2012-11-06T14:26:13-06:00 2011-12-31 390859910 BAKER TILLY VIRCHOW KRAUSE LLP 225 S 6TH ST STE 2300 MINNEAPOLIS MN 55402 990 2011-01-01 411328097 RIDGEVIEW FOUNDATION RIDG 9524426010 500 SOUTH MAPLE STREET WACONIA MN 55387 GORDON GABLENZ 9524422191 2012-10-30 1 LAWRENCE H MOHR CPA P00447603 6128764500 2011 2016-02-24 21:20:13Z GORDON GABLENZ 500 SOUTH MAPLE STREET WACONIA MN 55387 3413700 0 X N/A X 1978 MN TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 19 19 0 300 0 0 1739448 1945444 0 0 98307 -56198 156295 31986 1994050 1921232 1057482 1110000 0 0 0 0 0 0 119986 240066 311824 1297548 1421824 696502 499408 7782936 8545416 1200 248746 7781736 8296670 RIDGEVIEW FOUNDATION IS AN INDEPENDENT NONPROFIT ORGANIZATION THAT PARTNERS WITH RIDGEVIEW MEDICAL CENTER IN ITS MISSION TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 0 0 1262986 1110000 TO RAISE FUNDS EXCLUSIVELY FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER, A NOT-FOR-PROFIT HOSPITAL IN WACONIA, MINNESOTA. DURING THE YEAR ENDED DECEMBER 31, 2011, RIDGEVIEW FOUNDATION EXPENSED A TOTAL OF $1,262,986 TO RIDGEVIEW MEDICAL CENTER. $496,006 WAS TRANSFERRED TO BUILD AND FURNISH A NEW HOSPICE RESIDENCE THAT WAS A NEW SERVICE THAT STARTED IN 2009. $424,100 WAS TRANSFERRED TO THE HOSPITAL TO SUPPORT THE BUILDING AND FURNISHING OF A HEART CENTER AND CATH LAB AT THE HOSPITAL. THE REMAINING $342,880 TRANSFERRED TO THE HOSPITAL WAS USED FOR VARIOUS PROJECTS AND PROGRAMS DURING 2011. 1262986 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 2 0 0 0 0 0 0 0 1 1 0 0 0 0 X 19 19 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X GORDON GABLENZ 9524426010 500 SOUTH MAPLE STREET WACONIA MN 55387 X DAVID ADINOLFI 0.50 X 0 0 0 DARLA HOLMGREN 0.50 X 0 0 0 RANDY SCHNEEWIND 0.50 X 0 0 0 JEAN BULLER 0.50 X 0 0 0 BRIAN MARK 0.50 X X 0 0 0 DERMOT COWLEY 0.50 X 0 0 0 PETER NELSON 0.50 X 0 0 0 LARRY WILHELM 0.50 X 0 0 0 LAURA FLEMAL 0.50 X 0 0 0 STACY DESAI 0.50 X 0 0 0 TIM FOSTER 0.50 X 0 0 0 KEITH RACHEY 0.50 X 0 0 0 CHARLES SPEVACEK 0.50 X 0 0 0 KATE ROEHL 0.50 X 0 0 0 MIKE GRESSER 0.50 X 0 0 0 KATHY HACKETT 0.50 X 0 0 0 GREG KUMMER 0.50 X 0 0 0 BRIAN BENIEK 0.50 X 0 0 0 JEFF LAUREL 0.50 X 0 0 0 ROBERT STEVENS 0.50 X 0 324892 354126 GORDON GABLENZ 0.50 X 0 192974 24337 DOUGLAS STASEK 47.50 X 0 177060 22891 0 694926 401354 0 0 1 0 0 304871 145135 1495438 284116 1945444 28520 28520 1182660 1267378 -84718 -84718 -84718 241851 304871 217564 24287 24287 15225 7526 7699 7699 1921232 0 0 -24212 1100000 1100000 10000 10000 7004 7004 15493 15493 16901 16901 118836 15751 103085 MISCELLANEOUS 143590 142986 604 WHOLE LIFE INSURANCE EX 10000 10000 1421824 1262986 38852 119986 1249807 1895940 959052 1235390 3269640 3030346 462093 708790 1842344 1674950 7782936 8545416 1200 248746 1200 248746 X 1742129 1711083 5072552 5513398 967055 1072189 7781736 8296670 7782936 8545416 X 499408 15526 X X 0 1 1 X 0 X 3761997 2540736 1096638 1739448 1945444 11084263 3761997 2540736 1096638 1739448 1945444 11084263 3333905 7750358 132660 126263 60771 43863 28520 392077 11476340 1292905 0.67530 0.62360 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: THE FOUNDATION TRANSFERS FUNDS TO THE HOSPITAL ONLY WHEN THE HOSPITAL HAS COMMITTED TO DONOR RESTRICTED PROJECTS AND HAS SPENT A REQUIRED AMOUNT OF FUNDS ON THE PROJECT. DURING 2011, TOTAL SUPPORT OF THE HOSPITAL WAS $1,262,986 WHICH REPRESENTED TRANSFERS TO RIDGEVIEW MEDICAL CENTER FROM THE FOUNDATION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1228652 227270 48325 48078 1456169 1068586 195012 56843 91789 1228652 2171052 7534 75524 1185524 1068586 2142931 303299 -72288 202890 2171052 0.23050 0.73630 0.03320 0 0 0 KEY PERSON LIFE INSURANCE 232208 BRIDGE LOAN TO RIDGEVIEW MEDICAL CENTER 1041014 ANNUITY CONTRACT 46728 CASH HELD IN REMAINDER TRUST 355000 1674950 1921232 1421824 499408 15526 15526 514934 2669768 15526 507920 225090 748536 1921232 0 1921232 2154834 507920 225090 733010 1421824 0 1421824 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FOUNDATION HAS RECEIVED NOTIFICATION THAT IT QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING PROVISIONS OF STATE LAW AND, ACCORDINGLY, IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, ANY UNRELATED BUSINESS INCOME MAY BE SUBJECT TO TAXATION. DURING 2010, THE FOUNDATION REQUESTED AND WAS APPROVED TO RECLASS FROM 509(A)(3)STATUS TO 509(A)(1) AND 170(B)(1)(A)(VI) STATUS WITH THE IRS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE THE FOUNDATION TO EVALUATE TAX POSITIONS TAKEN BY THE FOUNDATION AND RECOGNIZE A TAX LIABILITY (OR ASSET) IF THE ORGANIZATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY APPLICABLE TAX AUTHORITIES. MANAGEMENT HAS ANALYZED TAX POSITIONS TAKEN BY THE FOUNDATION, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2011, THERE ARE NO UNCERTAIN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY (OR ASSET) OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE FOUNDATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. THE FOUNDATION BELIEVES IT IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR YEARS PRIOR TO 2008. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT FUNDRAISING EXPENSES 217,564. DIRECT GAMING EXPENSES 7,526. PART XIII, LINE 2D - OTHER ADJUSTMENTS: DIRECT FUNDRAISING EXPENSES 217,564. DIRECT GAMING EXPENSES 7,526. GOLF 361728 221149 140579 18257 138556 FALL HARVEST MOON 184994 83722 101272 38336 1 22415 546722 304871 241851 18257 199307 217564 24287 15225 7526 1 0.80000 15225 7526 7526 7699 MN 1 0 0 0 1.00000 GORDON GABLENZ 500 SOUTH MAPLE STREET WACONIA MN 55387 0 JAN HELD 58055 JAN HELD IS THE EVENTS COORDINATOR FOR THE FOUNDATION. X 1 7699 1 RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 501(C)(3) 1100000 FUNDRAISING SUPPORT OF RIDGEVIEW MEDICAL CENTER BY FOUNDATION 1 SCHOLARSHIPS 10 10000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SCHOLARSHIP PAYMENTS ARE MADE DIRECTLY TO THE SCHOOL THAT THE STUDENT IS ATTENDING. X X 0 1 0 0 0 0 0 0 0 ROBERT STEVENS 0 324892 0 0 0 0 0 343717 0 10409 0 679018 0 0 GORDON GABLENZ 0 192974 0 0 0 0 0 14027 0 10310 0 217311 0 0 DOUGLAS STASEK 0 177060 0 0 0 0 0 12828 0 10063 0 199951 0 0 PART I, LINE 4B ROBERT STEVENS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT SPLIT-DOLLAR WHOLE LIFE PLAN. ACCRUED 329,401.67 DURING 2011. SUPPLEMENTAL INFORMATION PART III SCHEDULE J PART I LINE 3: THE CEO'S COMPENSATION IS DETERMINED BY RIDGEVIEW FOUNDATION'S PARENT ORGANIZATION, RIDGEVIEW MEDICAL CENTER. THE PROCESS USED BY RIDGEVIEW MEDICAL CENTER INCLUDES A COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. X 3 101978 FAIR MARKET VALUE X SUPPLIES AND EQUIPMENT 6 182138 FAIR MARKET VALUE 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS REFERS TO THE NUMBER OF ACTUAL CONTRIBUTORS. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS OF THE FOUNDATION DESIGNATED SEVEN BOARD MEMBERS AS AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE ACTS ONLY DURING INTERVALS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS OF THE FOUNDATION AND IS AT ALL TIMES SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD OF DIRECTORS OF THE FOUNDATION. DURING SUCH INTERVALS AND SUBJECT TO SUCH CONTROL AND DIRECTION, THE EXECUTIVE COMMITTEE HAS ALL OF THE AUTHORITY AND POWER OF THE BOARD OF DIRECTORS OF THE FOUNDATION IN THE MANAGEMENT OF THE BUSINESS OF THE FOUNDATION, SUBJECT TO SUCH LIMITATIONS AS THE BOARD OF DIRECTORS OF THE FOUNDATION MAY IMPOSE FROM TIME TO TIME. FORM 990, PART VI, SECTION A, LINE 6 RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF RIDGEVIEW FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A EACH PERSON ELECTED BY THE BOARD OF DIRECTORS OF RIDGEVIEW FOUNDATION IS RATIFIED OR REJECTED BY THE BOARD OF DIRECTORS OF RIDGEVIEW MEDICAL CENTER, THE FOUNDATION'S SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B IN ADDITION TO THE APPOINTMENT OF DIRECTORS TO THE BOARD OF DIRECTORS OF RIDGEVIEW FOUNDATION, AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FOUNDATION REQUIRE APPROVAL OF RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE CFO REVIEWED THE FORM 990 AND PROVIDED COPIES TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE RIDGEVIEW FOUNDATION BOARD ANNUALLY REQUIRES EACH OF ITS MEMBERS TO RESPOND TO A CONFLICT OF INTEREST QUESTIONNAIRE. FORM 990, PART VI, SECTION B, LINE 15 RIDGEVIEW FOUNDATION DOES NOT COMPENSATE ITS OFFICERS OR BOARD MEMBERS. ANY COMPENSATION RECEIVED BY THOSE INDIVIDALS IS DETERMINED BY RIDGEVIEW MEDICAL CENTER, THE FOUNDATION'S PARENT. FORM 990, PART VI, SECTION C, LINE 19 RIDGEVIEW FOUNDATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. OFFICER HOURS FOR RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, COL B: ROBERT STEVENS IS THE CEO OF RIDGEVIEW MEDICAL CENTER AND ITS RELATED ORGANIZATIONS, RIDGEVIEW CLINICS AND RIDGEVIEW FOUNDATION. ROBERT STEVEN'S ESTIMATED AVERAGE HOURS PER WEEK DEVOTED TO ALL ORGANIZATIONS IS 50 HRS/WEEK. HE SPENDS AN ESTIMATED 1% (0.5 HRS/WEEK) OF HIS TIME DEVOTED TO RIDGEVIEW FOUNDATION, 10% (5 HRS/WEEK) OF HIS TIME DEVOTED TO RIDGEVIEW CLINICS, AND 89% (44.5 HRS/WEEK) OF HIS TIME DEVOTED TO RIDGEVIEW MEDICAL CENTER. GORDON GABLENZ IS THE CFO OF RIDGEVIEW MEDICAL CENTER AND ITS RELATED ORGANIZATIONS, RIDGEVIEW CLINICS AND RIDGEVIEW FOUNDATION. GORDON GABLENZ'S ESTIMATED AVERAGE HOURS PER WEEK DEVOTED TO ALL ORGANIZATIONS IS 50 HRS/WEEK. HE SPENDS AN ESTIMATED 1% (0.5 HRS/WEEK) OF HIS TIME DEVOTED TO RIDGEVIEW FOUNDATION, 1% (0.5 HRS/WEEK) OF HIS TIME DEVOTED TO RIDGEVIEW CLINICS, AND 98% (49.0 HRS/WEEK) OF HIS TIME DEVOTED TO RIDGEVIEW MEDICAL CENTER. DOUGLAS STASEK IS THE VICE-PRESIDENT OF RIDGEVIEW FOUNDATION, A RELATED ORGANIZATION OF RIDGEVIEW MEDICAL CENTER. DOUGLAS STASEK'S ESTIMATED AVERAGE HOURS PER WEEK DEVOTED TO ALL ORGANIZATIONS IS 50HRS/WEEK. HE SPENDS AN ESTIMATED 95% (47.5 HRS/WEEK) OF HIS TIME DEVOTED TO RIDGEVIEW FOUNDATION, AND 5% (2.5 HRS/WEEK) OF HIS TIME DEVOTED TO RIDGEVIEW MEDICAL CENTER. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 15,526. REVIEW OF AUDIT FORM 990, PART XI, LINE 2C THE PROCESS FOR THE REVIEW AND OVERSIGHT OF THE AUDIT HAS NOT CHANGED FROM PRIOR YEAR. RIDGEVIEW CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 411651783 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 0 RIDGEVIEW INSURANCE COMPANY 60 E SOUTH TEMPLE STE 1800 SALT LAKE CITY UT 84111 454109041 CAPTIVE INSURANCE CO. UT 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER LLC 500 SOUTH MAPLE STREET WACONIA MN 55387 205785920 CARDIOLOGY SERVICES MN N/A CHASKA PLAZA SURGERY CENTER 3000 HUNDERTMARK RD CHASKA MN 55318 450975783 SURGERY SERVICES MN N/A RIDGEVIEW REAL ESTATE LLC 500 SOUTH MAPLE STREET WACONIA MN 55387 LAND LESSOR MN N/A RIDGEVIEW REAL ESTATE II LLC 500 SOUTH MAPLE STREET WACONIA MN 55387 LAND LESSOR MN N/A EXECUTIVE HEALTH MANAGEMENT SERVICES INC 500 SOUTH MAPLE STREET WACONIA MN 55387 411760239 MANAGEMENT SERVICES MN N/A C CHARITABLE REMAINDER UNITRUST (1) CHARITABLE TRUST MN RIDGEVIEW FOUNDATION T 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 RIDGEVIEW MEDICAL CENTER N 463073 EMPLOYEE SALARIES & BENEFITS RIDGEVIEW MEDICAL CENTER C 145135 FAIR VALUE RIDGEVIEW MEDICAL CENTER D 1041014 FAIR VALUE RIDGEVIEW MEDICAL CENTER B 1100000 ACTUAL CASH GRANT