2018-09-25T08:58:46-05:00 2017-12-31 410746749 CLIFTONLARSONALLEN LLP 818 SECOND ST SO SUITE 320 WAITE PARK MN 56387 990 2017-01-01 237146628 LAKES REGION EMS INC LAKE 6512774911 40245 FLETCHER AVE PO BOX 266 NORTH BRANCH MN 55056 SCOTT SELLMAN TREASURER 6512774911 2018-09-13 1 WILLIAM A LECLAIRE CPA P00058875 3202035500 67.137.57.251 2018-09-13 12:26:49 CD P 2445D9F23906184C4D8AC5CFB2D61DB567B3B979 2E0D7D06F106C8D332254A4512B5BBA3400C4AD7 2017 2018-06-14 16:35:46Z SCOTT SELLMAN 40245 FLETCHER AVE PO BOX 266 NORTH BRANCH MN 55056 6547467 0 X WWW.LREMS.COM X 1970 MN NOT-FOR-PROFIT AMBULANCE SERVICE, SERVICING CHISAGO COUNTY, PARTS OF ISANTI AND PINE COUNTIES IN MN. 6 6 96 6 0 0 101305 697839 5062684 5148852 29542 46967 491026 653167 5684557 6546825 0 0 0 0 3734549 3695222 0 0 0 1661859 1725319 5396408 5420541 288149 1126284 5978173 6789985 882605 449198 5095568 6340787 X TO LEASE, MAINTAIN AND OPERATE AN EMERGENCY RESCUE AND AMBULANCE SERVICE WHICH WILL SERVE THE CHISAGO LAKES, MN AREA TO RENDER AID TO THE SICK, INJURED OR DISABLED WITHOUT REGARD TO RACE, CREED, OR TO STATION IN LIFE. TO SERVE THE SOCIAL WELFARE OF THE PEOPLE OF THE AREA. 0 0 4015426 5802019 THE AMBULANCE SERVICE, STAFFED BY TRAINED PERSONNEL, PROVIDES AMBULANCE SERVICE FOR THE COMMUNITIES OF CHISAGO LAKES, RUSH CITY, AND NORTH BRANCH, MINNESOTA AS WELL AS PART OF POLK COUNTY IN WISCONSIN. 4015426 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 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 0 0 0 0 1 3 0 96 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X TODD J FISK 6512774911 40245 FLETCHER AVE PO BOX 266 NORTH BRANCH MN 55056 X KEITH CARLSON CHAIRMAN 1.00 X X 0 0 0 MIKE CARROLL VICE-CHAIRMAN 1.00 X X 0 0 0 SCOTT SELLMAN SECRETARY / TREASURER 1.00 X X 0 0 0 DAN MEYER DIRECTOR 1.00 X 0 0 0 JULIE SCHROEDER DIRECTOR 1.00 X 0 0 0 BRYAN GAFFY DIRECTOR 1.00 X 0 0 0 AARRON REINERT EXECUTIVE DIRECTOR 40.00 X 204870 0 0 TODD J FISK DIRECTOR OF FINANCE 40.00 X 133022 0 12630 BEN WASMUND DIRECTOR OF OPERATIONS 40.00 X 141395 0 0 KEN LARSON DIRECTOR OF CLINIC SERVICES 40.00 X 107854 0 4753 587141 0 17383 4 0 1 0 94 SERVICES 118 OAKWOOD DR E PO BOX 70 MONTICELLO MN 55362 AMBULANCE, TRUCK MAINT., PARTS 403185 STRYKER MEDICAL PO BOX 93308 CHICAGO IL 60673 POWERLOAD, COTS 177795 2 697839 697839 AMBULANCE SERVICE 621910 5118113 5118113 EMS EDUCATION 621910 30739 30739 5148852 47609 47609 642 -642 -642 -642 MANAGEMENT INCOME 561000 506152 506152 OTHER REVENUE 621910 147015 147015 653167 6546825 5802019 0 46967 350522 350522 2641771 2075482 566289 88827 61872 26955 401040 288142 112898 213062 148408 64654 42289 42289 41863 41863 18076 9038 9038 71947 51615 20332 142322 71161 71161 121491 99789 21702 181661 181661 3168 2416 752 513995 489375 24620 56230 40340 15890 MEDICAL SUPPLIES 158784 158784 TRAINING 87759 87759 DISPATCH SERVICES 81000 81000 MN CARE TAX 72080 72080 132654 96504 36150 5420541 4015426 1405115 0 120013 19613 689098 824428 1190531 1024888 28482 48911 5603171 1713068 3132663 3890103 693846 832625 123540 149417 5978173 6789985 747925 375620 105971 56154 28709 17424 882605 449198 X 5095346 6313387 222 27400 5095568 6340787 5978173 6789985 1126284 118935 0 X 0 1 X 1 0 X 2716 434425 101305 697839 1236285 4430115 4308154 4423322 5062684 5148852 23373127 4430115 4310870 4857747 5163989 5846691 24609412 0 43154 622364 665518 43154 622364 665518 23943894 2896 2029 29398 29542 47609 111474 2896 2029 29398 29542 47609 111474 294490 349287 400970 491026 653167 2188940 4727501 4662186 5288115 5684557 6547467 26909826 0.88980 0.92650 0.00410 0.00280 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER REVENUE - 2013 AMOUNT: $ 294,490. 2014 AMOUNT: $ 349,287. 2015 AMOUNT: $ 400,970. 2016 AMOUNT: $ 491,026. 2017 AMOUNT: $ 653,167. 222137 222137 2514200 185276 2328924 2866834 1527792 1339042 3890103 CAPITAL LEASE PAYABLES 17424 17424 X 6665760 118935 118935 6546825 0 6546825 5420541 0 5420541 0 5420541 PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND CORRESPONDING STATE TAX CODES. THE ORGANIZATION IS NOT A PRIVATE FOUNDATION AND CONTRIBUTIONS TO THE ORGANIZATION QUALIFY AS A CHARITABLE TAX DEDUCTION BY THE CONTRIBUTOR. THE ORGANIZATION FOLLOWS THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE IMPLEMENTATION OF THIS STANDARD HAD NO IMPACT ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ORGANIZATION'S TAX RETURNS ARE SUBJECT TO REVIEW BY FEDERAL AND STATE AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. X 0 0 0 0 0 0 0 0 0 AARRON REINERT EXECUTIVE DIRECTOR 186870 0 0 0 18000 0 0 0 0 0 204870 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 FIRST GOES TO THE FINANCE COMMITTEE FOR REVIEW/APPROVAL, AND THEN MOVES ON TO THE BOARD. THE BOARD WILL VOTE AND APPROVE, THEN THE FORM 990 IS SENT TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, OFFICER AND MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT THAT AFFIRMS THAT SUCH PERSON: A. HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; B. HAS READ AND UNDERSTANDS THE CONFLICTS OF INTEREST POLICY; C. AGREES TO COMPLY WITH THE CONFLICTS OF INTEREST POLICY; AND D. UNDERSTANDS THAT LREMS IS A CHARITABLE ORGANIZATION AND THAT, IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION, IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES AND NO PART OF ITS NET EARNINGS, DIRECTLY OR INDIRECTLY, IMPROPERLY INURE TO THE BENEFIT OF ANY PRIVATE PERSON. TO ENSURE THAT LREMS OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX, LREMS'S BOARD OF DIRECTORS SHALL CONDUCT PERIODIC REVIEWS. IF IT IS UNCLEAR WHETHER A CONFLICT EXISTS, THE REMAINING BOARD MEMBERS MAKE THE DETERMINATION. AN INTERESTED PERSON MUST DISCLOSE ACTUAL OR POTENTIAL CONFLICTS TO THE BOARD AS SOON AS THE INTERESTED PERSON BECOMES AWARE OF IT. THE INTERESTED PERSON MUST LEAVE THE ROOM FOR DISCUSSIONS OF THE TRANSACTION AND ANY VOTES CONCERNING THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR'S COMPENSATION PACKAGE IS REVIEWED EACH YEAR BY THE EXECUTIVE COMMITTEE. AT TIMES THE MEMBERS WILL REQUEST COMPARATIVE INFORMATION FROM AN OUTSIDE SOURCE. THE REVIEW WAS LAST COMPLETED IN 2018. THE COMPENSATION OF OTHER OFFICERS OR KEY EMPLOYEES OF THE ORGANIZATION ARE REVIEWED AND DETERMINED BY THE EXECUTIVE DIRECTOR. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC ONLY BY APPOINTMENT WITH THE DIRECTOR OF FINANCE. FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC THROUGH THE MINNESOTA ATTORNEY GENERAL'S OFFICE. FORM 990, PART VIII, LINE 11A RELATED REVENUE: STARTING ON SEPTEMBER 6, 2011 LAKES REGION, EMS, INC. ENTERED INTO A CONTRACT TO PROVIDE MANAGEMENT SERVICES TO ST. CROIX VALLEY EMERGENCY MEDICAL SERVICES, INC. IN MARCH 2013, LAKES REGION, EMS, INC. ENTERED INTO A CONTRACT TO PROVIDE MANAGEMENT SERVICES TO CUMBERLAND MEMORIAL HOSPITAL. THIS REVENUE REPRESENTS THE MANAGEMENT FEES THAT WERE EARNED BY LAKES REGION EMS, INC. FOR SERVICES RENDERED FOR THE YEAR.