SIBLEY MEDICAL CENTER: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- SIBLEY MEDICAL CENTER (EIN 41-1801967)
- Tax period
- 2014-01-01 to 2014-12-31
- Filed
- 2015-11-16
- IRS object ID
- 201523209349303927
- Schema version
- 2014v5.0
- 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 H
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-11-16T10:03:24-06:00 | ReturnTs |
| Tax Period End | 2014-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411801967 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIBLEY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SIBL | BusinessNameControlTxt |
| Phone | 5079642271 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 W CHANDLER STREET | AddressLine1Txt |
| City | ARLINGTON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55307 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DARLA ANDERSON | PersonNm |
| Person Title | DIRECTOR OF FINANCE | PersonTitleTxt |
| Phone | 5079642271 | PhoneNum |
| Signature | 2015-11-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KACIE MCEWEN | PreparerPersonNm |
| PTIN | P01599614 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIDGEVIEW SIBLEY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DARLA ANDERSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 W CHANDLER STREET | AddressLine1Txt |
| City | ARLINGTON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55307 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $23,478,303 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SIBLEYMEDICAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1948 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 2 | TotalEmployeeCnt |
| Total Volunteers | 23 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $401 | PYContributionsGrantsAmt |
| CY Contributions Grants | $10,361,622 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $12,628,554 | CYProgramServiceRevenueAmt |
| PY Investment Income | $172 | PYInvestmentIncomeAmt |
| CY Investment Income | $27,158 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,150 | PYOtherRevenueAmt |
| CY Other Revenue | $448,558 | CYOtherRevenueAmt |
| PY Total Revenue | $1,723 | PYTotalRevenueAmt |
| CY Total Revenue | $23,465,892 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $4,035,226 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,286,070 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $442 | PYOtherExpensesAmt |
| CY Other Expenses | $4,882,186 | CYOtherExpensesAmt |
| PY Total Expenses | $442 | PYTotalExpensesAmt |
| CY Total Expenses | $16,203,482 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,281 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,262,410 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $184,650 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,071,533 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $6,617,064 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $184,650 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,454,469 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | RIDGEVIEW SIBLEY MEDICAL CENTER EXISTS TO ENHANCE THE LIFELONG HEALTH OF PEOPLE IT SERVES WITH A CULTURE THAT NURTURES THE WHOLE PERSON: MIND, BODY, AND SPIRIT. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $14,995,629 | ExpenseAmt |
| Grant | $4,035,226 | GrantAmt |
| Revenue | $12,628,554 | RevenueAmt |
| Desc | LOCATED IN ARLINGTON, MINNESOTA, RIDGEVIEW SIBLEY MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL--PROVIDING URGENT CARE, GENERAL SURGERY, AND 24/7 HOSPITAL AND EMERGENCY SERVICES TO RESIDENTS OF SIBLEY COUNTY AND THE SURROUNDING AREA. RIDGEVIEW SIBLEY ALSO HAS CLINIC LOCATIONS IN ARLINGTON, GAYLORD, HENDERSON AND WINTHROP. IT IS PART OF THE RIDGEVIEW MEDICAL CENTER NETWORK, WHICH ALSO INCLUDES A HOSPITAL IN WACONIA, A MULTITUDE OF PRIMARY AND SPECIALTY CARE CLINICS, EMERGENCY SERVICES AND SPECIALTY PROGRAMS, AND TWO TWELVE MEDICAL CENTER IN CHASKA. EFFECTIVE JANUARY 1, 2014, THE CITY OF ARLINGTON, MINNESOTA (CITY), WHO PREVIOUSLY OWNED AND CONTROLLED THE OPERATIONS OF SIBLEY MEDICAL CENTER, ENTERED INTO A HOSPITAL OPERATING LEASE AGREEMENT WITH RIDGEVIEW MEDICAL CENTER (RMC) AND AS OF THE EFFECTIVE DATE, RMC BECAME THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, WHICH NOW OPERATES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. RIDGEVIEW SIBLEY MEDICAL CENTER BELIEVES EVERYONE DESERVES TOP-QUALITY MEDICAL CARE AND THAT THE PEOPLE OF SIBLEY COUNTY SHOULDN'T HAVE TO TRAVEL FAR TO GET THE LATEST MEDICAL ADVANCEMENTS. IT'S THIS BELIEF THAT DRIVES US TO BRING SPECIALTY CARE TO OUR COMMUNITY. IT'S WHY WE CONSTANTLY PURSUE THE TECHNOLOGIES, RECRUIT THE EXPERTS, AND EXPAND AND IMPROVE FACILITIES THAT MAKE GREAT HEALTH CARE POSSIBLE. | Desc |
| Total Program Service Expenses | $14,995,629 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 30 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 2 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (1) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| 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 | DARLA ANDERSON | PersonNm |
| Phone | 5079648424 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 WEST CHANDLER | AddressLine1Txt |
| City | ARLINGTON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55307 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| KEVIN LINDSTRAND | |||||||
| PRESIDENT | 0.50 | 0.00 | Yes (X) | Yes (X) | $1,800 | $0 | $0 |
| DENNIS SCHULTZ | |||||||
| VICE PRESIDENT | 0.50 | 0.00 | Yes (X) | Yes (X) | $1,200 | $0 | $0 |
| LISA PFARR | |||||||
| SECRETARY | 0.50 | 0.00 | Yes (X) | Yes (X) | $1,200 | $0 | $0 |
| LYLE RUD | |||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $1,200 | $0 | $0 | |
| BRENDA PAUTSCH | |||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $1,200 | $0 | $0 | |
| DEE THOMAS | |||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $1,200 | $0 | $0 | |
| TIM DOLAN | |||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $1,200 | $0 | $0 | |
| DAVE WELCH | |||||||
| TRUSTEE | 0.50 | 0.00 | Yes (X) | $1,200 | $0 | $0 | |
| MIKE WERNER | |||||||
| TRUSTEE | 0.50 | 2.00 | Yes (X) | $1,200 | $0 | $0 | |
| TODD SANDBERG | |||||||
| RSMC ADMINISTRATOR | 1.00 | 49.00 | Yes (X) | $0 | $194,640 | $29,416 | |
| DARLA ANDERSON | |||||||
| DIRECTOR OF FINANCE | 1.00 | 49.00 | Yes (X) | $0 | $73,201 | $22,110 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $11,400 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $267,841 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $51,526 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| RIDGEVEIW MEDICAL CENTER | |||||
| 500 S MAPLE ST | WACONIA | MN | 55387 | MANAGEMENT SERVICES | $7,564,000 |
| PREMIER STAFFING INC | |||||
| 243 WINKLER TRAIL | COLOGNE | MN | 55322 | NURSING SERVICES | $399,328 |
| CPSI | |||||
| 6600 WALL STREET | MOBILE | AL | 36695 | IT SERVICES | $334,117 |
| CMDI | |||||
| 150 10TH STREET NW | MILACA | MN | 56353 | IMAGING SERVICES | $107,463 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $12,241 | FundraisingAmt |
| All Other Contributions | $10,349,381 | AllOtherContributionsAmt |
| Noncash Contributions | $6,413,763 | NoncashContributionsAmt |
| Total Contributions | $10,361,622 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT REVENUE | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $12,628,554 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,628,554 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $12,628,554 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,958 | TotalRevenueColumnAmt |
| Exclusion | $20,958 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $80,457 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $80,457 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $80,457 | TotalRevenueColumnAmt |
| Exclusion | $80,457 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $6,200 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $6,200 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,200 | TotalRevenueColumnAmt |
| Exclusion | $6,200 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $22,513 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $12,241 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $9,787 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,726 | TotalRevenueColumnAmt |
| Exclusion | $12,726 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $4,423 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $2,624 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,799 | TotalRevenueColumnAmt |
| Exclusion | $1,799 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| MEANINGFUL USE INCOME | 900099 | $253,409 | $253,409 |
| JOINT VENTURE INCOME | 900099 | $39,517 | $39,517 |
| FINANCE CHARGE | 900099 | $39,141 | $39,141 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $21,509 | TotalRevenueColumnAmt |
| Exclusion | $21,509 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $353,576 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,465,892 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12,628,554 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $475,716 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,035,226 | TotalAmt |
| Program Services | $4,035,226 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,113,950 | TotalAmt |
| Program Services | $5,496,036 | ProgramServicesAmt |
| Management And General | $617,914 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $199,801 | TotalAmt |
| Program Services | $190,315 | ProgramServicesAmt |
| Management And General | $9,486 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $580,589 | TotalAmt |
| Program Services | $521,911 | ProgramServicesAmt |
| Management And General | $58,678 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $391,730 | TotalAmt |
| Program Services | $369,193 | ProgramServicesAmt |
| Management And General | $22,537 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,638 | TotalAmt |
| Management And General | $3,638 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,020 | TotalAmt |
| Management And General | $15,020 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $66,265 | TotalAmt |
| Management And General | $66,265 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,501,314 | TotalAmt |
| Program Services | $1,496,405 | ProgramServicesAmt |
| Management And General | $4,909 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,136 | TotalAmt |
| Management And General | $39,136 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,123 | TotalAmt |
| Program Services | $96,543 | ProgramServicesAmt |
| Management And General | $49,580 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $174,666 | TotalAmt |
| Management And General | $174,666 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $262,524 | TotalAmt |
| Program Services | $262,524 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,989 | TotalAmt |
| Program Services | $51,960 | ProgramServicesAmt |
| Management And General | $5,029 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,668 | TotalAmt |
| Program Services | $35,641 | ProgramServicesAmt |
| Management And General | $5,027 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $180,529 | TotalAmt |
| Program Services | $180,529 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $206,527 | TotalAmt |
| Program Services | $186,624 | ProgramServicesAmt |
| Management And General | $19,903 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,266 | TotalAmt |
| Management And General | $15,266 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,438,430 | $1,438,430 | $0 |
| BAD DEBT EXPENSE | $220,149 | $220,149 | |
| MINNESOTA CARE TAX | $166,133 | $166,133 | |
| OTHER | $118,599 | $52,766 | $65,833 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $230,210 | TotalAmt |
| Program Services | $195,244 | ProgramServicesAmt |
| Management And General | $34,966 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,203,482 | TotalAmt |
| Program Services | $14,995,629 | ProgramServicesAmt |
| Management And General | $1,207,853 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,650 | BOYAmt |
| EOY | $3,831,917 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $744,090 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,489,485 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $11,290 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $280,006 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $62,302 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,620,152 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $206,528 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $5,413,624 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,010,163 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $228,656 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,650 | BOYAmt |
| EOY | $14,071,533 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $345,738 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $333,062 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $4,618,324 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,319,940 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $6,617,064 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,650 | BOYAmt |
| EOY | $7,454,469 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,650 | BOYAmt |
| EOY | $7,454,469 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,650 | BOYAmt |
| EOY | $14,071,533 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $7,262,410 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $7,409 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,852,887 | OtherCostOrOtherBasisAmt |
| Depreciation | $161,545 | DepreciationAmt |
| Book Value | $4,691,342 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $113,451 | OtherCostOrOtherBasisAmt |
| Book Value | $113,451 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $354,563 | OtherCostOrOtherBasisAmt |
| Depreciation | $44,983 | DepreciationAmt |
| Book Value | $309,580 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $299,251 | OtherCostOrOtherBasisAmt |
| Book Value | $299,251 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,413,624 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD PARTY PAYOR SETTLEMENTS | $391,000 |
| RELATED PARTY PAYABLE | $928,940 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,319,940 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $12,981,587 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$220,149 | OtherRevenueAmt |
| Revenue Not Reported | -$220,149 | RevenueNotReportedAmt |
| Revenue Subtotal | $13,201,736 | RevenueSubtotalAmt |
| Other Revenues Not Included | $10,264,156 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $10,264,156 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $23,465,892 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,961,183 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $12,411 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $12,411 | ExpensesNotReportedAmt |
| Expenses Subtotal | $11,948,772 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $4,254,710 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $4,254,710 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $16,203,482 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE ORGANIZATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATION UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS -220,149. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | INVESTMENT INCOME 20,958. SPECIAL EVENT EXPENSES -9,787. TRANSFER FROM SIBLEY MEDICAL CENTER (CITY OWNED) 10,255,609. COST OF GOODS SOLD -2,624. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | SPECIAL EVENT EXPENSES 9,787. COST OF GOODS SOLD 2,624. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBT 220,149. TRASNFER TO CITY OF ARLINGTON, MN 4,034,561. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | SPRING BENEFIT | Event1Nm |
| Gross Receipts Event1 | $18,751 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $9,241 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $9,510 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $50 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $295 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $360 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $2,352 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $500 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $208 | OtherDirectExpensesEvent1Amt |
| Event2 | FISH HOUSE RAFFLE | Event2Nm |
| Gross Receipts Event2 | $12,280 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $3,000 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $9,280 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $5,811 | CashPrizesEvent2Amt |
| Non Cash Prizes Event2 | $0 | NonCashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $0 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $0 | FoodAndBeverageEvent2Amt |
| Entertainment Event2 | $0 | EntertainmentEvent2Amt |
| Other Direct Expenses Event2 | $210 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $31,031 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $12,241 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $18,790 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $5,861 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $295 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $360 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $2,352 | FoodAndBeverageTotalEventsAmt |
| Entertainment Total Events | $500 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $418 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $9,786 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $9,004 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 225.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $142,864 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $142,864 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00890 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $349,023 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $225,590 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $123,433 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00770 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $491,887 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $225,590 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $266,297 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01660 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,501 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,078 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $22,423 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,142,264 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,111,769 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $30,495 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,176,765 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,117,847 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $58,918 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,668,652 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,343,437 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $325,215 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02030 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $220,149 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $5,531,128 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,506,803 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $24,325 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIDGEVIEW SIBLEY MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 601 WEST CHANDLER STREET | AddressLine1Txt |
| City | ARLINGTON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55307 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SIBLEYMEDICAL.ORG | WebsiteAddressTxt |
| State License | HFID-00618 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RIDGEVIEW SIBLEY MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | Yes (1) | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.SIBLEYMEDICAL.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.SIBLEYMEDICAL.ORG/ABOUT-US/COMMUNITY-INVOLVEMENT | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 225.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Explained Basis | 0 | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Includes Publicity Measures | 0 | IncludesPublicityMeasuresInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| RIDGEVIEW SIBLEY MEDICAL CENTER | PART V, SECTION B, LINE 5: IN ORDER TO ENSURE THE REVIEW OF THE RESEARCH WAS QUALITY DATA, COMMUNITY LEADERSHIP TEAM (CLT) INITIATED, PLANNED AND IMPLEMENTED THE PROJECT. PERSONNEL THAT PARTICIPATED REPRESENT A VARIETY OF SECTORS INCLUDING PUBLIC HEALTH AND MEDICAL SERVICES, NON-PROFIT AND SOCIAL ORGANIZATIONS, AND THE BUSINESS COMMUNITY. TWO FOCUS GROUPS WERE FORMED THAT REPRESENTED A TOTAL OF 35 KEY COMMUNITY LEADERS IN MAY AND JUNE OF 2013. THE ASSESSMENT INITIATIVE WAS CONDUCTED IN TWO DISTINCT PHASES. INITIALLY, PHONE CONFERENCES WERE HELD WITH A CONSULTANT FROM STRATUS HEALTH TO DETERMINE HOW TO GATHER KEY STAKEHOLDERS INPUT AND INFORMATION. BETWEEN THE LOCAL PUBLIC HEALTH STAFF AND THE HOSPITAL STAFF, IT WAS DECIDED TO CONDUCT COMMUNITY FOCUS GROUPS. THROUGH COLLABORATION, A LIST OF KEY STAKEHOLDERS WAS DEVELOPED AND INVITATIONS WERE SENT OUT TO THE COMMUNITY. APPROXIMATELY 100 PEOPLE WERE SELECTED TO PARTICIPATE IN THE FOCUS GROUPS. THE SELECTION OF THE PERSONNEL ASKED TO PARTICIPATE WAS BASED ON: - PERSONS WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH - REPRESENTATIVES FROM HEALTH DEPARTMENTS OR GOVERNMENT AGENCIES SERVING COMMUNITY HEALTH - LEADERS OR MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE - OTHER KEY STAKEHOLDERS IN THE COMMUNITYINVITATIONS WERE SENT BY MAIL AND E-MAIL WITH A REQUEST TO RESPOND FOR ATTENDANCE. OUR RECOMMENDATION WAS TO MEET FOR TWO SESSIONS AND ASSESS THE HEALTH NEEDS OF OUR COMMUNITY. |
| RIDGEVIEW SIBLEY MEDICAL CENTER | PART V, SECTION B, LINE 2: EFFECTIVE JANUARY 1, 2014, THE CITY OF ARLINGTON, MINNESOTA, WHO PREVIOUSLY OWNED AND CONTROLLED THE OPERATIONS OF SIBLEY MEDICAL CENTER, ENTERED INTO A HOSPITAL LEASE OPERATING AGREEMENT WITH RIDGEVIEW MEDICAL CENTER (RMC) AND AS OF THE EFFECTIVE DATE, RMC BECAME THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, WHICH NOW OPERATES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. |
| RIDGEVIEW SIBLEY MEDICAL CENTER | PART V, SECTION B, LINE 11: UPON REVIEWING THE TOP TEN LEADING HEALTH CARE INDICATORS, A LIST OF CRITERIA WAS CREATED TO ASSIST ASSESSING THE AREAS MOST NEEDING IMPROVEMENT IN OUR COMMUNITY. THE GOAL WAS TO THEN DETERMINE THE TOP THREE TOPICS FOR DEVELOPING PLANS TO IMPLEMENT CHANGE IN THE COMMUNITY.DECISION MAKING CRITERIA: - AFFORDABILITY - CAN WE MAKE AN IMPACT - IS THERE SUPPORT ALREADY IN PLACE - MULTIPLE IMPACT POINTS/OVERLAP WITH MULTIPLE AREAS - SUSTAINABILITY - IS IT REALISTIC - WITH WHOM CAN WE COLLABORATE FOR A BIGGER IMPACT - IS THE COMMUNITY READY TO ENGAGE - AWARENESS OF WHAT IS CHANGING BEYOND 3 YEARS - SUPPORT OF LEADERSHIP - LEGISLATIVE/COUNTY COMMISSIONER SUPPORT - DATA/ABILITY TO MEASURE CHANGEAFTER ANALYZING THE TEN TOPICS WITH THE DECISION MAKING CRITERIA, THE FOCUS GROUP INDIVIDUALS VOTED FOR THEIR TOP THREE TOPICS. THE FOLLOWING HAD THE MAJORITY OF THE VOTES AND WILL BE THE FOCUS OF SIBLEY MEDICAL CENTER'S COMMUNITY HEALTH NEEDS ASSESSMENT: OBESITY, MENTAL HEALTH, AND PREVENTION AND WELLNESS. SIBLEY MEDICAL CENTER PLANS TO FOCUS ON THE FOLLOWING ISSUES IDENTIFIED THOUGH THE COMMUNITY HEALTH NEEDS ASSESSMENT. THESE PRIORITY AREAS WILL BE ADDRESSED BY CONTINUING TO STRENGTHEN EXISTING SIBLEY MEDICAL CENTER PARTNERSHIPS, AS WELL AS BY ATTEMPTING TO REACH MORE INDIVIDUALS THAT WOULD BE INTERESTED IN CONTRIBUTING IN THE COMMUNITY.AFTER COMPLETING THE FOCUS GROUPS AND MEETING WITH THE COMMUNITY TO IDENTIFY HEALTH PRIORITIES, THE COMMUNITY LEADERSHIP TEAM (CLT) IS TO HELP CONTINUE TO MAKE PROGRESS ON THESE PRIORITIES. CLT IS COMPRISED OF A VARIETY OF INDIVIDUALS IN A THREE COUNTY-WIDE SPREAD. PERSONNEL INCLUDE: PUBLIC HEALTH, LOCAL BUSINESSES, COALITIONS, CITY PERSONNEL AND HOSPITALS. THE COMMUNITY LEADERSHIP TEAM HAS BEEN WORKING ON COUNTY HEALTH INITIATIVES SINCE 2009. NOW, THE TEAM WILL BE INVOLVED IN PLANNING AND IMPLEMENTING CHANGES IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT.WHEN THE TEAM MET IN JUNE AND JULY, THEY DERIVED A PLAN TO CREATE THREE SUBCOMMITTEES, WHICH WILL ADDRESS THE HEALTH PRIORITIES. THE SUB COMMITTEES ARE AS FOLLOWS: MEEKER-MCLEOD-SIBLEY HEALTH COMMUNITIES COLLABORATIVE (DISEASE PREVENTION AND WELLNESS, MENTAL HEALTH, AND HEALTHY BEHAVIORS. IN AUGUST 2013, THE CLT COMMITTEE MET AND BEGAN ASSIGNING PERSONNEL TO EACH COMMITTEE. THE COMMITTEES WILL MEET QUARTERLY TO IDENTIFY, DEVELOP AND IMPLEMENT A STRATEGIC PLAN TO ADDRESS EACH OF THESE TOPICS. THE PROGRESS REPORTS FROM EACH COMMITTEE WILL BE SHARED WITH THE CLT COMMITTEE TO ENSURE BOTH PROGRESS IS BEING MADE AND THE WORK EACH COMMITTEE IS COMPLETING IS NOT BEING DUPLICATED IN ANOTHER COMMITTEE. |
| RIDGEVIEW SIBLEY MEDICAL CENTER | PART V, SECTION B, LINE 22D: EVERY SELF-PAY PATIENT GETS A DISCOUNT EQUAL TO THE GREATEST COMMERCIAL PAYOR. UPON DETERMINATION OF A PATIENT'S CHARITY CARE ELIGIBLITY, SIBLEY MEDICAL CENTER, REVERSES THE ORIGINAL SELF-PAY DISCOUNT GIVEN AND AT A MINIMUM IS GIVEN 25% DISCOUNT ON THEIR BILL WHICH IS GREATER THAN THE DISCOUNT GIVEN TO ALL SELF-PAY AND COMMERCIALLY INSURED PATIENTS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 4 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| RIDGEVIEW ARLINGTON CLINIC | ||||
| 601 WEST CHANDLER STREET | ARLINGTON | MN | 55307 | CLINIC |
| RIDGEVIEW GAYLORD CLINIC | ||||
| 660 3RD STREET | GAYLORD | MN | 55334 | CLINIC |
| RIDGEVIEW HENDERSON CLINIC | ||||
| 505 MAIN STREET | HENDERSON | MN | 56044 | CLINIC |
| RIDGEVIEW WINTHROP CLINIC | ||||
| 223 NORTH CARVER STREET | WINTHROP | MN | 55396 | CLINIC |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ELIGIBILITY FOR SIBLEY MEDICAL CENTER'S CHARITY CARE PROGRAM IS BASED ON FAMILY INCOME RELATIVE TO FEDERAL POVERTY GUIDELINES (FPG). FREE CARE IS OFFERED FOR FEDERAL ADJUSTED GROSS INCOME UP TO 150% OF FPG. 75% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME UP TO 175% OF FPG. 50% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME UP TO 200% OF FPG. AND 25% OF A PATIENT'S CHARGES ARE FORGIVEN FOR FEDERAL ADJUSTED GROSS INCOME UP TO 225% OF FPG. |
| PART I, LINE 7: | THE COSTING METHODOLOGY USED BY SIBLEY MEDICAL CENTER TO DETERMINE THE COMMUNITY BENEFIT EXPENSES INCLUDED IN PART I, LINES 7A-D WERE DERIVED BY TAKING THE RESPECTIVE AMOUNTS PER THE AUDITED FINANCIAL STATEMENTS AND APPLYING THE COST-TO-CHARGE RATIO FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS. THE COMMUNITY BENEFIT EXPENSES INCLUDED IN LINES 7E-J WERE REPORTED BASED ON SMC'S ACTUAL COSTS FOR EACH CLASSIFICATION OF EXPENSES. |
| PART I, LN 7 COL(F): | BAD DEBT EXPENSES INCLUDED ON FORM 990, PART IX, LINE 24, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $220,149 FOR THE YEAR ENDED DECEMBER 31, 2014. |
| PART III, LINE 4: | THE NOTE OF SIBLEY MEDICAL CENTER'S 2014 FINANCIAL STATEMENTS THAT INCLUDES THE EXPLANATION OF BAD DEBT EXPENSE IS THE "PATIENT RECEIVABLES, NET" FOOTNOTE INCLUDED ON PAGE 8. |
| PART III, LINE 8: | SIBLEY MEDICAL CENTER USED THE 2014 FILED MEDICARE COST REPORT TO CALCULATE THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6. THERE WAS NO MEDICARE SHORTFALL CALCULATED IN PART III, LINE 7 FOR THE YEAR ENDED DECEMBER 31, 2014. |
| PART III, LINE 9B: | AT ANY POINT DURING THE BILLING AND COLLECTION PROCESS A PATIENT HAS THE ABILITY TO REQUEST AN APPLICATION FOR FINANCIAL ASSISTANCE. ONCE AN APPLICATION HAS BEEN REQUESTED, THE COLLECTION PROCESS PAUSES AND DOES NOT CONTINUE UNTIL A DETERMINATION IS MADE FOR FINANCIAL ASSISTANCE. |
| PART VI, LINE 2: | IN 2013, SIBLEY MEDICAL CENTER PARTNERED WITH NEIGHBORING COMMUNITIES, PUBLIC HEALTH DEPARTMENTS AND STRATIS HEALTH (AN INDEPENDENT, NONPROFIT ORGANIZATION THAT LEADS IN COLLABORATION AND INNOVATION IN HEALTH CARE QUALITY AND SAFETY) TO COMPLETE THE INITIAL DISCOVERY PHASE OF THE ASSESSMENT. THE LEAD CONSULTANT, KIM MCCOY WITH STRATIS HEALTH, FACILITATED THE INITIAL PHASE OF CONDUCTING A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT. THE OVERALL GOAL OF THE ASSESSMENT WAS TO IDENTIFY THE MAJOR HEALTH NEEDS, SERVICE GAPS, BARRIERS TO ACCESS, AND HEALTH PRIORITIES FOR THE COMMUNITY. AS PART OF THE ASSESSMENT, STRATUS HEALTH COLLECTED QUANTITATIVE AND QUALITATIVE INFORMATION FROM A BROAD ARRAY OF SOURCES. THE PURPOSE OF GATHERING THE INFORMATION AND STATISTICS WAS TO ANALYZE THE HEALTH OF THE COMMUNITY AND THEN FACILITATE THE DEVELOPMENT OF SHORT AND LONG-TERM PLANS TO GUIDE THE HEALTH INVESTMENTS OF SIBLEY COUNTY. |
| PART VI, LINE 4: | SIBLEY COUNTY INCLUDES SEVEN CITIES. IN AGGREGATE, THE LAND SIZE IS 600.41 SQUARE MILES WITH A TOTAL POPULATION OF 15,123 PEOPLE. SIBLEY COUNTY IS CONSIDERED A "FRINGE" COUNTY AND IS ON THE WESTERN BOUNDARY OF THE SEVEN-COUNTY TWIN CITIES METROPOLITAN AREA. THE DISTINCT QUALITIES OF EACH COMMUNITY PROVIDE A UNIQUE BLEND OF HISTORY AND CULTURE. MANY COMMUTERS TAKE ADVANTAGE OF OUR LOWER HOUSING COSTS AND THE BENEFITS OF RURAL LIVING.AGRICULTURE IN SIBLEY COUNTY IS A MAIN SOURCE OF EMPLOYMENT AND INCOME. THERE ARE 352,000 ACRES DEDICATED TO FARMING. OF THESE FARMS, 86.55% OF THEM ARE INDIVIDUALLY / FAMILY OWNED AND OPERATED. THE AVERAGE VALUE OF THE AGRICULTURAL PRODUCTS SOLD PER FARM IS $175,079. ALONG WITH THE PRODUCTION OF CROPS, A LARGE NUMBER OF FARMS RAISE LIVESTOCK, POULTRY, AND DAIRY CATTLE.ACCORDING TO THE 2010 US CENSUS, THERE ARE 15,123 PEOPLE LIVING IN SIBLEY COUNTY, WITH THE MAJORITY OF THE POPULATION RESIDING IN THE CITIES OF ARLINGTON, GAYLORD, AND WINTHROP. THE POPULATION BREAKDOWN SHOWS THOSE UNDER 18 YEARS OF AGE AT 24.7%, THOSE 65 YEARS AND OVER AT 16.9%; WITH THE MEDIAN RESIDENT AGE AT 40.0 YEARS. THE POPULATION DECREASED -0.7% SINCE 2010, BUT OVERALL THE POPULATION HAS STAYED CONSISTENT OVER THE LAST DECADE. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF ARLINGTON MN | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 204 SHAMROCK DRIVE | AddressLine1Txt |
| City | ARLINGTON | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55307 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 416004941 | RecipientEIN |
| IRC Section | 115 | IRCSectionDesc |
| Non Cash Assistance | $4,034,561 | NonCashAssistanceAmt |
| Valuation Method Used | NET BOOK VALUE | ValuationMethodUsedDesc |
| Non Cash Assistance | BUILDINGS AND TAX EXEMPT BONDS | NonCashAssistanceDesc |
| Purpose Of Grant | THE HOSPITAL TRANSFERRED THE HOSPITAL FACILITY AND TAX EXEMPT BONDS TO THE CITY OF ARLINGTON, MN UNDER THE TERMS OF A LEASE AGREEMENT WITH THE CITY. | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE TRANSFER OF NET ASSETS TO THE CITY WAS A RESULT OF A LEASE AGREEMENT BETWEEN THE HOSPITAL AND THE CITY. THE ONGOING RELATIONSHIP BETWEEN THE PARTIES WILL SERVE AS THE PROCEDURES TO MONITOR THE USE OF THE ASSETS. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TODD SANDBERG | PersonNm |
| Title | RSMC ADMINISTRATOR | TitleTxt |
| Base Compensation Filing Org | $0 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $164,568 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $29,530 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $542 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $7,717 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $0 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $21,699 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $0 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $224,056 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $224,056 | CompReportPrior990RltdOrgsAmt |
Schedule M IRS990ScheduleM
Securities Publicly Traded SecuritiesPubliclyTradedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $1,695,019 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Secur Prtnrshp Trust Intrsts SecurPrtnrshpTrustIntrstsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $272,939 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Real Estate Other RealEstateOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $6,787,706 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Drugs And Medical Supplies DrugsAndMedicalSuppliesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $278,366 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
Other Non Cash Contri Table OtherNonCashContriTableGrp (3 entries)
| Non Cash CheckboxNonCashCheckboxInd | DescDesc | ContributionContributionCnt | Noncash Contributions Rpt F990NoncashContributionsRptF990Amt | Method Of Determining RevenuesMethodOfDeterminingRevenuesTxt |
|---|---|---|---|---|
| Yes (X) | ACCOUNTS/NOTES RECEIVABLE | 1 | $2,110,601 | FMV |
| Yes (X) | PREPAID EXPENSES/OTHER ASSETS | 1 | $120,362 | FMV |
| Yes (X) | LIABILITIES | 1 | -$4,666,580 | FMV |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 2 | EFFECTIVE JANUARY 1, 2014, THE CITY OF ARLINGTON, MINNESOTA (CITY), WHO PREVIOUSLY OWNED AND CONTROLLED THE OPERATIONS OF SIBLEY MEDICAL CENTER, ENTERED INTO A HOSPITAL OPERATING LEASE AGREEMENT WITH RIDGEVIEW MEDICAL CENTER (RMC) AND AS OF THE EFFECTIVE DATE, RMC BECAME THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, WHICH NOW OPERATES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. UNDER THE TERMS OF THE LEASE AGREEMENT, THE CITY TRANSFERRED ALL ASSETS AND LIABILITIES, EXCEPT THE MAJORITY OF THE CAPITAL ASSETS (FACILITY) AND THE SERIES 2010B BONDS, TO THE ORGANIZATION. AS OF THE EFFECTIVE DATE, ALL EMPLOYEES OF THE SIBLEY MEDICAL CENTER (PREVIOUSLY OWNED BY THE CITY) BECAME EMPLOYEES OF RMC OR ITS AFFILIATES. ON THE EFFECTIVE DATE, THE ORGANIZATION ENTERED INTO A MANAGEMENT SERVICES AGREEMENT WITH RMC. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION HAS A MANAGEMENT SERVICE AGREEMENT WITH RIDGEVIEW MEDICAL CENTER TO PROVIDE PHYSICIAN, ADMINISTRATIVE, INFORMATION TECHNOLOGY, HUMAN RESOURCES, LAUNDRY, DIETICIAN AND OTHER SERVICES. THE ORGANZATION PURCHASED APPROXIMATELY $7,564,000 IN SERVICES FROM RIDGEVIEW FOR THE YEAR ENDED DECEMBER 31, 2014. |
| FORM 990, PART VI, SECTION A, LINE 4 | SIGNIFICANT CHANGES MADE TO SIBLEY MEDICAL CENTER'S GOVERNING DOCUMENTS ARE AS FOLLOWS: 1. NAME CHANGE FROM SIBLEY MEDICAL CENTER FOUNDATION TO SIBLEY MEDICAL CENTER. THE IRS WAS ALREADY NOTIFIED OF THIS CHANGE SO THERE WASN'T A NEED TO CHECK THE BOX ON PAGE 1 OF THE RETURN. 2. SMC'S PURPOSE AND MISSION. 3. RIDGEVIEW MEDICAL CENTER SHALL BE THE SOLE MEMBER OF SIBLEY MEDICAL CENTER, AS SUCH THEY HAVE CERTAIN RIGHTS IDENTIFIED IN THE GOVERNING DOCUMENTS. 4. THE NUMBER OF, ELECTION OF, AND TERMS OF SMC'S BOARD OF DIRECTORS ALL CHANGED. 5. THE AUTHORITY TO AMEND THE GOVERNING DOCUMENTS. |
| FORM 990, PART VI, SECTION A, LINE 6 | RIDGEVIEW MEDICAL CENTER SHALL BE THE SOLE MEMBER OF THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | AT ALL TIMES THERE WILL ALWAYS BE A DIRECTOR WHO IS APPOINTED BY THE MEMBER AND WHO SITS ON THE BOARD OF DIRECTORS OF THE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BOARD OF DIRECTORS WILL CARRY OUT THE DUTIES NORMALLY ASSOCIATED WITH A NONPROFIT HOSPITAL BOARD OF DIRECTORS, SUBJECT TO THE RESERVED POWERS OF THE MEMBER AND THE CITY BELOW. THE MEMBER RESERVED AUTHORITY WITH REGARD TO THE MATTERS LISTED BELOW, SUBJECT TO THE RESERVED POWERS OF THE CITY INCLUDED THEREAFTER. THE MEMBER WILL LOOK TO THE BOARD TO MAKE RECOMMENDATIONS ON DECISIONS ON MATTERS LISTED BELOW, BUT THE MEMBER IS NOT REQUIRED TO ACCEPT SUCH RECOMMENDATIONS, AND THE MEMBER MAY TAKE ACTION ON ITS OWN IN SUCH AREAS, SUBJECT TO THE CITY'S RESERVED POWERS. THE MEMBER'S APPROVAL WILL BE REQUIRED FOR ANY ACTION PROPOSED BY THE BOARD IN THESE AREAS: (I) FINAL APPOINTMENT OF BOARD MEMBERS (II) ISSUANCE OF DEBT BY THE CORPORATION (III) SALE OF SUBSTANTIAL ASSETS OF THE CORPORATION (IV) CHANGES IN THE CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS (V) ESTABLISHMENT OF ANOTHER MEMBER RELATIONSHIP BY THE CORPORATION OR ANOTHER FORM OF AFFILIATION (VI) STRATEGIC PLAN FOR THE CORPORATION (VII) OPERATING AND CAPITAL BUDGETS OF THE CORPORATION (VIII) UNBUDGETED TOTAL ANNUAL CAPITAL EXPENDITURES (IX) AUDIT AND COMPLIANCE PROGRAMS (X) ACCREDITATION PROGRAMS (XI) GROUP EMPLOYEE BENEFITS (XII) MANAGING THE CORPORATION'S CASH AND INVESTMENTS (THE MEMBER MAY MOVE FUNDS BETWEEN THE ORGANIZATIONS FREELY, SUBJECT TO BOND COVENANT OR TRUSTEE REQUIREMENTS) (XIII) THIRD PARTY PAYER CONTRACTING (XIV) INSURANCE (XV) INFORMATION SYSTEM DESIGN AND IMPLEMENTATION (XVI) GROUP PURCHASING THE CITY'S APPROVAL WILL BE REQUIRED FOR THE DECISIONS OF THE BOARD IN THE FOLLOWING AREAS: (I) SALE OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS (II) SALE OF ASSETS ABOVE THRESHOLDS ALLOWED BY BOND COVENANTS (III) ISSUANCE OF DEBT WHICH WOULD OBLIGATE THE CORPORATION IN EXCESS OF LEVELS ALLOWED BY BOND COVENANTS (IV) CHANGES TO THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS |
| FORM 990, PART VI, SECTION B, LINE 11 | THE MANAGEMENT TEAM REVIEWS THE FORM 990 IN DETAIL. ONCE APPROVED A COPY OF THE FORM 990 IS THEN PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL PRIOR TO FILING WIT THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE STATEMENTS FOR POTENTIAL CONFLICTS OF INTEREST POLICY. EACH MEMBER IS EXPECTED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THE SITUATION WILL BE EXAMINED AND HANDLED APPROPRIATELY BY THE BOARD. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 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 | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| RIDGEVIEW FOUNDATION | |||||||||||
| 500 SOUTH MAPLE STREET | WACONIA | MN | 55387 | 411328097 | RAISING FUNDS FOR RIDGEVIEW MEDICAL CENTER | MN | 501(3)(C) | LINE 7 | RIDGEVIEW MEDICAL CENTER | 0 | |
| RIDGEVIEW MEDICAL CENTER | |||||||||||
| 500 SOUTH MAPLE STREET | WACONIA | MN | 55387 | 311667875 | HEALTH CARE SERVICES | MN | 501(3)(C) | LINE 3 | 0 | N/A | |
| RIDGEVIEW INSURANCE COMPANY | |||||||||||
| 60 E SOUTH TEMPLE STE 1800 | SALT LAKE CITY | UT | 84111 | 454109041 | CAPTIVE INSURANCE COMPANY | UT | 501(3)(C) | LINE 11A, I | RIDGEVIEW MEDICAL CENTER | 0 | |
| RIDGEVIEW CLINICS | |||||||||||
| 500 SOUTH MAPLE STREET | WACONIA | MN | 55387 | 411651783 | HEALTH CARE SERVICES | MN | 501(3)(C) | LINE 3 | RIDGEVIEW MEDICAL CENTER | 0 | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|
| MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER LLC | |||||||
| 500 SOUTH MAPLE STREET | WACONIA | MN | 55387 | 205785920 | CARDIOLOGY SERVICES | MN | N/A |
| CHASKA PLAZA SURGERY CENTER | |||||||
| 3000 HUNDERTMARK ROAD | CHASKA | MN | 55318 | 450975783 | SURGERY SERVICES | MN | N/A |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| EXECUTIVE HEALTH MANAGEMENT SERVICES INC | |||||||||
| 500 SOUTH MAPLE STREET | WACONIA | MN | 55387 | 411760239 | MANAGEMENT SERVICES | MN | N/A | C | 0 |
| CHARITABLE REMAINDER UNITRUST (1) | |||||||||
| CHARITABLE TRUST | MN | N/A | T | 0 | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | Yes (1) | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |