2015-05-08T15:53:16-05:00 2014-06-30 861065772 Deloitte Tax LLP 50 South Sixth Street Suite 2800 Minneapolis MN 55402 990 2013-07-01 450346132 Sanford Heart of America Health Plan SANF 7017765848 810 South Main Rugby ND 58368 JoAnn Kunkel Chief Financial Officer 6053331000 2015-05-08 1 Anne Fulton P00941863 6123974000 2013 2016-02-25 16:41:14Z Kelby Krabbenhoft 1305 W 18th St PO Box 5039 Sioux Falls SD 571175039 4233137 0 X www.hoahp.com X 1978 ND To coordinate effective and efficient delivery of high-quality health care in a cost effective manner. 15 6 0 0 0 0 0 0 1889756 3945187 19422 37372 0 0 1909178 3982559 0 2000 0 0 95531 143329 0 0 0 1843658 4329250 1939189 4474579 -30011 -492020 1376502 2133802 544696 1026304 831806 1107498 X The Sanford Heart of America Health Plan is a rural, nonprofit health maintenance organization. Our mission is to coordinate effective and efficient delivery of high-quality health care in a cost effective manner. Member service is our priority. We are committed to the development of personal responsibility for a healthy lifestyle. 0 0 4324357 2000 3945187 Sanford Heart of America Health Plan was incorporated for the purpose of providing comprehensive health care services on a prepaid basis and for the purpose of establishing and operating organized health maintenance and health care delivery systems.Sanford Heart of America Health Plan (SHAHP) served 381 Medicare members during fiscal year 2014 and 647 commercial and individual members. Through June 30, 2014, the following community services were provided:Pierce County's annual Relay for Life was held which is an all-night walk in support of cancer victims and survivors. The event is open to the public and participants of all ages.In July, SHAHP hosted a community open house to introduce Sanford Health Plan to the area and its current members. SHAHP also hosted their annual Fun Walk event.Other miscellaneous items involved support of youth events including Dollars for Scholars, Saturday matinees during Christmas time, Imagination Library and safe-after-prom parties. 4324357 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 X 15 6 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X JoAnn Kunkel CFO 6053331000 1305 W 18th Street Sioux Falls SD 57117 X Barb Everist Trustee 0.10 5.30 X 0 0 0 Barbara Stork Trustee (thru Dec 13) 0.10 5.30 X 0 0 0 Brent Teiken Trustee 0.10 5.30 X 0 0 0 Christopher Meeker MD Trustee 0.10 59.90 X 0 393696 30403 David Beito Trustee 0.10 5.30 X 0 0 0 Don Morton Trustee 0.10 5.30 X 0 0 0 Jerome Feder Trustee 0.10 5.30 X 0 0 0 Jim Entenman Trustee 0.10 5.30 X 0 0 0 Lauris Molbert Trustee 0.10 5.30 X 0 0 0 Maria Bell MD Trustee 0.10 59.90 X 0 776820 40322 Mark Paulson MD Trustee 0.10 59.90 X 0 221733 29828 Patrick Durick Trustee 0.10 5.30 X 0 0 0 Richard Hardie MD Trustee 0.10 59.90 X 0 760534 40425 Ronald Moquist Trustee 0.10 5.30 X 0 0 0 Thomas Hruby Trustee 0.10 5.30 X 0 0 0 Kelby K Krabbenhoft Sanford Health President & CEO 0.10 59.90 X X 0 1320464 22992 Kelby K Krabbenhoft Deferred Comp Sanford Health President & CEO 0.10 59.90 X X 0 0 608477 JoAnn L Kunkel Chief Financial Officer Corp 0.10 59.90 X 0 463362 39674 Ruth Krystopolski President - Sanford Health Plan 10.00 50.00 X 0 431364 43371 Cecily Tucker CFO - Sanford Health Plan 10.00 50.00 X 0 258654 22568 Lisa Carlson Former Chief Financial Officer Corp 0.10 59.90 X 0 1614478 21738 0 6241105 899798 0 1 1 0 0 Premiums 524114 2936422 2936422 Medicare Reimbursement 524114 1008235 1008235 Reinsurance Recoveries 524114 530 530 3945187 36232 36232 251718 250578 1140 1140 1140 3982559 3945187 0 37372 2000 2000 117738 100077 17661 3321 2823 498 14102 11987 2115 8168 6943 1225 109737 109737 41469 35249 6220 9175 7799 1376 31031 26376 4655 6259 5320 939 20605 17514 3091 2091 1777 314 15069 12809 2260 Claims 3622335 3622335 Capitation Services 297166 297166 Reinsurance 98520 98520 Premium Tax 74842 74842 951 820 131 4474579 4324357 150222 0 0 1142146 341356 140143 8072 60294 0 19252 38579 38579 0 0 1008569 771967 18505 0 1376502 2133802 69887 114332 49319 140005 425490 771967 544696 1026304 X 831806 1107498 831806 1107498 1376502 2133802 X -492020 -12821 780533 X 0 1 X 1 0 38579 38579 0 0 Claims Payable 771967 771967 X Part X, Line 2: Certain controlled organizations are subject to income taxes. Deferred income tax assets and liabilities are recognized for the differences between the financial and income tax reporting basis of assets and liabilities based on enacted tax rates and laws. 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. The deferred income tax provision or benefit generally reflects the net change in deferred income tax assets and liabilities during the year. The current income tax provision reflects the tax consequences of revenues and expenses currently taxable or deductible on various income tax returns for the year reported. Sanford Heart of America Health Plan did not have an income tax liability at June 30, 2014; some related organizations have established reserves. 1 1 0 0 0 0 1 1 0 Christopher Meeker MD Trustee 0 393696 0 0 0 0 0 10000 0 20403 0 424099 0 0 Maria Bell MD Trustee 0 695606 0 0 0 81214 0 17152 0 23170 0 817142 0 0 Mark Paulson MD Trustee 0 207989 0 0 0 13744 0 11296 0 18532 0 251561 0 0 Richard Hardie MD Trustee 0 754303 0 0 0 6231 0 20400 0 20025 0 800959 0 0 Kelby K Krabbenhoft Sanford Health President & CEO 0 1117709 0 0 0 202755 0 0 0 22992 0 1343456 0 0 Kelby K Krabbenhoft Deferred Comp Sanford Health President & CEO 0 0 0 0 0 0 0 608477 0 0 0 608477 0 0 JoAnn L Kunkel Chief Financial Officer Corp 0 408018 0 0 0 55344 0 19176 0 20498 0 503036 0 0 Ruth Krystopolski President - Sanford Health Plan 0 336544 0 50000 0 44820 0 20400 0 22971 0 474735 0 0 Cecily Tucker CFO - Sanford Health Plan 0 231962 0 0 0 26692 0 18204 0 4364 0 281222 0 0 Lisa Carlson Former Chief Financial Officer Corp 0 243062 0 0 0 1371416 0 12153 0 9585 0 1636216 0 0 Part I, Line 1a Certain items listed on Line 1a are provided by related organizations. Part I, Line 3 The Executive Compensation Committee of the Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm annually to review the total compensation arrangements of the officers and executives of the organization, including the CEO, and to report the findings to them for deliberation and action. The deliberations and actions are recorded in the minutes of the Sanford Board of Trustees. The most recent study was completed in 2014. Part I, Lines 4a-b Part I, Line 4a: The following individuals participated in a severance arrangement and received payments during the year: Lisa Carlson $1,331,670 Part I, Line 4b: Certain executives participate in a defined benefit SERP Plan. There were no individuals who received payments during the year. Part I, Line 6 Sanford physicians are compensated based on the professional services they perform within the clinic in which they provide care. Generally, the model is based on production. Part I, Line 7 Certain employees are eligible for a discretionary incentive bonus, based on financial targets and other goals. Form 990, Schedule J, Supplemental: Compensation reported on Schedule J, Part II includes: (B)(i) Base compensation - salaries are based on the experience and performance of each executive and bench-marked using independent compensation survey information. (B)(ii) Bonus & incentive compensation - as part of executive compensation, individuals may be eligible for incentive performance compensation, however if the organization does not make its financial targets, incentive payments are not paid regardless of performance. (B)(iii) Other Reportable Compensation - generally includes taxable executive benefits. (C) Deferred Compensation - includes employer contributions to pension plans and the increase (or decrease) in the actuarial value (actuarial value factors include age, tenure and salary) of the benefit plans. (D) Nontaxable Benefits - generally includes health insurance premiums. A memo regarding executive compensation, written by the Chairman of the Sanford Board of Trustees, is on file and available upon request. Compensation paid to trustees is for full-time professional responsibilities as physicians, administrators or employees of the organization. The total compensation paid to Kelby Krabbenhoft of $1,320,464 is comprised of Base Salary of $1,117,709, Incentive Compensation of $0 and Other Taxable Earnings of $202,755. In addition, an amount of $608,477 has been reported for the estimated amount of ratable increase in value of the defined benefit pension plan, defined benefit SERP and a Gift Agreement Management Continuity Retention plan. Form 990, Part VI, Section A, line 2 The following officers, board members, and key employees are employees of Sanford or its related organizations. Many of these employees also serve on other related Sanford boards, or have business relationships with each other that span the organization as a whole: Christopher Meeker, Maria Bell, Mark Paulson, Richard Hardie, Kelby Krabbenhoft, JoAnn Kunkel, Ruth Krystopolski and Cecily Tucker. Form 990, Part VI, Section A, line 4 Effective July 1, 2013 Heart of America Health Plan was acquired by the Sanford Health system. Sanford Health Plan (EIN: 91-1842494) became its sole member and the entity was renamed Sanford Heart of America Health Plan. Form 990, Part VI, Section A, line 6 Sanford Health Plan is the sole member of the organization. Form 990, Part VI, Section A, line 7a Board members are members of the Board of Directors of Sanford Health Plan. Form 990, Part VI, Section A, line 7b Sanford Health Plan, as sole member, reviews the actions of Sanford Heart of America Health Plan. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by the finance department and reviewed by executive management. An external accounting firm reviews the return and prepares return highlights and key disclosures for the Board of Trustees meeting prior to the return filing date. Before the return is filed, a complete copy is provided to the current Board of Trustees. Form 990, Part VI, Section B, line 12c The annual Conflict of Interest disclosure process is managed by the Chief Compliance Officer (CCO). The CCO is responsible for assuring that all completed forms are returned in a timely and complete manner. Conflict of Interest questionnaires are sent to System Trustees, members of the governing boards of subsidiary entities, officers and key employees for all the entities subject to the IRS Form 990 filings. The disclosures are summarized for review by the executive committee of the Board of Trustees, pursuant to policy. This review allows: 1) The Board to acquire an awareness of financial relationships of board members and key management employees and can invoke the recusal process on a case-by-case basis when potential conflicts are implicated in Board decisions and deliberations, and, 2) Gives the Board the opportunity to seek additional information and clarification about disclosures to determine potential conflicts of interest and how to manage them. Form 990, Part VI, Section B, line 15 The Executive Compensation Committee of the Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm annually to review the total compensation arrangements of the officers and executives of the organization, including the CEO, and to report the findings to them for deliberation and action. The deliberations and actions are recorded in the minutes of the Sanford Board of Trustees. The most recent study was completed in 2014. Form 990, Part VI, Section C, line 19 Although the organization does not maintain a website where the public can access these documents, it would respond individually to any requests or inquiries from the public for these documents. Form 990, Part VII The Sanford Board of Trustees has ultimate governance responsibilities for each major operating entity within Sanford. In addition, a Board of Directors is established for each major operating entity. This Board has specific responsibilities delegated from the Board of Trustees. Generally these responsibilities are related to the oversight of the day to day operations of that entity. Form 990, Part XI, line 9: Transfer from related tax-exempt org for payroll and operating expenses 168,195. Change in net assets due to acquisition 612,338. Sanford 801 Broadway Drive Fargo ND 58122 271218956 Supporting Organization ND 501(c)(3) 11-II 0 Sanford Health 1305 West 18th Street Sioux Falls SD 57117 311527032 Supporting Organization SD 501(c)(3) 11-II Sanford 1 Sanford USD Medical Center 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460227855 Hospital SD 501(c)(3) 3 Sanford Health 1 Sanford Health Foundation 1305 West 18th Street Sioux Falls SD 57117 363297853 Foundation SD 501(c)(3) 11-II Sanford Health 1 Edith Sanford Breast Cancer Foundation 2301 60th Street N Sioux Falls SD 57104 450404126 Foundation ND 501(c)(3) 11-II Sanford Health 1 Sanford Clinic 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460447693 Clinical Services SD 501(c)(3) 3 Sanford Health 1 Sanford Home Health 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460282134 Home Health Services SD 501(c)(3) 9 Sanford Health 1 Sanford Health Network 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460388596 Hospitals/Clinics SD 501(c)(3) 3 Sanford Health 1 Sanford Research 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460450378 Research SD 501(c)(3) 3 Sanford Health 1 Sanford World Clinics 1305 West 18th Street Sioux Falls SD 57117 262707628 Healthcare SD 501(c)(3) 3 Sanford Health 1 Sanford North PO Box 2010 Fargo ND 58122 450385890 Supporting Organization ND 501(c)(3) 11-II Sanford 1 Sanford Medical Center Fargo PO Box 2010 Fargo ND 58122 450226909 Hospital ND 501(c)(3) 3 Sanford North 1 F-M Ambulance Service Inc 2215 18th Street S Fargo ND 58103 450344371 EMT ND 501(c)(4) Sanford North 1 Sanford Health Foundation North PO Box 2010 Fargo ND 58122 450398104 Foundation ND 501(c)(3) 7 Sanford North 1 Sanford Clinic North PO Box 2010 Fargo ND 58122 911770748 Clinics ND 501(c)(3) 9 Sanford North 1 Sanford Health Network North PO Box 2010 Fargo ND 58122 450409348 Hospitals/Clinics ND 501(c)(3) 11-II Sanford North 1 Sanford Hillsboro PO Box 609 Hillsboro ND 58045 450230400 Hospital ND 501(c)(3) 3 Sanford Health Network North 1 Sanford Health Foundation Hillsboro PO Box 609 Hillsboro ND 58045 363542187 Foundation ND 501(c)(3) 7 Sanford Hillsboro 1 Sanford Medical Center Mayville 42 6th Avenue SE Mayville ND 58257 450228899 Hospital ND 501(c)(3) 3 Sanford Health Network North 1 Sanford Medical Center Thief River Falls 120 Labree Avenue S Thief River Falls MN 56701 410709579 Hospital MN 501(c)(3) 3 Sanford Health Network North 1 Sanford Medical Center Wheaton 401 12th Street N Wheaton MN 56296 272042143 Hospital/Clinic MN 501(c)(3) 3 Sanford Health Network North 1 Sanford Health of Northern Minnesota 1300 Anne Street NW Bemidji MN 56601 411266009 Hospital MN 501(c)(3) 3 Sanford North 1 Sanford Health Foundation of Northern Minnesota 1300 Anne Street NW Bemidji MN 56601 411389317 Foundation MN 501(c)(3) 11-II Sanford Health of Northern Minnesota 1 Baker Park Inc 803 Dewey Avenue NW Bemidji MN 56601 411372480 Low Income Senior Housing MN 501(c)(3) 9 Sanford Health of Northern Minnesota 1 North Country Medical Clinic 1300 Anne Street NW Bemidji MN 56601 411753855 Family Practice Medical Clinic MN 501(c)(3) 3 Sanford Health of Northern Minnesota 1 Sanford West 300 North 7th Street Bismarck ND 58501 450397195 Supporting Organization ND 501(c)(3) 11-II Sanford 1 Sanford Bismarck 300 North 7th Street Bismarck ND 58501 450226700 Hospital ND 501(c)(3) 3 Sanford West 1 Sanford Living Centers 1000 18th Street NW Suite 1 Bismarck ND 58554 450416454 Long-term Care Facility ND 501(c)(3) 9 Sanford Bismarck 1 Sanford Health Foundation West 300 North 7th Street Bismarck ND 58501 450397196 Foundation ND 501(c)(3) 7 Sanford Bismarck 1 Medcenter One Inc Auxiliary 300 North 7th Street Bismarck ND 58501 237293043 Supporting Organization ND 501(c)(3) 11-I Sanford Bismarck 1 National Student Housing-South Dakota LLC 100 S Phillips Ave Sioux Falls SD 57104 202129839 Investment SD N/A RAC Rentals LLC 100 S Phillips Ave Sioux Falls SD 57104 261961077 Investment SD N/A Southwest MN Radiation Center LLC 1018 6th Avenue Worthington MN 56187 460447693 Radiation Services MN N/A Sanford Home Medical Equipment Inc 2710 W 12th Street Sioux Falls SD 57105 460388597 Healthcare Equipment SD N/A C 1 Sanford Health Plan 300 Cherapa Place Sioux Falls SD 57103 911842494 Insurance SD N/A C 1 Sanford Health Plan of MN 300 Cherapa Place Sioux Falls SD 57103 460445852 Insurance MN N/A C 1 Bemidji Medical Equipment Inc 1300 Anne Street NW Bemidji MN 56601 411551725 Retail Sales of DME MN N/A C 1 North Country Management Inc 1300 Anne Street NW Bemidji MN 56601 411820025 Management Services MN N/A C 1 Sanford Frontiers 1305 W 18th Street PO Box 5039 Sioux Falls SD 571175039 455436599 Weight Loss/Fitness SD N/A C 1 SOB Inc 2701 S Minnesota Avenue Suite 2 Sioux Falls SD 57105 460442628 Air Transportation SD N/A C 1 Sanford Affiliated Services Inc 300 N 7th Street Bismarck ND 58501 450403146 Investment Activity ND N/A C 1 Sanford World Clinics - Ghana Sarbah Road Tantri Lorry Station Cape Coast GH Healthcare GH N/A C 1 Shanghai Sanford Healthcare Management Consulting Co Ltd 188 Yesheng Road Room A-862 Guoma Shanghai CH Healthcare CH N/A C 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0