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Nonprofiteer
← MAPLE GROVE HOSPITAL CORPORATION

Form 990 for tax year 2022

Filed by MAPLE GROVE HOSPITAL CORPORATION.

Totals

Total revenue
$263,077,125
Total expenses
$224,834,241
Contributions and grants received
$2,354,667
Grants paid
$0
Program services expenses (Part IX)
$194,709,046
Management and general expenses
$30,125,195
Fundraising expenses
$0
Program service expenses (Part III)
$194,709,046

Program services were 86.6% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • J KEVIN CROSTON MD

    PRESIDENT AND CEO

    Total calculated
    $2,285,767
    From this org
    $0
    From related orgs
    $1,741,361
    Other
    $544,406
    Hours/week
    2 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,326,539 related
    Bonus
    $0 + $386,500 related
    Other
    $0 + $28,322 related
    Deferred
    $0 + $518,000 related
    Nontaxable benefits
    $0 + $26,406 related
    Filer's total
    $0 + $2,285,767 related

  • DAN FROMM

    TREASURER AND CFO

    Total calculated
    $767,227
    From this org
    $0
    From related orgs
    $720,094
    Other
    $47,133
    Hours/week
    2 + 42 related

    Schedule J breakdown matched by us

    Base
    $0 + $574,616 related
    Bonus
    $0 + $128,625 related
    Other
    $0 + $16,853 related
    Deferred
    $0 + $18,000 related
    Nontaxable benefits
    $0 + $29,133 related
    Filer's total
    $0 + $767,227 related

  • SAMANTHA HANSON

    DIRECTOR

    Total calculated
    $797,013
    From this org
    $0
    From related orgs
    $758,976
    Other
    $38,037
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $624,191 related
    Bonus
    $0 + $123,750 related
    Other
    $0 + $11,035 related
    Deferred
    $0 + $18,000 related
    Nontaxable benefits
    $0 + $20,037 related
    Filer's total
    $0 + $797,013 related

  • CAROLYN OGLAND MD

    DIRECTOR

    Total calculated
    $712,432
    From this org
    $0
    From related orgs
    $669,757
    Other
    $42,675
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $529,616 related
    Bonus
    $0 + $118,500 related
    Other
    $0 + $21,641 related
    Deferred
    $0 + $18,000 related
    Nontaxable benefits
    $0 + $24,675 related
    Filer's total
    $0 + $712,432 related

  • JAMES HEREFORD

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • ROBERT BEACHER

    DIRECTOR

    Total calculated
    $0
    Hours/week
    2

  • ANDREW COCHRANE

    CHIEF HOSPITAL OFFICER

    Total calculated
    $783,037
    From this org
    $0
    From related orgs
    $739,611
    Other
    $43,426
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $590,000 related
    Bonus
    $0 + $132,750 related
    Other
    $0 + $16,861 related
    Deferred
    $0 + $18,000 related
    Nontaxable benefits
    $0 + $25,426 related
    Filer's total
    $0 + $783,037 related

  • PAMELA DOORENBOS MD

    VP MEDICAL AFFAIRS

    Total calculated
    $434,500
    From this org
    $399,284
    From related orgs
    $0
    Other
    $35,216
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $320,535
    Bonus
    $68,750
    Other
    $9,999
    Deferred
    $18,000
    Nontaxable benefits
    $17,216
    Filer's total
    $434,500

  • WENDY ULFERTS

    VP PATIENT CARE/ CHIEF NUR

    Total calculated
    $403,391
    From this org
    $369,447
    From related orgs
    $0
    Other
    $33,944
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $300,506
    Bonus
    $62,500
    Other
    $6,441
    Deferred
    $18,000
    Nontaxable benefits
    $15,944
    Filer's total
    $403,391

  • ZWIRCHITZ FAITH E

    DIR, WMNS & CHILDRENS

    Total calculated
    $247,113
    From this org
    $218,900
    From related orgs
    $0
    Other
    $28,213
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $187,933
    Bonus
    $28,070
    Other
    $2,897
    Deferred
    $8,640
    Nontaxable benefits
    $19,573
    Filer's total
    $247,113

  • VUGTEVEEN SHERYL L

    DIR, ACUTE CARE

    Total calculated
    $245,282
    From this org
    $211,442
    From related orgs
    $0
    Other
    $33,840
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $179,310
    Bonus
    $26,728
    Other
    $5,404
    Deferred
    $12,398
    Nontaxable benefits
    $21,442
    Filer's total
    $245,282

  • ANNAMMA CHANDY

    PATIENT CARE FACILITATOR

    Total calculated
    $225,859
    From this org
    $198,427
    From related orgs
    $0
    Other
    $27,432
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $196,826
    Bonus
    $1,105
    Other
    $496
    Deferred
    $9,273
    Nontaxable benefits
    $18,159
    Filer's total
    $225,859

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

  • 3 · Independent compensation consultant
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 4b · Supplemental nonqualified retirement plan

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
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
THE CHIEF EXECUTIVE OFFICER IS AN EMPLOYEE OF NORTH MEMORIAL HEALTH CARE. OTHER BOARD MEMBERS LISTED WITH COMPENSATION FROM A RELATED ORGANIZATION ARE OFFICERS AND KEY EMPLOYEES OF NORTH MEMORIAL HEALTH CARE WHO PROVIDE SERVICES TO MAPLE GROVE HOSPITAL AS WELL AS TO ALL OR SOME RELATED ENTITIES AS IDENTIFIED ON SCHEDULE R. AS SUCH, THEIR COMPENSATION LEVELS INCORPORATE SERVICES PROVIDED TO MULTIPLE NORTH MEMORIAL ENTITIES.
PART I, LINE 4B
DR. KEVIN CROSTON RECIEVED A CONTRIBUTION TO HIS 457(F) PLAN OF $500,000 DURING THE TAX YEAR. THIS AMOUNT IS INCLUDED IN COLUMN (C) OF SCHEDULE J, PART II. THE AMOUNT WAS UNVESTED AS OF THE END OF THE TAX YEAR.

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

No itemized grants to organizations on this return.

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.

Provenance

Return type
form_990
Tax year
2022
Filed
15 November 2023
IRS schema version
2022v5.0
Source object
202343199349311999

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