TY 2017 Form 990 Schedule R

Instrumentl eFile RenderObject ID: 201833059349301313 - Rendered 2024-04-29 TIN: 38-3952644

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
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Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2017

Open to Public Inspection

Name of the organization

MAYO CLINIC GROUP RETURN

Employer identification number

38-3952644

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on 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" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled 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)DESTINATION MEDICAL CENTER EDA 50 SOUTH SIXTH STREET SUITE 1500 MINNEAPOLIS,MN554021498 46-4893585	ECONOMIC DEVELOPMENT	MN	501(C)(3)	12-I	MAYO CLINIC	Yes
(2)MAYO CLINIC 200 FIRST STREET SW ROCHESTER,MN55905 41-6011702	PATIENT CARE - CLINIC	MN	501(C)(3)	10	N/A	Yes
(3)MAYO CLINIC STIFTUNG 60486 FRANKFURT AM MAIN FRANKFURT GM	FUNDRAISING FOUNDATION	GM			MFMER	Yes
(4)MILES AND SHIRLEY FITERMAN ENDOWMENT FUND FOR DIGESTIVE DISEASES 200 FIRST STREET SW ROCHESTER,MN55905 41-2020392	SUPPORT RESEARCH, PRACTICE & EDUCATION	MN	501(C)(3)	12-I	MAYO CLINIC	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2017

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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 V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) FRANKLIN HEATING STATION 200 FIRST STREET SW ROCHESTER,MN55905 41-0264830	UTILITY	MN	MAYO CLINIC	EXCLUDED	46	8,365,107		No		Yes		15.950 %
(2) LATIGO PETROLEUM LLC PO BOX 14230 ODESSA,TX79768 36-4767494	OIL & GAS EXPLORATION	DE	N/A
(3) WATERSHED CAP INSTL PRTNRS III LP ONE MARITIME PLAZA SUITE 1525 SAN FRANCISCO,CA94111 46-2982848	INVESTMENT ACTIVITIES	DE	N/A

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(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) AMBIENT CLINICAL ANALYTICS INC 221 1ST AVE SW SUITE 202 ROCHESTER,MN55902 80-0928405	SOFTWARE	DE	MFMER	C	9,605	143,385	26.900 %	Yes
(2) BWL HOLDINGS INC 1209 ORANGE STREET WILMINGTON,DE19801 47-2413749	OIL & GAS EXPLORATION	DE	N/A	C				Yes
(3) BAIN CAPITAL CREDIT CLO 2017-2 LTD (FKA CAVALRY CLO III LTD PO BOX 1093 GT QUEENSGATE HOUSE S GRAND CAYMAN CJ	INVESTMENT ACTIVITIES	CJ	N/A	C				Yes
(4) CAVALRY CLO IV LTD PO BOX 1093 GT QUEENSGATE HOUSE S GRAND CAYMAN CJ	INVESTMENT ACTIVITIES	CJ	N/A	C				Yes
(5) GMO GLOBAL BOND INVESTMENT FUND 78 SIR JOHN ROGERSONS QUAY DUBLIN EI	OTHER FINANCIAL INVESTMENT ACTIVITIES	EI	N/A	C				Yes
(6) HEALTH TRADITION HEALTH PLAN 1808 EAST MAIN STREET ONALASKA,WI54650 39-1545987	MEDICAL SERVICES COMPANY	WI	N/A	C				Yes
(7) LOBSS NETWORK SUPPORT 2002 INC 200 FIRST STREET SW ROCHESTER,MN55905 48-1276150	ADMINISTRATIVE SERVICES	MN	N/A	C				Yes
(8) MAYO CLINIC SUPPORT SERVICES TEXAS 200 FIRST STREET SW ROCHESTER,MN55905 47-1751102	HEALTH SERVICES	TX	N/A	C				Yes
(9) MAYO CLINIC UK LTD 3 MORE LONDON RIVERSIDE LONDON UK	INVESTMENT ACTIVITIES	UK	MAYO CLINIC	C			100.000 %	Yes
(10) MAYO HOLDING COMPANY 200 FIRST STREET SW ROCHESTER,MN55905 41-1578020	HOLDING COMPANY	MN	N/A	C				Yes
(11) MAYO INSURANCE COMPANY LTD 200 FIRST STREET SW ROCHESTER,MN55905	SELF INSURANCE POOL	CJ	N/A	C				Yes
(12) MCHS--DECORAH CLINIC PHYSICIANS 907 MONTGOMERY STREET DECORAH,IA52101 41-1711329	PATIENT CARE - CLINIC	IA	N/A	C				Yes
(13) MCHS--PHARMACY & HOME MEDICAL INC 1221 WHIPPLE STREET EAU CLAIRE,WI54703 39-1528920	PHARMACY SERVICES	WI	N/A	C				Yes
(14) MMSI INC 200 FIRST STREET SW ROCHESTER,MN55905 41-1547003	THIRD PARTY ADMINISTRATION SERVICES	MN	N/A	C				Yes
(15) RESOUNDANT INC 221 1ST AVE SW SUITE 202 ROCHESTER,MN55902 46-1661978	MANUFACTURING MEDICAL DEVICE COMPONENT	MN	MFMER	C	3,587,623	4,510,114	60.000 %	Yes
(16) ROCHESTER AIRPORT COMPANY 200 FIRST STREET SW ROCHESTER,MN55905 41-0506870	AIRPORT MANAGEMENT	MN	N/A	C				Yes
(17) SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION 13400 E SHEA BLVD SCOTTSDALE,AZ85259 86-0870505	COMMERCIAL PROPERTY OWNERS ASSOCIATION	AZ	MAYO CLINIC ARIZONA	C			93.000 %	Yes
(18) THE STABILE BUILDING OWNERS' ASSOCIATION 200 FIRST STREET SW ROCHESTER,MN55905 20-8994499	COMMERCIAL PROPERTY OWNERS ASSOCIATION	MN	N/A	C				Yes
(19) CHARITABLE LEAD TRUST	CHARITABLE TRUST	CA	N/A	T				Yes
(20) PERPETUAL TRUST	CHARITABLE TRUST	ND	N/A	T				Yes
(21) PERPETUAL TRUST	CHARITABLE TRUST	LA	N/A	T				Yes
(22) PERPETUAL TRUST (2)	CHARITABLE TRUST	MA	N/A	T				Yes
(23) PERPETUAL TRUST	CHARITABLE TRUST	MO	N/A	T				Yes
(24) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	AZ	N/A	T				Yes
(25) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	CO	N/A	T				Yes
(26) CHARITABLE REMAINDER TRUST (8)	CHARITABLE TRUST	FL	N/A	T				Yes
(27) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	LA	N/A	T				Yes
(28) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	MA	N/A	T				Yes
(29) CHARITABLE REMAINDER TRUST (81)	CHARITABLE TRUST	MN	N/A	T				Yes
(30) CHARITABLE REMAINDER TRUST (3)	CHARITABLE TRUST	NC	N/A	T				Yes
(31) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	TX	N/A	T				Yes
(32) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	CO	N/A	T				Yes
(33) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	IL	N/A	T				Yes
(34) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	MI	N/A	T				Yes
(35) CHARITABLE REMAINDER TRUST (54)	CHARITABLE TRUST	MN	N/A	T				Yes
(36) CHARITABLE REMAINDER TRUST (7)	CHARITABLE TRUST	MN	N/A	T				Yes
(37) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	WI	N/A	T				Yes

Schedule R (Form 990) 2017

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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 .....................

Yes

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) .................

Yes

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

Yes

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) ............................

Yes

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH	C	160,129	GAAP
(2) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH	L	1,019,604	GAAP
(3) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH	M	8,454,775	GAAP
(4) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH	P	4,827,884,067	GAAP
(5) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH	Q	70,148	GAAP
(6) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH	R	608,189	GAAP
(7) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH	S	19,669,607	GAAP
(8) GOLD CROSS AMBULANCE SERVICE	L	397,662	GAAP
(9) GOLD CROSS AMBULANCE SERVICE	M	933,115	GAAP
(10) GOLD CROSS AMBULANCE SERVICE	Q	44,234,154	GAAP
(11) CHARTERHOUSE INC	Q	19,810,017	GAAP
(12) CHARTERHOUSE INC	M	2,628,676	GAAP
(13) MAYO HOLDING COMPANY	L	5,701,266	GAAP
(14) MAYO HOLDING COMPANY	Q	391,854	GAAP
(15) MMSI INC	L	12,146,826	GAAP
(16) MMSI INC	M	16,162,338	GAAP
(17) MMSI INC	P	16,162,338	GAAP
(18) MMSI INC	Q	19,538,727	GAAP
(19) MMSI INC	R	2,262,414	GAAP
(20) MMSI INC	S	560,911,818	GAAP
(21) MAYO CLINIC HOSPITAL - ROCHESTER	L	5,144,812	GAAP
(22) MAYO CLINIC HOSPITAL - ROCHESTER	M	199,029	GAAP
(23) MAYO CLINIC HOSPITAL - ROCHESTER	P	3,053,946	GAAP
(24) MAYO CLINIC HOSPITAL - ROCHESTER	Q	1,230,023,457	GAAP
(25) MAYO CLINIC HOSPITAL - ROCHESTER	R	11,256,825	GAAP
(26) FRANKLIN HEATING STATION	P	677,904	GAAP
(27) FRANKLIN HEATING STATION	Q	34,353,422	GAAP
(28) MAYO CLINIC ARIZONA	B	253,108	GAAP
(29) MAYO CLINIC ARIZONA	L	2,195,640	GAAP
(30) MAYO CLINIC ARIZONA	M	216,642	GAAP
(31) MAYO CLINIC ARIZONA	Q	1,036,682,525	GAAP
(32) MAYO CLINIC ARIZONA	R	3,868,614	GAAP
(33) MAYO CLINIC ARIZONA	S	200,651	GAAP
(34) MAYO CLINIC JACKSONVILLE	C	92,979	GAAP
(35) MAYO CLINIC JACKSONVILLE	L	1,585,227	GAAP
(36) MAYO CLINIC JACKSONVILLE	M	111,055	GAAP
(37) MAYO CLINIC JACKSONVILLE	Q	607,850,440	GAAP
(38) MAYO CLINIC JACKSONVILLE	R	2,030,583	GAAP
(39) MAYO CLINIC FLORIDA	L	33,111,377	GAAP
(40) MAYO CLINIC FLORIDA	M	3,330,198	GAAP
(41) MAYO CLINIC FLORIDA	P	2,379,918	GAAP
(42) MAYO CLINIC FLORIDA	Q	403,652,111	GAAP
(43) MAYO CLINIC FLORIDA	R	828,749	GAAP
(44) MAYO CLINIC FLORIDA	S	31,815,628	GAAP
(45) MCHS-PHARMACY & HOME MEDICAL INC	P	258,459	GAAP
(46) MCHS-PHARMACY & HOME MEDICAL INC	Q	57,360,555	GAAP
(47) MCHS-PHARMACY & HOME MEDICAL INC	S	2,011,895	GAAP
(48) MCHS--NORTHWEST WISCONSIN REGION INC	L	659,379	GAAP
(49) MCHS--NORTHWEST WISCONSIN REGION INC	M	1,110,178	GAAP
(50) MCHS--NORTHWEST WISCONSIN REGION INC	Q	364,666,557	GAAP
(51) MCHS--NORTHWEST WISCONSIN REGION INC	R	352,495	GAAP
(52) MCHS--NORTHWEST WISCONSIN REGION INC	S	77,456	GAAP
(53) MCHS-NORTHLAND INC	C	41,798,886	GAAP
(54) MCHS-NORTHLAND INC	L	1,693,841	GAAP
(55) MCHS-NORTHLAND INC	Q	48,888,018	GAAP
(56) MCHS-NORTHLAND INC	S	8,925,468	GAAP
(57) MCHS-OAKRIDGE INC	C	19,293,501	GAAP
(58) MCHS-OAKRIDGE INC	L	663,970	GAAP
(59) MCHS-OAKRIDGE INC	Q	15,199,267	GAAP
(60) MCHS-OAKRIDGE INC	S	3,862,335	GAAP
(61) MCHS-CHIPPEWA VALLEY INC	C	23,247,563	GAAP
(62) MCHS-CHIPPEWA VALLEY INC	L	1,171,261	GAAP
(63) MCHS-CHIPPEWA VALLEY INC	Q	21,539,187	GAAP
(64) MCHS-CHIPPEWA VALLEY INC	S	5,549,731	GAAP
(65) MCHS-RED CEDAR INC	C	193,661,926	GAAP
(66) MCHS-RED CEDAR INC	L	1,596,182	GAAP
(67) MCHS-RED CEDAR INC	P	356,934	GAAP
(68) MCHS-RED CEDAR INC	Q	59,856,910	GAAP
(69) MCHS-RED CEDAR INC	R	275,487	GAAP
(70) MCHS-RED CEDAR INC	S	12,402,805	GAAP
(71) MCHS-FRANCISCAN HEALTHCARE INC	Q	125,292	GAAP
(72) HEALTH TRADITION HEALTH PLAN	L	3,147,396	GAAP
(73) HEALTH TRADITION HEALTH PLAN	Q	3,591,486	GAAP
(74) MCHS-FRANCISCAN MEDICAL CENTER INC	L	490,913	GAAP
(75) MCHS-FRANCISCAN MEDICAL CENTER INC	M	605,664	GAAP
(76) MCHS-FRANCISCAN MEDICAL CENTER INC	Q	320,936,626	GAAP
(77) MCHS-FRANCISCAN MEDICAL CENTER INC	B	21,571,889	GAAP
(78) MCHS-FRANCISCAN MEDICAL CENTER INC	R	348,260	GAAP
(79) MCHS-FRANCISCAN HEALTHCARE FOUNDATION INC	C	21,581,570	GAAP
(80) MCHS-FRANCISCAN HEALTHCARE FOUNDATION INC	L	398,140	GAAP
(81) MCHS-FRANCISCAN HEALTHCARE FOUNDATION INC	Q	459,504	GAAP
(82) MCHS-OWATONNA	C	71,495,703	GAAP
(83) MCHS-OWATONNA	L	61,050	GAAP
(84) MCHS-OWATONNA	P	154,891	GAAP
(85) MCHS-OWATONNA	Q	54,876,899	GAAP
(86) MCHS-OWATONNA	R	120,895	GAAP
(87) MCHS-OWATONNA	S	9,904,701	GAAP
(88) MCHS-FAIRMONT	L	817,985	GAAP
(89) MCHS-FAIRMONT	Q	56,368,062	GAAP
(90) MCHS-FAIRMONT	S	10,333,434	GAAP
(91) MCHS-FAIRMONT	C	92,587	GAAP
(92) MCHS-CANNON FALLS	L	128,148	GAAP
(93) MCHS-CANNON FALLS	C	38,149,025	GAAP
(94) MCHS-CANNON FALLS	Q	20,164,268	GAAP
(95) MCHS-CANNON FALLS	S	3,748,452	GAAP
(96) MCHS-LAKE CITY	L	123,339	GAAP
(97) MCHS-LAKE CITY	Q	30,345,975	GAAP
(98) MCHS-LAKE CITY	R	56,272	GAAP
(99) MCHS-LAKE CITY	S	4,115,720	GAAP
(100) MCHS-RED WING	B	6,999,513	GAAP
(101) MCHS-RED WING	L	893,506	GAAP
(102) MCHS-RED WING	M	86,797	GAAP
(103) MCHS-RED WING	P	1,376,230	GAAP
(104) MCHS-RED WING	Q	85,208,954	GAAP
(105) MCHS-RED WING	R	200,278	GAAP
(106) MCHS-RED WING	S	16,204,761	GAAP
(107) MCHS-DECORAH CLINIC PHYSICIANS	Q	8,310,134	GAAP
(108) MAYO CLINIC HEALTH SYSTEM SOUTHEAST MINNESOTA REGION	B	109,644,728	GAAP
(109) MAYO CLINIC HEALTH SYSTEM SOUTHEAST MINNESOTA REGION	C	6,999,513	GAAP
(110) MAYO CLINIC HEALTH SYSTEM SOUTHEAST MINNESOTA REGION	L	1,315,411	GAAP
(111) MAYO CLINIC HEALTH SYSTEM SOUTHEAST MINNESOTA REGION	M	63,147	GAAP
(112) MAYO CLINIC HEALTH SYSTEM SOUTHEAST MINNESOTA REGION	Q	198,750,926	GAAP
(113) MAYO CLINIC HEALTH SYSTEM SOUTHEAST MINNESOTA REGION	R	34,448,893	GAAP
(114) MAYO CLINIC HEALTH SYSTEM SOUTHEAST MINNESOTA REGION	P	10,878,537	GAAP
(115) MCHS-AUSTIN FOUNDATION	C	732,720	GAAP
(116) MAYO CLINIC HEALTH SYSTEM SOUTHWEST MINNESOTA REGION	L	568,374	GAAP
(117) MAYO CLINIC HEALTH SYSTEM SOUTHWEST MINNESOTA REGION	M	1,008,604	GAAP
(118) MAYO CLINIC HEALTH SYSTEM SOUTHWEST MINNESOTA REGION	Q	289,276,861	GAAP
(119) MAYO CLINIC HEALTH SYSTEM SOUTHWEST MINNESOTA REGION	R	115,404	GAAP
(120) MCHS-SPRINGFIELD	C	19,231,058	GAAP
(121) MCHS-SPRINGFIELD	L	235,770	GAAP
(122) MCHS-SPRINGFIELD	Q	9,122,677	GAAP
(123) MCHS-SPRINGFIELD	S	1,805,562	GAAP
(124) MCHS-WASECA	C	52,758,449	GAAP
(125) MCHS-WASECA	L	383,080	GAAP
(126) MCHS-WASECA	Q	13,093,890	GAAP
(127) MCHS-WASECA	S	4,931,239	GAAP
(128) MCHS-ST JAMES	L	299,410	GAAP
(129) MCHS-ST JAMES	Q	13,606,054	GAAP
(130) MCHS-NEW PRAGUE	C	19,793,925	GAAP
(131) MCHS-NEW PRAGUE	L	337,255	GAAP
(132) MCHS-NEW PRAGUE	Q	30,824,201	GAAP
(133) MCHS-NEW PRAGUE	S	6,338,602	GAAP
(134) MCHS-MANKATO FOUNDATION	C	2,728,366	GAAP
(135) MCHS-MANKATO FOUNDATION	B	277,904	GAAP

Schedule R (Form 990) 2017

Page 4

Part VI

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

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

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

Schedule R (Form 990) 2017

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2017

Additional Data

Software ID:
Software Version: