2020-11-15T19:02:26-06:00 2019-12-31 135565207 KPMG LLP 4200 WELLS FARGO CTR 90S7TH STREET MINNEAPOLIS MN 55402 990 2019-01-01 391726539 AMERY REGIONAL MEDICAL CENTER FOUNDATION INC AMER 7152688000 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 DEBRA A RUDQUIST PRESIDENT 7152688000 2020-11-15 1 MONROE JORDAN GIERL P01413237 6123055000 198.153.9.194 2020-11-15 15:46:23 CS P 763097D6A2B3EA9277A508CC789A2C5E6C07E1F2 763097D6A2B3EA9277A508CC789A2C5E6C07E1F2 2019 2021-01-29 14:40:06Z DEBRA A RUDQUIST 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 435292 0 X WWW.AMERYMEDICALCENTER.ORG X 1991 WI TO PROMOTE THE HEALTH AND WELLNESS IN THE COMMUNITIES SERVED BY AMERY REGIONAL MEDICAL CENTER. 9 7 0 36 0 0 324463 405320 0 0 2997 3350 -2289 17698 325171 426368 95487 270186 0 0 0 0 0 0 0 163546 114458 259033 384644 66138 41724 579490 706221 46504 131511 532986 574710 X THE AMERY REGIONAL MEDICAL CENTER FOUNDATION (FOUNDATION) EXISTS TO PROMOTE THE HEALTH AND WELLNESS OF THE PEOPLE IN THE COMMUNITIES SERVED BY AMERY REGIONAL MEDICAL CENTER (ARMC) BY PARTICIPATING IN VARIOUS FUNDRAISING ACTIVITIES. 0 0 384644 270186 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS 384644 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI X DOUG JOHNSON CFO 7152688000 265 GRIFFIN STREET EAST AMERY WI 54001 X JOYCE SCHAEFER DIRECTOR & CHAIR 0.75 0.00 X X 0 0 0 HEIDI ERSPAMER DIRECTOR 0.25 1.75 X 0 1200 0 BRIAN BYRNES DIRECTOR & SECRETARY & TRE 0.50 0.00 X X 0 0 0 JON BUSS DIRECTOR 0.50 0.00 X 0 0 0 BRUCE DENNISON MD DIRECTOR 0.50 59.75 X 0 405379 55995 SHARI OVERBY DIRECTOR 0.50 0.00 X 0 0 0 J MARTIN NOONAN DIRECTOR & VICE CHAIR 0.50 0.00 X X 0 0 0 JAMES QUENAN MD DIRECTOR 0.50 0.00 X 0 0 0 ANN SEAGREN MD DIRECTOR 0.50 49.75 X 0 233514 72952 JOANNE L JACKSON EXECUTIVE DIRECTOR 45.00 0.00 X 0 160894 27544 JASON J LUHRS CFO (JAN-AUG) 0.50 49.50 X 0 231590 53365 DOUGLAS JOHNSON CFO (AUG-DEC) 0.50 54.50 X 0 380795 153262 DEBRA RUDQUIST PRESIDENT 0.50 53.50 X 0 329096 61861 0 1742468 424979 0 0 1 0 0 8874 40207 356239 405320 3350 3350 26622 8874 8924 17698 17698 426368 0 0 21048 X 269921 269921 265 265 49426 49426 32961 32961 4326 4326 1762 1762 565 565 MISCELLANEOUS OTHER EXP 25418 25418 384644 384644 0 0 566926 683052 12564 23169 579490 706221 46504 131511 46504 131511 X 532986 574710 532986 574710 579490 706221 41724 0 X 0 1 X 1 0 X 5319 181416 253561 324463 405320 1170079 5319 181416 253561 324463 405320 1170079 342245 827834 163 412 920 2997 3350 7842 1177921 178352 0.70280 0.69900 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 X PART X, LINE 2: AMERY REGIONAL MEDICAL CENTER FOUNDATION, INC. IS INCLUDED IN THE HEALTHPARTNERS, INC. (HP) CONSOLIDATED AUDITED FINANCIAL STATEMENT. HP'S ACCOUNTING POLICY PROVIDES THAT A TAX BENEFIT FROM AN UNCERTAIN TAX POSITION MAY BE RECOGNIZED WHEN IT IS MORE LIKELY THAN NOT THAT THE POSITION WILL BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTIONS OF ANY RELATED APPEALS OR LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS. HP RECORDED NO LIABILITIES AT DECEMBER 31, 2019 OR 2018 FOR UNRECOGNIZED TAX BENEFITS. X GOLF TOURNAMENT 35496 8874 26622 8924 0 35496 8874 26622 8924 8924 17698 1 AMERY REGIONAL MEDICAL CENTER INC 265 GRIFFIN STREET EAST AMERY WI 54001 390908320 501(C)(3) 265113 PROGRAM SUPPORT 1 PART I, LINE 2: AMERY REGIONAL MEDICAL CENTER FOUNDATION (FOUNDATION) MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH THE FOUNDATION'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO THE FOUNDATION'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE. 0 1 0 0 0 0 0 0 0 BRUCE DENNISON MD DIRECTOR 0 275303 0 0 0 130076 0 21000 0 34995 0 461374 0 0 ANN SEAGREN MD DIRECTOR 0 212661 0 0 0 20853 0 41335 0 31617 0 306466 0 0 JOANNE L JACKSON EXECUTIVE DIRECTOR 0 135348 0 8617 0 16929 0 6532 0 21012 0 188438 0 0 JASON J LUHRS CFO (JAN-AUG) 0 191700 0 33727 0 6163 0 23722 0 29643 0 284955 0 0 DOUGLAS JOHNSON CFO (AUG-DEC) 0 299890 0 55505 0 25400 0 121094 0 32168 0 534057 0 0 DEBRA RUDQUIST PRESIDENT 0 270025 0 49041 0 10030 0 30600 0 31261 0 390957 0 0 PART I, LINE 3 THE FOUNDATION HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. ALL OFFICERS AND KEY EMPLOYEES ARE PAID BY GROUP HEALTH PLAN, INC. (GHI), REGIONS HOSPITAL, OR AMERY REGIONAL MEDICAL CENTER, RELATED ORGANIZATIONS. ANY COMPENSATION DISCLOSED IS DETERMINED SOLELY BY THE RELATED ORGANIZATIONS FORM 990, PART III, LINE 4A - "EXEMPT PURPOSE AND ACHIEVEMENTS" CORPORATE STRUCTURE, PURPOSE, GOVERNANCE AMERY REGIONAL MEDICAL CENTER FOUNDATION, INC. (THE FOUNDATION), IS A WISCONSIN NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE HEALTHPARTNERS ORGANIZATION ("HEALTHPARTNERS"). FOUNDED IN 1957, HEALTHPARTNERS IS AN INTEGRATED HEALTH CARE ORGANIZATION, PROVIDING HEALTH CARE SERVICES AND HEALTH PLAN FINANCING AND ADMINISTRATION, AND IS THE LARGEST CONSUMER-GOVERNED NONPROFIT HEALTH CARE ORGANIZATION IN THE COUNTRY. HEALTHPARTNERS' MISSION IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS, AND COMMUNITY. HEALTHPARTNERS SEEKS TO TRANSFORM HEALTHCARE THROUGH A RELENTLESS FOCUS ON THE TRIPLE AIM - PROVIDING EXCEPTIONAL EXPERIENCE FOR THE INDIVIDUAL, IMPROVING THE HEALTH OF THE POPULATION, AND MAINTAINING AFFORDABILITY. HEALTHPARTNERS INCLUDES AN ARRAY OF TAX-EXEMPT AND TAXABLE ORGANIZATIONS WITH HEALTH CARE ACTIVITIES PRIMARILY OPERATING IN MINNESOTA, WESTERN WISCONSIN, AND EXPANDING TO SEVERAL OTHER MIDWESTERN STATES. HEALTHPARTNERS PROVIDES A FULL RANGE OF HEALTH CARE DELIVERY AND HEALTH PLAN SERVICES INCLUDING INSURANCE, PATIENT CARE, ADMINISTRATION, AND HEALTH AND WELL-BEING PROGRAMS. HEALTHPARTNERS HEALTH PLANS SERVE MORE THAN 1.8 MILLION MEDICAL AND DENTAL MEMBERS NATIONWIDE. HEALTHPARTNERS MEDICAL CARE SYSTEM INCLUDES MORE THAN 1,800 PHYSICIANS AND DENTISTS, SEVEN OWNED HOSPITALS WITH OVER 1,000 ACUTE CARE BEDS, MORE THAN 100 OWNED AND LEASED PRIMARY AND SPECIALTY CARE MEDICAL FACILITIES, AND 25 DENTAL FACILITIES WITH PRACTICES IN MINNESOTA AND WESTERN WISCONSIN. HEALTHPARTNERS ALSO CONTRACTS WITH OTHER PRIMARY AND SPECIALTY MEDICAL FACILITIES AND DENTAL FACILITIES, PHYSICIAN GROUPS, HOSPITALS AND RELATED HEALTHCARE PROVIDERS LOCATED PRIMARILY IN MINNESOTA, WESTERN WISCONSIN, AND EXPANDING TO OTHER MIDWESTERN STATES. HEALTHPARTNERS ALSO PROVIDES MEDICAL EDUCATION AND TRAINING TO MEDICAL PROFESSIONALS AND CONDUCTS RESEARCH AND FUND RAISING ACTIVITIES THAT SUPPORT THE HEALTH CARE DELIVERY SYSTEM. A COMPLETE LISTING OF ALL ORGANIZATIONS WITHIN HEALTHPARTNERS, AND THE RELATIONSHIP BETWEEN THEM, CAN BE FOUND ON SCHEDULE R WITHIN THIS 990 RETURN. DETAILED INFORMATION ABOUT THE COMMUNITY BENEFIT ACTIVITIES AND ACCOMPLISHMENTS OF EACH TAX-EXEMPT ORGANIZATION CAN BE FOUND IN THE INDIVIDUAL FORM 990 RETURN FOR THAT ORGANIZATION. HEALTHPARTNERS IS DRIVING CHANGE THAT HELPS OUR MEMBERS AND PATIENTS LIVE HEALTHIER LIVES. HEALTHPARTNERS COLLABORATE WITH OTHER PLANS, CARE PROVIDERS, AND OTHER COMMUNITY AND BUSINESS ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION TO INCREASE ACCESS, CREATE AND SHARE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY, AND COLLABORATE IN IMPROVEMENTS THAT SUPPORT THE TRIPLE AIM. AMONG HEALTHPARTNERS' SIGNATURE INITIATIVES CONTINUING IN 2019 ARE TOTAL COST OF CARE MEASUREMENTS (DEVELOPMENT OF A NATIONALLY RECOGNIZED METRIC, ENDORSED BY THE NATIONAL QUALITY FORUM, ENABLING MEASUREMENT AND INCENTIVES BASED ON COORDINATION AND EVIDENCE-BASED PRACTICES), MENTAL HEALTH (REDUCING STIGMA, AND ASSURING ACCESS TO HIGH QUALITY CARE IN THE MOST APPROPRIATE SETTINGS), CHILDREN'S HEALTH (IMPROVING CHILD HEALTH BY PROMOTING EARLY BRAIN DEVELOPMENT, PROVIDING FAMILY CENTERED CARE, AND STRENGTHENING COMMUNITIES), AND SUSTAINABILITY (ENERGY EFFICIENCY, WASTE REDUCTION, AND RESOURCE MANAGEMENT). HEALTHPARTNERS, INC. (HPI) IS THE PARENT ENTITY OF HEALTHPARTNERS AND IS A MINNESOTA NONPROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(4). HPI IS THE SOLE CORPORATE MEMBER OF HPI-RAMSEY, A MINNESOTA NONPROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF REGIONS HOSPITAL, REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, LAKEVIEW HEALTH, RAMSEY INTEGRATED HEALTH SERVICES, AND RH-WISCONSIN, INC., ALL OF WHICH ARE NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). RH-WISCONSIN AND GROUP HEALTH PLAN, INC. (GHI) ARE CORPORATE MEMBERS OF AMERY REGIONAL MEDICAL CENTER, INC. (ARMC). ARMC IS A WISCONSIN NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3). IN TURN, ARMC IS THE SOLE CORPORATE MEMBER OF THE FOUNDATION. AMERY REGIONAL MEDICAL CENTER IS DOING BUSINESS AS AMERY HOSPITAL & CLINIC (AHC). THE FOUNDATION EXISTS TO PROMOTE THE HEALTH AND WELLNESS OF THE PEOPLE IN THE COMMUNITIES SERVED BY AHC BY PARTICIPATING IN VARIOUS FUNDRAISING ACTIVITIES. BENEFIT TO THE COMMUNITY: FUNDRAISERS: IN THE SPRING OF 2019, THE FOUNDATION CONDUCTED ITS ANNUAL EMPLOYEE GIVING CAMPAIGN, RAISING $29,591 FROM AHC AND HEALTHPARTNERS EMPLOYEES. A PERCENTAGE OF DONATIONS WASERE MATCHED BY HEALTHPARTNERS INC. FOR $22,607 AND BY AHC FOR AN ADDITIONAL $15,000 -- FOR A TOTAL OF $67,198 FUNDS RAISED. THE FUNDS WERE DIRECTED TO COMMUNITY HEALTH INITIATIVES, PATIENT CARE NEEDS, EMPLOYEE TO EMPLOYEE ASSISTANCE AND GREATEST NEED. IN MAY THE FOUNDATION HOSTED ITS 2ND WINE TASTING EVENT, RAISING A NET OF $5,074 FOR THE AMERY BEHAVIORAL HEALTH FUND. IN JULY OF 2019, THE FOUNDATION HELD ITS 31ST ANNUAL GOLF CLASSIC, RAISING A NET OF $27,055 FOR THE AMERY BEHAVIORAL HEALTH FUND. IN NOVEMBER WE PILOTED A PURSE BINGO EVENT TO TEST FOR FUND RAISING POTENTIAL. THE EVENT WAS A HUGE SUCCESS AND NETTED $17,281 FOR THE AMERY BEHAVIORAL HEALTH FUND. DONATIONS RECEIVED: IN ADDITION TO THESE FUND RAISING EVENTS, THE FOUNDATION RECEIVED OVER $21,945 IN GENERAL DONATIONS AND MEMORIALS. GRANT FUNDING RECEIVED IS DESCRIBED BY PROGRAM SUPPORT BELOW. PROGRAM SUPPORT / COMMUNITY CONTRIBUTIONS: THE FOUNDATION STRATEGICALLY PARTNERED IN MANY AREAS OF THE HEALTH CARE DELIVERY AT AHC FOR PATIENTS AND COMMUNITY. HOSPITAL SUPPORTED PROGRAMS: ER ENHANCEMENTS: THE FOUNDATION HELPED SUPPORT PURCHASE OF THE FOLLOWING EQUIPMENT FOR ER STANDARDIZATION IN AMERY HOSPITAL, NEW SUPPLY CARTS, NEW STRETCHERS, AND A PORTABLE ULTRASOUND MACHINE. THE FOUNDATION SECURED GRANTS FROM THE FOLLOWING FOUNDATIONS FOR THIS PROJECT: ANDERSOEN FOUNDATION, ANDERSEON CORPORATE FOUNDATION, HARDENBERG FOUNDATION AND HUGH J ANDERSEON FOUNDATION. PATIENT CARE: THE FOUNDATION CONTRIBUTED ALMOST $10,000 TO AMERY HOSPITAL'S OPERATIONAL BUDGET TO PURCHASE NEW MINOR EQUIPMENT NEEDS FOR VARIOUS DEPARTMENTS, INCLUDING A NEW ICE/WATER MACHINE FOR MED/SURG UNIT, A NUSTEP MACHINE FOR CARDIAC REHAB AND MINOR DIAGNOSTIC IMAGING EQUIPMENT. CHILDREN'S HEALTH: THE FOUNDATION PROUDLY SUPPORTED THE POWERUP FOR KIDS PROGRAMING FOR OUR RURAL COMMUNITIES WITH A FINANCIAL CONTRIBUTION OF $75,160. POWERUP FOR KIDS' VISION IS TO REDUCE OR ELIMINATE CHILDHOOD OBESITY THROUGH BETTER EATING AND INCREASED ACTIVITY. THE POWERUP PROGRAM PARTNERS WITH THE SCHOOL DISTRICTS OF AMERY, CLEAR LAKE, AND TURTLE LAKE, THE NON-MOTORIZED STOWER SEVEN LAKES STATE TRAIL, THE FARM TABLE FOUNDATION (LOCAL VEGETABLE COOP GROWERS ), THE LOCAL FOOD SHELVES, AREA GROCERY STORES, THE AMERY PUBLIC LIBRARY, AND THE POLK COUNTY WISCONSIN PUBLIC HEALTH DEPARTMENT. IN ADDITION, THE FOUNDATION SECURED GRANTS FOR THE POWERUP FOR KIDS PROGRAM AS FOLLOWS: FROM THE AMERY HEALTH & WELLNESS ADVISORY FUND, THE BERNICK FAMILY FOUNDATION, AND FROM THE ST. CROIX VALLEY FOUNDATION. MENTAL HEALTH: THE FOUNDATION FUNDED "MAKE IT OK", A MENTAL HEALTH STIGMA REDUCTION PROGRAM, WITH $20,559. STAFF ARE ALSO TRAINED AND ENCOURAGED TO VOLUNTEER FOR THIS PROGRAM. THE FOUNDATION SECURED GRANT FUNDING TO SUPPORT THE LAUNCH OF A COMPREHENSIVE BEHAVIORAL HEALTH TELEMEDICINE PROGRAM IN THE AMOUNT OF $100,000 FROM THE OTTO BREMER FOUNDATION. EMPLOYEE EMERGENCY: THE FOUNDATION PROVIDED FUNDING IN TOTAL OF $13,000 TO EMPLOYEES WHO WERE IN DESPERATE FINANCIAL NEED DURING A PERSONAL EMERGENCY SITUATION. THIS FUNDS WERE GIVEN IN A VERY SELECTIVE PROCESS AND WERE REQUESTED AS THE RESULT OF A MAJOR STORM THAT CAUSED MILLIONS OF DOLLARS OF DAMAGE IN OUR SERVICE AREA. COMMUNITY SUPPORTED PROGRAMS MENTAL HEALTH: THE FOUNDATION PROVIDES FINANCIAL SUPPORT AND VOLUNTEERS TO THE MENTAL HEALTH TASK FORCE OF POLK COUNTY IN HOSTING EVENTS TO RAISE AWARENESS AND REDUCE STIGMA OF MENTAL ILLNESS. COMMUNITY GARDEN AND WELLNESS PARK: THE FOUNDATION MADE GRANTS FOR A TOTAL OF $8,632 TO SUPPORT OPERATIONAL EXPENSE OF THE COMMUNITY WIDE GARDEN PLOTS. THE GARDEN VOLUNTEERS PARTNER WITH THE CITY OF AMERY, THE HUNGRY TURTLE FOOD INSTITUTE -- TO OFFER COOKING CLASSES WITH FRESH LOCALLY GROWN FOODS -- THE AMERY FOOD SHELF - CONTRIBUTING OVER 200 POUNDS OF FRESH VEGETABLES -- AND THE AMERY HOUSING AUTHORITY, WHO BUILDS THE RAISED BEDS AT NO COST. AHC DONATES GARDEN BED SPACE TO SUPPORT THIS WELLNESS EFFORT. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE FOUNDATION IS ARMC. FORM 990, PART VI, SECTION A, LINE 7A PURSUANT TO BYLAWS, THE FOUNDATIONS BOARD OF DIRECTORS IS COMPRISED OF AT LEAST 5 BUT NO MORE THAN 9 PERSONS. AT LEAST 2 DIRECTORS MUST BE APPOINTED BY ARMC, THE FOUNDATION'S SOLE MEMBER, AND THE REMAINING DIRECTOR POSITIONS ARE FILLED BY PERSONS NOMINATED BY THE BOARD AND APPROVED BY THE ARMC. THE PRESIDENT OF ARMC SERVES AS AN EX-OFFICIO, NON-VOTING DIRECTOR. FORM 990, PART VI, SECTION A, LINE 7B THE FOUNDATION'S CORPORATE MEMBER, ARMC, MUST APPROVE THE FOLLOWING ACTIONS OF THE FOUNDATION'S BOARD OF DIRECTORS OR INITIATE THESE ACTIONS DIRECTLY: A. ADOPTION OF THE FOUNDATION'S ANNUAL BUDGET B. ADOPTION OF THE FOUNDATION'S STRATEGIC PLANS C. AMENDMENT OF THE FOUNDATION'S BYLAWS D. AMENDMENT OF THE FOUNDATION'S ARTICLES OF INCORPORATION E. ANY CHANGE, AMENDMENT, OR ALTERATION IN THE SLATED PURPOSES FOR WHICH THE FOUNDATION IS ORGANIZED F. ANY GRANT GREATER THAN $10,000 TO AN ENTITY OTHER THAN ARMC OR ANY ENTITY AFFILIATED WITH ARMC G. ELECTION OF THE FOUNDATION'S OFFICERS FORM 990, PART VI, SECTION B, LINE 11B THE FOUNDATION'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF THE FOUNDATION. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF THE FOUNDATION, GHI'S INTERNAL LEGAL DEPARTMENT AND THE FOUNDATION'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF THE FOUNDATION. ONCE THAT REVIEW PROCESS HAS BEEN COMPLETED, IT IS THE POLICY OF THE FOUNDATION TO MAKE AVAILABLE TO THE BOARD OF DIRECTORS OF THE FOUNDATION A COPY OF THE 990 PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY IS PROVIDED IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT A MEETING OF THE FULL BOARD OF DIRECTORS. THIS PROCESS IS NOTED AND DOCUMENTED IN THE WRITTEN MINUTES OF THE MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE FOUNDATION BOARD MONITORS POTENTIAL CONFLICTS OF INTEREST ON THE PART OF ITS BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS, AND KEY EMPLOYEES ("COVERED PERSONS") BY MAINTAINING A CONFLICT OF INTEREST POLICY. UNDER THE POLICY, COVERED PERSONS ANNUALLY ARE PROVIDED WITH A COPY OF THE POLICY AND ASKED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTERESTS. THE LEGAL DEPARTMENT OF HEALTHPARTNERS REVIEWS THE QUESTIONNAIRE RESPONSES AND DEVELOPS A REPORT DETAILING ANY POTENTIALLY MATERIAL CONFLICTS FOR THE PRESIDENT AND CHAIR OF THE BOARD. A VERBAL SUMMARY IS ALSO GIVEN TO THE FULL BOARD OR APPROPRIATE COMMITTEE ENDING WITH A REMINDER TO COVERED PERSONS OF THE POLICY'S MANDATE THAT EACH PERSON IS OBLIGATED TO DISCLOSE ANY NEW POTENTIAL CONFLICTS AS THEY MAY ARISE THROUGHOUT THE YEAR. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE MONITORED IN RELATION TO THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE FOUNDATION HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. ALL OFFICERS AND KEY EMPLOYEES ARE PAID BY GROUP HEALTH PLAN, INC. (GHI), REGIONS HOSPITAL, OR AMERY REGIONAL MEDICAL CENTER, RELATED ORGANIZATIONS. ANY COMPENSATION DISCLOSED IS PAID AND DETERMINED SOLELY BY THE RELATED ORGANIZATIONS. THEREFORE, PART VI, SECTION B, QUESTION 15 IS NOT APPLICABLE TO THE FOUNDATION. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION'S FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM THE FOUNDATION OR HEALTHPARTNERS. 990, PART VII, SECT A, LN 1A, COL (B): AVERAGE HRS - RELATED ORGANIZATION ALL DIRECTORS AND OFFICERS OF THE FOUNDATION ARE EMPLOYED AND COMPENSATED BY GROUP HEALTH PLAN, INC., REGIONS HOSPITAL OR AMERY REGIONAL MEDICAL CENTER. REPORTED AVERAGE HOURS WORKED ARE BASED ON THEIR TOTAL COMPENSATION FROM ALL RELATED ORGANIZATIONS. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 49,426. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,426. HEALTHPARTNERS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411693838 HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(4) N/A 0 HPI-RAMSEY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411793333 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 0 GROUP HEALTH PLAN INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410797853 STAFF MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(3) 170(B)(1) (A)(III) HEALTHPARTNERS INC 0 RH WISCONSIN INC 8171 33RD AVE S PO BOX 1309 MPLS MN 554401309 202287016 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 0 HEALTHPARTNERS INSTITUTE 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411670163 HEALTHCARE EDUCATION AND RESEARCH MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 0 CAPITOL VIEW TRANSITIONAL CARE CENTER 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 412011453 TRANSITIONAL CARE SERVICES, STEP DOWN FROM INPATIENT HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) HPI - 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