2014-11-11T14:05:02-06:00 2013-12-31 990 2013-01-01 411404075 MAYO CLINIC HEALTH SYSTEM-ALBERT LEA AND AUSTIN MAYO 5075381297 1000 FIRST DRIVE NW AUSTIN MN 55912 JAMES J TARASOVITCH CFO 5073852646 2014-11-11 2013 2015-11-30 17:44:51Z MARK R CIOTA MD 1000 FIRST DRIVE NW AUSTIN MN 55912 278727003 0 5983 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1981 MN HOSPITALS AND CLINICS 12 5 2423 309 0 0 2632354 3261039 139504634 267168874 2198778 6558116 748586 1343385 145084352 278331414 176982 261061 0 0 88680264 174853738 0 0 202305 54393975 95608039 143251221 270722838 1833131 7608576 316846724 332660841 30630711 28337642 286216013 304323199 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 226767945 250218834 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 1,000 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-ALBERT LEA AND AUSTIN (MCHS-AL/AU) IS A MINNESOTA NON-PROFIT CORPORATION, TAX EXEMPT AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. TO JUSTIFY THIS TAX EXEMPT STATUS, MCHS-AL/AU PROVIDES SCHOLARSHIPS, CHARITY CARE, INTERPRETING AND EDUCATIONAL SERVICES, AND VARIOUS OTHER COMMUNITY BENEFITS. MCHS-AL/AU PROVIDES PRIMARY CARE NEEDS, INCLUDING FAMILY MEDICINE, INTERNAL MEDICINE, OB/GYN, PEDIATRICS AND GENERAL SURGERY. IN ADDITION, MCHS-AL/AU ALSO PROVIDES SPECIALTY CARE IN CARDIOLOGY, DERMATOLOGY, NEUROLOGY, ONCOLOGY, OPHTHALMOLOGY, OPTOMETRY, OCCUPATIONAL HEALTH, PHYSICAL MEDICINE & REHAB, PSYCHIATRY, RHEUMATOLOGY, AUDIOLOGY, ALLERGY, ORTHOPEDICS, ENT, PSYCHOLOGY, PODIATRY, PHYSICAL THERAPY, WOUND CARE, UROLOGY, AND PLASTIC SURGERY. IN 2013, MCHS-AL/AU HAD 283,611 CLINIC VISITS. MCHS-AL/AU OPERATES REGIONAL CLINICS IN ADAMS, ALDEN, BLOOMING PRAIRIE, GRAND MEADOW, KIESTER, LEROY, NEW RICHLAND, AND WELLS, MINNESOTA AND LAKE MILLS, IOWA.DURING 2013, HOSPITAL INPATIENT DAYS TOTALED 17,078 WITH 1,713 ADDITIONAL DAYS FOR NEWBORN CARE. AS PART OF THE MAYO CLINIC HEALTH SYSTEM, MCHS-AL/AU ACCESSES EMERGENCY MEDICAL HELICOPTER SERVICE THROUGHOUT SOUTHERN MINNESOTA AND NORTHERN IOWA AND RECEIVES AMBULANCE SERVICES FROM GOLD CROSS. THE HELICOPTER PROVIDES RAPID PATIENT TRANSPORT TO THE APPROPRIATE HEALTH CARE FACILITY ALONG WITH DELIVERING HIGH-LEVEL CRITICAL CARE.FOUNTAIN CENTERS IS A MCHS-AL/AU PROGRAM FOR SUBSTANCE ABUSE AND ADDICTION; ITS MAIN CAMPUS IN ALBERT LEA OFFERS RESIDENTIAL AND OUTPATIENT TREATMENT, SUPPORT AND AFTERCARE PROGRAMS. CURRENTLY, FOUNTAIN CENTERS ALSO OFFERS OUTPATIENT PROGRAMS IN FAIRMONT, FARIBAULT, JACKSON, MANKATO, OWATONNA, ROCHESTER AND WASECA AND REACHES FAR OUTSIDE OF MCHS-AL/AU SERVICE AREA TO MEET CHEMICAL DEPENDENCY TREATMENT NEEDS IN SOUTHERN MINNESOTA.MCHS-AL/AU OPERATES ON A NONDISCRIMINATORY BASIS REGARDLESS OF RACE, COLOR, SEX, RELIGION OR NATIONAL ORIGIN.CHARITY CARE: MCHS-AL/AU PROVIDES A VARIETY OF FINANCIAL ASSISTANCE OPTIONS TO PATIENTS WHO MEET ESTABLISHED CRITERIA. ITS ALMCARE PROGRAM ALLOWS PATIENTS WHO MEET FINANCIAL GUIDELINES TO ENROLL ANNUALLY TO RECEIVE CARE DISCOUNTS FROM 10% TO 100%, WITH A $10 CO-PAY FOR PRESCRIPTIONS. SERVICES ARE ALSO PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. THE COST OF CHARITY CARE PROVIDED DURING 2013 WAS APPROXIMATELY $4,079,000, AND THE COST OF UNCOMPENSATED MEDICAID FOR 2013 WAS APPROXIMATELY $5,131,000. REPRESENTED IN THE UNCOMPENSATED MEDICAID AMOUNT IS THE MEDICAID SURCHARGE OF $921,952 AND MNCARE TAX OF $2,621,692. THE UNREIMBURSED COST OF MEDICARE WAS APPROXIMATELY $11,247,000. 1643677 12250 3815 EDUCATION AND SUPPORT SERVICES (SCHEDULE O): EDUCATION AND SUPPORT SERVICES:MCHS-AL/AU SPONSORS A SCHOLARSHIP PROGRAM FOR HIGH SCHOOL SENIORS AND NON-TRADITIONAL STUDENTS FROM THE MCHS-AL/AU SERVICE AREA WHO ARE ENTERING THE HEALTHCARE FIELD. IN THE YEAR ENDING DECEMBER 31, 2013, 13 SCHOLARSHIPS WERE AWARDED TOTALING $12,250. IN ADDITION, MCHS-AL/AU PROVIDES MEETING SPACE AND SPONSORS VARIOUS "ON-SITE" EDUCATION PROGRAMS INCLUDING SHADOWING, PRECEPTORSHIPS, AND INTERNSHIPS. THE ESTIMATED COST OF SUPERVISION AND SPACE FOR THESE PROGRAMS IS $918,351. THERE ARE NUMEROUS HEALTH AND WELLNESS EDUCATION PROGRAMS, CLASSES AND SUPPORT GROUPS PROVIDED TO THE COMMUNITY THROUGHOUT THE YEAR. THESE CLASSES/SUPPORT GROUPS INCLUDE CHILDBIRTH PREPARATION CLASS, BABY PLACE TOURS, PRENATAL BREASTFEEDING EDUCATION, PRENATAL DIET HEALTH EDUCATION, BEREAVEMENT EDUCATION SUPPORT SERIES, CANCER SUPPORT GROUP, DIABETES SUPPORT GROUP, HYPERTENSION CLASS, PULMONARY/CARDIAC REHAB SUPPORT GROUP, RTS BEREAVEMENT SERVICES, STROKE SUPPORT GROUP, OSTOMY SUPPORT GROUP, MENTORS FOR HOPE, TOBACCO CESSATION SERVICES, SPORTS SCREENINGS, INDIVIDUAL SPORTS CONDITIONING AND SPORTS INJURY EVALUATIONS, ALL AT NO CHARGE.MCHS-AL/AU'S PATIENT EDUCATION CENTER PROVIDES FREE BLOOD PRESSURE CHECKS AND HEALTH RESOURCES FOR THE COMMUNITY. LOCATED WITHIN THE FRONT CORRIDOR, THE CENTER'S LIBRARY AREA INCLUDES EASY ACCESS FOR COMMUNITY MEMBERS TO HEALTH EDUCATION AND WELLNESS INFORMATION VIA STAFF, BROCHURES, DVDS, AND USE OF FOUR PUBLIC COMPUTERS. ALSO LOCATED IN THE PATIENT EDUCATION CENTER IS MCHS-AL/AU'S PATIENT ADVOCATE. SHE IS A CERTIFIED SENIOR HEALTH INSURANCE PROGRAM VOLUNTEER WHO FACILITATES MEDICATION ASSISTANCE FOR THOSE UNABLE TO AFFORD MEDICATION PRESCRIBED. SHE ALSO ASSISTS MEDICARE PARTICIPANTS ENROLLING IN THE PART D PLAN. EXPLAINING INSURANCE AND CLARIFYING INSURANCE ISSUES ARE ALSO OFFERED THROUGH THE PATIENT ADVOCATE. WITH THE DEVELOPMENT OF ALMCARE, SHE WORKS CLOSELY WITH THE FINANCE DEPARTMENT IN EDUCATING AND FOLLOWING UP WITH UNINSURED OR UNDERINSURED PATIENTS THAT ARE ACCEPTED INTO THIS PROGRAM.FREE EDUCATION PROGRAMS INCLUDE: - 5 HEALTH EDUCATION PROGRAMS - 52 HEALTH TALK RADIO PROGRAMS - 3 HEALTH SYMPOSIUMS MCHS-AL/AU PROVIDES FREE HEALTH ASSESSMENTS AND SCREENINGS, COUNSELING SERVICES, FREE INTERPRETING SERVICES, AND SPACE FOR COMMUNITY MEETINGS AND SUPPORT GROUPS. SOME EXAMPLES OF THESE SERVICES ARE PROVIDED BELOW.MCHS-AL/AU HAS A HOME HEALTH PROGRAM IN WHICH PRIMARILY ELDERLY PATIENTS WITH CIRCULATORY, RESPIRATORY AND OTHER HEALTH PROBLEMS ARE PROVIDED ASSISTANCE WITH PERSONAL CARES AND ACTIVITIES OF DAILY LIVING. DURING 2013, THE HOME HEALTH PROGRAM SERVED 405 PATIENTS.MCHS-AL/AU ALSO PROVIDES A HOSPICE FOR THE FAMILIES OF TERMINAL PATIENTS. IN 2013, 371 FAMILIES WERE SERVICED BY THIS HOSPICE.DURING 2013, MCHS-AL/AU PROVIDED FREE SPORTS PHYSICALS TO 433 AREA STUDENT ATHLETES. MCHS-AL/AU ALSO BENEFITS FROM COMMUNITY VOLUNTEERS IN ITS AUXILIARY, HOSPICE AND CHEMICAL DEPENDENCY PROGRAMS, AND AS MOVERS AT THE FRONT INFORMATION DESK. DURING 2013, VOLUNTEERS DONATED APPROXIMATELY 28,251 HOURS TO THE MEDICAL CENTER. THE VALUE OF THIS DONATED TIME IS $637,100 BASED ON THE INDEPENDENT SECTORS AVERAGE ESTIMATED VALUE OF SUCH SERVICES. THESE SERVICE HOURS WERE PRIMARILY SPENT ORGANIZING AND MANAGING ACTIVITIES FOR THE BENEFIT OF THE MEDICAL CENTER'S PATIENTS, PATIENTS' FAMILIES, VISITORS, AND STAFF. 270781 248811 126310 COMMUNITY SUPPORT (SCHEDULE O): COMMUNITY SUPPORT: MCHS-AL/AU IS AN ACTIVE MEMBER OF THE COMMUNITY, SUPPORTING SUCH COMMUNITY SERVICES AS SENIOR RESOURCES, FREEBORN COUNTY FAMILY SERVICES COLLABORATIVE, RIVERLAND COMMUNITY COLLEGE, UNITED WAY, YMCA, AREA FOOD SHELVES, NUMEROUS YOUTH ACTIVITIES, COMMUNITY DEVELOPMENT PROJECTS AND SEVERAL OTHER HEALTH-RELATED ORGANIZATIONS.IN 2013, MCHS-AL/AU PREPARED 29,857 MEALS FOR MEALS ON WHEELS, AN ORGANIZATION THAT DISTRIBUTES MEALS TO ELDERLY RESIDENTS IN THE COMMUNITIES OF ALBERT LEA AND AUSTIN. DURING 2013, MCHS-AL/AU MADE CASH AND EQUIPMENT DONATIONS TOTALING OVER $248,000 TO VARIOUS CHARITABLE AND COMMUNITY ORGANIZATIONS. ITS COMMUNITY INVOLVEMENT PROGRAM ALLOWS STAFF TO VOLUNTEER EIGHT HOURS ANNUALLY DURING WORK TIME. IN 2013, 75 MCHS-AL/AU VOLUNTEERS PROVIDED 435 HOURS OF SERVICES TO ENDORSED COMMUNITY PROGRAMS AND PROJECTS. THE VALUE OF THIS DONATED TIME IS APPROXIMATELY $18,433. 12650022 17979332 RESEARCH AND OTHER ACTIVITIES:MCHS-AL/AU STAFF WORK WITH MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM PHYSICIAN INVESTIGATORS TO COORDINATE CLINICAL RESEARCH STUDIES WITH A CMS GRANT. IN 2013, MCHS-AL/AU PARTICIPATED IN A COMPASS GRANT TO PROVIDE CARE COORDINATION DESIGNED TO IMPROVE THE HEALTH AND WELL BEING OF PATIENTS DIAGNOSED WITH BOTH DEPRESSION AND A CHRONIC DISEASE IN COMMUNITIES THEY SERVE. MCHS-AL/AU LEASES SPACE AND PROVIDES SUPPORT SERVICES TO AFFILATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE. 12650022 17979332 241332425 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 104 0 1 2423 1 0 0 0 0 0 0 0 0 0 0 X 12 5 1 1 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 1 1 MN X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 CIOTA MD MARK R CEO/CHAIR/DIRECTOR 40.00 0.00 X X 682444 0 45841 CRANDALL DAVID TREASURER (1/31-12/31)/DIRECTOR 1.00 0.00 X X 0 0 0 CRUZ-LARES LINDA A SECRETARY (1/31-12/31)/DIRECTOR 1.00 0.00 X X 0 0 0 CUNNINGHAM MD PETER L DIRECTOR 40.00 0.00 X 162918 0 31465 FUNK MICHAEL S DIRECTOR 1.00 0.00 X 0 0 0 GABRIELSON SHARON R DIRECTOR 1.00 40.00 X 0 203206 40648 HEINZ MD DIETER V CHAIR (1/1-1/31)/DIR (1/1-6/20) 40.00 0.00 X X 281712 0 30866 MILLER MD ROBERT C V CHAIR(1/31-12/31)/TREAS(1/1-1/31) 1.00 40.00 X X 0 527067 50640 MONSON REV GLENN L DIRECTOR 1.00 0.00 X 0 0 0 PARKS DOUGLAS A REGION CAO/DIRECTOR 1.00 40.00 X X 0 203383 46538 POTACH BRENDA DIRECTOR 1.00 0.00 X 0 0 0 SAVELKOUL DONALD DIRECTOR (1/1-6/27) 1.00 0.00 X 0 0 0 SCHULZ MD JOHN M DIRECTOR (6/27-12/31) 40.00 0.00 X 775740 0 47717 YTTERBERG MD KAREN L DIRECTOR 1.00 40.00 X 0 188540 33603 AGERTER MD DAVID C REGION CEO 1.00 40.00 X 0 494245 16310 DANKERT SHERI S SITE CFO 40.00 0.00 X 154875 0 36009 KOCH MARK B ASSISTANT SECRETARY 1.00 40.00 X 0 316763 13860 PILOT DAVID L REGION CFO (1/1-4/26) 40.00 0.00 X 83823 0 13356 TARASOVITCH JAMES J REGION CFO (4/26-12/31) 1.00 40.00 X 0 266706 27577 WALDHOFF STEPHEN C CAO 1.00 40.00 X 0 262259 63931 BARNES MD DARRYL E MEDICAL STAFF PRESIDENT/PHYSICIAN 40.00 0.00 X 404343 0 42695 COLLIER DPM ROBERT L MEDICAL STAFF VP/PHYSICIAN 40.00 0.00 X 290358 0 42107 COPPES MD JOHN B MEDICAL DIRECTOR/PHYSICIAN 40.00 0.00 X 385027 0 38243 ECKSTROM MD MICHAEL T CHAIR OF SURGERY/PHYSICIAN 40.00 0.00 X 1148364 0 44956 EHN JEROME T OPERATIONS ADMINISTRATOR 40.00 0.00 X 153064 0 28266 GRZYBOWSKI MD JOHN A CHAIR OF PRIMARY CARE/PHYSICIAN 40.00 0.00 X 361842 0 42857 KRITZER TAMMY L OPERATIONS ADMINISTRATOR 40.00 0.00 X 150596 0 35221 LARSON VIRGINIA OPERATIONS ADMINISTRATOR 40.00 0.00 X 166141 0 35494 NORDENG RODNEY L OPERATIONS ADMINISTRATOR 40.00 0.00 X 165343 0 35548 YOUNG DO NATHAN P MEDICAL SPECIALTIES CHAIR/PHYSICIAN 40.00 0.00 X 305000 0 21446 BOYCE MD CORY A PHYSICIAN 40.00 0.00 X 703766 0 35330 ENGMAN MD STEVEN J PHYSICIAN 40.00 0.00 X 610075 0 45654 LOTTS MD JEFFREY P PHYSICIAN 40.00 0.00 X 578133 0 47087 SCHULZ MD JODI L PHYSICIAN 40.00 0.00 X 497200 0 46341 SKORIN DO LEONID PHYSICIAN 40.00 0.00 X 866102 0 37227 SHELHAMER MD LEONARD E FORMER VICE CHAIR 40.00 0.00 X 209125 0 31413 BUCKMASTER DPM ROY W FORMER KEY EMPLOYEE 40.00 0.00 X 265917 0 36783 LOMBARDI MD JOSEPH M FORMER KEY EMPLOYEE 40.00 0.00 X 273966 0 28273 STOLTENBERG MD HEIDI G FORMER KEY EMPLOYEE 40.00 0.00 X 236815 0 38873 ULRICH MD MICHAEL D FORMER KEY EMPLOYEE 40.00 0.00 X 337743 0 45889 10250432 2462169 1258064 195 1 1 0 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 PATIENT/LAB/ADMIN SERVICES 4716048 MEDICAL DOCTOR ASSOCIATES PO BOX 277185 ATLANTA GA 30384 PROFESSIONAL FEES 1108897 EXECUTIVE HEALTH RESOURCES INC PO BOX 822688 PHILADELPHIA PA 19182 CONSULTING 404699 EMERGENCY PRACTICE ASSOCIATES PO BOX 1260 WATERLOO IA 50704 PROFESSIONAL SERVICES 382638 SODEXO INC AND AFFILIATES PO BOX 70060 CHICAGO IL 60673 MANAGEMENT FEES 304226 27 31236 2933 1848 1080386 2119262 25374 3261039 NET PATIENT REVENUE 620000 249093396 249093396 SHARED SERVICES 561000 17712458 17712458 RENT FROM AFFILIATES 531120 266874 266874 MEALS ON WHEELS 624210 92331 92331 EDUCATION REVENUE 611600 3815 3815 267168874 6554097 6554097 24703 30262 -5559 -5559 -5559 257303 253284 4019 4019 4019 6306 1848 252 6054 6054 3490 627 2863 2863 154543 111164 43379 43379 CAFETERIA/VENDING 722210 1079765 1079765 MISC CONSULTING 541610 82718 82718 MISCELLANEOUS 900099 64851 16338 48513 69314 63314 6000 1296648 278331414 268328291 0 6742084 248811 248811 12250 12250 6243677 4457656 1786021 2057018 1843030 171637 42351 128646735 120297890 8265441 83404 7843102 7325191 512757 5154 21548601 20076956 1457758 13887 8514605 7881051 624093 9461 124176 124176 1620 1620 6573 6573 24773923 19018808 5754212 903 531878 11332 484816 35730 8632056 7723489 899584 8983 2889321 1421916 1467405 4120718 3978488 142230 1223063 921578 299515 1970 774187 708449 65738 52903 733 52170 9380692 4207223 5173469 1608161 1608161 MEDICAL SUPPLIES 30051108 30051108 BAD DEBT EXPENSE 6921932 6921932 MN CARE TAX 2621629 2621629 MEDICAID SURCHARGE 921952 921952 972147 679333 292352 462 270722838 241332425 29188108 202305 598193 5445 23637 8494 8004 40488516 42389275 4630662 4435445 3412816 2593036 214393357 101370289 115157651 113023068 134852792 151681147 20000 20000 17653963 18505421 316846724 332660841 20497539 18323227 89750 69750 14654 13826 10028768 9930839 30630711 28337642 X 273838565 301881312 12006291 2061283 371157 380604 286216013 304323199 316846724 332660841 X 7608576 10364619 133991 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1620 1620 0 PART II-B, LINE 1: MAYO CLINIC HEALTH SYSTEM - ALBERT LEA AND AUSTIN (MCHS-AL/AU) 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-AL/AU REPRESENTATIVES CONTACTED ELECTED OFFICIALS OF GOVERNMENT TO DISCUSS ISSUES RELATING TO HEALTH CARE AND HEALTH CARE REFORM. THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. 371157 9447 380604 301543 69614 371157 301543 301543 301543 301543 230192 71351 301543 1.00000 0 1 1 5116506 5116506 117272063 55191970 62080093 64991544 46178319 18813225 27013244 27013244 113023068 MAYO POOLED INVESTMENTS 151681147 F 151681147 DUE FROM AFFILIATES 1234279 DEFERRED COMPENSATION 8564967 INTEREST IN NET ASSETS OF FDNS 7887469 PARTNERSHIP INVESTMENT 63616 STRATEGIC PROPERTY INVESTMENTS 755090 18505421 DUE TO AFFILIATES 177664 DEFERRED COMPENSATION LIABILITY 8663775 ASSET RETIREMENT OBLIGATION 1087400 OTHER LIABILITY 2000 9930839 X PART V, LINE 4: THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR EDUCATION AND PATIENT SUPPORT. 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 4078605 4078605 0.01550 34263163 29132546 5130617 0.01940 4681641 4034637 647004 0.00250 43023409 33167183 9856226 0.03740 592625 33979 558646 0.00210 1063469 3815 1059654 0.00400 16956554 11683196 5273358 0.02000 377871 316905 60966 0.00020 93074 93074 0.00040 19083593 12037895 7045698 0.02670 62107002 45205078 16901924 0.06410 9663 9663 0.00000 154018 154018 0.00060 86 86 0.00000 169 169 0.00000 1270 1270 0.00000 170 170 0.00000 165376 165376 0.00060 0 6921932 28899254 46463960 -17564706 X 1 1 2 1 MAYO CLINIC HEALTH SYSTEM - ALBERT LEA 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 MAYOCLINICHEALTHSYSTEM.ORG 00920 X X X 2 MAYO CLINIC HEALTH SYSTEM - AUSTIN 1000 FIRST DRIVE NW AUSTIN MN 55912 MAYOCLINICHEALTHSYSTEM.ORG 00920 X X X MAYO CLINIC HEALTH SYSTEM - ALBERT LEA 1 1 X X X X X X X X 13 1 0 1 X MAYOCLINICHEALTHSYSTEM.ORG/ABOUT-US X X X 1 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 MAYO CLINIC HEALTH SYSTEM - AUSTIN 2 1 X X X X X X X X X 13 1 0 1 X MAYOCLINICHEALTHSYSTEM.ORG/ABOUT-US X X X 1 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 MAYO CLINIC HEALTH SYSTEM - ALBERT LEA PART V, SECTION B, LINE 3: A SURVEY WAS SENT OUT TO RANDOM RESIDENTS OF FREEBORN COUNTY AND KEY INFORMANT SESSIONS WERE HELD THAT INCLUDED, BUT WERE NOT LIMITED TO: THE DEAN OF STUDENTS FROM TWO AREA HIGH SCHOOLS, THE DIRECTOR OF FREEBORN COUNTY WORKFORCE DEVELOPMENT, THE DIRECTOR OF SEMCAC, A POLICE OFFICER OF THE ALBERT LEA POLICE DEPARTMENT, AND AN AREA CLERGYMAN. A CHNA ADVISORY GROUP WAS CONVENED IN THE PLANNING STAGES OF CONDUCTING THE CHNA AND AGAIN WHEN SURVEY AND KEY INFORMANT SESSION RESULTS WERE COMPLETED. THE CHNA ADVISORY GROUP INCLUDED: THE DIRECTOR OF FREEBORN COUNTY PUBLIC HEALTH, THE DIRECTOR OF ALBERT LEA FAMILY YMCA, THE DIRECTOR OF FREEBORN COUNTY CHILDREN'S CENTER, A REPRESENTATIVE OF FREEBORN COUNTY RESOURCES, THE DIRECTOR OF FREEBORN COUNTY UNITED WAY, THE DIRECTOR OF FREEBORN COUNTY FAMILY SERVICE COLLABORATIVE, THE EXECUTIVE DIRECTOR OF ALBERT LEA/FREEBORN COUNTY CHAMBER OF COMMERCE, THE DIRECTOR OF SOUTHEAST MINNESOTA COMMUNITY ACTION COMMITTEE. MAYO CLINIC HEALTH SYSTEM - AUSTIN PART V, SECTION B, LINE 3: THE CHNA EFFORT DIRECTLY REACHED OUT TO CITIZENS WHO REPRESENT THE VARIETY OF AGES, INCOMES, EDUCATION LEVELS AND ETHNIC BACKGROUNDS IN MOWER COUNTY, AND INTENTIONALLY CONNECTED WITH GROUPS SUCH AS THE COMMUNITY HEALTH SERVICES ADMINISTRATOR OF MOWER COUNTY HEALTH AND HUMAN SERVICES THAT REPRESENT THE 15.3 PERCENT OF CITIZENS WHO LIVE BELOW THE POVERTY LEVEL AND GROWING POPULATION OF MINORITIES. IN ADDITION, FOCUS GROUPS AND A CITIZEN SURVEY WERE CONDUCTED AT WORKPLACES, HEALTH FAIRS, HIGH SCHOOLS, THE LOCAL COMMUNITY COLLEGE, AND ENGLISH LANGUAGE LEARNING CLASSROOMS AS WELL AS TAKING INFORMATION FROM SURVEYS CONDUCTED BY MOWER COUNTY HEALTH AND HUMAN SERVICES AND MOWER REFRESHED, WHICH REFLECT A WIDE SAMPLING OF THE COUNTY'S POPULATION BY ETHNICITY, AGE, AND GENDER. MAYO CLINIC HEALTH SYSTEM - ALBERT LEA 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 - AUSTIN 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 - ALBERT LEA PART V, SECTION B, LINE 14G: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMBEROUS 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 - AUSTIN 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 - ALBERT LEA 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 GOVENMENTAL 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 - AUSTIN 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 GOVENMENTAL 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 - ALBERT LEA 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. MAYO CLINIC HEALTH SYSTEM - AUSTIN 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. 21 MCHS AT HEALTH REACH 1705 SE BROADWAY ALBERT LEA MN 56007 OUTPATIENT PHYSICAL THERAPY MCHS - ALBERT LEA IN LAKE MILLS 309 S 10TH AVE LAKE MILLS IA 50450 CLINIC MCHS - ALBERT LEA IN NEW RICHLAND 318 FIRST ST SW NEW RICHLAND MN 56072 CLINIC MCHS - ALBERT LEA IN ALDEN 192 WASHINGTON AVE ALDEN MN 56009 CLINIC MCHS - ALBERT LEA IN WELLS 301 S BROADWAY WELLS MN 56097 CLINIC MCHS - ALBERT LEA IN KIESTER 120 N MAIN ST KIESTER MN 56051 CLINIC MCHS - EXPRESS CARE IN ALBERT LEA 2708 BRIDGE AVE ALBERT LEA MN 56007 EXPRESS CARE CLINIC MCHS - AUSTIN - ADAMS 908 WEST MAIN ST ADAMS MN 55909 CLINIC FOUNTAIN CENTERS IN AUSTIN 101 14TH ST NW AUSTIN MN 55912 CHEMICAL DEPENDENCY FOUNTAIN CENTERS IN ALBERT LEA 408 WEST FOUNTAIN STREET ALBERT LEA MN 56007 CHEMICAL DEPENDENCY FOUNTAIN CENTERS IN FAIRMONT 828 N NORTH AVENUE FAIRMONT MN 56031 CHEMICAL DEPENDENCY FOUNTAIN CENTERS IN FARIBAULT 2301 NW 4TH STREET FARIBAULT MN 55021 CHEMICAL DEPENDENCY FOUNTAIN CENTERS IN MANKATO 1400 MADISON AVE SUITE 326 MANKATO MN 56001 CHEMICAL DEPENDENCY FOUNTAIN CENTERS IN OWATONNA 134 SOUTHVIEW OWATONNA MN 55060 CHEMICAL DEPENDENCY FOUNTAIN CENTERS IN ROCHESTER CEDARWOOD MALL 4122 18TH AVE NW ROCHESTER MN 55901 CHEMICAL DEPENDENCY FOUNTAIN CENTERS IN WASECA 505 S STATE STREET SUITE 6 WASECA MN 56093 CHEMICAL DEPENDENCY FOUNTAIN CENTERS IN JACKSON 308 W ASHLEY ST JACKSON MN 56143 CHEMICAL DEPENDENCY MCHS - AUSTIN HOME HEALTH 408 4TH AVE NW AUSTIN MN 55912 HOME HEALTH & HOSPICE OFFICES MCHS - AUSTIN - LEROY 671 EAST MAIN LEROY MN 55951 CLINIC MCHS - AUSTIN - BLOOMING PRAIRIE 405 EAST MAIN BLOOMING PRAIRIE MN 55917 CLINIC MCHS - AUSTIN - GRAND MEADOW 113 MAIN ST GRAND MEADOW MN 55936 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: $5,133,144. 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 $ 6,921,932. PART II, COMMUNITY BUILDING ACTIVITIES: THROUGH DONATIONS, GRANTS, AND VOLUNTEER HOURS TO PUBLIC, PRIVATE AND NONPROFIT ORGANIZATIONS, THE FILING ORGANIZATION ASSISTS WITH SUSTAINING AND ENHANCING THE COMMUNITIES IT SERVES. PART III, LINE 2: THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.METHODOLOGY FOR SCHEDULE H, PART III, LINE 2:BAD DEBT EXPENSE IS DETERMINED BASED ON GAAP AND IS EXPLAINED IN THE ACCOUNTS RECEIVABLE FOOTNOTE OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. PART III, LINE 4: FOOTNOTES RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS CAN BE FOUND ON PAGES 5, 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 $11,247,000 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 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: IT HAS LONG BEEN THE PRACTICE FOR MAYO CLINIC HEALTH SYSTEM ALBERT LEA AND AUSTIN TO REACH OUT TO THE COMMUNITY FOR FEEDBACK, TO IDENTIFY NEEDS AND TO BUILD PARTNERSHIPS TO MEET THOSE NEEDS. IN FACT, WE HAVE BEEN DOING THAT FOR WELL OVER 100 YEARS. ALBERT LEA/FREEBORN COUNTY:WORKING IN CONJUNCTION WITH FREEBORN COUNTY PUBLIC HEALTH AND THE MINNESOTA DEPARTMENT OF HEALTH, MAYO CLINIC HEALTH SYSTEM ALBERT LEA AND AUSTIN IN ALBERT LEA CONDUCTED A MULTI-FACETED APPROACH TO GATHERING INFORMATION AND IDENTIFYING LOCAL HEALTH NEEDS.THE PRIMARY TOOL WAS A COMMUNITY SURVEY DEVELOPED TO DETERMINE INDIVIDUAL HEALTH HABITS AND HEALTH CONCERNS THAT WOULD PROVIDE A GLIMPSE INTO THE HEALTH STATUS OF THE COMMUNITY THAT COULD BE COMPARED AGAINST OTHER COUNTY AND STATE DATA TO DETERMINE OUTLIERS.THE SURVEY WAS SUPPORTED BY KEY INFORMANT SURVEYS AND FACE-TO-FACE MEETINGS WITH COMMUNITY REPRESENTATIVES WHO PROVIDED VALUABLE FEEDBACK AND ANECDOTAL INFORMATION TO CLARIFY ISSUES AND GAPS IN COMMUNITY CARE AND SERVICES AND THROUGH REVIEW OF OTHER LOCAL ORGANIZATIONS' SURVEYS TO THEIR CONSTITUENTS. A COMMUNITY HEALTH NEEDS ASSESSMENT ADVISORY GROUP, COMPRISED OF LOCAL STAKEHOLDERS AND COMMUNITY ORGANIZATIONS AND PROGRAMS, WAS CREATED TO HELP IDENTIFY AND PRIORITIZE NEEDS AND DETERMINE WHICH COULD BE REALISTICALLY IMPACTED BY WORKING COLLABORATIVELY WITHIN THE COMMUNITY. NEEDS ASSESSMENT OUTCOMES REVEALED GAPS IN MENTAL HEALTH ACCESS AND CARE AND A HIGH PERCENTAGE OF OBESITY AND CHRONIC DISEASE WITHIN THE FREEBORN COUNTY POPULATION THAT HAVE POTENTIAL FOR IMPROVEMENT AS COMMUNITY GROUPS EXPAND CURRENT WORK OR IDENTIFY NEW PROGRAMS OR PROCESSES TO IMPACT HIGH PRIORITY NEEDS. AUSTIN/MOWER COUNTY:MOWER COUNTY HEALTH & HUMAN SERVICES AND MOWER REFRESHED (A CITIZEN DRIVEN WELLNESS MOVEMENT) COLLECTIVELY CONDUCTED A COMMUNITY SURVEY THAT REFLECTED A WIDE SAMPLING OF THE MOWER COUNTY POPULATION BY ETHNICITY, AGE AND GENDER.THE STRATEGY INVOLVED REACHING OUT DIRECTLY TO CITIZENS WHO REPRESENT THE VARIETY OF AGES, INCOMES, EDUCATION LEVELS, AND ETHNIC BACKGROUNDS IN MOWER COUNTY. AS SUCH AN INTENTIONAL EFFORT WAS MADE TO CONNECT WITH GROUPS THAT REPRESENTED THE 15.3% OF CITIZENS WHO LIVE BELOW THE POVERTY LEVEL AND OUR GROWING POPULATION OF MINORITIES TO ENGAGE THEM IN IDENTIFYING COMMUNITY NEEDS.IN THE PROCESS OF INTERVIEWING AND CONDUCTING SURVEYS, CITIZENS NOT ONLY RESPONDED WITH DATA,THE PROCESS ALSO RESULTED IN POTENTIAL SOLUTIONS AND THE DESIRE TO BECOME ENGAGED IN THE DEVELOPMENT OF THOSE SOLUTIONS. THIS WILL BE VALUABLE IN FUTURE NEEDS ASSESSMENTS, BUT MORE IMPORTANTLY IN EDUCATING AND EQUIPPING COMMUNITY MEMBERS TO TAKE RESPONSIBILITY FOR THEIR HEALTH AND THE WELLNESS OF THEIR FAMILIES.THIS SIGNIFICANT SAMPLING OF CITIZENS OFFERED BOTH MAYO CLINIC HEALTH SYSTEM, AUSTIN CAMPUS AND MOWER COUNTY PUBLIC HEALTH INSIGHT TO CONFIRM AND REFOCUS EFFORTS THROUGH PARTNERSHIPS TO ADDRESS THE BOTH IDENTIFIED HEALTH CONCERNS OF COMMUNITY MEMBERS AND POTENTIAL SOLUTIONS. 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 ALBERT LEA AND AUSTIN IS AN INTEGRATED ORGANIZATION, WITH MAIN SITES IN ALBERT LEA AND AUSTIN AND NINE REGIONAL CLINIC LOCATIONS WITHIN 20 MILES OF EACH SITE. THE PRIMARY SERVICE AREA FOR EACH IS ABOUT 35,000, CONCENTRATED IN FREEBORN AND MOWER COUNTIES, RESPECTIVELY. MAYO CLINIC HEALTH SYSTEM ALBERT LEA AND AUSTIN OFFERS A BROAD RANGE OF INPATIENT, OUTPATIENT AND SPECIALTY SERVICES IN SOUTHERN MINNESOTA AND NORTHERN IOWA, INCLUDING A CONVENIENCE CARE CLINIC, CANCER CENTER, PHYSICAL MEDICINE AND REHABILITATION CENTER AND INPATIENT AND OUTPATIENT DRUG AND ALCOHOL TREATMENT FACILITIES. 2012 POPULATION ESTIMATES:ALBERT LEA/FREEBORN COUNTY 30,948AUSTIN/MOWER COUNTY 39,371PERSONS UNDER 5 YEARSALBERT LEA/FREEBORN COUNTY 5.8%AUSTIN/MOWER COUNTY 7.2%PERSONS UNDER 18 YEARSALBERT LEA/FREEBORN COUNTY 21.8%AUSTIN/MOWER COUNTY 25.3% PERSONS 65 AND OVER ALBERT LEA/FREEBORN COUNTY 20.7%AUSTIN/MOWER COUNTY 17.3%TOTAL FEMALE ALBERT LEA/FREEBORN COUNTY 50.3%AUSTIN/MOWER COUNTY 50.2%ETHNICITY/RACE WHITE ALONE ALBERT LEA/FREEBORN COUNTY 96.4%AUSTIN/MOWER COUNTY 93.2%BLACK ALONE ALBERT LEA/FREEBORN COUNTY 1.0%AUSTIN/MOWER COUNTY 3.0%AMERICAN INDIAN/ALASKA NATIVE ALONE ALBERT LEA/FREEBORN COUNTY 0.4%AUSTIN/MOWER COUNTY 0.4%ASIAN ALONE ALBERT LEA/FREEBORN COUNTY 1.0%AUSTIN/MOWER COUNTY 1.9%NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER ALBERT LEA/FREEBORN COUNTY 0.1%AUSTIN/MOWER COUNTY 0.2%HISPANIC OR LATINO ORIGIN ALBERT LEA/FREEBORN COUNTY 9.1%AUSTIN/MOWER COUNTY 11.1%WHITE, NON-HISPANIC ALBERT LEA/FREEBORN COUNTY 87.9%AUSTIN/MOWER COUNTY 82.7%SOURCE: US CENSUS BUREAU 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 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. 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 PHSYICIANS 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 NAEVE HEALTH CARE FOUNDATION 404 W FOUNTAIN ST ALBERT LEA MN 56007 411989509 501(C)(3) 40000 SUPPORT EXEMPT PURPOSE UNITED WAY OF FREEBORN COUNTY 341 S BROADWAY AVE ALBERT LEA MN 56007 410956396 501(C)(3) 23500 SUPPORT EXEMPT PURPOSE ALBERT LEA FAMILY Y 2021 W MAIN ST ALBERT LEA MN 56007 411000679 501(C)(3) 22500 SUPPORT EXEMPT PURPOSE HORMEL FOUNDATION 329 N MAIN ST SUITE 102L AUSTIN MN 55912 410694716 501(C)(3) 10000 SUPPORT EXEMPT PURPOSE ALBERT LEA AREA SCHOOLS ALBERT LEA HIGH SCHOOL 2000 TIGER LN ALBERT LEA MN 56007 416001171 STATE OF MN 19400 SUPPORT PHYSICAL ACTIVITY UNITED WAY OF MOWER COUNTY PO BOX 605 AUSTIN MN 55912 410831896 501(C)(3) 8000 SUPPORT EXEMPT PURPOSE FREEBORN COUNTY HISTORICAL MUSEUM 1031 BRIDGE AVE ALBERT LEA MN 56007 410872543 501(C)(3) 7000 SUPPORT EXEMPT PURPOSE MAYO CLINIC HEALTH SYSTEM - FRANCISCAN MEDICAL CENTER INC 700 WEST AVENUE SOUTH LA CROSSE WI 54601 390806374 501(C)(3) 10000 FAIR MARKET VALUE EQUIPMENT SUPPORT EXEMPT PURPOSE 8 0 SCHOLARSHIPS 13 12250 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 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. SCHOLARSHIPS ARE AWARDED TO INDIVIDUALS PURSUING A DEGREE IN A HEALTHCARE FIELD. THESE SCHOLARSHIPS ARE PAID DIRECTLY TO THE COLLEGE OR UNIVERSITY. 0 1 0 0 0 0 0 0 0 CIOTA MD MARK R CEO/CHAIR/DIRECTOR 682444 0 0 0 0 0 17850 0 27991 0 728285 0 0 0 CUNNINGHAM MD PETER L DIRECTOR 162918 0 0 0 0 0 12181 0 19284 0 194383 0 0 0 GABRIELSON SHARON R DIRECTOR 0 202448 0 0 0 758 0 20273 0 20375 0 243854 0 0 HEINZ MD DIETER V CHAIR (1/1-1/31)/DIR (1/1-6/20) 281712 0 0 0 0 0 17850 0 13016 0 312578 0 0 0 MILLER MD ROBERT C V CHAIR(1/31-12/31)/TREAS(1/1-1/31) 0 471900 0 0 0 55167 0 23446 0 27194 0 577707 0 0 PARKS DOUGLAS A REGION CAO/DIRECTOR 0 198505 0 0 0 4878 0 18728 0 27810 0 249921 0 0 SCHULZ MD JOHN M DIRECTOR (6/27-12/31) 775740 0 0 0 0 0 17850 0 29867 0 823457 0 0 0 YTTERBERG MD KAREN L DIRECTOR 0 186270 0 0 0 2270 0 31269 0 2334 0 222143 0 0 AGERTER MD DAVID C REGION CEO 0 431194 0 0 0 63051 0 136 0 16174 0 510555 0 0 DANKERT SHERI S SITE CFO 149072 0 5803 0 0 0 12373 0 23636 0 190884 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 REGION CFO (4/26-12/31) 0 266706 0 0 0 0 0 10200 0 17377 0 294283 0 0 WALDHOFF STEPHEN C CAO 0 256818 0 0 0 5441 0 44846 0 19085 0 326190 0 0 BARNES MD DARRYL E MEDICAL STAFF PRESIDENT/PHYSICIAN 404343 0 0 0 0 0 20400 0 22295 0 447038 0 0 0 COLLIER DPM ROBERT L MEDICAL STAFF VP/PHYSICIAN 290358 0 0 0 0 0 20400 0 21707 0 332465 0 0 0 COPPES MD JOHN B MEDICAL DIRECTOR/PHYSICIAN 385027 0 0 0 0 0 20400 0 17843 0 423270 0 0 0 ECKSTROM MD MICHAEL T CHAIR OF SURGERY/PHYSICIAN 1148364 0 0 0 0 0 17850 0 27106 0 1193320 0 0 0 EHN JEROME T OPERATIONS ADMINISTRATOR 153064 0 0 0 0 0 10963 0 17303 0 181330 0 0 0 GRZYBOWSKI MD JOHN A CHAIR OF PRIMARY CARE/PHYSICIAN 361842 0 0 0 0 0 17850 0 25007 0 404699 0 0 0 KRITZER TAMMY L OPERATIONS ADMINISTRATOR 144960 0 5636 0 0 0 12022 0 23199 0 185817 0 0 0 LARSON VIRGINIA OPERATIONS ADMINISTRATOR 166141 0 0 0 0 0 11753 0 23741 0 201635 0 0 0 NORDENG RODNEY L OPERATIONS ADMINISTRATOR 159707 0 5636 0 0 0 13099 0 22449 0 200891 0 0 0 YOUNG DO NATHAN P MEDICAL SPECIALTIES CHAIR/PHYSICIAN 305000 0 0 0 0 0 20400 0 1046 0 326446 0 0 0 BOYCE MD CORY A PHYSICIAN 703766 0 0 0 0 0 17850 0 17480 0 739096 0 0 0 ENGMAN MD STEVEN J PHYSICIAN 610075 0 0 0 0 0 20400 0 25254 0 655729 0 0 0 LOTTS MD JEFFREY P PHYSICIAN 578133 0 0 0 0 0 17850 0 29237 0 625220 0 0 0 SCHULZ MD JODI L PHYSICIAN 497200 0 0 0 0 0 17850 0 28491 0 543541 0 0 0 SKORIN DO LEONID PHYSICIAN 866102 0 0 0 0 0 17850 0 19377 0 903329 0 0 0 SHELHAMER MD LEONARD E FORMER VICE CHAIR 209125 0 0 0 0 0 14267 0 17146 0 240538 0 0 0 BUCKMASTER DPM ROY W FORMER KEY EMPLOYEE 265917 0 0 0 0 0 17850 0 18933 0 302700 0 0 0 LOMBARDI MD JOSEPH M FORMER KEY EMPLOYEE 273966 0 0 0 0 0 17850 0 10423 0 302239 0 0 0 STOLTENBERG MD HEIDI G FORMER KEY EMPLOYEE 236815 0 0 0 0 0 17085 0 21788 0 275688 0 0 0 ULRICH MD MICHAEL D FORMER KEY EMPLOYEE 337743 0 0 0 0 0 17850 0 28039 0 383632 0 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). DAVID C. AGERTER, M.D. $ 57,612 ROBERT C. MILLER, M.D. $ 48,054 STEPHEN C. WALDHOFF $ 1,664 MARK KOCH $ 8,890 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. JULIE C SAVELKOUL SPOUSE OF DONALD SAVELKOUL, BOARD MEMBER 60372 EMPLOYMENT 0 BEVERLY A LOMBARDI MD SPOUSE OF JOSEPH M. LOMBARDI M.D., KEY EMPLOYEE 83445 EMPLOYMENT 0 PHILLIP HANSON SPOUSE OF HEIDI G. STOLTENBERG M.D., KEY EMPLOYEE 77131 EMPLOYMENT 0 TENEX HEALTH INC BOARD MEMBER OF TENEX HEALTH IS A KEY EMPLOYEE OF THE FILING ORG 35139 PRODUCT SALES 0 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: TARASOVITCH, JAMES J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL WHO IS ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: KOCH, MARK B. MARK R. CIOTA, M.D. AND MICHAEL S. FUNK HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 MAYO CLINIC, MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, AND OTHER RELATED COMPANIES PROVIDE MANAGEMENT SERVICES TO THE ENTIRE SYSTEM OF ENTITIES. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS, COMPENSATION FOR THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES HAS BEEN DISCLOSED IN PART VII AND SCHEDULE J AS REQUIRED. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS MAYO CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER ELECTS TRUSTEES TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENT OF ARTICLES OR BYLAWS REQUIRE APPROVAL BY BOTH THE GOVERNING BODY AND THE SOLE CORPORATE MEMBER. THE BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, AND DEBT DECISIONS. FORM 990, PART VI, SECTION A, LINE 8B THE BOARD OF THE FILING ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON ITS BEHALF. 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 OPERATIONS ADMINISTRATOR, AND THE SITE 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 15A 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, BOARD VICE CHAIR, TREASURER AND SEVERAL BOARD MEMBERS WERE REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO CLINIC HEALTH SYSTEM PHYSICIANS 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 MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE AND/OR THE MAYO CLINIC GOVERNANCE COMMITTEE, THE FILING ORGANIZATION ALSO HAS ITS OWN COMPENSATION REVIEW AND APPROVAL PROCESS FOR SENIOR LEADERSHIP AND PHYSICIANS. 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 IS 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: PLEDGE WRITE-OFF 133,991. FORM 990 PART VI LINE 1B THE BOARD OF TRUSTEES OF MAYO CLINIC, THE PARENT ENTITY OF THE MAYO CLINIC-AFFILIATED ENTITIES, IS COMPRISED OF MORE THAN 50% PUBLIC TRUSTEES. 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 THE HIRSH FAMILY FOUNDATION 108 NORTH MAIN STREET AUSTIN MN 55912 411749842 FUNDRAISING FOUNDATION MN 501(C)(3) 11-I N/A 0 HORMEL FOUNDATION 329 N MAIN ST SUITE 102L AUSTIN MN 55912 410694716 FUNDRAISING FOUNDATION MN 501(C)(3) 11-I N/A 0 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 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 GOLD CROSS AMBULANCE SERVICE M 160042 GAAP MAYO CLINIC -- METHODIST HOSPITAL L 92306 GAAP MAYO CLINIC -- METHODIST HOSPITAL A 116532 GAAP MMSI INC M 268878 GAAP MMSI INC S 14649494 GAAP MMSI INC R 11256507 GAAP MCHS - CANNON FALLS Q 3289989 GAAP MCHS - LAKE CITY Q 1065325 GAAP MCHS - LAKE CITY M 56628 GAAP MCHS - MANKATO L 74403 GAAP MCHS - MANKATO M 151831 GAAP MCHS - OWATONNA Q 11288381 GAAP MCHS - RED WING Q 1713148 GAAP