MINNESOTA VALLEY HEALTH CENTER INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- MINNESOTA VALLEY HEALTH CENTER INC (EIN 41-0837659)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-15
- IRS object ID
- 202113199349314331
- Schema version
- 2020v4.1
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-15T13:36:47-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 S 6TH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410837659 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MINNESOTA VALLEY HEALTH CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MINN | BusinessNameControlTxt |
| Phone | 5076653375 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 621 SOUTH 4TH STREET | AddressLine1Txt |
| City | LE SUEUR | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56058 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AARON BLOOMQUIST | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5076653375 | PhoneNum |
| Signature | 2021-11-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | AARON | PersonFirstNm |
| Person Last | BLOOMQUIST | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DARRYN MCGARVEY | PreparerPersonNm |
| PTIN | P00958683 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Preparation | 2021-11-10 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIDGEVIEW LE SUEUR MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | PAM WILLIAMS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 621 SOUTH 4TH STREET | AddressLine1Txt |
| City | LE SUEUR | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56058 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,508,818 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RIDGEVIEWLESUEUR.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1959 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | OUR MISSION IS TO PROVIDE COMMUNITY-BASED HEALTHCARE IN AN ENVIRONMENT THAT FOSTERS DIGNITY, RESPECT AND EXCELLENCE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 162 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $50,029 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,464,228 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,019,186 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $12,555,037 | CYProgramServiceRevenueAmt |
| PY Investment Income | $15,649 | PYInvestmentIncomeAmt |
| CY Investment Income | $14,816 | CYInvestmentIncomeAmt |
| PY Other Revenue | $482,440 | PYOtherRevenueAmt |
| CY Other Revenue | $474,737 | CYOtherRevenueAmt |
| PY Total Revenue | $13,567,304 | PYTotalRevenueAmt |
| CY Total Revenue | $14,508,818 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,535,101 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,301,032 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,664,011 | PYOtherExpensesAmt |
| CY Other Expenses | $6,842,663 | CYOtherExpensesAmt |
| PY Total Expenses | $13,199,112 | PYTotalExpensesAmt |
| CY Total Expenses | $13,143,695 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $368,192 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,365,123 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $16,334,633 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,560,454 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,193,374 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,891,415 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,141,259 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,669,039 | NetAssetsOrFundBalancesEOYAmt |
| Mission | OUR MISSION IS TO PROVIDE COMMUNITY-BASED HEALTHCARE IN AN ENVIRONMENT THAT FOSTERS DIGNITY, RESPECT, AND EXCELLENCE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,399,863 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $12,555,037 | RevenueAmt |
| Desc | RIDGEVIEW LE SUEUR MEDICAL CENTER IS CREATED & ORGANIZED EXCLUSIVELY FOR CHARITABLE AND EDUCATIONAL PURPOSES. RIDGEVIEW LE SUEUR MEDICAL CENTER IS CREATED AND ORGANIZED TO OWN, MAINTAIN, OPERATE AND CONDUCT, DIRECTLY OR INDIRECTLY, AND TO ASSIST AND COORDINATE ACTIVITIES OF FACILITIES FOR HEALTH CARE, EDUCATION, CARE FOR THE AGED AND SOCIAL SERVICES. RIDGEVIEW LE SUEUR MEDICAL CENTER INCLUDES A HOSPITAL, OUTPATIENT SPECIALTY CLINICS, COMPLETE LAB AND RADIOLOGY DEPARTMENTS, A COMPREHENSIVE PHYSICAL OCCUPATIONAL AND SPEECH THERAPY DEPARTMENT, EXTENDED CARE NURSING FACILITIES, AND INDEPENDENT LIVING SENIOR HOUSING. | Desc |
| Total Program Service Expenses | $8,399,863 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | 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 | 0 | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 162 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| 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 | 0 | QuidProQuoContributionsInd |
| 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | 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 | 0 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PATRICIA SCHLEGEL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5076658683 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 621 SOUTH 4TH STREET | AddressLine1Txt |
| City | LE SUEUR | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56058 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|
| IRENE MANKE | |||||||
| BOARD PRESIDENT | 10.00 | Yes (X) | Yes (X) | $1,800 | $0 | $0 | |
| STEVE SMITH | |||||||
| BOARD VICE PRESIDENT | 2.00 | Yes (X) | Yes (X) | $1,200 | $0 | $0 | |
| ROBERT BROEDER | |||||||
| BOARD SECRETARY/TREASURER | 5.00 | Yes (X) | Yes (X) | $1,200 | $0 | $0 | |
| MARK AMUNDSON | |||||||
| BOARD DIRECTOR | 2.00 | Yes (X) | $1,200 | $0 | $0 | ||
| DAVID BRAUN | |||||||
| BOARD DIRECTOR | 2.00 | Yes (X) | $1,200 | $0 | $0 | ||
| WAYNE HUBIN | |||||||
| BOARD DIRECTOR | 2.00 | Yes (X) | $1,200 | $0 | $0 | ||
| KAY KING | |||||||
| BOARD DIRECTOR | 2.00 | Yes (X) | $1,200 | $0 | $0 | ||
| SHAWN KIRBY | |||||||
| BOARD DIRECTOR | 3.00 | Yes (X) | $1,200 | $0 | $0 | ||
| MICHAEL PHELPS | |||||||
| CEO | 0.50 | Yes (X) | $0 | $561,195 | $64,748 | 49.50 | |
| AARON BLOOMQUIST | |||||||
| CFO | 1.00 | Yes (X) | $0 | $67,505 | $27,892 | ||
| GORDON GABLENZ | |||||||
| CFO | 0.50 | Yes (X) | $0 | $764,988 | $83,372 | 40.00 | |
| BENJAMIN NIELSEN | |||||||
| COO | 0.50 | Yes (X) | $0 | $320,292 | $15,401 | 50.00 | |
| PAMELA WILLIAMS | |||||||
| VICE PRESIDENT | 0.50 | Yes (X) | $0 | $150,868 | $46,261 | 50.00 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $10,200 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,864,848 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $237,674 | 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 |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| PREMIER STAFFING | |||||
| 243 WINKLER WAY | COLOGNE | MN | 55322 | ER PHYSICIAN SERVICES | $1,146,254 |
| AEGIS THERAPIES | |||||
| PO BOX 8103 | FORT SMITH | AR | 72902 | THERAPY SERVICES | $520,204 |
| ONESTAFF MEDICAL LLC | |||||
| PO BOX 3544 | OMAHA | NE | 68103 | STAFFING SERVICES | $360,834 |
| ESSENTIA HEALTH | |||||
| 632 EAST FIRST STREET | DULUTH | MN | 55805 | SUPPORT FEE FOR EPIC | $151,421 |
| MEDLINE INDUSTRIES INC | |||||
| DEPT CH 14400 | PALENTINE | IL | 60055 | MEDICAL SUPPLIES | $111,041 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,464,228 | GovernmentGrantsAmt |
| Total Contributions | $1,464,228 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT/RESIDENT REVENUE | 621110 | $12,245,967 | $12,245,967 |
| APARTMENT PROJECT REVENUES | 623000 | $309,070 | $309,070 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $12,555,037 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,816 | TotalRevenueColumnAmt |
| Exclusion | $14,816 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $361,710 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $361,710 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $361,710 | TotalRevenueColumnAmt |
| Exclusion | $361,710 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $113,027 | TotalRevenueColumnAmt |
| Exclusion | $113,027 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $113,027 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,508,818 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,555,037 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $489,553 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,000 | TotalAmt |
| Management And General | $9,000 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,175,832 | TotalAmt |
| Program Services | $3,546,944 | ProgramServicesAmt |
| Management And General | $1,628,888 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $151,693 | TotalAmt |
| Program Services | $103,773 | ProgramServicesAmt |
| Management And General | $47,920 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $598,044 | TotalAmt |
| Program Services | $409,122 | ProgramServicesAmt |
| Management And General | $188,922 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $366,463 | TotalAmt |
| Program Services | $250,697 | ProgramServicesAmt |
| Management And General | $115,766 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,940 | TotalAmt |
| Management And General | $29,940 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,807 | TotalAmt |
| Management And General | $61,807 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,571,059 | TotalAmt |
| Program Services | $973,873 | ProgramServicesAmt |
| Management And General | $597,186 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,353 | TotalAmt |
| Management And General | $16,353 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,707 | TotalAmt |
| Program Services | $12,386 | ProgramServicesAmt |
| Management And General | $7,321 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $389,199 | TotalAmt |
| Program Services | $244,612 | ProgramServicesAmt |
| Management And General | $144,587 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,310 | TotalAmt |
| Program Services | $2,709 | ProgramServicesAmt |
| Management And General | $1,601 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,565 | TotalAmt |
| Program Services | $6,640 | ProgramServicesAmt |
| Management And General | $3,925 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $400,998 | TotalAmt |
| Management And General | $400,998 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $971,810 | TotalAmt |
| Program Services | $320,989 | ProgramServicesAmt |
| Management And General | $650,821 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,977 | TotalAmt |
| Program Services | $11,927 | ProgramServicesAmt |
| Management And General | $7,050 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| REPAIRS AND MAINTENANCE | $1,421,503 | $893,415 | $528,088 |
| SUPPLIES | $969,198 | $944,677 | $24,521 |
| BAD DEBT | $412,480 | $412,480 | |
| DUES AND SUBSCRIPTIONS | $208,906 | $131,297 | $77,609 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $335,851 | TotalAmt |
| Program Services | $134,322 | ProgramServicesAmt |
| Management And General | $201,529 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,143,695 | TotalAmt |
| Program Services | $8,399,863 | ProgramServicesAmt |
| Management And General | $4,743,832 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $164,960 | BOYAmt |
| EOY | $266,630 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,632,978 | BOYAmt |
| EOY | $9,117,994 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,452,998 | BOYAmt |
| EOY | $3,031,354 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $88,444 | BOYAmt |
| EOY | $147,046 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,564 | BOYAmt |
| EOY | $63,051 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,161,891 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $11,183,285 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,169,573 | BOYAmt |
| EOY | $6,978,606 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $793,116 | BOYAmt |
| EOY | $955,773 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,334,633 | BOYAmt |
| EOY | $20,560,454 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,842,636 | BOYAmt |
| EOY | $2,180,122 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,958,066 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,537 | BOYAmt |
| EOY | $3,395 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,922,337 | BOYAmt |
| EOY | $6,513,010 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,414,864 | BOYAmt |
| EOY | $1,236,822 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,193,374 | BOYAmt |
| EOY | $12,891,415 | 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 | $5,348,143 | BOYAmt |
| EOY | $6,713,266 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $793,116 | BOYAmt |
| EOY | $955,773 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,141,259 | BOYAmt |
| EOY | $7,669,039 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,334,633 | BOYAmt |
| EOY | $20,560,454 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $1,365,123 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $162,657 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $316 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $316 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | RIDGEVIEW LE SUEUR MEDICAL CENTER PAY DUES TO A CERTAIN ORGANIZATION RELATED TO THE INDUSTRY WHICH HAS LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $793,116 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $162,657 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $955,773 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $722,130 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $111,628 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $30,050 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $10,592 | AdministrativeExpensesAmt |
| End Year Balance | $793,116 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $794,693 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$32,850 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $29,405 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $10,308 | AdministrativeExpensesAmt |
| End Year Balance | $722,130 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $711,289 | BeginningYearBalanceAmt |
| Contributions | $5,050 | ContributionsAmt |
| Investment Earnings Or Losses | $115,650 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $27,879 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $9,417 | AdministrativeExpensesAmt |
| End Year Balance | $794,693 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $704,595 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $6,694 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $711,289 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $46,482 | OtherCostOrOtherBasisAmt |
| Book Value | $46,482 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,025,414 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,457,712 | DepreciationAmt |
| Book Value | $1,567,702 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $253,994 | OtherCostOrOtherBasisAmt |
| Depreciation | $271,388 | DepreciationAmt |
| Book Value | -$17,394 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,790,783 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,454,185 | DepreciationAmt |
| Book Value | $5,336,598 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $45,218 | OtherCostOrOtherBasisAmt |
| Book Value | $45,218 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $6,978,606 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RIDGEVIEW | Desc |
| Amt | $1,236,822 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,236,822 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $14,096,338 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,096,338 | RevenueSubtotalAmt |
| Other Revenues Not Included | $412,480 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $412,480 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $14,508,818 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,731,215 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,731,215 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $412,480 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $412,480 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $13,143,695 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 2B: | RIDGEVIEW LE SUEUR MEDICAL CENTER, INC ACTS AS CUSTODIAN FOR THE FUNDS OF THE RESIDENTS. RESIDENT TRUST FUNDS TOTALED $3,395 AT DECEMBER 31, 2020. DURING THAT SAME TIME RIDGEVIEW LE SUEUR MEDICAL CENTER, INC HOLDS $3,395 IN A SEPARATE ACCOUNT FOR TENANT SECURITY DEPOSITS. |
| PART X, LINE 2: | THE HEALTH CENTER IS OPERATED AS A TAX-EXEMPT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAX RELATED TO BUSINESS INCOME. THE HEALTH CENTER FOLLOWS THE ACCOUNTING STANDARD FOR RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE HEALTH CENTER'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT 412,480. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT 412,480. |
| SCHEDULE D, PART V, LINE 4 | RIDGEVIEW LE SUEUR MEDICAL CENTER'S INTENDED USE OF ITS ENDOWMENT FUNDS IS FOR CAPITAL AND OTHER IMPROVEMENTS THAT FURTHER RIDGEVIEW LE SUEUR MEDICAL CENTER'S MISSION. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 315 | PersonsServedCnt |
| Total Community Benefit Expns | $404,875 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $404,875 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03180 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 588 | PersonsServedCnt |
| Total Community Benefit Expns | $3,048,138 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,362,749 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $685,389 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05380 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1807 | PersonsServedCnt |
| Total Community Benefit Expns | $1,471,668 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $594,442 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $877,226 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06890 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2710 | PersonsServedCnt |
| Total Community Benefit Expns | $4,924,681 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,957,191 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,967,490 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15450 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,158 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,619 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,539 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,158 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,619 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,539 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 2710 | PersonsServedCnt |
| Total Community Benefit Expns | $4,942,839 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,970,810 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,972,029 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.15490 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $412,480 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $206,240 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,269,448 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,910,998 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$641,550 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIDGEVIEW LE SUEUR MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 621 SOUTH 4TH STREET | AddressLine1Txt |
| City | LE SUEUR | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56058 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.RIDGEVIEWLESUEUR.ORG | WebsiteAddressTxt |
| State License | HFID-00336 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIDGEVIEW LE SUEUR MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.RIDGEVIEWLESUEUR.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.RIDGEVIEWLESUEUR.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | Yes (1) | OrganizationIncurExciseTaxInd |
| Form4720 Filed | Yes (1) | Form4720FiledInd |
| Excise Report Form4720 For All | $50,000 | ExciseReportForm4720ForAllAmt |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://RIDGEVIEWLESUEUR.ORG/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://RIDGEVIEWLESUEUR.ORG/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://RIDGEVIEWLESUEUR.ORG/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| RIDGEVIEW LE SUEUR MEDICAL CENTER | PART V, SECTION B, LINE 5: IN 2019 RIDGEVIEW PARTNERED WITH CARVER COUNTY PUBLIC HEALTH TO COMPLETE THE PRIMARY DATA COLLECTION FOR THE 2019 CHNA. THIS INCLUDED PRIMARY RESEARCH, DATA ANALYSIS, VALIDATION AND PRIORIZATION , AND ANALYSIS OF DOCUMENTED HEALTH AND SOCIOECONOMIC FACTORS WITH COMMUNITY INPUT. THE COMMUNITY INPUT INCLUDED SURVEYS FROM RESIDENTS OF CARVERCOUNTY PLUS ACROSS THE SIX OTHER COUNTIES IN RIDGEVIEW'S SERVICE AREA. DATA WAS ALSO COLLECTED FROM RIDGEVIEW'S ELECTRONIC MEDICAL RECORD AND FINANCIAL SYSTEM, US CENSUS BUREAU, COUNTY HEALTH RANKINGS AND MN HOSPITAL ASSN. |
| RIDGEVIEW LE SUEUR MEDICAL CENTER | PART V, SECTION B, LINE 6B: CARVER COUNTY PUBLIC HEALTH, US CENSUS BUREAU, COUNTY HEALTH RANKINGS AND MN HOSPITAL ASSN |
| RIDGEVIEW LE SUEUR MEDICAL CENTER | PART V, SECTION B, LINE 7D: ON WEBSITE |
| RIDGEVIEW LE SUEUR MEDICAL CENTER | PART V, SECTION B, LINE 11: RIDGEVIEW WILL CONTINUE TO IMPLEMENT SYSTEM-WIDE INITIATIVES THAT SUPPORT AND IMPACT THE HEALTH OF ITS GROWING SERVICE AREA AS WELL AS TARGETED RESOURCES TO ADDRESS SPECIFIC NEEDS OF ITS DIVERSE POPULATIONS. COMMUNITY HEALTH NEEDS THAT THE HOSPITAL DOES NOT PLAN TO ADDRESS ARE:-PREVENTION, CLINICAL CARE AND DISEASE MANAGEMENT: PREVENTIVE SCREENINGS, ACCESS TO CARE, SPECIFICALLY IN RURAL AREAS. |
| RIDGEVIEW LE SUEUR MEDICAL CENTER | PART V, SECTION B, LINE 16J: MINNESOTA VALLEY HEALTH CENTER, INC DBA RIDGEVIEW LE SUEUR MEDICAL CENTER, MAKES INFORMATION ON ITS FINANCIAL ASSISTANCE POLICY (FAP) READILY AVAILABLE TO THE PATIENT. INFORMATION ABOUT FINANCIAL ASSISTANCE PROGRAMS IS AVAILABLE ON THE WEB SITE WWW.RIDGEVIEWLESUEUR.ORG WHERE THE INFORMATION AND APPLICATION WERE EASILY ACCESSIBLE TO BE VIEWED, DOWNLOADED AND PRINTED AT NO CHARGE TO THE PATIENT. NOTICES ON THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE CONSPICUOUSLY POSTED IN EMERGENCY ROOM DEPARTMENTS AND IN WAITING ROOMS. FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE DURING THE PRE-ADMISSION FINANCIAL SCREENING, AT THE TIME OF REGISTRATION AND PRIOR TO A HOSPITAL DISCHARGE. INFORMATION ABOUT THE FAP IS IN ALL COLLECTION LETTERS AND PATIENT STATEMENTS. MINNEOSTA VALLEY HEALTH CENTER, INC DBA RIDGEVIEW LE SUEUR MEDICAL CENTER, EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS PROVIDING DIRECT PATIENT TREATMENT AND WHO WORK IN ADMISSIONS, BILLING AND COLLECTIONS, ABOUT THE EXISTENCE OF THE FAP AND HOW A PATIENT MAY OBTAIN MORE INFORMATION. ANNUAL EDUCATION/AWARENESS OF THE FAP IS PROVIDED TO ENSURE ALL EMPLOYEES WITH PATIENT CONTACT ARE AWARE OF THE PROGRAM AND HOW PATIENTS CAN OBTAIN ADDITIONAL INFORMATION. CLINICAL AND HOSPITAL STAFF WHO PROVIDE DIRECT PATIENT CARE HAVE KNOWLEDGE OF THE FAP AND KNOW TO DIRECT PATIENTS TO A REGISTRATION INTERVIEWER OR PATIENT FINANCIAL SERVICES. REGISTRATION STAFF HAVE AN UNDERSTANDING OF THE POLICY, KNOWLEDGE OF WHERE THE RELATED DOCUMENTS ARE LOCATED AND WHERE TO DIRECT THE PATIENT FOR MORE INFORMATION ON THE FAP. DESIGNATED EMPLOYEES HAVE A THOROUGH UNDERSTANDING OF THE FAP AND OFFER THE INFORMATION ON THE FAP TO THOSE PATIENTS WHO MAKE AN INQUIRY ABOUT THE PROGRAM OR ARE DETERMINED THROUGH A FINANCIAL SCREENING THAT THE PATIENT MAY BE ELIGIBLE FOR THIS PROGRAM. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT, A PATIENT'S GUARANTOR, A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. MINNESOTA VALLEY HEALTH CENTER, INC. RESPONDS TO ANY ORAL OR WRITTEN REQUESTS FOR MORE GENERAL INFORMATION ON THE FAP MADE BY A PATIENT OR ANY INTERESTED PARTY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - RIDGEVIEW LE SUEUR LONG-TERM CARE | ||||
| 621 SOUTH 4TH STREET | LE SUEUR | MN | 56058 | SKILLED NURSING FACILITY |
| 2 - SUNRIZE PLAZA | ||||
| 600 SOUTH 5TH STREET | LE SUEUR | MN | 56058 | SENIOR APARTMENTS |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | RIDGEVIEW LE SUEUR MEDICAL CENTER PROVIDES A 100% DISCOUNT UP TO 200% OF FEDERAL POVERTY GUIDELINES (FPG) AND DISCOUNTED CARE UP TO 250% OF FPG. TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE, PATIENTS MUST COOPERATE WITH THE HOSPITAL TO EXPLORE ALTERNATIVE MEANS OF ASSISTANCE IF NECESSARY. PATIENTS WILL BE REQUIRED TO PROVIDE NECESSARY INFORMATION AND DOCUMENTATION WHEN APPLYING FOR HOSPITAL FINANCIAL ASSISTANCE OR OTHER PRIVATE OR PUBLIC PAYMENT PROGRAMS. RIDGEVIEW MEDICAL CENTER WILL TAKE MEDICAL BILLS WITH CURRENT PATIENT RESPONSIBILITY INTO CONSIDERATION WHEN DETERMINING ELIGIBILITY FOR COMMUNITY CARE. RIDGEVIEW MEDICAL CENTER TAKES INTO ACCOUNT LIQUID ASSETS. ANY LIQUID ASSETS IN EXCESS OF $20,000 WILL BE CONSIDERED THE SAME AS FAMILY INCOME FOR THIS CALCULATION. EXTERNAL, PUBLIC SOURCES LIKE CREDIT SCORES MAY ALSO BE USED TO VERIFY ELIGIBILITY. WHEN DETERMINING PATIENTS' ELIGIBILITY FOR FINANCIAL ASSISTANCE, RIDGEVIEW MEDICAL CENTER DOES NOT TAKE INTO ACCOUNT RACE, GENDER, AGE, SEXUAL ORIENTATION, RELIGIOUS AFFILIATION, AND SOCIAL OR IMMIGRANT STATUS. |
| PART I, LINE 7: | THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS, RATIO OF PATIENT CARE COST-TO-CHARGES WAS USED TO CALCULATE THE COSTS FOR THE FOLLOWING COMMUNITY BENEFITS: CHARITY CARE, UNREIMBURSED MEDICAID AND COSTS FROM OTHER MEANS-TESTED GOVERNMENT PROGRAMS. ACTUAL COSTS WERE USED FOR THE REMAINDER OF THE COMMUNITY BENEFITS REPORTED. |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 412,480. |
| PART III, LINE 2: | DISCOUNTS, CHARITY CARE, AND BAD DEBT EXPENSE ARE ACCOUNTED FOR AS REDUCTIONS TO REVENUE. BAD DEBT EXPENSE ON PATIENT ACCOUNTS WOULD BE IDENTIFIED AS ANY BALANCE ON THE ACCOUNT, LESS ANY PREVIOUS PAYMENTS AND DISCOUNTS, THAT HAS AGED AND IS ABSENT OF ANY PAYMENTS. IF, DURING THE COLLECTION PROCESS, IT BECOMES KNOWN THAT THE PATIENT QUALIFIES FOR CHARITY CARE, THE AMOUNTS INCLUDED WITHIN THE BAD DEBT EXPENSE WOULD BE RECLASSIFIED TO CHARITY CARE. |
| PART III, LINE 3: | AS A TAX EXEMPT HOSPITAL, MEDICAL NECESSARY SERVICES ARE PROVIDED REGARDLESS OF THE PATIENTS ABILITY TO PAY FOR THAT CARE. RIDGEVIEW LE SUEUR MEDICAL CENTER APPLIED A HIGH-LEVEL CONSERVATIVE ANALYTIC REVIEW BY MULTIPLYING THE RATIO OF CHARITABLE ALLOWANCES TO GROSS PATIENT REVENUE AGAINST BAD DEBT EXPENSE TO ARRIVE AT AN APPROXIMATION OF CHAIRTY CARE THAT RESIDES IN BAD DEBT. |
| PART III, LINE 4: | THE HEALTH CENTER PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS USING MANAGEMENT'S JUDGMENT. PATIENTS AND RESIDENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES RENDERED. PAYMENT FOR SERVICES IS REQUIRED WITHIN 30 DAYS OF RECEIPT OF INVOICE. PAST DUE ACCOUNTS ARE INDIVIDUALLY ANALYZED FOR COLLECTABILITY, AND THEN TURNED OVER TO COLLECTION AGENTS. ACCOUNTS FOR WHICH NO PAYMENTS HAVE BEEN RECEIVED ARE ANALYZED AND AFTER APPROVAL ARE WRITTEN OFF. IN ADDITION, AN ALLOWANCE IS ESTIMATED FOR OTHER ACCOUNTS BASED ON HISTORICAL EXPERIENCE OF THE HEALTH CENTER. |
| PART III, LINE 8: | MINNESOTA VALLEY HEALTH CENTER, INC. INCORPORATED THE FULL VALUE OF THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. THE RATIONALE FOR THE ORGANIZATION'S OPINION IS PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE AND IT IS LIKELY TO GET WORSE. MANY MEDICARE BENEFICIARIES ARE POOR AND ARE ELIGIBLE FOR MEDICAID IN ADDITION TO MEDICARE. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL AND NURSING HOME IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY. |
| PART III, LINE 9B: | THE POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE POLICY (FAP) AND FINANCIAL ASSISTANCE, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR FINANCIAL ASSISTANCE FROM RIDGEVIEW LE SUEUR MEDICAL CENTER AND THE PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS/HER PAYMENT AGREEMENTS. RIDGEVIEW LE SUEUR MEDICAL CENTER OFFERS EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS AND WILL NOT IMPOSE LIENS ON PRIMARY RESIDENCES NOR WILL WE REPROT PATIENTS TO A CREDIT RATING AGENCY FOR OUTSTANDING PATIENT BILLS. RIDGEVIEW LE SUEUR MEDICAL CENTER WILL NOT CHARGE A PATIENT GROSS AMOUNT OF CHARGES FOR ANY UNINSURED TREATMENT. UNINSURED DISCOUNTS WILL BE APPLIED TO THE GROSS CHARGES PRIOR TO ANY FAP OR OTHER DISCOUNTS. AT ANY TIME RIDGEVIEW LE SUEUR MEDICAL CENTER RECOGNIZES THAT A PATIENT MAY BE ELIGIBLE FOR STATE OR FEDERAL PROGRAMS, A REPRESENTATIVE WILL ASSIST THE PATIENT IN OBTAINING INFORMATION ABOUT THOSE PROGRAMS OR PROVIDE CONTACT INFORMATION FOR THOSE PROGRAMS. RIDGEVIEW LE SUEUR MEDICAL CENTER CONTRACTS WITH AN OUTSIDE PATIENT ADVOCACY AGENCY, WHICH MAY PROVIDE ASSISTANCE TO THE UNINSURED PATIENT IN APPLYING TO CERTAIN STATE AND FEDERAL PROGRAMS. AT ANY STATE OF THE PATIENT EXPERIENCE AND UP THROUGH THE COLLECTION PROCESS, THE PATIENT MAY EXPRESS A CONCERN THAT THEY ARE UNABLE TO PAY THEIR BILL IN FULL OR MEET THE PAYMENT PLAN REQUIREMENTS. AT THAT TIME, THE PATIENT WILL BE GIVEN EVERY OPPORTUNITY TO COMPLETE AND SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. RIDGEVIEW LE SUEUR MEDICAL CENTER TRAINS ITS OUTSIDE DEBT COLLECTION AGENCIES AND ATTORNEYS ABOUT THE FINANCIAL ASSISTANCE POLICY AND HOW A PATIENT MAY OBTAIN MORE INFORMATION ABOUT THE FAP OR SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. RIDGEVIEW LE SUEUR MEDICAL CENTER REQUIRES ITS OUTSIDE COLLECTION AGENCIES AND ATTORNEYS TO REFER PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE TO RIDGEVIEW LE SUEUR MEDICAL CENTER IF A PATIENT HAS SUBMITTED AN APPLICATION FOR FINANCIAL ASSISTANCE AFTER AN ACCOUNT HAS BEEN REFERRED FOR COLLECTION ACTIVITY, RIDGEVIEW LE SUEUR MEDICAL CENTER AND ITS OUTSIDE DEBT COLLECTION AGENCIES SUSPEND ALL COLLECTION ACTIVITY UNTIL THE PATIENT'S FINANCIAL ASSISTANCE APPLICATION HAS BEEN PROCESSED AND RIDGEVIEW LE SUEUR MEDICAL CENTER HAS NOTIFIED THE PATIENT OF ITS DECISION. |
| PART VI, LINE 2: | RIDGEVIEW LE SUEUR MEDICAL CENTER IS A LICENSED 15 BED CRITICAL ACCESS HOSPITAL IN LE SUEUR, MN AND IS THE ONLY HOSPITAL IN LE SUEUR COUNTY. RIDGEVIEW LE SUEUR MEDICAL CENTER ALSO HAS TWO CLINICS. RIDGEVIEW LE SUEUR MEDICAL CENTER WORKS WITH THE ONLY LOCAL PRIMARY CARE PHYSICIAN CLINIC IN LE SUEUR, SIBLEY COUNTY PUBLIC HEALTH, NICOLLET COUNTY PUBLIC HEALTH AND LE SUEUR COUNTY PUBLIC HEALTH AGENCIES FOR ASSESSING THE NEEDS OF THE RURAL COMMUNITIES IN OUR AREA. THESE NEEDS ARE DETERMINED BY SEVERAL DIFFERENT MENTHODS, BUT MOSTLY BASED ON WHAT THESE AGENCIES ARE ACTUALLY SEEING WHEN THEY ARE WORKING WITH THEIR CLIENTS. THIS COMMUNICATION IS ONGOING THROUGHOUT THE YEAR. RIDGEVIEW LE SUEUR MEDICAL CENTER IS A MEMBER OF A LOCAL NON-PROFIT GROUP CALLED COMMUNITY WELLNESS COLLABORATION. THE MISSION OF THIS GROUP IS TO ADDRESS DEPRESSION, BULLYING AND SUICIDE PREVENTION IN OUR COMMUNITY. OTHER MEMBERS OF THIS COLLABORATION ARE LE SUEUR COUNTY PUBLIC HEALTH AND SOCIAL SERVICES, A LOCAL FAMILY PRACTICE CLINIC, LAW ENFORCEMENT AGENCIES AND A LOCAL SCHOOL. THE COLLABORATION WAS FORMED IN THE LAST THREE YEARS AND IS BASED ON WHAT THESE AGENCIES WERE SEEING EITHER IN THE EMERGENCY ROOM, CLINIC VISITS, AMBULANCE CALLS, INCIDENTS AT SCHOOL AND CALLS TO LAW ENFORCEMENT. THE COLLABORATION WAS DEEMED NECESSARY AS THE NUMBER OF THESE EVENTS HAVE BEEN INCREASING. |
| PART VI, LINE 3: | RIDGEVIEW LE SUEUR MEDICAL CENTER MAKES INFORMATION ON ITS FINANCIAL ASSISTANCE POLICY (FAP) READILY AVAILABLE TO THE PATIENT. INFORMATION ABOUT FINANCIAL ASSISTANCE PROGRAM IS AVAILABLE ON THE WEB SITE WWW.RIDGEVIEWLESUEUR.ORG WHERE THE INFORMATION AND APPLICATION WERE EASILY ACCESSIBLE TO BE VIEWED, DOWNLOADED AND PRINTED AT NO CHARGE TO THE PATIENT. NOTICES ON THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE CONSPICUOUSLY POSTED IN EMERGENCY ROOM DEPARTMENTS AND IN WAITING ROOMS. FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE DURING THE PRE-ADMISSION FINANCIAL SCREENING, AT THE TIME OF REGISTRATION AND PRIOR TO A HOSPITAL DISCHARGE. INFORMATION ABOUT THE FAP IS IN ALL COLLECTION LETTERS AND PATIENT STATEMENTS. RIDGEVIEW LE SUEUR MEDICAL CENTER EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS PROVIDING DIRECT PATIENT TREATMENT AND WHO WORK IN ADMISSIONS, BILLING AND COLLECTIONS, ABOUT THE EXISTENCE OF THE FAP AND HOW A PATIENT MAY OBTAIN MORE INFORMATION. ANNUAL EDUCATION/AWARENESS OF THE FAP IS PROVIDED TO ENSURE ALL EMPLOYEES WITH PATIENT CONTACT ARE AWARE OF THE PROGRAM AND HOW PATIENTS CAN OBTAIN ADDITIONAL INFORMATION. CLINICAL AND HOSPITAL STAFF WHO PROVIDE DIRECT PATIENT CARE HAVE KNOWLEDGE OF THE FAP AND KNOW TO DIRECT PATIENTS TO A REGISTRATION INTERVIEWER OR BUSINESS OFFICE REPRESENTATIVE. REGISTRATION STAFF HAVE AN UNDERSTANDING OF THE POLICY, KNOWLEDGE OF WHERE THE RELATED DOCUMENTS ARE LOCATED AND WHERE TO DIRECT THE PATIENT FOR MORE INFORMATION ON THE FAP. DESIGNATED EMPLOYEES HAVE A THOROUGH UNDERSTANDING OF THE FAP AND OFFER THE INFORMATION ON THE FAP TO THOSE PATIENTS WHO MAKE AN INQUIRY ABOUT THE PROGRAM OR ARE DETERMINED THROUGH A FINANCIAL SCREENING THAT THE PATIENT MAY BE ELIGIBLE FOR THIS PROGRAM. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT, A PATIENT'S GUARANTOR, A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. RIDGEVIEW LE SUEUR MEDICAL CENTER RESPONDS TO ANY ORAL OR WRITTEN REQUESTS FOR MORE GENERAL INFORMATION ON THE FAP MADE BY A PATIENT OR ANY INTERESTED PARTY. |
| PART VI, LINE 4: | RIDGEVIEW LE SUEUR MEDICAL CENTER IS LOCATED IN LE SUEUR, MN. RIDGEVIEW LE SUEUR MEDICAL CENTER OPERATES A CRITICAL ACCESS HOSPITAL, A LONG-TERM CARE FACILITY, AND A 37 UNIT HUD-SUBSIDIZED LOW INCOME HOUSING FOR SENIORS THAT SERVE THE COMMUNITIES OF LE SUEUR, NICOLLET AND SIBLEY COUNTIES. THE OVERALL COMMUNITY IS CLASSIFIED AS RURAL. RIDGEVIEW LE SUEUR MEDICAL CENTER AND ITS RELATED FACILITIES COVER A SERVICE REGION OF APPROXIMATELY 28,000 PEOPLE. THE SERVICE REGION AGE DISTRIBUTION IS 25% UNDER THE AGE OF 18, 54% BETWEEN THE AGES OF 18 AND 65, AND 16% OVER THE AGE OF 65. THE RACIAL MAKEUP OF THE SERVICE REGION IS 96% WHITE, NON-HISPANIC, 7% HISPANIC OR LATINO, 1% BLACK OR AFRICAN AMERICAN, .5% AMERICAN INDIAN AND .7% ASIAN. THE GENDER SLPIT RATIO IS 49.5% WOMEN AND 50.5% MEN. THE AVERAGE INCOME FOR THE SERVICE AREA IS APPROXIMATELY $67,451. APPROXIMATELY 7.8% OF THE POPULATION FALLS BELOW THE FEDERAL POVERTY GUIDELINES. RIDGEVIEW LE SUEUR MEDICAL CENTER IS COMMITTED TO SERVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 19% NET REVENUE DOLLARS WERE FROM SELF PAY PATIENTS. IN ADDITION, APPROXIMATELY 24% OF THEIR NET REVENUE DOLLARS WERE MEDICAID RECIPIENTS FOR THE HOSPITAL. APPROXIMATELY 70% NET REVENUE DOLLARS WERE FROM MEDICAL ASSISTANCE RESIDENTS IN THE NURSING HOME. RIDGEVIEW LE SUEUR MEDICAL CENTER HAS AN OUTREACH PROGRAM THAT BRINGS SPECIALISTS LIKE ONCOLOGISTS, CARDIOLOGISTS, NEUROLOGISTS, AND OTHERS INTO ITS SMALLER COMMUNITY. THIS ELIMINATES BARRIERS TO CARE FOR MANY PATIENTS, PARTICULARLY THOSE WHO ARE EDERLY, LIVING ON LOW INCOMES, OR ARE FACED WITH OTHER CHALLENGES THAT MAKE IT DIFFICULT TO TRAVEL LONG DISTANCES FOR CARE. |
| PART VI, LINE 5: | IN JANUARY 2017 MINNESOTA VALLEY HEALTH CENTER INC, BECAME PART OF THE RIDGEVIEW MEDICAL CENTER SYSTEM OUT OF WACONIA MN. RIDGEVIEW BOARD OF DIRECTORS HAVE RESERVCE POWERS OF THE MINNESOTA VALLEY HEALTH CENTER BOARD OF DIRECTORS. IN JANUARY 2018 MINNESOTA VALLEY HEALTH CENTER EMPLOYEES BECAME RIDGEVIEW MEDICAL CENTER EMPLOYEES MINNESOTA VALLEY HEALTH CENTER, INC'S BOARD OF DIRECTORS IS A VOLUNTEER BOARD CONSISTING OF LOCAL COMMUNITY MEMBERS WITH A CROSS SECTION OF OCCUPATIONS. ONE OF THE REPRESENTATIVES IS APPOINTED BY THE LE SUEUR CITY COUNCIL. NONE OF THE BOARD MEMBERS ARE EMPLOYEES, RELATED TO EMPLOYEES OR ARE INDEPENDENT CONTRACTORS OF THE ORGANIZATION. GIVEN THAT WE ARE A SMALL COMMUNITY IF A VOTE COMES UP FOR SOMETHING THAT COULD APPEAR TO BE A CONFLICT OF INTEREST THE BOARD MEMBER WILL ABSTAIN FROM VOTING. OUR MEDICAL STAFF CONSISTS OF OUR EMERGENCY ROOM DIRECTOR AND THE PROVIDERS FROM THE RIDGEVIEW LE SUEUR MEDICAL CLINIC. MINNESOTA VALLEY HEALTH CENTER, INC. IS AN OPEN MEDICAL STAFF, THEREFORE ANY QUALIFIED PHYSICAN OF THE COMMUNITY IS ALLOWED TO APPLY. ALL APPLICANTS THAT APPLY MUST MEET THE CREDENTIALING STANDARDS AND BE APPROVED BY OUR GOVERNING BOARD IN ORDER TO PROVIDE SERVICES IN OUR SYSTEM. ANY AND ALL EMERGENCY REPAIRS OR EQUIPMENT NEEDS THAT ARISE ARE TAKEN CARE OF IMMEDIATLEY. THE ADULT DAY HEALTH SERVICES PROGRAM IS ASSISTED BY THE HOSPITAL SERVICES. MOST OF THE CLIENTS IN THE ADULT DAY HEALTH SERVICES PROGRAM ARE ON THE ELDERLY WAIVER PROGRAM AND PAYMENT FROM THIS PROGRAM DOESN'T COVER ALL OF THE STAFF TIME OR THE COST TO TRANSPORT THE CLIENT FROM HOME TO OUR SITE AND BACK HOME AGAIN, YET IS IS A MUCH NEEDED SERVICE IN OUR COMMUNITY. WE OFFER A MEALS ON WHEELS PROGRAM FOR HOME BOUND RESIDENTS AND MOST OF THOSE MEALS ARE PAID FOR THROUGH AN ELDERLY WAIVER PROGRRAM THROUGH THE COUNTY, WHICH JUST COVERS THE COST OF THE FOOD. VOLUNTEERS DELIVER MEALS TO HOME BOUND CLIENTS MONDAYS - FRIDAYS, THIS PAST YEAR 3,726 MEALS WERE PREPARED AND DELIVERED. WE HAVE EVENING EVENTS FOR THE COMMUNITY SUCH AS "LINED IN PINK" FOR BREAST CANCER AWARENESS AND FLU SHOT CLINICS. WE PARTICIPATE IN LOCAL COMMUNITY EVENTS SUCH AS SUPER SATURDAY KIDS EVENTS, SCHOOL SUPPLIES AND WINTER CLOTHING DRIVES FOR THE SCHOOL, FOOD SHELF DRIVE AND 5K WALK/RUN EVENT TWO TIMES A YEAR. WE ALSO PARTICIPATE WITH THE COMMUNITY'S SENIOR EXPO EACH YEAR THAT HIGHLIGHTS SERVICES TO SENIORS. WE HAVE THE EMERGENCY HELICOPTER HERE FOR EVENTS FOR THE COMMUNITY TO COME AND MEET THEM AND BE AWARE OF THESE SERVICES. RIDGEVIEW LE SUEUR MEDICAL CENTER HAD A BOOTH AT THE ANNUAL RETAIL AND BUSINESS EXPO THAT WAS HELD AT THE LOCAL MALL TO EDUCATE THE COMMUNITY ON SERVICES AVAILABLE AT THE HEALTH CENTER. THE OUTPATIENT CLINIC WING PROVIDES SPACE FOR VISITING SPECIALISTS (CARDIOLOGY, PODIATRY, ORTHOPEDICS, UROLOGY, GENERAL SURGERY) FROM OTHER HEALTH CARE SYSTEMS TO SEE PATIENTS LOCALLY AND TO PERFORM OUTPATIENT PROCEDURES LOCALLY. MOST OF OUR POPULATION IS ELDERLY AND ARE UNABLE TO DRIVE GREAT DISTANCES SO THEY ARE ABLE TO RECEIVE CARE FROM SPECIALISTS LOCALLY. WE STRIVE TO PROVIDE HIGH-QUALITY, PATIENT-CENTERED CARE CLOSE TO HOME FOR THE COMMUNITIES WE SERVE. WE CONTINUE TO UPGRADE FACILITIES AND TECHNOLOGY TO ENSURE PATIENTS IN RURAL COMMUNITIES HAVE NEARBY ACCESS TO THESE SERVICES. . |
| PART VI, LINE 7, REPORTS FILED WITH STATES | MN |
| PART VI LINE 6 | RIDGEVIEW MEDICAL CENTER IS A 109-BED ACUTE CARE HOSPITAL IN WACONIA, MINNESOTA THAT PROVIDES HEALTHCARE SERVICES TO THE RESIDENTS OF THE WEST SUBURBAN METROPOLITAN AREA ON MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MN. RIDGEVIEW MEDICAL CENTER'S SUBSIDIARIES INCLUDE:RIDGEVIEW CLINICS PROVIDES OUTPATIENT HEALTHCARE SERVICES FROM VARIOUS CLINIC LOCATIONS THROUGHOUT THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MINNESOTA.SIBLEY MEDICAL CENTER (DBA: RIDGEVIEW SIBLEY MEDICAL CENTER) IS A CRITICAL ACCESS HOSPITAL PROVIDING URGENT CARE, GENERAL SURGERY, AND 24/7 HOSPITAL AND EMERGENCY SERVICES TO RESIDENTS OF SIBLEY COUNTY AND THE SURROUNDING AREA. RIDGEVIEW SIBLEY MEDICAL CENTER ALSO HAS CLINICAL LOCATIONS IN ARLINGTON, GAYLORD, HENDERSON AND WINTHROP.RIDGEVIEW LE SUEUR MEDICAL CENTER OPERATES A 15-BED ACUTE CARE HOSPITAL. A 50-BED NURSING HOME, AND A 37-UNIT HUD APARTMENT BUILDING FOR THE ELDERLY.CHASKA PLAZA SURGERY CENTER IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER OWNS A 51% INTEREST.MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER PROVIDES CARDIOLOGY SERVICES. THE HEART INSTITUTE IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER HOLDS A 50% INTEREST.WACONIA BUILDING INVESTMENTS OWNS A MEDICAL OFFICE BUILDING ON RIDGEVIEW MEDICAL CENTER'S CAMPUS LOCATION.RIDGEVIEW REAL ESTATE LLC HOLDS THE LAND LEASE FOR WACONIA BUILDING INVESTMENTS.RIDGEVIEW COMMUNITY NETWORK OPERATES AN ACCOUNTABLE CARE ORGANIZATION.RIDGEVIEW INSURANCE COMPANY OPERATES A CAPTIVE INSURANCE COMPANY FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER.RIDGEVIEW FOUNDATION OPERATES FOR THE EXCLUSIVE BENEFIT OF RIDGEVIEW MEDICAL CENTER. |
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 (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GORDON GABLENZ | ||||||||||||||
| CFO | $0 | $290,231 | $0 | $56,602 | $0 | $418,155 | $0 | $22,910 | $0 | $60,462 | $0 | $848,360 | $0 | $0 |
| MICHAEL PHELPS | ||||||||||||||
| CEO | $0 | $466,890 | $0 | $91,332 | $0 | $2,973 | $0 | $25,176 | $0 | $39,572 | $0 | $625,943 | $0 | $0 |
| BENJAMIN NIELSEN | ||||||||||||||
| COO | $0 | $259,023 | $0 | $37,452 | $0 | $23,817 | $0 | $14,647 | $0 | $754 | $0 | $335,693 | $0 | $0 |
| PAMELA WILLIAMS | ||||||||||||||
| VICE PRESIDENT | $0 | $117,164 | $0 | $17,538 | $0 | $16,166 | $0 | $15,155 | $0 | $31,106 | $0 | $197,129 | $0 | $0 |
| AARON BLOOMQUIST | ||||||||||||||
| CFO | $0 | $66,771 | $0 | $0 | $0 | $734 | $0 | $4,663 | $0 | $23,229 | $0 | $95,397 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE CEO, COO, CFO, & VICE PRESIDENT IS COMPENSATED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. THE FOLLOWING WERE USED BY RIDGEVIEW MEDICIAL CENTER TO DETERMINE THE CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) WRITTEN EMPLOYEMENT CONTRACT 5) COMPENSATION SURVEY OR STUDY 6) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) |
| PART I, LINE 4B | ROBERT STEVENS PARTICIPATED IN A SUPPLEMENT NON-QUALIFIED RETIREMENT PLAN. DURING 2020, $0 WAS CONTRIBUTED TO THE PLAN, $73,774 ACCRUED WITHIN THE PLAN, AND $170,042 WAS PAID OUT OF THE PLAN MICHAEL PHELPS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2020, $0 WAS CONTRIBUTED TO THE PLAN, $24,881 WAS ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. GORDON GABLENZ PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2020, $414,540 WAS CONTRIBUTED TO THE PLAN. $37,525 ACCRUED WITHIN THE PLAN AND $0 WAS PAID OUT OF THE PLAN. THESE DEFERRED COMPENSATION AMOUNTS ARE REPORTED ON A PRO-RATE BASIS WITHOUT REGARD TO THE INDIVIDUALS VESTING SCHEDULE. CURRENTLY, THE MAJORITY OF DEFERRED COMPENSATION IS NOT VESTED. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF THE FILING ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE FILING ORGANIZATION'S BOARD SHALL CONSIST TWO PERSONS APPOINTED BY THE SOLE MEMBER. OTHER MEMBERS OF THE FILING ORGANIZATION'S BOARD ARE SELECTED BY A NOMINATING COMMITTEE AND MUST BE APPROVED BY THE SOLE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE ARTICLES AND BYLAWS PROVIDE THE SOLE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, DEBT, AMENDMENT OF THE ARTICLES & BYLAWS AND GENERAL OPERATION DECISIONS. |
| FORM 990, PART VI, SECTION A, LINE 8B | FILING ORGANIZATION HAS NO EXECUTIVE COMMITTEE OR SIMILAR COMMITTEE WITH BOARD DELEGATED AUTHORITY. |
| FORM 990, PART VI, SECTION B, LINE 11B | MANAGEMENT REVIEWED THE FORM 990 AND PROVIDED COPIES TO THE BOARD OF DIRECTORS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE STATEMENTS FOR POTENTIAL CONFLICTES OF INTEREST POLICY. EACH MEMBER IS EXPECTED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR. IF IT IS DETERMINED THAT CONFLICT OF INTEREST EXISTS, THE SITUATION WILL BE EXAMINED AND HANDLED APPROPRIATELY BY THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO & CFO ARE PAID BY RIDGEVIEW MEDICAL CENTER, THE SOLE CORPORATE MEMBER, WHICH PERFORMS THE REVIEW AND APPROVAL OF THE COMPENSATION FOR THE CEO AND CFO. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFILICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONSULTING & OTHER PROFESSIONAL FEE: PROGRAM SERVICE EXPENSES 973,873. MANAGEMENT AND GENERAL EXPENSES 575,646. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,549,519. ER MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 21,540. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,540. |
| FORM 990, PART XI, LINE 9: | CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 162,657. |
| FORM 990, PART XII, LINE 2C | THE PROCESS REGARDING OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MINNESOTA VALLEY MEMORIAL HOSPITAL FOUNDATION | |||||||||||
| 621 SOUTH FOURTH STREET | LE SUEUR | MN | 56058 | 411754182 | RAISING FUNDS FOR RIDGEVIEW LE SUEUR MEDICAL CENTER. | MN | 501(C)(3) | LINE 12A, I | N/A | 0 | |
| RIDGEVIEW MEDICAL CENTER | |||||||||||
| 500 S MAPLE ST | WACONIA | MN | 55387 | 311667875 | HEALTH CARE SERVICES | MN | 501(C)(3) | LINE 3 | N/A | 0 | |
| RIDGEVIEW FOUNDATION | |||||||||||
| 500 S MAPLE ST | WACONIA | MN | 55387 | 411328097 | RAISING FUNDS FOR RIDGEVIEW MEDICAL CENTER | MN | 501(C)(3) | LINE 7 | 0 | RIDGEVIEW MEDICAL CENTER | |
| RIDGEVIEW CLINICS | |||||||||||
| 500 S MAPLE ST | WACONIA | MN | 55387 | 411651783 | HEALTH CARE SERVICES | MN | 501(C)(3) | LINE 3 | 0 | RIDGEVIEW MEDICAL CENTER | |
| RIDGEVIEW INSURANCE CO | |||||||||||
| 60 E SOUTH TEMPLE STE 1800 | SALT LAKE CITY | UT | 84111 | 454109041 | CAPTIVE INSURANCE COMPANY | UT | 501(C)(3) | LINE 12A, I | 0 | RIDGEVIEW MEDICAL CENTER | |
| SIBLEY MEDICAL CENTER | |||||||||||
| 601 W CHANDLER ST | ARLINGTON | MN | 55307 | 411801967 | CRITICAL ACCESS HOSPITAL | MN | 501(C)(3) | LINE 3 | 0 | RIDGEVIEW MEDICAL CENTER | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 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 |
|---|---|---|---|---|---|---|---|---|---|
| MINNEAPOLIS HEART INSTITITUE AT RIDGEVIEW HEART CENTER LLC | |||||||||
| 500 S MAPLE ST | WACONIA | MN | 55387 | 205785920 | CARDIOLOGY | MN | N/A | 0 | 0 |
| CHASKA PLAZA SURGERY CENTER | |||||||||
| 3000 HUNDERTMARK ROAD | CHASKA | MN | 55318 | 450975783 | SURGERY SERVICES | MN | N/A | 0 | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| EXECUTIVE HEALTH MANAGEMENT SERVICES | |||||||||
| 500 SOUTH MAPLE ST | WACONIA | MN | 55387 | 411760239 | MANAGEMENT SERVICES | MN | N/A | C | 0 |
| CHARITABLE REMAINDER UNITRUST (1) | |||||||||
| CHARITABLE TRUST | MN | N/A | 0 | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | 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
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NO TRANSACTIONS GREATER THAN 50000 | BusinessNameLine1Txt |