ST CROIX VALLEY EMERGENCY MEDICAL: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- ST CROIX VALLEY EMERGENCY MEDICAL (EIN 45-2872803)
- Tax period
- 2024-01-01 to 2024-12-31
- Filed
- 2025-09-30
- IRS object ID
- 202502739349300630
- Schema version
- 2024v5.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-09-30T11:39:36-05:00 | ReturnTs |
| Tax Period End | 2024-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 452872803 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ST CROIX VALLEY EMERGENCY MEDICAL | BusinessNameLine1Txt |
| Business Name Line2 | SERVICES INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | STCR | BusinessNameControlTxt |
| Phone | 6512774911 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 EAST STATE STREET | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MICHAEL YOUSO | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7154830556 | PhoneNum |
| Signature | 2025-09-18 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2025-09-12 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Final Return | Yes (X) | FinalReturnInd |
| Principal Officer | DAVID DOBOSENSKI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 235 EAST STATE ST | AddressLine1Txt |
| City | ST CROIX FALLS | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 54024 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,567,484 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.SAINTCROIXHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2011 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | TO LEASE, MAINTAIN, AND OPERATE AN EMERGENCY AMBULANCE SERVICE WHICH SERVES THE POLK COUNTY, WI AREA. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 2 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $65,058 | PYContributionsGrantsAmt |
| CY Contributions Grants | $187,342 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,178,979 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,322,364 | CYProgramServiceRevenueAmt |
| PY Investment Income | $27,363 | PYInvestmentIncomeAmt |
| CY Investment Income | $48,452 | CYInvestmentIncomeAmt |
| PY Other Revenue | $12,473 | PYOtherRevenueAmt |
| CY Other Revenue | $9,326 | CYOtherRevenueAmt |
| PY Total Revenue | $4,283,873 | PYTotalRevenueAmt |
| CY Total Revenue | $4,567,484 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,777,217 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,759,421 | PYOtherExpensesAmt |
| CY Other Expenses | $4,302,028 | CYOtherExpensesAmt |
| PY Total Expenses | $3,759,421 | PYTotalExpensesAmt |
| CY Total Expenses | $6,079,245 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $524,452 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,511,761 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,419,803 | TotalAssetsBOYAmt |
| Total Assets EOY | $0 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $311,816 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,107,987 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $0 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO LEASE, MAINTAIN, AND OPERATE AN EMERGENCY AMBULANCE SERVICE WHICH WILL SERVE THE POLK COUNTY, WI AREA TO RENDER AID TO THE SICK, INJURED, OR DISABLED WITHOUT THE REGARDS TO RACE, CREED, OR TO STATION IN LIFE. TO SERVE THE SOCIAL WELFARE OF THE PEOPLE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $5,148,529 | ExpenseAmt |
| Grant | $1,777,217 | GrantAmt |
| Revenue | $4,331,690 | RevenueAmt |
| Desc | ST. CROIX VALLEY EMS, INC. OPERATES AS AN "OUT-OF-HOSPITAL" CARE ORGANIZATION THAT PROVIDES MEDICAL CARE AND COMPREHENSIVE MEDICAL TRANSPORTATION IN THE COMMUNITIES WE SERVE. THE CORE PURPOSE OF ST. CROIX VALLEY EMS, INC. IS PROVIDING CARE TO PEOPLE DURING THEIR TIME OF NEED RESULTING FROM ACCIDENTS AND MEDICAL EMERGENCIES. ST. CROIX VALLEY EMS, INC. RESPONDS TO "911" CALLS IN EACH COMMUNITY SERVED WITHOUT ANY REGARD TO REIMBURSEMENT FOR SERVICES, INCLUDING THE ABILITY OF THE CALLING PARTY TO PAY FOR COSTS ASSOCIATED WITH THE SERVICE. ST. CROIX VALLEY EMS, INC, PROVIDES SERVICES TO THE COMMUNITIES OF: CITY OF ST. CROIX, TOWN OF ST. CROIX, TOWN OF GARFIELD, TOWN OF EUREKA, TOWN OF OSCEOLA, TOWN OF BALSAM LAKE, TOWN OF MILLTOWN, TOWN OF STERLING, CITY OF DRESSER, VILLAGE OF BALSAM LAKE, VILLAGE OF CENTURIA, VILLAGE OF MILLTOWN, IN POLK COUNTY, WISCONSIN AND THE COMMUNITIES OF THE CITY OF TAYLORS FALLS, AMADOR TOWNSHIP, AND SHAFER TOWNSHIP IN CHISAGO COUNTY, MINNESOTA. ST. CROIX VALLEY EMS, INC. SERVES APPROXIMATELY 7,400 RESIDENTS IN THE ABOVE CITIES/VILLAGES/TOWNS. | Desc |
| Total Program Service Expenses | $5,148,529 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | Yes (1) | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 4 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 2 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EMILY PINKSTON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6512774911 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 40245 FLETCHER AVENUE | AddressLine1Txt |
| City | NORTH BRANCH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55056 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (6 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DAVE DOBOSENSKI | ||||||||
| PRESIDENT | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $720,781 | $0 | |
| MICHAEL YOUSO | ||||||||
| CFO - SCVEMS | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $543,547 | $26,211 | |
| AARRON REINERT | ||||||||
| VICE PRESIDENT | 1.00 | 40.00 | Yes (X) | Yes (X) | $0 | $253,446 | $7,181 | |
| PAT MCCAULLY | ||||||||
| SECRETARY | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| RALPH J FRASCONE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KIMBERLY ERICSON | ||||||||
| CFO - ST. CROIX HEALTH | 1.00 | 40.00 | $0 | $260,354 | $26,289 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,778,128 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $59,681 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LAKES REGION EMS INC | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 40245 FLETCHER AVE | AddressLine1Txt |
| City | NORTH BRANCH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55056 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | MANAGEMENT FEES, PAYROLL, MISC EXPENSES | ServicesDesc |
| Compensation | $3,784,754 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $53,377 | GovernmentGrantsAmt |
| All Other Contributions | $133,965 | AllOtherContributionsAmt |
| Total Contributions | $187,342 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | FEE INCOME | Desc |
| Business | 621910 | BusinessCd |
| Total Revenue Column | $4,322,364 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,322,364 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,322,364 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $48,452 | TotalRevenueColumnAmt |
| Exclusion | $48,452 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| BAD DEBT RECOVERIES | 621910 | $8,819 | $8,819 |
| MEDICAL RECORDS | 621910 | $507 | $507 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $9,326 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,567,484 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,331,690 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $48,452 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,777,217 | TotalAmt |
| Program Services | $1,777,217 | ProgramServicesAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,329,993 | TotalAmt |
| Program Services | $2,435,728 | ProgramServicesAmt |
| Management And General | $894,265 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,650 | TotalAmt |
| Management And General | $17,650 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,477 | TotalAmt |
| Management And General | $8,477 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $134,553 | TotalAmt |
| Program Services | $134,553 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,736 | TotalAmt |
| Program Services | $5,736 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,351 | TotalAmt |
| Program Services | $26,351 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $413 | TotalAmt |
| Program Services | $413 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,501 | TotalAmt |
| Program Services | $25,501 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $107,366 | TotalAmt |
| Program Services | $107,366 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,867 | TotalAmt |
| Program Services | $172,867 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,008 | TotalAmt |
| Program Services | $21,008 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| BAD DEBT | $251,091 | $251,091 |
| MEDICAL SUPPLIES | $77,044 | $77,044 |
| MN CARE TAX | $44,847 | $44,847 |
| REPAIRS AND MAINTENANCE | $25,000 | $25,000 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,131 | TotalAmt |
| Program Services | $43,807 | ProgramServicesAmt |
| Management And General | $10,324 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,079,245 | TotalAmt |
| Program Services | $5,148,529 | ProgramServicesAmt |
| Management And General | $930,716 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $678,829 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,360,673 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $774,054 | BOYAmt |
| EOY | $0 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $0 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $0 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $606,247 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,419,803 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $311,816 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $311,816 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Org Does Not Follow FASB117 | Yes (X) | OrgDoesNotFollowFASB117Ind |
Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $776,822 | BOYAmt |
| EOY | $0 | EOYAmt |
Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,331,165 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,107,987 | BOYAmt |
| EOY | $0 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,419,803 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,511,761 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$1,596,227 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $308 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus2 Years | $360,190 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $65,058 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $187,342 | CurrentTaxYearAmt |
| Total | $612,898 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,555,110 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,037,664 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,252,434 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,178,979 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,322,364 | CurrentTaxYearAmt |
| Total | $17,346,551 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,555,418 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,037,664 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,612,624 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,244,037 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,509,706 | CurrentTaxYearAmt |
| Total | $17,959,449 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $17,959,449 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,673 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,830 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,893 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $27,363 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $48,452 | CurrentTaxYearAmt |
| Total | $86,211 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,673 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,830 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,893 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $27,363 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $48,452 | CurrentTaxYearAmt |
| Total | $86,211 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,776 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $626 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,971 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $12,473 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $9,326 | CurrentTaxYearAmt |
| Total | $31,172 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,560,867 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,041,120 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $3,623,488 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $4,283,873 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $4,567,484 | CurrentTaxYearAmt |
| Total | $18,076,832 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99350 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99530 | PublicSupportPY509Pct |
| Investment Income CY | 0.00480 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00280 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | MEDICAL RECORDS - 2024 AMOUNT: $ 507. MISCELLANEOUS REVENUE - 2020 AMOUNT: $ 1,776. 2021 AMOUNT: $ 626. 2022 AMOUNT: $ 6,971. 2023 AMOUNT: $ 12,473. 2024 AMOUNT: $ 8,819. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| ST CROIX REGIONAL MEDICAL CENTER | ||||||||
| 235 STATE STREET | ST CROIX FALLS | WI | 54024 | 390890676 | 501(C)(3) | $1,010,667 | $0 | GRANT UPON DISSOLUTION |
| REGIONS HOSPITAL | ||||||||
| 8170 33RD AVENUE SOUTH | MINNEAPOLIS | MN | 554401309 | 410956618 | 501(C)(3) | $766,550 | $0 | GRANT UPON DISSOLUTION |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAID GRANTS TO THE TWO GRANTEES IN ACCORDANCE WITH THE SIGNED DISSOLUTION DOCUMENTS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVE DOBOSENSKI | ||||||||||||||
| PRESIDENT | $0 | $0 | $0 | $0 | $0 | $720,781 | $0 | $0 | $0 | $0 | $0 | $720,781 | $0 | $226,425 |
| MICHAEL YOUSO | ||||||||||||||
| CFO - SCVEMS | $0 | $543,543 | $0 | $0 | $0 | $4 | $0 | $0 | $0 | $26,211 | $0 | $569,758 | $0 | $0 |
| KIMBERLY ERICSON | ||||||||||||||
| CFO - ST. CROIX HEALTH | $0 | $245,350 | $0 | $15,000 | $0 | $4 | $0 | $7,915 | $0 | $18,374 | $0 | $286,643 | $0 | $0 |
| AARRON REINERT | ||||||||||||||
| VICE PRESIDENT | $0 | $194,906 | $0 | $58,540 | $0 | $0 | $0 | $7,181 | $0 | $0 | $0 | $260,627 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | THE ORGANIZATION IS REPORTING COMPENSATION AND ARRANGEMENTS THAT CORRELATE TO THE SERVICES AND AGREEMENTS BETWEEN THE FOLLOWING INDIVIDUAL AND THE RELATED PARTY OF ST CROIX REGIONAL MEDICAL CENTER. ST CROIX REGIONAL MEDICAL CENTER'S BOARD WAS RESPONSIBLE FOR THE OVERSIGHT AND ADMINISTRATION OF THE FOLLOWING. BECAUSE THEY ARE A RELATED PARTY, THE ORGANIZATION IS RESPONSIBLE FOR REPORTING IT AS WELL. ON ST. CROIX REGIONAL MEDICAL CENTER'S SCHEDULE J THEY INDICATE THE FOLLOWING FOR ESTABLISHING COMPENSATION: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE |
| PART I, LINES 4A-B | DURING 2024, DAVE DOBOSENSKI, CFO, RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $285,340 DAVE DOBOSENSKI PARTICIPATES IN A 457(F) PLAN THROUGH A RELATED PARTY. DURING 2024, HE RECEIVED A PAYOUT OF $226,425 FROM THE 457(F) PLAN |
Schedule N IRS990ScheduleN
Liquidation Of Assets Table LiquidationOfAssetsTableGrp
Liquidation Of Assets Detail LiquidationOfAssetsDetail (3 entries)
| Assets Distri Or Expnss PaidAssetsDistriOrExpnssPaidDesc | DistributionDistributionDt | Fair Market Value Of AssetFairMarketValueOfAssetAmt | Method Of FMV DeterminationMethodOfFMVDeterminationTxt | EINEIN | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | IRC SectionIRCSectionTxt |
|---|---|---|---|---|---|---|---|---|---|
| LAKES REGION EMERGENCY MEDICAL SERVICES INC | |||||||||
| TRANSFER OF ASSETS UPON DISSOLUTION | 2024-12-31 | $1,596,227 | CASH | 237146628 | 40245 FLETCHER AVENUE | NORTH BRANCH | MN | 55056 | 501(C)(3) |
| ST CROIX REGIONAL MEDICAL CENTER | |||||||||
| CASH GRANT UPON DISSOLUTION | 2024-12-31 | $1,010,667 | CASH | 390890676 | 235 STATE STREET | ST CROIX FALLS | WI | 54024 | 501(C)(3) |
| REGIONS HOSPITAL | |||||||||
| CASH GRANT UPON DISSOLUTION | 2024-12-31 | $766,550 | CASH | 410956618 | 8170 33RD AVENUE SOUTH | MINNEAPOLIS | MN | 554401309 | 501(C)(3) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | 0 | DirectorOfSuccessorInd |
| Employee Of Successor | Yes (1) | EmployeeOfSuccessorInd |
| Owner Of Successor | 0 | OwnerOfSuccessorInd |
| Receive Compensation | 0 | ReceiveCompensationInd |
| Assets Distributed | Yes (1) | AssetsDistributedInd |
| Required To Notify AG | Yes (1) | RequiredToNotifyAGInd |
| Attorney General Notified | Yes (1) | AttorneyGeneralNotifiedInd |
| Liabilities Paid | Yes (1) | LiabilitiesPaidInd |
| Bonds Outstanding | 0 | BondsOutstandingInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 2E: | PERSON(S) INVOLVED: AARRON REINHERT |
| PART I, LINE 2E: | EXPLANATION OF INVOLVEMENT: AARRON REINERT, VICE PRESIDENT OF THE FILING ORGANIZATION, IS THE EXECUTIVE DIRECTOR OF THE SUCCESSOR ORGANIZATION, LAKES REGION EMS, INC. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | OPERATIONS AGREEMENT WITH LAKES REGION EMS, INC. $894,625 MANAGEMENT FEE FOR 2024. |
| FORM 990, PART VI, SECTION A, LINE 4 | THE ORGANIZATION PASSED A RESOLUTION (ATTACHED TO THE 990) TO ALLOW THEIR EMBERS TO EXIT AND MERGE THEIR ACTIVITIES AND OPERATIONS INTO LAKES REGIONS EMS, INC. (23-7146628). |
| FORM 990, PART VI, SECTION A, LINE 6 | THE CORPORATION HAS THREE MEMBERS: ST. CROIX REGIONAL MEDICAL CENTER, REGIONS HOSPITAL AND LAKES REGION, EMS, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE CORPORATION HAS THREE MEMBERS WITH THE POWER TO APPOINT DIRECTORS OF THE BOARD AS FOLLOWS: ST. CROIX REGIONAL MEDICAL CENTER SHALL APPOINT THREE DIRECTORS, REGIONS HOSPITAL SHALL APPOINT TWO DIRECTORS AND LAKES REGION EMS, INC. SHALL APPOINT ONE DIRECTOR. EACH DIRECTOR SHALL SERVE AN INDEFINITE TERM CONTINUING UNTIL HIS OR HER DEATH, INABILITY TO ACT, RESIGNATION OR REMOVAL. A VACANCY IN THE BOARD OF DIRECTORS SHALL BE FILLED BY THE MEMBER WHO APPOINTED THE DIRECTOR WHOSE CESSATION OF SERVICE CREATES THE VACANCY. |
| FORM 990, PART VI, SECTION A, LINE 7B | UNANIMOUS APPROVAL IS REQUIRED FOR MATERIAL CHANGES IN THE MISSION AND MAJOR CHANGES IN THE CORPORATION'S STRUCTURE. SUPER MAJORITY MEMBERSHIP INTEREST APPROVAL IS REQUIRED FOR MAJOR TRANSACTIONS. |
| FORM 990, PART VI, SECTION A, LINE 8B | THERE ARE NO STANDING COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | AFTER PREPARATION BY AN INDEPENDENT ACCOUNTING FIRM, THE FORM 990 WILL BE REVIEWED AND APPROVED BY THE FULL BOARD. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REQUIRES ALL BOARD MEMBERS AND OPERATIONS COMMITTEE MEMBERS TO ANNUALLY ACKNOWLEDGE REVIEWING THE CONFLICT OF INTEREST POLICY BY SIGNING THE CONFLICT OF INTEREST STATEMENT. IF A CONFLICT OF INTEREST EXISTS, HE OR SHE SHALL REFRAIN FROM PARTICIPATION IN ANY DECISION ON SUCH A MATTER WITH REMAINING MEMBERS DETERMINING WHETHER A CONFLICT EXISTS. PROCEEDINGS RELATED TO CONFLICTS OF INTEREST ARE DOCUMENTED IN THE MEETING MINUTES OR AS OTHERWISE APPROPRIATE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE FOR PUBLIC INSPECTION. |
| FORM 990, PART XI, LINE 9: | TRANSFER OF NET ASSETS UPON DISSOLUTION -1,596,227. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| ST CROIX REGIONAL MEDICAL CENTER | |||||||||
| 235 E STATE ST | ST CROIX FALLS | WI | 54024 | 390890676 | HEALTH - GENERAL & REHABILITATIVE | WI | 501(C)(3) | LINE 3 | 0 |
| LAKES REGION EMS INC | |||||||||
| 40245 FLETCHER AVENUE | NORTH BRANCH | MN | 55056 | 237146628 | EMERGENCY AMBULANCE SERVICES | MN | 501(C)(3) | LINE 10 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |