2023-08-29T10:56:43-05:00 2022-12-31 420714325 RSM US LLP 227 WEST FIRST STREET SUITE 700 DULUTH MN 55802 990 2022-01-01 237396466 MILLER-DWAN FOUNDATION MILL 2187862823 502 EAST SECOND STREET DULUTH MN 55805 TRACI MARCINIAK PRESIDENT 2187862823 2023-08-24 1 TRACI MARCINIAK 999009999 1 JULIE BOYER P01278549 2187275025 2023-08-24 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z TRACI MARCINIAK 502 EAST SECOND STREET DULUTH MN 55805 12174501 0 X WWW.MILLERDWANFOUNDATION.ORG X 1973 MN TO PROVIDE SUPPORT TO HISTORIC MILLER-DWAN MEDICAL CENTER AND POLINSKY MEDICAL REHABILITATION SPECIALTY HEALTHCARE PROGRAMS AND SERVICES AND FOR INNOVATIVE PROGRAMMING THROUGHOUT THE REGION. 15 15 7 40 0 0 1193097 1211209 29766 0 3899885 1470089 188 -114716 5122936 2566582 851932 1262047 0 0 522876 569401 0 0 500 959435 1067727 2334243 2899175 2788693 -332593 37367884 31065709 669620 554928 36698264 30510781 X THE MILLER-DWAN FOUNDATION IMPROVES THE HEALTH OF THE PEOPLE OF OUR REGION THROUGH THE CREATION OF IMPACTFUL COMMUNITY SOLUTIONS THAT OVERCOME BARRIERS. WE SUPPORT THE FUTURE AND THE LEGACY OF MILLER-DWAN MEDICAL CENTER, POLINSKY MEDICAL REHABILITATION CENTER, SOLVAY HOSPICE HOUSE, AMBERWING - CENTER FOR YOUTH & FAMILY WELL-BEING AND OTHER INITIATIVES FOR OUR REGION'S HEALTH. BY COMING TOGETHER WITH OTHERS WHO SHARE OUR VISION AND PASSION, WE ARE ABLE TO MAKE A DIFFERENCE IN THE LIVES OF PEOPLE EVERY DAY. 0 0 1357163 1262047 THE FOUNDATION SUPPORTS MEANINGFUL HEALTHCARE PROGRAMS ON THE MEDICAL CAMPUS AND IN THE COMMUNITY. GRANTS ARE MADE THROUGHOUT THE YEAR TO IMPROVE HEALTHCARE IN OUR REGION AND ARE PRIMARILY FOCUSED ON ADULT AND ADOLESCENT MENTAL HEALTH, HOSPICE, PHYSICAL REHABILITATION, CANCER CARE, BURN CARE, SURGICAL SERVICES, AND END-OF-LIFE. 456405 THE MILLER-DWAN FOUNDATION IS COMMITTED TO RAISING AWARENESS OF IMPORTANT HEALTH CARE ISSUES BY PROVIDING CHILDREN AND ADULTS WITH KNOWLEDGE AND SKILLS TO MOVE TOWARDS GREATER WELLNESS, TO MANAGE THEIR ILLNESS, AND TO UNDERSTAND OPTIONS AVAILABLE THROUGHOUT THE COURSE OF THEIR ILLNESS. IN 2022, EDUCATION WAS DONE IN-PERSON AND INCLUDED A VISIONING EVENT TO HELP PEOPLE CREATE THE LIFE THEY STRIVE TO LIVE, AS WELL AS AN EVENT DEDICATED TO THE IMPORTANCE OF THERAPY ANIMALS IN HEALTHCARE SETTINGS. EACH YEAR THE FOUNDATION CREATES PUBLICATIONS AND RESOURCES WHICH ARE WIDELY DISTRIBUTED, HAS AN ONLINE PRESENCE, AND ENGAGES THE MEDIA IN SHARING OUR MESSAGE. TOPIC AREAS INCLUDE, BUT ARE NOT LIMITED TO, HOSPICE AND END-OF-LIFE, MENTAL HEALTH, CANCER CARE AND SURVIVORSHIP, PHYSICAL REHABILITATION, AND BURN TREATMENT. THE FOUNDATION AWARDS GRANTS WITHIN THE MEDICAL MILIEU AND TO COMMUNITY ORGANIZATIONS WHO ARE FOCUSED ON HEALTHCARE, SPECIFICALLY FOR THE PROVISION OF EDUCATION. EDUCATION GRANTS ARE GIVEN TO MAINTAIN AND IMPROVE PATIENT CARE, AS WELL AS PREVENTION AND AFTERCARE FOR LONG TERM SUCCESS. 335557 AMBERWING - CENTER FOR YOUTH & FAMILY WELL-BEING IS OWNED BY THE MILLER-DWAN FOUNDATION, WHO HAS CONTINUED RESPONSIBILITY FOR THE STEWARDSHIP OF THE HOME AND THE TREATMENT PROGRAM. AMBERWING CARES FOR PATIENTS FROM BIRTH TO 18 AND ENGAGES THE FAMILY THROUGHOUT THE TREATMENT PROCESS. APPROXIMATELY 1,200 KIDS ANNUALLY PRESENT AT AMBERWING SEEKING CARE. AFTER AN ASSESSMENT, THE MAJORITY OF THE KIDS ENTER THE AMBERWING PARTIAL HOSPITALIZATION PROGRAM. IF NEEDED, CHILDREN AND FAMILIES ARE REFERRED TO OTHER ORGANIZATIONS PROVIDING THE TYPE OR LEVEL OF CARE APPROPRIATE FOR THAT SPECIFIC INDIVIDUAL. THE MILLER-DWAN FOUNDATION AND AMBERWING CONTINUE TO IDENTIFY AND IMPLEMENT WAYS TO OFFER SKILLS AND EDUCATION TO CHILDREN BEYOND THOSE ADMITTED TO THE AMBERWING PROGRAM-BOTH IN-PERSON AND VIRTUAL. DIALECTICAL BEHAVIOR THERAPY (DBT) TRAINING. WAS PROVIDED TO REGIONAL SCHOOL DISTRICTS AND COLLEGES.THE SUBSTANCE-USE DISORDER (SUD) PROGRAM THAT WAS IMPLEMENTED AT AMBERWING IN 2021, CONTINUED FOR ITS SECOND YEAR. THE SUD FELLOW CONTINUED HER ONSITE LEARNING OF SPECIALIZED DBT AND SUD CARE FOR CHILDREN AND IS PLANNING TRANSITION TO EMPLOYEE-STATUS ONCE THE FELLOWSHIP CONCLUDES.AMBERWING ALSO HOUSES A FAMILY RESOURCE CENTER THAT PROVIDES SUPPORT AND INFORMATION FOR PEOPLE FROM THROUGHOUT THE COMMUNITY. THE RESOURCE CENTER IS OFTEN FILLED WITH FAMILY MEMBERS WHO ARE SEEKING INFORMATION TO DETERMINE IF THEIR CHILD MAY NEED ADDITIONAL SUPPORT OR WHOSE CHILD IS IN THE AMBERWING PROGRAM. THE RESOURCE CENTER MANAGER FIELDED AN EXTENSIVE NUMBER OF PHONE CALLS AND WALK-IN VISITORS, IN ADDITION TO SERVING ON 6 LOCAL COMMITTEES AND ATTENDING 12 REGIONAL EVENTS AS AN AMBERWING AND MILLER-DWAN REPRESENTATIVE. DIALECTICAL BEHAVIOR THERAPY (DBT) SKILLS AND EDUCATION TRAININGS FOR FAMILY AND COMMUNITY MEMBERS EXCEEDED 100 SESSIONS IN 2022, REACHING MORE THAN 1,000 INDIVIDUALS.AMBERWING IS OWNED BY THE MILLER-DWAN FOUNDATION, AND CONTRACTS WITH ESSENTIA HEALTH TO PROVIDE THE MEDICAL CARE. MILLER-DWAN FOUNDATION DOES NOT CHARGE RENT TO ESSENTIA HEALTH FOR USE OF THE FACILITY. 405215 1) SOLVAY HOSPICE HOUSE (EXPENSES: $202,045)IN 2003, THE MILLER-DWAN FOUNDATION TOOK ON THE ROLE OF COMMUNITY ORGANIZER, FUNDRAISER, AND DEVELOPER TO COMPLETE A $4 MILLION CAPITAL CAMPAIGN TO CREATE SOLVAY HOSPICE HOUSE, WHICH OPENED IN 2007. SOLVAY WAS DESIGNED TO BE A COMFORTABLE HOME FOR THOSE FACING THE END OF LIFE AND THEIR FAMILIES. IN FY 2022, 220 WERE ADMITTED AND CARED FOR AT SOLVAY. OF THOSE, 82 WERE RESPITE PATIENTS, WHO RETURN HOME AFTER THEIR LOVED ONES ARE ABLE TO ENJOY A FIVE-DAY BREAK FROM THEIR CAREGIVING DUTIES. ON AVERAGE, PATIENTS ARE AT SOLVAY 7.9 DAYS BEFORE PASSING AWAY OR DISCHARGED TO HOME OR ANOTHER FACILITY. MOST PATIENTS ADMITTED TO SOLVAY QUALIFIED FOR FINANCIAL ASSISTANCE THROUGH THE MILLER-DWAN FOUNDATION'S COMPASSIONATE CARE FUND-A FUND DEVELOPED TO ENSURE PATIENTS WHO WOULD BENEFIT FROM CARE AT SOLVAY WOULD BE ABLE TO, REGARDLESS OF THEIR FINANCIAL CIRCUMSTANCE. SOLVAY IS OWNED BY THE MILLER-DWAN FOUNDATION AND CONTRACTS WITH ESSENTIA HEALTH TO PROVIDE THE MEDICAL CARE. MILLER-DWAN FOUNDATION DOES NOT CHARGE RENT TO ESSENTIA HEALTH FOR USE OF THE FACILITY.2) NEW PROGRAMS (EXPENSES: $50,985)WHEN A NEW HEALTH CARE NEED IS IDENTIFIED IN THE REGION OR ON THE MEDICAL CAMPUS, THE FOUNDATION WILL FOCUS ATTENTION AND RESOURCES TO HELP MEET THAT NEED. SOME OF THESE NEEDS CAN BE MET IN THE SHORT TERM AND CAN CHANGE FROM YEAR TO YEAR. RESPONSE TO THESE NEEDS CAN TAKE A VARIETY OF FORMS. IN 2022, THE EFFECTS OF THE PANDEMIC ON THE MENTAL HEALTH OF PEOPLE THROUGHOUT OUR REGION IS BECOMING MORE APPARENT. REFERRALS FOR ADULT AND ADOLESCENT MENTAL HEALTH CARE CONTINUE TO BE NEARLY DOUBLE PRE-PANDEMIC LEVELS. AS SUCH, MILLER-DWAN FOUNDATION DEVELOPED AN AGGRESSIVE STRATEGY TO ALLEVIATE THE MENTAL HEALTH CRISIS. THIS INVOLVES A COMMUNITY-WIDE PROGRAM TO EXPAND THE WORKFORCE THAT WILL LAUNCH IN 2023, AS WELL AS PLANS TO EXPAND FAMILY AND GROUP THERAPY CARE, TO MEET A SIGNIFICANT GAP IN CARE IN OUR REGION. WORK CONTINUES IN DOUGLAS COUNTY WITH AN EMPHASIS ON MENTAL HEALTH TRAINING, OPPORTUNITIES FOR RESIDENTS TO CONNECT, PROVIDER RECRUITMENT AND RETENTION AND THE POSSIBLE CREATION OF A MENTAL HEALTH CENTER.3) DEVELOPMENT (EXPENSES: $152,185)BUILDING AND SUSTAINING RELATIONSHIPS WITH SUPPORTERS IS OF PARAMOUNT IMPORTANCE TO OUR ORGANIZATION, AS THEY ARE TRULY THE CATALYST IN IMPROVING HEALTH CARE. STAFF KEEP IN FREQUENT CONTACT WITH SUPPORTERS AND USE SOPHISTICATED SOFTWARE TO ENSURE SUPPORTERS' GIFTS ARE RECORDED, DIRECTED AND RECOGNIZED CORRECTLY AND APPROPRIATELY. 405215 2554340 1 1 0 0 0 0 0 0 1 1 1 1 0 1 0 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 1 9 0 1 7 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MN WI FL AZ X TRACI MARCINIAK 2187862823 502 EAST SECOND STREET DULUTH MN 55805 TRACI MARCINIAK PRESIDENT 40.00 X 162338 0 29820 RYAN EDMUNDS DIRECTOR UNTIL 03/22 1.00 X 0 0 0 RYAN BOMAN DIRECTOR 1.00 X 0 0 0 MARK EMMEL DIRECTOR 1.00 X 0 0 0 TIM MCSHANE DIRECTOR 1.00 X 0 0 0 TRICIA BUNTEN DIRECTOR 1.00 X 0 0 0 JANICE SCHADE DIRECTOR 1.00 X 0 0 0 JENNY PETERSON DIRECTOR 1.00 X 0 0 0 JEFF HOLMES DIRECTOR 1.00 X 0 0 0 CARL CRAWFORD DIRECTOR 1.00 X 0 0 0 DR BRAD DAVIS DIRECTOR 1.00 X 0 0 0 MELISSA MEIERHOFF DIRECTOR 1.00 X 0 0 0 PAT MULLEN DIRECTOR UNTIL 02/22 1.00 X 0 0 0 KATHLEEN ATMORE DIRECTOR UNTIL 02/22 1.00 X 0 0 0 SHANE JOHNSON DIRECTOR UNTIL 02/22 1.00 X 0 0 0 JENNIFER CAREY DIRECTOR/FORMER CHAIR 1.00 X X 0 0 0 TANYA NICHOLS CHAIR 1.00 X X 0 0 0 MARY KAY BERARDUCCI VICE-CHAIR 1.00 X X 0 0 0 DR ELENA METCALF SECRETARY 1.00 X X 0 0 0 MIKE SEYFER TREASURER 1.00 X X 0 0 0 162338 0 29820 1 0 1 0 0 139802 226949 844458 101329 1211209 458947 458947 10450272 9439130 1011142 1011142 1011142 52560 139802 168789 -116229 -116229 FISCAL AGENT FEE 900099 1513 1513 1513 2566582 0 0 1355373 1245147 1245147 16900 16900 192158 153726 38432 298863 243641 55222 78380 63974 14406 24787 24787 33810 33810 137136 137136 14883 13608 775 500 37432 25437 11995 2119 2119 8261 6049 2212 406538 405531 1007 EDUCATION 280594 280594 MAINTENANCE 48471 48471 DONOR RECOGNITION EXPEN 48300 48300 BAD DEBT EXPENSE 12120 12120 13276 843 12433 2899175 2554340 344335 500 347923 236688 289900 367712 244749 153382 20419 52779 9755949 5805467 4357018 3950482 15056928 12358487 12515672 10291749 4535275 3654430 37367884 31065709 67155 131567 174646 143455 427819 279906 669620 554928 X 17212993 13345764 19485271 17165017 36698264 30510781 37367884 31065709 X -332593 -4974045 -880845 X 0 1 X 1 0 X 796577 1157343 1279082 1193097 1211209 5637308 796577 1157343 1279082 1193097 1211209 5637308 980274 4657034 774137 636592 432994 591755 458947 2894425 1513 1513 8533246 35432 0.54580 0.61540 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 19485271 736726 -1656423 996914 286249 117394 17165017 17806632 655927 2045630 650754 275359 96805 19485271 16392533 1028305 1530733 788242 263697 93000 17806632 14609263 965799 1775349 660594 202178 95106 16392533 15463117 654488 -467485 710117 241588 89152 14609263 0.78710 0.21290 0.00000 0 1 1 486930 486930 7537093 4143424 3393669 490231 420650 69581 1241695 1241393 302 3950482 ALTERNATIVE INVESTMENTS 5672566 F EXCHANGE TRADED FUNDS 973507 F CORPORATE, FIXED INCOME 2620503 F US GOVERNMENT AGENCY DEBT SECURITIES 1025173 F 10291749 PERPETUAL TRUST 3654430 3654430 X -3425444 -4974045 -1017981 -5992026 2566582 0 2566582 2762039 0 2762039 137136 137136 2899175 PART IV, LINE 2B: THE FOUNDATION RECEIVES ASSETS TRANSFERRED FROM UNAFFILIATED ENTITIES AND ACTS AS AN AGENT FOR THOSE ENTITIES. THE TRANSFER OF ASSETS IS NOT CONSIDERED A CONTRIBUTION RECEIVED BY THE FOUNDATION. THE FOUNDATION RECOGNIZES A LIABILITY CONCURRENT WITH THE RECOGNITION OF THE ASSETS RECEIVED. PART V, LINE 4: DONOR-DESIGNATED FUND: THE FUND CONSISTS OF DONOR-RESTRICTED CONTRIBUTIONS AND GRANTS FOR PROGRAM SERVICES AND FOR ACQUISITION OF LONG-LIVED ASSETS. VAN GORDEN FUND: THE FUND INCLUDES AMOUNTS RECEIVED FROM THE VAN GORDEN FOUNDATION OF PRC. THE VAN GORDEN FUND ADVISORY COMMITTEE MAKES RECOMMENDATIONS TO THE MILLER-DWAN FOUNDATION BOARD ON THE MANAGEMENT, INVESTMENT ALLOCATION AND DISBURSEMENT OF THE VAN GORDEN FUND. THE VAN GORDEN FUND CONSISTS OF THE FOLLOWING: ALBERT J. GONSKA MEMORIAL FUND: THE PURPOSE OF THIS FUND IS TO ASSIST THE PEDIATRIC REHABILITATION DEPARTMENT HISTORICALLY MAINTAINED BY POLINSKY, OR ITS SUCCESSOR, IN THE FINANCING OF PROGRAMS, RESEARCH AND NEW EQUIPMENT. SARA M. YOUNG EDUCATION FUND: THE PURPOSE OF THIS FUND IS TO PROVIDE EDUCATIONAL OPPORTUNITIES TO REHABILITATION PATIENTS, FAMILY MEMBERS AND PRACTITIONERS. VAN GORDEN NEW INITIATIVES FUND: THE PURPOSE OF THIS FUND IS TO SUPPORT AND PROMOTE NEW AND INNOVATIVE PROGRAMS OF REHABILITATION SERVICES, RESEARCH AND EDUCATION FOR TAX-EXEMPT INSTITUTIONS IN NORTHERN MINNESOTA, NORTHERN WISCONSIN AND THE UPPER PENINSULA OF MICHIGAN. - POLINSKY SUB FUND: THIS SUB FUND OF THE VAN GORDEN NEW INITIATIVES FUND IS DESIGNATED FOR POLINSKY AND POLINSKY CORPORATE AFFILIATES. ONE-HALF OF THE DISTRIBUTIONS FROM THE EDWARD S. AND JOSEPHINE WENDORF FOUNDATION THAT WERE PREVIOUSLY DESIGNATED FOR THE VAN GORDEN FUND OF PRC GO TO THIS SUB FUND. - OUTREACH SUB FUND: THIS SUB FUND OF THE VAN GORDEN NEW INITIATIVES FUND IS WITHOUT RESTRICTION AS TO AFFILIATION. ONE-HALF OF THE DISTRIBUTIONS FROM THE EDWARD S. AND JOSEPHINE WENDORF FOUNDATION THAT WERE PREVIOUSLY DESIGNATED FOR THE VAN GORDEN FUND OF PRC GO TO THIS SUB FUND. PART X, LINE 2: THE FOUNDATION AND ITS SUBSIDIARIES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND FROM STATE INCOME TAXES UNDER A SIMILAR STATE CODE SECTION. NONPROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGES, IF UNRELATED BUSINESS INCOME IS GENERATED, AND IN CERTAIN OTHER INSTANCES. NONPROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE FOUNDATION HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE FOUNDATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL OR STATE TAX AUTHORITIES FOR YEARS BEFORE 2019. PART XI, LINE 2D - OTHER ADJUSTMENTS: DECREASE IN BENEFICIAL INTEREST IN PERPETUAL TRUST -880,845. INVESTMENT EXPENSES NETTED WITH INVESTMENT INCOME -137,136. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT EXPENSES NETTED WITH INVESTMENT INCOME 137,136. ARTCETERA 192362 139802 52560 105 30090 65342 73252 192362 139802 52560 105 30090 65342 73252 168789 -116229 1 ESSENTIA HEALTH 400 E 3RD ST DULUTH MN 55805 200360007 501(C)(3) 1013687 0 DIALYSIS EQUIPMENT ($863,902); DESIGN AND FURNISHINGS FOR SOLVAY HOUSE AND AMBERWING ($119,540); DONOR WALL ($30,245) ESSENTIA INSTITUTE OF RURAL HEALTH 400 E 3RD ST DULUTH MN 55805 271291124 501(C)(3) 51358 0 RESEARCH LAKE SUPERIOR COMMUNITY HEALTH CENTER 4325 GRAND AVE DULUTH MN 55807 237167576 501(C)(3) 47980 0 FARMER'S MENTAL HEALTH COUNSELOR SALARY COLLEGE OF ST SCHOLASTICA 1200 KENWOOD AVE DULUTH MN 55811 410698301 501(C)(3) 40500 0 MOBILITY RESEARCH PAVSA 32 EAST 1ST STREET SUITE 200 DULUTH MN 55802 411350021 501(C)(3) 20000 0 PSYCHOTHERAPIST SALARY MN MASONIC CHILDREN'S CLINIC 24 WEST 2ND STREET DULUTH MN 55802 411420162 501(C)(3) 14000 0 PROGRAMMING FOR YOUTH WHO HAVE DISABILITIES UNIVERSITY OF MINNESOTA FOUNDATION 200 OAK STREET SE MINNEAPOLIS MN 554552010 416042488 501(C)(3) 9100 0 EDUCATION FOR TEACHERS WORKING WITH YOUTH WITH PHYSICAL CHALLENGES MINNESOTA BALLET 506 WEST MICHIGAN STREET DULUTH MN 55802 416055588 501(C)(3) 5175 0 DANCE FOR YOUTH WITH PHYSICAL CHALLENGES LIGHTHOUSE CENTER FOR VITAL LIVING 4505 WEST SUPERIOR STREET DULUTH MN 55807 410706140 501(C)(3) 30000 0 PROGRAMMING TO KEEP ELDERS IN THEIR HOMES 9 0 MDF/UW SUPERIOR MENTAL HEALTH PARTNERSHIP 1 16900 PART I, LINE 2: A FINAL GRANT REPORT MUST BE PROVIDED WITHIN TWO MONTHS OF PROJECT OR PROGRAM COMPLETION. FUTURE PROPOSALS WILL NOT BE ELIGIBLE FOR REVIEW UNTIL ALL OUTSTANDING REPORTS ON COMPLETED PROJECTS ARE SUBMITTED. THE FOLLOWING INFORMATION IS REQUIRED: - PROVIDE A HEADING FOR THE REPORT INCLUDING PROJECT NAME, GRANT NUMBER, ADDRESS, PHONE NUMBER AND THE NAME OF THE INDIVIDUAL RESPONSIBLE FOR COORDINATING THE PROJECT. - DESCRIBE THE GRANT-SUPPORTED ACTIVITIES OR EVENTS THAT OCCURRED BECAUSE OF FOUNDATION SUPPORT. - DESCRIBE ANY CHANGES THAT OCCURRED IN THE PROJECT FROM THE ORIGINAL CONCEPT AS PRESENTED IN YOUR PROPOSAL, WHY SUCH CHANGES WERE NECESSARY AND ANY PROBLEMS YOU ENCOUNTERED. - DESCRIBE THE RESULTS OF THIS PROJECT. INCLUDE SUMMARIES OF ANY OUTCOME MEASURES YOU USED ONLY IF THEY PROVIDE INFORMATION RELATED TO THE EFFECTIVENESS OF THE PROJECT. COMMENT ON YOUR SATISFACTION/DISSATISFACTION WITH THESE RESULTS AND ANY MODIFICATIONS YOU BELIEVE WOULD HAVE PRODUCED MORE DESIRABLE OUTCOMES. PROVIDE A STORY THAT EXEMPLIFIES YOUR RESULTS. - DISCUSS FUTURE IMPLICATIONS OF THE PROJECT (E.G. ALLOWED STARTUP OF A PROGRAM THAT WILL CONTINUE TO PROVIDE SERVICES, RESULTING IN BETTER PATIENT OUTCOMES). - PROVIDE A FINANCIAL REPORT DETAILING THE EXPENDITURES OF MILLER-DWAN FOUNDATION FUNDS AS WELL AS TOTAL PROJECT REVENUE AND EXPENSE. IN THE EVENT OF EQUIPMENT PURCHASE, PROVIDE VERIFICATION OF PURCHASE. - ATTACH COPIES OF PROJECT PUBLICITY, NEWSPAPER ARTICLES, PROGRAM BROCHURES, SCHEDULE OF EVENTS, NEWSLETTERS AND OTHER INFORMATION PUBLICLY ACKNOWLEDGING THE RECEIPT OF FUNDS AND/OR INFORMING THE PUBLIC OF GRANT ACTIVITIES. ANY DEVIATIONS FROM THE ORIGINAL GRANT MUST BE REPORTED TO AND REVIEWED BY THE MILLER-DWAN FOUNDATION GRANTS SPECIALIST. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 TRACI MARCINIAK PRESIDENT 162338 0 0 0 0 0 3383 0 26437 0 192158 0 0 0 PART I, LINE 1A THE MILLER-DWAN FOUNDATION SUPPORTS THE COST OF MEMBERSHIP TO LOCAL SOCIAL CLUBS AS THEY ARE DESIGNED TO OFFER PRIVATE MEETING SPACE IN A HOSPITALITY SETTING. LOCAL SOCIAL CLUBS ARE VENUES AT WHICH PROSPECTS, DONORS, AND BUSINESS ASSOCIATES GATHER ON A FREQUENT BASIS. THE MILLER-DWAN FOUNDATION PRESIDENT SHALL BE AUTHORIZED TO UTILIZE SOCIAL CLUBS TO FURTHER THE MISSION OF THE ORGANIZATION. THE PRESIDENT'S USE OF THE CLUB IS FOR BUSINESS PURPOSES ONLY. THIS BENEFIT WAS NOT TREATED AS TAXABLE COMPENSATION. SOCIAL CLUB BILLING STATEMENTS WILL BE SENT TO THE MILLER-DWAN FOUNDATION ACCOUNTANT WHO WILL COMPARE WITH SUBMITTED RECEIPTS, CODE APPROPRIATELY AND PROCESS. ALL OF THE PRESIDENT'S DONOR/PROSPECT MEETINGS ARE VISIBLE ON HER OUTLOOK CALENDAR FOR THE MILLER-DWAN FOUNDATION TEAM TO SEE. BASED ON WHO THE DONOR IS, INFORMATION IS INCLUDED IN THE DONOR DATABASE (RE) REGARDING ANY CULTIVATION/SOLICITATIONS IN PROCESS, AS WELL AS THE RELATIONSHIP AS IT RELATES TO GENERAL BUSINESS MATTERS. X 6 8825 FMV - PROVIDED BY DONORS X 2 52339 MEDIAN PRICE AT TRANSFER X AUCTION ITEMS 23 40165 FMV 0 0 1 0 PART I, COLUMN (B): THE ORGANIZATION REPORTED THE NUMBER OF ITEMS CONTRIBUTED FOR ART - WORKS OF ART AND AUCTION ITEMS. THE ORGANIZATION REPORTS THE NUMBER OF CONTRIBUTIONS FOR SECURITIES - PUBLICLY TRADED. FORM 990, PART I, LINE 5 MILLER-DWAN FOUNDATION HAS 7 EMPLOYEES. THESE EMPLOYEES ARE COMPENSATED BY ESSENTIA HEALTH, AN UNRELATED ORGANIZATION. MILLER-DWAN FOUNDATION REIMBURSES ESSENTIA HEALTH FOR THE COMPENSATION. FORM 990, PART VI, SECTION B, LINE 11B THE PRESIDENT AND ACCOUNTANT OF THE FOUNDATION REVIEW THE 990 FOR ACCURACY AND COMPLETENESS OF INFORMATION. THE FINAL COPY OF THE 990 IS PROVIDED TO ALL BOARD MEMBERS FOR THEIR REVIEW AND APPROVAL AT A BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD POLICY REGARDING CONFLICTS OF INTEREST AND DUALITY OF INVOLVEMENT IS AS FOLLOWS: A. DURING THE CONSIDERATION OF A PROPOSED ALLOCATION GRANT OR OTHER MATTER AFFECTING THE MILLER-DWAN FOUNDATION, ANY BOARD/COMMITTEE MEMBER WHO HAS OR IS AWARE OF A POTENTIAL CONFLICT OF INTEREST/DUALITY OF INVOLVEMENT, SHALL FULLY DISCLOSE SUCH CONFLICT TO THE BOARD PRIOR TO THE GRANTS DISCUSSION. B. ANY PERSON DEEMED BY HIMSELF/HERSELF OR BY THE CHAIR TO HAVE A CONFLICT OF INTEREST/DUALITY OF INTEREST, EXCLUDING THOSE ASSOCIATED WITH VAN GORDEN RELATED GRANT DISCUSSIONS, SHALL NOT PARTICIPATE IN ANY CONSIDERATION OF THE GRANT REQUEST AND MAY CHOSE TO LEAVE THE ROOM DURING THE DISCUSSION AND VOTING. C. BOARD/COMMITTEE MEMBERS SHALL NOT USE THEIR PERSONAL INFLUENCE IN THE DISCUSSION OF THE GRANT OR MATTER, HOWEVER, WHEN THE MEMBER'S KNOWLEDGE WILL ASSIST THE BOARD OR COMMITTEE AND WHEN THE BOARD OR COMMITTEE REQUESTS SUCH INFORMATION, A PERSON WITH A CONFLICT OR DUALITY OF INTEREST MAY RESPOND TO PERTINENT QUESTIONS. D. NO ORGANIZATION SHALL RECEIVE SPECIAL MILLER-DWAN FOUNDATION CONSIDERATION BASED ON A BOARD, COMMITTEE, OR FAMILY MEMBER OR FINANCIAL RELATIONSHIP. E. NO BOARD/COMMITTEE MEMBER SHALL USE HIS OR HER POSITION, OR THE KNOWLEDGE GAINED THERE FROM, IN SUCH A MANNER THAT A CONFLICT BETWEEN THE INTEREST OF THE MILLER-DWAN FOUNDATION OR ANY OF ITS ASSOCIATED AGENCIES OR ORGANIZATIONS AND HIS OR HER INTERESTED PERSONS, ARISES. F. A CONTRACT OR OTHER TRANSACTION BETWEEN THE MILLER-DWAN FOUNDATION AND A BOARD/COMMITTEE MEMBER IS NOT VOID OR VIOLABLE BECAUSE THE BOARD/COMMITTEE MEMBER IS A PARTY TO THE CONTRACT OR BECAUSE THE BOARD/COMMITTEE MEMBER IS PRESENT AT THE MEETING AT WHICH THE CONTRACT OR TRANSACTION IS AUTHORIZED, APPROVED OR RATIFIED, SO LONG AS THE FOLLOWING CONDITIONS ARE SATISFIED: A. THE MATERIAL FACTORS CONCERNING THE CONTRACT OR TRANSACTION AS THEY RELATE TO THE BOARD/ COMMITTEE MEMBER'S CONFLICT OF INTEREST MUST BE FULLY DISCLOSED, OR MUST BE KNOWN TO THE BOARD OR COMMITTEE AUTHORIZING, APPROVING OR RATIFYING THE CONTRACT OR TRANSACTION; AND B. THE BOARD OR COMMITTEE AUTHORIZING, APPROVING, OR RATIFYING THE CONTRACT OR TRANSACTION MUST DO SO IN GOOD FAITH BY A MAJORITY, NOT COUNTING ANY VOTE THAT THE INTERESTED BOARD/ COMMITTEE MEMBER MIGHT OTHERWISE HAVE, AND NOT COUNTING THE BOARD/COMMITTEE MEMBER IN DETERMINING THE PRESENCE OF A QUORUM. G. THESE CONDITIONS APPLY TO ANY CONTRACTS OR OTHER TRANSACTIONS BETWEEN MILLER-DWAN FOUNDATION AND A BOARD/COMMITTEE FAMILY MEMBER OR AN ORGANIZATION IN OR OF WHICH THE BOARD/COMMITTEE MEMBER OR A MEMBER OF THE BOARD/COMMITTEE MEMBER'S FAMILY IS A DIRECTOR, OFFICER OR LEGAL REPRESENTATIVE OR HAS A MATERIAL FINANCIAL INTEREST. H. BOARD/COMMITTEE MEMBERS HAVE A DUTY TO PLACE THE INTERESTS OF THE ORGANIZATION FOREMOST IN ANY DEALING WITH THE ORGANIZATION AND HAVE A CONTINUING RESPONSIBILITY TO COMPLY WITH THE REQUIREMENTS OF THIS POLICY. FOR THE PURPOSE OF CARRYING OUT THIS POLICY, THE MILLER-DWAN FOUNDATION PROVIDES A DISCLOSURE STATEMENT TO ALL BOARD MEMBERS REGARDING ORGANIZATIONS WITH WHICH EACH PERSON AND/OR FAMILY MEMBERS IS, OR HAS BEEN WITHIN THE PRIOR TWO YEARS, A TRUSTEE, DIRECTOR, SIGNIFICANT FINANCIAL SUPPORTER, ACTIVE VOLUNTEER, CURRENT CONSUMER OF ITS SERVICES OR STAFF MEMBER. ON THE BASIS OF THIS DISCLOSURE, STAFF WILL IDENTIFY ANY CONFLICT OF INTEREST/DUALITY OF INVOLVEMENT WHENEVER SUCH ORGANIZATIONS ARE CONSIDERED FOR A POSSIBLE ALLOCATION GRANT OR OTHER MATTER. THIS, HOWEVER, DOES NOT RELEASE A BOARD/COMMITTEE MEMBER OF THE RESPONSIBILITY TO INFORM THE PRESIDENT AND CHAIR OF ANY CONFLICTING ROLES OR DUAL ROLES THEY MAY HAVE IF NOT OTHERWISE DISCLOSED. DISCLOSURE STATEMENTS WILL BE DISTRIBUTED PERIODICALLY FOR THE PURPOSES OF UPDATING. THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED, REVIEWED, AND SIGNED BY BOARD MEMBERS ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15A THE MILLER-DWAN FOUNDATION EXECUTIVE COMMITTEE/OFFICERS REVIEW THE 990S OF OTHER COMPARABLE ORGANIZATIONS IN THE COMMUNITY TO DETERMINE CEO SALARIES, AS WELL AS NATIONAL NONPROFIT AND FOUNDATION SALARY AND BENEFITS SURVEY DATA TO DETERMINE THE APPROPRIATE SALARY. THAT GROUP THEN DISCUSSES AND DETERMINES SALARY FOR THE POSITION AS WELL AS ANY INCREASES OR OTHER CHANGES. FORM 990, PART VI, SECTION C, LINE 19 THE ANNUAL REPORT IS AVAILABLE ON THE FOUNDATION'S WEBSITE AND IN PERSON AT THE FOUNDATION'S OFFICE. ALL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, OTHER POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE AT THE FOUNDATION OFFICE FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN THE SECTION 6104(D). FORM 990, PART XI, LINE 9: DECREASE IN BENEFICIAL INTEREST IN PERPETUAL TRUST -880,845. MILLER-DWAN FOUNDATION AMBERWING LLC 502 EAST SECOND STREET DULUTH MN 55805 OWNERSHIP OF AMBERWING PROPERTY MN 0 2988053 N/A MILLER-DWAN FOUNDATION HOSPICE HOUSE LLC 502 EAST SECOND STREET DULUTH MN 55805 203644274 OWNERSHIP OF HOSPICE PROPERTY MN 0 945334 N/A EDWARD & JOSEPHINE WENDORF FOUNDATION PO BOX 16450 DULUTH MN 55816 416271710 SUPPORT OF THE MILLER-DWAN FOUNDATION MN 501(C)(3) LINE 12A, I N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0