2016-05-13T10:07:58-05:00 2015-06-30 861065772 Deloitte Tax LLP 50 South Sixth Street Suite 2800 Minneapolis MN 55402 990 2014-07-01 450344371 F-M Ambulance Service Inc F-MA 7012342000 2215 18th Street South Fargo ND 58103 JoAnn Kunkel Chief Financial Officer 6053331000 2016-05-13 1 Anne Fulton P00941863 6123974000 2014 2016-08-17 19:52:53Z Kelby Krabbenhoft 2301 East 60th St Sioux Falls SD 57104 15836294 0 X www.FMAmbulance.com X 1978 ND "Dedicated to the Work of Health and Healing" 15 7 0 0 0 0 30124 245750 14545710 15552941 91 0 24131 9921 14600056 15808612 0 0 0 0 5651878 6316733 0 0 0 7246375 6525495 12898253 12842228 1701803 2966384 7528538 7127289 994596 76387 6533942 7050902 X The Mission of F-M Ambulance, "Dedicated to the Work of Health and Healing and the vision "Improving the Human Condition through Exceptional Care, Innovation and Discovery", is the constant force that drives our plans, decisions and actions. 0 0 11197331 15552941 As part of the Sanford integrated delivery system, F-M Ambulance provides emergency medical and special transportation services to the Fargo, North Dakota/Moorhead, Minnesota metro area and other surrounding communities. F-M Ambulance is the largest advanced life support ground ambulance provider in North Dakota and serves as a resource to rescue and ambulance providers throughout the state. F-M Ambulance works closely with the local volunteer service to coordinate the delivery of emergency medical care to the communities in its service area and is a leader in Homeland Defense Preparedness by serving as a regional training, resources partner and responder.Through its Ready Wheels operations, F-M Ambulance provides local and long distance transportation for individuals using wheelchairs. This special transportation service is available 24 hours a day, seven days a week to provide door-to-door wheelchair service. These services allow individuals in the community to access transportation services that accommodate unique individual needs due to health conditions.Education and other services:F-M Ambulance also engages in various activities that promote the health of the community, including providing medical and safety education. F-M Ambulance provides educational programs for members of the community including first aid, automated external defibrillator, CPR and other courses. In addition, F-M Ambulance operates an on-site bookstore that is open to the public. The store sells education texts and reference books, trauma bags, first aid kits and supplies, medical supplies used in delivering emergency medical service outside the hospital and logo wear.F-M Ambulance also works with other organizations in the community to prepare for medical situations by having customized first aid supplies available to respond to workplace medical needs. These services help improve the health and well being of the community at large. F-M Ambulance is also very involved in numerous community activities that help promote health including participation in the national safe kids campaign, participating in bicycle safety helmet programs and providing non-dedicated stand-bys for community events. 11197331 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 1 0 X 15 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X JoAnn Kunkel CFO 6053331000 2301 East 60th Street Sioux Falls SD 57104 Barb Everist Trustee 0.10 1.40 X 0 0 0 Brent Teiken Trustee 0.10 1.40 X 0 0 0 Christopher Meeker MD Trustee/Sanford Physician (thru Dec 14) 0.10 59.90 X 0 409994 30330 David Beito Trustee 0.10 1.40 X 0 0 0 Don Jacobs Trustee 0.10 1.40 X 0 0 0 Don Morton Trustee 0.10 1.40 X 0 0 0 Jerome Feder Trustee (thru Dec 14) 0.10 1.40 X 0 0 0 Jim Entenman Trustee 0.10 1.40 X 0 0 0 Lauris Molbert Trustee 0.10 1.40 X 0 0 0 Maria Bell MD Trustee/Sanford Physician 0.10 59.90 X 0 741279 36536 Mark Lundeen MD Trustee/Sanford Physician 0.10 59.90 X 0 1060041 25249 Mark Paulson MD Trustee/Sanford Physician 0.10 59.90 X 0 236472 30216 Michael LeBeau MD Trustee/Sanford Physician 0.10 59.90 X 0 1159924 27411 Patrick Durick Trustee 0.10 1.40 X 0 0 0 Richard Hardie MD Trustee/Sanford Physician 0.10 59.90 X 0 730721 33295 Ronald Moquist Trustee (thru Dec 14) 0.10 1.40 X 0 0 0 Thomas Hruby Trustee 0.10 1.40 X 0 0 0 Kelby K Krabbenhoft Sanford President & CEO 0.10 59.90 X X 0 1749435 23433 Kelby K Krabbenhoft Deferred Comp Sanford President & CEO 0.10 59.90 X X 0 0 727751 JoAnn L Kunkel Chief Financial Officer 0.10 59.90 X 0 653020 33933 Paul Richard President - SMC Fargo 5.00 55.00 X 0 602117 32862 Tiffany Lawrence CFO - SMC Fargo 5.00 55.00 X 0 285609 35018 Karen Tobin COO - SMC Fargo 5.00 55.00 X 0 325509 21017 Dennis Millirons Former President SMC Fargo 0.00 0.00 X 0 1344466 23452 0 9298587 1080503 0 1 1 0 0 24258 219981 1511 245750 Emergency Medical Serv 621910 14837881 14837881 Education 900099 588860 588860 Special Transportation 621910 126200 126200 15552941 1800 0 1800 1800 1800 35803 27682 8121 8121 15808612 15552941 0 9921 5032812 4664307 368505 226025 208100 17925 592479 549441 43038 465417 342385 123032 15957 8413 7544 10687 9898 789 159036 85180 73856 96277 57932 38345 132383 64757 67626 355869 335932 19937 129088 75603 53485 708316 610678 97638 182552 1580 180972 Bad Debt 3722528 3722528 Purchased Services 503297 37788 465509 Medical Supplies 387806 359785 28021 Minnesota Care Tax 45603 45603 76096 17421 58675 12842228 11197331 1644897 0 2315227 2051350 9724 2036 48097 78227 8660011 5057417 3762408 3602594 1393082 1393082 7528538 7127289 970828 53221 23768 23166 994596 76387 X 6533942 7050902 6533942 7050902 7528538 7127289 X 2966384 -2449424 X 0 1 X 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 481239 481239 2730568 1166464 1564104 5313151 3813525 1499626 135053 77428 57625 3602594 X Part X, Line 2: Certain controlled organizations are subject to income taxes. Deferred income tax assets and liabilities are recognized for the differences between the financial and income tax reporting basis of assets and liabilities based on enacted tax rates and laws. A tax benefit from an uncertain tax position may be recognized when it is more likely than not that the position will be sustained upon examination. The deferred income tax provision or benefit generally reflects the net change in deferred income tax assets and liabilities during the year. The current income tax provision reflects the tax consequences of revenues and expenses currently taxable or deductible on various income tax returns for the year reported. F-M Ambulance Service, Inc did not have an income tax liability at June 30, 2015; some related organizations have established reserves. 1 1 0 0 0 0 1 1 0 Christopher Meeker MD Trustee/Sanford Physician (thru Dec 0 409994 0 0 0 0 0 10400 0 19930 0 440324 0 0 Maria Bell MD Trustee/Sanford Physician 0 685129 0 0 0 56150 0 13000 0 23536 0 777815 0 0 Mark Lundeen MD Trustee/Sanford Physician 0 600031 0 344768 0 115242 0 13000 0 12249 0 1085290 0 0 Mark Paulson MD Trustee/Sanford Physician 0 221472 0 15000 0 0 0 11978 0 18238 0 266688 0 0 Michael LeBeau MD Trustee/Sanford Physician 0 1159924 0 0 0 0 0 10400 0 17011 0 1187335 0 0 Richard Hardie MD Trustee/Sanford Physician 0 724403 0 0 0 6318 0 13000 0 20295 0 764016 0 0 Kelby K Krabbenhoft Sanford President & CEO 0 1182854 0 363300 0 203281 0 0 0 23433 0 1772868 0 0 Kelby K Krabbenhoft Deferred Comp Sanford President & CEO 0 0 0 0 0 0 0 727751 0 0 0 727751 0 0 JoAnn L Kunkel Chief Financial Officer 0 460778 0 130200 0 62042 0 13000 0 20933 0 686953 0 0 Paul Richard President - SMC Fargo 0 430566 0 102735 0 68816 0 13000 0 19862 0 634979 0 0 Tiffany Lawrence CFO - SMC Fargo 0 259582 0 2800 0 23227 0 13000 0 22018 0 320627 0 0 Karen Tobin COO - SMC Fargo 0 286651 0 2800 0 36058 0 13000 0 8017 0 346526 0 0 Dennis Millirons Former President SMC Fargo 0 257917 0 0 0 1086549 0 12896 0 10556 0 1367918 0 0 Part I, Line 1a Part I, Line 1a: Certain items listed on Line 1a are provided by related organizations. Part I, Line 3: The Executive Compensation Committee of the Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm annually to review the total compensation arrangements of the officers and executives of the organization, including the CEO, and to report the findings to them for deliberation and action. The deliberations and actions are recorded in the minutes of the Sanford Board of Trustees. The most recent study was completed in 2015. Part I, Lines 4a-b The following individual participated in a severance arrangement and received payments during the year: Dennis Millirons $1,045,018 Certain executives participate in a defined benefit SERP Plan. There were no individuals who received payments during the year. Part I, Line 6 Sanford physicians are compensated based on the professional services they perform within the clinic in which they provide care. Generally, the model is based on production. Part I, Line 7 Certain employees are eligible for a discretionary incentive bonus, based on financial targets and other goals. Form 990, Part VI, Section A, line 2 The following officers, board members, and key employees are employees of Sanford or its related organizations. Many of these employees also serve on other related Sanford boards, or have business relationships with each other that span the organization as a whole: Christopher Meeker Maria Bell Mark Lundeen Mark Paulson Michael LeBeau Richard Hardie Kelby Krabbenhoft JoAnn Kunkel Tiffany Lawrence Paul Richard Karen Tobin Form 990, Part VI, Section A, line 6 Sanford North is the sole stockholder of F-M Ambulance. Form 990, Part VI, Section A, line 7a Board members are appointed by the President and CEO of Sanford North. Form 990, Part VI, Section A, line 7b Sanford North must approve the following actions: * Modifying the purpose of the Corporation * Unbudgeted capital expenses in excess of 1/2 of 1% of approved operating budgets *Adoption of capital and operating budgets *Acquisition, sale, lease, disposition, or mortgaging of real property *Guarantee of debts or obligations of any other person, firm, corporation, partnership, association, or other entity which if held in default would obligate the corporation to an aggregate amount in excess of $100,000 *Merger or consolidation of the Corporation *Incurring a loan or other obligation in an agreement in excess of $500,000 for more than 60 days *Making of a gift, grant or other donation in an amount in excess of $5,000 to an organization not related to the Corporation or Member *Member has the authority to direct the Corporation regardless of the vote by the Corporation's Board of Directors to transfer assets and/or funds to the health system to satisfy obligations of the health system. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by Finance and reviewed by executive management. An external accounting firm reviews the return prior to filing and prepares return highlights and key disclosures for the Board of Trustees meeting prior to the return filing date. Before the return is filed, a complete copy is provided to the current Board of Trustees. Form 990, Part VI, Section B, line 12c The annual Conflict of Interest disclosure process is managed by the Chief Compliance Officer (CCO). The CCO is responsible for assuring that all completed forms are returned in a timely and complete manner. Conflict of Interest questionnaires are sent to System Trustees, members of the governing boards for subsidiary entities, officers, and key employees for all entities subject to the IRS Form 990 filings. The disclosures are summarized for review by the executive committee of the Board of Trustees, pursuant to policy. This review allows: 1) The Board to acquire an awareness of financial relationships of board members and key management employees and can invoke the recusal process on a case-by-case basis if potential conflicts are implicated in Board decisions and deliberations, and, 2) Gives the Board the opportunity to seek additional information and clarification about disclosures to determine potential conflicts of interest and how to manage them. Form 990, Part VI, Section B, line 15 The Executive Compensation Committee of the Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm annually to review the total compensation arrangements of the officers and executives of the organization, including the CEO, and to report the findings to them for deliberation and action. The deliberations and actions are recorded in the minutes of the Sanford Board of Trustees. The most recent study was completed in 2015. Form 990, Part VI, Section C, line 19 Although the organization does not maintain a website where the public can access these documents, it would respond individually to any requests or inquiries from the public for these documents. Form 990, Part XI, line 9: Transfer from related tax-exempt org for payroll and operating expenses -2,449,424. Sanford 801 Broadway Drive Fargo ND 58122 271218956 Supporting Organization ND 501(c)(3) 11-II 0 Sanford Health 1305 West 18th Street Sioux Falls SD 57117 311527032 Supporting Organization SD 501(c)(3) 11-II Sanford 1 Sanford USD Medical Center 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460227855 Hospital SD 501(c)(3) 3 Sanford Health 1 Sanford Health Foundation 101 S Reid Street Sioux Falls SD 57103 363297853 Foundation SD 501(c)(3) 11-II Sanford Health 1 Edith Sanford Breast Cancer Foundation 101 S Reid Street Sioux Falls SD 57103 450404126 Foundation ND 501(c)(3) 11-II Sanford Health 1 Sanford Clinic 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460447693 Clinical Services SD 501(c)(3) 3 Sanford Health 1 Sanford Home Health 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460282134 Home Health Services SD 501(c)(3) 9 Sanford Health 1 Sanford Health Network 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460388596 Hospitals/Clinics SD 501(c)(3) 3 Sanford Health 1 Sanford Research 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460450378 Research SD 501(c)(3) 3 Sanford Health 1 Sanford World Clinics 1305 West 18th Street Sioux Falls SD 57117 262707628 Healthcare SD 501(c)(3) 3 Sanford Health 1 Sanford North PO Box 2010 Fargo ND 58122 450385890 Supporting Organization ND 501(c)(3) 11-II Sanford 1 Sanford Medical Center Fargo PO Box 2010 Fargo ND 58122 450226909 Hospital ND 501(c)(3) 3 Sanford North 1 Sanford Health Foundation North PO Box 2010 Fargo ND 58122 450398104 Foundation ND 501(c)(3) 7 Sanford North 1 Sanford Clinic North PO Box 2010 Fargo ND 58122 911770748 Clinics ND 501(c)(3) 9 Sanford North 1 Sanford Health Network North PO Box 2010 Fargo ND 58122 450409348 Hospitals/Clinics ND 501(c)(3) 11-II Sanford North 1 Sanford Hillsboro PO Box 609 Hillsboro ND 58045 450230400 Hospital ND 501(c)(3) 3 Sanford Health Network North 1 Sanford Health Foundation Hillsboro PO Box 609 Hillsboro ND 58045 363542187 Foundation ND 501(c)(3) 7 Sanford Hillsboro 1 Sanford Medical Center Mayville 42 6th Ave SE Mayville ND 58257 450228899 Hospital ND 501(c)(3) 3 Sanford Health Network North 1 Sanford Medical Center Thief River Falls 120 Labree Ave S Thief River Falls MN 56701 410709579 Hospital MN 501(c)(3) 3 Sanford Health Network North 1 Sanford Medical Center Wheaton 401 12th Street North Wheaton MN 56296 272042143 Hospital/Clinic MN 501(c)(3) 3 Sanford Health Network North 1 Sanford Health of Northern Minnesota 1300 Anne St NW Bemidji MN 56601 411266009 Hospital MN 501(c)(3) 3 Sanford North 1 Sanford Health Foundation of Northern Minnesota 1300 Anne St NW Bemidji MN 56601 411389317 Foundation MN 501(c)(3) 11-II Sanford Health of Northern Minnesota 1 Baker Park Inc 803 Dewey Ave NW Bemidji MN 56601 411372480 Low Income Senior Housing MN 501(c)(3) 9 Sanford Health of Northern Minnesota 1 Sanford West 300 North 7th Street Bismarck ND 58501 450397195 Supporting Organization ND 501(c)(3) 11-II Sanford 1 Sanford Bismarck 300 North 7th Street Bismarck ND 58501 450226700 Hospital ND 501(c)(3) 3 Sanford West 1 Sanford Living Centers 1000 18th Street NW Suite 1 Mandan ND 58554 450416454 Long-term Care Facility ND 501(c)(3) 9 Sanford Bismarck 1 Sanford Health Foundation West 300 North 7th Street Bismarck ND 58501 450397196 Foundation ND 501(c)(3) 7 Sanford Bismarck 1 Medcenter One Inc Auxiliary 300 North 7th Street Bismarck ND 58501 237293043 Supporting Organization ND 501(c)(3) 11-I Sanford Bismarck 1 Sanford Heart of America Health Plan 810 South Main Rugby ND 58368 450346132 Insurance ND 501(c)(4) Sanford Health Plan 1 Sanford Health Foundation Thief River Falls 120 Labree Ave S Thief River Falls MN 56701 411761135 Foundation MN 501(c)(3) 7 Sanford Medical Center Thief River Falls 1 National Student Housing-South Dakota LLC 100 S Phillips Ave Sioux Falls SD 57104 202129839 Investment SD N/A RAC Rentals LLC 100 S Phillips Ave Sioux Falls SD 57104 261961077 Investment SD N/A Sanford Home Medical Equipment Inc 2710 W 12th Street Sioux Falls SD 57105 460388597 Healthcare Equipment SD N/A C 1 Sanford Health Plan 300 Cherapa Place Sioux Falls SD 57103 911842494 Insurance SD N/A C 1 Sanford Health Plan of MN 300 Cherapa Place Sioux Falls SD 57103 460445852 Insurance MN N/A C 1 Sanford Frontiers 1305 W 18th Street PO Box 5039 Sioux Falls SD 571175039 455436599 Weight Loss/Fitness SD N/A C 1 SOB Inc 2701 S Minnesota Avenue Suite 2 Sioux Falls SD 57105 460442628 Air Transportation SD N/A C 1 Sanford Affiliated Services Inc 300 N 7th Street Bismarck ND 58501 450403146 Investment Activity ND N/A C 1 Sanford World Clinics - Ghana Sarbah Road Tantri Lorry Station Cape Coast GH Healthcare GH N/A C 1 Shanghai Sanford Healthcare Management Consulting Co Ltd 188 Yesheng Road Room A-862 Guoma Shanghai CH Healthcare CH N/A C 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0