Totals
- Total revenue
- $272,620
- Total expenses
- $347,207
- Contributions and grants received
- $129,978
- Grants paid
- $336,935
- Program services expenses (Part IX)
- $336,935
- Management and general expenses
- $10,272
- Fundraising expenses
- $0
- Program service expenses (Part III)
- $336,935
Program services were 97.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.
Listed in Part VII
-
Elizabeth Miskovich
Co-Chair
- Total calculated
- $0
- Hours/week
- 1
-
Rose Villenueve GNP
Co-Chair
- Total calculated
- $294,799
- From this org
- $0
- From related orgs
- $250,826
- Other
- $43,973
- Hours/week
- 1 + 40 related
Schedule J breakdown matched by us
- Base
- $0 + $191,209 related
- Bonus
- $0 + $54,094 related
- Other
- $0 + $5,523 related
- Deferred
- $0 + $13,656 related
- Nontaxable benefits
- $0 + $30,317 related
- Filer's total
- $0 + $294,799 related
-
Bryan Sergot
Director
- Total calculated
- $0
- Hours/week
- 1
-
Crystal Burggraf
Director, new 1-2024
- Total calculated
- $0
- Hours/week
- 1
-
Dajana Condos DC
Director
- Total calculated
- $0
- Hours/week
- 1
-
Katie Troumbly RN
Secretary
- Total calculated
- $153,287
- From this org
- $0
- From related orgs
- $142,493
- Other
- $10,794
- Hours/week
- 1 + 40 related
Schedule J breakdown matched by us
- Base
- $0 + $134,201 related
- Bonus
- $0 + $7,588 related
- Other
- $0 + $704 related
- Deferred
- $0 + $8,495 related
- Nontaxable benefits
- $0 + $2,299 related
- Filer's total
- $0 + $153,287 related
-
Kim Morse
Director, new 1-2024
- Total calculated
- $103,237
- From this org
- $0
- From related orgs
- $96,324
- Other
- $6,913
- Hours/week
- 1 + 40 related
-
Mike Aultman
Director
- Total calculated
- $0
- Hours/week
- 1
-
Mike Johnson
Director
- Total calculated
- $0
- Hours/week
- 1
-
Nick Rothstein
Treasurer
- Total calculated
- $0
- Hours/week
- 1 + 1 related
-
Scott Gerling MD
Director
- Total calculated
- $0
- Hours/week
- 1
-
Shane Skelly
Director
- Total calculated
- $0
- Hours/week
- 1
-
Spencer Buchert DDS
Director
- Total calculated
- $0
- Hours/week
- 1
-
Wendy Roy
Director
- Total calculated
- $0
- Hours/week
- 1
-
Brianne Wagner
Foundation Director
- Total calculated
- $186,386
- From this org
- $0
- From related orgs
- $145,047
- Other
- $41,339
- Hours/week
- 40
Schedule J breakdown matched by us
- Base
- $0 + $130,497 related
- Bonus
- $0 + $13,838 related
- Other
- $0 + $712 related
- Deferred
- $0 + $9,213 related
- Nontaxable benefits
- $0 + $32,126 related
- Filer's total
- $0 + $186,386 related
-
Jean MacDonell
Ex-Officio
- Total calculated
- $658,456
- From this org
- $0
- From related orgs
- $568,690
- Other
- $89,766
- Hours/week
- 1 + 40 related
Schedule J breakdown matched by us
- Base
- $0 + $411,164 related
- Bonus
- $0 + $126,585 related
- Other
- $0 + $30,941 related
- Deferred
- $0 + $88,249 related
- Nontaxable benefits
- $0 + $1,517 related
- Filer's total
- $0 + $658,456 related
Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.
Schedule J
Answered yes
- 4b · Supplemental nonqualified retirement plan
- 7 · Other non-fixed payments
Answered no
- 4a · Severance or change-of-control payment
- 4c · Equity-based compensation arrangement
- 5a · Pay contingent on this organization's revenues
- 5b · Pay contingent on a related organization's revenues
- 6a · Pay contingent on this organization's net earnings
- 6b · Pay contingent on a related organization's net earnings
- 8 · Paid under the initial-contract exception
The filer's explanations (Part III)
- Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan
- THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NONQUALIFIED RETIREMENT PLAN: JEAN MACDONELL DUE TO A VESTING EVENT, THE FOLLOWING INDIVIDUALS HAD INCOME IN PART VII AND SCHEDULE J RELATED TO A NONQUALIFIED RETIREMENT PLAN: JEAN MACDONELL $29,940
- Schedule J, Part I, Line 7 Non-fixed payments
- FAIRVIEW HEALTH SERVICES PROVIDES LUMP SUM FINANCIAL AWARDS BASED ON SYSTEM-WIDE, BUSINESS UNIT AND/OR DEPARTMENTS FINANCIAL AND QUALITY MEASURES. ANNUAL GOALS, SPECIFICALLY TIED TO PRODUCTIVITY AND QUALITY INDICATORS, ARE SET FOR THE YEAR AND AN INCENTIVE PAID OUT ANNUALLY IF KEY GOALS AND MEASURES ARE ACHIEVED. THE NON-QUALIFIED PLAN (THE PLAN) IS ONLY OPEN TO A SELECT GROUP OF HIGHLY COMPENSATED EMPLOYEES. THE PLAN CONTRIBUTES THE DIFFERENCE OF WHAT 403(B) EMPLOYER CONTRIBUTIONS WERE MISSED FOR PARTICIPANTS WHO EARN MORE THAN THE IRS LIMIT ON ELIGIBLE COMPENSATION FOR QUALITIED RETIREMENT PLANS. PARTICIPANTS MAY NOT ELECT TO DEFER COMPENSATION. CONTRIBUTIONS WILL BE MADE IN THE FORM OF A CREDIT TO THE PARTICIPANT'S ACCOUNT, WITHIN 60 DAYS AFTER A PARTICIPANT BECOMES VESTED IN A CONTRIBUTION. THE PLAN SHALL PAY TO THE PARTICIPANT AN AMOUNT EQUAL TO THE AMOUNT THE PARTICIPANT IS REQUIRED TO PAY FEDERAL, STATE, LOCAL AND FOREIGN INCOME TAXES AND EMPLOYMENT TAXES DUE TO THE VESTING. THE REMAINING AMOUNT IN THE PARTICIPANT'S ACCOUNT SHALL NOT BE PAID UNTIL THE SEPARATION FROM SERVICES PAYMENT DATE. A PARTICIPANT'S ACCOUNT SHALL BE DISTRIBUTED IN CASH. THE PLAN COMPLIES WITH SECTION 457(F) OF THE IRS CODE.
- Schedule J, Part I, Line 3 Related Org to establish compensation
- THE ORGANIZATION IS PART OF THE FAIRVIEW HEALTH SERVICES SYSTEM AND FAIRVIEW HEALTH SERVICES HUMAN RESOURCES USES COMPARABLES TO ESTABLISH COMPENSATION FOR THE CEO/EXECUTIVE DIRECTOR ACCORDING TO MARKET STANDARDS.
- Schedule J, Part I, Line 4b Other Additional Information
- The non-qualified plan (the plan) is only open to a select group of highly compensated employees. The plan contributes the difference of what 403(b) employer contributions were missed for participants who earn more than the IRS limit on eligible compensation for qualitied retirement plans. Participants may not elect to defer compensation. Contributions will be made in the form of a credit to the participant's account, within 60 days after a participant becomes vested in a contribution. The plan shall pay to the participant an amount equal to the amount the participant is required to pay federal, state, local and foreign income taxes and employment taxes due to the vesting. The remaining amount in the participant's account shall not be paid until the separation from services payment date. A participant's account shall be distributed in cash. The plan complies with Section 457(f) of the IRS code.
Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.
Grants on this return
-
Grand Itasca Clinic and Hospital
$289,224
To support the program services of Grand Itasca Clinic and Hospital
Related organizations on this return
Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.
-
Grand Itasca Clinic and Hospital
501(c)(3) · Hospital · MN
Directly controlled by Fairview Health Services
-
501(c)(3) · Hospital · MN
Directly controlled by NA
Provenance
- Return type
- form_990
- Tax year
- 2024
- Filed
- 7 November 2025
- IRS schema version
- 2024v5.1
- Source object
- 202523119349303557
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