Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 171,581 | 258,615 | 263,091 | 259,513 | 268,684 | 1,221,484 |
| 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 | 171,581 | 258,615 | 263,091 | 259,513 | 268,684 | 1,221,484 |
| 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).. | 403,448 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 818,036 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 171,581 | 258,615 | 263,091 | 259,513 | 268,684 | 1,221,484 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 38,255 | 49,704 | 42,452 | 13,777 | 20,237 | 164,425 |
| 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.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | 1,385,909 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) |
||||
| 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) |
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| 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2020. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| 990, PART III, LINE 4A: PRIMARY EXEMPT PURPOSE AND ACHIEVEMENTS | CORPORATE STRUCTURE, PURPOSE, GOVERNANCE WESTFIELDS HOSPITAL FOUNDATION, INC. (FOUNDATION) IS A WISCONSIN NON-STOCK CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE HEALTHPARTNERS ORGANIZATION. FOUNDED IN 1957, HEALTHPARTNERS IS AN INTEGRATED HEALTH CARE ORGANIZATION, PROVIDING HEALTH CARE SERVICES AND HEALTH PLAN FINANCING AND ADMINISTRATION, AND IS THE LARGEST CONSUMER-GOVERNED NONPROFIT HEALTH CARE ORGANIZATION IN THE COUNTRY. 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 1,800 EMPLOYED PHYSICIANS AND DENTISTS, EIGHT OWNED HOSPITALS WITH OVER 1,000 ACUTE CARE BEDS, OVER 129 PRIMARY AND SPECIALTY CARE MEDICAL FACILITIES AND DENTAL FACILITIES WITH PRACTICES IN MINNESOTA AND WESTERN WISCONSIN SERVING MORE THAN 1.27 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 CONTINUING IN 2020 ARE TOTAL COST OF CARE MEASUREMENTS (A NATIONALLY RECOGNIZED METRIC, ENDORSED BY THE NATIONAL QUALITY FORUM, 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), 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 IS DRIVING CHANGE THAT HELPS OUR MEMBERS AND PATIENTS LIVE HEALTHIER LIVES. 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 CONTINUING IN 2020 ARE TOTAL COST OF CARE MEASUREMENTS (DEVELOPMENT OF A NATIONALLY RECOGNIZED METRIC, ENDORSED BY THE NATIONAL QUALITY FORUM, 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), AND SUSTAINABILITY (ENERGY EFFICIENCY, WASTE REDUCTION, AND RESOURCE MANAGEMENT). 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 REGIONS HOSPITAL, REGIONS HOSPITAL FOUNDATION, CAPITOL VIEW TRANSITIONAL CARE CENTER, STILLWATER HEALTH SYSTEM (LAKEVIEW HEALTH), RAMSEY INTEGRATED HEALTH SERVICES AND RH-WISCONSIN, INC., ALL OF WHICH ARE NON-PROFIT CORPORATIONS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). RH-WISCONSIN, INC. IS THE SOLE CORPORATE MEMBER OF WESTFIELDS HOSPITAL, INC. (HOSPITAL), A WISCONSIN STATE LICENSED 25-BED, LEVEL IV CRITICAL ACCESS HOSPITAL (CAH) AND IS A WISCONSIN NON-STOCK CORPORATION EXEMPT FROM FEDERAL INCOME TAX UNDER IRC 501(C)(3). THE HOSPITAL IS THE SOLE CORPORATE MEMBER OF THE FOUNDATION. THE FOUNDATION WAS INCORPORATED IN 1993 TO OPERATE FOR THE BENEFIT OF THE HOSPITAL. THE HOSPITAL IS LICENSED BY THE STATE OF WISCONSIN DEPARTMENT OF HEALTH AND HUMAN SERVICES TO PROVIDE PRIMARY, ACUTE AND EMERGENCY MEDICAL CARE, AND A VARIETY OF OUTPATIENT SERVICES. THE HOSPITAL IS ALSO RECOGNIZED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES AS A CAH. THE HOSPITAL WORKS TO IMPROVE THE HEALTH OF ITS PATIENTS AND COMMUNITY BY PROVIDING HIGH QUALITY HEALTH CARE WHICH MEETS THE NEEDS OF ALL PEOPLE. THE FOUNDATION SUPPORTS THIS MISSION WITH ITS FOCUS ON RAISING FUNDS TO BENEFIT THE HOSPITAL. CONTRIBUTIONS TO THE FOUNDATION ARE TAX DEDUCTIBLE. THE HOSPITAL HAS RESERVE POWERS RESPECTING CERTAIN MAJOR ACTIONS OF THE FOUNDATION. BENEFIT TO THE COMMUNITY: FUNDRAISERS: IN FEBRUARY OF 2020, THE FOUNDATION HOSTED THE ANNUAL WINEOLOGY EVENT. THE EVENT GROSSED $59,431 AND NETTED $47,861 FOR EDUCATION AND TRAINING. THIS MONEY IS USED TO TRAIN STAFF WITH MODERN AND EVIDENCE BASED EDUCATION AS WELL AS PURCHASE TRAINING EQUIPMENT. IN THE SPRING OF 2020, THE FOUNDATION RAISED $18,025 DURING THE ANNUAL EMPLOYEE GIVING CAMPAIGN. THESE FUNDS WERE DIRECTED TO COMMUNITY HEALTH INITIATIVES, PATIENT CARE NEEDS, EMPLOYEE TO EMPLOYEE ASSISTANCE AND GREATEST NEED. IN AUGUST OF 2020, THE FOUNDATION HELD THE ANNUAL GOLF OUTING. THE EVENT GROSSED $32,150 AND NETTED $26,532. THE FUNDS FROM THIS EVENT WERE DIRECTED TO THE BEHAVIORAL HEALTH PROGRAMS OF THE HOSPITAL AND CLINIC. DONATIONS RECEIVED: IN ADDITION TO THESE FUND RAISING EVENTS, THE FOUNDATION RECEIVED OVER $123,000 IN ANNUAL DONATIONS, MAJOR GIFTS, AND MEMORIALS. THE FOUNDATION ALSO RECEIVED $70,000 IN OUTSIDE GRANTS. HOSPITAL SUPPORTED PROGRAMS: * CAPITAL: THE FOUNDATION SUPPORTED THE HOSPITAL WITH VARIOUS CAPITAL NEEDS, INCLUDING EQUIPMENT AND SPACE. -EQUIPMENT: THE FOUNDATION SUPPORTED THE HOSPITAL WITH VARIOUS EQUIPMENT NEEDS THAT ARE UNMET BY THE ANNUAL BUDGET. TOTAL SUPPORT WAS $18,293. -$70,000 WAS GRANTED FROM THREE FOUNDATIONS FOR REMODELING OF SPACE ON WESTFIELDS CAMPUS. (GRANTING FOUNDATIONS ARE HUGH J. ANDERSEN, HARDENBERGH, AND GREEN BAY PACKERS). * COMMUNITY AWARENESS PROGRAMS (MENTAL HEALTH AND OBESITY): THE FOUNDATION ANNUALLY SUPPORTS TWO COMMUNITY AWARENESS CAMPAIGNS. "MAKE IT OK," A MENTAL HEALTH STIGMA REDUCTION PROGRAM, AND "POWERUP," AN ANTI-OBESITY CAMPAIGN FOR KIDS AND THEIR FAMILIES. THESE PROGRAM PARTNER WITH LOCAL SCHOOLS, CHARITIES, AND COUNTY ORGANIZATIONS TO EDUCATE THE GREATER COMMUNITY ON THESE ISSUES. FOUNDATION SUPPORT TOTALED $9,996. * COVID 19 RESPONSE & RELIEF: THE FOUNDATION SUPPORTED THE HOSPITAL AND CLINIC WITH VARIOUS UNMET NEEDS FOR EQUIPMENT AND PPES, AS WELL AS STAFF MORALE SUPPORT (FOOD, CANDY, CARDS, TOILET PAPER, ETC.). * EMPLOYEE EMERGENCY: THE FOUNDATION SUPPORTED EMPLOYEES WHO WERE STRUGGLING TO MAKE ENDS MEET DUE TO COVID19 LAYOFFS AND FURLOUGHS. TOTAL SUPPORT WAS $5,173. * EMPLOYEE EDUCATION AND TRAINING: THE FOUNDATION SUPPORTED THE HOSPITAL STAFF WITH A VARIETY OF EDUCATION AND TRAINING OPPORTUNITIES. THIS INCLUDES TRAINING AND TRAINING EQUIPMENT FOR TOTAL SUPPORT OF $4,743. * HEALING ARTS: THE FOUNDATION SUPPORTED THE HEALING ARTS PROGRAM WITH PERMANENT ART FOR $5,594. |
| PART III, CONT. | * PATIENT CARE: THE FOUNDATION SUPPORTED OVER $9,500 TO HELP PATIENTS WITH UNMET NEEDS SUCH AS GAS CARDS, MEDICATIONS AND HOME EQUIPMENT AS WELL AS FLOWERS AND CARDS FOR SPECIAL OCCASIONS. THIS INCLUDES SUPPORT FROM THREE FUNDS (GIVING TREE, GOOD SAMARITAN, PATIENT CARE) * PATIENT TRANSPORTATION: THE FOUNDATION RECEIVED A GRANT FROM THE UNITED WAY IN 2019/2020. THIS GRANT PROVIDED EMERGENCY TRANSPORT FOR BEHAVIORAL PATIENTS OF THE EMERGENCY DEPT. TOTAL SUPPORT FOR 2020 WAS $1,800. THE FOUNDATION ALSO SUPPORTED THE PATIENT TRANSPORTATION VAN WITH OPERATIONAL AND MAINTENANCE SUPPORT OF $51,481. * SPECIALTY CLINIC CARE: THE FOUNDATION SUPPORTED OPERATIONS OF THE PAIN CLINIC AT WESTFIELDS WITH $60,000. THIS FUNDING WAS PROVIDED BY GRANTS FROM THE HUGH J. ANDERSEN FOUNDATION AND THE ANDERSEN CORPORATE FOUNDATION. * SCHOLARSHIPS: THE FOUNDATION DONATED $2,500 TO SCHOLARSHIPS RECIPIENTS IN 2019 WHO COMPLETED THEIR SPRING 2020 SEMESTER. THE FOUNDATION ALSO PLEDGED SIX EMPLOYEES AND/OR THEIR DEPENDENTS A TOTAL OF $4,750 IN SCHOLARSHIPS IN NOVEMBER OF 2020. THE ACTUAL EXPENSE OF THE 2020 SCHOLARSHIPS WILL FALL IN 2021 AFTER COMPLETION OF EACH SEMESTER FOR STUDENTS. STUDENTS RECEIVE HALF OF THEIR SCHOLARSHIP EACH SEMESTER AFTER THE SUBMISSION OF THEIR AUTHENTICATED GRADES. COMMUNITY SUPPORTED PROGRAMS: * COMMUNITY GRANTS: THE FOUNDATION SUPPORTED THE EIGHT LOCAL CHARITIES WITH MISSIONS THAT ALIGN WITH WESTFIELDS HOSPITAL & CLINIC. TOTAL SUPPORT WAS $14,800. * COMMUNITY EDUCATION & SUPPORT: THE FOUNDATION SUPPORTED THE NR SCHOOL DISTRICT WITH A GRIEF PROGRAM FOR STRUGGLING STUDENTS. TOTAL SUPPORT WAS $33,790 FOR A LICENSED GRIEF COUNSELOR. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FOUNDATION'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF THE FOUNDATION. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF THE FOUNDATION, GHI'S INTERNAL LEGAL DEPARTMENT AND THE FOUNDATION'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. ONCE THAT REVIEW PROCESS HAS BEEN COMPLETED, IT IS THE POLICY OF THE FOUNDATION TO MAKE AVAILABLE TO THE BOARD OF DIRECTORS OF THE FOUNDATION A COPY OF THE 990 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 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 LEGAL DEPARTMENT 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. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE FOUNDATION HAS NO EMPLOYEES AND PAYS NO COMPENSATION. ALL OFFICERS AND KEY EMPLOYEES ARE PAID BY GROUP HEALTH PLAN, INC. (GHI), REGIONS HOSPITAL, LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION OR WESTFIELDS HOSPITAL, 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 THE FOUNDATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FOUNDATION'S FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM THE FOUNDATION OR HEALTHPARTNERS. |
| 990, PART VII, SECT A, LN 1A, COL (B): AVERAGE HRS - RELATED ORGANIZATION | ALL DIRECTORS AND OFFICERS OF THE FOUNDATION ARE EMPLOYED AND COMPENSATED BY GROUP HEALTH PLAN, INC. OR REGIONS HOSPITAL. REPORTED AVERAGE HOURS WORKED ARE BASED ON THEIR TOTAL COMPENSATION FROM ALL RELATED ORGANIZATIONS. |
| FORM 990, PART IX, LINE 11G | STAFFING: PROGRAM SERVICE EXPENSES 98,043. MANAGEMENT AND GENERAL EXPENSES 26,333. FUNDRAISING EXPENSES 80,604. TOTAL EXPENSES 204,980. |
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