2024-11-01T14:57:46-05:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 4150 2ND STREET SOUTH SUITE 400 ST CLOUD MN 56301 990 2023-01-01 452872803 ST CROIX VALLEY EMERGENCY MEDICAL SERVICES INC STCR 6512774911 235 EAST STATE STREET ST CROIX FALLS WI 54024 MIKE YOUSO CFO 7154830556 2024-10-30 1 0 KRISIN SCHMIDT CPA P01487323 3202035500 2024-10-30 2023 2024-10-15 13:58:12Z MIKE YOUSO 235 EAST STATE STREET ST CROIX FALLS WI 54024 4283873 0 1 X HTTPS://WWW.SAINTCROIXHEALTH.ORG X 2011 WI TO LEASE, MAINTAIN AND OPERATE AN EMERGENCY AMBULANCE SERVICE WHICH SERVES POLK COUNTY, WI AREA. 5 3 0 6 0 0 360190 65058 3252434 4178979 3893 27363 6971 12473 3623488 4283873 0 0 0 0 0 0 0 0 0 3531067 3759421 3531067 3759421 92421 524452 2853723 3419803 270188 311816 2583535 3107987 X TO LEASE, MAINTAIN AND OPERATE AN EMERGENCY AMBULANCE SERVICE WHICH WILL SERVE THE POLK CO WI AREA TO RENDER AID TO THE SICK, INJURED, OR DISABLED WITHOUT THE REGARDS TO RACE, CREED, OR TO STATION IN LIFE. TO SERVE THE SOCIAL WELFARE OF THE PEOPLE. 0 0 2881865 0 4186677 ST. CROIX VALLEY EMS, INC. OPERATES AS AN "OUT-OF-HOSPITAL" CARE ORGANIZATION THAT PROVIDES MEDICAL CARE AND COMPREHENSIVE MEDICAL TRANSPORTATION IN THE COMMUNITIES WE SERVE. THE CORE PURPOSE OF ST. CROIX VALLEY EMS, INC. IS PROVIDING CARE TO PEOPLE DURING THEIR TIME OF NEED RESULTING FROM ACCIDENTS AND MEDICAL EMERGENCIES. ST. CROIX VALLEY EMS, INC. RESPONDS TO "911" CALLS IN EACH COMMUNITY SERVED WITHOUT ANY REGARD TO REIMBURSEMENT FOR SERVICES, INCLUDING THE ABILITY OF THE CALLING PARTY TO PAY FOR COSTS ASSOCIATED WITH THE SERVICE.ST. CROIX VALLEY EMS, INC. PROVIDES SERVICES TO THE COMMUNITIES OF: CITY OF ST. CROIX, TOWN OF ST. CROIX, TOWN OF GARFIELD, TOWN OF EUREKA, TOWN OF OSCEOLA, TOWN OF BALSAM LAKE, TOWN OF MILLTOWN, TOWN OF STERLING, CITY OF DRESSER, VILLAGE OF BALSAM LAKE, VILLAGE OF CENTURIA, VILLAGE OF MILLTOWN, IN POLK COUNTY WISCONSIN AND THE COMMUNITIES OF THE CITY OF TAYLORS FALLS, AMADOR TOWNSHIP AND SHAFER TOWNSHIP IN CHISAGO COUNTY, MN.ST. CROIX VALLEY EMS, INC. SERVES APPROXIMATELY 7,400 RESIDENTS IN THE ABOVE CITIES/VILLAGES/TOWNS. 2881865 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 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 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 3 0 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 WI MN X EMILY PINKSTON 6512774911 40245 FLETCHER AVENUE NORTH BRANCH MN 55056 DAVE DOBOSENSKI PRESIDENT 1.00 40.00 X X 0 769770 25563 MICHAEL YOUSO CFO - SCVEMS 1.00 40.00 X X 0 443213 43798 AARRON REINERT VICE PRESIDENT 1.00 X X 0 0 0 PAT MCCAULLY SECRETARY 1.00 X X 0 0 0 RALPH J FRASCONE DIRECTOR 1.00 X 0 0 0 KIMBERLY ERICSON CFO - ST. CROIX HEALTH 1.00 40.00 X 0 169049 6491 0 1382032 75852 0 0 1 0 LAKES REGION EMS INC 40245 FLETCHER AVE NORTH BRANCH MN 55056 MANAGEMENT FEES, PAYROLL, MISC EXPENSES 3119827 3 64958 100 65058 FEE INCOME 621910 4178979 4178979 4178979 27363 27363 MISCELLANEOUS 621910 12473 7698 4775 12473 4283873 4186677 0 32138 2859494 2054963 804531 469 469 3825 3825 68731 68731 8464 8464 11157 11157 32455 32455 102647 102647 195485 195485 28605 28605 BAD DEBT WRITEOFFS 218949 218949 MEDICAL SUPPLIES 98900 98900 REPAIRS AND MAINTENANCE 32231 32231 98009 98009 3759421 2881865 877556 0 873841 678829 983310 1360673 460838 774054 1565528 959281 535734 606247 2853723 3419803 195953 311816 74235 270188 311816 X 0 0 776822 776822 1806713 2331165 2583535 3107987 2853723 3419803 524452 0 X 0 1 X 0 0 X 73000 308 360190 65058 498556 2494171 2555110 3037664 3252434 4178979 15518358 2567171 2555418 3037664 3612624 4244037 16016914 0 0 0 16016914 6553 3673 2830 3893 27363 44312 6553 3673 2830 3893 27363 44312 8993 1776 626 6971 12473 30839 2582717 2560867 3041120 3623488 4283873 16092065 0.99530 0.99670 0.00280 0.00140 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE - 2019 AMOUNT: $ 8,993. 2020 AMOUNT: $ 1,776. 2021 AMOUNT: $ 626. 2022 AMOUNT: $ 6,971. 2023 AMOUNT: $ 12,473. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 27042 27042 328967 205118 123849 1209519 754163 455356 606247 X PART X, LINE 2: THE ORGANIZATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE INCOME TAXES. THE ORGANIZATION'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE ORGANIZATION IS NOT AWARE OF ANY ADDITIONAL ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME OR EXCISE OR OTHER TAXES THAN ARE CURRENTLY FILED IN THE TAX RETURN. 0 0 0 0 0 0 0 0 0 DAVE DOBOSENSKI PRESIDENT 0 742340 0 0 0 27430 0 20045 0 5518 0 795333 0 0 MICHAEL YOUSO CFO - SCVEMS 0 411233 0 0 0 31980 0 22500 0 21298 0 487011 0 0 KIMBERLY ERICSON CFO - ST. CROIX HEALTH 0 167899 0 0 0 1150 0 0 0 6491 0 175540 0 0 PART II THE FILING ORGANIZATION RELIES ON A RELATED ORGANIZATION TO DETERMINE THE COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WHICH IS PAID BY THE RELATED ORGANIZATION. THE RELATED ORGANIZATION USES THE FOLLOWING PRACTICES TO DETERMINE COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL: 1) COMPENSATION COMMITTEE 2) INDEPENDENT COMPENSATION CONSULTANT 3) WRITTEN EMPLOYMENT CONTRACT 4) COMPENSATION SURVEY OR STUDY 5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE FORM 990, PART VI, SECTION A, LINE 3 OPERATIONS AGREEMENT WITH LAKES REGION EMS, INC. $804531.46 MANAGEMENT FEE FOR 2023. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATION HAS THREE MEMBERS: ST. CROIX REGIONAL MEDICAL CENTER, REGIONS HOSPITAL AND LAKES REGION, EMS, INC. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATION HAS THREE MEMBERS WITH THE POWER TO APPOINT DIRECTORS OF THE BOARD AS FOLLOWS: ST. CROIX REGIONAL MEDICAL CENTER SHALL APPOINT THREE DIRECTORS, REGIONS HOSPITAL SHALL APPOINT TWO DIRECTORS AND LAKES REGION EMS, INC. SHALL APPOINT ONE DIRECTOR. EACH DIRECTOR SHALL SERVE AN INDEFINITE TERM CONTINUING UNTIL HIS OR HER DEATH, INABILITY TO ACT, RESIGNATION OR REMOVAL. A VACANCY IN THE BOARD OF DIRECTORS SHALL BE FILLED BY THE MEMBER WHO APPOINTED THE DIRECTOR WHOSE CESSATION OF SERVICE CREATES THE VACANCY. FORM 990, PART VI, SECTION A, LINE 7B UNANIMOUS APPROVAL IS REQUIRED FOR MATERIAL CHANGES IN THE MISSION AND MAJOR CHANGES IN THE CORPORATION'S STRUCTURE. SUPER MAJORITY MEMBERSHIP INTEREST APPROVAL IS REQUIRED FOR MAJOR TRANSACTIONS. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO STANDING COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B AFTER PREPARATION BY AN INDEPENDENT ACCOUNTING FIRM, THE FORM 990 WILL BE REVIEWED AND APPROVED BY THE FULL BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ALL BOARD MEMBERS AND OPERATIONS COMMITTEE MEMBERS TO ANNUALLY ACKNOWLEDGE REVIEWING THE CONFLICT OF INTEREST POLICY BY SIGNING THE CONFLICT OF INTEREST STATEMENT. IF A CONLICT OF INTEREST EXISTS, HE OR SHE SHALL REFRAIN FROM PARTICIPATION IN ANY DECISION ON SUCH A MATTER WITH REMAINING MEMBERS DETERMINING WHETHER A CONFLICT EXISTS. PROCEEDINGS RELATED TO CONFLICTS OF INTEREST ARE DOCUMENTED IN THE MEETING MINUTES OR AS OTHERWISE APPROPRIATE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE FOR PUBLIC INSPECTION. ST CROIX REGIONAL MEDICAL CENTER 235 E STATE ST ST CROIX FALLS WI 54024 390890676 HEALTH - GENERAL & REHABILITATIVE WI 501(C)(3) LINE 3 N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0