2013-08-30T09:41:50-05:00 2012-12-31 990 2012-01-01 411989509 NAEVE HEALTH CARE FOUNDATION NAEV 5073776380 404 WEST FOUNTAIN ST ALBERT LEA MN 56007 CLAIRE VERMEDAHL 5073776380 2013-08-30 2012 2016-02-24 21:20:13Z CLAIRE VERMEDAHL 404 WEST FOUNTAIN ST ALBERT LEA MN 56007 1904051 0 X HTTP:WWW.NAEVEFOUNDATION.COM X 2000 MN RAISING PHILANTHROPIC DOLLARS FOR HIGH QUALITY COST-EFFECTIVE HEALTHCARE AT MCHS-ALBERT LEA. 15 15 0 25 0 0 147203 61858 0 0 216023 185057 15470 0 378696 246915 392122 329398 0 0 0 0 0 0 0 24808 31676 416930 361074 -38234 -114159 4897080 4509151 475845 0 4421235 4509151 X 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. 0 0 329398 329398 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. 329398 1 1 0 0 0 0 0 0 1 1 0 1 0 0 0 1 1 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 1 1 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X DAVID BONNERUP 5073776380 404 FOUNTAIN ST ALBERT LEA MN 56007 X BENDA HEATHER 1.00 0.00 X 0 0 0 BROWNLOW STEVE 1.00 0.00 X X 0 0 0 CLARK DIANE 1.00 0.00 X X 0 0 0 ECKSTROM MD MICHAEL 1.00 0.00 X 0 0 0 ERLANDSON KENT 1.00 0.00 X 0 0 0 HABBEN MARCIA 1.00 0.00 X 0 0 0 JOHNSTON ALEX 1.00 0.00 X 0 0 0 KALIS HENRY 1.00 0.00 X 0 0 0 LADLIE PENNIE 1.00 0.00 X 0 0 0 MURRAY RICHARD 1.00 0.00 X 0 0 0 MYERS MD THEODORE P 1.00 0.00 X X 0 0 0 PULLEY BARB 1.00 0.00 X 0 0 0 RASK MD CLIFFORD 1.00 0.00 X 0 0 0 SKOPHAMMER NANCY 1.00 0.00 X 0 0 0 VERMEDAHL CLAIRE 1.00 0.00 X X 0 0 0 LOCH SUE 1.00 0.00 X 0 0 0 CIOTA MD MARK 1.00 0.00 X 0 0 0 0 0 0 0 0 0 0 0 22178 39680 61858 139536 139536 1702657 1657136 45521 45521 45521 246915 0 0 185057 329398 329398 31676 31676 361074 329398 31676 0 174756 23700 45966 0 4658552 4465536 17806 19915 4897080 4509151 475845 0 475845 0 X 4000976 4150948 118716 76660 301543 281543 4421235 4509151 4897080 4509151 -114159 202075 0 X 0 1 X 1 0 X 310716 61465 201110 147203 61858 782352 310716 61465 201110 147203 61858 782352 68965 713387 224173 144279 117588 128359 139536 753935 15470 15470 1551757 0.45970 0.72400 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: GROSS RECEIPTS FROM FUNDRAISING EVENT - 2011 AMOUNT: $ 15,470. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 301543 20000 281543 301543 301543 301543 301543 281543 20000 301543 281543 281543 1.00000 0 0 0 WELLS FARGO INVESTMENTS 4465536 F 4465536 X 496375 202075 47385 249460 246915 0 246915 408459 47385 47385 361074 0 361074 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. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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 UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. 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 0 0 0 0 0 0 886847 0 886847 0 0 0 0 0 0 1 MAYO CLINIC HEALTH SYSTEM-ALBERT LEA 404 FOUNTAIN ST ALBERT LEA MN 56007 411404075 501(C)(3) 329398 SUPPORT PROGRAMS OF MAYO CLINIC HEALTH SYSTEM AT THE ALBERT LEA CAMPUS. 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: 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. 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.