NORTH MEMORIAL HEALTH CARE: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
NORTH MEMORIAL HEALTH CARE (EIN 41-0729979)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-15
IRS object ID
201223209349302012
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-15T09:08:19-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN390859910EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BAKER TILLY VIRCHOW KRAUSE LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1225 S 6TH ST STE 2300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN410729979EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1NORTH MEMORIAL HEALTH CAREBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNORTNameControl
Phone7635205200Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line13300 OAKDALE AVENUE NORTHAddressLine1
CityROBBINSDALECity
StateMNState
ZIP Code55422ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePATRICK BORANName
TitleCHIEF FINANCIAL OFFICERTitle
Phone7635814562Phone
Date Signed2012-11-01DateSigned
Authorize Third Party0AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLAWRENCE H MOHR CPAName
PTINP00447603PTIN
Phone6128764500Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPATRICK BORANNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line13300 OAKDALE AVENUE NORTHAddressLine1
CityROBBINSDALECity
StateMNState
ZIP Code554222900ZIPCode
FieldValueIRS element (for citing)
Gross Receipts911537994GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.NORTHMEMORIAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1954YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionGENERAL ACUTE CARE HOSPITAL PROVIDING HIGHLY SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CORONARY CARE OPEN HEART SURGERY, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL-SURGICAL, OBSTETRICAL, PEDIATRIC REHABILITATIVE, AND BEHAVIORAL SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees5490TotalNbrEmployees
Total Nbr Volunteers975TotalNbrVolunteers
Total Gross UBI10664153TotalGrossUBI
Net Unrelated Business Txbl Income102716NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1348772ContributionsGrantsPriorYear
Contributions Grants Current Year1036554ContributionsGrantsCurrentYear
Program Service Revenue Prior Year593451178ProgramServiceRevenuePriorYear
Program Service Revenue CY617110561ProgramServiceRevenueCY
Investment Income Prior Year11126827InvestmentIncomePriorYear
Investment Income Current Year54576333InvestmentIncomeCurrentYear
Other Revenue Prior Year-2680145OtherRevenuePriorYear
Other Revenue Current Year-2308164OtherRevenueCurrentYear
Total Revenue Prior Year603246632TotalRevenuePriorYear
Total Revenue Current Year670415284TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year372951709SalariesEtcPriorYear
Salaries Etc Current Year372718647SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year252198769OtherExpensePriorYear
Other Expenses Current Year252459977OtherExpensesCurrentYear
Total Expenses Prior Year625150478TotalExpensesPriorYear
Total Expenses Current Year625178624TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-21903846RevenuesLessExpensesPriorYear
Revenues Less Expenses CY45236660RevenuesLessExpensesCY
Total Assets BOY638765423TotalAssetsBOY
Total Assets EOY557564309TotalAssetsEOY
Total Liabilities BOY335267433TotalLiabilitiesBOY
Total Liabilities EOY241051561TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY303497990NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY316512748NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionINSPRIRING EACH OTHER TO GIVE OUR PATIENTS AND THEIR FAMILIES COMPASSIONATE, REMARKABLE CARE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense553186756Expense
Revenue599239344Revenue
DescriptionNORTH MEMORIAL MEDICAL CENTER IS A GENERAL ACUTE CARE HOSPITAL PROVIDING HIGHLY SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CORONARY CARE OPEN HEART SURGERY, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL - SURGICAL, OBSTETRICAL, PEDIATRIC REHABILITATIVE, AND BEHAVIORAL SERVICES. IN ADDITION TO CHARITY AND UNCOMPENSATED CARE, NMMC ALSO PROVIDES NUMEROUS COMMUNITY BENEFITS (AT NO COST OR BELOW COST).IN FURTHERANCE OF ITS CHARITABLE PURPOSE, NORTH MEMORIAL PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY BASED PROGRAMS, SUCH A HEALTH SCREENINGS, SUPPORT COUNSELING FOR PARENTS AND FAMILIES, PASTORAL CARE, CRISIS INTERVENTION, TRANSPORTATION TO AND FROM THE HOSPITAL CAMPUSES, AND THE DONATION OF SPACE FOR USE BY COMMUNITY GROUPS. ADDITIONALLY A LARGE NUMBER OF HEALTH-RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, UNREIMBURSED COSTS OF MEDICAL EDUCATION, TELEPHONE INFORMATION SERVICES, AND COST RELATED TO PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. NORTH MEMORIAL ALSO PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED COSTS TO RESIDENTS OF ITS COMMUNITY, PRIMARILY THROUGH: (A) THE DIFFERENCE BETWEEN PUBLIC PROGRAM PAYMENTS (PRIMARILY MEDICARE AND MEDICAID) AND THE RELATED COSTS OF PROVIDING SUCH SERVICES; AND (B) SERVICES PROVIDED TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE DETERMINED UNABLE TO PAY BECAUSE OF ECONOMIC FACTORS. IN ADDITION, NORTH MEMORIAL CONTRIBUTES TO FUNDING MEDICAL CARE FOR THE UNINSURED THROUGH PAYMENT OF PATIENT SERVICE TAXES, WHICH INCLUDE THE MEDICAID SURCHARGE AND THE MINNESOTA CARE TAX ON CERTAIN NET REVENUE.Description
Total Program Service Expense553186756TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer1OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions1DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity1DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096578NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees5490NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account1ForeignFinancialAccount
Name Of Foreign CountryBDNameOfForeignCountry
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1PATRICK BORANBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number7635814562TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13300 OAKDALE AVENUE NORTHAddressLine1
CityROBBINSDALECity
StateMNState
ZIP Code55422ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (30 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
ROBERT POTTS
CHAIRMAN OF THE BOARD1.00X450000
TIMOTHY BAYLOR
BOARD MEMBER1.00X450000
YVONNE CHEUNG-HO
BOARD MEMBER1.00X450000
WARREN MACK
BOARD MEMBER1.00X450000
PAT MCHALE
BOARD MEMBER1.00X000
JON NIELSON MD
BOARD MEMBER1.00X12219100
ROBERT PRENTISS
BOARD MEMBER1.00X450000
KAREN RAUENHORST
BOARD MEMBER1.00X450000
MIKE STEINHAUSER
BOARD MEMBER1.00X000
BILL TOBIN
BOARD MEMBER1.00X450000
MICHAEL WOOTEN MD
BOARD MEMBER1.00X4600000
LOREN TAYLOR
CHIEF EXECUTIVE OFFICER50.00X807651022052X
BETTY PAKZAK MD
BOARD MEMBER1.00X270000
PATRICK BORAN
CHIEF FINANCIAL OFFICER50.00464704038809X
DAVID ABRAMS
VICE PRESIDENT - HUMAN RESOURCES50.00304147053058X
JOHN ALLEN
VICE PRESIDENT - SERVICE LINE50.00260057021781X
JOSEPH BOSTON
VICE PRESIDENT - FOUNDATION50.00172437012803X
ANDREW COCHRANE
PRESIDENT50.00382446019967X
KEVIN CROSTON
CHIEF MEDICAL OFFICER50.00582065016652X
VIRGINIA MALONE
CHIEF NURSING OFFICER50.0026096207591X
MICHAEL PARRISH
VICE PRESIDENT - EMERGENCY50.00310666020738X
PATRICK TAFFE
CHIEF INFORMATION OFFICER50.00299987020710X
TOM TIMMONS
VICE PRESIDENT50.00862402021659X
STEVEN ROH
CARDIOLOGIST50.00758118025045X
THOMAS ROSSINI
ER STAFF PHYSICIAN50.00842258024960X
GEORGE TADROS
CARDIOLOGIST50.00690048027952X
PAMELA PAULSEN
CARDIOLOGIST50.00644980027387X
ALOK MAHESHWARI
CARDIOLOGIST50.00661083024006X
PAMELA LINDEMOEN
FORMER CHIEF OPERATING OFFICER50.004987500707X
JERRY MOEN
FORMER VICE PRESIDENT - PRIMARY CARE50.0053682602972X
FieldValueIRS element (for citing)
Total Reportable Comp From Org9541978TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation388849TotalOtherCompensation
Number Individuals GT100 K388NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ACCRETIVE HEALTH
39918 TREASURY CENTERCHICAGOIL606949900REVENUE CYCLE SUPPORT9520912
NORTH CLINIC
3366 OAKDALE AVE N 601ROBBINSDALEMN55422PHYSICIAN SERVICES7160558
ARAMARK HEALTHCARE FOOD
25271 NETWORK PLACECHICAGOIL60673MANAGEMENT SUPPORT FOR DIETARY3219754
RESPIRATORY CONSULTANTS PA
3366 OAKDALE AVE N 605ROBBINSDALEMN55422INTENSIVISTS STAFFING2451608
REVENUE CYCLE SOLUTIONS
4524 SOUTHLAKE PARKWAY 15HOOVERAL35244A/R MANAGEMENT SERVICES1499351
FieldValueIRS element (for citing)
Number Of Contractors GT100 K66NumberOfContractorsGT100K
Related Organizations510908RelatedOrganizations
All Other Contributions525646AllOtherContributions
Noncash Contributions453093NoncashContributions
Total Contributions1036554TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
HOSPITAL PATIENT REVEN62150061221166160154750810664153
PARKING9000991751949$1,751,949
CAFETERIA9000991035384$1,035,384
TRANSCRIPTION SERVICES900099884357$884,357
COFFEE SHOP900099709740$709,740

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column517470TotalRevenueColumn
Exclusion$517,470ExclusionAmount
FieldValueIRS element (for citing)
Total Program Service Revenue617110561TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column5455768TotalRevenueColumn
Exclusion$5,455,768ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column1648064TotalRevenueColumn
Exclusion$1,648,064ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real11816374Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real14124538Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-2308164Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-2308164TotalRevenueColumn
Related Or Exempt Function Income-2308164RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities274366193Securities
Other104480Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities226419950Securities
Other578222Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities47946243Securities
Other-473742Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column47472501TotalRevenueColumn
Exclusion$47,472,501ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column670415284TotalRevenueColumn
Related Or Exempt Function Income599239344RelatedOrExemptFunctionIncome
Unrelated Business Revenue10664153UnrelatedBusinessRevenue
Exclusion$59,475,233ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total5295645Total
Management And General5295645ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total291510261Total
Program Services260958074ProgramServices
Management And General30552187ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total22886949Total
Program Services20270213ProgramServices
Management And General2616736ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total32735148Total
Program Services28908356ProgramServices
Management And General3826792ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total20290644Total
Program Services17855767ProgramServices
Management And General2434877ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total1470333Total
Program Services1293893ProgramServices
Management And General176440ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total326215Total
Program Services287069ProgramServices
Management And General39146ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total104919Total
Management And General104919ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total677772Total
Management And General677772ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total45953264Total
Program Services40438872ProgramServices
Management And General5514392ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total1656933Total
Program Services1546101ProgramServices
Management And General110832ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total7876927Total
Program Services6931696ProgramServices
Management And General945231ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total20510413Total
Program Services18049163ProgramServices
Management And General2461250ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total1441509Total
Program Services1268528ProgramServices
Management And General172981ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total5315562Total
Program Services4675284ProgramServices
Management And General640278ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total33294154Total
Program Services29242006ProgramServices
Management And General4052148ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total6287676Total
Program Services5533155ProgramServices
Management And General754521ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
SUPPLIES836330427359707710035965
BAD DEBT EXPENSE2088233020882330
GOVERNMENTAL TAXES98282179828217
MAINTENANCE & REPAIRS872615376790151047138

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total4474558Total
Program Services3941940ProgramServices
Management And General532618ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total625178624Total
Program Services553186756ProgramServices
Management And General71991868ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4337BOY
EOY9381EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY27090465BOY
EOY15675164EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY127615BOY
EOY345991EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY85657938BOY
EOY86029544EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY4185088BOY
EOY5595194EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY5504738BOY
EOY5825134EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis576379505LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec346752629LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY246159391BOY
EOY229626876EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY171363493BOY
EOY134867799EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY54829269BOY
EOY49276441EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY43843089BOY
EOY30312785EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY638765423BOY
EOY557564309EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY70005790BOY
EOY64071117EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY431998BOY
EOY443845EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY199617262BOY
EOY124176381EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY17889970BOY
EOY23513623EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY47322413BOY
EOY28846595EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY335267433BOY
EOY241051561EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY303497990BOY
EOY316512748EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY303497990BOY
EOY316512748EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY638765423BOY
EOY557564309EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses45236660ReconcilationRevenueExpenses
Reconcilation Other Changes-32221902ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management1PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations1GrantsOtherOrganizations
Grants Other Organizations$40,000GrantsOtherOrganizationsAmount
Direct Contact Legislators1DirectContactLegislators
Direct Contact Legislators$60,000DirectContactLegislatorsAmount
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB100000TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance2251229BeginningOfYearBalance
Contributions72500Contributions
Investment Earnings Or Losses71751InvestmentEarningsOrLosses
Other Expenditures12813OtherExpenditures
End Of Year Balance2382667EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1737891BeginningOfYearBalance
Contributions513452Contributions
Investment Earnings Or Losses25341InvestmentEarningsOrLosses
Other Expenditures24455OtherExpenditures
End Of Year Balance2252229EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1537773BeginningOfYearBalance
Contributions247046Contributions
Investment Earnings Or Losses17937InvestmentEarningsOrLosses
Other Expenditures64865OtherExpenditures
End Of Year Balance1737891EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1910328BeginningOfYearBalance
Contributions-382648Contributions
Investment Earnings Or Losses19699InvestmentEarningsOrLosses
Other Expenditures9606OtherExpenditures
End Of Year Balance1537773EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.98510PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.01490TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis15594663OtherCostOrOtherBasis
Book Value15594663BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis218074551OtherCostOrOtherBasis
Depreciation96651930Depreciation
Book Value121422621BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis14257915OtherCostOrOtherBasis
Depreciation7907097Depreciation
Book Value6350818BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis318729615OtherCostOrOtherBasis
Depreciation236961266Depreciation
Book Value81768349BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis9722761OtherCostOrOtherBasis
Depreciation5232336Depreciation
Book Value4490425BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings229626876TotalOfBookValueLandBuildings

Other Securities OtherSecurities (4 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
RREEF AMERICA REIT II18747140F
MELLON AGGREGATE BOND INDEX FUND25019301F
CASH ON DEPOSIT WITH BOND TRUSTEE5451111F
AGENCY ACCOUNT58889F
FieldValueIRS element (for citing)
Total Of Book Value Securities49276441TotalOfBookValueSecurities

Other Assets OtherAssets (16 entries)

DescriptionDescriptionBook ValueBookValue
OHE - NORTH AMBULANCE DOUGLAS COUNTY100000
ASSOCIATED HEALTH ASSURANCE, LTD500000
INSTITUTE ATHLETIC MEDICINE521294
NORTH RADIATION THERAPY CENTER3643680
PREFERRED ADMINISTRATIVE SERVICES, INC.10234144
NORTHPORT PROPERTIES74067
PREFERRED ONE COMMUNITY HEALTH PLAN328048
MCG CAA DEPOSIT RESERVE176441
COVENANT NOT TO SELL (NET OF AMORTIZATION)1155000
DEFERRED FINANCING COSTS1794325
MINNESOTA DIAGNOSTIC IMAGING1409941
MAPLE GROVE HOSPITAL6174153
MONTICELLO CANCER CENTER592522
VHA UPPER MIDWEST200000
COLLATERAL SECURITY LENDING2238554
MAPLE GROVE ASC1170616
FieldValueIRS element (for citing)
Total Book Value Other Assets30312785TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (6 entries)

DescriptionDescriptionAmountAmount
EXECUTIVE PENSION PLAN$5,754,618
RESTORATION PENSION PLAN$49,311
PY PENSION LIABILITY$17,784,836
POST RETIREMENT HEALTH INSURANCE$2,272,554
SECURITIES LENDING$2,808,835
MCG CAA DEPOSIT RESERVE$176,441
FieldValueIRS element (for citing)
Total Of Amounts28846595TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:ALL ENDOWMENT FUNDS ARE HELD BY A RELATED ENTITY: NORTH MEMORIAL FOUNDATION. 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 ENDOWNMENT: 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 OPENED 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 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 PROVDE CARE TO INDIVIDUALS UNABLE TO PAY FOR SERVICES AT THE FACILITY. 6) PAY IT FORWARD THE PAY IT FORWARD FUND WAS ESTABLISHED BY BREAST CANCER SURVIVOR MICHELLE MOREY AND HER HUSBAND SCOTT BISSEN. MICHELLE RECOGNIZED A NEED TO HELP WOMEN STRUGGLING FINANCIALLY WHILE GOING THROUGH CANCER TREATMENT. PATIENTS ELIGIBLE FOR ASSISTANCE ARE FROM NORTH MEMORIAL, UNITY AND MONTICELLO HOSPITALS. THE FUND IS ADMINISTERED AT NO FEE THROUGH THE NORTH MEMORIAL FOUNDATION. 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.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:NORTH MEMORIAL EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2011. NORTH MEMORIAL IS NOT CURRENTLY UNDER EXAMINATION BY ANY TAX JURISDICTION.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense12749158TotalCommunityBenefitExpense
Net Community Benefit Expense12749158NetCommunityBenefitExpense
Percent Of Total Expense0.02040PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense77061075TotalCommunityBenefitExpense
Direct Offsetting Revenue51904776DirectOffsettingRevenue
Net Community Benefit Expense25156299NetCommunityBenefitExpense
Percent Of Total Expense0.04020PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense89810233TotalCommunityBenefitExpense
Direct Offsetting Revenue51904776DirectOffsettingRevenue
Net Community Benefit Expense37905457NetCommunityBenefitExpense
Percent Of Total Expense0.06060PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1929995TotalCommunityBenefitExpense
Net Community Benefit Expense1929995NetCommunityBenefitExpense
Percent Of Total Expense0.00310PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense5021049TotalCommunityBenefitExpense
Direct Offsetting Revenue3000994DirectOffsettingRevenue
Net Community Benefit Expense2020055NetCommunityBenefitExpense
Percent Of Total Expense0.00320PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense55373966TotalCommunityBenefitExpense
Direct Offsetting Revenue42234182DirectOffsettingRevenue
Net Community Benefit Expense13139784NetCommunityBenefitExpense
Percent Of Total Expense0.02100PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense464846TotalCommunityBenefitExpense
Net Community Benefit Expense464846NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense62789856TotalCommunityBenefitExpense
Direct Offsetting Revenue45235176DirectOffsettingRevenue
Net Community Benefit Expense17554680NetCommunityBenefitExpense
Percent Of Total Expense0.02800PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense152600089TotalCommunityBenefitExpense
Direct Offsetting Revenue97139952DirectOffsettingRevenue
Net Community Benefit Expense55460137NetCommunityBenefitExpense
Percent Of Total Expense0.08860PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$6,884,479BadDebtExpenseAmount
Amount Reimbursed By Medicare130526889AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare169355781CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-38828892MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (8 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipOfficers Etc Profit Or OwnershipOfficersEtcProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
1 MAPLE GROVE HOSPITAL
HOSPITAL0.750000.000000.00000
2 NM SURGERY CENTER MAPLE GROVE
OUTPATIENT SURG CTR0.500000.000000.50000
4 MN DIAGNOSTIC IMAGING PARTNERS
OUTPATIENT IMAGING CTR0.600000.000000.40000
5 PREFERRED ONE ADMINISTRATIVE SERVICES
CLAIMS ADMINISTRATOR0.250000.000000.25000
6 PREFERRED ONE COMMUNITY HEALTH PLAN
INSURANCE COMPANY0.500000.000000.00000
7 INSTITUTE OF ATHLETIC MEDICINE
CLINIC0.370000.000000.00000
10 MONTICELLO CANCER CENTER
OPTNT CANCER CLINIC0.400000.000000.00000
11 NORTH RADIATION ONCOLOGY
OPTNT RADIATION ONC CLNC0.500000.000000.00000
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1NORTH MEMORIAL MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line13300 OAKDALE AVENUE NORTHAddressLine1
CityROBBINSDALECity
StateMNState
ZIP Code55422ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NORTH MEMORIAL MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent400.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
State RegulationXStateRegulation
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges1GrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

ExplanationExplanationIdentifierIdentifier
PART III, LINE 4: NORTH MEMORIAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE DESCRIPTION ABOUT BAD DEBT EXPENSE. THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNT ON PART III, SECTION A, LINE 2. WE DO NOT HAVE THE INFORMATION NECESSARY TO DETERMINE WHICH PORTION OF THE AMOUNT REPORTED ON LINE 2 IS COMMUNITY BENEFIT.
PART III, LINE 8: THE SHORTFALL REPORTED REPRESENTS THE AMOUNT MEDICARE REIMBURSEMENT IS LESS THAN THE ESTIMATED COST OFPROVIDING SERVICES TO THOSE PATIENTS. THE METHOD USED TO ESTIMATE THOSE COSTS IS THE COST TO CHARGE RATIO APPROACH WHICH CALCULATES THE RATIO OF TOTAL HOSPITAL COSTS / TOTAL HOSPITAL GROSS REVENUE AND THEM APPLIES THAT RATIO TO TOTAL MEDICARE GROSS REVENUE.
PART III, LINE 9B: NORTH MEMORIAL HAS POLICIES AND PROCEDURES IN PLACE FOR COLLECTION PRACTICES THAT INCLUDE IDENTIFICATION AND SCREENING FOR CHARITY CARE AND FINANCIAL ASSISTANCE. THE POLICIES ARE AVAILABLE ON THE ORGANIZATIONS INTRANET AND PERTAIN TO ALL ENTITIES UNDER THE NORTH MEMORIAL CORPORATE UMBRELLA.
PART V, SECTION B, LINE 19D: THE MINNESOTA ATTORNEY GENERAL'S OFFICE REQUIRES HOSPITALS TO RENDER SERVICES TO THOSE PATIENTS WHO DO NOT HAVE INSURANCE AT A REDUCED RATE EQUAL TO THE DISCOUNT INCURRED FROM THE HIGHEST VOLUME MANAGE CARE PLAN.NORTH MEMORIAL MEDICAL CENTER
PART V, SECTION B, LINE 21: PER THE MINNESOTA ATTORNEY GENERAL'S AGREEMENT, THIRD PARTY LIABILITY AND PROCEDURES THAT ARE NOT MEDICALLY NECESSARY ARE NOT COVERED UNDER THE MINNESOTA ATTORNEY GENERAL'S AGREEMENT AND THOSE PATIENTS CAN BE BILLED FULL CHARGES.NORTH MEMORIAL MEDICAL CENTER
PART VI, LINE 2: NORTH MEMORIAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF COMMUNITY BENEFITS AND CHARITY CARE IT PROVIDES. THOSE RECORDS INCLUDE MANAGEMENT'S ESTIMATE OF THE COST TO PROVIDE CHARITY CARE, THE COST OF THE SERVICES AND SUPPLIES FURNISHED FOR COMMUNITY BENEFIT PROGRAMS AND PUBLIC PROGRAM PAYMENT DEFICITS.
PART VI, LINE 3: NORTH MEMORIAL HEALTH CARE HAS A VERY PROACTIVE PROGRAM TO ASSIST UNINSURED AND UNDERINSURED PATIENTS WITH THEIR MEDICAL BILLS. WE COMPLY WITH THE ATTORNEY GENERAL'S REQUIREMENT TO PROVIDE AN IMMEDIATE DISCOUNT TO UNINSURED MINNESOTA RESIDENTS. WE HAVE PATIENT FINANCIAL ADVOCATES AS WELL AS A CONTRACTED VENDOR THAT MEETS WITH ALL OF OUR UNINSURED INPATIENTS AND SPECIFIC OUTPATIENTS TO ASSIST THEM IN MEDICAL ASSISTANCE ELIGIBILITY AND APPLICATIONS. THIS COULD INCLUDE A VISIT TO THEIR RESIDENCE IF THEY NEED HELP IN COMPLETING ASSISTANCE APPLICATIONS. SHOULD THEY NOT QUALIFY FOR STATE OR FEDERAL ASSISTANCE PROGRAMS, WE OFFER AND ASSIST THEM IN APPLYING FOR THE HOSPITAL'S FINANCIAL ASSISTANCE (CHARITY CARE) PROGRAM.OUR CHARITY CARE PROGRAM IS PUBLISHED IN THE CORPORATE POLICIES AND PROCEDURES AND PROVIDES FOR 100% COVERAGE OF MEDICAL BILLS FOR ANYONE WHOSE INCOME IS LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES AND NEEDS ASSISTANCE IN RESOLVING THEIR FINANCIAL OBLIGATION TO THE HOSPITAL. THERE IS A GRADUAL REDUCTION IN THE CHARITY COVERAGE BETWEEN THE 201% AND 400% OF THE FEDERAL POVERTY GUIDELINES.IF WE ARE UNABLE TO MEET WITH THE PATIENT BEFORE DISCHARGE FROM NORTH MEMORIAL, THE PATIENT IS GIVEN A PAMPHLET THAT LISTS CONTACT NUMBERS TO OUR BUSINESS OFFICE CUSTOMER SERVICE AREA TO DISCUSS OPTIONS FOR ASSISTANCE WITH THEIR MEDICAL BILLS. THIS CONTACT INFORMATION IS ALSO PROVIDED ON EVERY STATEMENT THAT IS SENT TO OUR CUSTOMERS. IN ADDITION, OUR INTERNAL COLLECTIONS DEPARTMENT AND OUR COLLECTION AGENCIES ARE WELL VERSED IN OUR ASSISTANCE PROGRAMS AND WILL ASSESS DURING THEIR CONVERSATIONS WITH PATIENTS IF REFERRAL TO EITHER A STATE OR FEDERAL PROGRAM OR OUR CHARITY CARE PROGRAM WOULD BE APPROPRIATE.
PART VI, LINE 4: NORTH MEMORIAL SERVES A GEOGRAPHIC AREA THAT INCLUDES 42 ZIP CODES IN THE NORTHWEST QUADRANT OF THE TWIN CITIES METRO. THIS SERVICE AREA INCLUDES BOTH URBAN, SUBURBAN, EX-URBAN, AND RURAL AREAS. THIS SERVICE AREA INCLUDES A DIVERSE POPULATION OF MORE THAN 900,000 PEOPLE LIVING IN HENNEPIN, WRIGHT, SHERBURNE AND RAMSEY COUNTIES.
PART VI, LINE 5: NORTH MEMORIAL HEALTH CARE IS A GENERAL ACUTE CARE HOSPITAL PROVIDING SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CARDIOVASULAR AND OPEN HEART SERVICES, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL-SURGICAL, OBSTETRICAL, PEDIATRIC, REHABILITATIVE AND BEHAVIORAL SERVICES. NMHC ALSO PROVIDES AN ARRAY OF HEALTH CARE SERVICES TO OUR COMMUNITY INCLUDING PRIMARY CARE, AMBULANCE TRANSPORTATION AND HOME HEALTH AND HOSPICE SERVICES. NORTH MEMORIAL IS GOVERNED BY A BOARD OF 15 REPRESENTATIVES CONSISTING OF PHYSICIANS AND VARIOUS LEADERS FROM THROUGHOUT THE COMMUNITY. BOARD MEMBERS ARE ELECTED TO SERVE THREE-YEAR TERMS FOR A TOTAL OF FIVE TERMS. THE MEDICAL CENTER ALSO SUPPORTS AN OPEN MEDICAL STAFF ORGANIZATION INCLUDING APPROXIMATELY 900 BOARD CERTIFIED PHYSICIANS AND 300 ALLIED HEALTH PROFESSIONSALS. THE NORTH MEMORIAL BOARD OF TRUSTEES ESTABLISHES AN ANNUAL MARGIN TARGET FOR MANAGEMENT. PER BOARD POLICY 75% OF ANY EXCESS AVAILABLE CASH FLOW IS REINVESTED IN THE FORM OF CAPITAL IMPROVEMENTS TO THE CENTER. THE REMAINING 25% IS REINVESTED TO SUPPORT LONG TERM OPERATIONS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (18 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
LOREN TAYLOR
606008000201643076530143990829703000
PATRICK BORAN
3414140001232900308000800905035130632780
DAVID ABRAMS
225000000791470431240993403572050721980
JOHN ALLEN
22498000035077093730124080281838000
JOSEPH BOSTON
1481800002425705444073590185240000
ANDREW COCHRANE
33115400051292010402095650402413000
KEVIN CROSTON
40195400018011108063085890598717000
VIRGINIA MALONE
260962000001246063450268553000
MICHAEL PARRISH
261750000489160103740103640331404000
PATRICK TAFFE
256203000437840104100103000320697000
TOM TIMMONS
3299300005324720104950111640884061000
STEVEN ROH
739800000183180106910143540783163000
THOMAS ROSSINI
748096092136020260105080144520867218000
GEORGE TADROS
68830000017480101140178380718000000
PAMELA PAULSEN
624731000202490127680146190672367000
ALOK MAHESHWARI
651050000100330106910133150685089000
PAMELA LINDEMOEN
000049875000070704994570612500
JERRY MOEN
22500051432600017840118805397980767690

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SUPPLEMENTAL INFORMATIONPART IIIPART I, LINE 1A: THE ORGANIZATION REIMBURSES ONE OF THE EXECUTIVE MEMBERS FOR THE MONTHLY SOCIAL DUES AT THE GOLDEN VALLEY COUNTRY CLUB. THE DUES FOR 2011 WERE $90 PER MONTH OR 1,080 PER YEAR. THE NORTH MEMORIAL COMMUNITY FOUNDATION UTILIZES THE COUNTRY CLUB TO HOST VARIOUS FUND RAISING EVENTS THROUGH-OUT THE YEAR THAT SUPPORTS VARIOUS ACTIVITIES FOR NORTH MEMORIAL.
SUPPLEMENTAL INFORMATIONPART IIIPART 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.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
CITY OF MAPLE GROVE
41087325056516TAD72005-09-2255000000CONSTRUCTION OF OUTPATIENT CENTER010
CITY OF ROBBINSDALE
7160054962011-06-0760000000REFUND SERIES 2008 BONDS010
CITY OF ROBBINSDALE
7160054962011-06-0715000000REFUND SERIES 2008 BONDS010

Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundIssuance Costs From ProceedsIssuanceCostsFromProceedsCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaindAmount RetiredAmountRetired
54851782476798010838014900000120070011
6000000074935058710650201110112263171
150000001500000020111011

Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
01000.000000.000000.000001
00000.000000.000000.000001
00000.000000.000000.000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
000000
000000
000000

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
ROBIN DRUG AND MERWIN PHARMACIES
BOARD MEMBER IS THE OWNER OF ROBIN DRUG AND MERWIN PHARMACIES705215MICHAEL STEINHAUSER, A BOARD MEMBER, IS THE OWNER OF ROBIN DRUG AND MERWIN PHARMACIES, WHICH SUPPLY DRUGS AND PHARMACEUTICALS TO NORTH MEMORIAL HEALTH CARE.0
OAKDALE OBGYN
BOARD MEMBER IS AN OWNER OF OAKDALE OBGYN526369JON NIELSEN, A BOARD MEMBER, IS AN OWNER OF OAKDALE OBSTETRICS & GYNECOLOGY (A.K.A. OAKDALE OBGYN) WHICH PROVIDES GYNECOLOGICAL SERVICES TO NORTH MEMORIAL HEALTH CARE.0

Schedule M IRS990ScheduleM

Real Estate Commercial RealEstateCommercial

FieldValueIRS element (for citing)
Non Cash CheckboxXNonCashCheckbox
Number Of Contributions1NumberOfContributions
Noncash Contribs Rptd F990102662NoncashContribsRptdF990
Method Of Determining RevenuesFMVMethodOfDeterminingRevenues

Other Non Cash Contributions Table OtherNonCashContributionsTable (2 entries)

Non Cash CheckboxNonCashCheckboxDescriptionDescriptionNumber Of ContributionsNumberOfContributionsNoncash Contribs Rptd F990NoncashContribsRptdF990Method Of Determining RevenuesMethodOfDeterminingRevenues
XFURNITURE111568FMV
XEQUIPMENT1338863FMV
FieldValueIRS element (for citing)
Any Property That Must Be Held0AnyPropertyThatMustBeHeld
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGifts
Third Parties Used0ThirdPartiesUsed

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2LOREN TAYLOR AND BOB POTTS - BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION B, LINE 11THE ORGANIZATION'S FINANCE AND AUDIT COMMITTEE REVIEWS THE FORM 990 BEFORE IT IS FILED. REPRESENTATIVES FROM THE HOSPITAL'S INDEPENDENT ACCOUNTING FIRM REVIEWS THE FORM 990 WITH THE FINANCE AND AUDIT COMMITTEE IN DETAIL AND NOTES FOR THE COMMITTEE ANY CHANGES IN THE FORM 990 FROM PRIOR YEARS. AFTER THOROUGH DISCUSSION, THE FINANCE AND AUDIT COMMITTEE APPROVES THE FORM 990 AND FORWARDS IT TO THE FULL BOARD FOR ITS REVIEW.
FORM 990, PART VI, SECTION B, LINE 12CALL MEMBERS OF THE BOARD OF DIRECTORS AND ALL EMPLOYEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY EACH YEAR. EACH BOARD MEMBER AND STAFF MEMBER FILLS OUT A CONFLICT OF INTEREST QUESTIONNAIRE IN WHICH THEY ARE ASKED TO IDENTIFY ANY RELATIONSHIP THAT WOULD CREATE A CONFLICT OF INTEREST. THE RESULTS ARE SUMMARIZED AND REVIEWED TO DETERMINE ANY ACTUAL OR POTENTIAL CONFLICT AND ARE REPORTED TO THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 15COMPENSATION FOR KEY POSITIONS ARE REVIEWED BY THE EXECUTIVE COMMITTEE WORKING IN CONJUNCTION WITH AN OUTSIDE CONSULTANT. THE EXECUTIVE COMMITTEE INSURES THAT THE SALARY AND BENEFIT ADMINISTRATION REVIEW PROCESS IS BEING FOLLOWED, WHICH INCLUDES SALARY AND BENEFIT SURVEYS AND COMPARISONS OF ALL POSITIONS. THE CEO'S COMPENSATION IS SENT TO THE FULL BOARD FOR APPROVAL. THE COMPENSATION OF ALL OTHER KEY POSITIONS IS APPROVED BY THE CEO.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE SECRETARY OF THE STATE FILING WITH THE STATE OF MINNESOTA.
FORM 990, PART XI, LINE 5:NET UNREALIZED LOSSES ON INVESTMENTS: -15,015,163. CHANGE IN INTEREST RATE SWAP VALUATION -1,141,258. EQUITY TRANSFER -16,065,481. TOTAL TO FORM 990, PART XI, LINE 5: -32,221,902.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XII, LINE 2C:NEITHER THE OVERSIGHT OF THE AUDIT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT WERE CHANGED DURING THE TAX YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1OAKDALE MEDICAL CENTERBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13300 OALDALE AVENUE NORTHAddressLine1
CityROBBINSDALECity
StateMNState
ZIP Code55422ZIPCode
FieldValueIRS element (for citing)
EIN320022819EIN
Primary ActivitiesLEASE MEDICAL OFFICE SPACEPrimaryActivities
Legal Domicile StateMNLegalDomicileState
Total Income435686TotalIncome
EOY Assets18294754EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NORTH MEMORIALBusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgLegal Domicile Foreign CountryLegalDomicileForeignCountry
NORTH MEMORIAL COMMUNITY FOUNDATION
3300 OAKDALE AVENUE NORTHROBBINSDALEMN55422411777966FUNDRAISINGMN501(C)(3)7NORTH MEMORIAL0
ASSOCIATED HEALTH ASSURANCE
3300 OAKDALE AVENUE NORTHROBBINSDALEMN55422980343815INSURANCE501(C)(3)11ANORTH MEMORIAL1BD
MAPLE GROVE HOSPITAL CORPORATION
9875 HOSPITAL DRIVEMAPLE GROVEMN55369208316475ACUTE CAREMN501(C)(3)3NORTH MEMORIAL1
WEST HEALTH INC
2805 CAMPUS DRIVEPLYMOUTHMN55441SURGERY CENTERMN501(C)(3)3NORTH MEMORIAL0

Form990 Schedule R Part III Form990ScheduleRPartIII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodePrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStatePredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnershipShare Of EOY AssetsShareOfEOYAssets
WEST SUBURBAN HEALTH
2805 CAMPUS DRIVEPLYMOUTHMN55441REAL ESTATEMNRELATED-14301010.50000
NORTH MEMORIAL SURGERY CENTER AT MAPLE GROVE
3300 OAKDALE AVENUE NORTHROBBINSDALEMN55422OUTPATIENT SURGERYMNRELATED893789010.510002107861
NORTH MEMORIAL ENDOSCOPY CENTER AT MAPLE GROVE
3300 OAKDALE AVENUE NORTHROBBINSDALEMN55422OUTPATIENT SURGERYMNRELATED00
MONTICELLO CANCER CENTER
1013 HART BLVDMONTICELLOMN55362CANCER CENTERMNRELATED-935400010.400002211028
MINNESOTA DIAGNOSTIC IMAGING PARTNERS LLC
9855 HOSPITAL DRIVEMAPLE GROVEMN55369RADIOLOGYMNRELATED505224000.600001583138

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1OAKDALE HEALTH ENTERPRISES INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13300 OAKDALE AVENUE NORTHAddressLine1
CityROBBINSDALECity
StateMNState
ZIP Code55422ZIPCode
FieldValueIRS element (for citing)
EIN411546422EIN
Primary ActivityAMBULANCEPrimaryActivity
Legal Domicile StateMNLegalDomicileState
Type Of EntityCTypeOfEntity
Share Of Total Income289593ShareOfTotalIncome
Share Of EOY Assets865740ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (20 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
NORTH MEMORIAL COMMUNITY FOUNDATION (CONTRIBUTIONS)
C1018895FMV
NORTH MEMORIAL COMMUNITY FOUNDATION (LEASE PAYMENTS)
I98857FMV
MAPLE GROVE HOSPITAL CORPORATION (DEBT GUARANTEE)
D107704FMV
MAPLE GROVE HOSPITAL CORPORATION (LEASE PAYMENTS)
I564633FMV
MAPLE GROVE HOSPITAL CORPORATION (MANAGEMENT FEES)
P4823684FMV
MAPLE GROVE HOSPITAL CORPORATION (SALARY REIMBURSEMENT)
P5481484FMV
ASSOCIATED HEALTH ASSURANCE (PREMIUMS)
L802000FMV
OAKDALE HEALTH ENTERPRISES (PAYROLL)
B1593403FMV
OAKDALE HEALTH ENTERPRISES (MANAGEMENT FEES)
L664214FMV
OAKDALE HEALTH ENTERPRISES (INTEREST ON LOAN)
R75622FMV
OAKDALE MEDICAL OFFICE BUILDING (LEASE PAYMENTS)
J780470FMV
OAKDALE MEDICAL OFFICE BUILDING (EXPENSE REIMBURSEMENT)
P403921FMV
MINNEAPOLIS RADIATION ONCOLOGY (LOAN GUARANTEE)
D443690FMV
NORTH MEMORIAL AMBULATORY SURGERY CENTER (LEASE PAYMENTS)
I1392390FMV
NORTH MEMORIAL ENDOSCOPY CENTER (LEASE PAYMENTS)
I374590FMV
MAPLE GROVE DIAGNOSTIC IMAGING CENTER (LEASE PAYMENTS)
I698643FMV
MINNEAPOLIS RADIATION ONCOLOGY (LEASE PAYMENTS)
I226505FMV
MINNEAPOLIS RADIATION ONCOLOGY (DIVIDEND)
R1440000FMV
WEST HEALTH (MANAGEMENT FEE)
L274088FMV
WEST HEALTH (RENT)
J281911FMV

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