2022-08-26T11:07:06-05:00 2021-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Suite 1300 Minneapolis MN 554027033 990 2021-01-01 410682405 Hazelden Betty Ford Foundation HAZE 6512134006 PO Box 11 Center City MN 55012 James Blaha VP, CFO & CAO 6512134729 2022-08-18 1 James Blaha 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-08-18 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z Dr Joseph Lee PO Box 11 Center City MN 55012 414490294 0 X www.hazeldenbettyford.org X 1949 MN Inpatient and outpatient addiction and mental health care. 18 17 1893 43 30721 29171 13001552 20641408 170151373 182176812 3006184 49987965 1667131 1446462 187826240 254252647 488510 1247889 0 0 120428412 128789290 0 0 5255166 77759064 86826609 198675986 216863788 -10849746 37388859 539710719 572943680 198698408 222725171 341012311 350218509 X Hazelden Betty Ford Foundation is a force of healing and hope for individuals, families and communities affected by addiction to alcohol and other drugs. 0 0 131886037 145913004 Addiction Treatment for Adults, Youth and FamiliesThe goal of the Hazelden Betty Ford Foundation's love-inspired, science-powered care is to help patients and families survive substance use and mental health conditions, and thrive in lifelong recovery. We empower those we serve to initiate and sustain a process of change through which they improve their health and wellness, live a self-directed life, and strive to reach their full potential. The Foundation serves both adults and youth and approaches treatment in a holistic, person-centered way-addressing our patients' addiction, mental health and co-occurring medical conditions. Continued on Schedule O.Our comprehensive treatment integrates the use of evidence-based clinical therapies, peer support and medicine, and is individualized to meet patients' unique needs as they progress from clinical management of their disease to community-supported self-management of their recovery. Our interdisciplinary care teams consist of addiction counselors and technicians; psychologists and other mental health professionals; psychiatrists and other physicians; nurse practitioners, nurses and certified medical assistants; family specialists; spiritual care professionals; nutritionists; recovery coaches and wellness specialists. In addition to addiction treatment, available at multiple levels of care, the Hazelden Betty Ford Foundation provides assessment and evaluation services, intervention services, clinically supervised sober living options, continuing care services and mental health services. The Foundation also understands that recovery from addiction and mental health conditions involves rebuilding relationships with family members and friends who need help and support of their own. Through our family and children's programs, loved ones receive education, guidance and support to achieve healthier relationships and lives.Hazelden Betty Ford's services are available both in-person and virtually. In 2021, to ensure the safety of staff and patients amid the COVID-19 pandemic, most outpatient addiction and mental health services, as well as family and children's programs, were available virtually only. Residential services, however, continued on our campuses uninterrupted, thanks to robust safety protocols. The plan in 2022 and beyond is to offer a blend of virtual and in-person choices for those we serve. In 2021, the Foundation's physical sites were in Center City, Chaska, Maple Grove, Plymouth and St. Paul, Minnesota; Chicago, Illinois; Naples, Florida; New York, New York; Bellevue, Washington; Beaverton and Newberg, Oregon; Rancho Mirage, Los Angeles and San Diego, California; and Denver, Colorado. The organization also provided telehealth services that were accessible to people living anywhere in Arizona, California, Colorado, Florida, Idaho, Illinois, Minnesota, Missouri, Montana, New Jersey, New Mexico, New York, Oregon, Washington, Wisconsin and Wyoming. The following number of people directly benefited from Hazelden Betty Ford treatment and recovery programs in 2021: Primary Treatment Adult 4,867Intensive Outpatient Adult 3,658 Mental Health Adult 3,381Family Program Adult 3,290Day Treatment Adult 2,656 Outpatient Treatment Adult 1,617Renewal Center/Lodge 828Primary Treatment Youth 730Mental Health Youth 607 Family Program Youth 569Children's Program 499Day Treatment Youth 390Intensive Outpatient Youth 223Outpatient Treatment Youth 91 TOTAL PATIENTS SERVED 23,406 Additionally, financial assistance is available and was provided to 4,017 qualifying patients and family members at an approximate cost of $4,300,000. 28323888 33210218 Publication of Educational MaterialsHazelden Publishing is the leading publisher of state-of-the-art resources for preventing, treating and managing addiction and closely related issues. Translating research into practice, we help organizations treat the whole client by offering information, guidance, tools and support to meet their unique needs. With 98 new offerings in 2021, our publications continue to provide inspiration, guidance and encouragement to millions around the world every day. Continued on Schedule O.In 2021, Hazelden Publishing generated 13 new products, 5 new curriculums, 5 new Spanish translations, 10 new videos, 3 new distributed products, 8 new services and trainings, 4 new e-books, 9 new translation rights, 40 specialty products, and 1 new subscription. If not for our mission and commitment, much of this material would not be published and available to consumers because of its limited appeal to mainstream publishers. Hazelden Publishing's materials also reach underserved populations, including many customers in the community treatment, faith-based and corrections markets. Additionally, through its BookAid program, Hazelden Publishing sent out book packages that reached people through libraries that serve programs and institutions in need. BookAid resources were sent to individuals and organizations in the United States and around the world.Hazelden Publishing also has a Professional Education Continuum Solutions (PECS) division that transforms organizational systems and culture, empowering educators and providers in health care, treatment and social services to deliver evidence-based, best-practice services throughout the continuum of care. Building Assets and Reducing Risk (BARR)-a strengths-based program managed within PECS that provides schools with a comprehensive approach to meeting the academic, social, and emotional needs of all students through training and coaching-trained 148 schools in 2021, impacting the lives of over 30,000 students and 3,000 educators in a diverse range of communities. In addition, our Prevention Solutions team within PECS delivered virtual intensive education to 32,000 students across 149 schools in 35 states and 31 countries. Consultants and trainers on the PECS Clinical Solutions team reached over 4,100 professionals in 31 states and Japan in 2021, addressing stigma associated with addiction and helping communities embrace recovery as the expectation. Finally, our Summer Institute for Medical Students and Professionals in Residence programs-both managed within the PECS division of Hazelden Publishing-hosted 2,995 participants in 2021, expanding into new states with new partnerships across the country (see more under the program description for Higher Education and Medical & Professional Training). From Appalachia to the Pacific Ocean - and everywhere in between - the PECS team is empowering professionals to be agents of hope and healing. 4306945 1247889 4488602 Higher Education and Medical & Professional TrainingHazelden Betty Ford Graduate School of Addiction StudiesThe Hazelden Betty Ford Graduate School of Addiction Studies prepares future leaders in addiction counseling through two available degrees: Master of Arts in Addiction Counseling: Advanced Practice and Master of Arts in Addiction Studies: Integrated Recovery for Co-Occurring Disorders. The school emphasizes public engagement as a means of serving constituent communities. In 2021, students provided approximately 70,969 hours of clinical services at agencies reaching underserved and economically disadvantaged populations.The school offers a full scholarship each year to a student who works at Chisago County Health and Human Services, and we provide continuing education to these Chisago County professionals at no cost. In 2021, 60 students graduated from the school with master's degrees. Overall, more than 92% of graduates who seek careers in the addiction treatment field find employment in their home communities or at regional or national treatment agencies. Faculty and graduate school leaders participate in public service events throughout the United States and make research, educational and scholarly contributions to the field of addiction treatment.Medical & Professional EducationThe Professionals in Residence (PIR) program and the Summer Institute for Medical Students (SIMS) give medical students, residents, health care and legal professionals an in-depth experience with the dynamics of the disease of addiction. Intensive one-week programs blend classes presented by Hazelden Betty Ford Foundation physicians and expert clinicians with time spent interacting with patients and staff on treatment units or family programs. Participants learn about the latest research and evidence-based methods from our multidisciplinary faculty. A rotation on addiction for psychiatry, family medicine and internal medicine residents also is available in Minnesota and California. In addition, a one-year accredited Addiction Medicine Fellowship is available at the Betty Ford Center in Rancho Mirage, California, and an online Course on Addiction and Recovery Education (CARE) is available worldwide. Hazelden Betty Ford's residential treatment sites in Minnesota, California and Oregon offer customized programming for larger groups as well. In 2021, our Medical and Professional Education programs trained a total of 2,995 participants. In meeting the Foundation's mission and underlying charitable purpose, the Foundation invests time, financial resources and energy to help people and communities understand and address addiction as a treatable chronic disease, and spread the word that recovery is possible. "Be of service" is an integral core value which the Foundation demonstrates in a variety of ways.The Foundation provides treatment services to individuals and families who seek and qualify for care but are unable to pay the full cost. The Foundation's patient aid policy provides that the Foundation will annually establish a target amount of patient financial assistance.In addition to its annual provision for charity care, the Foundation provides a variety of other benefits for the public good including:Butler Center for Research-The Butler Center for Research (BCR) is dedicated to improving recovery from addiction by conducting clinical and institutional research, collaborating with other research centers and communicating scientific findings. It is the Center's vision that sustained recovery for all who seek help will be achieved through advancements in knowledge and integration of research into practice.In 2021, the BCR participated in the following activities:-As part of the Foundation's commitment to evidence-based practice, a variety of projects were conducted to inform clinical care and academic programming, identify treatment needs, drive data-based decision making, and contribute to the professional and public knowledge of addiction treatment. Projects included data analyses, and industry trend reports, among others.-In response to the global novel coronavirus pandemic, the Foundation had to pivot the majority of its in-person services to virtual in March 2020. Given that very little was currently known about the efficacy of virtual group services for addiction, the BCR undertook an evaluation of the intensive outpatient and partial hospitalization program virtual services rollouts in order to better understand what type of patients benefit from in-person or virtual addiction care. Preliminary findings from these projects have already helped inform the Foundation's approach to providing virtual care as a viable alternative to some in-person services, and have resulted in two manuscripts that are in press: o In-Person versus Telehealth Substance Use Treatment: An Ecologically Valid Comparison included a description of the VIOP study, and detailed the similarities and differences between patients in in-person, hybrid, and virtual IOP. It is currently in press with JMIR: Formative Research and will be published in the first or second quarter of 2022. o Telehealth Services for Substance Use Disorders During the COVID-19 Pandemic: Longitudinal Assessment of Intensive Outpatient Programming and Data Collection Practices showed that at 3-month follow-up, self-reported outcomes related to resumption of substance use, quality of life, and well-being were similar for patients in in-person or virtual IOP, which suggests virtual outpatient care for the treatment of SUDs is a feasible alternative to in-person only programming. It is currently in press with JMIR: Mental Health and will be published in the first or second quarter of 2022.-In 2021, the BCR continued to collaborate with researchers from the Mayo Clinic on a government grant to study the use of acamprosate, an FDA-approved medication targeting alcohol craving. Funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), this project will work to identify biomarkers that may predict patient response to the use of the medication, with the hope of finding new genes linked to alcoholism treatment response. The project continued recruitment throughout 2021, despite added COVID-19 restrictions, and will be ongoing in 2022. Findings from this study could have substantial impact and inform substance use treatment on a national scale.-The BCR started an additional donor-funded project in collaboration with the Mayo Clinic in 2020 and 2021 to study the use of naltrexone and buprenorphine, FDA-approved medications for the treatment of cravings related to opioid use disorder (OUD). In this innovative study, Mayo will use internally-developed breakthrough technology to reprogram the cell lines in patient blood samples over a 6-month period to differentiate into brain region specific organoids (so-called mini brains in a petri dish), which will then be exposed to the medications used to treat OUD to measure how each individuals brain cells respond. Results obtained from this pilot study will be used to generate new hypotheses to better understand the molecular underpinning of OUD and response to FDA-approved therapeutic agents used in the treatment of OUD.-The BCR also continued to collaborate on another NIAAA grant-funded study with researchers from Virginia Commonwealth University. Titled "Genes, addiction, and personality", this study is part of a genome-wide association study to learn more about the relationships between personality, mental health, substance use and genes. Data collection continued in 2021, and will be ongoing in 2022.-Research Updates were updated and disseminated to professionals, educators, researchers, students and other stakeholders. These two-page summaries of scientific findings from the field of addiction treatment research are provided at no cost as a community benefit to policymakers, treatment professionals and the public at large. Research Updates are also available on the BCR web page at www.hazeldenbettyford.org/education/bcr/addiction-research.Community Education and Relations-Due to continuing COVID-19 restrictions in 2021, the Foundation continued to deliver virtual speakers and events to alumni and the recovery community. During the year, the Foundation reached nearly 4,000 people.-The Speakers Bureau helped place the organization's many spokespeople at events, with 62 different employees delivering 110 presentations in 10 states and 10 cities, as well as 90 virtual presentations available globally.-Educational scholarships from the Foundation totaling $4,400 were awarded to students at five high schools in the Twin Cities and Center City areas of Minnesota, as well as two western Wisconsin high schools.-In Florida, the Foundation is an active member of the Collier Community Drug Response Team, an action-oriented work group that analyzes data and mobilizes support to overdose hotspots.Children's Programs-The Hazelden Betty Ford Children's Program provides prevention and education services to children and families with addiction. Programs are located in California, Minnesota and Colorado. Due to COVID-19 restrictions, the program shifted entirely online April through December 2020 and continued online in 2021. The program hosted 103 virtual programs and served 560 children from 12 states. Virtual programming includes a two-day initial virtual Children's Program, Stage II and caregiver workshops. An additional 1,190 children received support through virtual continuing care offered weekly on Wednesday evenings for alumni of the Children's Program. No child has ever been turned away because of lack of financial ability to pay: All of the virtual participants attended at no cost, due to the generous donations received through philanthropic support.-Additionally, the Children's Program continued to provide its Holiday Hotline over the winter break. In 2021, the Hazelden Betty Ford Foundation provided multiple phone numbers and added additional Children's Program staff to continue the tradition and serve even more children across the nation.Web and Social Networks-The corporate website, www.HazeldenBettyFord.org, continued to grow in 2021 with nearly 10 million sessions, an increase of 7 percent over 2020. "Thought for the Day" remained the most popular feature on the website, with an average of 15,000 visitors each day. "Thought for the Day" provides daily inspirational readings from one of six Hazelden Publishing meditation books.-More than 4.5 million people from 235 countries visited the website seeking information on a variety of addiction-related topics, including treatment, recovery, education, public advocacy and products in our online bookstore. Sixty-six percent of all visits to the hazeldenbettyford.org website were from a mobile device. Thirty-one percent of sessions were from a desktop or laptop computer and only 3 percent were from a tablet.-The Foundation produced 23 new episodes of the award-winning Let's Talk Addiction & Recovery educational podcast series, which generated nearly 425,000 engagements with people in 57 countries. A total of 175 Recovery Road podcast episodes were created with helpful excerpts fromleading authors in addiction recovery and mental health, surpassing 174,500 downloads. -Mobile apps provided free of charge since March 2020 had 200,000 downloads and 97.9% of reviewers rated the apps with five stars. Weekly Living in Recovery emails continued in 2021, reaching out with more than 5 million emails that shared helpful resources, news, and tools to help alumni and those in recovery continue their healing journey.-TheDailyPledge.org is an online support community for people in recovery and those who care about them. It is provided free of charge by the Foundation. The Daily Pledge is built around the idea of pledging to stay sober one day at a time. It also offers chat recovery meetings, forum-style discussions, and other ways for people to interact and support each other in recovery. Traffic to the site dropped some in 2021 from historic high numbers in 2020 during global lockdowns that kept people away from home groups, meetings, and in-patient treatment. Still, the site offered about 1,100 meetings during the year with a total attendance of about 4,300 participants. We sent out over 1,500 confirmations of attendance for those in court-ordered programs. Total users topped 15,000 with over 100,000 page views.-The Hazelden Betty Ford Foundation's Facebook, Twitter, Instagram, YouTube, LinkedIn and other social media accounts, which have more than 101,000 followers, along with its award-winning mobile apps--including several available at no cost--offered additional access to recovery resources, providing daily inspiration, information and fellowship.Resource Center-In 2021, the Foundation's Resource Center received nearly 153,000 calls from people seeking or referring to substance use disorder and mental health treatment, as well as many more seeking information, assistance and products related to substance use and addiction.Hazelden Betty Ford Library-In addition to its core mission of fulfilling the informational needs of the Foundation's staff and students, our Addiction Research Library-accessible at www.hazeldenbettyford.org/education/bcr/addiction-research-library serves the public by:-Working daily with information sharing and advocacy efforts in the regional Minitex, national Docline and international SALIS (Substance Abuse Librarians & Information Specialists) networks.-Facilitating on our website the preservation & access of archived versions of the ETOH and CORK addiction-related journal databases, free to internet users & available nowhere else online.-Providing scholarships, via the A.A. Heckman Endowed Fellowship Fund, to help individuals study the addiction-related archives housed on our campus in Center City, Minnesota. 164516870 1 1 0 1 0 0 0 1 0 1 1 1 0 1 1 1 0 1 0 0 1 0 1 0 1 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 0 0 1 824 0 1 1893 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 18 17 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 AK AL AR CA CO CT DC FL GA HI IL KS KY LA MA MD ME MI MN MS NC ND NH NJ NM NV NY OH OK OR PA RI SC TN UT VA WA WI WV X James Blaha VP Chief Financial A 6512134729 15251 Pleasant Valley Road Center City MN 55012 Lester Munson Chair 5.00 0.00 X X 0 0 0 Susan Engeleiter Vice-Chair 2.00 0.00 X X 0 0 0 Bill Parker Vice-Chair 2.00 0.00 X X 0 0 0 Ann Highet Member 1.00 0.00 X 0 0 0 Cameron Strang Member 1.00 0.00 X 0 0 0 Cini Gannon Robb Member 1.00 0.00 X 0 0 0 Gloria Perez Member 1.00 0.00 X 0 0 0 James R Greenbaum Member 1.00 0.00 X 0 0 0 John Power Sr Member 1.00 0.00 X 0 0 0 Kathryn Helgaas Burgum Member 1.00 0.00 X 0 0 0 Mary Turner Pattiz Member 1.00 0.00 X 0 0 0 MaryPat Woodard Member 1.00 0.00 X 0 0 0 Quinton Studer Member 1.00 0.00 X 0 0 0 Robert Reifschneider Member 1.00 0.00 X 0 0 0 Ruth Barker Member 1.00 0.00 X 0 0 0 Susan Ford Bales Member 1.00 0.00 X 0 0 0 Thomas Bradley Member (served part year) 1.00 0.00 X 0 0 0 William Cirone Member 1.00 0.00 X 0 0 0 Dr Joseph Lee PresidentCEO as of June 2021 50.00 10.00 X X 544823 0 43905 Mark Mishek PresidentCEO until June 2021 50.00 10.00 X X 534167 0 32218 James Blaha Treasurer, VP CFO and CAO 50.00 10.00 X 482225 0 66990 Jennifer Lohse Secretary, VP General Counsel 50.00 10.00 X 296392 0 54625 John Driscoll Sr. VP Recovery Services 50.00 0.00 X 408285 0 76315 Robert Poznanovich VP Business Development 50.00 0.00 X 362848 0 61603 Dr Marvin Seppala Chief Medical Officer 50.00 0.00 X 612477 0 63460 Nicholas Motu VP & Chief External Affairs 50.00 0.00 X 362639 0 49526 Melissa Fors VP Marketing Strategy 50.00 0.00 X 328900 0 31499 Moira McGinley VP Development & CDO 50.00 0.00 X 295515 0 12671 Joseph Jaksha VP Publisher 50.00 0.00 X 281287 0 56764 Dawne Carlson VP Human Resources 50.00 0.00 X 285657 0 29007 Debra Bauman VP Tech Services & CIO 50.00 0.00 X 282348 0 30419 Valerie Slaymaker VP Education and Research 50.00 0.00 X 282541 0 28433 Victor Vines Medical Administrator 45.00 0.00 X 287617 0 18874 Kristen Schmidt Psychiatrist 45.00 0.00 X 298455 0 31792 Jerry Moe Exec. 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Nat'l Children's Program 45.00 0.00 X 308524 0 46179 Cedric Skillon Psychiatrist 45.00 0.00 X 264901 0 32365 Nykolai Pidhorodeckyi Staff Physician 45.00 0.00 X 265540 0 28314 William Moyers Former key employee VP Public Affairs & Comm Relations 45.00 0.00 X 269279 0 59719 7054420 0 854678 170 1 1 0 Cerner 2800 Rockcreek Parkway Kansas City MO 64117 Technology consultants 3888780 Sodexo Inc & Affiliates 4800 Paysphere Circle Chicago IL 60674 Food service 3084711 Nantmedia Holdings LLC PO Box 740860 Los Angeles CA 900740860 Advertising 2470099 BARR Center 5115 Excelsior Blvd 476 St Louis Park MN 55416 Product development/mktg 874000 Insight Direct USA Inc 6820 S Harl Ave Tempe AZ 85283 Computer services 570640 40 81030 6080742 14479636 784196 20641408 Addiction Treatment 623990 144772626 144772626 Publishing 511130 32950665 32950665 Higher Education 611600 4453521 4453521 182176812 1830528 1830528 208375313 500 160199584 18792 48175729 -18292 48157437 48157437 0 81030 19271 -19271 -19271 Corporate support fee 561000 1435012 1435012 Personal property rent 900002 30721 30721 1465733 254252647 183611824 30721 49968694 1237889 1237889 10000 10000 5986279 1535304 4189694 261281 97673235 77085227 17907629 2680379 4804928 3853615 843738 107575 13341905 11107545 1777833 456527 6982943 5376866 1445469 160608 742842 97139 645703 112829 112829 65353 65353 273956 273956 14819772 13070411 1181118 568243 9527489 9108373 293599 125517 4398008 3008281 1328068 61659 9891535 495337 9343864 52334 2797353 2797353 5196474 4698468 414020 83986 1455268 1276185 80581 98502 149895 142152 6153 1590 1622419 1251058 362390 8971 17331335 13858736 3371399 101200 2592193 1615714 952890 23589 Cost of Materials Sold 3463183 3463183 Patient Food 2949272 2646188 303084 MNCare Taxes 1592138 1592138 UBIT 6126 6126 7839169 5189708 2186256 463205 216863788 164516870 47091752 5255166 15758825 12700508 6987748 7516373 23415020 25471764 2397843 2232802 1821416 2614578 373803318 220795865 157784560 153007453 84602273 140480158 86396541 48759233 13807238 13548617 146739255 166612194 539710719 572943680 33220274 36153820 569471 353975 53009767 50837927 918750 10393747 110980146 124985702 198698408 222725171 X 296614495 300950378 44397816 49268131 341012311 350218509 539710719 572943680 X 37388859 -28587313 404652 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 63307 1 495350 0 558657 0 Part II-B, Line 1: By informing public audiences and key stakeholders about important issues, Hazelden Betty Ford seeks to diminish public stigma related to addiction and improve the formulation of policy at its earliest stages. Through its advocacy, the Foundation also supports each Hazelden Betty Ford facility, its employees and other interested stakeholders by responding to requests and providing information on relevant federal, state and local issues and legislation. At the federal level, Hazelden Betty Ford continued contributions to the Partnership to Amend 42 CFR Part 2, a coalition that advocates for aligning conflicting federal laws related to the sharing of medical records to allow appropriate access to patient information that is essential for providing whole-person care. Additionally, Hazelden Betty Ford advocated for pandemic-specific investments in behavioral health, as well as policy changes to improve access to quality prevention, treatment and recovery-related resources. At the state level, Hazelden Betty Ford met and communicated with policymakers in California, Minnesota, New York, Oregon, Washington, West Virginia and elsewhere related to organizational priorities to expand services to people across the country. The firm Fredrikson & Byron, P.A., was retained to help with lobbying efforts in Minnesota. Hazelden Betty Ford's advocacy leaders sponsored or provided speakers for numerous events in 2021, distributed a monthly Advocacy Update email to a national list of subscribers, while also producing blogs and audio-video content, providing or securing media interviews to support its advocacy agenda, and generating thousands of social media impressions and website visitors. The Foundation regularly receives requests for information on addiction, treatment and recovery issues from policymakers, the media and the public. By serving as a reliable resource to many, the Foundation was able to influence policy and public attitudes in diverse ways. Through its advocacy, Hazelden Betty Ford provides a leading and trusted voice on emerging topics and public policy issues related to addiction and mental health, and facilitates conversation among those in recovery, those still suffering and society-at-large. The Foundation is and will remain committed to smashing stigma, shaping public policy and educating people everywhere about the problems of addiction and the promise of recovery. 793414 X X 0 32881217 193260 4161830 1477914 35758393 32962032 192546 1201747 1475108 32881217 28021818 2136509 4275729 1472024 32962032 31642133 107162 -2182857 1544620 28021818 30436060 108517 3052785 1488483 32108879 0.00000 1.00000 0.00000 0 0 11049395 11049395 211357863 99499379 111858484 3218408 1951192 1267216 127400647 108949897 18450750 20777005 10395397 10381608 153007453 3223473 F Rimrock High Income Value Fund 359219 F Silchester International 11131003 F Energy Capital 117099 F Wellington Trust Company 10592828 F Renaissance Ridge 1729344 F Hudson Bay International 1658616 F Arkkan Opportunities Feeder Fund Series 5 2417787 F Atalan Offshore Fund 1695639 F Brevan Howard MB Macro Fund Limited 2513054 F Davidson Kempner Institutional 3551407 F HG Vora Special Opportunities Fund 1920074 F Pelham Long Short Fund 1313571 F Shellback Offshore Fund 1580787 F Silver Point Capital Offshore 2473757 F Tudor Riverbend Crossing Partners 2481575 F 48759233 Intercompany receivables 157407941 Film and video costs, net 96594 CSV life insurance 291954 Collections 793414 Split interest agreements 1546416 Operating lease right to use 6226427 Curriculum costs, net 249448 166612194 Asset retirement obligation 183219 Intercompany payables 117423301 Capitalized finance costs -539505 Long term Cerner credit agreement 953831 Operating lease liability 6506956 Sodexo contract obligation 457900 124985702 X Part III, Line 4: Hazelden Betty Ford Foundation maintains a collection of historically significant books and archives on recovery and addiction which can be used for research as well as being on public display. Part V, Line 4: Earnings from the endowment funds are used for the purposes as specified by donor restrictions, including patient aid, operations, research, student aid, prevention programs and special projects. Part X, Line 2: In accounting for uncertain tax positions, the Foundation recognizes the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merit of the position. Examples of tax positions include the tax-exempt status of the Foundation and various tax positions related to potential sources of unrelated business taxable income. The Foundation had no uncertain tax positions as of December 31, 2021 and 2020. Part V, line 1a The 2018 beginning of year balance was updated to correct the endowment balance due to the merger with Betty Ford Center in 2014. 1 Central America and the Caribbean 0 0 Program services Hazelden Publishing sells and distributes books and related items. Education and preventive instruction is provided to high school students, parents and educators. East Asia and the Pacific 0 0 Program services Hazelden Publishing sells and distributes books and related items. Education and preventive instruction is provided to high school students, parents and educators. Europe 0 0 Program services Hazelden Publishing sells and distributes books and related items. Education and preventive instruction is provided to high school students, parents and educators. Middle East and North Africa 0 0 Program services Hazelden Publishing sells and distributes books and related items. Education and preventive instruction is provided to high school students, parents and educators. North America 0 0 Program services Hazelden Publishing sells and distributes books and related items. Education and preventive instruction is provided to high school students, parents and educators. Russia & Neighboring States 0 0 Program services Hazelden Publishing sells and distributes books and related items. Education and preventive instruction is provided to high school students, parents and educators. South America 0 0 Program services Hazelden Publishing sells and distributes books and related items. Education and preventive instruction is provided to high school students, parents and educators. South Asia 0 0 Program services Education and preventive instruction is provided to high school students, parents and educators. Sub-Saharan Africa 0 0 Program services Hazelden Publishing sells and distributes books and related items. Central America and Caribbean 0 0 Investments 18414079 0 0 0 0 0 0 0 18414079 18414079 Scholarships for Hazelden Betty Ford Graduate School of Addiction Studies North America 2 10000 Applied directly to tuition Book 1 0 1 1 0 0 Part III Accounting Method: Part I, Line 2 Hazelden Betty Ford Foundation Graduate School of Addiction Studies applies grants to students outside of the United States directly to the student's tuition. Part IV, Line 3 Hazelden Betty Ford Foundation reviews its direct and indirect investments during the tax period for determining required foreign filings. Hazelden Betty Ford Foundation's ownership interests in foreign corporations do not require a Form 5471 to be filed. Part IV, Line 4 Hazelden Betty Ford Foundation invests in partnerships that hold direct or indirect interests in passive foreign investment companies (PFIC) and also invests in PFIC's directly. The investment partnerships have properly filed Form 8621, or the underlying investments did not generate any unrelated business income. Under these facts, Hazelden Betty Ford Foundation is not required to file any additional Form 8621. Portland Humanitarian Awards 81030 81030 3600 15671 81030 81030 3600 15671 19271 -19271 1 1 X 0 1 X 0 1 0 1 0 4304986 0 4304986 0.01990 4304986 4304986 0.01990 3987334 1901593 2085741 0.00960 1243489 0 1243489 0.00570 795476 89939 705537 0.00330 6026299 1991532 4034767 0.01860 10331285 1991532 8339753 0.03850 1 5121050 0 0 1 1 1 1 Betty Ford Center 39000 Bob Hope Drive Rancho Mirage CA 92270 see supplemental info for website 106330120 X Betty Ford Center 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X See Part V, Page 8 X 1 21 1 See Part V, Page 8 0 1 X 400.000000000000 X X 1 1 X X X 1 X www.hazeldenbettyford.org/locations/betty-ford-center-rancho-mirage X www.hazeldenbettyford.org/locations/betty-ford-center-rancho-mirage X www.hazeldenbettyford.org/locations/betty-ford-center-rancho-mirage X X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section A: www.hazeldenbettyford.org/locations/betty-ford-center-rancho-mirage Betty Ford Center Part V, Section B, Line 5: The method of soliciting input from people representing the broad interests of the community was an online survey that targeted leaders of local organizations in the health and human services fields. The survey for local leaders assessed who these organizations served, what types of services they provided, and what their perspective was on substance use and/or mental health issues that their clients struggled with. The survey included questions regarding barriers to treatment, and the urgency of the need to address substance use and/or mental health issues in the region. The recruit participant list was produced by obtaining active provider information from the Substance Abuse and Mental Health Services Administration (SAMHSA) as well as California Office of Statewide Health Planning and Development (OSHPD). The list included a variety of health and human services organizations such as health clinics, hospitals, federally qualified health centers (FQHCs), nonprofits including homeless shelters, LGBT centers, senior centers, and county health departments including Department of Health, Department of Behavioral Health, and Department of Public Health. A total of 147 organizations (two of these were not originally on the recruitment list but received information about the survey) were reached. Among these 147 organizations, 51% participated in the survey. After the launch date, the organizations were sent an email reminder encouraging them to participate. Despite the email invitation and reminder emails, the response rate was subpar. To increase response rates, personal email reminders were sent. These recruitment efforts resulted in a total of 120 respondents, representing 80 organizations.All participants were asked to specify the County service area in which they work. Participation was acquired from each county, and some respondents indicated that they serve clients outside of these counties. Respondents were also asked to specify the populations they serve and to check all that apply. A total of 119 participants responded to this question. A range of populations are served, including various demographic races (Hispanic/Latino (93.3%), White/Caucasian (87.4%), African American (86.6%), American Indian/Alaska Native (80.7%), as well as LGBTQIA+ (84.9%), low-income (89.9%), homeless (72.3%), uninsured (67.2%), and medically underserved (68.1%). Participants were also asked to specify the types of services that their organization provides and were encouraged to select all of the response options that apply. The most common services provided, as expected, are mental healthcare (58.3%) and substance use treatment (57.5%); however, there were other selections such as advocacy (35.8%), homeless intervention services (33.3%), and primary healthcare (26.7%). The survey was designed to measure perceptions of local organizations providing substance use and mental health services in some capacity. However, some organizations may exclusively provide one type of service such as only substance use or only mental health services, while others provide a combination of these two services. For example, if an organization provided only mental health services, they received questions pertaining only to mental health. Nearly three-quarters (73.7%) of participants stated their organization provides both mental health and substance use services. Betty Ford Center Part V, Section B, Line 11: To assemble the list of significant health needs for the overall service area of Los Angeles County, Riverside County, and San Diego County, both the secondary data as well as the primary data collected from local community leaders were utilized. Health needs were rated with respect to their magnitude, severity, disparity, and feasibility. In other words, each health need was evaluated in terms of how many people are affected, the consequences of the need, the disproportionate impact, and then the potential to meaningfully address the need. The top health needs that had a high need priority as well as a high feasibility rating were retained.Thus, the health needs identified through this CHNA are as follows: 1. Substance Use - Education and Awareness 2. Mental Health - Education and Awareness 3. Substance Use - Improved Access to Care 4. Mental Health - Improved Access to Care Note that Betty Ford Center (BFC) is actively engaged in each of these above bullets at all times. Thus, based on community input, these areas will remain as primary focus areas for Betty Ford Center over the next three years.Substance Use Education and Awareness: The strategies being worked on are: 1. Continuing to provide education for community members focused on prevention and treatment of substance use disorders and the long-term recovery process.2. Continuing to establish Motivational Interviewing skills as key competencies for the care that is provided. 3. Continue providing support and education for children and families affected by substance use disorder. The following progress was made on these strategies:-Betty Ford Center contracted with Palo Verde College in Blythe, CA to offer nursing students collaboration and training at BFC starting in 2022. This allows BFC to provide education to nursing students on addiction treatment during their rotation. Betty Ford Center outreach had an informational booth at the 35th annual Palm Springs Pride Festival. -Multiple staff members applied for Motivational Interviewing training.-Alumni Services held the 39th annual Alumni Anniversary event (virtual due to the pandemic). The Children's Program offered Alumni Curbside participation. The children were given goodie bags with candy, toys, masks and Beamer t-shirts. Beamer is the mascot and ambassador that helps reinforce all the skills taught to children relative to addiction. Mental Health Education and Awareness: The strategies being worked on are: 1. Integrated care for mental health substance use disorders for patients.2. Providing training on integrated treatment of mental health and substance use disorders. 3. Continue providing education for community members focused on integrated treatment of mental health and substance use disorders.The following progress was made on these strategies:-A monthly meeting for Men's Association for Addition Treatment (MAAT) were held. The meeting is a networking meeting for men and women in the field of addiction, behavioral and mental health fields. Substance Use Improved Access to Care: The strategies being worked on are: 1. Continuing to expand virtual treatment options and services. 2. Continuing to improve care coordination and collaboration between Betty Ford Center and community providers, removing barriers to community accessing treatment and non-treatment resources related to substance use disorder. 3. Expanding Betty Ford Center services delivered in Spanish.The following progress was made on these strategies:-Intensive Outpatient, Family and Children's programs are being offered virtually.-Hazelden Betty Ford Foundation website has extensive informational resources.-The BFC Executive Director presented at Patient Care Network on our COVID response and continuing to provide access to care during the pandemic.-Recovery Trek is an alcohol and drug screening program for those needing screenings to attend virtual programs.-The Manger of Children's Programming and an addiction counselor gave a two-part presentation at the Labor Assistance Professionals Conference addressing cultural barriers to treatment and recovery and addressing family dynamics in treatment and recovery.-Leaders at Betty Ford Center and Eisenhower Health Behavioral Services meet periodically regarding services that are offered.-The Family Program and Children's Program are offered virtually in Spanish.-A Spanish speaking Children's Program counselor and a Family Program counselor created a Spanish speaking PSA along with a 30 second radio PSA to be run on Univision TV and radio in California.-A Spanish speaking Family Program counselor did a Let's Talk podcast regarding the program.-A Spanish speaking Family Program counselor and a patient did an interview with Together Magazine regarding the positive impact of the program.Mental Health Improved Access to Care:The strategies being worked on are: 1. Continuing to expand virtual treatment services for mental health disorders. 2. Continue to improve care coordination and collaboration between Betty ford Center and community mental health and psychiatric providers.The following progress has been made on these strategies:-The Hazelden Betty Ford Foundation website has extensive informational resources on mental health services provided.Secondary data collection and primary data collection focused on themes related to substance use and mental health, as Betty Ford Center is a chemical dependency hospital, unlike a traditional acute care hospital. Thus, general health conditions (heart disease, diabetes, immunodeficiency, etc.) are not included anywhere in the prioritization process. Although general health conditions were not included, the demographic findings did provide some insight to the community being served by Betty Ford Center. For example, it appears economic opportunity, as it pertains to educational attainment, employment status, and poverty status certainly are significant health needs and deserve special focus. For example, less than a third (29.6%) of adults have a bachelor's degree or higher, about a tenth (9.9%) of the labor force is unemployed, and about 14.0% are living below the poverty line (a line barely sufficient for suitable living standards). However, the need of economic opportunity is better suited for other employment development and educational institutions to pursue. When looking at Betty Ford Center's service area, those who are ages 65 and older (1.4%), or under the age of 19 (3.9%) are far less likely to be uninsured compared to working age adults (19-64) (12.8%). That said, about 14.9% of residents in the service area have delayed or didn't get needed healthcare. Thus, there is certainly a need to improve access to general healthcare. However, improving access to this type of care is better suited for other acute care hospitals, clinics, and federally qualified health centers. Betty Ford Center Part V, Section B, Line 13h: Factors other than the Federal Poverty Guidelines that are used by Hazelden Betty Ford Foundation for determining eligibility for financial assistance include proof of household income, evaluation of assets, number of dependents living in the household, debt associated with major assets to determine net worth, major monthly debt payments to calculate debt to income ratio, and trust documents, if any.The application process may be waived or suspended due to medical necessity, including timing and urgency of care.To the fullest extent possible, financial assistance can be estimated prior to services based on verbal information provided but must be verified by submission of the financial assistance application within ten (10) days before financial assistance is awarded. Part V, Section B, Line 7a www.hazeldenbettyford.org/locations/betty-ford-center-rancho-mirage Part V, Section B, Line 10a www.hazeldenbettyford.org/locations/betty-ford-center-rancho-mirage Part V, Section B, Line 22b The maximum amount that can be charged for FAP-eligible individuals for medically necessary care was calculated using the look-back method with private health insurers only as Hazelden Betty Ford Foundation does not receive Medicare or Medicaid funding. 13 1 - Hazelden Betty Ford in Center City 15251 Pleasant Valley Road Center City MN 55012 Inpatient addiction treatment center for adults 2 - Hazelden Betty Ford in Plymouth 11505 36th Avenue North Plymouth MN 55441 Inpatient/outpatient addiction treatment center for adolescents/young adults 3 - Hazelden Betty Ford in Newberg 1901 Esther Street Newberg OR 97132 Inpatient addiction treatment center for adults 4 - Hazelden Betty Ford in St Paul 680 Stewart Avenue St Paul MN 55102 Outpatient addiction treatment center for adults & recovery housing 5 - Hazelden Betty Ford in Naples 950 6th Ave N Suite 101 Naples FL 34102 In/outpatient addiction treatment center for adults & recovery housing 6 - Hazelden Chicago 867 North Dearborn Street Chicago IL 60610 Outpatient addiction treatment center for adults, adolescents & young adults 7 - Hazelden New York in Tribeca 283 West Broadway New York NY 10013 Outpatient addiction treatment center for adults 8 - Hazelden Betty Ford in Maple Grove 7001 E Fish Lake Road Suite 120 Maple Grove MN 55311 Outpatient addiction treatment center for adults 9 - Hazelden Betty Ford in Beaverton 6600 SW 105th Ave Suite 120 Beaverton OR 97008 Outpatient addiction treatment center for adults 10 - Hazelden Betty Ford in Chaska 1107 Hazeltine Blvd Ste 300 Chaska MN 55318 Outpatient addiction treatment center for adults, adolescents & young adults 11 - Hazelden Betty Ford in Bellevue 1231 116th Ave Ste 410 Bellevue WA 98004 Outpatient addiction treatment center for adults 12 - Betty Ford Center in San Diego 11720 El Camino Real Suite 200 San Diego CA 92130 Outpatient addiction treatment center for adults 13 - Betty Ford Center in Los Angeles 10700 Santa Monica Blvd Suite 310 Los Angeles CA 90025 Outpatient addiction treatment center for adults Part I, Line 3c: Factors other than the Federal Poverty Guidelines that are used by Hazelden Betty Ford Foundation for determining eligibility for financial assistance include proof of household income, evaluation of assets, number of dependents living in the household, debt associated with major assets to determine net worth, major monthly debt payments to calculate debt to income ratio, and trust documents, if any. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Community health improvement services, health professions education, and research are reported based on actual expenses recorded in the organization's general ledger. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The Foundation determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 4: The footnote to the Foundation's financial statements addressing implicit price concessions may be found on page 12 of the attached audited financial statements. Part III, Line 9b: The Betty Ford Center will not engage in extraordinary collection actions before it makes a reasonable effort to determine whether a patient is eligible for financial assistance under the financial aid policy which is up to a total of 240 days from the first post-discharge bill for the most recent episode of care. Actions that may be taken against a patient for nonpayment include utilizing a collection agency for debts older than 120 days. If a collection agency identifies a patient as meeting the Betty Ford Center's financial assistance eligibility criteria, the patient's account may be considered for patient aid. Collection activity will be suspended on these accounts and the Betty Ford Center will review the financial assistance application. If the entire account is adjusted, the account will be returned to the Betty Ford Center. If a partial adjustment occurs, the patient fails to cooperate with the financial assistance process, or if the patient is not eligible for patient aid, collection activity will resume. Part VI, Line 2: A community health needs assessment was completed for Betty Ford Center in 2021 which allows the organization to understand the needs of the community. Part VI, Line 3: Hazelden Betty Ford Foundation includes notices regarding the availability of patient aid on its website, and in marketing and program-related materials, and in locations where there is a high volume of admission and or registration related activity. Part VI, Line 4: Betty Ford Center serves people from all around the world, however the majority of the clients come from California. For calendar year 2020, most clients are coming from the counties of Los Angeles (27.7%), Riverside (24.5%), and San Diego (12.3%). Therefore, Betty Ford Center's community is defined as these counties, and is frequently referred to as the "overall service area". "Other counties" include all counties in which less than 1% of Betty Ford Center's California clients originate from.Across Betty Ford Center's service area, there are about 15.8 million people. About half are male while the other half are female. About 60.2% are white, and nearly half (45.5%) report being Hispanic/Latino. More than half (60.1%) of the adults in the overall service area have obtained either some college degree/associate's degree or bachelor's/higher degree. As of December of 2020, the unemployment rate of the overall service area was 9.9%. About 63.4% of households in the overall service area have a household income of $50,000 or more; however, about 14% of the service area lives in poverty. About half of the population ages 5 and older speak English in their home (49.8%); another third speak Spanish at home (35.4%). Rates of healthcare coverage vary by age group. The vast majority of seniors age 65 and older and youth younger than age 19 are insured. About 12.8% of working-age adults (ages 19 to 64) are uninsured. More than half (60.5%) of residents have private health insurance coverage whereas only 38.2% of residents have public health insurance. In 2020, about 12.5% of adults in the overall service area have likely had serious psychological distress. About 13.8% of adults have seriously thought about committing suicide at some point in their lives. There are about 1,636 emergency room (ER) visits and 344 ER admissions per 100,000 people in the overall service area. About a fifth (20.1%) of adults who have experienced psychological distress in the past year have been unable to work for more than 3 months due to mental problems. Riverside County's rate (34.4%) is noticeably higher. Across Betty Ford Center's service area, approximately 11.8% of the total population received opioid prescriptions in 2019. Approximately 3.0% of the adults in Betty Ford Center's service area have misused prescription pain killers in the past 12 months. While this number seems small, that 3.0% equates to more than 364,000 adults misusing prescription pain killers. Among adults who report having at least a single drink in the past month across Betty Ford Center's service area, about 17.4% report binge drinking, putting nearly a fifth of drinking adults at an increased risk for poor health outcomes. Among those aged 12 and older, between 11% and 14% have engaged in illicit drug use in the past month. However, when looking at those who engaged in illicit drug usage in past month other than marijuana, the rates drop by more than half (between 2% and 4%). For every 100,000 residents, between 101 and 124 residents visit the emergency department for all drug-related overdoses. The rate for drug-related hospitalizations is between 42 and 53 per 100,000 population. San Diego County has a slightly higher rate of hospitalizations per 100,000 compared to Los Angeles County, and to a lesser extent, Riverside County. The death rate due to drug overdoses ranges from 11 to 19 deaths per 100,000 population each year. Riverside County (18.1) is slightly higher than Los Angeles County (11.8) and San Diego County (13.6). Part VI, Line 5 The Betty Ford Center (BFC) promotes the health of the community outside of the CHNA needs. During 2021, the Betty Ford Center staff distributed thank you notes to local first responders that provide services to BFC. The Children's Program partnered with Hope Collaborative to provide holiday gifts for foster kids, infants and teens across Coachella Valley. BFC also held a food drive to support the local community for those who find themselves food insecure during the holiday season. The Betty Ford Center partnered with Coachella Valley Pharmacy to provide COVID vaccinations to the patients, staff, family and friends at no cost.Currently, the campus is undergoing a renovation which includes tearing down the patient unit buildings and building new ones so the patients can have a more comfortable and modern living and recovery environment. Along with the campus renovation, there are many smaller projects that take place to replace furniture, to improve the HVAC systems, etc. for the comfort and safety of the employees and patients.The Betty Ford Center recovery experts offer an intervention education seminar for adults. This seminar is free to the public and includes educational materials about the signs and symptoms of substance abuse as well as what's involved in planning and conducting a successful intervention.The Professionals in Residence (PIR) program and the Summer Institute for Medical Students (SIMS) give medical students, residents, health care and legal professionals an in-depth experience with the dynamics of the disease of addiction. Intensive one-week programs blend classes presented by Betty Ford Center physicians and expert clinicians with time spent interacting with patients and staff on treatment units or family programs. Participants learn about the latest research and evidence-based methods from our multidisciplinary faculty. A rotation on addiction for psychiatry, family medicine and internal medicine residents also is available in California. In addition, a one-year accredited Addiction Medicine Fellowship is available at the Betty Ford Center and an online Course on Addiction and Recovery Education (CARE) is available worldwide. The Hazelden Betty Ford Foundation's (HBFF) website, www.hazeldenbettyford.org, provides a wealth of knowledge on substance use disorders and mental health that is available to all, including health care professionals. There are free webinars presented by HBFF experts and authors. Online courses are available through the Hazelden Betty Ford Graduate School of Addiction Studies. There are also research updates, books, videos and curricula along with continuing education events and workshops. 1 Scholarships for Graduate School of Addiction Studies 119 366289 Scholarships for Professionals in Residence Training (PIR) 8 11200 Scholarships for Summer Institute for Medical Students (SIMS) 259 856000 Educational assistance for local high school students 5 4400 Part I, Line 2: Hazelden Betty Ford Foundation provides the assistance as part of its program services activity. All scholarships are provided to individuals and monitored through the Graduate School of Addiction Studies, the Professionals in Residence and Medical Education training programs and the Community Relations department to ensure the monies are used for the purpose intended. The tuition paid for those programs and the funds given to assist with the tuition is tracked by each individual. X X X X 0 0 0 0 0 0 0 0 0 Dr Marvin Seppala Chief Medical Officer 517174 0 89719 0 5584 0 33616 0 29844 0 675937 0 0 0 Dr Joseph Lee PresidentCEO as of June 2021 500955 0 43104 0 764 0 36150 0 7755 0 588728 0 0 0 Mark Mishek PresidentCEO until June 2021 328601 0 143821 0 61745 0 16650 0 15568 0 566385 0 0 0 James Blaha Treasurer, VP CFO and CAO 411490 0 67570 0 3165 0 36150 0 30840 0 549215 0 0 0 John Driscoll Sr. VP Recovery Services 345063 0 62424 0 798 0 36150 0 40165 0 484600 0 0 0 Robert Poznanovich VP Business Development 304803 0 55346 0 2699 0 31835 0 29768 0 424451 0 0 0 Nicholas Motu VP & Chief External Affairs 279747 0 56139 0 26753 0 16650 0 32876 0 412165 0 0 0 Melissa Fors VP Marketing Strategy 276336 0 51923 0 641 0 16650 0 14849 0 360399 0 0 0 Jerry Moe Exec. Dir. Nat'l Children's Program 276100 0 30309 0 2115 0 16434 0 29745 0 354703 0 0 0 Jennifer Lohse Secretary, VP General Counsel 250564 0 45571 0 257 0 14368 0 40257 0 351017 0 0 0 Joseph Jaksha VP Publisher 236989 0 43260 0 1038 0 15775 0 40989 0 338051 0 0 0 Kristen Schmidt Psychiatrist 298153 0 0 0 302 0 10999 0 20793 0 330247 0 0 0 William Moyers Former key employee VP Public Affairs & Comm Relations 241504 0 26194 0 1581 0 19645 0 40074 0 328998 0 0 0 Dawne Carlson VP Human Resources 239784 0 44866 0 1007 0 15104 0 13903 0 314664 0 0 0 Debra Bauman VP Tech Services & CIO 235301 0 44370 0 2677 0 14815 0 15604 0 312767 0 0 0 Valerie Slaymaker VP Education and Research 198084 0 44061 0 40396 0 15335 0 13098 0 310974 0 0 0 Moira McGinley VP Development & CDO 251884 0 43269 0 362 0 11875 0 796 0 308186 0 0 0 Victor Vines Medical Administrator 272527 0 0 0 15090 0 7119 0 11755 0 306491 0 0 0 Cedric Skillon Psychiatrist 264502 0 0 0 399 0 14509 0 17856 0 297266 0 0 0 Nykolai Pidhorodeckyi Staff Physician 264394 0 0 0 1146 0 11996 0 16318 0 293854 0 0 0 Part I, Line 4 Mark Mishek, President and CEO, participated in a nonqualified retirement plan. A City of Center City MN 416005039 151452BM0 2014-07-23 41439310 Refund bonds 11/17/00, 11/27/02, 10/13/05 & improvements at MN locations 0 0 0 B City of Center City MN 416005039 151452CD9 2019-08-05 18103654 Refund bonds issued 11/14/2011 0 0 0 A 6815000 41441547 434310 18702237 22305000 2015 1 0 1 1 B 1065000 18103654 250561 17853093 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 A 1 B 1 Date Rebate Computation Performed Issuer Name: City of Center City, MN Date the Rebate Computation was Performed: 01/16/2019 Schedule K Supplental Information Bond A - Interest income of $2,237 is included in Part II, Line 3 Recovery Partners PC 100% owned by a key employee of Hazelden Betty Ford Foundation 4917400 Reimbursable professional fees 0 X 14 784196 Gross selling price 0 0 1 0 Part I, Column (b): Column B is reported based on the number of contributions received. Form 990, Part VI, Section A, line 1a The Executive Committee of the Board of Trustees has the authority to act on behalf of the Board between the Board's regular meetings, subject to the limitations of power listed below. The Executive Committee consists of the Chair of the Board, the Immediate Past Chair, if still a member of the Board, Vice Chairs of the Board, President (ex-officio non-voting), Secretary, Treasurer, and the Chair of each standing committee. Limitations of Powers: The Executive Committee does not have the power to elect a trustee, to alter fundamental policies approved by the Board, to make appropriations which are not in accordance with the general policies approved by the Board, to modify, revoke or renew any contract previously entered into by the Board or to change the person or persons specifically designated by the Board to enter into or execute on behalf of the organization a particular contract, obligation, agreement or writing authorized by action of the Board of Trustees. Form 990, Part VI, Section B, line 11b Hazelden Betty Ford Foundation sent its Form 990, with Schedule B suppressed, via email to Board members for review and questions prior to filing. It was also reviewed by the CFO prior to filing. Form 990, Part VI, Section B, line 12c Hazelden Betty Ford Foundation requires an annual disclosure of any potential conflict of interest by Board Members, officers and key employees. If a Board Member discloses a potential conflict, that person then excuses him or herself from voting on that particular issue. All new Board Members are provided conflict of interest education and periodic training throughout their term. All Board Members sign an annual conflict of interest disclosure form. Form 990, Part VI, Section B, line 15 Hazelden Betty Ford has an established process for determining the compensation of the President and CEO, other officers and key employees. The Hazelden Betty Ford Foundation by-laws delegate responsibility for determining compensation for the President and CEO, other officers and key employees to the Executive Committee of the Board of Trustees. The Executive Committee approves, as necessary, the compensation philosophy for Hazelden Betty Ford Foundation. Hazelden Betty Ford has established a compensation process for executives that provides Hazelden Betty Ford with a rebuttable presumption of reasonableness as defined under Intermediate Sanction Regulations--Excess Benefit Transactions, IRS Section 4958. Each year the Board members complete a conflict of interest disclosure. The documents are reviewed by Hazelden Betty Ford's general counsel and if a Board member has a conflict of interest they are not involved in any compensation decisions. The Executive Committee in partnership with Human Resources, engages the use of an outside independent compensation consultant to identify comparable market data for comparable positions for the President and CEO and other disqualified individuals consistent with the approved compensation philosophy. Generally, the market analysis includes competitive data from published survey sources, and may be supplemented with compensation data from custom Form 990 analyses. Where possible, competitive data is pulled from organizations similar in size, revenue and industry. The compensation consultant analyzes the pay packages of the President and CEO and other disqualified individuals by reviewing base salary, total cash compensation (salary plus annual incentive at both target and actual levels). In addition, the Executive Committee reviews the total compensation package of the President and CEO and other disqualified individuals. The total compensation package includes total direct compensation plus severance, employee benefits, perquisites and any other pay. Comparable market data are reviewed and discussed by the Executive Committee and minutes record those discussions and any resulting compensation decisions. A compensation review for the President and CEO was most recently done in March 2021. The compensation review for other officers and key employees was completed in March 2021. Form 990, Part VI, Section C, line 19 Hazelden Betty Ford Foundation makes its annual report available to the public via its website at www.hazeldenbettyford.org. The governing documents and conflict of interest policy are not available for public inspection. Form 990, Part XI, line 9: Net assets released - intercompany transactions 405,153. Rounding -501. Hazelden Chicago PO Box 11 Center City MN 55012 364099403 Substance use and mental health services are provided to people seeking help IL 501 (c)3 3 Hazelden Betty Ford Foundation 1 Hazelden New York PO Box 11 Center City MN 55012 133673215 Substance use & mental health services are provided to individuals/families NY 501 (c)3 10 Hazelden Betty Ford Foundation 1 Charitable remainder trust Charitable remainder trust CA N/A T 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 Hazelden Chicago Q 646234 Fair market value Hazelden New York Q 788778 Fair market value