2015-08-03T13:02:05-05:00 2014-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-10-01 411728753 AUGUSTANA CARE AUGU 6122385225 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 CRAIG KITTELSON VP - FINANCE/CFO 6122385225 2015-07-31 1 EMILY SCHEEVEL P01814921 6123764500 2013 2016-03-07 17:11:31Z TIM TUCKER 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 41516886 0 X WWW.AUGUSTANACARE.ORG X 1991 MN TO PROVIDE HEALTHCARE, HOUSING AND COMMMUNITY SERVICES FOR THE ELDERLY. 17 17 1065 296 1842529 82140 2732392 7024078 31838773 33583822 248586 184853 509335 530536 35329086 41323289 1025850 2607800 0 0 18560912 20169884 0 23000 424091 15124273 15684440 34711035 38485124 618051 2838165 72652501 73331631 63515903 61492305 9136598 11839326 X 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 20217150 552300 21374765 EXPENSES ABOVE ARE RELATED TO DIRECT COSTS ASSOCIATED WITH ASSISTED LIVING FOR AUGUSTANA ELK RUN ASSISTED LIVING IN EVERGREEN, CO, AUGUSTANA REGENT IN BURNSVILLE, MN AND AUGUSTANA RESIDENTIAL CARE. ALSO INCLUDED ARE EXPENSES FOR EMERALD CREST, A SPECIALIZED ASSISTED LIVING PROGRAM FOR ADULTS WITH MEMORY LOSS AT FOUR SITES IN THE SUBURBAN MINNEAPOLIS AREA. AUGUSTANA EMERALD CREST EMPLOYS A MODEL OF DELIVERING STRENGTH-BASED CARE FOR INDIVIDUALS WITH MEMORY CHALLENGES IN SMALLER, HOME-LIKE RESIDENCES WHERE ONE'S DIGNITY, PRIVACY, SAFETY AND QUALITY OF LIFE CAN BE PRESERVED. COMBINED, THESE ASSISTED LIVING COMMUNITIES SERVED 472 PEOPLE DURING THE FISCAL YEAR. 10775451 1925000 10334796 THE ABOVE TOTAL INCLUDES OPERATING EXPENSES FOR MERCY HEALTH CARE CENTER OF MOOSE LAKE AND AUGUSTANA LAKESIDE HEALTH CARE CENTER OF DASSEL. DURING THE FISCAL YEAR, THESE TWO RURAL SKILLED NURSING FACILITIES PROVIDED LONG-TERM CARE, TRANSITIONAL CARE AND MEMORY CARE TO 510 PEOPLE. 1806999 130500 1874261 AS A LONGTIME PROVIDER OF SENIOR SERVICES, AUGUSTANA CARE USES THIS EXPERIENCE AND IN-DEPTH KNOWLEDGE OF THE SENIOR CARE MARKET TO PROVIDE MANAGEMENT SERVICES TO OTHER ORGANIZATIONS. EXPENSES ABOVE ARE FOR SENIOR DEVELOPMENT II, A BUSINESS UNIT OF AUGUSTANA CARE OFFERING THESE MANAGEMENT SERVICES FOR UNRELATED NOT-FOR-PROFIT HOUSING COMMUNITIES IN MINNESOTA. THESE INCLUDE BROOKSIDE MANOR IN MONTEVIDEO; EASTWOOD SENIOR LIVING IN MORA; AUGUSTANA APARTMENTS AND CARDINAL HOMES IN FERGUS FALLS; AND ST. PAUL APARTMENTS, THE PINES AT RICHFIELD, SIGNE BURKHARDT MANOR, THOMAS FEENEY MANOR, AND HERITAGE PARK ALL LOCATED IN MINNEAPOLIS. SERVICES INCLUDE CONSULTING, MARKETING, LEADERSHIP DEVELOPMENT, INFORMATION SYSTEMS SUPPORT, HOUSING DEVELOPMENT AND EMPLOYEE RELATIONS. ALTOGETHER, THESE MANAGED FACILITIES SERVED 400 PEOPLE DURING THE FISCAL YEAR. 32799600 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 1065 1 1 1 0 0 0 0 1 1 0 0 0 0 X 17 17 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 MICHELENE VERLAUTZ DIRECTOR 1.00 X 0 0 0 BRUCE CRAWFORD DIRECTOR 1.00 X 0 0 0 LARRY KULA DIRECTOR 1.00 X 0 0 0 PR DAN SIEDELMANN DIRECTOR 1.00 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 TOM TURNER DIRECTOR 1.00 X 0 0 0 BILL SOULES DIRECTOR 1.00 X 0 0 0 NIC PUZAK DIRECTOR 1.00 X 0 0 0 BERNIE CABLE-PROKOP DIRECTOR 1.00 X 0 0 0 ALLEN OLSON DIRECTOR 1.00 X 0 0 0 DUANE HETLAND DIRECTOR 1.00 X 0 0 0 PATRICK IRVINE DIRECTOR 1.00 X 0 0 0 TIM TUCKER PRESIDENT/CEO 4.50 40.50 X 0 317552 85758 CRAIG KITTELSON VP - FINANCE/CFO 4.50 40.50 X 0 257419 76305 TIM MIDDENDORF VP - OPERATIONS/COO 4.50 40.50 X 0 220365 36256 KATHERINE KOPP VP - NEW BUSINESS DEVELOPMENT 4.50 40.50 X 0 225659 54431 0 1020995 252750 0 0 1 0 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 MANAGEMENT SERVICES 1892314 1 12976 2457601 4553501 125 7024078 ASSISTED LIVING 623000 22462613 22462613 NURSING 623000 9246948 9246948 PAYROLL 541200 1339341 1339341 CONSULTING 541610 534920 534920 33583822 184853 184853 325098 164403 160695 160695 -31732 192427 98592 12976 29194 69398 69398 3413 0 3413 3413 DIETARY INCOME 722210 96028 96028 HOUSEKEEPING INCOME 812900 75037 75037 EMERGENCY PULL CORD INCOME 812900 39369 39369 86596 86596 297030 41323289 31709561 1842529 747121 2605500 2605500 2300 2300 16976258 15569062 1407196 138724 130795 7929 1915502 1808846 106656 1139400 1071483 67917 1955513 1594971 360542 46622 46622 69582 69582 23000 23000 1158666 1009007 142837 6822 240241 233546 6695 725737 532021 190315 3401 68236 67442 794 1479413 1426944 52469 422679 123922 295793 2964 126490 86846 39629 15 2610841 2610841 2488411 2488411 301566 301566 NURSING SUPPLIES 1099444 1099444 LOSS ON EXTINGUISHMENT 859288 859288 DIETARY EXPENSES 784203 784203 MISCELLANEOUS 422026 -446 422472 825482 523691 281139 20652 38485124 32799600 5261433 424091 2980284 5817213 268965 0 92323 1875348 2074309 1809916 185505 254833 69629310 12867820 57749298 56761490 1597216 1597316 169649 1408080 1356508 6296521 3689358 72652501 73331631 2305662 2164238 24224998 30314898 280925 289372 35646141 26931038 1058177 1792759 63515903 61492305 X 8637256 7111832 351492 4579544 147850 147950 9136598 11839326 72652501 73331631 2838165 -135437 0 X 0 1 X 1 0 X 5447400 1393259 1100175 2732392 7024078 17697304 5447400 1393259 1100175 2732392 7024078 17697304 17697304 227245 381497 542902 481657 448003 2081304 83140 83140 87916 126149 213688 272317 300443 1000513 20862261 125237276 0.84830 0.83080 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME FROM TENANTS - 2009 AMOUNT: $ 2,494. 2010 AMOUNT: $ 3,481. 2011 AMOUNT: $ 5,523. 2012 AMOUNT: $ 3,619. 2013 AMOUNT: $ 14,292. DIETARY INCOME FROM TENANTS - 2009 AMOUNT: $ 37,616. 2010 AMOUNT: $ 34,215. 2011 AMOUNT: $ 49,600. 2012 AMOUNT: $ 75,674. 2013 AMOUNT: $ 96,028. HOUSEKEEPING INCOME FROM TENANTS - 2009 AMOUNT: $ 18,000. 2010 AMOUNT: $ 36,443. 2011 AMOUNT: $ 66,789. 2012 AMOUNT: $ 77,234. 2013 AMOUNT: $ 75,037. VENDING INCOME FROM TENANTS - 2009 AMOUNT: $ 321. 2010 AMOUNT: $ 309. 2011 AMOUNT: $ 464. 2012 AMOUNT: $ 562. 2013 AMOUNT: $ 544. LAUNDRY INCOME FROM TENANTS - CABLE TV INCOME FROM TENANTS - 2009 AMOUNT: $ 5,485. 2010 AMOUNT: $ 13,601. 2011 AMOUNT: $ 23,884. 2012 AMOUNT: $ 25,206. 2013 AMOUNT: $ 37,534. EMERGENCY PULL CORD INCOME FROM TENANTS - 2009 AMOUNT: $ 24,000. 2010 AMOUNT: $ 38,100. 2011 AMOUNT: $ 38,100. 2012 AMOUNT: $ 38,544. 2013 AMOUNT: $ 39,369. MAINTENANCE INCOME - 2011 AMOUNT: $ 5,158. 2012 AMOUNT: $ 9,376. 2013 AMOUNT: $ 9,687. PENDANT ALARM INCOME - 2011 AMOUNT: $ 4,649. 2012 AMOUNT: $ 4,052. 2013 AMOUNT: $ 4,680. TELEPHONE INCOME - 2011 AMOUNT: $ 19,521. 2012 AMOUNT: $ 23,316. 2013 AMOUNT: $ 23,272. ANNUITY CONVERSION INCOME - 2012 AMOUNT: $ 14,734. 2013 AMOUNT: $ 0. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 147850 100 0 147950 147835 15 147850 146298 1537 9348 9348 147835 145493 815 8122 8122 146298 110831 34662 5839 5839 145493 0.00000 1.00000 0.00000 0 1 1 10895780 10895780 53055847 9631101 43424746 5360602 3236719 2123883 317081 317081 56761490 DUE FROM AFFILIATES 663367 RESIDENT TRUST FUNDS 9159 FUNDS HELD IN ESCROW 281408 BOND FUNDS 2430377 TENANT SECURITY DEPOSIT 305047 3689358 DUE TO AFFILIATES 798982 ASSET RETIREMENT OBLIGATION 43784 NON-COMPETE AGREEMENT 949993 1792759 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. 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. THE TAX RETURNS FOR THE FISCAL YEARS 2011 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. X X X X X X X 1 JULIE STROUD 1767 JULIET AVE ST PAUL MN 55105 GRANTS WRITER 0 0 23000 -23000 23000 -23000 MN CO GOLF TOURNAMENT 85525 4298 81227 150 14947 5492 2497 REGENT FESTIVAL OF TREES 18880 2975 15905 3254 671 1 7163 5703 1460 1250 933 111568 12976 98592 150 14947 9996 4101 29194 69398 1 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411806946 501(C)(3) 2600000 SUPPORT GENERAL OPERATION NORTH CENTRAL UNIVERSITY 910 ELLIOT AVENUE MINNEAPOLIS MN 55404 410706151 501(C)(3) 5500 FOR SUPPORT OF ELLIOT PARK COMMUNITY SOCCER FIELD 2 0 PART I, LINE 2: AUGUSTANA CARE MAKES INTERCOMPANY TRANSFERS TO RELATED ORGANIZATIONS. AUGUSTANA CARE AND THE RELATED ORGANIZATIONS ARE UNDER COMMON MANAGEMENT WHO REGULARLY MONITOR THE USE OF THE 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 ACCOMODATE ANY NECESSARY CHANGES IN WORK HOURS; AND (5) UPON COMPLETION 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 FOR THEIR LAST PAYCHECK. 0 1 0 0 0 0 0 0 0 TIM TUCKER PRESIDENT/CEO 0 259866 0 34747 0 22939 0 60391 0 25367 0 403310 0 0 CRAIG KITTELSON VP - FINANCE/CFO 0 194723 0 29317 0 33379 0 47238 0 29067 0 333724 0 0 TIM MIDDENDORF VP - OPERATIONS/COO 0 185169 0 22343 0 12853 0 22356 0 13900 0 256621 0 0 KATHERINE KOPP VP - NEW BUSINESS DEVELOPMENT 0 182714 0 25431 0 17514 0 25929 0 28502 0 280090 0 0 PART I, LINE 3 FOR THE PURPOSE OF DETERMINING COMPENSATION, AUGUSTANA CARE 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 - $39,677 CRAIG KITTELSON, VICE PRESIDENT OF FINANCE AND CFO - $27,346 TIM MIDDENDORF, VICE PRESIDENT OF OPERATIONS AND COO - $9,500 KATHERINE KOPP, VICE PRESIDENT OF SENIOR DEVELOPMENT - $6,500 A CITY OF DASSEL MN 410851701 2010-09-15 1400000 FACILITY DEVELOPMENT 0 0 0 B DAKOTA COUNTY COMMUNITY DEVELOPMENT AGENCY 411253302 23409VDN7 2007-07-12 5176617 ACQUIRE FACILITY 0 0 0 C CITY OF DASSEL MN 410851701 2007-08-21 1500000 ACQUIRE FACILITY 0 0 0 D COLORADO HEALTH FACILITIES AUTHORITY 840732932 2011-03-31 875000 TO REFINANCE SERIES 2011 BONDS 0 0 0 A 150967 1400000 28000 1372000 2011 0 0 1 1 B 196617 5176617 358800 103532 4714285 2007 0 0 1 1 C 399135 1500000 30000 1470000 2007 0 0 1 1 D 875000 875000 2011 0 0 1 1 A 0 0 1 1 0 0 0 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 0.00050 0.00050 0 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 0 1 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 D 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: DAKOTA COUNTY COMMUNITY DEVELOPMENT AGENCY DATE THE REBATE COMPUTATION WAS PERFORMED: 08/27/2012 A CITY OF VICTORIA MN 410997257 92627TAT3 2014-07-31 22110000 TO REFINANCE SERIES 2009 BONDS 0 0 0 A 22110000 1097153 21667800 442200 2014 1 0 1 1 A 0 0 1 1 0 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 OVERALL MISSION FOR 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, WE PROVIDE SERVICES TO HELP THEM CONTINUE LIVING LIFE TO THE FULLEST, GIVING US ALL THE BENEFIT OF THEIR WISDOM AND EXPERIENCE. WE OFFER A FULL SPECTRUM OF SERVICES FOR OLDER ADULTS AND SERVE MORE THAN 15,000 PEOPLE EACH YEAR IN COMMUNITIES IN MINNESOTA AND COLORADO. OUR HEALTH CARE FACILITIES PROVIDE TRANSITIONAL CARE, LONG-TERM CARE, DEMENTIA CARE, AND REHABILITATION SERVICES TO MORE THAN 4,000 PEOPLE EACH YEAR. AUGUSTANA CARE ALSO OWNS AND MANAGES A VARIETY OF LIVING COMMUNITIES SERVING OLDER ADULTS WITH COMFORTABLE LIVING AND CARE OPTIONS, INCLUDING APARTMENTS FOR INDEPENDENT LIVING, HOUSING WITH SERVICES, AND ASSISTED LIVING AND MEMORY CARE. ADDITIONALLY, WE OFFER A RANGE OF COMMUNITY-BASED SUPPORT SERVICES SUCH AS ADULT DAY PROGRAMS TO ENHANCE THE QUALITY OF LIFE FOR OLDER ADULTS WHO CONTINUE TO LIVE IN THEIR OWN HOMES, AS WELL AS MANAGEMENT CONSULTING SERVICES TO OTHER ORGANIZATIONS THAT SERVE OLDER ADULTS. FORM 990, PART VI, SECTION A, LINE 3 AUGUSTANA CARE SERVICES PROVIDES MANAGEMENT SERVICES FOR AUGUSTANA CARE AND ITS RELATED ORGANIZATIONS. AUGUSTANA CARE SERVICES PROVIDES FINANCIAL ACCOUNTING, OPERATIONAL OVERSIGHT, HUMAN RESOURCES, INFORMATION TECHNOLOGY, CLINICAL NURSING CONSULTATION, CORPORATE COMPLIANCE, COORDINATED ADVERTISING AND MARKETING, STAFFING FOR FUND DEVELOPMENT, AND NEW BUSINESS DEVELOPMENT. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S MEMBERSHIP CONSISTS OF LUTHERAN CONGREGATIONS OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA (ELCA) AND OTHER CONGREGATIONS AS ARE FROM TIME TO TIME ELECTED BY THE MEMBERS. AT ALL TIMES A MAJORITY OF MEMBER CONGREGATIONS SHALL BE LUTHERAN CONGREGATIONS. THERE SHALL BE AT LEAST ONE MEMBER CONGREGATION OF THE ELCA AT ALL TIMES. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS THROUGH THEIR VOTING DELEGATES ELECT THE DIRECTORS AFTER CONSIDERATION OF THE SLATE OF NOMINEES SUBMITTED BY THE NOMINATING AND BOARD DEVELOPMENT COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ORGANIZATION'S GOVERNING DOCUMENTS MUST BE APPROVED BY AN AFFIRMATIVE VOTE OF A MAJORITY OF THE TOTAL NUMBER OF DIRECTORS HOLDING OFFICE AND BY THE AFFIRMATIVE VOTE OF A MAJORITY OF VOTING DELEGATES OF THE MEMBER CONGREGATIONS PRESENT AND VOTING AT WHICH A QUORUM OF MEMBERS IS PRESENT AND VOTING. ANY AMENDMENT WHICH RELATES TO THE REQUIREMENTS FOR AFFILIATION WITH THE EVANGELICAL LUTHERAN CHURCH IN AMERICA ARE SUBMITTED TO THE ELCA PROGRAM UNIT FOR CHURCH IN SOCIETY FOR APPROVAL. 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 VP - FINANCE/CFO. THE FORM 990 WAS THEN PRESENTED TO THE FULL BOARD BY THE VP - FINANCE/CFO PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS AND KEY EMPLOYEES. ALL COVERED INDIVIDUALS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST STATEMENT. ALL COVERED INDIVIDUALS ARE REQUIRED 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. REPLACEMENT RESERVES LLC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 752990222 HOME HEALTH SERVICES MN 3151922 341707 AUGUSTANA CARE AUGUSTANA DASSEL LAKESIDE COMMUNITY HOME LLC 439 WILLIAM AVENUE EAST DASSEL MN 55325 208916091 NURSING/ASSISTED LIVING FACILITY MN 4768536 5789398 AUGUSTANA CARE AUGUSTANA SENIOR DEVELOPMENT II LLC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 481293891 CONSULTING MN 1874261 146521 AUGUSTANA CARE AUGUSTANA MERCY CARE CENTER LLC 710 S KENWOOD AVENUE MOOSE LAKE MN 55767 271466676 NURSING/ASSISTED LIVING FACILITY MN 5982143 4229991 AUGUSTANA CARE AUGUSTANA LAND DEVELOPMENT LLC 14650 GARRENTT AVENUE APPLE VALLEY MN 55124 271456660 LAND DEVELOPMENT MN 0 2206260 AUGUSTANA CARE AUGUSTANA ELK RUN LLC 1425 10TH AVENUE SOUTH MINNEAPOLIS MN 55404 273219747 ASSISTED LIVING MN 2200484 7311524 AUGUSTANA CARE AUGUSTANA EMERALD CARE LLC 451 EAST TRAVELERS TRAIL BURNSVILLE MN 55337 271279704 MEMORY CARE MN 10156302 23893664 AUGUSTANA CARE AUGUSTANA REGENT AT BURNSVILLE 14500 REGENT LANE BURNSVILLE MN 55306 208915982 ASSISTED LIVING MN 6372815 21303224 AUGUSTANA CARE AUGUSTANA PROPERTIES LLC 1425 10TH AVENUE SOUTH MINNEAPOLIS MN 55404 462166624 RENTAL PROPERTIES MN 506655 1806880 AUGUSTANA CARE CASTLE PEAK SENIOR CARE LLC 1425 10TH AVENUE SOUTH MINNEAPOLIS MN 55404 460904337 NURSING/ASSISTED LIVING FACILITY MN 4367720 5535087 AUGUSTANA CARE APPLE VALLEY VILLA APARTMENTS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311608691 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 AUGUSTANA CARE 1 AUGUSTANA APARTMENTS OF HASTINGS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311608701 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 AUGUSTANA CARE 1 AUGUSTANA CARE FOUNDATION 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411360678 CHARITABLE FOUNDATION MN 501(C)(3) 11 - TYPE I AUGUSTANA CARE 1 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411806946 MANAGEMENT SERVICES MN 501(C)(3) 11 - TYPE I AUGUSTANA CARE 1 AUGUSTANA CHAPEL VIEW HOMES INC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 410693953 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 AUGUSTANA CARE 1 AUGUSTANA COMMUNITY PARTNERS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411783680 HOME HEALTH CARE SERVICES MN 501(C)(3) 9 AUGUSTANA CARE 1 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 1 AUGUSTANA HOME OF HASTINGS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311572624 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 AUGUSTANA CARE 1 OPEN CIRCLE ADULT DAY CENTER 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411424801 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 AUGUSTANA CARE 1 AUGUSTANA SENIOR DEVELOPMENT INC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 264136110 CONSULTING MN AUGUSTANA CARE C 70285 313974 1.00000 1 0 1 1 1 1 0 0 0 0 0 1 1 1 1 1 1 0 0 0 AUGUSTANA CARE FOUNDATION C 1039686 CASH AUGUSTANA CARE SERVICES B 2600000 CASH AUGUSTANA CARE SERVICES C 1417915 CASH AUGUSTANA CARE SERVICES M 1892314 % OF REVENUE