MeritCare Minnesota: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- MeritCare Minnesota (EIN 26-1530302)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-05-13
- IRS object ID
- 201141339349303654
- 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 | 2011-05-13T15:36:32-05:00 | 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 South Sixth Street Suite 2800 | AddressLine1 |
| City | Minneapolis | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 261530302 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MeritCare Minnesota | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | MERI | NameControl |
| Phone | 7012342000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1720 South Highway 59 | AddressLine1 |
| City | Thief River Falls | City |
| State | MN | State |
| ZIP Code | 56701 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Lisa M 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 |
| Date Prepared | 2011-05-13 | DatePrepared |
| 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 K 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 | 63372 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | WWW.sanfordhealth.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2007 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | Dedicated to the Work of Health and Healing | ActivityOrMissionDescription |
| Termination Or Contraction | X | TerminationOrContraction |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 3284947 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 52432 | ProgramServiceRevenueCY |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 10940 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 3284947 | TotalRevenuePriorYear |
| Total Revenue Current Year | 63372 | 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 | 1859611 | OtherExpensePriorYear |
| Other Expenses Current Year | 0 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1859611 | TotalExpensesPriorYear |
| Total Expenses Current Year | 0 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1425336 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 63372 | RevenuesLessExpensesCY |
| Total Assets BOY | 1636916 | TotalAssetsBOY |
| Total Assets EOY | 0 | TotalAssetsEOY |
| Total Liabilities BOY | 41662 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1595254 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 0 | NetAssetsOrFundBalancesEOY |
| Mission Description | The Mission of Sanford, "Dedicated to the Work of Health and healing" and the Vision, "Improving the Human Condition Through Exceptional Care, Innovation and Discovery", are the constant force that drive the organization's plans, decisions and actions. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 1 | SignificantChange |
| Expense | 0 | Expense |
| Revenue | 63372 | Revenue |
| Description | As part of the Sanford integrated delivery system, MeritCare Minnesota operates an ambulatory surgical center called MeritCare Thief River Falls Southeast Surgery Center in Thief River Falls, Minnesota. | Description |
| 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 | 0 | BalanceSheetAmountsReported |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 1 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | 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 | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | 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 | 0 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Les Wietstock | NamePerson |
| Telephone Number | 7012342000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 2010 | AddressLine1 |
| City | Fargo | City |
| State | ND | State |
| ZIP Code | 58122 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee |
|---|---|---|---|---|---|---|---|
| Kelby Krabbenhoft | |||||||
| President & CEO | 60.00 | X | X | 0 | 1123846 | 748719 | |
| Ronald Moquist | |||||||
| Trustee/Chairman | 0.50 | X | X | 0 | 0 | 0 | |
| Lauris Molbert | |||||||
| Trustee/Vice Chairman | 0.50 | X | X | 0 | 0 | 0 | |
| Barbara Stork | |||||||
| Trustee/Secretary | 0.50 | X | X | 0 | 0 | 0 | |
| David Bieto | |||||||
| Trustee/Treasurer | 0.50 | X | X | 0 | 0 | 0 | |
| Roger Gilbertson MD | |||||||
| President (Jul-Nov09) | 60.00 | X | X | 0 | 1004743 | 989160 | |
| Douglas Vang | |||||||
| Vice President (Jul-Nov0 | 60.00 | X | X | 0 | 285002 | 48657 | |
| Paul Richard | |||||||
| Secretary (Jul-Nov09) | 60.00 | X | X | 0 | 286282 | 49603 | |
| Terry Baloun | |||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||
| Michael Olson MD | |||||||
| Trustee | 60.00 | X | 0 | 561750 | 53780 | ||
| Pamela Anderson | |||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||
| Terrence Grimm MD | |||||||
| Trustee | 60.00 | X | 0 | 607209 | 41089 | ||
| Barry Martin | |||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||
| John Jambois | |||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||
| James Entenman | |||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||
| John Vander Woude Jr MD | |||||||
| Trustee | 60.00 | X | 0 | 2134556 | 29404 | ||
| Jerome Feder | |||||||
| Trustee | 0.50 | X | 0 | 0 | 0 | ||
| Mark Paulson MD | |||||||
| Trustee | 60.00 | X | 0 | 225981 | 43832 | ||
| Bruce Pitts MD | |||||||
| Director (Jul-Nov09) | 60.00 | X | 0 | 439889 | 49257 | ||
| Lisa Carlson | |||||||
| Sanford CFO | 60.00 | X | 0 | 294054 | 49603 | ||
| Michael Gibbs | |||||||
| Senior Vice President | 60.00 | 0 | 259344 | 13836 | X | ||
| Jeffrey Hoss | |||||||
| Senior Vice President | 60.00 | 0 | 255549 | 50245 | X | ||
| Linda O'Halloran | |||||||
| Senior Vice President | 60.00 | 0 | 258830 | 5116 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 7737035 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 2172301 | 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 | Patient Services | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 52432 | TotalRevenueColumn |
| Related Or Exempt Function Income | 52432 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 52432 | TotalProgramServiceRevenue |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Bad Debt Recoveries | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 10940 | TotalRevenueColumn |
| Related Or Exempt Function Income | 10940 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 10940 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 63372 | TotalRevenueColumn |
| Related Or Exempt Function Income | 63372 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 413884 | BOY |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 343051 | BOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 879981 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1636916 | BOY |
| EOY | 0 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41662 | BOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41662 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1595254 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1595254 | BOY |
| EOY | 0 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1636916 | BOY |
| EOY | 0 | 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 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | The operations of MeritCare Minnesota were combined with Sanford Medical Center Thief River Falls (Northwest Medical Center) on July 1, 2009. | Explanation |
Schedule H IRS990ScheduleH
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MeritCare TRF Southeast Surgery Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1720 South Highway 59 | AddressLine1 |
| City | Thief River Falls | City |
| State | MN | State |
| ZIP Code | 56701 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Other | Ambulatory surgery center | Other |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| General Explanation | The operations of MeritCare Minnesota were combined with Sanford Medical Center Thief River Falls (Northwest Medical Center) on July 1, 2009. | GeneralExplanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 1 | 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 | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (13 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Kelby Krabbenhoft | |||||||||||||
| 0 | 746924 | 0 | 0 | 0 | 376922 | 0 | 730587 | 0 | 18132 | 0 | 1872565 | 0 | 79234 |
| Roger Gilbertson MD | |||||||||||||
| 0 | 567216 | 0 | 0 | 0 | 437527 | 0 | 973515 | 0 | 15645 | 0 | 1993903 | 0 | 48624 |
| Douglas Vang | |||||||||||||
| 0 | 281769 | 0 | 0 | 0 | 3233 | 0 | 32720 | 0 | 15937 | 0 | 333659 | 0 | 0 |
| Paul Richard | |||||||||||||
| 0 | 285250 | 0 | 0 | 0 | 1032 | 0 | 32720 | 0 | 16883 | 0 | 335885 | 0 | 0 |
| Michael Olson MD | |||||||||||||
| 0 | 535584 | 0 | 1456 | 0 | 24710 | 0 | 39748 | 0 | 14032 | 0 | 615530 | 0 | 15838 |
| Terrence Grimm MD | |||||||||||||
| 0 | 497424 | 0 | 108201 | 0 | 1584 | 0 | 32720 | 0 | 8369 | 0 | 648298 | 0 | 0 |
| John Vander Woude Jr MD | |||||||||||||
| 0 | 1038461 | 0 | 0 | 0 | 1096095 | 0 | 7350 | 0 | 22054 | 0 | 2163960 | 0 | 920379 |
| Mark Paulson MD | |||||||||||||
| 0 | 180376 | 0 | 45053 | 0 | 552 | 0 | 28836 | 0 | 14996 | 0 | 269813 | 0 | 0 |
| Bruce Pitts MD | |||||||||||||
| 0 | 434319 | 0 | 0 | 0 | 5570 | 0 | 32720 | 0 | 16537 | 0 | 489146 | 0 | 0 |
| Lisa Carlson | |||||||||||||
| 0 | 292197 | 0 | 0 | 0 | 1857 | 0 | 32720 | 0 | 16883 | 0 | 343657 | 0 | 0 |
| Michael Gibbs | |||||||||||||
| 0 | 256916 | 0 | 0 | 0 | 2428 | 0 | 0 | 0 | 13836 | 0 | 273180 | 0 | 0 |
| Jeffrey Hoss | |||||||||||||
| 0 | 253328 | 0 | 0 | 0 | 2221 | 0 | 32720 | 0 | 17525 | 0 | 305794 | 0 | 0 |
| Linda O'Halloran | |||||||||||||
| 0 | 257798 | 0 | 0 | 0 | 1032 | 0 | 0 | 0 | 5116 | 0 | 263946 | 0 | 0 |
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. 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. 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: Kelby Krabbenhoft $79,234 Michael Olson, MD $15,838 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: Kelby Krabbenhoft $706,194 Roger Gilbertson, MD $ 94,324 Part I, Line 4c: Several listed individuals received payment distributions from a benefit plan that falls within the definition of an "equity based" compensation plan. These amounts were deferred over multiple year periods, and were included in compensation in those periods. Distributions were paid to: John Vander Woude, MD $920,379 | |
| Part I, Line 6 | Sanford 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, MD | |
| Part III | 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 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 | 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 N IRS990ScheduleN
Disposition Table DispositionTable
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Asset | All Net Assets | DescriptionOfAsset |
| Date Of Distribution | 2010-04-30 | DateOfDistribution |
| FMV Of Asset | 1658626 | FMVOfAsset |
| Method Of FMV Determination | Book Value | MethodOfFMVDetermination |
| EIN | 450226909 | EIN |
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANFORD MEDICAL CENTER FARGO | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 801 BROADWAY NORTH | AddressLine1 |
| City | FARGO | City |
| State | ND | State |
| ZIP Code | 58122 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | 501(C)(3) | IRCSection |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | 1 | DirectorOfSuccessor2 |
| Employee Of Successor2 | 1 | EmployeeOfSuccessor2 |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2 |
| Receive Compensation2 | 0 | ReceiveCompensation2 |
Form990 Schedule N Part III Form990ScheduleNPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Part II, Line 2e: Roger Gilbertson, Douglas Vang, Lisa Carlson, Paul Richard were and are Trustees / Board members pre and post transfer of assets.Trustees are employees of Sanford, a related organization | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990, Part III, line 3 | Changes in Program Services | As a part of the Sanford Delivery System, MeritCare Minnesota operated an ambulatory surgery center in Thief River Falls, MN called MeritCare Thief River Falls Southeast Surgery Center. During the tax year, the operations of this business were moved to Sanford Medical Center Thief River Falls (a related organization). |
| Form 990, Part VI, Section A, line 2 | Pamela Anderson, Trustee and Lisa Carlson, CFO, have a business relationship. | |
| Form 990, Part VI, Section A, line 4 | The number and composition of the Board of Directors of MeritCare Minnesota has changed in the past fiscal year. The number of individuals who are members of the Board of Directors was amended to the members shall consist of those individuals who from time to time serve as members of the Board of Trustees for Sanford North. The new Bylaws state the officers of MeritCare Minnesota consist of the President and CEO of Sanford North and those persons serving from time to time as officers of the Board of Trustees of Sanford North. Officers of the Board of Directors shall consist of a Chair, Vice Chair and Secretary / Treasurer. | |
| Form 990, Part VI, Section A, line 6 | Sanford North is the sole corporate member of MeritCare Minnesota. Sanford North's members are its Trustees. The Trustees of Sanford North are also the Trustees of MeritCare Minnesota and approve the actions of both organizations. | |
| Form 990, Part VI, Section A, line 7a | The Trustees of Sanford North are also the Trustees of MeritCare Minnesota and approve the actions of both organizations. | |
| Form 990, Part VI, Section A, line 7b | The Trustees of Sanford North approve the actions by MeritCare Minnesota. | |
| 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. 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. | |
| Form 990, Schedule R, Part V | Costing Method for Related Party Transactions | The transfer of assets to Sanford Medical Center Fargo was recored at cost. |
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 | Clinic | ND | 501(c)(3) | 9 | 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 EnterprisesInc | |||||||||
| PO Box 2010 | Fargo | ND | 58122 | 450359785 | Sales of prescription drugs | ND | 501(c)(4) | Sanford North | |
| F-M 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 |
| Agassiz Assurance Company | |||||||||
| 100 Bank Street610 | Burlington | VT | 05401 | 743121855 | Malpractice Insurance | VT | 501(c)(3) | 11-II | 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-III | 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 | Clinic | 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-I | 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 | Research | SD | 501(c)(3) | 4 | Sanford Health |
| Sanford World Clinics | |||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 262707628 | Healthcare | SD | 501(c)(3) | 3 | Sanford Health |
| Sanford | |||||||||
| 801 N Broadway Drive | Fargo | ND | 58122 | 271218956 | Supporting Organization | ND | 501(c)(3) | 11-II | |
| SHM-MeritCare | |||||||||
| 801 N Broadway Drive | Fargo | ND | 58122 | 271213717 | Supporting Organization | ND | 501(c)(3) | 11-II | |
| SHM-Sanford | |||||||||
| 1305 W 18th St PO Box 5039 | Sioux Falls | SD | 571175039 | 271213769 | Supporting Organization | SD | 501(c)(3) | 11-II | |
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 Ave | Sioux Falls | SD | 57104 | 202129839 | Investment | SD | Sanford | Related | 0 | 0 |
| RAC Rentals LLC | ||||||||||
| 100 S Phillips Ave | Sioux Falls | SD | 57104 | 261961077 | Investment | SD | Sanford | 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 & 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 Street | 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 | ||||||||
| 301 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 | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sanford Medical Center Fargo | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | Q | TransactionType |
| Amount Involved | 1658626 | AmountInvolved |