LAKEWOOD HEALTH SYSTEM: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- LAKEWOOD HEALTH SYSTEM (EIN 41-1842965)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201323189349305412
- Schema version
- 2012v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-14T14:58:46-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7601 FRANCE AVENUE SOUTH SUITE 400 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411842965 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKEWOOD HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LAKE | NameControl |
| Phone | 2188941515 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 49725 COUNTY 83 | AddressLine1 |
| City | STAPLES | City |
| State | MN | State |
| ZIP Code | 56479 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JIM DREGNEY | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 2188941515 | Phone |
| Date Signed | 2013-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TIM A RITTER CPA | Name |
| PTIN | P00732856 | PTIN |
| Phone | 9525483400 | Phone |
| Date Prepared | 2013-11-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JIM DREGNEY | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 49725 COUNTY 83 | AddressLine1 |
| City | STAPLES | City |
| State | MN | State |
| ZIP Code | 56479 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 92691356 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.LAKEWOODHEALTHSYSTEM.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1996 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE PERSONALIZED HEALTHCARE FOR A LIFETIME. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1070 | TotalNbrEmployees |
| Total Nbr Volunteers | 112 | TotalNbrVolunteers |
| Total Gross UBI | 60013 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -54338 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 230334 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 291186 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 84369027 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 91137423 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 251282 | InvestmentIncomePriorYear |
| Investment Income Current Year | 19310 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 795934 | OtherRevenuePriorYear |
| Other Revenue Current Year | 782839 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 85646577 | TotalRevenuePriorYear |
| Total Revenue Current Year | 92230758 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 45151743 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 47975460 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 308022 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 37597758 | OtherExpensePriorYear |
| Other Expenses Current Year | 40673909 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 82749501 | TotalExpensesPriorYear |
| Total Expenses Current Year | 88649369 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2897076 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3581389 | RevenuesLessExpensesCY |
| Total Assets BOY | 82524477 | TotalAssetsBOY |
| Total Assets EOY | 85105756 | TotalAssetsEOY |
| Total Liabilities BOY | 54000105 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 53013599 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 28524372 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 32092157 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE PERSONALIZED HEALTHCARE FOR A LIFETIME. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 69748477 | Expense |
| Revenue | 91183966 | Revenue |
| Description | LAKEWOOD HEALTH SYSTEM PROVIDED FOR 4,296 INPATIENT HOSPITAL AND SWING-BED DAYS, 2,667 INPATIENT GERIATRIC BEHAVIORAL HEALTH UNIT DAYS, 34,971 RESIDENT DAYS IN THE NURSING HOME, 658 ASSISTED LIVING UNIT RENTED MONTHS, 61,796 MEDICAL AND MENTAL HEALTH RURAL HEALTH CLINIC VISITS AND PROVIDED AMBULANCE, HOSPICE/HOME CARE, AND OTHER PATIENT SERVICES. | Description |
| Total Program Service Expense | 69748477 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 83 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1070 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 0 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JIM DREGNEY CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2188941515 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 49725 COUNTY 83 | AddressLine1 |
| City | STAPLES | City |
| State | MN | State |
| ZIP Code | 56479 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| CHRISTINE ALBRECHT MD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| JULIE BENSON MD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| BARB PETERSON | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| CAROLYN BISEL | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| WILLIAM MENNIS MD | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| MARIE ROSE | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| PAUL WICK | ||||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |||
| LOREN MOREY | ||||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X | ||
| JIM HOFER | ||||||||
| VICE-CHAIRMAN | 1.00 | X | 0 | 0 | 0 | X | ||
| SARAH ISRAELSON MD | ||||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | X | ||
| LARRY LUNDBLAD | ||||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | X | ||
| TIM RICE | ||||||||
| PRESIDENT | 40.00 | X | 360623 | 0 | 36329 | X | ||
| JAMES DREGNEY | ||||||||
| CHIEF FINANCIAL OFFICER | 40.00 | 179906 | 0 | 30952 | X | |||
| CRAIG WOLHOWE | ||||||||
| DIVISION DIRECTOR | 40.00 | 187620 | 0 | 32843 | X | |||
| DANIEL DONAHUE | ||||||||
| DIVISION DIRECTOR | 40.00 | 188477 | 0 | 32391 | X | |||
| LAURIE BACH | ||||||||
| DIVISION DIRECTOR | 40.00 | 192554 | 0 | 20958 | X | |||
| LYNN NEWTON RICE | ||||||||
| DIVISION DIRECTOR | 40.00 | 187819 | 0 | 13480 | X | |||
| JEFFREY D OSEGARD | ||||||||
| DIVISION DIRECTOR | 40.00 | 176812 | 0 | 32060 | X | |||
| ROBERT SCHMIEG | ||||||||
| DIRECTOR ANESTHESIA, CRNA | 40.00 | 339238 | 0 | 23877 | X | |||
| SHERREE ENGEN | ||||||||
| ANESTHETIST | 40.00 | 257098 | 0 | 32380 | X | |||
| BRIAN L HINMAN | ||||||||
| DIRECTOR OF PHARMACY | 40.00 | 153734 | 0 | 19391 | X | |||
| REBECCA LYNN BENNETT | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | 150935 | 0 | 29655 | X | |||
| AMY LYNN WINKELS | ||||||||
| PHYSICIAN ASSISTANT | 40.00 | 146199 | 0 | 29625 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 2521015 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 333941 | TotalOtherCompensation |
| Number Individuals GT100 K | 43 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| LAKEWOOD CLINIC PA | |||||
| 49725 COUNTY 83 | STAPLES | MN | 56479 | PHYSICIAN SERVICES | 9831367 |
| MCKESSON TECHNOLOGIES | |||||
| PO BOX 98347 | CHICAGO | IL | 60673 | EMR | 1678480 |
| BWBR ARCHITECTS | |||||
| 380 ST PETER STREET | ST PAUL | MN | 55102 | ARCHITECTED SERVICES | 896373 |
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 75397 | LOCUM COVERAGE | 648283 |
| QUEST DIAGNOSTICS | |||||
| 12989 COLLECTION CENTER DRIVE | CHICAGO | IL | 60693 | LAB TEST SERVICES | 485617 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 18 | NumberOfContractorsGT100K |
| Fundraising Events | 35417 | FundraisingEvents |
| Government Grants | 64101 | GovernmentGrants |
| All Other Contributions | 191668 | AllOtherContributions |
| Total Contributions | 291186 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT AND RESIDENT SERVICE | 621110 | 89400379 | 89340366 | 60013 |
| OTHER SERVICE REVENUE | 621110 | 810707 | 810707 | |
| OCCUPATIONAL HEALTH | 621300 | 400276 | 400276 | |
| RENTAL REVENUE | 531120 | 261911 | 261911 | |
| FASD | 624100 | 84609 | 84609 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 179541 | TotalRevenueColumn |
| Related Or Exempt Function Income | 179541 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 91137423 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 187894 | TotalRevenueColumn |
| Exclusion | $187,894 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14382 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14382 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14382 | TotalRevenueColumn |
| Exclusion | $14,382 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 283884 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 452468 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -168584 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -168584 | TotalRevenueColumn |
| Exclusion | -$168,584 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 12142 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 35417 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 8130 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4012 | TotalRevenueColumn |
| Exclusion | $4,012 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | FOOD SERVICE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 756012 | TotalRevenueColumn |
| Related Or Exempt Function Income | 106556 | RelatedOrExemptFunctionIncome |
| Exclusion | $649,456 | ExclusionAmount |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8433 | TotalRevenueColumn |
| Exclusion | $8,433 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 764445 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 92230758 | TotalRevenueColumn |
| Related Or Exempt Function Income | 91183966 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 60013 | UnrelatedBusinessRevenue |
| Exclusion | $695,593 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1672824 | Total |
| Management And General | 1672824 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34388266 | Total |
| Program Services | 26993686 | ProgramServices |
| Management And General | 7351799 | ManagementAndGeneral |
| Fundraising | 42781 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1395856 | Total |
| Program Services | 1095702 | ProgramServices |
| Management And General | 298417 | ManagementAndGeneral |
| Fundraising | 1737 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8003696 | Total |
| Program Services | 6282645 | ProgramServices |
| Management And General | 1711094 | ManagementAndGeneral |
| Fundraising | 9957 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2514818 | Total |
| Program Services | 1974051 | ProgramServices |
| Management And General | 537638 | ManagementAndGeneral |
| Fundraising | 3129 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29112 | Total |
| Management And General | 29112 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28036 | Total |
| Management And General | 28036 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7719066 | Total |
| Program Services | 6049093 | ProgramServices |
| Management And General | 1650244 | ManagementAndGeneral |
| Fundraising | 19729 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 251897 | Total |
| Program Services | 197152 | ProgramServices |
| Management And General | 53853 | ManagementAndGeneral |
| Fundraising | 892 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10637994 | Total |
| Program Services | 7774112 | ProgramServices |
| Management And General | 2826205 | ManagementAndGeneral |
| Fundraising | 37677 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2518890 | Total |
| Program Services | 1971461 | ProgramServices |
| Management And General | 538508 | ManagementAndGeneral |
| Fundraising | 8921 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 651617 | Total |
| Program Services | 510001 | ProgramServices |
| Management And General | 139308 | ManagementAndGeneral |
| Fundraising | 2308 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33403 | Total |
| Program Services | 26144 | ProgramServices |
| Management And General | 7141 | ManagementAndGeneral |
| Fundraising | 118 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1909954 | Total |
| Program Services | 1494864 | ProgramServices |
| Management And General | 408325 | ManagementAndGeneral |
| Fundraising | 6765 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4675040 | Total |
| Program Services | 3659015 | ProgramServices |
| Management And General | 999467 | ManagementAndGeneral |
| Fundraising | 16558 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 256076 | Total |
| Program Services | 200423 | ProgramServices |
| Management And General | 54746 | ManagementAndGeneral |
| Fundraising | 907 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL FEES | 7939560 | 7939560 | |
| PROVISION FOR BAD DEBTS | 1680643 | 1680643 | |
| MN CARE TAX | 947238 | 744730 | 202508 |
| SURCHARGES | 834527 | 834527 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 560856 | Total |
| Program Services | 320668 | ProgramServices |
| Management And General | 83645 | ManagementAndGeneral |
| Fundraising | 156543 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 88649369 | Total |
| Program Services | 69748477 | ProgramServices |
| Management And General | 18592870 | ManagementAndGeneral |
| Fundraising | 308022 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4918 | BOY |
| EOY | 4441 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9743427 | BOY |
| EOY | 4341064 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15623480 | BOY |
| EOY | 20410976 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 370887 | BOY |
| EOY | 1529945 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1380588 | BOY |
| EOY | 1302882 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1722974 | BOY |
| EOY | 1674745 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 85884991 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 34133619 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49255497 | BOY |
| EOY | 51751372 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 660703 | BOY |
| EOY | 680129 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3762003 | BOY |
| EOY | 3410202 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 82524477 | BOY |
| EOY | 85105756 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9204769 | BOY |
| EOY | 8631584 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 40276116 | BOY |
| EOY | 38934881 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4483904 | BOY |
| EOY | 5414061 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35316 | BOY |
| EOY | 33073 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54000105 | BOY |
| EOY | 53013599 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28183502 | BOY |
| EOY | 31940899 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 340870 | BOY |
| EOY | 151258 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28524372 | BOY |
| EOY | 32092157 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 82524477 | BOY |
| EOY | 85105756 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3581389 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -13604 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $523 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 523 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | THE ORGANIZATION IS A MEMBER OF MINNESOTA HOSPITAL ASSOCIATION AND A PORTION OF THE MEMBERSHIP DUES IS FOR LOBBYING EXPENSES. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 340870 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 196691 | InvestmentEarningsOrLosses |
| Other Expenditures | 386303 | OtherExpenditures |
| End Of Year Balance | 151258 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 190279 | BeginningOfYearBalance |
| Contributions | 207943 | Contributions |
| Investment Earnings Or Losses | 2559 | InvestmentEarningsOrLosses |
| Other Expenditures | 59911 | OtherExpenditures |
| End Of Year Balance | 340870 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 220292 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 196691 | InvestmentEarningsOrLosses |
| Other Expenditures | 151258 | OtherExpenditures |
| End Of Year Balance | 265725 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 123893 | BeginningOfYearBalance |
| Contributions | 93133 | Contributions |
| Investment Earnings Or Losses | 4328 | InvestmentEarningsOrLosses |
| Other Expenditures | 1062 | OtherExpenditures |
| End Of Year Balance | 220292 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 270098 | BeginningOfYearBalance |
| Contributions | 10996 | Contributions |
| Investment Earnings Or Losses | 6423 | InvestmentEarningsOrLosses |
| Other Expenditures | 163624 | OtherExpenditures |
| End Of Year Balance | 123893 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 1.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 838858 | OtherCostOrOtherBasis |
| Book Value | 838858 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 33811444 | OtherCostOrOtherBasis |
| Depreciation | 13863812 | Depreciation |
| Book Value | 19947632 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 160508 | OtherCostOrOtherBasis |
| Depreciation | 2675 | Depreciation |
| Book Value | 157833 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 47739982 | OtherCostOrOtherBasis |
| Depreciation | 20267132 | Depreciation |
| Book Value | 27472850 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3334199 | OtherCostOrOtherBasis |
| Book Value | 3334199 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 51751372 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| RESIDENTS PERSONAL ACCOUNT | $6,676 |
| SENIOR HOUSING DEPOSITS | $26,397 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 33073 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 90550115 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 90550115 | RevenueSubtotal |
| Other Revenues Not Included | 1680643 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 1680643 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 92230758 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 86968726 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 86968726 | ExpensesSubtotal |
| Other Expenses Not Included | 1680643 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 1680643 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 88649369 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | UNRESTRICTED NET ASSETS CONSIST OF INVESTMENTS AND OTHERWISE UNRESTRICTED AMOUNTS THAT ARE AVAILABLE FOR USE IN CARRYING OUT THE MISSION OF THE ORGANIZATION AND INCLUDE THOSE EXPENDABLE RESOURCES THAT HAVE BEEN DESIGNATED FOR SPECIAL USE BY THE ORGANIZATION'S BOARD OF DIRECTORS. TEMPORARILY RESTRICTED NET ASSETS ARE THOSE WHOSE USE BY THE ORGANIZATION HAS BEEN LIMITED BY DONORS TO A SPECIFIC TIME PERIOD OR PURPOSE. PERMANENTLY RESTRICTED NET ASSETS HAVE BEEN RESTRICTED BY DONORS TO BE MAINTAINED BY THE ORGANIZATION IN PERPETUITY. THE ORGANIZATION HAS NO PERMANENTLY RESTRICTED NET ASSETS |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, ASC TOPIC 740-10, INCOME TAXES, REQUIRES AN ORGANIZATION TO ASSESS WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. MANAGEMENT DOES NOT BELIEVE THE ORGANIZATION HAS ANY MATERIAL UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2012 AND 2011. FEDERAL RETURNS FOR 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 1,680,643. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 1,680,643. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | DINNER AUCTION | NameOfEvent1 |
| Gross Receipts Event1 | 31080 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 25055 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 6025 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 1961 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 2031 | FoodAndBeverageEvent1 |
| Name Of Event2 | GOLF TOURNAMENT | NameOfEvent2 |
| Gross Receipts Event2 | 16479 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 10362 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 6117 | GrossRevenueEvent2 |
| Cash Prizes Event2 | 635 | CashPrizesEvent2 |
| Rent Facility Costs Event2 | 3074 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 429 | FoodAndBeverageEvent2 |
| Gross Receipts Total | 47559 | GrossReceiptsTotal |
| Charitable Contributions Total | 35417 | CharitableContributionsTotal |
| Gross Revenue Total Events | 12142 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 635 | CashPrizesTotalEvents |
| Rent Facility Costs Total Events | 5035 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 2460 | FoodAndBeverageTotalEvents |
| Direct Expense Summary Events | 8130 | DirectExpenseSummaryEvents |
| Net Income Summary | 4012 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 75.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 240.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 722706 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 722706 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00830 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 22785159 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21814608 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 970551 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01120 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 23507865 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21814608 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1693257 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01950 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 169789 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6300 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 163489 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 46261 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 46261 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3339102 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1915344 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1423758 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01640 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 42261 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 42261 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3597413 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1921644 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1675769 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01930 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 27105278 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 23736252 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3369026 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03880 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 11324 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 11324 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 3221 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3221 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 14545 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 14545 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,680,643 | BadDebtExpenseAmount |
| Amount Attributable To | 1042799 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 14931159 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 15594770 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -663611 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKEWOOD HEALTH SYSTEM | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 49725 COUNTY ROAD 83 | AddressLine1 |
| City | STAPLES | City |
| State | MN | State |
| ZIP Code | 56479 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKEWOOD HEALTH SYSTEM | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 75.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 240.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Uninsured Discount | X | UninsuredDiscount |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 7 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (7 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| STAPLES CLINIC | ||||
| 49725 COUNTY ROAD 83 | STAPLES | MN | 56479 | CLINIC |
| PILLAGER CLINIC | ||||
| 653 PILLSBURY ST N STE 1 | PILLAGER | MN | 56473 | CLINIC |
| MOTLEY CLINIC | ||||
| 1233 HWY 10 | MOTLEY | MN | 56466 | CLINIC |
| BROWERVILLE CLINIC | ||||
| 30535 241ST AVE | BROWERVILLE | MN | 56438 | CLINIC |
| EAGLE VALLEY CLINIC | ||||
| 815 HWY 71 S | EAGLE BEND | MN | 56446 | CLINIC |
| LHS CARE CENTER | ||||
| 401 PRAIRIE AVE NE | STAPLES | MN | 56479 | SKILLED NURSING FACILITY |
| ST CLOUD DERMATOLOGY CLINIC | ||||
| 2251 CONNETICUT AVE SO SUITE 3800 | SARTELL | MN | 56377 | CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7G: AMOUNTS USED FOR SUBSIDIZED SERVICES WERE CALCULATED USING DETAILED REPORT DATA KEPT BY THE ORGANIZATION. DATA INCLUDED THE TOTAL CHARGES, ALLOWANCES AND DISCOUNTS, MEDICAID, AND ACTUAL COST OF SERVICES PROVIDED. SUBSIDIZED SERVICES ARE DETERMINED BY THE ORGANIZATION DUE TO THE NEED IN THE COMMUNITY THAT CAN ONLY BE FILLED BY THE ORGANIZATION. | ||
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1680643. | ||
| PART II: LAKEWOOD HEALTH SYSTEM HAS SET ASIDE A SMALL AREA OF LAND ON WHICH A COMMUNITY PARK WAS ESTABLISHED. TO PROMOTE PHYSICAL ACTIVITY IN CHILDREN, LHS PURCHASED PLAYGROUND EQUIPMENT FOR THE PARK. THIS PARK IS THE ONE MOST OFTEN UTILIZED BY CHILDREN AND IS AFFECTIONATELY KNOWN AS THE "DINO PARK" DUE TO SOME OF THE EQUIPMENT HAVING A DINOSAUR THEME.IN 2010, LAKEWOOD HEALTH SYSTEM CREATED A COMMUNITY RELATIONS DIRECTOR POSITION. THE RESPONSIBILITY OF THIS INDIVIDUAL IS TO WORK WITH VARIOUS COMMUNITY AGENCIES AND INDIVIDUALS TO HELP PROMOTE ECONOMIC GROWTH IN THE COMMUNITIES WHERE A LAKEWOOD HEALTH SYSTEM FACILITY IS LOCATED. | ||
| PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLY UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE.FINANCIAL STATEMENT FOOTNOTE 3 ACCOUNTS RECEIVABLE: THE ORGANIZATION'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS INCREASED FROM 46.1% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2011, TO 50.8% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2012. THE ORGANIZATION HAD $1,911,942 AND $6,311,915 OF SELF-PAY ACCOUNTS AT COLLECTION AGENCIES FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011, RESPECTIVELY. THE SELF-PAY ACCOUNTS HELD AT COLLECTION AGENCIES HAVE BEEN FULLY RESERVED FOR AND ARE INCLUDED IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AT THE NET OF THE RECEIVABLE AND ALLOWANCE. BAD DEBT WRITE-OFFS WERE APPROXIMATELY $4,079,000 AND $1,162,000 FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011, RESPECTIVELY. THE ORGANIZATION HAD NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES THAT AFFECTED BAD DEBT WRITE-OFFS DURING 2012 OR 2011, BUT SUBSEQUENT TO DECEMBER 31, 2012, ADDENDUMS TO THE CHARITY CARE POLICY WERE APPROVED WHICH ARE EXPECTED TO INCREASE CHARITY CARE AMOUNTS THAT ARE AVAILABLE TO THE LOWEST INCOME PATIENTS AND REDUCE CHARITY CARE AMOUNTS THAT ARE AVAILABLE TO THOSE PATIENTS WITH A GREATER ABILITY TO PAY. | ||
| PART III, LINE 8: THE MEDICARE ALLOWABLE COST OF CARE RELATING TO PAYMENTS ON LINE 5 WERE CALCULATED USING OUR FILED 2012 MEDICARE COST REPORT. | ||
| PART III, LINE 9B: PATIENTS ARE REQUIRED TO APPLY FOR MEDICAL ASSISTANCE IN ORDER TO RECEIVE A 50% OR GREATER DISCOUNT PER LAKEWOOD'S CUSTOMER ASSITANCE PROGRAM. | ||
| PART V, SECTION B, LINE 11: INCOME OF 75% TO 240% OF FPG WOULD BE ELIGIBLE FOR DISCOUNTED CARE. | LAKEWOOD HEALTH SYSTEM | |
| PART V, SECTION B, LINE 12H: THE AMOUNT INVOICED DOES NOT CHANGE, HOWEVER A DISCOUNT AMOUNT IS DETERMINED BY INCOME LEVEL AND UNINSURED STATUS THAT WILL RESULT IN THE AMOUNT OF PAYMENT, IF ANY, FROM THE FAP-ELIGIBLE PATIENT. | LAKEWOOD HEALTH SYSTEM | |
| PART V, SECTION B, LINE 14G: EACH APPLICABLE ADMISSION AREA HAS A POLICY AVAILABLE FOR THE PATIENT AS NEEDED AND UPON REQUEST. | LAKEWOOD HEALTH SYSTEM | |
| PART V, SECTION B, LINE 20D: UNINSURED PATIENTS MEETING INCOME GUIDELINES WILL NOT BE CHARGED MORE IN WHICH THE PROVIDER WOULD BE REIMBURSED FROM OUR MOST FAVORED INSURER. CHARITY CARE DISCOUNTS ARE DETERMINED BASED ON INCOME LEVELS USING THE FPG. | LAKEWOOD HEALTH SYSTEM | |
| PART VI, LINE 2: THE ORGANIZATION CONDUCTS COMMUNITY SURVEYS AND USES PATIENT FEEDBACK TO ASSESS THE NEEDS OF THE COMMUNITIES IT SERVES. | ||
| PART VI, LINE 3: PATIENT FINANCIAL SERVICES (PFS) STAFF ARE AVAILABLE AND UTILIZED THROUGHOUT THE PATIENT EXPERIENCE. PFS STAFF EDUCATE PATIENTS ON MEANS-TESTED PROGRAMS AVAILABLE TO THE PATIENT AS WELL AS ASSIST THE PATIENT WITH THE CUSTOMER ASSISTANCE APPLICATION PROCESS. PAYMENT PLANS ARE ALSO ESTABLISHED TO ASSIST PATIENTS IN PAYING OFF OBLIGATIONS OWED TO THE ORGANIZATION. | ||
| PART VI, LINE 4: LAKEWOOD HEALTH SYSTEM OFFERS A BROAD SPECTRUM OF CARE. OUR SYSTEM INCLUDES A NEW, STATE-OF-THE-ART MAIN CAMPUS WITH A 25-BED, CRITICAL ACCESS HOSPITAL AND CLINIC (STAPLES, MN); FOUR MODERN SATELLITE CLINICS BROWERVILLE, PILLAGER, MOTLEY & EAGLE BEND, MN), SENIOR SERVICES, HOUSING AND A SPECIALIZED SENIOR BEHAVIORAL HEALTH UNIT (STAPLES, MN), AND A MEDICAL SPA (BAXTER, MN). WE ALSO HAVE ON-STAFF SPECIALISTS AND VISITING PARTNERS, WHICH ALLOWS US TO OFFER COMPREHENSIVE CARE IN THESE VARIOUS COMMUNITIES. ITS NEIGHBOR, MOTLEY, IS JUST A FEW MILES AWAY AND HAS ANOTHER 1,000 PEOPLE. THE TWO TOWNS COLLABORATE ON MANY COMMUNITY-WIDE INITIATIVES, INCLUDING THE LOCAL SCHOOL SYSTEM. STAPLES BOASTS MANY ATTRACTIVE STORE FRONTS AND BUSINESSES IN THE DOWNTOWN AREA, GIVING IT A "MAIN STREET USA" FEEL. STAPLES IS PROUD OF ITS RICH HISTORY AND ACCOMPLISHMENTS IN THE AREAS OF BUSINESS, EDUCATION, HEALTH CARE, ATHLETICS AND CULTURAL ACTIVITIES. COMMUNITY INVOLVEMENT, PASSION, AND LOYALTY IS ALIVE AND WELL IN STAPLES - FROM THE TOWN RALLYING AROUND LOCAL SPORTS TEAMS, TO ATTENDING CONCERTS AND OTHER FINE ARTS - RELATED EVENTS, TO SUPPORTING LOCAL PHILANTHROPIC EFFORTS, TO CULTURAL ACTIVITIES REPRESENTING THE STRONG SCANDINAVIAN & FINNISH ANCESTRIES IN THE AREA. | ||
| PART VI, LINE 5: A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE WITHIN LAKEWOOD'S PRIMARY SERVICE AREA.LHS PROVIDES SPECIAL SERVICES INCLUDING PALLIATIVE CARE, MEDICAL HOME, AND HOME HEATLH, FOR THE COMMUNITY. LHS'S EMERGENCY ROOM IS AVAILABLE TO ALL DESPITE PATIENT FINANCIAL IMPLICATIONS. THERE ARE NO LIMITS IN REGARDS TO THE AMOUNT OF CHARITY CARE OR CAP PROGRAM PARTICIPANTS. GOVERNMENT HEALTH SPONSORED PROGRAMS WOULD INCLUDE MEDICARE AND MEDICAID. LHS IS THE SOLE COMMUNITY PROVIDER IN THE STAPLES AREA. | ||
| PART VI, LINE 6: N/A | ||
| MN | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TIM RICE | ||||||||||||||
| PRESIDENT | 360623 | 0 | 0 | 0 | 0 | 0 | 20446 | 0 | 15883 | 0 | 396952 | 0 | 0 | 0 |
| JAMES DREGNEY | ||||||||||||||
| CHIEF FINANCIAL OFFICER | 179906 | 0 | 0 | 0 | 0 | 0 | 19029 | 0 | 11923 | 0 | 210858 | 0 | 0 | 0 |
| CRAIG WOLHOWE | ||||||||||||||
| DIVISION DIRECTOR | 187620 | 0 | 0 | 0 | 0 | 0 | 20436 | 0 | 12407 | 0 | 220463 | 0 | 0 | 0 |
| DANIEL DONAHUE | ||||||||||||||
| DIVISION DIRECTOR | 188477 | 0 | 0 | 0 | 0 | 0 | 20077 | 0 | 12314 | 0 | 220868 | 0 | 0 | 0 |
| LAURIE BACH | ||||||||||||||
| DIVISION DIRECTOR | 192554 | 0 | 0 | 0 | 0 | 0 | 8549 | 0 | 12409 | 0 | 213512 | 0 | 0 | 0 |
| LYNN NEWTON RICE | ||||||||||||||
| DIVISION DIRECTOR | 187819 | 0 | 0 | 0 | 0 | 0 | 1547 | 0 | 11933 | 0 | 201299 | 0 | 0 | 0 |
| JEFFREY D OSEGARD | ||||||||||||||
| DIVISION DIRECTOR | 176812 | 0 | 0 | 0 | 0 | 0 | 20350 | 0 | 11710 | 0 | 208872 | 0 | 0 | 0 |
| ROBERT SCHMIEG | ||||||||||||||
| DIRECTOR ANESTHESIA, CRNA | 339238 | 0 | 0 | 0 | 0 | 0 | 21600 | 0 | 2277 | 0 | 363115 | 0 | 0 | 0 |
| SHERREE ENGEN | ||||||||||||||
| ANESTHETIST | 257098 | 0 | 0 | 0 | 0 | 0 | 20969 | 0 | 11411 | 0 | 289478 | 0 | 0 | 0 |
| BRIAN L HINMAN | ||||||||||||||
| DIRECTOR OF PHARMACY | 153734 | 0 | 0 | 0 | 0 | 0 | 18821 | 0 | 570 | 0 | 173125 | 0 | 0 | 0 |
| REBECCA LYNN BENNETT | ||||||||||||||
| PHYSICIAN ASSISTANT | 150935 | 0 | 0 | 0 | 0 | 0 | 20086 | 0 | 9569 | 0 | 180590 | 0 | 0 | 0 |
| AMY LYNN WINKELS | ||||||||||||||
| PHYSICIAN ASSISTANT | 146199 | 0 | 0 | 0 | 0 | 0 | 19638 | 0 | 9987 | 0 | 175824 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|
| UNITED HOSPITAL DISTRICT TODD MORRISON CASS AND WADENA COUNTIES MN | ||||||||
| A | 416005558 | 88903ABXX | 2004-12-01 | 32000000 | NEW HOSPITAL CONSTRUCTION | 0 | 0 | 0 |
| UNITED HOSPITAL DISTRICT TODD MORRISON CASS AND WADENA COUNTIES MN | ||||||||
| B | 416005558 | 2007-10-31 | 4800000 | SENIOR CAMPUS RENOVATION | 0 | 0 | 0 | |
| UNITED HOSPITAL DISTRICT TODD MORRISON CASS AND WADENA COUNTIES MN | ||||||||
| C | 416005558 | 2003-09-15 | 5093625 | CONSTRUCTION OF MEDICAL CLINIC AND REFINANCE DEBT | 0 | 0 | 0 | |
| UNITED HOSPITAL DISTRICT TODD MORRISON CASS AND WADENA COUNTIES MN | ||||||||
| D | 416005558 | 2003-09-15 | 612000 | LAND OF NEW HOSPITAL | 0 | 0 | 0 | |
Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)
| Bond ReferenceBondReferenceCd | Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Other Spent ProceedsOtherSpentProceeds |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 2495000 | 32000000 | 549307 | 31450693 | 2006 | 0 | 0 | 1 | 1 | |
| B | 842682 | 4800000 | 96000 | 2787440 | 2011 | 1 | 0 | 1 | 1 | |
| C | 1905120 | 5093625 | 101872 | 1275505 | 2004 | 1 | 0 | 1 | 1 | 3716248 |
| D | 235426 | 612000 | 612000 | 2004 | 0 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Total Private Business UseTotalPrivateBusinessUse | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 1 | 0 | 0 | 0.00400 | 0.00400 | 0 | 0 | 1 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 1 | ||
| C | 0 | 1 | 0 | 0 | 0.02290 | 0.02290 | 0 | 0 | 1 |
| D | 0 | 0 | 0 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Rebate Not Due YetRebateNotDueYet | Exception To RebateExceptionToRebate | No Rebate DueNoRebateDue | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
| C | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
| D | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part V Form990ScheduleKPartV (4 entries)
| Bond ReferenceBondReferenceCd | Proc To Undertk Corrective ActionProcToUndertkCorrectiveAction |
|---|---|
| A | 0 |
| B | 0 |
| C | 0 |
| D | 0 |
Form990 Schedule K Part VI Form990ScheduleKPartVI (3 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, SCHEDULE K, PART III, LINE 9 | THE ORGANIZATION ESTABLISHED WRITTEN PROCEDURES IN 2013 TO ENSURE THAT ALL NONQUALIFIED BONDS OF THE ISSUE ARE REMEDIATED IN ACCORDANCE WITH THE REQUIREMENTS UNDER REGULATIONS 1.141-12 AND 1.145-2. | |
| FORM 990, SCHEDULE K, PART IV, LINE 2 | FOR QUESTION 2B OF PART IV , THE ORGANIZATION HAS ANSWERED "NO" FOR ALL TAX-EXEMPT BONDS. THERE IS NO REBATE CALCULATION DUE YET. THIS CALCULATION IS ONLY PERFORMED ONCE EVERY 5 YEARS. | EXPLANATION FOR THE RESPONSE TO LINE 2B |
| FORM 990, SCHEDULE K, PART IV, LINE 7 | THE ORGANIZATION ESTABLISHED WRITTEN PROCEDURES IN 2013 TO MONITOR THE REQUIREMENTS OF SECTION 148. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNITED HOSPITAL DISTRICT TODD MORRISON CASS AND WADENA COUNTIES MN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 416005558 | IssuerEIN |
| Date Issued | 2009-04-17 | DateIssued |
| Issue Price | 3000000 | IssuePrice |
| Description Of Purpose | CONSTRUCTION OF MEDICAL CLINIC AND REMODEL OF MEDICAL CLINIC | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Amount Retired | 1092516 | AmountRetired |
| Total Proceeds | 3000000 | TotalProceeds |
| Issuance Costs From Proceeds | 60000 | IssuanceCostsFromProceeds |
| Capital Expenditures | 2241239 | CapitalExpenditures |
| Year Of Subst Completion | 2010 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Iss Meet Prvt Security Pay Test | 0 | BondIssMeetPrvtSecurityPayTest |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedProp |
| Non Qualified Bond Remed Procdrs | 1 | NonQualifiedBondRemedProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiled |
| Rebate Not Due Yet | 0 | RebateNotDueYet |
| Exception To Rebate | 0 | ExceptionToRebate |
| No Rebate Due | 0 | NoRebateDue |
| Variable Rate Issue | 1 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqs |
Form990 Schedule K Part V Form990ScheduleKPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Proc To Undertk Corrective Action | 0 | ProcToUndertkCorrectiveAction |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKEWOOD CLINIC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | BOARD MEMBERS HAVE OWNERSHIP INTEREST IN LAKEWOOD CLINIC, PA. | Relationship |
| Amount Of Transaction | 9831367 | AmountOfTransaction |
| Description Of Transaction | THE ORGANIZATION HAS A MEDICAL SERVICE AGREEMENT WITH LAKEWOOD CLINIC, PA FOR THE PROVISION OF PHYSICIAN AND OTHER PROFESSIONAL MEDICAL SERVICES. THE AGREEMENT EXPIRES IN 2016. LAKEWOOD CLINIC, PA IS PAID PER A NEGOTIATED PRICE OF RELATIVE VALUE UNIT (RVU). THE RVU IS DETERMINED BASED ON THIRD-PARTY COMPENSATION DATA. IN ADDITION, THERE ARE COMPENSATION AGREEMENTS FOR SERVICES THAT USE HOURLY RATES DETERMINED USING MARKET DATA TO ENSURE COMPENSATION IS REASONABLE. THERE ARE SPECIALIST POSITIONS THAT RECEIVE AN ANNUAL COMPENSATION THAT IS ALSO DETERMINED USING MARKET DATA. THE FOLLOWING LAKEWOOD HEALTH SYSTEM BOARD MEMBERS HAVE OWNERSHIP IN LAKEWOOD CLINIC, PA: -CHRISTINE ALBRECHT MD -JULIE BENSON MD-SARAH ISRAELSON MD-WILLIAM MENNIS MD | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | TIM RICE, PRESIDENT/CEO, IS MARRIED TO LYNN NEWTON RICE, DIVISION DIRECTOR. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE PREPARER OF FORM 990 EMAILS A COPY OF THE FINAL 990 TO THE ORGANIZATION'S CHIEF FINANCIAL OFFICER. THE CHIEF FINANCIAL OFFICER PERFORMS A DETAIL REVIEW OF FORM 990. THE CHIEF FINANCIAL OFFICER PROVIDES EACH VOTING BOARD MEMBER WITH A COPY OF FORM 990 BEFORE IT IS FILED WITH THE IRS. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ANY INTERESTS WHICH WERE IDENTIFIED AS PART OF THE ANNUAL CONFLICT OF INTEREST DISCLOSURE WOULD BE DOCUMENTED IN THE BOARD OF DIRECTOR MEETING MINUTES. FOR ANY BOARD ACTION THAT REQUIRED A VOTE AND COULD BE INFLUENCED BY A CONFLICT, THE AFFECTED BOARD MEMBER IS NOT PERMITTED TO VOTE ON THE ACTION. THE OFFICERS, DIRECTORS, AND KEY EMPLOYEES COMPLETE A FORMAL CONFLICT OF INTEREST DISCLOSURE ANNUALLY. THE ORGANIZATION ALSO CONSIDERS WHETHER OTHER POTENTIAL CONFLICTS OF INTEREST COULD RESULT FOR ANY OF THESE INDIVIDUALS BASED ON POSSIBLE ACTIONS UNDER CONSIDERATION BY THE ORGANIZATION DURING THE YEAR. | |
| FORM 990, PART VI, SECTION B, LINE 15 | FOR THE CEO, INITIAL COMPENSATION CONSIDERATION IS MADE BASED ON A REVIEW OF SALARY SURVEY DATA COMPILED BY THE MINNESOTA HOSPITAL ASSOCIATION. THIS DATA IS THEN REVIEWED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. AFTER THIS REVIEW, THE DATA IS SUBMITTED TO THE FULL FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR REVIEW ALONG WITH THE ENTIRE ANNUAL BUDGET PACKAGE. FINALLY, THE FULL BUDGET PACKAGE, ALONG WITH ALL SPECIFIC SALARY PROPOSALS ARE SUBMITTED TO THE FULL BOARD OF DIRECTORS FOR FINAL APPROVAL. AT ANY TIME IN THIS PROCESS, ANY OF THE COMMITTEES OR BOARD COULD REQUEST ADDITIONAL INDEPENDENT SALARY INFORMATION SUPPORTING THE PROPOSED SALARY. A FIRM NAMED CLARK CONSULTING IS USED TO PROVIDE ADDITIONAL CEO COMPENSATION DATA. THIS COMPENSATION AMOUNT IS INCLUDED IN THE CEO EMPLOYMENT CONTRACT WHICH IS PREPARED EACH YEAR WITH A ONE YEAR TERM. FOR THE CFO AND THE OTHER DIVISION DIRECTORS, THE PROCESS IS THE SAME EXCEPT THAT THE INDEPENDENT EXTERNAL DATA TYPICALLY STARTS WITH WHAT CLARK CONSULTING PROVIDES. ADDITIONALLY, WE HAVE INCLUDED THE MHA SALARY SURVEY DATA. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THESE DOCUMENTS CAN BE REQUESTED FROM THE ORGANIZATION'S CHIEF FINANCIAL OFFICER. | |
| FORM 990, PART XI, LINE 9: | NET ASSETS RELEASED FROM RESTRICTIONS -13,604. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MEDICAL SPA LLC | |||||||||||||
| 49725 CTY 83 | STAPLES | MN | 56479 | 800807773 | DERMATOLOGY CLINIC AND MEDICAL SPA | MN | N/A | RELATED | 24226 | 159647 | 0 | 1 | 0.50000 |
| LAKEWOOD-CENTRACARE LLC | |||||||||||||
| 49725 CTY 83 | STAPLES | MN | 56479 | 411974939 | CLINICAL SERVICES | MN | N/A | RELATED | 18478 | -55501 | 0 | 1 | 0.50000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Comments