2021-11-12T11:07:24-06:00 2020-12-31 390859910 BAKER TILLY US LLP 225 S 6TH ST 2300 MINNEAPOLIS MN 55402 990 2020-01-01 411777966 NORTH MEMORIAL FOUNDATION NORT 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 KENT SPAULDING VP FOUNDATION 7635205200 2021-11-11 1 KENT SPAULDING XXX-XX-XXXX LAWRENCE H MOHR CPA P00447603 6128764500 2021-11-11 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z KENT SPAULDING 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 1944114 0 X WWW.NORTHMEMORIAL.COM X 1993 MN 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. 15 12 0 150 0 0 901679 1377215 0 0 469099 289899 226272 165017 1597050 1832131 660607 930134 0 0 0 0 0 0 0 401436 143900 1062043 1074034 535007 758097 10556316 12362803 270796 34475 10285520 12328328 X 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. 0 0 531524 531524 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. EIGHT STAFF RECEIVED $500 IN ASSISTANCE TO SUPPORT HOUSING COSTS FOR A TOTAL OF $4,000 IN DIRECT FINANCIAL ASSISTANCE PROVIDED. 43199 43199 HOSPICE SUPPORT:NORTH MEMORIAL HEALTH'S HOSPICE TEAM PROVIDED SERVICES FOR 1,000 PATIENTS IN 2020, 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. 194297 194297 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 2020. 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. 282083 161114 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. 282083 161114 1051103 1 1 0 0 0 1 0 0 0 1 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 4 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 12 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN WI X DAN FROMM 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 J KEVIN CROSTON MD BOARD MEMBER 2.00 44.00 X 0 1433961 48912 PAMELA DOORENBOS MD BOARD MEMBER 1.00 40.00 X 0 374814 20956 BETH MEJIA BOARD MEMBER 1.00 40.00 X 0 81538 7999 SCOTT HEMENWAY BOARD CHAIR 1.00 X X 0 0 0 JANDEEN BOONE VICE CHAIR 1.00 X X 0 0 0 JIM BYRNE TREASURER 1.00 X X 0 0 0 DANA GARRETT BOARD MEMBER 1.00 X 0 0 0 DAVID HANCOX BOARD MEMBER 1.00 X 0 0 0 BRUCE QUAM BOARD MEMBER 1.00 X 0 0 0 DIANE NILSON BOARD MEMBER 1.00 X 0 0 0 TROY REDING BOARD MEMBER 1.00 X 0 0 0 MICHAEL HOLTZ BOARD MEMBER 1.00 X 0 0 0 DEEPAK KADEMANI DMD MD BOARD MEMBER 1.00 X 0 0 0 ERIC SKALLAND BOARD MEMBER 1.00 X 0 0 0 MIKE STEINHAUSER BOARD MEMBER 1.00 X 0 0 0 KENT SPAULDING VICE PRESIDENT 2.00 40.00 X 0 275299 38762 0 2165612 116629 0 0 1 0 0 289788 1087427 518259 1377215 289899 289899 277000 289788 111983 165017 165017 1832131 0 0 454916 893964 893964 36170 36170 6159 6159 SUPPLIES 103084 80153 22931 MISCELLANEOUS 34657 34657 1074034 1051103 22931 0 312649 349640 29717 6459 9412739 11302189 801211 704515 10556316 12362803 261146 24850 9650 9625 270796 34475 X 3227821 4458294 7057699 7870034 10285520 12328328 10556316 12362803 X 758097 1245066 39645 X X 0 1 X 1 0 X 1574758 787759 692238 901679 1377215 5333649 1574758 787759 692238 901679 1377215 5333649 87723 5245926 99819 145775 182305 469099 289899 1186897 6520546 0.80450 0.84160 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 0 0 9625 1 1 3533987 15237 292934 7218 1169161 2665779 2919654 7303 659124 52094 3533987 3344063 82062 -75671 414300 16500 2919654 3029196 370959 56092 3344063 2203143 155228 707969 37144 3029196 0.00000 0.66442 0.33558 1 0 0 BENEFICIAL INTEREST IN REMAINDER TRUST 704515 704515 AMOUNTS HELD FOR OTHERS 9625 9625 X 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 $445,000 AND $97,000 IN 2020 AND 2019, 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, 2020 OR 2019. 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 2020. DINNER/DANCE GALA 548924 271924 277000 42000 50900 11632 GOLF FUNDRAISER 17864 17864 4000 3451 566788 289788 277000 42000 54900 15083 111983 165017 1 NORTH MEMORIAL HEALTH CARE 3300 OAKDALE AVE N ROBBINSDALE MN 55422 410729979 501(C)(3) 725821 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) 44420 TO SUPPORT MGH NICU, OTHER PATIENT AND EMPLOYEE NEEDS BLAZE HEALTH LLC 8301 GOLDEN VALLEY RD STE 300 GOLDEN VALLEY MN 55427 842906333 123723 TO SUPPORT HOSPICE SERVICES, OTHER PATIENT AND EMPLOYEE NEEDS 2 1 TEAM MEMBER ASSISTANCE/CRISIS FUND 33 23830 TEAM MEMBER CRISIS ASSISTANCE JUNIOR VOLUNTEER SCHOLARSHIPS 2 2700 SCHOLARSHIPS FOR EDUCATION AND SPECIFIC STUDIES PATIENT ASSISTANCE 15 9640 FINANCIAL ASSISTANCE INCLUDING CANCER PHARMACEUTICALS, MENTAL HEALTH EMERGENCIES, AND OTHER NEEDS PART I, LINE 2: THE ORGANIZATION PRIMARILY MAKES GRANTS TO RELATED ORGANIZATIONS 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. 0 0 0 0 0 0 1 0 0 J KEVIN CROSTON MD BOARD MEMBER 0 947216 0 473587 0 13158 0 19950 0 28962 0 1482873 0 0 PAMELA DOORENBOS MD BOARD MEMBER 0 294867 0 79947 0 0 0 11400 0 9556 0 395770 0 0 KENT SPAULDING VICE PRESIDENT 0 207286 0 66561 0 1452 0 15905 0 22857 0 314061 0 0 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 6 NORTH MEMORIAL HEALTH CARE'S ANNUAL INCENTIVE PLAN REQUIRES ACHIEVEMENT OF STATED PERFORMANCE METRICS, WHICH INCLUDE OPERATING MARGIN. X 1 10219 FMV X COVID SUPPLIES 71628 463227 FMV X GALA AUCTION ITEMS 107 42000 FMV X GALA SUPPLIES 1 2813 FMV 0 0 1 0 PART I, COLUMN (B): THE NUMBER IN PART I, COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTIONS. 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 FORM 990 WILL BE DISTRIBUTED TO ALL BOARD MEMBERS AT THE MEETING CLOSEST TO THE FILING DATE FOR REVIEW AND APPROVAL PRIOR TO FILING. 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 39,645. FORM 990, PART XII, LINE 2C: NEITHER THE OVERSIGHT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT CHANGED DURING THE TAX YEAR. 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 BD 501(C)(3) 11A NORTH MEMORIAL 0 MAPLE GROVE HOSPITAL CORPORATION 3300 OAKDALE AVE N ROBBINSDALE MN 55422 208316475 ACUTE CARE MN 501(C)(3) LINE 3 NORTH MEMORIAL 0 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 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 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NORTH MEMORIAL HEALTH CARE (CONTRIBUTIONS TO NMHC) B 725821 FMV (SEE SCH I) BLAZE HEALTH LLC B 123723 FMV (SEE SCH I)