2024-11-13T18:43:02-06:00 2023-12-31 135565207 KPMG LLP 350 N 5TH STREET SUITE 600 MINNEAPOLIS MN 55401 990 2023-01-01 300221189 LAKEVIEW HEALTH LAKE 9528836584 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 ALITA R RISINGER CFO 9528836584 2024-11-13 1 0 HOLLY K MOEN P01800653 6123055000 2023 2024-10-15 13:58:12Z ALITA R RISINGER 8170 33RD AVENUE SOUTH PO BOX 1309 MINNEAPOLIS MN 554401309 4397078 0 X WWW.LAKEVIEW.ORG X 2003 MN TO MEET THE HEALTHCARE NEEDS OF THE SERVICE AREA POPULATION. 13 8 0 8 0 0 0 0 0 0 2543305 4397078 0 0 2543305 4397078 0 0 0 0 0 0 0 0 0 0 59968 0 59968 2543305 4337110 125980141 141838923 9561 1080 125970580 141837843 X TO SUPPORT ITS SUPPORTED ORGANIZATIONS, LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION AND STILLWATER MEDICAL GROUP, IN THEIR DELIVERY OF INTEGRATED PRIMARY AND HOSPITAL CARE TO MEET THE HEALTHCARE NEEDS OF THE SERVICE AREA POPULATION. 0 0 59968 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS 59968 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 8 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 X BRETT C HAAKE MD DIRECTOR 0.50 54.50 X 0 730568 113054 MICHAEL FUNK DIRECTOR 0.58 0.00 X 0 0 0 ELIZABETH BRADSHAW DIRECTOR 0.58 0.00 X 0 0 0 JASON HOWARD DIRECTOR 0.58 0.00 X 0 0 0 JOHN UPPGREN DIRECTOR 0.58 0.00 X 0 0 0 BRIAN L CRESS MD DIRECTOR 0.50 44.50 X 0 347743 40815 KHU THAOR DIRECTOR 0.58 0.00 X 0 0 0 ALITA R RISINGER DIRECTOR 0.50 49.50 X 0 574234 112052 ANNIE JACOBSEN MD DIRECTOR 0.50 49.50 X 0 569641 69516 PAHOUA HOFFMAN DIRECTOR 0.50 49.50 X 0 427857 105197 BRANDI L LUNNEBORG DIRECTOR & PRESIDENT 0.50 59.50 X X 0 671461 139951 SHARON TOLVA DIRECTOR & TREASURER 0.58 0.00 X X 0 0 0 SUE HEDLUND DIRECTOR & VICE CHAIR 0.58 0.00 X X 0 0 0 MATTHEW A RICHIE DIRECTOR & VP SMG 0.50 44.50 X X 0 403091 47575 PATRICK T COURNEYA MD DIRECTOR (JAN-APR) 0.50 54.50 X 0 494297 76938 STEVEN C HOUSH DIRECTOR (JAN-APR) 0.50 49.50 X 0 317969 45951 KEVIN J BJORK MD DIRECTOR (JAN-AUG) 0.50 15.00 X 0 274610 42519 PHAEDRA COFIELD DIRECTOR (JAN-NOV) 0.58 0.00 X 0 0 0 NICHOLAS MEYER MD DIRECTOR (JAN-OCT) 0.58 0.00 X 0 0 0 MIKE ANDERSON DIRECTOR AND CHAIR 0.58 0.00 X X 0 0 0 DOUGLAS E JOHNSON CFO, LHS 4.00 51.00 X 0 603783 44121 NANCY L EVERT SEC. & GENERAL COUNSEL 0.50 54.50 X 0 811272 238674 EMILIENNE ANDERSON VP NURSING SERVICES & CNO 0.50 39.50 X 0 253764 25767 THOMAS S ANDERSON MD VPMA 0.50 44.50 X 0 479739 67935 THEODORE WEGLEITNER FORMER PRESIDENT 0.00 0.00 X 0 269652 13842 ANDREW E DORWART MD FORMER SMG PRESIDENT 0.00 0.00 X 0 282322 61384 NATHAN S PULSCHER FORMER VP ANCILLARY SERVICES 0.00 50.00 X 0 313799 66188 0 7825802 1311479 0 1 1 0 0 4397078 4397078 4397078 0 0 4397078 X 59968 59968 59968 59968 0 0 2395118 2324739 59874 72714 20873 28513 123504276 139412957 125980141 141838923 9561 1080 9561 1080 X 125970580 141837843 125970580 141837843 125980141 141838923 4337110 11530153 0 X 0 1 X 1 0 X X 2 LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC 410811697 3 1 0 0 STILLWATER MEDICAL GROUP 830379473 10 1 0 0 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 PART I, LINE 12G, COLUMNS (V) & (VI): MONETARY SUPPORT NO DIRECT MONETARY SUPPORT IS INDICATED FROM LAKEVIEW HEALTH (LH) TO ITS SUPPORTED ORGANIZATIONS: HOWEVER, LH PROVIDES CORPORATE PLANNING AND OVERSIGHT, WHICH INCLUDES LH'S INITIALLY INCURRING ADMINISTRATIVE EXPENSES THAT ARE ALLOCATED TO ITS SUPPORTED ORGANIZATIONS. LH'S RELATIONSHIP WITH ITS SUPPORTED ORGANIZATIONS IS DESCRIBED IN SCHEDULE O "FORM 990, PART III, LINE 4A, EXEMPT PURPOSE AND ACHIEVEMENTS." 990, SCH A, PART IV, SECT C, LINE 1: BOARD MEMBERS LH IS A TYPE II SUPPORTING ORGANIZATION TO LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION (HOSPITAL) AND STILLWATER MEDICAL GROUP, BECAUSE THERE IS SUBSTANTIAL OVERLAP OF DIRECTORS AND OFFICERS AMONG THE ORGANIZATIONS. ALL OF THE DIRECTORS ON THE HOSPITAL BOARD ARE ALSO DIRECTORS ON THE LH BOARD. FURTHER, THE SAME PERSONS SERVE AS THE BOARDS OF DIRECTORS OF THE SUPPORTED ORGANIZATIONS - THE HOSPITAL AND STILLWATER MEDICAL GROUP - AND OF LH, THE SUPPORTING ORGANIZATION. THE SAME PERSONS ARE IN THE POSITION OF CHIEF FINANCIAL OFFICER AND CHIEF MEDICAL OFFICER ACROSS ALL THREE ENTITIES. PART I, LINE 12G, COLUMN (III) - TYPE OF ORGANIZATION SUPPORTED ORGANIZATION INFORMATION STILLWATER MEDICAL GROUP IS AN ORGANIZATION TYPE 12. DUE TO SOFTWARE LIMITATIONS, THAT BOX IS TYPE 10 INSTEAD OF TYPE 12. PART IV SECTION A, LINE 2 STILLWATER MEDICAL GROUP, ONE OF LH'S SUPPORTED ORGANIZATIONS IS ALSO A SUPPORTING ORGANIZATION. SMG IS NOT A 509(A)(1) OR (A)(2) ENTITY - INSTEAD A 509(A)(3). 0 0 0 0 0 0 0 0 1 0 0 PART II-B, LINE 1: LH PURCHASES CERTAIN CORPORATE AND EMPLOYEE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES. 0 X PART X, LINE 2: LAKEVIEW HEALTH 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, 2023 OR 2022 FOR UNRECOGNIZED TAX BENEFITS. 0 1 0 0 0 0 0 0 0 NANCY L EVERT SEC. & GENERAL COUNSEL 0 503395 0 251362 0 56515 0 206367 0 32307 0 1049946 0 36575 BRETT C HAAKE MD DIRECTOR 0 541746 0 164908 0 23914 0 66326 0 46728 0 843622 0 0 BRANDI L LUNNEBORG DIRECTOR & PRESIDENT 0 414094 0 212500 0 44867 0 94716 0 45235 0 811412 0 2556 ALITA R RISINGER DIRECTOR 0 452971 0 40000 0 81263 0 72026 0 40026 0 686286 0 0 DOUGLAS E JOHNSON CFO, LHS 0 386739 0 106273 0 110771 0 6600 0 37521 0 647904 0 0 ANNIE JACOBSEN MD DIRECTOR 0 378503 0 0 0 191138 0 24750 0 44766 0 639157 0 0 PATRICK T COURNEYA MD DIRECTOR (JAN-APR) 0 220858 0 236391 0 37048 0 39914 0 37024 0 571235 0 0 THOMAS S ANDERSON MD VPMA 0 379108 0 22500 0 78131 0 24750 0 43185 0 547674 0 0 PAHOUA HOFFMAN DIRECTOR 0 298112 0 123833 0 5912 0 62902 0 42295 0 533054 0 0 MATTHEW A RICHIE DIRECTOR & VP SMG 0 309093 0 0 0 93998 0 15870 0 31705 0 450666 0 0 BRIAN L CRESS MD DIRECTOR 0 257279 0 0 0 90464 0 0 0 40815 0 388558 0 0 NATHAN S PULSCHER FORMER VP ANCILLARY SERVICES 0 261957 0 45121 0 6721 0 28036 0 38152 0 379987 0 0 STEVEN C HOUSH DIRECTOR (JAN-APR) 0 195879 0 111847 0 10243 0 17247 0 28704 0 363920 0 0 ANDREW E DORWART MD FORMER SMG PRESIDENT 0 205223 0 0 0 77099 0 21900 0 39484 0 343706 0 0 KEVIN J BJORK MD DIRECTOR (JAN-AUG) 0 138805 0 0 0 135805 0 20689 0 21830 0 317129 0 0 THEODORE WEGLEITNER FORMER PRESIDENT 0 0 0 0 0 269652 0 0 0 13842 0 283494 0 269652 EMILIENNE ANDERSON VP NURSING SERVICES & CNO 0 169688 0 41600 0 42476 0 11115 0 14652 0 279531 0 0 PART I, LINE 3 LH HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. LH'S PRESIDENT AND ITS OFFICERS AND KEY EMPLOYEES ARE PAID BY GROUP HEALTH PLAN, INC., LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC., AND STILLWATER MEDICAL GROUP, RELATED ORGANIZATIONS. ANY COMPENSATION DISCLOSED IS PAID AND DETERMINED SOLELY BY THE RELATED ORGANIZATIONS. PART I, LINE 4B DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTORS AND OFFICERS: NANCY L. EVERT $ 54,148 BRANDI L. LUNNEBORG $23,255 ALITA R. RISINGER $34,771 PAHOUA HOFFMAN $30,366 990, SCH J, PART II: PRIOR REPORTED COMPENSATION COLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION, FOR THE FOLLOWING DIRECTORS AND OFFICERS: NANCY L. EVERT $ 36,575 BRANDI L. LUNNEBORG $ 2,556 THEODORE WEGLEITNER $269,652 ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, FOR THESE PARTICIPANTS OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S. 990, PART III, LINE 4A: EXEMPT PURPOSE AND ACHIEVEMENTS I. CORPORATE STRUCTURE, PURPOSE, GOVERNANCE LAKEVIEW HEALTH (LH) 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 2,000 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 HPI-RAMSEY, A MINNESOTA NON-PROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). IN TURN, HPI-RAMSEY IS THE SOLE CORPORATE MEMBER OF LH AND ITS SISTER ORGANIZATIONS, REGIONS HOSPITAL (REGIONS), REGIONS HOSPITAL FOUNDATION, RH-WISCONSIN, INC., AND CAPITOL VIEW TRANSITIONAL CARE CENTER, ALL OF WHICH ARE NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). LH IS THE SOLE CORPORATE MEMBER OF LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC. (HOSPITAL), LAKEVIEW HEALTH FOUNDATION (FOUNDATION) AND STILLWATER MEDICAL GROUP. ALL THREE ENTITIES ARE MINNESOTA 501(C) (3) TAX EXEMPT ORGANIZATIONS. LH IS A SUPPORTING ORGANIZATION TO THE HOSPITAL, AND TO SMG. THE BOARDS OF DIRECTORS OF LH AND ITS SUPPORTED ORGANIZATIONS ARE COMPRISED OF THE SAME PERSONS. THE POSITIONS OF PRESIDENT AND CHIEF FINANCIAL OFFICER FOR LH ARE FILLED BY THE SAME PERSONS. II. PROGRAM SERVICE ACCOMPLISHMENTS SEE THE 990 FILINGS FOR EACH OF LH'S SUPPORTED ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER IS HPI-RAMSEY. FORM 990, PART VI, SECTION A, LINE 7A HPI-RAMSEY HAS THE POWER TO APPOINT THREE DIRECTORS TO THE LH BOARD OF DIRECTORS. HPI-RAMSEY ALSO APPOINTS THE OTHER MEMBERS OF THE LAKEVIEW HEALTH BOARD FROM NOMINEES SUBMITTED BY THE LAKEVIEW HEALTH BOARD OF DIRECTORS. HPI-RAMSEY CAN REMOVE SUCH OTHER MEMBERS OF THE LAKEVIEW HEALTH BOARD ONLY UPON HIS OR HER CONVICTION OF A FELONY OR TO ASSURE ONGOING COMPLIANCE WITH APPLICABLE LAW. FORM 990, PART VI, SECTION A, LINE 7B HPI-RAMSEY HAS THE POWER TO APPROVE THE FOLLOWING ACTIONS OF THE LAKEVIEW HEALTH BOARD OF DIRECTORS: - CHANGE IN MISSION, INCLUDING CONSOLIDATION, MERGER OR SALE OF SUBSTANTIALLY ALL ASSETS - AMENDMENT TO ARTICLES OF INCORPORATION OR BYLAWS - ISSUANCE OF DEBT THAT OBLIGATES THE MEMBER OR MEMBER AFFILIATE, OR, THAT IS NOT IN THE APPROVED BUDGET - ANNUAL CAPITAL AND OPERATING BUDGETS - LONG RANGE STRATEGIC PLANS - SIGNIFICANT AFFILIATIONS AND JOINT VENTURES FORM 990, PART VI, SECTION B, LINE 11B LH'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF LAKEVIEW HEALTH. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF LH, GHI'S INTERNAL LEGAL DEPARTMENT AND LH'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 LH. LH 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 TO THE FULL BOARD OF DIRECTORS IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT THE MEETING. THIS PROCESS IS DOCUMENTED IN THE WRITTEN MEETING MINUTES. FORM 990, PART VI, SECTION B, LINE 12C THE LH 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 GENERAL COUNSEL 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. IF A DISCLOSED CONFLICT OF INTEREST IMPACTS AN AGENDA ITEM OR DECISION, THE COVERED PERSON WOULD BE EXCLUDED FROM VOTING AND MAY BE EXCLUDED FROM RECEIVING INFORMATION AND/OR PARTICIPATING IN DELIBERATIONS, DEPENDING ON THE CIRCUMSTANCES. FORM 990, PART VI, SECTION B, LINE 15 LH HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. ALL OFFICERS AND KEY EMPLOYEES ARE PAID BY GROUP HEALTH PLAN, INC., LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC., AND STILLWATER MEDICAL GROUP, RELATED ORGANIZATIONS. ANY COMPENSATION DISCLOSED IS PAID AND DETERMINED SOLELY BY THE RELATED ORGANIZATIONS. THEREFORE, PART VI, SECTION B, QUESTION 15 IS NOT APPLICABLE TO LH. FORM 990, PART VI, SECTION C, LINE 19 LH'S FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM LH OR HEALTHPARTNERS. LH'S ARTICLES OF INCORPORATION ARE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION THROUGH THE MINNESOTA SECRETARY OF STATE'S OFFICE. 990, PART VII, SEC A, COL (B): AVERAGE HOURS PER WEEK AVERAGE WEEKLY HOURS: THE COMPENSATED BOARD MEMBERS AND OFFICERS FREQUENTLY DEVOTE THEIR TIME TO MULTIPLE RELATED ORGANIZATIONS IN A PARTICULAR WEEK. EACH INDIVIDUAL WORKS AN AVERAGE OF APPROXIMATELY 55 HOURS PER WEEK FOR LH AND ITS RELATED ORGANIZATIONS. FORM 990, PART IX, LINE 11G CONSULTANTS: PROGRAM SERVICE EXPENSES 59,968. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 59,968. HEALTHPARTNERS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411693838 HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(4) N/A 0 HPI-RAMSEY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411793333 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS INC 0 GROUP HEALTH PLAN INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410797853 STAFF MODEL HEALTH MAINTENANCE ORGANIZATION MN 501(C)(3) 170(B)(1) (A)(III) HEALTHPARTNERS INC 0 RH WISCONSIN INC 8170 33RD AVE S PO BOX 1309 MPLS 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 MPLS 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 MPLS 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 MPLS 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 MPLS 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 MPLS MN 554401309 411891928 HEALTHCARE STAFFING AND INTENSE REHAB SERVICES MN 501(C)(3) 509(A)(3) TYPE II HPI - RAMSEY 0 HUDSON HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS 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 MPLS 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 MPLS MN 554401309 411386635 PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH MN 501(C)(3) 170(B)(1) (A)(VI) LAKEVIEW HEALTH 1 LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 410811697 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) LAKEVIEW HEALTH 1 STILLWATER MEDICAL GROUP 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 830379473 CLINIC STAFF AND FACILITIES MN 501(C)(3) 509(A)(3) TYPE I LAKEVIEW HEALTH 1 WESTFIELDS HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390808442 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN INC 0 WESTFIELDS HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391770913 PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH WI 501(C)(3) 170(B)(1) (A)(VI) WESTFIELDS HOSPITAL INC 0 PARK NICOLLET HEALTH SERVICES 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 363465840 CORPORATE PLANNING AND OVERSIGHT MN 501(C)(3) 509(A)(2) HEALTHPARTNERS INC 0 PARK NICOLLET FOUNDATION 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 237346465 SUPPORT TO RELATED ENTITIES AND COMMUNITY HEALTH MN 501(C)(3) 170(B)(1) (A)(VI) PARK NICOLLET HEALTH SERVICES 0 PARK NICOLLET METHODIST HOSPITAL 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 410132080 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 0 PARK NICOLLET HEALTH CARE PRODUCTS 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 010638901 DURABLE MEDICAL EQUIPMENT AND OTHER HEALTH CARE RETAIL SALES MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET HEALTH SERVICES 0 PARK NICOLLET CLINIC 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 410834920 CLINIC SERVICES MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 0 PNMC HOLDINGS 6500 EXCELSIOR BLVD ST LOUIS PARK MN 55426 411741792 HEALTHCARE REAL ESTATE MN 501(C)(3) 509(A)(3) TYPE I PARK NICOLLET HEALTH SERVICES 0 AMERY REGIONAL MEDICAL CENTER INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 390908320 HOSPITAL WI 501(C)(3) 170(B)(1) (A)(III) RH-WISCONSIN INC 0 AMERY REGIONAL MEDICAL CENTER FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 391726539 PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH WI 501(C)(3) 170(B)(1) (A)(VI) AMERY REGIONAL MEDICAL CENTER INC 0 HUTCHINSON HEALTH 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 841715908 HOSPITAL MN 501(C)(3) 170(B)(1) (A)(III) PARK NICOLLET HEALTH SERVICES 0 HUTCHINSON HEALTH FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 363317820 PROVIDE SUPPORT TO HOSPITAL MN 501(C)(3) 170(B)(1) (A)(VI) HUTCHINSON HEALTH 0 HEALTHPARTNERS RC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 844261122 HOSPITAL MN 501(C)(3) 170(B)(1)(A)(III) PARK NICOLLET HEALTH SERVICES 0 OLIVIA HOSPITAL & CLINIC FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411839619 PROVIDE SUPPORT TO HOSPITAL MN 501(C)(3) 509(A)(3) TYPE I HEALTHPARTNERS RC 0 HEALTHPARTNERS ADMINISTRATORS INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411629390 THIRD PARTY ADMINISTRATOR MN HEALTHPARTNERS INC C 0 HEALTHPARTNERS ASSOCIATES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 522365151 MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS SERVICES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411683568 MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT MN HEALTHPARTNERS ADMINISTRATORS INC C 0 HEALTHPARTNERS INSURANCE COMPANY 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 411683523 MEDICAL AND DENTAL INSURANCE MN HEALTHPARTNERS ADMINISTRATORS INC C 0 DENTAL SPECIALTIES INC 8170 33RD AVE S PO BOX 1309 MPLS MN 554401309 451297583 PROFESSIONAL DENTAL SERVICES MN HEALTHPARTNERS ADMINISTRATORS INC C 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 0 0