2019-11-15T08:28:11-06:00 2018-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 225 S 6TH ST 2300 MINNEAPOLIS MN 55402 990 2018-01-01 411777966 NORTH MEMORIAL FOUNDATION NORT 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 KENT SPAULDING VP FOUNDATION 7635205200 2019-11-14 1 LAWRENCE H MOHR CPA P00447603 6128764500 38.88.188.75 2019-11-14 11:01:40 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 42991B41A32A13F77B110C5B470B2D73D8292482 2018 2020-04-17 16:48:07Z KENT SPAULDING 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 1940772 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. 16 13 0 150 0 0 787759 692238 0 0 -32147 209046 78409 128116 834021 1029400 387752 394163 0 0 0 0 0 0 0 40295 282633 428047 676796 405974 352604 8905755 8408067 45642 21989 8860113 8386078 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 14105 14105 CANCER CARE:FOUNDATION FUNDS IN 2018 HELPED IMPROVE CUSTOMER CARE, UPDATE TREATMENT FACILITIES AND EXPAND THE SERVICES PROVIDED. FINANCIAL SUPPORT ALLOWS US TO PAY FOR PHARMACEUTICAL TREATMENTS FOR INDIVIDUALS STRUGGLING TO AFFORD CARE THEY NEED TO GET BETTER OR MANAGE THEIR PAIN, PROVIDE ACCESS TO ADVANCED TECHNOLOGIES THAT ALLOW US TO TREAT PATIENTS MORE QUICKLY AND MORE EFFECTIVELY, SUPPORT FACILITY RENOVATIONS AND PURCHASE NEW EQUIPMENT TO IMPROVE TREATMENT ENVIRONMENTS SO WE CAN PROVIDE TREATMENTS MORE COMFORTABLY AND WITH LESS PAIN AND DELIVER EDUCATIONAL PROGRAMMING AND MATERIALS, AS WELL AS CANCER SCREENING SERVICES, TO VULNERABLE, UNDERSERVED COMMUNITIES. 45042 45042 TEAM MEMBER CRISIS FUND:FOUNDATION FUNDS IN 2018 DEDICATED TO THE NORTH MEMORIAL HEALTH TEAM MEMBER CRISIS FUND HELPED PROVIDE FINANCIAL ASSISTANCE TO CURRENT TEAM MEMBERS IN GOOD STANDING. THESE DOLLARS HELP TEAM MEMBERS QUICKLY WHEN SERIOUS HEALTH CONDITIONS, INJURIES, NEW OR UNANTICIPATED MEDICATIONS COSTS, CATASTROPHIC EVENTS OR OTHER HARDSHIPS OCCUR THAT HINDER TEAM MEMBERS FROM BEING ABLE TO AFFORD THE COST OF EMERGENT OR BASIC LIVING EXPENSES. THE FUND IS INTENDED TO HELP IN A TIME OF NEED AND IS NOT INTENDED TO MAKE THE INCURRED LOSS WHOLE FOR THE INDIVIDUAL. 510593 335016 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. 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. 569740 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 12 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 16 13 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN WI X AARON BLOOMQUIST 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 J KEVIN CROSTON MD BOARD MEMBER 1.00 52.00 X 0 1020962 46962 BRUCE QUAM BOARD CHAIR 1.00 0.00 X X 0 0 0 MICHAEL STEINHAUSER SECRETARY 1.00 2.00 X X 0 10000 0 JANDEEN BOONE BOARD MEMBER 1.00 0.00 X 0 0 0 CHENG LOR BOARD MEMBER 1.00 0.00 X 0 0 0 JIM BYRNE BOARD MEMBER 1.00 0.00 X 0 0 0 MARK NIBLICK BOARD MEMBER 1.00 0.00 X 0 0 0 DIANE NILSON BOARD MEMBER 1.00 0.00 X 0 0 0 PAMELA DOORENBOS MD BOARD MEMBER 1.00 50.00 X 0 346284 25501 SCOTT HEMENWAY BOARD MEMBER 1.00 0.00 X 0 0 0 TROY REDING BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL HOLTZ BOARD MEMBER 1.00 0.00 X 0 0 0 DEEPAK KADEMANI DMD MD BOARD MEMBER 1.00 50.00 X 0 684540 45591 BRIAN BRUGGEMAN BOARD MEMBER 1.00 0.00 X 0 0 0 BETH MEJIA BOARD MEMBER 1.00 0.00 X 0 0 0 ERIC SKALLAND BOARD MEMBER 1.00 0.00 X 0 0 0 KENT SPAULDING VICE PRESIDENT 1.00 50.00 X 0 259354 39640 0 2321140 157694 0 0 1 0 0 355576 336662 110786 692238 182305 182305 724451 697710 26741 26741 26741 341778 355576 213662 128116 128116 1029400 0 0 337162 252543 252543 141620 141620 2946 2946 10534 10534 OUTSIDE SERVICES 133779 79778 54001 SUPPLIES 82189 32080 50109 EQUIPMENT AND REPAIRS 53185 53185 676796 569740 107056 0 281281 310465 58545 0 15758 9983 7474474 7592689 1075697 494930 8905755 8408067 19623 0 26019 21989 45642 21989 X 2265772 2091762 4199485 0 2394856 6294316 8860113 8386078 8905755 8408067 X 352604 -540012 -286627 X X 0 1 X 1 0 X 1649575 1464107 1574758 787759 692238 6168437 1649575 1464107 1574758 787759 692238 6168437 6168437 125014 122845 99819 145775 182305 675758 6844195 0.90130 0.92560 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3 1840 5893 21966 1 1 3344063 82062 -75671 414300 16500 2919654 3029196 370959 56092 3344063 2203143 155228 707969 37144 3029196 3591423 17322 1405602 2203143 3446092 76703 118858 50230 3591423 0.00000 0.72210 0.27790 1 0 0 BENEFICIAL INTEREST IN REMAINDER TRUST 494930 494930 AMOUNTS HELD FOR OTHERS 21989 21989 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 EVALUATES ITS UNCERTAIN POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2018 OR 2017. DINNER/DANCE GALA 524482 355576 168906 93203 65728 GOLF FUNDRAISER 172872 172872 39108 15623 697354 355576 341778 93203 104836 15623 213662 128116 1 NORTH MEMORIAL HEALTH CARE 3300 OAKDALE AVE N ROBBINSDALE MN 55422 410729979 501(C)(3) 124373 GRANTS IN CONNECTION WITH CANCER RELATED PROGRAMS NORTH MEMORIAL HEALTH CARE 3300 OAKDALE AVE N ROBBINSDALE MN 55422 410729979 501(C)(3) 128170 TO SUPPORT NMHC PROGRAMS AND SERVICES 1 0 TEAM MEMBER ASSISTANCE/CRISIS FUND 28 45042 JUNIOR VOLUNTEER SCHOLARSHIPS 11 7000 HOSPICE FUND 100 15036 CANCER CARE PHARMACY FUND 20 24673 NURSING DEVELOPMENT FUND 1 35961 HAROLD ECKER ENDOWMENT 1 7976 ALL OTHER 5932 PART I, LINE 2: THE ORGANIZATION PRIMARILY MAKES GRANTS TO RELATED ORGANIZATION NORTH MEMORIAL HEALTH CARE AND RECORDS ARE MAINTAINED AS TO HOW FUNDS ARE DISBURSED BY BOTH ORGANIZATIONS. THE ORGANIZATION ALSO FUNDS CONTINUING EDUCATION FOR NORTH MEMORIAL EMPLOYEES AND MAKES SEVERAL SMALL SPONSORSHIPS. 0 0 0 0 0 0 1 0 0 J KEVIN CROSTON MD BOARD MEMBER 0 809165 0 202500 0 9297 0 19250 0 27712 0 1067924 0 0 PAMELA DOORENBOS MD BOARD MEMBER 0 300769 0 45115 0 400 0 16500 0 9001 0 371785 0 0 DEEPAK KADEMANI DMD MD BOARD MEMBER 0 481724 0 199958 0 2858 0 19250 0 26341 0 730131 0 0 KENT SPAULDING VICE PRESIDENT 0 224519 0 33750 0 1085 0 18079 0 21561 0 298994 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 CASH FLOW MARGIN. X AUCTION ITEMS & MISC 156 110786 FMV 0 0 1 0 PART I, COLUMN (B): THE NUMBER IN PART I, COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION A, LINE 4 THE FOUNDATION CHANGED ITS BYLAWS TO INCREASE THE NUMBER OF BOARD MEMBERS. THE PREVIOUS BYLAWS STATED THAT THE BOARD WOULD HAVE NO MORE THAN 15 MEMBERS. THE AMENDED BYLAWS STATE THAT THE BOARD SHALL BE COMPRISED OF NOT LESS THAN 9 AND NOT MORE THAN 20 MEMBERS. MEMBERSHIP CAN BE INCREASED UP TO 25 MEMBERS IN SUPPORT OF A CAPITAL FUNDRAISING CAMPAIGN OR OTHER LARGE FUNDRAISING EVENT, IF APPROVED BY MAJORITY VOTE OF THE FOUNDATION BOARD OF DIRECTORS. 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. 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 -286,627. 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 MINNESOTA DIAGNOSTIC IMAGING PARTNERS LLC 2955 XENIUM LANE SUITE 40 PLYMOUTH MN 55441 352162215 RADIOLOGY MN N/A NORTH RADIATION THERAPY CENTER LLC 6950 FRANCE AVE S SUITE 200 EDINA MN 55435 743069974 RADIOLOGY MN N/A MINNETONKA AMBULATORY SURGERY CENTER 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 55422 465653486 OUTPATIENT SURGERY MN N/A MULTICARE SLEEP CENTER LLC 10600 OLD COUNTY ROAD 15 PLYMOUTH MN 55441 274833673 OUTPATIENT SLEEP CENTER MN N/A 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 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 NORTH MEMORIAL HEALTH CARE (CONTRIBUTIONS TO NMHC) B 252543 FMV