TY 2021 Form 990

(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)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) BILL MARLETTE...................................................................... EVP, CFO & TREASURER-END 12/21	0.50 ................. 59.50		X			2,180,340	13,341
(2) BILL MARLETTE...................................................................... SEE SCH J, PART III, LINES 4A-4B	0.50 ................. 59.50		X			4,817,032	0
(3) BILL GASSEN III...................................................................... TRUSTEE, PRESIDENT & CEO	0.50 ................. 59.50	X	X			3,147,051	207,603
(4) BRYAN NERMOE...................................................................... PRESIDENT & CEO, FARGO	5.00 ................. 55.00			X		1,366,110	527,663
(5) MICHELLE BRUHN...................................................................... EVP, CFO & TREASURER-BEG 12/21	0.50 ................. 59.50		X			1,150,758	117,377
(6) MARIA BELL MD...................................................................... TRUSTEE, PHYSICIAN	0.50 ................. 59.50	X				1,074,403	42,172
(7) MARK LUNDEEN MD...................................................................... TRUSTEE, PHYSICIAN	0.50 ................. 59.50	X				421,764	17,875
(8) JOANN KUNKEL...................................................................... FORMER CFO-SCH J, PART III, 4A-4B	0.00 ................. 0.00				X	339,000	0
(9) ANDY NORTH...................................................................... TRUSTEE, SECRETARY	0.50 ................. 6.61	X	X			303,056	0
(10) MARK PAULSON MD...................................................................... TRUSTEE, PAST CHAIR, PHYSICIAN	0.50 ................. 59.50	X	X			262,715	38,966
(11) BRENT TEIKEN...................................................................... TRUSTEE, CHAIRPERSON	0.50 ................. 6.61	X	X			63,158	0
(12) BARB EVERIST...................................................................... TRUSTEE-END 12/21	0.50 ................. 6.61	X				46,308	0
(13) NEIL GULSVIG...................................................................... TRUSTEE, TREASURER	0.50 ................. 6.61	X	X			36,000	0
(14) WESLEY ENGBRECHT...................................................................... TRUSTEE-BEG 1/21	0.50 ................. 6.61	X				33,000	0
(15) ROBIN SMITH...................................................................... TRUSTEE-BEG 1/21	0.50 ................. 6.61	X				32,000	0
(16) JAMES CAIN...................................................................... TRUSTEE	0.50 ................. 6.61	X				29,500	0
(17) LAURIS MOLBERT...................................................................... TRUSTEE-BEG 1/21	0.50 ................. 6.61	X				29,364	0

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

F-M AMBULANCE SERVICE INC

Employer identification number

45-0344371

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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.

If the organization elected, as permitted under FASB 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.

If the organization elected, as permitted under FASB 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

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

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 .....	410,810		410,810
b	Buildings ....	2,360,494	1,392,731	967,763
c	Leasehold improvements
d	Equipment ....	8,014,284	5,977,340	2,036,944
e	Other .....	133,494	118,105	15,389
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				3,430,906

Schedule D (Form 990) 2021

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)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

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.)

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)OTHER ASSETS-CIP				397,308
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				397,308

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

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
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) 2021

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 X, LINE 2:	CERTAIN CONTROLLED ORGANIZATIONS ARE SUBJECT TO INCOME TAXES. DEFERRED INCOME TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE DIFFERENCES BETWEEN THE FINANCIAL AND INCOME TAX REPORTING BASIS OF ASSETS AND LIABILITIES BASED ON ENACTED TAX RATES AND LAWS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION. THE DEFERRED INCOME TAX PROVISION OR BENEFIT GENERALLY REFLECTS THE NET CHANGE IN DEFERRED INCOME TAX ASSETS AND LIABILITIES DURING THE YEAR. THE CURRENT INCOME TAX PROVISION REFLECTS THE TAX CONSEQUENCES OF REVENUES AND EXPENSES CURRENTLY TAXABLE OR DEDUCTIBLE ON VARIOUS INCOME TAX RETURNS FOR THE YEAR REPORTED. F-M AMBULANCE SERVICE, INC DID NOT HAVE AN INCOME TAX LIABILITY AT DECEMBER 31, 2021; SOME RELATED ORGANIZATIONS HAVE ESTABLISHED RESERVES.

Return Reference

Explanation

PART X, LINE 2:

CERTAIN CONTROLLED ORGANIZATIONS ARE SUBJECT TO INCOME TAXES. DEFERRED INCOME TAX ASSETS AND LIABILITIES ARE RECOGNIZED FOR THE DIFFERENCES BETWEEN THE FINANCIAL AND INCOME TAX REPORTING BASIS OF ASSETS AND LIABILITIES BASED ON ENACTED TAX RATES AND LAWS. A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION. THE DEFERRED INCOME TAX PROVISION OR BENEFIT GENERALLY REFLECTS THE NET CHANGE IN DEFERRED INCOME TAX ASSETS AND LIABILITIES DURING THE YEAR. THE CURRENT INCOME TAX PROVISION REFLECTS THE TAX CONSEQUENCES OF REVENUES AND EXPENSES CURRENTLY TAXABLE OR DEDUCTIBLE ON VARIOUS INCOME TAX RETURNS FOR THE YEAR REPORTED. F-M AMBULANCE SERVICE, INC DID NOT HAVE AN INCOME TAX LIABILITY AT DECEMBER 31, 2021; SOME RELATED ORGANIZATIONS HAVE ESTABLISHED RESERVES.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

F-M AMBULANCE SERVICE INC

Employer identification number

45-0344371

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on 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 .....

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 on Line 1a? ....

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

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:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1BILL MARLETTE EVP, CFO & TREASURER-END 12/21	(i) (ii)	0 ------------- 1,504,270	0 ------------- 431,002	0 ------------- 245,068	0 ------------- 0	0 ------------- 13,341	0 ------------- 2,193,681	0 ------------- 0
2BILL MARLETTE SEE SCH J, PART III, LINES 4A-4B	(i) (ii)	0 ------------- 0	0 ------------- 436,802	0 ------------- 4,380,230	0 ------------- 0	0 ------------- 0	0 ------------- 4,817,032	0 ------------- 0
3BILL GASSEN III TRUSTEE, PRESIDENT & CEO	(i) (ii)	0 ------------- 1,703,249	0 ------------- 1,182,759	0 ------------- 261,043	0 ------------- 205,720	0 ------------- 1,883	0 ------------- 3,354,654	0 ------------- 0
4BRYAN NERMOE PRESIDENT & CEO, FARGO	(i) (ii)	0 ------------- 826,264	0 ------------- 402,504	0 ------------- 137,342	0 ------------- 503,120	0 ------------- 24,543	0 ------------- 1,893,773	0 ------------- 0
5MICHELLE BRUHN EVP, CFO & TREASURER-BEG 12/21	(i) (ii)	0 ------------- 847,016	0 ------------- 179,504	0 ------------- 124,238	0 ------------- 92,080	0 ------------- 25,297	0 ------------- 1,268,135	0 ------------- 0
6MARIA BELL MD TRUSTEE, PHYSICIAN	(i) (ii)	0 ------------- 966,197	0 ------------- 54,000	0 ------------- 54,206	0 ------------- 14,500	0 ------------- 27,672	0 ------------- 1,116,575	0 ------------- 0
7MARK LUNDEEN MD TRUSTEE, PHYSICIAN	(i) (ii)	0 ------------- 420,939	0 ------------- 0	0 ------------- 825	0 ------------- 14,500	0 ------------- 3,375	0 ------------- 439,639	0 ------------- 0
8JOANN KUNKEL FORMER CFO-SCH J, PART III, 4A-4B	(i) (ii)	0 ------------- 0	0 ------------- 339,000	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 339,000	0 ------------- 0
9ANDY NORTH TRUSTEE, SECRETARY	(i) (ii)	0 ------------- 303,056	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 303,056	0 ------------- 0
10MARK PAULSON MD TRUSTEE, PAST CHAIR, PHYSICIAN	(i) (ii)	0 ------------- 261,607	0 ------------- 0	0 ------------- 1,108	0 ------------- 11,913	0 ------------- 27,053	0 ------------- 301,681	0 ------------- 0

Schedule J (Form 990) 2021

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	CERTAIN ITEMS LISTED ON LINE 1A ARE PROVIDED BY RELATED ORGANIZATIONS. PART I, LINE 3: THE EXECUTIVE COMPENSATION COMMITTEE OF THE SANFORD BOARD OF TRUSTEES DIRECTLY ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND EXECUTIVES OF THE ORGANIZATION, INCLUDING THE CEO, AND TO REPORT THE FINDINGS TO THEM FOR DELIBERATION AND ACTION. THE DELIBERATIONS AND ACTIONS ARE RECORDED IN THE MINUTES OF THE SANFORD BOARD OF TRUSTEES. THE MOST RECENT STUDY WAS COMPLETED IN 2021.
PART I, LINES 4A-B	LINE 4A - SEVERANCE OR CHANGE OF CONTROL PAYMENT UPON HIRE OR PROMOTION, SELECT OFFICERS AND KEY EMPLOYEES SIGN AN EXECUTIVE SEVERANCE AGREEMENT (THE "AGREEMENT"). THE AGREEMENT PROVIDES THAT THE EXECUTIVE WILL RECEIVE A MULTIPLE OF HIS OR HER SALARY (BASED ON YEARS OF SERVICE OR POSITION) AS A PAYMENT IN THE EVENT OF A DEFINED SEPARATION EVENT, WHICH CAN INCLUDE AN INVOLUNTARY SEPARATION OR AN EMPLOYEE VOLUNTARILY LEAVING FOR A DEFINED CONTRACTUAL REASON. FINAL SEPARATION PAYMENTS MIGHT VARY FROM THE AMOUNT PROVIDED IN THE AGREEMENT AS A RESULT OF NEGOTIATIONS SURROUNDING POST-SEPARATION OBLIGATIONS AND INCENTIVES (THE "SEPARATION" PAYMENT). LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS SANFORD SPONSORS NONQUALIFIED RETIREMENT PLANS FOR SELECT OFFICERS OR KEY EMPLOYEES. CERTAIN OF THE BELOW OFFICERS OR KEY EMPLOYEES WERE PAID AS A RESULT OF A VESTING EVENT. LINES 4A AND 4B - PAYMENTS THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE OR CHANGE OF CONTROL PAYMENTS AND/OR SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: BILL MARLETTE: 2021 BONUS AND INCENTIVE COMPENSATION $436,802 SEPARATION $2,924,223 NONQUALIFIED RETIREMENT PLAN $1,456,007 TOTAL $4,817,032 JOANN KUNKEL: 2020 BONUS AND INCENTIVE COMPENSATION $339,000

Return Reference

Explanation

PART I, LINE 1A

CERTAIN ITEMS LISTED ON LINE 1A ARE PROVIDED BY RELATED ORGANIZATIONS. PART I, LINE 3: THE EXECUTIVE COMPENSATION COMMITTEE OF THE SANFORD BOARD OF TRUSTEES DIRECTLY ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND EXECUTIVES OF THE ORGANIZATION, INCLUDING THE CEO, AND TO REPORT THE FINDINGS TO THEM FOR DELIBERATION AND ACTION. THE DELIBERATIONS AND ACTIONS ARE RECORDED IN THE MINUTES OF THE SANFORD BOARD OF TRUSTEES. THE MOST RECENT STUDY WAS COMPLETED IN 2021.

PART I, LINES 4A-B

LINE 4A - SEVERANCE OR CHANGE OF CONTROL PAYMENT UPON HIRE OR PROMOTION, SELECT OFFICERS AND KEY EMPLOYEES SIGN AN EXECUTIVE SEVERANCE AGREEMENT (THE "AGREEMENT"). THE AGREEMENT PROVIDES THAT THE EXECUTIVE WILL RECEIVE A MULTIPLE OF HIS OR HER SALARY (BASED ON YEARS OF SERVICE OR POSITION) AS A PAYMENT IN THE EVENT OF A DEFINED SEPARATION EVENT, WHICH CAN INCLUDE AN INVOLUNTARY SEPARATION OR AN EMPLOYEE VOLUNTARILY LEAVING FOR A DEFINED CONTRACTUAL REASON. FINAL SEPARATION PAYMENTS MIGHT VARY FROM THE AMOUNT PROVIDED IN THE AGREEMENT AS A RESULT OF NEGOTIATIONS SURROUNDING POST-SEPARATION OBLIGATIONS AND INCENTIVES (THE "SEPARATION" PAYMENT). LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS SANFORD SPONSORS NONQUALIFIED RETIREMENT PLANS FOR SELECT OFFICERS OR KEY EMPLOYEES. CERTAIN OF THE BELOW OFFICERS OR KEY EMPLOYEES WERE PAID AS A RESULT OF A VESTING EVENT. LINES 4A AND 4B - PAYMENTS THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE OR CHANGE OF CONTROL PAYMENTS AND/OR SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS: BILL MARLETTE: 2021 BONUS AND INCENTIVE COMPENSATION $436,802 SEPARATION $2,924,223 NONQUALIFIED RETIREMENT PLAN $1,456,007 TOTAL $4,817,032 JOANN KUNKEL: 2020 BONUS AND INCENTIVE COMPENSATION $339,000

Schedule J (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

F-M AMBULANCE SERVICE INC

Employer identification number

45-0344371

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	THE FOLLOWING OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE EMPLOYEES OF SANFORD OR ITS RELATED ORGANIZATIONS. MANY OF THESE EMPLOYEES ALSO SERVE ON OTHER RELATED SANFORD BOARDS, OR HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER THAT SPAN THE ORGANIZATION AS A WHOLE: MARIA BELL, MARK LUNDEEN, MARK PAULSON, BRYAN NERMOE, MICHELLE BRUHN, BILL MARLETTE, AND BILL GASSEN.
FORM 990, PART VI, SECTION A, LINE 6	SANFORD NORTH IS THE SOLE STOCKHOLDER OF F-M AMBULANCE.
FORM 990, PART VI, SECTION A, LINE 7A	BOARD MEMBERS ARE APPOINTED BY THE PRESIDENT AND CEO OF SANFORD NORTH.
FORM 990, PART VI, SECTION A, LINE 7B	SANFORD NORTH MUST APPROVE THE FOLLOWING ACTIONS: * MODIFYING THE PURPOSE OF THE CORPORATION * UNBUDGETED CAPITAL EXPENSES IN EXCESS OF 1/2 OF 1% OF APPROVED OPERATING BUDGETS ADOPTION OF CAPITAL AND OPERATING BUDGETS ACQUISITION, SALE, LEASE, DISPOSITION, OR MORTGAGING OF REAL PROPERTY GUARANTEE OF DEBTS OR OBLIGATIONS OF ANY OTHER PERSON, FIRM, CORPORATION, PARTNERSHIP, ASSOCIATION, OR OTHER ENTITY WHICH IF HELD IN DEFAULT WOULD OBLIGATE THE CORPORATION TO AN AGGREGATE AMOUNT IN EXCESS OF $100,000 MERGER OR CONSOLIDATION OF THE CORPORATION INCURRING A LOAN OR OTHER OBLIGATION IN AN AGREEMENT IN EXCESS OF $500,000 FOR MORE THAN 60 DAYS MAKING OF A GIFT, GRANT OR OTHER DONATION IN AN AMOUNT IN EXCESS OF $5,000 TO AN ORGANIZATION NOT RELATED TO THE CORPORATION OR MEMBER *MEMBER HAS THE AUTHORITY TO DIRECT THE CORPORATION REGARDLESS OF THE VOTE BY THE CORPORATION'S BOARD OF DIRECTORS TO TRANSFER ASSETS AND/OR FUNDS TO THE HEALTH SYSTEM TO SATISFY OBLIGATIONS OF THE HEALTH SYSTEM.
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 IS PREPARED INTERNALLY BY THE TAX DEPARTMENT AND REVIEWED BY EXECUTIVE MANAGEMENT. AN EXTERNAL ACCOUNTING FIRM REVIEWS THE RETURN. THE TAX DEPARTMENT PREPARES RETURN HIGHLIGHTS AND KEY DISCLOSURES FOR THE BOARD OF TRUSTEES MEETING PRIOR TO THE RETURN FILING DATE. BEFORE THE RETURN IS FILED, A COMPLETE COPY IS PROVIDED TO THE CURRENT BOARD OF TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 12C	THE ANNUAL CONFLICT OF INTEREST DISCLOSURE PROCESS IS MANAGED BY THE CHIEF COMPLIANCE OFFICER (CCO). THE CCO IS RESPONSIBLE FOR ASSURING THAT ALL COMPLETED FORMS ARE RETURNED IN A TIMELY AND COMPLETE MANNER. CONFLICT OF INTEREST QUESTIONNAIRES ARE SENT TO SYSTEM TRUSTEES, MEMBERS OF THE GOVERNING BOARDS FOR SUBSIDIARY ENTITIES, OFFICERS, AND KEY EMPLOYEES FOR ALL ENTITIES SUBJECT TO THE IRS FORM 990 FILINGS. THE DISCLOSURES ARE SUMMARIZED FOR REVIEW BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES, PURSUANT TO POLICY. THIS REVIEW ALLOWS: 1) THE BOARD TO ACQUIRE AN AWARENESS OF FINANCIAL RELATIONSHIPS OF BOARD MEMBERS AND KEY MANAGEMENT EMPLOYEES AND CAN INVOKE THE RECUSAL PROCESS ON A CASE-BY-CASE BASIS IF POTENTIAL CONFLICTS ARE IMPLICATED IN BOARD DECISIONS AND DELIBERATIONS, AND, 2) GIVES THE BOARD THE OPPORTUNITY TO SEEK ADDITIONAL INFORMATION AND CLARIFICATION ABOUT DISCLOSURES TO DETERMINE POTENTIAL CONFLICTS OF INTEREST AND HOW TO MANAGE THEM.
FORM 990, PART VI, SECTION B, LINE 15	A RELATED PARTY, SANFORD HEALTH, DOES HAVE A PROCESS FOR DETERMINING COMPENSATION OF THE PERSONS LISTED ON PART VII SECTION A, INCLUDING A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, REVIEW OF COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION FOR SUCH COMPENSATION. THE EXECUTIVE COMPENSATION COMMITTEE OF THE SANFORD BOARD OF TRUSTEES DIRECTLY ENGAGES A NATIONALLY RECOGNIZED INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY TO REVIEW THE TOTAL COMPENSATION ARRANGEMENTS OF THE OFFICERS AND EXECUTIVES OF THE ORGANIZATION, INCLUDING THE CEO, AND TO REPORT THE FINDINGS TO THEM FOR DELIBERATION AND ACTION. THE DELIBERATIONS AND ACTIONS ARE RECORDED IN THE MINUTES OF THE SANFORD BOARD OF TRUSTEES. THE MOST RECENT STUDY WAS COMPLETED IN 2021.
FORM 990, PART VI, SECTION C, LINE 19	ALTHOUGH THE ORGANIZATION DOES NOT MAINTAIN A WEBSITE WHERE THE PUBLIC CAN ACCESS THESE DOCUMENTS, IT WOULD RESPOND INDIVIDUALLY TO ANY REQUESTS OR INQUIRIES FROM THE PUBLIC FOR THESE DOCUMENTS.
FORM 990, PART VII	THE SANFORD BOARD OF TRUSTEES HAS ULTIMATE GOVERNANCE RESPONSIBILITIES FOR EACH MAJOR OPERATION ENTITY WITHIN SANFORD. IN ADDITION, A BOARD OF DIRECTORS IS ESTABLISHED FOR EACH MAJOR OPERATING ENTITY. THIS BOARD HAS SPECIFIC RESPONSIBILITIES DELEGATED FROM THE BOARD OF TRUSTEES. GENERALLY THESE RESPONSIBILITIES ARE RELATED TO THE OVERSIGHT OF THE DAY TO DAY OPERATIONS OF THAT ENTITY.
FORM 990, PART XI, LINE 9:	TRANSFER TO RELATED TAX-EXEMPT ORG FOR PAYROLL AND OPERATING EXPENSES -3,452,233.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

F-M AMBULANCE SERVICE INC

Employer identification number

45-0344371

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(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	Yes	No
(1)ADAMS COUNTY GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-1495572	LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP	SD	501(C)(3)	12-I	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(2)ALLIANCE GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 20-4714573	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(3)ARLINGTON GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 37-1805492	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(4)BOISE GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 36-3370371	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	PF	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(5)BROOKINGS GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0439509	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(6)COLLISTER DRIVE HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 30-0872973	LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP	SD	501(C)(3)	PF	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(7)EL PASO GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 27-2876627	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(8)GOOD SAMARITAN SOCIETY INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0349951	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	12-I	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(9)GRANTS GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0439511	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(10)GREELEY GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0456087	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(11)HASTINGS GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0434693	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(12)HASTINGS VILLAGE GARDENS GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 27-1212446	LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP	SD	501(C)(3)	12-I	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(13)HOWARD LAKE GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 36-4885253	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(14)INVER GROVE HEIGHTS GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 76-0789504	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(15)JASONVILLE GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0396355	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(16)JEFFERSONTOWN GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 91-1751137	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(17)KEARNEY GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0421846	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	PF	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(18)LEA COUNTY GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 45-3946645	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(19)LEMARS GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 20-4714415	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(20)LILAC WAY GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-5740381	LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP	SD	501(C)(3)	12-I	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(21)LOVINGTON GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0392944	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(22)MILLARD GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0396332	LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP	SD	501(C)(3)	12-I	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(23)NORTHPORT GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 38-3993597	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(24)OLATHE GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0396398	LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP	SD	501(C)(3)	12-I	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(25)PRESCOTT GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 27-5114421	LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP	SD	501(C)(3)	12-I	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(26)PROPHETSTOWN GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0392943	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(27)RAPID CITY GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-1579750	LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP	SD	501(C)(3)	12-I	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(28)SANFORD P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 27-1218956	SUPPORTING ORGANIZATION	ND	501(C)(3)	12-II			No
(29)SANFORD HEALTH FOUNDATION P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 36-3297853	FOUNDATION	SD	501(C)(3)	12-II	SANFORD HEALTH	Yes
(30)SANFORD HEALTH FOUNDATION NORTH P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 45-0398104	FOUNDATION	ND	501(C)(3)	7	SANFORD NORTH	Yes
(31)SANFORD HEALTH FOUNDATION OF NORTHERN MINNESOTA P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 41-1389317	FOUNDATION	MN	501(C)(3)	7	SANFORD HEALTH OF NORTHERN MINNESOTA	Yes
(32)SANFORD HEALTH FOUNDATION WEST P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 45-0397196	FOUNDATION	ND	501(C)(3)	7	SANFORD BISMARCK	Yes
(33)SIOUX FALLS 57 GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 20-4714647	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(34)SIOUX FALLS DOWNTOWN GOOD SAMARITAN HOUSING GP INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 45-2473519	LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP	SD	501(C)(3)	12-I	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(35)SIOUX FALLS GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0385187	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(36)SOUTH DAYTONA BEACH GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0461264	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(37)THE EVANGELICAL LUTHERAN GOOD SAMARITAN FOUNDATION P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0422866	FOUNDATION	MN	501(C)(3)	7	SANFORD HEALTH	Yes
(38)THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 45-0228055	LONG-TERM CARE, SENIOR HOUSING & HOME AND COMMUNITY BASED SERVICES	ND	501(C)(3)	10	SANFORD	Yes
(39)VALENTINE GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 91-1751139	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(40)WINFIELD GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 20-1115155	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes
(41)WISCONSIN GOOD SAMARITAN HOUSING INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 46-0447338	PROVIDE LOW INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	501(C)(3)	10	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

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	(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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) ADA COUNTY GOOD SAMARITAN HOUSING LP P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 36-4799439	PROVIDE LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	N/A				No			No
(2) ADAMS COUNTY GOOD SAMARITAN HOUSING LP P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 38-3896526	PROVIDE LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	N/A				No			No
(3) COLLISTER DRIVE HOUSING LLC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 61-1752929	LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP	SD	N/A				No			No
(4) GOOD SAMARITAN INSURANCE PLAN LLC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 81-5051671	INSURANCE	DE	N/A				No			No
(5) HASTINGS VILLAGE GARDENS GOOD SAMARITAN HOUSING LP P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 27-1212511	PROVIDE LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	N/A				No			No
(6) LILAC WAY GOOD SAMARITAN HOUSING LP P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 36-4786577	PROVIDE LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	N/A				No			No
(7) MILLARD GOOD SAMARITAN HOUSING LP P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 27-1212324	PROVIDE LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	N/A				No			No
(8) NATIONAL STUDENT HOUSING-SOUTH DAKOTA LLC 100 S PHILLIPS AVE SIOUX FALLS,SD57104 20-2129839	INVESTMENT	SD	N/A				No			No
(9) OLATHE GOOD SAMARITAN HOUSING LP P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 20-5297369	PROVIDE LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	N/A				No			No
(10) PENNINGTON COUNTY GOOD SAMARITAN HOUSING LP P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 38-4060178	PROVIDE LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	N/A				No			No
(11) PRESCOTT GOOD SAMARITAN HOUSING LP P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 27-5115281	PROVIDE LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	N/A				No			No
(12) RAC RENTALS LLC 100 S PHILLIPS AVE SIOUX FALLS,SD57104 26-1961077	INVESTMENT	SD	N/A				No			No
(13) RAPID CITY GOOD SAMARITAN HOUSING LP P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 35-2466169	PROVIDE LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	N/A				No			No
(14) RUTH STREET GOOD SAMARITAN HOUSING LLC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 61-1748321	LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP	SD	N/A				No			No
(15) SIOUX FALLS DOWNTOWN GOOD SAMARITAN LP P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 32-0377442	PROVIDE LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS	SD	N/A				No			No
(16) TEXAS GOOD SAMARITAN HOUSING LLC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 37-1774574	LOW-INCOME HOUSING TO SENIORS AND OTHER ELIGIBLE POPULATIONS AS GP	SD	N/A				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) GOOD SAMARITAN HUMANITARIAN SERVICE INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 20-5533741	MANAGEMENT AND UNBUNDLED SERVICES; UNRELATED BUSINESS ACTIVITIES	SD	N/A	C				Yes
(2) GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 81-5037667	INSURANCE	NE	N/A	C				Yes
(3) GOOD SAMARITAN INSURANCE PLAN OF NORTH DAKOTA P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 81-5037667	INSURANCE	ND	N/A	C				Yes
(4) GOOD SAMARITAN INSURANCE PLAN OF SOUTH DAKOTA INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 81-4989242	INSURANCE	SD	N/A	C				Yes
(5) GOOD SAMARITAN SOCIETY INSURANCE LTD P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 98-0379099	INSURANCE	CJ	N/A	C				Yes
(6) HERITAGE HEALTHCARE OF NORTHERN NEW MEXICO INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 90-0491537	PROVIDE HOME AND COMMUNITY BASED SERVICES	NM	N/A	S				Yes
(7) HERITAGE HEALTHCARE SERVICES INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 85-0418562	PROVIDE HOME AND COMMUNITY BASED SERVICES	NM	N/A	S				Yes
(8) HERITAGE HOME HEALTHCARE & HOSPICE INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 85-0463468	PROVIDE HOME AND COMMUNITY BASED SERVICES	NM	N/A	S				Yes
(9) HERITAGE HOME HEALTHCARE OF ARIZONA INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 20-4243949	PROVIDE HOME AND COMMUNITY BASED SERVICES	NM	N/A	S				Yes
(10) HERITAGE HOME HEALTHCARE SERVICES INC P O BOX 5039 RTE 5218 SIOUX FALLS,SD571175039 85-0463469	PROVIDE HOME AND COMMUNITY BASED SERVICES	NM	N/A	S				Yes
(11) SANFORD FRONTIERS 1305 W 18TH STREET PO BOX 5039 SIOUX FALLS,SD571175039 45-5436599	WEIGHT LOSS/FITNESS	SD	N/A	C				Yes
(12) SANFORD HEALTH PLAN 300 CHERAPA PLACE SIOUX FALLS,SD57103 91-1842494	INSURANCE	SD	N/A	C				Yes
(13) SANFORD HEALTH PLAN OF MN 300 CHERAPA PLACE SIOUX FALLS,SD57103 46-0445852	INSURANCE	MN	N/A	C				Yes
(14) SANFORD INTERNATIONAL - MUNICH GMBH NYMPHENBURGER STRASSE 3 MUNICH GM	HEALTHCARE	GM	N/A	C				Yes
(15) SANFORD WORLD CLINICS - GHANA SARBAH ROAD TANTRI LORRY STATION CAPE COAST GH	HEALTHCARE	GH	N/A	C				Yes
(16) SHANGHAI SANFORD HEALTHCARE MANAGEMENT CONSULTING CO LTD 188 YESHENG ROAD ROOM A-862 GUOMA SHANGHAI CH	HEALTHCARE	CH	N/A	C				Yes

Schedule R (Form 990) 2021

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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

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) SANFORD HEALTH	P	3,452,233	CASH METHOD

Schedule R (Form 990) 2021

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)	(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
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: "DEDICATED TO THE WORK OF HEALTH AND HEALING"
2	Check this box
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	6
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	930,278	221,483
9	Program service revenue (Part VIII, line 2g) .........	16,516,908	18,436,733
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,977	0
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	9,352	5,094
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	17,459,515	18,663,310
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)	10,149,657	10,845,284
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	3,634,876	4,167,470
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	13,784,533	15,012,754
19	Revenue less expenses. Subtract line 18 from line 12.......	3,674,982	3,650,556
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	6,442,712	6,709,124
21	Total liabilities (Part X, line 26).............	108,308	176,397
22	Net assets or fund balances. Subtract line 21 from line 20.....	6,334,404	6,532,727

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 12,604,384 including grants of $ ) (Revenue $ 18,436,733 )
	AS PART OF THE SANFORD HEALTH INTEGRATED DELIVERY SYSTEM, F-M AMBULANCE SERVICE, INC. (FMA) PROVIDES EMERGENCY MEDICAL CARE AND SPECIALTY CARE TRANSPORTATION SERVICES TO FARGO, NORTH DAKOTA/MOORHEAD, MINNESOTA METRO AREA AND SURROUNDING COMMUNITIES. FMA IS ACCREDITED BY THE COMMISSION ON ACCREDITATION OF AMBULANCE SERVICES (CAAS) AND IS THE LARGEST ADVANCED LIFE SUPPORT GROUND AMBULANCE PROVIDER IN NORTH DAKOTA AND OUTSTATE MINNESOTA. FMA RESPONDS TO MORE THAN 35,000 CALLS FOR SERVICE ANNUALLY WHICH RESULTED IN TRANSPORTING MORE THAN 24,000 PEOPLE AND OVER 9,000 CALLS THAT DID NOT RESULT IN A PATIENT TRANSPORT. FMA SERVES AS A RESOURCE TO RESCUE SQUADS, FIRE DEPARTMENTS, LAW ENFORCEMENT AGENCIES AND BASIC LIFE SUPPORT AMBULANCE PROVIDERS THROUGHOUT THE STATE. FMA PROVIDES TACTICAL PARAMEDICS FOR THE REGIONAL S.W.A.T. TEAM AND PROVIDES FIREFIGHTER REHAB SERVICES PRO-BONO. FMA WORKS CLOSELY WITH LOCAL VOLUNTEER SERVICES TO COORDINATE THE DELIVERY OF EMERGENCY MEDICAL CARE TO COMMUNITIES IN ITS SERVICE AREA AND IS A LEADER IN HOMELAND DEFENSE PREPAREDNESS BY SERVING AS A REGIONAL TRAINING SITE, RESOURCES PARTNER AND FIRST RESPONDER.THROUGH ITS READY WHEELS OPERATIONS (A SPECIALTY CARE TRANSPORTATION SERVICE), FMA PROVIDES LOCAL AND LONG DISTANCE TRANSPORTATION FOR INDIVIDUALS CONFINED TO WHEELCHAIRS. THIS SPECIALTY CARE TRANSPORTATION SERVICE IS AVAILABLE 24 HOURS A DAY, SEVEN DAYS A WEEK TO PROVIDE DOOR-TO-DOOR SERVICE. THESE SERVICES ALLOW INDIVIDUALS IN THE COMMUNITY TO ACCESS TRANSPORTATION SERVICES THAT ACCOMMODATE UNIQUE INDIVIDUAL NEEDS DUE TO HEALTH CONDITIONS.EDUCATION AND OTHER SERVICES:FMA PROMOTES COMMUNITY HEALTH AND INJURY PREVENTION WITH MORE THAN 8,000 MEMBERS OF THE PUBLIC EACH YEAR PARTICIPATING IN FIRST AID, AUTOMATED EXTERNAL DEFIBRILLATOR, CPR, BABYSITTER TRAINING AND OTHER COMMUNITY WELLNESS COURSES. FMA IS ALSO THE HOME TO THE REGION'S LARGEST INITIAL EMS CERTIFICATION CENTER. EMERGENCY MEDICAL RESPONDER CLASSES ARE TAUGHT TO AREA FIRE DEPARTMENTS, LAW ENFORCEMENT AGENCIES AND LOCAL OR INDUSTRIAL RESCUE SQUADS. EMT CLASSES ARE HELD MULTIPLE TIMES A YEAR AND SUPPLY STAFFING FOR FULL-TIME AND VOLUNTEER AGENCIES ACROSS OUR AREA. NEW IN 2021, FMA OFFERS FREE EMT TRAINING AND MENTAL HEALTH TRAINING FOR RURAL RESPONDERS IN ND AND MN.IN CONJUNCTION WITH THE NORTH DAKOTA STATE COLLEGE OF SCIENCE, OUR PARAMEDIC PROGRAM OFFERS AN ASSOCIATE DEGREE LEVEL COURSE ACCREDITED BY THE COMMISSION ON ACCREDITATION OF ALLIED HEALTH EDUCATION PROGRAMS (ONE OF 3 IN ND). FMA ALSO OFFERS RECERTIFICATION COURSES IN-PERSON AND VIRTUALLY THAT ARE ACCREDITED THROUGH THE COMMISSION ON ACCREDITATION FOR PRE-HOSPITAL CONTINUING EDUCATION (ONLY ONE IN ND). SEVERAL OF OUR EDUCATORS ARE ACTIVE REGIONALLY AND NATIONALLY ON EMS EDUCATION TOPICS.

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 expenses12,604,384

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	15,360,059	964,997

(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/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) DON JACOBS........................................................................ TRUSTEE, VICE CHAIRPERSON	0.50 .......................6.61	X	X	0	28,500	0

(A) Name and business address	(B) Description of services	(C) Compensation





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 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	288
e	Government grants (contributions)		1e	221,195

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		221,483

		Business Code
2a	EMERGENCY MEDICAL SERV	621910	17,669,789	17,669,789
b	EDUCATION	611430	658,053	658,053
c	SPECIAL TRANSPORTATION	621910	108,891	108,891
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		18,436,733

3 Investment income (including dividends, interest, and othersimilar amounts) ......
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a	13,815
b	Less: cost of goods sold ..		10b	8,721
c	Net income or (loss) from sales of inventory..			5,094			5,094
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			18,663,310	18,436,733	0	5,094

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........
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........	8,845,745	7,664,635	1,181,110
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	423,617	371,828	51,789
9	Other employee benefits .......	905,989	719,048	186,941
10	Payroll taxes ...........	669,933	583,679	86,254
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,225		1,225
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	688,987	587,530	101,457
12	Advertising and promotion ....	65,197	56,304	8,893
13	Office expenses .......	122,489	78,442	44,047
14	Information technology ......	363,818	106,452	257,366
15	Royalties ..
16	Occupancy ...........	215,147	131,182	83,965
17	Travel ............	329,773	321,353	8,420
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	201,142	195,689	5,453
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	793,905	747,621	46,284
23	Insurance ...	283,551	2,586	280,965
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	980,107	947,431	32,676
b	MINNESOTACARE TAX	48,816	48,816
c
d
e	All other expenses	73,313	41,788	31,525
25	Total functional expenses. Add lines 1 through 24e	15,012,754	12,604,384	2,408,370	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			-10,060	1	250
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			1,123,374	4	1,481,111
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			7,531	8	6,218
9	Prepaid expenses and deferred charges ......			17,413	9	249
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	10,919,082
b	Less: accumulated depreciation	10b	7,488,176	3,502,743	10c	3,430,906
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............			1,393,082	14	1,393,082
15	Other assets. See Part IV, line 11 ...........			408,629	15	397,308
16	Total assets. Add lines 1 through 15 (must equal line 33)...			6,442,712	16	6,709,124

17	Accounts payable and accrued expenses .....	108,308	17	176,397
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			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		25
26	Total liabilities. Add lines 17 through 25..	108,308	26	176,397

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	6,334,404	27	6,532,727
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	6,334,404	32	6,532,727
33	Total liabilities and net assets/fund balances ........	6,442,712	33	6,709,124