2012-11-12T11:34:58-06:00 2011-12-31 990 2011-01-01 274116873 ALLINA ASSOCIATED FOUNDATION ALLI 6122620660 PO BOX 43 MR 10890 MINNEAPOLIS MN 554400043 LAURIE M LAFONTAINE 6122620660 2012-11-12 2011 2016-02-24 21:20:13Z DUKE ADAMSKI 2925 CHICAGO AVE MINNEAPOLIS MN 55407 6645927 0 X N/A X 2010 MN 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. 13 5 0 313 0 0 0 4310174 0 0 0 63452 0 70994 0 4444620 0 3870508 0 0 0 0 0 66132 1002145 0 1411785 0 5348425 0 -903805 0 4626779 0 1223619 0 3403160 X 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. 1 0 3264610 3264610 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EXPANSION - 2011 GRANT $150,099THE GOAL OF THE SURGERY CENTER EXPANSION PROJECT WAS TO RECONSTRUCT AND EXPAND THE OUTDATED EXISTING SURGERY CENTER FOR INCREASED PRIVACY AND CAPACITY FOR PATIENTS, AS WELL AS PROVIDE MORE COMFORTABLE AND ATTRACTIVE SPACE FOR FAMILIES AND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. 439779 439779 HOSPITAL AND MEDICAL CENTER GENERAL OPERATIONS: $439,779 127160 127160 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. 38959 38959 $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. 38959 38959 3870508 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 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 X 13 5 0 0 0 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 DUKE ADAMSKI 40.00 X X 0 339931 72974 DAVID ALBRECHT 40.00 X 0 207732 46410 GAYLE ANDERSON 40.00 X 0 312100 32473 KATHLEEN BACKER 2.00 X X 0 0 0 JASON BRADSHAW 2.00 X X 0 0 0 DENNIS DORAN 40.00 X 0 371423 61397 TOBY FREIER 40.00 X 0 189455 45271 PATRICIA HACKMAN 40.00 X X 0 46985 24274 S DOUGLAS HUTCHINGS 40.00 X X 0 276014 52069 RICHARD MEYER 40.00 X X 0 306097 65227 CHRISTINE MILLER 2.00 X 0 0 0 DAVID MILLER 40.00 X 0 322741 62864 JENNIFER MYSTER 40.00 X 0 299962 48472 JENNIFER O'NEILL 2.00 X X 0 0 0 DOUG RUTH 2.00 X 0 0 0 0 2672440 511431 0 0 1 0 0 24805 198073 1474666 2612630 4310174 80039 80039 2140661 2157248 -16587 -16587 -16587 112278 198073 44059 68219 68219 SALE OF BRACELETS 900099 1650 1650 SALE OF SCOOTER 900099 1125 1125 2775 4444620 0 0 134446 3743348 3743348 127160 127160 3300 1527 1773 66132 66132 6659 1250 5409 51361 36632 14729 13734 3910 9824 41917 15653 26264 3452 1795 1657 STAFF SERVICES 821323 246915 574408 PURCH SVCS-AFFILIATES 414383 142503 271880 OTHER PURCH. SERVICES 44407 20289 24118 MISCELLANEOUS EXPENSE 10398 5045 5353 851 253 598 5348425 3870508 475772 1002145 0 646806 0 2000 3977973 0 4626779 0 1223619 0 1223619 X 0 1086920 0 2316240 0 3403160 0 4626779 X -903805 4306965 X X 0 1 1 X 0 X X X 0 0 0 ALLINA HEALTH SYS 363261413 3 1 1 1 3704388 1 3704388 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 CASH EQUIVALENTS 712755 F FIXED INCOME SECURITIES 3265218 F 3977973 DUE TO AFFILIATE 1223619 1223619 4444620 5348425 -903805 -9990 4316955 4306965 3403160 4434630 -9990 -9990 4444620 0 4444620 5348425 0 5348425 0 5348425 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. X X X X X X X 1 RUFFALOCODY 65 KIRKWOOD NORTH ROAD SW CEDAR RAPIDS IA 52404 TELEFUNDRAISING 0 51620 66132 -14512 51620 66132 -14512 MN WI 2011 HOSPICE GALA 158840 112906 45934 2000 16693 9323 2011 CAMBRIDGE GOLF EVENT 24733 8758 15975 2397 3781 5 126778 76409 50369 4141 3945 1550 229 310351 198073 112278 6141 23035 1550 13333 44059 68219 1 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 3 HOUSING AND LIVING ASSISTANCE 107 46609 MEDICAL / PATIENT CARE 50 64758 RESEARCH AND EDUCATION 26 14177 FUNERAL 3 1616 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: 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. 0 1 0 0 0 0 1 0 1 1 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 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. SUPPLEMENTAL INFORMATION 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. 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. 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