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Nonprofiteer
← OLIVIA HOSPITAL & CLINIC FOUNDATION

Form 990 for tax year 2023

Filed by OLIVIA HOSPITAL & CLINIC FOUNDATION.

Totals

Total revenue
$224,257
Total expenses
$266,739
Contributions and grants received
$169,746
Grants paid
$244,762
Program services expenses (Part IX)
$252,276
Management and general expenses
$14,463
Fundraising expenses
$0
Program service expenses (Part III)
$252,276

Program services were 94.6% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • BECCA THIESSE

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JENNIFER MACIK

    DIRECTOR & CHAIR

    Total calculated
    $236,524
    From this org
    $0
    From related orgs
    $192,512
    Other
    $44,012
    Hours/week
    1 + 56 related

    Schedule J breakdown matched by us

    Base
    $0 + $159,365 related
    Bonus
    $0 + $33,147 related
    Other
    $0
    Deferred
    $0 + $8,807 related
    Nontaxable benefits
    $0 + $35,205 related
    Filer's total
    $0 + $236,524 related

  • SARA BENSON

    DIRECTOR & TREASURER

    Total calculated
    $0
    Hours/week
    1

  • SHANE WOHLMAN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • AMY HOLLAN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • JAN SIMONSEN

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • BARBARA MELBERG

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • AMY DEWANE

    DIRECTOR

    Total calculated
    $525,628
    From this org
    $0
    From related orgs
    $458,049
    Other
    $67,579
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $333,972 related
    Bonus
    $0 + $104,314 related
    Other
    $0 + $19,763 related
    Deferred
    $0 + $24,750 related
    Nontaxable benefits
    $0 + $42,829 related
    Filer's total
    $0 + $525,628 related

  • HEATHER JESERITZ

    DIRECTOR & SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • NATHAN PULSCHER

    DIRECTOR & PRESIDENT

    Total calculated
    $379,987
    From this org
    $0
    From related orgs
    $313,799
    Other
    $66,188
    Hours/week
    1

    Schedule J breakdown matched by us

    Base
    $0 + $261,957 related
    Bonus
    $0 + $45,121 related
    Other
    $0 + $6,721 related
    Deferred
    $0 + $28,036 related
    Nontaxable benefits
    $0 + $38,152 related
    Filer's total
    $0 + $379,987 related

  • TOM KROES

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • NANCY A ANDERSON

    CFO

    Total calculated
    $254,620
    From this org
    $0
    From related orgs
    $209,639
    Other
    $44,981
    Hours/week
    1 + 44 related

    Schedule J breakdown matched by us

    Base
    $0 + $172,345 related
    Bonus
    $0 + $37,294 related
    Other
    $0
    Deferred
    $0 + $9,528 related
    Nontaxable benefits
    $0 + $35,453 related
    Filer's total
    $0 + $254,620 related

  • JACKIE EDWARDS

    DIRECTOR & COMM RELATIONS

    Total calculated
    $133,428
    From this org
    $0
    From related orgs
    $97,837
    Other
    $35,591
    Hours/week
    1

  • NATHAN BLAD

    FORMER PRESIDENT

    Total calculated
    $353,202
    From this org
    $0
    From related orgs
    $302,156
    Other
    $51,046
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $0 + $217,354 related
    Bonus
    $0 + $83,562 related
    Other
    $0 + $1,240 related
    Deferred
    $0 + $27,462 related
    Nontaxable benefits
    $0 + $23,584 related
    Filer's total
    $0 + $353,202 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

  • 6b · Pay contingent on a related organization's net earnings

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 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
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
OLIVIA HOSPITAL & CLINIC FOUNDATION HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. ALL OFFICERS AND KEY EMPLOYEES ARE PAID BY GROUP HEALTH, INC OR BY PARK NICOLLET HEALTH SERVICES OR HEALTHPARTNERS RC, RELATED ORGANIZATIONS. ANY COMPENSATION IS DETERMINED SOLELY BY THE RELATED ORGANIZATIONS.
PART I, LINE 6
OLIVIA HOSPITAL & CLINIC FOUNDATION OFFICERS AND DIRECTORS ARE EMPLOYED BY GROUP HEALTH PLAN, INC (GHI), PARK NICOLLET HEALTH SERVICES (PNHS) OR BY HEALTHPARTNERS RC (HPRC), RELATED ORGANIZATIONS. COMPENSATION REPORTED IN FORM 990, PART VII INCLUDES ANY COMPENSATION DERIVED FROM GHI, PNHS OR HPRC LEADERSHIP INCENTIVE PROGRAMS WHICH INCENT AND REWARD BUSINESS LEADERS WHO HELP THE ORGANIZATION ACHIEVE STATED BUSINESS AND/OR HEALTH IMPROVEMENT GOALS FOR A SPECIFIC FISCAL YEAR. THE PROGAMS ARE A KEY ELEMENT OF THE PARTICIPANT'S TOTAL COMPENSATION PACKAGE. THE LEADERSHIP INCENTIVE PROGRAMS' REWARDS ARE BASED ON POSITION IN THE ORGANIZATION (E.G., SENIOR VICE PRESIDENT, VICE PRESIDENT, DIRECTOR MANAGER, OR OTHER SPECIFICALLY IDENTIFIED LEADERS) AND THE ACHIEVEMENT OF BUSINESS AND HEALTH IMPROVEMENT GOALS ESTABLISHED IN A VARIETY OF AREAS. GOALS WILL BE RELATED TO THE ORGANIZATION'S STRATEGIC PLAN AND WILL BE BALANCED. THESE AREAS MAY INCLUDE, BUT ARE NOT LIMITED TO, PATIENT SATISFACTION, EMPLOYEE SATISFACTION, WORK ENVIRONMENT, HEALTH EQUITY, HEALTHCARE AFFORDABILITY MEASURES, FINANCIAL PERFORMANCE (OPERATING INCOME), ETC AND WILL BE DEFINED ANNUALLY FOR EACH YEAR'S PROGRAM. AN OPERATING INCOME THRESHOLD MUST BE MET FOR ANY PAYMENT TO BE MADE FROM THE PROGRAM AND THERE IS A CAP ON THE MAXIMUM INCENTIVE POTENTIALLY AVAILABLE TO EACH PARTICIPANT.

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

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
2023
Filed
13 November 2024
IRS schema version
2023v5.1
Source object
202443189349306054

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