2019-11-11T12:24:02-06:00 2018-12-31 990 2018-01-01 274116873 ALLINA ASSOCIATED FOUNDATION ALLI 6122620660 PO BOX 43 MR 10890 MINNEAPOLIS MN 554400043 RICHARD E MAGNUSON CHIEF FINANCIAL OFFICER 6122620660 2019-11-11 167.177.39.9 2019-11-11 08:24:41 CS P 0B59101D2A9F53A82A53094D08818AF2D3C99314 0B59101D2A9F53A82A53094D08818AF2D3C99314 2018 2020-04-17 16:48:07Z STEPHEN BARITEAU PO BOX 43 MR 10890 MINNEAPOLIS MN 554400043 13077838 0 X SEE STATEMENT X 2010 MN TO RAISE, STEWARD AND DISTRIBUTE PHILANTHROPIC FUNDS IN SUPPORT OF BUFFALO HOSPITAL, CAMBRIDGE MEDICAL CENTER, NEW ULM MEDICAL CENTER, OWATONNA HOSPITAL, RIVER FALLS AREA HOSPITAL, ALLINA HEALTH HOME CARE SERVICES AND PENNY GEORGE INSTITUTE OF HEALTH & HEALING. 15 6 0 211 0 0 4000686 3613479 0 0 89310 114453 116912 35316 4206908 3763248 2425550 1768465 0 0 0 0 23987 31742 990316 1626390 1533108 4075927 3333315 130981 429933 7452937 7970752 71920 194169 7381017 7776583 X THE MISSION OF ALLINA ASSOCIATED FOUNDATION IS TO RAISE, STEWARD AND DISTRIBUTE PHILANTHROPIC FUNDS IN SUPPORT OF BUFFALO HOSPITAL, CAMBRIDGE MEDICAL CENTER, NEW ULM MEDICAL CENTER, OWATONNA HOSPITAL, RIVER FALLS AREA HOSPITAL, ALLINA HEALTH HOME CARE SERVICES AND PENNY GEORGE INSTITUTE FOR HEALTH & HEALING. THE FOUNDATION IS A SEPARATE NOT-FOR-PROFIT ENTITY DEDICATED TO SUPPORTING THE HOSPITALS, ALLINA HEALTH HOME CARE SERVICES PROGRAM AND PENNY GEORGE INSTITUTE FOR HEALTH & HEALING AND IS GOVERNED BY A SEPARATE BOARD. 0 0 1518237 1518237 HOSPITAL AND MEDICAL CENTER GENERAL OPERATIONS: $1,518,237.OPERATIONAL GRANTS ARE USED TO SUPPORT A MULTITUDE OF PROGRAMS INCLUDING RESEARCH, BIRTH, HEART, LITERACY AND INTEGRATIVE THERAPY PROGRAMS. THESE PROGRAMS WERE ESTABLISHED TO SUPPORT THE PATIENTS AND COMMUNITIES OF BUFFALO HOSPITAL, CAMBRIDGE MEDICAL CENTER, NEW ULM MEDICAL CENTER, OWATONNA HOSPITAL, RIVER FALLS AREA HOSPITAL, ALLINA HEALTH HOME CARE SERVICES AND PENNY GEORGE INSTITUTE FOR HEALTH & HEALING. 108354 108354 EXTERNAL GRANTS-2018 GRANT $108,354THE FOLLOWING ARE SOME EXAMPLES OF EXTERNAL PROGRAMS SUPPORTED IN 2018: $100,000 WAS PROVIDED FOR A NEW ULM CAPITAL GRANT TO IMPROVE PATIENT EXPERIENCE, SAFETY AND INFECTION CONTROL ISSUES IN THE CURRENT SPACE WHILE UPDATING FUNCTIONALITY AESTHETICS OF THE CCU PATIENT ROOMS THROUGH: REMOVING SHARED BATHROOM FOR ROOMS 90 AND 92 BY ADDING AN ADA BATHROOM TO ROOM 90 - THIS WILL ENSURE EACH PATIENT ROOM HAS A PRIVATE BATHROOM AND REDUCES INFECTION CONTROL CONCERNS, UPDATE FLOORING AND WALLS THAT SHOWS TRANSITIONS TO REDUCE FALL RISK, UPDATE BATHROOMS WITH NEW TILING AND FLOORING THAT SHOWS TRANSITIONS TO REDUCE FALL RISK, ADD PIPED-IN MEDICAL GAS, REPLACE HEADWALLS FOR IMPROVED FUNCTIONALITY, REPLACE FOOTWALL CABINETRY FOR IMPROVED FUNCTIONALITY, AND REPLACE SLIDING GLASS DOORS, WHICH CONSISTENTLY FALL OUT OF TRACKS CAUSING STAFF AND PATIENT SAFETY CONCERNS. $8,354 IN ADDITIONAL CAPITAL GRANTS WERE PROVIDED TO SUPPORT VARIOUS INDIVIDUAL PROJECTS 66246 66246 BUFFALO HOSPITAL'S HOPE FUND AND CANCER CARE FUND OFFER EMERGENCY FINANCIAL ASSISTANCE TO HELP WITH EXPENSES DURING BREAST CANCER CARE AND TREATMENT. $66,246 IN ASSISTANCE WAS PROVIDED IN 2018. 75628 75628 HOUSING/LIVING, MEDICAL, AND EDUCATIONAL ASSISTANCE TO CO-WORKERS AND PATIENTS - $75,628:THE FOLLOWING ARE SOME EXAMPLES OF HOSPITAL AND MEDICAL CENTER PROGRAMS SUPPORTING INDIVIDUAL PATIENTS AND EMPLOYEES. BUFFALO HOSPITAL'S "CARING FOR CO-WORKERS" PROVIDES CONFIDENTIAL EMERGENCY ASSISTANCE TO HOSPITAL EMPLOYEES WHO SUFFER SUDDEN ECONOMIC HARDSHIP AND ARE STRUGGLING TO PAY MEDICAL BILLS, RENT AND OTHER EVERYDAY EXPENSES. $13,360 IN ASSISTANCE WAS PROVIDED IN 2018.BUFFALO AND NEW ULM PROVIDED $9,000 AND $13,000, RESPECTIVELY IN EDUCATIONAL SCHOLARSHIPS IN 2018.OWATONNA PROVIDED $13,915 TO SUPPORT THE "EMPLOYEE EMERGENCY FUND".RIVER FALLS PROVIDED $21,178 TO SUPPORT "CANCER PATIENT ASSISTANCE AND EDUCATIONAL SCHOLARSHIPS.$5,176 IN ADDITIONAL GRANTS WERE PROVIDED. 75628 75628 1768465 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 1 1 0 0 1 1 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 1 1 1 1 0 0 0 0 0 0 X 15 6 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN WI X TAX SERVICES MR 10890 6122620660 2925 CHICAGO AVENUE MINNEAPOLIS MN 554071321 DAVID ALBRECHT DIRECTOR 2.00 40.00 X 0 330084 77132 KATHLEEN BACKER DIRECTOR/SECRETARY 2.00 0.00 X 0 0 0 COURTNEY BAECHLER MD DIRECTOR 2.00 40.00 X 0 561447 24574 STEPHEN BARITEAU DIRECTOR/PRESIDENT 2.00 40.00 X X 0 333723 72837 DENISE BLIZIL DIRECTOR 2.00 0.00 X 0 0 0 JULIA CRIST DIRECTOR 2.00 40.00 X 0 223426 62284 ANGELA FAHMY DIRECTOR/VICE CHAIR/TREASURER 2.00 0.00 X 0 0 0 TOBY FREIER DIRECTOR 2.00 40.00 X 0 376606 89691 HEATHER JOHNSON DIRECTOR 2.00 40.00 X 0 162136 9899 DAVID MILLER DIRECTOR 2.00 40.00 X 0 370958 67344 JENNIFER MYSTER DIRECTOR 2.00 40.00 X 0 367316 62031 GAYLE OBER DIRECTOR 2.00 0.00 X 0 0 0 JENNIFER O'NEILL DIRECTOR/CHAIR 2.00 0.00 X 0 0 0 GARY SHAW DIRECTOR 2.00 40.00 X 0 469329 65686 PAUL SMITH DIRECTOR 2.00 0.00 X 0 0 0 DAVID STURGES DIRECTOR 2.00 0.00 X 0 0 0 ERIC WILTROUT DIRECTOR 2.00 0.00 X 0 0 0 RICHARD MAGNUSON CFO 2.00 40.00 X 0 834474 234998 0 4029499 766476 0 0 1 0 0 9554 433778 1420676 1749471 1040 3613479 176761 176761 9071741 9134049 -62308 -62308 -62308 215857 433778 180541 35316 35316 3763248 0 0 149769 1631591 1631591 136874 136874 8930 2322 6608 31742 31742 100150 26039 74111 338 88 250 112364 30471 81893 8854 2302 6552 41899 10894 31005 1358 353 1005 STAFF SERVICES 898217 233536 664681 PURCH SVCS-AFFILIATES 358507 267881 90626 2491 648 1843 3333315 1768465 574534 990316 185744 122189 6803137 7756571 464056 91992 7452937 7970752 71920 194169 71920 194169 X 4485433 4768931 2895584 3007652 7381017 7776583 7452937 7970752 X 429933 995 -35362 X X 0 1 X 1 0 X 4680028 4804384 3983430 4000686 3613479 21082007 4680028 4804384 3983430 4000686 3613479 21082007 1971515 19110492 69512 75675 111877 134026 176761 567851 29702 23323 58170 116912 35316 263423 21913281 0.87210 0.84110 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 CASH EQUIVALENTS 34515 F FIXED INCOME SECURITIES 7368129 F EQUITY SECURITIES 49679 F FUNDS OF HEDGE FUNDS 37789 F MONEY MARKET 187278 F COMMODITIES AND OTHER 56766 F REAL RETURN MUTUAL FUNDS 22415 F 7756571 CHARITABLE REMAINDER TRUSTS - BENEFICIARIES PAYABLE 82356 DUE TO ALLINA HEALTH SYSTEM 111813 194169 X 3728881 995 -35362 -34367 3763248 0 3763248 3333315 0 3333315 0 3333315 PART X, LINE 2: "ALLINA ASSOCIATED 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 BUSINESS INCOME, EXCISE OR OTHER TAXES." PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS -35,362. X X X X X X X 1 RUFFALO NOEL LEVITZ 1025 KIRKWOOD PARKWAY SW CEDAR RAPIDS IA 52404 TELEFUNDRAISING 0 25975 31742 -5767 25975 31742 -5767 MN WI 2018 DRAGONFLY GALA 224182 166566 57616 10000 19021 300 13916 2018 SPRING TONIC BUFFALO GALA 106547 76565 29982 200 2173 3053 11091 800 11122 7 318906 190647 128259 2352 10714 17807 32638 45354 649635 433778 215857 200 4525 23767 47919 33738 70392 180541 35316 1 ALLINA HEALTH SYSTEM DBA BUFFALO HOSPITAL 2925 CHICAGO AVENUE MINNEAPOLIS MN 55407 363261413 170(B)(1)(A)(III) 99304 SUPPORT GENERAL OPERATIONS BUFFALO HOSPITAL AND AED PROGRAM ALLINA HEALTH SYSTEM DBA CAMBRIDGE MEDICAL CENTER 2925 CHICAGO AVENUE MINNEAPOLIS MN 55407 363261413 170(B)(1)(A)(III) 117072 SUPPORT GENERAL OPERATIONS CAMBRIDGE MEDICAL CENTER ALLINA HEALTH SYSTEM DBA NEW ULM MEDICAL CENTER 2925 CHICAGO AVENUE MINNEAPOLIS MN 55407 363261413 170(B)(1)(A)(III) 178037 SUPPORT GENERAL OPERATIONS NEW ULM MEDICAL CENTER, COURAGE KENNY INSTITUTE RENOVATION AND LARYNGOSCOPY EQUIPMENT. ALLINA HEALTH SYSTEM DBA OWATONNA HOSPITAL 2925 CHICAGO AVENUE MINNEAPOLIS MN 55407 363261413 170(B)(1)(A)(III) 100760 SUPPORT GENERAL OPERATIONS OWATONNA HOSPITAL ALLINA HEALTH SYSTEM DBA RIVER FALLS AREA HOSPITAL 2925 CHICAGO AVENUE MINNEAPOLIS MN 55407 363261413 170(B)(1)(A)(III) 68117 SUPPORT GENERAL OPERATIONS RIVER FALLS AREA HOSPITAL AND PURCHASE OF LOCAL ART ALLINA HEALTH SYSTEM DBA ALLINA HOME CARE HOPSICE AND PALLIATIVE CARE 2925 CHICAGO AVENUE MINNEAPOLIS MN 55407 363261413 170(B)(1)(A)(III) 967370 INTEGRATIVE THERAPIES, OPERATIONS AND REIMBURSEMENT OF PATIENT BILLS ALLINA HEALTH SYSTEM DBA PENNY GEORGE INSTITUTE HEALTH & HEALING 2925 CHICAGO AVENUE MINNEAPOLIS MN 55407 363261413 170(B)(1)(A)(III) 95931 SUPPORT OF PGIHH OPERATIONS LAFAYETTE AMBULANCE SERVICE PO BOX 274 LAFAYETTE MN 56054 501(C)(3) 5000 SUPPORT OF NEW AMBULANCE IN LAFAYETTE HOUSING AND LIVING ASSISTANCE 169 109313 RESEARCH AND EDUCATION 16 25561 FUNERAL 3 2000 PART I, LINE 2: ALLINA ASSOCIATED 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 A PROCESS THAT INCLUDES A WRITTEN APPLICATION REQUIRING 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 0 1 0 1 1 DAVID ALBRECHT DIRECTOR 0 254160 0 51479 0 24445 0 51534 0 25598 0 407216 0 687 COURTNEY BAECHLER MD DIRECTOR 0 148750 0 77851 0 334846 0 13155 0 11419 0 586021 0 104324 STEPHEN BARITEAU DIRECTOR/PRESIDENT 0 245537 0 53833 0 34353 0 44797 0 28040 0 406560 0 25325 JULIA CRIST DIRECTOR 0 166502 0 34042 0 22882 0 33657 0 28627 0 285710 0 0 TOBY FREIER DIRECTOR 0 282138 0 66038 0 28430 0 57151 0 32540 0 466297 0 5483 HEATHER JOHNSON DIRECTOR 0 145976 0 14388 0 1772 0 9638 0 261 0 172035 0 0 DAVID MILLER DIRECTOR 0 239196 0 55777 0 75985 0 54525 0 12819 0 438302 0 26028 JENNIFER MYSTER DIRECTOR 0 254214 0 61145 0 51957 0 44404 0 17627 0 429347 0 33110 GARY SHAW DIRECTOR 0 312646 0 74168 0 82515 0 59659 0 6027 0 535015 0 42831 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): COURTNEY BAECHLER, MD - $196,174. LINE 4(B): COURTNEY BAECHLER, MD - $115,701; STEPHEN BARITEAU - $29,346; DAVID MILLER - $50,300; JENNIFER MYSTER - $39,914; GARY SHAW - $44,807; 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 COMPENSATION DISCLOSURE: 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 DEFINED CONTRIBUTION SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ELIGIBLE ALLINA EXECUTIVES PARTICIPAPTED IN A DEFINED CONTRIBUTION SERP. THIS PLAN WAS AMENDED AND FROZEN EFFECTIVE DECEMBER 31, 2008, SUCH THAT NO FUTURE BENEFITS ACCRUE FOR SERVICE AFTER THAT DATE. THIS PLAN WAS REPLACED WITH THE EXECUTIVE RETIREMENT BENEFIT RESTORATION PLAN EFFECTIVE JANUARY 1, 2009, WHICH WAS ALSO FROZEN EFFECTIVE DECEMBER 31, 2018 EMPLOYER CREDITS WERE MADE EACH YEAR TO THEIR DC SERP BALANCE ACCORDING TO THE FOLLOWING SCHEDULE: EXEC YRS OF SERVICE CONTRIBUTION % OF PENSIONABLE EARNINGS 0-5 2.75% 6-10 3.50% 11+ 4.75% EXECUTIVES WERE ALSO CREDITED AN AMOUNT EQUAL TO THE EXCESS AMOUNT THAT WOULD HAVE BEEN CREDITED TO THE PENSION ACCOUNT PLAN WERE IT NOT FOR THE QUALIFIED PLAN COMPENSATION LIMITS. DEPOSITS EARN THE INVESTMENT RATE OF RETURN EQUAL TO THE PENSION ACCOUNT PLAN CREDITING RATE AS DECLARED BY ALLINA. THE CURRENT RATE IS 4%. THE PARTICIPANT VESTS AFTER THREE YEARS OF EXECUTIVE SERVICE PROVIDED THAT IF THE PARTICIPANT TERMINATES EMPLOYMENT WITH ALLINA PRIOR TO AGE 65 FOR ANY REASON OTHER THAN ELIMINATION OF POSITION, THE PARTICIPANT MUST FULFILL THE TERMS OF A COVENANT NOT TO COMPETE. BENEFITS ARE PAID AS A SINGLE LUMP-SUM AMOUNT UPON AGE 65, RETIREMENT OR JOB POSITION ELIMINATION. IN THE CASE OF OTHER VOLUNTARY TERMINATIONS, PAYMENT IS DELAYED UNTIL COMPLETION OF THE TWO-YEAR NON-COMPETE PERIOD. THE SERP 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. 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. FORM 990, PART VI, SECTION A, LINE 4 ON DECEMBER 28, 2018 ALLINA ASSOCIATED FOUNDATION (AAF) REQUESTED RECLASSIFICATION OF FOUNDATION STATUS AS A PUBLIC CHARITY. ON APRIL 25, 2019 THE INTERNAL REVENUE SERVICE DETERMINED AAF MEETS THE REQUIREMENTS FOR CLASSIFICATION AS A PUBLIC CHARITY DESCRIBED IN IRC SECTIONS 509(A)(1) AND 170(B)(1)(A)(VI). AAF'S ARTICLES OF INCORPORATION WERE UPDATED TO REFLECT THIS CHANGE. FORM 990, PART VI, SECTION A, LINE 6 PARENT COMPANY ALLINA HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER ORGANIZATION OF ALLINA ASSOCIATED FOUNDATION. SEE SCHEDULE R FOR FURTHER DETAILS. ALLINA HEALTH SYSTEM PROVIDES ALLINA ASSOCIATED FOUNDATION WITH ADMINISTRATIVE AND STAFF SERVICES AT NO COST. THE VALUE OF THE SERVICES PROVIDED BY ALLINA HEALTH SYSTEM TO ALLINA ASSOCIATED FOUNDATION DURING 2018 WERE ESTIMATED AT $1,378,776 AND HAVE BEEN RECORDED AS CONTRIBUTION REVENUE FROM A RELATED ORGANIZATION IN THE STATEMENT OF REVENUE AND AS ADMINISTRATIVE AND FUNDRAISING EXPENSES IN THE STATEMENT OF FUNCTIONAL EXPENSES. ALLINA ASSOCIATED 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 ALLINA ASSOCIATED FOUNDATION. THE RESERVED POWERS ARE FULLY DESCRIBED IN ALLINA ASSOCIATED 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 THE EXPLANATION IN SCHEDULE O FOR FORM 990, PART VI, SECTION A, LINE 7A FORM 990, PART VI, SECTION B, LINE 11B ALLINA ASSOCIATED FOUNDATION'S FORM 990 WAS PREPARED BY THE TAX SERVICES FUNCTION OF ALLINA HEALTH SYSTEM, ALLINA ASSOCIATED FOUNDATION'S SOLE CORPORATE MEMBER. THE FORM 990 FILING WAS SUBJECTED TO A RIGOROUS REVIEW PROCESS BY ALLINA'S TAX MANAGER AND TAX DIRECTOR AND AN EXECUTIVE REVIEW BY ALLINA'S VP OF FINANCE AND ALLINA'S CHIEF FINANCIAL OFFICER. AFTER THE MANAGEMENT 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 ALLINA ASSOCIATED FOUNDATION'S BOARD OF DIRECTORS. ALLINA ASSOCIATED FOUNDATION'S 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 ALLINA ASSOCIATED 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 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 ALLINA ASSOCIATED 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, PART VI, SECTION B, LINE 15A AND LINE 15B ARE NOT APPLICABLE TO ALLINA ASSOCIATED FOUNDATION. FORM 990, PART VI, SECTION C, LINE 19 ALLINA ASSOCIATED 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: ALLINA ASSOCIATED 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 AGREEMENTS -35,362. FORM 990, PART XII, LINE 2C: THIS PROCESS REMAINS UNCHANGED FROM THE PRIOR YEAR. FORM 990 PAGE 1 ITEM J ALLINA ASSOCIATED FOUNDATION ITSELF DOES NOT HAVE A WEBSITE. EACH OF THE ORGANIZATIONS SUPPORTED BY ALLINA ASSOCIATED FOUNDATION HAVE A PHILANTHROPIC WEBSITE. THE FOLLOWING ARE THE WEBSITES: BUFFALO HOSPITAL-HTTPS://WWW.ALLINAHEALTH.ORG/BUFFALO-HOSPITAL/FOUNDATION/ CAMBRIDGE MEDICAL CENTER-HTTPS://WWW.ALLINAHEALTH.ORG/CAMBRIDGE-MEDICAL-CENTER/FOUNDATION NEW ULM MEDICAL CENTER-HTTPS://WWW.ALLINAHEALTH.ORG/NEW-ULM-MEDICAL-CENTER/FOUNDATION/ OWATONNA HOSPITAL-HTTPS://WWW.ALLINAHEALTH.ORG/OWATONNA-HOSPITAL/FOUNDATION/ RIVER FALLS AREA HOSPITAL-HTTPS://WWW.ALLINAHEALTH.ORG/RIVER-FALLS-AREA-HOSPITAL/FOUNDAT ION/ ALLINA HEALTH HOME CARE-HTTPS://WWW.ALLINAHEALTH.ORG/MEDICAL-SERVICES/CHRONIC-AND-ADVANCED -ILLNESS/HOSPICE/ALLINA-HEALTH-HOSPICE-FOUNDATION/ PENNY GEORGE INSTITUTE OF HEALTH & HEALING-HTTPS://WWW.ALLINAHEALTH.ORG/PENNY-GEORGE-INSTITUTE-FOR-HEALTH -AND-HEALING/PENNY-GEORGE-INSTITUTE-FOUNDATION/ ABBOTT NORTHWESTERN HOSPITAL FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 554400043 043643816 FUNDRAISING AND GRANTMAKING FOUNDATION MN 501(C)(3) LINE 7 ALLINA HEALTH SYSTEM 0 MERCY & UNITY HOSPITALS FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 554400043 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 554400043 411613017 FUNDRAISING AND GRANTMAKING FOUNDATION MN 501(C)(3) LINE 7 ALLINA HEALTH SYSTEM 0 COURAGE KENNY FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 554400043 411952989 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 554400043 237420998 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 554400043 363261413 HEALTHCARE SERVICES MN 501(C)(3) LINE 3 0 MBP FACILITY LLC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 554400043 454078371 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 12A, I N/A 0 REGINA FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 554400043 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 METROPOLITAN INTEGRATED CANCER CENTER LLC PO BOX 819067 DALLAS TX 75381 205068485 RADIOLOGY DE N/A MAGNETO LEASING LLC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 554400043 201582501 RENTAL EQUIPMENT MN N/A ASPEN SLEEP CENTERLLC 1010 BANDANA BOULEVARD WEST ST PAUL MN 55108 261850227 HEALTHCARE SERVICES MN N/A GERIATRIC SERVICES OF MINNESOTA LLC 3433 BROADWAY ST 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 SERVICESLLC 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 554400043 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 HEALTHSPAN SERVICES COMPANY PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411249999 DEBT COLLECTION MN C 0 ALLINA SPECIALTY ASSOCIATES INC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411802815 HEALTHCARE SERVICES MN C 0 ALLINA HEALTH SYSTEM TRUST PO BOX 535007 PITTSBURGH PA 15253 276712988 TRUST PA T 0 ALLINA HEALTH SYSTEM DEFINED BENEFIT MASTER TRUST 500 GRANT STREET SUITE 0625 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 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1