AMERY REGIONAL MEDICAL CENTER FOUNDATION INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
AMERY REGIONAL MEDICAL CENTER FOUNDATION INC (EIN 39-1726539)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-13
IRS object ID
201843179349307629
Schema version
2017v2.2
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)
Return2018-11-13T16:53:33-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

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 Begin2017-01-01TaxPeriodBeginDt

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
Signature2018-11-13SignatureDt
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 Address198.174.110.146IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-11-13IPDt
IP Tm16:20:15IPTm
IP TimezoneCSIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdBC53011EDF70B2E1BD72B439C4A42BAD8A5D7AD2AtSubmissionCreationDeviceId
At Submission Filing Device IdBC53011EDF70B2E1BD72B439C4A42BAD8A5D7AD2AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

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$288,795GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.AMERYMEDICALCENTER.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1991FormationYr
Legal Domicile StateWILegalDomicileStateCd
Activity Or MissionSEE SCHEDULE O - "MISSION STATEMENT AND "EXEMPT PURPOSE AND ACHIEVEMENTS"ActivityOrMissionDesc
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent7VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers7TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$181,415PYContributionsGrantsAmt
CY Contributions Grants$253,561CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$412PYInvestmentIncomeAmt
CY Investment Income$920CYInvestmentIncomeAmt
PY Other Revenue$1,227PYOtherRevenueAmt
CY Other Revenue$28,217CYOtherRevenueAmt
PY Total Revenue$183,054PYTotalRevenueAmt
CY Total Revenue$282,698CYTotalRevenueAmt
PY Grants And Similar Paid$63,149PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$60,907CYGrantsAndSimilarPaidAmt
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$56,571CYTotalFundraisingExpenseAmt
PY Other Expenses$1,031PYOtherExpensesAmt
CY Other Expenses$65,613CYOtherExpensesAmt
PY Total Expenses$64,180PYTotalExpensesAmt
CY Total Expenses$126,520CYTotalExpensesAmt
PY Revenues Less Expenses$118,874PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$156,178CYRevenuesLessExpensesAmt
Total Assets BOY$315,445TotalAssetsBOYAmt
Total Assets EOY$479,855TotalAssetsEOYAmt
Total Liabilities BOY$4,775TotalLiabilitiesBOYAmt
Total Liabilities EOY$13,007TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$310,670NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$466,848NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionSEE SCHEDULE O - "MISSION STATEMENT"MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$69,949ExpenseAmt
Grant$60,907GrantAmt
DescSEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTSDesc
Total Program Service Expenses$69,949TotalProgramServiceExpensesAmt
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
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
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 With Officer Ent0BusinessRlnWithOfficerEntInd
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
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
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 Line1JASON LUHRS 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 (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
DAN DRAXLER
DIRECTOR0.251.75Yes (X)$0$1,200$0
HEIDI ERSPAMER
DIRECTOR & SECRETARY0.251.75Yes (X)$0$1,200$0Yes (X)
JAMES A LEADHOLM JR
DIRECTOR & VICE CHAIR0.251.75Yes (X)$0$1,200$0Yes (X)
DANIEL LIEN
DIRECTOR & CHAIR0.251.75Yes (X)$0$1,200$0Yes (X)
DAVID RASMUSSEN
DIRECTOR0.251.75Yes (X)$0$1,200$0
CHRIS PETERSON
DIRECTOR0.251.75Yes (X)$0$800$0
ORALEE SCHOCK
DIRECTOR0.251.75Yes (X)$0$800$0
ROSS R BULLARD
DIRECTOR & TREASURER1.0044.00Yes (X)$0$209,385$59,571Yes (X)
DYLAN COE MD
DIRECTOR0.2539.75Yes (X)$0$299,925$83,618
MARTIN E RICHARDS MD
DIRECTOR0.2539.75Yes (X)$0$512,084$53,479
ANN SEAGREN MD
DIRECTOR0.2549.75Yes (X)$0$264,867$68,957
TED WEGLEITNER
DIRECTOR0.2552.75Yes (X)$0$555,832$109,748
MARYANN SCOGLIO CANP
DIRECTOR0.2564.75Yes (X)$0$186,318$41,672
JOANNE L JACKSON
EXECUTIVE DIRECTOR50.00$0$142,365$24,600Yes (X)
JASON J LUHRS
CFO0.5049.50$0$209,275$61,093Yes (X)
DEBRA RUDQUIST
CHIEF EXECUTIVE OFFICER55.00$0$318,572$78,697Yes (X)
PATRICK SURA MD
CHIEF MEDICAL OFFICER0.2559.75$0$559,077$54,160Yes (X)
SANDRA REED
VP - AMBULATORY CARE FORMER0.0050.00$0$162,025$37,052Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$3,427,325TotReportableCompRltdOrgAmt
Total Other Compensation$672,647TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$4,554FundraisingAmt
Related Organizations$32,596RelatedOrganizationsAmt
All Other Contributions$216,411AllOtherContributionsAmt
Total Contributions$253,561TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$920TotalRevenueColumnAmt
Exclusion$920ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$34,314FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$4,554ContriRptFundraisingEventAmt
Fundraising Direct Expenses$6,097FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$28,217TotalRevenueColumnAmt
Exclusion$28,217ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$282,698TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$29,137ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$60,907TotalAmt
Program Services$60,907ProgramServicesAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$52,006TotalAmt
Program Services$978ProgramServicesAmt
Fundraising$51,028FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$2,033TotalAmt
Program Services$1,759ProgramServicesAmt
Fundraising$274FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$5,050TotalAmt
Program Services$5,050ProgramServicesAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,255TotalAmt
Program Services$1,255ProgramServicesAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUS OTHER EXPDesc
Total$5,269TotalAmt
Fundraising$5,269FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$126,520TotalAmt
Program Services$69,949ProgramServicesAmt
Management And General$0ManagementAndGeneralAmt
Fundraising$56,571FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$305,199BOYAmt
EOY$472,351EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$10,246BOYAmt
EOY$7,504EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$315,445BOYAmt
EOY$479,855EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$4,775BOYAmt
EOY$13,007EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,775BOYAmt
EOY$13,007EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$310,670BOYAmt
EOY$466,848EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$310,670BOYAmt
EOY$466,848EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$315,445BOYAmt
EOY$479,855EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$156,178ReconcilationRevenueExpnssAmt
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$46,546CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$27,377CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,319CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$181,416CurrentTaxYearMinus1YearAmt
Current Tax Year$253,561CurrentTaxYearAmt
Total$514,219TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$46,546CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$27,377CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,319CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$181,416CurrentTaxYearMinus1YearAmt
Current Tax Year$253,561CurrentTaxYearAmt
Total$514,219TotalAmt
FieldValueIRS element (for citing)
Substantial Contributors Tot$115,235SubstantialContributorsTotAmt
Public Support Total170$398,984PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$117CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$147CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$163CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$412CurrentTaxYearMinus1YearAmt
Current Tax Year$920CurrentTaxYearAmt
Total$1,759TotalAmt
FieldValueIRS element (for citing)
Total Support$515,978TotalSupportAmt
Gross Receipts Rltd Activities$72,829GrossReceiptsRltdActivitiesAmt
Public Support CY1700.77330PublicSupportCY170Pct
Public Support PY1700.77050PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

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, 2017 OR 2016 FOR UNRECOGNIZED TAX BENEFITS.ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GOLF TOURNAMENTEvent1Nm
Gross Receipts Event1$38,868GrossReceiptsEvent1Amt
Charitable Contri Event1$4,554CharitableContriEvent1Amt
Gross Revenue Event1$34,314GrossRevenueEvent1Amt
Other Direct Expenses Event1$6,097OtherDirectExpensesEvent1Amt
Other Events Total0OtherEventsTotalCnt
Gross Receipts Total$38,868GrossReceiptsTotalAmt
Charitable Contributions Tot$4,554CharitableContributionsTotAmt
Gross Revenue Total Events$34,314GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events$6,097OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$6,097DirectExpenseSummaryEventsAmt
Net Income Summary$28,217NetIncomeSummaryAmt

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$56,578CashGrantAmt
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 (11 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
ROSS R BULLARD
DIRECTOR & TREASURER$0$184,046$0$21,234$0$4,105$0$31,660$0$27,911$0$268,956$0$0
DYLAN COE MD
DIRECTOR$0$195,920$0$0$0$104,005$0$64,743$0$18,875$0$383,543$0$0
MARTIN E RICHARDS MD
DIRECTOR$0$369,589$0$10,830$0$131,665$0$20,250$0$33,229$0$565,563$0$0
ANN SEAGREN MD
DIRECTOR$0$194,454$0$0$0$70,413$0$40,255$0$28,702$0$333,824$0$0
TED WEGLEITNER
DIRECTOR$0$408,444$0$110,594$0$36,794$0$75,885$0$33,863$0$665,580$0$31,729
MARYANN SCOGLIO CANP
DIRECTOR$0$162,122$0$0$0$24,196$0$14,362$0$27,310$0$227,990$0$0
JOANNE L JACKSON
EXECUTIVE DIRECTOR$0$127,814$0$9,707$0$4,844$0$4,279$0$20,321$0$166,965$0$0
JASON J LUHRS
CFO$0$182,408$0$25,725$0$1,142$0$34,255$0$26,838$0$270,368$0$0
DEBRA RUDQUIST
CHIEF EXECUTIVE OFFICER$0$261,858$0$54,164$0$2,550$0$50,076$0$28,621$0$397,269$0$0
PATRICK SURA MD
CHIEF MEDICAL OFFICER$0$363,107$0$10,024$0$185,946$0$20,250$0$33,910$0$613,237$0$0
SANDRA REED
VP - AMBULATORY CARE FORMER$0$132,851$0$20,950$0$8,224$0$4,945$0$32,107$0$199,077$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 4BDEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTOR: TED WEGLEITNER $36,634
SCHEDULE J, PART IICOLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION, FOR THE FOLLOWING DIRECTORS: TED WEGLEITNER $ 31,729 ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, FOR THESE PARTICIPANTS OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 1 - "MISSION STATEMENT"THE 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.
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 FAMILY OF HEALTHPARTNERS ORGANIZATIONS ("HEALTHPARTNERS"). FOUNDED IN 1957, HEALTHPARTNERS IS AN INTEGRATED SYSTEM OF HEALTH CARE DELIVERY AND HEALTH CARE FINANCING ORGANIZATIONS, AND IS ONE OF THE LARGEST CONSUMER-GOVERNED ORGANIZATIONS 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, SIX OWNED HOSPITALS WITH OVER 1,000 ACUTE CARE BEDS, OVER 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 THE HEALTHPARTNERS FAMILY, 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 2017 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 NON-PROFIT 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 NON-PROFIT 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, STILLWATER HEALTH SYSTEM (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 2017, THE FOUNDATION LAUNCHED ITS SECOND ANNUAL EMPLOYEE GIVING CAMPAIGN RAISING $32,056 FROM AHC AND HEALTHPARTNERS EMPLOYEES. A PERCENTAGE OF DONATIONS WERE MATCHED BY HEALTHPARTNERS INC. FOR $22,596 AND BY AHC FOR AN ADDITIONAL $10,000 FOR A TOTAL FUNDS RAISED OF $64,652. THE FUNDS WERE DIRECTED TO COMMUNITY HEALTH INITIATIVES, PATIENT CARE NEEDS, EMPLOYEE TO EMPLOYEE ASSISTANCE AND GREATEST NEED. IN AUGUST OF 2017, THE FOUNDATION HELD THE 29TH ANNUAL GOLF CLASSIC RAISING A NET OF $32,771 FOR THE MENTAL HEALTH NEEDS / MAKE IT OK FUND. DONATIONS RECEIVED: IN ADDITION TO THE EMPLOYEE GIVING CAMPAIGN AND THE GOLF CLASSIC, THE FOUNDATION RECEIVED DONATIONS FROM SEVEN INDIVIDUALS, TWO FOR-PROFIT COMPANIES, FOUR CHARITABLE ORGANIZATIONS AND A SMALL CRAFT GROUP. PROGRAM SUPPORT / COMMUNITY CONTRIBUTIONS: THE FOUNDATION STRATEGICALLY PARTNERED IN MANY AREAS OF THE HEALTH CARE DELIVERY AT AHC FOR PATIENTS AND COMMUNITY. MATERNITY CARE: IN 2017, THE FOUNDATION SECURED A GRANT FOR $56,578 AND PURCHASED A CENTRALIZED FETAL MONITORING SYSTEM, ALLOWING CAREGIVERS REMOTE ACCESS TO VITAL SIGNS OF MOMS AND UNBORN BABIES. THIS TECHNOLOGY REPLACED A PAPER STRIP SYSTEM THAT PROHIBITED OBSERVATION FROM A SPECIALIST IN THE METRO AREA CONSULTING WITH LOCAL RURAL HEALTHCARE FAMILY PRACTICE PHYSICIANS. PATIENT MEDICATION ADMINISTRATION: THE FOUNDATION ALSO SUPPORTED THE PURCHASE OF WIRELESS MEDICATION BAR CODE SCANNERS IN EFFORTS TO IMPROVE STANDARD PROCESSES THAT FACILITATE REDUCTION/ELIMINATION IN MEDICATION ERRORS. THE WIRELESS SCANNERS ALLOW THE CAREGIVER TO REACH AWKWARD AND DISTANT ANGLES ON PATIENT IDENTIFICATION BANDS TO ENSURE A CONSISTENT MATCH BETWEEN THE PATIENT, MEDICATION AND PHYSICIAN ORDER. INTEGRATED THERAPY: FUNDING SUPPORTED THERAPIES THAT INCLUDED AROMA THERAPY, PET THERAPY AND HEALING TOUCH THERAPY FOR MANY PATIENT CARE AREAS. CHILDREN'S HEALTH: THE FOUNDATION PROUDLY SUPPORTED THE POWERUP KIDS PROGRAMING FOR OUR RURAL COMMUNITIES WITH FINANCIAL CONTRIBUTIONS OF $37,695. POWERUP FOR KIDS' VISION IS TO REDUCE/ELIMINATE CHILDHOOD OBESITY THROUGH BETTER EATING AND INCREASED ACTIVITY. THE PROGRAM PARTNERS WITH THE SCHOOL DISTRICT OF AMERY, THE NON-MOTORIZED STOWER SEVEN LAKES STATE TRAIL, THE FARM TABLE FOUNDATION (LOCAL GROWERS COOP), THE LOCAL FOOD SHELVES, AREA GROCERY STORES, THE AMERY PUBLIC LIBRARY AND THE POLK COUNTY WISCONSIN PUBLIC HEALTH DEPARTMENT. MENTAL HEALTH: THE FOUNDATION IS ACTIVE IN FINANCIAL SUPPORT AND VOLUNTEERING WITH THE MENTAL HEALTH TASK FORCE OF POLK COUNTY IN HOSTING EVENTS TO RAISE AWARENESS AND REDUCE STIGMA. THE FOUNDATION ALSO CO-LEAD FUNDRAISING FOR A NORTHWEST WISCONSIN EMERGENCY BEHAVIORAL HEALTH TELEMEDICINE TRIAGE PROJECT. ADDITIONALLY, THE FOUNDATION FUNDS AND PROMOTES STAFF TO VOLUNTEER FOR THE MENTAL HEALTH STIGMA REDUCTION PROGRAM, 'MAKE IT OK' COMMUNITY GARDENS: THE FOUNDATION FUNDS THE OPERATIONAL EXPENSE FOR THE COMMUNITY WIDE GARDEN PLOTS. THE GARDEN VOLUNTEERS PARTNER WITH THE CITY OF AMERY, THE HUNGRY TURTLE FOOD INSTITUTE, THE AMERY FOOD SHELF AND THE AMERY HOUSING AUTHORITY. AHC DONATES GARDEN BED SPACE TO SUPPORT THIS WELLNESS EFFORT. DEVELOPMENT OF FUTURE HEALTH CAREGIVERS: THE FOUNDATION PARTNERS WITH AHC TO FUND $1,000 SCHOLARSHIPS TO A HIGH SCHOOL SENIOR PURSUING HEALTHCARE RELATED CAREERS IN EACH OF 7 RURAL SERVICE AREA SCHOOL DISTRICTS.
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 THE PERSONS WHO ARE DIRECTORS OF THE MEMBER. IN ADDITION, UP TO FIVE ADDITIONAL DIRECTORS MAY BE APPOINTED BY THE MEMBER. THE PRESIDENT OF THE MEMBER AND THE CHIEF MEDICAL OFFICER OF THE MEMBER SERVE AS EX-OFFICIO NON-VOTING MEMBERS OF THE BOARD.
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: - AMENDMENTS OF THE ARTICLES, BYLAWS OR OTHER GOVERNING DOCUMENTS - SALE, LEASE, MORTGAGE OR PLEDGE OF ANY REAL ESTATE OR INTEREST THEREIN, OR OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS - ADOPTION OF AMENDMENT OF A STRATEGIC PLAN, AND CAPITAL AND OPERATING BUDGETS - APPROVAL OF UNBUDGETED CAPITAL EXPENDITURES - APPROVAL OF BORROWING OR LENDING OF FUNDS OF THE FOUNDATION - MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY AND TRANSFER OR CONTRIBUTION OF ASSETS AND FUNDS TO SEPARATE ENTITIES - ESTABLISHMENT OR DIVESTITURE OF ENTITIES OF WHICH HHF HAS AN EQUITY OR MANAGEMENT INTEREST, OR ESTABLISHMENT OF ANY SIGNIFICANT AND CONTINUING RELATIONSHIP WITH ANY ENTITY - DISSOLUTION AND DISTRIBUTION OF ASSETS
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 REQUESTED 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, AND REINFORCES 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 11GSTAFFING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 51,028. TOTAL EXPENSES 51,028. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 978. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 978.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (26 entries)

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8171 33RD AVE S PO BOX 1309MPLSMN554401309202287016CORPORATE PLANNING AND OVERSIGHTWI501(C)(3)0509(A)(3) TYPE IHPI - RAMSEY
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PARK NICOLLET HEALTH SERVICES
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6500 EXCELSIOR BLVDST LOUIS PARKMN55426237346465SUPPORT TO RELATED ENTITIES AND COMMUNITY TO IMPROVE HEALTHMN501(C)(3)0170(B)(1) (A)(VI)PARK NICOLLET HEALTH SERVICES
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Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)

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