TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) David Abelson MD President and CEO	55.00	X	X	0	1,037,727	204,677
(2) Steven Connelly MD Exec VP & CMO	55.00	X	X	0	605,453	101,236
(3) Judith Corson Secretary	3.00	X	X	0	0	0
(4) Michael Kaupa Executive VP and COO	55.00	X	X	0	712,622	140,460
(5) Donald Lewis JD Vice Chair	3.00	X	X	0	0	0
(6) Sheila McMillan Sr VP & CFO	55.00	X	X	0	455,991	93,913
(7) Richard E Struthers Treasurer	3.00	X	X	0	0	0
(8) Kenneth L Thome Chair	3.00	X	X	0	0	0
(9) Barbara Degnan Director	3.00	X		0	0	0
(10) Paul Dominski Director	55.00	X		0	548,428	141,934
(11) Bruce W Engelsma Director	3.00	X		0	0	0
(12) Steve Frank Director	3.00	X		0	0	0
(13) Roxanna Gapstur PhD Director	55.00	X		0	228,552	67,467
(14) Christa Getchell Director	55.00	X		0	181,653	21,496
(15) David Homans MD Chief of Specialty Serv	55.00	X		0	502,433	78,019
(16) Jeffrey B Husband MD Director	55.00	X		559,721	0	47,479
(17) Tom Jones MD Director	55.00	X		696,192	0	30,136

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Charles McCoy MD Director	55.00	X				195,593	0	26,937
(19) Ken Melrose Director	3.00	X				0	0	0
(20) Ruth Mickelsen Director	3.00	X				0	0	0
(21) Lee N Newcomer MD Director	3.00	X				0	0	0
(22) James O Pohlad Director	3.00	X				0	0	0
(23) William Richards MD Director	55.00	X				285,948	0	29,327
(24) Janet Schaffer MD Director	55.00	X				348,834	0	44,421
(25) Eric Schned MD Director	55.00	X				358,528	0	40,282
(26) Dan Schumacher Director	3.00	X				0	0	0
(27) Janette Strathy MD Director	55.00	X				283,879	0	33,474
(28) Katherine Tarvestad Director	55.00	X				0	40,790	17,235
(29) Mark Wilkowske MD Chief of Oncology Serv	55.00	X				515,192	0	46,833
(30) Susan Zwaschka VP Corp Compliance	55.00	X				0	556,458	39,930
(31) Mary Johnson TRIA COO	55.00		X			0	310,138	20,473
(32) Theodore Wegleitner TRIA COO	55.00		X			0	333,820	54,800
(33) Dane Christensen MD Medical Doctor	55.00			X		813,975	0	51,166
(34) Timothy Diegel MD Medical Doctor	55.00			X		1,067,526	0	67,063
(35) Darin Epstein MD Medical Doctor	55.00			X		916,553	0	52,653
(36) Steven Rakes MD Medical Doctor	55.00			X		827,746	0	51,365
(37) Anton Willerscheidt MD Medical Doctor	55.00			X		806,752	0	67,561
(38) Kathryn D Kallas Former VP Inpatient Care & CNO	0.00				X	0	481,623	59,060

(A) Name and business address	(B) Description of services	(C) Compensation
RJM Construction 5455 HWY 169 Plymouth,MN55442	Construction Services	5,641,005
Mequist Transcriptions LTD PO Box 102467 Atlanta,GA30368	Transcription	3,790,333
ABM Janitorial Services Inc 75 Remittance Dr Suite 3048 Chicago,IL60693	Janitorial	3,115,880
Digital Prospectors Corporation 100 High Street Building B Exeter,NH03833	Training	3,081,690
Memorial Blood Center of Minneapolis PO Box 1164 Minneapolis,MN55480	Medical Services	2,699,816
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 133

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	167,777	167,777
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	19,099	19,099
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	2,816,444	2,417,758	398,686
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	498,723,262	477,128,084	21,224,357	370,821
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	31,441,915	29,359,501	2,053,059	29,355
9	Other employee benefits .......	47,971,945	45,028,746	2,887,779	55,420
10	Payroll taxes ...........	30,583,538	29,018,823	1,531,445	33,270
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,036,953		1,036,953
c	Accounting ...........	448,883		448,883
d	Lobbying ...........
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......	740,657		740,657
g	Other ..........	34,159,131	31,354,780	2,732,351	72,000
12	Advertising and promotion ....	3,654,242	271,119	3,383,123
13	Office expenses .......	14,850,089	10,538,470	4,311,619
14	Information technology ......	8,935,225	8,593,519	341,706
15	Royalties ..
16	Occupancy ...........	43,704,336	40,082,286	3,622,050
17	Travel ............	936,195	778,246	157,949
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	801,880	698,213	103,667
20	Interest ...........	9,789,418	9,789,418
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	30,430,126	27,527,472	2,902,654
23	Insurance ..............	7,889,654		7,889,654
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	Management Fees	156,429,670	51,414,077	105,015,593	0
b	Medical Supplies	134,980,485	134,548,555	431,930	0
c	Cost of Goods Sold	40,837,694	40,837,694	0	0
d	Bad Debt Expense	26,018,410	26,018,410	0	0
e
f	All other expenses	28,379,662	27,468,671	910,991
25	Total functional expenses. Add lines 1 through 24f	1,155,746,690	993,060,718	162,125,106	560,866
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	602,996	1	830,871
2	Savings and temporary cash investments .......	192,677	2	282,705
3	Pledges and grants receivable, net .........	1,972,690	3	3,414,212
4	Accounts receivable, net .........	112,572,899	4	135,003,069
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	11,219,361	8	10,046,399
9	Prepaid expenses and deferred charges ............	8,249,643	9	11,936,459
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	954,957,878
b	Less: accumulated depreciation. .....	10b	613,787,542	358,091,019	10c	341,170,336
11	Investments—publicly traded securities ..........		11	386,672,271
12	Investments—other securities. See Part IV, line 11 ......	394,731,187	12	28,139,728
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	42,108,311	15	7,819,845
16	Total assets. Add lines 1 through 15 (must equal line 34)...	929,740,783	16	925,315,895
	17	Accounts payable and accrued expenses .	93,815,825	17	82,424,257
18	Grants payable ..........		18
19	Deferred revenue ..........	6,191,231	19	11,939,650
20	Tax-exempt bond liabilities ..........	388,720,675	20	379,891,311
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	2,698,222	23	1,984,777
24	Unsecured notes and loans payable to unrelated third parties ....	4,132,852	24	1,930,180
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	10,075,014	25	9,411,578
26	Total liabilities. Add lines 17 through 25.....	505,633,819	26	487,581,753
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	422,917,533	27	436,481,051
28	Temporarily restricted net assets .....	914,699	28	976,854
29	Permanently restricted net assets .....	274,732	29	276,237
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	424,106,965	33	437,734,142
34	Total liabilities and net assets/fund balances .....	929,740,783	34	925,315,895

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(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.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation
Schedule A, Part IV, Supplemental Information: Park Nicollet Methodist Hospital Line 3; 170(b)(1)(a)(iii) Park Nicollet Clinic Line 3; 170(b)(1)(a)(iii) Park Nicollet Institute Line 4; 170(b)(1)(a)(iii) Park Nicollet Health Care Products Line 11 Type II; 509(a)(3) PNMC Holdings Line 11 Type I; 509(a)(3) Part I, Line 11: Supporting organizations detail: PNMC Holdings and Park Nicollet Healthcare Products provide support to following organizations: PNMC Holdings: Line 11, column (i) Park Nicollet Clinic, (ii) 41-0834920, (iii) 170(b)(1)(a)(iii), (iv), Yes, (v) Yes, (vi) Yes, (vii) $2,205,011 Park Nicollet Health Care Products: Line 11, column (i) Park Nicollet Methodist Hospital, (ii) 41-0132080, (iii) 170(b)(1)(a)(iii), (iv), Yes, (v) Yes, (vi) Yes, (vii) $5,385,974 Line 11, column (i) Park Nicollet Clinic, (ii) 41-0834920, (iii) 170(b)(1)(a)(iii), (iv), Yes, (v) Yes, (vi) Yes, (vii) $ 65,563,597

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

Park Nicollet Group Return

Employer identification number

45-5023260

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization Park Nicollet Group Return
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization Park Nicollet Group Return
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
Park Nicollet Group Return

Employer identification number

45-5023260

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2011

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2011

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

55,089

Total. Add lines 1c through 1i ...............................

55,089

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
Explanation of Lobbying Activities:	Part II-B, Line 1:	Park Nicollet reimburses certain professional membership dues of employees. A portion of such membership dues are used by the professional associations for lobbying activities.

Schedule C (Form 990 or 990EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back
1a	Beginning of year balance ....	22,048,592	23,127,080	40,045,623	40,780,143
b	Contributions ........	1,489,934	1,474,161	3,239,794	3,726,005
c	Net investment earnings, gains, and losses ...	-341,465	850,097	538,558	-162,788
d	Grants or scholarships .....	2,342,091	3,402,746	20,696,895	4,297,737
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......	20,854,970	22,048,592	23,127,080	40,045,623

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

43.000 %

Temporarily restricted endowment SchDMd Bullet

57.000 %

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	27,670,907		27,670,907
b	Buildings ................	445,936,748	250,225,141	195,711,607
c	Leasehold improvements ............	50,098,266	33,571,055	16,527,211
d	Equipment ................	426,937,522	329,991,346	96,946,176
e	Other .................	4,314,435		4,314,435
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				341,170,336

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes
Capital Lease Obligation		73,179
Long-term Capital Lease Obligation		3,164,318
Securities Loan Agreement		6,174,081






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		9,411,578
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8
9	Total adjustments (net). Add lines 4 through 8 .........................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
Description of Intended Use of Endowment Funds:	Part V, Line 4:	The Term endowment funds for use within Park Nicollet Clinic, Park Nicollet Institute and Park Nicollet Methodist Hospital are for Grants related to Education, Research and Patient Care.
Description of Uncertain Tax Positions Under FIN 48:	Part X:	Park Nicollet Health Services and affiliates adopted the provisions of FIN 48, Accounting for Uncertainty in Income Taxes - an interpretation of FASB Statement No. 109, on January 1, 2007. As a result of the implementation of FIN 48, Park Nicollet Health Services and affiliates were not required to recognize a liability for unrecognized tax benefits. There were no unrecognized tax benefits for the years ended December 31, 2009, 2010 and 2011.

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization
Park Nicollet Group Return

Employer identification number

45-5023260

Part I

General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants

and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? ..............................

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other
assistance outside the United States.

Activites per Region. (Use Part V if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees or agents in region or independent contractors	(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in region	(f) Total expenditures for region/investments in region
	East Asia and the Pacific	0	0	Program Services	Education	13,733
	Europe (including Iceland & Greenland)	0	0	Program Services	Education	29,333
	Middle East and North Africa	0	0	Program Services	Education	14,288














3a	Sub-total .....	0	0			57,354
b	Total from continuation sheets to Part I ...	0	0			0
c	Totals (add lines 3a and 3b)	0	0			57,354

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011

Schedule F (Form 990) 2011

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,

Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet

Use Part V if additional space is needed.

1 (a) Name of organization		(b) IRS code section and EIN (if applicable)	(c) Region	(d) Purpose of grant	(e) Amount of cash grant	(f) Manner of cash disbursement	(g) Amount of of non-cash assistance	(h) Description of non-cash assistance	(i) Method of valuation (book, FMV, appraisal, other)

Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ..... MediumBullet

Enter total number of other organizations or entities ........................ MediumBullet

Schedule F (Form 990) 2011

Schedule F (Form 990) 2011Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.

Use Part V if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of non-cash assistance	(g) Description of non-cash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2011

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2011

Page 5

Part V

Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).

Identifier	ReturnReference	Explanation

Schedule F (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 27500.0000000000 %

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

Yes

200% 250% 300% 350% 400% Other 27500.0000000000 %

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did the organization make it available to the public? ...............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..		11,580,871	165,368	11,415,503	1.010 %
b Medicaid (from Worksheet 3, column a) .....		105,691,914	58,427,819	47,264,095	4.180 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .
dTotal Financial Assistance and Means-Tested Government Programs .....		117,272,785	58,593,187	58,679,598	5.190 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	20,072	5,144,526	441,943	4,702,583	0.420 %
f Health professions education (from Worksheet 5) ..		5,794,367	1,487,507	4,306,860	0.380 %
g Subsidized health services (from Worksheet 6) ..
h Research (from Worksheet 7)		7,176,759	4,712,706	2,464,053	0.220 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....		50,000		50,000	0 %
jTotal Other Benefits ...	20,072	18,165,652	6,642,156	11,523,496	1.020 %
kTotal. Add lines 7d and 7j. ..	20,072	135,438,437	65,235,343	70,203,094	6.210 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(f) Percent of total expense
1	Physical improvements and housing	0 %
2	Economic development	0 %
3	Community support	0 %
4	Environmental improvements	0 %
5	Leadership development and training for community members	0 %
6	Coalition building	0 %
7	Community health improvement advocacy	0 %
8	Workforce development	0 %
9	Other	0 %
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense........

16,279,755

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

220,257,408

Enter Medicare allowable costs of care relating to payments on line 5.....

260,611,957

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-40,354,549

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	Park Nicollet Methodist Hospital 6500 Excelsior Blvd St Louis Park,MN55426	X	X	X	X

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Park Nicollet Methodist Hospital

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 275.000000000000% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 275.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21	Yes
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?28
Name and address		Type of Facility (describe)
1	Struther's Parkinson Center 6701 Country Club Drive Golden Valley,MN55427	Research and Treatment of Parkinson's Disease
2	Park Nicollet Melrose Institute 3625 Monterey Drive St Louis Park,MN55416	Eating disorder clinic/General Medical
3	3900 ClinicAmbulatory Surgical Center 3900 Park Nicollet Boulevard St Louis Park,MN55416	Ambulatory Surgical Center and General Medical and Retail
4	Meadowbrook Medical Building 3931 Louisiana Ave S St Louis Park,MN55426	Physican offices, ancillary medical services and Medical Retail
5	Prairie Center 8455 Flying Cloud Drive Eden Prairie,MN55344	Physican offices, ancillary medical services and Medical Retail
6	Bloomington Clinic 5320 Hyland Greens Drive Bloomington,MN55437	Physican offices, ancillary medical services and Medical Retail
7	Brookdale Clinic 6000 Earle Brown Drive Brooklyn Center,MN55430	Physican offices, ancillary medical services and Medical Retail
8	Burnsville Clinic 1400 Fairview Drive Burnsville Clinic,MN55337	Physican offices, ancillary medical services and Medical Retail
9	Carlson Parkway Clinic 15111 Twelve Oaks Center Drive Minnetonka,MN55305	Physican offices, ancillary medical services and Medical Retail
10	Chanhassen Clinic 300 Lake Drive E Chanhassen,MN55317	Physican offices, ancillary medical services and Medical Retail
11	Creekside 6600 Excelsior Blvd St Louis Park,MN55426	Physican offices, ancillary medical services and Medical Retail
12	CT-MRI Center 4951 Excelsior Blvd St Louis Park,MN55416	Imaging Center/Optical Retail
13	Eagan Clinic 1885 Plaza Drive Eagan,MN55122	Physican offices, ancillary medical services and Medical Retail
14	Golden Valley Clinic 8240 Golden Valley Drive Golden Valley,MN55427	Physican offices, ancillary medical services and Medical Retail
15	Lakeville Clinic 18432 Kenrick Ave Lakeville,MN55044	Physican offices, ancillary medical services and Medical Retail
16	Maple Grove Clinic 15800 95th Ave N Maple Grove,MN55369	Physican offices, ancillary medical services and Medical Retail
17	Maple Grove OB 9855 Hospital Drive Suite 275 Maple Grove,MN55369	OB services
18	Maple Grove Rehab 9827 Maplge Grove Pkwy N Maple Grove,MN55369	Rehabiliation Services
19	Minneapolis Clinic 2001 Blaisdell Ave S Minneapolis,MN55404	Physican offices, ancillary medical services and Medical Retail
20	Minnetonka - Shorewood Clinic 19685 Highway 7 Shorewood,MN55331	Physican offices, ancillary medical services and Medical Retail
21	Plymouth Clinic 3007 Harbor Lane N Plymouth,MN55447	Physican offices, ancillary medical services and Medical Retail
22	Prior Lake Clinic 4670 Park Nicollet Ave SE Prior Lake,MN55372	Physican offices, ancillary medical services and Medical Retail
23	Shakopee Clinic 1415 St Francis Ave Shakopee,MN55379	Physican offices, ancillary medical services and Medical Retail
24	Shakopee Clinic 1515 St Francis Ave Shakopee,MN55379	Physican offices, ancillary medical services and Medical Retail
25	Shakopee Clinic 1601 St Francis Ave Shakopee,MN55379	Physican offices, ancillary medical services and Medical Retail
26	St Louis Park Clinic 3800 Park Nicollet Blvd St Louis Park,MN55416	Physican offices, ancillary medical services and Medical Retail
27	St Louis Park Clinic 3850 Park Nicollet Blvd St Louis Park,MN55416	Physican offices, ancillary medical services and Medical Retail
28	Wayzata Medical Building 250 Central Ave N Wayzata,MN55391	Physican offices, ancillary medical services and Medical Retail

Schedule H (Form 990) 2011

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
		Part I, Line 6a: Park Nicollet Foundation, a related organization of Park Nicollet Methodist Hospital, completes an organization wide annual community benefit report that includes Park Nicollet Methodist Hospital and other affiliated entities.
		Part I, Line 7: Park Nicollet Methodist Hospital uses the cost-to-charge ratio method when calculating the amounts reported on Part I, line 7. The cost-to-ratio was derived using Worksheet 2, ratio of patient care-cost-to charge, from the schedule H instructions.
		Part I, L7 Col(f): Bad Debt Expense of $26,018,410 was subtracted for purposes of calculating the percentage in Schedule H, Part I, Line 7, column (f).Part III, Line 3: Park Nicollet Methodist Hospital and its affiliates work with those qualifying for charity care along every step of the process including accepting applications for financial assistance after previous attempts to work with the patient fail. Every effort is made to work with the patient to provide financial assistance when appropriate. While there are people who do not cooperate with the hospital regarding payment plans, financial assistance or with those trying to help them get on government programs, it is impossible to know their reason for not cooperating and therefore know whether they may have qualified for charity care. Park Nicollet doesn't have predictive software which would make assumptions based on housing situation, credit reports, etc. and recommend assistance without a process for gathering income verification. In light of the foregoing facts, Park Nicollet is unable to reasonably determine whether any amount of bad debt could have been classified as charity care.
		Part III, Line 4: Park Nicollet Methodist Hospital's audited financial statement do not include a footnote discussing bad debt expense, or allowance of doubtful accounts. Bad debt is accounted for on the financial statements by estimating patient liability net of any charity care and then calculating what portion of that will not be collected based historical uncollectable rates. When a patient meets our financial requirements it is classified as charity care; if they do not quality, their services will be written off as bad debt. Park Nicollet Methodist Hospital does not include any charity care in their bad debt expense calculation.
		Part III, Line 8: Park Nicollet Methodist Hospital believes that all of the Medicare loss should be classified as a community benefit. The reason is that if these services were not provided by us they would become the obligation of the federal government. Based on this, Medicare losses should be included as a community benefit because the losses are incurred in performing an important public service. The allowable costs in our calculation came from the Medicare Cost Report as instructed per the 990 Schedule H instructions.
		Part III, Line 9b: The collection policy incorporates the requirements as stated by the Minnesota Attorney general and views account resolution through the Park Nicollet financial assistance program as an option for account resolution. This option is shared with debtors via statements and as part of collection calls to debtors from Park Nicollet staff and collection agencies. Park Nicollet's financial assistance is also described in pamphlets and on our website. The website includes a simple interactive schedule to allow a debtor to see if they may qualify. If the Debtor qualifies for financial assistance, collection efforts cease and charges are cleared from their account.
Park Nicollet Methodist Hospital		Part V, Section B, Line 19d: Park Nicollet uses the discount rate associated with our "most preferred payer" which is defined as our largest commercial payer.
Park Nicollet Methodist Hospital		Part V, Section B, Line 21: Park Nicollet charges its patients gross charges if the patient has elective surgery, which is not medically necessary.
		Part VI, Line 2: Integrated in our strategic planning process, Park Nicollet Methodist Hospital and its affiliates actively involve its patients, employees, board members and community partners in identifying patient and community needs. This process encourages awareness of changing patterns of need to improve the health of our patients and community members. As part of current assessment of needs, Park Nicollet Foundation convenes patients and community partners at monthly and quarterly meetings of several Healthy Communities Collaboratives and Advisory Groups located throughout our service area. A few examples of participating members include 1) representatives from the school districts of St. Louis Park, Hopkins, Wayzata/Plymouth, Brooklyn Center, Osseo and Burnsville/Eagan/Savage, 2) Mental health providers such as The Family Partnership and North Psychology, 3) Groups working with underserved populations such as Northwest Hennepin Family Services Collaborative, Portico HealthNet, 360 Communities, Interfaith Outreach and providers who work with the developmental needs of young children such as St. David's Center. In 2011, Park Nicollet continued its joint sponsorship of the Successful Aging Initiative in St. Louis Park. This community based group meets monthly to identify and focus on the needs of senior citizens including improving coordination of community and health related services. Sixty to eighty participants regularly attend these sessions which include educational and networking opportunities for seniors and those working with seniors. In addition, patient advisory groups and councils have been established to foster collaboration between patients, families and care teams. These councils focus on topics such as patient safety, facility design, clinician-patient communication, quality improvement, patient/family education, ethics and research. Councils support work in the following areas: - Methodist Hospital Patient Family Council - focusing on quality and safety - Frauenshuh Cancer Center - Health Care Home quality teams - After teams grown from four to seven "Health Care Home Patient Partner Councils" - Melrose Institute - Struthers Parkinson's CenterIn 2011, Park Nicollet Methodist Hospital began the planning and research phase for a formal Community Health Needs Assessment which will be completed in 2012. This formal assessment builds on the strength of Park Nicollet Health Services as a convener of the community by inviting 1100 community leaders, workers, and members of the community to participate in an online health needs survey and also convening focus groups utilizing the World Cafe model of facilitation. Results will be prioritized and presented to the Board of Directors in 2012 along with recommendations for an implementation plan to be incorporated into the strategic planning process for 2013-2015.Park Nicollet Institute participated in strategic planning in 2011 and used data gathered as part of this process to prioritize work in research and education. The key to assessing the needs for patient education involve including patients in the assessment process. Steps in the needs assessment process include defining the community or population, followed by determining what type of data is needed to complete the assessment and then collecting the data from a variety of sources which include but are not limited to patient and clinician surveys, local and national statistics related to the problem that is being addressed, evidence-based care guidelines, quality and safety outcome reports, proprietary data sources as appropriate and published literature. For professional education, understanding the gaps in clinical practice and the educational needs of physicians is critical to the success of the overall CME program and its planned activities. As part of the semi-annual review process, the Medical Education Committee (MEC) and the CME team identify data sources and methods to review data for CME program planning. We identify our learners' professional practice gaps and needs by reviewing one or more of the following: - organizational planning survey of target audience, which includes e-surveys, structured interviews and biannual staff surveys - patient care audit and quality assurance reports - morbidity and mortality statistics - peer-reviewed abstracts - faculty input - individual clinician behavior and prescribing data - community measures quality data - clinician registries - quality outcomes reports - dashboards - desirable patient care improvements identified from measurement of clinical practice guidelines - literature review of recent trends in biomedical science research - evaluation data from preceding CME activities - input from regional and national medical education and research communities provided by the MEC committee, CME faculty and Park Nicollet leadership - HEDIS data - Institute for Clinical Systems Improvement guidelines - focused patient and staff surveys - feedback from planning committees and focus groups representative of the target audience - patient surveys regarding quality of care and interaction with providers (Press Ganey reports) - topic-specific patient surveys - annual Park Nicollet quality reports - safety tracking database-quality tracking - physician competencies - Park Nicollet planning - maintenance of certification requirements - Lean results (Rapid Process Improvement Workshop)In research, clinical areas work with principal investigators to determine whether a study fills a gap in patient care. If the study addresses an identified need, a feasibility checklist is reviewed to address scientific merit, impact on patient care, mission of department and cost.
		Part VI, Line 3: Park Nicollet Methodist Hospital participates in multiple unique financial assistance programs, including our own Financial Assistance (FA). We inform our patients in multiple ways about our FA program and other financial assistance options for services received at PNHS. Approximately 14 percent of hospital patients participate in state public programs and approximately 2 percent are uninsured. A list of communications for patients relating to financial assistance follows: - Hospital booklets given to inpatients - Website, FA information found in billing and insurance section - FAQ on FA - FA calculator - online calculator allows quick and easy estimation of eligibility under the program - FA application - application may be printed for submission - Information on Medical Assistance, including eligibility and application process - Patient statements - All balance forward statements, regardless of balance, include a financial assistance application and responses to frequently asked questions regarding FA.In addition to the written material, Customer Service, Collections and hospital Patient Access Liaisons (PALs) inform patients about assistance options, including government programs and FA. PALs are on-site in the hospital and can meet with patients in their rooms or prior to admission. Most customer service and collections work is done though phone calls, but our main clinic has an on-site location for personal conversations. Park Nicollet Methodist Hospital staff is trained in helping patients apply for Medical Assistance and has also contracted with outside services to assist patients in the application process for Medical Assistance in more complicated circumstances.
		Part VI, Line 4: Park Nicollet Health Services, through its 19 Twin Cities primary care clinics, other care locations and Methodist Hospital and specialty facilities, provides health care access to more than 1.6 million people, primarily in the western Twin Cities area. The majority (75.5 percent)of this population, spread over 96 ZIP codes, is white, 7.1 percent is black, 4.2 percent is Asian, 2.5 percent is Latino , with those defining themselves as "multiracial" or "other" making up the rest of those we serve. Park Nicollet clinics are strategically located in communities to provide access to care, regardless of economic status or means of transportation. The socio-economics of our population served varies both between and within each community. Our clinic locations span the entire west metro from Maple Grove and Brooklyn Center in the northwest to Minnetonka and St. Louis Park in the central west to Shakopee and Prior Lake in the southwest, to Eagan in the southeast and to Lakeville (which opened in 2011) in the south. These clinics serve communities (and individuals) across the socio-economic spectrum. True to their metropolitan nature, each community served enjoys diversity within its own borders. For example, in Brooklyn Center, in addition to Park Nicollet Clinic - Brookdale, Park Nicollet has set up a health clinic for school district students. This clinic is located in the high school and is available to all students regardless of their ability to pay. Minorities make up half of the Brooklyn Center population, and 72 percent of district students are from low-income families. Three other school based or affiliated clinics operate in Wayzata, Burnsville and St. Louis Park. In St. Louis Park, home to many of the state's 12,500 Russian immigrants, we offer services, including translation, for those whose primary language is not English.
		Part VI, Line 5: Park Nicollet Methodist Hospital is a 426-bed facility recognized as an area leader in cancer care, cardiovascular services, maternity care and neuro-rehabiliation medicine, located in St. Louis Park, Minnesota. Medical staff privileges at the hospital are extended to all qualified physicians in the community. Park Nicollet Methodist Hospital's Board of Directors is a community board with all of its independent members living in the area served by the organization.Park Nicollet Methodist Hospital owns a facility in Golden Valley, Minnesota that houses the Struthers Parkinson's Center, which is dedicated to providing comprehensive assessment, treatment, support, education and research to improve the quality of life of people touched by this disease. Health professionals help patients from around the world receive specialized programs and services for Parkinson's Disease at Struthers.A national leader in the treatment of eating disorders, Park Nicollet Methodist Hospital owns and operates the Park Nicollet Melrose Institute for eating disorders, located in St. Louis Park, Minnesota. This facility, was specially constructed for treating those with eating disorders. The Melrose Institute treatment model revolutionizes care, taking individualized treatment to a whole new level. The care teams work with patients to determine appropriate placement in inpatient, residential or one of four levels of outpatient care, including unique specialty areas not currently found elsewhere. In 2011, the Melrose Institute sponsored over 100 presentations, trainings, webinars, exhibits, and other events to increase community awareness and prevention.Methodist Hospital sponsors and supports the Creekside Family Medicine Residency program, affiliated with the University of Minnesota. This 3 year residency trains 6 new family physicians each year to work in primary care including underserved areas. In addition to its training program, the Creekside residency provides vital community services for the uninsured and underinsured along with outreach programs to promote community health. Methodist Hospital participates as a training site for other specialty training of residents including the areas of general surgery, ob/gyn and critical care.As a part of the Emergency Management program, a Hazard Vulnerability Assessment is completed for the Methodist Hospital Campus. This survey assesses numerous risks in the community that may impact hospital operations. Risks unique to the geographical area of Methodist Hospital include numerous industrial worksites with multiple chemicals on site and close proximity to a rail line that transports hazardous chemicals. Because of these hazards in the community, Methodist Hospital plans with local first responders for the decontamination and treatment of affected community members.The ongoing process for assessing community health needs as described in Schedule H, Part VI, Question 2 has enabled the entire PNHS organization to focus attention to the needs described below in addition to other health needs.Park Nicollet Foundation's community connectivity model of convening on need, building relationships and raising support has brought responses in these priority areas: 1. Healthy kids are better learners:Park Nicollet Methodist Hospital, Park Nicollet Foundation and Park Nicollet Clinic partner with 21 school districts to assure that all students are up to date with their immunizations on the first day of school each year.- Four school-affiliated clinics, built, staffed and funded in partnership with Park Nicollet Foundation, Park Nicollet Methodist Hospital and Park Nicollet Clinic provide access to no cost or low cost medical, mental health and dental care to children and youth in the community.- The Ophthalmology department reaches out to the schools in an effort to assure eye health, by providing comprehensive eye exams and a prescription pair of eyewear yearly for children without health insurance.- Students referred by school nurses, whose families are unable to afford medications, receive needed medications at no charge through Park Nicollet Pharmacies.2. Increasing access to care for the uninsured:- In 2011, Park Nicollet Methodist Hospital, along with Park Nicollet Clinic and other affiliates provided needed comprehensive care, including primary, specialty, hospital and pharmacy services, at no charge to 1,400 individuals enrolled in the St. Mary's program, an innovative model of providing continuity of care for the uninsured.- Provided 6300 prescriptions for outpatient medications to low income individuals and families, assuring medical treatment for acute and chronic conditions such as asthma and diabetes.- Traditional financial assistance provided to individuals and families in need who are not enrolled in the St. Mary's program. 3. Focus on seniors:- The Successful Aging Initiative continues to respond to the needs of senior citizens in St. Louis Park, utilizing multidisciplinary work groups specifically focused on helping seniors stay safe in their homes by reducing the risk of falls and other injuries, increasing opportunities for fitness and exercise, improving transportation options, providing education to improve one's self-management of chronic illnesses, and encouraging completion of health care directives.4. Creating the health care home:- Growing economic and ethnic diversity in our communities has widened the gap of health disparities. Increased rates of obesity and diabetes, a growth in early childhood mental health issues, increased numbers of new immigrants unfamiliar with accessing our country's model of health care delivery and still struggling with issues of war and civil strife from their countries of origin and seniors isolated in their homes are just a few of the challenges that threaten the health of members of our communities.- Park Nicollet Clinics are leading the way in developing "health care homes" that not only provide needed medical care, but do so in a comprehensive model of support for patients and families to assure that they have timely access, effective coordination of care, a personal relationship with their physician and clinical care team, and a connection to other community resources.- An example of a Park Nicollet Clinic that has taken the lead in creating a model for the Health Care Home is the Plymouth Park Nicollet Clinic. In 2011 this clinic: * Offered classes at the clinic on Medicare and CareNextion. Participated in the Plymouth parade annually and the Plymouth Healthy Living Fair. Formed an onsite Healthy Living Support group facilitated by a Care Coordinator and a Patient Partner. The clinic participates on the Plymouth Yellow Ribbon Campaign Steering Committee. Established a partnership with Plymouth Community Center to work together to provide community needs. * Serves clients that come from group homes and assisted living facilities. * Patients involved in the clinic's Quality Committee. * Care Coordination in place for patient care, aimed at addressing the patient's medical and social needs and helping them navigate healthcare and community resources. This results in better patient outcomes and reduced total cost of care through reduced hospitalizations and ER visits. 5. Sticking with patients when they need us most: - Often the services needed to maintain one's health and wellbeing during a serious or life-threatening illness are not fully funded or reimbursed under traditional health insurance. Park Nicollet Methodist Hospital and Park Nicollet Foundation strive to assure the help is there when needed. * Club CREATE, a therapeutic adult day program at Struthers Parkinson's Center, offers activities that enrich patients physically, mentally, spiritually and socially. The program utilizes a variety of artistic and creative outlets, relaxation and meditative programs, and movement and exercise opportunities. * Park Nicollet Methodist Hospital's INSPIRE program is a unique service offering stroke survivors and their family support and education through seminars and support groups. * Park Nicollet Methodist Hospital's Melrose Institute offers comprehensive care, education and support through innovative curriculum-based programs for those struggling with eating disorders. * Reducing the number of "sleepless nights" while waiting for a diagnosis, helping patients conserve their energy by bringing services to them during treatments, offering spiritual care, social services and financial assistance for medications, groceries and other expenses while patients recover from their illness are commitments Frauenshuh Cancer Center at Park Nicollet Methodist Hospital makes to its patients.
		Part VI, Line 6:
		The Park Nicollet Institute reaches thousands each year through research studies, professional and patient education, and library services. In 2011, we held 223 patient education classes for 2,387 attendees. We conducted more than 5,000 diabetes education visits. The Health Library received 2,261 visitors. We published 326 new or revised patient education materials. Our Office of Continuing Medical Education granted 32,097 CME credits through 95 professional education activities. Almost 500 research studies were active in 2011 at Park Nicollet and through Minnesota Metro Community Clinical Oncology Program. Park Nicollet authors published 72 peer-reviewed papers, books and book chapters. - Community health: Throughout the year, employees participate in health fairs and screenings, most frequently in the area of diabetes and nutrition. International Diabetes Center hosts a Back to School fair for children with diabetes and hosts diabetes support groups for men, women and children. Numerous employees participate on national and local society and Park Nicollet committees that serve the community. Rich Bergenstal, MD, serves in a leadership role for the American Diabetes Association (ADA). We also provide health education lectures and workshops, and respond to media inquiries to share expertise about diabetes and nutrition. - Research: Research is embedded in departments and strategies across Park Nicollet to support quality initiatives and the patient experience. Research encompasses investigator-initiated studies, clinical trials, practice-based research, outcomes and quality improvement projects, data analytics, statistics, survey development and focus groups. At Park Nicollet and its affiliates, more than 500 research studies are active each year. Park Nicollet Institute provides the infrastructure and resources to support research and clinical quality goals of the organization, which includes the following:- Needs assessment and feasibility- Mentoring and training- Scientific and humans subjects review- Regulatory compliance and reporting- Grant management, including application preparation and submission, contract and agreement negotiation, finance, budget development, identification of funding sources- Protocol development and research design- Manuscript and poster/presentation preparation- Database development, data cleaning, statistics and analytics, survey review and design, focus group facilitation- Study operations support including recruitment, consenting, enrolling, data collection/entry- Patient Education:Park Nicollet Institute's Patient Education department provides educational tools to support patients in preventing and managing illness and improving health. We work closely with clinicians to create programs, classes, videos, web content and decision support tools to help patients take an active role in their health. These resources help patients prevent and manage common health problems, live well with chronic conditions, prepare for procedures and improve overall health and well-being. Our Park Nicollet Health Library provides resources and services for patients, family and the community. This includes literature searches and document delivery, as well as access to print, online and Internet resoures. - Professional Education:The Institute's Professional Education department provides learning activities to enhance physician knowledge, competence and performance. Continuing medical education (CME) staff partners with Park Nicollet physicians and departments to manage a comprehensive educational program through activities designed to meet individual and department needs.
	Part Vi, Line 6:	Park Nicollet Methodist Hospital is part of Park Nicollet Health Services, an integrated health system. Other affiliates include 1) Park Nicollet Clinics in 19 locations, and other care locations, 2) Park Nicollet Foundation, the philanthropic arm of Park Nicollet Health Services helping to bring resources to needs in its communities, 3) Park Nicollet Institute, focused on education and research for Park Nicollet Health Services and its community, 4)Park Nicollet Health Care Products, providing retail pharmacy and health related products through existing Park Nicollet locations.All affiliates are under a common Board of Directors. Park Nicollet Foundation has a separate board which is overseen by the Park Nicollet Health Services Board. The communities' health needs are shared among the affiliates and decisions regarding the effective use of resources to respond to these needs are coordinated.A specific example of this coordination of services to respond to community need is with the four school-affiliated community clinics. Initial development, funding and ongoing facilitation is provided by the Park Nicolet Foundation, staffing through the Park Nicollet Clinics, laboratory and other diagnostic services through Park Nicollet Methodist Hospital, and outpatient medications, eye glasses, and DME supplies through Park Nicollet Health Care Products.
	Part VI, Line 7: List of States Receiving Community Benefit Report:	MN

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
Park Nicollet Group Return

Employer identification number
45-5023260

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) Park Nicollet Foundation6500 Excelisior Blvd St Louis Park,MN55416	23-7346465	501(c)(3)	117,777	Community Services
(2) Minnesota Medical Foundation200 Oak Street SE Suite 300 Minneapolis,MN55455	41-6027707	501(c)(3)	50,000	Neurosurgery Fund

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2011

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant
(1) Individual scholarships	19	18,500
(2) Earl Young Award	1	599

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
Procedure for Monitoring Grants in the U.S.:	Part I, Line 2:	Schedule I, Part I, Line 2: The Park Nicollet Service League has a student volunteer scholarship program to give financial support to student volunteers who have provided exceptional volunteer service and are interested in furthering their education. Applicants must be an active student volunteer, a senior in high school and who has applied to a post-high school education program and must be dedicated volunteer at Park Nicollet Methodist Hospital. Occasionally Park Nicollet Methodist Hospital grants monies to other tax-exempt organizations conducting programs and/or research that will ultimately benefit those served by Park Nicollet Health Services and affiliates. During calendar year 2011, grants were made to Park Nicollet Foundation and Park Nicollet Institute for improvements to medical services and medical research. These grants were made to parties related to Park Nicollet Methodist Hospital, so employees of Park Nicollet Methodist Hospital were able to verify the use of the monies contributed.

Schedule I (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) David Abelson MD	(i) (ii)	0 650,840	0 294,551	0 92,336	0 148,500	0 56,177	0 1,242,404	0 70,698
(2) Steven Connelly MD	(i) (ii)	0 431,266	0 163,086	0 11,101	0 52,265	0 48,971	0 706,689	0 0
(3) Michael Kaupa	(i) (ii)	0 429,776	0 224,172	0 58,674	0 68,879	0 71,581	0 853,082	0 47,105
(4) Sheila McMillan	(i) (ii)	0 388,862	0 54,982	0 12,147	0 48,000	0 45,913	0 549,904	0 0
(5) Paul Dominski	(i) (ii)	0 328,596	0 180,560	0 39,272	0 25,175	0 116,759	0 690,362	0 0
(6) Roxanna Gapstur PhD	(i) (ii)	0 221,227	0 0	0 7,325	0 20,250	0 47,217	0 296,019	0 0
(7) Christa Getchell	(i) (ii)	0 172,981	0 0	0 8,672	0 13,125	0 8,371	0 203,149	0 0
(8) David Homans MD	(i) (ii)	0 485,365	0 6,392	0 10,676	0 40,441	0 37,578	0 580,452	0 0
(9) Jeffrey B Husband MD	(i) (ii)	526,839 0	24,249 0	8,633 0	0 0	47,479 0	607,200 0	0 0
(10) Tom Jones MD	(i) (ii)	630,325 0	31,491 0	34,376 0	0 0	30,136 0	726,328 0	0 0
(11) Charles McCoy MD	(i) (ii)	182,907 0	8,046 0	4,640 0	0 0	26,937 0	222,530 0	0 0
(12) William Richards MD	(i) (ii)	201,183 0	8,992 0	75,773 0	0 0	29,327 0	315,275 0	0 0
(13) Janet Schaffer MD	(i) (ii)	328,864 0	9,022 0	10,948 0	0 0	44,421 0	393,255 0	0 0
(14) Eric Schned MD	(i) (ii)	295,500 0	14,041 0	48,987 0	0 0	40,282 0	398,810 0	0 0
(15) Janette Strathy MD	(i) (ii)	242,907 0	6,920 0	34,052 0	0 0	33,474 0	317,353 0	0 0
(16) Mark Wilkowske MD	(i) (ii)	473,344 0	32,868 0	8,980 0	0 0	46,833 0	562,025 0	0 0
(17) Susan Zwaschka	(i) (ii)	0 117,360	0 99,929	0 339,169	0 5,561	0 34,369	0 596,388	0 47,651
(18) Mary Johnson	(i) (ii)	0 161,192	0 105,629	0 43,317	0 0	0 20,473	0 330,611	0 32,193
(19) Theodore Wegleitner	(i) (ii)	0 247,202	0 59,584	0 27,034	0 4,810	0 49,990	0 388,620	0 16,976
(20) Dane Christensen MD	(i) (ii)	769,804 0	43,096 0	1,075 0	0 0	51,166 0	865,141 0	0 0
(21) Timothy Diegel MD	(i) (ii)	627,296 0	33,320 0	406,910 0	0 0	67,063 0	1,134,589 0	0 0
(22) Darin Epstein MD	(i) (ii)	878,782 0	36,706 0	1,065 0	0 0	52,653 0	969,206 0	0 0
(23) Steven Rakes MD	(i) (ii)	784,627 0	38,811 0	4,308 0	0 0	51,365 0	879,111 0	0 0
(24) Anton Willerscheidt MD	(i) (ii)	768,324 0	34,143 0	4,285 0	0 0	67,561 0	874,313 0	0 0
(25) Kathryn D Kallas	(i) (ii)	0 68,383	0 125,336	0 287,904	0 29,713	0 29,347	0 540,683	0 30,600

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
	Part I, Lines 4a-b	During 2011, Park Nicollet Health Services, a related entity, terminated without cause the employment of individuals in reportable positions. Severance payments were determined to be payable under the Park Nicollet Health Services Executive Management Group Severance Policy (the "Policy"). The policy provides that if Park Nicollet Health Services terminates a covered individual without cause, and if the individual releases all legal claims against Park Nicollet Health Services, then Park Nicollet Health Services will provide the terminated individual severance compensation for a period of one year including salary, health, life, dental and disability benefits, as well as deferred compensation, incentive compensation, and pension plan payments. Based on the foregoing, the amount of severance compensation and benefits provided to each of the individual on severance during 2011 is as follows: - Kathryn D. Kallas, $255,000 - Susan R. Zwaschka, $240,000 Part I, Line 4B: Senior leaders of Park Nicollet Health Services and affiliates are given the opportunity to participate in the Capital Accumulation Account Plan. The Capital Accumulation Account Plan (CAA Plan) participation is limited to senior leaders and all the vice presidents. Each participant receives an annual allowance equal to the sum of (i) a stated percent of salary, (ii) voluntary salary deferrals. The allowance is credited to a bookkeeping account. Earnings are credited to the account based on the performance of simulated investments. Benefits vest upon the earliest of remaining employed to an elective vesting date (two years to age 68), involuntary termination without cause, disability, death, or not competing for 24 months following voluntary or for-cause termination. Benefits are paid in a single lump sum upon vesting. Participants are general creditors of the employer for the payment of the benefits. The following participants received payouts from a related organization, Park Nicollet Health Services, related to CAA plan: - David Abelson, $70,698 - Mary Johnson $32,193 - Kathryn D. Kallas, $30,600 - Michael Kaupa, $47,105 - Theodore Wegleitner, $16,976 - Susan R. Zwaschka, $47,651
	Part I, Line 7	All physicians, employed by and seeing patients for Park Nicollet Health Services and affiliates, are eligible for a 3% access incentive payout based on their department reaching certain goals including access for patients and quality initiatives. In their roles as executives employed by Park Nicollet Health Services, the executives are eligible for incentive payouts. The incentive award will be 35% of base pay compensation for the CEO, 30% for the CFO, COO, CMO and 25% for all other executives with an opportunity for incentive credit above the target level. The ultimate payout includes a reduction/increase multiplier depending on whether the consolidated Park Nicollet Health Services organization reached that year's operating margin goal as set by the Board of Directors. Each participant will be responsible for two financial goals, and not less than three and not more than five individual strategic objectives. In their roles as management employed by Park Nicollet Health Services, certain managers are eligible for incentive payouts. The incentive award will be 15% of their annual base pay compensation with an opportunity for incentive credit above the target level. The ultimate payout includes a reduction/increase multiplier depending on whether the consolidated Park Nicollet Health Services organization reached that year's operating margin goal as set by the Board of Directors. Incentive payments are a function of both individual and organizational performance. The participant must be assigned at least three, and not more than four focused incentive objective, one of which must be financial in nature.

Schedule J (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Shannon Neale MD	William Richards, MD Family Member	178,230	Employment: Shannon Neale is a Medical Doctor employed by Park Nicollet Clinic.	Yes
(2) RJM Construction	James Pohlad: owner	5,641,005	Construction: RJM Construction performed construction services for Park Nicollet Clinic.		No
(3) Gregg Strathy MD	Jannette Strathy, MD: Family Member	233,975	Employment: Gregg Strathy, MD is a Medical Doctor employed by Park Nicollet Clinic.	Yes

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Identifier	Return Reference	Explanation
List of Subordinate Organizations: Names, Addresses and EINs	Page 1, Line H(a):	Park Nicollet Methodist Hospital 41-0132080 6500 Excelsior Blvd, St. Louis Park, MN 55426 Park Nicollet Institute 41-0961862 3800 Park Nicollet Blvd St. Louis Park, MN 55416 Park Nicollet Health Care Products 01-0638901 3800 Park Nicollet Blvd St. Louis Park, MN 55416 Park Nicollet Clinic 41-0834920 3800 Park Nicollet Blvd St. Louis Park, MN 55416 PNMC Holdings 41-1741792 3800 Park Nicollet Blvd St. Louis Park, MN 55416
	Form 990, Part IV, Line 24A:	Park Nicollet Health Services, along with related organizations, is jointly liable for the tax exempt bonds held by Park Nicollet Health Services under a master trust agreement. The members of the jointly liable group, which is collectively referred to as the "Obligated Group", include Park Nicollet Clinic, Park Nicollet Methodist Hospital, PNMC Holdings, Park Nicollet Institute, and Park Nicollet Health Care Products. In accordance with reporting requirements for Schedule K, all outstanding tax exempt bonds are reported solely on the Schedule K of Park Nicollet Health Services. Part V, Line 3a: Park Nicollet Health Care Products has unrelated business gross income over $1,000.
	Form 990, Part VI, Section A, line 2	Park Nicollet Health Services and its related entities have a common board. The following officers, Board Members and key employees are employees of and paid by Park Nicollet Health Services or its related organizations. These employees serve together on the common board which serves Park Nicollet Health Services and its related entities. David Abelson, MD Steven Connelly, MD Paul Dominski Roxanna Gapstur, PhD Christa Getchell David Homans, MD Jeffrey B, Husband, MD Tom Jones, MD Michael Kaupa Charles McCoy, MD Sheila McMillan William Richards, MD Janet Schaffer, MD Janette Strathy, MD Katherine Tarvestad Mark Wilkowske, MD Susan Zwaschka
	Form 990, Part VI, Section A, line 6	Park Nicollet Health Services is the sole member of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute and Park Nicollet Health Care Products. Park Nicollet Clinic is the sole member of PNMC Holdings.
	Form 990, Part VI, Section A, line 7a	The Board of Directors of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products are those individuals who are contemporaneously members of the Board of Directors of Park Nicollet Health Services.
	Form 990, Part VI, Section A, line 7b	All decisions, including dissolution of the organization, made by the governing body of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products are subject to the approval of the Board of Directors of Park Nicollet Health Services. However, the Board of Directors of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products are those individuals who are contemporaneously members of the Board of Directors of Park Nicollet Health Services.
	Form 990, Part VI, Section B, line 11	The Form 990 filed on behalf of the subordinate organizations (Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products) is prepared within the finance department at Park Nicollet Health Services with assistance from individuals in human resources, marketing, and operations. Upon completion of gathering the necessary information for the return, the form was compiled by the Park Nicollet accounting firm. Drafts of the form were reviewed by the Assistant Controller - Accounting Operations, Vice President of Finance, Chief Financial Officer, and the Audit and Compliance Committee. After all internal reviews were complete; the final version of the Form 990 was given to each member of the Board of Directors for approval prior to filing the return.
	Form 990, Part VI, Section B, line 12c	At Park Nicollet Health Services all key employees, directors, and officers are asked to complete a conflict of interest disclosure statement each year; however the obligation to report conflicts is ongoing. The Governance Committee, which meets five times per year, reviews all potential conflict disclosures and discusses the impact on the organization. If a potential conflict arises during the year, it is disclosed and reviewed by the Governance Committee. The Governance Committee presents the disclosure information and makes recommendations to the Board of Directors regarding management of any conflicts identified. When a transaction involving a potential conflict of interest is identified, the Board of Directors may appoint a disinterested individual or committee to review that conflict and ensure discussions related to those transactions can occur separately from those individuals with potential conflicts. All significant transactions include an analysis of fair market value.
	Form 990, Part VI, Section B, line 15	The Board of Directors of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products are those individuals who are contemporaneously members of the Board of Directors of Park Nicollet Health Services. The Park Nicollet Health Services' Board of Directors is responsible for the implementation and oversight of executive compensation and benefit plans for Park Nicollet. Park Nicollet uses an outside consultant to provide yearly market based indexes of salary adjustments for executives in similar leadership positions. The Board of Directors reviews the salary ranges and recommends salary increases for each executive, including the CEO, based upon the Board of Directors' evaluation of job performance and experience level of the individual within the organization. The average salary increases for all Park Nicollet executives cannot exceed the average market salary increase reported for executives by the consultant. The compensation committee then reviews and approves compensation adjustments based on the information provided by the outside consultants and the Board of Directors' recommendations. For certain physicians, the majority of pay disclosed is for his/her work as a physician for Park Nicollet. A small stipend is added for serving on the Board of Directors. The following is a description of how pay for physicians' patient care work is determined. The Park Nicollet Health Services' Board of Directors is responsible for the implementation and oversight of the physician compensation and benefit plans for Park Nicollet. The Board of Directors delegates the day-to-day administration of the physician compensation plan to the Clinical Board of Governors and the Physician Compensation and Benefits Subcommittee. The purpose of the Physician Compensation and Benefits Subcommittee is to oversee physician and other clinician compensation and benefits plans and administration within the budget to ensure fairness and alignment with Park Nicollet Health Services' goals. The responsibilities of this committee include: Recommending of compensation policies and plan designs for physicians to the clinical board and Board of Directors; Overseeing compensation plan operation and payments to clinical departments; Evaluating compensation plan for performance on a periodic basis; Serving as final appeal process for issues unresolved by individuals, department chairs and chiefs of services. Annually, information on each physician's pay and productivity is graphed against the survey results for the same year. This information is presented to the compensation committee of the Park Nicollet Health Services Board of Directors for review. Park Nicollet Health Services' physician pay program is designed to ensure market based pay for market based productivity standards. The market is determined by the American Medical Group Association (AMGA) national physician compensation survey data, which provides market data for both compensation and productivity. When appropriate, the Clinic Compensation and Benefit Subcommittee grants adjustments to these guidelines with evidence of local market data.
	Form 990, Part VI, Section C, line 19	Park Nicollet Group members' governing documents, conflict of interest policy and financial statements are available to the public upon request. Park Nicollet Health Services, as the parent organization of the Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products, mails its consolidated audited financial statements to financial institutions, governmental institutions, board members, media representatives, vendors, and the Minnesota Hospital Association (MHA). Park Nicollet Health Services discloses quarterly consolidated financial statements to bondholders and MHA. The annual consolidated audited and quarterly financial statements are also posted at emma.msrb.org. The Forms 990 are available upon request or from the state of Minnesota or at Guidestar.org. Form 990, Part VII: Certain board members for Park Nicollet Group also provide services as employees to Park Nicollet Health Services and its subsidiaries. Hours worked are estimates and are not tracked on an entity by entity basis. Therefore, these officers, directors, and key employees' hours reported on Form 990, Part VII represent aggregate hours worked per week for all Park Nicollet Health Services entities. Community board members hours reported on Form 990, Part VII are an estimate and are not tracked on an entity by entity basis. Therefore, these directors hours reported on Form 990, Part VII represent aggregate hours of service provided per week for all Park Nicollet Health Services entities.
Changes in Net Assets or Fund Balances:	Form 990, Part XI, line 5:	Net unrealized losses on investments: -10,858,332. Net Assets Released from Restrictions -70,447. Total to Form 990, Part XI, Line 5: -10,928,779.
	Form 990, Part XII, Line 2C:	Neither the oversight process for the audit nor the auditor selection process for Park Nicollet Health Services and affiliates' financial statements have changed during the tax year.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) Park Nicollet Health Services 6500 Excelsior Blvd St Louis Park,MN55426 36-3465840	Health Care Adminstration	MN	501(c)(3)	11 Type III			No
(2) Park Nicollet Foundation 6500 Excelsior Blvd St Louis Park,MN55426 23-7346465	Grants to Serve the Community	MN	501(c)(3)	7	Park Nicollet Health Services	Yes
(3) TRIA Orthopaedic Center Research Institute 8100 Northland Drive Bloomington,MN55431 20-0033919	Health Care Research and Education	MN	501(c)(3)	11 Type I	Park Nicollet Health Services	Yes

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Methodist Brain Lab Leasing LLC 6500 Excelsior Blvd St Louis Park,MN55426 20-8725994	Health Care	MN	Park Nicollet Methodist Hospital	Related	290,552	70,370		No		Yes		60.000 %
(2) Park Nicollet Health Services Investment Partnership 6500 Excelsior Blvd St Louis Park,MN55426 41-1675033	Investment	MN	Park Nicollet Methodist Hospital	Investment	16,428,822			No		Yes		92.500 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)
(1) Park Nicollet Enterprises 6500 Excelsior Blvd St Louis Park,MN55426 41-1656735	Real Estate for Related Organization	MN	Park Nicollet Health Services	C

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) Park Nicollet Enterprises	K	166,577	Cost
(2) Park Nicollet Health Services	K	1,916,325	Cost
(3) Park Nicollet Health Services	P	20,769,628	Cost
(4) Park Nicollet Health Services	R	23,335,177	Cost
(5) Park Nicollet Health Services	Q	94,955	Cost
(6) Methodist Brain Lab Leasing LLC	J	800,854	Cost
(7) Methodist Brain Lab Leasing LLC	R	804,472	Cost
(8) Park Nicollet Foundation	C	2,149,214	Cost
(9) Park Nicollet Foundation	B	117,777	Cost
(10) TRIA Orthopaedic Research Institute	N	212,021	Cost

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Cares for and supports the health, healing, and learning of those served.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	24
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	11
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	0
6	Total number of volunteers (estimate if necessary) ....	6	1,087
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	4,032,986
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-729,543

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	18,790,749	14,391,919
9	Program service revenue (Part VIII, line 2g) .........	1,165,706,743	1,141,830,201
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	7,046,714	17,727,333
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	6,447,050	6,353,193
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	1,197,991,256	1,180,302,646
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	5,939,785	186,876
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	601,848,526	611,537,104
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 560,866
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	550,000,008	544,022,710
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,157,788,319	1,155,746,690
19	Revenue less expenses. Subtract line 18 from line 12.......	40,202,937	24,555,956
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	929,740,783	925,315,895
21	Total liabilities (Part X, line 26).............	505,633,819	487,581,753
22	Net assets or fund balances. Subtract line 21 from line 20.....	424,106,964	437,734,142

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 893,535,110 including grants of $ 186,876 ) (Revenue $ 1,048,037,604 )
	Park Nicollet Health Services is the parent organization to an integrated care system that includes Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Health Care Products, Park Nicollet Institute and PNMC Holdings. Park Nicollet Health Services and affiliates have more than 8,100 team members, including more than 1,000 physicians on staff. Park Nicollet Health Services is a nonprofit system staffed by nationally recognized doctors, clinical professionals, nurses and other team members who help patients stay healthy and take care of them when they are sick.In 2011, Park Nicollet Health Services and affiliates, a national health care improvement leader, continued to make dramatic patient care advances, win prominent awards, expand access to services and integrate efficiency into Park Nicollet Health Services' operations. Park Nicollet Health Services and affiliates also have enhanced community health, increased team member satisfaction and promoted research and education. Park Nicollet Health Services mission is to care for and support the health, healing and learning of those served. Park Nicollet Health Services uses five core values to accomplish its mission: care, service, stewardship, joy and learning. Highlights of 2011 that support Park Nicollet Health Service's values include the following: - Park Nicollet opened Park Nicollet Clinic-Lakeville on Aug. 22 near the intersection of 185th Street and I-35W. The clinic opened with 25 team members, including four physicians. It offers family medicine, pediatrics and extended hours. - Park Nicollet Melrose Institute expanded its eating disorders care to Park Nicollet Clinic-Burnsville in October after the number of Melrose patient from Dakota County doubled over a three-year period. - Melrose Institute added a metabolic health and weight management program to its eating disorders treatment offerings. - Park Nicollet International Diabetes Center (IDC) began working with Mayo Clinic to develop a clinical diabetes training program for Chinese physicians after signing a $3.9 million contract with the China Ministry of Health. This is a five-year initiative to train 500 emerging expert physicians in China regarding advances in diabetes research, care and education. - With a $1.5 million grant awarded by the Leona M. and Harry B. Helmsley Charitable Trust, IDC worked to further standardize glucose analysis to improve type 1 diabetes clinical outcomes. - Park Nicollet Frauenshuh Cancer Center (FCC) became the first program in Minnesota to be certified as a Quality Oncology Practice Initiative. - In February, the 1,700 United Health Group employees who work at UHG's Minnetonka headquarters began using The Well, a new work-site clinic staffed by Park Nicollet clinicians and Optum Health wellness providers. - Launched Head + Heart, Together internal culture that combines intellect and the science of medicine with the compassion, spirit and humanity of Park Nicollet team members. The launch included team vision meetings, rollout of HHT competencies, a new appraisal system and HHT magazine for team members. - Park Nicollet completed its electronic medical record (EMR) transition from Last Word to Epic in early July. This was the culmination of three years of planning and implementations. The EPIC Command Center received more than 13,000 calls between July 2 and 18, and 130 people were working in the center when Epic went live on July 5. As part of the transition to Epic, Park Nicollet launched My Chart service, so patients can access portions of their EMR at mychart.parknicollet.com. - Park Nicollet began conducting patient surveys at all locations as part of our effort to continually improve our Patient and Family Experience. Results will be tied to team member surveys. - For the third consecutive year, Park Nicollet achieved 100 percent of its quality goals as part of its participation in the Physicians Group Practice (PGP) Demonstration, Medicare's first physician pay-for-performance initiative at the group practice level. Park Nicollet's 2011 federal PGP bonus payment was nearly $5.7 million. - Park Nicollet is one of 32 health systems to receive Accountable Care Organization (ACO) status from the Centers for Medicare & Medicaid Services (CMS). Through the Pioneer ACO Model, Park Nicollet is working with CMS to test new payment models in order to provide Medicare beneficiaries with higher quality care while reducing growth in Medicare expenditures through enhanced care coordination.We are gratified that many of our clinical and cost-saving achievements were recognized by respected third-party organizations. These honors and recognition included: - Park Nicollet received 2011 HealthGrades recognition that included: * Distinguished Hospital Award for Patient Safety * Cardiac Excellence Award * Stroke Care Excellence Award * Critical Care Excellence Award * Pulmonary Care Excellence Award * Gastrointestinal Medical Treatment Excellence Award * Women's Health Excellence Award * Innovation in Health Care Award - Park Nicollet's Leigh Myers-Higgins, RN, received the Good Catch for Patient Safety Award from the Minnesota Hospital Association. - Methodist Hospital's vascular laboratory was the only one in the Twin Cities to receive accreditation in four major testing areas from the Intersocietal Commission for the Accreditation of Vascular Labs. - Thomson Reuters named Methodist Hospital as one of its 50 Top Cardiovascular Hospitals. - Park Nicollet was named a Leader in Lesbian, Gay, Bi-sexual and Transgender (LGBT) Equality by the Human Rights Campaign Foundation, which publishes the annual Healthcare Equality Index report. The index focuses on policies and practices that help create a welcoming environment for LGBT patients and families. - 2011 Nurse of Excellence Award recipients were: Angel Larson, RN; Carrie Wickland, LPN; Kelly Albers, RN; Mary Jo Macklem, RN; Laura Nicklay, RN; Kris Smith, RN; and Vicki Norton, RN. - Joel Jahrus, MD, Medical Director of the Melrose Institute, received the Ellis Island Medal of Honor, which recognizes leadership dedicated to community service and a commitment to teaching and improving the health and well-being of others. Past recipients include former presidents Bill Clinton, George H. Bush and Gerald Ford. - FCC received the Commission on Cancer Outstanding Achievement Award. - IDC was selected as one of the top 25 medical organizations to participate in the Type 1 Diabetes Exchange.

4b	(Code: ) (Expenses $ 60,467,729 including grants of $ ) (Revenue $ 60,911,521 )
	Park Nicollet Health Care Products is part of Park Nicollet Health Services, a nonprofit integrated care delivery system, staffed by nationally recognized hospital and clinic doctors, clinical professionals, nurses, researchers and other staff at Park Nicollet Methodist Hospital and Park Nicollet Clinic who help patients stay healthy and take care of patients when they are sick. Park Nicollet Health Care Products is a supporting organization to Park Nicollet Methodist Hospital and Park Nicollet Clinic, providing durable medical equipment (DME)/supplies and pharmaceuticals supporting ongoing patient care. Park Nicollet Health Care Products focus on the health, healing and learning of patients by providing easy access to products and services that support successful self-management of a health condition at home. The products support both short term acute conditions and chronic lifelong conditions, such as eyewear, hearing aids, and many products that cross into almost every medical subspecialty. The Pharmacy @ Park Nicollet, meets growing demand for self-care products and services. The Pharmacies are at these Park Nicollet Clinic locations: Bloomington, Brookdale, Burnsville, Carlson Parkway (Minnetonka), Chanhassen, Eagan, Maple Grove, Minneapolis, St. Louis Park, and Wayzata as well as the Heart and Vascular Center and Meadowbrook at the Park Nicollet Methodist Hospital.The patient care experience does not end at the hospital or clinic door. Patients have many self-care needs to manage both their acute and chronic health conditions, and Park Nicollet Health Care Products is expanding its capacity to better serve these growing needs. Major accomplishments for The Pharmacy @ Park Nicollet in 2011 include: - Enhanced product and pharmaceutical assortments available for patients, especially patients living with chronic health conditions such as diabetes, cancer, and bone and joint disease. - Educated physicians and care provider's about Pharmacy services and products to better link solutions for patient health care needs, including smoking cessation. - Developed standard work around provider referrals to Park Nicollet Pharmacies, assuring that patients have the products needed as they go home from clinic or hospital. - Continue to provide customer service and sales training to all store staff and management. - Expanded Pharmacy MTM, (Medication Therapy Management) services directly into the care environment to assist both providers and patients alike. - Update e-commerce Web site for Pharmacy @ Park Nicollet to make it easier for providers and patients to locate and purchase health care products. - Worked with staff to ensure their job satisfaction and self worth so that they can, in turn, share their positive attitude with clinical team members and customers. - Enhanced the focus on customer satisfaction scores to reinforce best practices and provide superior service. - Enhanced tracking systems to measure and monitor customer success of sales strategies. - Ensured all Pharmacy staff attended learning events to achieve their continuing education requirements. - Attended major trade shows to keep current with pharmacy assortment and billing information. - Held meetings and educational sessions for Pharmacy staff to learn the complexities of billing 3rd party payers to ensure compliance and accuracy of claims submission.The Contact Lens and Optical Store @ Park Nicollet Health Care Products, which meet growing demand for self-care products and services, are at these Park Nicollet Clinic sites: Bloomington, Brookdale, Burnsville, Carlson Parkway (Minnetonka), Chanhassen, Maple Grove, Minneapolis, Shakopee, and St. Louis Park. The patient care experience does not end at the hospital or clinic door. Patients have many self-care needs to manage both their acute and chronic health conditions, and Park Nicollet Health Care Products is expanding its capacity to better serve these growing needs. Major accomplishments for The Contact Lens and Optical Store @ Park Nicollet in 2011 include: - Enhanced optical product assortments available for patients, especially patients living with chronic health conditions affecting their vision. - Enhanced the optical benefit program offered to PN employees to increase the affordability of eyewear.Park Nicollet Health Care Products, branded as The Stores @ Park Nicollet, is a group of departments within Park Nicollet Health Services providing durable medical equipment (DME)/supplies and pharmaceuticals, supporting ongoing patient care. HCP partners with your clinician to provide products and services to help you live more comfortably.The Health and Care Stores, which meet a growing demand for self-care products and services, located within Park Nicollet Clinics, include: Health & Care Store offering DME products at 4 locations, Hearing Center & Store with 3 locations, CPAP clinic/Store with 2 locations and Breastfeeding Center, (1 location within the Meadowbrook Health & Care store).The Health & Care Stores are at these Park Nicollet Clinic sites: Burnsville, St. Louis Park, as well as the Heart and Vascular Center and Meadowbrook at the Park Nicollet Methodist Hospital.The patient care experience does not end at the hospital or clinic door. Patients have many self-care needs to manage both their acute and chronic health conditions, and Park Nicollet Health Care Products is expanding its capacity to better serve these growing needs. Major accomplishments for The Health & Care Stores in 2011 include: - Enhanced product assortments available for patients, especially patients living with chronic health conditions. - Educated physicians and care provider's about Health Care Stores product offerings to better link patient health care needs to product solutions, including smoking cessation. - Developed standard work for provider referrals to Health Care stores, assuring that patients have the products needed as they go home from clinic or hospital. - Continued customer service and sales training to all store staff and management. - Expanded point of care operation and specialty stores to help bring more products directly into the care environment to assist both providers and patients alike.

4c	(Code: ) (Expenses $ 39,057,879 including grants of $ ) (Revenue $ 32,881,076 )
	Members of the Park Nicollet Group incur expenses on behalf of the affiliated tax exempt organizations, (Park Nicollet Health Services, Park Nicollet Clinic, Park Nicollet Health Care Products, Park Nicollet Methodist Hospital, PNMC Holdings, and Park Nicollet Institute.) These organizations provide rental space, employment and management services in order to assure the efficient and professional delivery of health care to the community.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 993,060,718

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	7,676,439	5,995,688	1,629,397

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		2,149,214
e	Government grants (contributions)1e		3,983,539

f	All other contributions, gifts, grants, and similar amounts not included above1f		8,259,166
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			14,391,919
			Business Code
2a	Medical Services		621,400	733,475,025	732,582,199		892,826
b	Medicare/Medicaid		621,400	310,225,584	310,225,584
c	Retail Sales		446,110	60,911,521	56,843,848	4,032,986	34,687
d	Services to Affilates		561,000	32,881,076	32,881,076
e	Research		541,700	4,336,995	4,336,995
f	All other program service revenue .
g	Total. Add lines 2a–2f........			1,141,830,201
3	Investment income (including dividends, interest
	and other similar amounts).....			6,125,159			6,125,159
4	Income from investment of tax-exempt bond proceeds..			364,955			364,955
5	Royalties............			5,811			5,811
		(i) Real	(ii) Personal
6a	Gross rents	1,980,491
b	Less: rental expenses	1,495,573
c	Rental income or (loss)	484,918
d	Net rental income or (loss).......			484,918			484,918
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	252,573,248	1,762,777
b	Less: cost or other basis and sales expenses	242,103,996	994,810
c	Gain or (loss)	10,469,252	767,967
d	Net gain or (loss)..........			11,237,219			11,237,219
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a		1,494,243
b	Less: cost of goods sold ..b		532,481
c	Net income or (loss) from sales of inventory..			961,762			961,762
Miscellaneous Revenue			Business Code
11a	Cafeteria		722,210	2,439,519			2,439,519
b	Property Management		812,930	2,271,308			2,271,308
c	Misc Services		900,099	189,875			189,875
d	All other revenue ....
e	Total. Add lines 11a–11d ......			4,900,702
12	Total revenue. See Instructions....			1,180,302,646	1,136,869,702	4,032,986	25,008,039


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			602,996	1	830,871
2	Savings and temporary cash investments .......			192,677	2	282,705
3	Pledges and grants receivable, net .........			1,972,690	3	3,414,212
4	Accounts receivable, net .........			112,572,899	4	135,003,069
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			11,219,361	8	10,046,399
9	Prepaid expenses and deferred charges ............			8,249,643	9	11,936,459
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	954,957,878
b	Less: accumulated depreciation. .....	10b	613,787,542	358,091,019	10c	341,170,336
11	Investments—publicly traded securities ..........				11	386,672,271
12	Investments—other securities. See Part IV, line 11 ......			394,731,187	12	28,139,728
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			42,108,311	15	7,819,845
16	Total assets. Add lines 1 through 15 (must equal line 34)...			929,740,783	16	925,315,895
17	Accounts payable and accrued expenses .			93,815,825	17	82,424,257
18	Grants payable ..........				18
19	Deferred revenue ..........			6,191,231	19	11,939,650
20	Tax-exempt bond liabilities ..........			388,720,675	20	379,891,311
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			2,698,222	23	1,984,777
24	Unsecured notes and loans payable to unrelated third parties ....			4,132,852	24	1,930,180
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			10,075,014	25	9,411,578
26	Total liabilities. Add lines 17 through 25.....			505,633,819	26	487,581,753
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			422,917,533	27	436,481,051
28	Temporarily restricted net assets .....			914,699	28	976,854
29	Permanently restricted net assets .....			274,732	29	276,237
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			424,106,965	33	437,734,142
34	Total liabilities and net assets/fund balances .....			929,740,783	34	925,315,895

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................	Yes	No