2015-09-13T11:19:09-05:00 2014-12-31 990 2014-01-01 391735831 MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE CLINIC INC MAYO 5075381297 733 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 PAUL BAMMEL CFO 5075381297 2015-09-13 2014 2016-02-25 16:41:14Z RANDALL LINTON MD 733 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54701 209449770 0 5983 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1992 WI OPERATION OF A MEDICAL CLINIC. 7 5 1854 66 0 0 2178583 963486 222258504 208281089 131470 95269 -9417 75422 224559140 209415266 252235 220719 0 0 161133685 140145903 0 0 0 63840267 78884071 225226187 219250693 -667047 -9835427 130561123 125458938 109881859 130723012 20679264 -5264074 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 176705817 338 208254774 PATIENT CARE & MEDICAL EDUCATION - SEE SCHEDULE O: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 NEARLY 70 COMMUNITIES, MAYO CLINIC HEALTH SYSTEM INCLUDES 19 OWNED HOSPITALS, FIVE 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 - EAU CLAIRE CLINIC, INC. (THE CLINIC), IN AFFILIATION WITH MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL (THE HOSPITAL), IS ONE OF THE MAIN PROVIDERS OF HEALTH CARE SERVICES IN THE SURROUNDING AREA. THE HOSPITAL IS A RELATED HOSPITAL EXEMPT UNDER SECTION 501(C)(3) OF THE CODE. THE AFFILIATED ORGANIZATIONS ARE LOCALLY THOUGHT OF AS ONE HEALTHCARE ORGANIZATION.IN ADDITION TO SERVING THE RESIDENTS OF EAU CLAIRE, THE CLINIC AND THE HOSPITAL HAVE EVOLVED INTO REGIONAL REFERRAL CENTERS WHICH OFFER A FULL RANGE OF MEDICAL SERVICES THROUGH A NETWORK OF RURAL COMMUNITY-BASED HEALTHCARE PROVIDERS IN SEVERAL LOCATIONS THROUGHOUT WEST-CENTRAL WISCONSIN, INCLUDING BARRON, BLOOMER, CAMERON, CHETEK, CHIPPEWA FALLS, COLFAX, MENOMONIE, MONDOVI, AND OSSEO. THE FACILITIES IN THESE OUTLYING RURAL COMMUNITIES ARE SMALL NONPROFIT CLINICS AND HOSPITALS OWNED BY ORGANIZATIONS THAT ARE CONTROLLED BY THE HOSPITAL AND MAYO CLINIC AND ARE LIKEWISE EXEMPT UNDER SECTION 501(C)(3) OF THE CODE. CLINIC STAFF VISIT THESE LOCATIONS ON A REGULAR BASIS TO PROVIDE HEALTH CARE SERVICES TO RESIDENTS OF THESE SMALL COMMUNITIES AND RURAL AREAS. THE CLINIC RECORDED 946,720 PATIENT VISITS DURING 2014.THE CLINIC PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. SERVICES ARE ALSO PROVIDED TO BOTH MEDICAID AND MEDICARE PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. IN 2014, THE CLINIC PROVIDED APPROXIMATELY $3,077,000 IN FINANCIAL ASSISTANCE (AT COST) TO PATIENTS. THE UNREIMBURSED COST OF SERVICES PROVIDED TO MEDICAID PATIENTS WAS APPROXIMATELY $10,218,000, AND THE UNREIMBURSED COST OF SERVICES PROVIDED TO MEDICARE PATIENTS WAS APPROXIMATELY $46,274,000.THE CLINIC ALSO PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE OF PROVIDING PATIENT CARE.THE CLINIC, ALONG WITH THE HOSPITAL, VOLUNTARILY ENTERED INTO AN AGREEMENT WITH THE WISCONSIN ATTORNEY GENERAL RELATING TO CHARITY CARE. THE TERMS OF THE AGREEMENT INCLUDE AN AUTOMATIC DISCOUNT FOR UNINSURED PATIENTS, A PAYMENT CAP FOR THOSE UNINSURED PATIENTS THAT MEET THE CLINIC'S CHARITY CARE CRITERIA, AND A COMMITMENT TO MAKE INFORMATION AVAILABLE TO PATIENTS REGARDING THE CHARITY CARE PROGRAM. ADDITIONALLY, THE WISCONSIN ATTORNEY GENERAL REVIEWED AND APPROVED THE CLINIC'S BILLING AND COLLECTION POLICIES AND PRACTICES.THE CLINIC, IN AFFILIATION WITH THE HOSPITAL, HAS NUMEROUS AGREEMENTS WITH EDUCATIONAL ORGANIZATIONS TO PROVIDE FORMAL EDUCATION AND EXPERIENCE FOR STUDENTS STUDYING TO BECOME HEALTHCARE PROFESSIONALS. CURRENTLY THESE AGREEMENTS ARE WITH THE FOLLOWING ORGANIZATIONS:- UNIVERSITY OF WISCONSIN MEDICAL SCHOOL- UNIVERSITY OF WISCONSIN-MADISON- UNIVERSITY OF WISCONSIN-EAU CLAIRE - CHIPPEWA VALLEY TECHNICAL COLLEGE - UNIVERSITY OF WISCONSIN-LA CROSSE- WESTERN TECHNICAL - UNIVERSITY OF MINNESOTA-MINNEAPOLIS- UNIVERSITY OF CINCINNATI - UNIVERSITY OF MINNESOTA-DULUTH - COLLEGE OF ST. CATHERINE'S - COLLEGE OF ST. SCHOLASTICA - WINONA STATE UNIVERSITY - UNIVERSITY OF WISCONSIN-STOUT - MAYO CLINIC SCHOOL OF HEALTH RELATED SCIENCES- CONCORDIA UNIVERSITY - LAKE SUPERIOR COLLEGE - UNIVERSITY OF WISCONSIN - OSHKOSH- ARGOSY UNIVERSITY- DES MOINES UNIVERSITY- FINLANDIA UNIVERSITY- CARROLL UNIVERSITY- CREIGHTON UNIVERSITY- GLOBE UNIVERSITY- NORTHEAST WISCONSIN TECHNICAL COLLEGE- VITERBO UNIVERSITY- AT STILL UNIVERSITY- COLORADO STATE UNIVERSITY- FRONTIER SCHOOL OF MIDWIFERY- GEORGE WASHINGTON UNIVERSITY- INVER HILLS/CENTURY COLLEGE- KAPIOLANI COMMUNITY COLLEGE- KAPLAN UNIVERSITY- KEISER UNIVERSITY- MILWAUKEE AREA TECHNICAL COLLEGE- MINNESOTA STATE COMMUNITY & TECHNICAL COLLEGE- VANDERBILT UNIVERSITY- WALDEN UNIVERSITY- ADLER GRADUATE SCHOOL- ANDREWS UNIVERSITY- BETHEL UNIVERSITY- CHAMBERLAIN COLLEGE OF NURSING- DRAKE UNIVERSITY- JAMESTOWN UNIVERSITY- LIBERTY UNIVERSITY- MARQUETTE UNIVERSITY- MAYO SCHOOL OF MEDICAL EDUCATION- MID-STATE TECHNICAL COLLEGE- MIDWESTERN UNIVERSITY- MINNEAPOLIS BUSINESS COLLEGE - UNIVERSITY OF MONTANA- LCO OJIBWA COMMUNITY COLLEGE- RASMUSSEN COLLEGE- SOUTH UNIVERSITY- SOUTHWEST TECHNICAL COLLEGE- TEXAS CHRISTIAN UNIVERSITY- UNIVERSITY OF MISSOURI - ST. LOUIS- UNIVERSITY OF NEW ENGLAND- UNIVERSITY OF NORTH DAKOTA- UNIVERSITY OF ST. FRANCIS- UNIVERSITY OF WISCONSIN GREEN BAY- UNIVERSITY OF WISCONSIN STEVENS POINT- WEBER STATE UNIVERSITY- WISCONSIN INDIANHEAD TECHNICAL COLLEGETHE CLINIC ALSO ACTIVELY PROVIDES A CONTINUING EDUCATION PROGRAM FOR ITS MEDICAL STAFF. 607768 220381 37544 COMMUNITY BENEFIT - SEE SCHEDULE O:THE CLINIC, OFTEN IN CONJUNCTION WITH THE HOSPITAL, PROVIDES COMMUNITY CLASSES, EDUCATIONAL OPPORTUNITIES AND SERVICES. THESE PROGRAMS AND CLASSES INCLUDE SEVERAL HEALTH RELATED TOPICS. ADDITIONAL INFORMATION REGARDING SOME OF THE SPECIFIC EVENTS ARE LISTED BELOW:APPROXIMATELY 1,239 PEOPLE PARTICIPATED IN CHILDBIRTH CLASSES GIVEN FOR EXPECTANT PARENTS AND THEIR CHILDREN IN 2014.EMPLOYEE HEALTHCARE PROFESSIONALS OFFER PRESENTATIONS ON A VARIETY OF HEALTHCARE TOPICS, DRAWING ANYWHERE FROM 15-75 PARTICIPANTS. PRESENTATIONS ARE INFORMAL AND OFFER DISCUSSION TOPICS IMPORTANT TO COMMUNITY MEMBERS.SINCE 1998 THE CLINIC AND THE HOSPITAL HAVE SPONSORED A PERMANENT KIOSK IN THE MACY'S WING OF OAKWOOD MALL (A MAJOR SHOPPING CENTER). THE KIOSK IS STAFFED AT VARIOUS TIMES BY CLINICIANS AND EMPLOYEES WHO ARE AVAILABLE TO ANSWER CONSUMER QUESTIONS AND DISTRIBUTE HEALTH RELATED INFORMATION. FREE BLOOD PRESSURE SCREENINGS COMBINED WITH INFORMAL EDUCATION ARE OFFERED EVERY THURSDAY TO AREA RESIDENTS. IN 2014, APPROXIMATELY 2,500 SCREENINGS WERE CONDUCTED FREE OF CHARGE. HEALTH FAIRS AND OTHER SPECIAL EVENTS ARE HELD SEVERAL TIMES THROUGHOUT THE YEAR TO OFFER COMMUNITY MEMBERS THE OPPORTUNITY TO LEARN ABOUT NUTRITION, EXERCISE, HEART HEALTH, CANCER AND SEVERAL OTHER TOPICS. MORE THAN 150 WALKERS ARE PART OF THE "HEART 'N SOLE" WALKING CLUB AT THE MALL AND RECEIVE EXERCISE AND FITNESS TIPS IN A QUARTERLY NEWSLETTER.THE CLINIC AND THE HOSPITAL, IN PARTNERSHIP WITH THE EAU CLAIRE YMCA, OFFERS "CAMP WABI". THIS PROGRAM IS SPECIFICALLY FOR CHILDREN DEALING WITH OBESITY. IN A FUN, OUTDOOR SETTING, THESE CHILDREN (AGES 10-14) LEARN HOW TO MAKE LIFESTYLE CHANGES NECESSARY TO ACHIEVE A HEALTHY WEIGHT. THE CLINIC AND HOSPITAL CONTRIBUTE HALF OF THE COST OF THIS 12-DAY CAMP AND ALSO OFFER SCHOLARSHIP MONIES IF NEEDED. SPECIALISTS WITH EXPERTISE IN NUTRITION, BEHAVIOR THERAPY AND EXERCISE PHYSIOLOGY TAKE PART IN CAMP PLANNING AND PROGRAMMING. THIS IS THE FOURTH YEAR THIS PROGRAM HAS BEEN OFFERED TO THE COMMUNITY.THE TRAUMA DEPARTMENT HAS PARTNERED WITH LOCAL BUSINESSES SINCE 1998 TO PRESENT SAFETY CAMP - AN OPPORTUNITY FOR AREA FOURTH GRADERS TO SPEND TWO DAYS LEARNING ABOUT WATER SAFETY, BIKE SAFETY, ANIMAL SAFETY AND MANY OTHER TOPICS. ADDITIONALLY, THE DEPARTMENT OFFERS A BI-ANNUAL CAR CONTROL CLASS - A PROGRAM DESIGNED TO PROVIDE TEEN DRIVERS WITH REAL-WORLD ACCIDENT SITUATIONS IN A SAFE ENVIRONMENT AND THEN LEARN HOW TO CORRECT THEM. THE TRAUMA DEPARTMENT ALSO PROVIDES ONGOING OUTREACH PROGRAMS INCLUDING PROM TRAUMA SIMULATIONS AT AREA HIGH SCHOOLS, CONCUSSION AWARENESS PRESENTATIONS, DRIVERS' EDUCATION PRESENTATIONS, DISTRIBUTION OF FIRST-AID KITS TO LOCAL YOUTH SPORTS PROGRAMS AND CAR SEAT CHECKS FOR NEW OR EXPECTANT PARENTS. THE DEPARTMENT ALSO PROVIDES FREE BICYCLE HELMETS AND CAR SEATS TO PATIENTS.IN 2014, CLINIC AND HOSPITAL EMPLOYEES RAISED $28,201 FOR THE "RELAY FOR LIFE" EVENT HELD TO BENEFIT THE AMERICAN CANCER SOCIETY. THE CLINIC AND THE HOSPITAL WERE A CORPORATE SPONSOR FOR THE EVENT.THE CLINIC AND THE HOSPITAL WERE A CORPORATE SPONSOR FOR THE "AMERICAN HEART WALK" TO RAISE MONEY FOR THE AMERICAN HEART ASSOCIATION. MORE THAN 100 WALKERS RAISED NEARLY $10,000.THE CLINIC AND THE HOSPITAL WERE A CORPORATE SPONSOR FOR THE "EPILEPSY STROLL IN THE PARK" EVENT WHICH RAISED MORE THAN $31,000. THE CLINIC AND THE HOSPITAL ALSO SPONSORED THE "SHARE THE FLAME" EVENT AND RAISED ANOTHER $15,150 FOR THE EPILEPSY FOUNDATION.SINCE 2013 THE MAYO CLINIC HEALTH SYSTEM COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS WAS LED BY A REGIONAL COMMUNITY HEALTH NEEDS ASSESSMENT COMMITTEE. THAT COMMITTEE FOLLOWED A SYSTEMATIC PROCESS TO EVALUATE THE HEALTH NEEDS OF OUR COMMUNITY AND DETERMINED THREE COMMUNITY HEALTH PRIORITIES: PHYSICAL ACTIVITY, NUTRITION, AND CHRONIC DISEASE.THIS COMMITTEE IS RESPONSIBLE FOR SEEKING OUT AND IMPLEMENTING NEW EVIDENCE-BASED HOSPITAL AND COMMUNITY PROGRAMMING IN RESPONSE TO THE IDENTIFIED COMMUNITY HEALTH NEEDS. THIS COMMITTEE WILL COLLABORATE WITH LOCAL GOVERNMENT AGENCIES, HEALTH DEPARTMENTS AND COMMUNITY STAKEHOLDERS TO ADVANCE ITS MISSION.A FORMAL COMMUNITY ENGAGEMENT AND WELLNESS DEPARTMENT WAS CREATED IN 2014 WITH THE PRIMARY FOCUS OF IMPACTING CHANGE ON THE THREE IDENTIFIED HEALTH NEEDS OF PHYSICAL ACTIVITY, NUTRITION AND CHRONIC DISEASE. THE DEPARTMENT HAS MADE SIGNIFICANT STRIDES IN FORMING COMMUNITY COALITIONS, BUILDING STRONG PARTNERSHIPS WITH LOCAL ORGANIZATIONS AND SCHOOLS, INCREASING THE NUMBER OF COMMUNITY WELLNESS ACTIVITIES TO OUR RESIDENTS, AND PLAYING ACTIVE ROLES IN TEAMS FOCUSED ON IMPROVING HEALTH. WITHIN THE HOSPITAL, A COMMUNITY WELLNESS COMMITTEE HAS BEEN ESTABLISHED, AND INTERESTED EMPLOYEES ARE PAID TO TAKE PART IN MANY WELLNESS PROGRAMS EDUCATING OUR COMMUNITY.A NUMBER OF SUPPORT GROUPS ARE OFFERED BY THE CLINIC. THE SUPPORT GROUPS OFFERED INCLUDED:- APHASIA SUPPORT- STROKE SUPPORT- DIABETES SUPPORT- MILD BRAIN INJURY SUPPORT- MYELOMA SUPPORT- US TOO (PROSTATE CANCER)- WIND WALKERS - A GROUP FOR PATIENTS WITH LUNG DISEASE- SHARING THE CANCER JOURNEYTHE "HERS" WOMEN'S CENTER REGULARLY REACHES OUT TO WOMEN OF ALL AGES IN THE COMMUNITY BY PROVIDING FREE HEALTH INFORMATION AND EDUCATION REGARDING BREAST SELF-EXAMS AT LOCAL HEALTH FAIRS, OAKWOOD MALL AND TO GIRL SCOUT TROOPS.THE LIBRARY AND AUDIO VISUAL SERVICES DEPARTMENT PROVIDES HEALTH-RELATED TAPES, FILMSTRIPS, MODELS, COMPUTER SOFTWARE, AND OTHER EDUCATIONAL MATERIALS FOR AREA RESIDENTS TO USE FREE OF CHARGE TO INCREASE HEALTH AWARENESS WITHIN THE COMMUNITY. IN ADDITION, THE SOCIAL SERVICES DEPARTMENT IS AVAILABLE AS A RESOURCE TO PATIENTS AND THE COMMUNITY, REGARDING HEALTH AND WELLNESS RESOURCES, BOTH INTERNALLY AND WITHIN THE COMMUNITY.SPIRITUAL CARE SERVICES INCLUDE 24-HOUR, ON-CALL SERVICES INCLUDING DAILY CARE ROUNDS, DAILY PATIENT AND FAMILY VISITS, ASSISTING WITH END-OF-LIFE DECISIONS, BEREAVEMENT SUPPORT, BEING A LIAISON WITH COMMUNITY CLERGY AND INSTRUCTION IN CLINICAL PASTORAL EDUCATION.THE "YOUR HEALTH, YOUR CHOICE" PROGRAM PARTNERS WITH BUSINESSES TO IMPROVE PRODUCTIVITY, ENHANCE WORKPLACE SAFETY AND DEAL WITH OTHER HEALTH-RELATED WORKPLACE CONCERNS.THE CLINIC ALSO OFFERS TRANSPORTATION SERVICES (TAXIS, HANDICAPPED VEHICLES, BUSES) TO THOSE PATIENTS MEETING THE CLINIC'S FINANCIAL ASSISTANCE GUIDELINES. TYPICALLY, TRANSPORT IS TO THE CLINIC AND BACK TO THE PATIENT'S HOME OR TO A NURSING HOME.APPROXIMATELY 57 COMMUNITY VOLUNTEERS PROVIDED APPROXIMATELY 6,824 HOURS OF DONATED TIME TO THE CLINIC IN 2014. VOLUNTEERS PROVIDE HOSPITALITY SERVICES TO PATIENTS, FAMILIES AND VISITORS. THE DONATED SERVICES PROVIDED BY THE VOLUNTEERS IN 2014 IS VALUED AT APPROXIMATELY $157,430 BASED ON STATISTICS FROM THE INDEPENDENT SECTOR. 177313585 1 1 0 0 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 2 0 1 1854 1 0 0 0 0 0 0 0 0 0 0 X 7 5 0 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 WI X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 BISOGNANO MAUREEN DIRECTOR (1/1-10/1) 1.00 X 0 0 0 CLUMPNER DANIEL SECY/TREAS/DIRECTOR 1.00 X X 0 0 0 LINTON MD RANDALL L CHAIR/CEO/DIRECTOR 40.00 X X 577599 0 59749 MOORE EMILY DIRECTOR 1.00 X 0 0 0 OLSON RICK DIRECTOR 1.00 X 0 0 0 PASTERNACK MD MORRIS VICE CHAIR/DIRECTOR 40.00 X X 497226 0 68573 PERRY MICHAEL DIRECTOR 1.00 X 0 0 0 SORENSEN CHARLES DIRECTOR 1.00 X 0 0 0 TOLANDER JANET DIRECTOR (1/1-4/16) 1.00 X 0 0 0 BAMMEL PAUL M CFO 40.00 X 351236 0 62740 DICKEY JOHN M CAO 40.00 X 391503 0 61766 EIDE DEAN B VP 40.00 X 195932 0 33059 FISCHER DEBORAH R VP 40.00 X 199414 0 44829 GROSETH BRADLEY D VP 40.00 X 215595 0 60200 PECK MD ROBERT C CMO 40.00 X 383298 0 68616 RINALDI BLYTHE A VP 40.00 X 214072 0 56521 SULLIVAN MAURITA A VP 40.00 X 194711 0 51116 BLEDSOE MD JONATHAN M PHYSICIAN 40.00 X 1059755 0 58749 CARMODY MD THOMAS T PHYSICIAN 40.00 X 1005354 0 70332 PEREZ MD EDUARDO J CHAIR NEURO SURGERY 40.00 X 1182829 0 48240 WIECHMANN MD ROBERT J CHAIR CV SURGERY 40.00 X 1131546 0 72114 WU MD WAYNE W PHYSICIAN 40.00 X 912382 0 67607 GREWE MD BRADLEY FORMER VP 40.00 X 464750 0 64573 SKOLD M COLLEEN FORMER VP 40.00 X 117899 0 32946 9095101 0 981730 286 1 1 0 MAYO FOUNDATION FOR MEDICAL EDUCATION & 200 FIRST STREET SW ROCHESTER MN 55905 PROCUREMENT/SUPPORT SERVICES 5181737 MCHS - EAU CLAIRE HOSPITAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 MEDICAL/SUPPORT SERVICES 3432486 MMSI INC 200 FIRST STREET SW ROCHESTER MN 55905 CLAIMS PROCESSING 967066 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 MEDICAL/SUPPORT SERVICES 383630 4 6175 956203 1108 963486 NET PATIENT REVENUE 621110 204950920 204950920 SHARED SERVICES 561000 3330169 3330169 208281089 102348 102348 9800 17737 -7937 -7937 -7937 9688 16767 -7079 -7079 -7079 MEDICAL DIRECTOR FEES 541900 72130 72130 MISC. REVENUE 900099 9421 9421 MEDICAL RECORD/TRANSCR 541900 1808 1808 83359 209415266 208292318 0 159462 220381 220381 338 338 3787756 762452 3025304 1154562 583815 570747 108502555 99992415 8510140 9266229 8492707 773522 11782212 10856135 926077 5652589 5056347 596242 27478 27478 34080 10341 23739 2995581 2995581 12981917 9789002 3192915 47239 46939 300 3272042 2664582 607460 17930659 209719 17720940 8322003 8112572 209431 1433315 1126849 306466 145597 55122 90475 2182170 2135937 46233 2147730 2147730 MEDICAL SUPPLIES 19033407 19033407 BAD DEBT 6745742 6745742 EMPLOYEE RELATED 958796 808033 150763 DUES/LICENSES/SUBSCR 626315 583272 43043 219250693 177313585 41937108 0 7033 7418 91886 31248781 32124460 50000 1416541 1109760 132536 131860 1081759 524140 41432601 24668715 18914346 16763886 31872116 35422502 29066365 18565611 16679760 20809301 130561123 125458938 41234159 55170227 68647700 75552785 109881859 130723012 X 20679264 -5264074 20679264 -5264074 130561123 125458938 X -9835427 -16107911 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1070226 1070226 25346625 14273331 11073294 14440722 10395384 4045338 575028 575028 16763886 MAYO POOLED INVESTMENTS 18565611 F 18565611 DUE FROM AFFILIATES 20809301 20809301 DEFERRED COMPENSATION LIABILITY 35422502 DUE TO AFFILIATES 40130283 75552785 X PART X, LINE 2: AT DECEMBER 31, 2014 AND 2013, THE RESERVE FOR UNRECOGNIZED TAX BENEFITS WAS NOT SIGNIFICANT, AND AS A RESULT, THERE IS NO LONGER A RESERVE FOR UNRECOGNIZED TAX BENEFITS RECORDED FOR THE FILING ORGANIZATION. CENTRAL AMERICA AND THE CARIBBEAN 0 6 TRAVEL - INTERNATIONAL BUSINESS & CONFERENCES 7082 EAST ASIA AND THE PACIFIC 0 1 TRAVEL - INTERNATIONAL BUSINESS & CONFERENCES 713 EUROPE (INCLUDING ICELAND & GREENLAND) 0 6 TRAVEL - INTERNATIONAL BUSINESS & CONFERENCES 13698 NORTH AMERICA 0 9 TRAVEL - INTERNATIONAL BUSINESS & CONFERENCES 13855 SOUTH AMERICA 0 3 TRAVEL - INTERNATIONAL BUSINESS & CONFERENCES 3067 SUB-SAHARAN AFRICA 0 1 TRAVEL - INTERNATIONAL BUSINESS & CONFERENCES 794 0 26 0 0 0 26 39209 0 39209 0 0 0 0 0 0 PART V 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) MAYO CLINIC ARIZONA (EIN: 86-0800150) MAYO CLINIC JACKSONVILLE (EIN: 59-3337028) 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 MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE FOUNDATION INC 733 WEST CLAIREMONT AVE EAU CLAIRE WI 54701 391633407 501(C)(3) 121800 COMMUNITY HEALTH CITY OF EAU CLAIRE 203 S FARWELL ST EAU CLAIRE WI 54701 396005436 CITY OF EAU CLAIRE 20200 COMMUNITY HEALTH DOWNTOWN EAU CLAIRE INC 203 S FARWELL ST EAU CLAIRE WI 54701 030376253 501(C)(3) 9000 COMMUNITY HEALTH 3 0 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. X 1 1 0 0 0 0 0 0 0 0 0 LINTON MD RANDALL L CHAIR/CEO/DIRECTOR 558144 0 0 0 19455 0 26250 0 33499 0 637348 0 0 0 PASTERNACK MD MORRIS VICE CHAIR/DIRECTOR 472511 0 0 0 24715 0 26250 0 42323 0 565799 0 0 0 BAMMEL PAUL M CFO 334867 0 0 0 16369 0 26250 0 36490 0 413976 0 0 0 DICKEY JOHN M CAO 374455 0 0 0 17048 0 26250 0 35516 0 453269 0 0 0 EIDE DEAN B VP 193277 0 0 0 2655 0 12647 0 20412 0 228991 0 0 0 FISCHER DEBORAH R VP 195681 0 0 0 3733 0 18992 0 25837 0 244243 0 0 0 GROSETH BRADLEY D VP 212791 0 0 0 2804 0 21297 0 38903 0 275795 0 0 0 PECK MD ROBERT C CMO 367886 0 0 0 15412 0 26250 0 42366 0 451914 0 0 0 RINALDI BLYTHE A VP 209806 0 0 0 4266 0 21919 0 34602 0 270593 0 0 0 SULLIVAN MAURITA A VP 190173 0 0 0 4538 0 17948 0 33168 0 245827 0 0 0 BLEDSOE MD JONATHAN M PHYSICIAN 991798 0 2500 0 65457 0 26250 0 32499 0 1118504 0 0 0 CARMODY MD THOMAS T PHYSICIAN 990836 0 0 0 14518 0 26250 0 44082 0 1075686 0 0 0 PEREZ MD EDUARDO J CHAIR NEURO SURGERY 1170003 0 0 0 12826 0 26250 0 21990 0 1231069 0 0 0 WIECHMANN MD ROBERT J CHAIR CV SURGERY 1117038 0 0 0 14508 0 26250 0 45864 0 1203660 0 0 0 WU MD WAYNE W PHYSICIAN 898986 0 0 0 13396 0 26250 0 41357 0 979989 0 0 0 GREWE MD BRADLEY FORMER VP 448807 0 0 0 15943 0 26250 0 38323 0 529323 0 0 0 SKOLD M COLLEEN FORMER VP 113603 0 0 0 4296 0 19097 0 13849 0 150845 0 0 0 PART I, LINE 1A AS A BENEFIT TO ITS EMPLOYEES, THE FILING ORGANIZATION SUBSIDIZES EMPLOYEE MEMBERSHIPS TO THE YMCA AND SIMILAR HEALTH/FITNESS FACILITIES. SUCH SUBSIDIES ARE AVAILABLE TO ALL EMPLOYEES. FOR 2014, DR. RANDALL LINTON, DR. THOMAS CARMODY AND DR. JONATHAN BLEDSOE RECEIVED THIS BENEFIT THAT WAS TREATED AS TAXABLE INCOME TO THE INDIVIDUALS. 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 II: COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. ERIN SKOLD FAMILY MEMBER OF COLLEEN SKOLD, KEY EMPLOYEE 220131 EMPLOYMENT 0 CONNIE DENNIS FAMILY MEMBER OF MAURITA SULLIVAN, KEY EMPLOYEE 54492 EMPLOYMENT 0 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. MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE HOSPITAL,INC. ALSO PROVIDES MANAGEMENT SERVICES ON A REGIONAL BASIS THAT INCLUDES THE FILING ORGANIZATION. 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 4 THE BYLAWS OF MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE CLINIC, INC. (MCHS-EC CLINIC)WERE AMENDED AND RESTATED IN 2014 WITH AN EFFECTIVE DATE OF JANUARY 1, 2015. THE BYLAWS WERE AMENDED TO EXPAND ON THE RESERVED POWERS OF THE SOLE MEMBER WITH THE INTENT TO ENSURE THAT MCHS-EC CLINIC OPERATES CONSISTENT WITH THE VISION, STRATEGIC PLAN, AND OPERATING PLAN DEFINED BY THE SOLE MEMBER, MAYO CLINIC. THE AMENDMENT INCLUDES INCREASING THE NUMBER OF VOTING DIRECTORS ON THE BOARD OF MCHS-EC CLINIC TO INCLUDE DIRECTORS ELECTED SOLELY BY THE MEMBER OF MCHS-EC CLINIC. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS MAYO CLINIC. FORM 990, PART VI, SECTION A, LINE 7A TWO DIRECTORS ARE VOTING PHYSICIANS (THE CEO AND ANOTHER CHOSEN BY THE PRACTICE COMMITTEE). FIVE DIRECTORS ARE THE FIVE COMMUNITY DIRECTORS OF MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, WHICH ARE SELF-PERPETUATING. TWO MORE COMMUNITY DIRECTORS ARE APPOINTED BY A SELECTION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7B THE ARTICLES AND BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, DEBT, AMENDMENT OF THE ARTICLES AND BYLAWS, AND GENERAL OPERATION DECISIONS. 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 REGIONAL CHIEF FINANCIAL OFFICER (OR HIS DELEGATE) AND 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 AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST AND ALSO ON THE MAYOCLINIC.ORG WEBSITE. FORM 990, PART XI, LINE 9: PENSION-POST RETIREMENT FAS 158 -16,107,911. 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 - 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