Civic Intelligence

Mercy Hospital Foundation

EIN 41-1956174 • 501(c)3 • Moose Lake, MN

Profile

The mission of the mercy foundation is to inspire giving that supports mercy hospital's ability to respond to the changing healthcare needs of our community.

4572 County Rd 61Moose Lake, MN 55767

www.mercymooselake.org

Siviq Scores

Precomputed percentiles relative to similar nonprofits. These scores are descriptive rather than judgmental.

Liabilities / Assets

Score unavailable

No value available

Liabilities-to-assets requires both liabilities and assets on the latest valid filing.

Source year 2020

Liabilities / Revenue

61st percentile

0.00x

Tied with the lowest-debt nonprofits in its peer group.

501(c)3 • <$500k nonprofits • Source year 2020

Net Margin

2nd percentile

-1356%

Higher net margin than 2% of similar nonprofits.

501(c)3 • <$500k nonprofits • Source year 2020

Top Officer Pay

Score unavailable

No value available

No filing with officer rows is available for this organization yet.

Asset Growth

9th percentile

-100%

Faster asset growth than 9% of similar nonprofits.

501(c)3 • <$500k nonprofits • Annualized from 2018 to 2020

Revenue Growth

34th percentile

-16%

Faster revenue growth than 34% of similar nonprofits.

501(c)3 • <$500k nonprofits • Annualized from 2018 to 2020

Assets

Down

$0

Down $805,787 (-100%) from 2019

Liabilities

Flat

$0

Flat from 2019

Net Assets

Down

$0

Down $805,787 (-100%) from 2019

Revenue

Down

$59,572

Down $51,342 (-46%) from 2019

Expenses

Up

$867,170

Up $721,990 (+497%) from 2019

Net Income

Down

-$807,598

Down $773,332 (-2257%) from 2019

Trend Graphs

Balance Sheet Trend

Grouped bars show assets, liabilities, and net assets across loaded filings.

$1.0M$500K$0Assets 2011: $433,677Liabilities 2011: $02011Assets 2012: $448,362Liabilities 2012: $0Net Assets 2012: $448,3622012Assets 2013: $523,421Liabilities 2013: $0Net Assets 2013: $523,4212013Assets 2014: $767,879Liabilities 2014: $0Net Assets 2014: $767,8792014Assets 2015: $761,716Liabilities 2015: $0Net Assets 2015: $761,7162015Assets 2016: $827,793Liabilities 2016: $0Net Assets 2016: $827,7932016Assets 2017: $921,554Liabilities 2017: $0Net Assets 2017: $921,5542017Assets 2018: $838,651Liabilities 2018: $0Net Assets 2018: $838,6512018Assets 2019: $805,787Liabilities 2019: $0Net Assets 2019: $805,7872019Assets 2020: $0Liabilities 2020: $0Net Assets 2020: $02020

Highlighted filing

2020

Assets$0
Liabilities$0
Net Assets$0

Operations Trend

Revenue, expenses, and net income by year, with the latest filing highlighted.

$1.0M$500K$0-$500K-$1.0MRevenue 2011: $95,402Expenses 2011: $53,318Net Income 2011: $42,0842011Revenue 2012: $96,938Expenses 2012: $84,201Net Income 2012: $12,7372012Revenue 2013: $149,277Expenses 2013: $75,635Net Income 2013: $73,6422013Revenue 2014: $326,401Expenses 2014: $78,356Net Income 2014: $248,0452014Revenue 2015: $204,854Expenses 2015: $209,597Net Income 2015: -$4,7432015Revenue 2016: $186,055Expenses 2016: $122,640Net Income 2016: $63,4152016Revenue 2017: $220,180Expenses 2017: $127,050Net Income 2017: $93,1302017Revenue 2018: $85,424Expenses 2018: $169,438Net Income 2018: -$84,0142018Revenue 2019: $110,914Expenses 2019: $145,180Net Income 2019: -$34,2662019Revenue 2020: $59,572Expenses 2020: $867,170Net Income 2020: -$807,5982020

Highlighted filing

2020

Revenue$59,572
Expenses$867,170
Net Income-$807,598

Filings

Latest Filing Detail
Jump To
Filing Snapshot
Filing Period
Oct 1, 2019 to Aug 31, 2020
Signed
Mar 19, 2021
Return Version
2019v5.2
Gross Receipts
$65,898
Mission and Program Overview

Mission

The mission of the mercy foundation is to inspire giving that supports mercy hospital's ability to respond to the changing healthcare needs of our community.

Balance Sheet Detail
LineBeginningEndChange
Assets
Savings and Temporary Cash Investments$592,086$0▼ $592,086
Investments in Publicly Traded Securities$182,356$0▼ $182,356
Pledges and Grants Receivable$31,345$0▼ $31,345
Cash and Non-Interest-Bearing Accounts-$0-
Accounts Receivable-$0-
Other Notes and Loans Receivable, Net-$0-
Receivable From Disqualified Prsn-$0-
Receivables From Officers Etc-$0-
Investments Other Securities-$0-
Investments Program Related-$0-
Land, Buildings, and Equipment, Net-$0-
Intangible Assets-$0-
Inventories for Sale or Use-$0-
Prepaid Expenses and Deferred Charges-$0-
Total Assets$805,787$0▼ $805,787
Other Assets Total-$0-
Liabilities
Total Liabilities$0$0→ $0
Net Assets / Fund Balance
Net Assets Without Donor Restrictions$750,824$0▼ $750,824
Net Assets With Donor Restrictions$54,963$0▼ $54,963
Total Net Assets Fund Balance$805,787$0▼ $805,787
Total Liabilities and Net Assets / Fund Balance$805,787$0▼ $805,787

Endowment Activity

PeriodBeginningContrib.Gain/LossOther UsesEnd
2019$54,963$2,500▲ $3,851--
2018$48,855$2,500▲ $3,608-$54,963
2017$43,800$2,500▲ $2,555-$48,855
2016$39,934$2,000▲ $1,866-$43,800
2015$33,802$2,500▲ $3,632-$39,934
Compensation and Service Providers

Board Members and Trustees

NameTitle
Lainie JankeChair
Amanda CisarVice Chair, Secretary
Anna LattuDirector
Bella MeyerDirector
Jeanne DotyDirector
John ShannonDirector
Jon LundDirector
Rick BothwellDirector
Sue AndersonTreasurer
Revenue and Support

Revenue Composition

Contributions and Grants
$43,645
Program Service Revenue
$0
Investment Income
$15,927
Other Revenue
$0
All Other Contributions
$26,595
Change in Net Assets
$-807,598
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Grants and Similar Amounts Paid$847,764
Other Expenses$19,406
Total Fundraising Expense$6,030
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Grants to Domestic Orgs$841,264--$841,264
Fees for Services Other$11,384--$11,384
Grants to Domestic Individuals$6,500--$6,500
Information Technology--$5,014$5,014
Advertising$769--$769
All Other Expenses-$515-$515
Office Expenses$276$21-$297
Other Expenses$97$167$1,016$97
Total Functional Expenses$860,437$703$6,030$867,170
International Activity

Grant and Assistance Recipients

RecipientLocationCategoryPurposeAmount
Essentia Health FoundationDuluth, MN501(c)(3)Liquidation of Assets, See Schedule N$750,175
Mercy Hospital and Healthcare CenterMoose Lake, MNGovernmentGeneral Operations and Capital Needs$90,239
Fundraising, Events, and Gaming
Fundraising activities
Yes
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Fundraising Direct Expenses$6,283
Fundraising Gross Income$6,283
Professional Fundraising Fees$0

Fundraising Events

EventGross ReceiptsGross RevenueDirect ExpensesNet Income
Autumn Gala$23,333$6,283$2,031$4,252
Total Events$23,333$6,283$6,283$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Receivables from Disqualified Persons-$0-
Receivables from Officers, Directors, Trustees, and Key Employees-$0-
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
No
Business relationship with 35% controlled entity
No
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Section A, Line 2

Anna lattu, trina lower, rita parzy and jon lund have a business relationship with each other. Trina and rita are hospital employees. Anna and jon are members of the hospital board of directors.

Form 990, Part VI, Section A, Line 7A

Moose lake community hospital district has the right to approval of appointments or removal of directors. A minimum of two members of moose lake community hospital district's board of directors must be members of the board of directors of the foundation.

Form 990, Part VI, Section A, Line 7B

Moose lake community hospital district has the right to approval of appointments or removal of directors; the approval or removal of officers; the approval of any amendments of the articles of incorporation and bylaws; the approval of any dissolution, consolidation, or merger of the corporation; the approval of any acquisition or creation of any wholly-owned or controlled corporations; the approval of all indebtedness in excess of ten thousand dollars; the approval of the annual operating and capital budgets and all material variations from these budgets; the approval of all non-budgeted capital expenditures; the approval of all loans by the corporation; the approval of any compensation of directors; and the approval of any appointment of the executive director of the corporation.

Form 990, Part VI, Section A, Line 8B

There are no committees with the authority to act on behalf of the board.

Form 990, Part VI, Section B, Line 11B

The form 990 is reviewed by the executive director and e-mailed to the members of the board of directors prior to filing with the irs.

Form 990, Part VI, Section B, Line 12C

Officers, directors, and staff of the mercy hospital foundation are required to annually complete a conflict of interest policy. Individuals are required to identify any potential conflicts of interest. Any potential conflicts are reviewed by the remaining board members. Individuals with conflicts will recuse themselves from voting on issues involving the conflict.

Form 990, Part VI, Section B, Line 15

The executive director is compensated by a related organization, moose lake community hospital district. The related organizations determines the compensation. There are no employees of the filing organizations.

Form 990, Part VI, Section C, Line 19

The organization makes it's governing documents, conflict of interest policy, and financial statements available upon request.

Filing and Contact Details

Filer

Filer Name
Mercy Hospital Foundation
EIN
41-1956174
Phone
2184855586
Address
4572 COUNTY RD 61, MOOSE LAKE, MN 55767

Signing Officer

Name
Amanda Cisar
Title
Vice Chair, Secretary
Phone
2184855586
Signed
2021-03-19
Discuss with paid preparer
Yes

Organization Details

Principal Officer
Amanda Cisar
Formed
1999
Legal Domicile
Mn
Voting Board Members
9
Independent Board Members
9
Employees
0
Volunteers
20

Preparer

Firm
Wipfli Llp
Address
1502 LONDON ROAD SUITE 200, DULUTH, MN 55812
Preparer
Michael J Peterson CPA
Phone
2187224705
Supplemental Narrative

Additional Explanations

Form 990, Part III, Line 3

The organization merged into essentia health foundation at year end. Further details are provided elsewhere on the form 990.

Financial Statement Notes

PART V, LINE 4:

Endowment funds are to be held with interest until there is a minimum of $50,000 that is permanently endowed. Once the permanent endowment is at least $50,000, a modest 3% to 5% may be used in a grant to mercy hospital to be used for needs such as new equipment. Due to the dissolution in 2019 the organization did not liquidate the endowment, but did transfer to essentia health foundation. See schedule n for further details.

Raw XML AppendixShowing 400 of 519 raw XML fields

This appendix keeps the raw XML leaves available for debugging and edge-case review. The human report above is the primary experience.

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IRS990/EmployeeCnt00
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IRS990/PYInvestmentIncomeAmt010810
IRS990/PYOtherExpensesAmt030575
IRS990/PYOtherRevenueAmt0-264
IRS990/PYProgramServiceRevenueAmt00
IRS990/PYRevenuesLessExpensesAmt0-34266
IRS990/PYSalariesCompEmpBnftPaidAmt00
IRS990/PYTotalExpensesAmt0145180
IRS990/PYTotalProfFndrsngExpnsAmt00
IRS990/PYTotalRevenueAmt0110914
IRS990/QuidProQuoContributionsInd00
IRS990/RcvblFromDisqualifiedPrsnGrp/EOYAmt00
IRS990/RcvFndsToPayPrsnlBnftCntrctInd00
IRS990/ReceivablesFromOfficersEtcGrp/EOYAmt00
IRS990/ReconcilationRevenueExpnssAmt0-807598
IRS990/RegularMonitoringEnfrcInd01
IRS990/RelatedEntityInd01
IRS990/RelatedOrganizationCtrlEntInd00
IRS990/ReportInvestmentsOtherSecInd00
IRS990/ReportLandBuildingEquipmentInd00
IRS990/ReportOtherAssetsInd00
IRS990/ReportOtherLiabilitiesInd00
IRS990/ReportProgramRelatedInvstInd00
IRS990/RevenueAmt00
IRS990/SavingsAndTempCashInvstGrp/BOYAmt0592086
IRS990/SavingsAndTempCashInvstGrp/EOYAmt00
IRS990ScheduleA/Form990ScheduleAPartVIGrp/ExplanationTxt0MOOSE LAKE FOUNDATION HAD A SHORT YEAR IN 2019 AS THE FOUNDATION EXPERIENCED A DISSOLUTION IN THE CURRENT YEAR. SEE SCHEDULE N FOR FURTHER DETAILS.
IRS990ScheduleA/Form990ScheduleAPartVIGrp/FormAndLineReferenceDesc0PART VI
IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearAmt043645
IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearMinus1YearAmt0100368
IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearMinus2YearsAmt069154
IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearMinus3YearsAmt0208162
IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/CurrentTaxYearMinus4YearsAmt0198266
IRS990ScheduleA/GiftsGrantsContriRcvd170Grp/TotalAmt0619595
IRS990ScheduleA/GrossInvestmentIncome170Grp/CurrentTaxYearAmt015970
IRS990ScheduleA/GrossInvestmentIncome170Grp/CurrentTaxYearMinus1YearAmt010810
IRS990ScheduleA/GrossInvestmentIncome170Grp/CurrentTaxYearMinus2YearsAmt06829
IRS990ScheduleA/GrossInvestmentIncome170Grp/CurrentTaxYearMinus3YearsAmt04537
IRS990ScheduleA/GrossInvestmentIncome170Grp/CurrentTaxYearMinus4YearsAmt03437
IRS990ScheduleA/GrossInvestmentIncome170Grp/TotalAmt041583
IRS990ScheduleA/GrossReceiptsRltdActivitiesAmt06283
IRS990ScheduleA/PublicOrganization170Ind0X
IRS990ScheduleA/PublicSupportCY170Pct00.90020
IRS990ScheduleA/PublicSupportPY170Pct00.94650
IRS990ScheduleA/PublicSupportTotal170Amt0595223
IRS990ScheduleA/SubstantialContributorsTotAmt024372
IRS990ScheduleA/ThirtyThrPctSuprtTestsCY170Ind0X
IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearAmt043645
IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearMinus1YearAmt0100368
IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearMinus2YearsAmt069154
IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearMinus3YearsAmt0208162
IRS990ScheduleA/TotalCalendarYear170Grp/CurrentTaxYearMinus4YearsAmt0198266
IRS990ScheduleA/TotalCalendarYear170Grp/TotalAmt0619595
IRS990ScheduleA/TotalSupportAmt0661178
IRS990ScheduleB/ContributorInformationGrp/ContributorBusinessName/BusinessNameLine10RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorNum0RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/AddressLine10RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/AddressLine20RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/City0RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/State0RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/ContributorUSAddress/ZIPCode0RESTRICTED
IRS990ScheduleB/ContributorInformationGrp/TotalContributionsAmt0RESTRICTED
IRS990/ScheduleBRequiredInd01
IRS990ScheduleD/CYEndwmtFundGrp/BeginningYearBalanceAmt054963
IRS990ScheduleD/CYEndwmtFundGrp/ContributionsAmt02500
IRS990ScheduleD/CYEndwmtFundGrp/GrantsOrScholarshipsAmt061314
IRS990ScheduleD/CYEndwmtFundGrp/InvestmentEarningsOrLossesAmt03851
IRS990ScheduleD/CYMinus1YrEndwmtFundGrp/BeginningYearBalanceAmt048855
IRS990ScheduleD/CYMinus1YrEndwmtFundGrp/ContributionsAmt02500
IRS990ScheduleD/CYMinus1YrEndwmtFundGrp/EndYearBalanceAmt054963
IRS990ScheduleD/CYMinus1YrEndwmtFundGrp/InvestmentEarningsOrLossesAmt03608
IRS990ScheduleD/CYMinus2YrEndwmtFundGrp/BeginningYearBalanceAmt043800
IRS990ScheduleD/CYMinus2YrEndwmtFundGrp/ContributionsAmt02500
IRS990ScheduleD/CYMinus2YrEndwmtFundGrp/EndYearBalanceAmt048855
IRS990ScheduleD/CYMinus2YrEndwmtFundGrp/InvestmentEarningsOrLossesAmt02555
IRS990ScheduleD/CYMinus3YrEndwmtFundGrp/BeginningYearBalanceAmt039934
IRS990ScheduleD/CYMinus3YrEndwmtFundGrp/ContributionsAmt02000
IRS990ScheduleD/CYMinus3YrEndwmtFundGrp/EndYearBalanceAmt043800
IRS990ScheduleD/CYMinus3YrEndwmtFundGrp/InvestmentEarningsOrLossesAmt01866
IRS990ScheduleD/CYMinus4YrEndwmtFundGrp/BeginningYearBalanceAmt033802
IRS990ScheduleD/CYMinus4YrEndwmtFundGrp/ContributionsAmt02500
IRS990ScheduleD/CYMinus4YrEndwmtFundGrp/EndYearBalanceAmt039934
IRS990ScheduleD/CYMinus4YrEndwmtFundGrp/InvestmentEarningsOrLossesAmt03632
IRS990ScheduleD/EndowmentsHeldRelatedOrgInd00
IRS990ScheduleD/EndowmentsHeldUnrelatedOrgInd00
IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0ENDOWMENT FUNDS ARE TO BE HELD WITH INTEREST UNTIL THERE IS A MINIMUM OF $50,000 THAT IS PERMANENTLY ENDOWED. ONCE THE PERMANENT ENDOWMENT IS AT LEAST $50,000, A MODEST 3% TO 5% MAY BE USED IN A GRANT TO MERCY HOSPITAL TO BE USED FOR NEEDS SUCH AS NEW EQUIPMENT. DUE TO THE DISSOLUTION IN 2019 THE ORGANIZATION DID NOT LIQUIDATE THE ENDOWMENT, BUT DID TRANSFER TO ESSENTIA HEALTH FOUNDATION. SEE SCHEDULE N FOR FURTHER DETAILS.
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0PART V, LINE 4:
IRS990ScheduleD/TotalBookValueLandBuildingsAmt00
IRS990ScheduleG/FundraisingEventInformationGrp/CharitableContributionsTotAmt017050
IRS990ScheduleG/FundraisingEventInformationGrp/CharitableContriEvent1Amt017050
IRS990ScheduleG/FundraisingEventInformationGrp/DirectExpenseSummaryEventsAmt06283
IRS990ScheduleG/FundraisingEventInformationGrp/EntertainmentEvent1Amt0500
IRS990ScheduleG/FundraisingEventInformationGrp/EntertainmentTotalEventsAmt0500
IRS990ScheduleG/FundraisingEventInformationGrp/Event1Nm0AUTUMN GALA
IRS990ScheduleG/FundraisingEventInformationGrp/FoodAndBeverageEvent1Amt03752
IRS990ScheduleG/FundraisingEventInformationGrp/FoodAndBeverageTotalEventsAmt03752
IRS990ScheduleG/FundraisingEventInformationGrp/GrossReceiptsEvent1Amt023333
IRS990ScheduleG/FundraisingEventInformationGrp/GrossReceiptsTotalAmt023333
IRS990ScheduleG/FundraisingEventInformationGrp/GrossRevenueEvent1Amt06283
IRS990ScheduleG/FundraisingEventInformationGrp/GrossRevenueTotalEventsAmt06283
IRS990ScheduleG/FundraisingEventInformationGrp/NetIncomeSummaryAmt00
IRS990ScheduleG/FundraisingEventInformationGrp/OthDirectExpnssTotalEventsAmt02031
IRS990ScheduleG/FundraisingEventInformationGrp/OtherDirectExpensesEvent1Amt02031
IRS990ScheduleI/GrantRecordsMaintainedInd01
IRS990ScheduleI/GrantsOtherAsstToIndivInUSGrp/CashGrantAmt06500
IRS990ScheduleI/GrantsOtherAsstToIndivInUSGrp/GrantTypeTxt0SCHOLARSHIP
IRS990ScheduleI/GrantsOtherAsstToIndivInUSGrp/RecipientCnt05
IRS990ScheduleI/RecipientTable/CashGrantAmt090239
IRS990ScheduleI/RecipientTable/CashGrantAmt1750175
IRS990ScheduleI/RecipientTable/IRCSectionDesc0GOVERNMENT
IRS990ScheduleI/RecipientTable/IRCSectionDesc1501(C)(3)
IRS990ScheduleI/RecipientTable/PurposeOfGrantTxt0GENERAL OPERATIONS AND CAPITAL NEEDS
IRS990ScheduleI/RecipientTable/PurposeOfGrantTxt1LIQUIDATION OF ASSETS, SEE SCHEDULE N
IRS990ScheduleI/RecipientTable/RecipientBusinessName/BusinessNameLine1Txt0MERCY HOSPITAL AND HEALTHCARE CENTER
IRS990ScheduleI/RecipientTable/RecipientBusinessName/BusinessNameLine1Txt1ESSENTIA HEALTH FOUNDATION
IRS990ScheduleI/RecipientTable/RecipientEIN0271984704
IRS990ScheduleI/RecipientTable/USAddress/AddressLine1Txt04572 COUNTY ROAD 61
IRS990ScheduleI/RecipientTable/USAddress/AddressLine1Txt1502 E 2ND ST
IRS990ScheduleI/RecipientTable/USAddress/CityNm0MOOSE LAKE
IRS990ScheduleI/RecipientTable/USAddress/CityNm1DULUTH
IRS990ScheduleI/RecipientTable/USAddress/StateAbbreviationCd0MN
IRS990ScheduleI/RecipientTable/USAddress/StateAbbreviationCd1MN
IRS990ScheduleI/RecipientTable/USAddress/ZIPCd055767
IRS990ScheduleI/RecipientTable/USAddress/ZIPCd155805
IRS990ScheduleI/SupplementalInformationDetail/ExplanationTxt0THE BOARD MEMBER OF THE MECRY HOSPITAL FOUNDATION ALSO SERVE ON THE MOOSE LAKE COMMUNITY HOSPITAL DISTRICT BOARD. THESE INDIVIDUALS MONITOR THE USE OF THE MONEY GIVEN BY THE MERCY HOSPITAL FOUNDATION.
IRS990ScheduleI/SupplementalInformationDetail/FormAndLineReferenceDesc0PART I, LINE 2:
IRS990ScheduleI/Total501c3OrgCnt02
IRS990ScheduleI/TotalOtherOrgCnt00
IRS990/ScheduleJRequiredInd00
IRS990ScheduleN/AssetsDistributedInd00
IRS990ScheduleN/AttorneyGeneralNotifiedInd01
IRS990ScheduleN/BondsOutstandingInd00
IRS990ScheduleN/DirectorOfSuccessorInd01
IRS990ScheduleN/EmployeeOfSuccessorInd00
IRS990ScheduleN/LiabilitiesPaidInd00
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/AssetsDistriOrExpnssPaidDesc0CASH & INVESTMENTS
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/BusinessName/BusinessNameLine1Txt0ESSENTIA HEALTH FOUNDATION
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/DistributionDt02020-08-01
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/EIN0271984704
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/FairMarketValueOfAssetAmt0750175
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/IRCSectionTxt0501(C)(3)
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/MethodOfFMVDeterminationTxt0FMV
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/AddressLine1Txt0502 E 2ND ST
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/CityNm0DULUTH
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/StateAbbreviationCd0MN
IRS990ScheduleN/LiquidationOfAssetsTableGrp/LiquidationOfAssetsDetail/USAddress/ZIPCd055805
IRS990ScheduleN/OwnerOfSuccessorInd00
IRS990ScheduleN/ReceiveCompensationInd00
IRS990ScheduleN/RequiredToNotifyAGInd01
IRS990ScheduleN/SupplementalInformationDetail/ExplanationTxt0PERSON(S) INVOLVED: ALL BOARD MEMBERS
IRS990ScheduleN/SupplementalInformationDetail/ExplanationTxt1EXPLANATION OF INVOLVEMENT: THE FOLLOWING PERSONS BECAME VOTING MEMBERS OF THE NEW ORGANIZATION - LAINIE JANKE, AMANDA CISAR, SUE ANDERSON, RICK BOTHWELL, JEANNE DOTY, ANNA LATTU, JON LUND, BELLA MEYER, JOHN SHANNON.
IRS990ScheduleN/SupplementalInformationDetail/FormAndLineReferenceDesc0PART I, LINE 2E:
IRS990ScheduleN/SupplementalInformationDetail/FormAndLineReferenceDesc1PART I, LINE 2E:
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0THE ORGANIZATION MERGED INTO ESSENTIA HEALTH FOUNDATION AT YEAR END. FURTHER DETAILS ARE PROVIDED ELSEWHERE ON THE FORM 990.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1ANNA LATTU, TRINA LOWER, RITA PARZY AND JON LUND HAVE A BUSINESS RELATIONSHIP WITH EACH OTHER. TRINA AND RITA ARE HOSPITAL EMPLOYEES. ANNA AND JON ARE MEMBERS OF THE HOSPITAL BOARD OF DIRECTORS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2MOOSE LAKE COMMUNITY HOSPITAL DISTRICT HAS THE RIGHT TO APPROVAL OF APPOINTMENTS OR REMOVAL OF DIRECTORS. A MINIMUM OF TWO MEMBERS OF MOOSE LAKE COMMUNITY HOSPITAL DISTRICT'S BOARD OF DIRECTORS MUST BE MEMBERS OF THE BOARD OF DIRECTORS OF THE FOUNDATION.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3MOOSE LAKE COMMUNITY HOSPITAL DISTRICT HAS THE RIGHT TO APPROVAL OF APPOINTMENTS OR REMOVAL OF DIRECTORS; THE APPROVAL OR REMOVAL OF OFFICERS; THE APPROVAL OF ANY AMENDMENTS OF THE ARTICLES OF INCORPORATION AND BYLAWS; THE APPROVAL OF ANY DISSOLUTION, CONSOLIDATION, OR MERGER OF THE CORPORATION; THE APPROVAL OF ANY ACQUISITION OR CREATION OF ANY WHOLLY-OWNED OR CONTROLLED CORPORATIONS; THE APPROVAL OF ALL INDEBTEDNESS IN EXCESS OF TEN THOUSAND DOLLARS; THE APPROVAL OF THE ANNUAL OPERATING AND CAPITAL BUDGETS AND ALL MATERIAL VARIATIONS FROM THESE BUDGETS; THE APPROVAL OF ALL NON-BUDGETED CAPITAL EXPENDITURES; THE APPROVAL OF ALL LOANS BY THE CORPORATION; THE APPROVAL OF ANY COMPENSATION OF DIRECTORS; AND THE APPROVAL OF ANY APPOINTMENT OF THE EXECUTIVE DIRECTOR OF THE CORPORATION.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5THE FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR AND E-MAILED TO THE MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE IRS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6OFFICERS, DIRECTORS, AND STAFF OF THE MERCY HOSPITAL FOUNDATION ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST POLICY. INDIVIDUALS ARE REQUIRED TO IDENTIFY ANY POTENTIAL CONFLICTS OF INTEREST. ANY POTENTIAL CONFLICTS ARE REVIEWED BY THE REMAINING BOARD MEMBERS. INDIVIDUALS WITH CONFLICTS WILL RECUSE THEMSELVES FROM VOTING ON ISSUES INVOLVING THE CONFLICT.

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