2013-05-14T16:39:38-07:00 2012-09-30 990 2011-10-01 411677288 LAKE REGION HOSPITAL FOUNDATION LAKE 2187368000 712 S CASCADE ST FERGUS FALLS MN 565380728 BRETT LONGTIN CPA 2187368000 2013-04-18 2011 2016-02-25 16:41:14Z Larry Dorn 712 S Cascade St Fergus Falls MN 56537 1286603 0 X X Foundation 2000 MN THE PURPOSE OF THE LAKE REGION HOSPITAL FOUNDATION IS TO RECEIVE GIFTS AND DONATIONS TO HELP LAKE REGION HOSPITAL FULFILL IT'S MISSION OF PROVIDING QUALITY HEALTHCARE SERVICES IN A CARING MANNER TO EVERY INDIVIDUAL WE SERVE. 16 16 0 186 0 0 1476063 714670 0 0 135333 292378 22699 19489 1634095 1026537 5718 43463 0 0 0 0 0 0 0 2363 136930 8081 180393 1626014 846144 8970249 10343272 6419 12507 8963830 10330765 THE PURPOSE OF THE LAKE REGION HOSPITAL FOUNDATION IS TO RECEIVE GIFTS AND DONATIONS TO HELP LAKE REGION HOSPITAL FULFILL IT'S MISSION OF PROVIDING QUALITY HEALTHCARE SERVICES IN A CARING MANNER TO EVERY INDIVIDUAL WE SERVE. 0 0 180393 43463 365049 LAKE REGION HOSPITAL FOUNDATION RECEIVED DONATIONS AND MEMORIALS FROM SEVERAL INDIVIDUALS AND BUSINESSES. IT ALSO RECEIVES PLEDGES AND PAYMENTS OF THOSE PLEDGES. THE FOUNDATION USES SOME OF IT'S FUNDS FOR A VARIETY OF PURPOSES WHICH AID LAKE REGION HEALTHCARE AND THE COMMUNITY IN PROVIDING QUALITY HEALTHCARE. 0 0 0 180393 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X X X LAKE REGION HEALTHCARE CORPORATION 2187368000 712 S CASCADE ST PO BOX 728 FERGUS FALLS MN 565380728 X LARRY DORN 2 X 0 0 0 SOLVEIG HALBAKKEN 2 X 0 0 0 DENNIS EMMEN 2 X 0 0 0 DAVID JOHNSON 2 X 0 0 0 STEPHEN RUFER 2 X 0 0 0 LESLIE SYVERSON MD 2 X 0 0 0 GARY SPIES 2 X 0 0 0 MARY LAMPY VELO 2 X 0 0 0 DAVID BJORK MD 2 X 0 0 0 PAUL ETZELL MD 2 X 0 0 0 LINDA MATTER PHD 2 X 0 0 0 DAVE BICKETT 2 X 0 0 0 TODD MCGOVERN DDS 2 X 0 0 0 DIC PICKET CPA 2 X 0 0 0 CRYSTAL ADAMS 2 X 0 0 0 KATHY BURGAU 2 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 714670 310959 714670 0 286438 286438 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 212824 0 206884 0 5940 0 5940 5940 0 0 65903 0 39912 25991 0 25991 0 0 0 0 0 0 6768 13270 -6502 -6502 0 0 0 1026537 285876 0 25991 X 43463 43463 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MISCELLANEOUS EXPENSE 9039 9039 0 0 SERVICE CHARGES 45 45 0 0 MEALS & MEETING EXPENSE 1657 1657 0 0 BAD DEBTS 126189 126189 0 0 180393 180393 0 0 944315 1536265 0 0 2288517 1327253 0 0 0 0 0 0 0 0 0 0 0 0 5737417 7479754 0 0 0 0 8970249 10343272 6419 12507 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6419 12507 X 8963830 10330765 0 0 0 0 8963830 10330765 8970249 10343272 X 846144 520791 X 0 1 1 X 0 X X 1 0 0 LAKE REGION HEALTHCARE CORPORATION 410730602 170(b)(1)(A)(iii) 1 1 1 52191 1 52191 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10277 0 254 0 812 0 9719 0 1 1 1026537 180393 846144 573483 0 0 0 -52691 520792 1366936 715287 0 0 0 0 0 715287 0 311250 311250 1026537 256419 0 0 0 76026 76026 180393 0 0 0 180393 SchD_P11_S00_L08 Schedule D, Part XI, Line 8 THERE WAS A TOTAL OF $(52,691) OF RELATED COMPANY TRANSFERS FOR THE LAKE REGION HOSPITAL FOUNDATION. SchD_P12_S00_L04b Schedule D, Part XII, Line 4b THERE WAS A TOTAL OF CONTRIBUTIONS OF $275,747, PRESENT VALUE AND PLEDGE ALLOWANCE ADJUSTMENT OF $86,837, FUNDRAISING EXPENSE $(39,912), COST OF GOODS SOLD $(13,270), AND INVESTMENT INCOME OF $1,850. SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d THERE WAS A TOTAL OF ADDITIONAL RELATED PARTY TRANSFERS OF $22,844, COST OF GOODS SOLD OF $13,270 AND $39,912 OF FUNDRAISING EXPENSE. PRCA RODEO 22140 0 22140 0 0 0 0 0 5861 ROCK & ROLL REVUE 31190 0 31190 0 0 0 0 0 24551 5 12572 0 12572 0 0 0 0 0 9500 65902 0 65902 0 0 0 0 0 39912 39912 25990 1 X SchI_P01_S00_L02 Schedule I, Part I, Line 2 GRANTS AWARDED BY THE LAKE REGION HOSPITAL FOUNDATION HAVE TO MEET CERTAIN GUIDELINES WHICH INCLUDE (1) REQUESTS MUST BE FOR HEALTH-RELATED PROGRAMS OR PROJECTS, AND MUST BENEFIT INDIVIDUALS LIVING WITHIN THE LRHC SERVICE AREA (2) NO REQUESTS WILL BE ACCEPTED ON BEHALF OF AN INDIVIDUAL OR A FAMILY (3) NO GRANTS WILL BE MADE TO INSTITUTIONS WHICH IN POLICY OR PRACTICE DISCRIMINATE ON THE BASIS OF RACE, CREED, GENDER, OR SEXUAL ORIENTATION (4) ANY PUBLISHED ARTICLES, PRESS RELEASES, OR INFORMATION RELATED TO THE GRANT RELEASED BY YOUR ORGANIZATION SHOULD STATE THAT THE PROJECT WAS FULLY OR PARTIALLY FUNDED BY DONATIONS TO THE LAKE REGION HOSPITAL FOUNDATION (5) FUNDS AWARDED MUST BE EXPENDED ONLY FOR THE STATED PURPOSE ON THE APPLICATION (6) FUNDS MUST BE DISTRIBUTED WITHIN ONE CALENDAR YEAR OF THE AWARD AND (7) DISBURSEMENTS MAY BE DISCONTINUED IF THE PROGRAM OR PROJECT IS DISCONTINUED, OR ITS ORIGINAL PURPOSE ALTERED. X 7 310959 Market Value 0 0 0 0 F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 LAKE REGION HEALTHCARE CORPORATION IS A SOLE MEMBER. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b COPIES OF THE COMPLETED 990, WITH SUPPORTING SCHEDULES AND FOOTNOTES, WILL BE DISTRIBUTED TO ALL THE FOUNDATION BOARD MEMEBERS SUFFICIENTLY IN ADVANCE OF THE FILING DEADLINE TO ENABLE DETAILED AND CONSCIENTIOUS REVIEW BY ALL BOARD MEMBERS, CHIEF EXECUITVE OFFICER, AND CHIEF FINANCIAL OFFICER TO ENABLE AN OPPORTUNITY FOR FEEDBACK AND CORRECTION. ALL QUESTIONS, CONCERNS, OR OTHER FEEDBACK FROM BOARD MEMBERS WILL BE DIRECTED TO THE LRHC CHIEF FINANCIAL OFFICER AND INCORPORATED INTO THE FORM 990 AS APPROPRIATE. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c OFFICERS AND TRUSTEES ANNUALLY ASSESS WHETHER OR NOT THERE ARE ANY CONFLICTS OF INTEREST ACCORDING TO THE CONFLICTS OF INTERST POLICY. IT IS CONSISTANTLY MONITORED DURING THE YEAR TO BE SURE THAT THE POLICY IS BEING FOLLOWED. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. F990_P09_S00_L24a Form 990, Part IX, Line 24a - 24e THE BAD DEBT EXPENSE OF $126,189 WAS DUE TO WRITING OFF PLEDGES THAT LAKE REGION HOSPITAL FOUNDATION DEEMED UNCOLLECTIBLE. F990_P11_S00_L05 Form 990, Part XI, Line 5 THERE WAS A TOTAL OF $520,792 OF RELATED COMPANY TRANSFERS AND UNREALIZED GAINS ON INVESTMENTS. LAKE REGION HEALTHCARE CORPORATION 712 S CASCADE ST PO BOX 728 FERGUS FALLS MN 565380728 410730602 HOSPITAL MN 501(C)(3) N/A 0 LRHC LONG TERM CARE FACILITIES INC 712 S CASCADE ST PO BOX 728 FERGUS FALLS MN 565380728 411817549 ASSISTED LIVING MN 501(C)(3) LAKE REGION HEALTHCARE CORPORATION 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0