RED WING SEMINARY HOME: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- RED WING SEMINARY HOME (EIN 41-1263419)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-06-29
- IRS object ID
- 201211819349300416
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-06-29T13:13:45-05:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411263419 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRVIEW SEMINARY HOME | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FAIR | NameControl |
| Phone | 6512675000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O BOX 95 - 701 FAIRVIEW BLVD | AddressLine1 |
| City | RED WING | City |
| State | MN | State |
| ZIP Code | 55066 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Scott Wordelman | Name |
| Title | CEO | Title |
| Phone | 6512675000 | Phone |
| Date Signed | 2012-06-29 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Scott Wordelman | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 701 Fairview Blvd | AddressLine1 |
| City | Red Wing | City |
| State | MN | State |
| ZIP Code | 55066 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 5687606 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | n/a | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1943 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | Fairview Seminary Home's mission is to provide exemplary care to the whole person, encompassing body, mind and spirit, at every stage of life. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 5431 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 11030 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 5670703 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 5629984 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 17135 | InvestmentIncomePriorYear |
| Investment Income Current Year | 36192 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 6421 | OtherRevenuePriorYear |
| Other Revenue Current Year | 10400 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 5699690 | TotalRevenuePriorYear |
| Total Revenue Current Year | 5687606 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 74385 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 5477068 | OtherExpensePriorYear |
| Other Expenses Current Year | 5573677 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 5477068 | TotalExpensesPriorYear |
| Total Expenses Current Year | 5648062 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 222622 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 39544 | RevenuesLessExpensesCY |
| Total Assets BOY | 2564925 | TotalAssetsBOY |
| Total Assets EOY | 2700415 | TotalAssetsEOY |
| Total Liabilities BOY | 327233 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 465403 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2237692 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 2235012 | NetAssetsOrFundBalancesEOY |
| Mission Description | Fairview Seminary Home's mission is to provide exemplary care to the whole person, encompassing body, mind and spirit, at every stage of life. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 4626401 | Expense |
| Revenue | 5629984 | Revenue |
| Description | Fairview Seminary Home operates a home for the aged to satisfy their health care and financial security needs. Fairview Seminary Home provides care to residents for a total of over 24,406 resident days. Fairview Seminary Home participates in the Medicare and Medicaid programs and operates to provide services at the lowest possible cost. It furnishes care and housing to aged individuals who otherwise would be unable to provide for themselves without hardship. These services rendered are nursing care, social services, and if desired, spiritual support. | Description |
| Total Program Service Expense | 4626401 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 2 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MIKE LARSON | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6512675000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | P O BOX 95 - 701 FAIRVIEW BLVD | AddressLine1 |
| City | RED WING | City |
| State | MN | State |
| ZIP Code | 55066 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| David D Murphy | ||||||||
| Past Chair | 5.00 | X | 0 | 0 | 0 | |||
| Jeffrey Ketcham M D | ||||||||
| Secretary - Physician | 5.00 | X | 0 | 622425 | 31499 | |||
| Silas B Foot III | ||||||||
| Treasurer | 5.00 | X | 0 | 0 | 0 | |||
| Jack Alexander M D | ||||||||
| CMO | 5.00 | X | 0 | 252549 | 31592 | |||
| Amy DeJong M D | ||||||||
| MPC Member | 5.00 | X | 0 | 219699 | 30405 | |||
| Barbara Haley | ||||||||
| Chair | 5.00 | X | 0 | 0 | 0 | |||
| John O Hanson | ||||||||
| Director | 5.00 | X | 0 | 0 | 0 | |||
| Paula Phillippe | ||||||||
| Director | 5.00 | X | 0 | 478288 | 72123 | |||
| John Doherty | ||||||||
| Director | 5.00 | X | 0 | 394760 | 51957 | |||
| Robert Riegelman | ||||||||
| Director | 5.00 | X | 0 | 0 | 0 | |||
| Jennifer Beck | ||||||||
| Director | 5.00 | X | 0 | 0 | 0 | |||
| Theodore R Thompson M D | ||||||||
| Ex-Officio | 5.00 | X | 0 | 0 | 0 | |||
| Scott R Wordelman | ||||||||
| President & CEO | 5.00 | X | 0 | 378387 | 22497 | X | ||
| Michael Larson | ||||||||
| VP & CFO | 40.00 | 0 | 220710 | 30051 | X | |||
| Nancy Dimunation | ||||||||
| CNO | 40.00 | 0 | 160379 | 23233 | X | |||
| Matthew A Eich M D | ||||||||
| Physician | 40.00 | 0 | 622666 | 30267 | X | |||
| Everett M Hughes M D | ||||||||
| Physician | 40.00 | 0 | 606268 | 31499 | X | |||
| Michael R Johnson M D | ||||||||
| Physician | 40.00 | 0 | 518674 | 14349 | X | |||
| Christopher McDevitt | ||||||||
| Physician | 40.00 | 0 | 418072 | 31499 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 4892877 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 400971 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Ebenezer Management Services | |||||
| 2722 Park Avenue | Minneapolis | MN | 55407 | Staffing Services | 3494408 |
| Aegis Therapies Inc | |||||
| 1000 Fianna Way | Fort Smiuth | AZ | 72919 | Rehab Services | 410076 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| All Other Contributions | 11030 | AllOtherContributions |
| Total Contributions | 11030 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient Care | 624100 | 5562132 | 5562132 |
| Medical Services | 624100 | 57250 | 57250 |
| Cafeteria | 722210 | 10602 | 10602 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 5629984 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 36192 | TotalRevenueColumn |
| Exclusion | $36,192 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 10400 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 10400 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10400 | TotalRevenueColumn |
| Exclusion | $10,400 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5687606 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5629984 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $46,592 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20796 | Total |
| Program Services | 20796 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53589 | Total |
| Program Services | 53589 | ProgramServices |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3455171 | Total |
| Program Services | 3108050 | ProgramServices |
| Management And General | 347121 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 771831 | Total |
| Program Services | 484604 | ProgramServices |
| Management And General | 287227 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18515 | Total |
| Program Services | 18515 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 226067 | Total |
| Program Services | 174297 | ProgramServices |
| Management And General | 51770 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33423 | Total |
| Program Services | 31101 | ProgramServices |
| Management And General | 2322 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 152652 | Total |
| Program Services | 147311 | ProgramServices |
| Management And General | 5341 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Supplies | 529907 | 516588 | 13319 |
| Taxes | 271040 | 32704 | 238336 |
| Miscellaneous | 51371 | 19100 | 32271 |
| Repairs & Maintenance | 34510 | 19746 | 14764 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29190 | Total |
| Management And General | 29190 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5648062 | Total |
| Program Services | 4626401 | ProgramServices |
| Management And General | 1021661 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 647992 | BOY |
| EOY | 661474 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 571444 | BOY |
| EOY | 676180 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23785 | BOY |
| EOY | 60249 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 5127466 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4358104 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 792634 | BOY |
| EOY | 769362 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 529070 | BOY |
| EOY | 527090 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 6060 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2564925 | BOY |
| EOY | 2700415 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 326533 | BOY |
| EOY | 464703 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 700 | BOY |
| EOY | 700 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 327233 | BOY |
| EOY | 465403 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2230920 | BOY |
| EOY | 2232291 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6772 | BOY |
| EOY | 2721 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2237692 | BOY |
| EOY | 2235012 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2564925 | BOY |
| EOY | 2700415 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 39544 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -42224 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 0 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 3234 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 2287 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 4325 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 5431 | CurrentTaxYearMinus1Year |
| Current Tax Year | 11030 | CurrentTaxYear |
| Total | 26307 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 5032838 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 5020849 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 5505265 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 5712087 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5629984 | CurrentTaxYear |
| Total | 26901023 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 5036072 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 5023136 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 5509590 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 5717518 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5641014 | CurrentTaxYear |
| Total | 26927330 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 26927330 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 131474 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 19686 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1652 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 17135 | CurrentTaxYearMinus1Year |
| Current Tax Year | 36192 | CurrentTaxYear |
| Total | 206139 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 131474 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 19686 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 1652 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 17135 | CurrentTaxYearMinus1Year |
| Current Tax Year | 36192 | CurrentTaxYear |
| Total | 206139 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 5167546 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 5042822 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 5511242 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 5734653 | CurrentTaxYearMinus1Year |
| Current Tax Year | 5677206 | CurrentTaxYear |
| Total | 27133469 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Percentage509 | 0.99240 | PublicSupportPercentage509 |
| Prior Year Support Percentage | 0.98880 | PriorYearSupportPercentage |
| Investment Income Percentage | 0.00760 | InvestmentIncomePercentage |
| Prior Yr Invest Income Percentage | 0.01120 | PriorYrInvestIncomePercentage |
| Thirty Three Percnt Tests CY509 | X | ThirtyThreePercntTestsCY509 |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 203289 | OtherCostOrOtherBasis |
| Book Value | 203289 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3970216 | OtherCostOrOtherBasis |
| Depreciation | 3612196 | Depreciation |
| Book Value | 358020 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 205866 | OtherCostOrOtherBasis |
| Depreciation | 144440 | Depreciation |
| Book Value | 61426 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 748095 | OtherCostOrOtherBasis |
| Depreciation | 601468 | Depreciation |
| Book Value | 146627 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 769362 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Damage Deposit | Description |
| Amount | $700 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 700 | TotalOfAmounts |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Jeffrey Ketcham M D | |||||||||||||
| 0 | 622425 | 0 | 0 | 0 | 0 | 0 | 17150 | 0 | 14349 | 0 | 653924 | 0 | 0 |
| Jack Alexander M D | |||||||||||||
| 0 | 252549 | 0 | 0 | 0 | 0 | 0 | 17150 | 0 | 14442 | 0 | 284141 | 0 | 0 |
| Amy DeJong M D | |||||||||||||
| 0 | 219699 | 0 | 0 | 0 | 0 | 0 | 15963 | 0 | 14442 | 0 | 250104 | 0 | 0 |
| Paula Phillippe | |||||||||||||
| 0 | 375027 | 0 | 67103 | 0 | 36158 | 0 | 0 | 0 | 72123 | 0 | 550411 | 0 | 0 |
| John Doherty | |||||||||||||
| 0 | 323460 | 0 | 71300 | 0 | 0 | 0 | 19116 | 0 | 32841 | 0 | 446717 | 0 | 0 |
| Scott R Wordelman | |||||||||||||
| 0 | 284284 | 0 | 91586 | 0 | 2517 | 0 | 5886 | 0 | 16611 | 0 | 400884 | 0 | 9317 |
| Michael Larson | |||||||||||||
| 0 | 208795 | 0 | 0 | 0 | 11915 | 0 | 16051 | 0 | 14000 | 0 | 250761 | 0 | 0 |
| Nancy Dimunation | |||||||||||||
| 0 | 160379 | 0 | 0 | 0 | 0 | 0 | 11296 | 0 | 11937 | 0 | 183612 | 0 | 0 |
| Matthew A Eich M D | |||||||||||||
| 0 | 622666 | 0 | 0 | 0 | 0 | 0 | 17150 | 0 | 13117 | 0 | 652933 | 0 | 0 |
| Everett M Hughes M D | |||||||||||||
| 0 | 586449 | 0 | 0 | 0 | 19819 | 0 | 17150 | 0 | 14349 | 0 | 637767 | 0 | 0 |
| Michael R Johnson M D | |||||||||||||
| 0 | 501501 | 0 | 0 | 0 | 17173 | 0 | 0 | 0 | 14349 | 0 | 533023 | 0 | 0 |
| Christopher McDevitt | |||||||||||||
| 0 | 418072 | 0 | 0 | 0 | 0 | 0 | 17150 | 0 | 14349 | 0 | 449571 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 3 | Ebenezer Management Services manages the home under the direction of Fairview Red Wing Health Services. | |
| Form 990, Part VI, Section A, line 6 | Fairview Red Wing Health Services is the sole member of Fairview Seminary Home. | |
| Form 990, Part VI, Section A, line 7a | Fairview Health Services can appoint board members. | |
| Form 990, Part VI, Section A, line 7b | Governance decisions are subject Fairview Health Services (FHS) reserve powers. Board membership is as follows: CEO is ex-officio-voting, 2 members appointed by FHS, employed physicians of Fairview Red Wing Health Services elect two employed physicians and 6 community members are nominated by Fairview Red Wing Health Services board nominating committee, approved by the Red Wing Board and appointments are ratified by Christian Health Services, a group of Red Wing churches. Fairview Red Wing Health Services CMO and a University of Minnesota Physicians representative are exofficios without vote. | |
| Form 990, Part VI, Section B, line 11 | The Tax Department conducts a detailed review of the completed return. The return is also review by the Controller. The Form 990 is presented to the Finance area for review of content. The Form 990 is subsequently presented to the Board of Directors. Upon approval from the Board of Directors, the Form 990 is filed. | |
| Form 990, Part VI, Section B, line 12c | Managers, directors and senior management of Fairview Seminary Home are required to annually complete Fairview Health Service's Duty of Loyalty and Conflict of Interest Statement in compliance with Fairview Health Service's Conflict of Interest policy. Disclosures are reviewed by the compliance department. Conflicts of interests by Board members are brought to the Audit and Compliance Committee of the Board, along with additional detailed information, for specific review. In addition, the Compliance Officer compiles a schedule showing reported conflicts of interest by managers, directors and senior management which is also presented to the Audit and Compliance Committe of the Board for review and discussion. Any problematic issues arising from these disclosures are discussed and resolved by the committee. Board members and management employees are expected to update their conficts, as necessary, during the year. | |
| Form 990, Part VI, Section C, line 19 | Fairview Seminary Home makes its governing documents, conflict of interest policy, and financial statements available to the public upon request and inspection of the documents is available at the corporate finance department. | |
| Form 990, Part XI, line 5: | Net unrealized losses on investments: -42,224. | Changes in Net Assets or Fund Balances: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|
| Fairview Regional Community Services | |||||||||
| PO Box 95- 701 Fairview Blvd | Red Wing | MN | 55066 | 411539756 | Home healthcare services | MN | 501(c)(3) | 7 | 0 |
| Fairview Seminary Plaza | |||||||||
| PO Box 95- 701 Fairview Blvd | Red Wing | MN | 55066 | 411532554 | Elderly housing | MN | 501(c)(3) | 9 | 0 |
| Fairview Red Wing Health Services | |||||||||
| PO Box 95- 701 Fairview Blvd | Red Wing | MN | 55066 | 411713783 | Hospital patient care services | MN | 501(c)(3) | 3 | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fairview Seminary Plaza | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | P | TransactionType |
| Amount Involved | 2028 | AmountInvolved |