2011-05-16T11:29:32-05:00 2010-09-30 LARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2009-10-01 411806946 AUGUSTANA CARE SERVICES AUGU 6122385225 1007 EAST FOURTEENTH STREET MINNEAPOLIS MN 55404 CRAIG KITTELSON 6122385225 2011-05-13 1 Gordon J Vetsch 6123764500 2009 2016-02-24 21:20:13Z TIM TUCKER 1007 EAST FOURTEENTH STREET MINNEAPOLIS MN 55404 7779372 0 X WWW.AUGUSTANACARE.ORG X 1995 MN TO PROVIDE MANAGEMENT SERVICES TO AUGUSTANA CARE CORPORATION AND AFFILIATES. 9 9 56 10 82604 37532 1500000 1950000 5222443 5745099 119 0 46082 84273 6768644 7779372 1737084 1015203 0 4191857 4701716 0 0 868657 957347 6797598 6674266 -28954 1105106 2124912 2525140 4125536 3420658 -2000624 -895518 TO ASSIST IN CARRYING OUT THE CHARITABLE PURPOSES OF AUGUSTANA CARE CORPORATION AND AFFILIATES BY PROVIDING MANAGEMENT SERVICES TO THE RELATED ORGANIZATIONS. 0 0 6674266 1015203 5745099 Housing. Augustana Care owns and manages a variety of older adult living communities in Minnesota. Each of the campuses has comfortable living and care options for older adults. Housing options include apartments for independent living, housing with services, and assisted living. In 2010, 1,617 older adults resided in housing either owned or managed by Augustana Care. Expenses shown are for the Augustana Care Services portion of expenses related to management of the housing communities. Health Care. Augustana Cares health care facilities in Minneapolis, Apple Valley, Hastings, Hopkins, Moose Lake and Dassel provide transitional care, long-term care, dementia care, and rehabilitation serves. In fiscal year 2010, 3,545 people received compassionate care at these facilities. The expense total reflects Augustana Care Servicess portion of expenses related to management of the health care centers. Augustana Care offers a range of community-based support services to enhance the quality of life for older adults who continue to live in their own homes. More than 986 people received these community-based services during the last fiscal year. The total reflects the Augustana Care Services portion of expenses related to management of these community-based services. Augustana Cares mission is to foster fullness of life for older adults and others in need through the provision of healthcare, housing and other services. Augustana Care helps people stay connected to the things that bring meaning to their lives as they age so they can continue sharing and adding to their personal stories. We offer a full spectrum of services for older adults and serve more than 6,000 people each year. Augustana Care Services provides management services for the organizations affiliated entities that deliver housing, healthcare and community-based services. 6674266 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 179 0 1 56 1 1 1 0 0 0 0 0 0 0 0 9 9 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X CRAIG KITTELSON 6122385205 1007 EAST FOURTEENTH STREET MINNEAPOLIS MN 55404 PR GARY WILKERSON 1.00 X X 0 0 0 MARSHALL MACKAY 1.00 X X 0 0 0 PR ELIZABETH BEISSEL 1.00 X X 0 0 0 CHARLES PARKS JR 1.00 X X 0 0 0 ERIC RICK EILLINGSON 1.00 X X 0 0 0 DEAN SCHUMANN 1.00 X X 0 0 0 DAVID JEBENS 1.00 X 0 0 0 DON JACOBSON 1.00 X 0 0 0 JIM EHLEN 1.00 X 0 0 0 KURT GALENTI 1.00 X 0 0 0 SCOTT RAMSDALE 1.00 X 0 0 0 TIM TUCKER 4.50 X 316400 0 62817 CRAIG KITTELSON 4.50 X 251192 0 59945 TIM MIDDENDORF 4.50 X 196561 0 43531 KATHERINE KOPP 4.50 X 215248 0 33372 MICHAEL JOHNSON 4.50 X 138411 0 50520 BRIDGET GIBSON 4.50 X 132082 0 28242 KAY GUDMESTAD 4.50 X 109925 0 27006 SHARON WILSON 4.50 X 119280 0 12575 SHAWN JOHNSON 4.50 X 107345 0 23860 1586444 0 341868 11 0 1 0 LARSONALLEN LLP 220 SOUTH 6TH STREET MINNEAPOLIS MN 55404 AUDITING AND CONSULTING SERVICES 294034 DART CHART SYSTEMS LLC 3825 GREEN TREE ROAD MILWAUKEE WI 53209 MEDICAL RECORD CHARTING 262584 VOIT KLEGON & RODE LLC 2550 UNIVERSITY AVE W ST PAUL MN 55114 LEGAL SERVICES 152948 REINHART FOOD SERVICES 13400 COMMERCE BLVD ROGERS MN 55374 FOOD SUPPLY 114454 LUTHERAN SERVICES IN AMERICA 700 LIGHT STREET BALTIMORE MD 21230 CONSULTING SERVICES 104397 9 1950000 1950000 CENTRAL OFFICE FEE 561000 5669888 5647388 22500 INFO. TECH CONSULTING 541519 72832 15107 57725 NURSING CONSULTING 541900 2379 2379 5745099 MISCELLANEOUS INCOME 900099 84273 84273 84273 7779372 5662495 82604 84273 1002722 1002722 12481 12481 1195609 1195609 2893686 2893686 110115 110115 261125 261125 241181 241181 13779 13779 13036 13036 112318 112318 189447 189447 251414 251414 130786 130786 23714 23714 19264 19264 161892 161892 2400 2400 INCOME TAXES 14709 14709 DUES AND SUBSCRIPTIONS 11044 11044 RECRUITING/RETENTION 9219 9219 DIETARY EXPENSES 2193 2193 LICENSES, PERMITS, FEES 1939 1939 193 193 6674266 6674266 0 0 1176999 1227836 40393 144417 68408 73926 1357350 923625 411959 433725 427153 645236 2124912 2525140 2266820 2265564 1858716 1155094 4125536 3420658 X -2000624 -895518 -2000624 -895518 2124912 2525140 X 0 1 1 X 0 X X X 0 0 0 APPLE VALLEY VILLA APTS 311608691 9 1 195401 APTS OF HASTINGS 311608701 9 1 65963 AUGUSTANA CARE 411728753 9 1 1617902 AUGUSTANA CARE FOUND 411360678 11 - TYPE 1 1 462615 CHAPEL VIEW HOMES 410693953 9 1 2252502 COMMUNITY PARTNERS 411783680 9 1 391770 HCC OF APPLE VALLEY 311608696 9 1 1145673 HOME OF HASTINGS 311572624 9 1 429672 OPEN CIRCLE 411424801 9 1 49415 9 6610913 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10666 5101 5565 1346684 918524 428160 433725 RECEIVABLE FROM COLLATERALIZED ASSIGNMENT 505188 DUE FROM AFFILIATES 140048 645236 DEFERRED COMPENSATION LIABILITY 1155094 1155094 1 AUGUSTANA CARE 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411728753 501(C)(3) 552722 GENERAL OPERATING SUPPORT AUGUSTANA CARE FOUNDATION 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411360678 501(C)(3) 450000 GENERAL OPERATING SUPPORT 2 0 SCHOLARSHIPS 3 12481 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: AUGUSTANA CARE SERVICES MAKES INTERCOMPANY TRANSFERS TO RELATED ORGANIZATIONS IN THE FORM OF FORGIVENESS OF INTERCOMPANY RECEIVABLES RELATED TO DAILY OPERATIONS. AUGUSTANA CARE SERVICES AND THE RELATED ORGANIZATIONS ARE UNDER COMMON MANAGEMENT WHO REGULARLY MONITOR THE USE OF THE 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 DURING, WHICH WILL BE DEDUCTED FROM THE RECIPIENT'S FINAL PAYCHECK. X X X X X 0 1 0 0 0 0 0 0 0 TIM TUCKER 247016 0 42593 0 26791 0 38049 0 24768 0 379217 0 0 0 CRAIG KITTELSON 185011 0 34507 0 31674 0 29598 0 30347 0 311137 0 0 0 TIM MIDDENDORF 167002 0 21877 0 7682 0 21610 0 21921 0 240092 0 0 0 KATHERINE KOPP 171994 0 28545 0 14709 0 19697 0 13675 0 248620 0 0 0 MICHAEL JOHNSON 109405 0 19040 0 9966 0 20496 0 30024 0 188931 0 0 0 BRIDGET GIBSON 119082 0 13000 0 0 0 8262 0 19980 0 160324 0 0 0 Part I, Line 4a PART I, LINE 4B: THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN: 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 - $12,500 KATHERINE KOPP, VICE PRESIDENT OF SENIOR DEVELOPMENT - $9,500 MICHAEL JOHNSON, VICE PRESIDENT & EXECUTIVE DIRECTOR OF HR - $12,500 KATY KITTELSON FAMILY MEMBER OF AN OFFICER 10181 COMPENSATION PAID FOR EMPLOYMENT OF AUGUSTANA CARE SERVICES. 0 Form 990, Part VI, Section A, line 4 Changes were made to all governing documents of all legal entities in the organization. Changes included: 1.) Updates for consistency among entities 2.) Updates for changes in state law and ELCA affiliation standards 3.) Updates for improving governance focus on strategic direction and robust leadership 4.) Updates for consistency with third party financing requirements No changes in fundamental inter-entity control relationships or tax exemption considerations were made. 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, AT THE ANNUAL MEETING. 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 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 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 WILL BE NOTED IN THE MEETING MINUTES. Form 990, Part VI, Section B, line 15 THE COMPENSATION OF THE PRESIDENT/CEO AND ALL OTHER SENIOR STAFF IS ESTABLISHED BY THE AUGUSTANA CARE SERVICES BOARD OF DIRECTORS BASED ON APPROPRIATE COMPARABILITY DATA PROVIDED BY A PROFESSIONAL COMPENSATION CONSULTANT. THE COMPENSATION STUDY WAS LAST PERFORMED IN 2008 AND AUGUSTANA RECEIVES UPDATES EACH YEAR SINCE THEN AS THE ORGANIZATION HAS BEEN IN A WAGE FREEZE. FOR ALL OFFICERS AND KEY EMPLOYEES, THE PROCESS LAST INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2010. 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. FORM 990, PART VII, LINE 1A EXPLANATION FOR HOURS WORKED TIM TUCKER, CRAIG KITTELSON, TIM MIDDENDORF, KATHERINE KOPP, KAY GUDMESTAD, SHARON WILSON, MICHAEL JOHNSON, BRIDGET GIBSON, AND SHAWN JOHNSON EACH SERVE AUGUSTANA CARE SERVICES AND ITS RELATED ORGANIZATIONS. EACH INDIVIDUAL SPEND APPROXIMATELY 4.5 HOURS PER WEEK WORKING FOR EACH OF THE RELATED ORGANIZATIONS, FOR A TOTAL OF 45 HOURS PER WEEK. APPLE VALLEY VILLA APARTMENTS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311608691 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 N/A AUGUSTANA APARTMENTS OF HASTINGS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311608701 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 N/A AUGUSTANA CARE 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411728753 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 7 N/A AUGUSTANA CARE FOUNDATION 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411360678 CHARITABLE FOUNDATION MN 501(C)(3) 11 - TYPE 1 N/A AUGUSTANA CHAPEL VIEW HOMES INC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 410693953 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 N/A AUGUSTANA COMMUNITY PARTNERS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411783680 HOME HEALTH CARE SERVICES MN 501(C)(3) 9 N/A 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 AUGUSTANA HOME OF HASTINGS 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 311572624 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 N/A OPEN CIRCLE ADULT DAY CENTER 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411424801 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 9 N/A AUGUSTANA SENIOR DEVELOPMENT INC 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 481293891 CONSULTING MN N/A C 0 1 1 0 1 0 0 0 0 1 1 0 1 1 0 1 0 0