2014-08-13T11:58:42-05:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2013-01-01 370818454 LUTHERAN HILLSIDE VILLAGE INC C/O LUTHERAN SENIOR SERVICES LUTH 3149689313 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 PAUL J OGIER CFO 3149689313 2014-08-06 1 AMANDA TINNEY P01587658 3149254300 2013 2015-11-30 17:44:51Z JOHN KOTOVSKY 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 15886769 0 X WWW.LSSLIVING.ORG X 1960 IL FAITH BASED ORGANIZATION WHICH PROVIDES A NETWORK OF SUPPORTIVE SERVICES FOR OLDER ADULTS. SEE BELOW FOR SUMMARY OF LSS CONSOLIDATED OPERATIONS. 11 10 0 608 0 0 401655 426808 14539304 14601130 283832 373165 462880 439371 15687671 15840474 0 0 0 0 6914579 7135404 0 0 0 9628700 9572589 16543279 16707993 -855608 -867519 51358844 50212812 72703766 72309581 -21344922 -22096769 X THE PRIMARY PURPOSE OF THE EXEMPT ORGANIZATION IS TO ADDRESS AND MEET THE NEEDS OF AGED PERSONS, INCLUDING HOUSING, HEALTHCARE, AND FINANCIAL SECURITY. THE CORPORATION'S RESIDENTIAL FACILITIES AND PROGRAMS ARE SPECIFICALLY DESIGNED TO MEET AND MAINTAIN ITS AGED RESIDENTS PHYSICAL AND EMOTIONAL WELL-BEING, AS WELL AS MEET THEIR RECREATIONAL, SOCIAL, AND RELIGIOUS NEEDS. 0 0 14990664 14601130 OPERATION OF A CONTINUING CARE RETIREMENT COMMUNITY THAT OFFERS A CONTINUUM OF CARE THAT INCLUDES 126 INDEPENDENT LIVING APARTMENTS, 49 PATIO HOMES, 39 ASSISTED LIVING UNITS, 20 ASSISTED LIVING MEMORY CARE UNITS AND 82 SKILLED NURSING BEDS, WHICH INCLUDE 18 MEDICAID CERTIFIED BEDS. BENEVOLENT CARE ASSISTANCE IS ALSO PROVIDED, WHICH INCLUDES MEDICAID CONTRACTUAL ALLOWANCES. TOTAL BENEVOLENT CARE ASSISTANCE PROVIDED WAS $578,787, OF WHICH, $578,787 IS OFFSETTING PROGRAM SERVICE REVENUE. 14990664 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 6 0 0 0 0 0 0 0 0 0 0 X 11 10 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X PAUL OGIER 3149689313 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 MR JOHN EWING BOARD MEMBER 1.00 X 0 0 0 REV RON MILLER BOARD MEMBER 1.00 X 0 0 0 MR RICHARD MOORE BOARD MEMBER 1.00 X 0 0 0 MR THOMAS J PILAT BOARD MEMBER 1.00 X 0 0 0 MR FLOYD RADEMAKER BOARD MEMBER 1.00 X 0 0 0 MR GARY W SETTERLUND BOARD MEMBER 1.00 X 0 0 0 MS DEBRA J SIPPEL BOARD MEMBER 1.00 X 0 0 0 MR JOHN R KOTOVSKY PRESIDENT/CHIEF EXECUTIVE 1.00 40.00 X X 0 456893 53188 JEFFREY D BAILEY BOARD MEMBER 1.00 X 0 0 0 REV JOHN BATES BOARD MEMBER 1.00 X 0 0 0 DR JAMES BAUER BOARD MEMBER 1.00 X 0 0 0 DAN LOSBY FOUNDATION PRESIDENT 1.00 X X 0 0 0 RICHARD J HANSON BOARD MEMBER 1.00 X 0 0 0 RICHARD PETERSON BOARD MEMBER 1.00 X 0 0 0 EUGENE PHILLIPS BOARD MEMBER 1.00 X 0 0 0 DEAN BORDEAUX BOARD MEMBER 1.00 X 0 0 0 MR PAUL OGIER TREASURER/CFO 1.00 40.00 X 0 300869 56315 MS LINDA DETRING CHIEF OPERATING OFFICER (RETIRED 9/13) 1.00 40.00 X 0 190606 12785 MR MARK SCHOEDEL VP OF CONSTRUCTION AND IT 1.00 40.00 X 0 211255 41553 MR DALE KREIENKAMP VP OF HUMAN RESOURCES 1.00 40.00 X 0 204397 38667 MR MIKE RASO REGIONAL VP 1.00 40.00 X 0 161549 16608 MS CARLA BAUM REGIONAL VICE PRESIDENT 1.00 40.00 X 0 156501 13561 DONALD BELL CHIEF OPERATING OFFICER 1.00 40.00 X 0 38990 0 LORRAINE NEITZER EXECUTIVE DIRECTOR 40.00 X 0 110194 7547 0 1831254 240224 0 0 1 0 ALLIANCE REHAB 1520 KENSINGTON ROAD STE 110 OAKBROOK IL 60523 THERAPY & CONSULTANT 560189 ZOBRIST CONSTRUCTION 95 COMMERCE DRIVE MORTON IL 61550 CONSTRUCTION CONTRACTOR 218065 WIDMER & SONS 23460 2200 NORTH AVENUE PRINCETON IL 61356 CONSTRUCTION CONTRACTOR 178216 REINHARDT GROUNDS MAINTENANCE INC 2185 HAMPTON AVENUE ST LOUIS IL 63139 LAWN & LANDSCAPING 117588 PERKINS EASTMAN ARCHITECTS PC 115 FIFTH AVENUE NEW YORK NY 10003 ARCHITECT 103731 6 411835 14973 426808 RESIDENT SERVICE FEES 623000 14106370 14106370 AMORTIZATION OF ENTRANCE FEES 623000 494760 494760 14601130 201731 201731 217729 44665 1630 173064 -1630 171434 171434 MISCELLANEOUS INCOME 900099 249034 249034 MEALS 623000 87474 87474 BEAUTY & BARBER 623000 69673 69673 33190 33190 439371 15840474 14601130 0 812536 5777758 5670537 107221 81158 79652 1506 847754 832022 15732 428734 420778 7956 1016820 1016820 7965 7965 606310 583437 22873 69331 69331 700458 475137 225321 924010 889152 34858 45092 40800 4292 1510 1510 1832688 1763551 69137 2648777 2548853 99924 146208 146208 ANCILLARY EXPENSE 724278 724278 FOOD/DIETARY 723112 723112 DESIGNATED EXPENSE 85195 85195 BAD DEBT EXPENSE 20744 20744 20091 7952 12139 16707993 14990664 1717329 0 3109572 2593868 650438 807571 319834 465410 43328 42493 20880 47186 72052554 31731636 41753532 40320918 5269951 5846165 191309 89201 51358844 50212812 875361 850774 4119232 4071463 40728445 40728445 26980728 26658899 72703766 72309581 X -21595851 -22406454 245929 304685 5000 5000 -21344922 -22096769 51358844 50212812 -867519 115672 0 X X 0 1 X 1 0 X 170705 325209 354524 401655 426808 1678901 14281173 14540672 14207249 14539304 14601130 72169528 14451878 14865881 14561773 14940959 15027938 73848429 0 0 0 73848429 91386 153113 178735 167550 201731 792515 91386 153113 178735 167550 201731 792515 386329 389350 415384 462920 439371 2093354 14929593 15408344 15155892 15571429 15669040 76734298 0.96240 0.95990 0.01030 0.01200 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2009 AMOUNT: $ 386,329. 2010 AMOUNT: $ 389,350. 2011 AMOUNT: $ 415,384. 2012 AMOUNT: $ 281,956. 2013 AMOUNT: $ 249,034. BEAUTY BARBER - 2012 AMOUNT: $ 80,654. 2013 AMOUNT: $ 69,673. MEALS - 2012 AMOUNT: $ 71,591. 2013 AMOUNT: $ 87,474. TRANSPORTATION - 2012 AMOUNT: $ 10,696. 2013 AMOUNT: $ 10,459. GENERAL STORE - 2012 AMOUNT: $ 11,737. 2013 AMOUNT: $ 12,773. HOUSEKEEPING LAUNDRY - 2012 AMOUNT: $ 6,286. 2013 AMOUNT: $ 9,958. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 369068 369068 67575899 28672530 38903369 3816224 3059106 757118 291363 291363 40320918 RESIDENT DEPOSITS 388816 REFUNDABLE RESIDENCY FEES 26270083 26658899 X PART X, LINE 2: THE ORGANIZATION QUALIFIES AS A TAX-EXEMPT CORPORATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ORGANIZATION IS NOT SUBJECT TO FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE CODE. THE ORGANIZATION IS CLASSIFIED AS A PUBLICLY-SUPPORTED CHARITABLE ORGANIZATION UNDER THE CODE AND CONTRIBUTIONS TO THE ORGANIZATION WHICH QUALIFIES AS A CHARITABLE TAX DEDUCTION FOR THE CONTRIBUTOR. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE TAX RETURNS FOR THE YEARS 2010 TO 2013 ARE SUBJECT TO REVIEW AND EXAMINATION BY THE IRS. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 MR JOHN R KOTOVSKY PRESIDENT/CHIEF EXECUTIVE 0 300296 0 0 0 156597 0 20000 0 33188 0 510081 0 24597 MR PAUL OGIER TREASURER/CFO 0 252627 0 0 0 48242 0 20000 0 36315 0 357184 0 33122 MS LINDA DETRING CHIEF OPERATING OFFICER (RETIRED 9/1 0 190606 0 0 0 0 0 0 0 12785 0 203391 0 0 MR MARK SCHOEDEL VP OF CONSTRUCTION AND IT 0 174830 0 0 0 36425 0 20000 0 21553 0 252808 0 27104 MR DALE KREIENKAMP VP OF HUMAN RESOURCES 0 173561 0 0 0 30836 0 20000 0 18667 0 243064 0 25740 MR MIKE RASO REGIONAL VP 0 155299 0 0 0 6250 0 0 0 16608 0 178157 0 0 MS CARLA BAUM REGIONAL VICE PRESIDENT 0 149853 0 0 0 6648 0 0 0 13561 0 170062 0 0 PART I, LINE 1A JOHN R. KOTOVSKY HAS A HOUSING ALLOWANCE RELATED TO HIS PASTORAL DUTIES THAT IS INCLUDED IN HIS OTHER REPORTABLE COMPENSATION. PART I, LINE 4B LINDA DETRING SEC 457(F) PLAN 44,818 PAUL OGIER SEC 457(F) PLAN 35,388 MARK SCHOEDEL SEC 457(F) PLAN 25,121 DALE KREIENKAMP SEC 457(F) PLAN 20,032 A ILLINOIS FINANCE AUTHORITY 861091967 45200BE87 2006-08-03 46564912 TO REFINANCE THE SERIES 2001A AND 2001B BONDS 0 0 0 A 3125000 46564912 2832012 807882 141981 45468 42737569 2007 0 1 1 1 A 0 0 0 0 0 0 0 A 0 0 0 1 0 0 0 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: ILLINOIS FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 11/01/2012 SCHEDULE K, PART II, LINE 11 THE AMOUNT OF OTHER SPENT PROCEEDS REPRESENTS $45,459,758 OF PROCEEDS IN REFUNDING OR DEFEASANCE ESCROWS THAT ARE NO LONGER REPORTED, 288,547 WHICH REPRESENTS THE DIFFERENCE BETWEEN THE CURRENT MARKET VALUE OF THE DEBT RESERVE FUND AND THE INITIAL FUNDING AMOUNT, AND -3,010,736 FOR THE DEBT SERVICE RESERVE FUND THAT WAS NOT FUNDED WITH DEBT PROCEEDS SINCE THIS WAS A REFUNDING ISSUE. FORM 990, PART I, LINE 1 LUTHERAN SENIOR SERVICES IS A LARGE COMPLEX ORGANIZATION THAT IS COMPRISED OF 19 SEPARATE LEGAL ENTITIES, EACH OF WHICH FILES ITS OWN TAX RETURN. DUE TO THE REQUIREMENTS FOR COMPLETING THESE 990'S (WHICH ARE FILED BY 16 OF THE 19 LSS ENTITIES), SOME OF THE INFORMATION CONTAINED WITHIN THE FORM, SUCH AS REVENUE AND EXPENSES, IS RELATED ONLY TO THAT PARTICULAR ENTITY. HOWEVER, SOME OF THE INFORMATION, SUCH AS EXECUTIVE COMPENSATION, RELATES TO THE ENTIRE ORGANIZATION. TO HELP MAKE THIS INFORMATION MORE MEANINGFUL, THE FOLLOWING PARAGRAPH PROVIDES A SUMMARY OF THE OVERALL OPERATIONS OF LSS. LUTHERAN SENIOR SERVICES IS A NOT FOR PROFIT ORGANIZATION OWNED BY 104 LUTHERAN CHURCHES AND WAS INITIALLY FOUNDED IN 1858. LUTHERAN SENIOR SERVICES OPERATES 10 SENIOR LIVING COMMUNITIES SERVING OVER 3,000 OLDER ADULTS, NINE AFFORDABLE HOUSING COMMUNITIES SERVING OVER 570 OLDER ADULTS AND A VARIETY OF IN HOME SERVICES PROGRAMS SERVING OVER 5,000 OLDER ADULTS. IN 2013, LSS HAD TOTAL OPERATING INCOME OF APPROXIMATELY $169,000,000, PROVIDED APPROXIMATELY $6,000,000 IN BENEVOLENT CARE, HAD OVER 86,000 VOLUNTEER HOURS, AND EMPLOYED 18 CHAPLAINS. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATES MANAGEMENT DUTIES INCLUDING SUPERVISING PERSONNEL, OPERATION, AND BUDGETING TO LUTHERAN SENIOR SERVICES, THE PARENT COMPANY. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BOARD MEMBERS ARE ELECTED BY THE SOLE MEMBER, LUTHERAN SENIOR SERVICES. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS NOT PROVIDED TO THE ORGANIZATION'S GOVERNING BODY PRIOR TO BEING FILED. HOWEVER, REVIEW AND APPROVAL OF THE FORM 990 WAS DELEGATED TO THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS OF THE PARENT ORGANIZATION, LUTHERAN SENIOR SERVICES, PRIOR TO BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C ALL DIRECTORS AND EMPLOYEES WILL DISCLOSE A CONFLICT OF INTEREST ON THE "CONFLICT OF INTEREST FORM" IN THE FOLLOWING SITUATIONS AND IN OTHER CIRCUMSTANCES WHICH HE/SHE THINKS MIGHT CAUSE A CONFLICT BETWEEN HIS/HER PERSONAL INTERESTS AND HIS/HER FIDUCIARY DUTY: FINANCIAL INTERESTS, INSIDE INFORMATION, CONFLICTING INTEREST OTHER THAN FINANCIAL, GIFTS AND FAVORS. THE FOLLOWING LSS EMPLOYEES ARE REQUIRED TO SIGN A "CONFLICT OF INTEREST FORM" ANNUALLY: PRESIDENT, CHIEF OPERATING OFFICER, CHIEF FINANCIAL OFFICER/TREASURER, VICE PRESIDENT OF CONSTRUCTION AND IT, VICE PRESIDENT OF HUMAN RESOURCES, ALL DIRECTORS, ADMINISTRATORS AND ASSISTANT ADMINISTRATORS. THE CORPORATE COMPLIANCE OFFICER FOLLOWS UP WITH ANY CONFLICTS OF INTERESTS AND DOCUMENTS THE RESOLUTIONS OF THE CONFLICTS. THESE FORMS ARE KEPT BY THE CORPORATE COMPLIANCE OFFICE. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS ESTABLISHED A SEPARATE COMPENSATION COMMITTEE CHARGED WITH PERFORMING AN ANNUAL PERFORMANCE REVIEW OF THE CEO AND REVIEWING THE CEO'S COMPENSATION PACKAGE. THE COMPENSATION COMMITTEE ENGAGED A THIRD-PARTY GLOBAL HUMAN CAPITAL CONSULTING FIRM TO: (1) DEVELOP AN ANNUAL CEO PERFORMANCE REVIEW PROCESS, INCLUDING A NEW EVALUATION FORM, AND (2) DEVELOP A COMPENSATION PACKAGE BASED ON ITS KNOWLEDGE OF SIMILARLY SIZED NON-PROFIT ORGANIZATIONS IN ORDER TO ENSURE THAT THE COMPENSATION PAID TO THE CEO IS REASONABLE. ALL MEMBERS OF THE BOARD COMPLETE AN ANNUAL EVALUATION, WHICH THE COMPENSATION COMMITTEE SUMMARIZES AND REVIEWS. THE COMPENSATION COMMITTEE THEN MAKES A RECOMMENDATION TO THE FULL BOARD OF DIRECTORS FOR ANY COMPENSATION ADJUSTMENTS. FORM 990, PART VI, SECTION C, LINE 19 ALTHOUGH NOT A REQUIREMENT, THE ORGANIZATION PROVIDES PHOTOCOPIES OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, FINANCIAL STATEMENTS, AND OTHER DOCUMENTS TO ALL WHO REQUEST ONE OR MORE OF THESE ITEMS. FORM 990, PART XII, LINE 2C THE ORGANIZATION HAS AN AUDIT COMMITTEE THAT IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT. THIS PROCESS IS CONSISTENT WITH THE PRIOR YEARS. FORM 990, PART V, LINE 2 AND PART IX, LINES 7, 8, 9, AND 10 THE ORGANIZATION'S PAYROLL IS PROCESSED WITH LUTHERAN SENIOR SERVICES, THE PARENT COMPANY. FORMS W-3 AND W-2 WERE NOT ISSUED BY LUTHERAN HILLSIDE VILLAGE, INC. AS OF DECEMBER 31, 2013. THE ORGANIZATION DID PAY THE SALARIES, EMPLOYMENT TAXES, AND EMPLOYEE BENEFITS FOR THE ORGANIZATION'S EMPLOYEES. AS OF DECEMBER 31, 2013 THE ORGANIZATION HAD 179 FULL-TIME EMPLOYEES. LUTHERAN SENIOR SERVICES 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 430654862 SENIOR LIVING MO 501(C)(3) LINE 9 N/A 0 LUTHERAN HILLSIDE VILLAGE FOUNDATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 371371314 SENIOR LIVING IL 501(C)(3) LINE 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1