2013-05-15T08:16:33-05:00 2012-06-30 861065772 Deloitte Tax LLP 50 South Sixth Street Suite 2800 Minneapolis MN 55402 990 2011-07-01 450398104 Sanford Health Foundation North SANF 7012342000 PO Box 2010 Fargo ND 581220302 JoAnn Kunkel 6053331000 2013-05-15 1 Kristina Rasmussen P00143920 6123974000 2011 2016-02-24 21:20:13Z Brian Mortenson PO Box 2010 Fargo ND 581220302 11029507 0 X www.sanfordhealth.org/about/foundation/fargo X 1986 ND The Foundation's purpose is to encourage and assist Sanford North in its activities. 16 7 0 400 0 0 6354163 6305203 0 0 434954 328825 9464 -235949 6798581 6398079 1409260 1736788 0 0 817553 821536 0 0 934053 549074 683925 2775887 3242249 4022694 3155830 12741059 17444774 35305 34047 12705754 17410727 Sanford Health Foundation North was incorporated for the purpose of encouraging and assisting Sanford North in its activities and to encourage and assist other exempt entities associated with Sanford North in providing health care, medical, or educational services. 0 0 1534824 1534824 The Foundation continues its proud tradition of supporting the programs, services and operations of Sanford as it continues its growth regionally. Specifically, grants helped provide patient care and family support ($967,718), equipment and renovation projects ($460,142) and other community programs ($106,964). 136264 136264 Additional grants helped support healthcare education. Sanford North is dedicated to providing continuing training and education for its employees, ensuring that patients are receiving the very best, and latest, in care. 65700 65700 Grants continually help support our investment in research. These special project areas include the Children's Oncology Group. 1736788 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 2 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 16 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X JoAnn Kunkel CFO 6053331000 1305 W 18th Street Sioux Falls SD 571175039 X Pamela Anderson 0.50 X 0 0 0 Terry D Baloun 0.50 X 0 0 0 David Beito 0.50 X 0 0 0 Mikal L Claar 0.50 X 0 0 0 Jim Entenman 0.50 X 0 0 0 Barbara M Everist 0.50 X 0 0 0 Jerome D Feder 0.50 X 0 0 0 Terrence Grimm MD 60.00 X 0 557673 26124 Richard D Hardie MD 60.00 X 0 566503 24244 Thomas C Hruby 0.50 X 0 0 0 John C Jambois 0.50 X 0 0 0 Kelby K Krabbenhoft 60.00 X X 0 1484297 21738 Kelby K Krabbenhoft Def Comp 60.00 X X 0 0 565035 Barry L Martin 0.50 X 0 0 0 Lauris Molbert 0.50 X 0 0 0 Ronald M Moquist 0.50 X 0 0 0 Don Morton 0.50 X 0 0 0 Michael L Olson MD 60.00 X 0 572221 6711 Michael L Olson MD Def Comp 60.00 X 0 0 49282 Mark Paulson MD 60.00 X 0 268151 30760 Barbara J Stork 0.50 X 0 0 0 Brent Teiken 0.50 X 0 0 0 John VanderWoude Jr MD 60.00 X 0 1183385 28640 Lisa Carlson 60.00 X 0 717737 31290 Brian Mortenson 60.00 X 0 361974 25594 Deborah Soliah 60.00 X 157932 0 15322 Roger Gilbertson MD 60.00 X 0 501987 0 157932 6213928 824740 1 1 1 0 0 677707 260000 5367496 485647 6305203 135104 135104 4549328 4355607 193721 193721 193721 39872 677707 275821 -235949 -235949 6398079 0 0 92876 1736788 1736788 662607 283118 379489 27446 11802 15644 85718 37591 48127 45765 18495 27270 185940 153846 32094 48177 48177 162141 13421 148720 26982 26982 37724 5909 31815 27024 2830 24194 83 83 4693 4693 Professional Dues 133552 17331 116221 Uncollectible Pledges 57609 57609 3242249 1736788 571408 934053 45163 151683 5430496 7223166 2236 36637 3000 83 0 2917 7263164 9446337 584034 12741059 17444774 6098 6002 29207 28045 35305 34047 X 536027 737582 5236738 6713092 6932989 9960053 12705754 17410727 12741059 17444774 X 3155830 1549143 X 0 1 1 X 0 X 1534324 1512185 1742114 6354163 6305203 17447989 1534324 1512185 1742114 6354163 6305203 17447989 4725842 12722147 610956 130513 135104 876573 18324562 2802118 0.69430 0.59900 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6932989 3027064 9960053 1275054 5657935 6932989 1236381 10897 142717 18200 96741 1275054 1364340 108233 -158380 19750 58062 1236381 1.00000 0 0 3000 83 2917 2917 Annuities Payable 28045 28045 Description of Intended Use of Endowment Funds: Part V, Line 4: The organization's use of the endowment funds is to meet the donors intent in providing health care, medical, or educational services to Sanford North. 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 Foundation North did not have an income tax liability at June 30, 2012; however, some related organizations have established reserves. 61for61/Home Run Walk 144540 120306 24234 54 36748 Against All Odds Event 547384 534124 13260 25575 210721 1 25655 23277 2378 2723 717579 677707 39872 25629 250192 275821 -235949 1 Sanford North PO Box 2010 Fargo ND 58122 450385890 501(c)(3) 54778 See Form 990, Page 2, Part III Sanford Medical Center Fargo PO Box 2010 Fargo ND 58122 450226909 501(c)(3) 1497217 See Form 990, Page 2, Part III Sanford Clinic North PO Box 2010 Fargo ND 58122 911770748 501(c)(3) 24358 See Form 990, Page 2, Part III Sanford Medical Center Mayville 42 6th Avenue SE Mayville ND 58257 450228899 501(c)(3) 154219 See Form 990, Page 2, Part III 4 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Grants are disbursed by the organization only after the expenditure has been made and properly authorized by the related tax-exempt organizations along with related documentation indicating the fulfillment of donor wishes. 1 1 0 0 0 0 1 1 0 Terrence Grimm MD 0 500004 0 0 0 57669 0 12250 0 13874 0 583797 0 0 Richard D Hardie MD 0 562511 0 0 0 3992 0 7350 0 16894 0 590747 0 0 Kelby K Krabbenhoft 0 913461 0 0 0 570836 0 0 0 21738 0 1506035 0 0 Kelby K Krabbenhoft Def Comp 0 0 0 0 0 0 0 565035 0 0 0 565035 0 0 Michael L Olson MD 0 563933 0 0 0 8288 0 0 0 6711 0 578932 0 0 Michael L Olson MD Def Comp 0 0 0 0 0 0 0 49282 0 0 0 49282 0 0 Mark Paulson MD 0 236419 0 0 0 31732 0 12250 0 18510 0 298911 0 0 John VanderWoude Jr MD 0 1000000 0 0 0 183385 0 4900 0 23740 0 1212025 0 0 Lisa Carlson 0 500321 0 0 0 217416 0 12250 0 19040 0 749027 0 0 Brian Mortenson 0 256231 0 0 0 105743 0 7350 0 18244 0 387568 0 0 Deborah Soliah 138648 0 0 0 19284 0 6303 0 9019 0 173254 0 0 0 Roger Gilbertson MD 0 501987 0 0 0 0 0 0 0 0 0 501987 0 0 Part I, Line 1a Certain items listed on Line 1a are provided by related organizations. Part I, Line 3: Sanford's Trustees directly engage 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 Trustees for deliberation and action. The most recent study was completed in 2012. Part I, Lines 4a-b Roger Gilbertson, MD, 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: 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: Dr. Richard Hardie, Dr. Michael Olson. Part I, Line 7 Certain executives are eligible for a discretionary incentive bonus, based on financial targets and other goals. Supplemental Information Part III Supplemental: Compensation reported on Schedule J includes: (B)(i) Base compensation - salaries are based on the experience and performance of each executive and benchmarked 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 Sanford's Trustees, is on file and available upon request. Compensation paid to Sanford 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. X 3 32124 Average high/low price X 1 453523 FMV of CRUT 0 0 1 0 Method for Determining Number of Contributors: Part I, Column (b): The organization is using the number of contributors method. 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 that span the organization as a whole: Dr. Terrence Grimm, Dr. Richard Hardie, Kelby Krabbenhoft, Dr. Michael Olson, Dr. Mark Paulson, Dr. John VanderWoude, Jr., Lisa Carlson, Brian Mortenson, Deborah Soliah, Dr. Roger Gilbertson. Form 990, Part VI, Section A, line 6 Sanford is governed by a Board of Trustees that has ultimate strategic and decision making authority. Sanford's Trustees 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 Sanford's Trustees. These Boards function much like committees in a traditional corporate structure. Sanford's Trustees 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 Sanford's Trustees appoints the board members for the Board of Directors of Sanford Health Foundation North. Form 990, Part VI, Section A, line 7b Sanford's Trustees approve the actions approved by the Board of Directors of Sanford Health Foundation North. 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 Committee prior to the return filing date. Before the return is filed, a complete copy is made available to the current 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 Sanford's 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 its 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 15 Sanford's Trustees directly engage 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's 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 19 Although the organization does not maintain a website where the public can access these documents, it would respond individually to any requests or inquiries from the public for these documents. Form 990, Part VII, Section A: Sanford's 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's 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 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: -25,279. Change in value of split-interest agreements 921. Transfer from related tax-exempt organization 1,573,501. Total to Form 990, Part XI, Line 5: 1,549,143. Sanford North PO Box 2010 Fargo ND 58122 450385890 Supporting Organization ND 501(c)(3) 11-II Sanford 1 Sanford Clinic North PO Box 2010 Fargo ND 58122 911770748 Clinics ND 501(c)(3) 9 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 Sanford Medical Center Fargo PO Box 2010 Fargo ND 58122 450226909 Hospital ND 501(c)(3) 3 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 MeritCare Health Enterprises Inc 201 5th St N 14th Floor Fargo ND 58102 453788040 Prescription Drugs PA 501(c)(4) 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 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 Sanford Medical Center Wheaton 401 12th St N Wheaton MN 56296 272042143 Hospital / Clinic 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 Sanford Health 1305 W 18th St PO Box 5039 Sioux Falls SD 571175039 311527032 Supporting Organization SD 501(c)(3) 11-II Sanford 1 Sanford USD Medical Center 1305 W 18th St PO Box 5039 Sioux Falls SD 571175039 460227855 Hospital SD 501(c)(3) 3 Sanford Health 1 Sanford Clinic 1305 W 18th St PO Box 5039 Sioux Falls SD 571175039 460447693 Clinical Services SD 501(c)(3) 3 Sanford Health 1 Sanford Health Network 1305 W 18th St PO Box 5039 Sioux Falls SD 571175039 460388596 Hospitals / Clinics SD 501(c)(3) 11-II Sanford Health 1 Sanford Home Health 1305 W 18th St PO Box 5039 Sioux Falls SD 571175039 460282134 Home Health Services SD 501(c)(3) 9 Sanford Health 1 Sanford Health Foundation 1305 W 18th St PO Box 5039 Sioux Falls SD 571175039 363297853 Supporting Organization SD 501(c)(3) 11-II Sanford Health 1 Sanford ResearchUSD 1305 W 18th St PO Box 5039 Sioux Falls SD 571175039 460450378 Research SD 501(c)(3) 3 Sanford Health 1 Sanford 801 N Broadway Drive Fargo ND 58122 271218956 Supporting Organization ND 501(c)(3) 11-II 0 Sanford Health of Northern Minnesota 1300 Anne Street NW Bemidji MN 56601 411266009 Hospital MN 501(c)(3) 3 Sanford North 1 Baker Park Inc 803 Dewey Avenue NW Bemidji MN 56601 411372480 Low Income Senior Housing MN 501(c)(3) 9 Sanford Health of Northern Minnesota 1 Sanford Health Foundation of Northern Minnesota 1300 Anne Street NW Bemidji MN 56601 411389317 Supporting Organization MN 501(c)(3) 11-II Sanford Health of Northern Minnesota 1 North Country Medical Clinic 1300 Anne Street NW Bemidji MN 56601 411753855 Family Practice Medical Clinic MN 501(c)(3) 3 Sanford Health of Northern Minnesota 1 Sanford World Clinics 1305 W 18th St PO Box 5039 Sioux Falls SD 571175039 262707628 Healthcare SD 501(c)(3) 3 Sanford Health 1 Edith Sanford Breast Cancer Foundation 101 S Reid Street Sioux Falls SD 57103 450404126 Supporting Organization ND 501(c)(3) 11-II 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 West 12th Street N Sioux Falls SD 571043701 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 Street NW Bemidji MN 56601 411551725 Retail Sales of DME MN N/A C North Country Management Inc 1300 Anne Street NW Bemidji MN 56601 411820025 Management Services MN N/A C Sanford Frontiers 1305 West 18th Street PO Box 5039 Sioux Falls SD 571175039 455436599 Weight Loss Management SD N/A C 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Sanford Medical Center Fargo B 1497217 Cash Method Sanford Medical Center Mayville B 154219 cash Method Sanford North B 54778 Cash Method Sanford Health C 250000 Accrual Method