Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 01-01-2013 , 2013, and ending 12-31-2013
BCheck if applicable:
CName of organization
PARK NICOLLET GROUP RETURN
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
6500 EXCELSIOR BLVD
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
ST LOUIS PARK, MN55426
D Employer identification number

45-5023260
E Telephone number

G Gross receipts $ 1,616,909,950
F Name and address of principal officer:
CATHERINE LENAGH
6500 EXCELSIOR BLVD
ST LOUIS PARK,MN55426
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.PARKNICOLLET.COM
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet5874
K Form of organization:
 
L Year of formation:  
M State of legal domicile: MN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 21
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 17
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 0
6 Total number of volunteers (estimate if necessary) ............. 6 1,234
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 4,733,020
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 17,418,737 13,492,826
9 Program service revenue (Part VIII, line 2g) ......... 1,194,561,165 1,220,725,539
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 12,435,208 25,398,507
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 6,666,342 6,862,518
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 1,231,081,452 1,266,479,390
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 167,496 422,828
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 727,620,366 762,686,851
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet306,733    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 452,244,235 456,893,137
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,180,032,097 1,220,002,816
19 Revenue less expenses. Subtract line 18 from line 12....... 51,049,355 46,476,574
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 943,062,738 1,014,855,016
21 Total liabilities (Part X, line 26)............. 442,730,848 442,737,764
22 Net assets or fund balances. Subtract line 21 from line 20..... 500,331,890 572,117,252
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 987,048,343 including grants of $ 422,828 ) (Revenue $ 1,121,201,147 )
IN 2013, PARK NICOLLET HEALTH SERVICES AND AFFILIATES, A NATIONAL HEALTH CARE IMPROVEMENT LEADER, CONTINUED TO MAKE DRAMATIC PATIENT CARE ADVANCES, WIN PROMINENT AWARDS, EXPAND ACCESS TO SERVICES AND INTEGRATE EFFICIENCY INTO PARK NICOLLET HEALTH SERVICES' OPERATIONS. PARK NICOLLET HEALTH SERVICES AND AFFILIATES ALSO HAVE ENHANCED COMMUNITY HEALTH, INCREASED TEAM MEMBER SATISFACTION AND PROMOTED RESEARCH AND EDUCATION. PARK NICOLLET SPECIALTY CENTERS INCLUDE: ALEXANDER CENTER - THE LARGEST CLINIC IN MINNESOTA SERVING THE DEVELOPMENTAL AND BEHAVIORAL NEEDS OF CHILDREN AND THEIR FAMILIES. BARIATRIC SURGERY CENTER - A BARIATRIC CENTER OF EXCELLENCE THAT HAS PERFORMED MORE THAN 2,000 SURGERIES IN THE PAST FIVE YEARS. EMERGENCY CENTER - OPERATING OUT OF METHODIST HOSPITAL AND TREATING MEDICAL EMERGENCIES FOR MORE THAN 50,000 PATIENTS A YEAR. FRAUENSHUH CANCER CENTER - MORE THAN 2,000 CANCER CASES PER YEAR ARE DIAGNOSED AT PARK NICOLLET. CANCER SERVICES INCLUDE MEDICAL ONCOLOGY, RADIATION ONCOLOGY, ONCOLOGY PSYCHIATRY AND PSYCHOTHERAPY, INTEGRATIVE THERAPIES, MUSIC THERAPY AND MORE. HEART AND VASCULAR CENTER - INCLUDES A CARDIAC REHAB DEPARTMENT, CARDIOLOGY CLINIC, INTERVENTIONAL CARDIOLOGY, HEART FAILURE CLINIC, SECONDARY PREVENTION CLINIC, CARDIOVASCULAR RESEARCH PROGRAM, INTERVENTIONAL RADIOLOGY, ELECTROPHYSIOLOGY, NEURO RADIOLOGY AND A NON-INVASIVE LAB. CARDIOLOGY SEES ABOUT 12,000 PATIENTS PER YEAR. JANE BRATTAIN BREAST CENTER - SPECIALIZING IN BREAST IMAGING, ANNUAL SCREENING MAMMOGRAMS, BIOPSIES AND SURGERY. JOINT REPLACEMENT INSTITUTE - PROVIDING KNEE, HIP AND OTHER JOINT REPLACEMENTS FOR THOSE STRUGGLING WITH SEVERE PAIN. MORE THAN 1,000 JOINT REPLACEMENTS ARE PERFORMED ANNUALLY. MELROSE CENTER - HELPING PATIENTS WITH EATING DISORDERS FOR MORE THAN 25 YEARS. OUR MULTIDISCIPLINARY APPROACH INCLUDES MEDICAL, NUTRITIONAL, PSYCHOLOGICAL AND BEHAVIORAL CARE. STRUTHERS PARKINSON'S CENTER - SERVING PATIENTS WITH PARKINSONS DISEASE THROUGH COMPREHENSIVE ASSESSMENT, INTERDISCIPLINARY TREATMENT, SUPPORT, RESEARCH AND EDUCATION. TRIA ORTHOPAEDIC CENTER - INCLUDES AN ACUTE INJURY CLINIC, ORTHOPEDIC TREATMENT, ON-SITE MRI, SURGERY, PHYSICAL THERAPY AND MORE.PARK NICOLLET HEALTH SERVICES MISSION IS TO TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY. WE USE FOUR CORE VALUES TO ACCOMPLISH OUR MISSION: EXCELLENCE, COMPASSION, PARTNERSHIP AND INTEGRITY. HIGHLIGHTS OF 2013 THAT ILLUSTRATE PARK NICOLLET HEALTH SERVICE'S VALUES INCLUDE: NEW CLINIC OPENING - PARK NICOLLET CLINIC-CHAMPLIN OPENED JAN. 14. THE CLINIC OFFERS INTERNAL MEDICINE, PEDIATRICS, URGENT CARE AND EXTENDED HOURS. NEW SPECIALTY CENTER - ON AUGUST 19, MAPLE GROVE PARK NICOLLET SPECIALTY CENTER OPENED. SERVICES INCLUDE CARDIOLOGY, ONCOLOGY, OTOLARYNGOLOGY, RHEUMATOLOGY, GASTROENTEROLOGY, AND GENERAL SURGERY. TARGET CLINIC - PARK NICOLLET PARTNERED WITH TARGET CORPORATION TO OPEN THE HEALTH & WELL-BEING CENTER AT TARGET HEADQUARTERS IN DOWNTOWN MINNEAPOLIS. BURNSVILLE IMAGING AND INFUSION SERVICES - PARK NICOLLET CLINIC-BURNSVILLE ADDED NEW IMAGING SERVICES AND TECHNOLOGY, INCLUDING A LOW DOSE CT SCANNER, HIGHER TABLE WEIGHT LIMIT AND SILENT MRI MACHINE. TOP WORKPLACE - IN JANUARY, PARK NICOLLET WAS NAMED ONE OF THE "TOP 150 WORKPLACES" IN THE UNITED STATES. IN THE RANKING, COMPILED BY WORKPLACE DYNAMICS, PARK NICOLLET WAS PLACED INTO A NATIONAL POOL WITH 872 LARGE COMPANIES (1,000-PLUS EMPLOYEES). LEADER IN LGBT - THE HUMAN RIGHTS CAMPAIGN RECOGNIZED PARK NICOLLET METHODIST HOSPITAL AS A LEADER IN LGBT HEALTHCARE EQUALITY IN THE HEALTHCARE EQUALITY INDEX 2013 REPORT. WE EARNED TOP MARKS FOR OUR COMMITMENT TO EQUITABLE, INCLUSIVE CARE FOR LGBT PATIENTS AND THEIR FAMILIES. ANTICOAGULATION CENTER OF EXCELLENCE - BY SUCCESSFULLY MEETING THE RIGOROUS STANDARDS IN EACH PATIENT CARE PILLAR, PARK NICOLLET QUALIFIED FOR TWO-YEAR RECOGNITION AS AN ANTICOAGULATION CENTER OF EXCELLENCE. HEALTH CARE HOME CERTIFICATION - ALL 20 PARK NICOLLET CLINIC LOCATIONS RECEIVED HEALTH CARE HOME CERTIFICATION IN NOVEMBER.
4b (Code:   ) (Expenses $ 26,951,017 including grants of $   ) (Revenue $ 57,758,954 )
PARK NICOLLET HEALTH CARE PRODUCTS IS PART OF PARK NICOLLET HEALTH SERVICES, A NONPROFIT INTEGRATED CARE DELIVERY SYSTEM, STAFFED BY NATIONALLY RECOGNIZED HOSPITAL AND CLINIC DOCTORS, CLINICAL PROFESSIONALS, NURSES, RESEARCHERS AND OTHER STAFF AT PARK NICOLLET METHODIST HOSPITAL AND PARK NICOLLET CLINIC WHO HELP PATIENTS STAY HEALTHY AND TAKE CARE OF PATIENTS WHEN THEY ARE SICK. PARK NICOLLET HEALTH CARE PRODUCTS IS A SUPPORTING ORGANIZATION WITHIN PARK NICOLLET METHODIST HOSPITAL AND PARK NICOLLET CLINIC, PROVIDING DURABLE MEDICAL EQUIPMENT (DME)/SUPPLIES SUPPORTING ONGOING PATIENT CARE. PARK NICOLLET HEALTH CARE PRODUCTS FOCUS ON THE HEALTH, HEALING AND LEARNING OF PATIENTS BY PROVIDING EASY ACCESS TO PRODUCTS AND SERVICES THAT SUPPORT SUCCESSFUL SELF-MANAGEMENT OF A HEALTH CONDITION AT HOME. THE PRODUCTS SUPPORT BOTH SHORT TERM ACUTE CONDITIONS AND CHRONIC LIFELONG CONDITIONS, SUCH AS EYEWEAR, HEARING AIDS, AND MANY PRODUCTS THAT CROSS INTO ALMOST EVERY MEDICAL SUBSPECIALTY.PARK NICOLLET HEALTH CARE PRODUCTS, BRANDED AS THE STORES @ PARK NICOLLET, IS A GROUP OF DEPARTMENTS WITHIN PARK NICOLLET HEALTH SERVICES PROVIDING DURABLE MEDICAL EQUIPMENT (DME)/SUPPLIES SUPPORTING ONGOING PATIENT CARE. HCP PARTNERS WITH YOUR CLINICIAN TO PROVIDE PRODUCTS AND SERVICES TO HELP YOU LIVE MORE COMFORTABLY.THE HEALTH AND CARE STORES, WHICH MEET A GROWING DEMAND FOR SELF-CARE PRODUCTS AND SERVICES, LOCATED WITHIN PARK NICOLLET CLINICS, INCLUDE: HEALTH & CARE STORE OFFERING DME PRODUCTS AT 5 LOCATIONS, HEARING CENTER & STORE WITH 3 LOCATIONS, CPAP CLINIC/STORE WITH 3 LOCATIONS AND BREASTFEEDING CENTER, (1 LOCATION WITHIN THE MEADOWBROOK HEALTH & CARE STORE), ORTHOTICS & PROSTHETICS CLINIC, (2 LOCATION), THE CONTACT LENS AND OPTICAL STORE @ PARK NICOLLET HEALTH CARE PRODUCTS, WHICH MEET GROWING DEMAND FOR SELF-CARE EYEWARE AND SERVICES, ARE AT THESE PARK NICOLLET CLINIC SITES: BLOOMINGTON, BROOKDALE, BURNSVILLE, CARLSON PARKWAY (MINNETONKA), CHANHASSEN, MAPLE GROVE, MINNEAPOLIS, SHAKOPEE, AND ST. LOUIS PARK. THE PATIENT CARE EXPERIENCE DOES NOT END AT THE HOSPITAL OR CLINIC DOOR. PATIENTS HAVE MANY SELF-CARE NEEDS TO MANAGE BOTH THEIR ACUTE AND CHRONIC HEALTH CONDITIONS, AND PARK NICOLLET HEALTH CARE PRODUCTS IS EXPANDING ITS CAPACITY TO BETTER SERVE THESE GROWING NEEDS. MAJOR ACCOMPLISHMENTS FOR 2013 INCLUDE: ENHANCED PRODUCT ASSORTMENTS AVAILABLE FOR PATIENTS ESPECIALLY PATIENTS LIVING WITH CHRONIC HEALTH CONDITIONS SUCH AS DIABETES, CANCER, AND BONE AND JOINT DISEASE. NEW AND ROBUST DME POINT OF SALE, FINANCIAL REPORTING, INVENTORY, AND BILLING SYSTEM FOR BETTER PATIENT SERVICE AND EASE OF OBTAINING THEIR PRESCRIPTIONS EDUCATED PHYSICIANS AND CARE PROVIDERS ABOUT SERVICES AND PRODUCTS TO BETTER LINK SOLUTIONS FOR PATIENT HEALTH CARE NEEDS, INCLUDING ANNUAL STAFF SKILLS REVIEW FOR DME APPLICATIONS. ENHANCED OPTICAL PRODUCT ASSORTMENTS AVAILABLE FOR PATIENTS, ESPECIALLY PATIENTS LIVING WITH CHRONIC HEALTH CONDITIONS AFFECTING THEIR VISION. CONDUCTED A STUDY TO IMPROVE THE OPERATIONS AND EFFICIENCY FOR THE OPTICAL LAB LENS SERVICES TO THE OPTICAL STORES EDUCATED PHYSICIANS AND CARE PROVIDER'S ABOUT HEALTH CARE STORES PRODUCT OFFERINGS TO BETTER LINK PATIENT HEALTH CARE NEEDS TO PRODUCT SOLUTIONS, INCLUDING SMOKING CESSATION. EXPANDED POINT OF CARE OPERATION AND SPECIALTY STORES IN TRIA ORTHOPEDICS AND THE NEW PLYMOUTH CLINIC. ALONG WITH DME PRODUCTS OFFERED THROUGH THE TARGET STORE CLINICS, BRINGING MORE PRODUCTS DIRECTLY INTO THE CARE ENVIRONMENT TO ASSIST BOTH PROVIDERS AND PATIENTS.
4c (Code:   ) (Expenses $ 36,069,416 including grants of $   ) (Revenue $ 37,024,250 )
PARK NICOLLET HEALTH SERVICES AFFILIATES INCURS EXPENSES ON BEHALF OF AFFILIATED TAX EXEMPT ORGANIZATIONS, PARK NICOLLET METHODIST HOSPITAL, PARK NICOLLET CLINIC, PNMC HOLDINGS, PARK NICOLLET HEALTH CARE PRODUCTS, AND PARK NICOLLET INSTITUTE, PROVIDING RENTAL SPACE AND LAB SERVICES TO ITS AFFILIATED ORGANIZATIONS IN ORDER TO ASSURE THE EFFICIENT AND PROFESSIONAL DELIVERY OF HEALTH CARE AND OTHER SERVICES TO THE COMMUNITY AND AIDS IN THE PROVISION OF LOW COST MEDICAL SERVICE.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet1,050,068,776
Form 990 (2013)
Form 990 (2013)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IVClick to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV... Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
Yes
 
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II.................... Click to see attachment
26
Yes
 
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
482
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
0
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
No
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
21
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
17
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
MN
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletCATHERINE LENAGH6500 EXCELSIOR BLVDST LOUIS PARKMN55426 (952) 993-3108
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) THOMAS JONES MD........................................................................
DIRECTOR
 55.00
.......................1.00 		X           677,220 0 52,717
(2) JEFF MENDELOFF MD........................................................................
DIRECTOR
 55.00
.......................1.00 		X           699,828 0 59,551
(3) ERIC SCHNED MD........................................................................
DIRECTOR
 55.00
.......................1.00 		X           315,234 0 46,868
(4) ANN WYNIA........................................................................
DIRECTOR & CHAIR
 4.40
.......................   		X           0 43,750 0
(5) DONALD LEWIS........................................................................
DIRECTOR & VICE CHAIR
 4.30
.......................   		X           0 22,000 0
(6) RUTH MICKELSON........................................................................
DIRECTOR & SECRETARY
 3.80
.......................   		X           0 22,000 0
(7) JAMES MALECHA........................................................................
DIRECTOR & TREASURER
 4.00
.......................   		X           0 27,500 0
(8) THOMAS R BRINSKO........................................................................
DIRECTOR
 3.50
.......................   		X           0 23,750 0
(9) JUDITH S CORSON........................................................................
DIRECTOR
 3.80
.......................   		X           0 18,000 0
(10) LUZ MARIA FRIAS........................................................................
DIRECTOR
 2.70
.......................   		X           0 22,500 0
(11) JOHN E GHERTY........................................................................
DIRECTOR
 3.20
.......................   		X           0 22,500 0
(12) SUSAN L HOYT........................................................................
DIRECTOR
 3.30
.......................   		X           0 18,750 0
(13) TERESA M MORROW........................................................................
DIRECTOR
 2.50
.......................   		X           0 24,500 0
(14) KENDRICK B MELROSE........................................................................
DIRECTOR
 1.30
.......................   		X           0 15,000 0
(15) LAURA A OBERST........................................................................
DIRECTOR
 3.00
.......................   		X           0 18,750 0
(16) BRIAN H RANK MD........................................................................
DIRECTOR
 1.00
.......................63.00 		X           0 734,018 208,836
(17) GREGORY S STRONG........................................................................
DIRECTOR
 3.20
.......................   		X           0 18,750 0
Form 990 (2013)
Form 990 (2013)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) ELOIT A SEIDE........................................................................
DIRECTOR
 1.70
.......................   		X           0 18,750 0
(19) RICHARD E STRUTHERS........................................................................
DIRECTOR
 2.90
.......................   		X           0 15,000 0
(20) CHRISTOPHER H TASHJIAN MD FAAFP........................................................................
DIRECTOR
 2.90
.......................   		X           0 24,500 0
(21) KEN L THOME........................................................................
DIRECTOR
 3.50
.......................   		X           0 22,000 0
(22) DAVID ABELSON MD........................................................................
SR EXEC VP & CEO PN
 55.00
.......................1.00 		    X       0 1,410,881 291,935
(23) BABETTE APLAND........................................................................
VP BEHAVIORAL HEALTH AND COO MELROSE
 60.00
.......................1.00 		    X       0 421,315 117,780
(24) CURT BOEHMMD........................................................................
CMIO
 55.00
.......................1.00 		    X       0 302,528 40,884
(25) STEVEN CONNELLY MD........................................................................
CMO SYSTEM ALIGNMENT & INTEGRATION
 55.00
.......................1.00 		    X       0 724,209 131,957
(26) PAUL DAMROW MD........................................................................
CHIEF SURGICAL SERVICES
 55.00
.......................1.00 		    X       0 743,810 92,297
(27) JULIE FLASCHENRIEM........................................................................
VP AND CIO
 55.00
.......................1.00 		    X       0 402,557 102,196
(28) LAURA FRAZIER........................................................................
VP SURGICAL SERVICES
 55.00
.......................1.00 		    X       0 319,279 83,418
(29) ROXANNA GAPSTUR PHD........................................................................
SR VP & COO METHODIST HOSPITAL
 55.00
.......................1.00 		    X       0 400,605 83,586
(30) CHRISTA GETCHELL........................................................................
PRESIDENT PNF, VP COMMUNITY ADVANCEMENT
 55.00
.......................1.00 		    X       0 259,392 57,812
(31) DAVID HOMANS MD........................................................................
CHIEF SPECIALTY SSERVICES
 55.00
.......................1.00 		    X       0 611,213 104,239
(32) MICHAEL KAUPA........................................................................
EXEC VP & SYSTEM ALIGNMENT & INTEGRATION
 55.00
.......................1.00 		    X       0 864,774 137,626
(33) KATE KLUGHERZ........................................................................
VP SPECIALTY SERVICES
 55.00
.......................1.00 		    X       0 292,214 59,398
(34) GARY LARSON........................................................................
VP FINANCIAL SERVICES
 55.00
.......................1.00 		    X       0 283,951 54,637
(35) CATHERINE LENAGH........................................................................
VP & CFO
 55.00
.......................1.00 		    X       0 306,074 82,460
(36) BRETT LONG........................................................................
VP STRATEGY & GROWTH, HR
 55.00
.......................1.00 		    X       0 315,606 86,393
(37) KRISTI LYON........................................................................
VP PAYER RELATIONS
 55.00
.......................1.00 		    X       0 189,530 50,633
(38) JOHN MISA MD........................................................................
CHIEF PRIMARY CARE
 55.00
.......................1.00 		    X       0 582,935 97,820
(39) JOAN SANDSTROM........................................................................
VP PRIMARY CARE
 55.00
.......................1.00 		    X       0 392,916 87,289
(40) MELISSA SCHOENHERR........................................................................
VP MARKETING AND COMMUNICATIONS & CMO
 55.00
.......................1.00 		    X       0 273,804 56,929
(41) CYNTHIA TOHER MD........................................................................
CHIEF IMPATIENT SERVICES
 55.00
.......................1.00 		    X       0 660,715 114,108
(42) DUANE SPIEGLE........................................................................
VP REAL ESTATE AND SUPPORT SERVICES
 55.00
.......................1.00 		    X       0 317,908 82,881
(43) KATHERINE TARVESTAD........................................................................
VP AND CARE GROUP COMPLIANCE OFFICER
 55.00
.......................1.00 		    X       0 350,345 52,526
(44) THEODORE WEGLEITNER........................................................................
COO TRIA
 55.00
.......................1.00 		    X       0 380,828 98,529
(45) JOSHUA ZIMMERMAN........................................................................
CHIEF OF BEHAVORIAL HEALTH
 55.00
.......................1.00 		    X       0 360,926 71,877
(46) SHELIA MCMILLAN........................................................................
VP & CFO
 55.00
.......................   		    X       0 760,350 86,505
(47) ROBERT WERLING MD........................................................................
MEDICAL DOCTOR
 55.00
.......................   		        X   828,708 0 61,420
(48) OLIVER CASS MD........................................................................
MEDICAL DOCTOR
 55.00
.......................   		        X   813,295 0 62,290
(49) MARNI FELDMANN MD........................................................................
MEDICAL DOCTOR
 55.00
.......................   		        X   807,773 0 61,116
(50) DANE CHRISTENSEN MD........................................................................
MEDICAL DOCTOR
 55.00
.......................   		        X   824,126 0 62,447
(51) TIMOTHY DIEGEL MD........................................................................
MEDICAL DOCTOR
 55.00
.......................   		        X   782,994 0 44,151
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 5,749,178 13,040,683 2,985,111
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet1,214
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
RJM CONSTRUCTION5455 HWY 169PLYMOUTHMN55442 CONSTRUCTION SERVICES 10,639,575
UNIVERSITY OF MN PHYSICIANS720 WASHINGTON AVENUE SEMINNEAPOLISMN55407 MEDICAL SERVICES 9,235,859
KNUTSON CONSTRUCTION SERVICES7515 WAYZATA BLVDMINNEAPOLISMN55426 CONSTRUCTION SERVICES 4,369,072
RBM SERVICESSUITE 120 1107 HAZELTINE BLVDCHASKAMN55318 JANITORIAL SERVICES 3,156,719
DELL FINANCIAL SERVICES12519 COLLEXTIONS CENTER DRIVECHICIAGOIL60693 COMPUTER SERVICES 2,802,742
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet132
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 1,959,664
e Government grants (contributions)1e 3,987,619
f All other contributions, gifts, grants, and
similar amounts not included above1f 		7,545,543
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 13,492,826
Program Service RevenueAmt Business Code
2a MEDICAL SERVICES 621400 765,003,166 765,003,166    
b MEDICARE/MEDICAID 621400 356,197,980 356,197,980    
c RETAIL SALES 446110 62,500,142 57,758,954 4,733,020 8,168
d SERVICES TO AFFILIATES 561000 37,024,251 37,024,251    
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 1,220,725,539
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 6,857,460     6,857,460
4 Income from investment of tax-exempt bond proceeds..MediumBullet 285,798     285,798
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 1,963,506  
b Less: rental expenses 1,340,221  
c Rental income or (loss) 623,285  
d Net rental income or (loss).......MediumBullet 623,285     623,285
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 366,082,774 867,792
b Less: cost or other basis and sales expenses 348,582,543 112,774
c Gain or (loss) 17,500,231 755,018
d Net gain or (loss)..........MediumBullet 18,255,249     18,255,249
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a 1,242,356
b Less: cost of goods sold ..b 395,022
c Net income or (loss) from sales of inventory..MediumBullet 847,334     847,334
Miscellaneous Revenue Business Code
11a PROPERTY MANAGEMENT 812930 2,682,021     2,682,021
b CAFETERIA 722210 2,554,171     2,554,171
c MISC SERVICES 722210 155,707     155,707
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 5,391,899
12 Total revenue. See Instructions......MediumBullet 1,266,479,390 1,215,984,351 4,733,020 32,269,193
Form 990 (2013)
Form 990 (2013)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 392,828 392,828
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 30,000 30,000
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 1,692,282 1,569,576 122,706  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 623,285,886 546,669,297 76,361,086 255,503
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 34,593,666 29,857,803 4,721,880 13,983
9 Other employee benefits ....... 65,621,805 54,103,762 11,496,166 21,877
10 Payroll taxes ........... 37,493,212 32,021,895 5,455,947 15,370
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 589,378   589,378  
c Accounting ........... 382,049   382,049  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 499,098   499,098  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 51,006,916 33,456,244 17,550,672  
12 Advertising and promotion .... 3,967,820 144,153 3,823,667  
13 Office expenses ....... 16,279,902 9,946,055 6,333,847  
14 Information technology ...... 27,773,168 13,638,105 14,135,063  
15 Royalties ..        
16 Occupancy ........... 41,331,552 37,963,775 3,367,777  
17 Travel ............ 1,328,924 1,011,958 316,966  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 534,835 479,824 55,011  
20 Interest ........... 10,040,344 10,040,344    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 46,710,202 41,514,032 5,196,170  
23 Insurance .............. 2,792,016 2,695,287 96,729  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES AND EQ 151,149,401 147,457,641 3,691,760  
b COST OF GOOD SOLD 40,380,398 40,380,398    
c BAD DEBT EXPENSE 25,090,744 25,090,744    
d MANAGEMENT FEES 13,720,658   13,720,658  
e All other expenses 23,315,732 21,605,055 1,710,677  
25 Total functional expenses. Add lines 1 through 24e 1,220,002,816 1,050,068,776 169,627,307 306,733
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 374,262 1 8,597,067
2 Savings and temporary cash investments ......... 344,066 2 403,712
3 Pledges and grants receivable, net ........... 3,812,152 3 4,388,795
4 Accounts receivable, net ............. 127,500,666 4 134,983,015
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6 69,279
7 Notes and loans receivable, net .............   7 0
8 Inventories for sale or use .............. 10,143,838 8 10,696,185
9 Prepaid expenses and deferred charges .......... 11,094,375 9 17,813,781
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,018,970,627
b Less: accumulated depreciation ..... 10b 685,776,998 327,023,205 10c 333,193,629
11 Investments—publicly traded securities .......... 404,678,771 11 501,577,381
12 Investments—other securities. See Part IV, line 11 ..... 770,643 12 493,396
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 57,320,760 15 2,638,776
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 943,062,738 16 1,014,855,016
Liabilities 17 Accounts payable and accrued expenses ......... 60,549,128 17 70,382,843
18 Grants payable .................   18  
19 Deferred revenue ................ 6,939,535 19 4,727,727
20 Tax-exempt bond liabilities ............. 370,849,064 20 361,578,782
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 1,228,803 23 327,899
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 3,164,318 25 5,720,513
26 Total liabilities. Add lines 17 through 25......... 442,730,848 26 442,737,764
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 499,512,581 27 571,120,208
28 Temporarily restricted net assets ........... 541,533 28 717,797
29 Permanently restricted net assets ........... 277,776 29 279,247
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 500,331,890 33 572,117,252
34 Total liabilities and net assets/fund balances ........ 943,062,738 34 1,014,855,016
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
1,266,479,390
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
1,220,002,816
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
46,476,574
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
500,331,890
5
Net unrealized gains (losses) on investments ...............
5
26,119,391
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-810,603
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
572,117,252
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
PARK NICOLLET GROUP RETURN
 
Employer identification number

45-5023260
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
PARK NICOLLET GROUP RETURN
 
Employer identification number

45-5023260
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
PARK NICOLLET GROUP RETURN
  		Employer identification number

45-5023260
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

   
RESTRICTED
RESTRICTED
RESTRICTED, RESTRICTEDRESTRICTED

$RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
PARK NICOLLET GROUP RETURN
  		Employer identification number

45-5023260
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
PARK NICOLLET GROUP RETURN
  		Employer identification number

45-5023260
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
PARK NICOLLET GROUP RETURN
 
Employer identification number

45-5023260
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2013

Schedule C (Form 990 or 990-EZ) 2013
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2013


Schedule C (Form 990 or 990-EZ) 2013
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
56,397
j
Total. Add lines 1c through 1i ...............................
56,397
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
PART II-B, LINE 1: PARK NICOLLET REIMBURSES CERTAIN PROFESSIONAL MEMBERSHIP DUES OF EMPLOYEES,. A PORTION OF SUCH MEMBERSHIP DUES ARE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES.
Schedule C (Form 990 or 990EZ) 2013

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PARK NICOLLET GROUP RETURN
 
Employer identification number

45-5023260
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 21,981,337 20,854,970 22,048,592 23,127,080 40,045,623
b Contributions ........ 4,508,387 2,046,767 1,489,934 1,474,161 3,239,794
c Net investment earnings, gains, and losses 2,715,649 877,865 -341,465 850,097 538,558
d Grants or scholarships ..... 1,988,774 1,798,265 2,342,091 3,402,746 20,696,895
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ...... 27,216,599 21,981,337 20,854,970 22,048,592 23,127,080
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet44.800 %
c
Temporarily restricted endowment SchDMd Bullet55.200 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   27,661,044 27,661,044
b Buildings ................   479,880,686 280,954,033 198,926,653
c Leasehold improvements ............   50,981,860 34,978,620 16,003,240
d Equipment ................   449,008,970 364,533,745 84,475,225
e Other .................   11,438,067 5,310,600 6,127,467
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 333,193,629
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
CAPITAL LEASE OBILGATION 3,079,926
DUE TO RELATED PARTIES 2,640,587







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 5,720,513
2. Liability for uncertain tax positions In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART V, LINE 4: THE TERM ENDOWMENT FUNDS FOR USE WITHIN PARK NICOLLET CLINIC, PARK NICOLLET INSTITUTE AND PARK NICOLLET METHODITS HOSPITAL ARE FOR GRANTS RELATED TO EDUCATION, RESEARCH AND PATIENT CARE.
PART X, LINE 2 PARK NICOLLET HEALTH SERVICES AND AFFILIATES RECORDED NO LIABILITIES AT DECEMBER 31, 2013 OR JANUARY 1, 2013 FOR UNRECOGNIZED TAX BENEFITS.
Schedule D (Form 990) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.Right pointing arrow large image Information about Schedule F (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PARK NICOLLET GROUP RETURN
 
Employer identification number

45-5023260
Part I
General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.
1
For grantmakers.Does the organization maintain records to substantiate the amount of its grants and
other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? ...............................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total expenditures
for and investments
in region
EAST ASIA AND THE PACIFIC 0 0 PROGRAM SERVICES EDUCATION 22,197
EUROPE 0 0 PROGRAM SERVICES EDUCATION 4,047
NORTH AMERICA 0 0 PROGRAM SERVICES EDUCATION 1,220
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 27,464
b Total from continuation sheets to Part I ... 0 0 0
c Totals (add lines 3a and 3b) 0 0 27,464
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2013
Schedule F (Form 990) 2013
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ....MediumBullet
 
3
Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2013
Schedule F (Form 990) 2013Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2013
Schedule F (Form 990) 2013
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................
2 Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A).......................................
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)...............................................
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713)................................................
Schedule F (Form 990) 2013
Schedule F (Form 990) 2013
Page 5
Part V
Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
ReturnReference Explanation
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule F (Form 990) 2013
Additional Data


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Software Version:  



SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PARK NICOLLET GROUP RETURN
 
Employer identification number

45-5023260
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

 

No
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    9,093,851 65,994 9,027,857 0.740 %
b Medicaid (from Worksheet 3,
column a) .... 		    114,934,323 69,976,503 44,957,820 3.690 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    124,028,174 70,042,497 53,985,677 4.430 %
Other Benefits
   37,672 4,832,252 736,704 4,095,548 0.340 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    6,218,989 2,231,692 3,987,297 0.330 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)     6,552,134 4,369,049 2,183,085 0.180 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		           
j Total. Other Benefits ..   37,672 17,603,375 7,337,445 10,265,930 0.850 %
k Total. Add lines 7d and 7j .   37,672 141,631,549 77,379,942 64,251,607 5.280 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
15,503,177
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
136,317,106
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
133,934,191
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
2,382,915
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 PARK NICOLLET METHODIST HOSPITAL
6500 EXCELSIOR BLVD
ST LOUIS PARK,MN55426
PARKNICOLLET.COM 		X X   X     X      
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
PARK NICOLLET METHODIST HOSPITAL
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 275.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 385.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.......... 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ......................... 22 Yes  
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
PARK NICOLLET METHODIST HOSPITAL PART V, SECTION B, LINE 3: OVER 1,100 COMMUNITY MEMBERS REPRESENTING AREA GOVERNMENT, SCHOOLS, CHURCHES, SOCIAL SERVICE AGENCIES, AND HEALTHCARE PROVIDERS WERE IDENTIFIED TO PARTICIPATE IN AN ONLINE SURVEY AND FOCUS GROUP. AN ONLINE SURVEY WAS CONDUCTED USING SURVEY MONKEY. THE SURVEY TOOL WAS DESIGNED TO GAIN INFORMATION FROM THE RESPONDENTS ABOUT THERE GEOGRAPHIC LOCATION ALONG WITH CONNECTIONS IN THE COMMUNITY. IN ADDITION TO THE ONLINE SURVEY THESE COMMUNITY PARTICIPANTS WERE ALSO OFFERED THE OPPORTUNITY TO ATTEND ONE OF SEVEN CONNUNITY-BASED FOCUS GROUPS USING THE WORLD CAFE MODEL OF FACILITATION. THESE WERE OFFERED IN SEVEN DIFFERENT LOCATIONS AND PROVIDED THE OPPORTUNITY FOR PARTICIPATNS TO ENGAGE IN DIALOGUE THAT WOULD OFFER MORE IN-DEPTH ABOUT THEIR COMMUNITIES AND THE IDENTIFIED NEEDS. TEAM MEMBERS FROM PARK NICOLLET HEALTH SERVICES WERE PRESENT TO TAKE NOTES AND SUMMARIZE REPSONSES. THE COMMUNITY HEALTH NEEDS ASSESSMENT LEADERSHIP TEAM REVIEWED THE INPUT FROM BOTH THE SURVEYS AND THE FOCUS GROUPS AND IDENTIFIED SEVEN KEY THEMES THAT CONSISTENTLY EMERGED. AN ADDITIONAL THREE AREAS OF NEED WERE IDENTIFIED; ALTHOUGH NOT CONSISTENTLY REPORTED, THEY WERE FELT TO BE IMPORTANT FOR INCLUSION IN THIS REPORT.TO BROADEN THE INFORMATION RECEIVED, MEETINGS WERE HELD WITH SMALL GROUPS OFPROFESSIONALS FOR INSIGHT GATHERING AND TARGETED TO SPECIFIC AREAS IDENTIFIED BY OURCOMMUNITY PARTICIPANTS. ADDITIONAL MEETINGS WITH SOMALI COMMUNITY HEALTH WORKERSTHROUGH WELLSHARE AND RETIRED PHYSICIANS FROM METHODIST HOSPITAL WERE ALSO HELD.FOCUS GROUP PARTICIPANTS INCLUDED COMMUNITY MEMBERS FROM THE FOLLWOING ORGANIZATIONS: CHILDREN FIRST, IOCP, PNF SUCCESSFUL AGING INITATIVE, CRISIS CONNECTION, PILLSBUY HOUSE, MISSION, INC. MINNEAPOLIS CRISIS NURSERY, SHALOM HOSPICE, TEENS ALONE, WELLSHARE, PATHWAYS, SAINTS HEALTHCARE FOUNDATION, SHAKOPEE SCHOOL DISTRICT, CITY OF SHAKOPEE, PRIOR LAKE/SAVAGE SCHOOL DISSTRICT, PNHS STROKE INSPIRE, ST. MARY'S HELATH CLINICS, CITY OF ST. LOUIS PARK, DEPOT COFFEE HOUSE, STEP, YOUTH CARE, CHILDREN'S DENTAL SERVICE, BLOOMINGTON SCHOOL DISTRICT, ALZHEIMER'S ASSOCIATION, LENOX CENTER, COMMUNITY IN COLLABORATION COUNCIL, GREATER WAYZATA AREA OF COMMERCE, COMMUNITY EDUCATION ADVISORY COUNCIL, WAYZATA SCHOOL DISTRICT,ST. DAVID'S CENTER FOR CHILD AND FAMILY DEVELOPMENT, ST. LOUIS PARK SCHOOL DISTRICT, CITY OF CHANHASSEN, RELATE COUNSELING CENTER, HOPIKINS SCHOOL DISTRICT, ICA, STORE TO DOOR, CITY OF GOLDEN VALLEY, GREATER MINNEAPOLIS COUNCIL OF CHURCHES.
PARK NICOLLET METHODIST HOSPITAL PART V, SECTION B, LINE 5D: PARK NICOLLET HEALTH SERVICES BOARD OF DIRECTOR'S APPROVED THE IMPLEMENTATION STRATEGY FOR PARK NICOLLET METHODIST HOSPITAL DURING 2012. A COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY IS POSTED TO THE PARK NICOLLET WEBSITE AT HTTP://WWW.PARKNICOLLET.COM/COMMUNITYANDVOLUNTEERISM/COMMUNITY%20NEEDS%20HEALTH%20ASSESSMENT
PARK NICOLLET METHODIST HOSPITAL PART V, SECTION B, LINE 20D: PARK NICOLLET USES THE DISCOUNT RATE ASSOCIATED WITH OUR "MOST PREFERRED PAYER: WHICH IS DIFINED AS OUR LARGEST COMMERICAL PAYER.
PARK NICOLLET METHODIST HOSPITAL PART V, SECTION B, LINE 22: PARK NICOLLET CHARGES ITS PATIENTS GROSS CHARGES IF THE PATIENT HAS ELECTIVE SURGURY, WHICH IS NOT MEDICALLY NECESSARY.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?30
Name and address Type of Facility (describe)
1 STRUTHER'S PARKINSON CENTER
6701 COUNTRY S PARKINSON CENTER
GOLDEN VALLEY,MN55427 		RESEARCH AND TREATMENT OF PARKINSON'S DISEASE
2 PARK NICOLLET MELROSE INSTITUTE
3625 MONTEREY DRIVE
ST LOUIS PARK,MN55416 		EATING DISORDER CLINIC/GENERAL MEDICAL
3 3900 CLINICAMBULATORY SURGICAL CENTER
3900 PARK NICOLLET BOULEVARD
ST LOUIS PARK,MN55416 		AMBULATORY SURGICAL CENTER AND GENERAL MEDICAL AND RETAIL
4 MEADOWBROOK MEDICAL BUILDING
3931 LOUISIANA AVE S
ST LOUIS PARK,MN55426 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
5 PRAIRIE CENTER
8455 FLYING CLOUD DRIVE
EDEN PRAIRIE,MN55344 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
6 BLOOMINGTON CLINIC
5320 HYLAND GREENS DRIVE
BLOOMINGTON,MN55437 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
7 BROOKDALE CLINIC
6000 EARLE BROWN DRIVE
BROOKLYN CENTER,MN55430 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
8 BURNSVILLE CLINIC
1400 FAIRVIEW DRIVE
BURNSVILLE,MN55337 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
9 CARLSON PARKWAY CLINIC
15111 TWELVE OAKS CENTER DRIVE
MINNETONKA,MN55305 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
10 CHANHASSEN CLINIC
300 LAKE DRIVE E
CHANHASSEN,MN55317 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
11 CREEKSIDE
6600 EXCELSIOR BLVD
ST LOUIS PARK,MN55426 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
12 CT-MRI CENTER
4951 EXCELSIOR BLVD
ST LOUIS PARK,MN55416 		IMAGING CENTER/OPTICAL RETAIL
13 EAGAN CLINIC
1885 PLAZA DRIVE
EAGAN,MN55122 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
14 GOLDEN VALLEY CLINIC
8240 GOLDEN VALLEY DRIVE
GOLDEN VALLEY,MN55427 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
15 LAKEVILLE CLNIC
18432 KENRICK AVE
LAKEVILLE,MN55044 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
16 MAPLE GROVE CLNIC
15800 95TH AVE N
MAPLE GROVE,MN55369 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
17 MAPLE GROVE OB
9855 HOSPITAL DRIVE SUITE 275
MAPLE GROVE,MN55369 		OB SERVICES
18 MAPLE GROVE REHAB
9827 MAPLE GROVE PKWY N
MAPLE GROVE,MN55369 		REHABILIATION SERVICES
19 MINNEAPOLIS CLINIC
2001 BLAISDELL AVE S
MINNEAPOLIS,MN55404 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
20 MINNETONKA - SHOREWOOD CLINIC
19685 HIGHWAY 7
SHOREWOOD,MN55331 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
21 PLYMOUTH CLINIC
3007 HARBOR LANE N
PLYMOUTH,MN55447 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
22 PRIOR LAKE CLINIC
4670 PARK NICOLLET AVE SE
PRIOR LAKE,MN55372 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
23 SHAKOPEE CLINIC
1415 ST FRANCIS AVE
SHAKOPEE,MN55379 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
24 SHAKOPEE CLINIC
1515 ST FRANCIS AVE
SHAKOPEE,MN55379 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
25 SHAKOPEE CLINIC
1601 ST FRANCIS AVE
SHAKOPEE,MN55379 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
26 ST LOUIS PARK CLINIC
3800 PARK NICOLLET BLVD
ST LOUIS PARK,MN55416 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
27 ST LOUIS PARK CLINIC
3850 PARK NICOLLET BLVD
ST LOUIS PARK,MN55416 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
28 WAYZATA MEDICAL BUILDING
250 CENTRAL AVE N
WAYZATA,MN55391 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES AND MEDICAL RETAIL
29 ROGERS CLINIC
13688 ROGERS DRIVE
ROGERS,MN55374 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES
30 CHAMPLIN CLINIC
12142 BUSINESS PARK BLVD N
CHAMPLIN,MN55316 		PHYSICAN OFFICES, ANCILLARY MEDICAL SERVICES
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PARK NICOLLET METHODIST HOSPITAL PART V, SECTION B, LINE 3: OVER 1,100 COMMUNITY MEMBERS REPRESENTING AREA GOVERNMENT, SCHOOLS, CHURCHES, SOCIAL SERVICE AGENCIES, AND HEALTHCARE PROVIDERS WERE IDENTIFIED TO PARTICIPATE IN AN ONLINE SURVEY AND FOCUS GROUP. AN ONLINE SURVEY WAS CONDUCTED USING SURVEY MONKEY. THE SURVEY TOOL WAS DESIGNED TO GAIN INFORMATION FROM THE RESPONDENTS ABOUT THERE GEOGRAPHIC LOCATION ALONG WITH CONNECTIONS IN THE COMMUNITY. IN ADDITION TO THE ONLINE SURVEY THESE COMMUNITY PARTICIPANTS WERE ALSO OFFERED THE OPPORTUNITY TO ATTEND ONE OF SEVEN CONNUNITY-BASED FOCUS GROUPS USING THE WORLD CAFE MODEL OF FACILITATION. THESE WERE OFFERED IN SEVEN DIFFERENT LOCATIONS AND PROVIDED THE OPPORTUNITY FOR PARTICIPATNS TO ENGAGE IN DIALOGUE THAT WOULD OFFER MORE IN-DEPTH ABOUT THEIR COMMUNITIES AND THE IDENTIFIED NEEDS. TEAM MEMBERS FROM PARK NICOLLET HEALTH SERVICES WERE PRESENT TO TAKE NOTES AND SUMMARIZE REPSONSES. THE COMMUNITY HEALTH NEEDS ASSESSMENT LEADERSHIP TEAM REVIEWED THE INPUT FROM BOTH THE SURVEYS AND THE FOCUS GROUPS AND IDENTIFIED SEVEN KEY THEMES THAT CONSISTENTLY EMERGED. AN ADDITIONAL THREE AREAS OF NEED WERE IDENTIFIED; ALTHOUGH NOT CONSISTENTLY REPORTED, THEY WERE FELT TO BE IMPORTANT FOR INCLUSION IN THIS REPORT.TO BROADEN THE INFORMATION RECEIVED, MEETINGS WERE HELD WITH SMALL GROUPS OFPROFESSIONALS FOR INSIGHT GATHERING AND TARGETED TO SPECIFIC AREAS IDENTIFIED BY OURCOMMUNITY PARTICIPANTS. ADDITIONAL MEETINGS WITH SOMALI COMMUNITY HEALTH WORKERSTHROUGH WELLSHARE AND RETIRED PHYSICIANS FROM METHODIST HOSPITAL WERE ALSO HELD.FOCUS GROUP PARTICIPANTS INCLUDED COMMUNITY MEMBERS FROM THE FOLLWOING ORGANIZATIONS: CHILDREN FIRST, IOCP, PNF SUCCESSFUL AGING INITATIVE, CRISIS CONNECTION, PILLSBUY HOUSE, MISSION, INC. MINNEAPOLIS CRISIS NURSERY, SHALOM HOSPICE, TEENS ALONE, WELLSHARE, PATHWAYS, SAINTS HEALTHCARE FOUNDATION, SHAKOPEE SCHOOL DISTRICT, CITY OF SHAKOPEE, PRIOR LAKE/SAVAGE SCHOOL DISSTRICT, PNHS STROKE INSPIRE, ST. MARY'S HELATH CLINICS, CITY OF ST. LOUIS PARK, DEPOT COFFEE HOUSE, STEP, YOUTH CARE, CHILDREN'S DENTAL SERVICE, BLOOMINGTON SCHOOL DISTRICT, ALZHEIMER'S ASSOCIATION, LENOX CENTER, COMMUNITY IN COLLABORATION COUNCIL, GREATER WAYZATA AREA OF COMMERCE, COMMUNITY EDUCATION ADVISORY COUNCIL, WAYZATA SCHOOL DISTRICT,ST. DAVID'S CENTER FOR CHILD AND FAMILY DEVELOPMENT, ST. LOUIS PARK SCHOOL DISTRICT, CITY OF CHANHASSEN, RELATE COUNSELING CENTER, HOPIKINS SCHOOL DISTRICT, ICA, STORE TO DOOR, CITY OF GOLDEN VALLEY, GREATER MINNEAPOLIS COUNCIL OF CHURCHES.
PARK NICOLLET METHODIST HOSPITAL PART V, SECTION B, LINE 5D: PARK NICOLLET HEALTH SERVICES BOARD OF DIRECTOR'S APPROVED THE IMPLEMENTATION STRATEGY FOR PARK NICOLLET METHODIST HOSPITAL DURING 2012. A COPY OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY IS POSTED TO THE PARK NICOLLET WEBSITE AT HTTP://WWW.PARKNICOLLET.COM/COMMUNITYANDVOLUNTEERISM/COMMUNITY%20NEEDS%20HEALTH%20ASSESSMENT
PARK NICOLLET METHODIST HOSPITAL PART V, SECTION B, LINE 20D: PARK NICOLLET USES THE DISCOUNT RATE ASSOCIATED WITH OUR "MOST PREFERRED PAYER: WHICH IS DIFINED AS OUR LARGEST COMMERICAL PAYER.
PARK NICOLLET METHODIST HOSPITAL PART V, SECTION B, LINE 22: PARK NICOLLET CHARGES ITS PATIENTS GROSS CHARGES IF THE PATIENT HAS ELECTIVE SURGURY, WHICH IS NOT MEDICALLY NECESSARY.
Schedule H (Form 990) 2013
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
PARK NICOLLET GROUP RETURN
 
Employer identification number
45-5023260
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) PARK NICOLLET FOUNDATION
6500 EXCELSIOR BLVD
ST LOUIS PARK,MN55426 		23-7346465 501(C)(3) 212,731       GRANT MONEY TO OTHER ORGANIZATIONS
(2) MINNESOTA MEDICAL FOUNDATION
200 OAK STREET SE SUITE 300
MINNEAPOLIS,MN55455 		41-6027707 501(C)(3) 150,000       NEUROSURGERY FUND
(3) UNIVERSITY OF MN FOUNDATION
200 OAK STREET SE SUITE 500
MINNEAPOLIS,MN55455 		41-6042488 501(C)(3) 11,668       SCHOOL OF NURSING


















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2013

Schedule I (Form 990) 2013
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) SCHOLARSHIPS 21 30,000      












Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
PART I, LINE 2: THE PARK NICOLLET SERVICE LEAGUE HAS A STUDENT VOLUNTEER SCHOLARSHIP PROGRAM TO GIVE FINANCIAL SUPPORT TO STUDENT VOLUNTEERS WHO HAVE PROVIDED EXCEPTIONAL VOLUNTEER SERVICE AND ARE INTERESTED IN FURTHERING THEIR EDUCATIONS. APPLICANTS MUST BE AN ACTIVE STUDENT VOLUNTEER, A SENIOR IN HIGH SCHOOL AND WHO HAS APPLIED TO A POST-HIGH SCHOOL EDUCATION PROGRAM AND MUST BE DEDICATED VOLUNTEER AT PARK NICOLLET METHODIST HOSPITAL. OCCASIONALLY PARK NICOLLET METHODIST HOSPITAL GRANTS MONIES TO OTHER TAX-EXEMPT ORGANIZATIONS CONDUCTION PROGRAMS AND/OR RESEARCH THAT WILL ULTIMATELY BENEFIT THOSE SERVICED BY PARK NICOLLET HEALTH SERVICES AND AFFILIATES, DURING CALENDAR YEAR 2013 GRANTS WERE MADE TO PARK NICOLLET FOUNDATION FOR IMPROVEMENT TO MEDICAL SERVICES, MEDICAL RESEARCH AND HEALTHY PATIENTS.
Schedule I (Form 990) 2013


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PARK NICOLLET GROUP RETURN
 
Employer identification number

45-5023260
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)THOMAS JONES MDDIRECTOR (i)
(ii)		 588,321
0 		20,367
0 		68,532
0 		0
0 		52,717
0 		729,937
0 		0
0
(2)JEFF MENDELOFF MDDIRECTOR (i)
(ii)		 625,741
0 		18,870
0 		55,217
0 		0
0 		59,551
0 		759,379
0 		0
0
(3)ERIC SCHNED MDDIRECTOR (i)
(ii)		 252,453
0 		7,391
0 		55,390
0 		0
0 		46,868
0 		362,102
0 		0
0
(4)BRIAN H RANK MDDIRECTOR (i)
(ii)		 0
538,408 		0
144,639 		0
50,971 		0
167,347 		0
41,489 		0
942,854 		0
27,358
(5)DAVID ABELSON MDSR EXEC VP & CEO PN (i)
(ii)		 0
889,915 		0
367,419 		0
153,547 		0
230,400 		0
61,535 		0
1,702,816 		0
0
(6)BABETTE APLANDVP BEHAVIORAL HEALTH AND COO MELROSE (i)
(ii)		 0
296,526 		0
82,373 		0
42,416 		0
80,472 		0
37,308 		0
539,095 		0
269,491
(7)CURT BOEHMMDCMIO (i)
(ii)		 0
229,248 		0
70,624 		0
2,656 		0
0 		0
40,884 		0
343,412 		0
0
(8)STEVEN CONNELLY MDCMO SYSTEM ALIGNMENT & INTEGRATION (i)
(ii)		 0
494,416 		0
165,631 		0
64,162 		0
59,760 		0
72,197 		0
856,166 		0
0
(9)PAUL DAMROW MDCHIEF SURGICAL SERVICES (i)
(ii)		 0
602,745 		0
100,689 		0
40,376 		0
29,318 		0
62,979 		0
836,107 		0
27,670
(10)JULIE FLASCHENRIEMVP AND CIO (i)
(ii)		 0
280,423 		0
79,086 		0
43,048 		0
34,620 		0
67,576 		0
504,753 		0
29,209
(11)LAURA FRAZIERVP SURGICAL SERVICES (i)
(ii)		 0
226,033 		0
68,544 		0
24,702 		0
27,720 		0
55,698 		0
402,697 		0
18,275
(12)ROXANNA GAPSTUR PHDSR VP & COO METHODIST HOSPITAL (i)
(ii)		 0
285,729 		0
80,685 		0
34,191 		0
36,780 		0
46,806 		0
484,191 		0
25,322
(13)CHRISTA GETCHELLPRESIDENT PNF, VP COMMUNITY ADVANCEM (i)
(ii)		 0
189,577 		0
61,036 		0
8,779 		0
17,280 		0
40,532 		0
317,204 		0
0
(14)DAVID HOMANS MDCHIEF SPECIALTY SSERVICES (i)
(ii)		 0
539,526 		0
11,298 		0
60,389 		0
49,613 		0
54,626 		0
715,452 		0
0
(15)MICHAEL KAUPAEXEC VP & SYSTEM ALIGNMENT & INTEGRA (i)
(ii)		 0
527,715 		0
260,755 		0
76,304 		0
63,600 		0
74,026 		0
1,002,400 		0
61,278
(16)KATE KLUGHERZVP SPECIALTY SERVICES (i)
(ii)		 0
217,591 		0
65,986 		0
8,637 		0
19,350 		0
40,048 		0
351,612 		0
0
(17)GARY LARSONVP FINANCIAL SERVICES (i)
(ii)		 0
182,622 		0
60,116 		0
41,213 		0
10,378 		0
44,259 		0
338,588 		0
31,668
(18)CATHERINE LENAGHVP & CFO (i)
(ii)		 0
214,802 		0
63,926 		0
27,346 		0
25,545 		0
56,915 		0
388,534 		0
17,015
(19)BRETT LONGVP STRATEGY & GROWTH, HR (i)
(ii)		 0
224,775 		0
63,151 		0
27,680 		0
27,600 		0
58,793 		0
401,999 		0
18,056
(20)KRISTI LYONVP PAYER RELATIONS (i)
(ii)		 0
150,206 		0
31,322 		0
8,002 		0
10,140 		0
40,493 		0
240,163 		0
0
(21)JOHN MISA MDCHIEF PRIMARY CARE (i)
(ii)		 0
357,338 		0
109,413 		0
116,184 		0
43,200 		0
54,620 		0
680,755 		0
97,812
(22)JOAN SANDSTROMVP PRIMARY CARE (i)
(ii)		 0
264,094 		0
80,518 		0
48,304 		0
32,160 		0
55,129 		0
480,205 		0
35,266
(23)MELISSA SCHOENHERRVP MARKETING AND COMMUNICATIONS & CM (i)
(ii)		 0
207,826 		0
58,300 		0
7,678 		0
19,350 		0
37,579 		0
330,733 		0
0
(24)CYNTHIA TOHER MDCHIEF IMPATIENT SERVICES (i)
(ii)		 0
504,101 		0
140,075 		0
16,539 		0
48,571 		0
65,537 		0
774,823 		0
0
(25)DUANE SPIEGLEVP REAL ESTATE AND SUPPORT SERVICES (i)
(ii)		 0
204,974 		0
74,851 		0
38,083 		0
18,900 		0
63,981 		0
400,789 		0
26,810
(26)KATHERINE TARVESTADVP AND CARE GROUP COMPLIANCE OFFICER (i)
(ii)		 0
253,901 		0
86,637 		0
9,807 		0
30,900 		0
21,626 		0
402,871 		0
0
(27)THEODORE WEGLEITNERCOO TRIA (i)
(ii)		 0
258,188 		0
75,321 		0
47,319 		0
31,560 		0
66,969 		0
479,357 		0
34,820
(28)JOSHUA ZIMMERMANCHIEF OF BEHAVORIAL HEALTH (i)
(ii)		 0
314,986 		0
34,616 		0
11,324 		0
26,460 		0
45,417 		0
432,803 		0
0
(29)SHELIA MCMILLANVP & CFO (i)
(ii)		 0
314,858 		0
160,679 		0
284,813 		0
21,900 		0
64,605 		0
846,855 		0
174,864
(30)ROBERT WERLING MDMEDICAL DOCTOR (i)
(ii)		 799,487
0 		26,070
0 		3,151
0 		0
0 		61,420
0 		890,128
0 		0
0
(31)OLIVER CASS MDMEDICAL DOCTOR (i)
(ii)		 784,709
0 		23,334
0 		5,252
0 		0
0 		62,290
0 		875,585
0 		0
0
(32)MARNI FELDMANN MDMEDICAL DOCTOR (i)
(ii)		 782,969
0 		23,448
0 		1,356
0 		0
0 		61,116
0 		868,889
0 		0
0
(33)DANE CHRISTENSEN MDMEDICAL DOCTOR (i)
(ii)		 802,739
0 		20,057
0 		1,330
0 		0
0 		62,447
0 		886,573
0 		0
0
(34)TIMOTHY DIEGEL MDMEDICAL DOCTOR (i)
(ii)		 529,089
0 		17,902
0 		236,003
0 		0
0 		44,151
0 		827,145
0 		0
0
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
PART I, LINES 4A-B THE AMOUNT OF SEVERANCE COMPENSATION AND BENEFITS PROVIDED TO EACH OF THE INDIVIDUALS ON SEVERANCE DURING 2013 IS AS FOLLOWS: SHEILA MCMILLAN $101,077 SCHEDULE J, PART I, LINE 4B: SENIOR LEADERS OF PARK NICOLLET HEALTH SERVICES AND AFFILIATES ARE GIVEN THE OPPORTUNITY TO PARTICIPATE IN THE CAPITAL ACCUMULATION ACCOUNT PLAN. THE CAPITAL ACCUMULATION ACCOUNT PLAN (CAA PLAN) PARTICIPATION IS LIMITED TO SENIOR LEADERS AND ALL THE VICE PRESIDENTS. EACH PARTICIPANT RECEIVES AN ANNUAL ALLOWANCE EQUAL TO THE SUM OF (I) A STATED PERCENT OF SALARY, (II) VOLUNTARY SALARY DEFERRALS. THE ALLOWANCE IS CREDITED TO A BOOKKEEPING ACCOUNT. EARNINGS ARE CREDITED TO THE ACCOUNT BASED ON THE PERFORMANCE OF SIMULATED INVESTMENTS. BENEFITS VEST UPON THE EARLIEST OF REMAINING EMPLOYED TO AN ELECTIVE VESTING DATE (TWO YEARS TO AGE 68), INVOLUNTARY TERMINATION WITHOUT CAUSE, DISABILITY, DEATH, OR NOT COMPETING FOR 24 MONTHS FOLLOWING VOLUNTARY OR FOR-CAUSE TERMINATION. BENEFITS ARE PAID IN A SINGLE LUMP SUM UPON VESTING. PARTICIPANTS ARE GENERAL CREDITORS OF THE EMPLOYER FOR THE PAYMENT OF THE BENEFITS. THE FOLLOWING PARTICIPANTS RECEIVED PAYOUTS FROM A RELATED ORGANIZATION, PARK NICOLLET HEALTH SERVICES, RELATED TO CAA PLAN: LAST NAME FIRST NAME 2013 COMPENSATION CONNELLY, STEVEN $ 52,281 DAMROW, PAUL, MD $ 27,770 FLASCHENRIEM, JULIE $ 29,208 FRAZIER, LAURA $ 18,275 GAPSTUR, ROXANNA $ 25,322 HOMANS, DAVID $ 40,453 KAUPA, MICHAEL $ 61,277 LARSON, GARY $ 31,668 LENAGH, CATHERINE $ 17,015 LONG, BRETT $ 18,005 MCMILLAN, SHEILA $ 12,129 MISA, JOHN $ 97,612 SANDSTROM, JOAN $ 35,286 SPIEGLE, DUANE $ 26,810 WEGLEITNER, THEODORE $ 34,820 OFFICERS AND DIRECTORS EMPLOYED BY HEALTHPARTNERS, INC HAVE DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II WHICH INCLUDE AMOUNTS FROM A NONQUALIFIED 457(F) PLAN, THE FOLLOWING PARTICIPANTS RECEIVED PAYOUTS: DAVID ABELSON, MD $ 113,160 BABETTE APLAND $ 9,023 MARY BRAINERD $ 130,379 BRIAN RANK, MD $ 30,313
PART I, LINE 7 ALL PHYSICIANS, EMPLOYED BY AND SEEING PATIENTS FOR PARK NICOLLET HEALTH SERVICES AND AFFILIATES, ARE ELIGIBLE FOR A 3% ACCESS INCENTIVE PAYOUT BASED ON THEIR DEPARTMENT REACHING CERTAIN GOALS INCLUDING ACCESS FOR PATIENTS AND QUALITY INITIATIVES. IN THEIR ROLES AS EXECUTIVES EMPLOYED BY PARK NICOLLET HEALTH SERVICES, THE EXECUTIVES ARE ELIGIBLE FOR INCENTIVE PAYOUTS. THE INCENTIVE AWARD WILL BE 30% FOR THE CFO, COO, CMO AND 25% FOR ALL OTHER EXECUTIVES WITH AN OPPORTUNITY FOR INCENTIVE CREDIT ABOVE THE TARGET LEVEL. THE ULTIMATE PAYOUT INCLUDES A REDUCTION/INCREASE MULTIPLIER DEPENDING ON WHETHER THE CONSOLIDATED PARK NICOLLET HEALTH SERVICES ORGANIZATION REACHED THAT YEAR'S OPERATING MARGIN GOAL AS SET BY THE BOARD OF DIRECTORS. EACH PARTICIPANT WILL BE RESPONSIBLE FOR TWO FINANCIAL GOALS, AND NOT LESS THAN THREE AND NOT MORE THAN FIVE INDIVIDUAL STRATEGIC OBJECTIVES. IN THEIR ROLES AS MANAGEMENT EMPLOYED BY PARK NICOLLET HEALTH SERVICES, CERTAIN MANAGERS ARE ELIGIBLE FOR INCENTIVE PAYOUTS. THE INCENTIVE AWARD WILL BE 15% OF THEIR ANNUAL BASE PAY COMPENSATION WITH AN OPPORTUNITY FOR INCENTIVE CREDIT ABOVE THE TARGET LEVEL. THE ULTIMATE PAYOUT INCLUDES A REDUCTION/INCREASE MULTIPLIER DEPENDING ON WHETHER THE CONSOLIDATED PARK NICOLLET HEALTH SERVICES ORGANIZATION REACHED THAT YEAR'S OPERATING MARGIN GOAL AS SET BY THE BOARD OF DIRECTORS. INCENTIVE PAYMENTS ARE A FUNCTION OF BOTH INDIVIDUAL AND ORGANIZATIONAL PERFORMANCE. THE PARTICIPANT MUST BE ASSIGNED AT LEAST THREE, AND NOT MORE THAN FOUR FOCUSED INCENTIVE OBJECTIVE, ONE OF WHICH MUST BE FINANCIAL IN NATURE
Schedule J (Form 990) 2013

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PARK NICOLLET GROUP RETURN
 
Employer identification number

45-5023260
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
(1) ROBERT WERLING MD   SALARY DRAW IN EXCESS   X 15,092 15,092   No   No   No
(2) DANE CHRISTENSEN MD   SALARY DRAW IN EXCESS   X 35,378 35,378   No   No   No
(3) MARNI FELDMANN MD   SALARY DRAW IN EXCESS   X 11,513 11,513   No   No   No
(4) TIMOTHY DIEGEL MD   SALARY DRAW IN EXCESS   X 7,296 7,296   No   No   No
Total ......Small Bullet $ 69,279
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2013
Schedule L (Form 990 or 990-EZ) 2013
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) RANDI NORBY ROXANNA GAPSTUR, PHD 127,577 EMPLOYMENT Yes  
(2) SUSAN SPIEGLE DUANE SPIEGLE 44,342 EMPLOYMENT Yes  
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
PARK NICOLLET GROUP RETURN
 
Employer identification number

45-5023260
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 4 AS OF JANUARY 1, 2013, PARK NICOLLET METHODIST HOSPITAL AND PARK NICOLLET CLINIC ADOPTED AMENDED AND RESTATED BYLAWS. THIS OCCURRED IN CONJUNCTION WITH PARK NICOLLET HEALTH SERVICES AND ITS SUBSIDIARIES BECOMING PART OF THE HEALTHPARTNERS ORGANIZATION OF RELATED HEALTH CARE DELIVERY AND FINANCING ENTITIES. THE CHANGES TO THE BYLAWS ALIGNED THE LANGUAGE AND PROVISIONS WITH THE AMENDED AND RESTATED BYLAWS OF PARK NICOLLET HEALTH SERVICES, AND ARE NOT MATERIAL CHANGES. NOTABLY, FOR THE SIGNIFICANT MATTERS THAT REQUIRE SUPERMAJORITY APPROVAL OF THE BOARD, THE AMENDED BYLAWS LOWER THE THRESHOLD FROM 3/4S OF ALL DIRECTORS TO 2/3RDS OF ALL DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 6 PARK NICOLLET HEALTH SERVICES IS THE SOLE MEMBER OF PARK NICOLLET METHODIST HOSPITAL, PARK NICOLLET CLINIC, PARK NICOLLET INSTITUTE AND PARK NICOLLET HEALTH CARE PRODUCTS. PARK NICOLLET CLINIC IS THE SOLE MEMBER OF PNMC HOLDINGS.
FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF PARK NICOLLET METHODIST HOSPITAL, PARK NICOLLET CLINIC, PARK NICOLLET INSTITUTE, PNMC HOLDINGS AND PARK NICOLLET HEALTH CARE PRODUCTS ARE THOSE INDIVIDUALS WHO ARE CONTEMPORANEOUSLY MEMBERS OF THE BOARD OF DIRECTORS OF PARK NICOLLET HEALTH SERVICES.
FORM 990, PART VI, SECTION A, LINE 7B ALL DECISIONS, INCLUDING DISSOLUTION OF THE ORGANIZATION, MADE BY THE GOVERNING BODY OF PARK NICOLLET METHODIST HOSPITAL, PARK NICOLLET CLINIC, PARK NICOLLET INSTITUTE, PNMC HOLDINGS AND PARK NICOLLET HEALTH CARE PRODUCTS ARE SUBJECT TO THE APPROVAL OF THE BOARD OF DIRECTORS OF PARK NICOLLET HEALTH SERVICES.
FORM 990, PART VI, SECTION B, LINE 11 PARK NICOLLET GROUP PREPARES THE FORM 990 WITHIN THE FINANCE DEPARTMENT WITH ASSISTANCE FROM INDIVIDUALS IN HUMAN RESOURCES, MARKETING, AND OPERATIONS. UPON COMPLETION OF GATHERING THE NECESSARY INFORMATION FOR THE RETURN, THE FORM WAS REVIEWED BY THE PARK NICOLLET GROUP'S ACCOUNTING FIRM. DRAFTS OF THE FORM WERE ALSO REVIEWED BY THE ASSISTANT CONTROLLER - ACCOUNTING OPERATIONS, VICE PRESIDENT OF FINANCE, CHIEF FINANCIAL OFFICER, AND THE AUDIT AND COMPLIANCE COMMITTEE. AFTER ALL REVIEWS WERE COMPLETE; THE FORM 990 WAS GIVEN TO EACH MEMBER OF THE BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING THE RETURN.
FORM 990, PART VI, SECTION B, LINE 12C AT PARK NICOLLET HEALTH SERVICES ALL KEY EMPLOYEES, DIRECTORS, AND OFFICERS ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST DISCLOSURE STATEMENT EACH YEAR; HOWEVER THE OBLIGATION TO REPORT POTENTIAL CONFLICTS IS ONGOING. PARK NICOLLET HEALTH SERVICES BOARD MONITORS POTENTIAL CONFLICTS OF INTEREST ON THE PART OF BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES PURSUANT TO ITS CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ALL BOARD MEMBERS AND OFFICERS ANNUALLY ARE PROVIDED A COPY FO THE POLICY AND REQUIRED TO COMPLETE A QUESTIONNAIRE INDENTIFYING ANY POTENTIAL CONFLICTS OF INTEREST. THE GENERAL COUNCEL REVIEWS THE COMPLETED QUESTIONNAIRES AND PROVIDES A REPORT TO THE GOVERNANCE COMMITTEE OF THE BOARD. THE REPORT IDENTIFIES ANY SIGNIFICANT POTENTIAL CONFLICTS DISCLOSED IN THE COMPLETED QUESTIONNAIRES. A WRITTEN REPORT IS PROVIDED TO THE CHAIR AND CHIEF EXECUTIVE OFFICER (CEO). BOARD AGENDAS AND EXECUTIVE DECISIONS ARE MONITORED IN RELATION TO THIS POLICY.`
FORM 990, PART VI, SECTION B, LINE 15 THE PARK NICOLLET HEALTH SERVICES' BOARD OF DIRECTORS IS RESPONSIBLE FOR THE IMPLEMENTATION AND OVERSIGHT OF EXECUTIVE COMPENSATION AND BENEFIT PLANS. PARK NICOLLET USES AN OUTSIDE CONSULTANT TO PROVIDE A YEARLY MARKET BASED INDEX OF SALARY ADJUSTMENTS FOR EXECUTIVES IN SIMILAR LEADERSHIP POSITIONS. THE BOARD OF DIRECTORS REVIEWS THE SALARY RANGES AND RECOMMENDS SALARY INCREASES FOR EACH EXECUTIVE, INCLUDING THE CEO, BASED UPON THE BOARD OF DIRECTORS' EVALUATION OF JOB PERFORMANCE AND EXPERIENCE LEVEL OF THE INDIVIDUAL WITHIN THE ORGANIZATION. THE AVERAGE SALARY INCREASES FOR ALL PARK NICOLLET EXECUTIVES CANNOT EXCEED THE AVERAGE MARKET SALARY INCREASE REPORTED FOR EXECUTIVES BY THE CONSULTANT. THE COMPENSATION COMMITTEE THEN REVIEWS AND APPROVES COMPENSATION ADJUSTMENTS BASED ON THE INFORMATION PROVIDED BY THE OUTSIDE CONSULTANTS AND THE BOARD OF DIRECTORS' RECOMMENDATIONS. FOR CERTAIN PHYSICIANS, THE MAJORITY OF PAY DISCLOSED IS FOR HIS/HER WORK AS A PHYSICIAN FOR PARK NICOLLET INSTITUTE OR PARK NICOLLET CLINIC. A SMALL STIPEND IS ADDED FOR SERVING ON THE BOARD OF DIRECTORS. THE FOLLOWING IS A DESCRIPTION OF HOW PAY FOR PHYSICIANS' PATIENT CARE WORK IS DETERMINED. THE PARK NICOLLET HEALTH SERVICES' BOARD OF DIRECTORS IS RESPONSIBLE FOR THE IMPLEMENTATION AND OVERSIGHT OF THE PHYSICIAN COMPENSATION AND BENEFIT PLANS. THE BOARD OF DIRECTORS DELEGATES THE DAY-TO-DAY ADMINISTRATION OF THE PHYSICIAN COMPENSATION PLAN TO THE CEO. THE CHIEF MEDICAL OFFICER, WHO REPORTS DIRECTLY TO THE CEO, ADMINISTERS THE COMPENSATION PROGRAM. A COMPENSATION AND BENEFITS COMMITTEE SERVES IN AN ADVISORY CAPACITY TO THE CMO IN ORDER TO ADMINISTER PHYSICIAN COMPENSATION WITHIN THE BUDGET TO ENSURE FAIRNESS AND ALIGNMENT WITH PARK NICOLLET HEALTH SERVICES' GOALS. THE RESPONSIBILITIES OF THE CMO: RECOMMENDING COMPENSATION POLICIES AND PLAN DESIGNS FOR PHYSICIANS TO THE CEO AND BOARD OF DIRECTORS; OVERSEEING COMPENSATION PLAN OPERATION AND PAYMENTS TO CLINICAL DEPARTMENTS; EVALUATING COMPENSATION PLAN FOR PERFORMANCE ON A PERIODIC BASIS; SERVING AS FINAL APPEAL PROCESS FOR ISSUES UNRESOLVED BY INDIVIDUALS, DEPARTMENT CHAIRS AND CHIEFS OF SERVICES. ANNUALLY, INFORMATION ON EACH PHYSICIAN'S PAY AND PRODUCTIVITY IS GRAPHED AGAINST THE SURVEY RESULTS FOR THE SAME YEAR. THIS INFORMATION IS PRESENTED TO THE COMPENSATION COMMITTEE OF THE PARK NICOLLET HEALTH SERVICES BOARD OF DIRECTORS FOR REVIEW. PARK NICOLLET HEALTH SERVICES' PHYSICIAN PAY PROGRAM IS DESIGNED TO ENSURE MARKET BASED PAY FOR MARKET BASED PRODUCTIVITY STANDARDS. THE MARKET IS DETERMINED BY THE AMERICAN MEDICAL GROUP ASSOCIATION (AMGA) NATIONAL PHYSICIAN COMPENSATION SURVEY DATA, WHICH PROVIDES MARKET DATA FOR BOTH COMPENSATION AND PRODUCTIVITY. WHEN APPROPRIATE, THE CMO MAY RECOMMEND ADJUSTMENTS TO THESE GUIDELINES WITH EVIDENCE OF LOCAL MARKET DATA.
FORM 990, PART VI, SECTION C, LINE 19 : PARK NICOLLET GROUP MEMBERS' GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. PARK NICOLLET HEALTH SERVICES, AS THE PARENT ORGANIZATION OF THE PARK NICOLLET GROUP, MAILS ITS CONSOLIDATED AUDITED FINANCIAL STATEMENTS TO FINANCIAL INSTITUTIONS, GOVERNMENTAL INSTITUTIONS, BOARD MEMBERS, MEDIA REPRESENTATIVES, VENDORS, AND THE MINNESOTA HOSPITAL ASSOCIATION (MHA). PARK NICOLLET HEALTH SERVICES DISCLOSES QUARTERLY FINANCIAL STATEMENTS TO BONDHOLDERS AND MHA. THE ANNUAL AUDITED AND QUARTERLY FINANCIAL STATEMENTS ARE ALSO POSTED AT EMMA.MSRB.ORG. THE FORMS 990 ARE AVAILABLE UPON REQUEST OR FROM THE STATE OF MINNESOTA OR AT GUIDESTAR.ORG.
FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS 279,748. GRANTS RUN THROUGH THE FOUNDATION -1,090,351.
PAGE 1, LINE H(A) LIST OF SUBORDINATE ORGANIZATIONS: NAME, ADDRESS AND EINS PARK NICOLLET METHODIST HOSPITAL 41-0132080 6500 EXCELSIOR BLVD, ST. LOUIS PARK MN 55426 PARK NICOLLET INSTITUTE 41-0961862 3800 PARK NICOLLET BLVD ST. LOUIS PARK MN 55416 PARK NICOLLET HEALTH CARE PRODUCTS 01-0638901 3800 PARK NICOLLET BLVD ST. LOUIS PARK MN 55416 PARK NICOLLET CLINIC 41-0834920 3800 PARK NICOLLET BLVD ST. LOUIS PARK MN 55416 PNMC HOLDINGS 41-1741792 3800 PARK NICOLLET BLVD ST. LOUIS PARK MN 55416
FORM 990 PART IV LINE 24A PARK NICOLLET HEALTH SERVICES, ALONG WITH RELATED ORGANIZATIONS, IS JOINTLY LIABLE FOR THE TAX EXEMPT BONDS HELD BY PARK NICOLLET HEALTH SERVICES UNDER A MASTER TRUST AGREEMENT. THE MEMBERS OF THE JOINTLY LIABLE GROUP, WHICH IS COLLECTIVELY REFERRED TO AS THE "OBLIGATED GROUP", INCLUDE PARK NICOLLET CLINIC, PARK NICOLLET METHODIST HOSPITAL, PNMC HOLDINGS, PARK NICOLLET INSTITUTE, AND PARK NICOLLET HEALTH CARE PRODUCTS. IN ACCORDANCE WITH REPORTING REQUIREMENTS FOR SCHEDULE K, ALL OUTSTANDING TAX EXEMPT BONDS ARE REPORTED SOLELY ON THE SCHEDULE K OF PARK NICOLLET HEALTH SERVICES.
PART V LINE 3A PARK NICOLLET HEALTH CARE PRODUCTS HAS UNRELATED BUSINESS GROSS INCOME OVER $1,000.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PARK NICOLLET GROUP RETURN
 
Employer identification number

45-5023260
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) PARK NICOLLET HEALTH SERVICE

6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
36-3465840 		HEALTH CARE ADMINSTRATIONS MN   LINE 11C, III-FI  
 
No
(2) PARK NICOLLET FOUNDATION

6500 EXCELSIOR BLVD

ST LOUIS PARK,MN55426
23-7346465 		GRANTS TO SERVE THE COMMUNITY MN 501(C)(1) LINE 7 PARK NICOLLET HEALTH SERVICES
 
Yes
 
(3) TRIA ORTHOPEADIC CENTER RESEARCH INSTITUTE

8100 NOIRTHLAND DRIVE

BLOOMINGTON,MN55431
20-0033919 		HEALTH CARE RESEARCH AND EDUCATION MN 501(C)(1) LINE 11A, I PARK NICOLLET HEALTH SERVICES
 
Yes
 
(4) HEALTHPARTNERS INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1693838 		HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(4) 509(A)(3) TYPE I N/A
Yes
 
(5) HPI - RAMSEY

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1793333 		CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC
 
Yes
 
(6) GROUP HEALTH PLAN INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-0797853 		STAFF MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(3) 170(B)(1) (A)(III) HEALTHPARTNERS INC
 
Yes
 
(7) HEALTHPARTNERS INSTITUTE FOR EDUCATION AND RESEARCH

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1670163 		HEALTHCARE EDUCATION & RESEARCH MN 501(C)(3) 509(A)(3) TYPE I GROUP HEALTH PLAN INC
 
Yes
 
(8) CAPITOL VIEW TRANSITIONAL CARE CENTER

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-2011453 		POST HOSPITALIZATION PATIENT CARE MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY
 
Yes
 
(9) REGIONS HOSPITAL

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-0956618 		HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) HPI - RAMSEY
 
Yes
 
(10) REGIONS HOSPITAL FOUNDATION

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1888902 		PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT MN 501(C)(3) 170(B)(1) (A)(VI) HPI - RAMSEY
 
Yes
 
(11) RHSC INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1891928 		HEALTHCARE STAFFING MN 501(C)(3) 509(A)(3) TYPE II HEALTHPARTNERS INC
 
Yes
 
(12) RH-WISCONSIN

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
20-2287016 		CORPORATE PLANNING AND OVERSIGHT WI 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY
 
Yes
 
(13) PHYSICIANS NECK AND BACK CLINICS

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
27-0684883 		SPECIALTY PATIENT CARE MN 501(C)(3) 509(A)(3) TYPE II GROUP HEALTH PLAN INC
 
Yes
 
(14) HUDSON HOSPITAL INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
39-0804125 		HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN
 
Yes
 
(15) HUDSON HOSPITAL FOUNDATION INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
39-1279567 		PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT WI 501(C)(3) 170(B)(1) (A)(VI) HUDSON HOSPITAL INC
 
Yes
 
(16) WESTERN WISCONSIN EMERGENCY MEDICAL SERVICES COMPANY

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
26-3616590 		PROVIDE MEDICAL TRANSPORT SERVICES WI 501(C)(3) 509(A)(3) TYPE II RH-WISCONSIN
 
Yes
 
(17) LAKEVIEW MEMORIAL HOSPITAL FOUNDATION

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1386635 		PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT MN 501(C)(3) 509(A)(3) TYPE II STILLWATER HEALTH SYSTEM
 
Yes
 
(18) LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-0811697 		HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) STILLWATER HEALTH SYSTEM
 
Yes
 
(19) STILLWATER MEDICAL GROUP

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
83-0379473 		PHYSICIANS GROUP MN 501(C)(3) 509(A)(2) STILLWATER HEALTH SYSTEM
 
Yes
 
(20) STILLWATER HEALTH SYSTEM

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
30-0221189 		CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY
 
Yes
 
(21) WESTFIELDS HOSPITAL INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
39-0808442 		HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN
 
Yes
 
(22) WESTFIELDS HOSPITAL FOUNDATION INC

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
39-1770913 		PROVIDE HOSPITAL PROGRAM FINANCIAL SUPPORT WI 501(C)(3) 509(A)(3) TYPE I WESTFIELDS HOSPITAL INC
 
Yes
 
(23) RAMSEY INTEGRATED HEALTH SERVICES

8170 33RD AVE S PO BOX 1309

MPLS,MN554401309
41-1503090 		IN-HOME PATIENT CARE MN 501(C)(3) 509(A)(2) HPI - RAMSEY
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) METHODIST BRAIN LAB LEASING LLC

6500 EXCELSIOR BLVD
ST LOUIS PARK,MN55426
20-8725994 		HEALTH CARE MN PARK NICOLLET METHODIST HOSPITAL
  		        No     No  












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) PARK NICOLLET ENTERPRISES

6500 EXCELSIOR BLVD
ST LOUIS PARK,MN55426
41-1656735 		REAL ESTATE FOR RELATED ORGANICATION MN PARK NICOLLET HEATLH SERVICES
  		C 4,640,133 16,369,858 100.000 %   No
(2) HEALTHPARTNERS ADMINISTRATORS INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1629390 		THIRD PARTY ADMINISTRATOR MN HEALTHPARTNERS INC
  		C         No
(3) HEALTHPARTNERS ASSOCIATES INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
52-2365151 		MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC
  		C         No
(4) HEALTHPARTNERS SERVICES INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1683568 		MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC
  		C         No
(5) HEALTHPARTNERS VENTURES INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1838197 		DEVELOP HEALTHCARE BUSINESS OPPORTUNITIES MN HEALTHPARTNERS INC
  		C         No
(6) HEALTHPARTNERS INSURANCE COMPANY

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1683523 		MEDICAL AND DENTAL INSURANCE MN HEALTHPARTNERS ADMINISTRATORS INC
  		C         No
(7) DENTAL SPECIALTIES INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
45-1297583 		PROFESSIONAL DENTAL SERVICES MN HEALTHPARTNERS ADMINISTRATORS INC
  		C         No
(8) HEALTHPARTNERS CENTRAL MINNESOTA CLINICS INC

8170 33RD AVE S PO BOX 1309
MPLS,MN554401309
41-1236798 		MEDICAL CLINIC STAFFING MN HEALTHPARTNERS ADMINISTRATORS INC
  		C         No
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) PARK NICOLLET HEALTH SERVICES

 K 138,962,376 COST
(2) PARK NICOLLET HEALTH SERVICES

 Q 575,489,327 COST
(3) PARK NICOLLET HEALTH SERVICES

 J 4,116,523 COST
(4) PARK NICOLLET HEALTH SERVICES

 R 110,307,420 COST
(5) METHODIST BRAIN LAB LEASING LLC

 K 630,749 COST
(6) METHODIST BRAIN LAB LEASING LLC

 S 246,683 COST
(7) HEALTHPARTNERS INC

 L 44,991,020 COST
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V?UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


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