STILLWATER MEDICAL GROUP: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
STILLWATER MEDICAL GROUP (EIN 83-0379473)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-14
IRS object ID
201323189349305442
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-14T15:29:24-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN135665207EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14200 WELLS FARGO CTR 90 S 7THAddressLine1
Address Line2STREETAddressLine2
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN830379473EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1STILLWATER MEDICAL GROUPBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSTILNameControl
Phone9528836584Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line18170 33RD AVENUE SOUTH PO BOX 1309AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code554401309ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDOUGLAS E JOHNSONName
TitleCFOTitle
Phone9528836584Phone
Date Signed2013-11-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameJASON DIVINEName
PTINP01076050PTIN
Phone6123055000Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDOUGLAS E JOHNSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line18170 33RD AVENUE SOUTH PO BOX 1309AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code554401309ZIPCode
FieldValueIRS element (for citing)
Gross Receipts46243183GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.STILLWATERMEDICALGROUP.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2003YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionTO MEET THE HEALTHCARE NEEDS OF INDIVIDUALS, FAMILIES & COMMUNITIES OF THE ST. CROIX VALLEY.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members1NbrIndependentVotingMembers
Total Nbr Employees495TotalNbrEmployees
Total Nbr Volunteers1TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1775103ContributionsGrantsPriorYear
Contributions Grants Current Year2292510ContributionsGrantsCurrentYear
Program Service Revenue Prior Year32822761ProgramServiceRevenuePriorYear
Program Service Revenue CY43852723ProgramServiceRevenueCY
Investment Income Prior Year1282InvestmentIncomePriorYear
Investment Income Current Year3898InvestmentIncomeCurrentYear
Other Revenue Prior Year107204OtherRevenuePriorYear
Other Revenue Current Year44762OtherRevenueCurrentYear
Total Revenue Prior Year34706350TotalRevenuePriorYear
Total Revenue Current Year46193893TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year27405095SalariesEtcPriorYear
Salaries Etc Current Year39957104SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year11182017OtherExpensePriorYear
Other Expenses Current Year12985199OtherExpensesCurrentYear
Total Expenses Prior Year38587112TotalExpensesPriorYear
Total Expenses Current Year52942303TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-3880762RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-6748410RevenuesLessExpensesCY
Total Assets BOY38589916TotalAssetsBOY
Total Assets EOY31918395TotalAssetsEOY
Total Liabilities BOY6149354TotalLiabilitiesBOY
Total Liabilities EOY6226243TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY32440562NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY25692152NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO MEET THE HEALTHCARE NEEDS OF INDIVIDUALS, FAMILIES & COMMUNITIES OF THE ST. CROIX VALLEY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense47151637Expense
Grants0Grants
Revenue43852723Revenue
DescriptionSEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTSDescription
Total Program Service Expense47151637TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees495NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members1NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Other WebsiteXOtherWebsite
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DOUG JOHNSONBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6514304581TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1927 CHURCHILL STREET WESTAddressLine1
CitySTILLWATERCity
StateMNState
ZIP Code55082ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelatedOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
REX CATTANACH
DIRECTOR0.10X000
ANDREW E DORWART MD
CHAIR & DIRECTOR60.00X436085030860
BRIAN H RANK MD
DIRECTOR0.50X068262218207864.50
JEFFREY J ROBERTSON
DIRECTOR & CEO13.30X05700185894032.70X
MARTHA SANFORD MD
DIRECTOR57.00X183970025576
STEPHEN M SCALLON MD
DIRECTOR50.00X267554018986
THOMAS J STORMONT MD
DIRECTOR60.00X815202039650
DON WESSELL MD
DIRECTOR55.00X260558022470
DOUGLAS E JOHNSON
TREASURER & CFO16.0002979955087439.00X
MATHEW RICHIE
ADMINISTRATOR45.00200055022213X
KEVIN J BJORK MD
PHYSICIAN50.00459308033381X
CANDY COREY
PHYSICIAN50.00436469026644X
LAURA A DEAN
PHYSICIAN70.00383363022314X
BRUCE F DENNISON
PHYSICIAN40.00337738029346X
BENJAMIN G WILLIAMS
PHYSICIAN50.00463721020634X
FieldValueIRS element (for citing)
Total Reportable Comp From Org4244023TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1550635TotalReportableCompFrmRltdOrgs
Total Other Compensation583966TotalOtherCompensation
Number Individuals GT100 K77NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
GREINER CONSTRUCTION INC
625 MARQUETTE AVE STE 840MINNEAPOLISMN55402CONSTRUCTION SERVICES794825
ALLINA MEDICAL TRANSPORTATION
PO BOX 9382MINNEAPOLISMN554409382TRANSPORTATION SERVICES514394
THREE RIVERS PATHOLOGY
PO BOX 1725MINNETONKAMN55345PATHOLOGY PROFESSIONAL SERVICES237671
INTEREM HEALTHCARE STAFFING SOLUTIONS
8170 33RD AVE SBLOOMINGTONMN55425TEMPORARY STAFFING173623
ST PAUL RADIOLOGY
166 4TH ST EST PAULMN551011421RADIOLOGY PROFESSIONAL SERVICES165638
FieldValueIRS element (for citing)
Number Of Contractors GT100 K10NumberOfContractorsGT100K
Related Organizations1646500RelatedOrganizations
Government Grants468000GovernmentGrants
All Other Contributions178010AllOtherContributions
Total Contributions2292510TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUES6214004127302641273026
PHYSICIAN COVERAGE62441025796972579697
FieldValueIRS element (for citing)
Total Program Service Revenue43852723TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column3898TotalRevenueColumn
Exclusion$3,898ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real78958Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real49290Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real29668Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column29668TotalRevenueColumn
Exclusion$29,668ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUS REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column15094TotalRevenueColumn
Exclusion$15,094ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue15094TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column46193893TotalRevenueColumn
Related Or Exempt Function Income43852723RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$48,660ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1750099Total
Program Services1750099ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total32137989Total
Program Services29651329ProgramServices
Management And General2486660ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1605266Total
Program Services1481609ProgramServices
Management And General123657ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2413285Total
Program Services2227384ProgramServices
Management And General185901ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2050465Total
Program Services1892513ProgramServices
Management And General157952ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total702316Total
Program Services1006649ProgramServices
Management And General-304333ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total75082Total
Program Services6112ProgramServices
Management And General68970ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1047174Total
Program Services481253ProgramServices
Management And General565921ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total946276Total
Program Services90994ProgramServices
Management And General855282ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1427094Total
Program Services647865ProgramServices
Management And General779229ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total22216Total
Program Services3002ProgramServices
Management And General19214ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total7844Total
Program Services887ProgramServices
Management And General6957ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total2335Total
Management And General2335ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2731133Total
Program Services2647096ProgramServices
Management And General84037ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total591753Total
Program Services569821ProgramServices
Management And General21932ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES - MEDICAL342306834154997569
TAXES & ASSESSMENTS641956645165-3209
RECRUITMENT, TRAINING &525699275449250250
MAINTENANCE & REPAIR470241156831313410

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total371012Total
Program Services202080ProgramServices
Management And General168932ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total52942303Total
Program Services47151637ProgramServices
Management And General5790666ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY5848702BOY
EOY846310EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7117500BOY
EOY6077410EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY655021BOY
EOY798175EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY27330BOY
EOY17901EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis28645546LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4466947LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY24941363BOY
EOY24178599EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY38589916BOY
EOY31918395EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY6125405BOY
EOY5212049EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY23949BOY
EOY14194EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY1000000EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY6149354BOY
EOY6226243EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY32440562BOY
EOY25692152EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY32440562BOY
EOY25692152EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY38589916BOY
EOY31918395EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-6748410ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4776111CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5742558CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3850607CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1775103CurrentTaxYearMinus1Year
Current Tax Year1824510CurrentTaxYear
Total17968889Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years39850338CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years40025219CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years21837212CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year32822761CurrentTaxYearMinus1Year
Current Tax Year43852723CurrentTaxYear
Total178388253Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years44626449CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years45767777CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years25687819CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year34597864CurrentTaxYearMinus1Year
Current Tax Year45677233CurrentTaxYear
Total196357142Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509196357142PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years103694CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years99638CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years48457CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1282CurrentTaxYearMinus1Year
Current Tax Year3898CurrentTaxYear
Total256969Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years103694CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years99638CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years48457CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year1282CurrentTaxYearMinus1Year
Current Tax Year3898CurrentTaxYear
Total256969Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years44730143CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years45867415CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years25736276CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year34599146CurrentTaxYearMinus1Year
Current Tax Year45681131CurrentTaxYear
Total196614111Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99870PublicSupportPercentage509
Prior Year Support Percentage0.99820PriorYearSupportPercentage
Investment Income Percentage0.00130InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00180PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$0OtherActivitiesAmount
Total Lobbying Expenditures IIB0TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationSTILLWATER MEDICAL GROUP PAYS FOR CERTAIN CORPORATE AND EMPLOYEE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis571589OtherCostOrOtherBasis
Book Value571589BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis22999341OtherCostOrOtherBasis
Depreciation2793332Depreciation
Book Value20206009BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis72269OtherCostOrOtherBasis
Depreciation10966Depreciation
Book Value61303BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5002347OtherCostOrOtherBasis
Depreciation1662649Depreciation
Book Value3339698BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings24178599TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionPAYABLE TO RELATED ORGANIZATION - LAKEVIEW MEMORIAL HOSPITAL ASSOCIATIONDescription
Amount$1,000,000Amount
FieldValueIRS element (for citing)
Total Of Amounts1000000TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt46243183TotRevenueEtcAuditedFinclStmt
Revenue Not Rptd F9900RevenueNotRptdF990
Revenue Subtotal46243183RevenueSubtotal
Other Revenues Not Included-49290OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-49290RevenueNotRptdOnFinStmt
Total Revenue Per Form99046193893TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt52991593TotExpensesEtcAuditedFinclStmt
Other Expenses Included49290OtherExpensesIncluded
Expenses Not Rptd F99049290ExpensesNotRptdF990
Expenses Subtotal52942303ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99052942303TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 4B - OTHER ADJUSTMENTS:RENTAL EXPENSE
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSE

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
ANDREW E DORWART MD
CHAIR & DIRECTOR41436301517706545091900216700466945000
BRIAN H RANK MD
DIRECTOR0487550014645004862201412420408360864700025410
JEFFREY J ROBERTSON
DIRECTOR & CEO0390617017940100033007025933062895800
MARTHA SANFORD MD
DIRECTOR1689120142150843057470198290209546000
STEPHEN M SCALLON MD
DIRECTOR2483700186640520064040125820286540000
THOMAS J STORMONT MD
DIRECTOR7329860621500200660114820281680854852000
DON WESSELL MD
DIRECTOR23893502162300024740199960283028000
DOUGLAS E JOHNSON
TREASURER & CFO022732407067100028672022202034886900
MATHEW RICHIE
ADMINISTRATOR2000550000041030181100222268000
KEVIN J BJORK MD
PHYSICIAN41563904366900093730240080492689000
CANDY COREY
PHYSICIAN41925001721900093220173220463113000
LAURA A DEAN
PHYSICIAN33859904476400075370147770405677000
BRUCE F DENNISON
PHYSICIAN30649903123900073010220450367084000
BENJAMIN G WILLIAMS
PHYSICIAN45338800010333063880142460484355000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 4BDEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTOR: BRIAN H. RANK $ 27,380
PART I, LINE 6STILLWATER MEDICAL GROUP'S (THE MEDICAL GROUP) OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE EMPLOYED BY THE MEDICAL GROUP, LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC. (THE HOSPITAL) OR BY GROUP HEALTH PLAN, INC. (GHI). THE HOSPITAL AND GHI ARE BOTH RELATED ORGANIZATIONS. COMPENSATION REPORTED IN FORM 990, PART VIII INCLUDES ANY COMPENSATION DERIVED FROM EITHER THE MEDICAL GROUP'S, THE HOSPITAL'S, OR GHI'S MANAGEMENT INCENTIVE PROGRAMS, WHICH INCENT AND REWARD BUSINESS LEADERS WHO HELP THE ORGANIZATION ACHIEVE STATED BUSINESS AND/OR HEALTH IMPROVEMENT GOALS FOR A SPECIFIC FISCAL YEAR. THE PROGRAMS ARE A KEY ELEMENT OF THE PARTICIPANT'S TOTAL COMPENSATION PACKAGE. THE MANAGEMENT INCENTIVE PROGRAMS' REWARDS ARE BASED ON POSITION IN THE ORGANIZATION (E.G. VICE PRESIDENT, DIRECTOR, MANAGER, OTHER SPECIFICALLY IDENTIFIED LEADERS) AND THE ACHIEVEMENT OF BUSINESS AND HEALTH IMPROVEMENT GOALS ESTABLISHED IN A VARIETY OF AREAS. GOALS WILL BE RELATED TO THE ORGANIZATION'S STRATEGIC PLAN AND WILL BE BALANCED. THESE AREAS MAY INCLUDE BUT ARE NOT LIMITED TO PATIENT SATISFACTION, EMPLOYEE SATISFACTION, WORK ENVIRONMENT, EMPLOYEE AND/OR LEADERSHIP DEVELOPMENT, CARE DELIVERY, PATIENT EDUCATION, SIX AIMS, MARKET SHARE, STRATEGIC CAPABILITIES, FINANCIAL PERFORMANCE (NET MARGIN), ETC., AND WILL BE DEFINED ANNUALLY FOR EACH YEAR'S PROGRAM. A NET MARGIN THRESHOLD MUST BE MET FOR ANY PAYMENT TO BE MADE FROM THE PROGRAM AND THERE IS A CAP ON THE MAXIMUM INCENTIVE POTENTIALLY AVAILABLE TO EACH PARTICIPANT.
PART IIISCHEDULE J, PART II - PRIOR REPORTED COMPENSATION: PART II, COLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION. ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, OF ANY PARTICIPANT OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S.SUPPLEMENTAL INFORMATION

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
EXEMPT PURPOSE AND ACHIEVEMENTSFORM 990, PART III, LINE 4ASTILLWATER MEDICAL GROUP (CLINIC), A MULTI-SPECIALTY CLINIC, IS A MINNESOTA NON-PROFIT ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THE CLINIC IS A PART OF STILLWATER HEALTH SYSTEM, A MINNESOTA 501(C)(3) TAX EXEMPT ORGANIZATION, ALONG WITH THE LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, A MINNESOTA 501(C)(3) TAX EXEMPT ORGANIZATION (HOSPITAL), LAKEVIEW MEMORIAL HOSPITAL FOUNDATION, A MINNESOTA 501(C)(3) TAX EXEMPT ORGANIZATION AND ST. CROIX VALLEY HEALTHCARE AND RESEARCH FOUNDATION, A MINNESOTA 501(C)(3) TAX EXEMPT PRIVATE FOUNDATION WHICH DISSOLVED SEPTEMBER 2012. STILLWATER HEALTH SYSTEM IS THE SOLE MEMBER OF THE CLINIC. THROUGH THIS RELATIONSHIP, THE CLINIC IS PART OF THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS (HEALTHPARTNERS). HEALTHPARTNERS, INC. (HPI), A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) WHICH IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(4), IS THE SOLE CORPORATE MEMBER OF HPI-RAMSEY, A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF REGIONS HOSPITAL AND REGIONS HOSPITAL'S SISTER ORGANIZATIONS, REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, STILLWATER HEALTH SYSTEM (LAKEVIEW HEALTH) AND RAMSEY INTEGRATED HEALTH SERVICES, ALL OF WHICH ARE MINNESOTA NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). HPI-RAMSEY IS ALSO THE SOLE CORPORATE MEMBER OF RH-WISCONSIN, INC., A WISCONSIN NON-STOCK CORPORATION THAT IS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). HEALTHPARTNERS, INC. IS ALSO THE SOLE CORPORATE MEMBER OF THE FOLLOWING ORGANIZATIONS THAT ARE MINNESOTA NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C) (3): GROUP HEALTH PLAN, INC. (GHI) (A MINNESOTA LICENSED STAFF MODEL HMO) WHICH IS ALSO THE SOLE CORPORATE MEMBER OF PHYSICIANS NECK & BACK CLINICS, WHICH IS ALSO A MINNESOTA NON-PROFIT CORPORATION EXEMPT UNDER SECTION 501(C) (3); HEALTHPARTNERS RESEARCH & EDUCATION (D/B/A HEALTHPARTNERS INSTITUTE FOR EDUCATION AND RESEARCH (HPIER)), AND RHSC, INC.. RH-WISCONSIN, INC. AND GHI ARE CORPORATE MEMBERS OF HUDSON HOSPITAL, INC. AND WESTFIELDS HOSPITAL, INC., BOTH OF WHICH ARE WISCONSIN NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). RH-WISCONSIN, INC. IS ALSO THE SOLE CORPORATE MEMBER OF WESTERN WISCONSIN EMERGENCY MEDICAL SERVICES COMPANY, AN AMBULANCE SERVICE WHICH IS A WISCONSIN NON-PROFIT CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). TOGETHER, ALL OF THESE RELATED ORGANIZATIONS COMPRISE THE HEALTHPARTNERS FAMILY OF ORGANIZATIONS (HEALTHPARTNERS), WHICH IS AN INTEGRATED HEALTH CARE DELIVERY SYSTEM THAT COMBINES THE PROVISION AND FINANCING OF HEALTH CARE SERVICES, FOR THE PURPOSE OF IMPROVING THE HEALTH OF ITS VARIOUS ENTITIES' MEMBERS, PATIENTS, AND THE BROADER COMMUNITY. HEALTHPARTNERS AND THE CLINIC ALSO PARTNER WITH OTHER PLANS, CARE PROVIDERS AND NON-PROFIT ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION; TO INCREASE ACCESS, CREATE AND DISSEMINATE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY AND COLLABORATE ON SYSTEM IMPROVEMENTS. TOTAL CHARITY CARE PROVIDED (CALCULATED AT COST) WAS $68,891 DURING THIS REPORTING PERIOD.
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER IS STILLWATER HEALTH SYSTEM.
FORM 990, PART VI, SECTION A, LINE 7ATHE MEMBER HAS THE POWER TO RATIFY APPROVE AND REMOVE ALL MEMBERS OF THE BOARD OF DIRECTORS, WITH OR WITHOUT CAUSE.
FORM 990, PART VI, SECTION A, LINE 7BTHE MEMBER HAS RESERVED TO ITSELF THE FOLLOWING POWERS CONCERNING THE GOVERNANCE OF THE CORPORATION: 1. RATIFICATION, APPROVAL AND REMOVAL ALL MEMBERS OF THE BOARD OF DIRECTORS, WITH OR WITHOUT CAUSE. 2. APPROVAL OF ANY MISSION OR VISION STATEMENT OR STATEMENT OF CORPORATE PURPOSE ADOPTED BY THE ORGANIZATION. 3. APPROVAL OF THE ORGANIZATION'S STRATEGIC PLANS, CAPITAL BUDGETS, OPERATING BUDGETS AND FINANCIAL POLICIES. 4. APPROVAL OF ANY PLANS OF MERGER OR CONSOLIDATION BY THE ORGANIZATION WITH ANY FOREIGN OR DOMESTIC ORGANIZATION VOLUNTARY DISSOLUTION OF THE ORGANIZATION, OR SALE, LEASE OR TRANSFER OF THE ORGANIZATION'S REAL ESTATE OR A SIGNIFICANT PORTION OF THE OPERATIONS OR ASSETS OF THE ORGANIZATION. 5. APPROVAL OF THE GRANT OF A SECURITY INTEREST IN ALL OR SUBSTANTIALLY ALL OF THE ORGANIZATION'S ASSETS, OR THE INCURRENCE OF INDEBTEDNESS OR THE GUARANTEE OF ANY INDEBTEDNESS. 6. APPROVAL OF INDIVIDUAL CAPITAL EXPENDITURES BY THE ORGANIZATION, WHETHER BUDGETED OR UNBUDGETED, IN EXCESS OF $500,000. 7. RATIFICATION OF SELECTION AND EVALUATION, AND TERMINATION, OF THE PRESIDENT OF THE ORGANIZATION. 8. APPROVAL OF PHYSICIAN, EMPLOYEE AND EXECUTIVE COMPENSATION PLANS FOR THE ORGANIZATION, INCLUDING CRITERIA FOR INCENTIVE COMPENSATION ARRANGEMENTS. 9. APPROVAL OF ALL SUBSTANTIVE AFFILIATIONS BETWEEN THE ORGANIZATION AND A THIRD PARTY. 10. APPROVAL OF CONFLICTS OF INTEREST POLICIES FOR THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 11THE CLINIC'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF THE CLINIC. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF THE CLINIC, GHI'S INTERNAL LEGAL DEPARTMENT AND THE CLINIC'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF THE CLINIC. THE CLINIC MAKES AVAILABLE TO THE GOVERNING BODY (BOARD OF DIRECTORS) A COPY OF THE 990 FOR REVIEW AND COMMENT PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY WILL BE PROVIDED IN A MAILING TO THE BOARD MEMBERS PRIOR TO THE FILING OF THE 990. EACH BOARD MEMBER WILL HAVE AN OPPORTUNITY TO COMMENT OR ASK QUESTIONS ABOUT THE 990 BEFORE IT IS FILED. THIS PROCESS WILL BE NOTED AND DOCUMENTED IN A WRITTEN MEMO IN THE FILES OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12CTHE ORGANIZATION REQUIRES INTERESTED PERSON TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST. INTERESTED PERSONS ARE EXCLUDED FROM DELIBERATIONS AND VOTES PERTAINING TO THE TRANSACTION OR ARRANGEMENT. ALTERNATIVES TO THE TRANSACTION OR ARRANGEMENT ARE EXPLORED. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE IDENTIFIED THAT DOES NOT GIVE RISE TO CONFLICT OF INTEREST, THE BOARD CONSIDERS THE TRANSACTION OR ARRANGEMENT BASED ON ITS BENEFIT TO THE CORPORATION. IF THE BOARD HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE POSSIBLE CONFLICTS OF INTEREST, IT INFORMS THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORDS THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS IS WARRANTED, THE BOARD DETERMINES THAT THE MEMBER HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT TAKES APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. THE BOARD OF DIRECTORS AND OFFICERS ARE COVERED UNDER THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. DETERMINATIONS OF CONFLICTS OF INTEREST ARE MADE AND REVIEWED AT THE CLINIC PROVIDER LEVEL AND AT THE CORPORATION EXECUTIVE AND BOARD LEVEL.
FORM 990, PART VI, SECTION B, LINE 15THE PROCESS FOR DETERMINING OFFICERS' COMPENSATION INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION IN 2012. EACH YEAR, UNDER THE DIRECTION OF THE LAKEVIEW HEALTH SYSTEM'S COMPENSATION COMMITTEE, AN ANNUAL TOTAL COMPENSATION MARKET REVIEW IS COMPLETED TO PROVIDE A COMPREHENSIVE MARKET REVIEW FOR THE FOLLOWING EXECUTIVE POSITIONS WITHIN LAKEVIEW HEALTH SYSTEM CEO, SYSTEM CFO, CLINIC PRESIDENT, CLINIC ADMINISTRATOR, AND HOSPITAL PRESIDENT. IN 2011, THE COMPENSATION COMMITTEE RETAINED AN INDEPENDENT EXECUTIVE CONSULTING FIRM TO PROVIDE A REVIEW OF ALL COMPONENTS OF COMPENSATION INCLUDING BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. IN 2012, UNDER THE COMMITTEE'S DIRECTION, THE GHI HUMAN RESOURCES DEPARTMENT USED THE SAME RECOGNIZED THIRD PARTY SALARY SURVEYS TO DETERMINE MEDIAN SALARY STRUCTURE CHANGES. BASED ON THIS UPDATED DATA, THE COMMITTEE LEARNED THE COMPENSATION RATES THAT ARE CONSIDERED P50 TO P60 OF THE MARKET FOR COMPARABLE LAKEVIEW POSITIONS. OTHER CONSIDERATIONS OF THE COMMITTEE INCLUDE: ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES, INDIVIDUAL PERFORMANCE, EXPERIENCE, SUBJECTIVE EVALUATION BY BOARD MEMBERS, GENERAL ECONOMIC CONDITIONS, COSTS OF REPLACEMENT, PREVAILING COMMUNITY ATTITUDES AND BELIEFS REGARDING COMPENSATION. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND W2S.
FORM 990, PART VI, SECTION C, LINE 19THE CLINIC'S FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM THE CLINIC OR HEALTHPARTNERS, INC.. THE CLINIC'S ARTICLES OF INCORPORATION ARE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION THROUGH THE MINNESOTA SECRETARY OF STATE'S OFFICE.
AVERAGE HOURS PER WEEK - RELATED ORGANIZATIONFORM 990, PART VII, SECTION A, LINE 1A, COLUMN (B)THE COMPENSATED BOARD MEMBERS AND OFFICERS FREQUENTLY DEVOTE THEIR TIME TO MULTIPLE RELATED ORGANIZATIONS IN A PARTICULAR WEEK. EACH INDIVIDUAL WORKS AN AVERAGE OF APPROXIMATELY 55 HOURS PER WEEK FOR STILLWATER HEALTH SYSTEM AND ITS RELATED ORGANIZATIONS.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (20 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
HEALTHPARTNERS INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309411693838HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATIONMN501(C)(4)N/A1
HPI - RAMSEY
8170 33RD AVE S PO BOX 1309MPLSMN554401309411793333CORPORATE PLANNING AND OVERSIGHTMN501(C)(3)1509(A)(3) TYPE IHEALTHPARTNERS INC
GROUP HEALTH PLAN INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309410797853STAFF MODEL HEALTH MAINTENANCE ORGANIZATIONMN501(C)(3)1170(B)(1) (A)(III)HEALTHPARTNERS INC
HEALTHPARTNERS INSTITUTE FOR EDUCATION AND RESEARCH
8170 33RD AVE S PO BOX 1309MPLSMN554401309411670163HEALTHCARE RESEARCHMN501(C)(3)1509(A)(3) TYPE IGROUP HEALTH PLAN INC
CAPITOL VIEW TRANSITIONAL CARE CENTER
8170 33RD AVE S PO BOX 1309MPLSMN554401309412011453POST HOSPITALIZATION PATIENT CAREMN501(C)(3)1170(B)(1) (A)(III)HPI - RAMSEY
REGIONS HOSPITAL
8170 33RD AVE S PO BOX 1309MPLSMN554401309410956618HOSPITALMN501(C)(3)1170(B)(1) (A)(III)HPI - RAMSEY
REGIONS HOSPITAL FOUNDATION
8170 33RD AVE S PO BOX 1309MPLSMN554401309411888902PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORTMN501(C)(3)1170(B)(1) (A)(VI)HPI - RAMSEY
RHSC INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309411891928HEALTHCARE STAFFINGMN501(C)(3)1509(A)(3) TYPE IIHEALTHPARTNERS INC
WESTFIELDS HOSPITAL INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309390808442HOSPITALWI501(C)(3)1170(B)(1) (A)(III)RH-WISCONSIN
WESTFIELDS HOSPITAL FOUNDATION INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309391770913PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORTWI501(C)(3)1509(A)(3) TYPE IWESTFIELDS HOSPITAL INC
RH-WISCONSIN
8170 33RD AVE S PO BOX 1309MPLSMN554401309202287016CORPORATE PLANNING AND OVERSIGHTWI501(C)(3)1509(A)(3) TYPE IIHPI - RAMSEY
PHYSICIANS NECK AND BACK CLINICS
8170 33RD AVE S PO BOX 1309MPLSMN554401309270684883SPECIALTY PATIENT CAREMN501(C)(3)1509(A)(3) TYPE IIGROUP HEALTH PLAN INC
HUDSON HOSPITAL INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309390804125HOSPITALWI501(C)(3)1170(B)(1) (A)(III)RH-WISCONSIN
HUDSON HOSPITAL FOUNDATION INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309391279567PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORTWI501(C)(3)1170(B)(1) (A)(VI)HUDSON HOSPITAL INC
WESTERN WISCONSIN EMERGENCY MEDICAL SERVICES COMPANY INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309263616590PROVIDE MEDICAL TRANSPORT SERVICESWI501(C)(3)1509(A)(3) TYPE IIRH-WISCONSIN
LAKEVIEW MEMORIAL HOSPITAL FOUNDATION
8170 33RD AVE S PO BOX 1309MPLSMN554401309411386635PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORTMN501(C)(3)1509(A)(3) TYPE IISTILLWATER HEALTH SYSTEM
LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309410811697HOSPITALMN501(C)(3)1170(B)(1) (A)(III)STILLWATER HEALTH SYSTEM
ST CROIX VALLEY HEALTHCARE & RESEARCH FOUNDATION
8170 33RD AVE S PO BOX 1309MPLSMN554401309411923524FOUNDATIONMN501(C)(3)1PFSTILLWATER HEALTH SYSTEM
STILLWATER HEALTH SYSTEM
8170 33RD AVE S PO BOX 1309MPLSMN554401309300221189CORPORATE PLANNING AND OVERSIGHTMN501(C)(3)1509(A)(3) TYPE IIHPI - RAMSEY
RAMSEY INTEGRATED HEALTH SERVICES
8170 33RD AVE S PO BOX 1309MPLSMN554401309411503090IN-HOME PATIENT CAREMN501(C)(3)1509(A)(2)HPI - RAMSEY

Form990 Schedule R Part IV Form990ScheduleRPartIV (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityControlled OrgControlledOrg
HEALTHPARTNERS ADMINISTRATORS INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309411629390THIRD PARTY ADMINISTRATORMNHEALTHPARTNERS INCC1
HEALTHPARTNERS ASSOCIATES INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309522365151MEDICAL CLINIC STAFFING AND ASSET MANAGEMENTMNHEALTHPARTNERS ADMINISTRATORS INCC1
HEALTHPARTNERS SERVICES INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309411683568MEDICAL CLINIC STAFFING AND ASSET MANAGEMENTMNHEALTHPARTNERS ADMINISTRATORS INCC1
HEALTHPARTNERS VENTURES INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309411838197DEVELOP HEALTHCARE BUSINESS OPPORTUNITIESMNHEALTHPARTNERS INCC1
HEALTHPARTNERS INSURANCE COMPANY
8170 33RD AVE S PO BOX 1309MPLSMN554401309411683523MEDICAL AND DENTAL INSURANCEMNHEALTHPARTNERS ADMINISTRATORS INCC1
DENTAL SPECIALTIES INC
8170 33RD AVE S PO BOX 1309MPLSMN554401309451297583DENTAL CLINIC STAFFINGMNHEALTHPARTNERS ADMINISTRATORS INCC1
HEALTHPARTNERS CENTRAL MINNESOTA CLINICS
8170 33RD AVE S PO BOX 1309MPLSMN554401309411236798MEDICAL CLINIC STAFFING AND MANAGEMENTMNHEALTHPARTNERS ADMINISTRATORS INCC1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICESBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeLTransactionType
Amount Involved1709225AmountInvolved

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