2013-11-14T09:25:11-06:00 2012-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2012-01-01 411328097 RIDGEVIEW FOUNDATION RIDG 9524426010 500 SOUTH MAPLE STREET WACONIA MN 55387 GORDON GABLENZ 9524426010 2013-11-13 1 KURT BENNION P01469618 6123764500 2012 2016-02-25 16:41:14Z ROBERT STEVENS 500 SOUTH MAPLE STREET WACONIA MN 55387 3309609 0 X WWW.RIDGEVIEWMEDICAL.ORG X 1978 MN TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 23 23 0 500 0 0 1945444 1208259 0 0 -56198 243535 31986 113638 1921232 1565432 1110000 1612000 0 0 0 0 0 0 67732 311824 108788 1421824 1720788 499408 -155356 8545416 8561954 248746 342996 8296670 8218958 RIDGEVIEW FOUNDATION IS AN INDEPENDENT NONPROFIT ORGANIZATION THAT PARTNERS WITH RIDGEVIEW MEDICAL CENTER IN ITS MISSION TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 0 0 1612000 1612000 0 TO RAISE FUNDS EXCLUSIVELY FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER IN WACONIA, MINNESOTA, A NOT-FOR-PROFIT HOSPITAL. DURING THE YEAR ENDED DECEMBER 31, 2012, RIDGEVIEW FOUNDATION EXPENSED A TOTAL OF $1,730,870 TO RIDGEVIEW MEDICAL CENTER. $600,000 WAS TRANSFERRED TO PURCHASE A NEW DAVINCI ROBOT SURGERY PROGRAM AT THE HOSPITAL $307,941 WAS TRANSFERRED TO BUILD AND FURNISH A NEW HOSPICE RESIDENCE THAT WAS A NEW SERVICE THAT STARTED IN 2009. $302,444 WAS TRANSFERRED TO THE HOSPITAL TO SUPPORT THE BUILDING AND FURNISHING OF A HEART CENTER AND CATH LAB AT THE HOSPITAL. THE REMAINING $520,485 TRANSFERRED TO THE HOSPITAL WAS USED FOR VARIOUS PROJECTS AND PROGRAMS DURING 2012. 1612000 1 1 0 0 0 0 0 0 0 1 1 1 0 1 0 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 7 0 0 0 0 0 0 0 1 1 0 0 0 0 X 23 23 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X GORDON GABLENZ 9524426010 500 SOUTH MAPLE STREET WACONIA MN 55387 BRIAN MARK 0.50 X X 0 0 0 NANCY BACH 0.50 X 0 0 0 BRIAN BENIEK 0.50 X 0 0 0 JEAN BULLER 0.50 X 0 0 0 DERMOT COWLEY 0.50 X 0 0 0 STACY DESAI 0.50 X 0 0 0 TIM FOSTER 0.50 X 0 0 0 FRED GREEN 0.50 X 0 0 0 MICHAEL GRESSER 0.50 X 0 0 0 KATHY HACKETT 0.50 X 0 0 0 DARLA HOLMGREN 0.50 X 0 0 0 GREG KUMMER 0.50 X 0 0 0 LAURA LANZ 0.50 X 0 0 0 JEFF LAUREL 0.50 X 0 0 0 PETER NELSON 0.50 X 0 0 0 JOHN ROEBKE 0.50 X 0 0 0 KATE ROEHL 0.50 X 0 0 0 DANIEL ROSS 0.50 X 0 0 0 RANDY SCHNEEWIND 0.50 X 0 0 0 CHUCK SPEVACEK 0.50 X 0 0 0 MARK STEINGAS 0.50 X 0 0 0 LARRY WILHELM 0.50 X 0 0 0 DAVID WINDSCHITL 0.50 X 0 0 0 ROBERT STEVENS 0.50 49.50 X 0 339986 164486 GORDON GABLENZ 0.50 49.50 X 0 200608 26020 DOUGLAS STASEK 47.50 2.50 X 0 181836 23192 0 722430 213698 0 0 1 0 0 316200 892059 85072 1208259 65816 65816 1736554 1558835 177719 177719 177719 275380 316200 170586 104794 104794 23600 14756 8844 8844 1565432 0 0 357173 1600000 1600000 12000 12000 6772 6772 12000 12000 787 787 63820 21497 42323 25409 25409 1720788 1612000 41056 67732 1895940 1849916 1235390 582952 3030346 2502324 9697 9697 0 0 708790 1614756 506272 1674950 1505734 8545416 8561954 248746 342996 248746 342996 X 1711083 2012414 5513398 5134265 1072189 1072279 8296670 8218958 8545416 8561954 -155356 77643 0 X 0 1 X 1 0 X 2540736 1096638 1739448 1945444 1208259 8530525 2540736 1096638 1739448 1945444 1208259 8530525 8530525 126263 60771 43863 28520 65816 325233 8855758 1412809 0.96330 0.67530 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1456169 20090 64733 0 12043 1528949 1228652 227270 48325 0 48078 0 1456169 1068586 195012 56843 0 91789 0 1228652 2171052 7534 75524 0 1185524 0 1068586 2142931 303299 -72288 0 0 202890 2171052 0.23900 0.70130 0.05970 0 0 9697 9697 0 0 CORPORATE OBLIGATIONS 506272 F 506272 KEY PERSON LIFE INSURANCE 318359 BRIDGE LOAN TO RIDGEVIEW MEDICAL CENTER 816524 ANNUITY CONTRACT 51222 CASH HELD IN REMAINDER TRUST 319629 1505734 X 2894383 77643 686923 1837801 2602367 292016 1273416 1273416 1565432 2593052 686923 185342 872265 1720787 0 1720787 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: TO SATISFY THE RESTRICTIONS OF DONORS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE FOUNDATION HAS RECEIVED NOTIFICATION THAT IT QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING PROVISIONS OF STATE LAW AND, ACCORDINGLY, IS NOT SUBJECT TO TAXATION. DURING 2010, THE FOUNDATION REQUESTED AND WAS APPROVED TO RECLASSIFY FROM 5099(A)(C) STATUS TO 509(A)(1) AND 170(B)(1)(A)(VI) STATUS WITH THE IRS. THE FOUNDATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE FOUNDATION FOLLOWS THE ACCOUNTING STANDARDS FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAD NO EFFECT ON THE FINANCIAL STATEMENTS. THE FOUNDATION'S INCOME TAX RETURNS ARE SUBJECT TO REVEIW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2010 TO 2012 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 1,837,801. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -185,342. TEMPORARILY RESTRICTED CONTRIBUTIONS 843,488. EVENT PROCEEDS 615,180. PERMANENTLY RESTRICTED CONTRIBUTIONS 90. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 185,342. GOLF TOURNAMENT 464733 295928 168805 18633 115136 FALL HARVEST MOON 126847 20272 106575 36817 1 591580 316200 275380 18633 151953 170586 104794 23600 14756 0 23600 14756 14756 8844 MN 1 0 0 0 1.00000 GORDON GABLENZ 500 SOUTH MAPLE STREET WACONIA MN 55387 0 JAN HELD 66229 JAN HELD IS THE EVENTS COORDINATOR FOR THE FOUNDATION. SHE SUPERVISES ALL FUNDRAISING EVENTS AND FILLS OUT ALL OF THE PAPERWORK RELATED TO GAMING ACTIVITIES. X 1 8844 1 RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 501(C)(3) 1600000 FUNDRAISING SUPPORT OF RIDGEVIEW MEDICAL CENTER 1 0 SCHOLARSHIPS 12 12000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS AND OTHER ASSISTANCE TO ENTITIES IN THE U.S.: TRANSFERS ARE TO RELATED ENTITIES UNDER COMMON MANAGEMENT AND TRACKED THROUGH THE INTERNAL FINANCIAL REPORTING PROCESS. GRANTS AND OTHER ASSISTANCE TO INDIVIDUALS IN THE U.S.: SCHOLARSHIP PAYMENTS ARE MADE DIRECTLY TO THE SCHOOL THAT THE STUDENT IS ATTENDING. 0 1 0 0 0 0 0 0 0 ROBERT STEVENS 0 339986 0 0 0 0 0 154233 0 10253 0 504472 0 0 GORDON GABLENZ 0 200608 0 0 0 0 0 14814 0 11206 0 226628 0 0 DOUGLAS STASEK 0 181836 0 0 0 0 0 13337 0 9855 0 205028 0 0 PART I, LINE 3 THE PRESIDENT/CEO IS COMPENSATED BY RIDGEVIEW MEDICAL CENTER, A RELATED PARTY. RIDGEVIEW MEDICAL CENTER USES THE FOLLOWING WHEN DETERMINING HIS COMPENSATION: 1) COMPENSATION SURVY OR STUDY 2) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART I, LINE 4B ROBERT STEVENS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT SPLIT-DOLLAR WHOLE LIFE PLAN ACCRUED $154,233 DURING 2012. X SUPPLIES AND EQUIPMENT 243 85072 FAIR MARKET VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS OF THE FOUNDATION DESIGNATED SEVEN BOARD MEMBERS AS AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE ACTS ONLY DURING INTERVALS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS OF THE FOUNDATION AND IS AT ALL TIMES SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD OF DIRECTORS OF THE FOUNDATION. DURING SUCH INTERVALS AND SUBJECT TO SUCH CONTROL AND DIRECTION, THE EXECUTIVE COMMITTEE HAS ALL OF THE AUTHORITY AND POWER OF THE BOARD OF DIRECTORS OF THE FOUNDATION IN THE MANAGEMENT OF THE BUSINESS OF THE FOUNDATION, SUBJECT TO SUCH LIMITATIONS AS THE BOARD OF DIRECTORS OF THE FOUNDATION MAY IMPOSE FROM TIME TO TIME. FORM 990, PART VI, SECTION A, LINE 6 RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF RIDGEVIEW FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A EACH PERSON ELECTED BY THE BOARD OF DIRECTORS OF RIDGEVIEW FOUNDATION IS RATIFIED OR REJECTED BY THE BOARD OF DIRECTORS OF RIDGEVIEW MEDICAL CENTER, THE FOUNDATION'S SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B IN ADDITION TO THE APPOINTMENT OF DIRECTORS TO THE BOARD OF DIRECTORS OF RIDGEVIEW FOUNDATION, AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FOUNDATION REQUIRE APPROVAL OF RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE CFO REVIEWED THE FORM 990 AND PROVIDED COPIES TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE RIDGEVIEW FOUNDATION BOARD ANNUALLY REQUIRES EACH OF ITS MEMBERS TO RESPOND TO A CONFLICT OF INTEREST QUESTIONNAIRE. FORM 990, PART VI, SECTION C, LINE 19 RIDGEVIEW FOUNDATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. RIDGEVIEW CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 411651783 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 N/A 0 RIDGEVIEW INSURANCE COMPANY 60 E SOUTH TEMPLE STE 1800 SALT LAKE CITY UT 84111 454109041 CAPTIVE INSRUANCE COMPANY UT 501(C)(3) LINE 11A, I RIDGEVIEW MEDICAL CENTER 0 MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER LCC 500 SOUTH MAPLE STREET WACONIA MN 55387 205785920 CARDIOLOGY SERVICES MN N/A CHASKA PLAZA SURGERY CENTER 3000 HUNDERTMARK ROAD CHASKA MN 55318 450975783 SURGERY SERVICES MN N/A EXECUTIVE HEALTH MANAGEMENT SERVICES INC 500 SOUTH MAPLE STREET WACONIA MN 55387 411760239 MANAGEMENT SERVICES MN N/A C 0 CHARITABLE REMAINDER UNITRUST (1) CHARITABLE TRUST MN RIDGEVIEW FOUNDATION T 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0