NAEVE HEALTH CARE FOUNDATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- NAEVE HEALTH CARE FOUNDATION (EIN 41-1989509)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-08-30
- IRS object ID
- 201332429349300213
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2013-08-30T09:41:50-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411989509 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NAEVE HEALTH CARE FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NAEV | NameControl |
| Phone | 5073776380 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 WEST FOUNTAIN ST | AddressLine1 |
| City | ALBERT LEA | City |
| State | MN | State |
| ZIP Code | 56007 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CLAIRE VERMEDAHL | Name |
| Title | PRESIDENT | Title |
| Phone | 5073776380 | Phone |
| Date Signed | 2013-08-30 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CLAIRE VERMEDAHL | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 WEST FOUNTAIN ST | AddressLine1 |
| City | ALBERT LEA | City |
| State | MN | State |
| ZIP Code | 56007 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1904051 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | HTTP:WWW.NAEVEFOUNDATION.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2000 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | RAISING PHILANTHROPIC DOLLARS FOR HIGH QUALITY COST-EFFECTIVE HEALTHCARE AT MCHS-ALBERT LEA. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 15 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 25 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 147203 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 61858 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 216023 | InvestmentIncomePriorYear |
| Investment Income Current Year | 185057 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 15470 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 378696 | TotalRevenuePriorYear |
| Total Revenue Current Year | 246915 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 392122 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 329398 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 24808 | OtherExpensePriorYear |
| Other Expenses Current Year | 31676 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 416930 | TotalExpensesPriorYear |
| Total Expenses Current Year | 361074 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -38234 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -114159 | RevenuesLessExpensesCY |
| Total Assets BOY | 4897080 | TotalAssetsBOY |
| Total Assets EOY | 4509151 | TotalAssetsEOY |
| Total Liabilities BOY | 475845 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4421235 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 4509151 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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 MAYO CLINIC HEALTH SYSTEMS IN ALBERT LEA AND SURROUNDING COMMUNITIES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 329398 | Expense |
| Grants | 329398 | Grants |
| Description | NAEVE HEALTH CARE FOUNDATION'S 2012 GIFT OF $329,398 WAS DIRECTED TOWARDS VARIOUS PROJECTS WITHIN MAYO CLINIC HEALTH SYSTEM-ALBERT LEA; $50,000 WAS TO COMPLETE PROJECT PINK SUPPORTING RADIOLOGY, $147,953 TO SUPPORT THE PURCHASE OF HYPERBARIC CHAMBERS FOR THE WOUND CARE DEPARTMENT, $1,000 TO SUPPORT PATIENT EDUCATION'S ANNUAL WOMEN'S HEALTH CARE SYMPOSIUM, $42,000 FOR THE LONG-TERM CAPITAL CAMPAIGN, $39,000 TO "THE BEAT GOES ON" TO PURCHASE CARDIAC CARE EQUIPMENT FOR AREA FIRST RESPONDERS AND MCHS-ALBERT LEA'S AMBULANCE SERVICES, CARDIOLOGY, AND CARDIAC REHAB DEPARTMENTS, AND $49,375 TO SUPPORT OTHER MISCELLANEOUS PROJECTS. | Description |
| Total Program Service Expense | 329398 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 0 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 1 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 15 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DAVID BONNERUP | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5073776380 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 FOUNTAIN ST | AddressLine1 |
| City | ALBERT LEA | City |
| State | MN | State |
| ZIP Code | 56007 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|---|
| BENDA HEATHER | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| BROWNLOW STEVE | |||||||
| TREASURER / DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | X |
| CLARK DIANE | |||||||
| SECRETARY / DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | X |
| ECKSTROM MD MICHAEL | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| ERLANDSON KENT | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| HABBEN MARCIA | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| JOHNSTON ALEX | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| KALIS HENRY | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| LADLIE PENNIE | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| MURRAY RICHARD | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| MYERS MD THEODORE P | |||||||
| PRESIDENT / DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | X |
| PULLEY BARB | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| RASK MD CLIFFORD | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| SKOPHAMMER NANCY | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| VERMEDAHL CLAIRE | |||||||
| VICE-PRESIDENT / DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | X |
| LOCH SUE | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| CIOTA MD MARK | |||||||
| EX-OFFICIO | 1.00 | 0.00 | 0 | 0 | 0 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Government Grants | 22178 | GovernmentGrants |
| All Other Contributions | 39680 | AllOtherContributions |
| Total Contributions | 61858 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 139536 | TotalRevenueColumn |
| Exclusion | $139,536 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1702657 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1657136 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 45521 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 45521 | TotalRevenueColumn |
| Exclusion | $45,521 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 246915 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $185,057 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 329398 | Total |
| Program Services | 329398 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31676 | Total |
| Management And General | 31676 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 361074 | Total |
| Program Services | 329398 | ProgramServices |
| Management And General | 31676 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 174756 | BOY |
| EOY | 23700 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 45966 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4658552 | BOY |
| EOY | 4465536 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17806 | BOY |
| EOY | 19915 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4897080 | BOY |
| EOY | 4509151 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 475845 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 475845 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4000976 | BOY |
| EOY | 4150948 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 118716 | BOY |
| EOY | 76660 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 301543 | BOY |
| EOY | 281543 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4421235 | BOY |
| EOY | 4509151 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4897080 | BOY |
| EOY | 4509151 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -114159 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 202075 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 310716 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 61465 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 201110 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 147203 | CurrentTaxYearMinus1Year |
| Current Tax Year | 61858 | CurrentTaxYear |
| Total | 782352 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 310716 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 61465 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 201110 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 147203 | CurrentTaxYearMinus1Year |
| Current Tax Year | 61858 | CurrentTaxYear |
| Total | 782352 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 68965 | AmountsSubstContributorsTotal |
| Public Support Total170 | 713387 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 224173 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 144279 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 117588 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 128359 | CurrentTaxYearMinus1Year |
| Current Tax Year | 139536 | CurrentTaxYear |
| Total | 753935 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus1 Year | 15470 | CurrentTaxYearMinus1Year |
| Total | 15470 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 1551757 | TotalSupport |
| Public Support Pertcentage170 | 0.45970 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.72400 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
| General Explanation | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: GROSS RECEIPTS FROM FUNDRAISING EVENT - 2011 AMOUNT: $ 15,470. | GeneralExplanation |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtc |
| Included On FS | 1 | IncludedOnFS |
| Explanation In Part XIII | X | ExplanationInPartXIII |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 301543 | BeginningOfYearBalance |
| Grants Or Scholarships | 20000 | GrantsOrScholarships |
| End Of Year Balance | 281543 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 301543 | BeginningOfYearBalance |
| End Of Year Balance | 301543 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 301543 | BeginningOfYearBalance |
| End Of Year Balance | 301543 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 281543 | BeginningOfYearBalance |
| Contributions | 20000 | Contributions |
| End Of Year Balance | 301543 | EndOfYearBalance |
Current Year Minus4 Years CurrentYearMinus4Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 281543 | BeginningOfYearBalance |
| End Of Year Balance | 281543 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | WELLS FARGO INVESTMENTS | Description |
| Book Value | 4465536 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 4465536 | TotalOfBookValueSecurities |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 496375 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 202075 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 47385 | DonatedSrvcAndUseOfFacilities |
| Revenue Not Rptd F990 | 249460 | RevenueNotRptdF990 |
| Revenue Subtotal | 246915 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 246915 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 408459 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 47385 | DonatedServicesUseOfFacilities |
| Expenses Not Rptd F990 | 47385 | ExpensesNotRptdF990 |
| Expenses Subtotal | 361074 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 361074 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART IV, LINE 2B: | THE FOUNDATION HELD FUNDS ON BEHALF OF MAYO CLINIC HEALTH SYSTEM-ALBERT LEA. THE FOUNDATION HAD SIGNATURE AUTHORITY OVER THESE FUNDS AND INVESTED THEM ON BEHALF OF MCHS-ALBERT LEA. THESE FUNDS WERE SEGREGATED ON THE BOOKS AND RECORDS OF THE FOUNDATION, AND WERE TRANSFERRED TO MCHS-ALBERT LEA DURING THE 2ND QUARTER OF 2012 RESULTING IN A ZERO BALANCE ON THE FOUNDATION BALANCE SHEET AS OF 12/31/2012. | |
| PART V, LINE 4: | TO SUPPORT PATIENTS OF MAYO CLINIC HEALTH SYSTEM'S ALBERT LEA CAMPUS AND PROVIDE SCHOLARSHIPS FOR STUDENTS OF FOUNTAIN CENTERS. | DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: |
| PART X, LINE 2: | MANAGEMENT ANNUALLY MAKES AN APPROPRIATE EVALUATION OF ANY UNCERTAIN INCOME TAX POSITIONS BASED UPON CURRENT STATUTES IN COMPLETING THESE FINANCIAL STATEMENTS AND THE NOTES TO THE FINANCIAL STATEMENTS. AS OF DECEMBER 31, 2012, MANAGEMENT BELIEVES THAT THERE WERE NO UNCERTAIN INCOME TAX POSITIONS FOR WHICH A MATERIAL CHANGE IN THE UNRECOGNIZED EFFECT WOULD BE REASONABLY POSSIBLE WITHIN THE NEXT 12 MONTHS. | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: |
Schedule F IRS990ScheduleF
Accts Actvs Out US Table AcctsActvsOutUSTable (8 entries)
| RegionRegion | Number Of OfficesNumberOfOffices | Number Of EmployeesNumberOfEmployees | Type Of Activities ConductedTypeOfActivitiesConducted | Total ExpendituresTotalExpenditures |
|---|---|---|---|---|
| EAST ASIA AND THE PACIFIC | 0 | 0 | INVESTMENT | 307527 |
| EUROPE (INCLUDING ICELAND & GREENLAND) | 0 | 0 | INVESTMENT | 315112 |
| MIDDLE EAST AND NORTH AFRICA | 0 | 0 | INVESTMENT | 9176 |
| NORTH AMERICA | 0 | 0 | INVESTMENT | 67261 |
| RUSSIA & THE NEWLY INDEPENDENT STATES | 0 | 0 | INVESTMENT | 47871 |
| SOUTH AMERICA | 0 | 0 | INVESTMENT | 39505 |
| SOUTH ASIA | 0 | 0 | INVESTMENT | 33080 |
| SUB-SAHARAN AFRICA | 0 | 0 | INVESTMENT | 67315 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Subtotal Number Of Offices | 0 | SubtotalNumberOfOffices |
| Subtotal Number Of Employees | 0 | SubtotalNumberOfEmployees |
| Cont Number Of Offices | 0 | ContNumberOfOffices |
| Cont Number Of Employees | 0 | ContNumberOfEmployees |
| Total Number Of Offices | 0 | TotalNumberOfOffices |
| Total Number Of Employees | 0 | TotalNumberOfEmployees |
| Subtotal Amount Spent | 886847 | SubtotalAmountSpent |
| Cont Amount Spent | 0 | ContAmountSpent |
| Total Amount Spent | 886847 | TotalAmountSpent |
| Transfer To Foreign Corp | 0 | TransferToForeignCorp |
| Interest In Foreign Trust | 0 | InterestInForeignTrust |
| Own Foreign Corp | 0 | OwnForeignCorp |
| Passive Foreign Invest Co | 0 | PassiveForeignInvestCo |
| Foreign Partnership | 0 | ForeignPartnership |
| Boycott Countries | 0 | BoycottCountries |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAYO CLINIC HEALTH SYSTEM-ALBERT LEA | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 FOUNTAIN ST | AddressLine1 |
| City | ALBERT LEA | City |
| State | MN | State |
| ZIP Code | 56007 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 411404075 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 329398 | AmountOfCashGrant |
| Purpose Of Grant | SUPPORT PROGRAMS OF MAYO CLINIC HEALTH SYSTEM AT THE ALBERT LEA CAMPUS. | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: GRANTS ARE USED TO SUPPORT THE OPERATIONS OF MAYO CLINIC HEALTH SYSTEM-ALBERT LEA, THE FOUNDATION'S MISSION IS TO PROVIDE FINANCIAL SUPPORT TO THE ALBERT LEA CAMPUS, GRANTS CAN ONLY BE USED FOR THE INTENDED PURPOSE. NO ADDITIONAL MONITORING IS PERFORMED. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | MARK R. CIOTA, M.D., DIANE L. CLARK, AND MICHAEL T. ECKSTROM, M.D. HAVE A BUSINESS RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 3 | THE DEVELOPMENT OFFICER OF THE REPORTING ORGANIZATION IS AN EMPLOYEE OF MAYO CLINIC HEALTH SYSTEM-ALBERT LEA. |
| FORM 990, PART VI, SECTION A, LINE 4 | ARTICLE III, SECTION 6 OF THE ORGANIZATIONS BYLAWS WAS AMENDED TO EXPAND ON THE PURPOSE AND ACTIVITIES OF THE ORGANIZATION. ARTICLE III, SECTION 5, AND ARTICLE VIII WAS AMENDED TO REFLECT THE NAME CHANGE OF MAYO CLINIC HEALTH SYSTEM-ALBERT LEA. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PREPARED BY MAYO CLINIC CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE DEVELOPMENT OFFICER AND SITE FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FILING ORGANIZATION'S GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990. |
| 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 - EMPLOYEES AND/OR THE DEVELOPMENT OFFICER OF NAEVE HEALTH CARE FOUNDATION 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 ASSISTS THE BOARD IN DISTRIBUTION AND COLLECTION OF ANNUAL CONFLICT OF INTEREST DISCLOSURE FORMS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FILING ORGANIZATION'S FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. |
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