TY 2012 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) David Abelson MD........................................................................ President and CEO	55.00 .......................1.00	X	X	0	1,260,661	256,563
(2) Steven Connelly MD........................................................................ Exec VP & CMO	55.00 .......................0.00	X	X	0	640,962	125,270
(3) Judith Corson........................................................................ Secretary	12.00 .......................0.00	X	X	0	0	0
(4) Michael Kaupa........................................................................ Executive VP and COO	55.00 .......................1.00	X	X	0	826,209	129,063
(5) Donald Lewis JD........................................................................ Vice Chair	12.00 .......................0.00	X	X	0	0	0
(6) Sheila McMillan........................................................................ CFO	55.00 .......................1.00	X	X	0	597,712	92,282
(7) Ken Melrose........................................................................ Director	3.00 .......................0.00	X	X	0	0	0
(8) Richard E Struthers........................................................................ Treasurer	6.00 .......................0.00	X	X	0	0	0
(9) Kenneth L Thome........................................................................ Chair	12.00 .......................0.00	X	X	0	0	0
(10) Leslie Baken MD........................................................................ Director	55.00 .......................0.00	X		327,814	0	49,850
(11) John Berg........................................................................ Director	1.00 .......................0.00	X		0	0	0
(12) Timothy Crimmins MD........................................................................ Director	3.00 .......................0.00	X		0	0	0
(13) Barbara Degnan........................................................................ Director	10.00 .......................0.00	X		0	0	0
(14) Paul Dominski........................................................................ Director	55.00 .......................0.00	X		0	358,861	67,471
(15) Bruce W Engelsma........................................................................ Director	3.00 .......................0.00	X		0	0	0
(16) Steve Frank........................................................................ Director	3.00 .......................0.00	X		0	0	0
(17) Roxanna Gapstur PhD........................................................................ Director	55.00 .......................0.00	X		0	345,604	73,368

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Christa Getchell........................................................................ Director	1.00 .......................55.00	X			0	244,070	32,522
(19) Tom Jones MD........................................................................ Director	55.00 .......................0.00	X			746,054	0	52,052
(20) Jeff Mendeloff MD........................................................................ Director	55.00 .......................0.00	X			674,305	0	59,091
(21) Ruth Mickelsen........................................................................ Director	3.00 .......................0.00	X			0	0	0
(22) Lee N Newcomer MD........................................................................ Director	8.00 .......................0.00	X			0	0	0
(23) William Richards MD........................................................................ Director	30.00 .......................0.00	X			242,262	0	36,279
(24) Janet Schaffer MD........................................................................ Director	55.00 .......................0.00	X			306,397	0	53,479
(25) Eric Schned MD........................................................................ Director	55.00 .......................0.00	X			296,909	0	48,100
(26) Dan Schumacher........................................................................ Director	3.00 .......................0.00	X			0	0	0
(27) Katherine Tarvestad........................................................................ Director	55.00 .......................0.00	X			0	253,246	48,745
(28) Mark Wilkowske MD........................................................................ Chief of Oncology Serv	55.00 .......................1.00	X			514,143	0	56,769
(29) Theodore Wegleitner........................................................................ TRIA COO	55.00 .......................0.00		X		0	373,859	99,515
(30) Oliver Cass MD........................................................................ Medical Doctor	55.00 .......................0.00			X	816,215	0	62,270
(31) Darin Epstein MD........................................................................ Medical Doctor	55.00 .......................0.00			X	840,250	0	58,498
(32) Marni Feldmann MD........................................................................ Medical Doctor	55.00 .......................0.00			X	813,564	0	61,170
(33) Robert Werling MD........................................................................ Medical Doctor	55.00 .......................0.00			X	902,315	0	62,397
(34) Anton Willerscheidt MD........................................................................ Medical Doctor	55.00 .......................0.00			X	835,324	0	61,426

(A) Name and business address	(B) Description of services	(C) Compensation
University of MN Physicians720 Washington Avenue SEMinneapolisMN55414	Medical Services	10,600,689
RJM Construction5455 HWY 169PlymouthMN55442	Construction Services	5,325,467
Dell Financial Services12519 Collections Center DriveChiciagoIL60693	Computer Services	4,074,071
MModel ServicesPO Box 102467AtlantaGA30368	Medical Services	3,073,001
Memorial Blood Center of MinneapolisPO Box 1164MinneapolisMN55480	Medical Services	2,812,162
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 117

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	147,496	147,496
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	20,000	20,000
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 ....	3,463,504	2,998,623	464,881
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	592,170,808	521,528,806	70,414,764	227,238
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	34,376,356	30,275,488	4,087,677	13,191
9	Other employee benefits .......	61,636,140	54,283,362	7,329,126	23,652
10	Payroll taxes ...........	35,973,558	31,682,154	4,277,600	13,804
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	1,061,986		1,061,986
c	Accounting ...........	406,929		406,929
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	457,075		457,075
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	48,321,664	36,047,960	12,263,058	10,646
12	Advertising and promotion ....	4,052,842	140,139	3,912,703
13	Office expenses .......	15,217,502	10,796,159	4,421,343
14	Information technology ......	24,737,809	14,186,544	10,551,265
15	Royalties ..
16	Occupancy ...........	38,539,147	35,151,584	3,387,563
17	Travel ............	1,061,087	808,962	252,125
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	802,459	722,648	79,811
20	Interest ...........	10,402,034	10,402,034
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	46,940,705	41,384,717	5,555,988
23	Insurance ..............	6,128,029	5,967,973	160,056
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	139,207,836	137,683,034	1,524,802	0
b	Cost of Goods Sold	40,560,745	40,560,745	0	0
c	Bad Debt Expense	28,581,705	28,581,705	0	0
d	Management Fees	21,521,805		21,521,805	0
e	All other expenses	24,242,876	22,865,855	1,377,021
25	Total functional expenses. Add lines 1 through 24e	1,180,032,097	1,026,235,988	153,507,578	288,531
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
	1	Cashnon-interest-bearing .............	830,871	1	374,262
2	Savings and temporary cash investments .........	282,705	2	344,066
3	Pledges and grants receivable, net ...........	3,414,212	3	3,812,152
4	Accounts receivable, net .............	135,003,069	4	127,500,666
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	10,046,399	8	10,143,838
9	Prepaid expenses and deferred charges ..........	11,936,459	9	11,094,375
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	971,123,343
b	Less: accumulated depreciation .....	10b	644,100,138	341,170,336	10c	327,023,205
11	Investments—publicly traded securities ..........	386,672,271	11	404,678,771
12	Investments—other securities. See Part IV, line 11 .....	28,139,728	12	770,643
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	7,819,845	15	57,320,760
16	Total assets. Add lines 1 through 15 (must equal line 34)......	925,315,895	16	943,062,738
	17	Accounts payable and accrued expenses .........	82,424,257	17	60,549,128
18	Grants payable .................		18
19	Deferred revenue ................	11,939,650	19	6,939,535
20	Tax-exempt bond liabilities .............	379,891,311	20	370,849,064
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other 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 ..	1,984,777	23	1,228,803
24	Unsecured notes and loans payable to unrelated third parties ....	1,930,180	24	0
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....................	9,411,578	25	3,164,318
26	Total liabilities. Add lines 17 through 25.........	487,581,753	26	442,730,848
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	436,481,051	27	499,512,581
28	Temporarily restricted net assets ...........	976,854	28	541,533
29	Permanently restricted net assets ...........	276,237	29	277,776
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	437,734,142	33	500,331,890
34	Total liabilities and net assets/fund balances ........	925,315,895	34	943,062,738

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

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

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

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I

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

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

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

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

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

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

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

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

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

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

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

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

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

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

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

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

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

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

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

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

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

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

Yes

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

11g(i)

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

11g(ii)

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

11g(iii)

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

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2012

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2011 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2012. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2012

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2008	(b) 2009	(c) 2010	(d) 2011	(e) 2012	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

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

Section C. Computation of Public Support Percentage

Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2011 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2011 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2012. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

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

Schedule A (Form 990 or 990-EZ) 2012

Page 4

Part IV

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

Facts And Circumstances Test

Explanation
Schedule A, Part IV, Supplemental Information: Park Nicollet Methodist Hospital Line 3; 170(b)(1)(a)(iii) Park Nicollet Clinic Line 3; 170(b)(1)(a)(iii) Park Nicollet Institute Line 4; 170(b)(1)(a)(iii) Park Nicollet Health Care Products Line 11 Type II; 509(a)(3) PNMC Holdings Line 11 Type I; 509(a)(3) Part I, Line 11: Supporting organizations detail: PNMC Holdings and Park Nicollet Healthcare Products provide support to following organizations: PNMC Holdings: Line 11, column (i) Park Nicollet Clinic, (ii) 41-0834920, (iii) 170(b)(1)(a)(iii), (iv), Yes, (v) Yes, (vi) Yes, (vii) $2,205,011 Park Nicollet Health Care Products: Line 11, column (i) Park Nicollet Methodist Hospital, (ii) 41-0132080, (iii) 170(b)(1)(a)(iii), (iv), Yes, (v) Yes, (vi) Yes, (vii) $5,622,927 Line 11, column (i) Park Nicollet Clinic, (ii) 41-0834920, (iii) 170(b)(1)(a)(iii), (iv), Yes, (v) Yes, (vi) Yes, (vii) $66,447,892

Schedule A (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

OMB No. 1545-0047

2012

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

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

General Rule

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

Special Rules

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

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

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

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

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 2

Name of organization Park Nicollet Group Return

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 3

Name of organization Park Nicollet Group Return

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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 4

Name of organization
Park Nicollet Group Return

Employer identification number

45-5023260

Part III

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

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

(a) No.
from
Part I

(b) Purpose of gift

(d) Description of how gift is held

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

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

See separate instructions.

OMB No. 1545-0047

2012

Open to Public
Inspection

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

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

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

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

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

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

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

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I-A

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

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

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

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

Part I-B

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

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

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

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

Yes No

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

Yes No

If "Yes," describe in Part IV.

Part I-C

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

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

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

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

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

Yes No

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

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

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2012

Page 2

Part II-A

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

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

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

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

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2009	(b) 2010	(c) 2011	(d) 2012	(e) Total

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2012

Page 3

Part II-B

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

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

(a)

Yes

(b)

Amount

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

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

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

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

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

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

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

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

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

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

Yes

56,865

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

56,865

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

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

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

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

Part III-A

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

Yes

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

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

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

Part III-B

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

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

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

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

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

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

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

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

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

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.

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

Schedule C (Form 990 or 990EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I

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

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

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

Yes No

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

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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


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

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

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

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

Yes No

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

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

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

Yes No

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

Part III

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

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

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

(i)

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

(ii)

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

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

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

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

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

Cat. No. 52283D

Schedule D (Form 990) 2012

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

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

Yes No

Part IV

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

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

Yes No

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


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

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

Yes No

If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

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

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	20,854,970	22,048,592	23,127,080	40,045,623	40,780,143
b	Contributions ........	2,046,767	1,489,934	1,474,161	3,239,794	3,726,005
c	Net investment earnings, gains, and losses	877,865	-341,465	850,097	538,558	-162,788
d	Grants or scholarships .....	1,798,265	2,342,091	3,402,746	20,696,895	4,297,737
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......	21,981,337	20,854,970	22,048,592	23,127,080	40,045,623

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

44.000 %

Temporarily restricted endowment SchDMd Bullet

56.000 %

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

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

Yes

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

3a(i)

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

3a(ii)

Yes

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

Yes

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

Part VI

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

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	27,661,044		27,661,044
b	Buildings ................	450,941,858	265,962,813	184,979,045
c	Leasehold improvements ............	54,239,184	36,490,735	17,748,449
d	Equipment ................	435,145,529	341,646,590	93,498,939
e	Other .................	3,135,728		3,135,728
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				327,023,205

Schedule D (Form 990) 2012

Page 3

Part VII

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

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








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

Part VIII

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

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









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

Part IX

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

(a) Description				(b) Book value
(1) Due From Related Parties				54,243,700
(2) LT Real Estate Deposits				35,018
(3) Bond Issue costs				3,042,042






Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				57,320,760

Part X

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

1.(a) Description of liability		(b) Book value
Federal income taxes
Capital Lease Obligation		84,392
Long-term Capital Lease Obligation		3,079,926







Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		3,164,318
2. Fin 48 (ASC 740) Footnote. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................

Schedule D (Form 990) 2012

Page 4

Part XI 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 XIII.) ............	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 XIII.) ...........	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 XII 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 XIII.) ............	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 XIII.) ............	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 XIII

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
Description of Intended Use of Endowment Funds:	Part V, Line 4:	The term endowment funds for use within Park Nicollet Clinic, Park Nicollet Institute and Park Nicollet Methodist Hospital are for Grants related to Education, Research and Patient Care.
Description of Uncertain Tax Positions Under FIN 48:	Part X, Line 2:	Park Nicollet Health Services and affiliates adopted the provisions of FIN 48, Accounting for Uncertainty in Income Taxes - an interpretation of FASB Statement No. 109, on January 1, 2007. As a result of the implementation of FIN 48, Park Nicollet Health Services and affiliates were not required to recognize a liability for unrecognized tax benefits. There were no unrecognized tax benefits for the years ended December 31, 2011 and 2012.

Schedule D (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

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

Attach to Form 990. Right pointing arrow large image

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization
Park Nicollet Group Return

Employer identification number

45-5023260

Part I

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

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

assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used to award

the grants or assistance? ...................................

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside
the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in region	(d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in region	(f) Total expenditures for and investments in region
	East Asia and the Pacific	0	0	Program Services	Education	27,617
	Europe (including Iceland & Greenland)	0	0	Program Services	Education	20,716
	North America	0	0	Program Services	Education	19,999














3a	Sub-total .....	0	0			68,332
b	Total from continuation sheets to Part I ...	0	0			0
c	Totals (add lines 3a and 3b)	0	0			68,332

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2012

Schedule F (Form 990) 2012

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

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

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

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

Schedule F (Form 990) 2012

Schedule F (Form 990) 2012Page 3

Part III

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

Part III can be duplicated if additional space is needed.

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

Schedule F (Form 990) 2012

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2012

Page 5

Part V

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

Identifier	ReturnReference	Explanation

Schedule F (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

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

Yes

100% 150% 200% Other 27500.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

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

Yes

200% 250% 300% 350% 400% Other 38500.0000000000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

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

Yes

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

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

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

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..		9,770,007	83,924	9,686,083	0.840 %
b	Medicaid (from Worksheet 3, column a) ....		110,462,687	65,424,712	45,037,975	3.910 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .		120,232,694	65,508,636	54,724,058	4.750 %
Other Benefits		28,822	4,467,384	631,135	3,836,249	0.330 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	28,822	4,467,384	631,135	3,836,249	0.330 %
f	Health professions education (from Worksheet 5) ..		6,031,132	1,443,276	4,587,856	0.400 %
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)		7,506,770	6,042,957	1,463,813	0.130 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)
j	Total. Other Benefits ..	28,822	18,005,286	8,117,368	9,887,918	0.860 %
k	Total. Add lines 7d and 7j .	28,822	138,237,980	73,626,004	64,611,976	5.610 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012

Schedule H (Form 990) 2012

Page

Part II

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

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	7,281	7,281	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	7,281	7,281

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

18,031,554

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

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

126,482,048

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

125,069,455

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

1,412,593

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

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

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

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

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

Schedule H (Form 990) 2012

Page

Part VFacility Information

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

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

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

	Park Nicollet Methodist Hospital
Name of hospital facility or facility reporting group

For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If “Yes,” indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 12

In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If “Yes,” indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 275.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 385.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a	Income level
b	Asset level
c	Medical indigency
d	Insurance status
e	Uninsured discount
f	Medicaid/Medicare
g	State regulation
h	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a	The policy was posted on the hospital facility’s website
b	The policy was attached to billing invoices
c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d	The policy was posted in the hospital facility’s admissions offices
e	The policy was provided, in writing, to patients on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)
17	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........	17		No
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Part VI)

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the patients regarding the patients’ bills

Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Part VI)

Policy Relating to Emergency Medical Care

Yes

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........

Yes

If “No,” indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................

If “Yes,” explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? .........................

Yes

If “Yes,” explain in Part VI.

Schedule H (Form 990) 2012

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?29
Name and address		Type of Facility (describe)
1	Struther's Parkinson Center 6701 Country Club Drive Golden Valley,MN55427	Research and Treatment of Parkinson's Disease
2	Park Nicollet Melrose Institute 3625 Monterey Drive St Louis Park,MN55416	Eating disorder clinic/General Medical
3	3900 ClinicAmbulatory Surgical Ctr 3900 Park Nicollet Boulevard St Louis Park,MN55416	Ambulatory Surgical Center and General Medical and Retail
4	Meadowbrook Medical Building 3931 Louisiana Avenue South St Louis Park,MN55426	Physician offices, ancillary medical services and Medical Retail
5	Prairie Center 8455 Flying Cloud Drive Eden Prairie,MN55344	Physician offices, ancillary medical services and Medical Retail
6	Bloomington Clinic 5320 Hyland Greens Drive Bloomington,MN55437	Physician offices, ancillary medical services and Medical Retail
7	Brookdale Clinic 6000 Earle Brown Drive Brooklyn Center,MN55430	Physician offices, ancillary medical services and Medical Retail
8	Burnsville Clinic 1400 Fairview Drive Burnsville Clinic,MN55337	Physician offices, ancillary medical services and Medical Retail
9	Carlson Parkway Clinic 15111 Twelve Oaks Center Drive Minnetonka,MN55305	Physician offices, ancillary medical services and Medical Retail
10	Chanhassen Clinic 300 Lake Drive East Chanhassen,MN55317	Physician offices, ancillary medical services and Medical Retail
11	Creekside 6600 Excelsior Blvd St Louis Park,MN55426	Physician offices, ancillary medical services and Medical Retail
12	CT-MRI Center 4951 Excelsior Blvd St Louis Park,MN55416	Imaging Center/Optical Retail
13	Eagen Clniic 1885 Plaza Drive Eagan,MN55122	Physician offices, ancillary medical services and Medical Retail
14	Golden Valley Clinic 8240 Golden Valley Drive Golden Valley,MN55427	Physician offices, ancillary medical services and Medical Retail
15	Lakeville Clnic 18432 Kenrick Avenue Lakeville,MN55044	Physician offices, ancillary medical services and Medical Retail
16	Maple Grove Clnic 15800 95th Avenue North Maple Grove,MN55369	Physician offices, ancillary medical services and Medical Retail
17	Maple Grove OB 9855 Hospital Drive Suite 275 Maple Grove,MN55369	OB services
18	Maple Grove Rehab 9827 Maplge Grove Pkwy North Maple Grove,MN55369	Rehabiliation Services
19	Minneapolis Clinic 2001 Blaisdell Avenue South Minneapolis,MN55404	Physician offices, ancillary medical services and Medical Retail
20	Minnetonka - Shorewood Clinic 19685 Highway 7 Shorewood,MN55331	Physician offices, ancillary medical services and Medical Retail
21	Plymouth Clinic 3007 Harbor Lane North Plymouth Clinic,MN55447	Physician offices, ancillary medical services and Medical Retail
22	Prior Lake Clinic 4670 Park Nicollet Avenue SE Prior Lake,MN55372	Physician offices, ancillary medical services and Medical Retail
23	Shakopee Clinic 1415 St Francis Avenue Shakopee Clinic,MN55379	Physician offices, ancillary medical services and Medical Retail
24	Shakopee Clinic 1515 St Francis Avenue Shakopee Clinic,MN55379	Physician offices, ancillary medical services and Medical Retail
25	Shakopee Clinic 1601 St Francis Avenue Shakopee Clinic,MN55379	Physician offices, ancillary medical services and Medical Retail
26	St Louis Park Clinic 3800 Park Nicollet Blvd St Louis Park,MN55416	Physician offices, ancillary medical services and Medical Retail
27	St Louis Park Clinic 3850 Park Nicollet Blvd St Louis Park,MN55416	Physician offices, ancillary medical services and Medical Retail
28	Wayzata Medical Building 250 Central Avenue North Wayzata,MN55391	Physician offices, ancillary medical services and Medical Retail
29	Rogers Clinic 13688 Rogers Drive Rogers,MN55374	Physician offices, ancillary medical services and Medical Retail

Schedule H (Form 990) 2012

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8	Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.

Identifier	ReturnReference	Explanation
		Part I, Line 6a: Park Nicollet Foundation a related organization of Park Nicollet Methodist Hospital completes an organization wide annual community benefit report that includes Park Nicollet Methodist Hospital and other affiliated entities.
		Part I, Line 7: Park Nicollet Methodist Hospital uses the cost-to-charge ratio method when calculating the amounts reported on part I, line 7. The cost-to-ratio was derived using Worksheet 2, ratio of patient care-cost-to charge, from the schedule H instructions.
		Part I, L7 Col(f): Bad Debt Expense of $28,581,705 was subtracted for purposes of calculating the percentage in Schedule H, Part I, Line 7, column (f).Part III, Line 3: Park Nicollet Methodist Hospital and its affiliates work with those qualifying for charity care along every step of the process including accepting applications for financial assistance after previous attempts to work with the patient fail. Every effort is made to work with the patient to provide financial assistance when appropriate. While there are people who do not cooperate with the hospital regarding payment plans, financial assistance or with those trying to help them get on government programs, it is impossible to know their reason for not cooperating and therefore know whether they may have qualified for charity care. Park Nicollet doesn't have predictive software which would make assumptions based on housing situation, credit reports, etc. and recommend assistance without a process for gathering income verification. In light of the foregoing facts, Park Nicollet is unable to reasonably determine whether any amount of bad debt could have been classified as charity care.
		Part II: Park Nicollet Methodist Hospital partnered with first responders from the cities of St. Louis Park, Edina, Eden Prairie, Hopkins, Richfield, Minnetonka, Chanhassen and Bloomington to conduct training using Methodist Hospital 8th Floor. The drill helped firefighters develop skills for search, rescue and evacuations in a hospital setting. This event was planned in order to be prepared for a variety of disaster situations. Because Methodist's 8th Floor is scheduled for remodeling in the near future, this is a unique opportunity to use an empty hospital floor for this kind of training.
		Part III, Line 4: Park Nicollet Methodist Hospital's audited financial statements include a footnote discussing bad debt expense, or allowance of doubtful accounts. The footnote is located on Note 7 on page 14 and 15 of the attached Audit Report.
		Part III, Line 8: Park Nicollet Health Services believes that all of the Medicare loss should be classified as a community benefit. If these services were not provided to Medicare beneficiaries they would become the obligation of the federal government. Based on this, Medicare losses should be included as a community benefit because the losses are incurred while performing an important public service. The Medicare loss for Park Nicollet Methodist Hospital is based on the Medicare Cost Report as instructed per the 990 Schedule H instructions. The Medicare Cost Report only includes allowable costs for traditional Medicare products. Allowable costs are defined by the Centers for Medicare and Medicaid and do not include all of the costs that are incurred while providing services. If all costs where included in the calculation along with our Medicare advantage products our Medicare loss would be $9.0 million. In addition to the loss incurred at Park Nicollet Methodist Hospital, Park Nicollet Clinic incurred a Medicare loss of $63.0 million. This includes all Medicare products and all costs incurred by the clinic while providing services to Medicare beneficiaries.The losses from Medicare products for the group of entities included in this Group return total $72 million.
		Part III, Line 9b: The collection policy incorporates the requirements as stated by the Minnesota Attorney general and views account resolution through the Park Nicollet financial assistance program as an option for account resolution. This option is shared with debtors via statements and as part of collection calls to debtors from Park Nicollet staff and collection agencies. Park Nicollet's financial assistance is also described in pamphlets and on our website. The website includes a simple interactive schedule to allow a debtor to see if they may qualify. If the Debtor qualifies for financial assistance, collection efforts cease and charges are cleared from their account.
	Part III, Line 2:	Bad debt is accounted for on the financial statements by estimating patient liability net of any charity care and then calculating what portion of that will not be collected based historical uncollectable rates. When a patient meets our financial requirements it is classified as charity care; if they do not quality, their services will be written off as bad debt. Park Nicollet Methodist Hospital does not include any charity care in their bad debt expense calculation.
Park Nicollet Methodist Hospital		Part V, Section B, Line 3: Over 1,100 community members representing area government, schools, churches, social service agencies, and healthcare providers were identified to participate in an online survey and focus Group. An online survey was conducted using Survey Monkey. The survey tool was designed to gain information from the respondents about their geographic location along with connections in the community. In addition to the online survey these community participants were also offered the opportunity to attend one of seven community-based focus groups using the World Cafe model of facilitation. These were offered in seven different locations and provided the opportunity for participants to engage in dialogue that would offer more in-depth about their communities and the identified needs. Team Members from Park Nicollet Health Services were present to take notes and summarize responses. The community needs assessment leadership team reviewed the input from both surveys and focus groups identified seven key themes that consistently emerged. An additional three areas of need were identified; although not consistently reported, they were felt to be important for inclusion in the report. To broaden the information received, meetings were held with groups of professionals for insight gathering and targeted to specific areas identified by Park Nicollet's community participants. Additional meetings with Somali Community Health Workers through Wellshare and retired physicians from Methodist Hospital were also held. Focus group participants included community members from the following organizations: Children First, IOCP, PNF Successful Aging Initiative, Crisis Connection, Pillsbury House, Mission, Inc., Minneapolis Crisis Nursery, Shalom Hospice, Teens Alone, Wellshare, Pathways, Saints Healthcare Foundation, Shakopee School District, City of Shakopee, Prior Lake/Savage School District, PNHS Stroke Inspire, St. Mary's Health Clinics, City of St. Louis Park, Depot Coffee House, STEP, Youth Care, Children's Dental Service, Bloomington School District, Alzheimer's Association, Lenox Center, Community In Collaboration Council, Greater Wayzata Area of Commerce, Community Education Advisory Council, Wayzata School District, St. David's Center for Child and Family Development, St. Louis Park School District, City of Chanhassen, Relate Counseling Center, Hopkins School District, ICA, Store to Door, City of Golden Valley, Greater Minneapolis Council of Churches.
Park Nicollet Methodist Hospital		Part V, Section B, Line 5c: Park Nicollet Health Services Board of Director's approved the Implementation Strategy for Park Nicollet Methodist Hospital during 2012. A copy of the Community Health Needs Assessment and Implementation Strategy is posted to the Park Nicollet website at http://www.parknicollet.com/CommunityAndVolunteerism/Community%20Needs%20Health%20Assessment
Park Nicollet Methodist Hospital		Part V, Section B, Line 7: Park Nicollet Methodist Hospital did not address the following needs identified in the Community Health Needs Assessment as these programs are adequately funded at the county level through federal, state, and county resources:Teen Pregnancy and Teen ParentingTeen and Young Adult Drug and Alcohol AbuseSmoking CessationPark Nicollet Methodist Hospital completed its Community Health Needs Assessment in December 2012 when it was approved by the Board of Directors. An implementation plan was also adopted by the Board, but execution of the implementation strategies did not begin until January 2013.
Park Nicollet Methodist Hospital		Part V, Section B, Line 20d: Park Nicollet uses the discount rate associated with our "most preferred payer" which is defined as our largest commercial payer.
Park Nicollet Methodist Hospital		Part V, Section B, Line 22: Park Nicollet charges its patients gross charges if the patient has elective surgery, which is not medically necessary.
	Part VI, Line 2:	In late 2012, Park Nicollet Health Services Methodist Hospital completed its Community Health Needs Assessment. This assessment was the culmination of work that began in 2011 and was presented to and approved by the Park Nicollet Board of Directors in December 2012. This work resulted in the creation of the Park Nicollet Methodist Hospital 2013-2015 Implementation Strategy to meet community health needs identified through this process.To develop this needs assessment, Park Nicollet drew upon long-standing relationships with the broader community it serves and internal resources focusing on research and data analytics. For 22 years, Park Nicollet has convened populations of patients, government and service organizations in its service area in order to identify and act upon community needs. These convening activities became a valuable tool to survey and identify needs across the Park Nicollet Methodist Hospital and Park Nicollet Clinics' service areas.The Park Nicollet Foundation developed and integrated a successful "community connectivity model" in its planning process, developing priorities and goals across the entire organization. As a convener of communities across the service area, Park Nicollet engaged individuals within the community, social service agencies both public and private, established community organizations and community leaders in order to identify areas of unmet need within the community. Park Nicollet also brought to bear internal expertise, health data and administrative resources to partner with the community to identify needs. These resources include medical expertise, data analytics and research staff, financial and business services and other administrative services identified as important through the convening process. This convening activity has resulted in the creation of initiatives across the communities served by Park Nicollet Methodist Hospital and the Park Nicollet Clinics. These initiatives include: - Park Nicollet sponsored community clinics. - Growing through grief programs providing grief support and education to children who have experienced death of a loved one. - No Shots, No School Immunization initiatives providing enhanced access for children needing immunizations as part of the No Shots, No School program. - Healthy Community Collaborative groups to discuss issues and topics affecting residents in the community. This initiative currently supports the needs of residents in 8 different communities across our service area. - A Successful Aging Initiative in St. Louis Park providing support to senior citizens in the community to support their various medical and social needs.Community Health Needs Assessment (CHNA) Process:The convening role Park Nicollet plays is successful in identifying ongoing needs across the many communities we serve. In 2011 Park Nicollet began a more formal process to identify the greatest areas of unmet needs. The convening role we play is critical for identifying and creating connections to address needs of residents in the community. However, the CHNA process was more formalized and analytic in nature to pinpoint and prioritize the most prevalent needs in the community. Demographic Analysis/Data:A variety of data sources were used to collect and analyze the geographic, socio-economic and health data on the communities in the Park Nicollet Health Services' service area. These data sources provide a framework for reaching out to community members, local government and social service agencies and social support groups within the community. The following defines the sources used to undertake our Community Health Needs Assessment: - Thomson Reuters - Minnesota State Demographic Center - The Metropolitan Council - The U.S. Census Bureau - The Minnesota Department of Employment and Economic Development - The Minnesota Department of Health, Center for Health Statistics - The University of Wisconsin Population health Institute - The Centers for Disease Control (CDC) and Prevention's Behavioral Risk Factor Surveillance System (BRFSS) - CDC's National Center for Chronic Disease Preevention and Health Promotion - National Center for health Statistics - The Minnesota Hospital Association - Internal Park Nicollet DataPark Nicollet:The CHNA process is designed to reach broadly into the community to identify needs, gaps and barriers to health and health services. Deploying primary research, data analysis, validation and prioritization, the assessment process identified the following seven key themes of need: 1. Mental Health 2. Obesity 3. Seniors 4. Connecting Community Resources 5. Access and Affordability of care 6. Wellness 7. Culturally sensitive careThe process also identified the need for teen and young adult drug and alcohol abuse, teen pregnancy and parenting and smoking cessation; however, these needs did not elevate themselves to the level of the seven identified themes due to the availability of services already available in the community.Park Nicollet Methodist Hospital's CHNA was designed to provide broad community input from both primary research and analysis of existing community data. Park Nicollet was able to draw upon the above mentioned initiatives and processes to undertake this analysis of community need. The key elements of the CHNA process included the following teams and processes:1. A leadership team that was charged to conduct the 2011/2012 Needs Assessment:The responsibilities of this team included research and understanding of the requirements of a Community Health Needs Assessment, developing a strategic design for primary research and data analytics, validation and prioritization of the results and preparation of a final formal report that would be presented to the Park Nicollet Health Services Board of Directors. 2. A guidance group:The guidance group provides the skills and expertise of a diverse representation of: a. Park Nicollet Methodist Hospital b. Park Nicollet Foundation c. Area schools d. Local social service agencies e. Members of the community. f. County Government Health AgenciesThe guidance group met three times to review the proposed plan design for the CHNA, review preliminary results, assist with prioritization of the needs identified and provide input into potential responses to the identified needs. 3. Primary Research:Over 1100 community members representing churches, government, schools, social service agencies and health care providers were identified to participate in an online survey and focus group meetings across our service area. Park Nicollet leaders were also involved in this survey and focus group process. The survey was conducted using Survey Monkey. The survey tool was designed to obtain information from the respondents about their geographic location and their connections in the community. The survey asked the following questions of respondents: a. Which geographic region do you most affiliate with? Using state demographic data from the state Demographer, respondents were given seven geographic locations to choose from within the service area, with cities identified within each region. b. In your opinion, what are the major health care concerns in your community? c. Which health care concerns of those listed is the Most Important for the community to address? d. What role should Park Nicollet Clinics and Methodist Hospital play in responding to the most important concerns you identify? e. Are you aware of any services offered in your community to address concern you identified?4. Focus Groups:Using the World Cafe model of facilitation, community participants were also offered the opportunity to attend one of seven community - based focus group meetings. Each focus group was encouraged to discuss: a. What top needs most impact the health and wellness of individuals and families in your local community? b. What would it take to create the change needed to address these issues? c. What is the unique role of Park Nicollet Methodist Hospital in responding to those needs? d. Who in the community should be involved and why should they care?The results from the survey and the focus groups were tabulated. The leadership team then reviewed the summaries and identified seven key themes that consistently emerged in the data. 5. Additional Group Meetings:To broaden the information gathered, additional meetings were also held with small groups of professionals for insight gathering and targeted to specific areas identified by community participants. As a result meetings were also held with Somali Community Health Workers and retired physicians from Methodist Hospital.
		6. Validation Process:Once the key themes of need were identified and prioritized, meetings were scheduled with county health departments to discuss our findings and compare them with results from their own county needs assessments, and to identify any potential gaps that may exist from our own research. Prioritization of Community Health Needs:Once the responses through the survey and focus group process were collated, the results were presented to the CHNA Guidance Group, Park Nicollet Health Services Executive and Management Group and the Park Nicollet Foundation Board of Directors, for review, comment and prioritization. Participants were asked to rank each identified theme based on two criteria: importance or impact that the theme had on community health need; and, how strongly the theme correlated with Park Nicollet's strengths as a health care system. The results were then aggregated, summarized through averaging of rank values and plotted into a bubble graph. This process informed Park Nicollet on the major themes of need identified by the community and resulted in the development of a "Park Nicollet Methodist Hospital 2013-2015 Implementation Strategy" to meet Community Health Needs. Since the conclusion of this process, Park Nicollet hired staff to lead this process.
	Part VI, Line 3:	Park Nicollet Methodist Hospital participates in multiple unique financial assistance programs, including our own Financial Assistance (FA). We inform our patients in multiple ways about our FA program and other financial assistance options for services received at PNHS. Approximately 14 percent of hospital patients participate in state public programs and approximately 2 percent are uninsured.In addition to the written material, Customer Service, Collections and hospital Patient Access Liaisons (PALs) inform patients about assistance options, including government programs and FA. PALs are on-site in the hospital and can meet with patients in their rooms or prior to admission. Most customer service and collections work is done though phone calls, but our main clinic has an on-site location for personal conversations. Park Nicollet Methodist Hospital staff is trained in helping patients apply for Medical Assistance and has also contracted with outside services to assist patients in the application process for Medical Assistance in more complicated circumstances.
	Part VI, Line 4:	Park Nicollet Health Services is an integrated delivery system that includes Park Nicollet Methodist Hospital, 24 clinic locations and 10 specialty care centers, all of which are located in the west metropolitan area of the Twin Cities. The service area for the system defines the communities we serve and primarily includes the counties of: Hennepin, Carver, Dakota, and Scott. Park Nicollet Health Services also serves patients in Wright, Rice, Sibley and Le Seuer Counties. Park Nicollet Health Services draws patients from a larger 96 zip code service area. Park Nicollet Methodist Hospital's primary catchment area covers a smaller 28 zip code service area. Ninety percent of Park Nicollet's outpatient clinic visits and eighty-eight percent of Methodist Hospital admissions come from the 96 ZIP code service area. Fifty-four percent of the Methodist Hospital admissions come from the 28 ZIP code service area. The population density in the Park Nicollet Service Area consists of a mix of urban, suburban, ex-urban and rural communities. In order to fit our analysis to more specific communities within the broader service area, our assessment focused on the sub services areas defined in the following manner: - Core Service Area - Minneapolis Service Area - North East Service Area - North West Service Area - South East Service Area - South West Service Area - West Service AreaThis breakdown assures that needs are properly identified in accordance with the specific population of patients served by Service Area and reflects population density socio-economic factors. It also permits survey and focus group respondents to speak to needs based upon their own local community.Population Demographics:Based on 2010 estimates, 1.65 million people reside within the Park Nicollet 96 ZIP code service area. 535,000 people (one-third) reside within the smaller 28 ZIP code service area. Population density varies by the 7 service areas Park Nicollet serves and is described below. - Core Service Area (401,085) - Minneapolis Service Area (249,171) - North East Service Area (184,062) - North West Service Area (226,685) - South East Service Area (334,393) - South West Service Area (101,825) - West Service Area (157,176)Park Nicollet's service area (96 ZIP codes) is estimated to grow 3.2% in the next five years. The most significant growth in populations is projected to occur in the suburban and ex-urban service areas while the Core Service area, the Minneapolis Service Area, and the North East service area populations are expected to experience no growth. Over the next 20 years the population growth in the broader Park Nicollet service area is expected to grow by less than 1% per year, however, the biggest change during this 20 year period will be in the aging of the population served by Park Nicollet. Over the next 20 years the 65+ age group is estimated to more than double. The following section describes the demographic constituencies served by Park Nicollet Health Services:1. The Aging Population: The Core Service Area contains a more aged demographic than the other Service areas served by Park Nicollet. In the Core Service Area, 15% of the population is 65+ years old and 45% are 45+ years old. The North West and the South East Service Areas have a low distribution of population aged 65+. The first ring suburbs (Golden Valley, Richfield, St. Louis Park, New Hope and Edina) have large senior populations. There are also dense pockets of aged (65+) in Burnsville, Apple Valley, Minneapolis, Brooklyn Center, Brooklyn Park, Wayzata and Excelsior. 30% of seniors in the Park Nicollet Service area are currently in situations where they are living alone. 2. Minority Populations:Park Nicollet Health Services' service area contains a very diverse population of patients. There is wide variation in populations served across the 7 sub-service areas. The North East Service Area and the Minneapolis Service Area have the largest minority populations, 49% and 40% respectively. The West and the North West Service areas have low minority populations, 7% and 8% respectively. The most prevalent minority groups also vary by Service Area: * Hispanic population is the top minority group in 3 of 7 service areas (Minneapolis, South West and West). * Asian population is the top minority group in 3 of 7 service areas (Core, North West and South East) * Black population is the top minority group in 1 of the 7 service areas(North East).Minority population density is greater in areas in or near to the urban core of the Twin Cities.Over the next 5 years, the Park Nicollet service area population is estimated to grow by 3.8%. The minority populations are expected to account for 79% of that growth. Population growth in the Hispanic population is expected to see the largest increase over the next 5 years (22.3%). The largest portion of the increase in the Hispanic population is expected to occur in the Minneapolis Service Area. Nearly all service areas expect to see double digit increases in minority populations through 2015. Population Income and Access to Insurance:The diversity in income in the Park Nicollet service area is also very diverse. While the Park Nicollet Service Area contains 22 of the top 25 wealthiest zip codes (situated in the West/North West Service areas), the Eastern Service Area contains several low income zip codes (Core, Minneapolis, North East Service Areas). The West, North West, South East and South West service areas have the highest distribution of upper income households. Like income, the suburban/ex-urban service areas (North West, South East, South West and West) have a high percentage of the population that is commercially insured (80+%). The sub-service areas with the highest percent of Medicare patients include the Core (16%), Minneapolis (10.8%), North East (10.5%) and West (10.4%). The Minneapolis and the North East service areas have high Medicaid populations compared to the other service areas, with the Minneapolis Service Area having 16.7% and the North East Service Area having 14.3%.
	Part VI, Line 5:	Park Nicollet Health Services furthers its exempt purposes in multiple ways through its Methodist Hospital, Park Nicollet Clinics, its specialty programs and its commitment to research and education. Park Nicollet strives to meet its commitment to the Triple Aim of providing high quality health care at an affordable cost to the community by enhancing the patient experience. Park Nicollet's commitment to the patient and family experience is articulated through a focus on "Head + Heart, Together" (HHT)."Head" refers to our work around evidence-based medicine, our attention to clinical outcomes, the way we will use data to make decisions about the best care protocol to follow, and to the business of running a large healthcare system. "Heart" is all about providing compassionate care in the moment and keeping our patients at the center of everything we do and every decision we make. When we work across boundaries with our patients and families, we won't do things "to" or "for" patients we will do things with patients and their families."Together" means doing both head- and heart-centered activities in combination. It also means working as a team across departments and specialties, all of us united around caring together with our patients, their families in the communities we serve.Entities included in this return that further Park Nicollet Health Services exempt purpose , are Park Nicollet Methodist Hospital, a 426 bed hospital in St. Louis Park, Park Nicollet Clinic, with 19 primary care clinic locations in its 96 ZIP code service area, 30 lines of specialty services, and 8 specialty centers, Park Nicollet Institute, research and education, and Park Nicollet Health Care Products. Outside of the group, Park Nicollet Foundation serves as the convener of the communities we serve, involving Park Nicollet administrative and medical staff, to assess community need and facilitate a broad array of clinical and specialty services and the administrative support to meet unmet needs in the community. The Park Nicollet Foundation also provides financial assistance to community organizations and services that are consistent with needs identified by its Board of Directors. Park Nicollet's integrated system provides community benefit to underserved populations through convening of communities, education and support of patients and community members diagnosed with chronic disease, and research to improve quality of life. Health professionals within the integrated system assist patients in the community, in the state, in the nation, and around the world who need specialized programs and services for various conditions. Park Nicollet is also a recognized leader in process improvements to coordinate patient care and provide patients with social support systems to improve population health. This has been accomplished through its initiatives through the Physician Group Practice Demonstration Program sponsored by the Centers for Medicare and Medicaid Services. Park Nicollet also participates in the Pioneer ACO Demonstration that is sponsored by the Center for Medicare and Medicaid Innovation. In addition to innovating around care delivery design and patient support services, Park Nicollet participates in multiple learning initiatives through the demonstration program to share its knowledge and lessons learned with other organizations across the community and the country. Park Nicollet has been committed to these efforts in support of its commitment to the Triple Aim by providing communities with support systems assisting patients and families to improve their health. Park Nicollet Supports Community Sponsored Clinics:In 2012, in addition to funding programs and services to enhance the patient/family experience, the Park Nicollet Foundation granted nearly $850,000 directly to organizations that support the health and well-being of the communities we serve. We offer no-charge healthcare to children from infancy through high school at our community clinics in Brooklyn Center, Burnsville, St. Louis Park and Wayzata. No-charge and low-cost dental and mental health care is available by appointment at select clinics. Participating families include those who are unable to afford healthcare, are new to the area or have sensitive healthcare needs. Walk-in visitors are welcome at all locations. All clinics are operated in partnership with local school districts and funded by Park Nicollet Foundation. In 2012, there were 4336 visits to these clinics. The Brooklyn Center clinic alone had 1800 visits.Participating Park Nicollet Clinic locations: - Brookdale - Chanhassen - Creekside - Eagan - Golden Valley - Maple Grove - Minnetonka (Shorewood) - Plymouth - St. Louis Park - WayzataNo Shots No School Initiative:Minnesota law requires immunizations, or written proof of exemption, for school-age children to attend school. Park Nicollet Foundation collaborates with school districts to have all children immunized. Park Nicollet offers enhanced access for children needing immunizations as part of the No Shots, No School program, which is available May, August and the first two weeks of September. Participating school districts encourage parents to schedule appointments with a primary care doctor early to ensure required immunizations are given and documented well in advance of starting school. It takes at least four months to complete the Hepatitis B series.Park Nicollet provides immunization-only visits on a same-day appointment basis; immunizes children without a doctor visit or preventive care exam at the time of immunization; immunizes children not previously established as patients with the clinic; and provides immunizations to children with no direct charge to families.Park Nicollet Sponsored Community Collaboratives:Park Nicollet Foundation regularly convenes collaborative groups to discuss issues and topics affecting residents in the community. These meetings are held at different locations throughout Park Nicollet's service area. The following are some examples of this work: - Children First - Dakota County Healthy Community Collaborative - Meadowbrook Collaborative - NorthWest Hennepin Collaborative. - St. Louis Park Successful Aging Initiative - Scott County Healthy Community Collaborative The following are examples of specific activities that are supported by the Park Nicollet Foundation and Park Nicollet Health Services and demonstrate the organization's commitment to the community and meeting unmet community needs. 1. Growing Through Grief Program:Growing Through Grief is a school support program that provides 1:1 counseling and groups for children and teens who have experienced the death of someone important in their life. Over 450 students are served by the program on a weekly basis. 54 groups and 56 1:1 counseling sessions occur weekly. The children and teens age range served is 5 years of age to 18 year olds. All socio-economic groups are served. Students served are in the school districts of Osseo-Maple Grove, Wayzata, Hopkins, Mound-WestTonka, Minnetonka, St. Louis Park, Chanhassen/Chaska, Burnsville, Edina, Minneapolis; Eastview and Rosemount High Schools. Counselors serve on the emergency response team for schools. Counselors are certified traumatologists. This program is supported by Park Nicollet Foundation. Total expenses for 2012 were $212,692.2. Research and Education Activities:Research:Research is embedded in departments and strategies across Park Nicollet to support quality initiatives and the patient experience. Research encompasses investigator-initiated studies, clinical trials, practice-based research, outcomes and quality improvement projects, data analytics, statistics, survey development and focus groups. At Park Nicollet and Metro Minnesota Community Clinical Oncology Program, up to 500 research studies are active each year. Park Nicollet authors published 46 peer-reviewed papers, books and book chapters in 2012, sharing their findings with the medical community. Park Nicollet Institute provides the infrastructure and resources to support research and clinical quality goals of the organization, which includes the following: - Needs assessment and feasibility - Mentoring and training - Scientific and humans subjects review - Regulatory compliance and reporting - Grant management, including application preparation and submisson, contract and agreement negotiation, finance, budget development, identification of funding sources - Protocol development and research design - Manuscript and poster/presentation preparation - Database development, data cleaning, statistics and analytics, survey review and design, focus group facilitation - Study operations support including recruitment, consenting, enrolling, data collection/entry
		Park Nicollet Institute's Patient Education department provides educational tools to support patients in preventing and managing illness and improving health. We provide programs, classes, videos, web content and decision support tools to help patients take an active role in their health. These resources help patients prevent and manage common health problems, live well with chronic conditions, prepare for procedures and improve overall health and well-being. In 2012, we held 118 patient education classes for 2,200 attendees. We conducted more than 6,757 diabetes education visits. We published 403 new or revised patient education materials. Our Park Nicollet Health Library provides resources and services for patients, family and the community. This includes literature searches and document delivery, as well as access to print, online and Internet resources. In 2012, the Library received 1,899 visitors and conducted 433 information searches for patients and their families. Funds library spends to make available.The Institute's Professional Education department provides learning activities to enhance physician knowledge, competence and performance. Continuing medical education (CME) staff partners with Park Nicollet physicians and departments to manage a comprehensive educational program through activities designed to meet individual and department needs. Our Office of Continuing Medical Education granted 30,464 CME credits through 69 professional education activities in 2012, reaching 8,422 participants.3. Advanced Care Planning and Hospice Education:Advance Care Planning: The program goal is to improve the quality of patient care by creating and implementing a blueprint of ideal management/progression of care planning and goals discussion over the course of adult life. We aim to: 1) define the best practice of progression of conversations and care planning, 2) improve the delivery of time appropriate utilization of existing advance care planning interventions, 3) develop or adopt new tools and processes where gaps exist, and 4) improve communication of goals and treatment preferences across care settings.In 2012, thirty-two community presentations were held and 827 individuals attended. Ten individual support sessions were held in St. Louis Park as part of the Successful Aging Initiative. Parish Nursing: Park Nicollet has five parish nurse programs and financially provides the benefits allocation for all of the nurses. The Foundation provided partial financial support for one program during 2012 and has provided seed funding to assist new programs to start up and operate. Additional benefits are provided through the system. The goals of the program are to provide education regarding wellness and healthy lifestyle, assessment of congregants and community members and referral to appropriate resources, and program development in the areas of health and wellness. Services provided include: blood pressure monitoring and referral for follow-up as needed, 1:1 visits to clients in their homes for assessment of health issues and referral to community resources, counseling regarding health issues, individual and group education on health related issues (advance care planning, exercise, diet, aging, lifestyle factors, etc.). The congregations we work with have an increasing number of elderly members and the nurses often assist in coordinating with other health care professionals.Community Presentations about Hospice: The hospice program provides community education about hospice and end of life issues at no charge to the participants. In 2012 eleven educational programs were held. A total of 120 people attended the community education events. Each one of these events lasted 1.5 hours in duration. Two hospice staff members presented at each session. 4. Providing Patient Financial Assistance:Park Nicollet Methodist Hospital participates in multiple unique financial assistance programs, including our own financial assistance (FA). We inform our patients in multiple ways about our FA program and other financial assistance options for services received at PNHS. A list of communications for patient relating to financial assistance follows: - Hospital booklets given to emergency center patients and inpatients - Website has FA information under Patient Accounts & Services - A financial assistance calculator is available to allow quick and easy estimation of eligibility under the program - A list of frequently asked questions to answer commonly asked questions related to the program - FA application can be printed for submission - All balance forward patient statements with a balance of $200 or greater include an FA application and instruction to complete the application along with answers to frequently asked questions about the FA program.In addition to the written materials, Customer Service, Collections, Financial Counselors and Account Specialists inform patients about assistance options, including government programs and FA. Most customer service and collection work is done over the phone, though many of our clinics and the hospital have staff on site to assist in applying for FA. Park Nicollet Methodist Hospital and clinic staff have also been trained to assist patients in applying for government programs. We also contract with an outside service to assist patients in the government program application process in more complicated circumstances.5. AdvoCare Program:AdvoCare is a free confidential service provided to Park Nicollet patients, employees, and community members who are living with domestic abuse. AdvoCare offers on-call coverage 24 hours a day, 365 days a year. AdvoCare provide face-to-face and/or phone advocacy for patients at Methodist Hospital, Park Nicollet Clinics and Urgent Cares, Melrose Institute, and offer office appointments. AdvoCare also provide phone advocacy for community calls.AdvoCare provides the following to patients and employees who are living with domestic abuse: - Crisis counseling - Advocacy - Safety planning - Information and Education - Emergency Housing Resources (for victims of domestic abuse) - Legal Resources - Information about support groups - On-going supportAdvoCare's Impact 2007-2012: - AdvoCare provided services to 4811 abuse victims. - 3682 of these clients were seen on Park Nicollet grounds while the client was receiving some sort of medical care. - 748 of these clients were community members who received services over the phone. - 381 of these clients were Park Nicollet employees.6. Chaplaincy Programs:Park Nicollet's Chaplaincy programs are supported by the Park Nicollet Foundation through funding from the Foundation. Jewish Chaplaincy Coverage: Funding for which helps support our Jewish Chaplain and his work. Funds are used to pay for expenses for the daily ministry that is provided by this chaplain for our Jewish patients and family members. It also covers expenses related to his weekly Jewish prayer services in our chapel and for chapel supplies.Clinical Pastoral Education: Funding is also made available for our hospice chaplain resident. This resident provides spiritual care and grief support to home and in-patient hospice patients and family member, and participates in our Clinical Pastoral Education program, an intensive graduate level experience that promotes personal and professional growth and more effective ministry.
		7. Eating Disorders Support and Education Services:Park Nicollet Melrose Institute has helped treat and heal patients and families with all types of eating disorders for more than 25 years. Our facilities, located in St. Louis Park and Maple Grove offer varying levels and intensity of treatment including inpatient (sub-acute), residential, and three levels of outpatient care to meet the needs of patients. We use a multidisciplinary approach that includes medical, nutritional, psychological and behavioral care. Our innovative care includes treating males and females of all ages, eating disorders and diabetes, eating disorders and chemical dependency, eating disorders and athletes and recently has expanded to include a metabolic health and weight management program. Melrose aims to provide the best and most comprehensive care to individuals who may be struggling with eating issues. We have contracts with most major insurance companies in the state of Minnesota. We also have financial counselors on staff to help define the in's and out's of insurance plans to patients and their families. In those instances when we are not able to provide the needed services we are able to direct individuals to community resources that might better fit their needs.Our Community Relations Team keeps a pulse on our community's needs and responds to those needs by educating and raising awareness of eating disorders. The team spends hundreds of hours presenting and exhibiting to middle schools, high schools, church youth staff, corporations, physician groups, community professionals, employee assistance programs, and professional conferences to raise awareness of not only eating disorders but the importance of a positive body image. 8. Successful Aging Initiative (Senior Support Services):The mission of the Park Nicollet Successful Aging Initiative is to convene on need and learn from the St. Louis Park Community in order to build a vital aging community where seniors and their care partners will feel supported and have access to health care, services, work and volunteer opportunities. Work committees within the initiative have included Senior Stay Safe At Home, Advance Care Planning, Get Up and Get Active, ACT on Alzheimer's, and transportation. 9. Center for Population Health:Park Nicollet continued efforts this year to advance population health, patient experience and affordability. Under our partnership with CMS we agreed to take financial risk for quality and affordability for our attributed Medicare fee-for-service patients. As a result of this commitment we worked with patients and care teams to identify opportunities for improving health outside of scheduled office visits, urgent care, emergency care or inpatient stays - in pursuit of a continuous healing relationship. And, through the use of high-touch care coordination and case management we helped patients access the care they needed when they needed it and avoid unnecessarily expensive or invasive services. In partnership with physicians, nurses, pharmacists and other members of the medical home we implemented efforts to improve medication therapy, ease transitions of care, follow up with patients after hospitalization and address patients in our community with complex medical and social needs.In addition to the initiatives sited above the Foundation provides financial and other support to assist community non-profit partners. In 2012 that support included:a. Pharmacy for Healthy Youth and Community Clinics:This grant supports the provision of outpatient medications to the uninsured and under-insured youth through the four Park Nicollet Foundation Community Clinics, a mental health program for Hopkins and youth and Healthy Youth Facilitated Access programs.b. Children First:This grant from the Foundation helps the Children First organization spread the asset-building philosophy of the Search Institute throughout the community of St. Louis Park. It supports efforts to encourage all facets of the community to focus on making life better for its youth. c. Meadowbrook Collaborative:This grant supports program implementation in the areas of health, education and safety for the residents of the Meadowbrook neighborhood, a local community in need that is situated next door to Park Nicollet Methodist Hospital. d. Stroke Inspire Program:Stroke Inspire provides support, education, resources, and therapist-guided groups to stroke and brain injury survivors, their families and caregivers, Park Nicollet staff, and the surrounding community. e. West Suburban Teen Clinic (MyHealth):The West Suburban Teen Clinic offers access to adolescent-focused mental health services in two locations. This grant supported five additional hours per week of mental health care and allowed for an increase in the variety of care delivery methods, including offering dialectical behavior therapy (DBT) groups. Staff members have close relationships with teachers, administrators, and school counselors in over 20 school districts, where staff conduct presentations and host youth development groups on-site. In addition the clinic maintains referral relationships with hundreds of other middle schools, junior highs, high schools, alternative schools, and community colleges in the area. f. Intercongregational Communities Association:This grant supports the health of the community (primarily needy seniors) by supporting a refrigerated truck to delivery groceries, including purchasing gas and paying the salary of a driver/coordinator. In collaboration with the local school district, youth learn about hunger through food drive collections in their schools. g. St. Louis Park Emergency Program (STEP):STEP provides rent assistance to keep residents in their homes, transportation to medical appointments, and other social services for the elderly. The Park Nicollet Foundation grant partially funded a part-time transportation coordinator to work with senior citizens to address their need for services.h. ResourceWest:This grant allowed for the provision of in-depth mental health therapy to uninsured individuals, couples and families in the Hopkins and Minnetonka school districts. It also provided resources to reduce transportation barriers that can make it difficult for those served by ResourceWest to follow through on referrals to offsite providers.i. Teens Alone:Park Nicollet support helps Teens Alone provide year-round, free and confidential counseling and crisis services to youth and parents in the western suburbs of Minneapolis. The organization addresses issues of drug/alcohol abuse; emotional, sexual and physical abuse; racial issues; pregnancy; sexual orientation; family breakups; and teen homelessness. j. Interfaith Community Outreach and Community Partners (IOCP):The CONECT (Community Organizations Networking Compassionately Together) program of the IOCP serves more than 800 families living in eight low-income, multi-unit apartment neighborhoods in Plymouth, Minnesota. It offers onsite family and children support services and strong links with community resources. It also engages residents in building healthy neighborhoods. k. YMCA Ridgedale Branch:This grant supported the expansion of YMCA services in Minnetonka heights, a very low income community within the territory served by Park Nicollet Health Services. The grant provides for direct program implementation costs, including supplies, food, staffing, resident assistance, transportation, childcare assistance, class fees, sport team/community education fees and emerging needs. l. Family Partnership; West African Immigrant Outreach:This initiative addresses the mental health concerns of the large West African immigrant population of Brooklyn Park and Brooklyn Center, Minnesota a population that has experienced significant trauma. It works to expand the understanding of mental health among the target population, with the goal of reducing stigma and the reluctance to seek treatment.m. One Heartland:One Heartland offers a week-long family camp for those affected by or at-risk for type 2 diabetes. It focuses on educating children and their parents on ways to improve their health and manage their diabetes with Park Nicollet clinicians acting as content experts.n. Youth Determined to Succeed:Youth Determined to Succeed offers a youth-focused, comprehensive health, fitness and wellness program addressing obesity and weight management challenges. In partnership with their physicians, the program targets youth in Brooklyn Center and North Minneapolis to prevent and manage acute health concerns such as diabetes, cardio-vascular disease and asthma.
	Part VI, Line 6:	Park Nicollet Health Services, an integrated health system includes the members of the Group: 1) Park Nicollet Clinic, with 19 primary care clinic locations, and other care locations, 2) Park Nicollet Methodist Hospital, a 426 bed facility. 3) Park Nicollet Institute, focused on education and research for Park Nicollet Health Services and its community, 4) Park Nicollet Health Care Products, providing retail pharmacy and health related products through existing Park Nicollet locations. Outside of the group, entities include Park Nicollet Foundation, the philanthropic arm of Park Nicollet Health Services helping to bring resources to needs in its communities, and Tria Orthopaedic Center, a leader in orthopaedic treatment, providing comprehensive care from diagnosis, to treatment, to rehabilitation, even surgery in one facility.All affiliates are under a common Board of Directors. Park Nicollet Foundation has a separate board which is overseen by the Park Nicollet Health Services Board. The communities' health needs are shared among the affiliates and decisions regarding the effective use of resources to respond to these needs are coordinated.A specific example of this coordination of services to respond to community need is with the four school-affiliated community clinics. Initial development, funding and ongoing facilitation is provided by the Park Nicolet Foundation, staffing through the Park Nicollet Clinics, laboratory and other diagnostic services through Park Nicollet Methodist Hospital, and outpatient medications, eye glasses, and DME supplies through Park Nicollet Health Care Products.
	Part VI, Line 7: List of States Receiving Community Benefit Report:	MN

Schedule H (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

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

Attach to Form 990

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization
Park Nicollet Group Return

Employer identification number
45-5023260

Part I

General Information on Grants and Assistance

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

Yes No

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

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) Park Nicollet Foundation 6500 Excelsior Blvd St Louis Park,MN55426	23-7346465	501(c)(3)	123,902	Grant Money to Other Organizations

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2012

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.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant
(1) Scholarships	15	20,000

Part IV

Supplemental Information.

Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Identifier	Return Reference	Explanation
Procedure for Monitoring Grants in the U.S.:	Part I, Line 2:	Schedule I, Part I, Line 2: The Park Nicollet Service League has a student volunteer scholarship program to give financial support to student volunteers who have provided exceptional volunteer service and are interested in furthering their education. Applicants must be an active student volunteer, a senior in high school and who has applied to a post-high school education program and must be dedicated volunteer at Park Nicollet Methodist Hospital. Occasionally Park Nicollet Hospital grants monies to other tax-exempt organizations conducting programs and/or research that will ultimately benefit those served by Park Nicollet Health Services and affiliates. During calendar year 2012, grants were made to Park Nicollet Foundation for improvements to medical services and medical research. These grants were made to parties related to Park Nicollet Methodist Hospital, so employees of Park Nicollet Methodist Hospital were able to verify the use of the monies contributed.

Schedule I (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I

Questions Regarding Compensation

Yes

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

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

Travel for companions Payments for business use of personal residence

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

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

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

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

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

Yes

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

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

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

Cat. No. 50053T

Schedule J (Form 990) 2012

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 (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1)David Abelson MDPresident and CEO	(i) (ii)	0 778,762	0 328,156	0 153,743	0 180,400	0 76,163	0 1,517,224	0 132,075
(2)Steven Connelly MDExec VP & CMO	(i) (ii)	0 441,588	0 187,134	0 12,240	0 53,760	0 71,510	0 766,232	0 0
(3)Michael KaupaExecutive VP and COO	(i) (ii)	0 467,702	0 286,948	0 71,559	0 57,600	0 71,463	0 955,272	0 56,421
(4)Sheila McMillanCFO	(i) (ii)	0 412,710	0 172,632	0 12,370	0 51,000	0 41,282	0 689,994	0 0
(5)Leslie Baken MDDirector	(i) (ii)	279,342 0	8,454 0	40,018 0	0 0	49,850 0	377,664 0	0 0
(6)Paul DominskiDirector	(i) (ii)	0 198,130	0 114,965	0 45,766	0 14,000	0 53,471	0 426,332	0 39,136
(7)Roxanna Gapstur PhDDirector	(i) (ii)	0 239,021	0 99,154	0 7,429	0 29,400	0 43,968	0 418,972	0 0
(8)Christa GetchellDirector	(i) (ii)	0 180,846	0 54,489	0 8,735	0 13,725	0 18,797	0 276,592	0 0
(9)Tom Jones MDDirector	(i) (ii)	676,185 0	29,426 0	40,443 0	0 0	52,052 0	798,106 0	0 0
(10)Jeff Mendeloff MDDirector	(i) (ii)	631,734 0	23,466 0	19,105 0	0 0	59,091 0	733,396 0	0 0
(11)William Richards MDDirector	(i) (ii)	125,051 0	6,535 0	110,676 0	0 0	36,279 0	278,541 0	0 0
(12)Janet Schaffer MDDirector	(i) (ii)	290,172 0	0 0	16,225 0	0 0	53,479 0	359,876 0	0 0
(13)Eric Schned MDDirector	(i) (ii)	250,869 0	12,594 0	33,446 0	0 0	48,100 0	345,009 0	0 0
(14)Katherine TarvestadDirector	(i) (ii)	0 244,785	0 0	0 8,461	0 30,000	0 18,745	0 301,991	0 0
(15)Mark Wilkowske MDChief of Oncology Serv	(i) (ii)	464,615 0	38,107 0	11,421 0	0 0	56,769 0	570,912 0	0 0
(16)Theodore WegleitnerTRIA COO	(i) (ii)	0 251,213	0 87,277	0 35,369	0 30,000	0 69,515	0 473,374	0 25,191
(17)Oliver Cass MDMedical Doctor	(i) (ii)	778,299 0	32,545 0	5,371 0	0 0	62,270 0	878,485 0	0 0
(18)Darin Epstein MDMedical Doctor	(i) (ii)	785,318 0	51,475 0	3,457 0	0 0	58,498 0	898,748 0	0 0
(19)Marni Feldmann MDMedical Doctor	(i) (ii)	779,086 0	33,431 0	1,047 0	0 0	61,170 0	874,734 0	0 0
(20)Robert Werling MDMedical Doctor	(i) (ii)	865,289 0	33,873 0	3,153 0	0 0	62,397 0	964,712 0	0 0
(21)Anton Willerscheidt MDMedical Doctor	(i) (ii)	814,283 0	16,737 0	4,304 0	0 0	61,426 0	896,750 0	0 0

Schedule J (Form 990) 2012

Page 3

Part III

Supplemental Information

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

Identifier	Return Reference	Explanation
	Part I, Line 4b	Senior leaders of Park Nicollet Health Services and affiliates are given the opportunity to participate in the Capital Accumulation Account Plan. The Capital Accumulation Account Plan (CAA Plan) participation is limited to senior leaders and all the vice presidents. Each participant receives an annual allowance equal to the sum of (i) a stated percent of salary, (ii) voluntary salary deferrals. The allowance is credited to a bookkeeping account. Earnings are credited to the account based on the performance of simulated investments. Benefits vest upon the earliest of remaining employed to an elective vesting date (two years to age 68), involuntary termination without cause, disability, death, or not competing for 24 months following voluntary or for-cause termination. Benefits are paid in a single lump sum upon vesting. Participants are general creditors of the employer for the payment of the benefits. The following participants received payouts from a related organization, Park Nicollet Health Services, related to CAA plan: - David Abelson, $132,075 - Paul Dominski, $39,136 - Michael Kaupa, $56,421 - Theodore Wegleitner, $25,191
	Part I, Line 7	All physicians, employed by and seeing patients for Park Nicollet Health Services and affiliates, are eligible for a 3% access incentive payout based on their department reaching certain goals including access for patients and quality initiatives. In their roles as executives employed by Park Nicollet Health Services, the executives are eligible for incentive payouts. The incentive award will be 35% of base pay compensation for the CEO, 30% for the CFO, COO, CMO and 25% for all other executives with an opportunity for incentive credit above the target level. The ultimate payout includes a reduction/increase multiplier depending on whether the consolidated Park Nicollet Health Services organization reached that year's operating margin goal as set by the Board of Directors. Each participant will be responsible for two financial goals, and not less than three and not more than five individual strategic objectives. In their roles as management employed by Park Nicollet Health Services, certain managers are eligible for incentive payouts. The incentive award will be 15% of their annual base pay compensation with an opportunity for incentive credit above the target level. The ultimate payout includes a reduction/increase multiplier depending on whether the consolidated Park Nicollet Health Services organization reached that year's operating margin goal as set by the Board of Directors. Incentive payments are a function of both individual and organizational performance. The participant must be assigned at least three, and not more than four focused incentive objective, one of which must be financial in nature.

Schedule J (Form 990) 2012

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I

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

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

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

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

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No
(1) Tom Jones MD	Director	Salary Draw in Excess		X	1,068	1,068		No		No		No
(2) Janet Schaffer MD	Director	Salary Draw in Excess		X	7,088	7,088		No		No		No
(3) Eric Schned MD	Director	Salary Draw in Excess		X	5,123	5,123		No		No		No
(4) Anton Willerscheidt MD	Highest Compensated Employee	Salary Draw in Excess		X	6,096	6,096		No		No		No


Total ...... $						19,375

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 assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2012

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) Shannon Neale MD	William Richards, MD Family Member	182,748	Employment: Shannon Neale is a Medical Doctor employed by Park Nicollet Clinic.	Yes
(2) Randi Norby	Roxanna Gapstur, PhD; Family Member	58,090	Employment: Randi Norby is a Clinical Nurse Specialist employed by Park Nicollet Clinic.	Yes

Part V

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

Identifier	Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

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

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Identifier	Return Reference	Explanation
List of Subordinate Organizations: Names, Addresses and EINs	Page 1, Line H(a):	Park Nicollet Methodist Hospital 41-0132080 6500 Excelsior Blvd, St. Louis Park, MN 55426 Park Nicollet Institute 41-0961862 3800 Park Nicollet Blvd St. Louis Park, MN 55416 Park Nicollet Health Care Products 01-0638901 3800 Park Nicollet Blvd St. Louis Park, MN 55416 Park Nicollet Clinic 41-0834920 3800 Park Nicollet Blvd St. Louis Park, MN 55416 PNMC Holdings 41-1741792 3800 Park Nicollet Blvd St. Louis Park, MN 55416
	Form 990, Part IV, Line 24A:	Park Nicollet Health Services, along with related organizations, is jointly liable for the tax exempt bonds held by Park Nicollet Health Services under a master trust agreement. The members of the jointly liable group, which is collectively referred to as the "Obligated Group", include Park Nicollet Clinic, Park Nicollet Methodist Hospital, PNMC Holdings, Park Nicollet Institute, and Park Nicollet Health Care Products. In accordance with reporting requirements for Schedule K, all outstanding tax exempt bonds are reported solely on the Schedule K of Park Nicollet Health Services. Part V, Line 3a: Park Nicollet Health Care Products has unrelated business gross income over $1,000.
	Form 990, Part VI, Section A, line 2	Park Nicollet Health Services and its related entities have a common board. The following officers, Board Members and key employees are employees of and paid by Park Nicollet Health Services or its related organizations. These employees serve together on the common board which serves Park Nicollet Health Services and its related entities. David Abelson, MD Steven Connelly, MD Paul Dominski Roxanna Gapstur, PhD Christa Getchell Tom Jones, MD Michael Kaupa Sheila McMillan William Richards, MD Janet Schaffer, MD Katherine Tarvestad Mark Wilkowske, MD
	Form 990, Part VI, Section A, line 6	Park Nicollet Health Services is the sole member of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute and Park Nicollet Health Care Products. Park Nicollet Clinic is the sole member of PNMC Holdings.
	Form 990, Part VI, Section A, line 7a	The Board of Directors of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products are those individuals who are contemporaneously members of the Board of Directors of Park Nicollet Health Services.
	Form 990, Part VI, Section A, line 7b	All decisions, including dissolution of the organization, made by the governing body of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products are subject to the approval of the Board of Directors of Park Nicollet Health Services. However, the Board of Directors of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products are those individuals who are contemporaneously members of the Board of Directors of Park Nicollet Health Services.
	Form 990, Part VI, Section B, line 11	The Form 990 filed on behalf of the subordinate organizations (Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products) is prepared within the finance department at Park Nicollet Health Services with assistance from individuals in human resources, marketing, and operations. Upon completion of gathering the necessary information for the return, the form was compiled by the Park Nicollet accounting firm. Drafts of the form were reviewed by the Assistant Controller - Accounting Operations, Vice President of Finance, Chief Financial Officer, and the Audit and Compliance Committee. After all internal reviews were complete; the final version of the Form 990 was given to each member of the Board of Directors for approval prior to filing the return.
	Form 990, Part VI, Section B, line 12c	At Park Nicollet Health Services all key employees, directors, and officers are asked to complete a conflict of interest disclosure statement each year; however the obligation to report conflicts is ongoing. The Governance Committee, which meets five times per year, reviews all potential conflict disclosures and discusses the impact on the organization. If a potential conflict arises during the year, it is disclosed and reviewed by the Governance Committee. The Governance Committee presents the disclosure information and makes recommendations to the Board of Directors regarding management of any conflicts identified. When a transaction involving a potential conflict of interest is identified, the Board of Directors may appoint a disinterested individual or committee to review that conflict and ensure discussions related to those transactions can occur separately from those individuals with potential conflicts. All significant transactions include an analysis of fair market value.
	Form 990, Part VI, Section B, line 15	The Board of Directors of Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products are those individuals who are contemporaneously members of the Board of Directors of Park Nicollet Health Services. The Park Nicollet Health Services' Board of Directors is responsible for the implementation and oversight of executive compensation and benefit plans for Park Nicollet. Park Nicollet uses an outside consultant to provide yearly market based indexes of salary adjustments for executives in similar leadership positions. The Board of Directors reviews the salary ranges and recommends salary increases for each executive, including the CEO, based upon the Board of Directors' evaluation of job performance and experience level of the individual within the organization. The average salary increases for all Park Nicollet executives cannot exceed the average market salary increase reported for executives by the consultant. The compensation committee then reviews and approves compensation adjustments based on the information provided by the outside consultants and the Board of Directors' recommendations. For certain physicians, the majority of pay disclosed is for his/her work as a physician for Park Nicollet. A small stipend is added for serving on the Board of Directors. The following is a description of how pay for physicians' patient care work is determined. The Park Nicollet Health Services' Board of Directors is responsible for the implementation and oversight of the physician compensation and benefit plans for Park Nicollet. The Board of Directors delegates the day-to-day administration of the physician compensation plan to the Clinical Board of Governors and the Physician Compensation and Benefits Subcommittee. The purpose of the Physician Compensation and Benefits Subcommittee is to oversee physician and other clinician compensation and benefits plans and administration within the budget to ensure fairness and alignment with Park Nicollet Health Services' goals. The responsibilities of this committee include: Recommending of compensation policies and plan designs for physicians to the clinical board and Board of Directors; Overseeing compensation plan operation and payments to clinical departments; Evaluating compensation plan for performance on a periodic basis; Serving as final appeal process for issues unresolved by individuals, department chairs and chiefs of services. Annually, information on each physician's pay and productivity is graphed against the survey results for the same year. This information is presented to the compensation committee of the Park Nicollet Health Services Board of Directors for review. Park Nicollet Health Services' physician pay program is designed to ensure market based pay for market based productivity standards. The market is determined by the American Medical Group Association (AMGA) national physician compensation survey data, which provides market data for both compensation and productivity. When appropriate, the Clinic Compensation and Benefit Subcommittee grants adjustments to these guidelines with evidence of local market data.
	Form 990, Part VI, Section C, line 19	Park Nicollet Group members' governing documents, conflict of interest policy and financial statements are available to the public upon request. Park Nicollet Health Services, as the parent organization of the Park Nicollet Methodist Hospital, Park Nicollet Clinic, Park Nicollet Institute, PNMC Holdings and Park Nicollet Health Care Products, mails its consolidated audited financial statements to financial institutions, governmental institutions, board members, media representatives, vendors, and the Minnesota Hospital Association (MHA). Park Nicollet Health Services discloses quarterly consolidated financial statements to bondholders and MHA. The annual consolidated audited and quarterly financial statements are also posted at emma.msrb.org. The Forms 990 are available upon request or from the state of Minnesota or at Guidestar.org.
Changes in Net Assets or Fund Balances:	Form 990, Part XI, line 9:	Net Assets Released from Restrictions -732,286.
	Form 990, Part XII, Line 2C:	Neither the oversight process for the audit nor the auditor selection process for Park Nicollet Health Services and affiliates' financial statements have changed during the tax year.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2012

Open to Public Inspection

Name of the organization

Park Nicollet Group Return

Employer identification number

45-5023260

Part I

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

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

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

Cat. No. 50135Y

Schedule R (Form 990) 2012

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Methodist Brain Lab Leasing LLC 6500 Excelsior Blvd St Louis Park,MN55426 20-8725994	Health Care	MN	Park Nicollet Methodist Hospital	Related	182,060	46,493		No		Yes		60.000 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) Park Nicollet Enterprises 6500 Excelsior Blvd St Louis Park,MN55426 41-1656735	Real Estate for Related Organization	MN	Park Nicollet Health Services	C				No

Schedule R (Form 990) 2012

Page 3

Part V

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

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

Yes

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

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

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

Yes

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

Yes

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

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

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

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

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

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

Yes

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

Yes

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

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

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

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

Yes

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

Yes

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

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

Yes

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

(a) Name of other organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Park Nicollet Enterprises	L	157,459	Cost
(2) Park Nicollet Health Services	L	1,693,708	Cost
(3) Park Nicollet Health Services	P	240,906	Cost
(4) Park Nicollet Health Services	S	91,657	Cost
(5) Methodist Brain Lab Leasing LLC	K	444,903	Cost
(6) Methodist Brain Lab Leasing LLC	S	266,601	Cost
(7) Park Nicollet Foundation	C	2,014,078	Cost
(8) Park Nicollet Foundation	B	123,902	Cost
(9) Park Nicollet Health Services	Q	13,960,975	Cost

Schedule R (Form 990) 2012

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2012

Page 5

Part VII

Supplemental Information

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

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: Cares for and supports the health, healing, and learning of those served.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	20
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	1,047
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	4,999,954
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-912,886

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	14,391,919	17,418,737
9	Program service revenue (Part VIII, line 2g) .........	1,141,830,201	1,194,561,165
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	17,727,333	12,435,208
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	6,353,193	6,666,342
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	1,180,302,646	1,231,081,452
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	186,876	167,496
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)	611,537,104	727,620,366
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 288,531
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	544,022,710	452,244,235
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	1,155,746,690	1,180,032,097
19	Revenue less expenses. Subtract line 18 from line 12.......	24,555,956	51,049,355
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	925,315,895	943,062,738
21	Total liabilities (Part X, line 26).............	487,581,753	442,730,848
22	Net assets or fund balances. Subtract line 21 from line 20.....	437,734,142	500,331,890

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 931,126,516 including grants of $ 167,496 ) (Revenue $ 1,097,253,810 )
	In 2012, Park Nicollet Health Services and affiliates, a national healthcare improvement leader, continued to make dramatic patient care advances, win prominent awards, expand access to services and integrate efficiency into Park Nicollet Health Services' operations. Park Nicollet Health Services and affiliates also have enhanced community health, increased team member satisfaction and promoted research and education. Park Nicollet Health Services uses five core values to accomplish its mission: care, service, stewardship, joy and learning. Highlights of 2012 that support Park Nicollet Health Service's values include the following: - Park Nicollet Clinic - Rogers opened August 6. The clinic offers Family Medicine, Pediatrics and extended hours. - Melrose Institute opened the doors at its new Maple Grove location in June. Patients are seen for initial assessments and for individual appointments with treatment teams. - Five times the size of the old OB/GYN department at Park Nicollet Clinic - Maple Grove, the expansion at Maple Grove Hospital includes two new services: Perinatology and Urogynecology. - Park Nicollet began a partnership with Virtuwell, an online health pioneer. - Mammo-a-go-go Park Nicollet began offering mobile mammography throughout our service area. - Methodist Hospital qualified for $3.3 million dollars from the Federal Government for "Meaningful Use" of an Electronic Medical Record. Park Nicollet demonstrated with 33 specific measures how we use the Electronic Medical Record for quality. - Park Nicollet was named one of the Top Workplaces in Minnesota by a Star Tribune survey. It recognizes the most progressive companies based on employee opinions about company leadership, communication, career opportunities, workplace environment, managerial skills, pay and benefits. - The Human Rights Campaign recognized Park Nicollet as a Leader in LGBT Healthcare Equality in the Healthcare Equality Index 2012 report. Park Nicollet earned top marks for our commitment to equitable, inclusive care for LGBT patients and their families. Park Nicollet was one of 234 healthcare facilities nationwide to be named. - The U.S. Military awarded Park Nicollet the Patriot Award, which recognizes employers who contribute to national security and protect liberty and freedom by supporting participation in America's National Guard and Reserve Force. - The Leapfrog Group awarded Methodist Hospital an "A" rating in its Hospital Safety Scores. Areas graded include infections, medication mix-ups and acquired injuries (bedsores). - Methodist Hospital was one of only five hospitals in Minnesota chosen by HealthGrades to receive an Emergency Medicine Excellence Award. This placed us in the top five percent of hospitals judged on the 12 most common conditions leading to hospitalization for Medicare recipients. - Eleven Park Nicollet Clinic locations were named to Consumer Reports' Top Clinics list. Of the 522 practices surveyed, only 37 clinics achieved the very highest score. - Park Nicollet was selected for a Reader's Choice Award in several categories including Best Clinic, Best Urgent Care and Best Hospital. Twelve Park Nicollet physicians were also mentioned.

4b	(Code: ) (Expenses $ 61,349,504 including grants of $ ) (Revenue $ 61,902,773 )
	Park Nicollet Health Care Products is part of Park Nicollet Health Services, a nonprofit integrated care delivery system, staffed by nationally recognized hospital and clinic doctors, clinical professionals, nurses, researchers and other staff at Park Nicollet Methodist Hospital and Park Nicollet Clinic who help patients stay healthy and take care of patients when they are sick. Park Nicollet Health Care Products is a supporting organization to Park Nicollet Methodist Hospital and Park Nicollet Clinic, providing durable medical equipment (DME)/supplies and pharmaceuticals supporting ongoing patient care. Park Nicollet Health Care Products focus on the health, healing and learning of patients by providing easy access to products and services that support successful self-management of a health condition at home. The products support both short term acute conditions and chronic lifelong conditions, such as eyewear, hearing aids, and many products that cross into almost every medical subspecialty. The Pharmacy @ Park Nicollet meets growing demand for self-care products and services. The Pharmacies are at these Park Nicollet Clinic locations: Bloomington, Brookdale, Burnsville, Carlson Parkway (Minnetonka), Chanhassen, Eagan, Maple Grove, Minneapolis, St. Louis Park, and Wayzata as well as the Heart and Vascular Center and Meadowbrook at the Park Nicollet Methodist Hospital.The patient care experience does not end at the hospital or clinic door. Patients have many self-care needs to manage both their acute and chronic health conditions, and Park Nicollet Health Care Products is expanding its capacity to better serve these growing needs. Major accomplishments for 2012 include: - Enhanced product and pharmaceutical assortments available for patients, especially patients living with chronic health conditions such as diabetes, cancer, and bone and joint disease. - New and robust point of sale system for better patient service and ease of obtaining their prescriptions. - Automated dispensing for greater accuracy and efficient drugs. - Educated physicians and care provider's about Pharmacy services and products to better link solutions for patient health care needs, including smoking cessation. - Developed standard work around provider referrals to Park Nicollet Pharmacies, assuring that patients have the products needed as they go home from clinic or hospital. - Continue to provide customer service and sales training to all store staff and management. - Expanded Pharmacy MTM (Medication Therapy Management) services directly into the care environment to assist both providers and patients alike. - Update e-commerce Web site for Pharmacy @ Park Nicollet to make it easier for providers and patients to locate and purchase health care products. - Worked with staff to ensure their job satisfaction and self worth so that they can, in turn, share their positive attitude with clinical team members and customers. - Enhanced the focus on customer satisfaction scores to reinforce best practices and provide superior service. - Enhanced tracking systems to measure and monitor customer success of sales strategies. - Ensured all Pharmacy staff attended learning events to achieve their continuing education requirements. - Attended major trade shows to keep current with pharmacy assortment and billing information. - Held meetings and educational sessions for Pharmacy staff to learn the complexities of billing 3rd party payers to ensure compliance and accuracy of claims submission.The Contact Lens and Optical Store @ Park Nicollet Health Care Products, which meet growing demand for self-care products and services, are at these Park Nicollet Clinic sites: Bloomington, Brookdale, Burnsville, Carlson Parkway (Minnetonka), Chanhassen, Maple Grove, Minneapolis, Shakopee, and St. Louis Park. The patient care experience does not end at the hospital or clinic door. Patients have many self-care needs to manage both their acute and chronic health conditions, and Park Nicollet Health Care Products is expanding its capacity to better serve these growing needs.Major accomplishments for 2012 include: - Enhanced optical product assortments available for patients, especially patients living with chronic health conditions affecting their vision. - Enhance and expand the optical benefit program offered to Park Nicollet employees to increase the affordability of eyewear.Park Nicollet Health Care Products, branded as The Stores @ Park Nicollet, is a group of departments within Park Nicollet Health Services providing durable medical equipment (DME)/supplies and pharmaceuticals, supporting ongoing patient care. Park Nicollet Health Care Products partners with your clinician to provide products and services to help you live more comfortably.The Health and Care Stores, which meet a growing demand for self-care products and services, located within Park Nicollet Clinics, include: Health & Care Store offering DME products at 4 locations, Hearing Center & Store with 3 locations, CPAP clinic/Store with 2 locations and Breastfeeding Center, (1 location within the Meadowbrook Health & Care store).The Health & Care Stores are at these Park Nicollet Clinic sites: Burnsville, St. Louis Park, as well as the Heart and Vascular Center and Meadowbrook at the Park Nicollet Methodist Hospital.The patient care experience does not end at the hospital or clinic door. Patients have many self-care needs to manage both their acute and chronic health conditions, and Park Nicollet Health Care Products is expanding its capacity to better serve these growing needs. Major accomplishments for 2012 include: - Enhanced and expanded product assortments available for patients, especially patients living with chronic health conditions. - Educated physicians and care provider's about Health Care Stores product offerings to better link patient health care needs to product solutions, including smoking cessation. - Developed standard work for provider referrals to Health Care stores, assuring that patients have the products needed as they go home from clinic or hospital. - Continued customer service and sales training to all store staff and management. - Expanded point of care operation and specialty stores to help bring more products directly into the care environment to assist both providers and patients alike.

4c	(Code: ) (Expenses $ 33,759,968 including grants of $ ) (Revenue $ 35,404,582 )
	Park Nicollet Health Services affiliates incurs expenses on behalf of affiliated tax exempt organizations, Park Nicollet Methodist Hospital, Park Nicollet Clinic, PNMC Holdings, Park Nicollet Health Care Products, and Park Nicollet Institute, providing rental space and lab services to its affiliated organizations in order to assure the efficient and professional delivery of health care and other services to the community and aids in the provision of low cost medical service.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses1,026,235,988

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	7,315,552	4,901,184	1,586,180

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		2,014,078
e	Government grants (contributions)1e		4,153,279

f	All other contributions, gifts, grants, and similar amounts not included above1f		11,251,380

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			17,418,737
			Business Code
2a	Medical Services		621400	760,575,566	759,609,733		965,833
b	Medicare/Medicaid		621400	336,678,244	336,678,244
c	Retail Sales		446110	61,902,773	56,884,676	4,999,954	18,143
d	Services to Affiliates		561000	35,404,582	35,404,582
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			1,194,561,165
3	Investment income (including dividends, interest, and other similar amounts).......			6,823,521			6,823,521
4	Income from investment of tax-exempt bond proceeds..			191,842			191,842
5	Royalties...........			1,570			1,570
		(i) Real	(ii) Personal
6a	Gross rents	2,117,213
b	Less: rental expenses	1,465,317
c	Rental income or (loss)	651,896
d	Net rental income or (loss).......			651,896			651,896
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	227,053,910	76,367
b	Less: cost or other basis and sales expenses	221,435,983	274,449
c	Gain or (loss)	5,617,927	-198,082
d	Net gain or (loss)..........			5,419,845			5,419,845
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a		1,249,164
b	Less: cost of goods sold ..b		475,393
c	Net income or (loss) from sales of inventory..			773,771			773,771
Miscellaneous Revenue			Business Code
11a	Property Management		812930	2,650,959			2,650,959
b	Cafeteria		722210	2,404,291			2,404,291
c	Misc Services		722210	183,855			183,855
d	All other revenue ....
e	Total. Add lines 11a–11d ......			5,239,105
12	Total revenue. See Instructions......			1,231,081,452	1,188,577,235	4,999,954	20,085,526


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing .............			830,871	1	374,262
2	Savings and temporary cash investments .........			282,705	2	344,066
3	Pledges and grants receivable, net ...........			3,414,212	3	3,812,152
4	Accounts receivable, net .............			135,003,069	4	127,500,666
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			10,046,399	8	10,143,838
9	Prepaid expenses and deferred charges ..........			11,936,459	9	11,094,375
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	971,123,343
b	Less: accumulated depreciation .....	10b	644,100,138	341,170,336	10c	327,023,205
11	Investments—publicly traded securities ..........			386,672,271	11	404,678,771
12	Investments—other securities. See Part IV, line 11 .....			28,139,728	12	770,643
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			7,819,845	15	57,320,760
16	Total assets. Add lines 1 through 15 (must equal line 34)......			925,315,895	16	943,062,738
17	Accounts payable and accrued expenses .........			82,424,257	17	60,549,128
18	Grants payable .................				18
19	Deferred revenue ................			11,939,650	19	6,939,535
20	Tax-exempt bond liabilities .............			379,891,311	20	370,849,064
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other 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 ..			1,984,777	23	1,228,803
24	Unsecured notes and loans payable to unrelated third parties ....			1,930,180	24	0
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....................			9,411,578	25	3,164,318
26	Total liabilities. Add lines 17 through 25.........			487,581,753	26	442,730,848
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			436,481,051	27	499,512,581
28	Temporarily restricted net assets ...........			976,854	28	541,533
29	Permanently restricted net assets ...........			276,237	29	277,776
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			437,734,142	33	500,331,890
34	Total liabilities and net assets/fund balances ........			925,315,895	34	943,062,738

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