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 | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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. | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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)
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(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 2024 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-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, 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 2024. 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 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| FORM 990, PART III, LINE 4A - EXEMPT PURPOSE AND ACHIEVEMENTS | INTRODUCTION - HP LEGAL HEALTHPARTNERS RC, DBA OLIVIA HOSPITAL AND CLINIC (OLIVIA), 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. 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. HEALTHPARTNERS INCLUDES AN ARRAY OF TAX-EXEMPT AND TAXABLE ORGANIZATIONS. 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. HPI IS THE PARENT ENTITY OF PARK NICOLLET HEALTH SERVICES (PNHS), WHICH IS A MINNESOTA NONPROFIT CORPORATION RECOGNIZED AS EXEMPT FROM FEDERAL INCOME TAX UNDER IRC SECTION 501(C)(3). PNHS IS THE SOLE CORPORATE MEMBER OF OLIVIA. OLIVIA IS A MEDICAL CENTER DEDICATED TO PROVIDING QUALITY PATIENT CARE WITH A PASSION FOR CLINICAL EXCELLENCE, PATIENT SAFETY, AND A COMMITMENT TO ASSURE QUALITY HEALTH CARE FOR THOSE WE SERVE. OLIVIA IS CHANGING THE FACE OF RURAL HEALTH CARE; STRIVING TO BUILD A HEALTHIER TODAY AND TOMORROW FOR THE COMMUNITY. OLIVIA'S FOCUS IS NOT ONLY ON GETTING PATIENTS HEALTHY BUT ALSO KEEPING OUR COMMUNITY WELL. IN 1951 THE RENVILLE COUNTY HOSPITAL WAS DEDICATED AND OPENED AS A NEW HEALTH OPPORTUNITY FOR RESIDENTS IN THE AREA. OVER THE YEARS, SERVICES HAVE EVOLVED, AND BUILDINGS HAVE BEEN RENOVATED TO MEET THE DYNAMIC NEEDS OF OUR COMMUNITY. IN 2007, RURAL HEALTH CLINICS LOCATED IN THE CITIES OF HECTOR, OLIVIA AND RENVILLE, MINNESOTA WERE INTEGRATED INTO THE HOSPITAL. IN 2015, A NEW MEDICAL CENTER IN OLIVIA OPENED. ON MAY 1, 2020, RENVILLE COUNTY TRANSFERRED THE HOSPITAL AND CLINIC OPERATIONS TO OLIVIA. OLIVIA, WHICH INCLUDES CLINICS IN HECTOR AND RENVILLE, HAS REMAINED A DISTINCT, LOCALLY GOVERNED ENTITY AS PART OF HEALTHPARTNERS. THROUGH THE AFFILIATION, OLIVIA PATIENTS AND COMMUNITIES HAVE BETTER ACCESS TO MORE CARE OPTIONS AND SERVICES. TODAY OLIVIA IS MADE UP OF: OLIVIA HEALTH CARE SYSTEM INCLUDES A 16-BED CRITICAL ACCESS HOSPITAL ON THE OLIVIA CAMPUS, DESIGNATED AS A LEVEL 4 TRAUMA CENTER AND ACUTE STROKE READY FACILITY. OLIVIA OPERATES THREE AMBULATORY CLINICS, LOCATED IN OLIVIA, HECTOR, AND RENVILLE, MINNESOTA PROVIDING ACCESSIBLE CARE ACROSS THE REGION. OLIVIA'S DIVERSE MEDICAL STAFF OFFERS A WIDE RANGE OF SPECIALTIES, INCLUDING FAMILY MEDICINE, PEDIATRICS, OB/GYN, GENERAL SURGERY, ORTHOPEDICS, EMERGENCY AND HOSPITAL MEDICINE, ONCOLOGY, CARDIOLOGY, RADIOLOGY, INFECTIOUS DISEASE, PULMONOLOGY, PODIATRY, NEPHROLOGY, AND PATHOLOGY, AS WELL AS OSTEOPATHIC CARE. THIS INTEGRATED STRUCTURE ENABLES OLIVIA TO DELIVER COMPREHENSIVE, HIGH-QUALITY CARE TO OUR COMMUNITY. 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. OLIVIA PROVIDED $472,000 IN FREE OR DISCOUNTED CARE TO LOW INCOME AND UNINSURED PATIENTS IN 2024. GOVERNMENT-SPONSORED MEANS TESTED HEALTH CARE: OLIVIA PROVIDES ESSENTIAL SERVICES TO MEDICAID BENEFICIARIES. IN 2024, THE SHORTFALL-CALCULATED AS THE DIFFERENCE BETWEEN COST OF SERVICES PROVIDED AND PAYMENTS RECEIVEDAMOUNTED TO $410,000. COMMUNITY BENEFIT TO THE COMMUNITY: BETTER RURAL HEALTH CARE STARTS FROM THE GROUND UP. OLIVIA IS MAKING THE COMMUNITIES HEALTHIER WHEREVER IT CAN WHETHER THAT IS INSIDE A DOCTOR'S OFFICE OR AT A LOCAL FARMER'S MARKET. OLIVIA IS PROUD TO PARTNER WITH HOMETOWN COMMUNITY AND SERVICE ORGANIZATIONS, PUBLIC HEALTH EXPERTS, FRIENDS, NEIGHBORS AND MORE. HEALTH PROFESSIONS EDUCATION OLIVIA IS COMMITTED TO TRAINING THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS. IN 2024, OLIVIA'S STAFF DEDICATED 9,218 HOURS MENTORING 125 STUDENTS PURSUING A VARIETY OF MEDICAL DEGREES THROUGH OBSERVATIONAL (20 OBSERVATIONAL STUDENTS WITH 350 HOURS) AND CLINICAL ROTATIONS (105 ROTATIONAL STUDENTS WITH 8,868 HOURS). FINANCIAL CONTRIBUTIONS IN 2024, OLIVIA MADE CHARITABLE CONTRIBUTIONS TOTALING $10,591 TO SUPPORT A VARIETY OF LOCAL ORGANIZATIONS, INCLUDING: AREA SCHOOLS, AREA COMMUNITY EVENTS/TOWN DAYS, RENVILLE COUNTY AGRICULTURAL SOCIETY, TIM ORTH MEMORIAL FOUNDATION, RENVILLE COUNTY WALK IN THE PARK AND OTHERS. COMMUNITY BUILDING ACTIVITIES COMMUNITY ENGAGEMENT AND EDUCATION: OLIVIA IS DEEPLY COMMITTED TO COMMUNITY ENGAGEMENT, EDUCATION, AND OVERALL WELLNESS. OLIVIA ACTIVELY SUPPORTS STUDENT DEVELOPMENT THROUGH MENTORSHIP AND HANDS-ON LEARNING OPPORTUNITIES. CAREER EXPLORATION AND WORKFORCE DEVELOPMENT: STAFF PARTICIPATE IN AREA CAREER FAIRS IN PARTNERSHIP WITH HUMAN RESOURCES TO INSPIRE THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS. COMMUNITY BLOOD DRIVES: HOSTED TWICE ANNUALLY AT THE OLIVIA CAMPUS, THESE EVENTS ARE OPEN TO BOTH STAFF AND COMMUNITY MEMBERS AND ENCOURAGE REGULAR BLOOD DONATION TO SUPPORT REGIONAL BLOOD BANKS. GRIEF SUPPORT GROUP: ADULT GRIEF SUPPORT CLASSES ARE OFFERED THROUGHOUT THE YEAR AT OLIVIA. THESE IN-PERSON SESSIONS PROVIDE A SPACE FOR INDIVIDUALS TO PROCESS FEELINGS, SHARE EXPERIENCES, AND FIND COMFORT AND CONNECTION DURING TIMES OF LOSS. COMMUNITY FOUNDATION EVENT: THE HEALTHY WAY CAF TEAM PREPARED AND SERVED FOOD DURING A COMMUNITY FOUNDATION EVENT THAT RAISED FUNDS IN SUPPORT OF THE CANCER CARE FUND, DEMONSTRATING OUR COMMITMENT TO COMMUNITY-DRIVEN PHILANTHROPY. ATHLETIC AND EDUCATIONAL SUPPORT: OLIVIA PROVIDES ATHLETIC TRAINING SERVICES TO RENVILLE COUNTY WEST, BOLD, AND BUFFALO LAKE-HECTOR-STEWART HIGH SCHOOLS. SEVERAL OLIVIA STAFF MEMBERS ARE FURTHER INVOLVED IN YOUTH DEVELOPMENT, WITH TWO SERVING AS ATHLETIC COACHES AND OTHERS VOLUNTEERING AS CERTIFIED EMTS IN THEIR HOME COMMUNITIES. THREE STAFF MEMBERS CONTRIBUTE TO LOCAL EDUCATION THROUGH ADVISORY BOARD SERVICE AT AREA HIGH SCHOOLS. TRAINING AND OUTREACH: COMMUNITY PREPAREDNESS AND HEALTH EDUCATION ARE CENTRAL TO OLIVIA'S MISSION. OLIVIA OFFERS STOP THE BLEED TRAINING FOR THE PUBLIC AND PROVIDES EMS EDUCATION AND CASE REVIEWS FOR LOCAL EMERGENCY PERSONNEL. STAFF ALSO ENGAGE WITH LOCAL SCHOOLS BY PARTICIPATING IN PRESCHOOL SCREENINGS, HEALTH EDUCATION SESSIONS, AND THE 2B CONTINUED MENTAL HEALTH AWARENESS PROGRAM ACROSS THREE SCHOOL DISTRICTS. COLLABORATIVE INITIATIVES: IN PARTNERSHIP WITH THE OLIVIA HOSPITAL & CLINIC FOUNDATION, OLIVIA ACTIVELY LEADS AND SUPPORTS STRATEGIC INITIATIVES THAT ADDRESS KEY COMMUNITY HEALTH CHALLENGES. THESE INCLUDE THE MINNESOTA RURAL POPULATION HEALTH COLLABORATIVE, MN CARES (HEALTH CARE HOMES), RENVILLE COUNTY CHA/CHIP, THE RENVILLE COUNTY HOUSING COMMITTEE, RENVILLE COUNTY DAYCARE INITIATIVES, AND LOCAL SHIP (STATEWIDE HEALTH IMPROVEMENT PARTNERSHIP) EFFORTS SUCH AS THE SUPER FOOD SHELF AND COMMUNITY WELLNESS CAMPAIGNS. OLIVIA ALSO CONTRIBUTES TO BROADER COMMUNITY-BUILDING EFFORTS THROUGH ECONOMIC DEVELOPMENT, EMERGENCY PREPAREDNESS, LEADERSHIP DEVELOPMENT, COALITION BUILDING, HEALTH ADVOCACY, AND WORKFORCE DEVELOPMENT, ALL OF WHICH AIMED AT CREATING A STRONGER, HEALTHIER FUTURE FOR THE COMMUNITIES OLIVIA PROUDLY SERVES. COMMUNITY BENEFIT OPERATIONS: OLIVIA STAFF'S TIME TO COLLECT, ANALYZE AND REPORT COMMUNITY BENEFITS FOR 2024 WAS APPROXIMATELY 32 HOURS. |
| FORM 990, PART VI, SECTION A, LINE 6 | PARK NICOLLET HEALTH SERVICE (PNHS) IS THE SOLE CORPORATE MEMBER OF OLIVIA HOSPITAL & CLINIC. |
| FORM 990, PART VI, SECTION A, LINE 7A | OLIVIA HOSPITAL AND CLINIC'S BOARD OF DIRECTORS IS COMPRISED OF 10 VOTING DIRECTORS AS FOLLOWS: FIVE COMMUNITY DIRECTORS NOMINATED BY THE BOARD AND APPOINTED BY THE CORPORATE MEMBER, TWO PHYSICIAN DIRECTORS NOMINATED BY THE BOARD AND APPOINTED BY THE CORPORATE MEMBER, AND THREE MEMBER DIRECTORS DESIGNATED BY THE CORPORATE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | PNHS THE SOLE CORPORATE MEMBER, MUST APPROVE THE DECISIONS OF OLIVIA HOSPITAL & CLINIC'S BOARD OF DIRECTORS AS FOLLOWS: - AMENDMENT OF ARTICLES OR BYLAWS -APPOINTMENT AND REMOVAL OF THE CORPORATION'S PRESIDENT - MERGER, CONSOLIDATION, LIQUIDATION OR DISSOLUTION OR THE CORPORATION. -BORROWING , MORTGAGE, PLDEGE, ENCUMBERING OR TRANSFER OF CORPORATE ASSETS -AFFILIATIONS OR JOINT VENTURES WITH ANY OTHER ORGANIZATION - ADDITIONS, EXPANSIONS, ELIMINATIONS OR REDUCTIONS OF MAJOR SERVICES LINES - UNBUDGETED CAPITAL EXPENDITURES OR OTHER FINANCIAL COMMITMENTS IN EXCESS OF $1,000,000 |
| FORM 990, PART VI, SECTION B, LINE 11B | OLIVIA HOSPITAL AND CLINIC'S (OHC) 990 RETURN HAS A COMPREHENSIVE REVIEW PROCESS THAT IS FOLLOWED BEFORE IT IS PRESENTED TO THE GOVERNING BODY OF OHC. THE REVIEW PROCESS INCLUDES A LAYERED REVIEW BY THE TAX DEPARTMENT OF GROUP HEALTH, INC. (GHI), THE MANAGEMENT TEAM OF OHC, GHI'S INTERNAL LEGAL DEPARTMENT AND OHC'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 OHC. OHC 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. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE OHC 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 GENERAL COUNSEL 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. IF A DISCLOSED CONFLICT OF INTEREST IMPACTS AN AGENDA ITEM OR DECISION, THE COVERED PERSON WOULD BE EXCLUDED FROM VOTING AND MAY BE EXCLUDED FROM RECEIVING INFORMATION AND/OR PARTICIPATING IN DELIBERATIONS, DEPENDING ON THE CIRCUMSTANCES. |
| FORM 990, PART VI, SECTION B, LINE 15 | OHC OFFICERS, DIRECTORS AND HIGHEST COMPENSATION EMPLOYEES ARE EMPLOYED BY GROUP HEALTH, INC. (GHI) OR PARK NICOLLET HEALTH SERVICES (PNHS), RELATED ORGANIZATIONS, OR BY OHC. GHI, PNHS AND OHC HAVE AN ANNUAL PROCESS TO REVIEW THE MARKET COMPARABILITY OF THE TOTAL COMPENSATION OF THE OHC 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 COMPENSATION COMMITTEE OF GHI OR THE OHC FINANCE COMMITTEE (THE "COMMITTEES") DETERMINE MINIMUM AND MAXIMUM SALARY AND TOTAL COMPENSATION RANGES EACH EMPLOYED OFFICER. IN INTERIM YEARS, GHI'S HUMAN RESOURCES STAFF, UNDER 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, OHC BOARD OF DIRECTOR MEMBERS COMPLETE AN ANNUAL CONFLICT OF INTEREST SURVEY TO ASSURE THE FINANCE COMMITTEE 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 OHC BOARD OF DIRECTORS INPUT, THE PRESIDENT OF PNHS CONDUCTS THE ANNUAL PERFORMANCE REVIEW AND, WITH OHC'S BOARD APPROVAL, DETERMINES THE COMPENSATION OF THE OHC PRESIDENT. THE PRESIDENT OF OHC ALSO DETERMINES THE COMPENSATION OF OTHER EMPLOYED OHC'S OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE PRESIDENT, OHC HR DIRECTOR AND THE PNHS SENIOR DIRECTOR OF COMPENSATION & BENEFITS. THE OHC BOARD HAS DELEGATED TO OHC'S PRESIDENT THE ACCOUNTABILITY TO CONDUCT ANNUAL PERFORMANCE REVIEWS AND DETERMINE THE COMPENSATION OF ALL OHC-EMPLOYED OFFICERS WITHIN THE COMPENSATION RANGES DETERMINED BY THE SURVEY, THE OHC PRESIDENT, OHC HR DIRECTOR AND PNHS SENIOR DIRECTOR OF COMPENSATION & BENEFITS. |
| FORM 990, PART VI, SECTION C, LINE 19 | OHC'S FINANCIAL STATEMENTS AND 990 RETURNS ARE MADE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION FROM OHC OR HEALTHPARTNERS. OHC'S ARTICLES OF INCORPORATION ARE AVAILABLE TO ANY PERSON WHO REQUESTS THE INFORMATION THROUGH THE MINNESOTA SECRETARY OF STATE'S OFFICE. OHC'S CONFLICT OF INTEREST POLICY THROUGH ITS RELATED ORGANIZATION, HEALTHPARTNERS, INC. CAN BE VIEWED THROUGH THE HEALTHPARTNERS.COM WEBSITE. |
| FORM 990, PART IX, LINE 11G | MEDICAL SUPPORT SERVICES: PROGRAM SERVICE EXPENSES 3,334,156. MANAGEMENT AND GENERAL EXPENSES 215,370. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,549,526. OTHER CONSULTANTS: PROGRAM SERVICE EXPENSES 7,850. MANAGEMENT AND GENERAL EXPENSES 129,600. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 137,450. |
| FORM 990, PART XI, LINE 9: | CAPITAL TRANSFER FROM OLIVIA HOSPITAL & CLINIC FOUNDATION 70,353. |
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