ALLINA HEALTH FOUNDATION: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- ALLINA HEALTH FOUNDATION (EIN 27-4116873)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-12
- IRS object ID
- 201233179349301448
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-12T11:34:58-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 274116873 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALLINA ASSOCIATED FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ALLI | NameControl |
| Phone | 6122620660 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 43 MR 10890 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 554400043 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | LAURIE M LAFONTAINE | Name |
| Title | VP, FINANCE AND TREASURY | Title |
| Phone | 6122620660 | Phone |
| Date Signed | 2012-11-12 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DUKE ADAMSKI | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2925 CHICAGO AVE | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55407 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 6645927 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2010 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | TO RAISE, STEWARD AND DISTRIBUTE PHILANTHROPIC FUNDS IN SUPPORT OF BUFFALO, CAMBRIDGE, NEW ULM, OWATONNA, AND RIVER FALLS AREA HOSPITALS AND ALLINA HOME AND COMMUNITY SERVICES PROGRAM. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 313 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 4310174 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 63452 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 70994 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 0 | TotalRevenuePriorYear |
| Total Revenue Current Year | 4444620 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 3870508 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 66132 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 1002145 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 0 | OtherExpensePriorYear |
| Other Expenses Current Year | 1411785 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 0 | TotalExpensesPriorYear |
| Total Expenses Current Year | 5348425 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 0 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -903805 | RevenuesLessExpensesCY |
| Total Assets BOY | 0 | TotalAssetsBOY |
| Total Assets EOY | 4626779 | TotalAssetsEOY |
| Total Liabilities BOY | 0 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1223619 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 0 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3403160 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION OF ALLINA ASSOCIATED FOUNDATION IS TO DISTRIBUTE PHILANTHROPIC FUNDS IN SUPPORT OF BUFFALO, CAMBRIDGE, NEW ULM, OWATONNA, AND RIVER FALLS AREA HOSPITALS AND ALLINA HOME AND COMMUNITY SERVICES PROGRAM. THE FOUNDATION IS A SEPARATE NOT-FOR-PROFIT ENTITY DEDICATED TO SUPPORTING THE HOSPITALS AND ALLINA HOME AND COMMUNITY SERVICES PROGRAM AND IS GOVERNED BY A SEPARTE BOARD. | MissionDescription |
| Significant New Program Services | 1 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 3264610 | Expense |
| Grants | 3264610 | Grants |
| Description | HOSPITAL AND MEDICAL CENTER CAPITAL EXPANSION : $3,264,610:IN 2011, ALLINA ASSOCIATED FOUNDATION PROVIDED $3,264,609 FOR CAPITAL EXPANSION PROJECTS FOR BUFFALO AND NEW ULM AREA HOSPITALS AND FOR A RESIDENTIAL HOSPICE BUILDING IN ST. PAUL.J.A.WEDUM RESIDENTIAL HOSPICE - 2011 GRANT $2,594,320J.A. WEDUM RESIDENTIAL HOSPICE IS ENHANCING THE WAY ALLINA HOSPICE PROVIDES END-OF-LIFE CARE IN THIS REGION. BY PROVIDING AROUND-THE-CLOCK HOSPICE CARE, THE WISHES OF PATIENTS WHO WANT TO LIVE THE REMAINDER OF THEIR DAYS IN A HOME-LIKE SETTING ARE HONORED. THEIR LOVED ONES ARE OFFERED THE ABILITY TO STEP BACK FROM BEING THE CAREGIVER AND FOCUS ON WHAT REALLY MATTERS - BEING A FAMILY.VIRGINIA PIPER CANCER INSTITUTE - NEW ULM - 2011 GRANT $341,150THE VIRGINIA PIPER CANCER INSTITUTE (VPCI) - NEW ULM PROVIDES OUTPATIENT CARE THAT IS INDIVIDUALLY TAILORED AND CONVENIENT FOR PATIENTS.AN ONSITE ONCOLOGIST, NURSES AND PHARMACISTS WORK COLLABORATIVELY TO PROVIDE COMPASSIONATE CARE BASED ON THE INDIVIDUALIZED NEEDS OF EACH PATIENT. AS A TEAM, THEY STRIVE TO ADDRESS THE EMOTIONAL, AS WELL AS THE PHYSICAL NEEDS OF THE PATIENT.NEW ULM SURGERY CENTER EXPANSION - 2011 GRANT $150,099THE GOAL OF THE SURGERY CENTER EXPANSION PROJECT WAS TO RECONSTRUCT AND EXPAND THE OUTDATED EXISTING SURGERY CENTER FOR INCREASED PRIVACY AND CAPACITY FOR PATIENTS, AS WELL AS PROVIDE MORE COMFORTABLE AND ATTRACTIVE SPACE FOR FAMILIES AND STAFF.BUFFALO HOSPITAL'S WOMEN & CHILDREN'S CENTER - 2011 GRANT $179,041THIS BEAUTIFUL NEW CENTER WAS DESIGNED TO BE ENVIRONMENTALLY SAFE AND FRIENDLY WITH RECYCLED FLOORINGS, FABRICS, WALL COVERINGS AND WINDOW GLAZING TO REDUCE HEATING AND COOLING COSTS. IN ADDITION TO THE MODERN TECHNOLOGY FOR THE PHYSICIANS AND NURSES, THE BIRTH CENTER OFFERS NEW MOTHERS AND FAMILY MEMBERS A PRIVATE POST-PARTUM ROOM WITH A SOAKING TUB, WIRELESS INTERNET ACCESS, IPOD DOCKING STATION, SMALL PERSONAL REFRIGERATOR, A ROCKING CHAIR FOR NEW MOTHERS AND A BEAUTIFUL, LIGHT-FILLED SPACE WITH THE EQUIPMENT NEEDED FOR NEWBORN CARE. ALSO, A SPECIAL MUSIC SYSTEM WAS INSTALLED TO PLAY BEAUTIFUL LULLABY CHIMES THROUGHOUT THE HOSPITAL TO CELEBRATE THE BIRTH OF EACH NEW BABY. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 439779 | Expense |
| Grants | 439779 | Grants |
| Description | HOSPITAL AND MEDICAL CENTER GENERAL OPERATIONS: $439,779 | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 127160 | Expense |
| Grants | 127160 | Grants |
| Description | HOUSING/LIVING, MEDICAL, AND EDUCATIONAL ASSISTANCE TO CO-WORKERS AND PATIENTS - $127,160:THE FOLLOWING ARE SOME EXAMPLES OF HOSPITAL AND MEDICAL CENTER PROGRAMS SUPPORTING INDIVIDUAL PATIENTS AND EMPLOYEES. CAMBRIDGE MEDICAL CENTER'S "HOPE FUND" OFFERS EMERGENCY FINANCIAL ASSISTANCE TO HELP WITH EXPENSES DURING BREAST CANCER CARE AND TREATMENT. $14,690 IN ASSISTANCE WAS PROVIDED IN 2011.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. $15,242 IN ASSISTANCE WAS PROVIDED IN 2011.$59,102 IN ASSISTANCE WAS PROVIDED IN 2011 TO PAY MEDICAL BILLS FOR OWATONNA HOSPITAL HOSPICE PATIENTS.HOSPICE'S "TENDER LOVING CARE" PROGRAM PROVIDES ASSISTANCE TO HOSPICE PATIENTS WHO ARE EXPERIENCING FINANCIAL HARDSHIPS. $11,671 IN ASSISTANCE WAS PROVIDED IN 2011 TO ASSIST WITH HOUSING AND LIVING COSTS AND MEDICAL AND FUNERAL COSTS. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 38959 | Expense |
| Grants | 38959 | Grants |
| Description | $38,959 IN EXTERNAL GRANTS WERE PROVIDED IN 2011. THE FOLLOWING ARE SOME EXAMPLES OF EXTERNAL PROGRAMS THAT RIVER FALLS AREA HOSPITAL SUPPORTED IN 2011: $26,259 WAS PROVIDED TO THE "FREE CLINIC OF PIERCE AND ST. CROIX COUNTIES." GRANTS WERE GIVEN TO PROVIDE FLU SHOTS FOR FREE CLINIC PATIENTS, LAB AND RADIOLOGY SERVICES AND FOR GENERAL CLINIC OPERATIONS. SINCE 2007, THE CLINIC HAS BEEN PROVIDING FREE PRIMARY HEALTH CARE TO LOW-INCOME, UNINSURED RESIDENTS OF PIERCE AND ST. CROIX COUNTIES IN WESTERN WISCONSIN.$10,000 WAS GIVEN TO "CIRCLE IN THE FIELD" IN 2011 BY RIVER FALLS AREA HOSPITAL. THE GRANT WAS GIVEN TO SUPPORT CIRCLE IN THE FIELDS'S WORK TO PROVIDE SUPPORT FOR BREAST CANCER PATIENTS. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 38959 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 38959 | TotalOfOtherProgramServiceGrnt |
| Total Program Service Expense | 3870508 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 1 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Excess Business Holdings | 0 | ExcessBusinessHoldings |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| States Where Copy Of Return Is Filed | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TAX SERVICES MR 10890 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6122620660 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2925 CHICAGO AVENUE | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 554071321 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| DUKE ADAMSKI | ||||||
| DIR/CHAIR/PRES | 40.00 | X | X | 0 | 339931 | 72974 |
| DAVID ALBRECHT | ||||||
| DIRECTOR | 40.00 | X | 0 | 207732 | 46410 | |
| GAYLE ANDERSON | ||||||
| DIRECTOR | 40.00 | X | 0 | 312100 | 32473 | |
| KATHLEEN BACKER | ||||||
| DIRECTOR/SECRETARY | 2.00 | X | X | 0 | 0 | 0 |
| JASON BRADSHAW | ||||||
| DIRECTOR/VICE CHAIR | 2.00 | X | X | 0 | 0 | 0 |
| DENNIS DORAN | ||||||
| DIRECTOR | 40.00 | X | 0 | 371423 | 61397 | |
| TOBY FREIER | ||||||
| DIRECTOR | 40.00 | X | 0 | 189455 | 45271 | |
| PATRICIA HACKMAN | ||||||
| DIRECTOR/TREASURER | 40.00 | X | X | 0 | 46985 | 24274 |
| S DOUGLAS HUTCHINGS | ||||||
| DIRECTOR/SECRETARY | 40.00 | X | X | 0 | 276014 | 52069 |
| RICHARD MEYER | ||||||
| DIR/VICE CHAIR/TREAS | 40.00 | X | X | 0 | 306097 | 65227 |
| CHRISTINE MILLER | ||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |
| DAVID MILLER | ||||||
| DIRECTOR | 40.00 | X | 0 | 322741 | 62864 | |
| JENNIFER MYSTER | ||||||
| DIRECTOR | 40.00 | X | 0 | 299962 | 48472 | |
| JENNIFER O'NEILL | ||||||
| DIRECTOR/CHAIR | 2.00 | X | X | 0 | 0 | 0 |
| DOUG RUTH | ||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2672440 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 511431 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Federated Campaigns | 24805 | FederatedCampaigns |
| Fundraising Events | 198073 | FundraisingEvents |
| Related Organizations | 1474666 | RelatedOrganizations |
| All Other Contributions | 2612630 | AllOtherContributions |
| Total Contributions | 4310174 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 80039 | TotalRevenueColumn |
| Exclusion | $80,039 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2140661 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2157248 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -16587 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -16587 | TotalRevenueColumn |
| Exclusion | -$16,587 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 112278 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 198073 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 44059 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 68219 | TotalRevenueColumn |
| Exclusion | $68,219 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| SALE OF BRACELETS | 900099 | 1650 | $1,650 |
| SALE OF SCOOTER | 900099 | 1125 | $1,125 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2775 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4444620 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $134,446 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3743348 | Total |
| Program Services | 3743348 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 127160 | Total |
| Program Services | 127160 | ProgramServices |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3300 | Total |
| Management And General | 1527 | ManagementAndGeneral |
| Fundraising | 1773 | Fundraising |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 66132 | Total |
| Fundraising | 66132 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6659 | Total |
| Management And General | 1250 | ManagementAndGeneral |
| Fundraising | 5409 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51361 | Total |
| Management And General | 36632 | ManagementAndGeneral |
| Fundraising | 14729 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13734 | Total |
| Management And General | 3910 | ManagementAndGeneral |
| Fundraising | 9824 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41917 | Total |
| Management And General | 15653 | ManagementAndGeneral |
| Fundraising | 26264 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3452 | Total |
| Management And General | 1795 | ManagementAndGeneral |
| Fundraising | 1657 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|
| STAFF SERVICES | 821323 | 246915 | 574408 |
| PURCH SVCS-AFFILIATES | 414383 | 142503 | 271880 |
| OTHER PURCH. SERVICES | 44407 | 20289 | 24118 |
| MISCELLANEOUS EXPENSE | 10398 | 5045 | 5353 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 851 | Total |
| Management And General | 253 | ManagementAndGeneral |
| Fundraising | 598 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5348425 | Total |
| Program Services | 3870508 | ProgramServices |
| Management And General | 475772 | ManagementAndGeneral |
| Fundraising | 1002145 | Fundraising |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 646806 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 2000 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 3977973 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 4626779 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 1223619 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 1223619 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 1086920 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 2316240 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 3403160 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 4626779 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -903805 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 4306965 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Both | X | FinancialStatementBoth |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALLINA HEALTH SYS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363261413 | EIN |
| Type Of Organization | 3 | TypeOfOrganization |
| Listed In Governing Doc | 1 | ListedInGoverningDoc |
| Supported Organization Notified | 1 | SupportedOrganizationNotified |
| Organized In US | 1 | OrganizedInUS |
| Amount | $3,704,388 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 3704388 | SumOfAmounts |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| CASH EQUIVALENTS | 712755 | F |
| FIXED INCOME SECURITIES | 3265218 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 3977973 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE TO AFFILIATE | Description |
| Amount | $1,223,619 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1223619 | TotalOfAmounts |
| Total Revenue | 4444620 | TotalRevenue |
| Total Expenses | 5348425 | TotalExpenses |
| Excess Or Deficit For Year | -903805 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -9990 | NetUnrealizedGLOnInvestments |
| Other | $4,316,955 | OtherAmount |
| Total Adjustments | 4306965 | TotalAdjustments |
| Excess Or Deficit Per FS | 3403160 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 4434630 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -9990 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -9990 | RevenueNotRptdF990 |
| Revenue Subtotal | 4444620 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 4444620 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 5348425 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 5348425 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 5348425 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | 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. THE FILINGS FOR THE YEAR ENDING 2011 ARE OPEN TO EXAMINATION BY FEDERAL AND STATE AUTHORITIES. |
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | ASSETS TRANSFERRED FROM ALLINA HEALTH SYSTEM TO FOUNDATION 1/1/2011 4,316,955. |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Mail Solicitations | X | MailSolicitations |
| Email Solicitations | X | EmailSolicitations |
| Phone Solicitations | X | PhoneSolicitations |
| In Person Solicitations | X | InPersonSolicitations |
| Solicitation Of Non Govt Grants | X | SolicitationOfNonGovtGrants |
| Solicitation Of Govt Grants | X | SolicitationOfGovtGrants |
| Special Fundraising Events | X | SpecialFundraisingEvents |
| Agreement Ref Fundraising | 1 | AgreementRefFundraising |
Fundraiser Activity Information FundraiserActivityInformation
Name Of Organization NameOfOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RUFFALOCODY | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 65 KIRKWOOD NORTH ROAD SW | AddressLine1 |
| City | CEDAR RAPIDS | City |
| State | IA | State |
| ZIP Code | 52404 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activity | TELEFUNDRAISING | Activity |
| Fundraiser Control Of Funds | 0 | FundraiserControlOfFunds |
| Gross Receipts | 51620 | GrossReceipts |
| Amount Retained By Contractor | 66132 | AmountRetainedByContractor |
| Net To Organization | -14512 | NetToOrganization |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Gross Receipts | 51620 | TotalGrossReceipts |
| Total Retained By Contractors | 66132 | TotalRetainedByContractors |
| Total Net To Organization | -14512 | TotalNetToOrganization |
| Licensed States | MN | LicensedStates |
| Licensed States | WI | LicensedStates |
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | 2011 HOSPICE GALA | NameOfEvent1 |
| Gross Receipts Event1 | 158840 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 112906 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 45934 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 2000 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 16693 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 9323 | OtherDirectExpensesEvent1 |
| Name Of Event2 | 2011 CAMBRIDGE GOLF EVENT | NameOfEvent2 |
| Gross Receipts Event2 | 24733 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 8758 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 15975 | GrossRevenueEvent2 |
| Food And Beverage Event2 | 2397 | FoodAndBeverageEvent2 |
| Other Direct Expenses Event2 | 3781 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 5 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 126778 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 76409 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 50369 | GrossRevenueOtherEvents |
| Rent Facility Costs Other Events | 4141 | RentFacilityCostsOtherEvents |
| Food And Beverage Other Events | 3945 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 1550 | EntertainmentOtherEvents |
| Other Direct Expenses Other Events | 229 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 310351 | GrossReceiptsTotal |
| Charitable Contributions Total | 198073 | CharitableContributionsTotal |
| Gross Revenue Total Events | 112278 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 6141 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 23035 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 1550 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 13333 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 44059 | DirectExpenseSummaryEvents |
| Net Income Summary | 68219 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| ALLINA HEALTH SYSTEM (DBA BUFFALO HOSPITAL) | |||||||
| 2925 CHICAGO AVENUE | MINNEAPOLIS | MN | 55407 | 363261413 | 170(B)(1)(A)(III) | 227694 | WOMENS & CHILDRENS CENTER AND GENERAL OPERATIONS BUFFALO HOSPITAL |
| ALLINA HEALTH SYSTEM (DBA CAMBRIDGE MEDICAL CENTER) | |||||||
| 2925 CHICAGO AVENUE | MINNEAPOLIS | MN | 55407 | 363261413 | 170(B)(1)(A)(III) | 32022 | 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) | 592836 | NEW ULM CANCER CENTER, SURGERY CENTER AND GENERAL OPERATIONS NEW ULM MEDICAL CENTER |
| ALLINA HEALTH SYSTEM (DBA OWATONNA HOSPITAL) | |||||||
| 2925 CHICAGO AVENUE | MINNEAPOLIS | MN | 55407 | 363261413 | 170(B)(1)(A)(III) | 127816 | GENERAL OPERATIONS OWATONNA HOSPITAL |
| ALLINA HEALTH SYSTEM (DBA RIVER FALLS AREA HOSPITAL) | |||||||
| 2925 CHICAGO AVENUE | MINNEAPOLIS | MN | 55407 | 363261413 | 170(B)(1)(A)(III) | 37000 | GENERAL OPERATIONS RIVER FALLS AREA HOSPITAL |
| ALLINA HEALTH SYSTEM (DBA ALLINA HOME AND COMMUNITY SERVICES) | |||||||
| 2925 CHICAGO AVENUE | MINNEAPOLIS | MN | 55407 | 363261413 | 170(B)(1)(A)(III) | 2687020 | RESIDENTIAL HOSPICE BLDG, INTEGRATIVE THERAPIES AND GENERAL OPERATIONS |
| FREE CLINIC OF PIERCE AND ST CROIX COUNTIES | |||||||
| PO BOX 745 | RIVER FALLS | WI | 54022 | 205892220 | 170(B)(1)(A)(III) | 26259 | PROVIDE FLU SHOTS, LAB AND RADIOLOGY SERVICES & GENERAL CLINIC OPERATIONS |
| CIRCLE IN THE FIELD | |||||||
| 8481 QUANT AVE S | HASTINGS | MN | 55033 | 273601169 | 170(B)(1)(A)(III) | 10000 | SUPPORT BREAST CANCER PATIENTS , FAMILY & FRIENDSSUPPORT BREAST CANCER PATIENTS, FAMILY & FRIENDS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part III Form990ScheduleIPartIII (4 entries)
| Type Of GrantTypeOfGrant | Number Of RecipientsNumberOfRecipients | Amount Of Cash GrantAmountOfCashGrant |
|---|---|---|
| HOUSING AND LIVING ASSISTANCE | 107 | 46609 |
| MEDICAL / PATIENT CARE | 50 | 64758 |
| RESEARCH AND EDUCATION | 26 | 14177 |
| FUNERAL | 3 | 1616 |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 1 | InitialContractException |
| Rebuttable Presumption Procedure | 1 | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DUKE ADAMSKI | |||||||||||||
| 0 | 231843 | 0 | 64902 | 0 | 43186 | 0 | 63357 | 0 | 9617 | 0 | 412905 | 0 | 0 |
| DAVID ALBRECHT | |||||||||||||
| 0 | 157694 | 0 | 48145 | 0 | 1893 | 0 | 29913 | 0 | 16497 | 0 | 254142 | 0 | 0 |
| GAYLE ANDERSON | |||||||||||||
| 0 | 215642 | 0 | 64396 | 0 | 32062 | 0 | 15925 | 0 | 16548 | 0 | 344573 | 0 | 0 |
| DENNIS DORAN | |||||||||||||
| 0 | 250421 | 0 | 74866 | 0 | 46136 | 0 | 55162 | 0 | 6235 | 0 | 432820 | 0 | 0 |
| TOBY FREIER | |||||||||||||
| 0 | 165558 | 0 | 21008 | 0 | 2889 | 0 | 28766 | 0 | 16505 | 0 | 234726 | 0 | 0 |
| S DOUGLAS HUTCHINGS | |||||||||||||
| 0 | 194046 | 0 | 60318 | 0 | 21650 | 0 | 23609 | 0 | 28460 | 0 | 328083 | 0 | 0 |
| RICHARD MEYER | |||||||||||||
| 0 | 198858 | 0 | 61456 | 0 | 45783 | 0 | 36802 | 0 | 28425 | 0 | 371324 | 0 | 0 |
| DAVID MILLER | |||||||||||||
| 0 | 218219 | 0 | 67242 | 0 | 37280 | 0 | 56668 | 0 | 6196 | 0 | 385605 | 0 | 0 |
| JENNIFER MYSTER | |||||||||||||
| 0 | 212600 | 0 | 63810 | 0 | 23552 | 0 | 37962 | 0 | 10510 | 0 | 348434 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 4B | DUKE ADAMSKI - $38,693; GAYLE ANDERSON - $27,397; DENNIS DORAN - $32,206; S. DOUGLAS HUTCHINGS - $13,024; RICHARD MEYER - $28,237; DAVID MILLER - $32,091; JENNIFER MYSTER - $20,531. | |
| PART I, LINE 6 | MANAGEMENT INCENTIVE PLAN ALLINA PROVIDES AN ANNUAL INCENTIVE COMPENSATION OPPORTUNITY TO MOST MANAGERS, SOME HIGH-LEVEL INDIVIDUAL CONTRIBUTORS AND EXECUTIVES. UNDER THIS PLAN, THE TARGET AWARD IS EXPRESSED AS A FUNCTION 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 PERFORMANCE OVER THE CALENDAR YEAR. PERFORMANCE MEASURES INCLUDE FINANCIAL PERFORMANCE, SERVICE QUALITY, PATIENT SATISFACTION, PATIENT SAFETY AND COMMUNITY SERVICE. NO AWARDS ARE PROVIDED UNLESS THRESHOLD FINANCIAL PERFORMANCE IS ACHIEVED. PARTICIPANTS WHO HAVE LEFT EMPLOYMENT PRIOR TO THE END OF THE YEAR AS THE RESULT OF VOLUNTARY TERMINATION OR TERMINATION FOR POOR PERFORMANCE ARE NOT ELIGIBLE FOR AN AWARD. | |
| 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. | |
| PART III | DEFERRED COMPENSATION PLANS: TERMS AND CONDITIONS ALLINA HOSPITALS & CLINICS EXECUTIVE BENEFIT PLAN ALLINA HOSPITALS & CLINICS PHYSICIANS BENEFIT PLAN EXECUTIVE 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 AN UNSECURED CREDITOR OF ALLINA AND WILL NOT HAVE A PREFERRED CLAIM TO PAYMENT IN THE CASE OF THE COMPANYS INABILITY TO PAY. HOWEVER, THE COMPANY DOES SET ASIDE ASSETS FOR ITS OBLIGATIONS BY ACTUALLY INVESTING THE PROMISED ASSETS CONSISTENT WITH PARTICIPANT ELECTIONS. ALLINA SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) ELIGIBLE ALLINA EXECUTIVES PARTICIPATE IN A DEFINED CONTRIBUTION SERP. EMPLOYER CREDITS ARE MADE EACH YEAR TO THEIR SERP BALANCE ACCORDING TO THE FOLLOWING SCHEDULE: EXECUTIVE YEARS OF SERVICE CONTRIBUTION AS A % OF PENSIONABLE EARNINGS 0-5 YEARS 2.75% 6-10 YEARS 3.5% 11+ YEARS 4.75% EXECUTIVES ARE 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. THIS PLAN WAS AMENDED EFFECTIVE DECEMBER 31, 2008, SUCH THAT NO FUTURE BENEFITS ACCRUE FOR SERVICE AFTER THAT DATE. ALLINA EXECUTIVE RETIREMENT BENEFIT RESTORATION PLAN (SERP) ELIGIBLE ALLINA EXECUTIVES PARTICIPATE IN A DEFERRED COMPENSATION SERP. 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 SERP 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 SERP ACCOUNT ATTRIBUTABLE TO THE ANNUAL SERP CREDIT FOR A PARTICULAR YEAR AS OF JANUARY 15 OF THE YEAR FOLLOWING THE CALENDAR YEAR IN WHICH THE ANNUAL SERP 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 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. THIS PLAN WAS EFFECTIVE JANUARY 1, 2009. 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. | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| NEW PROGRAM SERVICES | FORM 990, PART III, LINE 2 | FORM 990, PART III LINE 2 - SEE DETAILED DESCRIPTION FORM 990 PART III LINE 4. |
| FORM 990, PART VI, SECTION A, LINE 6 | ALLINA HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER ORGANIZATION OF ALLINA ASSOCIATED FOUNDATION. ALLINA ASSOCIATED FOUNDATION IS THE SUPPORTING ORGANIZATION AND ALLINA HEALTH SYSTEM IS THE SUPPORTED ORGANIZATION. SEE SCHEDULE A AND 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 2011 WERE ESTIMATED AT $1,453,279 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 11 | ALLINA ASSOCIATED FOUNDATION'S FORM 990 WAS PREPARED BY THE TAX SERVICES FUNCTION OF ALLINA HEALTH SYSTEM, ALLINA ASSOCIATED FOUNDATION'S SOLE CORPORATE MEMBER AND SUPPORTED ORGANIZATION. 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 & TREASURY ALSO PERFORMED AN EXECUTIVE REVIEW OF THE FORM 990. 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. AN ALLINA ASSOCIATED FOUNDATION BOARD OF DIRECTORS MEETING WAS HELD ON OCTOBER 16,2012 TO REVIEW AND DISCUSS THE FORM 990 FILING. 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 REGULATION AND LICENSING. 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 REGULATION AND LICENSING. 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 OF REGULATION AND LICENSING. | |
| 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. | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -9,990. ASSETS TRANSFERRED FROM ALLINA HEALTH SYSTEM TO FOUNDATION 1/1/2011 4,316,955. TOTAL TO FORM 990, PART XI, LINE 5: 4,306,965. |
| FORM 990, PART XII, LINE 2C: | THIS PROCESS REMAINS UNCHANGED FROM THE PRIOR YEAR. | |
| ASSETS TRANSFERRED JANUARY 1, 2011-4,316,995 : | FORM 990 , PART XI LINE 5 | THE ALLINA ASSOCIATED FOUNDATION (THE FOUNDATION) WAS ESTABLISHED AS A SEPARATE LEGAL ENTITY AS OF NOVEMBER 23, 2010. PRIOR TO THAT DATE, DEPARTMENTS WITHIN ALLINA HEALTH SYSTEM'S BUFFALO HOSPITAL, CAMBRIDGE MEDICAL CENTER, NEW ULM MEDICAL CENTER, OWATONNA HOSPITAL, RIVER FALLS AREA HOSPITAL AND ALLINA HOME AND COMMUNITY SERVICES PROGRAM (THE HOSPITALS) CONDUCTED THE HOSPITALS' FUND-RAISING ACTIVITIES. THE FOUNDATION COMBINED THESE DEPARTMENTS INTO A NEW SEPARATE LEGAL ENTITY TO MANAGE AND RAISE FUNDS THROUGH GIFTS, CONTRIBUTIONS AND GRANTS FOR THE BENEFIT OF EACH RESPECTIVE HOSPITAL. THE ASSETS WERE TRANSFERRED FROM ALLINA HEALTH SYSTEM TO FORM THE FOUNDATION ON JANUARY 1, 2011. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (14 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| ALLINA MEDICAL CLINIC | ||||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 554400043 | 411781624 | HEALTHCARE SERVICES | MN | 501(C)(3) | LINE 3 | ALLINA HEALTH SYSTEM | 0 |
| ABBOTT NORTHWESTERN HOSPITAL FOUNDATION | ||||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 554400043 | 043643816 | SUPPORTING ORGANIZATION | MN | 501(C)(3) | LINE 11A, I | ALLINA HEALTH SYSTEM | 0 |
| MERCY & UNITY HOSPITALS FOUNDATION | ||||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 554400043 | 300086426 | SUPPORTING ORGANIZATION | MN | 501(C)(3) | LINE 11A, I | ALLINA HEALTH SYSTEM | 0 |
| PHILLIPS EYE INSTITUTE FOUNDATION | ||||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 554400043 | 411613017 | SUPPORTING ORGANIZATION | MN | 501(C)(3) | LINE 11A, I | ALLINA HEALTH SYSTEM | 0 |
| SISTER KENNY FOUNDATION | ||||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 554400043 | 411952989 | SUPPORTING ORGANIZATION | MN | 501(C)(3) | LINE 11A, I | ALLINA HEALTH SYSTEM | 0 |
| UNITED HOSPITAL FOUNDATION | ||||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 554400043 | 237420998 | SUPPORTING ORGANIZATION | MN | 501(C)(3) | LINE 11A, I | ALLINA HEALTH SYSTEM | 0 |
| CENTER FOR HEALTHCARE INNOVATION FOUNDATION | ||||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 554400043 | 263553868 | SUPPORTING ORGANIZATION | MN | 501(C)(3) | LINE 11A, I | ALLINA HEALTH SYSTEM | 0 |
| ALLINA HEALTH SYSTEM | ||||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 554400043 | 363261413 | HEALTHCARE SERVICES | MN | 501(C)(3) | LINE 3 | 0 | |
| ASPEN ASSET CORPORATION | ||||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 554400043 | 411788674 | HOLDING TITLE TO PROPERTY | MN | 501(C)(2) | ALLINA HEALTH SYSTEM | 0 | |
| ASPEN MEDICAL GROUP | ||||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 554400043 | 411452624 | HEALTHCARE SERVICES | MN | 501(C)(4) | ALLINA HEALTH SYSTEM | 0 | |
| ALLINA INTEGRATED MEDICAL NETWORK | ||||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 554400043 | 275129095 | SUPPORTING ORGANIZATION | MN | 501(C)(3) | LINE 11A, I | ALLINA HEALTH SYSTEM | 0 |
| UNITED AND CHILDRENS AMBULATORY SURGERY CENTER ASSOCIATION | ||||||||||
| 310 NORTH SMITH AVENUE | ST PAUL | MN | 55102 | 411694626 | SUPPORTING ORGANIZATION | MN | 501(C)(3) | LINE 11A, I | ALLINA HEALTH SYSTEM | 0 |
| MBP FACILITY LLC | ||||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 554400043 | 454078371 | SUPPORTING ORGANIZATION | MN | 501(C)(3) | LINE 11A, I | ALLINA HEALTH SYSTEM | 0 |
| WESTHEALTH INC | ||||||||||
| 2855 CAMPUS DRIVE | PLYMOUTH | MN | 55441 | 411768814 | HEALTHCARE SERVICES | MN | 501(C)(3) | LINE 3 | ALLINA HEALTH SYSTEM | 0 |
Form990 Schedule R Part III Form990ScheduleRPartIII (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|
| APPLE VALLEY BUILDING ASSOCIATES LLC | |||||||
| 14655 GALAXIE AVENUE S | APPLE VALLEY | MN | 55124 | 411677072 | RENTAL REAL ESTATE | MN | N/A |
| METROPOLITAN INTEGRATED CANCER CARE LLC | |||||||
| 16825 NORTHCHASE DRIVE SUITE 1300 | HOUSTON | TX | 77060 | 205068485 | RADIOLOGY | TX | N/A |
| SOUTHWEST SURGICAL CENTER LLC | |||||||
| 920 EAST 28TH STREET SUITE 500 | MINNEAPOLIS | MN | 55407 | 412013700 | SURGICAL SERVICES | MN | N/A |
| MAGNETO LEASING LLC | |||||||
| 225 SMITH AVE N SUITE 201 | ST PAUL | MN | 55102 | 201582501 | RENTAL EQUIPMENT | MN | N/A |
| WEST SUBURBAN HEALTH CAMPUS | |||||||
| 2855 CAMPUS DRIVE | PLYMOUTH | MN | 55441 | 411730888 | RENTAL REAL ESTATE | MN | N/A |
| ASPEN SLEEP CENTER | |||||||
| 1010 BANDANA BOULEVARD WEST | ST PAUL | MN | 55108 | 261850227 | HEALTHCARE SERVICES | MN | N/A |
| GERIATRIC SERVICES OF MINNESOTA LLC | |||||||
| 3366 OAKDALE AVE NORTH SUITE 551 | ROBBINSDALE | MN | 55422 | 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 |
| DISTRICT ONE CANCER CENTER LLC | |||||||
| 200 STATE AVENUE | FAIRBAULT | MN | 55021 | 451258847 | HEALTHCARE SERVICES | MN | N/A |
| MOBILE IMAGING SERVICES LLC | |||||||
| 1221 NICOLLET MALL STE 600 | MINNEAPOLIS | MN | 554032444 | 411883212 | RADIOLOGY | MN | N/A |
| CROSBY CARDIOVASCULAR SERVICESLLC | |||||||
| 920 E 28TH STREET SUITE 500 | MINNEAPOLIS | MN | 55407 | 412010368 | HEALTHCARE SERVICES | MN | N/A |
Form990 Schedule R Part IV Form990ScheduleRPartIV (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Type Of EntityTypeOfEntity | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|
| HEALTHSPAN SERVICES CORPORATION | ||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 55440 | 411716415 | DEBT COLLECTION | MN | C | |
| ALLINA SPECIALTY ASSOCIATES | ||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 55440 | 411802815 | HEALTHCARE SERVICES | MN | C | |
| ALLINA CLINIC HOLDINGS LTD | ||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 55440 | 263954371 | HOLDING COMPANY | MN | C | |
| QUELLO CLINIC LIMITED | ||||||||
| PO BOX 43 | MINNEAPOLIS | MN | 55440 | 410874754 | HEALTHCARE SERVICES | MN | C | |
| ALLINA HEALTH SYSTEM TRUST | ||||||||
| 500 GRANT STREET SUITE 0625 | PITTSBURGH | PA | 15258 | 276712988 | TRUST | PA | T | |
| ALLINA HEALTH SYSTEM DEFINED BENEFIT MASTER TRUST | ||||||||
| 500 GRANT STREET SUITE 0625 | PITTSBURGH | PA | 15258 | 376520273 | TRUST | PA | T | N/A |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
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