Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
GCAS
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
200 FIRST STREET SW
 
Room/suite
City or town, state or country, and ZIP + 4
ROCHESTER, MN55905
D Employer identification number

41-1917517
E Telephone number

G Gross receipts $ 7,954,376
F Name and address of principal officer:
SCOTT A SEINOLA
200 FIRST STREET SW
ROCHESTER,MN55905
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.MAYOMEDICALTRANSPORT.COM
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1998
M State of legal domicile: MN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: AMBULANCE SERVICE
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 7
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 0
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 53
6 Total number of volunteers (estimate if necessary) .... 6 0
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 22,652 26,398
9 Program service revenue (Part VIII, line 2g) ......... 7,497,557 7,926,782
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 3,784 1,060
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 2,015 136
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 7,526,008 7,954,376
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 380 7,153,070
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 2,885,099 3,021,139
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 3,784,590 3,826,122
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 6,670,069 14,000,331
19 Revenue less expenses. Subtract line 18 from line 12....... 855,939 -6,045,955
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 7,272,140 0
21 Total liabilities (Part X, line 26)............. 1,226,186 0
22 Net assets or fund balances. Subtract line 21 from line 20..... 6,045,954 0
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: TO PROVIDE SUPERIOR PATIENT CARE, AT A REASONABLE COST IN A WAY THAT ENGAGES THE WHOLE TEAM, WORKING TOGETHER IN CLINICAL PRACTICE, EDUCATION AND RESEARCH.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 12,928,690 including grants of $ 7,153,070 ) (Revenue $ 7,926,918 )
PATIENT CARE - SEE SCHEDULE OGCAS (DULUTH, MN) OPERATES IN CONJUNCTION WITH GOLD CROSS AMBULANCE INC. (EAU CLAIRE, WI) AND GOLD CROSS AMBULANCE SERVICE (ROCHESTER, MN) TO FORM A MEDICAL TRANSPORTATION SERVICE REFERRED TO AS GOLD CROSS. THE ABOVE REFERENCED THREE GOLD CROSS LEGAL ENTITIES OPERATE AS "OUT-OF-HOSPITAL" CARE ORGANIZATIONS THAT PROVIDE MEDICAL CARE, COMPREHENSIVE MEDICAL TRANSPORTATION AND MEDICAL EDUCATION AND TRAINING TO GROUPS AND INDIVIDUALS IN THE COMMUNITIES THEY SERVE. THE CORE PURPOSE OF THE GOLD CROSS SERVICE IS PROVIDING CARE TO PEOPLE DURING THEIR TIME OF NEED RESULTING FROM ACCIDENTS AND MEDICAL EMERGENCIES. GOLD CROSS RESPONDS TO "911" CALLS IN EACH COMMUNITY SERVED WITHOUT ANY REGARD TO REIMBURSEMENT FOR SERVICES, INCLUDING THE ABILITY OF THE CALLING PARTY TO PAY FOR THE COSTS ASSOCIATED WITH THE SERVICE. GOLD CROSS PROVIDES BASIC LIFE SUPPORT, ADVANCED LIFE SUPPORT, AND CRITICAL CARE SERVICES. NATIONALLY REGISTERED PARAMEDICS AND EMT'S (EMERGENCY MEDICAL TECHNICIANS) STAFF GOLD CROSS AMBULANCES. THIS CERTIFICATION REPRESENTS THE HIGHEST LEVEL OF CERTIFICATION FOR OUT-OF-HOSPITAL EMERGENCY CARE PROVIDERS AVAILABLE AND EXCEEDS THE AMBULANCE SERVICE STANDARDS REQUIRED BY MINNESOTA AND WISCONSIN LAW. THE AMBULANCE SERVICE UTILIZES DISPATCHING SERVICES PROVIDED BY A SOPHISTICATED COMPUTER AIDED DISPATCH SYSTEM HOUSED IN OUR CENTRALIZED EMERGENCY COMMUNICATIONS CENTER (ECC) IN ROCHESTER, MN, WHICH IS LOCATED IN AND OPERATED BY MAYO CLINIC - SAINT MARYS HOSPITAL, A RELATED EXEMPT MAYO ENTITY. THE ECC ENABLES AREA-WIDE DIGITAL PAGING, PROVIDES PRE-ARRIVAL MEDICAL INSTRUCTIONS TO CALLERS, AND ENSURES TIMELY AND EFFICIENT DISPATCH FOR ALL GOLD CROSS UNITS. WHEN PATIENT CARE REQUIRES IT, GOLD CROSS TEAMS UP WITH SPECIALLY TRAINED STAFF, INCLUDING REGISTERED NURSES FROM REGIONAL MEDICAL HELICOPTER PROGRAMS TO PROVIDE A HIGHER LEVEL OF CARE FOR THE PATIENT, CRITICAL CARE. THE STANDARDIZATION OF PATIENT CARE, SERVICES AND SUPPLIES ACROSS THE SYSTEM AND THE INTEGRATION OF GROUND AND AIR RESPONSE THROUGH A CENTRALIZED EMERGENCY COMMUNICATIONS CENTER HAS ENABLED GOLD CROSS TO PREPARE AN EFFICIENT PLAN OF ACTION FOR MULTIPLE INJURY INCIDENTS. IN ADDITION, GOLD CROSS FILLS A VARIETY OF PUBLIC SAFETY SERVICES IN EACH COMMUNITY SERVED. IN 2011, GOLD CROSS, AS AN INTEGRATED SYSTEM, PROVIDED MEDICAL TRANSPORTATION TO MORE THAN 49,937 PATIENTS, OFTEN INVOLVING COMPREHENSIVE MEDICAL CARE DURING TRANSPORTATION. OF THESE PATIENT TRANSPORTS, GCAS PROVIDED SERVICE TO APPROXIMATELY 11,969 OF THEM. IN ADDITION, GCAS RESPONDED TO OVER 3,000 EMERGENT REQUESTS FOR SERVICE THAT DID NOT RESULT IN THE TRANSPORTATION OF A PATIENT. THESE NO TRANSPORT REQUESTS CONSUME A SIGNIFICANT AMOUNT OF FINANCIAL RESOURCES, WITHOUT A MEANS OF BILLING FOR AND COLLECTING REVENUE, AS GCAS FULFILLS ONE OF ITS ROLES AS A PUBLIC SAFETY PROVIDER IN THE COMMUNITIES SERVED. OVER 80 OF THESE NO TRANSPORTS ARE SPECIFIC REQUESTS FOR US TO STANDBY AS OTHER PUBLIC SAFETY PROVIDERS CONDUCT THEIR NORMAL BUSINESS SUCH AS FIGHTING FIRES, DOING HIGH-RISK POLICE ENTRIES AND ACTIVITIES, ETC., WHICH CAN OFTEN CONSUME SEVERAL HOURS OF UNPAID SERVICE BY OUR CREWS FOR EACH STANDBY. IN ADDITION, GOLD CROSS SERVES THE NEEDS OF VETERANS THROUGH CONTRACTS FOR AMBULANCE SERVICE WITH THE VETERANS ADMINISTRATION IN ST. CLOUD, MINNESOTA AND SUPERIOR, WISCONSIN.GCAS PROVIDES CHARITY CARE FOR PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. SERVICES ARE ALSO PROVIDED TO PATIENTS COVERED BY MEDICARE, MEDICAID, AND OTHER GOVERNMENTAL PROGRAMS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. CHARITY CARE IS AN ADDITIONAL FINANCIAL STRAIN ON AMBULANCE SERVICES. A RECENT GAO STUDY ON MEDICARE REIMBURSEMENT INDICATED REIMBURSEMENT FALLS SHORT OF ACTUAL COSTS BY 6% IN URBAN AND RURAL AREAS AND 17% IN SUPER-RURAL AREAS. THE COST OF CHARITY CARE PROVIDED IN 2011 TOTALED APPROXIMATELY $13,000 AND THE COST OF UNCOMPENSATED CARE PROVIDED TO LOW INCOME PATIENTS THROUGH MEDICAID IN 2011 TOTALED APPROXIMATELY $422,000. THE COST OF UNCOMPENSATED CARE PROVIDED TO MEDICARE ELIGIBLE PATIENTS TOTALED APPROXIMATELY $770,000 IN 2011. IN ADDITION, IN 2011, GCAS PAID $60,000 TO MNCARE - A PROGRAM THAT PROVIDES HEALTHCARE TO BENEFIT ELIGIBLE MINNESOTA RESIDENTS.GOLD CROSS HAS BEEN DESIGNATED BY THE AMERICAN HEART ASSOCIATION (AHA) AS A COMMUNITY TRAINING CENTER (CTC) FOR THE AHA WHICH HAS ESTABLISHED GOLD CROSS AS A PROVIDER OF EMERGENCY CARDIAC CARE TRAINING AT VARIOUS PROFESSIONAL LEVELS FOR THE AHA. GOLD CROSS PROVIDES CUSTOMIZED EDUCATIONAL AND TRAINING PROGRAMS TO THE PUBLIC, MAYO CLINIC, MAYO FOUNDATION, OTHER ALLIED HEALTH CARE AGENCIES, AND PUBLIC SAFETY AGENCIES COVERING TOPICS SUCH AS BASIC EMERGENCY CARE, MEDICAL-LEGAL ISSUES, OSHA REQUIREMENTS, ENVIRONMENTAL EMERGENCIES AND OTHER COURSES SPECIFIC TO CUSTOMER NEEDS. THROUGHOUT 2011, OVER 30,000 PEOPLE WERE TRAINED THROUGH THE CTC OPERATED BY GOLD CROSS.GOLD CROSS DONATES TRAINING TIME TO A VARIETY OF CITIES, COUNTIES, FIRE DEPARTMENTS, EMERGENCY MEDICAL SERVICE AGENCIES, AS WELL AS THE GENERAL PUBLIC. GCAS HAS DEMONSTRATED THIS COMMITMENT BY SUPPORTING VARIOUS NON-PROFIT ORGANIZATIONS SUCH AS ARROWHEAD EMS ASSOCIATION, LAKEHEAD (MINNESOTA) MUTUAL AID ASSOCIATION, VACATIONLAND (WISCONSIN) FIRE ASSOCIATION, GRANDMA'S MARATHON, DULUTH AIRPORT DISASTER COMMITTEE, SUPERIOR FAMILY FUN FESTIVAL, LAKE SUPERIOR REGIONAL TRAUMA ADVISORY COUNCIL (LSRTAC), THE MN EMS REGULATORY BOARD DATA COLLECTION SUBCOMMITTEE, THE MN EMS REGULATORY BOARD PREHOSPITAL EDUCATION ADVISORY COMMITTEE, THE MN EMS REGULATORY BOARD MENTAL HEALTH TRANSFER TASK FORCE, AND THE AMERICAN HEART ASSOCIATION. APPROXIMATELY 2,400 HOURS OF EMPLOYEE TIME WAS PROVIDED FOR A VARIETY OF SAFETY-RELATED PROGRAMS TO VARIOUS COMMUNITIES, BUSINESSES, AND SCHOOLS. IN ADDITION, GCAS EMPLOYEES PARTICIPATED IN A LARGE NUMBER OF COMMUNITY EVENTS, SCHOOL CAREER FAIRS, STUDENT TOURS, BROWNIE TROOPS, CUB SCOUTS, BOY SCOUTS, VARIOUS PARADES, HEAD START EVENTS AND HEALTH FAIRS, AMONG OTHERS. THE ESTIMATED DOLLAR VALUE OF THESE EFFORTS AND OTHER DONATED SERVICES EXCEEDED $117,600.IN ROCHESTER, MN, GOLD CROSS IS PROUD TO HAVE ATTAINED THE NATION'S HIGHEST SURVIVAL RATE FOR OUT-OF-HOSPITAL VENTRICULAR FIBRILLATION CARDIAC ARREST VICTIMS. GOLD CROSS' RESEARCH DEMONSTRATED THE VALUE OF, AND HAS RESULTED IN NATIONWIDE EFFORTS TO PLACE AUTOMATIC DEFIBRILLATORS IN POLICE AND OTHER FIRST RESPONSE VEHICLES. AT THE END OF 2011, GOLD CROSS HAD 20 RESEARCH PROJECTS UNDERWAY, WHICH WILL HELP SHAPE CARE PROVIDED TO PATIENTS IN THE OUT-OF-HOSPITAL SETTING IN THE FUTURE. THESE RESEARCH PROJECTS INCLUDE PROJECTS RELATED TO CARDIAC PATIENTS, STROKE PATIENTS, AIRWAY MANAGEMENT TOOLS AND TECHNIQUES, DRIVER SAFETY, CREW CONFIGURATION AS RELATED TO PATIENT CARE, AND OTHER CRITICAL TREATMENTS FOR PATIENTS SERVED BY GOLD CROSS AND ALL OF EMS ACROSS THE NATION. RESEARCH PROJECTS ARE ESTABLISHED AND COORDINATED THROUGH THE MAYO CLINIC MEDICAL TRANSPORT RESEARCH COMMITTEE AND COMPLY WITH THE STANDARDS OF MAYO CLINIC IN ALL ASPECTS. THE INFORMATION PUBLISHED IS THE RESULT OF COLLABORATIVE EFFORTS BETWEEN GOLD CROSS AND REGIONAL HOSPITALS. GOLD CROSS HAS REQUESTED AND RECEIVED "INSTITUTIONAL REVIEW BOARD" (IRB) APPROVAL FROM THE REGIONAL HOSPITALS DEMONSTRATING THE QUALITY OF RESEARCH BEING CONDUCTED BY GOLD CROSS. OTHER RESEARCH PROJECTS UNDERWAY, DIRECTLY RELATED TO PATIENT CARE, INCLUDE A RETROSPECTIVE REVIEW OF SPINAL IMMOBILIZATION EFFICACY, A COMMUNITY CARDIAC ARREST STUDY, TRAUMA REVIEW STUDIES, AND A RETROSPECTIVE 12-LEAD ECG STUDY RELATED TO ST ELEVATION IN MYOCARDIAL INFARCTION PATIENTS. ALL RESEARCH PROJECTS ARE WELL INTEGRATED WITH OTHER MEDICAL INSTITUTIONS, INCLUDING IRB APPROVALS WHERE APPROPRIATE. THESE ARE IN ADDITION TO INTERNAL QUALITY ASSURANCE AND IMPROVEMENT STUDIES DONE WITHIN GOLD CROSS TO CONTINUALLY IMPROVE PATIENT CARE. RESULTS OF INTERNAL STUDIES ARE SHARED IN VARIOUS VENUES TO PROMOTE A HIGHER LEVEL OF CARE FOR PATIENTS SERVED BY THE EMS INDUSTRY NATIONWIDE. MANY LOCAL COMMUNITIES CANNOT UPGRADE THEIR AMBULANCE SERVICE FROM BASIC (BLS) TO ADVANCED (ALS) BECAUSE VOLUNTEERS DO NOT HAVE ACCESSIBLE TRAINING. INSPIRED BY THIS FACT, THE GOLD CROSS ENTITIES HAVE WORKED WITH COMMUNITY PARTNERS IN ST. PETER, MOOSE LAKE AND PINE COUNTY (ALL IN MINNESOTA), TO DEVELOP INNOVATIVE TRAINING SOLUTIONS. SIMILARLY, VOLUNTEER COMMUNITY GROUPS SPECIALIZING IN FIRST RESPONSE OR DISASTER RESPONSE OFTEN LACK FINANCES TO MAKE INITIAL PURCHASES OF EQUIPMENT OR TO UPGRADE EQUIPMENT. GOLD CROSS DONATES USED EQUIPMENT TO SUCH ORGANIZATIONS REGULARLY. THE TOTAL VALUE OF DONATED EQUIPMENT, INCLUDING VEHICLES IN 2011 WAS APPROXIMATELY $27,000. GOLD CROSS FURTHER SUPPORTS VARIOUS COMMUNITIES BY CONTRACTING WITH THEM TO PROVIDE MANAGEMENT SUPPORT SERVICES FOR THEIR SERVICES.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
COMMUNITY BENEFIT - SEE SCHEDULE OOVER THE YEARS, GOLD CROSS HAS DEVELOPED COOPERATIVE APPROACHES IN MEETING MEDICAL CENTER STAFFING NEEDS AS WELL AS INCREASING TRAINING FOR GOLD CROSS PARAMEDICS. BY COLLABORATING WITH HOSPITALS IN VARIOUS CITIES IN WHICH WE PROVIDE SERVICE, GOLD CROSS PARAMEDICS PROVIDE ADVANCED LEVEL PATIENT CARE IN THE EMERGENCY ROOM ENVIRONMENT IN COMMUNITIES THAT BENEFIT FROM THAT STAFFING. THROUGH THIS COLLABORATIVE EFFORT, GOLD CROSS PARAMEDICS RECEIVE TRAINING AND EXPERIENCE TO KEEP THEIR SKILLS UP TO DATE AND THE HOSPITAL AND MEDICAL CENTER BENEFIT FROM THE AVAILABILITY OF PARAMEDICS TO ASSIST DURING PERIODS OF TIME WHEN THEY EXPERIENCE SHORTAGES IN STAFFING.GOLD CROSS IS A FOUNDING MEMBER OF THE NORTH CENTRAL EMS COOPERATIVE (NCEMSC). THE NCEMSC IS OPEN TO MEMBERSHIP FROM EMS AGENCIES IN MINNESOTA, IOWA, NORTH DAKOTA, SOUTH DAKOTA, WISCONSIN AND OTHER PARTS OF THE COUNTRY, AND PROVIDES GROUP PURCHASING OF AMBULANCES, MEDICAL SUPPLIES AND DEVICES AND OTHER SERVICES IN AN EFFORT TO REDUCE COSTS OF VARIOUS INFRASTRUCTURES FOR AMBULANCE SERVICES FACING FINANCIAL HARDSHIP. IN ADDITION, GOLD CROSS PARTICIPATES IN THE WORK OF THE NORTH CENTRAL EMS INSTITUTE (NCEMSI) FOR THE PURPOSES OF ADVANCING BENCHMARKING AND PUBLIC POLICY RESEARCH RELATED TO THE EMS INDUSTRY. SIMILAR INVESTMENTS OF STAFF TIME AND ADMINISTRATIVE RESOURCES ARE EXPENDED IN EFFORTS WITH THE AMERICAN AMBULANCE ASSOCIATION ON NATIONAL BENCHMARKING EFFORTS FOR THE PURPOSE OF IMPROVING THE SERVICES PROVIDED TO THE PATIENTS SERVED BY EMS NATIONWIDE, AS WELL AS THE AMERICAN HEART ASSOCIATION ON RESEARCH FUNDING AND EXECUTION OF COMMUNITY AWARENESS.
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 12,928,690
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
 
No
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements.
20b
 
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I........................... Click to see attachment
31
Yes
 
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II....................... Click to see attachment
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
53
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
7
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
0
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
 
No
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
Yes
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
MN
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
CORPORATE TAX UNIT
200 FIRST STREET SW
ROCHESTER,MN55905
(507) 538-1297
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(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) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) BOLTON JEFFREY W
DIRECTOR
 1.00 X           0 715,940 50,237
(2) DECKER MD WYATT W
DIRECTOR
 1.00 X           0 850,361 40,890
(3) SANTRACH MD PAULA J
VICE-CHAIR
 1.00 X   X       0 329,884 44,289
(4) SCHNEIDER KENNETH J
DIRECTOR
 1.00 X           0 271,610 14,230
(5) SEINOLA SCOTT A
PRESIDENT / CEO
 1.00 X   X       0 209,473 41,119
(6) SMOLDT CRAIG A
CHAIR
 1.00 X   X       0 373,981 8,088
(7) TRANKEL SUSAN K
SECRETARY
 1.00 X   X       0 164,324 14,276
(8) ZIETLOW MD SCOTT P
DIRECTOR
 1.00 X           0 442,016 49,414
(9) ANDERSON PAUL D
VICE-PRESIDENT
 4.00     X       0 153,574 4,167
(10) GALINDEZ JR PETER
ASSISTANT SECRETARY
 1.00     X       0 179,530 35,466
(11) PEREZ ROBERT E
TREASURER
 4.00     X       0 120,036 23,424
(12) OTTE KIMBERLY K
FORMER ASSISTANT SECRETARY
 1.00           X 0 195,183 36,516










Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(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) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 0 4,005,912 362,116
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet0
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
MAYO FOUNDATION FOR MEDICAL EDUCATION &
200 FIRST STREET SW
ROCHESTER,MN55905 		ACCOUNTS PAYABLE PROCUREMENT AGENT 205,977
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet1
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e 26,398
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 26,398
Program Service Revenue Business Code
2a NET PATIENT REVENUE 621,910 7,926,782 7,926,782    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 7,926,782
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 1,060     1,060
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet        
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..MediumBullet      
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...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a MISC. REVENUE 900,099 136 136    
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 136
12 Total revenue. See Instructions....MediumBullet 7,954,376 7,926,918 0 1,060
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
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 7,153,070 7,153,070
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
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 ....        
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 2,347,217 2,347,217    
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 131,447 131,447    
9 Other employee benefits ....... 362,913 362,913    
10 Payroll taxes ........... 179,562 179,562    
11 Fees for services (non-employees):        
a Management ...... 1,084   1,084  
b Legal .........        
c Accounting ...........        
d Lobbying ...........        
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ......        
g Other .......... 1,888,783 821,122 1,067,661  
12 Advertising and promotion .... 1,100 1,100    
13 Office expenses ....... 318,222 318,222    
14 Information technology ...... 2,582 2,582    
15 Royalties ..        
16 Occupancy ........... 200,963 200,963    
17 Travel ............ 3,109 3,109    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ........... 1,993 1,993    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 21,581 18,685 2,896  
23 Insurance ..............        
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 BAD DEBT EXPENSE 1,300,406 1,300,406    
b MN CARE TAX 60,000 60,000    
c EMPLOYEE RELATED EXPENS 24,679 24,679    
d DUES, LICENSES AND SUBS 1,620 1,620    
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 14,000,331 12,928,690 1,071,641 0
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 MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ..........   1 0
2 Savings and temporary cash investments .......   2 0
3 Pledges and grants receivable, net .........   3 0
4 Accounts receivable, net ......... 860,695 4 0
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5 0
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 0
7 Notes and loans receivable, net .............   7 0
8 Inventories for sale or use ..............   8 0
9 Prepaid expenses and deferred charges ............   9 0
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 0
b Less: accumulated depreciation. ..... 10b   73,345 10c 0
11 Investments—publicly traded securities ..........   11 0
12 Investments—other securities. See Part IV, line 11 ...... 5,789,942 12 0
13 Investments—program-related. See Part IV, line 11 ..   13 0
14 Intangible assets .........   14 0
15 Other assets. See Part IV, line 11 ........... 548,158 15 0
16 Total assets. Add lines 1 through 15 (must equal line 34)... 7,272,140 16 0
Liabilities 17 Accounts payable and accrued expenses . 205,161 17 0
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities ..........   20  
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 ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
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..... 1,021,025 25 0
26 Total liabilities. Add lines 17 through 25..... 1,226,186 26 0
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 6,045,954 27 0
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet 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 ..... 6,045,954 33 0
34 Total liabilities and net assets/fund balances ..... 7,272,140 34 0
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
7,954,376
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
14,000,331
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
-6,045,955
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
6,045,954
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
1
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
0
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
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.
right arrow 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
GCAS
 
Employer identification number

41-1917517
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.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
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.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
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)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
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).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
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.") . 5,107,752 19,552 31,990 22,652 26,398 5,208,344
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...... 6,832,083 7,314,171 7,017,101 7,497,557 7,926,782 36,587,694
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. 11,939,835 7,333,723 7,049,091 7,520,209 7,953,180 41,796,038
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...           0
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.           0
c Add lines 7a and 7b..           0
8 Public Support (Subtract line 7c from line 6.)           41,796,038
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... 11,939,835 7,333,723 7,049,091 7,520,209 7,953,180 41,796,038
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 189,988 266,592 10,445 3,783 1,060 471,868
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b. 189,988 266,592 10,445 3,783 1,060 471,868
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.) 3,885 2,717 16 2,015 136 8,769
13 Total support (Add lines 9, 10c, 11 and 12.). 12,133,708 7,603,032 7,059,552 7,526,007 7,954,376 42,276,675
14
Section C. Computation of Public Support Percentage
15
15
98.860 %
16
16
98.800 %
Section D. Computation of Investment Income Percentage
17
17
1.120 %
18
18
1.180 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
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 II, LINE 12, EXPLANATION OF OTHER INCOME: MISCELLANEOUS REVENUE
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
GCAS
 
Employer identification number

41-1917517
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




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
Special Rules
......................... 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
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
GCAS
  		Employer identification number

41-1917517
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




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
GCAS
  		Employer identification number

41-1917517
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
GCAS
  		Employer identification number

41-1917517
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		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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		 (c)
Use 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:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet 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
GCAS
 
Employer identification number

41-1917517
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 .......    
5
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? ............
6
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? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
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)? ....................................
9
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.
1a
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.
b
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 $  
2
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:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
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?........
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.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
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 (e)Four Years Back
1a Beginning of year balance ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
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 (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............        
d Equipment ................        
e Other .................        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 0
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other 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.)Small Bullet  
Part VIII
Investments—Program 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.)Small Bullet  
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.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes  








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
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

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 UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: AT DECEMBER 31, 2011 AND 2010, THERE WAS NO SIGNIFICANT LIABILITY FOR UNRECOGNIZED TAX BENEFITS FOR THE FILING ORGANIZATION.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




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
GCAS
 
Employer identification number
41-1917517
Part I
General Information on Grants and Assistance
1
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? ....................................
2
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 (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) GOLD CROSS AMBULANCE SERVICE200 FIRST STREET SW
ROCHESTER,MN55905 		41-1917516 501(C)(3)   7,152,950 BOOK TRANSFER OF NET ASSETS MERGER OF ORGANIZATION






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
1
3
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

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		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













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 FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY WITH PROGRAMS THAT ENHANCE THE MISSION OF THE FILING ORGANIZATION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY THAT ADDRESS UNMET OR UNDER-FUNDED COMMUNITY NEEDS IN THE AREAS OF HEALTHCARE, EDUCATION, RESEARCH, DIVERSITY AND EQUALITY OF OPPORTUNITY. FEDERAL AWARDS THAT ARE SUBCONTRACTED TO OTHER ORGANIZATIONS ARE MONITORED BY THE FILING ORGANIZATION AS PRESCRIBED IN OMB CIRCULAR A-133. NO ADDITIONAL MONITORING IS PERFORMED. TRANSFERS OR GRANTS TO AFFILIATED TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED.
Schedule I (Form 990) 2011


Additional Data


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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
GCAS
 
Employer identification number

41-1917517
Part I
Questions Regarding Compensation
Yes
No
1a
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.
b
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....
1b
 
 
2
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? ....
2
 
 
3
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.
4
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:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
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.
5
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:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
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:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
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 ............
7
 
No
8
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 .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

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
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) BOLTON JEFFREY W (i)
(ii)		 0
624,800 		0
0 		0
91,140 		0
29,749 		0
20,488 		0
766,177 		0
85,363
(2) DECKER MD WYATT W (i)
(ii)		 0
576,050 		0
0 		0
274,311 		0
20,922 		0
19,968 		0
891,251 		0
14,640
(3) SANTRACH MD PAULA J (i)
(ii)		 0
313,614 		0
0 		0
16,270 		0
32,761 		0
11,528 		0
374,173 		0
12,796
(4) SCHNEIDER KENNETH J (i)
(ii)		 0
269,121 		0
0 		0
2,489 		0
226 		0
14,004 		0
285,840 		0
0
(5) SEINOLA SCOTT A (i)
(ii)		 0
208,321 		0
0 		0
1,152 		0
21,091 		0
20,028 		0
250,592 		0
0
(6) SMOLDT CRAIG A (i)
(ii)		 0
362,057 		0
0 		0
11,924 		0
0 		0
8,088 		0
382,069 		0
0
(7) TRANKEL SUSAN K (i)
(ii)		 0
162,202 		0
0 		0
2,122 		0
32 		0
14,244 		0
178,600 		0
0
(8) ZIETLOW MD SCOTT P (i)
(ii)		 0
422,820 		0
0 		0
19,196 		0
26,446 		0
22,968 		0
491,430 		0
16,279
(9) ANDERSON PAUL D (i)
(ii)		 0
141,118 		0
0 		0
12,456 		0
0 		0
4,167 		0
157,741 		0
0
(10) GALINDEZ JR PETER (i)
(ii)		 0
178,882 		0
0 		0
648 		0
15,378 		0
20,088 		0
214,996 		0
0
(11) OTTE KIMBERLY K (i)
(ii)		 0
193,882 		0
0 		0
1,301 		0
16,548 		0
19,968 		0
231,699 		0
0





Schedule J (Form 990) 2011

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, LINE 4B THIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(A)(17). STARTING JANUARY 1, 2011, ALL SRP BENEFITS ARE PAID AS AN ANNUAL TAXABLE CASH PAYMENT. THE FOLLOWING INDIVIDUALS RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN. AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). A PORTION OF THE AMOUNT MAY BE INCLUDED IN SCHEDULE J, PART II, COLUMN (F) IF DISCLOSED ON A PRIOR YEARS FORM 990. JEFFREY W. BOLTON $85,363 WYATT W. DECKER, M.D. $14,640 PAULA J. SANTRACH, M.D. $12,796 SCOTT P. ZIETLOW, M.D. $16,279
SUPPLEMENTAL INFORMATION PART III COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE CORE 990 PART VI SECTION B LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED.
Schedule J (Form 990) 2011

Additional Data


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Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet 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. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
GCAS
 
Employer identification number

41-1917517
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?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
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?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
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
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?
Yes No
(1) MICHAEL J NELSON FAMILY MEMBER OF PAUL ANDERSON, VICE-PRESIDENT 10,813 COMPENSATION   No
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:  




SCHEDULE N
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Liquidation, Termination, Dissolution or Significant Disposition of Assets
bullet Complete if the organization answered "Yes" to Form 990, Part IV, lines 31 or 32 or Form 990-EZ, line 36.
bullet Attach certified copies of any articles of dissolution, resolutions or plans.
bullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
GCAS
 
Employer identification number
41-1917517
Part I
Liquidation, Termination or Dissolution. Complete if the organization answered "Yes" to Form 990, Part IV, line 31, or Form 990-EZ, line
36. Use Part III if additional space is needed.
1(a)Description of asset(s)
distributed or transaction
expenses paid		 (b)Date of
distribution		 (c)Fair market value of
asset(s) distributed or
amount of transaction
expenses		 (d)Method of
determining FMV for
asset(s) distributed or
transaction expenses		 (e)EIN of recipient (f)Name and address of recipient (g)IRC section
of recipient(s) (if
tax-exempt) or type
of entity
ACCOUNTS RECEIVABLE, NET 12-31-2011 975,774 BOOK VALUE OF ASSETS AT END OF YEAR 41-1917516 GOLD CROSS AMBULANCE SERVICE
 
200 FIRST STREET SW
ROCHESTER,MN55905 		501(C)(3)
LAND, BUILDINGS, EQUIPMENT 12-31-2011 332,889 BOOK VALUE OF ASSETS AT END OF YEAR 41-1917516 GOLD CROSS AMBULANCE SERVICE
 
200 FIRST STREET SW
ROCHESTER,MN55905 		501(C)(3)
INVESTMENTS - OTHER SECURITIES 12-31-2011 6,598,956 BOOK VALUE OF ASSETS AT END OF YEAR 41-1917516 GOLD CROSS AMBULANCE SERVICE
 
200 FIRST STREET SW
ROCHESTER,MN55905 		501(C)(3)




















Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .
2a
 
No
b
Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .
2b
 
No
c
Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . .
2c
 
No
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization's liquidation, termination, or dissolution? . . . . .
2d
 
No
e
If the organization answered "Yes" to any of the questions in this line, provide the name of the person involved and explain in Part III. bullet
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ.
Cat. No. 50087Z
Schedule N (Form 990 or 990-EZ) 2011

Schedule N (Form 990 or 990-EZ) 2011
Page 2
Part I
Liquidation, Termination or Dissolution (continued)
Note. If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should equal -0-.
Yes
No
3
Did the organization distribute its assets in accordance with its governing instrument(s)? If “No,” describe in Part III . . . . . . . . . . .
3
Yes
 
4a
Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminate? . . . . . .
4a
Yes
 
b
If “Yes,” did the organization provide such notice? . . . . . . . . . . . . . . . . . . . . . . . . . .
4b
Yes
 
5
Did the organization discharge or pay all of its liabilities in accordance with state laws? . . . . . . . . . . . . . . . . .
5
Yes
 
6a
Did the organization have any tax-exempt bonds outstanding during the year? . . . . . . . . . . . . . . . . . . . .
6a
 
No
b
Did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws? .
6b
 
No
c
If ‘Yes’ to line 6b, describe in Part III how the organization defeased or otherwise settled these liabilities. If “No,” explain in Part III.

Part II
Sale, Exchange, Disposition or Other Transfer of More Than 25% of the Organization's Assets. Complete if the organization answered "Yes" to Form 990, Part IV, line 32, or Form 990-EZ, line 36. Use Part III if additional space is needed.
1(a)Description of asset(s)
distributed or transaction
expenses paid		 (b)Date of
distribution		 (c)Fair market value of
asset(s) distributed or
amount of transaction
expenses		 (d)Method of
determining FMV for
asset(s) distributed or
transaction expenses		 (e)EIN of recipient (f)Name and address of recipient (g)IRC section
of recipient(s) (if
tax-exempt) or type
of entity


















Yes
No
2
Did or will any officer, director, trustee, or key employee of the organization:
a
Become a director or trustee of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .
2a
 
No
b
Become an employee of, or independent contractor for, a successor or transferee organization? . . . . . . . . . . . . . . . .
2b
 
No
c
Become a direct or indirect owner of a successor or transferee organization? . . . . . . . . . . . . . . . . . . . . .
2c
 
No
d
Receive, or become entitled to, compensation or other similar payments as a result of the organization’s significant disposition of assets? . . . . . . .
2d
 
No
e
If the organization answered "Yes" to any of the questions in this line, provide the name of the person involved and explain in Part III.
Schedule N(Form 990 or 990-EZ) 2011

Schedule N (Form 990 or 990-EZ) 2011
Page 3
Part III
Supplemental Information. Complete to provide the information required by Parts I and II,
and any additional information.
Identifier Return Reference Explanation
    PART I, LINE 7C: THE FILING ORGANIZATION DID NOT HAVE ANY TAX EXEMPT BOND LIABILITIES TO DISCHARGE OR DEFEASE DURING THE TAX YEAR IN ACCORDANCE WITH THE INTERNAL REVENUE CODE AND STATE LAWS.
Schedule N (Form 990 or 990-EZ) 2011


Additional Data


Software ID:  
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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
GCAS
 
Employer identification number

41-1917517
Identifier Return Reference Explanation
CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 DUE TO A MERGER BETWEEN FILING ORGANIZATION AND GOLD CROSS AMBULANCE SERVICE (GCMN), THE PROGRAM SERVICES OF THE FILING ORGANIZATION WILL BE CARRIED ON BY THE SURVIVING ORGANIZATION, WHICH WILL BE CALLED GOLD CROSS AMBULANCE SERVICE.
  FORM 990, PART VI, SECTION A, LINE 2 DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUAL: PAUL D. ANDERSON HAS A BUSINESS RELATIONSHIP WITH: JEFFREY W. BOLTON, WYATT W. DECKER M.D., PETER GALINDEZ, KIMBERLY K. OTTE, ROBERT E. PEREZ, PAULA J. SANTRACH M.D., KENNETH J. SCHNEIDER, SCOTT A. SEINOLA, CRAIG A. SMOLDT, SUSAN K. TRANKEL, AND SCOTT P. ZIETLOW M.D. DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUAL: JEFFREY W. BOLTON HAS A BUSINESS RELATIONSHIP WITH: PETER GALINDEZ, KIMBERLY K. OTTE, AND ROBERT E. PEREZ. DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUALS: JEFFREY W. BOLTON, WYATT W. DECKER, KENNETH J. SCHNEIDER, AND CRAIG A. SMOLDT HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: WYATT W. DECKER, M.D., PAULA J. SANTRACH M.D., KENNETH J. SCHNEIDER, SCOTT SEINOLA, CRAIG A. SMOLDT, SUSAN K. TRANKEL, AND SCOTT P. ZIETLOW M.D. JEFFREY W. BOLTON AND CRAIG A. SMOLDT SERVED AS BOARD MEMBERS OF MAYO COLLABORATIVE SERVICES, INC. AND HEALTH TRADITIONS HEALTH PLAN, AFFILIATED TAXABLE ORGANIZATIONS. JEFFREY W. BOLTON AND SCOTT A. SEINOLA SERVED AS BOARD MEMBERS OF MMSI, INC., AN AFFILIATED TAXABLE ORGANIZATION.
  FORM 990, PART VI, SECTION A, LINE 3 MAYO-AFFILIATED ENTITIES ROUTINELY DELEGATED VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO RELATED ENTITIES.
  FORM 990, PART VI, SECTION A, LINE 4 THE FILING ORGANIZATION MERGED WITH GOLD CROSS AMBULANCE SERVICE (MN) AT YEAR END OF 2011 AND EXERCISED THE ARTICLES OF MERGER.
  FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH.
  FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER ELECTS AND/OR REMOVES THE DIRECTORS.
  FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER MUST APPROVE CERTAIN ACTIONS OF THE BOARD SUCH AS INCURRENCE OF DEBT, CHANGES INVOLVING THE CORPORATION OR ITS STRATEGIC PLAN AND/OR MISSION, THE ALTERATION OF NAMES USED BY FACILITIES OPERATED BY THE CORPORATION, AND DISTRIBUTION OF ASSETS UPON DISSOLUTION.
  FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. HENCE, THERE IS NO DOCUMENTATION FOR PART VI SECTION A LINE 8B.
  FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. THE TAX RETURN IS THEN REVIEWED BY SITE FINANCE STAFF AND THE TREASURER. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF GCAS GOVERNING BODY VIA DISTRIBUTION AT A BOARD MEETING. HIGHLIGHTS ARE PRESENTED TO BOARD MEMBERS, AND THE REVIEW IS DOCUMENTED IN MEETING MINUTES. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990.
  FORM 990, PART VI, SECTION B, LINE 12C MAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF MAYO CLINIC (AND/OR AFFILIATE) AND THE OUTSIDE ENTITY. ADDITIONAL CONFLICT OF INTEREST POLICIES AND PROCEDURES EXIST FOR CERTAIN ENTITIES CONCERNING RESEARCH CONTRACTS AND OTHER TYPES OF POTENTIAL CONFLICTS.
    FORM 990, PART VI, SECTION B, LINE 15: THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY IN THE FALL FOR THE NEXT YEAR'S COMPENSATION. THE SALARIES OF THE CHAIR, VICE-CHAIR, AND SEVERAL DIRECTORS WERE REVIEWED BY THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR FLORIDA, ARIZONA, AND ROCHESTER, MN - PHYSICIAN AND ADMINISTRATIVE LEADERSHIP. THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE ARIZONA, FLORIDA, AND ROCHESTER, MINNESOTA CAMPUSES. THE COMMITTEE IS COMPRISED OF MAYO EMPLOYEES, BUT IS INDEPENDENT FOR INTERNAL REVENUE CODE 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED (WITH RECUSAL WHERE APPROPRIATE). FOR THOSE INDIVIDUALS FOR WHICH THIS COMMITTEE CAN NOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE SALARY AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION, AND GOVERNANCE (GOVERNANCE COMMITTEE) IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. THIS GROUP REVIEWS THE COMPENSATION AND BENEFITS FOR PHYSICIANS FROM ALL CAMPUSES, INCLUDING THE MAYO HEALTH SYSTEM LOCATIONS, AS WELL AS CERTAIN SENIOR ADMINISTRATIVE AND EXECUTIVE LEADERSHIP (INCLUDING ALL PERSONS BELIEVED TO BE DISQUALIFIED PERSONS). THIS PROCESS ESTABLISHES ACCEPTABLE RANGES FOR VARIOUS POSITIONS, LEVELS, AND SPECIALTIES. THE COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. IN ADDITION, THE GOVERNANCE COMMITTEE DIRECTLY RETAINS AN INDEPENDENT THIRD-PARTY COMPENSATION CONSULTANT TO PROVIDE RELEVANT, CONTEMPORANEOUS BENCHMARK INFORMATION FOR A SMALL GROUP OF SENIOR PHYSICIAN, ADMINISTRATIVE, AND EXECUTIVE LEADERSHIP POSITIONS FOR WHICH AN INDIVIDUALIZED REVIEW AND RECOMMENDATION IS MADE. THE SALARY OF THE CEO, WAS REVIEWED BY THE ORGANIZATION'S GOVERNING BODY PURSUANT TO THE PROCESS DESCRIBED BELOW FOR FLORIDA, ARIZONA, AND ROCHESTER,MN - ALLIED HEALTH STAFF. FOR ALLIED HEALTH STAFF NOT INCLUDED IN THE ABOVE PROCESS, THERE IS A REVIEW PROCESS WHICH CULMINATES IN REVIEW AND APPROVAL BY THE GOVERNING BODY AT EACH INDIVIDUAL SITE. THIS REVIEW IS BASED ON COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) AND THE REVIEW AND APPROVAL IS DOCUMENTED IN THE MINUTES.
  FORM 990, PART VI, SECTION C, LINE 19 THE FILING ORGANIZATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT PUBLICLY AVAILABLE. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST AND ALSO ON THE MAYOCLINIC.ORG WEBSITE.
AVERAGE HOURS PER WEEK DEVOTED TO POSITION WITH RELATED ORGANIZATION: FORM 990 PART VII SECTION A: CRAIG A. SMOLDT 40.0 JEFFREY W. BOLTON 40.0 PAUL D. ANDERSON 36.0 PAULA J. SANTRACH, M.D. 40.0 ROBERT E. PEREZ 36.0 SCOTT A. SEINOLA 40.0 SCOTT P. ZIETLOW, M.D. 40.0 WYATT W. DECKER, M.D. 40.0 KENNETH SCHNEIDER 40.0 PETER GALINDEZ 40.0 SUSAN TRANKEL 40.0 KIMBERLY K. OTTE 40.0
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: ROUNDING 1. TOTAL TO FORM 990, PART XI, LINE 5: 1.
CHANGES IN PROGRAM SERVICES: FORM 990 PART III, LINE 3 DUE TO A MERGER BETWEEN FILING ORGANIZATION AND GOLD CROSS AMBULANCE SERVICE (GCMN), THE PROGRAM SERVICES OF THE FILING ORGANIZATION WILL BE CARRIED ON BY THE SURVIVING ORGANIZATION, WHICH WILL BE CALLED GOLD CROSS AMBULANCE SERVICE.
CONTINUATION OF PROGRAM SERVICE ACCOMPLISHMENTS: FORM 990 PART III, LINE 4A GOLD CROSS IS ACCREDITED BY THE COMMISSION ON ACCREDITATION OF MEDICAL TRANSPORT SYSTEMS (CAMTS). GOLD CROSS IS CURRENTLY THE ONLY AMBULANCE SERVICE IN MINNESOTA AND WISCONSIN WITH THE CAMTS DESIGNATION. ACHIEVING CAMTS ACCREDITATION REQUIRES AN EXTENSIVE REVIEW OF A MEDICAL TRANSPORT PROGRAMS POLICIES AND PROCEDURES SPECIFICALLY RELATED TO OUTREACH AND EDUCATION, DISPATCH, CLINICAL CARE, QUALITY ASSURANCE AND SAFETY. THIS VOLUNTARY EXAMINATION IS FOLLOWED BY A COMPREHENSIVE IN-PERSON VISIT BY CAMTS-CERTIFIED SITE SURVEYORS. THE STRINGENT CAMTS ACCREDITATION STANDARDS ARE CONSIDERED A MARK OF EXCELLENCE FOR LOCAL, STATE, AND FEDERAL GOVERNMENT AGENCIES, AS WELL AS PRIVATE AGENCIES AND THE GENERAL PUBLIC. THE FOCUSED REVIEW CONDUCTED BY CAMTS HELPS ASSURE CARE PROVIDED TO PATIENTS IS OF THE HIGHEST QUALITY AND THAT STANDARDS ARE SPECIFIC AND MEASURABLE.
INDEPENDENCE FORM 990 PART VI LINE 1B THE BOARD OF TRUSTEES OF MAYO CLINIC, THE PARENT ENTITY OF THE MAYO CLINIC-AFFILIATED ENTITIES, IS COMPRISED OF MORE THAN 50% PUBLIC TRUSTEES.
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:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
GCAS
 
Employer identification number

41-1917517
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
Yes No
(1) BLOOMER LAKEVIEW INC

2110 DUNCAN ROAD

BLOOMER,WI54724
39-1450617 		LOW INCOME HOUSING WI 501(C)(3) 7 MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC
 
Yes
 
(2) CHARTERHOUSE INC

200 FIRST STREET SW

ROCHESTER,MN55905
41-1405254 		RETIREMENT LIVING CENTER MN 501(C)(3) 9 MAYO CLINIC
 
Yes
 
(3) FOUNTAIN LAKE TREATMENT CENTER

404 WEST FOUNTAIN STREET

ALBERT LEA,MN56007
41-1404076 		CHEMICAL DEPENDENCY TREATMENT MN 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--ALBERT LEA
 
Yes
 
(4) FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC

464 SOUTH JOHNSON STREET

ARCADIA,WI54612
39-1322480 		FUNDRAISING FOUNDATION WI 501(C)(3) 9 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC
 
Yes
 
(5) GCAS

200 FIRST STREET SW

ROCHESTER,MN55905
41-1917517 		AMBULANCE SERVICE MN 501(C)(3) 9 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
 
Yes
 
(6) GOLD CROSS AMBULANCE SERVICE

200 FIRST STREET SW

ROCHESTER,MN55905
41-1917516 		AMBULANCE SERVICE MN 501(C)(3) 9 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
 
Yes
 
(7) GOLD CROSS AMBULANCE INC

200 FIRST STREET SW

ROCHESTER,MN55905
39-1942957 		AMBULANCE SERVICE MN 501(C)(3) 9 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
 
Yes
 
(8) LUTHER LAKESIDE APARTMENTS INC

714 SOUTH BARSTOW STREET

EAU CLAIRE,WI54701
39-1409024 		LOW INCOME HOUSING WI 501(C)(3) 9 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC
 
Yes
 
(9) MAYO CLINIC

200 FIRST STREET SW

ROCHESTER,MN55905
41-6011702 		PATIENT CARE - CLINIC MN 501(C)(3) 9 MAYO CLINIC
 
Yes
 
(10) MAYO CLINIC -- METHODIST HOSPITAL

200 FIRST STREET SW

ROCHESTER,MN55905
41-0739106 		HOSPITAL MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(11) MAYO CLINIC -- SAINT MARYS HOSPITAL

200 FIRST STREET SW

ROCHESTER,MN55905
41-0944601 		HOSPITAL MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(12) MAYO CLINIC ARIZONA

13400 EAST SHEA BLVD

SCOTTSDALE,AZ85259
86-0800150 		HOSPITAL AND CLINIC AZ 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(13) MAYO CLINIC FLORIDA (A NONPROFIT CORPORATION)

4500 SAN PABLO ROAD

JACKSONVILLE,FL32224
59-0714831 		HOSPITAL FL 501(C)(3) 3 MAYO CLINIC JACKSONVILLE
 
Yes
 
(14) MAYO CLINIC HEALTH SYSTEM--ALBERT LEA

404 WEST FOUNTAIN STREET

ALBERT LEA,MN56007
41-1404075 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(15) MAYO CLINIC HEALTH SYSTEM--AUSTIN

1000 FIRST DRIVE NW

AUSTIN,MN55912
41-0695606 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(16) MAYO CLINIC HEALTH SYSTEM--AUSTIN FOUNDATION

1000 FIRST DRIVE NW

AUSTIN,MN55912
30-0107471 		FUNDRAISING FOUNDATION MN 501(C)(3) 7 MAYO CLINIC HEALTH SYSTEM--AUSTIN
 
Yes
 
(17) MAYO CLINIC HEALTH SYSTEM--CANNON FALLS

1116 WEST MILL STREET

CANNON FALLS,MN55009
20-4156428 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(18) MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC

1501 THOMPSON STREET

BLOOMER,WI54724
39-0980343 		HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC
 
Yes
 
(19) MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC

PO BOX 1510

EAU CLAIRE,WI54702
39-1735831 		PATIENT CARE - CLINIC WI 501(C)(3) 3 MAYO CLINIC
 
 
No
(20) MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE FOUNDATION INC

733 W CLAIREMONT AVE PO BOX 1510

EAU CLAIRE,WI54702
39-1633407 		GRANTMAKING FOUNDATION WI 501(C)(3) PF MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC
 
 
No
(21) MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC

1221 WHIPPLE STREET

EAU CLAIRE,WI54703
39-0813418 		HOSPITAL WI 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(22) MAYO CLINIC HEALTH SYSTEM--FAIRMONT

800 MEDICAL CENTER DRIVE PO BOX 800

FAIRMONT,MN56031
41-0760836 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(23) MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC

700 WEST AVE SOUTH

LA CROSSE,WI54601
39-1186647 		FUNDRAISING FOUNDATION WI 501(C)(3) 11-II MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC
 
Yes
 
(24) MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION-SPARTA INC

310 WEST MAIN STREET

SPARTA,WI54656
39-1423234 		FUNDRAISING FOUNDATION WI 501(C)(3) 9 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC
 
Yes
 
(25) MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC

700 WEST AVE SOUTH

LA CROSSE,WI54601
39-1411999 		HEALTHCARE SYSTEM PARENT WI 501(C)(3) 11-I MAYO CLINIC
 
Yes
 
(26) MAYO CLINIC HEALTH SYSTEM--FRANCISCAN MEDICAL CENTER INC

700 WEST AVE SOUTH

LA CROSSE,WI54601
39-0806374 		HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC
 
Yes
 
(27) MAYO CLINIC HEALTH SYSTEM--HOME HEALTH & HOSPICE INC

PO BOX 2060

EAU CLAIRE,WI54702
39-1491516 		HOME HEALTH AND HOSPICE CARE WI 501(C)(3) 9 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC
 
Yes
 
(28) MAYO CLINIC HEALTH SYSTEM--LAKE CITY

500 WEST GRANT STREET

LAKE CITY,MN55041
41-1906820 		HOSPITAL MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(29) MAYO CLINIC HEALTH SYSTEM--MANKATO

1025 MARSH STREET

MANKATO,MN56002
41-1236756 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(30) MAYO CLINIC HEALTH SYSTEM--MANKATO HEALTH CARE FOUNDATION

1025 MARSH STREET

MANKATO,MN56002
41-1663357 		FUNDRAISING FOUNDATION MN 501(C)(3) 7 MAYO CLINIC HEALTH SYSTEM--MANKATO
 
Yes
 
(31) MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE

301 SECOND STREET NORTHEAST

NEW PRAGUE,MN56071
41-0723639 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(32) MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC

1222 EAST WOODLAND AVE

BARRON,WI54812
39-0920634 		HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC
 
Yes
 
(33) MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC

PO BOX 70 / 13025 EIGHTH STREET

OSSEO,WI54758
39-1029430 		HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC
 
Yes
 
(34) MAYO CLINIC HEALTH SYSTEM--OWATONNA

134 SOUTHVIEW

OWATONNA,MN55060
41-1862132 		PATIENT CARE - CLINIC MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(35) MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC

2321 STOUT ROAD

MENOMONIE,WI54751
51-0190875 		HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(36) MAYO CLINIC HEALTH SYSTEM--SPRINGFIELD

625 NORTH JACKSON AVENUE

SPRINGFIELD,MN56087
41-1893827 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--MANKATO
 
Yes
 
(37) MAYO CLINIC HEALTH SYSTEM--ST JAMES

1101 MOULTON PARSONS DR PO BOX 460

ST JAMES,MN56081
41-0797368 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--MANKATO
 
Yes
 
(38) MAYO CLINIC HEALTH SYSTEM--ST JAMES HEALTH CARE FOUNDATION

1101 MOULTON PARSONS DR PO BOX 460

ST JAMES,MN56081
41-1444129 		FUNDRAISING FOUNDATION MN 501(C)(3) 7 MAYO CLINIC HEALTH SYSTEM--ST JAMES
 
Yes
 
(39) MAYO CLINIC HEALTH SYSTEM--SUPPORTIVE HOMECARE INC

PO BOX 2060

EAU CLAIRE,WI54702
39-1686673 		HOME HEALTH CARE WI 501(C)(3) 9 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC
 
Yes
 
(40) MAYO CLINIC HEALTH SYSTEM--WASECA

501 NORTH STATE STREET

WASECA,MN56093
36-3606405 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--MANKATO
 
Yes
 
(41) MAYO CLINIC JACKSONVILLE

4500 SAN PABLO ROAD

JACKSONVILLE,FL32224
59-3337028 		PATIENT CARE - CLINIC FL 501(C)(3) 7 MAYO CLINIC
 
Yes
 
(42) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH

200 FIRST STREET SW

ROCHESTER,MN55905
41-1506440 		CHARITABLE, EDUCATIONAL & SCIENTIFIC ACTIVITIES MN 501(C)(3) 9 MAYO CLINIC
 
Yes
 
(43) MAYO KLINIK STIFTUNG

60486 FRANKFURT AM MAIN
FRANKFURT    
GM
FUNDRAISING FOUNDATION GM     MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
 
Yes
 
(44) MILES AND SHIRLEY FITERMAN ENDOWMENT FUND FOR DIGESTIVE DISEASES

200 FIRST STREET SW

ROCHESTER,MN55905
41-2020392 		SUPPORT RESEARCH, PRACTICE & EDUCATION MN 501(C)(3) 11-I MAYO CLINIC
 
Yes
 
(45) POVERELLO FOUNDATION

200 FIRST STREET SW

ROCHESTER,MN55905
41-1494881 		FUNDRAISING FOUNDATION MN 501(C)(3) 11-I MAYO CLINIC -- SAINT MARYS HOSPITAL
 
Yes
 
(46) SOUTHERN METRO MEDICAL CLINICS INC

301 MAIN STREET

NEW PRAGUE,MN56071
41-1623632 		FAMILY PRACTICE CLINICS MN 501(C)(3) 9 MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
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 V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) FRANKLIN HEATING STATION

119 THIRD ST SW
ROCHESTER,MN55902
41-0264830 		UTILITY MN N/A
                  












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)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) MAYO CLINIC HEALTH SYSTEM--FARIBAULT
635 FIRST STREET SE
FARIBAULT,MN55021
41-1817179 		PATIENT CARE - CLINIC MN N/A
 C      
(2) MAYO CLINIC HEALTH SYSTEM--DECORAH CLINIC PHYSICIANS
907 MONTGOMERY STREET
DECORAH,IA52101
41-1711329 		PATIENT CARE - CLINIC IA N/A
 C      
(3) FIOS THERAPEUTICS INC
200 FIRST STREET SW
ROCHESTER,MN55905
71-1029189 		RESEARCH MN N/A
 C      
(4) HEALTH TRADITION HEALTH PLAN
1808 EAST MAIN STREET
ONALASKA,WI54650
39-1545987 		MEDICAL SERVICES COMPANY WI N/A
 C      
(5) LOBSS NETWORK SUPPORT 2002 INC
200 FIRST STREET SW
ROCHESTER,MN55905
48-1276150 		ADMINISTRATIVE SERVICES MN N/A
 C      
(6) MAYO COLLABORATIVE SERVICES INC
200 FIRST STREET SW
ROCHESTER,MN55905
41-1346366 		REFERENCE LAB SERVICES MN N/A
 C      
(7) MAYO HOLDING COMPANY
200 FIRST STREET SW
ROCHESTER,MN55905
41-1578020 		HOLDING COMPANY MN N/A
 C      
(8) MAYO INSURANCE COMPANY LTD
200 FIRST STREET SW
ROCHESTER,MN55905
 SELF INSURANCE POOL CJ N/A
 C      
(9) MAYO MEDICAL LABORATORIES NEW ENGLAND INC
265 BALLARDVALE STREET
WILMINGTON,MA01887
04-3323713 		LABORATORY SERVICES MA N/A
 C      
(10) MAYO REGIONAL PRACTICES OF ARIZONA
13400 EAST SHEA BOULEVARD
SCOTTSDALE,AZ85259
06-1190278 		THIRD PARTY ADMINISTRATION SERVICES AZ N/A
 C      
(11) MHS SERVICES INC
200 FIRST STREET SW
ROCHESTER,MN55905
41-1282517 		EQUIPMENT & REAL ESTATE LEASING MN N/A
 C      
(12) MMSI INC
21 FIRST STREET SW
ROCHESTER,MN55905
41-1547003 		THIRD PARTY ADMINISTRATION SERVICES MN N/A
 C      
(13) MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC
1221 WHIPPLE STREET
EAU CLAIRE,WI54703
39-1528920 		PHARMACY SERVICES WI N/A
 C      
(14) PHYSICIAN AND HOSPITAL PRACTICES INC
4500 SAN PABLO ROAD
JACKSONVILLE,FL32224
93-0926631 		HEALTH SERVICES FL N/A
 C      
(15) ROCHESTER AIRPORT COMPANY
ROUTE 2
ROCHESTER,MN55902
41-0506870 		AIRPORT MANAGEMENT MN N/A
 C      
(16) SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION
13400 E SHEA BLVD
SCOTTSDALE,AZ85259
86-0870505 		COMMERCIAL PROPERTY OWNERS ASSOCIATION AZ N/A
 C      
(17) THE STABILE BUILDING OWNERS' ASSOCIATION
200 FIRST STREET SW
ROCHESTER,MN55905
20-8994499 		COMMERCIAL PROPERTY OWNERS ASSOCIATION MN N/A
 C      
(18) MAYO CLINIC GBS MAURITIUS
2ND FLOOR EBENE MEWS 57
EBENE CYBERCITY    
MP
HEALTHCARE MANAGEMENT MP N/A
 C      
(19) CHARITABLE LEAD TRUST (1)
 
 
CHARITABLE TRUST CA N/A
 T      
(20) PERPETUAL TRUST (1)
 
 
CHARITABLE TRUST ND N/A
 T      
(21) PERPETUAL TRUST (1)
 
 
CHARITABLE TRUST LA N/A
 T      
(22) PERPETUAL TRUST (2)
 
 
CHARITABLE TRUST MA N/A
 T      
(23) PERPETUAL TRUST (1)
 
 
CHARITABLE TRUST MO N/A
 T      
(24) PERPETUAL TRUST (1)
 
 
CHARITABLE TRUST AZ N/A
 T      
(25) CHARITABLE REMAINDER TRUST (1)
 
 
CHARITABLE TRUST CO N/A
 T      
(26) CHARITABLE REMAINDER TRUST (6)
 
 
CHARITABLE TRUST FL N/A
 T      
(27) CHARITABLE REMAINDER TRUST (1)
 
 
CHARITABLE TRUST FL N/A
 T      
(28) CHARITABLE REMAINDER TRUST (1)
 
 
CHARITABLE TRUST IL N/A
 T      
(29) CHARITABLE REMAINDER TRUST (1)
 
 
CHARITABLE TRUST LA N/A
 T      
(30) CHARITABLE REMAINDER TRUST (1)
 
 
CHARITABLE TRUST MI N/A
 T      
(31) CHARITABLE REMAINDER TRUST (66)
 
 
CHARITABLE TRUST MN N/A
 T      
(32) CHARITABLE REMAINDER TRUST (82)
 
 
CHARITABLE TRUST MN N/A
 T      
(33) CHARITABLE REMAINDER TRUST (1)
 
 
CHARITABLE TRUST NC N/A
 T      
(34) CHARITABLE REMAINDER TRUST (2)
 
 
CHARITABLE TRUST TX N/A
 T      
Schedule R (Form 990) 2011
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
No
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 . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
Yes
 
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
Yes
 
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
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) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH

 G 840,360 GAAP
(2) MMSI INC

 R 877,226 GAAP
(3) GOLD CROSS AMBULANCE SERVICE

 O 377,788 GAAP
(4) GOLD CROSS AMBULANCE SERVICE

 O 1,067,661 GAAP
(5) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH

 N 2,320,925 GAAP
(6) MAYO CLINIC

 O 402,758 GAAP
(7) GOLD CROSS AMBULANCE SERVICE

 F 7,152,950 GAAP
Schedule R (Form 990) 2011
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) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(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 V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
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


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