2024-11-07T11:29:57-06:00 2023-12-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2023-01-01 411700972 LAKE VIEW MEMORIAL HOSPITAL FOUNDATION OF NORTHEAST MINNESOTA LAKE 2188347300 325 11TH AVENUE TWO HARBORS MN 55616 JERRY M YANG ASPIRUS SENIOR VP & CFO 2188347300 2024-11-04 1 0 KURT BENNION CPA P01469618 6123764500 2024-11-04 2023 2024-10-15 13:58:12Z GREG RUBERG 325 11TH AVENUE TWO HARBORS MN 55616 43543 0 X N/A X 1990 MN PROVIDE CHARITABLE FINANCIAL SUPPORT FOR LAKE VIEW MEMORIAL HOSPITAL. 6 5 0 5 0 0 55604 15603 0 0 78525 27940 0 0 134129 43543 10575 3005 0 0 0 0 0 0 0 377 7565 10952 10570 123177 32973 798038 916334 0 0 798038 916334 PROVIDES CHARITABLE FINANCIAL SUPPORT TO LAKE VIEW MEMORIAL HOSPITAL, INC. TO ADVANCE COMPASSIONATE PATIENT CARE AND IMPROVE THE HEALTH OF THE COMMUNITY. 0 0 3005 3005 0 CHARITABLE SUPPORT TO LAKE VIEW MEMORIAL HOSPITAL, TO ADVANCE COMPASSIONATE AND HIGH-QUALITY PATIENT CARE AND IMPROVE THE HEALTH OF THE COMMUNITY. 3005 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 5 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X X NATHAN CAVALLIN 2188347300 325 11TH AVENUE TWO HARBORS MN 55616 SHELLEY FREDRICKSON CHAIR 1.00 0.00 X X 0 4117 118 LAREESA SANDRETSKY VICE CHAIR 1.00 0.00 X X 0 0 0 LAURIE KRAGSETH TREASURER 1.00 0.00 X X 0 0 0 ROLAND KANE DIRECTOR 1.00 0.00 X 0 0 0 CHARLIE MICHELS DIRECTOR 1.00 0.00 X 0 0 0 SANDI PILLSBURY-GREDZENS DIRECTOR 1.00 0.00 X 0 0 0 ERIC LOHN ST. LUKE'S CO-PRESIDENT/CE0 1.00 39.00 X 0 1026111 79070 NICHOLAS VAN DEELEN MD ST. LUKE'S CO PRESIDENT/CMO 1.00 39.00 X 0 990213 79070 GREG RUBERG LAKE VIEW PRESIDENT/CEO 1.00 39.00 X 0 300272 49893 NATHAN CAVALLIN LAKE VIEW FINANCE DIRECTOR 1.00 39.00 X 0 94804 32228 0 2415517 240379 0 0 1 0 0 15603 15603 12285 12285 15655 0 15655 15655 15655 43543 0 0 27940 1005 1005 2000 2000 7255 7255 310 310 10570 3005 7565 0 204077 217454 15805 17765 578156 681115 798038 916334 0 0 X 798038 916334 798038 916334 798038 916334 32973 83013 2310 0 X 0 1 X 1 0 X X X 1 LAKE VIEW MEMORIAL HOSPITAL 410786046 3 1 1005 0 1 1005 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV, SECTION A, LINE 2: LAKE VIEW MEMORIAL HOSPITAL, THE SUPPORTED ORGANIZATION, IS CLASSIFIED AS A PUBLIC CHARITY UNDER SECTION 170(B)(1)(A)(III) FOR PROVIDING HEALTHCARE SERVICES AS A HOSPITAL. LAKE VIEW MEMORIAL HOSPITAL FOUNDATION OF NORTHEAST MINNESOTA COMPLETED THE PUBLIC SUPPORT CALCULATION IN FORM 990, SCHEDULE A, PART III FOR LAKE VIEW MEMORIAL HOSPITAL FOR THE PERIOD JANUARY 1, 2019 TO DECEMBER 31, 2023, WHICH SHOWED THAT LAKE VIEW MEMORIAL HOSPITAL WOULD ALSO QUALIFY AS A PUBLIC CHARITY UNDER SECTION 509(A)(2). 0 X PART X, LINE 2: THE FOUNDATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) THAT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(C)(3) OF THE CODE. THE FOUNDATION HAS ELECTED TO ADOPT GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE FOUNDATION FOLLOWS THE ACCOUNTING STANDARD FOR CONTINGENCIES FOR EVALUATING UNCERTAIN TAX POSITIONS. THE ADOPTION OF THIS STANDARD HAS NO EFFECT ON THE FINANCIAL STATEMENTS. THE FOUNDATION'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. 0 1 0 0 0 0 0 0 0 ERIC LOHN ST. LUKE'S CO-PRESIDENT/CE0 0 885321 0 139548 0 1242 0 51757 0 27313 0 1105181 0 0 NICHOLAS VAN DEELEN MD ST. LUKE'S CO PRESIDENT/CMO 0 833406 0 149325 0 7482 0 51757 0 27313 0 1069283 0 0 GREG RUBERG LAKE VIEW PRESIDENT/CEO 0 260593 0 38944 0 735 0 18765 0 31128 0 350165 0 0 PART I, LINE 3 THE PRESIDENT/CEO OF LAKE VIEW MEMORIAL HOSPITAL AND FOUNDATION IS AN EMPLOYEE OF ST. LUKE'S HOSPITAL OF DULUTH, A 501(C)(3) RELATED ORGANIZATION. THE FOLLOWING METHODS ARE USED BY ST. LUKE'S WHEN DETERMINING THE CEO'S COMPENSATION: 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. WRITTEN EMPLOYMENT CONTRACT 4. COMPENSATION SURVEY OR STUDY 5. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B ST. LUKE'S HOSPITAL OF DULUTH MAINTAINS 457(F) NONQUALIFIED DEFERRED COMPENSATION PLANS FOR ELIGIBLE EMPLOYEES. IN 2023, CONTRIBUTIONS TO THE 457(F) PLANS WERE: ERIC LOHN - $43,607 NICHOLAS VAN DEELEN - $43,607 GREG RUBERG - $10,958 IN 2023, DISTRIBUTIONS FROM THE 457(F) PLAN WERE: ERIC LOHN - $139,548 NICHOLAS VAN DEELEN - $149,325 GREG RUBERG - $38,944 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE OF THE FOUNDATION IS MADE UP OF THE OFFICERS OF THE BOARD OF DIRECTORS AND SHALL HAVE ALL THE POWERS AND AUTHORITY OF THE BOARD OF DIRECTORS OF THIS ORGANIZATION IN TRANSACTING THE REGULAR BUSINESS OF THE ORGANIZATION, INCLUDING DIRECTING THE MANAGEMENT OF THE PROPERTY, AFFAIRS AND BUSINESS OF THE ORGANIZATION, DURING THE INTERVAL BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT AT ALL TIMES TO THE DIRECTION AND CONTROL OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 3 THE FOUNDATION HAS A MANEGMENT SERVICE AGREEMENT WITH WITH ST. LUKE'S HOSPITAL. SERVICES ARE PROVIDED BY BOTH ST. LUKE'S AND LAKE VIEW EMPLOYEES. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE FOUNDATION SHALL BE LAKE VIEW MEMORIAL HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7A THE FOUNDATION'S BOARD OF DIRECTORS SHALL BE ELECTED BY THE BOARD OF DIRECTORS OF THE LAKE VIEW MEMORIAL HOSPITAL, ITS SOLE MEMBER, OR BY AN OFFICER OF THE HOSPITAL DESIGNATED BY THE HOSPITAL'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS MUST BE APPROVED BY THE BOARD OF DIRECTORS OF LAKE VIEW MEMORIAL HOSPITAL. IN ADDITION TO DOING ALL THINGS REQUIRED BY LAW AND EXCEPT AS OTHERWISE PROVIDED, THE CORPORATE MEMBER SHALL HAVE THE FOLLOWING SPECIFIC RIGHTS AND RESPONSIBILITIES: A) APPOINT THE BOARD OF DIRECTORS; B) APPROVE ANY CHANGE IN THE PHILOSOPHY, CHARACTER OR MISSION, AND APPROVE THE LONG-RANGE GOALS, STRATEGIC PLANS AND OVERALL PURPOSES; C) APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF LAKE VIEW MEMORIAL HOSPITAL AND ALL SUBSIDIARIES; D) APPROVE THE ADDITION OF NEW MEMBERS; E) APPROVE THE ESTABLISHMENT, TRANSFER AND/OR DISSOLUTION OF ANY SUBSIDIARY CORPORATION; F) APPROVE LONG-TERM BORROWING OF MONEY AND OTHER FORMS OF LONG-TERM INDEBTEDNESS; G) APPROVE THE PURCHASE, SALE, LEASE, DISPOSITION, ENCUMBRANCE OR ALIENATION OF REAL PROPERTY, AND THE SALE, LEASE DISPOSITION OR ENCUMBRANCE OF SUBSTANTIALLY ALL OF THE PERSONAL PROPERTY; H) PARTICIPATE IN THE PREPARATION OF, AND GIVE APPROVAL TO, ANY PLAN OF DISSOLUTION OR MERGER, CONSOLIDATION, ACQUISITION OR DISPOSITION OF REAL PROPERTY OR RELOCATION OF THE FACILITIES; I) RATIFY THE CHIEF EXECUTIVE OFFICER AS RECOMMENDED BY THE BOARD OF DIRECTORS; J) APPROVE ANY RECOMMENDATION BY THE BOARD OF DIRECTORS TO REMOVE THE CHIEF EXECUTIVE OFFICER AND CONDUCT REGULAR EVALUATION OF THE CHIEF EXECUTIVE OFFICER IN CONJUNCTION WITH THE BOARD OF DIRECTORS; K) CONDUCT, THROUGH THE CORPORATE MEMBER'S CEO, REGULAR EVALUATIONS OF THE CHIEF EXECUTIVE OFFICER OF THE HOSPITAL IN CONJUNCTION WITH THE BOARD OF DIRECTORS; L) RATIFY THE BUDGETS AND APPROVE UNBUDGETED CAPITAL EXPENDITURES GREATER THAN $100,000 IN ANY ONE FISCAL YEAR; M) REVIEW AND APPROVE THE AUDITED FINANCIAL REPORTS; N) RATIFY THE SELECTION AND RETENTION OF THE INDEPENDENT AUDITING FIRM AND LEGAL COUNSEL; AND O) HAVE THE EXCLUSIVE AUTHORITY TO APPROVE ALL USE BY THE CORPORATION OF THE NAME "ST LUKE'S HOSPITAL AND ANY OTHER TRADE, NAMES OR REFERENCES TO ST LUKE'S. FORM 990, PART VI, SECTION B, LINE 11B A FINAL DRAFT OF THE FORM 990 WAS PREPARED AND REVIEWED BY THE FOLLOWING GROUPS 1.) LAKE VIEW'S OFFICERS AND SENIOR MANAGEMENT; 2.) LAKE VIEW FOUNDATION'S BOARD OF DIRECTORS. IN THE CASE OF THE BOARD OF DIRECTORS, A COPY OF THE FINAL DRAFT WAS SENT TO THEM FOR REVIEW AND APPROVAL PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C EACH DIRECTOR, OFFICER AND COMMITTEE MEMBER SHALL SIGN, AS A CONDITION TO SERVING THE CORPORATION IN HIS/HER RESPECTIVE ROLE AND ANNUALLY THEREAFTER, A STATEMENT AGREEING TO BE BOUND BY THE TERMS OF THE POLICY. PURSUANT TO THE POLICY, ANY DIRECTOR, OFFICER OR COMMITTEE MEMBER HAVING A FINANCIAL INTEREST IN A CONTRACT OR OTHER TRANSACTION PRESENTED TO THE BOARD OF DIRECTORS OR A COMMITTEE THEREOF FOR AUTHORIZATION, APPROVAL, OR RATIFICATION SHALL MAKE A PROMPT, FULL AND FRANK DISCLOSURE OF SUCH PERSON'S INTEREST TO THE BOARD OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. SUCH DISCLOSURE SHALL INCLUDE ANY RELEVANT AND MATERIAL FACTS, KNOWN TO SUCH PERSON, ABOUT THE CONTRACT OR TRANSACTION WHICH MIGHT REASONABLY BE CONSTRUED TO BE ADVERSE TO THE CORPORATION'S INTEREST. THE BOARD OR COMMITTEE TO WHICH SUCH DISCLOSURE IS MADE SHALL THEREUPON DETERMINE, BY MAJORITY VOTE, WHETHER THE DISCLOSURE SHOWS THAT A CONFLICT OF INTEREST EXISTS OR CAN REASONABLY BE CONSTRUED TO EXIST. IF A CONFLICT IS DEEMED TO EXIST, SUCH PERSON SHALL NOT VOTE ON, NOR USE PERSONAL INFLUENCE ON, OR PARTICIPATE (OTHER THAN TO PRESENT FACTUAL INFORMATION TO OR RESPOND TO QUESTIONS) IN THE DISCUSSIONS AND DELIBERATIONS WITH RESPECT TO SUCH CONTRACT OR TRANSACTION. SUCH PERSON MAY BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM AT ANY MEETING WHERE THE CONTRACT OR TRANSACTION IS UNDER DISCUSSION OR IS BEING VOTED UPON. THE MINUTES OF THE MEETING SHALL REFLECT THE DISCLOSURE MADE, THE VOTE AND, WHERE APPLICABLE, THE ABSTENTION FROM VOTING AND PARTICIPATION, AND WHETHER A QUORUM WAS PRESENT. FORM 990, PART VI, SECTION C, LINE 18 IN ADDITION TO BEING AVAILABLE UPON REQUEST, THE FOUNDATION'S FORM 990 IS INCLUDED ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE REVIEWED AND UPDATED (IF NECESSARY) ANNUALLY BY THE BOARD OF DIRECTORS. THEY ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC. THE FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC. THE FORM 990 IS MADE AVAILABLE TO THE PUBLIC IN ACCORDANCE WITH IRS GUIDANCE. LAKE VIEW MEMORIAL HOSPITAL INC 325 11TH AVENUE TWO HARBORS MN 55616 410786046 HEALTH CARE / HOSPITAL MN 501(C)(3) LINE 3 ST LUKE'S HOSPITAL OF DULUTH 0 ST LUKE'S HOSPITAL OF DULUTH 915 E 1ST STREET DULUTH MN 55805 410714079 HEALTH CARE / HOSPITAL MN 501(C)(3) LINE 3 N/A 0 ST LUKE'S FOUNDATION 1000 E 1ST STREET SUITE 120 DULUTH MN 55805 411448118 FUNDRAISING SUPPORT FOR ST. LUKE'S HOSPITAL OF DULUTH MN 501(C)(3) LINE 12A, I ST LUKE'S HOSPITAL OF DULUTH 0 NORTHERN LAKES SURGERY CENTER LLC 4570 COUNTY HIGHWAY 61 MOOSE LAKE MN 55767 874431494 SURGICAL SERVICES MN N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0