MAYO CLINIC HEALTH SYSTEM - RED WING: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- MAYO CLINIC HEALTH SYSTEM - RED WING (EIN 41-1713783)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-06-29
- IRS object ID
- 201221819349300817
- 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 | 2012-06-29T14:49:41-05:00 | 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 | 411713783 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRVIEW RED WING HEALTH SERVICES | 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 | 97224992 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.redwing.fairview.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1905 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | Fairview Red Wing Health Services provides health care services and promotes healthcare in the service area. This includes medical education, research and scientific investigations related to health and medicine. Provided care to 2,576 inpatients for a total of 4,867 patient days. Provided treatment for 10,309 emergency room visits and provided a total of 148,815 clinical encounters. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 797 | TotalNbrEmployees |
| Total Nbr Volunteers | 170 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 295650 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 92279136 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 92445259 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1971194 | InvestmentIncomePriorYear |
| Investment Income Current Year | 4579249 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 182584 | OtherRevenuePriorYear |
| Other Revenue Current Year | 184181 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 94728564 | TotalRevenuePriorYear |
| Total Revenue Current Year | 97208689 | 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 | 56319395 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 55772186 | 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 | 37249557 | OtherExpensePriorYear |
| Other Expenses Current Year | 38000756 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 93568952 | TotalExpensesPriorYear |
| Total Expenses Current Year | 93772942 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1159612 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3435747 | RevenuesLessExpensesCY |
| Total Assets BOY | 141319167 | TotalAssetsBOY |
| Total Assets EOY | 140582095 | TotalAssetsEOY |
| Total Liabilities BOY | 72994891 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 68822072 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 68324276 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 71760023 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | Fairview Red Wing Health Services exists to deliver exemplary care to the whole person, encompassing body, mind and spirit, at every stage of life. See Schedule OWe will be unrelenting in our responsiveness to patients, customers and the communities we serve, and will inspire excellence, innovation and compassion at every opportunity. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 80997554 | Expense |
| Revenue | 92445259 | Revenue |
| Description | Fairview Red Wing Medical Center combines a clinic and hospital into one state-of-the-art facility. Opened in 2001, the medical center has a 30-bed inpatient hospital care unit that includes intensive care and a birthing center. Clinic services include: primary family services, specialty medical and specialty surgical services, urgent and emergency care and rehabilitation services. This medical center also offers the latest in diagnostic tools, i.e. CT scan, MRI and full lab services. Red Wing Medical Center is a complete health care facility for patients throughout Goodhue and Pierce counties. In 2011, the medical center provided care to 2,576 inpatients for a total of 4,867 patient days. Provided treatment for 10,309 emergency room visits and provided a total of 148,815 clinical encounters. | Description |
| Total Program Service Expense | 80997554 | 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 | 1 | 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 | 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 | 1 | 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 | 11 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 797 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 1 | ForeignFinancialAccount |
| Name Of Foreign Country | CJ | NameOfForeignCountry |
| 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 | 0 | 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 |
| 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 | Key EmployeeKeyEmployee | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| David D Murphy | ||||||||
| Chair | 5.00 | X | 0 | 0 | 0 | |||
| Jeffrey Ketcham M D | ||||||||
| Secretary | 40.00 | X | 622425 | 0 | 31499 | X | ||
| Silas B Foot III | ||||||||
| Treasurer | 5.00 | X | 0 | 0 | 0 | |||
| Jack Alexander M D | ||||||||
| CMO | 40.00 | X | 252549 | 0 | 31592 | X | ||
| Amy DeJong M D | ||||||||
| MPC | 40.00 | X | 219699 | 0 | 30405 | X | ||
| Barbara Haley | ||||||||
| Vice 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 | 40.00 | X | 0 | 378387 | 22497 | X | ||
| Michael Larson | ||||||||
| CFO | 40.00 | 220710 | 0 | 30051 | X | |||
| Nancy Dimunation | ||||||||
| CNO | 40.00 | 160379 | 0 | 23233 | X | |||
| Matthew A Eich M D | ||||||||
| Musculoskeletal System Phy | 40.00 | 622666 | 0 | 30267 | X | |||
| Everett M Hughes | ||||||||
| Musculoskeletal System Phy | 40.00 | 606268 | 0 | 31499 | X | |||
| Michael R Johnson | ||||||||
| Physician | 40.00 | 518674 | 0 | 14349 | X | |||
| Christopher McDevitt | ||||||||
| Eye Physician | 40.00 | 418072 | 0 | 31499 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3641442 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1251435 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 400971 | TotalOtherCompensation |
| Number Individuals GT100 K | 75 | NumberIndividualsGT100K |
| Formers Listed | 0 | 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 |
|---|---|---|---|---|---|
| Central Minnesota Diagnostics Inc | |||||
| 150 10th Street NW | Milaca | MN | 56353 | Radiology Services | 816725 |
| McKesson Info Solutions | |||||
| 5995 Windward Parkway | Alpharetta | GA | 30005 | Software Services | 725316 |
| Midwest Surgical Services | |||||
| 5575 West Old Shakopee Rd Ste 90 | Bloomington | MN | 55437 | Ophthalmology Service | 454080 |
| University of Minnesota Physicians | |||||
| 720 Washington Ave SE | Minneapolis | MN | 55414 | Physicians | 374634 |
| Dell Marketing LP | |||||
| P O Box 802816 | Chicago | IL | 60680 | Computer Services | 280293 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 11 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient care | 621110 | 90178420 | 90178420 |
| Medical Services | 621990 | 1810650 | 1810650 |
| Cafeteria | 722210 | 208237 | 208237 |
| Miscellaneous Rev | 561439 | 149340 | 149340 |
| Laboratory | 621500 | 98612 | 98612 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 92445259 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4589031 | TotalRevenueColumn |
| Exclusion | $4,589,031 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 184181 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 184181 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 184181 | TotalRevenueColumn |
| Exclusion | $184,181 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 6521 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 16303 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -9782 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -9782 | TotalRevenueColumn |
| Exclusion | -$9,782 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 97208689 | TotalRevenueColumn |
| Related Or Exempt Function Income | 92445259 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $4,763,430 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45130688 | Total |
| Program Services | 40346906 | ProgramServices |
| Management And General | 4783782 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2441330 | Total |
| Program Services | 2241375 | ProgramServices |
| Management And General | 199955 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5377629 | Total |
| Program Services | 4807609 | ProgramServices |
| Management And General | 570020 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2822539 | Total |
| Program Services | 2476550 | ProgramServices |
| Management And General | 345989 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1905201 | Total |
| Program Services | 1856983 | ProgramServices |
| Management And General | 48218 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 187500 | Total |
| Management And General | 187500 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7111778 | Total |
| Program Services | 4559145 | ProgramServices |
| Management And General | 2552633 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 579933 | Total |
| Program Services | 382263 | ProgramServices |
| Management And General | 197670 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1735951 | Total |
| Program Services | 1279697 | ProgramServices |
| Management And General | 456254 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43633 | Total |
| Program Services | 43633 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 259517 | Total |
| Program Services | 209490 | ProgramServices |
| Management And General | 50027 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3675702 | Total |
| Program Services | 3670077 | ProgramServices |
| Management And General | 5625 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4331546 | Total |
| Program Services | 3457577 | ProgramServices |
| Management And General | 873969 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Supplies | 9234525 | 9156346 | 78179 |
| Bad Debt | 4179968 | 4179968 | |
| Taxes | 2579649 | 690816 | 1888833 |
| Util, Repairs & Mainten | 1433276 | 1049527 | 383749 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 742577 | Total |
| Program Services | 589592 | ProgramServices |
| Management And General | 152985 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93772942 | Total |
| Program Services | 80997554 | ProgramServices |
| Management And General | 12775388 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -763046 | BOY |
| EOY | 38726 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13296985 | BOY |
| EOY | 13507022 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 250440 | BOY |
| EOY | 250440 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1135743 | BOY |
| EOY | 1153042 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 406853 | BOY |
| EOY | 437861 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 86997725 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 43534697 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44541979 | BOY |
| EOY | 43463028 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 71221413 | BOY |
| EOY | 70981420 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11228800 | BOY |
| EOY | 10750556 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 141319167 | BOY |
| EOY | 140582095 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9344916 | BOY |
| EOY | 5817538 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 60190707 | BOY |
| EOY | 60722965 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3459268 | BOY |
| EOY | 2281569 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 72994891 | BOY |
| EOY | 68822072 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68316777 | BOY |
| EOY | 71748755 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7499 | BOY |
| EOY | 11268 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68324276 | BOY |
| EOY | 71760023 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 141319167 | BOY |
| EOY | 140582095 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 3435747 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | 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) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1632275 | OtherCostOrOtherBasis |
| Book Value | 1632275 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 56298228 | OtherCostOrOtherBasis |
| Depreciation | 23551464 | Depreciation |
| Book Value | 32746764 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2077821 | OtherCostOrOtherBasis |
| Depreciation | 1444450 | Depreciation |
| Book Value | 633371 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 26411149 | OtherCostOrOtherBasis |
| Depreciation | 18538783 | Depreciation |
| Book Value | 7872366 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 578252 | OtherCostOrOtherBasis |
| Book Value | 578252 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 43463028 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| CMDI | 607045 |
| Deferred Debt Acquisition Cost | 712948 |
| Funds Held by Trustee | 8114537 |
| Limited Use Assets | 1316026 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 10750556 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Current portion of long term debt | Description |
| Amount | $2,281,569 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2281569 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 275.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| 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 | 1455907 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1455907 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01630 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14578512 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8785301 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5793211 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06470 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16034419 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8785301 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7249118 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08100 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 131071 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 131071 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00150 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 622225 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 622225 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00690 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2526 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2526 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 755822 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 755822 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00840 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16790241 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8785301 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 8004940 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08940 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 26622 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 26622 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 26622 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 26622 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $4,179,968 | BadDebtExpenseAmount |
| Amount Attributable To | 83599 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 14035021 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 16676830 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2641809 | 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 | 0 | 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 | Fairview Red Wing Health Services | BusinessNameLine1 |
Address Address
| 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) |
|---|---|---|
| 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 | Fairview Red Wing Health Services | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 11 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 0 | CHNAWidelyAvailable |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 275.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 275.000000000000 | FPGDiscountPercent |
| Explains Basis | 0 | ExplainsBasis |
| Explains Application Method | 0 | ExplainsApplicationMethod |
| Includes Publicity Measures | 0 | IncludesPublicityMeasures |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| Part I, Line 3c: Patients that are eligible for the Fairview Community Care Program or other Charity Care Plans may receive a reduction on amounts owed or up to 100% of total charges. Fairview informs patients about the Community Care Program prior to delivery of services if feasible and as appropriate and during the billing process. Fairview's uninsured discount program gives uninsured patients with a household income below $125,000 an uninsured discount equivalent to Fairview's higest revenue private payer contracted rate for medically necessary services. | ||
| Part I, Line 7: Fairview Red Wing Health Services uses the cost to charge ratio method for determining expenses. The Medicare cost reporting calculates services line by line where other expenses are calculated at the overall cost to charge ratio. One component of the costing method used is the Other Means tested government program. Minnesotas General Assistance Medical Care program (GAMC) meets this criteria. GAMC is a state funded program for low income adults, ages 21-64, who have no dependent children living with them and who do not qualify for federally funded health care programs. Eligible recipients must also meet income and asset tests. | ||
| Part I, Line 7g: Fairview Red Wing Health Services provides inpatient units and ambulatory programs that serve low-income communities and home health programs. The following are areas of need which have been identified: Adolescent health based on assessment of diet, nutrition and exercise, as well as assets and risk behaviors such as substance use. | ||
| Part I, L7 Col(f): The provision for bad debts is based on management's assessment of historical and expected net collections considering historical business and economic conditions, trends in healthcare coverage, and other collection indicators. | ||
| Part II: Fairview Red Wing Health Services is involved in a limited number of activities which are classified by definition as community building activities. While the majority of community activity addresses direct health needs, the community building activities are valuable for building tangible and intangible community infrastructure housing, safety, leadership skills and more. | ||
| Part III, Line 4: The provision for bad debts is based on management's assessment of historical and expected net collections considering historical business and economic conditions, trends in healthcare coverage, and other collection indicators. Fairview Red Wing Health Services uses the cost to charge ratio method for determining expenses. | ||
| Part III, Line 8: Fairview Red Wing Health Services uses the cost to charge ratio method for determining expenses. The Medicare cost to charge ratio reporting is calculated service line by service line. Other expenses are calculated using the overall cost to charge ratio. | ||
| Part III, Line 9b: After our patients have received services, it is the policy of Fairview Red Wing Health Services to bill patients and their applicable payors on a timely and accurate basis. During this billing and collection process, Fairview staff will be committed to providing quality customer service and timely follow up on all outstanding accounts. Billing: It is the goal of Fairview to bill all claims accurately and on a timely basis. Although dependent on information and communications from patients and payors, Fairview Red Wing Health Services will provide sufficient follow up service to ensure that patients receive accurate account and billing information and have the oportunity to make payment and/or apply for community care. The billing process will be assisted by the following guideline:1) For all insured patients, Fairview Red Wing Health Services will bill all third party payor information (as provided by or verified by the patient) on a timely basis.2) For all uninsured with Minnesota residency receiving hospital based services deemed medically necessary. Fairview Red Wing Health Services will apply an uninsured discount equal to the discount provider to our largest contracted non-government payor, any remaining balance will be billed to the patient in a timely manner.3) All billed patients have the opportunity to contact Fairview Red Wing Health Services regarding financial assistance for their accounts. Financial assistance may include Community Care, payment arrangements, medical assistance or other applicable programs.4) If a patient contacts Fairview Red Wing Health Services regarding Community Care the account will not be referred to a collection agency or attorney, once the application and required documentation is received (income verification etc). The account will then be processed based on the outcome of the Community Care determination.5) If a patient contacts Fairview Red Wing Health Services regarding Community Care after their account has been referred to a collection agency or attorney, Fairview Red Wing Health Services will send a application to the patient, provided the account meets the Community Care requirements. If the completed application with required documents (income verification, etc.) is submitted, all collection action will be suspended until the patient is notified of Fairview Red Wing Health Service's determination. | ||
| Part V, Section B, Line 9: In support of our values and mission and in compliance with the Minnesota Attorney General Agreement signed by Fairview, Fairview Red Wing Health Services is providing uninsured patients with a household income below $125,000 an uninsured discount on billed charges equivalent to Fairview Red Wing Health Services' highest revenue private payer contracted rate for medically necessary services. | Fairview Red Wing Health Services | |
| Part V, Section B, Line 16e: It is the goal of Fairview Red Wing Health Services to bill all claims accurately and on a timely basis. Although dependent on information and communication from patients and payors, Fairview Red Wing Health Services will provide sufficient follow up service to ensure that patients receive accurate account and billing information and have the opportunity to make payment and or apply for Community Care. | Fairview Red Wing Health Services | |
| Part V, Section B, Line 21: Patients who do not comply with the Community Care application process may be denied Community Care. Patients who have insurance and payment has not been received from the insurance company will be denied Community Care if the applicant fails to cooperate with claims filing or collecting from potential third party resources. Other exclusions include services from non-Fairview providers, other Fairview providers not covered by the Charity Care policy and expenses related to transportation or personal living expenses. Non-US Citizens are not eligible for Community Care unless they are an undocumented alien and have established residence in the United States. Out-of-state residents are not eligible for 100 percent Community Care Discount. | Fairview Red Wing Health Services | |
| Part VI, Line 2: Community health assessments are conducted by Fairview Health System's corporate community health department staff every year on a rolling three year cycle for the primary service areas within Fairview Red Wing Health Services. Year 1: Basic Demographic Assessments Year 2: Adolescent Assessments Year 3: Site or Issue Specific Assessments (e.g. analysis of charity care patients). Staff start with existing community documents to build a baseline of information. Information may include patient data, existing recent social and cultural reports, education and business reports, new demographic information about income, housing, education and more. Next, staff conduct key interviews with community leaders from diverse sectors social services, philanthrophy, government, health, education, business, minority groups, faith groups. Interview allow assumptions to be validated and new information to be gathered. In addition site community health staff work with local public health departments and other community groups as part of their supplemental assessment of community need and/or to utilize the findings from their groups in understanding their communities. Beyond the formal needs assessments, Fairview leadership is engaged in their respective communities. Involvement includes participation on community boards, foundations, schools and more. Fairview also seeks community involvement through, community leaders serving on hospital boards and committees. Information gleaned through these connections are equally important as the formal needs assessments. Often these connections can identify emerging issues. | ||
| Part VI, Line 3: Fairview makes informaton about their charity care programs available on the Website (www.fairview.org), at the time of registration for services and through written materials in lobbies and waiting rooms. For patients identified as self-pay (whether that occurs before services are delivered or during the billing cycle), Fairview Red Wing Health Services utilizes a standard process to help patients learn about and access assistance from government programs or Fairview's charity care program.For uninsured patients seen in a Fairview hospital, Fairview partners with an external vendor who meets with self-pay patients to help them determine eligibility for government programs of Fairview's charity care program. The vendor will also help patients complete necessary paperwork to assess these resources.Staff in Fairview's business office have a self-pay team, which directs patients to the appropriate resources. There is also a community care coordinator who helps get patients connected to additional resources for which they may qualify. | ||
| Part VI, Line 4: Fairview Red Wing Medical Center has a primary service area of 47,000 individuals who reside in Goodhue County in Minnesota and Pierce County in Wisconsin. This rural, agricultural community is relatively stable by population, ethnicity and language.Red Wing is located in Goodhue County. Fairview Red Wing Medical Center is the only hospital in the community. Fairview Red Wing provides a full continuum of services, from primary care services at the clinic to home care services to long-term care. | ||
| Part VI, Line 5: Fairview Red Wing Health Services is governed by an unpaid board of directors. The majority of the directors are community members who represent the various service areas and entities within the system. | ||
| Part VI, Line 6: As a nonprofit health system, Fairview Red Wing Health Services reinvests any excess revenues into the core operations of the organization. The Fairview corporate community health department supports the local effort by sharing best practices, finding efficiencies among hospital community health leaders as appropriate, coordinating the formal community needs assessments and more. | ||
| MN | Reports Filed With States | Part VI, Line 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| 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 | |||||||||||||
| 622425 | 0 | 0 | 0 | 0 | 0 | 17150 | 0 | 14349 | 0 | 653924 | 0 | 0 | 0 |
| Jack Alexander M D | |||||||||||||
| 252549 | 0 | 0 | 0 | 0 | 0 | 17150 | 0 | 14442 | 0 | 284141 | 0 | 0 | 0 |
| Amy DeJong M D | |||||||||||||
| 219699 | 0 | 0 | 0 | 0 | 0 | 15963 | 0 | 14442 | 0 | 250104 | 0 | 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 | |||||||||||||
| 208795 | 0 | 0 | 0 | 11915 | 0 | 16051 | 0 | 14000 | 0 | 250761 | 0 | 0 | 0 |
| Nancy Dimunation | |||||||||||||
| 160379 | 0 | 0 | 0 | 0 | 0 | 11296 | 0 | 11937 | 0 | 183612 | 0 | 0 | 0 |
| Matthew A Eich M D | |||||||||||||
| 622666 | 0 | 0 | 0 | 0 | 0 | 17150 | 0 | 13117 | 0 | 652933 | 0 | 0 | 0 |
| Everett M Hughes | |||||||||||||
| 586449 | 0 | 0 | 0 | 19819 | 0 | 17150 | 0 | 14349 | 0 | 637767 | 0 | 0 | 0 |
| Michael R Johnson | |||||||||||||
| 501501 | 0 | 0 | 0 | 17173 | 0 | 0 | 0 | 14349 | 0 | 533023 | 0 | 0 | 0 |
| Christopher McDevitt | |||||||||||||
| 418072 | 0 | 0 | 0 | 0 | 0 | 17150 | 0 | 14349 | 0 | 449571 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | Part I, Line 4b | ReturnReference |
| Explanation | Those participating in a supplemental non-qualified retirement plan: Scott Wordelman $7208. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| City of Minneapolis | |||||||
| 416005375 | 60374VCH4 | 2008-11-12 | 49815000 | Refunded 2005B refunding 2000A Issue for new medical center. | 0 | 0 | 0 |
| City of Minneapolis | |||||||
| 416005375 | 60374VCH4 | 2008-10-29 | 9066000 | Hospital surgery expansion | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Year Of Subst CompletionYearOfSubstCompletion |
|---|---|---|---|---|---|---|---|
| 49815000 | 720000 | 49095000 | 0 | 0 | 0 | 0 | |
| 9066000 | 79000 | 8987000 | 0 | 0 | 0 | 0 | 2009 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs | Engage Bond Counsel ContractsEngageBondCounselContracts |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | |
| 0 | 0 | 1 | 0 | 1 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 1 | 0 | 0 | 0 | 1 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 6 | Fairview Health Services is the sole member of Fairview Red Wing health Services. |
| Form 990, Part VI, Section A, line 7a | Fairview Health Services has reserve powers. |
| 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 VP and Chief Financial Officer. 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 Red Wing Health Services are required to annually complete Fairview's Duty of Loyalty and Conflict of Interest Statement in compliance with Fairview'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 B, line 15 | The determination of executive compensation of the organization is processed by the Human Resources Executive Committee and includes a review of comparablility data, review by independent experts and contemporaneous substantiation of the deliberation and decision process. |
| Form 990, Part VI, Section C, line 19 | Fairview Red Wing Health Services 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (11 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 | 501c(3) | 7 | 0 |
| Fairview Seminary Home | |||||||||
| PO Box 95 - 701 FAIRVIEW BLVD | Red Wing | MN | 55066 | 411263419 | Resident care and housing | MN | 501c(3) | 9 | 0 |
| Fairview Seminary Plaza | |||||||||
| PO Box 95 - 701 FAIRVIEW BLVD | Red Wing | MN | 55066 | 411532554 | Elderly housing | MN | 501c(3) | 9 | 0 |
| Fairview Health Services | |||||||||
| 2450 Riverside Avenue | Minneapolis | MN | 55454 | 410991680 | Hospital patient services | MN | 501c(3) | 3 | 0 |
| Fairview Foundation | |||||||||
| 2450 Riverside Avenue | Minneapolis | MN | 55454 | 411573810 | Fundraising to support Fairviews mission | MN | 501c(3) | 7 | 0 |
| Fairview Home Care and Hospice | |||||||||
| 2450 26th Ave S | Minneapolis | MN | 55406 | 411434246 | Home Health Care | MN | 501c(3) | 9 | 0 |
| RMC Properties | |||||||||
| 2450 Riverside Avenue | Minneapolis | MN | 55454 | 411482417 | Land Lease Hold | MN | 501c(3) | 9 | 0 |
| Fairview Physician Associates Network | |||||||||
| 3400 West 66th Street | Minneapolis | MN | 55435 | 411753325 | Clinical Integration | MN | 501c(3) | 9 | 0 |
| Range Regional Health Services | |||||||||
| 750 East 34th Street | Hibbing | MN | 55746 | 411293970 | Hospital patient services | MN | 501c(3) | 3 | 0 |
| Ebenezer Social Ministries | |||||||||
| 2722 Park Avenue South | Minneapolis | MN | 55407 | 411883845 | Nursing Home Management | MN | 501c(3) | 9 | 0 |
| Fairview Auxiliary | |||||||||
| 6401 France Avenue South | Minneapolis | MN | 55435 | 411414831 | Support hospital services | MN | 501c(3) | 13 | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| Fairview Clinics | ||||||||
| 2450 Riverside Avenue | Minneapolis | MN | 55454 | 411761760 | Physician Services | MN | N/A | C |
| Fairview Physician and Clinic Services | ||||||||
| 2450 Riverside Avenue | Minneapolis | MN | 55454 | 411544996 | Physician Services | MN | N/A | C |
| Ridges Development Co & Subsidiary | ||||||||
| 2450 Riverside Avenue | Minneapolis | MN | 55454 | 411568579 | Leasehold Management | MN | N/A | C |
| Fairview Subsidiary III (Express Care) | ||||||||
| 2450 Riverside Avenue | Minneapolis | MN | 55454 | 205996177 | Physician Services | MN | N/A | C |
| Behavioral Healthcare Providers | ||||||||
| 2450 Riverside Avenue | Minneapolis | MN | 55454 | 411805759 | Mental Health Practitioners | MN | N/A | C |
| Surgical Consultants | ||||||||
| 2450 Riverside Avenue | Minneapolis | MN | 55454 | 410877307 | Medical Services | MN | N/A | C |
| Minnesota Heart | ||||||||
| 2450 Riverside Avenue | Minneapolis | MN | 55454 | 411598660 | Medical Services | MN | N/A | C |
| 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 | 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 | 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 | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| Fairview Health Services | |
| L | 87677 |
| Fairview Seminary Plaza | |
| O | 82 |
| Fairview Regional Community Services | |
| P | 102 |
| Fairview Red Wing Auxiliaryn Association | |
| C | 24334 |
| Fairview Health Services | |
| P | 19386 |
| Fairview Health Services | |
| Q | 190833 |