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 410693953 AUGUSTANA CHAPEL VIEW HOMES INC AUGU 6122385205 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 CRAIG KITTELSON 6122385205 2013-08-13 1 JEFF VRIEZE P01273590 6123764500 2011 2016-02-24 21:20:13Z TIM TUCKER 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 38292262 0 X WWW.AUGUSTANACARE.ORG X 1908 MN TO PROVIDE HEALTH CARE, HOUSING AND COMMUNITY SERVICES FOR THE ELDERLY. 7 7 836 312 -5572 -5572 3187042 1185486 38429595 35632405 401600 329076 642409 700100 42660646 37847067 3619467 60990 0 0 20699199 20386878 0 0 0 18274687 18020478 42593353 38468346 67293 -621279 41074925 40060438 34928711 34478223 6146214 5582215 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 29156367 55964 30790367 AUGUSTANA CHAPEL VIEW HOMES, INC. OPERATES TWO LICENSED HEALTH CARE FACILITIES WITH A TOTAL CAPACITY TO SERVE 405 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 1,615 INDIVIDUALS DURING THE YEAR ENDED 09/30/2012. 4801988 5026 4842038 AUGUSTANA CHAPEL VIEW HOMES, INC. OPERATES SENIOR LIVING COMMUNITIES IN MINNEAPOLIS AND HOPKINS, MN. THE DOWNTOWN MINNEAPOLIS CAMPUS IS AUGUSTANA CARES 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 09/30/2012, 451 PEOPLE RESIDED IN THESE TWO APARTMENT COMMUNITIES. 33958355 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 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 836 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 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 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 JEAN COLE 40.00 X 125886 0 22642 125886 1163713 250252 1 0 1 0 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 MANAGEMENT SERVICES 1934099 1 519784 665702 1185486 NURSING 623000 30790367 30790367 ASSISTED LIVING 623000 4842038 4834338 7700 35632405 364301 364301 934289 388945 545344 545344 -5572 550916 21025 56250 -35225 -35225 -35225 ANNUITY CONVERSION INC 900099 55956 55956 DIETARY INCOME 623990 44544 44544 TELEPHONE INCOME 623990 37140 37140 17116 17116 154756 37847067 35624705 -5572 1042448 60990 60990 16995474 16134373 861101 206661 176265 30396 1931673 1820557 111116 1253070 1191648 61422 1934099 1934099 112705 112705 53190 53190 3277062 3036749 240313 86652 86652 709314 530686 178628 2052790 2052790 29548 20833 8715 48399 42069 6330 1781657 1781657 2238420 2238420 338255 338255 NURSING SUPPLIES 1762030 1762030 DIETARY EXPENSES 1672310 1672310 LICENSES, PERMITS, FEES 1276175 1212806 63369 BAD DEBT EXPENSE 304893 304893 342979 224172 118807 38468346 33958355 4509991 0 59685 77077 496286 555849 3142551 3033243 154058 163765 70046523 41233910 30111174 28812613 50000 50000 879544 824250 6181627 6543641 41074925 40060438 2803731 2573539 107448 77843 29727921 28470000 339231 413182 1470974 1700593 479406 1243066 34928711 34478223 X 3673644 3007265 12064 20743 2460506 2554207 6146214 5582215 41074925 40060438 X -621279 57278 X 0 1 1 X 0 X 398791 1224501 154082 3187042 1185486 6149902 38440969 39750023 38933835 38429595 35632405 191186827 38839760 40974524 39087917 41616637 36817891 197336729 4698 565 5263 0 4698 565 5263 197331466 575025 1111197 1064528 1288198 1298595 5337543 575025 1111197 1064528 1288198 1298595 5337543 404142 10568 214361 148397 154756 932224 39818927 42096289 40366806 43053232 38271242 203606496 0.96920 0.97180 0.02620 0.02280 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 LAUNDRY INCOME FROM TENANTS VENDING MACHINE INCOME FROM TENANTS PULL CORD INCOME FROM TENANTS ANNUITY CONVERSION INCOME HCIR INSURANCE RECIPROCAL RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 1964220 34139 108246 108246 1998359 1958920 5700 87534 87534 1964220 1950375 8145 80637 80637 1958520 1905706 44669 88455 88455 1950375 0.00000 1.00000 0.00000 0 1 1 1851595 1851595 54289592 29026871 25262721 13905336 12207039 1698297 28812613 ASSETS UNDER BOND INDENTURE AGREEMENT 3465605 RESIDENT TRUST FUNDS 86797 HRIR INSURANCE RECIPROCAL 325815 CONTRACT FOR DEED 325000 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 1397353 DUE FROM AFFILIATES 943071 6543641 ANNUITY OBLIGATIONS 149287 ASSET RETIREMENT OBLIGATIONS 193790 DUE TO AFFILIATES 899989 1243066 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. A PORTION OF 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 SCHOLARSHIPS 27 60752 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: 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 EACH 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 - $8,00 SUPPLEMENTAL INFORMATION PART III 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, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. CITY OF MINNEAPOLIS MINNESOTA 416005375 603908KZ6 2005-02-24 3310000 REFINANCE SERIES 1995 AND 1999 BONDS 0 0 0 CITY OF MINNEAPOLIS MINNESOTA 416005375 603908MD3 2005-05-31 12470000 CONSTRUCTION AND REMODELING 0 0 0 CITY OF MINNEAPOLIS MINNESOTA 416005375 603908LW2 2005-05-31 2160000 CONSTRUCTION AND REMODELING 0 0 0 CITY OF MINNEAPOLIS MINNESOTA 416005375 603926CC8 2006-05-19 7010000 CONSTRUCTION AND REMODELING AND REFINANCE SERIES 1997 BONDS 0 0 0 340000 3310000 120000 3123800 66200 2005 1 0 1 1 1250963 12470000 920547 756116 249400 10543937 2006 0 0 1 1 205000 2160000 159089 356160 43200 1601551 2006 0 0 1 1 1275000 7010000 286610 6583190 140200 2006 1 0 1 1 0 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 1 1 0 0 0 0 SCHEDULE K, PART V PROCEDURES TO UNDERTAKE CORRECTIVE ACTION AUGUSTANA CHAPEL VIEW HOMES, INC. 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. CITY OF MINNEAPOLIS MINNESOTA 416005375 603926BR6 2004-01-28 8621449 CONSTRUCTION AND REMODELING 0 0 0 2236449 8621449 731832 5577188 172429 2140000 2006 0 0 1 1 0 0 0 0 1 1 1 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. FORM 990, PART VI, SECTION A, LINE 3 AUGUSTANA CARE SERVICES PROVIDES MANAGEMENT SERVICES FOR AUGUSTANA CHAPEL VIEW HOMES. 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 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 SERVE AUGUSTANA CHAPEL VIEW HOMES 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 CARE 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: -2,284. P/R UNREALIZED LOSS ON TRUST 59,562. TOTAL TO FORM 990, PART XI, LINE 5: 57,278. 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 481293891 CONSULTING MN N/A C 0 0 0 1 0 0 0 0 0 1 0 1 1 1 1 1 0 0