2023-11-08T11:48:28-07:00 2022-12-31 990 2022-01-01 411927112 PIONEER HOUSE ASSISTED LIVING INC PION 9528555000 7171 OHMS LANE EDINA MN 55439 KATHY YOUNGQUIST CFO 9528555000 2023-11-15 1 1 11 0 AAL2 X 2022 2023-04-26 12:10:37Z ROBERT DAHL 7171 OHMS LANE EDINA MN 55439 2711631 0 X www.cassialife.org X 1999 MN TO PROVIDE HEALTHCARE, HOUSING, AND COMMUNITY SERVICES FOR THE ELDERLY. 5 5 42 7 0 0 652772 180000 2025347 2209353 105926 58310 15819 14403 2799864 2462066 0 0 0 0 1662315 1369129 0 0 0 1028113 1000889 2690428 2370018 109436 92048 5344308 4880789 2248504 1938043 3095804 2942746 TO FOSTER FULLNESS OF LIFE FOR OLDER ADULTS IN THE SPIRIT OF CHRIST'S LOVE. 0 0 2033832 0 2193746 PIONEER HOUSE ASSISTED LIVING, INC. WAS ORGANIZED FOR THE PURPOSE OF OPERATING AN ASSISTED LIVING FACILITY FOR THE ELDERLY. IT IS LOCATED IN FARGO, ND AND HAS 48 ASSISTED LIVING UNITS. 30000 0 30000 Pioneer House rents its chapel space to the attached nursing home, which is owned by Elim Homes, Inc. (a related organization) 0 0 0 2063832 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 5 0 1 42 1 0 0 0 0 0 0 0 0 X 5 5 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 EDINA MN 55439 ROBERT DAHL PRESIDENT/CEO 0.23 39.77 X 0 602456 87428 KATHY YOUNGQUIST CHIEF FINANCIAL OFFICER 0.23 39.77 X 0 462088 70621 KATHY KOPP CHIEF STRATEGIC OFFICER 0.23 39.77 X 0 320482 76596 MATTHEW KERN CHIEF OPERATING OFFICER 0.23 39.77 X 0 317298 72793 SHARON WILSON CHIEF CLINICAL AND COMPLIANCE OFFICER 0.23 39.77 X 0 245326 42846 ANGELA BROWN CHIEF HUMAN RESOURCE OFFICER 0.23 39.77 X 0 234321 44974 RENEE MUHONEN ADMINISTRATOR 16 24 X 66844 92677 10131 STANN LEFF CHAIRPERSON AND DIRECTOR 0.25 0.25 X 0 0 0 PAT NUSS VICE CHAIRPERSON AND DIRECTOR 0.25 0.25 X 0 0 0 PAUL ANDERSON SECRETARY/TREASURER AND DIRECTOR 0.25 0.25 X 0 0 0 DOCTOR GUY TANGEDAHL DIRECTOR 0.25 0.25 X 0 0 0 NIKKI WEBER DANIELS DIRECTOR 0.25 0.25 X 0 0 0 66844 2274648 405389 0 0 1 0 0 0 0 0 180000 0 0 0 180000 ASSISTED LIVING REVENUE 623311 2179343 2179343 0 0 RENTAL REVENUE 532000 30010 30000 0 10 0 0 0 0 2209353 36786 0 0 36786 0 0 0 0 0 0 0 0 0 0 271089 0 249565 0 21524 0 21524 0 0 21524 0 BEAUTY SHOP REVENUE 812900 14403 14403 0 0 0 0 0 0 14403 2462066 2223746 0 58320 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1094252 1007855 86397 0 27266 25113 2153 0 164010 151061 12949 0 83601 77000 6601 0 88959 0 88959 0 951 0 951 0 1648 0 1648 0 0 0 0 0 0 0 14206 0 14206 0 24729 18504 6225 0 30875 0 30875 0 27264 411 26853 0 18793 0 18793 0 0 0 0 0 189150 189150 0 0 4902 0 4902 0 0 0 0 0 3725 0 3725 0 56260 56260 0 0 0 0 0 0 203119 203119 0 0 36487 36487 0 0 FOOD 198967 198967 0 0 SUPPLIES 57949 57949 0 0 MAINTENANCE CONTRACTS/PURCHASED SERVICES 39154 39154 0 0 LICENSES 5945 4103 1842 0 -2194 -1301 -893 0 2370018 2063832 306186 0 96800 240736 233929 103627 88969 64208 18320 5400 6150338 3885241 2337019 2265097 2121563 1710017 447708 491704 5344308 4880789 185192 111148 65205 63797 1973382 1735520 24725 27578 2248504 1938043 X 3095804 2942746 0 0 3095804 2942746 5344308 4880789 X 92048 -350152 0 0 0 105046 X 0 1 X 1 1 1 X 200000 580536 652772 180000 1613308 1743766 1519028 1985120 1995347 2179343 9422604 1743766 1719028 2565656 2648119 2359343 11035912 681032 609274 572562 462413 556121 2881402 681032 609274 572562 462413 556121 2881402 8154510 104909 128210 174470 135926 88320 631835 104909 128210 174470 135926 88320 631835 15536 17090 210074 15819 14403 272922 1864211 1864328 2950200 2799864 2462066 11940669 0.68292 0.65952 0.05291 0.05664 X Schedule A, Part III, Line 12 BEAUTY SHOP INCOME (2018-$15,536, 2019-$17,090, 2020-$11,764, 2021-$15,819, 2022-$14,403);INSURANCE PROCEEDS (2020-$198,400) RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 0 14370 14370 0 5439329 3312953 2126376 0 0 0 0 0 630852 513590 117262 0 65787 58698 7089 2265097 DUE FROM AFFILIATES 244225 SECURITY DEPOSITS 62940 INTEREST RECEIVABLE 9600 REPAIR AND REPLACEMENT FUND 75523 CIP BUILDING 99416 491704 0 MISCELLANEOUS PAYABLE 27578 27578 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 ELIM CARE, INC. 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. ELIM CARE, INC. 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 RENEE MUHONEN ADMINISTRATOR 66342 90467 0 1500 503 710 2702 3744 1581 2103 71128 98524 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. A CASS COUNTY 456002205 2014-09-09 3597900 REFINANCE EXISTING LOAN 0 0 0 A 1808373 0 3597900 0 0 0 0 0 0 0 0 0 2014 1 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-09/09/2014 3,597,900 CASS COUNTY THERE WERE NO INVESTMENT EARNINGS ON ANY BOND PROCEEDS. 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 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 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 WAS AS FOLLOWS:$105,046 NET RESTRICTED CONTRIBUTIONS TRANSFERRED FROM CASSIA (A RELATED ORGANIZATION). 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 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 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 ELIM PREFERRED SERVICES INC 7171 OHMS LANE EDINA MN 55439 411681856 MEDICAL SALES MN ELIM CARE INC C 0 0 PREFERRED SENIOR SERVICES INC 7171 OHMS LANE EDINA MN 55439 411942480 MANAGEMENT SERVICES MN ELIM CARE INC C 0 0 AUGUSTANA SENIOR DEVELOPMENT INC 7171 OHMS LANE EDINA MN 55439 264136110 CONSULTING MN AUGUSTANA CARE C 0 0 0 0 1 0 1 0 0 1 0 1 0 0 1 0 1 0 1 0 1