TY 2013 Form 990 Schedule O

efile Public Visual Render ObjectId: 201540449349300244 - Submission: 2015-02-13 TIN: 41-0693906

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
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Attach to Form 990 or 990-EZ.
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Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

CHILDREN'S HOME SOCIETY OF MINNESOTA

Employer identification number

41-0693906

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 1	THE ORGANIZATION'S EXECUTIVE COMMITTEE CONSISTS OF THE BOARD CHAIR, VICE-CHAIRS, AND THE CHAIRS OF OTHER BOARD COMMITTEES. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO ACT FOR AND ON BEHALF OF THE BOARD WHEN THE BOARD IS NOT IN SESSION, BUT IS ACCOUNTABLE TO THE BOARD FOR ALL ACTIONS TAKEN. ALL FORMAL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE ARE REPORTED TO THE BOARD FOR RATIFICATION DURING THE NEXT MEETING.
FORM 990, PART VI, SECTION A, LINE 3	EFFECTIVE JULY 1, 2012, THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT WITH LUTHERAN SOCIAL SERVICE OF MINNESOTA, EFFECTIVE THROUGH JUNE 30, 2018.
FORM 990, PART VI, SECTION B, LINE 11	THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND PROVIDED TO BOTH THE BOARD OF DIRECTORS AND FINANCE COMMITTEE PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12C	ANNUAL DISCLOSURE FORMS ARE REQUIRED TO BE COMPLETED BY ALL BOARD MEMBERS. IF A POTENTIAL CONFLICT ARISES, THE CONFLICTED INDIVIDUAL SHALL NOT PARTICIPATE IN THE DISCUSSION (EXCEPT TO DISCLOSE MATERIAL FACTS), VOTE, OR HAVE INVOLVEMENT IN ANY OTHER ACTION RELATED TO THE CONFLICTED TRANSACTION. CONFLICTS ARE DETERMINED BY UNCONFLICTED BOARD MEMBERS. ANY CONFLICT OF INTEREST PROCEEDINGS ARE DOCUMENTED IN THE MEETING MINUTES.
FORM 990, PART VI, SECTION B, LINE 15	AS OF 7/1/12, UNDER THE MANAGEMENT AGREEMENT WITH LSSMN, JODI HARPSTEAD BECAME THE CEO OF CHSMN. HER COMPENSATION AND ANNUAL APPRAISAL IS PERFORMED BY THE EXECUTIVE COMMITTEE OF THE LSSMN BOARD OF DIRECTORS. THE CFO & TREASURER, KEN BORLE, ALSO SERVES UNDER THE MANAGEMENT AGREEMENT AND HIS COMPENSATION IS REVIEWED AND DETERMINED UNDER THE POLICIES OF LSSMN. PERFORMANCE APPRAISALS AND SALARY ADJUSTMENTS FOR THE SENIOR DIRECTOR ARE MADE BY THE CEO. THIS PROCESS WAS LAST UNDERTAKEN FOR THE SENIOR DIRECTOR OF ADOPTION, ALEXIS OBERDORFER, IN 2014.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC. THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 9:	CHANGE IN VALUE OF SPLIT INTEREST AGREEMENT 4,844. CHANGE IN VALUE OF BENEFICIAL INTEREST COMMUNITY FOUNDATION HOLDING 156,655. CHANGE IN VALUE OF TRUST 37,085.

Return Reference

Explanation

FORM 990, PART VI, SECTION A, LINE 1

THE ORGANIZATION'S EXECUTIVE COMMITTEE CONSISTS OF THE BOARD CHAIR, VICE-CHAIRS, AND THE CHAIRS OF OTHER BOARD COMMITTEES. THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO ACT FOR AND ON BEHALF OF THE BOARD WHEN THE BOARD IS NOT IN SESSION, BUT IS ACCOUNTABLE TO THE BOARD FOR ALL ACTIONS TAKEN. ALL FORMAL ACTIONS TAKEN BY THE EXECUTIVE COMMITTEE ARE REPORTED TO THE BOARD FOR RATIFICATION DURING THE NEXT MEETING.

FORM 990, PART VI, SECTION A, LINE 3

EFFECTIVE JULY 1, 2012, THE ORGANIZATION ENTERED INTO A MANAGEMENT AGREEMENT WITH LUTHERAN SOCIAL SERVICE OF MINNESOTA, EFFECTIVE THROUGH JUNE 30, 2018.

FORM 990, PART VI, SECTION B, LINE 11

THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND PROVIDED TO BOTH THE BOARD OF DIRECTORS AND FINANCE COMMITTEE PRIOR TO FILING.

FORM 990, PART VI, SECTION B, LINE 12C

ANNUAL DISCLOSURE FORMS ARE REQUIRED TO BE COMPLETED BY ALL BOARD MEMBERS. IF A POTENTIAL CONFLICT ARISES, THE CONFLICTED INDIVIDUAL SHALL NOT PARTICIPATE IN THE DISCUSSION (EXCEPT TO DISCLOSE MATERIAL FACTS), VOTE, OR HAVE INVOLVEMENT IN ANY OTHER ACTION RELATED TO THE CONFLICTED TRANSACTION. CONFLICTS ARE DETERMINED BY UNCONFLICTED BOARD MEMBERS. ANY CONFLICT OF INTEREST PROCEEDINGS ARE DOCUMENTED IN THE MEETING MINUTES.

FORM 990, PART VI, SECTION B, LINE 15

AS OF 7/1/12, UNDER THE MANAGEMENT AGREEMENT WITH LSSMN, JODI HARPSTEAD BECAME THE CEO OF CHSMN. HER COMPENSATION AND ANNUAL APPRAISAL IS PERFORMED BY THE EXECUTIVE COMMITTEE OF THE LSSMN BOARD OF DIRECTORS. THE CFO & TREASURER, KEN BORLE, ALSO SERVES UNDER THE MANAGEMENT AGREEMENT AND HIS COMPENSATION IS REVIEWED AND DETERMINED UNDER THE POLICIES OF LSSMN. PERFORMANCE APPRAISALS AND SALARY ADJUSTMENTS FOR THE SENIOR DIRECTOR ARE MADE BY THE CEO. THIS PROCESS WAS LAST UNDERTAKEN FOR THE SENIOR DIRECTOR OF ADOPTION, ALEXIS OBERDORFER, IN 2014.

FORM 990, PART VI, SECTION C, LINE 19

THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC. THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.

FORM 990, PART XI, LINE 9:

CHANGE IN VALUE OF SPLIT INTEREST AGREEMENT 4,844. CHANGE IN VALUE OF BENEFICIAL INTEREST COMMUNITY FOUNDATION HOLDING 156,655. CHANGE IN VALUE OF TRUST 37,085.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

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