PARK NICOLLET HEALTH SERVICES: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
PARK NICOLLET HEALTH SERVICES (EIN 41-0834920)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-10
IRS object ID
201113149349302851
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

FieldValueIRS element (for citing)
Timestamp2011-11-10T14:10:45-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line150 South Sixth Street Suite 2800AddressLine1
CityMinneapolisCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN410834920EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Park Nicollet ClinicBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPARKNameControl
Phone9529936790Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line13800 Park Nicollet BlvdAddressLine1
CitySt Louis ParkCity
StateMNState
ZIP Code55416ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSheila McMillanName
TitleCFOTitle
Phone9529936790Phone
Date Signed2011-10-31DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKristina RasmussenName
Phone6123974000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSheila McMillanNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line16500 Excelsior BlvdAddressLine1
CitySt Louis ParkCity
StateMNState
ZIP Code55416ZIPCode
FieldValueIRS element (for citing)
Gross Receipts671662728GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.parknicollet.ComWebSite
Type Of Organization AssociationXTypeOfOrganizationAssociation
Year Formation1959YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionCares for and supports the health, healing,and learning of those served.ActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members9NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers287TotalNbrVolunteers
Total Gross UBI8500228TotalGrossUBI
Net Unrelated Business Txbl Income-13363NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year1766175ContributionsGrantsPriorYear
Contributions Grants Current Year441222ContributionsGrantsCurrentYear
Program Service Revenue Prior Year627316471ProgramServiceRevenuePriorYear
Program Service Revenue CY630370147ProgramServiceRevenueCY
Investment Income Prior Year820559InvestmentIncomePriorYear
Investment Income Current Year1167119InvestmentIncomeCurrentYear
Other Revenue Prior Year1380934OtherRevenuePriorYear
Other Revenue Current Year1025314OtherRevenueCurrentYear
Total Revenue Prior Year631284139TotalRevenuePriorYear
Total Revenue Current Year633003802TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year101791GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY906266GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year345686151SalariesEtcPriorYear
Salaries Etc Current Year354891857SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year54689TotalFundrsngExpCurrentYear
Other Expense Prior Year241967727OtherExpensePriorYear
Other Expenses Current Year240614670OtherExpensesCurrentYear
Total Expenses Prior Year587755669TotalExpensesPriorYear
Total Expenses Current Year596412793TotalExpensesCurrentYear
Revenues Less Expenses Prior Year43528470RevenuesLessExpensesPriorYear
Revenues Less Expenses CY36591009RevenuesLessExpensesCY
Total Assets BOY216005002TotalAssetsBOY
Total Assets EOY250029815TotalAssetsEOY
Total Liabilities BOY104254708TotalLiabilitiesBOY
Total Liabilities EOY98630250TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY111750294NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY151399565NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionPark Nicollet Clinic has a mission to care for and support the health, healing, and learning of those served. The focus is on excellent care, delivered in a caring manner, with emphasis on disease prevention and wellness education.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense516691128Expense
Grants906266Grants
Revenue608820304Revenue
DescriptionPark Nicollet Clinic is one of the largest multispecialty clinics in the United States, providing care in more than 55 medical specialties. Approximately 700 physicians and 350 clinical professionals are on staff at 18 primary care clinics and several other care locations in Minneapolis and surrounding suburbs.Park Nicollet Clinic is part of Park Nicollet Health Services, an integrated care system, staffed by nationally recognized hospital and clinic doctors, clinical professionals, nurses and other staff. Park Nicollet Clinic helps patients stay healthy and takes care of them when they are sick. Park Nicollet Clinic's mission is to care for and support the health, healing and learning of those served.Park Nicollet Clinic uses five core values to accomplish its mission - care, service, stewardship, joy and learning. Highlights of 2010 that support Park Nicollet Health Service's values include the following:Park Nicollet Clinic actively involved its patients, employees, board members and community partners in identifying patient and community needs. In 2010, Park Nicollet Clinic provided more than $7 million in patient services charity care and $29.8 million in unreimbursed medical care. Patient councils continue to foster collaboration between patients, families and care teams. These councils focus on topics such as patient safety, facility design, clinician-patient communication, quality improvement, patient/family education, ethics and research. Park Nicollet Clinic helped open a new health resource center in the Brooklyn Center High School in 2010. It provides free and low-cost medical, mental health and dental care to children and youth in the community. This community resource is the fourth such school-affiliated clinic established, staffed and funded in partnership with Park Nicollet Foundation and Park Nicollet Clinic.In 2010, by partnering with the local non-profit Children's Dental Services, four community clinics for children began offering free or reduced cost dental care to any child or adolescent in the communities served.Park Nicollet Clinic and other affiliates provided needed comprehensive care, including primary, specialty, hospital and pharmacy services, at no charge to 1,996 individuals enrolled in the St. Mary's program - an innovative model of providing continuity of care for the uninsured. In total, the clinic provided reduced charge or free care to approximately 14,700 individuals. In 2010, Park Nicollet Clinic received four of the eleven certifications by the state of Minnesota to be "health care homes." Health care homes, also known as "medical homes," offer a team approach to care. A care coordinator works with patients and their families to coordinate with a clinical team that may include physicians, nurses, clinicians, specialists and pharmacists. The program also coordinates with community resources such as schools and social service agencies to ensure continuity of care that will follow patients after they leave the clinic and into the communities where they live.Park Nicollet Clinic is affiliated with Park Nicollet Health Services, Park Nicollet Methodist Hospital, Park Nicollet Foundation, Park Nicollet Institute and Park Nicollet Health Care Products. Together with the affiliated organizations, Park Nicollet Clinic has accomplished the following in 2010:Park Nicollet Clinic and its affiliates are dedicated to caring for, and supporting the health, healing and learning of patients, employees and the community. Park Nicollet Clinic and its affiliates accomplish this in many ways and are especially grateful to its volunteers. In 2010, Park Nicollet Health Services and affiliates gave more than $3.1 million through 106 grants. Park Nicollet Health Services and affiliates continued its joint sponsorship of the Successful Aging Initiative, which focuses on improving coordination of community and health care services for senior citizens. Park Nicollet Clinic and Park Nicollet Foundation partner with 21 school districts to assure that all students are up to date with their immunizations. Park Nicollet Health Services and affiliates strive to assure help is there when needed during serious or life-threatening illnesses. We offer programs that are not fully funded or reimbursed under traditional health insurance, including Club CREATE, Stroke INSPIRE and Melrose Institute.Park Nicollet Health Services provided more than 9,900 prescriptions for outpatient medications to low income individuals and families, assuring medical treatment for acute and chronic conditions such as asthma and diabetes.The Park Nicollet Frauenshuh Cancer Center Rehabilitation Program received a HealthPartners "Innovation Award" in 2010 for its excellent work in improving the lives of cancer survivors. The program helps cancer patients reduce pain, improve function and strength, and find support from rehabilitation staff and fellow patients.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense13439931Expense
Revenue21549843Revenue
DescriptionPark Nicollet Clinic has expenses related to affiliated tax exempt organizations: Park Nicollet Methodist Hospital, Park Nicollet Health Care Products, Park Nicollet Institute and Park Nicollet Health Services. Park Nicollet Clinic provides rental space and lab services to its affiliated organizations in order to assure the efficient and professional delivery of health care and other services to the community and aids in the provision of low cost medical service.Description
FieldValueIRS element (for citing)
Total Program Service Expense530131059TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
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 Invest1ReportProgRelInvest
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
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096130NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members9NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
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 Line1Sheila McMillan CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9529936790TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line16500 Excelsior BlvdAddressLine1
CitySt Louis ParkCity
StateMNState
ZIP Code55426ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (32 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
David Abelson MD
President and CEO55.00XX0789529220188
Steven Connelly MD
Chief Medical Officer55.00XX051438848590
David J Cooke
Sr VP & CFO (1/1-1/4)55.00XX069994193397
Judith Corson
Secretary3.00XX000
Bruce W Engelsma
Director3.00X000
Steven Frank
Director3.00X000
David Homans MD
Chief of Specialty Serv55.00X047622638872
Jeffrey B Husband MD
Director55.00X569522049426
Ann Rockler Jackson
Director3.00X000
Michael Johnson
Sr VP Community Advance55.00X035568459876
Kathryn D Kallas
VP Inpatient Care & CNO55.00XX0344809103609
Michael Kaupa
Executive VP and COO55.00XX0602417137571
Jodee Kozlak
Director3.00X000
Donald Lewis
Vice Chair3.00XX000
Charles McCoy MD
Director55.00X188968032901
Sheila McMillan
Sr VP & CFO (8/30-12/31)55.00XX014744349507
Ken Melrose
Director3.00X000
Ruth Mickelsen
Director3.00X000
Lee N Newcomer MD
Director3.00X000
James O Pohlad
Director3.00X000
Janette Strathy MD
Director55.00X304114036101
Richard E Struthers
Treasurer3.00XX000
Kenneth L Thome
Chair3.00XX000
Mark Wilkowske MD
Chief of Oncology Serv55.00X609656049964
Susan Zwaschka
VP Corp Compliance55.00X031985194811
Oliver Cass MD
Medical Doctor55.00813923053205X
Dane Christensen MD
Medical Doctor55.00920507054477X
Timothy Diegel MD
Medical Doctor55.00874732066393X
Salim Kathawalla MD
Medical Doctor55.00879377070426X
Steven Rakes MD
Medical Doctor55.00807393052831X
Samuel Carlson MD
Former Exec VP & CMO173093079194X
David K Wessner
Former President & CEO01387855101086X
FieldValueIRS element (for citing)
Total Reportable Comp From Org6141285TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs5638143TotalReportableCompFrmRltdOrgs
Total Other Compensation1492425TotalOtherCompensation
Number Individuals GT100 K710NumberIndividualsGT100K
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
The Orthopaedic Center LLC
8100 Northland DriveBloomingtonMN55431Medical Services3624947
University of Minnesota Physicians
420 Delaware St SeMinneapolisMN55405Medical Services3386883
ABM Janitorial Services Inc
75 Remittance Dr Ste 3048ChicagoIL60693Janitorial Services2820224
Medquist Transcriptions Ltd
PO Box 102467AtlantaGA30368Transcription2817198
Spheris Corporation
13552 Collections Center DriveChicagoIL60693Transcription2230102
FieldValueIRS element (for citing)
Number Of Contractors GT100 K44NumberOfContractorsGT100K
Related Organizations441222RelatedOrganizations
Total Contributions441222TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Medical Services Inc.621400489862129489862129
Medicare/Medicaid621400118933993118933993
Services to Affiliates90000321549843130496158500228
Medical Services - Edu9000992418224182
FieldValueIRS element (for citing)
Total Program Service Revenue630370147TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1444025TotalRevenueColumn
Exclusion$1,444,025ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column13911TotalRevenueColumn
Exclusion$13,911ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1784543Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real1030366Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real754177Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column754177TotalRevenueColumn
Exclusion$754,177ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities37334393Securities
Other3350Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities37620106Securities
Other8454Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-285713Securities
Other-5104Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-290817TotalRevenueColumn
Exclusion-$290,817ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionCafeteriaDescription
Business Code722210BusinessCode
Total Revenue Column271137TotalRevenueColumn
Exclusion$271,137ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue271137TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column633003802TotalRevenueColumn
Related Or Exempt Function Income621869919RelatedOrExemptFunctionIncome
Unrelated Business Revenue8500228UnrelatedBusinessRevenue
Exclusion$2,192,433ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total906266Total
Program Services906266ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1840653Total
Program Services1463371ProgramServices
Management And General377282ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total295104245Total
Program Services288092493ProgramServices
Management And General6966032ManagementAndGeneral
Fundraising45720Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total17954994Total
Program Services17538666ProgramServices
Management And General413545ManagementAndGeneral
Fundraising2783Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total24296108Total
Program Services23655390ProgramServices
Management And General636965ManagementAndGeneral
Fundraising3753Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total15695857Total
Program Services15331913ProgramServices
Management And General361511ManagementAndGeneral
Fundraising2433Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total14123Total
Management And General14123ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total62101Total
Management And General62101ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total18818228Total
Program Services18744098ProgramServices
Management And General74130ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total75329Total
Program Services24702ProgramServices
Management And General50627ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total6392665Total
Program Services5671587ProgramServices
Management And General721078ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total4156198Total
Program Services3965734ProgramServices
Management And General190464ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total27005143Total
Program Services25308671ProgramServices
Management And General1696472ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total175655Total
Program Services92616ProgramServices
Management And General83039ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total74505Total
Program Services39529ProgramServices
Management And General34976ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total1499428Total
Program Services1499428ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total11038983Total
Program Services10089452ProgramServices
Management And General949531ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total3657591Total
Management And General3657591ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
Mgmt Exps to Affiliate7379093224077944497129880
Medical Supplies5458075754495176855810
Bad Debt Expense160092231600922300
Lab/Purch Svc Expense139599831395998300
MN Care Expense8671476867147600

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total632350Total
Program Services493341ProgramServices
Management And General139009ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total596412793Total
Program Services530131059ProgramServices
Management And General66227045ManagementAndGeneral
Fundraising54689Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY467567BOY
EOY324136EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY56508445BOY
EOY56399543EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1404860BOY
EOY1639204EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis228918167LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec145864943LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY87457373BOY
EOY83053224EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY45792293BOY
EOY67606033EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY23075094BOY
EOY26705692EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1299370BOY
EOY14301983EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY216005002BOY
EOY250029815EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY27166435BOY
EOY28399997EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY1415078BOY
EOY2030829EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY60445379BOY
EOY58124410EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY15227816BOY
EOY10075014EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY104254708BOY
EOY98630250EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY111750294BOY
EOY151399565EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY111750294BOY
EOY151399565EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY216005002BOY
EOY250029815EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses36591009ReconcilationRevenueExpenses
Reconcilation Other Changes3058262ReconcilationOtherChanges
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 Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$21,278OtherActivitiesAmount
Total Lobbying Expenditures IIB21278TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Other Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1i:ReturnReference
ExplanationPark Nicollet Clinic reimburses certain professional membership dues of employees. A portion of such membership dues are used by the professional association for lobbying activities.Explanation

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance6997832BeginningOfYearBalance
Contributions374312Contributions
Investment Earnings Or Losses109910InvestmentEarningsOrLosses
Grants Or Scholarships860133GrantsOrScholarships
End Of Year Balance6621921EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance13741563BeginningOfYearBalance
Contributions935251Contributions
Investment Earnings Or Losses92610InvestmentEarningsOrLosses
Grants Or Scholarships7771592GrantsOrScholarships
End Of Year Balance6997832EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance13988569BeginningOfYearBalance
Contributions1360221Contributions
Investment Earnings Or Losses-235258InvestmentEarningsOrLosses
Grants Or Scholarships1371969GrantsOrScholarships
End Of Year Balance13741563EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.51000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.49000TermEndowmentEOYBalance
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 Basis18440147OtherCostOrOtherBasis
Book Value18440147BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis75114321OtherCostOrOtherBasis
Depreciation45506020Depreciation
Book Value29608301BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis37472664OtherCostOrOtherBasis
Depreciation25229895Depreciation
Book Value12242769BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis77986020OtherCostOrOtherBasis
Depreciation69795171Depreciation
Book Value8190849BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis19905015OtherCostOrOtherBasis
Depreciation5333857Depreciation
Book Value14571158BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings83053224TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Investment in PNHS Investment Partnership59003372F
Treasury Money Market fund8602661F
FieldValueIRS element (for citing)
Total Of Book Value Securities67606033TotalOfBookValueSecurities

Investments Program Related InvestmentsProgramRelated (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
Investment in St. Francis Regional Medical Center26396092C
Preferred One stock309600C
FieldValueIRS element (for citing)
Total Of Book Value Program Related26705692TotalOfBookValueProgramRelated

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
Building held for sale909933
Bond Issue Costs374197
Due to/from affiliates13017853
FieldValueIRS element (for citing)
Total Book Value Other Assets14301983TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
Capital Lease Obligation$3,298,960
Securities on Loan$6,776,054
FieldValueIRS element (for citing)
Total Of Amounts10075014TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Intended Use of Endowment Funds:Part V, Line 4:The Term endowment funds for use within Park Nicollet Clinic are for Grants related to Education, Research and Patient Care.
Description of Uncertain Tax Positions Under FIN 48:Part X:There were no unrecognized Tax Benefits or liabilities for the years ended December 31, 2010, 2009, and 2008.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1Park Nicollet InstituteBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13800 Park Nicollet BlvdAddressLine1
CitySt Louis ParkCity
StateMNState
ZIP Code55416ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient410961862EINOfRecipient
IRC Section501(c)(3)IRCSection
Amount Of Cash Grant906266AmountOfCashGrant
Purpose Of GrantResearch and EducationPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierProcedure for Monitoring Grants in the U.S.:Identifier
Return ReferencePart I, Line 2:ReturnReference
ExplanationSchedule I, Part I, Line 2: Park Nicollet Clinic grants monies to other tax-exempt organizations conducting programs and/or research that will ultimately benefit those served by Park Nicollet Health Services and affiliates. During calendar year 2010, grants were made to Park Nicollet Institute for improvements to the medical services for our community and for medical research. These grants were made to parties related to Park Nicollet Clinic, so employees of Park Nicollet Clinic were able to verify the use of the monies contributed.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
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 Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (20 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
David Abelson MD
0593117017175202466001320000881880100971700
Steven Connelly MD
042386108025201027500048590056297800
David J Cooke
03596001794870484494000933970793338047333
David Homans MD
0466334043030558900038872051509800
Jeffrey B Husband MD
54593701409709488000494260618948000
Michael Johnson
0231294081203043187000598760415560025300
Kathryn D Kallas
0246209086343012257038405065204044841800
Michael Kaupa
03845100202453015454056390081181073998800
Charles McCoy MD
1802290509903640000329010221869000
Sheila McMillan
012420200023241030400019107019695000
Janette Strathy MD
21731406002080798000361010340215000
Mark Wilkowske MD
56449504157203589000499640659620000
Susan Zwaschka
0226426077201016224028200066611041466200
Oliver Cass MD
78416602454305214000532050867128000
Dane Christensen MD
88313403599301380000544770974984000
Timothy Diegel MD
7408030225920111337000663930941125000
Salim Kathawalla MD
7183350383330122709000704260949803000
Steven Rakes MD
77437802954203473000528310860224000
Samuel Carlson MD
411000172682000791940252287000
David K Wessner
04499003676030975262000101086014889410154681

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 1aPark Nicollet Health Services pays social club dues to both the Interlachen and Minneapolis Clubs in the name of David Abelson,CEO, for use by all Park Nicollet Health Services officers and key employees. The facilities are used for a variety of business meetings held by key executives from Park Nicollet Health Services. Park Nicollet Health Services also pays for Rotary Club of Minneapolis dues for Michael J. Johnson, Park Nicollet Foundation President and Park Nicollet Health Services and affiliates Director. Park Nicollet Health Services considers these expenses to be business expenses of the organization; therefore these amounts are not included in taxable income for the individuals. Part I, Line 3: The Park Nicollet Health Services' Board of Directors is responsible for establishing the compensation of the organization's CEO and Executive Directors for Park Nicollet Clinic.
Part I, Lines 4a-bSchedule J Part I, Line 4a: During 2010, Park Nicollet Health Services, a related entity, terminated without cause the employment of individuals in reportable positions. Severance payments were determined to be payable under the Park Nicollet Health Services Executive Management Group Severance Policy (the "Policy"). The policy provides that if Park Nicollet Health Services terminates a covered individual without cause, and if the individual releases all legal claims against Park Nicollet Health Services, then Park Nicollet Health Services will provide the terminated individual severance compensation for a period of one year including salary, health, life, dental and disability benefits, as well as deferred compensation, incentive compensation, and pension plan payments. Based on the foregoing, the amount of severance compensation and benefits provided to each of the individual on severance during 2010 is as follows: Samuel E. Carlson, MD $142,974 David K. Wessner, $703,040 David J. Cooke, $400,000 Schedule J Part I, Line 4B: Senior leaders of Park Nicollet Clinic are given the opportunity to participate in the Capital Accumulation Account Plan. The Capital Accumulation Account Plan (CAA Plan) participation is limited to senior leaders and all the vice presidents. Each participant receives an annual allowance equal to the sum of (i) a stated percent of salary, (ii) voluntary salary deferrals, and (iii) credits for exchanging up to five vacation days. The allowance is credited to a bookkeeping account. Earnings are credited to the account based on the performance of simulated investments. Benefits vest upon the earliest of remaining employed to an elective vesting date (two years to age 68), involuntary termination without cause, disability, death, or not competing for 24 months following voluntary or for-cause termination. Benefits are paid in a single lump sum upon vesting. Participants are general creditors of the employer for the payment of the benefits. The following participants received payouts from a related organization, Park Nicollet Health Services, related to CAA plan: David K. Wessner, $154,681 David J. Cooke, $47,333 Michael Johnson $25,300
Part I, Line 7All physicians employed by and seeing patients for Park Nicollet Clinic, are eligible for a 3% access incentive payout based on their department reaching certain goals including access for patients and quality initiatives. In their roles as executives employed by Park Nicollet Health Services, the executives are eligible for incentive payouts which are paid by Park Nicollet Health Services and Park Nicollet Clinic. The incentive award will be 35% of base pay compensation for the CEO, 30% for the CFO, COO, CMO and 25% for all other executives with an opportunity for incentive credit above the target level. The ultimate payout includes a reduction/increase multiplier depending on whether the consolidated Park Nicollet Health Services organization reached that year's operating margin goal as set by the Board of Directors. Each participant will be responsible for two financial goals, and not less than three and not more than five individual strategic objectives. In their roles as management employed by Park Nicollet Health Services, certain managers are eligible for incentive payouts. The incentive award will be 15% of their annual base pay compensation with an opportunity for incentive credit above the target level. The ultimate payout includes a reduction/increase multiplier depending on whether the consolidated Park Nicollet Health Services organization reached that year's operating margin goal as set by the Board of Directors. Incentive payments are a function of both individual and organizational performance. The participant must be assigned at least three, and not more than four focused incentive objective, one of which must be financial in nature.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
Marquette Real Estate Holdings
James O. Pohlad: Owner of Marquette Real Estate Holdings (MREH)4199956Development: Marquette Real Estate Holdings leases the TRIA Orthopaedic Center building to an affiliate of Park Nicollet Health Services. Park Nicollet Clinic occupies space in the building.0
RJM Construction
James O. Pohlad: Owner of MREH, Parent of RJM Construction695109Construction: RJM Construction performed construction services for Park Nicollet Clinic.0
Gregg Strathy MD
Jannette Strathy, MD : Family member205043Employment: Gregg Strathy, MD is a Medical Doctor employed by Park Nicollet Clinic.1

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part IV, Line 24A:Park Nicollet Clinic, along with related organizations, is jointly liable for the tax exempt bonds held by Park Nicollet Health Services under a master trust agreement. The other members of the jointly liable group, which is collectively referred to as the "Obligated Group", include Park Nicollet Methodist Hospital, PNMC Holdings, Park Nicollet Institute, and Park Nicollet Health Care Products. In accordance with reporting requirements for Schedule K, all outstanding tax exempt bonds are reported solely on the Schedule K of Park Nicollet Health Services.
Park Nicollet Health Services and its related entities have a common board. The following officers, board members, and key employees are employees of and paid by Park Nicollet Health Services or its related organizations. These employees serve together on the common board which serves Park Nicollet Health Services and its related entities. David Abelson Steven Connelly David J. Cooke David Homans Jeffrey B. Husband Michael Johnson Kathryn D. Kallas Michael Kaupa Charles McCoy Sheila McMillan Janette Strathy Mark Wilkowske Susan ZwaschkaForm 990, Part VI, Section A, line 2
Bylaws were amended to clarify the composition of the Board of Directors to be the same as the members of the Board of Directors of Park Nicollet Health Services, the sole member of the corporation. The bylaws were also amended to reserve certain powers to Park Nicollet Health Services, such as the power to approve major corporate actions, including amendments to governing documents, mergers and dissolution. The Articles of Incorporation were amended to provide that, upon dissolution, the assets remaining after payment of debts will be transferred to Park Nicollet Health Services, as long as Park Nicollet Health Services continues to be exempt from federal income tax under Section 501(c)(3).Form 990, Part VI, Section A, line 4
Park Nicollet Health Services is the sole member of Park Nicollet Clinic.Form 990, Part VI, Section A, line 6
The Board of Directors of Park Nicollet Clinic are those individuals who are contemporaneously members of the Board of directors of Park Nicollet Health Services.Form 990, Part VI, Section A, line 7a
All Decisions, Including dissolution of the organization, made by the governing body of Park Nicollet Clinic are subject to the approval of the board of directors of Park Nicollet Health Services.Form 990, Part VI, Section A, line 7b
Park Nicollet Clinic prepares the Form 990 within the finance department with assistance from individuals in human resources, marketing, and operations. Upon completion of gathering the necessary information for the return, the form was complied by Park Nicollet Clinic's accounting firm. Drafts of the form were reviewed by the Assistant Controller-Accounting Operations, Vice President of Finance, Chief Financial Officer, and the audit and compliance committee. After all internal reivews were complete, the final version of the Form 990 was given to each member of the Board of Directors prior to filing the return.Form 990, Part VI, Section B, line 11
Form 990, Part VI, Section B, line 12cAt Park Nicollet Clinic all key employees, directors, and officers are required to fill out a conflict of interest statement each year; however the obligation to report conflicts is ongoing. The conflict of interest statments are reviewed by the Chief Compliance Officer and reported to the Park Nicollet Health Service's board's governance committee. The board ensures that any potential conflicts reported have been mitigated in an appropriate manner. When a transaction involving a potential conflict of interest is noted, the board of directors assigns a committee to review that conflict and ensure discussions related to those transactions can occur separately from those individuals with potential conflicts. All significant transactions include an analysis of fair market value.
Form 990, Part VI, Section B, line 15The Board of Directors of Park Nicollet Clinic are those individuals who are contemporaneously members of the Board of Directors of Park Nicollet Health Services. The Park Nicollet Health Services' Board of Directors is responsible for the implementation and oversight of executive compensation and benefit plans for Park Nicollet Clinic. Park Nicollet Clinic uses an outside consultant to provide yearly market based indexes of salary adjustments for executives in similar leadership positions. The Board of Directors reviews the salary ranges and recommends salary increases for each executive, including the CEO, based upon the Board of Directors' evaluation of job performance and experience level of the individual within the organization. The average salary increases for all Park Nicollet Clinic executives cannot exceed the average market salary increase reported for executives by the consultant. The compensation committee then reviews and approves compensation adjustments based on the information provided by the outside consultants and the Board of Directors' recommendations. For certain physicians, the majority of pay disclosed is for his/her work as a physician for Park Nicollet Clinic. A small stipend is added for serving on the Board of Directors. The following is a description of how pay for physicians' patient care work is determined. The Park Nicollet Health Services' Board of Directors is responsible for the implementation and oversight of the physician compensation and benefit plans for Park Nicollet Clinic. The Board of Directors delegates the day-to-day administration of the physician compensation plan to the Clinical Board of Governors and the Physician Compensation and Benefits Subcommittee. The purpose of the Physician Compensation and Benefits Subcommittee is to oversee physician and other clinician compensation and benefits plans and administration within the budget to ensure fairness and alignment with Park Nicollet Health Services' goals. The responsibilities of this committee include: Recommending of compensation policies and plan designs for physicians to the clinical board and Board of Directors; Overseeing compensation plan operation and payments to clinical departments; Evaluating compensation plan for performance on a periodic basis; Serving as final appeal process for issues unresolved by individuals, department chairs and chiefs of services. Annually, information on each physician's pay and productivity is graphed against the survey results for the same year. This information is presented to the compensation committee of the Park Nicollet Health Services Board of Directors for review. Park Nicollet Health Services' physician pay program is designed to ensure market based pay for market based productivity standards. The market is determined by the American Medical Group Association (AMGA) national physician compensation survey data, which provides market data for both compensation and productivity. When appropriate, the Clinic Compensation and Benefit Subcommittee grants adjustments to these guidelines with evidence of local market data.
Form 990, Part VI, Section C, line 19Park Nicollet Clinic's governing documents, conflict of interest policy and financial statements are available to the public upon request. Park Nicollet Health Services, as the parent organization of Park Nicollet Clinic, mails its consolidated audited financial statements to financial institutions, governmental institutions, board members, media representatives, vendors, and the Minnesota Hospital Association (MHA) . Park Nicollet Health Services discloses quarterly financial statements to bondholders. The annual audited and quarterly financial statements are also posted at EMMA.MSRB.ORG. The forms 990 are available upon request or from the State of Minnesota or at Guidestar.org. Form 990, Part VII: Certain board members for Park Nicollet Clinic also provide services as employees to Park Nicollet Health Services and its subsidiaries. Hours worked are an estimate and are not tracked on an entity by entity basis. Therefore, these officers, directors, and key employees hours reported on Form 990, Part VII represent aggregate hours worked per week for all Park Nicollet Health Services entities. Community board members hours reported on Form 990, Part VII are an estimate and are not tracked on an entity by entity basis. Therefore, these directors hours reported on Form 990, Part VII represent aggregate hours of service provided per week for all Park Nicollet Health Services entities.
Form 990, Part XI, line 5:Net unrealized gains on investments: 3,170,939. Expenses for Grants Paid by Park Nicollet Foundation -112,677. Total to Form 990, Part XI, Line 5: 3,058,262.Changes in Net Assets or Fund Balances:
Form 990, Part XII, Line 2c:Neither the oversight process nor the selection process for the review of the audit of Park Nicollet Health Services and affiliates' financial statements have changed during the tax year.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
Park Nicollet Health Services
6500 Excelsior BlvdSt Louis ParkMN55426363465840Health Care AdministrationMN501(C)(3)11, Type III0
Park Nicollet Foundation
6500 Excelsior BlvdSt Louis ParkMN55426237346465Grants to Serve the CommunityMN501(C)(3)71Park Nicollet Health Services
Park Nicollet Methodist Hospital
6500 Excelsior BlvdSt Louis ParkMN55426410132080Health CareMN501(C)(3)31Park Nicollet Health Services
Park Nicollet Institute
6500 Excelsior BlvdSt Louis ParkMN55426410961862Health Care ResearchMN501(C)(3)41Park Nicollet Health Services
Park Nicollet Health Care Products
3800 Park Nicollet BlvdSt Louis ParkMN55416010638901Health Care ProductsMN501(C)(3)11, Type II1Park Nicollet Health Services
PNMC Holdings
3800 Park Nicollet BlvdSt Louis ParkMN55416411741792Health Care Real EstateMN501(C)(3)11, Type I1Park Nicollet Clinic

Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
Park Nicollet Health Services Investment Partnership
6500 Excelsior BlvdSt Louis ParkMN55426411675033InvestmentsMNPark Nicollet Methodist HospitalExcluded93691151859431010.17580
Tria Orthopaedic Center LLC
8100 Northland DriveBloomingtonMN55431200034003Health CareMNPark Nicollet Health ServicesN/A000.00000
Methodist Brain Lab Leasing LLC
6500 Excelsior BlvdSt Louis ParkMN55426208725994Health CareMNPark Nicollet Methodist HospitalN/A000.00000

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Park Nicollet EnterprisesBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line16500 Excelsior BlvdAddressLine1
CitySt Louis ParkCity
StateMNState
ZIP Code55426ZIPCode
FieldValueIRS element (for citing)
EIN411656735EIN
Primary ActivityReal Estate for Related OrganizationPrimaryActivity
Legal Domicile StateMNLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Park Nicollet Health ServicesBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
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 Org0LoansOrGuaranteesToOtherOrg
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 Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (16 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Park Nicollet Health Care Products
O43598037Cost
Park Nicollet Health Care Products
I1506371Fair Market Value
Park Nicollet Health Care Products
P288468Cost
Tria Orthopaedic Center LLC
P8363856Cost
Tria Orthopaedic Center LLC
J3022871Fair Market Value
Tria Orthopaedic Center LLC
O2391076Cost
PNMC Holdings
I2500000Fair Market Value
Park Nicollet Institute
J692887Fair Market Value
Park Nicollet Institute
P80466Cost
Park Nicollet Institute
B906266Cost
Park Nicollet Methodist Hospital
O20775342Cost
Park Nicollet Methodist Hospital
J1348294Fair Market Value
Park Nicollet Methodist Hospital
L61298913Cost
Park Nicollet Health Care Products
R20893917Cost
Tria Orthopaedic Center LLC
A207065Cost
Park Nicollet Foundation
C441222Cost

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