AUGUSTANA MOUNT OLIVET HOSPICE CARE LLC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- AUGUSTANA MOUNT OLIVET HOSPICE CARE LLC (EIN 46-4564958)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-14
- IRS object ID
- 202213189349302901
- Schema version
- 2021v4.2
- 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) |
|---|---|---|
| Return | 2022-11-14T08:33:28-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 S 6TH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 464564958 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AUGUSTANA MOUNT OLIVET HOSPICE CARE LLC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | AUGU | BusinessNameControlTxt |
| Phone | 9528555000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1015 4TH AVENUE NORTH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55405 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SARAH VAN WINKLE | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 9528555000 | PhoneNum |
| Signature | 2022-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | SARAH | PersonFirstNm |
| Person Last | VAN WINKLE | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MATTHEW WOCKEN | PreparerPersonNm |
| PTIN | P01598291 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Preparation | 2022-11-11 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRACE HOSPICE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SARAH VAN WINKLE | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1015 4TH AVENUE NORTH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55405 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,105,039 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.GRACEHOSPICECARING.ORG | WebsiteAddressTxt |
| Type Of Organization Other | Yes (X) | TypeOfOrganizationOtherInd |
| Other Organization Dsc | LLC | OtherOrganizationDsc |
| Formation | 2014 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE HOSPICE SERVICES TO THE ELDERLY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 114 | TotalEmployeeCnt |
| Total Volunteers | 29 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $649,399 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,150,574 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $12,411,028 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $12,455,312 | CYProgramServiceRevenueAmt |
| PY Investment Income | $33,787 | PYInvestmentIncomeAmt |
| CY Investment Income | $12,873 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $13,094,214 | PYTotalRevenueAmt |
| CY Total Revenue | $13,618,759 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $500,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $600,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,083,992 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,858,818 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $17,690 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,572,711 | PYOtherExpensesAmt |
| CY Other Expenses | $5,669,528 | CYOtherExpensesAmt |
| PY Total Expenses | $12,156,703 | PYTotalExpensesAmt |
| CY Total Expenses | $13,128,346 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $937,511 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $490,413 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,306,056 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,903,582 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,453,757 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,565,675 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,852,299 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,337,907 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | OUR MISSION IS TO SERVE GOD BY RECOGNIZING THAT EVERY PERSON DESERVES TO LIVE OUT HIS OR HER LIFE WITH RESPECT AND DIGNITY, FREE OF PAIN, AND IN AN ENVIRONMENT THAT PROMOTES QUALITY OF LIFE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $11,367,243 | ExpenseAmt |
| Grant | $600,000 | GrantAmt |
| Revenue | $12,455,312 | RevenueAmt |
| Desc | AUGUSTANA MOUNT OLIVET HOSPICE, LLC ("THE LLC") IS A JOINT VENTURE BETWEEN AUGUSTANA CARE (EIN: 41-1728753) AND MOUNT OLIVET CAREVIEW HOME (EIN: 41-0802697). AUGUSTANA CARE AND MOUNT OLIVET CAREVIEW HOME ARE THE ONLY MEMBERS OF THE LLC. BOTH MEMBERS ARE MINNESOTA NONPROFIT CORPORATIONS AND TAX EXEMPT PUBLIC CHARITIES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AUGUSTANA CARE IS A PUBLIC CHARITY UNDER SECTIONS 509(A)(1) AND 170(B)(1)(A)(VI). MOUNT OLIVET CAREVIEW HOME IS A PUBLIC CHARITY UNDER SECTION 509 (A)(2).HOSPICE CARE:THE LLC PROVIDES END-OF-LIFE CARE TO PATIENTS, WHEREVER THEY LIVE, THAT HAVE BEEN CERTIFIED AS BEING TERMINALLY ILL WITH LESS THAN SIX MONTHS OF LIFE. THE PURPOSES OF THE LLC INCLUDE:(A) TO PROVIDE END-OF-LIFE SERVICES THAT SUPPORTS EACH INDIVIDUAL'S PHYSICAL, SPIRITUAL, CULTURAL AND EMOTIONAL NEEDS TO ENHANCE THEIR QUALITY OF LIFE;(B) TO SUPPORT AND HELP PATIENTS AND FAMILIES THROUGH THEIR END OF LIFE JOURNEY UTILIZING A TEAM APPROACH OF: MEDICAL DIRECTOR, NURSES, SOCIAL WORKERS, CHAPLAINS, HOME HEALTH AIDES, MUSIC THERAPISTS, MASSAGE THERAPISTS, GRIEF COUNSELORS, MEDICATIONS RELATED TO TERMINAL DIAGNOSIS, DURABLE MEDICAL EQUIPMENT, 24/7 ON-CALL SUPPORT AND VOLUNTEERS;(C) TO PROVIDE 13 MONTHS OF BEREAVEMENT SERVICES;(D) TO ACCEPT ALL WHO ARE ELIGIBLE TO HOSPICE SERVICES REGARDLESS OF ABILITY TO PAY;(E) A FAITH-BASED ORGANIZATION BRINGING HOSPICE CARE TO PATIENTS AND FAMILIES THAT BEST FITS THEIR NEEDS; AND(F) OTHER PROGRAMS AS MAY FROM TIME TO TIME THAT IS APPROPRIATE TO THE ACCOMPLISHMENT OF THIS COMPANY'S CHARITABLE PURPOSE. | Desc |
| Total Program Service Expenses | $11,367,243 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 114 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KATHY YOUNGQUIST - CASSIA SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9528555000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7171 OHMS LN | AddressLine1Txt |
| City | EDINA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55439 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| SARAH VAN WINKLE | |||||||
| PRESIDENT/CEO | 41.50 | Yes (X) | $201,088 | $0 | $10,407 | ||
| STACY LYSEN | |||||||
| DIRECTOR OF NURSING | 41.50 | $138,826 | $0 | $40,880 | Yes (X) | ||
| DEBRA MELLING | |||||||
| REGISTERED NURSE | 41.50 | $102,335 | $0 | $26,964 | Yes (X) | ||
| BERNIE CABLE-PROKOP | |||||||
| CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| TIMOTHY HOKANSON | |||||||
| VICE CHAIR | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| KATHY KOPP | |||||||
| SECRETARY | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| SHARON WILSON | |||||||
| SECRETARY (THRU 3/2021) | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| EILEEN CARTWRIGHT | |||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| MATTHEW KERN | |||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| DAVID LOSE | |||||||
| DIRECTOR | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $442,249 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $78,251 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 3 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HOSPICE PHARMACY SOLUTIONS | |||||
| PO BOX 161583 | ATLANTA | GA | 30321 | PHARMACY BENEFIT MANAGER | $635,198 |
| CASSIA SERVICES | |||||
| 7171 OHMS LANE | EDINA | MN | 55439 | MANAGEMENT SERVICES | $270,592 |
| INTERNAL MEDICINE & GERIATRIC ASSOCIATIO | |||||
| 21490 FAIRVIEW ST | EXCELSIOR | MN | 55331 | MEDICAL DIRECTOR | $163,200 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,074,307 | GovernmentGrantsAmt |
| All Other Contributions | $76,267 | AllOtherContributionsAmt |
| Total Contributions | $1,150,574 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | HOSPICE CARE | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $12,455,312 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,455,312 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $12,455,312 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $96,592 | TotalRevenueColumnAmt |
| Exclusion | $96,592 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,402,561 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,486,280 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$83,719 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$83,719 | TotalRevenueColumnAmt |
| Exclusion | -$83,719 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,618,759 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,455,312 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $12,873 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $600,000 | TotalAmt |
| Program Services | $600,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $211,495 | TotalAmt |
| Management And General | $211,495 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,395,405 | TotalAmt |
| Program Services | $4,942,600 | ProgramServicesAmt |
| Management And General | $452,805 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,559 | TotalAmt |
| Program Services | $103,285 | ProgramServicesAmt |
| Management And General | $22,274 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $710,620 | TotalAmt |
| Program Services | $584,556 | ProgramServicesAmt |
| Management And General | $126,064 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $415,739 | TotalAmt |
| Program Services | $341,987 | ProgramServicesAmt |
| Management And General | $73,752 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $270,592 | TotalAmt |
| Management And General | $270,592 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,064 | TotalAmt |
| Management And General | $21,064 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,995,986 | TotalAmt |
| Program Services | $3,995,986 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,097 | TotalAmt |
| Management And General | $35,097 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $182,203 | TotalAmt |
| Program Services | $13,445 | ProgramServicesAmt |
| Management And General | $151,068 | ManagementAndGeneralAmt |
| Fundraising | $17,690 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,797 | TotalAmt |
| Management And General | $149,797 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,381 | TotalAmt |
| Program Services | $382 | ProgramServicesAmt |
| Management And General | $50,999 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $123,984 | TotalAmt |
| Program Services | $113,383 | ProgramServicesAmt |
| Management And General | $10,601 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,039 | TotalAmt |
| Program Services | $6,524 | ProgramServicesAmt |
| Management And General | $25,515 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33 | TotalAmt |
| Program Services | $33 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,727 | TotalAmt |
| Management And General | $26,727 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,824 | TotalAmt |
| Management And General | $30,824 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| NURSING EQUIPMENT | $528,689 | $528,689 | |
| NURSING SUPPLIES | $134,343 | $134,343 | |
| BAD DEBT EXPENSE | $26,994 | $26,994 | |
| LICENSES, PERMITS AND F | $23,484 | $23,484 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,291 | TotalAmt |
| Program Services | $2,030 | ProgramServicesAmt |
| Management And General | $34,261 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,128,346 | TotalAmt |
| Program Services | $11,367,243 | ProgramServicesAmt |
| Management And General | $1,743,413 | ManagementAndGeneralAmt |
| Fundraising | $17,690 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,881,734 | BOYAmt |
| EOY | $148,588 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,354,935 | BOYAmt |
| EOY | $1,204,443 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $86,201 | BOYAmt |
| EOY | $67,140 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $291,874 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $233,423 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $63,828 | BOYAmt |
| EOY | $58,451 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,919,358 | BOYAmt |
| EOY | $3,424,960 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,306,056 | BOYAmt |
| EOY | $4,903,582 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,060,454 | BOYAmt |
| EOY | $1,385,011 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,081,213 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $312,090 | BOYAmt |
| EOY | $180,664 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,453,757 | BOYAmt |
| EOY | $1,565,675 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,852,299 | BOYAmt |
| EOY | $3,337,907 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,852,299 | BOYAmt |
| EOY | $3,337,907 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,306,056 | BOYAmt |
| EOY | $4,903,582 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $490,413 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$4,805 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $75,979 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $95,381 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $16,345 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $649,399 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,150,574 | CurrentTaxYearAmt |
| Total | $1,987,678 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $8,530,622 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,661,798 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,109,115 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,411,028 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $12,455,312 | CurrentTaxYearAmt |
| Total | $47,167,875 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $8,606,601 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,757,179 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,125,460 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,060,427 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,605,886 | CurrentTaxYearAmt |
| Total | $49,155,553 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $49,155,553 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus2 Years | $63 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $60,926 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $96,592 | CurrentTaxYearAmt |
| Total | $157,590 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $9 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus2 Years | $63 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $60,926 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $96,592 | CurrentTaxYearAmt |
| Total | $157,590 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $30,365 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $14,816 | CurrentTaxYearMinus3YearsAmt |
| Total | $45,181 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $8,636,975 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $10,771,995 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,125,523 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,121,353 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $13,702,478 | CurrentTaxYearAmt |
| Total | $49,358,324 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99590 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99740 | PublicSupportPY509Pct |
| Investment Income CY | 0.00320 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00150 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | MISCELLANEOUS INCOME - 2017 AMOUNT: $ 24,440. FUNDRAISING EVENT REVENUES - 2017 AMOUNT: $ 5,925. 2018 AMOUNT: $ 14,816. |
| FORM 990, SCHEDULE A, COLUMN D: | COLUMN D, 2019, IS FOR A SHORT PERIOD THAT BEGAN ON OCTOBER 1, 2019 AND ENDED ON DECEMBER 31, 2019. |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $129,510 | OtherCostOrOtherBasisAmt |
| Depreciation | $129,510 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $162,364 | OtherCostOrOtherBasisAmt |
| Depreciation | $103,913 | DepreciationAmt |
| Book Value | $58,451 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $58,451 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO AFFILIATES | Desc |
| Amt | $180,664 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $180,664 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $13,613,954 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$4,805 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | -$4,805 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,618,759 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $13,618,759 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,528,346 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,528,346 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $600,000 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $600,000 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $13,128,346 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | AS A LIMITED LIABILITY COMPANY, THE COMPANY IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES AND ITS INCOME IS ALLOCATED TO AND REPORTED IN THE TAX RETURNS OF ITS MEMBERS, WHICH ARE BOTH NON-PROFIT CORPORATIONS. THE COMPANY FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES IN EVALUATING THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE STANDARD PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE MEMBERS' INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | EQUITY TRANSFER 600,000. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|---|---|
| AUGUSTANA CARE | ||||||||||
| 7171 OHMS LANE | EDINA | MN | 55439 | 411728753 | 501(C)(3) | $300,000 | $0 | N/A | N/A | GENERAL ASSISTANCE |
| MOUNT OLIVET CAREVIEW HOME | ||||||||||
| 7171 OHMS LANE | EDINA | MN | 55439 | 410802697 | 501(C)(3) | $300,000 | $0 | N/A | N/A | GENERAL ASSISTANCE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE TRANSFERS WERE MADE TO THE MEMBERS, WHO ARE BOTH 501 (C)(3) ORGANIZATIONS, AND WERE USED FOR GENERAL OPERATING SUPPORT. NO FOLLOW-UP OR OVERSIGHT WAS CONDUCTED REGARDING THE SPECIFIC USE OF TRANSFERRED FUNDS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SARAH VAN WINKLE | ||||||||||||||
| PRESIDENT/CEO | $183,312 | $0 | $17,065 | $0 | $711 | $0 | $6,258 | $0 | $4,149 | $0 | $211,495 | $0 | $0 | $0 |
| STACY LYSEN | ||||||||||||||
| DIRECTOR OF NURSING | $128,626 | $0 | $10,100 | $0 | $100 | $0 | $5,935 | $0 | $34,945 | $0 | $179,706 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | 1. BERNADINE CABLE-PROKOP AND SHARON WILSON HAVE A BUSINESS RELATIONSHIP. 2. EILEEN CARTWRIGHT AND TIMOTHY HOKANSON HAVE A BUSINESS RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 3 | CASSIA SERVICES PROVIDES THE FOLLOWING SERVICES TO AUGUSTANA MOUNT OLIVET HOSPICE CARE, LLC: FINANCIAL ACCOUNTING, OPERATIONAL OVERSIGHT, HUMAN RESOURCES, INFORMATION TECHNOLOGY, CLINICAL NURSING CONSULTATION, CORPORATE COMPLIANCE, COORDINATED ADVERTISING & MARKETING, PHILANTHROPY, AND NEW BUSINESS DEVELOPMENT. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEMBERS OF THE ORGANIZATION ARE AUGUSTANA CARE AND MOUNT OLIVET CAREVIEW HOME, BOTH MINNESOTA NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501C3 OF THE CODE AND AFFILIATED WITH THE EVANGELICAL LUTHERAN CHURCH OF AMERICA. THE INCUMBENT CHIEF EXECUTIVE OFFICER OF EACH MEMBER SHALL BE THE MEMBER DELEGATE OF EACH MEMBER ENTITLED TO VOTE ON BEHALF OF THE VOTING INTERESTS OF EACH MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF GOVERNORS SHALL CONSIST OF AT LEAST SIX GOVERNORS, THREE OF WHOM SHALL BE APPOINTED BY THE MEMBER DELEGATE OF AUGUSTANA CARE AND THREE OF WHOM SHALL BE APPOINTED BY THE MEMBER DELEGATE OF MOUNT OLIVET CAREVIEW HOME. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE ARTICLES OF ORGANIZATION AND THE BYLAWS OF THIS ORGANIZATION MAY BE AMENDED OR RESTATED ONLY BY THE UNANIMOUS APPROVAL OF THE MEMBERS. ANY PROPOSED AMENDMENTS RELATING TO THE AFFILIATION REQUIREMENTS OF THE ELCA SHALL BE SUBMITTED TO THE ELCA FOR COMMENT PRIOR TO THEIR EFFECTIVE DATE. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM 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 | INFORMATION REGARDING THE HOSPICE'S POLICY ON CONFLICTS OF INTEREST IS PROVIDED DURING ORIENTATION OF NEW STAFF, VOLUNTEERS, AND BOARD MEMBERS. MEMBERS OF THE BOARD OF DIRECTORS AND HOSPICE STAFF SUBMIT A FORM TO DISCLOSE PERSONAL OR FINANCIAL INTERESTS THAT COULD POTENTIALLY INTERFERE WITH THEIR DUTIES AND RESPONSIBILITIES TO GRACE HOSPICE. DISCLOSURE FORMS ARE SUBMITTED AT THE TIME OF HIRE OR BOARD APPOINTMENT, ANNUALLY, AND WHENEVER A POTENTIAL CONFLICT ARISES. FAILURE TO DISCLOSE EXISTING OR POTENTIAL CONFLICTS OF INTEREST IS GROUNDS FOR TERMINATION OF EMPLOYMENT OR BOARD APPOINTMENT. POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED BY THE BOARD OF DIRECTORS AND/OR BY THE HOSPICE ADMINISTRATOR TO DETERMINE APPROPRIATE ACTION. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE COMPENSATION FOR SARAH VAN WINKLE, PRESIDENT/CEO, IS SET BY TWO REPRESENTATIVES OF THE PARTNERING AGENCIES: BOB DAHL, CEO OF AUGUSTANA CARE, AND TIM HOKANSON, ADMINISTRATOR OF MOUNT OLIVET CAREVIEW HOME AND APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS. THEY SET SARAH'S COMPENSATION BY REVIEWING SALARY SURVEYS SPECIFIC TO HOSPICE AGENCIES. ADDITIONALLY, THEY REVIEW FINANCIAL OUTCOMES, GROWTH OUTCOMES, QUALITY INDICATORS, AND STAFF RETENTION. THIS PROCESS WAS LAST PERFORMED IN 2021. |
| 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 IX, LINE 11G | OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 3,995,986. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,995,986. |
| FORM 990, PART XII, LINE 2C: | OVERSIGHT OF THE AUDIT PROCESS IS HANDLED BY THE BOARD OF DIRECTORS. |