2021-11-05T11:47:40-05:00 2020-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2020-01-01 311572624 AUGUSTANA HOME OF HASTINGS AUGU 9528555000 7171 OHMS LANE EDINA MN 55439 KATHY YOUNGQUIST CFO 9528555000 2021-11-04 1 KATHY YOUNGQUIST 999009999 MATT WOCKEN P01598291 6123764500 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z AUGUSTANA CARE HASTINGS HEALTH AND REHABILITATION ROBERT DAHL 7171 OHMS LANE EDINA MN 55439 8151057 0 X WWW.CASSIALIFE.ORG X 1997 MN TO PROVIDE HEALTH CARE, HOUSING, AND SERVICES FOR THE ELDERLY. 6 6 194 31 0 0 2093 738699 2055122 7349347 816 52797 3437 9998 2061468 8150841 100000 600 0 0 1297263 5318878 0 0 0 737768 2775917 2135031 8095395 -73563 55446 4201058 4342269 4006833 4089925 194225 252344 TO FOSTER FULLNESS OF LIFE FOR OLDER ADULTS IN THE SPIRIT OF CHRIST'S LOVE. 0 0 6338442 600 7349347 AUGUSTANA HOME OF HASTINGS OWNS AND OPERATES A 91-BED LICENSED NURSING FACILITY IN HASTINGS, MN TO FACILITATE THE OBJECTIVES SET FORTH IN THEIR PRIMARY EXEMPT PURPOSE. AUGUSTANA HOME OF HASTINGS SERVED 283 INDIVIDUALS DURING THE PERIOD ENDED DECEMBER 31, 2020. 6338442 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 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 194 1 0 0 0 0 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 LN EDINA MN 55439 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 CHIP PARKS SECRETARY 0.25 2.25 X X 0 0 0 ERIK RICK ELLINGSON TREASURER 0.25 2.25 X 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 ROBERT DAHL PRESIDENT/CEO 1.00 39.00 X 0 520872 73644 KATHY KOPP CHIEF STRATEGY OFFICER 1.00 39.00 X 0 447607 93161 KATHY YOUNGQUIST CFO 1.00 39.00 X 0 391409 75089 MATTHEW KERN COO 1.00 39.00 X 0 322194 60097 ANGELA BROWN CHRO 1.00 39.00 X 0 228372 53127 SHARON WILSON CHIEF CLINICAL & COMPLIANC 1.00 39.00 X 0 211131 39181 KAY MARTHALER DIRECTOR OF NURSING 41.54 0.00 X 120376 0 27265 PAUL LUITJENS NURSING HOME ADMINISTRATOR 41.54 0.00 X 140040 0 2700 260416 2121585 424264 2 0 1 0 CASSIA SERVICES 7171 OHMS LANE EDINA MN 55439 MANAGEMENT SERVICES 359366 1 100000 619355 19344 738699 NURSING FACILITIES 623000 7349347 7349347 7349347 52797 52797 216 -216 -216 -216 CABLE TV INCOME 812900 6875 6875 TELEPHONE INCOME 812900 3339 3339 10214 8150841 7349347 0 62795 600 600 4382830 4141958 240872 57552 57552 522563 17609 504954 355933 355933 408674 49308 359366 56 56 18537 18537 605386 547425 57961 23470 23470 137865 82021 55844 188617 188617 2384 1584 800 30669 29772 897 115711 115711 310039 310039 68165 68165 NURSING SUPPLIES 356600 356600 LICENSES, PERMITS, FEES 242395 241557 838 DIETARY EXPENSES 192525 192525 MISCELLANEOUS 64814 58570 6244 10010 4546 5464 8095395 6338442 1756953 0 1350 1350 270436 271491 706198 845663 8543 19660 8480758 5928827 2796680 2551931 19215 21888 398636 630286 4201058 4342269 395311 671836 27107 3439382 3210446 8417 8627 163723 171909 4006833 4089925 X 176035 234154 18190 18190 194225 252344 4201058 4342269 55446 2673 0 X X 0 1 X 1 0 X 75674 242320 5160 2093 738699 1063946 7506437 7910914 8142196 2055122 7349347 32964016 7582111 8153234 8147356 2057215 8088046 34027962 0 472678 472678 472678 472678 33555284 34037 13870 37647 1334 52797 139685 34037 13870 37647 1334 52797 139685 16884 17700 15078 2919 10214 62795 7633032 8184804 8200081 2061468 8151057 34230442 0.98030 0.98050 0.00410 0.00340 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: VENDING MACHINE INCOME FROM TENANTS - 2016 AMOUNT: $ 265. MISCELLANEOUS INCOME FROM TENANTS - 2016 AMOUNT: $ 250. DIETARY INCOME FROM TENANTS - 2016 AMOUNT: $ 2,212. 2017 AMOUNT: $ 3,302. 2018 AMOUNT: $ 1,183. 2019 AMOUNT: $ 74. 2020 AMOUNT: $ 0. TELEPHONE INCOME FROM TENANTS - 2016 AMOUNT: $ 4,219. 2017 AMOUNT: $ 4,230. 2018 AMOUNT: $ 4,700. 2019 AMOUNT: $ 920. 2020 AMOUNT: $ 3,339. CABLE TELEVISION INCOME FROM TENANTS - 2016 AMOUNT: $ 9,938. 2017 AMOUNT: $ 10,168. 2018 AMOUNT: $ 9,195. 2019 AMOUNT: $ 1,925. 2020 AMOUNT: $ 6,875. 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 18190 111 111 18190 18160 115 115 18190 18160 18160 18136 24 112 112 18160 18112 24 118 118 18136 0.00000 1.00000 0.00000 0 1 0 602927 602927 5668009 3925723 1742286 2209822 2003104 206718 2551931 HCIR INSURANCE RECIPROCAL 68777 BENEFICIAL INTEREST IN ASSETS HELD BY FOUNDATION 4630 DUE FROM AFFILIATES 556879 630286 ASSET RETIREMENT OBLIGATION 171909 171909 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. 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. 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 311455 0 50389 0 29565 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 CHIEF CLINICAL & COMPLIANC 0 187957 0 12683 0 10491 0 27521 0 11660 0 250312 0 0 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. A CITY OF HASTINGS MINNESOTA 416005220 2012-04-26 4975000 FACILITY REMODEL AND REFUND SERIES 1998 BONDS 0 0 0 A 1671708 4975000 99500 1646468 3441093 2014 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 1 0 0 0 1 A 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 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 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 C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C OVERSIGHT OF THE AUDIT PROCESS CHANGED IN THE CURRENT YEAR 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) LINE 7 N/A 0 CASSIA SERVICES 7171 OHMS LANE EDINA MN 55439 411806946 MANAGEMENT SERVICES MN 501(C)(3) LINE 12A, I CASSIA 0 ELIM CARE INC 7171 OHMS LANE EDINA MN 55439 411694818 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 7 CASSIA 0 AUGUSTANA CARE 7171 OHMS LANE EDINA MN 55439 411728753 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 7 CASSIA 0 PIONEER HOUSE ASSISTED LIVING INC 7171 OHMS LANE EDINA MN 55439 411927112 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 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) LINE 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) LINE 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) LINE 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) LINE 10 ELIM CARE INC 0 EVANGELICAL RETIREMENT HOMES INC 7171 OHMS LANE EDINA MN 55439 420868449 HEALTH CARE FACILITIES/SERVICES IA 501(C)(3) LINE 10 ELIM CARE INC 0 VILLAGE ASSISTED LIVING INC 7171 OHMS LANE EDINA MN 55439 262086933 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 ELIM CARE INC 0 BAPTIST HOME INC 7171 OHMS LANE EDINA MN 55439 450232943 HEALTH CARE FACILITIES/SERVICES ND 501(C)(3) LINE 10 ELIM CARE INC 0 THE BAPTIST APARTMENTS INC 7171 OHMS LANE EDINA MN 55439 450359794 HEALTH CARE FACILITIES/SERVICES ND 501(C)(3) LINE 10 ELIM CARE INC 0 ELIM SHORES INC 7171 OHMS LANE EDINA MN 55439 411625095 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 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) LINE 10 ELIM CARE INC 0 HAVEN HOMES INC 7171 OHMS LANE EDINA MN 55439 416045816 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 ELIM CARE INC 0 ELIM SENIOR HOUSING INC 7171 OHMS LANE EDINA MN 55439 810754064 HEALTH CARE FACILITIES/SERVICES FL 501(C)(3) LINE 10 ELIM CARE INC 0 NEWTON VILLAGE INC 7171 OHMS LANE EDINA MN 55439 200044030 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 ELIM CARE INC 0 ELIM HOMES INC 7171 OHMS LANE EDINA MN 55439 411539761 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 ELIM CARE INC 0 REDEEMER RESIDENCE INC 7171 OHMS LANE EDINA MN 55439 410711597 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 ELIM HOMES INC 0 PARK VIEW CARE CENTER 7171 OHMS LANE EDINA MN 55439 410855707 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 ELIM HOMES INC 0 THE PARK LANE APARTMENTS INC 7171 OHMS LANE EDINA MN 55439 410972384 LOW INCOME HOUSING MN 501(C)(3) LINE 10 ELIM CARE INC 0 ELIM CHILDREN'S CENTER INC 7171 OHMS LANE EDINA MN 55439 411974507 CHILD DAYCARE MN 501(C)(3) LINE 10 ELIM CARE INC 0 ELIM CARE FOUNDATION 7171 OHMS LANE EDINA MN 55439 411694817 CHARITABLE FOUNDATION MN 501(C)(3) LINE 12A, I ELIM CARE INC 0 COMMUNITY HEALTH FOUNDATION OF WRIGHT COUNTY 7171 OHMS LANE EDINA MN 55439 363546789 CHARITABLE FOUNDATION MN 501(C)(3) LINE 10 ELIM CARE INC 0 APPLE VALLEY VILLA APARTMENTS 7171 OHMS LANE EDINA MN 55439 311608691 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 AUGUSTANA CARE 0 AUGUSTANA CARE FOUNDATION 7171 OHMS LANE EDINA MN 55439 411360678 CHARITABLE FOUNDATION MN 501(C)(3) LINE 12A, I AUGUSTANA CARE 0 AUGUSTANA CHAPEL VIEW HOMES INC 7171 OHMS LANE EDINA MN 55439 410693953 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 AUGUSTANA CARE 0 AUGUSTANA COMMUNITY PARTNERS 7171 OHMS LANE EDINA MN 55439 411783680 HOME HEALTH CARE SERVICES MN 501(C)(3) LINE 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) LINE 10 AUGUSTANA CARE 0 AUGUSTANA APARTMENTS OF HASTINGS 7171 OHMS LANE EDINA MN 55439 311608701 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 AUGUSTANA CARE 0 BROOKSIDE SENIOR LIVING 7171 OHMS LANE EDINA MN 55439 410871848 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) LINE 10 N/A 0 OPEN CIRCLE ADULT DAY CENTER 7171 OHMS LANE EDINA MN 55439 411424801 ADULT DAYCARE MN 501(C)(3) LINE 10 AUGUSTANA CARE 0 AUGUSTANA SENIOR DEVELOPMENT INC 7171 OHMS LN EDINA MN 55439 264136110 CONSULTING MN N/A C 0 ELIM PREFERRED SERVICES INC 7171 OHMS LN EDINA MN 55439 411681856 MEDICAL SALES MN N/A C 0 PREFERRED SENIOR SERVICES INC 7171 OHMS LN EDINA MN 55439 411942480 MANAGEMENT SERVICES MN N/A C 0 0 0 1 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 0