SCHEDULE O
(Form 990)

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 990-EZ or to provide any additional information.
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OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN
SOCIETY
Employer identification number

45-0228055
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE EMPLOYEES OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY OR ITS RELATED ORGANIZATIONS. MANY OF THESE EMPLOYEES ALSO SERVE ON OTHER RELATED ORGANIZATION BOARDS OR HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER THAT SPAN THE ORGANIZATION AS A WHOLE: RANDY BURY, ELIZABETH CALLAHAN, PATRICIA CAMERO, TABBITHA COOK, MATT HOCKS, BILL MARLETTE, LISA MELBY, AIMEE MIDDLETON, NATHAN SCHEMA, ERIC VANDEN HULL AND TRACI WOOLFOLK.
FORM 990, PART VI, SECTION A, LINE 6 ON JANUARY 1, 2019, SANFORD BECAME THE CLASS A CORPORATE MEMBER OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY. AT THAT TIME, THE EXISTING MEMBERSHIP OF THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY (THE "SOCIETY") BECAME THE CLASS B MEMBER THAT RETAINED THE ABILITY TO RECOMMEND MEMBERS OF THE SOCIETY BOARD OF DIRECTORS FOR APPOINTMENT BY THE CLASS A CORPORATE MEMBER, SANFORD. THE SOCIETY BOARD OF DIRECTORS ADMINISTERS THE AFFAIRS OF THE SOCIETY, INCLUDING BUDGET DEVELOPMENT AND PROVIDING ADVICE AND CONSENT TO SANFORD IN SELECTING AND EVALUATING THE SOCIETY PRESIDENT. SOME ACTIONS OF THE SOCIETY BOARD OF DIRECTORS REQUIRE APPROVAL OF THE SANFORD BOARD OF TRUSTEES (SEE PART VI, LINE 7B).
FORM 990, PART VI, SECTION A, LINE 7A THE CLASS A CORPORATE MEMBER, SANFORD, APPOINTS THE BOARD MEMBERS FOR THE BOARD OF DIRECTORS OF THE SOCIETY.
FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS OF THE SOCIETY BOARD OF DIRECTORS MUST BE APPROVED BY THE CLASS A CORPORATE MEMBER, SANFORD: (1) APPROVAL OF THE SOCIETY'S ANNUAL AND LONG-TERM STRATEGIC PLANS; (2) APPROVAL OF THE SOCIETY'S ANNUAL OPERATING AND CAPITAL BUDGET AND FINANCIAL FORECAST; (3) MERGER, CONSOLIDATION, DISSOLUTION, SALE OF SUBSTANTIALLY ALL OF SOCIETY'S ASSETS, OR ANY OF THE SAME ACTIONS WITH RESPECT TO ANY SOCIETY SUBSIDIARY TO THE EXTENT SUCH TRANSACTION WOULD REPRESENT SUBSTANTIALLY ALL OF THE SOCIETY'S ASSETS; (4) AMENDMENT, MODIFICATION OR TERMINATION OF THE ARTICLES OF INCORPORATION OR BYLAWS.
FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED INTERNALLY BY THE TAX DEPARTMENT AND REVIEWED BY EXECUTIVE MANAGEMENT. AN EXTERNAL ACCOUNTING FIRM REVIEWS THE RETURN. THE TAX DEPARTMENT PREPARES RETURN HIGHLIGHTS AND KEY DISCLOSURES FOR THE BOARD OF TRUSTEES MEETING PRIOR TO THE RETURN FILING DATE. BEFORE THE RETURN IS FILED, A COMPLETE COPY IS PROVIDED TO THE CURRENT BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 12C THE ANNUAL CONFLICT OF INTEREST DISCLOSURE PROCESS IS MANAGED BY THE CHIEF COMPLIANCE OFFICER (CCO). THE CCO IS RESPONSIBLE FOR ASSURING THAT ALL COMPLETED FORMS ARE RETURNED IN A TIMELY AND COMPLETE MANNER. CONFLICT OF INTEREST QUESTIONNAIRES ARE SENT TO SYSTEM TRUSTEES, MEMBERS OF THE GOVERNING BOARDS OF SUBSIDIARY ENTITIES, OFFICERS, AND KEY EMPLOYEES FOR ALL ENTITIES SUBJECT TO THE IRS FORM 990 FILINGS. THE DISCLOSURES ARE SUMMARIZED FOR REVIEW BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES, PURSUANT TO POLICY. THIS REVIEW ALLOWS: 1) THE BOARD TO ACQUIRE AN AWARENESS OF FINANCIAL RELATIONSHIPS OF BOARD MEMBERS AND KEY MANAGEMENT EMPLOYEES AND CAN INVOKE THE RECUSAL PROCESS ON A CASE-BY-CASE BASIS IF POTENTIAL CONFLICTS ARE IMPLICATED IN BOARD DECISIONS AND DELIBERATIONS, AND, 2) GIVES THE BOARD THE OPPORTUNITY TO SEEK ADDITIONAL INFORMATION AND CLARIFICATION ABOUT DISCLOSURES TO DETERMINE POTENTIAL CONFLICTS OF INTEREST, AND HOW TO MANAGE THEM.
FORM 990, PART VI, SECTION B, LINE 15 SANFORD AS THE PARENT ORGANIZATION DOES HAVE A PROCESS FOR DETERMINING COMPENSATION OF THE PERSONS LISTED ON PART VII SECTION A, INCLUDING A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, REVIEW OF COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION FOR SUCH COMPENSATION. THE EXECUTIVE COMPENSATION COMMITTEE OF THE SANFORD BOARD OF TRUSTEES DIRECTLY ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND EXECUTIVES OF THE ORGANIZATION, INCLUDING THE CEO, AND TO REPORT THE FINDINGS TO THEM FOR DELIBERATION AND ACTION. THE DELIBERATIONS AND ACTIONS ARE RECORDED IN THE MINUTES OF THE SANFORD BOARD OF TRUSTEES. THE MOST RECENT STUDY WAS COMPLETED IN 2021.
FORM 990, PART VI, SECTION C, LINE 19 ALTHOUGH THE ORGANIZATION DOES NOT MAINTAIN A WEBSITE WHERE THE PUBLIC CAN ACCESS THESE DOCUMENTS, IT WOULD RESPOND INDIVIDUALLY TO ANY REQUESTS OR INQUIRIES FROM THE PUBLIC FOR THESE DOCUMENTS.
FORM 990, PART VII THE SANFORD BOARD OF TRUSTEES HAS ULTIMATE GOVERNANCE RESPONSIBILITIES FOR EACH MAJOR OPERATION ENTITY WITHIN SANFORD. IN ADDITION, A BOARD OF DIRECTORS IS ESTABLISHED FOR EACH MAJOR OPERATING ENTITY. THIS BOARD HAS SPECIFIC RESPONSIBILITIES DELEGATED FROM THE BOARD OF TRUSTEES. GENERALLY THESE RESPONSIBILITIES ARE RELATED TO THE OVERSIGHT OF THE DAY TO DAY OPERATIONS OF THAT ENTITY.
FORM 990, PART XI, LINE 9: FAIR MARKET VALUE ADJUSTMENT -1,120,286. HERITAGE DISTRIBUTION 252,391. TRANSFER TO RELATED TAX-EXEMPT ORG FOR PAYROLL AND OPERATING EXPENSES -29,205,803. CAPITAL CONTRIBUTION TO HERITAGE HERALTHCARE SERVICES -1,270,159.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


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