2019-11-11T12:24:02-06:00 2018-12-31 990 2018-01-01 411952989 COURAGE KENNY FOUNDATION COUR 6122620660 P O BOX 43 INTERNAL ZIP 10890 MINNEAPOLIS MN 554400043 RICHARD E MAGNUSON CHIEF FINANCIAL OFFICER 6122620660 2019-11-11 167.177.39.9 2019-11-11 08:26:26 CS P F8852DABB6779BB8558CD61C3ACDA2353D9550A9 0B59101D2A9F53A82A53094D08818AF2D3C99314 2018 2020-04-17 16:48:07Z STEPHEN BARITEAU P O BOX 43 INTERNAL ZIP 10890 MINNEAPOLIS MN 554400043 22174831 0 X SEE STATEMENT FOR WEBSITE ADDRESS X 1999 MN TO RAISE FUNDS AND ENGAGE THE COMMUNITY TO SUPPORT HEALTH AND INDEPENDENCE FOR THOSE WITH FUNCTIONAL LIMITATIONS THROUGH COURAGE KENNY REHAB'S COMPREHENSIVE CONTINUUM OF TRANSFORMATIVE SERVICES, RESEARCH AND INNOVATION, AND PUBLIC ADVOCACY. WITH THE FOUNDATION'S SUPPORT, THE CONTINUUM ENRICHES LIVES AND PROVIDES A LEVEL OF CARE ABOVE AND BEYOND THE CORE MEDICAL SERVICES PROVIDED BY ALLINA HEALTH. 23 19 0 215 0 0 6807643 6850646 0 0 2440947 1170779 16226 45453 9264816 8066878 11786317 8229400 0 0 0 0 66230 79089 1227403 2325115 2713048 14177662 11021537 -4912846 -2954659 42238430 37280655 1174311 1219422 41064119 36061233 X TO RAISE FUNDS AND ENGAGE THE COMMUNITY TO SUPPORT HEALTH AND INDEPENDENCE FOR THOSE WITH FUNCTIONAL LIMITATIONS THROUGH COURAGE KENNY REHAB'S COMPREHENSIVE CONTINUUM OF TRANSFORMATIVE SERVICES, RESEARCH AND INNOVATION, AND PUBLIC ADVOCACY. WITH THE FOUNDATION'S SUPPORT, THE CONTINUUM ENRICHES LIVES AND PROVIDES A LEVEL OF CARE ABOVE AND BEYOND THE CORE MEDICAL SERVICES PROVIDED BY ALLINA HEALTH. 0 0 7922940 7922940 PROGRAMS, SERVICES AND CAPITAL IMPROVEMENTS FUNDS WERE APPROVED TO ENHANCE THE COMPONENTS OF COURAGE KENNY REHABILITATION INSTITUTE'S REHABILITATIVE PROGRAM: OPTIMIZING PHYSICAL FUNCTION, MAXIMIZING ABILITIES OF DAILY LIVING AND LESSENING DISADVANTAGES PEOPLE MAY FACE IN SOCIAL ROLES. THE RESULTS LEAD TO STRONGER OUTCOMES FOR THE INSTITUTE'S PATIENTS WITH THE ABILITY TO FUNCTION AS INDEPENDENTLY AS POSSIBLE AND ACTIVELY PARTICIPATE IN THEIR OWN COMMUNITY. $7.9 MILLION IN SUPPORT OF THE PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES, INPATIENT REHABILITATIVE SERVICES, COMMUNITY BASED SERVICES, INDEPENDENT LIVING SKILLS (ILS) PROGRAM AND SPORTS AND RECREATION PROGRAMS OF COURAGE KENNY REHABILITATION INSTITUTE, AN UNINCORPORATED DIVISION OF ALLINA HEALTH SYSTEM, WERE INCLUDED IN PROGRAMS AND SERVICES IN 2018.INCLUDED IN PROGRAMS, SERVICES AND CAPITAL IMPROVEMENTS IN 2018 IS $26 THOUSAND TO ENLARGE THE ADAPTED FITNESS AND ABLE CENTER AT CKRI-GOLDEN VALLEY. THIS PROJECT PROVIDES SPACE TO DOUBLE THE SIZE OF CKRI'S UNIQUE ABLE PROGRAM AND CREATES THE LARGEST ADAPTED FITNESS CENTER IN THE UPPER MIDWEST. PROFESSIONAL EDUCATIONCOURAGE KENNY REHABILITATION INSTITUTE ENSURES THAT PATIENTS RECEIVE THE HIGHEST QUALITY CARE BY ADHERING TO THE PRINCIPLES OF PATIENT CARE SET FORTH BY THE INSTITUTE OF MEDICINE: SAFE, EFFECTIVE, PATIENT-CENTERED, TIMELY, EFFICIENT AND EQUITABLE. THE FOUNDATION SUPPORTS THIS QUEST BY INVESTING IN PROFESSIONAL EDUCATION OF ITS CLINICIANS TO ACHIEVE THE HIGHEST LEVEL OF CLINICAL COMPETENCE. 180316 180316 GRANTS TO OTHERSGRANTS TO OTHERS IN THE AMOUNT OF $180,316 WAS PAID TO EIGHT 501(C)(3) ORGANIZATIONS. 91625 91625 DONATION OF ASSISTIVE DEVICES TO BE USED WITH THE PATIENTS OF COURAGE KENNY REHABILITATION INSTITUTE. 34519 34519 COURAGE KENNY RESEARCH CENTER (CKRC)OF THE GRANTS AWARDED IN 2018, THE RESEARCH CENTER WAS APPROVED FOR $34,519 IN FUNDING. THE RESEARCH CENTER, ESTABLISHED IN 2007, SERVES AS A LABORATORY FOR CLINICAL RESEARCH, INNOVATION AND EDUCATION WITH THE GOAL OF OPTIMIZING THE CARE AND QUALITY OF LIFE FOR ALL PERSONS, BUT IN PARTICULAR THOSE LIVING WITH DISABILITIES. THE RESEARCH CENTER HAS ACHIEVED SIGNIFICANT MILESTONES INCLUDING THE DEVELOPMENT OF PATENTABLE TECHNOLOGIES, AS WELL AS ESTABLISHING EDUCATIONAL AND ENTREPRENEURIAL COLLABORATIVE RELATIONSHIPS. CKRC HAS AN ESTABLISHED FACULTY OF SIXTY EIGHT ACTIVE RESEARCHERS & CLINICIANS INCLUDING THERAPISTS AND PHYSICIANS, WHO CONDUCT RESEARCH ON BRAIN INJURIES, SPINAL CORD INJURIES, STROKE REHABILITATION AND CANCER REHABILITATION. THEIR RESEARCH HAS LED TO THE DEVELOPMENT OF COMMERCIALLY VIABLE TECHNOLOGIES AND TWELVE PEER-REVIEWED PAPERS ACCEPTED OR IN PRINT IN 2018 AND SEVEN PRESENTATIONS. 34519 34519 8229400 1 1 0 0 0 1 0 0 0 1 0 1 0 0 1 1 1 1 0 0 0 0 0 1 1 1 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 481 0 1 0 0 0 0 0 1 1 1 1 1 5 0 0 1 0 0 0 0 0 0 X 23 19 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN WI X TAX SERVICES MAIL ROUTE 10890 6122620660 2925 CHICAGO AVENUE MINNEAPOLIS MN 554071321 BRUCE BACKBERG DIRECTOR 2.00 0.00 X 0 0 0 STEPHEN BARITEAU DIRECTOR/PRES. CK FNDTN. 32.00 8.00 X X 0 333723 72837 LES BRUNKER DIRECTOR/TREASURER 2.00 0.00 X 0 0 0 MIKE CHAPPUIS DIRECTOR 2.00 0.00 X 0 0 0 TIMOTHY DELAPP DIRECTOR/PAST CHAIR 2.00 0.00 X 0 0 0 ROSS D'EMANUELE DIRECTOR 2.00 0.00 X 0 0 0 ERIK EKSTROM MD DIRECTOR 2.00 0.00 X 0 0 0 TOM ERICKSON DIRECTOR 2.00 0.00 X 0 0 0 J MARIE FIEGER DIRECTOR 2.00 0.00 X 0 0 0 MARY FREY DIRECTOR 2.00 0.00 X 0 0 0 PETER GALLUS DIRECTOR 2.00 0.00 X 0 0 0 ROSS GUSTAFSON DIRECTOR/VP OPERATIONS 2.00 40.00 X 0 330411 73687 SHERRY GYDESEN DIRECTOR 2.00 0.00 X 0 0 0 PETER HASSELQUIST DIRECTOR 2.00 0.00 X 0 0 0 KEVIN HYKES DIRECTOR 2.00 0.00 X 0 0 0 TOMMY JOHNS DIRECTOR 2.00 0.00 X 0 0 0 LINDA KRACH MD DIRECTOR 2.00 40.00 X 0 401932 66546 ANDY KRANE DIRECTOR 2.00 0.00 X 0 0 0 MARK KRANZ DIRECTOR 2.00 0.00 X 0 0 0 RICHARD LAY DIRECTOR 2.00 0.00 X 0 0 0 JAN MALCOLM DIRECTOR/FORMER CKF PRESIDENT 2.00 0.00 X 0 49316 0 ROBERT MALCOMSON DIRECTOR 2.00 0.00 X 0 0 0 ERIC NORBERG DIRECTOR/CHAIRMAN 4.00 0.00 X 0 0 0 ERIC PETERSON DIRECTOR 2.00 0.00 X 0 0 0 SUSAN PIVA DIRECTOR 2.00 0.00 X 0 0 0 BRET PULS DIRECTOR 2.00 0.00 X 0 0 0 SUSAN RHODE DIRECTOR/VICE CHAIR/SECRET 2.00 0.00 X 0 0 0 DAN SEEMAN DIRECTOR 2.00 0.00 X 0 0 0 BOB SPENCER DIRECTOR 2.00 0.00 X 0 0 0 DARCY SWENSON DIRECTOR 2.00 0.00 X 0 0 0 JIM VEDDER DIRECTOR 2.00 0.00 X 0 0 0 RICHARD MAGNUSON CFO 2.00 40.00 X 0 834474 234998 0 1949856 448068 0 0 1 0 STAR TRIBUNE MEDIA COMPANY LLC 650 3RD AVENUE SOUTH SUITE 1300 MINNEAPOLIS MN 55488 ADVERTISING 151336 1 453542 791083 35400 5570621 1245854 6850646 772277 772277 25336 25336 13311900 12913398 398502 398502 398502 906855 791083 1059551 -152696 -152696 32920 10099 22821 22821 274897 124905 149992 149992 8066878 149992 0 1066240 8229400 8229400 16860 16860 79089 79089 28584 13720 14864 314470 150946 163524 613628 548268 65360 9823 4715 5108 245335 117761 127574 FOUNDATION STAFF SVCS 1533733 736192 797541 MISCELLANEOUS 5846 2806 3040 PURCH SVCS - AFFILIATES -55231 -26534 -28697 11021537 8229400 1564734 1227403 770122 470067 145082 107689 38703977 35538134 2619249 1164765 42238430 37280655 1174311 1219422 1174311 1219422 X 17209682 12827199 14588633 13803579 9265804 9430455 41064119 36061233 42238430 37280655 X -2954659 -1781024 -267202 X X 0 1 X 1 0 X 8077566 8020788 6521086 6807643 6850646 36277729 0 0 0 0 0 0 0 0 0 0 8077566 8020788 6521086 6807643 6850646 36277729 3186696 33091033 783142 869236 756889 640674 797613 3847554 0 0 0 0 0 -225857 -121522 -114234 -116305 -129875 -707793 39417490 749639 0.83950 0.86080 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2 0 43611 378530 1 1 17767748 54124 -448928 -456415 16916529 15911054 23249 2255674 -422229 17767748 14873718 21456 1588432 572552 15911054 15646105 66493 -262298 576582 14873718 14834117 9934 868207 66153 15646105 0.00000 0.55850 0.44150 0 0 0 CASH EQUIVALENTS 36311 F EQUITY SECURITIES 6504146 F FIXED INCOME SECURITIES 13676209 F FUNDS OF HEDGE FUNDS 3412975 F COMMODITIES & OTHER 9240556 F MONEY MARKET 2667937 F 35538134 REMAINDER TRUST BENEFICIARIES PAYABLE 1219422 1219422 X 5902917 -1781024 -142297 -1923321 7826238 240640 240640 8066878 10905803 124905 124905 10780898 240640 240640 11021538 PART V, LINE 4: CHARITY AND INDIGENT CARE. EDUCATION AND RESEARCH. BUILDINGS AND EQUIPMENT. PATIENT CARE. PART X, LINE 2: THE FOLLOWING IS A COPY OF NOTE 1 TO THE AUDITED FINANCIAL STATEMENTS: "SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - INCOME TAX" "COURAGE KENNY FOUNDATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. IT IS CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION. THEREFORE, CHARITABLE CONTRIBUTIONS ARE TAX DEDUCTIBLE. THE FOUNDATION HAS ADOPTED GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION OF UNCERTAIN TAX POSITIONS. THE GUIDANCE PRESCRIBES RECOGNITION THRESHOLD PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX FILING THAT ARE NOT CERTAIN TO BE REALIZED. THE IMPLEMENTATION OF THIS GUIDANCE HAD NO IMPACT ON THE FOUNDATION'S FINANCIAL STATEMENTS. THE FOUNDATION'S TAX FILINGS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. THE FOUNDATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX EXEMPT STATUS. THE FOUNDATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINES INCOME, EXCISE OR OTHER TAXES." PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -267,202. CARDS FOR COURAGE EXPENSES 124,905. PART XI, LINE 4B - OTHER ADJUSTMENTS: GIFT IN KIND, NET 240,640. PART XII, LINE 2D - OTHER ADJUSTMENTS: CARDS FOR COURAGE EXPENSES 124,905. PART XII, LINE 4B - OTHER ADJUSTMENTS: GIFT IN KIND, NET 240,640. X X X X X X X 1 RUFFALO NOEL LEVITZ 1025 KIRKWOOD PARKWAY SW CEDAR RAPIDS IA 52404 TELEFUNDRAISING AND DIRECT MAIL 0 28085 79089 -51004 28085 79089 -51004 MN WI TOAST TO COURAGE 379536 315411 64125 34291 3750 28135 GIFT IN KIND SALES 849144 849144 933402 4 469258 475672 -6414 4817 21921 600 32635 1697938 791083 906855 4817 56212 4350 994172 1059551 -152696 32920 9999 100 0 32920 9999 100 10099 22821 MN 1 0 0 0 1.00000 STEPHEN BARITEAU 3915 GOLDEN VALLEY RD MINNEAPOLIS MN 55422 0 STEPHEN BARITEAU CONTROLLING CASH AND KEEPING RECORDS OF INCOME AND EXPENSE ACCOUNTS RELATED TO THE RAFFLE AND MANAGING RESOURCES. X 0 1 ALLINA HEALTH SYSTEM DBA COURAGE KENNY REHABILITATION SERVICES 800 E 28TH STREET MINNEAPOLIS MN 55407 363261413 170(B)(1)(A)(III) 34519 SUPPORT COURAGE KENNY RESEARCH CENTER OPERATIONS AND VARIOUS RESEARCH STUDIES. ALLINA HEALTH SYSTEM DBA COURAGE KENNY REHABILITATION SERVICES 800 E 28TH STREET MINNEAPOLIS MN 55407 363261413 170(B)(1)(A)(III) 7922940 PROGRAM COSTS, PATIENT CARE EQUIPMENT. ALLINA HEALTH SYSTEM DBA COURAGE KENNY REHABILITATION SERVICES 800 E 28TH STREET MINNEAPOLIS MN 55407 363261413 170(B)(1)(A)(III) 91625 FMV POWER WHEELCHAIRS, ASSISTIVE DEVICES DONATION OF ASSISTIVE DEVICES TO BE USED WITH PATIENTS OF COURAGE KENNY REHABILITATION INSTITUTE. TRUE FRIENDS 10509 108TH ST NW ANNANDALE MN 55302 411543013 501(C)(3) 167524 GENERAL SUPPORT FOR CAMP PROVIDING EXPERIENCES ENHANCING INDEPENDENCE AND SELF-ESTEEM FOR THOSE WITH DISABILITIES;THERAPEUTIC HORSEBACK RIDING PROGRAM;ENDOWMENT FUND IMMANUEL LUTHERAN CHURCH 16515 LUTHER WAY EDEN PRAIRIE MN 55346 410968965 501(C)(3) 6500 SUPPORTING OPENING DOORS CAMPAIGN AND GENERAL CHURCH OPERATIONS PART I, LINE 2: COURAGE KENNY FOUNDATION STRICTLY MONITORS GRANT FUNDS TO ENSURE THAT SUCH GRANTS ARE USED FOR PROPER AND INTENDED PURPOSES AND ARE NOT OTHERWISE DIVERTED FROM THE INTENDED USE. THE ORGANIZATION HAS PROCESS WHICH INCLUDES A WRITTEN APPLICATION WHICH REQUIRES SUPPORTING DOCUMENTATION AND SUBSTANTIATION PRIOR TO A GRANT BEING APPROVED AND DISBURSED. IN ADDITION AND DEPENDING ON THE FACTS AND CIRCUMSTANCE OF THE GRANT, THE ORGANIZATION EMPLOYS VARIOUS METHODS TO ENSURE PROPER AND INTENDED USE SUCH AS: PERIODIC REPORTING TO THE ORGANIZATION, FIELD INVESTIGATIONS, CONTRACTS WITH REPAYMENT CLAUSES, REQUIRING ADDITIONAL SUBSTANTIATION AND DOCUMENTATION NOT AVAILABLE AT THE TIME OF THE GRANT, PAYING THIRD PARTIES DIRECTLY ON BEHALF OF THE GRANTEE ORGANIZATION, AND OTHER METHODS AS APPROPRIATE AND WARRANTED. 1 1 0 0 0 1 1 0 1 1 STEPHEN BARITEAU DIRECTOR/PRES. CK FNDTN. 0 245537 0 53833 0 34353 0 44797 0 28040 0 406560 0 25325 ROSS GUSTAFSON DIRECTOR/VP OPERATIONS 0 255454 0 56170 0 18787 0 48091 0 25596 0 404098 0 495 LINDA KRACH MD DIRECTOR 0 319493 0 69307 0 13132 0 55275 0 11271 0 468478 0 5492 RICHARD MAGNUSON CFO 0 586834 0 146950 0 100690 0 217050 0 17948 0 1069472 0 24337 PART I, LINE 3 SEE NARRATIVE ON SCHEDULE O - FOR FORM 990, PART VI, SECTION A, LINE 6. PART I, LINES 4A-B LINE 4(A) JAN MALCOLM - $44,428 LINE 4(B): STEPHEN BARITEAU - $29,346; ROSS GUSTAFSON - $15,760; RICHARD MAGNUSON - $51.841. PART I, LINE 6 DEFERRED COMPENSATION PLANS TERMS AND CONDITIONS: ALLINA INCENTIVE PLAN ALLINA PROVIDES AN ANNUAL INCENTIVE COMPENSATION OPPORTUNITY FOR EXECUTIVES, MANAGEMENT AND KEY INDIVIDUAL CONTRIBUTOR EMPLOYEES. UNDER THIS PLAN, THE TARGET AWARD IS EXPRESSED AS A FUNCTION OF THE PARTICIPANT'S SALARY PAID DURING THE CALENDAR YEAR AND REQUIRES AT LEAST FOUR MONTHS OF SERVICE IN AN ELIGIBLE POSITION DURING THE YEAR. ACTUAL AWARDS CAN RANGE FROM 0% TO 150% OF THE TARGET AWARD, BASED ON ALLINA'S FINANCIAL AND NON-FINANCIAL PERFORMANCE OVER THE CALENDAR YEAR. NON-FINANCIAL PERFORMANCE MEASURES INCLUDE PATIENT & EMPLOYEE SAFETY, QUALITY, PATIENT EXPERIENCE AND FINANCIAL HEALTH. NO AWARDS ARE PROVIDED UNLESS THRESHOLD FINANCIAL PERFORMANCE IS ACHIEVED. PARTICIPANTS WHO HAVE LEFT EMPLOYMENT PRIOR TO THE END OF THE YEAR AS A RESULT OF VOLUNTARY TERMINATION OR TERMINATION FOR POOR PERFORMANCE ARE NOT ELIGIBLE FOR AN AWARD. LONG-TERM INCENTIVE PLAN ALLINA HAS A LONG-TERM INCENTIVE PLAN THAT PROVIDES A CASH AWARD OPPORTUNITY TO A SMALL NUMBER OF TOP EXECUTIVES APPROVED FOR PARTICIPATION BY THE HUMAN RESOURCES & COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF ALLINA HEALTH ("THE COMMITTEE"). THE AWARD OPPORTUNITY IS BASED ON ALLINA PERFORMANCE DURING OVERLAPPING THREE-YEAR CYCLES. PERFORMANCE MEASURES AND TARGETS ARE DEFINED BY THE COMMITTEE FOR EACH THREE-YEAR PERIOD AND CAN VARY FROM ONE PERIOD TO ANOTHER DEPENDING ON THE COMMITTEE'S JUDGEMENT OF THE MOST IMPORTANT MEASURES OF SUCCESS. AWARDS CAN RANGE FROM 0% TO 150% OF TARGET AWARDS. PART I, LINE 8 CERTAIN AMOUNTS REPORTED ON FORM 990, PART VII WERE PAID OR ACCRUED PURSUANT TO A CONTRACT THAT WAS SUBJECT TO THE INITIAL CONTRACT EXCEPTION DESCRIBED IN REGULATION SECTION 53.4958-4(A)(3). FROM TIME TO TIME, ALLINA HEALTH SYSTEM ENTERS INTO CONTRACTUAL ARRANGEMENTS THAT MAY QUALIFY FOR THE INITIAL CONTRACT EXCEPTION BASED ON THE TERMS AND UNDERSTANDINGS OF THE CONTRACTUAL AGREEMENTS. SCHEDULE J, LINE 4(A) & (B) ADDITIONAL DISCLOSURES: DEFERRED COMPENSATION PLANS - TERMS AND CONDITIONS: EXECUTIVE MUTUAL FUND ACCOUNT PLAN PHYSICIAN MUTUAL FUND ACCOUNT PLAN THESE ACCOUNTS GIVE THE PARTICIPANT THE OPPORTUNITY FOR CAPITAL ACCUMULATION NOT FULLY AVAILABLE TO THEM THROUGH SOCIAL SECURITY OR THE GENERAL EMPLOYEE RETIREMENT PLANS BECAUSE OF MAXIMUMS PLACED ON COMPENSATION THAT CAN BE RECOGNIZED UNDER FEDERAL LAW FOR PURPOSES OF CONTRIBUTIONS. THEY ALSO SERVE AS AN IMPORTANT NON-COMPETE INCENTIVE TO PARTICIPANTS. PRIOR TO THE YEAR IN WHICH CONTRIBUTIONS ARE MADE, THE PARTICIPANT MUST DESIGNATE A VESTING/PAYOUT DATE CONSISTENT WITH THE CONSTRAINTS OF THE PLANS AND FEDERAL DEFERRED COMPENSATION REGULATIONS. AFTER THE CONTRIBUTIONS ARE MADE, THE PARTICIPANT HAS A ONE-TIME LIMITED OPPORTUNITY TO EXTEND THE ELECTED PAYMENT DATE FOR AT LEAST FIVE YEARS. ONCE THE VESTING/PAYOUT DATE HAS BEEN REACHED, ALLINA WILL WITHHOLD THE APPROPRIATE TAXES AND THE BALANCE WILL BE PAID TO THE PARTICIPANT ON THEIR PAYCHECK AS SOON AS ADMINISTRATIVELY FEASIBLE. IF THE PARTICIPANT TERMINATES EMPLOYMENT VOLUNTARILY BEFORE AN AMOUNT IS PAID, PAYMENT WILL BE SUBJECT TO THE PARTICIPANT'S COMPLIANCE WITH A NON-COMPETE AGREEMENT WITH ALLINA FOR TWO YEARS AFTER TERMINATION. THE PARTICIPANT MAY ELECT FROM AMONG INVESTMENT ALTERNATIVES THAT ARE SIMILAR TO THOSE AVAILABLE IN THE RETIREMENT SAVINGS PLAN. UNLIKE THE RETIREMENT SAVINGS PLAN, THE PARTICIPANT HAS THE STATUS OF AN UNSECURED CREDITOR OF ALLINA AND WILL NOT HAVE A PREFERRED CLAIM TO PAYMENT IN THE CASE OF THE COMPANY'S INABILITY TO PAY. HOWEVER, THE COMPANY DOES SET ASIDE ASSETS FOR ITS OBLIGATIONS BY ACTUALLY INVESTING THE PROMISED ASSETS CONSISTENT WITH PARTICIPANT ELECTIONS. THE MUTUAL FUND PLANS TERMINATED EFFECTIVE DECEMBER 31, 2018. ALL MUTUAL FUND ACCOUNTS SHALL BE DISTRIBUTED IN A LUMP SUM NO LATER THAN JANUARY 2021, OR IF ELECTED BY THE PARTICIPANT IN DECEMBER 2018, IN THREE ANNUAL INSTALLMENTS WITH THE FIRST MADE FEBRUARY 2019 (33.33 PERCENT OF ACCOUNT BALANCE), THE SECOND MADE FEBRUARY 2020 (50 PERCENT OF REMAINING BALANCE), AND THE THIRD MADE JANUARY 2021 (REMAINING BALANCE). ALLINA EXECUTIVE RETIREMENT BENEFIT RESTORATION PLAN ELIGIBLE ALLINA EXECUTIVES PARTICIPATE IN A DEFERRED COMPENSATION RETIREMENT PLAN. EXECUTIVES ARE CREDITED AN AMOUNT EQUAL TO THE EXCESS AMOUNT THAT WOULD HAVE BEEN CREDITED TO THE ALLINA RETIREMENT SAVINGS PLAN WERE IT NOT FOR THE QUALIFIED PLAN COMPENSATION LIMITS. EMPLOYER CREDITS ARE MADE EACH YEAR TO THEIR ACCOUNT BALANCE ACCORDING TO THE FOLLOWING SCHEDULE AS OF THE END OF THE PLAN YEAR: PARTICIPANT'S YEARS OF VESTING SERVICE APPLICABLE PERCENTAGE LESS THAN 1 0% 1-5 5.0% 6-10 5.5% 11-15 6.0% 16 OR MORE 6.5% DEPOSITS EARN THE INVESTMENT RATE OF RETURN EQUAL TO THE INVESTMENT OPTIONS SELECTED BY THE PARTICIPANT WHICH ARE THE SAME OPTIONS AVAILABLE UNDER THE QUALIFIED PLAN. A PARTICIPANT WHO HAS COMPLETED AT LEAST TWO YEARS OF SERVICE BECOMES VESTED IN THE PORTION OF HIS OR HER ACCOUNT ATTRIBUTABLE TO THE ANNUAL CREDIT FOR A PARTICULAR YEAR AS OF JANUARY 15 OF THE YEAR FOLLOWING THE CALENDAR YEAR IN WHICH THE ANNUAL CREDIT IS EARNED. IN THE EVENT OF TERMINATION (OTHER THAN BECAUSE OF DEATH) PRIOR TO AGE 67, THE DISTRIBUTION DATE SHALL BE AS SOON AS ADMINISTRATIVELY POSSIBLE AFTER TERMINATION IN THE FORM OF A LUMP SUM PAYMENT. THE PLAN IS PAYABLE FROM ALLINA'S GENERAL ASSETS. IF ALLINA BECOMES INSOLVENT, THE PARTICIPANT WILL BE AN UNSECURED CREDITOR AND WILL HAVE NO PREFERRED CLAIM TO ANY ASSETS. THIS PLAN WAS EFFECTIVE JANUARY 1, 2009 AND FROZEN EFFECTIVE DECEMBER 31, 2018. EXECUTIVE SEVERANCE PLAN ALLINA PROVIDES SALARY CONTINUATION FOR EXECUTIVES WHOSE EMPLOYMENT HAS BEEN INVOLUNTARILY TERMINATED FOR REASONS OTHER THAN CAUSE OR POOR PERFORMANCE. THE LENGTH OF THE SEVERANCE PAY PERIOD IS DEFINED BY THE PLAN AND DEPENDS ON THE LEVEL OF THE EXECUTIVE POSITION. UNDER THE PLAN THE SEVERED EXECUTIVE ALSO COULD CONTINUE CERTAIN BENEFITS FOR A LIMITED PERIOD OF TIME. IN 2009 THE PLAN WAS AMENDED TO FURTHER RESTRICT SEVERANCE BENEFITS IN THE CASE THAT THE EXECUTIVE OBTAINS OTHER EMPLOYMENT DURING THE SEVERANCE PERIOD. X 1401 929054 SALE PRICE DONATED CARS X 54 37337 SALE PRICE DONATED BOATS X 27 187838 FAIR MARKET VALUE X EQUIPMENT 69 91625 FAIR MARKET VALUE 5 0 1 1 PART I, LINE 32B: COURAGE KENNY FOUNDATION MAY FROM TIME TO TIME AND IN THE ORDINARY COURSE OF ITS CHARITABLE ACTIVITIES ACCEPT NONCASH CONTRIBUTIONS OF PUBLICLY TRADED SECURITIES. COURAGE KENNY FOUNDATION USES THIRD PARTIES SUCH AS SECURITIES BROKERAGE FIRMS TO LIQUIDATE THE PUBLICLY TRADED SECURITIES TO CASH ON THE OPEN SECURITIES MARKET. THE SALE OF PUBLICLY TRADED SECURITIES ARE GENERALLY SUBJECT TO MARKET RATE BROKERAGE COMMISSIONS AND FEES OF THE THIRD PARTY SECURITIES BROKER. COURAGE KENNY FOUNDATION CASH AND INVESTMENTS ARE POOLED WITH ITS SOLE MEMBER ORGANIZATION, ALLINA HEALTH SYSTEM, AND ITS RELATED ORGANIZATIONS. COURAGE KENNY FOUNDATION,IN THE COURSE OF ITS CHARITABLE ACTIVITIES, ACCEPTS NONCASH CONTRIBUTIONS OF AUTOMOBILES, BOATS , MOTORCYCLES, ATVS AND VARIOUS OTHER TRANSPORTATION VEHICLES THROUGH A PROGRAM CALLED "CARS FOR COURAGE KENNY". AFTER THE VEHICLE IS RECEIVED , COURAGE KENNY'S STAFF, DETERMINES WHERE TO SELL IT FOR THE HIGHEST POSSIBLE RETURN. COURAGE KENNY USES A VARIETY OF SELLING VENUES WHICH MAY INVOLVE THIRD PARTIES, INCLUDING RETAIL AUCTIONS, REPAIRABLE AUCTIONS, AND RECYCLE AND SALVAGE VENDORS, IN ORDER TO MAXIMIZE THE VALUE OF THE GIFT. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIP - SUSAN RHODE AND JAMES VEDDER SHARE AN EMPLOYER. JAMES VEDDER ALSO SERVES AS AN OFFICER AND DIRECTOR OF SHARED EMPLOYER. FORM 990, PART VI, SECTION A, LINE 4 ON DECEMBER 26, 2018 COURAGE KENNY FOUNDATION (CKF) REQUESTED RECLASSIFICATION OF FOUNDATION STATUS AS A PUBLIC CHARITY. ON APRIL 24, 2019 THE INTERNAL REVENUE SERVICE DETERMINED CKF MEETS THE REQUIREMENTS FOR CLASSIFICATION AS A PUBLIC CHARITY DESCRIBED IN IRC SECTIONS 509(A)(1) AND 170(B)(1)(A)(VI). CKF'S ARTICLES OF INCORPORATION WERE UPDATED TO REFLECT THIS CHANGE. FORM 990, PART VI, SECTION A, LINE 6 PARENT ORGANIZATION ALLINA HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER ORGANIZATION OF COURAGE KENNY FOUNDATION. SEE SCHEDULE R FOR FURTHER DETAILS. ALLINA HEALTH SYSTEM PROVIDES COURAGE KENNY FOUNDATION WITH ADMINISTRATIVE AND STAFF SERVICES. COURAGE KENNY FOUNDATION HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. COMPENSATION DISCLOSED AS PAID BY A RELATED ORGANIZATION IS DETERMINED SOLELY BY THE RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE CORPORATE MEMBER ORGANIZATION, ALLINA HEALTH SYSTEM HOLDS CERTAIN RESERVED POWERS OVER COURAGE KENNY FOUNDATION. THE RESERVED POWERS ARE FULLY DESCRIBED IN COURAGE KENNY FOUNDATION'S GOVERNING DOCUMENTS AND INCLUDE SUCH POWERS AS ELECTION AND APPROVAL OF DIRECTORS, FINAL APPROVAL OF AMENDMENTS TO ARTICLES OF INCORPORATION OR BYLAWS, APPROVAL OF STRATEGIC PLANS AND CAPITAL AND OPERATING BUDGETS, APPROVAL OF PLANS OF MERGER OR CONSOLIDATION, APPROVAL OF INCURRENCE OF DEBT OR EXPENDITURES IN EXCESS OF CERTAIN AMOUNTS, AND VARIOUS OTHER RESERVED POWERS AS DESCRIBED THEREIN. FORM 990, PART VI, SECTION A, LINE 7B SEE FORM 990, PART VI, SECTION A, LINE 7A AND THE DESCRIPTION ABOVE RELATED TO IT IN SCHEDULE O. FORM 990, PART VI, SECTION B, LINE 11B COURAGE KENNY FOUNDATION'S FORM 990 WAS PREPARED BY THE TAX SERVICES FUNCTION OF ALLINA HEALTH SYSTEM, COURAGE KENNY FOUNDATION'S SOLE CORPORATE MEMBER. THE FORM 990 FILING WAS SUBJECTED TO A RIGOROUS REVIEW PROCESS BY ALLINA'S TAX MANAGER AND TAX DIRECTOR. ALLINA'S VICE PRESIDENT OF FINANCE AND ALLINA'S CHIEF FINANCIAL OFFICER ALSO PERFORMED AN EXECUTIVE REVIEW OF THE FORM 990. MEMBERS OF THE FINANCE COMMITTEE WERE ALSO PROVIDED WITH AN OPPORTUNITY TO REVIEW THE FORM 990 PRIOR TO FILING. AFTER THE MANAGEMENT AND FINANCE COMMITTEE REVIEW PROCESS DESCRIBED ABOVE WAS COMPLETED, THE FINAL FORM 990, AS ULTIMATELY FILED WITH THE INTERNAL REVENUE SERVICE ["IRS"], WAS PROVIDED TO EACH VOTING MEMBER OF THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS VOTED ON AND APPROVED A RESOLUTION APPROVING THE FORM 990, THE MINNESOTA CHARITABLE ORGANIZATION ANNUAL REPORT TO BE FILED WITH THE MINNESOTA ATTORNEY GENERAL, AND THE WISCONSIN CHARITABLE ORGANIZATION ANNUAL REPORT TO BE FILED WITH THE WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTIONS. THE BOARD OF DIRECTORS RESOLUTION ALSO DIRECTED OFFICERS TO FILE THE FORM 990 WITH THE IRS, THE CHARITABLE ANNUAL REPORT WITH THE CHARITIES DIVISION OF THE OFFICE OF THE MINNESOTA ATTORNEY GENERAL, AND THE WISCONSIN CHARITABLE ORGANIZATION ANNUAL REPORT WITH THE WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTIONS. THE ABOVE STATED REVIEW AND APPROVAL PROCESS OCCURRED PRIOR TO FILING COURAGE KENNY FOUNDATION'S FORM 990 WITH THE IRS, MINNESOTA CHARITABLE ORGANIZATION ANNUAL REPORT WITH THE MINNESOTA ATTORNEY GENERAL, AND WISCONSIN CHARITABLE ORGANIZATION ANNUAL REPORT WITH THE WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTIONS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS SEVERAL METHODS OF MONITORING AND ENFORCING COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. FIRST, THE ORGANIZATION REGULARLY DISTRIBUTES CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRES TO ITS OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES. THESE INDIVIDUALS ARE REQUIRED TO DISCLOSE ANNUALLY ANY INTEREST THAT COULD GIVE RISE TO CONFLICTS, INCLUDING ANY FAMILY OR BUSINESS RELATIONSHIP. SECOND, THE GENERAL COUNSEL'S OFFICE ANNUALLY DELIVERS A REPORT TO ALLINA'S BOARD OF DIRECTORS WHICH INCLUDES, AMONG OTHER THINGS, THE RESULTS OF THE CONFLICT OF INTEREST QUESTIONNAIRE, AN ANALYSIS OF POTENTIAL CONFLICTS, AND GUIDANCE FOR SATISFACTORILY RESOLVING CONFLICTS. THIRD, THE ORGANIZATION UNDERTAKES MANDATORY COMPLIANCE TRAINING OF ALL ITS EMPLOYEES WHICH INCLUDES TRAINING ON CONFLICTS OF INTEREST. FOURTH, ALL EMPLOYEES RECEIVE, AND ARE EXPECTED TO CONDUCT THEMSELVES IN ACCORDANCE WITH ALLINA'S CODE OF CONDUCT. THE CODE OF CONDUCT CONTAINS EDUCATIONAL MATERIALS AND GUIDANCE TO RESOLVE POTENTIAL CONFLICTS OF INTEREST. FIFTH, ALLINA MAINTAINS A CORPORATE INTEGRITY HOTLINE, A CONFIDENTIAL 24 HOUR EXTERNAL RESOURCE TO HELP ANSWER QUESTIONS RELATED TO ETHICAL BUSINESS CONDUCT. ALL CALLS TO THE INTEGRITY LINE ARE KEPT CONFIDENTIAL. FORM 990, PART VI, SECTION B, LINE 15 COURAGE KENNY FOUNDATION HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. ANY COMPENSATION DISCLOSED AS PAID BY A RELATED ORGANIZATION IS DETERMINED SOLELY BY THE RELATED ORGANIZATION. THEREFORE, FORM 990, PART VI, SECTION B, LINES 15A AND 15B ARE NOT APPLICABLE TO COURAGE KENNY FOUNDATION. FORM 990, PART VI, SECTION C, LINE 19 COURAGE KENNY FOUNDATION MAKES ITS FORM 990, FORM 1023, GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. TO ARRANGE AN INSPECTION OR RECEIVE A COPY, PLEASE CONTACT THE FOLLOWING: COURAGE KENNY FOUNDATION TAX SERVICES MAIL ROUTE 10890 P.O. BOX 43 MINNEAPOLIS, MN 55407-0043 TELEPHONE: 612-262-0660 PHYSICAL ADDRESS: 2925 CHICAGO AVENUE MINNEAPOLIS, MN 55407-1321 THE FORM 990 AND FORM 1023 ARE ALSO AVAILABLE DIRECTLY FROM THE INTERNAL REVENUE SERVICE. THE FORM 990 AND FINANCIAL STATEMENTS ARE ALSO AVAILABLE FROM THE CHARITIES DIVISION OF THE OFFICE OF THE MINNESOTA ATTORNEY GENERAL. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST -267,202. FORM 990, PART XII, LINE 2C: THIS PROCESS REMAINS UNCHANGED FROM THE PRIOR YEAR. FORM 990 ITEM J PAGE 1 COURAGE KENNY FOUNDATION'S WEBSITE ADDRESS IS: HTTPS://WWW.ALLINAHEALTH.ORG/COURAGE-KENNY-REHABILITATION-INSTITUTE/ COURAGE-KENNY-FOUNDATION ABBOTT NORTHWESTERN HOSPITAL FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 043643816 FUNDRAISING AND GRANTMAKING FOUNDATION MN 501(C)(3) LINE 7 ALLINA HEALTH SYSTEM 0 ALLINA ASSOCIATED FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 274116873 FUNDRAISING AND GRANTMAKING FOUNDATION MN 501(C)(3) LINE 7 ALLINA HEALTH SYSTEM 0 ALLINA HEALTH SYSTEM PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 363261413 HEALTHCARE SERVICES MN 501(C)(3) LINE 3 N/A 0 MERCY & UNITY HOSPITALS FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 300086426 FUNDRAISING AND GRANTMAKING FOUNDATION MN 501(C)(3) LINE 7 ALLINA HEALTH SYSTEM 0 PHILLIPS EYE INSTITUTE FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411613017 FUNDRAISING AND GRANTMAKING FOUNDATION MN 501(C)(3) LINE 7 ALLINA HEALTH SYSTEM 0 UNITED HOSPITAL FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 237420998 FUNDRAISING AND GRANTMAKING FOUNDATION MN 501(C)(3) LINE 7 ALLINA HEALTH SYSTEM 0 MBP FACILITY LLC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 454078371 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 12A, I N/A 0 REGINA FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411987372 FUNDRAISING AND GRANTMAKING FOUNDATION MN 501(C)(3) LINE 7 N/A 0 APPLE VALLEY BUILDING ASSOCIATES LLC 14655 GALAXIE AVENUE S APPLE VALLEY MN 55124 411677072 RENTAL REAL ESTATE MN N/A ASPEN SLEEP CENTER LLC 1010 BANDANA BOULEVARD WEST ST PAUL MN 55108 261850227 HEALTHCARE SERVICES MN N/A MAGNETO LEASING LLC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 201582501 RENTAL EQUIPMENT MN N/A METROPOLITAN INTEGRATED CANCER CENTERLLC PO BOX 819067 DALLAS TX 75381 205068485 RADIOLOGY DE N/A GERIATRIC SERVICES OF MINNESOTA LLC 3433 BROADWAY STREET NE SUITE 300 MINNEAPOLIS MN 55413 453357936 HEALTHCARE SERVICES MN N/A NORTHSTAR SLEEP CENTER LLC 920 EAST 28TH STREET SUITE 700 MINNEAPOLIS MN 55407 452532456 HEALTHCARE SERVICES MN N/A MOBILE IMAGING SERVICES LLC 7505 METRO BOULEVARD SUITE 400 EDINA MN 55439 411883212 RADIOLOGY MN N/A CROSBY CARDIOVASCULAR SERVICES LLC 920 E 28TH STREET SUITE 500 MINNEAPOLIS MN 55407 412010368 HEALTHCARE SERVICES MN N/A BPA HEALTH LLC 2845 HAMLINE AVENUE NORTH ROSEVILLE MN 55113 352490984 HEALTHCARE SERVICES MN N/A TWIN CITIES MEDICAL IMAGING LLC 7505 METRO BOULEVARD SUITE 400 EDINA MN 55439 463959737 RADIOLOGY MN N/A WESTHEALTH SURGERY CENTER LLC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 371763155 SURGICAL SERVICES MN N/A CT ONE LLC 200 STATE AVENUE FARIBAULT MN 55021 261187480 RADIOLOGY MN N/A HEALTHCARE CAMPUS IMAGING ONE LLC 200 STATE AVENUE FARIBAULT MN 55021 522401657 RADIOLOGY MN N/A GLOBAL MARKET RESERVE FUND LLC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 554400043 832659070 FINANCE MN N/A ALLINA HEALTH SYSTEM TRUST PO BOX 535007 PITTSBURGH PA 15253 276712988 TRUST PA N/A T 0 ALLINA SPECIALTY ASSOCIATESINC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411802815 HEALTHCARE SERVICES MN N/A C 0 HEALTHSPAN SERVICES COMPANY PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411249999 DEBT COLLECTION MN N/A C 0 ALLINA HEALTH SYSTEM DEFINED BENEFIT MASTER TRUST 500 GRANT STREET STE 625 PITTSBURGH PA 15258 376520273 TRUST PA N/A T 0 LIFESPAN AFFILIATES DEFERRED COMPENSATION PLAN PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411720860 TRUST MN N/A T 0 ALLINA INTEGRATED MEDICAL NETWORK PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 275129095 HEALTHCARE SERVICES MN N/A C 0 FORSETI RISK MANAGEMENT INDEMNIFICATION COMPANY SPC PO BOX 1085 GRAND CAYMAN CJ KY1-1102 981366132 CAPTIVE INSURANCE CJ N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1