AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY (EIN 31-1608696)
Tax period
2012-10-01 to 2013-09-30
Filed
2014-05-13
IRS object ID
201431339349304388
Schema version
2012v2.1
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)
Timestamp2014-05-13T14:59:44-05:00Timestamp
Tax Period End Date2013-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN410746749EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1220 SOUTH SIXTH STREET SUITE 300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN311608696EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEYBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlAUGUNameControl
Phone6122385225Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11007 EAST 14TH STREETAddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55404ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCRAIG KITTELSONName
TitleVP - FINANCE/CFOTitle
Phone6122385225Phone
Date Signed2014-05-08DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJEFF VRIEZEName
PTINP01273590PTIN
Phone6123764500Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTIM TUCKERNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11007 EAST 14TH STREETAddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55404ZIPCode
FieldValueIRS element (for citing)
Gross Receipts16149008GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.AUGUSTANACARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1998YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HEALTH CARE, HOUSING AND COMMUNITY SERVICES FOR THE ELDERLY.ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees351TotalNbrEmployees
Total Nbr Volunteers90TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year19934ContributionsGrantsPriorYear
Contributions Grants Current Year194407ContributionsGrantsCurrentYear
Program Service Revenue Prior Year17149505ProgramServiceRevenuePriorYear
Program Service Revenue CY15756871ProgramServiceRevenueCY
Investment Income Prior Year319826InvestmentIncomePriorYear
Investment Income Current Year125642InvestmentIncomeCurrentYear
Other Revenue Prior Year137368OtherRevenuePriorYear
Other Revenue Current Year72088OtherRevenueCurrentYear
Total Revenue Prior Year17626633TotalRevenuePriorYear
Total Revenue Current Year16149008TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year270386GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY578171GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year9353366SalariesEtcPriorYear
Salaries Etc Current Year8376840SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year8484899OtherExpensePriorYear
Other Expenses Current Year7387766OtherExpensesCurrentYear
Total Expenses Prior Year18108651TotalExpensesPriorYear
Total Expenses Current Year16342777TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-482018RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-193769RevenuesLessExpensesCY
Total Assets BOY23148046TotalAssetsBOY
Total Assets EOY22454707TotalAssetsEOY
Total Liabilities BOY20469723TotalLiabilitiesBOY
Total Liabilities EOY20026909TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY2678323NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY2427798NetAssetsOrFundBalancesEOY
Mission DescriptionTO 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense14533125Expense
Grants578171Grants
Revenue15756871Revenue
DescriptionAUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY OPERATES A 200 BED LICENSED NURSING FACILITY IN APPLE VALLEY, MINNESOTA. THE FACILITY OFFERS LONG-TERM CARE AND TRANSITIONAL CARE, AND THERAPEUTIC AND REHABILITATION SERVICES. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2013 THE CARE CENTER SERVED 1,243 PEOPLE.Description
Total Program Service Expense14533125TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees351NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonCRAIG KITTELSON - AUGUSTANA CARE SENamePerson
Telephone Number6122385205TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11007 EAST 14TH STREETAddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55404ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (11 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployee
REV DR GARY WILKERSON
CHAIR1.008.00XX000
MARSHALL MACKAY
VICE CHAIR1.008.00XX000
CHARLES PARKS JR
SECRETARY1.008.00XX000
ERIC RICK ELLINGSON
TREASURER1.009.00XX000
JIM EHLEN
DIRECTOR1.008.00X000
SCOTT RAMSDALE
DIRECTOR1.008.00X000
PR ELIZABETH BEISSEL
DIRECTOR1.008.00X000
TIM TUCKER
PRESIDENT/CEO4.5040.50X031699067832
CRAIG KITTELSON
VP - FINANCE/CFO4.5040.50X025379261363
TIM MIDDENDORF
VP - OPERATIONS/COO4.5040.50X020358528605
KATHERINE KOPP
VP - NEW BUSINESS DEVELOPMENT4.5040.50022040443005X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs994771TotalReportableCompFrmRltdOrgs
Total Other Compensation200805TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1AUGUSTANA CARE SERVICESBusinessNameLine1

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11007 EAST 14TH STREETAddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55404ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesMANAGEMENT SERVICESDescriptionOfServices
Compensation885960Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Government Grants174812GovernmentGrants
All Other Contributions19595AllOtherContributions
Total Contributions194407TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNURSING FACILITIESDescription
Business Code623000BusinessCode
Total Revenue Column15756871TotalRevenueColumn
Related Or Exempt Function Income15756871RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue15756871TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column125642TotalRevenueColumn
Exclusion$125,642ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real4247Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real4247Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column4247TotalRevenueColumn
Exclusion$4,247ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
MISCELLANEOUS INCOME90009927430$27,430
TELEPHONE INCOME81290017537$17,537
CABLE TV INCOME81290012633$12,633

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column10241TotalRevenueColumn
Exclusion$10,241ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue67841TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column16149008TotalRevenueColumn
Related Or Exempt Function Income15756871RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$197,730ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total557000Total
Program Services557000ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total21171Total
Program Services21171ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total7008582Total
Program Services6697687ProgramServices
Management And General310895ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total96863Total
Program Services86637ProgramServices
Management And General10226ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total757073Total
Program Services691574ProgramServices
Management And General65499ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total514322Total
Program Services492261ProgramServices
Management And General22061ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total885960Total
Management And General885960ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total17426Total
Management And General17426ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total24209Total
Management And General24209ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total412430Total
Program Services360813ProgramServices
Management And General51617ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total9640Total
Management And General9640ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total233155Total
Program Services145971ProgramServices
Management And General87184ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total276983Total
Program Services276983ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total8134Total
Program Services2190ProgramServices
Management And General5944ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total21551Total
Program Services17637ProgramServices
Management And General3914ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total988021Total
Program Services988021ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total675259Total
Program Services675259ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total97314Total
Management And General97314ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
NURSING SUPPLIES24485932448593
LICENSES, PERMITS, FEES5304525210779375
DIETARY EXPENSES482815482815
BAD DEBT EXPENSE180062180062

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total95762Total
Program Services67436ProgramServices
Management And General28326ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total16342777Total
Program Services14533125ProgramServices
Management And General1809652ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1627009BOY
EOY592101EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1792711BOY
EOY1722906EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY1084916BOY
EOY1286289EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY67937BOY
EOY303677EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis17803320LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4010910LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY12911223BOY
EOY13792410EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY704661BOY
EOY707877EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4959589BOY
EOY4049447EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY23148046BOY
EOY22454707EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY950145BOY
EOY1046448EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY19200000BOY
EOY18955000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY18653BOY
EOY21510EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY300925BOY
EOY3951EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY20469723BOY
EOY20026909EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY2674158BOY
EOY2424162EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2250BOY
EOY1721EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1915BOY
EOY1915EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY2678323BOY
EOY2427798EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY23148046BOY
EOY22454707EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-193769ReconcilationRevenueExpenses
Reconciliation Unrealized Invest-56756ReconciliationUnrealizedInvest
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years477224CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years34575CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years244200CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year19934CurrentTaxYearMinus1Year
Current Tax Year194407CurrentTaxYear
Total970340Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years22356265CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22365488CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22433010CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17149505CurrentTaxYearMinus1Year
Current Tax Year15756871CurrentTaxYear
Total100061139Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years22833489CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22400063CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22677210CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17169439CurrentTaxYearMinus1Year
Current Tax Year15951278CurrentTaxYear
Total101031479Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1272CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years450CurrentTaxYearMinus3Years
Total1722Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years1272CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years450CurrentTaxYearMinus3Years
Total1722Total
FieldValueIRS element (for citing)
Public Support Total509101029757PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years137501CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years148039CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years156961CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year319826CurrentTaxYearMinus1Year
Current Tax Year129889CurrentTaxYear
Total892216Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years137501CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years148039CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years156961CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year319826CurrentTaxYearMinus1Year
Current Tax Year129889CurrentTaxYear
Total892216Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years152407CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years156132CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years155822CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year111393CurrentTaxYearMinus1Year
Current Tax Year67841CurrentTaxYear
Total643595Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years23123397CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years22704234CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22989993CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year17600658CurrentTaxYearMinus1Year
Current Tax Year16149008CurrentTaxYear
Total102567290Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98500PublicSupportPercentage509
Prior Year Support Percentage0.98460PriorYearSupportPercentage
Investment Income Percentage0.00870InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00820PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME FROM TENANTS - 2008 AMOUNT: $ 30,228. 2009 AMOUNT: $ 33,438. 2010 AMOUNT: $ 34,998. 2011 AMOUNT: $ 44,708. 2012 AMOUNT: $ 27,430. TELEPHONE INCOME FROM TENANTS - 2008 AMOUNT: $ 17,932. 2009 AMOUNT: $ 18,517. 2010 AMOUNT: $ 17,773. 2011 AMOUNT: $ 16,723. 2012 AMOUNT: $ 17,537. DIETARY INCOME FROM TENANTS - 2008 AMOUNT: $ 53,740. 2009 AMOUNT: $ 55,101. 2010 AMOUNT: $ 41,642. 2011 AMOUNT: $ 16,921. 2012 AMOUNT: $ 3,912. HOUSEKEEPING INCOME FROM TENANTS - 2008 AMOUNT: $ 7,879. 2009 AMOUNT: $ 11,010. 2010 AMOUNT: $ 34,346. 2011 AMOUNT: $ 10,116. MAINTENANCE INCOME FROM TENANTS - 2008 AMOUNT: $ 17,078. 2009 AMOUNT: $ 17,278. 2010 AMOUNT: $ 8,093. 2011 AMOUNT: $ 1,786. GIFT SHOP INCOME FROM TENANTS - 2008 AMOUNT: $ 5,532. 2009 AMOUNT: $ 2,001. PENDANT ALARM INCOME FROM TENANTS - 2008 AMOUNT: $ 9,192. 2009 AMOUNT: $ 7,792. 2010 AMOUNT: $ 5,995. 2011 AMOUNT: $ 2,507. CABLE TV INCOME FROM TENANTS - 2008 AMOUNT: $ 10,826. 2009 AMOUNT: $ 10,995. 2010 AMOUNT: $ 12,975. 2011 AMOUNT: $ 11,735. 2012 AMOUNT: $ 12,633. ANNUITY CONVERSION INCOME - VENDING INCOME - 2011 AMOUNT: $ 6,897. 2012 AMOUNT: $ 6,329.GeneralExplanation

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS
Explanation In Part XIIIXExplanationInPartXIII

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1915BeginningOfYearBalance
End Of Year Balance1915EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance3292BeginningOfYearBalance
Other Expenditures1377OtherExpenditures
End Of Year Balance1915EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance3052BeginningOfYearBalance
Contributions240Contributions
End Of Year Balance3292EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2812BeginningOfYearBalance
Contributions240Contributions
Investment Earnings Or Losses166InvestmentEarningsOrLosses
Other Expenditures166OtherExpenditures
End Of Year Balance3052EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2432BeginningOfYearBalance
Contributions380Contributions
Investment Earnings Or Losses154InvestmentEarningsOrLosses
Other Expenditures154OtherExpenditures
End Of Year Balance2812EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1423149OtherCostOrOtherBasis
Book Value1423149BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis12964684OtherCostOrOtherBasis
Depreciation2657627Depreciation
Book Value10307057BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2397433OtherCostOrOtherBasis
Depreciation1353283Depreciation
Book Value1044150BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1018054OtherCostOrOtherBasis
Book Value1018054BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings13792410TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
ASSETS UNDER BOND AND MORTGAGE INDENTURE AGREEMENTS3692413
BENEFICIAL INTEREST IN NET ASSETS OF THE FOUNDATION1915
RESIDENT TRUST FUNDS21510
DUE TO/FROM AFFILIATES333609
FieldValueIRS element (for citing)
Total Book Value Other Assets4049447TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionASSET RETIREMENT OBLIGATIONDescription
Amount$3,951Amount
FieldValueIRS element (for citing)
Total Of Amounts3951TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 2B:THE ORGANIZATION HOLDS, IN TRUST, FUNDS ADVANCED BY RESIDENTS TO BE USED AT EACH RESIDENT'S DISCRETION. THE FUNDS ARE MAINTAINED IN A SEPARATE INTEREST-BEARING SAVINGS ACCOUNT AND THE ORGANIZATION HAS A FIDUCIARY RESPONSIBILITY FOR THE ADMINISTRATION OF THESE FUNDS.
PART V, LINE 4:THE PRINCIPAL WILL BE INVESTED AND KEPT INTACT FOR PERPETUITY TO PROVIDE AN ADDITIONAL SOURCE OF INCOME. THE INCOME GENERATED WILL BE USED TO SUPPORT THE FUND DESIGNATED PROGRAM. THE ORGANIZATION'S ENDOWMENT IS HELD AND ADMINISTERED BY AUGUSTANA CARE FOUNDATION. SEE SCHEDULE R FOR ADDITIONAL DETAILS.DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:
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 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1AUGUSTANA CARE SERVICESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11007 EAST 14TH STREETAddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55404ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient411806946EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant557000AmountOfCashGrant
Purpose Of GrantSUPPORT OF GENERAL OPERATIONSPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients11NumberOfRecipients
Amount Of Cash Grant21171AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY MAKES INTERCOMPANY TRANSFERS TO RELATED ORGANIZATIONS. AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY AND THE RELATED ORGANIZATIONS ARE UNDER COMMON MANAGEMENT WHO REGULARLY MONITOR THE USE OF FUNDS. RECIPIENTS OF SCHOLARSHIPS RECEIVED 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 FROM THE EDUCATIONAL INSTITUTION, AND A DETAILED VERIFICATION OF THE COSTS 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 A SCHOLARSHIP PAYMENT IS MADE, THE RECIPIENT WILL WORK FOR THE ORGANIZATION FOR TWO YEARS WITH A MINIMUM OF 2,000 HOURS OR WILL REIMBURSE THE ORGANIZATION A PRO-RATED AMOUNT OF THE SCHOLARSHIP PAYMENT RECEIVED, WHICH WILL BE DEDUCTED FROM THE RECIPIENT'S FINAL PAYCHECK.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
TIM TUCKER
PRESIDENT/CEO0248658044700023632042284025548038482200
CRAIG KITTELSON
VP - FINANCE/CFO0188047034593031152033116028247031515500
TIM MIDDENDORF
VP - OPERATIONS/COO017003202391109642015920012685023219000
KATHERINE KOPP
VP - NEW BUSINESS DEVELOPMENT0170327034640015437015013027992026340900

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 3FOR THE PURPOSE OF DETERMINING COMPENSATION, AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY 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 4BTHE 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 - $33,534 CRAIG KITTELSON, VICE PRESIDENT OF FINANCE AND CFO - $25,061 TIM MIDDENDORF, VICE PRESIDENT OF OPERATIONS AND COO - $10,500 KATHERINE KOPP, VICE PRESIDENT OF NEW BUSINESS DEVELOPMENT - $7,500

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Bond ReferenceBondReferenceCdIssuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
APPLE VALLEY ECONOMIC DEVELOPMENT AUTHORITY
A41088255903788ABK42006-01-2515675000ACQUIRE & IMPROVE FACILITY000
APPLE VALLEY ECONOMIC DEVELOPMENT AUTHORITY
B41088255903788ACR82011-12-222945000FACILITY REMODEL000
APPLE VALLEY ECONOMIC DEVELOPMENT AUTHORITY
C41088255903788ACUI2012-01-311000000FACILITY REMODEL000

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Bond ReferenceBondReferenceCdAmount RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindCapitalized InterestCapitalizedInterestAmount UnspentAmountUnspent
A6450001567500010905123135001427098820060011
B2000029450002218325890018640542013000179912720302
C10000004932017500000110403922777

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyEngage Bond Counsel ContractsEngageBondCounselContractsAny Research AgreementsAnyResearchAgreementsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUseBond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTestChange In Use Bond Financed PropChangeInUseBondFinancedPropNon Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs
A001100.000000.000000.00000001
B001100.000000.000000.00000001
C001100.000000.000000.00000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledRebate Not Due YetRebateNotDueYetException To RebateExceptionToRebateNo Rebate DueNoRebateDueVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedWritten Proc To Monitor ReqsWrittenProcToMonitorReqs
A000100001
B010000001
C010000001

Form990 Schedule K Part V Form990ScheduleKPartV (3 entries)

Bond ReferenceBondReferenceCdProc To Undertk Corrective ActionProcToUndertkCorrectiveAction
A1
B1
C1

Form990 Schedule K Part VI Form990ScheduleKPartVI

FieldValueIRS element (for citing)
IdentifierSCHEDULE K PART IV, ARBITRAGE, LINE 2CIdentifier
Return ReferenceDATE REBATE COMPUTATION PERFORMEDReturnReference
ExplanationISSUER NAME: APPLE VALLEY ECONOMIC DEVELOPMENT AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 01/27/2011Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION MISSION STATEMENTOVERALL MISSION OF AUGUSTANA ENTITIESAUGUSTANA 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. 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 10,500 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 3AUGUSTANA CARE SERVICES PROVIDES MANAGEMENT SERVICES FOR AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY. 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 6THE SOLE MEMBER OF THE ORGANIZATION IS AUGUSTANA CARE.
FORM 990, PART VI, SECTION A, LINE 7ATHE 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 7BTHE 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 11THE 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 12CTHE 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 WILL BE NOTED IN THE MEETING MINUTES.
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.
OTHER FEESFORM 990, PART IX, LINE 11GCONTRACT SERVICES: PROGRAM SERVICE EXPENSES 284,499. MANAGEMENT AND GENERAL EXPENSES 51,617. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 336,116. CONSULTANTS: PROGRAM SERVICE EXPENSES 76,314. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 76,314.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
APPLE VALLEY VILLA APARTMENTS
1007 EAST 14TH STREETMINNEAPOLISMN55404311608691HEALTH CARE FACILITIES/SERVICESMN501(C)(3)9AUGUSTANA CARE0
AUGUSTANA APARTMENTS OF HASTINGS
1007 EAST 14TH STREETMINNEAPOLISMN55404311608701HEALTH CARE FACILITIES/SERVICESMN501(C)(3)9AUGUSTANA CARE0
AUGUSTANA CARE
1007 EAST 14TH STREETMINNEAPOLISMN55404411728753HEALTH CARE FACILITIES/SERVICESMN501(C)(3)70N/A
AUGUSTANA CARE FOUNDATION
1007 EAST 14TH STREETMINNEAPOLISMN55404411360678CHARITABLE FOUNDATIONMN501(C)(3)11 - TYPE 1AUGUSTANA CARE0
AUGUSTANA CARE SERVICES
1007 EAST 14TH STREETMINNEAPOLISMN55404411806946MANAGEMENT SERVICESMN501(C)(3)11 - TYPE 1AUGUSTANA CARE0
AUGUSTANA CHAPEL VIEW HOMES INC
1007 EAST 14TH STREETMINNEAPOLISMN55404410693953HEALTH CARE FACILITIES/SERVICESMN501(C)(3)9AUGUSTANA CARE0
AUGUSTANA COMMUNITY PARTNERS
1007 EAST 14TH STREETMINNEAPOLISMN55404411783680HOME HEALTH CARE SERVICESMN501(C)(3)9AUGUSTANA CARE0
AUGUSTANA HOME OF HASTINGS
1007 EAST 14TH STREETMINNEAPOLISMN55404311572624HEALTH CARE FACILITIES/SERVICESMN501(C)(3)9AUGUSTANA CARE0
OPEN CIRCLE ADULT DAY CENTER
1007 EAST 14TH STREETMINNEAPOLISMN55404411424801HEALTH CARE FACILITIES/SERVICESMN501(C)(3)9AUGUSTANA CARE0

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1AUGUSTANA SENIOR DEVELOPMENT INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11007 EAST 14TH STREETAddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55404ZIPCode
FieldValueIRS element (for citing)
EIN264136110EIN
Primary ActivityCONSULTINGPrimaryActivity
Legal Domicile StateMNLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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