2012-08-13T13:11:40-05:00 2011-12-31 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2011-01-01 800015864 LEGACY SENIOR SERVICES LEGA 7635375700 14416 SPRING LAKE ROAD MINNETONKA MN 55345 ERIC LUNDE 7635375700 2012-08-09 1 KIM HUNWARDSEN CPA P00484560 6122536500 2012-08-08 2011 2016-02-24 21:20:13Z WAUKESHA SPRINGS HEALTH & REHAB CENTER ERIC LUNDE 14416 SPRING LAKE ROAD MINNETONKA MN 55345 40886496 0 X N/A X 2001 MN TO OPERATE SKILLED NURSING FACILITIES AND SENIOR HOUSING COMMUNITIES THAT PROVIDE FOR THE LONG-TERM CARE OF THE AGED, INFIRMED, INJURED AND SICK. 3 3 1104 566 28315 3979 38914 91071 39732833 40793567 9116 1858 260433 0 40041296 40886496 0 14917 0 0 24092504 24470645 27176 31424 31424 15362773 16960076 39482453 41477062 558843 -590566 18521750 18126824 14117761 14275921 4403989 3850903 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 0 34956781 14917 40765252 LEGACY SENIOR SERVICES IS A MINNESOTA CORPORATION THAT OPERATES A 170 BED SKILLED NURSING FACILITY IN WAUKESHA, WISCONSIN, CALLED WAUKESHA SPRINGS HEALTH & REHABILITATION CENTER. WAUKESHA SPRINGS HEALTH & REHABILITATION CENTER HAD AN AVERAGE DAILY CENSUS OF 148 RESIDENTS DURING 2011. 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 FIVE 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 81 DURING 2011.-LSS OF FRAZEE, LLC, A 74 BED SKILLED NURSING FACILITY AND A 19 UNIT ASSISTED 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 99 DURING 2011.-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 2011.-LSS OF SHEBOYGAN, LLC, A 140 BED SKILLED NURSING FACILITY LOCATED IN SHEBOYGAN, WISCONSIN. LSS OF SHEBOYGAN, LLC HAD AN AVERAGE DAILY CENSUS OF 120 DURING 2011.-LSS OF TRAVERSE, LLC, A 50 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 64 DURING 2011.ALL OF THE SKILLED NURSING FACILITIES ARE MEDICARE AND MEDICAID CERTIFIED. 34956781 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 0 1 104 0 1 1104 1 1 1 0 0 0 0 0 0 0 0 0 X 3 3 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 0 1 0 0 0 MN X HEALTH DIMENSIONS GROUP 7635375700 4400 BAKER ROAD STE 100 MINNEAPOLIS MN 55343 ERIC LUNDE 6.00 X X 8400 0 0 ROGER GREEN 1.00 X X 3600 0 0 CHAR SAMUELSON 1.00 X 3600 0 0 CRAIG ABBOTT 1.00 X 0 0 0 VIRGINIA ANDERSON 4.00 X 0 0 0 15600 0 0 0 0 0 0 HEALTH DIMENSIONS CONSULTING INC 4400 BAKER ROAD MINNEAPOLIS MN 55343 MANAGEMENT FEES, ADMINISTRATION 1913092 HDG-WI LLC 4400 BAKER ROAD MINNEAPOLIS MN 55343 MANAGEMENT FEES, ADMINISTRATION 1379128 AVIANDS LLC NW 5704 PO BOX 1450 MINNEAPOLIS MN 554855704 DIETARY SERVICES 552943 BSG MAINTENANCE INC PO BOX 165 NEWBURG WI 53060 LAUNDRY & HOUSEKEEPING SERVICES 495701 PROREHAB 200 LEWIS AVE SOUTH SUITE 210 WATERTOWN MN 55388 THERAPY SERVICES 266378 6 91071 91071 RESIDENT SERVICE REVEN 623000 40201654 40201654 MISCELLANEOUS REVENUE 900099 591913 563598 28315 40793567 1858 1858 40886496 40765252 28315 1858 14917 14917 15600 15600 19537513 17787018 1750495 56104 51038 5066 3058049 2781907 276142 1803379 1640534 162845 2152667 2152667 40046 40046 75971 75971 31424 31424 2571637 2450135 121502 166785 166785 1352223 1128489 223734 170935 170935 3350066 3291205 58861 9735 2423 7312 113184 12137 101047 642875 642875 775096 775096 593886 593886 MEDICAL SUPPLIES 2209025 2209025 MN DHS SURCHARGE/WI PRO 1196475 1196475 FOOD 688888 688888 BAD DEBT EXPENSE 420809 420809 429773 284619 145154 41477062 34956781 6488857 31424 448607 1269652 1255719 39019 3847938 4011360 19426 19426 171105 277220 15214872 2961170 12585805 12253702 5833 3333 187317 253112 18521750 18126824 2437322 4414608 4310917 184665 10105172 4960625 405106 1575267 14117761 14275921 X 1403554 1208974 3000435 2641929 4403989 3850903 18521750 18126824 X -590566 37480 X 0 1 1 X 0 X 25985 14754 38914 91071 170724 27947877 34641309 38965370 39732833 40765252 182052641 27947877 34667294 38980124 39771747 40856323 182223365 0 0 0 182223365 45989 30037 8064 9116 1858 95064 45989 30037 8064 9116 1858 95064 27993866 34697331 38988188 39780863 40858181 182318429 0.99950 0.98680 0.00050 0.00060 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 1413200 1413200 8970866 1587784 7383082 2473098 169862 2303236 2243732 1157947 1085785 113976 45577 68399 12253702 40886496 41477062 -590566 37480 37480 -553086 40886496 0 40886496 0 40886496 41477062 0 41477062 0 41477062 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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. X X 1 MULLEN COMPANY LLC 4825 S AMMON ST 127 DENVER CO 80123 GRANT WRITING AND FUND SOLICITATION 0 27346 31424 -4078 27346 31424 -4078 CO MN 1 SCHOLARSHIPS 3 14677 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION PROVIDES FUNDS UNDER SCHOLARSHIP AND TUITION ASSISTANCE PROGRAMS FOR ITS EMPLOYEES. EMPLOYEES MUST MEET CERTAIN CRITERIA TO QUALIFY. THE ORGANIZATION EITHER REIMBURSES THE EMPLOYEE FOR EDUCATIONAL EXPENSES OR PAYS THE EDUCATIONAL INSTITUTION DIRECTLY. CITY OF FRAZEE MN HEALTH CARE FACILITIES REVENUE NOTE SERIES 2007A & 2007C 416005174 2007-08-01 4850000 HEALTH CARE FACILITY ACQUISITION 0 0 0 539083 4882400 133384 4749016 2008 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 0 0 0 0 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 7: 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 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 AND LSS OF MARYCREST, LLC. 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 MANAGER OF FINANCIAL SERVICES AND THE VICE PRESIDENT OF FINANCIAL SERVICES 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. PART VI, SECTION B, LINE 15: THE CEO AND VICE PRESIDENT OF FINANCIAL SERVICES ARE COMPENSATED AND EMPLOYED 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: PRIOR PERIOD ADJUSTMENTS: 37,480. FORM 990, PART XII, LINE 2C: HEALTH DIMENSIONS GROUP (HDG), AS LEGACY SENIOR SERVICES' MANAGEMENT COMPANY, HAS RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND PREPARATION OF THE MONTHLY FINANCIAL STATEMENTS. THE LEGACY SENIOR SERVICES' BOARD PRESIDENT, HDG'S FINANCIAL SERVICES MANAGER, AND HDG'S VP OF FINANCIAL SERVICES WERE INVOLVED TOGETHER IN SELECTION OF AN INDEPENDENT ACCOUNTANT FOR AUDIT/TAX SERVICES. LSS OF MADISON LLC 110 BELMONT ROAD MADISON WI 53714 201209404 NURSING HOME WI 6788212 1358168 LEGACY SENIOR SERVICES LSS OF SHEBOYGAN LLC 3014 ERIE AVENUE SHEBOYGAN WI 53081 208658381 NURSING HOME WI 9317484 2567521 LEGACY SENIOR SERVICES LSS OF FRAZEE LLC 219 W MAPLE AVENUE FRAZEE MN 56544 208729268 NURSING HOME & ASSISTED LIVING MN 5779854 5104060 LEGACY SENIOR SERVICES LSS OF MARYCREST 2850 COLUMBINE ROAD DENVER CO 80221 262181659 ASSISTED LIVING CO 3681913 6120710 LEGACY SENIOR SERVICES LSS OF TRAVERSE LLC 303 7TH STREET SOUTH WHEATON MN 56296 273274611 NURSING HOME & INDEPENDENT LIVING MN 3336266 424894 LEGACY SENIOR SERVICES