2011-11-15T10:39:39-06:00 2010-12-31 LARSONALLEN LLP 600 WASHINGTON AVENUE SUITE 1800 ST LOUIS MO 63101 990 2010-01-01 430654862 LUTHERAN SENIOR SERVICES LUTH 3149689313 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 PAUL OGIER 3149689313 2011-11-14 1 ALLAN LARSON 3149254300 2010 2016-03-07 17:11:31Z JOHN KOTOVSKY 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 199457966 0 X WWW.LSSLIVING.ORG X 1863 MO FAITH BASED ORGANIZATION WHICH PROVIDES A NETWORK OF SUPPORTIVE SERVICES FOR OLDER ADULTS. 15 15 2216 4063 0 0 1822102 1686859 99490770 100896490 3064196 6173551 0 0 104377068 108756900 0 0 0 0 10556349 10800778 0 0 0 91266455 92876528 101822804 103677306 2554264 5079594 326212133 365670317 287925283 321132904 38286850 44537413 TO PROVIDE A NETWORK OF SUPPORTIVE SERVICES THAT MEET THE NEEDS OF OLDER ADULTS AT ALL INCOME LEVELS IN ORDER TO LIVE OUT OUR MISSION OF "OLDER ADULTS LIVING LIFE TO THE FULLEST". 0 0 76492406 97963820 OPERATIONS FOR FIVE CONTINUING CARE RETIREMENT COMMUNITIES THAT OFFER A CONTINUUM OF CARE THAT INCLUDES INDEPENDENT LIVING, ASSISTED LIVING, MEMORY CARE AND SKILLED NURSING, AND ALL ARE MEDICARE AND MEDICAID CERTIFIED. IN ADDITION, OPERATIONS INCLUDE ONE ASSISTED LIVING AND ONE SKILLED NURSING FACILITY NOT ASSOCIATED WITH A CONTINUING CARE RETIREMENT COMMUNITY. A TOTAL OF 3,066 UNITS ARE OFFERED WITH A SUBSTAINED OCCUPANCY RATE EXCEEDING 90%. 5371187 6513296 A VARIETY OF IN-HOME SERVICES FOR OLDER ADULTS WHO REMAIN IN THEIR OWN HOMES, INCLUDING MEDICARE CERTIFIED HOME HEALTH, PRIVATE DUTY HOME HEALTH SERVICES, OUTPATIENT SERVICES, A HOSPICE PROGRAM, AND THREE PROGRAMS IN PARTNERSHIP WITH THE UNITED WAY: OUTREACH SOCIAL SERVICES, THE GOOD NEIGHBOR PROGRAM, AND VOLUNTEER MONEY MANAGEMENT. MORE THAN 3,000 CLIENTS ARE SERVED ANNUALLY. -3580626 A BENEVOLENT CARE FUND EXISTS TO PROVIDE FINANCIAL ASSISTANCE TO RESIDENTS OR CLIENTS WHO OUTLIVE THEIR ABILITY TO PAY. TOTAL BENEVOLENT CARE ASSISTANCE PROVIDED WAS $3,580,626, OF WHICH $3,580,626 IS OFFSETTING PROGRAM SERVICE REVENUE. 81863593 1 1 0 1 0 0 0 0 0 1 1 0 1 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 1 1 1 0 0 0 1 133 0 1 2216 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 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 JAMES R DANKENBRING 1.00 X X 0 0 0 REV WILLIAM T SIMMONS 1.00 X X 0 0 0 LEE H BODENDIECK 1.00 X X 0 0 0 FRANKLIN P MOSLEY 1.00 X X 0 0 0 RICHARD J BAGY JR 1.00 X 0 0 0 NORMA J BARR 1.00 X 0 0 0 KARL A DUNAJCIK 1.00 X 0 0 0 REV VERNON D GUNDERMANN 1.00 X 0 0 0 SCOTT M HARTWIG 1.00 X 0 0 0 JAN S KRAEMER 1.00 X 0 0 0 KATHLEEN T MUELLER 1.00 X 0 0 0 CARLA S ROBINSON-RAINEY 1.00 X 0 0 0 WILLIAM F ROTH 1.00 X 0 0 0 ROGER H VOLK 1.00 X 0 0 0 DR H DOUGLAS WALDEN 1.00 X 0 0 0 JOHN R KOTOVSKY 40.00 X 365163 0 44499 PAUL OGIER 40.00 X 258564 0 42046 LINDA M DETRING 40.00 X 240277 0 31176 MARK W SCHOEDEL 40.00 X 158448 0 30034 DALE KREIENKAMP 40.00 X 157251 0 30007 CARLA BAUM 40.00 X 123077 0 8334 MICHAEL RASO 40.00 X 144637 0 8872 KIRK MATTES 40.00 X 135199 0 8607 JEFFREY BROWN 40.00 X 118824 0 8239 JEFFREY GOLDONE 40.00 X 115931 0 8173 TERRY ETLING 40.00 X 111503 0 8074 CHADWICK SNEED 40.00 X 107780 0 7990 2036654 0 236051 17 0 1 0 REINHARDT-WILSON JOINT VENTURE 627 N ROLLINS ST CENTRALIA IL 65240 CONSTRUCTION CONTRACTOR 3803234 ALLIANCE REHAB 1520 KENSINGTON RD SUITE 110 OAK BROOK IL 60523 THERAPY SERVICES 3116071 PERKINS-EASTMAN ARCHTECTS 115 FIFTH AVENUE NEW YORK NY 10003 ARCHITECT 1321456 SM WILSON & CO 2185 HAMPTON AVE ST LOUIS MO 63139 CONSTRUCTION CONTRACTOR 1062719 PARIC CORPORATION PO BOX 796022 ST LOUIS MO 63179 CONSTRUCTION CONTRACTOR 1015940 36 1319074 367785 1686859 CONTINUING CARE RETIRE 623000 97963820 97963820 IN HOME SERVICES REVEN 623000 6513296 6513296 BENEVOLENT CARE FUND 623000 -3580626 -3580626 100896490 3148743 3148743 93725874 90680074 20992 3045800 -20992 3024808 3024808 108756900 100896490 0 6173551 1447417 1447417 9353361 9158393 194968 2683542 2683542 16154672 16154672 7960088 7960088 6182810 6182810 9680347 9680347 NURSING 25222395 25222395 DIETARY 11403520 11403520 IN-HOME SERVICE 5371187 5371187 HOUSEKEEPING & LAUNDRY 4006687 4006687 ACTIVITIES & SOCIAL SER 2878166 2878166 1333114 1333114 103677306 81863593 21813713 0 6832644 3958954 4879660 1973886 2687998 269642388 104278686 160690037 165363702 38580516 37487441 93516211 113376588 20659885 41874928 326212133 365670317 12279525 13205906 7938043 7686229 159933148 188406608 107774567 111834161 287925283 321132904 X 38061217 44138176 225633 399237 38286850 44537413 326212133 365670317 X 5079594 1170969 X X 0 1 1 X 0 X 1532182 1744757 208472 264884 385355 4135650 73234759 81898337 97981573 99490770 100896490 453501929 74766941 83643094 98190045 99755654 101281845 457637579 0 0 0 457637579 1437630 3240878 2473106 4695898 3148743 14996255 1437630 3240878 2473106 4695898 3148743 14996255 76204571 86883972 100663151 104451552 104430588 472633834 0.96830 0.97060 0.03170 0.02940 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 30000 0 0 30000 0 23866609 23866609 226561920 91118313 135443607 19213859 13160373 6053486 165363702 CASH AND CASH EQUIVALENTS 27847052 F BONDS 1687485 F MUTUAL FUNDS 83842051 F 113376588 DUE FROM AFFILIATE 28586546 INTEREST RECEIVABLE AND OTHER 2607792 DEFERRED FINANCING COSTS 3729615 DEFERRED MARKETING COSTS 345360 CONSTRUCTION IN PROGRESS 6605615 41874928 REFUNDABLE ADMISSION FEES 100360336 RESIDENT DEPOSITS 2870718 ACCRUED PENSION COST 3921694 INTEREST RATE SWAP AGREEMENT 1998375 CASH PAID IN EXCESS OF BANK 2683038 111834161 108756900 103677306 5079594 1763154 -592185 1170969 6250563 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATIONS, EXCEPT FOR THE WHOLLY OWNED SUBSIDIARY, PROVIDENT GROUP, INC., AND THE WHOLLY OWNED LIMITED LIABILITY COMPANIES, MACKENZIE PLACE LIHTC, L.P. AND MACKENZIE PLACE HTC, L.P., 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 YEAR 2007 TO 2010 ARE SUBJECT TO REVIEW AND EXAMINATION BY THE IRS. PART XI, LINE 8 - OTHER ADJUSTMENTS: NET PERIODIC PENSION COST -672,135. CHANGE IN VALUE OF INTEREST RATE SWAP -618,947. OTHER CHANGES IN PLAN ASSETS AND BENEFIT OBLIGATIONS 698,897. X X X X X 0 0 0 0 0 0 0 0 0 JOHN R KOTOVSKY 279900 0 0 0 85263 0 20000 0 24499 0 409662 0 85263 0 PAUL OGIER 228281 0 0 0 30283 0 20000 0 22046 0 300610 0 30283 0 LINDA M DETRING 220158 0 0 0 20119 0 20000 0 11176 0 271453 0 20119 0 MARK W SCHOEDEL 158448 0 0 0 0 0 20000 0 10034 0 188482 0 0 0 DALE KREIENKAMP 157251 0 0 0 0 0 20000 0 10007 0 187258 0 0 0 MICHAEL RASO 144637 0 0 0 0 0 0 0 8872 0 153509 0 0 0 HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF THE STATE OF MISSOURI 431178966 60635HD89 2008-08-27 50000000 CAP. IMPROVEMENTS TO LUTHERAN SENIOR SVCS & LUTHERAN RETIREMENT CENTER ASSOC 0 0 0 HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF THE STATE OF MISSOURI 431178966 60635HC49 2007-02-08 61166776 CAPITAL IMPROVEMENTS TO VARIOUS FACILTIES NOTED IN PART V 0 0 0 HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF THE STATE OF MISSOURI 431178966 60635HYM5 2005-08-31 30848043 FINANCE PURCHASE AND CONSTRUCTION IMPROVEMENTS OF VARIOUS CAMPUSES 0 0 0 HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF THE STATE OF MISSOURI 431178966 60635HZA0 2005-11-03 22311871 REFUNDING PRIOR BOND ISSUANCE FROM SERIES 1996A, FUND DEBT SERVICE RESERVE 0 0 0 50000000 375000 208438 49416562 2009 0 0 1 1 3390000 65779769 2972627 50397765 847650 4612993 7738087 2007 0 1 1 1 31011201 1681349 500000 163158 28766609 2007 0 0 1 1 2950000 22311871 21993223 318648 1 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 1 1 US BANK 7.000000000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE K, PAGE 1, PART II, COLUMN(B), LINE 4 INTEREST ON RESERVE FUNDS INCLUDES ACCUMULATED INTEREST INCOME ON RESERVE FUNDS THROUGH 12/31/2010 OF 789,353. SCHEDULE K, PAGE 1, PART II, COLUMN(B), LINE 3 INCLUDES ACCUMULATED INTEREST INCOME THROUGH 12/31/2010 OF 4,612,993. SCHEDULE K, PAGE 1, PART II, COLUMN(C), LINE 3 INCLUDES ACCUMULATED INTEREST INCOME THROUGH 12/31/2010 OF 163,158. SCHEDULE K, PAGE 1, PART II, COLUMN(C), LINE 4 INTEREST ON RESERVE FUNDS INCLUDES ACCUMULATED INTEREST INCOME ON RESERVE FUNDS THROUGH 12/31/2010 OF 99,915. SCHEDULE K, PAGE 1, PART II, COLUMN(D), LINE 14 SCHEDULE K, ENTITY 2, PAGE 1, PART II, LINE (A), COLUMN (F) THE CAPITAL IMPROVEMENTS BENEFITTED LUTHERAN SENIOR SERVICES, HEISINGER LUTHERAN HOME, LUTHERAN RETIREMENT CENTER ASSOCIATION, AND MERIDIAN VILLAGE ASSOCIATION III SCHEDULE K, ENTITY 1, PAGE 1, PART II, LINE (A), COLUMN (B) THE 2007 SERIES A BONDS FUNDED PROJECTS AT THE FOLLOWING FACILITIES: MERIDIAN VILLAGE RETIREMENT COMMUNITY IN GLEN CARBON, IL, ST. JOSEPH'S HOME IN JEFFERSON CITY, MO, LUTHERAN CONVALESCENT HOME IN WEBSTER GROVES, MO, BREEZE PARK RETIREMENT COMMUNITY IN ST. CHARLES, MO, LENOIR WOODS IN COLUMBIA, MO, AND HIDDEN LAKE RETIREMENT COMMUNITY IN SPANISH LAKE, MO. THE 2007 SERIES B BONDS FUNDED PROJECTS AT MERIDIAN VILLAGE ASSOCIATION IN GLEN CARBON, IL. THE 2007 SERIES C BONDS FUNDED PROJECTS AT MERIDIAN VILLAGE ASSOCIATION II IN GLEN CARBON, IL. HEALTH AND EDUCATIONAL FACILITIES AUTHORITY OF THE STATE OF MISSOURI 431178966 60635HK40 2010-10-14 38277316 CAP. IMPROVEMENTS TO VARIOUS FACILITIES NOTED IN PART V 0 0 0 38277316 3777233 650335 33849748 2011 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BOARD MEMBERS ARE ELECTED BY ASSOCIATED CHURCHES. FORM 990, PART VI, SECTION B, LINE 11 THE GOVERNING BODY IS PROVIDED A COPY OF THE FORM 990 FOR REVIEW PRIOR TO FILING. APPROVAL OF THE FORM 990 IS DELEGATED TO THE AUDIT COMMITTEE OF THE GOVERNING BODY PRIOR TO FILING. 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 POLICY, FINANCIAL STATEMENTS, AND OTHER DOCUMENTS TO ALL WHO REQUEST ONE OR MORE OF THE ITEMS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,763,154. NET PERIODIC PENSION COST -672,135. CHANGE IN VALUE OF INTEREST RATE SWAP -618,947. OTHER CHANGES IN PLAN ASSETS AND BENEFIT OBLIGATIONS 698,897. TOTAL TO FORM 990, PART XI, LINE 5: 1,170,969. 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. MACKENZIE PLACE LIHTC LP 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 272136187 DEVELOPMENT OF INDEPENDENT LIVING FACILITY MO 0 928175 N/A MACKENZIE PLACE HTC MASTER LANDLORD LP 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 272136274 DEVELOPMENT OF INDEPENDENT LIVING FACILITY MO 0 0 N/A LUTHERAN SENIOR SERVICES ENDOWMENT FUND 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 431818832 SENIOR LIVING MO 501(C)(3) 509(A)(3) N/A 1 HALLS FERRY MANOR 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 431660879 SENIOR LIVING MO 501(C)(3) 509(A)(2) N/A 0 DUNN ROAD MANOR INC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 431874215 SENIOR LIVING MO 501(C)(3) 509(A)(2) N/A 0 ROSE HILL HOUSE INC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 431736720 SENIOR LIVING MO 501(C)(3) 509(A)(2) N/A 0 ROSE HILL HOUSE II INC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 201889216 SENIOR LIVING MO 501(C)(3) 509(A)(2) N/A 0 HILLTOP MANOR ASSOCIATION INC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 020667342 SENIOR LIVING MO 501(C)(3) 509(A)(2) N/A 0 WESTFIELD MANOR ASSOCIATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 020568032 SENIOR LIVING IL 501(C)(3) 509(A)(2) N/A 0 MERIDIAN VILLAGE ASSOCIATION I 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 364200225 SENIOR LIVING IL 501(C)(3) 509(A)(3) N/A 0 MERIDIAN VILLAGE ASSOCIATION II 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 371415587 SENIOR LIVING IL 501(C)(3) 509(A)(2) N/A 0 MERIDIAN VILLAGE ASSOCIATION III 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 371415588 SENIOR LIVING IL 501(C)(3) 509(A)(2) N/A 0 COLE COUNTY LUTHERAN HOME ASSOCIATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 431147326 SENIOR LIVING MO 501(C)(3) 509(A)(2) N/A 0 HEISINGER HOPE FOUNDATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 431905378 SENIOR LIVING MO 501(C)(3) 509(A)(3) N/A 0 LUTHERAN RETIREMENT CENTER ASSOCIATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 371199021 SENIOR LIVING MO 501(C)(3) 509(A)(2) N/A 0 LUTHERAN HILLSIDE VILLAGE INC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 370818454 SENIOR LIVING MO 501(C)(3) 509(A)(2) N/A 0 LUTHERAN HILLSIDE VILLAGE FOUNDATION 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 371371314 SENIOR LIVING MO 501(C)(3) 509(A)(1) N/A 0 PROVIDENT GROUP INC 1150 HANLEY INDUSTRIAL COURT ST LOUIS MO 63144 300134496 DEVELOPMENT & MANAGEMENT OF ASSISTED LIVING FACILITIES MO C -2315 -367929 1.00000 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 COLE COUNTY LUTHERAN HOME ASSOCIATION K 513910 MERIDIAN VILLAGE ASSOCIATION III K 454123 LUTHERAN HILLSIDE VILLAGE INC K 806986 WESTFIELD MANOR ASSOCIATION K 57428 LUTHERAN SENIOR SERVICES ENDOWMENT FUND C 1319074 MERIDIAN VILLAGE ASSOCIATION III P 51229 LUTHERAN RETIREMENT CENTER ASSOCIATION K 192961