Attach to Form 990 or Form 990-EZ.
See separate instructions.| (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? |
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|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| (1)
HealthEast Woodwinds Hospital |
411592761 | 3 | Yes | 0 | |||||
| Total | 0 | ||||||||
| 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. | ||||||
| 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). | ||||||






| 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 | 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...... | ||||||
| 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. | ||||||
| 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.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 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.). | ||||||




| Facts And Circumstances Test |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
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| Form 990, Part VI, Section A, line 6 | The members of the D & T Facility Management Company are HealthEast Woodwinds Hospital, a 501(c)(3) tax-exempt, non-profit organization and Children's Hospitals & Clinics a 501(c)(3) tax-exempt, non-profit organization. The member organizations elect the members of the Board of Directors. The member organizations do not approve any decisions of the board. Upon dissolution, the organization will distribute all remaining assets to the member organizations in proportion to their ownership percentage provided the member is exempt from Federal income tax under Section 501(c)(3). | |
| Form 990, Part VI, Section A, line 7a | The Board of Directors are elected by the members of the organizaion. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 is sent electronically to all members of the Board of Directors prior to the filing of the Form 990. Members of the Board of Directors will contact the Director of Tax with any questions regarding the Form 990. | |
| Form 990, Part VI, Section B, line 12c | The organization monitors proposed or ongoing transactions for conflicts of interest through the procedures set forth in its Conflicts of Interest Policy (the Policy). The Policy covers the organizaion's Directors, Officers and members of a Committee with Board-delegated powers. A Director, Officer or member of a Committee with Board-delegated powers who has a direct or indirect financial interest, is an interested person under the terms of the Policy. Pursuant to the terms of the Policy, in connection with any actual or possible conflicts of interest, an interested person must disclose the existence of his or her financial interest and must be given the opportunity to disclose all material facts relating to his or her financial interest to the Directors or members of Committees with Board-delegated powers considering the proposed transaction or arrangement. After disclosure of the financial interest and all material facts, and after any discussion with the interested person, the interested person must leave the Board (or Committee) meeting while the financial interest is discussed and voted upon. The remaining Board (or Committee) members shall decide if a conflict of interest exists. An interested person may make a presentation at the Board or Committee meeting regarding the proposed transaction or arrangement, but after such presentation, the interested person shall leave the meeting during the discussion of, and the vote on, the proposed transaction or arrangement that results in the conflict of interest. | |
| This organization does not pay their Board of Directors and therefore does not have a process for determing their compensation. | ||
| Form 990, Part VI, Section C, line 19 | The Articles of Incorporation for this organization are available to the public through the Secretary of State Office. The organization's conflict of interest policy and other governing documents are not made available to the public. The financial statements for this organization are not made available to the public. | |
| Contact Addresses for Officers, Directors, Etc | Form 990, Part VII | Alan Goldbloom, M.D. - 2525 Chicago Avenue South, Minneapolis, MN 55404. |
| Average hours worked per week devoted to related organizations: | Form 990, Part VII, Section A, Column B | Individuals listed on Form 990, Part VII, Section A, Column A worked the following average hours per week for a related organization: Timothy Hanson 40 hours, Stephen Kolar M.D. 40 hours, Thomas Schmitt 40 hours, Alan Goldbloom M.D. 0 hours, Julie Schmidt 40 hours, Michael F. Nass 40 hours. |
| Changes in Net Assets or Fund Balances: | Form 990, Part XI, line 5: | Contribution to Parent Organization -168,630. Minority Interest reclassed to the Fund Balance 200,000. Total to Form 990, Part XI, Line 5: 31,370. |
| Were financial statements audited by independent accountant: | Form 990, Part XI, Line 2 | This organization's financial statements were audited by an independent auditor as part of a consolidated financial statement only. |
| Explanation for number reported in Box 3 of Form 1096: | Form 990, Part V, Line 1a | Cash disbursements are centralized through the parent organization. Therefore the parent organization, HealthEast Care System, makes the payment and files the related Form 1099's and Form 1096 instead of D & T Facility Management Company. |
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