AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY (EIN 31-1608696)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-06-20
IRS object ID
201211729349300141
Schema version
2010v3.4
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)
Timestamp2012-06-20T15:56:12-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

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 Date2010-10-01TaxPeriodBeginDate

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 Signed2012-05-30DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone6123764500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

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 Receipts22989993GrossReceipts
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 Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees466TotalNbrEmployees
Total Nbr Volunteers79TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year35536ContributionsGrantsPriorYear
Contributions Grants Current Year244200ContributionsGrantsCurrentYear
Program Service Revenue Prior Year22365488ProgramServiceRevenuePriorYear
Program Service Revenue CY22433010ProgramServiceRevenueCY
Investment Income Prior Year112766InvestmentIncomePriorYear
Investment Income Current Year117602InvestmentIncomeCurrentYear
Other Revenue Prior Year192344OtherRevenuePriorYear
Other Revenue Current Year195181OtherRevenueCurrentYear
Total Revenue Prior Year22706134TotalRevenuePriorYear
Total Revenue Current Year22989993TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year23564GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY620402GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year11278333SalariesEtcPriorYear
Salaries Etc Current Year11285842SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year10868759OtherExpensePriorYear
Other Expenses Current Year11416577OtherExpensesCurrentYear
Total Expenses Prior Year22170656TotalExpensesPriorYear
Total Expenses Current Year23322821TotalExpensesCurrentYear
Revenues Less Expenses Prior Year535478RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-332828RevenuesLessExpensesCY
Total Assets BOY43532125TotalAssetsBOY
Total Assets EOY42591294TotalAssetsEOY
Total Liabilities BOY41826076TotalLiabilitiesBOY
Total Liabilities EOY41180667TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY1706049NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1410627NetAssetsOrFundBalancesEOY
Mission DescriptionTO PROVIDE HEALTH CARE FACILITIES, HOUSING ALTERNATIVES AND COMMUNITY SERVICES FOR THE PHYSICAL, CULTURAL, SOCIAL AND RECREATIONAL NEEDS OF THE ELDERLY AND THE DISABLED IN A CHRISTIAN ENVIRONMENT.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense14942377Expense
Grants620402Grants
Revenue16741722Revenue
DescriptionAUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY IS A LICENSED CARE FACILITY WITH THE CAPACITY TO SERVE 200 PEOPLE AT A TIME. THE FACILITY OFFERS LONG-TERM CARE AND TRANSITIONAL CARE, AND THERAPEUTIC AND REHABILITATION SERVICES. DURING THE FISCAL YEAR, THE CARE CENTER SERVED 1,119 PEOPLE.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense5340925Expense
Revenue5691288Revenue
DescriptionTHE 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 REGENTS MEMORY CARE SUITES BRING A PROFESSIONAL AND FOCUSED APPROACH FOR THOSE WITH MEMORY CHALLENGES WITHIN A SECURE RESIDENTIAL SETTING. DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2011, AUGUSTANA REGENT SERVED 180 PEOPLE.Description
FieldValueIRS element (for citing)
Total Program Service Expense20283302TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
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 Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees466NumberOfEmployees
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 Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
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 Number6122385225TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11007 EAST 14TH STREETAddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55404ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (12 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
REV DR GARY WILKERSON
CHAIR1.00XX000
MARSHALL MACKAY
VICE CHAIR1.00XX000
CHARLES PARKS JR
SECRETARY1.00XX000
ERIC RICK ELLINGSON
TREASURER1.00XX000
JIM EHLEN
DIRECTOR1.00X000
SCOTT RAMSDALE
DIRECTOR1.00X000
PR ELIZABETH BEISSEL
DIRECTOR1.00X000
TIM TUCKER
PRESIDENT/CEO4.50X031302552237
CRAIG KITTELSON
VP - FINANCE/CFO4.50X024945448561
TIM MIDDENDORF
VP - OPERATIONS/COO4.50X019812036133
KATHERINE KOPP
VP - SENIOR DEVELOPMENT4.50021722328266X
GLEN SHAW
ADMINISTRATOR45.00110420017155X
FieldValueIRS element (for citing)
Total Reportable Comp From Org110420TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs977822TotalReportableCompFrmRltdOrgs
Total Other Compensation182352TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
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
Compensation1130459Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Government Grants218590GovernmentGrants
All Other Contributions25610AllOtherContributions
Total Contributions244200TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NURSING FACILITIES6230001674172216741722
HOUSING FACILITIES62300056912885691288
FieldValueIRS element (for citing)
Total Program Service Revenue22433010TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column117602TotalRevenueColumn
Exclusion$117,602ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real39359Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real39359Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column39359TotalRevenueColumn
Exclusion$39,359ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmount
DIETARY INCOME72221041642$41,642
MISCELLANEOUS INCOME90009934998$34,998
HOUSEKEEPING INCOME81230034346$34,346

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column44836TotalRevenueColumn
Exclusion$44,836ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue155822TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column22989993TotalRevenueColumn
Related Or Exempt Function Income22433010RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$312,783ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total600000Total
Program Services600000ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total20402Total
Program Services20402ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total9478393Total
Program Services8902363ProgramServices
Management And General576030ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total127846Total
Program Services114952ProgramServices
Management And General12894ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total983379Total
Program Services875808ProgramServices
Management And General107571ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total696224Total
Program Services654907ProgramServices
Management And General41317ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total1130459Total
Management And General1130459ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total48498Total
Management And General48498ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total35241Total
Management And General35241ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total540604Total
Program Services504493ProgramServices
Management And General36111ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total78961Total
Management And General78961ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total334431Total
Program Services191184ProgramServices
Management And General143247ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total789632Total
Program Services789632ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total27023Total
Program Services9677ProgramServices
Management And General17346ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total31607Total
Program Services13766ProgramServices
Management And General17841ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2403744Total
Program Services2403744ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1535006Total
Program Services1535006ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total233971Total
Management And General233971ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
NURSING SUPPLIES23220822322082
DIETARY EXPENSES705068705068
LICENSES, PERMITS, FEES59701958249614523
BAD DEBT EXPENSE2741570274157
LOSS ON DEVELOPMENT212584212584

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total116490Total
Program Services57722ProgramServices
Management And General58768ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total23322821Total
Program Services20283302ProgramServices
Management And General3039519ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2559415BOY
EOY2254313EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1933673BOY
EOY2157091EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY626674BOY
EOY880002EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY136650BOY
EOY122078EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis39391722LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6406742LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY34294241BOY
EOY32984980EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY726390BOY
EOY737638EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3255082BOY
EOY3455192EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY43532125BOY
EOY42591294EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1658948BOY
EOY1453129EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY20855000BOY
EOY20605000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY152536BOY
EOY143529EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY18848214BOY
EOY18688978EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY311378BOY
EOY290031EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY41826076BOY
EOY41180667EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY1696803BOY
EOY1400235EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY6194BOY
EOY7100EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3052BOY
EOY3292EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY1706049BOY
EOY1410627EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY43532125BOY
EOY42591294EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-332828ReconcilationRevenueExpenses
Reconcilation Other Changes37405ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 Years28452CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years18786CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years477224CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year34575CurrentTaxYearMinus1Year
Current Tax Year244200CurrentTaxYear
Total803237Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14846999CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20218677CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22356265CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year22365488CurrentTaxYearMinus1Year
Current Tax Year22433010CurrentTaxYear
Total102220439Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14875451CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20237463CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years22833489CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year22400063CurrentTaxYearMinus1Year
Current Tax Year22677210CurrentTaxYear
Total103023676Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years1272CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year450CurrentTaxYearMinus1Year
Total1722Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years1272CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year450CurrentTaxYearMinus1Year
Total1722Total
FieldValueIRS element (for citing)
Public Support Total509103021954PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years127294CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years116972CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years137501CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year148039CurrentTaxYearMinus1Year
Current Tax Year156961CurrentTaxYear
Total686767Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years127294CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years116972CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years137501CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year148039CurrentTaxYearMinus1Year
Current Tax Year156961CurrentTaxYear
Total686767Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years206115CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years195004CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years152407CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year156132CurrentTaxYearMinus1Year
Current Tax Year155822CurrentTaxYear
Total865480Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years15208860CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years20549439CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years23123397CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year22704234CurrentTaxYearMinus1Year
Current Tax Year22989993CurrentTaxYear
Total104575923Total
FieldValueIRS element (for citing)
Public Support Percentage5090.98510PublicSupportPercentage509
Prior Year Support Percentage0.98530PriorYearSupportPercentage
Investment Income Percentage0.00660InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00680PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509
General ExplanationSCHEDULE 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 INCOMEGeneralExplanation

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

Current Year CurrentYear

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

Current Year Minus1 Year CurrentYearMinus1Year

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

Current Year Minus2 Years CurrentYearMinus2Years

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 Basis3394290OtherCostOrOtherBasis
Book Value3394290BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis31701218OtherCostOrOtherBasis
Depreciation4420963Depreciation
Book Value27280255BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4272179OtherCostOrOtherBasis
Depreciation1985779Depreciation
Book Value2286400BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis24035OtherCostOrOtherBasis
Book Value24035BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings32984980TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
TENANT SECURITY DEPOSITS131893
ASSETS UNDER BOND AND MORTGAGE INDENTURE AGREEMENTS3297678
BENEFICIAL INTEREST IN NET ASSETS OF THE FOUNDATION3292
RESIDENT TRUST FUNDS22329
FieldValueIRS element (for citing)
Total Book Value Other Assets3455192TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DUE TO AFFILIATES$286,447
ASSET RETIREMENT OBLIGATION$3,584
FieldValueIRS element (for citing)
Total Of Amounts290031TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (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. SECURITY DEPOSITS ARE REQUIRED FOR THE ORGANIZATION'S TENANTS AND INCLUDE RESERVED APARTMENTS IF AMOUNTS ARE PAID BEFORE THE TENANT ACTUALLY MOVES IN.
PART V, LINE 4:THE PRINCIPAL WILL BE INVESTED AND KEPT INTACT FOR PERPETUITY TO PROVIDE AN ADDITIONAL SOURCE OF INCOME. THE INCOME GENERATED WILL BE USED TO SUPPORT THE FUND DESIGNATED PROGRAM. THE ORGANIZATION'S ENDOWMENT IS HELD AND ADMINISTERED BY AUGUSTANA CARE FOUNDATION. SEE SCHEDULE R FOR ADDITIONAL DETAILS.DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:
PART X:THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES IN EVALUATING THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITYS 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 2008 TO 2010 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 FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11007 EAST 14TH STREETAddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55404ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient411360678EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant600000AmountOfCashGrant
Purpose Of GrantTRANSFER EXCESSIVE CASH TO THE FOUNDATION.PurposeOfGrant
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 Recipients18NumberOfRecipients
Amount Of Cash Grant20402AmountOfCashGrant

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)

Base 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
0247016041438024571031459020778036526200
CRAIG KITTELSON
0186511033323029620023704024857029801500
TIM MIDDENDORF
016550202465407964016702019431023425300
KATHERINE KOPP
0171494032005013724015008013258024548900

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
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 - $22,708 CRAIG KITTELSON, VICE PRESIDENT OF FINANCE AND CFO - $15,958 TIM MIDDENDORF, VICE PRESIDENT OF OPERATIONS AND COO - $11,500 KATHERINE KOPP, VICE PRESIDENT OF SENIOR DEVELOPMENT - $8,500
PART IIIPART 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.SUPPLEMENTAL INFORMATION

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
APPLE VALLEY ECONOMIC DEVELOPMENT AUTHORITY
41088255903788ABK42006-01-2515675000ACQUIRE & IMPROVE FACILITY000
DAKOTA COUNTY COMMUNITY DEVELOPMENT AGENCY
41125330223409VDN72007-07-125176617ACQUIRE FACILITY000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Amount RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
2050001567500010905123135001427098820060011
416175176617358800103532471428520070011

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
00001
00001

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
110000
110000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 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 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 OLDER ADULT LIVING COMMUNITIES 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 1IF THE BOARD ESTABLISHES AN EXECUTIVE COMMITTEE, THE EXECUTIVE COMMITTEE SHALL INCLUDE THE CHAIR, THE VICE-CHAIR(S), THE TREASURER AND THE SECRETARY, AND SUCH OTHER DIRECTORS AS THE BOARD MAY DESIGNATE FROM TIME TO TIME. THE PRESIDENT SHALL BE A NON-VOTING MEMBER OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE BUSINESS OF THIS CORPORATION IN THE INTERVAL BETWEEN BOARD MEETINGS, AND THE EXECUTIVE COMMITTEE SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL HAVE SUCH OTHER DUTIES AS MAY BE PRESCRIBED BY THE BOARD FROM TIME TO TIME.
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, AT THE ANNUAL MEETING.
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 THEREFOR; (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 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.
EXPLANATION FOR HOURS WORKEDFORM 990, PART VII, LINE 1ATIM 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 GAINS ON INVESTMENTS: 37,405.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1AUGUSTANA REGENT AT BURNSVILLE LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line114500 REGENT LANEAddressLine1
CityBURNSVILLECity
StateMNState
ZIP Code55306ZIPCode
FieldValueIRS element (for citing)
EIN208915982EIN
Primary ActivitiesASSISTED LIVING FACILITYPrimaryActivities
Legal Domicile StateMNLegalDomicileState
Total Income5829473TotalIncome
EOY Assets23397663EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1SEE PART VIIBusinessNameLine1

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)
EIN481293891EIN
Primary ActivityCONSULTINGPrimaryActivity
Legal Domicile StateMNLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
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
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 Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

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