TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(1) SCOTT A AEBISCHER...................................................................... DIRECTOR	0.50 ................. 49.50	X		3,054,007	75,662
(2) MIKE ANDERSON...................................................................... DIRECTOR & TREASURER	0.58 ................. 0.00	X	X	0	0
(3) ELIZABETH BRADSHAW...................................................................... VICE CHAIR & DIRECTOR	0.58 ................. 0.00	X	X	0	0
(4) JASON HOWARD...................................................................... DIRECTOR	0.58 ................. 0.00	X		0	0
(5) MEGAN M REMARK...................................................................... DIRECTOR	0.50 ................. 54.50	X		764,111	236,346
(6) SHARON TOLVA...................................................................... DIRECTOR	0.58 ................. 0.00	X		0	0
(7) SUE HEDLUND...................................................................... DIRECTOR	0.58 ................. 0.00	X		0	0
(8) JOHN UPPGREN...................................................................... DIRECTOR	0.58 ................. 0.00	X		0	0
(9) NICHOLAS MEYER MD...................................................................... DIRECTOR	0.58 ................. 0.00	X		0	0
(10) DENISE PONTRELLI...................................................................... DIRECTOR	0.58 ................. 0.00	X		0	0
(11) JULIE SCHMIDT...................................................................... CHAIR & DIRECTOR	0.58 ................. 0.00	X	X	0	0
(12) KEVIN J BJORK MD...................................................................... DIRECTOR	0.50 ................. 39.50	X		287,785	38,755
(13) BRETT C HAAKE MD...................................................................... DIRECTOR	0.50 ................. 54.50	X		610,106	90,699
(14) BRIAN L CRESS MD...................................................................... DIRECTOR	0.50 ................. 39.50	X		320,095	53,125
(15) THEODORE T WEGLEITNER...................................................................... DIRECTOR & PRESIDENT (JAN-JUNE)	1.00 ................. 52.00	X	X	381,403	38,782
(16) MATTHEW A RICHIE...................................................................... DIRECTOR & VP ADMINISTRATO	0.50 ................. 42.50	X	X	334,544	43,512
(17) BRANDI L LUNNEBORG...................................................................... DIRECTOR & PRESIDENT (DEC)	39.50 ................. 0.50	X	X	103,495	26,174

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)
(18) PATRICK T COURNEYA........................................................................ DIRECTOR	0.50 .......................59.50	X				0	524,922	116,102
(19) PHAEDRA COFIELD........................................................................ DIRECTOR	0.58 .......................0.00	X				0	0	0
(20) DOUGLAS E JOHNSON........................................................................ CFO	51.00 .......................4.00		X			410,661	0	233,539
(21) ROBBI A HAGELBERG........................................................................ VP OF OPERATIONS & CNO	39.50 .......................0.50		X			241,710	0	35,121
(22) NATHAN S PULSCHER........................................................................ VP ANCILLARY SERVICES	49.50 .......................0.50		X			235,893	0	46,117
(23) THOMAS S ANDERSON........................................................................ VP MEDICAL AFFAIRS	0.50 .......................54.50		X			0	457,771	54,314
(24) NANCY L EVERT........................................................................ SECRETARY & GENERAL COUNCS	0.50 .......................54.50		X			0	600,979	171,579
(25) MICHAEL D WEIS........................................................................ CRNA	46.00 .......................0.00			X		260,291	0	48,024
(26) MICHAEL S KENNEDY........................................................................ CRNA	40.00 .......................0.00			X		214,981	0	42,630
(27) JUSTIN R CUSICK........................................................................ CRNA	50.00 .......................0.00			X		241,548	0	45,606
(28) JASON D TAUZELL........................................................................ CRNA	40.00 .......................0.00			X		211,992	0	44,784
(29) CATHY J MANLEY........................................................................ CRNA	40.00 .......................0.00			X		218,245	0	10,177
(30) ANDREW E DORWART MD........................................................................ FORMER SMG PRESIDENT	0.00 .......................50.00				X	0	306,611	53,471

(A) Name and business address	(B) Description of services	(C) Compensation
BOUTWELLS LANDING CARE CENTER 13575 58TH ST N OAK PARK HEIGHTS,MN55082	TRANSITIONAL CARE	892,584
GARDNER BUILDERS 730 2ND AVE S STE 1233 MINNEAPOLIS,MN55402	CONSTRUCTION SERVICES	491,959
ESTATES AT LINDEN 105 W LINDEN ST STILLWATER,MN55082	MEDICAL SERVICES	436,816
HEALTH SYSTEM COOP LAUNDRIES 55 5TH ST E STE 960 ST PAUL,MN551012595	LAUNDRY SERVICES	351,888
SHARED MED SERV INC 1885 CITY RD C WEST ROSEVILLE,MN55113	MEDICAL SERVICES	255,760
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 23

- TIN:

SCHEDULE A
(Form 990)

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.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

LAKEVIEW MEMORIAL HOSPITAL
ASSOCIATION INC

Employer identification number

41-0811697

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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 ....................... right arrow

33 1/3% support test—2020. If the organization did not check a 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 ..................... right arrow

17a

10%-facts-and-circumstances test—2021. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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 ....... right arrow

33 1/3% support tests—2020. 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 .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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)
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):
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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

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 2021 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-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

LAKEVIEW MEMORIAL HOSPITAL
ASSOCIATION INC

Employer identification number

41-0811697

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC		Employer identification number 41-0811697

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC			Employer identification number 41-0811697
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

LAKEVIEW MEMORIAL HOSPITAL
ASSOCIATION INC

Employer identification number

41-0811697

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

Total. Add lines 1c through 1i ....................................................................................................

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION PAYS FOR CERTAIN CORPORATE AND EMPLOYEE PROFESSIONAL ASSOCIATION MEMBERSHIPS. A PORTION OF SUCH MEMBERSHIP DUES POTENTIALLY COULD BE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

LAKEVIEW MEMORIAL HOSPITAL
ASSOCIATION INC

Employer identification number

41-0811697

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	22,364,922		22,364,922
b	Buildings ....	37,283,901	14,088,274	23,195,627
c	Leasehold improvements	1,637,197	172,201	1,464,996
d	Equipment ....	26,557,701	21,465,134	5,092,567
e	Other .....	1,374,594	1,218,979	155,615
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				52,273,727

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,447,803
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

PART X, LINE 2:

LAKEVIEW HOSPITAL. 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, 2021 OR 2020 FOR UNRECOGNIZED TAX BENEFITS.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

LAKEVIEW MEMORIAL HOSPITAL
ASSOCIATION INC

Employer identification number

41-0811697

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other 27500.0000000000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	1,350,923		1,350,923	0.930 %
b	Medicaid (from Worksheet 3, column a) . . . . .	2,598,238	947,309	1,650,929	1.140 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	11,370,749	7,345,515	4,025,234	2.770 %
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	15,319,910	8,292,824	7,027,086	4.840 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	571,374	17,150	554,224	0.380 %
f	Health professions education (from Worksheet 5) . . .	257,374	0	257,374	0.180 %
g	Subsidized health services (from Worksheet 6) . . . .	9,831,951	5,273,583	4,558,368	3.140 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	204,886		204,886	0.140 %
j	Total. Other Benefits . .	10,865,585	5,290,733	5,574,852	3.840 %
k	Total. Add lines 7d and 7j .	26,185,495	13,583,557	12,601,938	8.680 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	53,749	53,749	0.040 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	53,749	53,749	0.040 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

2,865,559

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

28,220,899

Enter Medicare allowable costs of care relating to payments on line 5.....

29,048,519

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-827,620

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION INC 927 CHURCHILL STREET W STILLWATER,MN55082 WWW.LAKEVIEWHEALTH.ORG/ 8029322	X	X	X

Schedule H (Form 990) 2021

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/LAKEVIEW

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/LAKEVIEW

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 275.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

HTTP://WWW.LAKEVIEWHEALTH.ORG/POLICIES

The FAP application form was widely available on a website (list url):

HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/LAKEVIEW/PATIENT-GUEST/

A plain language summary of the FAP was widely available on a website (list url):
HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/LAKEVIEW/

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION	PART V, SECTION B, LINE 5: TO COMPREHENSIVELY UNDERSTAND AND DESCRIBE THE NEEDS OF THE COMMUNITIES HEALTHPARTNERS SERVES, WE SYSTEMATICALLY IDENTIFIED A LIST OF PUBLICLY AVAILABLE DATA SOURCES AND A LIST OF INTERNALLY AVAILABLE HEALTHPARTNERS DATA SOURCES. WITH THE CHNA WORKGROUP THAT HAD EXPERTISE FROM PUBLIC HEALTH, HEALTHCARE AND EPIDEMIOLOGY, WE CAREFULLY REVIEWED THE LIST TO IDENTIFY OPPORTUNITIES WITH A SPECIFIC LENS TOWARDS INCLUDING MEMBERS WITH UNIQUE INSIGHT INTO NEEDS OF OUR UNDERSERVED COMMUNITIES WHERE HEALTH AND OTHER DISPARITIES EXIST. TO FURTHER ROUND OUT UNDERSTANDING, WE SOUGHT ADDITIONAL DATA SOURCES TOGETHER WITH OUR COMMUNITY PARTNERS. WHERE OPPORTUNITIES STILL REMAIN FOR BETTER UNDERSTANDING DUE TO LACK OF CURRENTLY AVAILABLE DATA, WE HAVE NOTED IN THE REPORT. FOR EXAMPLE, WE IDENTIFIED SPECIFIC GAPS IN DATA AVAILABLE TO UNDERSTAND THE COVID-19 PANDEMIC CONTEXT AND THE INFLUENCE OF STRUCTURAL RACISM ON THE NEEDS AREAS. THUS, WE SPECIFICALLY DESIGNED OUR QUALITATIVE COMMUNITY CONVERSATIONS AND OUR QUANTITATIVE HEALTHPARTNERS PROVIDER SURVEYS TO FILL THESE GAPS. HEALTHPARTNERS PROVIDER SURVEYS: SELECT HEALTHPARTNERS STAFF WHO PROVIDE DIRECT CARE FOR OUR PATIENTS WERE INVITED BY HOSPITAL LEADERS AND THE CHNA EXPERT PANEL MEMBERS TO COMPLETE A BRIEF WEB SURVEY ABOUT THE NEEDS OF THE PATIENTS THEY SERVE. THE SURVEY WAS DEVELOPED BY AN EXPERT SURVEY METHODOLOGIST WITH INPUT FROM THE CHNA WORKGROUP. OVERALL, 444 PROVIDERS INCLUDING DOCTORS, CARE COORDINATORS, PHARMACISTS, PHYSICAL OR OCCUPATIONAL THERAPISTS, DIETITIANS, NURSES, AND SOCIAL WORKERS COMPLETED SURVEYS ACROSS ALL HEALTHPARTNERS HOSPITALS. DESCRIPTIVE STATISTICS AND A THEMATIC ANALYSIS WERE COMPLETED AND INCLUDED IN THE NEEDS AREA SUMMARIES BELOW.COMMUNITY CONVERSATIONS: A TOTAL OF 41 COMMUNITY CONVERSATIONS WERE HELD OR ATTENDED BY HEALTHPARTNERS WORKGROUP MEMBERS. RESULTS WERE SUMMARIZED AND KEY THEMES AND QUOTES WERE ADDED TO THE NEEDS AREA SUMMARIES THROUGHOUT. ADDITIONAL DETAILS ABOUT THE COMMUNITY CONVERSATIONS CAN BE FOUND IN THE APPENDIX OF THE LAKEVIEW HOSPITAL'S 2021 CHNA AT HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/LAKEVIEW/ABOUT/COMMUNITY-HEALTH-NEEDS/
LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION	PART V, SECTION B, LINE 6A: HEALTHPARTNERS COLLABORATED ACROSS EIGHT HOSPITALS WITHIN ITS FAMILY OF CARE FOR THE 2021 CHNA: AMERY HOSPITAL & CLINIC (AMERY, WI) HUDSON HOSPITAL & CLINIC (HUDSON, WI) LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION HOSPITAL (STILLWATER, MN) PARK NICOLLET HEALTH SERVICES INCLUDING PARK NICOLLET METHODIST HOSPITAL (ST. LOUIS PARK, MN) REGIONS HOSPITAL (ST. PAUL, MN) HUTCHINSON HEALTH (HUTCHINSON, MN) WESTFIELDS HOSPITAL & CLINIC (NEW RICHMOND, WI) HEALTHPARTNERS RC, DBA OLIVIA HOSPITAL & CLINIC, OLIVIA, MN
LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION	PART V, SECTION B, LINE 11: PROGRESS ON 2018 GOALS IN 2021ACCESS TO CAREGOAL: IMPROVE ACCESS TO CARE THAT IS APPROPRIATE, AFFORDABLE, AND CONVENIENT, -CONTINUED TO INCREASE WEBSITE ACCESS TO PATIENT AND COMMUNITY ACCESS TO HEALTH INFORMATION AND APPOINTMENT SCHEDULING. -IMPROVED GEOGRAPHIC ACCESS OF CARE FOR PATIENTS THROUGH COORDINATION OF APPOINTMENT SCHEDULING BETWEEN FIVE SITES IN THE ST. CROIX VALLEY AREA.-SIGNIFICANTLY INCREASED TELEMEDICINE FOR PRIMARY, SPECIALTY AND BEHAVIORAL HEALTH SERVICES IN A VERY SHORT TIME FRAME TO INCREASE ACCESS DURING PANDEMIC RESTRICTIONS. -EXPANDED HOSPICE, HOME CARE AND PALLIATIVE CARE SERVICES TO BETTER SERVE ALL ST. CROIX VALLEY COMMUNITIES. CONTINUED TO SERVE PATIENTS DURING PANDEMIC. -CONTINUED PATIENT EXPERIENCE IN ADVISORY COUNCILS IN A VIRTUAL FORMAT, TO BETTER UNDERSTAND AND IMPROVE CARE EXPERIENCE DURING PANDEMIC.ACCESS TO HEALTH GOAL: STRENGTHEN EXISTING AND EXPLORE NEW COMMUNITY PARTNERSHIPS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH PROMOTE EARLY CHILDHOOD BRAIN DEVELOPMENT, PROMOTE SUSTAINABLE OPERATIONS. -NEW PARTNERSHIPS WERE ESTABLISHED AND EXISTING PARTNERSHIP STRENGTHENED TO MEET COMMUNITY NEEDS. -COMMUNITY HEALTH ACTION TEAM (CHAT) CONTINUED TO ENGAGE COMMUNITY LEADERS TO COLLABORATE AND PARTNER DURING THE PANDEMIC, PROVIDING UPDATES AND CROSS-PROMOTING HEALTH MESSAGES TO THE COMMUNITY.-HEALTH AND WELL-BEING ADVISORY COMMITTEE CONTINUED TO GUIDE COMMUNITY HEALTH EFFORTS AND RESPONSE THROUGH CROSS-SECTOR COLLABORATION. -UPDATED COMMUNITY RESOURCE LIST TO INCLUDE NEW RESOURCES AND SUPPORT DURING COVID PANDEMIC; AVAILABLE TO PATIENTS, STAFF AND COMMUNITY MEMBERS.-COLLABORATED WITH WASHINGTON COUNTY TO SUPPORT AND COMMUNICATE NEW SOURCES OF FOOD FOR FOOD INSECURE RESIDENTS.-DISTRIBUTED MORE THAN 500 BOOKS TO CHILDREN IN CLINICS THROUGH REACH OUT AND READ. LITTLE MOMENTS COUNT OFFERED VIRTUAL TRAINING AND RESOURCES TO CONTINUE MOMENTUM OF COLLABORATION TO PROMOTE EARLY CHILDHOOD BRAIN DEVELOPMENT.-INCREASED RECYCLING AND PURCHASES OF SUSTAINABLY PRODUCED AND LOCAL FOODS AND BEVERAGES. -REDUCED WASTE TO LANDFILLS, MEAT PURCHASES, SINGLE USE PLASTIC BOTTLES, ELECTRICITY, NATURAL GAS AND WATER USE AND TOTAL GREENHOUSE EMISSIONS. INCREASED USE OF ENVIRONMENTALLY PREFERRED AND RECYCLED PAPER AND OFFICE SUPPLIES. MENTAL HEALTH AND WELL-BEING GOAL: REDUCE THE STIGMA SURROUNDING MENTAL ILLNESS. INCREASE ACCESS TO EDUCATION AND RESOURCES AROUND MENTAL HEALTH AND WELL-BEING AND SERVICES.THE HOSPITAL IS A PARTNER IN MAKE IT OK, A PROGRAM FOCUSED ON REDUCING THE STIGMA OF MENTAL ILLNESS. IN 2021, THE REACH OF THE MAKE IT OK CAMPAIGN EXPANDED THROUGH TRAINING LOCAL AMBASSADORS, PROMOTION, AND PARTNERSHIPS WITH LOCAL AGENCIES AND PUBLIC HEALTH. DESPITE THE CHALLENGE OF COVID-19, MAKE IT OK MADE PROGRESS IN REDUCING THE STIGMA OF MENTAL ILLNESS WITH THE FOLLOWING IMPACT:-RECEIVED 81,349 WEBSITE VISITS WITH 62,780 UNIQUE VISITORS IN 2021. THE MAKE IT OK TOOLS AND RESOURCES WERE DOWNLOADED MORE THAN 500 TIMES BY PEOPLE IN 250 US CITIES AND 25 MINNESOTA COUNTIES.-HELD 11 AMBASSADOR TRAININGS BOTH IN PERSON AND VIRTUALLY, MOBILIZING AN ADDITIONAL 200 AMBASSADORS. -REACHED MORE THAN 2,000 PEOPLE THROUGH COMMUNITY PRESENTATIONS, EVENTS AND TABLING. MORE THAN 90 PERCENT OF PARTICIPANTS REPORTED INCREASED KNOWLEDGE ABOUT MENTAL ILLNESS AND GREATER CONFIDENCE IN TALKING ABOUT MENTAL ILLNESS AS A RESULT OF THE PRESENTATIONS.-MAKE IT OK HAS BEEN A KEY PARTNER IN A COMPREHENSIVE APPROACH TO MENTAL HEALTH FOR STUDENTS IN THE LOCAL SCHOOLS.-IN A SURVEY OF MAKE IT OK AMBASSADORS IN OCTOBER 2021, 88% SAID THAT MAKE IT OK WAS MORE IMPORTANT THAN EVER IN A TIME OF SOCIAL ISOLATION AND EMOTIONAL STRESS FOR MANY IN OUR COMMUNITIES.-MORE THAN 500 AMBASSADORS ARE NOW TRAINED IN THE ST. CROIX VALLEY AREA. MORE THAN 90 PERCENT OF PARTICIPANTS REPORTED INCREASED KNOWLEDGE ABOUT MENTAL ILLNESS AND GREATER CONFIDENCE IN TALKING ABOUT MENTAL ILLNESS AS A RESULT OF THE PRESENTATIONS-OFFERED BEATING THE BLUES AND RESILIENCY RESOURCES AT NO CHARGE TO MEMBERS, PATIENTS AND EMPLOYEES. MENTAL HEALTH RESOURCES PROMOTED AS KEY PART OF EMPLOYEE WELL-BEING PROGRAM. HOSPITAL CONVENES AND PARTICIPATES IN MULTIPLE COLLABORATIVES FOCUSING ON MENTAL HEALTH. -INCREASED VALLEY-WIDE USE OF BEHAVIORAL HEALTH TELEHEALTH (BHTV) PROGRAM FOR PATIENTS ACCESSING EMERGENCY DEPARTMENT CARE DURING A MENTAL HEALTH CRISIS.-BEHAVIORAL HEALTH TEAM SERVED OUR COMMUNITY IN NEW AND DIFFERENT WAYS, INCLUDING SOME DIGITAL/VIRTUAL FORMATS, INCLUDING PODCASTS. SIX PODCASTS WERE RECORDED IN 2021, PRIMARILY WITH A MENTAL HEALTH FOCUS ON TOPICS SUCH AS DEPRESSION, ANXIETY AND STRESS RELIEF. IN TOTAL, THESE HAVE BEEN ACCESSED OVER 400 TIMES.-CONTINUED: INCREASING TELEHEALTH CAPACITY FOR BEHAVIORAL HEALTH APPOINTMENTS.-CONTINUED: COLLABORATED WITH PARTNERS HAVE IMPROVED AWARENESS INCLUDING COUNTY DHS, OTHER HOSPITALS AND CLINICS, MAKE IT OK, NAMI, AND OTHERS (BEHAVIORAL HEALTH CO-OP).-CONTINUED: INTEGRATED BEHAVIORAL HEALTH INTO TOTAL HEALTH CARE AT ALL LOCATIONS.NUTRITION AND PHYSICAL ACTIVITY GOALS: PROMOTE AND SUPPORT PHYSICAL ACTIVITY AND NUTRITION AND SUPPORT AND ENCOURAGE HEALTHY FOOD AND PHYSICAL ACTIVITY ENVIRONMENT CHANGE. POWERUP IS OUR KEY COMMUNITY-WIDE HEALTH INITIATIVE THAT INSPIRES AND ENGAGES THE ENTIRE COMMUNITY TO PROMOTE BETTER EATING AND PHYSICAL ACTIVITIES SO YOUTH CAN REACH THEIR FULL POTENTIAL. WE WORK WITH HUNDREDS OF PARTNERS ACROSS THE REGION RESULTING IN A HIGH LEVEL OF COMMUNITY AND SCHOOL ENGAGEMENT, STRONGER SCHOOL WELLNESS POLICIES AND PRACTICES; MORE FREE AND LOW-COST OPTIONS FOR PHYSICAL ACTIVITY INCLUDING OPEN GYMS; PARTNERSHIPS WITH STATE AND LOCAL PARKS; TRANSFORMED FOOD PANTRIES, CAFETERIAS AND CONCESSIONS; AND COMMUNITY MOMENTUM TO CREATE CHANGE. KEY RESULTS INCLUDE:-NEW POWERUP4KIDS.ORG WEB PLATFORM WITH IMPROVED NAVIGATION, NEW RESOURCES FOR AT-HOME FAMILY ACTIVITIES AND SCHOOL RESOURCES FOR VIRTUAL AND IN-PERSON LEARNING ENVIRONMENTS.-ONLINE RECIPE GALLERY, WITH MORE THAN 300 KIDAPPROVED RECIPES.-VIDEO GALLERY FOR SCHOOLS AND FAMILIES WITH PHYSICAL ACTIVITY AND FOOD IDEAS FOR KIDS, CLASSROOMS AND FAMILIES.-POWERUP SCHOOL CHALLENGE PROGRAM WAS REVISED TO PROVIDE SCHOOLS AND YOUTH SERVING ORGANIZATIONS TO COMPLETE THE CHALLENGE IN A FLEXIBLE WAY, ONLINE OR IN PERSON. THE PROGRAM INSPIRES STUDENTS TO EAT BETTER AND MOVE MORE, AND IN 2021 REACHED ELEMENTARY AGE STUDENTS IN 476 CLASSROOMS IN 23 ST. CROIX VALLEY AREA SCHOOLS. THE TOTAL PROGRAM REACHED STUDENTS IN 54 SCHOOLS AND MORE THAN 900 CLASSROOMS THROUGHOUT MINNESOTA AND WISCONSIN.-THE THREEWEEK WINTER WARMUP CHALLENGE INSPIRED KIDS TO STAY ACTIVE DURING THE COLD MONTHS AND WAS IMPLEMENTED IN LOCAL SCHOOLS IN A VIRTUAL FORMAT, REACHING 70 ELEMENTARY CLASSROOMS IN FOUR VALLEY SCHOOL DISTRICTS.-POWERUP WORKED WITH PARTNERS TO HELP INSPIRE AND INFLUENCE THEIR COMMUNITIES, INCLUDING 19 OPEN GYMS IN JANUARY AND FEBRUARY 2021 PRIOR TO RESTRICTIONS.SUBSTANCE ABUSEREDUCED OPIOID PRESCRIPTIONS, DOSES, AND PATIENTS MEETING CHRONIC OPIOID USE CRITERIA. THROUGH COLLABORATIVE EFFORTS WITH PHARMACY, PRESCRIBERS AND PAIN CLINICS, ACHIEVED SIGNIFICANT REDUCTION IN OPIOID PRESCRIBING IN OUR CARE SYSTEM.-VALLEY-WIDE , SINCE 2016, THERE HAS BEEN A 68% AND 52% REDUCTION IN OPIOIDS PRESCRIBED AT DISCHARGE IN HOSITALS AND EMERGENCY DEPARTMENTS, RESPECTIVELY. -INCREASED AWARENESS AND ACCESS OF TREATMENT FOR SUBSTANCE ABUSE. -REDUCED ACCIDENTAL POISONING AND DRUG ABUSE BY OFFERING FREE AND ENVIRONMENTALLY FRIENDLY MEDICATION COLLECTION AT OUR HOSPITALS AND CLINICS FOR THE COMMUNITY. PROMOTED COMMUNITY PRESCRIPTION TAKE-BACK LOCATIONS AND DISPOSAL BAGS, COLLECTING 449 LBS. AT LAKEVIEW IN 2021.
LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION	PART V, SECTION B, LINE 16J: THE FINANCIAL ASSISTANCE POLICY IS LISTED ON THE BACK OF THE PATIENT STATEMENT PER THE MINNESOTA ATTORNEY GENERAL (AG) AGREEMENT.
LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION	PART V, SECTION B, LINE 24: WHEN A PATIENT IS UNINSURED THERE HAVE BEEN INSTANCES WHERE A PORTION OF THE BALANCE IS COVERED BY THE UNINSURED DISCOUNT AND THE REMAINING BALANCE IS COVERED BY CHARITY CARE. EXAMPLE: AN UNINSURED PATIENT HAS $1,000 IN GROSS CHARGES FOR AN EMERGENCY ROOM VISIT. THE PATIENT QUALIFIES FOR CHARITY CARE AND ALSO IS ELIGIBLE FOR THE UNINSURED DISCOUNT. A PORTION OF THE GROSS CHARGES IS COVERED BY THE UNINSURED DISCOUNT AND THE REMAINDER BY CHARITY CARE, WHICH MAY TOTAL AN AMOUNT EQUAL TO THE GROSS CHARGE FOR THAT VISIT.
PART V LINE 20A	LAKEVIEW HOSPITAL DOES NOT PERFORM ANY ECAS (EXTRAORDINARY COLLECTION ACTIONS), THEREFORE WE WOULD NOT GIVE A PATIENT A WRITTEN NOTICE OF DOING SO.

Schedule H (Form 990) 2021

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2021

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 7:	ACTUAL COSTS WERE ESTIMATED USING A COST-TO-CHARGE RATIO AND EXCLUDING BAD DEBT.
PART I, LINE 7E: COMMUNITY HEALTH IMPROVEMENT SERVICES	LAKEVIEW HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITY. LAKEVIEW HOSPITAL PROVIDED COMMUNITY ACTIVITIES AND PROGRAMS WHICH WERE SUBSIDIZED BY THE HOSPITAL IN ORDER TO IMPROVE COMMUNITY HEALTH. SEE SCHEDULE O, 1. COMMUNITY HEALTH IMPROVEMENT SERVICES FOR THE TYPES OF CLASSES AND EVENTS PROVIDED TO THE COMMUNITY. THE NET COST OF PROVIDING COMMUNITY HEALTH IMPROVEMENT AND OPERATIONS ASSOCIATED WITH OFFERING CLASSES AND SUPPORT GROUPS IN 2021 WAS $77,734. LAKEVIEW HOSPITAL PROVIDED SUPPORT SERVICES TO PATIENTS AND FAMILIES IN MANY WAYS DURING 2021. MOST NOTABLY, LAKEVIEW HOSPITAL PROVIDED NURSE NAVIGATORS FOR BREAST HEALTH AND CANCER SUPPORT TO ASSIST PATIENTS WITH SCHEDULING, COORDINATION, FOLLOW-UP APPOINTMENTS, AND PROVIDING CONSULTS AND COMFORT TO THOSE PATIENTS DIAGNOSED WITH CANCER. THE NET COST OF THIS PROGRAM WAS $283,755 IN 2021. THE CHAPLAINCY PROGRAM AT LAKEVIEW HOSPITAL ALSO PROVIDED OUTREACH SERVICES, INCLUDING BEREAVEMENT GROUP CLASSES, AT A NET COMMUNITY BENEFIT COST OF $22,310.STAFF HOURS TO GATHER AND REPORT COMMUNITY BENEFIT INFORMATION TOTALED 902 HOURS AND $50,080 IN COMMUNITY BENEFIT EXPENSE FOR 2021.
PART I, LINE 7F: HEALTH PROFESSIONS EDUCATION	LAKEVIEW HOSPITAL COORDINATES AND SUPPORTS WEEKLY CONTINUING MEDICAL EDUCATION (CME) PROGRAMS FOR STAFF AND COMMUNITY EDUCATION. TOTAL DIRECT COSTS FOR STIPENDS, PURCHASED SERVICES, SUPPLIES, ROOM RENTALS AND INDIRECT COSTS FOR THE YEAR WERE $60,657.IN 2021, OUR STAFF PROVIDED PRECEPTOR TIME TO STUDENT PROFESSIONAL INTERNS IN PHARMACY AND NURSING AT A NET COST OF $215,869.
PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES	LAKEVIEW HOSPITAL IS COMMITTED TO PROVIDING NEEDED SERVICES, EVEN AT A FINANCIAL LOSS. IN 2021, LAKEVIEW HOSPITAL SUBSIDIZED INPATIENT AND OUTPATIENT HEALTH SERVICES, INCLUDING CLINICAL DIABETES AND NUTRITION, LABOR AND DELIVERY SERVICES, AND HOMECARE SERVICES, TOTALING $4,300,686.
PART I, LINE 7I: CONTRIBUTIONS FOR COMMUNITY BENEFIT	TO FORM PARTNERSHIPS THAT IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITIES, LAKEVIEW HOSPITAL PROVIDES GRANTS TO LOCAL ORGANIZATIONS. OUR GRANTMAKING EMPOWERS OUR COMMUNITIES AND BUILDS MOMENTUM FOR INNOVATIVE PROGRAMS AND SERVICES THAT MAKE A DIRECT IMPACT ON LOCAL HEALTH PRIORITIES.LAKEVIEW HEALTH FOUNDATION'S BOARD OF DIRECTORS HAS OVERSIGHT OF THE DISBURSEMENT OF HEALTH AND WELL-BEING GRANTS ON BEHALF OF LAKEVIEW HOSPITAL. NINETEEN GRANTS WERE APPROVED IN 2021, WHICH BENEFITED THE COMMUNITY. INKIND CONTRIBUTIONS INCLUDED SUPPORT OF MISSION TRIPS FOR EMPLOYEES AND PHARMACEUTICALS. SEE SCHEDULE O, SECTION 4. CASH AND IN-KIND CONTRIBUTIONS, FOR DETAIL ON GRANTS OFFERED, SPONSORSHIPS PROVIDED, AND INKIND SUPPORT GIVEN IN 2021.LAKEVIEW HOSPITAL'S DONATIONS TO COMMUNITYBASED TAXEXEMPT ORGANIZATIONS IN THE FORM OF SPONSORSHIPS, GRANTS, DONATIONS TO MATTER FOUNDATION AND SUPPLIES FOR MEDICAL MISSION TRIPS TOTALED $205,590 IN 2021.
PART II, COMMUNITY BUILDING ACTIVITIES:	LAKEVIEW HOSPITAL CONTINUOUSLY FOCUSES ON SUSTAINABILITY EFFORTS. IN 2021, $53,749 IN COSTS WERE EXPENDED IN THESE EFFORTS. SEE SCHEDULE O, SECTION 5. COMMUNITY BUILDING ACTIVITIES, FOR MORE DETAIL.OTHER COMMUNITY BUILDING ACTIVITIES INCLUDED LEADERSHIP ATTENDING COMMUNITY EVENTS PROMOTING THE HEALTH AND WELLBEING OF COMMUNITY MEMBERS AND HOSPITAL LEADERS HOLDING A HEALTH & WELLNESS DAY FOR ST. CROIX LEADERSHIP IN THE VALLEY PARTICIPANTS.
PART III, LINE 4:	SEE THE ORGANIZATION'S FOOTNOTES 1.O AND 1.Q, ON PAGE 25 OF THE ATTACHED CONSOLIDATED FINANCIAL STATEMENT.
PART III, LINE 8:	THE MEDICARE COST IS DERIVED BASED ON THE RATIO OF MEDICARE FFS CHARGES TO TOTAL CHARGES MULTIPLIED BY TOTAL EXPENSES (LESS CHARITY CARE & BAD DEBT). NONE OF THE MEDICARE FFS LOSS REPORTED ON SCHEDULE H, PART III, LINE 7 IS TREATED AS COMMUNITY BENEFIT ON SCHEDULE H, PART I, LINE 7A.THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT FOR THE FOLLOWING REASONS:1) IT PROVIDES SERVICES TO A SIGNIFICANT PORTION OF OUR SERVICE POPULATION AT A NEGATIVE MARGIN; 2) THE HOSPITAL WOULD DISCONTINUE PROVIDING SERVICES TO MEDICARE PATIENTS IF THE DECISION WERE BASED STRICTLY ON A FINANCIAL BASIS; 3) THERE IS A COMMUNITY NEED TO PROVIDE THESE SERVICES LOCALLY; 4) IF THE HOSPITAL DID NOT PROVIDE THESE SERVICES; THEY WOULD BECOME THE OBLIGATION OF THE GOVERNMENT.
PART III, LINE 9B:	IF LAKEVIEW HOSPITAL DETERMINES THAT A PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, AND IF THE PATIENT IS ELIGIBLE FOR DISCOUNTED (AND NOT FREE) CARE, THEY WILL PROVIDE THE PATIENT WITH A BILLING STATEMENT AND APPROVAL OR DECLINATION LETTER REGARDING THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. LAKEVIEW HOSPITAL WILL REFUND ANY PAYMENT THE PATIENT MADE FOR CARE WHICH EXCEEDS THE AMOUNT THAT IS DETERMINED TO BE PATIENT RESPONSIBILITY. THEY WILL ALSO TAKE REASONABLE MEASURES TO REVERSE ANY COLLECTION ACTIONS THAT MAY HAVE BEEN INITIATED AGAINST THE PATIENT.
PART III, SECTION A, LINE 2: BAD DEBT EXPENSE METHODOLOGY	THE "ACTUAL COST" OF BAD DEBT EXPENSE IS ESTIMATED. BAD DEBT EXPENSE REPRESENTS THOSE ACCOUNTS RECEIVABLE WRITTEN OFF FROM PATIENTS THAT HAVE NOT PAID THEIR BILL AND HAVE NOT APPLIED FOR FINANCIAL ASSISTANCE. THE BAD DEBT AMOUNT IS THE RECEIVABLE AFTER INSURANCE PAYMENT AND ADJUSTMENTS HAVE ALREADY BEEN MADE, INCLUDING ADJUSTMENTS FOR SELF-PAY IN ACCORDANCE WITH THE AGREEMENT WITH THE MINNESOTA ATTORNEY GENERAL'S OFFICE. SINCE REDUCTIONS HAVE ALREADY BEEN MADE FOR DISCOUNTS AND OTHER ALLOWANCES, THE ENTIRE BALANCE IS CONSIDERED BAD DEBT AND NO FURTHER REDUCTIONS ARE CONSIDERED.THE PROVISIONS FOR BAD DEBT FOOTNOTE IN THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS IS INCLUDED IN SECTION 1, PART (P), PAGES 11 AND 12.
PART VI, LINE 2:	TO COMPREHENSIVELY UNDERSTAND AND DESCRIBE THE NEEDS OF THE COMMUNITIES HEALTHPARTNERS SERVES, WE SYSTEMATICALLY IDENTIFIED A LIST OF PUBLICLY AVAILABLE DATA SOURCES AND A LIST OF INTERNALLY AVAILABLE HEALTHPARTNERS DATA SOURCES. WITH THE CHNA WORKGROUP THAT HAD EXPERTISE FROM PUBLIC HEALTH, HEALTHCARE AND EPIDEMIOLOGY, WE CAREFULLY REVIEWED THE LIST TO IDENTIFY OPPORTUNITIES WITH A SPECIFIC LENS TOWARDS INCLUDING MEMBERS WITH UNIQUE INSIGHT INTO NEEDS OF OUR UNDERSERVED COMMUNITIES WHERE HEALTH AND OTHER DISPARITIES EXIST. TO FURTHER ROUND OUT UNDERSTANDING, WE SOUGHT ADDITIONAL DATA SOURCES TOGETHER WITH OUR COMMUNITY PARTNERS. WHERE OPPORTUNITIES STILL REMAIN FOR BETTER UNDERSTANDING DUE TO LACK OF CURRENTLY AVAILABLE DATA, WE HAVE NOTED IN THE REPORT. FOR EXAMPLE, WE IDENTIFIED SPECIFIC GAPS IN DATA AVAILABLE TO UNDERSTAND THE COVID-19 PANDEMIC CONTEXT AND THE INFLUENCE OF STRUCTURAL RACISM ON THE NEEDS AREAS. THUS, WE SPECIFICALLY DESIGNED OUR QUALITATIVE COMMUNITY CONVERSATIONS AND OUR QUANTITATIVE HEALTHPARTNERS PROVIDER SURVEYS TO FILL THESE GAPS. HEALTHPARTNERS PROVIDER SURVEYS: SELECT HEALTHPARTNERS STAFF WHO PROVIDE DIRECT CARE FOR OUR PATIENTS WERE INVITED BY HOSPITAL LEADERS AND THE CHNA EXPERT PANEL MEMBERS TO COMPLETE A BRIEF WEB SURVEY ABOUT THE NEEDS OF THE PATIENTS THEY SERVE. THE SURVEY WAS DEVELOPED BY AN EXPERT SURVEY METHODOLOGIST WITH INPUT FROM THE CHNA WORKGROUP. OVERALL, 444 PROVIDERS INCLUDING DOCTORS, CARE COORDINATORS, PHARMACISTS, PHYSICAL OR OCCUPATIONAL THERAPISTS, DIETITIANS, NURSES, AND SOCIAL WORKERS COMPLETED SURVEYS ACROSS ALL HEALTHPARTNERS HOSPITALS. DESCRIPTIVE STATISTICS AND A THEMATIC ANALYSIS WERE COMPLETED AND INCLUDED IN THE NEEDS AREA SUMMARIES BELOW.COMMUNITY CONVERSATIONS: A TOTAL OF 41 COMMUNITY CONVERSATIONS WERE HELD OR ATTENDED BY HEALTHPARTNERS WORKGROUP MEMBERS. RESULTS WERE SUMMARIZED AND KEY THEMES AND QUOTES WERE ADDED TO THE NEEDS AREA SUMMARIES THROUGHOUT. ADDITIONAL DETAILS ABOUT THE COMMUNITY CONVERSATIONS CAN BE FOUND IN THE APPENDIX OF THE LAKEVIEW HOSPITAL'S 2021 CHNA AT HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/LAKEVIEW/ABOUT/COMMUNITY-HEALTH-NEEDS/
PART VI, LINE 3:	LAKEVIEW HOSPITAL DEFINES FINANCIAL ASSISTANCE AS THE COST OF CARE DELIVERED TO PATIENTS WHO HAVE A NEED FOR MEDICALLY NECESSARY TREATMENT BUT WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY; PATIENTS WHO ARE UNABLE TO PAY THE REMAINING BALANCE LEFT BY THEIR INSURANCE; AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES OR SPECIAL FINANCIAL HARDSHIP WARRANT SPECIAL CONSIDERATION.LAKEVIEW HOSPITAL IS COMPLIANT WITH THE 501R FEDERAL REGULATIONS, AND PROVIDES EASY ACCESS TO THE FINANCIAL ASSISTANCE PROGRAM INCLUDING THE FINANCIAL ASSISTANCE POLICY (FAP), APPLICATION, AND PLAIN LANGUAGE SUMMARY. THE FINANCIAL ASSISTANCE PROGRAM AND LISTS OF PROVIDERS COVERED BY THE PROGRAM IS ALSO WIDELY PUBLICIZED AND AVAILABLE ON LAKEVIEW HOSPITAL'S WEBSITE.TO INFORM AND EDUCATE PATIENTS ABOUT THE FINANCIAL ASSISTANCE PROGRAM, FINANCIAL ASSISTANCE POLICY, AND GOVERNMENT PROGRAMS, EACH PATIENT IS OFFERED AND PROVIDED WITH THE FINANCIAL ASSISTANCE PROGRAM POLICY AT REGISTRATION. THIS INFORMATION IS ALSO IS ALSO PROVIDED IN PUBLIC LOCATIONS, INCLUDING REGISTRATION, ON PATIENT STATEMENTS, AND LAKEIVEW HOSPITAL'S PUBLIC WEBSITE, HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/LAKEVIEW/.IN ADDITION TO FINANCIAL COUNSELING, THE HOSPITAL HAS STAFF SOCIAL WORKERS AND CASE MANAGERS TO HANDLE CRISIS INTERVENTIONS, EMERGENCY ROOM NEEDS, AND PATIENT AFTERCARE.TO INFORM AND EDUCATE PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE, EACH PATIENT BILLING STATEMENT AND COLLECTIONS LETTER PRODUCED BY LAKEVIEW HOSPITAL INCLUDE THE FOLLOWING NOTICE: LAKEVIEW HOSPITAL OFFERS A FINANCIAL ASSISTANCE PROGRAM. FOR COPIES OF OUR APPLICATION, FINANCIAL ASSISTANCE POLICY, AND PLAIN LANGUAGE SUMMARY, WHICH INCLUDE INFORMATION ON ELIGIBILITY AND HOW WE CALCULATE FINANCIAL ASSISTANCE, PLEASE VISIT HTTPS://WWW.HEALTHPARTNERS.COM/CARE/HOSPITALS/LAKEVIEW/. OUR PATIENT FINANCIAL SERVICES TEAM CAN HELP YOU ENROLL IN THIS PROGRAM. PLEASE CALL 651-430-4533.
PART VI, LINE 4:	LAKEVIEW HOSPITAL SERVES THE EASTERN TWIN CITIES' METRO AREA AND WESTERN WISCONSIN. LAKEVIEW HOSPITAL'S CORE SERVICE AREA INCLUDES STILLWATER, BAYPORT, LAKE ELMO, LAKELAND, AND MARINE ON ST. CROIX, MN ALONG WITH HOULTON AND SOMERSET, WI. PRIMARY SERVICE AREAS ARE HUDSON, NEW RICHMOND AND STAR PRAIRIE, WI, AND AFTON, MN. SECONDARY SERVICE AREAS ARE NEARBY CITIES IN EASTERN MINNESOTA AND WESTERN WISCONSIN.
PART VI, LINE 5:	LAKEVIEW HOSPITAL PROVIDED EDUCATION SCHOLARSHIPS TO PEOPLE WITH DIABETES THAT REQUIRED NUTRITION AND LIFE-STYLE EDUCATION; THEY ALSO PROVIDED FREE LAB AND PHARMACY SERVICES FOR PATIENTS OF THE ST. CROIX FAMILY MEDICAL CENTER, A LOCAL MEDICAL CLINIC THAT PROVIDES FREE AND DISCOUNTED SERVICES FOR INDIGENT AND LOW INCOME PATIENTS OF THE AREA. FOR ADDITIONAL DISCUSSION, SEE FORM 990, SCHEDULE O - "EXEMPT PURPOSE AND ACHIEVEMENTS".
PART VI, LINE 6:	AS A MEMBER OF LAKEVIEW HEALTH, LAKEVEIW HOSPITAL PARTICIPATES WITH THE MULTI-SPECIALTY CLINIC AND HEALTH SYSTEM LEADERSHIP WITHIN OUR OVERALL ORGANIZATION IN PROVIDING ACCESS TO CARE, SUPPORT GROUPS, EDUCATIONAL ACTIVITIES, AND FINANCIAL CONTRIBUTIONS TO THE MARKET AREA DESCRIBED ABOVE. THE MULTI-SPECIALTY CLINIC FURTHER PARTICIPATES IN MINNESOTA COMMUNITY MEASUREMENT, PRACTICES AND MEASURES PROVIDER, PERFORMANCE WITH SPECIFIC PREVENTIVE CARE METRICS AND SPECIFIC CHRONIC DISEASE MANAGEMENT METRICS. IN 2011, LAKEVIEW HEALTH AFFILIATED WITH HEALTHPARTNERS. THE MISSION OF HEALTHPARTNERS IS TO IMPROVE HEALTH AND WELL-BEING IN PARTNERSHIP WITH OUR MEMBERS, PATIENTS AND COMMUNITY.
PART VI, LINE 7, REPORTS FILED WITH STATES	MN

Schedule H (Form 990) 2021

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
LAKEVIEW MEMORIAL HOSPITAL
ASSOCIATION INC

Employer identification number
41-0811697

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) FAMILY MEANS 1875 NORTHWESTERN AVENUE STILLWATER,MN55082	41-6045574	501 (C)(3)	30,500	PROGRAM SUPPORT
(2) CANVAS HEALTH 7066 STILLWATER BLVD N OAKDALE,MN55128	41-0955577	501 (C)(3)	17,500	PROGRAM SUPPORT
(3) YOUTH SERVICE BUREAU 101 W PINE ST STILLWATER,MN55082	41-1333578	501 (C)(3)	10,000	PROGRAM SUPPORT
(4) COMMUNITY THREAD 2300 ORLEANS ST W STILLWATER,MN55082	41-0967271	501 (C)(3)	15,500	PROGRAM SUPPORT
(5) VALLEY OUTREACH 1901 CURVE CREST BLVD W STILLWATER,MN55082	41-1452973	501 (C)(3)	13,500	PROGRAM SUPPORT
(6) ST ANDREW'S LUTHERAN CHURCH 900 STILLWATER RD MAHTOMEDI,MN55115	41-0880458	501 (C)(3)	10,000	PROGRAM SUPPORT
(7) GREATER STILLWATER CHAMBER OF COMMERCE 333 MAIN ST N STE 202 STILLWATER,MN55082	41-1990512	501 (C)(3)	8,745	PROGRAM SUPPORT
(8) SILVER SOBRIETY INC 11550 STILLWATER BLVD N STE 103 LAKE ELMO,MN55042	47-3080139	501 (C)(3)	10,000	PROGRAM SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2021

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PART I, LINE 2:	LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION, INC. (THE HOSPITAL) MANAGEMENT STAFF REVIEWS THE MISSION AND PURPOSE OF POTENTIAL GRANTEE ORGANIZATIONS TO ASSURE CONSISTENCY WITH THE HOSPITAL'S MISSION AND PURPOSE. AMOUNTS SUBSEQUENTLY GRANTED ARE SUBJECT TO THE HOSPITAL'S FORMAL SPENDING APPROVAL AND DOCUMENTATION PROCESS BASED ON AMOUNT OF THE EXPENDITURE.

Schedule I (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

LAKEVIEW MEMORIAL HOSPITAL
ASSOCIATION INC

Employer identification number

41-0811697

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Yes

Any related organization? ......................

Yes

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1SCOTT A AEBISCHER DIRECTOR	(i) (ii)	0 ------------- 268,260	0 ------------- 83,000	0 ------------- 2,702,747	0 ------------- 5,061	0 ------------- 70,601	0 ------------- 3,129,669	0 ------------- 2,668,878
2MEGAN M REMARK DIRECTOR	(i) (ii)	0 ------------- 588,476	0 ------------- 116,000	0 ------------- 59,635	0 ------------- 192,540	0 ------------- 43,806	0 ------------- 1,000,457	0 ------------- 37,665
3NANCY L EVERT SECRETARY & GENERAL COUNCS	(i) (ii)	0 ------------- 485,640	0 ------------- 96,000	0 ------------- 19,339	0 ------------- 144,276	0 ------------- 27,303	0 ------------- 772,558	0 ------------- 15,979
4BRETT C HAAKE MD DIRECTOR	(i) (ii)	0 ------------- 518,850	0 ------------- 79,000	0 ------------- 12,256	0 ------------- 48,868	0 ------------- 41,831	0 ------------- 700,805	0 ------------- 0
5DOUGLAS E JOHNSON CFO	(i) (ii)	334,804 ------------- 0	49,000 ------------- 0	26,857 ------------- 0	198,123 ------------- 0	35,416 ------------- 0	644,200 ------------- 0	0 ------------- 0
6PATRICK T COURNEYA DIRECTOR	(i) (ii)	0 ------------- 446,000	0 ------------- 61,000	0 ------------- 17,922	0 ------------- 75,506	0 ------------- 40,596	0 ------------- 641,024	0 ------------- 0
7THOMAS S ANDERSON VP MEDICAL AFFAIRS	(i) (ii)	0 ------------- 328,854	0 ------------- 12,000	0 ------------- 116,917	0 ------------- 15,498	0 ------------- 38,816	0 ------------- 512,085	0 ------------- 0
8THEODORE T WEGLEITNER DIRECTOR & PRESIDENT (JAN-JUNE)	(i) (ii)	0 ------------- 227,505	0 ------------- 91,000	0 ------------- 62,898	0 ------------- 11,233	0 ------------- 27,549	0 ------------- 420,185	0 ------------- 46,259
9MATTHEW A RICHIE DIRECTOR & VP ADMINISTRATO	(i) (ii)	0 ------------- 287,004	0 ------------- 43,000	0 ------------- 4,540	0 ------------- 14,976	0 ------------- 28,536	0 ------------- 378,056	0 ------------- 0
10BRIAN L CRESS MD DIRECTOR	(i) (ii)	0 ------------- 246,548	0 ------------- 0	0 ------------- 73,547	0 ------------- 15,499	0 ------------- 37,626	0 ------------- 373,220	0 ------------- 0
11ANDREW E DORWART MD FORMER SMG PRESIDENT	(i) (ii)	0 ------------- 244,163	0 ------------- 48,000	0 ------------- 14,448	0 ------------- 15,493	0 ------------- 37,978	0 ------------- 360,082	0 ------------- 0
12KEVIN J BJORK MD DIRECTOR	(i) (ii)	0 ------------- 278,489	0 ------------- 0	0 ------------- 9,296	0 ------------- 15,499	0 ------------- 23,256	0 ------------- 326,540	0 ------------- 0
13MICHAEL D WEIS CRNA	(i) (ii)	206,082 ------------- 0	16,000 ------------- 0	38,209 ------------- 0	14,382 ------------- 0	33,642 ------------- 0	308,315 ------------- 0	0 ------------- 0
14JUSTIN R CUSICK CRNA	(i) (ii)	189,940 ------------- 0	0 ------------- 0	51,608 ------------- 0	12,240 ------------- 0	33,366 ------------- 0	287,154 ------------- 0	0 ------------- 0
15NATHAN S PULSCHER VP ANCILLARY SERVICES	(i) (ii)	195,830 ------------- 0	20,000 ------------- 0	20,063 ------------- 0	12,833 ------------- 0	33,284 ------------- 0	282,010 ------------- 0	0 ------------- 0
16ROBBI A HAGELBERG VP OF OPERATIONS & CNO	(i) (ii)	219,210 ------------- 0	22,000 ------------- 0	500 ------------- 0	13,735 ------------- 0	21,386 ------------- 0	276,831 ------------- 0	0 ------------- 0
17MICHAEL S KENNEDY CRNA	(i) (ii)	176,365 ------------- 0	0 ------------- 0	38,616 ------------- 0	11,971 ------------- 0	30,659 ------------- 0	257,611 ------------- 0	0 ------------- 0
18JASON D TAUZELL CRNA	(i) (ii)	191,853 ------------- 0	0 ------------- 0	20,139 ------------- 0	11,843 ------------- 0	32,941 ------------- 0	256,776 ------------- 0	0 ------------- 0
19CATHY J MANLEY CRNA	(i) (ii)	189,058 ------------- 0	0 ------------- 0	29,187 ------------- 0	10,177 ------------- 0	0 ------------- 0	228,422 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 3	LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION ( LAKEVIEW HOSPITAL) PRESIDENT AND ITS OFFICERS ARE EMPLOYED BY GROUP HEALTH PLAN, INC. (GHI), STILLWATER MEDICAL GROUP (SMG) WHICH ARE RELATED ORGANIZATIONS OR BY LAKEVIEW HOSPITAL. GHI, SMG AND LAKEIVEW HOSPITAL HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF LAKEVIEW HOSPITAL'S PRESIDENT AND OTHER OFFICERS.
PART I, LINE 4B	DEFERRED COMPENSATION IN COLUMN C OF SCHEDULE J, PART II INCLUDES AMOUNTS FROM A NONQUALIFIED 457(F) PLAN FOR THE FOLLOWING DIRECTORS AND OFFICERS: MEGAN M. REMARK $ 30,639 NANCY L. EVERT $ 41,170 PATRICK T. COURNEYA $ 36,517
PART I, LINE 6	LAKEVIEW HOSPITAL'S OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE EMPLOYED BY SMG, LAKEVIEW HOSPITAL OR BY GROUP HEALTH PLAN, INC. (GHI). THE HOSPITAL AND GHI ARE BOTH RELATED ORGANIZATIONS. COMPENSATION REPORTED IN FORM 990, PART VIII INCLUDES ANY COMPENSATION DERIVED FROM EITHER SMG'S, THE HOSPITAL'S, OR GHI'S MANAGEMENT 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 PROGRAMS ARE A KEY ELEMENT OF THE PARTICIPANT'S TOTAL COMPENSATION PACKAGE. THE MANAGEMENT INCENTIVE PROGRAMS' REWARDS ARE BASED ON POSITION IN THE ORGANIZATION (E.G. SENIOR VICE PRESIDENT, VICE PRESIDENT, DIRECTOR, MANAGER, AND OTHER SPECIFICALLY IDENTIFIED LEADERS) AND THE ACHIEVEMENT OF BUSINESS AND HEALTH IMPROVEMENT GOALS ESTABLISHED IN A VARIETY OF AREAS. THESE AREAS MAY INCLUDE, BUT ARE NOT LIMITED TO, PATIENT SATISFACTION, EMPLOYEE SATISFACTION, WORK ENVIRONMENT, HEALTH EQUITY, HEALTHCARE AFFORDABILITY MEASURES, HEALTH CARE AND CARE DELIVERY MARKET SHARE, STRATEGIC CAPABILITIES, HOSPITAL AND CLINIC QUALITY MEASURES, FINANCIAL PERFORMANCE (OPERATING INCOME), ETC., AND WILL BE DEFINED ANNUALLY FOR EACH YEAR'S PROGRAM. A NET OPERATING MARGIN 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, SCHEDULE J, PART II, COLUMN F: PRIOR REPORTED COMPENSATION	COLUMN (F) INCLUDES AMOUNTS PAID TO PARTICIPANTS IN THE CURRENT YEAR, WHICH WERE PREVIOUSLY REPORTED IN COLUMN (C) OF PRIOR YEARS' 990'S, AS RETIREMENT AND DEFERRED COMPENSATION, FOR THE FOLLOWING DIRECTOR: SCOTT A. AEBISCHER $ 2,668,878 MEGAN M. REMARK $ 37,665 THEODORE T. WEGLENITER $ 46,259 NANCY L. EVERT $ 15,979 ANY ANALYSIS OF EARNINGS FOR THE CURRENT YEAR, FOR THESE PARTICIPANTS OF THE PLAN, SHOULD EXCLUDE THE AMOUNT IN COLUMN F AS PART OF THE ANALYSIS SINCE THOSE EARNINGS WERE ALREADY REPORTED IN COLUMN (C) OF PREVIOUS YEARS' 990'S.

Schedule J (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

LAKEVIEW MEMORIAL HOSPITAL
ASSOCIATION INC

Employer identification number

41-0811697

Return Reference	Explanation
990, PART III, LINE 4A: EXEMPT PURPOSE AND ACHIEVEMENTS	CORPORATE STRUCTURE, PURPOSE, GOVERNANCE LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION (LAKEVIEW HOSPITAL) IS A MINNESOTA NONPROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER INTERNAL REVENUE CODE ("IRC") SECTION 501(C)(3) AND IS PART OF THE FAMILY OF HEALTHPARTNERS ORGANIZATIONS ("HEALTHPARTNERS"). 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 1.32 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 2021 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, INC. (HPI) IS THE PARENT ENTITY OF HEALTHPARTNERS AND IS A MINNESOTA NONPROFIT 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 NONPROFIT 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, LAKEVIEW HEALTH (LH), 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). LAKEVIEW HEALTH IS THE SOLE CORPORATE MEMBER OF LAKEVIEW HOSPITAL. LAKEVIEW HOSPITAL AND LAKEVIEW HEALTH ARE PART OF THE LAKEVIEW HEALTH SYSTEM ALONG WITH THE LAKEVIEW HEALTH FOUNDATION, A MINNESOTA 501(C) (3) TAX EXEMPT ORGANIZATION (THE FOUNDATION) AND STILLWATER MEDICAL GROUP (SMG), A MINNESOTA 501(C) (3) TAX EXEMPT ORGANIZATION. LAKEVIEW HEALTH IS ALSO THE SOLE CORPORATE MEMBER OF THE FOUNDATION AND SMG. HEALTHPARTNERS AND LAKEVIEW HOSPITAL ALSO PARTNER WITH OTHER PLANS, CARE PROVIDERS AND NONPROFIT ORGANIZATIONS IN THE REGION AND THROUGHOUT THE NATION; TO INCREASE ACCESS, CREATE AND DISSEMINATE QUALITY MEASURES AND INITIATIVES, PARTICIPATE IN DEVELOPMENT OF PUBLIC POLICY AND COLLABORATE ON SYSTEM IMPROVEMENTS. LAKEVIEW HOSPITAL CONTINUES TO BE AN INTEGRAL PART OF THE STILLWATER COMMUNITY AND SURROUNDING AREA A VITAL AND NECESSARY COMMUNITY RESOURCE SINCE 1880, THE FIFTH OLDEST HOSPITAL, AND SECOND OLDEST CONTINUALLY OPERATING HOSPITAL IN MINNESOTA. THE HOSPITAL CONVENES AND SUPPORTS MULTIPLE COMMUNITY COLLABORATIVES TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITY. LAKEVIEW HOSPITAL IS DESIGNATED A LEVEL 3 TRAUMA HOSPITAL AND HAS MEDICAL STAFF IN A VARIETY OF SPECIALTIES, INCLUDING FAMILY MEDICINE, INTERNAL MEDICINE, PEDIATRICS, OB/GYN WITH A LEVEL II NURSERY, GENERAL SURGERY, ORTHOPEDICS, OTOLARYNGOLOGY, OCCUPATIONAL HEALTH, EMERGENCY MEDICINE, HOSPITAL MEDICINE, NEUROLOGY, ONCOLOGY, UROLOGY, CARDIOLOGY, SPORTS MEDICINE, GASTROENTEROLOGY, RADIOLOGY, PATHOLOGY AND ANESTHESIOLOGY. COURTESY AND CONSULTING STAFF PROVIDE ADDITIONAL SERVICES, INCLUDING PAIN MANAGEMENT, INFECTIOUS DISEASE, PULMONARY/SLEEP MEDICINE, AND ORAL SURGERY. CHARITY CARE: CHARITY CARE IS DEFINED AS THE COST OF CARE DELIVERED TO PATIENTS WHO ARE WILLING, BUT UNABLE TO PAY FOR THE SERVICES THEY RECEIVE. THIS INCLUDES PATIENTS WHOSE CHARGES ARE FORGIVEN OR REDUCED BECAUSE OF INABILITY TO PAY; PATIENTS WHO ARE UNABLE TO PAY THE BALANCE LEFT BY ANY PAYER; AND PATIENTS FOR WHOM UNUSUAL CIRCUMSTANCES, OR SPECIAL FINANCIAL HARDSHIP, WARRANT SPECIAL CONSIDERATION. WITH ALL HEALTH CARE ENTITIES COMBATING A WORLDWIDE PANDEMIC, 2021 WAS YET ANOTHER UNPRECEDENTED YEAR. LAKEVIEW HOSPITAL VOLUMES WERE STILL DOWN IN 2021 COMPARED TO PRE-COVID VOLUMES, WHICH MEANT FEWER PEOPLE MAY HAVE QUALIFIED FOR DISCOUNTED CARE, RESULTING IN DECREASED CHARITY-CARE SPENDING. MOREOVER, OUR UNINSURED COVID PATIENTS QUALIFIED FOR THE HRSA PROGRAM AND DID NOT HAVE TO APPLY FOR CHARITY OR MEDICAL ASSISTANCE. IN-PERSON COMMUNITY SUPPORT WAS LIMITED, AS WAS PARTICIPATION IN ALMOST EVERY COMMUNITY PROGRAM. WHILE THE NEED FOR COMMUNITY SUPPORT WAS GREATER THAN EVER IN MANY CASES, HOSPITALS TURNED THEIR FOCUS TO PEOPLE'S IMMEDIATE CONCERNS AND LOOKED FOR NEW APPROACHES TO SERVING NEEDS. LAKEVIEW HOSPITAL PROVIDED $1,350,923 IN FREE OR DISCOUNTED CARE TO LOW INCOME AND UNINSURED PATIENTS IN 2021. GOVERNMENT-SPONSORED MEANS-TESTED HEALTH CARE: LAKEVIEW HOSPITAL PROVIDED INPATIENT AND OUTPATIENT CARE, INCLUDING EMERGENCY DEPARTMENT SERVICES TO MEDICAID PATIENTS. PAYMENTS RECEIVED FOR THESE SERVICES WERE BELOW THE COST OF CARE PROVIDED. THE EXPENSE TO COVER UNREIMBURSED MEDICAID COSTS FOR PATIENTS TOTALED $1,650,930. THE COST INCURRED FOR OTHER MEANS-TESTED GOVERNMENT PROGRAMS WAS $4,025,234.
PART III CONT.	COMMUNITY BENEFIT SERVICES: 1. COMMUNITY HEALTH IMPROVEMENT SERVICES: $525,253 LAKEVIEW HOSPITAL IS COMMITTED TO COMMUNITY HEALTH IMPROVEMENT SERVICES, WHICH INCLUDE A RANGE OF ACTIVITIES CARRIED OUT TO IMPROVE COMMUNITY HEALTH BEYOND PATIENT CARE. BELOW ARE HIGHLIGHTS OF SUCH ACTIVITIES THAT FALL WITHIN THE CATEGORIES OF COMMUNITY HEALTH EDUCATION, COMMUNITY-BASED CLINICAL SERVICES, HEALTH CARE SUPPORT SERVICES AND SOCIAL AND ENVIRONMENTAL IMPROVEMENT. EACH YEAR, LAKEVIEW HOSPITAL HELPS EDUCATE THE LOCAL COMMUNITIES ABOUT HEALTH TOPICS BY PROVIDING THEM WITH A VARIETY OF COMMUNITY EDUCATION. WHILE THE COVID-19 PANDEMIC AND SUBSEQUENT PAUSE OF NEARLY ALL IN-PERSON ACTIVITIES, CLASSES AND EVENTS CONTINUED IN 2021, WE CONTINUED TO ADAPT AND SERVE OUR COMMUNITIES IN DIGITAL/VIRTUAL FORMATS. OVER 50 VIRTUAL CLASSES, EVENTS, AND PODCASTS WERE CARRIED OUT ON A VARIETY OF TOPICS, INCLUDING: STRESS RELIEF, BUILDING RESILIENCE IN CHILDREN, SUICIDE PREVENTION, DEMENTIA, HIGH BLOOD PRESSURE, AND HOW TO SUPPORT LOVED ONES IN RECOVERY. IN TOTAL, THESE HAVE BEEN ACCESSED OVER 3,500 TIMES. ONLINE CHILDBIRTH AND BREASTFEEDING CLASSES WERE ALSO OFFERED 22 TIMES, REACHING APPROXIMATELY 300 INDIVIDUALS. MAKE IT OK IS A COMMUNITY CAMPAIGN TO HELP END THE STIGMA OF MENTAL ILLNESSES. DESPITE THE MANY CHALLENGES FACED DURING COVID 19 RESTRICTIONS, MAKE IT OK REACHED THOUSANDS THROUGH VIRTUAL AND IN-PERSON EVENTS, TRAININGS, PRESENTATIONS, MESSAGING EFFORTS, AND OUR NETWORK OF AMBASSADORS AND COMMUNITY PARTNERS. OUR HOSPITAL'S 2021 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), IDENTIFIED MENTAL HEALTH AND WELL-BEING AS THE NUMBER ONE COMMUNITY HEALTH PRIORITY, REAFFIRMING THE IMPORTANCE OF MAKE IT OK AND FOCUSING THE EFFORT. REDUCING STIGMA AND CREATING CARING COMMUNITIES ARE KEY STRATEGIES OF THAT PRIORITY. MAKE IT OK UPDATED CONTENT AND MATERIALS FOR TRAINING, WEBSITE AND ONLINE TOOLKITS. 2021 MAKE IT OK IMPACT INCLUDED MORE THAN: - 270 NEW MAKE IT OK AMBASSADORS TRAINED THROUGH 17 TRAINING SESSIONS - 630 PARTICIPANTS IN 32 VIRTUAL MAKE IT OK PRESENTATIONS -1500 ENGAGED IN MAKE IT OK THROUGH SEVEN OUTDOOR COMMUNITY EVENTS THE POWERUP INITIATIVE CONTINUES TO FOCUS PROGRAMS, CLASSES AND RESOURCES TO INSPIRE KIDS AND FAMILIES TO EAT BETTER, MOVE MORE AND FEEL GOOD. POWERUP PROVIDES NUMEROUS PROGRAMS, CLASSES AND RESOURCES TO THE COMMUNITY, INCLUDING SCHOOL CHALLENGE, A COMPREHENSIVE WEBSITE (POWERUP4KIDS.ORG), COOKING CLASSES, PRINT RESOURCES ON NUTRITION AND PHYSICAL ACTIVITY AND COMMUNITY PARTNERSHIPS TO CREATE HEALTHY COMMUNITIES. WITH A STRONG COMMITMENT TO HEALTH EQUITY, POWER UP RESOURCES FOCUS ON BEING INCLUSIVE, DIVERSE AND WELCOMING FOR ALL KIDS, FAMILIES, AND COMMUNITY. WITH A FOCUS ON VIRTUAL TOOLS TO INCREASE ACCESS, POWERUP DEVELOPED TWO NEW LIVE VIRTUAL COOKING CLASSES AND TWO NEW KIDS COOKING CLASS VIDEOS WITH A LOCAL COOKING SCHOOL PARTNER. IN ADDITION, TWO NEW FAMILY MAGAZINES WERE DEVELOPED WITH A FOCUS ON FAMILY PHYSICAL ACTIVITY AND MINDFULNESS. 2021 POWERUP IMPACT INCLUDED MORE THAN: - 78,000 REACHED VIRTUALLY, THROUGH CLASSES, EVENTS, WEBSITES, AND E-NEWSLETTERS - 41,000 WITH THE POWERUP PRESS FAMILY NEWSLETTERS DISTRIBUTED TO FAMILIES, SCHOOLS AND COMMUNITY - 8,000 STUDENTS PARTICIPATED IN THE POWERUP SCHOOL CHALLENGE ACROSS 24 ELEMENTARY SCHOOLS THROUGHOUT THE ST. CROIX VALLEY - 4,100 PEOPLE ENGAGED THROUGH 20 OUTDOOR EVENTS LAKEVIEW HOSPITAL IS COMMITTED TO PROVIDING SEVERAL HEALTH CARE SUPPORT SERVICES, INTENDED TO INCREASE ACCESS AND QUALITY OF CARE IN HEALTH SERVICES TO INDIVIDUALS, ESPECIALLY PERSONS LIVING IN POVERTY AND THOSE IN OTHER VULNERABLE POPULATIONS. THESE SUPPORT SERVICES INCLUDE: NURSE NAVIGATORS FOR BREAST HEALTH AND CANCER CARE, OUTREACH CHAPLAINCY SERVICES, FAITH COMMUNITY NURSING, PRESCRIPTION ASSISTANCE/PATIENT EMERGENCY FUND, SOCIAL WORKERS PROVIDING SUPPORT ABOVE AND BEYOND STANDARD OF PRACTICE, AND ADVANCE CARE DIRECTIVES ASSISTANCE. 2. HEALTH PROFESSIONS EDUCATION: $ 257,374 IN 2021, LAKEVIEW HOSPITAL PROVIDED CLINICAL TRAINING FOR STUDENTS IN THE FOLLOWING FIELDS: NURSING (65), PHARMACY (17), RESIDENT PHYSICIANS (28), PHYSICIAN ASSISTANTS (23), PHYSICIANS (22). 3. SUBSIDIZED HEALTH SERVICES: $4,558,368 LAKEVIEW HOSPITAL IS COMMITTED TO PROVIDING NEEDED SERVICES, EVEN AT A FINANCIAL LOSS. IN 2021, SUBSIDIZED HEALTH SERVICES INCLUDED: OUTPATIENT DIABETES AND NUTRITION, INPATIENT LABOR AND DELIVERY AND NURSERY, AND HOMECARE SERVICES. 4. CASH AND IN-KIND CONTRIBUTIONS: $204,886 LAKEVIEW HOSPITAL HELPED VARIOUS NON-PROFIT ORGANIZATIONS, COMMUNITY GROUPS, AND SCHOOL PROGRAMS THROUGH CASH DONATIONS AND SPONSORSHIPS. THE FOLLOWING ARE A FEW EXAMPLES OF ORGANIZATIONS AND PROGRAMS THAT WERE SUPPORTED VIA SPONSORSHIPS OR CASH DONATIONS FOR OVERALL COMMUNITY BENEFIT: YELLOW RIBBON ALLIANCE, MARCH OF DIMES, SCHEUERMAN YOUTH FUND, AND COURAGE KENNY FOUNDATION. IN ADDITION, ON BEHALF OF LAKEVIEW HOSPITAL, THE FOUNDATION ADMINISTERS GRANTS, WHICH ARE APPROVED BY LAKEVIEW HOSPITAL'S GRANT COMMITTEE. IN 2021, 13 GRANTS WERE GIVEN TO LOCAL COMMUNITY ORGANIZATIONS, INCLUDING CANVAS HEALTH, COMMUNITY THREAD, VALLEY OUTREACH, FAMILY MEANS, YOUTH SERVICE BUREAU, SILVER SOBRIETY INC, AND ST. ANDREWS CHURCH. IN-KIND DONATIONS INCLUDE STAFF HOURS SPENT IN SUPPORT OF LOCAL COMMUNITY BOARDS OR COMMITTEE WORK. LAKEVIEW HOSPITAL HOSTED ONE BLOOD DRIVE IN 2021, IN SUPPORT OF THE AMERICAN RED CROSS. 5. COMMUNITY BUILDING ACTIVITIES: $ 53,749 IN 2021, COVID-19 CONTINUED TO AFFECT OUR ENTIRE COMMUNITY, INCLUDING OUR EMPLOYEES AND THEIR FAMILIES. RESPONDING TO THE PANDEMIC TO SERVE AND SAFEGUARD PATIENTS AND COMMUNITY MEMBERS WAS A PRIORITY, ESPECIALLY REGARDING VACCINE ROLLOUT. MORE THAN 61,000 COVID-19 VACCINATIONS AND BOOSTERS HAVE BEEN ADMINISTERED TO PEOPLE IN OUR ST. CROIX VALLEY COMMUNITIES IN 2021. IN ADDITION, CLEAR AND EFFECTIVE PUBLIC HEALTH MESSAGING RELATED TO THE VACCINE ROLLOUT, SURGES, VARIANTS, RESEARCH, EQUITY, DRIVE-UP SITES, MONOCLONAL ANTIBODIES, MANDATES, AND CAPACITY HAVE BEEN CENTRAL TO OUR RESPONSE AND BUILDING COMMUNITY TRUST AND AWARENESS. LAKEVIEW HOSPITAL PROVIDES LEADERSHIP AND PARTICIPATES IN SEVERAL STRATEGIC COMMUNITY COLLABORATIONS AND INITIATIVES, INCLUDING: COMMUNITY HEALTH ACTION TEAM, CONNECT TO PREVENT AND REDUCE YOUTH ALCOHOL, TOBACCO AND OTHER DRUG USE, WASHINGTON COUNTY COMMUNITY LEADERSHIP TEAM, WASHINGTON COUNTY PUBLIC HEALTH, METRO HEALTHCARE COALITION, REGIONAL HOSPITAL LIAISON PLANNING. LAKEVIEW HOSPITAL CONTINUOUSLY FOCUSES ON SUSTAINABILITY EFFORTS. THE HOSPITAL COLLECTED 143 TONS OF MATERIALS, WHICH WERE REUSED AND RECYCLED, THEREBY KEPT OUT OF THE LANDFILL; $129,000 WAS SAVED THROUGH THE LAKEVIEW SUSTAINABILITY PROGRAM IN 2021. THE MEDICATION TAKE BACK PROGRAM COLLECTS UNUSED PRESCRIPTION MEDICATIONS IN A SECURE MANNER TO PREVENT ACCIDENTAL POISONING OR MISUSE AND PREVENT MEDICATIONS FROM ENTERING THE WATER AND DRINKING WATER. GREENING THE OR IS AN INITIATIVE TO REDUCE WASTE ALONG WITH CERTAIN TYPES OF GASES THAT DAMAGE THE OZONE. THIS INITIATIVE IN THE OPERATING ROOM RESULTED IN $84,182 OF SAVINGS DURING 2021. LAKEVIEW HOSPITAL REDUCES FOOD WASTE FROM THE CAFETERIA BY FEEDING PIG LIVESTOCK THROUGH THE FOODTOHOGS PROGRAM. LAKEVIEW HOSPITAL'S EMERGENCY MEDICAL SERVICES (EMS) DEPARTMENT PROVIDES EVENT COVERAGE IN THE SURROUNDING COMMUNITIES, WHICH SUPPORT COALITION BUILDING WITH COMMUNITY PARTNERS AS WELL AS REDUCE RESPONSE TIME TO INJURIES.
PART III CONT.	6. COMMUNITY BENEFIT OPERATIONS: $72,147 STAFF TIME IS ALLOCATED TO THE TRAINING, MANAGEMENT, AND REPORTING OF COMMUNITY BENEFITS TO BEST CAPTURE THE HOSPITAL'S COMMITMENT TO COMMUNITY HEALTH IMPROVEMENT. HEALTHPARTNERS AND LAKEVIEW HOSPITAL CONTRACTED WITH THE CENTER FOR EVALUATION AND SURVEY RESEARCH (CESR), PART OF HEALTHPARTNERS INSTITUTE, TO COMPLETE THE 2021 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THE CHNA IS COMPRISED OF MULTIPLE DATA SOURCES, MANY EXISTING FOR OTHER PRIMARY PURPOSES, WHILE OTHERS WERE COLLECTED SPECIFICALLY FOR THIS PURPOSE. TYPES OF DATA CESR GATHERED INCLUDE HEALTHPARTNERS ADMINISTRATIVE DATA, HEALTHPARTNERS PATIENT AND MEMBER-REPORTED DATA COLLECTED PRIMARILY FOR EVALUATION OF HEALTHPARTNERS COMMUNITY INITIATIVES OR OPERATIONAL PURPOSES, AND PUBLICLY AVAILABLE DATA DESCRIBING BOTH DEMOGRAPHIC CHARACTERISTICS AND HEALTH AND WELL-BEING OUTCOMES. 7. ORGANIZATION AWARDS AND ACHIEVEMENTS DESPITE 2021 BEING FOCUSED ON COVID, WE ARE VERY PROUD THAT OUR HOSPITAL CONTINUED ITS NATIONAL AWARD-WINNING TRADITIONS OF EXCEPTIONAL CARE AND PERFORMANCE IN ALL AREAS. HERE ARE A FEW OF THE HIGHLIGHTS FROM 2021: - RECEIVED A FIVE-STAR RATING FROM THE CENTERS FOR MEDICARE AND MEDICAID (CMS) AND WAS RECOGNIZED NATIONALLY FOR QUALITY IN HIP FRACTURES, HIP AND KNEE JOINT REPLACEMENT, AND PATIENT SAFETY. - CMS AWARDED A FIVE-STAR RATING IN THE OVERALL HOSPITAL QUALITY STAR RATINGS ON THE HOSPITAL COMPARE WEBSITE. LAKEVIEW WAS AMONG THE 455 HOSPITALS OUT OF 3,355 ACROSS THE U.S. THAT WERE AWARDED A FIVE-STAR RATING. - THE LEAPFROG GROUP AWARDED AN EIGHTH A GRADE FOR PATIENT SAFETY IN MAY AND A NINTH A GRADE FOR PATIENT SAFETY IN NOVEMBER. - US NEWS & WORLD REPORT RECOGNITION AS A HIGH-PERFORMING HOSPITAL IN HIP REPLACEMENT, KNEE REPLACEMENT, HIP FRACTURE.
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE MEMBER IS LAKEVIEW HEALTH.
FORM 990, PART VI, SECTION A, LINE 7A	THE SOLE MEMBER RATIFIES THE PERSONS ELECTED TO LAKEVIEW HOSPITAL BOARD, AT LEAST 75% OF WHOM MUST BE COMMUNITY LEADERS. THE PRESIDENT OF THE SOLE MEMBER SERVES AS AN EX OFFICIO NON-VOTING HOSPITAL BOARD MEMBER. ADDITIONALLY, HEALTHPARTNERS AS THE SOLE MEMBER OF LAKEVEIW HEALTH APPOINTS ONE PERSON TO THE LAKEVIEW HOSPITAL BOARD.THE PERSONS WHO SERVE AS THE BOARD OF DIRECTORS OF LAKEVIEW HEALTH ALSO SERVE AS BOARD OF DIRECTORS OF LAKEVIEW HOSPITAL, INCLUDING 9 COMMUNITY MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7B	THE SOLE MEMBER HAS CUSTOMARY POWERS INCLUDING APPROVAL OF HIGHLY SIGNIFICANT ACTIONS OF LAKEVIEW HOSPITAL'S BOARD OF DIRECTORS. THESE INCLUDE AMENDMENT OF THE GOVERNING DOCUMENTS; APPROVAL OF STRATEGIC PLANS AND ANNUAL BUDGETS; MERGER, CONSOLIDATION OR SUBSTANTIAL AFFILIATION WITH ANOTHER ENTITY; APPOINTMENT OF THE PRESIDENT OF LAKEVIEW HOSPITAL; AND INCURRENCE OF DEBT.
FORM 990, PART VI, SECTION B, LINE 11B	LAKEVIEW HOSPITAL'S 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH PLAN, INC. (GHI), THE MANAGEMENT TEAM OF THE HOSPITAL, GHI'S INTERNAL LEGAL DEPARTMENT AND LAKEVIEW HOSPITAL'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 LAKEVIEW HOSPITAL. LAKEVIEW HOSPITAL 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 TO THE FULL BOARD OF DIRECTORS IN A PRE-MEETING PACKET, AND IS AN AGENDA ITEM AT THE MEETING. THIS PROCESS IS DOCUMENTED IN THE WRITTEN MEETING MINUTES.
FORM 990, PART VI, SECTION B, LINE 12C	LAKEVIEW HOSPITAL 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	LAKEVIEW MEMORIAL HOSPITAL ASSOCIATION (LAKEVIEW HOSPITAL) PRESIDENT AND ITS OFFICERS ARE EMPLOYED BY GROUP HEALTH PLAN, INC. (GHI), OR BY STILLWATER MEDICAL GROUP (SMG), BOTH OF WHICH ARE RELATED ORGANIZATIONS OR BY LAKEVIEW HOSPITAL. GHI, SMG AND LAKEVIEW HOSPITAL HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF LAKEVIEW HOSPITAL'S PRESIDENT AND OTHER OFFICERS. EVERY THREE YEARS, THE INDEPENDENT COMPENSATION COMMITTEE OF THE GHI BOARD OF DIRECTORS (THE "COMMITTEE"), RETAINS AN EXTERNAL COMPENSATION EXPERT TO CONDUCT AN EXTENSIVE MARKET COMPARABILITY REVIEW FOR ALL OFFICERS OF THE ORGANIZATION. THE REVIEW INCLUDES ALL COMPONENTS OF TOTAL COMPENSATION: BASE SALARY, ANNUAL INCENTIVES, BENEFITS AND PERQUISITES. THE MARKET SURVEY RESULTS ARE PRESENTED TO, REVIEWED BY AND APPROVED BY THE APPROPRIATE COMMITTEE. BASED ON THIS DATA, EITHER THE EXECUTIVE COMMITTEE OF THE LH OR THE COMPENSATION COMMITTEE OF GHI (THE "COMMITTEES") DETERMINE MINIMUM AND MAXIMUM TOTAL COMPENSATION RANGES ARE DETERMINED FOR EACH EMPLOYED OFFICER. IN INTERIM YEARS, GHI'S HUMAN RESOURCES STAFF, UNDER THE COMMITTEES' DIRECTION, UPDATES CHANGES IN THE SALARY STRUCTURE BASED ON THE SAME INDEPENDENT STUDIES PERFORMED BY THE COMPENSATION CONSULTANT FOR THE COMMITTEE. FOR CERTAIN POSITIONS FULL INDEPENDENT REVIEWS ARE PERFORMED TO SET SALARY RANGES BASED ON THE COMPETITIVE MARKET DATA SPECIFIC TO THOSE POSITIONS. THE COMMITTEES REVIEW AND APPROVE EACH YEAR'S COMPENSATION RESULTS. IN ALL CASES, THE COMMITTEES' MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY TO ASSURE THE COMMITTEES MEMBERS' INDEPENDENCE AND THIS IS UPDATED AT ANY MEETING AT WHICH DECISIONS ARE BEING MADE. STAFF (OTHER THAN THE SECRETARY TO THE BOARD) IS NOT IN THE ROOM DURING DELIBERATIONS OR VOTE INCLUDING EXECUTIVE SESSIONS, AND CONTEMPORANEOUS MINUTES ARE KEPT. WITH LAKEVIEW HOSPITAL'S BOARD OF DIRECTORS INPUT, THE PRESIDENT OF REGIONS HOSPITAL CONDUCTS THE ANNUAL PERFORMANCE REVIEW AND, WITH THE COMPENSATION COMMITTEE'S APPROVAL, DETERMINES THE COMPENSATION OF THE LAKEVIEW HOSPITAL PRESIDENT. THE BOARD HAS DELEGATED TO THE PRESIDENT THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL HOSPITAL-EMPLOYED OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE COMMITTEE. ANY EXCEPTIONS TO COMPENSATION IN EXCESS OF THE APPROVED RANGES ARE APPROVED BY THE COMPENSATION COMMITTEE OF THE LAKEVIEW HOSPITAL. TOTAL COMPENSATION IS APPROPRIATELY DOCUMENTED ON THE FORM 990 AND ON THE EMPLOYEE'S W-2.
FORM 990, PART VI, SECTION C, LINE 19	LAKEVIEW HOSPITAL'S FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM THE HOSPITAL OR HEALTHPARTNERS. LAKEVIEW HOSPITAL'S ARTICLES OF INCORPORATION ARE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION THROUGH THE MINNESOTA SECRETARY OF STATE'S OFFICE.
990, PART VII, SECT A, LN 1A, COL B: AVERAGE HOURS - RELATED ORGANIZATION	AVERAGE WEEKLY HOURS: THE COMPENSATED BOARD MEMBERS AND OFFICERS OF LAKEIVE HOSPITAL ARE EMPLOYED AND COMPENSATED BY LAKEVIEW HOSPITAL, GHI OR SMG. THE COMPENSATED BOARD MEMBERS AND OFFICERS DEVOTE THEIR TIME TO MULTIPLE RELATED ORGANIZATIONS. REPORTED AVERAGE HOURS WORKED ARE BASED ON THEIR TOTAL COMPENSATION FROM ALL RELATED ORGANIZATIONS.
FORM 990, PART XI, LINE 9:	TRANSFER TO AFFILIATE - SMG AND LHF -4,778,337. CHANGE IN PENSION LIABILITY VALUATION 7,755,895. CONTRIBUTIONS FROM LHF RUN THROUGH THE FUND BALANCE -50,572.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

LAKEVIEW MEMORIAL HOSPITAL
ASSOCIATION INC

Employer identification number

41-0811697

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)HEALTHPARTNERS INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-1693838	HYBRID STAFF MODEL/NETWORK MODEL HEALTH MAINTENANCE ORGANIZATION	MN	501(C)(4)		N/A		No
(2)HPI-RAMSEY 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-1793333	CORPORATE PLANNING AND OVERSIGHT	MN	501(C)(3)	509(A)(3) TYPE I	HEALTHPARTNERS INC		No
(3)GROUP HEALTH PLAN INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-0797853	STAFF MODEL HEALTH MAINTENANCE ORGANIZATION	MN	501(C)(3)	170(B)(1) (A)(III)	HEALTHPARTNERS INC		No
(4)RH WISCONSIN INC 8171 33RD AVE S PO BOX 1309 MPLS,MN554401309 20-2287016	CORPORATE PLANNING AND OVERSIGHT	WI	501(C)(3)	509(A)(3) TYPE I	HPI - RAMSEY		No
(5)HEALTHPARTNERS INSTITUTE 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-1670163	HEALTHCARE EDUCATION AND RESEARCH	MN	501(C)(3)	509(A)(3) TYPE I	HEALTHPARTNERS INC		No
(6)CAPITOL VIEW TRANSITIONAL CARE CENTER 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-2011453	TRANSITIONAL CARE SERVICES, STEP DOWN FROM INPATIENT HOSPITAL	MN	501(C)(3)	170(B)(1) (A)(III)	HPI - RAMSEY		No
(7)REGIONS HOSPITAL 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-0956618	HOSPITAL	MN	501(C)(3)	170(B)(1) (A)(III)	HPI - RAMSEY		No
(8)REGIONS HOSPITAL FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-1888902	PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH	MN	501(C)(3)	170(B)(1) (A)(VI)	HPI - RAMSEY		No
(9)RHSC INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-1891928	HEALTHCARE STAFFING AND INTENSE REHAB SERVICES	MN	501(C)(3)	509(A)(3) TYPE II	HEALTHPARTNERS INC		No
(10)PHYSICIANS NECK & BACK CLINICS 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 27-0684883	SPECIALTY PATIENT CARE	MN	501(C)(3)	509(A)(3) TYPE II	GROUP HEALTH PLAN INC		No
(11)HUDSON HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 39-0804125	HOSPITAL	WI	501(C)(3)	170(B)(1) (A)(III)	RH-WISCONSIN INC		No
(12)HUDSON HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 39-1279567	PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH	WI	501(C)(3)	170(B)(1) (A)(VI)	HUDSON HOSPITAL INC		No
(13)LAKEVIEW HEALTH FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-1386635	PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH	MN	501(C)(3)	170(B)(1) (A)(VI)	LAKEVIEW HEALTH		No
(14)STILLWATER MEDICAL GROUP 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 83-0379473	CLINIC STAFF AND FACILITIES	MN	501(C)(3)	509(A)(3) TYPE I	LAKEVIEW HEALTH		No
(15)LAKEVIEW HEALTH 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 30-0221189	CORPORATE PLANNING AND OVERSIGHT	MN	501(C)(3)	509(A)(3) TYPE II	HPI - RAMSEY		No
(16)WESTFIELDS HOSPITAL INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 39-0808442	HOSPITAL	WI	501(C)(3)	170(B)(1) (A)(III)	RH-WISCONSIN INC		No
(17)WESTFIELDS HOSPITAL FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 39-1770913	PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH	WI	501(C)(3)	170(B)(1) (A)(VI)	WESTFIELDS HOSPITAL INC		No
(18)RAMSEY INTEGRATED HEALTH SERVICES 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-1503090	HOME CARE AND HOSPICE	MN	501(C)(3)	509(A)(2)	HPI - RAMSEY		No
(19)PARK NICOLLET HEALTH SERVICES 6500 EXCELSIOR BLVD ST LOUIS PARK,MN55426 36-3465840	CORPORATE PLANNING AND OVERSIGHT	MN	501(C)(3)	509(A)(2)	HEALTHPARTNERS INC		No
(20)PARK NICOLLET FOUNDATION 6500 EXCELSIOR BLVD ST LOUIS PARK,MN55426 23-7346465	SUPPORT TO RELATED ENTITIES AND COMMUNITY HEALTH	MN	501(C)(3)	170(B)(1) (A)(VI)	PARK NICOLLET HEALTH SERVICES		No
(21)PARK NICOLLET METHODIST HOSPITAL 6500 EXCELSIOR BLVD ST LOUIS PARK,MN55426 41-0132080	HOSPITAL	MN	501(C)(3)	170(B)(1) (A)(III)	PARK NICOLLET HEALTH SERVICES		No
(22)PARK NICOLLET HEALTH CARE PRODUCTS 6500 EXCELSIOR BLVD ST LOUIS PARK,MN55426 01-0638901	DURABLE MEDICAL EQUIPMENT AND OTHER HEALTH CARE RETAIL SALES	MN	501(C)(3)	509(A)(3) TYPE I	PARK NICOLLET HEALTH SERVICES		No
(23)PARK NICOLLET CLINIC 6500 EXCELSIOR BLVD ST LOUIS PARK,MN55426 41-0834920	CLINIC SERVICES	MN	501(C)(3)	170(B)(1) (A)(III)	PARK NICOLLET HEALTH SERVICES		No
(24)PNMC HOLDINGS 6500 EXCELSIOR BLVD ST LOUIS PARK,MN55426 41-1741792	HEALTHCARE REAL ESTATE	MN	501(C)(3)	509(A)(3) TYPE I	PARK NICOLLET HEALTH SERVICES		No
(25)AMERY REGIONAL MEDICAL CENTER INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 39-0908320	HOSPITAL	WI	501(C)(3)	170(B)(1) (A)(III)	RH-WISCONSIN INC		No
(26)AMERY REGIONAL MEDICAL CENTER FOUNDATION INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 39-1726539	PROVIDE SUPPORT TO HOSPITAL AND COMMUNITY HEALTH	WI	501(C)(3)	170(B)(1) (A)(VI)	AMERY REGIONAL MEDICAL CENTER INC		No
(27)HUTCHINSON HEALTH 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 84-1715908	HOSPITAL	MN	501(C)(3)	170(B)(1) (A)(III)	PARK NICOLLET HEALTH SERVICES		No
(28)HUTCHINSON HEALTH FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 36-3317820	PROVIDE SUPPORT TO HOSPITAL	MN	501(C)(3)	170(B)(1) (A)(VI)	HUTCHINSON HEALTH		No
(29)HEALTHPARTNERS RC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 84-4261122	HOSPITAL	MN	501(C)(3)	170(B)(1)(A)(III)	PARK NICOLLET HEALTH SERVICES		No
(30)OLIVIA HOSPITAL & CLINIC FOUNDATION 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-1839619	PROVIDE SUPPORT TO HOSPITAL	MN	501(C)(3)	509(A)(3) TYPE I	HEALTHPARTNERS RC		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) HEALTHPARTNERS ADMINISTRATORS INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-1629390	THIRD PARTY ADMINISTRATOR	MN	HEALTHPARTNERS INC	C					No
(2) HEALTHPARTNERS ASSOCIATES INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 52-2365151	MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT	MN	HEALTHPARTNERS ADMINISTRATORS INC	C					No
(3) HEALTHPARTNERS SERVICES INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-1683568	MEDICAL CLINIC STAFFING AND ASSET MANAGEMENT	MN	HEALTHPARTNERS ADMINISTRATORS INC	C					No
(4) HEALTHPARTNERS INSURANCE COMPANY 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-1683523	MEDICAL AND DENTAL INSURANCE	MN	HEALTHPARTNERS ADMINISTRATORS INC	C					No
(5) DENTAL SPECIALTIES INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 45-1297583	PROFESSIONAL DENTAL SERVICES	MN	HEALTHPARTNERS ADMINISTRATORS INC	C					No
(6) HEALTHPARTNERS CENTRAL MINNESOTA CLINICS INC 8170 33RD AVE S PO BOX 1309 MPLS,MN554401309 41-1236798	MEDICAL CLINIC STAFFING	MN	HEALTHPARTNERS ADMINISTRATORS INC	C					No
(7) PARK NICOLLET ENTERPRISES 6500 EXCELSIOR BLVD ST LOUIS PARK,MN55426 41-1656735	REAL ESTATE FOR RELATED ORGANIZATIONS	MN	PARK NICOLLET HEALTH SERVICES	C					No

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) HEALTHPARTNERS INC - CLAIMSHEALTHCARE SERVICES	L	12,205,689	CASH AMOUNT

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO MEET THE HEALTHCARE NEEDS OF INDIVIDUALS, FAMILIES & COMMUNITIES OF THE ST. CROIX VALLEY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	1,133
6	Total number of volunteers (estimate if necessary) .............	6	49
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	2,841,841	3,605,671
9	Program service revenue (Part VIII, line 2g) .........	124,424,098	159,955,454
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	97,834	1,121,291
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	9,866	20,457
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	127,373,639	164,702,873
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	225,990	184,451
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	72,116,485	80,858,905
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	48,484,053	64,330,065
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	120,826,528	145,373,421
19	Revenue less expenses. Subtract line 18 from line 12.......	6,547,111	19,329,452
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	112,606,795	128,319,414
21	Total liabilities (Part X, line 26).............	30,106,087	23,562,268
22	Net assets or fund balances. Subtract line 21 from line 20.....	82,500,708	104,757,146

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 130,685,124 including grants of $ 184,451 ) (Revenue $ 159,675,592 )
	SEE SCHEDULE O - EXEMPT PURPOSE AND ACHIEVEMENTS FOR A DESCRIPTION OF PROGRAM SERVICE ACCOMPLISHMENTS

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses130,685,124

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,035,321	7,745,829	1,504,519

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	50,573
e	Government grants (contributions)		1e	3,555,098

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		3,605,671

		Business Code
2a	NET PATIENT REVENUE	623990	159,490,503	159,490,503
b	CAFETERIA	445200	228,808		228,808
c	OTHER REVENUE	561000	185,089	185,089
d	GIFT SHOP	453220	51,054		51,054
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		159,955,454

3 Investment income (including dividends, interest, and othersimilar amounts) ......			35,875			35,875
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		433,662	6a
b	Less: rental expenses		413,205	6b
c	Rental income or (loss)		20,457	6c
d	Net rental income or (loss).......			20,457			20,457
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	2,786,870		7a
b	Less: cost or other basis and sales expenses	1,701,454		7b
c	Gain or (loss)	1,085,416		7c
d	Net gain or (loss).........			1,085,416			1,085,416
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			164,702,873	159,675,592	0	1,421,610

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	184,451	184,451
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	1,203,041		1,203,041
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	62,396,142	56,089,457	6,306,685
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,875,297	3,622,180	253,117
9	Other employee benefits .......	11,054,574	10,626,757	427,817
10	Payroll taxes ...........	2,329,851	2,128,149	201,702
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	194,170		194,170
c	Accounting ...........	10,515		10,515
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	7,633,081	6,463,963	1,169,118
12	Advertising and promotion ....	78,333	67,748	10,585
13	Office expenses .......	1,369,332	1,307,356	61,976
14	Information technology ......	298,721	184,915	113,806
15	Royalties ..
16	Occupancy ...........	2,038,530	1,273,384	765,146
17	Travel ............	229,221	227,177	2,044
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	20,207	9,441	10,766
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	5,578,293	4,853,153	725,140
23	Insurance ...	525,467	43,173	482,294
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL & PHARMACY SUPP	38,927,618	38,879,128	48,490
b	EQUIPMENT & MAINTENANCE	3,971,412	1,742,206	2,229,206
c	TAXES & ASSESSMENTS	2,125,403	2,125,403
d	OTHER EXPENSE	1,223,767	766,037	457,730
e	All other expenses	105,995	91,046	14,949
25	Total functional expenses. Add lines 1 through 24e	145,373,421	130,685,124	14,688,297	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			40,056,676	1	49,234,246
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			12,088,942	4	16,078,573
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			1,947,055	8	2,184,365
9	Prepaid expenses and deferred charges ......			333,839	9	7,922,624
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	89,218,315
b	Less: accumulated depreciation	10b	36,944,588	57,525,281	10c	52,273,727
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			655,002	15	625,879
16	Total assets. Add lines 1 through 15 (must equal line 33)...			112,606,795	16	128,319,414

17	Accounts payable and accrued expenses .....	27,688,838	17	22,049,077
18	Grants payable ...		18
19	Deferred revenue .........	483,579	19	65,388
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	1,933,670	25	1,447,803
26	Total liabilities. Add lines 17 through 25..	30,106,087	26	23,562,268

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	82,500,708	27	104,757,146
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	82,500,708	32	104,757,146
33	Total liabilities and net assets/fund balances ........	112,606,795	33	128,319,414