AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY (EIN 31-1608696)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-08-15
- IRS object ID
- 201902279349303025
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule I
- Schedule J
- Schedule K
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-08-15T15:46:04-05:00 | ReturnTs |
| Tax Period End | 2018-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311608696 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AUGUSTANA HEALTH CARE CENTER | BusinessNameLine1Txt |
| Business Name Line2 | OF APPLE VALLEY | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | AUGU | BusinessNameControlTxt |
| Phone | 9528555000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7171 OHMS LN | AddressLine1Txt |
| City | EDINA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55439 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KATHY YOUNGQUIST | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9528555000 | PhoneNum |
| Signature | 2019-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | EMILY SCHEEVEL | PreparerPersonNm |
| PTIN | P01814921 | PTIN |
| Phone | 6123764500 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-08-15 | IPDt |
| IP Tm | 07:09:14 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 556679616493003E6E17937C0791D09847FC9451 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 64D167D091931D8555FA058DC075EC7E31BCB1E3 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AUGUSTANA CARE HEALTH AND | BusinessNameLine1Txt |
| Business Name Line2 | REHABILITATION OF APPLE VALLEY | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROBERT DAHL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7171 OHMS LN | AddressLine1Txt |
| City | EDINA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55439 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,978,830 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.AUGUSTANACARE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1998 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HEALTH CARE, HOUSING AND COMMUNITY SERVICES FOR THE ELDERLY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 399 | TotalEmployeeCnt |
| Total Volunteers | 78 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $362,466 | PYContributionsGrantsAmt |
| CY Contributions Grants | $428,698 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,466,351 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $19,472,063 | CYProgramServiceRevenueAmt |
| PY Investment Income | $46,471 | PYInvestmentIncomeAmt |
| CY Investment Income | $11,882 | CYInvestmentIncomeAmt |
| PY Other Revenue | $61,312 | PYOtherRevenueAmt |
| CY Other Revenue | $66,187 | CYOtherRevenueAmt |
| PY Total Revenue | $18,936,600 | PYTotalRevenueAmt |
| CY Total Revenue | $19,978,830 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,343,601 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $859,406 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,235,850 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,523,767 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,051,422 | PYOtherExpensesAmt |
| CY Other Expenses | $8,270,853 | CYOtherExpensesAmt |
| PY Total Expenses | $19,630,873 | PYTotalExpensesAmt |
| CY Total Expenses | $19,654,026 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$694,273 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $324,804 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,219,052 | TotalAssetsBOYAmt |
| Total Assets EOY | $19,595,909 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $17,351,689 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $17,416,342 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,867,363 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,179,567 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $17,170,102 | ExpenseAmt |
| Grant | $859,406 | GrantAmt |
| Revenue | $19,472,063 | RevenueAmt |
| Desc | AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY OPERATES A 200 BED LICENSED NURSING FACILITY IN APPLE VALLEY, MINNESOTA. THE FACILITY OFFERS LONG-TERM CARE AND TRANSITIONAL CARE, AND THERAPEUTIC AND REHABILITATION SERVICES. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2018 THE CARE CENTER SERVED 1,140 RESIDENTS. | Desc |
| Total Program Service Expenses | $17,170,102 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 399 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KATHY YOUNGQUIST - AE CARE SERVICE | PersonNm |
| Phone | 9528555000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7171 OHMS LN | AddressLine1Txt |
| City | EDINA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55439 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|---|
| REV DR GARY WILKERSON | ||||||||||
| CHAIR | 1.00 | 8.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| MARSHALL MACKAY | ||||||||||
| VICE CHAIR | 1.00 | 9.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| CHARLES PARKS JR | ||||||||||
| SECRETARY | 1.00 | 8.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| ERIK RICK ELLINGSON | ||||||||||
| TREASURER | 1.00 | 9.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |||
| JIM EHLEN | ||||||||||
| DIRECTOR | 1.00 | 8.00 | Yes (X) | $0 | $0 | $0 | ||||
| JERRY NYE | ||||||||||
| DIRECTOR | 1.00 | 8.00 | Yes (X) | $0 | $0 | $0 | ||||
| SCOTT RAMSDALE | ||||||||||
| DIRECTOR | 1.00 | 8.00 | Yes (X) | $0 | $0 | $0 | ||||
| TIM TUCKER | ||||||||||
| PRESIDENT/CEO | 4.10 | 40.90 | Yes (X) | $0 | $534,949 | $345,355 | ||||
| CRAIG KITTELSON | ||||||||||
| VP - FINANCE/CFO | 4.10 | 40.90 | Yes (X) | $0 | $355,306 | $100,645 | ||||
| MATTHEW KERN | ||||||||||
| VP - OPERATIONS/COO | 4.10 | 40.90 | Yes (X) | $0 | $116,025 | $8,017 | ||||
| KATHERINE KOPP | ||||||||||
| VP - NEW BUSINESS DEVELOPMENT | 4.10 | 40.90 | $0 | $293,436 | $58,361 | Yes (X) | ||||
| GLEN SHAW | ||||||||||
| NURSING HOME ADMINISTRATOR | 45.00 | 0.00 | $124,803 | $0 | $23,489 | Yes (X) | ||||
| CAROLYN ULRICH | ||||||||||
| DIRECTOR OF NURSING | 45.00 | 0.00 | $114,423 | $0 | $11,281 | Yes (X) | ||||
| TIM MIDDENDORF | ||||||||||
| FORMER VP - OPERATIONS/COO | 4.10 | 40.90 | $0 | $234,157 | $57,998 | Yes (X) | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $239,226 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,533,873 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $605,146 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 2 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | A&E CARE SERVICES | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7171 OHMS LANE | AddressLine1Txt |
| City | EDINA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55439 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | MANAGEMENT SERVICES | ServicesDesc |
| Compensation | $1,294,586 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $388,899 | GovernmentGrantsAmt |
| All Other Contributions | $39,799 | AllOtherContributionsAmt |
| Noncash Contributions | $25,645 | NoncashContributionsAmt |
| Total Contributions | $428,698 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NURSING FACILITIES | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $19,472,063 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,472,063 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $19,472,063 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,882 | TotalRevenueColumnAmt |
| Exclusion | $11,882 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,900 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,900 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,900 | TotalRevenueColumnAmt |
| Exclusion | $1,900 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| TELEPHONE INCOME | 812900 | $15,792 | $15,792 |
| MISCELLANEOUS INCOME | 900099 | $15,119 | $15,119 |
| CABLE TV INCOME | 812900 | $13,766 | $13,766 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,610 | TotalRevenueColumnAmt |
| Exclusion | $19,610 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $64,287 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,978,830 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,472,063 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $78,069 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $830,000 | TotalAmt |
| Program Services | $830,000 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,406 | TotalAmt |
| Program Services | $29,406 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,789,430 | TotalAmt |
| Program Services | $8,442,490 | ProgramServicesAmt |
| Management And General | $346,940 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,053 | TotalAmt |
| Program Services | $94,274 | ProgramServicesAmt |
| Management And General | $11,779 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $959,461 | TotalAmt |
| Program Services | $911,602 | ProgramServicesAmt |
| Management And General | $47,859 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $668,823 | TotalAmt |
| Program Services | $639,316 | ProgramServicesAmt |
| Management And General | $29,507 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,294,586 | TotalAmt |
| Program Services | $97,401 | ProgramServicesAmt |
| Management And General | $1,197,185 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,417 | TotalAmt |
| Management And General | $1,417 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,536 | TotalAmt |
| Management And General | $26,536 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $677,753 | TotalAmt |
| Program Services | $616,290 | ProgramServicesAmt |
| Management And General | $61,463 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,601 | TotalAmt |
| Management And General | $13,601 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $288,419 | TotalAmt |
| Program Services | $206,046 | ProgramServicesAmt |
| Management And General | $82,373 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $271,757 | TotalAmt |
| Program Services | $271,757 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,185 | TotalAmt |
| Program Services | $3,331 | ProgramServicesAmt |
| Management And General | $1,854 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,210 | TotalAmt |
| Program Services | $34,927 | ProgramServicesAmt |
| Management And General | $3,283 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $637,832 | TotalAmt |
| Program Services | $637,832 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $708,145 | TotalAmt |
| Program Services | $708,145 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,918 | TotalAmt |
| Management And General | $153,918 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| NURSING SUPPLIES | $2,586,707 | $2,586,707 | |
| LICENSES, PERMITS, FEES | $533,733 | $520,272 | $13,461 |
| DIETARY EXPENSES | $521,607 | $521,607 | |
| BAD DEBT EXPENSE | $267,517 | $267,517 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $243,930 | TotalAmt |
| Program Services | $18,699 | ProgramServicesAmt |
| Management And General | $225,231 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,654,026 | TotalAmt |
| Program Services | $17,170,102 | ProgramServicesAmt |
| Management And General | $2,483,924 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $506,862 | BOYAmt |
| EOY | $772,378 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,961,662 | BOYAmt |
| EOY | $2,349,984 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,075,266 | BOYAmt |
| EOY | $2,253,368 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $482,807 | BOYAmt |
| EOY | $510,203 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $20,406,581 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,463,897 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,206,931 | BOYAmt |
| EOY | $12,942,684 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $985,524 | BOYAmt |
| EOY | $767,292 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,219,052 | BOYAmt |
| EOY | $19,595,909 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $806,737 | BOYAmt |
| EOY | $779,413 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,505,736 | BOYAmt |
| EOY | $16,588,222 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,107 | BOYAmt |
| EOY | $23,781 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,306 | BOYAmt |
| EOY | $463 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,803 | BOYAmt |
| EOY | $24,463 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,351,689 | BOYAmt |
| EOY | $17,416,342 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,861,294 | BOYAmt |
| EOY | $2,173,619 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,154 | BOYAmt |
| EOY | $4,033 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,915 | BOYAmt |
| EOY | $1,915 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,867,363 | BOYAmt |
| EOY | $2,179,567 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,219,052 | BOYAmt |
| EOY | $19,595,909 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $324,804 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$12,600 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $187,130 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $202,738 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $312,535 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $362,466 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $428,698 | CurrentTaxYearAmt |
| Total | $1,493,567 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $16,853,676 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,609,924 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,767,428 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $18,466,351 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $19,472,063 | CurrentTaxYearAmt |
| Total | $90,169,442 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $17,040,806 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,812,662 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $18,079,963 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $18,828,817 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $19,900,761 | CurrentTaxYearAmt |
| Total | $91,663,009 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $91,663,009 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $120,408 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $102,693 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $45,203 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $48,411 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,782 | CurrentTaxYearAmt |
| Total | $330,497 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $120,408 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $102,693 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $45,203 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $48,411 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,782 | CurrentTaxYearAmt |
| Total | $330,497 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $69,709 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $81,858 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | -$608,416 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $58,492 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $64,287 | CurrentTaxYearAmt |
| Total | -$334,070 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $17,230,923 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $17,997,213 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $17,516,750 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $18,935,720 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $19,978,830 | CurrentTaxYearAmt |
| Total | $91,659,436 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 1.00000 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99870 | PublicSupportPY509Pct |
| Investment Income CY | 0.00360 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00510 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | MISCELLANEOUS INCOME FROM TENANTS - 2013 AMOUNT: $ 22,789. 2014 AMOUNT: $ 35,048. 2015 AMOUNT: $ 18,005. 2016 AMOUNT: $ 12,285. 2017 AMOUNT: $ 15,119. TELEPHONE INCOME FROM TENANTS - 2013 AMOUNT: $ 16,683. 2014 AMOUNT: $ 14,901. 2015 AMOUNT: $ 16,137. 2016 AMOUNT: $ 15,511. 2017 AMOUNT: $ 15,792. DIETARY INCOME FROM TENANTS - 2013 AMOUNT: $ 6,062. 2014 AMOUNT: $ 8,668. 2015 AMOUNT: $ 5,724. 2016 AMOUNT: $ 5,886. 2017 AMOUNT: $ 6,967. HOUSEKEEPING INCOME FROM TENANTS - MAINTENANCE INCOME FROM TENANTS - GIFT SHOP INCOME FROM TENANTS - 2016 AMOUNT: $ 1,406. 2017 AMOUNT: $ 4,130. PENDANT ALARM INCOME FROM TENANTS - CABLE TV INCOME FROM TENANTS - 2013 AMOUNT: $ 15,885. 2014 AMOUNT: $ 14,886. 2015 AMOUNT: $ 15,799. 2016 AMOUNT: $ 16,393. 2017 AMOUNT: $ 13,766. ANNUITY CONVERSION INCOME - VENDING INCOME - 2013 AMOUNT: $ 8,290. 2014 AMOUNT: $ 8,355. 2015 AMOUNT: $ 8,109. 2016 AMOUNT: $ 7,011. 2017 AMOUNT: $ 8,513. LOSS ON EXTINGUISHMENT OF DEBT - 2015 AMOUNT: $ -672,190. | ExplanationTxt |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,915 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $47 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $47 | OtherExpendituresAmt |
| End Year Balance | $1,915 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,915 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $50 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $50 | OtherExpendituresAmt |
| End Year Balance | $1,915 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,915 | BeginningYearBalanceAmt |
| End Year Balance | $1,915 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,915 | BeginningYearBalanceAmt |
| End Year Balance | $1,915 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,915 | BeginningYearBalanceAmt |
| End Year Balance | $1,915 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,431,120 | OtherCostOrOtherBasisAmt |
| Book Value | $1,431,120 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,546,966 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,982,517 | DepreciationAmt |
| Book Value | $10,564,449 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,232,465 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,481,380 | DepreciationAmt |
| Book Value | $751,085 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $196,030 | OtherCostOrOtherBasisAmt |
| Book Value | $196,030 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,942,684 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ASSET RETIREMENT OBLIGATION | $5,043 |
| DUE TO AFFILIATES | $19,420 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $24,463 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 2B: | THE ORGANIZATION HOLDS, IN TRUST, FUNDS ADVANCED BY RESIDENTS TO BE USED AT EACH RESIDENT'S DISCRETION. THE FUNDS ARE MAINTAINED IN A SEPARATE INTEREST-BEARING SAVINGS ACCOUNT AND THE ORGANIZATION HAS A FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION OF THESE FUNDS. |
| PART V, LINE 4: | THE PRINCIPAL WILL BE INVESTED AND KEPT INTACT FOR PERPETUITY TO PROVIDE AN ADDITIONAL SOURCE OF INCOME. THE INCOME GENERATED WILL BE USED TO SUPPORT THE FUND DESIGNATED PROGRAM. THE ORGANIZATION'S ENDOWMENT IS HELD AND ADMINISTERED BY AUGUSTANA CARE FOUNDATION. SEE SCHEDULE R FOR ADDITIONAL DETAILS. |
| 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. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | A&E CARE SERVICES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7171 OHMS LN | AddressLine1Txt |
| City | EDINA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55439 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 411806946 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $830,000 | CashGrantAmt |
| Purpose Of Grant | GENERAL SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 10 | RecipientCnt |
| Cash Grant | $28,531 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY MAKES INTERCOMPANY TRANSFERS TO RELATED ORGANIZATIONS. AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY AND THE RELATED ORGANIZATIONS ARE UNDER COMMON MANAGEMENT WHO REGULARLY MONITOR THE USE OF FUNDS. RECIPIENTS OF SCHOLARSHIPS FROM THE ORGANIZATION AGREE TO THE FOLLOWING TERMS UPON ACCEPTANCE: (1) THE ORGANIZATION WILL DETERMINE THE AMOUNT OF THE SCHOLARSHIP; (2) TUITION AND ASSOCIATED COSTS WILL BE PAID UP TO A STATED AMOUNT UPON PRESENTATION BY THE RECIPIENT OF A BILLING STATEMENT AND A DETAILED VERIFICATION OF THE COST OF BOOKS; (3) THE RECIPIENT WILL COMPLETE THE TRAINING FOR WHICH A SCHOLARSHIP PAYMENT WAS GRANTED WITH PROOF OF A FINAL GRADE OF A C OR BETTER, OR RECIPIENT WILL REIMBURSE THE ORGANIZATION FOR THE COST OF THE COURSE; (4) THE RECIPIENT WILL CONTINUE EMPLOYMENT WITH THE ORGANIZATION WHILE COMPLETING COURSEWORK, WITH BOTH PARTIES MAKING EVERY EFFORT TO ACCOMODATE ANY NECESSARY CHANGES IN WORK HOURS; AND (5) UPON COMPLETING TRAINING FOR WHICH SCHOLARSHIP WAS GRANTED, THE RECIPIENT WILL WORK FOR THE ORGANIZATION AT LEAST TWO YEARS AND A MINIMUM OF 2,000 HOURS OR WILL REIMBURSE THE ORGANIZATION A PRORATED AMOUNT OF EACH SCHOLARSHIP PAYMENT RECEIVED DURING THE PREVIOUS ONE YEAR PERIOD, WHICH WILL BE DEDUCTED FROM THEIR LAST PAYCHECK. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TIM TUCKER | ||||||||||||||
| PRESIDENT/CEO | $0 | $426,861 | $0 | $78,000 | $0 | $30,088 | $0 | $314,219 | $0 | $31,136 | $0 | $880,304 | $0 | $0 |
| CRAIG KITTELSON | ||||||||||||||
| VP - FINANCE/CFO | $0 | $266,405 | $0 | $55,000 | $0 | $33,901 | $0 | $69,714 | $0 | $30,931 | $0 | $455,951 | $0 | $0 |
| KATHERINE KOPP | ||||||||||||||
| VP - NEW BUSINESS DEVELOPMENT | $0 | $223,833 | $0 | $46,200 | $0 | $23,403 | $0 | $28,940 | $0 | $29,421 | $0 | $351,797 | $0 | $0 |
| TIM MIDDENDORF | ||||||||||||||
| FORMER VP - OPERATIONS/COO | $0 | $185,684 | $0 | $31,360 | $0 | $17,113 | $0 | $17,634 | $0 | $40,364 | $0 | $292,155 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | FOR THE PURPOSE OF DETERMINING COMPENSATION, AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY RELIED ON A RELATED ORGANIZATION, A&E CARE SERVICES (FORMERLY KNOWN AS AUGUSTANA 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, LINE 4B | THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN PROVIDED BY A&E CARE SERVICES (FORMERLY KNOWN AS AUGUSTANA CARE SERVICES), A RELATED ORGANIZATION: TIM TUCKER, PRESIDENT AND CEO - $287,793 CRAIG KITTELSON, VICE PRESIDENT OF FINANCE AND CFO - $43,287 KATHERINE KOPP, VICE PRESIDENT OF NEW BUSINESS DEVELOPMENT - $3,000 |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | APPLE VALLEY ECONOMIC DEVELOPMENT AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 410882559 | BondIssuerEIN |
| CUSIP | 03788ADQ9 | CUSIPNum |
| Bond Issued | 2016-02-29 | BondIssuedDt |
| Issue Price | $17,610,000 | IssuePriceAmt |
| Purpose | REFINANCE SERIES 2006, 2011, AND 2012 DEBT | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,040,000 | RetiredAmt |
| Total Proceeds | $17,610,000 | TotalProceedsAmt |
| In Reserve Fund | $572,365 | InReserveFundAmt |
| Issuance Costs From Proceeds | $352,200 | IssuanceCostsFromProceedsAmt |
| Other Spent Proceeds | $16,685,800 | OtherSpentProceedsAmt |
| Substantial Completion | 2014 | SubstantialCompletionYr |
| Current Refunding | Yes (1) | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | EQUIPMENT | Desc |
| Contribution | 5 | ContributionCnt |
| Noncash Contributions Rpt F990 | $25,645 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2018 FISCAL YEAR, MORE THAN 16,500 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 3,900 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 2018, A TOTAL OF 1,727 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 11,213 INDIVIDUALS WERE SERVED THROUGH THESE PROGRAMS IN FISCAL YEAR 2018. FINALLY, MANAGEMENT CONSULTING SERVICES WERE PROVIDED TO NINE OTHER ORGANIZATIONS THAT SERVED 533 OLDER ADULTS IN FISCAL YEAR 2018. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE PURPOSE OF AUGUSTANA CARE SERVICES IS TO MANAGE AUGUSTANA 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. EFFECTIVE JANUARY 1, 2018 THE NAME OF THE CORPORATION WAS CHANGED TO A&E CARE SERVICES AND THE ORGANIZATIONAL DOCUMENTS WERE AMENDED TO APPOINT AUGUSTANA CARE AND ELIM CARE, INC. AS THE TWO MEMBERS OF THE CORPORATION. THE PURPOSE OF A&E CARE SERVICES REMAINS THE SAME AS THAT OF AUGUSTANA CARE SERVICES. |
| 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; (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 INTERNAL REVENUE SERVICE. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (10 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| APPLE VALLEY VILLA APARTMENTS | |||||||||||
| 7171 OHMS LN | EDINA | MN | 55439 | 311608691 | HEALTH CARE FACILITIES/SERVICES | MN | 501(C)(3) | LINE 10 | AUGUSTANA CARE | 0 | |
| AUGUSTANA APARTMENTS OF HASTINGS | |||||||||||
| 7171 OHMS LN | EDINA | MN | 55439 | 311608701 | HEALTH CARE FACILITIES/SERVICES | MN | 501(C)(3) | LINE 10 | AUGUSTANA CARE | 0 | |
| AUGUSTANA CARE | |||||||||||
| 7171 OHMS LN | EDINA | MN | 55439 | 411728753 | HEALTH CARE FACILITIES/SERVICES | MN | 501(C)(3) | LINE 7 | 0 | N/A | |
| AUGUSTANA CARE FOUNDATION | |||||||||||
| 7171 OHMS LN | EDINA | MN | 55439 | 411360678 | CHARITABLE FOUNDATION | MN | 501(C)(3) | LINE 12A, I | AUGUSTANA CARE | 0 | |
| A&E CARE SERVICES | |||||||||||
| 7171 OHMS LN | EDINA | MN | 55439 | 411806946 | MANAGEMENT SERVICES | MN | 501(C)(3) | LINE 12C, III-FI | AUGUSTANA CARE & ELIM CARE INC | 0 | |
| AUGUSTANA CHAPEL VIEW HOMES INC | |||||||||||
| 7171 OHMS LN | EDINA | MN | 55439 | 410693953 | HEALTH CARE FACILITIES/SERVICES | MN | 501(C)(3) | LINE 10 | AUGUSTANA CARE | 0 | |
| AUGUSTANA COMMUNITY PARTNERS | |||||||||||
| 7171 OHMS LN | EDINA | MN | 55439 | 411783680 | HOME HEALTH CARE SERVICES | MN | 501(C)(3) | LINE 10 | AUGUSTANA CARE | 0 | |
| AUGUSTANA HOME OF HASTINGS | |||||||||||
| 7171 OHMS LN | EDINA | MN | 55439 | 311572624 | HEALTH CARE FACILITIES/SERVICES | MN | 501(C)(3) | LINE 10 | AUGUSTANA CARE | 0 | |
| OPEN CIRCLE ADULT DAY CENTER | |||||||||||
| 7171 OHMS LN | EDINA | MN | 55439 | 411424801 | 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 | 0 | N/A | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AUGUSTANA SENIOR DEVELOPMENT INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7171 OHMS LN | AddressLine1Txt |
| City | EDINA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55439 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481293891 | EIN |
| Primary Activities | CONSULTING | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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