NORTH MEMORIAL FOUNDATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- NORTH MEMORIAL FOUNDATION (EIN 41-1777966)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-14
- IRS object ID
- 202203189349316760
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-14T16:22:59-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 S 6TH ST 2300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411777966 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH MEMORIAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 7635205200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVENUE NORTH | AddressLine1Txt |
| City | ROBBINSDALE | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554222900 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KENT SPAULDING | PersonNm |
| Person Title | VP FOUNDATION | PersonTitleTxt |
| Phone | 7635205200 | PhoneNum |
| Signature | 2022-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | KENT | PersonFirstNm |
| Person Last | SPAULDING | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LAWRENCE H MOHR CPA | PreparerPersonNm |
| PTIN | P00447603 | PTIN |
| Phone | 6128764500 | PhoneNum |
| Preparation | 2022-11-11 | PreparationDt |
| Self Employed | Yes (X) | SelfEmployedInd |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KENT SPAULDING | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVENUE NORTH | AddressLine1Txt |
| City | ROBBINSDALE | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554222900 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,538,831 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.NORTHMEMORIAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1993 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO SUPPORT NORTH MEMORIAL HEALTH CARE AND ITS COMMITMENT TO CHANGING AND SAVING LIVES. THROUGH PHILANTHROPY, OUR DONORS ASSIST IN GIVING OUR PATIENTS AND THEIR FAMILIES COMPASSIONATE, REMARKABLE CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 150 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,377,215 | PYContributionsGrantsAmt |
| CY Contributions Grants | $731,636 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $289,899 | PYInvestmentIncomeAmt |
| CY Investment Income | $402,813 | CYInvestmentIncomeAmt |
| PY Other Revenue | $165,017 | PYOtherRevenueAmt |
| CY Other Revenue | $227,906 | CYOtherRevenueAmt |
| PY Total Revenue | $1,832,131 | PYTotalRevenueAmt |
| CY Total Revenue | $1,362,355 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $930,134 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $560,206 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $143,900 | PYOtherExpensesAmt |
| CY Other Expenses | $107,546 | CYOtherExpensesAmt |
| PY Total Expenses | $1,074,034 | PYTotalExpensesAmt |
| CY Total Expenses | $667,752 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $758,097 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $694,603 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,362,803 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,323,337 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $34,475 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $23,548 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,328,328 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,299,789 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO SUPPORT NORTH MEMORIAL HEALTH CARE AND ITS COMMITMENT TO CHANGING AND SAVING LIVES. THROUGH PHILANTHROPY, OUR DONORS ASSIST IN GIVING OUR PATIENTS AND THEIR FAMILIES COMPASSIONATE, REMARKABLE CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $306,604 | ExpenseAmt |
| Grant | $306,604 | GrantAmt |
| Desc | COVID-19 EMERGENCY RESPONSE:THIS PROGRAM SUPPORTS EMERGENT NEEDS RELATED TO THE COVID-19 PANDEMIC. FUNDS HAVE PROVIDED EQUIPMENT AND SUPPLIES TO TREAT COVID-19 POSITIVE PATIENTS AS WELL AS PERSONAL PROTECTIVE EQUIPMENT TO PROTECT STAFF WORKING WITH COVID-19 POSITIVE/SUSPECTED PATIENTS. IT HAS ALSO PROVIDED STAFF TRAINING AND RESILIENCY SUPPORT. A CRISIS ASSISTANCE FUND HAS PROVIDED FINANCIAL AID FOR STAFF DIRECTLY AFFECTED BY COVID-19. FOUR STAFF RECEIVED $500 IN ASSISTANCE TO SUPPORT HOUSING COSTS FOR A TOTAL OF $2,000 IN DIRECT FINANCIAL ASSISTANCE PROVIDED. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $42,393 | ExpenseAmt |
| Grant | $42,393 | GrantAmt |
| Desc | HOSPICE SUPPORT:NORTH MEMORIAL HEALTH'S HOSPICE TEAM PROVIDED SERVICES FOR 1,000 PATIENTS IN 2021, AS WELL AS GRIEF SUPPORT SERVICES FOR THEIR FAMILIES AND LOVED ONES. FOUNDATION SUPPORT PROVIDED COMPLEMENTARY SERVICES SUCH AS MASSAGE THERAPY AND ANIMAL THERAPY GRIEF TO HELP INDIVIDUALS COPE WITH THEIR DIAGNOSIS, MANAGE PAIN/DISCOMFORT AND PREPARE FOR THE END OF THEIR LIVES. ADDITIONALLY, FUNDS SUPPORTED GRIEF ACTIVITIES AND CARE ITEMS SUCH AS SENSORY BASKETS, SUPPORT GROUPS AND SEASONAL MEMORY PACKAGES. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $108,000 | ExpenseAmt |
| Grant | $108,000 | GrantAmt |
| Desc | PROGRAM, SERVICE AND OPERATIONAL SUPPORT FOR NORTH MEMORIAL HEALTH:THE FOUNDATION DEDICATES ITSELF TO RAISING MONEY TO SUPPORT THE HEALTH OF THE ENTIRE COMMUNITY SERVED BY NORTH MEMORIAL HEALTH, APPROXIMATELY 650,000 INDIVIDUALS IN 2021. THE FOUNDATION HELPS CLOSE THE GAP BETWEEN THE SERVICES PROVIDED BY THE HEALTH CARE SYSTEM AND THE COMPENSATION RECEIVED FROM CUSTOMER PAYMENTS, INSURANCE AND THE GOVERNMENT. DONOR SUPPORT HELPS IMPROVEMENTS THAT WOULD LIKELY NOT OTHERWISE BE POSSIBLE, MAKING US A STRONG, RESPONSIVE AND ACCESSIBLE COMMUNITY RESOURCE. DONATIONS HELP IMPROVE CUSTOMER EXPERIENCE, MODERNIZE FACILITIES, BROADEN PROGRAMS AND SERVICES, SUPPORT COMMUNITY PARTNERSHIPS, PROVIDE ACCESS TO SPECIALIZED MEDICAL EQUIPMENT AND NEW TECHNOLOGIES. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $166,047 | ExpenseAmt |
| Grant | $103,209 | GrantAmt |
| Desc | THE FOUNDATION SUPPORTS OTHER PROGRAMS AND INITIATIVES THROUGHOUT THE ORGANIZATION AS IDENTIFIED BY DONORS AND FOUNDATION LEADERSHIP. THESE FUNDS SUPPORT A WIDE ARRAY OF PROJECTS, FROM TECHNOLOGY UPGRADES TO NEW CARE PROGRAMS, TEAM-MEMBER EDUCATION TO FACILITY ENHANCEMENTS. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $166,047 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Grant | $103,209 | TotalOtherProgSrvcGrantAmt |
| Total Program Service Expenses | $623,044 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | Yes (1) | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 9 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAN FROMM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7635205200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVENUE NORTH | AddressLine1Txt |
| City | ROBBINSDALE | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554222900 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| J KEVIN CROSTON MD | |||||||
| DIRECTOR | 2.00 | 44.00 | Yes (X) | $0 | $1,512,326 | $542,727 | |
| PAMELA DOORENBOS MD | |||||||
| DIRECTOR | 1.00 | 40.00 | Yes (X) | $0 | $406,365 | $23,778 | |
| BETH MEJIA | |||||||
| DIRECTOR | 1.00 | 40.00 | Yes (X) | $0 | $88,232 | $9,633 | |
| SCOTT HEMENWAY | |||||||
| BOARD CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JANDEEN BOONE | |||||||
| VICE CHAIR | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JIM BYRNE | |||||||
| TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| DANA GARRETT | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID HANCOX | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BRUCE QUAM | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DIANE NILSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TROY REDING | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL HOLTZ | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DEEPAK KADEMANI DMD MD | |||||||
| DIRECTOR - OUTGOING | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ERIC SKALLAND | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MIKE STEINHAUSER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $10,000 | $0 | ||
| KENT SPAULDING | |||||||
| VICE PRESIDENT | 2.00 | 40.00 | $0 | $299,347 | $23,502 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,316,270 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $599,640 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $204,223 | FundraisingAmt |
| All Other Contributions | $527,413 | AllOtherContributionsAmt |
| Noncash Contributions | $114,643 | NoncashContributionsAmt |
| Total Contributions | $731,636 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $402,813 | TotalRevenueColumnAmt |
| Exclusion | $402,813 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $404,382 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $204,223 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $176,476 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $227,906 | TotalRevenueColumnAmt |
| Exclusion | $227,906 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,362,355 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $630,719 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $520,323 | TotalAmt |
| Program Services | $520,323 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,883 | TotalAmt |
| Program Services | $39,883 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,630 | TotalAmt |
| Program Services | $5,630 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $61,720 | $49,081 | $12,639 |
| OUTSIDE SERVICES | $32,069 | $32,069 | |
| MISCELLANEOUS | $8,127 | $8,127 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $667,752 | TotalAmt |
| Program Services | $623,044 | ProgramServicesAmt |
| Management And General | $44,708 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $349,640 | BOYAmt |
| EOY | $423,998 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,459 | BOYAmt |
| EOY | $16,348 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,302,189 | BOYAmt |
| EOY | $13,115,375 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $704,515 | BOYAmt |
| EOY | $767,616 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,362,803 | BOYAmt |
| EOY | $14,323,337 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,850 | BOYAmt |
| EOY | $13,923 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,625 | BOYAmt |
| EOY | $9,625 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,475 | BOYAmt |
| EOY | $23,548 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,458,294 | BOYAmt |
| EOY | $5,675,825 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,870,034 | BOYAmt |
| EOY | $8,623,964 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,328,328 | BOYAmt |
| EOY | $14,299,789 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,362,803 | BOYAmt |
| EOY | $14,323,337 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $694,603 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,213,756 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $63,102 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $787,759 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $692,238 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $901,679 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,377,215 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $731,636 | CurrentTaxYearAmt |
| Total | $4,490,527 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $787,759 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $692,238 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $901,679 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,377,215 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $731,636 | CurrentTaxYearAmt |
| Total | $4,490,527 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $81,613 | SubstantialContributorsTotAmt |
| Public Support Total170 | $4,408,914 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $145,775 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $182,305 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $469,099 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $289,899 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $402,813 | CurrentTaxYearAmt |
| Total | $1,489,891 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $5,980,418 | TotalSupportAmt |
| Public Support CY170 | 0.73720 | PublicSupportCY170Pct |
| Public Support PY170 | 0.80450 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Donor Advised Funds Held | 1 | DonorAdvisedFundsHeldCnt |
| Donor Advised Funds Contri | $0 | DonorAdvisedFundsContriAmt |
| Donor Advised Funds Grants | $0 | DonorAdvisedFundsGrantsAmt |
| Donor Advised Funds Vl EOY | $9,625 | DonorAdvisedFundsVlEOYAmt |
| Disclosed Org Leg Ctrl | Yes (1) | DisclosedOrgLegCtrlInd |
| Disclosed For Charitable Prps | Yes (1) | DisclosedForCharitablePrpsInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,665,779 | BeginningYearBalanceAmt |
| Contributions | $2,772 | ContributionsAmt |
| Investment Earnings Or Losses | $333,957 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $3,630 | GrantsOrScholarshipsAmt |
| End Year Balance | $2,998,878 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,533,987 | BeginningYearBalanceAmt |
| Contributions | $15,237 | ContributionsAmt |
| Investment Earnings Or Losses | $292,934 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $7,218 | GrantsOrScholarshipsAmt |
| Other Expenditures | $1,169,161 | OtherExpendituresAmt |
| End Year Balance | $2,665,779 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,919,654 | BeginningYearBalanceAmt |
| Contributions | $7,303 | ContributionsAmt |
| Investment Earnings Or Losses | $659,124 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $52,094 | GrantsOrScholarshipsAmt |
| End Year Balance | $3,533,987 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,344,063 | BeginningYearBalanceAmt |
| Contributions | $82,062 | ContributionsAmt |
| Investment Earnings Or Losses | -$75,671 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $414,300 | OtherExpendituresAmt |
| Administrative Expenses | $16,500 | AdministrativeExpensesAmt |
| End Year Balance | $2,919,654 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,029,196 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $370,959 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $56,092 | OtherExpendituresAmt |
| End Year Balance | $3,344,063 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.61260 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.38740 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | BENEFICIAL INTEREST IN REMAINDER TRUST | Desc |
| Book Value | $767,616 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $767,616 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | AMOUNTS HELD FOR OTHERS | Desc |
| Amt | $9,625 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $9,625 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | 1) RALPH ROSSEN ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED IN 1986 TO PROVIDE RECOGNITION TO NURSING STAFF THAT PROVIDE REMARKABLE SERVICE TO NORTH MEMORIAL PATIENTS AND THEIR FAMILIES. MEMBERS OF THE ROSSEN FAMILY SERVE ON A COMMITTEE ALONG WITH THE VP AND CHIEF NURSING OFFICER OF NORTH MEMORIAL TO SELECT THE RECIPIENTS. 2) HAROLD B. KAISER HONORARY LECTURESHIP ENDOWMENT: DR KAISER IS THE FOUNDER OF ALLERGY & ASTHMA SPECIALISTS, P.A. ESTABLISHED IN 1966. THE HAROLD B KAISER HONORARY LECTURESHIP ENDOWMENT PROVIDES FUNDING FOR A KEYNOTE SPEAKER FOR THE ANNUAL ALLERGY & ASTHMA CONFERENCE HELD IN THE MINNEAPOLIS AREA IN MARCH. 3) HAROLD ECKER ENDOWMENT: ESTABLISHED IN 1994 IN HONOR OF THE EXCELLENT CARE THAT MR. ECKER RECEIVED AS A PATIENT AT NORTH MEMORIAL, THE HAROLD ECKER ENDOWMENT PROVIDES A $500 AWARD TO THREE NORTH MEMORIAL EMPLOYEES RECOGNIZING THEIR OUTSTANDING PERFORMANCE AND PERSONAL ATTITUDE. THE AWARD IS OPENED TO ALL EMPLOYEES AND THE WINNERS ARE SELECTED BY A COMMITTEE OF NORTH MEMORIAL EMPLOYEES AND PRESENTED AT THE ANNUAL QUALITY AWARDS LUNCHEON IN NOVEMBER EACH YEAR. 4) RESIDENTIAL HOSPICE ENDOWMENT: THE RESIDENTIAL HOSPICE ENDOWMENT WAS ESTABLISHED BY DR. JOHN AND PATTY MANION TO PROVIDE ASSISTANCE TO THE RESIDENTIAL HOSPICE PROGRAM AT NORTH MEMORIAL. FUNDS ARE USED TO UPGRADE THE FACILITIES AND EQUIPMENT AT THE NORTH RESIDENTIAL HOSPICE FACILITY IN BROOKLYN CENTER, PROVIDE ADDITIONAL PROGRAM SUPPORT, STAFF TRAINING AND TO ASSIST THOSE FAMILIES THAT CANNOT AFFORD THIS SERVICE. THE RESIDENTIAL HOSPICE FACILITY WAS SOLD IN 2017 AND WE ARE CURRENTLY WORKING THROUGH THE PROCESS TO REPURPOSE THE ENDOWMENT FUNDS. NO FUNDS WILL BE USED UNTIL THE PROCESS IS COMPLETE. 5) HELEN MURRAY MEMORIAL ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED WITH AN IRREVOCABLE CHARITABLE REMAINDER TRUST BY JEANNE MITHUN TO RECOGNIZE THE OUTSTANDING SERVICE THAT NORTH RESIDENTIAL HOSPICE PROVIDED TO HER MOTHER (HELEN MURRAY) AND HER FAMILY. FUNDS ARE USED TO PROVDE CARE TO INDIVIDUALS UNABLE TO PAY FOR SERVICES AT THE FACILITY. 6) MEDICAL STAFF ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED IN 2010 BY THE NORTH MEMORIAL MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND NORTH MEMORIAL PROGRAMS SUCH AS JUNIOR VOLUNTEER SCHOLARSHIP, SAFEJOURNEY, PASTORAL CARE, ETC. 7) MAPLE GROVE MEDICAL STAFF ENDOWMENT WAS ESTABLISHED IN 2013 BY THE MAPLE GROVE MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND MAPLE GROVE PROGRAMS. |
| PART X, LINE 2: | NORTH MEMORIAL IS ENGAGED IN CERTAIN ACTIVITIES THAT RESULT IN UNRELATED BUSINESS INCOME. NORTH MEMORIAL RECORDED AN INCOME TAX EXPENSE OF APPROXIMATELY $175,000 AND $445,000 IN 2021 AND 2020, RESPECTIVELY, WHICH IS INCLUDED WITH OTHER OPERATING EXPENSES IN THE CONSOLIDATED STATEMENTS OF OPERATIONS. NORTH MEMORIAL RECOGNIZES ALL TAX POSITIONS WHEN IT IS MORE LIKELY THAN NOT THAT, BASED ON TECHNICAL MERITS, THE POSITION WILL BE SUSTAINED UPON EXAMINATION. NORTH MEMORIAL EVALUATES ITS UNCERTAIN POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN THE CONSOLIDATED BALANCE SHEETS AS OF DECEMBER 31, 2021 OR 2020. PLEASE NOTE THAT AMOUNTS INCLUDED ABOVE REGARDING UNRELATED BUSINESS INCOME ARE FOR NORTH MEMORIAL HEALTH AS WELL AS OTHER ORGANIZATIONS INCLUDED IN THE CONSOLIDATED AUDIT REPORT. NORTH MEMORIAL FOUNDATION DOES NOT HAVE ANY UNRELATED BUSINESS INCOME TAX LIABILITY FOR TAX YEAR 2021. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | DINNER/DANCE GALA | Event1Nm |
| Gross Receipts Event1 | $392,966 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $119,743 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $273,223 | GrossRevenueEvent1Amt |
| Food And Beverage Event1 | $34,800 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $48,437 | OtherDirectExpensesEvent1Amt |
| Event2 | GOLF FUNDRAISER | Event2Nm |
| Gross Receipts Event2 | $215,639 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $84,480 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $131,159 | GrossRevenueEvent2Amt |
| Food And Beverage Event2 | $49,422 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $43,817 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $608,605 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $204,223 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $404,382 | GrossRevenueTotalEventsAmt |
| Food And Beverage Total Events | $84,222 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $92,254 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $176,476 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $227,906 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| NORTH MEMORIAL HEALTH CARE | ||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 410729979 | 501(C)(3) | $371,817 | $0 | TO SUPPORT COVID-19 EMERGENCY, INPATIENT MENTAL HEALTH SERVICES, OTHER PATIENT AND EMPLOYEE NEEDS |
| MAPLE GROVE HOSPITAL | ||||||||
| 9875 HOSPITAL DR | MAPLE GROVE | MN | 55369 | 208316475 | 501(C)(3) | $69,838 | $0 | TO SUPPORT MGH NICU, OTHER PATIENT AND EMPLOYEE NEEDS |
| BLAZE HEALTH LLC | ||||||||
| 8301 GOLDEN VALLEY RD STE 300 | GOLDEN VALLEY | MN | 55427 | 842906333 | $78,668 | $0 | TO SUPPORT HOSPICE SERVICES, OTHER PATIENT AND EMPLOYEE NEEDS | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|
| TEAM MEMBER ASSISTANCE/CRISIS FUND | 26 | $17,890 | TEAM MEMBER CRISIS ASSISTANCE |
| JUNIOR VOLUNTEER SCHOLARSHIPS | 5 | $7,500 | SCHOLARSHIPS FOR EDUCATION AND SPECIFIC STUDIES |
| PATIENT ASSISTANCE | 50 | $14,493 | FINANCIAL ASSISTANCE INCLUDING CANCER PHARMACEUTICALS, MENTAL HEALTH EMERGENCIES, AND OTHER NEEDS |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PRIMARILY MAKES GRANTS TO RELATED ORGANIZATION NORTH MEMORIAL HEALTH CARE AND RECORDS ARE MAINTAINED AS TO HOW FUNDS ARE DISBURSED BY BOTH ORGANIZATIONS. THE ORGANIZATION ALSO FUNDS CONTINUING EDUCATION FOR NORTH MEMORIAL EMPLOYEES AND MAKES SEVERAL SMALL SPONSORSHIPS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| J KEVIN CROSTON MD | ||||||||||||||
| DIRECTOR | $0 | $1,038,400 | $0 | $459,680 | $0 | $14,246 | $0 | $511,600 | $0 | $31,127 | $0 | $2,055,053 | $0 | $0 |
| PAMELA DOORENBOS MD | ||||||||||||||
| DIRECTOR | $0 | $319,615 | $0 | $86,750 | $0 | $0 | $0 | $17,259 | $0 | $6,519 | $0 | $430,143 | $0 | $0 |
| KENT SPAULDING | ||||||||||||||
| VICE PRESIDENT | $0 | $234,615 | $0 | $63,375 | $0 | $1,357 | $0 | $11,600 | $0 | $11,902 | $0 | $322,849 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE CHIEF EXECUTIVE OFFICER OF NORTH MEMORIAL PROVIDES SERVICES TO NORTH MEMORIAL HEALTH CARE AS WELL AS TO ALL RELATED ENTITIES AS IDENTIFIED ON SCHEDULE R. AS SUCH, HIS COMPENSATION LEVEL INCORPORATES SERVICES PROVIDED TO MULTIPLE NORTH MEMORIAL ENTITIES. THE CEO OF NORTH MEMORIAL HEALTH CARE HAS A PERMANENT SPOT ON THE BOARD OF THE NORTH MEMORIAL FOUNDATION. |
| PART I, LINE 4B | DR. KEVIN CROSTON RECIEVED A CONTRIBUTION TO HIS 457(F) PLAN OF $500,000 DURING THE TAX YEAR. THIS AMOUNT IS INCLUDED IN COLUMN (C) OF SCHEDULE J, PART II. THE AMOUNT WAS UNVESTED AS OF THE END OF THE TAX YEAR. |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTradedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $2,582 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp (3 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | COVID SUPPLIES | 8 | $76,537 | FMV |
| Yes (X) | GALA AUCTION ITEMS | 100 | $26,813 | FMV |
| Yes (X) | ALL OTHER | 25 | $8,712 | FMV |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, COLUMN (B): | FormAndLineReferenceDesc |
| Explanation | THE NUMBER IN PART I, COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTIONS. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE BOARD OF DIRECTORS MAY, BY ACTION OF A MAJORITY OF THE ENTIRE BOARD, DESIGNATE TWO OR MORE OF ITS MEMBERS AS AN EXECUTIVE COMMITTEE WHICH, TO THE EXTENT DETERMINED BY THE RESOLUTION OF THE BOARD, SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE BUSINESS OF THE CORPORATION. THE EXECUTIVE COMMITTEE SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL MAINTAIN MINUTES OF EACH MEETING. |
| FORM 990, PART VI, SECTION A, LINE 6 | NORTH MEMORIAL HEALTH CARE IS THE SOLE MEMBER OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | NORTH MEMORIAL HEALTH CARE, AS THE SOLE MEMBER OF THE ORGANIZATION, DETERMINES THE NUMBER OF BOARD MEMBERS AND ELECTS MEMBERS AT THE ANNUAL MEETING AFTER CONSIDERATION OF NOMINATIONS, IF ANY, FROM THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE APPROVAL OF NORTH MEMORIAL HEALTH CARE AS THE SOLE MEMBER OF THE ORGANIZATION IS REQUIRED FOR THE FOLLOWING ACTIONS OF THE ORGANIZATION'S GOVERNING BODY: (1) AMENDMENTS TO THE GOVERNING DOCUMENTS; (2) MERGER OR CONSOLIDATION OF THE ORGANIZATION; (3) SALE, LEASE, PLEDGE, TRANSFER, ASSIGNMENT OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (4) MORTGAGES OR OTHER SECURITY INTERESTS AFFECTING ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (5) ISSUANCE OF CAPITAL CALLS TO THE MEMBER; AND (6) DISSOLUTION AND LIQUIDATION OF THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE BOARD OF DIRECTORS REVIEW THE FORM 990 BEFORE IT IS FILED. REPRESENTATIVES FROM THE FOUNDATION'S INDEPENDENT ACCOUNTING FIRM REVIEW THE FORM 990 WITH MANAGEMENT IN DETAIL AND NOTE ANY CHANGES IN THE FORM 990 FROM PRIOR YEARS. AFTER THOROUGH DISCUSSION, THE BOARD APPROVES THE FORM 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL MEMBERS OF THE BOARD OF DIRECTORS AND ALL EMPLOYEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY EACH YEAR. EACH BOARD MEMBER AND STAFF MEMBER FILLS OUT A CONFLICT OF INTEREST QUESTIONNAIRE IN WHICH THEY ARE ASKED TO IDENTIFY ANY RELATIONSHIP THAT WOULD CREATE A CONFLICT OF INTEREST. THE RESULTS ARE SUMMARIZED AND REVIEWED TO DETERMINE ANY ACTUAL OR POTENTIAL CONFLICT AND ARE REPORTED TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION'S OFFICERS RECEIVED THEIR COMPENSATION FROM NORTH MEMORIAL HEALTH CARE (NMHC) WHICH FOLLOWS NMHC'S POLICIES AND PROCEDURES ON DETERMINING COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | NET CHANGE IN INTEREST IN BENEFICIAL TRUST 63,102. |
| FORM 990, PART XII, LINE 2C: | NEITHER THE OVERSIGHT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT CHANGED DURING THE TAX YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTH MEMORIAL HEALTH CARE | |||||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 410729979 | ACUTE CARE | MN | 501(C)(3) | LINE 3 | NORTH MEMORIAL | 0 | |
| ASSOCIATED HEALTH ASSURANCE | |||||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 980343815 | INSURANCE | 501(C)(3) | 11A | NORTH MEMORIAL | 0 | BD | |
| MAPLE GROVE HOSPITAL CORPORATION | |||||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 208316475 | ACUTE CARE | MN | 501(C)(3) | LINE 3 | NORTH MEMORIAL | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| NORTH MEMORIAL AMBULATORY SURGERY CENTER AT MAPLE GROVE LLC | |||||||||
| 9855 HOSPITAL DRIVE | MAPLE GROVE | MN | 55369 | 260393039 | OUTPATIENT SURGERY | MN | N/A | 0 | 0 |
| MINNESOTA DIAGNOSTIC IMAGING PARTNERS LLC | |||||||||
| 2955 XENIUM LANE SUITE 40 | PLYMOUTH | MN | 55441 | 352162215 | RADIOLOGY | MN | N/A | 0 | 0 |
| NORTH RADIATION THERAPY CENTER LLC | |||||||||
| 6950 FRANCE AVE S SUITE 200 | EDINA | MN | 55435 | 743069974 | RADIOLOGY | MN | N/A | 0 | 0 |
| BLAZE HEALTH LLC | |||||||||
| 8301 GOLDEN VALLEY RD STE 300 | GOLDEN VALLEY | MN | 55427 | 842906333 | HEALTHCARE | MN | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| OAKDALE HEALTH ENTERPRISES INC | |||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 411546422 | AMBULANCE | MN | N/A | C | 0 |
| CHARITABLE REMAINDER TRUST (1) | |||||||||
| CHARITABLE TRUST | MN | N/A | T | 0 | |||||
| NORTH COLLABORATIVE CARE | |||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 461680666 | PRIMARY CARE | MN | N/A | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| NORTH MEMORIAL HEALTH CARE (CONTRIBUTIONS TO NMHC) | ||
| B | $371,817 | FMV (SEE SCH I) |
| BLAZE HEALTH LLC | ||
| B | $78,668 | FMV (SEE SCH I) |
| MAPLE GROVE HOSPITAL | ||
| B | $69,839 | FMV (SEE SCH I) |
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