AUGUSTANA CHAPEL VIEW HOMES INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
AUGUSTANA CHAPEL VIEW HOMES INC (EIN 41-0693953)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-05-16
IRS object ID
201131369349303453
Schema version
2009v1.7
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)
Timestamp2011-05-16T11:28:09-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1LARSONALLEN 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 Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN410693953EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1AUGUSTANA CHAPEL VIEW HOMES INCBusinessNameLine1
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 Signed2011-05-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone6123764500Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
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 Receipts40612002GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.augustanacare.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1908YearFormation
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 Employees879TotalNbrEmployees
Total Nbr Volunteers272TotalNbrVolunteers
Total Gross UBI3341TotalGrossUBI
Net Unrelated Business Txbl Income-1665NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1224501ContributionsGrantsPriorYear
Contributions Grants Current Year154082ContributionsGrantsCurrentYear
Program Service Revenue Prior Year39750023ProgramServiceRevenuePriorYear
Program Service Revenue CY38933835ProgramServiceRevenueCY
Investment Income Prior Year306973InvestmentIncomePriorYear
Investment Income Current Year457926InvestmentIncomeCurrentYear
Other Revenue Prior Year587719OtherRevenuePriorYear
Other Revenue Current Year672963OtherRevenueCurrentYear
Total Revenue Prior Year41869216TotalRevenuePriorYear
Total Revenue Current Year40218806TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1630247GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1067155GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year22117843SalariesEtcPriorYear
Salaries Etc Current Year21359124SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year18204991OtherExpensePriorYear
Other Expenses Current Year18160604OtherExpensesCurrentYear
Total Expenses Prior Year41953081TotalExpensesPriorYear
Total Expenses Current Year40586883TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-83865RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-368077RevenuesLessExpensesCY
Total Assets BOY43739152TotalAssetsBOY
Total Assets EOY43040649TotalAssetsEOY
Total Liabilities BOY37694492TotalLiabilitiesBOY
Total Liabilities EOY37124125TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY6044660NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY5916524NetAssetsOrFundBalancesEOY
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
Expense31314820Expense
Grants1067055Grants
Revenue34150905Revenue
DescriptionNURSING HOME: AUGUSTANA CHAPEL VIEW HOMES OPERATES TWO LICENSED LONG TERM CARE FACILITIES WITH A TOTAL OF 414 LICENSED BEDS. THESE AUGUSTANA CHAPEL VIEW FACILITIES SERVED 1,801 INDIVIDUALS DURING THE YEAR ENDED SEPTEMBER 30, 2010.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense4886500Expense
Grants100Grants
Revenue4782930Revenue
DescriptionSENIOR HOUSING: AUGUSTANA CHAPEL VIEW HOMES OPERATES TWO ATTACHED CONGREGATE HOUSING FACILITIES OF 422 UNITS. THESE AUGUSTANA CHAPEL VIEW FACILITIES SERVED 458 INDIVIDUALS DURING THE YEAR ENDED SEPTEMBER 30, 2010.Description
FieldValueIRS element (for citing)
Total Program Service Expense36201320TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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 Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees879NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
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
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
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)
No Listed Persons CompensatedXNoListedPersonsCompensated

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
PR DAN SEIDELMANN
CHAIR (FORMER)2.00XX000
ED VICTORSEN
VICE CHAIR (FORMER)2.00XX000
SCOTT SWISHER
SECRETARY/TREASURER (FORMER)2.00XX000
DONALD BROWN
DIRECTOR2.00X000
PR MICHELENE VERLAUTZ
DIRECTOR2.00X000
PR GARY WILKERSON
CHAIR2.00XX000
MARSHALL MACKAY
VICE CHAIR2.00XX000
CHARLES PARKS JR
SECRETARY2.00XX000
ERIC RICK ELLINGSON
TREASURER2.00XX000
PR ELIZABETH BEISSEL
DIRECTOR2.00X000
JIM EHLEN
DIRECTOR2.00X000
SCOTT RAMSDALE
DIRECTOR2.00X000
TIM TUCKER
PRESIDENT/CEO4.50X031640062817
CRAIG KITTELSON
VP - FINANCE/CFO4.50X025119259945
TIM MIDDENDORF
VP - OPERATIONS/COO4.50X019656143531
KATHERINE KOPP
VP - SENIOR DEVELOPMENT4.50021524833372X
JEAN COLE
ADMINISTRATOR40.00120986024696X
MARY ROY
ADMINISTRATOR40.00107669023437X
FieldValueIRS element (for citing)
Total Reportable Comp From Org228655TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs979401TotalReportableCompFrmRltdOrgs
Total Other Compensation247798TotalOtherCompensation
Number Individuals GT100 K2NumberIndividualsGT100K
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
Compensation2265117Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
All Other Contributions154082AllOtherContributions
Total Contributions154082TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
NURSING6230003415090534150905
ASSISTED LIVING62300047829304775124$7,806
FieldValueIRS element (for citing)
Total Program Service Revenue38933835TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column457926TotalRevenueColumn
Exclusion$457,926ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real851798Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real393196Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real458602Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column458602TotalRevenueColumn
Unrelated Business Revenue3341UnrelatedBusinessRevenue
Exclusion$455,261ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionOTHER REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column214361TotalRevenueColumn
Exclusion$214,361ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue214361TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column40218806TotalRevenueColumn
Related Or Exempt Function Income38926029RelatedOrExemptFunctionIncome
Unrelated Business Revenue3341UnrelatedBusinessRevenue
Exclusion$1,135,354ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1000000Total
Program Services1000000ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total67155Total
Program Services67155ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total17668149Total
Program Services16842339ProgramServices
Management And General825810ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total261599Total
Program Services238416ProgramServices
Management And General23183ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2120574Total
Program Services2015832ProgramServices
Management And General104742ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1308802Total
Program Services1248238ProgramServices
Management And General60564ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total2265117Total
Management And General2265117ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total32197Total
Management And General32197ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total59610Total
Management And General59610ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3188628Total
Program Services3099738ProgramServices
Management And General88890ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total83351Total
Management And General83351ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total689907Total
Program Services517451ProgramServices
Management And General172456ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2048456Total
Program Services2048456ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total23305Total
Program Services13404ProgramServices
Management And General9901ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total24918Total
Program Services22444ProgramServices
Management And General2474ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2027764Total
Program Services2027764ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2259709Total
Program Services2259709ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total332534Total
Management And General332534ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
NURSING SUPPLIES18161311816131
DIETARY EXPENSES15342591534259
LICENSES, PERMITS, FEES1328409126305065359
BAD DEBT EXPENSE206902206902
PREADMISSION SCREENING9120391203

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total148204Total
Program Services95731ProgramServices
Management And General52473ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total40586883Total
Program Services36201320ProgramServices
Management And General4385563ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY78814BOY
EOY58749EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY533594BOY
EOY548201EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3523392BOY
EOY3128423EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY180732BOY
EOY184331EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis67680360LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec36701643LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY32155529BOY
EOY30978717EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY39996BOY
EOY17354EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY990314BOY
EOY934838EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY6236781BOY
EOY7190036EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY43739152BOY
EOY43040649EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3190644BOY
EOY2993120EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY128185BOY
EOY134921EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY31160000BOY
EOY30310000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY337571BOY
EOY311996EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY1955795BOY
EOY1876175EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY922297BOY
EOY1497913EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY37694492BOY
EOY37124125EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY3542926BOY
EOY3367628EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY17775BOY
EOY42176EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2483959BOY
EOY2506720EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6044660BOY
EOY5916524EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY43739152BOY
EOY43040649EOY
FieldValueIRS element (for citing)
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 Years1131756CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years599565CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years398791CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1224501CurrentTaxYearMinus1Year
Current Tax Year154082CurrentTaxYear
Total3508695Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years35542150CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years36489828CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years38440969CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year39750023CurrentTaxYearMinus1Year
Current Tax Year38933835CurrentTaxYear
Total189156805Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years36673906CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years37089393CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years38839760CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year40974524CurrentTaxYearMinus1Year
Current Tax Year39087917CurrentTaxYear
Total192665500Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14506CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11328CurrentTaxYearMinus3Years
Current Tax Year Minus1 Year4698CurrentTaxYearMinus1Year
Current Tax Year565CurrentTaxYear
Total31097Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years14506CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years11328CurrentTaxYearMinus3Years
Current Tax Year Minus1 Year4698CurrentTaxYearMinus1Year
Current Tax Year565CurrentTaxYear
Total31097Total
FieldValueIRS element (for citing)
Public Support Total509192634403PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years296545CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years598567CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years575025CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1111197CurrentTaxYearMinus1Year
Current Tax Year1064528CurrentTaxYear
Total3645862Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years296545CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years598567CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years575025CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1111197CurrentTaxYearMinus1Year
Current Tax Year1064528CurrentTaxYear
Total3645862Total

Other Income509 OtherIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years754231CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years302021CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years404142CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year10568CurrentTaxYearMinus1Year
Current Tax Year214361CurrentTaxYear
Total1685323Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years37724682CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years37989981CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years39818927CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year42096289CurrentTaxYearMinus1Year
Current Tax Year40366806CurrentTaxYear
Total197996685Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97290PublicSupportPercentage509
Prior Year Support Percentage0.97510PriorYearSupportPercentage
Investment Income Percentage0.01840InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.01440PriorYrInvestIncomePercentage
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 LAUNDRY INCOME FROM TENANTS HCIR INSURANCE RECIPROCALGeneralExplanation

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 Balance1950375BeginningOfYearBalance
Contributions8145Contributions
Investment Earnings Or Losses80637InvestmentEarningsOrLosses
Grants Or Scholarships0GrantsOrScholarships
Other Expenditures80637OtherExpenditures
Administrative Expenses0AdministrativeExpenses
End Of Year Balance1958520EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1905706BeginningOfYearBalance
Contributions44669Contributions
Investment Earnings Or Losses88455InvestmentEarningsOrLosses
Other Expenditures88455OtherExpenditures
End Of Year Balance1950375EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
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 Basis1737654OtherCostOrOtherBasis
Book Value1737654BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis53037217OtherCostOrOtherBasis
Depreciation25634408Depreciation
Book Value27402809BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis12905489OtherCostOrOtherBasis
Depreciation11067235Depreciation
Book Value1838254BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings30978717TotalOfBookValueLandBuildings

Other Assets OtherAssets (6 entries)

DescriptionDescriptionBook ValueBookValue
ASSETS UNDER BOND INDENTURE AGREEMENT3402980
RESIDENT TRUST FUNDS108321
HRIR INSURANCE RECIPROCAL325815
CONTRACT FOR DEED325000
BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION1365704
DUE FROM AFFILIATES1662216
FieldValueIRS element (for citing)
Total Book Value Other Assets7190036TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
ANNUITY OBLIGATIONS$180,601
RESERVATION DEPOSITS$97,500
ASSET RETIREMENT OBLIGATIONS$175,774
DUE TO AFFILIATES$1,044,038
FieldValueIRS element (for citing)
Total Of Amounts1497913TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
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. A PORTION OF 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:

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1AUGUSTANA CARE SERVICESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11007 EAST 14TH STREETAddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55404ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient411806946EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant1000000AmountOfCashGrant
Purpose Of GrantGENERAL OPERATING SUPPORTPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations1TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantSCHOLARSHIPSTypeOfGrant
Number Of Recipients27NumberOfRecipients
Amount Of Cash Grant67155AmountOfCashGrant

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 CHAPEL VIEW HOMES MAKES INTERCOMPANY TRANSFERS TO RELATED ORGANIZATIONS. AUGUSTANA CHAPEL VIEW HOMES 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 EACH 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
0247016042593026791038049024768037921700
CRAIG KITTELSON
0185011034507031674029598030347031113700
TIM MIDDENDORF
016700202187707682021610021921024009200
KATHERINE KOPP
0171994028545014709019697013675024862000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 4aTHE 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
Part IIIPART I, LINE 3: FOR THE PURPOSE OF DETERMINING COMPENSATION, AUGUSTANA CHAPEL VIEW HOMES 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 (5 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuer
CITY OF MINNEAPOLIS MINNESOTA
416005375603908KZ62005-02-243310000REFINANCE00
CITY OF MINNEAPOLIS MINNESOTA
416005375603908MD32005-05-3112470000CONSTRUCTION AND REMODELING00
CITY OF MINNEAPOLIS MINNESOTA
416005375603908LW22005-05-312160000CONSTRUCTION AND REMODELING00
CITY OF MINNEAPOLIS MINNESOTA
416005375603926CC82006-05-197010000REFINANCE00
CITY OF MINNEAPOLIS MINNESOTA
416005375603926BR62004-01-288621449CONSTRUCTION AND REMODELING00

Form990 Schedule K Part II Form990ScheduleKPartII (5 entries)

Total ProceedsTotalProceedsAmount DefeasedAmountDefeasedIssuance Costs From ProceedsIssuanceCostsFromProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount In Reserve FundAmountInReserveFundCapital ExpendituresCapitalExpenditures
331000032438006620020051011
124700007561162494002006001192054710543937
216000035616043200200600111590891601551
7010000658319014020020061011286610
86214495577188172429200610117318322140000

Form990 Schedule K Part III Form990ScheduleKPartIII (5 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
000001
000001
000001
000001
000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (5 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
110000
110000
100000
110000
110000

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part VI, Section A, line 3AUGUSTANA CARE SERVICES PROVIDES MANAGEMENT SERVICES FOR AUGUSTANA CHAPEL VIEW HOMES. 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 4Changes 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 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. AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS MUST BE APPROVED, BY A 2/3-MAJORITY VOTE, BY THE BOARD OF DIRECTORS OF THE SOLE MEMBER, AUGUSTANA CARE CORPORATION. AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS THAT RELATE TO THE REQUIREMENTS FOR AFFILIATION WITH THE EVANGELICAL LUTHERAN CHURCH IN AMERICA MUST BE APPROVED BY THE DIVISION FOR SOCIAL MINISTRY ORGANIZATIONS OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA.
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.
FORM 990, PART VII, LINE 1ATIM TUCKER, CRAIG KITTELSON, TIM MIDDENDORF, AND KATHERINE KOPP EACH SERVE AUGUSTANA CHAPEL VIEW HOMES 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.EXPLANATION FOR HOURS WORKED

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNA
APPLE VALLEY VILLA APARTMENTS
1007 EAST 14TH STREETMINNEAPOLISMN55404311608691HEALTH CARE FACILITIES/SERVICESMN501(C)(3)9N/A
AUGUSTANA APARTMENTS OF HASTINGS
1007 EAST 14TH STREETMINNEAPOLISMN55404311608701HEALTH CARE FACILITIES/SERVICESMN501(C)(3)9N/A
AUGUSTANA CARE
1007 EAST 14TH STREETMINNEAPOLISMN55404411728753HEALTH CARE FACILITIES/SERVICESMN501(C)(3)7N/A
AUGUSTANA CARE FOUNDATION
1007 EAST 14TH STREETMINNEAPOLISMN55404411360678CHARITABLE FOUNDATIONMN501(C)(3)11 - TYPE 1N/A
AUGUSTANA CARE SERVICES
1007 EAST 14TH STREETMINNEAPOLISMN55404411806946MANAGEMENT SERVICESMN501(C)(3)11 - TYPE 1N/A
AUGUSTANA COMMUNITY PARTNERS
1007 EAST 14TH STREETMINNEAPOLISMN55404411783680HOME HEALTH CARE SERVICESMN501(C)(3)9N/A
AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY
1007 EAST 14TH STREETMINNEAPOLISMN55404311608696HEALTH CARE FACILITIES/SERVICESMN501(C)(3)9N/A
AUGUSTANA HOME OF HASTINGS
1007 EAST 14TH STREETMINNEAPOLISMN55404311572624HEALTH CARE FACILITIES/SERVICESMN501(C)(3)9N/A
OPEN CIRCLE ADULT DAY CENTER
1007 EAST 14TH STREETMINNEAPOLISMN55404411424801HEALTH CARE FACILITIES/SERVICESMN501(C)(3)9N/A

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 Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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