2019-11-15T09:48:06-06:00 2018-12-31 135565207 KPMG LLP 4200 WELLS FARGO CTR 90S7TH STREET MINNEAPOLIS MN 55402 990 2018-01-01 391726539 AMERY REGIONAL MEDICAL CENTER FOUNDATION INC AMER 7152688000 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 DEBRA A RUDQUIST PRESIDENT 7152688000 2019-11-14 1 MONROE JORDAN GIERL P01413237 6123055000 198.153.9.209 2019-11-14 13:26:49 CS P BC53011EDF70B2E1BD72B439C4A42BAD8A5D7AD2 31AD5F3C55E0BEE4726FCC0867C2B4B74D95884E 2018 2020-04-17 16:48:07Z DEBRA A RUDQUIST 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 333295 0 X WWW.AMERYMEDICALCENTER.ORG X 1991 WI TO PROMOTE THE HEALTH AND WELLNESS IN THE COMMUNITIES SERVED BY AMERY REGIONAL MEDICAL CENTER. 7 6 0 6 0 0 253561 324463 0 0 920 2997 28217 -2289 282698 325171 60907 95487 0 0 0 0 0 0 0 65613 163546 126520 259033 156178 66138 479855 579490 13007 46504 466848 532986 X SEE SCHEDULE O - "MISSION STATEMENT AND "EXEMPT PURPOSE AND ACHIEVEMENTS" 0 0 259033 95487 0 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS 259033 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 7 6 0 0 1 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 0.25 1.75 X X 0 0 0 HEIDI ERSPAMER DIRECTOR 0.25 1.75 X 0 0 0 BRIAN BYRNES DIRECTOR & SECRETARY & TREASURER 0.25 1.75 X X 0 0 0 JON BUSS DIRECTOR 0.25 1.75 X 0 0 0 SHARI OVERBY DIRECTOR 0.25 1.75 X 0 0 0 J MARTIN NOONAN DIRECTOR & VICE CHAIR 0.25 1.75 X X 0 0 0 ANN SEAGREN MD DIRECTOR 0.25 49.75 X 0 269275 72512 JOANNE L JACKSON EXECUTIVE DIRECTOR 45.00 X 0 158591 25265 JASON J LUHRS CFO 0.50 49.50 X 0 205235 62557 DEBRA RUDQUIST CHIEF EXECUTIVE OFFICER 40.00 X 0 308982 77721 0 942083 238055 0 0 1 0 0 29006 28664 266793 324463 2997 2997 5835 29006 8124 -2289 -2289 325171 0 0 708 X 95487 95487 43511 43511 15864 15864 35364 35364 928 928 477 477 MISCELLANEOUS OTHER EXP 67402 67402 259033 259033 0 0 472351 566926 7504 12564 479855 579490 13007 46504 13007 46504 X 466848 532986 466848 532986 479855 579490 66138 0 X 0 1 X 1 0 X 27377 5319 181416 253561 324463 792136 27377 5319 181416 253561 324463 792136 235225 556911 147 163 412 920 2997 4639 796775 119452 0.69900 0.77330 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, 2018 OR 2017 FOR UNRECOGNIZED TAX BENEFITS. GOLF TOURNAMENT 34841 29006 5835 8124 0 34841 29006 5835 8124 8124 -2289 1 AMERY REGIONAL MEDICAL CENTER INC 265 GRIFFIN STREET EAST AMERY WI 54001 390908320 501(C)(3) 87500 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 ANN SEAGREN MD DIRECTOR 0 192000 0 0 0 77275 0 42221 0 30291 0 341787 0 0 JOANNE L JACKSON EXECUTIVE DIRECTOR 0 131832 0 24490 0 2269 0 5519 0 19746 0 183856 0 0 JASON J LUHRS CFO 0 186683 0 17473 0 1079 0 34342 0 28215 0 267792 0 0 DEBRA RUDQUIST CHIEF EXECUTIVE OFFICER 0 268899 0 37543 0 2540 0 46864 0 30857 0 386703 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 1 - "MISSION STATEMENT" 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. 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 HEALTH CARE 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 INTO 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, OVER 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 INTO OTHER MIDWESTERN STATES. HEALTHPARTNERS ALSO PROVIDES MEDICAL EDUCATION AND TRAINING TO MEDICAL PROFESSIONALS AND CONDUCTS RESEARCH AND FUNDRAISING 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 COLLABORATES 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 2018 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 NON-PROFIT 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 NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF RIHS AND ITS SISTER ORGANIZATIONS, REGIONS HOSPITAL (REGIONS), REGIONS HOSPITAL FOUNDATION, RH-WISCONSIN, INC., STILLWATER HEALTH SYSTEM (LAKEVIEW HEALTH), AND CAPITOL VIEW TRANSITIONAL CARE CENTER, 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 2018, THE FOUNDATION CONDUCTED ITS ANNUAL EMPLOYEE GIVING CAMPAIGN, RAISING $26,929 FROM AHC AND HEALTHPARTNERS EMPLOYEES. A PERCENTAGE OF DONATIONS WERE MATCHED BY HEALTHPARTNERS INC. FOR $18,664 AND BY AHC FOR AN ADDITIONAL $10,000-- FOR A TOTAL OF $55,593 FUNDS RAISED. THE FUNDS WERE DIRECTED TO COMMUNITY HEALTH INITIATIVES, PATIENT CARE NEEDS, EMPLOYEE TO EMPLOYEE ASSISTANCE AND GREATEST NEED. IN AUGUST OF 2018, THE FOUNDATION HELD ITS 30TH ANNUAL GOLF CLASSIC, RAISING A NET OF $30,735 FOR THE POWERUP FOR KIDS FUND. IN OCTOBER WE PILOTED A WINE TASTING EVENT TO TEST FOR FUND RAISING POTENTIAL. THIS EXPERIMENT NETTED $1,120. DONATIONS RECEIVED: IN ADDITION TO THESE FUND RAISING EVENTS, THE FOUNDATION RECEIVED A $1,000 DONATION FROM ONE COMMUNITY INDIVIDUAL AND $250 FROM A SMALL GROUP OF HOSPITAL EMPLOYEES WHO SELL CRAFTS IN THE HOSPITAL AT CHRISTMAS. 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. MOMS & BABIES: THE FOUNDATION PROVIDED $17,000 FOR THE PURCHASE OF FIVE NEW INFANT BASSINETTES FOR THE OBSTETRICS DEPARTMENT AT AHC. WE ALSO SPONSORED A COMMUNITY PROGRAM THAT PROVIDED RESOURCES FOR NEW MOMS WHO WERE EXPERIENCING BARRIERS TO SUCCESSFUL PARENTING OF CHILDREN, TITLED MAKING CONNECTIONS - MOM & BABY - MIND & BODY. PATIENT CARE: THE FOUNDATION CONTRIBUTED $50,000 TO THE HOSPITAL'S OPERATIONAL BUDGET TO PURCHASE A NEW HOSPITAL NURSE CALL TO REPLACE THE OUTDATED, NONFUNCTIONING SYSTEM. THE NURSE CALL SYSTEM IS THE ELECTRONIC COMMUNICATION BETWEEN PATIENTS AND CAREGIVERS COVERING BESIDE CALLS, BED ALARMS FOR FALL RISKS, MEDICATION ADMINISTRATION AS WELL AS PROVIDING TECHNOLOGY SCREENS OUTSIDE PATIENT ROOM WITH INDICATORS FOR INFECTIOUS INDICATORS, BEHAVIORAL CONCERNS, ETC. IT IS ESSENTIAL FOR PATIENT SAFETY. CHILDREN'S HEALTH: THE FOUNDATION PROUDLY SUPPORTED THE POWERUP FOR KIDS PROGRAMING FOR OUR RURAL COMMUNITIES WITH A FINANCIAL CONTRIBUTION OF $42,500. 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: $49,400 FROM THE AMERY HEALTH & WELLNESS ADVISORY FUND, $62,500 FROM THE FRED C. & KATHERINE B. ANDERSEN FOUNDATION, $1,500 FROM POLK*BURNETT CHARITIES, AND $2,500 FROM THE ST. CROIX VALLEY FOUNDATION. 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. THE FOUNDATION CO-SPONSORED THE 2018 POLK COUNTY SUICIDE AWARENESS WALK. IT ALSO COLLABORATED WITH ST. CROIX VALLEY UNITED WAY IN COVERING EXPENSES TO BRING FREE MENTAL HEALTH FIRST AID TRAINING TO OUR REGION. ADDITIONALLY, THE FOUNDATION FUNDED AND ENCOURAGED STAFF TO VOLUNTEER FOR "MAKE IT OK", A MENTAL HEALTH STIGMA REDUCTION PROGRAM. THE FOUNDATION ALSO SECURED GRANT FUNDING TO SUPPORT THE LAUNCH OF A NEW ALCOHOL AND OTHER DRUG TREATMENT PROGRAM IN THE AMOUNT OF $62,500 FROM THE FRED C. AND KATHERINE B. ANDERSEN FOUNDATION. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS OF THE FOUNDATION CHANGED THE COMPOSITION AND SIZE OF THE BOARD AND THE TERM LIMITS OF BOARD MEMBERS. THIS CHANGE IS EFFICTIVE 1-1-2018. 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 THE PERSONS WHO ARE DIRECTORS OF THE MEMBER. IN ADDITION, UP TO FIVE ADDITIONAL DIRECTORS MAY BE APPOINTED BY THE MEMBER. THE PRESIDENT OF THE MEMBER AND THE CHIEF MEDICAL OFFICER OF THE MEMBER SERVE AS EX-OFFICIO NON-VOTING MEMBERS OF THE BOARD. 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: - AMENDMENTS OF THE ARTICLES, BYLAWS OR OTHER GOVERNING DOCUMENTS - SALE, LEASE, MORTGAGE OR PLEDGE OF ANY REAL ESTATE OR INTEREST THEREIN, OR OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS - ADOPTION OF AMENDMENT OF A STRATEGIC PLAN, AND CAPITAL AND OPERATING BUDGETS - APPROVAL OF UNBUDGETED CAPITAL EXPENDITURES - APPROVAL OF BORROWING OR LENDING OF FUNDS OF THE FOUNDATION - MERGER, CONSOLIDATION, AFFILIATION OR JOINT VENTURE WITH ANY OTHER ENTITY AND TRANSFER OR CONTRIBUTION OF ASSETS AND FUNDS TO SEPARATE ENTITIES - ESTABLISHMENT OR DIVESTITURE OF ENTITIES OF WHICH HHF HAS AN EQUITY OR MANAGEMENT INTEREST, OR ESTABLISHMENT OF ANY SIGNIFICANT AND CONTINUING RELATIONSHIP WITH ANY ENTITY - DISSOLUTION AND DISTRIBUTION OF ASSETS 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 STAFFING FEES: PROGRAM SERVICE EXPENSES 41,244. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 41,244. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,267. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,267. 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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