Agassiz Assurance Company: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- Agassiz Assurance Company (EIN 74-3121855)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-13
- IRS object ID
- 201141339349304494
- Schema version
- 2009v1.4
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-13T15:34:05-05:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Deloitte Tax LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 So 6th St Suite 2800 | AddressLine1 |
| City | Minneapolis | City |
| State | MN | State |
| ZIP Code | 554021538 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 743121855 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Agassiz Assurance Company | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | AGAS | NameControl |
| Phone | 8028645599 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 Bank Street No 610 | AddressLine1 |
| City | Burlington | City |
| State | VT | State |
| ZIP Code | 05401 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Lisa Carlson | Name |
| Title | CFO | Title |
| Phone | 7012344811 | Phone |
| Date Signed | 2011-05-13 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6123974000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Kelby Krabbenhoft | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1305 W 18th St | AddressLine1 |
| City | Sioux Falls | City |
| State | SD | State |
| ZIP Code | 57117 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 9030079 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2004 | YearFormation |
| State Legal Domicile | VT | StateLegalDomicile |
| Activity Or Mission Description | Dedicated to the work of health and healing. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 1 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 5245 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 6075686 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 6006379 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 651544 | InvestmentIncomePriorYear |
| Investment Income Current Year | 639805 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6727230 | TotalRevenuePriorYear |
| Total Revenue Current Year | 6646184 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4353189 | OtherExpensePriorYear |
| Other Expenses Current Year | 5321899 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 4353189 | TotalExpensesPriorYear |
| Total Expenses Current Year | 5321899 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2374041 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1324285 | RevenuesLessExpensesCY |
| Total Assets BOY | 22401903 | TotalAssetsBOY |
| Total Assets EOY | 28176904 | TotalAssetsEOY |
| Total Liabilities BOY | 13767531 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 17866647 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 8634372 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 10310257 | NetAssetsOrFundBalancesEOY |
| Mission Description | Our Mission "Dedicated to the work of health and healing" and our Vision "Improving the human condition trhough exceptional care, innovation and discovery", is the constant force that drives our plans, decisions and actions. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 5189631 | Expense |
| Revenue | 6001134 | Revenue |
| Description | Agassiz 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 Expense | 5189631 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 1 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 0 | WhistleblowerPolicy |
| Document Retention Policy | 0 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Heather Cook CO Marsh Management | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 8028645599 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 Bank Street Suite 610 | AddressLine1 |
| City | Burlington | City |
| State | VT | State |
| ZIP Code | 05401 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (8 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| Paul Richard | ||||||
| President | 60.00 | X | X | 0 | 286282 | 49603 |
| Kim Patrick | ||||||
| Vice President | 60.00 | X | X | 0 | 403448 | 61086 |
| Bill Marlette | ||||||
| Secretary | 60.00 | X | X | 0 | 567500 | 275751 |
| Lisa Carlson | ||||||
| Treasurer | 60.00 | X | X | 0 | 294054 | 49603 |
| Roger Gilbertson MD | ||||||
| Director (Jul-Nov 09) | 60.00 | X | X | 0 | 1004743 | 989160 |
| Roger Lee | ||||||
| Secretary (Jul-Nov 09) | 60.00 | X | X | 0 | 141381 | 24886 |
| Marcy Waterfall | ||||||
| Director | 0.50 | X | 0 | 0 | 0 | |
| Kelby Krabbenhoft | ||||||
| President & CEO | 60.00 | X | 0 | 1123846 | 748719 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3821254 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 2198808 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Premiums Earned | Description |
| Business Code | 525100 | BusinessCode |
| Total Revenue Column | 6006379 | TotalRevenueColumn |
| Related Or Exempt Function Income | 6001134 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 5245 | UnrelatedBusinessRevenue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 6006379 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 571352 | TotalRevenueColumn |
| Exclusion | $571,352 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2452348 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2383895 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 68453 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 68453 | TotalRevenueColumn |
| Exclusion | $68,453 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6646184 | TotalRevenueColumn |
| Related Or Exempt Function Income | 6001134 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 5245 | UnrelatedBusinessRevenue |
| Exclusion | $639,805 | ExclusionAmount |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57500 | Total |
| Management And General | 57500 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9243 | Total |
| Management And General | 9243 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22320 | Total |
| Management And General | 22320 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43205 | Total |
| Management And General | 43205 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Losses Incurred | 5152400 | 5152400 |
| Premium Tax | 22824 | 22824 |
| Misc Expenses | 14407 | 14407 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5321899 | Total |
| Program Services | 5189631 | ProgramServices |
| Management And General | 132268 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1749135 | BOY |
| EOY | 826356 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3143877 | BOY |
| EOY | 6670000 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11913 | BOY |
| EOY | 21110 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17271952 | BOY |
| EOY | 20436313 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 225026 | BOY |
| EOY | 223125 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22401903 | BOY |
| EOY | 28176904 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 577998 | BOY |
| EOY | 67789 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3135000 | BOY |
| EOY | 5555288 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10054533 | BOY |
| EOY | 12243570 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13767531 | BOY |
| EOY | 17866647 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 750000 | BOY |
| EOY | 750000 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7884372 | BOY |
| EOY | 9560257 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8634372 | BOY |
| EOY | 10310257 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22401903 | BOY |
| EOY | 28176904 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type2 | X | SupportingOrg509a3Type2 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (6 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | AmountAmount |
|---|---|---|---|
| Sanford Medical Center Fargo | |||
| 450226909 | 3 | 1 | $0 |
| Sanford Clinic North | |||
| 911770748 | 9 | 1 | $0 |
| Sanford North | |||
| 450385890 | 11-II | 1 | $2,963,363 |
| Sanford Health Foundation North | |||
| 450398104 | 7 | 1 | $0 |
| Sanford Health Network North | |||
| 450409348 | 11-II | 1 | $0 |
| MeritCare Health Enterprises Inc | |||
| 450359785 | 501(C)(4) | 1 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 6 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 2963363 | SumOfAmounts |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Losses & Loss Adjustments | $12,148,755 |
| Due to Related Parties | $94,815 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 12243570 | TotalOfAmounts |
| Total Revenue | 6646184 | TotalRevenue |
| Total Expenses | 5321899 | TotalExpenses |
| Excess Or Deficit For Year | 1324285 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 351600 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 351600 | TotalAdjustments |
| Excess Or Deficit Per FS | 1675885 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 6712873 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 66689 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 66689 | RevenueNotRptdF990 |
| Revenue Subtotal | 6646184 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 6646184 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 5321899 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 5321899 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 5321899 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part X: | Identifier |
| Return Reference | Description of Uncertain Tax Positions Under FIN 48: | ReturnReference |
| Explanation | Certain controlled organizations are subject to income taxes. Deferred income tax assets and liabilities are recognized for the differences between the financial and income tax reporting basis of assets and liabilities based on enacted tax rates and laws. A tax benefit from an uncertain tax position may be recognized when it is more likely than not that the position will be sustained upon examination. The deferred income tax provision or benefit generally reflects the net change in deferred income tax assets and liabilities during the year. The current income tax provision reflects the tax consequences of revenues and expenses currently taxable or deductible on various income tax returns for the year reported. Agassiz Assurance Company did not have an income tax liability at June 30, 2010; some related organizations have established reserves. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | 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 (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Paul Richard | |||||||||||||
| 0 | 285250 | 0 | 0 | 0 | 1032 | 0 | 32720 | 0 | 16883 | 0 | 335885 | 0 | 0 |
| Kim Patrick | |||||||||||||
| 0 | 298233 | 0 | 0 | 0 | 105215 | 0 | 44784 | 0 | 16302 | 0 | 464534 | 0 | 17587 |
| Bill Marlette | |||||||||||||
| 0 | 409620 | 0 | 0 | 0 | 157880 | 0 | 274383 | 0 | 1368 | 0 | 843251 | 0 | 25619 |
| Lisa Carlson | |||||||||||||
| 0 | 292197 | 0 | 0 | 0 | 1857 | 0 | 32720 | 0 | 16883 | 0 | 343657 | 0 | 0 |
| Roger Gilbertson MD | |||||||||||||
| 0 | 567216 | 0 | 0 | 0 | 437527 | 0 | 973515 | 0 | 15645 | 0 | 1993903 | 0 | 48624 |
| Roger Lee | |||||||||||||
| 0 | 134513 | 0 | 0 | 0 | 6868 | 0 | 18469 | 0 | 6417 | 0 | 166267 | 0 | 0 |
| Kelby Krabbenhoft | |||||||||||||
| 0 | 746924 | 0 | 0 | 0 | 376922 | 0 | 730587 | 0 | 18132 | 0 | 1872565 | 0 | 79234 |
Form990 Schedule J Part III Form990ScheduleJPartIII (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 1a | On 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. These costs are not included in the W-2's of the individuals as they meet the business purpose of Sanford North. Travel for Companions - Limited travel for companions is required for an annual meeting. These costs are not included in the W-2's of the individuals as they meet the business purpose of Sanford North. Tax Indemnification and gross-up payments - Compensation may be grossed up to include appropriate tax amounts in certain circumstances. 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 taxed as fringe benefits. 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 2010. | |
| Part I, Line 4a | Part I, Line 4a: 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. These amounts were already reported in previous years as compensation. Distributions were paid to the following individuals: Kim Patrick $17,587 Bill Marlette $25,619 Kelby Krabbenhoft $79,234 Dr. Roger Gilbertson was President and CEO of MeritCare Health System. MeritCare and Sanford Health merged on November 2, 2009 at which time Dr. Gilbertson retired. Upon retirement Dr. Gilbertson received a separation payment of $1,000,920 of which $48,624 was paid during the calendar year and $952,295 was accrued to be paid monthly through November 1, 2011. The payment was consistent with the President's Employment Agreement effective January 1, 2007. Part I, Line 4b/Schedule J, Part II, Column C: 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 contribution and defined benefit SERP Plans are included in Column C. Participants and changes in values include: Kim Patrick $ 37,434 Bill Marlette $245,737 Kelby Krabbenhoft $706,194 Roger Gilbertson, MD $ 94,324 | |
| Part III | Compensation reported on Schedule J, Part II 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 make its financial budget, the Executive does not receive an incentive payment 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 benefit plans. (D) Nontaxable Benefits generally includes health insurance premiums. | Supplemental Information |
| Part III | The 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 III | A memo regarding executive compensation, written by the Chairman of the Sanford Board of Trustees, is on file and available upon request. | Supplemental Information |
| Part III | The total compensation paid to Kelby Krabbenhoft of $1,123,846 is comprised of Base salary of $746,924, the one-time payment of previously deferred compensation of $79,234 (see also explanation above) and Other Taxable Earning of $297,688. | Supplemental Information |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| Form 990, Part VI, Section A, line 1 | Board members also serve on the boards of Sanford and/or related entities. | |
| Form 990, Part VI, Section A, line 3 | Agassiz utilized Marsh Vermont to provide management services to the Corporation. | |
| Form 990, Part VI, Section A, line 6 | Sanford North is the sole member of the organization. | |
| Form 990, Part VI, Section A, line 8b | There are no committees with authority to act on behalf of the board. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 is prepared internally by the finance department and reviewed by executive management, including both the System CEO and CFO. An external accounting firm reviews the return prior to filing and presents return highlights and key disclosures to the Board of Trustees at the 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 12c | The annual Conflict of Interest disclosure process is managed by the Chief Compliance Officer (CCO). The CCO is responsible for assuring that all completed forms are returned in a timely and complete manner. Conflict of Interest questionnaires are sent to Sanford Trustees, members of the governing boards for subsidiary entities, officers, and key employees. 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 15 | The 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 2010. | |
| Form 990, Part VI, Section C, line 19 | Although the organization does not maintain a website where the public can access these documents, it would respond individually to any requests or inquiries from the public for these documents. | |
| Form 990, Part VII | Board members of Sanford provide services to Sanford subsidiaries. Hours reported for each individual reflect the time spent on work related to either the filing organization or related organization. | |
| Form 990, Schedule R, Part V | Related Party Premiums are recorded at cost based on claims experience. | Costing Method for Related Party Transactions |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (22 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| Sanford North | |||||||||
| PO Box 2010 | Fargo | ND | 58122 | 450385890 | Supporting Organization | ND | 501(c)(3) | 11-II | Sanford |
| Sanford Clinic North | |||||||||
| PO Box 2010 | Fargo | ND | 58122 | 911770748 | Clinical Services | ND | 501(c)(3) | 11-II | Sanford North |
| MeritCare Minnesota | |||||||||
| 1720 South Highway 59 | Thief River Falls | MN | 56701 | 261530302 | Promotion of health | MN | 501(c)(3) | 3 | Sanford North |
| Sanford Medical Center Fargo | |||||||||
| PO Box 2010 | Fargo | ND | 58122 | 450226909 | Hospital | ND | 501(c)(3) | 3 | Sanford North |
| Sanford Health Foundation North | |||||||||
| PO Box 2010 | Fargo | ND | 58122 | 450398104 | Supporting Organization | ND | 501(c)(3) | 7 | Sanford North |
| Sanford Health Network North | |||||||||
| PO Box 2010 | Fargo | ND | 58122 | 450409348 | Hospitals / Clinics | ND | 501(c)(3) | 11-II | Sanford North |
| MeritCare Health Enterprises Inc | |||||||||
| PO Box 2010 | Fargo | ND | 58122 | 450359785 | Sales of prescription drugs | ND | 501(c)(4) | Sanford North | |
| FM Ambulance Service | |||||||||
| 2215 18th St South | Fargo | ND | 58103 | 450344371 | Emergency Medical Transport Services | ND | 501(c)(4) | Sanford North | |
| Sanford Medical Center Thief River Falls | |||||||||
| 120 Labree Ave S | Thief River Falls | MN | 56701 | 410709579 | Hospital | MN | 501(c)(3) | 3 | Sanford North |
| Sanford Medical Center Mayville | |||||||||
| 42 6th Ave SE | Mayville | ND | 58257 | 450228899 | Hospital | ND | 501(c)(3) | 3 | Sanford North |
| Sanford Medical Center Wheaton | |||||||||
| 401 12th St N | Wheaton | MN | 56296 | 272042143 | Hospitals / Clinics | MN | 501(c)(3) | 3 | Sanford North |
| Sanford Health | |||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 311527032 | Supporting Organization | SD | 501(c)(3) | 11-II | Sanford |
| Sanford USD Medical Center | |||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 460227855 | Hospital | SD | 501(c)(3) | 3 | Sanford Health |
| Sanford Clinic | |||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 460447693 | Clinics | SD | 501(c)(3) | 3 | Sanford Health |
| Sanford Health Network | |||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 460388596 | Hospitals / Clinics | SD | 501(c)(3) | 11-II | Sanford Health |
| Sanford Home Health | |||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 460282134 | Home Health Services | SD | 501(c)(3) | 9 | Sanford Health |
| Sanford Health Foundation | |||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 363297853 | Supporting Organization | SD | 501(c)(3) | 11-I | Sanford Health |
| Sanford Research USD | |||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 460450378 | Medical Research | SD | 501(c)(3) | 4 | Sanford Health |
| SHM-Sanford | |||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 271213769 | Supporting Organization | SD | 501(c)(3) | 11-II | |
| SHM-MeritCare | |||||||||
| 801 N Broadway Drive | Fargo | ND | 58122 | 271213717 | Supporting Organization | ND | 501(c)(3) | 11-II | |
| Sanford | |||||||||
| 801 N Broadway Drive | Fargo | ND | 58122 | 271218956 | Supporting Organization | ND | 501(c)(3) | 11-II | |
| Sanford World Clinics | |||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 262707628 | Healthcare | SD | 501(c)(3) | 3 | Sanford Health |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner |
|---|---|---|---|---|---|---|---|---|---|---|
| National Student Housing South Dakota LLC | ||||||||||
| 100 S Phillips | Sioux Falls | SD | 57104 | 202129839 | Investment | SD | Sanford Health | Related | 0 | 0 |
| RAC Rentals LLC | ||||||||||
| 100 S Phillips | Sioux Falls | SD | 57104 | 261961077 | Investment | SD | Sanford Health | Related | 0 | 0 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (5 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity |
|---|---|---|---|---|---|---|---|---|
| Healthcare Environmental Services Inc | ||||||||
| 1420 40th St NW | Fargo | ND | 58102 | 450336598 | Laundry and Incineration Services | ND | Sanford North | C |
| Heart Partners at Sanford | ||||||||
| 1305 West 18th St | Sioux Falls | SD | 57117 | 460449572 | Healthcare | SD | Sanford Health | C |
| Sanford Home Medical Equipment Inc | ||||||||
| 2710 West 12th St | Sioux Falls | SD | 571043701 | 460388597 | Healthcare Equipment | SD | Sanford Health | C |
| Sanford Health Plan | ||||||||
| 300 Cherapa Place 201 | Sioux Falls | SD | 57103 | 911842494 | Insurance | SD | Sanford Health | C |
| Sanford Health Plan of Minnesota | ||||||||
| 300 Cherapa Place 201 | Sioux Falls | SD | 57103 | 460445852 | Insurance | MN | Sanford Health | 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 | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| Sanford Clinic North | |
| K | 4111144 |
| Sanford Medical Center Fargo | |
| K | 1278143 |