2024-08-05T08:44:01-05:00 2023-09-30 420714325 RSM US LLP 227 WEST FIRST STREET SUITE 700 DULUTH MN 55802 990 2022-10-01 411738787 RIVERWOOD HEALTHCARE CENTER & COMMUNITY HOSPITAL FOUNDATION RIVE 2189272121 200 BUNKER HILL AITKIN MN 56431 CASEY JOHNSON RHCC CFO 2189272121 2024-08-05 1 0 JULIE BOYER P01278549 2187275025 2024-08-05 2022 2024-08-08 14:25:15Z KEN WESTMAN 200 BUNKER HILL AITKIN MN 56431 761444 0 X WWW.RIVERWOODHEALTHCARE.ORG/FOUNDATION/ X 1992 MN TO SUPPORT CAPITAL IMPROVEMENTS AND ACTIVITIES OF AITKIN COMMUNITY HOSPITAL, INC. D/B/A RIVERWOOD HEALTHCARE CENTER; TO SPONSOR SPECIFIC PROJECTS AND PROGRAMS TO CONTINUE TO ENHANCE HEALTHCARE IN RURAL MINNESOTA; AND TO PROMOTE AND ENCOURAGE HEALTH EDUCATION. 12 9 0 100 0 0 1214059 273702 0 0 163037 191761 -9550 -15948 1367546 449515 189604 497880 0 0 0 0 0 0 14409 136787 103134 326391 601014 1041155 -151499 6771811 6630854 0 0 6771811 6630854 RIVERWOOD FOUNDATION EXISTS TO RAISE MONEY FOR RIVERWOOD HEALTHCARE CENTER TO ENHANCE THE QUALITY OF CARE FOR THE COMMUNITY WE SERVE. 0 0 499262 497880 0 THE FOUNDATION HELPS RIVERWOOD HEALTHCARE CENTER BY RAISING FUNDS TO SUPPORT ADVANCED MEDICINE AND ALLOWING MEDICAL CARE TO BE DELIVERED LOCALLY SO THAT PATIENTS DON'T HAVE TO TRAVEL OUT OF THE AREA. IT RECOGNIZES THE IMPORTANCE OF QUALITY HEALTHCARE IN OUR RURAL AREA AND PURCHASES CAPITAL EQUIPMENT FOR THE HOSPITAL. THE FOUNDATION IS COMMITTED TO MAINTAINING AND EXPANDING QUALITY HEALTHCARE FOR RESIDENTS OF AITKIN COUNTY AND SURROUNDING COMMUNITIES. 499262 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 12 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X JUDY TURNER 2189272121 200 BUNKER HILL AITKIN MN 56431 MELISSA MAGNUSON DIRECTOR/PROVIDER 1.00 39.00 X 0 119670 39390 STEPHANIE JACOBS DIRECTOR/RHCC EMPLOYEE 1.00 39.00 X 0 39219 30353 LANE FISCHER DIRECTOR/RHCC EMPLOYEE 1.00 39.00 X 0 26649 29804 PEG LUNDBERG DIRECTOR 1.00 X 0 0 0 LOREN LARSON DIRECTOR 1.00 X 0 0 0 MARK MEYER DIRECTOR 1.00 X 0 0 0 TOM KUPPICH DIRECTOR 1.00 X 0 0 0 KATHLEEN RYAN DIRECTOR 1.00 X 0 0 0 DAVID HOMMES TREASURER 1.00 X X 0 0 0 SHIRLEY WINEGAR VICE CHAIR 1.00 X X 0 0 0 TERRY BUTENHOFF SECRETARY 1.00 X X 0 0 0 HENRY BRUCKER CHAIR 1.00 X X 0 0 0 KEN WESTMAN RHCC CEO 1.00 39.00 X 0 402039 36590 CASEY JOHNSON RHCC CFO 1.00 39.00 X 0 239131 43937 TODD SANDBERG RHCC CEO UNTIL 7/31/21 (FORMER OFFICER) 1.00 39.00 X 0 196923 0 0 1023631 180074 0 1 1 0 0 57285 101780 114637 115335 273702 166212 166212 295750 270201 25549 25549 25549 16880 57285 41728 -24848 -24848 REFUND INCOME 900099 8900 8900 8900 449515 0 0 175813 X 478130 478130 19750 19750 11363 11363 61757 61757 13519 1216 258 12045 4144 4144 6360 6360 MEMBERSHIPS AND DUES 3489 28 3461 CATERING 2275 2275 BAD DEBT EXPENSE 138 138 PLANNED GIVING 89 89 601014 499262 87343 14409 424691 232302 596566 731991 647048 544913 55220 61484 4345250 4345250 703036 714914 6771811 6630854 0 0 X 5024270 5219689 1747541 1411165 6771811 6630854 6771811 6630854 -151499 10542 0 X 0 0 0 X X 1 AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD HEALTHCARE CENTER 410745522 3 1 478130 0 1 478130 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 536857 0 50366 15000 572223 656179 8000 -111322 16000 536857 593667 77512 15000 656179 542002 250 51415 593667 558828 18132 31974 26932 40000 542002 0.25479 0.47137 0.27383 0 0 0 PART V, LINE 4: TO BE USED AND DISTRIBUTED AS A SCHOLARSHIP OR EDUCATIONAL FUND TO AID IN THE EDUCATION AND RECRUITMENT OF HEALTH CARE PROFESSIONALS FOR RIVERWOOD HEALTHCARE CENTER. GOLF CHARITY EVENT 46940 32710 14230 2675 9011 7123 4855 GALA EVENT 27225 24575 2650 10880 2000 2650 2534 74165 57285 16880 13555 11011 9773 7389 41728 -24848 1 RIVERWOOD HEALTHCARE CENTER 200 BUNKER HILL DRIVE AITKIN MN 56431 410745522 501(C)(3) 478130 0 TO SUPPORT HOSPITAL OPERATIONS; FOR PURCHASE OF EQUIPMENT AND SOFTWARE 1 0 ZACH JOHNSON - KIDS WITH CANCER 4 9000 CASH WILSON SCHOLARSHIP 1 2250 CASH EMILY'S GIFT - ASSISTANCE FOR INDIVIDUALS IN NEED 2 500 CASH ZILVERBERG SCHOLARSHIP 5 8000 CASH PART I, LINE 2: PROOF OF PREVIOUSLY INCURRED QUALIFYING EXPENSES OR INVOICE, PURCHASE ORDER, QUOTE FOR FUTURE QUALIFYING EXPENDITURES. 1 0 0 0 0 0 0 0 0 KEN WESTMAN RHCC CEO 0 376994 0 25000 0 45 0 7139 0 29451 0 438629 0 0 CASEY JOHNSON RHCC CFO 0 202036 0 37050 0 45 0 9934 0 34003 0 283068 0 0 TODD SANDBERG RHCC CEO UNTIL 7/31/21 (FORMER OFFIC 0 0 0 0 0 196923 0 0 0 0 0 196923 0 0 MELISSA MAGNUSON DIRECTOR/PROVIDER 0 119625 0 0 0 45 0 5267 0 34123 0 159060 0 0 PART I, LINE 3 RIVERWOOD HEALTHCARE CENTER AND COMMUNITY HOSPITAL FOUNDATION DOES NOT COMPENSATE ANY INDIVIDUALS. THE CEO IS COMPENSATED BY THE AITKIN COMMUNITY HOSPITAL, DBA RIVERWOOD HEALTHCARE CENTER. THE COMPENSATION IS ESTABLISHED USING: - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION COMMITTEE - FORM 990 OF OTHER ORGANIZATIONS - COMPENSATION SURVERY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4A RIVERWOOD HEALTHCARE CENTER, A RELATED ORGANIZATION, PAID TODD A. SANDBERG, FORMER CEO, $196,923 IN SEVERENCE PAYMENTS DURING CALENDAR YEAR 2022. THE TERMINATION TERMS ARE FROM AUGUST 1, 2021 TO JULY 31, 2022. MR. SANDBERG RECEIVED PAY TOTALING $320,000 AND BENEFITS TOTALING $14,300 RELATED TO HIS TERMINATION. X SUPPLIES 1 101780 FMV X EVENT DONATIONS 31 13555 FMV 0 0 1 0 PART I, COLUMN (B): REPORTING THE NUMBER OF CONTRIBUTIONS FORM 990, PART VI, SECTION B, LINE 11B THE BOARD REVIEWS AND APPROVES THE 990 AFTER PREPARATION. AFTER APPROVAL, THE 990 IS SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY. RIVERWOOD HEALTHCARE CENTER & COMMUNITY HOSPITAL FOUNDATION ADOPTED RIVERWOOD HEALTHCARE CENTER'S CONFLICT OF INTEREST POLICY. SECTION 1. PURPOSE THE PURPOSE OF THIS POLICY IS TO PROVIDE A MEANS BY WHICH TO ADDRESS ANY CONFLICT OF INTEREST INVOLVING THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT, OR EMPLOYED PRACTITIONERS, AND EMPLOYEES THAT AFFECT OR HAVE THE POTENTIAL TO AFFECT THE SAFETY OR QUALITY OF CARE, TREATMENT, AND SERVICES. SECTION 2. PERSONS CONCERNED THIS STATEMENT IS DIRECTED NOT ONLY TO BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT, OR EMPLOYED PRACTITIONERS, BUT TO ALL EMPLOYEES OR NON-EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF RHCC. FOR EXAMPLE, THIS WOULD INCLUDE ALL WHO MAKE PURCHASING DECISIONS, ALL PERSONS WHO MIGHT BE DESCRIBED AS "MANAGEMENT PERSONNEL, AND ANYONE WHO HAS PROPRIETARY INFORMATION CONCERNING RHCC. SECTION 3. AREAS IN WHICH CONFLICT MAY ARISE CONFLICTS OF INTEREST MAY ARISE IN THE RELATIONS OF THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS, AND MANAGEMENT EMPLOYEES WITH ANY OF THE FOLLOWING THIRD PARTIES: 1. PERSONS AND FIRMS SUPPLYING GOODS AND SERVICES TO RHCC. 2. PERSONS AND FIRMS FROM WHOM RHCC LEASES PROPERTY AND EQUIPMENT. 3. PERSONS AND FIRMS WITH WHOM RHCC IS DEALING OR PLANNING TO DEAL IN CONNECTION WITH THE GIFT, PURCHASE OR SALE OF REAL ESTATE, SECURITIES, OR OTHER PROPERTY. 4. COMPETING OR AFFINITY ORGANIZATIONS. 5. DONORS AND OTHERS SUPPORTING RHCC. 6. AGENCIES, ORGANIZATIONS AND ASSOCIATIONS WHICH AFFECT THE OPERATIONS OF RHCC. 7. FAMILY MEMBERS, FRIENDS, AND OTHER EMPLOYEES. SECTION 4. NATURE OF CONFLICTING INTEREST A CONFLICTING INTEREST MAY BE DEFINED AS AN INTEREST, DIRECT OR INDIRECT, WITH ANY PERSONS OR FIRMS MENTIONED IN SECTION 3. SUCH AN INTEREST MIGHT ARISE THROUGH: SECTION 5. INTERPRETATION OF THIS STATEMENT OF POLICY THE AREAS OF CONFLICTING INTEREST LISTED IN SECTION 3, AND THE RELATIONS IN THOSE AREAS WHICH MAY GIVE RISE TO CONFLICT, AS LISTED IN SECTION 4, ARE NOT EXHAUSTIVE. CONFLICTS MIGHT ARISE IN OTHER AREAS OR THROUGH OTHER RELATIONS. IT IS ASSUMED THAT THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS, AND MANAGEMENT EMPLOYEES WILL RECOGNIZE SUCH AREAS AND RELATION BY ANALOGY. THE FACT THAT ONE OF THE INTERESTS DESCRIBED IN SECTION 4 EXISTS DOES NOT NECESSARILY MEAN THAT A CONFLICT EXISTS, OR THAT THE CONFLICT, IF IT EXISTS, IS MATERIAL ENOUGH TO BE OF PRACTICAL IMPORTANCE, OR IF MATERIAL, THAT UPON FULL DISCLOSURE OF ALL RELEVANT FACTS AND CIRCUMSTANCES IT IS NECESSARILY ADVERSE TO THE INTERESTS OF RHCC. HOWEVER, IT IS THE POLICY OF THE GOVERNING BOARD THAT THE EXISTENCE OF ANY OF THE INTERESTS DESCRIBED IN SECTION 4 SHALL BE DISCLOSED BEFORE ANY TRANSACTION IS CONSUMMATED. IT SHALL BE THE CONTINUING RESPONSIBILITY OF THE BOARDS OF DIRECTORS, OFFICERS, LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS, AND MANAGEMENT EMPLOYEES TO SCRUTINIZE THEIR TRANSACTIONS AND OUTSIDE BUSINESS INTERESTS AND RELATIONSHIPS FOR POTENTIAL CONFLICTS AND TO IMMEDIATELY MAKE SUCH DISCLOSURES. SECTION 6. DISCLOSURE POLICY AND PROCEDURE PROCEDURES FOR ADDRESSING CONFLICTS OF INTEREST. TRANSACTIONS WITH PARTIES WITH WHOM A CONFLICTING INTEREST EXISTS MAY BE UNDERTAKEN ONLY IF ALL OF THE FOLLOWING ARE OBSERVED: 1. THE CONFLICTING INTEREST AND ALL MATERIAL FACTS ARE FULLY DISCLOSED TO THE GOVERNING BOARD OF DIRECTORS OR TO A COMMITTEE WITH BOARD-DELEGATED POWERS; 2. THE PERSON WITH THE CONFLICT OF INTEREST MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE OR SHE SHALL BE EXCLUDED FROM THE DISCUSSION AND VOTE ON APPROVAL OF SUCH TRANSACTION; 3. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT; 4. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER RHCC CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST; 5. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN RHCC'S BEST INTEREST AND FOR ITS OWN BENEFIT AND WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO RHCC, AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. DISCLOSURE DISCLOSURE IN RHCC SHOULD BE MADE TO THE CHIEF EXECUTIVE OFFICER (OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE BOARD CHAIR), WHO SHALL BRING THE MATTER TO THE ATTENTION OF THE GOVERNING BOARD OF DIRECTORS. DISCLOSURE INVOLVING DIRECTORS SHOULD BE MADE TO THE GOVERNING BOARD CHAIR (OR IF SHE OR HE IS THE ONE WITH THE CONFLICT, THEN TO THE GOVERNING BOARD VICE-CHAIR) WHO SHALL BRING THESE MATTERS TO THE GOVERNING BOARD. DECISION THE GOVERNING BOARD OF DIRECTORS OR A COMMITTEE WITH GOVERNING BOARD-DELEGATED POWERS SHALL DETERMINE WHETHER A CONFLICT EXISTS AND IN THE CASE OF AN EXISTING CONFLICT, WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED AS JUST, FAIR, AND REASONABLE TO RHCC. IN THE CASE OF A CONFLICT INVOLVING A MEMBER OF THE GOVERNING BOARD OF DIRECTORS, THE GOVERNING BOARD OR COMMITTEE REVIEWING THE MATTER SHALL CONSIDER THE DISABLING GUIDELINES ATTACHED HERETO. THE DECISION OF THE GOVERNING BOARD OR COMMITTEE ON THESE MATTERS WILL REST IN ITS SOLE DISCRETION, AND ITS CONCERN MUST BE THE WELFARE OF RHCC AND THE ADVANCEMENT OF RHCC'S PURPOSE. SECTION 7. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY 1. IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE PERSON OF THE BASIS FOR SUCH BELIEF AND AFFORD THE PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. 2. IF, AFTER HEARING THE RESPONSE OF THE PERSON AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THAT THE PERSON HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION, WHICH MAY INCLUDE NO ACTION, REPRIMAND, REQUEST FOR RESIGNATION OR REMOVAL FROM THE BOARD OF DIRECTORS AS THE FACTS AND CIRCUMSTANCES MAY WARRANT. SECTION 9. COMPENSATION 1. A VOTING MEMBER OF THE BOARD OF DIRECTORS WHO RECEIVES COMPENSATION FOR PROVISION OF SERVICES AS AN EMPLOYEE OR CONTRACTOR, DIRECTLY OR INDIRECTLY, FROM RHCC IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 2. A VOTING MEMBER OF ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM RHCC FOR SERVICES IS PRECLUDED FROM VOTING ON MATTERS PERTAINING TO THAT MEMBER'S COMPENSATION. 3. NO MEMBER OF THE BOARD OR ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS AND WHO RECEIVES COMPENSATION, DIRECTLY OR INDIRECTLY, FROM RHCC, EITHER INDIVIDUALLY OR COLLECTIVELY, IS PROHIBITED FROM PROVIDING INFORMATION TO ANY COMMITTEE REGARDING COMPENSATION. 4. PHYSICIANS WHO RECEIVE COMPENSATION FROM RHCC, WHETHER DIRECTLY OR INDIRECTLY OR AS EMPLOYEES OR INDEPENDENT CONTRACTORS, ARE PRECLUDED FROM MEMBERSHIP ON ANY COMMITTEE WHOSE JURISDICTION INCLUDES COMPENSATION MATTERS. NO PHYSICIAN, EITHER INDIVIDUALLY OR COLLECTIVELY, IS PROHIBITED FROM PROVIDING INFORMATION TO ANY COMMITTEE REGARDING PHYSICIAN COMPENSATION. SECTION 10. ANNUAL STATEMENTS EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING OR FOUNDATION BOARD DELEGATED POWERS, AND ALL LICENSED INDEPENDENT, CONTRACT OR EMPLOYED PRACTITIONERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON-- 1. HAS RECEIVED A COPY OF THE CONFLICTS OF INTEREST POLICY; 2. HAS READ AND UNDERSTANDS THE POLICY; 3. HAS AGREED TO COMPLY WITH THE POLICY; AND 4. UNDERSTANDS THAT RHCC IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 61,757. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 61,757. AITKIN COMMUNITY HOSPITAL DBA RIVERWOOD HEALTHCARE CENTER 200 BUNKER HILL DRIVE AITKIN MN 56431 410745522 HOSPITAL MN 501(C)(3) LINE 3 N/A 0 RIVERWOOD MEDICAL PROPERTIES LLC 200 BUNKER HILL DRIVE AITKIN MN 56431 823113322 SUPPORT MN 501(C)(3) LINE 12A, I RIVERWOOD HEALTHCARE CENTER 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0