NORTH MEMORIAL FOUNDATION: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- NORTH MEMORIAL FOUNDATION (EIN 41-1777966)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-15
- IRS object ID
- 201823199349311522
- Schema version
- 2017v2.3
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-15T14:11:27-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390859910 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY VIRCHOW KRAUSE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 S 6TH ST 2300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411777966 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH MEMORIAL FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 7635205200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVENUE NORTH | AddressLine1Txt |
| City | ROBBINSDALE | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554222900 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KENT SPAULDING | PersonNm |
| Person Title | VP FOUNDATION | PersonTitleTxt |
| Phone | 7635205200 | PhoneNum |
| Signature | 2018-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LAWRENCE H MOHR CPA | PreparerPersonNm |
| PTIN | P00447603 | PTIN |
| Phone | 6128764500 | PhoneNum |
| Preparation | 2018-11-14 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 38.88.188.75 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-11-14 | IPDt |
| IP Tm | 06:50:06 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 2519A5C6D4FE43330A9B665C55E2C286A0409372 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2018-06-14 16:35:46Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KENT SPAULDING | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVENUE NORTH | AddressLine1Txt |
| City | ROBBINSDALE | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554222900 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,668,896 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.NORTHMEMORIAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1993 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 150 | TotalVolunteersCnt |
| Total Gross UBI | $145,775 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,574,758 | PYContributionsGrantsAmt |
| CY Contributions Grants | $787,759 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,182,872 | PYInvestmentIncomeAmt |
| CY Investment Income | -$32,147 | CYInvestmentIncomeAmt |
| PY Other Revenue | $198,312 | PYOtherRevenueAmt |
| CY Other Revenue | $78,409 | CYOtherRevenueAmt |
| PY Total Revenue | $2,955,942 | PYTotalRevenueAmt |
| CY Total Revenue | $834,021 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $255,883 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $387,752 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $917,224 | PYOtherExpensesAmt |
| CY Other Expenses | $40,295 | CYOtherExpensesAmt |
| PY Total Expenses | $1,173,107 | PYTotalExpensesAmt |
| CY Total Expenses | $428,047 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,782,835 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $405,974 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,789,533 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,905,755 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $133,412 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $45,642 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,656,121 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,860,113 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $68,732 | ExpenseAmt |
| Grant | $68,732 | GrantAmt |
| Desc | CANCER CARE:FOUNDATION FUNDS IN 2017 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. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $20,195 | ExpenseAmt |
| Grant | $20,195 | GrantAmt |
| Desc | TEAM MEMBER CRISIS FUND:FOUNDATION FUNDS IN 2017 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. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $336,634 | ExpenseAmt |
| Grant | $298,824 | GrantAmt |
| Desc | 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. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $425,561 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | Yes (1) | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 10 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | 0 | ConflictOfInterestPolicyInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AARON BLOOMQUIST | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7635205200 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVENUE NORTH | AddressLine1Txt |
| City | ROBBINSDALE | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554222900 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| BRUCE QUAM | |||||||
| BOARD CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MICHAEL STEINHAUSER | |||||||
| SECRETARY | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $10,000 | $0 |
| JANDEEN BOONE | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TROY REDING | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JIM BYRNE | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MARK NIBLICK | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| PAMELA DOORENBOS MD | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $359,993 | $20,092 | |
| DIANE NILSON | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| SCOTT HEMENWAY | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MICHAEL HOLTZ | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DEEPAK KADEMANI DMD MD | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $646,192 | $45,303 | |
| CHENG LOR | |||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| J KEVIN CROSTON MD | |||||||
| BOARD MEMBER | 1.00 | 51.00 | Yes (X) | $0 | $965,781 | $46,407 | |
| KENT SPAULDING | |||||||
| VICE PRESIDENT | 50.00 | 0.00 | Yes (X) | Yes (X) | $0 | $232,388 | $34,852 |
| KAREN BIRD | |||||||
| BOARD MEMBER - PART YEAR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,214,354 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $146,654 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $401,605 | FundraisingAmt |
| All Other Contributions | $386,154 | AllOtherContributionsAmt |
| Noncash Contributions | $78,580 | NoncashContributionsAmt |
| Total Contributions | $787,759 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $145,775 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $145,775 | UnrelatedBusinessRevenueAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $390,113 | SecuritiesAmt |
| Other | $17,788 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $364,099 | SecuritiesAmt |
| Other | $221,724 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $26,014 | SecuritiesAmt |
| Other | -$203,936 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$177,922 | TotalRevenueColumnAmt |
| Exclusion | -$177,922 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $327,461 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $401,605 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $249,052 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $78,409 | TotalRevenueColumnAmt |
| Exclusion | $78,409 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $834,021 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $145,775 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$99,513 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $360,367 | TotalAmt |
| Program Services | $360,367 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,385 | TotalAmt |
| Program Services | $27,385 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,828 | TotalAmt |
| Program Services | $3,342 | ProgramServicesAmt |
| Management And General | $2,486 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,477 | TotalAmt |
| Program Services | $3,477 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS | Desc |
| Total | $30,990 | TotalAmt |
| Program Services | $30,990 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $428,047 | TotalAmt |
| Program Services | $425,561 | ProgramServicesAmt |
| Management And General | $2,486 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $348,205 | BOYAmt |
| EOY | $281,281 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,074 | BOYAmt |
| EOY | $58,545 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,619 | BOYAmt |
| EOY | $15,758 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $225,000 | BOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,145,525 | BOYAmt |
| EOY | $7,474,474 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $995,110 | BOYAmt |
| EOY | $1,075,697 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,789,533 | BOYAmt |
| EOY | $8,905,755 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $102,009 | BOYAmt |
| EOY | $19,623 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,403 | BOYAmt |
| EOY | $26,019 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,412 | BOYAmt |
| EOY | $45,642 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,874,630 | BOYAmt |
| EOY | $2,265,772 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,479,951 | BOYAmt |
| EOY | $4,199,485 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,301,540 | BOYAmt |
| EOY | $2,394,856 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,656,121 | BOYAmt |
| EOY | $8,860,113 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,789,533 | BOYAmt |
| EOY | $8,905,755 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $405,974 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $704,702 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $93,316 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,931,145 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,649,575 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,464,107 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,574,758 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $787,759 | CurrentTaxYearAmt |
| Total | $7,407,344 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,931,145 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,649,575 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,464,107 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $1,574,758 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $787,759 | CurrentTaxYearAmt |
| Total | $7,407,344 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $7,407,344 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $102,244 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $125,014 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $122,845 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $99,819 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $145,775 | CurrentTaxYearAmt |
| Total | $595,697 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $8,003,041 | TotalSupportAmt |
| Public Support CY170 | 0.92560 | PublicSupportCY170Pct |
| Public Support PY170 | 0.93950 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Donor Advised Funds Held | 3 | DonorAdvisedFundsHeldCnt |
| Donor Advised Funds Contri | $4,241 | DonorAdvisedFundsContriAmt |
| Donor Advised Funds Grants | $9,626 | DonorAdvisedFundsGrantsAmt |
| Donor Advised Funds Vl EOY | $26,019 | DonorAdvisedFundsVlEOYAmt |
| Disclosed Org Leg Ctrl | Yes (1) | DisclosedOrgLegCtrlInd |
| Disclosed For Charitable Prps | Yes (1) | DisclosedForCharitablePrpsInd |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,029,196 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $370,959 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $56,092 | OtherExpendituresAmt |
| End Year Balance | $3,344,063 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,203,143 | BeginningYearBalanceAmt |
| Contributions | $155,228 | ContributionsAmt |
| Investment Earnings Or Losses | $707,969 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $37,144 | OtherExpendituresAmt |
| End Year Balance | $3,029,196 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,591,423 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $17,322 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,405,602 | OtherExpendituresAmt |
| End Year Balance | $2,203,143 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,446,092 | BeginningYearBalanceAmt |
| Contributions | $76,703 | ContributionsAmt |
| Investment Earnings Or Losses | $118,858 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $50,230 | OtherExpendituresAmt |
| End Year Balance | $3,591,423 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $2,683,970 | BeginningYearBalanceAmt |
| Contributions | $710,628 | ContributionsAmt |
| Investment Earnings Or Losses | $85,294 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $33,800 | OtherExpendituresAmt |
| End Year Balance | $3,446,092 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.71620 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.28380 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (1) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | BENEFICIAL INTEREST IN REMAINDER TRUST | Desc |
| Book Value | $1,075,697 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,075,697 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | AMOUNTS HELD FOR OTHERS | Desc |
| Amt | $26,019 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $26,019 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2017 OR 2016. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | DINNER/DANCE GALA | Event1Nm |
| Gross Receipts Event1 | $579,396 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $300,095 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $279,301 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $47,522 | NonCashPrizesEvent1Amt |
| Food And Beverage Event1 | $66,242 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $47,428 | OtherDirectExpensesEvent1Amt |
| Event2 | GOLF FUNDRAISER | Event2Nm |
| Gross Receipts Event2 | $149,670 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $101,510 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $48,160 | GrossRevenueEvent2Amt |
| Food And Beverage Event2 | $34,596 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $53,264 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $729,066 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $401,605 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $327,461 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $47,522 | NonCashPrizesTotalEventsAmt |
| Food And Beverage Total Events | $100,838 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $100,692 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $249,052 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $78,409 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|---|---|---|---|---|---|---|
| NORTH MEMORIAL HEALTH CARE | ||||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 410729979 | 501(C)(3) | $13,025 | GRANTS IN CONNECTION WITH MEDICAL TRAINING PAID ON BEHALF OF NORTH MEMORIAL. | |||
| NORTH MEMORIAL HEALTH CARE | ||||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 410729979 | 501(C)(3) | $287,853 | TO SUPPORT NMHC PROGRAMS AND SERVICES | $59,489 | BOOK VALUE | FURNITURE |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| EMPLOYEE ASSISTANCE | 24 | $17,185 |
| JUNIOR VOLUNTEER SCHOLARSHIPS | 3 | $6,000 |
| HOPE CHEST BREAST CENTER | 4 | $4,200 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PAMELA DOORENBOS MD | ||||||||||||||
| BOARD MEMBER | $0 | $299,757 | $0 | $59,575 | $0 | $661 | $0 | $10,911 | $0 | $9,181 | $0 | $380,085 | $0 | $0 |
| DEEPAK KADEMANI DMD MD | ||||||||||||||
| BOARD MEMBER | $0 | $484,580 | $0 | $157,942 | $0 | $3,670 | $0 | $18,900 | $0 | $26,403 | $0 | $691,495 | $0 | $0 |
| J KEVIN CROSTON MD | ||||||||||||||
| BOARD MEMBER | $0 | $765,410 | $0 | $191,639 | $0 | $8,732 | $0 | $18,900 | $0 | $27,507 | $0 | $1,012,188 | $0 | $0 |
| KENT SPAULDING | ||||||||||||||
| VICE PRESIDENT | $0 | $200,000 | $0 | $30,000 | $0 | $2,388 | $0 | $14,000 | $0 | $20,852 | $0 | $267,240 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | SUPPLIES, AUCTIONS ITEMS, MISC | Desc |
| Contribution | 126 | ContributionCnt |
| Noncash Contributions Rpt F990 | $78,580 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | Yes (1) | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, COLUMN (B): | FormAndLineReferenceDesc |
| Explanation | CONTAINS THE NUMBER OF ITEMS CONTRIBUTED. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 12 | NORTH MEMORIAL FOUNDATION DOES NOT HAVE A CONFLICT OF INTEREST POLICY THAT COVERS CERTAIN EMPLOYEES, PHYSICIANS AND BOARD MEMBERS. THE BOARD OF DIRECTORS WILL SIGN A CONFLICT OF INTEREST POLICY IN 2018 AND GOING FORWARD. |
| 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 93,316. |
| FORM 990, PART XII, LINE 2C: | NEITHER THE OVERSIGHT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT CHANGED DURING THE TAX YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 501(C)(3) | 11A | NORTH MEMORIAL | 0 | BD | |
| MAPLE GROVE HOSPITAL CORPORATION | |||||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 208316475 | ACUTE CARE | MN | 501(C)(3) | LINE 3 | NORTH MEMORIAL | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| 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 |
| BLAINE URGENCY CENTER LLC | |||||||
| 480 OSBORNE RD | FRIDLEY | MN | 55432 | 461630126 | URGENT CARE | MN | N/A |
| PLYMOUTH CITY CENTER MEDICAL BUIDING | |||||||
| 5700 SMETANA DRIVE SUITE 120 | MINNETONKA | MN | 55343 | 463883617 | MEDICAL OFFICE BUILDING | MN | N/A |
| MINNETONKA AMBULATORY SURGERY CENTER | |||||||
| 3300 OAKDALE AVENUE NORTH | ROBBINSDALE | MN | 55422 | 465653486 | OUTPATIENT SURGERY | MN | N/A |
| CRYSTAL IMAGING CENTER LLC | |||||||
| 2955 XENIUM LANE SUITE 40 | PLYMOUTH | MN | 55441 | 454265124 | RADIOLOGY | MN | N/A |
| MULTICARE SLEEP CENTER LLC | |||||||
| 10600 OLD COUNTY ROAD 15 | PLYMOUTH | MN | 55441 | 274833673 | OUTPATIENT SLEEP CENTER | MN | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH MEMORIAL HEALTH CARE (CONTRIBUTIONS TO NMHC) | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | B | TransactionTypeTxt |
| Involved | $360,367 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |
Comments