2022-11-09T14:19:25-07:00 2021-12-31 990 2021-01-01 311608691 APPLE VALLEY VILLA APARTMENTS APPL 9528555000 7171 Ohms Lane Edina MN 55439 KATHY YOUNGQUIST CHIEF FINANCIAL OFFICER 9528555000 2022-11-08 0 11 1 AAL2 X 2021 2022-09-23 18:48:47Z Robert Dahl 7171 Ohms Lane Edina MN 55439 5207161 0 X www.cassialife.org X 1997 MN TO PROVIDE HEALTH CARE, HOUSING AND COMMUNITY SERVICES FOR THE ELDERLY. 6 6 98 21 0 0 271349 981 4939039 4700440 1179 628 568722 505112 5780289 5207161 1713 0 0 0 2418016 2480576 0 0 0 3071534 3184586 5491263 5665162 289026 -458001 13062958 12354817 13828359 13575225 -765401 -1220408 TO FOSTER FULLNESS OF LIFE FOR OLDER ADULTS IN THE SPIRIT OF CHRIST'S LOVE. 0 0 4265382 0 5207162 APPLE VALLEY VILLA APARTMENTS IS A 208-UNIT SENIOR SERVICE AND CONGREGATE HOUSING COMPLEX IN APPLE VALLEY, MINNESOTA. APPLE VALLEY VILLA APARTMENTS SERVED 263 INDIVIDUALS DURING THE PERIOD ENDED DECEMBER 31, 2021. 0 0 0 4265382 1 0 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 98 1 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X KATHY YOUNGQUIST CASSIA SERVICES 9528555000 7171 Ohms Lane Edina MN 55439 ROBERT DAHL PRESIDENT/CEO 0.69 39.31 X 0 569472 79039 KATHY YOUNGQUIST CHIEF FINANCIAL OFFICER 0.69 39.31 X 0 385391 82587 MATTHEW KERN CHIEF OPERATING OFFICER 0.69 39.31 X 0 324672 83458 KATHY KOPP CHIEF STRATEGIC OFFICER 0.69 39.31 X 0 267750 90300 ANGELA BROWN CHIEF HUMAN RESOURCES OFFICER 0.69 39.31 X 0 236279 60827 SHARON WILSON CHIEF CLINICAL AND COMPLIANCE OFFICER 0.69 31.31 X 0 241179 42698 REV DR GARY WILKERSON CHAIR 0.25 2.25 X X 0 0 0 TIMOTHY KUCK VICE CHAIR 0.25 2.25 X X 0 0 0 ERIK ELLINGSON TREASURER 0.25 2.25 X X 0 0 0 CHIP PARKS SECRETARY 0.25 2.25 X X 0 0 0 JERRY NYE DIRECTOR 0.25 3.5 X 0 0 0 SCOTT RAMSDALE DIRECTOR 0.25 2.00 X 0 0 0 0 2024743 438909 0 0 1 0 CASSIA SERVICES 7171 OHMS LANDE EDINA MN 55439 MANAGEMENT SERVICES 260588 1 0 0 0 0 0 981 0 981 SENIOR APARTMENTS 623000 4700440 4700440 0 0 0 0 0 0 4700440 628 0 0 628 0 0 0 0 0 0 0 0 0 0 0 0 0 DIETARY REVENUE 623990 281876 0 0 281876 TELEPHONE REVENUE 623990 83229 0 0 83229 HOUSEKEEPING REVENUE 623990 70061 0 0 70061 69946 0 0 69946 505112 5207161 4700440 0 505740 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2011080 1557486 453594 0 29713 23011 6702 0 307856 238420 69436 0 131927 102171 29756 0 260588 0 260588 0 1548 0 1548 0 22418 0 22418 0 0 0 0 0 0 0 0 0 0 0 215876 154596 61280 0 29515 0 29515 0 107842 43186 64656 0 17324 0 17324 0 0 0 0 0 531996 457670 74326 897 0 897 0 0 0 0 0 8710 0 8710 0 503583 433226 70357 0 0 0 0 0 857475 737675 119800 0 79282 68205 11077 0 SUPPLIES 169753 162415 7338 0 DIETARY EXPENSES 234526 234526 0 0 BAD DEBT EXPENSE 59511 0 59511 0 83742 52795 30947 0 5665162 4265382 1399780 0 791163 493012 0 0 0 0 206191 172219 0 0 0 0 0 0 0 0 25573 24779 17937624 7979623 10549891 9958001 0 0 0 0 0 0 0 0 1490140 1706806 13062958 12354817 179200 195534 0 0 0 0 0 0 108407 123509 0 0 12227831 11949288 538103 555884 774818 751010 13828359 13575225 X -1536318 -1973544 770917 753136 -765401 -1220408 13062958 12354817 X -458001 0 0 0 -6 3000 X 0 1 X 1 1 1 X 7079 65518 50403 271349 972 395321 4930933 4996295 1240518 4939039 4770440 20877225 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4938012 5061813 1290921 5210388 4771412 21272546 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 21272546 5054 2772 523 2291 628 11268 0 0 0 0 0 0 5054 2772 523 2291 628 11268 0 0 0 0 0 0 553927 562822 153808 567610 505113 2343280 5496993 5627407 1445252 5780289 5277153 23627094 0.90035 0.9018 0.00048 0.0006 X Schedule A, Part III, Line 12 DIETARY INCOME FROM TENANTS: 2017-$358,774, 2018-$369,331, 2019-$97,798, 2020-$362,337, 2021-$281,876 MISCELLANOUS INCOME FROM TENANTS: 2017-$53,220, 2018-$52,731, 2019-$13,532, 2020-$45,200, 2021-$69,946 HOUSKEEPING INCOME FROM TENANTS: 2017-$77,019, 2018-$74,677, 2019-$26,266, 2020-$97,521, 2021-$70,061 TELEPHONE INCEOM FROM TENANTS: 2017-$64,914, 2018-$65,083, 2019-$16,212, 2020-$62,552, 2021-$83,229 Schedule A, Part III, Line 13(f) COLUMN C, 2019, IS FOR A SHORT PERIOD THAT BEGAN ON OCTOBER 1, 2019 AND ENDED ON SEPTEMBER 31, 2019. 0 1 X 525 0 0 0 0 0 525 525 0 0 0 0 0 525 525 0 0 0 0 0 525 525 0 0 0 0 0 525 525 0 0 0 0 0 525 0 1 0 0 1 1 0 1402457 1402457 0 14666107 6645345 8020762 0 0 0 0 0 1710374 1334278 376096 0 158686 0 158686 9958001 TENANT SECURITY DEPOSITS 127917 BENEFICIAL INTEREST IN NET ASSETS OF THE FOUNDATION 525 TAX AND INSURANCE ESCROW 232602 RESIDUAL RECEIPTS ESCROW 629407 RESERVE FOR REPLACEMENTS 713355 DUE FROM AFFILIATE 3000 1706806 0 DUE TO AFFILIATES 751010 751010 X Schedule D, Part IV, Line 2b SECURITY DEPOSITS ARE REQUIRED FOR THE ORGANIZATION'S TENANTS AND INCLUDE RESERVED APARTMENTS IF AMOUNTS ARE PAID BEFORE THE TENANT ACTUALLY MOVES IN. Schedule D, 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 FUNDS DESIGNATED PROGRAM. THE ORGANIZATION'S ENDOWMENT IS HELD AND ADMINISTERED BY AUGUSTANA CARE FOUNDAITON. SEE SCHEDULE R FOR ADDITIONAL DETAILS. Schedule D, Part X, Line 2 THE CORPORATIONS HAS 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 ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME, EXCISE OR OTHER TAXES AND FILES ALL PROPER RETURNS RELATED TO THESE ACTIVITEIS. 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 48337 KATHY YOUNGQUIST CHIEF FINANCIAL OFFICER 0 317931 0 10000 0 57460 0 58286 0 24301 0 467978 0 32615 MATTHEW KERN CHIEF OPERATING OFFICER 0 304172 0 12273 0 8227 0 48009 0 35449 0 408130 0 0 KATHY KOPP CHIEF STRATEGIC OFFICER 0 250790 0 11059 0 5901 0 50739 0 39561 0 358050 0 0 SHARON WILSON CHIEF CLINICAL AND COMPLIANCE OFFICER 0 195286 0 30867 0 15026 0 27967 0 14731 0 283877 0 19279 ANGELA BROWN CHIEF HUMAN RESOURCES OFFICER 0 195671 0 10000 0 30608 0 37914 0 22913 0 297106 0 18838 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. Schedule J, Part II ALL OFFICERS' COMPENSATION WAS PAID BY CASSIA SERVICES, THE MANAGEMENT SERVICES COMPANY. 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 AUGUSTANA CARE. THE SOLE MEMBER OF AUGUSTANA CARE IS CASSIA. 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 AUGUSTANA CARE IS THE SOLE MEMBER OF THE CORPORATION. BOARD MEMBERS OF THE CORPORATION ARE APPOINTED BY THE SOLE MEMBER. DECISIONS OF THE CORPORATION ARE SUBJECT TO APPROVAL BY THE SOLE MEMBER. CERTAIN ACTIONS ARE FURTHER SUBJECT TO APPROVAL BY THE CASSIA BOARD, WHICH IS THE PARENT ORGANIZATION. 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: UNRESRICITED FUND TRANSFER $3,000 CASSIA 7171 OHMS LANE EDINA MN 55439 831758728 PARENT CO/FUND RAISING MN 501(C)(3) 7 N/A 0 CASSIA SERVICES 7171 OHMS LANE EDINA MN 55439 411806946 MANAGEMENT SERVICES MN 501(C)(3) 12 CASSIA 0 ELIM CARE INC 7171 OHMS LANE EDINA MN 55439 411694818 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 7 CASSUA 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 CARE INC 0 PARK VIEW CARE CENTER 7171 OHMS LANE EDINA MN 55439 410855707 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE 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 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 1 0 0 0 0 1 0 0 0 0 1 1 1 1 1 0 1 EXTENSION WAS FILED TIMELY.