Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
|||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| (1)
HENNEPIN COUNTY MEDICAL CENTER |
421707837 | 3 | Yes | 248,787 | |||||
| (2)
REGIONS HOSPITAL |
410797853 | 3 | No | 112,905 | |||||
| (3)
UNIVERSITY OF MINNESOTA MEDICAL CENTER |
410991680 | 3 | No | 5,000 | |||||
| (4)
ALLINA HEALTH SYSTEMS |
363261413 | 3 | No | 59,357 | |||||
| (5)
PARK NICOLLET METHODIST |
410132080 | 3 | No | 27,576 | |||||
| (6)
CHILDREN'S HOSPITALS AND CLINICS |
411754276 | 3 | No | 44,402 | |||||
| (7)
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE |
363379150 | 3 | No | 9,989 | |||||
| (8)
NORTH MEMORIAL MEDICAL CENTER |
410729979 | 3 | No | 26,450 | |||||
| (9)
ST JOHN'S HOSPITAL |
411456897 | 3 | No | 0 | |||||
| (10)
ST JOSEPH'S HOSPITAL |
410693880 | 3 | No | 10,486 | |||||
| (11)
MAYO CLINIC HEALTH SYSTEM MANKATO |
411236756 | 3 | No | 0 | |||||
| (12)
ST LUKE'S HOSPITAL |
410714079 | 3 | No | 9,952 | |||||
| (13)
ST MARY'S MEDICAL CENTER |
410695604 | 3 | No | 14,572 | |||||
| (14)
UNIVERSTITY OF MINNESOTA |
411462740 | 2 | Yes | 0 | |||||
| (15)
VETERANS AFFAIRS MEDICAL CENTER |
741612229 | 3 | Yes | 111,155 | |||||
| Total | 680,631 | ||||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




| Facts And Circumstances Test |
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| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE BOARD APPROVES A DRAFT OF THE FORM 990 BEFORE IT IS FILED. | |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY BOARD MEMERS, OFFICERS, AND KEY EMPLOYEES DISCLOSE POTENTIAL CONFLICTS OF INTEREST TO THE BOARD. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES AVAILABLE TO THE PUBLIC AT ITS MAIN ADDRESS ITS GOVERNING DOCUMENTS, CONFLIECT OF INTEREST POLICY, AND FINANCIAL STATEMENTS UPON REQUEST. | |
| FORM 990, PART XI, LINE 2C | THERE HAS BEEN NO CHANGE IN THIS PROCESS FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |