2016-08-03T08:55:08-05:00 2015-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2014-10-01 410693953 AUGUSTANA CHAPEL VIEW HOMES INC AUGU 6122385225 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 CRAIG KITTELSON VP - FINANCE/CFO 6122385225 2016-07-26 1 EMILY SCHEEVEL P01814921 6123764500 2014 2016-12-15 16:53:06Z TIM TUCKER 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 40054064 0 X WWW.AUGUSTANACARE.ORG X 1908 MN TO PROVIDE HEALTH CARE, HOUSING AND COMMUNITY SERVICES FOR THE ELDERLY. 6 6 842 352 -5165 -5165 1330937 664177 36778898 38032478 226414 197714 665862 659453 39002111 39553822 59014 91292 0 0 20323106 20729076 0 0 0 18020394 18497514 38402514 39317882 599597 235940 39235729 38282688 33359744 32262988 5875985 6019700 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 29884272 91292 32115800 AUGUSTANA CHAPEL VIEW HOMES, INC. OPERATES TWO LICENSED HEALTH CARE FACILITIES WITH A TOTAL CAPACITY TO SERVE 386 PEOPLE. 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 1,745 INDIVIDUALS DURING THE YEAR ENDED 09/30/2015. 4960756 0 5916678 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 09/30/2015, 546 PEOPLE RESIDED IN THESE TWO APARTMENT COMMUNITIES. 34845028 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 0 842 1 1 1 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 SE 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 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 358498 171568 CRAIG KITTELSON VP - FINANCE/CFO 4.50 40.50 X 0 275000 95933 TIM MIDDENDORF VP - OPERATIONS/COO 4.50 40.50 X 0 246637 30379 KATHY KOPP VP - NEW BUSINESS DEVELOPMENT 4.50 40.50 X 0 239638 56145 GEORGE SERRA FOOD SERVICE DIRECTOR 45.00 0.00 X 129639 0 25225 JEAN COLE ADMINISTRATOR 45.00 0.00 X 140334 0 10968 SHABIR HIRJI-WALJI MAINTENANCE DIRECTOR 45.00 0.00 X 103031 0 24293 373004 1119773 414511 3 0 1 0 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 MANAGEMENT SERVICES 2227933 1 482728 181449 664177 NURSING 623000 32115800 32115800 ASSISTED LIVING 623000 5916678 5916678 38032478 197714 197714 992837 500242 492595 492595 -5165 497760 DIETARY INCOME 623990 47402 47402 MISC INCOME 900099 42394 42394 ANNUITY CONVERSION INCOME 900099 36919 36919 40143 40143 166858 39553822 38032478 -5165 862332 50000 50000 41292 41292 17090150 16175186 914964 211836 193323 18513 2123955 2035733 88222 1303135 1237574 65561 2212921 228559 1984362 46089 46089 63844 63844 3467600 3353557 114043 63846 63846 505891 263195 242696 2450119 2444262 5857 44151 36808 7343 32228 22799 9429 1330321 1330321 2333226 2333226 292417 292417 NURSING SUPPLIES 1948006 1948006 DIETARY EXPENSES 1899379 1899379 LICENSES, PERMITS, FEES 1196640 1127937 68703 BAD DEBT EXPENSE 473509 473509 137327 123871 13456 39317882 34845028 4472854 0 343092 314543 573118 510849 3470517 3419890 425426 304662 75376664 48255459 28219832 27121205 50000 29686 764427 712863 5389317 5868990 39235729 38282688 2505955 2626216 80370 61336 26674643 25675512 443391 457213 1640420 1508954 2014965 1933757 33359744 32262988 X 3201213 3421535 90705 74714 2584067 2523451 5875985 6019700 39235729 38282688 235940 -92224 0 X 0 1 X 1 0 X 3187042 1185486 963955 1330937 664177 7331597 38429595 35632405 35871022 36778898 38032478 184744398 41616637 36817891 36834977 38109835 38696655 192075995 0 0 0 192075995 1288198 1298595 1248252 1206039 1170274 6211358 5353 5353 1288198 1298595 1248252 1211392 1170274 6216711 148397 154756 143919 157584 166858 771514 43053232 38271242 38227148 39478811 40033787 199064220 0.96490 0.96520 0.03120 0.03060 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME FROM TENANTS - 2010 AMOUNT: $ 4,079. 2011 AMOUNT: $ 8,597. 2012 AMOUNT: $ 10,891. 2013 AMOUNT: $ 30,280. 2014 AMOUNT: $ 42,394. TELEPHONE INCOME FROM TENANTS - 2010 AMOUNT: $ 39,239. 2011 AMOUNT: $ 37,140. 2012 AMOUNT: $ 32,654. 2013 AMOUNT: $ 27,184. 2014 AMOUNT: $ 28,440. DIETARY INCOME FROM TENANTS - 2010 AMOUNT: $ 43,506. 2011 AMOUNT: $ 44,544. 2012 AMOUNT: $ 53,247. 2013 AMOUNT: $ 56,172. 2014 AMOUNT: $ 47,402. LAUNDRY INCOME FROM TENANTS - 2010 AMOUNT: $ 3,228. 2011 AMOUNT: $ 3,146. 2012 AMOUNT: $ 2,862. 2013 AMOUNT: $ 4,757. 2014 AMOUNT: $ 4,545. VENDING MACHINE INCOME FROM TENANTS - 2010 AMOUNT: $ 5,909. 2011 AMOUNT: $ 5,373. 2012 AMOUNT: $ 6,727. 2013 AMOUNT: $ 6,566. 2014 AMOUNT: $ 7,158. ANNUITY CONVERSION INCOME - 2010 AMOUNT: $ 52,436. 2011 AMOUNT: $ 55,956. 2012 AMOUNT: $ 37,538. 2013 AMOUNT: $ 32,625. 2014 AMOUNT: $ 36,919. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 2010949 1653 2012602 2000615 250 10084 2010949 1998359 15 2242 2000615 1964220 34139 108246 108246 1998359 1958920 5700 87534 87534 1964220 0.00000 1.00000 0.00000 0 1 1 1914612 1914612 57874743 34400290 23474453 15547842 13855169 1692673 39467 39467 27121205 ASSETS UNDER BOND INDENTURE AGREEMENT 1772365 RESIDENT TRUST FUNDS 97568 HRIR INSURANCE RECIPROCAL 351223 CONTRACT FOR DEED 203125 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 1397618 DUE FROM AFFILIATES 2047091 5868990 ANNUITY OBLIGATIONS 95431 ASSET RETIREMENT OBLIGATIONS 224336 DUE TO AFFILIATES 1613990 1933757 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. 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. 1 AUGUSTANA CARE SERVICES 1007 E 14TH ST MINNEAPOLIS MN 55404 411806946 501(C)(3) 50000 GENERAL SUPPORT 1 0 SCHOLARSHIPS 29 41292 PART I, LINE 2: AUGUSTANA CHAPEL VIEW HOMES MAKES INTERCOMANY TRANSFERS TO RELATED ORGANIZATIONS. AUGUSTANA CHAPEL VIEW HOMES 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 280143 0 50190 0 28165 0 64199 0 107369 0 530066 0 0 CRAIG KITTELSON VP - FINANCE/CFO 0 205599 0 36633 0 32768 0 50420 0 45513 0 370933 0 0 TIM MIDDENDORF VP - OPERATIONS/COO 0 201224 0 28410 0 17003 0 24979 0 5400 0 277016 0 0 KATHY KOPP VP - NEW BUSINESS DEVELOPMENT 0 191502 0 28173 0 19963 0 24693 0 31452 0 295783 0 0 GEORGE SERRA FOOD SERVICE DIRECTOR 115937 0 8280 0 5422 0 4567 0 20658 0 154864 0 0 0 JEAN COLE ADMINISTRATOR 127312 0 13000 0 22 0 4959 0 6009 0 151302 0 0 0 PART I, LINE 3 FOR THE PURPOSE OF DETERMINING COMPENSATION, AUGUSTANA CHAPEL VIEW HOMES 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 - $42,142 CRAIG KITTELSON, VICE PRESIDENT OF FINANCE AND CFO - $28,756 TIM MIDDENDORF, VICE PRESIDENT OF OPERATIONS AND COO - $8,500 KATHERINE KOPP, VICE PRESIDENT OF NEW BUSINESS DEVELOPMENT - $5,500 A CITY OF MINNEAPOLIS MINNESOTA 416005375 603908KZ6 2005-02-24 3310000 REFINANCE SERIES 1995 AND 1999 BONDS 0 0 0 B CITY OF MINNEAPOLIS MINNESOTA 416005375 603908MD3 2005-05-31 12470000 CONSTRUCTION AND REMODELING 0 0 0 C CITY OF MINNEAPOLIS MINNESOTA 416005375 603908LW2 2005-05-31 2160000 CONSTRUCTION AND REMODELING 0 0 0 D MINNEAPOLIS COMMUNITY DEVELOPMENT AGENCY 416009115 2012-12-28 6612000 REFINANCE SERIES 2004 BONDS AND CAPITAL PURCHASES 0 0 0 A 540000 3310000 120008 66200 3243800 2005 1 0 1 1 B 1790000 12470000 964972 249400 10543937 756116 2006 0 0 1 1 C 350000 2160000 163177 43200 1601551 356160 2006 0 0 1 1 D 870640 6612000 121634 1173812 5316554 2014 1 1 1 1 B 0 0 1 1 0 0 0 1 C 0 0 1 1 0 0 0 1 D 0 0 1 1 0 0.01200 0.01200 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 1 0 0 1 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: 03/22/2010 ISSUER NAME: CITY OF MINNEAPOLIS, MINNESOTA DATE THE REBATE COMPUTATION WAS PERFORMED: 06/18/2010 ISSUER NAME: CITY OF MINNEAPOLIS, MINNESOTA DATE THE REBATE COMPUTATION WAS PERFORMED: 06/18/2010 A CITY OF HOPKINS MINNESOTA 416005247 2013-06-11 5290000 REFINANCE SERIES 2006 BONDS 0 0 0 A 647232 5290000 102275 5187725 2013 1 0 1 1 A 0 0 1 1 0 0.01200 0.01200 0 0 1 A 0 1 0 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 2015 FISCAL YEAR, MORE THAN 11,500 PEOPLE WERE SERVED IN COMMUNITIES IN MINNESOTA AND COLORADO. OUR FIVE HEALTH CARE CENTERS PROVIDED TRANSITIONAL, LONG-TERM AND MEMORY CARE AND REHABILITATION SERVICES TO MORE THAN 3,700 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 2015, A TOTAL OF 1,617 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 5,500 INDIVIDUALS WERE SERVED THROUGH THESE PROGRAMS IN FISCAL YEAR 2015. 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. 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 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. 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 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 AUGUSTANA HOME OF HASTINGS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311572624 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 264136110 CONSULTING MN N/A C 0 0 1 0 1 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0