Form990
Click to see attachment
Department of the TreasuryInternal 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.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 01-01-2015 , and ending 12-31-2015
BCheck if applicable:
CName of organization
North Memorial Health Care
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
3300 Oakdale Avenue North
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Robbinsdale, MN55422
D Employer identification number

41-0729979
E Telephone number

G Gross receipts $ 1,020,554,972
F Name and address of principal officer:
J Kevin Croston MD
3300 Oakdale Avenue North
Robbinsdale,MN55422
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.northmemorial.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 MediumBullet  
K Form of organization:  
L Year of formation: 1954
M State of legal domicile: MN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: EMPOWERING OUR CUSTOMERS TO ACHIEVE THEIR BEST HEALTH. WE VIEW PEOPLE WE SERVE AS CUSTOMERS, NOT PATIENTS, EMPOWERING THEM TO EXPECT THE BEST CARE, COMMUNICATE THEIR NEEDS AND ALLOWING US TO BE CREATIVE AND ACCOUNTABLE FOR MEETING THEIR NEEDS.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 13
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 12
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 5,696
6 Total number of volunteers (estimate if necessary) ............. 6 509
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 9,841,744
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -932,227
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 755,248 605,846
9 Program service revenue (Part VIII, line 2g) ......... 655,017,004 708,020,979
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 18,475,881 5,546,644
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -1,569,444 -804,498
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 672,678,689 713,368,971
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
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) 405,110,904 432,738,440
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 269,506,611 283,578,372
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 674,617,515 716,316,812
19 Revenue less expenses. Subtract line 18 from line 12....... -1,938,826 -2,947,841
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 598,327,991 562,852,611
21 Total liabilities (Part X, line 26)............. 244,073,385 223,747,920
22 Net assets or fund balances. Subtract line 21 from line 20..... 354,254,606 339,104,691
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 (2015)
Form 990 (2015)
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: EMPOWERING OUR CUSTOMERS TO ACHIEVE THEIR BEST HEALTH. WE VIEW PEOPLE WE SERVE AS CUSTOMERS, NOT PATIENTS, EMPOWERING THEM TO EXPECT THE BEST CARE, COMMUNICATE THEIR NEEDS AND ALLOWING US TO BE CREATIVE AND ACCOUNTABLE FOR MEETING THEIR NEEDS.
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 $ 620,521,641 including grants of $   ) (Revenue $ 644,510,393 )
NORTH MEMORIAL HEALTH CARE (NMHC) IS A GENERAL ACUTE CARE HOSPITAL PROVIDING HIGHLY SPECIALIZED TRAUMA AND EMERGENCY SERVICES, CORONARY CARE, OPEN HEART SURGERY, ONCOLOGY, HIGH RISK MATERNITY AND NEONATAL CARE, AND GENERAL MEDICAL: SURGICAL, OBSTETRICAL, PEDIATRIC, REHABILITATION, BEHAVIORAL HEALTH, MEDICAL TRANSPORTATION AND HOME HEALTH AND HOSPICE SERVICES. IN ADDITION TO CHARITY AND UNCOMPENSATED CARE, NMHC ALSO PROVIDES NUMEROUS COMMUNITY BENEFITS (AT NO COST OR BELOW COST) IN FURTHERANCE OF ITS CHARITABLE PURPOSE. NORTH MEMORIAL PROVIDES A WIDE VARIETY OF BENEFITS TO THE COMMUNITY, INCLUDING OFFERING VARIOUS COMMUNITY BASED PROGRAMS, SUCH AS HEALTH SCREENINGS, SUPPORT COUNSELING FOR PARENTS AND FAMILIES, PASTORAL CARE, CRISIS INTERVENTION, TRANSPORTATION TO AND FROM THE HOSPITAL CAMPUSES, AND THE DONATION OF SPACE FOR USE BY COMMUNITY GROUPS. ADDITIONALLY A LARGE NUMBER OF HEALTH-RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, UNREIMBURSED COSTS OF MEDICAL EDUCATION, TELEPHONE INFORMATION SERVICES, AND COST RELATED TO PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. NORTH MEMORIAL ALSO PROVIDES MEDICAL CARE WITHOUT CHARGE OR AT REDUCED COSTS TO RESIDENTS OF ITS COMMUNITY, PRIMARILY THROUGH (A) THE DIFFERENCE BETWEEN PUBLIC PROGRAM PAYMENTS (PRIMARILY MEDICARE AND MEDICAID) AND THE RELATED COSTS OF PROVIDING SUCH SERVICES, AND (B) SERVICES PROVIDED TO PATIENTS EXPRESSING A WILLINGNESS TO PAY BUT WHO ARE DETERMINED UNABLE TO PAY BECAUSE OF ECONOMIC FACTORS. IN ADDITION, NORTH MEMORIAL CONTRIBUTES TO FUNDING MEDICAL CARE FOR THE UNINSURED THROUGH PAYMENT OF PATIENT SERVICE TAXES, WHICH INCLUDE THE MEDICAID SURCHARGE AND THE MINNESOTA CARE TAX ON CERTAIN NET REVENUE.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet620,521,641
Form 990 (2015)
Form 990 (2015)
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
Yes
 
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.........
14b
 
No
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 IV.....
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...
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? Click to see attachment
20b
Yes
 
Form 990 (2015)
Form 990 (2015)
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 domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....
21
 
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
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...............Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
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
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) 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 "Yes," complete Schedule L, Part II ................Click to see attachment
26
 
No
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
 
No
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
Yes
 
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
Yes
 
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 (2015)
Form 990 (2015)
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
514
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
 
 
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
5,696
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
Yes
 
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
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletBD
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
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.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring 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 (2015)
Form 990 (2015)
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
13
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
12
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
Yes
 
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
 
No
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
 
No
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
 
No
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
 
No
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, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletAaron Bloomquist3300 Oakdale Avenue North   Robbinsdale,MN55422 (763) 520-5200
Form 990 (2015)
Form 990 (2015)
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) Michael Steinhauser......................................................................
Chairman of Board, Past april 2015
 2.00
.................
0.00 		X   X       0 0 0
(2) Robert Potts......................................................................
Chairman of Board, part year
 2.00
.................
0.00 		X   X       900 0 0
(3) Timothy Baylor......................................................................
Board Member
 2.00
.................
0.00 		X           3,600 0 0
(4) Scott Colson MD......................................................................
Board Member
 2.00
.................
0.00 		X           3,600 0 0
(5) Robert Dahl......................................................................
Board Member
 2.00
.................
0.00 		X           3,600 0 0
(6) Warren Mack......................................................................
Board Member
 2.00
.................
0.00 		X           3,600 0 0
(7) Patrick McHale......................................................................
Board Member
 2.00
.................
0.00 		X           0 0 0
(8) Robert N Prentiss Jr......................................................................
Board Member
 2.00
.................
0.00 		X           3,600 0 0
(9) Rahul Tamhane MD......................................................................
Board Member
 2.00
.................
0.00 		X           3,600 0 0
(10) Ted Ferrara......................................................................
Board Member
 2.00
.................
0.00 		X           3,600 0 0
(11) Kevin S Raff MD......................................................................
Board Member
 2.00
.................
0.00 		X           3,600 0 0
(12) Laurie Lafontaine......................................................................
Board Member
 2.00
.................
0.00 		X           3,600 0 0
(13) Dana Carlson......................................................................
Board Member
 2.00
.................
0.00 		X           900 0 0
(14) LOREN TAYLOR......................................................................
CEO North Memorial, part year**
 42.00
.................
10.00 		X   X       488,513 0 25,829
(15) J Kevin Croston MD......................................................................
CEO North Memorial**
 42.00
.................
10.00 		X   X       937,930 0 47,707
(16) Todd Ostendorf......................................................................
VP Finance, CFO**
 42.00
.................
10.00 		    X       518,356 0 44,328
(17) David Abrams......................................................................
VP Human Resources**
 42.00
.................
10.00 		      X     369,450 0 32,904
Form 990 (2015)
Form 990 (2015)
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) Aaron Bloomquist........................................................................
VP Payer Strategy**
 42.00
.......................10.00 		      X     151,086 0 8,816
(19) Andrew Cochrane........................................................................
CEO - Maple Grove Hospital
 0.00
.......................50.00 		      X     527,057 0 43,397
(20) Patrick Coyne........................................................................
VP Medical Transportation
 50.00
.......................0.00 		      X     259,788 0 32,940
(21) Brendon Cullinan........................................................................
VP Mental Health
 50.00
.......................0.00 		      X     315,656 0 12,749
(22) Andrew Houlton........................................................................
VP Medical Affairs
 50.00
.......................0.00 		      X     516,899 0 40,442
(23) Laura Latt........................................................................
VP Operations
 50.00
.......................0.00 		      X     190,226 0 22,335
(24) Kelly Macken-Marble........................................................................
President of Population Health
 50.00
.......................0.00 		      X     369,512 0 33,612
(25) Craig Matticks........................................................................
Staff Emergency Physician**
 42.00
.......................10.00 		      X     598,337 0 46,234
(26) Colleen Nadeau........................................................................
VP Patient Care Operations
 0.00
.......................50.00 		      X     0 203,333 7,200
(27) Saurin Patel........................................................................
Chief Medical Officer
 50.00
.......................0.00 		      X     369,791 0 33,296
(28) Kent Spaulding........................................................................
VP Chief Development Officer
 50.00
.......................0.00 		      X     238,386 0 31,580
(29) Patrick Taffe........................................................................
Chief Information Officer**
 42.00
.......................10.00 		      X     389,850 0 37,834
(30) Kelly White........................................................................
VP Inpatient Care/CNO
 50.00
.......................0.00 		      X     304,296 0 39,441
(31) JEFF WICKLANDER........................................................................
President of North Memorial
 50.00
.......................0.00 		      X     462,441 0 42,971
(32) Tiffany Zitzewitz........................................................................
VP Business Development**
 42.00
.......................10.00 		      X     373,289 0 40,917
(33) COREY OLSON........................................................................
VP OPERATIONS, AMBULATORY SERVICES
 50.00
.......................0.00 		      X     266,818 0 7,378
(34) Thomas Koenig MD........................................................................
Gastroenterologist
 50.00
.......................0.00 		        X   874,976 0 45,566
(35) Alok Maheshwari MD........................................................................
Cardiologist
 50.00
.......................0.00 		        X   888,079 0 47,282
(36) Gregory Mevissen MD........................................................................
Gastroenterologist
 50.00
.......................0.00 		        X   866,323 0 45,566
(37) Hashim Nemat MD........................................................................
Gastroenterologist
 50.00
.......................0.00 		        X   1,252,747 0 46,017
(38) Steven Roh MD........................................................................
Cardiologist
 50.00
.......................0.00 		        X   857,550 0 47,282
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 12,421,556 203,333 863,623
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet649
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
NORTH CLINIC,
3366 OAKDALE AVE N 601
ROBBINSDALE,MN55422 		PHYsician services 14,146,869
DJ KRANZ COMPANY INCORPORATED,
725 HIGHWAY 169 NORTH
PLYMOUTH,MN554416403 		CONSTRUCTION 12,013,147
RESPIRATORY CONSULTANTS PA,
3366 OAKDALE AVE N 605
ROBBINSDALE,MN55422 		INTENSIVISTS STAFFING 3,357,547
Favorite Nurses,
PO Box 803356
Kansas City,MO641803356 		Nurse Staffing 3,293,298
Crothall Laundry Service INc,
13028 Collections Center Drive
Chicago,IL60693 		Laundry Services 2,070,204
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet40
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 346,727
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f 259,119
g Noncash contributions included in lines 1a-1f:$ 10,203
h Total.Add lines 1a-1f.......MediumBullet 605,846
Program Service RevenueAmt Business Code
2a HOSPITAL PATIENT REVENUE 621500 652,300,586 642,458,842 9,841,744  
b contract revenue 900099 35,640,507     35,640,507
c EHR/MEDICARE & other 900099 9,178,323     9,178,323
d PHARMACY 900099 4,760,611     4,760,611
e JOINT VENTURE REVENUE 900099 2,856,049 2,856,049    
f All other program service revenue. 3,284,903     3,284,903
g Total.Add lines 2a–2f.....MediumBullet 708,020,979
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet 6,180,912     6,180,912
4 Income from investment of tax-exempt bond proceedsMediumBullet 885     885
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   10,835,137
b Less: rental expenses   11,639,635
c Rental income or (loss)   -804,498
d Net rental income or (loss)......MediumBullet -804,498 -804,498    
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 208,387 294,702,826
b Less: cost or other basis and sales expenses 7,899,436 287,646,930
c Gain or (loss) -7,691,049 7,055,896
d Net gain or (loss).....MediumBullet -635,153     -635,153
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  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See Instructions......MediumBullet 713,368,971 644,510,393 9,841,744 58,410,988
Form 990 (2015)
Form 990 (2015)
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 domestic organizations and domestic governments. See Part IV, line 21    
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
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 .... 9,078,533   9,078,533  
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 340,262,297 296,028,198 44,234,099  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 21,432,054 18,645,887 2,786,167  
9 Other employee benefits ....... 40,015,186 34,813,212 5,201,974  
10 Payroll taxes ........... 21,950,370 19,096,822 2,853,548  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 3,060,096 2,662,284 397,812  
c Accounting ........... 279,508 243,172 36,336  
d Lobbying ........... 108,127   108,127  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 890,034   890,034  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 63,311,908 57,218,912 6,092,996  
12 Advertising and promotion .... 3,423,638 3,069,915 353,723  
13 Office expenses ....... 9,912,827 8,624,159 1,288,668  
14 Information technology ...... 10,806,697 9,401,826 1,404,871  
15 Royalties ..        
16 Occupancy ........... 19,492,805 16,958,740 2,534,065  
17 Travel ............        
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings ....        
20 Interest ........... 3,415,433 2,971,427 444,006  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 30,218,978 26,280,751 3,938,227  
23 Insurance ... 5,754,240 5,006,189 748,051  
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 Supplies 83,077,415 72,277,351 10,800,064  
b BAD DEBT EXPENSE 19,196,958 19,196,958    
c MAINTENANCE & REPAIR 12,344,745 10,739,928 1,604,817  
d GOVERNMENT TAXES 11,142,074 11,142,074    
e All other expenses 7,142,889 6,143,836 999,053  
25 Total functional expenses. Add lines 1 through 24e 716,316,812 620,521,641 95,795,171 0
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 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 12,174 1 12,974
2 Savings and temporary cash investments ......... 14,970,298 2 1,339,416
3 Pledges and grants receivable, net ...... 128,351 3 111,421
4 Accounts receivable, net ............. 97,938,989 4 96,461,938
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  
7 Notes and loans receivable, net .... 6,250,000 7 6,662,500
8 Inventories for sale or use ........ 6,391,600 8 6,994,931
9 Prepaid expenses and deferred charges ...... 4,505,563 9 5,298,992
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 626,707,109
b Less: accumulated depreciation 10b 416,782,141 205,954,796 10c 209,924,968
11 Investments—publicly traded securities . 214,845,345 11 209,773,979
12 Investments—other securities. See Part IV, line 11 ..... 42,745,377 12 49,657,192
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 4,585,498 15 -23,385,700
16 Total assets. Add lines 1 through 15 (must equal line 34)... 598,327,991 16 562,852,611
Liabilities 17 Accounts payable and accrued expenses ..... 80,221,606 17 79,111,566
18 Grants payable ...   18  
19 Deferred revenue ......... 418,209 19 433,483
20 Tax-exempt bond liabilities ......... 131,974,673 20 121,200,303
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 ..   23  
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 31,458,897 25 23,002,568
26 Total liabilities. Add lines 17 through 25.. 244,073,385 26 223,747,920
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 354,254,606 27 339,104,691
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets   29  
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 ........... 354,254,606 33 339,104,691
34 Total liabilities and net assets/fund balances ........ 598,327,991 34 562,852,611
Form 990 (2015)
Form 990 (2015)
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
713,368,971
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
716,316,812
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-2,947,841
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
354,254,606
5
Net unrealized gains (losses) on investments ...............
5
-12,202,074
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
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
339,104,691
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
 
No
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
 
 
Form 990 (2015)
Form 990 (2015)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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 Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
North Memorial Health Care
 
Employer identification number

41-0729979
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
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations ..............  

g
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 (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total      

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
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) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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 VI.)..            
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 section 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) 2015

Schedule A (Form 990 or 990-EZ) 2015
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) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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 VI.) ..            
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) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity		  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions		  
9 Distributable amount for 2015 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2015 		(iii)
Distributable
Amount for 2015
1 Distributable amount for 2015 from Section C, line
6 		 
2 Underdistributions, if any, for years prior to 2015
(reasonable cause required--see instructions)		  
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......  
e From 2014.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2015 distributable amount  
i Carryover from 2010 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2015 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2015 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2015, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)		  
6 Remaining underdistributions for 2015. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)		  
7 Excess distributions carryover to 2016. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a
b
c Excess from 2013.......  
d From 2014.......  
e From 2015.......  
Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2015


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
2015
Name of the organization
North Memorial Health Care
 
Employer identification number

41-0729979
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) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
Name of organization
North Memorial Health Care
  		Employer identification number
41-0729979
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


(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) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 3
Name of organization
North Memorial Health Care
  		Employer identification number

41-0729979
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) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 4
Name of organization
North Memorial Health Care
  		Employer identification number

41-0729979
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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) (2015)

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 BulletInformation about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
North Memorial Health Care
 
Employer identification number

41-0729979
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-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2015

Schedule C (Form 990 or 990-EZ) 2015
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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2012 (b) 2013 (c) 2014 (d) 2015 (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) 2015


Schedule C (Form 990 or 990-EZ) 2015
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 on 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)? ........
Yes
 
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? ..........................................................
Yes
 
40,000
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
Yes
 
65,000
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
3,127
j
Total. Add lines 1c through 1i ....................................................................................................
108,127
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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Part II-B, Line 1: CONTACTS AND VISITS WERE MADE WITH STATE LEVEL LEGISLATORS TO PROMOTE HEALTH CARE RELATED ISSUES. LINE 1I INCLUDES THE NON-DEDUCTIBLE PORTION OF MHA DUES.
Schedule C (Form 990 or 990EZ) 2015


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," on 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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
North Memorial Health Care
 
Employer identification number

41-0729979
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year ....    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of 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" on 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, 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" on 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)
Revenue included on 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
Revenue included on 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) 2015

Schedule D (Form 990) 2015
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" on 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, for escrow or custodial account liability?
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" on Form 990, Part IV, line 10.
(a)Current year (b)Prior year (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 3,591,423 3,446,092 2,683,970 2,382,667 2,251,229
b Contributions ...   76,703 710,628 270,795 72,500
c Net investment earnings, gains, and losses 17,322 118,858 85,294 92,571 71,751
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		1,405,602 50,230 33,800 62,063 12,813
f Administrative expenses ....          
g End of year balance ...... 2,203,143 3,591,423 3,446,092 2,683,970 2,382,667
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet95.520 %
c
Temporarily restricted endowment SchDMd Bullet4.480 %
The percentages on 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" on 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' on 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 ...   16,201,706 16,201,706
b Buildings   241,729,225 135,871,990 105,857,235
c Leasehold improvements   14,404,027 11,638,863 2,765,164
d Equipment ...   341,753,249 262,448,021 79,305,228
e Other ...   12,618,902 6,823,267 5,795,635
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 209,924,968
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' on 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    
(3)Other
(A) RREEF America REIT II 		25,785,187 F

(B) Mellon Aggregate bond index fund 		20,669,062 F

(C) Cash on deposit with bond trustee 		837,107 F

(D) Agency account 		89,836 F

(E) CASUALTY INSURANCE SECURITY 		2,276,000 F
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 49,657,192
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on 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
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
Executive pension plan 3,716,065
Restoration pension plan 60,503
Defined Benefit Pension Plan 14,805,964
Post retirement health insurance 1,428,745
CAA deposit reserve 163,076
settlements and claims payable 161,548
Deferred Income Long Term 2,666,667
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 23,002,568
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) 2015

Schedule D (Form 990) 2015
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on 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 (losses) 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' on 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: ALL ENDOWMENT FUNDS ARE HELD BY A RELATED ENTITY: NORTH MEMORIAL FOUNDATION. 1) RALPH ROSSEN ENDOWMENT: THIS ENDOWMENT WAS ESTABLISHED IN 1986 TO PROVIDE RECOGNITION TO NURSING STAFF THAT PROVIDE REMARKABLE SERVICE TO NORTH MEMORIAL PATIENTS AND THEIR FAMILIES. MEMBERS OF THE ROSSEN FAMILY SERVE ON A COMMITTEE ALONG WITH THE VP AND CHIEF NURSING OFFICER OF NORTH MEMORIAL TO SELECT THE RECIPIENTS. 2) HAROLD B. KAISER HONORARY LECTURESHIP ENDOWMENT: DR KAISER IS THE FOUNDER OF ALLERGY & ASTHMA SPECIALISTS, P.A. ESTABLISHED IN 1966. THE HAROLD B KAISER HONORARY LECTURESHIP ENDOWMENT PROVIDES FUNDING FOR A KEYNOTE SPEAKER FOR THE ANNUAL ALLERGY & ASTHMA CONFERENCE HELD IN THE MINNEAPOLIS AREA IN MARCH. 3) HAROLD ECKER ENDOWMENT: ESTABLISHED IN 1994 IN HONOR OF THE EXCELLENT CARE THAT MR. ECKER RECEIVED AS A PATIENT AT NORTH MEMORIAL, THE HAROLD ECKER ENDOWMENT PROVIDES A $500 AWARD TO THREE NORTH MEMORIAL EMPLOYEES RECOGNIZING THEIR OUTSTANDING PERFORMANCE AND PERSONAL ATTITUDE. THE AWARD IS OPENED TO ALL EMPLOYEES AND THE WINNERS ARE SELECTED BY A COMMITTEE OF NORTH MEMORIAL EMPLOYEES AND PRESENTED AT THE ANNUAL QUALITY AWARDS LUNCHEON IN NOVEMBER EACH YEAR. 4) RESIDENTIAL HOSPICE ENDOWMENT: THE RESIDENTIAL HOSPICE ENDOWMENT WAS ESTABLISHED BY DR. JOHN AND PATTY MANION TO PROVIDE ASSISTANCE TO THE RESIDENTIAL HOSPICE PROGRAM AT NORTH MEMORIAL. FUNDS ARE USED TO UPGRADE THE FACILITIES AND EQUIPMENT AT THE NORTH RESIDENTIAL HOSPICE FACILITY IN BROOKLYN CENTER, PROVIDE ADDITIONAL PROGRAM SUPPORT, STAFF TRAINING AND TO ASSIST THOSE FAMILIES THAT CANNOT AFFORD THIS SERVICE. 5) HELEN MURRAY MEMORIAL ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED WITH AN IRREVOCABLE CHARITABLE REMAINDER TRUST BY JEANNE MITHUN TO RECOGNIZE THE OUTSTANDING SERVICE THAT NORTH RESIDENTIAL HOSPICE PROVIDED TO HER MOTHER (HELEN MURRAY) AND HER FAMILY. FUNDS ARE USED TO PROVDE CARE TO INDIVIDUALS UNABLE TO PAY FOR SERVICES AT THE FACILITY. 6) PAY IT FORWARD THE PAY IT FORWARD FUND WAS ESTABLISHED BY BREAST CANCER SURVIVOR MICHELLE MOREY AND HER HUSBAND SCOTT BISSEN. MICHELLE RECOGNIZED A NEED TO HELP WOMEN STRUGGLING FINANCIALLY WHILE GOING THROUGH CANCER TREATMENT. PATIENTS ELIGIBLE FOR ASSISTANCE ARE FROM NORTH MEMORIAL, UNITY AND MONTICELLO HOSPITALS. THE FUND was ADMINISTERED AT NO FEE THROUGH THE NORTH MEMORIAL FOUNDATION. DURING 2015, NORTH MEMORIAL CEASED ADMINISTRATING THE FUND AND THE ASSETS ASSOCIATED WITH PAY IT FORWARD AND THE ASSETS ARE NO LONGER INCLUDED IN THE ENDOWMENT FUND BALANCE. 7) MEDICAL STAFF ENDOWMENT THIS ENDOWMENT WAS ESTABLISHED IN 2010 BY THE NORTH MEMORIAL MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND NORTH MEMORIAL PROGRAMS SUCH AS JUNIOR VOLUNTEER SCHOLARSHIP, SAFEJOURNEY, PASTORAL CARE, ETC. 8) MAPLE GROVE MEDICAL STAFF ENDOWMENT WAS ESTABLISHED IN 2013 BY THE MAPLE GROVE MEDICAL STAFF EXECUTIVE COMMITTEE. PROCEEDS FROM THE ENDOWMENT WILL FUND MAPLE GROVE PROGRAMS.
Part X, Line 2: NORTH MEMORIAL EVALUATES ITS UNCERTAIN POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2015 OR 2014.
Schedule D (Form 990) 2015


Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
North Memorial Health Care
 
Employer identification number

41-0729979
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 criteria used 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

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
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) . . . 		    9,053,537   9,053,537 1.260 %
b Medicaid (from Worksheet 3, column a) . . . . .     97,822,903 66,866,231 30,956,672 4.320 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     106,876,440 66,866,231 40,010,209 5.580 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     3,302,236 112,898 3,189,338 0.450 %
f Health professions education (from Worksheet 5) . . .     5,918,650 252,459 5,666,191 0.790 %
g Subsidized health services (from Worksheet 6) . . . .     47,821,968 30,774,233 17,047,735 2.380 %
h Research (from Worksheet 7) .     94,412 1,556 92,856 0.010 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     841,810   841,810 0.120 %
j Total. Other Benefits . .     57,979,076 31,141,146 26,837,930 3.750 %
k Total. Add lines 7d and 7j .     164,855,516 98,007,377 66,848,139 9.330 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
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
7,415,225
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
 
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
151,439,336
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
202,780,470
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-51,341,134
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 %
11 Maple Grove Hospital
  		Hospital 75.000 % 0 % 0 %
22 NM Surgery Center Maple Grove
  		Outpatient surg ctr 50.000 % 0 % 50.000 %
33 MN Diagnostic Imaging Partners
  		Outpatient imaging ctr 60.000 % 0 % 40.000 %
44 Preferred One Administrative Services
  		Claims administrator 25.000 % 0 % 25.000 %
55 Preferred One Community Health Plan
  		Insurance Company 50.000 % 0 % 0 %
66 Institute of Athletic Medicine
  		Clinic 37.000 % 0 % 0 %
77 Monticello Cancer Center
  		Optnt cancer clinic 40.000 % 0 % 0 %
88 North Radiation Oncology
  		Optnt radiation onc clnc 50.000 % 0 % 50.000 %
99 BLAINE URGENCY CENTER
  		URGENT CARE 50.000 % 0 % 50.000 %
1010 PLYMOUTH CITY CENTER MEDICAL BUILDING
  		MEDICAL OFFICE BUILDING 50.000 % 0 % 0 %
1111 MINNETONKA AMBULATORY SURGERY CENTER
  		Outpatient Surgery Center 76.000 % 0 % 0 %
1212 BLAINE AMBULATORY SURGERY CENTER
  		Outpatient Surgery Center 10.000 % 0 % 0 %
1314 Crystal Imaging Center
  		MedICAL OFFICE BUILDING 50.000 % 0 % 50.000 %
1415 FAIRVIEW HOME INFUSION
  		OPTNT Infusion Clinic 49.000 % 0 % 0 %
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
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 (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 NORTH MEMORIAL MEDICAL CENTER
3300 Oakdale Avenue North
Robbinsdale,MN55422
WWW.NORTHMEMORIAL.COM 		X X   X     X      
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 4
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)
NORTH MEMORIAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 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 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
5 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 Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.northmemorial.com
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a 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)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, 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) 2015
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
NORTH MEMORIAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
 
b
WWW.NORTHMEMORIAL.COM
c
d
e
f
g
h
i
Billing and Collections
17 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 all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 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
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

NORTH MEMORIAL MEDICAL CENTER
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized 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?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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
23 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? ............................... 23   No
If "Yes," explain in Section C.
24 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? ........................... 24 Yes  
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 7
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
NORTH MEMORIAL MEDICAL CENTER Part V, Section B, Line 5: One of the key objectives in conducting the 2013 CHNA was to identify health issues most important to our community members. This was accomplished in several ways. North Memorial Health Care convened 4 focus groups from target populations from throughout the community. We further interviewed community leaders representing local government, law enforcement, education, religious organization, public health and community-based organizations. Lastly, we conducted an online survey for community members and North Memorial employees. We retained an outside consulting firm to lead the focus groups. A new Community Health Needs Assessment will be conducted in 2016.
NORTH MEMORIAL MEDICAL CENTER Part V, Section B, Line 11: SEE SCHEDULE O
NORTH MEMORIAL MEDICAL CENTER Part V, Section B, Line 22d: The Minnesota Attorney General's Office requires hospitals to render services to those patients who do not have insurance at a reduced rate equal to the discount incurred from the highest volume managed care plan.
NORTH MEMORIAL MEDICAL CENTER Part V, Section B, Line 24: Per the Minnesota Attorney General's agreement, Third Party Liability and procedures that are not medically necessary are not covered under the Minnesota Attorney General's agreement and those patients can be billed full charges.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 8
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?7
Name and address Type of Facility (describe)
1 1 - MINNESOTA DIAGNOSTIC IMAGING PARTNERS
2955 XENIUM LANE SUITE 40
PLYMOUTH,MN55441 		OUTPATIENT RADIOLOGY
2 2 - BLAINE URGENCY CENTER
480 OSBORNE RD NE
FRIDLEY,MN55432 		URGENT CARE
3 3 - NM Surgery Center Maple Grove
9875 HOSPITAL DRIVE
MAPLE GROVE,MN55369 		OUTPATIENT SURGERY
4 4 - NORTH RADIATION THERAPY CENTER
6950 FRANCE AVE S SUITE 200
EDINA,MN55435 		OUTPATIENT RADIOLOGY
5 5 - MINNETONKA AMBULATORY SURGERY CENTER
15450 HIGHWAY 7 SUITE 200
MINNETONKA,MN55345 		OUTPATIENT SURGERY
6 6 - BLAINE AMBULATORY SURGERY CENTER
11855 ULYSSES ST NE
BLAINE,MN55434 		OUTPATIENT SURGERY
7 7 - CRYSTAL IMAGING CENTER
5700 BOTTINEAU BLVD
CRYSTAL,MN55429 		OUTPATIENT RADIOLOGY
8
9
10
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 9
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
Part III, Line 2: AMOUNT REPRESENTS THE HOSPITAL'S BAD DEBT PROVISION REDUCED BY THE HOSPITAL'S COST TO CHARGE RATIO WHICH REPRESENTS THE BEST ESTIMATE OF COST FOR THE BAD DEBT PROVISION.
Part III, Line 4: North Memorial's audited financial statements do not include a footnote description about bad debt expense. The cost to charge ratio was used to determine the amount on Part III, section A, line 2. We do not have the information necessary to determine which portion of the amount reported on line 2 is community benefit.
Part III, Line 8: The shortfall reported represents the amount Medicare reimbursement is less than the estimated cost of providing services to those patients. The method used to estimate those costs is the Cost to Charge Ratio approach which calculates the ratio of total hospital costs / total hospital gross revenue and them applies that ratio to total Medicare gross revenue.
Part III, Line 9b: North Memorial has policies and procedures in place for collection practices that include identification and screening for charity care and financial assistance. The policies are available on the Organizations intranet and pertain to all entities under the North Memorial corporate umbrella.
Part VI, Line 2: NORTH MEMORIAL WORKS CLOSELY WITH THE COMMUNITY HEALTH STEERING COMMITTEE MEMBERS TO DETERMINE AREAS OF NEED AND COMMUNITY HEALTH CONCERNS. OUR COMMUNITY HEALTH OUTREACH MANAGER IS A MEMBER OF THE HENNEPIN COUNTY COMMUNITY HEALTH IMPROVEMENT PARTNERSHIP STEERING COMMITTEE WHICH ALLOWS NORTH MEMORIAL MEDICAL CENTER TO BE INVOLVED IN KEY COMMUNITY HEALTH ISSUES. A NEW COMMUNITY HEALTH NEEDS ASSESSMENT WILL BE CONDUCTED IN 2016.
Part VI, Line 3: North Memorial Health Care has a very proactive program to assist uninsured and underinsured patients with their medical bills. We comply with the Attorney General's requirement to provide an immediate discount to uninsured Minnesota residents. We have Patient Financial Advocates as well as a contracted vendor that meets with all of our uninsured inpatients and specific outpatients to assist them in Medical Assistance eligibility and applications. This could include a visit to their residence if they need help in completing assistance applications. Should they not qualify for state or federal assistance programs, we offer and assist them in applying for the hospital's Financial Assistance (Charity Care) Program.Our Charity Care Program is published in the Corporate Policies and Procedures and provides for 100% coverage of medical bills for anyone whose income is less than 200% of the Federal Poverty Guidelines and needs assistance in resolving their financial obligation to the hospital. There is a gradual reduction in the Charity coverage between the 201% and 400% of the Federal Poverty Guidelines.If we are unable to meet with the patient before discharge from North Memorial, the patient is given a pamphlet that lists contact numbers to our Business Office Customer Service area to discuss options for assistance with their medical bills. This contact information is also provided on every statement that is sent to our customers. In addition, our internal collections department and our collection agencies are well versed in our assistance programs and will assess during their conversations with patients if referral to either a state or federal program or our Charity Care Program would be appropriate.
Part VI, Line 4: North Memorial serves a geographic area that includes 42 zip codes in the northwest quadrant of the Twin Cities metro. This service area includes both urban, suburban, ex-urban, and rural areas. This service area includes a diverse population of more than 900,000 people living in Hennepin, Wright, Sherburne and Ramsey counties.
Part VI, Line 5: North Memorial Medical Center is a general acute care hospital providing specialized trauma and emergency services, cardiovascular and open heart services, oncology, high risk maternity and neonatal care, and general medical-surgical, obstetrical, pediatric, rehabilitative and behavioral services. NMHC also provides an array of health care services to our community including primary care, ambulance transportation and Home Health and Hospice services. North Memorial is governed by a board of 15 representatives consisting of physicians and various leaders from throughout the community. Board members are elected to serve three-year terms for a total of five terms. The Medical Center also supports an open medical staff organization including approximately 900 board certified physicians and 300 allied health professionals. The North Memorial Board of Trustees establishes an annual margin target for management. Per board policy 75% of any excess available cash flow is reinvested in the form of capital improvements to the center. The remaining 25% is reinvested to support long term operations. We provide education to the community on child safety, stroke risk factors, heart disease risk factors and other health promotion information.
Part VI, Line 6: NORTH MEMORIAL HEALTH CARE IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. THROUGH TARGETED OUTREACH, EDUCATION AND PARTNERSHIPS, WE IMPROVE THE HEALTH OF OUR COMMUNITIES BY LISTENING TO THEIR NEEDS AND RESPONDING WITH APPROPRIATE PROGRAMS AND SERVICES. OUR PROGRAMS, MANY OF WHICH HAVE BEEN NATIONALLY RECOGNIZED, RANGE FROM HEALTH EDUCATION AND FREE SCREENINGS TO TRAINING HEALTH PROFESSIONALS.
Part VI, Line 7: NORTH MEMORIAL HEALTH CARE FILES A COMMUNITY BENEFIT REPORT WITH THE STATE OF MINNESOTA.
Schedule H (Form 990) 2015
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" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
North Memorial Health Care
 
Employer identification number

41-0729979
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 on 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
Yes
 
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
Yes
 
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 on 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
 
No
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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on 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," on line 5a or 5b, describe in Part III.
6
For persons listed on 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
Yes
 
b
Any related organization? .........................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on 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
 
No
8
Were any amounts reported on 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" on 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) 2015

Schedule J (Form 990) 2015
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 on 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 in column(B) reported as deferred on prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1LOREN TAYLORCEO North Memorial, part year** (i)

(ii)		 208,239
-------------
0 		272,516
-------------
0 		7,758
-------------
0 		18,550
-------------
0 		7,279
-------------
0 		514,342
-------------
0 		0
-------------
0
2J Kevin Croston MDCEO North Memorial** (i)

(ii)		 597,577
-------------
0 		335,538
-------------
0 		4,815
-------------
0 		18,550
-------------
0 		29,157
-------------
0 		985,637
-------------
0 		0
-------------
0
3Todd OstendorfVP Finance, CFO** (i)

(ii)		 362,712
-------------
0 		153,673
-------------
0 		1,971
-------------
0 		18,937
-------------
0 		25,391
-------------
0 		562,684
-------------
0 		0
-------------
0
4David AbramsVP Human Resources** (i)

(ii)		 258,365
-------------
0 		67,950
-------------
0 		43,135
-------------
0 		18,810
-------------
0 		14,094
-------------
0 		402,354
-------------
0 		0
-------------
0
5Aaron BloomquistVP Payer Strategy** (i)

(ii)		 150,446
-------------
0 		0
-------------
0 		640
-------------
0 		5,080
-------------
0 		3,736
-------------
0 		159,902
-------------
0 		0
-------------
0
6Andrew CochraneCEO - Maple Grove Hospital (i)

(ii)		 342,692
-------------
0 		181,758
-------------
0 		2,607
-------------
0 		18,550
-------------
0 		24,847
-------------
0 		570,454
-------------
0 		0
-------------
0
7Patrick CoyneVP Medical Transportation (i)

(ii)		 204,496
-------------
0 		51,690
-------------
0 		3,602
-------------
0 		15,345
-------------
0 		17,595
-------------
0 		292,728
-------------
0 		0
-------------
0
8Brendon CullinanVP Mental Health (i)

(ii)		 107,448
-------------
0 		0
-------------
0 		208,208
-------------
0 		3,447
-------------
0 		9,302
-------------
0 		328,405
-------------
0 		0
-------------
0
9Andrew HoultonVP Medical Affairs (i)

(ii)		 361,229
-------------
0 		150,010
-------------
0 		5,660
-------------
0 		18,550
-------------
0 		21,892
-------------
0 		557,341
-------------
0 		0
-------------
0
10Laura LattVP Operations (i)

(ii)		 165,000
-------------
0 		24,750
-------------
0 		476
-------------
0 		13,406
-------------
0 		8,929
-------------
0 		212,561
-------------
0 		0
-------------
0
11Kelly Macken-MarblePresident of Population Health (i)

(ii)		 314,232
-------------
0 		53,803
-------------
0 		1,477
-------------
0 		13,212
-------------
0 		20,400
-------------
0 		403,124
-------------
0 		0
-------------
0
12Craig MatticksStaff Emergency Physician** (i)

(ii)		 533,749
-------------
0 		60,982
-------------
0 		3,606
-------------
0 		18,550
-------------
0 		27,684
-------------
0 		644,571
-------------
0 		0
-------------
0
13Colleen NadeauVP Patient Care Operations (i)

(ii)		 0
-------------
174,131 		0
-------------
28,560 		0
-------------
642 		0
-------------
5,067 		0
-------------
2,133 		0
-------------
210,533 		0
-------------
0
14Saurin PatelChief Medical Officer (i)

(ii)		 368,942
-------------
0 		0
-------------
0 		849
-------------
0 		10,600
-------------
0 		22,696
-------------
0 		403,087
-------------
0 		0
-------------
0
15Kent SpauldingVP Chief Development Officer (i)

(ii)		 184,627
-------------
0 		53,115
-------------
0 		644
-------------
0 		11,111
-------------
0 		20,469
-------------
0 		269,966
-------------
0 		0
-------------
0
16Patrick TaffeChief Information Officer** (i)

(ii)		 266,057
-------------
0 		115,803
-------------
0 		7,990
-------------
0 		18,550
-------------
0 		19,284
-------------
0 		427,684
-------------
0 		0
-------------
0
17Kelly WhiteVP Inpatient Care/CNO (i)

(ii)		 218,077
-------------
0 		85,641
-------------
0 		578
-------------
0 		18,040
-------------
0 		21,401
-------------
0 		343,737
-------------
0 		0
-------------
0
18JEFF WICKLANDERPresident of North Memorial (i)

(ii)		 313,948
-------------
0 		147,381
-------------
0 		1,112
-------------
0 		18,899
-------------
0 		24,072
-------------
0 		505,412
-------------
0 		0
-------------
0
19Tiffany ZitzewitzVP Business Development** (i)

(ii)		 259,615
-------------
0 		113,000
-------------
0 		674
-------------
0 		18,550
-------------
0 		22,367
-------------
0 		414,206
-------------
0 		0
-------------
0
20COREY OLSONVP OPERATIONS, AMBULATORY SERVICES (i)

(ii)		 95,585
-------------
0 		0
-------------
0 		171,233
-------------
0 		2,455
-------------
0 		4,923
-------------
0 		274,196
-------------
0 		0
-------------
0
21Thomas Koenig MDGastroenterologist (i)

(ii)		 483,068
-------------
0 		389,008
-------------
0 		2,900
-------------
0 		18,550
-------------
0 		27,016
-------------
0 		920,542
-------------
0 		0
-------------
0
22Alok Maheshwari MDCardiologist (i)

(ii)		 811,771
-------------
0 		73,415
-------------
0 		2,893
-------------
0 		18,550
-------------
0 		28,732
-------------
0 		935,361
-------------
0 		0
-------------
0
23Gregory Mevissen MDGastroenterologist (i)

(ii)		 496,298
-------------
0 		363,456
-------------
0 		6,569
-------------
0 		18,550
-------------
0 		27,016
-------------
0 		911,889
-------------
0 		0
-------------
0
24Hashim Nemat MDGastroenterologist (i)

(ii)		 483,068
-------------
0 		768,376
-------------
0 		1,303
-------------
0 		18,550
-------------
0 		27,467
-------------
0 		1,298,764
-------------
0 		0
-------------
0
25Steven Roh MDCardiologist (i)

(ii)		 780,771
-------------
0 		73,415
-------------
0 		3,364
-------------
0 		18,550
-------------
0 		28,732
-------------
0 		904,832
-------------
0 		0
-------------
0
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
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, Line 1a THE ORGANIZATION REIMBURSES ONE OF THE EXECUTIVE MEMBERS FOR THE MONTHLY SOCIAL DUES AT THE GOLDEN VALLEY COUNTRY CLUB. THE DUES FOR 2015 WERE $90 PER MONTH OR $1,080 PER YEAR. THE NORTH MEMORIAL COMMUNITY FOUNDATION UTILIZES THE COUNTRY CLUB TO HOST VARIOUS FUNDRAISING EVENTS THROUGH-OUT THE YEAR THAT SUPPORT VARIOUS ACTIVITIES FOR NORTH MEMORIAL.
Part I, Line 3 The Chief Executive Officer, as well as other officers and key employees marked with an asterisk on Part VII of the 990 and Part II of Schedule J, provides services to North Memorial Health Care as well as to all or some related entities as identified on Schedule R. As such, their compensation levels incorporate services provided to multiple North Memorial entities.
Part I, Line 4a A PORTION OF THE AMOUNTS REPORTED IN "OTHER REPORTABLE COMPENSATION" REFLECTS PAYMENTS MADE IN 2015 PURSUANT TO SEVERANCE AGREEMENTS WITH 2 EMPLOYEES AS FOLLOWS: COREY OLSON - $171,233 BRENDON CULLINAN - $207,450
Part I, Line 6 North Memorial Health Care's annual incentive plan requires achievement of stated performance metrics, which include operating cash flow margin.
Schedule J (Form 990) 2015
Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
North Memorial Health Care
 
Employer identification number
41-0729979
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A CITY OF ROBBINSDALE
  		71-6005496   06-07-2011 60,000,000 Refund Series 2008 bonds   X X     X
B City of Robbinsdale
  		71-6005496   06-07-2011 15,000,000 Refund Series 2008 bonds   X X     X
C City of Maple Grove
  		41-0873250 56516tay1 08-26-2015 44,915,000 REFUND SERIES 2005 BONDS   X X     X
Part II
Proceeds
A B C D
1 Amount of bonds retired .................. 14,479,934 2,898,750    
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 60,000,000 15,000,000 48,679,699  
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............     48,135,634  
7 Issuance costs from proceeds ............... 749,350   544,065  
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds ............. 58,710,650 15,000,000    
11 Other spent proceeds .............        
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2011 2011 2015
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? .... X   X   X      
15 Were the bonds issued as part of an advance refunding issue? .....   X   X   X    
16 Has the final allocation of proceeds been made? .......... X   X   X      
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X X      
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2015

Schedule K (Form 990) 2015
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X   X   X    
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X    
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet        
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet        
6 Total of lines 4 and 5 .............        
7 Does the bond issue meet the private security or payment test? ...   X   X   X    
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X    
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X   X    
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? ....... X   X   X      
b Exception to rebate? ........   X   X   X    
c No rebate due? .........   X   X   X    
If "Yes" to line 2c, provide in Part VI the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X   X   X    
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X    
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
Schedule K (Form 990) 2015

Schedule K (Form 990) 2015
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X    
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X   X    
7 Has the organization established written procedures to monitor the requirements of section 148? ...   X   X   X    
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X      
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
Schedule K (Form 990) 2015

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.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
North Memorial Health Care
 
Employer identification number

41-0729979
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) 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
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefiting 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) 2015
Schedule L (Form 990 or 990-EZ) 2015
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) Merwin Home Medical
  		BOARD MEMBER is the owner of Merwin Home Medical 338,057 MICHAEL STEINHAUSER, a board member, IS THE OWNER OF Merwin HOme Medical, WHICH SUPPLIES durable medical equipment TO NORTH MEMORIAL HEALTH CARE.   No
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) 2015


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 990-EZ 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
2015
Open to Public
Inspection
Name of the organization
North Memorial Health Care
 
Employer identification number

41-0729979
Return Reference Explanation
Form 990, Part VI, Section A, line 2 LOREN TAYLOR AND BOB POTTS - Business Relationship.
Form 990, Part VI, Section B, line 11 The organization's Finance and Audit Committee reviews the Form 990 before it is filed. Representatives from the hospital's independent accounting firm review the Form 990 with the Finance and Audit Committee in detail and notes for the committee any changes in the Form 990 from prior years. After thorough discussion, the finance and audit committee approves the Form 990 and forwards it to the full board for its review.
Form 990, Part VI, Section B, line 12c All members of the board of directors and all employees receive a copy of the conflict of interest policy each year. Each board member and staff member fills out a conflict of interest questionnaire in which they are asked to identify any relationship that would create a conflict of interest. The results are summarized and reviewed to determine any actual or potential conflict and are reported to the board of directors.
Form 990, Part VI, Section B, line 15 COMPENSATION FOR KEY POSITIONS IS REVIEWED BY THE COMPENSATION COMMITTEE WORKING IN CONJUNCTION WITH AN OUTSIDE CONSULTANT. THE COMPENSATION COMMITTEE INSURES THAT THE SALARY AND BENEFIT ADMINISTRATION REVIEW PROCESS IS BEING FOLLOWED, WHICH INCLUDES SALARY AND BENEFIT SURVEYS AND COMPARISONS OF ALL POSITIONS. THE CEO'S COMPENSATION IS SENT TO THE FULL BOARD FOR APPROVAL. THE COMPENSATION OF ALL OTHER KEY POSITIONS IS APPROVED BY THE CEO.
Form 990, Part VI, Section C, line 19 Governing documents and the conflict of interest policy are available upon request. Financial statements are available online through the office of the attorney general via the charity report filed with the state of Minnesota.
Form 990, Part XII, Line 2c: NEITHER THE OVERSIGHT OF THE AUDIT OR THE SELECTION PROCESS OF THE INDEPENDENT ACCOUNTANT WERE CHANGED DURING THE TAX YEAR.
Schedule H, Part V, Section B, Line 11: NORTH MEMORIAL IDENTIFIED FIVE PRIORITY AREAS IN THE COMMUNITY HEALTH ASSESSMENT CONDUCTED IN 2013. THESE PRIORITY AREAS AND A SUMMARY OF SOME OF THE ACTIVITIES CONDUCTED TO ADDRESS THESE AREAS ARE: PRIORITY AREA 1-ACCESS & AFFORDABILITY 1.1-EDUCATION OF COMMUNITY MEMBERS ON HOW TO ENGAGE AND INTERACT WITH HEALTH CARE RESOURCES. NORTH MEMORIAL DID AN EDUCATION MAILER TO EVERYONE IN OUR SERVICE AREA. THE GOAL WAS TO EDUCATE POTENTIAL CONSUMERS ON WHERE TO GET THE APPROPRIATE LEVEL OF CARE FOR A VARIETY OF HIGH LEVEL CONDITIONS. THESE WERE ALSO PRODUCED AND HANDED OUT IN OUR CLINICS AS WELL AS AT LOCAL PHARMACIES. 1.2-STRATEGIC PARTNERSHIP WITH COMMUNITY-BASED RESOURCES THAT SUPPORT ACCESS AND ENROLLMENT IN HEALTH INSURANCE PROGRAMS . NORTH MEMORIAL CONTINUED TO ENGAGE WITH PORTICO HEALTHNET, A LOCAL NONPROFIT SPECIALIZING IN INSURANCE ELIGIBILITY AND ENROLLMENT TO EXPAND STRATEGIC PARTNERSHIP FOR MEDICAL ASSISTANCE POPULATION. WE ALSO CONTINUED TO DEVELOP PRIMARY CARE-BASED REFERRAL AND PATIENT ADVOCATE ROLE IN ORDER TO EXPAND ACCESS TO RESOURCES. 1.3-DELIVERY OF CARE TO THE COMMUNITY: SCREENINGS, EDUCATION, ETC. NORTH MEMORIAL DELIVERED FREE FLU SHOTS DURING GRAND OPENING EVENTS AT TWO OF OUR CLINICS. NORTH MEMORIAL DOES MONTHLY HEALTH TIPS THAT ARE PRINTED AND HANDED OUT IN ALL OUR PRIMARY CARE LOCATIONS, AT LOCAL PHARMACY LOCATIONS ACROSS THE TWIN CITIES AND SENT OUT IN OUR MONTHLY E NEWSLETTER. PRIORITY AREA 2-COMMUNITY COLLABORATION & CONNECTING COMMUNITY RESOURCES 2.1-QUARTERLY MEETINGS BETWEEN NMMC PRESIDENT AND COMMUNITY LEADERS THE NORTH MEMORIAL COMMUNITY HEALTH STEERING COMMITTEE MET 3 TIMES IN 2015. THE FOLLOWING ITEMS WERE DISCUSSED AT THESE MEETINGS; CHARTER, 2013 HEALTH PRIORITY PROGRESS, HENNEPIN COUNTY COMMUNITY HEALTH IMPROVEMENT PARTNERSHIP ACTIVITIES, CENTER FOR COMMUNITY HEALTH ACTIVITIES AND PRESENTATIONS BY STEERING COMMITTEE MEMBERS -THE MINNEAPOLIS PUBLIC SCHOOLS AND COOKIE CART. THE COMMUNITY HEALTH STEERING COMMITTEE ALSO REVIEWED AND APPROVED THE 2016 COMMUNITY HEALTH NEEDS ASSESSMENT PLAN. 2.2-LINKING PATIENTS TO COMMUNITY-BASED RESOURCES NORTH MEMORIAL CONTINUED TO EXPAND THE NETWORK OF COMMUNITY-BASED RESOURCES THAT CARE COORDINATORS REFER NORTH MEMORIAL PATIENTS TO through BI-WEEKLY MEETINGS WITH THE CARE COORDINATOR STAFF AND OTHER CARE TEAM MEMBERS. NORTH MEMORIAL HAS ALSO WORKED IN 2015 TO IMPROVE INTEGRATION BETWEEN NORTH MEMORIAL AND COMMUNITY-PARTNERS THROUGH ENHANCED REFERRAL COORDINATION AND COMMUNICATION. A FEW KEY COMMUNITY PARTNERS HAVE DEVELOPED A MORE INTEGRATED APPROACH TO ADDRESS THE NEEDS OF HIGH-RISK PATIENTS THROUGH CARE CONFERENCES AND TARGETED CARE MANAGEMENT. FOR EXAMPLE, WE HAVE OBTAINED EPIC CARE LINK ACCESS FOR A LOCAL COMMUNITY-BASED ORGANIZATION FOCUSED ON MENTAL HEALTH, VAIL PLACE. THROUGH OUR PARTNERSHIP WITH VAIL PLACE, WE ARE DIRECTLY REFERRING PATIENTS FROM ACROSS THE SYSTEM (INPATIENT PSYCH, CLINICS, COMMUNITY PARAMEDICS, ETC.) INTO SERVICES LIKE CASE MANAGEMENT, HOUSING SUPPORT AND JOB SKILLS DEVELOPMENT. 2.3-LUTHERAN SOCIAL SERVICES SENIOR CORPS PROGRAMS. NORTH MEMORIAL HAS WORKED WITH TEN SENIOR COMPANION VOLUNTEERS AND HAS REFERRED IN NEARLY 30 HIGH-RISK SENIORS INTO THE PROGRAM. PRIORITY AREA 3-CULTURAL COMPETENCY IN TREATMENT INTERACTIONS 3.1-CLASS ASSESSMENT TO REVIEW ORGANIZATIONAL SYSTEMS, POLICIES AND PRACTICES THAT AFFECT THE CARE OF DIVERSE PATIENTS NORTH MEMORIAL HAS INCORPORATED A SECTION ON "CULTURAL COMPETENCY AND "CONVERSATIONS ON COMMUNITY" INTO NEW EMPLOYEE ORIENTATION. COVERED IN THIS SECTION ARE: CULTURAL COMPETENCY COVERS THE FOLLOWING TOPICS: -WHAT MAKES AN INTERPRETER QUALIFIED -HOW TO WORK WITH AN INTERPRETER -EXPECTATIONS OF AGENCY INTERPRETERS -EXPECTATIONS OF TEAM MEMBERS WHEN WORKING WITH LEP (LIMITED ENGLISH PROFICIENT) CUSTOMERS -OTHER RESOURCES: CERTIFIED LANGUAGE INTERNATIONAL, M.A.R.T.T.I. (MY ACCESSIBLE REAL-TIME TRUSTED INTERPRETER) -CONVERSATIONS ON COMMUNITY PROGRAM OBJECTIVES: -DEEPENING SELF-AWARENESS -EXAMINE THE IMPACT OF DIFFERENCES AND SIMILARITIES ON THE NORTH MEMORIAL COMMUNITY -EXAMINE THE DYNAMICS OF MOVING OUR BEHAVIORS FROM TOLERANCE TO APPRECIATION -UNDERSTAND YOUR ROLE AND RESPONSIBILITIES TO CONTINUOUSLY IMPROVE THE WORK ENVIRONMENT SO THAT EVERYONE CAN FEEL MORE INCLUDED-MORE A PART OF THE COMMUNITY -PRACTICE HAVING CONVERSATIONS THAT MATTER THE RED PACKET THAT EVERYONE RECEIVES IN THEIR NEW HIRE FOLDER COVERS INFORMATION REGARDING WORKING WITH DEAF AND HARD OF HEARING PATIENTS AND COMPANIONS. NORTH MEMORIAL OFFERS A FACILITATED PROGRAM CALLED "CONVERSATIONS ON COMMUNITY" THAT IS PART OF EVERY NEW TEAM MEMBER'S ORIENTATION AND IS ALSO OFFERED AT OTHER TIMES THROUGHOUT THE YEAR. CONVERSATIONS ON COMMUNITY PROVIDE NORTH MEMORIAL TEAM MEMBERS THE OPPORTUNITY: -TO SELF-REFLECT AND SELF-ASSESS REACTIONS TO OTHERS. -TO DEEPEN OUR OWN SELF-AWARENESS OF OUR OWN-GROWING EDGES IN OUR RELATIONSHIPS. -TO BEGIN TO POSITIVELY EVOLVE IN OUR RELATIONSHIPS WITH OUR CUSTOMERS, FAMILIES, VISITORS AND TEAM MEMBERS. 3.2-PHASE II: CULTURALLY-COMPETENT NURSE MIDWIFE PROGRAM WOMEN'S SPECIALTY SERVICES AT NORTH MEMORIAL OFFERS A NURSE MIDWIFE PROGRAM WHICH PROVIDES PRIMARY CARE TO WOMEN OF CHILDBEARING AGE. IN ADDITION TO THE CARE WE GIVE PATIENTS BEFORE, DURING AND AFTER PREGNANCY AND CHILDBIRTH, THE PROGRAM ALSO FOCUSES ON WOMEN'S OVERALL HEALTH. IN 2015 THEY HAD 802 VISITS AND 88 BIRTHS IN THE PROGRAM. PRIORITY AREA 4-SOCIAL & EMOTIONAL WELLBEING 4.1-SAFE JOURNEY PROGRAM SAFE JOURNEY IS AN INNOVATIVE, VOLUNTEER-DRIVEN PROGRAM THAT PROVIDES VICTIMS OF DOMESTIC VIOLENCE WITH SAFETY PLANNING, INJURY DOCUMENTATION, IMMEDIATE EMOTIONAL SUPPORT, LEGAL ADVOCACY, AND OPTIONS FOR LONGER-TERM SUPPORT. TRAINED VOLUNTEER ADVOCATES PROVIDE 24-HOUR ON-SITE ADVOCACY TO PATIENTS AT NORTH MEMORIAL, MAPLE GROVE HOSPITAL, NORTH MEMORIAL CLINICS, AS WELL AS INDIVIDUALS IN OUR COMMUNITIES. ON-GOING SUPPORT BY WEEKLY SUPPORT GROUPS, INDIVIDUAL COUNSELING, AND FOLLOW UP CALLS. IN 2015 THERE WERE AT TOTAL OF 1,474 TOTAL DOMESTIC ABUSE ENCOUNTERS. 4.2-POST-INCIDENCE CRISIS RESPONSE PROGRAM THAT ASSISTS IN COMMUNITY RESPONSE AFTER A VIOLENT CRIME OUR POST INCIDENCE CRISIS RESPONSE PROGRAM IS WHERE WE GATHER NECESSARY RESOURCES FROM VARIOUS HOSPITAL DEPARTMENTS AND POOL THOSE RESOURCES TOGETHER TO DEAL WITH A SUDDEN, OFTEN TRAUMATIC SITUATION THAT OCCURS IN OUR COMMUNITY AND ENDS UP AT THE HOSPITAL. MOST LIKELY THIS IS A SITUATION THAT STEMS FROM A VIOLENT INCIDENT. 4.3-PSYCH SERVICES FOR COMMUNITY: PARTIAL HOSPITAL PROGRAM AND PSYCH INTEGRATION IN PRIMARY CARE IN 2015, NORTH MEMORIAL'S BEHAVIORAL HEALTH DEPARTMENT EXPANDED PROGRAMMING FOR PATIENTS WITH MENTAL ILLNESS BY OPENING AN INTENSIVE OUTPATIENT PROGRAM FOR PATIENTS SUFFERING FROM MOOD DISORDERS. THIS EIGHT-WEEK PROGRAM PROVIDED A NATURAL STEP-DOWN IN CARE FOR PATIENTS IN THE PARTIAL HOSPITAL PROGRAM, AND A LESS-INTENSIVE OPTION FOR STRUGGLING OUTPATIENTS WHO DIDN'T REQUIRE INPATIENT PSYCHIATRIC HOSPITALIZATION. DURING THIS TIME, PSYCHIATRISTS AND PSYCHOLOGISTS WERE ALSO EMBEDDED WITHIN SEVERAL OF NORTH MEMORIAL'S OUTPATIENT CLINICS TO ASSIST PRIMARY CARE PROVIDERS AND ALLOW EASY ACCESS TO MENTAL HEALTH SERVICES FOR PATIENTS. 4.4-CATHOLIC CHARITIES TRANSITIONAL RECOVERY-CARE: PROGRAM FOR DISCHARGING HOMELESS PATIENTS IN 2015, NORTH MEMORIAL'S BEHAVIORAL HEALTH DEPARTMENT EXPANDED PROGRAMMING FOR PATIENTS WITH MENTAL ILLNESS BY OPENING AN INTENSIVE OUTPATIENT PROGRAM FOR PATIENTS SUFFERING FROM MOOD DISORDERS. THIS EIGHT-WEEK PROGRAM PROVIDED A NATURAL STEP-DOWN IN CARE FOR PATIENTS IN THE PARTIAL HOSPITAL PROGRAM, AND A LESS-INTENSIVE OPTION FOR STRUGGLING OUTPATIENTS WHO DIDN'T REQUIRE INPATIENT PSYCHIATRIC HOSPITALIZATION. DURING THIS TIME, PSYCHIATRISTS AND PSYCHOLOGISTS WERE ALSO EMBEDDED WITHIN SEVERAL OF NORTH MEMORIAL'S OUTPATIENT CLINICS TO ASSIST PRIMARY CARE PROVIDERS AND ALLOW EASY ACCESS TO MENTAL HEALTH SERVICES FOR PATIENTS.
Schedule H, Part V, Section B, Line 11, continued: PRIORITY AREA 5-HEALTH INFORMATION 5.1-INJURY PREVENTION: SAFE KIDS NW METRO MINNEAPOLIS COALITION AND THE PARTNERSHIP FOR CHANGE: SAFE KIDS NORTHWEST METRO MINNEAPOLIS THROUGH THE LOW COST BIKE HELMET PROGRAM SOLD OR GAVE AWAY OVER 1,500 BIKE HELMETS DURING 2015. NINE CAR SEAT CLINICS WERE HELD IN THE REGION AND OVER 200 CAR SEATS WERE CHECKED AT THESE EVENTS FOR CORRECT INSTALLATION, KEEPING THESE KIDS SAFE WHILE RIDING IN THEIR VEHICLES. PARTNERSHIP FOR CHANGE MET 11 TIMES IN 2015, WITH ADDITIONAL SUB-COMMITTEE AND WORKGROUP MEETINGS. SOME OF THE MAJOR ACTIVITIES CARRIED OUT INCLUDED: OVER 250 YARD SIGNS/POSTERS/FLYERS PLACED AROUND THE COMMUNITY FOR THE SPRING CAMPAIGN, 15 COMMUNITY PRESENTATIONS ON PLACE OF LAST DRINK INITIATIVE AND OTHER PROGRAMS MAINTAINED UNDER THE COALITION, YOUTH-LED LEADERSHIP GROUPS MET OVER 24 TIMES THROUGHOUT THE SCHOOL YEAR AND COMPLETED A NUMBER OF CAMPAIGNS WITHIN THE HIGH SCHOOL AND COMMUNITY SUCH AS DISTRIBUTED SOCIAL HOST ORDINANCE REMINDERS TO PARENTS AT THE HOMECOMING GAMES AND STICKER SHOCK AT LOCAL LIQUOR STORES. 5.2-STROKE AWARENESS & PREVENTION: THE NORTH MEMORIAL STROKE PROGRAM PARTICIPATED IN MULTIPLE COMMUNITY EVENTS AND SPONSORED TWO EDUCATIONAL WORKSHOPS ON STROKE. WE HAVE THREE ACTIVE SUPPORT GROUPs FOR STROKE SURVIVORS AND THEIR FAMILIES. IN 2015, THE PROGRAM PROVIDED 380 STROKE RISK ASSESSMENT SCREENINGS DURING OUR COMMUNITY OUTREACH EVENTS. TO INCREASE EARLY RECOGNITION OF STROKE BY INDIVIDUALS LIVING IN CRITICAL ACCESS AREAS THE DEPARTMENT FUNDED FAST ADVERTISING ON BILLBOARDS AND GAS PUMPS IN VARIOUS RURAL MINNESOTA CITIES. 5.3-CANCER SCREENING & PREVENTION: NORTH MEMORIAL HELD ORAL/HEAD AND NECK CANCER AWARENESS EVENT AT THE NORTH MEMORIAL OUTPATIENT CENTER ON APRIL 8, 2015. APPROXIMATELY 50 PATIENTS ATTENDED THIS EVENT AT THE NORTH MEMORIAL OUTPATIENT CENTER WHERE DR. KADEMANI, DR. MEHROTRA AND DR. NISI DISCUSSED RISKS OF HEAD AND NECK CANCER, PREVENTION, SMOKING CESSATION, TREATMENTS. THE PATHWAY OUTLINES FOR PRIMARY CARE CLINICS WERE PRESENTED FOR BOTH BREAST CANCER AND COLON CANCER SCREENING AND FOLLOW-UP. NORTH MEMORIAL'S PREVENTION CARE TEAM DEVELOPED AND DROVE MULTIPLE INITIATIVES TO REDUCE THE BARRIERS THAT PATIENTS HAVE EXPRESSED REGARDING BREAST AND COLON CANCER SCREENING. FOR BREAST CANCER SCREENING: -WE LED EFFORTS TO STANDARDIZE THE CORE PROCESSES OF PRIMARY CARE CLINICS IN ORDER TO "SEIZE THE OPPORTUNITY" DURING CLINIC VISITS TO DISCUSS THE IMPORTANCE OF EARLY DETECTION AND BREAST CANCER SCREENING WITH PATIENTS WHO ARE DUE FOR A MAMMOGRAM. -REDUCED THE FINANCIAL AND TRANSPORTATION BARRIERS BY DEVELOPING A PARTNERSHIP WITH THE SAGE PROGRAM. -REDUCED THE FEAR AND ANXIETY OF THE UNKNOWNS OF THE MAMMOGRAM PROCEDURE BY DEVELOPING A "WHAT TO EXPECT DURING A MAMMOGRAM" PATIENT BROCHURE THAT IS NOW AVAILABLE IN ALL CLINICS. IN ADDITION, WE DROVE THE PROJECT TO RAPID RELEASE OF MAMMOGRAM RESULTS VIA MYCHART IN ORDER TO REDUCE THE ANXIETY OF WAITING FOR A MAILED LETTER. -DEVELOPED A PROCESS TO RE-ENGAGE PATIENTS WHO NO-SHOW FOR A SCHEDULED MAMMOGRAM which RE-CLAIMED 61% OF THESE PATIENTS. -APPLIED MULTIPLE OUTREACH APPROACHES TO CREATE AWARENESS AND ENCOURAGE PATIENTS TO GET SCREENED. -2,567 NORTH MEMORIAL PATIENTS WERE UP TO DATE WITH BREAST CANCER SCREENING DURING 2015, WHICH WAS ABOUT 75% OF THE ELIGIBLE PATIENT POPULATION. FOR COLON CANCER SCREENING: -WE LED EFFORTS TO STANDARDIZE THE PROCESS OF OFFERING LESS INVASIVE OPTIONS OF STOOL TESTING -WHEN PATIENTS DO NOT WISH TO SCHEDULE THE GOLD STANDARD OF A COLONOSCOPY. -WE OPERATIONALIZED A FIT KIT/ FOLLOW UP PROCESS, WHICH HAS INCREASED OUR OVERALL SCREENING RATE BY 5%. -APPLIED MULTIPLE OUTREACH APPROACHES TO CREATE AWARENESS AND ENCOURAGE PATIENTS TO GET SCREENED. -18,228 NORTH MEMORIAL PATIENTS WERE UP TO DATE WITH COLON CANCER SCREENING DURING 2015, WHICH WAS ABOUT 74% OF THE ELIGIBLE PATIENT POPULATION. 5.4-ADVANCE CARE PLANNING (ACP): COMMUNITY OUTREACH FOR ADVANCE CARE PLANNING INCLUDES FORMAL PRESENTATIONS TO COMMUNITY GROUPS, AS WELL AS INFORMATION TABLES AT COMMUNITY EVENTS. IN 2015 NORTH MEMORIAL DID FIVE PRESENTATIONS TO COMMUNITY GROUPS SERVING A TOTAL OF 100 PEOPLE. THE PRESENTATIONS INVOLVE A POWERPOINT AND THE OPPORTUNITY FOR ATTENDEES TO FILL OUT A HEALTH CARE DIRECTIVE. 24 HEALTH CARE DIRECTIVES WERE COMPLETED AND NOTARIZED AT THESE EVENTS. A NORTH MEMORIAL STAFF MEMBER ATTENDED THREE COMMUNITY EVENTS WHERE WE MANNED AN ADVANCE CARE PLANNING TABLE. 580 PEOPLE ATTENDED THESE EVENTS AND 140 HEALTH CARE DIRECTIVES WERE DISTRIBUTED. IN ADDITION, WE DONATED 16 HOURS OF TIME TRAINING ACP FACILITATORS IN THE COMMUNITY, ONE FROM A LOCAL CHURCH AND ONE FROM A SKILLED NURSING FACILITY.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


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 Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
North Memorial Health Care
 
Employer identification number

41-0729979
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
(1) OAKDALE MEDICAL CENTER
3300 OAKDALE AVENUE NORTH
ROBBINSDALE,MN55422
32-0022819 		LEASE MEDICAL OFFICE SPACE MN 164,516 13,428,765 NORTH MEMORIAL
 










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)NORTH MEMORIAL FOUNDATION
3300 Oakdale Avenue North

Robbinsdale,MN55422
41-1777966 		Fundraising MN 501(c)(3) 7 North Memorial
 
 
No
(2)Associated Health Assurance
3300 Oakdale Avenue North

Robbinsdale,MN55422
98-0343815 		Insurance BD 501(c)(3) Line 11a, I North Memorial
 
Yes
 
(3)Maple Grove Hospital Corporation
9875 Hospital Drive

Maple Grove,MN55369
20-8316475 		Acute Care MN 501(c)(3) 3 North Memorial
 
Yes
 








For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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) NORTH MEMORIAL AMBULATORY SURGERY CENTER AT MAPLE GROVE

9855 Hospital Drive
Maple Grove,MN55369
26-0393039 		Outpatient Surgery MN  
Related 1,630,170 3,210,469   No   Yes   50.000 %
(2) Minnesota Diagnostic Imaging Partners LLC

2955 Xenium Lane Suite 40
Plymouth,MN55441
35-2162215 		RADIOLOGY MN  
RELATED 1,249,967 1,770,250   No   Yes   60.000 %
(3) North Radiation Therapy Center LLC

6950 France Ave S Suite 200
Edina,MN55435
74-3069974 		RADIOLOGY MN  
related 1,017,680 2,958,699   No   Yes   50.000 %
(4) BLAINE URGENCY CENTER

480 OSBORNE RD NE
FRIDLEY,MN55432
46-1630126 		URGENT CARE MN  
RELATED 36,997 623,964   No   Yes   50.000 %
(5) PLYMOUTH CITY CENTER MEDICAL BUILDING

5700 SMETANA DRIVE SUITE 120
MINNETONKA,MN55343
46-3883617 		Medical Office Building MN  
RELATED -379,990 9,739,618   No   Yes   50.000 %
(6) MINNETONKA AMBULATORY SURGERY CENTER

3300 OAKDALE AVE NORTH
ROBBINSDALE,MN55422
46-5653486 		OUTPATIENT SURGERY MN  
RELATED -1,304,026 1,239,627   No   Yes   76.090 %
(7) Crystal Imaging Center LLC

2955 Xenium Lane Suite 40
PLymouth,MN55441
45-4265124 		MEDICAL OFFICE BUILDING MN  
RElated -55,665 311,475   No   Yes   50.000 %
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) Oakdale Health Enterprises Inc

3300 Oakdale Avenue North
Robbinsdale,MN55422
41-1546422 		Ambulance MN NORTH MEMORIAL
  		C 356,753 1,708,406 100.000 % Yes  
(2) NORTH COLLABORATIVE CARE

3300 Oakdale Avenue North
Robbinsdale,MN55422
46-1680666 		PRIMARY CARE MN  
C         No










Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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
Yes
 
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
Yes
 
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
Yes
 
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
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
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
Yes
 
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) North Memorial Foundation (Contributions)

 C 346,727 FMV
(2) Maple Grove Hospital Corporation (return of capital)

 C 16,462,500 FMV
(3) Maple Grove Hospital Corporation (Debt Guarantee)

 D 100,755,000 FMV
(4) Maple Grove Hospital Corporation (Lease Pmts)

 J 458,957 FMV
(5) Maple Grove Hospital Corporation (Mgmt Fee)

 S 16,613,642 FMV
(6) Maple Grove Hospital Corporation (Salary Reimbursment)

 Q 7,847,823 FMV
(7) Associated Health Assurance (Premiums)

 M 2,673,833 FMV
(8) Oakdale Health Enterprises (Payroll)

 P 1,611,296 FMV
(9) Oakdale Health Enterprises (Mgmt Fees)

 S 322,021 FMV
(10) Oakdale Health Enterprises (Interest on Loan)

 S 43,252 FMV
(11) Oakdale Medical Office Building (Lease Payments)

 J 782,200 FMV
(12) Oakdale Medical Office Building (Expense Reimbursments)

 Q 406,059 FMV
(13) Minneapolis Radiation Oncology (Lease Pmts)

 J 227,470 FMV
(14) North Memorial Ambulatory Surgery Center (Lease PMTS)

 J 1,638,963 FMV
(15) NORTH MEMORIAL AMBULATORY SURGERY CENTER (RETURN OF CAPITAL)

 C 1,337,370 FMV
(16) Minneapolis Radiation Oncology (Dividend)

 R 980,000 FMV
(17) North Memorial Foundation (Staff Support)

 O 824,827 fmv
(18) BLAINE URGENCY CENTER (LINE OF CREDIT)

 D 1,559,197 fmv
(19) Blaine ASC (Capital Contribution)

 B 451,570 FMV
(20) Minnetonka Ambulatory Surgery Center (Capital Contribution)

 B 690,000 FMV
(21) Minnesota Diagnostic Imaging

 S 1,200,000 FMV
(22) North Collaborative Care

 L 207,749 FMV
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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) 2015
Schedule R (Form 990) 2015
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) 2015

Additional Data


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