2023-11-15T15:31:33-06:00 2022-12-31 390859910 BAKER TILLY US LLP 225 S 6TH ST 2300 MINNEAPOLIS MN 55402 990 2022-01-01 411777966 NORTH MEMORIAL FOUNDATION NORT 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 KENT SPAULDING VP FOUNDATION 7635205200 2023-11-15 1 KENT SPAULDING XXX-XX-XXXX 1 LAWRENCE H MOHR CPA P00447603 6128764500 2023-11-15 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z KENT SPAULDING 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 1677341 0 X WWW.NORTHMEMORIAL.COM X 1993 MN TO SUPPORT NORTH MEMORIAL HEALTH CARE AND ITS COMMITMENT TO CHANGING AND SAVING LIVES. THROUGH PHILANTHROPY, OUR DONORS ASSIST IN GIVING OUR PATIENTS AND THEIR FAMILIES COMPASSIONATE, REMARKABLE CARE. 14 10 0 51 0 0 731636 812413 0 0 402813 298838 227906 360201 1362355 1471452 560206 408166 0 0 0 0 0 0 0 107546 1851628 667752 2259794 694603 -788342 14323337 10934120 23548 101553 14299789 10832567 X TO SUPPORT NORTH MEMORIAL HEALTH CARE AND ITS COMMITMENT TO CHANGING AND SAVING LIVES. THROUGH PHILANTHROPY, OUR DONORS ASSIST IN GIVING OUR PATIENTS AND THEIR FAMILIES COMPASSIONATE, REMARKABLE CARE. 0 0 141029 MORE THAN 180 NORTH MEMORIAL HEALTH BOARD MEMBERS, LEADERS AND DEI WORKGROUP MEMBERS PARTICIPATED IN TRAININGS AND ACTIVITIES FOCUSED ON INCREASING AWARENESS OF THE CULTURAL IDENTITIES AND HEALTH BELIEFS OF DIVERSE CUSTOMERS AS WELL AS THEIR OWN BIASES. OUR NEW EMERGING LEADERS PROGRAM EMPOWERS AND EQUIPS OUTSTANDING TEAM MEMBERS WITH LIFE AND LEADERSHIP SKILLS AND THE FIRST COHORT, EXCLUSIVELY FOR TEAM MEMBERS OF COLOR WITH A GOAL TO INCREASE DIVERSITY IN OUR LEADERSHIP COMMUNITY, WAS FUNDED BY NORTH MEMORIAL HEALTH FOUNDATION. 65123 65123 THROUGH THE SUPPORT OF DONORS, NORTH MEMORIAL HEALTH FOUNDATION SUPPORTED STAFFING FOR RESILIENCE PROGRAMMING IN RESPONSE TO THE BURNOUT AND PRESSURES THE COVID-19 PANDEMIC BROUGHT UPON OUR FRONTLINE TEAM MEMBERS. THE PROGRAM PROVIDES INVALUABLE RESOURCES, TOOLS, AND SUPPORT THAT DECREASE BURNOUT, INCREASE JOB ENGAGEMENT, AND PROMOTE OVERALL WELLNESS. ACTIVITIES HAVE INCLUDED PAUSE FOR PAWS ANIMAL THERAPY SESSIONS, BURST SESSIONS DURING TEAM HUDDLES, HEARTMATH TEACHING SESSIONS AND LEADER DROP-IN SESSIONS. 47910 47910 NORTH MEMORIAL HEALTH'S HOSPICE TEAM PROVIDES END OF LIFE CARE, AS WELL AS GRIEF SUPPORT SERVICES FOR THEIR FAMILIES AND LOVED ONES. FOUNDATION SUPPORT PROVIDED COMPLEMENTARY SERVICES SUCH AS MASSAGE THERAPY AND ANIMAL THERAPY GRIEF TO HELP INDIVIDUALS COPE WITH THEIR DIAGNOSIS, MANAGE PAIN/DISCOMFORT AND PREPARE FOR THE END OF THEIR LIVES. ADDITIONALLY, FUNDS SUPPORTED GRIEF ACTIVITIES AND CARE ITEMS SUCH AS SENSORY BASKETS, SUPPORT GROUPS AND SEASONAL MEMORY PACKAGES. 1972796 295133 THE FOUNDATION SUPPORTS OTHER PROGRAMS AND INITIATIVES THROUGHOUT THE ORGANIZATION AS IDENTIFIED BY DONORS AND FOUNDATION LEADERSHIP. THESE FUNDS SUPPORT A WIDE ARRAY OF PROJECTS, FROM TECHNOLOGY UPGRADES TO NEW CARE PROGRAMS, TEAM-MEMBER EDUCATION TO FACILITY ENHANCEMENTS. 1972796 295133 2226858 1 1 0 0 0 1 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 6 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 10 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN WI X DAVE ALBRIGHT 7635205200 3300 OAKDALE AVENUE NORTH ROBBINSDALE MN 554222900 J KEVIN CROSTON MD DIRECTOR 2.00 44.00 X 0 1741361 544406 PAMELA DOORENBOS MD DIRECTOR 1.00 40.00 X 0 399284 35216 BETH MEJIA DIRECTOR 1.00 40.00 X 0 86670 13590 SCOTT HEMENWAY BOARD CHAIR 1.00 X X 0 0 0 JANDEEN BOONE VICE CHAIR 1.00 X X 0 0 0 JIM BYRNE TREASURER 1.00 X X 0 0 0 DANA GARRETT DIRECTOR 1.00 X 0 0 0 DAVID HANCOX DIRECTOR 1.00 X 0 0 0 BRUCE QUAM DIRECTOR 1.00 X 0 0 0 DIANE NILSON DIRECTOR 1.00 X 0 0 0 TROY REDING DIRECTOR 1.00 X 0 0 0 MICHAEL OPAT DIRECTOR 1.00 40.00 X 0 227548 25562 ERIC SKALLAND DIRECTOR 1.00 X 0 0 0 MIKE STEINHAUSER DIRECTOR 1.00 X 0 0 0 KENT SPAULDING VICE PRESIDENT 2.00 40.00 X 0 306047 23771 0 2760910 642545 0 0 1 0 0 263276 549137 68595 812413 298838 298838 566090 263276 205889 360201 360201 1471452 0 0 659039 322387 322387 85779 85779 21461 21461 7255 7255 1099 1099 PROGRAM DISBURSEMENTS 1688861 1688861 SUPPLIES 108036 96561 11475 OTHER MISCELLANEOUS 24916 24916 2259794 2226858 32936 0 423998 251037 16348 72560 13115375 10152967 767616 457556 14323337 10934120 13923 13428 78500 9625 9625 23548 101553 X 5675825 3294475 8623964 7538092 14299789 10832567 14323337 10934120 X -788342 -2511227 -167653 X X 0 1 X 1 0 X 692238 901679 1377215 731636 812413 4515181 692238 901679 1377215 731636 812413 4515181 152629 4362552 182305 469099 289899 402813 298838 1642954 6158135 0.70840 0.73720 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 0 0 9625 1 1 2998878 30942 -545367 180854 2303599 2665779 2772 333957 3630 2998878 3533987 15237 292934 7218 1169161 2665779 2919654 7303 659124 52094 3533987 3344063 82062 -75671 414300 16500 2919654 0.00000 0.74000 0.26000 1 0 0 AMOUNTS HELD FOR OTHERS 9625 9625 X PART V, LINE 4: 1) RALPH ROSSEN ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED IN 1986 TO PROVIDE RECOGNITION TO NURSING STAFF THAT PROVIDE REMARKABLE SERVICE TO NORTH MEMORIAL PATIENTS AND THEIR FAMILIES. MEMBERS OF THE ROSSEN FAMILY SERVE ON A COMMITTEE ALONG WITH THE VP AND CHIEF NURSING OFFICER OF NORTH MEMORIAL TO SELECT THE RECIPIENTS. 2) HAROLD B. KAISER HONORARY LECTURESHIP ENDOWMENT: DR KAISER IS THE FOUNDER OF ALLERGY & ASTHMA SPECIALISTS, P.A. ESTABLISHED IN 1966. THE HAROLD B KAISER HONORARY LECTURESHIP ENDOWMENT PROVIDES FUNDING FOR A KEYNOTE SPEAKER FOR THE ANNUAL ALLERGY & ASTHMA CONFERENCE HELD IN THE MINNEAPOLIS AREA IN MARCH. 3) HAROLD ECKER ENDOWMENT: ESTABLISHED IN 1994 IN HONOR OF THE EXCELLENT CARE THAT MR. ECKER RECEIVED AS A PATIENT AT NORTH MEMORIAL, THE HAROLD ECKER ENDOWMENT PROVIDES A $500 AWARD TO THREE NORTH MEMORIAL EMPLOYEES RECOGNIZING THEIR OUTSTANDING PERFORMANCE AND PERSONAL ATTITUDE. THE AWARD IS OPENED TO ALL EMPLOYEES AND THE WINNERS ARE SELECTED BY A COMMITTEE OF NORTH MEMORIAL EMPLOYEES AND PRESENTED AT THE ANNUAL QUALITY AWARDS LUNCHEON IN NOVEMBER EACH YEAR. 4) RESIDENTIAL HOSPICE ENDOWMENT: THE RESIDENTIAL HOSPICE ENDOWMENT WAS ESTABLISHED BY DR. JOHN AND PATTY MANION TO PROVIDE ASSISTANCE TO THE RESIDENTIAL HOSPICE PROGRAM AT NORTH MEMORIAL. FUNDS ARE USED TO UPGRADE THE FACILITIES AND EQUIPMENT AT THE NORTH RESIDENTIAL HOSPICE FACILITY IN BROOKLYN CENTER, PROVIDE ADDITIONAL PROGRAM SUPPORT, STAFF TRAINING AND TO ASSIST THOSE FAMILIES THAT CANNOT AFFORD THIS SERVICE. THE RESIDENTIAL HOSPICE FACILITY WAS SOLD IN 2017 AND WE ARE CURRENTLY WORKING THROUGH THE PROCESS TO REPURPOSE THE ENDOWMENT FUNDS. NO FUNDS WILL BE USED UNTIL THE PROCESS IS COMPLETE. 5) HELEN MURRAY MEMORIAL ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED WITH AN IRREVOCABLE CHARITABLE REMAINDER TRUST BY JEANNE MITHUN TO RECOGNIZE THE OUTSTANDING SERVICE THAT NORTH RESIDENTIAL HOSPICE PROVIDED TO HER MOTHER (HELEN MURRAY) AND HER FAMILY. FUNDS ARE USED TO PROVDE CARE TO INDIVIDUALS UNABLE TO PAY FOR SERVICES AT THE FACILITY. 6) MEDICAL STAFF ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED IN 2010 BY THE NORTH MEMORIAL MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND NORTH MEMORIAL PROGRAMS SUCH AS JUNIOR VOLUNTEER SCHOLARSHIP, SAFEJOURNEY, PASTORAL CARE, ETC. 7) MAPLE GROVE MEDICAL STAFF ENDOWMENT WAS ESTABLISHED IN 2013 BY THE MAPLE GROVE MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND MAPLE GROVE PROGRAMS. PART X, LINE 2: NORTH MEMORIAL IS ENGAGED IN CERTAIN ACTIVITIES THAT RESULT IN UNRELATED BUSINESS INCOME. NORTH MEMORIAL RECORDED AN INCOME TAX EXPENSE OF APPROXIMATELY $300,000 AND $175,000 IN 2022 AND 2021, RESPECTIVELY, WHICH IS INCLUDED WITH OTHER OPERATING EXPENSES IN THE CONSOLIDATED STATEMENTS OF OPERATIONS. NORTH MEMORIAL RECOGNIZES ALL TAX POSITIONS WHEN IT IS MORE LIKELY THAN NOT THAT, BASED ON TECHNICAL MERITS, THE POSITION WILL BE SUSTAINED UPON EXAMINATION. NORTH MEMORIAL EVALUATES ITS UNCERTAIN POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN THE CONSOLIDATED BALANCE SHEETS AS OF DECEMBER 31, 2022 OR 2021. PLEASE NOTE THAT AMOUNTS INCLUDED ABOVE REGARDING UNRELATED BUSINESS INCOME ARE FOR NORTH MEMORIAL HEALTH AS WELL AS OTHER ORGANIZATIONS INCLUDED IN THE CONSOLIDATED AUDIT REPORT. NORTH MEMORIAL FOUNDATION DOES NOT HAVE ANY UNRELATED BUSINESS INCOME TAX LIABILITY FOR TAX YEAR 2022. DINNER/DANCE GALA 636829 179126 457703 22577 138718 GOLF FUNDRAISER 192537 84150 108387 18072 26522 829366 263276 566090 40649 165240 205889 360201 1 NORTH MEMORIAL HEALTH CARE 3300 OAKDALE AVE N ROBBINSDALE MN 55422 410729979 501(C)(3) 264021 0 TO SUPPORT COVID-19 EMERGENCY, INPATIENT MENTAL HEALTH SERVICES, OTHER PATIENT AND EMPLOYEE NEEDS MAPLE GROVE HOSPITAL 9875 HOSPITAL DR MAPLE GROVE MN 55369 208316475 501(C)(3) 33397 0 TO SUPPORT MGH NICU, OTHER PATIENT AND EMPLOYEE NEEDS BLAZE HEALTH LLC 8301 GOLDEN VALLEY RD STE 300 GOLDEN VALLEY MN 55427 842906333 24969 0 TO SUPPORT HOSPICE SERVICES, OTHER PATIENT AND EMPLOYEE NEEDS 2 1 TEAM MEMBER ASSISTANCE/CRISIS FUND 40 40715 TEAM MEMBER CRISIS ASSISTANCE PATIENT ASSISTANCE 24 31540 FINANCIAL ASSISTANCE INCLUDING CANCER PHARMACEUTICALS, MENTAL HEALTH EMERGENCIES, AND OTHER NEEDS SCHOLARSHIPS AND EDUCATION ASSISTANCE 13 13524 SCHOLARSHIPS AND EDUCATION REIMBURSEMENT FOR SPECIFIC STUDIES. PART I, LINE 2: THE ORGANIZATION PRIMARILY MAKES GRANTS TO RELATED ORGANIZATIONS NORTH MEMORIAL HEALTH CARE, MAPLE GROVE HOSPITAL, AND BLAZE HEALTH. RECORDS ARE MAINTAINED AS TO HOW FUNDS ARE DISBURSED BY ALL ORGANIZATIONS. 0 1 0 0 0 0 0 0 0 J KEVIN CROSTON MD DIRECTOR 0 1326539 0 386500 0 28322 0 518000 0 26406 0 2285767 0 0 PAMELA DOORENBOS MD DIRECTOR 0 320535 0 68750 0 9999 0 18000 0 17216 0 434500 0 0 KENT SPAULDING VICE PRESIDENT 0 249423 0 52188 0 4436 0 17865 0 5906 0 329818 0 0 MICHAEL OPAT DIRECTOR 0 198095 0 21667 0 7786 0 11417 0 14145 0 253110 0 0 PART I, LINE 3 THE CHIEF EXECUTIVE OFFICER OF NORTH MEMORIAL PROVIDES SERVICES TO NORTH MEMORIAL HEALTH CARE AS WELL AS TO ALL RELATED ENTITIES AS IDENTIFIED ON SCHEDULE R. AS SUCH, HIS COMPENSATION LEVEL INCORPORATES SERVICES PROVIDED TO MULTIPLE NORTH MEMORIAL ENTITIES. THE CEO OF NORTH MEMORIAL HEALTH CARE HAS A PERMANENT SPOT ON THE BOARD OF THE NORTH MEMORIAL FOUNDATION. PART I, LINE 4B DR. KEVIN CROSTON RECIEVED A CONTRIBUTION TO HIS 457(F) PLAN OF $500,000 DURING THE TAX YEAR. THIS AMOUNT IS INCLUDED IN COLUMN (C) OF SCHEDULE J, PART II. THE AMOUNT WAS UNVESTED AS OF THE END OF THE TAX YEAR. X 28830 FMV X AUCTION ITEMS 99 39765 FMV 0 1 0 PART I, COLUMN (B): THE NUMBER IN PART I, COLUMN (B) REPRESENTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART VI, SECTION A, LINE 3 THE BOARD OF DIRECTORS MAY, BY ACTION OF A MAJORITY OF THE ENTIRE BOARD, DESIGNATE TWO OR MORE OF ITS MEMBERS AS AN EXECUTIVE COMMITTEE WHICH, TO THE EXTENT DETERMINED BY THE RESOLUTION OF THE BOARD, SHALL HAVE AND EXERCISE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE BUSINESS OF THE CORPORATION. THE EXECUTIVE COMMITTEE SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL MAINTAIN MINUTES OF EACH MEETING. FORM 990, PART VI, SECTION A, LINE 6 NORTH MEMORIAL HEALTH CARE IS THE SOLE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A NORTH MEMORIAL HEALTH CARE, AS THE SOLE MEMBER OF THE ORGANIZATION, DETERMINES THE NUMBER OF BOARD MEMBERS AND ELECTS MEMBERS AT THE ANNUAL MEETING AFTER CONSIDERATION OF NOMINATIONS, IF ANY, FROM THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE APPROVAL OF NORTH MEMORIAL HEALTH CARE AS THE SOLE MEMBER OF THE ORGANIZATION IS REQUIRED FOR THE FOLLOWING ACTIONS OF THE ORGANIZATION'S GOVERNING BODY: (1) AMENDMENTS TO THE GOVERNING DOCUMENTS; (2) MERGER OR CONSOLIDATION OF THE ORGANIZATION; (3) SALE, LEASE, PLEDGE, TRANSFER, ASSIGNMENT OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (4) MORTGAGES OR OTHER SECURITY INTERESTS AFFECTING ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (5) ISSUANCE OF CAPITAL CALLS TO THE MEMBER; AND (6) DISSOLUTION AND LIQUIDATION OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD OF DIRECTORS REVIEW THE FORM 990 BEFORE IT IS FILED. REPRESENTATIVES FROM THE FOUNDATION'S INDEPENDENT ACCOUNTING FIRM REVIEW THE FORM 990 WITH MANAGEMENT IN DETAIL AND NOTE ANY CHANGES IN THE FORM 990 FROM PRIOR YEARS. AFTER THOROUGH DISCUSSION, THE BOARD APPROVES THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C ALL MEMBERS OF THE BOARD OF DIRECTORS AND ALL EMPLOYEES RECEIVE A COPY OF THE CONFLICT OF INTEREST POLICY EACH YEAR. EACH BOARD MEMBER AND STAFF MEMBER FILLS OUT A CONFLICT OF INTEREST QUESTIONNAIRE IN WHICH THEY ARE ASKED TO IDENTIFY ANY RELATIONSHIP THAT WOULD CREATE A CONFLICT OF INTEREST. THE RESULTS ARE SUMMARIZED AND REVIEWED TO DETERMINE ANY ACTUAL OR POTENTIAL CONFLICT AND ARE REPORTED TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S OFFICERS RECEIVED THEIR COMPENSATION FROM NORTH MEMORIAL HEALTH CARE (NMHC) WHICH FOLLOWS NMHC'S POLICIES AND PROCEDURES ON DETERMINING COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: NET CHANGE IN INTEREST IN BENEFICIAL TRUST -167,653. FORM 990, PART XII, LINE 2C: NEITHER THE OVERSIGHT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT CHANGED DURING THE TAX YEAR. NORTH MEMORIAL HEALTH CARE 3300 OAKDALE AVE N ROBBINSDALE MN 55422 410729979 ACUTE CARE MN 501(C)(3) LINE 3 NORTH MEMORIAL 0 ASSOCIATED HEALTH ASSURANCE 3300 OAKDALE AVE N ROBBINSDALE MN 55422 980343815 INSURANCE BD 501(C)(3) 11A NORTH MEMORIAL 0 MAPLE GROVE HOSPITAL CORPORATION 3300 OAKDALE AVE N ROBBINSDALE MN 55422 208316475 ACUTE CARE MN 501(C)(3) LINE 3 NORTH MEMORIAL 0 NORTH MEMORIAL AMBULATORY SURGERY CENTER AT MAPLE GROVE LLC 9855 HOSPITAL DRIVE MAPLE GROVE MN 55369 260393039 OUTPATIENT SURGERY MN N/A 0 0 MINNESOTA DIAGNOSTIC IMAGING PARTNERS LLC 2955 XENIUM LANE SUITE 40 PLYMOUTH MN 55441 352162215 RADIOLOGY MN N/A 0 0 NORTH RADIATION THERAPY CENTER LLC 6950 FRANCE AVE S SUITE 200 EDINA MN 55435 743069974 RADIOLOGY MN N/A 0 0 BLAZE HEALTH LLC 8301 GOLDEN VALLEY RD STE 300 GOLDEN VALLEY MN 55427 842906333 HEALTHCARE MN N/A 0 0 OAKDALE HEALTH ENTERPRISES INC 3300 OAKDALE AVE N ROBBINSDALE MN 55422 411546422 AMBULANCE MN N/A C 0 CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST MN N/A T 0 NORTH COLLABORATIVE CARE 3300 OAKDALE AVE N ROBBINSDALE MN 55422 461680666 PRIMARY CARE MN N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0