2019-08-15T15:44:10-05:00 2018-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2017-10-01 410693953 AUGUSTANA CHAPEL VIEW HOMES INC AUGU 9528555000 7171 OHMS LANE EDINA MN 55439 KATHY YOUNGQUIST CFO 9528555000 2019-08-15 1 EMILY SCHEEVEL P01814921 6123764500 67.137.57.251 2019-08-15 07:32:17 CD P 556679616493003E6E17937C0791D09847FC9451 64D167D091931D8555FA058DC075EC7E31BCB1E3 2017 2019-02-21 02:37:17Z X ROBERT DAHL 7171 OHMS LANE EDINA MN 55439 44393450 0 X WWW.AUGUSTANACARE.ORG X 1908 MN TO PROVIDE HEALTH CARE, HOUSING AND COMMUNITY SERVICES FOR THE ELDERLY. 7 7 954 316 0 0 623440 848530 40419405 42234351 272596 152520 681401 824229 41996842 44059630 48297 751900 0 0 22872555 23742709 0 0 0 19182228 19914686 42103080 44409295 -106238 -349665 34778889 33845510 29305769 28724365 5473120 5121145 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 33307922 751900 36216007 AUGUSTANA CHAPEL VIEW HOMES, INC. OPERATES TWO LICENSED HEALTH CARE FACILITIES WITH A TOTAL OF 376 LICENSED BEDS. AUGUSTANA HEALTH CARE CENTER OF MINNEAPOLIS AND AUGUSTANA CHAPEL VIEW HEALTH CARE CENTER IN HOPKINS, MN PROVIDE TRANSITIONAL CARE, LONG-TERM CARE, DEMENTIA CARE AND REHABILITATIVE THERAPIES. THE TWO CARE CENTERS SERVED 1,593 INDIVIDUALS DURING THE YEAR ENDED SEPTEMBER 30, 2018. 5501147 0 6018344 AUGUSTANA CHAPEL VIEW HOMES, INC. OPERATES SENIOR LIVING COMMUNITIES IN MINNEAPOLIS AND HOPKINS, MN. THE DOWNTOWN MINNEAPOLIS CAMPUS IS AUGUSTANA CARE'S LONGEST STANDING CAMPUS AND INCLUDES FOUR HIGH-RISE BUILDINGS WITH 334 ONE- AND TWO-BEDROOM APARTMENTS OFFERING INDEPENDENT HOUSING, A MEMORY CARE UNIT, CARE SUITES AND A RANGE OF ASSISTED LIVING OPTIONS. AUGUSTANA CHAPEL VIEW IN HOPKINS OFFERS 56 UNITS OF SIMILAR HOUSING OPTIONS IN A MORE SUBURBAN SETTING. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2018, 498 PEOPLE RESIDED IN THESE TWO APARTMENT COMMUNITIES. 38809069 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 954 1 1 1 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 LANE 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 BOARD MEMBER 1.00 8.00 X 0 0 0 JERRY NYE BOARD MEMBER 1.00 8.00 X 0 0 0 SCOTT RAMSDALE BOARD MEMBER 1.00 8.00 X 0 0 0 TIM TUCKER PRESIDENT/CEO 4.50 40.50 X 0 534949 345355 CRAIG KITTELSON VP - FINANCE/CFO 4.50 40.50 X 0 355306 100645 MATTHEW KERN VP - OPERATIONS/COO 4.50 40.50 X 0 116025 8017 KATHY KOPP VP - NEW BUSINESS DEVELOPMENT 4.50 40.50 X 0 293436 58361 GEORGE SERRA FOOD SERVICE DIRECTOR 45.00 0.00 X 153042 0 25828 JEAN COLE NURSING HOME ADMINISTRATOR 45.00 0.00 X 146806 0 10919 SHABIR HIRJI-WALJI MAINTENANCE DIRECTOR 45.00 0.00 X 134696 0 24076 PAULA SPARLING NURSING HOME ADMINISTRATOR 45.00 0.00 X 113553 0 6328 PATRICIA LEEMAN DIRECTOR OF NURSING 45.00 0.00 X 105442 0 10577 TIM MIDDENDORF FORMER VP - OPERATIONS/COO 4.50 40.50 X 0 234157 57998 653539 1533873 648104 5 1 1 0 A&E CARE SERVICES 7171 OHMS LANE EDINA MN 55439 MANAGEMENT SERVICES 2876579 1 150000 596042 102488 848530 NURSING 623000 36216007 36216007 ASSISTED LIVING 623000 6018344 6018344 42234351 152520 152520 1042611 333820 708791 708791 708791 DIETARY INCOME 623990 41742 41742 TELEPHONE INCOME 623990 24592 24592 MISC INCOME 900099 21131 21131 27973 27973 115438 44059630 42234351 0 976749 680000 680000 71900 71900 19714313 18583506 1130807 261176 237773 23403 2253584 2173940 79644 1513636 1430685 82951 2857502 222412 2635090 83833 83833 62039 62039 3887636 3733221 154415 59629 59629 713109 438427 274682 2803733 2794225 9508 51700 45362 6338 93038 87228 5810 1153638 1153638 2329447 2329447 408344 408344 DIETARY EXPENSES 1967856 1967856 NURSING SUPPLIES 1586875 1586875 LICENSES, PERMITS, FEES 1103431 1044358 59073 BAD DEBT EXPENSE 354785 354785 398091 228216 169875 44409295 38809069 5600226 0 308368 319723 554418 545537 3261701 3493372 508865 591697 78294404 55333016 23986979 22961388 6638 30680 6151920 5903113 34778889 33845510 2733779 2893011 44805 35687 22977670 22373582 484175 493186 1400326 1345837 1665014 1583062 29305769 28724365 X 2762256 2464408 135675 87917 2575189 2568820 5473120 5121145 34778889 33845510 -349665 -2310 0 X 0 1 X 1 0 X 1330937 664177 819039 623440 848530 4286123 36778898 38032478 40362338 40419405 42234351 197827470 38109835 38696655 41181377 41042845 43082881 202113593 0 0 0 202113593 1206039 1170274 1275251 1308763 1195131 6155458 5353 5353 1211392 1170274 1275251 1308763 1195131 6160811 157584 166858 146037 132501 115438 718418 39478811 40033787 42602665 42484109 44393450 208992822 0.96710 0.96570 0.02950 0.03060 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME FROM TENANTS - 2013 AMOUNT: $ 30,280. 2014 AMOUNT: $ 42,394. 2015 AMOUNT: $ 18,139. 2016 AMOUNT: $ 20,674. 2017 AMOUNT: $ 21,131. TELEPHONE INCOME FROM TENANTS - 2013 AMOUNT: $ 27,184. 2014 AMOUNT: $ 28,440. 2015 AMOUNT: $ 28,342. 2016 AMOUNT: $ 24,761. 2017 AMOUNT: $ 24,592. DIETARY INCOME FROM TENANTS - 2013 AMOUNT: $ 56,172. 2014 AMOUNT: $ 47,402. 2015 AMOUNT: $ 56,040. 2016 AMOUNT: $ 46,093. 2017 AMOUNT: $ 41,742. LAUNDRY INCOME FROM TENANTS - 2013 AMOUNT: $ 4,757. 2014 AMOUNT: $ 4,545. 2015 AMOUNT: $ 4,660. 2016 AMOUNT: $ 9,028. 2017 AMOUNT: $ 2,716. VENDING MACHINE INCOME FROM TENANTS - 2013 AMOUNT: $ 6,566. 2014 AMOUNT: $ 7,158. 2015 AMOUNT: $ 7,221. 2016 AMOUNT: $ 7,504. 2017 AMOUNT: $ 9,729. ANNUITY CONVERSION INCOME - 2013 AMOUNT: $ 32,625. 2014 AMOUNT: $ 36,919. 2015 AMOUNT: $ 31,635. 2016 AMOUNT: $ 24,441. 2017 AMOUNT: $ 15,528. 0 1 X 2020770 1000 1513 2023283 2019209 1561 2020770 2012602 4999 1608 2019209 2010949 1653 2012602 2000615 250 10084 2010949 0.00000 1.00000 0.00000 0 1 1 1950029 1950029 59537645 39970011 19567634 16806730 15363005 1443725 22961388 ASSETS UNDER BOND INDENTURE AGREEMENT 1906878 RESIDENT TRUST FUNDS 110374 HCIR INSURANCE RECIPROCAL 351223 CONTRACT FOR DEED 81252 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 1403618 DUE FROM AFFILIATES 2049768 5903113 ANNUITY OBLIGATIONS 53297 ASSET RETIREMENT OBLIGATIONS 259697 DUE TO AFFILIATES 1270068 1583062 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. SECURITY DEPOSITS ARE REQUIRED FOR THE ORGANIZATION'S TENANTS AND INCLUDE RESERVED APARTMENTS IF AMOUNTS ARE PAID BEFORE THE TENANT ACTUALLY MOVES IN. 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. A PORTION OF 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. 1 A&E CARE SERVICES 7171 OHMS LANE EDINA MN 55439 411806946 501(C)(3) 680000 DEBT FORGIVENESS 1 0 SCHOLARSHIPS 34 71470 PART I, LINE 2: CHAPEL VIEW HOMES INC MAKES INTERCOMPANY TRANSFERS TO RELATED ORGANIZATIONS. CHAPEL VIEW HOMES, INC 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 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 ACCOMMODATE ANY NECESSARY CHANGES IN WORK HOURS; AND (5) UPON COMPLETION OF 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. 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 KATHY KOPP VP - NEW BUSINESS DEVELOPMENT 0 223833 0 46200 0 23403 0 28940 0 29421 0 351797 0 0 GEORGE SERRA FOOD SERVICE DIRECTOR 122191 0 25139 0 5712 0 5396 0 20432 0 178870 0 0 0 JEAN COLE NURSING HOME ADMINISTRATOR 141040 0 5744 0 22 0 5181 0 5738 0 157725 0 0 0 SHABIR HIRJI-WALJI MAINTENANCE DIRECTOR 105983 0 22676 0 6037 0 4705 0 19371 0 158772 0 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 CHAPEL VIEW HOMES 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 MINNEAPOLIS MINNESOTA 416005375 603908MD3 2005-05-31 12470000 CONSTRUCTION AND REMODELING 0 0 0 B MINNEAPOLIS COMMUNITY DEVELOPMENT AGENCY 416009115 2012-12-28 6612000 REFINANCE SERIES 2004 BONDS AND CAPITAL PURCHASES 0 0 0 C CITY OF HOPKINS MINNESOTA 416005247 2013-06-11 5290000 REFINANCE SERIES 2006 BONDS 0 0 0 D CITY OF INDEPENDENCE MINNESOTA 410958873 45363KAM3 2017-12-13 4760000 REFINANCE SERIES 2005 BONDS AND CAPITAL IMPROVEMENTS 0 0 0 A 2645000 12470000 920547 249400 10543937 756116 2006 0 0 1 1 B 1993526 6612000 121634 1173812 5316554 2014 1 0 1 1 C 1599737 5290000 102275 5187725 2013 1 0 1 1 D 4760000 179000 95200 551971 3933829 2019 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 1 1 0 0.01200 0.01200 0 0 1 C 0 0 1 1 0 0.01200 0.01200 0 0 1 D 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF MINNEAPOLIS, MINNESOTA DATE THE REBATE COMPUTATION WAS PERFORMED: 07/06/2015 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 THEREFORE; (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, PARTNERSIHPS, 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 ENTITES 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 SUBPARAGRAPHS (F) THROUGH (H) ABOVE AS PROPOSED BY THE BOARD OF DIRECTORS OF ANY CORPORATION, PARTNERSHIP, OR OTHER LEGAL ENTITES 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 10 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 12C, III-FI AUGUSTANA CARE & ELIM CARE INC 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 411424801 HEALTH CARE FACILITIES/SERVICES ME 501(C)(3) LINE 10 N/A 0 OPEN CIRCLE ADULT DAY CENTER 7171 OHMS LANE EDINA MN 55439 411424801 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 AUGUSTANA CARE 0 AUGUSTANA SENIOR DEVELOPMENT INC 7171 OHMS LANE EDINA MN 55439 264136110 CONSULTING MN N/A C 0 0 1 1 1 0 0 0 0 0 1 0 0 1 1 1 1 1 0 0