STRATEGY STUDIO / PUBLIC DATA EXPLORER

AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY (EIN 31-1608696)
Tax period
2020-01-01 to 2020-12-31
Filed
2021-11-05
IRS object ID
202113099349301741
Schema version
2020v4.1
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

FieldValueIRS element (for citing)
Return2021-11-05T11:47:56-05:00ReturnTs
Tax Period End2020-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1220 S 6TH STREET SUITE 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55402ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN311608696EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1AUGUSTANA HEALTH CARE CENTERBusinessNameLine1Txt
Business Name Line2OF APPLE VALLEYBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlAUGUBusinessNameControlTxt
Phone9528555000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line17171 OHMS LANEAddressLine1Txt
CityEDINACityNm
State AbbreviationMNStateAbbreviationCd
ZIP55439ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKATHY YOUNGQUISTPersonNm
Person TitleCFOPersonTitleTxt
Phone9528555000PhoneNum
Signature2021-11-04SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstKATHYPersonFirstNm
Person LastYOUNGQUISTPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMATT WOCKENPreparerPersonNm
PTINP01598291PTIN
Phone6123764500PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1AUGUSTANA CARE HEALTH ANDBusinessNameLine1Txt
Business Name Line2REHABILITATION OF APPLE VALLEYBusinessNameLine2Txt
FieldValueIRS element (for citing)
Principal OfficerROBERT DAHLPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line17171 OHMS LANEAddressLine1Txt
CityEDINACityNm
State AbbreviationMNStateAbbreviationCd
ZIP55439ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$21,540,295GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CASSIALIFE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1998FormationYr
Legal Domicile StateMNLegalDomicileStateCd
Activity Or MissionTO PROVIDE HEALTH CARE, HOUSING AND COMMUNITY SERVICES FOR THE ELDERLY.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee418TotalEmployeeCnt
Total Volunteers52TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$4,983PYContributionsGrantsAmt
CY Contributions Grants$1,492,156CYContributionsGrantsAmt
PY Program Service Revenue$5,281,647PYProgramServiceRevenueAmt
CY Program Service Revenue$19,959,445CYProgramServiceRevenueAmt
PY Investment Income$3,271PYInvestmentIncomeAmt
CY Investment Income$17,583CYInvestmentIncomeAmt
PY Other Revenue$15,190PYOtherRevenueAmt
CY Other Revenue$66,981CYOtherRevenueAmt
PY Total Revenue$5,305,091PYTotalRevenueAmt
CY Total Revenue$21,536,165CYTotalRevenueAmt
PY Grants And Similar Paid$20,202PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$61,363CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$2,895,212PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$12,265,481CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$2,136,138PYOtherExpensesAmt
CY Other Expenses$7,991,870CYOtherExpensesAmt
PY Total Expenses$5,051,552PYTotalExpensesAmt
CY Total Expenses$20,318,714CYTotalExpensesAmt
PY Revenues Less Expenses$253,539PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,217,451CYRevenuesLessExpensesAmt
Total Assets BOY$20,893,838TotalAssetsBOYAmt
Total Assets EOY$22,328,774TotalAssetsEOYAmt
Total Liabilities BOY$17,078,285TotalLiabilitiesBOYAmt
Total Liabilities EOY$17,291,704TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$3,815,553NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$5,037,070NetAssetsOrFundBalancesEOYAmt
MissionTO FOSTER FULLNESS OF LIFE FOR OLDER ADULTS IN THE SPIRIT OF CHRIST'S LOVE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$17,901,428ExpenseAmt
Grant$61,363GrantAmt
Revenue$19,958,939RevenueAmt
DescAUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY OPERATES A 200 BED LICENSED NURSING FACILITY IN APPLE VALLEY, MINNESOTA. THE FACILITY OFFERS LONG-TERM CARE AND TRANSITIONAL CARE, AND THERAPEUTIC AND REHABILITATION SERVICES. DURING THE PERIOD ENDED DECEMBER 31, 2020 THE CARE CENTER SERVED 615 RESIDENTS.Desc
Total Program Service Expenses$17,901,428TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee418EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonKATHY YOUNGQUIST - CASSIA SERVICESPersonNm
Phone9528555000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line17171 OHMS LANEAddressLine1Txt
CityEDINACityNm
State AbbreviationMNStateAbbreviationCd
ZIP55439ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeIndIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
ROBERT DAHL
PRESIDENT/CEO3.5836.42Yes (X)$0$520,872$73,644
KATHY KOPP
CHIEF STRATEGY OFFICER3.5836.42Yes (X)$0$447,607$93,161
KATHY YOUNGQUIST
CFO3.5836.42Yes (X)$0$391,409$75,089
MATTHEW KERN
COO3.5836.42Yes (X)$0$322,194$60,097
ANGELA BROWN
CHRO3.5836.42Yes (X)$0$228,372$53,127
SHARON WILSON
CHIEF CLINICAL & COMPLIANC3.5836.42Yes (X)$0$211,131$39,181
EVANS NYARIKI
LPN77.910.00$155,603$0$7,539Yes (X)
GLEN SHAW
NURSING HOME ADMINISTRATOR40.850.00$143,661$0$26,212Yes (X)
MERCY BERKO
NURSING ASSISTANT80.690.00$118,242$0$19,421Yes (X)
SILVIJA KANCANS
RN47.990.00$103,257$0$25,076Yes (X)
RUTH NYAKERIGA
NURSE ASSISTANT72.660.00$103,055$0$22,432Yes (X)
REV DR GARY WILKERSON
CHAIR0.252.25Yes (X)$0$0$0Yes (X)
TIMOTHY KUCK
VICE CHAIR0.252.25Yes (X)$0$0$0Yes (X)
MARSHALL MACKAY
VICE CHAIR (THRU JUNE 2020)0.252.25Yes (X)$0$0$0Yes (X)
ERIK RICK ELLINGSON
TREASURER0.252.25Yes (X)$0$0$0Yes (X)
CHIP PARKS
SECRETARY0.252.25Yes (X)$0$0$0Yes (X)
JERRY NYE
DIRECTOR0.253.50$0$0$0Yes (X)
SCOTT RAMSDALE
DIRECTOR0.252.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$623,818TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,121,585TotReportableCompRltdOrgAmt
Total Other Compensation$494,979TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K7IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CASSIA SERVICESBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line17171 OLMS LANEAddressLine1Txt
CityEDINACityNm
State AbbreviationMNStateAbbreviationCd
ZIP55439ZIPCd
FieldValueIRS element (for citing)
ServicesMANAGEMENT SERVICESServicesDesc
Compensation$1,288,533CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Government Grants$1,477,002GovernmentGrantsAmt
All Other Contributions$15,154AllOtherContributionsAmt
Total Contributions$1,492,156TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescNURSING FACILITIESDesc
Business623000BusinessCd
Total Revenue Column$19,959,445TotalRevenueColumnAmt
Related Or Exempt Func Income$19,959,445RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$19,959,445TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$18,089TotalRevenueColumnAmt
Exclusion$18,089ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$590RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$590RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$590TotalRevenueColumnAmt
Exclusion$590ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$3,624OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$4,130OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$506OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$506TotalRevenueColumnAmt
Related Or Exempt Func Income-$506RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
MISCELLANEOUS INCOME900099$33,160$33,160
TELEPHONE INCOME812900$15,950$15,950
VENDING INCOME900099$5,501$5,501

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$11,780TotalRevenueColumnAmt
Exclusion$11,780ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$66,391OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$21,536,165TotalRevenueColumnAmt
Related Or Exempt Func Income$19,958,939RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$85,070ExclusionAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$61,363TotalAmt
Program Services$61,363ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$10,182,132TotalAmt
Program Services$9,790,019ProgramServicesAmt
Management And General$392,113ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$176,980TotalAmt
Program Services$170,165ProgramServicesAmt
Management And General$6,815ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,084,795TotalAmt
Program Services$1,043,020ProgramServicesAmt
Management And General$41,775ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$821,574TotalAmt
Program Services$789,935ProgramServicesAmt
Management And General$31,639ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,403,673TotalAmt
Program Services$115,140ProgramServicesAmt
Management And General$1,288,533ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$12,617TotalAmt
Management And General$12,617ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$23,388TotalAmt
Management And General$23,388ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$975,605TotalAmt
Program Services$869,176ProgramServicesAmt
Management And General$106,429ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$26,164TotalAmt
Management And General$26,164ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$304,381TotalAmt
Program Services$233,972ProgramServicesAmt
Management And General$70,409ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$272,898TotalAmt
Program Services$272,898ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,127TotalAmt
Program Services$764ProgramServicesAmt
Management And General$363ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$32,081TotalAmt
Program Services$28,616ProgramServicesAmt
Management And General$3,465ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$637,407TotalAmt
Program Services$637,407ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$722,776TotalAmt
Program Services$722,776ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$165,210TotalAmt
Management And General$165,210ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
NURSING SUPPLIES$1,889,260$1,889,260
DIETARY EXPENSES$574,603$574,603
LICENSES, PERMITS, FEES$528,487$520,900$7,587
MISCELLANEOUS$180,496$168,142$12,354

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$241,697TotalAmt
Program Services$13,272ProgramServicesAmt
Management And General$228,425ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$20,318,714TotalAmt
Program Services$17,901,428ProgramServicesAmt
Management And General$2,417,286ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$664,060BOYAmt
EOY$1,840,899EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,650,359BOYAmt
EOY$2,226,929EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$2,526,764BOYAmt
EOY$2,702,069EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$311,818BOYAmt
EOY$246,925EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$21,248,232LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$8,997,950LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$12,691,583BOYAmt
EOY$12,250,282EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,049,254BOYAmt
EOY$3,061,670EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$20,893,838BOYAmt
EOY$22,328,774EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$950,900BOYAmt
EOY$1,121,864EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$16,012,783BOYAmt
EOY$15,453,224EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$23,855BOYAmt
EOY$48,592EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$90,747BOYAmt
EOY$668,024EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$17,078,285BOYAmt
EOY$17,291,704EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,806,654BOYAmt
EOY$5,029,536EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$8,899BOYAmt
EOY$7,534EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,815,553BOYAmt
EOY$5,037,070EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$20,893,838BOYAmt
EOY$22,328,774EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$1,217,451ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$4,066NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$362,466CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$428,698CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$13,398CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$4,983CurrentTaxYearMinus1YearAmt
Current Tax Year$1,492,156CurrentTaxYearAmt
Total$2,301,701TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$18,466,351CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$19,472,063CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$21,229,609CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,281,647CurrentTaxYearMinus1YearAmt
Current Tax Year$19,959,445CurrentTaxYearAmt
Total$84,409,115TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$18,828,817CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$19,900,761CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$21,243,007CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,286,630CurrentTaxYearMinus1YearAmt
Current Tax Year$21,451,601CurrentTaxYearAmt
Total$86,710,816TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$86,710,816PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$48,411CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$13,782CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$13,792CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$3,773CurrentTaxYearMinus1YearAmt
Current Tax Year$18,089CurrentTaxYearAmt
Total$97,847TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$48,411CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$13,782CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$13,792CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$3,773CurrentTaxYearMinus1YearAmt
Current Tax Year$18,089CurrentTaxYearAmt
Total$97,847TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$58,492CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$64,287CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$110,093CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$14,688CurrentTaxYearMinus1YearAmt
Current Tax Year$66,391CurrentTaxYearAmt
Total$313,951TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$18,935,720CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$19,978,830CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$21,366,892CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,305,091CurrentTaxYearMinus1YearAmt
Current Tax Year$21,536,081CurrentTaxYearAmt
Total$87,122,614TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99530PublicSupportCY509Pct
Public Support PY5091.00000PublicSupportPY509Pct
Investment Income CY0.00110InvestmentIncomeCYPct
Investment Income PY0.00150InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME:MISCELLANEOUS INCOME FROM TENANTS - 2016 AMOUNT: $ 12,285. 2017 AMOUNT: $ 15,119. 2018 AMOUNT: $ 71,085. 2019 AMOUNT: $ 6,695. 2020 AMOUNT: $ 33,160. TELEPHONE INCOME FROM TENANTS - 2016 AMOUNT: $ 15,511. 2017 AMOUNT: $ 15,792. 2018 AMOUNT: $ 15,132. 2019 AMOUNT: $ 3,829. 2020 AMOUNT: $ 15,950. DIETARY INCOME FROM TENANTS - 2016 AMOUNT: $ 5,886. 2017 AMOUNT: $ 6,967. 2018 AMOUNT: $ 7,425. 2019 AMOUNT: $ 1,881. 2020 AMOUNT: $ 2,317. GIFT SHOP INCOME FROM TENANTS - 2016 AMOUNT: $ 1,406. 2017 AMOUNT: $ 4,130. 2018 AMOUNT: $ -620. 2019 AMOUNT: $ 909. 2020 AMOUNT: $ 5,410. CABLE TV INCOME FROM TENANTS - 2016 AMOUNT: $ 16,393. 2017 AMOUNT: $ 13,766. 2018 AMOUNT: $ 5,600. 2019 AMOUNT: $ 1,024. 2020 AMOUNT: $ 4,053. VENDING INCOME - 2016 AMOUNT: $ 7,011. 2017 AMOUNT: $ 8,513. 2018 AMOUNT: $ 11,471. 2019 AMOUNT: $ 350. 2020 AMOUNT: $ 5,501.
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

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,915BeginningYearBalanceAmt
Investment Earnings Or Losses$46InvestmentEarningsOrLossesAmt
Other Expenditures$46OtherExpendituresAmt
End Year Balance$1,915EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,915BeginningYearBalanceAmt
Investment Earnings Or Losses$48InvestmentEarningsOrLossesAmt
Other Expenditures$48OtherExpendituresAmt
End Year Balance$1,915EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,915BeginningYearBalanceAmt
End Year Balance$1,915EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,915BeginningYearBalanceAmt
Investment Earnings Or Losses$47InvestmentEarningsOrLossesAmt
Other Expenditures$47OtherExpendituresAmt
End Year Balance$1,915EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,915BeginningYearBalanceAmt
Investment Earnings Or Losses$50InvestmentEarningsOrLossesAmt
Other Expenditures$50OtherExpendituresAmt
End Year Balance$1,915EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,431,120OtherCostOrOtherBasisAmt
Book Value$1,431,120BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$16,263,592OtherCostOrOtherBasisAmt
Depreciation$6,150,936DepreciationAmt
Book Value$10,112,656BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,475,996OtherCostOrOtherBasisAmt
Depreciation$2,847,014DepreciationAmt
Book Value$628,982BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$77,524OtherCostOrOtherBasisAmt
Book Value$77,524BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$12,250,282TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDescBook ValueBookValueAmt
ASSETS UNDER BOND AND MORTGAGE INDENTURE AGREEMENTS$1,050,728
BENEFICIAL INTEREST IN NET ASSETS OF THE FOUNDATION$1,915
DUE FROM AFFILIATES$2,009,027
FieldValueIRS element (for citing)
Total Book Value Other Assets$3,061,670TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
ASSET RETIREMENT OBLIGATION$5,560
COVID MC ADVANCE PAYMENT LIABILITY$662,464
FieldValueIRS element (for citing)
Total Liability$668,024TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
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.
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: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.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeSCHOLARSHIPSGrantTypeTxt
Recipient19RecipientCnt
Cash Grant$61,363CashGrantAmt
Valuation Method UsedN/AValuationMethodUsedDesc
Non Cash AssistanceN/ANonCashAssistanceDesc

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationRECIPIENTS 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 A 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 COMPLETING 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 FROM THEIR LAST PAYCHECK.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (1)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsYes (1)CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
ROBERT DAHL
PRESIDENT/CEO$0$452,956$0$47,554$0$20,362$0$57,237$0$16,407$0$594,516$0$147,021
KATHY KOPP
CHIEF STRATEGY OFFICER$0$243,050$0$16,581$0$187,976$0$58,917$0$34,244$0$540,768$0$182,581
KATHY YOUNGQUIST
CFO$0$311,454$0$50,389$0$29,566$0$51,642$0$23,447$0$466,498$0$21,108
MATTHEW KERN
COO$0$295,044$0$19,208$0$7,942$0$37,484$0$22,613$0$382,291$0$0
ANGELA BROWN
CHRO$0$189,303$0$28,674$0$10,395$0$32,464$0$20,663$0$281,499$0$12,788
SHARON WILSON
CHIEF CLINICAL & COMPLIANC$0$187,957$0$12,683$0$10,491$0$27,521$0$11,660$0$250,312$0$0
EVANS NYARIKI
LPN$137,763$0$17,840$0$0$0$0$0$7,539$0$163,142$0$0$0
GLEN SHAW
NURSING HOME ADMINISTRATOR$133,204$0$7,689$0$2,768$0$5,348$0$20,864$0$169,873$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3THE 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 4BTHE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN PROVIDED BY CASSIA SERVICES: KATHY KOPP, CSO - $48,475 KATHY YOUNGQUIST, CFO - $40,242 MATTHEW KERN, COO - $26,084 ANGELA BROWN, CHRO - $24,172
PART I, LINE 6OFFICERS 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 K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1APPLE VALLEY ECONOMIC DEVELOPMENT AUTHORITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Bond Issuer EIN410882559BondIssuerEIN
CUSIP03788ADQ9CUSIPNum
Bond Issued2016-02-29BondIssuedDt
Issue Price$17,610,000IssuePriceAmt
PurposeREFINANCE SERIES 2006, 2011, AND 2012 DEBTPurposeDesc
Defeased0DefeasedInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Pool Financing0PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Retired$2,205,000RetiredAmt
Total Proceeds$17,610,000TotalProceedsAmt
In Reserve Fund$578,029InReserveFundAmt
Issuance Costs From Proceeds$352,200IssuanceCostsFromProceedsAmt
Other Spent Proceeds$16,685,800OtherSpentProceedsAmt
Substantial Completion2014SubstantialCompletionYr
Refunding Tax Exempt BondsYes (1)RefundingTaxExemptBondsInd
Refunding Taxable Bonds0RefundingTaxableBondsInd
Final Allocation MadeYes (1)FinalAllocationMadeInd
Adequate Books And Rec MaintYes (1)AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedPropertyInd
Any Lease Arrangements0AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop0MgmtContractBondFincdPropInd
Any Research Agreements0AnyResearchAgreementsInd
Private Bus Use By Others0.00000PrivateBusUseByOthersPct
Private Bus Concerning UBI0.00000PrivateBusConcerningUBIPct
Total Private Business Use0.00000TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test0BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop0ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond RemdtdYes (1)ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiledInd
Rebate Not Due YetYes (1)RebateNotDueYetInd
Exception To Rebate0ExceptionToRebateInd
No Rebate Due0NoRebateDueInd
Variable Rate Issue0VariableRateIssueInd
Hedge Identified In Bks And Rec0HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGICInd
Gross Proceeds Invested0GrossProceedsInvestedInd
Written Proc To Monitor ReqsYes (1)WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Procedures Corrective ActionYes (1)ProceduresCorrectiveActionInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3A RELATED ORGANIZATION, CASSIA SERVICES, MANAGES ITS OWN AFFILIATES, 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 6THE SOLE MEMBER OF THE ORGANIZATION IS AUGUSTANA CARE. THE SOLE MEMBER OF AUGUSTANA CARE IS CASSIA.
FORM 990, PART VI, SECTION A, LINE 7ATHE 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 7BAUGUSTANA 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 11BTHE 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 12CTHE ORGANIZATION ANNUALLY REQUESTS A CONFLICT OF INTEREST DISCLOSURE FROM EACH BOARD MEMBER 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 C, LINE 19THE 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 CHANGED IN THE CURRENT YEAR AND IS NOW HANDLED BY THE FINANCE COMMITTEE FOR CASSIA AND ITS AFFILIATES.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (33 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
CASSIA
7171 OHMS LANEEDINAMN55439831758728PARENT CO/FUND RAISINGMN501(3)LINE 7N/A0
CASSIA SERVICES
7171 OHMS LANEEDINAMN55439411806946MANAGEMENT SERVICESMN501(3)LINE 12A, I0CASSIA
ELIM CARE INC
7171 OHMS LANEEDINAMN55439411694818HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 70CASSIA
AUGUSTANA CARE
7171 OHMS LANEEDINAMN55439411728753HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 70CASSIA
PIONEER HOUSE ASSISTED LIVING INC
7171 OHMS LANEEDINAMN55439411927112HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM CARE INC
NEW HARMONY CARE CENTER INC
7171 OHMS LANEEDINAMN55439411821882HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM CARE INC
COUNTRY MEADOWS OF MILACA INC
7171 OHMS LANEEDINAMN55439201723948HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM CARE INC
LAKE RIDGE CARE CENTER OF BUFFALO INC
7171 OHMS LANEEDINAMN55439200507069HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM CARE INC
PARK TERRACE ASSISTED LIVING INC
7171 OHMS LANEEDINAMN55439204063752HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM CARE INC
EVANGELICAL RETIREMENT HOMES INC
7171 OHMS LANEEDINAMN55439420868449HEALTH CARE FACILITIES/SERVICESIA501(3)LINE 100ELIM CARE INC
VILLAGE ASSISTED LIVING INC
7171 OHMS LANEEDINAMN55439262086933HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM CARE INC
BAPTIST HOME INC
7171 OHMS LANEEDINAMN55439450232943HEALTH CARE FACILITIES/SERVICESND501(3)LINE 100ELIM CARE INC
THE BAPTIST APARTMENTS INC
7171 OHMS LANEEDINAMN55439450359794HEALTH CARE FACILITIES/SERVICESND501(3)PF0ELIM CARE INC
ELIM SHORES INC
7171 OHMS LANEEDINAMN55439411625095HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM CARE INC
CORNERSTONE ASSISTED LIVING OF PLYMOUTH INC
7171 OHMS LANEEDINAMN55439412013927HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM CARE INC
HAVEN HOMES INC
7171 OHMS LANEEDINAMN55439416045816HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM CARE INC
ELIM SENIOR HOUSING INC
7171 OHMS LANEEDINAMN55439810754064HEALTH CARE FACILITIES/SERVICESFL501(3)LINE 100ELIM CARE INC
NEWTON VILLAGE INC
7171 OHMS LANEEDINAMN55439200044030HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM CARE INC
ELIM HOMES INC
7171 OHMS LANEEDINAMN55439411539761HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM CARE INC
REDEEMER RESIDENCE INC
7171 OHMS LANEEDINAMN55439410711597HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM HOMES INC
PARK VIEW CARE CENTER
7171 OHMS LANEEDINAMN55439410855707HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100ELIM HOMES INC
THE PARK LANE APARTMENTS INC
7171 OHMS LANEEDINAMN55439410972384LOW INCOME HOUSINGMN501(3)LINE 100ELIM CARE INC
ELIM CHILDREN'S CENTER INC
7171 OHMS LANEEDINAMN55439411974507CHILD DAYCAREMN501(3)LINE 100ELIM CARE INC
ELIM CARE FOUNDATION
7171 OHMS LANEEDINAMN55439411694817CHARITABLE FOUNDATIONMN501(3)LINE 12A, I0ELIM CARE INC
COMMUNITY HEALTH FOUNDATION OF WRIGHT COUNTY
7171 OHMS LANEEDINAMN55439363546789CHARITABLE FOUNDATIONMN501(3)PF0ELIM CARE INC
APPLE VALLEY VILLA APARTMENTS
7171 OHMS LANEEDINAMN55439311608691HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100AUGUSTANA CARE
AUGUSTANA CARE FOUNDATION
7171 OHMS LANEEDINAMN55439411360678CHARITABLE FOUNDATIONMN501(3)LINE 12A, I0AUGUSTANA CARE
AUGUSTANA CHAPEL VIEW HOMES INC
7171 OHMS LANEEDINAMN55439410693953HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100AUGUSTANA CARE
AUGUSTANA COMMUNITY PARTNERS
7171 OHMS LANEEDINAMN55439411783680HOME HEALTH CARE SERVICESMN501(3)LINE 100AUGUSTANA CARE
AUGUSTANA HOME OF HASTINGS
7171 OHMS LANEEDINAMN55439311572624HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100AUGUSTANA CARE
AUGUSTANA APARTMENTS OF HASTINGS
7171 OHMS LANEEDINAMN55439311608701HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 100AUGUSTANA CARE
BROOKSIDE SENIOR LIVING
7171 OHMS LANEEDINAMN55439410871848HEALTH CARE FACILITIES/SERVICESMN501(3)LINE 10N/A0
OPEN CIRCLE ADULT DAY CENTER
7171 OHMS LANEEDINAMN55439411424801ADULT DAYCAREMN501(3)LINE 100AUGUSTANA CARE

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
AUGUSTANA SENIOR DEVELOPMENT INC
7171 OHMS LNEDINAMN55439264136110CONSULTINGMNN/AC0
ELIM PREFERRED SERVICES INC
7171 OHMS LNEDINAMN55439411681856MEDICAL SALESMNN/AC0
PREFERRED SENIOR SERVICES INC
7171 OHMS LNEDINAMN55439411942480MANAGEMENT SERVICESMNN/AC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd