STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

F-M AMBULANCE SERVICE INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
F-M AMBULANCE SERVICE INC (EIN 45-0344371)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-15
IRS object ID
201321359349300802
Schema version
2011v1.2
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-05-15T08:09:22-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN861065772EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line150 South Sixth Street Suite 2800AddressLine1
CityMinneapolisCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN450344371EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1F-M Ambulance Service IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlF-MANameControl
Phone7012342000Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12215 18th Street SouthAddressLine1
CityFargoCity
StateNDState
ZIP Code58103ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJoAnn KunkelName
TitleChief Financial OfficerTitle
Phone6053331000Phone
Date Signed2013-05-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKristina RasmussenName
PTINP00143920PTIN
Phone6123974000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKelby K KrabbenhoftNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11305 W 18th StAddressLine1
CitySioux FallsCity
StateSDState
ZIP Code57117ZIPCode
FieldValueIRS element (for citing)
Gross Receipts11967696GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.FMAmbulance.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1978YearFormation
State Legal DomicileNDStateLegalDomicile
Activity Or Mission DescriptionDedicated to the work of health and healingActivityOrMissionDescription
Nbr Voting Members Governing Body16NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees164TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year103085ContributionsGrantsPriorYear
Contributions Grants Current Year15300ContributionsGrantsCurrentYear
Program Service Revenue Prior Year11257992ProgramServiceRevenuePriorYear
Program Service Revenue CY11847776ProgramServiceRevenueCY
Investment Income Prior Year20202InvestmentIncomePriorYear
Investment Income Current Year21109InvestmentIncomeCurrentYear
Other Revenue Prior Year122544OtherRevenuePriorYear
Other Revenue Current Year37880OtherRevenueCurrentYear
Total Revenue Prior Year11503823TotalRevenuePriorYear
Total Revenue Current Year11922065TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year50GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year5332996SalariesEtcPriorYear
Salaries Etc Current Year5173641SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4194174OtherExpensePriorYear
Other Expenses Current Year4618426OtherExpensesCurrentYear
Total Expenses Prior Year9527220TotalExpensesPriorYear
Total Expenses Current Year9792067TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1976603RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2129998RevenuesLessExpensesCY
Total Assets BOY6188786TotalAssetsBOY
Total Assets EOY7048918TotalAssetsEOY
Total Liabilities BOY1081031TotalLiabilitiesBOY
Total Liabilities EOY945834TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY5107755NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY6103084NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionThe 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense8377880Expense
Grants0Grants
Revenue11847776Revenue
DescriptionAs 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.Description
Total Program Service Expense8377880TotalProgramServiceExpense
Described In501 C30DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees164NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions1NonDeductibleContributions
Non Deductible Disclosure1NonDeductibleDisclosure
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members16NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1JoAnn Kunkel CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6053331000TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11305 West 18th StreetAddressLine1
CitySioux FallsCity
StateSDState
ZIP Code57117ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (29 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
Barb Everist
Trustee0.50X000
Barbara Stork
Trustee0.50X000
Barry Martin
Trustee0.50X000
Brent Teiken
Trustee0.50X000
David Beito
Trustee0.50X000
Don Morton
Trustee0.50X000
Jerome Feder
Trustee0.50X000
Jim Entenman
Trustee0.50X000
John C Vanderwoude
Trustee60.00X0118338528640
John Jambois
Trustee0.50X000
Lauris Molbert
Trustee0.50X000
Mark Paulson MD
Trustee60.00X026815130760
Michael L Olson
Trustee60.00X05722216711
Michael L Olson Deferred Comp
Trustee60.00X0049282
Mikal Claar
Trustee0.50X000
Pamela Anderson
Trustee0.50X000
Richard D Hardie
Trustee60.00X056650324244
Ronald Moquist
Trustee0.50X000
Terrence Grimm MD thru Feb12
Trustee60.00X055767326124
Terry Baloun
Trustee0.50X000
Thomas Hruby
Trustee0.50X000
Kelby K Krabbenhoft
Sanford Health President & CEO60.00X0148429721738X
Kelby K Krabbenhoft Deferred Comp
Sanford Health President & CEO60.00X00565035X
Lisa Carlson
Chief Financial Officer Corp60.00071773731290X
Dennis Millirons
President - Medical Center Fargo60.00066605126514X
Tiffany Lawrence
CFO - Sanford Medical Center Fargo60.00027146328534X
Linda O'Halloran
COO - Sanford Medical Center Fargo60.00043515019026X
Dean Lampe
Executive Director - FM Ambulance60.00117512085X
Roger Gilbertson MD
Former President60.0005019870X
FieldValueIRS element (for citing)
Total Reportable Comp From Org117512TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs7224618TotalReportableCompFrmRltdOrgs
Total Other Compensation857983TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K
Government Grants14600GovernmentGrants
All Other Contributions700AllOtherContributions
Total Contributions15300TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Emergency Medical Serv6219101094511610945116
Education900099708527708527
Special Transportation621910194133194133
FieldValueIRS element (for citing)
Total Program Service Revenue11847776TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column164TotalRevenueColumn
Exclusion$164ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real12780Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real12780Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column12780TotalRevenueColumn
Exclusion$12,780ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other21000Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other55Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other20945Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column20945TotalRevenueColumn
Exclusion$20,945ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory70676GrossSalesOfInventory
Cost Of Goods Sold45576CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column25100TotalRevenueColumn
Exclusion$25,100ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11922065TotalRevenueColumn
Related Or Exempt Function Income11847776RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$58,989ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total55529Total
Management And General55529ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4064935Total
Program Services3724444ProgramServices
Management And General340491ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total190680Total
Program Services165354ProgramServices
Management And General25326ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total495493Total
Program Services422228ProgramServices
Management And General73265ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total367004Total
Program Services283006ProgramServices
Management And General83998ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total26227Total
Management And General26227ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total48499Total
Program Services25875ProgramServices
Management And General22624ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total20608Total
Program Services13735ProgramServices
Management And General6873ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total246388Total
Program Services123922ProgramServices
Management And General122466ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total94936Total
Program Services49035ProgramServices
Management And General45901ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total160838Total
Program Services86999ProgramServices
Management And General73839ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total361243Total
Program Services347766ProgramServices
Management And General13477ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total55583Total
Program Services54946ProgramServices
Management And General637ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total19140Total
Program Services17727ProgramServices
Management And General1413ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total553614Total
Program Services436290ProgramServices
Management And General117324ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total201605Total
Program Services733ProgramServices
Management And General200872ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Bad Debt231957223178991673
Medical Supplies2235702215482022
Intercompany Purchased20071128263172448
Miscellaneous Expense858925811027782

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total9792067Total
Program Services8377880ProgramServices
Management And General1414187ManagementAndGeneral
Fundraising0Fundraising

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1248808BOY
EOY1805998EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY71764BOY
EOY51392EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY46202BOY
EOY28958EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis8066153LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec4296665LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY3428930BOY
EOY3769488EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY1393082BOY
EOY1393082EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6188786BOY
EOY7048918EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY583839BOY
EOY579367EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY21813BOY
EOY44887EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY475379BOY
EOY321580EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY1081031BOY
EOY945834EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY5107755BOY
EOY6103084EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5107755BOY
EOY6103084EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6188786BOY
EOY7048918EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses2129998ReconcilationRevenueExpenses
Reconcilation Other Changes-1134669ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis481239OtherCostOrOtherBasis
Book Value481239BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2762068OtherCostOrOtherBasis
Depreciation893836Depreciation
Book Value1868232BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis135053OtherCostOrOtherBasis
Depreciation55528Depreciation
Book Value79525BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis2213043OtherCostOrOtherBasis
Depreciation1783582Depreciation
Book Value429461BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2474750OtherCostOrOtherBasis
Depreciation1563719Depreciation
Book Value911031BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings3769488TotalOfBookValueLandBuildings

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDescription of Uncertain Tax Positions Under FIN 48:Identifier
Return ReferencePart X:ReturnReference
ExplanationCertain 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, 2012; some related organizations have established reserves.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (13 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
John C Vanderwoude
01000000000183385049000237400121202500
Mark Paulson MD
023641900031732012250018510029891100
Michael L Olson
056393300082880006711057893200
Michael L Olson Deferred Comp
0000000492820004928200
Richard D Hardie
0562511000399207350016894059074700
Terrence Grimm MD thru Feb12
050000400057669012250013874058379700
Kelby K Krabbenhoft
0913461000570836000217380150603500
Kelby K Krabbenhoft Deferred Comp
000000056503500056503500
Lisa Carlson
0500321000217416012250019040074902700
Dennis Millirons
0465027000201024012250014264069256500
Tiffany Lawrence
025089000020573012145016390029999800
Linda O'Halloran
03874870004766301225006776045417600
Roger Gilbertson MD
050198700000000050198700

Form990 Schedule J Part III Form990ScheduleJPartIII (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 1aOn Part I, Questions Regarding Compensation, Sanford checked several of the items as provided to listed persons: First Class or Charter Travel - Charter travel for business purposes is provided for individuals as needed and as cost appropriate. These costs are not included in the W-2's of the individuals as they are incurred for business purposes of Sanford. Travel for Companions - Limited travel for companions is required for certain annual meetings. These costs are not included in the W-2's of the individuals as they are incurred for business purposes of Sanford. Tax Indemnification and gross-up payments - Certain compensation may be grossed up to include appropriate tax amounts. Health or social club dues or initiation fees - All Sanford employees are eligible for discounted wellness memberships, a portion of these discounts and other club dues are included as fringe benefits, and taxed as such. Personal services - Individuals may have benefits which include tax preparation or planning, this benefit is included in income and taxed. Part I, Line 3: The Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm to annually review the total compensation of arrangements of the officers of the organization, 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, Lines 4a-bPart I, Lines 4a-b: Roger Gilbertson, former MeritCare President and CEO, received a payment of $501,987 upon his retirement, per employment contract. Part I, Line 4b/Schedule J, Part II, Column C: In addition to employer contributions to pension plans, amounts representing increases and decreases in actuarial value (actuarial value factors include age, tenure and salary) of defined contribution and defined benefit SERP Plans are included in Column C. Participants and changes in values include: Kelby Krabbenhoft $418,302
Part I, Line 6Sanford 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 L Olson Richard Hardie
Part IIICompensation reported on Schedule J, Part II 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 make 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 benefit plans. (D) Nontaxable Benefits generally includes health insurance premiums.Supplemental Information
Part IIIA memo regarding executive compensation, written by the Chairman of the Sanford Board of Trustees, is on file and available upon request.Supplemental Information
Part IIICompensation 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.Supplemental Information

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 2Pamela Anderson, Trustee, and Lisa Carlson, CFO, 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 that span the organization as a whole: John Vanderwoude Mark Paulson Michael Olson Richard Hardie Terrence Grimm Kelby Krabbenhoft Lisa Carlson Tiffany Lawrence Dennis Millirons Linda O'Halloran
Form 990, Part VI, Section A, line 6Sanford North is the sole stockholder of F-M Ambulance.
Form 990, Part VI, Section A, line 7aBoard members are appointed by the President and CEO of Sanford North.
Form 990, Part VI, Section A, line 7bSanford 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 deafult 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 transger assets and/or funds to the health system to satisfy obligations of the health system.
Form 990, Part VI, Section B, line 11The 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 Committee 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 12cThe 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 when 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 such.
Form 990, Part VI, Section B, line 15The 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 arrangements was completed in 2009.
Form 990, Part VI, Section C, line 19Although 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 VIISanford 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 within 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.
Form 990, Part XI, line 5:Net Asset Transfers (AP Intercompany) -1,134,669. Total to Form 990, Part XI, Line 5: -1,134,669.Changes in Net Assets or Fund Balances:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (26 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Sanford Health
1305 West 18th StreetSioux FallsSD57117311527032Supporting OrganizationSD501(c)(3)11-IISanford1
Sanford Health Foundation
1305 West 18th StreetSioux FallsSD57117363297853Supporting OrganizationSD501(c)(3)11-IISanford Health1
Sanford
801 Broadway DriveFargoND58122271218956Supporting OrganizationND501(c)(3)11-II0
Sanford North
PO Box 2010FargoND58122450385890Supporting OrganizationND501(c)(3)11-IISanford1
Sanford Medical Center Fargo
PO Box 2010FargoND58122450226909HospitalND501(c)(3)3Sanford North1
Sanford Clinic North
PO Box 2010FargoND58122911770748ClinicsND501(c)(3)9Sanford North1
Sanford Health Network North
PO Box 2010FargoND58122450409348Hospitals/ClinicsND501(c)(3)11-IISanford North1
Sanford Medical Center Wheaton
401 12th Street NorthWheatonMN56296272042143Hospital/ClinicMN501(c)(3)3Sanford North1
Sanford Health Foundation North
PO Box 2010FargoND58122450398104FundraisingND501(c)(3)7Sanford North1
Sanford Medical Center Thief River Falls
120 Labree Ave SThief River FallsMN56701410709579HospitalMN501(c)(3)3Sanford North1
Sanford Medical Center Mayville
42 6th Ave SEMayvilleND58257450228899HospitalND501(c)(3)3Sanford North1
MeritCare Minnesota
1720 South Highway 59Thief River FallsMN56701261530302Promotion of healthMN501(c)(3)3Sanford North1
Agassiz Assurance Company
100 Bank Street Suite 610BurlingtonVT05401743121855InsuranceVT501(c)(3)11-IISanford North1
MeritCare Health Enterprises Inc
PO Box 2010FargoND58122450359785Prescription drugsND501(c)(4)Sanford North1
Sanford Health of Northern Minnesota
1300 Anne St NWBemidjiMN56601411266009HospitalMN501(c)(3)3Sanford North1
Baker Park Inc
803 Dewey Ave NWBemidjiMN56601411372480Low Income Senior HousingMN501(c)(3)9Sanford Health of Northern Minnesota1
Sanford Health Foundation of Northern Minnesota
1300 Anne St NWBemidjiMN56601411389317Fundraising - SupportMN501(c)(3)11-IISanford Health of Northern Minnesota1
North Country Medical Clinic
1300 Anne St NWBemidjiMN56601411753855Family Practice Medical ClinicMN501(c)(3)3Sanford Health of Northern Minnesota1
Sanford ResearchUSD
1305 West 18th Street PO Box 5039Sioux FallsSD571175039460450378ResearchSD501(c)(3)3Sanford Health1
Sanford USD Medical Center
1305 West 18th Street PO Box 5039Sioux FallsSD571175039460227855HospitalSD501(c)(3)3Sanford Health1
Sanford Clinic
1305 West 18th Street PO Box 5039Sioux FallsSD571175039460447693Clinical ServicesSD501(c)(3)3Sanford Health1
Sanford Health Network
1305 West 18th Street PO Box 5039Sioux FallsSD571175039460388596Hospitals/ClinicsSD501(c)(3)11-IISanford Health1
Sanford Home Health
1305 West 18th Street PO Box 5039Sioux FallsSD571175039460282134Home Health ServicesSD501(c)(3)9Sanford Health1
MeritCare Health Enterprises Inc
201 Fifth Street North 14 FloorFargoND58102453788040Prescription drugsPA501(c)(4)Sanford North1
Edith Sanford Breast Cancer Foundation
2301 E 60th Street NSioux FallsSD57104450404126FoundationND501(c)(3)11-IISanford Health1
Sanford World Clinics
1305 West 18th StreetSioux FallsSD57117262707628HealthcareSD501(c)(3)3Sanford Health1

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
National Student Housing - South Dakota LLC
100 S Phillips AveSioux FallsSD57104202129839InvestmentSDN/A
RAC Rentals LLC
100 S Phillips AveSioux FallsSD57104261961077InvestmentSDN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (6 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
Sanford Home Medical Equipment Inc
2710 W 12th StreetSioux FallsSD57105460388597Healthcare EquipmentSDN/AC
Sanford Health Plan
300 Cherapa PlaceSioux FallsSD57103911842494InsuranceSDN/AC
Sanford Health Plan of MN
300 Cherapa PlaceSioux FallsSD57103460445852InsuranceMNN/AC
Bemidji Medical Equipment Inc
1300 Anne St NWBemidjiMN56601411551725Retail Sales of DMEMNN/AC
North Country Management Inc
1300 Anne St NWBemidjiMN56601411820025Management ServicesMNN/AC
Sanford Frontiers
1305 W 18th St PO Box 5039Sioux FallsSD571175039455436599Weight Loss ManagementSDN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg