PARK NICOLLET HEALTH SERVICES: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
PARK NICOLLET HEALTH SERVICES (EIN 36-3465840)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-14
IRS object ID
201343189349302989
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)
Timestamp2013-11-14T11:24:32-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line150 South Sixth StreetAddressLine1
CityMinneapolisCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN363465840EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Park Nicollet Health ServicesBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPARKNameControl
Phone9529933108Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line16500 Excelsior BlvdAddressLine1
CitySt Louis ParkCity
StateMNState
ZIP Code55426ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCatherine LenaghName
TitleCFOTitle
Phone9529933108Phone
Date Signed2013-11-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKristina RasmussenName
PTINP00143920PTIN
Phone6123974000Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCATHERINE LENAGHNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line16500 Excelsior BlvdAddressLine1
CitySt Louis ParkCity
StateMNState
ZIP Code55426ZIPCode
FieldValueIRS element (for citing)
Gross Receipts94423341GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.parknicollet.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1986YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionCares for and supports the health, healing, and learning of those served.ActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees9406TotalNbrEmployees
Total Nbr Volunteers12TotalNbrVolunteers
Total Gross UBI26548TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year90023909ProgramServiceRevenuePriorYear
Program Service Revenue CY94377481ProgramServiceRevenueCY
Investment Income Prior Year11187InvestmentIncomePriorYear
Investment Income Current Year-1061647InvestmentIncomeCurrentYear
Other Revenue Prior Year-24930OtherRevenuePriorYear
Other Revenue Current Year-34642OtherRevenueCurrentYear
Total Revenue Prior Year90010166TotalRevenuePriorYear
Total Revenue Current Year93281192TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year5000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year16832711SalariesEtcPriorYear
Salaries Etc Current Year18450743SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year66510834OtherExpensePriorYear
Other Expenses Current Year71769304OtherExpensesCurrentYear
Total Expenses Prior Year83348545TotalExpensesPriorYear
Total Expenses Current Year90220047TotalExpensesCurrentYear
Revenues Less Expenses Prior Year6661621RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3061145RevenuesLessExpensesCY
Total Assets BOY126439298TotalAssetsBOY
Total Assets EOY180813556TotalAssetsEOY
Total Liabilities BOY131489767TotalLiabilitiesBOY
Total Liabilities EOY183173040TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-5050469NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-2359484NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionPark Nicollet Health Services has a mission to care for and support the health, healing, and learning of those served. The focus is on excellent care, delivered in a caring manner, with emphasis on disease prevention and wellness education.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense20332051Expense
Revenue21757658Revenue
DescriptionPark Nicollet Health Services is the parent organization to an integrated care system that includes Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Health Care Products, Park Nicollet Foundation and Park Nicollet Institute. Park Nicollet Health Services and affiliates have more than 8,100 team members, including more than 1,000 physicians on staff. Park Nicollet Health Services is a nonprofit, integrated care delivery system. It is staffed by nationally recognized hospital and clinic doctors, clinical professionals, nurses and other team members who help patients stay healthy and take care of them when they are sick.In 2012, Park Nicollet Health Services and affiliates, a national healthcare improvement leader, continued to make dramatic patient care advances, win prominent awards, expand access to services and integrate efficiency into Park Nicollet Health Services' operations. Park Nicollet Health Services and affiliates also have enhanced community health, increased team member satisfaction and promoted research and education. Park Nicollet Health Services uses five core values to accomplish its mission: care, service, stewardship, joy and learning. Highlights of 2012 that support Park Nicollet Health Service's values include the following: - Park Nicollet Clinic - Rogers opened August 6. The clinic offers Family Medicine, Pediatrics and extended hours. - Melrose Institute opened the doors at its new Maple Grove location in June. Patients are seen for initial assessments and for individual appointments with treatment teams. - Five times the size of the old OB/GYN department at Park Nicollet Clinic-Maple Grove, the expansion at Maple Grove Hospital includes two new services: Perinatology and Urogynecology. - Park Nicollet began a partnership with Virtuwell, an online health pioneer. - Mammo-a-go-go Park Nicollet began offering mobile mammography throughout our service area. - Methodist Hospital qualified for $3.3 million dollars from the Federal Government for "Meaningful Use" of an Electronic Medical Record. Park Nicollet demonstrated with 33 specific measures how we use the Electronic Medical Record for quality. - Park Nicollet was named one of the Top Workplaces in Minnesota by a Star Tribune survey. It recognizes the most progressive companies based on employee opinions about company leadership, communication, career opportunities, workplace environment, managerial skills, pay and benefits. - The Human Rights Campaign recognized Park Nicollet as a Leader in LGBT Healthcare Equality in the Healthcare Equality Index 2012 report. Park Nicollet earned top marks for our commitment to equitable, inclusive care for LGBT patients and their families. Park Nicollet was one of 234 healthcare facilities nationwide to be named. - The U.S. Military awarded Park Nicollet the Patriot Award, which recognizes employers who contribute to national security and protect liberty and freedom by supporting participation in America's National Guard and Reserve Force. - The Leapfrog Group awarded Methodist Hospital an "A" rating in its Hospital Safety Scores. Areas graded include infections, medication mix-ups and acquired injuries (bedsores). - Methodist Hospital was one of only five hospitals in Minnesota chosen by HealthGrades to receive an Emergency Medicine Excellence Award. This placed us in the top five percent of hospitals judged on the 12 most common conditions leading to hospitalization for Medicare recipients. - Eleven Park Nicollet Clinic locations were named to Consumer Reports' Top Clinics list. Of the 522 practices surveyed, only 37 clinics achieved the very highest score. - Park Nicollet was selected for a Reader's Choice Award in several categories including Best Clinic, Best Urgent Care and Best Hospital. Twelve Park Nicollet physicians were also mentioned. - Park Nicollet Foundation awarded $2.4 million in grants. Almost $1.5 million went to support the patient and family experience. More than $860,000 went to community outreach and initiatives. - Park Nicollet Foundation provided no-fee healthcare to 5,000 youth at our community clinics. - More than 1,000 people attended Park Nicollet Foundation's Hope Heals Gala on Nov. 3, raising more than $450,000 to provide children with access to affordable healthcare and sustain the Growing Through Grief program.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense56351828Expense
Revenue72622641Revenue
DescriptionTRIA Orthopaedic Center ("TRIA") is a leader in orthopaedic treatment, providing comprehensive care from diagnosis, to treatment, to rehabilitation, even surgery at one convenient location in Bloomington, Minnesota. TRIA has over 40 highly-trained orthopaedic doctors with a variety of sub-specialties such as sports medicine, acute injury, shoulder, knee, spine, hand and wrist, foot and ankle, hip and fractures. For immediate orthopaedic needs, TRIA offers walk-in care seven days a week through the Acute Injury Clinic, with no appointment needed. TRIA's sports medicine specialists have served as official team physicians for Minnesota's pro sports teams for over 25 years. TRIA is a Limited Liability Company that is fully owned by Park Nicollet Health Services, a nonprofit integrated care delivery system. TRIA's mission is to provide our patients and community with exceptional orthopaedic care and services supported by innovative education and research. TRIA'S belief that the success of TRIA will be sustained through the talent of our people, the satisfaction of the patients we serve, the dedication we share to our profession and the core values/beliefs we will uphold. These values are:PATIENTS: Our patients come firstPEOPLE: Our people are our greatest assetORTHOPAEDICS: Orthopaedics is our focusRESEARCH: Research is fundamental to improving patient careEDUCATION: Education enhances our profession and patient careGROWTH: Sustainable growth creates valueCOMMUNITY: We will be a good neighbor in our communityProgram service accomplishments for TRIA include: - TRIA underwent a major expansion in the past year including moving the administrative offices and physical therapy to larger space in the Northland Plaza Building. This has created space in the TRIA Building to better meet tour overall patient care demands as well as provide a much larger space for continued physical therapy growth. Construction continues through the balance of 2012 with the expansion of our Acute Injury Clinic and additional clinic exam space. - TRIA continues to grow to meet the musculoskeletal needs of the community. In the past year, the TRIA Clinic Services have grown by 9.8%, the Acute Injury Clinic by 7.3%, and Physical Therapy by 20%. Ancillary services have also grown to keep up with demand. X-ray has grown by 17.9% and MRI by 10.6%. - The Hilton Recovery program continues to grow. In the past year, total hip arthroplasty cases were added to the procedures that recover in the Hilton Hotel. The first four cases have now been successfully conducted. Over 450 patients have now taken advantage of this lower-cost program with exceptional patient satisfaction feedback. In the past year, the Hilton Recovery program was awarded Medica's Innovation award. - TRIA continues to lead the way in outcomes measurement. Patient complete extensive pre and post surveys to assess functional outcomes on six different procedure types. Some of TRIA's patient registries are now amongst the most extensive in the industry. In the past few months, surveys are now able to be distributed and completed online. - The TRIA Institute developed a new "Day in the Life of an Orthopaedic Provider" program. This educational program is for students in our community that would like to learn more about the healthcare profession, specifically orthopaedics, and includes the shadowing of TRIA clinicians. - Over 160 free high school physicals were provided for area high school athletes prior to the fall season. - TRIA now provides on athletic trainers in three area high schools including Blake, Holy Angels, and Minnehaha Academy and at Dakota County Technical College. TRIA also provides no-cost athletic training coverage for a number of area high school sporting events. - TRIA provided medical coverage for the following major sporting events in the community in the past year: * Red Bull Crashed Ice Championships in St. Paul, MN. * U.S. Pond Hockey Championships at Lake Nokomis, Jan 20-22, 2012. * Nature Valley Grand Prix Bicycle Festival in St. Paul, Minneapolis, Canon Falls, Menomonie, WI and Stillwater, June 13-17, 2012. - Annually, TRIA trains three sports medicine fellows and medical school residents rotate through TRIA each year. - Every Tuesday morning TRIA provides professional education sessions for area medical students and clinical professionals. TRIA's annual spring sports medicine conference drew over 250 professionals. - TRIA employees raise money for those in need through the Jeans for a Cause program. Employees who contribute $5 are allowed to wear jeans on Fridays. The wearing of Jeans for the Cause buttons signifies the fund raising aspect of the program to patients. - TRIA conducted 2 blood drives in the past year with over 23 employees participating. - TRIA provides periodic Smart Body Talks for the community. The topic for the last seminar was Carpal Tunnel: Conservative and Surgical Management. - TRIA provided free grip strength testing, carpal tunnel screening, and shoulder mobility testing for the Medica LaborCare Health Fair for over 5,000 labor fund members at Target Field, employee health fairs at Toro Company and State Farm Insurance, and Prep 45 Day for the Minnesota State High School League at the Minnesota State Fair. - TRIA's physician's frequently speak and offer free assessments in the community. Most recently, Dr. Anne Moore provided free shoulder mobility assesments for over 120 women at the Women's Wellness Event at the Marriott Minneapolis West Hotel on September 9th and Dr. Joel Boyd addressed injury prevention to team members at Prime Therapeutics on August 22nd.Description
FieldValueIRS element (for citing)
Total Program Service Expense76683879TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
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 Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
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 Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096117NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees9406NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
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Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Number Of8282 Filed0NumberOf8282Filed
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Excess Business Holdings0ExcessBusinessHoldings
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters1LocalChapters
Policies Reference Chapters1PoliciesReferenceChapters
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 Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Catherine LenaghBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9529933108TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line16500 Excelsior BlvdAddressLine1
CitySt Louis ParkCity
StateMNState
ZIP Code55426ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (4 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
Park Nicollet Group Return-See Sch
Directors30.00X12017813107884577726
Park Nicollet Group Return-See Sch
Officers55.0033255450603178X
Park Nicollet Group Return-See Sch
Key Employees55.00373859099515X
Park Nicollet Group Return-See Sch
Highest Compensated Emp55.0004207666305761X
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Total Reportable Comp From Org4901185TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs7315550TotalReportableCompFrmRltdOrgs
Total Other Compensation1586180TotalOtherCompensation
Number Individuals GT100 K29NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Patient Care6214007262264172622641
Services to Affiliates5610002018821520188215
Income - Premier Purch9000991566625154353223093
FieldValueIRS element (for citing)
Total Program Service Revenue94377481TotalProgramServiceRevenue

Investment Income InvestmentIncome

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Total Revenue Column9459TotalRevenueColumn
Exclusion$9,459ExclusionAmount

Gross Rents GrossRents

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Real18128Real

Less Rental Expenses LessRentalExpenses

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Real59043Real

Rental Income Or Loss RentalIncomeOrLoss

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Real-40915Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

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Total Revenue Column-40915TotalRevenueColumn
Exclusion-$40,915ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

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Other12000Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

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Other1083106Other

Gain Or Loss GainOrLoss

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Other-1071106Other

Net Gain Or Loss Investments NetGainOrLossInvestments

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Total Revenue Column-1071106TotalRevenueColumn
Exclusion-$1,071,106ExclusionAmount

Other Revenue Misc OtherRevenueMisc

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DescriptionMiscellaneousDescription
Business Code900099BusinessCode
Total Revenue Column6273TotalRevenueColumn
Related Or Exempt Function Income2818RelatedOrExemptFunctionIncome
Unrelated Business Revenue3455UnrelatedBusinessRevenue
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Total Other Revenue6273TotalOtherRevenue

Total Revenue TotalRevenue

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Total Revenue Column93281192TotalRevenueColumn
Related Or Exempt Function Income94357206RelatedOrExemptFunctionIncome
Unrelated Business Revenue26548UnrelatedBusinessRevenue
Exclusion-$1,102,562ExclusionAmount
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Info In Schedule O Part IXXInfoInScheduleOPartIX

Comp Current Officers Directors CompCurrentOfficersDirectors

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Total5776471Total
Management And General5776471ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

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Total9318391Total
Management And General9318391ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

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Total481770Total
Management And General481770ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

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Total1998136Total
Program Services167849ProgramServices
Management And General1830287ManagementAndGeneral

Payroll Taxes PayrollTaxes

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Total875975Total
Management And General875975ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

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Total438190Total
Management And General438190ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

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Total2025Total
Management And General2025ManagementAndGeneral

Fees For Services Other FeesForServicesOther

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Total47118162Total
Program Services36687415ProgramServices
Management And General10430747ManagementAndGeneral

Advertising Advertising

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Total882415Total
Program Services6387ProgramServices
Management And General876028ManagementAndGeneral

Office Expenses OfficeExpenses

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Total1093855Total
Program Services454659ProgramServices
Management And General639196ManagementAndGeneral

Information Technology InformationTechnology

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Total434382Total
Program Services301467ProgramServices
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Occupancy Occupancy

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Travel Travel

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Program Services2575ProgramServices
Management And General14424ManagementAndGeneral

Conferences Meetings ConferencesMeetings

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Management And General125028ManagementAndGeneral

Interest Interest

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Total15278Total
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Depreciation Depletion DepreciationDepletion

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Total2699543Total
Program Services2345061ProgramServices
Management And General354482ManagementAndGeneral

Insurance Insurance

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Total1042897Total
Program Services115371ProgramServices
Management And General927526ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

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Medical Supplies76064327554227522050
Bad Debt3676914367691400
MN Care tax1195543119554300
Ind exp all- Shared Exp020332051-203320510

All Other Expenses AllOtherExpenses

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Program Services12258ProgramServices
Management And General752836ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

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Program Services76683879ProgramServices
Management And General13536168ManagementAndGeneral
Fundraising0Fundraising

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EOY33563214EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

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Accounts Receivable AccountsReceivable

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EOY11619700EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

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EOY461160EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

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EOY1523592EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis61150991LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec31196768LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY27037739BOY
EOY29954223EOY

Investments Program Related InvestmentsProgramRelated

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BOY6413976BOY
EOY4633879EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3099973BOY
EOY3234693EOY

Total Assets TotalAssets

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BOY126439298BOY
EOY180813556EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

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BOY92087045BOY
EOY90687138EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY39402722BOY
EOY92485902EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY131489767BOY
EOY183173040EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-5050469BOY
EOY-2359484EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-5050469BOY
EOY-2359484EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY126439298BOY
EOY180813556EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3061145ReconcilationRevenueExpenses
Reconcilation Other Changes-370160ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
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)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type3 Func IntXSupportingOrg509a3Type3FuncInt
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation (3 entries)

EINEINType Of OrganizationTypeOfOrganizationListed In Governing DocListedInGoverningDocSupported Organization NotifiedSupportedOrganizationNotifiedOrganized In USOrganizedInUSAmountAmount
Park Nicollet Methodist Hospital
4101320803111$8,449,261
Park Nicollet Clinic
4108349203111$11,472,590
Park Nicollet Institute
4109618624111$410,200
FieldValueIRS element (for citing)
Total Number Of Supported Orgs3TotalNumberOfSupportedOrgs
Sum Of Amounts20332051SumOfAmounts

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Org Belongs To Affiliated GroupXOrgBelongsToAffiliatedGroup

Total Grassroots Lobbying TotalGrassrootsLobbying

FieldValueIRS element (for citing)
Filing Organizations Totals0FilingOrganizationsTotals
Affiliated Group Totals0AffiliatedGroupTotals

Total Direct Lobbying TotalDirectLobbying

FieldValueIRS element (for citing)
Filing Organizations Totals210630FilingOrganizationsTotals
Affiliated Group Totals210630AffiliatedGroupTotals

Total Lobbying Expenditures TotalLobbyingExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals210630FilingOrganizationsTotals
Affiliated Group Totals210630AffiliatedGroupTotals

Other Exempt Purpose Expenditures OtherExemptPurposeExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals90009416FilingOrganizationsTotals
Affiliated Group Totals1013104611AffiliatedGroupTotals

Total Exempt Purpose Expenditures TotalExemptPurposeExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals90220046FilingOrganizationsTotals
Affiliated Group Totals1013315241AffiliatedGroupTotals

Lobbying Nontaxable LobbyingNontaxableAmount

FieldValueIRS element (for citing)
Filing Organizations Totals1000000FilingOrganizationsTotals
Affiliated Group Totals1000000AffiliatedGroupTotals

Grassroots Nontaxable GrassrootsNontaxableAmount

FieldValueIRS element (for citing)
Filing Organizations Totals250000FilingOrganizationsTotals
Affiliated Group Totals250000AffiliatedGroupTotals

Tot Lobbying Grassroot Minus Non Tx TotLobbyingGrassrootMinusNonTx

FieldValueIRS element (for citing)
Filing Organizations Totals0FilingOrganizationsTotals
Affiliated Group Totals0AffiliatedGroupTotals

Tot Lobby Expend Mns Lobbying Nontx TotLobbyExpendMnsLobbyingNontx

FieldValueIRS element (for citing)
Filing Organizations Totals0FilingOrganizationsTotals
Affiliated Group Totals0AffiliatedGroupTotals

Lobbying Nontaxable Amount2 LobbyingNontaxableAmount2

FieldValueIRS element (for citing)
Current Year Minus31000000CurrentYearMinus3
Current Year Minus21000000CurrentYearMinus2
Current Year Minus11000000CurrentYearMinus1
Current Year1000000CurrentYear
Total4000000Total
FieldValueIRS element (for citing)
Lobbying Ceiling$6,000,000LobbyingCeilingAmount

Total Lobbying Expenditures2 TotalLobbyingExpenditures2

FieldValueIRS element (for citing)
Current Year Minus3108350CurrentYearMinus3
Current Year Minus2200569CurrentYearMinus2
Current Year Minus1191800CurrentYearMinus1
Current Year210630CurrentYear
Total711349Total

Grassroots Nontaxable Amount2 GrassrootsNontaxableAmount2

FieldValueIRS element (for citing)
Current Year Minus3250000CurrentYearMinus3
Current Year Minus2250000CurrentYearMinus2
Current Year Minus1250000CurrentYearMinus1
Current Year250000CurrentYear
Total1000000Total
FieldValueIRS element (for citing)
Grassroots Ceiling$1,500,000GrassrootsCeilingAmount

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance52482BeginningOfYearBalance
Contributions23918Contributions
End Of Year Balance76400EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance40627BeginningOfYearBalance
Contributions11855Contributions
End Of Year Balance52482EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance145133BeginningOfYearBalance
Contributions15494Contributions
Grants Or Scholarships120000GrantsOrScholarships
End Of Year Balance40627EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance124503BeginningOfYearBalance
Contributions20630Contributions
End Of Year Balance145133EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance138463BeginningOfYearBalance
Contributions15140Contributions
Grants Or Scholarships29100GrantsOrScholarships
End Of Year Balance124503EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1917864OtherCostOrOtherBasis
Book Value1917864BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis21134OtherCostOrOtherBasis
Depreciation21134Depreciation
Book Value0BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis38548577OtherCostOrOtherBasis
Depreciation14329540Depreciation
Book Value24219037BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis20663416OtherCostOrOtherBasis
Depreciation16846094Depreciation
Book Value3817322BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings29954223TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Due to and from Related Parties$68,996,402
Contingent Malpractice Liability$20,421,943
Post Retirement Obligation$3,067,557
FieldValueIRS element (for citing)
Total Of Amounts92485902TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Intended Use of Endowment Funds:Part V, Line 4:The Term endowment funds for use within Park Nicollet Health Services are for the Caring for Colleagues program.
Description of Uncertain Tax Positions Under FIN 48:Part X, Line 2:There were no unrecognized tax benefits of liabilities for the years ended December 31, 2012, 2011 and 2010.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
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 Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (4 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
Park Nicollet Group Return-See Sch
Directors86278227179682686081185827039127133487125013498135562014238873463504391360
Park Nicollet Group Return-See Sch
Officers210076209748710249912034276002604180392872301884960
Park Nicollet Group Return-See Sch
Key Employees25121308727703536903000006951504733740251910
Park Nicollet Group Return-See Sch
Highest Compensated Emp0402227401680600173320003057610451342700

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 1aPark Nicollet Health Services pays social dues to both the Interlachen and Minneapolis Club in the name of David Abelson, CEO for the use by all Park Nicollet Health Services officers and key employees. The facilities are used for a variety of business meetings held by key executives from Park Nicollet Health Services. Park Nicollet Health Services considers these expenses to be business expenses of the organization; therefore these amounts are not considered taxable income to these individuals. Part I, Line 3: The Park Nicollet Health Services' Board of Directors is responsible for establishing the compensation of the organization's CEO and Executive Directors.
Part I, Line 4bSenior leaders of Park Nicollet Health Services and affiliates are given the opportunity to participate in the Capital Accumulation Account Plan. The Capital Accumulation Account Plan (CAA Plan) participation is limited to senior leaders and all the vice presidents. Each participant receives an annual allowance equal to the sum of (i) a stated percent of salary, and (ii) voluntary salary deferrals. The allowance is credited to a bookkeeping account. Earnings are credited to the account based on the performance of simulated investments. Benefits vest upon the earliest of remaining employed to an elective vesting date (two years to age 68), involuntary termination without cause, disability, death, or not competing for 24 months following voluntary or for-cause termination. Benefits are paid in a single lump sum upon vesting. Participants are general creditors of the employer for the payment of the benefits.
Part I, Line 7All physicians, employed by and seeing patients for Park Nicollet Health Services and affiliates, are eligible for a 3% access incentive payout based on their department reaching certain goals including access for patients and quality initiatives. In their roles as executives employed by Park Nicollet Health Services, the executives are eligible for incentive payouts. The incentive award will be 35% of base pay compensation for the CEO, 30% for the CFO, COO, CMO and 25% for all other executives with an opportunity for incentive credit above the target level. The ultimate payout includes a reduction/increase multiplier depending on whether the consolidated Park Nicollet Health Services organization reached that year's operating margin goal as set by the Board of Directors. Each participant will be responsible for two financial goals, and not less than three and not more than five individual strategic objectives. In their roles as management employed by Park Nicollet Health Services, certain managers are eligible for incentive payouts. The incentive award will be 15% of their annual base pay compensation with an opportunity for incentive credit above the target level. The ultimate payout includes a reduction/increase multiplier depending on whether the consolidated Park Nicollet Health Services organization reached that year's operating margin goal as set by the Board of Directors. Incentive payments are a function of both individual and organizational performance. The participant must be assigned at least three, and not more than four focused incentive objective, one of which must be financial in nature.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Bond ReferenceBondReferenceCdIssuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
City of St Louis Park
A416005519791748EE22008-08-14223727818Refinance Series 2003 A Bonds issued 11/13/03000
City of St Louis Park
B416005519791748EG72009-12-31182727701Refinance Series 2008A and 2008B's Bond issued 8/14/08000

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Bond ReferenceBondReferenceCdAmount RetiredAmountRetiredTotal ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsWorking Capital ExpendituresWorkingCapitalExpendituresOther Spent ProceedsOtherSpentProceedsYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
A34075000223727818303522441580827686373019480000020081011
B1827277012390838118619561854381614404915920091011

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyEngage Bond Counsel ContractsEngageBondCounselContractsAny Research AgreementsAnyResearchAgreementsEngage Bond Counsel ResearchEngageBondCounselResearchPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUseBond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTestChange In Use Bond Financed PropChangeInUseBondFinancedPropNon Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs
A0111110.000000.000000.00000000
B0111110.000000.000000.00000000

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledRebate Not Due YetRebateNotDueYetException To RebateExceptionToRebateNo Rebate DueNoRebateDueVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedWritten Proc To Monitor ReqsWrittenProcToMonitorReqs
A010000000
B010000000

Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)

Bond ReferenceBondReferenceCdProc To Undertk Corrective ActionProcToUndertkCorrectiveAction
A0
B0

Form990 Schedule K Part VI Form990ScheduleKPartVI (4 entries)

IdentifierIdentifierExplanationExplanation
Explanation of Reporting on an Obligated Group Basis:Pursuant to a loan agreement with the City of St. Louis Park, Minnesota, Park Nicollet Health Services is named as a member of the "Obligated Group" along with Park Nicollet Methodist Hospital, Park Nicollet Clinic, PNMC Holdings, Park Nicollet Institute, and Park Nicollet Health Care Products. Each member of the obligated group is an obligor under the loan agreement. Park Nicollet Health Services did not use bond funds; therefore there are no bonds on the balance sheet. Park Nicollet Health Services is the parent of the Obligated Group, and has elected to report all tax-exempt bond activity on its return.
Part I, Column (c), Line A:The CUSIP shown on Form 8038 is 791740EE2, which is incorrect, the correct value, 791748EE2, is shown here.
Part II, Line 4:The amount shown in column A consists of $20,473,983 in a debt service reserve fund plus $9,878,261 in a debt service fund. The amount shown in column B consists of $18,200,285 in a debt service reserve fund plus $5,708,096 in a debt service fund.
Part II, Line 13:Park Nicollet Health Services determined the year of substantial completion for each issue as follows: The purpose of the issues in column A was to refund prior issues for which the original capital project was complete prior to refunding. Therefore the year of substantial completion is the year of issuance. The purpose of the bond issue in column B was to refund the 2008 A and B bond issue since the related capital project of the 2008 B issue was not yet complete until 2009 the year of substantial completion is 2009.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 2Park Nicollet Health Services and its related entities (Park Nicollet Clinic, Park Nicollet Health Care Products, Park Nicollet Methodist Hospital, Park Nicollet Institute and PNMC Holdings) have a common board. The following officers, board members, and key employees are employees of and paid by Park Nicollet Health Services or its related organizations. These employees serve together on the common board which serves Park Nicollet Health Services and its related entities. David Abelson Leslie Baken, MD Steven Connelly, MD Paul Dominski Roxanna Gapstur, PhD Christa Getchell Tom Jones, MD Michael Kaupa Sheila McMillan Jeff Mendeloff, MD William Richards, MD Janet Schaffer, MD Eric Schned, MD Katherine Tarvestad Theodore Wegleitner Mark Wilkowske, MD
Form 990, Part VI, Section B, line 11Park Nicollet Health Services prepares the Form 990 within the finance department with assistance from individuals in human resources, marketing, and operations. Upon completion of gathering the necessary information for the return, the form was compiled by Park Nicollet Health Services' accounting firm. Drafts of the form were reviewed by the Assistant Controller - Accounting Operations, Vice President of Finance, Chief Financial Officer, and the Audit and Finance Committee. After all internal reviews were complete, the final version of the Form 990 was given to each member of the Board of Directors for approval prior to filing return.
Form 990, Part VI, Section B, line 12cAt Park Nicollet Health Services all key employees, directors, and officers are required to fill out a conflict of interest disclosure statement each year; however the obligation to report potential conflicts is ongoing. The Governance Committee, which meets five times per year, reviews all potential conflicts and discusses the impact on the organization. If a potential conflict arises during the year, it is disclosed and reviewed by the governance committee. The Governance Committee presents the disclosure information and makes recommendations to the Board of Directors regarding management of any conflicts identified. When a transaction involving a potential conflict of interest is identified, the Board of Directors may appoint a disinterested individual or committee to review that conflict and ensure discussions related to those transactions can occur separately from those individuals with potential conflicts. All significant transactions include an analysis of fair market value.
Form 990, Part VI, Section B, line 15The Board of Directors of Park Nicollet Health Services affiliates are those individuals who are contemporaneously members of the Board of Directors of Park Nicollet Health Services. The Park Nicollet Health Services' Board of Directors is responsible for the implementation and oversight of executive compensation and benefit plans. Park Nicollet uses an outside consultant to provide a yearly market based index of salary adjustments for executives in similar leadership positions. The Board of Directors reviews the salary ranges and recommends salary increases for each executive, including the CEO, based upon the Board of Directors' evaluation of job performance and experience level of the individual within the organization. The average salary increases for all Park Nicollet executives cannot exceed the average market salary increase reported for executives by the consultant. The compensation committee then reviews and approves compensation adjustments based on the information provided by the outside consultants and the Board of Directors' recommendations. For certain physicians, the majority of pay disclosed is for his/her work as a physician for Park Nicollet Institute or Park Nicollet Clinic. A small stipend is added for serving on the Board of Directors. The following is a description of how pay for physicians' patient care work is determined. The Park Nicollet Health Services' Board of Directors is responsible for the implementation and oversight of the physician compensation and benefit plans. The Board of Directors delegates the day-to-day administration of the physician compensation plan to the CEO. The Chief Medical Officer, who reports directly to the CEO, administers the compensation program. A compensation and benefits committee serves in an advisory capacity to the CMO in order to administer physician compensation within the budget to ensure fairness and alignment with Park Nicollet Health Services' goals. The responsibilities of the CMO: recommending compensation policies and plan designs for physicians to the CEO and Board of Directors; Overseeing compensation plan operation and payments to clinical departments; Evaluating compensation plan for performance on a periodic basis; Serving as final appeal process for issues unresolved by individuals, department chairs and chiefs of services. Annually, information on each physician's pay and productivity is graphed against the survey results for the same year. This information is presented to the compensation committee of the Park Nicollet Health Services Board of Directors for review. Park Nicollet Health Services' physician pay program is designed to ensure market based pay for market based productivity standards. The market is determined by the American Medical Group Association (AMGA) national physician compensation survey data, which provides market data for both compensation and productivity. When appropriate, the CMO may recommend adjustments to these guidelines with evidence of local market data.
Form 990, Part VI, Section C, line 19Park Nicollet Health Services governing documents, conflict of interest policy and financial statements are available to the public upon request. Park Nicollet Health Services mails its consolidated audited financial statements to financial institutions, governmental institutions, board members, media representatives, vendors, and the Minnesota Hospital Association (MHA). Park Nicollet Health Services discloses quarterly financial statements to bondholders and MHA. The annual audited and quarterly financial statements are also posted at emma.msrb.org. The forms 990 are available upon request or from the state of Minnesota or at Guidestar.org.
Form 990, Part IX, line 11gEmployment: Program service expenses 25,368,027. Management and general expenses 5,256,442. Fundraising expenses 0. Total expenses 30,624,469. Other Purchased Services: Program service expenses 11,319,088. Management and general expenses 2,155,201. Fundraising expenses 0. Total expenses 13,474,289. Management Consultants: Program service expenses 300. Management and general expenses 3,019,104. Fundraising expenses 0. Total expenses 3,019,404.Other Fees
Form 990, Part XI, line 9:Post Retirement Obligation -370,160.Changes in Net Assets or Fund Balances:
Form 990, Part XII, Line 2C:Neither the Oversight Process nor the Selection Process for the review of the audit of Park Nicollet Health Services and affiliates' financial statements have changed during the tax year.
Election:Pursuant to Treasury Reg Section 1.6033-2(d)(5), Park Nicollet Health Services has elected to report information about contributions, gifts & grants, compensation, and other information about officers, directors, trustees, key employees, former employees, certain other highly paid employees, certain professional contractors, and certain other contractors on a consolidated basis for all members of the group, including the parent organization, on the group return of Park Nicollet Group Return (EIN 45-5023260).

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateTotal IncomeTotalIncomeEOY AssetsEOYAssetsBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Deferred Compensation Trust
6500 Excelsior BlvdSt Louis ParkMN55426411809020InvestmentsMN02052369Park Nicollet Health Services
TRIA Orthopaedic Center LLC
8100 Northland DriveBloomingtonMN55431200034003Health CareMN305765141891834Park Nicollet Health Services

Form990 Schedule R Part II Form990ScheduleRPartII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Park Nicollet Methodist Hospital
6500 Excelsior BlvdSt Louis ParkMN55426410132080Health CareMN501(c)(3)3Park Nicollet Health Services1
Park Nicollet Foundation
6500 Excelsior BlvdSt Louis ParkMN55426237346465Grants to serve the communityMN501(c)(3)7Park Nicollet Health Services1
Park Nicollet Clinic
3800 Park Nicollet BlvdSt Louis ParkMN55416410834920Health CareMN501(c)(3)3Park Nicollet Health Services1
Park Nicollet Institute
3800 Park Nicollet BlvdSt Louis ParkMN55416410961862Health Care ResearchMN501(c)(3)4Park Nicollet Health Services1
Park Nicollet Health Care Products
3800 Park Nicollet BlvdSt Louis ParkMN55416010638901Health Care ProductsMN501(c)(3)11 Type IIPark Nicollet Health Services1
PNMC Holdings
3800 Park Nicollet BlvdSt Louis ParkMN55416411741792Health Care Real EstateMN501(c)(3)11 Type IPark Nicollet Clinic1
TRIA Orthopaedic Center Research Institute
8100 Northland DriveBloomingtonMN55431200033919Health Care Research and EducationMN501(c)(3)11 Type IPark Nicollet Health Services1

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Methodist Brain Lab Leasing LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line16500 Excelsior BlvdAddressLine1
CitySt Louis ParkCity
StateMNState
ZIP Code55426ZIPCode
FieldValueIRS element (for citing)
EIN208725994EIN
Primary ActivityHealth CarePrimaryActivity
Legal Domicile StateMNLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Park Nicollet Methodist HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeN/APredominantIncomeType
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner0GeneralOrManagingPartner

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Park Nicollet EnterprisesBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line16500 Excelsior BlvdAddressLine1
CitySt Louis ParkCity
StateMNState
ZIP Code55426ZIPCode
FieldValueIRS element (for citing)
EIN411656735EIN
Primary ActivityReal Estate for Related OrganizationPrimaryActivity
Legal Domicile StateMNLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Park Nicollet Health ServicesBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income4610332ShareOfTotalIncome
Share Of EOY Assets17356551ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
Controlled Org1ControlledOrg
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 Org1GiftGrantOrCapContrFrOtherOrg
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 Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (29 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Park Nicollet Health Care Products
S30724787Cost
Park Nicollet Health Care Products
L1345955Cost
Park Nicollet Health Care Products
Q108078160Cost
Park Nicollet Enterprises
Q4545902Cost
Park Nicollet Methodist Hospital
Q533400692Cost
Park Nicollet Methodist Hospital
P51624Cost
Park Nicollet Methodist Hospital
K1230637Cost
Park Nicollet Methodist Hospital
L8425390Cost
Park Nicollet Methodist Hospital
S466442547Cost
Park Nicollet Institute
Q12680093Cost
Park Nicollet Institute
L412305Cost
Park Nicollet Institute
S11656653Cost
Park Nicollet Clinic
Q455742109Cost
Park Nicollet Clinic
L11485814Cost
Park Nicollet Clinic
S810188339Cost
Park Nicollet Clinic
K3170305Cost
PNMC Holdings
Q2725430Cost
Park Nicollet Foundation
C100000Cost
Park Nicollet Methodist Hospital (TRIA)
P162014Cost
Park Nicollet Methodist Hospital (TRIA)
M1519541Cost
Park Nicollet Methodist Hospital (TRIA)
Q240906Cost
Park Nicollet Health Care Products (TRIA)
P957859Cost
Park Nicollet Clinic (TRIA)
P12841102Cost
Park Nicollet Clinic (TRIA)
M174167Cost
Park Nicollet Clinic (TRIA)
R91657Cost
Park Nicollet Enterprises (TRIA)
P2533156Cost
Park Nicollet Enterprises (TRIA)
K2077176Cost
TRIA Orthopaedic Center Research Institute (TRIA)
J207198Cost
TRIA Orthopaedic Center Research Institute (TRIA)
R113275Cost

Affiliated Group Attachment AffiliatedGroupAttachment

FieldValueIRS element (for citing)
ExplanationPark Nicollet Health Services incurs lobbying expenses on behalf of Park Nicollet Methodist Hospital, Park Nicollet Institute, Park Nicollet Health Care Products and Park Nicollet Clinic. Other exempt expenses relate to the management expenses incurred by Park Nicollet Health Services on behalf of each entity.Explanation

Affiliated Group Schedule AffiliatedGroupSchedule

Affiliated Schedule AffiliatedSchedule (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINElecting OrgElectingOrgTotal Grassroots LobbyingTotalGrassrootsLobbyingTotal Direct LobbyingTotalDirectLobbyingTotal Lobbying ExpendituresTotalLobbyingExpendituresOther Exempt Purpose ExpendituresOtherExemptPurposeExpendituresTotal Exempt Purpose ExpendituresTotalExemptPurposeExpendituresLobbying NontaxableLobbyingNontaxableAmountGrassroots NontaxableGrassrootsNontaxableAmountTot Lobbying Grassroot Minus NontxTotLobbyingGrassrootMinusNontxTot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontxShare Of Excess Lobbying ExpendtrsShareOfExcessLobbyingExpendtrs
Park Nicollet Health Services
6500 Excelsior BoulevardSt Louis ParkMN55416363465840X021063021063099010309640$61,928$15,48201487020
Park Nicollet Methodist Hospital
6500 Excelsior BoulevardSt Louis ParkMN554164101320800003504066635040666$1,000,000$250,000000
Park Nicollet Clinic
3800 Park Nicollet BoulevardSt Louis ParkMN554164108349200004757897747578977$1,000,000$250,000000
Park Nicollet Health Care Products
3800 Park Nicollet BoulevardSt Louis ParkMN5541601063890100055895855589585$429,479$107,370000
Park Nicollet Institute
3800 Park Nicollet BoulevardSt Louis ParkMN5541641096186200017011781701178$235,059$58,765000
PNMC Holdings
3800 Park Nicollet BoulevardSt Louis ParkMN5541641174179200000$0$0000

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