Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
INVITATION HEALTH INSTITUTE
Employer identification number
41-1907276
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
4,102,667
3,795,988
3,038,768
3,652,407
2,532,125
17,121,955
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
1,057,943
1,093,771
1,236,231
834,246
73,846
4,296,037
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
5,160,610
4,889,759
4,274,999
4,486,653
2,605,971
21,417,992
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
21,417,992
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
5,160,610
4,889,759
4,274,999
4,486,653
2,605,971
21,417,992
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
119,700
50,381
-17,006
60,987
-6,245
207,817
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
119,700
50,381
-17,006
60,987
-6,245
207,817
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
5,280,310
4,940,140
4,257,993
4,547,640
2,599,726
21,625,809
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
99.040 %
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
98.910 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
1.000 %
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
1.000 %
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
INVITATION HEALTH INSTITUTE
Employer identification number
41-1907276
Identifier
Return Reference
Explanation
ANY SIGNIFICANT CHANGES IN CONDUCT FOR PROGRAM SERVICES
FORM 990, PAGE 2, PART III, LINE 3
-CHANGES IN PROGRAM SERVICES INVITATION HEALTH INSTITUTE'S SUBCONTRACT WITH EDUCATION DEVELOPMENT CENTER, INC. FOR SERVICES RELATED TO THE CENTER FOR THE APPLICATION OF PREVENTION TECHNOLOGIES (CAPT) PROGRAM ENDED IN OCTOBER, 2011.
ALL OTHER ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
PROGRAM EVALUATION SERVICES - FEE FOR SERVICE BASIS HEALTH PROMOTION RESOURCES - MATERIALS AND TRAINING - FEE FOR SERVICES BASIS
SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS
FORM 990, PAGE 6, PART VI, LINE 4
EFFECTIVE NOVEMBER 18, 2011, THE SOLE MEMBERSHIP IN MINNESOTA INSTITUTE OF PUBLIC HEALTH (MIPH) WAS TRANSFERRED BY BCBSM, INC. TO INVITATION HEALTH & WELLNESS, INC. (IHW), A WHOLLY OWNED SUBSIDIARY OF AWARE INTEGRATED, INC., WHO IS ALSO THE PARENT COMPANY OF BCBSM, INC. THE RESTATED BYLAWS OF MIPH, ALSO EFFECTIVE NOVEMBER 18, 2011, PROVIDE THAT THE BOARD SHALL CONSIST OF NO FEWER THAN THREE AND NO MORE THAN NINE PERSONS, AND THAT THE SOLE MEMBER SHALL HAVE THE RIGHT TO ELECT ALL DIRECTORS, AT LEAST TWO OF WHOM SHALL BE COMMUNITY DIRECTORS WHO ARE NOT EMPLOYEES OR OFFICERS OF BCBSM, INC. OR IHW. ON FEBRUARY 27, 2012 THE NAME 'MINNESOTA INSTITUTE OF PUBLIC HEALTH' WAS CHANGED TO 'INVITATION HEALTH INSTITUTE.' THE IRS WAS NOTIFIED OF THIS CHANGE IN WRITING ON MARCH 26, 2012.
CLASSES OF MEMBERS OR STOCKHOLDERS
FORM 990, PAGE 6, PART VI, LINE 6
INVITATION HEALTH AND WELLNESS, INC. IS THE SOLE MEMBER OF THE ORGANIZATION.
ELECTION OF MEMBERS AND THEIR RIGHTS
FORM 990, PAGE 6, PART VI, LINE 7A
INVITATION HEALTH AND WELLNESS, INC. AS THE SOLE MEMBER, ELECTS DIRECTORS OF THE CORPORATION.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
REVIEWED BY THE BOARD OF DIRECTORS.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
ANNUALLY DIRECTORS, OFFICERS AND KEY EMPLOYEES OF INVITATION HEALTH INSTITUTE, ARE REQUIRED TO COMPLETE A DETAILED QUESTIONNAIRE ASKING FOR INFORMATION THAT COULD GIVE RISE TO POTENTIAL CONFLICTS PURSUANT TO THE INVITATION HEALTH INSTITUTE STANDARDS OF CONDUCT FOR THE BOARD AND ITS MEMBERS, THE INVITATION HEALTH INSTITUTE ARTICLES OF INCORPORATION, AND THE BCBSM, INC. COMPLIANCE PROGRAM ADOPTED BY THE INVITATION HEALTH INSTITUTE. ALL THOSE PERSONS ARE ADVISED TO PROVIDE UPDATES WITH RESPECT TO CIRCUMSTANCES THAT COULD GIVE RISE TO POTENTIAL CONFLICTS. INFORMATION IS REVIEWED BY THE BOARD CHAIR, LEGAL COUNSEL AND THE FULL BOARD OF DIRECTORS TO DETERMINE IF CONFLICTS EXIST AND IF ANY SAFEGUARDS NEED TO BE TAKEN WITH RESPECT TO ANY SUCH POTENTIAL CONFLICTS. IF CONFLICTS WERE TO BE FOUND, THE PERSON WOULD RECUSE HIMSELF/HERSELF FROM ANY BOARD DISCUSSIONS AND/OR BOARD ACTIONS IF IT BECAME A BOARD RELATED MATTER AND THE CORPORATION WOULD FOLLOW APPLICABLE LAW FOR MINNESOTA NONPROFIT CORPORATIONS IN DEALING WITH THE SITUATION.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
PROTOCOL OF BCBSM, INC. VIA MARKETPLACE
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
PROTOCOL OF BLUE CROSS BLUE SHIELD MN VIA MARKETPLACE
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
FINANCIAL INFORMATION ABOUT THE ORGANIZATION IS AVAILABLE TO THE GENERAL PUBLIC THROUGH THE WEBSITE MAINTAINED BY THE MINNESOTA ATTORNEY GENERAL. THE GENERAL CONFLICT OF INTEREST POLICY WITHIN THE CODE OF CONDUCT IS AVAILABLE ON THE BCBSM, INC. WEBSITE. COPIES OF THE ORGANIZATION'S ARTICLES OF INCORPORATION CAN BE ORDERED FROM THE MN SECRETARTY OF STATE'S WEBSITE. THE ORGANIZATION'S BYLAWS ARE NOT MADE AVAILABLE TO THE PUBLIC.
RELATED ORGANIZATIONS
FORM 990, PAGE 7, PART VII
AVERAGE HOURS WORKED FOR RELATED ORGANIZATION: PAMELA SEDMAK 40 HOURS JAMES EPPEL 40 HOURS SCOTT LYNCH 40 HOURS KATHY MOCK 40 HOURS MARSHA SHOTLEY 40 HOURS GREG GILMET 40 HOURS KATHY DUNMIRE 40 HOURS LAURA WOODWARD 40 HOURS DENISE BERGEVIN 40 HOURS DIANE POZDOLSKI 40 HOURS ZACHARY MEYER 22 HOURS NANCY REED 40 HOURS
OTHER CHANGES IN NET ASSETS EXPLANATION
FORM 990, PART XI, LINE 5
UNREALIZED GAIN/(LOSSES) ON INVESTMENTS (50,669)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.