NAEVE HEALTH CARE FOUNDATION: Form 990, tax year 2021

View the entire original 990 at ProPublica ↗

Organization
NAEVE HEALTH CARE FOUNDATION (EIN 41-1989509)
Tax period
2021-01-01 to 2021-12-31
Filed
2022-10-19
IRS object ID
202202929349300805
Schema version
2021v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-10-19T08:51:00-05:00ReturnTs
Tax Period End2021-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN410746749PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1121 WEST BRIDGE STREETAddressLine1Txt
CityOWATONNACityNm
State AbbreviationMNStateAbbreviationCd
ZIP55060ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2021-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN411989509EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1NAEVE HEALTH CARE FOUNDATIONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlNAEVBusinessNameControlTxt
Phone5074341595PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1404 WEST FOUNTAIN STAddressLine1Txt
CityALBERT LEACityNm
State AbbreviationMNStateAbbreviationCd
ZIP56007ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDANIEL KOLKERPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone5074341595PhoneNum
Signature2022-10-04SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstDANIELPersonFirstNm
Person LastKOLKERPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonBRAD SVENBYPreparerPersonNm
PTINP00449887PTIN
Phone5074467100PhoneNum
Preparation2022-10-04PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2021TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDANIEL KOLKERPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1404 WEST FOUNTAIN STAddressLine1Txt
CityALBERT LEACityNm
State AbbreviationMNStateAbbreviationCd
ZIP56007ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$2,200,180GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.NAEVEFOUNDATION.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2000FormationYr
Legal Domicile StateMNLegalDomicileStateCd
Activity Or MissionRAISING PHILANTHROPIC DOLLARS FOR HIGH QUALITY COST EFFECTIVE HEALTHCARE AT MCHS IN ALBERT LEA.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers12TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,905PYContributionsGrantsAmt
CY Contributions Grants$993CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$271,930PYInvestmentIncomeAmt
CY Investment Income$355,560CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$273,835PYTotalRevenueAmt
CY Total Revenue$356,553CYTotalRevenueAmt
PY Grants And Similar Paid$437,431PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$227,523CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$40,257PYOtherExpensesAmt
CY Other Expenses$43,560CYOtherExpensesAmt
PY Total Expenses$477,688PYTotalExpensesAmt
CY Total Expenses$271,083CYTotalExpensesAmt
PY Revenues Less Expenses-$203,853PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$85,470CYRevenuesLessExpensesAmt
Total Assets BOY$5,347,686TotalAssetsBOYAmt
Total Assets EOY$5,959,953TotalAssetsEOYAmt
Total Liabilities BOY$0TotalLiabilitiesBOYAmt
Total Liabilities EOY$227,523TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$5,347,686NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$5,732,430NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionSEE SCHEDULE OMissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$227,523ExpenseAmt
Grant$227,523GrantAmt
Revenue$0RevenueAmt
DescNAEVE HEALTH CARE FOUNDATION'S GIFT WAS DIRECTED TOWARDS PROJECTS WITHIN MAYO CLINIC HEALTH SYSTEM IN ALBERT LEA.Desc
Total Program Service Expenses$227,523TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMNStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MARK CHRISTOPHERSONBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5074341069PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11000 FIRST DRIVE NWAddressLine1Txt
CityAUSTINCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55912ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
DAN KOLKER
PRESIDENT12.00Yes (X)Yes (X)$0$0$0
DIANE CLARK
SECRETARY10.00Yes (X)Yes (X)$0$0$0
SHANNON STEENSMA
TREASURER10.00Yes (X)Yes (X)$0$0$0
KAREN CONN
TRUSTEE6.00Yes (X)$0$0$0
DIANE DAMEROW
TRUSTEE6.00Yes (X)$0$0$0
CORRINE TIMS
TRUSTEE6.00Yes (X)$0$0$0
VIRGINIA LARSON
TRUSTEE6.00Yes (X)$0$0$0
BWAY SHEE
TRUSTEE6.00Yes (X)$0$0$0
DR VIJAY VENUGOPAL
TRUSTEE6.00Yes (X)$0$0$0
DIANE WICHMANN
TRUSTEE6.00Yes (X)$0$0$0
GARY SCHINDLER
TRUSTEE6.00Yes (X)$0$0$0
DR SUMIT BHAGRA
EX-OFFICIO OFFICER12.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
All Other Contributions$993AllOtherContributionsAmt
Total Contributions$993TotalContributionsAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$78,923TotalRevenueColumnAmt
Exclusion$78,923ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$2,120,264SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$1,843,627SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$276,637SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$276,637TotalRevenueColumnAmt
Exclusion$276,637ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$356,553TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$355,560ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$227,523TotalAmt
Program Services$227,523ProgramServicesAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$39,516TotalAmt
Management And General$39,516ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUS EXPENSEDesc
Total$4,044TotalAmt
Management And General$4,044ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$271,083TotalAmt
Program Services$227,523ProgramServicesAmt
Management And General$43,560ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$17,686BOYAmt
EOY$18,668EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$5,319,922BOYAmt
EOY$5,931,050EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$10,078BOYAmt
EOY$10,235EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$5,347,686BOYAmt
EOY$5,959,953EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
EOY$227,523EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$227,523EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,777,620BOYAmt
EOY$5,098,784EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$570,066BOYAmt
EOY$633,646EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,347,686BOYAmt
EOY$5,732,430EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,347,686BOYAmt
EOY$5,959,953EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$85,470ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$299,274NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type3 Non FuncYes (X)SupportingOrgType3NonFuncInd
IRS Written DeterminationYes (X)IRSWrittenDeterminationInd
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1MAYO CLINIC HEALTH SYSTEMSBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN411404075EIN
Organization Type3OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$227,523SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$227,523SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings RulesYes (1)ExcessBusinessHoldingsRulesInd
Excess Business Holdings0ExcessBusinessHoldingsInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp

FieldValueIRS element (for citing)
Timely Provided DocumentsYes (1)TimelyProvidedDocumentsInd
Officers Close RelationshipYes (1)OfficersCloseRelationshipInd
Supported Org Voice InvestmentYes (1)SupportedOrgVoiceInvestmentInd

Adjusted Net Income AdjustedNetIncomeGrp

Net ST Capital Gain Adj Net Incm NetSTCapitalGainAdjNetIncmGrp

FieldValueIRS element (for citing)
Prior Year$29,112PriorYearAmt
Current Year$10,356CurrentYearAmt

Recoveries PY Distributions RecoveriesPYDistributionsGrp

FieldValueIRS element (for citing)
Prior Year$0PriorYearAmt
Current Year$0CurrentYearAmt

Other Gross Income OtherGrossIncomeGrp

FieldValueIRS element (for citing)
Prior Year$94,903PriorYearAmt
Current Year$78,923CurrentYearAmt

Adjusted Gross Income AdjustedGrossIncomeGrp

FieldValueIRS element (for citing)
Prior Year$124,015PriorYearAmt
Current Year$89,279CurrentYearAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Prior Year$0PriorYearAmt
Current Year$0CurrentYearAmt

Production Income ProductionIncomeGrp

FieldValueIRS element (for citing)
Prior Year$36,516PriorYearAmt
Current Year$39,516CurrentYearAmt

Other Expenses OtherExpensesGrp

FieldValueIRS element (for citing)
Prior Year$0PriorYearAmt
Current Year$0CurrentYearAmt

Total Adjusted Net Income TotalAdjustedNetIncomeGrp

FieldValueIRS element (for citing)
Prior Year$87,499PriorYearAmt
Current Year$49,763CurrentYearAmt

Minimum Asset Amount MinimumAssetAmountGrp

Average Monthly FMV Of Sec AverageMonthlyFMVOfSecGrp

FieldValueIRS element (for citing)
Prior Year$4,960,656PriorYearAmt
Current Year$547,678CurrentYearAmt

Average Monthly Cash Balances AverageMonthlyCashBalancesGrp

FieldValueIRS element (for citing)
Prior Year$16,733PriorYearAmt
Current Year$1,283CurrentYearAmt

FMV Other Non Exempt Use Asset FMVOtherNonExemptUseAssetGrp

FieldValueIRS element (for citing)
Prior Year$0PriorYearAmt
Current Year$0CurrentYearAmt

Total FMV Of Non Exempt Use Asset TotalFMVOfNonExemptUseAssetGrp

FieldValueIRS element (for citing)
Prior Year$4,977,389PriorYearAmt
Current Year$548,961CurrentYearAmt
FieldValueIRS element (for citing)
Discount Claimed$0DiscountClaimedAmt

Acquisition Indebtedness AcquisitionIndebtednessGrp

FieldValueIRS element (for citing)
Prior Year$0PriorYearAmt
Current Year$0CurrentYearAmt

Adjusted FMV Less Indebtedness AdjustedFMVLessIndebtednessGrp

FieldValueIRS element (for citing)
Prior Year$4,977,389PriorYearAmt
Current Year$548,961CurrentYearAmt

Cash Deemed Charitable CashDeemedCharitableGrp

FieldValueIRS element (for citing)
Prior Year$74,661PriorYearAmt
Current Year$8,234CurrentYearAmt

Net Vl Non Exempt Use Assets NetVlNonExemptUseAssetsGrp

FieldValueIRS element (for citing)
Prior Year$4,902,728PriorYearAmt
Current Year$540,727CurrentYearAmt

Pct Of Net Vl Non Exempt Use Ast PctOfNetVlNonExemptUseAstGrp

FieldValueIRS element (for citing)
Prior Year$171,595PriorYearAmt
Current Year$18,925CurrentYearAmt

Recoveries PY Distri Min Asset RecoveriesPYDistriMinAssetGrp

FieldValueIRS element (for citing)
Prior Year$0PriorYearAmt
Current Year$0CurrentYearAmt

Total Minimum Asset TotalMinimumAssetGrp

FieldValueIRS element (for citing)
Prior Year$171,595PriorYearAmt
Current Year$18,925CurrentYearAmt

Distributable Amount DistributableAmountGrp

FieldValueIRS element (for citing)
CY Adj Net Income Distributable$87,499CYAdjNetIncomeDistributableAmt
CY Pct85 Adjusted Net Income$74,374CYPct85AdjustedNetIncomeAmt
CY Total Min Ast Distributable$171,595CYTotalMinAstDistributableAmt
CY Greater Adjusted Minimum$171,595CYGreaterAdjustedMinimumAmt
CY Income Tax Imposed PY$0CYIncomeTaxImposedPYAmt
CY Distributable As Adjusted$171,595CYDistributableAsAdjustedAmt

Distributions DistributionsGrp

FieldValueIRS element (for citing)
CY Paid Accomplish Exempt Prps$227,523CYPaidAccomplishExemptPrpsAmt
CY Pd In Excess Income Activity$0CYPdInExcessIncomeActivityAmt
CY Administrative Expense Paid$0CYAdministrativeExpensePaidAmt
Exempt Use Assets Acquis Paid$0ExemptUseAssetsAcquisPaidAmt
Qualified Set Aside$0QualifiedSetAsideAmt
CY Other Distributions$0CYOtherDistributionsAmt
CY Total Annual Distributions$227,523CYTotalAnnualDistributionsAmt
CY Distri Attentive Suprt Org$227,523CYDistriAttentiveSuprtOrgAmt
CY Distributable As Adjusted$171,595CYDistributableAsAdjustedAmt
CY Distribution Yr100.000000000000CYDistributionYrRt

Distribution Allocations DistributionAllocationsGrp

FieldValueIRS element (for citing)
CY Distributable As Adjusted$171,595CYDistributableAsAdjustedAmt
Underdistributions$0UnderdistributionsAmt
Excess Distribution Cyov Yr5$0ExcessDistributionCyovYr5Amt
Excess Distribution Cyov Yr4$0ExcessDistributionCyovYr4Amt
Excess Distribution Cyov Yr3$0ExcessDistributionCyovYr3Amt
Excess Distribution Cyov Yr2$0ExcessDistributionCyovYr2Amt
Excess Distribution Cyov Yr1$141,612ExcessDistributionCyovYr1Amt
Total Excess Distribution Cyov$141,612TotalExcessDistributionCyovAmt
Cyov Applied Underdistri PY$0CyovAppliedUnderdistriPYAmt
Cyov Applied Underdistr CPY$141,612CyovAppliedUnderdistrCPYAmt
Carryover PY Not Applied$0CarryoverPYNotAppliedAmt
Excess Distribution Cyov$0ExcessDistributionCyovAmt
CY Total Annual Distributions$227,523CYTotalAnnualDistributionsAmt
CY Distrib App Underdistri PY$0CYDistribAppUnderdistriPYAmt
CY Distri App Distributable$29,983CYDistriAppDistributableAmt
Excess Distribution$197,540ExcessDistributionAmt
Remaining Underdistri PY$0RemainingUnderdistriPYAmt
Remaining Underdistri CY$0RemainingUnderdistriCYAmt
Excess Distri Cyov To Next Yr$197,540ExcessDistriCyovToNextYrAmt
Excess From Year5$0ExcessFromYear5Amt
Excess From Year4$0ExcessFromYear4Amt
Excess From Year3$0ExcessFromYear3Amt
Excess From Year2$0ExcessFromYear2Amt
Excess From Year1$197,540ExcessFromYear1Amt

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferencePART IV, SECTION D, LINE 3 - ROLE OF SUPPORTED ORGANIZATIONSFormAndLineReferenceDesc
ExplanationTHE CEO OF THE FOUNDATION'S SUPPORTED ORGANIZATION, MAYO CLINIC HEALTH SYSTEM - ALBERT LEA AND AUSTIN (THE "MEDICAL CENTER"), SERVES AS AN EX OFFICIO VOTING MEMBER OF THE BOARD OF TRUSTEES OF THE FOUNDATION. THE MEDICAL CENTER'S CEO ALSO SERVES AS AN EX OFFICIO MEMBER OF THE BOARD OF DIRECTORS OF THE MEDICAL CENTER, THUS PROVIDING REPRESENTATION OF MEDICAL CENTER LEADERSHIP ON THE BOARD OF THE FOUNDATION AT BOTH THE OFFICER AND GOVERNING BODY LEVELS OF THE MEDICAL CENTER. THE MEDICAL CENTER CEO IS COMMITTED TO ENSURING THAT THE FOUNDATION'S FACILITIES ARE MANAGED AND OPERATED IN A MATTER THAT REFLECTS THE MEDICAL CENTER'S CHARITABLE PURPOSES AND MISSION. HE IS ACTIVELY ENGAGED AS A BOARD MEMBER IN THE FOUNDATION'S GOVERNANCE AND PARTICIPATES IN DECISIONS AND DISCUSSIONS AT THE BOARD LEVEL AND WITH THE FOUNDATION'S LEADERSHIP IN ALL ASPECTS OF THE FOUNDATION'S MANAGEMENT AND USE OF ITS INCOME AND ASSETS FOR THE BENEFIT OF THE MEDICAL CENTER. IN ADDITION, THE FOUNDATION'S BYLAWS PROVIDE THAT THE FOUNDATION MUST MAINTAIN A CLOSE AND CONTINUOUS WORKING RELATIONSHIP WITH THE MEDICAL CENTER'S OFFICERS AND DIRECTORS IN ORDER TO ENSURE THAT THE MEDICAL CENTER'S LEADERSHIP HAS A SIGNIFICANT VOICE IN THE FOUNDATION'S OPERATIONS AND ITS ACQUISITION, USE, AND MANAGEMENT OF ITS INCOME AND ASSETS.ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$281,543BeginningYearBalanceAmt
End Year Balance$281,543EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$281,543BeginningYearBalanceAmt
End Year Balance$281,543EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$281,543BeginningYearBalanceAmt
End Year Balance$281,543EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$281,543BeginningYearBalanceAmt
End Year Balance$281,543EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$281,543BeginningYearBalanceAmt
End Year Balance$281,543EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescWELLS FARGO INVESTMENTSDesc
Book Value$5,931,050BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$5,931,050TotalBookValueSecuritiesAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART V, LINE 4:FormAndLineReferenceDesc
ExplanationTO SUPPORT PATIENTS OF MAYO CLINIC HEALTH SYSTEM IN ALBERT LEA.ExplanationTxt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records Maintained0GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1MAYO CLINIC HEALTH SYSTEMBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1404 FOUNTAIN STREETAddressLine1Txt
CityALBERT LEACityNm
State AbbreviationMNStateAbbreviationCd
ZIP56007ZIPCd
FieldValueIRS element (for citing)
Recipient EIN411404075RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$227,523CashGrantAmt
Non Cash Assistance$0NonCashAssistanceAmt
Valuation Method UsedACTUAL AMOUNTValuationMethodUsedDesc
Non Cash AssistanceMEDICAL SUPPLIES & EQUIPMENTNonCashAssistanceDesc
Purpose Of GrantSUPPORT PROGRAMSPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 1 - ORGANIZATION'S MISSION:TO ENSURE THE FUTURE OF LOCAL, QUALITY HEALTH CARE THROUGH THE CONTINUED DEVELOPMENT OF A PERMANENT ENDOWMENT FUND AND OTHER PHILANTHROPIC RELATIONSHIPS AND ACTIVITIES AS MAY BE DEEMED APPROPRIATE FOR THE GROWTH AND DEVELOPMENT OF MCHS IN ALBERT LEA AND SURROUNDING COMMUNITIES.
FORM 990, PART VI, SECTION A, LINE 8BTHE ORGANIZATION DOES NOT HAVE ANY COMMITTEES THAT HAVE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11BTHE FORM 990 IS PREPARED BY A NATIONAL CPA OFFICE AND THEN REVIEWED BY THE BOARD MEMBERS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 12CIN ACCORDANCE WITH THE FILING ORGANIZATION'S CONFLICT OF INTEREST POLICY, THE FOLLOWING INDIVIDUALS ARE REQUIRED TO ANNUALLY SIGN A CONFLICT OF INTEREST ACKNOWLEDGEMENT: -BOARD OF TRUSTEE MEMBERS -MEMBERS OF THE MAJOR NAEVE HEALTH CARE FOUNDATION COMMITTEES ANY INDIVIDUAL FROM THE ABOVE GROUPS MAY BE ASKED TO ABSTAIN FROM VOTING OR PARTICIPATING IN THE DECISION MAKING ACTIVITIES AFFECTED BY THE CONFLICT OF INTEREST DISCLOSURE. AN INDIVIDUAL MAY BE ASKED TO LEAVE A MEETING WHERE THE DECISION MAKING ACTIVITIES WOULD BE AFFECTED BY THE CONFLICT OF INTEREST DISCLOSURE. IF AN INDIVIDUAL NEGLECTS TO DISCLOSE APPROPRIATELY, DISCIPLINARY ACTION WILL BE CONSIDERED UP TO AND INCLUDING TERMINATION OF EMPLOYMENT AND/OR POSITION ON THE FOUNDATION BOARD. THE COMPLIANCE OFFICER OF MAYO CLINIC HEALTH SYSTEM - ALBERT LEA AND AUSTIN ASSISTS THE BOARD IN DISTRIBUTION AND COLLECTION OF ANNUAL CONFLICT OF INTEREST DISCLOSURE FORMS.
FORM 990, PART VI, SECTION C, LINE 19NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1MAYO CLINICBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 FIRST STREET SWAddressLine1Txt
CityROCHESTERCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55905ZIPCd
FieldValueIRS element (for citing)
EIN416011702EIN
Primary ActivitiesPATIENT CARE, RESEARCH, AND EDUCATIONPrimaryActivitiesTxt
Legal Domicile StateMNLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 10PublicCharityStatusTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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