2011-11-15T14:58:53-06:00 2011-03-31 RSM MCGLADREY INC 700 MISSABE BUILDING DULUTH MN 55802 990 2010-04-01 411724637 LONGVILLE LAKES CLINIC INC LONG 2185464366 180 JORDAN LANE LONGVILLE MN 56655 KYLE BAUER 2185464366 2011-10-27 1 JENNIFER MILLER 2187278253 2010 2016-03-07 17:11:31Z KYLE BAUER 180 JORDAN LANE LONGVILLE MN 56655 463994 0 X N/A X 1992 MN TO PROVIDE PRIMARY MEDICAL CARE TO RESIDENTS OF THE LONGVILLE AREA. 8 8 12 0 0 0 0 12442 0 451493 0 59 0 0 0 463994 0 0 0 0 0 290549 0 0 0 0 418361 0 708910 0 -244916 143181 225243 143181 225243 0 0 TO PROVIDE PRIMARY MEDICAL CARE TO RESIDENTS OF THE LONGVILLE AREA. 0 0 659509 451493 PROVIDED FULL-TIME PRIMARY MEDICAL CARE TO RESIDENTS OF THE LONGVILLE AREA FIVE DAYS A WEEK. 659509 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 12 1 0 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 1 1 1 1 1 0 0 1 1 0 0 1 1 0 1 0 MN X KYLE BAUER 2185467000 320 EAST MAIN ST CROSBY MN 56441 EARL W BEDARD 1.00 X X 0 0 0 PEG ATZEN 1.00 X X 0 0 0 THOMAS F REEK 1.00 X 0 0 0 MARY JANE LEWIS 1.00 X 0 0 0 MYRON MIDTHUN 1.00 X 0 0 0 LAURA HANSEN 1.00 X X 0 0 0 BONNIE JEPSON 1.00 X 0 0 0 SCOTT CARPENTER 1.00 X 0 0 0 KYLE BAUER 40.00 X 0 143148 16737 THERESA SULLIVAN 40.00 X 0 116600 11260 0 259748 27997 0 0 1 0 CENTRAL LAKES MEDICAL CLINIC 318 MAIN STREET CROSBY MN 56441 PHYSICIAN SERVICES 179380 1 12442 12442 PATIENT REVENUE 621500 451493 451493 451493 59 59 463994 451493 0 59 246330 246330 11144 11144 13793 13793 19282 19282 5950 5950 282079 231223 50856 43902 43902 49857 49857 8597 8597 10707 10707 8521 8521 PUBLIC RELATIONS 6721 6721 MISCELLANEOUS 6182 6182 MINNESOTA CARE TAX 2403 2403 WORKERS' COMPENSATION 1618 1618 PROVISION FOR DOUBTFUL -8176 -8176 708910 659509 49401 0 11695 37700 83845 71707 5690 7346 5090 4926 273595 170031 36861 103564 143181 225243 21858 22649 121323 202594 143181 225243 X 0 0 143181 225243 X -244916 244916 X X 1 0 1 X 0 X 25721 24536 21605 25131 12442 109435 360065 382864 462333 470924 451493 2127679 385786 407400 483938 496055 463935 2237114 0 0 0 2237114 511 384 223 83 59 1260 511 384 223 83 59 1260 386297 407784 484161 496138 463994 2238374 0.99940 0.99920 0.00060 0.00080 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 273595 170031 103564 103564 DUE TO CUYUNA RANGE HOSPITAL DISTRICT 202594 202594 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: NOT-FOR-PROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGES, IF UNRELATED BUSINESS INCOME IS GENERATED, AND IN CERTAIN OTHER INSTANCES. NOT-FOR-PROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE CLINIC HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. 0 0 0 0 0 0 0 0 0 KYLE BAUER 0 143148 0 0 0 0 0 11630 0 5107 0 159885 0 0 FORM 990, PART VI, SECTION A, LINE 6 CUYUNA RANGE HEALTH CORPORATION IS THE SOLE MEMBER OF LONGVILLE LAKES CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS CONSISTS OF EIGHT DIRECTORS WHO ARE DESIGNATED BY CUYUNA RANGE HEALTH CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WILL BE PROVIDED TO THE GOVERNING BODY BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 15B THE COMPENSATION FOR KEY EMPLOYEES IS REVIEWED BY THE COMPENSATION COMMITTEE, ALL COMPENSATION IS REVIEWED AGAINST HHRAM AND MMGMA AVERAGES FOR REASONABLENESS. LONGVILLE LAKES CLINIC DOES NOT COMPENSATE ANY TOP MANAGEMENT OFFICIALS. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTS ARE AVAILABLE AT THE REQUEST OF THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: FORGIVENESS OF DEBT BY CUYUNA RANGE HOSPITAL DISTRICT 244,916. TOTAL TO FORM 990, PART XI, LINE 5: 244,916. FORM 990, PAGE 11, PART XII, LINE 2C THE ORGANIZATION HAS A COMMITTEE THAT OVERSEES THE REVIEW AND SELECTS AN INDEPENDENT ACCOUNTANT. CUYUNA REGIONAL MEDICAL CENTER 320 E MAIN STREET CROSBY MN 56441 410879376 HEALTH CARE MN 115 N/A 0 CUYUNA RANGE HEALTH CORP 320 EAST MAIN STREET CROSBY MN 56441 411696402 HEALTH CARE MN CUYUNA RANGE HOSPITAL DISTRICT C 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 1 0 1