345 44681230 0 X N/A X 2001 MN To operate skilled nursing facilities and senior housing communities. 4 4 1232 385 133391 30261 86937 30937 46896325 44454506 1660 -40230 6934 191935 46991856 44637148 3465 6991 0 0 27020053 25840441 35889 10364 10364 19251354 19533060 46310761 45390856 681095 -753708 20729749 18889540 13911621 12825120 6818128 6064420 X Legacy Senior Services' mission is to create communities of dignity, passion, and respect for adults and to partner with other not for profit organizations across the country. Through its efforts, Legacy Senior Services seeks to provide broad continuums of care to promote health, mind, and spirit of those we serve. 0 1 37973086 6991 44454506 Legacy Senior Services is a Minnesota corporation that operates a 150 bed skilled nursing facility in Waukesha, Wisconsin, called Waukesha Springs Health & Rehabilitation Center. Waukesha Springs Health & Rehabilitation Center had an average daily census of 123 residents during 2015. Legacy Senior Services is organized to own and operate facilities with the intent of housing elderly and other vulnerable persons and meeting their healthcare, residential, physical and social needs. Legacy Senior Services is the sole member of seven other limited liability companies which operate as skilled nursing, assisted living, and/or independent living facilities as follows: -LSS of Madison, LLC, a 90 bed skilled nursing facility located in Madison, Wisconsin. LSS of Madison, LLC had an average daily census of 80 during 2015.-LSS of Frazee, LLC, a 74 bed skilled nursing facility, a 19 unit assisted living facility, and an 8 unit independent living facility located in Frazee, Minnesota and a 15 unit assisted living facility located in Vergas, Minnesota. LSS of Frazee, LLC had an average daily census of 103 during 2015.-LSS of Marycrest, LLC, a 138 unit assisted living facility located in Denver, Colorado. LSS of Marycrest, LLC had an average daily census of 133 during 2015.-LSS of Sheboygan, LLC, a 121 bed skilled nursing facility located in Sheboygan, Wisconsin. LSS of Sheboygan, LLC had an average daily census of 104 during 2015.-LSS of Traverse, LLC, a 49 bed skilled nursing facility and a 20 unit independent living facility located in Wheaton, Minnesota. LSS of Traverse, LLC had an average daily census of 65 during 2015.-LSS of Wadena, LLC, a 75 bed skilled nursing facility and a 32 unit independent living facility located in Wadena, Minnesota. LSS of Wadena, LLC had an average daily census of 185 during 2015.-LSS Home Health and Hospice, LLC, provides hospice, home health and nursing services in Wadena, Minnesota.All of the skilled nursing facilities are Medicare and Medicaid certified. 37973086 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 121 0 1 1232 1 1 1 0 0 0 0 0 0 0 0 0 X 4 4 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 MN CO X Health Dimensions Group 7635375700 4400 Baker Road Ste 100 Minneapolis MN 55343 Eric Lunde President/Treasurer 8.00 X X 12000 0 0 Roger Green Secretary 1.00 X X 4800 0 0 Robert Beck Director 1.00 X 4800 0 0 Joel Jensen Director 1.00 X 4800 0 0 Megan Simpson Administrator - LSS of Madison 40.00 X 0 0 0 Andrew Huhta Administrator - LSS of Frazee 40.00 X 0 0 0 Jonathan Stone Administrator - LSS of Frazee 40.00 X 0 0 0 Richard Blanchard Administrator - LSS of Wadena 40.00 X 0 0 0 Linda Sebenaler Administrator - LSS of Wadena 40.00 X 0 0 0 Daniel Peterson Admin. - LSS Home Health & Hospice 40.00 X 0 0 0 Julie Callender Administrator - LSS of Marycrest 40.00 X 0 0 0 Chelsy Stattelman Administrator - LSS of Traverse 40.00 X 0 0 0 Dennis Videtic Administrator - LSS of Sheboygan 40.00 X 0 0 0 Barton Smith Administrator Waukesha Springs Health & 40.00 X 0 0 0 26400 0 0 0 0 0 0 Health Dimensions Consulting Inc 4400 Baker Road Minneapolis MN 55343 Mgmt fees, Admin. salaries, consulting 3809089 HDG-WI LLC 4400 Baker Road Minneapolis MN 55343 Management fees 1623779 BSG Maintenance Inc PO Box 165 Newburg WI 53060 Laundry & Housekeeping Services 1004739 Pro Rehab 200 Lewis Ave S 210 Watertown MN 55388 Therapy Services 808460 VCPI 1555 N Rivercenter Dr Milwaukee WI 53212 IT Services 237287 7 30937 30937 Resident Service Revenue 623000 43883298 43883298 Miscellaneous Revenue 900099 571208 437817 133391 44454506 2447 2447 8340 1405 6935 6935 6935 42677 -42677 -42677 -42677 Sale of Subsidiary 900099 185000 185000 185000 44637148 44321115 133391 151705 6991 6991 26400 26400 20870192 18929563 1940629 56411 51101 5310 3146066 2849922 296144 1741372 1577454 163918 2468044 2468044 59046 59046 120610 120610 10364 10364 2526330 2031261 495069 128020 7978 120042 1391678 1139030 252648 402338 34551 367787 3451978 3368825 83153 78082 55302 22780 122882 48627 74255 357968 357968 892177 892177 686422 18109 668313 Medical Supplies 2496462 2496462 Food 1525589 1525589 MN DHS Surcharge/WI Pro 1293944 1293944 Bad Debt Expense 409238 409238 1122252 878994 243258 45390856 37973086 7407406 10364 1558819 1017629 36839 36957 4636422 4201652 18942 18942 532322 237702 19070971 6471008 13127020 12599963 819385 776695 20729749 18889540 4741382 3154462 190440 190440 3420712 3176861 201718 235307 5095385 5972804 261984 95246 13911621 12825120 X 6818128 6064420 6818128 6064420 20729749 18889540 -753708 0 X 0 1 X 1 0 X 91071 905228 42518 86937 30937 1156691 40765252 43891737 46429715 46606155 44321115 222013974 40856323 44796965 46472233 46693092 44352052 223170665 0 0 0 223170665 1858 9393 5049 1660 2447 20407 1858 9393 5049 1660 2447 20407 4979 34191 38606 43264 31261 152301 185000 185000 40863160 44840549 46515888 46738016 44570760 223528373 0.99840 0.99980 0.00010 0.00020 X Schedule A, Part III, Line 12, Explanation of Other Income: Gain on Sale of Subsidiary - 2015 Amount: $ 185,000. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 1413200 1413200 14227892 4169063 10058829 2941395 2214800 726595 488484 87145 401339 12599963 X 44496230 0 44496230 140918 140918 44637148 45392261 1405 1405 45390856 0 45390856 Part IV, Line 2b: The organization acts as custodian for the funds of the residents of the nursing facilities and holds tenant security deposits for tenants of the assisted living facilities. Part X, Line 2: Legacy Senior Services is organized as a Minnesota not-for-profit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). Each of the controlled limited liability corporations maintains exempt status under Legacy Senior Services' exemption since Legacy Senior Services is the sole member of each entity. The Organization is required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS annually. In addition, the Organization is subject to income tax on any net income that is derived from business activities that are unrelated to their exempt purpose. The Organization files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Organization believes that it has appropriate support for any tax positions taken affecting filing requirements, and, as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense, if such interest and penalties are incurred. The Organization's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2012. Part XI, Line 4b - Other Adjustments: Rental expenses reported in expenses on financial statements -1,405. Gain on sale of subsidiary reported in fund balance on financial statements 185,000. Loss on sale of assets reported in fund balance on financial statements -42,677. Part XII, Line 2d - Other Adjustments: Rental expenses reported in expenses on financial statements 1,405. X X X X 1 Mullen Company LLC 4825 S Ammons St 127 Denver CO 80123 Grant writing and fund solicitation 0 24270 10364 13906 24270 10364 13906 CO MN 1 Scholarships 7 6991 Part I, Line 2: The organization pays tuition for employees continuing their education. Guidelines from Minnesota Medicaid are followed. The funds are either paid directly to the school or to the employee. The employee must provide proof of cost from the school. A City of Frazee MN 416005174 2007-08-01 4850000 Health care facility acquisition in Frazee, MN 0 0 0 A 1673139 4882400 133384 4749016 2008 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 1 0 0 0 0 A 0 Date Rebate Computation Performed Issuer Name: City of Frazee, MN Date the Rebate Computation was Performed: 09/11/2012 Schedule K Supplental Information The amount reported as bonds retired for the privately placed tax-exempt revenue notes is the original issue price less the outstanding principal balance of the underlying bank loan as of the end of the Schedule K reporting period. Schedule K, Part II, Lines 3 and 10: These amounts include interest earned during the construction period. Schedule K, Part III, Line 9: The organization does not have a formal board adopted policy, but the organization does ensure post-issuance compliance through their management practices and procedures. Form 990, Part III, line 3 On October 9, 2015, the Organization sold the operations of LSS Home Health and Hospice, LLC. Form 990, Part VI, Section A, line 3 Legacy Senior Services has a management agreement with Health Dimensions Consulting, Inc. (dba Health Dimensions Group) or HDG-WI, LLC to provide management services to Legacy Senior Services and the following wholly owned single-member LLC's: LSS of Madison, LLC; LSS of Sheboygan, LLC; LSS of Frazee, LLC; LSS of Traverse, LLC, LSS of Marycrest, LLC; LSS of Wadena, LLC, and LSS Home Health and Hospice, LLC. The following individuals provided services as administrators of the facilities that included day to day management of functional operations, management of facility personnel, and execution of policies governing facility operations. Megan Simpson LSS of Madison, LLC $123,973 Andrew Huhta LSS of Frazee, LLC $22,157 Jonathan Stone LSS of Frazee, LLC $50,154 Richard Blanchard LSS of Wadena, LLC $46,910 Linda Sebenaler LSS of Wadena, LLC $41,041 Daniel Peterson LSS Home Health & Hospice, LLC $65,343 Julie Callender LSS of Marycrest, LLC $114,913 Chelsy Stattelman LSS of Traverse, LLC $72,803 Dennis Videtic LSS of Sheboygan, LLC $111,557 Barton Smith Waukesha Springs Health & Rehab $136,769 Form 990, Part VI, Section A, line 8b The organization has no committees. The full board handles all meetings. Form 990, Part VI, Section B, line 11 The 990 is reviewed by the Director of Financial Services and Senior Accountant of the management company prior to filing. The 990 is also provided to the Legacy Senior Services board for review and approval prior to filing. Form 990, Part VI, Section B, line 12c The policy covers all board directors and officers of the organization. Individuals are required to disclose any actual or possible conflicts of interest to the board of directors considering the proposed transaction or arrangement. The board of directors determines whether or not a conflict exists. If the individual with a conflict is a board member, the remaining board members determine whether a conflict exists. If an individual has a conflict of interest, they must leave the meeting while the transaction or agreement is discussed and voted upon. Form 990, Part VI, Section B, line 15 The administrators' compensation is determined by an unrelated management company, Health Dimensions Group. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy and financial statements are available upon request. LSS of Madison LLC 110 Belmont Road Madison WI 53714 201209404 Nursing Home WI 7431763 1577253 Legacy Senior Services LSS of Sheboygan LLC 3014 Erie Avenue Sheboygan WI 53081 208658381 Nursing Home WI 8211461 2973733 Legacy Senior Services LSS of Frazee LLC 219 W Maple Avenue Frazee MN 56544 208729268 Nursing Home & Assisted Living MN 5798472 5052001 Legacy Senior Services LSS of Marycrest 2850 Columbine Road Denver CO 80221 262181659 Assisted Living CO 3975438 6826644 Legacy Senior Services LSS of Traverse LLC 303 7th Street South Wheaton MN 56296 273274611 Nursing Home & Independent Living MN 3224568 624453 Legacy Senior Services LSS of Wadena LLC 201 Shady Lane Drive Wadena MN 56482 454632615 Nursing Home & Independent Living MN 5311434 1545690 Legacy Senior Services LSS Home Health & Hospice LLC 201 Shady Lane Drive Wadena MN 56482 454700887 Home Health and Hospice Agency MN 1039845 180440 Legacy Senior Services