F-M AMBULANCE SERVICE INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- F-M AMBULANCE SERVICE INC (EIN 45-0344371)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-15
- IRS object ID
- 201221369349301147
- Schema version
- 2010v3.4
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-15T08:39:50-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Deloitte Tax LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 South Sixth Street Suite 2800 | 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 | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450344371 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | F-M Ambulance Service Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | F-MA | NameControl |
| Phone | 7012342000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2215 18th Street South | AddressLine1 |
| City | Fargo | City |
| State | ND | State |
| ZIP Code | 58103 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Lisa M Carlson | Name |
| Title | CFO | Title |
| Phone | 7012344811 | Phone |
| Date Signed | 2012-05-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kristina Rasmussen | Name |
| Phone | 6123974000 | Phone |
| Date Prepared | 2012-05-11 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Kelby K Krabbenhoft | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1305 W 18th St | AddressLine1 |
| City | Sioux Falls | City |
| State | SD | State |
| ZIP Code | 57117 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 11735026 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.FMAmbulance.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1978 | YearFormation |
| State Legal Domicile | ND | StateLegalDomicile |
| Activity Or Mission Description | Dedicated to the work of health and healing | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 20 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 182 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 56248 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -18292 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 101689 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 103085 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 10014992 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 11257992 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 5244 | InvestmentIncomePriorYear |
| Investment Income Current Year | 20202 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 122176 | OtherRevenuePriorYear |
| Other Revenue Current Year | 122544 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 10244101 | TotalRevenuePriorYear |
| Total Revenue Current Year | 11503823 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 150 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 50 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5130151 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5332996 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3907862 | OtherExpensePriorYear |
| Other Expenses Current Year | 4194174 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 9038163 | TotalExpensesPriorYear |
| Total Expenses Current Year | 9527220 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1205938 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1976603 | RevenuesLessExpensesCY |
| Total Assets BOY | 9370073 | TotalAssetsBOY |
| Total Assets EOY | 6188786 | TotalAssetsEOY |
| Total Liabilities BOY | 1476651 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1081031 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7893422 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 5107755 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | The Mission of F-M Ambulance, "Dedicated to the Work of Health and Healing" and the vision "Improving the Human Condition through Exceptional Care, Innovation and Discovery", is the constant force that drives our plans, decisions and actions. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 8079606 | Expense |
| Grants | 50 | Grants |
| Revenue | 11321183 | Revenue |
| Description | As part of the Sanford integrated delivery system, F-M Ambulance provides emergency medical and special transportation services to the Fargo, North Dakota/Moorhead, Minnesota metro area and other surrounding communities. F-M Ambulance is the largest advanced life support ground ambulance provider in North Dakota and serves as a resource to rescue and ambulance providers throughout the state. F-M Ambulance works closely with the local volunteer service to coordinate the delivery of emergency medical care to the communities in its service area and is a leader in Homeland Defense Preparedness by serving as a regional training, resources partner and responder.Through its Ready Wheels operations, F-M Ambulance provides local and long distance transportation for individuals using wheelchairs. This special transportation service is available 24 hours a day, seven days a week to provide door-to-door wheelchair service. These services allow individuals in the community to access transportation services that accommodate unique individual needs due to health conditions.Education and other services:F-M Ambulance also engages in various activities that promote the health of the community, including providing medical and safety education. F-M Ambulance provides educational programs for members of the community including first aid, automated external defibrillator, CPR and other courses. In addition, F-M Ambulance operates an on-site bookstore that is open to the public. The store sells education texts and reference books, trauma bags, first aid kits and supplies, medical supplies used in delivering emergency medical service outside the hospital and logo wear.F-M Ambulance also works with other organizations in the community to prepare for medical situations by having customized first aid supplies available to respond to workplace medical needs. These services help improve the health and well being of the community at large. F-M Ambulance is also very involved in numerous community activities that help promote health including participation in the national safe kids campaign, participating in bicycle safety helmet programs and providing non-dedicated stand-bys for community events. | Description |
| Total Program Service Expense | 8079606 | TotalProgramServiceExpense |
| Described In501 C3 | 0 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | 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 | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | 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 | 0 | 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 | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 12 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 182 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 1 | NonDeductibleContributions |
| Non Deductible Disclosure | 1 | NonDeductibleDisclosure |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 20 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | 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 | 0 | 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 | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tiffany Lawrence | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7012342000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 2010 | AddressLine1 |
| City | Fargo | City |
| State | ND | State |
| ZIP Code | 58122 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (38 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| Ann Christenson | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Barb Everist | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Barbara Stork | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Barry Martin | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Brent Teiken | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| David Beito | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Don Morton | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Jerome Feder | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Jim Entenman | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| John C Vanderwoude | |||||||||
| Trustee | 60.00 | X | 0 | 1184560 | 30701 | ||||
| John Jambois | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Lauris Molbert | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Mark Paulson MD | |||||||||
| Trustee | 60.00 | X | 0 | 220036 | 46521 | ||||
| Michael L Olson | |||||||||
| Trustee | 60.00 | X | 0 | 518455 | 6998 | ||||
| Michael L Olson Deferred Comp | |||||||||
| Trustee | 60.00 | X | 0 | 0 | 46935 | ||||
| Mikal Claar | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Pamela Anderson | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Richard D Hardie | |||||||||
| Trustee | 60.00 | X | 0 | 444434 | 18343 | ||||
| Ronald Moquist | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Terrence Grimm MD | |||||||||
| Trustee | 60.00 | X | 0 | 585887 | 42328 | ||||
| Terry Baloun | |||||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||||
| Kelby K Krabbenhoft | |||||||||
| Sanford Health President & CEO | 60.00 | X | 0 | 1274514 | 19513 | X | |||
| Kelby K Krabbenhoft Deferred Comp | |||||||||
| Sanford Health President & CEO | 60.00 | X | 0 | 0 | 565838 | X | |||
| Lisa Carlson | |||||||||
| Chief Financial Officer Corp | 60.00 | 0 | 418112 | 51907 | X | ||||
| Dennis Millirons | |||||||||
| President - Medical Center Fargo | 60.00 | 0 | 550996 | 20098 | X | ||||
| Michael Gibbs | |||||||||
| VP Sanford Medical Center Fargo - Heart & Vascular | 60.00 | 0 | 308310 | 38810 | X | ||||
| Tiffany Lawrence | |||||||||
| CFO - Sanford Medical Center Fargo | 60.00 | 0 | 204274 | 37540 | X | ||||
| Linda O'Halloran | |||||||||
| COO - Sanford Medical Center Fargo | 60.00 | 0 | 341521 | 38178 | X | ||||
| Dean Lampe | |||||||||
| Executive Director - FM Ambulance Service | 60.00 | 109406 | 0 | 1130 | X | ||||
| Roger Gilbertson MD | |||||||||
| Former President | 60.00 | 0 | 549117 | 0 | X | ||||
| Roger Lee | |||||||||
| Former Treasurer | 60.00 | 0 | 155194 | 21659 | X | ||||
| Paul Richard | |||||||||
| Former Executive VP | 60.00 | 0 | 395926 | 41452 | X | ||||
| Bruce Pitts MD | |||||||||
| Former Executive VP | 60.00 | 0 | 557647 | 40890 | X | ||||
| Gregory Post MD | |||||||||
| Former SR Vice President | 60.00 | 0 | 431368 | 41890 | X | ||||
| Rhonda Ketterling MD | |||||||||
| Former SR Vice President | 60.00 | 0 | 357957 | 37740 | X | ||||
| Jeffrey Hoss | |||||||||
| Former SR Vice President | 60.00 | 0 | 281751 | 41878 | X | ||||
| Evelyn Quigley | |||||||||
| Former SR Vice President | 60.00 | 0 | 207342 | 35995 | X | ||||
| Douglas Vang | |||||||||
| Former SR Vice President | 60.00 | 0 | 760803 | 4058 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 109406 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 9748204 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 1230402 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Government Grants | 103085 | GovernmentGrants |
| Total Contributions | 103085 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| Emergency Medical Serv | 621910 | 10267567 | 10257600 | 9967 |
| Education | 900099 | 756189 | 756189 | |
| Special Transportation | 621910 | 234236 | 234236 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 11257992 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2559 | TotalRevenueColumn |
| Exclusion | $2,559 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 14400 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1328 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 13072 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13072 | TotalRevenueColumn |
| Exclusion | $13,072 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 23790 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 6147 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 17643 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17643 | TotalRevenueColumn |
| Exclusion | $17,643 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 333200 | GrossSalesOfInventory |
| Cost Of Goods Sold | 223728 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 109472 | TotalRevenueColumn |
| Related Or Exempt Function Income | 63191 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 46281 | UnrelatedBusinessRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11503823 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11311216 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 56248 | UnrelatedBusinessRevenue |
| Exclusion | $33,274 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50 | Total |
| Program Services | 50 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 115747 | Total |
| Management And General | 115747 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4142315 | Total |
| Program Services | 3674236 | ProgramServices |
| Management And General | 468079 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 198516 | Total |
| Program Services | 163300 | ProgramServices |
| Management And General | 35216 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 475404 | Total |
| Program Services | 390341 | ProgramServices |
| Management And General | 85063 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 401014 | Total |
| Program Services | 277539 | ProgramServices |
| Management And General | 123475 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9933 | Total |
| Management And General | 9933 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42162 | Total |
| Program Services | 31538 | ProgramServices |
| Management And General | 10624 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16241 | Total |
| Program Services | 11865 | ProgramServices |
| Management And General | 4376 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 276609 | Total |
| Program Services | 132308 | ProgramServices |
| Management And General | 144301 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96924 | Total |
| Program Services | 66667 | ProgramServices |
| Management And General | 30257 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 135688 | Total |
| Program Services | 48642 | ProgramServices |
| Management And General | 87046 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 366160 | Total |
| Program Services | 336051 | ProgramServices |
| Management And General | 30109 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44428 | Total |
| Program Services | 44428 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22084 | Total |
| Program Services | 21322 | ProgramServices |
| Management And General | 762 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 529608 | Total |
| Program Services | 408764 | ProgramServices |
| Management And General | 120844 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 155514 | Total |
| Management And General | 155514 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Bad Debt | 2178215 | 2178215 | 0 |
| Medical Supplies | 240313 | 236005 | 4308 |
| Miscellaneous Expense | 47564 | 31754 | 15810 |
| Intercompany Purchased | 32731 | 26581 | 6150 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9527220 | Total |
| Program Services | 8079606 | ProgramServices |
| Management And General | 1447614 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3161192 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1399493 | BOY |
| EOY | 1248808 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 119499 | BOY |
| EOY | 71764 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 112474 | BOY |
| EOY | 46202 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 7712179 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4283249 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3184333 | BOY |
| EOY | 3428930 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1393082 | BOY |
| EOY | 1393082 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9370073 | BOY |
| EOY | 6188786 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 600103 | BOY |
| EOY | 583839 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23592 | BOY |
| EOY | 21813 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 802920 | BOY |
| EOY | 475379 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50036 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1476651 | BOY |
| EOY | 1081031 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7893422 | BOY |
| EOY | 5107755 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7893422 | BOY |
| EOY | 5107755 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9370073 | BOY |
| EOY | 6188786 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 1976603 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -4762270 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 465003 | OtherCostOrOtherBasis |
| Book Value | 465003 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2276909 | OtherCostOrOtherBasis |
| Depreciation | 792709 | Depreciation |
| Book Value | 1484200 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 135053 | OtherCostOrOtherBasis |
| Depreciation | 47407 | Depreciation |
| Book Value | 87646 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2453805 | OtherCostOrOtherBasis |
| Depreciation | 1755117 | Depreciation |
| Book Value | 698688 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2381409 | OtherCostOrOtherBasis |
| Depreciation | 1688016 | Depreciation |
| Book Value | 693393 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3428930 | TotalOfBookValueLandBuildings |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Description of Uncertain Tax Positions Under FIN 48: | Identifier |
| Return Reference | Part X: | ReturnReference |
| Explanation | Certain controlled organizations are subject to income taxes. Deferred income tax assets and liabilities are recognized for the differences between the financial and income tax reporting basis of assets and liabilities based on enacted tax rates and laws. A tax benefit from an uncertain tax position may be recognized when it is more likely than not that the position will be sustained upon examination. The deferred income tax provision or benefit generally reflects the net change in deferred income tax assets and liabilities during the year. The current income tax provision reflects the tax consequences of revenues and expenses currently taxable or deductible on various income tax returns for the year reported. F-M Ambulance Service, Inc did not have an income tax liability at June 30, 2011; some related organizations have established reserves. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 1 | 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 | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (22 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| John C Vanderwoude | |||||||||||||
| 0 | 1000000 | 0 | 0 | 0 | 184560 | 0 | 7350 | 0 | 23351 | 0 | 1215261 | 0 | 0 |
| Mark Paulson MD | |||||||||||||
| 0 | 196432 | 0 | 0 | 0 | 23604 | 0 | 31527 | 0 | 14994 | 0 | 266557 | 0 | 0 |
| Michael L Olson | |||||||||||||
| 0 | 504486 | 0 | 0 | 0 | 13969 | 0 | 0 | 0 | 6998 | 0 | 525453 | 0 | 0 |
| Michael L Olson Deferred Comp | |||||||||||||
| 0 | 0 | 0 | 0 | 0 | 0 | 0 | 46935 | 0 | 0 | 0 | 46935 | 0 | 0 |
| Richard D Hardie | |||||||||||||
| 0 | 414473 | 0 | 0 | 0 | 29961 | 0 | 7350 | 0 | 10993 | 0 | 462777 | 0 | 0 |
| Terrence Grimm MD | |||||||||||||
| 0 | 500004 | 0 | 0 | 0 | 85883 | 0 | 34928 | 0 | 7400 | 0 | 628215 | 0 | 0 |
| Kelby K Krabbenhoft | |||||||||||||
| 0 | 789232 | 0 | 0 | 0 | 485282 | 0 | 0 | 0 | 19513 | 0 | 1294027 | 0 | 0 |
| Kelby K Krabbenhoft Deferred Comp | |||||||||||||
| 0 | 0 | 0 | 0 | 0 | 0 | 0 | 565838 | 0 | 0 | 0 | 565838 | 0 | 0 |
| Lisa Carlson | |||||||||||||
| 0 | 335811 | 0 | 0 | 0 | 82301 | 0 | 34928 | 0 | 16979 | 0 | 470019 | 0 | 0 |
| Dennis Millirons | |||||||||||||
| 0 | 428166 | 0 | 0 | 0 | 122830 | 0 | 13136 | 0 | 6962 | 0 | 571094 | 0 | 0 |
| Michael Gibbs | |||||||||||||
| 0 | 273000 | 0 | 0 | 0 | 35310 | 0 | 34928 | 0 | 3882 | 0 | 347120 | 0 | 0 |
| Tiffany Lawrence | |||||||||||||
| 0 | 192997 | 0 | 0 | 0 | 11277 | 0 | 29641 | 0 | 7899 | 0 | 241814 | 0 | 0 |
| Linda O'Halloran | |||||||||||||
| 0 | 299379 | 0 | 0 | 0 | 42142 | 0 | 34928 | 0 | 3250 | 0 | 379699 | 0 | 0 |
| Roger Gilbertson MD | |||||||||||||
| 0 | 549117 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 549117 | 0 | 0 |
| Roger Lee | |||||||||||||
| 0 | 141070 | 0 | 0 | 0 | 14124 | 0 | 20253 | 0 | 1406 | 0 | 176853 | 0 | 0 |
| Paul Richard | |||||||||||||
| 0 | 314418 | 0 | 0 | 0 | 81508 | 0 | 34928 | 0 | 6524 | 0 | 437378 | 0 | 0 |
| Bruce Pitts MD | |||||||||||||
| 0 | 457914 | 0 | 0 | 0 | 99733 | 0 | 34928 | 0 | 5962 | 0 | 598537 | 0 | 0 |
| Gregory Post MD | |||||||||||||
| 0 | 434446 | 0 | 0 | 0 | -3078 | 0 | 34928 | 0 | 6962 | 0 | 473258 | 0 | 0 |
| Rhonda Ketterling MD | |||||||||||||
| 0 | 314702 | 0 | 0 | 0 | 43255 | 0 | 34928 | 0 | 2812 | 0 | 395697 | 0 | 0 |
| Jeffrey Hoss | |||||||||||||
| 0 | 260000 | 0 | 0 | 0 | 21751 | 0 | 34928 | 0 | 6950 | 0 | 323629 | 0 | 0 |
| Evelyn Quigley | |||||||||||||
| 0 | 181819 | 0 | 0 | 0 | 25523 | 0 | 29033 | 0 | 6962 | 0 | 243337 | 0 | 0 |
| Douglas Vang | |||||||||||||
| 0 | 719167 | 0 | 0 | 0 | 41636 | 0 | 552 | 0 | 3506 | 0 | 764861 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 1a | On Part I, Questions Regarding Compensation, Sanford checked several of the items as provided to listed persons: First Class or Charter Travel - Charter travel for business purposes is provided for individuals as needed and as cost appropriate. These costs are not included in the W-2's of the individuals as they are incurred for business purposes of Sanford. Travel for Companions - Limited travel for companions is required for certain annual meetings. These costs are not included in the W-2's of the individuals as they are incurred for business purposes of Sanford. Tax Indemnification and gross-up payments - Certain compensation may be grossed up to include appropriate tax amounts. Health or social club dues or initiation fees - All Sanford employees are eligible for discounted wellness memberships, a portion of these discounts and other club dues are included as fringe benefits, and taxed as such. Personal services - Individuals may have benefits which include tax preparation or planning, this benefit is included in income and taxed. Part I, Line 3: The Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm to annually review the total compensation of arrangements of the officers of the organization, and to report findings and recommendations to the Sanford Board of Trustees for deliberation and action. The most recent study was completed in 2011. | |
| Part I, Lines 4a-c | Part I, Lines 4a-c: Roger Gilbertson, former MeritCare President and CEO, received a payment of $549,117 upon his retirement, per employment contract. Douglas Vang received a severance payment of $478,906. Part I, Line 4b/Schedule J, Part II, Column C: In addition to employer contributions to pension plans, amounts representing increases and decreases in actuarial value (actuarial value factors include age, tenure and salary) of defined contribution and defined benefit SERP Plans are included in Column C. Participants and changes in values include: Kelby Krabbenhoft $420,519 | |
| Part I, Line 6 | Sanford physicians are compensated based on the professional services they perform within the clinic in which they provide care. Generally, the model is revenues less expenses. Physicians listed that were paid on this model include: Michael L Olson Richard Hardie | |
| Part III | Compensation reported on Schedule J, Part II includes: (B)(i) Base compensation - salaries are based on the experience and performance of each executive and bench-marked using independent compensation survey information. (B)(ii) - Bonus & incentive compensation - as part of executive compensation, individuals may be eligible for incentive performance compensation, however if the organization does not make its financial targets, incentive payments are not paid regardless of performance. (B)(iii) Other Reportable Compensation - generally includes taxable executive benefits. It also includes the one-time payout of previously deferred compensation (which was also reported as compensation in the earned period). To be in compliance with the IRS regulatory environment, listed individuals compensation includes a one-time payment of deferred compensation; this compensation was earned over multiple periods, and should be treated as earned over that length of time in exchange for services provided. (C) Deferred Compensation includes employer contributions to pension plans and the increase (or decrease) in the actuarial value (actuarial value factors include age, tenure and salary) of the benefit plans. (D) Nontaxable Benefits generally includes health insurance premiums. | Supplemental Information |
| Part III | A memo regarding executive compensation, written by the Chairman of the Sanford Board of Trustees, is on file and available upon request. | Supplemental Information |
| Part III | Compensation paid to trustees is for full-time professional responsibilities as physicians, administrators or employees of the organization. The total compensation paid to Kelby Krabbenhoft of $1,274,514 is comprised of Base salary of $789,232, and Other Taxable Earnings of $485,282. In addition, an amount of $565,838 has been reported for the estimated amount of ratable increase in value of the defined benefit pension plan, defined benefit SERP and a Gift Agreement Management Continuity Retention. | Supplemental Information |
| Part III | Part I, Line 7: Certain Executives are eligible for a discretionary incentive bonus, based on financial targets and other goals. | Supplemental Information |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 2 | Pamela Anderson, Trustee, and Lisa Carlson, CFO, have a business relationship. The following officers, board members, and key employees are employees of Sanford or its related organizations. Many of these employees also serve on other related Sanford boards, or have business relationships with each other that span the organization as a whole: John Vanderwoude Mark Paulson Michael Olson Richard Hardie Terrence Grimm Kelby Krabbenhoft Lisa Carlson Tiffany Lawrence Dennis Millirons Linda O'Halloran Michael Gibbs | |
| Form 990, Part VI, Section A, line 6 | Sanford North is the sole stockholder of F-M Ambulance. | |
| Form 990, Part VI, Section A, line 7a | Board members are appointed by the President and CEO of Sanford North. | |
| Form 990, Part VI, Section A, line 7b | Sanford North must approve the following actions: * Modifying the purpose of the Corporation * Unbudgeted capital expenses in excess of 1/2 of 1% of approved operating budgets *Adoption of capital and operating budgets *Acquisition, sale, lease, disposition, or mortgaging of real property *Guarantee of debts or obligations of any other person, firm, corporation, partnership, association, or other entity which if held in deafult would obligate the corporation to an aggregate amount in excess of $100,000 *Merger or consolidation of the Corporation *Incurring a loan or other obligation in an agreement in excess of $500,000 for more than 60 days *Making of a gift, grant or other donation in an amount in excess of $5,000 to an organization not related to the Corporation or Member *Member has the authority to direct the Corporation regardless of the vote by the Corporation's Board of Directors to transger assets and/or funds to the health system to satisfy obligations of the health system. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 is prepared internally by the finance department and reviewed by executive management. An external accounting firm reviews the return prior to filing and prepares return highlights and key disclosures for the Board of Trustees meeting immediately following the return filing date. After the return is filed, a complete copy is made available to the current trustees. | |
| The annual Conflict of Interest disclosure process is managed by the Chief Compliance Officer (CCO). The CCO is responsible for assuring that all completed forms are returned in a timely and complete manner. Conflict of Interest questionnaires are sent to System Trustees, members of the governing boards for subsidiary entities, officers, and key employees for all entities subject to the IRS Form 990 filings. The disclosures are summarized for review by the executive committee of the Board of Trustees, pursuant to policy. This review allows: 1) The Board to acquire an awareness of financial relationships of board members and key management employees and can invoke the recusal process on a case-by-case basis when potential conflicts are implicated in Board decisions and deliberations, and, 2) Gives the Board the opportunity to seek additional information and clarification about disclosures to determine potential conflicts of interest and how to manage such. | Form 990, Part VI, Section B, line 12c | |
| The Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm to annually review the total compensation arrangements of the officers and operating unit executives of the organization, including the CEO, and to report the findings and recommendations to them for deliberation and action. The deliberations and actions are recorded in the minutes of the Sanford Board of Trustees. The most recent study was completed in 2011. Additionally, Sanford periodically engages an independent compensation consultant to review and issue a report regarding the reasonableness of the total compensation arrangements of all physicians employed by the organization. The most recent study of physician total compensation arrangements was completed in 2009. | Form 990, Part VI, Section B, line 15 | |
| Although the organization does not maintain a website where the public can access these documents, it would respond individually to any requests or inquiries from the public for these documents. | Form 990, Part VI, Section C, line 19 | |
| Board Members of Sanford provide services to Sanford subsidiaries. Hours reported for each individual reflect the time spent on work related to either the filing organization or related organization. Sanford Board of Trustees has ultimate governance responsibilities for each entity within the Sanford system. In addition, a Board of Directors is established for each entity, which has specific delegated responsibilities from the Board of Trustees related to the oversight of day to day operations of that entity. | Form 990, Part VII | |
| Changes in Net Assets or Fund Balances: | Prior period adjustments: 50,035. Net Asset Transfers (AP Intercompany) -4,812,305. Total to Form 990, Part XI, Line 5: -4,762,270. | Form 990, Part XI, line 5: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (26 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| Sanford Health | ||||||||||
| 1305 West 18th Street | Sioux Falls | SD | 57117 | 311527032 | Supporting Organization | SD | 501(c)(3) | 11-III | Sanford | 0 |
| Sanford Health Foundation | ||||||||||
| 1305 West 18th Street | Sioux Falls | SD | 57117 | 363297853 | Supporting Organization | SD | 501(c)(3) | 11-I | Sanford Health | 1 |
| Sanford | ||||||||||
| 801 Broadway Drive | Fargo | ND | 58122 | 271218956 | Supporting Organization | ND | 501(c)(3) | 11-II | 0 | |
| SHM-Sanford | ||||||||||
| 1305 West 18th Street | Sioux Falls | SD | 57105 | 271213769 | Supporting Organization | SD | 501(c)(3) | 11-II | 0 | |
| SHM-MeritCare | ||||||||||
| 801 Broadway Drive | Fargo | ND | 58122 | 271213717 | Supporting Organization | ND | 501(c)(3) | 11-II | 0 | |
| Sanford North | ||||||||||
| PO Box 2010 | Fargo | ND | 58122 | 450385890 | Supporting Organization | ND | 501(c)(3) | 11-II | Sanford | 0 |
| Sanford Medical Center Fargo | ||||||||||
| PO Box 2010 | Fargo | ND | 58122 | 450226909 | Hospital | ND | 501(c)(3) | 3 | Sanford North | 1 |
| Sanford Clinic North | ||||||||||
| PO Box 2010 | Fargo | ND | 58122 | 911770748 | Clinics | ND | 501(c)(3) | 9 | Sanford North | 1 |
| Sanford Health Network North | ||||||||||
| PO Box 2010 | Fargo | ND | 58122 | 450409348 | Hospitals/Clinics | ND | 501(c)(3) | 11-II | Sanford North | 1 |
| Sanford Medical Center Wheaton | ||||||||||
| 401 12th Street North | Wheaton | MN | 56296 | 272042143 | Hospital/Clinic | MN | 501(c)(3) | 3 | Sanford North | 1 |
| Sanford Health Foundation North | ||||||||||
| PO Box 2010 | Fargo | ND | 58122 | 450398104 | Supporting Organization | ND | 501(c)(3) | 7 | Sanford North | 1 |
| Sanford Medical Center Thief River Falls | ||||||||||
| 120 Labree Ave S | Thief River Falls | MN | 56701 | 410709579 | Hospital | MN | 501(c)(3) | 3 | Sanford North | 1 |
| Sanford Medical Center Mayville | ||||||||||
| 42 6th Ave SE | Mayville | ND | 58257 | 450228899 | Hospital | ND | 501(c)(3) | 3 | Sanford North | 1 |
| MeritCare Minnesota | ||||||||||
| 1720 South Highway 59 | Thief River Falls | MN | 56701 | 261530302 | Promotion of health | MN | 501(c)(3) | 3 | Sanford North | 1 |
| Agassiz Assurance Company | ||||||||||
| 100 Bankd Street Suite 610 | Burlington | VT | 05401 | 743121855 | Insurance | VT | 501(c)(3) | 11-II | Sanford North | 1 |
| MeritCare Health Enterprises Inc | ||||||||||
| PO Box 2010 | Fargo | ND | 58122 | 450359785 | Prescription drugs | ND | 501(c)(4) | Sanford North | 1 | |
| FM Ambulance Service | ||||||||||
| 2215 18 St South | Fargo | ND | 58103 | 450344371 | EMT | ND | 501(c)(4) | Sanford North | 1 | |
| Sanford Health of Northern Minnesota fka North Country Health Service | ||||||||||
| 1300 Anne St NW | Bemidji | MN | 56601 | 411266009 | Hospital | MN | 501(c)(3) | 3 | Sanford North | 1 |
| Baker Park Inc | ||||||||||
| 803 Dewey Ave NW | Bemidji | MN | 56601 | 411372480 | Low Income Senior Housing | MN | 501(c)(3) | 9 | Sanford Health of Northern Minnesota | 1 |
| Sanford Health Foundation of Northern Minnesota fka North Country Health Se | ||||||||||
| 1300 Anne St NW | Bemidji | MN | 56601 | 411389317 | Fundraising - Support | MN | 501(c)(3) | 11-I | Sanford Health of Northern Minnesota | 1 |
| North Country Medical Clinic | ||||||||||
| 1300 Anne St NW | Bemidji | MN | 56601 | 411753855 | Family Practice Medical Clinic | MN | 501(c)(3) | 3 | Sanford Health of Northern Minnesota | 1 |
| Sanford ResearchUSD | ||||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 460450378 | Research | SD | 501(c)(3) | 3 | Sanford Health | 1 |
| Sanford USD Medical Center | ||||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 460227855 | Hospital | SD | 501(c)(3) | 3 | Sanford Health | 1 |
| Sanford Clinic | ||||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 460447693 | Clinical Services | SD | 501(c)(3) | 3 | Sanford Health | 1 |
| Sanford Health Network | ||||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 460388596 | Hospitals/Clinics | SD | 501(c)(3) | 11-I | Sanford Health | 1 |
| Sanford Home Health | ||||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 460282134 | Home Health Services | SD | 501(c)(3) | 9 | Sanford Health | 1 |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| National Student Housing - South Dakota LLC | |||||||||||
| 100 S Phillips Ave | Sioux Falls | SD | 57104 | 202129839 | Investment | SD | Sanford Health | Related | 0 | 0 | 0.00000 |
| RAC Rentals LLC | |||||||||||
| 100 S Phillips Ave | Sioux Falls | SD | 57104 | 261961077 | Investment | SD | Sanford Health | Related | 0 | 0 | 0.00000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| Heart Partners at Sanford | ||||||||
| 1305 W 18th Street | Sioux Falls | SD | 57117 | 460449572 | Healthcare | SD | Sanford Health | C |
| Sanford Home Medical Equipment Inc | ||||||||
| 2710 W 12th Street | Sioux Falls | SD | 57105 | 460388597 | Healthcare Equipment | SD | Sanford Health | C |
| Sanford Health Plan | ||||||||
| 300 Cherapa Place | Sioux Falls | SD | 57103 | 911842494 | Insurance | SD | Sanford Health | C |
| Sanford Health Plan of MN | ||||||||
| 300 Cherapa Place | Sioux Falls | SD | 57103 | 460445852 | Insurance | MN | Sanford Health | C |
| Healthcare Environmental Services Inc | ||||||||
| 1420 40th St NW | Fargo | ND | 58102 | 450336598 | Laundry and Incineration Services | ND | Sanford North | C |
| Bemidji Medical Equipment Inc | ||||||||
| 1300 Anne St NW | Bemidji | MN | 56601 | 411551725 | Retail Sales of DME | MN | Sanford Health of Northern Minnesota | C |
| North Country Management Inc | ||||||||
| 1300 Anne St NW | Bemidji | MN | 56601 | 411820025 | Management Services | MN | Sanford Health of Northern Minnesota | C |
| Sanford World Clinics | ||||||||
| 1305 West 18th Street | Sioux Falls | SD | 57117 | 262707628 | Healthcare | SD | Sanford Health | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| 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 | 0 | 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 | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |