2020-11-12T13:10:50-06:00 2019-12-31 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2019-01-01 411328097 RIDGEVIEW FOUNDATION RIDG 9524426010 500 SOUTH MAPLE STREET WACONIA MN 55387 AARON BLOOMQUIST CFO 9524426010 2020-11-11 1 DARRYN MCGARVEY P00958683 6123764500 66.188.188.148 2020-11-11 14:05:25 CS P 64D167D091931D8555FA058DC075EC7E31BCB1E3 8DF0D5A1DBF8E44DE93554FEEDBEEE801640FE4C 2019 2021-01-29 14:40:06Z MICHAEL PHELPS 500 SOUTH MAPLE STREET WACONIA MN 55387 7358872 0 X WWW.RIDGEVIEWMEDICAL.ORG X 1978 MN TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 24 24 0 322 0 0 2592909 3204981 0 0 2577271 248365 -219497 -299835 4950683 3153511 2137894 3414459 0 0 0 0 0 0 0 517753 478967 2655647 3893426 2295036 -739915 18702001 19315628 433239 243464 18268762 19072164 RIDGEVIEW FOUNDATION IS AN INDEPENDENT NONPROFIT ORGANIZATION THAT PARTNERS WITH RIDGEVIEW MEDICAL CENTER IN ITS MISSION TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 0 0 3803338 3414459 0 TO RAISE FUNDS EXCLUSIVELY FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER, A NOT-FOR-PROFIT HOSPITAL IN WACONIA, MINNESOTA. DURING THE YEAR ENDED DECEMBER 31, 2019, RIDGEVIEW FOUNDATION EXPENSED A TOTAL OF $3,785,971 TO RIDGEVIEW MEDICAL CENTER. OF THIS, $1,760,299 WAS TRANSFERRED TO THE HOSPITAL TO SUPPORT THE BUILDING AND FURNISHING OF AN EMERGENCY DEPARTMENT EXPANSION, $411,601 WAS TRANSFERRED TO THE HOSPITAL TO SUPPORT ENDOWMENT FUND ACTIVITES, AND $298,217 WAS TRANSFERRED TO THE HOSPITAL TO SUPPORT ANNUAL FUND ATIVITIES. THE REMAINING $1,315,854 WAS TRANSFERRED TO THE HOSPITAL TO BE USED FOR VARIOUS PROJECTS AND PROGRAMS DURING 2019. 3803338 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 20 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 24 24 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X AARON BLOOMQUIST 9524422191 500 SOUTH MAPLE STREET WACONIA MN 55387 MICHAEL PHELPS PRESIDENT / CEO 0.50 49.50 X 0 615975 79168 GORDON GABLENZ CFO & CIO 4.00 46.00 X 0 366510 90148 DOUGLAS STASEK EXECUTIVE DIRECTOR 47.50 2.50 X 0 216024 89291 FRED GREEN CHAIRPERSON 0.50 0.00 X X 0 0 0 KATHRYN BARNES VICE CHAIR 0.50 0.00 X X 0 0 0 CARLA STRUBLE SECRETARY 0.50 0.00 X X 0 0 0 JON CROW TREASURER 0.50 0.00 X X 0 0 0 MIKE BAUER BOARD MEMBER 0.50 0.00 X 0 0 0 BRIAN BENIEK BOARD MEMBER 0.50 0.00 X 0 0 0 JEAN BULLER BOARD MEMBER 0.50 0.00 X 0 0 0 BRETT COLBJORSEN BOARD MEMBER 0.50 0.00 X 0 0 0 MIKE DRAZAN BOARD MEMBER 0.50 0.00 X 0 0 0 TIM FOSTER BOARD MEMBER 0.50 0.00 X 0 0 0 JOHN HAYES BOARD MEMBER 0.50 0.00 X 0 0 0 DARLA HOLMGREN BOARD MEMBER 0.50 0.00 X 0 0 0 ROCHELLE LINDBERG BOARD MEMBER 0.50 0.00 X 0 0 0 SUSAN MILLER BOARD MEMBER 0.50 0.00 X 0 0 0 DR LORENE RUTHERFORD MD BOARD MEMBER 0.50 0.00 X 0 0 0 TIM SCHMIDT BOARD MEMBER 0.50 0.00 X 0 0 0 CHUCK SPEVACEK BOARD MEMBER 0.50 0.00 X 0 0 0 MARK STEINGAS BOARD MEMBER 0.50 0.00 X 0 0 0 LINDSEY THOMPSON BOARD MEMBER 0.50 0.00 X 0 0 0 JENNIFER TREGARTHEN BOARD MEMBER 0.50 0.00 X 0 0 0 MARK UNDESTAD BOARD MEMBER 0.50 0.00 X 0 0 0 JEFF WIGEN BOARD MEMBER 0.50 0.00 X 0 0 0 DAVID WINDSCHITL BOARD MEMBER 0.50 0.00 X 0 0 0 STEVE YETZER BOARD MEMBER 0.50 0.00 X 0 0 0 0 1198509 258607 0 0 1 0 0 960998 333653 1910330 394577 3204981 288703 288703 3667757 3708095 -40338 -40338 -40338 114441 960998 401375 -286934 -286934 82990 95891 -12901 -12901 3153511 0 0 -51470 3380459 3380459 34000 34000 12312 12312 13500 13500 64276 64276 MISCELLANEOUS EXPENSES 388879 388879 3893426 3803338 90088 0 1354577 1624427 933328 1245579 2961364 1066340 50000 9697 9697 0 0 9878126 11391593 3574606 3937689 18702001 19315628 433239 243464 433239 243464 X 9945004 12204768 8323758 6867396 18268762 19072164 18702001 19315628 -739915 1543317 0 X 0 1 X 1 0 X 4017312 2308131 5569184 2592909 3204981 17692517 4017312 2308131 5569184 2592909 3204981 17692517 2738862 14953655 106017 127973 297958 256230 288703 1076881 106718 67898 134350 183870 197431 690267 19459665 0.76840 0.75380 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: SPECIAL FUNDRAISING EVENTS CHARITABLE GAMING ACTIVITIES RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6041811 39614 429578 429578 6081425 7474066 10773 18456 18456 1443028 6041811 7461924 12142 713500 713500 7474066 7021304 440620 176379 176379 7461924 5873869 1147435 2689 936 1753 7021304 0.49330 0.50670 0.00000 0 0 9697 9697 0 0 ASSETS HELD IN CHARITABLE REMAINDER TRUST 392427 CASH SURRENDER VALUE LIFE INSURANCE POLICY 3545262 3937689 X 7215715 1543317 757855 3781835 6083007 1132708 96705 1924098 2020803 3153511 4955951 757855 401375 1159230 3796721 96705 96705 3893426 PART V, LINE 4: THE EARNING FROM THE ENDOWMENT FUNDS ARE INTENDED TO BE USED FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER, A NOT-FOR-PROFIT HOSPITAL IN WACONIA, MINNESOTA. PART X, LINE 2: THE FOUNDATION HAS RECEIVED NOTIFICATION THAT IT QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING PROVISIONS OF STATE LAW AND, ACCORDINGLY, IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, ANY UNRELATED BUSINESS INCOME MAY BE SUBJECT TO TAXATION. DURING 2010, THE FOUNDATION REQUESTED AND WAS APPROVED TO RECLASSIFY FROM 509(A)(3) STATUS TO 509(A)(1) AND 170(B)(1)(A)(VI) STATUS WITH THE INTERNAL REVENUE SERVICE. THE FOUNDATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE FOUNDATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAD NO EFFECT ON THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 3,380,460. FUNDRAISING EVENT EXPENSES 401,375. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 1,924,098. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 401,375. GOLF TOURNAMENT 461507 406906 54601 16038 238628 CASINO NIGHT 384136 367333 16803 5901 3613 17608 26826 2 229796 186759 43037 200 27896 4560 19884 40221 1075439 960998 114441 200 33797 24211 37492 305675 401375 -286934 82990 70048 25843 0 82990 70048 25843 95891 -12901 MN 1 0 0 0 0.00000 1.00000 GORDON GABLENZ 500 SOUTH MAPLE STREET WACONIA MN 55387 0 KIM KIMBALL 54214 KIM KIMBALL IS THE EVENTS COORDINATOR FOR THE FOUNDATION. SHE SUPERVISES ALL FUNDRAISING EVENTS AND FILLS OUT ALL OF THE PAPERWORK RELATED TO GAMING ACTIVITIES. X 0 1 SIBLEY MEDICAL CENTER 601 WEST CHANDLER STREET ARLINGTON MN 55307 311801967 501(C)(3) 37773 0 FUNDRAISING SUPPORT OF SIBLEY MEDICAL CENTER RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 501(C)(3) 3342686 0 FUNDRAISING SUPPORT OF RIDGEVIEW MEDICAL CENTER 2 0 SCHOLARSHIPS 17 34000 0 PART I, LINE 2: GRANTS AND OTHER ASSISTANCE TO ENTITIES IN THE U.S.: TRANSFERS ARE TO RELATED ENTITIES UNDER COMMON MANAGEMENT AND TRACKED THROUGH THE INTERNAL FINANCIAL REPORTING PROCESS. GRANTS AND OTHER ASSISTANCE TO INDIVIDUALS IN THE U.S.: SCHOLARSHIP PAYMENTS ARE MADE DIRECTLY TO THE SCHOOL THAT THE STUDENT IS ATTENDING. 0 1 0 0 0 1 1 0 0 MICHAEL PHELPS PRESIDENT / CEO 0 532445 0 83530 0 0 0 40836 0 38332 0 695143 0 0 GORDON GABLENZ CFO & CIO 0 313049 0 53461 0 0 0 33688 0 56460 0 456658 0 0 DOUGLAS STASEK EXECUTIVE DIRECTOR 0 185832 0 30192 0 0 0 48763 0 40528 0 305315 0 0 PART I, LINE 3 THE PRESIDENT/CEO IS COMPENSATED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. THE FOLLOWING WERE USED BY RIDGEVIEW MEDICAL CENTER TO DETERMINE THE PRESIDENT/CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) WRITTEN EMPLOYMENT CONTRACT 5) COMPENSATION SURVEY OR STUDY 6) APROVAL BY THE BOARD OR COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) PART I, LINE 4B MICHAEL PHELPS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2019, $0 WAS CONTRIBUTED TO THE PLAN, $28,277 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. GORDON GABLENZ PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2019, $0 WAS CONTRIBUTED TO THE PLAN, $16,804 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. THESE DEFERRED COMPENSATION AMOUNTS ARE REPORTED ON A PRO-RATA BASIS WITHOUT REGARD TO THE INDIVIDUAL'S VESTING SCHEDULE. CURRENTLY, THE MAJORITY OF DEFERRED COMPENSATION IS NOT VESTED. PART I, LINE 6 THE OFFICERS OF RIDGEVIEW MEDICAL CENTER AND AFFILIATES RECEIVE BONUSES CONTINGENT ON THE NET EARNINGS OF THE CONSOLIDATED ENTITY AND GOALS ACHIEVED. BONUSES WERE EARNED IN 2018 AND PAID IN 2019. X 2017 FAIR MARKET VALUE X 3 19696 FAIR MARKET VALUE X 5 9850 FAIR MARKET VALUE X AUCTION ITEMS 559 208928 FAIR MARKET VALUE X GIFTS 167 154086 FAIR MARKET VALUE 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS OF THE FOUNDATION DESIGNATED SEVEN BOARD MEMBERS AS AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE ACTS ONLY DURING INTERVALS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS OF THE FOUNDATION AND IS AT ALL TIMES SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD OF DIRECTORS OF THE FOUNDATION. DURING SUCH INTERVALS AND SUBJECT TO SUCH CONTROL AND DIRECTION, THE EXECUTIVE COMMITTEE HAS ALL OF THE AUTHORITY AND POWER OF THE BOARD OF DIRECTORS OF THE FOUNDATION IN THE MANAGEMENT OF THE BUSINESS OF THE FOUNDATION, SUBJECT TO SUCH LIMITATIONS AS THE BOARD OF DIRECTORS OF THE FOUNDATION MAY IMPOSE FROM TIME TO TIME. FORM 990, PART VI, SECTION A, LINE 3 ALL MANAGEMENT SERVICES ARE PROVIDED BY RIDGEVIEW MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 6 RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF RIDGEVIEW FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A EACH PERSON ELECTED BY THE BOARD OF DIRECTORS OF RIDGEVIEW FOUNDATION IS RATIFIED OR REJECTED BY THE BOARD OF DIRECTORS OF RIDGEVIEW MEDICAL CENTER, THE FOUNDATION'S SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B IN ADDITION TO THE APPOINTMENT OF DIRECTORS TO THE BOARD OF DIRECTORS OF RIDGEVIEW FOUNDATION, AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FOUNDATION REQUIRE APPROVAL OF RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B THE CFO 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 CONFLICTS OF INTEREST POLICY. EACH MEMBER IS EXPECTED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THE SITUATION WILL BE EXAMINED AND HANDLED APPROPRIATELY BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 RIDGEVIEW FOUNDATION DOES NOT COMPENSATE ITS OFFICERS OR BOARD MEMBERS. ANY COMPENSATION RECEIVED BY THOSE INDIVIDUALS IS DETERMINED BY RIDGEVIEW MEDICAL CENTER, THE FOUNDATION'S PARENT. FORM 990, PART VI, SECTION C, LINE 19 RIDGEVIEW FOUNDATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. 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