NORTH MEMORIAL FOUNDATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- NORTH MEMORIAL FOUNDATION (EIN 41-1777966)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201343189349301094
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-14T11:24:28-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390859910 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY VIRCHOW KRAUSE LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 S 6TH ST STE 2300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411777966 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH MEMORIAL FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NORT | NameControl |
| Phone | 7635205200 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVENUE NORTH | AddressLine1 |
| City | ROBBINSDALE | City |
| State | MN | State |
| ZIP Code | 554222900 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DON PARK | Name |
| Title | TREASURER | Title |
| Phone | 7635205200 | Phone |
| Date Signed | 2013-11-05 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LAWRENCE H MOHR CPA | Name |
| PTIN | P00447603 | PTIN |
| Phone | 6128764500 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | LOREN TAYLOR | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVENUE NORTH | AddressLine1 |
| City | ROBBINSDALE | City |
| State | MN | State |
| ZIP Code | 554222900 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 2450361 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.NORTHMEMORIAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1993 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | TO SUPPORT NORTH MEMORIAL HEALTH CARE AND ITS COMMITTMENT TO CHANGING AND SAVING LIVES. THROUGH PHILANTHROPY, OUR DONORS ASSIST IN GIVING OUR PATIENTS AND THEIR FAMILIES COMPASSIONATE, REMARKABLE CARE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 240 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1941680 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1727243 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 117846 | InvestmentIncomePriorYear |
| Investment Income Current Year | 129781 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | -280664 | OtherRevenuePriorYear |
| Other Revenue Current Year | 49160 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 1778862 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1906184 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 1619579 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 946726 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 244335 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 501297 | OtherExpensePriorYear |
| Other Expenses Current Year | 765626 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2120876 | TotalExpensesPriorYear |
| Total Expenses Current Year | 1712352 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -342014 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 193832 | RevenuesLessExpensesCY |
| Total Assets BOY | 5941557 | TotalAssetsBOY |
| Total Assets EOY | 6349565 | TotalAssetsEOY |
| Total Liabilities BOY | 403294 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 283837 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5538263 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6065728 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO SUPPORT NORTH MEMORIAL HEALTH CARE AND ITS COMMITMENT TO CHANGING AND SAVING LIVES. THROUGH PHILANTHROPY, OUR DONORS ASSIST IN GIVING OUR PATIENTS AND THEIR FAMILIES COMPASSIONATE, REMARKABLE CARE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 198121 | Expense |
| Grants | 152518 | Grants |
| Description | HOSPICE: IN 2012 THE NORTH MEMORIAL HOSPICE AND PALLATIVE CARE PROGRAM SERVED 1,200 PATIENTS. FOUNDATION DOLLARS WERE UTILIZED TO PAY FOR HEATING, UTILITIES, MEDICAL COSTS, EQUIPMENT, AND OTHER EXPENSES FOR PATIENTS. THE FOUNDATION ALSO PROVIDED SUPPORT FOR MASSAGE AND MUSIC THERAPY FOR PATIENTS. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 280063 | Expense |
| Grants | 232016 | Grants |
| Description | PAY IT FORWARD FUND: THIS FUND WAS ESTABLISHED BY BREAST CANCER SURVIVOR, MICHELLE MOREY AND HER HUSBAND SCOTT BISSEN IN OCTOBER OF 2005. MICHELLE RECOGNIZED THE NEED TO HELP FAMILIES STRUGGLING FINANCIALLY WHILE GOING THROUGH CANCER TREATMENT. IN FEBRURARY OF 2006, THE FIRST PAY IT FORWARD EVENT WAS HELD AND OVER THE LAST SIX YEARS MORE THAN $1,500,000 HAS BEEN RAISED TO HELP CANCER PATIENTS AND THEIR FAMILIES. DURING 2012, THE FUND PROVIDED PATIENT ASSISTANCE IN THE AMOUNT OF $228,599, WITH A MAXIMUM PER PATIENT OF $1,500. PATIENTS ELIGIBLE FOR ASSISTANCE ARE FROM NORTH MEMORIAL, MERCY, UNITY, AND MONTICELLO HOSPITALS. THE FUND IS ADMINISTERED AT NO FEE THROUGH THE FOUNDATION. EACH YEAR THE FUND HELPS NEARLY 200 PATIENTS BUY GROCERIES, PAY THEIR MORTGAGES, HEAT THEIR HOMES, PAY FOR UTILITIES, REPAIR THEIR CARS, AND ASSIST WITH UNFUNDED MEDICAL BILLS. THE FUND HELPS PATIENTS TO PAY EXPENSES SO THEY CAN FOCUS ON WHAT'S REALLY IMPORTANT-GETTING HEALTHY. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 159206 | Expense |
| Grants | 124869 | Grants |
| Description | SAFEJOURNEY PROGRAM: IN RESPONSE TO COMMUNITY NEED AND EMERGENCY AWARENESS OF THE CRUCIAL ROLE HEALTH CARE PROVIDERS CAN PLAY IN ASSISTING ABUSE VICTIMS, NORTH MEMORIAL MEDICAL CENTER DEVELOPED A COMPREHENSIVE RESPONSE TO PROACTIVELY IDENTIFY AND RESPOND TO PATIENTS SUFFERING FROM FAMILY VIOLENCE. FOUNDED IN 1994, SAFEJOURNEY PROVIDES A VARIETY OF DIRECT SERVICES, ADVOCACY, ASSESSMENT, INTERVENTION, PREVENTION AND EDUCATION TO ASSIST OVER ONE THOUSAND INDIVIDUAL VICTIMS OF ABUSE AS WELL AS THE LARGER COMMUNITY EACH YEAR. SERVICES FOCUSED ON THE NORTHERN AND WESTERN TWIN CITIES SUBURBS AND MINNEAPOLIS' NORTH SIDE, INCLUDE 24 HOURS/DAY, SEVEN DAYS/WEEK COVERAGE OF THE HOSPITAL, USING SKILLED VOLUNTEERS TO PROVIDE PATIENT ASSESSMENT AND ADVOCACY; A WEEKLY SUPPORT GROUP FOR BATTERED WOMEN; COMMUNITY AND PROFESSIONAL EDUCATION; AND TEEN VIOLENCE PREVENTION EDUCATION. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 705016 | Expense |
| Grants | 437323 | Grants |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 705016 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 437323 | TotalOfOtherProgramServiceGrnt |
| Total Program Service Expense | 1342406 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 1 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 1 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 48 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 5 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LOREN L TAYLOR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7635814702 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVENUE NORTH | AddressLine1 |
| City | ROBBINSDALE | City |
| State | MN | State |
| ZIP Code | 554222900 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated |
|---|---|---|---|---|---|---|---|
| BRAD BAKKEN | |||||||
| CHAIR | 5.00 | X | X | 0 | 0 | 0 | |
| DON PARK | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| MIKE STEINHAUSER | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| STEINAR BERG | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MARK NIBLICK | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| TIM CRONIN | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LYNN STARKOVICH | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| SUSAN KEENEY | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| CHENG LOR | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LOREN TAYLOR | |||||||
| PRESIDENT & CEO | 2.00 | X | X | 0 | 922034 | 26638 | 50.00 |
| MICHELLE MOREY | |||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| JOSEPH G BOSTON | |||||||
| VICE PRESIDENT | 2.00 | X | 0 | 229583 | 20185 | 50.00 | |
| PATRICK BORAN | |||||||
| VP FINANCE/CFO | 2.00 | X | 0 | 459510 | 22631 | 50.00 | |
| PATRICK BORAN - SERP PAYMENT | |||||||
| VP FINANCE/CFO | 2.00 | X | 0 | 1521420 | 0 | 50.00 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3132547 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 69454 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 564948 | FundraisingEvents |
| Related Organizations | 488664 | RelatedOrganizations |
| All Other Contributions | 673631 | AllOtherContributions |
| Noncash Contributions | 509782 | NoncashContributions |
| Total Contributions | 1727243 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 87596 | TotalRevenueColumn |
| Exclusion | $87,596 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 300000 | Securities |
| Other | 463 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 257815 | Securities |
| Other | 463 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 42185 | Securities |
| Other | 0 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 42185 | TotalRevenueColumn |
| Exclusion | $42,185 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 335059 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 564948 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 285899 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 49160 | TotalRevenueColumn |
| Exclusion | $49,160 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1906184 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $178,941 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 946726 | Total |
| Program Services | 946726 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40000 | Total |
| Program Services | 40000 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22774 | Total |
| Program Services | 19326 | ProgramServices |
| Management And General | 3445 | ManagementAndGeneral |
| Fundraising | 3 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76432 | Total |
| Program Services | 76432 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40300 | Total |
| Program Services | 40300 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3706 | Total |
| Program Services | 3706 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| STAFF SUPPORT | 488691 | 122193 | 122166 | 244332 |
| DONATIONS | 42950 | 42950 | ||
| SPONSORSHIPS | 26000 | 26000 | ||
| BAD DEBT | 12500 | 12500 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12273 | Total |
| Program Services | 12273 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1712352 | Total |
| Program Services | 1342406 | ProgramServices |
| Management And General | 125611 | ManagementAndGeneral |
| Fundraising | 244335 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 140695 | BOY |
| EOY | 278870 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 831844 | BOY |
| EOY | 480113 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 99300 | BOY |
| EOY | 81603 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 225000 | LandBuildingsEquipmentBasis |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 229169 | BOY |
| EOY | 225000 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3703301 | BOY |
| EOY | 4295936 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 937248 | BOY |
| EOY | 988043 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5941557 | BOY |
| EOY | 6349565 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 369494 | BOY |
| EOY | 260170 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33800 | BOY |
| EOY | 23667 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 403294 | BOY |
| EOY | 283837 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1155397 | BOY |
| EOY | 1223030 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2035656 | BOY |
| EOY | 2224693 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2347210 | BOY |
| EOY | 2618005 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5538263 | BOY |
| EOY | 6065728 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5941557 | BOY |
| EOY | 6349565 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 193832 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 282838 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 50795 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1625833 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2407544 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2574278 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1941680 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1727243 | CurrentTaxYear |
| Total | 10276578 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 1625833 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2407544 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 2574278 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 1941680 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1727243 | CurrentTaxYear |
| Total | 10276578 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 10393 | AmountsSubstContributorsTotal |
| Public Support Total170 | 10266185 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 88041 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 79699 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 80575 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 117846 | CurrentTaxYearMinus1Year |
| Current Tax Year | 87596 | CurrentTaxYear |
| Total | 453757 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 10730335 | TotalSupport |
| Public Support Pertcentage170 | 0.95670 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.95510 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number DA Fs Held | 5 | NumberDAFsHeld |
| Donor Advised Contributions | 109475 | DonorAdvisedContributions |
| Grants Paid From Donor Funds | 119608 | GrantsPaidFromDonorFunds |
| Aggregate DAF Value | 23667 | AggregateDAFValue |
| Disclosed Orgs Legal Control | 1 | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | 1 | DisclosedForCharitablePurposes |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2382667 | BeginningOfYearBalance |
| Contributions | 270795 | Contributions |
| Investment Earnings Or Losses | 92571 | InvestmentEarningsOrLosses |
| Other Expenditures | 62063 | OtherExpenditures |
| End Of Year Balance | 2683970 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2251229 | BeginningOfYearBalance |
| Contributions | 72500 | Contributions |
| Investment Earnings Or Losses | 71751 | InvestmentEarningsOrLosses |
| Other Expenditures | 12813 | OtherExpenditures |
| End Of Year Balance | 2382667 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1737891 | BeginningOfYearBalance |
| Contributions | 513452 | Contributions |
| Investment Earnings Or Losses | 25341 | InvestmentEarningsOrLosses |
| Other Expenditures | 25455 | OtherExpenditures |
| End Of Year Balance | 2251229 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1537773 | BeginningOfYearBalance |
| Contributions | 58657 | Contributions |
| Investment Earnings Or Losses | 206326 | InvestmentEarningsOrLosses |
| Other Expenditures | 64865 | OtherExpenditures |
| End Of Year Balance | 1737891 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1910328 | BeginningOfYearBalance |
| Contributions | 62422 | Contributions |
| Investment Earnings Or Losses | -425371 | InvestmentEarningsOrLosses |
| Other Expenditures | 9606 | OtherExpenditures |
| End Of Year Balance | 1537773 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 0.97540 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.02460 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 225000 | InvestmentCostOrOtherBasis |
| Book Value | 225000 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 225000 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | FUNDS HELD IN TRUST BY OTHERS | Description |
| Book Value | 988043 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 988043 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DEPOSIT ACCOUNTS | Description |
| Amount | $23,667 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 23667 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | NORTH MEMORIAL EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2012 OR 2011. NORTH MEMORIAL IS NOT CURRENTLY UNDER EXAMINATION BY ANY TAX JURISDICTION. |
| PART V, LINE 4: 1) RALPH ROSSEN ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED IN 1986 TO PROVIDE RECOGNITION TO NURSING STAFF THAT PROVIDE REMARKABLE SERVICE TO NORTH MEMORIAL PATIENTS AND THEIR FAMILIES. MEMBERS OF THE ROSSEN FAMILY SERVE ON A COMMITTEE ALONG WITH THE VP AND CHIEF NURSING OFFICER OF NORTH MEMORIAL TO SELECT THE RECIPIENTS. 2) HAROLD B. KAISER HONORARY LECTURESHIP ENDOWMENT: DR. KAISER IS THE FOUNDER OF ALLERGY & ASTHMA SPECIALISTS, P.A. ESTABLISHED IN 1966. THE HAROLD B. KAISER HONORARY LECTURESHIP ENDOWMENT PROVIDES FUNDING FOR A KEYNOTE SPEAKER FOR THE ANNUAL ALLERGY & ASTHMA CONFERENCE HELD IN THE MINNEAPOLIS AREA IN MARCH. 3). HAROLD ECKER ENDOWMENT: ESTABLISHED IN 1994 IN HONOR OF THE EXCELLENT CARE THAT MR. ECKER RECEIVED AS A PATIENT AT NORTH MEMORIAL, THE HAROLD ECKER ENDOWMENT PROVIDES A $500 AWARD TO THREE NORTH MEMORIAL EMPLOYEES RECOGNIZING THEIR OUTSTANDING PERFORMANCE AND PERSONAL ATTITUDE. THE AWARD IS OPEN TO ALL EMPLOYEES AND THE WINNERS ARE SELECTED BY A COMMITTEE OF NORTH MEMORIAL EMPLOYEES AND PRESENTED AT THE ANNUAL QUALITY AWARDS LUNCHEON IN NOVEMBER EACH YEAR. 4). RESIDENTIAL HOSPICE ENDOWMENT: THE RESIDENTIAL HOSPICE ENDOWMENT WAS ESTABLISHED BY DR. JOHN AND PATTY MANION TO PROVIDE ASSISTANCE TO THE RESIDENTIAL HOSPICE PROGRAM AT NORTH MEMORIAL. FUNDS ARE USED TO UPGRADE THE FACILITIES AND EQUIPMENT AT THE NORTH RESIDENTIAL HOSPICE FACILITY IN BROOKLYN CENTER, PROVIDE ADDITIONAL PROGRAM SUPPORT, STAFF TRAINING AND TO ASSIST THOSE FAMILIES THAT CANNOT AFFORD THIS SERVICE. 5). HELEN MURRAY MEMORIAL ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED WITH AN IRREVOCABLE CHARITABLE REMAINDER TRUST BY JEANNE MITHUN TO RECOGNIZE THE OUTSTANDING SERVICE THAT NORTH RESIDENTIAL HOSPICE PROVIDED TO HER MOTHER (HELEN MURRAY) AND HER FAMILY. FUNDS ARE USED TO PROVIDE CARE TO INDIVIDUALS UNABLE TO PAY FOR SERVICES AT THE FACILITY. 6). PAY IT FORWARD ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED IN 2009 BY FOUNDER MICHELLE MOREY AND THE PIFF COMMITTEE TO INSURE THAT THE GREAT WORK OF THE PAY IT FORWARD FUND CONTINUES WELL INTO THE FUTURE. EACH YEAR THE FUND HELPS MORE THAN 100 PATIENTS PAY THEIR BILLS SO THAT THEY CAN FOCUS ON WHAT'S REALLY IMPORTANT: GETTING HEALTHY. 7). MEDICAL STAFF ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED IN 2010 BY THE NORTH MEMORIAL MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND NORTH MEMORIAL PROGRAMS SUCH AS JUNIOR VOLUNTEER SCHOLARSHIP, SAFEJOURNEY, PASTORAL CARE, ETC. |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | DINNER/DANCE GALA | NameOfEvent1 |
| Gross Receipts Event1 | 324337 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 201776 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 122561 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 5575 | CashPrizesEvent1 |
| Food And Beverage Event1 | 97105 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 5500 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 45008 | OtherDirectExpensesEvent1 |
| Name Of Event2 | PAY IT FORWARD CASINO NIGHT | NameOfEvent2 |
| Gross Receipts Event2 | 261244 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 156549 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 104695 | GrossRevenueEvent2 |
| Cash Prizes Event2 | 0 | CashPrizesEvent2 |
| Non Cash Prizes Event2 | 5500 | NonCashPrizesEvent2 |
| Food And Beverage Event2 | 17633 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 8551 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 8506 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 5 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 314426 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 206623 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 107803 | GrossRevenueOtherEvents |
| Cash Prizes Other Events | 0 | CashPrizesOtherEvents |
| Non Cash Prizes Other Events | 104 | NonCashPrizesOtherEvents |
| Rent Facility Costs Other Events | 30906 | RentFacilityCostsOtherEvents |
| Food And Beverage Other Events | 26363 | FoodAndBeverageOtherEvents |
| Other Direct Expenses Other Events | 35148 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 900007 | GrossReceiptsTotal |
| Charitable Contributions Total | 564948 | CharitableContributionsTotal |
| Gross Revenue Total Events | 335059 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 5575 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 5604 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 30906 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 141101 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 14051 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 88662 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 285899 | DirectExpenseSummaryEvents |
| Net Income Summary | 49160 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTH MEMORIAL HEALTH CARE | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVE N | AddressLine1 |
| City | ROBBINSDALE | City |
| State | MN | State |
| ZIP Code | 55422 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 410729979 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 478215 | AmountOfCashGrant |
| Purpose Of Grant | TO SUPPORT NMHC PROGRAMS AND SERVICES | PurposeOfGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE I, PART I, LINE 2: | Identifier |
| Explanation | THE ORGANIZATION ONLY MAKES GRANTS TO RELATED ORGANIZATION NORTH MEMORIAL HEALTH CARE AND RECORDS ARE MAINTAINED AS TO HOW FUNDS ARE DISBURSED BY BOTH ORGANIZATIONS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LOREN TAYLOR | ||||||||||||||
| PRESIDENT & CEO | 0 | 606008 | 0 | 145819 | 0 | 170207 | 0 | 17500 | 0 | 9138 | 0 | 948672 | 0 | 151502 |
| JOSEPH G BOSTON | ||||||||||||||
| VICE PRESIDENT | 0 | 164580 | 0 | 25468 | 0 | 39535 | 0 | 14351 | 0 | 5834 | 0 | 249768 | 0 | 0 |
| PATRICK BORAN | ||||||||||||||
| VP FINANCE/CFO | 0 | 340106 | 0 | 58456 | 0 | 60948 | 0 | 17500 | 0 | 5131 | 0 | 482141 | 0 | 0 |
| PATRICK BORAN - SERP PAYMENT | ||||||||||||||
| VP FINANCE/CFO | 0 | 0 | 0 | 0 | 0 | 1521420 | 0 | 0 | 0 | 0 | 0 | 1521420 | 0 | 1375503 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SUPPLEMENTAL INFORMATION | PART III | THE FOUNDATION DOES NOT COMPENSATE ANY INDIVIDUALS. THE ORGANIZATION RELIED ON NORTH MEMORIAL HEALTH CARE (NMHC) IN SETTING THE COMPENSATION FOR THOSE INDIVIDUALS. NMHC USED THE FOLLOWING METHODS TO ESTABLISH THE TOP MANAGEMENT OFFICIALS' COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 1A: JOSEPH BOSTON - THE DUES FOR 2012 WERE $90/ MONTH OR $1,080 PER YEAR. THE NORTH MEMORIAL FOUNDATION UTILIZES THE COUNTRY CLUB TO HOST VARIOUS FUND-RAISING EVENTS THROUGH-OUT THE YEAR THAT SUPPORTS VARIOUS ACTIVITIES FOR NORTH MEMORIAL. PART I, LINE 2: ALL EXPENSES ARE REVIEWED PRIOR TO REIMBURSEMENT AND SIGNED OFF BY THE CEO. NORTH MEMORIAL REPORTS EXECUTIVE EXPENSE REIMBURSEMENT DATA TO THE BOARD OF TRUSTEES ON A PERIODIC BASIS. |
| SUPPLEMENTAL INFORMATION | PART III | PART I, LINE 4B: MR. PATRICK BORAN - SERP PAYMENT MR. BORAN HAS BEEN EMPLOYED BY NORTH MEMORIAL HEALTH CARE (A RELATED ORGANIZATION) FOR TWENTY-NINE YEARS, THE MOST RECENT EIGHTEEN YEARS AS THE CHIEF FINANCIAL OFFICER OF THE ORGANIZATION. THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) WAS ESTABLISHED TO COMPENSATE KEY EMPLOYEES FOR QUALIFIED RETIREMENT PLAN LIMITS. ANNUAL AMOUNTS RELATED TO THIS RETIREMENT BENEFIT WERE ACCRUED AND REPORTED ON THE FORM 990 AS DEFERRED COMPENSATION IN PRIOR YEARS. THE DETERMINATION OF PATRICK BORAN'S TOTAL COMPENSATION (ANNUAL SALARY, DEFERRED COMPENSATION AND EMPLOYEE BENEFITS) IS BASED ON ADVICE FROM A NATIONALLY RECOGNIZED COMPENSATION CONSULTANT REGARDING THE MARKET VALUE OF THE SERVICES MR. BORAN PROVIDES. PATRICK BORAN'S TOTAL COMPENSATION IS APPROVED ANNUALLY BY THE BOARD OF TRUSTEES OF NORTH MEMORIAL HEALTH CARE. IN 2012, A SERP PAYMENT WAS MADE TO PATRICK BORAN IN THE AMOUNT OF $1,521,420. THIS PAYMENT WAS MADE UPON THE ELECTION OF THE PLAN PARTICIPANT (PATRICK BORAN) AS HE MET THE REQUIREMENTS OF AGE PLUS YEARS-OF-SERVICE REQUIRED FOR A PLAN DISTRIBUTION. THIS IS A ONE-TIME PAYMENT AS REQUIRED BY THE AGREEMENT. |
Schedule M IRS990ScheduleM
Works Of Art WorksOfArt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 540 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | PURCHASE PRICE | MethodOfDeterminingRevenues |
Securities Publicly Traded SecuritiesPubliclyTraded
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | X | NonCashCheckbox |
| Number Of Contributions | 1 | NumberOfContributions |
| Noncash Contribs Rptd F990 | 5079 | NoncashContribsRptdF990 |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenues |
Other Non Cash Contributions Table OtherNonCashContributionsTable (2 entries)
| Non Cash CheckboxNonCashCheckbox | DescriptionDescription | Number Of ContributionsNumberOfContributions | Noncash Contribs Rptd F990NoncashContribsRptdF990 | Method Of Determining RevenuesMethodOfDeterminingRevenues |
|---|---|---|---|---|
| X | SILENT AUCTION ITEMS DONATED | 688 | 182101 | FMV |
| X | GOLF BALLS | 25 | 2088 | FMV |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeld |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGifts |
| Third Parties Used | 0 | ThirdPartiesUsed |
Form990 Schedule M Part II Form990ScheduleMPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: | Identifier |
| Return Reference | PART I, COLUMN (B): | ReturnReference |
| Explanation | SCHEDULE M, PART I, COLUMN (B) SHOWS THE NUMBER OF CONTRIBUTORS. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | NORTH MEMORIAL HEALTH CARE IS THE SOLE MEMBER OF THE ORGANIZATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | NORTH MEMORIAL HEALTH CARE, AS THE SOLE MEMBER OF THE ORGANZIATION, DETERMINES THE NUMBER OF BOARD MEMBERS AND ELECTS MEMBERS AT THE ANNUAL MEETING AFTER CONSIDERATION OF NOMINATIONS, IF ANY, FROM THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE APPROVAL OF NORTH MEMORIAL HEALTH CARE AS THE SOLE MEMBER OF THE ORGANZIATION IS REQUIRED FOR THE FOLLOWING ACTIONS OF THE ORGANIZATION'S GOVERNING BODY: (1) AMENDMENTS TO THE GOVERNING DOCUMENTS; (2) MERGER OR CONSOLIDATION OF THE ORGANIZATION; (3) SALE, LEASE, PLEDGE, TRANSFER, ASSIGNMENT OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (4) MORTGAGES OR OTHER SECURITY INTERESTS AFFECTING ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (5) ISSUANCE OF CAPITAL CALLS TO THE MEMBER; AND (6) DISSOLUTION AND LIQUIDATION OF THE ORGANIZATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WILL BE DISTRIBUTED TO ALL BOARD MEMBERS AT THE MEETING CLOSEST TO THE FILING DATE FOR REVIEW AND APPROVAL. | |
| FORM 990, PART VI, SECTION B, LINE 12C | NORTH MEMORIAL HEALTH CARE HAS A CONFLICT OF INTEREST POLICY THAT COVERS CERTAIN EMPLOYEES, PHYSICIANS AND BOARD MEMBERS. THE NORTH MEMORIAL FOUNDATION BOARD OF DIRECTORS SIGNS AN ANNUAL CONFLICT OF INTEREST STATEMENT IN ACCORDANCE WITH THIS POLICY. IF A BOARD MEMBER DISCLOSES A CONFLICT OF INTEREST, THE INFORMATION IS SENT TO LEGAL COUNSEL FOR EVALUATION. PROCEDURES: THE BOARD OF DIRECTORS AND ITS COMMITTEES SHALL USE THE FOLLOWING PROCEDURES FOR DETERMINING CONFLICTS OF INTEREST AND FOR DECIDING HOW TO PROCEED WHEN CONFLICTS OF INTEREST ARE REVEALED: A. DUTY TO DISCLOSE: IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND/OR COMMITTEE MEMBERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. B. DETERMINATION WHETHER A CONFLICT OF INTEREST EXISTS: AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING DIRECTORS OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. C. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST: I) AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. II). THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. III). AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE COMPANY CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IV). IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES OR COMMITTEE MEMBERS WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE COMPANY. THE BOARD OR COMMITTEE SHALL THEN MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. D. RECORDING OF PROCEEDINGS: THE MINUTES OF THE BOARD AND ITS COMMITTEES SHOULD INCLUDE: (I) THE NAMES OF ANY PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED, AND (II) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION WITH THE PROCEEDINGS. | |
| THE ORGANIZATION'S OFFICERS RECEIVED THEIR COMPENSATION FROM NORTH MEMORIAL HEALTH CARE (NMHC) WHICH FOLLOWS NMHC'S POLICIES AND PROCEDURES ON DETERMINING COMPENSATION. | ||
| FORM 990, PART VI, SECTION C, LINE 19 | THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN BENEFICIAL TRUST 50,795. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE OVERSIGHT AND SELECTION PROCESS HAS NOT CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTH MEMORIAL HEALTH CARE | |||||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 410729979 | ACUTE CARE | MN | 501(C)(3) | LINE 3 | NORTH MEMORIAL | 0 | |
| ASSOCIATED HEALTH ASSURANCE | |||||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 980343815 | INSURANCE | 501(C)(3) | 11A | NORTH MEMORIAL | 0 | BD | |
| MAPLE GROVE HOSPITAL CORPORATION | |||||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 208316475 | ACUTE CARE | MN | 501(C)(3) | LINE 3 | NORTH MEMORIAL | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner |
|---|---|---|---|---|---|---|---|---|---|---|
| NORTH MEMORIAL AMBULATORY SURGERY CENTER AT MAPLE GROVE LLC | ||||||||||
| 9855 HOSPITAL DRIVE | MAPLE GROVE | MN | 55369 | 260393039 | OUTPATIENT SURGERY | MN | N/A | |||
| MONTICELLO CANCER CENTER | ||||||||||
| 1013 HARAT BLVD | MONTICELLO | MN | 55362 | 261909519 | CANCER CENTER | MN | N/A | |||
| MINNESOTA DIAGNOSTIC IMAGING PARTNERS LLC | ||||||||||
| 2955 XENIUM LANE SUITE 40 | PLYMOUTH | MN | 55441 | 352162215 | RADIOLOGY | MN | N/A | |||
| NORTH RADIATION THERAPY CENTER LLC | ||||||||||
| 6950 FRANCE AVE S SUITE 200 | EDINA | MN | 55435 | 743069974 | RADIOLOGY | MN | N/A | |||
| BLAINE URGENCY CENTER LLC | ||||||||||
| 480 OSBORNE RD | FRIDLEY | MN | 55432 | 461630126 | URGENT CARE | MN | RELATED | 0 | 0 | |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|
| OAKDALE HEALTH ENTERPRISES INC | ||||||||||
| 3300 OAKDALE AVE N | ROBBINSDALE | MN | 55422 | 411546422 | AMBULANCE | MN | N/A | C | 0 | |
| CHARITABLE REMAINDER TRUST (1) | ||||||||||
| CHARITABLE TRUST | MN | T | 0 | NORTH MEMORIAL FOUNDATION | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 1 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| NORTH MEMORIAL HEALTH CARE (CONTRIBUTIONS TO NMHC) | ||
| B | 478215 | FMV |
| NORTH MEMORIAL HEALTH CARE (LEASE PAYMENT) | ||
| K | 65905 | AMOUNT PAID |
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