2012-07-23T12:08:32-05:00 2011-09-30 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-10-01 411728753 AUGUSTANA CARE AUGU 6122385225 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 CRAIG KITTELSON 6122385225 2012-07-09 1 JEFF VRIEZE 6123764500 2010 2016-02-24 21:20:13Z TIM TUCKER 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 25178866 0 X WWW.AUGUSTANACARE.ORG X 1991 MN TO PROVIDE HEALTHCARE, HOUSING, AND COMMUNITY SERVICES FOR THE ELDERLY. 15 14 566 110 513885 -7336 5365832 1393259 14252230 23186981 144454 182521 217807 372810 19980323 25135571 5406 707250 0 0 8212014 12502720 0 0 325586 6489385 10543907 14706805 23753877 5273518 1381694 39056867 49351886 29956428 38834550 9100439 10517336 TO PROVIDE HEALTHCARE, HOUSING, AND COMMUNITY SERVICES FOR THE ELDERLY BY ENHANCING THE FUNDRAISING, LONG RANGE STRATEGIC PLANNING AND PROMOTION OF AUGUSTANA AFFILIATED ENTITIES. 0 0 433286 0 513885 AS A LONGTIME PROVIDER OF SENIOR SERVICES, AUGUSTANA CARE USES THIS EXPERIENCE AND IN-DEPTH KNOWLEDGE OF THE SENIOR CARE MARKET TO PROVIDE MANAGEMENT SERVICES TO OTHER ORGANIZATIONS. EXPENSES ABOVE ARE FOR SENIOR DEVELOPMENT II, A BUSINESS UNIT OF AUGUSTANA CARE OFFERING THESE MANAGEMENT SERVICES FOR UNRELATED NOT-FOR-PROFIT HOUSING COMMUNITIES IN MINNESOTA. THESE INCLUDE BROOKSIDE MANOR IN MONTEVIDEO, EASTWOOD SENIOR LIVING IN MORA, AUGUSTANA APARTMENTS AND CARDINAL HOMES IN FERGUS FALLS, ST. PAUL APARTMENTS IN MINNEAPOLIS AND THOMAS T. FEENEY MANOR IN MINNEAPOLIS. SERVICES INCLUDE CONSULTING, MARKETING, LEADERSHIP DEVELOPMENT, FINANCIAL MANAGEMENT, INFORMATION SYSTEMS SUPPORT, HOUSING DEVELOPMENT AND EMPLOYEE RELATIONS. ALTOGETHER, THESE MANAGED FACILITIES SERVED 276 PEOPLE DURING THE FISCAL YEAR. 7763029 500000 9207097 THE ABOVE TOTAL INCLUDES OPERATING EXPENSES FOR MERCY HEALTH CARE CENTER OF MOOSE LAKE AND AUGUSTANA LAKESIDE HEALTH CARE CENTER OF DASSEL. DURING THE FISCAL YEAR, THESE TWO RURAL FACILITIES PROVIDED LONG-TERM CARE, TRANSITIONAL CARE AND MEMORY CARE TO 411 PEOPLE. THIS FIGURE ALSO INCLUDES OPERATING EXPENSES FOR APPLE VALLEY LAND DEVELOPMENT, AN AUGUSTANA CARE ENTITY WHICH WAS ESTABLISHED TO PURCHASE LAND ADJACENT TO AUGUSTANA CARE'S APPLE VALLEY CAMPUS TO BE HELD FOR FUTURE DEVELOPMENT. 11353951 200000 13465999 EXPENSES ABOVE ARE RELATED TO DIRECT COSTS ASSOCIATED WITH ASSISTED LIVING AND RESIDENTIAL HOME CARE SERVICES AT MINNESOTA APARTMENT COMMUNITIES IN DASSEL, MOOSE LAKE, MINNEAPOLIS AND HOPKINS AND FOR ASSISTED LIVING SERVICES FOR AUGUSTAN ELK RUN ASSISTED LIVING IN EVERGREEN, COLORADO. ALSO INCLUDED ARE EXPENSES FOR EMERALD CREST, A SPECIALIZED ASSISTED LIVING PROGRAM FOR ADULTS WITH MEMORY LOSS AT FOUR SITES IN THE SUBURBAN MINNEAPOLIS AREA. AUGUSTANA EMERALD CREST EMPLOYS A MODEL OF DELIVERING STRENGTH-BASED CARE FOR INDIVIDUALS WITH MEMORY CHALLENGES IN SMALLER, HOME-LIKE RESIDENCES WHERE ONE'S DIGNITY, PRIVACY, SAFETY AND QUALITY OF LIFE CAN BE PRESERVED. COMBINED, THESE ASSISTED LIVING COMMUNITIES SERVED 754 PEOPLE DURING THE FISCAL YEAR. 19550266 1 1 0 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 566 1 1 1 0 0 0 0 1 1 0 0 0 1 0 X 15 14 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 MICHELENE VERLAUTZ 1.00 X 0 0 0 BRUCE CRAWFORD 1.00 X 0 0 0 LARRY KULA 1.00 X 0 0 0 PR DAN SIEDELMANN 1.00 X 0 0 0 JIM EHLEN 1.00 X 0 0 0 SCOTT RAMSDALE 1.00 X 0 0 0 TOM TURNER 1.00 X 0 0 0 STEVE SJOBLAD 1.00 X 0 0 0 BILL SOULES 1.00 X 0 0 0 PR ELIZABETH BEISSEL 1.00 X 0 0 0 NIC PUZAK 1.00 X 0 0 0 TIM TUCKER 4.50 X 0 313025 52237 CRAIG KITTELSON 4.50 X 0 249454 48561 TIM MIDDENDORF 4.50 X 0 198120 36133 KATHERINE KOPP 4.50 X 0 217223 28266 0 977822 165197 0 0 1 0 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 MANAGEMENT SERVICES 1528152 1 50836 989409 88103 264911 8500 1393259 ASSISTED LIVING 623000 13465999 13465999 NURSING 623000 9207097 9207097 PAYROLL 541200 345899 345899 CONSULTING 541610 167986 167986 23186981 182496 182496 199001 199001 199001 199001 25 25 25 25 83462 50836 43295 40167 40167 EMERGENCY PULL CORD IN 900099 38100 38100 HOUSEKEEPING INCOME 900099 36443 36443 DIETARY INCOME 722210 34215 34215 24884 24884 133642 25135571 22673096 513885 555331 700000 700000 7250 7250 10700798 9938116 762682 93356 47681 45675 949328 711584 237744 759238 690486 68752 1528152 1261170 266982 16390 16390 28024 28024 1087073 951722 108725 26626 213140 205974 7166 475046 338068 122160 14818 857547 857547 91457 33045 54900 3512 121042 16583 103748 711 1848325 1848325 1174983 1174983 116333 116333 NURSING SUPPLIES 1063954 1063954 DIETARY EXPENSES 773967 773967 MISCELLANEOUS 464111 63905 400206 DUES AND SUBSCRIPTIONS 244323 375 243386 562 LICENSES, PERMITS, FEES 180552 171209 7606 1737 259488 161466 94550 3472 23753877 19550266 3878025 325586 1172802 2823653 250000 250000 40822 71078 1631812 1544263 103490 154963 40771061 2088487 30909053 38682574 1594849 1595664 1045460 1051939 2308579 3177752 39056867 49351886 1305114 1559503 19170000 26049196 32822 153482 8351657 9479029 1096835 1593340 29956428 38834550 X 8873463 10162820 81493 208218 145483 146298 9100439 10517336 39056867 49351886 X 1381694 35203 X 0 1 1 X 0 X 2995912 278227 1620606 5447400 1393259 11735404 2995912 278227 1620606 5447400 1393259 11735404 11735404 8212 41789 113464 227245 381497 772207 41433 95175 56425 87916 126149 407098 12914709 45122071 0.90870 0.93920 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 145493 815 8122 8122 146298 110831 34662 5839 5839 145493 74163 36668 3933 3933 110831 0.00000 1.00000 0.00000 0 1 1 8562026 8562026 30949583 1667819 29281764 1259452 420668 838784 38682574 DUE FROM AFFILIATES 138851 RESIDENT TRUST FUNDS 151219 FUNDS HELD IN ESCROW 142575 BOND FUNDS 2186417 CONTRACT FOR DEED RECEIVABLE 558690 3177752 DUE TO AFFILIATES 1205518 ASSET RETIREMENT OBLIGATION 37822 NON-COMPETE AGREEMENT 350000 1593340 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: 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 2008 TO 2010 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. GOLF TOURNAMENT 75600 15193 60407 127 10500 4523 7220 WILD GAME DINNER 38000 18745 19255 12730 25 2227 1 20698 16898 3800 4422 615 906 134298 50836 83462 127 10500 21675 640 10353 43295 40167 1 AUGUSTANA CARE FOUNDATION 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411360678 501(C)(3) 700000 TRANSFER EXCESSIVE CASH TO FOUNDATION. 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: AUGUSTANA CARE MAKES INTERCOMPANY TRANSFERS TO RELATED ORGANIZATIONS. AUGUSTANA CARE AND THE RELATED ORGANIZATIONS ARE UNDER COMMON MANAGEMENT WHO REGULARLY MONITOR THE USE OF THE FUNDS. RECIPIENTS OF SCHOLARSHIPS FROM THE ARGANIZATION 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 AND A DETAILED VERIFICATION OF THE COST OF BOOKS (3) THE RECIPIENT WILL COMPLETE THE TRAINING FOR WHICH A SCHOLARSHIP PAYMENT WAS GRANTED WITH PROOF OF A FINAL GRADE OF A 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 ACCOMODATE ANY NECESSARY CHANGES IN WORK HOURSE; AND (5) UPON COMPLETION TRAINING FOR WHICH SCHOLARSHIP WAS GRANTED, THE RECIPIENT WILL WORK FOR THE ORGANIZATION AT LEAST TWO YEARS AND A MINIMUM OF 2,000 HOURS OR WILL REIMBURSE THE ORGANIZATION A PRORATED AMOUNT OF EACH SCHOLARSHIP PAYMENT RECEIVED DURING THE PREVIOUS ONE YEAR PERIOD, WHICH WILL BE DEDUCTED FOR THEIR LAST PAYCHECK. 0 1 0 0 0 0 0 0 0 TIM TUCKER 0 247016 0 41438 0 24571 0 31459 0 20778 0 365262 0 0 CRAIG KITTELSON 0 186511 0 33323 0 29620 0 23704 0 24857 0 298015 0 0 TIM MIDDENDORF 0 165502 0 24654 0 7964 0 16702 0 19431 0 234253 0 0 KATHERINE KOPP 0 171494 0 32005 0 13724 0 15008 0 13258 0 245489 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 - $11,500 KATHERINE KOPP, VICE PRESIDENT OF SENIOR DEVELOPMENT - $8,500 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: FOR THE PURPOSE OF DETERMINING COMPENSATION, AUGUSTANA CARE 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 DASSEL MN 410851701 2010-09-15 1400000 FACILITY DEVELOPMENT 0 0 0 CITY OF VICTORIA MN 410997257 92627TAIO 2009-12-31 19125503 FINANCE ACQUISITION OF EMERALD CARE 0 0 0 CITY OF VICTORIA MN 410997257 2009-12-31 4500000 FINANCE ACQUISITION OF EMERALD CARE 0 0 0 126109 1400000 28000 1372000 2011 0 0 1 1 230505 19125503 1420706 382510 17322287 2010 0 0 1 1 85436 4500000 4500000 2010 0 0 1 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 SCOTT RAMSDALE SCOTT RAMSDALE IS PRESIDENT OF ANCHOR BANK 77467 APPLE VALLEY LAND DEVELEPMENT, A WHOLLY OWNED SUBSIDIARY OF AUGUSTANA CARE, HAS A LOAN WITH ANCHOR BANK. 0 ORGANIZATION MISSION STATEMENT OVERALL MISSION FOR 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 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 1 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 3 AUGUSTANA CARE SERVICES PROVIDES MANAGEMENT SERVICES FOR AUGUSTANA CARE AND ITS RELATED ORGANIZATIONS. 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 ORGANIZATION'S MEMBERSHIP CONSISTS OF LUTHERAN CONGREGATIONS OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA (ELCA), AND OTHER CONGREGATIONS, AS ARE FROM TIME TO TIME ELECTED BY THE MEMBERS. AT ALL TIMES, A MAJORITY OF MEMBER CONGREGATIONS SHALL BE LUTHERAN CONGREGATIONS. THERE SHALL BE AT LEAST ONE MEMBER CONGREGATION OF THE ELCA AT ALL TIMES. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS THROUGH THEIR VOTING DELEGATES ELECT THE DIRECTORS AFTER CONSIDERATION OF THE SLATE OF NOMINEES SUBMITTED BY THE NOMINATING AND BOARD DEVELOPMENT COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ORGANIZATION'S GOVERNING DOCUMENTS MUST BE APPROVED BY A AN AFFIRMATIVE VOTE OF A MAJORITY OF THE TOTAL NUMBER OF DIRECTORS HOLDING OFFICE AND BY THE AFFIRMATIVE VOTE OF A MAJORITY OF VOTING DELEGATES OF THE MEMBER CONGREGATIONS PRESENT AND VOTING AT WHICH A QUORUM OF MEMBERS IS PRESENT AND VOTING. ANY AMENDMENT WHICH RELATES TO THE REQUIREMENTS FOR AFFILIATION WITH THE EVANGELICAL LUTHERAN CHURCH IN AMERICA ARE SUBMITTED TO THE ELCA PROGRAM UNIT FOR CHURCH IN SOCIETY FOR APPROVAL. 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 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 ARE 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 CARE CORPORATION 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 GAINS ON INVESTMENTS: 38,254. SENIOR DEVELOPMENT, INC EQUITY -3,051. TOTAL TO FORM 990, PART XI, LINE 5: 35,203. REPLACEMENT RESERVES LLC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 752990222 HOME HEALTH SERVICES MN 0 0 N/A AUGUSTANA DASSEL LAKESIDE COMMUNITY HOME LLC 439 WILLIAM AVENUE EAST DASSEL MN 55325 208916091 NURSING/ASSISTED LIVING FACILITY MN 4277342 6337044 N/A AUGUSTANA SENIOR DEVELOPMENT II LLC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 481293891 CONSULTING MN 513885 184321 N/A AUGUSTANA MERCY CARE CENTER LLC 710 S KENWOOD AVENUE MOOSE LAKE MN 55767 271466676 NURSING/ASSISTED LIVING FACILITY MN 6115730 4491624 N/A AUGUSTANA LAND DEVELOPMENT LLC 14650 GARRENTT AVENUE APPLE VALLEY MN 55124 271456660 LAND DEVELOPMENT MN 0 2213651 N/A AUGUSTANA ELK RUN LLC 1425 10TH AVENUE SOUTH MINNEAPOLIS MN 55404 273219747 ASSISTED LIVING MN 1019554 7456428 N/A AUGUSTANA EMERALD CARE LLC 451 EAST TRAVELERS TRAIL BURNSVILLE MN 55337 271279704 MEMORY CARE MN 10654129 27579147 N/A APPLE VALLEY VILLA APARTMENTS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311608691 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 N/A 1 AUGUSTANA APARTMENTS OF HASTINGS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311608701 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 N/A 1 AUGUSTANA CARE FOUNDATION 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411360678 CHARITABLE FOUNDATION MN 501(C)(3) 11 - TYPE I N/A 1 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411806946 MANAGEMENT SERVICES MN 501(C)(3) 11 - TYPE I N/A 1 AUGUSTANA CHAPEL VIEW HOMES INC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 410693953 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 N/A 1 AUGUSTANA COMMUNITY PARTNERS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411783680 HOME HEALTH CARE SERVICES MN 501(C)(3) 9 N/A 1 AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311608696 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 N/A 1 AUGUSTANA HOME OF HASTINGS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311572624 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 N/A 1 OPEN CIRCLE ADULT DAY CENTER 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411424801 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 N/A 1 AUGUSTANA SENIOR DEVELOPMENT INC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 264136110 CONSULTING MN N/A C 1.00000 0 1 1 1 1 0 0 0 0 1 1 0 1 1 1 0 0 0 AUGUSTANA CARE SERVICES C 985525 CASH AUGUSTANA CARE FOUNDATION B 700000 CASH AUGUSTANA CARE SERVICES L 1528152 % OF REVENUE