2012-08-24T09:30:04-05:00 2011-12-31 410746749 CLIFTONLARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2011-01-01 370818454 LUTHERAN HILLSIDE VILLAGE INC C/O LUTHERAN SENIOR SERVICES LUTH 3149689313 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 PAUL OGIER 3149689313 2012-08-22 1 ALLAN B LARSON CPA P00028482 3149254300 2011 2016-02-24 21:20:13Z JOHN KOTOVSKY 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 15587000 0 X WWW.LSSLIVING.ORG X 1960 IL FAITH BASED ORGANIZATION WHICH PROVIDES A NETWORK OF SUPPORTIVE SERVICES FOR OLDER ADULTS. 11 11 0 621 0 0 325209 354524 14540672 14207249 297473 240627 389350 415384 15552704 15217784 0 0 0 0 6528314 6849201 0 0 0 9087688 9308563 15616002 16157764 -63298 -939980 54496387 54905934 74030103 75542517 -19533716 -20636583 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 14394443 14207249 (1) OPERATION OF A CONTINUING CARE RETIREMENT COMMUNITY THAT OFFERS A CONTINUUM OF CARE THAT INCLUDES 126 INDEPENDENT LIVING APARTMENTS, 49 PATIO HOMES, 40 ASSISTED LIVING UNITS, 20 ASSISTED LIVING MEMORY CARE UNITS AND 85 SKILLED NURSING BEDS, WHICH INCLUDES 22 MEDICAID CERTIFIED BEDS. (2) BENEVOLENT CARE ASSISTANCE IS ALSO PROVIDED IN THE AMOUNT OF $604,018, OF WHICH $604,018 IS OFFSETTING PROGRAM SERVICE REVENUE. BENEVOLENCE CARE ASSISTANCE ALSO INCLUDES MEDICAID CONTRACTUAL ALLOWANCES. 14394443 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 0 1 0 0 0 0 0 0 0 0 0 0 0 X 11 11 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 DEAN A HEINZMANN 1.00 X X 0 0 0 MR JOHN EWING 1.00 X 0 0 0 REV RICHARD J HANSON 1.00 X 0 0 0 REV RON MILLER 1.00 X 0 0 0 MR RICHARD MOORE 1.00 X 0 0 0 MR THOMAS J PILAT 1.00 X 0 0 0 MR FLOYD RADEMAKER 1.00 X 0 0 0 MR GARY W SETTERLUND 1.00 X 0 0 0 MS DEBRA J SIPPEL 1.00 X 0 0 0 MS MARILEE A TILLY 1.00 X 0 0 0 MR MIKE RASO 40.00 X X 0 148706 11015 MR JOHN R KOTOVSKY 40.00 X 0 387476 48749 MR PAUL OGIER 40.00 X 0 273657 46157 MS LINDA DETRING 40.00 X 0 247839 34595 MR MARK SCHOEDEL 40.00 X 0 179198 33538 MR DALE KREIENKAMP 40.00 X 0 163458 32987 MS CARLA BAUM 40.00 X 0 132408 10382 LORRAINE NEITZER 40.00 X 0 101469 4146 0 1634211 221569 0 0 1 0 ALLIANCE REHAB 1520 KENSINGTON ROAD STE 110 OAKBROOK IL 60523 THERAPY & CONSULTANT 569331 TECH ELECTRONICS PO BOX 790379 ST LOUIS MO 63139 TELEPHONE EQUIPMENT, WIRING AND MAINTENA 145176 WIDEMER & SONS 23460 2200 NORTH AVENUE PRINCETON IL 61356 CONSTRUCTION CONTRACTOR 113735 3 341916 12608 354524 RESIDENT SERVICE FEES 623000 13823562 13823562 AMORTIZATION OF ENTRAN 623000 383687 383687 14207249 178735 178735 431108 369216 61892 61892 61892 MISCELLANEOUS INCOME 900099 268372 268372 BEAUTY & BARBER 623000 71817 71817 MEALS 623000 54003 54003 21192 21192 415384 15217784 14207249 0 656011 5523553 5369560 153993 94311 91682 2629 822510 799579 22931 408827 397429 11398 792420 792420 210 210 11547 11547 518414 498857 19557 70063 70063 944709 591959 352750 1171569 1127372 44197 31321 29771 1550 1780 1780 1757553 1691250 66303 2453201 2360655 92546 FOOD/DIETARY 748255 748255 ANCILLARY EXPENSE 611770 611770 DESIGNATED EXPENSE 70614 70614 MISCELLANEOUS EXPENSE 67575 67575 57562 5690 51872 16157764 14394443 1763321 0 3867318 5703294 851812 769068 455983 306280 42204 40961 -3394 32529 69478258 26598932 44177349 42879326 4786297 4849115 0 318818 325361 54496387 54905934 643090 839635 3801129 4180097 41969730 41207552 27616154 29315233 74030103 75542517 X -19637211 -20774855 98495 133272 5000 5000 -19533716 -20636583 54496387 54905934 X -939980 -162887 X X 0 1 1 X 0 X 232714 106096 170705 325209 354524 1189248 13496248 13806876 14281173 14540672 14207249 70332218 13728962 13912972 14451878 14865881 14561773 71521466 0 0 0 71521466 475097 314976 91386 153113 178735 1213307 475097 314976 91386 153113 178735 1213307 299786 474939 386329 389350 415384 1965788 14503845 14702887 14929593 15408344 15155892 74700561 0.95740 0.95950 0.01620 0.01910 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 369068 369068 65468026 23875187 41592839 3456788 2723745 733043 184376 184376 42879326 RESIDENT DEPOSITS 373130 DUE TO RELATED ORGANIZATION 1392744 REFUNDABLE RESIDENCY FEES 27549359 29315233 15217784 16157764 -939980 -162887 -162887 -1102867 14984287 -162887 -70610 -233497 15217784 0 15217784 16087154 0 16087154 70610 70610 16157764 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATIONS QUALIFY AS TAX-EXEMPT CORPORATIONS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, THE ORGANIZATIONS ARE NOT SUBJECT TO FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE CODE. THE ORGANIZATIONS ARE CLASSIFIED AS PUBLICLY-SUPPORTED CHARITABLE ORGANIZATIONS UNDER THE CODE AND CONTRIBUTIONS TO THE ORGANIZATIONS QUALIFY AS A CHARITABLE TAX DEDUCTION FOR THE CONTRIBUTOR. PROVIDENT GROUP IS ORGANIZED AS A TAXABLE NON-PROFIT FOR FEDERAL AND STATE INCOME TAX PURPOSES. THE ORGANIZATIONS ARE NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE TAX RETURNS FOR THE YEARS 2008 TO 2011 ARE SUBJECT TO REVIEW AND EXAMINATION BY THE IRS. SCH D, PART XII, LINE 2D: THIS AMOUNT REPRESENTS AMOUNTS THAT ARE GROUPED WITH REVENUES FOR THE FINANCIAL STATEMENTS BUT ARE BROKEN OUT ON THE STATEMENT OF FUNCTIONAL EXPENSES FOR USE ON FORM 990. SCH D, PART XIII, LINE 4B: THIS AMOUNT REPRESENTS AMOUNTS THAT ARE GROUPED WITH REVENUES FOR THE FINANCIAL STATEMENTS BUT ARE BROKEN OUT ON THE STATEMENT OF FUNCTIONAL EXPENSES FOR USE ON FORM 990. X X X X X 0 0 0 0 0 0 0 0 0 MR MIKE RASO 0 148706 0 0 0 0 0 0 0 11015 0 159721 0 0 MR JOHN R KOTOVSKY 0 280754 0 0 0 106722 0 20000 0 28749 0 436225 0 0 MR PAUL OGIER 0 241749 0 0 0 31908 0 20000 0 26157 0 319814 0 0 MS LINDA DETRING 0 230143 0 0 0 17696 0 20000 0 14595 0 282434 0 0 MR MARK SCHOEDEL 0 166198 0 0 0 13000 0 20000 0 13538 0 212736 0 0 MR DALE KREIENKAMP 0 163458 0 0 0 0 0 20000 0 12987 0 196445 0 0 ILLINOIS FINANCE AUTHORITY 861091967 45200BE87 2006-08-03 46564912 TO REFINANCE THE SERIES 2001A AND 2001B BONDS 0 0 0 1485000 46564912 3339420 807882 141981 45468 42230161 2007 0 1 1 1 0 0 0 0 1 0 0 0 0 0 0 X 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, -218,861 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -162,887. 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, 2011. THE ORGANIZATION DID PAY THE SALARIES, EMPLOYMENT TAXES, AND EMPLOYEE BENEFITS FOR THE ORGANIZATION'S EMPLOYEES. AS OF DECEMBER 31, 2011 THE ORGANIZATION HAD 302 FULL-TIME EMPLOYEES. LUTHERAN SENIOR SERVICES 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 430654862 SENIOR LIVING MO 501(C)(3) 509A2 N/A 0 LUTHERAN HILLSIDE VILLAGE FOUNDATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 371371314 SENIOR LIVING IL 501(C)(3) 509A1 N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 LUTHERAN HILLSIDE VILLAGE FOUNDATION C 341916 LUTHERAN SENIOR SERVICES L 792421