2015-08-26T09:07:25-05:00 2014-12-31 990 2014-01-01 510190875 MAYO CLINIC HEALTH SYSTEM-RED CEDAR INC MAYO 5075381297 2321 STOUT ROAD MENOMONIE WI 54751 PAUL M BAMMEL CFO 5075381297 2015-08-26 2014 2016-02-25 16:41:14Z HENRY SIMPSON MD 2321 STOUT ROAD MENOMONIE WI 54751 100521227 0 5983 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1976 WI OPERATION OF A HOSPITAL & THREE CLINICS. 11 4 785 90 0 0 833351 492441 92342379 97710361 1667842 1755373 620589 510260 95464161 100468435 24560 64667 0 0 54852486 49121408 0 0 1315 30989972 36732723 85867018 85918798 9597143 14549637 133574257 148490704 16543177 16811509 117031080 131679195 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 78042188 98066114 PATIENT CARE (SEE SCHEDULE O):MAYO CLINIC HEALTH SYSTEM-RED CEDAR (MCHS-RED CEDAR) 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. MAYO CLINIC HEALTH SYSTEM-RED CEDAR (MCHS-RED CEDAR) IS A WISCONSIN NONPROFIT CORPORATION, TAX EXEMPT AS AN ORGANIZATION DESCRIBED IN SEC. 501(C)(3) OF THE INTERNAL REVENUE CODE. MCHS-RED CEDAR'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 PART OF THE MAYO CLINIC HEALTH SYSTEM, MCHS-RED CEDAR OPERATES A CLINIC AND A HOSPITAL IN MENOMONIE, WISCONSIN, ALONG WITH REGIONAL CLINICS IN GLENWOOD CITY AND ELMWOOD, WISCONSIN. MCHS-RED CEDAR'S CLINICS PROVIDE PRIMARY CARE, INCLUDING FAMILY PRACTICE, INTERNAL MEDICINE, OB/GYN, PEDIATRICS AND GENERAL SURGERY. IN ADDITION, SPECIALTY CARE IN OCCUPATIONAL MEDICINE, BEHAVIORAL HEALTH, ORTHOPEDICS, PODIATRY AND NUTRITIONAL EDUCATION ARE ALSO PROVIDED. DURING 2014, THERE WERE 96,024 CLINIC VISITS. MCHS-RED CEDAR'S HOSPITAL IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING MEDICAL, SURGICAL, MATERNITY, EMERGENCY AND CRITICAL CARE SERVICES TO AREA RESIDENTS. IN 2014, 1,800 PATIENTS WERE ADMITTED, 2,687 SURGICAL PROCEDURES WERE PERFORMED AND 11,210 PATIENTS USED THE HOSPITAL'S EMERGENCY ROOM.IN CONJUNCTION WITH MAYO CLINIC AND ITS AFFILIATES, MCHS-RED CEDAR IS ABLE TO PROVIDE EMERGENCY MEDICAL HELICOPTER SERVICE THROUGHOUT THE REGION. THE HELICOPTER PROVIDES RAPID PATIENT TRANSPORT TO THE APPROPRIATE HEALTHCARE FACILITY ALONG WITH DELIVERING HIGH-LEVEL CRITICAL CARE.MCHS-RED CEDAR OPERATED LINK TO LIFE (AN EASY-TO-USE PERSONAL RESPONSE SERVICE) TO ENSURE THAT OLDER ADULTS LIVING AT HOME CAN GET QUICK ASSISTANCE WHENEVER IT MAY BE NEEDED - 24 HOURS A DAY, 365 DAYS A YEAR. WHEN THE PERSONAL HELP BUTTON IS PRESSED, A MCHS-RED CEDAR MONITOR RESPONDS, ASSESSES THE SITUATION AND SUMMONS APPROPRIATE HELP, HOWEVER, THIS SERVICE WAS DISCONTINUED EFFECTIVE 10/31/2014.MCHS-RED CEDAR 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 CEDAR PROVIDED APPROXIMATELY $632,000 IN FINANCIAL ASSISTANCE TO PATIENTS. THE UNREIMBURSED COST OF MEDICAID PATIENTS WAS APPROXIMATELY $3,395,000.MCHS-RED CEDAR ALSO PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE. 471485 64667 19328 OTHER COMMUNITY PROGRAMS (SEE SCHEDULE O):IN 2014, MCHS-RED CEDAR PROVIDED VARIOUS COMMUNITY SERVICES AND EDUCATIONAL OFFERINGS TO AREA RESIDENTS. SOME OF THESE ACTIVITIES ARE DESCRIBED BELOW. A FREE CLINIC PROVIDING HEALTH CARE TO THE UNDERPRIVILEGED OF THE COMMUNITY IS HOUSED AT MCHS-RED CEDAR. OFFICE SPACE, STORAGE AND SERVICES ARE PROVIDED TO THE FREE CLINIC AT OR BELOW COST OR FREE OF CHARGE. THE IN-KIND VALUE OF THESE SERVICES WAS ESTIMATED TO BE $29,257 IN 2014. MCHS-RED CEDAR ALSO CONDUCTED FIVE BLOOD DRIVES TO BENEFIT THE AMERICAN RED CROSS, DONATING STAFF TIME, FACILITIES AND SUPPORT. IN ADDITION, MCHS-RED CEDAR PROVIDED SPORTS PHYSICALS TO 167 STUDENTS AT DISCOUNTED RATES. MCHS-RED CEDAR DONATED $33,094 TO LOCAL CHARITES/COMMUNITY GROUPS AND PROVIDED $2,000 IN SCHOLARSHIPS TO GRADUATING HIGH SCHOOL SENIORS WHO ARE ENTERING COLLEGE OR A VOCATIONAL PROGRAM FOR A HEALTH-RELATED FIELD OF STUDY. ALSO DURING 2014, MCHS-RED CEDAR PROVIDED CLINICAL TRAINING FOR PHARM-D (DOCTOR OF PHARMACY) STUDENTS FROM THE UNIVERSITY OF WISCONSIN-MADISON.MCHS-RED CEDAR SPONSORS SEVERAL PROGRAMS FOR THE BENEFIT OF THE COMMUNITY. THE PROGRAMS OFFERED DURING 2014 ARE LISTED BELOW:- 324 AQUACISE CLASSES- 24 CAREGIVER SUPPORT GROUP SESSIONS- 12 RELATIVES RAISING CHILDREN SUPPORT GROUP SESSIONS- 3 HEART DISEASE SUPPORT GROUP SESSIONS- 77 CPR / FIRST AID PROGRAMS- 29 FAMILY / PARENTING / PRENATAL EDUCATION PROGRAMS- 36 BLOOD PRESSURE / BLOOD SUGAR SCREENINGS- 4 SENIOR EDUCATION & OUTREACH PROGRAMS- 4 CHOLESTEROL SCREENING EVENTS- 1 CHILDREN'S HEALTH & SAFETY EVENT- 56 WELLNESS ROCKS FITNESS AND/OR NUTRITION EVENTS- 4 COMMUNITY HOSTED FAIRS/EVENTS- 16 FITNESS CLASSES- 2 STRESS/MENTAL HEALTH EVENTS- 6 BABYSITTER TRAINING CLASSES- 5 YOUTH/SCHOOL OUTREACH OR MENTORING- SEVERAL OTHER COMMUNITY PRESENTATIONS/EVENTSMCHS-RED CEDAR ALSO RECEIVES DONATED SERVICES FROM VOLUNTEERS CONSISTING OF INDIVIDUALS AND ORGANIZATIONS THAT HELP ORGANIZE AND MANAGE ACTIVITIES FOR THE BENEFIT OF MCHS-RED CEDAR'S PATIENTS, PATIENT'S FAMILIES, VISITORS AND STAFF. THE VOLUNTEERS OPERATE A GIFT SHOP, ASSIST PATIENTS AND GREET VISITORS. DURING 2014, VOLUNTEERS DONATED APPROXIMATELY 10,454 HOURS OF SERVICE. BASED ON 2014 INDEPENDENT SECTOR STATISTICS, THE APPROXIMATE VALUE OF THESE SERVICES WERE $241,179. 78513673 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 0 0 785 1 0 0 0 0 0 0 0 0 0 0 X 11 4 1 1 1 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0 0 WI MN X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 IMSANDE KRISTIN DIRECTOR 1.00 0.00 X 0 0 0 JACOBSON ROSEMARY DIRECTOR 1.00 0.00 X 0 0 0 KRYSHAK WILLIAM DIRECTOR/TREASURER 1.00 0.00 X X 0 0 0 LINTON MD RANDALL L DIRECTOR/REGIONAL CEO/PHYSICIAN 1.00 40.00 X X 0 577599 59749 NELSON MD CARRIE J DIRECTOR/VICE PRESIDENT/PHYSICIAN 40.00 0.00 X X 218639 0 21188 NESSE MD ROBERT E DIRECTOR/PHYSICIAN 1.00 40.00 X 0 866876 19647 O'NEILL JEANETTE E DIRECTOR 1.00 0.00 X 5532 0 239 QUILLING CINDY DIRECTOR 1.00 0.00 X 0 0 0 RUSTAD CHRISTOPHER D DIRECTOR/SECRETARY/ADMINISTRATOR 1.00 40.00 X X 0 146216 31473 SIMPSON MD HENRY J DIRECTOR/PRESIDENT/SITE CEO/PHYSICIAN 40.00 0.00 X X 306137 0 33919 WITT MD THOMAS J DIRECTOR/PHYSICIAN 1.00 40.00 X 0 456792 66580 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 LINDBERG STEVEN J SITE ADMINISTRATOR/VP-OPERATIONS 40.00 0.00 X 242149 0 31100 DEYO-SVENDSEN MD MARK E MEDICAL DIRECTOR/PHYSICIAN 40.00 0.00 X 278918 0 17124 HERRMANN MD THOMAS M GENERAL SURGEON 40.00 0.00 X 380178 0 42173 MCNALLY DO PAUL D ORTHOPEDIST 40.00 0.00 X 693278 0 42199 RICH MD NATHAN L FAMILY PRACTICE PHYSICIAN 40.00 0.00 X 383823 0 44507 SWAENEPOEL DO SHAWN W FAMILY PRACTICE PHYSICIAN 40.00 0.00 X 356373 0 45289 THIRUMALAI MD SRIDHAR INTERNAL MEDICINE PHYSICIAN 40.00 0.00 X 690848 0 45659 LUBINSKY JEANENNE M FORMER CFO 1.00 40.00 X 6367 165731 8297 3562242 2955953 633649 60 1 1 0 MAYO FOUNDATION FOR MEDICAL EDUCATION AN 200 FIRST STREET SW ROCHESTER MN 55905 PROCUREMENT AGENT 4409234 MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE H 1221 WHIPPLE STREET EAU CLAIRE WI 54702 SERVICES 1409687 MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE C 733 W CLAIREMONT AVE EAU CLAIRE WI 54701 SERVICES 1152111 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 SERVICES 240524 4 394 13355 478692 3252 492441 NET PATIENT REVENUE 620000 97615210 97615210 LIFELINE 621990 82368 82368 EDUCATION REVENUE 611600 11733 11733 SHARED SERVICES 561000 1050 1050 97710361 1781832 1781832 1200 0 1200 1200 1200 11357 37816 -26459 -26459 -26459 9343 4784 4559 4559 18665 10192 8473 8473 CAFETERIA / VENDING 722210 325047 325047 MISC. REVENUE 900099 88022 32383 55639 MEDICAL DIRECTOR FEES 541900 47308 47308 35651 17651 18000 496028 100468435 98085442 0 1890552 X 62667 62667 2000 2000 1154945 808794 346151 220888 220888 36349128 35872875 476253 2989199 2924112 65087 6140453 6006750 133703 2266795 2217438 49357 62833 24081 38593 159 35500 35500 1751 1751 15285502 9718415 5566177 910 77301 3286 74015 1956837 1794620 162217 42111 42111 921639 552847 368792 375619 350631 24988 57286 45476 11564 246 2879865 2868287 11578 231749 231749 MEDICAL SUPPLIES 8439353 8439353 BAD DEBT EXPENSE 5761125 5761125 EMPLOYEE RELATED EXP 252709 231184 21525 MEDICAID SURCHARGE 212368 212368 139175 120865 18310 85918798 78513673 7403810 1315 417724 378817 103956 83549 14450367 16420444 30000 15000 212500 442500 553678 544643 483023 260090 59236945 27518909 31965208 31718036 81667506 93995477 3690295 4632148 133574257 148490704 5983345 5656998 10559832 11154511 16543177 16811509 X 116953802 131533069 77278 146126 117031080 131679195 133574257 148490704 X 14549637 95290 3188 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1751 1751 0 PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. 2110397 2110397 44033226 20395190 23638036 12120718 7123719 4996999 972604 972604 31718036 MAYO POOLED INVESTMENTS 93995477 F 93995477 DEFERRED COMPENSATION LIABILITY 2302592 DUE TO AFFILIATES 8851919 11154511 X PART X, LINE 2: AT DECEMBER 31, 2014 AND 2013, THE RESERVE FOR UNRECOGNIZED TAX BENEFITS WAS NOT SIGNIFICANT, AND AS A RESULT, THERE IS NO LONGER A RESERVE FOR UNRECOGNIZED TAX BENEFITS RECORDED. 1 1 X 1 X 1 X 1 1 0 0 632435 632435 0.00790 9831627 6436472 3395155 0.04240 10464062 6436472 4027590 0.05030 374741 19328 355413 0.00440 2000 2000 0.00000 28583686 20244129 8339557 0.10400 41750 41750 0.00050 29002177 20263457 8738720 0.10890 39466239 26699929 12766310 0.15920 12500 12500 0.00020 6611 6611 0.00010 14435 14435 0.00020 5698 5698 0.00010 13184 13184 0.00020 566 566 0.00000 52994 52994 0.00080 0 5761125 11909813 12014422 -104609 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM - RED CEDAR 2321 STOUT ROAD MENOMONIE WI 54751 WWW.MAYOCLINICHEALTHSYSTEM.ORG/LOCATIO 1044 X X X X MAYO CLINIC HEALTH SYSTEM-RED CEDAR 1 0 0 1 X X X X X X X X 13 1 0 0 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-RED CEDAR PART V, SECTION B, LINE 5: THE PRIMARY INPUT INTO THE ASSESSMENT AND PRIORITIZATION PROCESS WAS THE DUNN COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT 2011-2015, A JOINT EFFORT OF DUNN COUNTY HEALTH DEPARTMENT, MAYO CLINIC HEALTH SYSTEM-RED CEDAR, MARSHFIELD CLINIC, MAYO CLINIC HEALTH SYSTEM-CHIPPEWA VALLEY, DUNN COUNTY HUMAN SERVICES, HEAD START, CITY GOVERNMENT REPRESENTATIVES AND OTHER LOCAL ORGANIZATIONS. THE COMMITTEE LEADING THE COUNTY CHNA PROCESS WAS CHAIRED BY THE DIRECTOR OF THE DUNN COUNTY HEALTH DEPARTMENT. IN ADDITION, INPUT WAS TAKEN FROM THE RESULTS OF A COMPREHENSIVE RANDOM HOUSEHOLD COMMUNITY SURVEY CONDUCTED IN 2012. MAYO CLINIC HEALTH SYSTEM-RED CEDAR PART V, SECTION B, LINE 11: MAYO CLINIC HEALTH SYSTEM-RED CEDAR HAS BEEN WORKING TO MEET THE HEALTH NEEDS OF THE COMMUNITY THROUGH OUTREACH PROGRAMMING AND COMMUNITY EDUCATION OFFERINGS RELATED TO A VARIETY OF HEALTH NEEDS, INCLUDING FITNESS, NUTRITION AND CHRONIC DISEASE. MOST CLASSES ARE OFFERED IN MENOMONIE; SOME ARE HOSTED IN THE SURROUNDING SMALLER COMMUNITIES IF THE COMMUNITY WELCOMES THE OPPORTUNITY. THE COMMUNITY ENGAGEMENT AND WELLNESS DEPARTMENT HAS MADE SIGNIFICANT STRIDES IN FORMING COMMUNITY COALITIONS, BUILDING STRONG PARTNERSHIPS WITH LOCAL ORGANIZATIONS AND SCHOOLS, INCREASING THE NUMBER OF COMMUNITY WELLNESS ACTIVITIES TO OUR RESIDENTS, AND PLAYING ACTIVE ROLES IN TEAMS FOCUSED ON IMPROVING HEALTH. WITHIN THE HOSPITAL, A COMMUNITY WELLNESS COMMITTEE HAS BEEN ESTABLISHED, AND INTERESTED EMPLOYEES ARE PAID TO TAKE PART IN MANY WELLNESS PROGRAMS EDUCATING OUR COMMUNITY.THE FOLLOWING OFFERINGS WERE PROVIDED IN 2014: - MUSIC & MOVEMENT-PROMOTE MOVEMENT AND EXPLORATION THROUGH MUSIC FOR TODDLERS. - MONDAYS IN MOTION-PROMOTE INDOOR FITNESS DURING THE WINTER MONTHS. - COOKING CLASSES - FARMERS MARKET AND GARDENING EVENTS - AQUACISE - TAI CHI - YOGA - ZUMBA - STRONG BONES - STEPPING ON - WALKING PROGRAMS - "WEIGHT OF THE NATION" MOVIE SCREENING - THE SERIES WAS VIEWED OVER A FOUR-WEEK PERIOD TO LEARN ABOUT THE ISSUE OF OBESITY IN AMERICAN AND ALL THE LONG-TERM HEALTH IMPLICATIONS THAT RESULT FROM OBESITY. A PANEL OF SPEAKERS WAS AVAILABLE EACH WEEK TO HAVE A COMMUNITY CONVERSATION ABOUT THE WEEK'S TOPIC. - GROCERY STORE TOURS - MAYO CLINIC DIET - LIVING WELL WITH CHRONIC CONDITIONS - A SIX-WEEK COURSE TARGETED AT EMPOWERING PEOPLE TO SELF-MANAGE THEIR CHRONIC CONDITION FOR A HEALTHIER LIFE. - FOOT AND NAIL CLINIC - A MONTHLY, LOW FEE OFFERING TO ENSURE PROPER FOOT CARE. - DIABETES - A VARIETY OF PRESENTATIONS. - CHOLESTEROL, BLOOD SUGAR AND BLOOD PRESSURE SCREENING - PROMOTES KNOWING YOUR NUMBERS AND TAKING ACTION IF YOUR VALUES ARE TOO HIGH. - OPTIMAL AGING OFFERINGS - TARGETED A VARIETY OF CHRONIC HEALTH ISSUES DURING THE ONE-HOUR LUNCH SESSION THAT WAS OFFERED A FEW TIMES PER YEAR.THE AGING AND DISABILITY RESOURCE CENTER OF DUNN COUNTY IS A STRONG PARTNER FOR MANY OF OUR EVIDENCE-BASED, CHRONIC DISEASE-PREVENTION CLASSES. IN ADDITION, WE HAVE DEVELOPED A MULTITUDE OF RELATIONSHIPS THAT HAVE HELPED TO FURTHER PROGRAMMING SUCH AS THE LOCAL SCHOOL DISTRICTS AND UNIVERSITY, THE MENOMONIE THUNDERHAWKS AND THE MENOMONIE BLUE CAPS. IDENTIFIED HEALTH NEEDS MCHS-RED CEDAR IS NOT WORKING ON 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 THE 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 THESE ISSUES. 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 WE WILL CONTINUE TO ADDRESS TO MEET THE NEEDS OF OUR PATIENTS.ACCESS TO HEALTH CARE: MAYO CLINIC HEALTH SYSTEM WILL CONTINUE TO FOCUS ON INCREASING ACCESS TO CARE FOR OUR PATIENTS. MAYO CLINIC HEALTH SYSTEM-RED CEDAR 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 CEDAR 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-RED CEDAR 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 CEDAR PART V, SECTION B, LINE 22D: THE POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 10% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE. 5 MENOMONIE CLINIC 2321 STOUT ROAD MENOMONIE WI 54751 CLINIC CENTER FOR PREVENTION & PHYSICAL REHABIL 2407 STOUT ROAD MENOMONIE WI 54751 PHYSICAL REHABILITATION GLENWOOD CITY CLINIC 219 EAST OAK AVENUE GLENWOOD CITY WI 54013 CLINIC BEHAVIORAL HEALTH BUILDING 2411 STOUT ROAD MENOMONIE WI 54751 BEHAVIORAL HEALTH ELMWOOD CLINIC 236 EAST SPRINGER AVENUE ELMWOOD WI 54740 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: $1,032,698 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 $ 5,761,125. PART I LINE 7 MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE HOSPITAL, INC. AND MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE CLINIC, INC. VOLUNTARILY ENTERED INTO AN AGREEMENT WITH THE WI 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 PATIENTS REGARDING OUR CHARITY CARE PROGRAM. ADDITIONALLY, THE WI ATTORNEY GENERAL REVIEWED AND APPROVED OUR BILLING AND COLLECTION POLICIES AND PRACTICES. PART II, COMMUNITY BUILDING ACTIVITIES: THROUGH DONATIONS AND GRANTS TO PUBLIC, PRIVATE AND NONPROFIT ORGANIZATIONS, THE FILING ORGANIZATION ASSISTS WITH SUSTAINING AND ENHANCING THE COMMUNITIES IT SERVES. PART III, LINE 2: THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.METHODOLOGY FOR SCHEDULE H, PART III, LINE 2:BAD DEBT EXPENSE IS DETERMINED BASED ON GAAP AND IS EXPLAINED IN THE ACCOUNTS RECEIVABLE FOOTNOTE OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. PART III, LINE 4: FOOTNOTES RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS CAN BE FOUND ON PAGES 5, 7, 8 AND 9 OF MAYO CLINIC'S 2014 CONSOLIDATED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE 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: THE VISION STATEMENT FOR MAYO CLINIC HEALTH SYSTEM-RED CEDAR (MCHS-RED CEDAR) SPEAKS TO CREATING A HEALTHIER COMMUNITY BY PROVIDING EXCEPTIONAL CARE. WHILE MCHS-RED CEDAR'S PATIENT CARE EFFORTS FOCUS ON THOSE WHO UTILIZE ITS SERVICES, MCHS-RED CEDAR PROVIDES EDUCATION THAT EXTENDS TO THE COMMUNITY-BASED SETTING THAT IS OPEN TO THE ENTIRE POPULATION. IN ITS CURRENT STRATEGIC PLAN, MCHS-RED CEDAR IDENTIFIED UNMET COMMUNITY HEALTH NEEDS AS A STRATEGIC OBJECTIVE. AS PART OF THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) THAT IS FACILITATED EVERY FIVE YEARS, MCHS-RED CEDAR COLLABORATES WITH REPRESENTATIVES FROM THE DUNN COUNTY HEALTH DEPARTMENT, LOCAL SCHOOL DISTRICTS, AND LOCAL NONPROFIT ORGANIZATIONS TO IDENTIFY, EVALUATE, AND PRIORITIZE UNMET COMMUNITY HEALTH NEEDS. THE MCHS-RED CEDAR EDUCATION DEPARTMENT UTILIZES DATA FROM THE CHIP TO MAKE RECOMMENDATIONS TO MCHS-RED CEDAR'S OPERATIONS COMMITTEE AND BOARD OF DIRECTORS ABOUT INTERVENTIONS THAT MCHS-RED CEDAR SHOULD CONSIDER FOR COMMUNITY EDUCATION AND HEALTH PROMOTION OUTREACH. MCHS-RED CEDAR'S EDUCATION DEPARTMENT HAS STRATIFIED HEALTH CARE NEED WITHIN OUR GEOGRAPHIC REGION BASED ON MULTIPLE INPUTS INCLUDING: 2006 AND 2011 DUNN COUNTY COMMUNITY HEALTH ASSESSMENT, FOCUS GROUPS, SURVEYS, AND REVIEW OF PERTINENT LITERATURE. THESE IDENTIFIED NEEDS ARE THEN FILTERED AND PRIORITIZED BASED ON CONSISTENCY WITH MCHS-RED CEDAR'S VISION/MISSION/VALUES, ABILITY OF MCHS-RED CEDAR TO IMPACT NEED IDENTIFIED, AND PATIENT COMMUNITY/BENEFIT. MCHS-RED CEDAR'S EDUCATION DEPARTMENT DEVELOPED A PROCESS TO DELIVER EDUCATIONAL PROGRAMMING AND FREE OR LOW-COST HEALTH SCREENINGS TO THE COMMUNITY AT LARGE, WITH A SUBSET OF PROGRAMMING TARGETING CHILDREN AND FAMILIES WITHIN THE SERVICE AREA THROUGH THE WELLNESS ROCKS PROGRAM. COMMUNITY EDUCATION OFFERINGS HAVE EXPANDED ANNUALLY AND CONTINUE TO ENGAGE MORE COMMUNITY ORGANIZATIONS AND PARTNERSHIPS. 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 CEDAR (MCHS-RED CEDAR) IS LOCATED IN MENOMONIE, WISCONSIN. ITS SERVICE AREA INCLUDES PORTIONS OF DUNN, ST. CROIX, PEPIN AND PIERCE COUNTIES IN WESTERN WISCONSIN. MCHS-RED CEDAR HAS THE ONLY ACUTE CARE HOSPITAL IN MENOMONIE, WHICH IS A DESIGNATED CRITICAL ACCESS HOSPITAL FOR MEDICARE PURPOSES. IT ALSO HAS A CLINIC IN MENOMONIE, ELMWOOD AND GLENWOOD CITY. 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:MAYOCLINICHEALTHSYSTEM.ORG/LOCATIONS/MENOMONIE/BILLING/FINANCIAL-ASSISTANCE 1 COMMUNITY FOUNDATION OF DUNN COUNTY INC 500 MAIN STREET E 322 MENOMONIE WI 54751 391819945 501(C)(3) 25000 COMMUNITY CENTER SUPPORT 1 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. 0 1 0 0 0 0 0 0 0 LINTON MD RANDALL L DIRECTOR/REGIONAL CEO/PHYSICIAN 0 558144 0 0 0 19455 0 26250 0 33499 0 637348 0 0 NELSON MD CARRIE J DIRECTOR/VICE PRESIDENT/PHYSICIAN 215367 0 0 0 3272 0 10690 0 10498 0 239827 0 0 0 NESSE MD ROBERT E DIRECTOR/PHYSICIAN 0 749175 0 0 0 117701 0 0 0 19647 0 886523 0 0 RUSTAD CHRISTOPHER D DIRECTOR/SECRETARY/ADMINISTRATOR 0 145263 0 0 0 953 0 12997 0 18476 0 177689 0 0 SIMPSON MD HENRY J DIRECTOR/PRESIDENT/SITE CEO/PHYSICIA 303278 0 0 0 2859 0 12888 0 21031 0 340056 0 0 0 WITT MD THOMAS J DIRECTOR/PHYSICIAN 0 408368 0 0 0 48424 0 44943 0 21637 0 523372 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 LINDBERG STEVEN J SITE ADMINISTRATOR/VP-OPERATIONS 236548 0 2500 0 3101 0 10915 0 20185 0 273249 0 0 0 DEYO-SVENDSEN MD MARK E MEDICAL DIRECTOR/PHYSICIAN 272987 0 2500 0 3431 0 12888 0 4236 0 296042 0 0 0 HERRMANN MD THOMAS M GENERAL SURGEON 378157 0 0 0 2021 0 12888 0 29285 0 422351 0 0 0 MCNALLY DO PAUL D ORTHOPEDIST 692898 0 0 0 380 0 12888 0 29311 0 735477 0 0 0 RICH MD NATHAN L FAMILY PRACTICE PHYSICIAN 380514 0 0 0 3309 0 12888 0 31619 0 428330 0 0 0 SWAENEPOEL DO SHAWN W FAMILY PRACTICE PHYSICIAN 353202 0 0 0 3171 0 12888 0 32401 0 401662 0 0 0 THIRUMALAI MD SRIDHAR INTERNAL MEDICINE PHYSICIAN 683886 0 0 0 6962 0 12888 0 32771 0 736507 0 0 0 LUBINSKY JEANENNE M FORMER CFO 6356 163441 0 0 11 2290 0 7087 69 1141 6436 173959 0 0 PART I, LINE 3 THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE CORE 990 PART VI SECTION B LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED. PART I, LINE 4B 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). NESSE M.D., ROBERT E. $106,863 WITT M.D., THOMAS J. $ 38,983 PART II: COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. TERRENCE J WITT MD EMPLOYEE SIGNING BONUS IN FORM OF FORGIVEABLE LOAN X 45000 15000 0 1 1 15000 TERRENCE J WITT MD BROTHER OF THOMAS J. WITT, M.D., BOARD MEMBER 220888 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: LINTON M.D., RANDALL L. 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 INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: RUSTAD, CHRISTOPHER D. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL WHO IS ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: NESSE M.D., ROBERT E. 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 4 MEMBERSHIP OF THE CORPORATION WAS EXPANDED TO INCLUDE BOTH MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE HOSPITAL, INC. 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 CORPORATE MEMBERS SHALL ELECT THE COMMUNITY AND MAYO DIRECTORS. COMMUNITY MEMBERS ARE ELECTED FROM A SLATE OF NOMINEES RECOMMENDED BY A NOMINATING COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7B THE ARTICLES AND BYLAWS PROVIDE THE CORPORATE MEMBERS CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, DEBT, AMENDMENT OF 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 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 I/C PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 7,876,261. MANAGEMENT AND GENERAL EXPENSES 5,357,334. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,233,595. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,842,154. MANAGEMENT AND GENERAL EXPENSES 208,843. FUNDRAISING EXPENSES 910. TOTAL EXPENSES 2,051,907. FORM 990, PART XI, LINE 9: PLEDGE CHANGE (PER FASB ASC 958-20) 3,188. 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 0 1 1 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH M 165451 GAAP MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH P 57777153 GAAP MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH R 87868 GAAP MCHS-EAU CLAIRE CLINIC INC M 1152111 GAAP MCHS-EAU CLAIRE CLINIC INC P 9573738 GAAP MMSI INC R 7714788 GAAP MMSI INC S 3562996 GAAP