2013-08-14T12:58:37-05:00 2012-09-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-10-01 311608696 AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY AUGU 6122385225 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 CRAIG KITTELSON 6122385225 2013-08-13 1 JEFF VRIEZE P01273590 6123764500 2011 2016-02-25 16:41:14Z TIM TUCKER 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 17626633 0 X WWW.AUGUSTANACARE.ORG X 1998 MN TO PROVIDE HEALTH CARE, HOUSING AND COMMUNITY SERVICES FOR THE ELDERLY. 7 7 363 90 0 0 244200 19934 22433010 17149505 117602 319826 195181 137368 22989993 17626633 620402 270386 0 0 11285842 9353366 0 0 0 11416577 8484899 23322821 18108651 -332828 -482018 42591294 23148046 41180667 20469723 1410627 2678323 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 1 13968493 20386 15176635 AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY IS A LICENSED CARE FACILITY WITH THE CAPACITY TO SERVE 188 PEOPLE AT A TIME. THE FACILITY OFFERS LONG-TERM CARE AND TRANSITIONAL CARE, AND THERAPEUTIC AND REHABILITATION SERVICES. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2012, THE CARE CENTER SERVED 1,172 PEOPLE. 2185707 250000 1972870 AUGUSTANA REGENT AT BURNSVILLE IS A 148-UNIT APARTMENT COMMUNITY IN BURNSVILLE, MN PROVIDING RESIDENTS THE OPPORTUNITY TO AGE IN PLACE. AS RESIDENT'S NEEDS CHANGE, THEY CAN MOVE FROM INDEPENDENT TO ASSISTED LIVING, OR TO CARE SUITES OR MEMORY CARE. WHEN A HIGHER LEVEL OF PHYSICAL CARE IS NECESSARY, THE REGENT'S 18 CARE SUITES BRING MORE INTENSIVE NURSING SERVICES 24 HOURS A DAY TO RESIDENTS IN THE PRIVACY OF INDIVIDUAL APARTMENTS. THE REGENT'S MEMORY CARE SUITES BRING A PROFESSIONAL AND FOCUSED APPROACH FOR THOSE WITH MEMORY CHALLENGES WITHIN A SECURE RESIDENTIAL SETTING. ON JANUARY 25, 2012 AUGUSTANA REGENT WAS TRANSFERRED TO AUGUSTANA CARE. 16154200 1 0 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 1 1 1 0 0 0 0 1 0 0 363 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X CRAIG KITTELSON - AUGUSTANA CARE SE 6122385225 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 X REV DR GARY WILKERSON 1.00 X X 0 0 0 MARSHALL MACKAY 1.00 X X 0 0 0 CHARLES PARKS JR 1.00 X X 0 0 0 ERIC RICK ELLINGSON 1.00 X X 0 0 0 JIM EHLEN 1.00 X 0 0 0 SCOTT RAMSDALE 1.00 X 0 0 0 PR ELIZABETH BEISSEL 1.00 X 0 0 0 TIM TUCKER 4.50 X 0 319547 54491 CRAIG KITTELSON 4.50 X 0 253836 50711 TIM MIDDENDORF 4.50 X 0 205906 38163 KATHERINE KOPP 4.50 X 0 221780 40457 MICHAEL JOHNSON 0.00 X 0 162644 43788 0 1163713 227610 0 0 1 0 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 MANAGEMENT SERVICES 776644 1 19934 19934 NURSING FACILITIES 623000 15176635 15176635 HOUSING FACILITIES 623000 1972870 1972870 17149505 319826 319826 25975 0 25975 25975 25975 MISCELLANEOUS INCOME 900099 44708 44708 DIETARY INCOME 722210 16921 16921 TELEPHONE INCOME 812900 16723 16723 33041 33041 111393 17626633 17149505 0 457194 250000 250000 20386 20386 7866747 7447204 419543 107938 96784 11154 804360 709238 95122 574321 546736 27585 776644 776644 27598 27598 37198 37198 513598 478180 35418 32823 32823 269521 148512 121009 430327 430327 22655 8329 14326 23012 18606 4406 1476170 1476170 960532 960532 142813 142813 NURSING SUPPLIES 2415204 2415204 LICENSES, PERMITS, FEES 560871 550704 10167 DIETARY EXPENSES 532075 532075 BAD DEBT EXPENSE 171476 171476 92382 65213 27169 18108651 16154200 1954451 0 2254313 1627009 2157091 1792711 880002 1084916 122078 67937 16277078 3365855 32984980 12911223 737638 704661 3455192 4959589 42591294 23148046 1453129 950145 20605000 19200000 143529 18653 18688978 0 290031 300925 41180667 20469723 X 1400235 2674158 7100 2250 3292 1915 1410627 2678323 42591294 23148046 X -482018 1749715 X 0 1 1 X 0 X 18786 477224 34575 244200 19934 794719 20218677 22356265 22365488 22433010 17149505 104522945 20237463 22833489 22400063 22677210 17169439 105317664 1272 450 1722 0 1272 450 1722 105315942 116972 137501 148039 156961 319826 879299 116972 137501 148039 156961 319826 879299 195004 152407 156132 155822 111393 770758 20549439 23123397 22704234 22989993 17600658 106967721 0.98460 0.98510 0.00820 0.00660 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME FROM TENANTS TELEPHONE INCOME FROM TENANTS DIETARY INCOME FROM TENANTS HOUSEKEEPING INCOME FROM TENANTS MAINTENANCE INCOME FROM TENANTS GIFT SHOP INCOME FROM TENANTS PENDANT ALARM INCOME FROM TENANTS CABLE TV INCOME FROM TENANTS ANNUITY CONVERSION INCOME VENDING INCOME 0 1 3292 0 1377 1915 3052 240 3292 2812 240 166 166 3052 2432 380 154 154 2812 0.00000 1.00000 0.00000 0 1 1 1423149 1423149 12099905 2280181 9819724 1821530 1085674 735856 932494 932494 12911223 ASSETS UNDER BOND AND MORTGAGE INDENTURE AGREEMENTS 4939021 BENEFICIAL INTEREST IN NET ASSETS OF THE FOUNDATION 1915 RESIDENT TRUST FUNDS 18653 4959589 DUE TO AFFILIATES 297162 ASSET RETIREMENT OBLIGATION 3763 300925 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. DESCRIPTION OF INTENDED USE OF ENDOWMENT 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 UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. 1 AUGUSTANA CARE FOUNDATION 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411360678 501(C)(3) 250000 TRANSFER EXCESS CASH TO THE FOUNDATION. 1 0 SCHOLARSHIPS 13 20386 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE 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. 0 1 0 0 0 0 0 0 0 TIM TUCKER 0 247516 0 44415 0 27616 0 31283 0 23208 0 374038 0 0 CRAIG KITTELSON 0 187311 0 33897 0 32628 0 23724 0 26987 0 304547 0 0 TIM MIDDENDORF 0 165401 0 30123 0 10382 0 16202 0 21961 0 244069 0 0 KATHERINE KOPP 0 170993 0 35721 0 15066 0 15305 0 25152 0 262237 0 0 MICHAEL JOHNSON 0 124008 0 27093 0 11543 0 16324 0 27464 0 206432 0 0 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 - $22,708 CRAIG KITTELSON, VICE PRESIDENT OF FINANCE AND CFO - $15,958 TIM MIDDENDORF, VICE PRESIDENT OF OPERATIONS AND COO - $11,000 KATHERINE KOPP, VICE PRESIDENT OF NEW BUSINESS DEVELOPMENT - $8,000 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: FOR 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, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. APPLE VALLEY ECONOMIC DEVELOPMENT AUTHORITY 410882559 03788ABK4 2006-01-25 15675000 ACQUIRE & IMPROVE FACILITY 0 0 0 APPLE VALLEY ECONOMIC DEVELOPMENT AUTHORITY 410882559 03788ACR8 2011-12-22 2945000 FACILITY REMODEL 0 0 0 APPLE VALLEY ECONOMIC DEVELOPMENT AUTHORITY 410882559 03788ACUI 2012-01-31 1000000 FACILITY REMODEL 0 0 0 420000 15675000 1090512 313500 14270988 2006 0 0 1 1 2945000 221832 79912 58900 2584356 0 0 0 1 1000000 49320 10403 17500 922777 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 1 1 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0 SCHEDULE K, PART V PROCEDURES TO UNDERTAKE CORRECTIVE ACTION AUGUSTANA HEALTH CARE CENTER OF APPLY VALLEY DOES NOT HAVE A WRITTEN POLICY IN PLACE AS OF FISCAL YEAR ENDED SEPTEMBER 30, 2012 BUT IS WORKING TO HAVE ONE IN PLACE BY FISCAL YEAR ENDING SEPTEMBER 30, 2013. CASH AND CASH EQUIVALENTS 2012-01-25 221049 BOOK VALUE AS OF TRANSFER DATE 411728753 AUGUSTANA CARE 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 501(C)(3) ACCOUNTS RECEIVABLES 2012-01-25 166636 BOOK VALUE AS OF TRANSFER DATE 411728753 AUGUSTANA CARE 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 501(C)(3) OTHER ASSETS 2012-01-25 235439 BOOK VALUE AS OF TRANSFER DATE 411728753 AUGUSTANA CARE 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 501(C)(3) PROPERTY AND EQUIPMENT 2012-01-25 20523778 BOOK VALUE AS OF TRANSFER DATE 411728753 AUGUSTANA CARE 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 501(C)(3) ASSETS UNDER BOND AND MORTGAGE AGREEMENTS 2012-01-25 1446132 BOOK VALUE AS OF TRANSFER DATE 411728753 AUGUSTANA CARE 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 501(C)(3) UNAMORTIZED FINANCING COSTS 2012-01-25 1177957 BOOK VALUE AS OF TRANSFER DATE 411728753 AUGUSTANA CARE 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 501(C)(3) 0 0 0 0 ORGANIZATION MISSION STATEMENT 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. 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 6,000 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 3,500 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. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 TRANSFERED ASSETS FROM AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY TO AUGUSTANA CARE CORPORATION AS OF 1/25/2012. FORM 990, PART VI, SECTION A, LINE 3 AUGUSTANA 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 4 AUGUSTANA REGENT AT BURNSVILLE, LLC'S SOLE MEMBER CHANGED FROM AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY TO AUGUSTANA CARE. THIS CHANGE OF MEMBERSHIP WAS EFFECTIVE JANUARY 25, 2012. 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 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 WILL BE 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. EXPLANATION FOR HOURS WORKED FORM 990, PART VII, LINE 1A TIM TUCKER, CRAIG KITTELSON, TIM MIDDENDORF, AND KATHERINE KOPP EACH EARVE AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY AND ITS RELATED ORGANIZATIONS. EACH INDIVIDUAL SPENDS APPROXIMATELY 4.5 HOURS PER WEEK WORKING FOR EACH OF THE RELATED ORGANIZATIONS, FOR A TOTAL OF 45 HOURS PER WEEK. REV. DR. GARY WILKERSON, CHARLES PARKS, JR., MARSHALL MACKAY, ERIC (RICK) ELLINGSON, JIM EHLEN, SCOTT RAMSDALE, AND PR. ELIZABETH BEISSEL EACH SERVE ON THE BOARD OF AUGUSTANA HEALTHCARE CENTER OF APPLE VALLEY AND ITS RELATED ORGANIZATIONS, WITH THE EXCEPTION OF AUGUSTANA CARE FOUNDATION. EACH INDIVIDUAL SPENDS APPROXIMATELY 1 HOUR PER WEEK WORKING FOR EACH OF THE RELATED ORGANIZATIONS, FOR A TOTAL OF 8 HOURS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -617. TRANSFER OF REGENT, LLC TO AUGUSTANA CARE 1,750,332. TOTAL TO FORM 990, PART XI, LINE 5: 1,749,715. AUGUSTANA REGENT AT BURNSVILLE LLC 14500 REGENT LANE BURNSVILLE MN 55306 208915982 ASSISTED LIVING FACILITY MN 2015356 23770991 HCCAV & 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 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 CHAPEL VIEW HOMES INC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 410693953 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 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 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 481293891 CONSULTING MN N/A C 0 1 0 1 0 0 0 0 1 0 0 1 1 1 1 1 1 0