2023-11-08T13:34:12-07:00 2022-12-31 990 2022-01-01 410871848 BROOKSIDE SENIOR LIVING BROO 9528555000 7171 OHMS LANE EDINA MN 55439 Kathy Youngquist Chief Financial Officer 9528555000 2023-11-08 1 1 11 1 AAL2 X 2022 2023-04-26 12:10:37Z ROBERT DAHL 7171 OHMS LANE EDINA MN 55439 2461292 0 X WWW.CASSIALIFE.ORG X 1961 MN TO PROVIDE HEALTH CARE, HOUSING, AND COMMUNITY SERVICES FOR THE ELDERLY. 7 7 89 10 -46794 0 35481 34303 2218460 2368286 3558 2754 -24567 -41996 2232932 2363347 0 0 0 0 1049626 1080197 0 0 0 1083453 1209589 2133079 2289786 99853 73561 9993263 9834395 7312416 7289997 2680847 2544398 TO FOSTER FULLNESS OF LIFE FOR OLDER ADULTS IN THE SPIRIT OF CHRIST'S LOVE. 0 0 1256482 0 2368286 BROOKSIDE SENIOR LIVING WAS ORGANIZED FOR THE PURPOSE OF OPERATING AN ASSISTED LIVING FACILITY FOR THE ELDERLY. IT IS LOCATED IN MONTEVIDEO, MN AND HAS 57 UNITS. 0 0 0 1256482 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 0 0 89 1 1 1 0 0 0 0 0 0 0 X 7 7 0 1 0 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 0.55 39.45 X 0 602456 87428 KATHY YOUNGQUIST CHIEF FINANCIAL OFFICER 0.55 39.45 X 0 462088 70621 KATHY KOPP CHIEF STRATEGIC OFFICER 0.55 39.45 X 0 320482 76596 MATTHEW KERN CHIEF OPERATING OFFICER 0.55 39.45 X 0 317298 72793 SHARON WILSON CHIEF CLINICAL AND COMPLIANCE OFFICER 0.55 39.45 X 0 245326 42846 ANGELA BROWN CHIEF HUMAN RESOURCE OFFICER 0.55 39.45 X 0 234321 44974 KARI HOSKIN CHAIRPERSON & DIRECTOR 0.25 0 X X 0 0 0 SUSAN JERVE VICE CHAIRPERSON & DIRECTOR 0.25 0 X X 0 0 0 DUSTIN CITROWSKE SECRETARY AND DIRECTOR 0.25 0 X X 0 0 0 MATTHEW CRAWFORD DIRECTOR 0.25 0 X 0 0 0 NANCY AAGESEN DIRECTOR 0.25 0 X 0 0 0 MATTHEW HAUGEN DIRECTOR 0.25 0 X 0 0 0 GINA KONTZ DIRECTOR 0.25 0 X 0 0 0 KARI HUNTLEY DIRECTOR 0.25 0 X 0 0 0 0 2181971 395258 0 0 1 0 0 0 0 0 0 34303 0 0 34303 RESIDENT SERVICES 623000 2368286 2368286 0 0 0 0 0 0 2368286 2754 0 0 2754 0 0 0 0 0 0 0 0 0 0 0 0 0 51151 97945 -46794 0 -46794 0 RENTAL REVENUE 900099 920 0 0 920 OTHER REVENUE 900099 3878 0 0 3878 0 0 0 0 4798 2363347 2368286 -46794 7552 936029 822625 113404 10022 8808 1214 60069 51950 8119 74077 65102 8975 210853 210853 5606 5606 1611 1611 753 753 43397 36182 7215 8369 8369 19454 898 18556 23220 23220 100807 86147 14660 466 252 214 1301 1301 320375 320375 251473 251473 16599 16599 SUPPLIES 71569 69851 1718 0 LICENSES 15135 0 15135 0 FOOD 102391 102391 0 0 BAD DEBT -2000 0 -2000 0 18210 12276 5934 0 2289786 1256482 1033304 0 1607456 1933753 96553 104091 5629 533 8195779 1110244 7317788 7085535 965837 710483 9993263 9834395 109460 113266 60919 7074936 6955586 42448 40672 52534 24116 33038 95438 7312416 7289997 X 2611316 2468059 69531 76339 2680847 2544398 9993263 9834395 X 73561 -16818 0 0 0 -193192 X 0 1 X 1 1 1 X 105247 17834 73831 35481 34303 266696 2021045 490881 2061190 2218460 2368286 9159862 2126292 508715 2135021 2253941 2402589 9426558 542604 198936 579781 992368 1057260 3370949 542604 198936 579781 992368 1057260 3370949 6055609 14067 3029 8635 3558 2754 32043 14067 3029 8635 3558 2754 32043 2309 440 3313 6790 4798 17650 2142668 512184 2146969 2264289 2410141 9476251 0.63903 0.67578 0.00338 0.00564 X Schedule A, Part I, Line 10 COLUMN B, 2019, IS FOR A SHORT PERIOD THAT BEGAN ON OCTOBER 1, 2019 AND ENDED ON DECEMBER 31, 2019. Schedule A, Part III, Line 12 EXPLANATION FOR OTHER INCOME FOR 2018: BEAUTY SHOP REVENUE $1,140, CABLE REVENUE $125, LAUNDRY REVENUE $981, AND VENDING REVENUE $63. EXPLANATION FOR OTHER INCOME FOR 2019: BEAUTY SHOP REVENUE $270, LAUNDRY REVENUE $181, AND VENDING REVENUE $11. EXPLANATION FOR OTHER INCOME FOR 2020: BEAUTY SHOP REVENUE $580, MAINTENANCE REVENUE $655, CABLE REVENUE $250, LAUNDRY REVENUE $1,217, VENDING REVENUE $375, AND MISCELLANEOUS REVENUE $236. EXPLANATION FOR OTHER INCOME FOR 2021: BEAUTY SHOP REVENUE $230, RENTAL REVENUE $780, AND MISCELELANEOUS REVENUE $5,780. EXPLANATION FOR OTHER INCOME FOR 2022: RENTAL REVENUE $920 AND MISCELLANEOUS REVENUE $3,878. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 0 104043 104043 0 7720683 922206 6798477 0 0 0 0 0 371053 188038 183015 0 0 0 0 7085535 BOND FUNDS 642866 SECURITY DEPOSITS 48726 DUE FROM AFFILIATES 14514 DONATED RESIDNET ACTIVITY FUND 4377 710483 DUE TO AFFILIATES 95438 95438 X Schedule D, Part IV, Line 2b SECURITY DEPOSITS ARE REQUIRED FOR THE ORGANIZATION'S TENANTS AND INCLUDE RESERVED APARTMENTS IF AMOUNTS ARE PAID BEFORE THE TENANT ACTUALLY MOVES IN. Schedule D, Part 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. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES IN EVALUATION 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. X 1 1 X X X X 0 1 0 0 0 0 0 0 0 ROBERT DAHL PRESIDENT/CEO 0 546533 0 49716 0 6207 0 67622 0 19807 0 689885 0 49716 KATHY YOUNGQUIST CHIEF FINANCIAL OFFICER 0 327536 0 0 0 134552 0 45601 0 25020 0 532709 0 131952 MATTHEW KERN CHIEF OPERATING OFFICER 0 313032 0 0 0 4266 0 44525 0 28268 0 390091 0 0 KATHY KOPP CHIEF STRATEGIC OFFICER 0 257664 0 0 0 62818 0 50298 0 26298 0 397078 0 59672 SHARON WILSON CHIEF CLINICAL AND COMPLIANCE OFFICER 0 212660 0 19955 0 12711 0 30259 0 12588 0 288173 0 19955 ANGELA BROWN CHIEF HUMAN RESOURCE OFFICER 0 214699 0 0 0 19622 0 20586 0 24388 0 279295 0 18282 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 - $13,263 KATHY YOUNGQUIST, CFO - $33,401 MATTHEW KERN, COO - $32,325 ANGELA BROWN, CHRO - $11,030 Schedule J, Part I, Line 6 OFFICERS OF CASSIA SERVICES AND KEY EMPLOYEES OF CASSIA AND ITS AFFILIATES ARE ELIGIBLE TO ACCRUE INCENTIVE BONUSES EACH YEAR THAT ARE CONTINGENT ON PERFORMANCE METRICS AND FINANCIAL GOALS OF THE ORGANIZATION. Schedule J, Part II ALL OFFICERS' COMPENSATION WAS PAID BY CASSIA SERVICES, THE MANAGEMENT SERVICES COMPANY. A CITY OF MADISON MINNESOTA 416005335 557842ASO 2016-11-22 7750000 BUILDING CONSTRUCTION 0 0 0 A 490000 0 7750000 447834 295184 0 155000 0 400000 6129578 22527 302712 2018 0 0 0 1 A 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 Schedule K, Part IV, Line 2c-11/22/2016 7,750,000 CITY OF MADISON MINNESOTA REBATE COMPUTATION WAS PERFORMED IN 2022 AND NO REBATE WAS DUE. Form 990, Part VI, Section A, Line 3 A RELATED ORGANIZATION, CASSIA SERVICES, MANAGES ITS OWN AFFILIATES, CASSIA, ELIM CARE, INC., AUGUSTANA CARE AND ALL ELIM/AUGUSTANA AFFILIATES. SERVICES PROVIDED INCLUDE FINANCIAL ACCOUNTING, OPERATIONAL OVERSIGHT, HUMAN RESOURCES, INFORMATION TECHNOLOGY, CLINICAL NURSING CONSULTATION, CORPORATE COMPLIANCE, COORDINATED ADVERTISING AND MARKETING, PHILANTHROPY AND NEW BUSINESS DEVELOPMENT. Form 990, Part VI, Section A, Line 6 THE MEMBERS OF THE CORPORTATION CONSIST OF TWO CLASSES: MONTEVIDEO AREA MEMBERS, (UNITED METHODIST CHURCH) AND SUCH OTHER AREA RELIGIOUS CONGREGATION AS MAY APPLY AND ARE APPROVED BY THE EXISTING MEMBERS, AND AUGUSTANA CARE. EACH MEMBER HAS THE RIGHT TO ELECT FOUR BOARD MEMBERS. Form 990, Part VI, Section A, Line 7a THE MEMBERS HAVE THE RIGHT TO ELECT THE BOARD MEMBERS. Form 990, Part VI, Section A, Line 7b CERTAIN ACTIONS REQUIRE AFFIRMATIVE APPROVAL FROM THE MEMBERS OF THE ORGANIZATION. THOSE ACTIONS ARE DETAILED IN THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION. Form 990, Part VI, Section B, Line 11b THE FORM 990 AND ALL RELATED SCHEDULES WERE PREPARED BY INTERNAL FINANCE STAFF AND REVIEWED BY THE ORGANIZATION'S CFO. THE FORM 990 WAS MADE AVAILABLE TO THE FULL BOARD OF DIRECTORS PRIOR TO BEING FILED WITH THE IRS. Form 990, Part VI, Section B, Line 12c THE ORGANIZATION ANNUALLY REQUESTS A CONFLICT OF INTEREST DISCLOSURE FROM EACH BOARD MEMBER, KEY EMPLOYEE AND OFFICER. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS AND KEY EMPLOYEES. ALL COVERED INDIVIDUALS ARE REQUIRED TO COMPLETE AN ANNUAL CONFLICT OF INTEREST STATEMENT AND TO DISCLOSE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST TO THE APPROPRIATE LEVEL OF MANAGEMENT OR TO THE BOARD OF DIRECTORS AS OUTLINED IN THE POLICY, BASED ON THE INDIVIDUAL'S POSITION WITHIN THE ORGANIZATION. CONFLICTS ARE DETERMINED AT THE APPROPRIATE LEVEL OF MANAGEMENT OR BY THE BOARD OF DIRECTORS. INDIVIDUALS WITH ACTUAL OR POTENTIAL CONFLICTS WILL ABSTAIN FROM DISCUSSING OR VOTING ON ANY MATTERS RELATING TO THE CONFLICT. ALL PROCEEDINGS RELATING TO ACTUAL OR POTENTIAL CONFLICTS ARE NOTED IN THE MEETING MINUTES. Form 990, Part VI, Section B, Line 15 THE BOARD OF DIRECTORS ROUTINELY RETAINS THE SERVICES OF A COMPENSATION CONSULTANT TO REVIEW THE CURRENT WAGE AND BENEFIT LEVELS OF SIMILAR POSITIONS IN SIMILAR ORGANIZATIONS. THE COMPENSATION COMMITTEE USES THIS INFORMATION TO MAKE A RECOMMENDATION TO THE BOARD OF DIRECTORS. Form 990, Part VI, Section C, Line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part XI, Line 9 OTHER CHANGES IN NET ASSETS: TRANSFER TO AFFILIATES: $193,192. 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) 10 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 HAVEN HOMES INC 7171 OHMS LANE EDINA MN 55439 416045816 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 ELIM SENIOR HOUSING INC 7171 OHMS LANE EDINA MN 55439 810754064 HEALTH CARE FACILITIES/SERVICES FL 501(C)(3) 10 ELIM CARE INC 0 NEWTON VILLAGE INC 7171 OHMS LANE EDINA MN 55439 200044030 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 ELIM HOMES INC 7171 OHMS LANE EDINA MN 55439 411539761 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC 0 REDEEMER RESIDENCE INC 7171 OHMS LANE EDINA MN 55439 410711597 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM HOMES INC 0 PARK VIEW CARE CENTER 7171 OHMS LANE EDINA MN 55439 410855707 HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM HOMES 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 OPEN CIRCLE ADULT DAY CENTER 7171 OHMS LANE EDINA MN 55439 411424801 ADULT DAYCARE MN 501(C)(3) 10 AUGUSTANA CARE 0 ELIM PREFERRED SERVICES INC 7171 Ohms Lane Edina MN 55439 411681856 MEDICAL SALES MN N/A C 0 0 PREFERRED SENIOR SERVICES INC 7171 Ohms Lane Edina MN 55439 411942480 MANAGEMENT SERVICES MN N/A C 0 0 AUGUSTANA SENIOR DEVELOPMENT 7171 Ohms Lane Edina MN 55439 264136110 CONSULTING MN N/A C 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1 0 1 1