2023-08-10T17:47:38-05:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2022-01-01 260022777 OMC REGIONAL FOUNDATION OMCR 5072927200 210 NINTH STREET SE ROCHESTER MN 55904 TIM WEIR CHIEF EXECUTIVE OFFICER 5072927200 2023-07-13 1 TIM WEIR XXX-XX-XXXX 1 KURT BENNION CPA P01469618 4252506100 2023-07-13 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z TIM WEIR 210 NINTH STREET SE ROCHESTER MN 55904 750427 0 X WWW.OMCREGIONALFOUNDATION.ORG X 2002 MN TO ADVOCATE FOR AND SUPPORT OLMSTED MEDICAL CENTER AND ASSIST ITS HEALTHCARE SERVICES. 11 8 0 22 0 0 434090 410148 0 0 71917 105224 63398 65394 569405 580766 142409 73432 0 0 0 0 0 0 0 173773 193091 316182 266523 253223 314243 5262617 5187654 0 0 5262617 5187654 TO ADVOCATE FOR AND SUPPORT OLMSTED MEDICAL CENTER AND TO ASSIST IT IN FUNDING QUALITY HEALTHCARE SERVICES AND EDUCATION IN THE COMMUNITIES IT SERVES. 0 0 256415 73432 0 ESTABLISHED, DEVELOPED, SPONSORED, PROMOTED AND CONDUCTED CHARITABLE ACTIVITIES DEVOTED TO PROMOTING AND IMPROVING HEALTH FOR RESIDENTS OF THE COMMUNITY THROUGH COMMUNITY EDUCATION AND HEALTH AWARENESS ACTIVITIES, HEALTHCARE RELATED CAPITAL EXPENDITURES AND EDUCATIONAL SCHOLARSHIPS IN THE HEALTHCARE PROFESSIONS. THE FOUNDATION SERVED APPROXIMATELY 47,581 CLIENTS DURING 2022. 0 0 0 CARL AND IHLA PETERSEN TRUST PATIENT ASSISTANCE PROGRAM: OMC REGIONAL FOUNDATION HAS DESIGNATED PROCEEDS FROM THE CARL AND IHLA PETERSEN TRUST TO ASSIST WITH OLMSTED MEDICAL CENTER PATIENTS AND FAMILIES WHO RESIDE IN OLMSTED COUNTY, THAT DO NOT HAVE SUFFICIENT INSURANCE COVERAGE NOR FINANCIAL MEANS BUT ARE NOT ELIGIBLE FOR MEDICAL ASSISTANCE, TO PAY AT LEAST A PORTION OF THEIR MEDICAL BILLS. 0 0 0 MEDICAL EDUCATION FOR THE COMMUNITY: TO PROVIDE EDUCATIONAL OPPORTUNITIES TO OLMSTED MEDICAL CENTER CLINICIANS AND TO THE COMMUNITY VIA THE NOEL R PETERSON LECTURE SERIES, BURICH ELECTRONIC LIBRARY, AND CONTINUING MEDICAL EDUCATION LECTURES. 256415 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 11 8 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X KEVIN HIGGINS 5072883443 210 NINTH STREET SE ROCHESTER MN 55904 TIM WEIR FACHE DIRECTOR & OMC CEO 1.00 40.00 X X 0 860633 45159 JAMES HOFFMANN MD DIRECTOR & OMC PRESIDENT 1.00 32.00 X X 0 585303 46011 CORENIA WALZ PRESIDENT 1.00 0.00 X X 0 0 0 JEANINE GANGENESS PHD VICE PRESIDENT 1.00 0.00 X X 0 0 0 PAUL TIESKOTTER TREASURER 1.00 0.00 X X 0 0 0 LILIA PONTON MD SECRETARY 1.00 40.00 X X 0 266133 29648 CASSIE HARRINGTON DIRECTOR 1.00 1.00 X 0 0 0 DAVID OETH DIRECTOR 1.00 0.00 X 0 0 0 DHARANI RAMAMOORTHY DIRECTOR 1.00 0.00 X 0 0 0 MITCH STEVENSON DIRECTOR 1.00 0.00 X 0 0 0 DON SUPALLA DIRECTOR 1.00 1.00 X 0 0 0 KEVIN HIGGINS OMC CFO 1.00 40.00 X 0 525381 61127 STACEY VANDEN HEUVEL VP MARKETING & PHILANTHROP 24.00 16.00 X 0 230448 22631 0 2467898 204576 0 0 1 0 0 23400 183694 203054 410148 102791 102791 84447 82014 2433 2433 2433 120791 23400 59660 61131 61131 32250 27987 4263 4263 580766 0 0 170618 70432 70432 3000 3000 3310 3310 5608 5608 8329 8329 46302 46302 115471 114281 1190 1058 1058 10690 10690 BOOKS & PERIODICALS 1186 1186 MEMBERSHIPS & DUES 710 710 MEDICAL SUPPLIES 427 427 266523 256415 10108 0 2007855 2260630 2046436 1795517 1208326 1131507 5262617 5187654 0 0 X 2897292 2887042 2365325 2300612 5262617 5187654 5262617 5187654 314243 -389206 0 X X 0 1 X 1 0 X X 1 OLMSTED MEDICAL CENTER 410855367 3 1 68932 0 1 68932 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4340508 205202 -321395 109598 5608 4109109 4075084 215914 198832 143592 5730 4340508 3851422 203561 113512 88541 4870 4075084 3444342 205096 304179 98419 3776 3851422 3356545 205499 -61945 53920 1837 3444342 0.44000 0.39000 0.17000 1 0 0 BENEFICIAL INTEREST IN TRUST 1131507 1131507 X PART V, LINE 4: THE MAJORITY OF THE ENDOWMENT FUNDS ARE RESTRICTED IN USE TO SPECIFIC PURPOSES. THE LARGEST RESTRICTED USE FUND IS SET UP FOR DEBT RELIEF OF HOSPITAL PATIENTS FOR THE POOR AND INDIGENT OF OLMSTED COUNTY. PART X, LINE 2: THE FOUNDATION IS EXEMPT FROM FEDERAL INCOME TAX AS A TAX EXEMPT ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, EXCEPT FOR INCOME ON CERTAIN UNRELATED BUSINESS INCOME. THERE IS NO MATERIAL UNRELATED BUSINESS INCOME FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021. THE FOUNDATION IS ALSO EXEMPT FROM STATE INCOME TAXES UNDER APPLICABLE MINNESOTA STATUTES. THE FOUNDATION FILES FEDERAL AND STATE INCOME TAX RETURNS. GENERALLY, THE FOUNDATION IS NO LONGER SUBJECT TO STATE AND FEDERAL INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEAR ENDED DECEMBER 31, 2018, AND PRIOR. AT DECEMBER 31, 2022, THERE WERE NO UNCERTAIN TAX POSITIONS. GOLF OUTING 107666 21000 86666 8628 14271 15819 7952 CROQUET EVENT 36525 2400 34125 2350 2289 8247 104 144191 23400 120791 10978 16560 24066 8056 59660 61131 1 OLMSTED MEDICAL CENTER 210 9TH STREET SE ROCHESTER MN 55904 410855367 501(C)(3) 68932 0 N/A N/A DONATIONS TO OMC 1 0 PART I, LINE 2: GRANTS AWARDED TO THE SUPPORTED ORGANIZATION, OLMSTED MEDICAL CENTER, WHICH HAS COMMON CONTROL, ARE TRACKED AND EXPENSES ARE REPORTED BACK TO THE FOUNDATION FOR REVIEW. THE STAFF ALSO VERIFY THE PURCHASE OF EQUIPMENT THROUGH THE USE OF BUDGETARY CONTROLS, MANAGER SIGN-OFFS AND INVOICE VERIFICATIONS. 0 1 0 0 0 0 0 0 0 TIM WEIR FACHE DIRECTOR & OMC CEO 0 699187 0 161446 0 0 0 27550 0 17609 0 905792 0 0 JAMES HOFFMANN MD DIRECTOR & OMC PRESIDENT 0 503580 0 80723 0 1000 0 27550 0 18461 0 631314 0 0 KEVIN HIGGINS OMC CFO 0 428970 0 79680 0 16731 0 27550 0 33577 0 586508 0 0 LILIA PONTON MD SECRETARY 0 266133 0 0 0 0 0 27550 0 2098 0 295781 0 0 STACEY VANDEN HEUVEL VP MARKETING & PHILANTHROP 0 195120 0 35328 0 0 0 20829 0 1802 0 253079 0 0 PART I, LINE 3 THE COMPENSATION FOR THE PRESIDENT AND CEO WAS ESTABLISHED AND PAID BY OLMSTED MEDICAL CENTER, THE SOLE MEMBER OF THE FOUNDATION. THE FOLLOWING METHODS WERE RELIED UPON BY OLMSTED MEDICAL CENTER TO DETERMINE SUCH COMPENSATION: 1. COMPENSATION COMMITTEE, 2. INDEPENDENT COMPENSATION CONSULTANT, 3. COMPENSATION SURVEY OR STUDY, AND 4. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. IN ORDER TO ENSURE THAT ALL OLMSTED MEDICAL CENTER (OMC) EXECUTIVE COMPENSATION DECISIONS ARE COMPETITIVE, EQUITABLE, UNIFORMLY ADMINISTERED, AND CONSISTENT WITH MARKET PRACTICES, OMC FOLLOWS RECOMMENDED BEST PRACTICES. THE GOALS OF EXECUTIVE COMPENSATION ARE TO ATTRACT AND RETAIN HIGHLY QUALIFIED PERSONNEL, TO MAINTAIN COMPENSATION LEVELS COMMENSURATE WITH THE SCOPE OF RESPONSIBILITIES FOR EACH POSITION, AND TO REWARD OUTSTANDING PERFORMANCE. OMC WILL SEEK MANAGEMENT TALENT BY CONDUCTING NATIONAL SEARCHES FOR QUALIFIED APPLICANTS FOR ANY VACANCIES AT THE CHIEF MEDICAL OFFICER AND CEO POSITIONS IN ADDITION TO VICE PRESIDENT POSITIONS AS NECESSARY. THE SAME PHILOSOPHY IS APPLICABLE TO THE POSITION OF OMC PRESIDENT. OMC ENGAGES AN EXTERNAL CONSULTANT WHO ANNUALLY COMPILES A PEER GROUP COMPENSATION ANALYSIS AND ON A TWO YEAR BASIS COMPILES A PEER GROUP COMPENSATION AND BENEFITS ANALYSIS. PEER GROUPS FOR EXECUTIVE COMPENSATION, WHICH INCLUDES BASE SALARIES, INCENTIVE AND BENEFITS, WILL BE PROVIDED FOR HEALTH DELIVERY SYSTEMS WITH A MINIMUM OF A HOSPITAL AND AN EMPLOYED PHYSICIAN NETWORK AND NET REVENUES ROUGHLY SIMILAR TO THE REVENUES OF OLMSTED MEDICAL CENTER. MOST RECENTLY A COMPENSATION PEER REVIEW STUDY WAS COMPLETED FOR THE CEO, PRESIDENT, CHIEF MEDICAL OFFICER, AND VICE PRESIDENTS AND PRESENTED TO THE BOARD EXECUTIVE COMPENSATION COMMITTEE. THE EXECUTIVE COMPENSATION COMMITTEE RECEIVES A SUMMARY OF EVERYONE'S COMPENSATION TO ENSURE IT IS IN ALIGNMENT WITH THE SAME COMPENSATION METHODOLOGY AND AGREED UPON METHODOLOGY OF THE EXECUTIVE COMPENSATION SYSTEM OF OMC. THESE POSITIONS INCLUDE THE CHIEF MEDICAL OFFICER AND VICE PRESIDENTS OF OMC. THE EXECUTIVE COMPENSATION COMMITTEE WILL SET THE COMPENSATION OF THE PRESIDENT, AND CEO, AND MINUTES ARE KEPT OF THESE DISCUSSIONS. THE BOARD OF TRUSTEES, ACTING THROUGH THE BOARD OF TRUSTEES COMPENSATION COMMITTEE, MUST APPROVE THE EXECUTIVE COMPENSATION POLICY AND PROCESS OF DETERMINING EXECUTIVE COMPENSATION. IN ADDITION, THE PHYSICIAN SALARIES ARE CALCULATED ANNUALLY, USING NATIONAL PHYSICIAN SALARY COMPARISON GUIDES FACTORING IN PRODUCTIVITY AND QUALITY MEASURES, AND REVIEWED ON AN ANNUAL BASIS FOR MARKET REASONABLENESS BY AN INDEPENDANT CONSULTING FIRM. THE PHYSICIANS RECEIVE NO COMPENSATION AS ATTENDING BOARD MEMBERS. THESE DISCUSSIONS ARE NOTED IN THE MINUTES OF THE BOARD OF TRUSTEES COMPENSATION COMMITTEE ANNUAL MEETING. THE BOARD OF TRUSTEES COMPENSATION COMMITTEE REPORTS TO THE FULL BOARD OF TRUSTEES ON AN ANNUAL BASIS THE COMPLETION OF SUCH DUTIES AND ARE ALSO NOTED IN THE MINUTES. PART I, LINE 4B THE RELATED ORGANIZATION, OLMSTED MEDICAL CENTER, HAS A SUPPLEMENTAL, NON-QUALIFIED RETIREMENT PLAN FOR CERTAIN INDIVIDUALS IN LEADERSHIP POSITIONS. IN 2022 THE FOLLOWING INDIVIDUALS BECAME ELIGIBLE TO BE VESTED IN 2026. THEIR VESTED BALANCES WILL BE TAXABLE IN 2026 WITH THE NET AMOUNT RETURNED TO THEIR 401K ACCOUNTS. THE FOLLOWING AMOUNTS WERE EARNED IN 2022 - TIM WEIR $88,750 JAMES HOFFMANN $44,375 KEVIN HIGGINS $30,450 STACEY VANDEN HEUVEL $4,825 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE OFFICERS OF THE FOUNDATION AND SHALL HAVE THE AUTHORITY TO EXERCISE THE POWER OF THE BOARD TO ACHIEVE THEIR PURPOSE, SUBJECT TO LIMITATIONS THAT MAY BE IMPOSED BY THE BOARD OR BY LAW. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT AND SUPPORT FUNCTIONS ARE DELEGATED TO OLMSTED MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION HAS ONE CLASS OF MEMBERS. THE SOLE MEMBER OF THE FOUNDATION IS OLMSTED MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A DIRECTORS ARE ELECTED BY THE FOUNDATION DIRECTORS THEN IN OFFICE, SUBJECT TO THE APPROVAL OF OLMSTED MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B OLMSTED MEDICAL CENTER SHALL HAVE AUTHORITY OVER THE FOLLOWING MATTERS WITH RESPECT TO THE FOUNDATION: (1) TO APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION; (2) TO ADOPT, AMEND OR REPEAL BYLAWS ADOPTED, AMENDED OR REPEALED BY THE BOARD OF DIRECTORS; (3) TO APPROVE A PLAN OF MERGER OR CONSOLIDATION OF THE FOUNDATION; (4) TO APPROVE A PLAN OF DISSOLUTION; (5) TO APPROVE ANY AND ALL DIRECTORS OF THE FOUNDATION, AS ELECTED BY THE FOUNDATION'S BOARD OF DIRECTORS; (6) TO REMOVE ANY DIRECTOR OF THE FOUNDATION, WITH OR WITHOUT CAUSE, UPON THE RECOMMENDATION OF THE FOUNDATION'S BOARD OF DIRECTORS; AND (7) TO APPROVE THE FOUNDATION'S STRATEGIC PLAN AND ANNUAL OPERATING AND CAPITAL BUDGETS. THE FOUNDATION DIRECTOR SHALL BE ELECTED BY THE FOUNDATION BOARD, BASED ON THE RECOMMENDATION OF THE CHIEF EXECUTIVE OFFICER OF OLMSTED MEDICAL CENTER. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN EXTERNAL ACCOUNTANT. A DRAFT OF THE FORM 990 IS REVIEWED IN DETAIL BY THE OLMSTED MEDICAL CENTER FINANCIAL SERVICES MANAGER, CONTROLLER, AND CFO. ANY NECESSARY CORRECTIONS AND ADJUSTMENTS ARE MADE. THE FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR AND CFO AND PRESENTED TO THE COMPENSATION COMMITTEE. THE FINAL FORM 990 IS MADE AVAILABLE TO THE BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES OF THE FOUNDATION. ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES ("COVERED MEMBERS") OF THE CORPORATION ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT EACH PERSON HAS RECEIVED AND UNDERSTANDS THE CONFLICTS OF INTEREST POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE CORPORATION IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. UNLESS A PREVIOUSLY DISCLOSED AND DOCUMENTED CONFLICT OF INTEREST IS KNOWN TO THE BOARD, ALL CONFLICTS OF INTEREST ARE DISCLOSED TO THE BOARD BY THE COVERED MEMBER WITH THE CONFLICT(S) AND DOCUMENTED IN BOARD MEETING MINUTES. A COVERED MEMBER HAS DISCLOSED A CONFLICT IF HE OR SHE PROMPTLY PROVIDES A DESCRIPTION OF THE MATERIAL FACTS COMPRISING THE CONFLICT OF INTEREST TO THE BOARD. IF A COVERED MEMBER HAS A CONFLICT OF INTEREST ON ANY MATTER CONSIDERED BY THE BOARD, SUCH MATTER IS APPROVED BY THE BOARD IN A MANNER THAT COMPLIES WITH THE REQUIREMENTS OF THE SEVENTH RESTATED BYLAWS OF OLMSTED MEDICAL CENTER AND MINNESOTA STATUE SECTION 317A.255. THE COVERED MEMBER MUST ABSTAIN FROM VOTING ON THAT ISSUE. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICTS OF INTEREST STATEMENTS, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. THE ANNUAL FORM 990 REPORT IS AVAILABLE FOR PUBLIC VIEWING BY APPOINTMENT. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. OLMSTED MEDICAL CENTER 210 9TH STREET SE ROCHESTER MN 55904 410855367 HEALTHCARE MN 501(C)(3) LINE 3 N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0