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Agassiz Assurance Company: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
Agassiz Assurance Company (EIN 74-3121855)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-15
IRS object ID
201231369349301653
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-15T09:05:14-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Deloitte Tax LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line150 So 6th St Suite 2800AddressLine1
CityMinneapolisCity
StateMNState
ZIP Code554021538ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN743121855EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Agassiz Assurance CompanyBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlAGASNameControl
Phone8028645599Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1100 Bank Street No 610AddressLine1
CityBurlingtonCity
StateVTState
ZIP Code05401ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLisa M CarlsonName
TitleCFOTitle
Phone7012344811Phone
Date Signed2012-05-15DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKristina RasmussenName
Phone6123974000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

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

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11305 W 18th StAddressLine1
CitySioux FallsCity
StateSDState
ZIP Code57117ZIPCode
FieldValueIRS element (for citing)
Gross Receipts17145229GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2004YearFormation
State Legal DomicileVTStateLegalDomicile
Activity Or Mission DescriptionDedicated to the work of health and healing.ActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees0TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year6006379ProgramServiceRevenuePriorYear
Program Service Revenue CY1342015ProgramServiceRevenueCY
Investment Income Prior Year639805InvestmentIncomePriorYear
Investment Income Current Year1460631InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year6646184TotalRevenuePriorYear
Total Revenue Current Year2802646TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year0SalariesEtcPriorYear
Salaries Etc Current Year0SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5321899OtherExpensePriorYear
Other Expenses Current Year1482365OtherExpensesCurrentYear
Total Expenses Prior Year5321899TotalExpensesPriorYear
Total Expenses Current Year1482365TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1324285RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1320281RevenuesLessExpensesCY
Total Assets BOY28176904TotalAssetsBOY
Total Assets EOY25716738TotalAssetsEOY
Total Liabilities BOY17866647TotalLiabilitiesBOY
Total Liabilities EOY13932587TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY10310257NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY11784151NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSanford's mission is "Dedicated to the Work of Health and Healing." Part of the Sanford Health System, Sanford is committed to the healthcare needs of communities throughout South Dakota, North Dakota, Minnesota and Iowa. Sanford provides a full range of primary and specialty health care services.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change1SignificantChange
Expense1332345Expense
Revenue1342015Revenue
DescriptionAgassiz Assurance Company (the company) was formed under the captive insurance laws of the state of Vermont in 2004 and provides claims made and occurrence based health care professional liability and commercial general liability coverage to Sanford and its affiliates. The purpose of this company is to provide other Sanford entities a long term, stable access to healthcare professional liability coverage and over the long term reduce the cost of this coverage through improved risk control and better claim management. The company has no employees and is managed by Marsh Management Services, Inc. pursuant to a management agreement.Description
Total Program Service Expense1332345TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip0ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With10961NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees0NumberOfEmployees
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Excess Business Holdings0ExcessBusinessHoldings
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs1ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Heather Cook CO Marsh ManagementBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number8028645599TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1100 Bank Street Suite 610AddressLine1
CityBurlingtonCity
StateVTState
ZIP Code05401ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (29 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficer
Ann Christenson
Trustee0.50X000
Barb Everist
Trustee0.50X000
Barbara Stork
Trustee0.50X000
Barry Martin
Trustee0.50X000
Brent Teiken
Trustee0.50X000
David Beito
Trustee0.50X000
Don Morton
Trustee0.50X000
Jerome Feder
Trustee0.50X000
Jim Entenman
Trustee0.50X000
John C Vanderwoude
Trustee60.00X0118456030701
John Jambois
Trustee0.50X000
Lauris Molbert
Trustee0.50X000
Marcy Waterfall
Director0.50X000
Mark Paulson MD
Trustee60.00X022003646521
Michael L Olson
Trustee60.00X05184556998
Michael L Olson Deferred Comp
Trustee60.00X0046935
Mikal Claar
Trustee0.50X000
Pamela Anderson
Trustee0.50X000
Richard D Hardie
Trustee60.00X044443418343
Ronald Moquist
Trustee0.50X000
Terrence Grimm MD
Trustee60.00X058588742328
Terry Baloun
Trustee0.50X000
Kelby K Krabbenhoft
Sanford Health President & CEO60.00X0127451419513X
Kelby K Krabbenhoft Deferred Comp
Sanford Health President & CEO60.00X00565838X
Lisa Carlson
Treasurer60.00X041811251907X
Bill Marlette
Secretary60.00X06953551438X
Bill Marlette Deferred Compensation
Secretary60.00X00129024X
Paul Richard
President60.00X039592641452X
Kim J Patrick
Vice President60.00X043852255000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org0TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs6175801TotalReportableCompFrmRltdOrgs
Total Other Compensation1055998TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources
Number Of Contractors GT100 K0NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Favorable Loss Develop90009913047271304727
Net conversion to depo5251003728837288
FieldValueIRS element (for citing)
Total Program Service Revenue1342015TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1415642TotalRevenueColumn
Exclusion$1,415,642ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities14387572Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities14342583Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities44989Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column44989TotalRevenueColumn
Exclusion$44,989ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column2802646TotalRevenueColumn
Related Or Exempt Function Income1342015RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$1,460,631ExclusionAmount

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total57500Total
Management And General57500ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total13667Total
Management And General13667ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total27500Total
Management And General27500ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total51353Total
Management And General51353ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
PolicyHolder Dividend13047271304727
Premium Tax2616526165
Misc Expenses14531453

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total1482365Total
Program Services1332345ProgramServices
Management And General150020ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY826356BOY
EOY5221704EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6670000BOY
EOY1364202EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY21110BOY
EOY25193EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY20436313BOY
EOY18900715EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY223125BOY
EOY204924EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY28176904BOY
EOY25716738EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY67789BOY
EOY93516EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY5555288BOY
EOY6965231EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY12243570BOY
EOY6873840EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY17866647BOY
EOY13932587EOY
FieldValueIRS element (for citing)
Do Not Follow SFAS117XDoNotFollowSFAS117

Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

FieldValueIRS element (for citing)
BOY750000BOY
EOY750000EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

FieldValueIRS element (for citing)
BOY9560257BOY
EOY11034151EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY10310257BOY
EOY11784151EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY28176904BOY
EOY25716738EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1320281ReconcilationRevenueExpenses
Reconcilation Other Changes153613ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement BothXFinancialStatementBoth
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type2XSupportingOrg509a3Type2
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation (14 entries)

EINEINType Of OrganizationTypeOfOrganizationListed In Governing DocListedInGoverningDocAmountAmount
Sanford USD Medical Center
46022785531$116,514
Sanford Medical Center Fargo
46022690931$77,676
Sanford Clinic
46044769331$565,078
Sanford Clinic North
91177074891$612,810
Sanford Home Health
46028213491$0
Sanford Health Foundation North
45039810471$0
Sanford ResearchUSD
46045037831$1,038
Sanford Medical Center Thief River Falls
41070957931$19,567
Sanford Medical Center Mayville
45022889931$889
Meritcare Minnesota
26153030231$0
Sanford Medical Center Wheaton
27204214331$0
Sanford Health of Northern Minnesota
41126600931$0
North Country Medical Clinic
41175385531$0
Baker Park Inc
41137248091$0
FieldValueIRS element (for citing)
Total Number Of Supported Orgs14TotalNumberOfSupportedOrgs
Sum Of Amounts1393572SumOfAmounts

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Total Of Book Value Land Buildings0TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Losses & Loss Adjustments$2,821,752
Due to Related Parties$2,747,361
Policyholder Dividend Payable$1,304,727
FieldValueIRS element (for citing)
Total Of Amounts6873840TotalOfAmounts
Total Revenue2802646TotalRevenue
Total Expenses1482365TotalExpenses
Excess Or Deficit For Year1320281ExcessOrDeficitForYear
Net Unrealized GL On Investments782260NetUnrealizedGLOnInvestments
Other-$628,647OtherAmount
Total Adjustments153613TotalAdjustments
Excess Or Deficit Per FS1473894ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt3584906TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments782260NetUnrealizedGainsInvestments
Revenue Not Rptd F990782260RevenueNotRptdF990
Revenue Subtotal2802646RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form9902802646TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt1482365TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal1482365ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form9901482365TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Description of Uncertain Tax Positions Under FIN 48:Part X:The Company recognizes uncertain tax positions under accounting guidance which clarifies the accounting for uncertainty in income taxes recognized in a company's financial statements. Accounting guidance prescribes a recognition threshold and measurement attribute for the financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The interpretation also provides guidance on derecognition, classification, interest and penalties, accounting in interim periods, disclosure and transition. The Company had no uncertain tax positions as of June 30, 2011 and 2010.
Part XI, Line 8 - Other Adjustments:Transfer to trading securities -628,647.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (12 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
John C Vanderwoude
01000000000184560073500233510121526100
Mark Paulson MD
019643200023604031527014994026655700
Michael L Olson
0504486000139690006998052545300
Michael L Olson Deferred Comp
0000000469350004693500
Richard D Hardie
04144730002996107350010993046277700
Terrence Grimm MD
05000040008588303492807400062821500
Kelby K Krabbenhoft
0789232000485282000195130129402700
Kelby K Krabbenhoft Deferred Comp
000000056583800056583800
Lisa Carlson
033581100082301034928016979047001900
Bill Marlette
04407590002545960001438069679300
Paul Richard
03144180008150803492806524043737800
Kim J Patrick
0303696000134826035520019480049352200

Form990 Schedule J Part III Form990ScheduleJPartIII (8 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 1aOn Part I, Questions Regarding Compensation, Sanford checked several of the items as provided to listed persons: First Class or Charter Travel - Charter travel for business purposes is provided for individuals as needed and as cost appropriate, in accordance with written policies. These costs are not included in the W-2's of the individuals as they are incurred for business purposes of Sanford. Travel for Companions - Limited travel for companions is required for certain annual meetings. These costs are not included in the W-2's of the individuals as they are incurred for business purposes of Sanford. Tax Indemnification and gross-up payments - Certain compensation may be grossed up to include appropriate tax amounts. Health or social club dues or initiation fees - All Sanford employees are eligible for discounted wellness memberships, a portion of these discounts and other club dues are included as fringe benefits, and taxed as such. Personal services - Individuals may have benefits which include tax preparation or planning, this benefit is included in income and taxed. Part I, Line 3: The Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm to annually review the total compensation of arrangements of the officers of the organization, and to report findings and recommendations to the Sanford Board of Trustees for deliberation and action. The most recent study was completed in 2011.
Part I, Line 4bPart I, Line 4b / Schedule J, Part II, Column C: Employer contributions to defined contribution SERP Plans are included in Column C. Participants and contributions include: Kim Patrick $28,170. In addition to employer contributions to pension plans, amounts representing increases and decreases in actuarial value (actuarial value factors include age, tenure and salary) of defined benefit SERP Plans are included in Column C. Participants and changes in values include: Kelby Krabbenhoft $420,519, Bill Marlette $96,062.
Part I, Line 6Sanford physicians are compensated based on the professional services they perform within the clinic in which they provide care. Generally, the model is revenues less expenses. Physicians listed that were paid on this model include: Michael Olson, Richard Hardie.
Part I, Line 7Certain Executives are eligible for a discretionary incentive bonus, based on financial targets and other goals.
Part IIISupplemental: Compensation reported on Schedule J includes: (B)(i) Base compensation - salaries are based on the experience and performance of each executive and bench-marked using independent compensation survey information. (B)(ii) - Bonus & incentive compensation - as part of executive compensation, individuals may be eligible for incentive performance compensation, however if the organization does not meet its financial targets, incentive payments are not paid, regardless of performance. (B)(iii) Other Reportable Compensation - generally includes taxable executive benefits. It also includes the one-time payout of previously deferred compensation (which was also reported as compensation in the earned period). To be in compliance with the IRS regulatory environment, listed individuals compensation includes a one-time payment of deferred compensation; this compensation was earned over multiple periods, and should be treated as earned over that length of time in exchange for services provided. (C) Deferred Compensation includes employer contributions to pension plans and the increase (or decrease) in the actuarial value (actuarial value factors include age, tenure and salary) of the defined benefit plans. (D) Nontaxable Benefits generally includes health insurance premiums.Supplemental Information
Part IIIThe Sanford Board of Trustees is comprised of 15 members, including nine volunteer community members, five physicians and the CEO. Compensation paid to any trustee is for full-time professional responsibilities as physicians or administrators of the organization.Supplemental Information
Part IIIA memo regarding executive compensation, written by the Chairman of the Sanford Board of Trustees, is on file and available upon request.Supplemental Information
Part IIICompensation paid to trustees is for full-time professional responsibilities as physicians, administrators or employees of the organization. The total compensation paid to Kelby Krabbenhoft of $1,274,514 is comprised of Base salary of $789,232, and Other Taxable Earnings of $485,282. In addition, an amount of $565,838 has been reported for the estimated amount of ratable increase in value of the defined benefit pension plan, defined benefit SERP and a Gift Agreement Management Continuity Retention.Supplemental Information

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Changes in Program ServicesForm 990, Part III, line 3Change to Deposit Accounting. Deposit accounting is utilized for policies beginning May 1, 2010 effective July 1, 2010. Under deposit accounting, funds transferred to the Company are recorded as deposit liabilities. These liabilities are reduced as claim payments are made.
Form 990, Part VI, Section A, line 2Lisa Carlson and Pamela Anderson have a business relationship. The following officers, board members, and key employees are employees of Sanford or its related organizations. Many of these employees also serve on other related Sanford boards, or have business relationships with each other that span the organization as a whole: John Vanderwoude, Mark Paulson, Michael Olson, Richard Hardie, Terrence Grimm, Kelby Krabbenhoft, Lisa Carlson, Bill Marlette, Paul Richard.
Form 990, Part VI, Section A, line 3Agassiz utilized Marsh Vermont to provide management services to the Corporation.
Form 990, Part VI, Section A, line 4The sole member of the organization is Sanford. This was changed in the Articles of Incorporation and the By-Laws effective September 2010.
Form 990, Part VI, Section A, line 6Sole member is Sanford or its subsidiaries or affiliates.
Form 990, Part VI, Section A, line 8bThere are no committees with authority to act on behalf of the board.
Form 990, Part VI, Section B, line 11The Form 990 is prepared internally by the finance department and reviewed by executive management. An external accounting firm reviews the return prior to filing and prepares return highlights and key disclosures for the Board of Trustees meeting immediately following the return filing date. After the return is filed, a complete copy is made available to the current trustees.
Form 990, Part VI, Section B, line 12cThe annual Conflict of Interest disclosure process is managed by the Chief Compliance Officer (CCO). The CCO is responsible for assuring that all completed forms are returned in a timely and complete manner. Conflict of Interest questionnaires are sent to Sanford Trustees, members of the governing boards for subsidiary entities, officers, and key employees for all entities subject to the IRS Form 990 filings. The disclosures are summarized for review by the executive committee of the Board of Trustees, pursuant to policy. This review allows: 1) The Board to acquire an awareness of financial relationships of board members and key management employees and can invoke the recusal process on a case-by-case basis when potential conflicts are implicated in Board decisions and deliberations, and, 2) Gives the Board the opportunity to seek additional information and clarification about disclosures to determine potential conflicts of interest and how to manage such.
Form 990, Part VI, Section B, line 15The Sanford Board of Trustees directly engages a nationally recognized independent compensation consulting firm to annually review the total compensation arrangements of the officers and operating unit executives of the organization, including the CEO, and to report the findings and recommendations to them for deliberation and action. The deliberations and actions are recorded in the minutes of the Sanford Board of Trustees. The most recent study was completed in 2011. Additionally, Sanford periodically engages an independent compensation consultant to review and issue a report regarding the reasonableness of the total compensation arrangements of all physicians employed by the organization. The most recent study of physician total compensation arrangements was completed in 2009.
Form 990, Part VI, Section C, line 19Although the organization does not maintain a website where the public can access these documents, it would respond individually to any requests or inquiries from the public for these documents.
Form 990, Part VII:Sanford Trustees provide services to Sanford and its subsidiaries. Hours reported for each individual reflect the time spent on work related to either the filing organization or a related organization. Sanford Board of Trustees has ultimate governance responsibilities for each entity within the Sanford system. In addition, a Board of Directors is established for each entity, which has specific delegated responsibilities from the Board of Trustees related to the oversight of day to day operations of that entity.
Changes in Net Assets or Fund Balances:Form 990, Part XI, line 5:Net unrealized gains on investments: 782,260. Transfer to trading securities -628,647. Total to Form 990, Part XI, Line 5: 153,613.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (25 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
Sanford Health
1305 West 18th StreetSioux FallsSD57117311527032Supporting OrganizationSD501(c)(3)11-IIISanford0
Sanford Health Foundation
1305 West 18th StreetSioux FallsSD57117363297853Supporting OrganizationSD501(c)(3)11-ISanford Health1
Sanford
801 Broadway DriveFargoND58122271218956Supporting OrganizationND501(c)(3)11-II0
SHM-Sanford
1305 West 18th StreetSioux FallsSD57105271213769Supporting OrganizationSD501(c)(3)11-II0
SHM-MeritCare
801 Broadway DriveFargoND58122271213717Supporting OrganizationND501(c)(3)11-II0
Sanford North
PO Box 2010FargoND58122450385890Supporting OrganizationND501(c)(3)11-IISanford0
Sanford Medical Center Fargo
PO Box 2010FargoND58122450226909HospitalND501(c)(3)3Sanford North1
Sanford Clinic North
PO Box 2010FargoND58122911770748ClinicsND501(c)(3)9Sanford North1
Sanford Health Network North
PO Box 2010FargoND58122450409348Hospitals/ClinicsND501(c)(3)11-IISanford North1
Sanford Medical Center Wheaton
401 12th Street NorthWheatonMN56296272042143Hospital/ClinicMN501(c)(3)3Sanford North1
Sanford Health Foundation North
PO Box 2010FargoND58122450398104Supporting OrganizationND501(c)(3)7Sanford North1
Sanford Medical Center Thief River Falls
120 Labree Ave SThief River FallsMN56701410709579HospitalMN501(c)(3)3Sanford North1
Sanford Medical Center Mayville
42 6th Ave SEMayvilleND58257450228899HospitalND501(c)(3)3Sanford North1
MeritCare Minnesota
1720 South Highway 59Thief River FallsMN56701261530302Promotion of healthMN501(c)(3)3Sanford North1
MeritCare Health Enterprises Inc
PO Box 2010FargoND58122450359785Prescription drugsND501(c)(4)Sanford North1
FM Ambulance Service
2215 18 St SouthFargoND58103450344371EMTND501(c)(4)Sanford North1
Sanford Health of Northern Minnesota
1300 Anne St NWBemidjiMN56601411266009HospitalMN501(c)(3)3Sanford North1
Baker Park Inc
803 Dewey Ave NWBemidjiMN56601411372480Low Income Senior HousingMN501(c)(3)9Sanford Health of Northern Minnesota1
Sanford Health Foundation of Northern Minnesota
1300 Anne St NWBemidjiMN56601411389317Fundraising - SupportMN501(c)(3)11-ISanford Health of Northern Minnesota1
North Country Medical Clinic
1300 Anne St NWBemidjiMN56601411753855Family Practice Medical ClinicMN501(c)(3)3Sanford Health of Northern Minnesota1
Sanford ResearchUSD
1305 W 18th St PO Box 5039Sioux FallsSD571175039460450378ResearchSD501(c)(3)3Sanford Health1
Sanford USD Medical Center
1305 W 18th St PO Box 5039Sioux FallsSD571175039460227855HospitalSD501(c)(3)3Sanford Health1
Sanford Clinic
1305 W 18th St PO Box 5039Sioux FallsSD571175039460447693Clinical ServicesSD501(c)(3)3Sanford Health1
Sanford Health Network
1305 W 18th St PO Box 5039Sioux FallsSD571175039460388596Hospitals/ClinicsSD501(c)(3)11-ISanford Health1
Sanford Home Health
1305 W 18th St PO Box 5039Sioux FallsSD571175039460282134Home Health ServicesSD501(c)(3)9Sanford Health1

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

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

Form990 Schedule R Part IV Form990ScheduleRPartIV (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntity
Heart Partners at Sanford
1305 W 18th StreetSioux FallsSD57117460449572HealthcareSDN/AC
Sanford Home Medical Equipment Inc
2710 W 12th StreetSioux FallsSD57105460388597Healthcare EquipmentSDN/AC
Sanford Health Plan
300 Cherapa PlaceSioux FallsSD57103911842494InsuranceSDN/AC
Sanford Health Plan of MN
300 Cherapa PlaceSioux FallsSD57103460445852InsuranceMNN/AC
Healthcare Environmental Services Inc
1420 40th St NWFargoND58102450336598Laundry and Incineration ServicesNDN/AC
Bemidji Medical Equipment Inc
1300 Anne St NWBemidjiMN56601411551725Retail Sales of DMEMNN/AC
North Country Management Inc
1300 Anne St NWBemidjiMN56601411820025Management ServicesMNN/AC
Sanford World Clinics
1305 West 18th StreetSioux FallsSD57117262707628HealthcareSDN/AC
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Sanford Medical Center Fargo
K3558942Cost
Sanford USD Medical Center
K3074294Cost