AUGUSTANA MOUNT OLIVET HOSPICE CARE LLC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization: AUGUSTANA MOUNT OLIVET HOSPICE CARE LLC (EIN 46-4564958)
Tax period: 2015-10-01 to 2016-09-30
Filed: 2017-08-09
IRS object ID: 201722219349300312
Schema version: 2015v3.0
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 J
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-08-09T09:03:32-05:00	ReturnTs
Tax Period End	2016-09-30	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	2015-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	464564958	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	AUGUSTANA MOUNT OLIVET HOSPICE CARE LLC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	AUGU	BusinessNameControlTxt
Phone	6122385225	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1425 10TH AVENUE SOUTH NO 100	AddressLine1Txt
City	MINNEAPOLIS	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55404	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	CRAIG A KITTELSON	PersonNm
Person Title	VP - FINANCE/CFO	PersonTitleTxt
Phone	6122385225	PhoneNum
Signature	2017-07-28	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

Field	Value	IRS element (for citing)
Tax	2015	TaxYr
Build TS	2021-01-29 14:40:06Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	GRACE HOSPICE	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	SARAH VAN WINKLE	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1425 10TH AVENUE SOUTH NO 100	AddressLine1Txt
City	MINNEAPOLIS	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55404	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$4,091,572	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.GRACEHOSPICECARING.ORG	WebsiteAddressTxt
Type Of Organization Other	Yes (X)	TypeOfOrganizationOtherInd
Other Organization Dsc	LIMITED LIABILITY COMPANY	OtherOrganizationDsc
Formation	2014	FormationYr
Legal Domicile State	MN	LegalDomicileStateCd
Activity Or Mission	PROVIDE HOSPICE SERVICES TO THE ELDERLY.	ActivityOrMissionDesc
Voting Members Governing Body	7	VotingMembersGoverningBodyCnt
Voting Members Independent	6	VotingMembersIndependentCnt
Total Employee	29	TotalEmployeeCnt
Total Volunteers	20	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$309,203	PYContributionsGrantsAmt
CY Contributions Grants	$110,578	CYContributionsGrantsAmt
PY Program Service Revenue	$2,557,734	PYProgramServiceRevenueAmt
CY Program Service Revenue	$3,980,994	CYProgramServiceRevenueAmt
PY Investment Income	$0	PYInvestmentIncomeAmt
CY Investment Income	$0	CYInvestmentIncomeAmt
PY Other Revenue	$0	PYOtherRevenueAmt
CY Other Revenue	$0	CYOtherRevenueAmt
PY Total Revenue	$2,866,937	PYTotalRevenueAmt
CY Total Revenue	$4,091,572	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$1,262,616	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$2,011,484	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$1,127,224	PYOtherExpensesAmt
CY Other Expenses	$1,904,081	CYOtherExpensesAmt
PY Total Expenses	$2,389,840	PYTotalExpensesAmt
CY Total Expenses	$3,915,565	CYTotalExpensesAmt
PY Revenues Less Expenses	$477,097	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$176,007	CYRevenuesLessExpensesAmt
Total Assets BOY	$983,647	TotalAssetsBOYAmt
Total Assets EOY	$1,265,893	TotalAssetsEOYAmt
Total Liabilities BOY	$367,252	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$473,491	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$616,395	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$792,402	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	OUR MISSION IS TO RECOGNIZE THAT EVERY PERSON DESERVES TO LIVE OUT HIS OR HER LIFE WITH RESPECT AND DIGNITY, FREE OF PAIN AND IN AN ENVIRONMENT THAT PROMOTES QUALITY OF LIFE.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$3,088,368	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$3,980,994	RevenueAmt
Desc	AUGUSTANA MOUNT OLIVET HOSPICE, LLC ("THE LLC") IS A JOINT VENTURE BETWEEN AUGUSTANA CARE (EIN: 41-1728753) AND MOUNT OLIVET CAREVIEW HOME (EIN: 41-0802697). AUGUSTANA CARE AND MOUNT OLIVET CAREVIEW HOME ARE THE ONLY MEMBERS OF THE LLC. BOTH MEMBERS ARE MINNESOTA NONPROFIT CORPORATIONS AND TAX EXEMPT PUBLIC CHARITIES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AUGUSTANA CARE IS A PUBLIC CHARITY UNDER SECTIONS 509(A)(1) AND 170(B)(1)(A)(VI). MOUNT OLIVET CAREVIEW HOME IS A PUBLIC CHARITY UNDER SECTION 509(A)(2). THE LLC PROVIDES END-OF-LIFE CARE TO PATIENTS, WHEREVER THEY LIVE, THAT HAVE BEEN CERTIFIED AS BEING TERMINALLY ILL WITH LESS THAN SIX MONTHS OF LIFE. THE PURPOSES OF THE LLC INCLUDE:(A) TO PROVIDE HOME CARE AND END-OF-LIFE SERVICES THAT SUPPORTS EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, CULTURAL, SOCIAL AND RECREATIONAL NEEDS TO ENHANCE THEIR QUALITY OF LIFE;(B) TO SUPPORT, AID AND DEVELOP METHODS AND MEANS TO MAKE THE LIVES OF PERSONS IN THEIR HOMES AND AT THE END OF THEIR LIVES AS INDEPENDENT, HEALTHFUL, MEANINGFUL AND SECURE AS POSSIBLE IN AN ENVIRONMENT WHICH EMPHASIZES CHRISTIAN CARE AND CONCERN, INCLUDING BUT NOT LIMITED TO HOME CARE, HOSPICE AND PALLIATIVE CARE SERVICES, FACILITIES AND PROGRAMS FOR SUPPORTIVE SERVICES AND EDUCATION FOR PERSONS IN THEIR HOMES AND AT THE END OF THEIR LIVES, THEIR FAMILIES, PROFESSIONALS WHO SERVE SUCH PERSONS, AND OTHER MEMBERS OF THE COMMUNITIES SERVED BY THIS COMPANY; AND(C) SUCH OTHER FACILITIES OR PROGRAMS AS MAY FROM TIME TO TIME BE APPROPRIATE TO THE ACCOMPLISHMENT OF THIS COMPANY'S CHARITABLE PURPOSES.IN FY 2016, WE PROVIDED HOSPICE SERVICES TO 246 PEOPLE. SERVICES INCLUDED MEDICAL DIRECTOR, NURSING, SOCIAL SERVICES, CHAPLAINS, HOME HEALTH AIDES, MEDICATIONS RELATED TO TERMINAL ILLNESS, MEDICAL EQUIPMENT, 24/7 ON-CALL SUPPORT, AND BEREAVEMENT SUPPORT FOR FAMILY MEMBERS FOR 13 MONTHS AFTER THE DEATH.	Desc
Total Program Service Expenses	$3,088,368	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	0	CreditCounselingInd
Temp Or Permanent Endowments	0	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	Yes (1)	ReportOtherAssetsInd
Report Other Liabilities	0	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	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	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
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	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	0	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	8	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	29	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	6	IndependentVotingMemberCnt
Family Or Business Rln	Yes (1)	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

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	AUGUSTANA CARE SERVICES	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Phone	6122385205	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1007 EAST 14TH STREET	AddressLine1Txt
City	MINNEAPOLIS	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55404	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt
BERNIE CABLE-PROKOP
CHAIR	1.00	Yes (X)	Yes (X)	$0	$0	$0
TIMOTHY HOKANSON
VICE CHAIR	1.00	Yes (X)	Yes (X)	$0	$0	$0
DAN SEIDELMANN
TREASURER	1.00	Yes (X)	Yes (X)	$0	$0	$0
SHARON WILSON
SECRETARY	1.00	Yes (X)	Yes (X)	$0	$0	$0
EILEEN CARTWRIGHT
BOARD MEMBER	1.00	Yes (X)		$0	$0	$0
THOMAS MACNALLY
BOARD MEMBER	1.00	Yes (X)		$0	$0	$0
SARAH VAN WINKLE
PRESIDENT/CEO	45.00	Yes (X)	Yes (X)	$158,612	$0	$3,452

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$158,612	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$3,452	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	1	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	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	AUGUSTANA CARE SERVICES	BusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1007 EAST 14TH STREET	AddressLine1Txt
City	MINNEAPOLIS	CityNm
State Abbreviation	MN	StateAbbreviationCd
ZIP	55404	ZIPCd

Field	Value	IRS element (for citing)
Services	MANAGEMENT SERVICES	ServicesDesc
Compensation	$159,623	CompensationAmt

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	1	CntrctRcvdGreaterThan100KCnt
All Other Contributions	$110,578	AllOtherContributionsAmt
Total Contributions	$110,578	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

Field	Value	IRS element (for citing)
Desc	HOSPICE CARE	Desc
Business	624100	BusinessCd
Total Revenue Column	$3,980,994	TotalRevenueColumnAmt
Related Or Exempt Func Income	$3,980,994	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$3,980,994	TotalProgramServiceRevenueAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$4,091,572	TotalRevenueColumnAmt
Related Or Exempt Func Income	$3,980,994	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$0	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$169,602	TotalAmt
Management And General	$169,602	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$1,505,581	TotalAmt
Program Services	$1,328,429	ProgramServicesAmt
Management And General	$177,152	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$7,947	TotalAmt
Program Services	$6,302	ProgramServicesAmt
Management And General	$1,645	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$202,607	TotalAmt
Program Services	$160,668	ProgramServicesAmt
Management And General	$41,939	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$125,747	TotalAmt
Program Services	$99,718	ProgramServicesAmt
Management And General	$26,029	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$159,623	TotalAmt
Management And General	$159,623	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$4,839	TotalAmt
Management And General	$4,839	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$5,051	TotalAmt
Management And General	$5,051	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$1,131,216	TotalAmt
Program Services	$1,131,216	ProgramServicesAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$12,464	TotalAmt
Management And General	$12,464	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$66,962	TotalAmt
Program Services	$13,626	ProgramServicesAmt
Management And General	$53,336	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$54,096	TotalAmt
Management And General	$54,096	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$36,782	TotalAmt
Program Services	$36,782	ProgramServicesAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$85,047	TotalAmt
Program Services	$75,216	ProgramServicesAmt
Management And General	$9,831	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$8,532	TotalAmt
Program Services	$6,781	ProgramServicesAmt
Management And General	$1,751	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,463	TotalAmt
Program Services	$1,463	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$22,257	TotalAmt
Program Services	$22,257	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$12,251	TotalAmt
Management And General	$12,251	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
NURSING EQUIPMENT	$161,152	$161,152
BAD DEBT EXPENSE	$84,512		$84,512
NURSING SUPPLIES	$44,608	$44,608
RECRUITMENT AND RETENTI	$8,544		$8,544

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$4,682	TotalAmt
Program Services	$150	ProgramServicesAmt
Management And General	$4,532	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,915,565	TotalAmt
Program Services	$3,088,368	ProgramServicesAmt
Management And General	$827,197	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$263,377	BOYAmt
EOY	$449,406	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$671,170	BOYAmt
EOY	$506,078	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$15,813	BOYAmt
EOY	$80,052	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$191,772	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$29,668	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$33,287	BOYAmt
EOY	$162,104	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$68,253	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$983,647	BOYAmt
EOY	$1,265,893	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$367,252	BOYAmt
EOY	$356,396	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$117,095	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$367,252	BOYAmt
EOY	$473,491	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$616,395	BOYAmt
EOY	$792,402	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$616,395	BOYAmt
EOY	$792,402	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$983,647	BOYAmt
EOY	$1,265,893	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$176,007	ReconcilationRevenueExpnssAmt
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)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

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 Minus2 Years	$500,000	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$309,203	CurrentTaxYearMinus1YearAmt
Current Tax Year	$110,578	CurrentTaxYearAmt
Total	$919,781	TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus2 Years	$110,191	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$2,557,734	CurrentTaxYearMinus1YearAmt
Current Tax Year	$3,980,994	CurrentTaxYearAmt
Total	$6,648,919	TotalAmt

Total509 Total509Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus2 Years	$610,191	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$2,866,937	CurrentTaxYearMinus1YearAmt
Current Tax Year	$4,091,572	CurrentTaxYearAmt
Total	$7,568,700	TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus2 Years	$500,000	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$300,000	CurrentTaxYearMinus1YearAmt
Current Tax Year	$100,000	CurrentTaxYearAmt
Total	$900,000	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)
Current Tax Year Minus2 Years	$500,000	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$300,000	CurrentTaxYearMinus1YearAmt
Current Tax Year	$100,000	CurrentTaxYearAmt
Total	$900,000	TotalAmt

Field	Value	IRS element (for citing)
Public Support Total509	$6,668,700	PublicSupportTotal509Amt

Total Support Calendar Year TotalSupportCalendarYearGrp

Field	Value	IRS element (for citing)
Current Tax Year Minus2 Years	$610,191	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$2,866,937	CurrentTaxYearMinus1YearAmt
Current Tax Year	$4,091,572	CurrentTaxYearAmt
Total	$7,568,700	TotalAmt

Field	Value	IRS element (for citing)
First5 Years509	Yes (X)	First5Years509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

Field	Value	IRS element (for citing)
Form And Line Reference	SCHEDULE A, PART III, COLUMN D	FormAndLineReferenceDesc
Explanation	THE AMOUNTS INCLUDED IN COLUMN D FOR TAX YEAR 2013 ARE FOR A SHORT PERIOD STARTING ON JANUARY 13, 2014 AND ENDING ON SEPTEMBER 30, 2014.	ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$129,510	OtherCostOrOtherBasisAmt
Depreciation	$12,951	DepreciationAmt
Book Value	$116,559	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$62,262	OtherCostOrOtherBasisAmt
Depreciation	$16,717	DepreciationAmt
Book Value	$45,545	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$162,104	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp

Field	Value	IRS element (for citing)
Desc	DUE FROM HOME HEALTH	Desc
Book Value	$68,253	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$68,253	TotalBookValueOtherAssetsAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$3,991,572	TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported	$0	RevenueNotReportedAmt
Revenue Subtotal	$3,991,572	RevenueSubtotalAmt
Other Revenues Not Included	$100,000	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$100,000	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$4,091,572	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$3,915,565	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$3,915,565	ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt	$0	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$3,915,565	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

PART X, LINE 2:

AS A LIMITED LIABILITY COMPANY, THE COMPANY IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES AND ITS INCOME IS ALLOCATED TO AND REPORTED IN THE TAX RETURNS OF ITS MEMBERS, WHICH ARE BOTH NON-PROFIT CORPORATIONS. THE COMPANY 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. THE COMPANY'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES.

PART XI, LINE 4B - OTHER ADJUSTMENTS:

MEMBERS' CONTRIBUTION 100,000.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Independent Consultant	Yes (X)	IndependentConsultantInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	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

Field	Value	IRS element (for citing)
Person	SARAH VAN WINKLE	PersonNm
Title	PRESIDENT/CEO	TitleTxt
Base Compensation Filing Org	$143,590	BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs	$0	CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization	$15,000	BonusFilingOrganizationAmount
Bonus Related Organizations	$0	BonusRelatedOrganizationsAmt
Other Compensation Filing Org	$22	OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs	$0	OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org	$3,452	DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs	$0	DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org	$0	NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs	$0	NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org	$162,064	TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs	$0	TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org	$0	CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs	$0	CompReportPrior990RltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2	1. BERNADINE CABLE-PROKOP AND DAN SIEDELMANN - BUSINESS RELATIONSHIP 2. BERNADINE CABLE-PROKOP AND SHARON WILSON - BUSINESS RELATIONSHIP 3. DAN SIEDELMANN AND SHARON WILSON - BUSINESS RELATIONSHIP 4. THOMAS MACNALLY AND EILEEN CARTWRIGHT - BUSINESS RELATIONSHIP 5. THOMAS MACNALLY AND TIMOTHY HOKANSON - BUSINESS RELATIONSHIP 6. EILEEN CARTWRIGHT AND TIMOTHY HOKANSON - BUSINESS RELATIONSHIP
FORM 990, PART VI, SECTION A, LINE 3	AUGUSTANA CARE SERVICES PROVIDES MANAGEMENT SERVICES FOR AUGUSTANA MOUNT OLIVET HOSPICE CARE, LLC. AUGUSTANA CARE SERVICES PROVIDES FINANCIAL ACCOUNTING, HUMAN RESOURCES, INFORMATION TECHNOLOGY, MARKETING, COMPLIANCE AND RISK MANAGEMENT, OPERATIONAL OVERSIGHT, AND TELEPHONE AND INTERNET SERVICES.
FORM 990, PART VI, SECTION A, LINE 6	THE MEMBERS OF THE ORGANIZATION ARE AUGUSTANA CARE AND MOUNT OLIVET CAREVIEW HOME, BOTH MINNESOTA NON PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL CODE AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND AFFILIATED WITH THE EVANGELICAL LUTHERAN CHURCH IN AMERICA. THE INCUMBENT CHIEF EXECUTIVE OFFICER OF EACH MEMBER SHALL BE THE MEMBER DELEGATE OF EACH MEMBER ENTITLED TO VOTE ON BEHALF OF THE VOTING INTERESTS OF EACH MEMBER.
FORM 990, PART VI, SECTION A, LINE 7A	THE BOARD OF GOVERNORS SHALL CONSIST OF AT LEAST SIX GOVERNORS, THREE OF WHOM SHALL BE APPOINTED BY THE MEMBER DELEGATE OF AUGUSTANA CARE AND THREE OF WHOM SHALL BE APPOINTED BY THE MEMBER DELEGATE OF MOUNT OLIVET CAREVIEW HOME.
FORM 990, PART VI, SECTION A, LINE 7B	THE ARTICLES OF ORGANIZATION AND THE BYLAWS OF THIS ORGANIZATION MAY BE AMENDED OR RESTATED ONLY BY THE UNANIMOUS APPROVAL OF THE MEMBERS. ANY PROPOSED AMENDMENTS RELATING TO THE AFFILIATION REQUIREMENTS OF THE ELCA SHALL BE SUBMITTED TO THE ELCA FOR COMMENT PRIOR TO THEIR EFFECTIVE DATE.
FORM 990, PART VI, SECTION B, LINE 11	THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND REVIEWED IN DETAIL BY THE PRESIDENT/CEO OF THE ORGANIZATION ALONG WITH AUGUSTANA CARE'S VP OF FINANCE/CFO. THE FORM 990 WAS THEN PRESENTED TO THE FULL BOARD OF DIRECTORS BY THE VP OF FINANCE/CFO OF AUGUSTANA CARE PRIOR TO BEING FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	INFORMATION REGARDING THE HOSPICE'S POLICY ON CONFLICTS OF INTEREST IS PROVIDED DURING ORIENTATION OF NEW STAFF, VOLUNTEERS AND BOARD MEMBERS. MEMBERS OF THE BOARD OF DIRECTORS AND HOSPICE STAFF, SUBMIT A FORM TO DISCLOSE PERSONAL OR FINANCIAL INTERESTS THAT COULD POTENTIALLY INTERFERE WITH THEIR DUTIES AND RESPONSIBILITIES TO GRACE HOSPICE. DISCLOSURE FORMS ARE SUBMITTED AT THE TIME OF HIRE OR BOARD APPOINTMENT, ANNUALLY AND WHENEVER A POTENTIAL CONFLICT ARISES. FAILURE TO DISCLOSE EXISTING OR POTENTIAL CONFLICTS OF INTEREST IS GROUNDS FOR TERMINATION OF EMPLOYMENT OR BOARD APPOINTMENT. POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY THE BOARD OF DIRECTORS AND/OR BY THE HOSPICE ADMINISTRATOR TO DETERMINE APPROPRIATE ACTION.
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 FOR SERVICES: PROGRAM SERVICE EXPENSES 1,131,216. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,131,216.