2014-11-17T13:56:03-06:00 2013-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-01-01 411328097 RIDGEVIEW FOUNDATION RIDG 9524426010 500 SOUTH MAPLE STREET WACONIA MN 55387 GORDON GABLENZ VICE PRESIDENT & CFO 9524426010 2014-11-17 1 DARRYN MCGARVEY P00958683 6123764500 2013 2015-11-30 17:44:51Z ROBERT STEVENS 500 SOUTH MAPLE STREET WACONIA MN 55387 7334067 0 X WWW.RIDGEVIEWMEDICAL.ORG X 1978 MN TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 23 23 0 500 0 0 1208259 4409325 0 0 243535 680862 113638 127399 1565432 5217586 1612000 1521190 0 0 0 0 0 0 97720 108788 136388 1720788 1657578 -155356 3560008 8561954 12100156 342996 288738 8218958 11811418 RIDGEVIEW FOUNDATION IS AN INDEPENDENT NONPROFIT ORGANIZATION THAT PARTNERS WITH RIDGEVIEW MEDICAL CENTER IN ITS MISSION TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 0 0 1521190 1521190 0 TO RAISE FUNDS EXCLUSIVELY FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER, A NOT-FOR-PROFIT HOSPITAL IN WACONIA, MINNESOTA. DURING THE YEAR ENDED DECEMBER 31, 2013, RIDGEVIEW FOUNDATION EXPENSED A TOTAL OF $1,531,732 TO RIDGEVIEW MEDICAL CENTER, $375,000 WAS TRANSFERRED TO PURCHASE A NEW DAVINCI ROBOT SURGERY PROGRAM AT THE HOSPITAL. $225,575 WAS TRANSFERRED TO BUILD AND FURNISH A NEW HOSPICE RESIDENCE THAT WAS A NEW SERVICE THAT STARTED IN 2009. $362,556 WAS TRANSFERRED TO THE HOSPITAL TO SUPPORT THE BUILDING AND FURNISHING OF A HEART CENTER AND CATH LAB AT THE HOSPITAL. THE REMAINING $568,601 TRANSFERRED TO THE HOSPITAL WAS USED FOR VARIOUS PROJECTS AND PROGRAMS DURING 2013. 1521190 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 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 5 0 0 0 0 0 0 0 1 1 0 0 0 0 X 23 23 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X GORDON GABLENZ 9524426010 500 SOUTH MAPLE STREET WACONIA MN 55387 NANCY BACH BOARD MEMBER 0.50 X X 0 0 0 BRIAN BENIEK BOARD MEMBER 0.50 X 0 0 0 JEAN BULLER BOARD MEMBER 0.50 X 0 0 0 DERMOT COWLEY BOARD MEMBER 0.50 X 0 0 0 STACY DESAI BOARD MEMBER 0.50 X 0 0 0 KATHERINE FORRESTER BOARD MEMBER 0.50 X 0 0 0 TIM FOSTER BOARD MEMBER 0.50 X 0 0 0 FRED GREEN BOARD MEMBER 0.50 X 0 0 0 KATHY HACKETT BOARD MEMBER 0.50 X 0 0 0 DARLA HOLMGREN BOARD MEMBER 0.50 X 0 0 0 GREG KUMMER BOARD MEMBER 0.50 X 0 0 0 LAURA LANZ BOARD MEMBER 0.50 X 0 0 0 JEFF LAUREL BOARD MEMBER 0.50 X 0 0 0 JIM LEONARD BOARD MEMBER 0.50 X 0 0 0 BRIAN MARK CHAIRPERSON 0.50 X 0 0 0 LINDA ROEBKE BOARD MEMBER 0.50 X 0 0 0 KATE ROEHL BOARD MEMBER 0.50 0.80 X 0 1600 0 DANIEL ROSS BOARD MEMBER 0.50 X 0 0 0 RANDY SCHNEEWIND BOARD MEMBER 0.50 X 0 0 0 CHUCK SPEVACEK BOARD MEMBER 0.50 X 0 0 0 MARK STEINGAS BOARD MEMBER 0.50 X 0 0 0 LARRY WILHELM BOARD MEMBER 0.50 X 0 0 0 DAVID WINDSCHITL BOARD MEMBER 0.50 X 0 0 0 ROBERT STEVENS CEO 0.50 49.50 X 0 343711 329451 GORDON GABLENZ CFO 0.50 49.50 X 0 211128 27773 DOUGLAS STASEK VICE PRESIDENT 47.50 2.50 X 0 186146 25503 0 742585 382727 0 0 1 0 0 399005 3000000 1010320 239915 4409325 71712 71712 2427988 1818838 609150 609150 609150 402492 399005 287014 115478 115478 22550 10629 11921 11921 5217586 0 0 808261 1510190 1510190 11000 11000 6349 6349 8500 8500 212 212 49495 23607 25888 71832 71832 1657578 1521190 38668 97720 1849916 1347391 582952 528232 2502324 2350356 9697 9697 0 0 1614756 3290814 506272 486144 1505734 4097219 8561954 12100156 342996 288738 342996 288738 X 2012414 5402783 5134265 4845265 1072279 1563370 8218958 11811418 8561954 12100156 3560008 32452 0 X 0 1 X 1 0 X 1096638 1739448 1945444 1208259 4409325 10399114 1096638 1739448 1945444 1208259 4409325 10399114 10399114 60771 43863 28520 65816 71712 270682 10669796 1574928 0.97460 0.96330 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1528949 3504360 148437 20121 1637 5159988 1456169 20090 64733 12043 1528949 1228652 227270 48325 48078 1456169 1068586 195012 56843 91789 1228652 2171052 7534 75524 1185524 1068586 0.65900 0.30300 0.03800 0 0 9697 9697 0 0 KEY PERSON LIFE INSURANCE 408248 PLEDGE RECEIVABLE FROM RIDGEVIEW MEDICAL CENTER 3004245 ANNUITY CONTRACT 55888 CASH HELD IN REMAINDER TRUST 375138 CASH SURRENDER VALUE 253700 4097219 X 3025136 32452 679546 1599230 2311228 713908 4503678 4503678 5217586 2634767 679546 297643 977189 1657578 0 1657578 PART V, LINE 4: TO SATISFY THE RESTRICTIONS OF DONORS. PART X, LINE 2: THE FOUNDATION HAS RECEIVED NOTIFICATION THAT IT QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING PROVISIONS OF STATE LAW AND, ACCORDINGLY, IS NOT SUBJECT TO TAXATION. DURING 2010, THE FOUNDATION REQUESTED AND WAS APPROVED TO RECLASSIFY FROM 509(A)(3) STATUS TO 509(A)(1) AND 170(B)(1)(A)(VI) STATUS WITH THE IRS. THE FOUNDATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE FOUNDATION FOLLOWS THE ACCOUNTING STANDARDS FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAD NO EFFECT ON THE FINANCIAL STATEMENTS. THE FOUNDATION'S INCOME TAX RETURNS ARE SUBJECT TO REVEIW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2011 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 1,599,230. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -297,643. TEMPORARILY RESTRICTED CONTRIBUTIONS 751,305. EVENT PROCEEDS 558,925. PERMANENTLY RESTRICTED CONTRIBUTIONS 491,091. EQUITY TRANSFER FROM RMC 3,000,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 297,643. GOLF TOURNAMENT 545975 304853 241122 21239 197074 FALL HARVEST MOON 255522 94152 161370 68701 801497 399005 402492 21239 265775 287014 115478 22550 10629 0 22550 10629 10629 11921 MN 1 0 0 0 1.00000 GORDON GABLENZ 500 SOUTH MAPLE STREET WACONIA MN 55387 0 JAN HELD 63621 JAN HELD IS THE EVENTS COORDINATOR FOR THE FOUNDATION. SHE SUPERVISES ALL FUNDRAISING EVENTS AND FILLS OUT ALL OF THE PAPERWORK RELATED TO GAMING ACTIVITIES. X 1 5968 1 RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 501(C)(3) 1510190 FUNDRAISING SUPPORT OF RIDGEVIEW MEDICAL CENTER 1 0 SCHOLARSHIPS 11 11000 PART I, LINE 2: GRANTS AND OTHER ASSISTANCE TO ENTITIES IN THE U.S.: TRANSFERS ARE TO RELATED ENTITIES UNDER COMMON MANAGEMENT AND TRACKED THROUGH THE INTERNAL FINANCIAL REPORTING PROCESS. GRANTS AND OTHER ASSISTANCE TO INDIVIDUALS IN THE U.S.: SCHOLARSHIP PAYMENTS ARE MADE DIRECTLY TO THE SCHOOL THAT THE STUDENT IS ATTENDING. 0 1 0 0 0 0 0 0 0 ROBERT STEVENS CEO 0 343711 0 0 0 0 0 317391 0 12060 0 673162 0 0 GORDON GABLENZ CFO 0 211128 0 0 0 0 0 15713 0 12060 0 238901 0 0 DOUGLAS STASEK VICE PRESIDENT 0 186146 0 0 0 0 0 14038 0 11465 0 211649 0 0 PART I, LINE 3 THE PRESIDENT/CEO IS COMPENSATED BY RIDGEVIEW MEDICAL CENTER, A RELATED PARTY. RIDGEVIEW MEDICAL CENTER USES THE FOLLOWING WHEN DETERMINING HIS COMPENSATION: 1) COMPENSATION SURVY OR STUDY 2) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B ROBERT STEVENS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT SPLIT-DOLLAR WHOLE LIFE PLAN ACCRUED $317,391 DURING 2013. ROBERT STEVENS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT SPLIT-DOLLAR WHOLE LIFE PLAN ACCRUED $317,391 DURING 2013. ROBERT STEVEN'S DEFERRED COMPENSATION IS REPORTED ON A PRO-RATA BASIS WITHOUT REGARD TO HIS VESTING SCHEDULE. CURRENTLY, THE MAJORITY OF MR. STEVEN'S DEFERRED COMPENSATION PACKAGE IS NOT VESTED. IN ADDITION TO SCHEDULE J, PART II, LINE 1, COLUMN C, THIS AMOUNT IS ALSO INCLUDED IN PART VII, SECTION A, LINE 24, COLUMN F. X 6241 FAIR MARKET VALUE X 2 52661 FAIR MARKET VALUE X 20 4091 FAIR MARKET VALUE X 1 90 FAIR MARKET VALUE X WATER HEATERS 1 77115 CASH VALUE X TICKETS/GIFT 153 39865 FAIR MARKET VALUE X LIFE INSURANC 1 30329 FAIR MARKET VALUE X MISC AUCTION 101 19648 FAIR MARKET VALUE X TRAVEL 11 9875 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS OF THE FOUNDATION DESIGNATED SEVEN BOARD MEMBERS AS AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE ACTS ONLY DURING INTERVALS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS OF THE FOUNDATION AND IS AT ALL TIMES SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD OF DIRECTORS OF THE FOUNDATION. DURING SUCH INTERVALS AND SUBJECT TO SUCH CONTROL AND DIRECTION, THE EXECUTIVE COMMITTEE HAS ALL OF THE AUTHORITY AND POWER OF THE BOARD OF DIRECTORS OF THE FOUNDATION IN THE MANAGEMENT OF THE BUSINESS OF THE FOUNDATION, SUBJECT TO SUCH LIMITATIONS AS THE BOARD OF DIRECTORS OF THE FOUNDATION MAY IMPOSE FROM TIME TO TIME. FORM 990, PART VI, SECTION A, LINE 6 RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF RIDGEVIEW FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A EACH PERSON ELECTED BY THE BOARD OF DIRECTORS OF RIDGEVIEW FOUNDATION IS RATIFIED OR REJECTED BY THE BOARD OF DIRECTORS OF RIDGEVIEW MEDICAL CENTER, THE FOUNDATION'S SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B IN ADDITION TO THE APPOINTMENT OF DIRECTORS TO THE BOARD OF DIRECTORS OF RIDGEVIEW FOUNDATION, AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FOUNDATION REQUIRE APPROVAL OF RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE CFO REVIEWED THE FORM 990 AND PROVIDED COPIES TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE RIDGEVIEW FOUNDATION BOARD ANNUALLY REQUIRES EACH OF ITS MEMBERS TO RESPOND TO A CONFLICT OF INTEREST QUESTIONNAIRE. FORM 990, PART VI, SECTION C, LINE 19 RIDGEVIEW FOUNDATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. RIDGEVIEW CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 411651783 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 N/A 0 RIDGEVIEW INSURANCE COMPANY 60 E SOUTH TEMPLE STE 1800 SALT LAKE CITY UT 84111 454109041 CAPTIVE INSRUANCE COMPANY UT 501(C)(3) LINE 11A, I RIDGEVIEW MEDICAL CENTER 0 MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER LCC 500 SOUTH MAPLE STREET WACONIA MN 55387 205785920 CARDIOLOGY SERVICES MN N/A CHASKA PLAZA SURGERY CENTER 3000 HUNDERTMARK ROAD CHASKA MN 55318 450975783 SURGERY SERVICES MN N/A EXECUTIVE HEALTH MANAGEMENT SERVICES INC 500 SOUTH MAPLE STREET WACONIA MN 55387 411760239 MANAGEMENT SERVICES MN N/A C 0 CHARITABLE REMAINDER UNITRUST (1) CHARITABLE TRUST MN RIDGEVIEW FOUNDATION T 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0