2024-11-13T12:23:02-06:00 2023-12-31 135565207 KPMG LLP 350 N 5TH STREET SUITE 600 MINNEAPOLIS MN 55401 990 2023-01-01 411839619 OLIVIA HOSPITAL & CLINIC FOUNDATION OLIV 9529935603 8170 33RD AVE SOUTH BLOOMINGTON MN 55425 NATHAN PULSCHER PRESIDENT 3205233575 2024-11-13 1 0 HOLLY K MOEN P01800653 6123055000 2023 2024-10-15 13:58:12Z NATHAN PULSCHER 100 HEALTHY WAY OLIVIA MN 56277 230683 0 X WWW.HEALTHPARTNERS.COM/FOUNDATIONS/OLIVIA X 1997 MN TO SUPPORT HEALTHPARTNERS RC-OLIVIA HOSPITAL & CLINIC IN DELIVERING ACCESSIBLE AND QUALITY HEALTH CARE. 10 8 0 8 0 0 459313 169746 0 0 22004 56627 5383 -2116 486700 224257 158930 244762 0 0 0 0 0 0 0 10077 21977 169007 266739 317693 -42482 2474261 2640879 9623 80740 2464638 2560139 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 252276 244762 SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS 252276 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 10 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 BECCA THIESSE DIRECTOR 1.00 0.00 X 0 0 0 JENNIFER MACIK DIRECTOR & CHAIR 1.00 56.00 X X 0 192512 44012 SARA BENSON DIRECTOR & TREASURER 1.00 0.00 X X 0 0 0 SHANE WOHLMAN 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 49.00 X 0 458049 67579 HEATHER JESERITZ DIRECTOR & SECRETARY 1.00 0.00 X X 0 0 0 NATHAN PULSCHER DIRECTOR & PRESIDENT 1.00 0.00 X X 0 313799 66188 TOM KROES DIRECTOR 1.00 0.00 X 0 0 0 NANCY A ANDERSON CFO 1.00 44.00 X 0 209639 44981 JACKIE EDWARDS DIRECTOR & COMM RELATIONS 1.00 0.00 X 0 97837 35591 NATHAN BLAD FORMER PRESIDENT 1.00 39.00 X 0 302156 51046 0 1573992 309397 0 1 1 0 0 21849 72175 75722 10297 169746 39591 39591 17036 0 17036 17036 17036 4310 21849 6426 -2116 -2116 224257 0 0 54511 236762 236762 8000 8000 14463 14463 6860 6860 MISCELLANEOUS EXPENSE 654 654 266739 252276 14463 0 468750 512882 17354 35114 1988157 2092883 2474261 2640879 9623 80740 9623 80740 X 1737578 1702740 727060 857399 2464638 2560139 2474261 2640879 -42482 137983 0 X 0 1 X 1 0 X X 1 HEALTHPARTNERS RC 844261122 3 1 68063 0 1 68063 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 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 833497 76199 29421 290717 648400 723060 338514 -105122 115302 7653 833497 1030970 56474 38841 113885 289340 723060 1401681 116603 5245 10000 482559 1030970 1162198 279618 421 16524 24032 1401681 1.00000 0 0 0 THRIVENT 1352707 C LINCOLN FINANCIAL GROUP 740176 C 2092883 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, 2023 OR 2022 FOR UNRECOGNIZED TAX BENEFITS. X GOLF EVENT 18625 16865 1760 4013 MEALS FOR GOOD 7534 4984 2550 2413 26159 21849 4310 6426 6426 -2116 0 HEALTHPARTNERS RC DBA OLIVIA HOSPITAL AND CLINIC 8170 33RD AVE S BLOOMINGTON MN 55369 844261122 501C3 68063 0 PROGRAM SUPPORT KANDIYOHI COUNTY AREA FAMILY YMCA 1000 LAKELAND DRIVE SE WILMAR MN 56201 411908049 501C3 74536 0 PROGRAM SUPPORT OLIVIA AMBULANCE SERVICE INC PO BOX 97 OLIVIA MN 56277 410823526 501C3 25000 0 PROGRAM SUPPORT UNITED COMMUNITY ACTION PARTNERSHIP 1400 S SARATOGA ST MARSHALL MN 56258 410904860 501C3 20000 0 PROGRAM SUPPORT 4 SCHOLARSHIPS 4 8000 PART I, LINE 2: OLIVIA HOSPITAL & CLINIC FOUNDATION'S (THE FOUNDATION) MANAGEMENT STAFF REVIEW THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH THE FOUNDATION'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO THE FOUNDATION'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 333972 0 104314 0 19763 0 24750 0 42829 0 525628 0 0 NATHAN PULSCHER DIRECTOR & PRESIDENT 0 261957 0 45121 0 6721 0 28036 0 38152 0 379987 0 0 NATHAN BLAD FORMER PRESIDENT 0 217354 0 83562 0 1240 0 27462 0 23584 0 353202 0 0 NANCY A ANDERSON CFO 0 172345 0 37294 0 0 0 9528 0 35453 0 254620 0 0 JENNIFER MACIK DIRECTOR & CHAIR 0 159365 0 33147 0 0 0 8807 0 35205 0 236524 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 OR BY PARK NICOLLET HEALTH SERVICES OR HEALTHPARTNERS RC, 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 PLAN, INC (GHI), PARK NICOLLET HEALTH SERVICES (PNHS) OR BY HEALTHPARTNERS RC (HPRC), RELATED ORGANIZATIONS. COMPENSATION REPORTED IN FORM 990, PART VII INCLUDES ANY COMPENSATION DERIVED FROM GHI, PNHS OR HPRC LEADERSHIP 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 LEADERSHIP 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 (THE 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". HEALTHPARTNERS IS A NONPROFIT ORGANIZATION WITH A MISSION OF IMPROVING HEALTH AND WELL-BEING IN PARTNERSHIP WITH ITS PATIENTS, MEMBERS AND COMMUNITY. 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 PARK NICOLLET HEALTH SERVICES WHICH IN TURN IS THE SOLE CORPORATE MEMBER OF HEALTHPARTNERS RC (HPRC), BOTH OF WHICH ARE MINNESOTA NON-PROFIT CORPORATIONS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3). HPPC IS THE PARENT ENTITY OF OLIVIA THE FOUNDATION. THE FOUNDATION IS RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX AS A SUPPORTING ORGANIZATION TO HPRC. ALL OF THE FOUNDATION'S ACTIVITIES EITHER DIRECTLY SUPPORT HPRC OR ARE IN FURTHERANCE OF ITS MISSION. HEALTH PROFESSIONAL EDUCATION: IN 2023, THE FOUNDATION AWARDED 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. THE SCHOLARSHIPS TOTALED $8,000 IN 2023. THE FOUNDATION FUNDRAISING AND GRANTING: THE FOUNDATION RECEIVED A TOTAL OF CONTRIBUTIONS AND IN-KIND CONTRIBUTIONS OF $169,746 IN 2023. THESE FUNDS WERE DIRECTED TO SEVERAL PROGRAMS IN OUR COMMUNITY, AS WELL AS WELL AS INTERNAL PROGRAMS, GREATEST NEED ALLOCATIONS AND CAPITAL REQUESTS WITHIN HPRC. THE FUNDING: SUPPORTED OUR PATIENTS WITH SHORT-TERM NEEDS THAT COULD PREVENT THEM FROM GETTING NECESSARY CARE THROUGH THE FOUNDATION GOOD SAMARITAN FUND. TOTAL FUNDS SUPPORTED $1,221.93. SUPPORTED HPRC HOSPICE PROGRAMS TO HELP SUPPORT MEDICATION, TRANSPORTATION, AND MANY SOOTHING THERAPIES. IN ADDITION, SUPPORTING SPIRITUAL CARE, SOCIAL SERVICES, GRIEF COUNSELING AND MORE FOR THE PATIENTS AND THEIR FAMILIES. TOTAL FUNDS SUPPORTED $39,522.32. 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, BACK THE PACK PROGRAM, REVOLUTION WELLNESS YMCA, MENTAL HEALTH, DENTAL OUTREACH CLINICS AND MORE. TOTAL FUNDS SUPPORTED $28,920.14. SUPPORTED HPRC COLLEAGUES BY PROVIDING AN ONSITE SIMULATION TRAINING. TOTAL FUNDS SUPPORTED $3,358.47. SUPPORTED A PURCHASE OF A CENTRIFUGE (LABORATORY EQUIPMENT) AND A BLOOD BANK REFRIGERATOR FOR HPRC. TOTAL FUNDS SUPPORTED $11,368.62. SUPPORTED THE OLIVIA AMBULANCE SERVICE WITH A CONTRIBUTION OF $25,000 TOWARDS THEIR NEW FACILITY, WHICH IS NOW NEAR THE HPRC CAMPUS. 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 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 (THE FOUNDATION) 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT (THE 990) IS PRESENTED TO THE GOVERNING BODY OF THE FOUNDATION . THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GHI, THE MANAGEMENT TEAM OF HPRC , GHI'S INTERNAL LEGAL DEPARTMENT AND HPRC '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 THE FOUNDATION . THE 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 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 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 HEALTHPARTNERS RC, RELATED ORGANIZATIONS. ANY COMPENSATION IS DETERMINED SOLELY BY THE RELATED ORGANIZATIONS. THEREFORE, PART VI, SECTION B, QUESTION 15 IS NOT APPLICABLE T0 THE 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. 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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