2015-11-10T12:28:05-06:00 2014-12-31 990 2014-01-01 204156428 MAYO CLINIC HEALTH SYSTEM-CANNON FALLS MAYO 5075381297 32021 COUNTY ROAD 24 BLVD CANNON FALLS MN 55009 JAMES J TARASOVITCH REGION CFO 5072634221 2015-11-10 2014 2016-02-25 16:41:14Z X DAVID C AGERTER MD 32021 COUNTY ROAD 24 BLVD CANNON FALLS MN 55009 28314825 0 5983 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 2006 MN OPERATION OF A HOSPITAL AND CLINIC. 9 4 225 32 0 0 2418739 395892 23357673 27284171 841129 439950 57591 53160 26675132 28173173 9750 7917 0 0 12848634 13040096 15000 15000 15000 9835311 12428761 22708695 25491774 3966437 2681399 23875577 47754061 2901070 24096108 20974507 23657953 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 21054443 27321815 PATIENT SERVICES (HOSPITAL & CLINIC) - SEE SCHEDULE OMAYO 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 IN CANNON FALLS (MCHS-CF) MOVED TO A NEW STATE-OF-THE-ART FACILITY IN 2014. THE NEW MEDICAL CENTER IS 92,000 SQUARE FEET AND INCLUDES A CLINIC, HOSPITAL AND A 24/7 EMERGENCY DEPARTMENT IN A SINGLE FACILITY DESIGNED TO PROVIDE A MORE SEAMLESS HEALTH CARE EXPERIENCE. PATIENTS AND VISITORS CAN EXPECT AN IMPROVED OVERALL EXPERIENCE BEYOND THE CONTINUED PRESENCE OF DEPENDABLE, HIGH-QUALITY HEALTH CARE. THE NEW FACILITY HAS THREE TIMES MORE SPACE THAN THE PREVIOUS ONE ALLOWING MCHS-CF TO EXPAND PRIMARY AND SPECIALTY SERVICES, IMPROVE PRIVACY AND ADD NEW TECHNOLOGY. HEALTH CARE TEAMS WILL BE ABLE TO COLLABORATE MORE EASILY TO MEET PATIENT NEEDS.IN 2014, MAYO CLINIC HEALTH SYSTEM-CANNON FALLS (MCHS-CF) HAD 325 MEDICAL/SURGICAL ADMISSIONS AND 111 SWING BED ADMISSIONS WITH AN AVERAGE DAILY CENSUS OF 9.1. THERE WERE ALSO 3,370 EMERGENCY ROOM VISITS AND 211 OUTPATIENT SURGERIES. MCHS-CF PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER THEIR CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. IN 2014, THE COST OF CHARITY CARE PROVIDED BY MCHS-CF WAS APPROXIMATELY $103,600.SERVICES ARE ALSO PROVIDED TO MEDICAID AND MEDICARE PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. IN ADDITION, SERVICES ARE PROVIDED TO PATIENTS UNDER OTHER MEANS-TESTED GOVERNMENT PROGRAMS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. THE COST OF UNCOMPENSATED CARE PROVIDED TO LOW INCOME PATIENTS THROUGH MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS WAS APPROXIMATELY $1,251,000. THIS AMOUNT INCLUDES A MEDICAID SURCHARGE OF $200,222 AND $261,150 PAID TO MINNESOTA CARE (A PROGRAM THAT PROVIDES HEALTH CARE FOR LOW INCOME POPULATIONS).MCHS-CF ALSO LEASES SPACE TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE OF PROVIDING PATIENT CARE. 161430 7917 13968 COMMUNITY OUTREACH - SEE SCHEDULE OMAYO CLINIC HEALTH SYSTEM-CANNON FALLS (MCHS-CF) PARTICIPATES IN COMMUNITY AND WELLNESS EVENTS WHERE FREE OR NOMINAL FEE SCREENING TESTS ARE OFFERED AS WELL AS FREE PATIENT EDUCATION MATERIALS. THESE EVENTS INCLUDE FIRST THURSDAYS, SHEPHERDS CENTER, AND TWIN RIVERS. FLU SHOTS WERE GIVEN TO VOLUNTEER FIREFIGHTERS AND AMBULANCE RESPONDERS. EMERGENCY PREPAREDNESS TRAINING WAS PROVIDED TO 28 FIRE FIGHTERS THROUGH USE OF THE PREVIOUS MEDICAL FACILITY. FREE COMMUNITY SCREENING FOR DIABETES IS DONE THROUGH A PARTNERSHIP WITH THE LOCAL LIONS CLUB AT THE MEDICAL CENTER ON AN ANNUAL BASIS. MCHS-CF MEALS ON WHEELS PROGRAM PROVIDES FREE HOME DELIVERED NOON MEALS TO HOMEBOUND SENIORS OVER 60 WITH A MODERATE TO HIGH NUTRITIONAL RISK. THIS PROGRAM IS AVAILABLE ON AN ANNUAL BASIS, MONDAY THROUGH FRIDAY TO APPROXIMATELY 12-15 DAILY PARTICIPANTS WITH MORE THAN 185 DIFFERENT COMMUNITY MEMBERS RECEIVING MEALS DURING 2014. MCHS-CANNON FALLS OFFERED SPORTS PHYSICALS AT A REDUCED RATE FOR 17 STUDENTS WHO ARE PARTICIPATING IN SPORTS THROUGH THE LOCAL SCHOOLS AND COMPLETED CONCUSSION ASSESSMENTS FOR 7 STUDENT ATHLETES. MCHS-CF AUXILIARY PROVIDES APPROXIMATELY 28 VOLUNTEERS TO GREET AND DIRECT PATIENTS DURING HIGH-VOLUME SURGERY WEEKDAYS AND OFFERS CLERICAL SUPPORT TO STAFF. THE AUXILIARY VOLUNTEERS PROVIDED APPROXIMATELY 891 HOURS OF VOLUNTEER SERVICES. BASED ON THE 2014 INDEPENDENT SECTOR STATISTICS, THE APPROXIMATE VALUE OF THESE SERVICES IS $20,555. THE AUXILIARY ALSO SPONSORS A SCHOLARSHIP PROGRAM FOR LOCAL STUDENTS PURSUING A CAREER IN A HEALTH-CARE RELATED FIELD; IN 2014 $3,000 WAS GIVEN OUT IN SCHOLARSHIPS. 21215873 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 0 225 1 0 0 0 0 0 0 0 0 0 0 X 9 4 1 1 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 0 0 0 MN X MAYO CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 ALTRICHTER MD PAUL M VICE CHAIR / DIRECTOR 1.00 40.00 X X 0 237245 54876 BAILEY TED DIRECTOR 1.00 0.00 X 0 0 0 BERNARD MD MATTHEW E DIRECTOR 1.00 40.00 X 0 262980 53837 BREKKEN KATHLEEN A DIRECTOR 1.00 0.00 X 0 0 0 PARKS DOUGLAS A DIRECTOR / REGION CAO 1.00 40.00 X X 0 232013 50759 SJOQUIST MARK E DIRECTOR 1.00 0.00 X 0 0 0 WHITED MD BRIAN L DIRECTOR 1.00 40.00 X 0 444464 39145 WITT MD THOMAS J CHAIR / CEO / DIRECTOR 1.00 40.00 X X 0 456792 66580 WULF GREG DIRECTOR 1.00 0.00 X 0 0 0 AGERTER MD DAVID C REGION CEO 1.00 40.00 X 0 555112 18208 CHRISTIAN GLENN P SECRETARY (1/1-3/17/14) 40.00 0.00 X 177403 0 44054 GUDGELL STEPHEN F CORRIDOR CAO/TREASURER (3/17-12/31) 1.00 40.00 X 0 196790 19698 KOCH MARK B ASST SECRETARY 1.00 40.00 X 0 395727 18025 PRIEST WILLIAM F SECRETARY (3/17-12/31/14) 40.00 0.00 X 191580 0 52234 TARASOVITCH JAMES J REGION CFO 1.00 40.00 X 0 354461 28513 TUSA EDWARD A SITE CFO / TREASURER (1/1-3/17/14) 40.00 0.00 X 130062 0 44927 CHESTNUT MD JANET S PHYSICIAN 40.00 0.00 X 343700 0 70580 JOHNSTON-FLANDERS MD MEGAN S PHYSICIAN 40.00 0.00 X 257733 0 46404 NORDAHL MD THOMAS W PHYSICIAN 40.00 0.00 X 614256 0 73689 STRICKER MD ALEXANDER W PHYSICIAN 40.00 0.00 X 272979 0 24720 TURNA MD TARLOCHAN S FAMILY MEDICINE PHYSICIAN 40.00 0.00 X 356443 0 43822 LOHR MD ROBERT H FMR INTERIM CHAIR / CEO 0.00 40.00 X 0 260876 70445 2344156 3396460 820516 15 1 1 0 TW WALTER ANESTHESIA SERVICES INC 17189 COUNTY 27 BLVD PINE ISLAND MN 55963 ANESTHESIA (CRNA) 273381 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 LAB & OTHER SUPPORT SERVICES 238193 2 219600 176292 395892 NET PATIENT REVENUE 620000 27268103 27268103 MEALS ON WHEELS 624210 13968 13968 RENT FROM AFFILIATE 531120 2100 2100 27284171 478726 478726 102876 141652 -38776 -38776 -38776 CAFETERIA / VENDING 722210 52232 51184 1048 MEDICAL DIRECTOR FEES 541900 500 500 MEDICAL RECORDS 541900 418 418 10 10 53160 28173173 27335783 0 441498 X 4917 4917 3000 3000 640260 640260 1184382 1184382 8522047 8522047 592181 592181 1479435 1479435 621791 593265 28526 14378 14378 1028 1028 15000 15000 5080036 2043950 3036086 500 500 1089585 1038038 51547 65341 65341 519740 519170 570 64802 55581 9221 39507 34437 5070 8056 8056 1886017 1522417 363600 70967 1195 69772 BAD DEBT EXPENSE 1657320 1657320 MEDICAL SUPPLIES 1395813 1395813 MN CARE TAX 261151 261151 MEDICAID SURCHARGE 200220 200220 74300 32929 41371 25491774 21215873 4260901 15000 750 496 2032700 2107557 4743185 6252510 231302 285199 134977 64178 33019943 2402713 11270233 30617230 5462430 8426891 23875577 47754061 2102677 3289541 798393 20806567 2901070 24096108 X 18659168 21585758 2262759 2019615 52580 52580 20974507 23657953 23875577 47754061 2681399 2047 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1028 1028 0 PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. 52580 52580 52580 1087 1087 52580 52580 1066 1066 52580 52580 52580 52580 52580 1.00000 0 1 1 770066 770066 26425461 673232 25752229 5580018 1729481 3850537 244398 244398 30617230 HOSPITAL DISTRICT INVESTMENT 21783 F MAYO POOLED INVESTMENTS 8405108 F 8426891 ASSET RETIREMENT OBLIGATION 172465 DUE TO AFFILIATES 20634102 20806567 X PART V, LINE 4: THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE TO SUPPORT THE MISSION OF THE ORGANIZATION. 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. 1 1 X 1 X 1 X 1 1 0 1 1 103636 103636 0.00430 1653534 720855 932679 0.03910 572930 254582 318348 0.01340 2330100 975437 1354663 0.05680 35643 13968 21675 0.00090 120873 120873 0.00510 156516 13968 142548 0.00600 2486616 989405 1497211 0.06280 500 500 0.00000 1750 1750 0.00010 100 100 0.00000 2567 2567 0.00010 4917 4917 0.00020 0 1657320 10466870 10544977 -78107 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM-CANNON FALLS 32021 COUNTY ROAD 24 BLVD CANNON FALLS MN 55009 MAYOCLINICHEALTHSYSTEM.ORG 140 X X X X MAYO CLINIC HEALTH SYSTEM-CANNON FALLS 1 0 0 1 X X X X X X X 13 1 1 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 1 1 X X X 1 X X X X X X X X X 1 X 0 X X X X X 1 X 0 0 MAYO CLINIC HEALTH SYSTEM-CANNON FALLS PART V, SECTION B, LINE 5: INPUT WAS PROVIDED BY THE HEALTHY COMMUNITIES SUPERVISOR AND COMMUNITY HEALTH SPECIALIST OF THE PUBLIC HEALTH DIVISION OF GOODHUE COUNTY HEALTH AND HUMAN SERVICES AND THE DIRECTOR OF WABASHA COUNTY PUBLIC HEALTH. IN ADDITION, INPUT WAS RECEIVED FROM KEY INFORMANT INTERVIEWS, COUNTY-WIDE MAIL SURVEYS, LOCAL FOCUS GROUPS, AND SURVEYS COMPLETED BY THE SCHOOL DISTRICTS, AND THE CHEMICAL HEALTH INITIATIVE. MAYO CLINIC HEALTH SYSTEM-CANNON FALLS PART V, SECTION B, LINE 6A: MAYO CLINIC HEALTH SYSTEM-CANNON FALLS, MAYO CLINIC HEALTH SYSTEM-LAKE CITY, AND MAYO CLINIC HEALTH SYSTEM-RED WING COLLABORATED ON THE CHNA WHICH ENCOMPASSES THE COUNTIES THAT THE THREE HOSPITALS SERVE. MAYO CLINIC HEALTH SYSTEM-CANNON FALLS PART V, SECTION B, LINE 11: MAYO CLINIC IS A NOT-FOR-PROFIT ORGANIZATION WITH THE MISSION 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. AS PART OF MAYO CLINIC, MAYO CLINIC HEALTH SYSTEM OFFERS A VARIETY OF HEALTH CARE OPTIONS TO THE COMMUNITIES IT SERVES, RANGING FROM PRIMARY AND SPECIALTY CARE TO MORE COMPLEX CARE AT MAYO CLINIC. THE RESIDENTS OF CANNON FALLS, LAKE CITY AND RED WING ALSO BENEFIT FROM MAYO CLINIC EDUCATION AND RESEARCH EFFORTS SO BEST PRACTICES IDENTIFIED ARE IMPLEMENTED LOCALLY TO ASSURE THE HIGHEST STANDARDS OF CARE, QUALITY AND SAFETY. ONGOING PARTNERSHIPS WITH LOCAL PUBLIC HEALTH, SENIOR SERVICE PROGRAMS, NON PROFITS AND OTHER COMMUNITY ORGANIZATIONS ARE INTEGRAL TO IMPROVING THE HEALTH AND QUALITY OF LIFE FOR AREA RESIDENTS. WITH THE COMMUNITY HEALTH NEEDS ASSESSMENTS AND SUBSEQUENT SURVEYS, COMMUNITY MEETINGS AND INTERVIEWS, OUR CONTINUING WORK WITH OUR COMMUNITY PARTNERS HAVE NEVER BEEN MORE IMPORTANT. WE APPRECIATE THE UNIQUE PERSPECTIVES AND INSIGHTS THAT ALL COMMUNITY GROUPS CONTRIBUTE AS WE COLLECTIVELY IDENTIFY HEALTH AND SOCIAL ISSUES AND WORK TOWARD IMPROVING THE HEALTH STATUS OF OUR COMMUNITY. MAYO CLINIC HEALTH SYSTEM IN CANNON FALLS, LAKE CITY, AND RED WING (MCHS-CANNON FALLS/LAKE CITY/RED WING) COLLABORATED ON A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, IDENTIFIED COMMON NEEDS, AND DEVELOPED THE FOLLOWING JOINT IMPLEMENTATION PLANS TO ADDRESS THE NEEDS IDENTIFIED IN THE ASSESSMENT.IDENTIFIED NEED: OBESITYGOAL: INCREASE AWARENESS OF INDIVIDUAL HEALTH AND OBESITY MANAGEMENT OPTIONS FOR YOUTH AND FAMILIES.IMPLEMENTATION PLAN UPDATE:SOCIAL MEDIA STRATEGY - MCHS- CANNON FALLS/LAKE CITY/RED WING UTILIZED SOCIAL MEDIA TO PROMOTE THE MAYO MESSAGES FOR HEALTHY ACTIVITY AND NUTRITION. PINS AND POSTS THAT FOLLOW TRENDS AND HEALTH EVENTS ARE UPDATED DAILY. THE TEAM CONTINUES TO WORK ON HOW TO QUANTIFY THE EFFECT THESE HEALTHY AND POSITIVE MESSAGES HAVE ON THE REGION. SOCIAL MEDIA ALLOWS VARIOUS DEMOGRAPHIC AUDIENCES THAT INCLUDE MALES AND FEMALES AGES 18-64 TO RECEIVE EDUCATION AND ENGAGE ONLINE WITH MAYO CLINIC HEALTH SYSTEM. MCHS SOCIAL MEDIA CHANNELS INCLUDE: FACEBOOK, TWITTER, YOUTUBE, PINTEREST AND GOOGLE PLUS. EXAMPLES OF STRATEGIC SOCIAL MEDIA CAMPAIGNS INCLUDE RUNNING TIPS, HEALTHY RECIPES, HEART HEALTH TIPS, EXERCISE, AND WELLNESS INFORMATION. WRITTEN CONTENT, PHOTOS AND VIDEOS ARE INCORPORATED AS APPLICABLE IN EACH SOCIAL MEDIA CHANNEL. 5210 STRATEGY - THE 5210 PROGRAM HAS BEEN PROMOTED IN PEDIATRICS AND FAMILY PRACTICE THROUGHOUT WABASHA COUNTY BY WORKING WITH THE HEALTH DEPARTMENT'S STATE HEALTH IMPROVEMENT PROGRAM. THE 5210 PROGRAM IS A SPECIFIC PROGRAM TO REDUCE SCREEN TIME (TV, COMPUTER, IPAD AND GAMES) AND INCREASE EXERCISE AND ACTIVITY OF ELEMENTARY STUDENTS FOR ONE MONTH. BIKES WERE GIVEN AS REWARDS FOR THOSE WHO SUCCESSFULLY ELIMINATED EXCESS SCREEN TIME FROM THEIR DAY. COMMUNITY EVENT SPONSORSHIP - MCHS CANNON FALLS/LAKE CITY/RED WING PARTNERED WITH LOCAL NONPROFITS TO ENCOURAGE YOUTH ACTIVITY SUCH AS THE LAKE CITY SCHOOLS BIKE PROGRAM, CANNON FALLS BIKE EVENT, "GET READY TO RAMBLE", THE CANNON VALLEY TRAIL, AND RED WING'S "OPEN YOUR DOOR" CAMPAIGN FOR MAPS AND TRAILS. NUTRITION AND COOKING EVENTS WERE HELD AT THE FARMERS MARKET WITH THE SUSTAINABILITY COMMISSION. FREE EDUCATION AND SCREENINGS WERE GIVEN BY THE OUTREACH NURSES WHO HAD INDIVIDUAL CONTACT WITH 1,822 PERSONS. IN ORDER TO ROLE MODEL ACTIVITY, MINI FRISBEES ARE DISTRIBUTED RATHER THAN TREATS AT YOUTH EVENTS, BIKE HELMETS ARE USED AS GIVE A WAYS, COOKBOOKS ARE DISTRIBUTED AND MCHS SPONSORS HEALTHY LIVING COMMUNITY EVENTS INCLUDING BIKE RALLYS AND RUN/WALKS.IMPROVE EMPLOYEE HEALTH STRATEGY - MCHS CANNON FALLS/LAKE CITY/RED WING EMPLOYEES MODEL HEALTH STRATEGIES AND ARE INFLUENCERS IN ALL THE COMMUNITIES MCHS SERVES. EMPLOYEE HEALTH AND WELLNESS CONDUCTED A "TAKE YOUR BREAK" EXERCISE PROGRAM WITH 60 EMPLOYEES ATTENDING AND CHANGING DAILY OFFICE HABITS. WALKING MEETING TRAINING WAS HELD AT A LEADERSHIP DEVELOPMENT INSTITUTE AND EMPLOYEES ARE ENCOURAGED TO CONDUCT WALKING MEETINGS. MCHS CANNON FALLS AND LAKE CITY HAVE PATHS MAPPED IN AND AROUND THEIR FACILITIES TO ENCOURAGE WALKING BREAKS FOR ALL STAFF. IDENTIFIED NEED: ACCESSGOAL: TO SUPPORT AND PROMOTE COMMUNITY HEALTH CARE ACCESS.IMPLEMENTATION PLAN UPDATE: MCHS CANNON FALLS/LAKE CITY/RED WING PARTNERS WITH LOCAL VOLUNTEERS, COUNTY SERVICES, THE CARE FREE CLINIC BOARD OF DIRECTORS AND CARE CLINIC STAFF TO MAINTAIN THE FREE CLINIC FOR OUR SERVICE AREA. MALPRACTICE INSURANCE IS PROVIDED FOR ALL MCHS EMPLOYEES WHO VOLUNTEER AT THE CLINIC. MCHS PROVIDES $15,000 IN LAB AND RADIOLOGY SERVICES BILLED AT A MEDICARE LEVEL FOR CARE PATIENTS SO THE CARE CLINIC CAN INCREASE THE SCOPE OF SERVICES THEY PROVIDE WITHOUT ADDITIONAL FEES TO THE PATIENTS. THE CARE CLINIC IS LOCATED IN THE MCHS BUILDING THAT WAS PREVIOUSLY THE RED WING HOSPITAL EMERGENCY ROOM. THE SPACE IS PROVIDED FREE OF CHARGE. TECHNOLOGY IS PROVIDED TO CONNECT THE VOLUNTEER PROVIDERS WITH THE PATIENT RECORDS AND TEST RESULTS WHILE MAINTAINING THE HIGHEST LEVEL OF PATIENT CONFIDENTIALITY. SPECIALTY SERVICES (DIABETES, OPHTHALMOLOGY) CLINICS ARE SUPPORTED WITH TIME AND EQUIPMENT. MCHS-CANNON FALLS INVITED NONPROFIT ORGANIZATIONS TO CHOOSE ITEMS THEY NEEDED FROM THE EQUIPMENT THAT WAS NOT MOVED TO THE NEW FACILITY. THE NURSE TRIAGE LINE PROMOTES ACCESS TO SERVICES FOR COMMUNITY MEMBERS WHETHER THEY ARE CURRENT OR NON-CURRENT PATIENTS. THE TRIAGE STAFF ARE ABLE TO DIRECT INDIVIDUALS WHO CALL ASKING FOR ADVICE TO APPROPRIATE LEVELS OF SERVICE AND MANY TIMES ARE ABLE TO SAVE THEM FROM AN APPOINTMENT BY PROVIDING OVER THE COUNTER OPTIONS. LIMITED PROTOCOLS CAN BE SHARED WITH NON PATIENTS INCREASING THEIR ACCESS TO CARE. THIS SERVICE IS STILL BEING ASSESSED AND WILL BE EVALUATED IN THE 2015 CHNA IMPLEMENTATION REVIEW.IDENTIFIED NEED: MENTAL HEALTHGOAL: EDUCATE AND PROVIDE RESOURCES FOR THE COMMUNITY BY UTILIZING SOCIAL MEDIA TO EDUCATE THE COMMUNITY.IMPLEMENTATION PLAN UPDATE: DR. SOOD'S "GUIDE TO STRESS FREE LIVING" BOOK HAS HAD MULTIPLE FACEBOOK POSTS TO PROMOTE MENTAL HEALTH AND PERSONAL STRESS MANAGEMENT. A COMMUNITY COLLABORATION LED BY MCHS CANNON FALLS/LAKE CITY/RED WING AND THE RED WING SHOE FOUNDATION SUCCEEDED IN MEETING THEIR THREE ESTABLISHED GOALS - 1) COUNTY WIDE RESOURCE LISTS WERE DEVELOPED AND SHARED, 2) NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) CHAPTER WAS REINSTATED IN GOODHUE COUNTY, AND 3) THE "MAKE IT OK" ANTI STIGMA PROGRAM WAS PROMOTED TO 1,263 PERSONS THROUGH EMPLOYERS AND IN TWELVE COMMUNITY SESSIONS. MENTAL HEALTH FIRST AID TRAINING WAS HELD IN TWO LOCATIONS IN GOODHUE COUNTY AND ADDITIONAL PARTICIPANTS ATTENDED TRAINING IN A NEIGHBORING COUNTY. IN TOTAL 42 COMMUNITY MEMBERS COMPLETED THE 8 HOUR TRAINING. THE GOAL OF "EVERY HAND JOINED" IS TO HELP YOUNG PEOPLE REACH THEIR FULL POTENTIAL FROM CRADLE TO CAREER. THE PROGRAM GIVES THEM THE KNOWLEDGE AND STRENGTHS NEEDED TO SUCCEED IN THE 21ST CENTURY. "EVERY HAND JOINED" FOCUSES ON THREE AREAS WHERE EXTRA SUPPORT WILL MAKE A LONG-TERM IMPACT ON SUCCESS. IT CURRENTLY INCLUDES: KINDERGARTEN READINESS, 3RD GRADE READING SKILLS, AND MATH SCORES. IMPROVE EMPLOYEE MENTAL HEALTH: UNDER THE EMPLOYEE ASSISTANCE (EAP) PROGRAM, NEWSLETTERS AND EDUCATIONAL FLYERS ARE DISTRIBUTED TO EMPLOYEES. THE EAP STAFF ATTEND AN ANNUAL EMPLOYEE HEALTH FAIR, IN ADDITION TO, ANTI STIGMA TRAINING AND BEHAVIORAL HEALTH PROMOTIONS INCLUDING CHAIR MASSAGES AND YOGA PROGRAMS.IDENTIFIED NEED: HIGHWAY SAFETYIMPLEMENTATION PLAN UPDATE: THE CITY OF CANNON FALLS SPECIFICALLY ASSESSED THE NEED TO INCREASE SAFETY ON HIGHWAY 52. AFTER THE ASSESSMENT WAS COMPLETE, THE STATE REVEALED PLANS TO ELIMINATE ALL CROSSOVER TRAFFIC IN CANNON FALLS. THESE CHANGES WERE IMPLEMENTED AS PART OF THE HIGHWAY 52 RECONSTRUCTION DURING 2014. A COMMUNITY GROUP HAS BEEN FORMED TO LEAD DISCUSSIONS ON REOPENING ONE OF THE HIGHWAY 52 CROSSINGS. IF THIS HAPPENS, THIS SAFETY NEED WILL NEED TO BE ADDRESSED AT THAT TIME. NEEDS NOT BEING ADDRESSED WITH ADDITIONAL RESOURCES: CHEMICAL HEALTH: THIS NEED IS BEING ADDRESSED IN THE COUNTY. MCHS-CANNON FALLS AND MCHS-RED WING ARE PARTNERS WITH THE GOODHUE COUNTY CHEMICAL HEALTH INITIATIVE AND THEY ARE IN THE FINAL YEAR OF A TEN YEAR GRANT PROCESS. THIS NEED MAY RESURFACE IN THE NEXT ASSESSMENT AND WILL BE EVALUATED AT THAT TIME.TOBACCO: PROGRAMS ARE SUPPORTED IN THE COUNTY THROUGH HEALTH AND HUMAN SERVICES. MCHS-RED WING DOES HAVE A CESSATION PROGRAM AND WORKS WITH OTHER STATE AND LOCAL REDUCTION EDUCATION PROGRAMS. MAYO CLINIC HEALTH SYSTEM-CANNON FALLS 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. MAYO CLINIC HEALTH SYSTEM-CANNON FALLS 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. MAYO CLINIC HEALTH SYSTEM-CANNON FALLS 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. MAYO CLINIC HEALTH SYSTEM-CANNON FALLS PART V, SECTION B, LINE 22D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 10% 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. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY MAYO CLINIC HEALTH SYSTEM-CANNON FALLS PART V, SECTION B, LINE 16A WEBSITE: SEE PART VI MAYO CLINIC HEALTH SYSTEM-CANNON FALLS PART V, SECTION B, LINE 16B WEBSITE: SEE PART VI MAYO CLINIC HEALTH SYSTEM-CANNON FALLS PART V, SECTION B, LINE 16C WEBSITE: SEE PART VI 1 MAYO CLINIC HEALTH SYSTEM-CANNON FALLS 32021 COUNTY ROAD 24 BLVD CANNON FALLS MN 55009 CLINIC, SWING BED, DME 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 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 $ 1,657,320. PART II, COMMUNITY BUILDING ACTIVITIES: THROUGH DONATIONS AND GRANTS TO PUBLIC, PRIVATE AND NONPROFIT ORGANIZATIONS, THE FILING ORGANIZATION ASSISTS WITH SUSTAINING AND ENHANCING THE COMMUNITIES IT SERVES. PART III, LINE 2: 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 2014 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: MAYO CLINIC HEALTH SYSTEM-CANNON FALLS (MCHS-CANNON FALLS) DETERMINES PATIENT NEEDS THROUGH A VARIETY OF MEANS: DIRECT FEEDBACK FROM PATIENTS TO EMPLOYEES AT POINT OF CARE AND AT OTHER OPPORTUNITIES, THROUGH COMMUNITY REPRESENTATION ON THE MEDICAL CENTER COMMUNITY ADVISORY COUNCIL AND THROUGH CONTINUAL, RANDOM, CONFIDENTIAL PATIENT SATISFACTION SURVEYS WHICH ARE PART OF THE DECISION-MAKING PROCESSES FOR IMPROVING PATIENT CARE AND CUSTOMER SERVICE.MCHS-CANNON FALLS EMPLOYEES ARE ALSO STRONGLY CONNECTED WITH LOCAL CIVIC GROUPS. MANY EMPLOYEES ARE ACTIVE MEMBERS OF VARIOUS CANNON FALLS ORGANIZATIONS, WHILE OTHERS GIVE HEALTHCARE PRESENTATIONS TO THESE GROUPS. THIS PARTICIPATION NOT ONLY PROMOTES INVOLVEMENT IN THE COMMUNITY, BUT ALSO GIVES COMMUNITY MEMBERS A CHANCE TO ASK QUESTIONS, SHARE COMMENTS, CONCERNS OR OTHER SUGGESTIONS THEY MAY HAVE REGARDING THE MEDICAL CENTER. MCHS-CANNON FALLS EMPLOYEES PROMOTE THE ACTIVE REFERRAL OF PATIENTS TO LOCAL RESOURCES SUCH AS ACCESS TO HIGH QUALITY NUTRITIOUS FOODS, PHYSICAL ACTIVITY AND TOBACCO USE CESSATION PROGRAMS. MCHS-CANNON FALLS ACTIVELY SEEKS FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS THROUGH ITS PATIENT ADVISORY COUNCIL (PAC) AND PATIENT SATISFACTION SURVEYS. THE PAC IS A GROUP OF TEN COMMUNITY MEMBERS WHO SERVE AS A MCHS-CANNON FALLS /LAKE CITY/ RED WING FOCUS GROUP TO PROVIDE FEEDBACK PRIOR TO THE IMPLEMENTATION OF NEW PROGRAMS AND SERVICES, ASSIST IN THE IDENTIFICATION OF OPPORTUNITIES THAT WILL IMPROVE PATIENT AND FAMILY SATISFACTION, PROVIDE TIMELY AND DIRECT INPUT INTO MCHS-CANNON FALLS SYSTEM AND PROCESS CHANGES, OFFER INPUT TO LEADERSHIP IN THE PLANNING AND EVALUATION OF SERVICES, AND SERVE AS A VITAL LINK BETWEEN MCHS-CANNON FALLS AND THE COMMUNITY.MCHS-CANNON FALLS STAFF IS TRAINED TO IDENTIFY PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE PROGRAMS. THE ORGANIZATION HAS PROGRAMS IN PLACE FOR FINANCIAL ASSISTANCE TO HELP THOSE WHO ARE IN NEED OF HEALTH CARE BUT HAVE NO INSURANCE OR ARE NOT ABLE TO RECEIVE OTHER FINANCIAL ASSISTANCE.AS THESE EXAMPLES OF INVOLVEMENT DEMONSTRATE, MCHS-CANNON FALLS IS CLOSELY CONNECTED WITH THE COMMUNITY. IN ADDITION TO THIS, MCHS-CANNON FALLS ACTIVELY SEEKS FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS THROUGH AVATAR SURVEYS. THE SURVEY IS SENT TO A CROSS SECTION OF PATIENTS TO COMPILE USEFUL FEEDBACK ON WAYS MCHS-CANNON FALLS CAN IMPROVE CUSTOMER SERVICE AND DETERMINE WHETHER OR NOT THERE IS A NEED FOR NEW OR EXPANDED SERVICES. THE DATA FROM THE SURVEY IS REVIEWED AND ANALYZED BY MEMBERS OF QUALITY AND ADMINISTRATION DEPARTMENTS AS WELL AS MCHS-CANNON FALLS EMERGENCY ROOM (ER)/INPATIENT SATISFACTION TEAM, A TEAM DEDICATED TO IMPROVING PATIENT SATISFACTION IN THE ER AND HOSPITAL.THROUGH THESE VARIOUS AVENUES, MCHS-CANNON FALLS STAFF MEMBERS ACROSS MANY DEPARTMENTS STAY CONNECTED WITH THE COMMUNITY TO ASSESS THE HEALTHCARE NEEDS OF CANNON FALLS AND SURROUNDING AREAS. 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. PART VI, LINE 4: MAYO CLINIC HEALTH SYSTEM-CANNON FALLS (MCHS-CF) IS LOCATED IN CANNON FALLS, MINNESOTA. MCHS-CF SERVES CANNON FALLS AND THE SURROUNDING AREA WITHIN GOODHUE COUNTY. THE MCHS-CF CAMPUS INCLUDES A HOSPITAL LICENSED FOR 21 BEDS WITH 15 CURRENTLY IN SERVICE AND A MULTI-SPECIALTY HOSPITAL-BASED CLINIC SERVING CANNON FALLS.ACCORDING TO THE U.S. CENSUS BUREAU AND THE MINNESOTA COMPASS MOST RECENT DATA: CANNON FALLS IS A RURAL COMMUNITY WITH A POPULATION OF 4,090, GOODHUE COUNTY POPULATION WAS ESTIMATED AT 46,464. THE POPULATION IS 49.2% MALE AND 50.8% FEMALE WITH THE MEDIAN RESIDENT AGE BEING 38.5 YEARS OF AGE. THE ESTIMATED MEDIAN HOUSEHOLD INCOME IN CANNON FALLS WAS $45,500, 8.5% OF RESIDENTS HAVE AN INCOME BELOW THE POVERTY LEVEL. 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 ORGANIZATIONS 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. COMMUNITY REPRESENTATION ON GOVERNING BODY: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 CLINICS 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 (BROCHURE):MAYOCLINICHEALTHSYSTEM.ORG/LOCATIONS/CANNON-FALLS/BILLING 0 1 1 0 0 0 0 0 0 ALTRICHTER MD PAUL M VICE CHAIR / DIRECTOR 0 236378 0 0 0 867 0 27402 0 27474 0 292121 0 0 BERNARD MD MATTHEW E DIRECTOR 0 261254 0 0 0 1726 0 30720 0 23117 0 316817 0 0 PARKS DOUGLAS A DIRECTOR / REGION CAO 0 230653 0 0 0 1360 0 24478 0 26281 0 282772 0 0 WHITED MD BRIAN L DIRECTOR 0 427369 0 0 0 17095 0 13000 0 26145 0 483609 0 0 WITT MD THOMAS J CHAIR / CEO / DIRECTOR 0 408368 0 0 0 48424 0 44943 0 21637 0 523372 0 0 AGERTER MD DAVID C REGION CEO 0 499015 0 0 0 56097 0 675 0 17533 0 573320 0 0 CHRISTIAN GLENN P SECRETARY (1/1-3/17/14) 177403 0 0 0 0 0 25891 0 18163 0 221457 0 0 0 GUDGELL STEPHEN F CORRIDOR CAO/TREASURER (3/17-12/31) 0 195549 0 0 0 1241 0 311 0 19387 0 216488 0 0 KOCH MARK B ASST SECRETARY 0 378314 0 0 0 17413 0 533 0 17492 0 413752 0 0 PRIEST WILLIAM F SECRETARY (3/17-12/31/14) 191580 0 0 0 0 0 24732 0 27502 0 243814 0 0 0 TARASOVITCH JAMES J REGION CFO 0 293754 0 0 0 60707 0 10400 0 18113 0 382974 0 0 TUSA EDWARD A SITE CFO / TREASURER (1/1-3/17/14) 130062 0 0 0 0 0 22048 0 22879 0 174989 0 0 0 CHESTNUT MD JANET S PHYSICIAN 342867 0 833 0 0 0 53609 0 16971 0 414280 0 0 0 JOHNSTON-FLANDERS MD MEGAN S PHYSICIAN 236400 0 21333 0 0 0 15467 0 30937 0 304137 0 0 0 NORDAHL MD THOMAS W PHYSICIAN 613506 0 750 0 0 0 44189 0 29500 0 687945 0 0 0 STRICKER MD ALEXANDER W PHYSICIAN 252146 0 20833 0 0 0 24116 0 604 0 297699 0 0 0 TURNA MD TARLOCHAN S FAMILY MEDICINE PHYSICIAN 355110 0 1333 0 0 0 27408 0 16414 0 400265 0 0 0 LOHR MD ROBERT H FMR INTERIM CHAIR / CEO 0 246481 0 0 0 14395 0 53198 0 17247 0 331321 0 0 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 RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN. AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). AGERTER M.D., DAVID C. $49,966 BERNARD M.D., MATTHEW E. $ 759 CHESTNUT M.D., JANET S. $15,647 KOCH, MARK B. $14,770 NORDAHL M.D., THOMAS W. $26,570 TURNA M.D., TARLOCHAN S. $15,553 WITT M.D., THOMAS J. $38,983 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. 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. RYAN SCHRAMM SON-IN-LAW OF BOARD OFFICER, GLENN CHRISTIAN 96171 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: WITT M.D., THOMAS J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: PARKS, DOUGLAS A. KOCH, MARK B. GUDGELL, STEPHEN F. AGERTER M.D., DAVID C. TARASOVITCH, JAMES J. THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: WHITED M.D., BRIAN L. TARASOVITCH, JAMES J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: KOCH, MARK B. WHITED M.D., BRIAN L. TARASOVITCH, JAMES J. THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: PARKS, DOUGLAS A. GUDGELL, STEPHEN F. BERNARD M.D., MATTHEW E. ALTRICHTER M.D., PAUL M. AGERTER M.D., DAVID C. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL WHO IS ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: KOCH, MARK B. 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 MEMBER OF THE CORPORATION IS MAYO CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BODY, THE BOARD OF TRUSTEES, CONSISTS OF NINE PERSONS ELECTED AS FOLLOWS: (A) FOUR COMMUNITY TRUSTEES ELECTED BY THE CANNON FALLS HOSPITAL DISTRICT; (B) CHAIR/CEO AND VICE CHAIR ELECTED BY THE BOARD OF TRUSTEES AND APPROVED BY AND ELECTED BY THE SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE BYLAWS ALSO PROVIDE THE SOLE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS OPERATIONS, CAPITAL, BUDGET, AMENDMENT OF ARTICLES OR BYLAWS 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 OR HIS DELEGATE, 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 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 - PS : PROGRAM SERVICE EXPENSES 1,149,985. MANAGEMENT AND GENERAL EXPENSES 3,004,135. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,154,120. OTHER PURCHASED SERVICES - PS : PROGRAM SERVICE EXPENSES 893,965. MANAGEMENT AND GENERAL EXPENSES 31,951. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 925,916. 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) 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 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 KLINIK 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 0 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 0 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 FOUNDATION-SPARTA INC 310 WEST MAIN STREET SPARTA WI 54656 391423234 FUNDRAISING FOUNDATION WI 501(C)(3) 9 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--HOME HEALTH & HOSPICE INC PO BOX 2060 EAU CLAIRE WI 54702 391491516 HOME HEALTH AND HOSPICE CARE WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL 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 MAYO CLINIC 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--ST JAMES HEALTH CARE FOUNDATION 1101 MOULTON PARSONS DR PO BOX 460 ST JAMES MN 56081 411444129 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--ST JAMES 1 MCHS--SUPPORTIVE HOMECARE INC PO BOX 2060 EAU CLAIRE WI 54702 391686673 HOME HEALTH CARE WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL INC 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 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 PHYSICIAN SOFTWARE SYSTEMS LLC 3333 WARRENVILLE ROAD SUITE 200 LISLE IL 60532 453414836 HEALTHCARE RELATED SOFTWARE IL N/A WATERSHED CAP INSTL PRTNRS III LP ONE MARITIME PLAZA SUITE 1525 SAN FRANCISCO CA 94111 462982848 INVESTMENT ACTIVITIES DE N/A BWL HOLDINGS INC 1209 ORANGE STREET WILMINGTON DE 19801 472413749 OIL & GAS EXPLORATION DE N/A C 1 AMBIENT CLINICAL ANALYTICS INC 221 1ST AVE SW SUITE 202 ROCHESTER MN 55902 800928405 SOFTWARE 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 21 FIRST STREET SW ROCHESTER MN 55905 411547003 THIRD PARTY ADMINISTRATION SERVICES MN N/A C 1 RESOUNDANT INC 221 1ST AVE SW ROCHESTER MN 55902 461661978 MANUFACTURING MEDICAL DEVICE COMPONENT MN N/A C 1 ROCHESTER AIRPORT COMPANY ROUTE 2 ROCHESTER MN 55902 410506870 AIRPORT MANAGEMENT MN N/A C 1 SATILLA HEALTHNET INC 1900 TEBEAU STREET WAYCROSS GA 31501 582151076 HEALTH SERVICES GA 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 (9) CHARITABLE TRUST FL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST LA N/A T 1 CHARITABLE REMAINDER TRUST (73) CHARITABLE TRUST MN N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NC N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NM N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NV N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NY N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST TX N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST WI 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 (70) CHARITABLE TRUST MN N/A T 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 MCHS-ALBERT LEA AND AUSTIN P 3876661 GAAP MCHS-LAKE CITY R 276635 GAAP MCHS-OWATONNA S 121222 GAAP MCHS-RED WING A 2100 GAAP MMSI INC R 1748977 GAAP MMSI INC S 1153952 GAAP