Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 | |||||
| (A)
Dakota Medical Foundation |
456012318 | 7 | Yes | 1,212,000 | 0 | |
| (B)
Class of supported organizations |
000000000 | 7 | No | 419,751 | 0 | |
|
Total 2
|
1,631,751 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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.).. | ||||||
| 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 | ||||
| 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 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Part IV, Section A, Line 1: | Dakota Medical Foundation is specified by name in the organization's governing documents. In addition, the governing documents specify a class of organizations operated exclusively for one or more purposes described in Section 501(c)(3) that are exempt from federal income taxes under Section 501(a) and the support of which is consistent with the charitable health-related purposes of Dakota Medical Foundation. The organization supports Dakota Medical Foundation and other 501(c)(3) organizations that fall within the charitable health-related purposes of Dakota Medical Foundation. |
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Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, line 3 | The ChildcareAlive! initiative, which is part of the Chronic Disease Prevention grant, ceased funding at the beginning of 2019. In 2019, the GiveBack Website, ImpactGiveBack.org, was transitioned to the new GivingHeartsDay.org site. This technology platform allows charities to accept online contributions from donors, share their stories, and engage volunteers. |
| Form 990, Part VI, Section A, line 1 | The Executive Committee will be comprised of the Chair, Vice Chair, Secretary, Treasurer, the Chairs of the Governance Committee, Finance/Investment Committee, and Strategic Platforms Committee, and up to two Board Members At-Large. The Immediate Past Chair shall also serve on the Executive Committee. The Board Member(s) At-Large shall be elected by the Board at its organizational meeting. Four (4) members of the total committee membership shall be members of the medical staff of hospitals or clinics. The Executive Committee: A. Shall be responsible for the day-to-day activities of the Foundations. B. May review actions of all the Foundation's committees and give recommendations to the Board. C. Shall annually evaluate the performance of the Executive Director and may appoint a Compensation Subcommittee to conduct the evaluation. D. Shall set the Executive Director's annual compensation and terms of employment. E. Shall recommend to the Board a process for recruiting and selecting an Executive Director of the Foundations in the event of a vacancy in the position. F. Shall review and recommend to the Board the number and salary ranges of all staff of the Foundations. G. Shall review and may make expenditures up to and including fifty thousand dollars ($50,000) without Board approval unless otherwise specifically prohibited. |
| Form 990, Part VI, Section A, line 2 | J. Patrick Traynor has a business relationship, as an employee and Executive Director of Dakota Medical Foundation (a related organization), with Michael Schumacher who serves as the CFO and is an employee of Dakota Medical Charities, and the Board members of the Foundations pursuant to the business relationship definition per IRS guidelines. Board members include: Barbra Brookshire, OD, Julene Brown, RN, Richard Vetter, M.D., Chris Kennelly, Susan Mathison, M.D., Ben Meland, Eric Monson, Nancy Slotten, Sindy Keller, Hope Yongsmith, M.D., Seth Novak, Amanda Thomas, Robert Bakkum, Rob Lauf, DDS, Nola McNeally, David Akkerman, M.D., Kim Meyer, Ann Malmberg, RN and John Deutsch, Pharm D. Ben Meland, John Deutsch, and Seth Novak have a business relationship in real estate investments. |
| Form 990, Part VI, Section A, line 6 | The sole member of the organization is Dakota Medical Foundation. |
| Form 990, Part VI, Section A, line 7a | The voting board members of Dakota Medical Charities consist of the voting members that have been elected to serve on the Board of Directors of Dakota Medical Foundation. |
| Form 990, Part VI, Section A, line 7b | The sole member, Dakota Medical Foundation, has the power and right, prior to the Board of Directors taking final action, to approve or reject or consent with on the following matters: -The adoption and implementation of annual operating and capital budgets; -Capital expenditures in excess of any specific limit that may from time to time be established; -The sale or transfer of assets other than in the ordinary course of business; -Any amendment of the Articles of Incorporation or the Bylaws; -Merger, reorganization, dissolution, or transfer of any substantial portion of the assets; -The incurrence of debt; -The compensation of officers; -The adoption and modification of employee benefit plans. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is provided to all Board members for review and comment prior to filing. In addition, the filed copy is presented as an agenda item at the next scheduled Board meeting. |
| Form 990, Part VI, Section B, line 12c | Board Members and staff are annually required to review and declare conflicts. Members of the Foundations' management follow written procedures for staff conflicts. Board Members abstain from voting on any issues that create a conflict of interest. |
| Form 990, Part VI, Section B, line 15b | The Executive Director's performance and compensation are reviewed annually by the Executive Committee. The Executive Director's compensation changes are approved by the Board. The Executive Director's compensation was reviewed in December 2016 by HR Advisors, an independent human resource consulting firm engaged by the Board to establish a reasonable and competitive base compensation range. Changes to compensation in subsequent years are based on the established range, performance and inflationary changes, and compared with the Council on Foundations' annual salary surveys and other available relevant sources. Other staff compensation ranges are reviewed by the Executive Committee and/or the Executive Director and compared periodically with the Council on Foundations' salary surveys and other available relevant sources. |
| Form 990, Part VI, Section C, line 19 | The Foundations make their governing documents, conflict of interest policy, and audited consolidated financial statements available to the public upon request. |
| Form 990, Part XII, Line 2c: | The Finance/Investment Committee has responsibility for oversight of the annual audit of the Foundations' consolidated financial statements and the selection of an independent accountant. The Finance/Investment Committee recommends to the Board of Directors for approval the results of the annual audit and the annual selection of the independent accountant. |
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