2017-07-27T14:09:30-05:00 2016-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2015-10-01 311572624 AUGUSTANA HOME OF HASTINGS AUGU 6122385225 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 CRAIG KITTELSON VP - FINANCE/CFO 6122385225 2017-07-13 1 EMILY SCHEEVEL P01814921 6123764500 2015 2021-01-29 14:40:06Z HEALTH CARE CENTER OF HASTINGS TIM TUCKER 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 7443155 0 X WWW.AUGUSTANACARE.ORG X 1997 MN TO PROVIDE HEALTH CARE, HOUSING, AND COMMUNITY SERVICES FOR THE ELDERLY 6 6 194 55 0 0 237388 187445 7313074 7212797 14446 28487 15619 14426 7580527 7443155 303412 0 0 0 4254546 4500839 0 0 0 3103071 3029722 7661029 7530561 -80502 -87406 5292119 5030194 4925519 4754344 366600 275850 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 6750203 0 7212797 AUGUSTANA HOME OF HASTINGS OWNS AND OPERATES A 80-BED LICENSED NURSING FACILITY IN HASTINGS, MN TO FACILITATE THE OBJECTIVES SET FORTH IN THEIR PRIMARY EXEMPT PURPOSE. AUGUSTANA HOME OF HASTINGS SERVED 362 INDIVIDUALS DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016. 6750203 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 0 194 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X CRAIG KITTELSON - AUGUSTANA CARE SERVICES 6122385205 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 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 ERIC RICK ELLINGSON TREASURER 1.00 9.00 X X 0 0 0 JIM EHLEN DIRECTOR 1.00 8.00 X 0 0 0 SCOTT RAMSDALE DIRECTOR 1.00 8.00 X 0 0 0 TIM TUCKER PRESIDENT/CEO 4.50 40.50 X 0 408367 98317 CRAIG KITTELSON VP - FINANCE/CFO 4.50 40.50 X 0 312056 89780 TIM MIDDENDORF VP - FINANCE/COO 4.50 40.50 X 0 276034 32305 KATHERINE KOPP VP - NEW BUSINESS DEVELOPMENT 4.50 40.50 X 0 272525 60575 0 1268982 280977 0 0 1 0 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 MANAGEMENT SERVICES 389490 1 172798 14647 187445 NURSING FACILITIES 623000 7212797 7212797 7212797 28487 28487 248 0 248 248 248 40 0 40 40 CABLE TV INCOME 812900 8113 8113 TELEPHONE INCOME 812900 4731 4731 DIETARY INCOME 722210 1014 1014 280 280 14138 7443155 7212797 0 42913 X 3691189 3485288 205901 10873 7456 3417 519422 498374 21048 279355 262455 16900 389490 74698 314792 18769 18769 878091 851197 26894 10023 10023 146425 76519 69906 129702 129702 15359 10838 4521 22773 22236 537 137145 137145 339582 339582 46883 46883 NURSING SUPPLIES 402396 402396 LICENSES, PERMITS, FEES 239547 238568 979 DIETARY EXPENSES 201592 201592 BAD DEBT EXPENSE 23469 23469 28476 12157 16319 7530561 6750203 780358 0 1350 1350 262932 263690 842002 744103 106945 124459 8180008 4596449 3768141 3583559 14843 11500 135856 127663 160050 173870 5292119 5030194 341128 349462 4417004 4239220 8488 8059 24204 16173 134695 141430 4925519 4754344 X 346312 257738 2200 0 18088 18112 366600 275850 5292119 5030194 -87406 -3344 0 X 0 1 X 1 0 X 131440 618062 426313 237388 187445 1600648 6939607 6759290 7112666 7313074 7212797 35337434 7071047 7377352 7538979 7550462 7400242 36938082 0 0 0 36938082 162405 16969 19102 15166 28735 242377 162405 16969 19102 15166 28735 242377 16840 16875 16049 14899 14178 78841 7250292 7411196 7574130 7580527 7443155 37259300 0.99140 0.99010 0.00650 0.00780 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: DIETARY INCOME FROM TENANTS - 2011 AMOUNT: $ 4,699. 2012 AMOUNT: $ 4,655. 2013 AMOUNT: $ 2,794. 2014 AMOUNT: $ 3,135. 2015 AMOUNT: $ 1,014. VENDING MACHINE INCOME FROM TENANTS - 2011 AMOUNT: $ 661. 2012 AMOUNT: $ 378. 2013 AMOUNT: $ 470. 2014 AMOUNT: $ 297. 2015 AMOUNT: $ 280. MISCELLANEOUS INCOME FROM TENANTS - 2014 AMOUNT: $ 141. 2015 AMOUNT: $ 40. TELEPHONE INCOME FROM TENANTS - 2011 AMOUNT: $ 5,189. 2012 AMOUNT: $ 5,002. 2013 AMOUNT: $ 5,042. 2014 AMOUNT: $ 4,310. 2015 AMOUNT: $ 4,731. CABLE TELEVISION INCOME FROM TENANTS - 2011 AMOUNT: $ 6,291. 2012 AMOUNT: $ 6,840. 2013 AMOUNT: $ 7,743. 2014 AMOUNT: $ 7,016. 2015 AMOUNT: $ 8,113. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 18088 24 18112 18064 24 18088 18040 24 18064 18016 24 18040 17994 22 18016 0.00000 1.00000 0.00000 0 1 1 599232 599232 5617516 3011276 2606240 1963260 1585173 378087 3583559 ASSET RETIREMENT OBLIGATION 141430 141430 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. AUGUSTANA CARE AND ITS AFFILIATES 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 318469 0 61200 0 28698 0 66373 0 31944 0 506684 0 0 CRAIG KITTELSON VP - FINANCE/CFO 0 227810 0 50400 0 33846 0 57991 0 31789 0 401836 0 0 TIM MIDDENDORF VP - FINANCE/COO 0 220614 0 41800 0 13620 0 26850 0 5455 0 308339 0 0 KATHERINE KOPP VP - NEW BUSINESS DEVELOPMENT 0 209780 0 41640 0 21105 0 30267 0 30308 0 333100 0 0 PART I, LINE 3 FOR THE PURPOSE OF DETERMINING COMPENSATION, AUGUSTANA HOME OF HASTINGS RELIED ON A RELATED ORGANIZATION, AUGUSTANA CARE SERVICES, TO ESTABLISH THE COMPENSATION OF THE PRESIDENT/CEO. AUGUSTANA 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 AUGUSTANA CARE SERVICES, A RELATED ORGANIZATION: TIM TUCKER, PRESIDENT AND CEO - $42,577 CRAIG KITTELSON, VICE PRESIDENT OF FINANCE AND CFO - $34,194 TIM MIDDENDORF, VICE PRESIDENT OF OPERATIONS AND COO - $8,000 KATHERINE KOPP, VICE PRESIDENT OF NEW BUSINESS DEVELOPMENT - $5,000 A CITY OF HASTINGS MINNESOTA 416005220 2012-04-26 4975000 FACILITY REMODEL AND REFUND SERIES 1998 BONDS 0 0 0 A 735780 4975000 99500 1434407 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. BECAUSE ELDERS ARE VITAL TO OUR COMMUNITIES, PROVIDING SERVICES TO HELP THEM CONTINUE LIVING LIFE TO THE FULLEST ALSO GIVES US IN THE GREATER COMMUNITY ALL THE BENEFIT OF THEIR WISDOM AND EXPERIENCE. WE OFFER A FULL SPECTRUM OF SERVICES. IN OUR 2016 FISCAL YEAR, MORE THAN 12,200 PEOPLE WERE SERVED IN COMMUNITIES IN MINNESOTA AND COLORADO. OUR SEVEN HEALTH CARE CENTERS PROVIDED TRANSITIONAL, LONG-TERM AND MEMORY CARE AND REHABILITATION SERVICES TO MORE THAN 3,500 PEOPLE. AUGUSTANA CARE ALSO PROVIDES A VARIETY OF HOUSING COMMUNITIES THAT SERVE OLDER ADULTS WITH COMFORTABLE LIVING AND CARE OPTIONS, INCLUDING INDEPENDENT LIVING, HOUSING WITH SERVICES, AND ASSISTED LIVING AND MEMORY CARE. IN FISCAL YEAR 2016, A TOTAL OF 1,653 ELDERS BENEFITED FROM THESE SERVICES. ADDITIONALLY, WE 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 3,736 INDIVIDUALS WERE SERVED THROUGH THESE PROGRAMS IN FISCAL YEAR 2016. FINALLY, MANAGEMENT CONSULTING SERVICES WERE PROVIDED TO SEVEN OTHER ORGANIZATIONS THAT SERVE OLDER ADULTS. 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, FUND DEVELOPMENT AND NEW BUSINESS DEVELOPMENT. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS AUGUSTANA CARE. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S BOARD OF DIRECTORS ARE APPOINTED BY A MAJORITY VOTE FROM THE BOARD OF DIRECTORS OF THE SOLE MEMBER, AUGUSTANA CARE, AT THE ANNUAL MEETING. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS REQUIRE AFFIRMATIVE APPROVAL FROM THE SOLE MEMBER OF THE ORGANIZATION, AUGUSTANA CARE: (A) AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THIS CORPORATION; (B) CAPITAL BUDGETS OF THIS CORPORATION AND ALL CORPORATIONS, PARTNERSHIPS, AND OTHER LEGAL ENTITIES DIRECTLY OR INDIRECTLY CONTROLLED BY THIS CORPORATION, AND ALL MAJOR EXPENDITURES BEFORE FUNDS ARE EXPENDED 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 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 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 11 THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND REVIEWED IN DETAIL BY THE ORGANIZATION'S VICE PRESIDENT OF FINANCE/CFO. THE FORM 990 WAS THEN PRESENTED TO THE FULL BOARD OF DIRECTORS BY THE VICE PRESIDENT OF FINANCE/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 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 851,197. MANAGEMENT AND GENERAL EXPENSES 26,894. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 878,091. APPLE VALLEY VILLA APARTMENTS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311608691 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 AUGUSTANA CARE 0 AUGUSTANA APARTMENTS OF HASTINGS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311608701 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 AUGUSTANA CARE 0 AUGUSTANA CARE 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411728753 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 7 N/A 0 AUGUSTANA CARE FOUNDATION 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411360678 CHARITABLE FOUNDATION MN 501(C)(3) 11 - TYPE 1 AUGUSTANA CARE 0 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411806946 MANAGEMENT SERVICES MN 501(C)(3) 11 - TYPE 1 AUGUSTANA CARE 0 AUGUSTANA CHAPEL VIEW HOMES INC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 410693953 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 AUGUSTANA CARE 0 AUGUSTANA COMMUNITY PARTNERS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411783680 HOME HEALTH CARE SERVICES MN 501(C)(3) 9 AUGUSTANA CARE 0 AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311608696 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 AUGUSTANA CARE 0 OPEN CIRCLE ADULT DAY CENTER 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411424801 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 AUGUSTANA CARE 0 AUGUSTANA SENIOR DEVELOPMENT INC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 481293891 CONSULTING MN N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0