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 411783680 AUGUSTANA COMMUNITY PARTNERS 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 9122489 0 X WWW.AUGUSTANACARE.ORG X 1994 MN TO PROVIDE HEALTH CARE, HOUSING AND COMMUNITY SERVICES FOR THE ELDERLY. 7 7 223 7 2132274 221989 4049 7327 8427044 9112617 6870 2545 0 0 8437963 9122489 200000 0 0 0 5836979 6328765 0 0 0 2569954 2616194 8606933 8944959 -168970 177530 680546 1340698 686508 1169129 -5962 171569 TO SERVE GOD BY FOSTERING FULLNESS OF LIFE FOR OLDER ADULTS AND OTHER PEOPLE IN NEEDS THROUGH THE PROVISION OF HEALTH CARE, HOUSING AND OTHER SERVICES IN A CHRISTIAN TRADITION. 0 0 5954278 0 7269857 AUGUSTANA THERAPY SERVICES PROVIDED THERAPY SERVICES FOR ALL OF AUGUSTANA'S AFFILIATED SKILLED CARE CENTERS, WITH THE EXCEPTION OF AUGUSTANA CARE MERCY, AND PEOPLE IN COMMUNITY SETTINGS. AUGUSTANA THERAPY SERVICES PROVIDED THERAPY FOR APPROXIMATELY 1,162 RESIDENTS FOR THE YEAR ENDED SEPTEMBER 30, 2012. 1241079 0 1463559 AUGUSTANA HOME HEALTH PROVIDED HOME HEALTH CARE SERVICES FOR THE ASSISTED LIVING RESIDENTS OF HERITAGE COMMONS ON POND'S EDGE AND FEENEY MANOR, WHICH CONSISTS OF 88 UNITS OF A CITY OF MINNEAPOLIS SENIOR HOUSING PROJECT. FOR THE YEAR ENDED SEPTEMBER 30,2012, AUGUSTANA HOME HEALTH SERVED 106 RESIDENTS. 404304 0 379201 AUGUSTANA'S TABLE TALK PROGRAM SERVED APPROXIMATELY 65,000 MEALS ON WHEELS DURING THE YEAR ENDED SEPTEMBER 30, 2012. 7599661 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 223 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 KRISTY BROWN 40.00 X 134064 0 39097 134064 1001069 222919 1 0 1 0 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 MANAGEMENT SERVICES 456124 1 776 6551 7327 THERAPY SERVICES 621300 7269857 5160377 2109480 HOME HEALTH 621300 1463559 1463559 CATERING REVENUE 722320 379201 217607 22794 138800 9112617 2545 2545 9122489 6841543 2132274 141345 5091837 4630976 460861 79420 70586 8834 720590 645525 75065 436918 408147 28771 456124 456124 17337 17337 20101 20101 1213202 1170786 42416 18461 18461 122080 75873 46207 181671 181671 106309 52748 53561 7511 7188 323 9847 9847 31773 31773 41572 41572 UNREL. BUS. TAX (UBIT) 21554 21554 DIETARY EXPENSES 294591 294591 BAD DEBT EXPENSE 39310 39310 NURSING SUPPLIES 19171 19171 15580 779 14801 8944959 7599661 1345298 0 625 621 403341 634594 62912 65660 387828 207621 83762 180207 129906 459616 680546 1340698 493478 590678 193030 578451 686508 1169129 X -5962 170744 825 -5962 171569 680546 1340698 177530 0 X 0 1 1 X 0 X 302 173788 16176 4049 7327 201642 5029941 5869418 6284908 6323503 6986246 30494016 5030243 6043206 6301084 6327552 6993573 30695658 0 0 0 30695658 3368 4871 9561 6870 2545 27215 3368 4871 9561 6870 2545 27215 102216 95913 40352 74618 220941 534040 37322 1306 38628 5173149 6143990 6352303 6409040 7217059 31295541 0.98080 0.98150 0.00090 0.00100 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME FROM PATIENTS 387828 207621 180207 180207 HCIR INSURANCE RECIPROCAL 30388 DUE FROM AFFILIATES 429228 459616 DEFERRED COMPENSATION LIABILITY 226793 DUE TO AFFILIATES 351658 578451 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. 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 KRISTY BROWN 117339 0 7531 0 9194 0 12482 0 26615 0 173161 0 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 KRISTY BROWN, THERAPY SERVICES DIRECTOR - $8,000 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: FOR THE PURPOSE OF DETERMINING COMPENSATION, AUGUSTANA COMMUNITY PARTNERS 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. 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 COMMUNITY PARTNERS. 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 OF HOURS WORKED FORM 990, PART VII, LINE 2A TIM TUCKER, CRAIG KITTELSON, TIM MIDDENDORF, AND KATHERINE KOPP EACH SERVE AUGUSTANA COMMUNITY PARTNERS 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 COMMUNITY PARTNERS 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. 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 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 1 1 1 1 1 1 0 0