2023-11-13T16:37:47-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2022-01-01 454109041 RIDGEVIEW INSURANCE COMPANY 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 10010914 0 X N/A X 2011 UT THE COMPANY IS ORGANIZED TO BE A PURE CAPTIVE INSURANCE COMPANY. 5 1 0 2 0 0 0 0 5318960 5612036 330314 393284 0 0 5649274 6005320 0 0 0 0 0 0 0 0 0 3663818 3831485 3663818 3831485 1985456 2173835 15758174 16773903 593239 958520 15164935 15815383 RIDGEVIEW INSURANCE COMPANY EXISTS TO INSURE THE RISKS OF RIDGEVIEW MEDICAL CENTER AND ITS SUBSIDIARIES AND AFFILIATES. 0 0 3732850 0 5612036 PROVIDE STOP LOSS INSURANCE COVERAGE FOR RIDGEVIEW MEDICAL CENTER'S SELF-FUNDED HEALTH INSURANCE TO INSURE THE RISKS OF RIDGEVIEW MEDICAL CENTER AND ITS SUBSIDIARIES AND AFFILIATES.RIDGEVIEW MEDICAL CENTER IS AN INDEPENDENT, NONPROFIT, REGIONAL HEALTH CARE SYSTEM SERVING THE SOUTHWEST METRO REGION OF THE TWIN CITIES. ITS NETWORK INCLUDES THREE HOSPITALS - LOCATED IN WACONIA, ARLINGTON AND LE SUEUR - A MULTITUDE OF PRIMARY AND SPECIALTY CARE CLINICS, EMERGENCY SERVICES AND SPECIALTY PROGRAMS, A NURSING HOME, INDEPENDENT LIVING APARTMENTS AND TWO TWELVE MEDICAL CENTER IN CHASKA - A FREE-STANDING 24/7 EMERGENCY AND URGENT CARE FACILITY WITH MULTISPECIALTY CLINICS AND SERVICES. 3732850 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 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 2 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 1 0 1 0 0 1 1 0 1 0 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 VICE PRESIDENT 1.00 49.00 X X 0 1274183 64040 GORDON GABLENZ PRESIDENT 1.00 49.00 X X 0 794145 89439 SARAH HASTINGS SECRETARY 1.00 49.00 X X 0 265282 63374 BRENT WORDELMAN TREASURER 2.00 48.00 X X 0 240710 39991 ANN WICK ASSISTANT SECRETARY 1.00 0.00 X 0 0 0 KEN BIRRELL DIRECTOR 1.00 0.00 X 0 0 0 0 2574320 256844 0 0 1 0 0 PREMIUM REVENUE 524114 5612036 5612036 5612036 178819 178819 4220059 4005594 214465 214465 214465 6005320 5612036 0 393284 48373 48373 2105 2105 15498 15498 26284 26284 INSURANCE CLAIMS 3732850 3732850 STATE INSURER LICENSE 6375 6375 3831485 3732850 98635 0 9655020 5514706 151507 1194418 75138 206338 11700 0 5796786 8595988 68023 1262453 15758174 16773903 14798 7499 67281 63419 511160 887602 593239 958520 X 100000 100000 338000 338000 14726935 15377383 15164935 15815383 15758174 16773903 2173835 -1523387 0 X X 0 1 X 1 0 X X 1 RIDGEVIEW MEDICAL CENTER 311667875 3 1 3831485 0 1 3831485 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV, SEC. A, LINE 2 RIDGEVIEW INSURANCE COMPANY SUPPORTS RIDGEVIEW MEDICAL CENTER, A 501(C)(3) ORGANIZATION CLASSIFIED AS A PUBLIC CHARITY UNDER IRC SECTION 170(B)(1)(A)(III). RIDGEVIEW INSURANCE COMPANY 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 LEASE RECEIVABLE FROM AFFILIATE 1259538 DUE FROM AFFILIATE 2915 1262453 PROFESSIONAL LIABILITY LOSSES PAYABLE 176091 MEDICAL LOSSES PAYABLE 534999 PROPERTY LIABILITY LOSSES PAYABLE 137756 AUTO LIABILITY LOSSES PAYABLE 38756 887602 X 5612036 0 5612036 26284 367000 393284 6005320 3805201 0 3805201 26284 26284 3831485 PART X, LINE 2: THE COMPANY IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE U.S. INTERNAL REVENUE CODE. CONSEQUENTLY, THE COMPANY HAS NOT RECORDED ANY PROVISION OR LIABILITY FOR FEDERAL INCOME TAXES. THE COMPANY FOLLOWS THE GUIDANCE IN THE INCOME TAX STANDARD REGARDING RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON THE COMPANY'S FINANCIAL STATEMENTS. THE COMPANY'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE AND LOCAL AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT INCOME, NET 367,000. 0 1 0 0 0 1 1 0 0 MICHAEL PHELPS VICE PRESIDENT 0 1270809 0 0 0 3374 0 26074 0 37966 0 1338223 0 0 GORDON GABLENZ PRESIDENT 0 789842 0 0 0 4303 0 28440 0 60999 0 883584 0 0 SARAH HASTINGS SECRETARY 0 245738 0 0 0 19544 0 26015 0 37359 0 328656 0 0 BRENT WORDELMAN TREASURER 0 222797 0 0 0 17913 0 24806 0 15185 0 280701 0 0 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. GORDON GABLENZ PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN AT RIDGEVIEW MEDICAL CENTER. DURING 2022, $395,053 WAS CONTRIBUTED TO THE PLAN, $50,590 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 STRATEGIC RISK SOLUTIONS INC. (SRS) PROVIDES CAPTIVE FORMATION, FINANCIAL REPORTING, INSURANCE OPERATION, REGULATORY COMPLIANCE AND TAKES MINUTES AT RIDGEVIEW INSURANCE COMPANY MEETINGS WHILE GUIDING THE DECISIONS TO BE MADE. FORM 990, PART VI, SECTION A, LINE 6 RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF RIDGEVIEW INSURANCE COMPANY. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS ARE ELECTED AT THE ANNUAL MEETING OF THE SOLE MEMBER, RIDGEVIEW MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES THAT HAVE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY IN THERE BYLAWS. 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 RIDGEVIEW INSURANCE COMPANY'S CONFLICT OF INTEREST POLICY INCLUDES THE FOLLOWING: IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE COMPANY CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENITITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE COMPANY'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENTS. IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE MEMBER'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. MINUTES OF MEETINGS INCLUDE: 1. THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO HAVE A FINANCIAL INTEREST IN CONNECTION WITH AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, THE NATURE OF THE FINANCIAL INTEREST, ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST WAS PRESENT, AND THE GOVERNING BOARD'S OR COMMITTEE'S DECISION AS TO WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. 2. THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTING WITH THE PROCEEDINGS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSIGHT AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. RIDGEVIEW FOUNDATION 500 SOUTH MAPLE STREET WACONIA MN 55387 411328097 RAISING FUNDS FOR RIDGEVIEW MEDICAL CENTER MN 501(C)(3) LINE 7 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 411651783 HEALTH CARE SERVICES MN 501(C)(3) LINE 12A, I RIDGEVIEW MEDICAL CENTER 0 SIBLEY MEDICAL CENTER 601 WEST CHANDLER STREET ARLINGTON MN 55307 411801967 CRITICAL ACCESS HOSPITAL MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW LE SUEUR MEDICAL CENTER 621 S 4TH STREET LE SUEUR MN 56058 410837659 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 N/A 0 MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER LLC 500 MAPLE STREET WACONIA MN 55387 205785920 CARDIOLOGY SERVICES MN N/A 0 0 CHASKA PLAZA SURGERY CENTER 3000 HUNDERTMARK RD CHASKA MN 55318 450975783 SURGERY SERVICES MN N/A 0 0 EXECUTIVE HEALTH MANAGEMENT SERVICES 500 SOUTH MAPLE STREET WACONIA MN 55387 411760239 MANAGEMENT SERVICES MN N/A C 0 CHARITABLE REMAINDER UNITRUST (1) CHARITABLE TRUST MN 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 1 0 0 1 0