GRAND ITASCA FOUNDATION: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- GRAND ITASCA FOUNDATION (EIN 41-1560554)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-10
- IRS object ID
- 202003159349303505
- Schema version
- 2019v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-10T12:54:32-06:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRVIEW HEALTH SVCS | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2450 RIVERSIDE AVE S DEPT C-207 LE | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554541450 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411560554 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GRAN | BusinessNameControlTxt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE ROAD | AddressLine1Txt |
| City | GRAND RAPIDS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55744 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEAN MACDONELL | PersonNm |
| Person Title | PRESIDENT & CEO-GICH | PersonTitleTxt |
| Signature | 2020-10-29 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparation | 2020-11-10 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 162.96.9.40 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-11-10 | IPDt |
| IP Tm | 12:54:32 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 9A7795162CD8FED1DB572D6341B886463E8B285F | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 9A7795162CD8FED1DB572D6341B886463E8B285F | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEAN MACDONELL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1680 GOLF COURSE ROAD | AddressLine1Txt |
| City | GRAND RAPIDS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55744 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $770,660 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO BUILD PHILANTHROPIC PARTNERSHIPS TO SUPPORT THE MISSION OF GRAND ITASCA CLINIC AND HOSPITAL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 98 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $402,198 | PYContributionsGrantsAmt |
| CY Contributions Grants | $750,634 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,033 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,587 | CYInvestmentIncomeAmt |
| PY Other Revenue | $13,891 | PYOtherRevenueAmt |
| CY Other Revenue | -$16,806 | CYOtherRevenueAmt |
| PY Total Revenue | $417,122 | PYTotalRevenueAmt |
| CY Total Revenue | $735,415 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,415,926 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $647,058 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $30,860 | PYOtherExpensesAmt |
| CY Other Expenses | $10,896 | CYOtherExpensesAmt |
| PY Total Expenses | $1,446,786 | PYTotalExpensesAmt |
| CY Total Expenses | $657,954 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,029,664 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $77,461 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $1,433,229 | TotalAssetsBOYAmt |
| Total Assets EOY | $1,086,497 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $557,700 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $133,507 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $875,529 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $952,990 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO BUILD PHILANTHROPIC PARTNERSHIPS TO SUPPORT THE MISSION OF GRAND ITASCA CLINIC AND HOSPITAL. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $647,058 | ExpenseAmt |
| Grant | $647,058 | GrantAmt |
| Desc | GRAND ITASCA FOUNDATION ENHANCES AND HELPS TO GUARANTEE THE DELIVERY OF CONTRIBUTIONS AND PROVIDE FINANCIAL SUPPORT TO GRAND ITASCA CLINIC AND HOSPITAL. IN 2019 GRAND ITASCA FOUNDATION AWARDED 647,058 IN GRANT FUNDING TO ORGANIZATIONS AND INDIVIDUALS. THIS INCLUDES 620,658 TO GRAND ITASCA CLINIC AND HOSPITAL FOR PATIENT FOCUSED PROJECTS, 7 INDIVIDUAL SCHOLARSHIP AWARDS TOTALING 20,000 AND CARE TO SHARE GRANTS TO 14 RECIPENTS FOR A TOTAL OF 6,400 | Desc |
| Total Program Service Expenses | $647,058 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | false | OperateHospitalInd |
| Grants To Organizations | Yes (true) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TODD CHRISTENSEN | PersonNm |
| Phone | 2189991702 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE ROAD | AddressLine1Txt |
| City | GRAND RAPIDS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55744 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|
| JAMES HEREFORD | ||||||||
| PRESIDENT/CE | 1.00 | 40.00 | Yes (X) | $0 | $3,290,078 | $266,908 | ||
| PATTY CARLIN-JANSSEN MD | ||||||||
| DIRECTOR | 1.00 | 40.00 | $0 | $277,483 | $35,568 | Yes (X) | ||
| MICHAEL YOUSO | ||||||||
| FORMER OFFIC | 1.00 | 40.00 | $0 | $188,455 | $84,895 | Yes (X) | ||
| JEAN MACDONELL | ||||||||
| PRESIDENT & | 1.00 | 40.00 | Yes (X) | $0 | $231,796 | $24,200 | ||
| KELLY KIRWIN | ||||||||
| FOUNDATION D | 1.00 | 40.00 | Yes (X) | $0 | $89,652 | $25,173 | ||
| KATIE TROUMBLY | ||||||||
| DIRECTOR, NE | 40.00 | 0.00 | $0 | $104,320 | $6,609 | Yes (X) | ||
| CHARITY BRANSTAD RN | ||||||||
| DIRECTOR | 1.00 | 40.00 | $0 | $84,964 | $3,806 | Yes (X) | ||
| DALE ADAMS | ||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| AMBER BURGGRAF | ||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| JOE CARGILL | ||||||||
| CHAIR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| SCOTT GERLING | ||||||||
| DIRECTOR, NE | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| KIRK GILBERTSON | ||||||||
| DIRECTOR, NE | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| CRICKET GUYER | ||||||||
| DIRECTOR, EN | 0.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| CORY JACKSON | ||||||||
| VICE CHAIR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| JERRY KLEVEN | ||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| MARY KOSAK | ||||||||
| DIRECTOR, EN | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| RON JOHNSON MD | ||||||||
| DIRECTOR, EN | 0.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| TARA MAKINEN | ||||||||
| SECRETARY | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| SUE MATTSON | ||||||||
| DIRECTOR | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| AMANDA OKECH | ||||||||
| BOARD CHAIR, | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| NICK ROTHSTEIN | ||||||||
| DIRECTOR, NE | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| ANDY SHERMOEN | ||||||||
| TREASURER | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| STEVE WRIGHT | ||||||||
| DIRECTOR, EN | 0.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Reportable Comp Rltd Org | $4,266,748 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $447,159 | TotalOtherCompensationAmt |
| Former Ofcr Employees Listed | Yes (true) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $104,908 | FundraisingAmt |
| Related Organizations | $250,000 | RelatedOrganizationsAmt |
| All Other Contributions | $395,726 | AllOtherContributionsAmt |
| Total Contributions | $750,634 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,587 | TotalRevenueColumnAmt |
| Exclusion | $1,587 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $18,439 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $104,908 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $35,245 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$16,806 | TotalRevenueColumnAmt |
| Exclusion | -$16,806 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $735,415 | TotalRevenueColumnAmt |
| Exclusion | -$15,219 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $620,658 | TotalAmt |
| Program Services | $620,658 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,400 | TotalAmt |
| Program Services | $26,400 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $181 | TotalAmt |
| Management And General | $181 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|
| PRINTING | $8,075 | $8,075 |
| MISCELLANEOUS | $2,640 | $2,640 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $657,954 | TotalAmt |
| Program Services | $647,058 | ProgramServicesAmt |
| Management And General | $10,896 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $555,492 | BOYAmt |
| EOY | $777,589 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $857,153 | BOYAmt |
| EOY | $296,459 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,584 | BOYAmt |
| EOY | $11,246 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,203 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,433,229 | BOYAmt |
| EOY | $1,086,497 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,222 | BOYAmt |
| EOY | $10,604 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $534,478 | BOYAmt |
| EOY | $122,903 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $557,700 | BOYAmt |
| EOY | $133,507 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $84,371 | BOYAmt |
| EOY | $38,230 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $791,158 | BOYAmt |
| EOY | $914,760 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $875,529 | BOYAmt |
| EOY | $952,990 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,433,229 | BOYAmt |
| EOY | $1,086,497 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $77,461 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA CLINIC AND HOSITAL | BusinessNameLine1Txt |
| Business Name Line2 | GRAND ITASCA CLINIC AND HOSPITAL | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411865874 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (true) | GoverningDocumentListedInd |
| Support | $620,658 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $620,658 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (true) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | false | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | false | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | false | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | false | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | false | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | false | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | false | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | false | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | false | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | false | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | false | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | false | ContributionControllerInd |
| Contribution Family | false | ContributionFamilyInd |
| Contribution35 Controlled | false | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (true) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | false | OperateBenefitNonSuprtOrgInd |
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 D IRS990ScheduleD
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INTERCOMPANY PAYABLE | Desc |
| Amt | $122,903 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $122,903 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | GRAND ITASCA FOUNDATION AS PART OF FAIRVIEW HEALTH SERVICES RECOGNIZES ALL TAX POSITIONS, INCLUDING THOSE POSITIONS IN A PREVIOUSLY FILED TAX RETURN OR A POSITION EXPECTED TO BE TAKEN IN A FUTURE TAX FILING THAT IS REFLECTED IN MEASURING CURRENT OR DEFERRED INCOME TAX ASSETS AND LIABILITIES, WHEN IT IS MORE LIKELY THAN NOT (LIKELIHOOD OF GREATER THAN 50%) THAT, BASED ON TECHNICAL MERITS, THE POSITION WILL BE SUSTAINED UPON EXAMINATION. THERE ARE NO UNCERTAIN TAX POSITIONS RECORDED IN THE CONSOLIDATED BALANCE SHEETS AS OF DECEMBER 31, 2019 OR 2018. FAIRVIEW HAS MADE REASONABLE ESTIMATES OF THE PROVISION FOR INCOME TAXES AND ON EXISTING DEFERRED TAX BALANCES BASED ON ACCOUNTING GUIDANCE INCLUDED IN ASC 740, INCOME TAXES. FAIRVIEW DOES NOT EXPECT THAT THERE WILL BE A SIGNIFICANT CHANGE IN THE TOTAL AMOUNT OF UNRECOGNIZED TAX BENEFITS WITHIN THE NEXT 12 MONTHS. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | CARING FOR KIDS | Event1Nm |
| Gross Receipts Event1 | $123,347 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $104,908 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $18,439 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $4,900 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $16,094 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $11,850 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $2,401 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $123,347 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $104,908 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $18,439 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $4,900 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $16,094 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $11,850 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $2,401 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $35,245 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$16,806 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GRAND ITASCA CLINIC & HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE ROAD | AddressLine1Txt |
| City | GRAND RAPIDS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55744 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 411865874 | RecipientEIN |
| IRC Section | 501(C) | IRCSectionDesc |
| Cash Grant | $620,658 | CashGrantAmt |
| Purpose Of Grant | PROGRAM SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| SCHOLARSHIPS | 7 | $20,000 |
| CARE TO SHARE | 13 | $6,400 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PAGE 1, PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | ALL GRANT REQUESTS ARE APPROVED OR DENIED BY THE FOUNDATION BOARD PRIOR TO APPROVAL AND/OR PAYMENT AND MUST BE IN LINE WITH THE FOUNDATION'S MISSION OF HELPING TO SUPPORT THE INTERNAL NEEDS OF GRAND ITASCA CLINIC & HOSPITAL, PROMOTING A HEALTHY COMMUNITY, AND RAISING AWARENESS OF THE IMPACT AND VALUE OF GRAND ITASCA CLINIC & HOSPITAL. SCHOLARSHIP FUNDS ARE SENT DIRECTLY TO THE SCHOOL ON BEHALF OF THE RECIPIENT. IF A STUDENT HAS ANY CHANGES (TRANSFERS, ETC.) WE RECEIVE FUNDS BACK FOR UNUSED DOLLARS, BUT THE FOUNDATION DOES NOT FOLLOW-UP WITH STUDENTS/RECIPIENTS SPECIFICALLY ABOUT THEIR SCHOLARSHIP FUNDS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt |
|---|---|---|---|---|---|---|
| JAMES HEREFORD | ||||||
| PRESIDENT/CEO-FHS | $1,503,003 | $1,648,436 | $138,639 | $223,823 | $43,085 | $3,556,986 |
| PATTY CARLIN-JANSSEN MD | ||||||
| DIRECTOR | $277,483 | $12,544 | $23,024 | $313,051 | ||
| MICHAEL YOUSO | ||||||
| FORMER OFFICER | $97,168 | $91,287 | $60,840 | $24,055 | $273,350 | |
| JEAN MACDONELL | ||||||
| PRESIDENT & CEO-GICH | $231,308 | $488 | $12,810 | $11,390 | $255,996 | |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PAGE 1, PART I, LINE 4 | FormAndLineReferenceDesc |
| Explanation | JAMES HEREFORD 0 179,826 0 MICHAEL YOUSO 0 28,358 0 | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 6 | GRAND ITASCA CLINIC & HOSPITAL, A MINNESOTA NONPROFIT CORPORATION, IS THE SOLE MEMBER OF GRAND ITASCA FOUNDATION. |
| FORM 990, PAGE 6, PART VI, LINE 7A | GRAND ITASCA CLINIC & HOSPITAL, AS THE ONLY VOTING MEMBER OF GRAND ITASCA FOUNDATION, HAS THE AUTHORITY TO ELECT AND REMOVE THE DIRECTORS OF GRAND ITASCA FOUNDATION WITH OR WITHOUT CAUSE, AT ANY TIME. |
| FORM 990, PAGE 6, PART VI, LINE 7B | VARIOUS POWERS, AS STATED IN SECTION 4.4 OF GRAND ITASCA FOUNDATION'S BYLAWS, ARE RESERVED FOR GRAND ITASCA CLINIC & HOSPITAL, THE ONE VOTING MEMBER OF GRAND ITASCA FOUNDATION. |
| FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS AND THE FOUNDATION DIRECTOR PRIOR TO FILING WITH THE IRS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICT OF INTEREST POLICIES ARE REVIEWED ANNUALLY. CONFLICT OF INTEREST FORMS ARE SIGNED ANNUALLY BY ALL BOARD MEMBERS. |
| FORM 990, PAGE 6, PART VI, LINE 19 | FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D). |
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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| GRAND ITASCA CLINIC AND HOSPITAL | ||||||||||
| 1601 GOLF COURSE ROAD | GRAND RAPIDS | MN | 55744 | 411865874 | HOSPITAL | MN | 501C3 | 3 | FAIRVIEW | Yes (true) |
| FAIRVIEW HEALTH SERVICES | ||||||||||
| 2450 RIVERSIDE AVENUE | MINNEAPOLIS | MN | 55454 | 410991680 | HOSPITAL | MN | 501C3 | 3 | NA | false |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CDI GRAND RAPIDS LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 GOLF COURSE ROAD | AddressLine1Txt |
| City | GRAND RAPIDS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55744 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 453783014 | EIN |
| Primary Activities | MRI-DTI | PrimaryActivitiesTxt |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Disproportionate Allocations | false | DisproportionateAllocationsInd |
| General Or Managing Partner | false | GeneralOrManagingPartnerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (true) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRVIEW HEALTH SERVICES | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $250,000 | InvolvedAmt |
| Method Of Amount Determination | CASH | MethodOfAmountDeterminationTxt |