2021-11-08T10:31:59-06:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2020-01-01 411728753 AUGUSTANA CARE AUGU 9528555000 7171 OHMS LANE EDINA MN 55439 KATHY YOUNGQUIST CFO 9528555000 2021-11-05 1 KATHY YOUNGQUIST 999009999 MATT WOCKEN P01598291 6123764500 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z ROBERT DAHL 7171 OHMS LANE EDINA MN 55439 60401333 0 X WWW.CASSIALIFE.ORG X 1991 MN TO PROVIDE HEALTHCARE, HOUSING AND COMMMUNITY SERVICES FOR THE ELDERLY. 9 9 1856 357 10769069 76096 1519913 4050654 13848027 55597867 53123 136722 209042 175076 15630105 59960319 303082 186578 0 0 9525334 39015894 0 0 203692 4963174 21003420 14791590 60205892 838515 -245573 98716118 109644831 85295866 97290559 13420252 12354272 X TO FOSTER FULLNESS OF LIFE FOR OLDER ADULTS IN THE SPIRIT OF CHRIST'S LOVE. 0 0 25185475 16219 28215821 THE EXPENSES LISTED ABOVE ARE RELATED TO DIRECT COSTS ASSOCIATED WITH THE PROVISION OF ASSISTED LIVING SERVICES AT AUGUSTANA ELK RUN ASSISTED LIVING IN EVERGREEN, CO, AUGUSTANA REGENT IN BURNSVILLE, MN, AUGUSTANA OAKVIEW CARE IN MOOSE LAKE, MN, CASTLE PEAK SENIOR CARE IN EAGLE, CO, AND THROUGH AUGUSTANA RESIDENTIAL CARE. EXPENSES FOR EMERALD CREST ASSISTED LIVING AND MEMORY CARE, A SPECIALIZED PROGRAM FOR ADULTS WITH MEMORY LOSS AT FOUR SITES IN THE SUBURBAN MINNEAPOLIS AREA ARE ALSO INCLUDED. EMERALD CREST EMPLOYS A MODEL OF STRENGTH-BASED CARE FOR INDIVIDUALS WITH MEMORY LOSS IN SMALLER, HOME-LIKE RESIDENCES WHERE ONE'S DIGNITY, PRIVACY, SAFETY AND QUALITY OF LIFE ARE PRIORITIZED. IN TOTAL, THESE ASSISTED LIVING COMMUNITIES SERVED MORE THAN 521 PEOPLE DURING THE PERIOD ENDING DECEMBER 31, 2020. 16280733 9200 16574997 THE ABOVE TOTAL INCLUDES OPERATING EXPENSES FOR AUGUSTANA MERCY HEALTH CARE CENTER OF MOOSE LAKE, MN, AUGUSTANA LAKESIDE HEALTH CARE CENTER OF DASSEL, MN, AND CASTLE PEAK SENIOR LIVING OF EAGLE, CO. DURING THE PERIOD ENDING DECEMBER 31, 2020, THESE THREE RURAL SKILLED NURSING COMMUNITIES PROVIDED REHABILITATION, SKILLED NURSING AND MEMORY CARE TO 462 PEOPLE. 9321664 161159 0 AS A LONG-TIME PROVIDER OF HEALTH CARE, HOUSING, AND COMMUNITY-BASED SERVICES, 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. THE NOT-FOR-PROFIT COMMUNITIES INCLUDE AUGUSTANA APARTMENTS AND CARDINAL HOMES IN FERGUS FALLS, AND ST. PAUL'S HOME APARTMENTS, SIGNE BURCKHARDT MANOR, THOMAS FEENEY MANOR, AND HERITAGE PARK ALL LOCATED IN MINNEAPOLIS. THE FOR-PROFIT ASSISTED LIVING COMMUNITIES INCLUDE THE PINES IN RICHFIELD, THE ROSEMOUNT IN ROSEMOUNT, OKALEE IN MEDINA, PARKS PLACE IN PLYMOUTH, PRAHA VILLAGE IN NEW PRAGUE, AND RIVER BEND ASSISTED LIVING IN ROCHESTER. SERVICES INCLUDE CONSULTING, MARKETING, LEADERSHIP DEVELOPMENT, INFORMATION SYSTEMS SUPPORT, HOUSING DEVELOPMENT, AND EMPLOYEE RELATIONS. ALTOGETHER, THESE MANAGED FACILITIES SERVED 892 PEOPLE DURING THE PERIOD ENDING DECEMBER 31, 2020. 0 0 0 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. 0 0 0 50787872 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 1 208 0 1856 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 1 0 1 1 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 ROBERT DAHL PRESIDENT/CEO 6.54 33.46 X 0 520872 73644 KATHY KOPP CHIEF STRATEGY OFFICER 6.54 33.46 X 0 447607 93161 KATHY YOUNGQUIST CFO 6.54 33.46 X 0 391409 75089 MATTHEW KERN COO 6.54 33.46 X 0 322194 60097 ANGELA BROWN CHRO 6.54 33.46 X 0 228372 53127 SHARON WILSON CCCO 6.54 33.46 X 0 211131 39181 SHELLY CORNISH ADMINISTRATOR 41.54 0.00 X 200252 0 25269 BRIANNE WOLTERS ADMINISTRATOR 40.00 0.00 X 120583 0 20085 SHAWNA SMITH ADMINISTRATOR 40.00 0.00 X 120623 0 2195 VICKI TOBROXEN HOUSING DIRECTOR 40.77 0.00 X 110968 0 5994 RENEE MICALETTI DIRECTOR OF NURSING 41.54 0.00 X 105822 0 2114 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 MARSHALL MACKAY VICE CHAIR (THRU JUNE 2020) 0.25 2.25 X X 0 0 0 ERIK RICK ELLINGSON TREASURER 0.25 2.25 X X 0 0 0 CHIP PARKS SECRETARY 0.25 2.25 X X 0 0 0 BRUCE CRAWFORD DIRECTOR (THRU AUGUST 2020) 0.25 0.00 X 0 0 0 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 658248 2121585 449956 8 0 1 0 NETWORK THERAPY SERVICES 8120 PENN AVE S SUITE 227 BLOOMINGTON MN 55431 THERAPY SERVICES (PT, OT, ST) 3862738 CASSIA SERVICES 7171 OHMS LANE EDINA MN 55439 MANAGEMENT SERVICES 2665431 ANNLEO INC 2501 BOJI BEND DR STE 200 MILFORD IA 51351 STAFFING SERVICES 460768 CLIFTONLARSONALLEN 220 S 6TH ST STE 300 MINNEAPOLIS MN 55402 PROFESSIONAL SERVICES 450919 INTERIM HEALTHCARE 2950 METRO DR STE 115 BLOOMINGTON MN 55425 STAFFING SERVICES 424590 23 460000 3169198 421456 4050654 ASSISTED LIVING 623000 28215821 28215821 NURSING 623000 16574997 16574997 PAYROLL 541200 8611905 8611905 CONSULTING 541610 2195144 2195144 55597867 133197 133197 256585 441014 -184429 -184429 -37980 -146449 3525 0 3525 3525 3525 4035 0 4035 4035 GAIN ON INVESTMENT IN BUSINESS VE 900003 689537 689537 DIETARY INCOME 722210 97421 97421 CABLE TV INCOME 515100 72471 72471 -503959 -503959 355470 59960319 44790818 10769069 349778 160000 160000 26578 26578 33951296 30530531 3259668 161097 224558 205867 18691 2941619 2375683 565936 1898421 1737694 160727 2887745 2887745 21253 21253 119934 119934 2571217 2050423 514086 6708 204940 202103 2837 991616 614905 369272 7439 1923842 1911617 12225 662201 623914 36385 1902 108747 97734 10698 315 2523516 2520986 2530 3584302 3584302 511684 511684 NURSING SUPPLIES 2023907 2023907 DIETARY EXPENSES 1554308 1554308 LICENSES, PERMITS, FEES 511872 369357 141344 1171 MISCELLANEOUS 309754 271700 38054 492582 128366 341993 22223 60205892 50787872 9214328 203692 9381170 19202702 2377914 102605 307115 3977495 5031661 786250 736250 475786 306774 103918126 33223479 73472188 70694647 0 2403266 1603266 971707 1426152 7145651 7958350 98716118 109644831 6943618 5440856 30250078 25251388 378399 367290 39150669 42946097 8573102 23284928 85295866 97290559 X 13210830 12028017 209422 326255 13420252 12354272 98716118 109644831 X -245573 -20407 -800000 X X 0 1 X 1 0 X 2207536 5981364 2071138 1519913 4050654 15830605 2207536 5981364 2071138 1519913 4050654 15830605 15830605 400118 470588 301507 114313 346166 1632692 8593 147050 155643 429828 432275 962866 239045 359505 2423519 20042459 181187172 0.78990 0.80570 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS INCOME - 2016 AMOUNT: $ 43,497. 2017 AMOUNT: $ 40,449. 2018 AMOUNT: $ 11,384. 2019 AMOUNT: $ 4,033. 2020 AMOUNT: $ 19,534. DIETARY INCOME - 2016 AMOUNT: $ 117,866. 2017 AMOUNT: $ 112,423. 2018 AMOUNT: $ 112,323. 2019 AMOUNT: $ 25,727. 2020 AMOUNT: $ 97,421. HOUSEKEEPING INCOME - 2016 AMOUNT: $ 44,817. 2017 AMOUNT: $ 55,152. 2018 AMOUNT: $ 58,663. 2019 AMOUNT: $ 12,152. 2020 AMOUNT: $ 52,740. VENDING INCOME - 2016 AMOUNT: $ 708. 2017 AMOUNT: $ 637. 2018 AMOUNT: $ 489. 2019 AMOUNT: $ 106. 2020 AMOUNT: $ 964. CABLE TV INCOME - 2016 AMOUNT: $ 55,919. 2017 AMOUNT: $ 65,188. 2018 AMOUNT: $ 76,195. 2019 AMOUNT: $ 19,504. 2020 AMOUNT: $ 72,471. EMERGENCY PULL CORD INCOME - 2016 AMOUNT: $ 39,612. 2017 AMOUNT: $ 39,612. 2018 AMOUNT: $ 40,503. 2019 AMOUNT: $ 10,200. 2020 AMOUNT: $ 40,404. MAINTENANCE INCOME - 2016 AMOUNT: $ 38,494. 2017 AMOUNT: $ 61,474. 2018 AMOUNT: $ 58,876. 2019 AMOUNT: $ 13,865. 2020 AMOUNT: $ 44,799. PENDANT ALARM INCOME - 2016 AMOUNT: $ 4,481. 2017 AMOUNT: $ 5,196. 2018 AMOUNT: $ 7,018. 2019 AMOUNT: $ 1,881. 2020 AMOUNT: $ 5,693. TELEPHONE INCOME - 2016 AMOUNT: $ 25,840. 2017 AMOUNT: $ 22,895. 2018 AMOUNT: $ 22,817. 2019 AMOUNT: $ 11,104. 2020 AMOUNT: $ 46,748. ANNUITY CONVERSION INCOME - 2016 AMOUNT: $ 1,548. 2017 AMOUNT: $ 1,524. 2019 AMOUNT: $ 1,497. 2020 AMOUNT: $ 29,842. FUNDRAISING EVENT INCOME - 2016 AMOUNT: $ 51,857. 2017 AMOUNT: $ 24,710. 2018 AMOUNT: $ 25,873. 2019 AMOUNT: $ 9,375. 2020 AMOUNT: $ 0. GIFT SHOP INCOME - 2016 AMOUNT: $ 5,189. 2017 AMOUNT: $ 3,015. 2018 AMOUNT: $ 1,796. 2019 AMOUNT: $ 217. 2020 AMOUNT: $ 4,035. GAIN ON INVESTMENT IN BUSINESS VENTURES - 2018 AMOUNT: $ 546,929. 2019 AMOUNT: $ 129,384. 2020 AMOUNT: $ 689,537. LOSS ON EXTINGUISHMENT OF DEBT - 2020 AMOUNT: $ -744,683. 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 148900 148900 148750 150 148900 148750 148750 148450 300 148750 148250 200 148450 0.00000 1.00000 0.00000 0 1 1 12834725 12834725 81142913 25983615 55159298 9671272 7239864 2431408 269216 269216 70694647 DUE FROM AFFILIATES 4885472 RESIDENT TRUST FUNDS 102090 FUNDS HELD IN ESCROW 276076 BOND FUNDS 2537058 TENANT SECURITY DEPOSITS 157654 7958350 DUE TO AFFILIATES 18580538 ASSET RETIREMENT OBLIGATION 58674 NOTES PAYABLE TO AFFILIATES 2702069 DEFERRED COMPENSATION LIABILITY 797674 MEDICARE ADVANCE PAYMENT LIABILITY 1145973 23284928 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: WITH THE EXCEPTION OF ITS WHOLLY OWNED, FOR-PROFIT SUBSIDIARY, AUGUSTANA SENIOR DEVELOPMENT, 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. 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) 60000 N/A N/A GENERAL ASSISTANCE AUGUSTANA HOME OF HASTINGS 7171 OHMS LANE EDINA MN 55439 311572624 501(C)(3) 100000 N/A N/A GENERAL ASSISTANCE 2 0 SCHOLARSHIPS 10 25419 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 1 1 0 0 ROBERT DAHL PRESIDENT/CEO 0 452956 0 47554 0 20362 0 57237 0 16407 0 594516 0 147021 KATHY KOPP CHIEF STRATEGY OFFICER 0 243050 0 16581 0 187976 0 58917 0 34244 0 540768 0 182581 KATHY YOUNGQUIST CFO 0 311454 0 50389 0 29566 0 51642 0 23447 0 466498 0 21108 MATTHEW KERN COO 0 295044 0 19208 0 7942 0 37484 0 22613 0 382291 0 0 ANGELA BROWN CHRO 0 189303 0 28674 0 10395 0 32464 0 20663 0 281499 0 12788 SHARON WILSON CCCO 0 187957 0 12683 0 10491 0 27521 0 11660 0 250312 0 0 SHELLY CORNISH ADMINISTRATOR 168847 0 12080 0 19325 0 2364 0 22905 0 225521 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 - $48,475 KATHY YOUNGQUIST, CFO - $40,242 MATTHEW KERN, COO - $26,084 ANGELA BROWN, CHRO - $24,172 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. 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 536630 1400000 28000 1372000 2011 0 0 1 1 B 1185589 1500000 30000 1470000 2007 0 0 1 1 C 875000 875000 2011 0 0 1 1 D 3385000 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 860000 5805000 191680 116100 5497263 2017 0 0 1 1 B 2672 912000 12689 6113 893198 2021 1 0 1 1 C 29302 10000000 139136 64372 9796492 2021 1 0 1 1 D 29302 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 0 0 1 1 0 0 0 1 C 0 0 0 1 1 0 0 0 1 D 0 0 0 1 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, 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 4 THE ARTICLES AND BYLAWS OF AUGUSTANA CARE WERE AMENDED DURING THE YEAR TO CHANGE THE SOLE MEMBER OF THE ORGANIZATION FROM LUTHERAN CONGREGATIONS OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA (ELCA) TO CASSIA, A MINNESOTA NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 6 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 AUGUSTANA CARE BOARD OF DIRECTORS FROM THE SLATE OF NOMINEES SUBMITTED BY THE NOMINATING AND BOARD DEVELOPMENT COMMITTEE. AT LEAST A MAJORITY OF THE DIRECTORS SHALL BE MEMBERS OF LUTHERAN CONGREGATIONS, WITH PREFERENCE TO ELCA CONGREGATIONS. 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 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: EQUITY ADJUSTMENT FOR INVESTMENT WRITE-OFF -800,000. 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. 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