2019-08-15T15:46:42-05:00 2018-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2017-10-01 311572624 AUGUSTANA HOME OF HASTINGS AUGU 9528555000 7171 OHMS LN EDINA MN 55439 KATHY YOUNGQUIST CFO 9528555000 2019-08-15 1 EMILY SCHEEVEL P01814921 6123764500 67.137.57.251 2019-08-15 07:51:02 CD P 556679616493003E6E17937C0791D09847FC9451 64D167D091931D8555FA058DC075EC7E31BCB1E3 2017 2019-02-21 02:37:17Z X AUGUSTANA CARE HASTINGS HEALTH AND REHABILITATION ROBERT DAHL 7171 OHMS LN EDINA MN 55439 8184804 0 X WWW.AUGUSTANACARE.ORG X 1997 MN TO PROVIDE HEALTH CARE, HOUSING, AND COMMUNITY SERVICES FOR THE ELDERLY. 7 7 201 40 0 0 75674 242320 7506437 7910914 32340 13012 18581 18558 7633032 8184804 145228 3664 0 0 4647917 4877196 0 0 0 3060753 3249148 7853898 8130008 -220866 54796 4557394 4437730 4510591 4324109 46803 113621 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 7208917 3664 7910914 AUGUSTANA HOME OF HASTINGS OWNS AND OPERATES A 91-BED LICENSED NURSING FACILITY IN HASTINGS, MN TO FACILITATE THE OBJECTIVES SET FORTH IN THEIR PRIMARY EXEMPT PURPOSE. AUGUSTANA HOME OF HASTINGS SERVED 433 INDIVIDUALS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2018. 7208917 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 201 1 0 0 0 0 0 0 0 0 0 0 X 7 7 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 LN EDINA MN 55439 REV DR GARY WILKERSON CHAIR 1.00 8.00 X X 0 0 0 MARSHALL MACKAY VICE CHAIR 1.00 8.00 X X 0 0 0 CHARLES PARKS JR SECRETARY 1.00 8.00 X X 0 0 0 ERIK RICK ELLINGSON TREASURER 1.00 9.00 X X 0 0 0 JIM EHLEN DIRECTOR 1.00 8.00 X 0 0 0 JERRY NYE DIRECTOR 1.00 8.00 X 0 0 0 SCOTT RAMSDALE DIRECTOR 1.00 8.00 X 0 0 0 TIM TUCKER PRESIDENT/CEO 4.10 40.90 X 0 534949 345355 CRAIG KITTELSON VP - FINANCE/CFO 4.10 40.90 X 0 355306 100645 MATTHEW KERN VP - OPERATIONS/COO 4.10 40.90 X 0 116025 8017 KATHERINE KOPP VP - NEW BUSINESS DEVELOPMENT 4.10 40.90 X 0 293436 58361 TIM MIDDENDORF FORMER VP - OPERATIONS/COO 4.10 40.90 X 0 234157 57998 0 1533873 570376 0 1 1 0 A&E CARE SERVICES 7171 OHMS LANE EDINA MN 55439 MANAGEMENT SERVICES 417007 1 90000 146401 5919 242320 NURSING FACILITIES 623000 7910914 7910914 7910914 13012 13012 858 0 858 858 858 CABLE TV INCOME 812900 10168 10168 TELEPHONE INCOME 812900 4230 4230 DIETARY INCOME 722210 3302 3302 17700 8184804 7910914 0 31570 X 3664 3664 4019641 3805568 214073 45088 41313 3775 508216 496746 11470 304251 286977 17274 417007 52200 364807 17237 17237 931385 897769 33616 17286 17286 131311 89418 41893 190258 190258 6024 4217 1807 54540 52925 1615 131301 131301 336886 336886 60212 60212 NURSING SUPPLIES 364267 364267 LICENSES, PERMITS, FEES 234269 233629 640 DIETARY EXPENSES 213747 213747 BAD DEBT EXPENSE 82834 82834 60584 8032 52552 8130008 7208917 921091 0 1350 1350 264577 266595 675878 778348 224224 242024 8298012 5248402 3306065 3049610 3319 15340 81981 84463 4557394 4437730 385600 399724 3951409 3742553 8628 11085 7825 237 157129 170510 4510591 4324109 X 28667 95461 18136 18160 46803 113621 4557394 4437730 54796 12022 0 X 0 1 X 1 0 X 426313 237388 187445 75674 242320 1169140 7112666 7313074 7212797 7506437 7910914 37055888 7538979 7550462 7400242 7582111 8153234 38225028 0 0 0 38225028 19102 15166 28735 34037 13870 110910 19102 15166 28735 34037 13870 110910 16049 14899 14178 16884 17700 79710 7574130 7580527 7443155 7633032 8184804 38415648 0.99500 0.99490 0.00290 0.00300 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: DIETARY INCOME FROM TENANTS - 2013 AMOUNT: $ 2,794. 2014 AMOUNT: $ 3,135. 2015 AMOUNT: $ 1,014. 2016 AMOUNT: $ 2,212. 2017 AMOUNT: $ 3,302. VENDING MACHINE INCOME FROM TENANTS - 2013 AMOUNT: $ 470. 2014 AMOUNT: $ 297. 2015 AMOUNT: $ 280. 2016 AMOUNT: $ 265. MISCELLANEOUS INCOME FROM TENANTS - 2014 AMOUNT: $ 141. 2015 AMOUNT: $ 40. 2016 AMOUNT: $ 250. TELEPHONE INCOME FROM TENANTS - 2013 AMOUNT: $ 5,042. 2014 AMOUNT: $ 4,310. 2015 AMOUNT: $ 4,731. 2016 AMOUNT: $ 4,219. 2017 AMOUNT: $ 4,230. CABLE TELEVISION INCOME FROM TENANTS - 2013 AMOUNT: $ 7,743. 2014 AMOUNT: $ 7,016. 2015 AMOUNT: $ 8,113. 2016 AMOUNT: $ 9,938. 2017 AMOUNT: $ 10,168. 0 1 X 18136 24 18160 18112 24 18136 18088 24 18112 18064 24 18088 18040 24 18064 0.00000 1.00000 0.00000 0 1 1 602927 602927 5630146 3451937 2178209 2064939 1796465 268474 3049610 ASSET RETIREMENT OBLIGATION 155926 DUE TO AFFILIATES 14584 170510 X 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. 0 1 0 0 0 0 0 0 0 TIM TUCKER PRESIDENT/CEO 0 426861 0 78000 0 30088 0 314219 0 31136 0 880304 0 0 CRAIG KITTELSON VP - FINANCE/CFO 0 266405 0 55000 0 33901 0 69714 0 30931 0 455951 0 0 KATHERINE KOPP VP - NEW BUSINESS DEVELOPMENT 0 223833 0 46200 0 23403 0 28940 0 29421 0 351797 0 0 TIM MIDDENDORF FORMER VP - OPERATIONS/COO 0 185684 0 31360 0 17113 0 17634 0 40364 0 292155 0 0 PART I, LINE 3 FOR THE PURPOSE OF DETERMINING COMPENSATION, AUGUSTANA HOME OF HASTINGS 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 A CITY OF HASTINGS MINNESOTA 416005220 2012-04-26 4975000 FACILITY REMODEL AND REFUND SERIES 1998 BONDS 0 0 0 A 1149783 4975000 99500 1646468 3441093 2014 1 0 1 1 A 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 A 1 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; 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 ANY 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. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 897,769. MANAGEMENT AND GENERAL EXPENSES 33,616. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 931,385. 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 N/A 0 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 12A, I 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 HEALTH CARE CENTER OF APPLE VALLEY 7171 OHMS LN EDINA MN 55439 311608696 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 N/A 0 AUGUSTANA SENIOR DEVELOPMENT INC 7171 OHMS LN EDINA MN 55439 481293891 CONSULTING MN N/A C 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0