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← GRAND ITASCA CLINIC AND HOSPITAL

Form 990 for tax year 2023

Filed by GRAND ITASCA CLINIC AND HOSPITAL.

Totals

Total revenue
$122,233,895
Total expenses
$117,575,949
Contributions and grants received
$173,420
Grants paid
$0
Program services expenses (Part IX)
$105,756,925
Management and general expenses
$11,819,024
Fundraising expenses
$0
Program service expenses (Part III)
$105,756,925

Program services were 89.9% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • Laura Reed

    Officer, end 11-1-2023

    Total calculated
    $2,033,363
    From this org
    $0
    From related orgs
    $1,929,528
    Other
    $103,835
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,136,201 related
    Bonus
    $0 + $658,230 related
    Other
    $0 + $135,097 related
    Deferred
    $0 + $86,725 related
    Nontaxable benefits
    $0 + $17,110 related
    Filer's total
    $0 + $2,033,363 related

  • Brian Amdahl

    Director

    Total calculated
    $583,547
    From this org
    $0
    From related orgs
    $553,460
    Other
    $30,087
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $441,199 related
    Bonus
    $0 + $109,071 related
    Other
    $0 + $3,190 related
    Deferred
    $0 + $13,200 related
    Nontaxable benefits
    $0 + $16,887 related
    Filer's total
    $0 + $583,547 related

  • Cindy Feyer

    Director

    Total calculated
    $0
    Hours/week
    1

  • Connie Ross-Henderschott

    Director

    Total calculated
    $0
    Hours/week
    1

  • Dale Adams

    Chair

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Dale Furman

    Director

    Total calculated
    $0
    Hours/week
    1

  • Dennis Roy

    Secretary, end 2023

    Total calculated
    $0
    Hours/week
    1

  • Keith Murphy MD

    Director

    Total calculated
    $422,091
    From this org
    $389,036
    From related orgs
    $0
    Other
    $33,055
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $369,676
    Bonus
    $19,000
    Other
    $360
    Deferred
    $19,634
    Nontaxable benefits
    $13,421
    Filer's total
    $422,091

  • Kimberly DeRoche MD

    Director

    Total calculated
    $814,571
    From this org
    $0
    From related orgs
    $685,843
    Other
    $128,728
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $495,966 related
    Bonus
    $0 + $126,655 related
    Other
    $0 + $63,222 related
    Deferred
    $0 + $106,429 related
    Nontaxable benefits
    $0 + $22,299 related
    Filer's total
    $0 + $814,571 related

  • Mike Ives

    Vice Chair, end 2023

    Total calculated
    $0
    Hours/week
    1

  • Mike Miskovich DDS

    Secretary

    Total calculated
    $0
    Hours/week
    1

  • Mindy Nuhring

    Vice Chair

    Total calculated
    $0
    Hours/week
    1

  • Nick Rothstein

    Director

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Simon Lick MD

    Treasurer

    Total calculated
    $426,482
    From this org
    $375,835
    From related orgs
    $0
    Other
    $50,647
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $365,595
    Bonus
    $10,000
    Other
    $240
    Deferred
    $19,044
    Nontaxable benefits
    $31,603
    Filer's total
    $426,482

  • Tom McBride

    Director

    Total calculated
    $0
    Hours/week
    1

  • James Hereford

    Officer

    Total calculated
    $5,246,751
    From this org
    $0
    From related orgs
    $5,208,444
    Other
    $38,307
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,888,932 related
    Bonus
    $0 + $1,260,653 related
    Other
    $0 + $2,058,859 related
    Deferred
    $0 + $21,097 related
    Nontaxable benefits
    $0 + $17,210 related
    Filer's total
    $0 + $5,246,751 related

  • Jean MacDonell

    President & CEO

    Total calculated
    $573,096
    From this org
    $0
    From related orgs
    $492,874
    Other
    $80,222
    Hours/week
    20 + 20 related

    Schedule J breakdown matched by us

    Base
    $0 + $394,328 related
    Bonus
    $0 + $97,925 related
    Other
    $0 + $621 related
    Deferred
    $0 + $78,769 related
    Nontaxable benefits
    $0 + $1,453 related
    Filer's total
    $0 + $573,096 related

  • Jeoff Will

    Officer, New 11-1-2023

    Total calculated
    $1,253,184
    From this org
    $0
    From related orgs
    $1,082,554
    Other
    $170,630
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $709,455 related
    Bonus
    $0 + $322,267 related
    Other
    $0 + $50,832 related
    Deferred
    $0 + $148,183 related
    Nontaxable benefits
    $0 + $22,447 related
    Filer's total
    $0 + $1,253,184 related

  • Jon Pederson

    VP Operations

    Total calculated
    $290,549
    From this org
    $245,116
    From related orgs
    $0
    Other
    $45,433
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $216,698
    Bonus
    $26,013
    Other
    $2,405
    Deferred
    $15,175
    Nontaxable benefits
    $30,258
    Filer's total
    $290,549

  • Todd Christensen

    VP Finance

    Total calculated
    $259,357
    From this org
    $224,134
    From related orgs
    $0
    Other
    $35,223
    Hours/week
    20 + 20 related

    Schedule J breakdown matched by us

    Base
    $198,208
    Bonus
    $23,647
    Other
    $2,279
    Deferred
    $13,803
    Nontaxable benefits
    $21,420
    Filer's total
    $259,357

  • Daniel Soular

    CMO

    Total calculated
    $539,038
    From this org
    $497,609
    From related orgs
    $0
    Other
    $41,429
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $438,088
    Bonus
    $49,000
    Other
    $10,521
    Deferred
    $19,070
    Nontaxable benefits
    $22,359
    Filer's total
    $539,038

  • Brent Schotl MD

    Physician

    Total calculated
    $617,256
    From this org
    $575,541
    From related orgs
    $0
    Other
    $41,715
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $516,952
    Bonus
    $50,053
    Other
    $8,536
    Deferred
    $19,630
    Nontaxable benefits
    $22,085
    Filer's total
    $617,256

  • Darin Skaudis MD

    Physician

    Total calculated
    $1,055,379
    From this org
    $1,002,372
    From related orgs
    $0
    Other
    $53,007
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $960,597
    Bonus
    $22,000
    Other
    $19,775
    Deferred
    $19,734
    Nontaxable benefits
    $33,273
    Filer's total
    $1,055,379

  • David Anderson MD

    Physician

    Total calculated
    $637,210
    From this org
    $583,520
    From related orgs
    $0
    Other
    $53,690
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $555,774
    Bonus
    $25,256
    Other
    $2,490
    Deferred
    $19,734
    Nontaxable benefits
    $33,956
    Filer's total
    $637,210

  • John Kole MD

    Physician

    Total calculated
    $530,224
    From this org
    $476,731
    From related orgs
    $0
    Other
    $53,493
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $451,147
    Bonus
    $15,000
    Other
    $10,584
    Deferred
    $19,734
    Nontaxable benefits
    $33,759
    Filer's total
    $530,224

  • Jonathan Germscheid MD

    Physician

    Total calculated
    $522,004
    From this org
    $468,540
    From related orgs
    $0
    Other
    $53,464
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $459,824
    Bonus
    $4,000
    Other
    $4,716
    Deferred
    $19,734
    Nontaxable benefits
    $33,730
    Filer's total
    $522,004

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: JAMES HEREFORD, LAURA REED, JEAN MACDONELL, KIMBERLEY DEROCHE MD DUE TO A VESTING EVENT, THE FOLLOWING INDIVIDUALS HAD INCOME IN PART VII AND SCHEDULE J RELATED TO A NONQUALIFIED RETIREMENT PLAN: JAMES HEREFORD $2,049,355 LAURA REED $126,353 JEOFF WILL $49,594 KIMBERLY DeROCHE $55,895
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.
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 4a
Severance benefit payments will commence on the first regularly scheduled pay date that occurs at least five (5) days after the expiration of the rescission period. Payment of severance benefits is contingent upon (i) my having first signed and not rescinded my Service Agreement and Release Agreement and (ii) the return of Fairview's property.
Schedule J, Part I, Line 4b
The nonqualified 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 qualified 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 service payment date. A participant's account shall be distributed in cash. The plan complies with section 457(f) of the 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

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
2023
Filed
11 November 2024
IRS schema version
2023v5.1
Source object
202423169349304142

Check it against the return as filed: the GivingTuesday Data Lake hosts a public copy of the original XML.

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