NAEVE HEALTH CARE FOUNDATION: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- NAEVE HEALTH CARE FOUNDATION (EIN 41-1989509)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-10-15
- IRS object ID
- 201822889349301707
- Schema version
- 2017v2.3
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-10-15T13:15:52-05:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 586 | AddressLine1Txt |
| City | OWATONNA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 550600586 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411989509 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NAEVE HEALTH CARE FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NAEV | BusinessNameControlTxt |
| Phone | 5074341595 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 WEST FOUNTAIN ST | AddressLine1Txt |
| City | ALBERT LEA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56007 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SUE LOCH | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 5074341595 | PhoneNum |
| Signature | 2018-10-04 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | BRAD SVENBY | PreparerPersonNm |
| PTIN | P00449887 | PTIN |
| Phone | 5074467100 | PhoneNum |
| Preparation | 2018-10-01 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 67.137.57.251 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-10-04 | IPDt |
| IP Tm | 14:21:18 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | B5C6689AE7AF5414E27E4467F9AB971DF3B0FBE3 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 59AF7F7AE0AD7FB228FE1884CD01039D19CBB9C6 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2018-06-14 16:35:46Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SUE LOCH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1950 LAKEWOOD AVE | AddressLine1Txt |
| City | ALBERT LEA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56007 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $2,400,296 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.NAEVEFOUNDATION.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2000 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | RAISING PHILANTHROPIC DOLLARS FOR HIGH QUALITY COST EFFECTIVE HEALTHCARE AT MCHS IN ALBERT LEA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 11 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $9,403 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,881 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $215,880 | PYInvestmentIncomeAmt |
| CY Investment Income | $372,097 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $57 | CYOtherRevenueAmt |
| PY Total Revenue | $225,283 | PYTotalRevenueAmt |
| CY Total Revenue | $378,035 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $219,617 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $365,241 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $40,490 | PYOtherExpensesAmt |
| CY Other Expenses | $39,950 | CYOtherExpensesAmt |
| PY Total Expenses | $260,107 | PYTotalExpensesAmt |
| CY Total Expenses | $405,191 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$34,824 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$27,156 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,802,328 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,011,935 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,802,328 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,011,935 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | SEE SCHEDULE O | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $365,241 | ExpenseAmt |
| Grant | $365,241 | GrantAmt |
| Desc | NAEVE HEALTH CARE FOUNDATION'S GIFT WAS DIRECTED TOWARDS PROJECTS WITHIN MAYO CLINIC HEALTH SYSTEM IN ALBERT LEA. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $975 | ExpenseAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $975 | TotalOtherProgSrvcExpenseAmt |
| Total Program Service Expenses | $366,216 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARY ANNE WOLESKY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5074341595 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 WEST FOUNTAIN ST | AddressLine1Txt |
| City | ALBERT LEA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56007 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd |
|---|---|---|---|---|---|---|
| STEPHEN BROWNLOW | ||||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DIANE CLARK | ||||||
| SECRETARY | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DIANE DAMEROW | ||||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 | |
| ALEX JOHNSTON | ||||||
| VICE PRESIDENT | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DAN KOLKER | ||||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 | |
| SUE LOCH | ||||||
| PRESIDENT | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| RICHARD MUELLER | ||||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RICH MURRAY | ||||||
| TREASURER | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DR TED MYERS | ||||||
| PAST PRESIDENT | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| CLIFFORD RASK | ||||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 | |
| KARI ULRICH | ||||||
| DIRECTOR | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DR MARK CIOTA | ||||||
| EX-OFFICIO OFFICER | 0.00 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $5,881 | AllOtherContributionsAmt |
| Total Contributions | $5,881 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $111,691 | TotalRevenueColumnAmt |
| Exclusion | $111,691 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,282,667 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $2,022,261 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $260,406 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $260,406 | TotalRevenueColumnAmt |
| Exclusion | $260,406 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET RENTAL | Desc |
| Business | 531390 | BusinessCd |
| Total Revenue Column | $57 | TotalRevenueColumnAmt |
| Exclusion | $57 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $57 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $378,035 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $372,154 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $365,241 | TotalAmt |
| Program Services | $365,241 | ProgramServicesAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,975 | TotalAmt |
| Management And General | $38,975 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $975 | TotalAmt |
| Program Services | $975 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $405,191 | TotalAmt |
| Program Services | $366,216 | ProgramServicesAmt |
| Management And General | $38,975 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,798 | BOYAmt |
| EOY | $11,657 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $25 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,786,505 | BOYAmt |
| EOY | $4,989,880 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,025 | BOYAmt |
| EOY | $10,373 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,802,328 | BOYAmt |
| EOY | $5,011,935 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,380,271 | BOYAmt |
| EOY | $4,538,677 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $140,514 | BOYAmt |
| EOY | $191,715 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $281,543 | BOYAmt |
| EOY | $281,543 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,802,328 | BOYAmt |
| EOY | $5,011,935 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,802,328 | BOYAmt |
| EOY | $5,011,935 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$27,156 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $238,738 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$1,975 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type3 Non Func | Yes (X) | SupportingOrgType3NonFuncInd |
| IRS Written Determination | Yes (X) | IRSWrittenDeterminationInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAYO CLINIC HEALTH SYSTEMS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411506440 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $365,241 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $365,241 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | Yes (1) | ExcessBusinessHoldingsRulesInd |
| Excess Business Holdings | 0 | ExcessBusinessHoldingsInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timely Provided Documents | Yes (1) | TimelyProvidedDocumentsInd |
| Officers Close Relationship | Yes (1) | OfficersCloseRelationshipInd |
| Supported Org Voice Investment | Yes (1) | SupportedOrgVoiceInvestmentInd |
Adjusted Net Income AdjustedNetIncomeGrp
Net ST Capital Gain Adj Net Incm NetSTCapitalGainAdjNetIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $260,406 | CurrentYearAmt |
Recoveries PY Distributions RecoveriesPYDistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
Other Gross Income OtherGrossIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $134,203 | PriorYearAmt |
| Current Year | $111,302 | CurrentYearAmt |
Adjusted Gross Income AdjustedGrossIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $134,203 | PriorYearAmt |
| Current Year | $371,708 | CurrentYearAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
Production Income ProductionIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $34,337 | PriorYearAmt |
| Current Year | $39,162 | CurrentYearAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $6,153 | PriorYearAmt |
| Current Year | $975 | CurrentYearAmt |
Total Adjusted Net Income TotalAdjustedNetIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $93,713 | PriorYearAmt |
| Current Year | $331,571 | CurrentYearAmt |
Minimum Asset Amount MinimumAssetAmountGrp
Average Monthly FMV Of Sec AverageMonthlyFMVOfSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $4,802,328 | PriorYearAmt |
| Current Year | $5,011,935 | CurrentYearAmt |
Average Monthly Cash Balances AverageMonthlyCashBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
FMV Other Non Exempt Use Asset FMVOtherNonExemptUseAssetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
Total FMV Of Non Exempt Use Asset TotalFMVOfNonExemptUseAssetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $4,802,328 | PriorYearAmt |
| Current Year | $5,011,935 | CurrentYearAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Discount Claimed | $0 | DiscountClaimedAmt |
Acquisition Indebtedness AcquisitionIndebtednessGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
Adjusted FMV Less Indebtedness AdjustedFMVLessIndebtednessGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $4,802,328 | PriorYearAmt |
| Current Year | $5,011,935 | CurrentYearAmt |
Cash Deemed Charitable CashDeemedCharitableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $72,035 | PriorYearAmt |
| Current Year | $75,179 | CurrentYearAmt |
Net Vl Non Exempt Use Assets NetVlNonExemptUseAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $4,730,293 | PriorYearAmt |
| Current Year | $4,936,756 | CurrentYearAmt |
Pct Of Net Vl Non Exempt Use Ast PctOfNetVlNonExemptUseAstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $165,560 | PriorYearAmt |
| Current Year | $172,786 | CurrentYearAmt |
Recoveries PY Distri Min Asset RecoveriesPYDistriMinAssetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $0 | PriorYearAmt |
| Current Year | $0 | CurrentYearAmt |
Total Minimum Asset TotalMinimumAssetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prior Year | $165,560 | PriorYearAmt |
| Current Year | $172,786 | CurrentYearAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| CY Adj Net Income Distributable | $93,713 | CYAdjNetIncomeDistributableAmt |
| CY Pct85 Adjusted Net Income | $79,656 | CYPct85AdjustedNetIncomeAmt |
| CY Total Min Ast Distributable | $165,560 | CYTotalMinAstDistributableAmt |
| CY Greater Adjusted Minimum | $165,560 | CYGreaterAdjustedMinimumAmt |
| CY Income Tax Imposed PY | $0 | CYIncomeTaxImposedPYAmt |
| CY Distributable As Adjusted | $165,560 | CYDistributableAsAdjustedAmt |
Distributions DistributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| CY Paid Accomplish Exempt Prps | $0 | CYPaidAccomplishExemptPrpsAmt |
| CY Pd In Excess Income Activity | $0 | CYPdInExcessIncomeActivityAmt |
| CY Administrative Expense Paid | $0 | CYAdministrativeExpensePaidAmt |
| Exempt Use Assets Acquis Paid | $0 | ExemptUseAssetsAcquisPaidAmt |
| Qualified Set Aside | $0 | QualifiedSetAsideAmt |
| CY Other Distributions | $0 | CYOtherDistributionsAmt |
| CY Total Annual Distributions | $0 | CYTotalAnnualDistributionsAmt |
| CY Distri Attentive Suprt Org | $0 | CYDistriAttentiveSuprtOrgAmt |
| CY Distributable As Adjusted | $165,560 | CYDistributableAsAdjustedAmt |
| CY Distribution Yr | 0.000000000000 | CYDistributionYrRt |
Distribution Allocations DistributionAllocationsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| CY Distributable As Adjusted | $165,560 | CYDistributableAsAdjustedAmt |
| Underdistributions | $0 | UnderdistributionsAmt |
| Excess Distribution Cyov Yr4 | $0 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $0 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $0 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $0 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $0 | TotalExcessDistributionCyovAmt |
| Cyov Applied Underdistri PY | $0 | CyovAppliedUnderdistriPYAmt |
| Cyov Applied Underdistr CPY | $0 | CyovAppliedUnderdistrCPYAmt |
| Excess Distribution Cyov | $0 | ExcessDistributionCyovAmt |
| CY Total Annual Distributions | $0 | CYTotalAnnualDistributionsAmt |
| CY Distrib App Underdistri PY | $0 | CYDistribAppUnderdistriPYAmt |
| Excess Distribution | $0 | ExcessDistributionAmt |
| Remaining Underdistri PY | $0 | RemainingUnderdistriPYAmt |
| Remaining Underdistri CY | $165,560 | RemainingUnderdistriCYAmt |
| Excess Distri Cyov To Next Yr | $0 | ExcessDistriCyovToNextYrAmt |
| Excess From Year5 | $0 | ExcessFromYear5Amt |
| Excess From Year4 | $0 | ExcessFromYear4Amt |
| Excess From Year3 | $0 | ExcessFromYear3Amt |
| Excess From Year2 | $0 | ExcessFromYear2Amt |
| Excess From Year1 | $0 | ExcessFromYear1Amt |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART IV, SECTION D, LINE 3 - ROLE OF SUPPORTED ORGANIZATIONS | FormAndLineReferenceDesc |
| Explanation | THE 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $281,543 | BeginningYearBalanceAmt |
| End Year Balance | $281,543 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $281,543 | BeginningYearBalanceAmt |
| End Year Balance | $281,543 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $281,543 | BeginningYearBalanceAmt |
| End Year Balance | $281,543 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $281,543 | BeginningYearBalanceAmt |
| End Year Balance | $281,543 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $281,543 | BeginningYearBalanceAmt |
| End Year Balance | $281,543 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | WELLS FARGO INVESTMENTS | Desc |
| Book Value | $4,989,880 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $4,989,880 | TotalBookValueSecuritiesAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART XIII - SUPPLEMENTAL FINANCIAL INFORMATION | FormAndLineReferenceDesc |
| Explanation | PART V, LINE 4: TO SUPPORT PATIENTS OF MAYO CLINIC HEALTH SYSTEM IN ALBERT LEA. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAYO CLINIC HEALTH SYSTEM | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 FOUNTAIN STREET | AddressLine1Txt |
| City | ALBERT LEA | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 56007 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 411404075 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $365,241 | CashGrantAmt |
| Purpose Of Grant | SUPPORT PROGRAMS | PurposeOfGrantTxt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2 - PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS | FormAndLineReferenceDesc |
| Explanation | GRANTS ARE USED TO SUPPORT THE OPERATIONS OF MAYO CLINIC HEALTH SYSTEM IN ALBERT LEA. GRANTS CAN ONLY BE USED FOR THE INTENDED PURPOSE. NO ADDITIONAL MONITORING IS PERFORMED. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990 - 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 III, LINE 4D - ALL OTHER ACCOMPLISHMENTS | CARDIAC REHAB DONATION - PROGRAM WITHDRAWAL |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 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 12C | IN 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 19 | NO DOCUMENTS ARE AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9: | INCOME FROM K-1 -1,975. |
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