2011-11-09T13:10:58-06:00 2010-12-31 BAKER TILLY VIRCHOW KRAUSE LLP 225 S 6TH ST STE 2300 MINNEAPOLIS MN 55402 990 2010-01-01 411328097 RIDGEVIEW FOUNDATION RIDG 9524426010 500 SOUTH MAPLE STREET WACONIA MN 55387 GORDON GABALENZ 9524422191 2011-11-08 1 6128764500 2011-11-01 2010 2016-02-24 21:20:13Z GORDON GABLENZ 500 SOUTH MAPLE STREET WACONIA MN 55387 2812499 0 X N/A X 1978 MN TO MAKE A POSITIVE DIFFERENCE IN THE QUALIFY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 20 20 0 280 0 0 1096638 1739448 0 0 -25795 98307 129121 156295 1199964 1994050 4245220 1057482 0 0 0 0 0 0 210881 350389 240066 4595609 1297548 -3395645 696502 6900358 7782936 15497 1200 6884861 7781736 RIDGEVIEW FOUNDATION IS AN INDEPENDENT NONPROFIT ORGANIZATION THAT PARTNERS WITH RIDGEVIEW MEDICAL CENTER IN ITS MISSION TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 0 0 1072233 1057482 TO RAISE FUNDS EXCLUSIVELY FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER IN WACONIA, MINNESOTA, A NOT-FOR-PROFIT HOSPITAL. DURING THE YEAR ENDED DECEMBER 31, 2010, RIDGEVIEW FOUNDATION EXPENSED A TOTAL OF $1,072,333 TO RIDGEVIEW MEDICAL CENTER. $348,401 WAS TO BUILD AND FURNISH A NEW HOSPICE RESIDENCE THAT WAS A NEW SERVICE OFFERING THAT STARTED IN 2009. $400,000 WAS TRANSFERRED TO THE HOSPITAL TO SUPPORT THE BUILDING AND FURNISHING OF A HEART CENTER AND CATH LAB AT THE HOSPITAL. THE REMAINING $323,832 TRANSFERRED TO THE HOSPITAL WAS USED FOR VARIOUS PROJECTS AND PROGRAMS DURING 2010. 1072233 1 1 0 0 0 0 0 0 1 0 0 0 1 0 1 1 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 X 20 20 0 0 0 0 1 1 1 1 1 0 0 1 0 1 1 1 1 0 MN X GORDON GABLENZ 9524426010 500 SOUTH MAPLE STREET WACONIA MN 55387 DAVID ADINOLFI 0.50 X 0 0 0 DARLA HOLMGREN 0.50 X 0 0 0 RANDY SCHNEEWIND 0.50 X 0 0 0 JEAN BULLER 0.50 X 0 0 0 BRIAN MARK 0.50 X 0 0 0 MARK STEINGAS 0.50 X 0 0 0 DERMOT COWLEY 0.50 X 0 0 0 PETER NELSON 0.50 X 0 0 0 LARRY WILHELM 0.50 X 0 0 0 LAURA FLEMAL 0.50 X 0 0 0 STACY DESAI 0.50 X 0 0 0 TIM FOSTER 0.50 X 0 0 0 KEITH RACHEY 0.50 X 0 0 0 MARY FREDERICK 0.50 X 0 0 0 LINDA ROEBKE 0.50 X 0 0 0 CHARLES SPEVACEK 0.50 X 0 0 0 KATE ROEHL 0.50 X X 0 0 0 MIKE GRESSER 0.50 X 0 0 0 KATHY HACKETT 0.50 X 0 0 0 MARK SCHIFFMAN 0.50 X 0 0 0 ROBERT STEVENS 40.00 X 0 325267 26468 GORDON GABLENZ 40.00 X 0 201318 40512 DOUGLAS STASEK 40.00 X 0 191657 22458 0 718242 89438 0 0 1 0 0 114454 272509 1352485 392664 1739448 43863 43863 693375 638931 54444 54444 54444 320163 114454 175563 144600 144600 15650 3955 11695 11695 1994050 0 0 254602 1048482 1048482 9000 9000 4348 4348 220892 10011 210881 MISCELLANEOUS 14826 14751 75 1297548 1072233 14434 210881 430833 1249807 379077 959052 3752955 3269640 203154 462093 199671 1934668 1842344 6900358 7782936 15497 1200 15497 1200 X 1594149 1742129 4398857 5072552 891855 967055 6884861 7781736 6900358 7782936 X 696502 200373 X X 0 1 1 X 0 X 4711888 3761997 2540736 1096638 1739448 13850707 4711888 3761997 2540736 1096638 1739448 13850707 4922151 8928556 103213 132660 126263 60771 43863 466770 14317477 15708635 0.62360 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: THE FOUNDATION TRANSFERS FUNDS TO THE HOSPITAL ONLY WHEN THE HOSPITAL HAS COMMITTED TO DONOR RESTRICTED PROJECTS AND HAS SPENT A REQUIRED AMOUNT OF FUNDS ON THE PROJECT. DURING 2010, TOTAL SUPPORT OF THE HOSPITAL WAS $1,072,233 WHICH REPRESENTED TRANSFERS TO RIDGEVIEW MEDICAL CENTER FROM THE FOUNDATION. SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: DURING 2010, THE FOUNDATION REQUESTED AND WAS APPROVED TO RECLASS FROM 509(A)(3) STATUS TO 509(A)(1) AND 170(B)(1)(A)(VI) STATUS WITH THE IRS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1068586 195012 56843 91789 1228652 2171052 7534 75524 1185524 1068586 2142931 303299 -72288 202890 2171052 0.21000 0.79000 0 0 0 KEY PERSON LIFE INSURANCE 150836 BRIDGE LOAN TO RIDGEVIEW MEDICAL CENTER 1691508 1842344 1994050 1297548 696502 200373 200373 896875 2892576 200373 518635 719008 2173568 -179518 -179518 1994050 1995701 518635 179518 698153 1297548 0 1297548 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FOUNDATION HAS RECEIVED NOTIFICATION THAT IT QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING PROVISIONS OF STATE LAW AND, ACCORDINGLY, IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, ANY UNRELATED BUSINESS INCOME MAY BE SUBJECT TO TAXATION. GENERALLY, THE ORGANIZATION IS NO LONGER SUBJECT TO U.S. FEDERAL, STATE OR LOCAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2007. THE FOUNDATION IS NOT CURRENTLY UNDER EXAMINATION BY ANY TAXING JURISDICTION. DURING 2010, THE FOUNDATION REQUESTED AND WAS APPROVED TO RECLASS FROM 509(A)(3) STATUS TO 509(A)(1) AND 170(B)(1)(A)(VI) STATUS WITH THE IRS. ON JANUARY 1, 2009, THE FOUNDATION ADOPTED A NEW STANDARD RELATED TO THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THE TAX EFFECTS FROM AN UNCERTAIN TAX POSITION CAN BE RECOGNIZED IN THE FINANCIAL STATEMENTS, ONLY IF THE POSITION IS MORE LIKELY THAN NOT TO BE SUSTAINED ON AUDIT, BASED ON THE TECHNICAL MERITS OF THE POSITION. THERE WAS NO EFFECT ON PREVIOUSLY REPORTED NET ASSETS AS A RESULT OF THE ADOPTING THIS NEW STANDARD. THE FOUNDATION HAS NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2010 AND 2009. PART XII, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES -175,563. GAMING EXPENSES -3,955. PART XIII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 175,563. GAMING EXPENSES 3,955. GOLF 390217 70054 320163 20739 91500 FALL HARVEST MOON 37300 37300 50756 1 7100 7100 12568 434617 114454 320163 20739 154824 175563 144600 15650 3955 1 0.80000 15650 3955 3955 11695 MN 1 0 0 0 1.00000 0.00000 GORDON GABLENZ 500 SOUTH MAPLE STREET WACONIA MN 55387 0 JAN HELD 52498 JAN HELD IS THE EVENTS COORDINATOR FOR THE FOUNDATION. X 1 11695 1 RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 501(C)(3) 1048482 FUNDRAISING SUPPORT OF RIDGEVIEW MEDICAL CENTER BY FOUNDATION 1 SCHOLARSHIPS 13 9000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SCHOLARSHIP PAYMENTS ARE MADE DIRECTLY TO THE SCHOOL THAT THE STUDENT IS ATTENDING. X X 0 0 0 0 0 0 0 0 0 ROBERT STEVENS 0 325267 0 0 0 0 0 15742 0 10726 0 351735 0 0 GORDON GABLENZ 0 201318 0 0 0 0 0 29786 0 10726 0 241830 0 0 DOUGLAS STASEK 0 191657 0 0 0 0 0 12042 0 10416 0 214115 0 0 SUPPLEMENTAL INFORMATION PART III SCHEDULE J PART I LINE 3: THE CEO'S COMPENSATION IS DETERMINED BY RIDGEVIEW FOUNDATION'S PARENT ORGANIZATION, RIDGEVIEW MEDICAL CENTER. THE PROCESS USED BY RIDGEVIEW MEDICAL CENTER INCLUDES A COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. X 4 125301 FAIR MARKET VALUE X SUPPLIES AND EQUIPMENT 6 267363 FAIR MARKET VALUE X AUCTION PRIZE 1 8000 FAIR MARKET VALUE 0 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS REFERS TO THE NUMBER OF ACTUAL CONTRIBUTORS. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS OF THE FOUNDATION DESIGNATED SEVEN BOARD MEMBERS AS AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE ACTS ONLY DURING INTERVALS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS OF THE FOUNDATION AND IS AT ALL TIMES SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD OF DIRECTORS OF THE FOUNDATION. DURING SUCH INTERVALS AND SUBJECT TO SUCH CONTROL AND DIRECTION, THE EXECUTIVE COMMITTEE HAS ALL OF THE AUTHORITY AND POWER OF THE BOARD OF DIRECTORS OF THE FOUNDATION IN THE MANAGEMENT OF THE BUSINESS OF THE FOUNDATION, SUBJECT TO SUCH LIMITATIONS AS THE BOARD OF DIRECTORS OF THE FOUNDATION MAY IMPOSE FROM TIME TO TIME. FORM 990, PART VI, SECTION A, LINE 6 RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF RIDGEVIEW FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A EACH PERSON ELECTED BY THE BOARD OF DIRECTORS OF RIDGEVIEW FOUNDATION IS RATIFIED OR REJECTED BY THE BOARD OF DIRECTORS OF RIDGEVIEW MEDICAL CENTER, THE FOUNDATION'S SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B IN ADDITION TO THE APPOINTMENT OF DIRECTORS TO THE BOARD OF DIRECTORS OF RIDGEVIEW FOUNDATION, AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FOUNDATION REQUIRE APPROVAL OF RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11 THE CFO REVIEWED THE FORM 990 AND PROVIDED COPIES TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12 THE BOARD ADOPTED A CONFLICT OF INTEREST POLICY IN FEBRUARY 2011. THIS POLICY WILL TAKE EFFECT IN THE YEAR 2011. FORM 990, PART VI, SECTION B, LINE 15 RIDGEVIEW FOUNDATION DOES NOT COMPENSATE ITS OFFICERS OR BOARD MEMBERS. ANY COMPENSATION RECEIVED BY THOSE INDIVIDALS IS DETERMINED BY RIDGEVIEW MEDICAL CENTER, THE FOUNDATION'S PARENT, OR BY EXECUTIVE HEALTH MANAGEMENT SERVICES, INC., THE MANAGEMENT SERVICES PROVIDER OF RIDGEVIEW MEDICAL CENTER. FORM 990, PART VI, SECTION C, LINE 19 RIDGEVIEW FOUNDATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 200,373. REVIEW OF AUDIT FORM 990, PART XI, LINE 2C THE PROCESS FOR THE REVIEW AND OVERSIGHT OF THE AUDIT HAS NOT CHANGED FROM PRIOR YEAR. RIDGEVIEW CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 411651783 HEALTH CARE SERVICES MN 501(C) LINE 3 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 HEALTH CARE SERVICES MN 501(C) LINE 3 0 CREATE HEALTH INC 500 SOUTH MAPLE STREET WACONIA MN 55387 260594364 HEALTHCARE SERVICES MN N/A C EXECUTIVE HEALTH MANAGEMENT SERVICES INC 500 SOUTH MAPLE STREET WACONIA MN 55387 411760239 MANAGEMENT SERVICES MN N/A C 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 RIDGEVIEW MEDICAL CENTER N 508635 EMPLOYEE SALARIES & BENEFITS RIDGEVIEW MEDICAL CENTER C 197309 FAIR VALUE RIDGEVIEW MEDICAL CENTER D 1691508 FAIR VALUE RIDGEVIEW MEDICAL CENTER B 1048482 ACTUAL CASH GRANT