2011-10-12T10:46:08-05:00 2010-12-31 LARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-01-01 411777966 NORTH MEMORIAL FOUNDATION NORT 7635207205 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 BRAD BAKKEN 7635207205 2011-10-07 1 XIAOYAN LUO 6123764500 2010 2016-03-07 17:11:31Z JOSEPH G BOSTON 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 2794371 0 X WWW.NORTHMEMORIAL.COM X 1993 MN TO SUPPORT NORTH MEMORIAL HEALTH CARE AND ITS COMMITTMENT TO CHANGING AND SAVING LIVES. 9 8 0 160 0 0 2407544 2574278 0 0 75045 80575 -111193 -288459 2371396 2366394 1152670 1093455 0 0 0 0 0 0 200250 689701 652489 1842371 1745944 529025 620450 5142458 6127050 157961 202064 4984497 5924986 X TO SUPPORT NORTH MEMORIAL HEALTH CARE AND ITS COMMITTMENT TO CHANGING AND SAVING LIVES. THROUGH PHILANTHROPY, OUR DONORS ASSIST IN GIVING OUR PATIENTS AND THEIR FAMILIES COMPASSIONATE, REMARKABLE CARE. 0 0 367643 279258 0 HOSPICEIN 2010, THE NORTH MEMORIAL HOSPICE AND PALLIATIVE CARE PROGRAM SERVED 1,200 PATIENTS. FOUNDATION DOLLARS WERE UTILIZED TO PAY FOR HEATING, UTILITIES, MEDICAL COSTS, EQUIPMENT, AND OTHER EXPENSES FOR PATIENTS. THE FOUNDATION ALSO PROVIDED SUPPORT FOR MASSAGE AND MUSIC THERAPY FOR PATIENTS. 255814 194314 0 PAY IT FORWARD FUNDTHIS FUND WAS ESTABLISHED BY BREAST CANCER SURVIVOR, MICHELLE MOREY AND HER HUSBAND SCOTT BISSEN IN OCTOBER OF 2005. MICHELLE RECOGNIZED THE NEED TO HELP FAMILIES STRUGGLING FINANCIALLY WHILE GOING THROUGH CANCER TREATMENT. IN FEBRUARY OF 2006, THE FIRST PAY IT FORWARD EVENT WAS HELD AND OVER THE LAST FIVE YEARS - MORE THAN $1,000,000 HAS BEEN RAISED TO HELP CANCER PATIENTS AND THEIR FAMILIES. CURRENTLY, THE FUND IS PROVIDING PATIENT ASSISTANCE IN THE AMOUNT OF $194,314 PER YEAR WITH A MAXIMUM PER PATIENT OF $1,500. PATIENTS ELIGIBLE FOR ASSISTANCE ARE FROM NORTH MEMORIAL, MERCY, UNITY, AND MONITCELLO HOSPITALS. THE FUND IS ADMINISTERED AT NO FEE THROUGH THE FOUNDATION.EACH YEAR THE FUND HELPS MORE THAN 100 PATIENTS BUY GROCERIES, PAY THEIR MORTGAGES, HEAT THEIR HOMES, PAY FOR UTILITIES, REPAIR THEIR CARS, AND ASSIST WITH UNFUNDED MEDICAL BILLS. THE FUND HELPS PATIENTS TO PAY EXPENSES SO THEY CAN FOCUS ON WHAT'S REALLY IMPORTANT - GETTING HEALTHY. 138848 105468 0 SAFEJOURNEY PROGRAMIN RESPONSE TO COMMUNITY NEED AND EMERGENCY AWARENESS OF THE CRUCIAL ROLE HEALTH CARE PROVIDERS CAN PLAY IN ASSISTING ABUSE VICTIMS, NORTH MEMORIAL MEDICAL CENTER DEVELOPED A COMPREHENSIVE RESPONSE TO PROACTIVELY IDENTIFY AND RESPOND TO PATIENTS SUFFERING FROM FAMILY VIOLENCE. FOUNDED IN 1994, SAFEJOURNEY PROVIDES A VARIETY OF DIRECT SERVICES, ADVOCACY, ASSESSMENT, INTERVENTION, PREVENTION AND EDUCATION TO ASSIST OVER ONE THOUSAND INDIVIDUAL VICTIMS OF ABUSE AS WELL AS THE LARGER COMMUNITY EACH YEAR. SERVICES, FOCUSED ON THE NORTHERN AND WESTERN TWIN CITIES SUBURBS AND MINNEAPOLIS' NORTH SIDE, INCLUDE 24 HOURS/DAY, SEVEN DAYS/WEEK COVERAGE OF THE HOSPITAL, USING SKILLED VOLUNTEERS TO PROVIDE PATIENT ASSESSMENT AND ADVOCACY; A WEEKLY SUPPORT GROUP FOR BATTERED WOMEN; COMMUNITY AND PROFESSIONAL EDUCATION; AND TEEN VIOLENCE PREVENTION EDUCATION. 658549 514415 0 OTHER PROGRAMS AND FUNDS 658549 514415 1420854 1 1 0 0 1 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 42 2 1 0 0 0 0 0 0 1 1 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X X NORTH MEMORIAL HEALTH CARE 7635207205 3300 OAKDALE AVE N ROBBINSDALE MN 554222900 X BRAD BAKKEN 5.00 X X 0 0 0 MIKE STEINHAUSER 1.00 X X 0 0 0 DON PARK 1.00 X X 0 0 0 STEINAR BERG 1.00 X 0 0 0 CHENG LOR 1.00 X 0 0 0 TIM CRONIN 1.00 X 0 0 0 MICHELLE MOREY 1.00 X 0 0 0 MARK NIBLICK 1.00 X 0 0 0 DAVID W CRESS 2.00 X X 0 774908 52715 LOREN TAYLOR 2.00 X X 0 183782 19386 JOSEPH G BOSTON 50.00 X 0 169174 18185 PATRICK J BORAN 2.00 X 0 456191 51469 0 1584055 141755 0 0 1 0 0 868864 303482 1401932 437837 2574278 80575 80575 139518 868864 427977 -288459 -288459 2366394 0 0 -207884 1093455 1093455 60749 54278 6471 59265 11275 17819 30171 98857 98857 116 116 5559 5559 STAFF SUPPORT 340367 86362 100550 153455 COMM BENEFIT EDUCATION 66327 65452 875 MISCELLANEOUS 21249 5616 0 15633 1745944 1420854 124840 200250 164525 191070 1006666 820840 36412 49284 926703 691975 15286 234728 2879339 3797773 1040230 1033355 5142458 6127050 151367 195793 6594 6271 157961 202064 X 688417 1388147 2602680 2232752 1693400 2304087 4984497 5924986 5142458 6127050 X 620450 320039 X 0 1 1 X 0 X 1673246 2273010 1625833 2407544 2574278 10553911 1673246 2273010 1625833 2407544 2574278 10553911 10553911 130074 138460 88041 79699 80575 516849 11070760 1616093 0.95330 0.95430 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4 13865 14188 6271 1 1 1737891 513452 25341 25455 2251229 1537773 58657 206326 64865 1737891 1910328 62422 -425371 9606 1537773 0.00000 0.99000 0.01000 1 0 225000 225000 685251 675523 9728 16452 16452 0 234728 CHARITABLE REMAINDER TRUST 1033355 1033355 AGENCY FUNDS 6271 6271 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: 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 ENDOWMENT: 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 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 PROVIDE CARE TO INDIVIDUALS UNABLE TO PAY FOR SERVICES AT THE FACILITY. 6) PAY IT FORWARD ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED IN 2009 BY FOUNDER MICHELLE MOREY AND THE PIFF COMMITTEE TO INSURE THAT THE GREAT WORK OF THE PAY IT FORWARD FUND CONTINUES WELL INTO THE FUTURE. EACH YEAR THE FUND HELPS MORE THAN 100 PATIENTS PAY THEIR BILLS SO THAT THEY CAN FOCUS ON WHATS REALLY IMPORTANT GETTING HEALTHY. 7) MEDICAL STAFF ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED IN 2010 BY THE NORTH MEMORIAL MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND NORHT MEMORIAL PROGRAMS SUCH AS JUNIOR VOLUNTEER SCHOLARSHIP, SAFEJOURNEY, PASTORAL CARE, ETC. DINNER DANCE/GALA 322084 277434 44650 5500 32222 76691 6000 42567 PAY IT FORWARD 376935 356145 20790 0 71837 15676 0 6000 34590 5 309362 235284 74078 27199 70355 845 38496 1008381 868863 139518 5500 131258 86031 77536 12000 115653 427978 -288460 1 NORTH MEMORIAL HEALTH CARE 3300 OAKDALE AVE N ROBBINSDALE MN 55422 410729979 501(C)(3) 1093455 N/A N/A TO SUPPORT NMHC PROGRAMS AND SERVICES 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE ORGANIZATION ONLY MAKES GRANTS TO RELATED ORGANIZATION NORTH MEMORIAL HEALTH CENTER AND RECORDS ARE MAINTAINED AS TO HOW FUNDS ARE DISBURSED BY BOTH ORGANIZATIONS. X 1 1 0 1 0 0 0 0 0 0 0 DAVID W CRESS 0 424820 0 0 0 350088 0 17464 0 35251 0 827623 0 131470 LOREN TAYLOR 0 182547 0 0 0 1235 0 12911 0 6475 0 203168 0 0 JOSEPH G BOSTON 0 141204 0 0 0 27970 0 9718 0 8467 0 187359 0 0 PATRICK J BORAN 0 339192 0 0 0 116999 0 37718 0 13751 0 507660 0 62370 PART I, LINE 1A JOSEPH BOSTON - THE DUES FOR 2010 WERE $90/ MONTH OR $1,080 PER YEAR. THE NORTH MEMORIAL FOUNDATION UTILIZES THE COUNTRY CLUB TO HOST VARIOUS FUND-RAISING EVENTS THROUGH-OUT THE YEAR THAT SUPPORTS VARIOUS ACTIVITIES FOR NORTH MEMORIAL. PART I, LINE 4B DAVID W. CRESS - $17,464 ACCRUED IN 2010 FOR SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN DAVID W. CRESS - $131,470 DISTRIBUTION FROM SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN - THIS PAYMENT WAS MADE UPON THE ELECTION OF THE PLAN PARTICIPANT AS THE REQUIREMENTS FOR AGE AND YEARS OF SERVICE HAD BEEN MET. PATRICK J. BORAN - $62,370 ACCRUED IN 2010 FOR SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN SUPPLEMENTAL INFORMATION PART III THE FOUNDATION DOES NOT COMPENSATE ANY INDIVIDUALS. THE ORGANIZATION RELIED ON NORTH MEMORIAL HEALTH CARE (NMHC) IN SETTING THE COMPENSATION FOR THOSE INDIVIDUALS. NMHC USED THE FOLLOWING METHODS TO ESTABLISH THE TOP MANAGEMENT OFFICIALS' COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE X 4 18053 STOCK MARKET QUOTES X 1 225000 APPRAISAL X SP EVENT DONATED GOODS 675 173232 ESTIMATED VALUE X VARIOUS OTHER 0 21552 ESTIMATED VALUE 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 NORTH MEMORIAL HEALTH CARE IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A NORTH MEMORIAL HEALTH CARE, AS THE SOLE MEMBER OF THE ORGANIZATION DETERMINES THE NUMBER OF BOARD MEMBERS AND ELECTS MEMBERS AT THE ANNUAL MEETING AFTER CONSIDERATION OF NOMINATIONS, IF ANY, FROM THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE APPROVAL OF NORTH MEMORIAL HEALTH CARE AS THE SOLE MEMBER OF THE ORGANIZATION IS REQUIRED FOR THE FOLLOWING ACTIONS OF THE ORGANIZATION'S GOVERNING BODY: (1) AMENDMENTS TO THE GOVERNING DOCUMENTS; (2) MERGER OR CONSOLIDATION OF THE ORGANIZATION; (3) SALE, LEASE, PLEDGE, TRANSFER, ASSIGNMENT OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (4) MORTGAGES OR OTHER SECURITY INTERESTS AFFECTING ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (5) ISSUANCE OF CAPITAL CALLS TO THE MEMBER; AND (6) DISSOLUTION AND LIQUIDATION OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WILL BE DISTRIBUTED TO ALL BOARD MEMBERS AT THE MEETING CLOSEST TO THE FILING DATE FOR REVIEW AND APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C NORTH MEMORIAL HEALTH CARE HAS A CONFLICT OF INTEREST POLICY THAT COVERS CERTAIN EMPLOYEES, PHYSICIANS AND BOARD MEMBERS. THE NORTH MEMORIAL FOUNDATION BOARD OF DIRECTORS SIGNS AN ANNUAL CONFLICT OF INTEREST STATEMENT IN ACCORDANCE WITH THIS POLICY. IF A BOARD MEMBER DISCLOSES A CONFLICT OF INTEREST, THE INFORMATION IS SENT TO LEGAL COUNSEL FOR EVALUATION. PROCEDURES. THE BOARD OF DIRECTORS AND ITS COMMITTEES SHALL USE THE FOLLOWING PROCEDURES FOR DETERMINING CONFLICTS OF INTEREST AND FOR DECIDING HOW TO PROCEED WHEN CONFLICTS OF INTEREST ARE REVEALED: A. DUTY TO DISCLOSE. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS OR HER FINANCIAL INTEREST AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND/OR COMMITTEE MEMBERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. B. DETERMINATION WHETHER A CONFLICT OF INTEREST EXISTS. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING DIRECTORS OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. C. PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST. (I) AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. (II) THE CHAIRPERSON OF THE BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. (III) AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE COMPANY CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. (IV) IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY. A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES OR COMMITTEE MEMBERS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE COMPANY'S BEST INTEREST AND FOR ITS OWN BENEFIT, AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE COMPANY. THE BOARD OR COMMITTEE SHALL THEN MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. RECORDS OF PROCEEDINGS. THE MINUTES OF THE BOARD AND ITS COMMITTEES SHOULD INCLUDE (I) THE NAMES OF ANY PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED, AND (II) THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION WITH THE PROCEEDINGS. FORM 990, PART VI, LINES 15A AND 15B: THE ORGANIZATION'S OFFICERS RECEIVED THEIR COMPENSATION FROM NORTH MEMORIAL HEALTH CARE (NHMC) WHICH FOLLOWS NMHC'S POLICIES AND PROCEDURES ON DETERMINING COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. EXPLANATION FOR HOURS WORKED FORM 990, PART VII, SECTION A DAVID W. CRESS WORKED APPROXIMATELY 52 HOURS PER WEEK AS FOLLOWS: NORTH MEMORIAL HEALTH CARE 50 HOURS NORTH MEMORIAL FOUNDATION 2 HOURS LOREN TAYLOR WORKED APPROXIMATELY 52 HOURS PER WEEK AS FOLLOWS: NORTH MEMORIAL HEALTH CARE 50 HOURS NORTH MEMORIAL FOUNDATION 2 HOURS PATRICK J. BORAN WORKED APPROXIMATELY 52 HOURS PER WEEK AS FOLLOWS: NORTH MEMORIAL HEALTH CARE 50 HOURS NORTH MEMORIAL FOUNDATION 2 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 320,039. NORTH MEMORIAL HEALTH CARE 3300 OAKDALE AVE N ROBBINSDALE MN 55422 410729979 PATIENT CARE HOSPITAL MN 501(C)(3) LINE 3 N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1