2012-05-31T17:15:29-07:00 2011-09-30 990 2010-10-01 411677288 LAKE REGION HOSPITAL FOUNDATION LAKE 2187368000 712 S CASCADE ST FERGUS FALLS MN 565380728 EDWARD STRAND CPA INACTIVE 2187368000 2012-05-15 2010 2016-02-24 21:20:13Z LARRY DORN 712 S CASCADE ST PO BOX 728 FERGUS FALLS MN 56537 1785686 0 X X Foundation 2000 MN THE PURPOSE OF THE LAKE REGION HOSPITAL FOUNDATION IS TO RECEIVE GIFTS AND DONATIONS TO HELP LAKE REGION HOSPITAL FULFILL IT'S MISSION OF PROVIDING QUALITY HEALTHCARE SERVICES IN A CARING MANNER TO EVERY INDIVIDUAL WE SERVE. 16 16 0 175 0 0 1172444 1476063 0 0 27685 135333 -11508 22699 1188621 1634095 303480 5718 0 0 0 0 0 0 0 4476 2363 307956 8081 880665 1626014 6393068 8970249 0 6419 6393068 8963830 THE PURPOSE OF THE LAKE REGION HOSPITAL FOUNDATION IS TO RECEIVE GIFTS AND DONATIONS TO HELP LAKE REGION HOSPITAL FULFILL IT'S MISSION OF PROVIDING QUALITY HEALTHCARE SERVICES IN A CARING MANNER TO EVERY INDIVIDUAL WE SERVE. 0 0 8081 5718 184423 LAKE REGION HOSPITAL FOUNDATION RECEIVED DONATIONS AND MEMORIALS FROM SEVERAL INDIVIDUALS AND BUSINESSES. IT ALSO RECEIVES PLEDGES AND PAYMENTS OF THOSE PLEDGES. THE FOUNDATION USES SOME OF IT'S FUNDS FOR A VARIETY OF PURPOSES WHICH AID LAKE REGION HEALTHCARE AND THE COMMUNITY IN PROVIDING QUALITY HEALTHCARE. 0 0 0 8081 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 X 16 16 0 0 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X X LAKE REGION HEALTHCARE CORPORATION 2187368000 712 S CASCADE ST PO BOX 728 FERGUS FALLS MN 565380728 X LARRY DORN 2 X 0 0 0 SOLVEIG HALBAKKEN 2.00 X 0 0 0 DENNIS EMMEN 2.00 X 0 0 0 DAVID JOHNSON 2.00 X 0 0 0 STEPHEN RUFER 2.00 X 0 0 0 LESLIE SYVERSON MD 2.00 X 0 0 0 GARY SPIES 2.00 X 0 0 0 MARY LAMPY VELO 2.00 X 0 0 0 DAVID BJORK MD 2.00 X 0 0 0 PAUL ETZELL MD 2.00 X 0 0 0 LINDA MATTER PHD 2.00 X 0 0 0 DAVE BICKETT 2.00 X 0 0 0 KIM EMBRETSON CFRE 2.00 X 0 0 0 TODD MCGOVERN DDS 2.00 X 0 0 0 DIC PICKET CPA 2.00 X 0 0 0 CRYSTAL ADAMS 2.00 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1476063 172709 1476063 0 0 0 0 0 134852 134852 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 125682 0 125201 0 481 0 481 481 0 0 45941 0 22561 23380 0 23380 0 0 0 0 0 0 3148 3829 -681 -681 0 0 0 1634095 134652 0 23380 5718 5718 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 929 929 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MISCELLANEOUS EXPENSE 1196 1196 0 0 SERVICE CHARGES 180 180 0 0 MEALS EXPENSE 58 58 0 0 0 0 0 0 8081 8081 0 0 1436499 944315 0 0 2570687 2288517 0 0 0 0 0 0 0 0 0 0 0 0 0 2385882 5737417 0 0 0 0 0 0 0 0 6393068 8970249 0 6419 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6419 X 6393068 8963830 0 0 0 0 6393068 8963830 6393068 8970249 X 1626014 944748 X 0 1 1 X 0 X X 1 0 0 LAKE REGION HEALTHCARE CORPORATION 410730602 170(b)(1)(A)(iii) 1 1 1 18922 1 18922 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10455 0 892 0 1070 0 10277 0 1 1 1634095 8081 1626014 -362187 0 0 0 1306935 944748 2570762 1634095 0 0 0 0 0 1634095 0 0 0 1634095 8081 0 0 0 0 0 8081 0 0 0 8081 SchD_P11_S00_L08 Schedule D, Part XI, Line 8 THERE WAS A TOTAL OF $1,306,935 OF RELATED COMPANY TRANSFERS FOR THE LAKE REGION HOSPITAL FOUNDATION. PRCA RODEO 7382 0 7382 0 0 0 0 0 5214 NEW YEARS GALA 15000 0 15000 0 0 0 0 0 16101 7 23560 0 23560 0 0 0 0 0 1248 45942 0 45942 0 0 0 0 0 22563 22563 23379 1 X SchI_P01_S00_L02 Schedule I, Part I, Line 2 GRANTS AWARDED BY THE LAKE REGION HOSPITAL FOUNDATION HAVE TO MEET CERTAIN GUIDELINES WHICH INCLUDE (1) REQUESTS MUST BE FOR HEALTH-RELATED PROGRAMS OR PROJECTS, AND MUST BENEFIT INDIVIDUALS LIVING WITHIN THE LRHC SERVICE AREA (2) NO REQUESTS WILL BE ACCEPTED ON BEHALF OF AN INDIVIDUAL OR A FAMILY (3) NO GRANTS WILL BE MADE TO INSTITUTIONS WHICH IN POLICY OR PRACTICE DISCRIMINATE ON THE BASIS OF RACE, CREED, GENDER, OR SEXUAL ORIENTATION (4) ANY PUBLISHED ARTICLES, PRESS RELEASES, OR INFORMATION RELATED TO THE GRANT RELEASED BY YOUR ORGANIZATION SHOULD STATE THAT THE PROJECT WAS FULLY OR PARTIALLY FUNDED BY DONATIONS TO THE LAKE REGION HOSPITAL FOUNDATION (5) FUNDS AWARDED MUST BE EXPENDED ONLY FOR THE STATED PURPOSE ON THE APPLICATION (6) FUNDS MUST BE DISTRIBUTED WITHIN ONE CALENDAR YEAR OF THE AWARD AND (7) DISPURSEMENTS MAY BE DISCONTINUED IF THE PROGRAM OR PROJECT IS DISCONTINUED, OR ITS ORIGINAL PURPOSE ALTERED. X 9 172709 MARKET VALUE 0 0 0 0 F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 LAKE REGION HEALTHCARE CORPORATION IS A SOLE MEMBER. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b COPIES OF THE COMPLETED FORM 990, WITH SUPPORTING SCHEDULES AND FOOTNOTES, WILL BE DISTRIBUTED TO ALL THE FOUNDATION BOARD MEMBERS SUFFICIENTLY IN ADVANCE OF THE FILING DEADLINE TO ENABLE A DETAILED AND CONSCIENTIOUS REVIEW BY ALL BOARD MEMBERS AND AN OPPORTUNITY FOR FEEDBACK AND CORRECTION. ALL QUESTIONS, CONCERNS, OR OTHER FEEDBACK FROM BOARD MEMBERS WILL BE DIRECTED TO THE LRHC CHIEF FINANCIAL OFFICER AND INCORPORATED INTO THE FORM 990 AS APPROPRIATE. SUFFICIENTLY IN ADVANCE OF THE FILING DEADLINE TO ENABLE A DETAILED AND CONSCIENTIOUS REVIEW BY ALL THE FOUNDATION BOARD MEMBERS. CHIEF EXECUTIVE OFFICER, OR CHIEF FINANCIAL OFFICER WILL REVIEW THE FORM 990 WITH THE BOARD. ANY CORRECTIONS OR CHANGES WILL BE NOTED AND ADDRESSED. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c OFFICERS AND TRUSTEES ANNUALLY ASSESS WHETHER OR NOT THERE ARE ANY CONFLICTS OF INTEREST ACCORDING TO THE CONFLICTS OF INTEREST POLICY. IT IS CONSISTANTLY MONITORED DURING THE YEAR TO BE SURE THAT THE POLICY IS BEING FOLLOWED. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. F990_P11_S00_L05 Form 990, Part XI, Line 5 THERE WAS A TOTAL OF $944,748 OF RELATED COMPANY TRANSFERS FOR THE LAKE REGION HOSPITAL FOUNDATION. LAKE REGION HEALTHCARE CORPORATION 712 S CASCADE ST PO BOX 728 FERGUS FALLS MN 565380728 410730602 HOSPITAL MN 501(C)(3) N/A 0 LRHC LONG TERM CARE FACILITIES INC 712 S CASCADE ST PO BOX 728 FERGUS FALLS MN 565380728 411817549 NURSING HOME MN 501(C)(3) LAKE REGION HEALTHCARE CORPORATION 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0