Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
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(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.") .. | 730,764 | 749,370 | 689,220 | 587,552 | 734,097 | 3,491,003 |
| 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 | 730,764 | 749,370 | 689,220 | 587,552 | 734,097 | 3,491,003 |
| 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) .. | 415,342 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 3,075,661 | |||||
Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 730,764 | 749,370 | 689,220 | 587,552 | 734,097 | 3,491,003 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1,178,814 | 1,313,740 | 1,129,812 | 1,035,972 | 1,747,720 | 6,406,058 |
| 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 | 9,897,061 | |||||
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.) | ||||||
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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 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. |
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| 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) |
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| 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. |
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|
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. |
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7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 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..... | ||||
| Facts And Circumstances Test |
|---|
| Winona Health Foundation fails to meet the public support test for the years ended September 30, 2018 through September 30, 2022. However, based on the following facts and circumstances, the organization should continue to be recognized as a publicly supported organization under Internal Revenue Code Section 509(A)(1).Ten-Percent of Support:The total amount of public support for the organization during the above mentioned period is 31.08%. Therefore, the total public support is greater than the required 10%.Attraction of Public Support:The organization does not receive more than 33 1/3% of its support from government units or from contributions from the general public due to the fact that it has received some substantial donations from local corporations and individuals. The organization uses several methods toattract support from the general public. Some of these methods include an annual fundraising event, advertising for memorials at annual community events, community-wide direct mailings, personal visits during patient stays at affiliated healthcare facilities, and onlinesolicitations via the organization's website.Sources of Support:Winona Health Foundation does not receive support from a single family; rather it receives support from members of the general public. The organization received a portion of its support from individuals in the community. The number of unique donors who have made contributions tothe organization each fiscal year are as follows:FY2022 1,146FY2021 1,250FY2020 942FY2019 1,431FY2018 1,293The Foundation receives a significant amount of it total support from investment income which impacts the percentage from contributions.Representative Governing Body:Winona Health Foundation is served by a governing body that represents the interest of the public; it does not represent the interests of a limited number of donors of Winona Health Foundation. These representatives ensure that the organization meets the needs of the healthcare community.Based on the above facts and circumstances, Winona Health Foundation should continue to be considered as publicly supported under Internal Revenue Code Section 509(A)(1). |
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, line 1a | The Executive Committee has the authority to act on behalf of the governing board in between board meetings. The Executive Committee consists of the Board Chair, the chair of each Standing Committee, the President/CEO of the organization. |
| Form 990, Part VI, Section A, line 2 | The following individuals have business relationships: Hugh Miller and Todd Paulson Matt Broghammer, Nicholas Modjeski and E. Allen Beguin Steve Blue and David Vaselaar Fatima Said and David Vaselaar The CEO, CFO and some of the board members of the Foundation are compensated by a related organization. The board of the Foundation and related organizations have 100% overlap, therefore the officers and board members have a business relationship with each other. |
| Form 990, Part VI, Section A, line 6 | The sole member of the organization is Winona Health Services. |
| Form 990, Part VI, Section A, line 7a | The sole member has authority to elect all At-Large Directors to the Corporation's Board of Directors and remove them, with or without cause. The sole member also has the right to appoint the Chair and the President/CEO of the Corporation, and remove them, with or without cause, subject to any contract rights that may apply. |
| Form 990, Part VI, Section A, line 7b | The following decisions of the Board of Directors are subject to approval by the sole member: (A) Approving the amendment of the articles of incorporation of the corporation and bylaws. (B) Approving all mission and/or vision statements and all strategic or long-term plans of the corporation. (C) Approving the creation or acquisition of any and all subsidiaries or controlled affiliates; any mergers or consolidations; any permanent or long-term affiliations; and all joint ventures of the corporation involving capital investments in excess of one hundred thousand dollars ($100,000). (D) Approving the sale or encumbrance of all or substantially all the assets of the corporation and all long-term debt in excess of one hundred thousand dollars ($100,000). (E) Approving the corporation's annual operating and capital budgets and any material amendments thereto or deviations there from. (F) Approving the dissolution of the corporation or any partial or complete liquidation of its assets. |
| Form 990, Part VI, Section B, line 11b | The return is reviewed initially by the CFO and CEO. It is then reviewed by the Executive Committee before it is filed. In addition, the Form 990 is available to the full governing board prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | The conflict of interest policy covers senior leaders, directors, officers and board committee members. The policy is signed annually and reviewed by CEO for conflicts. Any conflicts are brought to the Board for discussion. If a Board Member has a potential conflict, they must abstain from voting. |
| Form 990, Part VI, Section B, line 15 | The CEO and CFO are compensated by a related organization. The Executive Committee has a process in place for determining compensation for the CEO and CFO based on results of a compensation study, approval and documentation by the Board/committee members and the use of independent consultants every 3 years. The Board reviews compensation for these individuals annually. |
| Form 990, Part VI, Section C, line 19 | The organization makes its governing documents, conflict of interest policy and financial statements available upon request. |
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| Software Version: |