2014-06-26T12:56:13-05:00 2013-12-31 420714325 MCGLADREY LLP 227 W FIRST ST STE 700 DULUTH MN 558021919 990 2013-01-01 237396466 MILLER-DWAN FOUNDATION MILL 2187862823 502 EAST SECOND STREET DULUTH MN 55805 TRACI MARCINIAK PRESIDENT 2187862823 2014-06-19 1 JULIE BOYER P01278549 2187275025 2013 2015-11-30 17:44:51Z TRACI MARCINIAK 502 EAST SECOND STREET DULUTH MN 55805 7239634 0 X WWW.MILLERDWANFOUNDATION.ORG X 1973 MN TO PROVIDE SUPPORT TO HISTORIC MILLER-DWAN MEDICAL CENTER SPECIALTY HEALTHCARE PROGRAMS AND SERVICES AND FOR INNOVATIVE PROGRAMMING THROUGHOUT THE REGION. 18 18 0 95 0 0 1055572 836245 20749 26360 825222 841934 29280 68078 1930823 1772617 376534 458963 0 0 0 0 0 0 122602 1048811 1206264 1425345 1665227 505478 107390 27939922 29310365 983003 812555 26956919 28497810 X THE MILLER-DWAN FOUNDATION IMPROVES THE HEALTH OF THE PEOPLE OF OUR REGION THROUGH THE CREATION OF IMPACTFUL COMMUNITY SOLUTIONS THAT OVERCOME BARRIERS. WE SUPPORT THE FUTURE AND THE LEGACY OF MILLER-DWAN MEDICAL CENTER, POLINSKY MEDICAL REHABILITATION CENTER, SOLVAY HOSPICE HOUSE, AMBERWING -- CENTER FOR YOUTH & FAMILY WELL-BEING AND OTHER INITIATIVES FOR OUR REGION'S HEALTH. BY COMING TOGETHER WITH OTHERS WHO SHARE OUR VISION AND PASSION, WE ARE ABLE TO MAKE A DIFFERENCE IN THE LIVES OF PEOPLE EVERY DAY. 0 0 912479 26360 THE MILLER-DWAN FOUNDATION PROVIDES AN ONGOING SERIES OF EDUCATIONAL PROGRAMS, SEMINARS AND WORKSHOPS THAT SPEAK TO COMMUNITY NEED AND REFLECT THE MISSION OF AND GOALS OF THE MILLER-DWAN FOUNDATION. IN 2013, FOR EXAMPLE, THE FOUNDATION HOSTED SEVERAL NATIONALLY KNOWN SPEAKERS AND SUPPORTED THE EDUCATIONAL NEEDS OF PROFESSIONALS THROUGHOUT THE REGION. 458963 458963 IN 2003, THE FOUNDATION TOOK ON THE ROLE OF COMMUNITY ORGANIZER, FUNDRAISER, DEVELOPER AND OWNER TO COMPLETE A $4,000,000 CAPITAL CAMPAIGN FOR SOLVAY HOSPICE HOUSE, THE REGION'S FIRST AND ONLY RESIDENTIAL HOSPICE HOME. FUNDING FOR THE PROJECT CAME SOLELY FROM THE FOUNDATION AND FROM COMMUNITY MEMBER DONATIONS TO THE FOUNDATION. THE FOUNDATION RETAINS OWNERSHIP OF THE 12-BED HOSPICE HOME AND HAS AN AGREEMENT WITH ESSENTIA HOSPICE AND PALLIATIVE CARE TO PROVIDE CARE WITHIN THE HOME. IN 2007, THE MILLER-DWAN FOUNDATION IDENTIFIED CHILDREN'S MENTAL HEALTH CARE AS OUR REGION'S MOST PRESSING NEED AND MADE A COMMITMENT TO WORK CLOSELY WITH OUR REGION'S TOP MENTAL HEALTH PRACTITIONERS TO RADICALLY CHANGE THE STANDARD OF CHILDREN'S MENTAL HEALTH CARE IN OUR REGION. THE CULMINATION OF THAT EFFORT HAS RESULTED IN THE CREATION OF AMBERWING -- CENTER FOR YOUTH & FAMILY WELL-BEING.OTHER LEADERSHIP AND COMMUNITY ORGANIZING EFFORTS HAVE INCLUDED, BUT ARE NOT LIMITED TO THE: - RENOVATION OF THE CHILDREN'S PHYSICAL REHABILITATION SPACE; - DEVELOPMENT OF A DIZZINESS AND BALANCE CENTER; AND - CREATION AND OPERATION OF THE CARING WAYS CANCER RESOURCE CENTERSINCE 1973, THE MILLER-DWAN FOUNDATION HAS DISTRIBUTED MORE THAN $27,000,000 IN GRANTS TO IMPROVE THE COMMUNITY'S HEALTH. WITH SERVICES TO NORTHEASTERN WISCONSIN AND NORTHWESTERN MINNESOTA, THE FOUNDATION SUPPORTS THE TRADITIONAL AND HISTORIC SPECIALTY AREAS OF THE FORMER MILLER-DWAN MEDICAL CENTER INCLUDING PHYSICAL REHABILITATION, MENTAL HEALTH, RADIATION ONCOLOGY, INPATIENT AND OUTPATIENT SURGICAL SERVICES, BURN AND WOUND CARE, AND PAIN MANAGEMENT. 1371442 1 1 0 0 0 0 0 0 0 1 1 1 0 1 0 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 1 8 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 18 18 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X X TRACI MARCINIAK 2187862823 502 E 2ND STREET DULUTH MN 55805 DIANE BODIN-LINK CHAIR 1.00 X X 0 0 0 JOHN HINZMAN DIRECTOR 1.00 X 0 0 0 MARSHA HYSTEAD SECRETARY 1.00 X X 0 0 0 JOHN LAWIEN TREASURER 1.00 X X 0 0 0 BOB HEIMBACH DIRECTOR 1.00 X 0 0 0 LISA STARR DIRECTOR 1.00 X 0 0 0 SONJA BAERTSCH DIRECTOR 1.00 X 0 0 0 DON MONACO VICE-CHAIR 1.00 X X 0 0 0 KRISTIN TEBERG DIRECTOR 1.00 X 0 0 0 SHANE JOHNSON DIRECTOR 1.00 X 0 0 0 DR STEVE SUTHERLAND DIRECTOR 1.00 X 0 0 0 DR TIMOTHY ZAGER DIRECTOR 1.00 X 0 0 0 JOHN GOLDFINE DIRECTOR 1.00 X 0 0 0 JILL KAISER DIRECTOR 1.00 X 0 0 0 MIKE LIEN DIRECTOR 1.00 X 0 0 0 PAT MULLEN DIRECTOR 1.00 X 0 0 0 MELINDA MACHONES DIRECTOR 1.00 X 0 0 0 SUSAN SKYTTA DIRECTOR 1.00 X 0 0 0 STEVEN OVEROM DIRECTOR 1.00 X 0 0 0 TRACI MARCINIAK-HILINSKI PRESIDENT 40.00 X 93886 0 17114 PAT BURNS PRESIDENT 40.00 X 57437 0 8231 151323 0 25345 0 0 0 1 MILLER-DWAN MEDICAL CENTER 502 E 2ND ST DULUTH MN 55805 MANAGEMENT SERVICES 406285 1 X 241067 595178 174080 836245 PROGRAM FEES 900099 26360 26360 26360 542704 542704 97449 0 97449 97449 97449 5680106 5380876 299230 299230 299230 56770 241067 86141 -29371 -29371 1772617 26360 0 910012 458963 458963 406416 247944 103108 55364 18112 8297 9815 21680 21680 11809 11809 350 350 42137 18344 6958 16835 3509 2947 562 8441 7301 1140 7777 7777 533829 532967 862 GENERAL PUBLIC INFORMAT 71735 71735 FUNDRAISING 43300 43300 EQUIPMENT RENTAL & MAIN 14764 6169 1704 6891 MISCELLANEOUS 8178 8178 14227 8998 5017 212 1665227 1371442 171183 122602 720136 279606 781799 393253 10048 7674 11197163 2877261 8577692 8319902 3110339 2515470 10935782 13610984 3804126 4183476 27939922 29310365 93516 95985 482187 516570 407300 200000 983003 812555 X 15151986 15506654 8000807 8807680 3804126 4183476 26956919 28497810 27939922 29310365 X 107390 1054151 379350 X 0 1 X 1 0 X 2499957 2056281 2243197 1055572 836245 8691252 2499957 2056281 2243197 1055572 836245 8691252 1900740 6790512 566231 474463 676933 666690 640153 3024470 97039 130345 109378 336762 12052484 110772 0.56340 0.55180 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11806729 730679 1159217 387052 257411 59209 12992953 14077645 822618 1257601 513904 3770901 66330 11806729 14614896 2411535 -292687 754525 1836020 65554 14077645 11908706 2193371 1237228 440157 284252 14614896 8200832 2569988 1672323 487636 46801 11908706 0.32210 0.67790 1 0 531931 531931 8077482 1686879 6390603 952366 422049 530317 1635384 768333 867051 8319902 MUTUAL FUNDS 11131139 F REAL ESTATE FUNDS 2260 F HEDGE FUNDS 2026588 F MONEY MARKET FUNDS 449880 F CASH 1117 F 13610984 PERPETUAL TRUST 4183476 4183476 X 3206118 1054151 379350 1433501 1772617 0 1772617 1665227 0 1665227 0 1665227 PART V, LINE 4: DONOR DESIGNATED FUND - FOR PROGRAM SERVICES AND FOR ACQUISITION OF LONG-LIVED ASSETS. VAN GORDON FUND: FUNDS ARE USED TO: 1. ASSIST THE PEDIATRIC REHABILITATION DEPARTMENT 2. FINANCE PROGRAMS, RESEARCH AND NEW EQUIPMENT 3. PROVIDE EDUCATIONAL OPPORTUNITIES TO REHABILITATION PATIENTS, FAMILY MEMBERS AND PRACTITIONERS 4. SUPPORT AND PROMOTE NEW AND INNOVATIVE PROGRAMS OF REHABILITATION SERVICES, RESEARCH AND EDUCATION FOR TAX-EXEMPT INSTITUTIONS IN NORTHERN MINNESOTA, NORTHERN WISCONSIN AND UPPER PENINSULA OF MICHIGAN PART X, LINE 2: NOT-FOR-PROFIT ORGANIZATIONS MAY BECOME SUBJECT TO INCOME TAXES IF QUALIFICATION AS A TAX-EXEMPT ENTITY CHANGES, IF UNRELATED BUSINESS INCOME IS GENERATED, AND IN CERTAIN OTHER INSTANCES. NOT-FOR-PROFIT ORGANIZATIONS ARE REQUIRED TO ASSESS THE CERTAINTY OF THEIR TAX POSITIONS RELATED TO THESE MATTERS AND, IN SOME CASES, RECORD LIABILITIES FOR POTENTIAL TAXES, INTEREST AND PENALTIES ACCOMPANIED BY FOOTNOTE DISCLOSURES. THE FOUNDATION HAS NOT IDENTIFIED ANY UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE THE ACCRUAL OF AN INCOME TAX PROVISION. GENERALLY, THE FOUNDATION IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE U.S. FEDERAL, STATE OR LOCAL TAX AUTHORITIES FOR YEARS BEFORE 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: INCREASE IN BENEFICIAL INTEREST IN PERPETUAL TRUST 379,350. ARTCETERA 258992 241067 17925 32479 9800 40006 COLOR DASH 38845 0 38845 970 2886 297837 241067 56770 970 32479 9800 42892 86141 -29371 1 ESSENTIA HEALTH 502 E 2ND ST DULUTH MN 55805 200360007 501(C)(3) 105091 CASH ASSISTANCE & PURCHASE OF MACHINES COURAGE CENTER 3915 GOLDEN VALLEY ROAD GOLDEN VALLEY MN 55422 410706118 501(C)(3) 10000 CASH ASSISTANCE ESSENTIA HEALTH 502 E 2ND ST DULUTH MN 55805 200360007 501(C)(3) 75888 CASH ASSISTANCE YMCA CAMP MILLER 89382 E FRONTAGE ROAD STURGEON LAKE MN 55783 410693931 501(C)(3) 6810 CASH ASSISTANCE COLLEGE OF ST SCHOLASTICA 1200 KENWOOD AVE DULUTH MN 55811 410698301 501(C)(3) 41740 CASH ASSISTANCE EQUIPALIFE 563 PIONEER CREEK DRIVE MAPLE PLAIN MN 55359 411913782 501(C)(3) 10000 CASH ASSISTANCE FAITH UNITED METHODIST CHURCH 1531 HUGHITT AVE SUPERIOR WI 54880 391840533 501(C)(3) 5000 CASH ASSISTANCE GIRL SCOUTS OF MN AND WI LAKES AND PINES 400 2ND AVE S WAITE PARK MN 56387 410877820 501(C)(3) 5000 CASH ASSISTANCE LIFE HOUSE 102 W 1ST ST DULUTH MN 55802 411704840 501(C)(3) 15000 CASH ASSISTANCE LUTHERAN SOCIAL SERVICE 104 W 1ST ST DULUTH MN 55802 410872993 501(C)(3) 16000 CASH ASSISTANCE NORTHERN WATERS PARISH NURSE MINISTRY 3500 TOWER AVE SUPERIOR WI 54880 312001278 501(C)(3) 5000 CASH ASSISTANCE PAVSA 32 E 1ST STREET SUITE 200 DULUTH MN 55802 411350021 501(C)(3) 15000 CASH ASSISTANCE RESIDENTIAL SERVICES OF NE MN INC 2619 W 15TH ST DULUTH MN 55811 411296663 501(C)(3) 10000 CASH ASSISTANCE CAMPS OF COURAGE & FRIENDSHIP 10509 18TH ST NW ANNANDALE MN 55302 411543013 501(C)(3) 10000 CASH ASSISTANCE ESSENTIA INSTITUTE OF RURAL HEALTH 502 E 2ND ST DULUTH MN 55802 271291124 501(C)(3) 9073 CASH ASSISTANCE MILLER-DWAN FOUNDATION AMBERWING LLC 502 E 2ND ST DULUTH MN 55802 203644274 DISREGARDED ENTITY 41778 CASH ASSISTANCE 15 SCHEDULE I, PART I, LINE 2 MILLER-DWAN FOUNDATION GRANTEES, WHEN APPROVED FOR GRANT AWARDS, ENTER INTO A FORMAL GRANT AGREEMENT THAT DIRECTLY REFLECTS THE PROJECT OR SERVICES FOR WHICH THEY REQUESTED FUNDING. ALL FINAL GRANTING DECISIONS WILL BE MADE BY THE MILLER-DWAN FOUNDATION BOARD OF DIRECTORS. NOTIFICATION OF GRANTING DECISIONS WILL BE MADE WITHIN 5 DAYS FOLLOWING A GRANT REVIEW. UPON APPROVAL, THE FOLLOWING DOCUMENTS ARE PREPARED AND MAILED TO THE GRANTEE FOR SIGNATURES: - AWARD LETTER - AGREEMENT OF GRANTEE - MEDIA INFORMATION - FINAL REPORT FORM APPLICANTS DECLINED FOR APPROVAL RECEIVE A LETTER SIGNIFYING THE BOARD'S DECISION. FOR GRANTS AWARDED OUTSIDE OF THE HEALTH SYSTEM, A CHECK REQUEST IS FORWARDED TO THE FOUNDATION ACCOUNTANT TO INITIATE PAYMENT WITH FOUNDATION GRANT FUNDS AFTER SIGNED PAPERWORK IS RETURNED. FOR INTERNAL GRANTS, NOTIFICATION OF AWARD WILL BE DISTRIBUTED TO DESIGNATED ESSENTIA ACCOUNTANTS. THE MILLER-DWAN FOUNDATION WILL BE BILLED BY ACCOUNTING FOR GRANT-RELATED EXPENDITURES. A COPY OF THE FOUNDATION AWARD LETTER MUST ACCOMPANY EACH PURCHASE REQUISITION. THE PURCHASE REQUISITION MUST INDICATE THAT THE PURCHASE IS FOUNDATION RELATED. GRANT FUNDS WILL BE SPENT USING ESSENTIA'S APPROVED PURCHASING PROCESS. MILLER-DWAN FOUNDATION IS UNABLE TO DIRECTLY REIMBURSE INDIVIDUALS OR DEPARTMENTS FOR GRANT EXPENDITURES NOT MADE USING THE APPROVED PURCHASING PROCESS. IF THERE ARE EXTENUATING CIRCUMSTANCES, APPROVAL FOR DIRECT REIMBURSEMENT MUST BE OBTAINED FROM MILLER-DWAN FOUNDATION IN ADVANCE OF ANY PURCHASES. COPIES OF ALL ASSOCIATED PAPERWORK INCLUDING CHECK REQUESTS, CHECK COPIES AND GRANTEE CORRESPONDENCE ARE FILED IN THE ORIGINAL GRANT FILE. X X X 0 0 0 0 0 0 0 0 0 TRACI MARCINIAK-HILINSKI PRESIDENT 93886 0 0 0 0 0 4692 0 12422 0 111000 0 0 0 PAT BURNS PRESIDENT 57437 0 0 0 0 0 2860 0 5371 0 65668 0 0 0 SCHEDULE J, PART II ESSENTIA HEALTH IS THE UNRELATED ORGANIZATION THAT IS COMPENSATING PAT BURNS AND TRACI MARCINIAK-HILINSKI. MILLER-DWAN FOUNDATION REIMBURSES ESSENTIA HEALTH FOR THE COMPENSATION. X 41 27475 FMV - PROVIDED BY DONOR X 1 40878 MSR PRICE X 6 105727 STOCK PRICE 0 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE PRESIDENT AND ACCOUNTANT OF THE FOUNDATION REVIEW THE 990 FOR ACCURACY AND COMPLETENESS OF INFORMATION. THE FINAL COPY OF THE 990 IS PROVIDED TO ALL BOARD MEMBERS FOR THEIR REVIEW. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS ARE GIVEN CONFLICT OF INTEREST FORM TO SIGN AT THE START OF THEIR TERM. PERIODICALLY THEY WILL SIGN ANOTHER COPY IF A DISCUSSION OR GRANT ROUND IS APPLICABLE. FORM 990, PART VI, SECTION C, LINE 18 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE FOUNDATION'S OFFICE. FORM 990, PART VI, SECTION C, LINE 19 THE ANNUAL REPORT IS AVAILABLE ON THE FOUNDATION'S WEBSITE AND IN PERSON AT THE FOUNDATION'S OFFICE. ALL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, OTHER POLICIES, AND FINANCIAL STATEMENTS ARE AVAILABLE AT THE FOUNDATION OFFICE. FORM 990, PART VIII, LINE 8 THE TOTAL GROSS RECEIPTS FROM FUNDRAISING EVENTS IS $297,837. THIS INCLUDES $241,067 OF CONTRIBUTIONS THAT IS INCLUDED ON PART VIII, LINE 1C. WHEN THE CONTRIBUTIONS ARE RECLASSED TO LINE 1C, A LOSS IS SHOWN FOR THE FUNDRAISING EVENTS. FORM 990, PART XI, LINE 9: DECREASE IN BENEFICIAL INTEREST IN PERPETUAL TRUST 379,350. FORM 990, PART I, LINE 5 MILLER-DWAN FOUNDATION HAS 6 EMPLOYEES. THESE EMPLOYEES ARE COMPENSATED BY ESSENTIA HEALTH, AN UNRELATED ORGANIZATION. MILLER-DWAN FOUNDATION REIMBURSES ESSENTIA HEALTH FOR THE COMPENSATION. MILLER-DWAN FOUNDATION HOSPICE HOUSE LLC 502 EAST SECOND STREET DULUTH MN 55805 203644274 OWNERSHIP OF HOSPICE PROPERTY MN -225888 2569802 N/A MILLER-DWAN FOUNDATION AMBERWING LLC 502 EAST SECOND STREET DULUTH MN 55805 OWNERSHIP OF AMBERWING PROPERTY MN 222026 5715178 N/A