AMERY REGIONAL MEDICAL CENTER FOUNDATION INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
AMERY REGIONAL MEDICAL CENTER FOUNDATION INC (EIN 39-1726539)
Tax period
2019-01-01 to 2019-12-31
Filed
2020-11-15
IRS object ID
202043209349301664
Schema version
2019v5.1
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 ReturnHeader

FieldValueIRS element (for citing)
Return2020-11-15T19:02:26-06:00ReturnTs
Tax Period End2019-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN135565207PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line14200 WELLS FARGO CTR 90S7TH STREETAddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55402ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN391726539EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1AMERY REGIONAL MEDICAL CENTER FOUNDATIONBusinessNameLine1Txt
Business Name Line2INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlAMERBusinessNameControlTxt
Phone7152688000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line18170 33RD AVENUE SOUTH PO BOX 1309AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP554401309ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDEBRA A RUDQUISTPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone7152688000PhoneNum
Signature2020-11-15SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMONROE JORDAN GIERLPreparerPersonNm
PTINP01413237PTIN
Phone6123055000PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address198.153.9.194IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-11-15IPDt
IP Tm15:46:23IPTm
IP TimezoneCSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id763097D6A2B3EA9277A508CC789A2C5E6C07E1F2AtSubmissionCreationDeviceId
At Submission Filing Device Id763097D6A2B3EA9277A508CC789A2C5E6C07E1F2AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDEBRA A RUDQUISTPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line18170 33RD AVENUE SOUTH PO BOX 1309AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP554401309ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$435,292GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.AMERYMEDICALCENTER.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1991FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionTO PROMOTE THE HEALTH AND WELLNESS IN THE COMMUNITIES SERVED BY AMERY REGIONAL MEDICAL CENTER.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers36TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$324,463PYContributionsGrantsAmt
CY Contributions Grants$405,320CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$2,997PYInvestmentIncomeAmt
CY Investment Income$3,350CYInvestmentIncomeAmt
PY Other Revenue-$2,289PYOtherRevenueAmt
CY Other Revenue$17,698CYOtherRevenueAmt
PY Total Revenue$325,171PYTotalRevenueAmt
CY Total Revenue$426,368CYTotalRevenueAmt
PY Grants And Similar Paid$95,487PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$270,186CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$163,546PYOtherExpensesAmt
CY Other Expenses$114,458CYOtherExpensesAmt
PY Total Expenses$259,033PYTotalExpensesAmt
CY Total Expenses$384,644CYTotalExpensesAmt
PY Revenues Less Expenses$66,138PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$41,724CYRevenuesLessExpensesAmt
Total Assets BOY$579,490TotalAssetsBOYAmt
Total Assets EOY$706,221TotalAssetsEOYAmt
Total Liabilities BOY$46,504TotalLiabilitiesBOYAmt
Total Liabilities EOY$131,511TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$532,986NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$574,710NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE AMERY REGIONAL MEDICAL CENTER FOUNDATION (FOUNDATION) EXISTS TO PROMOTE THE HEALTH AND WELLNESS OF THE PEOPLE IN THE COMMUNITIES SERVED BY AMERY REGIONAL MEDICAL CENTER (ARMC) BY PARTICIPATING IN VARIOUS FUNDRAISING ACTIVITIES.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$384,644ExpenseAmt
Grant$270,186GrantAmt
DescSEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTSDesc
Total Program Service Expenses$384,644TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member7IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldWIStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1DOUG JOHNSON CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7152688000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1265 GRIFFIN STREET EASTAddressLine1Txt
CityAMERYCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54001ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
JOYCE SCHAEFER
DIRECTOR & CHAIR0.750.00Yes (X)Yes (X)$0$0$0
HEIDI ERSPAMER
DIRECTOR0.251.75Yes (X)$0$1,200$0
BRIAN BYRNES
DIRECTOR & SECRETARY & TRE0.500.00Yes (X)Yes (X)$0$0$0
JON BUSS
DIRECTOR0.500.00Yes (X)$0$0$0
BRUCE DENNISON MD
DIRECTOR0.5059.75Yes (X)$0$405,379$55,995
SHARI OVERBY
DIRECTOR0.500.00Yes (X)$0$0$0
J MARTIN NOONAN
DIRECTOR & VICE CHAIR0.500.00Yes (X)Yes (X)$0$0$0
JAMES QUENAN MD
DIRECTOR0.500.00Yes (X)$0$0$0
ANN SEAGREN MD
DIRECTOR0.5049.75Yes (X)$0$233,514$72,952
JOANNE L JACKSON
EXECUTIVE DIRECTOR45.000.00Yes (X)$0$160,894$27,544
JASON J LUHRS
CFO (JAN-AUG)0.5049.50Yes (X)$0$231,590$53,365
DOUGLAS JOHNSON
CFO (AUG-DEC)0.5054.50Yes (X)$0$380,795$153,262
DEBRA RUDQUIST
PRESIDENT0.5053.50Yes (X)$0$329,096$61,861
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,742,468TotReportableCompRltdOrgAmt
Total Other Compensation$424,979TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$8,874FundraisingAmt
Related Organizations$40,207RelatedOrganizationsAmt
All Other Contributions$356,239AllOtherContributionsAmt
Total Contributions$405,320TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$3,350TotalRevenueColumnAmt
Exclusion$3,350ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$26,622FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$8,874ContriRptFundraisingEventAmt
Fundraising Direct Expenses$8,924FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$17,698TotalRevenueColumnAmt
Exclusion$17,698ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$426,368TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$21,048ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$269,921TotalAmt
Program Services$269,921ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$265TotalAmt
Program Services$265ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$49,426TotalAmt
Program Services$49,426ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$32,961TotalAmt
Program Services$32,961ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$4,326TotalAmt
Program Services$4,326ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$1,762TotalAmt
Program Services$1,762ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$565TotalAmt
Program Services$565ProgramServicesAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUS OTHER EXPDesc
Total$25,418TotalAmt
Program Services$25,418ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$384,644TotalAmt
Program Services$384,644ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$566,926BOYAmt
EOY$683,052EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$12,564BOYAmt
EOY$23,169EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$579,490BOYAmt
EOY$706,221EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$46,504BOYAmt
EOY$131,511EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$46,504BOYAmt
EOY$131,511EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$532,986BOYAmt
EOY$574,710EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$532,986BOYAmt
EOY$574,710EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$579,490BOYAmt
EOY$706,221EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$41,724ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$5,319CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$181,416CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$253,561CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$324,463CurrentTaxYearMinus1YearAmt
Current Tax Year$405,320CurrentTaxYearAmt
Total$1,170,079TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$5,319CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$181,416CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$253,561CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$324,463CurrentTaxYearMinus1YearAmt
Current Tax Year$405,320CurrentTaxYearAmt
Total$1,170,079TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$342,245SubstantialContributorsTotAmt
Public Support Total170$827,834PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$163CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$412CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$920CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,997CurrentTaxYearMinus1YearAmt
Current Tax Year$3,350CurrentTaxYearAmt
Total$7,842TotalAmt
FieldValueIRS element (for citing)
Total Support$1,177,921TotalSupportAmt
Gross Receipts Rltd Activities$178,352GrossReceiptsRltdActivitiesAmt
Public Support CY1700.70280PublicSupportCY170Pct
Public Support PY1700.69900PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationAMERY REGIONAL MEDICAL CENTER FOUNDATION, INC. IS INCLUDED IN THE HEALTHPARTNERS, INC. (HP) CONSOLIDATED AUDITED FINANCIAL STATEMENT. HP'S ACCOUNTING POLICY PROVIDES THAT A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. HP RECORDED NO LIABILITIES AT DECEMBER 31, 2019 OR 2018 FOR UNRECOGNIZED TAX BENEFITS.ExplanationTxt

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Special Fundraising EventsYes (X)SpecialFundraisingEventsInd

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GOLF TOURNAMENTEvent1Nm
Gross Receipts Event1$35,496GrossReceiptsEvent1Amt
Charitable Contri Event1$8,874CharitableContriEvent1Amt
Gross Revenue Event1$26,622GrossRevenueEvent1Amt
Other Direct Expenses Event1$8,924OtherDirectExpensesEvent1Amt
Other Events Total0OtherEventsTotalCnt
Gross Receipts Total$35,496GrossReceiptsTotalAmt
Charitable Contributions Tot$8,874CharitableContributionsTotAmt
Gross Revenue Total Events$26,622GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events$8,924OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$8,924DirectExpenseSummaryEventsAmt
Net Income Summary$17,698NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1AMERY REGIONAL MEDICAL CENTER INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1265 GRIFFIN STREET EASTAddressLine1Txt
CityAMERYCityNm
State AbbreviationWIStateAbbreviationCd
ZIP54001ZIPCd
FieldValueIRS element (for citing)
Recipient EIN390908320RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$265,113CashGrantAmt
Purpose Of GrantPROGRAM SUPPORTPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationAMERY REGIONAL MEDICAL CENTER FOUNDATION (FOUNDATION) MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH THE FOUNDATION'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO THE FOUNDATION'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
BRUCE DENNISON MD
DIRECTOR$0$275,303$0$0$0$130,076$0$21,000$0$34,995$0$461,374$0$0
ANN SEAGREN MD
DIRECTOR$0$212,661$0$0$0$20,853$0$41,335$0$31,617$0$306,466$0$0
JOANNE L JACKSON
EXECUTIVE DIRECTOR$0$135,348$0$8,617$0$16,929$0$6,532$0$21,012$0$188,438$0$0
JASON J LUHRS
CFO (JAN-AUG)$0$191,700$0$33,727$0$6,163$0$23,722$0$29,643$0$284,955$0$0
DOUGLAS JOHNSON
CFO (AUG-DEC)$0$299,890$0$55,505$0$25,400$0$121,094$0$32,168$0$534,057$0$0
DEBRA RUDQUIST
PRESIDENT$0$270,025$0$49,041$0$10,030$0$30,600$0$31,261$0$390,957$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 3FormAndLineReferenceDesc
ExplanationTHE FOUNDATION HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. ALL OFFICERS AND KEY EMPLOYEES ARE PAID BY GROUP HEALTH PLAN, INC. (GHI), REGIONS HOSPITAL, OR AMERY REGIONAL MEDICAL CENTER, RELATED ORGANIZATIONS. ANY COMPENSATION DISCLOSED IS DETERMINED SOLELY BY THE RELATED ORGANIZATIONSExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 4A - "EXEMPT PURPOSE AND ACHIEVEMENTS"CORPORATE STRUCTURE, PURPOSE, GOVERNANCE AMERY REGIONAL MEDICAL CENTER FOUNDATION, INC. (THE FOUNDATION), IS A WISCONSIN NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE HEALTHPARTNERS ORGANIZATION ("HEALTHPARTNERS"). FOUNDED IN 1957, HEALTHPARTNERS IS AN INTEGRATED HEALTH CARE ORGANIZATION, PROVIDING HEALTH CARE SERVICES AND HEALTH PLAN FINANCING AND ADMINISTRATION, AND IS THE LARGEST CONSUMER-GOVERNED NONPROFIT HEALTH CARE ORGANIZATION IN THE COUNTRY. HEALTHPARTNERS' MISSION IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS, AND COMMUNITY. HEALTHPARTNERS SEEKS TO TRANSFORM HEALTHCARE THROUGH A RELENTLESS FOCUS ON THE TRIPLE AIM - PROVIDING EXCEPTIONAL EXPERIENCE FOR THE INDIVIDUAL, IMPROVING THE HEALTH OF THE POPULATION, AND MAINTAINING AFFORDABILITY. HEALTHPARTNERS INCLUDES AN ARRAY OF TAX-EXEMPT AND TAXABLE ORGANIZATIONS WITH HEALTH CARE ACTIVITIES PRIMARILY OPERATING IN MINNESOTA, WESTERN WISCONSIN, AND EXPANDING TO SEVERAL OTHER MIDWESTERN STATES. HEALTHPARTNERS PROVIDES A FULL RANGE OF HEALTH CARE DELIVERY AND HEALTH PLAN SERVICES INCLUDING INSURANCE, PATIENT CARE, ADMINISTRATION, AND HEALTH AND WELL-BEING PROGRAMS. HEALTHPARTNERS HEALTH PLANS SERVE MORE THAN 1.8 MILLION MEDICAL AND DENTAL MEMBERS NATIONWIDE. HEALTHPARTNERS MEDICAL CARE SYSTEM INCLUDES MORE THAN 1,800 PHYSICIANS AND DENTISTS, SEVEN OWNED HOSPITALS WITH OVER 1,000 ACUTE CARE BEDS, MORE THAN 100 OWNED AND LEASED PRIMARY AND SPECIALTY CARE MEDICAL FACILITIES, AND 25 DENTAL FACILITIES WITH PRACTICES IN MINNESOTA AND WESTERN WISCONSIN. HEALTHPARTNERS ALSO CONTRACTS WITH OTHER PRIMARY AND SPECIALTY MEDICAL FACILITIES AND DENTAL FACILITIES, PHYSICIAN GROUPS, HOSPITALS AND RELATED HEALTHCARE PROVIDERS LOCATED PRIMARILY IN MINNESOTA, WESTERN WISCONSIN, AND EXPANDING TO OTHER MIDWESTERN STATES. HEALTHPARTNERS ALSO PROVIDES MEDICAL EDUCATION AND TRAINING TO MEDICAL PROFESSIONALS AND CONDUCTS RESEARCH AND FUND RAISING ACTIVITIES THAT SUPPORT THE HEALTH CARE DELIVERY SYSTEM. A COMPLETE LISTING OF ALL ORGANIZATIONS WITHIN HEALTHPARTNERS, AND THE RELATIONSHIP BETWEEN THEM, CAN BE FOUND ON SCHEDULE R WITHIN THIS 990 RETURN. DETAILED INFORMATION ABOUT THE COMMUNITY BENEFIT ACTIVITIES AND ACCOMPLISHMENTS OF EACH TAX-EXEMPT ORGANIZATION CAN BE FOUND IN THE INDIVIDUAL FORM 990 RETURN FOR THAT ORGANIZATION. HEALTHPARTNERS IS DRIVING CHANGE THAT HELPS OUR MEMBERS AND PATIENTS LIVE HEALTHIER LIVES. HEALTHPARTNERS COLLABORATE WITH OTHER PLANS, CARE PROVIDERS, AND OTHER COMMUNITY AND BUSINESS ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION TO INCREASE ACCESS, CREATE AND SHARE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY, AND COLLABORATE IN IMPROVEMENTS THAT SUPPORT THE TRIPLE AIM. AMONG HEALTHPARTNERS' SIGNATURE INITIATIVES CONTINUING IN 2019 ARE TOTAL COST OF CARE MEASUREMENTS (DEVELOPMENT OF A NATIONALLY RECOGNIZED METRIC, ENDORSED BY THE NATIONAL QUALITY FORUM, ENABLING MEASUREMENT AND INCENTIVES BASED ON COORDINATION AND EVIDENCE-BASED PRACTICES), MENTAL HEALTH (REDUCING STIGMA, AND ASSURING ACCESS TO HIGH QUALITY CARE IN THE MOST APPROPRIATE SETTINGS), CHILDREN'S HEALTH (IMPROVING CHILD HEALTH BY PROMOTING EARLY BRAIN DEVELOPMENT, PROVIDING FAMILY CENTERED CARE, AND STRENGTHENING COMMUNITIES), AND SUSTAINABILITY (ENERGY EFFICIENCY, WASTE REDUCTION, AND RESOURCE MANAGEMENT). HEALTHPARTNERS, INC. (HPI) IS THE PARENT ENTITY OF HEALTHPARTNERS AND IS A MINNESOTA NONPROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(4). HPI IS THE SOLE CORPORATE MEMBER OF HPI-RAMSEY, A MINNESOTA NONPROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF REGIONS HOSPITAL, REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, LAKEVIEW HEALTH, RAMSEY INTEGRATED HEALTH SERVICES, AND RH-WISCONSIN, INC., ALL OF WHICH ARE NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). RH-WISCONSIN AND GROUP HEALTH PLAN, INC. (GHI) ARE CORPORATE MEMBERS OF AMERY REGIONAL MEDICAL CENTER, INC. (ARMC). ARMC IS A WISCONSIN NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3). IN TURN, ARMC IS THE SOLE CORPORATE MEMBER OF THE FOUNDATION. AMERY REGIONAL MEDICAL CENTER IS DOING BUSINESS AS AMERY HOSPITAL & CLINIC (AHC). THE FOUNDATION EXISTS TO PROMOTE THE HEALTH AND WELLNESS OF THE PEOPLE IN THE COMMUNITIES SERVED BY AHC BY PARTICIPATING IN VARIOUS FUNDRAISING ACTIVITIES. BENEFIT TO THE COMMUNITY: FUNDRAISERS: IN THE SPRING OF 2019, THE FOUNDATION CONDUCTED ITS ANNUAL EMPLOYEE GIVING CAMPAIGN, RAISING $29,591 FROM AHC AND HEALTHPARTNERS EMPLOYEES. A PERCENTAGE OF DONATIONS WASERE MATCHED BY HEALTHPARTNERS INC. FOR $22,607 AND BY AHC FOR AN ADDITIONAL $15,000 -- FOR A TOTAL OF $67,198 FUNDS RAISED. THE FUNDS WERE DIRECTED TO COMMUNITY HEALTH INITIATIVES, PATIENT CARE NEEDS, EMPLOYEE TO EMPLOYEE ASSISTANCE AND GREATEST NEED. IN MAY THE FOUNDATION HOSTED ITS 2ND WINE TASTING EVENT, RAISING A NET OF $5,074 FOR THE AMERY BEHAVIORAL HEALTH FUND. IN JULY OF 2019, THE FOUNDATION HELD ITS 31ST ANNUAL GOLF CLASSIC, RAISING A NET OF $27,055 FOR THE AMERY BEHAVIORAL HEALTH FUND. IN NOVEMBER WE PILOTED A PURSE BINGO EVENT TO TEST FOR FUND RAISING POTENTIAL. THE EVENT WAS A HUGE SUCCESS AND NETTED $17,281 FOR THE AMERY BEHAVIORAL HEALTH FUND. DONATIONS RECEIVED: IN ADDITION TO THESE FUND RAISING EVENTS, THE FOUNDATION RECEIVED OVER $21,945 IN GENERAL DONATIONS AND MEMORIALS. GRANT FUNDING RECEIVED IS DESCRIBED BY PROGRAM SUPPORT BELOW. PROGRAM SUPPORT / COMMUNITY CONTRIBUTIONS: THE FOUNDATION STRATEGICALLY PARTNERED IN MANY AREAS OF THE HEALTH CARE DELIVERY AT AHC FOR PATIENTS AND COMMUNITY. HOSPITAL SUPPORTED PROGRAMS: ER ENHANCEMENTS: THE FOUNDATION HELPED SUPPORT PURCHASE OF THE FOLLOWING EQUIPMENT FOR ER STANDARDIZATION IN AMERY HOSPITAL, NEW SUPPLY CARTS, NEW STRETCHERS, AND A PORTABLE ULTRASOUND MACHINE. THE FOUNDATION SECURED GRANTS FROM THE FOLLOWING FOUNDATIONS FOR THIS PROJECT: ANDERSOEN FOUNDATION, ANDERSEON CORPORATE FOUNDATION, HARDENBERG FOUNDATION AND HUGH J ANDERSEON FOUNDATION. PATIENT CARE: THE FOUNDATION CONTRIBUTED ALMOST $10,000 TO AMERY HOSPITAL'S OPERATIONAL BUDGET TO PURCHASE NEW MINOR EQUIPMENT NEEDS FOR VARIOUS DEPARTMENTS, INCLUDING A NEW ICE/WATER MACHINE FOR MED/SURG UNIT, A NUSTEP MACHINE FOR CARDIAC REHAB AND MINOR DIAGNOSTIC IMAGING EQUIPMENT. CHILDREN'S HEALTH: THE FOUNDATION PROUDLY SUPPORTED THE POWERUP FOR KIDS PROGRAMING FOR OUR RURAL COMMUNITIES WITH A FINANCIAL CONTRIBUTION OF $75,160. POWERUP FOR KIDS' VISION IS TO REDUCE OR ELIMINATE CHILDHOOD OBESITY THROUGH BETTER EATING AND INCREASED ACTIVITY. THE POWERUP PROGRAM PARTNERS WITH THE SCHOOL DISTRICTS OF AMERY, CLEAR LAKE, AND TURTLE LAKE, THE NON-MOTORIZED STOWER SEVEN LAKES STATE TRAIL, THE FARM TABLE FOUNDATION (LOCAL VEGETABLE COOP GROWERS ), THE LOCAL FOOD SHELVES, AREA GROCERY STORES, THE AMERY PUBLIC LIBRARY, AND THE POLK COUNTY WISCONSIN PUBLIC HEALTH DEPARTMENT. IN ADDITION, THE FOUNDATION SECURED GRANTS FOR THE POWERUP FOR KIDS PROGRAM AS FOLLOWS: FROM THE AMERY HEALTH & WELLNESS ADVISORY FUND, THE BERNICK FAMILY FOUNDATION, AND FROM THE ST. CROIX VALLEY FOUNDATION. MENTAL HEALTH: THE FOUNDATION FUNDED "MAKE IT OK", A MENTAL HEALTH STIGMA REDUCTION PROGRAM, WITH $20,559. STAFF ARE ALSO TRAINED AND ENCOURAGED TO VOLUNTEER FOR THIS PROGRAM. THE FOUNDATION SECURED GRANT FUNDING TO SUPPORT THE LAUNCH OF A COMPREHENSIVE BEHAVIORAL HEALTH TELEMEDICINE PROGRAM IN THE AMOUNT OF $100,000 FROM THE OTTO BREMER FOUNDATION. EMPLOYEE EMERGENCY: THE FOUNDATION PROVIDED FUNDING IN TOTAL OF $13,000 TO EMPLOYEES WHO WERE IN DESPERATE FINANCIAL NEED DURING A PERSONAL EMERGENCY SITUATION. THIS FUNDS WERE GIVEN IN A VERY SELECTIVE PROCESS AND WERE REQUESTED AS THE RESULT OF A MAJOR STORM THAT CAUSED MILLIONS OF DOLLARS OF DAMAGE IN OUR SERVICE AREA. COMMUNITY SUPPORTED PROGRAMS MENTAL HEALTH: THE FOUNDATION PROVIDES FINANCIAL SUPPORT AND VOLUNTEERS TO THE MENTAL HEALTH TASK FORCE OF POLK COUNTY IN HOSTING EVENTS TO RAISE AWARENESS AND REDUCE STIGMA OF MENTAL ILLNESS. COMMUNITY GARDEN AND WELLNESS PARK: THE FOUNDATION MADE GRANTS FOR A TOTAL OF $8,632 TO SUPPORT OPERATIONAL EXPENSE OF THE COMMUNITY WIDE GARDEN PLOTS. THE GARDEN VOLUNTEERS PARTNER WITH THE CITY OF AMERY, THE HUNGRY TURTLE FOOD INSTITUTE -- TO OFFER COOKING CLASSES WITH FRESH LOCALLY GROWN FOODS -- THE AMERY FOOD SHELF - CONTRIBUTING OVER 200 POUNDS OF FRESH VEGETABLES -- AND THE AMERY HOUSING AUTHORITY, WHO BUILDS THE RAISED BEDS AT NO COST. AHC DONATES GARDEN BED SPACE TO SUPPORT THIS WELLNESS EFFORT.
FORM 990, PART VI, SECTION A, LINE 6THE SOLE CORPORATE MEMBER OF THE FOUNDATION IS ARMC.
FORM 990, PART VI, SECTION A, LINE 7APURSUANT TO BYLAWS, THE FOUNDATIONS BOARD OF DIRECTORS IS COMPRISED OF AT LEAST 5 BUT NO MORE THAN 9 PERSONS. AT LEAST 2 DIRECTORS MUST BE APPOINTED BY ARMC, THE FOUNDATION'S SOLE MEMBER, AND THE REMAINING DIRECTOR POSITIONS ARE FILLED BY PERSONS NOMINATED BY THE BOARD AND APPROVED BY THE ARMC. THE PRESIDENT OF ARMC SERVES AS AN EX-OFFICIO, NON-VOTING DIRECTOR.
FORM 990, PART VI, SECTION A, LINE 7BTHE FOUNDATION'S CORPORATE MEMBER, ARMC, MUST APPROVE THE FOLLOWING ACTIONS OF THE FOUNDATION'S BOARD OF DIRECTORS OR INITIATE THESE ACTIONS DIRECTLY: A. ADOPTION OF THE FOUNDATION'S ANNUAL BUDGET B. ADOPTION OF THE FOUNDATION'S STRATEGIC PLANS C. AMENDMENT OF THE FOUNDATION'S BYLAWS D. AMENDMENT OF THE FOUNDATION'S ARTICLES OF INCORPORATION E. ANY CHANGE, AMENDMENT, OR ALTERATION IN THE SLATED PURPOSES FOR WHICH THE FOUNDATION IS ORGANIZED F. ANY GRANT GREATER THAN $10,000 TO AN ENTITY OTHER THAN ARMC OR ANY ENTITY AFFILIATED WITH ARMC G. ELECTION OF THE FOUNDATION'S OFFICERS
FORM 990, PART VI, SECTION B, LINE 11BTHE FOUNDATION'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF THE FOUNDATION. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF THE FOUNDATION, GHI'S INTERNAL LEGAL DEPARTMENT AND THE FOUNDATION'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF THE FOUNDATION. ONCE THAT REVIEW PROCESS HAS BEEN COMPLETED, IT IS THE POLICY OF THE FOUNDATION TO MAKE AVAILABLE TO THE BOARD OF DIRECTORS OF THE FOUNDATION A COPY OF THE 990 PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY IS PROVIDED IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT A MEETING OF THE FULL BOARD OF DIRECTORS. THIS PROCESS IS NOTED AND DOCUMENTED IN THE WRITTEN MINUTES OF THE MEETING.
FORM 990, PART VI, SECTION B, LINE 12CTHE FOUNDATION BOARD MONITORS POTENTIAL CONFLICTS OF INTEREST ON THE PART OF ITS BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS, AND KEY EMPLOYEES ("COVERED PERSONS") BY MAINTAINING A CONFLICT OF INTEREST POLICY. UNDER THE POLICY, COVERED PERSONS ANNUALLY ARE PROVIDED WITH A COPY OF THE POLICY AND ASKED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTERESTS. THE LEGAL DEPARTMENT OF HEALTHPARTNERS REVIEWS THE QUESTIONNAIRE RESPONSES AND DEVELOPS A REPORT DETAILING ANY POTENTIALLY MATERIAL CONFLICTS FOR THE PRESIDENT AND CHAIR OF THE BOARD. A VERBAL SUMMARY IS ALSO GIVEN TO THE FULL BOARD OR APPROPRIATE COMMITTEE ENDING WITH A REMINDER TO COVERED PERSONS OF THE POLICY'S MANDATE THAT EACH PERSON IS OBLIGATED TO DISCLOSE ANY NEW POTENTIAL CONFLICTS AS THEY MAY ARISE THROUGHOUT THE YEAR. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE MONITORED IN RELATION TO THIS POLICY.
FORM 990, PART VI, SECTION B, LINE 15THE FOUNDATION HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. ALL OFFICERS AND KEY EMPLOYEES ARE PAID BY GROUP HEALTH PLAN, INC. (GHI), REGIONS HOSPITAL, OR AMERY REGIONAL MEDICAL CENTER, RELATED ORGANIZATIONS. ANY COMPENSATION DISCLOSED IS PAID AND DETERMINED SOLELY BY THE RELATED ORGANIZATIONS. THEREFORE, PART VI, SECTION B, QUESTION 15 IS NOT APPLICABLE TO THE FOUNDATION.
FORM 990, PART VI, SECTION C, LINE 19THE FOUNDATION'S FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM THE FOUNDATION OR HEALTHPARTNERS.
990, PART VII, SECT A, LN 1A, COL (B): AVERAGE HRS - RELATED ORGANIZATIONALL DIRECTORS AND OFFICERS OF THE FOUNDATION ARE EMPLOYED AND COMPENSATED BY GROUP HEALTH PLAN, INC., REGIONS HOSPITAL OR AMERY REGIONAL MEDICAL CENTER. REPORTED AVERAGE HOURS WORKED ARE BASED ON THEIR TOTAL COMPENSATION FROM ALL RELATED ORGANIZATIONS.
FORM 990, PART IX, LINE 11GPROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 49,426. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,426.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (28 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
HEALTHPARTNERS INC
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HPI-RAMSEY
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GROUP HEALTH PLAN INC
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RH WISCONSIN INC
8171 33RD AVE S PO BOX 1309MPLSMN554401309202287016CORPORATE PLANNING AND OVERSIGHTMN501(C)(3)0509(A)(3) TYPE IHEALTHPARTNERS INC
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CAPITOL VIEW TRANSITIONAL CARE CENTER
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REGIONS HOSPITAL
8170 33RD AVE S PO BOX 1309MPLSMN554401309410956618HOSPITALMN501(C)(3)0170(B)(1) (A)(III)HPI - RAMSEY
REGIONS HOSPITAL FOUNDATION
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RHSC INC
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HUDSON HOSPITAL FOUNDATION INC
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LAKEVIEW HEALTH FOUNDATION
8170 33RD AVE S PO BOX 1309MPLSMN554401309411386635PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTHMN501(C)(3)0170(B)(1) (A)(VI)LAKEVIEW HEALTH
LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309410811697HOSPITALMN501(C)(3)0170(B)(1) (A)(III)LAKEVIEW HEALTH
STILLWATER MEDICAL GROUP
8170 33RD AVE S PO BOX 1309MPLSMN554401309830379473CLINIC STAFF AND FACILITIESMN501(C)(3)0509(A)(3) TYPE ILAKEVIEW HEALTH
LAKEVIEW HEALTH
8170 33RD AVE S PO BOX 1309MPLSMN554401309300221189CORPORATE PLANNING AND OVERSIGHTMN501(C)(3)0509(A)(3) TYPE IIHPI - RAMSEY
WESTFIELDS HOSPITAL INC
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WESTFIELDS HOSPITAL FOUNDATION INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309391770913PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTHWI501(C)(3)0170(B)(1) (A)(VI)WESTFIELDS HOSPITAL INC
RAMSEY INTEGRATED HEALTH SERVICES
8170 33RD AVE S PO BOX 1309MPLSMN554401309411503090HOME CARE AND HOSPICEMN501(C)(3)0509(A)(2)HPI - RAMSEY
PARK NICOLLET HEALTH SERVICES
6500 EXCELSIOR BLVDST LOUIS PARKMN55426363465840CORPORATE PLANNING AND OVERSIGHTMN501(C)(3)0509(A)(2)HEALTHPARTNERS INC
PARK NICOLLET FOUNDATION
6500 EXCELSIOR BLVDST LOUIS PARKMN55426237346465SUPPORT TO RELATED ENTITIES AND COMMUNITY HEALTHMN501(C)(3)0170(B)(1) (A)(VI)PARK NICOLLET HEALTH SERVICES
PARK NICOLLET METHODIST HOSPITAL
6500 EXCELSIOR BLVDST LOUIS PARKMN55426410132080HOSPITALMN501(C)(3)0170(B)(1) (A)(III)PARK NICOLLET HEALTH SERVICES
PARK NICOLLET HEALTH CARE PRODUCTS
6500 EXCELSIOR BLVDST LOUIS PARKMN55426010638901DURABLE MEDICAL EQUIPMENT , PHARMACY AND OTHER HEALTH CARE RETAIL SALESMN501(C)(3)0509(A)(3) TYPE IPARK NICOLLET HEALTH SERVICES
PARK NICOLLET CLINIC
6500 EXCELSIOR BLVDST LOUIS PARKMN55426410834920CLINIC SERVICESMN501(C)(3)0170(B)(1) (A)(III)PARK NICOLLET HEALTH SERVICES
PNMC HOLDINGS
6500 EXCELSIOR BLVDST LOUIS PARKMN55426411741792HEALTHCARE REAL ESTATEMN501(C)(3)0509(A)(3) TYPE IPARK NICOLLET HEALTH SERVICES
AMERY REGIONAL MEDICAL CENTER INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309390908320HOSPITALWI501(C)(3)0170(B)(1) (A)(III)RH-WISCONSIN INC
HUTCHINSON HEALTH
8170 33RD AVE S PO BOX 1309MPLSMN554401309841715908HOSPITALMN501(C)(3)0170(B)(1) (A)(III)PARK NICOLLET HEALTH SERVICES
HUTCHINSON HEALTH FOUNDATION
8170 33RD AVE S PO BOX 1309MPLSMN554401309363317820PROVIDE SUPPORT TO HOSPITALMN501(C)(3)0509(A)(3) TYPE IIIHUTCHINSON HEALTH

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)

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HEALTHPARTNERS ADMINISTRATORS INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309411629390THIRD PARTY ADMINISTRATORMNHEALTHPARTNERS INCC0
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8170 33RD AVE S PO BOX 1309MPLSMN554401309411683523MEDICAL AND DENTAL INSURANCEMNHEALTHPARTNERS ADMINISTRATORS INCC0
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8170 33RD AVE S PO BOX 1309MPLSMN554401309451297583PROFESSIONAL DENTAL SERVICESMNHEALTHPARTNERS ADMINISTRATORS INCC0
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PARK NICOLLET ENTERPRISES
6500 EXCELSIOR BLVDST LOUIS PARKMN55426411656735REAL ESTATE FOR RELATED ORGANIZATIONSMNPARK NICOLLET HEALTH SERVICESC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
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Div Related Organization0DivRelatedOrganizationInd
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Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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