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MINNESOTA VALLEY HEALTH CENTER INC: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
MINNESOTA VALLEY HEALTH CENTER INC (EIN 41-0837659)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-11-14
IRS object ID
202213189349310436
Schema version
2021v4.2
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

FieldValueIRS element (for citing)
Return2022-11-14T13:34:48-06:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1220 S 6TH STREET SUITE 300AddressLine1Txt
CityMINNEAPOLISCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55402ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN410837659EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MINNESOTA VALLEY HEALTH CENTER INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlMINNBusinessNameControlTxt
Phone5076653375PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1621 SOUTH 4TH STREETAddressLine1Txt
CityLE SUEURCityNm
State AbbreviationMNStateAbbreviationCd
ZIP56058ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAARON BLOOMQUISTPersonNm
Person TitleCFOPersonTitleTxt
Phone5076653375PhoneNum
Signature2022-11-11SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstAARONPersonFirstNm
Person LastBLOOMQUISTPersonLastNm
FieldValueIRS element (for citing)
SSNXXX-XX-XXXXSSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDARRYN MCGARVEYPreparerPersonNm
PTINP00958683PTIN
Phone6123764500PhoneNum
Preparation2022-11-11PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1RIDGEVIEW LE SUEUR MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerMICHAEL PHELPSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1621 SOUTH 4TH STREETAddressLine1Txt
CityLE SUEURCityNm
State AbbreviationMNStateAbbreviationCd
ZIP56058ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$15,775,964GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.RIDGEVIEWMEDICAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1959FormationYr
Legal Domicile StateMNLegalDomicileStateCd
Activity Or MissionPROVIDE COMMUNITY-BASED HEALTH CARE IN AN ENVIRONMENT THAT FOSTERS DIGNITY, RESPECT & EXCELLENCE.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee165TotalEmployeeCnt
Total Volunteers7TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,464,228PYContributionsGrantsAmt
CY Contributions Grants$2,059,652CYContributionsGrantsAmt
PY Program Service Revenue$12,555,037PYProgramServiceRevenueAmt
CY Program Service Revenue$13,235,751CYProgramServiceRevenueAmt
PY Investment Income$14,816PYInvestmentIncomeAmt
CY Investment Income$66,552CYInvestmentIncomeAmt
PY Other Revenue$474,737PYOtherRevenueAmt
CY Other Revenue$414,009CYOtherRevenueAmt
PY Total Revenue$14,508,818PYTotalRevenueAmt
CY Total Revenue$15,775,964CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$6,301,032PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$6,849,731CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$6,842,663PYOtherExpensesAmt
CY Other Expenses$6,351,498CYOtherExpensesAmt
PY Total Expenses$13,143,695PYTotalExpensesAmt
CY Total Expenses$13,201,229CYTotalExpensesAmt
PY Revenues Less Expenses$1,365,123PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$2,574,735CYRevenuesLessExpensesAmt
Total Assets BOY$20,560,454TotalAssetsBOYAmt
Total Assets EOY$20,327,367TotalAssetsEOYAmt
Total Liabilities BOY$12,891,415TotalLiabilitiesBOYAmt
Total Liabilities EOY$10,056,374TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,669,039NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$10,270,993NetAssetsOrFundBalancesEOYAmt
MissionOUR MISSION IS TO PROVIDE COMMUNITY-BASED HEALTHCARE IN AN ENVIRONMENT THAT FOSTERS DIGNITY, RESPECT, AND EXCELLENCE.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$8,487,838ExpenseAmt
Grant$0GrantAmt
Revenue$13,235,751RevenueAmt
DescRIDGEVIEW LE SUEUR MEDICAL CENTER IS CREATED & ORGANIZED EXCLUSIVELY FOR CHARITABLE PURPOSES. RIDGEVIEW LE SUEUR MEDICAL CENTER IS CREATED AND ORGANIZED TO OWN, MAINTAIN, OPERATE AND CONDUCT, DIRECTLY OR INDIRECTLY, AND TO ASSIST AND COORDINATE ACTIVITIES OF FACILITIES FOR HEALTH CARE, EDUCATION, CARE FOR THE AGED AND SOCIAL SERVICES. RIDGEVIEW LE SUEUR MEDICAL CENTER INCLUDES A HOSPITAL, OUTPATIENT SPECIALTY CLINICS, COMPLETE LAB AND RADIOLOGY DEPARTMENTS, A COMPREHENSIVE PHYSICAL OCCUPATIONAL AND SPEECH THERAPY DEPARTMENT, EXTENDED CARE NURSING FACILITIES, AND INDEPENDENT LIVING SENIOR HOUSING.Desc
Total Program Service Expenses$8,487,838TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document13IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee165EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonAARON BLOOMQUISTPersonNm
Phone9524422191PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 S MAPLE STREETAddressLine1Txt
CityWACONIACityNm
State AbbreviationMNStateAbbreviationCd
ZIP55387ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorInd
MICHAEL PHELPS
CEO0.5049.50Yes (X)$0$1,197,762$68,637
GORDON GABLENZ
CIO0.5049.50Yes (X)$0$801,951$87,436
AARON BLOOMQUIST
CFO0.5049.50Yes (X)$0$276,340$59,127
BENJAMIN NIELSEN
COO & BOARD DIRECTOR0.5049.50Yes (X)$0$298,901$14,170Yes (X)
PAMELA WILLIAMS
VICE PRESIDENT (THROUGH JULY 2021)0.5049.50Yes (X)$0$262,574$27,326
WAYNE HUBIN
BOARD DIRECTOR2.002.40$0$7,400$0Yes (X)
IRENE MANKE
BOARD PRESIDENT10.000.00Yes (X)$0$0$0Yes (X)
STEVE SMITH
BOARD VICE PRESIDENT2.000.00Yes (X)$0$0$0Yes (X)
ROBERT BROEDER
BOARD SECRETARY/TREASURER5.000.00Yes (X)$0$0$0Yes (X)
MARK AMUNDSON
BOARD DIRECTOR2.000.00$0$0$0Yes (X)
DAVID BRAUN
BOARD DIRECTOR2.000.00$0$0$0Yes (X)
KAY KING
BOARD DIRECTOR2.000.00$0$0$0Yes (X)
SHAWN KIRBY
BOARD DIRECTOR3.000.00$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,844,928TotReportableCompRltdOrgAmt
Total Other Compensation$256,696TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
PREMIER STAFFING INC
243 WINKLER WAYCOLOGNEMN55322ED PHYSICIAN SERVICES$665,669
AEGIS THERAPIES INC
PO BOX 8103FORT SMITHAR72902THERAPY SERVICES$538,689
EMPAC
500 S MAPLE STREETWACONIAMN55387ED PHYSICIAN SERVICES$515,206
SCHWICKERTS TECTA AMERICA LLC
330 POPLAR STEETMANKATOMN56001CONSTRUCTION$228,692
ESSENTIA HEALTH
632 EAST FIRST STREETDULUTHMN55805I.T. SUPPORT$198,707
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K9CntrctRcvdGreaterThan100KCnt
Related Organizations$47,789RelatedOrganizationsAmt
Government Grants$2,011,863GovernmentGrantsAmt
Total Contributions$2,059,652TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT/RESIDENT REVEN621110$12,872,207$12,872,207
APARTMENT PROJECT REVE623000$318,228$318,228
PHARMACY621110$45,316$45,316
FieldValueIRS element (for citing)
Total Program Service Revenue$13,235,751TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,392TotalRevenueColumnAmt
Exclusion$14,392ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$305,832RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$305,832RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$305,832TotalRevenueColumnAmt
Exclusion$305,832ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$52,160OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$52,160OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$52,160TotalRevenueColumnAmt
Exclusion$52,160ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUS INCOMEDesc
Business900099BusinessCd
Total Revenue Column$108,177TotalRevenueColumnAmt
Exclusion$108,177ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$108,177OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$15,775,964TotalRevenueColumnAmt
Related Or Exempt Func Income$13,235,751RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$480,561ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$5,714,008TotalAmt
Program Services$4,050,872ProgramServicesAmt
Management And General$1,663,136ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$162,191TotalAmt
Program Services$114,983ProgramServicesAmt
Management And General$47,208ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$557,740TotalAmt
Program Services$395,403ProgramServicesAmt
Management And General$162,337ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$415,792TotalAmt
Program Services$294,770ProgramServicesAmt
Management And General$121,022ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$6,370TotalAmt
Management And General$6,370ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$85,806TotalAmt
Management And General$85,806ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,841,854TotalAmt
Program Services$1,001,677ProgramServicesAmt
Management And General$840,177ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$21,175TotalAmt
Management And General$21,175ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$22,661TotalAmt
Program Services$11,132ProgramServicesAmt
Management And General$11,529ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$20,272TotalAmt
Program Services$8,939ProgramServicesAmt
Management And General$11,333ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$530,460TotalAmt
Program Services$296,541ProgramServicesAmt
Management And General$233,919ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$5,492TotalAmt
Program Services$3,070ProgramServicesAmt
Management And General$2,422ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$9,296TotalAmt
Program Services$5,197ProgramServicesAmt
Management And General$4,099ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$97,723TotalAmt
Management And General$97,723ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$890,248TotalAmt
Program Services$342,598ProgramServicesAmt
Management And General$547,650ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$44,692TotalAmt
Program Services$24,984ProgramServicesAmt
Management And General$19,708ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
REPAIRS AND MAINTENANCE$1,102,884$616,540$486,344
SUPPLIES$1,065,617$1,053,568$12,049
DUES AND SUBSCRIPTIONS$253,966$141,973$111,993
TAXES AND LICENSES$147,325$82,358$64,967

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$205,657TotalAmt
Program Services$43,233ProgramServicesAmt
Management And General$162,424ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$13,201,229TotalAmt
Program Services$8,487,838ProgramServicesAmt
Management And General$4,713,391ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$266,630BOYAmt
EOY$268,511EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$9,117,994BOYAmt
EOY$7,681,376EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,031,354BOYAmt
EOY$3,646,404EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$147,046BOYAmt
EOY$175,317EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$63,051BOYAmt
EOY$142,783EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$19,497,064LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$12,067,080LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$6,978,606BOYAmt
EOY$7,429,984EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$955,773BOYAmt
EOY$982,992EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$20,560,454BOYAmt
EOY$20,327,367EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,162,946BOYAmt
EOY$829,236EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$2,958,066BOYAmt
EOY$627,920EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$20,571BOYAmt
EOY$16,381EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$6,513,010BOYAmt
EOY$5,789,589EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,236,822BOYAmt
EOY$2,793,248EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$12,891,415BOYAmt
EOY$10,056,374EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$6,713,266BOYAmt
EOY$9,288,001EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$955,773BOYAmt
EOY$982,992EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,669,039BOYAmt
EOY$10,270,993EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$20,560,454BOYAmt
EOY$20,327,367EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$2,574,735ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$27,219OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$209OtherActivitiesAmt
Total Lobbying Expenditures$209TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationRIDGEVIEW LE SUEUR MEDICAL CENTER PAY DUES TO A CERTAIN ORGANIZATION RELATED TO THE INDUSTRY WHICH HAS LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$955,773BeginningYearBalanceAmt
Investment Earnings Or Losses$27,219InvestmentEarningsOrLossesAmt
End Year Balance$982,992EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$793,116BeginningYearBalanceAmt
Investment Earnings Or Losses$162,657InvestmentEarningsOrLossesAmt
End Year Balance$955,773EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$722,130BeginningYearBalanceAmt
Investment Earnings Or Losses$111,628InvestmentEarningsOrLossesAmt
Grants Or Scholarships$30,050GrantsOrScholarshipsAmt
Administrative Expenses$10,592AdministrativeExpensesAmt
End Year Balance$793,116EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$794,693BeginningYearBalanceAmt
Investment Earnings Or Losses-$32,850InvestmentEarningsOrLossesAmt
Grants Or Scholarships$29,405GrantsOrScholarshipsAmt
Administrative Expenses$10,308AdministrativeExpensesAmt
End Year Balance$722,130EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$711,289BeginningYearBalanceAmt
Contributions$5,050ContributionsAmt
Investment Earnings Or Losses$115,650InvestmentEarningsOrLossesAmt
Grants Or Scholarships$27,879GrantsOrScholarshipsAmt
Administrative Expenses$9,417AdministrativeExpensesAmt
End Year Balance$794,693EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgYes (1)EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$46,482OtherCostOrOtherBasisAmt
Book Value$46,482BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,108,189OtherCostOrOtherBasisAmt
Depreciation$4,802,729DepreciationAmt
Book Value$1,305,460BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$253,994OtherCostOrOtherBasisAmt
Depreciation$362,248DepreciationAmt
Book Value-$108,254BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,077,247OtherCostOrOtherBasisAmt
Depreciation$6,902,103DepreciationAmt
Book Value$5,175,144BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,011,152OtherCostOrOtherBasisAmt
Book Value$1,011,152BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$7,429,984TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO RIDGEVIEWDesc
Amt$2,793,248Amt
FieldValueIRS element (for citing)
Total Liability$2,793,248TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$15,688,263TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported$0RevenueNotReportedAmt
Revenue Subtotal$15,688,263RevenueSubtotalAmt
Other Revenues Not Included$87,701OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$87,701RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$15,775,964TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$13,175,709TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$13,175,709ExpensesSubtotalAmt
Other Expenses Not Included$25,520OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$25,520ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$13,201,229TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:RIDGEVIEW LE SUEUR MEDICAL CENTER, INC ACTS AS A CUSTODIAN FOR THE FUNDS OF THE RESIDENTS. RESIDENT TRUST FUNDS TOTALED $4,705 AT DECEMBER 31, 2021. DURING THAT SAME TIME RIDGEVIEW LE SUEUR MEDICAL CENTER, INC HOLDS $4,705 IN A SEPARATE ACCOUNT FOR TENANT SECURITY DEPOSITS. THE ORGANIZATION HOLDS SECURITY DEPOSITS FOR TENANTS LEASING SPACE WITHIN OUR FACILITIES. EACH SECURITY DEPOSIT WILL BE REFUNDED, LESS ANY REPAIRS FOR DAMAGES, WHEN THE LEASE IS TERMINATED.
PART V, LINE 4:RIDGEVIEW LE SUEUR MEDICAL CENTER'S INTENDED USE OF ITS ENDOWMENT FUNDS IS FOR CAPITAL AND OTHER IMPROVEMENTS THAT FURTHER RIDGEVIEW LE SUEUR MEDICAL CENTER'S MISSION.
PART X, LINE 2:THE HEALTH CENTER IS OPERATED AS A TAX-EXEMPT CORPORATION UNDER SECTION 501(C)(3) OF THE IRC AND IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAX RELATED TO BUSINESS INCOME. THE HEALTH CENTER FOLLOWS THE ACCOUNTING STANDARD FOR RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE HEALTH CENTER'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES.
PART XI, LINE 4B - OTHER ADJUSTMENTS:INVESTMENT INCOME 14,392. FOUNDATION CONTRIBUTION 47,789. BAD DEBT EXPENSE 25,520.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT EXPENSE 25,520.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent250Yes (X)Percent250Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$30,617TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$30,617NetCommunityBenefitExpnsAmt
Total Expense0.00230TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,714,985TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$970,320DirectOffsettingRevenueAmt
Net Community Benefit Expns$744,665NetCommunityBenefitExpnsAmt
Total Expense0.05650TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,745,602TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$970,320DirectOffsettingRevenueAmt
Net Community Benefit Expns$775,282NetCommunityBenefitExpnsAmt
Total Expense0.05880TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Total Community Benefit Expns$9,772TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$9,772NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Total Community Benefit Expns$9,772TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$9,772NetCommunityBenefitExpnsAmt
Total Expense0.00070TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Total Community Benefit Expns$1,755,374TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$970,320DirectOffsettingRevenueAmt
Net Community Benefit Expns$785,054NetCommunityBenefitExpnsAmt
Total Expense0.05950TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$25,520BadDebtExpenseAmt
Bad Debt Expense Attributable$6,380BadDebtExpenseAttributableAmt
Reimbursed By Medicare$4,740,111ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$4,760,799CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$20,688MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1RIDGEVIEW LE SUEUR MEDICAL CENTERBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1621 SOUTH 4TH STREETAddressLine1Txt
CityLE SUEURCityNm
State AbbreviationMNStateAbbreviationCd
ZIP56058ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.RIDGEVIEWMEDICAL.ORGWebsiteAddressTxt
State LicenseHFID-00336StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1RIDGEVIEW LE SUEUR MEDICAL CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted19CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLWWW.RIDGEVIEWMEDICAL.ORG/ABOUT-US/OtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt19ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLWWW.RIDGEVEIWMEDICAL.ORG/ABOUT-US/StrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care250.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE LINE 16JFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE LINE 16JFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE LINE 16JFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
RIDGEVIEW LE SUEUR MEDICAL CENTERPART V, SECTION B, LINE 5: RIDGEVIEW PARTNERED WITH CARVER COUNTY PUBLIC HEALTH TO COMPLETE THE PRIMARY DATA COLLECTION FOR THE 2019 CHNA. THIS INCLUDED PRIMARY RESEARCH, DATA ANALYSIS, VALIDATION AND PRIORITIZATION, AND ANALYSIS OF DOCUMENTED HEALTH AND SOCIOECONOMIC FACTORS WITH COMMUNITY INPUT.THE COMMUNITY INPUT INCLUDED SURVEYS FROM RESIDENTS OF CARVER COUNTY PLUS ACROSS THE SIX OTHER COUNTIES IN RIDGEVIEW'S SERVICE AREA. THIS PRIMARY DATA WAS SUPPLEMENTED WITH SECONDARY DATA* COLLECTED FROM THE FOLLOWING SOURCES (BUT NOT LIMITED TO): RIDGEVIEW'S ELECTRONIC MEDICAL RECORD AND FINANCIAL SYSTEMS, US CENSUS BUREAU, COUNTY HEALTH RANKINGS, MINNESOTA HOSPITAL ASSOCIATION.
RIDGEVIEW LE SUEUR MEDICAL CENTERPART V, SECTION B, LINE 6A: THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH RIDGEVIEW MEDICAL CENTER AND RIDGEVIEW SIBLEY MEDICAL CENTER.
RIDGEVIEW LE SUEUR MEDICAL CENTERPART V, SECTION B, LINE 6B: CARVER COUNTY PUBLIC HEALTH
RIDGEVIEW LE SUEUR MEDICAL CENTERPART V, SECTION B, LINE 11: RIDGEVIEW WILL CONTINUE TO IMPLEMENT SYSTEM-WIDE INITIATIVES THAT SUPPORT AND IMPACT THE HEALTH OF ITS GROWING SERVICE AREA AS WELL AS TARGETED RESOURCES TO ADDRESS SPECIFIC NEEDS OF ITS DIVERSE POPULATIONS. COMMUNITY HEALTH NEEDS THAT THE HOSPITAL DOES NOT PLAN TO ADDRESS ARE:-PREVENTION, CLINICAL CARE AND DISEASE MANAGEMENT: PREVENTIVE SCREENINGS, ACCESS TO CARE, SPECIFICALLY IN RURAL AREAS.
RIDGEVIEW LE SUEUR MEDICAL CENTERPART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY, PLAIN LANGUAGE SUMMARY, AND APPLICATION ARE AVAILABLE AT WWW.RIDGEVIEWMEDICAL.ORG/PATIENTS-VISITORS/FINANCIAL/.
FieldValueIRS element (for citing)
Facility2FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - RIDGEVIEW LE SUEUR LONG-TERM CARE
621 SOUTH 4TH STREETLE SUEURMN56058SKILLED NURSING FACILITY
2 - SUNRIZE PLAZA
600 SOUTH 5TH STREETLE SUEURMN56058SENIOR APARTMENTS

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C:TO QUALIFY FOR FINANCIAL ASSISTANCE, THE FOLLOWING CONDITIONS MUST BE MET:(A) THE MEDICAL CARE PROVIDED BY RIDGEVIEW LE SUEUR MEDICAL CENTER IS MEDICALLY NECESSARY;(B) THE INDIVIDUAL SUBMITS A COMPLETED APPLICATION;(C) THE INDIVIDUAL COOPERATES WITH THE HOSPITAL TO EXPLORE ALTERNATIVE MEANS OF ASSISTANCE, IF NECESSARY (INCLUDING SSI, DISABILITY, MEDICARE AND MEDICAID); AND(D) THE INDIVIDUAL'S FAMILY INCOME IS LESS THAN 250% OF FEDERAL POVERTY GUIDELINES ("FPG"). FREE CARE IS OFFERED FOR FEDERAL ADJUSTED GROSS INCOME UP TO 200% OF FPG. 75% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME BETWEEN 200% AND 225% FPG. 56% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME BETWEEN 225% AND 250% OF FPG.IN ADDITION, PATIENTS SEEKING FINANCIAL ASSISTANCE MAY BE ASKED FIRST TO APLY FOR OTHER EXTERNAL PROGRAMS (SUCH AS MEDICAID OR INSURANCE THROUGH THE PUBLIC MARKETPLACE).RIDGEVIEW MAY RELY ON EXTERNAL SOURCES TO DETERMINE ELIGIBILITY WHEN:(A) THE PATIENT IS HOMELESS;(B) THE PATIENT IS ELIGIBLE FOR OTHER UNFUNDED STATE OR LOCAL ASSISTANCE PROGRAMS;(C) THE PATIENT IS ELIGIBLE FOR FOOD STAMPS OR SUBSIDIZED SCHOOL LUNCH;(D) THE PATIENT IS ELIGIBLE FOR STATE-FUNDED PRESCRIPTION MEDICATION;(E) THE PATIENTS VALID ADDRESS IS CONSIDERED LOW-INCOME OR SUBSIDIZED HOUSING; OR(F) THE PATIENT RECEIVEDS FREE CARE FROM A COMMUNITY CLINIC AND IS REFERRED TO THE HOSPITAL FOR FURTHER TREATMENT.RIDGEVIEW LE SUEUR MEDICAL CENTER ALSO USES CHANGE HEALTHCARE, AN ELIGIBILITY VENDOR, TO HELP IDENTIFY PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE.
PART I, LINE 7:THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS, RATIO OF PATIENT CARE COST-TO-CHARGES WAS USED TO CALCULATE THE COSTS FOR THE FOLLOWING COMMUNITY BENEFITS: CHARITY CARE, UNREIMBURSED MEDICAID AND COSTS FROM OTHER MEANS-TESTED GOVERNMENT PROGRAMS. ACTUAL COSTS WERE USED FOR THE REMAINDER OF THE COMMUNITY BENEFITS REPORTED.
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 $ 25,520.
PART III, LINE 2:THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN PART III, LINE 2 IS CALCULATED BY RIDGEVIEW AS FOLLOWS: PAYMENT FOR SERVICES IS REQUIRED WITHIN 30 DAYS OF RECEIPT OF THE INVOICE OR CLAIM SUBMITTED. PATIENT ACCOUNTS THAT ARE MORE THAN 90 DAYS PAST DUE ARE INDIVIDUALLY ANALYZED FOR COLLECTIBILITY. IN ADDITION, AN ALLOWANCE IS ESTIMATED FOR OTHER ACCOUNTS BASED ON HISTORICAL EXPERIENCE OF THE ORGANIZATION. WHEN ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED, THE ACCOUNT IS WRITTEN OFF AGAINST THE RELATED ALLOWANCE.
PART III, LINE 3:MINNESOTA VALLEY HEALTH CENTER, INC. (DBA: RIDGEVIEW LE SUEUR MEDICAL CENTER) ESTIMATES THAT APPROXIMATELY 25% OF ITS TOTAL COST OF CHARITY CARE IS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE BUT DID NOT COMPLETE AN APPLICATION AND WERE ULTIMATELY INCLUDED IN BAD DEBT EXPENSE REPORTED IN PART III, LINE 2.
PART III, LINE 4:SEE NOTE 2, "PATIENT AND RESIDENT SERVICE REVENUE", ON PAGES 12-16 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR AN EXPLANATION OF MINNESOTA VALLEY HEALTH CENTER'S BAD DEBT EXPENSE.
PART III, LINE 8:MINNESOTA VALLEY HEALTH CENTER, INC. INCORPORATED THE FULL VALUE OF THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. THE RATIONALE FOR THE ORGANIZATION'S OPINION IS PROVIDING CARE FOR THE ELDERLY AND SERVING MEDICARE PATIENTS IS AN ESSENTIAL PART OF THE COMMUNITY BENEFIT STANDARD. MEDICARE, LIKE MEDICAID, DOES NOT PAY THE FULL COST OF CARE AND IT IS LIKELY TO GET WORSE. MANY MEDICARE BENEFICIARIES ARE POOR AND ARE ELIGIBLE FOR MEDICAID IN ADDITION TO MEDICARE. MEDICARE UNDERPAYMENT MUST BE SHOULDERED BY THE HOSPITAL AND NURSING HOME IN ORDER TO CONTINUE TREATING THE COMMUNITY'S ELDERLY AND POOR. THESE UNDERPAYMENTS REPRESENT A REAL COST OF SERVING THE COMMUNITY.
PART III, LINE 9B:RIDGEVIEW'S CHARITY PROGRAM ALLOWS FOR ACCOUNTS IN BAD DEBT STATUS TO COMPLETE A CHARITY CARE APPLICATION. IF APPROVED, THE ACCOUNT WILL BE RETURNED FROM BAD DEBT AND APPLIED TO OUR CHARITY CARE PROGRAM. ALL PATIENTS ARE ADVISED OF OUR CHARITY CARE PROGRAM THROUGH OUR MONTHLY BILLING PROCESS. RIDGEVIEW MEDICAL CENTER DOES NOT CHARGE INTEREST ON OUTSTANDING PATIENT ACCOUNT BALANCES.
PART VI, LINE 2:RIDGEVIEW LE SUEUR MEDICAL CENTER IS A LICENSED 15 BED CRITICAL ACCESS HOSPITAL IN LE SUEUR, MN AND IS THE ONLY HOSPITAL IN LE SUEUR COUNTY. RIDGEVIEW LE SUEUR MEDICAL CENTER ALSO HAS TWO CLINICS. RIDGEVIEW LE SUEUR MEDICAL CENTER WORKS WITH THE ONLY LOCAL PRIMARY CARE PHYSICIAN CLINIC IN LE SUEUR, SIBLEY COUNTY PUBLIC HEALTH, NICOLLET COUNTY PUBLIC HEALTH AND LE SUEUR COUNTY PUBLIC HEALTH AGENCIES FOR ASSESSING THE NEEDS OF THE RURAL COMMUNITIES IN OUR AREA. THESE NEEDS ARE DETERMINED BY SEVERAL DIFFERENT MENTHODS, BUT MOSTLY BASED ON WHAT THESE AGENCIES ARE ACTUALLY SEEING WHEN THEY ARE WORKING WITH THEIR CLIENTS. THIS COMMUNICATION IS ONGOING THROUGHOUT THE YEAR. RIDGEVIEW LE SUEUR MEDICAL CENTER IS A MEMBER OF A LOCAL NON-PROFIT GROUP CALLED COMMUNITY WELLNESS COLLABORATION. THE MISSION OF THIS GROUP IS TO ADDRESS DEPRESSION, BULLYING AND SUICIDE PREVENTION IN OUR COMMUNITY. OTHER MEMBERS OF THIS COLLABORATION ARE LE SUEUR COUNTY PUBLIC HEALTH AND SOCIAL SERVICES, A LOCAL FAMILY PRACTICE CLINIC, LAW ENFORCEMENT AGENCIES AND A LOCAL SCHOOL. THE COLLABORATION WAS FORMED IN THE LAST THREE YEARS AND IS BASED ON WHAT THESE AGENCIES WERE SEEING EITHER IN THE EMERGENCY ROOM, CLINIC VISITS, AMBULANCE CALLS, INCIDENTS AT SCHOOL AND CALLS TO LAW ENFORCEMENT. THE COLLABORATION WAS DEEMED NECESSARY AS THE NUMBER OF THESE EVENTS HAVE BEEN INCREASING.
PART VI, LINE 3:RIDGEVIEW LE SUEUR MEDICAL CENTER MAKES INFORMATION ON ITS FINANCIAL ASSISTANCE POLICY (FAP) READILY AVAILABLE TO THE PATIENT. INFORMATION ABOUT FINANCIAL ASSISTANCE PROGRAM IS AVAILABLE ON THE WEB SITE WWW.RIDGEVIEWLESUEUR.ORG WHERE THE INFORMATION AND APPLICATION WERE EASILY ACCESSIBLE TO BE VIEWED, DOWNLOADED AND PRINTED AT NO CHARGE TO THE PATIENT. NOTICES ON THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE CONSPICUOUSLY POSTED IN EMERGENCY ROOM DEPARTMENTS AND IN WAITING ROOMS. FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE DURING THE PRE-ADMISSION FINANCIAL SCREENING, AT THE TIME OF REGISTRATION AND PRIOR TO A HOSPITAL DISCHARGE. INFORMATION ABOUT THE FAP IS IN ALL COLLECTION LETTERS AND PATIENT STATEMENTS. RIDGEVIEW LE SUEUR MEDICAL CENTER EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS PROVIDING DIRECT PATIENT TREATMENT AND WHO WORK IN ADMISSIONS, BILLING AND COLLECTIONS, ABOUT THE EXISTENCE OF THE FAP AND HOW A PATIENT MAY OBTAIN MORE INFORMATION. ANNUAL EDUCATION/AWARENESS OF THE FAP IS PROVIDED TO ENSURE ALL EMPLOYEES WITH PATIENT CONTACT ARE AWARE OF THE PROGRAM AND HOW PATIENTS CAN OBTAIN ADDITIONAL INFORMATION. CLINICAL AND HOSPITAL STAFF WHO PROVIDE DIRECT PATIENT CARE HAVE KNOWLEDGE OF THE FAP AND KNOW TO DIRECT PATIENTS TO A REGISTRATION INTERVIEWER OR BUSINESS OFFICE REPRESENTATIVE. REGISTRATION STAFF HAVE AN UNDERSTANDING OF THE POLICY, KNOWLEDGE OF WHERE THE RELATED DOCUMENTS ARE LOCATED AND WHERE TO DIRECT THE PATIENT FOR MORE INFORMATION ON THE FAP. DESIGNATED EMPLOYEES HAVE A THOROUGH UNDERSTANDING OF THE FAP AND OFFER THE INFORMATION ON THE FAP TO THOSE PATIENTS WHO MAKE AN INQUIRY ABOUT THE PROGRAM OR ARE DETERMINED THROUGH A FINANCIAL SCREENING THAT THE PATIENT MAY BE ELIGIBLE FOR THIS PROGRAM. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT, A PATIENT'S GUARANTOR, A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. RIDGEVIEW LE SUEUR MEDICAL CENTER RESPONDS TO ANY ORAL OR WRITTEN REQUESTS FOR MORE GENERAL INFORMATION ON THE FAP MADE BY A PATIENT OR ANY INTERESTED PARTY.
PART VI, LINE 4:MINNESOTA VALLEY HEALTH CENTER, INC. (DBA: RIDGEVIEW LE SUEUR) IS LOCATED IN LE SUEUR, MN. MINNESOTA VALLEY HEALTH CENTER, INC. OPERATES A CRITICAL ACCESS HOSPITAL, A LONG-TERM CARE FACILITY, AND A 37 UNIT HUD-SUBSIDIZED LOW INCOME HOUSING FOR SENIORS THAT SERVE THE COMMUNITIES OF LE SUEUR, NICOLLET AND SIBLEY COUNTIES. THE OVERALL COMMUNITY IS CLASSIFIED AS RURAL. MINNESOTA VALLEY HEALTH CENTER, INC. AND ITS RELATED FACILITIES COVER A SERVICE REGION OF APPROXIMATELY 29,000 PEOPLE. THE SERVICE REGION AGE DISTRIBUTION IS 29% UNDER THE AGE OF 18, 52% BETWEEN THE AGES OF 18 AND 65, AND 19% OVER THE AGE OF 65. THE RACIAL MAKEUP OF THE SERVICE REGION IS 90% WHITE, NON-HISPANIC, 7% HISPANIC OR LATINO, 1% BLACK OR AFRICAN AMERICAN, 1% AMERICAN INDIAN AND 1% ASIAN. THE GENDER SPLIT RATIO IS 49% WOMEN AND 51% MEN. THE AVERAGE INCOME FOR THE SERVICE AREA IS APPROXIMATELY $75,925. APPROXIMATELY 6.7% OF THE POPULATION FALLS BELOW THE FEDREAL POVERTY GUIDELINES. MINNESOTA VALLEY HEALTH CENTER, INC. IS COMMITTED TO SERVE PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. MINNESOTA VALLEY HEALTH CENTER HAS AN OUTREACH PROGRAM THAT BRINGS SPECIALISTS LIKE CARDIOLOGISTS, GASTROENTEROLOGY, ORTHOPAEDICS AND OTHERS INTO ITS SMALLER COMMUNITY. THIS ELIMINATES BARRIERS TO CARE FOR MANY PATIENTS, PARTICULARLY THOSE WHO ARE EDERLY, LIVING ON LOW INCOMES, OR ARE FACED WITH OTHER CHALLENGES THAT MAKE IT DIFFICULT TO TRAVEL LONG DISTANCES FOR CARE. RIDGEVIEW LE SUEUR IS PART OF THE RIDGEVIEW HEALTH SYSTEM WHICH SERVES APPROXIMATELY 350,000 PEOPLE IN THE COUNTIES OF CARVER, SIBLEY, MCLEOD, LE SUEUR, SCOTT AND WRIGHT COUNTIES IN MN.
PART VI, LINE 5:MINNESOTA VALLEY HEALTH CENTER, INC'S DBA RIDGEVIEW LE SUEUR, BOARD OF DIRECTORS IS A BOARD CONSISTING OF LOCAL COMMUNITY MEMBERS WITH A CROSS SECTION OF OCCUPATIONS. ONE OF THE REPRESENTATIVES IS APPOINTED BY THE LE SUEUR CITY COUNCIL AND ANOTHER BOARD MEMBER IS FROM RIDGEVIEW'S CORPORATE BOARD. NONE OF THE BOARD MEMBERS ARE EMPLOYEES, RELATED TO EMPLOYEES OR ARE INDEPENDENT CONTRACTORS OF THE ORGANIZATION. GIVEN THAT WE ARE A SMALL COMMUNITY IF A VOTE COMES UP FOR SOMETHING THAT COULD APPEAR TO BE A CONFLICT OF INTEREST THE BOARD MEMBER WILL ABSTAIN FROM VOTING. ANY SURPLUS CASH IS USED TO UPDATE MEDICAL EQUIPMENT FOR BOTH THE HOSPITAL AND NURSING HOME. ANY AND ALL EMERGENCY REPAIRS OR EQUIPMENT NEEDS THAT ARISE ARE TAKEN CARE OF IMMEDIATLEY. RIDGEVIEW LE SUEUR OFFERS A MEALS ON WHEELS PROGRAM FOR HOME BOUND RESIDENTS AND MOST OF THOSE MEALS ARE PAID FOR THROUGH AN ELDERLY WAIVER PGORAM THROUGH THE COUNTY, WHICH JUST COVERS THE COST OF THE FOOD. VOLUNTEERS DELIVER MEALS TO HOME BOUND CLIENTS MONDAYS - FRIDAYS, THIS PAST YEAR 2,594_ MEALS WERE PREPARED AND DELIVERED. WITH THE IMPLEMENTATION OF COVID SAFETY PRECAUTIONS, WE WERE ABLE TO CONTINUE TAKING NURSING HOME RESIDENTS. THE OUTPATIENT CLINIC WING PROVIDES SPACE FOR VISITING SPECIALISTS (CARDIOLOGY, ORTHOPEDICS, UROLOGY, GENERAL SURGERY) FROM OTHER HEALTH CARE SYSTEMS TO SEE PATIENTS LOCALLY AND TO PERFORM OUTPATIENT PROCEDURES LOCALLY. MOST OF OUR POPULATION IS ELDERLY AND ARE UNABLE TO DRIVE GREAT DISTANCES SO THEY ARE ABLE TO RECEIVE CARE FROM SPECIALISTS LOCALLY. WE STRIVE TO PROVIDE HIGH-QUALITY, PATIENT-CENTERED CARE CLOSE TO HOME FOR THE COMMUNITIES WE SERVE. WE CONTINUE TO UPGRADE FACILITIES AND TECHNOLOGY TO ENSURE PATIENTS IN RURAL COMMUNITIES HAVE NEARBY ACCESS TO THESE SERVICES. WE ALSO WERE ABLE TO IMPLEMENT TELE VISITS FOR OUR PATIENTS WITH THE SPECIALISTS DURING 2020.
PART VI, LINE 6:MINNESOTA VALLEY HEALTH CENTER IS A SUBSIDIARY OF RIDGEVIEW MEDICAL CENTER. RIDGEVIEW MEDICAL CENTER IS A 109-BED ACUTE CARE HOSPITAL IN WACONIA, MINNESOTA THAT PROVIDES HEALTHCARE SERVICES TO THE RESIDENTS OF THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MN. RIDGEVIEW MEDICAL CENTER'S SUBSIDIARIES INCLUDE:RIDGEVIEW CLINICS, WHICH PROVIDES OUTPATIENT HEALTHCARE SERVICES FROM VARIOUS CLINIC LOCATIONS THROUGHOUT THE WEST SUBURBAN METROPOLITAN AREA OF MINNEAPOLIS AND ST. PAUL AND ADJACENT RURAL AREAS OF MINNESOTA.SIBLEY MEDICAL CENTER OPERATES AN AMBULATORY SURGICAL CENTER. CHASKA PLAZA SURGERY CENTER IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER OWNS A 51% INTEREST.MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER PROVIDES CARDIOLOGY SERVICES. THE HEART INSTITUTE IS A PARTNERSHIP IN WHICH RIDGEVIEW MEDICAL CENTER HOLDS A 50% INTEREST.WACONIA BUILDING INVESTMENTS OWNS A MEDICAL OFFICE BUILDING ON RIDGEVIEW MEDICAL CENTER'S CAMPUS.RIDGEVIEW REAL ESTATE LLC HOLDS THE LAND LEASE FOR WACONIA BUILDING INVESTMENTS.RIDGEVIEW COMMUNITY NETWORK OPERATES A AN ACCOUNTABLE CARE ORGANIZATION.RIDGEVIEW INSURANCE COMPANY OPERATES A CAPTIVE INSURANCE COMPANY FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER.RIDGEVIEW FOUNDATION OPERATE FOR THE EXCLUSIVE BENEFIT OF RIDGEVIEW MEDICAL CENTER.
PART VI, LINE 7, REPORTS FILED WITH STATESMN

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (1)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsYes (1)CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
MICHAEL PHELPS
CEO$0$530,661$0$0$0$667,101$0$28,337$0$40,300$0$1,266,399$0$0
GORDON GABLENZ
CIO$0$313,342$0$0$0$488,609$0$25,560$0$61,876$0$889,387$0$0
AARON BLOOMQUIST
CFO$0$275,606$0$0$0$734$0$13,627$0$45,500$0$335,467$0$0
BENJAMIN NIELSEN
COO & BOARD DIRECTOR$0$274,784$0$0$0$24,117$0$13,416$0$754$0$313,071$0$0
PAMELA WILLIAMS
VICE PRESIDENT (THROUGH JULY 2021)$0$247,423$0$0$0$15,151$0$9,772$0$17,554$0$289,900$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3THE CEO IS COMPENSATED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. THE FOLLOWING WERE USED BY RIDGEVIEW MEDICIAL CENTER TO DETERMINE THE CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) WRITTEN EMPLOYEMENT CONTRACT 5) COMPENSATION SURVEY OR STUDY 6) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE)
PART I, LINE 4BMICHAEL PHELPS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2021, $621,440 WAS CONTRIBUTED TO THE PLAN, $42,739 WAS ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. GORDON GABLENZ PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. DURING 2021, $434,954 WAS CONTRIBUTED TO THE PLAN, $50,027 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. THESE DEFERRED COMPENSATION AMOUNTS ARE REPORTED ON A PRO-RATA BASIS WITHOUT REGARD TO THE INDIVIDUAL'S VESTING SCHEDULE. CURRENTLY, THE MAJORITY OF DEFERRED COMPENSATION IS NOT VESTED.
PART I, LINE 6THE OFFICERS OF RIDGEVIEW MEDICAL CENTER AND AFFILIATES RECEIVE BONUSES CONTINGENT ON THE NET EARNINGS OF THE CONSOLIDATED ENTITY AND GOALS ACHIEVED. BONUSES WERE EARNED IN 2021 AND PAID IN 2022.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF THE FILING ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7ATHE FILING ORGANIZATION'S BOARD SHALL CONSIST TWO PERSONS APPOINTED BY THE SOLE MEMBER. OTHER MEMBERS OF THE FILING ORGANIZATION'S BOARD ARE SELECTED BY A NOMINATING COMMITTEE AND MUST BE APPROVED BY THE SOLE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7BTHE ARTICLES AND BYLAWS PROVIDE THE SOLE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, DEBT, AMENDMENT OF THE ARTICLES & BYLAWS AND GENERAL OPERATION DECISIONS.
FORM 990, PART VI, SECTION A, LINE 8BFILING ORGANIZATION HAS NO EXECUTIVE COMMITTEE OR SIMILAR COMMITTEE WITH BOARD DELEGATED AUTHORITY.
FORM 990, PART VI, SECTION B, LINE 11BMANAGEMENT REVIEWED THE FORM 990 AND PROVIDED COPIES TO THE BOARD OF DIRECTORS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CTHE BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE STATEMENTS FOR POTENTIAL CONFLICTES OF INTEREST POLICY. EACH MEMBER IS EXPECTED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR. IF IT IS DETERMINED THAT CONFLICT OF INTEREST EXISTS, THE SITUATION WILL BE EXAMINED AND HANDLED APPROPRIATELY BY THE BOARD.
FORM 990, PART VI, SECTION B, LINE 15THE CEO & CFO ARE PAID BY RIDGEVIEW MEDICAL CENTER, THE SOLE CORPORATE MEMBER, WHICH PERFORMS THE REVIEW AND APPROVAL OF THE COMPENSATION FOR THE CEO AND CFO.
FORM 990, PART VI, SECTION C, LINE 19GOVERNING DOCUMENTS, CONFILICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11GCONSULTING & OTHER PROFESSIONAL FEE: PROGRAM SERVICE EXPENSES 1,001,677. MANAGEMENT AND GENERAL EXPENSES 790,150. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,791,827. ER MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 50,027. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,027.
FORM 990, PART XI, LINE 9:CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 27,219.
FORM 990, PART XII, LINE 2CTHE PROCESS REGARDING OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
MINNESOTA VALLEY MEMORIAL HOSPITAL FOUNDATION
621 SOUTH FOURTH STREETLE SUEURMN56058411754182RAISING FUNDS FOR RIDGEVIEW LE SUEUR MEDICAL CENTER.MN501(C)(3)LINE 12A, IN/A0
RIDGEVIEW MEDICAL CENTER
500 S MAPLE STWACONIAMN55387311667875HEALTH CARE SERVICESMN501(C)(3)LINE 3N/A0
RIDGEVIEW FOUNDATION
500 S MAPLE STWACONIAMN55387411328097RAISING FUNDS FOR RIDGEVIEW MEDICAL CENTERMN501(C)(3)LINE 70RIDGEVIEW MEDICAL CENTER
RIDGEVIEW CLINICS
500 S MAPLE STWACONIAMN55387411651783HEALTH CARE SERVICESMN501(C)(3)LINE 30RIDGEVIEW MEDICAL CENTER
RIDGEVIEW INSURANCE CO
60 E SOUTH TEMPLE STE 1800SALT LAKE CITYUT84111454109041CAPTIVE INSURANCE COMPANYUT501(C)(3)LINE 12A, I0RIDGEVIEW MEDICAL CENTER
SIBLEY MEDICAL CENTER
601 W CHANDLER STARLINGTONMN55307411801967CRITICAL ACCESS HOSPITALMN501(C)(3)LINE 30RIDGEVIEW MEDICAL CENTER

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdDisproportionate AllocationsDisproportionateAllocationsIndGeneral Or Managing PartnerGeneralOrManagingPartnerInd
MINNEAPOLIS HEART INSTITITUE AT RIDGEVIEW HEART CENTER LLC
500 S MAPLE STWACONIAMN55387205785920CARDIOLOGYMNN/A00
CHASKA PLAZA SURGERY CENTER
3000 HUNDERTMARK ROADCHASKAMN55318450975783SURGERY SERVICESMNN/A00

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
EXECUTIVE HEALTH MANAGEMENT SERVICES
500 SOUTH MAPLE STWACONIAMN55387411760239MANAGEMENT SERVICESMNN/AC0
CHARITABLE REMAINDER UNITRUST (1)
CHARITABLE TRUSTMNN/A0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd