SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
PIONEER HOUSE ASSISTED LIVING INC
 
Employer identification number

41-1927112
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)CASSIA
7171 OHMS LANE

EDINA,MN55439
83-1758728 		PARENT CO/FUND RAISING MN 501(C)(3) 7 N/A
 
No
(2)CASSIA SERVICES
7171 OHMS LANE

EDINA,MN55439
41-1806946 		MANAGEMENT SERVICES MN 501(C)(3) 12 CASSIA
 
 
No
(3)ELIM CARE INC
7171 OHMS LANE

EDINA,MN55439
41-1694818 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 7 CASSIA
 
 
No
(4)AUGUSTANA CARE
7171 OHMS LANE

EDINA,MN55439
41-1728753 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 7 CASSIA
 
 
No
(5)NEW HARMONY CARE CENTER INC
7171 OHMS LANE

EDINA,MN55439
41-1821882 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC
 
 
No
(6)COUNTRY MEADOWS OF MILACA INC
7171 OHMS LANE

EDINA,MN55439
20-1723948 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC
 
 
No
(7)LAKE RIDGE CARE CENTER OF BUFFALO INC
7171 OHMS LANE

EDINA,MN55439
20-0507069 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC
 
 
No
(8)PARK TERRACE ASSISTED LIVING INC
7171 OHMS LANE

EDINA,MN55439
20-4063752 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC
 
 
No
(9)EVANGELICAL RETIREMENT HOMES INC
7171 OHMS LANE

EDINA,MN55439
42-0868449 		HEALTH CARE FACILITIES/SERVICES IA 501(C)(3) 10 ELIM CARE INC
 
 
No
(10)VILLAGE ASSISTED LIVING INC
7171 OHMS LANE

EDINA,MN55439
26-2086933 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC
 
 
No
(11)BAPTIST HOME INC
7171 OHMS LANE

EDINA,MN55439
45-0232943 		HEALTH CARE FACILITIES/SERVICES ND 501(C)(3) 10 ELIM CARE INC
 
 
No
(12)THE BAPTIST APARTMENTS INC
7171 OHMS LANE

EDINA,MN55439
45-0359794 		HEALTH CARE FACILITIES/SERVICES ND 501(C)(3) PF ELIM CARE INC
 
 
No
(13)ELIM SHORES INC
7171 OHMS LANE

EDINA,MN55439
41-1625095 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC
 
 
No
(14)CORNERSTONE ASSISTED LIVING OF PLYMOUTH INC
7171 OHMS LANE

EDINA,MN55439
41-2013927 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC
 
 
No
(15)HAVEN HOMES INC
7171 OHMS LANE

EDINA,MN55439
41-6045816 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC
 
 
No
(16)ELIM SENIOR HOUSING INC
7171 OHMS LANE

EDINA,MN55439
81-0754064 		HEALTH CARE FACILITIES/SERVICES FL 501(C)(3) 10 ELIM CARE INC
 
 
No
(17)NEWTON VILLAGE INC
7171 OHMS LANE

EDINA,MN55439
20-0044030 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC
 
 
No
(18)ELIM HOMES INC
7171 OHMS LANE

EDINA,MN55439
41-1539761 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM CARE INC
 
 
No
(19)REDEEMER RESIDENCE INC
7171 OHMS LANE

EDINA,MN55439
41-0711597 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM HOMES INC
 
 
No
(20)PARK VIEW CARE CENTER
7171 OHMS LANE

EDINA,MN55439
41-0855707 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 ELIM HOMES INC
 
 
No
(21)THE PARK LANE APARTMENTS INC
7171 OHMS LANE

EDINA,MN55439
41-0972384 		LOW INCOME HOUSING MN 501(C)(3) 10 ELIM CARE INC
 
 
No
(22)ELIM CHILDREN'S CENTER INC
7171 OHMS LANE

EDINA,MN55439
41-1974507 		CHILD DAYCARE MN 501(C)(3) 10 ELIM CARE INC
 
 
No
(23)ELIM CARE FOUNDATION
7171 OHMS LANE

EDINA,MN55439
41-1694817 		CHARITABLE FOUNDATION MN 501(C)(3) 12 ELIM CARE INC
 
 
No
(24)COMMUNITY HEALTH FOUNDATION OF WRIGHT COUNTY
7171 OHMS LANE

EDINA,MN55439
36-3546789 		CHARITABLE FOUNDATION MN 501(C)(3) PF ELIM CARE INC
 
 
No
(25)APPLE VALLEY VILLA APARTMENTS
7171 OHMS LANE

EDINA,MN55439
31-1608691 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 AUGUSTANA CARE
 
 
No
(26)AUGUSTANA CARE FOUNDATION
7171 OHMS LANE

EDINA,MN55439
41-1360678 		CHARITABLE FOUNDATION MN 501(C)(3) 12 AUGUSTANA CARE
 
 
No
(27)AUGUSTANA CHAPEL VIEW HOMES INC
7171 OHMS LANE

EDINA,MN55439
41-0693953 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 AUGUSTANA CARE
 
 
No
(28)AUGUSTANA COMMUNITY PARTNERS
7171 OHMS LANE

EDINA,MN55439
41-1783680 		HOME HEALTH CARE SERVICES MN 501(C)(3) 10 AUGUSTANA CARE
 
 
No
(29)AUGUSTANA HEALTH CARE CENTER OF APPLE VALLEY
7171 OHMS LANE

EDINA,MN55439
31-1608696 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 AUGUSTANA CARE
 
 
No
(30)AUGUSTANA HOME OF HASTINGS
7171 OHMS LANE

EDINA,MN55439
31-1572624 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 AUGUSTANA CARE
 
 
No
(31)AUGUSTANA APARTMENTS OF HASTINGS
7171 OHMS LANE

EDINA,MN55439
31-1608701 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 AUGUSTANA CARE
 
 
No
(32)BROOKSIDE SENIOR LIVING
7171 OHMS LANE

EDINA,MN55439
41-0871848 		HEALTH CARE FACILITIES/SERVICES MN 501(C)(3) 10 N/A
 
No
(33)OPEN CIRCLE ADULT DAY CENTER
7171 OHMS LANE

EDINA,MN55439
41-1424801 		ADULT DAYCARE MN 501(C)(3) 10 AUGUSTANA CARE
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Page 2
Schedule R (Form 990) 2021
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) ELIM PREFERRED SERVICES INC

7171 OHMS LANE
EDINA,MN55439
41-1681856 		MEDICAL SALES MN ELIM CARE INC
  		C     0 %   No
(2) PREFERRED SENIOR SERVICES INC

7171 OHMS LANE
EDINA,MN55439
41-1942480 		MANAGEMENT SERVICES MN ELIM CARE INC
  		C     0 %   No
(3) AUGUSTANA SENIOR DEVELOPMENT INC

7171 OHMS LANE
EDINA,MN55439
26-4136110 		CONSULTING MN AUGUSTANA CARE
  		C     0 %   No








Schedule R (Form 990) 2021
Page 3
Schedule R (Form 990) 2021
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
Yes
 
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
Yes
 
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
 
No
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2021
Page 4
Schedule R (Form 990) 2021
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2021
Page 5
Schedule R (Form 990) 2021
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R (Form 990) 2021

Additional Data


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