MAPLE GROVE HOSPITAL CORPORATION: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MAPLE GROVE HOSPITAL CORPORATION (EIN 20-8316475)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-15
- IRS object ID
- 201213209349302011
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-15T09:08:19-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390859910 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BAKER TILLY VIRCHOW KRAUSE LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 225 S 6TH ST STE 2300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208316475 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAPLE GROVE HOSPITAL CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MAPL | NameControl |
| Phone | 7635811000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9825 HOSPITAL DRIVE | AddressLine1 |
| City | MAPLE GROVE | City |
| State | MN | State |
| ZIP Code | 55369 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | PATRICK BORAN | Name |
| Title | CFO/ BOARD MEMBER | Title |
| Phone | 7635205048 | Phone |
| Date Signed | 2012-10-30 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LAWRENCE H MOHR CPA | Name |
| PTIN | P00447603 | PTIN |
| Phone | 6128764500 | Phone |
| 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 | PATRICK BORAN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVENUE NORTH | AddressLine1 |
| City | ROBBINSDALE | City |
| State | MN | State |
| ZIP Code | 55422 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 83624454 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.MAPLEGROVEHOSPITAL.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2007 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | GENERAL ACUTE CARE HOSPITAL PROVIDING EMERGENCY SERVICES, MEDICAL AND SURGICAL SERVICES, OBSTETRICAL SERVICES, AND PEDIATRIC SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 2 | NbrIndependentVotingMembers |
| Total Nbr Employees | 726 | TotalNbrEmployees |
| Total Nbr Volunteers | 149 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 16772 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 42089 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 54111374 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 83565625 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 537182 | InvestmentIncomePriorYear |
| Investment Income Current Year | 16740 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 54665328 | TotalRevenuePriorYear |
| Total Revenue Current Year | 83624454 | 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 | 22124547 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 32980257 | 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 | 40783745 | OtherExpensePriorYear |
| Other Expenses Current Year | 46807430 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 62908292 | TotalExpensesPriorYear |
| Total Expenses Current Year | 79787687 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -8242964 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3836767 | RevenuesLessExpensesCY |
| Total Assets BOY | 156370880 | TotalAssetsBOY |
| Total Assets EOY | 174479837 | TotalAssetsEOY |
| Total Liabilities BOY | 155725125 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 152776815 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 645755 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 21703022 | NetAssetsOrFundBalancesEOY |
| Mission Description | GENERAL ACUTE CARE HOSPITAL PROVIDING EMERGENCY SERVICES, MEDICAL/SURGICAL SERVICES, OBSTETRICAL AND PEDIATRIC SERVICES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 66903680 | Expense |
| Revenue | 83565625 | Revenue |
| Description | MAPLE GROVE HOSPITAL CORPORATION IS A GENERAL ACUTE CARE HOSPITAL PROVIDING EMERGENCY SERVICES, MEDICAL/SURGICAL SERVICES, OBSTETRICAL AND PEDIATRIC SERVICES. | Description |
| Total Program Service Expense | 66903680 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | 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 | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | 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 | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 89 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 726 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| 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 |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 2 | 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 | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PATRICK BORAN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7635205048 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVENUE NORTH | AddressLine1 |
| City | ROBBINSDALE | City |
| State | MN | State |
| ZIP Code | 55422 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| LOREN TAYLOR | ||||||||
| CHAIRMAN OF THE BOARD | 2.00 | X | 0 | 807651 | 22052 | |||
| VIRGINIA MALONE | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 260962 | 7591 | |||
| KEVIN CROSTON MD | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 582065 | 16652 | |||
| PATRICK BORAN | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 464704 | 38809 | |||
| MARK EUSTIS | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| DAN FROMM | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 0 | 0 | |||
| TIFFANY ZITZEWITZ | ||||||||
| BOARD MEMBER | 2.00 | X | 0 | 123090 | 6820 | |||
| ANDREW COCHRANE | ||||||||
| CHIEF EXECUTIVE OFFICER | 50.00 | X | 0 | 382446 | 19967 | X | ||
| LETTY TAM | ||||||||
| PHARMACIST | 40.00 | 118061 | 0 | 4217 | X | |||
| KAREN HALL | ||||||||
| PHARMACIST | 40.00 | 125174 | 0 | 10849 | X | |||
| VINCENT ADANENE | ||||||||
| PHARMACIST | 40.00 | 124968 | 0 | 6914 | X | |||
| THOMAS HOLETS | ||||||||
| FORMER BOARD MEMBER | 0.00 | 0 | 63875 | 0 | X | |||
| PAMELA LINDEMOEN | ||||||||
| FORMER BOARD MEMBER | 0.00 | 0 | 498750 | 707 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 368203 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3183543 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 134578 | TotalOtherCompensation |
| Number Individuals GT100 K | 22 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| ARAMARK CORPORATION | |||||
| 25271 NETWORK PLACE | CHICAGO | IL | 60673 | DIETARY | 968765 |
| GECKO GROUP | |||||
| 1472 IOWA AVE W | ST PAUL | MN | 55108 | IT SERVICES | 239105 |
| ARAMARK HEALTHCARE FOOD | |||||
| 25271 NETWORK PLACE | CHICAGO | IL | 60673 | MANAGEMENT SUPPORT FOR DIETARY | 213069 |
| CAREFUSION SOLUTIONS LLC | |||||
| 25082 NETWORK PLACE | CHICAGO | IL | 60673 | IT SERVICES | 166439 |
| MEDICAL STAFFING NETWORK | |||||
| PO BOX 202996 | DALLAS | TX | 75320 | CONSULTING | 129812 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| All Other Contributions | 42089 | AllOtherContributions |
| Total Contributions | 42089 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT REVENUE | 621500 | 82356347 | 82356347 |
| CONTRACT SERVICES | 900099 | 522483 | 522483 |
| CAFETERIA | 900099 | 379320 | 379320 |
| GIFT SHOP | 900099 | 179290 | 179290 |
| MISCELLANEOUS | 900099 | 93770 | 93770 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 34415 | TotalRevenueColumn |
| Related Or Exempt Function Income | 34415 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 83565625 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 42 | TotalRevenueColumn |
| Exclusion | $42 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16698 | TotalRevenueColumn |
| Exclusion | $16,698 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 83624454 | TotalRevenueColumn |
| Related Or Exempt Function Income | 83565625 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $16,740 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27919476 | Total |
| Program Services | 22665031 | ProgramServices |
| Management And General | 5254445 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 404484 | Total |
| Program Services | 328360 | ProgramServices |
| Management And General | 76124 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2683912 | Total |
| Program Services | 2178800 | ProgramServices |
| Management And General | 505112 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1972385 | Total |
| Program Services | 1601182 | ProgramServices |
| Management And General | 371203 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 46662 | Total |
| Program Services | 37880 | ProgramServices |
| Management And General | 8782 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28400 | Total |
| Program Services | 23055 | ProgramServices |
| Management And General | 5345 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13603507 | Total |
| Program Services | 11043327 | ProgramServices |
| Management And General | 2560180 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66318 | Total |
| Program Services | 53837 | ProgramServices |
| Management And General | 12481 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1659064 | Total |
| Program Services | 1346828 | ProgramServices |
| Management And General | 312236 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7210098 | Total |
| Program Services | 7210098 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7779950 | Total |
| Program Services | 6315763 | ProgramServices |
| Management And General | 1464187 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 625437 | Total |
| Program Services | 507730 | ProgramServices |
| Management And General | 117707 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 10121290 | 8216463 | 1904827 |
| BAD DEBT EXP | 2635709 | 2635709 | |
| GOVERNMENT TAXES | 1482758 | 1482758 | |
| MAINTENANCE & REPAIRS | 918919 | 745978 | 172941 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 629318 | Total |
| Program Services | 510881 | ProgramServices |
| Management And General | 118437 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 79787687 | Total |
| Program Services | 66903680 | ProgramServices |
| Management And General | 12884007 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5800194 | BOY |
| EOY | 3551 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 19246645 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8569814 | BOY |
| EOY | 15015249 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1291536 | BOY |
| EOY | 1442460 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 156420 | BOY |
| EOY | 473511 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 136943105 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 15134396 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 120353473 | BOY |
| EOY | 121808709 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17693689 | BOY |
| EOY | 12926288 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 3607000 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2505754 | BOY |
| EOY | -43576 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 156370880 | BOY |
| EOY | 174479837 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3589248 | BOY |
| EOY | 11349806 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 148218570 | BOY |
| EOY | 141427009 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3917307 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 155725125 | BOY |
| EOY | 152776815 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 645755 | BOY |
| EOY | 21703022 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 645755 | BOY |
| EOY | 21703022 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 156370880 | BOY |
| EOY | 174479837 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 3836767 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 17220500 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 103785115 | OtherCostOrOtherBasis |
| Depreciation | 6901359 | Depreciation |
| Book Value | 96883756 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 33157990 | OtherCostOrOtherBasis |
| Depreciation | 8233037 | Depreciation |
| Book Value | 24924953 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 121808709 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | CASH ON DEPOSIT WITH BOND TRUSTEE | Description |
| Book Value | 12926288 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 12926288 | TotalOfBookValueSecurities |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | MAPLE GROVE EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2011 OR 2010. MAPLE GROVE IS NOT CURRENTLY UNDER EXAMINATION BY ANY TAXING JURISDICTION. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3062243 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3062243 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03840 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9386850 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7101667 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2285183 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02860 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12449093 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7101667 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5347426 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06700 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4693470 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4706718 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -13248 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4693470 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4706718 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -13248 | NetCommunityBenefitExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17142563 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11808385 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5334178 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06700 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $948,855 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 11318261 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 14185114 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2866853 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAPLE GROVE HOSPITAL CORPORATION | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 9825 HOSPITAL DRIVE | AddressLine1 |
| City | MAPLE GROVE | City |
| State | MN | State |
| ZIP Code | 55369 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAPLE GROVE HOSPITAL CORPORATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (7 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART III, LINE 4: MAPLE GROVE HOSPITAL'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE DESCRIPTION ABOUT BAD DEBT EXPENSE. THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE AMOUNT ON PART III, SECTION A, LINE 2. WE DO NOT HAVE THE INFORMATION NECESSARY TO DETERMINE WHICH PORTION OF THE AMOUNT REPORTED ON LINE 2 IS COMMUNITY BENEFIT. | |
| PART III, LINE 8: THE SHORTFALL REPORTED REPRESENTS THE AMOUNT MEDICARE REIMBURSEMENT IS LESS THAN THE ESTIMATED COST OF PROVIDING SERVICES TO THOSE PATIENTS. THE METHOD USED TO ESTIMATE THOSE COSTS IS THE COST TO CHARGE RATIO APPROACH WHICH CALCULATES THE RATIO OF TOTAL HOSPITAL COSTS / TOTAL HOSPITAL GROSS REVENUE AND THEM APPLIES THAT RATIO TO TOTAL MEDICARE GROSS REVENUE. | |
| PART III, LINE 9B: MAPLE GROVE HOSPITAL CORPORATION HAS POLICIES AND PROCEDURES IN PLACE FOR COLLECTION PRACTICES THAT INCLUDE IDENTIFICATION AND SCREENING FOR CHARITY CARE AND FINANCIAL ASSISTANCE. THE POLICIES ARE AVAILABLE ON THE ORGANIZATIONS INTRANET AND EACH PATIENT IS GIVEN A BROCHURE UPON ADMISSION. | |
| PART V, SECTION B, LINE 19D: THE MINNESOTA ATTORNEY GENERAL'S OFFICE REQUIRES HOSPITALS TO RENDER SERVICES TO THOSE PATIENTS WHO DO NOT HAVE INSURANCE AT A REDUCED RATE EQUAL TO THE DISCOUNT INCURRED FROM THE HIGHEST VOLUME MANAGE CARE PLAN. | MAPLE GROVE HOSPITAL CORPORATION |
| PART V, SECTION B, LINE 21: ALL SERVICES ARE CHARGED TO ALL PATIENTS AT THE SAME PROCESS PER PROCEDURE REGARDLESS OF INSURANCE STATUS. PAYMENTS FOR THOSE SERVICES WILL VARY DEPENDING ON EXISTING INSURANCE ARRANGEMENTS, ELIGIBILITY FOR CHARITY AND UNINSURED DISCOUNTS. | MAPLE GROVE HOSPITAL CORPORATION |
| PART VI, LINE 2: MAPLE GROVE HOSPITAL CORPORATION MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF COMMUNITY BENEFITS AND CHARITY CARE IT PROVIDES. THOSE RECORDS INCLUDE MANAGEMENT'S ESTIMATE OF THE COST TO PROVIDE CHARITY CARE, THE COST OF THE SERVICES AND SUPPLIES FURNISHED FOR COMMUNITY BENEFIT PROGRAMS AND PUBLIC PROGRAM PAYMENT DEFICITS. | |
| PART VI, LINE 3: MAPLE GROVE HOSPITAL HAS A PROACTIVE PROGRAM TO ASSIST UNINSURED AND UNDERINSURED PATIENTS WITH THEIR MEDICAL BILLS. WE COMPLY WITH THE ATTORNEY GENERAL'S REQUIREMENT TO PROVIDE AN IMMEDIATE DISCOUNT TO UNINSURED MINNESOTA RESIDENTS. WE HAVE PATIENT FINANCIAL ADVOCATES AS WELL AS A CONTRACTED VENDOR THAT MEETS WITH ALL OF OUR UNINSURED INPATIENTS AND SPECIFIC OUTPATIENTS TO ASSIST THEM IN MEDICAL ASSISTANCE ELIGIBILITY AND APPLICATIONS. THIS COULD INCLUDE A VISIT TO THEIR RESIDENCE IF THEY NEED HELP IN COMPLETING ASSISTANCE APPLICATIONS. SHOULD THEY NOT QUALIFY FOR STATE OR FEDERAL ASSISTANCE PROGRAMS, WE OFFER AND ASSIST THEM IN APPLYING FOR THE HOSPITAL'S FINANCIAL ASSISTANCE (CHARITY CARE) PROGRAM.OUR CHARITY CARE PROGRAM IS PUBLISHED IN THE CORPORATE POLICIES AND PROCEDURES AND PROVIDES FOR 100% COVERAGE OF MEDICAL BILLS FOR ANYONE WHOSE INCOME IS LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES AND NEEDS ASSISTANCE IN RESOLVING THEIR FINANCIAL OBLIGATION TO THE HOSPITAL. THERE IS A GRADUAL REDUCTION IN THE CHARITY COVERAGE BETWEEN THE 201% AND 400% OF THE FEDERAL POVERTY GUIDELINES.IF WE ARE UNABLE TO MEET WITH THE PATIENT BEFORE DISCHARGE FROM MAPLE GROVE HOSPITAL, THE PATIENT IS GIVEN A PAMPHLET THAT LISTS CONTACT NUMBERS TO OUR BUSINESS OFFICE CUSTOMER SERVICE AREA TO DISCUSS OPTIONS FOR ASSISTANCE WITH THEIR MEDICAL BILLS. THIS CONTACT INFORMATION IS ALSO PROVIDED ON EVERY STATEMENT THAT IS SENT TO OUR CUSTOMERS. IN ADDITION, OUR INTERNAL COLLECTIONS DEPARTMENT AND OUR COLLECTION AGENCIES ARE WELL VERSED IN OUR ASSISTANCE PROGRAMS AND WILL ASSESS DURING THEIR CONVERSATIONS WITH PATIENTS IF REFERRAL TO EITHER A STATE OR FEDERAL PROGRAM OR OUR CHARITY CARE PROGRAM WOULD BE APPROPRIATE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LOREN TAYLOR | |||||||||||||
| 0 | 606008 | 0 | 0 | 0 | 201643 | 0 | 7653 | 0 | 14399 | 0 | 829703 | 0 | 0 |
| VIRGINIA MALONE | |||||||||||||
| 0 | 260962 | 0 | 0 | 0 | 0 | 0 | 1246 | 0 | 6345 | 0 | 268553 | 0 | 0 |
| KEVIN CROSTON MD | |||||||||||||
| 0 | 401954 | 0 | 0 | 0 | 180111 | 0 | 8063 | 0 | 8589 | 0 | 598717 | 0 | 0 |
| PATRICK BORAN | |||||||||||||
| 0 | 341414 | 0 | 0 | 0 | 123290 | 0 | 30800 | 0 | 8009 | 0 | 503513 | 0 | 63278 |
| ANDREW COCHRANE | |||||||||||||
| 0 | 331154 | 0 | 0 | 0 | 51292 | 0 | 10402 | 0 | 9565 | 0 | 402413 | 0 | 0 |
| THOMAS HOLETS | |||||||||||||
| 0 | 63875 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 63875 | 0 | 63875 |
| PAMELA LINDEMOEN | |||||||||||||
| 0 | 0 | 0 | 0 | 0 | 498750 | 0 | 0 | 0 | 707 | 0 | 499457 | 0 | 61250 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF MAPLE GROVE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 208316475 | IssuerEIN |
| CUSIP Number | 770278AA7 | CUSIPNumber |
| Date Issued | 2007-05-01 | DateIssued |
| Issue Price | 149139758 | IssuePrice |
| Description Of Purpose | CONSTRUCTION OF A HOSPITAL FACILITY | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 1 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Proceeds | 149139758 | TotalProceeds |
| Issuance Costs From Proceeds | 2686779 | IssuanceCostsFromProceeds |
| Capital Expenditures | 4768248 | CapitalExpenditures |
| Amount Unspent | 12923728 | AmountUnspent |
| Year Of Subst Completion | 2009 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 0 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 0 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 0 | ExceptionToRebate |
Form990 Schedule K Part VI Form990ScheduleKPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCHEDULE K, PART II, LINE 12: | Identifier |
| Return Reference | EXPLANATION OF UNSPENT FUNDS: | ReturnReference |
| Explanation | UNSPENT FUNDS ARE DUE TO A HIGHLY COMPETITIVE BIDDING ENVIRONMENT DURING THE PROJECT, I.E. BETTER PRICING AND VALUE ENGINEERING THAN EXPECTED. THE EXCESS WILL BE USED TO COMPLETE THE 4TH FLOOR AT AN ESTIMATED COST OF $20 MILLION. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | NORTH MEMORIAL HEALTH CARE, A RELATED PARTY, PERFORMS MANAGEMENT DUTIES ON BEHALF OF MAPLE GROVE HOSPITAL. | |
| FORM 990, PART VI, SECTION A, LINE 6 | MAPLE GROVE HOSPITAL HAS ONE CLASS OF MEMBERS. NORTH MEMORIAL HEALTH CARE ("NORTH MEMORIAL") AND FAIRVIEW HEALTH SERVICES ("FAIRVIEW") ARE THE ONLY MEMBERS OF THE CORPORATION AND BOTH MEMBERS ARE NONPROFIT, TAX-EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD OF DIRECTORS IS COMPRISED OF SEVEN VOTING DIRECTORS AND ONE NON-VOTING DIRECTOR, AS FOLLOWS: (A) THE CHIEF EXECUTIVE OFFICER OF NORTH MEMORIAL AND FOUR OTHER DIRECTORS APPOINTED ANNUALLY BY NORTH MEMORIAL (B) THE CHIEF EXECUTIVE OFFICER OF FAIRVIEW AND ONE OTHER DIRECTOR APPOINTED ANNUALLY BY FAIRVIEW AND (C) THE MAPLE GROVE HOSPITAL CHIEF EXECUTIVE OFFICER. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBERS, AND ONLY THE MEMBERS, MAY TAKE DIRECT ACTION ON THE FOLLLOWING MATTERS BY UNANIMOUS MEMBER APPROVAL: (A) AMENDMENTS TO THE ARTICLES OF INCORPORATION; (B) AMENDMENTS TO THE BYLAWS; (C) MERGER OR CONSOLIDATION OF THE CORPORATION (D) SALE, LEASE OR TRANSFER OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (E) JOINT VENTURES AFFECTING SUBSTANTIALLY ALL OF THE ASSETS OR OPERATIONS OF THE CORPORATION; (F) DETERMINATION OF THE NAME UNDER WHICH THE HOSPITAL CONDUCTS BUSINESS; (G) CERTAIN MORTGAGES OR OTHER SECURITY INTERESTS; (H) ISSUANCE OF CAPITAL CALLS; AND (I) DISSOLUTION AND LIQUIDATION OF THE CORPORATION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE MANAGEMENT COMPANY AND THE BOARD OF DIRECTORS REVIEW THE FORM 990 BEFORE IT IS FILED. REPRESENTATIVES FROM THE HOSPITAL'S INDEPENDENT ACCOUNTING FIRM REVIEW THE FORM 990 WITH THE MANAGEMENT COMPANY IN DETAIL AND NOTES FOR THE COMMITTEE ANY CHANGES IN THE FORM 990 FROM PRIOR YEARS. AFTER THOROUGH DISCUSSION, THE MANAGEMENT COMPANY APPROVES THE FORM 990 AND FORWARDS IT TO THE BOARD FOR ITS REVIEW. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL MEMBERS OF THE BOARD OF DIRECTORS AND ALL EMPLOYEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY EACH YEAR. EACH BOARD MEMBER AND STAFF MEMBER FILLS OUT A CONFLICT OF INTEREST QUESTIONNAIRE IN WHICH THEY ARE ASKED TO IDENTIFY ANY RELATIONSHIP THAT WOULD CREATE A CONFLICT OF INTEREST. THE RESULTS ARE SUMMARIZED AND REVIEWED TO DETERMINE ANY ACTUAL OR POTENTIAL CONFLICT AND ARE REPORTED TO THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION FOR KEY POSITIONS ARE REVIEWED BY THE EXECUTIVE COMMITTEE OF NORTH MEMORIAL WORKING IN CONJUNCTION WITH AN OUTSIDE CONSULTANT. THE EXECUTIVE COMMITTEE OF NORTH MEMORIAL INSURES THAT THE SALARY AND BENEFIT ADMINISTRATION REVIEW PROCESS IS BEING FOLLOWED, WHICH INCLUDES SALARY AND BENEFIT SURVEYS AND COMPARISONS OF ALL POSITIONS. THE CEO'S COMPENSATION IS SENT TO THE FULL BOARD FOR APPROVAL. THE COMPENSATION OF ALL OTHER KEY POSITIONS IS APPROVED BY THE CEO. | |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE SECRETARY OF THE STATE FILING WITH THE STATE OF MINNESOTA. | |
| FORM 990, PART XI, LINE 5: | CONTRIBUTED CAPITAL FROM SHAREHOLDERS 3,750,000. GAIN ON CONSOLIDATION 13,470,500. TOTAL TO FORM 990, PART XI, LINE 5: 17,220,500. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART IX, LINCE 2C: | THE ORGANIZATION DID NOT CHANGE EITHER THE OVERSIGHT PROCESS OF THE AUDIT OR THE SELCTION PROCESS OF THE INDEPENDENT ACCOUNTANT IN THE CURRENT YEAR. |
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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTH MEMORIAL HEALTH CARE | |||||||||||
| 3300 OAKDALE AVENUE NORTH | ROBBINSDALE | MN | 55422 | 410729979 | ACUTE CARE | MN | 501(C)(3) | LINE 3 | NORTH MEMORIAL | 0 | |
| NORTH MEMORIAL COMMUNITY FOUNDATION | |||||||||||
| 3300 OAKDALE AVENUE NORTH | ROBBINSDALE | MN | 55422 | 411777966 | FUNDRAISING | MN | 501(C)(3) | 7 | NORTH MEMORIAL | 0 | |
| ASSOCIATED HEALTH ASSURANCE | |||||||||||
| 3300 OAKDALE AVENUE NORTH | ROBBINSDALE | MN | 55422 | 980343815 | INSURANCE | 501(C)(3) | 11A | NORTH MEMORIAL | 0 | BD | |
Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|
| NORTH MEMORIAL SURGERY CENTER AT MAPLE GROVE | ||||||
| 3300 OAKDALE AVENUE NORTH | ROBBINSDALE | MN | 55422 | OUTPATIENT SURGERY | MN | N/A |
| NORTH MEMORIAL ENDOSCOPY CENTER AT MAPLE GROVE | ||||||
| 3300 OAKDALE AVENUE NORTH | ROBBINSDALE | MN | 55422 | OUTPATIENT SURGERY | MN | N/A |
| MONTICELLO CANCER CENTER | ||||||
| 1013 HARAT BLVD | MONTICELLO | MN | 55362 | CANCER CENTER | MN | N/A |
| MINNESOTA DIAGNOSTIC IMAGING PARTNERS LLC | ||||||
| 9855 HOSPITAL DRIVE | MAPLE GROVE | MN | 55422 | RADIOLOGY | MN | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | OAKDALE HEALTH ENTERPRISES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3300 OAKDALE AVENUE NORTH | AddressLine1 |
| City | ROBBINSDALE | City |
| State | MN | State |
| ZIP Code | 55422 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411546422 | EIN |
| Primary Activity | AMBULANCE | PrimaryActivity |
| Legal Domicile State | MN | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| 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 | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 1 | 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 | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| NORTH MEMORIAL HEALTH CARE | ||
| C | 2812500 | CASH |
| NORTH MEMORIAL HEALTH CARE | ||
| E | 107703750 | AMOUNT GUARANTEE |
| NORTH MEMORIAL HEALTH CARE | ||
| J | 564633 | AMOUNT PAID |
| NORTH MEMORIAL HEALTH CARE | ||
| O | 5481484 | AMOUNT PAID |
| NORTH MEMORIAL HEALTH CARE | ||
| L | 4823684 | AMOUNT PAID |