Skip to content
Nonprofiteer
← GRAND ITASCA CLINIC AND HOSPITAL

Form 990 for tax year 2022

Filed by GRAND ITASCA CLINIC AND HOSPITAL.

Totals

Total revenue
$116,492,227
Total expenses
$108,085,446
Contributions and grants received
$131,551
Grants paid
$0
Program services expenses (Part IX)
$98,519,206
Management and general expenses
$9,566,240
Fundraising expenses
$0
Program service expenses (Part III)
$98,519,206

Program services were 91.1% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Listed in Part VII

  • Laura Reed

    Officer

    Total calculated
    $1,736,000
    From this org
    $0
    From related orgs
    $1,544,185
    Other
    $191,815
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $989,718 related
    Bonus
    $0 + $469,914 related
    Other
    $0 + $84,553 related
    Deferred
    $0 + $175,641 related
    Nontaxable benefits
    $0 + $16,174 related
    Filer's total
    $0 + $1,736,000 related

  • Brian Amdahl

    Director

    Total calculated
    $511,918
    From this org
    $0
    From related orgs
    $477,659
    Other
    $34,259
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $422,092 related
    Bonus
    $0 + $52,530 related
    Other
    $0 + $3,037 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $15,959 related
    Filer's total
    $0 + $511,918 related

  • Cindy Feyer

    Director, New 1-2022

    Total calculated
    $0
    Hours/week
    1

  • Connie Ross-Henderschott

    Director

    Total calculated
    $0
    Hours/week
    1

  • Cory Jackson

    Director, end 2021

    Total calculated
    $0
    Hours/week
    0 + 1 related

  • Dale Adams

    Chair

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Dale Furman

    Director

    Total calculated
    $0
    Hours/week
    1

  • Dennis Roy

    Secretary

    Total calculated
    $0
    Hours/week
    1

  • Josh Skelton

    Fin Com Chair, end 2021

    Total calculated
    $0
    Hours/week
    0

  • Keith Murphy MD

    Director

    Total calculated
    $393,130
    From this org
    $361,975
    From related orgs
    $0
    Other
    $31,155
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $349,552
    Bonus
    $12,183
    Other
    $240
    Deferred
    $18,112
    Nontaxable benefits
    $13,043
    Filer's total
    $393,130

  • Kent Koerbitz

    Director, end 2021

    Total calculated
    $0
    Hours/week
    0

  • Kimberly DeRoche MD

    Director

    Total calculated
    $707,732
    From this org
    $0
    From related orgs
    $601,139
    Other
    $106,593
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $467,287 related
    Bonus
    $0 + $129,405 related
    Other
    $0 + $4,446 related
    Deferred
    $0 + $85,490 related
    Nontaxable benefits
    $0 + $21,103 related
    Filer's total
    $0 + $707,732 related

  • Mike Ives

    Vice Chair

    Total calculated
    $0
    Hours/week
    1

  • Mike Miskovich DDS

    Director

    Total calculated
    $0
    Hours/week
    1

  • Mindy Nuhring

    Director

    Total calculated
    $0
    Hours/week
    1

  • Nick Rothstein

    Director, New 2022

    Total calculated
    $0
    Hours/week
    1 + 1 related

  • Simon Lick MD

    Finance Chair

    Total calculated
    $405,888
    From this org
    $357,951
    From related orgs
    $0
    Other
    $47,937
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $345,525
    Bonus
    $9,850
    Other
    $2,576
    Deferred
    $17,523
    Nontaxable benefits
    $30,414
    Filer's total
    $405,888

  • Steve Burggraf

    Director, end 2021

    Total calculated
    $0
    Hours/week
    0

  • Tom McBride

    Director, New 2022

    Total calculated
    $0
    Hours/week
    1

  • James Hereford

    Officer

    Total calculated
    $3,487,618
    From this org
    $0
    From related orgs
    $3,370,758
    Other
    $116,860
    Hours/week
    2 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,753,793 related
    Bonus
    $0 + $1,399,311 related
    Other
    $0 + $217,654 related
    Deferred
    $0 + $100,535 related
    Nontaxable benefits
    $0 + $16,325 related
    Filer's total
    $0 + $3,487,618 related

  • Jean MacDonell

    President & CEO

    Total calculated
    $586,650
    From this org
    $0
    From related orgs
    $515,552
    Other
    $71,098
    Hours/week
    20 + 20 related

    Schedule J breakdown matched by us

    Base
    $0 + $372,868 related
    Bonus
    $0 + $142,100 related
    Other
    $0 + $584 related
    Deferred
    $0 + $69,797 related
    Nontaxable benefits
    $0 + $1,302 related
    Filer's total
    $0 + $586,650 related

  • Jon Pederson

    VP Operations

    Total calculated
    $275,449
    From this org
    $232,418
    From related orgs
    $0
    Other
    $43,031
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $203,072
    Bonus
    $26,850
    Other
    $2,496
    Deferred
    $13,727
    Nontaxable benefits
    $29,304
    Filer's total
    $275,449

  • Todd Christensen

    VP Finance

    Total calculated
    $250,271
    From this org
    $216,190
    From related orgs
    $0
    Other
    $34,081
    Hours/week
    20 + 20 related

    Schedule J breakdown matched by us

    Base
    $190,824
    Bonus
    $24,600
    Other
    $766
    Deferred
    $13,318
    Nontaxable benefits
    $20,763
    Filer's total
    $250,271

  • Daniel Soular

    CMO

    Total calculated
    $420,267
    From this org
    $378,843
    From related orgs
    $0
    Other
    $41,424
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $352,675
    Bonus
    $17,183
    Other
    $8,985
    Deferred
    $17,111
    Nontaxable benefits
    $24,313
    Filer's total
    $420,267

  • Brent Schotl MD

    Physician

    Total calculated
    $500,759
    From this org
    $461,007
    From related orgs
    $0
    Other
    $39,752
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $337,740
    Bonus
    $67,497
    Other
    $55,770
    Deferred
    $18,239
    Nontaxable benefits
    $21,513
    Filer's total
    $500,759

  • Darin Skaudis MD

    Physician

    Total calculated
    $628,336
    From this org
    $577,302
    From related orgs
    $0
    Other
    $51,034
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $551,922
    Bonus
    $15,183
    Other
    $10,197
    Deferred
    $18,239
    Nontaxable benefits
    $32,795
    Filer's total
    $628,336

  • David Anderson MD

    Physician

    Total calculated
    $559,612
    From this org
    $513,600
    From related orgs
    $0
    Other
    $46,012
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $481,419
    Bonus
    $23,151
    Other
    $9,030
    Deferred
    $18,239
    Nontaxable benefits
    $27,773
    Filer's total
    $559,612

  • Ryan Novak MD

    Physician

    Total calculated
    $617,452
    From this org
    $566,394
    From related orgs
    $0
    Other
    $51,058
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $520,654
    Bonus
    $44,850
    Other
    $890
    Deferred
    $18,239
    Nontaxable benefits
    $32,819
    Filer's total
    $617,452

  • WIlfred Gould MD

    Physician

    Total calculated
    $578,244
    From this org
    $528,778
    From related orgs
    $0
    Other
    $49,466
    Hours/week
    40

    Schedule J breakdown matched by us

    Base
    $522,645
    Bonus
    $4,350
    Other
    $1,783
    Deferred
    $18,239
    Nontaxable benefits
    $31,227
    Filer's total
    $578,244

  • Kevin Nelson

    Former Director

    Total calculated
    $61,576
    From this org
    $0
    From related orgs
    $61,576
    Other
    $0
    Hours/week
    0

    Schedule J breakdown matched by us

    Base
    $0
    Bonus
    $0
    Other
    $0 + $61,576 related
    Deferred
    $0
    Nontaxable benefits
    $0
    Filer's total
    $0 + $61,576 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

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 7 · Other non-fixed payments

Answered no

  • 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 4a Severance or change-of-control payment
SEVERANCE PAYMENTS MADE TO INDIVIDUALS: KEVIN NELSON $54,758
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 $208,150 LAURA REED $76,998 KEVIN NELSON $6,818
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
2022
Filed
26 October 2023
IRS schema version
2022v5.0
Source object
202302999349301245

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

The source document this was parsed from is served over the API, which is where bulk and document access live.