2023-11-14T09:40:50-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2022-01-01 411651783 RIDGEVIEW CLINICS RIDG 9524422191 500 SOUTH MAPLE STREET WACONIA MN 55387 AARON BLOOMQUIST CFO 9524422191 2023-11-11 1 AARON BLOOMQUIST XXX-XX-XXXX 0 KURT BENNION CPA P01469618 4252506100 2023-11-11 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z MICHAEL PHELPS 500 SOUTH MAPLE STREET WACONIA MN 55387 22739282 0 X WWW.RIDGEVIEWMEDICAL.ORG X 1989 MN TO PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY SERVED BY RIDGEVIEW MEDICAL CENTER. 2 0 65 0 0 0 2000000 0 20441233 22739282 0 0 2207 0 22443440 22739282 0 0 0 0 20375108 22646077 0 0 0 68332 93205 20443440 22739282 2000000 0 2362510 2053424 16944419 16635333 -14581909 -14581909 TO PROVIDE HEALTHCARE SERVICES TO THE COMMUNITY SERVED BY RIDGEVIEW MEDICAL CENTER. 0 0 21602319 0 22739282 PROVIDE HEALTHCARE SERVICES TO THE COMMUNITIES SURROUNDING RIDGEVIEW MEDICAL CENTER. FREE MEDICAL CARE TO ALL PATIENTS PARTICIPATING IN RESEARCH STUDIES. THE CENTER PROVIDES ITS FACILITIES TO ORGANIZATIONS FOR PUBLIC USE. 21602319 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 65 1 0 0 0 0 0 0 0 0 0 0 0 0 X 2 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X AARON BLOOMQUIST 9524422191 500 SOUTH MAPLE STREET WACONIA MN 55387 MICHAEL PHELPS BOARD CHAIR 5.00 45.00 X X 0 1274183 64040 NIMA ADIMI PHYSICIAN 40.00 0.00 X 1031377 0 68694 BRIAN GOOTZEIT PHYSICIAN 40.00 0.00 X 973729 0 78002 SABINA KHAN PHYSICIAN 40.00 0.00 X 869001 0 89415 MUSTAFA TIEWALA PHYSICIAN 40.00 0.00 X 734145 0 77900 SIDNEY JONES PHYSICIAN 40.00 0.00 X 507796 0 71413 AARON BLOOMQUIST CFO 0.50 49.50 X 0 490798 61669 TIM MEYER MD VICE CHAIR (AS OF APRIL 2022) 40.00 0.00 X 0 361975 58089 BENJAMIN NIELSON CEO, TREASURER & SECRETARY 5.00 45.00 X X 0 363774 18024 MICHAEL LANO VICE CHAIR (THROUGH MARCH 2022) 40.00 0.00 X 0 230881 38247 4116048 2721611 625493 58 0 1 0 0 PROVIDER-BASED FEES 621110 22739282 22739282 22739282 22739282 22739282 0 0 19609043 18628591 980452 1482893 1408748 74145 708881 673437 35444 845260 802997 42263 91706 87121 4585 MISC EXPENSE 1499 1425 74 22739282 21602319 1136963 0 23792 50257 2338718 2003167 2362510 2053424 4765421 5501781 12178998 11133552 16944419 16635333 X -14581909 -14581909 -14581909 -14581909 2362510 2053424 0 0 X X 0 1 X 1 0 X X 1 RIDGEVIEW MEDICAL CENTER 311667875 3 1 22739282 0 1 22739282 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV, SECTION A, LINE 2: RIDGEVIEW CLINICS SUPPORTS RIDGEVIEW MEDICAL CENTER, A 501(C)(3) ORGANIZATION CLASSIFIED AS A PUBLIC CHARITY UNDER IRC SECTION 170(B)(1)(A)(III). RIDGEVIEW CLINICS COMPLETED THE CALCULATIONS FOR THE SECTION 509(A)(2) PUBLIC SUPPORT TEST FOR RIDGEVIEW MEDICAL CENTER FOR THE PERIOD 1/1/2018 - 12/31/2022 AND DETERMINED THAT RIDGEVIEW MEDICAL CENTER WOULD QUALIFY AS A PUBLICLY SUPPORTED ORGANIZATION UNDER IRC SECTION 509(A)(2). 0 DUE TO RIDGEVIEW MEDICAL CENTER 11133552 11133552 X PART X, LINE 2: THE ORGANIZATION HAS RECEIVED NOTIFICATION THAT IT QUALIFIES AS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE AND CORRESPONDING PROVISIONS OF STATE LAW AND ACCORDINGLY, IS NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, ANY UNRELATED BUSINESS INCOME MAY BE SUBJECT TO TAXATION. THE ORGANIZATION IS NOT CURRRENTLY UNDER EXAMINATION BY ANY TAXING JURISDICTION. THE ORGANIZATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE ORGANIZATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. 0 1 0 0 0 1 1 0 0 MICHAEL PHELPS BOARD CHAIR 0 1270809 0 0 0 3374 0 26074 0 37966 0 1338223 0 0 NIMA ADIMI PHYSICIAN 562655 0 468236 0 486 0 35600 0 33094 0 1100071 0 0 0 BRIAN GOOTZEIT PHYSICIAN 690048 0 281839 0 1842 0 35600 0 42402 0 1051731 0 0 0 SABINA KHAN PHYSICIAN 687448 0 180953 0 600 0 29263 0 60152 0 958416 0 0 0 MUSTAFA TIEWALA PHYSICIAN 692779 0 39956 0 1410 0 32942 0 44958 0 812045 0 0 0 SIDNEY JONES PHYSICIAN 369576 0 135298 0 2922 0 32023 0 39390 0 579209 0 0 0 AARON BLOOMQUIST CFO 0 488856 0 0 0 1942 0 14169 0 47500 0 552467 0 0 TIM MEYER MD VICE CHAIR (AS OF APRIL 2022) 0 359653 0 0 0 2322 0 26485 0 31604 0 420064 0 0 BENJAMIN NIELSON CEO, TREASURER & SECRETARY 0 338638 0 0 0 25136 0 17240 0 784 0 381798 0 0 MICHAEL LANO VICE CHAIR (THROUGH MARCH 2022) 0 219157 0 0 0 11724 0 15776 0 22471 0 269128 0 0 PART I, LINE 3 THE PRESIDENT/CEO IS COMPENSATED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. THE FOLLOWING WERE USED BY RIDGEVIEW MEDICAL CENTER TO DETERMINE THE PRESIDENT/CEO'S COMPENSATION: 1) COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) WRITTEN EMPLOYMENT CONTRACT 5) COMPENSATION SURVEY OR STUDY 6) APROVAL BY THE BOARD OR COMPENSATION COMMITTEE (EXECUTIVE COMMITTEE) PART I, LINE 4B MICHAEL PHELPS PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2022, $397,642 WAS CONTRIBUTED TO THE PLAN, $68,254 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. AARON BLOOMQUIST PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2022, $125,556 WAS CONTRIBUTED TO THE PLAN, $0 ACCRUED WITHIN THE PLAN, AND $0 WAS PAID OUT OF THE PLAN. THESE DEFERRED COMPENSATION AMOUNTS ARE REPORTED ON A PRO-RATA BASIS WITHOUT REGARD TO THE INDIVIDUAL'S VESTING SCHEDULE. CURRENTLY, THE MAJORITY OF DEFERRED COMPENSATION IS NOT VESTED. PART I, LINE 6 THE OFFICERS OF RIDGEVIEW MEDICAL CENTER AND AFFILIATES RECEIVE BONUSES CONTINGENT ON THE NET EARNINGS OF THE CONSOLIDATED ENTITY AND GOALS ACHIEVED. BONUSES WERE EARNED IN 2022 AND PAID IN 2023. FORM 990, PART VI, SECTION A, LINE 3 ALL MANAGEMENT SERVICES ARE PROVIDED BY RIDGEVIEW MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBER OF RIDGEVIEW CLINICS IS RIDGEVIEW MEDICAL CENTER, A MINNESOTA NON-PROFIT CORPORATION AND A RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A DIRECTORS ARE ELECTED BY THE MEMBER. ANY DIRECTOR MAY ALSO BE REMOVED BY THE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS REQUIRE APPROVAL OF THE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B A DETAILED REVIEW OF THE FORM 990 WAS COMPLETED BY THE PRESIDENT AND TREASURER OF THE BOARD OF DIRECTORS. UPON APPROVAL, THE FINAL COPY OF THE FORM 990 WAS THEN PROVIDED TO THE FULL BOARD VIA EMAIL IN ADDITION TO BEING POSTED TO THE ORGANIZATION'S INTERNAL WEBSITE. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE STATEMENTS FOR POTENTIAL CONFLICTS OF INTEREST. EACH MEMBER IS EXPECTED TO DISCLOSE ANY CONFLICT OF INTEREST THAT MAY ARISE DURING THE YEAR. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THE SITUATION WILL BE EXAMINED AND HANDLED APPROPRIATELY BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 ANY COMPENSATION RECEIVED BY OFFICERS OR BOARD MEMBERS OF RIDGEVIEW CLINICS IS DETERMINED BY RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. FORM 990, PART VI, SECTION C, LINE 19 RIDGEVIEW CLINICS' FINANCIAL STATEMENTS, GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSIGHT AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. 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