2013-05-15T08:18:41-05:00 2012-06-30 861065772 Deloitte Tax LLP 50 South Sixth Street Suite 2800 Minneapolis MN 55402 990 2011-07-01 411389317 SANFORD HEALTH FOUNDATION OF NORTHERN MINNESOTA SANF 2187515430 1300 ANNE ST NW BEMIDJI MN 566015103 JoAnn Kunkel 6053331000 2013-05-15 1 Kristina Rasmussen P00143920 6123974000 2011 2016-02-25 16:41:14Z Kelby Krabbenhoft 1305 West 18th Street Sioux Falls SD 57117 590628 0 X N/A X 1977 MN Dedicated to the work of health and healing. 16 7 0 90 0 0 326965 535273 1449 0 34330 53615 0 350 362744 589238 45000 39000 0 0 0 0 0 0 412202 355738 492537 400738 531537 -37994 57701 7678893 7859677 499537 616351 7179356 7243326 "Dedicated to the Work of Health and Healing." Sanford Health System is committed to the healthcare needs of communities throughout South Dakota, North Dakota, Minnesota and Iowa. Sanford provides a full range of Primary and specialty health care services. 0 0 39000 39000 350 The primary activites of Sanford Health Foundation of Northern Minnesota includes fundraising, investment of funds and support for the activities of Sanford Health of Northern Minnesota, a Minnesota non profit corporation that operates a 118 bed medical center, 78 bed long-term care facility, home care and hospice agency and senior housing. Funds raised support major capital projects of the medical center and long-term care facility as well as community healthcare and wellness related projects. 39000 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 16 7 1 0 0 0 1 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 0 MN X JoAnn Kunkel 6053331000 1305 West 18th Street Sioux Falls SD 57117 X Barb Everist 0.50 X 0 0 0 Barbara Stork 0.50 X 0 0 0 Barry Martin 0.50 X 0 0 0 Brent Teiken 0.50 X 0 0 0 David Beito 0.50 X 0 0 0 Don Morton 0.50 X 0 0 0 Jerome Feder 0.50 X 0 0 0 Jim Entenman 0.50 X 0 0 0 John C Vanderwoude 60.00 X 0 1183385 28640 John Jambois 0.50 X 0 0 0 Lauris Molbert 0.50 X 0 0 0 Mark Paulson MD 60.00 X 0 268151 30760 Michael L Olson 60.00 X 0 572221 6711 Michael L Olson Deferred Comp 60.00 X 0 0 49282 Mikal Claar 0.50 X 0 0 0 Pamela Anderson 0.50 X 0 0 0 Richard D Hardie 60.00 X 0 566503 24244 Ronald Moquist 0.50 X 0 0 0 Terrence Grimm MD thru Feb12 60.00 X 0 557673 26124 Terry Baloun 0.50 X 0 0 0 Thomas Hruby 0.50 X 0 0 0 Kelby K Krabbenhoft 60.00 X X 0 1484297 21738 Kelby K Krabbenhoft Deferred Comp 60.00 X X 0 0 565035 Lisa Carlson 60.00 X 0 717737 31290 Paul Hanson 60.00 X 0 566527 66386 Craig Boyer 60.00 X 0 272252 30117 0 6188746 880327 0 0 1 0 0 535273 535273 53485 53485 1520 1390 130 130 130 Miscellaneous Revenue 900099 350 350 350 589238 350 0 53615 35000 35000 4000 4000 775 775 34275 34275 32098 32098 302282 45342 256940 278 278 650 650 6947 6947 Management Services 114059 34218 79841 Membership & Dues 1173 1173 531537 39000 80335 412202 5094361 414119 66986 84664 584921 506596 1932007 6853775 618 523 7678893 7859677 2603 4525 496934 611826 499537 616351 X 5580118 5429684 1324028 1538432 275210 275210 7179356 7243326 7678893 7859677 X 57701 6269 X 0 1 1 X 0 X X X 0 0 0 Sanford Health of Northern MN 411266009 Hospital 1 1 1 531537 1 531537 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 275210 3144 3144 275210 275210 3066 3066 275210 275210 5394 5308 86 275210 275210 7146 6998 148 275210 0.00000 1.00000 0.00000 0 0 0 Intercompany Payable 611826 611826 Description of Uncertain Tax Positions Under FIN 48: Part X: 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. Sanford Health of Northern Minnesota did not have a material income tax liability at June 30, 2012; some related organizations have established reserves. Part V: The Breen trust endowment funds are permanently restricted. The Foundation board annually designates the interest earnings for specific current foundation projects. 1 Beltrami Area Service Collabrative 701 Minnesota Ave NW Ste 235 Bemidji MN 56601 411941453 501(c)(3) 10000 Grant to fund general operations. Bemidji Area Boy's and Girl's Club PO Box 191 Bemidji MN 56601 810599601 501(c)(3) 5000 Grant to fund general operations. Lutheran Social Services PO Box 1886 Bemidji MN 56601 410872993 501(c)(3) 5000 Grant to fund general operations. Northwoods Coalition PO Box 563 Bemidji MN 56601 411333404 501(c)(3) 15000 Grant to fund general operations. 4 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Sanford Health Foundation of Northern Minnesota provides grants to community service groups for general operations. Justification for need is required at the time of the request for funds and the organization does not require reporting as to how the funds were used. 0 1 0 0 0 0 1 0 0 John C Vanderwoude 0 1000000 0 0 0 183385 0 4900 0 23740 0 1212025 0 0 Mark Paulson MD 0 236419 0 0 0 31732 0 12250 0 18510 0 298911 0 0 Michael L Olson 0 563933 0 0 0 8288 0 0 0 6711 0 578932 0 0 Michael L Olson Deferred Comp 0 0 0 0 0 0 0 49282 0 0 0 49282 0 0 Richard D Hardie 0 562511 0 0 0 3992 0 7350 0 16894 0 590747 0 0 Terrence Grimm MD thru Feb12 0 500004 0 0 0 57669 0 12250 0 13874 0 583797 0 0 Kelby K Krabbenhoft 0 913461 0 0 0 570836 0 0 0 21738 0 1506035 0 0 Kelby K Krabbenhoft Deferred Comp 0 0 0 0 0 0 0 565035 0 0 0 565035 0 0 Lisa Carlson 0 500321 0 0 0 217416 0 12250 0 19040 0 749027 0 0 Paul Hanson 0 374881 0 0 0 191646 0 57603 0 8783 0 632913 0 0 Craig Boyer 0 190183 0 0 0 82069 0 23978 0 6139 0 302369 0 0 Part I, Line 3 The Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm to annually review the total compensation arrangements of the officers of the organizations, and to report findings and recommendations to the Sanford Board of Trustees for deliberation and action. The most recent study was completed in 2012. Part I, Line 4b Schedule J, Part II, Column C: Employer contributions to pension plans, amounts representing increases and decreases in actuarial value (actuarial value factors include age, tenure and salary) of defined benefit SERP Plans are included in Column C. Participants and changes in values include: Kelby Krabbenhoft $418,302 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 revenues less expenses. Physicians listed that were paid on this model include: Michael Olson, Richard Hardie. Supplemental Information Part III Compensation reported on Schedule J includes: (B)(i) Base compensation - salaries are based on the experience and performance of each executive and bench-marked using independent compensation survey information. (B)(ii) Bonus & incentive compensation - as part of executive compensation, individuals may be eligible for incentive performance compensation, however if the organization does not meet its financial targets, incentive payments are not paid, regardless of performance. (B)(iii) Other reportable compensation - generally includes taxable executive benefits. (C) Deferred compensation includes employer contributions to pension plans and the increase (or decrease) in the actuarial value (actuarial value factors include age, tenure and salary) of the defined benefit plans. (D) Nontaxable benefits generally include health insurance premiums. A memo regarding executive compensation, written by the Chairman of the Sanford Board of Trustees, is on file and available upon request. Compensation paid to trustees is for full-time professional responsibilities as physicians, administrators or employees of the organization. The total compensation paid to Kelby Krabbenhoft of $1,484,297 is comprised of Base salary of $913,461, and Other Taxable Earnings of $570,836. In addition, an amount of $565,035 has been reported for the estimated amount of ratable increase in value of the defined benefit pension plan, defined benefit SERP and a Gift Agreement Management Continuity Retention plan. Form 990, Part VI, Section A, line 2 Lisa Carlson and Pamela Anderson have a business relationship. 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 than span the organization as a whole: John Vanderwoude, Mark Paulson, Michael Olson, Richard Hardie, Terrence Grimm, Kelby Krabbenhoft, Lisa Carlson, Paul Hanson and Craig Boyer. Form 990, Part VI, Section A, line 6 Sanford is governed by a Board of Trustees (BOT) that has ultimate strategic and decision making authority. The BOT delegates certain activities and responsibilities to Boards of each of Sanford's subsidiaries. The unique nature and complexity of the subsidiaries requires each to have a delegated Board with a singular entity focus. Such bodies, referred to as Boards of Directors and Boards of Governors, address matters such as credentialing, accreditation standards, developing budgets, programs and facilities on an entity-specific basis, and generally consist of individuals distinct from the BOT. These Boards function much like committees in a traditional corporate structure. The BOT then acts as a holding company Board, synthesizing and reconciling each entity's programs and budgets into a system-wide strategic plan. This structure of governance produces a significant number of trustees, governors and directors, creating a 400+ person collective which acts as a team of ambassadors for Sanford in their respective communities. Form 990, Part VI, Section A, line 7a The Sanford Board of Trustees appoints the board members for the Board of Directors of Sanford Health Foundation of Northern Minnesota. Form 990, Part VI, Section A, line 7b The Sanford Board of Trustees approves the actions approved by the Board of Directors of Sanford Health Foundation of Northern Minnesota. Form 990, Part VI, Section B, line 10b The corporation shall not, without the prior approval of the Member, (a) enter into any fund-raising project, (b) borrow any money, whether secured or unsercured, (c) enter into any contract providing for the sale, assignment, transfer, lease, or other disposition of any real estate or interest therein having a value of more than $50,000, or any other property or interest therein which involves, in the aggregate, more than $25,000 payable or receivable by the corporation and which is not cancelable by the corporation on notice of thirty(30)days or less without penalty, (d) make contributions or dispositions of propery(i)to any entity outside of SHNM and its controlled entities or (ii)in excess of $50,000 per individual contribution or disposition or $250,000 in the aggregate during any fiscal year of the corporation, (e) take any action violative of the restrictions set forth in its Restated Articles of Incorporation and any subsequent amendments thereto (f) raise funds by means of charitable gambling, although it may receive funds from outside entities which so raise funds so long as such funds are not raised in the name of this corporation, Sanford Health of Northern Minnesota or its controlled entities, or (g) take any action in contradiction with any express restrictions adopted by the Member. Form 990, Part VI, Section B, line 11 The Form 990 is prepared internally by the finance department and reviewed by executive management. An external accounting firm reviews the return prior to filing and prepares return highlights and key disclosures for the Audit Committe prior to the return filing date. Before the return is filed, a complete copy is made available 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 of 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 managment employees and can invoke the recusal process on a case-by-case basis when potentail 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 such. Form 990, Part VI, Section B, line 15 The Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm to annually review the total compensation arrangements of the officers and operating unit executives of the organization, including the CEO, and to report the findings and recommendations 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 2012. Additionally, Sanford periodically engages an independent compensation consultant to review and issue a report regarding the reasonableness of the total compensation arrangements of all physicians employed by the organization. The most recent study of Physician total compensation arragements was completed in 2009. Form 990, Part VI, Section C, line 19 Although the orgaization 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 the documents. Form 990, Part VII Sanford Trustees provide services to Sanford and its subsidiaries. Hours reported for each individual reflect the time spent on work related to either the filing organization or a related organization. Sanford Board of Trustees has ultimate governance responsibilities for each entity with the Sanford system. In addition, a Board of Directors is established for each entity, which has specific delegated responsibilities from the Board of Trustees related to the oversight of day to day operations of that entity. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -16,686. Prior period adjustments: -262. Net Asset Transfer to Sanford Health of Northern MN 23,217. Total to Form 990, Part XI, Line 5: 6,269. Sanford Health 1305 West 18th Street Sioux Falls SD 57117 311527032 Supporting Organization SD 501(c)(3) 11-II Sanford 1 Sanford Health Foundation 1305 West 18th Street Sioux Falls SD 57117 363297853 Supporting Organization SD 501(c)(3) 11-II Sanford Health 1 Sanford 801 Broadway Drive Fargo ND 58122 271218956 Supporting Organization ND 501(c)(3) 11-II 0 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 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 Medical Center Wheaton 401 12th Street North Wheaton MN 56296 272042143 Hospital/Clinic MN 501(c)(3) 3 Sanford North 1 Sanford Health Foundation North PO Box 2010 Fargo ND 58122 450398104 Fundraising ND 501(c)(3) 7 Sanford 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 North 1 Sanford Medical Center Mayville 42 6th Ave SE Mayville ND 58257 450228899 Hospital ND 501(c)(3) 3 Sanford North 1 MeritCare Minnesota 1720 South Highway 59 Thief River Falls MN 56701 261530302 Promotion of health MN 501(c)(3) 3 Sanford North 1 Agassiz Assurance Company 100 Bank Street Suite 610 Burlington VT 05401 743121855 Insurance VT 501(c)(3) 11-II Sanford North 1 MeritCare Health Enterprises Inc PO Box 2010 Fargo ND 58122 450359785 Prescription drugs ND 501(c)(4) Sanford North 1 FM Ambulance Service Inc 2215 18th St South Fargo ND 58103 450344371 EMT ND 501(c)(4) Sanford North 1 Sanford Health of Northern Minnesota 1300 Anne St NW Bemidji MN 56601 411266009 Hospital MN 501(c)(3) 3 Sanford North 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 North Country Medical Clinic 1300 Anne St NW Bemidji MN 56601 411753855 Family Practice Medical Clinic MN 501(c)(3) 3 Sanford Health of Northern Minnesota 1 Sanford ResearchUSD 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460450378 Research SD 501(c)(3) 3 Sanford Health 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 Clinic 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460447693 Clinical Services SD 501(c)(3) 3 Sanford Health 1 Sanford Health Network 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 460388596 Hospitals/Clinics SD 501(c)(3) 11-II 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 MeritCare Health Enterprises Inc 201 Fifth Street North 14 Floor Fargo ND 58102 453788040 Prescription drugs PA 501(c)(4) Sanford North 1 Edith Sanford Breast Cancer Foundation 2301 E 60th Street N Sioux Falls SD 57104 450404126 Foundation ND 501(c)(3) 11-II Sanford Health 1 Sanford World Clinics 1305 West 18th Street Sioux Falls SD 57117 262707628 Healthcare SD 501(c)(3) 3 Sanford Health 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 Sanford Health Plan 300 Cherapa Place Sioux Falls SD 57103 911842494 Insurance SD N/A C Sanford Health Plan of MN 300 Cherapa Place Sioux Falls SD 57103 460445852 Insurance MN N/A C Bemidji Medical Equipment Inc 1300 Anne St NW Bemidji MN 56601 411551725 Retail Sales of DME MN N/A C North Country Management Inc 1300 Anne St NW Bemidji MN 56601 411820025 Management Services MN N/A C Sanford Frontiers 1305 W 18th St PO Box 5039 Sioux Falls SD 571175039 455436599 Weight Loss Management SD N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0