2025-09-30T11:39:36-05:00 2024-12-31 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2024-01-01 452872803 ST CROIX VALLEY EMERGENCY MEDICAL SERVICES INC STCR 6512774911 235 EAST STATE STREET ST CROIX FALLS WI 54024 MICHAEL YOUSO CFO 7154830556 2025-09-18 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-09-12 2024 2025-03-06 01:10:19Z X DAVID DOBOSENSKI 235 EAST STATE ST ST CROIX FALLS WI 54024 4567484 0 X HTTPS://WWW.SAINTCROIXHEALTH.ORG X 2011 WI TO LEASE, MAINTAIN, AND OPERATE AN EMERGENCY AMBULANCE SERVICE WHICH SERVES THE POLK COUNTY, WI AREA. X 5 2 0 0 0 0 65058 187342 4178979 4322364 27363 48452 12473 9326 4283873 4567484 0 1777217 0 0 0 0 0 0 0 3759421 4302028 3759421 6079245 524452 -1511761 3419803 0 311816 0 3107987 0 X 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. 0 0 5148529 1777217 4331690 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. 5148529 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 2 0 1 1 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 MN X EMILY PINKSTON 6512774911 40245 FLETCHER AVENUE NORTH BRANCH MN 55056 DAVE DOBOSENSKI PRESIDENT 1.00 40.00 X X 0 720781 0 MICHAEL YOUSO CFO - SCVEMS 1.00 40.00 X X 0 543547 26211 AARRON REINERT VICE PRESIDENT 1.00 40.00 X X 0 253446 7181 PAT MCCAULLY SECRETARY 1.00 X X 0 0 0 RALPH J FRASCONE DIRECTOR 1.00 X 0 0 0 KIMBERLY ERICSON CFO - ST. CROIX HEALTH 1.00 40.00 X 0 260354 26289 0 1778128 59681 0 0 1 0 LAKES REGION EMS INC 40245 FLETCHER AVE NORTH BRANCH MN 55056 MANAGEMENT FEES, PAYROLL, MISC EXPENSES 3784754 1 53377 133965 187342 FEE INCOME 621910 4322364 4322364 4322364 48452 48452 BAD DEBT RECOVERIES 621910 8819 8819 MEDICAL RECORDS 621910 507 507 9326 4567484 4331690 0 48452 1777217 1777217 3329993 2435728 894265 17650 17650 8477 8477 134553 134553 5736 5736 26351 26351 413 413 25501 25501 107366 107366 172867 172867 21008 21008 BAD DEBT 251091 251091 MEDICAL SUPPLIES 77044 77044 MN CARE TAX 44847 44847 REPAIRS AND MAINTENANCE 25000 25000 54131 43807 10324 6079245 5148529 930716 0 678829 0 1360673 0 0 774054 0 0 0 0 0 0 0 0 606247 0 0 0 0 0 0 3419803 0 311816 0 311816 0 X 0 0 776822 0 2331165 0 3107987 0 3419803 0 X -1511761 -1596227 X 0 1 X 0 0 X 308 360190 65058 187342 612898 2555110 3037664 3252434 4178979 4322364 17346551 2555418 3037664 3612624 4244037 4509706 17959449 0 0 0 17959449 3673 2830 3893 27363 48452 86211 3673 2830 3893 27363 48452 86211 1776 626 6971 12473 9326 31172 2560867 3041120 3623488 4283873 4567484 18076832 0.99350 0.99530 0.00480 0.00280 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 ST CROIX REGIONAL MEDICAL CENTER 235 STATE STREET ST CROIX FALLS WI 54024 390890676 501(C)(3) 1010667 0 GRANT UPON DISSOLUTION REGIONS HOSPITAL 8170 33RD AVENUE SOUTH MINNEAPOLIS MN 554401309 410956618 501(C)(3) 766550 0 GRANT UPON DISSOLUTION 2 0 PART I, LINE 2: THE ORGANIZATION PAID GRANTS TO THE TWO GRANTEES IN ACCORDANCE WITH THE SIGNED DISSOLUTION DOCUMENTS. 1 1 0 0 0 0 0 0 0 DAVE DOBOSENSKI PRESIDENT 0 0 0 0 0 720781 0 0 0 0 0 720781 0 226425 MICHAEL YOUSO CFO - SCVEMS 0 543543 0 0 0 4 0 0 0 26211 0 569758 0 0 KIMBERLY ERICSON CFO - ST. CROIX HEALTH 0 245350 0 15000 0 4 0 7915 0 18374 0 286643 0 0 AARRON REINERT VICE PRESIDENT 0 194906 0 58540 0 0 0 7181 0 0 0 260627 0 0 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 TRANSFER OF ASSETS UPON DISSOLUTION 2024-12-31 1596227 CASH 237146628 LAKES REGION EMERGENCY MEDICAL SERVICES INC 40245 FLETCHER AVENUE NORTH BRANCH MN 55056 501(C)(3) CASH GRANT UPON DISSOLUTION 2024-12-31 1010667 CASH 390890676 ST CROIX REGIONAL MEDICAL CENTER 235 STATE STREET ST CROIX FALLS WI 54024 501(C)(3) CASH GRANT UPON DISSOLUTION 2024-12-31 766550 CASH 410956618 REGIONS HOSPITAL 8170 33RD AVENUE SOUTH MINNEAPOLIS MN 554401309 501(C)(3) 0 1 0 0 1 1 1 1 0 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. 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. 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 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0