2017-11-15T09:07:38-06:00 2016-12-31 390859910 Baker Tilly Virchow Krause LLP 225 S 6th St 2300 Minneapolis MN 55402 990 2016-01-01 411777966 North Memorial Foundation NORT 7635205200 3300 Oakdale Avenue North Robbinsdale MN 554222900 Kent Spaulding VP Foundation 7635205200 2017-11-08 1 Lawrence H Mohr CPA P00447603 6128764500 38.88.188.75 2017-11-08 08:40:15 CS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 167182DFA60A41E45EAE2F4EF9C72CA9A698CA21 2016 2018-03-14 21:41:22Z KENT SPAULDING 3300 Oakdale Avenue North Robbinsdale MN 554222900 4970182 0 X www.northmemorial.com X 1993 MN 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. 13 12 0 150 0 0 1464107 1574758 0 0 780167 1182872 398500 198312 2642774 2955942 760136 255883 0 0 0 0 21007 0 448307 840886 917224 1622029 1173107 1020745 1782835 6840610 7789533 278217 133412 6562393 7656121 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. 0 0 16884 16884 Cancer care:Foundation funds in 2016 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. 22295 22295 Team Member Crisis Fund:Foundation funds in 2016 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. 456029 216704 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. 495208 1 1 0 0 0 1 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 15 0 0 0 0 0 0 0 1 1 0 0 0 0 X 13 12 0 0 1 0 1 1 1 1 1 0 0 1 0 1 1 0 0 0 MN WI X Aaron Bloomquist 7635814562 3300 Oakdale Avenue North Robbinsdale MN 554222900 BRUCE QUAM Board Chair 1.00 0.00 X X 0 0 0 MIKE STEINHAUSER Board Member 1.00 2.00 X 0 0 0 KAREN BIRD Board Member 2.00 0.00 X 0 0 0 TANYA KORPI MACLEOD Board Member 1.00 0.00 X 0 0 0 JIM BYRNE VICE CHAIR/SECRETARY 2.00 0.00 X X 0 0 0 MARK NIBLICK Board Member 1.00 0.00 X 0 0 0 Pamela Doorenbos MD Board Member 1.00 0.00 X 0 0 0 Diane Nilson Board Member 1.00 0.00 X 0 0 0 SCOTT HEMENWAY Board Member 1.00 0.00 X 0 0 0 MIKE HOLTZ Board Member 2.00 0.00 X 0 0 0 DEEPAK KADEMANI DMD MD Board Member 1.00 0.00 X 0 0 0 CHENG LOR Board Member 1.00 0.00 X 0 0 0 J KEVIN CROSTON MD Board Member 1.00 51.00 X 0 992503 48711 Kent Spaulding Vice President 50.00 0.00 X X 0 250728 36167 KRISTIN NIMSGER BOARD MEMBER 1.00 0.00 X 0 0 0 LYNN STARKOVICH PAST PRESIDENT 1.00 0.00 X X 0 0 0 Loren Taylor Former Board Member 1.00 51.00 X 0 30155 0 0 1273386 84878 0 1 1 0 0 213217 896613 464928 59425 1574758 99819 99819 2862690 1779637 1083053 1083053 1083053 432915 213217 234603 198312 198312 2955942 0 0 1381184 229381 229381 26502 26502 3292 103 3189 3477 3477 Staff Support 896613 224153 224153 448307 MISCELLANEOUS 11592 11592 Uncollectible Pledge 2250 2250 1173107 495208 229592 448307 326876 348205 73428 56074 10381 19619 225000 225000 225000 5251729 6145525 953196 995110 6840610 7789533 243169 102009 35048 31403 278217 133412 X 2074294 1874630 2383701 3479951 2104398 2301540 6562393 7656121 6840610 7789533 X 1782835 -731021 41914 X X 0 1 X 1 0 X 1727243 1931145 1649575 1464107 1574758 8346828 1727243 1931145 1649575 1464107 1574758 8346828 8346828 87596 102244 125014 122845 99819 537518 8884346 0.93950 0.94010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3 5231 8877 31403 1 1 2203143 155228 707969 37144 3029196 3591423 17322 1405602 2203143 3446092 76703 118858 50230 3591423 2683970 710628 85294 33800 3446092 2382667 270795 92571 62063 2683970 0.00000 0.75980 0.24020 1 0 225000 225000 225000 BENEFICIAL INTEREST IN REMAINDER TRUST 995110 995110 AMOUNTS HELD FOR OTHERS 31403 31403 X 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. 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 2016 or 2015. Dinner/Dance Gala 510009 141044 368965 49055 71223 40373 Golf Fundraiser 136123 72173 63950 38353 35599 646132 213217 432915 49055 109576 75972 234603 198312 1 North Memorial Health Care 3300 Oakdale Ave N Robbinsdale MN 55422 410729979 501(c)(3) 20301 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) 209080 To support nmhc programs and services 1 EMPLOYEE ASSISTANCE 18 14402 JUNIOR VOLUNTEER SCHOLARSHIPS 7 7900 HOPE CHEST BREAST CENTER 4 4200 Part I, Line 2: 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. 0 0 0 0 0 0 1 0 0 J KEVIN CROSTON MD Board Member 0 705969 0 279409 0 7125 0 18550 0 30161 0 1041214 0 0 Kent Spaulding Vice President 0 199660 0 50386 0 682 0 15403 0 20764 0 286895 0 0 Loren Taylor Former Board Member 0 0 0 30155 0 0 0 0 0 0 0 30155 0 0 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. X SILENT AUCTION BASKETS 114 49055 FMV X SUPPLIES 5 6305 FMV X golf balls 191 2865 FMV X technical support 2 1200 fmv 0 0 1 0 Part I, Column (b): CONTAINS THE NUMBER OF CONTRIBUTIONS. Form 990, Part VI, Section A, line 4 Changes were made to the articles of incorporation to add "NMHC Entities" to all description lines in verification of support. It now reads, "2.2 In support of such purposes, the corporation shall engage in activities which support or benefit the NMHC Entities and their service communities." 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 2017 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 41,914. Form 990, Part XII, Line 2c: NEITHER THE OVERSIGHT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT CHANGED DURING THE TAX YEAR. 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 BD 501(c)(3) 11A North Memorial 0 Maple Grove Hospital Corporation 3300 Oakdale Ave N Robbinsdale MN 55422 208316475 ACUTE CARE MN 501(c)(3) Line 3 North Memorial 0 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 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 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 North Memorial Health Care (contributions to NMHC) B 229381 FMV NORTH MEMORIAL HEALTH CARE (STAFF SUPPORT) O 896613 FMV