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Nonprofiteer
← OLIVIA HOSPITAL & CLINIC FOUNDATION

Form 990 for tax year 2022

Filed by OLIVIA HOSPITAL & CLINIC FOUNDATION.

Totals

Total revenue
$486,700
Total expenses
$169,007
Contributions and grants received
$459,313
Grants paid
$158,930
Program service revenue
$0
Investment income
$22,004
Other revenue
$5,383
Total assets, end of year
$2,474,261
Total liabilities, end of year
$9,623
Net assets or fund balances, end of year
$2,464,638
Program services expenses (Part IX)
$169,007
Management and general expenses
$0
Fundraising expenses
$0
Program service expenses (Part III)
$169,007

Program services were 100.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1c · Fundraising events

    $17,318

  • 1d · Related organizations

    $16,450

  • 1f · All other contributions, gifts and grants

    $425,545

  • 1g · Noncash contributions included above

    $13,860

  • 3 · Investment income

    total $22,004 · excluded $22,004

  • 8a · Fundraising events: gross income

    $13,036

  • 8a · Fundraising events: contributions included on line 1c

    $17,318

  • 8b · Fundraising events: direct expenses

    $7,653

  • 8c · Net income from fundraising events

    total $5,383 · excluded $5,383

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $148,880 · program services $148,880

  • 2 · Grants to domestic individuals

    total $10,050 · program services $10,050

  • 24a · Other expenses: MISCELLANEOUS EXPENSE

    total $10,077 · program services $10,077

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $143,987 · end of year $468,750

  • 3 · Pledges and grants receivable

    beginning of year $4,298 · end of year $17,354

  • 12 · Investments: other securities

    beginning of year $2,371,567 · end of year $1,988,157

  • 17 · Accounts payable and accrued expenses

    beginning of year $22,460 · end of year $9,623

  • 27 · Net assets without donor restrictions

    beginning of year $1,473,734 · end of year $1,737,578

  • 28 · Net assets with donor restrictions

    beginning of year $1,023,658 · end of year $727,060

Mission and programs · 2022

Mission

THE FOUNDATION IS ORGANIZED TO SUPPORT HEALTHPARTNERS RC, DBA OLIVIA HOSPITAL AND CLINIC, IN DELIVERING ACCESSIBLE AND QUALITY HEALTH CARE FOR RESIDENTS OF THE COMMUNITIES IT SERVES.

Activities or mission (Part I)

TO SUPPORT OLIVIA HOSPITAL AND CLINIC IN DELIVERING ACCESSIBLE AND QUALITY HEALTH CARE.

  • SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS

    Expenses $169,007 · Grants $158,930

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Becca Thiesse

    DIRECTOR

    Total calculated
    $0
    Hours/week
    1

  • Nathan Blad

    PRESIDENT

    Total calculated
    $406,035
    From this org
    $0
    From related orgs
    $349,135
    Other
    $56,900
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $0 + $273,606 related
    Bonus
    $0 + $72,116 related
    Other
    $0 + $3,413 related
    Deferred
    $0 + $28,041 related
    Nontaxable benefits
    $0 + $28,859 related
    Filer's total
    $0 + $406,035 related

  • Jennifer Macik

    CHAIR

    Total calculated
    $221,940
    From this org
    $0
    From related orgs
    $179,305
    Other
    $42,635
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $148,264 related
    Bonus
    $0 + $31,041 related
    Other
    $0
    Deferred
    $0 + $8,199 related
    Nontaxable benefits
    $0 + $34,436 related
    Filer's total
    $0 + $221,940 related

  • Sara Benson

    TREASURER

    Total calculated
    $0
    Hours/week
    1

  • Karen Zieske

    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
    $490,233
    From this org
    $0
    From related orgs
    $428,046
    Other
    $62,187
    Hours/week
    1 + 52 related

    Schedule J breakdown matched by us

    Base
    $0 + $318,940 related
    Bonus
    $0 + $89,679 related
    Other
    $0 + $19,427 related
    Deferred
    $0 + $22,875 related
    Nontaxable benefits
    $0 + $39,312 related
    Filer's total
    $0 + $490,233 related

  • Heather Jeseritz

    SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • Nancy A Anderson

    CFO

    Total calculated
    $230,189
    From this org
    $0
    From related orgs
    $186,426
    Other
    $43,763
    Hours/week
    1 + 49 related

    Schedule J breakdown matched by us

    Base
    $0 + $167,139 related
    Bonus
    $0 + $19,287 related
    Other
    $0
    Deferred
    $0 + $9,224 related
    Nontaxable benefits
    $0 + $34,539 related
    Filer's total
    $0 + $230,189 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, and on a Form 990-PF Part VIII's — 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 (GHI) OR BY PARK NICOLLET HEALTH SERVICES (PNHS) OR OLIVIA HOSPITAL AND CLINICS (HPRC), 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, INC (GHI), PARK NICOLLET HEALTH SERVICES (PNHS) OR BY OLIVIA HOSPITAL AND CLINICS (HPRC), RELATED ORGANIZATIONS. COMPENSATION REPORTED IN FORM 990, PART VII INCLUDES ANY COMPENSATION DERIVED FROM GHI, PNHS OR HPRC 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 MANAGEMENT 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.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • HEALTHPARTNERS ADMINISTRATORS INC

    C · THIRD PARTY ADMINISTRATOR · MN

  • HEALTHPARTNERS ASSOCIATES INC

    C · MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT · MN

  • HEALTHPARTNERS SERVICES INC

    C · MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT · MN

  • HEALTHPARTNERS INSURANCE COMPANY

    C · MEDICAL AND DENTAL INSURANCE · MN

  • DENTAL SPECIALTIES INC

    C · DENTAL CLINIC STAFFING · MN

Provenance

Return type
form_990
Tax year
2022
Filed
14 November 2023
IRS schema version
2022v5.0
Source object
202333189349304563

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