Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
Bendictine Living Community of Winsted |
274219293 | Yes | 1,754,616 | 0 | ||
| (B)
Bendictine Living Community of New London |
274218436 | Yes | 904,770 | 0 | ||
| (C)
Bendictine Living Community of Mora |
274219119 | Yes | 596,711 | 0 | ||
| (D)
Bendictine Living Community of Wahpeton |
454274091 | Yes | 529,651 | 0 | ||
| (E)
Benedictine Living Community of Byron |
471538777 | Yes | 0 | 0 | ||
| (F)
Benedictine Health System |
411531892 | Yes | 0 | 0 | ||
Total 6
|
3,785,748 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Part IV, Section D, Line 3: | Benedictine Health System's CEO appointed one of the Foundation's five Directors, Kevin Rymanowski. In addition to his service on the Foundation's Board, Mr. Rymanowski serves as the Chief Financial Officer of BHS and each of the Supported Organizations. He is actively engaged as a Board member in the Foundation's governance and participates in decisions and discussions at the Board level and with the Foundation's leadership in all aspects of the Foundation's management and use of its income and assets for the benefit of BHS and the Supported Organizations. In this manner, the Supported organizations have a significant voice in the Foundation's management and use of its income and assets. |
| Part IV, Section E, Line 2a: | The Foundation holds title to and manages properties used by the Supported Organizations in furtherance of their exempt purposes of providing senior housing and long-term care services with special concern for the underserved and those in need of such services. The Supported Organizations each use the respective properties to provide housing to seniors and offer supportive long-term care services. |
| Part IV, Section E, Line 2b: | If these facilities were not owned and managed by the Foundation, the Supported Organizations would own and manage such facilities itself because these activities are critical to the Supported Organizations' ability to carry out their own activities in furtherance of their mission and purposes. Because the Supported Organizations would otherwise conduct these same activities if they were not performed by the Foundation, the Foundation's activities represent an integral part of the activities of the Supported Organizations. |
| Part IV, Section A, Line 11: | Benedictine Health System is a Type III Functionally Integrated Supporting Organization and is also recognized within the IRS Group Ruling for Catholic organizations under IRC Section 170(b)(1)(A)(i). |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part III, line 2 | Living Services Foundation/Byron, LLC and Benedictine Living Community of Byron began construction of a 50 unit senior housing campus. The services are not yet available. |
| Form 990, Part VI, Section A, line 2 | Dennis Kamstra and Jennifer Gleason have a family relationship. |
| Form 990, Part VI, Section A, line 4 | The organization's documents were amended for the addition of BLC Byron as a supporting organization. |
| Form 990, Part VI, Section A, line 7a | Benedictine Health Systems may appoint one board member with voting rights. |
| Form 990, Part VI, Section A, line 8b | No committees are able to act on behalf of the board. |
| Form 990, Part VI, Section B, line 11 | An electronic draft of the Form 990 is distributed to the full board of directors for review and approval prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | The Conflict of Interest policy is enforced and consistently monitored. An interested person must disclose the existence of their financial interest to the board considering the proposed transaction or arrangement. The remaining board members then determine if a conflict of interest exists. Corrective action is taken by the board of directors as deemed necessary when a conflict of interest is determined to have occurred. Disclosure of a conflict of interest would prevent that person from taking part in discussions or voting on related issues. |
| Form 990, Part VI, Section B, line 15 | The process for determining compensation for the CEO and COO is determined by a compensation survey and study. The compensation is then approved by the independent members of the Board of Directors. The last review took place during the summer of 2014. |
| Form 990, Part VI, Section C, line 19 | The Organization makes the governing documents and conflict of interest policy available upon request. |
| Amended Form 990: | The organization previously filed its June 30, 2015 Form 990 prior to having issued financial statements with final numbers. The audited financial statements have since been finalized and the organization is filing an amended Form 990 to report the changes in financial figures. Form 990, Part I, Lines 8, 17, 19, 20, 21, and 22: Amounts previously reported on these lines have been udpated according to changes made in Parts VIII, IX, and X. Form 990, Part III, Line 4a: Amounts for expenses and revenue have been updated according to changes made in Parts VIII and IX. Form 990, Part VIII, Line 2b: Lease revenue has been updated to reflect final amount per audited financial statement. Form 990, Part IX, Column (B), Lines 16, 22: Occupancy and depreciation expenses have been updated to reflect final amounts per audited financial statement. Form 990, Part X, End of Year: Lines 4, 10c, 15, 17 and 27 have been updated to reflect final amounts per audited financial statement. Form 990, Part XI: Lines 1, 2, 3, 9 and 10 have been updated to reflect final amounts per audited financial statement. Schedule D, Part VI: Amounts have been updated to reflect final amounts per audited financial statement. Schedule D, Part IX: Unamortized financing costs have been updated to reflect final amount per audited financial statement. Schedule D, Parts XI and XII, Line 1: Total revenue and total expense has been updated to reflect final amounts per audited financial statement. Schedule K, Part II, Lines 1, 4 and 10: Amounts have been updated to reflect final figures per audited financial statements. Schedule K, Part IV, Lines 2 and 3: Responses have been updated to reflect accurate information per Form 8038. |
| Software ID: | |
| Software Version: |