2023-11-14T09:37:02-06:00 2022-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2022-01-01 411328097 RIDGEVIEW FOUNDATION RIDG 9524426010 500 SOUTH MAPLE STREET WACONIA MN 55387 AARON BLOOMQUIST CFO 9524426010 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 2803708 0 X WWW.RIDGEVIEWMEDICAL.ORG X 1978 MN TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 27 27 0 106 0 0 3295578 2323370 0 0 1400058 249054 -237112 -414225 4458524 2158199 1806226 2401000 0 0 0 0 0 0 0 279183 362503 2085409 2763503 2373115 -605304 25209433 22122176 441963 1163844 24767470 20958332 RIDGEVIEW FOUNDATION IS AN INDEPENDENT NONPROFIT ORGANIZATION THAT PARTNERS WITH RIDGEVIEW MEDICAL CENTER IN ITS MISSION TO MAKE A POSITIVE DIFFERENCE IN THE QUALITY OF LIFE AND HEALTH FOR THE PEOPLE OF OUR AREA. 0 0 2604654 2401000 0 TO RAISE FUNDS FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER, A NOT-FOR-PROFIT HOSPITAL IN WACONIA, MINNESOTA. DURING 2022, RIDGEVIEW FOUNDATION EXPENDED $2,284,260 TO RIDGEVIEW MEDICAL CENTER. OF THIS, $1,535,077 WAS TRANSFERRED TO OUR "CAUSE FOR COMMUNITY" CAMPAIGN, WHICH IS A FUND THAT ALLOWS US TO BETTER MEDICALLY SUPPORT THE 300,000 RESIDENTS WITHIN OUR SEVEN-COUNTY SERVICE AREA, $119,057 WAS TRANSFERRED TO SUPPORT COVID-RELATED ACTIVITIES, AND $310,000 WAS TRANSFERRED TO THE HOSPITAL TO SUPPORT THE BUILDING AND FURNISHING OF AN EMERGENCY DEPARTMENT EXPANSION. THE REMAINING $342,234 WAS TRANSFERRED TO THE HOSPITAL FOR VARIOUS PROJECTS AND PROGRAMS DURING 2022. 2604654 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 31 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 27 27 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 PRESIDENT/CEO 0.50 49.50 X 0 1274183 64040 AARON BLOOMQUIST CFO 4.00 46.00 X 0 490798 61669 DOUGLAS STASEK EXECUTIVE DIRECTOR 47.50 2.50 X 0 20000 0 JON CROW CHAIR & BOARD MEMBER 0.50 0.00 X X 0 0 0 CARLA STRUBLE BOARD MEMBER & CHAIR 0.50 0.00 X X 0 0 0 KATHRYN BARNES VICE CHAIR & BOARD MEMBER 0.50 0.00 X X 0 0 0 JENNIFER TREGARTHEN SECRETARY / TREASURER & VICE CHAIR 0.50 0.00 X X 0 0 0 TROY WERK BOARD MEMBER & SECRETARY 0.50 0.00 X X 0 0 0 MIKE BAUER BOARD MEMBER 0.50 0.00 X 0 0 0 BRIAN BENIEK BOARD MEMBER 0.50 0.00 X 0 0 0 BRETT COLBJORNSEN BOARD MEMBER 0.50 0.00 X 0 0 0 TIM FOSTER BOARD MEMBER 0.50 0.00 X 0 0 0 JOHN HAYES BOARD MEMBER 0.50 0.00 X 0 0 0 DARLA HOLMGREN BOARD MEMBER 0.50 0.00 X 0 0 0 DR BRUCE HUBBARD BOARD MEMBER 0.50 0.00 X 0 0 0 RYAN JOHNSON BOARD MEMBER 0.50 0.00 X 0 0 0 KEVIN KOEMPTGEN BOARD MEMBER 0.50 0.00 X 0 0 0 SCOTT MANION BOARD MEMBER 0.50 0.00 X 0 0 0 JESSICA MONARCH BOARD MEMBER 0.50 0.00 X 0 0 0 JEAN MURRAY BOARD MEMBER 0.50 0.00 X 0 0 0 TIM SAMUELSON BOARD MEMBER 0.50 0.00 X 0 0 0 TIM SCHMIDT BOARD MEMBER 0.50 0.00 X 0 0 0 HANS SIEFKER BOARD MEMBER 0.50 0.00 X 0 0 0 DR MICHAEL SMITH BOARD MEMBER 0.50 0.00 X 0 0 0 CHUCK SPEVACEK BOARD MEMBER 0.50 0.00 X 0 0 0 MARK STEINGAS BOARD MEMBER 0.50 0.00 X 0 0 0 LINDSEY THOMPSON BOARD MEMBER 0.50 0.00 X 0 0 0 NIKKI VANECEK BOARD MEMBER 0.50 0.00 X 0 0 0 DAVID WINDSCHITL BOARD MEMBER 0.50 0.00 X 0 0 0 STEVE YETZER BOARD MEMBER 0.50 0.00 X 0 0 0 0 1784981 125709 0 0 1 0 0 978526 1344844 121053 2323370 328792 328792 79738 -79738 -79738 -79738 45386 978526 455527 -410141 -410141 106160 110244 -4084 -4084 2158199 0 0 -165171 2371000 2371000 30000 30000 21640 21640 134014 -3195 137209 MISCELLANEOUS EXPENSES 206849 206849 2763503 2604654 158849 0 1646932 918303 489169 232732 850029 1152604 65857 57857 9697 9697 0 0 17442881 14664396 4714565 5096284 25209433 22122176 240500 184786 201463 979058 441963 1163844 X 16483367 13756157 8284103 7202175 24767470 20958332 25209433 22122176 -605304 -3203834 0 X X 0 1 X 1 0 X 2592909 3204981 3293420 3295578 2323370 14710258 2592909 3204981 3293420 3295578 2323370 14710258 434269 14275989 256230 288703 241726 323707 328792 1439158 183870 197431 70606 141759 151546 745212 16894628 0.84500 0.73910 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: SPECIAL FUNDRAISING EVENTS CHARITABLE GAMING ACTIVITIES RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6633585 6633585 6107027 526558 287550 287550 6633585 6081425 25602 355046 355046 6107027 6041811 39614 429578 429578 6081425 7474066 10773 18456 18456 1443028 6041811 0.45220 0.54780 0.00000 0 0 9697 9697 0 0 ASSETS HELD IN CHARITABLE REMAINDER TRUST 335946 CASH SURRENDER VALUE LIFE INSURANCE POLICY 4760338 5096284 DUE TO RIDGEVIEW MEDICAL CENTER 979058 979058 X 1299169 -3066338 944558 2788887 667107 632062 137209 1388928 1526137 2158199 4026379 944558 455527 1400085 2626294 137209 137209 2763503 PART V, LINE 4: THE EARNING FROM THE ENDOWMENT FUNDS ARE INTENDED TO BE USED FOR THE BENEFIT OF RIDGEVIEW MEDICAL CENTER, A NOT-FOR-PROFIT HOSPITAL IN WACONIA, MINNESOTA. PART X, LINE 2: THE FOUNDATION 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. DURING 2010, THE FOUNDATION REQUESTED AND WAS APPROVED TO RECLASSIFY FROM 509(A)(3) STATUS TO 509(A)(1) AND 170(B)(1)(A)(VI) STATUS WITH THE INTERNAL REVENUE SERVICE. THE FOUNDATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE FOUNDATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAD NO EFFECT ON THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 2,290,000. FUNDRAISING EVENT EXPENSES 455,527. RESTRICTED REALIZED LOSSES ON INVESTMENTS 43,360. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 1,375,976. RESTRICTED INTEREST INCOME 12,952. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EVENT EXPENSES 455,527. GOLF TOURNAMENT 307849 267249 40600 77275 44210 204368 HARVEST MOON GALA 449371 449371 2500 8672 4 266692 261906 4786 3511 28574 86417 1023912 978526 45386 6011 105849 44210 299457 455527 -410141 106160 73101 37143 0 106160 73101 37143 110244 -4084 MN 1 0 0 0 0.00000 1.00000 AARON BLOOMQUIST 500 SOUTH MAPLE STREET WACONIA MN 55387 0 KIM KIMBALL AND BRIAN MASTEL 59321 GAMING MANAGER SUPERVISES ALL FUNDRAISING EVENTS AND FILLS OUT ALL OF THE PAPERWORK RELATED TO GAMING ACTIVITIES.KIM KIMBALL WAS EMPLOYED AS GAMING MANAGER THROUGH APRIL 30, 2022. KIM'S TOTAL COMPENSATION IN 2022 WAS $23,971. BRIAN MASTEL WAS EMPLOYED AS GAMING MANAGER AS OF JUNE 6, 2022. BRIAN'S TOTAL COMPENSATION IN 2022 WAS $35,350. X 0 1 RIDGEVIEW MEDICAL CENTER 500 SOUTH MAPLE STREET WACONIA MN 55387 311667875 501(C)(3) 2209837 0 FUNDRAISING SUPPORT OF RIDGEVIEW MEDICAL CENTER SIBLEY MEDICAL CENTER 601 WEST CHANDLER STREET ARLINGTON MN 55307 411801967 501(C)(3) 103250 0 FUNDRAISING SUPPORT OF SIBLEY MEDICAL CENTER MINNESOTA VALLEY HEALTH CENTER 621 SOUTH 4TH STREET LE SUEUR MN 56058 410837659 501(C)(3) 57913 0 FUNDRAISING SUPPORT OF MINNESOTA VALLEY HEALTH CENTER 3 0 SCHOLARSHIPS 15 30000 PART I, LINE 2: GRANTS AND OTHER ASSISTANCE TO ENTITIES IN THE U.S.: TRANSFERS ARE TO RELATED ENTITIES UNDER COMMON MANAGEMENT AND TRACKED THROUGH THE INTERNAL FINANCIAL REPORTING PROCESS. GRANTS AND OTHER ASSISTANCE TO INDIVIDUALS IN THE U.S.: SCHOLARSHIP PAYMENTS ARE MADE DIRECTLY TO THE SCHOOL THAT THE STUDENT IS ATTENDING. 0 1 0 0 0 1 1 0 0 MICHAEL PHELPS PRESIDENT/CEO 0 1270809 0 0 0 3374 0 26074 0 37966 0 1338223 0 0 AARON BLOOMQUIST CFO 0 488856 0 0 0 1942 0 14169 0 47500 0 552467 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. X 1 15049 FAIR MARKET VALUE X GIFTS 62 106004 FAIR MARKET VALUE 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS OF THE FOUNDATION DESIGNATED SEVEN BOARD MEMBERS AS AN EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE ACTS ONLY DURING INTERVALS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS OF THE FOUNDATION AND IS AT ALL TIMES SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD OF DIRECTORS OF THE FOUNDATION. DURING SUCH INTERVALS AND SUBJECT TO SUCH CONTROL AND DIRECTION, THE EXECUTIVE COMMITTEE HAS ALL OF THE AUTHORITY AND POWER OF THE BOARD OF DIRECTORS OF THE FOUNDATION IN THE MANAGEMENT OF THE BUSINESS OF THE FOUNDATION, SUBJECT TO SUCH LIMITATIONS AS THE BOARD OF DIRECTORS OF THE FOUNDATION MAY IMPOSE FROM TIME TO TIME. 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 RIDGEVIEW MEDICAL CENTER IS THE SOLE MEMBER OF RIDGEVIEW FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A EACH PERSON ELECTED BY THE BOARD OF DIRECTORS OF RIDGEVIEW FOUNDATION IS RATIFIED OR REJECTED BY THE BOARD OF DIRECTORS OF RIDGEVIEW MEDICAL CENTER, THE FOUNDATION'S SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B IN ADDITION TO THE APPOINTMENT OF DIRECTORS TO THE BOARD OF DIRECTORS OF RIDGEVIEW FOUNDATION, AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE FOUNDATION REQUIRE APPROVAL OF RIDGEVIEW MEDICAL CENTER, THE SOLE MEMBER. FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWED THE FORM 990 AND PROVIDED COPIES TO THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD MEMBERS ANNUALLY REVIEW AND SIGN THE STATEMENTS FOR POTENTIAL CONFLICTS OF INTEREST POLICY. 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 RIDGEVIEW FOUNDATION DOES NOT COMPENSATE ITS OFFICERS OR BOARD MEMBERS. ANY COMPENSATION RECEIVED BY THOSE INDIVIDUALS IS DETERMINED BY RIDGEVIEW MEDICAL CENTER, THE FOUNDATION'S PARENT. FORM 990, PART VI, SECTION C, LINE 19 RIDGEVIEW FOUNDATION'S 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. RIDGEVIEW CLINICS 500 SOUTH MAPLE STREET WACONIA MN 55387 411651783 HEALTH CARE SERVICES MN 501(C)(3) LINE 12A, I 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 RIDGEVIEW INSURANCE COMPANY 60 E SOUTH TEMPLE STE 1800 SALT LAKE CITY UT 84111 454109041 CAPTIVE INSURANCE COMPANY UT 501(C)(3) LINE 12A, I RIDGEVIEW MEDICAL CENTER 0 SIBLEY MEDICAL CENTER 601 W CHANDLER ST ARLINGTON MN 55307 411801967 CRITICAL ACCESS HOSPITAL MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 MINNESOTA VALLEY HEALTH CENTER 621 S 4TH STREET LE SUEUR MN 56058 410837659 HEALTH CARE SERVICES MN 501(C)(3) LINE 3 RIDGEVIEW MEDICAL CENTER 0 MINNEAPOLIS HEART INSTITUTE AT RIDGEVIEW HEART CENTER LCC 500 S MAPLE ST WACONIA MN 55387 205785920 CARDIOLOGY SERVICES MN N/A 0 0 CHASKA PLAZA SURGERY CENTER 3000 HUNDERTMARK ROAD 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 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 0