FOUNTAIN LAKE TREATMENT CENTER: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- FOUNTAIN LAKE TREATMENT CENTER (EIN 41-1404076)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-05
- IRS object ID
- 201223109349301402
- Schema version
- 2011v1.2
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule I
- Schedule J
- Schedule N
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-05T15:29:46-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411404076 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FOUNTAIN LAKE TREATMENT CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FOUN | NameControl |
| Phone | 5075381297 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 WEST FOUNTAIN STREET | AddressLine1 |
| City | ALBERT LEA | City |
| State | MN | State |
| ZIP Code | 56007 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID PILOT | Name |
| Title | CFO | Title |
| Phone | 5073776352 | Phone |
| Date Signed | 2012-11-05 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Terminated Return | X | TerminatedReturn |
| Name Of Principal Officer Person | MARK CIOTA MD | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 WEST FOUNTAIN STREET | AddressLine1 |
| City | ALBERT LEA | City |
| State | MN | State |
| ZIP Code | 56007 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 8429560 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.FOUNTAINCENTERS.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1981 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | CHEMICAL DEPENDENCY TREATMENT | ActivityOrMissionDescription |
| Termination Or Contraction | X | TerminationOrContraction |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 5 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 474309 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 61708 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 7230031 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 8367552 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 500 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 57 | OtherRevenuePriorYear |
| Other Revenue Current Year | 300 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 7704897 | TotalRevenuePriorYear |
| Total Revenue Current Year | 8429560 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 2357998 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4668464 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5102323 | 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 | 2142306 | OtherExpensePriorYear |
| Other Expenses Current Year | 2625100 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 6810770 | TotalExpensesPriorYear |
| Total Expenses Current Year | 10085421 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 894127 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -1655861 | RevenuesLessExpensesCY |
| Total Assets BOY | 1658748 | TotalAssetsBOY |
| Total Assets EOY | 0 | TotalAssetsEOY |
| Total Liabilities BOY | 2887 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1655861 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 0 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO INSPIRE HOPE AND CONTRIBUTE TO HEALTH AND WELL-BEING BY PROVIDING THE BEST CARE TO EVERY PATIENT THROUGH INTEGRATED CLINICAL PRACTICE, EDUCATION, AND RESEARCH. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 1 | SignificantChange |
| Expense | 8662062 | Expense |
| Grants | 2357998 | Grants |
| Revenue | 8367852 | Revenue |
| Description | PATIENT CARE (SCHEDULE O)FOUNTAIN LAKE TREATMENT CENTER (FLTC) IS A MEMBER OF THE MAYO CLINIC HEALTH SYSTEM. MAYO CLINIC HEALTH SYSTEM IS A FAMILY OF CLINICS, HOSPITALS AND HEALTH CARE FACILITIES SERVING COMMUNITIES IN MINNESOTA, IOWA AND WISCONSIN. AS PART OF MAYO CLINIC, MAYO CLINIC HEALTH SYSTEM OFFERS OUTSTANDING CARE CLOSE TO HOME. PHYSICIANS AND STAFF IN MAYO CLINIC HEALTH SYSTEM HAVE READY ACCESS TO THE KNOWLEDGE, RESOURCES, AND EXPERTISE OF MAYO CLINIC, YET CAN MEET PATIENT'S HEALTH CARE NEEDS LOCALLY. MAYO CLINIC HEALTH SYSTEM IS PART OF THE COMMUNITY, FOCUSED ON IMPROVING THE HEALTH OF THE COMMUNITIES IN WHICH WE LIVE AND WORK. MAYO CLINIC HEALTH SYSTEM TEAMS WITH MAYO CLINIC TO DELIVER UNPARALLELED HEALTH CARE TO COMMUNITIES THROUGH AN INTEGRATED NETWORK OF CLINICS AND HOSPITALS.IN 2011, MAYO CLINIC HEALTH SYSTEM SITES EMPLOYED APPROXIMATELY 900 PHYSICIANS AND 13,000 ALLIED HEALTH STAFF. IN ADDITION, MAYO CLINIC PHYSICIANS FROM MULTIPLE SPECIALTIES REGULARLY SEE PATIENTS AT THE MAYO CLINIC HEALTH SYSTEM FACILITIES. BESIDES HAVING HEALTH CARE FACILITIES IN 72 COMMUNITIES, THE SYSTEM INCLUDES 18 OWNED HOSPITALS, SEVEN OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH TWO ADDITIONAL HOSPITALS, AND CONTRACT MANAGEMENT AGREEMENTS WITH AN ADDITIONAL HOSPITAL AND NURSING HOME. SINCE ITS INCEPTION IN 1992, MAYO CLINIC HEALTH SYSTEM HAS GROWN FROM A NEW IDEA TO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN AMERICA. MAYO CLINIC HEALTH SYSTEM COMPLETES MORE THAN TWO-MILLION PATIENT VISITS ANNUALLY. IT ALSO SERVES AS A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS BEING RECOGNIZED SIX TIMES BY THE AMERICAN MEDICAL GROUP ASSOCIATION'S ACCLAIM AWARD PROGRAM (2005 ACCLAIM AWARD RECIPIENT AND FIVE-TIME ACCLAIM AWARD HONOREE). THE ACCLAIM AWARDS HONOR PHYSICIAN-LED ORGANIZATIONS DELIVERING CARE ALIGNED WITH THE IDEAL DELIVERY MODEL WHERE PATIENTS EXPERIENCE SAFE, RELIABLE, RESPONSIVE, READILY AVAILABLE AND INTEGRATED CARE. IN ADDITION, THE MINNESOTA COUNCIL FOR QUALITY HAS RECOGNIZED MAYO CLINIC HEALTH SYSTEM THREE TIMES FOR ITS PERFORMANCE EXCELLENCE EFFORTS. INDIVIDUAL MAYO CLINIC HEALTH SYSTEM LOCATIONS HAVE ALSO BEEN HONORED FOR THEIR COMMITMENT TO QUALITY, SAFETY, SERVICE, PERFORMANCE AND THEIR COMMUNITIES.PEOPLE IN MINNESOTA, IOWA AND WISCONSIN CAN HAVE PEACE OF MIND KNOWING THAT MAYO CLINIC HEALTH SYSTEM AND MAYO CLINIC PARTNER TO ENSURE HEALTHIER LIVES IN THE REGION.FOUNTAIN LAKE TREATMENT CENTER (FLTC/FOUNTAIN CENTERS) IS A 58 BED CHEMICAL DEPENDENCY TREATMENT CENTER. FOUNTAIN CENTERS ALSO PROVIDES A 10 BED BOARD AND LODGING HOUSING UNIT IN ALBERT LEA, MINNESOTA. FOUNTAIN CENTERS PROVIDES INTENSIVE OUTPATIENT TREATMENT SERVICES IN ALBERT LEA, FAIRMONT, FARIBAULT, MANKATO, OWATONNA, ROCHESTER, AND WASECA MINNESOTA. DURING 2011, RESIDENTIAL ADMISSIONS NUMBERED 1,088 FOR A TOTAL OF 17,157 RESIDENTIAL TREATMENT DAYS. IN ADDITION, 17,323 GROUP SESSIONS WERE OFFERED THROUGH THE OUTPATIENT PROGRAMS IN 2011.FLTC PROVIDES CARE TO PERSONS COVERED BY GOVERNMENT PROGRAMS. SERVICES ARE PROVIDED TO PUBLICLY FUNDED PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. FREE ASSESSMENTS AND INTERVENTION SERVICES ARE ALSO AVAILABLE FOR TREATMENT PATIENTS. AFTERCARE SERVICES ARE ALSO PROVIDED AT NO CHARGE. FOUNTAIN CENTER HAS AN OLDER ADULTS PROGRAM WHERE TREATMENT SUPPORT AND RECOVERY ACTIVITIES ARE PROVIDED EVEN THOUGH THERE IS NO REIMBURSEMENT BY MEDICARE.THE COST OF CHARITY CARE PROVIDED DURING 2011 WAS $115,222. THE UNREIMBURSED COST OF OTHER MEANS TESTED GOVERNMENT PROGRAMS WAS $854,949.FLTC PROVIDES SUPPORT SERVICES TO THE COMMUNITY BY PROVIDING EDUCATION PRESENTATIONS ON CHEMICAL DEPENDENCY TO COMMUNITY GROUPS. IN 2011, THE STAFF GAVE 10 PRESENTATIONS. FLTC ALSO PROVIDES SPACE FOR WEEKLY COMMUNITY SUPPORT GROUPS.AS OF DECEMBER 31, 2011, ALL FLTC ASSETS AND LIABILITIES WERE TRANSFERRED TO MAYO CLINIC HEALTH SYSTEM-ALBERT LEA. THE EFFECTIVE TIME OF THIS MERGER WAS 11:59 PM ON DECEMBER 31, 2011. | Description |
| Total Program Service Expense | 8662062 | 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 | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | 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 | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | 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 | 1 | 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 | 1 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| 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 | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | 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 | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | 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 | CORPORATE TAX UNIT | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5075381297 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 FIRST STREET SW | AddressLine1 |
| City | ROCHESTER | City |
| State | MN | State |
| ZIP Code | 55905 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | FormerFormer |
|---|---|---|---|---|---|---|---|
| AGERTER MD DAVID C | |||||||
| DIRECTOR | 1.00 | X | 0 | 439287 | 46318 | ||
| CIOTA MD MARK | |||||||
| CHAIR/CEO/DIRECTOR | 1.00 | X | 0 | 861046 | 44353 | X | |
| CRUZ-LARES LINDA | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| FUNK MICHAEL S | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| GABRIELSON SHARON | |||||||
| DIRECTOR | 1.00 | X | 0 | 166660 | 36971 | ||
| HEINZ MD DIETER | |||||||
| VICE CHAIR/DIRECTOR | 1.00 | X | 0 | 351109 | 43573 | X | |
| KEPPLE-JOHNSON JANE K | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| MILLER MD ROBERT C | |||||||
| TREASURER/DIRECTOR | 1.00 | X | 0 | 489366 | 42689 | X | |
| RIZZO MD MARCO | |||||||
| DIRECTOR | 1.00 | X | 0 | 529139 | 38256 | ||
| ROUTH LORI J | |||||||
| DIRECTOR | 1.00 | X | 0 | 134972 | 11866 | ||
| SAVELKOUL DONALD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| VERDOORN JUDY D | |||||||
| SECRETARY/DIRECTOR | 1.00 | X | 0 | 0 | 0 | X | |
| PARKS DOUGLAS A | |||||||
| CAO | 1.00 | 0 | 174599 | 36434 | X | ||
| PILOT DAVID | |||||||
| CFO | 1.00 | 0 | 187660 | 33075 | X | ||
| WALDHOFF STEPHEN C | |||||||
| CAO | 1.00 | 0 | 249049 | 54308 | X | ||
| SHELHAMER MD LEONARD | |||||||
| FORMER VICE CHAIR | 0.00 | 0 | 236575 | 33500 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 3819462 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 421343 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MAYO CLINIC HEALTH SYSTEM - ALBERT LEA | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 404 WEST FOUNTAIN STREET | AddressLine1 |
| City | ALBERT LEA | City |
| State | MN | State |
| ZIP Code | 56007 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Of Services | PURCHASED SERVICES | DescriptionOfServices |
| Compensation | 1393581 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Related Organizations | 1708 | RelatedOrganizations |
| Government Grants | 60000 | GovernmentGrants |
| Total Contributions | 61708 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT REVENUE | 620000 | 8364910 | 8364910 |
| SHARED SERVICES | 561000 | 2642 | 2642 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 8367552 | TotalProgramServiceRevenue |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MISC. REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 300 | TotalRevenueColumn |
| Related Or Exempt Function Income | 300 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 300 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8429560 | TotalRevenueColumn |
| Related Or Exempt Function Income | 8367852 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2357998 | Total |
| Program Services | 2357998 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3747994 | Total |
| Program Services | 3314580 | ProgramServices |
| Management And General | 433414 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 245602 | Total |
| Program Services | 217201 | ProgramServices |
| Management And General | 28401 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 831649 | Total |
| Program Services | 735478 | ProgramServices |
| Management And General | 96171 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 277078 | Total |
| Program Services | 245037 | ProgramServices |
| Management And General | 32041 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 412 | Total |
| Management And General | 412 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1181541 | Total |
| Program Services | 694524 | ProgramServices |
| Management And General | 487017 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3760 | Total |
| Program Services | 342 | ProgramServices |
| Management And General | 3418 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 668807 | Total |
| Program Services | 385421 | ProgramServices |
| Management And General | 283386 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 200 | Total |
| Management And General | 200 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 248335 | Total |
| Program Services | 246841 | ProgramServices |
| Management And General | 1494 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12733 | Total |
| Program Services | 12733 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 60829 | Total |
| Program Services | 27746 | ProgramServices |
| Management And General | 33083 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32238 | Total |
| Program Services | 11267 | ProgramServices |
| Management And General | 20971 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| BAD DEBT EXPENSE | 198256 | 198256 |
| MN CARE TAX | 117414 | 117414 |
| MEDICAL SUPPLIES | 59662 | 59662 |
| DUES, LICENSES & SUBSCR | 32489 | 32489 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8424 | Total |
| Program Services | 5073 | ProgramServices |
| Management And General | 3351 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10085421 | Total |
| Program Services | 8662062 | ProgramServices |
| Management And General | 1423359 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 750 | BOY |
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1536991 | BOY |
| EOY | 0 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 0 | LandBuildingsEquipmentBasis |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 121007 | BOY |
| EOY | 0 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1658748 | BOY |
| EOY | 0 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2887 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2887 | 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 | 1650034 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5827 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1655861 | BOY |
| EOY | 0 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1658748 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -1655861 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5827 | BeginningOfYearBalance |
| Grants Or Scholarships | 5827 | GrantsOrScholarships |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5827 | BeginningOfYearBalance |
| End Of Year Balance | 5827 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5827 | BeginningOfYearBalance |
| End Of Year Balance | 5827 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 5827 | BeginningOfYearBalance |
| End Of Year Balance | 5827 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
| Total Of Book Value Land Buildings | 0 | TotalOfBookValueLandBuildings |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR PATIENT SUPPORT AND EDUCATION PROGRAMS. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | AT DECEMBER 31, 2011 AND 2010, THERE WAS NO MATERIAL LIABILITY FOR UNRECOGNIZED TAX BENEFITS FOR THE FILING ORGANIZATION. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|---|
| MAYO CLINIC HEALTH SYSTEM - ALBERT LEA | |||||||||
| 404 WEST FOUNTAIN STREET | ALBERT LEA | MN | 56007 | 411404075 | 501(C)(3) | 2047902 | BOOK | TRANSFER OF NET ASSETS | MERGER OF ORGANIZATION |
| MAYO CLINIC HEALTH SYSTEM - ALBERT LEA | |||||||||
| 404 WEST FOUNTAIN STREET | ALBERT LEA | MN | 56007 | 411404075 | 501(C)(3) | 310096 | BOOK | SUPPORT OPERATIONS | |
| 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: TRANSFERS OR GRANTS TO AFFILIATED TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AGERTER MD DAVID C | |||||||||||||
| 0 | 341092 | 0 | 0 | 0 | 98195 | 0 | 32194 | 0 | 14124 | 0 | 485605 | 0 | 94907 |
| CIOTA MD MARK | |||||||||||||
| 0 | 861046 | 0 | 0 | 0 | 0 | 0 | 17150 | 0 | 27203 | 0 | 905399 | 0 | 0 |
| GABRIELSON SHARON | |||||||||||||
| 0 | 165658 | 0 | 0 | 0 | 1002 | 0 | 15443 | 0 | 21528 | 0 | 203631 | 0 | 0 |
| HEINZ MD DIETER | |||||||||||||
| 0 | 351109 | 0 | 0 | 0 | 0 | 0 | 17150 | 0 | 26423 | 0 | 394682 | 0 | 0 |
| MILLER MD ROBERT C | |||||||||||||
| 0 | 444151 | 0 | 0 | 0 | 45215 | 0 | 21221 | 0 | 21468 | 0 | 532055 | 0 | 43178 |
| RIZZO MD MARCO | |||||||||||||
| 0 | 498493 | 0 | 0 | 0 | 30646 | 0 | 18288 | 0 | 19968 | 0 | 567395 | 0 | 28294 |
| PARKS DOUGLAS A | |||||||||||||
| 0 | 173183 | 0 | 0 | 0 | 1416 | 0 | 13141 | 0 | 23293 | 0 | 211033 | 0 | 0 |
| PILOT DAVID | |||||||||||||
| 0 | 187660 | 0 | 0 | 0 | 0 | 0 | 13374 | 0 | 19701 | 0 | 220735 | 0 | 0 |
| WALDHOFF STEPHEN C | |||||||||||||
| 0 | 243356 | 0 | 0 | 0 | 5693 | 0 | 38104 | 0 | 16204 | 0 | 303357 | 0 | 638 |
| SHELHAMER MD LEONARD | |||||||||||||
| 0 | 236575 | 0 | 0 | 0 | 0 | 0 | 16417 | 0 | 17083 | 0 | 270075 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 4B | THIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(A)(17). STARTING JANUARY 1, 2011, ALL FUTURE SRP BENEFITS ARE PAID AS AN ANNUAL TAXABLE CASH PAYMENT. THE FOLLOWING INDIVIDUALS RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN. AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). A PORTION OF THE AMOUNT MAY BE INCLUDED IN SCHEDULE J, PART II, COLUMN (F) IF DISCLOSED ON A PRIOR YEAR'S FORM 990. DAVID C. AGERTER, M.D. $94,907 ROBERT C. MILLER, M.D. $43,178 MARCO RIZZO, M.D. $28,294 STEPHEN C. WALDHOFF $ 638 | |
| PART III | COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE CORE 990 PART VI SECTION B LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED. | SUPPLEMENTAL INFORMATION |
Schedule N IRS990ScheduleN
Liquidation Table LiquidationTable
Liquidation Detail LiquidationDetail (2 entries)
| Description Of AssetDescriptionOfAsset | Date Of DistributionDateOfDistribution | FMV Of AssetFMVOfAsset | Method Of FMV DeterminationMethodOfFMVDetermination | EINEIN | Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | IRC SectionIRCSection |
|---|---|---|---|---|---|---|---|---|---|
| MAYO CLINIC HEALTH SYSTEM - ALBERT LEA | |||||||||
| ACCOUNTS RECEIVABLE, NET | 2011-12-31 | 1960295 | BOOK VALUE OF ASSETS AT END OF YEAR | 411404075 | 404 WEST FOUNTAIN STREET | ALBERT LEA | MN | 56007 | 501(C)(3) |
| MAYO CLINIC HEALTH SYSTEM - ALBERT LEA | |||||||||
| EQUIPMENT | 2011-12-31 | 88769 | BOOK VALUE OF ASSETS AT END OF YEAR | 411404075 | 404 WEST FOUNTAIN STREET | ALBERT LEA | MN | 56007 | 501(C)(3) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor | 1 | DirectorOfSuccessor |
| Employee Of Successor | 0 | EmployeeOfSuccessor |
| Owner Of Successor | 0 | OwnerOfSuccessor |
| Receive Compensation | 0 | ReceiveCompensation |
| Assets Distributed | 1 | AssetsDistributed |
| Required To Notify AG | 1 | RequiredToNotifyAG |
| AG Notified | 1 | AGNotified |
| Liabilities Paid | 1 | LiabilitiesPaid |
| Bonds Outstanding | 0 | BondsOutstanding |
| Bond Liabilities Discharged | 0 | BondLiabilitiesDischarged |
Form990 Schedule N Part III Form990ScheduleNPartIII (2 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 2E: THE BOARD OF TRUSTEES FOR FOUNTAIN LAKE TREATMENT CENTER ARE THE SAME MEMBERS FOR MAYO CLINIC HEALTH SYSTEM - ALBERT LEA, WHICH IS THE SURVIVING ENTITY IN THE MERGER OF THE TWO ORGANIZATIONS. |
| PART I, LINE 7C: MAYO CLINIC'S LEGAL DEPARTMENT CONTACTED THE ATTORNEY GENERAL ABOUT THE DISSOLUTION OF FOUNTAIN LAKE TREATMENT CENTER. THE OUTSTANDING LIABILITIES WERE PART OF THE MERGER WITH MAYO CLINIC HEALTH SYSTEM - ALBERT LEA. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (13 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| CHANGES IN PROGRAM SERVICES | FORM 990, PART III, LINE 3 | DUE TO A MERGER BETWEEN FILING ORGANIZATION AND MAYO CLINIC HEALTH SYSTEM - ALBERT LEA, THE PROGRAM SERVICES OF THE FILING ORGANIZATION WILL BE CARRIED ON BY THE SURVIVING ORGANIZATION, WHICH WILL BE CALLED MAYO CLINIC HEALTH SYSTEM - ALBERT LEA. |
| FORM 990, PART VI, SECTION A, LINE 2 | DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUALS: AGERTER M.D., DAVID C. CIOTA M.D., MARK CRUZ-LARES, LINDA FUNK, MICHAEL GABRIELSON, SHARON HENIZ M.D., DIETER KEPPLE-JOHNSON, JANE K. MILLER M.D., ROBERT C. PARKS, DOUGLAS A. PILOT, DAVID RIZZO M.D., MARCO ROUTH, LORI J. SAVELKOUL, DONALD SHELHAMER M.D., LEONARD VERDOORN, JUDY D. AND WALDHOFF, STEPHAN C. HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: CIOTA M.D., MARK HEINZ M.D., DIETER PILOT, DAVID ROUTH, LORI J. AND SHELHAMER M.D., LEONARD DONALD SAVELKOUL AND STEPHAN C. WALDHOFF HAD A BUSINESS RELATIONSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 3 | MAYO-AFFILIATED ENTITIES ROUTINELY DELEGATED VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO RELATED ENTITIES. | |
| FORM 990, PART VI, SECTION A, LINE 4 | THE FILING ORGANIZATION MERGED WITH MAYO CLINIC HEALTH SYSTEM - ALBERT LEA AT YEAR END OF 2011, SO THE ARTICLES OF MERGER WERE EXECUTED. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE CORPORATE MEMBER IS MAYO CLINIC HEALTH SYSTEM - ALBERT LEA. | |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE CORPORATE MEMBER ELECTS THE DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RIGHTS OF APPROVAL FOR VARIOUS ITEMS/ACTIONS, SUCH AS: 1. REMOVAL OR ELECTION OF DIRECTORS 2. CHANGING THE SIZE OF THE BOARD 3. OR AMENDMENT OF ARTICLES OR BYLAWS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS PREPARED BY MAYO 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 SITE FINANCE STAFF AND THE SITE ADMINISTRATOR. 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. HIGHLIGHTS ARE PRESENTED TO BOARD MEMBERS, AND THE REVIEW IS DOCUMENTED IN MEETING MINUTES. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990. | |
| FORM 990, PART VI, SECTION B, LINE 12C | MAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF MAYO CLINIC (AND/OR AFFILIATE) AND THE OUTSIDE ENTITY. ADDITIONAL CONFLICT OF INTEREST POLICIES AND PROCEDURES EXIST FOR CERTAIN ENTITIES CONCERNING RESEARCH CONTRACTS AND OTHER TYPES OF POTENTIAL CONFLICTS. | |
| FORM 990, PART VI, SECT. B, LINE 15 THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY IN THE FALL FOR THE NEXT YEAR'S COMPENSATION. THE SALARY OF THE CEO, CAO, BOARD VICE CHAIR, BOARD TREASURER, AND SEVERAL BOARD MEMBERS WERE REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO CLINIC HEALTH SYSTEM PHYSICIANS. THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE MAYO CLINIC HEALTH SYSTEM ENTITIES. THE COMMITTEE IS COMPRISED OF MAYO EMPLOYEES, BUT IS INDEPENDENT FOR INTERNAL REVENUE CODE 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED (WITH RECUSAL WHERE APPROPRIATE). THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE THEN REVIEWS AND APPROVES THE COMPENSATION. FOR THOSE INDIVIDUALS FOR WHICH THIS COMMITTEE CAN NOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE COMPENSATION AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. INFORMATION ON MAYO CLINIC HEALTH SYSTEM PHYSICIAN AND ADMINISTRATIVE LEADERSHIP COMPENSATION AND BENEFITS IS ALSO REVIEWED BY THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION AND GOVERNANCE (GOVERNANCE COMMITTEE), WHICH IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. | ||
| FORM 990, PART VI, SECTION C, LINE 19 | THE FILING ORGANIZATION'S GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE CONFLICT OF INTEREST POLICY IS AVAILABLE ON THE MAYOCLINIC.ORG WEBSITE. | |
| AVERAGE HOURS PER WEEK DEVOTED TO POSITION WITH RELATED ORGANIZATION | PART VII SECTION A | DAVID C. AGERTER, M.D. 40.00 MARK CIOTA, M.D. 40.00 SHARON GABRIELSON 40.00 DIETER HEINZ, M.D. 40.00 ROBERT C. MILLER, M.D. 40.00 DOUGLAS A. PARKS 40.00 DAVID PILOT 40.00 MARCO RIZZO, M.D. 40.00 LORI J. ROUTH 40.00 LEONARD SHELHAMER, M.D. 40.00 STEPHEN C. WALDHOFF 40.00 |
| INDEPENDENCE | FORM 990 PART VI LINE 1B | THE BOARD OF TRUSTEES OF MAYO CLINIC, THE PARENT ENTITY OF THE MAYO CLINIC-AFFILIATED ENTITIES, IS COMPRISED OF MORE THAN 50% PUBLIC TRUSTEES. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (46 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | CountryAddressForeign/Country | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BLOOMER LAKEVIEW INC | ||||||||||||||
| 2110 DUNCAN ROAD | BLOOMER | WI | 54724 | 391450617 | LOW INCOME HOUSING | WI | 501(C)(3) | 7 | MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC | 1 | ||||
| CHARTERHOUSE INC | ||||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 411405254 | RETIREMENT LIVING CENTER | MN | 501(C)(3) | 9 | MAYO CLINIC | 1 | ||||
| FOUNTAIN LAKE TREATMENT CENTER | ||||||||||||||
| 404 WEST FOUNTAIN STREET | ALBERT LEA | MN | 56007 | 411404076 | CHEMICAL DEPENDENCY TREATMENT | MN | 501(C)(3) | 3 | MAYO CLINIC HEALTH SYSTEM--ALBERT LEA | 1 | ||||
| FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC | ||||||||||||||
| 464 SOUTH JOHNSON STREET | ARCADIA | WI | 54612 | 391322480 | FUNDRAISING FOUNDATION | WI | 501(C)(3) | 9 | MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC | 1 | ||||
| GCAS | ||||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 411917517 | AMBULANCE SERVICE | MN | 501(C)(3) | 9 | MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH | 1 | ||||
| GOLD CROSS AMBULANCE SERVICE | ||||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 411917516 | AMBULANCE SERVICE | MN | 501(C)(3) | 9 | MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH | 1 | ||||
| GOLD CROSS AMBULANCE INC | ||||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 391942957 | AMBULANCE SERVICE | MN | 501(C)(3) | 9 | MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH | 1 | ||||
| LUTHER LAKESIDE APARTMENTS INC | ||||||||||||||
| 714 SOUTH BARSTOW STREET | EAU CLAIRE | WI | 54701 | 391409024 | LOW INCOME HOUSING | WI | 501(C)(3) | 9 | MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC | 1 | ||||
| MAYO CLINIC | ||||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 416011702 | PATIENT CARE - CLINIC | MN | 501(C)(3) | 9 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC -- METHODIST HOSPITAL | ||||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 410739106 | HOSPITAL | MN | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC -- SAINT MARYS HOSPITAL | ||||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 410944601 | HOSPITAL | MN | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC ARIZONA | ||||||||||||||
| 13400 EAST SHEA BLVD | SCOTTSDALE | AZ | 85259 | 860800150 | HOSPITAL AND CLINIC | AZ | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC FLORIDA (A NONPROFIT CORPORATION) | ||||||||||||||
| 4500 SAN PABLO ROAD | JACKSONVILLE | FL | 32224 | 590714831 | HOSPITAL | FL | 501(C)(3) | 3 | MAYO CLINIC JACKSONVILLE | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--ALBERT LEA | ||||||||||||||
| 404 WEST FOUNTAIN STREET | ALBERT LEA | MN | 56007 | 411404075 | HOSPITAL AND CLINIC | MN | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--AUSTIN | ||||||||||||||
| 1000 FIRST DRIVE NW | AUSTIN | MN | 55912 | 410695606 | HOSPITAL AND CLINIC | MN | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--AUSTIN FOUNDATION | ||||||||||||||
| 1000 FIRST DRIVE NW | AUSTIN | MN | 55912 | 300107471 | FUNDRAISING FOUNDATION | MN | 501(C)(3) | 7 | MAYO CLINIC HEALTH SYSTEM--AUSTIN | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--CANNON FALLS | ||||||||||||||
| 1116 WEST MILL STREET | CANNON FALLS | MN | 55009 | 204156428 | HOSPITAL AND CLINIC | MN | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC | ||||||||||||||
| 1501 THOMPSON STREET | BLOOMER | WI | 54724 | 390980343 | HOSPITAL AND CLINIC | WI | 501(C)(3) | 3 | MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC | ||||||||||||||
| PO BOX 1510 | EAU CLAIRE | WI | 54702 | 391735831 | PATIENT CARE - CLINIC | WI | 501(C)(3) | 3 | MAYO CLINIC | 0 | ||||
| MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE FOUNDATION INC | ||||||||||||||
| 733 W CLAIREMONT AVE PO BOX 1510 | EAU CLAIRE | WI | 54702 | 391633407 | GRANTMAKING FOUNDATION | WI | 501(C)(3) | PF | MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC | 0 | ||||
| MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC | ||||||||||||||
| 1221 WHIPPLE STREET | EAU CLAIRE | WI | 54703 | 390813418 | HOSPITAL | WI | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--FAIRMONT | ||||||||||||||
| 800 MEDICAL CENTER DRIVE PO BOX 800 | FAIRMONT | MN | 56031 | 410760836 | HOSPITAL AND CLINIC | MN | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC | ||||||||||||||
| 700 WEST AVE SOUTH | LA CROSSE | WI | 54601 | 391186647 | FUNDRAISING FOUNDATION | WI | 501(C)(3) | 11-II | MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION-SPARTA INC | ||||||||||||||
| 310 WEST MAIN STREET | SPARTA | WI | 54656 | 391423234 | FUNDRAISING FOUNDATION | WI | 501(C)(3) | 9 | MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC | ||||||||||||||
| 700 WEST AVE SOUTH | LA CROSSE | WI | 54601 | 391411999 | HEALTHCARE SYSTEM PARENT | WI | 501(C)(3) | 11-I | MAYO CLINIC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--FRANCISCAN MEDICAL CENTER INC | ||||||||||||||
| 700 WEST AVE SOUTH | LA CROSSE | WI | 54601 | 390806374 | HOSPITAL AND CLINIC | WI | 501(C)(3) | 3 | MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--HOME HEALTH & HOSPICE INC | ||||||||||||||
| PO BOX 2060 | EAU CLAIRE | WI | 54702 | 391491516 | HOME HEALTH AND HOSPICE CARE | WI | 501(C)(3) | 9 | MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--LAKE CITY | ||||||||||||||
| 500 WEST GRANT STREET | LAKE CITY | MN | 55041 | 411906820 | HOSPITAL | MN | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--MANKATO | ||||||||||||||
| 1025 MARSH STREET | MANKATO | MN | 56002 | 411236756 | HOSPITAL AND CLINIC | MN | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--MANKATO HEALTH CARE FOUNDATION | ||||||||||||||
| 1025 MARSH STREET | MANKATO | MN | 56002 | 411663357 | FUNDRAISING FOUNDATION | MN | 501(C)(3) | 7 | MAYO CLINIC HEALTH SYSTEM--MANKATO | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE | ||||||||||||||
| 301 SECOND STREET NORTHEAST | NEW PRAGUE | MN | 56071 | 410723639 | HOSPITAL AND CLINIC | MN | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC | ||||||||||||||
| 1222 EAST WOODLAND AVE | BARRON | WI | 54812 | 390920634 | HOSPITAL AND CLINIC | WI | 501(C)(3) | 3 | MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC | ||||||||||||||
| PO BOX 70 / 13025 EIGHTH STREET | OSSEO | WI | 54758 | 391029430 | HOSPITAL AND CLINIC | WI | 501(C)(3) | 3 | MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--OWATONNA | ||||||||||||||
| 134 SOUTHVIEW | OWATONNA | MN | 55060 | 411862132 | PATIENT CARE - CLINIC | MN | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC | ||||||||||||||
| 2321 STOUT ROAD | MENOMONIE | WI | 54751 | 510190875 | HOSPITAL AND CLINIC | WI | 501(C)(3) | 3 | MAYO CLINIC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--SPRINGFIELD | ||||||||||||||
| 625 NORTH JACKSON AVENUE | SPRINGFIELD | MN | 56087 | 411893827 | HOSPITAL AND CLINIC | MN | 501(C)(3) | 3 | MAYO CLINIC HEALTH SYSTEM--MANKATO | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--ST JAMES | ||||||||||||||
| 1101 MOULTON PARSONS DR PO BOX 460 | ST JAMES | MN | 56081 | 410797368 | HOSPITAL AND CLINIC | MN | 501(C)(3) | 3 | MAYO CLINIC HEALTH SYSTEM--MANKATO | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--ST JAMES HEALTH CARE FOUNDATION | ||||||||||||||
| 1101 MOULTON PARSONS DR PO BOX 460 | ST JAMES | MN | 56081 | 411444129 | FUNDRAISING FOUNDATION | MN | 501(C)(3) | 7 | MAYO CLINIC HEALTH SYSTEM--ST JAMES | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--SUPPORTIVE HOMECARE INC | ||||||||||||||
| PO BOX 2060 | EAU CLAIRE | WI | 54702 | 391686673 | HOME HEALTH CARE | WI | 501(C)(3) | 9 | MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC | 1 | ||||
| MAYO CLINIC HEALTH SYSTEM--WASECA | ||||||||||||||
| 501 NORTH STATE STREET | WASECA | MN | 56093 | 363606405 | HOSPITAL AND CLINIC | MN | 501(C)(3) | 3 | MAYO CLINIC HEALTH SYSTEM--MANKATO | 1 | ||||
| MAYO CLINIC JACKSONVILLE | ||||||||||||||
| 4500 SAN PABLO ROAD | JACKSONVILLE | FL | 32224 | 593337028 | PATIENT CARE - CLINIC | FL | 501(C)(3) | 7 | MAYO CLINIC | 1 | ||||
| MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH | ||||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 411506440 | CHARITABLE, EDUCATIONAL & SCIENTIFIC ACTIVITIES | MN | 501(C)(3) | 9 | MAYO CLINIC | 1 | ||||
| MAYO KLINIK STIFTUNG | ||||||||||||||
| FUNDRAISING FOUNDATION | MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH | 1 | 60486 FRANKFURT AM MAIN | FRANKFURT | GM | GM | ||||||||
| MILES AND SHIRLEY FITERMAN ENDOWMENT FUND FOR DIGESTIVE DISEASES | ||||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 412020392 | SUPPORT RESEARCH, PRACTICE & EDUCATION | MN | 501(C)(3) | 11-I | MAYO CLINIC | 1 | ||||
| POVERELLO FOUNDATION | ||||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 411494881 | FUNDRAISING FOUNDATION | MN | 501(C)(3) | 11-I | MAYO CLINIC -- SAINT MARYS HOSPITAL | 1 | ||||
| SOUTHERN METRO MEDICAL CLINICS INC | ||||||||||||||
| 301 MAIN STREET | NEW PRAGUE | MN | 56071 | 411623632 | FAMILY PRACTICE CLINICS | MN | 501(C)(3) | 9 | MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE | 1 | ||||
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRANKLIN HEATING STATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 119 THIRD ST SW | AddressLine1 |
| City | ROCHESTER | City |
| State | MN | State |
| ZIP Code | 55902 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 410264830 | EIN |
| Primary Activity | UTILITY | PrimaryActivity |
| Legal Domicile State | MN | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
Form990 Schedule R Part IV Form990ScheduleRPartIV (34 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Legal Domicile Foreign CountryLegalDomicileForeignCountry | Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | CountryAddressForeign/Country |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MAYO CLINIC HEALTH SYSTEM--FARIBAULT | ||||||||||||
| 635 FIRST STREET SE | FARIBAULT | MN | 55021 | 411817179 | PATIENT CARE - CLINIC | MN | N/A | C | ||||
| MAYO CLINIC HEALTH SYSTEM--DECORAH CLINIC PHYSICIANS | ||||||||||||
| 907 MONTGOMERY STREET | DECORAH | IA | 52101 | 411711329 | PATIENT CARE - CLINIC | IA | N/A | C | ||||
| FIOS THERAPEUTICS INC | ||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 711029189 | RESEARCH | MN | N/A | C | ||||
| HEALTH TRADITION HEALTH PLAN | ||||||||||||
| 1808 EAST MAIN STREET | ONALASKA | WI | 54650 | 391545987 | MEDICAL SERVICES COMPANY | WI | N/A | C | ||||
| LOBSS NETWORK SUPPORT 2002 INC | ||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 481276150 | ADMINISTRATIVE SERVICES | MN | N/A | C | ||||
| MAYO COLLABORATIVE SERVICES INC | ||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 411346366 | REFERENCE LAB SERVICES | MN | N/A | C | ||||
| MAYO HOLDING COMPANY | ||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 411578020 | HOLDING COMPANY | MN | N/A | C | ||||
| MAYO INSURANCE COMPANY LTD | ||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | SELF INSURANCE POOL | N/A | C | CJ | |||||
| MAYO MEDICAL LABORATORIES NEW ENGLAND INC | ||||||||||||
| 265 BALLARDVALE STREET | WILMINGTON | MA | 01887 | 043323713 | LABORATORY SERVICES | MA | N/A | C | ||||
| MAYO REGIONAL PRACTICES OF ARIZONA | ||||||||||||
| 13400 EAST SHEA BOULEVARD | SCOTTSDALE | AZ | 85259 | 061190278 | THIRD PARTY ADMINISTRATION SERVICES | AZ | N/A | C | ||||
| MHS SERVICES INC | ||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 411282517 | EQUIPMENT & REAL ESTATE LEASING | MN | N/A | C | ||||
| MMSI INC | ||||||||||||
| 21 FIRST STREET SW | ROCHESTER | MN | 55905 | 411547003 | THIRD PARTY ADMINISTRATION SERVICES | MN | N/A | C | ||||
| MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC | ||||||||||||
| 1221 WHIPPLE STREET | EAU CLAIRE | WI | 54703 | 391528920 | PHARMACY SERVICES | WI | N/A | C | ||||
| PHYSICIAN AND HOSPITAL PRACTICES INC | ||||||||||||
| 4500 SAN PABLO ROAD | JACKSONVILLE | FL | 32224 | 930926631 | HEALTH SERVICES | FL | N/A | C | ||||
| ROCHESTER AIRPORT COMPANY | ||||||||||||
| ROUTE 2 | ROCHESTER | MN | 55902 | 410506870 | AIRPORT MANAGEMENT | MN | N/A | C | ||||
| SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION | ||||||||||||
| 13400 E SHEA BLVD | SCOTTSDALE | AZ | 85259 | 860870505 | COMMERCIAL PROPERTY OWNERS ASSOCIATION | AZ | N/A | C | ||||
| THE STABILE BUILDING OWNERS' ASSOCIATION | ||||||||||||
| 200 FIRST STREET SW | ROCHESTER | MN | 55905 | 208994499 | COMMERCIAL PROPERTY OWNERS ASSOCIATION | MN | N/A | C | ||||
| MAYO CLINIC GBS MAURITIUS | ||||||||||||
| HEALTHCARE MANAGEMENT | N/A | C | MP | 2ND FLOOR EBENE MEWS 57 | EBENE CYBERCITY | MP | ||||||
| CHARITABLE LEAD TRUST (1) | ||||||||||||
| CHARITABLE TRUST | CA | N/A | T | |||||||||
| PERPETUAL TRUST (1) | ||||||||||||
| CHARITABLE TRUST | ND | N/A | T | |||||||||
| PERPETUAL TRUST (1) | ||||||||||||
| CHARITABLE TRUST | LA | N/A | T | |||||||||
| PERPETUAL TRUST (2) | ||||||||||||
| CHARITABLE TRUST | MA | N/A | T | |||||||||
| PERPETUAL TRUST (1) | ||||||||||||
| CHARITABLE TRUST | MO | N/A | T | |||||||||
| PERPETUAL TRUST (1) | ||||||||||||
| CHARITABLE TRUST | AZ | N/A | T | |||||||||
| CHARITABLE REMAINDER TRUST (1) | ||||||||||||
| CHARITABLE TRUST | CO | N/A | T | |||||||||
| CHARITABLE REMAINDER TRUST (6) | ||||||||||||
| CHARITABLE TRUST | FL | N/A | T | |||||||||
| CHARITABLE REMAINDER TRUST (1) | ||||||||||||
| CHARITABLE TRUST | FL | N/A | T | |||||||||
| CHARITABLE REMAINDER TRUST (1) | ||||||||||||
| CHARITABLE TRUST | IL | N/A | T | |||||||||
| CHARITABLE REMAINDER TRUST (1) | ||||||||||||
| CHARITABLE TRUST | LA | N/A | T | |||||||||
| CHARITABLE REMAINDER TRUST (1) | ||||||||||||
| CHARITABLE TRUST | MI | N/A | T | |||||||||
| CHARITABLE REMAINDER TRUST (66) | ||||||||||||
| CHARITABLE TRUST | MN | N/A | T | |||||||||
| CHARITABLE REMAINDER TRUST (82) | ||||||||||||
| CHARITABLE TRUST | MN | N/A | T | |||||||||
| CHARITABLE REMAINDER TRUST (1) | ||||||||||||
| CHARITABLE TRUST | NC | N/A | T | |||||||||
| CHARITABLE REMAINDER TRUST (2) | ||||||||||||
| CHARITABLE TRUST | TX | N/A | T | |||||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 1 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
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