2011-05-16T11:28:48-05:00 2010-09-30 LARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2009-10-01 411783680 AUGUSTANA COMMUNITY PARTNERS FKA AUGUSTANA HOME HEALTH CARE SERVICES AUGU 6122385225 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 CRAIG KITTELSON 6122385225 2011-05-13 1 6123764500 2009 2016-02-24 21:20:13Z TIM TUCKER 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 7835392 0 X WWW.AUGUSTANACARE.ORG X 1994 MN TO PROVIDE HEALTH CARE, HOUSING AND COMMUNITY SERVICES FOR THE ELDERLY. 7 7 195 5 1677284 39352 173788 16176 7355035 7808349 4871 9561 1306 7533694 7835392 600000 0 4499632 5172911 0 0 2520508 2426993 7020140 8199904 513554 -364512 1024560 753019 497040 590011 527520 163008 THE PURPOSE OF AUGUSTANA COMMUNITY PARTNERS IS TO ASSIST PEOPLE IN THE COMMUNITY AT LARGE, AND THAT RESIDE IN AUGUSTANA CARE'S VARIOUS HOUSING ALTERNATIVES, TO REALIZE THEIR FULL POTENTIAL FOR LIVING A MEANINGFUL LIFE THROUGH THE PROVISION OF HOME HEALTH CARE, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES, MEALS ON WHEELS, AND OTHER CATEGORIES. 0 0 860131 948281 Augustana Home Health provided home health care services for the assisted living residents of Heritage Commons on Pond's Edge, which consist of 40 units of a City of Minneapolis senior housing project. For 2010, Augustana Home Health served 55 residents. 5980699 600000 6593628 Augustana Therapy Services provided therapy services for all of Augustana's affiliated skilled care centers and people in community settings. Augustana Therapy Services provided therapy for approximately 1,910 residents during fiscal 2010. 241672 266440 AUGUSTANA'S TABLE TALK PROGRAM SERVED 53,210 MEALS ON WHEELS DURING THE YEAR ENDED SEPTEMBER 30, 2010. 7082502 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 195 1 1 1 0 0 0 0 0 0 0 0 7 7 0 1 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X CRAIG KITTELSON - AUGUSTANA CARE SE 6122385225 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 X PR BUD BONN 2.00 X X 0 0 0 JANET LABRECQUE 2.00 X X 0 0 0 VICKI HAUGEN 2.00 X X 0 0 0 LARRY KULA 2.00 X 0 0 0 VERNA LUTES 2.00 X 0 0 0 PR GARY WILKERSON 2.00 X X 0 0 0 MARSHALL MACKAY 2.00 X X 0 0 0 CHARLES PARKS JR 2.00 X X 0 0 0 ERIC RICK ELLINGSON 2.00 X X 0 0 0 PR ELIZABETH BEISSEL 2.00 X 0 0 0 JIM EHLEN 2.00 X 0 0 0 SCOTT RAMSDALE 2.00 X 0 0 0 TIM TUCKER 4.50 X 0 316400 62817 CRAIG KITTELSON 4.50 X 0 251192 59945 TIM MIDDENDORF 4.50 X 0 196561 43531 KATHERINE KOPP 4.50 X 0 215248 33372 KRISTY BROWN 40.00 X 139487 0 37599 CARLA TOCKO 40.00 X 125137 0 12289 KATHLEEN MAGGI 40.00 X 103441 0 12608 368065 979401 262161 3 0 1 0 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 MANAGEMENT SERVICES 391770 1 16176 16176 THERAPY SERVICES 621300 6593628 4957665 1635963 HOME HEALTH 621300 948281 948281 CATERING REVENUE 722320 266440 185011 41321 40108 7808349 9561 9561 MISCELLANEOUS 900099 1306 1306 1306 7835392 6090957 1677284 50975 600000 600000 4118270 3782416 335854 72811 64247 8564 611753 531499 80254 370077 348218 21859 391770 391770 2873 2873 10580 10580 1238819 1202550 36269 5195 5195 197882 138332 59550 152957 152957 105135 51739 53396 11654 9899 1755 4162 4162 20444 20444 44148 44148 UNREL. BUS. TAX (UBIT) 9857 9857 DIETARY EXPENSES 158621 158621 BAD DEBT EXPENSE 33737 33737 MISCELLANEOUS 18602 13726 4876 DUES AND SUBSCRIPTIONS 7196 7196 13361 3692 9669 8199904 7082502 1117402 0 300 525 514107 567578 63791 78955 222957 153094 57638 69863 388724 36098 1024560 753019 379812 433794 117228 156217 497040 590011 X 527520 163008 527520 163008 1024560 753019 X 0 1 1 X 0 X 302 173788 16176 190266 3509492 4309130 5029941 5869418 6284908 25002889 3509492 4309130 5030243 6043206 6301084 25193155 0 0 0 25193155 4005 3061 3368 4871 9561 24866 4005 3061 3368 4871 9561 24866 118127 102216 95913 40352 356608 170 29219 37322 1306 68017 3513667 4459537 5173149 6143990 6352303 25642646 0.98250 0.98080 0.00100 0.00120 X Schedule A, Part II, Line 12, Explanation of Other Income: MISCELLANEOUS INCOME FROM PATIENTS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 222957 153094 69863 69863 DEFERRED COMPENSATION LIABILITY 156217 156217 1 AUGUSTANA CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 414806946 501(C)(3) 600000 TO SUPPORT GENERAL OPERATIONS. Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Augustana Community Partners makes intercompany transfers to related organizations. Augustana Community Partners and the related organizations are under common management who regularly monitor the use of funds. 0 1 0 0 0 0 0 0 0 TIM TUCKER 0 247016 0 42593 0 26791 0 38049 0 24768 0 379217 0 0 CRAIG KITTELSON 0 185011 0 34507 0 31674 0 29598 0 30347 0 311137 0 0 TIM MIDDENDORF 0 167002 0 21877 0 7682 0 21610 0 21921 0 240092 0 0 KATHERINE KOPP 0 171994 0 28545 0 14709 0 19697 0 13675 0 248620 0 0 KRISTY BROWN 122150 0 9375 0 7962 0 17299 0 20300 0 177086 0 0 0 Part I, Line 4a 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 - $12,500 KATHERINE KOPP, VICE PRESIDENT OF SENIOR DEVELOPMENT - $9,500 KRISTY BROWN, THERAPY SERVICES DIRECTOR - $8,625 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. 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 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 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 2A EXPLANATION OF HOURS WORKED 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. 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 CARE SERVICES 1007 EAST 14TH STREET MINNEAPOLIS MN 55404 411806946 MANAGEMENT SERVICES 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 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 0 1 0 0 0 0 0 1 0 1 1 1 1 0 0 0