2014-11-11T10:23:13-06:00 2013-12-31 990 2013-01-01 411236756 MAYO CLINIC HEALTH SYSTEM-MANKATO MAYO 5075381297 1025 MARSH STREET MANKATO MN 56002 JAMES TARASOVITCH CFO 5073856449 2014-11-11 2013 2015-11-30 17:44:51Z GREGORY KUTCHER MD 1025 MARSH STREET MANKATO MN 56002 320182073 0 5983 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1968 MN HOSPITAL AND CLINICS 15 7 2706 256 8549 -439 4515761 5116318 311650784 309942373 563303 2303263 2067320 2081229 318797168 319443183 126322 103047 0 0 174374882 192176250 0 0 429921 127843721 110960900 302344925 303240197 16452243 16202986 248126557 270240431 41948311 47797776 206178246 222442655 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 257732898 308519938 PATIENT CARE (SCHEDULE O):PATIENT CARE: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 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 - MANKATO (MCHS-MANKATO) IS A MEMBER OF THE MAYO CLINIC HEALTH SYSTEM.IN 2013, MCHS-MANKATO ADMITTED MORE THAN 10,500 PATIENTS, SERVED OVER 300,000 OUTPATIENTS AND SERVED OVER 225,000 CLINIC PATIENT VISITS.PHYSICIAN CLINICS: MCHS-MANKATO OPERATES SEVERAL PRIMARY CARE AND MULTI-SPECIALTY CLINICS TO SERVE THE NEEDS OF THE AREA. THESE CLINICS INCLUDE APPROXIMATELY 150 PHYSICIAN AND MID-LEVEL PROVIDERS. THESE CLINICS ARE LOCATED IN MANKATO, NORTH MANKATO, LAKE CRYSTAL, ST. PETER, AND LE SUEUR.MCHS-MANKATO EMPLOYS BOARD CERTIFIED EMERGENCY ROOM PHYSICIANS TO STAFF THE MCHS-MANKATO ER 24 HOURS A DAY, 7 DAYS A WEEK.MCHS-MANKATO CONTRACTS WITH MAYO CLINIC IN ROCHESTER FOR PHYSICIAN SERVICES IN CARDIOLOGY, MEDICAL ONCOLOGY, & RADIATION ONCOLOGY. WITHOUT THESE ARRANGEMENTS, MANKATO AREA PATIENTS WOULD HAVE TO TRAVEL GREATER DISTANCES FROM HOME TO RECEIVE THESE SPECIALTY SERVICES.MCHS-MANKATO 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 $1,863,000.THE COST OF UNCOMPENSATED CARE PROVIDED TO LOW INCOME PATIENTS THROUGH MEDICAID WAS APPROXIMATELY $22,190,000. THIS AMOUNT INCLUDES A MEDICAID SURCHARGE OF $1,746,886 AND $3,668,993 PAID TO MINNESOTA CARE (A PROGRAM THAT PROVIDES HEALTH CARE FOR LOW INCOME POPULATIONS).THE COST OF UNCOMPENSATED CARE PROVIDED THROUGH MEDICARE WAS APPROXIMATELY $44,249,000.MCHS-MANKATO ALSO PROVIDES DISCOUNTS TO UNINSURED PATIENTS. THE TOTAL DISCOUNTS GIVEN IN 2013 WERE $780,000.HOSPITAL AUXILIARY:THE HOSPITAL AUXILIARY OPERATES UNDER MCHS-MANKATO'S TAX EXEMPT STATUS. THE AUXILIARY'S MAIN SOURCES OF INCOME ARE THE OPERATION OF A GIFT SHOP AND FUNDRAISING.THE AUXILIARY AND ITS VOLUNTEERS HAVE ENHANCED THE HEALING ENVIRONMENT AND SERVICES OFFERED TO PATIENTS, VISITORS & STAFF OF THE HOSPITAL. AUXILIARY MEMBERSHIP TOTALED OVER 300 PEOPLE AND THESE MEMBERS CONTRIBUTE THOUSANDS OF HOURS OF SERVICE EACH YEAR. THE MAJOR SERVICES PROVIDED BY AUXILIARY MEMBER VOLUNTEERS ARE AS FOLLOWS: - THE GIFT SHOP-PATRONIZED BY PATIENTS, VISITORS MAKING PURCHASES FOR PATIENTS, AND EMPLOYEES-CONTRIBUTES IMPORTANTLY TO OUR EXEMPT FUNCTION BY IMPROVING PHYSICAL COMFORT AND MENTAL WELL BEING OF PATIENTS, THEREBY ENCOURAGING THEIR RECOVERY; AND ALSO KEEPING EMPLOYEES AND MEDICAL STAFF ON THE HOSPITAL PREMISES, THEREBY INCREASING THE HOSPITAL'S EFFICIENCY. - VOLUNTEERS HAVE ASSEMBLED LARGE NUMBERS OF MAILINGS FOR HOSPITAL DEPARTMENTS AS WELL AS BABY PACKETS FOR DISTRIBUTION TO NEW MOTHERS.DURING 2013, APPROXIMATELY 250 VOLUNTEERS DONATED APPROXIMATELY 20,200 HOURS OF VOLUNTEER SERVICE. THESE SERVICES WERE VALUED AT APPROXIMATELY $457,200 BASED ON THE INDEPENDENT SECTOR NATIONAL VALUE OF VOLUNTEER TIME. 3318667 564555 EDUCATION (SCHEDULE O):EDUCATION: RURAL FAMILY PRACTICE RESIDENCY PROGRAM - THIS PROGRAM IS BASED ON THE CONCEPT THAT EFFECTIVE TRAINING IN RURAL MEDICINE IS BEST CARRIED OUT IN A RURAL AREA. THE PROGRAM IS BASED IN MANKATO AND BEGAN IN 1994. RESIDENTS PARTICIPATE IN A HEALTH CARE DELIVERY SYSTEM THAT LINKS AMBULATORY & INPATIENT SERVICES IN A RURAL COMMUNITY WITH TERTIARY AND QUATERNARY CARE IN A MAJOR METROPOLITAN AREA. THE RESIDENCY PROVIDES A SUPPORTIVE ENVIRONMENT TO MAXIMIZE DIDACTIC LEARNING AND THE ACQUISITION OF PROCEDURAL AND PATIENT-PHYSICIAN COMMUNICATION SKILLS. CLINICAL REFERENCE LIBRARIES AND LIBRARY SEARCH SERVICES ARE AVAILABLE AT ALL SITES. DURING THEIR FIRST YEAR, RESIDENTS DEVELOP THEIR OWN PATIENT PANELS MUCH AS THEY WOULD IN A TYPICAL PRACTICE. THE FIRST YEAR OF TRAINING CONSISTS OF INTENSIVE EXPERIENCE IN THE BASIC DISCIPLINES OF INTERNAL MEDICINE, OBSTETRICS, PEDIATRICS, EMERGENCY MEDICINE, SURGERY, GYNECOLOGY AND NEUROLOGY. INTEGRATION INTO THE COMMUNITY IS AN IMPORTANT PART OF THE TRAINING. PRACTICE MANAGEMENT AND COMMUNITY MEDICINE ARE EMPHASIZED DURING THIS TIME. RESIDENTS ARE ENCOURAGED TO GET INVOLVED WITH COMMUNITY ORGANIZATIONS, CONDUCT EDUCATIONAL EVENTS IN SCHOOLS, AND OTHERWISE BE INVOLVED IN CIVIC ORGANIZATIONS.ROTATIONS IN ORTHOPEDICS, SURGERY, OBSTETRICS, INTERNAL MEDICINE, GYNECOLOGY, AND AMBULATORY PEDIATRICS OCCUR AT MCHS-MANKATO. IN THE THIRD YEAR, ROTATIONS IN OPHTHALMOLOGY, OTOLARYNGOLOGY, DERMATOLOGY, UROLOGY, AND SUBSPECIALTY MEDICINE ARE ALSO CARRIED OUT AT MCHS-MANKATO. BEHAVIORAL MEDICINE IS TAUGHT IN A LONGITUDINAL FASHION OVER ALL THREE YEARS WITH A ONE-MONTH CONCENTRATED EXPERIENCE IN THE SECOND OR THIRD YEAR.ALMOST TWO THIRDS OF THE PHYSICIANS THAT HAVE GRADUATED FROM THE PROGRAM HAVE BEGUN THEIR PRACTICE IN RURAL SETTINGS. 431037 103047 15057 COMMUNITY SUPPORT (SCHEDULE O)COMMUNITY SUPPORT:DIABETES WELLNESS PROGRAM - THE DIABETES & WELLNESS PROGRAM IS A COMMUNITY PROGRAM SPONSORED BY MCHS-MANKATO WHICH IS DESIGNED TO HELP PEOPLE WITH DIABETES BETTER MANAGE THEIR HEALTH. A TEAM OF HEALTH EXPERTS PROVIDES INDIVIDUALIZED CARE TO ANYONE WITH DIABETES INTERESTED IN IMPROVING THEIR HEALTH. MEETINGS CONSIST OF A THREE-HOUR SESSION EVERY SIX MONTHS INCLUDING INDIVIDUAL SESSIONS WITH VARIOUS MEMBERS OF THE DIABETES WELLNESS TEAM AND A ONE-HOUR GROUP SESSION WITH OTHER CLIENTS AND THEIR SPOUSES/SUPPORT PERSONS. THE DIABETES WELLNESS TEAM INCLUDES A DIABETES NURSE EDUCATOR, DIETITIAN, BEHAVIORAL COUNSELOR, SKIN/WOUND CARE SPECIALIST, EXERCISE SPECIALIST, SOCIAL WORKER, DIABETES CASE MANAGER, PHARMACIST, AND OTHERS AS NEEDED. ANYONE 18 YEARS OR OLDER WITH DIABETES IS ENCOURAGED TO PARTICIPATE, ALONG WITH THE SPOUSE OR OTHER SUPPORT PERSON. THIS PROGRAM IS OFFERED AT NO COST TO THE PARTICIPANTS.STOP! NICOTINE DEPENDENCE PROGRAM - THIS PROGRAM FOCUSES ON COUNSELING, PHARMACOLOGIC THERAPY, & RELAPSE PREVENTION. PARTICIPANTS ARE ENCOURAGED TO BRING A SMOKE-FREE SUPPORT PERSON TO GROUPS. THE STAFF OF STOP! ARE TRAINED IN THE TREATMENT OF NICOTINE DEPENDENCE AND WORK IN COLLABORATION WITH THE PATIENT'S PRIMARY CARE PHYSICIAN.SEXUAL ASSAULT RESOURCE TEAM - SURVIVORS OF SEXUAL VIOLENCE OFTEN EXPERIENCE FEAR, SHOCK, NUMBNESS, DISBELIEF, SHAME, ANGER, AND FEELINGS OF A LOSS OF CONTROL OVER THEIR LIVES. THEY HAVE EXPERIENCED A MAJOR CRISIS IN THEIR LIFE. IT MAY BE DIFFICULT TO TRUST PEOPLE, AND TO CONTINUE ON WITH A NORMAL ROUTINE MAY REQUIRE TREMENDOUS EFFORT. CRISES OF ANY KIND ARE EASIER TO COPE WITH WHEN THERE ARE SUPPORTIVE PEOPLE CLOSE BY, PEOPLE WHO ACCEPT AND UNDERSTAND YOUR FEELINGS, PEOPLE WHO CAN HELP YOU OBTAIN NEEDED INFORMATION, AND PEOPLE WHO CARE.THE PRIORITY FOR THE SEXUAL ASSAULT RESOURCE TEAM IS TO ATTEND TO THE PATIENT'S MEDICAL NEEDS IN A SAFE, NON-JUDGMENTAL SETTING. CARING AND SUPPORTIVE RESOURCE TEAM ADVOCATES ARE AVAILABLE TO LISTEN TO CONCERNS, ANSWER QUESTIONS AND PRESENT VARIOUS OPTIONS. WHILE IN THE EMERGENCY DEPARTMENT, CARE WILL BE PROVIDED BY A NURSE WHO HAS SPECIAL TRAINING IN HELPING VICTIMS OF SEXUAL ASSAULT. THE TEAM NURSE WILL EXPLAIN WHAT WILL HAPPEN WHILE IN THE EMERGENCY DEPARTMENT AND WILL ANSWER ANY QUESTIONS. SHE WILL ALSO OFFER EMOTIONAL SUPPORT & GUIDANCE, ALONG WITH PERFORMING THE SPECIAL EXAMS NEEDED.PREADMISSION EDUCATION PROGRAM - PREADMISSION EDUCATION IS PERSONAL TIME WITH A REGISTERED NURSE TO DISCUSS THE HOSPITAL STAY, PAIN MANAGEMENT, AND NURSING CARE. IT IS DESIGNED TO HELP THE PATIENT AND FAMILY PREPARE FOR THE HOSPITAL EXPERIENCE, TO HELP THEM UNDERSTAND WHAT TO EXPECT DURING THE STAY, AND TO HELP THEM PLAN FOR THE EVENTUAL RETURN HOME. A REGISTERED NURSE WILL PROVIDE ONE-ON-ONE INSTRUCTION FOR THE PATIENT AND FAMILY PRIOR TO ADMISSION TO THE HOSPITAL WHERE INFORMATION IS RECEIVED ON PREPARING FOR SURGERY AND THE HOSPITAL STAY. EACH PREADMISSION SESSION IS STRUCTURED SPECIFICALLY FOR THE INDIVIDUAL AND SUBJECTS ROUTINELY COVERED INCLUDE PRE-SURGERY INSTRUCTIONS, PAIN CONTROL, COUGHING, AND DEEP BREATHING TECHNIQUES. THIS PROGRAM IS OFFERED FREE OF CHARGE.SUPPORT GROUPS - A NUMBER OF GROUPS ARE SUPPORTED AND COORDINATED BY MCHS-MANKATO TO ASSIST PATIENTS AND THEIR FRIENDS AND FAMILY IN DEALING WITH A VARIETY OF MEDICAL ISSUES INCLUDING: ALZHEIMER'S, AIDS, ARTHRITIS/FIBROMYALGIA, BEREAVEMENT, BREAST CANCER, BRAIN INJURY, CANCER, CROHN'S DISEASE, DIABETES, MENTAL ILLNESSES, MULTIPLE SCLEROSIS, OSTOMY, STROKE, AND SUICIDE.BICYCLE SAFETY RALLY - MCHS-MANKATO ANNUALLY SPONSORS A BIKE SAFETY RALLY. THE EVENT FEATURED BIKE HELMETS FOR SALE AT UP TO 85 PERCENT OFF RETAIL PRICE, A BIKE SAFETY CHECK, A BIKE SAFETY RODEO, CHILDREN'S ACTIVITIES, PRIZE GIVEAWAYS AND LIVE RADIO BROADCASTS. OVER 1,000 HELMETS ARE SOLD AT THE EVENT. MCHS-MANKATO STAFF AND VOLUNTEERS PROVIDE OVER 500 HOURS OF TIME TO THIS EVENT. THE RALLY IS ALSO SPONSORED IN PART BY AREA BUSINESSES.DONATIONS - ANNUALLY, MCHS-MANKATO CONTRIBUTES IN-KIND RESOURCES AND FINANCIALLY TO NUMEROUS LOCAL AGENCIES AND INITIATIVES. DURING 2013, MCHS-MANKATO PROVIDED OVER $100,000 IN DONATIONS.MINNESOTA BREAST AND CERVICAL CANCER CONTROL - MCHS-MANKATO PARTICIPATES AS THE MANKATO FUNDING COORDINATOR FOR THE MINNESOTA BREAST AND CERVICAL CANCER CONTROL PROGRAM, WHICH IS SPONSORED BY THE STATE OF MINNESOTA. THE PROGRAM IS A PARTNERSHIP BETWEEN THE PUBLIC HEALTH AND PRIVATE HEALTH CARE SECTORS. THE GOAL IS TO PROVIDE QUALITY BREAST AND CERVICAL CANCER SCREENING, FREE OF CHARGE, TO LOW AND MODERATE INCOME MINNESOTA WOMEN, AGE 40 AND OVER, WHO ARE UNINSURED OR UNDERINSURED. THIS PROJECT INVOLVES PROVIDING SCREENING AND DIAGNOSTIC MAMMOGRAMS, CLINIC VISITS, COLPOSCOPY, PAP SMEARS AND FINE NEEDLE ASPIRATION OF A BREAST LUMP AT NO COST FOR QUALIFIED INDIVIDUALS. QUALIFICATIONS ARE BASED ON INCOME ELIGIBILITY DETERMINED BY FEDERAL POVERTY GUIDELINES.SUPPORTIVE PRAYER AND LISTENING: THIS IS OFFERED THROUGH PASTORAL CARE AS PART OF THE SPIRIT-CENTERED CARE INITIATIVE. STEPHEN MINISTRY: A STEPHEN MINISTER IS SOMEONE WHO HAS 50 HOURS OF TRAINING IN CONFIDENTIAL LISTENING. STEPHEN MINISTERS ARE AVAILABLE TO LISTEN TO A PATIENT'S STORY AFTER RETURNING HOME. WE REALIZE THAT THE PATIENT MAY BE IN THE MIDST OF A LIFE SITUATION THAT HAS BECOME OVERWHELMING AND HAS CONTRIBUTED TO THEIR HOSPITALIZATION. WE CARE ABOUT PATIENTS' SPIRITUAL AND PHYSICAL WELL-BEING AFTER THEY LEAVE THE HOSPITAL. A CHAPLAIN CAN DISCUSS THE POSSIBILITY OF CONNECTING WITH A STEPHEN MINISTER WHO WOULD TOUCH BASE REGULARLY.THE VARIOUS ASPECTS OF THE PARISH NURSING PROGRAM WERE FUNDED BY THE ORGANIZATION AND BY PARTICIPATION BY STAFF AND VOLUNTEERS TO CARRY OUT THE VARIOUS EFFORTS. 161075 2263623 RESEARCH: CLINICAL RESEARCH IN MEDICAL ONCOLOGY IS PROVIDED FOR PHASE III AND IV STUDIES, EMPLOYED RESEARCH ASSOCIATES AND A PHYSICIAN PRINCIPAL INVESTIGATOR COORDINATING THE PROGRAM. CLINICAL RESEARCH ACCRUAL OCCURS THOUGH THE NORTH CENTRAL CANCER TREATMENT GROUP (NCCTG), CLINICAL TRIALS SUPPORT UNIT (CTSU), MAYO CLINIC CANCER RESEARCH CONSORTIUM (MCCRC), AND RADIATION THERAPY ONCOLOGY GROUP (RTOG) RESEARCH GROUPS. CLINICAL RESEARCH PROTOCOLS AND TRIALS ARE AVAILABLE IN MANY SPECIALTY AREAS WITH NEW STUDIES OPENING ON A REGULAR BASIS. CLINICAL RESEARCH ASSOCIATES WORK WITH THE PHYSICIAN INVESTIGATORS TO COORDINATE THE STUDIES.SHARED SERVICES: MCHS-MANKATO LEASES SPACE AND PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE. 161075 2263623 261643677 1 1 0 1 0 0 0 0 0 0 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 0 1 0 0 0 0 0 1 1 1 0 0 1 306 0 1 2706 1 1 1 0 0 0 0 0 0 0 0 0 X 15 7 1 1 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 MN X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 ALLEN SHERI DIRECTOR 1.00 0.00 X 0 0 0 BROLSMA GREG DIRECTOR 1.00 0.00 X 0 0 0 CRAGUN MD KEVIN T DIRECTOR 1.00 40.00 X 0 571093 47849 GAALSWYK MARK DIRECTOR 1.00 0.00 X 0 0 0 GRACE RICHARD W DIRECTOR/SECY/CAO 40.00 0.00 X X 313519 568 30442 HEBL MD JAMES R DIRECTOR 1.00 40.00 X 0 450860 37699 HERRMANN MD MARTIN J DIRECTOR 1.00 40.00 X 0 251223 48155 JOHNSON TOM DIRECTOR 1.00 0.00 X 0 0 0 KUTCHER MD GREGORY R DIRECTOR/PRESIDENT/CEO 40.00 0.00 X X 455895 0 35280 MILLER DENNIS DIRECTOR/VICE CHAIR (JAN-OCT) 1.00 0.00 X X 0 0 0 MORRIS MD MARIE E DIRECTOR 1.00 40.00 X 0 367429 49741 NESSE MD ROBERT E DIRECTOR 1.00 40.00 X 0 740824 15779 PIESCHEL SHARON DIRECTOR 1.00 0.00 X 0 0 0 SCHOENBAUER BRAD DIRECTOR 1.00 0.00 X 0 0 0 SPINNER MD ROBERT J DIRECTOR 1.00 40.00 X 0 785492 49472 YEAR PAMELA DIRECTOR 1.00 0.00 X 0 0 0 FRATZKE MARK S COO, CHIEF NURSING OFFICER 40.00 0.00 X 256176 0 37322 GAGER BRIAN G SITE CAO 40.00 0.00 X 196960 0 36558 KOCH MARK B ASSISTANT SECRETARY 1.00 40.00 X 0 316763 13860 TARASOVITCH JAMES J CFO 40.00 0.00 X 266706 0 27577 CAMPBELL MD STEPHEN S CHIEF MEDICAL OFFICER 40.00 0.00 X 323389 0 42714 DEACONSON MD TIMOTHY F CHIEF OP MED OFFICER/PHYSICIAN 40.00 0.00 X 716596 0 33542 KOWAL DO GERALD K PHYSICIAN 40.00 0.00 X 316556 0 41714 PEARSON MD SUSAN E PHYSICIAN 40.00 0.00 X 573768 0 26746 CANNELLA MD DOMINIC M PHYSICIAN 40.00 0.00 X 697673 0 32631 CHYATTE MD DOUGLAS PHYSICIAN 40.00 0.00 X 698811 0 25130 LI MD SHILUN D PHYSICIAN 40.00 0.00 X 605298 0 37101 SHARMA MANISH S PHYSICIAN 40.00 0.00 X 609889 0 35986 STANCHFIELD JR MD WARREN R PHYSICIAN 40.00 0.00 X 636518 0 16849 BOROWSKI THOMAS J FORMER KEY EMPLOYEE 40.00 0.00 X 235404 0 36774 REEVES MD ANDREW L FORMER KEY EMPLOYEE 40.00 0.00 X 372501 0 42778 WHITED MD BRIAN L FORMER KEY EMPLOYEE 40.00 0.00 X 367740 0 39493 7643399 3484252 841192 227 1 1 0 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 ADMIN & MEDICAL SERVICES 9742193 ROBERT W CARLSTROM CO INC 1901 EXCEL DRIVE MANKATO MN 56001 CONSTRUCTION SERVICES 2137108 UNIVERSITY OF MN REGENTS 516 DELAWARE ST SE MINNEAPOLIS MN 55455 PHYSICIANS & RESIDENTS 1992687 MAYO CLINIC HEALTH SYSTEM - FAIRMONT 800 MEDICAL CENTER DRIVE FAIRMONT MN 56031 MEDICAL SERVICES 1758467 PRECYSE SOLUTIONS LLC 1275 DRUMMERS LANE SUITE 200 WAYNE PA 19087 TRANSCRIPTION SERVICES 1305319 34 1550 548750 4007429 558589 5116318 PATIENT CARE 620000 307114195 307114195 SHARED SERVICES 561000 2008666 2008666 EDUCATION 611600 564555 564555 RENT FROM AFFILIATES 531120 238054 238054 RESEARCH 541700 16903 16903 309942373 2133557 2133557 938299 409328 528971 528971 528971 373925 204219 169706 169706 169706 15615 12869 2746 2746 137049 112474 24575 24575 CAFETERIA/VENDING 722210 1168025 1149492 18533 MED REC/TRANSCRIPTION 541900 249881 249881 MISC. REVENUE 900099 68587 20862 47725 38444 565 8549 29330 1524937 319443183 311363173 8549 2955143 X 100047 100047 3000 3000 3731460 2075025 1656435 1360117 975988 384129 152173548 137062016 14855106 256426 5767274 5196438 560922 9914 19321494 17351201 1938215 32078 9822357 8757055 1049243 16059 253089 253089 232643 218389 14254 7659 7659 44975431 21368453 23578573 28405 473594 27122 446109 363 12769312 9589616 3130851 48845 5465831 5322027 138360 5444 1069192 688348 364201 16643 1054663 1045679 8984 146674 146674 11483271 10957228 525003 1040 1216424 650263 566161 FEDERAL INCOME TAXES 3928 3928 MEDICAL SUPPLIES 32891135 32891135 BAD DEBT EXPENSE 10956025 10956025 MN CARE TAX 3668993 3668993 -15706964 -7449404 -8258010 450 303240197 261643677 41166599 429921 5451 5921 88041 74822 0 291234 40420647 40411430 0 23333 3841081 4899083 3270974 2174349 205746414 108143367 103490033 97603047 88667321 109492206 8343009 15265006 248126557 270240431 33192950 37219996 534599 487030 2388288 2290216 5832474 7800534 41948311 47797776 X 206178246 222442655 206178246 222442655 248126557 270240431 16202986 61423 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 7659 7659 0 PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. MAYO CLINIC HEALTH SYSTEM - MANKATO (MCHS-MANKATO) PROVIDES INFORMATION OR EXPRESSES ITS CONCERN TO LEGISLATIVE BODIES AND GOVERNMENT OFFICIALS ON MATTERS DIRECTLY RELATED TO HEALTH, THE DELIVERY OF HEALTH CARE AND MEDICAL EDUCATION AND/OR RESEARCH. IN 2013, MCHS-MANKATO REPRESENTATIVES HAD SEVERAL MEETINGS WITH MEMBERS OF THE LEGISLATIVE AND EXECUTIVE BRANCHES OF GOVERNMENT TO DISCUSS ISSUES RELATING TO HEALTH CARE AND HEALTH CARE REFORM. 7738626 7738626 83765973 40106234 43659739 112232027 68037133 44194894 2009788 2009788 97603047 MAYO POOLED INVESTMENTS 109210329 F ASSETS HELD BY TRUSTEES 281877 F 109492206 LIFE INSURANCE RECEIVABLE 580650 DUE FROM AFFILIATES 6402679 DEFERRED COMPENSATION RESERVE 7800534 STREET PROJECT ASSESSMENTS 481143 15265006 DEFERRED COMPENSATION RESERVE 7800534 7800534 X 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. WOMEN'S SHOW - LADIES FIRST 14327 14327 9114 1119 2543 2 1288 1288 93 15615 15615 9114 93 1119 2543 12869 2746 1 1 X 1 X 1 X 1 1 1 0 1 1 1862952 1862952 0.00640 42068382 19878267 22190115 0.07590 43931334 19878267 24053067 0.08230 314990 15057 299933 0.00100 3318667 564555 2754112 0.00940 8090696 4247973 3842723 0.01310 161075 16903 144172 0.00050 29500 29500 0.00010 11914928 4844488 7070440 0.02410 55846262 24722755 31123507 0.10640 48547 48547 0.00020 35000 35000 0.00010 83547 83547 0.00030 0 10956025 62851799 70929745 -8077946 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM - MANKATO 1025 MARSH ST MANKATO MN 56002 MAYOCLINICHEALTHSYSTEM.ORG 00033 X X X X MAYO CLINIC HEALTH SYSTEM - MANKATO 1 1 X X X X X X X X X 13 1 0 1 X MAYOCLINICHEALTHSYSTEM.ORG/ABOUT-US/COMMU X X X 1 0 1 1 100.000000000000 1 400.000000000000 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 MAYO CLINIC HEALTH SYSTEM - MANKATO PART V, SECTION B, LINE 3: MAYO CLINIC HEALTH SYSTEM IN MANKATO RECEIVED INPUT FROM LOCAL COMMUNITY AND ORGANIZATION LEADERS AND PUBLIC HEALTH OFFICIALS INCLUDING THE BLUE EARTH COUNTY COMMUNITY HEALTH SUPERVISOR. MAYO CLINIC HEALTH SYSTEM - MANKATO 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. MAYO CLINIC HEALTH SYSTEM - MANKATO 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. MAYO CLINIC HEALTH SYSTEM - MANKATO 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. MAYO CLINIC HEALTH SYSTEM - MANKATO PART V, SECTION B, LINE 20D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 10% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE. 8 MCHS-MANKATO-EASTRIDGE 101 MARTIN LUTHER KING JR DRIVE MANKATO MN 56001 CLINIC MCHS-MANKATO-NORTHRIDGE 1695 LOR RAY DRIVE NORTH MANKATO MN 56003 CLINIC MCHS-MANKATO-ST PETER 1900 NORTH SUNRISE DRIVE ST PETER MN 56082 CLINIC MAYO CLINIC HEALTH SYSTEM-MANKATO 1400 MADISON AVENUE MANKATO MN 56001 DME AND PT MCHS-MANKATO-LE SUEUR 625 SOUTH 4TH STREET LE SUEUR MN 56058 CLINIC MCHS-MANKATO-NEW ULM 1324 5TH NORTH NEW ULM MN 56073 DIALYSIS MCHS-MANKATO-LAKE CRYSTAL 200 EAST PRINCE STREET LAKE CRYSTAL MN 56055 CLINIC MCHS-MANKATO 1400 MADISON AVENUE MANKATO MN 56001 HOSPICE 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: $939,099. 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 $ 10,956,025. PART II, COMMUNITY BUILDING ACTIVITIES: THE MISSION OF MAYO CLINIC AND ITS AFFILIATES IS TO PUT THE NEEDS OF THE PATIENT FIRST. WE BELIEVE THAT MISSION IS BEST ACCOMPLISHED WITHIN HEALTHY, WELCOMING AND THRIVING COMMUNITIES. TO DELIVER ON THAT BELIEF, MCHS-MANKATO COLLABORATES WITH PUBLIC, PRIVATE AND NONPROFIT ORGANIZATIONS TO SUSTAIN AND ENHANCE THE COMMUNITIES IT SERVES. PART III, LINE 2: PART III, SECTION A, LINE 1:THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.METHODOLOGY FOR SCHEDULE H, PART III, LINE 2:BAD DEBT EXPENSE IS DETERMINED BASED ON GAAP AND IS EXPLAINED IN THE ACCOUNTS RECEIVABLE FOOTNOTE OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. PART III, LINE 4: FOOTNOTES RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS CAN BE FOUND ON PAGES 5, 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 APPROXIMATELY $44,249,000 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 - MANKATO (MCHS-MANKATO) ADMINISTRATION AND ITS BOARD OF DIRECTORS ALONG WITH COMMUNITY STAKEHOLDERS, WORK CLOSELY WITH LOCAL EDUCATIONAL INSTITUTIONS, OPEN DOOR HEALTH CENTER, CHARITIES, AND HEALTH DEPARTMENTS TO ASSESS HEALTHCARE NEEDS. MCHS-MANKATO DEVELOPS A STRATEGIC PLAN TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY BASED ON THE INPUT RECEIVED. SERVICES, EDUCATION, VOLUNTEERS, IN KIND SUPPORT, MONETARY DONATIONS AND GOODS ARE SUPPLIED ONCE THOSE NEEDS ARE ASSESSED. REQUESTS FOR ASSISTANCE ARE TRIAGED THROUGH THE PUBLIC RELATIONS AND ADMINISTRATION DEPARTMENTS, AND EVALUATED BASED ON THE STRATEGIC PLAN. 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: MCHS-MANKATO IS LOCATED IN MANKATO, MINNESOTA. ITS SERVICE AREA INCLUDES BLUE EARTH, NICOLLET AND OTHER SURROUNDING COUNTIES IN SOUTHERN MINNESOTA. MCHS-MANKATO IS DESIGNATED AS A SOLE COMMUNITY HOSPITAL AND A RURAL REFERRAL CENTER FOR MEDICARE PURPOSES. MCHS-MANKATO IS THE ONLY HOSPITAL IN BLUE EARTH COUNTY. THE POPULATION OF BLUE EARTH AND NICOLLET COUNTY (WHICH COMPRISES A LARGE PORTION OF MCHS-MANKATO'S SERVICE AREA) IS APPROXIMATELY 100,000. ACCORDING TO THE U.S. CENSUS BUREAU, APPROXIMATELY 15% OF INDIVIDUALS IN THE TWO COUNTIES ARE LIVING BELOW POVERTY LEVEL. APPROXIMATELY 12% OF INDIVIDUALS IN THE TWO COUNTIES ARE ABOVE AGE 65 AND APPROXIMATELY 10% OF THE POPULATION WAS UNINSURED. 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 ORGANIZATION'S ACTIVITIES.SURPLUS FUNDSMAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE.COMMUNITY REPRESENTATION ON GOVERNING BODY:THE BOARD OF TRUSTEES IS THE GOVERNING BODY OF MAYO CLINIC. A MAJORITY OF ITS MEMBERS ARE EXTERNAL, INDEPENDENT TRUSTEES. IT HAS OVERALL RESPONSIBILITY FOR THE CHARITABLE, CLINICAL PRACTICE, SCIENTIFIC AND EDUCATIONAL MISSION AND PURPOSES OF MAYO CLINIC AND ITS AFFILIATES AS SET FORTH IN ITS ARTICLES OF INCORPORATION AND BYLAWS. BECAUSE OF MAYO CLINIC'S NATIONAL PRESENCE, THESE TRUSTEES ARE SELECTED BASED ON THEIR AREAS OF EXPERTISE, WHETHER IN HEALTH CARE POLICY, BUSINESS, GOVERNMENT OR ANOTHER FIELD. IN ADDITION TO THIS COMMUNITY REPRESENTATION AT THE PARENT ENTITY, THE FILING ORGANIZATION ALSO INVOLVES LOCAL COMMUNITY MEMBERS ON ITS GOVERNING BODY.OPEN V. CLOSED STAFF MODEL:STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.EMERGENCY ROOM THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. PART VI, LINE 6: THIS ORGANIZATION IS A PART OF MAYO CLINIC HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO CLINIC HEALTH SYSTEM IS DESCRIBED IN RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). THAT STATEMENT ALSO DESCRIBES THE ROLES OF THE VARIOUS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED. PART VI LINE 7: NEITHER THE FILING ORGANIZATION, NOR ANY RELATED ORGANIZATION, FILES A COMMUNITY BENEFIT REPORT WITH ANY STATE OTHER THAN THE EXTENT TO WHICH COMMUNITY BENEFIT INFORMATION IS INCLUDED IN OTHER REPORTING REQUIREMENTS SUCH AS INFORMATION PROVIDED TO A STATE HOSPITAL ASSOCIATION. 1 GREATER MANKATO AREA UNITED WAY INC 101 NORTH 2ND STREET 100 MANKATO MN 56001 416008819 501(C)(3) 8400 IN SUPPORT OF EXEMPT PURPOSE READY FOR KINDERGARTEN NORTHPORT CENTER 1970 LOOKOUT DRIVE DRIVE NORTH MANKATO MN 56003 416000310 STATE OF MN 13585 KINDERGARTEN PREP PROGRAM SOUTH CENTRAL COLLEGE NORTH MANKATO CAMPUS FOUNDATION 1920 LEE BOULEVARD NORTH MANKATO MN 56003 411649572 501(C)(3) 10000 SCHOLARSHIP SUPPORT CITY OF MANKATO 10 CIVIC CENTER PLAZA MANKATO MN 56001 416005344 CITY OF MANKATO 35000 SUPPORT FITNESS PROGRAM 4 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. 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 X X X 1 1 0 0 0 0 0 0 0 CRAGUN MD KEVIN T DIRECTOR 0 492122 0 0 0 78971 0 23464 0 24385 0 618942 0 0 GRACE RICHARD W DIRECTOR/SECY/CAO 313519 0 0 0 0 568 12750 0 17692 0 343961 568 0 0 HEBL MD JAMES R DIRECTOR 0 425391 0 0 0 25469 0 17235 0 20464 0 488559 0 0 HERRMANN MD MARTIN J DIRECTOR 0 248575 0 0 0 2648 0 23183 0 24972 0 299378 0 0 KUTCHER MD GREGORY R DIRECTOR/PRESIDENT/CEO 455895 0 0 0 0 0 12750 0 22530 0 491175 0 0 0 MORRIS MD MARIE E DIRECTOR 0 339893 0 0 0 27536 0 30488 0 19253 0 417170 0 0 NESSE MD ROBERT E DIRECTOR 0 633648 0 0 0 107176 0 54 0 15725 0 756603 0 0 SPINNER MD ROBERT J DIRECTOR 0 690679 0 0 0 94813 0 24974 0 24498 0 834964 0 0 FRATZKE MARK S COO, CHIEF NURSING OFFICER 256176 0 0 0 0 0 12750 0 24572 0 293498 0 0 0 GAGER BRIAN G SITE CAO 196960 0 0 0 0 0 10119 0 26439 0 233518 0 0 0 KOCH MARK B ASSISTANT SECRETARY 0 305711 0 0 0 11052 0 230 0 13630 0 330623 0 0 TARASOVITCH JAMES J CFO 266706 0 0 0 0 0 10200 0 17377 0 294283 0 0 0 CAMPBELL MD STEPHEN S CHIEF MEDICAL OFFICER 323389 0 0 0 0 0 12750 0 29964 0 366103 0 0 0 DEACONSON MD TIMOTHY F CHIEF OP MED OFFICER/PHYSICIAN 716596 0 0 0 0 0 12750 0 20792 0 750138 0 0 0 KOWAL DO GERALD K PHYSICIAN 316556 0 0 0 0 0 12750 0 28964 0 358270 0 0 0 PEARSON MD SUSAN E PHYSICIAN 573768 0 0 0 0 0 12750 0 13996 0 600514 0 0 0 CANNELLA MD DOMINIC M PHYSICIAN 697673 0 0 0 0 0 5100 0 27531 0 730304 0 0 0 CHYATTE MD DOUGLAS PHYSICIAN 698811 0 0 0 0 0 5100 0 20030 0 723941 0 0 0 LI MD SHILUN D PHYSICIAN 605298 0 0 0 0 0 10200 0 26901 0 642399 0 0 0 SHARMA MANISH S PHYSICIAN 609889 0 0 0 0 0 7955 0 28031 0 645875 0 0 0 STANCHFIELD JR MD WARREN R PHYSICIAN 636518 0 0 0 0 0 10200 0 6649 0 653367 0 0 0 BOROWSKI THOMAS J FORMER KEY EMPLOYEE 235404 0 0 0 0 0 11941 0 24833 0 272178 0 0 0 REEVES MD ANDREW L FORMER KEY EMPLOYEE 372501 0 0 0 0 0 12750 0 30028 0 415279 0 0 0 WHITED MD BRIAN L FORMER KEY EMPLOYEE 367740 0 0 0 0 0 12750 0 26743 0 407233 0 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, LINES 4A-B LINE 4A: IN 2013, TIMOTHY DEACONSON, M.D. RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $286,108, WHICH IS INCLUDED IN THE AMOUNT REPORTED IN COLUMN B(I) OF SCHEDULE J, PART II. 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). KEVIN T. CRAGUN, M.D. $ 52,527 JAMES R. HEBL, M.D. $ 24,223 MARK B. KOCH $ 8,890 MARIE E. MORRIS, M.D. $ 20,849 ROBERT E. NESSE, M.D. $ 97,541 ROBERT J. SPINNER, M.D. $ 91,649 PART III COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. MANISH S SHARMA HIGHEST PAID EMPLOYEE SIGNING BONUS X 40000 23333 0 1 1 23333 MMSI INC COMMON BOARD MEMBER 14693493 PURCHASED SERVICES & PAYMENTS AS A THIRD PARTY PAYOR 0 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: HERRMANN M.D., MARTIN J. MORRIS M.D., MARIE E. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: MORRIS M.D., MARIE E. GRACE, RICHARD W. KOCH, MARK B. BROLSMA, GREG GAALSWYK, MARK THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: CRAGUN M.D., KEVIN T. GRACE, RICHARD W. HEBL M.D., JAMES R. KOCH, MARK B. SPINNER M.D., ROBERT J. 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. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS, COMPENSATION FOR THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES HAS BEEN DISCLOSED IN PART VII AND SCHEDULE J AS REQUIRED. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS MAYO CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER ELECTS THE MEMBER DIRECTORS. THE SOLE MEMBER ELECTS THE COMMUNITY DIRECTORS THAT HAVE BEEN APPROVED BY THE BOARD OF DIRECTORS AND NOMINATED BY VARIOUS NOMINATING GROUPS. FORM 990, PART VI, SECTION A, LINE 7B THE BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS DEBT, AMENDMENT OF THE BYLAWS, MERGERS, AND NEW SERVICES. 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 DIRECTOR OF FINANCE, THE CFO AND THE ADMINISTRATOR. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FILING ORGANIZATION'S GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C MAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF MAYO CLINIC (AND/OR AFFILIATE) AND THE OUTSIDE ENTITY. ADDITIONAL CONFLICT OF INTEREST POLICIES AND PROCEDURES EXIST FOR CERTAIN ENTITIES CONCERNING RESEARCH CONTRACTS AND OTHER TYPES OF POTENTIAL CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS 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 SALARIES OF THE CEO, CAO, AND PHYSICIAN LEADERSHIP 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 MINNESOTA REGION OF THE MAYO CLINIC HEALTH SYSTEM (WHICH INCLUDES THE FILING ORGANIZATION) ALSO HAS ITS OWN COMPENSATION REVIEW AND APPROVAL PROCESSES FOR THE REGION'S SENIOR LEADERSHIP AND PHYSICIANS (WHICH INCLUDES THE CEO AND CAO). THE PROCESSES INCLUDE 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 IX, LINE 11G IC PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 7,231,739. MANAGEMENT AND GENERAL EXPENSES 22,720,194. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,951,933. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 14,136,714. MANAGEMENT AND GENERAL EXPENSES 858,379. FUNDRAISING EXPENSES 28,405. TOTAL EXPENSES 15,023,498. FORM 990, PART IX, LINE 24E MEDICAID SURCHARGE : PROGRAM SERVICE EXPENSES 1,746,886. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,746,886. EMPLOYEE RELATED EXPENSE : PROGRAM SERVICE EXPENSES 131,100. MANAGEMENT AND GENERAL EXPENSES 331,462. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 462,562. DUES/LICENSES/SUBSCRIPT : PROGRAM SERVICE EXPENSES 117,479. MANAGEMENT AND GENERAL EXPENSES 296,336. FUNDRAISING EXPENSES 450. TOTAL EXPENSES 414,265. MISC. EXPENSE : PROGRAM SERVICE EXPENSES 45,129. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 45,129. EXP ALLOCATED TO AFFILIATES: PROGRAM SERVICE EXPENSES -9,489,998. MANAGEMENT AND GENERAL EXPENSES -8,885,808. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -18,375,806. 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 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 GOLD CROSS AMBULANCE SERVICE M 119163 GAAP MAYO CLINIC HEALTH SYSTEM--FAIRMONT Q 2739654 GAAP MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE Q 4719156 GAAP MAYO CLINIC HEALTH SYSTEM--SPRINGFIELD Q 3238166 GAAP MAYO CLINIC HEALTH SYSTEM--ST JAMES Q 3501810 GAAP MAYO CLINIC HEALTH SYSTEM--WASECA Q 4177020 GAAP MAYO FOUNDATION FOR MEDICAL EDUCATION & RESEARCH M 101202 GAAP MMSI INC M 546379 GAAP MMSI INC S 14147114 GAAP MAYO CLINIC HEALTH SYSTEM--FAIRMONT M 1758467 GAAP MAYO CLINIC HEALTH SYSTEM-ALBERT LEA AND AUSTIN M 74403 GAAP MAYO CLINIC HEALTH SYSTEM-OWATONNA L 212108 GAAP MAYO CLINIC HEALTH SYSTEM-ALBERT LEA AND AUSTIN L 151831 GAAP MAYO CLINIC HEALTH SYSTEM - MANKATO HEALTH CARE FOUNDATION C 545113 GAAP