2015-11-10T12:13:51-06:00 2014-12-31 990 2014-01-01 043643816 ABBOTT NORTHWESTERN HOSPITAL FOUNDATION ABBO 6122620660 P O BOX 43 INTERNAL ZIP 10890 MINNEAPOLIS MN 554400043 DUNCAN GALLAGHER CHIEF FINANCIAL OFFICER 6122620660 2015-11-10 2014 2016-02-25 16:41:14Z RICHARD MEYER P O BOX 43 INTERNAL ZIP 10890 MINNEAPOLIS MN 554400043 44880472 0 X WWW.ALLINAHEALTH.ORG/AHS/ANW.NSF/FOUNDATION X 2001 MN TO RAISE, STEWARD, AND DISBURSE FUNDS FOR THE BENEFIT OF ABBOTT NORTHWESTERN HOSPITAL. 29 23 0 47 0 0 10404562 14310969 0 0 7219931 3262481 -193319 -216202 17431174 17357248 11264532 10363125 0 0 0 0 242341 172343 700276 1587430 1557788 13094303 12093256 4336871 5263992 79587092 83769407 658144 501675 78928948 83267732 X THE MISSION OF ABBOTT NORTHWESTERN HOSPITAL IS TO RAISE, STEWARD AND DISTRIBUTE FUNDS FOR THE BENEFIT OF ABBOTT NORTHWESTERN HOSPITAL AND THE COMMUNITIES IT SERVES. THE FOUNDATION IS A SEPARATE NOT-FOR-PROFIT ENTITY DEDICATED TO SUPPORTING THE HOSPITAL AND IS GOVERNED BY A SEPARATE BOARD. ABBOTT NORTHWESTERN HOSPITAL IS THE TWIN CITIES' LARGEST NOT-FOR-PROFIT HOSPITAL. EACH YEAR, THE HOSPITAL PROVIDES COMPREHENSIVE HEALTH CARE FOR MORE THAN 200,000 PATIENTS AND THEIR FAMILIES FROM THE TWIN CITIES AREA AND THROUGHOUT THE UPPER MIDWEST. THE HOSPITAL IS ROUTINELY NAMED IN NATIONAL RANKINGS OF THE NATION'S BEST HOSPITALS, INCLUDING BEING NAMED IN U.S. NEWS AND WORLD REPORT'S "AMERICA'S TOP 50 HOSPITALS" LIST FOR TEN CONSECUTIVE YEARS. ABBOTT NORTHWESTERN HOSPITAL IS A PART OF ALLINA HEALTH SYSTEM, A FAMILY OF HOSPITALS, CLINICS AND CARE SERVICES. 0 0 4993010 4993010 A SUPPORTIVE CARE APPROACH FOR PATIENTS LATE IN LIFE- $4,993,010PATIENTS WITH LATE LIFE LIMITING ILLNESS AND THEIR FAMILIES ARE OFTEN AT A LOSS WHEN SEEKING SUPPORT WITHIN THE CURRENT U.S. HEALTHCARE SYSTEM. POOR UNDERSTANDING OF CARE SERVICES WHICH INCLUDE ADVANCE CARE PLANNING, PALLIATIVE CARE AND HOSPICE SERVICES, COMBINED WITH LACK OF SYSTEMS TO PROMOTE REFERRAL UPON DIAGNOSIS, RESULTS IN POOR ACCESS TO SERVICES AND LEAVES FAMILIES WITH THE BURDEN OF MANAGING END OF LIFE CARE FOR THEIR LOVED ONES. WITH SUPPORT FROM ROBINA FOUNDATION, ALLINA AIMS TO SHIFT THE PRESENT LATE LIFE SUPPORTIVE CARE PARADIGM BY DEMONSTRATING AND TESTING A COMPREHENSIVE, SYSTEMIC APPROACH THAT IS PROACTIVE IN MEETING THE UNIQUE NEEDS OF PATIENTS WITH LIFE LIMITING ILLNESS. ABBOTT NORTHWESTERN HOSPITAL FOUNDATION PROVIDED/GRANTED $4,993,010 TO THIS PROGRAM IN 2014. FOLLOWING ARE COMPONENTS TO A NEW LATE LIFE SUPPORTIVE CARE MODEL:- TOOLS TO SUPPORT PATIENT REFERRAL UPON DIAGNOSIS- INSTRUMENTS TO ASSESS PATIENT AND CAREGIVERS' QUALITY OF LIFE- COMPREHENSIVE SUPPORTIVE CARE PLANS- EDUCATION AND SUPPORT TOOLS TO FOSTER END-OF-LIFE DIALOGUE- ELECTRONIC SUPPORT TOOLS THAT ARE INTEGRATED INTO THE MEDICAL RECORDONCE IMPLEMENTED, THE RESULT WILL BE COMPASSIONATE, COMPREHENSIVE AND RELIABLE LATE LIFE SUPPORTIVE CARE SERVICES FOR PATIENTS, CAREGIVERS AND CARE PROVIDERS. 3787290 3787290 GENERAL HOSPITAL SUPPORT-$ 3,787,290GENERAL HOSPITAL SUPPORT : A TOTAL OF $877,000 WAS PROVIDED BY THE FOUNDATION TO SUPPORT CLINICAL EDUCATION. A GRANT OF $435,000 MADE THE PURCHASE OF A CT SIMULATOR POSSIBLE. GENERAL HOSPITAL GRANTS TOTALING $3.8 MILLION IN 2014 ALSO INCLUDE: TRAINING FOR HEALTH CARE PROVIDERS SO THAT THEY CAN BETTER HELP FAMILIES ASSIST THOSE IN THE PROCESS OF DYING; TRAINING FOR A HEALING COACH TO ASSIST PARENTS IN HELPING THEIR CHILDREN COPE WITH THE PARENT'S CANCER DIAGNOSIS; THE PURCHASE OF A DEVICE TO LIFT WHEELCHAIR-BOUND PATIENTS ONTO THE EXAM TABLE; AUDIOVISUAL RESOURCES TO SUPPORT MENTAL HEALTH GROUP THERAPY SESSIONS; ACTIVITY PACKS FOR CHILDREN TO USE IN WAITING AREAS OF THE HOSPITAL; PORTABLE ULTRASOUND DEVICES FOR PHYSICIANS TO USE AT THE PATIENT BEDSIDE. 1220292 1220292 RESEARCH - $1,220,292 IN 2014, ABBOTT NORTHWESTERN HOSPITAL FOUNDATION PROVIDED $1,220,292 FOR RESEARCH.AMONG ITS MANY ATTRIBUTES AS A LEADING CLINICAL CARE HOSPITAL, ABBOTT NORTHWESTERN HOSPITAL ROUTINELY INVESTS IN AND CONTRIBUTES TO IMPORTANT RESEARCH. IN 2014, RESEARCH GRANTS OF $1.2 MILLION WERE MADE BY ABBOTT NORTHWESTERN HOSPITAL FOUNDATION TO SUPPORT A VARIETY OF RESEARCH PROJECTS IN NEUROLOGY, ONCOLOGY, CARDIOVASCULAR, CRITICAL CARE, AND NURSING. 362533 362533 OTHER PROGRAM SERVICES-$362,533INCLUDED IN OTHER PROGRAM SERVICES ARE COMMUNITY GRANTS AND GRANTS TO INDIVIDUALS OF $362,533.COMMUNITY GRANTS AND GRANTS TO OTHERS INCLUDE GRANTS OF $142,100 TO THE MINNEAPOLIS HEART INSTITUTE AND GRANTS OF $95,000 TO PROJECT FOR PRIDE AND LIVING. THE WALK-IN COUNSELING CENTER WAS GRANTED $40,000 IN 2014. CEDAR RIVERSIDE PEOPLE'S CENTER WAS AWARDED $45,000 IN 2014. EDUCATION GRANTS OF $15,433 WERE ALSO AWARDED IN 2014. 362533 362533 10363125 1 1 0 0 0 0 0 0 0 1 0 1 0 0 1 1 1 1 0 0 0 0 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 X 29 23 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN WI X TAX SERVICES MAIL ROUTE 10890 6122620660 2925 CHICAGO AVENUE MINNEAPOLIS MN 554071321 LEE AROSTEGUI MD DIRECTOR 2.00 2.00 X 0 22050 0 BEN BACHE-WIIG MD DIR/PRES ABBOTT NW HOSP 2.00 40.00 X 0 651269 226471 ROBERT BARROWS DIRECTOR 2.00 X 0 0 0 ANN BENTDAHL DIRECTOR 2.00 X 0 0 0 M NICHOLAS BURKE MD DIRECTOR 2.00 40.00 X 0 1011995 157874 CASSIDY BURNS DIRECTOR 2.00 X 0 0 0 RICHARD CHAFFEE DIRECTOR/VICE CHAIR 2.00 X 0 0 0 CHRISTOPHER DAHL DIRECTOR/TREASURER 2.00 X 0 0 0 PATRICK DENZER DIRECTOR 2.00 X 0 0 0 RICHARD EHRICH DIRECTOR 2.00 X 0 0 0 CARI ERICKSON DIRECTOR 2.00 X 0 0 0 MARNA FULLERTON DIRECTOR 2.00 X 0 0 0 LINDA GOLDENBERG DIRECTOR 2.00 X 0 0 0 SHARON HAWKINS DIRECTOR 2.00 X 0 0 0 CAROL HUTTNER DIRECTOR/VICE CHAIR 2.00 X 0 0 0 BENJAMIN JAFFRAY DIRECTOR 2.00 X 0 0 0 LINDA KETOVER MD DIRECTOR 2.00 X 0 0 0 ROGER LACEY DIRECTOR/TREASURER 2.00 X 0 0 0 GLORIA LEWIS DIRECTOR 2.00 X 0 0 0 TAMERA LILLEMOE MD DIRECTOR/SECRETARY 2.00 X 0 0 0 MARTHA MACMILLAN DIRECTOR/CHAIRMAN 2.00 X 0 0 0 LYNNE MCDONOUGH DIRECTOR 2.00 X 0 0 0 KITA MCVAY DIRECTOR 2.00 X 0 0 0 WILLIAM PARHAM MD DIRECTOR 2.00 40.00 X 0 499036 50597 JASON PAULNOCK DIRECTOR 2.00 X 0 0 0 RONALD POOLE DIRECTOR/VICE CHAIR 2.00 X 0 0 0 JASON REED DIRECTOR 2.00 17.00 X 0 100000 0 ROBERT SCOTT MD DIRECTOR 2.00 X 0 0 0 MORRIS SHERMAN DIRECTOR/VICE CHAIR 2.00 X 0 0 0 ROB SIT DIRECTOR 2.00 X 0 0 0 RICHARD MEYER DIRECTOR/PRESIDENT 40.00 2.00 X X 0 306595 67361 DUNCAN GALLAGHER CFO 2.00 40.00 X 0 1328758 367505 0 3919703 869808 0 0 1 0 RUFFALO NOEL LEVITZ 1025 KIRKWOOD PARKWAY SW CEDAR RAPIDS IA 52404 TELEFUNDRAISING 154044 1 2121 631220 2073858 11603770 766285 14310969 1105685 1105685 29397338 27240542 2156796 2156796 2156796 66480 631220 282682 -216202 -216202 17357248 0 0 3046279 10347692 10347692 15433 15433 18650 18650 172343 172343 78464 66575 11889 31219 17511 13708 4806 2674 2132 15865 8883 6982 633 355 278 FOUNDATION STAFF SVCS 1083575 606802 476773 PURCH. SVCS -AFFILIATES 320038 306227 13811 MISCELLANEOUS EXPENSES 4538 2178 2360 12093256 10363125 1029855 700276 5605469 7995000 100000 73072055 75070994 909568 603413 79587092 83769407 163250 11711 494894 489964 658144 501675 X 11652195 12068987 46152504 49860378 21124249 21338367 78928948 83267732 79587092 83769407 X 5263992 -870985 -54223 X X 0 1 X 1 0 X X 1 ALLINA HEALTH SYS 363261413 3 1 10000592 0 1 10000592 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 PART IV SECTION A LINE 6 FROM TIME TO TIME ABBOTT NORTHWESTERN HOSPITAL FOUNDATION SUPPORTS OTHER NON-PROFIT 501(C)(3) ORGANIZATIONS OR NON-PROFIT GOVERNMENTAL ORGANIZATIONS THAT SUPPORT AND OR CARRY OUT THE THE MISSION, VISION AND VALUES OF ALLINA HEALTH SYSTEM AND THEIR COMMITMENT TO PATIENTS AND THE COMMUNITIES SERVED. ALLINA HEALTH SYSTEM IS THE SUPPORTED ORGANIZATION OF ABBOTT NORTHWESTERN HOSPITAL FOUNDATION. PLEASE SEE SCHEDULE I PART II, GRANTS AND OTHER ASSISTANCE TO DOMESTIC ORGANIZATIONS AND DOMESTIC GOVERNMENTS, FOR ORGANIZATIONS SUPPORTED BY ABBOTT NORTHWESTERN HOSPITAL FOUNDATION THAT ARE ORGANIZED TO CARRY OUT OR SUPPORT THE PURPOSES, VALUES AND VISION OF ALLINA HEALTH SYSTEM . PART IV SECTION B LINE 2 FROM TIME TO TIME ABBOTT NORTHWESTERN HOSPITAL FOUNDATION SUPPORTS OR PROVIDES BENEFIT TO OTHER NON-PROFIT 501(C)(3) ORGANIZATIONS OR NON-PROFIT GOVERNMENTAL ORGANIZATIONS THAT SUPPORT AND OR CARRY OUT THE THE MISSION, VISION AND VALUES OF ALLINA HEALTH SYSTEM, THE SUPPORTED ORGANIZATION , AND THEIR COMMITMENT TO PATIENTS AND THE COMMUNITIES SERVED. PLEASE SEE SCHEDULE I PART II, GRANTS AND OTHER ASSISTANCE TO DOMESTIC ORGANIZATIONS AND DOMESTIC GOVERNMENTS, FOR ORGANIZATIONS BENEFITED BY ABBOTT NORTHWESTERN HOSPITAL FOUNDATION THAT ARE OPERATED TO CARRY OUT OR SUPPORT THE PURPOSES, VALUES AND VISION OF ALLINA HEALTH SYSTEM AND SUPPORT ALLINA'S CARE CONTINUUM OF SERVICES , INCLUDING MEDICAL REHABILITATION, COMMUNITY BASED HEALTH AND WELLNESS SERVICES, ADVOCACY , RESEARCH AND INNOVATION AND ACT IN THE BEST INTEREST OF THE PATIENTS AND COMMUNITIES ALLINA HEALTH SYSTEM IS COMMITTED TO SERVE. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 45071801 214118 1410076 1573714 45122281 43170772 51100 3220855 1370926 45071801 41471033 131 3275652 1576044 43170772 42761855 5410 70313 1366545 41471033 41320507 6456 3054935 1620043 42761855 0.03290 0.47290 0.49420 0 0 0 CASH EQUIVALENTS 2033431 F EQUITY SECURITIES 12785035 F FIXED INCOME SECURITIES 34741509 F FUNDS OF HEDGE FUNDS 7227220 F COMMODITIES & OTHER 11178919 F MONEY MARKET FUNDS 7104880 F 75070994 LONG-TERM LIABILITY, COLLATERAL AGREEMENT 478160 CHARITABLE GIFT ANNUITY OBLIG 11804 489964 X 16780381 -870985 11436 -859549 17639930 -282682 -282682 17357248 12441597 348341 348341 12093256 0 12093256 PART V, LINE 4: CHARITY AND INDIGENT CARE. EDUCATION AND RESEARCH. BUILDINGS AND EQUIPMENT. PATIENT CARE. PART X, LINE 2: THE FOLLOWING IS A COPY OF NOTE 1 TO THE AUDITED FINANCIAL STATEMENTS: "SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - INCOME TAX" "ABBOTT NORTHWESTERN HOSPITAL FOUNDATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. IT IS CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION. THEREFORE, CHARITABLE CONTRIBUTIONS ARE TAX DEDUCTIBLE. THE FOUNDATION HAS ADOPTED GUIDANCE IN THE INCOME TAX STANDARD REGARDING THE RECOGNITION OF UNCERTAIN TAX POSITIONS. THE GUIDANCE PRESCRIBES RECOGNITION THRESHOLD PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX FILING THAT ARE NOT CERTAIN TO BE REALIZED. THE IMPLEMENTATION OF THIS GUIDANCE HAD NO IMPACT ON THE FOUNDATION'S FINANCIAL STATEMENTS. THE FOUNDATION'S TAX FILINGS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. THE FOUNDATION IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX EXEMPT STATUS. THE FOUNDATION IS NOT AWARE OF ANY ACTIVITIES THAT ARE SUBJECT TO TAX ON UNRELATED BUSINESS INCOME, EXCISE OR OTHER TAXES. THE FILINGS FOR THE YEARS ENDING 2011 TO 2014 ARE OPEN TO EXAMINATION BY FEDERAL AND STATE AUTHORITIES." PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 11,436. PART XI, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES -282,682. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN LIABILITY COLLATERAL AGREEMENT -10,841. SPECIAL EVENT EXPENSES 282,682. PRIOR YEAR PLEDGE ADJUSTMENT 76,500. X X X X X X X 1 RUFFALO NOEL LEVITZ 1025 KIRKWOOD PARKWAY SW CEDAR RAPIDS IA 52404 TELEFUNDRAISING 0 135174 154044 -18870 BENTZ WHALEY FLESSNER AND ASSOCIATES INC 7251 OHMS LANE MINNEAPOLIS MN 55439 SOCIAL MEDIA ASSESSMENT 0 0 17000 -17000 135174 171044 -35870 MN WI GALA 697700 631220 66480 38389 93987 25561 124745 0 697700 631220 66480 38389 93987 25561 124745 282682 -216202 SCHEDULE G, PART I, LINE 2B, COLUMN (V) GRANT WRITING AND RESEARCH, DONOR RELATIONSHIP ACTIVITIES, TELEFUNDRAISING NOTE THAT GROSS RECEIPTS FROM CERTAIN GRANT WRITING, FUNDRAISING AND DONOR RELATIONSHIP ACTIVITIES CANNOT BE SEPARATELY QUANTIFIED. 1 ALLINA HEALTH SYSTEM DBA ABBOTT NORTHWESTERN HOSPITAL 2925 CHICAGO AVENUE MINNEAPOLIS MN 55407 363261413 170(B)(1)(A)(III) 10000592 HOSPITAL OPERATIONS AND PLANT ASSETS ABBOTT NORTHWESTERN HOSPITAL. PROJECT FOR PRIDE IN LIVING INC 1035 EAST FRANKLIN AVENUE MINNEAPOLIS MN 55404 237232208 170(B)(1)(A)(VI) 95000 JOBS TRAINING PROGRAMS FOR ABBOTT NORTHWESTERN HOSPITAL AND ALLINA HEALTH. CEDAR RIVERSIDE PEOPLES CENTER 425 20TH AVENUE SOUTH MINNEAPOLIS MN 55454 410982430 170(B)(1)(A)(III) 45000 SUPPORT MEDICAL, DENTAL, AND MENTAL HEALTH SERVICES TO UNINSURED/UNDER-INSURED. WALK-IN COUNSELING CENTER INC 2421 CHICAGO AVENUE MINNEAPOLIS MN 55404 410983461 170(B)(1)(A)(VI) 40000 OPERATIONAL SUPPORT FOR MENTAL HEALTH COUNSELING MINNEAPOLIS HEART INSTITUTE FOUNDATION 920 EAST 28TH STREET MINNEAPOLIS MN 55407 411426406 170(B)(1)(A)(III) 142100 SUPPORT RESEARCH AND REGISTRIES;SUMMER RESEARCH INTERNSHIP PROGRAM;VALVE SUMMIT 2014 MATTER 7005 OXFORD STREET ST LOUIS PARK MN 55426 371441658 170(B)(1)(A)(III) 10000 MEDICAL SUPPLIES TO LIBERIA FOR EBOLA CRISIS 6 0 SPRENGER SCHOLARSHIP TO STUDENTS AT VARIOUS COLLEGES AND UNIVERSITIES 3 15433 PART I, LINE 2: ABBOTT NORTHWESTERN HOSPITAL FOUNDATION STRICTLY MONITORS GRANT FUNDS TO ENSURE THAT SUCH GRANTS ARE USED FOR PROPER AND INTENDED PURPOSES AND ARE NOT OTHERWISE DIVERTED FROM THE INTENDED USE. THE ORGANIZATION HAS A PROCESS THAT INCLUDES A WRITTEN APPLICATION REQUIRING SUPPORTING DOCUMENTATION AND SUBSTANTIATION PRIOR TO GRANT APPROVAL AND DISBURSEMENT. IN ADDITION AND DEPENDING ON THE FACTS AND CIRCUMSTANCE OF THE GRANT, THE ORGANIZATION EMPLOYS VARIOUS METHODS TO ENSURE PROPER AND INTENDED USE SUCH AS PERIODIC REPORTING TO THE ORGANIZATION, FIELD INVESTIGATIONS, CONTRACTS WITH REPAYMENT CLAUSES, REQUIRING ADDITIONAL SUBSTANTIATION AND DOCUMENTATION NOT AVAILABLE AT THE TIME OF THE GRANT, PAYING THIRD PARTIES DIRECTLY ON BEHALF OF THE GRANTEE ORGANIZATION, AND OTHER METHODS AS APPROPRIATE AND WARRANTED. 0 1 0 0 0 1 1 0 1 1 BEN BACHE-WIIG MD DIR/PRES ABBOTT NW HOSP 0 438196 0 113344 0 99729 0 204482 0 21989 0 877740 0 66206 M NICHOLAS BURKE MD DIRECTOR 0 749915 0 106150 0 155930 0 133385 0 24489 0 1169869 0 111860 WILLIAM PARHAM MD DIRECTOR 0 397300 0 33784 0 67952 0 33820 0 16777 0 549633 0 24955 RICHARD MEYER DIRECTOR/PRESIDENT 0 218714 0 50058 0 37823 0 40222 0 27139 0 373956 0 24475 DUNCAN GALLAGHER CFO 0 611853 0 546534 0 170371 0 346364 0 21141 0 1696263 0 248841 PART I, LINE 4B BEN BACHE-WIIG, MD - $61,974; M. NICHOLAS BURKE, MD - $123,310; WILLIAM PARHAM, MD - $34,673; RICHARD MEYER - $28,829; DUNCAN GALLAGHER - $108,578 PART I, LINE 6 DEFERRED COMPENSATION PLANS TERMS AND CONDITIONS: MANAGEMENT INCENTIVE PLAN (MIP) ALLINA PROVIDES AN ANNUAL INCENTIVE COMPENSATION OPPORTUNITY TO MOST MANAGERS, SOME HIGH-LEVEL INDIVIDUAL CONTRIBUTORS AND EXECUTIVES. UNDER THIS PLAN, THE TARGET AWARD IS EXPRESSED AS A FUNCTION OF THE PARTICIPANT'S SALARY PAID DURING THE CALENDAR YEAR AND REQUIRES AT LEAST FOUR MONTHS OF SERVICE IN AN ELIGIBLE POSITION DURING THE YEAR. ACTUAL AWARDS CAN RANGE FROM 0% TO 150% OF THE TARGET AWARD, BASED ON ALLINA'S PERFORMANCE OVER THE CALENDAR YEAR. PERFORMANCE MEASURES INCLUDE FINANCIAL PERFORMANCE, HOSPITAL AND CLINIC CARE MEASURES AND HOSPITAL AND CLINIC PATIENT EXPERIENCE MEASURES. NO AWARDS ARE PROVIDED UNLESS THRESHOLD FINANCIAL PERFORMANCE IS ACHIEVED. PARTICIPANTS WHO HAVE LEFT EMPLOYMENT PRIOR TO THE END OF THE YEAR AS THE RESULT OF VOLUNTARY TERMINATION OR TERMINATION FOR POOR PERFORMANCE ARE NOT ELIGIBLE FOR AN AWARD. LONG-TERM INCENTIVE PLAN (LTIP) ALLINA HAS A LONG-TERM INCENTIVE PLAN THAT PROVIDES A CASH AWARD OPPORTUNITY TO A SMALL NUMBER OF TOP EXECUTIVES APPROVED FOR PARTICIPATION BY THE COMPENSATION COMMITTEE OF THE BOARD. THE AWARD OPPORTUNITY IS BASED ON ALLINA PERFORMANCE DURING OVERLAPPING THREE-YEAR CYCLES. PERFORMANCE MEASURES AND TARGETS ARE DEFINED BY THE COMMITTEE FOR EACH THREE-YEAR PERIOD AND CAN VARY FROM ONE PERIOD TO ANOTHER DEPENDING ON THE COMMITTEE'S JUDGMENT OF THE MOST IMPORTANT MEASURES OF SUCCESS. ACTUAL AWARDS CAN RANGE FROM 0% TO 150% OF TARGET AWARD, BASED ON ALLINA'S PERFORMANCE OVER THE PERFORMANCE PERIOD. PART I, LINE 8 CERTAIN AMOUNTS REPORTED ON FORM 990, PART VII WERE PAID OR ACCRUED PURSUANT TO A CONTRACT THAT WAS SUBJECT TO THE INITIAL CONTRACT EXCEPTION DESCRIBED IN REGULATION SECTION 53.4958-4(A)(3). FROM TIME TO TIME, ALLINA HEALTH SYSTEM ENTERS INTO CONTRACTUAL ARRANGEMENTS THAT MAY QUALIFY FOR THE INITIAL CONTRACT EXCEPTION BASED ON THE TERMS AND UNDERSTANDINGS OF THE CONTRACTUAL AGREEMENTS. SCHEDULE J, LINE 4(A)&(B) ADDITIONAL COMPENSATION DISCLOSURE: DEFERRED COMPENSATION PLANS TERMS AND CONDITIONS: ABBOTT NORTHWESTERN HOSPITAL CARDIOVASCULAR SERVICES DIVISION DEFERRED COMPENSATION PLAN UNDER THIS PLAN, THE EMPLOYER PROVIDES A CONTRIBUTION EQUAL TO 15% OF BASE SALARY EACH YEAR. PARTICIPANTS VEST AT A RATE OF 10% EACH YEAR. THERE IS IMMEDIATE VESTING UPON REACHING AGE 60. THE PARTICIPANT MAY ELECT FROM AMONG INVESTMENT ALTERNATIVES THAT ARE SIMILAR TO THOSE AVAILABLE IN THE GENERAL EMPLOYEE RETIREMENT SAVINGS PLAN. UNLIKE THE RETIREMENT SAVINGS PLAN, THE PARTICIPANT HAS THE STATUS AN UNSECURED CREDITOR OF ALLINA AND WILL NOT HAVE A PREFERRED CLAIM TO PAYMENT IN THE CASE OF THE COMPANY'S INABILITY TO PAY. HOWEVER, THE COMPANY DOES SET ASIDE ASSETS FOR ITS OBLIGATIONS BY ACTUALLY INVESTING THE PROMISED ASSETS CONSISTENT WITH PARTICIPANT ELECTIONS. DISTRIBUTIONS OCCUR AT THE EARLIEST OF TERMINATION OF EMPLOYMENT, DISABILITY OR DEATH. IN THE EVENT OF TERMINATION OF EMPLOYMENT, 50% OF THE VESTED BALANCE IS PAYABLE WITHIN 90 DAYS OF TERMINATION OF EMPLOYMENT. THE REMAINING 50% IS PAID ONE YEAR LATER SUBJECT TO COMPLIANCE WITH A NON-COMPETE AGREEMENT. PLAN RESTATEMENT EFFECTIVE JULY 31, 2009, THIS PLAN WAS AMENDED AND RESTATED - CHANGING MANY PROVISIONS OF THE PLAN. KEY CHANGES ARE: (1) THE VESTING CHANGED FROM 10% TO 20% PER YEAR. (2) THE COMPENSATION BASIS FOR CALCULATING THE CONTRIBUTIONS CHANGED FROM BASE ANNUAL SALARY TO "TOTAL BASE COMPENSATION" AS DEFINED IN THE EMPLOYMENT AGREEMENTS OF THE SENIOR CONSULTING CARDIOLOGISTS. (3) DISTRIBUTION RULES CHANGED SUCH THAT ONCE PARTICIPANTS MEET A SERVICE REQUIREMENT AND ALSO HAVE A MINIMUM BALANCE IN THE PLAN (MINIMUM BALANCE ONLY REQUIRES TO PARTICIPANTS ALREADY IN THE PLAN AS OF 12/31/2008) THEY BECOME ELIGIBLE TO CHOOSE A PAYOUT DATE FOR EACH PLAN YEAR GOING FORWARD. PAYOUT DATE CAN BE NO SOONER THAN ONE YEAR FROM THE START OF THE PLAN YEAR TO WHICH IT IS ATTRIBUTABLE. PARTICIPANTS ARE ALLOWED A ONE-TIME CHANGE OF THEIR ELECTED PAYOUT DATE, WITHIN 409A GUIDELINES. DEFAULT PAYOUT DATE IS JANUARY 2020 FOR ANY YEAR IN WHICH THE PARTICIPANT IS NOT ELIGIBLE TO MAKE AN ELECTION OR FOREGOES MAKING AN ELECTION. PLAN AMENDMENT EFFECTIVE JANUARY 1, 2010 ELIGIBILITY WAS AMENDED SUCH THAT A PARTICIPANT IS REQUIRED TO HAVE 12 MONTHS OF SERVICE AT A 0.8 FTE OR GREATER BEFORE ENTRY INTO THE PLAN ON THE FIRST OF THE FOLLOWING QUARTER. ALLINA SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) THIS PLAN WAS AMENDED EFFECTIVE DECEMBER 31, 2008, SUCH THAT NO FUTURE BENEFITS ACCRUE FOR SERVICE AFTER THAT DATE. ELIGIBLE ALLINA EXECUTIVES PARTICIPATED IN A DEFINED CONTRIBUTION SERP. EMPLOYER CREDITS WERE MADE EACH YEAR TO THEIR SERP BALANCE ACCORDING TO THE FOLLOWING SCHEDULE: EXEC YRS OF SERVICE CONTRIBUTION % OF PENSIONABLE EARNINGS 0-5 2.75% 6-10 3.50% 11+ 4.75% EXECUTIVES WERE ALSO CREDITED AN AMOUNT EQUAL TO THE EXCESS AMOUNT THAT WOULD HAVE BEEN CREDITED TO THE PENSION ACCOUNT PLAN WERE IT NOT FOR THE QUALIFIED PLAN COMPENSATION LIMITS. DEPOSITS EARN THE INVESTMENT RATE OF RETURN EQUAL TO THE PENSION ACCOUNT PLAN CREDITING RATE AS DECLARED BY ALLINA. THE CURRENT RATE IS 4%. THE PARTICIPANT VESTS AFTER THREE YEARS OF EXECUTIVE SERVICE PROVIDED THAT IF THE PARTICIPANT TERMINATES EMPLOYMENT WITH ALLINA PRIOR TO AGE 65 FOR ANY REASON OTHER THAN ELIMINATION OF POSITION, THE PARTICIPANT MUST FULFILL THE TERMS OF A COVENANT NOT TO COMPETE. BENEFITS ARE PAID AS A SINGLE LUMP-SUM AMOUNT UPON AGE 65, RETIREMENT, OR JOB ELIMINATION. IN THE CASE OF OTHER VOLUNTARY TERMINATIONS, PAYMENT IS DELAYED UNTIL COMPLETION OF THE TWO-YEAR NON-COMPETE PERIOD. THE SERP IS PAYABLE FROM ALLINA'S GENERAL ASSETS. IF ALLINA BECOMES INSOLVENT, THE PARTICIPANT WILL BE AN UNSECURED CREDITOR AND WILL HAVE NO PREFERRED CLAIM TO ANY ASSETS. EXECUTIVE MUTUAL FUND ACCOUNT PLAN PHYSICIAN MUTUAL FUND ACCOUNT PLAN THESE ACCOUNTS GIVE THE PARTICIPANT THE OPPORTUNITY FOR CAPITAL ACCUMULATION NOT FULLY AVAILABLE TO THEM THROUGH SOCIAL SECURITY OR THE GENERAL EMPLOYEE RETIREMENT PLANS BECAUSE OF MAXIMUMS PLACED ON COMPENSATION THAT CAN BE RECOGNIZED UNDER FEDERAL LAW FOR PURPOSES OF CONTRIBUTIONS. THEY ALSO SERVE AS AN IMPORTANT NON-COMPETE INCENTIVE TO PARTICIPANTS. PRIOR TO THE YEAR IN WHICH CONTRIBUTIONS ARE MADE, THE PARTICIPANT MUST DESIGNATE A VESTING/PAYOUT DATE CONSISTENT WITH THE CONSTRAINTS OF THE PLANS AND FEDERAL DEFERRED COMPENSATION REGULATIONS. AFTER THE CONTRIBUTIONS ARE MADE, THE PARTICIPANT HAS A ONE-TIME LIMITED OPPORTUNITY TO EXTEND THE ELECTED PAYMENT DATE FOR AT LEAST FIVE YEARS. ONCE THE VESTING/PAYOUT DATE HAS BEEN REACHED, ALLINA WILL WITHHOLD THE APPROPRIATE TAXES AND THE BALANCE WILL BE PAID TO THE PARTICIPANT ON THEIR PAYCHECK AS SOON AS ADMINISTRATIVELY FEASIBLE. IF THE PARTICIPANT TERMINATES EMPLOYMENT VOLUNTARILY BEFORE AN AMOUNT IS PAID, PAYMENT WILL BE SUBJECT TO THE PARTICIPANT'S COMPLIANCE WITH A NON-COMPETE AGREEMENT WITH ALLINA FOR TWO YEARS AFTER TERMINATION. THE PARTICIPANT MAY ELECT FROM AMONG INVESTMENT ALTERNATIVES THAT ARE SIMILAR TO THOSE AVAILABLE IN THE RETIREMENT SAVINGS PLAN. UNLIKE THE RETIREMENT SAVINGS PLAN, THE PARTICIPANT HAS THE STATUS AN UNSECURED CREDITOR OF ALLINA AND WILL NOT HAVE A PREFERRED CLAIM TO PAYMENT IN THE CASE OF THE COMPANY'S INABILITY TO PAY. HOWEVER, THE COMPANY DOES SET ASIDE ASSETS FOR ITS OBLIGATIONS BY ACTUALLY INVESTING THE PROMISED ASSETS CONSISTENT WITH PARTICIPANT ELECTIONS. ALLINA EXECUTIVE RETIREMENT BENEFIT RESTORATION PLAN (SERP) ELIGIBLE ALLINA EXECUTIVES PARTICIPATE IN A DEFERRED COMPENSATION SERP. EXECUTIVES ARE CREDITED AN AMOUNT EQUAL TO THE EXCESS AMOUNT THAT WOULD HAVE BEEN CREDITED TO THE ALLINA RETIREMENT SAVINGS PLAN WERE IT NOT FOR THE QUALIFIED PLAN COMPENSATION LIMITS. EMPLOYER CREDITS ARE MADE EACH YEAR TO THEIR SERP BALANCE ACCORDING TO THE FOLLOWING SCHEDULE AS OF THE END OF THE PLAN YEAR: PARTICIPANT'S YEARS OF VESTING SERVICE APPLICABLE PERCENTAGE LESS THAN 1 0% 1-5 5.0% 6-10 5.5% 11-15 6.0% 16 OR MORE 6.5% DEPOSITS EARN THE INVESTMENT RATE OF RETURN EQUAL TO THE INVESTMENT OPTIONS SELECTED BY THE PARTICIPANT WHICH ARE THE SAME OPTIONS AVAILABLE UNDER THE QUALIFIED PLAN. A PARTICIPANT WHO HAS COMPLETED AT LEAST TWO YEARS OF SERVICE BECOMES VESTED IN THE PORTION OF HIS OR HER SERP ACCOUNT ATTRIBUTABLE TO THE ANNUAL SERP CREDIT FOR A PARTICULAR YEAR AS OF JANUARY 15 OF THE YEAR FOLLOWING THE CALENDAR YEAR IN WHICH THE ANNUAL SERP CREDIT IS EARNED. IN THE EVENT OF TERMINATION (OTHER THAN BECAUSE OF DEATH) PRIOR TO AGE 67, THE DISTRIBUTION DATE SHALL BE AS SOON AS ADMINISTRATIVELY POSSIBLE AFTER TERMINATION IN THE FORM OF A LUMP SUM PAYMENT. THE SERP IS PAYABLE FROM ALLINA'S GENERAL ASSETS. IF ALLINA BECOMES INSOLVENT, THE PARTICIPANT WILL BE AN UNSECURED CREDITOR AND WILL HAVE NO PREFERRED CLAIM TO ANY ASSETS. THIS PLAN WAS EFFECTIVE JANUARY 1, 2009. EXECUTIVE SEVERANCE PLAN ALLINA PROVIDES SALARY CONTINUATION FOR EXECUTIVES WHOSE EMPLOYMENT HAS BEEN INVOLUNTARILY TERMINATED FOR REASONS OTHER THAN CAUSE OR POOR PERFORMANCE. THE LENGTH OF THE SEVERANCE PAY PERIOD IS DEFINED BY THE PLAN AND DEPENDS ON THE LEVEL OF THE EXECUTIVE POSITION. UNDER THE PLAN THE SEVERED EXECUTIVE ALSO COULD CONTINUE CERTAIN BENEFITS FOR A LIMITED PERIOD OF TIME. IN 2009, THE PLAN WAS AMENDED TO FURTHER RESTRICT SEVERANCE BENEFITS IN THE CASE THAT THE EXECUTIVE OBTAINS OTHER EMPLOYMENT DURING THE SEVERANCE PERIOD. X 14 186291 FAIR MARKET VALUE X 1 579994 SALE PRICE PROPERTY 0 0 1 1 PART I, LINE 32B: ABBOTT NORTHWESTERN HOSPITAL FOUNDATION MAY, FROM TIME TO TIME AND IN THE ORDINARY COURSE OF ITS CHARITABLE ACTIVITIES, ACCEPT NONCASH CONTRIBUTIONS OF PUBLICLY TRADED SECURITIES AND REAL ESTATE. ABBOTT NORTHWESTERN HOSPITAL FOUNDATION USES THIRD PARTIES, SUCH AS SECURITIES BROKERAGE FIRMS AND REAL ESTATE BROKERS SUCH AS REALTORS, TO LIQUIDATE THE PUBLICLY TRADED SECURITIES AND REAL ESTATE TO CASH ON THE OPEN SECURITIES MARKET AND REAL ESTATE MARKET. THE SALE OF PUBLICLY TRADED SECURITIES AND REAL ESTATE ARE GENERALLY SUBJECT TO MARKET RATE BROKERAGE COMMISSIONS AND FEES OF THE THIRD PARTY SECURITIES AND REAL ESTATE BROKERS. ABBOTT NORTHWESTERN HOSPITAL FOUNDATION CASH AND INVESTMENTS ARE POOLED WITH ITS SOLE MEMBER ORGANIZATION, ALLINA HEALTH SYSTEM, AND ITS RELATED ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 6 ALLINA HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER ORGANIZATION OF ABBOTT NORTHWESTERN HOSPITAL FOUNDATION. ABBOTT NORTHWESTERN HOSPITAL FOUNDATION IS THE SUPPORTING ORGANIZATION AND ALLINA HEALTH SYSTEM IS THE SUPPORTED ORGANIZATION. SEE SCHEDULE A AND SCHEDULE R FOR FURTHER DETAILS. ALLINA HEALTH SYSTEM PROVIDES ABBOTT NORTHWESTERN HOSPITAL FOUNDATION WITH ADMINISTRATIVE AND STAFF SERVICES AT NO COST. THE VALUE OF THE SERVICES PROVIDED BY ALLINA HEALTH SYSTEM TO ABBOTT NORTHWESTERN HOSPITAL FOUNDATION DURING 2014 WERE ESTIMATED AT $1,986,515 AND HAVE BEEN RECORDED AS CONTRIBUTION REVENUE FROM A RELATED ORGANIZATION IN THE STATEMENT OF REVENUE AND AS ADMINISTRATIVE AND FUNDRAISING EXPENSES IN THE STATEMENT OF FUNCTIONAL EXPENSES. ABBOTT NORTHWESTERN HOSPITAL FOUNDATION HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. COMPENSATION DISCLOSED AS PAID BY A RELATED ORGANIZATION IS DETERMINED SOLELY BY THE RELATED ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE CORPORATE MEMBER ORGANIZATION, ALLINA HEALTH SYSTEM HOLDS CERTAIN RESERVED POWERS OVER ABBOTT NORTHWESTERN HOSPITAL FOUNDATION. THE RESERVED POWERS ARE FULLY DESCRIBED IN ABBOTT NORTHWESTERN HOSPITAL FOUNDATION'S GOVERNING DOCUMENTS AND INCLUDE SUCH POWERS AS ELECTION AND APPROVAL OF DIRECTORS, FINAL APPROVAL OF AMENDMENTS TO ARTICLES OF INCORPORATION OR BYLAWS, APPROVAL OF STRATEGIC PLANS AND CAPITAL AND OPERATING BUDGETS, APPROVAL OF PLANS OF MERGER OR CONSOLIDATION, APPROVAL OF INCURRENCE OF DEBT OR EXPENDITURES IN EXCESS OF CERTAIN AMOUNTS, AND VARIOUS OTHER RESERVED POWERS AS DESCRIBED THEREIN. FORM 990, PART VI, SECTION A, LINE 7B SEE THE EXPLANATION IN SCHEDULE O FOR FORM 990, PART VI, SECTION A, LINE 7A. FORM 990, PART VI, SECTION B, LINE 11 ABBOTT NORTHWESTERN HOSPITAL FOUNDATION'S FORM 990 WAS PREPARED BY THE TAX SERVICES FUNCTION OF ALLINA HEALTH SYSTEM, ABBOTT NORTHWESTERN HOSPITAL FOUNDATION'S SOLE CORPORATE MEMBER AND SUPPORTED ORGANIZATION. THE FORM 990 FILING WAS SUBJECTED TO A RIGOROUS REVIEW PROCESS BY ALLINA'S TAX MANAGER AND TAX DIRECTOR. ALLINA'S CHIEF FINANCIAL OFFICER ALSO PERFORMED AN EXECUTIVE REVIEW OF THE FORM 990. AFTER THE MANAGEMENT REVIEW PROCESS DESCRIBED ABOVE WAS COMPLETED, THE FINAL FORM 990, AS ULTIMATELY FILED WITH THE INTERNAL REVENUE SERVICE ["IRS"], WAS PROVIDED TO EACH VOTING MEMBER OF ABBOTT NORTHWESTERN HOSPITAL FOUNDATION'S BOARD OF DIRECTORS. AN ABBOTT NORTHWESTERN HOSPITAL FOUNDATION BOARD OF DIRECTORS MEETING WAS HELD ON OCTOBER 6,2015 TO REVIEW AND DISCUSS THE FORM 990 FILING. ABBOTT NORTHWESTERN HOSPITAL FOUNDATION'S BOARD OF DIRECTORS VOTED ON AND APPROVED A RESOLUTION APPROVING THE FORM 990, THE MINNESOTA CHARITABLE ORGANIZATION ANNUAL REPORT TO BE FILED WITH THE MINNESOTA ATTORNEY GENERAL, AND THE WISCONSIN CHARITABLE ORGANIZATION ANNUAL REPORT TO BE FILED WITH THE WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTIONS. THE BOARD OF DIRECTORS RESOLUTION ALSO DIRECTED OFFICERS TO FILE THE FORM 990 WITH THE IRS, THE CHARITABLE ANNUAL REPORT WITH THE CHARITIES DIVISION OF THE OFFICE OF THE MINNESOTA ATTORNEY GENERAL, AND THE WISCONSIN CHARITABLE ORGANIZATION ANNUAL REPORT WITH THE WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTIONS. THE ABOVE STATED REVIEW AND APPROVAL PROCESS OCCURRED PRIOR TO FILING ABBOTT NORTHWESTERN HOSPITAL FOUNDATION'S FORM 990 WITH THE IRS, MINNESOTA CHARITABLE ORGANIZATION ANNUAL REPORT WITH THE MINNESOTA ATTORNEY GENERAL, AND WISCONSIN CHARITABLE ORGANIZATION ANNUAL REPORT WITH THE WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTIONS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS SEVERAL METHODS OF MONITORING AND ENFORCING COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. FIRST, THE ORGANIZATION REGULARLY DISTRIBUTES CONFLICT OF INTEREST DISCLOSURE QUESTIONNAIRES TO ITS OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES. THESE INDIVIDUALS ARE REQUIRED TO DISCLOSE ANNUALLY ANY INTEREST THAT COULD GIVE RISE TO CONFLICTS, INCLUDING ANY FAMILY OR BUSINESS RELATIONSHIP. SECOND, THE GENERAL COUNSEL'S OFFICE ANNUALLY DELIVERS A REPORT TO ALLINA'S BOARD OF DIRECTORS WHICH INCLUDES, AMONG OTHER THINGS, THE RESULTS OF THE CONFLICT OF INTEREST QUESTIONNAIRE, AN ANALYSIS OF POTENTIAL CONFLICTS, AND GUIDANCE FOR SATISFACTORILY RESOLVING CONFLICTS. THIRD, THE ORGANIZATION UNDERTAKES MANDATORY COMPLIANCE TRAINING OF ALL ITS EMPLOYEES WHICH INCLUDES TRAINING ON CONFLICTS OF INTEREST. FOURTH, ALL EMPLOYEES RECEIVE, AND ARE EXPECTED TO CONDUCT THEMSELVES IN ACCORDANCE WITH ALLINA'S CODE OF CONDUCT. THE CODE OF CONDUCT CONTAINS EDUCATIONAL MATERIALS AND GUIDANCE TO RESOLVE POTENTIAL CONFLICTS OF INTEREST. FIFTH, ALLINA MAINTAINS A CORPORATE INTEGRITY HOTLINE, A CONFIDENTIAL 24 HOUR EXTERNAL RESOURCE TO HELP ANSWER QUESTIONS RELATED TO ETHICAL BUSINESS CONDUCT. ALL CALLS TO THE INTEGRITY LINE ARE KEPT CONFIDENTIAL. FORM 990, PART VI, SECTION B, LINE 15 ABBOTT NORTHWESTERN HOSPITAL FOUNDATION HAS NO EMPLOYEES AND DOES NOT PAY COMPENSATION. ANY COMPENSATION DISCLOSED AS PAID BY A RELATED ORGANIZATION IS DETERMINED SOLELY BY THE RELATED ORGANIZATION. THEREFORE, FORM 990, PART VI, SECTION B, LINES 15A AND 15B ARE NOT APPLICABLE TO ABBOTT NORTHWESTERN HOSPITAL FOUNDATION. FORM 990, PART VI, SECTION C, LINE 19 ABBOTT NORTHWESTERN HOSPITAL FOUNDATION MAKES ITS FORM 990, FORM 1023, GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. TO ARRANGE AN INSPECTION OR RECEIVE A COPY, PLEASE CONTACT THE FOLLOWING: ABBOTT NORTHWESTERN HOSPITAL FOUNDATION TAX SERVICES MAIL ROUTE 10890 P.O. BOX 43 MINNEAPOLIS, MN 55407-0043 TELEPHONE: 612-262-0660 PHYSICAL ADDRESS: 2925 CHICAGO AVENUE MINNEAPOLIS, MN 55407-1321 THE FORM 990 AND FORM 1023 ARE ALSO AVAILABLE DIRECTLY FROM THE INTERNAL REVENUE SERVICE. THE FORM 990 AND FINANCIAL STATEMENTS ARE ALSO AVAILABLE FROM THE CHARITIES DIVISION OF THE OFFICE OF THE MINNESOTA ATTORNEY GENERAL. FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF SPLIT INTEREST AGREEMENTS 11,436. CHANGE IN LIABILITY COLLATERAL AGREEMENT 10,841. PRIOR YEAR PLEDGE ADJUSTMENT -76,500. FORM 990, PART XII, LINE 2C: THIS PROCESS REMAINS UNCHANGED FROM THE PRIOR YEAR. ALLINA ASSOCIATED FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 274116873 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM 0 CENTER FOR HEALTHCARE INNOVATION FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 263553868 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM 0 ALLINA HEALTH SYSTEM PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 363261413 HEALTHCARE SERVICES MN 501(C)(3) LINE 3 N/A 0 ALLINA INTEGRATED MEDICAL NETWORK PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 275129095 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM 0 MERCY & UNITY HOSPITALS FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 300086426 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM 0 PHILLIPS EYE INSTITUTE FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411613017 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM 0 COURAGE KENNY FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411952989 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM 0 UNITED HOSPITAL FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 237420998 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I ALLINA HEALTH SYSTEM 0 UNITED AND CHILDRENS AMBULATORY SURGERY CENTER ASSOCIATION 310 NORTH SMITH AVENUE ST PAUL MN 55102 411694626 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I N/A 0 WESTHEALTH INC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411768814 HEALTHCARE SERVICES MN 501(C)(3) LINE 3 ALLINA HEALTH SYSTEM 0 MBP FACILITY LLC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 454078371 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I N/A 0 REGINA FOUNDATION PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411987372 SUPPORTING ORGANIZATION MN 501(C)(3) LINE 11A, I N/A 0 APPLE VALLEY BUILDING ASSOCIATES LLC 14655 GALAXIE AVENUE S APPLE VALLEY MN 55124 411677072 RENTAL REAL ESTATE MN N/A ASPEN SLEEP CENTER LLC 1010 BANDANA BOULEVARD WEST ST PAUL MN 55108 261850227 HEALTHCARE SERVICES MN N/A MAGNETO LEASING LLC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 201582501 RENTAL EQUIPMENT MN N/A METROPOLITAN INTEGRATED CANCER CARELLC PO BOX 819066 DALLAS TX 75381 205068485 RADIOLOGY DE N/A SOUTHWEST SURGICAL CENTER LLC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 412013700 SURGICAL SERVICES MN N/A GERIATRIC SERVICES OF MINNESOTA LLC 3366 OAKDALE AVE NORTH SUITE 551 ROBBINSDALE MN 55422 453357936 HEALTHCARE SERVICES MN N/A NORTHSTAR SLEEP CENTER LLC 920 EAST 28TH STREET SUITE 700 MINNEAPOLIS MN 55407 452532456 HEALTHCARE SERVICES MN N/A DISTRICT ONE CANCER CENTER LLC 200 STATE AVENUE FARIBAULT MN 55021 451258847 HEALTHCARE SERVICES MN N/A MOBILE IMAGING SERVICES LLC 1221 NICOLLET MALL STE 600 MINNEAPOLIS MN 554032444 411883212 RADIOLOGY MN N/A CROSBY CARDIOVASCULAR SERVICESLLC 920 E 28TH STREET SUITE 500 MINNEAPOLIS MN 55407 412010368 HEALTHCARE SERVICES MN N/A BPA HEALTH LLC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 352490984 HEALTHCARE SERVICES MN N/A TWIN CITIES MEDICAL IMAGINING LLC 1221 NICOLLET MALL STE 600 MINNEAPOLIS MN 55403 463959737 RADIOLOGY MN N/A ALLINA HEALTH SYSTEM TRUST PO BOX 535007 PITTSBURGH PA 15253 276712988 TRUST PA N/A T 0 ALLINA SPECIALTY ASSOCIATESINC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411802815 HEALTHCARE SERVICES MN N/A C 0 HEALTHSPAN SERVICES COMPANY PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411249999 DEBT COLLECTION MN N/A C 0 ALLINA HEALTH SYSTEM DEFINED BENEFIT MASTER TRUST 500 GRANT STREET STE 625 PITTSBURGH PA 15258 376520273 TRUST PA N/A T 0 ALLINA HEALTH SYSTEM KEYSHARE PLAN PO BOX 535007 PITTSBURGH PA 15253 276678945 TRUST PA N/A T 0 LIFESPAN AFFILIATES DEFERRED COMPENSATION PLAN PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 411720860 TRUST MN N/A T 0 CREATEHEALTH INC PO BOX 43 MAIL ROUTE 10890 MINNEAPOLIS MN 55440 260594364 HEALTHCARE SERVICES MN N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1