AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY (EIN 31-1608696)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-05-16
- IRS object ID
- 201141369349303554
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-16T11:27:34-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LARSONALLEN LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311608696 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | AUGU | NameControl |
| Phone | 6122385225 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1007 EAST 14TH STREET | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55404 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CRAIG KITTELSON | Name |
| Title | VP - FINANCE/CFO | Title |
| Phone | 6122385225 | Phone |
| Date Signed | 2011-05-10 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6123764500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | TIM TUCKER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1007 EAST 14TH STREET | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55404 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 22739837 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.AUGUSTANACARE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1998 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HEALTH CARE, HOUSING AND COMMUNITY SERVICES FOR THE ELDERLY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 494 | TotalNbrEmployees |
| Total Nbr Volunteers | 203 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 477224 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 35536 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 22356265 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 22365488 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 97054 | InvestmentIncomePriorYear |
| Investment Income Current Year | 112766 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 194354 | OtherRevenuePriorYear |
| Other Revenue Current Year | 192344 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 23124897 | TotalRevenuePriorYear |
| Total Revenue Current Year | 22706134 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 1026501 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 23564 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 11318492 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11278333 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 10513987 | OtherExpensePriorYear |
| Other Expenses Current Year | 10868759 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 22858980 | TotalExpensesPriorYear |
| Total Expenses Current Year | 22170656 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 265917 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 535478 | RevenuesLessExpensesCY |
| Total Assets BOY | 43199752 | TotalAssetsBOY |
| Total Assets EOY | 43532125 | TotalAssetsEOY |
| Total Liabilities BOY | 42099521 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 41826076 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1100231 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1706049 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO 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 Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 14115371 | Expense |
| Grants | 22414 | Grants |
| Revenue | 16825586 | Revenue |
| Description | AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY OPERATES A 200-BED LICENSED NURSING FACILITY IN APPLE VALLEY, MINNESOTA. THE HEALTH CARE CENTER SERVED 1,043 INDIVIDUALS DURING THE YEAR ENDED SEPTEMBER 30, 2010. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 5282485 | Expense |
| Grants | 1150 | Grants |
| Revenue | 5539902 | Revenue |
| Description | AUGUSTANA REGENT AT BURNSVILLE OPERATES A 136-UNIT SENIOR SERVICE AND CONGREGATE HOUSING COMPLEX IN BURNSVILLE, MINNESOTA. THE REGENT SERVED 201 INDIVIDUALS DURING THE YEAR ENDED SEPTEMBER 30, 2010. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 19397856 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 494 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CRAIG KITTELSON - AUGUSTANA CARE SE | NamePerson |
| Telephone Number | 6122385225 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1007 EAST 14TH STREET | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55404 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| SCOTT RAMSDALE | ||||||||
| CHAIR (FORMER)/DIRECTOR | 4.00 | X | X | 0 | 0 | 0 | ||
| PAUL HARRINGTON | ||||||||
| VICE CHAIR (FORMER) | 2.00 | X | X | 0 | 0 | 0 | ||
| DON JACOBSON | ||||||||
| SECRETARY/TREASURER (FORMER) | 2.00 | X | X | 0 | 0 | 0 | ||
| TERRENCE MERRITT | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| LOWELL WILLIAMS | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| PR GARY WILKERSON | ||||||||
| CHAIR | 2.00 | X | X | 0 | 0 | 0 | ||
| MARSHALL MACKAY | ||||||||
| VICE CHAIR | 2.00 | X | X | 0 | 0 | 0 | ||
| CHARLES PARKS JR | ||||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | ||
| ERIC RICK ELLINGSON | ||||||||
| TREASURER | 2.00 | X | X | 0 | 0 | 0 | ||
| PR ELIZABETH BEISSEL | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| JIM EHLEN | ||||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |||
| TIM TUCKER | ||||||||
| PRESIDENT/CEO | 4.50 | X | 0 | 316400 | 62817 | |||
| CRAIG KITTELSON | ||||||||
| VP - FINANCE/CFO | 4.50 | X | 0 | 251192 | 59945 | |||
| TIM MIDDENDORF | ||||||||
| VP - OPERATIONS/COO | 4.50 | X | 0 | 196561 | 43531 | |||
| KATHERINE KOPP | ||||||||
| VP - SENIOR DEVELOPMENT | 4.50 | 0 | 215248 | 33372 | X | |||
| GLEN SHAW | ||||||||
| ADMINISTRATOR | 45.00 | 113647 | 0 | 24247 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 113647 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 979401 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 223912 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AUGUSTANA CARE SERVICES | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1007 EAST 14TH STREET | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55404 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | MANAGEMENT SERVICES | DescriptionOfServices |
| Compensation | 1145673 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| All Other Contributions | 35536 | AllOtherContributions |
| Total Contributions | 35536 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NURSING FACILITIES | 623000 | 16825586 | 16825586 |
| HOUSING FACILITIES | 623000 | 5539902 | 5539902 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 22365488 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 110866 | TotalRevenueColumn |
| Exclusion | $110,866 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 37173 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 37173 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 37173 | TotalRevenueColumn |
| Exclusion | $37,173 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 35603 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 33703 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1900 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1900 | TotalRevenueColumn |
| Exclusion | $1,900 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| DIETARY INCOME | 722210 | 55101 | $55,101 |
| MISCELLANEOUS INCOME | 900099 | 32477 | $32,477 |
| TELEPHONE INCOME | 812900 | 18517 | $18,517 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 49076 | TotalRevenueColumn |
| Exclusion | $49,076 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 155171 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22706134 | TotalRevenueColumn |
| Related Or Exempt Function Income | 22365488 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $305,110 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23564 | Total |
| Program Services | 23564 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9543156 | Total |
| Program Services | 8938389 | ProgramServices |
| Management And General | 604767 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 142542 | Total |
| Program Services | 126713 | ProgramServices |
| Management And General | 15829 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 897778 | Total |
| Program Services | 766230 | ProgramServices |
| Management And General | 131548 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 694857 | Total |
| Program Services | 653425 | ProgramServices |
| Management And General | 41432 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1145673 | Total |
| Management And General | 1145673 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10608 | Total |
| Management And General | 10608 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34997 | Total |
| Management And General | 34997 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 614891 | Total |
| Program Services | 575603 | ProgramServices |
| Management And General | 39288 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 61024 | Total |
| Management And General | 61024 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 362657 | Total |
| Program Services | 219760 | ProgramServices |
| Management And General | 142897 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 761650 | Total |
| Program Services | 761650 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40148 | Total |
| Program Services | 10844 | ProgramServices |
| Management And General | 29304 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21158 | Total |
| Program Services | 16381 | ProgramServices |
| Management And General | 4777 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2097380 | Total |
| Program Services | 2097380 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1814180 | Total |
| Program Services | 1814180 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 243843 | Total |
| Management And General | 243843 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| NURSING SUPPLIES | 2068551 | 2068551 | |
| DIETARY EXPENSES | 685267 | 685267 | |
| LICENSES, PERMITS, FEES | 595317 | 582533 | 12784 |
| BAD DEBT EXPENSE | 227279 | 227279 | |
| PREADMISSION SCREENING | 28165 | 28165 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 55971 | Total |
| Program Services | 29221 | ProgramServices |
| Management And General | 26750 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22170656 | Total |
| Program Services | 19397856 | ProgramServices |
| Management And General | 2772800 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1892410 | BOY |
| EOY | 2559415 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1955303 | BOY |
| EOY | 1933673 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 157246 | BOY |
| EOY | 136650 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 39219424 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4925183 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35208045 | BOY |
| EOY | 34294241 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 779741 | BOY |
| EOY | 726390 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3207007 | BOY |
| EOY | 3881756 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43199752 | BOY |
| EOY | 43532125 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1798304 | BOY |
| EOY | 1658948 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20900000 | BOY |
| EOY | 20855000 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 161405 | BOY |
| EOY | 152536 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19152647 | BOY |
| EOY | 18848214 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 87165 | BOY |
| EOY | 311378 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42099521 | BOY |
| EOY | 41826076 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1097291 | BOY |
| EOY | 1696803 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 128 | BOY |
| EOY | 6194 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2812 | BOY |
| EOY | 3052 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1100231 | BOY |
| EOY | 1706049 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43199752 | BOY |
| EOY | 43532125 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 100 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 28452 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 18786 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 477224 | CurrentTaxYearMinus1Year |
| Current Tax Year | 34575 | CurrentTaxYear |
| Total | 559137 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 8867237 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 14846999 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 20218677 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 22356265 | CurrentTaxYearMinus1Year |
| Current Tax Year | 22365488 | CurrentTaxYear |
| Total | 88654666 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 8867337 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 14875451 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 20237463 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 22833489 | CurrentTaxYearMinus1Year |
| Current Tax Year | 22400063 | CurrentTaxYear |
| Total | 89213803 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 1272 | CurrentTaxYearMinus1Year |
| Current Tax Year | 450 | CurrentTaxYear |
| Total | 1722 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 1272 | CurrentTaxYearMinus1Year |
| Current Tax Year | 450 | CurrentTaxYear |
| Total | 1722 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 89212081 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 82920 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 127294 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 116972 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 137501 | CurrentTaxYearMinus1Year |
| Current Tax Year | 148039 | CurrentTaxYear |
| Total | 612726 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 82920 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 127294 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 116972 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 137501 | CurrentTaxYearMinus1Year |
| Current Tax Year | 148039 | CurrentTaxYear |
| Total | 612726 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 6128 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 206115 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 195004 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 152407 | CurrentTaxYearMinus1Year |
| Current Tax Year | 156132 | CurrentTaxYear |
| Total | 715786 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 8956385 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 15208860 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 20549439 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 23123397 | CurrentTaxYearMinus1Year |
| Current Tax Year | 22704234 | CurrentTaxYear |
| Total | 90542315 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.98530 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.98490 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00680 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.00680 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
| General Explanation | Schedule 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 | GeneralExplanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtc |
| Included On FS | 1 | IncludedOnFS |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2812 | BeginningOfYearBalance |
| Contributions | 240 | Contributions |
| Investment Earnings Or Losses | 166 | InvestmentEarningsOrLosses |
| Other Expenditures | 166 | OtherExpenditures |
| End Of Year Balance | 3052 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2432 | BeginningOfYearBalance |
| Contributions | 380 | Contributions |
| Investment Earnings Or Losses | 154 | InvestmentEarningsOrLosses |
| Other Expenditures | 154 | OtherExpenditures |
| End Of Year Balance | 2812 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3377557 | OtherCostOrOtherBasis |
| Book Value | 3377557 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 31605488 | OtherCostOrOtherBasis |
| Depreciation | 3445973 | Depreciation |
| Book Value | 28159515 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4134372 | OtherCostOrOtherBasis |
| Depreciation | 1479210 | Depreciation |
| Book Value | 2655162 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 102007 | OtherCostOrOtherBasis |
| Book Value | 102007 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 34294241 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (5 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| TENANT SECURITY DEPOSITS | 145167 |
| ASSETS UNDER BOND AND MORTGAGE INDENTURE AGREEMENTS | 3073927 |
| BENEFICIAL INTEREST IN NET ASSETS OF THE FOUNDATION | 3052 |
| RESIDENT TRUST FUNDS | 32936 |
| NOTE RECEIVABLE | 626674 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 3881756 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DUE TO AFFILIATES | $307,965 |
| ASSET RETIREMENT OBLIGATION | $3,413 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 311378 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | ExplanationExplanation | Return 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. 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 15 | NumberOfRecipients |
| Amount Of Cash Grant | 23564 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Procedure for Monitoring Grants in the U.S.: | Identifier |
| Return Reference | Part I, Line 2: | ReturnReference |
| Explanation | Schedule I, Part I, Line 2: 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 | |
| Part III | PART 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 EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer |
|---|---|---|---|---|---|---|
| APPLE VALLEY ECONOMIC DEVELOPMENT AUTHORITY | ||||||
| 410882559 | 03788ABK4 | 2006-01-25 | 15675000 | ACQUIRE & IMPROVE FACILITY | 0 | 0 |
| DAKOTA COUNTY COMMUNITY DEVELOPMENT AGENCY | ||||||
| 411253302 | 23409VDN7 | 2007-07-12 | 5176617 | ACQUIRE FACILITY | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|
| 15675000 | 1090512 | 313500 | 14270988 | 2006 | 0 | 0 | 1 | 1 |
| 5176617 | 358800 | 103532 | 4714285 | 2007 | 0 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 1 |
| 0 | 0 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 1 | 1 | 0 | 0 | 0 | 0 |
| 1 | 1 | 0 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 3 | AUGUSTANA 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 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 1A | TIM 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. | EXPLANATION FOR HOURS WORKED |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AUGUSTANA REGENT AT BURNSVILLE LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14500 REGENT LANE | AddressLine1 |
| City | BURNSVILLE | City |
| State | MN | State |
| ZIP Code | 55306 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208915982 | EIN |
| Primary Activities | ASSISTED LIVING FACILITY | PrimaryActivities |
| Legal Domicile State | MN | LegalDomicileState |
| Total Income | 5698726 | TotalIncome |
| EOY Assets | 23946118 | EOYAssets |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
Form990 Schedule R Part II Form990ScheduleRPartII (9 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|
| 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 COMMUNITY PARTNERS | |||||||||
| 1007 EAST 14TH STREET | MINNEAPOLIS | MN | 55404 | 411783680 | HOME HEALTH CARE 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 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AUGUSTANA SENIOR DEVELOPMENT INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1007 EAST 14TH STREET | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55404 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481293891 | EIN |
| Primary Activity | CONSULTING | PrimaryActivity |
| Legal Domicile State | MN | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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