2022-11-09T17:53:26-07:00 2021-12-31 990 2021-01-01 411806946 CASSIA SERVICES CASS 9528555000 7171 OHMS LANE EDINA MN 55439 KATHY YOUNGQUIST CFO 9528555000 2022-11-09 0 11 1 AAL2 X 2021 2022-09-23 18:48:47Z ROBERT DAHL 7171 OHMS LANE EDINA MN 55439 27851513 0 X WWW.CASSIALIFE.ORG X 1995 MN TO PROVIDE MANAGEMENT SERVICES TO AUGUSTANA CARE AND ELIM CARE AND THEIR AFFILIATES. 6 6 169 22 912848 0 57770 0 13952184 14501764 10786 8840 4619051 5392614 18639791 19903218 5200 0 0 0 14072190 15765082 0 0 0 4948307 5607667 19025697 21372749 -385906 -1469531 14755616 26164936 13052766 25851822 1702850 313114 TO FOSTER FULLNESS OF LIFE FOR OLDER ADULTS IN THE SPIRIT OF CHRIST'S LOVE. 0 0 17008896 0 13588916 MANAGEMENT SERVICES: CASSIA SERVICES PROVIDES MANAGEMENT AND SUPPORT TO AUGUSTANA CARE AND ELIM CARE INC. AND THEIR AFFILIATES AND UNRELATED MANAGED COMPANIES. THESE SERVICES INCLUDE OPERATIONAL OVERSIGHT, HUMAN RESOURCES, FINANCIAL ACCOUNTING, INFORMATION TECHNOLOGY, CLINICAL AND DIETARY CONSULTATION, FUNDRAISING, NEW BUSINESS DEVELOPMENT, LONG RANGE STRATEGIC PLANNING, AND MARKETING AND PROMOTION FOR ALL AUGUSTANA CARE AND ELIM CARE INC. AFFILIATED ENTITIES. DURING THE PERIOD ENDING DECEMBER 31, 2021, THESE AFFILIATED ENTITIES SERVED MORE THAN 9,000 OLDER ADULTS AND OTHERS IN NEED THROUGH LONG-TERM AND TRANSITIONAL HEALTH CARE, THERAPY SERVICES, SENIOR HOUSING, ADULT DAY PROGRAMS, AND OTHER COMMUNITY-BASED SERVICES IN MINNESOTA, COLORADO, IOWA, FLORIDA AND NORTH DAKOTA. 4363853 0 5388829 PHARMACY SERVICES: A&E PHARMACY, A NONPROFIT LIMITED LIABILITY COMPANY, WAS FORMED IN FY 2018 TO PROVIDE PHARMACY AND CONSULTING SERVICES TO AUGUSTANA CARE AND ELIM CARE INC.'S RELATED NURSING FACILITIES, ASSISTED LIVING FACILITIES, MEMORY CARE FACILITIES, AND HOME AND COMMUNITY-BASED PROGRAMS. THE PHARMACY ALSO PROVIDES SERVICES TO UNRELATED MANAGED COMPANIES. DURING THE PERIOD ENDING DECEMBER 31, 2021, THE PHARMACY SERVED PATIENTS IN 29 RELATED FACILITIES AND 7 UNRELATED MANAGED FACILITIES. 0 0 0 21372749 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 45 0 1 169 1 1 1 0 0 0 0 0 0 0 X 6 6 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 MN X KATHY YOUNGQUIST 9528555000 7171 OHMS LANE EDINA MN 55439 ROBERT DAHL PRESIDENT/CEO 1.42 38.58 X 310760 258713 79039 KATHY YOUNGQUIST CHIEF FINANCIAL OFFICER 1.42 38.58 X 171013 214378 82587 MATTHEW KERN CHIEF OPERATING OFFICER 1.42 38.58 X 324672 0 83458 KATHY KOPP CHIEF STRATEGIC OFFICER 1.42 38.58 X 267750 0 90300 ANGELA BROWN CHIEF HUMAN RESOURCE OFFICER 1.42 38.58 X 110403 125877 60827 SHARON WILSON CHIEF CLINICAL AND COMPLIANCE OFFICER 1.42 38.58 X 241179 0 42698 DAVID SAEMROW VP OF MARKETING 1.42 38.58 X 177866 0 60216 PAUL LIBBON REGIONAL DIRECTOR 1.42 38.58 X 202338 0 7934 CUI LI VP OF FINANCE 1.42 38.58 X 166340 0 33694 ELIZABETH KAKACH PHARMACY DIRECTOR 40 0 X 155105 0 20007 LUKAS ATWOOD PHARMACIST 40 0 X 144380 0 30478 GARY WILKERSON DIRECTOR 0.25 2.25 X 0 0 0 NIKKI WEBER DANIELS CHAIR 0.25 4.5 X X 0 0 0 CHARLES PARKS VICE CHAIR 0.25 2.25 X X 0 0 0 PAUL ANDERSON DIRECTOR 0.25 4.75 X 0 0 0 PAT NUSS DIRECTOR 0.25 4.5 X 0 0 0 TIM KUCK SECRETARY 0.25 2.5 X X 0 0 0 2271806 598968 591238 29 0 1 0 INTEGRATED PHARMACY SOLUTIONS LLC POB 32441 FRIDLEY MN 55432 PHARMACY CONSULTING MANAGEMENT SERVICES 650277 CLIFTONLARSONALLEN LLP 220 SOUTH 6TH ST UNIT 300 MINNEAPOLIS MN 55402 AUDIT AND CONSULTING 538818 MAP TRANSPORTION 2582 LONG LAKE RD ROSEVILLE MN 55113 TRANSPORTATION SERVICES 272601 WORLDWIDE HEALTHSTAFF ASSOCIATIONS 9101 KINGS PARADE BLVD SUITE 100 CHARLOTTE NC 28273 INTERNATIONAL NURSE RECRUITMENT 242500 4 0 0 0 0 0 0 0 0 CENTRAL OFFICE FEE 561000 13258324 13258324 0 0 MANAGEMENT FEE 561000 1243440 330592 912848 0 0 0 0 0 14501764 7321 0 0 7321 0 0 0 0 0 0 0 0 0 0 0 1519 0 0 0 1519 1519 0 0 1519 0 13337124 7948295 5388829 5388829 0 0 MICELLANEOUS INCOME 900099 3785 0 0 3785 0 0 0 0 3785 19903218 18977745 912848 12625 2463651 2463651 10956852 10956852 504682 504682 668073 668073 1171824 1171824 33641 33641 36780 36780 1305 1305 2013491 2013491 14709 14709 553149 553149 163634 163634 334709 334709 180137 180137 392564 392564 1074055 1074055 106269 106269 INCOME TAXES -2708 -2708 0 0 MISCELLANEOUS 359156 359156 0 0 BAD DEBT EXPENSE 72327 72327 0 0 LICENSES AND PERMITS 60107 60107 0 0 214342 214342 0 0 21372749 21372749 0 0 1076967 3190265 932552 1444822 1011415 1377258 515331 891476 14223786 5212430 8954503 9011356 2264848 10249759 14755616 26164936 2604730 4760511 6687586 6527438 1472500 1204375 2287950 13359498 13052766 25851822 X 1702850 313114 0 0 1702850 313114 14755616 26164936 X -1469531 72715 0 0 0 7080 X 0 1 X 1 1 1 X X 2 AUGUSTANA CARE 411728753 7 1 6455863 0 ELIM CARE INC 411694818 7 1 6772755 0 2 13228618 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1337225 1337225 0 5478220 733829 4744391 0 115692 8264 107428 0 7292649 4470337 2822312 0 0 0 0 9011356 DUE FROM AFFILIATES 8958422 BOND RESERVE FUND 203540 BOND SERVICE FUND 255659 457(F) DEFERRED COMP 832138 10249759 0 DUE TO AFFILIATES 12479731 DEFERRED COMPENSATION 879767 13359498 X Schedule D, Part X, Line 2 THE CORPORATION AND ITS AFFILIATES HAVE BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND STATE CORPORATE INCOME TAXES UNDER SECTION 501 (C) (3) AND APPLICABLE STATE CODES. THE CORPORATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE CORPORATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE CORPORATION REPORTS ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES AND FILES ALL PROPER RETURNS RELATED TO THESE ACTIVITIES. X 1 1 X X X X 0 1 0 0 0 0 0 0 0 ROBERT DAHL PRESIDENT/CEO 248043 246456 0 48337 10669 15967 1551 58525 9715 9247 269978 378532 0 48337 KATHY YOUNGQUIST CHIEF FINANCIAL OFFICER 159088 158843 10000 0 1925 55535 51647 6639 12759 11541 235419 232558 0 32615 MATTHEW KERN CHIEF OPERATING OFFICER 304172 0 12273 0 8227 0 48009 0 35449 0 408130 0 0 0 KATHY KOPP CHIEF STRATEGIC OFFICER 250790 0 11059 0 5901 0 50739 0 39561 0 358050 0 0 0 SHARON WILSON CHIEF CLINICAL AND COMPLIANCE OFFICER 195286 0 30867 0 15026 0 27967 0 14731 0 283877 0 19279 0 ANGELA BROWN CHIEF HUMAN RESOURCE OFFICER 99958 95714 10000 0 445 30163 33844 4070 12065 10847 156312 140794 0 18838 PAUL LIBBON REGIONAL DIRECTOR 199162 0 0 0 3177 0 7466 0 468 0 210273 0 0 0 DAVID SAEMROW VP OF MARKETING 175433 0 253 0 2180 0 26211 0 34005 0 238082 0 0 0 CUI LI VP OF FINANCE 160928 0 0 0 5412 0 30496 0 3198 0 200034 0 0 0 ELIZABETH KAKACH PHARMACY DIRECTOR 143276 0 11200 0 629 0 6343 0 13664 0 175112 0 0 0 LUKAS ATWOOD PHARMACIST 139257 0 3602 0 1521 0 2514 0 27965 0 174859 0 0 0 Schedule J, Part I, Line 1a CASSIA AND ITS AFFILIATES PROVIDE VEHICLE BENEFITS FOR SOME OF ITS OFFICERS AND KEY EMPLOYEES. THE EMPLOYEE IS RESPONSIBLE FOR TRACKING BUSINESS VERSUS PERSONAL USE OF THE VEHICLE. THE PERSONAL USAGE OF THE VEHICLES IS TREATED AS TAXABLE COMPENSATION BY CASSIA AND ITS AFFILIATES. Schedule J, Part I, Line 3 THE CORPORATION RELIED ON THE PARENT ORGANIZATION, CASSIA, TO ESTABLISH THE COMPENSATION OF THE PRESIDENT/CEO. CASSIA USES THE FOLLOWING PRACTICES: INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY AND RECOMMENDATIONS FROM THE CASSIA COMPENSATION COMMITTEE TO THE CASSIA BOARD. Schedule J, Part I, Line 4 THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN PROVIDED BY CASSIA SERVICES: KATHY KOPP, CSO - $28,701 KATHY YOUNGQUIST, CFO - $48,725 MATTHEW KERN, COO - $36,409 ANGELA BROWN, CHRO - $29,958 Schedule J, Part I, Line 6 OFFICERS OF CASSIA SERVICES AND KEY EMPLOYEES OF CASSIA AND ITS AFFILIATES ARE ELIGIBLE TO ACCRUE INCENTIVE BONUSES EACH YEAR THAT ARE CONTINGENT ON PERFORMANCE METRICS AND FINANCIAL GOALS OF THE ORGANIZATION. A CITY OF MILACA MINNESOTA 416005370 2019-02-21 7000000 PURCHASE OF NEW OFFICE BUILDING 0 0 0 A 255000 0 7000000 0 0 0 140000 0 0 6615000 245000 0 2019 0 0 1 1 A 0 0 0 0 0 0 0 0 0 1 A 0 0 1 0 1 0 0 0 1 A 1 Form 990, Part VI, Section A, Line 6 THE SOLE MEMBER OF THE ORGANIZATION IS CASSIA. Form 990, Part VI, Section A, Line 7a THE ORGANIZATIONS BOARD OF DIRECTORS ARE APPOINTED BY A MAJORITY VOTE FROM THE BOARD OF DIRECTORS OF THE SOLE MEMBER, CASSIA, AT THE ANNUAL MEETINGS. Form 990, Part VI, Section A, Line 7b DECISIONS OF THE CASSIA SERVICES BOARD ARE SUBJECT TO APPROVAL BY THE CASSIA BOARD (PARENT COMPANY). Form 990, Part VI, Section B, Line 11b THE FORM 990 AND ALL RELATED SCHEDULES WERE PREPARED BY INTERNAL FINANCE STAFF AND REVIEWED BY THE ORGANIZATION'S CFO. THE FORM 990 WAS MADE AVAILABLE TO THE FULL BOARD OF DIRECTORS PRIOR TO BEING FILED WITH THE IRS. Form 990, Part VI, Section B, Line 12c THE ORGANIZATION ANNUALLY REQUESTS A CONFLICT OF INTEREST DISCLOSURE FROM EACH BOARD MEMBER, KEY EMPLOYEE AND OFFICER. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS AND KEY EMPLOYEES. ALL COVERED INDIVIDUALS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST STATEMENT AND TO DISCLOSE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST TO THE APPROPRIATE LEVEL OF MANAGEMENT OR TO THE BOARD OF DIRECTORS AS OUTLINED IN THE POLICY, BASED ON THE INDIVIDUAL'S POSITION WITHIN THE ORGANIZATION. CONFLICTS ARE DETERMINED AT THE APPROPRIATE LEVEL OF MANAGEMENT OR BY THE BOARD OF DIRECTORS. INDIVIDUALS WITH ACTUAL OR POTENTIAL CONFLICTS WILL ABSTAIN FROM DISCUSSING OR VOTING ON ANY MATTERS RELATING TO THE CONFLICT. ALL PROCEEDINGS RELATING TO ACTUAL OR POTENTIAL CONFLICTS ARE NOTED IN THE MEETING MINUTES. Form 990, Part VI, Section B, Line 15 THE BOARD OF DIRECTORS ROUTINELY RETAINS THE SERVICES OF A COMPENSATION CONSULTANT TO REVIEW THE CURRENT WAGE AND BENEFIT LEVELS OF SIMILAR POSITIONS IN SIMILAR ORGANIZATIONS. THE COMPENSATION COMMITTEE USES THIS INFORMATION TO MAKE A RECOMMENDATION TO THE BOARD OF DIRECTORS. Form 990, Part VI, Section C, Line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part XI, Line 9 OTHER CHANGES IN NET ASSETS OF $7,080 WAS NET ASSETS TRANSFERRED FROM AFFILIATES. A&E PHARMACY LLC 1265 GREY FOX ROAD SUITE 300 ARDEN HILLS MN 55112 PHARMACY SERVICES MN 13341444 2816099 CASSIA SERVICES A&E CARE PROPERTIES LLC 7171 OHMS LANE EDINA MN 55439 REAL ESTATE HOLDINGS MN 6260 7593994 CASSIA SERVICES CASSIA 7171 OHMS LANE EDINA MN 55439 831758728 PARENT CO/FUND RAISING MN 501(C)(3) 7 N/A 0 ELIM CARE INC 7171 OHMS LANE EDINA MN 55439 411694818 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 7 CASSIA 0 AUGUSTANA CARE 7171 OHMS LANE EDINA MN 55439 411728753 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 7 CASSIA 0 PIONEER HOUSE ASSISTED LIVING INC 7171 OHMS LANE EDINA MN 55439 411927112 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 NEW HARMONY CARE CENTER INC 7171 OHMS LANE EDINA MN 55439 411821882 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 COUNTRY MEADOWS OF MILACA INC 7171 OHMS LANE EDINA MN 55439 201723948 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 LAKE RIDGE CARE CENTER OF BUFFALO INC 7171 OHMS LANE EDINA MN 55439 200507069 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 PARK TERRACE ASSISTED LIVING INC 7171 OHMS LANE EDINA MN 55439 204063752 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 EVANGELICAL RETIREMENT HOMES INC 7171 OHMS LANE EDINA MN 55439 420868449 HEALTH CARE FACILITIES/SERVICES IA 501(C)(3) 10 ELIM CARE INC 0 VILLAGE ASSISTED LIVING INC 7171 OHMS LANE EDINA MN 55439 262086933 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 BAPTIST HOME INC 7171 OHMS LANE EDINA MN 55439 450232943 HEALTH CARE FACILITIES/SERVICES ND 501(C)(3) 10 ELIM CARE INC 0 THE BAPTIST APARTMENTS INC 7171 OHMS LANE EDINA MN 55439 450359794 HEALTH CARE FACILITIES/SERVICES ND 501(C)(3) PF ELIM CARE INC 0 ELIM SHORES INC 7171 OHMS LANE EDINA MN 55439 411625095 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 CORNERSTONE ASSISTED LIVING OF PLYMOUTH INC 7171 OHMS LANE EDINA MN 55439 412013927 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 HAVEN HOMES INC 7171 OHMS LANE EDINA MN 55439 416045816 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 ELIM SENIOR HOUSING INC 7171 OHMS LANE EDINA MN 55439 810754064 HEALTH CARE FACILITIES/SERVICES FL 501(C)(3) 10 ELIM CARE INC 0 NEWTON VILLAGE INC 7171 OHMS LANE EDINA MN 55439 200044030 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 ELIM HOMES INC 7171 OHMS LANE EDINA MN 55439 411539761 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 REDEEMER RESIDENCE INC 7171 OHMS LANE EDINA MN 55439 410711597 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM HOMES INC 0 PARK VIEW CARE CENTER 7171 OHMS LANE EDINA MN 55439 410855707 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM HOMES INC 0 THE PARK LANE APARTMENTS INC 7171 OHMS LANE EDINA MN 55439 410972384 LOW INCOME HOUSING MN 501(C)(3) 10 ELIM CARE INC 0 ELIM CHILDREN'S CENTER INC 7171 OHMS LANE EDINA MN 55439 411974507 CHILD DAYCARE MN 501(C)(3) 10 ELIM CARE INC 0 ELIM CARE FOUNDATION 7171 OHMS LANE EDINA MN 55439 411694817 CHARITABLE FOUNDATION MN 501(C)(3) 12 ELIM CARE INC 0 COMMUNITY HEALTH FOUNDATION OF WRIGHT COUNTY 7171 OHMS LANE EDINA MN 55439 363546789 CHARITABLE FOUNDATION MN 501(C)(3) PF ELIM CARE INC 0 APPLE VALLEY VILLA APARTMENTS 7171 OHMS LANE EDINA MN 55439 311608691 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 AUGUSTANA CARE 0 AUGUSTANA CARE FOUNDATION 7171 OHMS LANE EDINA MN 55439 411360678 CHARITABLE FOUNDATION MN 501(C)(3) 12 AUGUSTANA CARE 0 AUGUSTANA CHAPEL VIEW HOMES INC 7171 OHMS LANE EDINA MN 55439 410693953 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 AUGUSTANA CARE 0 AUGUSTANA COMMUNITY PARTNERS 7171 OHMS LANE EDINA MN 55439 411783680 HOME HEALTH CARE SERVICES MN 501(C)(3) 10 AUGUSTANA CARE 0 AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY 7171 OHMS LANE EDINA MN 55439 311608696 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 AUGUSTANA CARE 0 AUGUSTANA HOME OF HASTINGS 7171 OHMS LANE EDINA MN 55439 311572624 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 AUGUSTANA CARE 0 AUGUSTANA APARTMENTS OF HASTINGS 7171 OHMS LANE EDINA MN 55439 311608701 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 AUGUSTANA CARE 0 BROOKSIDE SENIOR LIVING 7171 OHMS LANE EDINA MN 55439 410871848 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 N/A 0 OPEN CIRCLE ADULT DAY CENTER 7171 OHMS LANE EDINA MN 55439 411424801 ADULT DAYCARE MN 501(C)(3) 10 AUGUSTANA CARE 0 ELIM PREFERRED SERVICES INC 7171 Ohms Lane Edina MN 55439 411681856 MEDICAL SALES MN N/A C 0 0 0 0 PREFERRED SENIOR SERVICES INC 7171 Ohms Lane Edina MN 55439 411942480 MANAGEMENT SERVICES MN N/A C 0 0 0 0 AUGUSTANA SENIOR DEVELOPMENT 7171 Ohms Lane Edina MN 55439 264136110 CONSULTING MN N/A C 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 1 1 1 1 1 1 0 0