STILLWATER MEDICAL GROUP: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- STILLWATER MEDICAL GROUP (EIN 83-0379473)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-14
- IRS object ID
- 201703189349309450
- Schema version
- 2016v3.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-14T15:38:00-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135665207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4200 WELLS FARGO CTR 90 S 7TH | AddressLine1Txt |
| Address Line2 | STREET | AddressLine2Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 830379473 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | STILLWATER MEDICAL GROUP | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STIL | BusinessNameControlTxt |
| Phone | 9528836584 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8170 33RD AVENUE SOUTH PO BOX 1309 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554401309 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DOUGLAS E JOHNSON | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9528836584 | PhoneNum |
| Signature | 2017-11-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MONROE JORDAN GIERL | PreparerPersonNm |
| PTIN | P01413237 | PTIN |
| Phone | 6123055000 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 198.174.110.146 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-14 | IPDt |
| IP Tm | 15:37:41 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 1A39D2BAC3E977A191A219CBBAAA8778AA2E0A5D | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 282CC43464B9830A349574F670F0BA37F913502D | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DOUGLAS E JOHNSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 8170 33RD AVENUE SOUTH PO BOX 1309 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554401309 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $1,180,049 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.STILLWATERMEDICALGROUP.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2003 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO MEET THE HEALTHCARE NEEDS OF INDIVIDUALS, FAMILIES & COMMUNITIES OF THE ST. CROIX VALLEY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 541 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $800,000 | PYContributionsGrantsAmt |
| CY Contributions Grants | $216,781 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $52,135,299 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $873,746 | CYProgramServiceRevenueAmt |
| PY Investment Income | $552 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,009 | CYInvestmentIncomeAmt |
| PY Other Revenue | $355,611 | PYOtherRevenueAmt |
| CY Other Revenue | $8,565 | CYOtherRevenueAmt |
| PY Total Revenue | $53,291,462 | PYTotalRevenueAmt |
| CY Total Revenue | $1,100,101 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $100 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $45,809,755 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,677,295 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $15,088,920 | PYOtherExpensesAmt |
| CY Other Expenses | $3,012,457 | CYOtherExpensesAmt |
| PY Total Expenses | $60,898,675 | PYTotalExpensesAmt |
| CY Total Expenses | $7,689,852 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$7,607,213 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$6,589,751 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $25,151,263 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,009,852 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,007,676 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,238,979 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $19,143,587 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $17,770,873 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO MEET THE HEALTHCARE NEEDS OF INDIVIDUALS, FAMILIES & COMMUNITIES OF THE ST. CROIX VALLEY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $6,352,626 | ExpenseAmt |
| Grant | $100 | GrantAmt |
| Revenue | $873,746 | RevenueAmt |
| Desc | SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS | Desc |
| Total Program Service Expenses | $6,352,626 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | 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 | 0 | 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 | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 541 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| 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 | 0 | QuidProQuoContributionsInd |
| 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 | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | 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 | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOUGLAS JOHNSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6514304581 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 927 CHURCHILL STREET WEST | AddressLine1Txt |
| City | STILLWATER | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55082 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (33 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| BRUCE BARTIE DO | |||||||||
| DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| ARBA-DELLA BECK | |||||||||
| DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| REBECCA BILLINGSLEY | |||||||||
| DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| ELIZABETH BRADSHAW | |||||||||
| SECRETARY & DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| DWIGHT CUMMINS | |||||||||
| DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| PHIL DONALDSON | |||||||||
| CHAIR & DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| ANDREW ROLLWAGEN | |||||||||
| DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| DAVID REAMER | |||||||||
| DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| JIM SCHUG | |||||||||
| VICE CHAIR & DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| JOHN UPPGREN | |||||||||
| DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| NICK MEYER MD | |||||||||
| DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| DENISE PONTRELLI | |||||||||
| DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| JULIE SCHMIDT | |||||||||
| DIRECTOR | 0.58 | Yes (X) | $0 | $0 | $0 | ||||
| KEVIN BJORK MD | |||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $527,927 | $51,278 | 49.50 | |||
| SCOTT A AEBISCHER | |||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $650,767 | $150,356 | 49.50 | |||
| CHARLES BRANSFORD | |||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $156,739 | $34,241 | 39.50 | |||
| KATHLEEN M COONEY | |||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $931,838 | $294,094 | 49.50 | |||
| ANDREW E DORWART MD | |||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $466,374 | $50,511 | 54.50 | |||
| JOHN MISA MD | |||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $557,263 | $97,212 | 49.50 | |||
| MARTHA SANFORD MD | |||||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $202,538 | $41,406 | 54.50 | |||
| DOUGLAS E JOHNSON | |||||||||
| CFO | 4.00 | Yes (X) | $0 | $372,676 | $76,277 | 51.00 | Yes (X) | ||
| TED WEGLEITNER | |||||||||
| DIRECTOR & CEO | 1.00 | Yes (X) | $0 | $521,283 | $106,696 | 54.00 | Yes (X) | ||
| PAUL L ERICKSON | |||||||||
| DIRECTOR OF DEVELOPMENT | 0.50 | $0 | $124,489 | $50,112 | 54.50 | Yes (X) | |||
| ROBBI A HAGELBERG | |||||||||
| VP OF OPERATIONS & CNO | 0.50 | $0 | $203,524 | $24,205 | 39.50 | Yes (X) | |||
| MATTHEW RICHIE | |||||||||
| ADMINISTRATOR | 0.50 | $0 | $300,309 | $37,233 | 46.50 | Yes (X) | |||
| NATE PULSCHER | |||||||||
| VP ANCILLARY SERVICES | 0.50 | $0 | $108,072 | $20,057 | 49.50 | Yes (X) | |||
| PATRICK DRESCICH | |||||||||
| DIRECTOR OF HUMAN RESOURCES | 40.00 | $135,794 | $0 | $27,909 | 0.00 | Yes (X) | |||
| SONYA STEINER | |||||||||
| DIRECTOR OF OPERATIONS | 45.00 | $139,260 | $0 | $14,606 | 0.00 | Yes (X) | |||
| MATTHEW TROM | |||||||||
| PHYSICIAN ASSISTANT - UC | 40.00 | $107,525 | $0 | $25,024 | 0.00 | Yes (X) | |||
| LAURA MORRISON | |||||||||
| AUDIOLOGIST | 50.00 | $105,358 | $0 | $24,482 | 0.00 | Yes (X) | |||
| SUSAN SMITH | |||||||||
| NURSE PRACTITIONER - PEDS | 40.00 | $105,587 | $0 | $20,028 | 0.00 | Yes (X) | |||
| JO E SITTLOW | |||||||||
| FORMER VP ANCILLARY SERVICES | 0.50 | $0 | $117,970 | $28,142 | 39.50 | Yes (X) | |||
| JEFFREY J ROBERTSON | |||||||||
| FORMER DIRECTOR & CEO | 0.50 | $0 | $574,771 | $28,812 | 39.50 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $593,524 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $5,816,540 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,202,681 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 12 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ST PAUL RADIOLOGY | |||||
| 166 4TH ST E | ST PAUL | MN | 551011421 | RADIOLOGY PROFESSIONAL SERVICES | $351,497 |
| I S S FACILITY SERVICES | |||||
| 4222 PARK GLEN RD | ST LOUIS PARK | MN | 55416 | FACILITY MAINTENANCE | $295,424 |
| 592 INVESTMENTS LLC | |||||
| 129 HEDIN AVE | RED WING | MN | 55066 | FACILITY RENT | $159,937 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $216,781 | GovernmentGrantsAmt |
| Total Contributions | $216,781 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT REVENUES | 621400 | $842,226 | $842,226 |
| PHYSICIAN COVERAGE | 624410 | $31,520 | $31,520 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $873,746 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,009 | TotalRevenueColumnAmt |
| Exclusion | $1,009 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $72,288 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $79,948 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$7,660 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$7,660 | TotalRevenueColumnAmt |
| Exclusion | -$7,660 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $16,225 | TotalRevenueColumnAmt |
| Exclusion | $16,225 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $16,225 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,100,101 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $873,746 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $9,574 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100 | TotalAmt |
| Program Services | $100 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,741,290 | TotalAmt |
| Program Services | $3,203,856 | ProgramServicesAmt |
| Management And General | $537,434 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,236 | TotalAmt |
| Program Services | $102,089 | ProgramServicesAmt |
| Management And General | $4,147 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $612,250 | TotalAmt |
| Program Services | $588,351 | ProgramServicesAmt |
| Management And General | $23,899 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $217,519 | TotalAmt |
| Program Services | $209,028 | ProgramServicesAmt |
| Management And General | $8,491 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $139,329 | TotalAmt |
| Program Services | $129,994 | ProgramServicesAmt |
| Management And General | $9,335 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,109 | TotalAmt |
| Program Services | $1,647 | ProgramServicesAmt |
| Management And General | $3,462 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $181,118 | TotalAmt |
| Program Services | $116,103 | ProgramServicesAmt |
| Management And General | $65,015 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,285 | TotalAmt |
| Program Services | $58,771 | ProgramServicesAmt |
| Management And General | $514 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,277 | TotalAmt |
| Program Services | $225,947 | ProgramServicesAmt |
| Management And General | $30,330 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,716 | TotalAmt |
| Program Services | $2,504 | ProgramServicesAmt |
| Management And General | $4,212 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,728 | TotalAmt |
| Program Services | $1,182 | ProgramServicesAmt |
| Management And General | $3,546 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $599,337 | TotalAmt |
| Program Services | $521,521 | ProgramServicesAmt |
| Management And General | $77,816 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,835 | TotalAmt |
| Program Services | $4,348 | ProgramServicesAmt |
| Management And General | $487 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES - MEDICAL | $1,081,530 | $1,074,915 | $6,615 |
| OTHER EXPENSE | $293,834 | $1,729 | $292,105 |
| MAINTENANCE & REPAIR | $287,924 | $53,071 | $234,853 |
| NON-CAPITAL EQUIPMENT | $32,154 | $29,989 | $2,165 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $60,281 | TotalAmt |
| Program Services | $27,481 | ProgramServicesAmt |
| Management And General | $32,800 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,689,852 | TotalAmt |
| Program Services | $6,352,626 | ProgramServicesAmt |
| Management And General | $1,337,226 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,485,888 | BOYAmt |
| EOY | $1,145,795 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,751,618 | BOYAmt |
| EOY | $912,543 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $646,046 | BOYAmt |
| EOY | $653,162 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $146,959 | BOYAmt |
| EOY | $171,268 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $32,133,263 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,006,179 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,120,752 | BOYAmt |
| EOY | $17,127,084 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,151,263 | BOYAmt |
| EOY | $20,009,852 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,007,676 | BOYAmt |
| EOY | $2,238,979 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,007,676 | BOYAmt |
| EOY | $2,238,979 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,143,587 | BOYAmt |
| EOY | $17,770,873 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,143,587 | BOYAmt |
| EOY | $17,770,873 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,151,263 | BOYAmt |
| EOY | $20,009,852 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$6,589,751 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $5,217,037 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 2 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp (2 entries)
| EINEIN | Organization TypeOrganizationTypeCd | Governing Document ListedGoverningDocumentListedInd | SupportSupportAmt | Other SupportOtherSupportAmt |
|---|---|---|---|---|
| LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC | ||||
| 411386635 | 3 | Yes (1) | $0 | $0 |
| GROUP HEALTH PLAN INC | ||||
| 410797853 | 3 | Yes (1) | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 2 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
| Public Support PY509 | 0.99330 | PublicSupportPY509Pct |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE LLG, COLUMNS (V) &(VI) - AMOUNT OF SUPPORT | FormAndLineReferenceDesc |
| Explanation | NO DIRECT MONETARY SUPPORT IS INDICATED FROM STILLWATER MEDICAL GROUP TO ITS SUPPORTED ORGANIZATIONS: HOWEVER, STILLWATER MEDICAL GROUP PROVIDES CORPORATE PLANNING AND OVERSIGHT, WHICH IS DESCRIBED IN SCHEDULE O. | ExplanationTxt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Total Lobbying Expenditures | $0 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | STILLWATER MEDICAL GROUP PAYS FOR CERTAIN CORPORATE AND EMPLOYEE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $571,589 | OtherCostOrOtherBasisAmt |
| Book Value | $571,589 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $24,252,845 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,412,895 | DepreciationAmt |
| Book Value | $14,839,950 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $72,269 | OtherCostOrOtherBasisAmt |
| Depreciation | $31,717 | DepreciationAmt |
| Book Value | $40,552 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,236,560 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,561,567 | DepreciationAmt |
| Book Value | $1,674,993 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $17,127,084 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | STILLWATER MEDICAL GROUP 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, 2016 OR 2015 FOR UNRECOGNIZED TAX BENEFITS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 | Yes (1) | 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 (16 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| KEVIN BJORK MD | ||||||||||||||
| DIRECTOR | $0 | $407,920 | $0 | $0 | $0 | $120,007 | $0 | $19,875 | $0 | $31,403 | $0 | $579,205 | $0 | $0 |
| SCOTT A AEBISCHER | ||||||||||||||
| DIRECTOR | $0 | $363,892 | $0 | $104,987 | $0 | $181,888 | $0 | $117,052 | $0 | $33,304 | $0 | $801,123 | $0 | $172,257 |
| CHARLES BRANSFORD | ||||||||||||||
| DIRECTOR | $0 | $110,200 | $0 | $0 | $0 | $46,539 | $0 | $9,213 | $0 | $25,028 | $0 | $190,980 | $0 | $0 |
| KATHLEEN M COONEY | ||||||||||||||
| DIRECTOR | $0 | $608,106 | $0 | $234,671 | $0 | $89,061 | $0 | $256,047 | $0 | $38,047 | $0 | $1,225,932 | $0 | $53,743 |
| ANDREW E DORWART MD | ||||||||||||||
| DIRECTOR | $0 | $369,407 | $0 | $68,769 | $0 | $28,198 | $0 | $19,875 | $0 | $30,636 | $0 | $516,885 | $0 | $0 |
| JOHN MISA MD | ||||||||||||||
| DIRECTOR | $0 | $434,975 | $0 | $103,547 | $0 | $18,741 | $0 | $71,637 | $0 | $25,575 | $0 | $654,475 | $0 | $47,843 |
| MARTHA SANFORD MD | ||||||||||||||
| DIRECTOR | $0 | $152,292 | $0 | $5,083 | $0 | $45,163 | $0 | $15,256 | $0 | $26,150 | $0 | $243,944 | $0 | $0 |
| DOUGLAS E JOHNSON | ||||||||||||||
| CFO | $0 | $272,057 | $0 | $74,284 | $0 | $26,335 | $0 | $42,843 | $0 | $33,434 | $0 | $448,953 | $0 | $0 |
| TED WEGLEITNER | ||||||||||||||
| DIRECTOR & CEO | $0 | $380,178 | $0 | $130,432 | $0 | $10,673 | $0 | $74,602 | $0 | $32,094 | $0 | $627,979 | $0 | $6,196 |
| PAUL L ERICKSON | ||||||||||||||
| DIRECTOR OF DEVELOPMENT | $0 | $115,067 | $0 | $7,908 | $0 | $1,514 | $0 | $20,750 | $0 | $29,362 | $0 | $174,601 | $0 | $0 |
| ROBBI A HAGELBERG | ||||||||||||||
| VP OF OPERATIONS & CNO | $0 | $189,278 | $0 | $14,227 | $0 | $19 | $0 | $6,299 | $0 | $17,906 | $0 | $227,729 | $0 | $0 |
| MATTHEW RICHIE | ||||||||||||||
| ADMINISTRATOR | $0 | $224,684 | $0 | $71,543 | $0 | $4,082 | $0 | $14,575 | $0 | $22,658 | $0 | $337,542 | $0 | $0 |
| PATRICK DRESCICH | ||||||||||||||
| DIRECTOR OF HUMAN RESOURCES | $122,853 | $0 | $12,941 | $0 | $0 | $0 | $7,924 | $0 | $19,985 | $0 | $163,703 | $0 | $0 | $0 |
| SONYA STEINER | ||||||||||||||
| DIRECTOR OF OPERATIONS | $127,758 | $0 | $11,502 | $0 | $0 | $0 | $4,852 | $0 | $9,754 | $0 | $153,866 | $0 | $0 | $0 |
| JO E SITTLOW | ||||||||||||||
| FORMER VP ANCILLARY SERVICES | $0 | $69,649 | $0 | $34,346 | $0 | $13,975 | $0 | $12,353 | $0 | $15,789 | $0 | $146,112 | $0 | $0 |
| JEFFREY J ROBERTSON | ||||||||||||||
| FORMER DIRECTOR & CEO | $0 | $0 | $0 | $137,136 | $0 | $437,635 | $0 | $28,812 | $0 | $0 | $0 | $603,583 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINES 4A-B | SCHEDULE J, PART I, LINE 4A THE AMOUNT OF SEVERANCE COMPENSATION PROVIDED TO EACH OF THE INDIVIDUALS ON SEVERANCE DURING 2016 IS AS FOLLOWS: JEFFERY ROBERTSON $437,635 SCHEDULE J, PART I, LINE 4B DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTORS: SCOTT A. AEBISCHER $13,871 KATHLEEN M. COONEY $58,834 JOHN MISA, MD $46,794 TED WEGLEITNER $36,015 |
| PART I, LINE 6 | STILLWATER MEDICAL GROUP'S (SMG) OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE EMPLOYED BY SMG, LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC. (THE HOSPITAL) OR BY GROUP HEALTH PLAN, INC. (GHI). THE HOSPITAL AND GHI ARE BOTH RELATED ORGANIZATIONS. COMPENSATION REPORTED IN FORM 990, PART VIII INCLUDES ANY COMPENSATION DERIVED FROM EITHER SMG'S, THE HOSPITAL'S, OR GHI'S MANAGEMENT INCENTIVE PROGRAMS, WHICH INCENT AND REWARD BUSINESS LEADERS WHO HELP THE ORGANIZATION ACHIEVE STATED BUSINESS AND/OR HEALTH IMPROVEMENT GOALS FOR A SPECIFIC FISCAL YEAR. THE PROGRAMS ARE A KEY ELEMENT OF THE PARTICIPANT'S TOTAL COMPENSATION PACKAGE. THE MANAGEMENT INCENTIVE PROGRAMS' REWARDS ARE BASED ON POSITION IN THE ORGANIZATION (E.G. SENIOR VICE PRESIDENT, VICE PRESIDENT, DIRECTOR, MANAGER, AND OTHER SPECIFICALLY IDENTIFIED LEADERS) AND THE ACHIEVEMENT OF BUSINESS AND HEALTH IMPROVEMENT GOALS ESTABLISHED IN A VARIETY OF AREAS. GOALS WILL BE RELATED TO THE ORGANIZATION'S STRATEGIC PLAN AND WILL BE BALANCED. THESE AREAS MAY INCLUDE BUT ARE NOT LIMITED TO PATIENT SATISFACTION, EMPLOYEE SATISFACTION, WORK ENVIRONMENT, EMPLOYEE AND/OR LEADERSHIP DEVELOPMENT, CARE DELIVERY, PATIENT EDUCATION, SIX AIMS, MARKET SHARE, STRATEGIC CAPABILITIES, FINANCIAL PERFORMANCE (NET MARGIN), ETC., AND WILL BE DEFINED ANNUALLY FOR EACH YEAR'S PROGRAM. A NET MARGIN THRESHOLD MUST BE MET FOR ANY PAYMENT TO BE MADE FROM THE PROGRAM AND THERE IS A CAP ON THE MAXIMUM INCENTIVE POTENTIALLY AVAILABLE TO EACH PARTICIPANT. |
| 990, SCHEDULE J, PART II: PRIOR REPORTED COMPENSATION | COLUMN (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 DIRECTOR: SCOTT A. AEBISCHER $ 172,257 KATHLEEN M. COONEY $ 53,473 JOHN MISA, MD $ 47,843 THEODORE WEGLEITNER $ 6,196 ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, FOR THIS PARTICIPANT 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 (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 990, PART III, LINE 4A: EXEMPT PURPOSE AND ACHIEVEMENTS | STILLWATER MEDICAL GROUP (SMG) IS A MINNESOTA 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 AND WESTERN WISCONSIN. 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 PLAN'S SERVE MORE THAN 1.6 MILLION MEDICAL AND DENTAL MEMBERS NATIONWIDE. HEALTHPARTNERS MEDICAL CARE SYSTEM INCLUDES MORE THAN 1,700 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 24 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 AND WESTERN WISCONSIN. 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 2016 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 (SHS), 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). SHS IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION (HOSPITAL). THE HOSPITAL AND SHS ARE PART OF THE LAKEVIEW HEALTH SYSTEM ALONG WITH THE LAKEVIEW MEMORIAL HOSPITAL FOUNDATION, A MINNESOTA 501(C) (3) TAX EXEMPT ORGANIZATION (THE FOUNDATION) AND SMG. CHARITY CARE: TOTAL CHARITY CARE PROVIDED (CALCULATED AT COST) WAS $84,758 DURING THIS REPORTING PERIOD. CHARITY CARE IS DEFINED AS THE COST OF CARE DELIVERED TO PATIENTS WHO ARE WILLING, BUT UNABLE TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY, PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER, AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES OR SPECIAL FINANCIAL HARDSHIP WARRANT SPECIAL CONSIDERATION. BENEFIT TO THE COMMUNITY: SMG CONTINUES TO WORK IN PARTNERSHIP WITH OTHER HEALTHPARTNERS ORGANIZATIONS AND THE COMMUNITY TO PROMOTE COMMUNITY HEALTH THROUGH CLINICAL INITIATIVES, EDUCATION AND OUTREACH, AND COMMUNITY HEALTH IMPROVEMENT EFFORTS SUCH AS THE POWERUP INITIATIVE. SMG CONTINUES TO BE AN INTEGRAL PART OF THE STILLWATER COMMUNITY AND SURROUNDING AREA. SMG OFFERS PRIMARY AND SPECIALTY SERVICES WITH MEDICAL CLINICS LOCATED IN STILLWATER AND MAHTOMEDI, MN AND SOMERSET, WI. IN ADDITION, SMG PROVIDES OUTREACH SPECIALTY SERVICES TOO WHITE BEAR LAKE, MN AND HUDSON, NEW RICHMOND, AMERY AND OSCEOLA, WI. SMG OFFERS URGENT CARE, FAMILY MEDICINE, EMERGENCY MEDICINE, HOSPITALISTS, INTERNAL MEDICINE, NEUROLOGY, PEDIATRICS AND ADOLESCENT MEDICINE, OB/GYN, GENERAL SURGERY, PODIATRY, ENT, AUDIOLOGY, GASTROENTEROLOGY, PULMONOLOGY, RHEUMATOLOGY, OCCUPATIONAL HEALTH, BEHAVIORAL HEALTH, SPORTS MEDICINE, ENDOCRINOLOGY, UROLOGY, ONCOLOGY AND CARDIOLOGY MEDICAL SERVICES. IN ADDITION TO PROFESSIONAL SERVICES, SMG ALSO OFFERS LABORATORY, IMAGING, HEARING AIDS, RETAIL PHARMACY AND PHYSICAL THERAPY ANCILLARY SERVICES. COMMUNITY HEALTH SERVICES: SMG HOSTS AND SPONSORS THE FOLLOWING COMMUNITY EVENTS: - COMMUNITY VEGGIE GIVEAWAY - FRESH VEGETABLES GROWN BY LOCAL PRODUCERS ARE GIVEN TO COMMUNITY MEMBERS AT ALL CLINIC CAMPUSES. APPROXIMATE COSTS FOR VEGETABLES GIVEN AWAY: - 2011 - $2,800 - 2012 - $2,900 - 2013 - $5,337 - 2014 - $6,017 - 2015 - $2,635 - 2016 - $7,539 - NOTE: LEFTOVER PRODUCE FROM GIVEAWAYS GOES TO LOCAL COMMUNITY FOOD SHELVES - HOPS FOR HEALTH - ANNUAL MEN'S HEALTH BENEFIT TO COMMUNITY MEMBERS, INCLUDING FREE BLOOD PRESSURE AND BLOOD SUGAR CHECKS, AND THE OPPORTUNITY TO TALK WITH PROVIDERS ABOUT MEN'S HEALTH ISSUES. - PARTICIPATION IN POWERUP CANDY TRADE-IN - COMMUNITY MEMBERS CAN TRADE IN THEIR HALLOWEEN CANDY FOR HEALTHY, NON-CANDY PRIZES. CANDY IS THEN SENT TO MEMBERS OF THE MILITARY. - PARTICIPATION IN AMERICAN RED CROSS BLOOD DRIVES (TWO TIMES PER YEAR) - HOSTED AT THE MAIN CAMPUS FOR STAFF AND COMMUNITY DONATIONS. - LADIES NIGHT OUT - ANNUAL WOMEN'S HEALTH BENEFIT TO COMMUNITY MEMBERS, INCLUDING FREE BLOOD PRESSURE AND BLOOD SUGAR CHECKS, SCHEDULING OF MAMMOGRAMS, AND THE OPPORTUNITY TO TALK WITH PROVIDERS ABOUT WOMEN'S HEALTH ISSUES. - PARTNERSHIP WITH POWERUP FOR CHILDREN ACTIVITIES AND HEALTHY FOOD CHOICES. - PRESCRIPTION ASSISTANCE PROGRAM - HOUSED ON THE MAIN CAMPUS. - FREE COMMUNITY CLASSES HEALTH PROFESSIONAL EDUCATION: SMG OFFERS A TUITION REIMBURSEMENT PLAN TO ITS' CLINICAL AND NON-CLINICAL EMPLOYEES. TOTAL AMOUNT REIMBURSED TO EMPLOYEES IN 2016 WAS $34,691. SMG SUPPORTS HIGHER EDUCATION AND THE PROGRAM OFFERS EMPLOYEES TO FURTHER GROW THEIR KNOWLEDGE BASE AND WORK TOWARDS AN ADVANCED PROFESSIONAL DEGREE. COMMUNITY BENEFIT OPERATIONS: SMG IS NOT REQUIRED TO COMPLETE A COMMUNITY NEEDS ASSESSMENT. ORGANIZATION AWARDS AND ACHIEVEMENTS: RECOGNIZED BY HEALTHPARTNERS WITH PARTNERS IN EXCELLENCE GOLD PERFORMANCE AWARD IN ATTRIBUTED TOTAL COST OF CARE (2014) RECOGNIZED BY HEALTHPARTNERS WITH PARTNERS IN EXCELLENCE GOLD PERFORMANCE AWARD IN OPTIMAL DIABETES CARE (2014) RECOGNIZED BY HEALTHPARTNERS WITH PARTNERS IN EXCELLENCE GOLD PERFORMANCE AWARD IN OPTIMAL VASCULAR CARE (PRIMARY CARE) (2014) TWO PHYSICIANS RECOGNIZED IN MPLS ST. PAUL MAGAZINE AS "TOP DOCTORS" 2015 ONE PHYSICIAN RECOGNIZED IN MPLS ST. PAUL MAGAZINE AS "BEST DOCTOR" 2015 RECOGNIZED BY THE MINNESOTA HEALTH ACTION GROUP WITH A MINNESOTA BRIDGES TO EXCELLENCE AWARD, FOR DELIVERING OPTIMAL CARE AND IMPROVING SPECIFIC PATIENT OUTCOMES (2014). RECOGNIZED BY HEALTHPARTNERS PARTNERS IN EXCELLENCE WITH A GOLD PERFORMANCE AWARD IN ATTRIBUTED TOTAL COST OF CARE AND MNCM PEDIATRIC IMMUNIZATIONS (2013). RECOGNIZED BY HEALTHPARTNERS PARTNERS IN EXCELLENCE WITH A SILVER PERFORMANCE AWARD IN OPTIMAL DEPRESSION CARE (2013). RECOGNIZED BY HEALTHPARTNERS PARTNERS IN EXCELLENCE WITH A SILVER PERFORMANCE AWARD IN OPTIMAL LIFESTYLES (2013). RECOGNIZED FOR PROVIDING TOP-QUALITY HEALTH CARE TO UCARE'S MEDICAID AND MINNESOTA SENIOR HEALTH OPTIONS (MSHO) MEMBERS (2013). |
| FORM 990, PART III, LINE 4A | RECIPIENT OF A PARTNERS IN EXCELLENCE TOTAL COST OF CARE GOLD PERFORMANCE AWARD FROM HEALTHPARTNERS (2012). RECIPIENT OF AN EXCELLENCE IN HEALTH CARE AWARD FROM UCARE FOR OUTSTANDING QUALITY RESULTS (2011). THIRTEEN PROVIDERS WERE NAMED 'BEST DOCTORS FOR WOMEN' IN MINNESOTA MONTHLY (OCT 2011) RECIPIENT OF INNOVATIONS IN HEALTH CARE WARD FOR REDUCING RISK IN VENOUS THROMBOEMBOLISM USING A TEAM APPROACH FROM HEALTHPARTNERS (2011) RECOGNIZED BY CONSUMER REPORTS "GUIDE TO MINNESOTA PHYSICIAN'S" FOR HIGH QUALITY OF CARE (PRIMARY CARE) 2016 TWO PHYSICIANS RECOGNIZED IN MPLS ST PAUL MAGAZINE AS "TOP DOCTORS RISING STAR'S " LIST 2016 |
| FORM 990, PART VI, SECTION A, LINE 4 | EFFECTIVE 1/2/2016 THE SMG ARTICLES OF INCORPORATION AND BYLAWS WERE RESTATED TO CONVERT THEIR TAX STATUS FROM A 509(A)(2) TO A 509(A)(3) AND IS A SUPPORTING ORGANIZATION TO STILLWATER HEALTH SYSTEM, LAKEVIEW HOSPITAL AND GROUP HEALTH PLAN, INC (HEALTH PARTNERS MEDICAL GROUP). THE COMPOSITION OF THE BOARD OF DIRECTORS HAS CHANGED TO BE THE SAME AS STILLWATER HEALTH SYSTEM BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER IS STILLWATER HEALTH SYSTEM. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBER HAS THE POWER TO RATIFY APPROVE AND REMOVE ALL MEMBERS OF THE BOARD OF DIRECTORS, WITH OR WITHOUT CAUSE. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBER HAS RESERVED TO ITSELF THE FOLLOWING POWERS CONCERNING THE GOVERNANCE OF THE CORPORATION: 1. RATIFICATION, APPROVAL AND REMOVAL ALL MEMBERS OF THE BOARD OF DIRECTORS, WITH OR WITHOUT CAUSE. 2. APPROVAL OF ANY MISSION OR VISION STATEMENT OR STATEMENT OF CORPORATE PURPOSE ADOPTED BY THE ORGANIZATION. 3. APPROVAL OF THE ORGANIZATION'S STRATEGIC PLANS, CAPITAL BUDGETS, OPERATING BUDGETS AND FINANCIAL POLICIES. 4. APPROVAL OF ANY PLANS OF MERGER OR CONSOLIDATION BY THE ORGANIZATION WITH ANY FOREIGN OR DOMESTIC ORGANIZATION VOLUNTARY DISSOLUTION OF THE ORGANIZATION, OR SALE, LEASE OR TRANSFER OF THE ORGANIZATION'S REAL ESTATE OR A SIGNIFICANT PORTION OF THE OPERATIONS OR ASSETS OF THE ORGANIZATION. 5. APPROVAL OF THE GRANT OF A SECURITY INTEREST IN ALL OR SUBSTANTIALLY ALL OF THE ORGANIZATION'S ASSETS, OR THE INCURRENCE OF INDEBTEDNESS OR THE GUARANTEE OF ANY INDEBTEDNESS. 6. APPROVAL OF INDIVIDUAL CAPITAL EXPENDITURES BY THE ORGANIZATION, WHETHER BUDGETED OR UNBUDGETED, IN EXCESS OF $500,000. 7. RATIFICATION OF SELECTION AND EVALUATION, AND TERMINATION, OF THE PRESIDENT OF THE ORGANIZATION. 8. APPROVAL OF PHYSICIAN, EMPLOYEE AND EXECUTIVE COMPENSATION PLANS FOR THE ORGANIZATION, INCLUDING CRITERIA FOR INCENTIVE COMPENSATION ARRANGEMENTS. 9. APPROVAL OF ALL SUBSTANTIVE AFFILIATIONS BETWEEN THE ORGANIZATION AND A THIRD PARTY. 10. APPROVAL OF CONFLICTS OF INTEREST POLICIES FOR THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | SMG'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF SMG. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF SMG, GHI'S INTERNAL LEGAL DEPARTMENT AND SMG'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 SMG. SMG MAKES AVAILABLE TO THE GOVERNING BODY (BOARD OF DIRECTORS) A COPY OF THE 990 FOR REVIEW AND COMMENT PRIOR TO THE FILING OF THE 990 RETURN. SMG MAKES AVAILABLE TO THE GOVERNING BODY (BOARD OF DIRECTORS) A COPY OF THE 990 FOR REVIEW AND COMMENT PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY IS PROVIDED T THE FULL BOARD OF DIRECTORS IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT THE MEETING. THIS PROCESS IS DOCUMENTED IN THE WRITTEN MEETING MINUTES. |
| FORM 990, PART VI, SECTION B, LINE 12C | SMG'S BOARD MONITORS POTENTIAL CONFLICTS OF INTEREST ON THE PART OF BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES BY MAINTAINING A CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ALL BOARD MEMBERS AND OFFICERS ANNUALLY ARE PROVIDED WITH A COPY OF THE POLICY AND REQUIRED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTEREST. THE GENERAL COUNSEL REVIEWS THE COMPLETED QUESTIONNAIRES AND PROVIDES A REPORT TO THE GOVERNANCE COMMITTEE OF THE BOARD. A WRITTEN REPORT IS PROVIDED TO THE GOVERNANCE COMMITTEE, CHAIR AND CHIEF EXECUTIVE OFFICER (CEO). BOARD AGENDAS AND EXECUTIVE DECISIONS ARE DOCUMENTED IN RELATION TO THIS POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE STILLWATER MEDICAL GROUP (SMG) PRESIDENT AND OTHER OFFICERS ARE EMPLOYED BY SHS, A RELATED ORGANIZATION, OR BY SMG. SHS AND SMG HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF THE SMG'S PRESIDENT AND OTHER OFFICERS. EVERY THREE YEARS, THE INDEPENDENT COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF GROUP HEALTH PLAN, INC. (GHI) (A RELATED ORGANIZATION) (THE "COMMITTEE"), RETAINS AN EXTERNAL COMPENSATION EXPERT TO CONDUCT AN EXTENSIVE MARKET COMPARABILITY REVIEW FOR ALL OFFICERS OF THE ORGANIZATION. THE REVIEW INCLUDES ALL COMPONENTS OF TOTAL COMPENSATION: BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. THE MARKET SURVEY RESULTS ARE PRESENTED TO, REVIEWED BY AND APPROVED BY THE APPROPRIATE COMMITTEE. BASED ON THIS DATA, EITHER THE COMPENSATION COMMITTEE OF THE STILLWATER HEALTH SYSTEM OR THE COMPENSATION COMMITTEE OF GHI (THE "COMMITTEES") DETERMINE MINIMUM AND MAXIMUM TOTAL COMPENSATION RANGES ARE DETERMINED FOR EACH EMPLOYED OFFICER. IN INTERIM YEARS, GHI'S HUMAN RESOURCES STAFF, UNDER THE COMMITTEES' DIRECTION, UPDATES CHANGES IN THE SALARY STRUCTURE BASED ON THE SAME INDEPENDENT STUDIES PERFORMED BY THE COMPENSATION CONSULTANT FOR THE COMMITTEE. FOR CERTAIN POSITIONS FULL INDEPENDENT REVIEWS ARE PERFORMED TO SET SALARY RANGES BASED ON THE COMPETITIVE MARKET DATA SPECIFIC TO THOSE POSITIONS. THE COMMITTEES REVIEW AND APPROVE EACH YEAR'S COMPENSATION RESULTS. IN ALL CASES, THE COMMITTEES' MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY TO ASSURE THE COMMITTEES MEMBERS' INDEPENDENCE AND THIS IS UPDATED AT ANY MEETING AT WHICH DECISIONS ARE BEING MADE. STAFF (OTHER THAN THE SECRETARY TO THE BOARD) IS NOT IN THE ROOM DURING DELIBERATIONS OR VOTE INCLUDING EXECUTIVE SESSIONS, AND CONTEMPORANEOUS MINUTES ARE KEPT. WITH SMG'S BOARD OF DIRECTORS INPUT, THE CEO OF THE STILLWATER HEALTH SYSTEM CONDUCTS THE ANNUAL PERFORMANCE REVIEW AND, WITH THE COMPENSATION COMMITTEE OF THE SHS'S APPROVAL, DETERMINES THE COMPENSATION OF THE SMG PRESIDENT. THE SMG BOARD HAS DELEGATED TO THE CEO OF STILLWATER HEALTH SYSTEM THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL SMG-EMPLOYED OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE COMMITTEE. ANY EXCEPTIONS TO COMPENSATION IN EXCESS OF THE APPROVED RANGES ARE APPROVED BY THE COMPENSATION COMMITTEE OF THE STILLWATER HEALTH SYSTEM. |
| FORM 990, PART VI, SECTION C, LINE 19 | SMG'S FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM SMG'S OR HEALTHPARTNERS. SMG'S ARTICLES OF INCORPORATION ARE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION THROUGH THE MINNESOTA SECRETARY OF STATE'S OFFICE. |
| 990, PART VII, SEC A, LINE 1A, COL B: AVERAGE HOURS - RELATED ORGANIZATIONS | THE COMPENSATED BOARD MEMBERS AND OFFICERS FREQUENTLY DEVOTE THEIR TIME TO MULTIPLE RELATED ORGANIZATIONS IN A PARTICULAR WEEK. REPORTED AVERAGE HOURS WORKED ARE BASED ON THEIR TOTAL COMPENSATION FROM ALL RELATED ORGANIZATIONS. |
| FORM 990, PART XI, LINE 9: | NET ASSET TRANSFER FROM LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC. 4,400,000. RETIREMENT PLAN TRUE UP 817,037. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (26 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| HEALTHPARTNERS INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411693838 | HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION | MN | 501(C)(4) | N/A | 0 | ||
| HPI - RAMSEY | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411793333 | CORPORATE PLANNING AND OVERSIGHT | MN | 501(C)(3) | 0 | 509(A)(3) TYPE I | HEALTHPARTNERS INC | |
| GROUP HEALTH PLAN INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 410797853 | STAFF MODEL HEALTH MAINTENANCE ORGANIZATION | MN | 501(C)(3) | 0 | 170(B)(1) (A)(III) | HEALTHPARTNERS INC | |
| HEALTHPARTNERS INSTITUTE | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411670163 | HEALTHCARE EDUCATION & RESEARCH | MN | 501(C)(3) | 0 | 509(A)(3) TYPE I | HEALTHPARTNERS INC | |
| CAPITOL VIEW TRANSITIONAL CARE CENTER | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 412011453 | POST HOSPITALIZATION PATIENT CARE | MN | 501(C)(3) | 0 | 170(B)(1) (A)(III) | HPI - RAMSEY | |
| REGIONS HOSPITAL | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 410956618 | HOSPITAL | MN | 501(C)(3) | 0 | 170(B)(1) (A)(III) | HPI - RAMSEY | |
| REGIONS HOSPITAL FOUNDATION | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411888902 | PROVIDE SUPPORT TO HOSPITAL AND TO IMPROVE COMMUNITY HEALTH | MN | 501(C)(3) | 0 | 170(B)(1) (A)(VI) | HPI - RAMSEY | |
| RHSC INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411891928 | HEALTHCARE STAFFING | MN | 501(C)(3) | 0 | 509(A)(3) TYPE II | HEALTHPARTNERS INC | |
| RH-WISCONSIN | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 202287016 | CORPORATE PLANNING AND OVERSIGHT | WI | 501(C)(3) | 0 | 509(A)(3) TYPE I | HPI - RAMSEY | |
| PHYSICIANS NECK AND BACK CLINICS | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 270684883 | SPECIALTY PATIENT CARE | MN | 501(C)(3) | 0 | 509(A)(3) TYPE II | GROUP HEALTH PLAN INC | |
| HUDSON HOSPITAL INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 390804125 | HOSPITAL | WI | 501(C)(3) | 0 | 170(B)(1) (A)(III) | RH-WISCONSIN | |
| HUDSON HOSPITAL FOUNDATION INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 391279567 | PROVIDE SUPPORT TO HOSPITAL AND TO IMPROVE COMMUNITY HEALTH | WI | 501(C)(3) | 0 | 170(B)(1) (A)(VI) | HUDSON HOSPITAL INC | |
| LAKEVIEW MEMORIAL HOSPITAL FOUNDATION | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411386635 | PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT | MN | 501(C)(3) | 0 | 509(A)(3) TYPE II | STILLWATER HEALTH SYSTEM | |
| LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 410811697 | HOSPITAL | MN | 501(C)(3) | 0 | 170(B)(1) (A)(III) | STILLWATER HEALTH SYSTEM | |
| STILLWATER HEALTH SYSTEM | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 300221189 | CORPORATE PLANNING AND OVERSIGHT | MN | 501(C)(3) | 0 | 509(A)(3) TYPE II | HPI - RAMSEY | |
| WESTFIELDS HOSPITAL INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 390808442 | HOSPITAL | WI | 501(C)(3) | 0 | 170(B)(1) (A)(III) | RH-WISCONSIN | |
| WESTFIELDS HOSPITAL FOUNDATION INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 391770913 | PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT | WI | 501(C)(3) | 0 | 509(A)(3) TYPE I | WESTFIELDS HOSPITAL INC | |
| RAMSEY INTEGRATED HEALTH SERVICES | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411503090 | IN-HOME PATIENT CARE | MN | 501(C)(3) | 0 | 509(A)(2) | HPI - RAMSEY | |
| PARK NICOLLET HEALTH SERVICES | |||||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 363465840 | CORPORATE PLANNING AND OVERSIGHT | MN | 501(C)(3) | 0 | 509(A)(2) | HEALTHPARTNERS INC | |
| PARK NICOLLET FOUNDATION | |||||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 237346465 | GRANTS TO SERVE THE COMMUNITY | MN | 501(C)(3) | 0 | 170(B)(1) (A)(VI) | PARK NICOLLET HEALTH SERVICES | |
| PARK NICOLLET METHODIST HOSPITAL | |||||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 410132080 | HOSPITAL | MN | 501(C)(3) | 0 | 170(B)(1) (A)(III) | PARK NICOLLET HEALTH SERVICES | |
| PARK NICOLLET HEALTH CARE PRODUCTS | |||||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 010638901 | HEALTHCARE PRODUCTS | MN | 501(C)(3) | 0 | 509(A)(3) TYPE I | PARK NICOLLET HEALTH SERVICES | |
| PARK NICOLLET CLINIC | |||||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 410834920 | HEALTHCARE | MN | 501(C)(3) | 0 | 170(B)(1) (A)(III) | PARK NICOLLET HEALTH SERVICES | |
| PNMC HOLDINGS | |||||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 411741792 | HEALTHCARE REAL ESTATE | MN | 501(C)(3) | 0 | 509(A)(3) TYPE I | PARK NICOLLET CLINIC | |
| AMERY REGIONAL MEDICAL CENTER INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 390908320 | HOSPITAL | WI | 501(C)(3) | 0 | 170(B)(1) (A)(III) | RH-WISCONSIN | |
| AMERY REGIONAL MEDICAL CENTER FOUNDATION INC | |||||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 391726539 | PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT | WI | 501(C)(3) | 0 | 170(B)(1) (A)(VI) | AMERY REGIONAL MEDICAL CENTER | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (7 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| HEALTHPARTNERS ADMINISTRATORS INC | |||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411629390 | THIRD PARTY ADMINISTRATOR | MN | HEALTHPARTNERS INC | C | 0 |
| HEALTHPARTNERS ASSOCIATES INC | |||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 522365151 | MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT | MN | HEALTHPARTNERS ADMINISTRATORS INC | C | 0 |
| HEALTHPARTNERS SERVICES INC | |||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411683568 | MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT | MN | HEALTHPARTNERS ADMINISTRATORS INC | C | 0 |
| HEALTHPARTNERS INSURANCE COMPANY | |||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411683523 | MEDICAL AND DENTAL INSURANCE | MN | HEALTHPARTNERS ADMINISTRATORS INC | C | 0 |
| DENTAL SPECIALTIES INC | |||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 451297583 | PROFESSIONAL DENTAL SERVICES | MN | HEALTHPARTNERS ADMINISTRATORS INC | C | 0 |
| HEALTHPARTNERS CENTRAL MINNESOTA CLINICS INC | |||||||||
| 8170 33RD AVE S PO BOX 1309 | MPLS | MN | 554401309 | 411236798 | MEDICAL CLINIC STAFFING | MN | HEALTHPARTNERS ADMINISTRATORS INC | C | 0 |
| PARK NICOLLET ENTERPRISES | |||||||||
| 6500 EXCELSIOR BLVD | ST LOUIS PARK | MN | 55426 | 411656735 | REAL ESTATE FOR RELATED ORGANIZATIONS | MN | PARK NICOLLET HEALTH SERVICES | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | 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 | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | L | TransactionTypeTxt |
| Involved | $87,918 | InvolvedAmt |
| Method Of Amount Determination | CASH AMOUNT | MethodOfAmountDeterminationTxt |
Comments