Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) .... | 1,132,228 | 1,118,030 | 1,084,049 | 1,358,047 | 811,405 | 5,503,759 |
| 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 | 1,132,228 | 1,118,030 | 1,084,049 | 1,358,047 | 811,405 | 5,503,759 |
| 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).. | 210,870 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 5,292,889 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,132,228 | 1,118,030 | 1,084,049 | 1,358,047 | 811,405 | 5,503,759 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 73,438 | 80,631 | 89,396 | 110,171 | 105,904 | 459,540 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | 33,000 | 1,061 | 927 | 1,738 | 1,464 | 38,190 |
| 11 | Total support. Add lines 7 through 10. | 6,001,489 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2015 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | MISCELLANEOUS REVENUE SPECIAL FUNDRAISING CAMPAIGNS |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 2 | SIGNIFICANT ACTIVITIES WERE SPENT FINALIZING THE INTEGRATION WITH HENNEPIN COUNTY MEDICAL CENTER (HCMC). HENNEPIN HEALTHCARE SYSTEM, INC., THE PUBLIC SUBSIDIARY CORPORATION THAT OPERATES HCMC, AND MVNA SIGNED AN AGREEMENT TO INTEGRATE THEIR OPERATIONS, WHICH BECAME EFFECTIVE JANUARY 1, 2015, WITH FULL INTEGRATION EFFECTIVE JANUARY 1, 2016. MVNA WILL SERVE AS HCMC'S COMMUNITY CARE DIVISION. MVNA AND HCMC CONTINUE TO HAVE INDIVIDUAL NON-PROFIT 501 (C) (3) STATUS UNTIL THE INTEGRATION IS COMPLETED. MVNA AND HCMC SHARE SIMILAR MISSIONS AND VISION AND THIS INTEGRATION WILL PROVIDE A STRONG SYNERGY AND OPPORTUNITY FOR PROGRAM EXPANSION. |
| FORM 990, PART III, LINE 3 | THERE WERE SEVERAL PROGRAM CHANGES DURING THE YEAR. INTERPRETING SERVICES EXPANDED WITH THE NEW OPTION OF VIDEO INTERPRETING THROUGH THE USE OF IPADS DURING HOME VISITS. PROVIDING RESOURCES AND INTEGRATING SERVICES TO THE MENTALLY ILL (PRISM), A TREATMENT PROGRAM THAT PROVIDES REHABILITATION AND COORDINATES MEDICAL. SOCIAL SERVICE, CORRECTIONS, AND COMMUNITY-BASED SERVICES, HAD A CONTRACT WITH MVNA TO PROVIDE NURSES TO COORDINATE CARE WITH THE MENTAL HEALTH COURT PSYCHIATRIST AND DISPENSING OF PSYCHIATRIC AND OTHER MEDICATIONS TO CLIENTS. WORK WAS NOT CORE TO MVNA'S MISSION, AND PRISM LEADERS DETERMINED A NEW PARTNER WITH ROBUST EXPERIENCE IN PROVIDING MEDICATION SUPPORT IN THIS TYPE OF A SETTING, AND THE CONTRACT WITH MVNA WAS NOT RENEWED BY MUTUAL AGREEMENT. THE ELIMINATING HEALTH DISPARITIES INITIATIVE (EHDI) PROVIDED CASE MANAGEMENT AND GROUPS FOR WOMEN BEFORE, DURING AND BETWEEN PREGNANCIES. THE GRANT ENDED FOR THIS PROGRAM AND IT WAS DETERMINED THAT THE HCMC AQUI PARA TI PROGRAM FULFILLED NEEDS IN THIS AREA FOR HISPANIC WOMEN. THE CHILD CARE HEALTH CONSULTATION PROGRAM THAT ASSISTED CHILD CARE PROVIDERS IN MEETING AND EXCEEDING STATE LICENSING REQUIREMENTS CLOSED AS WAS NO LONGER A DEMONSTRATED NEED IN THE COMMUNITY DUE TO OTHER COMMUNITY PROVIDERS NOW BEING AVAILABLE. ADVANCED ILLNESS MANAGEMENT (AIM), A PALLIATIVE CARE PROGRAM, TWO-YEAR GRANT FUNDED PILOT ENDED. MVNA WAS SELECTED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES TO BE A TEST SITE FOR A NEW PILOT CALLED ILLNESS MANAGEMENT THROUGH PALLIATIVE AND CURATIVE THERAPIES (IMPACT), THAT ALLOWS CLIENTS TO BEGIN RECEIVING PALLIATIVE SERVICES WHILE MAINTAINING THEIR CLINICAL CURATIVE SERVICES. THIS PROGRAM REPLACES AIM AND WILL START JANUARY 1, 2016. |
| FORM 990, PART VI, SECTION A, LINE 4 | IN THE PAST YEAR, MVNA INTEGRATED WITH THE HENNEPIN HEALTHCARE SYSTEM, INC. (HHS). OTHER SIGNIFICANT CHANGES MADE TO THE GOVERNING DOCUMENTS ARE INCLUDED IN FORM 990, PART VI, LINES 6-7B. |
| FORM 990, PART VI, SECTION A, LINE 6 | HENNEPIN HEALTH SYSTEM, INC., SHALL BE THE SOLE VOTING MEMBER OF THIS CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | IN ADDITION TO THE POWERS SET FORTH BELOW IN PART VI, LINE 7B, THE MEMBER SHALL ELECT THE BOARD OF DIRECTORS AND REMOVE DIRECTORS AT ANY TIME, WITH OR WITHOUT CAUSE. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER OF THE CORPORATION SHALL BE HENNEPIN HEALTHCARE SYSTEM, INC., A MINNESOTA PUBLIC, NONPROFIT CORPORATION (THE "MEMBER"). THE CORPORATION MAY NOT TAKE ANY OF THE FOLLOWING ACTIONS WITHOUT RECEIVING MEMBER APPROVAL IN ACCORDANCE WITH PROCEDURES ESTABLISHED BY THE MEMBER'S STATUTORY CHARTER AND BYLAWS: (A) INCUR LONG-TERM DEBT; (B) MORTGAGE OR ENCUMBER ANY ASSETS OF THE CORPORATION; (C) SELL, LEASE OR OTHERWISE DISPOSE OF ALL OR SUBSTANTIALLY ALL OF ITS PROPERTY AND ASSETS; (D) ADD OR DELETE MAJOR SERVICES; (E) VOLUNTARILY DISSOLVE; (F) PURCHASE OR ACQUIRE SUBSTANTIALLY ALL OF THE ASSETS OF ANOTHER ENTITY; (G) MERGE OR CONSOLIDATE WITH ANY DOMESTIC OR FOREIGN ORGANIZATION OR LEASE OR SELL MORE THAN FIFTY PERCENT (50%) OF THE CORPORATION'S PROPERTY AND ASSETS TO ANY ENTITY IN ANY ONE TRANSACTION OR SERIES OF RELATED TRANSACTIONS; (H) PREPAY ANY INDEBTEDNESS PRIOR TO THE TIME FOR PAYMENT THEREOF AS PROVIDED IN THE CONTRACT EVIDENCING OR CREATING SUCH INDEBTEDNESS; (I) LOAN MONEY OR OTHER ASSETS TO OR GUARANTEE THE OBLIGATIONS OF ANY PERSON OR ENTITY; (J) APPROVE ANNUAL OPERATING BUDGETS, ANNUAL OR LONG-RANGE CAPITAL BUDGETS, AND NON-BUDGETED CONTRACTS ENTERED INTO OVER $50,000; (K) APPOINT A CERTIFIED PUBLIC ACCOUNTANT TO AUDIT THE BOOKS AND RECORDS OF ACCOUNT OF THE CORPORATION; AND (L) AMEND THE ARTICLES OF INCORPORATION OR THESE BYLAWS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CFO DISTRIBUTES AN ELECTRONIC DRAFT OF THE FORM 990 TO OFFICERS, BOARD MEMBERS AND MANAGEMENT IN ADVANCE OF THE FILING DEADLINE. RECIPIENTS ARE ENCOURAGED TO ASK QUESTIONS, SEEK CLARIFICATION, OR OFFER SUGGESTIONS IF SOMETHING NEEDS TO BE CHANGED. ONCE MANAGEMENT HAS SUCCESSFULLY RESPSONDED TO QUESTIONS, THE FORM 990 IS FILED BY MVNA'S AUDITORS ON BEHALF OF MVNA. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY COVERS OFFICERS, DIRECTORS AND KEY EMPLOYEES. THE POLICY IS REVIEWED AND SIGNED ANNUALLY BY THE COVERED PERSONS. THE FORMS ARE REVIEWED BY THE CEO. IF A BOARD MEMBER IS AWARE OF A CONFLICT, HE OR SHE IS EXPECTED TO INFORM THE ORGANIZATION AND REFRAIN FROM DISCUSSING AND VOTING ON MATTERS AFFECTED BY THE CONFLICT. |
| FORM 990, PART VI, SECTION C, LINE 18 | THE FORM 1023 IS AVAILABLE UPON REQUEST. THE FORM 990 IS AVAILABLE UPON REQUEST, ONLINE AT MVNA'S WEBSITE, AND ONLINE AT WWW.GUIDESTAR.ORG. |
| FORM 990, PART VI, SECTION C, LINE 19 | MVNA'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE ALSO AVAILABLE ON MVNA'S WEBSITE. |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,083,240. MANAGEMENT AND GENERAL EXPENSES 990,855. FUNDRAISING EXPENSES 2,813. TOTAL EXPENSES 2,076,908. |
| FORM 990, PART XI, LINE 9: | NET ADJUSTMENT DUE TO MERGER WITH HHS -11,371,141. |
| Software ID: | |
| Software Version: |