2019-05-15T11:33:12-05:00 2018-06-30 861065772 Deloitte Tax LLP 50 South Sixth Street Suite 2800 Minneapolis MN 55402 990 2017-07-01 450344371 F-M Ambulance Service Inc F-MA 7012342000 PO Box 5039 Rte 5218 Sioux Falls SD 571175039 Bill Marlette Treasurer 6053331000 2019-05-15 1 Chris Meskimen P01314196 6123974000 206.208.217.34 2019-05-15 11:32:58 CD P E5BC8B5E57121AB33B8A1607D3C50835A925FFE9 E5BC8B5E57121AB33B8A1607D3C50835A925FFE9 2017 2019-02-21 02:37:17Z Kelby Krabbenhoft 2301 East 60th St Sioux Falls SD 57104 16589129 0 X www.FMAmbulance.com X 1978 ND "Dedicated to the Work of Health and Healing" 14 6 0 0 0 0 126629 87311 14349146 16466835 153 -1401 -948 5521 14474980 16558266 265 560 0 0 7796623 8815193 0 0 0 3270114 3514684 11067002 12330437 3407978 4227829 6344835 6291021 65455 120034 6279380 6170987 X The Mission of F-M Ambulance, "Dedicated to the Work of Health and Healing and the vision "Improving the Human Condition through Exceptional Care, Innovation and Discovery", is the constant force that drives our plans, decisions and actions. 0 0 10878079 560 16466835 As part of the Sanford Health integrated delivery system, F-M Ambulance Service, Inc. (FMA) provides emergency medical care and specialty care transportation services to Fargo, North Dakota/Moorhead, Minnesota metro area and surrounding communities. FMA is the largest advanced life support ground ambulance provider in North Dakota. FMA responds to more than 35,000 calls for service annually and serves as a resource to rescue squads, fire departments, law enforcement agencies and basic life support ambulance providers throughout the state. FMA provides tactical paramedics for the regional S.W.A.T. team and provides firefighter rehab services pro-bono. FMA works closely with local volunteer services to coordinate the delivery of emergency medical care to communities in its service area and is a leader in Homeland Defense Preparedness by serving as a regional training site, resources partner and first responder. Through its Ready Wheels operations (a specialty care transportation service), FMA provides local and long distance transportation for individuals confined to wheelchairs. This specialty care transportation service is available 24 hours a day, seven days a week to provide door-to-door service. These services allow individuals in the community to access transportation services that accommodate unique individual needs due to health conditions. Education and other services:FMA promotes community health and injury prevention. More than 10,000 people each year participate in first aid, automated external defibrillator, CPR, babysitter training and other community wellness courses. 10878079 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 1 0 X 14 6 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X JoAnn Kunkel CFO 6053331000 2301 East 60th Street Sioux Falls SD 57104 X Barb Everist Trustee 0.10 5.50 X 0 725 0 Andy North Trustee 0.10 7.50 X 0 121718 0 Brent Teiken Vice Chair 0.10 5.50 X X 0 1215 0 David Beito Past Chair 0.10 5.50 X X 0 0 0 Don Jacobs Treasurer 0.10 5.50 X X 0 0 0 Don Morton through 1217 Trustee 0.10 5.50 X 0 1353 0 James Cain Secretary 0.10 5.50 X X 0 0 0 Maria Bell MD Trustee/Research Administrator 0.10 59.90 X 0 789033 29050 Mark Lundeen MD Trustee/Orthopedics Service Chair 0.10 59.90 X 0 726619 29050 Mark Paulson MD Chair/Phyisican Regional Chair 0.10 59.90 X X 0 266366 26202 Melissa Hinton Trustee 0.10 5.50 X 0 0 0 Michael LeBeau MD Trustee/Senior VP - Bismarck Clinic 0.10 59.90 X 0 1414632 29050 Patrick Durick Trustee 0.10 5.50 X 0 1177 0 Thomas Hruby Trustee 0.10 5.50 X 0 1360 0 Kelby K Krabbenhoft Sanford President & CEO 0.10 59.90 X X 0 2276185 12726 Kelby K Krabbenhoft Def Comp Sanford President & CEO 0.10 59.90 X X 0 0 877405 JoAnn L Kunkel Chief Financial Officer 0.10 59.90 X 0 1020341 43188 Nate White COO/President Fargo 5.00 55.00 X 0 1432723 51351 Paul Richard Executive VP Fargo 5.00 55.00 X 0 931503 26226 0 8984950 1124248 0 0 1 0 0 11170 76141 87311 Emergency Medical Serv 621910 15354930 15354930 Education 900099 908442 908442 Special Transportation 621910 203463 203463 16466835 1401 -1401 -1401 -1401 34133 29462 4671 4671 Non operating interest 525990 850 850 850 16558266 16466835 0 4120 560 560 7205838 6725219 480619 337359 316417 20942 731048 675823 55225 540948 504824 36124 2548 2548 18841 18841 108606 67556 41050 33614 32935 679 130398 78820 51578 257155 7112 250043 178566 91227 87339 348684 327814 20870 222995 218588 4407 692700 591427 101273 233289 233289 Medical Supplies 662822 643796 19026 Purchased Services 496368 496368 MinnesotaCare Tax 66654 66654 61444 32939 28505 12330437 10878079 1452358 0 501 251 1391281 1625655 20410 3436 45097 216808 8561242 5713794 3315981 2847448 1393082 1393082 178483 204341 6344835 6291021 65455 120034 65455 120034 X 6279380 6170987 6279380 6170987 6344835 6291021 X 4227829 -4336222 X 0 1 X 1 0 410810 410810 2375029 1200183 1174846 5640350 4416043 1224307 135053 97568 37485 2847448 X Part X, Line 2: Certain controlled organizations are subject to income taxes. Deferred income tax assets and liabilities are recognized for the differences between the financial and income tax reporting basis of assets and liabilities based on enacted tax rates and laws. 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. The deferred income tax provision or benefit generally reflects the net change in deferred income tax assets and liabilities during the year. The current income tax provision reflects the tax consequences of revenues and expenses currently taxable or deductible on various income tax returns for the year reported. F-M Ambulance Service, Inc did not have an income tax liability at June 30, 2018; some related organizations have established reserves. 0 1 0 0 0 0 0 0 0 Maria Bell MD Trustee/Research Administrator 0 775124 0 10000 0 3909 0 0 0 29050 0 818083 0 0 Mark Lundeen MD Trustee/Orthopedics Service Chair 0 725227 0 0 0 1392 0 0 0 29050 0 755669 0 0 Mark Paulson MD Chair/Phyisican Regional Chair 0 268457 0 0 0 -2091 0 0 0 26202 0 292568 0 0 Michael LeBeau MD Trustee/Senior VP - Bismarck Clinic 0 1342178 0 3000 0 69454 0 0 0 29050 0 1443682 0 0 Kelby K Krabbenhoft Sanford President & CEO 0 1644254 0 542500 0 89431 0 0 0 12726 0 2288911 0 0 Kelby K Krabbenhoft Def Comp Sanford President & CEO 0 0 0 0 0 0 0 877405 0 0 0 877405 0 0 JoAnn L Kunkel Chief Financial Officer 0 703270 0 202500 0 114571 0 21375 0 21813 0 1063529 0 0 Nate White COO/President Fargo 0 861156 0 363500 0 208067 0 25125 0 26226 0 1484074 0 0 Paul Richard Executive VP Fargo 0 650764 0 160000 0 120739 0 0 0 26226 0 957729 0 0 Part I, Line 1a Certain items listed on Line 1a are provided by related organizations. Part I, Line 3: The Executive Compensation Committee of the Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm annually to review the total compensation arrangements of the officers and executives of the organization, including the CEO, and to report the findings to them for deliberation and action. The deliberations and actions are recorded in the minutes of the Sanford Board of Trustees. The most recent study was completed in 2018. Part I, Line 4b Certain executives participate in a defined benefit SERP Plan. There were no individuals who received payments during the year. Form 990, Part VI, Section A, line 2 The following officers, board members, and key employees are employees of Sanford or its related organizations. Many of these employees also serve on other related Sanford boards, or have business relationships with each other that span the organization as a whole: Maria Bell, Mark Lundeen, Mark Paulson, Michael LeBeau, Kelby Krabbenhoft, JoAnn Kunkel, Nate White and Paul Richard. Form 990, Part VI, Section A, line 6 Sanford North is the sole stockholder of F-M Ambulance. Form 990, Part VI, Section A, line 7a Board members are appointed by the President and CEO of Sanford North. Form 990, Part VI, Section A, line 7b Sanford North must approve the following actions: * Modifying the purpose of the Corporation * Unbudgeted capital expenses in excess of 1/2 of 1% of approved operating budgets *Adoption of capital and operating budgets *Acquisition, sale, lease, disposition, or mortgaging of real property *Guarantee of debts or obligations of any other person, firm, corporation, partnership, association, or other entity which if held in default would obligate the corporation to an aggregate amount in excess of $100,000 *Merger or consolidation of the Corporation *Incurring a loan or other obligation in an agreement in excess of $500,000 for more than 60 days *Making of a gift, grant or other donation in an amount in excess of $5,000 to an organization not related to the Corporation or Member *Member has the authority to direct the Corporation regardless of the vote by the Corporation's Board of Directors to transfer assets and/or funds to the health system to satisfy obligations of the health system. Form 990, Part VI, Section B, line 11b The Form 990 is prepared internally by Finance and reviewed by executive management. An external accounting firm reviews the return prior to filing and prepares return highlights and key disclosures for the Board of Trustees meeting prior to the return filing date. Before the return is filed, a complete copy is provided to the current Board of Trustees. Form 990, Part VI, Section B, line 12c The annual Conflict of Interest disclosure process is managed by the Chief Compliance Officer (CCO). The CCO is responsible for assuring that all completed forms are returned in a timely and complete manner. Conflict of Interest questionnaires are sent to System Trustees, members of the governing boards for subsidiary entities, officers, and key employees for all entities subject to the IRS Form 990 filings. The disclosures are summarized for review by the executive committee of the Board of Trustees, pursuant to policy. This review allows: 1) The Board to acquire an awareness of financial relationships of board members and key management employees and can invoke the recusal process on a case-by-case basis if potential conflicts are implicated in Board decisions and deliberations, and, 2) Gives the Board the opportunity to seek additional information and clarification about disclosures to determine potential conflicts of interest and how to manage them. Form 990, Part VI, Section B, line 15 A related party, Sanford Health, does have a process for determining compensation of the persons listed on Part VII Section A, including a review and approval by independent persons, review of comparability data and contemporaneous substantiation of the deliberation and decision for such compensation. The Executive Compensation Committee of the Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm annually to review the total compensation arrangements of the officers and executives of the organization, including the CEO, and to report the findings to them for deliberation and action. The deliberations and actions are recorded in the minutes of the Sanford Board of Trustees. The most recent study was completed in 2018. Form 990, Part VI, Section C, line 19 Although the organization does not maintain a website where the public can access these documents, it would respond individually to any requests or inquiries from the public for these documents. Form 990, Part VII The Sanford Board of Trustees has ultimate governance responsibilities for each major operation entity within Sanford. In addition, a Board of Directors is established for each major operating entity. This Board has specific responsibilities delegated from the Board of Trustees. Generally these responsibilities are related to the oversight of the day to day operations of that entity. Form 990, Part XI, line 9: Transfer to related tax-exempt org for payroll and operating expenses -4,336,222. Sanford P O Box 5039 Rte 5218 Sioux Falls SD 571175039 271218956 Supporting Organization ND 501(c)(3) 12-II 0 Sanford Health Foundation P O Box 5039 Rte 5218 Sioux Falls SD 571175039 363297853 Foundation SD 501(c)(3) 12-II Sanford Health 1 Edith Sanford Breast Cancer Foundation P O Box 5039 Rte 5218 Sioux Falls SD 571175039 450404126 Foundation ND 501(c)(3) 12-II Sanford Health 1 Sanford Health Foundation North P O Box 5039 Rte 5218 Sioux Falls SD 571175039 450398104 Foundation ND 501(c)(3) 7 Sanford North 1 Sanford Health Foundation Hillsboro P O Box 5039 Rte 5218 Sioux Falls SD 571175039 363542187 Foundation ND 501(c)(3) 7 Sanford Hillsboro 1 Sanford Health Foundation of Northern Minnesota 810 South Main Sioux Falls SD 571175039 411389317 Foundation MN 501(c)(3) 12-II Sanford Health of Northern Minnesota 1 Sanford Health Foundation West P O Box 5039 Rte 5218 Sioux Falls SD 571175039 450397196 Foundation ND 501(c)(3) 7 Sanford Bismarck 1 Medcenter One Inc Auxiliary P O Box 5039 Rte 5218 Sioux Falls SD 571175039 237293043 Supporting Organization ND 501(c)(3) 12-II Sanford Bismarck 1 Sanford Heart of America Health Plan P O Box 5039 Rte 5218 Sioux Falls SD 571175039 450346132 Insurance ND 501(c)(4) Sanford Health Plan 1 Sanford Health Foundation Thief River Falls P O Box 5039 Rte 5218 Sioux Falls SD 571175039 411761135 Foundation MN 501(c)(3) 7 Sanford Medical Center Thief River Falls 1 National Student Housing-South Dakota LLC 100 S Phillips Ave Sioux Falls SD 57104 202129839 Investment SD N/A RAC Rentals LLC 100 S Phillips Ave Sioux Falls SD 57104 261961077 Investment SD N/A Sanford Home Medical Equipment Inc 2710 W 12th Street Sioux Falls SD 57105 460388597 Healthcare Equipment SD N/A C 1 Sanford Health Plan 300 Cherapa Place Sioux Falls SD 57103 911842494 Insurance SD N/A C 1 Sanford Health Plan of MN 300 Cherapa Place Sioux Falls SD 57103 460445852 Insurance MN N/A C 1 Sanford Frontiers 1305 W 18th Street PO Box 5039 Sioux Falls SD 571175039 455436599 Weight Loss/Fitness SD N/A C 1 SOB Inc 2701 S Minnesota Avenue Suite 2 Sioux Falls SD 57105 460442628 Air Transportation SD N/A C 1 Sanford Affiliated Services Inc 300 N 7th Street Bismarck ND 58501 450403146 Investment Activity ND N/A C 1 Sanford World Clinics - Ghana Sarbah Road Tantri Lorry Station Cape Coast GH Healthcare GH N/A C 1 Shanghai Sanford Healthcare Management Consulting Co Ltd 188 Yesheng Road Room A-862 Guoma Shanghai CH Healthcare CH N/A C 1 Sanford International - Munich GmbH Nymphenburger Strasse 3 Munich GM Healthcare GM N/A C 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 Sanford Health R 4336222 Cash Method