AUGUSTANA MOUNT OLIVET HOSPICE CARE LLC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
AUGUSTANA MOUNT OLIVET HOSPICE CARE LLC (EIN 46-4564958)
Tax period
2014-10-01 to 2015-09-30
Filed
2016-08-11
IRS object ID
201612249349300031
Schema version
2014v6.0
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 ReturnHeader

FieldValueIRS element (for citing)
Return2016-08-11T08:19:35-05:00ReturnTs
Tax Period End2015-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1220 SOUTH SIXTH STREET SUITE 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55402ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN464564958EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1AUGUSTANA MOUNT OLIVET HOSPICE CARE LLCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlAUGUBusinessNameControlTxt
Phone6122385225PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11425 10TH AVENUE SOUTH NO 100AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55404ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCRAIG A KITTELSONPersonNm
Person TitleVP - FINANCE/CFOPersonTitleTxt
Phone6122385225PhoneNum
Signature2016-07-26SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonEMILY SCHEEVELPreparerPersonNm
PTINP01814921PTIN
Phone6123764500PhoneNum
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-12-15 16:53:06ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1GRACE HOSPICEBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerSARAH VAN WINKLEPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11425 10TH AVENUE SOUTH NO 100AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55404ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$2,866,937GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.GRACEHOSPICECARING.ORGWebsiteAddressTxt
Type Of Organization OtherYes (X)TypeOfOrganizationOtherInd
Other Organization DscLIMITED LIABILITY COMPANYOtherOrganizationDsc
Formation2014FormationYr
Legal Domicile StateMNLegalDomicileStateCd
Activity Or MissionPROVIDE HOSPICE SERVICES TO THE ELDERLY.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee11TotalEmployeeCnt
Total Volunteers29TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$500,000PYContributionsGrantsAmt
CY Contributions Grants$309,203CYContributionsGrantsAmt
PY Program Service Revenue$110,191PYProgramServiceRevenueAmt
CY Program Service Revenue$2,557,734CYProgramServiceRevenueAmt
PY Investment Income$0PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$610,191PYTotalRevenueAmt
CY Total Revenue$2,866,937CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$298,515PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$1,262,616CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$172,379PYOtherExpensesAmt
CY Other Expenses$1,127,224CYOtherExpensesAmt
PY Total Expenses$470,894PYTotalExpensesAmt
CY Total Expenses$2,389,840CYTotalExpensesAmt
PY Revenues Less Expenses$139,297PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$477,097CYRevenuesLessExpensesAmt
Total Assets BOY$251,603TotalAssetsBOYAmt
Total Assets EOY$983,647TotalAssetsEOYAmt
Total Liabilities BOY$112,306TotalLiabilitiesBOYAmt
Total Liabilities EOY$367,252TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$139,297NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$616,395NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionOUR 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 Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$1,838,007ExpenseAmt
Grant$0GrantAmt
Revenue$2,557,734RevenueAmt
DescAUGUSTANA 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 2015, WE PROVIDED HOSPICE SERVICES TO 191 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$1,838,007TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document3IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee11EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1AUGUSTANA CARE SERVICESBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6122385205PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11007 EAST 14TH STREETAddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55404ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
BERNIE CABLE-PROKOP
CHAIR1.00Yes (X)Yes (X)$0$0$0
TIMOTHY HOKANSON
VICE CHAIR1.00Yes (X)Yes (X)$0$0$0
DAN SEIDELMANN
TREASURER1.00Yes (X)Yes (X)$0$0$0
SHARON WILSON
SECRETARY1.00Yes (X)Yes (X)$0$0$0
EILEEN CARTWRIGHT
BOARD MEMBER1.00Yes (X)$0$0$0
THOMAS MACNALLY
BOARD MEMBER1.00Yes (X)$0$0$0
SARAH VAN WINKLE
PRESIDENT/CEO45.00Yes (X)Yes (X)$143,165$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$143,165TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1AUGUSTANA CARE SERVICESBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line11007 EAST 14TH STREETAddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55404ZIPCd
FieldValueIRS element (for citing)
ServicesMANAGEMENT SERVICESServicesDesc
Compensation$108,248CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
All Other Contributions$309,203AllOtherContributionsAmt
Total Contributions$309,203TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescHOSPICE CAREDesc
Business624100BusinessCd
Total Revenue Column$2,557,734TotalRevenueColumnAmt
Related Or Exempt Func Income$2,557,734RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$2,557,734TotalProgramServiceRevenueAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,866,937TotalRevenueColumnAmt
Related Or Exempt Func Income$2,557,734RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$143,485TotalAmt
Management And General$143,485ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$928,700TotalAmt
Program Services$824,502ProgramServicesAmt
Management And General$104,198ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$2,229TotalAmt
Program Services$1,714ProgramServicesAmt
Management And General$515ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$105,427TotalAmt
Program Services$81,073ProgramServicesAmt
Management And General$24,354ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$82,775TotalAmt
Program Services$63,653ProgramServicesAmt
Management And General$19,122ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$108,248TotalAmt
Management And General$108,248ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$330TotalAmt
Management And General$330ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$4,857TotalAmt
Management And General$4,857ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$616,870TotalAmt
Program Services$616,870ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$23,988TotalAmt
Management And General$23,988ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$40,321TotalAmt
Program Services$3,269ProgramServicesAmt
Management And General$37,052ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$44,472TotalAmt
Management And General$44,472ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$37,902TotalAmt
Program Services$37,902ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$49,123TotalAmt
Program Services$42,070ProgramServicesAmt
Management And General$7,053ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$9,827TotalAmt
Program Services$8,228ProgramServicesAmt
Management And General$1,599ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$5,516TotalAmt
Program Services$5,516ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$7,162TotalAmt
Management And General$7,162ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
NURSING EQUIPMENT$123,425$123,425
NURSING SUPPLIES$29,635$29,635
BAD DEBT EXPENSE$17,055$17,055
LICENSES, PERMITS AND F$5,600$5,600

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$2,893TotalAmt
Program Services$150ProgramServicesAmt
Management And General$2,743ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$2,389,840TotalAmt
Program Services$1,838,007ProgramServicesAmt
Management And General$551,833ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$120,332BOYAmt
EOY$263,377EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$110,191BOYAmt
EOY$671,170EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$4,029BOYAmt
EOY$15,813EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$40,697LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$7,410LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$17,051BOYAmt
EOY$33,287EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$251,603BOYAmt
EOY$983,647EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$112,306BOYAmt
EOY$367,252EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$112,306BOYAmt
EOY$367,252EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$139,297BOYAmt
EOY$616,395EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$139,297BOYAmt
EOY$616,395EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$251,603BOYAmt
EOY$983,647EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$477,097ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$500,000CurrentTaxYearMinus1YearAmt
Current Tax Year$309,203CurrentTaxYearAmt
Total$809,203TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$110,191CurrentTaxYearMinus1YearAmt
Current Tax Year$2,557,734CurrentTaxYearAmt
Total$2,667,925TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$610,191CurrentTaxYearMinus1YearAmt
Current Tax Year$2,866,937CurrentTaxYearAmt
Total$3,477,128TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$500,000CurrentTaxYearMinus1YearAmt
Current Tax Year$300,000CurrentTaxYearAmt
Total$800,000TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$500,000CurrentTaxYearMinus1YearAmt
Current Tax Year$300,000CurrentTaxYearAmt
Total$800,000TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$2,677,128PublicSupportTotal509Amt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year$610,191CurrentTaxYearMinus1YearAmt
Current Tax Year$2,866,937CurrentTaxYearAmt
Total$3,477,128TotalAmt
FieldValueIRS element (for citing)
First5 Years509Yes (X)First5Years509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE A, PART III, COLUMN EFormAndLineReferenceDesc
ExplanationTHE AMOUNTS INCLUDED IN COLUMN E 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

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$40,697OtherCostOrOtherBasisAmt
Depreciation$7,410DepreciationAmt
Book Value$33,287BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$33,287TotalBookValueLandBuildingsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 21. 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 3AUGUSTANA 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 6THE 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 7ATHE 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 7BTHE 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 11THE 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 12CINFORMATION 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 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11GOTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 616,870. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 616,870.

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