2023-11-14T09:59:11-06:00 2022-12-31 135565207 KPMG LLP 4200 WELLS FARO CIR 9 S 7TH STREET MINNEAPOLIS MN 55402 990 2022-01-01 411839619 OLIVIA HOSPITAL & CLINIC FOUNDATION FKA RC HOSPITAL FOUNDATION OLIV 3205233477 8170 33RD AVE S BLOOMINGTON MN 55440 NANCY ANDERSON CFO 3205233575 2023-11-14 1 NANCY ANDERSON 999009999 0 HOLLY K MOEN P01800653 6123055000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z NANCY ANDERSON 100 HEALTHY WAY OLIVIA MN 56277 494353 0 X WWW.HEALTHPARTNERS.COM/FOUNDATIONS/OLIVIA X 1997 MN TO SUPPORT OLIVIA HOSPITAL AND CLINIC IN DELIVERING ACCESSIBLE AND QUALITY HEALTH CARE. 9 7 0 10 0 0 79417 459313 0 0 60235 22004 2092 5383 141744 486700 415912 158930 0 0 0 0 0 0 0 14792 10077 430704 169007 -288960 317693 2519852 2474261 22460 9623 2497392 2464638 X THE FOUNDATION IS ORGANIZED TO SUPPORT HEALTHPARTNERS RC, DBA OLIVIA HOSPITAL AND CLINIC, IN DELIVERING ACCESSIBLE AND QUALITY HEALTH CARE FOR RESIDENTS OF THE COMMUNITIES IT SERVES. 0 0 169007 158930 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS 169007 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 9 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X KEVIN J BRANDT 9528836584 8170 33RD AVE S BLOOMINGTON MN 55440 BECCA THIESSE DIRECTOR 1.00 0.00 X 0 0 0 NATHAN BLAD PRESIDENT 1.00 39.00 X X 0 349135 56900 JENNIFER MACIK CHAIR 1.00 59.00 X X 0 179305 42635 SARA BENSON TREASURER 1.00 0.00 X X 0 0 0 KAREN ZIESKE DIRECTOR 1.00 0.00 X 0 0 0 AMY HOLLAN DIRECTOR 1.00 0.00 X 0 0 0 JAN SIMONSEN DIRECTOR 1.00 0.00 X 0 0 0 BARBARA MELBERG DIRECTOR 1.00 0.00 X 0 0 0 AMY DEWANE DIRECTOR 1.00 52.00 X 0 428046 62187 HEATHER JESERITZ SECRETARY 1.00 0.00 X X 0 0 0 NANCY A ANDERSON CFO 1.00 49.00 X 0 186426 43763 0 1142912 205485 0 0 1 0 0 17318 16450 425545 13860 459313 22004 22004 13036 17318 7653 5383 5383 486700 0 0 27387 148880 148880 10050 10050 MISCELLANEOUS EXPENSE 10077 10077 169007 169007 0 0 143987 468750 4298 17354 2371567 1988157 2519852 2474261 22460 9623 22460 9623 X 1473734 1737578 1023658 727060 2497392 2464638 2519852 2474261 X 317693 -336587 -13860 X 0 1 X 1 0 X X 1 HEALTHPARTNERS RC 844261122 3 1 102004 0 1 102004 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE A, PART IV, SECTION A, LINE 6 SUPPORT WAS GIVEN TO ORGANIZATIONS TO SUPPORT A HEALTHY COMMUNITY. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 723060 338514 -105122 115302 7653 833497 1030970 56474 38841 113885 289340 723060 1401681 116603 5245 10000 482559 1030970 1162198 279618 421 16524 24032 1401681 1106442 151286 5425 79389 21567 1162198 1.00000 0 0 0 THRIVENT 1233696 C LINCOLN FINANCIAL GROUP 754461 C 1988157 X PART X, LINE 2: OLIVIA HOSPITAL AND CLINIC FOUNDATION IS INCLUDED IN THE HEALTHPARTNERS, INC. (HP) CONSOLIDATED AUDITED FINANCIAL STATEMENT. JUDGMENT IS REQUIRED IN DETERMINING HP'S EFFECTIVE TAX RATE AND IN EVALUATING ITS TAX POSITION. HP ESTABLISHES ACCRUALS FOR UNCERTAIN TAX POSITIONS WHEN, DESPITE THE BELIEF THAT HP'S TAX RETURN POSITIONS ARE FULLY SUPPORTABLE, HP BELIEVES THAT ITS POSITION MAY NOT BE FULLY SUSTAINED, PRIMARILY GIVEN THE RISKS ASSOCIATED WITH TAX LITIGATION OR DISPUTES. THE UNCERTAIN TAX POSITION ACCRUALS ARE ADJUSTED IN LIGHT OF CHANGING FACTS AND CIRCUMSTANCES, SUCH AS THE PROGRESS OF TAX AUDITS, CASE LAW, AND EMERGING LEGISLATION. HP'S EFFECTIVE TAX RATE INCLUDES THE IMPACT OF CHANGES TO THE ACCRUALS FOR UNCERTAIN TAX POSITIONS. HP CLASSIFIES INTEREST AND PENALTIES ON TAX-RELATED MATTERS AS INCOME AND OTHER TAX EXPENSE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS. HP RECORDED NO LIABILITIES AT DECEMBER 31, 2022 OR 2021 FOR UNRECOGNIZED TAX BENEFITS. X GOLF EVENT 22138 15509 6629 4023 MEALS FOR GOOD 7986 1591 6395 2692 2 230 218 12 938 30354 17318 13036 7653 7653 5383 0 HEALTHPARTNERS RC DBA OLIVIA HOSPITAL AND CLINIC 8170 33RD AVE S BLOOMINGTON MN 55369 844261122 501C3 102004 0 PROGRAM SUPPORT KANDIYOHI COUNTY AREA FAMILY YMCA 1000 LAKELAND DRIVE SE WILMAR MN 56201 411908049 501C3 22875 0 PROGRAM SUPPORT 2 0 SCHOLARSHIPS 5 10050 PART I, LINE 2: OLIVIA HOSPITAL & CLINIC FOUNDATION'S (OHCF) MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH OHCF'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO OHCF'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE. 0 0 0 0 0 0 1 0 0 AMY DEWANE DIRECTOR 0 318940 0 89679 0 19427 0 22875 0 39312 0 490233 0 0 NATHAN BLAD PRESIDENT 0 273606 0 72116 0 3413 0 28041 0 28859 0 406035 0 0 NANCY A ANDERSON CFO 0 167139 0 19287 0 0 0 9224 0 34539 0 230189 0 0 JENNIFER MACIK CHAIR 0 148264 0 31041 0 0 0 8199 0 34436 0 221940 0 0 PART I, LINE 3 OLIVIA HOSPITAL & CLINIC FOUNDATION HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. ALL OFFICERS AND KEY EMPLOYEES ARE PAID BY GROUP HEALTH, INC (GHI) OR BY PARK NICOLLET HEALTH SERVICES (PNHS) OR OLIVIA HOSPITAL AND CLINICS (HPRC), RELATED ORGANIZATIONS. ANY COMPENSATION IS DETERMINED SOLELY BY THE RELATED ORGANIZATIONS. PART I, LINE 6 OLIVIA HOSPITAL & CLINIC FOUNDATION OFFICERS AND DIRECTORS ARE EMPLOYED BY GROUP HEALTH, INC (GHI), PARK NICOLLET HEALTH SERVICES (PNHS) OR BY OLIVIA HOSPITAL AND CLINICS (HPRC), RELATED ORGANIZATIONS. COMPENSATION REPORTED IN FORM 990, PART VII INCLUDES ANY COMPENSATION DERIVED FROM GHI, PNHS OR HPRC INCENTIVE PROGRAMS WHICH INCENT AND REWARD BUSINESS LEADERS WHO HELP THE ORGANIZATION ACHIEVE STATED BUSINESS AND/OR HEALTH IMPROVEMENT GOALS FOR A SPECIFIC FISCAL YEAR. THE PROGAMS ARE A KEY ELEMENT OF THE PARTICIPANT'S TOTAL COMPENSATION PACKAGE. THE MANAGEMENT INCENTIVE PROGRAMS' REWARDS ARE BASED ON POSITION IN THE ORGANIZATION (E.G., SENIOR VICE PRESIDENT, VICE PRESIDENT, DIRECTOR MANAGER, OR OTHER SPECIFICALLY IDENTIFIED LEADERS) AND THE ACHIEVEMENT OF BUSINESS AND HEALTH IMPROVEMENT GOALS ESTABLISHED IN A VARIETY OF AREAS. GOALS WILL BE RELATED TO THE ORGANIZATION'S STRATEGIC PLAN AND WILL BE BALANCED. THESE AREAS MAY INCLUDE, BUT ARE NOT LIMITED TO, PATIENT SATISFACTION, EMPLOYEE SATISFACTION, WORK ENVIRONMENT, HEALTH EQUITY, HEALTHCARE AFFORDABILITY MEASURES, FINANCIAL PERFORMANCE (OPERATING INCOME), ETC AND WILL BE DEFINED ANNUALLY FOR EACH YEAR'S PROGRAM. AN OPERATING INCOME THRESHOLD MUST BE MET FOR ANY PAYMENT TO BE MADE FROM THE PROGRAM AND THERE IS A CAP ON THE MAXIMUM INCENTIVE POTENTIALLY AVAILABLE TO EACH PARTICIPANT. 990, PART III, LINE 4A: EXEMPT PURPOSE AND ACHIEVEMENTS OLIVIA HOSPITAL & CLINIC FOUNDATION IS A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE HEALTHPARTNERS ORGANIZATION, "HEALTHPARTNERS". FOUNDED IN 1957, HEALTHPARTNERS IS AN INTEGRATED HEALTH CARE ORGANIZATION, PROVIDING HEALTH CARE SERVICES AND HEALTH PLAN FINANCING AND ADMINISTRATION. HEALTHPARTNERS' MISSION IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY. HEALTHPARTNERS SEEKS TO TRANSFORM HEALTH CARE THROUGH A RELENTLESS FOCUS ON THE TRIPLE AIM - PROVIDING EXCEPTIONAL EXPERIENCE FOR THE INDIVIDUAL, IMPROVING THE HEALTH OF THE POPULATION, AND MAINTAINING AFFORDABILITY. HEALTHPARTNERS, INC. (HPI) IS A MINNESOTA NONPROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(4) AND IS THE PARENT ENTITY OF HEALTHPARTNERS ORGANIZATIONS REFERRED TO COLLECTIVELY AS "HEALTHPARTNERS". HEALTHPARTNERS INCLUDES AN ARRAY OF TAX-EXEMPT AND TAXABLE ORGANIZATIONS. HEALTHPARTNERS PROVIDES A FULL RANGE OF HEALTH CARE DELIVERY AND HEALTH PLAN SERVICES INCLUDING INSURANCE, PATIENT CARE, ADMINISTRATION AND HEALTH AND WELL-BEING PROGRAMS. HEALTHPARTNERS HEALTH PLANS SERVE MORE THAN 1.8 MILLION MEDICAL AND DENTAL MEMBERS NATIONWIDE. HEALTHPARTNERS MEDICAL CARE SYSTEM INCLUDES MORE THAN 1,900 EMPLOYED PHYSICIANS AND DENTISTS, EIGHT OWNED HOSPITALS WITH OVER 1,000 ACUTE CARE BEDS, OVER 100 PRIMARY AND SPECIALTY CARE MEDICAL FACILITIES AND DENTAL FACILITIES WITH PRACTICES IN MINNESOTA AND WESTERN WISCONSIN SERVING MORE THAN 1.34 MILLION PATIENTS. HEALTHPARTNERS HEALTH PLANS CONTRACT WITH OTHER PRIMARY AND SPECIALTY MEDICAL FACILITIES AND DENTAL FACILITIES, PHYSICIAN GROUPS, HOSPITALS AND RELATED HEALTHCARE PROVIDERS TO SERVE PLAN MEMBERS. HEALTHPARTNERS ALSO PROVIDES MEDICAL EDUCATION AND TRAINING TO MEDICAL PROFESSIONALS AND CONDUCTS RESEARCH AND FUNDRAISING ACTIVITIES THAT SUPPORT THE HEALTH CARE DELIVERY SYSTEM. HEALTHPARTNERS COLLABORATES WITH OTHER PLANS, CARE PROVIDERS AND OTHER COMMUNITY AND BUSINESS ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION TO INCREASE ACCESS, CREATE AND SHARE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY, AND COLLABORATE IN IMPROVEMENTS THAT SUPPORT THE TRIPLE AIM. AMONG HEALTHPARTNERS' SIGNATURE INITIATIVES ARE TOTAL COST OF CARE MEASUREMENTS (A NATIONALLY RECOGNIZED METRIC, ENABLING MEASUREMENT AND INCENTIVES BASED ON COORDINATION AND EVIDENCE-BASED PRACTICES), MENTAL HEALTH (REDUCING STIGMA, AND ASSURING ACCESS TO HIGH QUALITY CARE IN THE MOST APPROPRIATE SETTINGS), CHILDREN'S HEALTH (IMPROVING CHILD HEALTH BY PROMOTING EARLY BRAIN DEVELOPMENT, PROVIDING FAMILY CENTERED CARE, AND STRENGTHENING COMMUNITIES), EQUITY, INCLUSION, AND ANTI-RACISM (ADDRESSING HEALTH EQUITY, ELIMINATING HEALTH CARE DISPARITIES, INCREASING DIVERSITY AND INCLUSION IN OUR WORKPLACES, BUILDING AN ANTI-RACIST CULTURE, AND DEEPENING OUR COLLECTIVE UNDERSTANDING OF CULTURAL HUMILITY) AND SUSTAINABILITY (ENERGY EFFICIENCY, WASTE REDUCTION, AND RESOURCE MANAGEMENT). A COMPLETE LISTING OF ALL ORGANIZATIONS WITHIN HEALTHPARTNERS, AND THE RELATIONSHIP BETWEEN THEM, CAN BE FOUND ON SCHEDULE R WITHIN THIS 990 RETURN. DETAILED INFORMATION ABOUT THE COMMUNITY BENEFIT ACTIVITIES AND ACCOMPLISHMENTS OF EACH TAX-EXEMPT ORGANIZATION CAN BE FOUND IN THE INDIVIDUAL FORM 990 RETURN FOR THAT ORGANIZATION. HEALTHPARTNERS, INC. (HPI) IS THE PARENT ENTITY OF HEALTHPARTNERS AND IS A MINNESOTA NON-PROFIT CORPORATION AND LICENSED HEALTH MAINTENANCE ORGANIZATION (HMO) RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(4). HPI IS THE SOLE CORPORATE MEMBER OF PARK NICOLLET HEALTH SERVICES WHICH IN TURN IS THE SOLE CORPORATE MEMBER OF HEALTHPARTNERS RC, DOING BUSINESS AS OLIVIA HOSPITAL & CLINIC, BOTH OF WHICH ARE MINNESOTA NON-PROFIT CORPORATIONS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3). OLIVIA HOSPITAL & CLINIC IS THE PARENT ENTITY OF OLIVIA HOSPITAL & CLINIC FOUNDATION. OLIVIA HOSPITAL & CLINIC FOUNDATION IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX AS A SUPPORTING ORGANIZATION TO OLIVIA HOSPITAL & CLINIC. ALL OF OLIVIA HOSPITAL & CLINIC FOUNDATION'S ACTIVITIES EITHER DIRECTLY SUPPORT OLIVIA HOSPITAL & CLINIC OR ARE IN FURTHERANCE OF ITS MISSION. HEALTH PROFESSIONAL EDUCATION: IN 2022, OLIVIA HOSPITAL & CLINIC FOUNDATION AWARDED $10,000 IN SCHOLARSHIPS FOR STUDENTS PURSUING DEGREES IN HEALTH CARE DELIVERY RELATED FIELDS. THESE SCHOLARSHIPS INVEST IN STUDENTS WITH BRIGHT FUTURES WHO WANT TO USE THEIR TALENTS TO CARE FOR OTHERS. THROUGH SCHOLARSHIP AWARDS, WE'RE HELPING TRAIN THE NEXT GENERATION OF RURAL HEALTH CARE LEADERS. OLIVIA HOSPITAL & CLINIC FOUNDATION FUNDRAISING AND GRANTING: THE OLIVIA HOSPITAL & CLINIC FOUNDATION RECEIVED A TOTAL OF CONTRIBUTIONS AND IN-KIND CONTRIBUTIONS OF $459,313 IN 2022. THESE FUNDS WERE DIRECTED TO SEVERAL PROGRAMS IN OUR COMMUNITY, AS WELL AS WELL AS INTERNAL PROGRAMS, GREATEST NEED ALLOCATIONS AND CAPITAL REQUESTS WITHIN OLIVIA HOSPITAL & CLINIC. THE FUNDING: SUPPORTED OUR PATIENTS WITH SHORT-TERM NEEDS THAT COULD PREVENT THEM FROM GETTING NECESSARY CARE THROUGH THE OLIVIA HOSPITAL & CLINIC FOUNDATION GOOD SAMARITAN FUND. TOTAL FUNDS SUPPORTED $1,989.95. SUPPORTED OLIVIA HOSPITAL & CLINIC HOSPICE PROGRAMS TO HELP SUPPORT MEDICATION, TRANSPORTATION, AND MANY SOOTHING THERAPIES. IN ADDITION, SUPPORTED SPIRITUAL CARE, SOCIAL SERVICES, GRIEF COUNSELING, AND MORE FOR THE PATIENTS AND THEIR FAMILIES. TOTAL FUNDS SUPPORTED $62,770.90. SUPPORTED PROGRAMS THAT MEET OUR NEIGHBORS WHERE THEY ARE, HELP TO EXPAND ACCESS TO FOOD, INFORMATION AND RESOURCES THAT IMPROVE HEALTH AND WELL-BEING. THESE PROGRAMS INCLUDE MOBILE FOOD SHELF IN RENVILLE COUNTY, FRUIT AND VEGGIE RX PROGRAM, REVOLUTION WELLNESS YMCA SUPPORT, AND MORE. TOTAL FUNDS SUPPORTED $40,361.96. SUPPORTED A PURCHASE OF A BARIATRIC BED FOR OLIVIA HOSPITAL & CLINIC TOTAL FUNDS SUPPORTED $31,447.50. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE OLIVIA HOSPITAL & CLINIC FOUNDATION IS HEALTHPARTNERS RC. FORM 990, PART VI, SECTION A, LINE 7A PURSUANT TO BYLAWS, THE OLIVIA HOSPITAL & CLINIC FOUNDATION'S BOARD OF DIRECTORS IS COMPRISED OF 2 MEMBERS APPOINTED BY HEALTHPARTNERS RC. THE REMAINING ARE CANDIDATES NOMINATED BY THE CORPORATION'S BOARD AND APPOINTED BY THE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE OLIVIA HOSPITAL & CLINIC FOUNDATION'S CORPORATE MEMBER, HEALTHPARTNERS RC, MUST APPROVE THE FOLLOWING ACTIONS OF THE OLIVIA HOSPITAL & CLINIC FOUNDATION'S BOARD OF DIRECTORS OR INITIATE THESE ACTIONS DIRECTLY: 1) AMEND THE ARTICLES OF INCORPORATION AND BYLAWS 2) ADOPT ANNUAL OPERATING AND CAPITAL BUDGETS 3) UNDERTAKE UNBUDGETED SPECIAL PROJECTS OR GRANTS TO ORGANIZATIONS NOT AFFILIATED WITH THE CORPORATION WHICH RESULT IN PAYMENTS IN EXCESS OF $100,000 PER YEAR UNLESS COVERED BY OFFSETTING REVENUE FROM AN EXTERNAL GRANT OR CONTRACT 4) GUARANTEE DEBTS OR OBLIGATIONS OF ANY OTHER PERSON OR ENTITY 5) UNDERTAKE ANY LOAN OR OTHER INDEBTEDNESS IN EXCESS OF AMOUNTS ESTABLISHED BY THE MEMBER 6) VOLUNTARILY DISSOLVE 7) SELL, LEASE, TRANSFER, MORTGAGE, PLEDGE, OR OTHERWISE DISPOSE OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS 8) MERGE OR CONSOLIDATE WITH ANY OTHER ENTITY FORM 990, PART VI, SECTION B, LINE 11B THE OLIVIA HOSPITAL & CLINIC FOUNDATION'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT (THE 990) IS PRESENTED TO THE GOVERNING BODY OF OLIVIA HOSPITAL & CLINIC FOUNDATION . THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GHI, THE MANAGEMENT TEAM OF OLIVIA HOSPITAL & CLINIC , GHI'S INTERNAL LEGAL DEPARTMENT AND OLIVIA HOSPITAL & CLINIC 'S OUTSIDE INDEPENDENT ACCOUNTANTS. EACH ONE OF THOSE AREAS HAS AN OPPORTUNITY TO REVIEW, ASK QUESTIONS AND MAKE COMMENTS BACK TO THE TAX DEPARTMENT OF GHI BEFORE THE FORM 990 IS COMPLETED AND PRESENTED TO THE GOVERNING BODY OF OLIVIA HOSPITAL & CLINIC FOUNDATION . OLIVIA HOSPITAL & CLINIC FOUNDATION MAKES AVAILABLE TO THE GOVERNING BODY (BOARD OF DIRECTORS) A COPY OF THE 990 FOR REVIEW AND COMMENT PRIOR TO THE FILING OF THE 990 RETURN. THIS COPY IS PROVIDED IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT A MEETING OF THE FULL BOARD OF DIRECTORS. THIS PROCESS IS NOTED AND DOCUMENTED IN THE WRITTEN MINUTES OF THE MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE OLIVIA HOSPITAL & CLINIC FOUNDATION BOARD MONITORS POTENTIAL CONFLICTS OF INTEREST ON THE PART OF ITS BOARD MEMBERS, PRINCIPAL OFFICERS, MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS, AND KEY EMPLOYEES ("COVERED PERSONS") BY MAINTAINING A CONFLICT OF INTEREST POLICY. UNDER THE POLICY, COVERED PERSONS ANNUALLY ARE PROVIDED WITH A COPY OF THE POLICY AND ASKED TO COMPLETE A QUESTIONNAIRE IDENTIFYING ANY POTENTIAL CONFLICTS OF INTERESTS. THE LEGAL DEPARTMENT OF HEALTHPARTNERS REVIEWS THE QUESTIONNAIRE RESPONSES AND DEVELOPS A REPORT DETAILING ANY POTENTIALLY MATERIAL CONFLICTS FOR THE PRESIDENT AND CHAIR OF THE BOARD. A VERBAL SUMMARY IS ALSO GIVEN TO THE FULL BOARD OR APPROPRIATE COMMITTEE ENDING WITH A REMINDER TO COVERED PERSONS OF THE POLICY'S MANDATE THAT EACH PERSON IS OBLIGATED TO DISCLOSE ANY NEW POTENTIAL CONFLICTS AS THEY MAY ARISE THROUGHOUT THE YEAR. BOARD AGENDAS AND EXECUTIVE DECISIONS ARE MONITORED IN RELATION TO THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15 OLIVIA HOSPITAL & CLINIC FOUNDATION HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. ALL OFFICER AND KEY EMPLOYEES ARE PAID BY GROUP HEALTH, INC (GHI) OR BY PARK NICOLLET HEALTH SERVICES (PNHS) OR OLIVIA HOSPITAL AND CLINICS (HPRC), RELATED ORGANIZATIONS. ANY COMPENSATION IS DETERMINED SOLELY BY THE RELATED ORGANIZATIONS. THEREFORE, PART VI, SECTION B, QUESTION 15 IS NOT APPLICABLE TO OLIVIA HOSPITAL & CLINIC FOUNDATION FORM 990, PART VI, SECTION C, LINE 19 THE OLIVIA HOSPITAL & CLINIC FOUNDATION'S FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM THE OLIVIA HOSPITAL & CLINIC FOUNDATION. THE OLIVIA HOSPITAL & CLINIC FOUNDATION'S ARTICLES OF INCORPORATION ARE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION THROUGH THE MINNESOTA SECRETARY OF STATE'S OFFICE. FORM 990, PART XI, LINE 9: GIFT IN KIND RUN THROUGH FUND BALANCE -13,860. HEALTHPARTNERS INC 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 411693838 HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(4) N/A 0 GROUP HEALTH PLAN INC 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 410797853 STAFF MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(3) 170(B)(1)(A)(III) HEALTHPARTNERS INC 0 HPI-RAMSEY 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 411793333 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 0 RH WISCONSIN INC 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 202287016 CORPORATE PLANNING AND OVERSIGHT WI 501(C)(3) 509(A)(3) TYPE I HPI-RAMSEY 0 HEALTHPARTNERS INSTITUTE 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 411670163 HEALTHCARE EDUCATION AND RESEARCH MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 0 CAPITOL VIEW TRANSITIONAL CARE CENTER 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 412011453 TRANSITIONAL CARE SERVICES, STEP DOWN FROM INPATIENT HOSPITAL MN 501(C)(3) 170(B)(1)(A)(III) HPI - RAMSEY 0 REGIONS HOSPITAL 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 410956618 HOSPITAL MN 501(C)(3) 170(B)(1)(A)(III) HPI - RAMSEY 0 REGIONS HOSPITAL FOUNDATION 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 411888902 PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH MN 501(C)(3) 170(B)(1)(A)(VI) HPI - RAMSEY 0 RHSC INC 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 411891928 HEALTHCARE STAFFING AND INTENSE REHAB SERVICES MN 501(C)(3) 509(A)(3) TYPE II HEALTHPARTNERS INC 0 HUDSON HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 390804125 HOSPITAL WI 501(C)(3) 170(B)(1)(A)(III) RH-WISCONSIN INC 0 HUDSON HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 391279567 PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH WI 501(C)(3) 170(B)(1)(A)(VI) HUDSON HOSPITAL INC 0 LAKEVIEW HEALTH FOUNDATION 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 411386635 PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH MN 501(C)(3) 170(B)(1)(A)(VI) LAKEVIEW HEALTH 0 LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 410811697 HOSPITAL MN 501(C)(3) 170(B)(1)(A)(III) LAKEVIEW HEALTH 0 STILLWATER MEDICAL GROUP 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 830379473 CLINIC STAFF AND FACILITIES MN 501(C)(3) 509(A)(3) TYPE I LAKEVIEW HEALTH 0 LAKEVIEW HEALTH 8170 33RD AVE S PO BOX 1309 MINNEAPOLIS MN 554401309 300221189 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE II HPI - 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