GRAND ITASCA FOUNDATION: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- GRAND ITASCA FOUNDATION (EIN 41-1560554)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-01
- IRS object ID
- 201843059349300929
- Schema version
- 2017v2.3
- 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 | 2018-11-01T10:07:23-05:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410991680 | PreparerFirmEIN |
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 | 2017-01-01 | 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 | AMANDA OKECH | PersonNm |
| Person Title | BOARD CHAIR | PersonTitleTxt |
| Signature | 2018-10-31 | SignatureDt |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparation | 2018-11-01 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 162.96.9.2 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-11-01 | IPDt |
| IP Tm | 10:07:23 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 5F2368D6BDA3FF5FC3D597F604724298C59CD620 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 5CADB5576C0A467FBF6013688B7D33E9E8CCDAB4 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2018-06-14 16:35:46Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL YOUSO | PrincipalOfficerNm |
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) |
|---|---|---|
| Gross Receipts | $1,484,533 | 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 | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 100 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $680,623 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,422,868 | CYContributionsGrantsAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $5,665 | PYInvestmentIncomeAmt |
| CY Investment Income | $5,655 | CYInvestmentIncomeAmt |
| PY Other Revenue | $12,431 | PYOtherRevenueAmt |
| CY Other Revenue | $5,098 | CYOtherRevenueAmt |
| PY Total Revenue | $698,719 | PYTotalRevenueAmt |
| CY Total Revenue | $1,433,621 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $174,387 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $74,339 | 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 | $48,379 | PYOtherExpensesAmt |
| CY Other Expenses | $79,467 | CYOtherExpensesAmt |
| PY Total Expenses | $222,766 | PYTotalExpensesAmt |
| CY Total Expenses | $153,806 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $475,953 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $1,279,815 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $943,038 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,330,351 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $22,164 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $140,370 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $920,874 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,189,981 | 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 | $74,339 | ExpenseAmt |
| Grant | $74,339 | 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 2017 GRAND ITASCA FOUNDATION AWARDED 48,489 IN GRANT FUNDING TO ORGANIZATIONS AND INDIVIDUALS. THIS INCLUDES 43,439 TO GRAND ITASCA CLINIC AND HOSPITAL FOR PATIENT FOCUSED PROJECTS, 9 INDIVIDUAL SCHOLARSHIP AWARDS TOTALING 18,100 , AND CARE TO SHARE GRANTS TO 17 RECIPENTS FOR A TOTAL OF 7,750. | Desc |
| Total Program Service Expenses | $74,339 | 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 |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| 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 With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | 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 | Yes (true) | 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 (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| PATTY CARLIN-JANSSEN MD | |||||||
| DIRECTOR | 1.00 | 40.00 | Yes (X) | $0 | $309,150 | $29,767 | |
| CHARITY BRANSTAD RN | |||||||
| DIRECTOR | 1.00 | 40.00 | Yes (X) | $0 | $81,682 | $4,885 | |
| DALE ADAMS | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CRICKET GUYER | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| SUE MATTSON | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CORY JACKSON | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| AMANDA OKECH | |||||||
| BOARD CHAIR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| AMBER BURGGRAF | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RON JOHNSON | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ANDY SHERMOEN | |||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JOE CARGILL | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MARY KOSAK | |||||||
| VICE CHAIR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| STEVE WRIGHT | |||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| TARA MAKINEN | |||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JAMES HEREFORD | |||||||
| PRESIDENT/CE | 1.00 | 40.00 | $0 | $1,347,774 | $23,564 | Yes (X) | |
| MICHAEL YOUSO | |||||||
| PRESIDENT&CE | 1.00 | 40.00 | $0 | $386,475 | $43,264 | Yes (X) | |
| KELLY KIRWIN | |||||||
| FOUNDATION D | 40.00 | 0.00 | $0 | $71,025 | $4,941 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Reportable Comp Rltd Org | $2,196,106 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $106,421 | TotalOtherCompensationAmt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
| Fundraising | $59,361 | FundraisingAmt |
| Related Organizations | $250,000 | RelatedOrganizationsAmt |
| All Other Contributions | $1,113,507 | AllOtherContributionsAmt |
| Total Contributions | $1,422,868 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,655 | TotalRevenueColumnAmt |
| Exclusion | $5,655 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $56,010 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $59,361 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $50,912 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,098 | TotalRevenueColumnAmt |
| Exclusion | $5,098 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,433,621 | TotalRevenueColumnAmt |
| Exclusion | $10,753 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,489 | TotalAmt |
| Program Services | $48,489 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,850 | TotalAmt |
| Program Services | $25,850 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,657 | TotalAmt |
| Management And General | $37,657 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59 | TotalAmt |
| Management And General | $59 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,018 | TotalAmt |
| Management And General | $11,018 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|
| MISCELLANEOUS | $29,131 | $29,131 |
| DONOR WALL | $1,602 | $1,602 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,806 | TotalAmt |
| Program Services | $74,339 | ProgramServicesAmt |
| Management And General | $79,467 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $156,983 | BOYAmt |
| EOY | $483,582 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $777,370 | BOYAmt |
| EOY | $1,541,397 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $305,372 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,685 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $943,038 | BOYAmt |
| EOY | $2,330,351 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,164 | BOYAmt |
| EOY | $24,997 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $115,373 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,164 | BOYAmt |
| EOY | $140,370 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $152,123 | BOYAmt |
| EOY | $424,401 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $746,779 | BOYAmt |
| EOY | $1,743,608 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,972 | BOYAmt |
| EOY | $21,972 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $920,874 | BOYAmt |
| EOY | $2,189,981 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $943,038 | BOYAmt |
| EOY | $2,330,351 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $1,279,815 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$10,708 | OtherChangesInNetAssetsAmt |
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411865874 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (true) | GoverningDocumentListedInd |
| Support | $43,439 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $43,439 | 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
Schedule D IRS990ScheduleD
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INTERCOMPANY PAYABLE | Desc |
| Amt | $115,373 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $115,373 | 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 | THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABALE MINNESOTA STATUTES. CONSEQUENTLY, NO PROVISION HAS BEEN MADE FOR INCOME TAXES. THE ORGANIZATION'S ANNUAL TAX FILINGS ARE SUBJECT TO REVIEW BY FEDERAL, STATE AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEPORDIZE ITS TAX-EXEMPT STATUS. THE ORGANIZATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR OTHER EXCISE TAXES. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | CARING FOR KIDS | Event1Nm |
| Gross Receipts Event1 | $80,229 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $49,211 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $31,018 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $9,758 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $9,790 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $2,318 | OtherDirectExpensesEvent1Amt |
| Event2 | GIFO GOLF TOURN | Event2Nm |
| Gross Receipts Event2 | $35,142 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $10,150 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $24,992 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $23,076 | CashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $3,470 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $2,500 | FoodAndBeverageEvent2Amt |
| Gross Receipts Total | $115,371 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $59,361 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $56,010 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $23,076 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $13,228 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $12,290 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $2,318 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $50,912 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $5,098 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt | Address Line2USAddress/AddressLine2Txt |
|---|---|---|---|---|---|---|---|---|
| GRAND ITASCA CLINIC & HOSPITAL | ||||||||
| 1601 GOLF COURSE ROAD | GRAND RAPIDS | MN | 55744 | 411865874 | 501(C) | $43,439 | PROGRAM SUPPORT | |
| GRAND RAPIDS AREA COMMUNITY FOUNDAT | ||||||||
| 350 NW 1ST AVENUE | GRAND RAPIDS | MN | 55744 | 411761590 | 501(C) | $5,050 | PROGRAM SUPPORT | SUITE E |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| SCHOLARSHIPS | 9 | $18,100 |
| CARE TO SHARE | 17 | $7,750 |
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) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | 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 (3 entries)
| TitleTitleTxt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Bonus Related OrganizationsBonusRelatedOrganizationsAmt |
|---|---|---|---|---|---|---|
| PATTY CARLIN-JANSSEN MD | ||||||
| DIRECTOR | $309,150 | $29,767 | $338,917 | |||
| JAMES HEREFORD | ||||||
| PRESIDENT/CEO-FHS | $1,200,014 | $1,371,338 | $147,760 | $23,564 | ||
| MICHAEL YOUSO | ||||||
| PRESIDENT&CEO-GICH | $356,475 | $18,900 | $429,739 | $24,364 | $30,000 | |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PAGE 1, PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | ALL COMPENSATION IS PAID BY GRAND ITASCA CLINIC & HOSPITAL (GICH) OR FAIRVIEW HEALTH SERVICES, BOTH ARE RELATED ORGANIZATIONS. THE FOLLOWING METHODS ARE USED TO ESTABLISH COMPENSATION: WRITTEN EMPLOYMENT CONTRACT COMPENSATION SURVEY OR STUDY APPROVAL OF THE BOARD OR COMPENSATION COMMITTEE. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 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 ONOLY 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). |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES 0 37,657 0 |
| FORM 990, PART XI, LINE 9 | ACQUISITION ADJUSTMENTS 703 GOLF EVENT INCOME NOT ON BOOKS -11,411 TOTAL -10,708 |
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 |