2014-09-08T12:55:56-05:00 2013-12-31 990 2013-01-01 390806374 MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER INC MAYO 5075381297 700 WEST AVENUE SOUTH LA CROSSE WI 54601 THOMAS H TIGGELAAR VP/CFO 5075381297 2014-09-08 2013 2015-11-30 17:44:51Z TIMOTHY J JOHNSON MD 700 WEST AVENUE SOUTH LA CROSSE WI 54601 432562031 0 5983 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1888 WI HOSPITALS AND CLINICS 18 0 4030 885 1152284 46986 14591874 4929555 400253847 423585845 -138431 -209060 2724526 3223267 417431816 431529607 243771 206049 0 0 276106865 261552893 0 0 0 160946143 158790671 437296779 420549613 -19864963 10979994 241691925 253462833 107230949 65774906 134460976 187687927 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 385518834 422197242 PATIENT CARE (SCHEDULE O)MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTER, INC. IS PART 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 AND 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 1000 PHYSICIANS AND 14,000 ALLIED HEALTH STAFF. IN ADDITION, MAYO CLINIC PHYSICIANS FROM MULTIPLE SPECIALTIES REGULARLY SEE PATIENTS AT HEALTH SYSTEM FACILITIES. BESIDES HAVING HEALTH CARE FACILITIES IN MORE THAN 70 COMMUNITIES, MAYO CLINIC HEALTH SYSTEM INCLUDES 18 OWNED HOSPITALS, SIX OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH TWO ADDITIONAL HOSPITALS, AND CONTRACT MANAGEMENT AGREEMENTS WITH AN ADDITIONAL HOSPITAL AND 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 2.5 MILLION VISITS ANNUALLY IN MAYO CLINIC HEALTH SYSTEM. IT IS ALSO A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS.MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC. (FMCI) FULFILLS ITS MISSION THROUGH THE FOLLOWING LOCATIONS AND SERVICES:HOSPITALS-2 HOSPITALS, LACROSSE (248 BEDS) AND SPARTA (25 BEDS). THE HOSPITALS PROVIDE ACUTE HEALTH CARE SERVICES INCLUDING 24-HOUR EMERGENCY CARE, ADULT AND PEDIATRIC SURGERY, LABOR, DELIVERY, MATERNITY CARE, REHABILITATION SERVICES, AND HEALTH EDUCATION CLASSES. THE HOSPITALS HAD 7,555 INPATIENT ADMISSIONS, 943 DELIVERIES, AND 8,478 SURGERIES DURING 2013.SLEEP LAB-THE FMCI SLEEP LAB HAS RECEIVED THE FULL FIVE-YEAR ACCREDITATION FROM AMERICAN ACADEMY OF SLEEP MEDICINE. THE FACILITY WAS APPROVED FOLLOWING A LENGTHY EXAMINATION PROCESS AND SITE VISIT THAT COVERED THE UNIT'S POLICIES, PROCEDURES AND ACTIVITIES. EACH YEAR THE SLEEP LAB EVALUATES APPROXIMATELY 250 PATIENTS. NATIONAL OUTCOMES MEASUREMENT SYSTEM-SINCE JAN. 1999, THE SPEECH-LANGUAGE PATHOLOGISTS AT FMCI HAVE BEEN TAKING PART IN A NATIONAL PROJECT THAT ALLOWS THEM TO TRACK PATIENT OUTCOMES AND COMPARE THEIR SERVICES WITH OTHER THERAPY PROGRAMS ACROSS THE STATE AND THE NATION. THE NATIONAL OUTCOMES MEASUREMENT SYSTEM PROJECT CONSISTS OF MAKING A SPECIAL ASSESSMENT OF THE PATIENT AT THE FIRST AND LAST VISIT. BY COMPARING SUCH FACTORS AS FUNCTIONALITY PRIOR TO CARE, NUMBER OF VISITS, NUMBER OF MINUTES OF CARE AND FUNCTIONALITY AT THE END OF THE SESSIONS, THERAPISTS CAN NOW ACCURATELY TRACK THE PROGRESS OF PATIENTS.LACROSSE COULEE REGION BRAIN TEAM-FMCI MEMBERS SERVED ON THE LACROSSE COULEE REGIONAL BRAIN TEAM, WHICH IS A COMMUNITY EFFORT TO ENCOURAGE PUBLIC DISCUSSION AND ACTIONS RELATED TO THE IMPORTANCE OF EARLY BRAIN DEVELOPMENT; TO FIND WAYS TO SUPPORT PARENTS/FAMILIES IN NURTURING THEIR CHILDREN; AND TO PROVIDE POSITIVE STIMULATING ENVIRONMENTS NECESSARY FOR LEARNING. IN COOPERATION WITH THE UNIVERSITY OF WISCONSIN-LA CROSSE, THE TEAM SURVEYED 1,200 AREA PROFESSIONALS WHO WORK WITH CHILDREN IN AN EFFORT TO DETERMINE THE LEVEL OF AWARENESS OF EARLY BRAIN DEVELOPMENT INFORMATION AND HOW THEIR PRACTICE IS AFFECTED. THE SURVEY RESULTS WILL BE USED TO DEVELOP ACTION PLANS WHICH MEET THE EDUCATIONAL NEEDS OF PROFESSIONALS WORKING WITH YOUNG CHILDREN. CLINICS-FAMILY PRACTICE CLINICS PROVIDE OUTPATIENT SERVICES AND ARE LOCATED IN THE FOLLOWING COMMUNITIES IN WISCONSIN, IOWA, AND MINNESOTA:WISCONSIN-ARCADIA, GALESVILLE, LACROSSE, ONALASKA, PRAIRIE DU CHIEN, SPARTA, TOMAHIOWA-WAUKONMINNESOTA-CALEDONIA, LACRESCENTAFFILIATION WITH THE LARGER MAYO CLINIC HEALTH SYSTEM ALLOWS ACCESS FOR MEMBERS OF THESE COMMUNITIES TO VARIOUS SPECIALTY SERVICES. SOME OF THESE SERVICES INCLUDE: OCCUPATIONAL HEALTH-THE SERVICES INCLUDE WORKERS' COMPENSATION SERVICES, DOT PHYSICALS, JOB SITE ASSESSMENTS, HEALTH AND SAFETY CONSULTATIONS, SIGNIFICANT EXPOSURE FOLLOW-UP, DISABILITY MANAGEMENT AND RETURN-TO-WORK PROGRAMS, DRUG TESTING SERVICES, BREATH ALCOHOL TESTING AND RESPIRATOR FIT TESTING.ALLERGY-PATIENTS WITH ALLERGIC CONDITIONS AND PROBLEMS WITH IMMUNE RESPONSE ARE TREATED AND SERVICES INCLUDE BOTH CONSULTATIONS AND DIAGNOSTICS.CARDIOLOGY-CARDIOLOGY SERVICES PROVIDED INCLUDE CARDIOLOGY ASSESSMENTS, CONSULTATIONS, AND FOLLOW-UPS.GERIATRIC-SERVICES PROVIDED INCLUDE GERIATRIC CONSULTATIONS AND FOLLOW-UPS RELATED TO ALL ASPECTS OF SPECIALTY ELDER CARE INCLUDING DEMENTIA, MEMORY LOSS, MEDICATION MANAGEMENT, LONG-TERM CARE AND DISEASE MANAGEMENT.PEDIATRIC NEUROLOGY-SERVICES PROVIDED INCLUDE PEDIATRIC NEUROLOGY CONSULTATIONS AND FOLLOW-UPS. PEDIATRIC NEUROLOGY PROVIDES SUB-SPECIALTY EXPERTISE FOR CHILDREN WITH DIFFICULT SEIZURE DISORDERS, HEADACHES, DEVELOPMENTAL DISORDERS AND HYPERACTIVITY AND LEARNING DISORDERS.HOME HEALTH-HOME HEALTH SERVICES PROVIDES HEALTH CARE SERVICES TO PATIENTS IN THE CONVENIENCE OF THEIR HOME, NURSING HOME, OR HOSPITAL ROOM. THE FIVE AREAS OF CARE PROVIDED ARE HOME CARE, HOSPICE, PHARMACY, HOME MEDICAL EQUIPMENT AND INFUSION THERAPY. HOME CARE-HOME CARE INCLUDES SERVICES OF SKILLED PROFESSIONAL NURSES WHO PROVIDE SPECIALIZED CARE AND TEACHING TO PATIENTS WITH ACUTE NEEDS SUCH AS WOUNDS, OSTOMIES, DIABETES MANAGEMENT, MEDICATION MANAGEMENT, AND INFUSION THERAPY INCLUDING CHEMO ADMINISTRATION. HOME HEALTH AIDES PROVIDE PERSONAL CARE AND ASSISTANCE WITH EXERCISE PROGRAMS. PHYSICAL THERAPISTS PROVIDE SPECIALIZED CARE AND TEACHING IN THE AREAS OF HOME THERAPEUTIC EXERCISE PROGRAMS, FUNCTIONAL/ACTIVITIES OF DAILY LIVING TRAINING, GAIT TRAINING, WHEELCHAIR FITTINGS AND THE USE OF ADAPTIVE EQUIPMENT. OCCUPATIONAL THERAPISTS PROVIDE SPECIALIZED CARE AND TEACHING PATIENTS HOW TO USE ADAPTIVE EQUIPMENT FOR ACTIVITIES OF DAILY LIVING, SAFETY ADAPTATIONS, FUNCTIONAL PROGRAMS, AND ENERGY CONSERVATION WITH DAILY TASKS. HOME CARE HAD 189 PATIENT ENCOUNTERS IN 2013.HOSPICE-HOSPICE USES A TEAM APPROACH TO CARING FOR PATIENTS WITH LIFE THREATENING ILLNESSES, PROVIDING SPECIALIZED CARE AND TEACHING AND ALSO FOCUSES ON PATIENTS' QUALITY OF LIFE AND DEATH WITH DIGNITY. THE TEAM CONSISTS OF SKILLED NURSES, HOME HEALTH AIDS, PHYSICAL THERAPISTS, OCCUPATIONAL THERAPISTS, SOCIAL WORKERS, CHAPLAINS AND VOLUNTEERS. BEREAVEMENT FOLLOW-UP AFTER THE PATIENT'S DEATH IS AN ADDITIONAL BENEFIT FOR THE FAMILY. HOSPICE PROVIDES THE EQUIPMENT, MEDICATIONS AND SUPPLIES (RELATED TO THEIR LIFE THREATENING ILLNESS) NECESSARY TO ASSURE THE COMFORT OF OUR PATIENTS IN THEIR FINAL DAYS IN FAMILIAR SURROUNDINGS WITH FAMILY AND FRIENDS. HOSPICE HAD 194 PATIENT ENCOUNTERS DURING 2013.HOME MEDICAL EQUIPMENT-THIS AREA OFFERS A FULL RANGE OF MEDICAL EQUIPMENT AND SUPPLIES INCLUDING BEDS, WALKERS, COMMODES, CANES, WHEELCHAIRS, SCOOTERS, SUPPLIES RELATED TO DIABETES, BREAST FEEDING, OSTOMY, AND SPORTS RELATED EQUIPMENT. RESPIRATORY THERAPISTS PROVIDE OXYGEN CONCENTRATORS AND PORTABLES, APNEA MONITORS, BI-PAPS AND CPAPS, NEBULIZERS, AS WELL AS OTHER RESPIRATORY NEEDS. OUR STAFF MEMBERS ARE TRAINED IN SEATING SYSTEMS FOR WHEELCHAIRS AND SCOOTERS. THERE ARE LOCATIONS IN LACROSSE, ARCADIA, SPARTA, AND TOMAH. FREE DELIVERY AND SERVICE IS PROVIDED IN A 100-MILE RADIUS AROUND LA CROSSE. HOME MEDICAL HAD 6,407 PATIENT ENCOUNTERS IN 2013.HOME INFUSION THERAPY-THERE WERE 161 NEW PATIENTS SERVICED BY HOME INFUSION THERAPY DURING 2013.CHARITY CARE: FMCI PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS/RESIDENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. CHARITY CARE IS ALSO PROVIDED FOR PATIENTS THAT ARE FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THE COST OF CHARITY CARE PROVIDED IN 2013 WAS APPROXIMATELY $2,971,000. THE COST OF UNCOMPENSATED CARE PROVIDED LOW INCOME PATIENTS THROUGH MEDICAID WAS APPROXIMATELY $25,414,000 IN 2013. THIS SHORTFALL INCLUDES THE MEDICAID SURCHARGE AND TAXES PAID TO MN CARE AND WI FOR PROGRAMS THAT OFFER HEALTHCARE ASSISTANCE TO LOW INCOME POPULATIONS ALL OF WHICH TOTAL APPROXIMATELY $5,371,000. OTHER EXPENSES REPORTED ELSEWHERE: THE UNREIMBURSED COST OF MEDICARE WAS $58,213,000 IN 2013.FMCI VOLUNTARILY ENTERED INTO AN AGREEMEENT 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 PATIENTS REGARDING OUR CHARITY CARE PROGRAM, IN ADDITION, THE WI ATTORNEY GENERAL REVIEWED AND APPROVED OUR BILLING AND COLLECTION POLICIES AND PRACTICES. 3429011 206049 476385 COMMUNITY ACTIVITIES & EDUCATIONAL PROGRAMS (SCHEDULE O) IN ADDITION TO THESE SERVICES AND IN KEEPING WITH ITS HISTORIC MISSION, FMCI ENGAGES IN NUMEROUS EXTERNAL ACTIVITIES THAT PROMOTE HEALTH AND WELLNESS FOR THE MIND, BODY AND SPIRIT OF INDIVIDUALS IN THE COMMUNITIES WE SERVE. FMCI NOT ONLY ENGAGES IN THESE ACTIVITIES AS A SYSTEM, BUT ALSO ENCOURAGES MEDICAL STAFF AND EMPLOYEES TO DO THE SAME. EXAMPLES INCLUDE:ST. CLARE HEALTH MISSION-THE MISSION IS A FREE MEDICAL CLINIC WITH LOCATIONS ON THE FMCI'S CAMPUSES IN LACROSSE AND SPARTA, AND SERVES PERSONS WHO HAVE NO MEDICAL INSURANCE AND DO NOT QUALIFY FOR PUBLIC ASSISTANCE. STAFFED BY VOLUNTEER PHYSICIANS AND OTHER EMPLOYEES, THE CLINIC HAD 4,936 PATIENT VISITS IN 2013. WOMEN'S HEALTH-MINNESOTA BREAST AND CERVICAL CANCER PROGRAM - THE MINNESOTA BREAST AND CERVICAL CANCER PROGRAM IS OFFERED TO PATIENTS FOR MAMMOGRAMS OR FOLLOW-UP BREAST OR CERVICAL CANCER PROCEDURES THAT CANNOT BE PROVIDED IN THOSE SITES. THIS PROGRAM SERVES LOW-INCOME WOMEN WHO ARE EITHER UNINSURED OR UNDERINSURED. THE GRANT WAS WRITTEN TO ADDRESS THE NEEDS OF WOMEN IN RURAL MINNESOTA SITES WHO WERE NOT RECEIVING ADEQUATE PREVENTATIVE SERVICES. WISCONSIN WELL WOMAN PROGRAM-OFFERED IN COOPERATION WITH THE STATE OF WISCONSIN AND LACROSSE COUNTY, THIS PROGRAM HELPS WOMEN WITH LITTLE OR NO HEALTH INSURANCE GET BETTER ACCESS TO FREE SCREENINGS FOR BREAST CANCER, CERVICAL CANCER, DEPRESSION, DIABETES, DOMESTIC ABUSE, HEART DISEASE, HIGH BLOOD PRESSURE AND OSTEOPOROSIS. SAFE PATH DOMESTIC ABUSE AND SEXUAL ASSAULT SERVICE-STARTED IN 1996, THIS PROGRAM IS FUNDED THROUGH THE OPERATING BUDGET OF FMCI WITH A SIGNIFICANT GRANT FROM MCHS-FRANCISCAN HEALTHCARE FOUNDATION. IN ADDITION, THIS GROUP WORKS WITH THE EMERGENCY MEDICINE TRAUMA CENTER (EMTC) TO DEVELOP THE SEXUAL ASSAULT COMPONENT. IN 2000, 6 NURSES WERE TRAINED TO DO SEXUAL ASSAULT NURSE EXAMS IN THE EMERGENCY ROOM. THE PROGRAM PROVIDES THE VICTIM WITH ONE-ON-ONE ATTENTION OF A FEMALE NURSE PROVIDER TRAINED TO DO THE EXAM AND COLLECT THE FORENSIC EVIDENCE THAT IS NEEDED. FMCI IS NOW A "DESIGNATED SEXUAL ASSAULT CENTER" IN WISCONSIN. ESTROGEN & WOMEN'S HEALTH-THIS IS AN EDUCATIONAL PROGRAM FOR THE MEDICAL COMMUNITY ON ADVANCES IN PREVENTION, DIAGNOSIS, AND TREATMENT OF DISEASES IN WOMEN. THE TOPIC OF ESTROGEN, AND ITS ROLE IN WOMEN'S HEALTH ISSUES, CONTINUES TO BE OF GREAT IMPORTANCE. A MULTIFACETED LEARNING APPROACH IS USED IN THIS COURSE, INCLUDING LECTURE FORMAT TO SHARE THE LATEST RESEARCH, SAMPLE CASE PRESENTATIONS, AND GROUP DISCUSSION. THIS COURSE WAS DESIGNED FOR PHYSICIANS AND RESIDENTS IN FAMILY PRACTICE, INTERNAL MEDICINE AND OB/GYN, MEDICAL STUDENTS, PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, AND REGISTERED NURSES AND MIDWIVES. LACROSSE MEDICAL HEALTH SCIENCE CONSORTIUM-THE CONSORTIUM IS A PARTNERSHIP OF THE TWO HEALTHCARE PROVIDERS AND THREE POST SECONDARY EDUCATIONAL INSTITUTIONS IN LACROSSE. THE PURPOSE OF THE CONSORTIUM IS TO CREATE OPPORTUNITIES FOR EDUCATION AND RESEARCH IN THE ALLIED HEALTH SCIENCES. THE MOST RECENT PROJECT OF THE CONSORTIUM WAS THE OPENING OF A $27 MILLION ALLIED HEALTH EDUCATION AND RESEARCH FACILITY IN LACROSSE. JOINT COMMUNITY HEALTH INITIATIONS-FMCI OFTEN COLLABORATES WITH GUNDERSEN LUTHERAN MEDICAL CENTER, COUNTY HEALTH DEPARTMENTS AND OTHER ORGANIZATIONS INTERESTED IN COMMUNITY HEALTH AND WELL-BEING ON NUMEROUS TOPICS, SUCH AS EDUCATION CONFERENCES, CHILD DEVELOPMENT MATERIALS, INFLUENZA VACCINATION EDUCATION ANNOUNCEMENTS, CHILD SAFETY, MEDICATION SAFETY, AND COMMUNITY HEALTH ASSESSMENT PROGRAMS.ADVANCE DIRECTIVES PROGRAM-ESTABLISHED IN COOPERATION WITH GUNDERSEN LUTHERAN, THE PROGRAM ASSISTS PATIENTS AND THEIR FAMILIES WITH END-OF-LIFE ISSUES AND DECISION-MAKING.FREE HEALTH CHECKS AND SCREENINGS-PHYSICIANS, HEALTH EDUCATORS, AND OTHER ALLIED HEALTH STAFF PROVIDE NUMEROUS HEALTH SCREENINGS AT EVENTS THROUGHOUT THE MCHS-FRANCISCAN HEALTHCARE (FHI) SERVICE AREA. SUCH SCREENINGS INCLUDE BLOOD PRESSURE, CHOLESTEROL, BLOOD SUGAR, AND STROKE ASSESSMENTS.HEALTH AND WELLNESS EDUCATION FOR THE PUBLIC-PROGRAMS OFFERED THROUGH FMCI INCLUDE PRENATAL CARE, SMOKING CESSATION, SUPPORT GROUPS FOR CANCER, SUDDEN INFANT DEATH, NEUROLOGICAL DISORDERS, DIABETES EDUCATION, AND BASIC AND ADVANCED LIFE SUPPORT INSTRUCTION OR CPR.LACROSSE-MAYO FAMILY PRACTICE RESIDENCY-THE FAMILY PRACTICE RESIDENCY PROGRAM IS AFFILIATED WITH THE MAYO GRADUATE SCHOOL OF MEDICINE. ITS FOCUS IS TO GIVE RESIDENTS THE KNOWLEDGE, SKILLS, AND ATTITUDES NECESSARY FOR FUTURE PRACTICE IN AN EVER-CHANGING MEDICAL ENVIRONMENT. CLINICAL PASTORAL EDUCATION PROGRAM-THIS PROGRAM IS WORKING COLLABORATIVELY AND ECUMENICALLY TO PROVIDE PASTORAL EDUCATION FOR CLERGY AND LAY PEOPLE OF ALL FAITH TRADITIONS AND DENOMINATIONS. THE PROGRAM'S PROFESSIONAL CONSULTATION BOARD IS COMPRISED OF REPRESENTATIVES FROM A DIVERSITY OF FAITH AND COMMUNITY ORGANIZATIONS. AN EMPHASIS IS PLACED ON PROVIDING SPIRITUAL CARE IN AN INTER-DISCIPLINARY ENVIRONMENT THAT SERVES PEOPLE TRADITIONALLY PUSHED TO THE MARGINS OF THE COMMUNITY BY POVERTY, MENTAL ILLNESS, RACISM, VIOLENCE, OR OTHER SOCIOECONOMIC CONDITIONS.GERONTOLOGY CERTIFICATE PROGRAM-IN A JOINT EFFORT WITH THE UNIVERSITY OF WISCONSIN-LACROSSE AND COMMUNITY AGENCIES, THIS NEW PROGRAM IS DESIGNED TO INCREASE THE SKILLS AND COMPETENCIES OF A BROAD RANGE OF PROFESSIONALS INCLUDING NURSES, NURSING ASSISTANTS, SOCIAL WORKERS, OCCUPATIONAL THERAPISTS, PHYSICAL THERAPISTS, PERSONAL CARE ASSISTANTS AND OTHERS. IT IS A DIRECT RESPONSE TO THE GROWING DEMAND PLACED ON AREA AGENCIES TO SERVE OUR RAPIDLY EXPANDING POPULATION OF OLDER ADULTS.CORPORATE FINANCIAL SUPPORT-IN BEING A "GOOD CORPORATE CITIZEN", FMCI ALSO PROVIDES FINANCIAL SUPPORT TO GROUPS WITHIN OUR SERVICE AREA WHO ARE ENGAGED IN COMMUNITY HEALTH AND WELLNESS, PUBLIC SAFETY, THE ARTS, EDUCATION AND QUALITY OF LIFE ISSUES. THESE ACTIVITIES INCLUDE: RUNS AND WALKS TO RAISE FUNDS FOR MEDICAL RESEARCH, PROGRAMS ON SELF ESTEEM FOR YOUNG WOMEN, FIRE SAFETY MATERIALS FOR SCHOOL CHILDREN, SELF-HELP OPPORTUNITIES FOR THE POOR AND UNDERPRIVILEGED, CONCERTS AND PERFORMANCES BY LOCAL ARTS GROUPS, AND SPONSORSHIPS OF LECTURES AND PROGRAMS ON HEALTH RELATED TOPICS.ALZHEIMER'S ASSOCIATION-FOR SEVERAL YEARS FMCI HAS BEEN A SPONSOR OF MEMORY WALKS HELD EACH FALL AND ITS ANNUAL EDUCATION CONFERENCE. SEVERAL MAYO CLINIC PHYSICIANS HAVE PRESENTED AT THE ANNUAL CONFERENCE.AMERICAN CANCER SOCIETY-FRANCISCAN MEDICAL CENTER WAS THE LEAD SPONSOR OF THE VERY FIRST LACROSSE AREA ALL YOUTH RELAY FOR LIFE. THIS RELAY, MODELED AFTER THE SUMMER EVENT, AND ORGANIZED AND DESIGNED ESPECIALLY FOR HIGH SCHOOL STUDENTS, RAISED MORE THAN $20,000. THE DAFFODILS THAT DECORATE THE MARKET PLACE RESTAURANT EACH SPRING ARE ALSO PART OF FMCI'S SUPPORT.AMERICAN HEART ASSOCIATION-STAFF FROM FMCI CARDIOVASCULAR SERVICES PLAY A LEAD ROLE IN THE ORGANIZATION OF THE ANNUAL HEART WALK. FOR THE PAST SEVERAL YEARS TEAMS FROM THE MEDICAL CENTER HAVE ALSO LED THE PACK IN FUNDS RAISED. THE MEDICAL CENTER IS ALSO A LONGTIME SPONSOR OF THE FRIGID FIVE RUN HELD IN JANUARY.UNITED CEREBRAL PALSY-FRANCISCAN MEDICAL CENTER HAS BEEN THE LEAD SPONSOR FOR THE ANNUAL CELEBRITY WAITER NIGHT.MULTIPLE SCLEROSIS-FMCI WAS THE LEAD SPONSOR FOR THIS EVENT, HELD IN APRIL THAT HAS RAISED NEARLY $80,000 YEARLY THROUGH THE EFFORTS OF MORE THAN 800 WALKERS.UNITED FUND FOR THE ARTS AND HUMANITIES-UFAH IS A CONSORTIUM OF 10 LOCAL ARTS AND HUMANITIES ORGANIZATIONS THAT CONTRIBUTE SIGNIFICANTLY TO THE QUALITY OF LIFE IN THE AREA. FMCI IS A CONTRIBUTOR TO THIS ANNUAL CAMPAIGN.HEALTH CAREER EXPLORATION-YOUNG MEN AND WOMEN INTERESTED IN HEALTH CAREERS HAVE AN OPPORTUNITY TO JOB SHADOW OR INTERN IN NUMEROUS PATIENT CARE AREAS WITHIN FMCI AND FHI.REPRESENTATION ON COMMUNITY BOARDS-FHI PROVIDES SUPPORT FOR PHYSICIANS AND EMPLOYEES WHO PARTICIPATE AT THE "BOARD OF DIRECTOR" LEVELS IN COMMUNITY SERVICE ORGANIZATIONS. ALL ARE ENCOURAGED TO IDENTIFY OPPORTUNITIES WHEREBY FHI CAN CONTRIBUTE ITS COLLECTIVE KNOWLEDGE AND EXPERTISE IN ASSISTING THESE COMMUNITY GROUPS TO MEET THEIR MISSIONS OF SERVICE.HEALTHTOUCH-WITH A TOUCH OF THE SCREEN, PATIENTS AND STAFF CAN NOW ACCESS ACCURATE, UP-TO-DATE INFORMATION ON MEDICATIONS, DISEASES AND WELLNESS TOPICS THANKS TO HEALTHTOUCH, AN INTERACTIVE KIOSK IN THE RESOURCE LIBRARY OF THE FAMILY HEALTH CLINIC.DISEASE MANAGEMENT STRATEGIES-FMCI IS PARTICIPATING IN THE UNITED COULEE REGION INFLUENZA COALITION IN COOPERATION WITH GUNDERSEN LUTHERAN AND THE HEALTH DEPARTMENT IN AN EFFORT TO COLLABORATE ON IMPROVING THE IMMUNIZATION RATES IN THE COMMUNITY. DEMENTIA CARE - FMCI HAS DEVELOPED A COMPREHENSIVE DEMENTIA CARE PROGRAM FOR PEOPLE WITH DEMENTIA AND THEIR FAMILIES. THE PROGRAM PROVIDES DIAGNOSIS, TREATMENT, EDUCATION, SUPPORT SERVICES AND LONG-TERM FOLLOW-UP. VOLUNTEER ACTIVITIES (SCHEDULE O) MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC. (VIA THE FRANCISCAN AUXILIARY WHICH IS PART OF FMCI) RECEIVES DONATED SERVICES FROM COMMUNITY TEEN, COLLEGE, AND ADULT VOLUNTEERS. THE AUXILIARY WAS ORGANIZED IN 1952 TO "IMPROVE THE HEALTH OF INDIVIDUALS AND COMMUNITIES" THROUGH FUNDRAISING, SERVICE, COLLABORATION, ADVOCACY AND EDUCATION. AUXILIARY PROJECTS ARE ORGANIZED BY A BOARD OF DIRECTORS THAT MEETS MONTHLY DURING THE SCHOOL YEAR AND ARE SUPPORTED THROUGH THE VOLUNTEER EFFORTS OF MORE THAN 200 MEMBERS. MEMBERSHIP IS OPEN TO ALL INTERESTED COMMUNITY MEMBERS. SPECIFICALLY, THE AUXILIARY SUPPORTS PROGRAMS AND SERVICES TO ADDRESS UNMET HEALTHCARE NEEDS; EQUIPMENT AND SERVICES TO ENHANCE PATIENT CARE DELIVERY; NEEDY PATIENT ACCOUNTS; NURSING EDUCATION FOR WWTC AND VITERBO COLLEGE STUDENTS; AND COMMUNITY HEALTH AWARENESS AND EDUCATION PROJECTS. THE AUXILIARY ALSO STRIVES TO ENHANCE THE VISIBILITY OF FMCI IN THE COMMUNITY.DURING 2013, APPROXIMATELY 885 VOLUNTEERS DONATED APPROXIMATELY 62,500 HOURS OF VOLUNTEER SERVICE THESE SERVICES WERE VALUED AT APPROXIMATELY $1,409,375 BASED ON THE INDEPENDENT SECTOR. THESE SERVICE HOURS WERE SPENT ORGANIZING AND MANAGING ACTIVITIES FOR THE BENEFIT OF THE HOSPITAL'S AND NURSING HOME'S PATIENTS, PATIENTS' FAMILIES, VISITORS AND STAFF.FMCI ALSO OPERATES LIFELINE (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 FMCI MONITOR RESPONDS, ASSESSES THE SITUATION AND SUMMONS APPROPRIATE HELP. 1003664 THE FILING ORGANIZATION LEASES SPACE AND PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE. 1003664 388947845 1 1 0 1 0 0 0 0 1 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 148 0 1 4030 1 1 1 0 0 0 0 0 0 0 0 0 X 18 0 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 MN WI X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 ANIL MD GOKHAN DIRECTOR / PHYSICIAN 40.00 0.00 X 481074 0 36582 ERICKSON ERIC B DIRECTOR / ADMINISTRATOR 40.00 0.00 X 215497 0 14317 FITZGERALD MD KEVIN DIRECTOR / PHYSICIAN 40.00 0.00 X 275237 0 43800 FLEISCHMANN MD ALAN J DIRECTOR (1/1-3/1/2013) / PHYSICIAN 40.00 0.00 X 72137 0 63377 GRAU MD THOMAS J DIRECTOR / PHYSICIAN 40.00 0.00 X 280268 0 66144 GRENISEN MD MARGARET M DIRECTOR / PHYSICIAN 40.00 0.00 X 223980 0 27540 HAGER NICKIJO L DIRECTOR / RN 40.00 0.00 X 146598 0 30662 HOLMAY DIANE K DIRECTOR / RN / CNO 40.00 0.00 X 194226 0 49211 HUGHES PETER R DIRECTOR/REGIONAL VP OF DEVELOPMENT 40.00 0.00 X X 244511 0 65744 JOHNSON MD TIMOTHY J CEO/CHAIR/DIRECTOR/PHYSICIAN 40.00 0.00 X X 443614 0 58595 JUNGCK MD MARK C DIRECTOR / PHYSICIAN 40.00 0.00 X 301171 0 53991 KORDUCKI MD JANE M DIRECTOR / PHYSICIAN 40.00 0.00 X 230433 0 54607 KRIEN MD JOSEPH S DIRECTOR / PHYSICIAN 40.00 0.00 X 285281 0 44307 KRUMHOLZ MD ALAN J DIRECTOR / PHYSICIAN 40.00 0.00 X 288817 0 66233 KRUSE JOSEPH J CAO/VICE-CHAIR/SECRETARY/DIRECTOR 40.00 0.00 X X 278644 0 55997 MOLLING DO PAUL E DIRECTOR / PHYSICIAN 40.00 0.00 X 275172 0 45941 NOEL AMY J DIRECTOR / ADMINISTRATOR 40.00 0.00 X 215750 0 38216 RUSHLOW MD DAVID R DIRECTOR / PHYSICIAN 40.00 0.00 X 285196 0 47419 SCHAEFER DANIEL E DIRECTOR (1/1-5/1/13) 1.00 40.00 X 0 108417 7284 TIGGELAAR THOMAS H CFO/TREASURER/DIRECTOR 40.00 0.00 X X 237554 0 50235 MORRISSEY MD JOHN E PHYSICIAN 40.00 0.00 X 1146645 0 57738 NOLTE DO CHARLES P PHYSICIAN 40.00 0.00 X 927139 0 44300 RADEMACHER MD DANA E PHYSICIAN 40.00 0.00 X 922350 0 45883 STEVENS MD MARK K PHYSICIAN 40.00 0.00 X 1095049 0 60105 UY MD JONATHAN J PHYSICIAN 40.00 0.00 X 738170 0 50461 NESSE MD ROBERT E FORMER CHAIR 0.00 40.00 X 0 740824 15779 9804513 849241 1194468 303 1 1 0 MAYO CLINIC 200 1ST STREET SW ROCHESTER MN 55905 HEALTHCARE & ADMIN 5583260 FOWLER & HAMMER INC 313 MONITOR STREET LACROSSE WI 54603 CONSTRUCTION 5486785 WEATHERBY LOCUMS 6541 NORTH FEDERAL HWY SUITE 800 FORT LAUDERDALE FL 33308 HEALTHCARE SERVICES 1707632 MAYO COLLABORATIVE SERVICES LIMITED 200 1ST STREET SW ROCHESTER MN 55905 HEALTHCARE SERVICES 1627536 COULEE REGION MECHANICAL 2255 PALACE STREET LACROSSE WI 54603 HEALTHCARE SERVICES 1251486 165 2122 65452 1663613 3144989 53379 24459 4929555 NET PATIENT REVENUE 620000 421888615 420015154 346541 1526920 RENTAL REVENUE FROM AFFILIATES 531120 570344 570344 SHARED SERVICES 561000 433320 433320 LIFELINE 621990 252335 252335 EDUCATION REVENUE 611600 150202 150202 291029 287754 3275 423585845 42850 42850 787426 304263 483163 483163 483163 84768 336678 -251910 -251910 -251910 98783 65452 147863 -49080 -49080 2051 150 1901 1901 275726 243470 32256 32256 CAFETERIA/VENDING REVENUE 722210 1940569 526255 1414314 MANAGEMENT FEE REVENUE 541610 357932 200000 157932 MISC. REVENUE 900099 332776 45560 79488 207728 123750 45886 77864 2755027 431529607 421800555 1152284 3647213 206049 206049 5888079 4222842 1665237 967536 723311 244225 191205065 187311165 3893900 15530464 15077198 453266 35578540 34563003 1015537 12383209 12021798 361411 18485024 18485024 103768 103768 14100 14100 10482 10482 14639619 13964890 674729 1044049 195234 848815 15523192 14622936 900256 1726506 1726506 13732890 13541092 191798 887296 863606 23690 2340900 2314248 26652 829597 829597 13448464 12758278 690186 1361995 1361995 UBI TAX 21900 21900 MEDICAL SUPPLIES 50379400 50379400 BAD DEBT EXPENSE 17384423 17384423 MN CARE TAX 5371231 5371231 1485835 1235549 250286 420549613 388947845 31601768 0 31339 32700 73197 68341 47745 22390 73318530 70465604 1734 1442889 1378593 7523145 7591383 7351128 18323569 275302180 163018831 110719374 112283349 330772 21613173 40853806 21681997 241691925 253462833 82613518 44722932 0 0 1230810 986945 54903 43931 23331718 20021098 107230949 65774906 X 134460976 187687927 134460976 187687927 241691925 253462833 X 10979994 42246957 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10482 10482 0 PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. 0 1 X 16637491 960654 1100771 672798 18026118 15943228 608124 632787 546648 16637491 16028434 1367448 -512980 939674 15943228 15824272 1086762 416290 1298890 16028434 8421455 7660836 596750 854769 15824272 0.78940 0.21060 0 1 1 11198461 11198461 136777 172055235 102305893 69886119 533300 522378 10922 82117658 59939732 22177926 9260749 250828 9009921 112283349 MAYO POOLED INVESTMENTS 21613173 F 21613173 DUE FROM AFFILIATES 21681997 21681997 DUE TO AFFILIATES 16561608 DEFERRED COMPENSATION LIABILITY 2231202 ASSET RETIREMENT OBLIGATION 1228288 20021098 X PART IV, LINE 2B: ASSISTED LIVING SECURITY DEPOSITS. PART V, LINE 4: THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR RESEARCH AND EDUCATION PROGRAMS. PART X, LINE 2: AT DECEMBER 31, 2013 AND 2012, 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. TINY TIM 104988 65197 39791 14459 13642 25662 GERANIUMS 33761 0 33761 24544 138749 65197 73552 14459 13642 50206 78307 -4755 1 1 X 1 X 1 X 1 1 0 1 1 2970997 2970997 0.00740 48076630 22662321 25414309 0.06300 51047627 22662321 28385306 0.07040 503153 90157 412996 0.00100 3230698 1067024 2163674 0.00540 11247529 7944325 3303204 0.00820 497056 143437 353619 0.00090 10760 10760 0.00000 15489196 9244943 6244253 0.01550 66536823 31907264 34629559 0.08590 26091 26091 0.00010 43014 43014 0.00010 14183 14183 0.00000 5249 5249 0.00000 88537 88537 0.00020 0 17384423 48389902 55513073 -7123171 X 1 1 2 1 FRANCISCAN MEDICAL CTR-LACROSSE HOSPITAL 700 WEST AVENUE SOUTH LACROSSE WI 546014796 WWW.MAYOCLINICHELATHSYSTEM.ORG 24 X X X X 2 FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL 310 WEST MAIN STREET SPARTA WI 546562142 WWW.MAYOCLINICHELATHSYSTEM.ORG 1009 X X X X FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL 1 1 X X X X X X X X X 13 1 1 1 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X X X 0 0 1 1 100.000000000000 1 300.000000000000 1 X X X X X X X X 1 1 X X X X X 1 0 X X X X X 1 X 0 0 FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL 2 1 X X X X X X X X X 13 1 1 1 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X X X 0 0 1 1 100.000000000000 1 300.000000000000 1 X X X X X X X X 1 1 X X X X X 1 0 X X X X X 1 X 0 0 FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 3: THE COALITION THAT CONDUCTED THE "COMPASS NOW" ASSESSMENT ON WHICH THIS CHNA IS BASED INCLUDED PARTICIPATION OF THE PUBLIC HEALTH DEPARTMENTS OF HOUSTON, LACROSSE, MONROE, TREMPEALEAU, AND VERNON COUNTIES. THE "COMPASS NOW" ASSESSMENT RECEIVED INPUT FROM THE FOLLOWING SOURCES: RANDOMLY SELECTED HOUSEHOLD SURVEYS, KEY STAKEHOLDER MEETINGS, AND FOCUS GROUPS. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 3: THE COALITION THAT CONDUCTED THE "COMPASS NOW" ASSESSMENT ON WHICH THIS CHNA IS BASED INCLUDED PARTICIPATION OF THE PUBLIC HEALTH DEPARTMENTS OF HOUSTON, LACROSSE, MONROE, TREMPEALEAU, AND VERNON COUNTIES. THE "COMPASS NOW" ASSESSMENT RECEIVED INPUT FROM THE FOLLOWING SOURCES: RANDOMLY SELECTED HOUSEHOLD SURVEYS, KEY STAKEHOLDER MEETINGS, AND FOCUS GROUPS. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 4: THE COALITION THAT CONDUCTED THE "COMPASS NOW" ASSESSMENT ON WHICH THIS CHNA REPORT IS BASED INCLUDED MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER-LACROSSE CAMPUS, MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER-SPARTA CAMPUS, GUNDERSEN LUTHERAN HEALTH SYSTEM, ST. JOSEPH'S HEALTH SERVICES-GUNDERSEN LUTHERAN, TOMAH MEMORIAL HOSPITAL, TRI-COUNTY MEMORIAL HOSPITAL, AND VERNON MEMORIAL HOSPITAL. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 4: THE COALITION THAT CONDUCTED THE "COMPASS NOW" ASSESSMENT ON WHICH THIS CHNA REPORT IS BASED INCLUDED MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER-LACROSSE CAMPUS, MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER-SPARTA CAMPUS, GUNDERSEN LUTHERAN HEALTH SYSTEM, ST. JOSEPH'S HEALTH SERVICES-GUNDERSEN LUTHERAN, TOMAH MEMORIAL HOSPITAL, TRI-COUNTY MEMORIAL HOSPITAL, AND VERNON MEMORIAL HOSPITAL. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 7: ACCESS TO AND COST OF DENTAL CARE AND ILLEGAL DRUG USE WERE DETERMINED TO BE EMERGING ISSUES TO WATCH. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 7: ACCESS TO AND COST OF DENTAL CARE AND ILLEGAL DRUG USE WERE DETERMINED TO BE EMERGING ISSUES TO WATCH. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 12I: 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. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 12I: 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. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 14G: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 14G: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 18E: 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. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 18E: 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. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 20D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 25% 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. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 20D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 25% 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. 26 FRANCISCAN MEDICAL CENTER - LACROSSE 800 WEST AVENUE SOUTH LACROSSE WI 546014796 CLINIC, PHARMACY ONALASKA CLINIC 191 THEATER ROAD ONALASKA WI 54650 CLINIC, BEHAVIORAL HEALTH CLINIC, PHARMACY, DME TOMAH CLINIC 325 BUTTS AVENUE TOMAH WI 546600610 CLINIC, BEHAVIORAL HEALTH CLINIC BEHAVIORAL HEALTH SERVICE-LACROSSE 212 11TH STREET SOUTH LACROSSE WI 54601 BEHAVIORAL HEALTH CLINIC HOLMEN CLINIC 1303 MAIN STREET S HOLMEN WI 546369337 CLINIC, BEHAVIORAL HEALTH CLINIC ARCADIA CLINIC 464 SOUTH ST JOSEPH AVENUE ARCADIA WI 546121499 CLINIC, BEHAVIORAL HEALTH CLINIC, DME SPARTA CLINIC 310 WEST MAIN STREET SPARTA WI 546562142 CLINIC, BEHAVIORAL HEALTH CLINIC, DME FRANCISCAN LACROSSE CLINIC DME 620 SOUTH 11TH STREET LACROSSE WI 546014711 DME WAUKON CLINIC 105 EAST MAIN STREET WAUKON IA 52172 CLINIC PRAIRIE DU CHIEN CLINIC 800 EAST BLACKHAWK AVENUE PRAIRIE DU CHIEN WI 53821 CLINIC, BEHAVORIAL HEALTH PROFESSIONAL ARTS BUILDING 615 SOUTH 10TH STREET LACROSSE WI 54601 ALLERGY, ORAL SURGERY FRANCISCAN FAMILY HEALTH CLINIC 815 SOUTH 10TH STREET LACROSSE WI 54601 FAMILY HEALTH CLINIC FRANCISCAN-HOME CARE PHARMACY 700 WEST AVENUE SOUTH LACROSSE WI 54601 PHARMACY CALEDONIA CLINIC 701 NORTH PRAGUE STREET CALEDONIA MN 559211066 CLINIC, BEHAVIORAL HEALTH CLINIC, DME LA CRESCENT CLINIC 524 NORTH ELM LA CRESCENT MN 559471027 CLINIC FRANCISCAN OCCUPATIONAL HEALTH CLINIC 630 10TH STREET LACROSSE WI 54601 OCCUPATIONAL HEALTH CLINIC SIENA HALL 613 SOUTH 10TH STREET LACROSSE WI 54601 BEHAVIORAL HEALTH VILLAGE ON 9TH 621 SOUTH 9TH STREET LACROSSE WI 54601 ELDERLY HOUSING VILLA SUCCESS 121 PRAIRIE STREET PRAIRIE DU CHIEN WI 53821 BEHAVIORAL HEALTH WOMEN'S LAAR HOUSE 1005 JACKSON STREET LACROSSE WI 54601 BEHAVIORAL HEALTH ST CLARE HEALTH MISSION 916 FERRY STREET LACROSSE WI 54601 CLINIC SCARSETH HOUSE 535 SOUTH 17TH STREET LACROSSE WI 54601 BEHAVIORAL HEALTH GROUP HOME I 518 10TH STREET SOUTH LACROSSE WI 54601 BEHAVIORAL HEALTH VILLAGE ON CASS 225 24TH STREET SOUTH LACROSSE WI 54601 ELDERLY HOUSING GERARD HALL 940 DIVISION STREET LACROSSE WI 54601 MATERNITY HOME WALMART CLINIC OPERATED BY FRANCISCAN HE 4622 MORMON COULEE RD LACROSSE WI 54601 CLINIC PART I, LINE 6A: THE ANNUAL REPORT FOR THE FILING ORGANIZATION IS PART OF A CONSOLIDATED REPORT PREPARED BY MAYO 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: $171,767. 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 $ 17,384,423. PART II, COMMUNITY BUILDING ACTIVITIES: THE FILING ORGANIZATION MADE SEVERAL CONTRIBUTIONS TO CHARITABLE ORGANIZATIONS WITHIN THE COMMUNITY WHICH PROMOTED COMMUNITY SUPPORT AND COALITION BUILDING. SOME OF THE LARGER CONTRIBUTIONS INCLUDED $10,000 TO THE BOYS AND GIRLS CLUB OF THE GREATER COULEE REGION, $10,000 TO THE CASA FOR KIDS PROGRAM AT THE YWCA, $6,000 TO BLUFF COUNTY FAMILY RESOURCE, $14,183 FOR SLEEP SACKS FOR NEWBORNS, $41,494 TO THE LACROSSE HEALTH SCIENCE CONSORTIUM AND $5,000 TO THE DIOCESE OF LACROSSE. 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, 6, 8 AND 9 OF MAYO CLINIC'S 2013 CONSOLIDATED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SHORTFALL REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT (USING A MEDICARE COST REPORT STEP-DOWN METHODOLOGY). HOWEVER, USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY ACTUALLY RESULTS IN A MEDICARE SHORTFALL OF $58,213,000 AS REPORTED IN THE CORE FORM, PART III, PROGRAM SERVICE ACCOMPLISHMENTS.THE MOST COMMON REASONS FOR A DIFFERENCE BETWEEN THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H AND THE MEDICARE SHORTFALL REPORTED ON THE CORE FORM, PART III INCLUDE: (1) INCLUSION OF MEDICARE ADVANTAGE REVENUE AND EXPENSES; (2) INCLUSION OF PART B REVENUE AND EXPENSES; (3) INCLUSION OF OTHER FEE SCHEDULE REVENUE; AND (4) SOME TIMING ISSUES.REASONS WHY MEDICARE SHORTFALL REPORTED ON LINE 7, IF ANY, SHOULD BE TREATED AS COMMUNITY BENEFIT ARE: (1) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; (3) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND (4) THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. PART III, LINE 9B: MAYO CLINIC AND ITS AFFILIATES STRIVE TO ASSIST ALL PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION PRIOR TO ENLISTING THE ASSISTANCE OF A COLLECTION AGENCY BY MAKING REASONABLE ATTEMPTS TO COLLECT FROM INSURANCE COMPANIES AND OTHER THIRD-PARTY PAYORS. IN ADDITION, MAYO CLINIC AND ITS AFFILIATES ACCEPT REASONABLE PAYMENT PLANS FROM PATIENTS WHEN AN ACCOUNT IS THE PATIENT'S RESPONSIBILITY AND TRY TO IDENTIFY THOSE PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE IS OFFERED TO ANY PATIENT IF THE FACTS AND CIRCUMSTANCES SUGGEST THAT THE PATIENT DOES NOT HAVE THE ABILITY TO PAY THEIR BILL IN WHOLE OR IN PART. IN THE EVENT THAT AN ACCOUNT IS REFERRED TO A COLLECTION AGENCY, GUIDELINES ARE FOLLOWED; INCLUDING SUSPENDING ALL COLLECTION ACTIVITY IF A FINANCIAL ASSISTANCE APPLICATION HAS BEEN SUBMITTED AFTER THE ACCOUNT HAS BEEN REFERRED FOR COLLECTION. IF A COLLECTION AGENCY IDENTIFIES A PATIENT AS MEETING MAYO CLINIC'S FINANCIAL ASSISTANCE ELIGIBILTY 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 MAYO WOULD TELL THE COLLECTION AGENCY TO PURSUE COLLECTIONS ON THE BALANCE OR PARTIAL BALANCE IF THERE WAS A CHARITY ADJUSTMENT. PART VI, LINE 2: MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER COLLABORATES WITH PUBLIC AND PRIVATE GROUPS IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. THESE GROUPS AND DATA SOURCES INCLUDE: 2012 COMMUNITY NEEDS ASSESSMENT IN PARTNERSHIP WITH THE GREAT RIVERS UNITED WAY AND GUNDERSON LUTHERAN MEDICAL CENTER;HEALTHIEST WISCONSIN 2020 (PLAN OF WI DHS); POPULATION HEALTH PROJECT OF THE LACROSSE MEDICAL HEALTH SCIENCE CONSORTIUM, WHICH COLLECTS AND ANALYZES DATA FROM A 20 COUNTY AREA THAT MIRRORS THE REPORTING ORGANIZATION'S SERVICE AREA. MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER ALSO HAS REPRESENTATION ON NUMEROUS LOCAL HEALTH ADVOCACY GROUPS THAT TARGET SPECIFIC DISEASES AND CONDITIONS (CHILDHOOD OBESITY, DIABETES, SMOKING CESSATION, SUICIDE PREVENTION, ETC.). WE USE INFORMATION AND DATA FROM THESE GROUPS AS WELL TO HELP PLAN EVENTS IN THE SERVICE AREA. PART VI, LINE 3: MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY:MAYO CLINIC IS COMMITTED TO OFFERING FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY FOR THEIR MEDICAL SERVICES IN WHOLE OR IN PART. IN ORDER TO ACCOMPLISH THIS CHARITABLE GOAL, MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM SITES WIDELY PUBLICIZE THIS POLICY IN THE COMMUNITIES THAT THE INDIVIDUAL MAYO CLINIC AFFILIATED SITES SERVE. MAYO CLINIC AFFILIATED SITES MAKE COPIES OF THIS POLICY AND APPLICATIONS AVAILABLE BY POSTING IT ON THEIR WEBPAGE INCLUDING THE ABILITY TO DOWNLOAD A COPY OF THE POLICY AND APPLICATION FREE OF CHARGE. INDIVIDUALS IN THE COMMUNITY SERVED WILL BE ABLE TO OBTAIN A COPY OF THE POLICY IN LOCATIONS THROUGHOUT EACH MAYO CLINIC AFFILIATED SITE OR UPON REQUEST. THE POLICY EXPLAINS THE FINANCIAL ASSISTANCE PROGRAM AND FACTORS AFFECTING ELIGIBILITY. WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. PART VI, LINE 4: MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC. IS AN INTEGRATED HEALTHCARE DELIVERY SYSTEM THAT SERVES THE RESIDENTS OF BUFFALO, TREMPELEAU, JACKSON, MONROE, LACROSSE, JUNEAU, VERNON, CRAWFORD, RICHLAND, SAUK, AND GRANT COUNTIES IN WISCONSIN, WABASHA, WINONA, FILLMORE, AND HOUSTON COUNTIES IN MINNESOTA, AND WINNESHIEK, AND ALLAMAKEE COUNTIES IN IOWA. THE CITIES OF LACROSSE (50K) AND WINONA (35K) REPRESENT SMALL METROPOLITAN AREAS AND THE BALANCE OF THE SERVICE AREA IS EITHER RURAL OR SMALL TOWNS (500 TO 10K). THE SERVICE AREA INCLUDES A GROWING NUMBER OF HISPANIC AND HMONG RESIDENTS. THE AREA POPULATION ALSO TRENDS OLDER, POORER AND LESS EDUCATED THAN THE STATEWIDE AVERAGE. PART VI, LINE 5: THIS FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION- EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO CLINIC HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATIONS ACTIVITIES.SURPLUS FUNDS:MAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE. COMMUNITY REPRESENTATION ON GOVERNING BODY:THE BOARD OF TRUSTEES IS THE GOVERNING BODY OF MAYO CLINIC. A MAJORITY OF ITS MEMBERS ARE EXTERNAL, INDEPENDENT TRUSTEES. IT HAS OVERALL RESPONSIBILITY FOR THE CHARITABLE, CLINICAL PRACTICE, SCIENTIFIC AND EDUCATIONAL MISSION AND PURPOSES OF MAYO CLINIC AND ITS AFFILIATES AS SET FORTH IN ITS ARTICLES OF INCORPORATION AND BYLAWS. BECAUSE OF MAYO CLINIC'S NATIONAL PRESENCE, THESE TRUSTEES ARE SELECTED BASED ON THEIR AREAS OF EXPERTISE, EXPERIENCE, AND OTHER CRITERIA ESTABLISHED BY THE INDEPENDENT NOMINATING COMMITTEE OF THE BOARD OF TRUSTEES. AREAS OF EXPERTISE AND EXPERIENCE INCLUDE SUCH AREAS AS HEALTH CARE POLICY, RESEARCH, EDUCATION, BUSINESS, AND GOVERNMENT. THE FILING ORGANIZATION, WHICH IS CONTROLLED BY MAYO CLINIC, RELIES ON THE COMMUNITY REPRESENTATION OF THE MAYO CLINIC BOARD OF TRUSTEES TO FULFILL THIS REQUIREMENT.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. 1 VITERBO UNIVERSITY 900 VITERBO DRIVE LACROSSE WI 54601 390978445 501C3 8500 EDUCATION BOYS AND GIRLS CLUB OF GREATER LACROSSE 1331 CLINTON STREET LACROSSE WI 54603 396084791 501C3 10000 SUPPORT MISSION YWCA OF THE COULEE REGION 3219 COMMERCE STREET LACROSSE WI 54603 390810543 501C3 10000 SUPPORT MISSION MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE FOUNDATION INC 700 WEST AVENUE SOUTH LACROSSE WI 54601 391186647 501C3 53260 SUPPORT MISSION LACROSSE MEDICAL HEALTH SCIENCE CONSORTIUM 1300 BADGER STREET LACROSSE WI 54601 391804725 501C3 41494 SUPPORT MISSION BLUFF COUNTY FAMILY RESOURCES PO BOX 294 HOKAH MN 55941 411502808 501C3 6000 SUPPORT MISSION BENEDICTINE LIVING COMMUNITY OF ARCADIA FOUNDATION 434 SOUTH ST JOSEPH AVENUE ARCADIA WI 54612 411513014 501C3 5808 SUPPORT MISSION 7 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 AND/OR AFFILIATED TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED. 0 1 0 0 0 0 0 0 0 ANIL MD GOKHAN DIRECTOR / PHYSICIAN 264938 0 0 0 216136 0 12213 0 24369 0 517656 0 0 0 ERICKSON ERIC B DIRECTOR / ADMINISTRATOR 197397 0 0 0 18100 0 2889 0 11428 0 229814 0 0 0 FITZGERALD MD KEVIN DIRECTOR / PHYSICIAN 192774 0 0 0 82463 0 17065 0 26735 0 319037 0 0 0 GRAU MD THOMAS J DIRECTOR / PHYSICIAN 274970 0 0 0 5298 0 45000 0 21144 0 346412 0 0 0 GRENISEN MD MARGARET M DIRECTOR / PHYSICIAN 139820 0 0 0 84160 0 24222 0 3318 0 251520 0 0 0 HAGER NICKIJO L DIRECTOR / RN 125989 0 0 0 20609 0 19180 0 11482 0 177260 0 0 0 HOLMAY DIANE K DIRECTOR / RN / CNO 160169 0 0 0 34057 0 28110 0 21101 0 243437 0 0 0 HUGHES PETER R DIRECTOR/REGIONAL VP OF DEVELOPMENT 213388 0 0 0 31123 0 44329 0 21415 0 310255 0 0 0 JOHNSON MD TIMOTHY J CEO/CHAIR/DIRECTOR/PHYSICIAN 410306 0 0 0 33308 0 37202 0 21393 0 502209 0 0 0 JUNGCK MD MARK C DIRECTOR / PHYSICIAN 227802 0 0 0 73369 0 33062 0 20929 0 355162 0 0 0 KORDUCKI MD JANE M DIRECTOR / PHYSICIAN 158130 0 0 0 72303 0 28443 0 26164 0 285040 0 0 0 KRIEN MD JOSEPH S DIRECTOR / PHYSICIAN 156844 0 0 0 128437 0 18761 0 25546 0 329588 0 0 0 KRUMHOLZ MD ALAN J DIRECTOR / PHYSICIAN 282808 0 0 0 6009 0 39481 0 26752 0 355050 0 0 0 KRUSE JOSEPH J CAO/VICE-CHAIR/SECRETARY/DIRECTOR 236632 0 0 0 42012 0 30447 0 25550 0 334641 0 0 0 MOLLING DO PAUL E DIRECTOR / PHYSICIAN 183339 0 0 0 91833 0 15667 0 30274 0 321113 0 0 0 NOEL AMY J DIRECTOR / ADMINISTRATOR 180055 0 0 0 35695 0 11963 0 26253 0 253966 0 0 0 RUSHLOW MD DAVID R DIRECTOR / PHYSICIAN 281301 0 0 0 3895 0 21063 0 26356 0 332615 0 0 0 TIGGELAAR THOMAS H CFO/TREASURER/DIRECTOR 202111 0 0 0 35443 0 28546 0 21689 0 287789 0 0 0 MORRISSEY MD JOHN E PHYSICIAN 892148 0 0 0 254497 0 33154 0 24584 0 1204383 0 0 0 NOLTE DO CHARLES P PHYSICIAN 771328 0 0 0 155811 0 18804 0 25496 0 971439 0 0 0 RADEMACHER MD DANA E PHYSICIAN 657808 0 0 0 264542 0 21210 0 24673 0 968233 0 0 0 STEVENS MD MARK K PHYSICIAN 863775 0 0 0 231274 0 35246 0 24859 0 1155154 0 0 0 UY MD JONATHAN J PHYSICIAN 636829 0 0 0 101341 0 24839 0 25622 0 788631 0 0 0 NESSE MD ROBERT E FORMER CHAIR 0 633648 0 0 0 107176 0 54 0 15725 0 756603 0 0 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). GOKHAN ANIL, M.D. $15,617 KEVIN FITZGERALD, M.D. $4,032 ALAN J. FLEISCHMANN, M.D. $4,349 THOMAS J. GRAU, M.D. $6,566 MARGARET M. GRENISEN, M.D.$2,739 TIMOTHY J. JOHNSON, M.D. $31,592 MARK C. JUNGCK, M.D. $14,901 JOSEPH S. KRIEN, M.D. $7,239 ALAN J. KRUMHOLZ, M.D. $8,755 PAUL E. MOLLING, D.O. $4,479 JOHN E. MORRISSEY, M.D. $206,927 ROBERT E. NESSE, M.D. $97,541 CHARLES P. NOLTE, D.O. $86,974 DANA E. RADEMACHER, M.D $113,487 DAVID R. RUSHLOW, M.D. $7,679 MARK K. STEVENS, M.D. $192,147 JONATHAN J. UY, M.D. $85,860 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 III: COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. GOKHAN ANIL MD DIRECTOR/PHYSICIAN COMPUTER PURCHASE PROGRAM X 2049 1734 0 0 1 1734 HEALTH TRADITION HEALTH PLAN COMMON BOARD MEMBER 29243361 CAPITATION PAYMENTS/MEDICAL INSURANCE PREMIUMS 0 MICHAEL TIGGELAAR EMPLOYMENT 62882 COMPENSATION PAID TO SON OF BOARD MEMBER, TOM TIGGELAAR 0 LORI JUNGCK EMPLOYMENT 45965 COMPENSATION PAID TO SPOUSE OF BOARD MEMBER, MARK JUNGCK, M.D. 0 NICHOLE J KRUSE EMPLOYMENT 55135 COMPENSATION PAID TO DAUGHTER OF BOARD MEMBER, JOSEPH J. KRUSE 0 HEATHER MOLLING EMPLOYMENT 55177 COMPENSATION PAID TO SISTER-IN-LAW OF BOARD MEMBER, PAUL MOLLING, D.O. 0 JOHN W COCHRAN MD EMPLOYMENT 291954 COMPENSATION PAID TO SPOUSE OF BOARD MEMBER, MARGARENT M. GRENISEN, M.D. 0 STACI M ANIL EMPLOYMENT 62367 COMPENSATION PAID TO SPOUSE OF BOARD MEMBER, GOKHAN ANIL, M.D. 0 MAUREEN E GRENISEN EMPLOYMENT 19417 COMPENSATION PAID TO SISTER OF BOARD MEMBER, MARGARET M. GRENISEN, M.D. 0 MMSI INC COMMON BOARD MEMBER 2749985 CAPITATION PAYMENTS/HEALTH BENEFIT PLAN 0 BEN MY KRUSE EMPLOYMENT 26703 COMPENSATION PAID TO SON OF BOARD MEMBER/CAO, JOSEPH J. KRUSE 0 LUKE C COCHRAN EMPLOYMENT 24322 COMPENSATION PAID TO SON OF BOARD MEMBER, MARGARET M. GRENISEN, M.D. 0 ROBIN L FITZGERALD EMPLOYMENT 27142 COMPENSATION PAID TO SPOUSE OF BAORAD MEMBER, KEVIN FITZGERALD, M.D. 0 FORM 990, PART VI, SECTION A, LINE 2 HUGHES, PETER R., JOHNSON M.D., TIMOTHY J., KRUMHOLZ M.D., ALAN J., KRUSE, JOSEPH J., TIGGELAAR, THOMAS H. HAVE A BUSINESS RELATIONSHIP AS THEY SERVE AS AN OFFICER, DIRECTOR, OR TRUSTEE OF HEALTH TRADITION HEALTH PLAN, A RELATED TAXABLE ENTITY. FORM 990, PART VI, SECTION A, LINE 3 MAYO CLINIC, MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, AND OTHER RELATED COMPANIES PROVIDE MANAGEMENT SERVICES TO THE ENTIRE SYSTEM OF ENTITIES. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS, COMPENSATION FOR THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES HAS BEEN DISCLOSED IN PART VII AND SCHEDULE J AS REQUIRED. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS OF THE ORGANIZATION WERE AMENDED ON OCTOBER 24, 2013 TO EXPAND ON THE RESERVE POWERS OF THE SOLE CORPORATE MEMEBER IN REGARD TO THE INCURRENCE OF DEBT, CAPITAL EXPENDITURES, BUDGETS, COMPENSATION, AND BRANDING. IN ADDITION, CHANGES WERE REFLECTED IN THE COMPOSITION OF THE MANAGEMENT COMMITTEE, AND A SECTION WAS ADDED REGARDING THE EXECUTION OF DOCUMENTS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE, INC. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BODY IS SUBJECT TO APPROVAL BY THE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE ARTICLES OF INCORPORATION PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS AMENDMENT OF ARTICLES AND BYLAWS, CERTAIN LARGE TRANSACTIONS, AND OTHER KEY DECISIONS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER AND FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FILING ORGANIZATIONS 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 AND ADMINISTRATIVE LEADERSHIP. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY IN THE FALL FOR THE NEXT YEAR'S COMPENSATION. THE SALARY OF THE CEO, CAO AND PHYSICIAN LEADERS ON THE BOARD OF THE FILING ORGANIZATION WERE REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO CLINIC HEALTH SYSTEM - PHYSICIAN AND ADMINISTRATIVE LEADERSHIP. THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE MAYO CLINIC HEALTH SYSTEM ENTITIES. THE COMMITTEE IS COMPRISED OF MAYO EMPLOYEES, BUT IS INDEPENDENT FOR INTERNAL REVENUE CODE 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED (WITH RECUSAL WHERE APPROPRIATE). THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE THEN REVIEWS AND APPROVES THE COMPENSATION. FOR THOSE INDIVIDUALS FOR WHICH THE MAYO CLINIC HEALTH SYSTEM COMMITTEE CAN NOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE COMPENSATION AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. INFORMATION ON MAYO CLINIC HEALTH SYSTEM PHYSICIAN AND ADMINISTRATIVE LEADERSHIP COMPENSATION AND BENEFITS IS ALSO REVIEWED BY THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION AND GOVERNANCE (GOVERNANCE COMMITTEE), WHICH IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. IN ADDITION TO THE ABOVE COORDINATED REVIEW PROCESS CONDUCTED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE AND/OR THE MAYO CLINIC GOVERNANCE COMMITTEE, THE SOUTHWEST WISCONSIN REGION OF THE MAYO CLINIC HEALTH SYSTEM (WHICH INCLUDES THE FILING ORGANIZATION) ALSO HAS ITS OWN COMPENSATION REVIEW AND APPROVAL PROCESS FOR THE REGION'S SENIOR LEADERSHIP AND PHYSICIANS (WHICH INCLUDES THE BOARD PRESIDENT/CEO AND CAO). THE PROCESS INCLUDES REVIEW OF COMPARABILITY DATA FOR SIMILAR SIZED ORGANIZATIONS BY AN INDEPENDENT COMMITTEE CONSISTING OF PUBLIC BOARD MEMBERS ONLY. SALARY RANGES FOR THE PAST YEAR AND RANGES FOR THE NEXT YEAR ARE REVIEWED FOR REASONABLENESS. CONTEMPORANEOUS MEETING MINUTES OF THE COMPENSATION COMMITTEE ARE KEPT ON FILE. 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 XI, LINE 9: FAS PENSION-POST RETIREMENT ADJUSTMENT 50,559,040. REVERSE BOOK / TAX DIFFERENCE FROM RELATED ORG RECEIVABLES -8,312,083. 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 FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC 464 SOUTH ST JOSEPH AVENUE ARCADIA WI 54612 391322480 FUNDRAISING FOUNDATION WI 501(C)(3) 9 MCHS--FRANCISCAN HEALTHCARE INC 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 -- METHODIST HOSPITAL 200 FIRST STREET SW ROCHESTER MN 55905 410739106 HOSPITAL MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HOSPITAL-- ROCHESTER 200 FIRST STREET SW ROCHESTER MN 55905 410944601 HOSPITAL MN 501(C)(3) 3 MAYO CLINIC 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 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 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 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 PHYSICIAN SOFTWARE SYSTEMS LLC 3333 WARRENVILLE ROAD SUITE 200 LISLE IL 60532 453414836 HEALTHCARE RELATED SOFTWARE IL N/A 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 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 MCHS PHYSICIANS IN WAYCROSS INC 1900 TEBEAU STREET WAYCROSS GA 31501 204363143 PHYSICIAN OFFICES GA 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 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 DESTINATION MEDICAL CENTER ECONOMIC DEVELOPMENT AGENCY 50 SOUTH SIXTH STREET SUITE 1500 MINNEAPOLIS MN 554021498 464893585 ECONOMIC DEVELOPMENT MN 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 CHARITABLE LEAD TRUST (2) CHARITABLE TRUST CA N/A T 0 CHARITABLE LEAD TRUST CHARITABLE TRUST MN N/A T 0 CHARITABLE LEAD TRUST CHARITABLE TRUST IL 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 MN 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 (7) CHARITABLE TRUST FL N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST LA N/A T 0 CHARITABLE REMAINDER TRUST (76) CHARITABLE TRUST MN N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NC N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST TX 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 (72) CHARITABLE TRUST MN N/A T 0 1 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC B 53260 GAAP MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC C 1581962 GAAP MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION-SPARTA INC C 64384 GAAP MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC R 719532 GAAP MAYO CLINIC - METHODIST HOSPITAL A 124325 GAAP MAYO CLINIC - METHODIST HOSPITAL L 68289 GAAP MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC Q 61668 GAAP MMSI INC M 181149 GAAP MMSI INC S 2749985 GAAP FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC S 210770 GAAP HEALTH TRADITION HEALTH PLAN R 29243361 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC Q 425000 GAAP