2020-08-12T09:53:54-05:00 2019-09-30 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2018-10-01 411424801 OPEN CIRCLE ADULT DAY CENTER OPEN 9528555000 7171 OHMS LANE EDINA MN 55439 KATHY YOUNGQUIST CFO 9528555000 2020-08-11 1 MATT WOCKEN P01598291 6123764500 2020-08-11 66.188.188.148 2020-08-11 08:19:45 CD P 80E1F4C36FD5403AFF9C3193509FEE9CEC8C2CF0 8DF0D5A1DBF8E44DE93554FEEDBEEE801640FE4C 2018 2020-09-22 18:59:49Z ROBERT DAHL 7171 OHMS LANE EDINA MN 55439 2159637 0 X WWW.CASSIALIFE.ORG X 1982 MN TO PROVIDE HEALTH CARE, HOUSING AND COMMUNITY SERVICES FOR THE ELDERLY. 11 11 49 45 0 0 30086 77478 2053258 2081323 968 836 0 0 2084312 2159637 0 0 0 0 1460159 1474695 0 0 0 570810 614459 2030969 2089154 53343 70483 426551 521566 129752 154284 296799 367282 TO SERVE GOD BY FOSTERING FULLNESS OF LIFE FOR OLDER ADULTS AND OTHER PEOPLE IN NEED THROUGH THE PROVISION OF HEALTH CARE, HOUSING, AND OTHER SERVICES IN A CHRISTIAN TRADITION. 0 0 1556644 0 2081323 ADULT DAY CARE - PROVIDED SOCIAL, THERAPEUTIC, AND HEALTH RELATED SERVICES TO ELDERLY AND DISABLED ADULTS. OPEN CIRCLE ADULT DAY CENTER SERVED 287 INDIVIDUALS DURING THE YEAR ENDED SEPTEMBER 30, 2019. 1556644 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 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 49 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X KATHY YOUNGQUIST - AE CARE SERVICE 9528555000 7171 OHMS LANE EDINA MN 55439 TIMOTHY TUCKER PRESIDENT/CEO (THROUGH JUNE 2019) 0.56 39.44 X 0 708792 131561 CRAIG KITTELSON FORMER VP/CFO (THROUGH JUNE 2018) 0.00 0.00 X 0 522500 53130 KATHY KOPP CHIEF STRATEGY OFFICER 0.00 40.00 X 0 288340 79995 MATTHEW KERN COO 0.35 24.65 X 0 291488 26049 SHARON WILSON CHIEF CLINICAL & COMPLIANCE OFFICER 0.28 19.72 X 0 180085 12689 ROBERT DAHL PRESIDENT/CEO 0.28 19.72 X 0 0 0 KATHY YOUNGQUIST CFO 1.50 18.50 X 0 0 0 ANGELA BROWN CHRO 0.28 19.72 X 0 0 0 REV DR GARY WILKERSON CHAIR 1.00 9.00 X X 0 0 0 MARSHALL MACKAY VICE CHAIR 1.00 9.00 X X 0 0 0 ERIK RICK ELLINGSON TREASURER 1.00 9.00 X X 0 0 0 CHIP PARKS SECRETARY 1.00 9.00 X X 0 0 0 BRUCE CRAWFORD DIRECTOR 1.00 8.00 X 0 0 0 JIM EHLEN DIRECTOR (THROUGH DEC 2018) 1.00 8.00 X 0 0 0 DUANE HETLAND DIRECTOR 1.00 9.00 X 0 0 0 TIMOTHY KUCK DIRECTOR 1.00 9.00 X 0 0 0 LARRY KULA DIRECTOR 1.00 9.00 X 0 0 0 JERRY NYE DIRECTOR 1.00 9.00 X 0 0 0 SCOTT RAMSDALE DIRECTOR 1.00 9.00 X 0 0 0 MICHELENE VERLAUTZ DIRECTOR 1.00 9.00 X 0 0 0 0 1991205 303424 0 1 1 0 A&E CARE SERVICES 7171 OHMS LANE EDINA MN 55439 MANAGEMENT SERVICES 129578 1 49700 27778 77478 HOUSING FACILITIES 623000 1962005 1962005 TRANSPORTATION INCOME 480000 119318 119318 2081323 836 836 2159637 2081323 0 836 1210107 971282 238825 19355 11543 7812 162704 142300 20404 82529 65938 16591 129578 129578 6773 6773 24550 14287 10263 5150 5150 49826 22177 27649 72490 72490 80351 79909 442 42642 6167 36475 23408 23408 8858 8858 PURCHASED MEALS 125326 125326 BAD DEBT EXPENSES 16581 16581 DIETARY EXPENSES 12411 12411 DUES AND SUBSCRIPTIONS 4884 1715 3169 11631 7691 3940 2089154 1556644 532510 0 600 600 276708 373219 5038 8982 818876 680111 144205 138765 426551 521566 104103 120954 25649 33330 129752 154284 X 293499 363982 3300 3300 296799 367282 426551 521566 70483 0 X X 0 1 X 1 0 X 16932 53756 89348 30086 77478 267600 1835078 1843720 1898408 2053258 2081323 9711787 1852010 1897476 1987756 2083344 2158801 9979387 0 0 0 9979387 302 47 267 968 836 2420 302 47 267 968 836 2420 1852312 1897523 1988023 2084312 2159637 9981807 0.99980 0.99980 0.00020 0.00020 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 20000 20000 529996 457873 72123 268880 222238 46642 138765 DUE TO AFFILIATES 33330 33330 X PART X, LINE 2: AUGUSTANA CARE AND ITS AFFILIATES HAVE BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND MINNESOTA CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THESE 501(C)(3) ORGANIZATIONS HAVE BEEN CLASSIFIED AS ENTITIES THAT ARE NOT PRIVATE FOUNDATIONS UNDER SECTION 509(A). THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES IN EVALUATING THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. AUGUSTANA CARE AND ITS AFFILIATES' INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE ORGANIZATION REPORTS ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES AND FILES ALL PROPER RETURNS RELATED TO THESE ACTIVITIES. 1 1 0 0 0 0 0 0 0 TIMOTHY TUCKER PRESIDENT/CEO (THROUGH JUNE 2019) 0 475147 0 0 0 233645 0 111869 0 19692 0 840353 0 0 CRAIG KITTELSON FORMER VP/CFO (THROUGH JUNE 2018) 0 246836 0 84981 0 190683 0 27888 0 25242 0 575630 0 0 KATHY KOPP CHIEF STRATEGY OFFICER 0 228951 0 36108 0 23281 0 30533 0 49462 0 368335 0 0 MATTHEW KERN COO 0 252354 0 39112 0 22 0 4971 0 21078 0 317537 0 0 SHARON WILSON CHIEF CLINICAL & COMPLIANCE OFFICER 0 153948 0 23715 0 2422 0 6271 0 6418 0 192774 0 0 PART I, LINE 3 FOR THE PURPOSES OF DETERMINING COMPENSATION, OPEN CIRCLE ADULT DAY CENTER RELIED ON A RELATED ORGANIZATION, A&E CARE SERVICES, TO ESTABLISH THE COMPENSATION OF THE PRESIDENT/CEO. A&E CARE SERVICES USED THE FOLLOWING PRACTICES TO ESTABLISH COMPENSATION FOR THE PRESIDENT/CEO: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINES 4A-B CRAIG KITTELSON STEPPED DOWN AS THE CFO OF AUGUSTANA CARE AND AFFILIATES ON JUNE 30, 2018. HE STAYED ON PAYROLL AS A CONSULTANT THROUGH SEPTEMBER 30, 2018. THERE WAS A $50,000 SEVERANCE PAID TO CRAIG IN NOVEMBER 2018. THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN PROVIDED BY A&E CARE SERVICES, A RELATED ORGANIZATION: TIM TUCKER, PRESIDENT AND CEO - $186,842 CRAIG KITTELSON, FORMER VICE PRESIDENT OF FINANCE AND CFO - $163,309 KATHERINE KOPP, CHIEF STRATEGY OFFICER - $2,500 OVERALL MISSION OF AUGUSTANA ENTITIES AUGUSTANA CARE AND ITS SUBSIDIARIES' MISSION IS TO FOSTER FULLNESS OF LIFE FOR OLDER ADULTS AND OTHERS IN NEED THROUGH THE PROVISION OF HEALTHCARE, HOUSING AND OTHER SERVICES IN A CHRISTIAN TRADITION. OUR GOAL IS TO HELP RESIDENTS LIVE THE LIVES THAT MOST INSPIRE THEM. THE PRINCIPLES THAT GUIDE OUR WORK INCLUDE VALUING OLDER GENERATIONS' TALENTS AND EXPERIENCE; WORKING TO PROVIDE THE CARE RESIDENTS NEED, WHEN AND WHERE THEY NEED IT; WORKING TO CONNECT RESIDENTS TO THE PEOPLE AND THINGS THAT MEAN THE MOST TO THEM; AND SUPPORTING RESIDENTS AND FAMILIES WITH SPIRITUAL CARE THAT SPEAKS TO WHO THEY ARE. WE OFFER A BROAD RANGE OF SERVICES TO ANTICIPATE AND ADDRESS THE NEEDS OF OLDER ADULTS. IN OUR 2019 FISCAL YEAR, MORE THAN 17,100 PEOPLE WERE SERVED IN MINNESOTA AND COLORADO. OUR SEVEN HEALTH CARE CENTERS PROVIDED TRANSITIONAL CARE, LONG-TERM AND MEMORY CARE, AND REHABILITATION SERVICES TO MORE THAN 3,000 PEOPLE. AUGUSTANA CARE ALSO PROVIDES VARIOUS HOUSING COMMUNITIES TO SERVE OLDER ADULTS WITH COMFORTABLE LIVING AND CARE OPTIONS, INCLUDING INDEPENDENT LIVING, HOUSING WITH SERVICES, ASSISTED LIVING, AND MEMORY CARE. IN FISCAL YEAR 2019, A TOTAL OF 1,742 RESIDENTS BENEFITED FROM THESE SERVICES. WE ALSO OFFER A RANGE OF COMMUNITY-BASED SERVICES, SUCH AS ADULT DAY PROGRAMS, HOSPICE, AND THERAPY SERVICES, TO ENHANCE THE QUALITY OF LIFE FOR OLDER ADULTS WHO CONTINUE TO LIVE IN THEIR OWN HOMES. MORE THAN 12,342 INDIVIDUALS WERE SERVED THROUGH THESE PROGRAMS IN FISCAL YEAR 2019. FINALLY, MANAGEMENT CONSULTING SERVICES WERE PROVIDED TO NINE OTHER ORGANIZATIONS THAT SERVED 594 OLDER ADULTS IN FISCAL YEAR 2019. FORM 990, PART VI, SECTION A, LINE 3 THE PURPOSE OF A&E CARE SERVICES IS TO MANAGE AUGUSTANA CARE AND ITS RELATED ORGANIZATIONS, AND ELIM CARE AND ITS RELATED ORGANIZATIONS. SERVICES PROVIDED INCLUDE FINANCIAL ACCOUNTING, OPERATIONAL OVERSIGHT, HUMAN RESOURCES, INFORMATION TECHNOLOGY, CLINICAL NURSING CONSULTATION, CORPORATE COMPLIANCE, COORDINATED ADVERTISING AND MARKETING, PHILANTHROPY AND NEW BUSINESS DEVELOPMENT. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS AUGUSTANA CARE. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S BOARD OF DIRECTORS ARE APPOINTED BY A MAJORITY VOTE FROM THE BOARD OF DIRECTORS OF THE SOLE MEMBER, AUGUSTANA CARE, AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE AFFIRMATIVE APPROVAL FROM THE SOLE MEMBER OF THE ORGANIZATION, AUGUSTANA CARE: (A) AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THIS CORPORATION; (B) CAPITAL BUDGETS OF THIS CORPORATION AND ALL CORPORATIONS, PARTNERSHIPS, AND OTHER LEGAL ENTITIES DIRECTLY OR INDIRECTLY CONTROLLED BY THIS CORPORATION, AND ALL MAJOR EXPENDITURES BEFORE FUNDS ARE EXPENDED THERFORE; (C) OPERATING BUDGETS OF THIS CORPORATION AND ALL CORPORATIONS, PARTNERSHIPS, AND OTHER LEGAL ENTITIES DIRECTLY OR INDIRECTLY CONTROLLED BY THIS CORPORATION, BEFORE AUTHORIZED EXPENDITURES MAY BE MADE THEREFROM; (D) STRATEGIC PLANS OF THIS CORPORATION AND ALL CORPORATIONS, PARTNERSHIPS, AND OTHER LEGAL ENTITIES DIRECTLY OR INDIRECTLY CONTROLLED BY THIS CORPORATION; (E) THE INCURRING OF ANY LONG TERM DEBT OF THIS CORPORATION AND ALL CORPORATIONS, PARTNERSHIPS, AND OTHER LEGAL ENTITIES DIRECTLY OR INDIRECTLY CONTROLLED BY THIS CORPORATION, OTHER THAN INTRA-SYSTEM OR REFINANCING DEBT; (F) HUMAN RESOURCES AND BENEFITS POLICIES OF THIS CORPORATION; (G) MAJOR RISK CONTRACTING AGREEMENTS, WHICH FOR THESE PURPOSES MEANS ANY CONTRACT WHICH DEALS WITH CAPITATION OR SIMILAR RISK BEARING CONCEPT; (H) MERGER, CONSOLIDATION, OR TOTAL OR PARTIAL DISSOLUTION INVOLVING THIS CORPORATION; AND (I) GOVERNANCE AND ACTION OF THE TYPE SET FORTH IN SUBPARAGRAPH (A) AND SUPARAGRAPHS (F) THROUGH (H) ABOVE AS PROPOSED BY THE BOARD OF DIRECTORS OF ANY CORPORATION, PARTNERSHIP, OR OTHER LEGAL ENTITIES DIRECTLY CONTROLLED BY THIS CORPORATION AS A MEMBER, SHAREHOLDER OR OTHERWISE, TO THE EXTENT THAT THE GOVERNING DOCUMENTS OF SUCH CORPORATION, PARTNERSHIP, OR OTHER LEGAL ENTITIES GIVE THIS CORPORATION OR THE BOARD A RIGHT OF APPROVAL OVER SUCH GOVERNANCE ACTION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND REVIEWED IN DETAIL BY THE ORGANIZATION'S CFO. THE FORM 990 WAS THEN PRESENTED TO THE FULL BOARD OF DIRECTORS BY THE CFO PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS AND KEY EMPLOYEES. ALL COVERED INDIVIDUALS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST STATEMENT AND TO DISCLOSE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST TO THE APPROPRIATE LEVEL OF MANAGEMENT OR TO THE BOARD OF DIRECTORS AS OUTLINED IN THE POLICY, BASED ON THE INDIVIDUAL'S POSITION WITHIN THE ORGANIZATION. CONFLICTS ARE DETERMINED AT THE APPROPRIATE LEVEL OF MANAGEMENT OR BY THE BOARD OF DIRECTORS. INDIVIDUALS WITH ACTUAL OR POTENTIAL CONFLICTS WILL ABSTAIN FROM DISCUSSING OR VOTING ON ANY MATTERS RELATING TO THE CONFLICT. ALL PROCEEDINGS RELATING TO ACTUAL OR POTENTIAL CONFLICTS ARE NOTED IN THE MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. APPLE VALLEY VILLA APARTMENTS 7171 OHMS LANE EDINA MN 55439 311608691 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 11 AUGUSTANA CARE 0 AUGUSTANA APARTMENTS OF HASTINGS 7171 OHMS LANE EDINA MN 55439 311608701 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 AUGUSTANA CARE 0 AUGUSTANA CARE 7171 OHMS LANE EDINA MN 55439 411728753 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 7 N/A 0 AUGUSTANA CARE FOUNDATION 7171 OHMS LANE EDINA MN 55439 411360678 CHARITABLE FOUNDATION MN 501(C)(3) LINE 12A, I AUGUSTANA CARE 0 A&E CARE SERVICES 7171 OHMS LANE EDINA MN 55439 411806946 MANAGEMENT SERVICES MN 501(C)(3) LINE 12A, I N/A 0 AUGUSTANA CHAPEL VIEW HOMES INC 7171 OHMS LANE EDINA MN 55439 410693953 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 AUGUSTANA CARE 0 AUGUSTANA COMMUNITY PARTNERS 7171 OHMS LANE EDINA MN 55439 411783680 HOME HEALTH CARE SERVICES MN 501(C)(3) LINE 10 AUGUSTANA CARE 0 AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY 7171 OHMS LANE EDINA MN 55439 311608696 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 AUGUSTANA CARE 0 AUGUSTANA HOME OF HASTINGS 7171 OHMS LANE EDINA MN 55439 311572624 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 AUGUSTANA CARE 0 BROOKSIDE SENIOR LIVING 804 BENSON ROAD MONTEVIDEO MN 56265 410871848 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 N/A 0 AUGUSTANA SENIOR DEVELOPMENT INC 7171 OHMS LANE EDINA MN 55439 481293891 CONSULTING MN N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0