2015-11-10T11:12:19-06:00 2014-12-31 990 2014-01-01 411713783 MAYO CLINIC HEALTH SYSTEM - RED WING MAYO 5075381297 701 HEWITT BLVD RED WING MN 55066 JAMES J TARASOVITCH REGION CFO 5075381297 2015-11-10 2014 2016-03-07 17:11:31Z DAVID C AGERTER MD 701 HEWITT BLVD RED WING MN 55066 97266177 0 5983 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1992 MN OPERATION OF A HOSPITAL AND THREE CLINICS 11 5 881 124 0 0 2334961 1858918 96219915 94700204 13955 -44729 452568 496039 99021399 97010432 36321 29955 0 0 57862115 63304747 0 0 0 43042970 45908999 100941406 109243701 -1920007 -12233269 66159237 64836916 53425249 64336197 12733988 500719 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 96780905 0 95018848 PATIENT CARE (SEE SCHEDULE O):MAYO CLINIC HEALTH SYSTEM-RED WING (MCHS-RED WING) IS A MEMBER OF THE MAYO CLINIC HEALTH SYSTEM. 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. AS PART OF THE MAYO CLINIC HEALTH SYSTEM, MCHS-RED WING OPERATES A CLINIC, HOSPITAL, SENIOR LIVING FACILITY, NURSING HOME, AND HOME HEALTH & HOSPICE IN RED WING, MINNESOTA. IN ADDITION, TWO REGIONAL CLINICS ARE OPERATED IN ZUMBROTA, MINNESOTA AND ELLSWORTH, WISCONSIN.THE RED WING LOCATION COMBINES A CLINIC AND HOSPITAL INTO ONE STATE-OF-THE-ART FACILITY. OPENED IN 2001, THE MEDICAL CENTER HAS A 30-BED INPATIENT HOSPITAL CARE UNIT THAT INCLUDES INTENSIVE CARE AND A BIRTHING CENTER. CLINIC SERVICES INCLUDES: PRIMARY FAMILY SERVICES, SPECIALTY MEDICAL AND SPECIALTY SURGICAL SERVICES, URGENT AND EMERGENCY CARE AND REHABILITATION SERVICES. THE MEDICAL CENTER ALSO OFFERS THE LATEST IN DIAGNOSTIC TOOLS (I.E. CT SCAN, MRI, AND FULL LAB SERVICES). MCHS-RED WING IS A COMPLETE HEALTH CARE FACILITY FOR PATIENTS THROUGHOUT GOODHUE AND PIERCE COUNTIES. IN 2014 THE MEDICAL CENTER PROVIDED CARE TO 1,725 INPATIENTS FOR A TOTAL OF 4,532 PATIENT DAYS. PROVIDED TREATMENT FOR 10,570 EMERGENCY ROOM VISITS AND PROVIDED A TOTAL OF 130,219 CLINICAL ENCOUNTERS.MCHS-RED WING 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 MEDICAID AND MEDICARE PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. IN 2014, MCHS-RED WING PROVIDED APPROXIMATELY $1,350,000 IN FINANCIAL ASSISTANCE TO PATIENTS. THE TOTAL COST OF UNCOMPENSATED CARE PROVIDED TO LOW INCOME PATIENTS THROUGH MEDICAID AND MINNESOTACARE (A STATE PROGRAM FOR PROVIDING MEDICAL CARE TO THE LOW INCOME POPULATION) WAS APPROXIMATELY $5,568,000 WHICH INCLUDES THE MEDICAID SURCHARGE OF $741,011 AND MNCARE TAX OF $1,459,871.THE UNREIMBURSED COST OF SERVICES TO MEDICARE PATIENTS DETERMINED BY USING INFORMATION FROM THE HOSPITAL'S MEDICARE COST REPORT WAS APPROXIMATELY $12,195,000. IF USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY, THE UNREIMBURSED COST OF SERVICES TO MEDICARE PATIENTS WAS APPROXIMATELY $13,549,000.MCHS-RED WING LEASES SPACE TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE OF PROVIDING PATIENT CARE. 769589 29955 26654 COMMUNITY PROGRAMS (SEE SCHEDULE O):AS PART OF ITS ACTIVITIES, MCHS-RED WING PROVIDES VARIOUS SUPPORT GROUPS AND PROGRAMS TO THE COMMUNITY AT NO CHARGE. THESE GROUPS AND CLASSES INCLUDE DIABETIC EDUCATIONAL PROGRAMS, LIVING WELL WITH CHRONIC CONDITIONS CLASSES, CARDIAC SUPPORT WELLNESS FOR LIFE CLASS FOR 22 PATIENTS, OUTREACH FOR SENIOR CITIZENS THROUGH PARTNERS IN AGING PROGRAMS THAT BENEFITED 2,388 PERSONS, AND PRENATAL CLASSES FOR EXPECTANT PARENTS WHICH WERE ATTENDED BY 3,643 PERSONS. MCHS-RED WING ALSO CONDUCTED FLU SHOT CLINICS AND OFFERED DISCOUNTED MAMMOGRAMS TO WOMEN WHO QUALIFIED DURING THE MONTH OF OCTOBER.MCHS-RED WING OFFERED SPORTS PHYSICALS AT A REDUCED RATE FOR 35 HIGH SCHOOL ATHLETES ALONG WITH CONCUSSION MANAGEMENT, AND STAFF COVERAGE AT HOME HIGH SCHOOL FOOTBALL GAMES TO RESPOND TO EMERGENCIES. MCHS-RED WING ALSO OFFERS A PROGRAM THAT ALLOWS 13 HIGH SCHOOL STUDENTS TO COME ON-SITE AND LEARN ABOUT HEALTH CARE CAREERS AND PARTICIPATE IN JOB SHADOWING EXPERIENCES FOR 52 HOURS. ALSO DURING 2014, MCHS-RED WING PROVIDED SCHOLARSHIP FUNDS TOTALING $1,000 TO SCHOOLS TO SUPPORT STUDENTS PURSUING A FIELD IN HEALTH CARE AND DONATIONS TO LOCAL CHARITIES OR COMMUNITY ORGANIZATIONS PROMOTING HEALTH IN THEIR COMMUNITIES. FUNDS PROVIDED TO COMMUNITY ORGANIZATIONS INCLUDE A $3,000 "LIVE HEALTHY RED WING" SPONSORSHIP. THIS IS A COMMUNITY PARTNERSHIP, MAKING POLICY AND ENVIRONMENTAL CHANGES TO IMPROVE NUTRITION AND ACTIVITY FOR OUR COMMUNITY. MCHS-RED WING ALSO PROVIDED $5,000 TO EVERY HAND JOINED WHICH IS A COMMUNITY PARTNERSHIP COMMITTED TO IMPROVING LIVES CRADLE TO CAREER. MCHS-RED WING SUPPORTS THE CARE CLINIC, A FREE CLINIC IN THE COUNTY, BY PROVIDING SPACE VALUED AT $25,900, LABORATORY AND RADIOLOGY SERVICES BENEFITTING 433 PEOPLE VALUED AT $12,000, AND MALPRACTICE INSURANCE FOR EMPLOYEES WHO DONATED 1,250 HOURS WITH 1,747 PATIENT ENCOUNTERS FOR 588 UNIQUE PATIENTS. MCHS-RED WING ALSO RECEIVES DONATED SERVICES FROM VOLUNTEERS CONSISTING OF INDIVIDUALS AND ORGANIZATIONS THAT HELP ORGANIZE AND MANAGE ACTIVITIES FOR THE BENEFIT OF MCHS-RED WING'S PATIENTS, PATIENT'S FAMILIES, VISITORS AND STAFF. THE VOLUNTEERS OPERATE A GIFT SHOP, ASSIST PATIENTS AND GREET VISITORS. DURING 2014, 119 AUXILIARY VOLUNTEERS DONATED APPROXIMATELY 11,563 HOURS OF SERVICE. BASED ON 2014 INDEPENDENT SECTOR STATISTICS, THE APPROXIMATE VALUE OF THESE SERVICES WERE $266,758. 97550494 1 1 0 1 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 110 0 1 881 1 0 0 0 0 0 0 0 0 0 0 X 11 5 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 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 AGERTER MD DAVID C DIRECTOR / REGION CEO 1.00 40.00 X X 0 555112 18208 ALEXANDER MD JACK W DIRECTOR (1/1-8/1) 40.00 0.00 X 255840 0 39752 ANDERST DONNA DIRECTOR 1.00 0.00 X 0 0 0 BECK JENNIFER DIRECTOR 1.00 0.00 X 0 0 0 BODENSTEINER RICHARD DIRECTOR 1.00 0.00 X 0 0 0 DEJONG MD AMY A DIRECTOR 40.00 0.00 X 244540 0 44038 FOOT III SILAS B DIRECTOR 1.00 0.00 X 0 0 0 KETCHAM MD JEFFREY M DIRECTOR 40.00 0.00 X 648791 0 44495 PARKS DOUGLAS A SECRETARY / DIRECTOR / REGION CAO 1.00 40.00 X X 0 232013 50759 RIEGELMAN ROBERT DIRECTOR 1.00 0.00 X 0 0 0 SIMPSON MD HENRY J DIRECTOR 1.00 40.00 X 0 306137 33919 WILLIAMS MD AMY W DIRECTOR 1.00 40.00 X 0 273718 37120 GUDGELL STEPHEN F TREASURER / RIVER CORRIDOR CAO 1.00 40.00 X 0 196790 19698 TARASOVITCH JAMES J REGIONAL CFO 1.00 40.00 X 0 354461 28513 WITT MD THOMAS J PRESIDENT / CEO 1.00 40.00 X 0 456792 66580 DIMUNATION NANCY NURSE ADMINISTRATOR 40.00 0.00 X 172440 0 30077 BREHMER MD JESS L PHYSICIAN 40.00 0.00 X 537732 0 23795 EICH MD MATTHEW A PHYSICIAN 40.00 0.00 X 541818 0 37252 HUGHES MD EVERETT M PHYSICIAN 40.00 0.00 X 621796 0 43795 JOHNSON MD MICHAEL R PHYSICIAN 40.00 0.00 X 592884 0 43495 SMITH MD HUGH S PHYSICIAN 40.00 0.00 X 447922 0 23056 4063763 2375023 584552 101 0 1 0 CENTRAL MN DIAGNOSTIC INC 150 10TH STREET NW MILACA MN 56353 RADIOLOGY SERVICES 717675 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 95397 MEDICAL STAFFING SERVICES 700256 MAYO CLINIC 200 1ST ST SW ROCHESTER MN 55905 MEDICAL & ADMIN SERVICES 634254 MCHS-EAU CLAIRE HOSPITAL INC PO BOX 1510 EAU CLAIRE WI 54702 MEDICAL SERVICES 558916 MDA HOLDINGS INC PO BOX 277185 ATLANTA GA 30384 MEDICAL STAFFING SERVICES 529906 11 1766296 92622 1858918 NET PATIENT REVENUE 620000 93379554 93379554 RESIDENT REVENUE 812930 1255296 1255296 OUTREACH REVENUE 620000 26654 26654 RENT FROM AFFILIATES 531120 25350 25350 EDUCATION REVENUE 611600 13350 13350 94700204 17997 17997 145636 139793 5843 5843 5843 62726 -62726 -62726 -62726 15113 2143 12970 12970 71451 51083 20368 20368 CAFETERIA/VENDING 722210 341853 341853 MISCELLANEOUS REVENUE 900099 74080 3445 70635 MEDICAL DIRECTOR FEES 541900 40925 40925 456858 97010432 95045502 0 106012 X 29955 29955 1479972 1479972 51401433 50940723 460710 2864824 2839756 25068 4248607 4217174 31433 3309911 3308057 1854 205309 205309 61621 60946 675 7616 7616 12207567 1580208 10627359 71937 71937 4098944 4031003 67941 234555 232395 2160 2795760 2795760 575982 537158 38824 654 654 2029688 2029688 3605033 3605033 436973 436973 MEDICAL SUPPLIES 11409489 11409489 BAD DEBT EXPENSE 5034397 5034397 MN CARE TAX 1459871 1459871 MEDICAID SURCHARGE 741011 741011 932592 932382 210 109243701 97550494 11693207 0 485566 1231844 14860676 17133609 31744 39594 433384 239850 1605635 1429682 14265 2809 95006158 53698637 42486650 41307521 2297469 2796669 3651599 476612 292249 178726 66159237 64836916 11788823 13640834 16356 10178 10178 99821 107585 41526427 50561244 53425249 64336197 X 12495388 169465 238600 331254 12733988 500719 66159237 64836916 -12233269 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 7616 7616 0 PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. MAYO CLINIC HEALTH SYSTEM-RED WING 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 2014, MCHS-RED WING REPRESENTATIVES HAD SEVERAL MEETINGS WITH MEMBERS OF THE LEGISLATIVE AND EXECUTIVE BRANCHES OF GOVERNMENT TO DISCUSS ISSUES RELATING TO HEALTH CARE AND HEALTH CARE REFORM. 0 1 X 100000 5600 5383 100217 100000 100000 1.00000 0 1 1 3870888 3870888 62567336 32929379 29637957 27875621 20769258 7106363 692313 692313 41307521 DUE TO AFFILIATES 50561244 50561244 X PART IV, LINE 2B: DEPOSITS ARE HELD FOR DOWNTOWN PLAZA AND SEMINARY HOME RESIDENTS. PART V, LINE 4: THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR RESEARCH AND EDUCATION PROGRAMS. 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. 13 15113 15113 2143 15113 15113 2143 2143 12970 1 1 X 1 X 1 X 1 1 1 0 1 1 1350060 1350060 0.01300 11567548 5999676 5567872 0.05340 12917608 5999676 6917932 0.06640 239156 239156 0.00230 316958 316958 0.00300 2557196 2243950 313246 0.00300 138475 138475 0.00130 3251785 2243950 1007835 0.00960 16169393 8243626 7925767 0.07600 15321 15321 0.00010 18188 18188 0.00020 29327 29327 0.00030 12164 12164 0.00010 75000 75000 0.00070 0 5034397 9141424 15824407 -6682983 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM - RED WING 701 HEWITT BLVD RED WING MN 55066 WWW.MAYOCLINICHEALTHSYSTEM.ORG 21423 X X X MAYO CLINIC HEALTH SYSTEM - RED WING 1 0 0 1 X X X X X X X 13 1 1 0 1 X WWW.MAYOCLINICHEALTHSYSTEM.ORG 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 - RED WING 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 INITIATIVE. MAYO CLINIC HEALTH SYSTEM - RED WING 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 - RED WING 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 RALLIES 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.NEEDS NOT BEING ADDRESSED: 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 - RED WING 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 - RED WING 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 - RED WING 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 - RED WING PART V, SECTION B, LINE 22D: THE POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 40% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN USING THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE. 6 MCHS-RED WING 701 HEWITT BOULEVARD RED WING MN 55066 CLINIC MCHS-RED WING IN ZUMBROTA 1350 JEFFERSON DRIVE ZUMBROTA MN 55992 CLINIC MCHS-RED WING HOME HEALTH & HOSPICE 1407 W 4TH STREET RED WING MN 55066 HOME HEALTH & HOSPICE RED WING SEMINARY HOME 906 COLLEGE AVENUE RED WING MN 55066 NURSING HOME MCHS-RED WING IN ELLSWORTH 530 CAIRNS STREET ELLSWORTH WI 54011 CLINIC DOWNTOWN PLAZA 434 W 4TH STREET RED WING MN 55066 SENIOR LIVING FACILITY 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 $ 5,034,397. PART II, COMMUNITY BUILDING ACTIVITIES: THROUGH IN-KIND 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). HOWEVER, USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY ACTUALLY RESULTS IN A MEDICARE SHORTFALL OF APPROXIMATELY $13,549,000 AS REPORTED IN THE CORE FORM, PART III, PROGRAM SERVICE ACCOMPLISHMENTS.THE MOST COMMON REASONS FOR A DIFFERENCE BETWEEN THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H AND THE MEDICARE SHORTFALL REPORTED ON THE CORE FORM, PART III INCLUDE: (1) INCLUSION OF MEDICARE ADVANTAGE REVENUE AND EXPENSES; (2) INCLUSION OF PART B REVENUE AND EXPENSES; (3) INCLUSION OF OTHER FEE SCHEDULE REVENUE; AND (4) SOME TIMING ISSUES.REASONS WHY MEDICARE SHORTFALL REPORTED ON LINE 7, IF ANY, 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-RED WING (MCHS-RED WING) EMPLOYEES THROUGHOUT THE ORGANIZATION ASSESS THE NEEDS OF RED WING AND THE SURROUNDING COMMUNITIES THROUGH PERSONAL INTERACTION AND INVOLVEMENT WITH LOCAL SCHOOLS, CIVIC GROUPS AND HEALTH DEPARTMENTS AS WELL AS THROUGH THE COLLECTION AND ANALYSIS OF FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS.MCHS-RED WING EMPLOYEES ARE STRONGLY CONNECTED WITH LOCAL CIVIC GROUPS. MANY EMPLOYEES ARE ACTIVE MEMBERS OF VARIOUS RED WING NON-PROFIT ORGANIZATIONS. MANY PROVIDE LEADERSHIP ON BOARDS WHILE OTHERS GIVE HEALTH CARE PRESENTATIONS TO THESE GROUPS. THIS PARTICIPATION NOT ONLY PROMOTES INVOLVEMENT IN THE COMMUNITY, BUT IT ALSO GIVES COMMUNITY MEMBERS A CHANCE TO ASK QUESTIONS, SHARE COMMENTS, CONCERNS OR OTHER SUGGESTIONS THEY MAY HAVE REGARDING THE MEDICAL CENTER. MCHS-RED WING ALSO WORKS WITH THE GOODHUE PUBLIC HEALTH ORGANIZATION TO DEVELOP RELATIONSHIPS AMONG HEALTH CARE PROVIDERS AND COMMUNITY LEADERS. THIS PARTNERSHIP PROMOTES THE ACTIVE REFERRAL OF PATIENTS TO LOCAL RESOURCES SUCH AS ACCESS TO HIGH QUALITY NUTRITIOUS FOODS, PHYSICAL ACTIVITY AND TOBACCO USE CESSATION PROGRAMS. MCHS-RED WING EMPLOYEES MEET AND REMAIN IN CLOSE CONTACT WITH ADMINISTRATION AT THE RED WING SCHOOL SYSTEM. AS A RESULT OF THIS CLOSE INTERACTION, MCHS-RED WING PROVIDED SEVERAL SERVICES TO STUDENTS IN 2014 INCLUDING MATURATION CLASSES IN THE ELEMENTARY SCHOOLS AND MIDDLE SCHOOL, SAFE ROUTES TO SCHOOLS DEVELOPMENT AND SEVERAL STAFF PRESENTATIONS ABOUT THEIR JOBS DURING HIGH SCHOOL CAREER CLASSES AT SCHOOL. THE REHABILITATION DEPARTMENT WORKS WITH THE LOCAL ATHLETIC DEPARTMENTS IN HIGH SCHOOL AND YOUTH SPORTS. MCHS-RED WING EMPLOYEES ALSO PARTICIPATE IN "EVERY HAND JOINED" WHICH IS A COLLECTIVE IMPACT INITIATIVE TO LIFT THE POTENTIAL OF ALL RED WING CHILDREN.MCHS-RED WING 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-RED WING SYSTEM AND PROCESS CHANGES, OFFER INPUT TO LEADERSHIP IN THE PLANNING AND EVALUATION OF SERVICES, AND SERVE AS A VITAL LINK BETWEEN MCHS-RED WING AND THE COMMUNITY.MCHS-RED WING 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. MCHS-RED WING ALSO PROVIDES FREE OR REDUCED COST SERVICES TO COMMUNITY MEMBERS THROUGH PREVENTATIVE HEALTH, SUPPORT FOR THE COUNTY WIDE FREE CLINIC (CARE CLINIC) AND FOOT CLINICS. AS THESE EXAMPLES OF INVOLVEMENT DEMONSTRATE, MCHS-RED WING IS CLOSELY CONNECTED WITH THE COMMUNITY. IN ADDITION TO THIS, MCHS-RED WING ACTIVELY SEEKS FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS THROUGH PRESS GANEY SURVEYS. THE SURVEY, WHICH IS ADMINISTERED BY PRESS GANEY, IS SENT TO A CROSS SECTION OF PATIENTS TO COMPILE USEFUL FEEDBACK ON WAYS MCHS-RED WING CAN IMPROVE CUSTOMER SERVICES AND DETERMINE WHETHER OR NOT THERE IS A NEED FOR NEW OR EXPANDED SERVICES. THE DATA FROM THE PRESS GANEY SURVEY IS REVIEWED AND ANALYZED BY MEMBERS OF QUALITY AND ADMINISTRATION DEPARTMENTS AS WELL AS MCHS-RED WING'S EMERGENCY ROOM (ER)/INPATIENT SATISFACTION TEAM, A TEAM DEDICATED TO IMPROVING PATIENT SATISFACTION IN THE ER AND HOSPITAL.THROUGH THESE VARIOUS AVENUES, MCHS-RED WING STAFF MEMBERS ACROSS MANY DEPARTMENTS STAY CONNECTED WITH THE COMMUNITY TO ASSESS THE HEALTH CARE NEEDS OF RED WING 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. 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-RED WING (MCHS-RED WING) HAS LOCATIONS IN RED WING AND ZUMBROTA, MINNESOTA AND ELLSWORTH, WISCONSIN. THE MAJORITY OF MCHS-RED WING SERVICE AREAS INCLUDE GOODHUE COUNTY IN SOUTHEASTERN MINNESOTA AND PIERCE COUNTY IN WEST CENTRAL WISCONSIN. THE MAIN CAMPUS, LOCATED IN RED WING, INCLUDES A HOSPITAL LICENSED FOR 50 BEDS AND A MULTI-SPECIALTY HOSPITAL-BASED CLINIC WITH 89 PROVIDERS SERVING RED WING AND SURROUNDING COMMUNITIES. ACCORDING TO THE UNITED STATES CENSUS BUREAU, AND MINNESOTA COMPASS THE 2013 POPULATION ESTIMATE FOR GOODHUE COUNTY (WHICH COMPRISES MOST OF RED WING SERVICE AREA) IS 46,464. A 2013 ESTIMATE REPORTS THAT MEDIAN AGE IS 42.8, AND 18.7% ARE 65 YEARS OLD OR OLDER. THE MEDIAN HOUSEHOLD INCOME IS $55,603, AND AN ESTIMATED 10.6% OF INDIVIDUALS ARE LIVING BELOW POVERTY LEVEL IN THE RED WING COMMUNITY. PART VI, LINE 5: THE FILING ORGANIZATION IS AN AFFILIATE OF THE 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.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 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 VS. 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 FAP, FAP APPLICATION, AND PLAIN LANGUAGE SUMMARY (BROCHURE):MAYOCLINICHEALTHSYSTEM.ORG/LOCATIONS/RED-WING/BILLING X 1 1 0 1 1 0 0 0 0 0 0 AGERTER MD DAVID C DIRECTOR / REGION CEO 0 499015 0 0 0 56097 0 675 0 17533 0 573320 0 0 ALEXANDER MD JACK W DIRECTOR (1/1-8/1) 253565 0 0 0 2275 0 18200 0 21552 0 295592 0 0 0 DEJONG MD AMY A DIRECTOR 242016 0 0 0 2524 0 17743 0 26295 0 288578 0 0 0 KETCHAM MD JEFFREY M DIRECTOR 646388 0 0 0 2403 0 18200 0 26295 0 693286 0 0 0 PARKS DOUGLAS A SECRETARY / DIRECTOR / REGION CAO 0 230653 0 0 0 1360 0 24478 0 26281 0 282772 0 0 SIMPSON MD HENRY J DIRECTOR 0 303278 0 0 0 2859 0 12888 0 21031 0 340056 0 0 WILLIAMS MD AMY W DIRECTOR 0 264035 0 0 0 9683 0 34167 0 2953 0 310838 0 0 GUDGELL STEPHEN F TREASURER / RIVER CORRIDOR CAO 0 195549 0 0 0 1241 0 311 0 19387 0 216488 0 0 TARASOVITCH JAMES J REGIONAL CFO 0 293754 0 0 0 60707 0 10400 0 18113 0 382974 0 0 WITT MD THOMAS J PRESIDENT / CEO 0 408368 0 0 0 48424 0 44943 0 21637 0 523372 0 0 DIMUNATION NANCY NURSE ADMINISTRATOR 171810 0 0 0 630 0 12139 0 17938 0 202517 0 0 0 BREHMER MD JESS L PHYSICIAN 518543 0 18664 0 525 0 0 0 23795 0 561527 0 0 0 EICH MD MATTHEW A PHYSICIAN 541793 0 0 0 25 0 18200 0 19052 0 579070 0 0 0 HUGHES MD EVERETT M PHYSICIAN 621271 0 0 0 525 0 18200 0 25595 0 665591 0 0 0 JOHNSON MD MICHAEL R PHYSICIAN 571628 0 20731 0 525 0 18200 0 25295 0 636379 0 0 0 SMITH MD HUGH S PHYSICIAN 447397 0 0 0 525 0 0 0 23056 0 470978 0 0 0 PART I, LINE 1A CHAMBER BUCKS ($25) WERE GIVEN TO ALL EMPLOYEES AND WERE GROSSED-UP. 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 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 WILLIAMS M.D., AMY W. $ 7,443 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 II: COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. MICHAEL R JOHNSON MD HIGHEST COMPENSATED EMPLOYEE SIGNING BONUS IN THE FORM OF A FORGIVABLE LOAN X 100000 11745 0 1 1 JESS L BREHMER MD HIGHEST COMPENSATED EMPLOYEE SIGNING BONUS IN THE FORM OF A FORGIVABLE LOAN X 50000 27849 0 1 1 39594 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. GUDGELL, STEPHEN F. AGERTER M.D., DAVID C. TARASOVITCH, JAMES J. THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: SIMPSON M.D., HENRY J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL WHO IS ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: WITT M.D., THOMAS J. 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 MEMBER ELECTS THE MEMBER DIRECTORS. THE MEMBER ELECTS COMMUNITY PHYSICIAN DIRECTORS FROM A SLATE NOMINATED BY THE MEDICAL STAFF. 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 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 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 OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 10,809,560. MANAGEMENT AND GENERAL EXPENSES 91,565. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,901,125. IC PURCHASED SERVICES: PROGRAM SERVICE EXPENSES -9,229,352. MANAGEMENT AND GENERAL EXPENSES 10,535,794. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,306,442. 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 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH A 17700 GAAP MCHS-CANNON FALLS A 2100 GAAP MCHS-EAU CLAIRE HOSPITAL INC M 558916 GAAP MCHS-LAKE CITY S 1056847 GAAP MMSI INC M 191812 GAAP MMSI INC S 5172501 GAAP