2016-11-11T09:51:24-06:00 2015-12-31 990 2015-01-01 411404075 MAYO CLINIC HEALTH SYSTEM-ALBERT LEA AND AUSTIN MAYO 5075381297 1000 FIRST DRIVE NW AUSTIN MN 55912 JAMES J TARASOVITCH REGION CFO 5073852646 2016-11-11 2015 2017-02-10 21:41:12Z DAVID C AGERTER MD 1000 FIRST DRIVE NW AUSTIN MN 55912 313592295 0 5983 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1981 MN HOSPITALS AND CLINICS 10 3 4427 255 0 0 3974230 2914924 275612472 303110230 5888073 6041778 1348594 1430559 286823369 313497491 251635 349147 0 0 181428102 190587398 0 0 91997 95413359 119995744 277093096 310932289 9730273 2565202 350759424 378538838 33688706 65676970 317070718 312861868 X TO INSPIRE HOPE AND CONTRIBUTE TO HEALTH AND WELL-BEING BY PROVIDING THE BEST CARE TO EVERY PATIENT THROUGH INTEGRATED CLINICAL PRACTICE, EDUCATION, AND RESEARCH. 0 0 261452798 304303317 PATIENT CARE (SEE SCHEDULE O)PATIENT CARE:MAYO CLINIC HEALTH SYSTEM IS A FAMILY OF CLINICS, HOSPITALS AND HEALTH CARE FACILITIES SERVING COMMUNITIES IN MINNESOTA, IOWA, WISCONSIN AND GEORGIA. AS PART OF MAYO CLINIC, THE HEALTH SYSTEM OFFERS CARE DESIGNED FOR THE WHOLE BODY CLOSE TO THE PATIENT'S HOME, WHEN THEY NEED IT. A MULTIDISCIPLINARY TEAM OF EXPERTS HAS READY ACCESS TO KNOWLEDGE, RESOURCES, AND EXPERTISE OF MAYO CLINIC AND COLLABORATES ON PROVIDING EXACTLY THE CARE THE PATIENT NEEDS. MAYO CLINIC HEALTH SYSTEM SITES EMPLOY APPROXIMATELY 1,000 PHYSICIANS AND 15,000 ALLIED HEALTH STAFF. IN ADDITION, MAYO CLINIC PHYSICIANS FROM MULTIPLE SPECIALTIES REGULARLY SEE PATIENTS AT HEALTH SYSTEM FACILITIES. BESIDES HAVING HEALTH CARE FACILITIES IN MORE THAN 60 COMMUNITIES, MAYO CLINIC HEALTH SYSTEM INCLUDES 19 OWNED HOSPITALS, TWO OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH ONE ADDITIONAL HOSPITAL, AND CONTRACT MANAGEMENT AGREEMENTS WITH TWO ADDITIONAL HOSPITALS AND ONE NURSING HOME.SINCE ITS INCEPTION IN 1992, MAYO CLINIC HEALTH SYSTEM HAS GROWN INTO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN THE UNITED STATES. MORE THAN 600,000 UNIQUE PATIENTS ACCOUNT FOR MORE THAN 2.6 MILLION VISITS ANNUALLY IN MAYO CLINIC HEALTH SYSTEM. IT IS ALSO A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS.MAYO CLINIC HEALTH SYSTEM-ALBERT LEA AND AUSTIN (MCHS-AL/AU) IS A MINNESOTA NON-PROFIT CORPORATION, TAX EXEMPT AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. TO JUSTIFY THIS TAX EXEMPT STATUS, MCHS-AL/AU PROVIDES SCHOLARSHIPS, CHARITY CARE, INTERPRETING AND EDUCATIONAL SERVICES, AND VARIOUS OTHER COMMUNITY BENEFITS. MCHS-AL/AU PROVIDES PRIMARY CARE NEEDS, INCLUDING FAMILY MEDICINE, INTERNAL MEDICINE, OB/GYN, PEDIATRICS AND GENERAL SURGERY. IN ADDITION, MCHS-AL/AU ALSO PROVIDES SPECIALTY CARE IN CARDIOLOGY, DERMATOLOGY, NEUROLOGY, ONCOLOGY, OPHTHALMOLOGY, OPTOMETRY, OCCUPATIONAL HEALTH, PHYSICAL MEDICINE & REHAB, PSYCHIATRY, RHEUMATOLOGY, AUDIOLOGY, ALLERGY, ORTHOPEDICS, ENT, PSYCHOLOGY, PODIATRY, PHYSICAL THERAPY, WOUND CARE, UROLOGY, AND PLASTIC SURGERY. IN 2015, MCHS-AL/AU HAD 316,349 CLINIC VISITS. MCHS-AL/AU OPERATES REGIONAL CLINICS IN ADAMS, ALDEN, BLOOMING PRAIRIE, KIESTER, LEROY, NEW RICHLAND, AND WELLS, MINNESOTA AND LAKE MILLS, IOWA.DURING 2015, HOSPITAL INPATIENT DAYS TOTALED 15,350 WITH 1,668 ADDITIONAL DAYS FOR NEWBORN CARE. AS PART OF THE MAYO CLINIC HEALTH SYSTEM, MCHS-AL/AU ACCESSES EMERGENCY MEDICAL HELICOPTER SERVICE THROUGHOUT SOUTHERN MINNESOTA AND NORTHERN IOWA AND RECEIVES AMBULANCE SERVICES FROM GOLD CROSS. THE HELICOPTER PROVIDES RAPID PATIENT TRANSPORT TO THE APPROPRIATE HEALTH CARE FACILITY ALONG WITH DELIVERING HIGH-LEVEL CRITICAL CARE.FOUNTAIN CENTERS IS A MCHS-AL/AU PROGRAM FOR SUBSTANCE ABUSE AND ADDICTION; ITS MAIN CAMPUS IN ALBERT LEA OFFERS RESIDENTIAL AND OUTPATIENT TREATMENT, SUPPORT AND AFTERCARE PROGRAMS. CURRENTLY, FOUNTAIN CENTERS ALSO OFFERS OUTPATIENT PROGRAMS IN AUSTIN, FAIRMONT, FARIBAULT, MANKATO, OWATONNA, ROCHESTER AND WASECA AND REACHES FAR OUTSIDE OF MCHS-AL/AU SERVICE AREA TO MEET CHEMICAL DEPENDENCY TREATMENT NEEDS IN SOUTHERN MINNESOTA.MCHS-AL/AU OPERATES ON A NONDISCRIMINATORY BASIS REGARDLESS OF RACE, COLOR, SEX, RELIGION OR NATIONAL ORIGIN.MCHS-AL/AU PROVIDES A VARIETY OF FINANCIAL ASSISTANCE OPTIONS TO PATIENTS WHO MEET ESTABLISHED CRITERIA. SERVICES ARE ALSO PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. THE COST OF CHARITY CARE PROVIDED DURING 2015 WAS APPROXIMATELY $5,196,200. THE COST OF UNCOMPENSATED MEDICAID FOR 2015 WAS APPROXIMATELY $18,706,300. THIS AMOUNT INCLUDES THE MEDICAID SURCHARGE OF $979,431 AND $3,472,586 PAID TO MINNESOTA CARE (A PROGRAM THAT PROVIDES HEALTH CARE FOR LOW INCOME POPULATIONS). THE UNREIMBURSED COST OF MEDICARE WAS APPROXIMATELY $24,036,000.MCHS-AL/AU ALSO LEASES SPACE AND PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE OF PROVIDING PATIENT CARE. 500640 349147 3267 COMMUNITY SUPPORT (SEE SCHEDULE 0):COMMUNITY SUPPORT: THERE ARE NUMEROUS HEALTH AND WELLNESS EDUCATION PROGRAMS, CLASSES AND SUPPORT GROUPS PROVIDED TO THE COMMUNITY THROUGHOUT THE YEAR. THESE CLASSES/SUPPORT GROUPS INCLUDE CHILDBIRTH EDUCATION, PRENATAL BREASTFEEDING EDUCATION CLASSES, BEREAVEMENT EDUCATION SUPPORT SERIES, CANCER SUPPORT GROUP, DIABETES SUPPORT GROUP, OSTOMY SUPPORT GROUP, CHEMICAL DEPENDENCY RELAPSE SUPPORT GROUP, TOBACCO CESSATION SERVICES, SPORTS SCREENINGS, INDIVIDUAL SPORTS CONDITIONING AND SPORTS INJURY EVALUATIONS, ALL AT NO CHARGE.MCHS-AL/AU'S PATIENT EDUCATION CENTER PROVIDES FREE BLOOD PRESSURE CHECKS AND HEALTH RESOURCES FOR THE COMMUNITY. 1,560 BLOOD PRESSURE CHECKS WERE PROVIDED IN 2015. LOCATED WITHIN THE FRONT CORRIDOR, THE CENTER'S LIBRARY AREA INCLUDES EASY ACCESS FOR COMMUNITY MEMBERS TO HEALTH EDUCATION AND WELLNESS INFORMATION VIA STAFF, BROCHURES, DVDS, AND USE OF FOUR PUBLIC COMPUTERS. IN 2015, 4,500 PEOPLE WERE ASSISTED WITH PATIENT EDUCATION SERVICES.ALSO LOCATED IN THE PATIENT EDUCATION CENTER IS MCHS-AL/AU'S PATIENT ADVOCATE. SHE IS A CERTIFIED SENIOR HEALTH INSURANCE PROGRAM VOLUNTEER WHO FACILITATES MEDICATION ASSISTANCE FOR THOSE UNABLE TO AFFORD MEDICATION PRESCRIBED. SHE ALSO ASSISTS MEDICARE PARTICIPANTS ENROLLING IN THE PART D PLAN. EXPLAINING INSURANCE AND CLARIFYING INSURANCE ISSUES ARE ALSO OFFERED THROUGH THE PATIENT ADVOCATE. FREE EDUCATION PROGRAMS INCLUDE: - WOMEN'S HEART HEALTH CONFERENCE - CANCER SYMPOSIUM MCHS-AL/AU PROVIDES FREE HEALTH ASSESSMENTS AND SCREENINGS, COUNSELING SERVICES, FREE INTERPRETING SERVICES, AND SPACE FOR COMMUNITY MEETINGS AND SUPPORT GROUPS. MCHS-AL/AU HAS A HOME HEALTH PROGRAM IN WHICH PRIMARILY ELDERLY PATIENTS WITH CIRCULATORY, RESPIRATORY AND OTHER HEALTH PROBLEMS ARE PROVIDED ASSISTANCE WITH PERSONAL CARES AND ACTIVITIES OF DAILY LIVING. DURING 2015, THE HOME HEALTH PROGRAM SERVED 195 PATIENTS.MCHS-AL/AU ALSO PROVIDES A HOSPICE FOR THE FAMILIES OF TERMINAL PATIENTS. IN 2015, 407 FAMILIES WERE SERVICED BY THIS HOSPICE.DURING 2015, MCHS-AL/AU PROVIDED FREE SPORTS PHYSICALS TO 545 AREA STUDENT ATHLETES. MCHS-AL/AU ALSO BENEFITS FROM COMMUNITY VOLUNTEERS IN ITS AUXILIARY, HOSPICE AND CHEMICAL DEPENDENCY PROGRAMS, AND AS MOVERS AT THE FRONT INFORMATION DESK. DURING 2015, VOLUNTEERS DONATED APPROXIMATELY 27,694 HOURS TO THE MEDICAL CENTER. THE VALUE OF THIS DONATED TIME IS APPROXIMATELY $652,470 BASED ON THE INDEPENDENT SECTORS AVERAGE ESTIMATED VALUE OF SUCH SERVICES. THESE SERVICE HOURS WERE PRIMARILY SPENT ORGANIZING AND MANAGING ACTIVITIES FOR THE BENEFIT OF THE MEDICAL CENTER'S PATIENTS, PATIENTS' FAMILIES, VISITORS, AND STAFF.MCHS-AL/AU SPONSORS A SCHOLARSHIP PROGRAM FOR HIGH SCHOOL SENIORS AND NON-TRADITIONAL STUDENTS FROM THE MCHS-AL/AU SERVICE AREA WHO ARE ENTERING THE HEALTHCARE FIELD. IN THE YEAR ENDING DECEMBER 31, 2015, 31 SCHOLARSHIPS WERE AWARDED TOTALING $32,575. IN ADDITION, MCHS-AL/AU PROVIDES MEETING SPACE AND SPONSORS VARIOUS "ON-SITE" EDUCATION PROGRAMS INCLUDING SHADOWING, PRECEPTORSHIPS, AND INTERNSHIPS. THE ESTIMATED COST OF SUPERVISION AND SPACE FOR THESE PROGRAMS IS $365,500. 290475 120766 RESEARCH (SEE SCHEDULE O):RESEARCH:MCHS-AL/AU STAFF WORK WITH MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM PHYSICIAN INVESTIGATORS TO COORDINATE CLINICAL RESEARCH STUDIES WITH A CMS GRANT. 262243913 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 0 4427 1 0 0 0 0 0 0 0 0 0 0 X 10 3 1 1 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0 0 MN X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 CIOTA MD MARK R DIRECTOR/CHAIR 40.00 0.00 X X 754743 0 72009 CRANDALL DAVID DIRECTOR/TREASURER 1.00 0.00 X X 0 0 0 CRUZ-LARES LINDA A DIRECTOR/SECRETARY 1.00 0.00 X X 0 0 0 FUNK MICHAEL S DIRECTOR 1.00 0.00 X 0 0 0 GABRIELSON SHARON R DIRECTOR 1.00 40.00 X 0 264255 58558 KLEIS DO KEITH R DIRECTOR 40.00 0.00 X 300568 0 58526 MILLER MD ROBERT C DIRECTOR/VICE CHAIR 1.00 40.00 X X 0 593087 62281 MONSON REV GLENN L DIRECTOR 1.00 0.00 X 0 0 0 PARKS DOUGLAS A DIRECTOR/REGION CAO 1.00 40.00 X X 0 239099 50017 PLATE MD REINOLD H DIRECTOR 1.00 40.00 X 0 315312 70436 POTACH BRENDA DIRECTOR 1.00 0.00 X 0 0 0 SCHULZ MD JOHN M DIRECTOR 40.00 0.00 X 559693 0 79638 YTTERBERG MD KAREN L DIRECTOR 1.00 40.00 X 0 214423 47271 AGERTER MD DAVID C REGION CEO 1.00 40.00 X 0 597592 26206 KOCH MARK B ASSISTANT SECRETARY 1.00 40.00 X 0 483196 23677 TARASOVITCH JAMES J REGION CFO 1.00 40.00 X 0 309144 66950 LARSON VIRGINIA OPERATIONS ADMINISTRATOR 40.00 0.00 X 175664 0 49305 SLEGH KERI A HUMAN RESOURCES DIVISION CHAIR 40.00 0.00 X 150994 0 35515 ECKSTROM MD MICHAEL T PHYSICIAN 40.00 0.00 X 1072560 0 68918 ENGMAN MD STEVEN J PHYSICIAN 40.00 0.00 X 618273 0 56326 NGUYEN MD EMILY C PHYSICIAN 40.00 0.00 X 699946 0 50517 SKORIN DO LEONID PHYSICIAN 40.00 0.00 X 909831 0 68421 WEAVER MD CHAD H PHYSICIAN 40.00 0.00 X 829232 0 27091 WALDHOFF STEPHEN C FORMER OFFICER 0.00 40.00 X 0 300255 26645 ANGSTMAN MD GREGORY L FORMER KEY EMPLOYEE 40.00 0.00 X 246883 0 55029 BARNES MD DARRYL E FORMER KEY EMPLOYEE 40.00 0.00 X 366746 0 56795 COLLIER DPM ROBERT L FORMER KEY EMPLOYEE 40.00 0.00 X 341150 0 69260 GOINS MD JENNIFER L FORMER KEY EMPLOYEE 40.00 0.00 X 427355 0 52408 GRZYBOWSKI MD JOHN A FORMER KEY EMPLOYEE 40.00 0.00 X 385575 0 56975 KATTEL MD SHARMA B FORMER KEY EMPLOYEE 40.00 0.00 X 321754 0 34196 LOMBARDI MD JOSEPH M FORMER KEY EMPLOYEE 40.00 0.00 X 324281 0 69528 NORDENG RODNEY L FORMER KEY EMPLOYEE 40.00 0.00 X 173151 0 47212 SCHULZ MD JODI L FORMER KEY EMPLOYEE 40.00 0.00 X 461593 0 60922 SMITH MD A DON FORMER KEY EMPLOYEE 40.00 0.00 X 499480 0 74022 STOLTENBERG MD HEIDI G FORMER KEY EMPLOYEE 40.00 0.00 X 240159 0 53554 ULRICH MD MICHAEL D FORMER KEY EMPLOYEE 40.00 0.00 X 375619 0 68744 YOUNG DO NATHAN P FORMER KEY EMPLOYEE 0.00 40.00 X 0 292308 54194 10235250 3608671 1751146 222 1 1 0 MAYO FND FOR MEDICAL EDUCATION AND RESEA 200 FIRST STREET SW ROCHESTER MN 55905 PURCHASING AGENT 9375418 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 PATIENT/LAB/ADMIN SERVICES 4229496 AMPHION MEDICAL SOLUTIONS 8301 EXCELSIOR DRIVE MADISON WI 53717 TRANSCRIPTION SERVICES 1575318 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 PROFESSIONAL SERVICES 777872 MAYO CLINIC HEALTH SYSTEM-MANKATO 1025 MARSH STREET MANKATO MN 56002 PURCHASED SERVICES 750194 18 16250 1975 3517 1279773 1560211 53198 2914924 NET PATIENT REVENUE 620000 252651358 252651358 SHARED SERVICES 561000 50395504 50395504 RENT FROM AFFILIATES 531120 63368 63368 303110230 6035543 6035543 2721 2721 2800 10570 -7770 -7770 -7770 6235 0 6235 6235 6235 7843 3517 828 7015 7015 2285 1508 777 777 135780 81898 53882 53882 CAFETERIA/VENDING 722210 1191155 1191155 MEDICAL RECORDS/TRANSC 541900 62716 62716 MISC CONSULTING 541610 40260 40260 79803 60528 19275 1373934 313497491 304427350 0 6155217 X 315072 315072 34075 34075 2236655 1449863 786792 6785047 4699256 2085791 132637795 114625778 17963260 48757 16289676 14077562 2206126 5988 23447074 20262996 3175459 8619 9191151 7943006 1244766 3379 127801 40 127761 1058 51 1007 3013 3013 50733498 38148855 12574484 10159 506848 24631 473165 9052 13638786 11469959 2163951 4876 1785072 478733 1306339 333 333 6071010 5044053 1026957 2164405 1479640 683931 834 142598 129257 13308 33 9897300 8448446 1448854 1070764 1258 1069506 MEDICAL SUPPLIES 22909870 22909870 BAD DEBT EXPENSE 5590014 5590014 MN CARE TAX 3472586 3472586 MEDICAID SURCHARGE 979431 979431 901357 656135 244922 300 310932289 262243913 48596379 91997 8787 10768 160 149345 44245858 40643376 4723896 3084371 1180307 0 229578926 122222052 108973015 107356874 173459885 191629071 55927 18167516 35609106 350759424 378538838 22040656 11636578 845397 114523 12959 0 10789694 53925869 33688706 65676970 X 314498645 306341630 2185256 6218695 386817 301543 317070718 312861868 350759424 378538838 X 2565202 -4120625 -2653427 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3013 3013 0 PART II-B, LINE 1: MAYO CLINIC HEALTH SYSTEM - ALBERT LEA AND AUSTIN (MCHS-AL/AU) PROVIDES INFORMATION OR EXPRESSES ITS CONCERN TO LEGISLATIVE BODIES AND GOVERNMENT OFFICIALS ON MATTERS DIRECTLY RELATED TO HEALTH, THE DELIVERY OF HEALTH CARE AND MEDICAL EDUCATION AND/OR RESEARCH. IN 2015, MCHS-AL/AU REPRESENTATIVES CONTACTED ELECTED OFFICIALS OF GOVERNMENT TO DISCUSS ISSUES RELATING TO HEALTH CARE AND HEALTH CARE REFORM. THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. 386817 432639 -2736 302592 514128 380604 6213 386817 371157 9447 380604 301543 69614 371157 301543 301543 0.59000 0.41000 0 1 1 6991776 6991776 138777256 61134729 77642527 513 81867972 61087323 20781162 1941409 1941409 107356874 MAYO POOLED INVESTMENTS 191629071 F 191629071 DUE FROM AFFILIATES 21256489 DEFERRED COMPENSATION 9708773 INTEREST IN NET ASSETS OF FDN 4643844 35609106 DUE TO AFFILIATES 44217096 DEFERRED COMPENSATION LIABILITY 9708773 53925869 X PART V, LINE 4: THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR EDUCATION AND PATIENT SUPPORT. PART X, LINE 2: AT DECEMBER 31, 2015 AND 2014, THE RESERVE FOR UNRECOGNIZED TAX BENEFITS WAS NOT SIGNIFICANT, AND AS A RESULT, THERE IS NO RESERVE FOR UNRECOGNIZED TAX BENEFITS RECORDED FOR THE FILING ORGANIZATION. CENTRAL AMERICA AND THE CARIBBEAN 0 5 TRAVEL - INTERNATIONAL CONFERENCE 9210 EUROPE (INCLUDING ICELAND AND GREENLAND) 0 2 TRAVEL - INTERNATIONAL CONFERENCE 4923 NORTH AMERICA 0 7 TRAVEL - INTERNATIONAL CONFERENCE 7643 SOUTH AMERICA 0 3 TRAVEL - INTERNATIONAL CONFERENCE 2828 0 17 0 0 0 17 24604 0 24604 0 0 0 0 0 0 FILING OF CERTAIN FOREIGN FORMS DISCLOSURE STATEMENT RELATED TO FORMS 5713: FORM 5713 HAS BEEN FILED BY THE FOLLOWING MEMBERS OF THE CONTROLLED GROUP: MAYO CLINIC (EIN: 41-6011702) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH (EIN: 41-1506440) DISCLOSURE STATEMENT RELATED TO FORMS 5471: UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, AS A CATEGORY 4 AND 5 FILER WITH RESPECT TO CERTAIN CONTROLLED FOREIGN CORPORATIONS (CFCS). THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 5471 FOR THESE CFCS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT. TAXPAYER NAME: MAYO CLINIC ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 41-6011702 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED TAXPAYER NAME: MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 41-1506440 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED DISCLOSURE STATEMENT RELATED TO FORMS 8865: UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 8865, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN PARTNERSHIPS, AS A CATEGORY 2 AND 3 FILER. THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 8865 FOR THESE PARTNERSHIPS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT. TAXPAYER NAME: MAYO CLINIC ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 8865 WAS FILED: 41-6011702 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED 1 1 X 1 X 1 X 1 0 0 5196112 5196112 0.01700 50291699 31586126 18705573 0.06130 55487811 31586126 23901685 0.07830 45883 3267 42616 0.00010 32719 32719 0.00010 5504282 3390177 2114105 0.00690 290475 120766 169709 0.00060 185856 185856 0.00060 6059215 3514210 2545005 0.00830 61547026 35100336 26446690 0.08660 19353 19353 0.00010 236159 236159 0.00080 11768 11768 0.00000 1621 250 1371 0.00000 268901 250 268651 0.00090 0 5590014 50448353 74788529 -24340176 X 1 1 2 1 MCHS IN ALBERT LEA 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 MAYOCLINICHEALTHSYSTEM.ORG 00920 X X X 2 MCHS IN AUSTIN 1000 FIRST DRIVE NW AUSTIN MN 55912 MAYOCLINICHEALTHSYSTEM.ORG 00920 X X X MCHS IN ALBERT LEA 1 0 0 1 X X X X X X X X 13 1 0 1 1 X MAYOCLINICHEALTHSYSTEM.ORG/ABOUT-US X 1 13 0 1 0 1 X 200.000000000000 400.000000000000 X X X X X X X 1 1 X X X 1 X MAYOCLINICHEALTHSYSTEM.ORG X MAYOCLINICHEALTHSYSTEM.ORG X MAYOCLINICHEALTHSYSTEM.ORG X X X X X X 1 X 0 X X X X X 1 X 0 0 MCHS IN AUSTIN 2 0 0 1 X X X X X X X X X 13 1 0 0 1 X MAYOCLINICHEALTHSYSTEM.ORG/ABOUT-US X 1 13 0 1 0 1 X 200.000000000000 400.000000000000 X X X X X X X 1 1 X X X 1 X MAYOCLINICHEALTHSYSTEM.ORG X MAYOCLINICHEALTHSYSTEM.ORG X MAYOCLINICHEALTHSYSTEM.ORG X X X X X X 1 X 0 X X X X X 1 X 0 0 MCHS IN ALBERT LEA PART V, SECTION B, LINE 5: A SURVEY WAS SENT OUT TO RANDOM RESIDENTS OF FREEBORN COUNTY AND KEY INFORMANT SESSIONS WERE HELD THAT INCLUDED, BUT WERE NOT LIMITED TO: THE DEAN OF STUDENTS FROM TWO AREA HIGH SCHOOLS, THE DIRECTOR OF FREEBORN COUNTY WORKFORCE DEVELOPMENT, THE DIRECTOR OF SEMCAC, A POLICE OFFICER OF THE ALBERT LEA POLICE DEPARTMENT, AND AN AREA CLERGYMAN. A CHNA ADVISORY GROUP WAS CONVENED IN THE PLANNING STAGES OF CONDUCTING THE CHNA AND AGAIN WHEN SURVEY AND KEY INFORMANT SESSION RESULTS WERE COMPLETED. THE CHNA ADVISORY GROUP INCLUDED: THE DIRECTOR OF FREEBORN COUNTY PUBLIC HEALTH, THE DIRECTOR OF ALBERT LEA FAMILY YMCA, THE DIRECTOR OF FREEBORN COUNTY CHILDREN'S CENTER, A REPRESENTATIVE OF FREEBORN COUNTY RESOURCES, THE DIRECTOR OF FREEBORN COUNTY UNITED WAY, THE DIRECTOR OF FREEBORN COUNTY FAMILY SERVICE COLLABORATIVE, THE EXECUTIVE DIRECTOR OF ALBERT LEA/FREEBORN COUNTY CHAMBER OF COMMERCE, AND THE DIRECTOR OF SOUTHEAST MINNESOTA COMMUNITY ACTION COMMITTEE. MCHS IN AUSTIN PART V, SECTION B, LINE 5: THE CHNA EFFORT DIRECTLY REACHED OUT TO CITIZENS WHO REPRESENT THE VARIETY OF AGES, INCOMES, EDUCATION LEVELS AND ETHNIC BACKGROUNDS IN MOWER COUNTY, AND INTENTIONALLY CONNECTED WITH GROUPS SUCH AS THE COMMUNITY HEALTH SERVICES ADMINISTRATOR OF MOWER COUNTY HEALTH AND HUMAN SERVICES THAT REPRESENT THE 15.3 PERCENT OF CITIZENS WHO LIVE BELOW THE POVERTY LEVEL AND GROWING POPULATION OF MINORITIES. IN ADDITION, FOCUS GROUPS AND A CITIZEN SURVEY WERE CONDUCTED AT WORKPLACES, HEALTH FAIRS, HIGH SCHOOLS, THE LOCAL COMMUNITY COLLEGE, AND ENGLISH LANGUAGE LEARNING CLASSROOMS AS WELL AS TAKING INFORMATION FROM SURVEYS CONDUCTED BY MOWER COUNTY HEALTH AND HUMAN SERVICES AND MOWER REFRESHED, WHICH REFLECT A WIDE SAMPLING OF THE COUNTY'S POPULATION BY ETHNICITY, AGE, AND GENDER. MCHS IN ALBERT LEA PART V, SECTION B, LINE 6B: FREEBORN COUNTY PUBLIC HEALTH MCHS IN ALBERT LEA PART V, SECTION B, LINE 11: MAYO CLINIC HEALTH SYSTEM (MCHS) IN ALBERT LEA IDENTIFIED SIX SIGNIFICANT HEALTH NEEDS IN FREEBORN COUNTY, IN PARTNERSHIP WITH FREEBORN COUNTY PUBLIC HEALTH. OF THOSE, MENTAL HEALTH, OBESITY AND CHRONIC DISEASE PREVENTION WERE CHOSEN AS THE TOP THREE HEALTH PRIORITIES WE HAD THE POTENTIAL TO POSITIVELY IMPACT. TOBACCO USE, DENTAL CARE AND BINGE DRINKING WERE ALSO IDENTIFIED, BUT NOT PURSUED. (SEE LAST PARAGRAPH)MENTAL HEALTHIMPLEMENTATION STRATEGIES FOR MENTAL HEALTH IN 2015 FOCUSED ON TWO INITIATIVES: (1) WORKPLACE WELLNESS, WITH AN EMPHASIS ON STRESS AND WELLBEING TO REACH OUR POPULATION WHERE THEY WORK AND (2) EXPANDING MENTAL HEALTH CLINICAL SERVICES IN SOUTHEAST MINNESOTA BY BLENDING THE CMS COMPASS CARE COORDINATION MODEL INTO THE ADULT COMPLEX CARE COORDINATION MODEL TO IDENTIFY PEOPLE WITH MENTAL HEALTH ISSUES AT CLINIC VISITS FOR OTHER HEALTH ISSUES.THE COMPASS MODEL IS BUILT ON A REFERRAL PROCESS WHERE PATIENTS WITH CHRONIC DISEASE ARE IDENTIFIED, SCREENED AND REFERRED FOR MENTAL HEALTH CARE. AS THE PRIORITY HEALTH NEED IDENTIFIED, ADDRESSING MENTAL HEALTH IS CRUCIAL TO MAKING IMPROVEMENT IN CHRONIC DISEASES OR OBESITY. BEGINNING IN 2015, ALL PATIENTS NEEDING CARE COORDINATION HAVE A PSYCHIATRIST ENGAGED IN THE CARE COORDINATION TEAM. TO FURTHER ASSIST WITH THE ENORMITY OF MENTAL HEALTH NEEDS IDENTIFIED IN THE 2013 CHHA AND TO INCREASE ACCESS TO CARE, NEW LICENSED SOCIAL WORKERS LICSWS WERE HIRED TO ACCOMMODATE PATIENT NEEDS.CHAIRED AND AUTHORED BY AN MCHS IN ALBERT LEA EMPLOYEE VOLUNTEER, THE ALBERT LEA/FREEBORN COUNTY CHAMBER WORKSITE WELLNESS COMMITTEE DEVELOPED A COMPREHENSIVE "ADDRESS STRESS" PROGRAM. ACCORDING TO THE AMERICAN INSTITUTE OF STRESS, WORKPLACE STRESS IS FAR AND AWAY THE MAJOR SOURCE OF STRESS FOR AMERICAN ADULTS AND IT HAS ESCALATED PROGRESSIVELY OVER THE PAST FEW DECADES. INCREASED LEVELS OF JOB STRESS AS ASSESSED BY THE PERCEPTION OF HAVING LITTLE CONTROL BUT LOTS OF DEMANDS HAVE BEEN DEMONSTRATED TO BE ASSOCIATED WITH INCREASED RATES OF HEART ATTACK, HYPERTENSION, STROKE, CANCER, DIABETES, FERTILITY ISSUES, DEPRESSION AND MORE. THE CHAMBER'S WELLNESS INITIATIVE HAS GARNERED SUPPORT FROM LOCAL WORKSITES, MANY OF WHOM HAVE TAKEN WORKPLACE PLEDGES TO HELP IMPROVE THEIR EMPLOYEES' HEALTH. IN COLLABORATION WITH BLUE ZONES/VITALITY PROJECT AND STATEWIDE HEALTH IMPROVEMENT PROGRAM (SHIP,) THE "ADDRESS STRESS" PROGRAM HAS ENGAGED A COMMUNITY VOLUNTEER TO TEACH MIND/BODY STRESS AND ANXIETY RELIEF TECHNIQUES THAT WILL BE REINFORCED BY WORKPLACE MANAGERS AND SUPERVISORS AND WITH TOP MANAGEMENT. THE PILOT IS SCHEDULED TO BEGIN IN 2016, WITH THREE, DIVERSE WORKPLACES.MENTAL HEALTH PRACTITIONERS AGREE THAT IMPROVING MENTAL HEALTH IS KEY AND A PRECURSOR TO DEALING WITH OBESITY AND CHRONIC HEALTH CONDITIONS. SO OUR STRATEGY ON MENTAL HEALTH HAS BEEN MORE FOCUSED AND INTENSE TO ALLOW FOR SUCCESS WITH OBESITY AND OTHER CHRONIC HEALTH CONDITIONS. OBESITYFIT FOREVER, ORGANIZED AND SUPPORTED BY THE COMMUNITY RELATIONS COMMITTEE OF MCHS IN ALBERT LEA, IS A COLLABORATIVE CHILDREN'S ANTI-OBESITY EFFORT WITH THE ALBERT LEA FAMILY "Y AND ALBERT LEA AREA SCHOOLS. IT WAS DEVELOPED TO ENCOURAGE ACTIVITY AND GOOD NUTRITION WHICH WOULD NOT ONLY LEAD TO LOWER INCIDENCE OF OBESITY AMONG YOUTH, BUT ENCOURAGE PARENTS AND FAMILIES TO MAKE SUBTLE CHANGES AS YOUTH SHARE INFORMATION GAINED AT FIT FOREVER ACTIVITIES. PRE AND POST-TESTS HELP MEASURE AWARENESS, AS WELL AS HEALTH IMPROVEMENTS, FOR PARTICIPANTS. THE PROGRAM, COMPRISED OF LOCAL 6TH AND 7TH GRADERS CONTINUES TO GROW. IN 2015, THE "Y" ATTENDED STUDENT/PARENT CONFERENCES AND INCREASED FIT FOREVER (WHICH STUDENTS KNOW AS FIT CLUB) MEMBERSHIP BY 20%. IN 2015, INDIVIDUAL SESSION PARTICIPATION INCREASED FROM FOUR TO SIX PER CLASS TO EIGHT TO 10 PER CLASS AND FULL SESSIONS INCREASED FROM SIX IN 2014 TO NINE IN 2015. 2014-15 SCHOOL YEAR PARTICIPANTS NUMBERED 84 PARTICIPANTS IN TOTAL WHICH IS ABOUT 20% OF STUDENTS IN 6TH AND 7TH GRADES. WE ALSO SUPPORT THE PROGRAM WITH FUNDS FOR FIT FOREVER PROGRAM COSTS AND SOME "Y" MEMBERSHIPS FOR 6TH AND 7TH GRADERS AT A SET AMOUNT OF $10,000 ANNUALLY AND THE "Y" EXECUTIVE DIRECTOR SITS ON OUR COMMUNITY RELATIONS COMMITTEE.CHRONIC HEALTH DISEASE PREVENTIONWITH A MEMO OF UNDERSTANDING TO COLLABORATE WITH THE Y-USA PRE-DIABETES PROGRAM, WE PRESENTED PROGRAM INFORMATION TO MEDICAL STAFF AND CARE COORDINATORS TO CREATE AN AWARENESS OF THE PROGRAM AND ITS EFFECTIVENESS AND TO INCREASE REFERRALS TO THE PROGRAM. WE ALSO PARTNERED WITH MAYO CLINIC COMMUNITY RESEARCH AND THE STATEWIDE HEALTH IMPROVEMENT PROGRAM (SHIP) IN FREEBORN COUNTY TO SUPPORT THE EVIDENCE-BASED COMMUNITY PROGRAM "LIVING WELL WITH CHRONIC DISEASE." IN 2015, MCHS IN ALBERT LEA REFERRALS INCREASED BY ABOUT 20%, WITH AN INCREASE OF 30% IN MEN WHO ATTENDED THE PROGRAM, WHICH WAS A 2015 TARGET. INCREASED AND ONGOING COMMUNICATION WITH MCHS CARE COORDINATORS AND THEIR SUBSEQUENT REFERRAL TO THE PROGRAM HAS HAD A GREAT IMPACT ON PROGRAM PARTICIPATION AND IDENTIFYING THE PATIENTS WHO WOULD MOST BENEFIT FROM COMPLETING THE PROGRAM. MCHS IN ALBERT LEA PARTICIPATED IN WELLCONNECT, ESTABLISHED IN 2015, AS A NEW REGIONAL CONSORTIUM OF HEALTH CARE PROVIDERS, PUBLIC HEALTH, SOCIAL SERVICE AGENCIES AND THE LIKE, WHERE EVIDENCE-BASED CHRONIC DISEASE PREVENTION AND INTERVENTION PROGRAMS ARE INTRODUCED AND VETTED AMONG THE COMMUNITY STAKEHOLDERS. TOGETHER, THE CONSORTIUM MEMBERS CREATE A COMMUNICATION PLAN, IDENTIFY BEST PRACTICES FOR ENGAGING PHYSICIANS AND REFERRAL STAFF AND, ULTIMATELY, HELP PATIENTS ACHIEVE OPTIMAL HEALTH THROUGH EDUCATION AND SKILLS LEARNED BY ATTENDING THESE PROGRAMS. NEW PATIENT AND REFERRAL WEBSITES ARE IN PROCESS TO INCREASE ACCESS AND CONVENIENCE TO THE INFORMATION, REFERRALS AND PROGRAM REGISTRATION.WE ALSO CONTINUE TO OFFER PUBLIC EDUCATION OPPORTUNITIES FOR DIABETES, CANCER AND HEALTHY EATING AND HOLD WOMEN'S HEART HEALTHY SYMPOSIUMS ANNUALLY, WHERE OUR PHYSICIANS AND NUTRITIONISTS PROVIDED WOMEN WITH INFORMATION AND TOOLS TO MAKE POSITIVE LIFESTYLE CHANGES TO PREVENT HEART DISEASE. THE IMPACT OVER TIME OF SUPPORTING AND REFERRING TO COMMUNITY WELLNESS PROGRAMS, WHERE PEOPLE GAIN KNOWLEDGE AND PRACTICAL TIPS ABOUT HOW TO LIVE HEALTHIER THROUGH GOOD NUTRITION, ACTIVITY AND STRESS-REDUCTION TECHNIQUES, IS A DELIBERATE STRATEGY TO HELP THEM TAKE RESPONSIBILITY FOR THEIR HEALTH AND LOWER UTILIZATION OF CLINIC SERVICES AND ASSOCIATED COSTS. IN ADDITION, PARTICIPANTS IN THESE PROGRAMS FORM THEIR OWN SUPPORT NETWORKS WHERE THEY MAY CONTINUE TO MEET OR CHAT OR TOUCH BASE TO SHARE INFORMATION AND SUCCESS WHEN THE PROGRAM SERIES IS COMPLETE. STAFF FROM MCHS IN ALBERT LEA, INCLUDING PUBLIC AFFAIRS, COMMUNITY ENGAGEMENT, NURSING AND NUTRITION, PARTICIPATE IN TEAMS CREATING AWARENESS OF THESE PROGRAMS, DEVELOPING COMMUNITY RESOURCES LISTS AND BUILDING A REFERRAL PROCESS WITH PROVIDERS.COMMUNITY HEALTH NEEDS IDENTIFIED BUT NOT CHOSEN FOR IMPLEMENTATIONTOBACCO USECOMMUNITY SURVEY RESPONDENTS WHO USE TOBACCO INDICATED LITTLE IMPETUS TO QUIT ON OUR COMMUNITY HEALTH NEEDS SURVEY IN 2013. OF THOSE WHO USE TOBACCO, 27.5% HAVE NEITHER TRIED TO QUIT NOR WANT TO QUIT. ANOTHER 40.4% EITHER LIVE WITH A SMOKER OR HAVE LIMITED RESOURCES TO QUIT TOBACCO USE, SO MCHS AND ITS COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY GROUP DETERMINED THAT INCREASED EFFORTS TO ENCOURAGE/ACHIEVE CESSATION WOULD REQUIRE SUBSTANTIAL RESOURCES, BUT YIELD LITTLE IMPACT.MCHS IN ALBERT LEA ALREADY PROVIDES FREE TOBACCO CESSATION PROGRAMS AND THE ALBERT LEA FREEBORN COUNTY CHAMBER, BLUE ZONES/VITALITY PROJECT AND SHIP HAVE UNDERTAKEN THE TASK OF INCREASING THE NUMBER OF SMOKE-FREE WORKPLACES AS BOTH A TACTIC AND AN INTERVENTION.DENTAL CARETHE BIGGEST GAP WITH DENTAL CARE IS THAT NO LOCAL DENTISTS ACCEPT MEDICAL ASSISTANCE WHICH PREVENTS LOW-INCOME FAMILIES FROM ACCESSING DENTAL CARE. MCHS EMPLOYS NO DENTISTS AND EFFORTS TO APPEAL TO THE COUNTY DENTAL GROUP TO PROVIDE LOW-COST SERVICES OR FREE SERVICES HAVE BEEN UNSUCCESSFUL.FREEBORN COUNTY PUBLIC HEALTH RECEIVED A SMALL GRANT TO HELP PROVIDE DENTAL HYGIENISTS FOR CHILDREN'S DENTAL CARE AND MCHS IN ALBERT LEA SUPPLEMENTED GRANT FUNDS WITH A DONATION TO THE FREEBORN COUNTY PUBLIC HEALTH CHILDREN'S DENTAL CARE PROGRAM. IT WAS DETERMINED DENTAL CARE COULD NOT BE IMPACTED IN THIS AREA WITHOUT INTEREST AND COMMITMENT FROM LOCAL DENTISTS TO MEET DENTAL HEALTH NEEDS OF PEOPLE UNABLE TO PAY FOR THE CARE.BINGE DRINKINGCOMMUNITY COALITIONS ARE ALREADY IN PLACE TO ADDRESS ALCOHOL AND YOUTH AND COULD BE EXPANDED TO INCLUDE BINGE DRINKING AWARENESS AND PREVENTION. MCHS STAFF, IN ITS FOUNTAIN CENTERS CHEMICAL DEPENDENCY TREATMENT PROGRAM, PARTICIPATES IN ALL LOCAL ALCOHOL AWARENESS EFFORTS. THESE INCLUDE PARTNERS IN PREVENTION, ZERO ALCOHOL PROVIDERS, ALCOHOL, TOBACCO AND OTHER DRUGS. MCHS IN AUSTIN PART V, SECTION B, LINE 11: MAYO CLINIC HEALTH SYSTEM IN AUSTIN (MCHS AU), IN PARTNERSHIP WITH MOWER COUNTY COMMUNITY HEALTH & HUMAN SERVICES (MCCHHS), WORKED TO ASSURE INDIVIDUAL VOICES IN THE COMMUNITIES SERVED NAMED THE TOP THREE HEALTH NEEDS THAT WOULD DRIVE MCHS AU'S COMMUNITY ENGAGEMENT EFFORTS. COMMUNITY MEMBERS IDENTIFIED OBESITY (CHILD AND ADULT), MENTAL HEALTH, AND ACCESS TO HEALTHCARE AS THE TOP THREE CONCERNS TO BE ADDRESSED AND AS SUCH, DRIVE THE WORK BEING DONE THROUGH MOWER REFRESHED, MCHS AU'S COMMUNITY ENGAGEMENT INITIATIVE. MOWER REFRESHED CONSISTS OF A COORDINATOR EMPLOYED BY MCHS AU TO PROVIDE THE COMMUNITY WITH COORDINATION OF WORK AROUND HEALTH AND WELLNESS, AND THREE CORE TEAMS: HEALTHIER CHOICES, MENTAL FITNESS, AND WORKFORCE WELLNESS. ANY EFFORT OR PROGRAM THE MOWER REFRESHED TEAMS FOCUS ON NEEDS TO LINK DIRECTLY BACK TO THE CURRENT CHNA. LIKEWISE, THE COORDINATOR'S WORK IS CENTERED ON THE CHNA COMMUNITY RESPONSES. THE MODEL SEEKS TO ENGAGE, EQUIP AND EMPOWER COMMUNITIES TO MAKE HEALTHY LIVING EASIER AS WELL AS OFFER A VENUE FOR COMMUNITY PARTNERS TO DIRECTLY ENGAGE WITH MCHS AU IN CREATING COMMUNITIES FOCUSED ON HEALTH, NOT HEALTHCARE ALONE. HTTP://MOWERREFRESHED.ORG/ OBESITYTHE FOLLOWING EFFORTS OF THE HEALTHIER CHOICES TEAM HAVE BEEN IMPLEMENTED TO IMPACT OBESITY AND HEALTH CONCERNS RELATED TO OBESITY:REFRESHED DINING - ENGAGES RESTAURANTS IN ACHIEVING SPECIFIC CRITERIA THAT PROMOTES ACCESS TO HEALTHY EATING WHEN DINING OUT. THERE ARE CURRENTLY FIVE RESTAURANTS ACTIVELY PARTICIPATING AND A GOAL OF ADDING TWO LOCATIONS ANNUALLY. HTTP://MOWERREFRESHED.ORG/REFRESHED-DINING/ REFRESHED SCHOOL ASSEMBLIES - STARTED AS A PILOT AND ARE NOW A REGULAR PART OF THE IJ HOLTON INTERMEDIATE SCHOOL THAT SERVES OVER THREE HUNDRED STUDENTS. THE ASSEMBLIES BRING IN COMMUNITY MEMBERS TO SHARE THEIR STORIES OF INSPIRATION OF MAKING WELLNESS (PHYSICAL, MENTAL, FINANCIAL, ETC) A PRIORITY IN THEIR LIVES. THE ASSEMBLIES ALSO CONNECT STUDENTS TO ORGANIZATIONS THAT ENCOURAGE HEALTHY LIFESTYLES SUCH AS THE YMCA, MCHS AU, PARKS AND RECREATION, ETC. AND OFFER POINTS OF ENGAGEMENT FOR THE STUDENTS AFTER SCHOOL AND DURING THE SUMMER. HARVEST 5K - IS AN ANNUAL WALK/RUN DEVELOPED TO ADDRESS THE NEED FOR DONATIONS OF HEALTHY FOODS TO AREA FOOD SHELVES. THE EVENT RAISES AWARENESS, FUNDS, AND FOOD DONATIONS AND ALSO EDUCATES ON THE IMPORTANCE OF DONATING HEALTHY FOOD ITEMS AND THE CURRENT POINTS OF CONNECTION TO THE FOOD SHELVES. KNOW YOUR NUMBERS WELLNESS FAIR - HOSTED BY MCHS AU AND AREA COMMUNITY PARTNERS, GAVE ACCESS TO COMMUNITY MEMBERS WANTING TO KNOW THEIR HEALTH NUMBERS. THE EVENT PROVIDED PARTICIPANTS WITH INFORMATION ON THEIR NUMBERS, IMMEDIATE ACCESS TO HEALTH COACHING, AND REFERRAL TO CARE PROVIDERS IF NEEDED.FAMILY KITCHEN CONNECTION PILOT - WAS DEVELOPED BASED COMMUNITY MEMBERS WHO MOVED TO THE AREA FROM OTHER COUNTRIES AND IDENTIFIED THE NEED TO BETTER UNDERSTAND HOW TO COOK HEALTHY AMERICAN FOOD. THE OBJECTIVES OF THE PILOT WERE TO CONNECT THESE NEW COMMUNITY MEMBERS WITH LOCALLY ESTABLISHED COMMUNITY MEMBERS TO BUILD "COMMUNITY" AS THEY COOKED AND PARTOOK IN A FAMILY STYLE MEAL AS WELL AS REINFORCE THE HEALTH VALUE OF DINING TOGETHER AS A FAMILY. MOWER REFRESHED IS CURRENTLY EXPLORING HOW TO OFFER THIS REGULARLY IN THE COMMUNITY DUE TO THE SUCCESS OF THE PILOT, DEMONSTRATED BY THE OVERWHELMING EVALUATION FROM PARTICIPANTS, AND THE ABILITY TO OFFER THE PROGRAM WITH MINIMAL COST. HARVEST FEST EXPLORE LIVING MOWER HEALTHY - IS A COLLABORATIVE EVENT WITH OVER FORTY COMMUNITY PARTNERS THAT WILL TAKE PLACE SEPTEMBER 2016 TO PROMOTE GOOD NUTRITION AND ACTIVE LIVING. MCHS AU IS A KEY FINANCIAL SUPPORTER AND PARTICIPANT FOR THIS FIRST TIME EVENT, WHICH WAS DEVELOPED IN RESPONSE TO THE DOWNTOWN RETAILERS ASSOCIATION REACHING OUT TO MOWER REFRESHED TO CONSIDER HOW THEY COULD PROMOTE HEALTHY LIVING. SUPPORTING PARTNERS: MCHS AU CARE PROVIDERS ARE ACTIVELY SUPPORTING THE PROGRAMMING OFFERED BY THE AUSTIN YMCA THAT DIRECTLY ADDRESSES DIABETES THROUGH THE DIABETES PREVENTION PROGRAM (DPP) AND CHILDHOOD OBESITY THROUGH A NEW PILOT BEING OFFERED AT THE LOCAL YMCA FOR CHILDREN AND THEIR PARENTS STRUGGLING WITH SIGNIFICANT OBESITY. MCHS AU WAS PIVOTAL IN ASSISTING THE LOCAL YMCA IN SECURING THE DDP FOR THE COMMUNITY.MENTAL HEALTHCOMMUNITY VIDEO ON RESILIENCY: COMMUNITY MEMBERS ON THE MENTAL FITNESS TEAM CREATED A VIDEO TO BE USED BY COMMUNITY GROUPS AND WHEN PRESENTING TO COMMUNITY ORGANIZATIONS ON FOSTERING RESILIENCY. HTTP://MOWERREFRESHED.ORG/MOWER-REFRESHED-SPEAK-LIFE/ PRESENTATIONS ON ADVERSE CHILDHOOD EXPERIENCES (ACES): THE MENTAL FITNESS TEAM CREATED A COMMUNITY PRESENTATION AND REGULARLY PRESENTS TO COMMUNITY GROUPS ON ACES AND THE IMPORTANCE OF BUILDING COMMUNITIES OF RESILIENCY. THE MESSAGE CENTERS AROUND THE ABILITY FOR EVERY PERSON TO POSITIVELY IMPACT THE ENVIRONMENTS THEY LIVE, WORK, LEARN, PRAY, AND PLAY IN BY SPEAKING AND ACTING IN WAYS THAT BUILD RESILIENCY AND FOSTER EMPATHY. THE CONVERSATION FOCUSES ON CREATING RESILIENT ENVIRONMENTS TO SHIFT CULTURE.ON CAMPUS YOGA PILOT: MCHS AU OFFERED A SIX MONTH PILOT TO EXPLORE THE NEED, DESIRE FOR, AND IMPACT OF OFFERING YOGA WITH PROMISING RESULTS. THE CLASSES WERE FREE TO EMPLOYEES AND COMMUNITY MEMBERS AND TOOK PLACE ON THE MEDICAL CAMPUS. MCHS AU COLLABORATED WITH LOCAL YOGA INSTRUCTORS AND FINANCED THIER SALARIES FOR THE PILOT. MOWER REFRESHED AND MCHS AU IS EXPLORING HOW TO BEST INTEGRATE THE CLASS BEYOND THE PILOT.SECOND HAND TRAUMA: THROUGH THE CHNA AND OTHER COMMUNITY SURVEYS/ASSESSMENTS IT WAS IDENTIFIED THAT SECONDARY TRAUMA WAS A SIGNIFICANT ISSUE TO MANY OF THE LOCAL PROFESSIONALS SUCH AS LAW ENFORCEMENT, HUMAN SERVICES, IMMIGRANT SUPPORT SERVICES, HEALTH CARE PROVIDERS, AND MORE. IN RESPONSE, MCHS AU HAS PARTNERED WITH OVER SEVEN OTHER COMMUNITY GROUPS TO HOST TRAINING ON WHAT SECONDARY TRAUMA IS, HOW SUPERVISORS/MANAGERS SUPPORT THEIR EMPLOYEES, AND WHAT LOCAL RESOURCES ARE AVAILABLE TO ASSIST THOSE DEALING WITH THE EFFECT OF THE TRAUMA. THE EVENT IS SCHEDULED FOR NOVEMBER 2016.ASSESSING MENTAL HEALTH CARE: THE WORKFORCE WELLNESS TEAM AND MENTAL FITNESS TEAM MEMBERS ARE COLLABORATING TO DEVELOP A SIMILAR BOOKLET TO THE ONE DESCRIBED ABOVE FOCUSED ON MENTAL HEALTH POINTS OF ACCESS IN THE MOWER COUNTY AREA. THE DEVELOPMENT IS IN PROCESS AND COMPLETION TIME IS SPRING 2016. COOPERATIVE HEALTH ACTION TRIAD (CHAT): MOWER REFRESHED HAS BEEN WORKING WITH AUSTIN PUBLIC SCHOOLS TO DEVELOP A MODEL TO ADDRESS THE INCREASED MENTAL HEALTH NEEDS OBSERVED BY SCHOOL PROFESSIONALS (SOCIAL WORKERS, SCHOOL PSYCHOLOGISTS, ETC). THE SCHOOL DISTRICT REACHED OUT TO MCHS AU WITH CONCERNS ABOUT THE INCREASE D RISKY BEHAVIORS AND DESIRED SUPPORT TO CONSIDER HOW IT MIGHT BE ADDRESSED. COLLABORATIVELY IT WAS DETERMINED THAT IT REQUIRED A CULTURE SHIFT AND NOT JUST PROGRAMS OR POLICIES CHANGES. CHAT WAS DEVELOPED BY THE PARTNERSHIPS AND CONSISTS OF THREE POINTS (TRIAD): COMMUNITY, STUDENTS AND STAFF. MCHS AU THROUGH MOWER REFRESHED HAS OFFERED FOCUS GROUPS, SURVEYING, PRACTICAL STRATEGIES AND IMPLEMENTATION OF COLLECTIVE IDEAS TO SHIFT CULTURE TO BE GROUNDED IN WELLBEING VS REACTING TO BEHAVIORS ALONE.INDEPENDENT FIELD STUDY - PSYCH 1271: IN COLLABORATION WITH RIVERLAND COMMUNITY COLLEGE, MCHS AU OFFERED A COURSE IN THE FALL OF 2015 THAT EQUIPS AND ENGAGES STUDENTS IN EXPLORING COMMUNITY ENGAGEMENT, ESPECIALLY ENGAGEMENT THAT ADDRESSES MENTAL HEALTH NEEDS IN THE COMMUNITY. STUDENTS WILL BE MATCHED WITH NON-PROFIT ORGANIZATIONS IN NEED OF ADDITIONAL SUPPORT TO STRENGTHEN PROGRAMS TO IMPROVE MENTAL FITNESS.ACCESS TO HEALTHCAREHEALTHCARE OPTIONS IN MOWER COUNTY BOOKLET: THROUGH THE 2013 SURVEYING PROCESS IT WAS IDENTIFIED THAT HOW, WHERE, AND WHEN TO ACCESS HEALTHCARE WAS CONFUSING. THIS CONFUSION LEADS TO HIGH UTILIZATION OF URGENT CARE SETTINGS FOR NON-URGENT HEALTH CONCERNS. STORIES HEARD THROUGH FOCUS GROUPS CONFIRMED THE CONFUSION AND NEED TO PROVIDE A RESOURCE THAT WAS MEANINGFUL TO THE COMMUNITIES SERVED. THROUGH MOWER REFRESHED'S CONNECTION WITH COMMUNITY PARTNERS, A GROUP GATHERED TO DEVELOP A HEALTHCARE OPTIONS BOOKLET FOR THE MOWER COUNTY AREA. MCHS AU THROUGH MOWER REFRESHED'S WORKFORCE WELLNESS TEAM CONTINUOUSLY ENGAGED A WIDE RANGE OF COMMUNITY MEMBERS TO DEVELOP THE BOOKLET AND ASSURE THE BOOK'S CONTENT WAS MEANINGFUL AND EASY TO UNDERSTAND. THE BOOKLET'S FIRST EDITION WAS PRINTED AND IS CURRENTLY BEING DISTRIBUTED THROUGH MCHS AU, SCHOOLS, BUSINESSES, AND COMMUNITY ORGANIZATIONS. THE BOOKLET IS AVAILABLE IN BOTH HARD COPY AND ONLINE, IN SPANISH AND ENGLISH. MCHS IN ALBERT LEA PART V, SECTION B, LINE 13B: IF A PATIENT BALANCE EXCEEDS 25% OF THE ANNUAL HOUSEHOLD INCOME, BUT THE PATIENT DOES NOT QUALIFY BASED ON FPG, CHARITY WILL BE ADJUSTED TO A MINIMUM OF THE AMOUNT GENERALLY BILLED (AGB). THE AGB IS DETERMINED USING THE LOOK-BACK METHOD AND CALCULATED USING ALL CLAIMS ALLOWED BY PRIVATE PAY INSURERS (INCLUDING MEDICARE ADVANTAGE) AND MEDICARE (TRADITIONAL) FOR INPATIENT AND OUTPATIENT SERVICES FOR THE YEAR. MCHS IN AUSTIN PART V, SECTION B, LINE 13B: IF A PATIENT BALANCE EXCEEDS 25% OF THE ANNUAL HOUSEHOLD INCOME, BUT THE PATIENT DOES NOT QUALIFY BASED ON FPG, CHARITY WILL BE ADJUSTED TO A MINIMUM OF THE AMOUNT GENERALLY BILLED (AGB). THE AGB IS DETERMINED USING THE LOOK-BACK METHOD AND CALCULATED USING ALL CLAIMS ALLOWED BY PRIVATE PAY INSURERS (INCLUDING MEDICARE ADVANTAGE) AND MEDICARE (TRADITIONAL) FOR INPATIENT AND OUTPATIENT SERVICES FOR THE YEAR. MCHS IN ALBERT LEA PART V, SECTION B, LINE 13H: THE REGIONAL PROXIMITY OF A PATIENT'S RESIDENCY IS A FACTOR FOR PRESCHEDULED SERVICES ONLY AND SECONDARY TO MEDICAL NEED. REGIONAL PROXIMITY IS NOT A FACTOR FOR EMERGENCY CARE PROVIDED. MCHS IN AUSTIN PART V, SECTION B, LINE 13H: THE REGIONAL PROXIMITY OF A PATIENT'S RESIDENCY IS A FACTOR FOR PRESCHEDULED SERVICES ONLY AND SECONDARY TO MEDICAL NEED. REGIONAL PROXIMITY IS NOT A FACTOR FOR EMERGENCY CARE PROVIDED. MCHS IN ALBERT LEA PART V, SECTION B, LINE 16I: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE ARE DISCUSSED WITH THE PATIENT. MCHS IN AUSTIN PART V, SECTION B, LINE 16I: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE ARE DISCUSSED WITH THE PATIENT. MCHS IN ALBERT LEA PART V, SECTION B, LINE 20E: FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE TO EVERY PATIENT VIA MAYO'S PUBLIC WEBSITE, FROM CUSTOMER SERVICE AND PATIENT ACCESS LOCATIONS, AND IS REFERENCED ON MAYO'S AUTHORIZATION FORMS AND STATEMENTS. IN ADDITION, BROCHURES ARE AVAILABLE IN THE ADMISSIONS AREA AND THE PROCESS OF HOW TO APPLY IS AVAILABLE ON THE MAYO CLINIC WEBSITE.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, MAYO DISCUSSES ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE.MONTHLY STATEMENTS ARE SENT TO PATIENTS THAT OUTLINE CURRENT CHARGES AND ACTIONS WITH INSURANCE AND INCLUDES INFORMATION ABOUT MAYO'S CHARITY CARE POLICY. SOME MAYO SITES UTILIZE ADVOCATES TO CONTACT THE PATIENT UPON DISCHARGE TO HELP THEM SECURE GOVERNMENTAL ASSISTANCE OR FINANCIAL ASSISTANCE.EACH CHARITY CARE REVIEW IS DOCUMENTED IN MAYO'S BILLING SYSTEM AND COMMUNICATED TO THE PATIENT. COMPLETED CHARITY CARE FORMS ARE MAINTAINED EITHER IN PAPER OR ELECTRONIC FORMAT. THE PATIENT IS INFORMED REGARDING THE OUTCOME OF THE REVIEW.MAYO OFTEN IDENTIFIES CHARITY CARE OPPORTUNITIES AFTER THE PATIENT HAS BEEN DISMISSED. IN MANY CASES, THIS IS DUE TO LIMITED INSURANCE COVERAGE OR INSURANCE DENIALS AFTER THE SERVICE WAS PERFORMED. IN THESE CASES, WHEN A PATIENT EXPRESSES AN INABILITY TO PAY FOR THEIR SERVICES, STAFF WILL INITIATE A CHARITY REVIEW AS INDICATED BY THE FINANCIAL ASSISTANCE POLICY, WHICH IS AVAILABLE FOR EVERY PATIENT AT MAYOCLINIC.ORG. MCHS IN AUSTIN PART V, SECTION B, LINE 20E: FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE TO EVERY PATIENT VIA MAYO'S PUBLIC WEBSITE, FROM CUSTOMER SERVICE AND PATIENT ACCESS LOCATIONS, AND IS REFERENCED ON MAYO'S AUTHORIZATION FORMS AND STATEMENTS. IN ADDITION, BROCHURES ARE AVAILABLE IN THE ADMISSIONS AREA AND THE PROCESS OF HOW TO APPLY IS AVAILABLE ON THE MAYO CLINIC WEBSITE.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, MAYO DISCUSSES ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE.MONTHLY STATEMENTS ARE SENT TO PATIENTS THAT OUTLINE CURRENT CHARGES AND ACTIONS WITH INSURANCE AND INCLUDES INFORMATION ABOUT MAYO'S CHARITY CARE POLICY. SOME MAYO SITES UTILIZE ADVOCATES TO CONTACT THE PATIENT UPON DISCHARGE TO HELP THEM SECURE GOVERNMENTAL ASSISTANCE OR FINANCIAL ASSISTANCE.EACH CHARITY CARE REVIEW IS DOCUMENTED IN MAYO'S BILLING SYSTEM AND COMMUNICATED TO THE PATIENT. COMPLETED CHARITY CARE FORMS ARE MAINTAINED EITHER IN PAPER OR ELECTRONIC FORMAT. THE PATIENT IS INFORMED REGARDING THE OUTCOME OF THE REVIEW.MAYO OFTEN IDENTIFIES CHARITY CARE OPPORTUNITIES AFTER THE PATIENT HAS BEEN DISMISSED. IN MANY CASES, THIS IS DUE TO LIMITED INSURANCE COVERAGE OR INSURANCE DENIALS AFTER THE SERVICE WAS PERFORMED. IN THESE CASES, WHEN A PATIENT EXPRESSES AN INABILITY TO PAY FOR THEIR SERVICES, STAFF WILL INITIATE A CHARITY REVIEW AS INDICATED BY THE FINANCIAL ASSISTANCE POLICY, WHICH IS AVAILABLE FOR EVERY PATIENT AT MAYOCLINIC.ORG. MCHS IN ALBERT LEA PART V, SECTION B, LINE 22D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 50% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE. MCHS IN AUSTIN PART V, SECTION B, LINE 22D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 50% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE. 19 1 - FOUNTAIN CENTERS IN ALBERT LEA 408 WEST FOUNTAIN STREET ALBERT LEA MN 56007 CHEMICAL DEPENDENCY 2 - MCHS - ALBERT LEA HEALTH REACH 1705 SE BROADWAY ALBERT LEA MN 56007 OUTPATIENT PHYSICAL THERAPY 3 - FOUNTAIN CENTERS IN ROCHESTER CEDARWOOD MALL 4122 18TH AVE NW ROCHESTER MN 55901 CHEMICAL DEPENDENCY 4 - MCHS - AUSTIN IN ADAMS 908 WEST MAIN ST ADAMS MN 55909 CLINIC 5 - FOUNTAIN CENTERS IN AUSTIN 101 14TH ST NW AUSTIN MN 55912 CHEMICAL DEPENDENCY 6 - MCHS - AUSTIN HOSPICE 101 14TH ST NW AUSTIN MN 55912 HOSPICE OFFICES 7 - FOUNTAIN CENTERS IN FAIRMONT 828 N NORTH AVENUE FAIRMONT MN 56031 CHEMICAL DEPENDENCY 8 - MCHS - ALBERT LEA IN LAKE MILLS 309 S 10TH AVE LAKE MILLS IA 50450 CLINIC 9 - FOUNTAIN CENTERS IN MANKATO 1400 MADISON AVE SUITE 326 MANKATO MN 56001 CHEMICAL DEPENDENCY 10 - FOUNTAIN CENTERS IN FARIBAULT 2301 NW 4TH STREET FARIBAULT MN 55021 CHEMICAL DEPENDENCY 11 - MCHS - ALBERT LEA IN WELLS 301 S BROADWAY WELLS MN 56097 CLINIC 12 - MCHS - ALBERT LEA IN NEW RICHLAND 318 FIRST ST SW NEW RICHLAND MN 56072 CLINIC 13 - MCHS - EXPRESS CARE IN ALBERT LEA 2708 BRIDGE AVE ALBERT LEA MN 56007 EXPRESS CARE CLINIC 14 - FOUNTAIN CENTERS IN WASECA 505 S STATE STREET SUITE 6 WASECA MN 56093 CHEMICAL DEPENDENCY 15 - FOUNTAIN CENTERS IN OWATONNA 134 SOUTHVIEW STREET OWATONNA MN 55060 CHEMICAL DEPENDENCY 16 - MCHS - ALBERT LEA IN ALDEN 192 WASHINGTON AVE ALDEN MN 56009 CLINIC 17 - MCHS - AUSTIN IN LEROY 671 EAST MAIN STREET LEROY MN 55951 CLINIC 19 - MCHS - ALBERT LEA IN KIESTER 120 N MAIN ST KIESTER MN 56051 CLINIC 19 - MCHS - AUSTIN IN BLOOMING PRAIRIE 405 EAST MAIN BLOOMING PRAIRIE MN 55917 CLINIC PART I, LINE 3C: MEDICAL INDIGENCY MAY BE USED TO DETERMINE ELIGIBILITY. IF A PATIENT BALANCE EXCEEDS 25% OF THE ANNUAL HOUSEHOLD INCOME, BUT THE PATIENT DOES NOT QUALIFY BASED ON FPG, CHARITY WILL BE ADJUSTED TO A MINIMUM OF THE AMOUNT GENERALLY BILLED (AGB). THE AGB IS DETERMINED USING THE LOOK-BACK METHOD AND CALCULATED USING ALL CLAIMS ALLOWED BY PRIVATE PAY INSURERS (INCLUDING MEDICARE ADVANTAGE) AND MEDICARE (TRADITIONAL) FOR INPATIENT AND OUTPATIENT SERVICES FOR THE YEAR. PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS).THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO-CHARGE RATIO. PART I, LINE 7G: THE FOLLOWING NET COMMUNITY BENEFIT COST ATTRIBUTED TO A PHYSICIAN CLINIC WAS INCLUDED AS SUBSIDIZED HEALTH SERVICES: $212,326. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5,590,014. SCHEDULE H, PART I, LINE 5A THE FILING ORGANIZATION ESTIMATES CHARITY CARE FOR FINANCIAL PLANNING PURPOSES ONLY. THE ESTIMATED AMOUNT OF CHARITY CARE DOES NOT INFLUENCE OR HAVE ANY IMPACT ON THE AMOUNT OF CHARITY CARE PROVIDED. PART II, COMMUNITY BUILDING ACTIVITIES: THROUGH DONATIONS, GRANTS, AND VOLUNTEER HOURS TO PUBLIC, PRIVATE AND NONPROFIT ORGANIZATIONS, THE FILING ORGANIZATION ASSISTS WITH SUSTAINING AND ENHANCING THE COMMUNITIES IT SERVES. PART III, LINE 2: PART III, SECTION A, LINE 1:THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP. METHODOLOGY FOR SCHEDULE H, PART III, LINE 2:BAD DEBT EXPENSE IS DETERMINED BASED ON GAAP AND IS EXPLAINED IN THE ACCOUNTS RECEIVABLE FOOTNOTE OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. PART III, LINE 4: FOOTNOTES RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS CAN BE FOUND ON PAGES 5, 7, 8 AND 9 OF MAYO CLINIC'S 2015 CONSOLIDATED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SHORTFALL REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT (USING A MEDICARE COST REPORT STEP-DOWN METHODOLOGY). REASONS WHY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT ARE: (1) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; (3) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND (4) THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. PART III, LINE 9B: MAYO CLINIC AND ITS AFFILIATES STRIVE TO ASSIST ALL PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION PRIOR TO ENLISTING THE ASSISTANCE OF A COLLECTION AGENCY BY MAKING REASONABLE ATTEMPTS TO COLLECT FROM INSURANCE COMPANIES AND OTHER THIRD-PARTY PAYORS. IN ADDITION, MAYO CLINIC AND ITS AFFILIATES ACCEPT REASONABLE PAYMENT PLANS FROM PATIENTS WHEN AN ACCOUNT IS THE PATIENT'S RESPONSIBILITY AND TRY TO IDENTIFY THOSE PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE IS OFFERED TO ANY PATIENT IF THE FACTS AND CIRCUMSTANCES SUGGEST THAT THE PATIENT DOES NOT HAVE THE ABILITY TO PAY THEIR BILL IN WHOLE OR IN PART. IN THE EVENT THAT AN ACCOUNT IS REFERRED TO A COLLECTION AGENCY, GUIDELINES ARE FOLLOWED; INCLUDING SUSPENDING ALL COLLECTION ACTIVITY IF A FINANCIAL ASSISTANCE APPLICATION HAS BEEN SUBMITTED AFTER THE ACCOUNT HAS BEEN REFERRED FOR COLLECTION. IF A COLLECTION AGENCY IDENTIFIES A PATIENT AS POTENTIALLY MEETING MAYO CLINIC'S FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA OR THE PATIENT ASKS TO APPLY FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY IS SUSPENDED UNTIL MAYO REVIEWS THE ACCOUNT FOR FINANCIAL ASSISTANCE ELIGIBILITY BASED ON SUBMISSION OF REQUESTED INFORMATION. COLLECTION ACTIVITY WOULD ONLY RESUME IF THE PATIENT IS DETERMINED TO BE INELIGIBLE FOR FINANCIAL ASSISTANCE OR IS ELIGIBLE FOR ONLY PARTIAL FINANCIAL ASSISTANCE AND DOES NOT AGREE TO PAY THE REMAINING BALANCE. PART VI, LINE 2: FOR WELL OVER 100 YEARS IT HAS BEEN THE PRACTICE FOR MAYO CLINIC HEALTH SYSTEM - ALBERT LEA AND AUSTIN TO REACH OUT TO THE COMMUNITY FOR FEEDBACK, TO IDENTIFY NEEDS AND TO BUILD PARTNERSHIPS TO MEET THOSE NEEDS. ALBERT LEA/FREEBORN COUNTY:WORKING IN CONJUNCTION WITH FREEBORN COUNTY PUBLIC HEALTH AND THE MINNESOTA DEPARTMENT OF HEALTH, MAYO CLINIC HEALTH SYSTEM - ALBERT LEA AND AUSTIN IN ALBERT LEA (MCHS-ALBERT LEA) CONDUCTED A MULTI-FACETED APPROACH TO GATHERING INFORMATION AND IDENTIFYING LOCAL HEALTH NEEDS.THE PRIMARY TOOL WAS A COMMUNITY SURVEY DEVELOPED TO DETERMINE INDIVIDUAL HEALTH HABITS AND HEALTH CONCERNS THAT WOULD PROVIDE A GLIMPSE INTO THE HEALTH STATUS OF THE COMMUNITY THAT COULD BE COMPARED AGAINST OTHER COUNTY AND STATE DATA TO DETERMINE OUTLIERS.THE SURVEY WAS SUPPORTED BY KEY INFORMANT SURVEYS AND FACE-TO-FACE MEETINGS WITH COMMUNITY REPRESENTATIVES WHO PROVIDED VALUABLE FEEDBACK AND ANECDOTAL INFORMATION TO CLARIFY ISSUES AND GAPS IN COMMUNITY CARE AND SERVICES AND THROUGH REVIEW OF OTHER LOCAL ORGANIZATIONS' SURVEYS TO THEIR CONSTITUENTS. A COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY GROUP, COMPRISED OF LOCAL STAKEHOLDERS AND COMMUNITY ORGANIZATIONS AND PROGRAMS, WAS CREATED TO HELP IDENTIFY AND PRIORITIZE NEEDS AND DETERMINE WHICH COULD BE REALISTICALLY IMPACTED BY WORKING COLLABORATIVELY WITHIN THE COMMUNITY. NEEDS ASSESSMENT OUTCOMES REVEALED GAPS IN MENTAL HEALTH ACCESS AND CARE AND A HIGH PERCENTAGE OF OBESITY AND CHRONIC DISEASE WITHIN THE FREEBORN COUNTY POPULATION THAT HAVE POTENTIAL FOR IMPROVEMENT AS COMMUNITY GROUPS EXPAND CURRENT WORK OR IDENTIFY NEW PROGRAMS OR PROCESSES TO IMPACT HIGH PRIORITY NEEDS. AUSTIN/MOWER COUNTY:THROUGH THE COMMUNITY ENGAGEMENT INITIATIVE, MOWER REFRESHED, MAYO CLINIC HEALTH SYSTEM - ALBERT LEA AND AUSTIN IN AUSTIN (MCHS-AU) IS IN CONTINUAL CONTACT WITH COMMUNITY MEMBERS TO HEAR IDEAS, INVITE PARTICIPATION IN CREATING SOLUTIONS, AND CONSIDERING HOW TO BEST TAKE WHAT IS WORKING WELL TO CREATE ENVIRONMENTS THAT FOSTER HEALTH AND EXPAND ON THEM. THIS IS ACHIEVED IN A VARIETY OF VENUES.THE DEVELOPMENT OF A WEBSITE, INDEPENDENT OF MCHS-AUSTIN HAS BEEN A WAY FOR MCHS-AUSTIN TO SUPPORT THE WORK OF THE COMMUNITY MEMBERS AS THEY LOOK TO GROW MORE GOOD. IT HAS OFFERED A TRULY COMMUNITY-DRIVEN MODEL TO COMMUNITY ENGAGEMENT. HTTP://MOWERREFRESHED.ORG/ SOCIAL MEDIA HAS BEEN ANOTHER VENUE WHERE WEEKLY WE ASK COMMUNITY MEMBERS KEY WELLNESS QUESTIONS TO KEEP A PULSE ON THE NEEDS, OPINIONS, AND INSPIRING IDEAS. THIS OCCURS EVERY WEDNESDAY AS A PART OF WELLNESS WEDNESDAYS. A REFRESHED TIP IS SENT BY EMAIL, POSTED ON FACEBOOK, AND TWITTER. COMMUNITY MEMBERS CAN DECIDE WHAT VENUE THEY WANT TO ENGAGE WITH. HTTPS://WWW.FACEBOOK.COM/MOWERREFRESHED REFRESHED ENEWS IS A BIMONTHLY GRASSROOTS ELECTRONIC NEWSLETTER THAT FEATURES LOCAL STORIES, RESOURCES AND POINTS OF ENGAGEMENT FOR COMMUNITIES SERVED BY MCHS-AUSTIN. THE NEWSLETTERS FOCUS ON TOPICS THAT LINK BACK TO THE CURRENT CHNA. HTTP://MOWERREFRESHED.ORG/REFRESHED-LIVING-NEWSLETTER/ PART VI, LINE 3: MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY:MAYO CLINIC IS COMMITTED TO OFFERING FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY FOR THEIR MEDICAL SERVICES IN WHOLE OR IN PART. IN ORDER TO ACCOMPLISH THIS CHARITABLE GOAL, MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM SITES WIDELY PUBLICIZE THIS POLICY IN THE COMMUNITIES THAT THE INDIVIDUAL MAYO CLINIC AFFILIATED SITES SERVE. MAYO CLINIC AFFILIATED SITES MAKE COPIES OF THIS POLICY AND APPLICATIONS AVAILABLE BY POSTING IT ON THEIR WEBPAGE INCLUDING THE ABILITY TO DOWNLOAD A COPY OF THE POLICY AND APPLICATION FREE OF CHARGE. INDIVIDUALS IN THE COMMUNITY SERVED WILL BE ABLE TO OBTAIN A COPY OF THE POLICY IN LOCATIONS THROUGHOUT EACH MAYO CLINIC AFFILIATED SITE OR UPON REQUEST. THE POLICY EXPLAINS THE FINANCIAL ASSISTANCE PROGRAM AND FACTORS AFFECTING ELIGIBILITY. WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. ADDITIONALLY, CHARITABLE CARE AND FINANCIAL ASSISTANCE IS REFERENCED ON PATIENT CORRESPONDENCE INCLUDING: THE MONTHLY STATEMENT OF ACCOUNT, ACCOUNT BALANCE LETTERS, AND LATE PAYMENT NOTIFICATIONS. ALL PATIENT CORRESPONDENCE REFERENCING CHARITABLE CARE AND FINANCIAL ASSISTANCE INCLUDE INTERNET, PHONE, AND MAILING ADDRESS CONTACT INFORMATION. PART VI, LINE 4: MAYO CLINIC HEALTH SYSTEM - ALBERT LEA AND AUSTIN IS AN INTEGRATED ORGANIZATION, WITH MAIN SITES IN ALBERT LEA AND AUSTIN AND NINE REGIONAL CLINIC LOCATIONS WITHIN 20 MILES OF EACH SITE. THE POPULATION OF THE PRIMARY SERVICE AREA FOR EACH IS ABOUT 35,000, CONCENTRATED IN FREEBORN AND MOWER COUNTIES, RESPECTIVELY. MAYO CLINIC HEALTH SYSTEM - ALBERT LEA AND AUSTIN OFFERS A BROAD RANGE OF INPATIENT, OUTPATIENT AND SPECIALTY SERVICES IN SOUTHERN MINNESOTA AND NORTHERN IOWA, INCLUDING A CONVENIENCE CARE CLINIC, CANCER CENTER, PHYSICAL MEDICINE AND REHABILITATION CENTER AND INPATIENT AND OUTPATIENT DRUG AND ALCOHOL TREATMENT FACILITIES. 2015 POPULATION ESTIMATES:ALBERT LEA/FREEBORN COUNTY 30,613AUSTIN/MOWER COUNTY 39,116PERSONS UNDER 5 YEARSALBERT LEA/FREEBORN COUNTY 5.6%AUSTIN/MOWER COUNTY 6.8%PERSONS UNDER 18 YEARSALBERT LEA/FREEBORN COUNTY 21.8%AUSTIN/MOWER COUNTY 24.6% PERSONS 65 AND OVER ALBERT LEA/FREEBORN COUNTY 21.7%AUSTIN/MOWER COUNTY 18.0%TOTAL FEMALE ALBERT LEA/FREEBORN COUNTY 50.3%AUSTIN/MOWER COUNTY 49.9%ETHNICITY/RACE WHITE ALONE ALBERT LEA/FREEBORN COUNTY 95.5%AUSTIN/MOWER COUNTY 91.9%BLACK ALONE ALBERT LEA/FREEBORN COUNTY 1.2%AUSTIN/MOWER COUNTY 3.4%AMERICAN INDIAN/ALASKA NATIVE ALONE ALBERT LEA/FREEBORN COUNTY 0.4%AUSTIN/MOWER COUNTY 0.5%ASIAN ALONE ALBERT LEA/FREEBORN COUNTY 1.5%AUSTIN/MOWER COUNTY 2.5%NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER ALBERT LEA/FREEBORN COUNTY 0.1%AUSTIN/MOWER COUNTY 0.2%HISPANIC OR LATINO ORIGIN ALBERT LEA/FREEBORN COUNTY 9.6%AUSTIN/MOWER COUNTY 11.0%WHITE, NON-HISPANIC ALBERT LEA/FREEBORN COUNTY 86.7%AUSTIN/MOWER COUNTY 81.6%SOURCE: US CENSUS BUREAU PART VI, LINE 5: THIS FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION - EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO CLINIC HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATION'S ACTIVITIES.SURPLUS FUNDS - MAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE. THE BOARD OF TRUSTEES IS THE GOVERNING BODY OF MAYO CLINIC. A MAJORITY OF ITS MEMBERS ARE EXTERNAL, INDEPENDENT TRUSTEES. IT HAS OVERALL RESPONSIBILITY FOR THE CHARITABLE, CLINICAL PRACTICE, SCIENTIFIC AND EDUCATIONAL MISSION AND PURPOSES OF MAYO CLINIC AND ITS AFFILIATES AS SET FORTH IN ITS ARTICLES OF INCORPORATION AND BYLAWS. BECAUSE OF MAYO CLINIC'S NATIONAL PRESENCE, THESE TRUSTEES ARE SELECTED BASED ON THEIR AREAS OF EXPERTISE, WHETHER IN HEALTH CARE POLICY, BUSINESS, GOVERNMENT OR ANOTHER FIELD. IN ADDITION TO THIS COMMUNITY REPRESENTATION AT THE PARENT ENTITY, THE FILING ORGANIZATION ALSO INVOLVES LOCAL COMMUNITY MEMBERS ON ITS GOVERNING BODY. OPEN V. CLOSED STAFF MODEL - STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.EMERGENCY ROOM - THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. PART VI, LINE 6: THIS ORGANIZATION IS A PART OF MAYO CLINIC HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO CLINIC HEALTH SYSTEM IS DESCRIBED IN RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). THAT STATEMENT ALSO DESCRIBES THE ROLES OF THE VARIOUS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED. PART VI, LINE 7 NEITHER THE FILING ORGANIZATION, NOR ANY RELATED ORGANIZATION, FILES A COMMUNITY BENEFIT REPORT WITH ANY STATE OTHER THAN THE EXTENT TO WHICH COMMUNITY BENEFIT INFORMATION IS INCLUDED IN OTHER REPORTING REQUIREMENTS SUCH AS INFORMATION PROVIDED TO A STATE HOSPITAL ASSOCIATION. PART V, SECTION B, LINES 16A, 16B, & 16C URL OF THE FAP, FAP APPLICATION, AND PLAIN LANGUAGE SUMMARY:MAYOCLINICHEALTHSYSTEM.ORG/LOCATIONS/ALBERT-LEA/BILLING ORMAYOCLINICHEALTHSYSTEM.ORG/LOCATIONS/AUSTIN/BILLING 1 AUSTIN ASPIRES INC 329 N MAIN SUITE 106L AUSTIN MN 55912 465424422 501(C)(3) 66668 SUPPORT CHARITABLE PROGRAMS AUSTIN COMMUNITY CHARITABLE FUND 329 N MAIN ST STE 106L AUSTIN MN 55912 363487772 501(C)(3) 25000 SUPPORT CHARITABLE PROGRAMS UNITED WAY OF FREEBORN COUNTY 341 S BROADWAY AVE ALBERT LEA MN 56007 410956396 501(C)(3) 21000 SUPPORT CHARITABLE PROGRAMS UNITED WAY OF MOWER CO 201 S MAIN AUSTIN MN 55912 410831896 501(C)(3) 20000 SUPPORT CHARITABLE PROGRAMS FAMILY Y OF ALBERT LEA MINNESOTA INC 2021 WEST MAIN ST ALBERT LEA MN 56007 411000679 501(C)(3) 16500 SUPPORT CHARITABLE PROGRAMS AUSTIN AREA COMMISSION FOR THE ARTS 300 N MAIN STREET AUSTIN MN 55912 411650727 501(C)(3) 15000 SUPPORT CHARITABLE PROGRAMS ST JOHNS LUTHERAN COMMUNITY 901 LUTHER PLACE ALBERT LEA MN 56007 410847708 501(C)(3) 10000 SUPPORT CHARITABLE PROGRAMS THE HORMEL FOUNDATION 301 N MAIN ST STE 102L AUSTIN MN 55912 410694716 501(C)(3) 10000 SUPPORT CHARITABLE PROGRAMS ALBERT LEA ART CENTER 226 W CLARK ST ALBERT LEA MN 56007 416038618 501(C)(3) 6300 SUPPORT CHARITABLE PROGRAMS MAYO CLINIC HEALTH SYSTEM--AUSTIN FOUNDATION 300 EIGHTH AVE NW AUSTIN MN 55912 300107471 501(C)(3) 57408 SUPPORT CHARITABLE PROGRAMS 10 0 SCHOLARSHIPS 31 32575 CHARITABLE SUPPORT OF INDIVIDUALS 1 1500 PART I, LINE 2: THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY WITH PROGRAMS THAT ENHANCE THE MISSION OF THE FILING ORGANIZATION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY THAT ADDRESS UNMET OR UNDER-FUNDED COMMUNITY NEEDS IN THE AREAS OF HEALTHCARE, EDUCATION, RESEARCH, DIVERSITY AND EQUALITY OF OPPORTUNITY. TRANSFERS OR GRANTS TO TAX-EXEMPT ORGANIZATIONS AND/OR AFFILIATED TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED. SCHOLARSHIPS ARE AWARDED TO INDIVIDUALS PURSUING A DEGREE IN A HEALTHCARE FIELD. THESE SCHOLARSHIPS ARE PAID DIRECTLY TO THE COLLEGE OR UNIVERSITY. SHORT-TERM FINANCIAL ASSISTANCE WAS PROVIDED TO AN INDIVIDUAL EXPERIENCING A TEMPORARY HARDSHIP. GRANTS ARE PROVIDED BASED ON A PROVEN NEED AND ARE NOT MONITORED. 0 1 1 0 0 0 0 0 0 CIOTA MD MARK R DIRECTOR/CHAIR 751523 0 0 0 3220 0 46188 0 25821 0 826752 0 0 0 GABRIELSON SHARON R DIRECTOR 0 263239 0 0 0 1016 0 43230 0 15328 0 322813 0 0 KLEIS DO KEITH R DIRECTOR 292268 0 70 0 8230 0 38048 0 20478 0 359094 0 0 0 MILLER MD ROBERT C DIRECTOR/VICE CHAIR 0 520434 0 0 0 72653 0 40837 0 21444 0 655368 0 0 PARKS DOUGLAS A DIRECTOR/REGION CAO 0 236962 0 0 0 2137 0 28462 0 21555 0 289116 0 0 PLATE MD REINOLD H DIRECTOR 0 309162 0 0 0 6150 0 49892 0 20544 0 385748 0 0 SCHULZ MD JOHN M DIRECTOR 515274 0 0 0 44419 0 54067 0 25571 0 639331 0 0 0 YTTERBERG MD KAREN L DIRECTOR 0 211730 0 0 0 2693 0 44485 0 2786 0 261694 0 0 AGERTER MD DAVID C REGION CEO 0 523301 0 0 0 74291 0 10639 0 15567 0 623798 0 0 KOCH MARK B ASSISTANT SECRETARY 0 446213 0 0 0 36983 0 10710 0 12967 0 506873 0 0 TARASOVITCH JAMES J REGION CFO 0 301807 0 0 0 7337 0 47461 0 19489 0 376094 0 0 LARSON VIRGINIA OPERATIONS ADMINISTRATOR 171752 0 110 0 3802 0 32840 0 16465 0 224969 0 0 0 SLEGH KERI A HUMAN RESOURCES DIVISION CHAIR 139207 0 0 0 11787 0 14770 0 20745 0 186509 0 0 0 ECKSTROM MD MICHAEL T PHYSICIAN 1068149 0 10 0 4401 0 44010 0 24908 0 1141478 0 0 0 ENGMAN MD STEVEN J PHYSICIAN 617181 0 25 0 1067 0 34319 0 22007 0 674599 0 0 0 NGUYEN MD EMILY C PHYSICIAN 650410 0 50 0 49486 0 30543 0 19974 0 750463 0 0 0 SKORIN DO LEONID PHYSICIAN 779724 0 25 0 130082 0 51462 0 16959 0 978252 0 0 0 WEAVER MD CHAD H PHYSICIAN 621604 0 10010 0 197618 0 25112 0 1979 0 856323 0 0 0 WALDHOFF STEPHEN C FORMER OFFICER 0 287918 0 0 0 12337 0 9734 0 16911 0 326900 0 0 ANGSTMAN MD GREGORY L FORMER KEY EMPLOYEE 214975 0 440 0 31468 0 43291 0 11738 0 301912 0 0 0 BARNES MD DARRYL E FORMER KEY EMPLOYEE 268765 0 0 0 97981 0 37382 0 19413 0 423541 0 0 0 COLLIER DPM ROBERT L FORMER KEY EMPLOYEE 329765 0 25 0 11360 0 45048 0 24212 0 410410 0 0 0 GOINS MD JENNIFER L FORMER KEY EMPLOYEE 419647 0 5000 0 2708 0 27251 0 25157 0 479763 0 0 0 GRZYBOWSKI MD JOHN A FORMER KEY EMPLOYEE 364784 0 10 0 20781 0 37953 0 19022 0 442550 0 0 0 KATTEL MD SHARMA B FORMER KEY EMPLOYEE 295213 0 8760 0 17781 0 20598 0 13598 0 355950 0 0 0 LOMBARDI MD JOSEPH M FORMER KEY EMPLOYEE 319152 0 0 0 5129 0 54067 0 15461 0 393809 0 0 0 NORDENG RODNEY L FORMER KEY EMPLOYEE 161657 0 35 0 11459 0 25824 0 21388 0 220363 0 0 0 SCHULZ MD JODI L FORMER KEY EMPLOYEE 454221 0 50 0 7322 0 37934 0 22988 0 522515 0 0 0 SMITH MD A DON FORMER KEY EMPLOYEE 488798 0 50 0 10632 0 55044 0 18978 0 573502 0 0 0 STOLTENBERG MD HEIDI G FORMER KEY EMPLOYEE 234690 0 65 0 5404 0 36353 0 17201 0 293713 0 0 0 ULRICH MD MICHAEL D FORMER KEY EMPLOYEE 351755 0 765 0 23099 0 44657 0 24087 0 444363 0 0 0 YOUNG DO NATHAN P FORMER KEY EMPLOYEE 0 291524 0 0 0 784 0 33837 0 20357 0 346502 0 0 PART I, LINE 3 THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE CORE 990 PART VI SECTION B LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED. PART I, LINES 4B-C THIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(A)(17). STARTING JANUARY 1, 2011, ALL SRP BENEFITS ARE PAID AS AN ANNUAL TAXABLE CASH PAYMENT. THE FOLLOWING INDIVIDUALS PARTICIPATED IN OR RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN. AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). AGERTER M.D., DAVID C. $67,586 BARNES M.D., DARRYL E. $ 0 CIOTA M.D., MARK R. $ 0 COLLIER D.P.M., ROBERT L. $ 0 ECKSTROM M.D., MICHAEL T. $ 0 ENGMAN M.D., STEVEN J. $ 0 GABRIELSON, SHARON R. $ 0 GOINS M.D., JENNIFER L. $ 0 GRZYBOWSKI M.D., JOHN A. $ 0 KATTEL M.D., SHARMA B. $ 0 KLEIS D.O., KEITH R. $ 0 KOCH, MARK B. $33,730 LOMBARDI M.D., JOSEPH M. $ 0 MILLER M.D., ROBERT C. $50,864 NGUYEN M.D., EMILY C. $ 0 PLATE M.D., REINOLD H. $ 0 SCHULZ M.D., JODI L. $ 0 SCHULZ M.D., JOHN M. $ 0 SKORIN D.O., LEONID $ 0 SMITH M.D., A. DON $ 0 TARASOVITCH, JAMES J. $ 0 ULRICH M.D., MICHAEL D. $ 0 WALDHOFF, STEPHEN C. $ 5,560 WEAVER M.D., CHAD H. $ 0 YOUNG D.O., NATHAN P. $ 417 UNDER MAYO CLINIC'S ROYALTY SHARING POLICY, INVENTORS, INCLUDING LISTED PERSONS, ARE ENTITLED TO SHARE IN A PORTION OF ROYALTIES RECEIVED BY MAYO INCLUDING INSTANCES WHERE SUCH ROYALTIES ARE IN THE FORM OF EQUITY-BASED INSTRUMENTS SUCH AS STOCK, WARRANTS, OR PARTNERSHIP INTERESTS. THE FOLLOWING INDIVIDUALS PARTICIPATED IN AN EQUITY-BASED COMPENSATION ARRANGEMENT: BARNES M.D., DARRYL E. PART II: COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. BEVERLY A LOMBARDI MD FAMILY MEMBER OF FORMER KEY EMPLOYEE, JOSEPH M. LOMBARDI M.D. 92170 EMPLOYMENT 0 PHILLIP R HANSON FAMILY MEMBER OF FORMER KEY EMPLOYEE, HEIDI G. STOLTENBERG M.D. 83931 EMPLOYMENT 0 STEVEN SCHULZ FAMILY MEMBER OF FORMER KEY EMPLOYEE, JODI L SCHULZ, M.D., 80468 EMPLOYMENT 0 MARY J SMITH FAMILY MEMBER OF FORMER KEY EMPLOYEE, A. DON SMITH, M.D. 65964 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUAL(S) IS/ARE EMPLOYED BY A RELATED ORGANIZATION: PLATE M.D., REINOLD H. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL(S) WHO IS/ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: TARASOVITCH, JAMES J., PARKS, DOUGLAS A., KOCH, MARK B., AGERTER M.D., DAVID C. THE FOLLOWING INDIVIDUAL(S) IS/ARE EMPLOYED BY A RELATED ORGANIZATION: TARASOVITCH, JAMES J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL(S) WHO IS/ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: KOCH, MARK B. YTTERBERG M.D., KAREN L. GABRIELSON, SHARON R. HAVE A BUSINESS RELATIONSHIP AS THEY SERVE AS AN OFFICER, DIRECTOR, OR TRUSTEE OF HEALTH TRADITION HEALTH PLAN, A RELATED TAXABLE ENTITY. MARK CIOTA AND MICHAEL S. FUNK HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 MAYO CLINIC, MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, AND OTHER RELATED COMPANIES PROVIDE MANAGEMENT SERVICES TO THE ENTIRE SYSTEM OF ENTITIES. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS, COMPENSATION FOR THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES HAS BEEN DISCLOSED IN PART VII AND SCHEDULE J AS REQUIRED. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS MAYO CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER ELECTS TRUSTEES TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENT OF ARTICLES OR BYLAWS REQUIRE APPROVAL BY BOTH THE GOVERNING BODY AND THE SOLE CORPORATE MEMBER. THE BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, AND DEBT DECISIONS. FORM 990, PART VI, SECTION A, LINE 8B THE FILING ORGANIZATION HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE REGION CHIEF FINANCIAL OFFICER AND FINANCE DIRECTOR, ALONG WITH SITE FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FILING ORGANIZATION'S GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C MAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF MAYO CLINIC (AND/OR AFFILIATE) AND THE OUTSIDE ENTITY. ADDITIONAL CONFLICT OF INTEREST POLICIES AND PROCEDURES EXIST FOR CERTAIN ENTITIES CONCERNING RESEARCH CONTRACTS AND OTHER TYPES OF POTENTIAL CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS, EXECUTIVE AND SENIOR ADMINISTRATIVE LEADERSHIP, ALONG WITH ALLIED HEALTH STAFF. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY OR REGIONAL LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY PRIOR TO IMPLEMENTATION OF THE RESPECTIVE COMPENSATION INCREASE. THE SALARIES AND BENEFIT PROGRAMS OF THE CHIEF EXECUTIVE OFFICER (CEO) AND THE CHIEF ADMINISTRATIVE OFFICER (CAO) WERE REVIEWED AND APPROVED BY THE PROCESS DESCRIBED BELOW FOR SENIOR ADMINISTRATIVE LEADERSHIP. THE COMPENSATION AND BENEFIT PROGRAMS FOR SENIOR ADMINISTRATIVE LEADERSHIP FOR ALL CAMPUSES, INCLUDING THE MAYO CLINIC HEALTH SYSTEM LOCATIONS, ARE REVIEWED AND APPROVED BY THE MAYO CLINIC BOARD OF TRUSTEES GOVERNANCE AND NOMINATING COMMITTEE. THE MAYO CLINIC BOARD OF TRUSTEES GOVERNANCE AND NOMINATING COMMITTEE IS COMPRISED OF NINE OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. THIS GROUP REVIEWS AND APPROVES THE COMPENSATION AND BENEFIT PROGRAMS FOR PHYSICIANS FROM ALL CAMPUSES, AS WELL AS CERTAIN SENIOR ADMINISTRATIVE AND EXECUTIVE LEADERSHIP (INCLUDING ALL PERSONS BELIEVED TO BE DISQUALIFIED PERSONS). THIS PROCESS ESTABLISHES ACCEPTABLE RANGES FOR VARIOUS POSITIONS, LEVELS, AND SPECIALTIES. THE COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE FILING ORGANIZATION'S GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST AND IS ALSO ON THE MAYOCLINIC.ORG WEBSITE. THE FILING ORGANIZATION IS A HOSPITAL AFFILIATED WITH MAYO CLINIC. AS SUCH, MAYO CLINIC'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THE FILING ORGANIZATION'S FORM 990 AND WOULD BE AVAILABLE UPON REQUEST OF THE FORM 990. FORM 990, PART IX, LINE 11G I/C PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 28,474,234. MANAGEMENT AND GENERAL EXPENSES 10,727,283. FUNDRAISING EXPENSES 10,159. TOTAL EXPENSES 39,211,676. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 9,674,621. MANAGEMENT AND GENERAL EXPENSES 1,847,201. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,521,822. FORM 990, PART XI, LINE 9: CHANGE IN NET ASSETS OF FOUNDATION -2,653,097. LOSSES ON UNCOLLECTIBLE PLEDGES -330. BLOOMER LAKEVIEW INC 2110 DUNCAN ROAD BLOOMER WI 54724 391450617 LOW INCOME HOUSING WI 501(C)(3) 7 MCHS--CHIPPEWA VALLEY INC 1 CHARTERHOUSE INC 200 FIRST STREET SW ROCHESTER MN 55905 411405254 RETIREMENT LIVING CENTER MN 501(C)(3) 9 MAYO CLINIC 1 DESTINATION MEDICAL CENTER EDA 50 SOUTH SIXTH STREET SUITE 1500 MINNEAPOLIS MN 554021498 464893585 ECONOMIC DEVELOPMENT MN 501(C)(3) 11-I MAYO CLINIC 1 GOLD CROSS AMBULANCE SERVICE 200 FIRST STREET SW ROCHESTER MN 55905 411917516 AMBULANCE SERVICE MN 501(C)(3) 9 MFMER 1 LUTHER LAKESIDE APARTMENTS INC PO BOX 1510 EAU CLAIRE WI 54702 391409024 LOW INCOME HOUSING FOR ELDERLY WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 416011702 PATIENT CARE - CLINIC MN 501(C)(3) 9 N/A 1 MAYO CLINIC ARIZONA 13400 EAST SHEA BOULEVARD SCOTTSDALE AZ 85259 860800150 HOSPITAL AND CLINIC AZ 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC FLORIDA (A NONPROFIT CORPORATION) 4500 SAN PABLO ROAD JACKSONVILLE FL 32224 590714831 HOSPITAL FL 501(C)(3) 3 MAYO CLINIC JACKSONVILLE 1 MAYO CLINIC HOSPITAL -- ROCHESTER 200 FIRST STREET SW ROCHESTER MN 55905 410944601 HOSPITAL MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC JACKSONVILLE 4500 SAN PABLO ROAD JACKSONVILLE FL 32224 593337028 PATIENT CARE - CLINIC FL 501(C)(3) 7 MAYO CLINIC 1 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 200 FIRST STREET SW ROCHESTER MN 55905 411506440 CHARITABLE, EDUCATIONAL & SCIENTIFIC ACTIVITIES MN 501(C)(3) 9 MAYO CLINIC 1 MAYO CLINIC STIFTUNG 60486 FRANKFURT AM MAIN FRANKFURT GM FUNDRAISING FOUNDATION GM MFMER 1 MCHS IN WAYCROSS INC 1900 TEBEAU STREET WAYCROSS GA 31501 581667166 HOSPITAL GA 501(C)(3) 3 MAYO CLINIC JACKSONVILLE 1 MCHS--ALBERT LEA AND AUSTIN 1000 FIRST DRIVE NW AUSTIN MN 55912 411404075 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MCHS--AUSTIN FOUNDATION 1000 FIRST DRIVE NW AUSTIN MN 55912 300107471 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--ALBERT LEA AND AUSTIN 1 MCHS--CANNON FALLS 32021 COUNTY ROAD 24 BLVD CANNON FALLS MN 55009 204156428 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MCHS--CHIPPEWA VALLEY INC 1501 THOMPSON STREET BLOOMER WI 54724 390980343 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MCHS--EAU CLAIRE CLINIC INC 733 W CLAIREMONT AVE PO BOX 1510 EAU CLAIRE WI 54702 391735831 PATIENT CARE - CLINIC WI 501(C)(3) 3 MAYO CLINIC 1 MCHS--EAU CLAIRE FOUNDATION INC 733 W CLAIREMONT AVE PO BOX 1510 EAU CLAIRE WI 54702 391633407 GRANTMAKING FOUNDATION WI 501(C)(3) 11-I MCHS--EAU CLAIRE CLINIC INC 1 MCHS--EAU CLAIRE HOSPITAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 390813418 HOSPITAL WI 501(C)(3) 3 MAYO CLINIC 1 MCHS--FAIRMONT 800 MEDICAL CENTER DRIVE PO BOX 800 FAIRMONT MN 56031 410760836 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MCHS--FRANCISCAN HEALTHCARE FOUNDATION INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391186647 FUNDRAISING FOUNDATION WI 501(C)(3) 7 MCHS--FRANCISCAN HEALTHCARE INC 1 MCHS--FRANCISCAN HEALTHCARE INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391411999 HEALTHCARE SYSTEM PARENT WI 501(C)(3) 11-I MAYO CLINIC 1 MCHS--FRANCISCAN MEDICAL CENTER INC 700 WEST AVE SOUTH LA CROSSE WI 54601 390806374 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--FRANCISCAN HEALTHCARE INC 1 MCHS--LAKE CITY 500 WEST GRANT STREET LAKE CITY MN 55041 411906820 HOSPITAL MN 501(C)(3) 3 MAYO CLINIC 1 MCHS--MANKATO 1025 MARSH STREET MANKATO MN 56002 411236756 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MCHS--MANKATO HEALTH CARE FOUNDATION 1025 MARSH STREET MANKATO MN 56002 411663357 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--MANKATO 1 MCHS--NEW PRAGUE 301 SECOND STREET NE NEW PRAGUE MN 56071 410723639 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MCHS--NORTHLAND INC 1222 EAST WOODLAND AVENUE BARRON WI 54812 390920634 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MCHS--OAKRIDGE INC 13025 EIGHTH STREET PO BOX 70 OSSEO WI 54758 391029430 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MCHS--OWATONNA 134 SOUTHVIEW ST OWATONNA MN 55060 411862132 PATIENT CARE - CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MCHS--RED CEDAR INC 2321 STOUT ROAD MENOMONIE WI 54751 510190875 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MCHS--RED WING 701 HEWITT BOULEVARD RED WING MN 55066 411713783 PATIENT CARE SERVICES MN 501(C)(3) 3 MAYO CLINIC 1 MCHS--SPRINGFIELD 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 411893827 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MCHS--ST JAMES 1101 MOULTON PARSONS DR PO BOX 460 ST JAMES MN 56081 410797368 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MCHS--WASECA 501 NORTH STATE STREET WASECA MN 56093 363606405 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MILES AND SHIRLEY FITERMAN ENDOWMENT FUND FOR DIGESTIVE DISEASES 200 FIRST STREET SW ROCHESTER MN 55905 412020392 SUPPORT RESEARCH, PRACTICE & EDUCATION MN 501(C)(3) 11-I MAYO CLINIC 1 POVERELLO FOUNDATION 200 FIRST STREET SW ROCHESTER MN 55905 411494881 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MAYO CLINIC HOSPITAL - ROCHESTER 1 THE HIRSH FAMILY FOUNDATION 108 NORTH MAIN STREET AUSTIN MN 55912 411749842 FUNDRAISING FOUNDATION MN 501(C)(3) 11-I N/A 0 HORMEL FOUNDATION 329 N MAIN ST SUITE 102L AUSTIN MN 55912 410694716 FUNDRAISING FOUNDATION MN 501(C)(3) 11-I N/A 0 FRANKLIN HEATING STATION 119 THIRD ST SW ROCHESTER MN 55902 410264830 UTILITY MN N/A LATIGO PETROLEUM LLC PO BOX 14230 ODESSA TX 79768 364767494 OIL & GAS EXPLORATION DE N/A WATERSHED CAP INSTL PRTNRS III LP ONE MARITIME PLAZA SUITE 1525 SAN FRANCISCO CA 94111 462982848 INVESTMENT ACTIVITIES DE N/A AMBIENT CLINICAL ANALYTICS INC 221 1ST AVE SW SUITE 202 ROCHESTER MN 55902 800928405 SOFTWARE DE N/A C 1 BWL HOLDINGS INC 1209 ORANGE STREET WILMINGTON DE 19801 472413749 OIL & GAS EXPLORATION DE N/A C 1 CAVALRY CLO III LTD PO BOX 1093 GT QUEENSGATE HOUSE S GRAND CAYMAN CJ INVESTMENT ACTIVITIES CJ N/A C 1 CAVALRY CLO IV LTD PO BOX 1093 GT QUEENSGATE HOUSE S GRAND CAYMAN CJ INVESTMENT ACTIVITIES CJ N/A C 1 GMO GLOBAL BOND INVESTMENT FUND 78 SIR JOHN ROGERSONS QUAY DUBLIN 2 EI OTHER FINANCIAL INVESTMENT ACTIVITIES EI N/A 1 HEALTH TRADITION HEALTH PLAN 1808 EAST MAIN STREET ONALASKA WI 54650 391545987 MEDICAL SERVICES COMPANY WI N/A C 1 LOBSS NETWORK SUPPORT 2002 INC 200 FIRST STREET SW ROCHESTER MN 55905 481276150 ADMINISTRATIVE SERVICES MN N/A C 1 MAYO CLINIC GBS MAURITIUS 2ND FLOOR EBENE MEWS 57 EBENE CYBERCITY MP HEALTHCARE MANAGEMENT MP N/A C 1 MAYO CLINIC SUPPORT SERVICES TEXAS 200 FIRST STREET SW ROCHESTER MN 55905 471751102 HEALTH SERVICES TX N/A C 1 MAYO HOLDING COMPANY 200 FIRST STREET SW ROCHESTER MN 55905 411578020 HOLDING COMPANY MN N/A C 1 MAYO INSURANCE COMPANY LTD 200 FIRST STREET SW ROCHESTER MN 55905 SELF INSURANCE POOL CJ N/A C 1 MCHS--DECORAH CLINIC PHYSICIANS 907 MONTGOMERY STREET DECORAH IA 52101 411711329 PATIENT CARE - CLINIC IA N/A C 1 MCHS--PHARMACY & HOME MEDICAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 391528920 PHARMACY SERVICES WI N/A C 1 MMSI INC 200 FIRST STREET SW ROCHESTER MN 55905 411547003 THIRD PARTY ADMINISTRATION SERVICES MN N/A C 1 RESOUNDANT INC 221 1ST AVE SW SUITE 202 ROCHESTER MN 55902 461661978 MANUFACTURING MEDICAL DEVICE COMPONENT MN N/A C 1 ROCHESTER AIRPORT COMPANY 200 FIRST STREET SW ROCHESTER MN 55905 410506870 AIRPORT MANAGEMENT MN N/A C 1 SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION 13400 E SHEA BLVD SCOTTSDALE AZ 85259 860870505 COMMERCIAL PROPERTY OWNERS ASSOCIATION AZ N/A C 1 THE STABILE BUILDING OWNERS' ASSOCIATION 200 FIRST STREET SW ROCHESTER MN 55905 208994499 COMMERCIAL PROPERTY OWNERS ASSOCIATION MN N/A C 1 CHARITABLE LEAD TRUST CHARITABLE TRUST CA N/A T 1 PERPETUAL TRUST CHARITABLE TRUST ND N/A T 1 PERPETUAL TRUST CHARITABLE TRUST AZ N/A T 1 PERPETUAL TRUST CHARITABLE TRUST LA N/A T 1 PERPETUAL TRUST (2) CHARITABLE TRUST MA N/A T 1 PERPETUAL TRUST CHARITABLE TRUST MO N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST AZ N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST CO N/A T 1 CHARITABLE REMAINDER TRUST (8) CHARITABLE TRUST FL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST LA N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST MA N/A T 1 CHARITABLE REMAINDER TRUST (77) CHARITABLE TRUST MN N/A T 1 CHARITABLE REMAINDER TRUST (2) CHARITABLE TRUST NC N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST TX N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST CO N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST IL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST MI N/A T 1 CHARITABLE REMAINDER TRUST (64) CHARITABLE TRUST MN N/A T 1 CHARITABLE REMAINDER TRUST (7) CHARITABLE TRUST MN N/A T 1 0 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 1 GOLD CROSS AMBULANCE SERVICE M 216004 GAAP MAYO CLINIC HOSPITAL - 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