2022-11-10T10:05:41-06:00 2021-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2021-01-01 411728753 AUGUSTANA CARE AUGU 9528555000 7171 OHMS LANE EDINA MN 55439 KATHY YOUNGQUIST CFO 9528555000 2022-11-09 1 KATHY YOUNGQUIST 999009999 MATT WOCKEN P01598291 6123764500 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z ROBERT DAHL 7171 OHMS LANE EDINA MN 55439 61363436 0 X WWW.CASSIALIFE.ORG X 1991 MN TO PROVIDE HEALTHCARE, HOUSING AND COMMMUNITY SERVICES FOR THE ELDERLY. 9 9 1822 68 11536355 0 4050654 5237265 55597867 54794316 136722 389936 175076 546781 59960319 60968298 186578 1000924 0 0 39015894 39584019 0 0 0 21003420 21011970 60205892 61596913 -245573 -628615 109644831 116750556 97290559 105334389 12354272 11416167 X TO FOSTER FULLNESS OF LIFE FOR OLDER ADULTS IN THE SPIRIT OF CHRIST'S LOVE. 0 0 24342953 24918 26474949 AUGUSTANA CARE WAS ORGANIZED FOR THE PURPOSE OF OPERATING ASSISTED LIVING FACILITIES FOR THE ELDERLY. AUGUSTANA ELK RUN ASSISTED LIVING IS LOCATED IN EVERGREEN, CO AND HAS 62 UNITS (OCCUPANCY 77.6%). AUGUSTANA REGENT IS LOCATED IN BURNSVILLE, MN AND HAS 148 UNITS (OCCUPANCY 78.8%). AUGUSTANA OAKVIEW CARE IS LOCATED IN MOOSE LAKE, MN AND HAS 30 UNITS (OCCUPANCY 92.3%). CASTLE PEAK SENIOR CARE IS LOCATED IN EAGLE, CO AND HAS 20 UNITS (OCCUPANCY 88.7%). EMERALD CREST ASSISTED LIVING FACILITIES LOCATED IN SHAKOPEE, BURNSVILLE, VICTORIA, AND MINNETONKA, MN AND HAS 43, 67, 34, AND 39 UNITS RESPECTIVELY (OCCUPANCY 70.6%, 89.4%, 79.9% AND 76.8% RESPECTIVELY). 15736098 12524 16757296 AUGUSTANA CARE WAS ORGANIZED FOR THE PURPOSE OF PROVIDING NURSING HOME CARE FOR THE ELDERLY. AUGUSTANA MERCY HEALTH CARE CENTER LOCATED IN MOOSE LAKE, MN HAS 72 BEDS. DURING 2021, TOTAL RESIDENT DAYS FOR THE FACILITY WERE 19,861 (61.1% OCCUPANCY). AUGUSTANA LAKESIDE HEALTH CARE CENTER IS LOCATED IN DASSEL, MN AND HAS 54 BEDS. DURING 2021, TOTAL RESIDENT DAYS FOR THE FACILITY WERE 15,969 (81.0% OCCUPANCY). CASTLE PEAK SENIOR LIVING IS LOCATED IN EAGLE, CO AND HAS 44 BEDS. DURING 2021, TOTAL RESIDENT DAYS FOR THE FACILITY WERE 13,313. 9373311 963482 0 AUGUSTANA CARE APPLIES ITS EXPERIENCE AND IN-DEPTH KNOWLEDGE OF THE HEALTH CARE FIELD TO PROVIDE MANAGEMENT SERVICES FOR OTHER ORGANIZATIONS. AUGUSTANA CASH MANAGEMENT COMPANY, LLC, MANAGES THE CASH INFLOWS AND OUTFLOWS FOR THE AUGUSTANA CARE SUBSIDIARIES. THE EXPENSES LISTED ABOVE ARE FOR AUGUSTANA SENIOR DEVELOPMENT II, LLC, A BUSINESS UNIT OF AUGUSTANA CARE THROUGH WHICH MANAGEMENT SERVICES ARE PROVIDED TO UNRELATED NOT-FOR-PROFIT AND FOR-PROFIT COMMUNITIES IN MINNESOTA. AUGUSTANA CARE'S FORM 990 ALSO INCLUDES FINANCIAL INFORMATION ABOUT A WHOLLY-OWNED SUBSIDIARY OF AUGUSTANA CARE CALLED AUGUSTANA PROPERTIES, LLC. THIS ENTITY OVERSEES EVERYTHING RELATED TO A NUMBER OF RENTAL PROPERTIES THAT HOUSE EMPLOYEES AND MEMBERS OF THE COMMUNITY AT LARGE. 49452362 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 204 0 1822 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X KATHY YOUNGQUIST - CASSIA SERVICES 9528555000 7171 OHMS LANE EDINA MN 55439 REV DR GARY WILKERSON CHAIR 0.25 2.25 X X 0 0 0 TIMOTHY KUCK VICE CHAIR 0.25 2.50 X X 0 0 0 CHARLES PARKS SECRETARY 0.25 2.25 X X 0 0 0 ERIK RICK ELLINGSON TREASURER 0.25 2.25 X X 0 0 0 ROBERT DAHL PRESIDENT/CEO 6.82 33.18 X 0 569472 79039 KATHY KOPP CHIEF STRATEGY OFFICER 6.82 33.18 X 0 385391 82587 KATHY YOUNGQUIST CFO 6.82 33.18 X 0 324672 83458 MATTHEW KERN COO 6.82 33.18 X 0 267750 90300 SHARON WILSON CCCO 6.82 33.18 X 0 236279 60827 ANGELA BROWN CHRO 6.82 33.18 X 0 241179 42698 SHELLY CORNISH ADMINISTRATOR 40.00 0.00 X 206359 0 42344 BRIANNE WOLTERS ADMINISTRATOR 40.00 0.00 X 109087 0 31174 SHAWNA SMITH ADMINISTRATOR 40.00 0.00 X 119257 0 5160 CORA FARMAH 405 CAREGIVEER 78.70 0.00 X 106983 0 27448 SAMSON MATOKE 622 - CAREGIVEER 67.90 0.00 X 104080 0 14718 DUANE HETLAND DIRECTOR 0.25 0.25 X 0 0 0 LARRY KULA DIRECTOR 0.25 0.50 X 0 0 0 JERRY NYE DIRECTOR 0.25 3.50 X 0 0 0 SCOTT RAMSDALE DIRECTOR 0.25 2.00 X 0 0 0 MICHELENE VERLAUTZ DIRECTOR 0.25 0.25 X 0 0 0 645766 2024743 559753 7 0 1 0 NETWORK THERAPY SERVICES 8120 PENN AVENUE S SUITE 227 BLOOMINGTON MN 55431 THERAPY SERVICES (PT, OT, ST) 3789199 CASSIA SERVICES 7171 OHMS LANE EDINA MN 55439 MANAGEMENT SERVICES 1211040 AUREUS NURSING LLC 2425 S 171ST STREET OMAHA NE 68130 STAFFING SERVICES 493031 FUSION MEDICAL STAFFING LLC 11808 GRANT STREET SUITE 100 OMAHA NE 68164 STAFFING SERVICES 483110 BEST OPTION MEDICAL STAFFING 8500 NORMANDALE LAKE BLVD BLOOMINGTON MN 55437 STAFFING SERVICES 465048 11 5138580 98685 5237265 ASSISTED LIVING 623000 26474949 26474949 NURSING 623000 16757296 16757296 PAYROLL 541200 9357491 9357491 CONSULTING 541610 2204580 2204580 54794316 255222 255222 151698 395138 -243440 -243440 -25716 -217724 134714 0 134714 134714 134714 6318 0 6318 6318 GAIN ON INVESTMENT IN BUSINESS VE 900003 490923 490923 DIETARY INCOME 722210 81741 81741 MISCELLANEOUS REVENUE 900099 59788 59788 151451 151451 783903 60968298 43232245 11536355 962433 963482 963482 37442 37442 34080870 29127494 4953376 259078 221423 37655 3462117 2958927 503190 1781954 1522962 258992 2753986 2753986 97028 97028 95593 95593 7095 7095 3765909 3218864 547045 284149 284149 651149 259098 392051 140517 26197 114320 1678030 1510227 167803 56048 8283 47765 141848 141848 2285510 2056959 228551 3351987 3016788 335199 540960 486864 54096 NURSING SUPPLIES 2025026 1888425 136601 DIETARY EXPENSES 1525224 1525134 90 MISCELLANEOUS 927769 257350 670419 LICENSES, PERMITS, FEES 366443 366443 317699 317699 61596913 49452362 12144551 0 19202702 11486468 2377914 2309344 307115 150550 5031661 2513314 736250 550000 306774 162383 104424008 36442572 70694647 67981436 1603266 1603266 1426152 1668955 7958350 28324840 109644831 116750556 5440856 5183093 166818 25251388 24462051 367290 400759 42946097 41603639 23284928 33518029 97290559 105334389 X 12028017 11042934 326255 373233 12354272 11416167 109644831 116750556 -628615 -14343 -295147 0 X X 0 1 X 1 1 1 X 5981364 2071138 1519913 4050654 5237265 18860334 5981364 2071138 1519913 4050654 5237265 18860334 18860334 470588 301507 114313 346166 377729 1610303 147050 147050 432275 962866 239045 359505 790221 2783912 23401599 187354032 0.80590 0.78990 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2017 AMOUNT: $ 40,449. 2018 AMOUNT: $ 11,384. 2019 AMOUNT: $ 4,033. 2020 AMOUNT: $ 19,534. 2021 AMOUNT: $ 59,788. DIETARY INCOME - 2017 AMOUNT: $ 112,423. 2018 AMOUNT: $ 112,323. 2019 AMOUNT: $ 25,727. 2020 AMOUNT: $ 97,421. 2021 AMOUNT: $ 81,741. HOUSEKEEPING INCOME - 2017 AMOUNT: $ 55,152. 2018 AMOUNT: $ 58,663. 2019 AMOUNT: $ 12,152. 2020 AMOUNT: $ 52,740. 2021 AMOUNT: $ 12,026. VENDING INCOME - 2017 AMOUNT: $ 637. 2018 AMOUNT: $ 489. 2019 AMOUNT: $ 106. 2020 AMOUNT: $ 964. 2021 AMOUNT: $ 1,421. CABLE TV INCOME - 2017 AMOUNT: $ 65,188. 2018 AMOUNT: $ 76,195. 2019 AMOUNT: $ 19,504. 2020 AMOUNT: $ 72,471. 2021 AMOUNT: $ 59,209. EMERGENCY PULL CORD INCOME - 2017 AMOUNT: $ 39,612. 2018 AMOUNT: $ 40,503. 2019 AMOUNT: $ 10,200. 2020 AMOUNT: $ 40,404. 2021 AMOUNT: $ 0. MAINTENANCE INCOME - 2017 AMOUNT: $ 61,474. 2018 AMOUNT: $ 58,876. 2019 AMOUNT: $ 13,865. 2020 AMOUNT: $ 44,799. 2021 AMOUNT: $ 6,939. PENDANT ALARM INCOME - 2017 AMOUNT: $ 5,196. 2018 AMOUNT: $ 7,018. 2019 AMOUNT: $ 1,881. 2020 AMOUNT: $ 5,693. 2021 AMOUNT: $ 12,958. TELEPHONE INCOME - 2017 AMOUNT: $ 22,895. 2018 AMOUNT: $ 22,817. 2019 AMOUNT: $ 11,104. 2020 AMOUNT: $ 46,748. 2021 AMOUNT: $ 57,723. ANNUITY CONVERSION INCOME - 2017 AMOUNT: $ 1,524. 2019 AMOUNT: $ 1,497. 2020 AMOUNT: $ 29,842. 2021 AMOUNT: $ 1,175. FUNDRAISING EVENT INCOME - 2017 AMOUNT: $ 24,710. 2018 AMOUNT: $ 25,873. 2019 AMOUNT: $ 9,375. GIFT SHOP INCOME - 2017 AMOUNT: $ 3,015. 2018 AMOUNT: $ 1,796. 2019 AMOUNT: $ 217. 2020 AMOUNT: $ 4,035. 2021 AMOUNT: $ 6,318. GAIN ON INVESTMENT IN BUSINESS VENTURES - 2018 AMOUNT: $ 546,929. 2019 AMOUNT: $ 129,384. 2020 AMOUNT: $ 689,537. 2021 AMOUNT: $ 490,923. LOSS ON EXTINGUISHMENT OF DEBT - 2020 AMOUNT: $ -744,683. FORM 990, SCHEDULE A, COLUMN C: COLUMN C, 2019, IS FOR A SHORT PERIOD THAT BEGAN ON OCTOBER 1, 2019 AND ENDED ON DECEMBER 31, 2019. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 148900 148900 148900 148900 148750 150 148900 148750 148750 148450 300 148750 0.00000 1.00000 0.00000 0 1 1 12837570 12837570 81450552 28731644 52718908 9852197 7710928 2141269 283689 283689 67981436 DUE FROM AFFILIATES 25249786 RESIDENT TRUST FUNDS 97925 FUNDS HELD IN ESCROW 339226 BOND FUNDS 2420248 TENANT SECURITY DEPOSITS 217655 28324840 DUE TO AFFILIATES 32606923 ASSET RETIREMENT OBLIGATION 61607 DEFERRED COMPENSATION LIABILITY 753798 MEDICARE ADVANCE PAYMENT LIABILITY 95701 33518029 X 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. PART X, LINE 2: AUGUSTANA CARE AND ITS AFFILIATES HAVE BEEN GRANTED EXEMPT STATUS RELATIVE TO FEDERAL AND MINNESOTA CORPORATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE CODES. THESE 501(C)(3) ORGANIZATIONS HAVE BEEN CLASSIFIED AS ENTITIES THAT ARE NOT PRIVATE FOUNDATIONS UNDER SECTION 509(A). THE ORGANIZATION 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. AUGUSTANA CARE AND ITS AFFILIATES' INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE ORGANIZATION 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. 1 AUGUSTANA CHAPEL VIEW HOMES 7171 OHMS LANE EDINA MN 55439 410693953 501(C)(3) 600000 0 N/A N/A GENERAL ASSISTANCE AUGUSTANA COMMUNITY PARTNERS 7171 OHMS LANE EDINA MN 55439 411783680 501(C)(3) 363482 0 N/A N/A GENERAL ASSISTANCE 2 0 SCHOLARSHIPS 60 37442 N/A N/A PART I, LINE 2: AUGUSTANA CARE MAKES INTERCOMPANY TRANSFERS TO RELATED ORGANIZATIONS. AUGUSTANA CARE AND THE RELATED ORGANIZATIONS ARE UNDER COMMON MANAGEMENT WHO REGULARLY MONITOR THE USE OF THE FUNDS. RECIPIENTS OF SCHOLARSHIPS 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 AND A DETAILED VERIFICATION OF THE COST 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 ACCOMODATE ANY NECESSARY CHANGES IN WORK HOURS; AND (5) UPON COMPLETION TRAINING FOR WHICH SCHOLARSHIP WAS GRANTED, THE RECIPIENT WILL WORK FOR THE ORGANIZATION AT LEAST TWO YEARS AND A MINIMUM OF 2,000 HOURS OR WILL REIMBURSE THE ORGANIZATION A PRORATED AMOUNT OF EACH SCHOLARSHIP PAYMENT RECEIVED DURING THE PREVIOUS ONE YEAR PERIOD, WHICH WILL BE DEDUCTED FOR THEIR LAST PAYCHECK. X 1 1 X X X X 0 1 0 0 0 0 0 0 0 ROBERT DAHL PRESIDENT/CEO 0 494499 0 48337 0 26636 0 60077 0 18962 0 648511 0 0 KATHY KOPP CHIEF STRATEGY OFFICER 0 317931 0 10000 0 57460 0 58286 0 24301 0 467978 0 0 KATHY YOUNGQUIST CFO 0 304172 0 12273 0 8227 0 48009 0 35449 0 408130 0 0 MATTHEW KERN COO 0 250790 0 11059 0 5901 0 50739 0 39561 0 358050 0 0 SHARON WILSON CCCO 0 195671 0 10000 0 30608 0 37914 0 22913 0 297106 0 0 ANGELA BROWN CHRO 0 195286 0 30867 0 15026 0 27967 0 14731 0 283877 0 0 SHELLY CORNISH ADMINISTRATOR 177304 0 20775 0 8280 0 7830 0 34514 0 248703 0 0 0 PART I, LINE 1A AUGUSTANA CARE PROVIDES VEHICLE BENEFITS FOR SOME OF ITS OFFICERS AND KEY EMPLOYEES. THE EMPLOYEE IS RESPONSIBLE FOR KEEPING TRACK OF THE BUSINESS VERSUS PERSONAL USE OF THE VEHICLE. THE PERSONAL USAGE OF THE VEHICLES IS TREATED AS A TAXABLE BENEFIT PAID OUT BY CASSIA AND ITS AFFILIATES. 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. PART I, LINE 4B 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 PART II ALL OFFICERS' COMPENSATION WAS PAID BY CASSIA SERVICES, THE MANAGEMENT SERVICES COMPANY. A CITY OF DASSEL MN 410851701 2010-09-15 1400000 FACILITY DEVELOPMENT 0 0 0 B CITY OF DASSEL MN 410851701 2007-08-21 1500000 ACQUIRE FACILITY 0 0 0 C COLORADO HEALTH FACILITIES AUTHORITY 840732932 2011-03-31 875000 TO REFINANCE SERIES 2011 BONDS 0 0 0 D CITY OF VICTORIA MN 410997257 92627TAT3 2014-07-31 22110000 TO REFINANCE SERIES 2009 BONDS 0 0 0 A 609537 1400000 28000 1372000 2011 0 0 1 1 B 977515 1500000 30000 1470000 2007 0 0 1 1 C 875000 875000 2011 0 0 1 1 D 4020000 22110000 1075979 442200 21667800 2014 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 0 0 0 0 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: CITY OF VICTORIA, MN DATE THE REBATE COMPUTATION WAS PERFORMED: 08/20/2018 ISSUER NAME: CARLTON COUNTY, MN DATE THE REBATE COMPUTATION WAS PERFORMED: 03/17/2020 A CARLTON COUNTY MN 416005767 142887BB3 2015-03-02 5805000 FACILITY DEVELOPMENT 0 0 0 B CITY OF MILACA MN 416005370 2020-10-01 912000 TO REFINANCE 2012 HUD LOAN AND SERIES 2015 BONDS 0 0 1 C CITY OF LANDFALL VILLAGE MN 411592821 2020-10-01 10000000 TO REFINANCE 2012 HUD LOAN AND SERIES 2015 BONDS 0 0 1 D CITY OF HAMPTON MN 411232259 2020-10-01 10000000 TO REFINANCE 2012 HUD LOAN AND SERIES 2015 BONDS 0 0 1 A 1030000 5805000 191680 116100 5497263 2017 0 0 1 1 B 37431 912000 12689 6113 893198 2021 1 0 1 1 C 410434 10000000 139136 64372 9796492 2021 1 0 1 1 D 410434 10000000 139136 64372 9796492 2021 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 1 0 0 1 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 1 0 0 1 0 0 0 1 A 1 B 1 C 1 D 1 FORM 990, PART VI, SECTION A, LINE 3 A RELATED ORGANIZATION, CASSIA SERVICES, MANAGES ITS OWN AFFILIATES, CASSIA, ELIM CARE, INC., AUGUSTANA CARE AND ALL ELIM/AUGUSTANA AFFILIATES. SERVICES PROVIDED INCLUDE FINANCIAL ACCOUNTING, OPERATIONAL OVERSIGHT, HUMAN RESOURCES, INFORMATION TECHNOLOGY, CLINICAL NURSING CONSULTATION, CORPORATE COMPLIANCE, COORDINATED ADVERTISING AND MARKETING, PHILANTHROPY AND NEW BUSINESS DEVELOPMENT. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS CASSIA. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ORGANIZATION'S GOVERNING DOCUMENTS MUST BE APPROVED BY AN AFFIRMATIVE VOTE OF A MAJORITY OF THE TOTAL NUMBER OF DIRECTORS HOLDING OFFICE AND FOR CERTAIN ISSUES BY THE AFFIRMATIVE VOTE OF A MAJORITY OF VOTING DELEGATES OF CASSIA, THE SOLE MEMBER. 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 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 XII, LINE 2C OVERSIGHT OF THE AUDIT PROCESS IS HANDLED BY THE FINANCE COMMITTEE FOR CASSIA AND ITS AFFILIATES. REPLACEMENT RESERVES LLC 7171 OHMS LANE EDINA MN 55439 752990222 HOME HEALTH SERVICES MN 0 0 AUGUSTANA CARE AUGUSTANA DASSEL LAKESIDE COMMUNITY HOME LLC 439 WILLIAM AVENUE EAST DASSEL MN 55325 208916091 NURSING/ASSISTED LIVING FACILITY MN 6996965 5668280 AUGUSTANA CARE AUGUSTANA SENIOR DEVELOPMENT II LLC 7171 OHMS LANE EDINA MN 55439 481293891 CONSULTING MN 11562071 491335 AUGUSTANA CARE AUGUSTANA MERCY CARE CENTER LLC 710 S KENWOOD AVENUE MOOSE LAKE MN 55767 271466676 NURSING/ASSISTED LIVING FACILITY MN 7867974 6239851 AUGUSTANA CARE AUGUSTANA LAND DEVELOPMENT LLC 14650 GARRETT AVENUE APPLE VALLEY MN 55124 271456660 LAND DEVELOPMENT MN 0 2219218 AUGUSTANA CARE AUGUSTANA ELK RUN LLC 31383 FROST WAY EVERGREEN CO 80439 273219747 ASSISTED LIVING MN 2922572 6282932 AUGUSTANA CARE AUGUSTANA EMERALD CARE LLC 451 EAST TRAVELERS TRAIL BURNSVILLE MN 55337 271279704 MEMORY CARE MN 12219018 22683347 AUGUSTANA CARE AUGUSTANA REGENT AT BURNSVILLE LLC 14500 REGENT LANE BURNSVILLE MN 55306 208915982 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