2015-08-25T09:01:59-05:00 2014-12-31 990 2014-01-01 390920634 MAYO CLINIC HEALTH SYSTEM-NORTHLANDINC MAYO 5075381297 1222 E WOODLAND AVE BARRON WI 548121798 PAUL M BAMMEL CFO 5075381297 2015-08-25 2014 2016-04-25 22:37:26Z RANDALL L LINTON MD 1222 E WOODLAND AVE BARRON WI 548121798 61392786 0 5983 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1956 WI HOSPITAL, CLINICS, NURSING HOME AND INDEPENDENT/ASSISTED LIVING CENTER. 11 5 509 126 0 0 300489 247483 59652056 60536913 470231 414629 119607 141053 60542383 61340078 13940 13674 0 0 32921636 32999125 0 0 5004 25879010 26803066 58814586 59815865 1727797 1524213 49934342 58154560 9912404 16445149 40021938 41709411 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 57874513 60630401 PATIENT CARE (SCHEDULE O)MAYO CLINIC HEALTH SYSTEM-NORTHLAND, INC. (MCHS-NORTHLAND) 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.MCHS-NORTHLAND IS A WISCONSIN NONPROFIT CORPORATION, TAX EXEMPT AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CORPORATION, WHICH INCLUDES A HOSPITAL, CLINICS, A NURSING HOME AND A RESIDENTIAL CARE APARTMENT COMPLEX, OPERATES PRIMARILY FOR THE RESIDENTS OF BARRON, WISCONSIN AND SURROUNDING COMMUNITIES.MCHS-NORTHLAND'S MISSION STATEMENT STATES THAT THE ORGANIZATION'S AIM IS 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. OUR VISION IS TO ACHIEVE THE HIGHEST STANDARDS FOR MEDICAL CARE AND HEALTH IMPROVEMENT IN THE COMMUNITIES IN WHICH WE LIVE AND WORK. OUR FIRST PRIORITY IS TO MEET PATIENT NEEDS GUIDED BY THE CORE VALUES OF INTEGRITY, CONTINUOUS IMPROVEMENT, SERVICE, TEAMWORK, INNOVATION, BALANCE AND FINANCIAL INTEGRITY. AS A MEMBER OF MAYO CLINIC HEALTH SYSTEM, MCHS-NORTHLAND PROVIDES QUALITY HEALTHCARE CLOSE TO HOME WITH DIRECT ACCESS TO HIGHLY SPECIALIZED CARE IF THE NEED ARISES. MCHS-NORTHLAND OPERATES ON A NONDISCRIMINATORY BASIS, REGARDLESS OF RACE, COLOR, SEX, RELIGION OR NATIONAL ORIGIN.THE HOSPITAL PLAYS A VITAL ROLE IN THE HEALTH AND WELL-BEING OF THE COMMUNITY BY OFFERING SERVICES SUCH AS FIVE CLINIC LOCATIONS, 24-HOUR EMERGENCY CARE, SAME DAY SURGERY, FAMILY CENTERED MATERNITY CARE, OB/GYN SERVICES, PEDIATRIC CARE, PAIN CLINIC SERVICES AND ADVANCED DIAGNOSTIC TECHNOLOGY. THE HOSPITAL HAD 887 ADMISSIONS INCLUDING ADULTS, CHILDREN, NEWBORN AND SWING BED ADMISSIONS. THERE WERE OVER 62,472 CLINIC ENCOUNTERS. THERE WERE 1,385 SURGICAL CASES IN 2014, ALONG WITH 149,822 LABORATORY PROCEDURES AND 20,918 IMAGING PROCEDURES PERFORMED IN THE HOSPITAL DURING 2014.EACH RESIDENT OF THE NURSING HOME RECEIVES PERSONALIZED MEDICAL, SOCIAL AND SPIRITUAL CARE. THE FOCUS IS ON PRESERVING THE LIFESTYLE OF EACH RESIDENT WITH 24-HOUR NURSING CARE, SOCIAL SERVICES, ACTIVITY THERAPY, DIETARY SERVICES, CHAPLAIN SERVICES AND REHABILITATION THERAPY. THERE WERE 6,488 DAYS OF SERVICE IN THE NURSING HOME DURING 2014.MAPLECROFT INDEPENDENT & ASSISTED LIVING IS A REGISTERED RESIDENTIAL CARE APARTMENT COMPLEX (RCAC), OFFERING INDEPENDENT APARTMENTS, AND IF NEEDED, UP TO 28 HOURS PER WEEK OF PERSONAL CARE, SUPPORTIVE CARE AND NURSING SERVICES TAILORED TO THE NEEDS AND PREFERENCES OF EACH INDIVIDUAL. ADDITIONAL AMENITIES INCLUDE AN EMERGENCY CALL SYSTEM, WEEKLY HOUSEKEEPING SERVICES, LAUNDRY FACILITIES AND DAILY NOON MEALS. THERE WERE 8 ADMISSIONS TO THE RETIREMENT COMMUNITY DURING 2014, WITH 10,010 DAYS OF SERVICE.THE AMBULANCE SERVICE IS A HOSPITAL BASED SERVICE WITH THREE AMBULANCES AND PROVIDES EMERGENCY RESPONSE TO THE ENTIRE SURROUNDING COMMUNITY. THERE WERE 689 AMBULANCE RUNS AND 531 INTER-FACILITY TRANSFERS IN 2014. EMT'S AND EMT-P'S ARE IN THE FACILITY 24/7 FOR 911 SERVICE AND ANOTHER TEAM IS ON CALL 24 HOURS PER DAY, 7 DAYS PER WEEK FOR INTER-FACILITY TRANSPORT.FINANCIAL ASSISTANCE IS AVAILABLE TO PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THE COST OF FINANCIAL ASSISTANCE PROVIDED IN 2014 WAS APPROXIMATELY $673,000.MCHS-NORTHLAND ALSO PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. THE UNREIMBURSED COST OF MEDICAID WAS APPROXIMATELY $1,494,000.THE NORTHWEST WISCONSIN REGION OF THE MAYO CLINIC HEALTH SYSTEM (WHICH INCLUDES THE FILING ORGANIZATION) VOLUNTARILY ENTERED INTO AN AGREEMENT WITH THE WISCONSIN ATTORNEY GENERAL RELATING TO CHARITY CARE. THE TERMS OF THE AGREEMENT INCLUDE AN AUTOMATIC DISCOUNT FOR UNINSURED PATIENTS, A PAYMENT CAP FOR THOSE UNINSURED PATIENTS THAT MEET THE ORGANIZATION'S CHARITY CARE CRITERIA, AND A COMMITMENT TO MAKE INFORMATION AVAILABLE TO OUR PATIENTS REGARDING OUR CHARITY CARE PROGRAM. ADDITIONALLY, THE WISCONSIN ATTORNEY GENERAL REVIEWED AND APPROVED OUR BILLING AND COLLECTION POLICIES AND PRACTICES. 40338 8500 HEALTH PROFESSIONAL EDUCATION (SCHEDULE O)MCHS-NORTHLAND HAS AGREEMENTS WITH EDUCATIONAL ORGANIZATIONS TO PROVIDE EDUCATION AND EXPERIENCE FOR STUDENTS STUDYING TO BECOME HEALTHCARE PROFESSIONALS. DURING 2014, STAFF WORKED WITH 41 NURSING STUDENTS AND 32 OTHER ALLIED HEALTH STUDENTS TO PROVIDE INSTRUCTION AND EXPERIENCE TO FURTHER THE STUDENT'S EDUCATION.UNDER THE HEALTH CARE ADMINISTRATION PRACTICUM PROGRAM, MCHS-NORTHLAND PROVIDES INTERNSHIPS FOR STUDENTS FROM THE UNIVERSITY OF WISCONSIN-EAU CLAIRE. THE INTERNS, UNDER THE DIRECTION OF NURSING HOME ADMINISTRATION, WORK WITH EMPLOYEES TO GAIN KNOWLEDGE AND EXPERIENCE IN HEALTHCARE ADMINISTRATION. IN 2014, TWO STUDENTS HAD THE OPPORTUNITY TO LEARN ABOUT THE HEALTH CARE ENVIRONMENT.FOR 2014, MCHS-NORTHLAND AWARDED $8,500 POST SECONDARY SCHOLARSHIPS TO LOCAL HIGH SCHOOL STUDENTS PURSUING CAREERS IN A HEALTH-RELATED FIELD. 170493 5174 34261 OTHER COMMUNITY BENEFITS (SCHEDULE O)MCHS-NORTHLAND IS INVOLVED IN SEVERAL COMMUNITY EVENTS.MCHS-NORTHLAND PARTICIPATES IN THE MEALS ON WHEELS PROGRAM WHICH PROVIDED 2,003 MEALS AT BELOW COST DURING 2014.MCHS-NORTHLAND STAFF PROVIDED ASSISTANCE WITH SAFETY PRECAUTIONS AND EMERGENCY MEDICAL COVERAGE AT VARIOUS COMMUNITY EVENTS SUCH AS THE HUNGRY HOLLOW DAYS, STEAM AND GAS ENGINE CLUB ANNUAL EVENT, NATIONAL NIGHT OUT EVENT, HIGH SCHOOL FOOTBALL GAMES, HIGH SCHOOL CROSS COUNTRY MEETS, A WRESTLING TOURNAMENT, AND LOCAL PARADES IN 2014.OPTIMAL AGING TO CAREGIVER SUPPORT GROUP AND LYMPHEDEMA LAUGH AND LEARN SUPPORT GROUP ASSISTED AREA RESIDENTS NEEDING SUPPORT.MCHS-NORTHLAND PROVIDES AN INSTYMEDS MACHINE IN THE FACILITY TO PROVIDE PATIENTS ACCESS TO EMERGENT MEDICATION PRESCRIPTIONS GENERATED FROM THE EMERGENCY DEPARTMENT WHEN RETAIL PHARMACIES ARE CLOSED. THERE WERE 1,887 PRESCRIPTIONS FILLED THRU INSTYMEDS IN 2014.MCHS-NORTHLAND ALSO OFFERS NUMEROUS EDUCATIONAL SEMINARS, CLASSES AND OPPORTUNITIES FOR ITS PATIENTS, THEIR FAMILIES, EMPLOYEES, COMMUNITY MEMBERS AND THE GENERAL PUBLIC. OVER 22,000 AREA RESIDENTS WERE SERVED BY THE VARIOUS PROGRAMS. SOME EXAMPLES OF EDUCATIONAL COMMUNITY ACTIVITIES ARE LISTED BELOW.MCHS-NORTHLAND OFFERED PRENATAL CLASSES, BREASTFEEDING CLASSES, TOBACCO FREE CLASSES AND DIABETES SELF CARE CLASSES FREE OF CHARGE TO MCHS-NORTHLAND PATIENTS REACHING MORE THAN 120 PEOPLE. EDUCATIONAL SEMINARS OFFERED TO AREA RESIDENTS, COMMUNITY GROUPS AND HEALTH CARE WORKERS INCLUDED THE FOLLOWING PRESENTATIONS: DIABETES SELF CARE CLASSES, NUTRITION MYTHS, HEALTH COACHING, ADVANCE DIRECTIVES, FERTILITY, CONTRACEPTION AND STD'S, ALONG WITH NUMEROUS TOURS, TALKS AND DEMONSTRATIONS FOR AREA ELEMENTARY AND HIGH SCHOOL STUDENTS.PRESENTED HEALTH INFORMATION AT: WITC HEALTH FAIR, UW-BARRON COUNTY, RICE LAKE WEIGHING SYSTEMS HEALTH FAIR, BARRON CO-OP EVENT, RICE LAKE AREA FARM SHOW, CAMERON NATIONAL NIGHT OUT, CHETEK COMMUNITY HEALTH FAIR, BARRON COUNTY GOVERNMENT EMPLOYEE HEALTH FAIR, CHILDREN'S SAFETY FAIR AND HEALTH & WELLNESS EXPO AT CAMERON HIGH SCHOOL. THE ABOVE PRESENTATIONS REACHED 1,500 PEOPLE.MCHS-NORTHLAND RECEIVES DONATED SERVICES FROM COMMUNITY VOLUNTEERS. DURING 2014, VOLUNTEERS DONATED OVER 9,045 HOURS OF VOLUNTEER SERVICE TO THE HOSPITAL, VALUED AT APPROXIMATELY $208,668 BASED ON THE INDEPENDENT SECTORS AVERAGE ESTIMATED VALUE OF SUCH SERVICES. THESE SERVICE HOURS WERE SPENT ORGANIZING AND MANAGING ACTIVITIES FOR THE BENEFIT OF OUR PATIENTS, PATIENTS' FAMILIES, VISITORS, AND STAFF.IN ADDITION, MCHS-NORTHLAND DONATED $5,174 TO LOCAL CHARITIES AND COMMUNITY ORGANIZATIONS DURING 2014. 3644 MCHS-NORTHLAND PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE OF PROVIDING PATIENT CARE. 3644 58085344 1 1 0 1 0 0 0 0 1 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 0 509 1 0 0 0 0 0 1 1 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 WI X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 CADMAN BERWYN DIRECTOR 1.00 0.00 X 0 0 0 DEGEN SUSANNE C DIRECTOR (4/28-12/31) 1.00 40.00 X 0 170588 43942 EZENAGU MD LEONARD C DIRECTOR/PHYSICIAN 1.00 40.00 X 0 456303 70146 HORSTMAN JENNIFER DIRECTOR (7/28-12/31) 1.00 0.00 X 0 0 0 JEROME TRICIA DIRECTOR (1/1-7/28) 1.00 0.00 X 0 0 0 LARSON MD JOHN L DIRECTOR/PRESIDENT/PHYSICIAN 1.00 40.00 X X 0 368210 59233 MOMMSEN HUGH DIRECTOR 1.00 0.00 X 0 0 0 NAGLER MD RICHARD DIRECTOR/PHYSICIAN 1.00 40.00 X 0 163786 58950 PETERSON DONALD DIRECTOR/VICE CHAIR 1.00 0.00 X X 0 0 0 RAZIM CHERYL DIRECTOR/TREASURER 1.00 0.00 X X 0 0 0 REISNER MD PETER D DIRECTOR/PHYSICIAN 1.00 40.00 X 0 299654 40955 SKOLD M COLLEEN DIRECTOR (1/1-4/28) 1.00 40.00 X 0 117899 32946 WHITE PAMELA K DIRECTOR/SECRETARY 1.00 40.00 X X 0 234939 57789 BAMMEL PAUL M REGIONAL CFO 1.00 40.00 X 0 351236 62740 DICKEY JOHN M REGIONAL CAO 1.00 40.00 X 0 391503 61766 LINTON MD RANDALL L REGIONAL CEO 1.00 40.00 X 0 577599 59749 MYERS MD DAVID A SITE CHAIR/PHYSICIAN 1.00 40.00 X 0 233623 60794 SULLIVAN MAURITA A SITE VP-OPERATIONS 1.00 40.00 X 0 194711 51116 BOYD ROBERT M PHYSICIAN ASSISTANT 40.00 0.00 X 171206 0 18910 GRAYKOSKI JOHN J PHYSICIAN ASSISTANT 40.00 0.00 X 212659 0 42341 LARSON STEPHEN H RN ANESTHETIST 40.00 0.00 X 214610 0 42009 LILLARD PATRICK H RN ANESTHETIST 40.00 0.00 X 212011 0 44846 THOMSEN THOMAS J RN ANESTHETIST 40.00 0.00 X 209557 0 45905 WITTROCK EDWARD A FORMER TREASURER 0.00 40.00 X 0 213724 63215 1020043 3773775 917352 16 1 1 0 MAYO FNDN FOR MEDICAL EDUCATION & RESEAR 200 FIRST STREET SW ROCHESTER MN 55905 PURCHASING AGENT 4692762 MAYO CLINIC HEALTH SYST-EAU CLAIRE HOSPI 1221 WHIPPLE STREET EAU CLAIRE WI 54703 PURCHASED SERVICES 1503297 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 PURCHASED SERVICES 137194 3 5790 7030 234663 1189 247483 NET PATIENT REVENUE 620000 60068633 60068633 RESIDENT REVENUE 623000 461407 461407 SHARED SERVICES 561000 3644 3644 EDUCATION REVENUE 611600 3229 3229 60536913 414713 414713 10000 31180 -21180 -21180 -21180 84 -84 -84 -84 3876 5790 3092 784 784 1106 1189 -83 -83 20601 17163 3438 3438 CAFETERIA/VENDING 722210 120430 120430 MEDICAL DIRECTOR FEES 541900 22880 22880 MISC. REVENUE 900099 14751 10930 3821 33 33 158094 61340078 60668306 0 424289 X 5174 5174 8500 8500 80026 80026 25382849 24525103 856710 1036 1831499 1769885 61545 69 4030520 3888854 141555 111 1674231 1610928 63235 68 58143 34027 24116 17500 17500 1669 1669 11529578 11503139 23160 3279 122588 208 121973 407 1977786 1923261 54525 181477 181477 3127819 2830911 296908 389725 357434 32257 34 21829 19645 2184 2203358 2182507 20851 6705 3150 3555 MEDICAL SUPPLIES 3825122 3825122 BAD DEBT EXPENSE 2890772 2890772 EMPLOYEE RELATED EXP 211051 210413 638 MEDICAID SURCHARGE 168106 168106 69838 65033 4805 59815865 58085344 1725517 5004 5381 5382 8670 110395 80550 11149542 10147942 310450 327717 171743 187956 43941 0 35186420 15986252 19218356 19200168 17409719 21373963 1506145 6830882 49934342 58154560 3177371 4934829 31159 33876 6703874 11476444 9912404 16445149 X 39852671 41666265 169267 43146 40021938 41709411 49934342 58154560 X 1524213 164560 -1300 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1669 1669 0 PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC., THE PARENT COMPANY OF THE FILING ORGANIZATION, PROVIDES SUPPORT SERVICES TO THE FILING ORGANIZATION THAT INCLUDES PROVIDING INFORMATION OR EXPRESSING 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, PARENT COMPANY 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. 1 385 2196 2086 495 1 X 172001 172001 24579424 10718929 13860495 660427 208048 452379 8961195 5059275 3901920 813373 813373 19200168 MAYO CLINIC INVESTMENT POOL 21373963 F 21373963 DUE FROM AFFILIATES 6830882 6830882 DUE TO AFFILIATES 11476444 11476444 X PART IV, LINE 1B: NURSING HOME RESIDENT FUNDS PART IV, LINE 2B: ASSISTED LIVING APARTMENT SECURITY DEPOSITS 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 0 672910 672910 0.01180 6615457 5121072 1494385 0.02630 7288367 5121072 2167295 0.03810 170493 31032 139461 0.00240 40338 40338 0.00070 24721995 17619944 7102051 0.12480 4628 4628 0.00010 24937454 17650976 7286478 0.12800 32225821 22772048 9453773 0.16610 1345 1345 0.00000 1345 1345 0 2890772 11056707 11172093 -115386 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM-NORTHLAND INC 1222 EAST WOODLAND BARRON WI 54812 WWW.MAYOCLINICHEALTHSYSTEM.ORG 1018 X X X X MAYO CLINIC HEALTH SYSTEM-NORTHLAND INC 1 0 0 1 X X X X X X X X 13 1 1 1 1 X WWW.MAYOCLINICHEALTHSYSTEM.ORG/ABOUT-US/COMMUNITY-HE 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-NORTHLAND INC. PART V, SECTION B, LINE 5: INPUT WAS PROVIDED BY A CROSS SECTION OF COMMUNITY AND ORGANIZATIONAL LEADERSHIP AS WELL AS DIRECT INPUT FROM THE COMMUNITY. THE ASSESSMENT PROCESS BEGAN WITH A THOROUGH REVIEW OF THE BARRON COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT OF WHICH INDIVIDUALS FROM THE BARRON COUNTY PUBLIC HEALTH DEPARTMENT WERE ACTIVE PARTICIPANTS. MAYO CLINIC HEALTH SYSTEM-NORTHLAND INC. PART V, SECTION B, LINE 6A: LAKEVIEW MEDICAL CENTER-RICE LAKE AND CUMBERLAND HEALTH CARE-CUMBERLAND MAYO CLINIC HEALTH SYSTEM-NORTHLAND INC. PART V, SECTION B, LINE 11: A FORMAL COMMUNITY ENGAGEMENT AND WELLNESS DEPARTMENT WAS CREATED IN 2014 WITH THE PRIMARY FOCUS OF IMPACTING CHANGE ON THE THREE IDENTIFIED HEALTH NEEDS OF PHYSICAL ACTIVITY, NUTRITION AND CHRONIC DISEASE. THE DEPARTMENT HAS MADE SIGNIFICANT STRIDES IN FORMING COMMUNITY COALITIONS, BUILDING STRONG PARTNERSHIPS WITH LOCAL ORGANIZATIONS AND SCHOOLS, INCREASING THE NUMBER OF COMMUNITY WELLNESS ACTIVITIES TO OUR RESIDENTS, AND PLAYING ACTIVE ROLES IN TEAMS FOCUSED ON IMPROVING HEALTH. WITHIN THE HOSPITAL, A COMMUNITY WELLNESS COMMITTEE HAS BEEN ESTABLISHED, AND INTERESTED EMPLOYEES ARE PAID TO TAKE PART IN MANY WELLNESS PROGRAMS EDUCATING THE COMMUNITY.IN 2014, MCHS-NORTHLAND OFFERED 69 COMMUNITY WELLNESS CLASSES AND EVENTS REACHING MORE THAN 5,000 PEOPLE. HERE IS A SNAPSHOT OF OFFERINGS PROVIDED IN 2014: * FAMILY FITNESS FUN (PARTNERSHIP WITH THE BARRON COMMUNITY CENTER) * ICEBREAKER TRIATHLON * TAI CHI * BABYSITTING COURSES * STEPPING ON - FALL PREVENTION FOR SENIORS * STRONG WOMEN * SMART SHOPPING GROCERY STORE TOURS * DIABETES EDUCATION * KNOW YOUR NUMBERS - FREE HEALTH SCREENINGSIN ADDITION, STAFF IS HEAVILY INVOLVED IN SEVERAL COMMUNITY HEALTH INITIATIVES INCLUDING: MEMBERSHIP ON BARRON COUNTY ACTION TEAMS (FOCUSING ON MENTAL HEALTH, CHRONIC DISEASE AND TOBACCO/SUBSTANCE ABUSE), PARTICIPATION WITH HEALTH DEPARTMENT INITIATIVES (BE WELL BARRON COUNTY AND THRIVE BARRON COUNTY), AND THE SAFE AND STABLE FAMILIES COALITION.IDENTIFIED NEEDS MCHS-NORTHLAND IS NOT ADDRESSING OR ADDRESSING WITH ADDITIONAL RESOURCES INCLUDE:ACCESS TO DENTAL CARE: THIS IS OUTSIDE THE EXPERTISE AND RESOURCES AVAILABLE AT THE HOSPITAL.DEATHS CAUSED BY MOTOR VEHICLE ACCIDENTS: MAYO CLINIC HEALTH SYSTEM DOES ADDRESS THIS NEED THROUGH OUR BI-ANNUAL TEEN CAR CONTROL CLASS; HOWEVER THIS ISSUE IS MOST EFFECTIVELY ADDRESSED THROUGH OTHER COMMUNITY AGENCIES. ALCOHOL AND DRUG USE/ABUSE: OTHER AGENCIES IN THE COUNTY, INCLUDING THE LOCAL UNITED WAY, ARE ADDRESSING THIS ISSUE. REPRESENTATIVES FROM MAYO CLINIC HEALTH SYSTEM ARE PART OF THIS ACTION TEAM.TOBACCO: WE WILL CONTINUE TO SUPPORT THE DECREASE IN TOBACCO USE THROUGH PATIENT EDUCATION.MENTAL HEALTH: THIS IS A CORE SERVICE OF MAYO CLINIC HEALTH SYSTEM WHICH WILL CONTINUE TO ADDRESS THE NEEDS OF THE PATIENTS. MAYO CLINIC HEALTH SYSTEM-NORTHLAND INC. 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-NORTHLAND INC. PART V, SECTION B, LINE 16I: IN REGARDS 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-NORTHLAND INC. 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-NORTHLAND INC. PART V, SECTION B, LINE 22D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 20% 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. 5 MCHS NORTHLAND - BARRON 1222 EAST WOODLAND AVENUE BARRON WI 54812 CLINIC, NURSING HOME, AMBULANCE MCHS NORTHLAND - RICE LAKE 331 S MAIN STREET SUITE H RICE LAKE WI 548682239 CLINIC MCHS NORTHLAND - CHETEK 220 DOUGLAS STREET CHETEK WI 547280027 CLINIC MCHS NORTHLAND - CAMERON 2049 15TH AVENUE CAMERON WI 548224380 CLINIC MCHS NORTHLAND - PRAIRIE FARM 224 RIVER AVENUE S PRAIRIE FARM WI 54762 CLINIC PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS).THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO-CHARGE RATIO. PART I, LINE 7G: THE FOLLOWING NET COMMUNITY BENEFIT COST ATTRIBUTED TO A PHYSICIAN CLINIC WAS INCLUDED AS SUBSIDIZED HEALTH SERVICES: $1,657,360. 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 $ 2,890,772. 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: PART III, SECTION A, LINE 1:THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.METHODOLOGY FOR SCHEDULE H, PART III, LINE 2:BAD DEBT EXPENSE IS DETERMINED BASED ON GAAP AND IS EXPLAINED IN THE ACCOUNTS RECEIVABLE FOOTNOTE OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. PART III, LINE 4: FOOTNOTES RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS CAN BE FOUND ON PAGES 5, 7, 8 AND 9 OF MAYO CLINIC'S 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 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: ADMINISTRATION, ALONG WITH MEMBERS OF THE MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE FOUNDATION, INC., WORK CLOSELY WITH LOCAL EDUCATIONAL INSTITUTIONS, AREA FREE CLINICS, NEIGHBORHOOD ASSOCIATIONS, CHARITIES, AND HEALTH DEPARTMENTS TO ASSESS HEALTHCARE NEED. MONETARY DONATIONS, SERVICES, EDUCATION, VOLUNTEERS AND GOODS ARE SUPPLIED ONCE THOSE NEEDS ARE ASSESSED. REQUESTS FOR ASSISTANCE ARE TRIAGED THROUGH THE PUBLIC AFFAIRS DEPARTMENTS, AND EVALUATED BASED ON ANNUAL STRATEGY. PART OF THAT STRATEGY INCLUDES INPUT FROM THE COMMUNITY ENGAGEMENT AND WELLNESS DEPARTMENT, AND ULTIMATELY REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE FOUNDATION, INC. ACCORDING TO THE DONATION REQUEST FLOWCHART. THE MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE FOUNDATION, INC. ANNUAL STRATEGY IS BASED ON COMMUNITY HEALTH NEED, STRATEGIC INITIATIVES AND COMMUNITY ASSESSMENTS. 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-NORTHLAND, INC. (MCHS-NORTHLAND) IS LOCATED IN BARRON, WISCONSIN. ITS SERVICE AREA INCLUDES BARRON COUNTY AND PORTIONS OF RUSK, WASHBURN, SAWYER, AND POLK COUNTIES IN NORTHWESTERN WISCONSIN. MCHS-NORTHLAND IS A DESIGNATED CRITICAL ACCESS HOSPITAL FOR MEDICARE PURPOSES AND IS ONE OF THREE HOSPITALS IN BARRON COUNTY. THE POPULATION OF BARRON COUNTY (WHICH COMPRISES MOST OF MCHS-NORTHLAND'S SERVICE AREA) IS APPROXIMATELY 46,000. ACCORDING TO 2012 WISCONSIN DEPARTMENT OF HEALTH SERVICES COUNTY PROFILE INFORMATION, APPROXIMATELY 14.5% OF BARRON COUNTY INDIVIDUALS ARE LIVING BELOW POVERTY LEVEL. IN ADDITION, ACCORDING TO THE 2012 WISCONSIN FAMILY HEALTH SURVEY, APPROXIMATELY 10% OF THE BARRON COUNTY POPULATION WAS UNINSURED FOR ALL OR PART OF THE PAST YEAR. ACCORDING TO 2014 COUNTY HEALTH RANKINGS, BARRON COUNTY RANKED 25 OF 72 COUNTIES IN HEALTH OUTCOMES AND 55 OF 72 IN HEALTH FACTORS. BARRON COUNTY IS A FEDERALLY-DESIGNATED MEDICALLY-UNDERSERVED AREA (OR STATE-DESIGNED HEALTH PROFESSIONAL SHORTAGE AREA). PART VI, LINE 5: THIS 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, 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 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 FAP, FAP APPLICATION, AND PLAIN LANGUAGE SUMMARY (BROCHURE):MAYOCLINICHEALTHSYSTEM.ORG/LOCATIONS/BARRON/BILLING/FINANCIAL-ASSISTANCE 1 SCHOLARSHIPS FOR STUDENTS ENTERING HEALTH CARE RELATED FIELD 11 8500 0 PART I, LINE 2: THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY WITH PROGRAMS THAT ENHANCE THE MISSION OF THE FILING ORGANIZATION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY THAT ADDRESS UNMET OR UNDER-FUNDED COMMUNITY NEEDS IN THE AREAS OF HEALTHCARE, EDUCATION, RESEARCH, DIVERSITY AND EQUALITY OF OPPORTUNITY. NO ADDITIONAL MONITORING IS PERFORMED. TRANSFERS OR GRANTS TO TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED. PART III SCHOLARSHIPS ARE PAID DIRECTLY TO STUDENTS AND/OR EDUCATIONAL INSTITUTIONS. NO ADDITIONAL MONITORING IS PERFORMED. 0 0 0 0 0 0 0 0 0 DEGEN SUSANNE C DIRECTOR (4/28-12/31) 0 147508 0 0 0 23080 0 12707 0 31235 0 214530 0 0 EZENAGU MD LEONARD C DIRECTOR/PHYSICIAN 0 444592 0 0 0 11711 0 26250 0 43896 0 526449 0 0 LARSON MD JOHN L DIRECTOR/PRESIDENT/PHYSICIAN 0 348252 0 0 0 19958 0 26250 0 32983 0 427443 0 0 NAGLER MD RICHARD DIRECTOR/PHYSICIAN 0 161090 0 0 0 2696 0 16173 0 42777 0 222736 0 0 REISNER MD PETER D DIRECTOR/PHYSICIAN 0 291111 0 0 0 8543 0 0 0 40955 0 340609 0 0 SKOLD M COLLEEN DIRECTOR (1/1-4/28) 0 113603 0 0 0 4296 0 19097 0 13849 0 150845 0 0 WHITE PAMELA K DIRECTOR/SECRETARY 0 231378 0 0 0 3561 0 26396 0 31393 0 292728 0 0 BAMMEL PAUL M REGIONAL CFO 0 334867 0 0 0 16369 0 26250 0 36490 0 413976 0 0 DICKEY JOHN M REGIONAL CAO 0 374455 0 0 0 17048 0 26250 0 35516 0 453269 0 0 LINTON MD RANDALL L REGIONAL CEO 0 558144 0 0 0 19455 0 26250 0 33499 0 637348 0 0 MYERS MD DAVID A SITE CHAIR/PHYSICIAN 0 229720 0 0 0 3903 0 21842 0 38952 0 294417 0 0 SULLIVAN MAURITA A SITE VP-OPERATIONS 0 190173 0 0 0 4538 0 17948 0 33168 0 245827 0 0 BOYD ROBERT M PHYSICIAN ASSISTANT 163172 0 7500 0 534 0 0 0 18910 0 190116 0 0 0 GRAYKOSKI JOHN J PHYSICIAN ASSISTANT 196541 0 0 0 16118 0 22846 0 19495 0 255000 0 0 0 LARSON STEPHEN H RN ANESTHETIST 211613 0 0 0 2997 0 20991 0 21018 0 256619 0 0 0 LILLARD PATRICK H RN ANESTHETIST 209016 0 0 0 2995 0 21512 0 23334 0 256857 0 0 0 THOMSEN THOMAS J RN ANESTHETIST 207606 0 0 0 1951 0 21571 0 24334 0 255462 0 0 0 WITTROCK EDWARD A FORMER TREASURER 0 208771 0 0 0 4953 0 39089 0 24126 0 276939 0 0 PART I, LINE 3 THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE CORE 990 PART VI SECTION B LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED. PART II COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. TERRANCE SULLIVAN FAMILY MEMBER OF MAURITA SULLIVAN, CORPORATE OFFICER 80026 COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: SULLIVAN, MAURITA A. SKOLD, M. COLLEEN REISNER M.D., PETER D. NAGLER M.D., RICHARD MYERS M.D., DAVID A. LINTON M.D., RANDALL L. LARSON M.D., JOHN L. EZENAGU M.D., LEONARD C. DICKEY, JOHN M. BAMMEL, PAUL M. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: LINTON M.D., RANDALL L. DICKEY, JOHN M. BAMMEL, PAUL M. THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: DEGEN, SUSANNE C. WHITE, PAMELA K. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: LINTON M.D., RANDALL L. DICKEY, JOHN M. BAMMEL, PAUL M. HUGH MOMMSEN (A CURRENT BOARD MEMBER) AND DONALD PETERSON (A CURRENT BOARD MEMBER) HAVE A FAMILY RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 3 MAYO CLINIC, MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, AND OTHER RELATED COMPANIES PROVIDE MANAGEMENT SERVICES TO THE ENTIRE SYSTEM OF ENTITIES. MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE HOSPITAL, INC. AND MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE CLINIC, INC. ALSO PROVIDE MANAGEMENT SERVICES ON A REGIONAL BASIS THAT INCLUDES THE FILING ORGANIZATION. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS, COMPENSATION FOR THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES HAS BEEN DISCLOSED IN PART VII AND SCHEDULE J AS REQUIRED. FORM 990, PART VI, SECTION A, LINE 6 THE CORPORATE MEMBERS ARE MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE HOSPITAL, INC. AND MAYO CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BODY SHALL BE ELECTED BY MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE HOSPITAL, INC. FORM 990, PART VI, SECTION A, LINE 7B THE CORPORATE MEMBERS MUST APPROVE ANY AMENDMENT TO THE ARTICLES AND BYLAWS IN ADDITION TO THE BOARD OF DIRECTORS. THE BYLAWS PROVIDE THE CORPORATE MEMBERS CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, DEBT, 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 REGIONAL CHIEF FINANCIAL OFFICER (OR HIS DELEGATE) AND FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FILING ORGANIZATION'S GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C MAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF THE 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 IC PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 9,572,351. MANAGEMENT AND GENERAL EXPENSES 2,437. FUNDRAISING EXPENSES 187. TOTAL EXPENSES 9,574,975. OTHER PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 1,930,788. MANAGEMENT AND GENERAL EXPENSES 20,723. FUNDRAISING EXPENSES 3,092. TOTAL EXPENSES 1,954,603. FORM 990, PART XI, LINE 9: PLEDGE WRITE-OFFS -1,300. 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 1116 WEST MILL STREET 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 0 AMBIENT CLINICAL ANALYTICS INC 221 1ST AVE SW SUITE 202 ROCHESTER MN 55902 800928405 SOFTWARE DE N/A C 0 CAVALRY CLO III LTD PO BOX 1093 GT QUEENSGATE HOUSE S GRAND CAYMAN CJ INVESTMENT ACTIVITIES CJ N/A C 0 CAVALRY CLO IV LTD PO BOX 1093 GT QUEENSGATE HOUSE S GRAND CAYMAN CJ INVESTMENT ACTIVITIES CJ N/A C 0 GMO GLOBAL BOND INVESTMENT FUND 78 SIR JOHN ROGERSONS QUAY DUBLIN 2 EI OTHER FINANCIAL INVESTMENT ACTIVITIES EI N/A 0 HEALTH TRADITION HEALTH PLAN 1808 EAST MAIN STREET ONALASKA WI 54650 391545987 MEDICAL SERVICES COMPANY WI N/A C 0 LOBSS NETWORK SUPPORT 2002 INC 200 FIRST STREET SW ROCHESTER MN 55905 481276150 ADMINISTRATIVE SERVICES MN N/A C 0 MAYO CLINIC GBS MAURITIUS 2ND FLOOR EBENE MEWS 57 EBENE CYBERCITY MP HEALTHCARE MANAGEMENT MP N/A C 0 MAYO CLINIC SUPPORT SERVICES TEXAS 200 FIRST STREET SW ROCHESTER MN 55905 471751102 HEALTH SERVICES TX N/A C 0 MAYO HOLDING COMPANY 200 FIRST STREET SW ROCHESTER MN 55905 411578020 HOLDING COMPANY MN N/A C 0 MAYO INSURANCE COMPANY LTD 200 FIRST STREET SW ROCHESTER MN 55905 SELF INSURANCE POOL CJ N/A C 0 MCHS--DECORAH CLINIC PHYSICIANS 907 MONTGOMERY STREET DECORAH IA 52101 411711329 PATIENT CARE - CLINIC IA N/A C 0 MCHS--PHARMACY & HOME MEDICAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 391528920 PHARMACY SERVICES WI N/A C 0 MMSI INC 21 FIRST STREET SW ROCHESTER MN 55905 411547003 THIRD PARTY ADMINISTRATION SERVICES MN N/A C 0 RESOUNDANT INC 221 1ST AVE SW ROCHESTER MN 55902 461661978 MANUFACTURING MEDICAL DEVICE COMPONENT MN N/A C 0 ROCHESTER AIRPORT COMPANY ROUTE 2 ROCHESTER MN 55902 410506870 AIRPORT MANAGEMENT MN N/A C 0 SATILLA HEALTHNET INC 1900 TEBEAU STREET WAYCROSS GA 31501 582151076 HEALTH SERVICES GA N/A C 0 SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION 13400 E SHEA BLVD SCOTTSDALE AZ 85259 860870505 COMMERCIAL PROPERTY OWNERS ASSOCIATION AZ N/A C 0 THE STABILE BUILDING OWNERS' ASSOCIATION 200 FIRST STREET SW ROCHESTER MN 55905 208994499 COMMERCIAL PROPERTY OWNERS ASSOCIATION MN N/A C 0 CHARITABLE LEAD TRUST CHARITABLE TRUST CA N/A T 0 PERPETUAL TRUST CHARITABLE TRUST ND N/A T 0 PERPETUAL TRUST CHARITABLE TRUST AZ N/A T 0 PERPETUAL TRUST CHARITABLE TRUST LA N/A T 0 PERPETUAL TRUST (2) CHARITABLE TRUST MA N/A T 0 PERPETUAL TRUST CHARITABLE TRUST MO N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST AZ N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST CO N/A T 0 CHARITABLE REMAINDER TRUST (9) CHARITABLE TRUST FL N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST LA N/A T 0 CHARITABLE REMAINDER TRUST (73) CHARITABLE TRUST MN N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NC N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NM N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NV N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NY N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST TX N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST WI N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST CO N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST IL N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST MI N/A T 0 CHARITABLE REMAINDER TRUST (70) CHARITABLE TRUST MN N/A T 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 MMSI INC S 2683561 GAAP MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH P 40559547 GAAP MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE CLINIC INC R 7805727 GAAP MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE CLINIC INC M 68048 GAAP MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE CLINIC INC P 7445412 GAAP