2021-11-01T15:14:57-07:00 2020-12-31 990 2020-01-01 416045816 HAVEN HOMES INC HAVE 9528555000 7171 Ohms Lane Edina MN 55439 Kathy Youngquist CFO 9528555000 2021-11-01 0 11 1 AAL2 X 2020 2022-09-23 18:48:47Z Robert Dahl 7171 Ohms Lane Edina MN 55439 6068925 0 X www.cassialife.org X 1965 MN TO PROVIDE HEALTH CARE, HOUSING AND SERVICES FOR THE ELDERLY. 4 4 193 43 0 0 0 420811 5785735 5608187 8136 1524 6527 38403 5800398 6068925 0 0 0 0 3700655 4142336 0 0 0 2026857 2308393 5727512 6450729 72886 -381804 45736543 48238887 42622937 45055224 3113606 3183663 TO FOSTER FULLNESS OF LIFE FOR OLDER ADULTS IN THE SPIRIT OF CHRIST'S LOVE. 0 0 4921852 4862682 HAVEN HOMES, INC. WAS ORGANIZED FOR THE PURPOSE OF PROVIDING NURSING HOME CARE FOR THE ELDERLY. IT IS LOCATED IN MAPLE PLAIN, MINNESOTA AND HAS 52 BEDS IN SERVICES. DURING 2020, TOTAL RESIDENT DAYS WERE 14,130 (74.3% OCCUPANCY). UTILIZATION BY PAYOR SOURCE WAS AS FOLLOWS: 54% MEDICAL ASSISTANCE, 5% MEDICARE, 33% PRIVATE PAY AND 8% HMO. 767587 745505 BRYANT HOUSE WAS ORGANIZED FOR THE PURPOSE OF OPERATING AN ASSISTED LIVING FACILITY FOR THE ELDERLY. IT HAS 21 UNITS AND IS ATTACHED TO TEH HAVEN HOMES NURSING HOME. DURING 2020, TOTAL RESIDENT DAYS WERE 5,404 (70.5% OCCUPANCY). 0 0 0 5689439 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 11 0 1 193 1 0 0 0 0 0 0 0 0 X 4 4 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X KATHY L YOUNGQUIST 9528555000 7171 Ohms Lane Edina MN 55439 ROBERT DAHL PRESIDENT/CEO 0.84 36.16 X 0 520872 73644 KATHY KOPP CHIEF STRATEGIC OFFICER 0.84 39.16 X 0 447607 93161 KATHY YOUNGQUIST CHIEF FINANCIAL OFFICER 0.84 39.16 X 0 391409 75089 MATTHEW KERN CHIEF OPERATING OFFICER 0.84 39.16 X 0 322194 60097 ANGELA BROWN CHIEF HUMAN RESOURCE OFFICER 0.84 39.16 X 0 228372 53127 SHARON WILSON CHIEF CLINICAL AND COMPLIANCE OFFICER 0.84 39.16 X 0 211131 39181 STANN LEFF DIRECTOR AND VICE CHAIRPERSON 0.25 2.25 X X 0 0 0 JERRY NYE DIRECTOR 0.25 3.50 X 0 0 0 ROLAND PETERSON DIRECTOR AND CHAIRPERSON 0.25 1.50 X X 0 0 0 DOCTOR GUY TANGEDAHL DIRECTOR AND SECRETARY/TREASURER 0.25 2.25 X X 0 0 0 0 2121585 394299 0 0 1 0 CASSIA SERVICES 7171 OHMS LANE EDINA MN 55439 MANAGEMENT SERVICES 316529 PRO REHAB 7171 OHMS LANE EDINA MN 55439 THERAPY SERVICES 257082 ANN LEO LLC 2501 BOJI BEND DRIVE MILFORD IA 51351 NURSING POOLED SERVICES 103836 3 0 0 0 0 420811 0 0 420811 NURSING HOME REVENUE 623000 4862682 4862682 0 0 ASSISTED LIVING REVENUE 623990 745505 745505 0 0 0 0 0 0 5608187 1524 1524 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Other Misc Revenue 900099 38403 38403 0 0 0 0 0 0 38403 6068925 5648114 0 0 3416252 3327802 88450 0 458749 446872 11877 0 267335 260413 6922 0 242620 0 242620 0 19579 0 19579 0 2995 0 2995 0 546730 489588 57142 0 60273 0 60273 0 100350 32513 67837 0 33142 0 33142 0 124222 113106 11116 0 3274 0 3274 0 5557 0 5557 0 87113 79318 7795 0 169081 153952 15129 0 52821 48095 4726 0 Supplies 366682 363280 3402 0 License Surcharge 134182 134182 0 0 Food 162365 162365 0 0 Maintenance Contracts/Purchased Services 58859 53592 5267 0 138548 24361 114187 0 6450729 5689439 761290 0 202042 244201 560768 747605 12800 18164 35098298 1923 1992597 35096375 670000 670000 42298336 11462542 45736543 48238887 86482 192043 39803907 39652126 20768 23537 0 0 2711780 5187518 42622937 45055224 X 2950704 2984618 162902 199045 3113606 3183663 45736543 48238887 X -381804 -78206 0 0 0 530067 X X 0 1 X 1 0 X 5663592 5471990 5770826 5785735 5608187 28300330 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5663592 5471990 5770826 5785735 5608187 28300330 0 0 0 0 0 0 3039663 2958179 3144468 3181136 3263397 15586843 3039663 2958179 3144468 3181136 3263397 15586843 12713487 3536 4224 8369 8137 1524 25790 0 0 0 0 0 0 3536 4224 8369 8137 1524 25790 0 0 0 0 0 0 2552 4335 6221 6527 7843 27478 5669680 5480549 5785416 5800399 5617554 28353598 0.44839 0.4879 0.00091 0.0009 X Schedule A, Part III, Line 12 Vending/Misc. Income RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 0 1813496 1813496 0 31283628 0 31283628 0 0 0 0 0 2001174 1923 1999251 0 0 0 0 35096375 Due from Affiliates 214953 Other Misc Receivable 10383 Resident Trust Cash 1337 Bond Reserve Fund 2350283 Bond Interest Reserve Fund 1159958 Cost of Issuance Fund 23025 Working Capital Fund 818012 Project Fund 5059153 Assets Held for Sale 1825438 11462542 0 Wages and Benefits Payable 378897 Interest Payble 883490 Due to Affiliates 23824 Other Misc Payble 186843 Construction Payable 3714464 5187518 X Schedule D, Part IV, Line 2b THE ORGANIZATION HOLD, IN TRUST, FUNDS ADVANCED BY RESIDENTS TO BE USED AT EACH RESIDENT'S DISCRETION. THE FUNDS ARE MAINTAINED IN A SEPARATE INTEREST-BEARING SAVINGS ACCOUNTS AND THE ORGANIZATION HAS A FIDUCIARY RESPONSIBLITY 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. Schedule D, Part X, Line 2 THE CORPORATION 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 ACTIVITIES. X 1 1 X X X X 0 1 0 0 0 0 0 0 0 ROBERT DAHL PRESIDENT/CEO 0 452956 0 47554 0 20362 0 57237 0 16407 0 594516 0 147021 KATHY KOPP CHIEF STRATEGIC OFFICER 0 243050 0 16581 0 187976 0 58917 0 34244 0 540768 0 182581 KATHY YOUNGQUIST CHIEF FINANCIAL OFFICER 0 311455 0 50389 0 29565 0 51642 0 23447 0 466498 0 21108 MATTHEW KERN CHIEF OPERATING OFFICER 0 295044 0 19208 0 7942 0 37484 0 22613 0 382291 0 0 ANGELA BROWN CHIEF HUMAN RESOURCE OFFICER 0 189303 0 28674 0 10395 0 32464 0 20663 0 281499 0 12788 SHARON WILSON CHIEF CLINICAL AND COMPLIANCE OFFICER 0 187957 0 12683 0 10491 0 27521 0 11660 0 250312 0 0 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 - $48,475 KATHY YOUNGQUIST, CFO - $40,242 MATTHEW KERN, COO - $26,084 ANGELA BROWN, CHRO - $24,172 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 OFFICER'S COMPENSATION WAS PAID BY CASSIA SERVICES, THE MANAGEMENT SERVICES COMPANY. A CITY OF MAPLE PLAIN MINNESOTA 416005346 565315AT5 2019-07-25 38115000 TO FINANCE CONSTRUCTION AND FURNISHING OF A NEW SENIOR LIVING CAMPUS 0 0 0 A 0 0 38882364 2211095 0 0 777647 0 3053143 32840479 0 0 0 0 1 1 A 0 0 0 0 0 0 0 0 0 1 A 0 1 0 1 1 0 0 0 1 A 1 Schedule K, Part IV, Line 2c-07/25/2019 38,115,000 CITY OF MAPLE PLAIN MINNESOTA 5 YEAR ANNIVERSARY HAS NOT OCCURED YET. Form 990, Part VI, Section A, Line 3 A RELATED ORGANIZATION, CASSIA SERVICES, MANAGES ITS OWN AFFILICATES, 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 ELIM CARE, INC. THE SOLE MEMBER OF ELIM CARE, INC. 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, ELIM CARE, INC. AT THE ANNUAL MEETING. Form 990, Part VI, Section A, Line 7b ELIM CARE, INC. 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 THE DIRECTOR OF FINANCIAL ANALYSIS 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 OTHER CHANGES IN NET ASSETS WERE AS FOLLOWS: $123,408 CONTRIBUTIONS TRANSERRED FROM ELIM CARE, INC. (A RELATED ORGANIZATION); $(11,841) CONTRIBUTION DISTRIBUTIONS; $418,500 EQUITY TRANSFER FROM AFFILIATE Form 990, Part XII, Line 2c OVERSIGHT OF THE AUDIT PROCESS CHANGED IN 2020 AND IS NOW HANDLED BY THE FINANCE COMMITTEE FOR CASSIA AND ITS AFFILIATES. 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 CASSIA 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 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 APPLE VALLEY VILLA APARTMENTS 7171 OHMS LANE EDINA MN 55439 311608691 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 AUGUSTANA CARE 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 0 0 1 0 1 0 0 1 0 0 0 0 1 0 1 1 0 0 1