RANGE REGIONAL HEALTH SERVICES: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- RANGE REGIONAL HEALTH SERVICES (EIN 41-1293970)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-08
- IRS object ID
- 201123129349300437
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-08T12:35:42-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM MCGLADREY INC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 700 MISSABE BUILDING | AddressLine1 |
| City | DULUTH | City |
| State | MN | State |
| ZIP Code | 55802 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411293970 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RANGE REGIONAL HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | RANG | NameControl |
| Phone | 2183626657 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 750 EAST 34TH STREET | AddressLine1 |
| City | HIBBING | City |
| State | MN | State |
| ZIP Code | 55746 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN KRITZ | Name |
| Title | CFO | Title |
| Phone | 2183626657 | Phone |
| Date Signed | 2011-11-03 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JENNIFER MILLER | Name |
| Phone | 2187278253 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JOHN KRITZ | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 750 EAST 34TH STREET | AddressLine1 |
| City | HIBBING | City |
| State | MN | State |
| ZIP Code | 55746 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 91533124 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.RANGE.FAIRVIEW.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1998 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE A REGIONAL INTEGRATED NETWORK OF HEALTH CARE SERVICES THROUGH PHYSICIANS, AMBULATORY CARE, AND HOSPITAL FACILITIES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1143 | TotalNbrEmployees |
| Total Nbr Volunteers | 267 | TotalNbrVolunteers |
| Total Gross UBI | 3943963 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -1177922 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 927529 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 156153 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 88573041 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 90396482 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 84472 | InvestmentIncomePriorYear |
| Investment Income Current Year | 517611 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 524842 | OtherRevenuePriorYear |
| Other Revenue Current Year | 461035 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 90109884 | TotalRevenuePriorYear |
| Total Revenue Current Year | 91531281 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 55549280 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 58142233 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 35383737 | OtherExpensePriorYear |
| Other Expenses Current Year | 36918640 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 90933017 | TotalExpensesPriorYear |
| Total Expenses Current Year | 95060873 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -823133 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -3529592 | RevenuesLessExpensesCY |
| Total Assets BOY | 76629291 | TotalAssetsBOY |
| Total Assets EOY | 80410378 | TotalAssetsEOY |
| Total Liabilities BOY | 44829219 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 45500652 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 31800072 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 34909726 | NetAssetsOrFundBalancesEOY |
| Mission Description | AN INTEGRATED HEALTH CARE SYSTEM MEETING THE NEEDS OF OUR PATIENTS IN AN EXEMPLARY MANNER. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 85961600 | Expense |
| Revenue | 90755324 | Revenue |
| Description | MAINTAIN AND OPERATE A HOSPITAL TO PROVIDE MEDICAL AND SURGICAL CARE TO THE SICK, INFIRM, AGED, OR INJURED. | Description |
| Total Program Service Expense | 85961600 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 0 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 1 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 145 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1143 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN D KRITZ | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2183626657 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 750 E 34TH STREET | AddressLine1 |
| City | HIBBING | City |
| State | MN | State |
| ZIP Code | 55746 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| DR SUSAN RUDBERG | ||||||||
| SECRETARY | 1.00 | X | X | 0 | 202670 | 47719 | ||
| JOHN FORT | ||||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | ||
| EDIE CARR | ||||||||
| CHAIR | 1.00 | X | X | 0 | 0 | 0 | ||
| DAVE CLUSIAU | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| JIM WEIKUM | ||||||||
| VICE-CHAIR | 1.00 | X | X | 0 | 0 | 0 | ||
| ANDY MCCOY | ||||||||
| DIRECTOR | 1.00 | X | 0 | 255399 | 32472 | |||
| CHARLIE CREP | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| JOHN DOHERTY | ||||||||
| DIRECTOR | 1.00 | X | 0 | 440771 | 53784 | |||
| MIKE FAY | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| SCOTT MAKI | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| KATHY STERK | ||||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |||
| DR KRISTIN FREDRICKSON | ||||||||
| DIRECTOR | 1.00 | X | 0 | 570831 | 71666 | |||
| DEBRA RUDQUIST | ||||||||
| DIRECTOR | 1.00 | X | 0 | 206576 | 23377 | |||
| BETH GOHDES | ||||||||
| DIRECTOR | 1.00 | X | 0 | 165042 | 29507 | |||
| DEBRA BOARDMAN | ||||||||
| CEO/DIRECTOR | 40.00 | X | X | 0 | 256701 | 6400 | ||
| JOHN KRITZ | ||||||||
| CFO | 40.00 | X | 183891 | 0 | 15270 | |||
| JOHN BERLAND | ||||||||
| COO | 40.00 | X | 195249 | 0 | 6701 | |||
| RICHARD DINTER | ||||||||
| HOSPITALIST | 54.50 | 248613 | 0 | 6744 | X | |||
| JOHN STONEBURNER | ||||||||
| NURSE ANESTHETIST | 40.00 | 190327 | 0 | 1370 | X | |||
| MICHAEL PATREGNANI | ||||||||
| NURSE ANESTHETIST | 40.00 | 199076 | 0 | 15025 | X | |||
| GINA CLAUGHERTY | ||||||||
| NURSE ANESTHETIST | 40.00 | 189203 | 0 | 15330 | X | |||
| KENNETH KLOS | ||||||||
| NURSE ANESTHETIST | 40.00 | 189243 | 0 | 6684 | X | |||
| LARRY PFAFF | ||||||||
| FORMER CEO | 40.00 | 0 | 127567 | -2768 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1395602 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2225557 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 329281 | TotalOtherCompensation |
| Number Individuals GT100 K | 17 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| JOHNSON-WILSON CONSTRUCTORS | |||||
| 4431 W MICHIGAN STREET PO BOX 1600 | DULUTH | MN | 55816 | CONSTRUCTION COMPANY | 1551455 |
| RANGE MENTAL HEALTH CENTER | |||||
| 624 S 13TH STREET PO BOX 1188 | VIRGINIA | MN | 55792 | MANAGEMENT FEES | 1388747 |
| MAX GRAY CONSTRUCTION | |||||
| 2501 STH AVE W PO BOX 689 | HIBBING | MN | 55746 | CONSTRUCTION COMPANY | 1385644 |
| EMERGENCY PRACTICE ASSOCIATES | |||||
| 3840 W NINTH ST | WATERLOO | IA | 50702 | PROFESSIONAL FEES | 1373486 |
| CENTRAL MINNESOTA DIAGNOSTICS INC | |||||
| 150 10TH ST NW PO BOX 158 | MILACA | MN | 56353 | PURCHASED SERVICES | 1003864 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 33 | NumberOfContractorsGT100K |
| Federated Campaigns | 8542 | FederatedCampaigns |
| Government Grants | 21359 | GovernmentGrants |
| All Other Contributions | 126252 | AllOtherContributions |
| Total Contributions | 156153 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT SERVICE RE | 621500 | 86056960 | 86056960 | |
| HEALTHLINE | 900099 | 3203287 | 3203287 | |
| PHARMACY REVENUE | 446110 | 740676 | 740676 | |
| CAFETERIA REVENUE | 722210 | 395559 | 395559 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 90396482 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 499670 | TotalRevenueColumn |
| Exclusion | $499,670 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 102193 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 102193 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 102193 | TotalRevenueColumn |
| Exclusion | $102,193 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 19784 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1843 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 17941 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 17941 | TotalRevenueColumn |
| Exclusion | $17,941 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 358842 | TotalRevenueColumn |
| Related Or Exempt Function Income | 358842 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 358842 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 91531281 | TotalRevenueColumn |
| Related Or Exempt Function Income | 86811361 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 3943963 | UnrelatedBusinessRevenue |
| Exclusion | $619,804 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 401111 | Total |
| Program Services | 343323 | ProgramServices |
| Management And General | 57788 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44104356 | Total |
| Program Services | 37750229 | ProgramServices |
| Management And General | 6354127 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4083614 | Total |
| Program Services | 3495287 | ProgramServices |
| Management And General | 588327 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6502076 | Total |
| Program Services | 5565319 | ProgramServices |
| Management And General | 936757 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3051076 | Total |
| Program Services | 2611507 | ProgramServices |
| Management And General | 439569 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4866095 | Total |
| Program Services | 4866095 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15071389 | Total |
| Program Services | 15071389 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 722705 | Total |
| Management And General | 722705 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4747920 | Total |
| Program Services | 4747920 | ProgramServices |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| FEES | 3865205 | 3865205 |
| BUILDING COSTS | 2941412 | 2941412 |
| BAD DEBTS | 2370716 | 2370716 |
| MN CARE TAX & SURCHARGE | 1698868 | 1698868 |
| EQUIPMENT RENTAL | 634330 | 634330 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 95060873 | Total |
| Program Services | 85961600 | ProgramServices |
| Management And General | 9099273 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2836701 | BOY |
| EOY | 4037863 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6693630 | BOY |
| EOY | 7779398 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13613994 | BOY |
| EOY | 13019283 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2315980 | BOY |
| EOY | 1985220 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1141175 | BOY |
| EOY | 1103646 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 91844064 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 52401651 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34979185 | BOY |
| EOY | 39442413 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 385081 | BOY |
| EOY | 337013 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14663545 | BOY |
| EOY | 12705542 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76629291 | BOY |
| EOY | 80410378 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 26973822 | BOY |
| EOY | 22874677 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 4188 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 17578233 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17855397 | BOY |
| EOY | 5043554 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44829219 | BOY |
| EOY | 45500652 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31800072 | BOY |
| EOY | 34909726 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31800072 | BOY |
| EOY | 34909726 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76629291 | BOY |
| EOY | 80410378 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -3529592 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 6639246 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 374539 | OtherCostOrOtherBasis |
| Book Value | 374539 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 34440780 | OtherCostOrOtherBasis |
| Depreciation | 15069565 | Depreciation |
| Book Value | 19371215 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 55468167 | OtherCostOrOtherBasis |
| Depreciation | 36197686 | Depreciation |
| Book Value | 19270481 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1560578 | OtherCostOrOtherBasis |
| Depreciation | 1134400 | Depreciation |
| Book Value | 426178 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 39442413 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| ASSET LIMITED AS TO USE | 11798065 |
| DIAGNOSTIC, INC. | 754491 |
| DEFERRED DEBT ACQUISITION | 152986 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 12705542 | TotalBookValueOtherAssets |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | THERE ARE NO UNCERTAIN TAX POSITIONS RECORDED IN THE CONSOLIDATED BALANCE SHEETS. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 120.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 280.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2042307 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2042307 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02200 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2953978 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2953978 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03190 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4996285 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4996285 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05390 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 4154 | PersonsServed |
| Total Community Benefit Expense | 1828838 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 34748 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1794090 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01940 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1027 | PersonsServed |
| Total Community Benefit Expense | 626130 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3000 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 623130 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00670 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6914759 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3508020 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3406739 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03680 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1021 | PersonsServed |
| Total Community Benefit Expense | 105401 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 105401 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6202 | PersonsServed |
| Total Community Benefit Expense | 9475128 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3545768 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5929360 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06400 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 6202 | PersonsServed |
| Total Community Benefit Expense | 14471413 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3545768 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10925645 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11790 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $2,370,716 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 19103049 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 25471193 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -6368144 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNIVERSITY MEDICAL CENTER MESABI | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 750 E 34TH STREET | AddressLine1 |
| City | HIBBING | City |
| State | MN | State |
| ZIP Code | 55746 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNIVERSITY MEDICAL CENTER MESABI | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 120.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 280.000000000000 | FPGDiscountPercent |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Lawsuit | X | PermitLawsuit |
| Collection Activities | 1 | CollectionActivities |
| Lawsuit | X | Lawsuit |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| HEALTHLINE HOMECARE | ||||
| 750 EAST 34TH STREET | HIBBING | MN | 55746 | HOME HEALTH |
| NORTHSTAR HOSPICE | ||||
| 750 EAST 34TH STREET | HIBBING | MN | 55746 | HOSPICE |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2370716. | ||
| PART II: N/A | ||
| PART III, LINE 8: THE SHORTFALL REPORTED IS FROM THE INPATIENT, OUTPATIENT, AND HOSPICE PROGRAMS. IF THESE SERVICES WERE NOT PROVIDED BY THE HOSPITAL, THE NEED FOR THE SERVICES WOULD NOT BE MET IN THE COMMUNITY. THE MEDICARE FEES FOR REIMBURSED SERVICES RESULTED IN NET REVENUE OF $698,325 AND ALLOWABLE COSTS OF $1,863,800 RESULTING IN A SHORTFALL OF $1,165,475. THE SHORTFALL IS THE RESULT OF UNREIMBURSED PROFESSIONAL CARE.THE HOSPITAL FOLLOWED MEDICARE'S PRESCRIBED METHODS OF DETERMINING COSTS PAYABLE UNDER TITLE XVIII (MEDICARE) IN COMPLETING ITS ANNUAL MEDICARE COST REPORT (COST REPORT) USING DATA AVAILABLE FROM THE INSTITUTION'S BASIC ACCOUNTS, AS USUALLY MAINTAINED, TO ARRIVE AT EQUITABLE AND PROPER PAYMENT FOR SERVICES. THE COST REPORT WAS COMPLETED USING THE HOSPITAL'S TRIAL BALANCE OF EXPENSES, AS WELL AS OTHER STATISTICAL AND FINANCIAL RECORDS MAINTAINED BY THE HOSPITAL. AS REQUIRED BY MEDICARE REGULATIONS, CERTAIN RECLASSIFICATIONS AND ADJUSTMENTS TO COSTS WERE INCLUDED IN THE COST REPORT TO DETERMINE MEDICARE ALLOWABLE COSTS.AFTER MEDICARE ALLOWABLE COSTS ARE DETERMINED, THE COST REPORT PROVIDES FOR THE STEP DOWN METHOD OF COST FINDING. THIS METHOD PROVIDES FOR ALLOCATING THE COST OF SERVICES RENDERED BY EACH GENERAL SERVICE COST CENTER TO OTHER COST CENTERS, WHICH UTILIZE THE SERVICES. ONCE THE COSTS OF A GENERAL SERVICE COST CENTER HAVE BEEN ALLOCATED, THAT COST CENTER IS CONSIDERED CLOSED. ONCE CLOSED, IT DOES NOT RECEIVE ANY OF THE COSTS SUBSEQUENTLY ALLOCATED FROM THE REMAINING GENERAL SERVICE COST CENTERS. AFTER ALL COSTS OF THE GENERAL SERVICE COST CENTERS HAVE BEEN ALLOCATED TO THE REMAINING COST CENTERS, THE TOTAL COSTS OF THESE REMAINING COST CENTERS ARE FURTHER DISTRIBUTED TO THE DEPARTMENTAL CLASSIFICATION TO WHICH THEY PERTAIN, E.G., HOSPITAL GENERAL INPATIENT ROUTINE, SUBPROVIDER, ANCILLARY, ETC.AFTER THE STEP-DOWN PROCESS, THE COST REPORT PROVIDES FOR THE APPORTIONMENT OF COSTS TO THE MEDICARE PROGRAM BASED ON A NUMBER OF DIFFERENT METHODOLOGIES INCLUDING PER PATIENT DAY, PER VISIT, AND PERCENTAGE OF CHARGES, AS MOST PREVALENT. MEDICARE COSTS AS DETERMINED BY THE COST REPORT METHODOLOGIES DESCRIBED PREVIOUSLY WERE UTILIZED TO COMPLETE THE APPLICABLE MEDICARE ALLOWABLE COSTS OF CARE FOR SCHEDULE H (FORM 990) PART III SECTION B LINE 6. | ||
| PART III, LINE 9B: UNDER OUR COMMUNITY CARE PROGRAM ALL UNINSURED OR UNDERINSURED PATIENTS ARE OFFERED TO APPLY. IF A PERSON DOESN'T FULLY COMPLETE THE APPLICATION OR DOESN'T FOLLOW THROUGH WITH SOME OF THE REQUIRED STEPS, THEY MAY BE DEEMED UNCOOPERATIVE BUT, IF POSSIBLE, WILL STILL BE QUALIFIED AT A LOWER LEVEL OF DISCOUNT WITH MORE PATIENT RESPONSIBILITY. THIS DETERMINATION IS ONLY TO BE MADE BY THE SUPERVISOR OF PATIENT FINANCIAL SERVICES. | ||
| PART V, SECTION B, LINE 19D: ALL PATIENTS ARE CHARGED GROSS CHARGES | UNIVERSITY MEDICAL CENTER MESABI | |
| PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED GROSS CHARGES | UNIVERSITY MEDICAL CENTER MESABI | |
| PART VI, LINE 2: FAIRVIEW HEALTH SERVICES HAS BEEN ASSESSING THE NEEDS OF OUR LOCAL COMMUNITIES SINCE THE COMMUNITY HEALTH DEPARTMENT WAS CREATED IN 1992. THESE ASSESSMENTS ARE USED TO DRIVE COMMUNITY HEALTH OUTREACH PROGRAMMING AT EACH HOSPITAL. COMMUNITY HEALTH ASSESSMENTS ARE CONDUCTED BY THE FAIRVIEW CORPORATE COMMUNITY HEALTH DEPARTMENT ALONG WITH AN OUTSIDE CONSULTANT AND HOSPITAL-BASED COMMUNITY HEALTH STAFF EVERY THREE YEARS. IN ADDITION, EVERY THREE YEARS (FOLLOWING THE TIMING OF THE MDH ADMINISTRATION OF THE MN STUDENT SURVEYS) A TEEN AND ADOLESCENT ASSESSMENT FOR EACH HOSPITAL IS COMPLETED. COMMUNITY HEALTH STAFF STARTS WITH PREVIOUS ASSESSMENTS AND EXISTING COMMUNITY DOCUMENTS TO BUILD A BASELINE OF INFORMATION. INFORMATION MAY INCLUDE PATIENT DATA, EXISTING RECENT SOCIAL AND CULTURAL REPORTS, EDUCATION AND BUSINESS REPORTS, NEW DEMOGRAPHIC INFORMATION ABOUT INCOME, HOUSING, EMERGING HEALTH NEEDS AND MORE. NEXT, STAFF MAY CONDUCT KEY INTERVIEWS WITH COMMUNITY LEADERS FROM DIVERSE SECTORS - SOCIAL SERVICES, PHILANTHROPY, GOVERNMENT, HEALTH, EDUCATION, BUSINESS, MINORITY GROUPS, FAITH GROUPS. INTERVIEWS ALLOW ASSUMPTIONS TO BE VALIDATED AND NEW INFORMATION TO BE GATHERED.IN ADDITION, SITE COMMUNITY HEALTH STAFF WORK WITH LOCAL PUBLIC HEALTH DEPARTMENTS AND OTHER COMMUNITY GROUPS AS PART OF THEIR SUPPLEMENTAL ASSESSMENT OF COMMUNITY NEED AND/OR TO UTILIZE THE FINDINGS FROM THEIR GROUPS IN UNDERSTANDING THEIR COMMUNITIES. CORPORATE COMMUNITY HEALTH STAFF WORKS WITH THE OFFICE OF THE STATE DEMOGRAPHER, THE MINNESOTA DEPARTMENT OF HEALTH AND AN OUTSIDE CONSULTANT TO GATHER AND ANALYZE DEMOGRAPHIC INFORMATION. HOSPITAL BASED STAFF WORK WITH THEIR LOCAL PUBLIC HEALTH DEPARTMENT AS WELL AS COMMUNITY ORGANIZATIONS. AFTER DATA IS GATHERED FOR ALL OF THE HOSPITALS HOSPITAL-BASED COMMUNITY HEALTH STAFF REVIEWS THE DATA AND MEETS WITH COMMUNITY LEADERS TO ASK ABOUT THE HEALTH NEEDS THEY SEE IN THEIR COMMUNITY. THE RESULTS OF THE COMMUNITY REPORTED NEEDS ARE INCORPORATED INTO THE FINAL ASSESSMENT. ONCE THE DATA AND REPORTED NEEDS HAVE BEEN FINALIZED TOP NEEDS FOR EACH COMMUNITY ARE IDENTIFIED THROUGH A REVIEW OF THE DEMOGRAPHIC DATA BY CORPORATE COMMUNITY HEALTH STAFF. | ||
| PART VI, LINE 3: PATIENTS THAT ARE ELIGIBLE FOR THE FAIRVIEW RANGE COMMUNITY CARE PROGRAM OR OTHER CHARITY CARE PLANS MAY RECEIVE A REDUCTION ON AMOUNTS OWED OF UP TO 100% OF TOTAL CHARGES BASED ON QUALIFYING FACTORS. FAIRVIEW RANGE SHALL INFORM PATIENTS ABOUT THE COMMUNITY CARE PROGRAM PRIOR TO DELIVERY OF SERVICE IF FEASIBLE AND AS APPROPRIATE AND DURING THE BILLING PROCESS.I. NOTICE TO PATIENTSCOMMUNITY CARE SHOULD ALWAYS BE OFFERED IF THE PATIENT/GUARANTOR INDICATES A FINANCIAL NEED. COMMUNITY CARE APPLIES TO UNIVERSITY MEDICAL CENTER-MESABI AND THE MESABA CLINICS. COMMUNITY CARE IS OFFERED TO BOTH UNINSURED AND UNDERINSURED IF THE PROPER STEPS ARE TAKEN. NON-COVERED AND ELECTIVE SERVICES ARE NOT APPROVED UNDER THE FAIRVIEW RANGE COMMUNITY CARE PROGRAM. REFER TO SECTION V FOR FURTHER EXPLANATION.COMMUNITY CARE APPLICATIONS ARE SENT OUT ON ALL ACCOUNTS THAT HAVE A BALANCE OVER $10,000. ALL UNINSURED (SELF PAY) PATIENTS RECEIVE AN ITEMIZED BILL ALONG WITH A CREDIT POLICY LETTER.II. MEDICAL ASSISTANCEPRIOR TO DETERMINING ELIGIBILITY FOR THE COMMUNITY CARE PROGRAM, THE PATIENT MUST APPLY FOR MEDICAL ASSISTANCE (MA) AND OTHER GOVERNMENTAL INSURANCE PROGRAMS. ADMISSION PROCEDURES FORASSISTING PATIENTS WITH MA APPLICATIONS SHALL BE FOLLOWED. III. COMMUNITY CARE PROGRAMEVERYONE HAS THE OPTION TO APPLY FOR OUR COMMUNITY CARE PROGRAM. THESE PROGRAMS ARE DESIGNED FOR PATIENTS IN FINANCIAL NEED AND MEET OUR GUIDELINES.A. DISCOUNT RATEPATIENTS THAT ARE ELIGIBLE FOR THE FAIRVIEW RANGE COMMUNITY CARE PROGRAM OR OTHER CHARITY CARE PLANS MAY RECEIVE A REDUCTION ON AMOUNTS OWED OF UP TO 100% OF TOTAL CHARGES BASED ON INCOME AND FAMILY SIZE ACCORDING TO THE FEDERAL POVERTY GUIDELINES.1. COOPERATION. BECAUSE THE COMMUNITY CARE PROGRAM IS NOT A SUBSTITUTE FOR PERSONAL RESPONSIBILITY, PERSONS SEEKING FINANCIAL ASSISTANCE THROUGH THE PROGRAM ARE EXPECTED TO COOPERATE WITH THE FAIRVIEW RANGE PROCEDURE FOR DETERMINING ELIGIBILITY AND TO CONTRIBUTE TO THE COST OF SERVICES TO THE EXTENT OF THEIR INDIVIDUAL ABILITY AND DETERMINED FINANCIAL RESPONSIBILITY. FAIRVIEW RANGE ENCOURAGES INDIVIDUALS WHO HAVE THE FINANCIAL ABILITY TO PURCHASE HEALTH INSURANCE IN ORDER TO ASSURE THEIR ONGOING ACCESS TO PREVENTATIVE HEALTH SERVICES AND TO PROTECT INDIVIDUAL ASSETS. ALL PATIENTS MUST APPLY FOR MEDICAID TO BE CONSIDERED COOPERATIVE.B. APPLICATION INFORMATION. COMMUNITY CARE APPLICANTS MUST PROVIDE THE FOLLOWING INFORMATION TO BE CONSIDERED COOPERATIVE:1. COMPLETED COMMUNITY CARE APPLICATION FORM. IT MUST BE SIGNED JOINTLY IF BOTH PARTIES ARE FILING2. COPY OF CURRENT YEAR FEDERAL INCOME TAX FORMS; INCLUDING ALL ATTACHMENTS AND SCHEDULES. IF MARRIED AND FILED TAXES SEPARATELY, BOTH PARTIES TAX INFORMATION MUST BE PROVIDED.3. DOCUMENTATION OF CURRENT INCOME FOR TWO CONSECUTIVE MONTHS. VALID DOCUMENTATION INCLUDES: RECENT PAYSTUBS, OR STUBS FROM UNEMPLOYMENT, DISABILITY, SOCIAL SECURITY, ETC.4. WRITTEN DOCUMENTATION FROM THE COUNTY OUTLINING IF THE PATIENT HAS BEEN APPROVED OR DENIED FROM MEDICAL ASSISTANCE. SERVICES PRIOR TO 3/1/07 DO NOT NEED A MA DENIAL.5. COPY OF CURRENT BANK STATEMENTS INCLUDING SAVINGS AND CHECKING.6. AN OPTIONAL LETTER OUTLINING ANY UNUSUAL CIRCUMSTANCES THAT MAY AFFECT THE ABILITY TO PAY.7. SPECIAL CIRCUMSTANCES MAY APPLY IF WE ARE ABLE TO DETERMINE INCOME FROM MA APPROVAL/DENIAL.8. FORMS MUST BE RETURNED WITHIN 30 DAYS. SPECIAL CIRCUMSTANCES MAY APPLY SUCH AS BACKLOG FROM THE COUNTY.9. PARTIAL APPLICATIONS WILL BE RETURNED TO THE PATIENT AND WILL NOT BE CONSIDERED.C. OTHER DISCOUNTS. UNINSURED DISCOUNT PROGRAM. A PROGRAM WHICH GIVES UNINSURED PATIENTS WITH A HOUSEHOLD INCOME EQUAL TO OR BELOW $125,000, AN UNINSURED DISCOUNT EQUIVALENT TO FAIRVIEW RANGE'S HIGHEST REVENUE PRIVATE PAYER CONTRACTED RATE FOR MEDICALLY NECESSARY SERVICES.D. MA OR GAMC PROGRAM IF A PATIENT HAS STRAIGHT MEDICAL ASSISTANCE OR GENERAL ASSISTANCE FOR TODAY'S DATE, THEIR PRIOR BALANCE(S) WILL BE WRITTEN OFF IN FULL.IV. INPATIENT SERVICESINPATIENT SERVICES ARE ADDRESSED MORE AGGRESSIVELY. IF A PATIENT IS SELF PAY AND IS AN INPATIENT, AN OUTREACH ADVOCATE WILL VISIT WITH THE PATIENT IN THEIR HOSPITAL ROOM. IF CONTACT IS NOT MADE WHILE AN INPATIENT, THE OUTREACH ADVOCATE WILL VISIT THE PATIENT IN THEIR HOME SETTING. THE ADVOCATE WILL PROVIDE AN MA APPLICATION AND ASSISTANCE IN FILLING IT OUT IF NEEDED. THE OUTREACH ADVOCATE WILL ALSO PROVIDE AND INFORM THE PATIENT ABOUT COMMUNITY CARE PROGRAM IN CASE MA IS DENIED. A FINANCIAL COUNSELORS WILL VISIT WITH THE PATIENT TO DISCUSS OPTIONS IF AN INPATIENT ACCOUNT HAS A HIGH DEDUCTIBLE OR COINSURANCE.A PROVIDER REQUEST FOR COVERAGE IS SENT TO THE COUNTY ON ALL SELF PAY ACCOUNTS AT THE TIME OF ADMISSION DUE TO THE COUNTY'S NEED TO BE NOTIFIED ON THE DAY OF ADMISSION.V. EXCLUSIONS. FAIRVIEW RANGE COMMUNITY CARE PROGRAM, DISCOUNT PROGRAM, AND OTHER CHARITY CARE PLANS DO NOT COVER THE FOLLOWING:THOSE PROCEDURES THAT ARE NOT MEDICALLY NECESSARY, COSMETIC, PHARMACY, HEARING AIDS, CHIROPRACTIC SERVICES, SERVICES NOT COVERED BY MINNESOTA MEDICAL ASSISTANCE AND OTHER INSURANCES, SERVICES WHICH YOU MAY BE RESPONSIBLE FOR IF YOU DO RECEIVE COUNTY ASSISTANCE, PROFESSIONAL SERVICES RENDERED AT OUR FACILITIES BY INDEPENDENT PHYSICIANS, OUT-OF-NETWORK SERVICES, HOSPICE, HOMECARE, DME, GREENVIEW ALZHEIMER'S, RETAIL STORE, FOREIGN OR OUT OF STATE SERVICES, SERVICES THAT WOULD HAVE QUALIFIED FOR INSURANCE COVERAGE IF RECEIVED AT ANOTHER FACILITY OR SERVICES NOT BILLED OR RECEIVED AT FAIRVIEW RANGE | ||
| PART VI, LINE 4: RANGE REGIONAL HEALTH SERVICES IS A REGIONAL HEALTH CARE SYSTEM BASED OUT OF HIBBING AND IS COMPRISED OF FAIRVIEW UNIVERSITY MEDICAL CENTER - MESABI, FAIRVIEW MESABA CLINICS, AND FAIRVIEW HEALTHLINE. FAIRVIEW RANGE HAS CLINICS, MEDICAL SUPPLY STORES, AND PROVIDES HOME CARE/HOSPICE/TRANSPORTATION SERVICES THROUGHOUT THE REGION. RANGE REGIONAL HEALTH SERVICES IS LOCATED IN NORTHEASTERN MINNESOTA APPROXIMATELY 72 MILES NORTHWEST OF DULUTH AND 190 MILES DUE NORTH OF MINNEAPOLIS/ ST. PAUL MINNESOTA ON WHAT IS CALL MINNESOTA'S FAMED "IRON RANGE". FOR MANY OF ITS SERVICES, RANGE REGIONAL HEALTH SERVICES, SERVES A POPULATION BASE OF OVER 133,000 RESIDENTS. IT COVERS A GEOGRAPHIC RANGE OF 45 MILES TO THE WEST, 100 MILES TO THE NORTH AND 70 MILES TO THE EAST AND 30 MILES TO THE SOUTH. WE ARE A TRUE REGIONAL REFERRAL CENTER FOR RADIATION ONCOLOGY AND BEHAVIORAL HEALTH SERVICES WITH PATIENTS COMING FROM ALL ACROSS N.E. MINNESOTA. THE POPULATION WE SERVE IS MADE UP OF APPROXIMATELY 66,079 MALES AND 66,999 FEMALES WITH THE MEDIAN FAMILY ANNUAL INCOME RANGING FROM $33,500 TO $37,000. WE HAVE A DIVERSE POPULATION MADE UP OF A VARIETY OF RACES AND ETHNIC GROUPS. WITH MORE THAN 60 LOCAL PHYSICIANS AND OVER 1,000 EMPLOYEES, FAIRVIEW RANGE HAS THE LARGEST ACTIVE MEDICAL STAFF ON THE IRON RANGE AND IS THE AREA'S 2ND LARGEST EMPLOYER. RANGE REGIONAL HEALTH SERVICES OFFERS HIGHLY-ADVANCED INPATIENT AND OUTPATIENT MEDICAL SERVICES, AND ALONG WITH OUR PROFESSIONAL STAFF, PROVIDES THE MOST COMPREHENSIVE HEALTH CARE SERVICES ON THE IRON RANGE AND NORTH TO THE CANADIAN BORDER. RANGE REGIONAL HEALTH SERVICES UTILIZES TRUE STATE-OF-THE-ART TECHNOLOGY, WITH SOME OF THE NEWEST EQUIPMENT AND FACILITIES IN THE REGION. WITH THE INSTALLATION OF THE MOST ADVANCED CT SCANNER IN THE AREA, A NEWLY EXPANDED AND ENHANCED RADIATION ONCOLOGY CENTER, A NEW COMPREHENSIVE BREAST CENTER, AND A NEWLY CONSTRUCTED AND EXPANDED EMERGENCY AND URGENT CARE CENTER, FAIRVIEW RANGE TRULY PROVIDES THE LATEST IN HIGH QUALITY HEALTHCARE RIGHT IN, OR CLOSE BY, YOUR HOME COMMUNITY | ||
| PART VI, LINE 6: RANGE REGIONAL HEALTH SERVICES IS GOVERNED BY AN UNPAID BOARD OF DIRECTORS. THE MAJORITY OF THE DIRECTORS ARE COMMUNITY MEMBERS WHO REPRESENT THE VARIOUS SERVICE AREAS AND ENTITIES WITHIN THE SYSTEM. AS A NONPROFIT HEALTH SYSTEM, RANGE REINVESTS ANY EXCESS REVENUES BEYOND EXPENSES INTO THE CORE OPERATIONS OF THE ORGANIZATION. IN 2009, RANGE STARTED A THREE-YEAR PROJECT TO IMPLEMENT AN INTEGRATED ELECTRONIC MEDICAL RECORD ACROSS THE CONTINUUM. THIS IS A SIGNIFICANT INVESTMENT IN CLINICAL QUALITY AND EFFICIENCY. RANGE PARTNERS WITH MYRIAD HIGHER EDUCATIONAL INSTITUTIONS TO PROVIDE CLINICAL HANDS-ON TRAINING FOR FUTURE NURSES, PHARMACISTS, LABORATORY PROFESSIONALS AND MORE. RANGE IS AN ACTIVE COMMUNITY MEMBER. LEADERS FROM RANGE HOSPITAL AND CLINICS ARE INVOLVED IN THEIR COMMUNITY THROUGH LEADERSHIP ON COMMUNITY BOARDS, LEGISLATIVE AND REGULATORY BOARDS AND MUCH MORE.WHEN SOMEONE IS SICK OR INJURED, THE EMERGENCY DEPARTMENTS (ED) AT RANGE SERVE AS FRONT DOOR FOR ALL INDIVIDUALS SEEKING MEDICAL CARE. THE EDS ARE PART OF A CRITICAL SAFETY NET OF SERVICES FOR UNINSURED INDIVIDUALS AND FAMILIES. FOR INDIVIDUALS WHO ARE UNABLE TO PAY FOR THEIR CARE, RANGE OFFERS CHARITY CARE ON A SLIDING FEE BASED ON INCOME. RANGE ALSO PROVIDES AN AUTOMATIC DISCOUNT ON ALL BILLS FOR UNINSURED INDIVIDUALS. THE DISCOUNT IS EQUAL TO THE DISCOUNT PROVIDED TO THE ORGANIZATION'S LARGEST COMMERCIAL INSURER. RANGE HOSPITAL AND CLINICS PARTICIPATE IN GOVERNMENT PROGRAMS SUCH AS MEDICARE, MEDICAID, GENERAL ASSISTANCE AND TRICARE. UMMC PROVIDES FOR A LARGE NUMBER OF INDIVIDUALS COVERED BY MEDICAID. THE AMOUNT OF MEDICAID VOLUME MAKES RANGE HOSPITAL A DISPROPORTIONATE SHARE RECIPIENT. | ||
| PART VI, LINE 7: RANGE REGIONAL HEALTH SERVICES IS AN AFFILIATE OF FAIRVIEW HEALTH SERVICE, AN INTEGRATED HEALTH CARE SYSTEM HEADQUARTERED IN MINNEAPOLIS, MN. BASED ON THE HEALTH CARE NEEDS IN THAT SERVICE AREA, COMMUNITY BENEFIT ACTIVITY IS CARRIED OUT BY STAFF/LEADERSHIP AT THAT FACILITY. THE FAIRVIEW CORPORATE COMMUNITY HEALTH DEPARTMENT SUPPORTS THE LOCAL EFFORT BY SHARING BEST PRACTICES, FINDING EFFICIENCIES AMONG HOSPITAL COMMUNITY HEALTH LEADERS AS APPROPRIATE, COORDINATING THE FORMAL COMMUNITY NEEDS ASSESSMENTS AND MORE. THESE SAME EFFORTS TAKE PLACE AT RRHS. | ||
| MN | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (15 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR SUSAN RUDBERG | |||||||||||||
| 0 | 202670 | 0 | 0 | 0 | 0 | 0 | 23287 | 0 | 24432 | 0 | 250389 | 0 | 0 |
| ANDY MCCOY | |||||||||||||
| 0 | 226429 | 0 | 28970 | 0 | 0 | 0 | 17150 | 0 | 15322 | 0 | 287871 | 0 | 0 |
| JOHN DOHERTY | |||||||||||||
| 0 | 327180 | 0 | 113591 | 0 | 0 | 0 | 24508 | 0 | 29276 | 0 | 494555 | 0 | 0 |
| DR KRISTIN FREDRICKSON | |||||||||||||
| 0 | 560831 | 0 | 10000 | 0 | 0 | 0 | 28175 | 0 | 43491 | 0 | 642497 | 0 | 0 |
| DEBRA RUDQUIST | |||||||||||||
| 0 | 184943 | 0 | 21633 | 0 | 0 | 0 | 5615 | 0 | 17762 | 0 | 229953 | 0 | 0 |
| BETH GOHDES | |||||||||||||
| 0 | 153329 | 0 | 11713 | 0 | 0 | 0 | 11767 | 0 | 17740 | 0 | 194549 | 0 | 0 |
| DEBRA BOARDMAN | |||||||||||||
| 0 | 246701 | 0 | 10000 | 0 | 0 | 0 | 0 | 0 | 6400 | 0 | 263101 | 0 | 0 |
| JOHN KRITZ | |||||||||||||
| 180391 | 0 | 0 | 0 | 3500 | 0 | 0 | 0 | 15270 | 0 | 199161 | 0 | 0 | 0 |
| JOHN BERLAND | |||||||||||||
| 191749 | 0 | 0 | 0 | 3500 | 0 | 0 | 0 | 6701 | 0 | 201950 | 0 | 0 | 0 |
| RICHARD DINTER | |||||||||||||
| 248613 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 6744 | 0 | 255357 | 0 | 0 | 0 |
| JOHN STONEBURNER | |||||||||||||
| 190327 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1370 | 0 | 191697 | 0 | 0 | 0 |
| MICHAEL PATREGNANI | |||||||||||||
| 199076 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 15025 | 0 | 214101 | 0 | 0 | 0 |
| GINA CLAUGHERTY | |||||||||||||
| 184203 | 0 | 5000 | 0 | 0 | 0 | 5741 | 0 | 9589 | 0 | 204533 | 0 | 0 | 0 |
| KENNETH KLOS | |||||||||||||
| 184243 | 0 | 5000 | 0 | 0 | 0 | 5513 | 0 | 1171 | 0 | 195927 | 0 | 0 | 0 |
| LARRY PFAFF | |||||||||||||
| 0 | 3962 | 0 | 66112 | 0 | 57493 | 0 | -2768 | 0 | 0 | 0 | 124799 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 6 | ReturnReference |
| Explanation | THE CEO HAS AN INCENTIVE PLAN BASED ON OVERALL COMPANY PERFORMANCE. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| CITY OF MINNEAPOLIS | |||||||
| 616005375 | 60374VCH4 | 2008-11-12 | 8868000 | REFUNDED 2005B REFUNDING 2000A ISSUE | 0 | 0 | 0 |
| CITY OF MINNEAPOLIS | |||||||
| 616005375 | 60374VCH4 | 2008-10-29 | 7870000 | AMBULATORY SERVICES CONSTRUCTION | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Refunding EscrowRefundingEscrow | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Year Of Subst CompletionYearOfSubstCompletion |
|---|---|---|---|---|---|---|---|---|---|
| 8868000 | 919000 | 7821000 | 128000 | 8740000 | 0 | 0 | 0 | 0 | |
| 7870000 | 69000 | 7801000 | 0 | 0 | 0 | 0 | 2010 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 1 | 0 | 1 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 1 | 0 | 0 | 1 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| MESABA CLINIC | |||
| THE CEO AND 1 COMMUNITY BOARD MEMBER ARE ALSO ON THE BOARD OF MESABA CLINIC | 7368006 | FEES PAID TO MESABA CLINIC FOR SERVICES | 0 |
| MIKE FAY | |||
| BOARD MEMBER | 37809 | INSURANCE COMMISSION | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS REVIEWED BY THE BOARD OF DIRECTORS BEFORE IT IS FILED. | |
| THE BOARD ANNUALLY COMPLETES A CONFLICT OF INTEREST STATEMENT. THE CFO DISCLOSES THE CONFLICTS TO THE ENTIRE BOARD. THE CFO MONITORS BOARD MOTIONS TO ENSURE DISCLOSURE OF POTENTIAL CONFLICTS WITH VOTES. | FORM 990, PART VI, SECTION B, LINE 12C | |
| COMPENSATION IS MARKET BASED AND BASED ON DATA COMPILED BY FAIRVIEW CORPORATE. | FORM 990, PART VI, SECTION B, LINE 15 | |
| THE FORMS ARE AVAILABLE UPON REQUEST | FORM 990, PART VI, SECTION C, LINE 18 | |
| THE DOCUMENTS ARE AVAILABLE UPON REQUEST IN THE ORGANIZATION'S ADMINISTRATION OFFICE. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 967,928. ADDITIONAL LIABILITY ASSOCIATED WITH THE DEFINED BENEFIT PLAN 5,671,318. TOTAL TO FORM 990, PART XI, LINE 5: 6,639,246. | FORM 990, PART XI, LINE 5: |
| THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. | FORM 990, PART XI, LINE 2C |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | EINEIN |
|---|---|---|---|---|---|---|---|---|
| HEALTHLINE LLC | ||||||||
| 750 EAST 34TH STREET | HIBBING | MN | 55746 | HOSPICE HOME CARE | DE | 8616581 | 0 | |
| UNIVERSITY MEDICAL CENTER-MESABI AUXILIARY | ||||||||
| 750 EAST 34TH STREET | HIBBING | MN | 55746 | AUXILIARY | MN | 135499 | 105958 | 411452117 |
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRVIEW HEALTH SERVICES | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2450 RIVERSIDE AVENUE | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55454 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410991680 | EIN |
| Primary Activities | HEALTH CARE | PrimaryActivities |
| Legal Domicile State | MN | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 170(B)(1)(A)(III) | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 0 | ControlledOrg |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MESABA CLINIC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3605 MAYFAIR AVENUE | AddressLine1 |
| City | HIBBING | City |
| State | MN | State |
| ZIP Code | 55746 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411805715 | EIN |
| Primary Activity | MEDICAL SERVICES | PrimaryActivity |
| Legal Domicile State | MN | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 7368006 | ShareOfTotalIncome |
| Share Of EOY Assets | 1000 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
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