2013-07-15T14:35:47-05:00 2012-12-31 990 2012-01-01 390806374 MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER INC MAYO 5075381297 700 WEST AVENUE SOUTH LA CROSSE WI 54601 THOMAS TIGGELAAR 5075381297 2013-07-16 2012 2016-02-25 16:41:14Z THOMAS TIGGELAAR 700 WEST AVENUE SOUTH LA CROSSE WI 54601 419185107 0 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1888 WI HOSPITALS AND CLINICS 20 0 4016 751 1553320 58235 2104279 14591874 393769032 400253847 12215 -138431 2384980 2724526 398270506 417431816 34040 243771 0 0 252084206 276106865 0 0 0 150085524 160946143 402203770 437296779 -3933264 -19864963 240278878 241691925 84637011 107230949 155641867 134460976 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 1 408780354 399832342 PATIENT CARE (SCHEDULE O)MAYO CLINIC HEALTH SYSTEM IS A FAMILY OF CLINICS, HOSPITALS AND HEALTH CARE FACILITIES SERVING COMMUNITIES IN MINNESOTA, IOWA AND WISCONSIN. AS PART OF MAYO CLINIC, MAYO CLINIC HEALTH SYSTEM OFFERS OUTSTANDING CARE CLOSE TO HOME. PHYSICIANS AND STAFF IN MAYO CLINIC HEALTH SYSTEM HAVE READY ACCESS TO THE KNOWLEDGE, RESOURCES, AND EXPERTISE OF MAYO CLINIC, YET CAN MEET PATIENTS HEALTH CARE NEEDS LOCALLY. MAYO CLINIC HEALTH SYSTEM IS PART OF THE COMMUNITY, FOCUSED ON IMPROVING THE HEALTH OF THE COMMUNITIES IN WHICH WE LIVE AND WORK. MAYO CLINIC HEALTH SYSTEM TEAMS WITH MAYO CLINIC TO DELIVER UNPARALLELED HEALTH CARE TO COMMUNITIES THROUGH AN INTEGRATED NETWORK OF CLINICS AND HOSPITALS.IN 2012, MAYO CLINIC HEALTH SYSTEM SITES EMPLOYED APPROXIMATELY 1,000 PHYSICIANS AND 14,000 ALLIED HEALTH STAFF. IN ADDITION, MAYO CLINIC PHYSICIANS FROM MULTIPLE SPECIALTIES REGULARLY SEE PATIENTS AT THE MAYO CLINIC HEALTH SYSTEM FACILITIES. BESIDES HAVING HEALTH CARE FACILITIES IN 72 COMMUNITIES, THE 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 FROM A NEW IDEA TO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN AMERICA. MAYO CLINIC HEALTH SYSTEM COMPLETES MORE THAN TWO-MILLION PATIENT VISITS ANNUALLY. IT ALSO SERVES AS A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS BEING RECOGNIZED SIX TIMES BY THE AMERICAN MEDICAL GROUP ASSOCIATION'S ACCLAIM AWARD PROGRAM (2005 ACCLAIM AWARD RECIPIENT AND FIVE-TIME ACCLAIM AWARD HONOREE). THE ACCLAIM AWARDS HONOR PHYSICIAN-LED ORGANIZATIONS DELIVERING CARE ALIGNED WITH THE IDEAL DELIVERY MODEL WHERE PATIENTS EXPERIENCE SAFE, RELIABLE, RESPONSIVE, READILY AVAILABLE AND INTEGRATED CARE. IN ADDITION, THE MINNESOTA COUNCIL FOR QUALITY HAS RECOGNIZED MAYO CLINIC HEALTH SYSTEM THREE TIMES FOR ITS PERFORMANCE EXCELLENCE EFFORTS. INDIVIDUAL MAYO CLINIC HEALTH SYSTEM LOCATIONS HAVE ALSO BEEN HONORED FOR THEIR COMMITMENT TO QUALITY, SAFETY, SERVICE, PERFORMANCE AND THEIR COMMUNITIES.PEOPLE IN MINNESOTA, IOWA AND WISCONSIN CAN HAVE PEACE OF MIND KNOWING THAT MAYO CLINIC HEALTH SYSTEM AND MAYO CLINIC PARTNER TO ENSURE HEALTHIER LIVES IN THE REGION.MAYO CLINIC HEALTH SYSTEMFRANCISCAN MEDICAL CENTER, INC. (FMCI) FULFILLS ITS MISSION THROUGH THE FOLLOWING LOCATIONS AND SERVICES:HOSPITALS - 2 HOSPITALS, LACROSSE (248 BEDS) AND SPARTA (25 BEDS). THE HOSPITALS PROVIDE ACUTE HEALTH CARE SERVICES INCLUDING 24-HOUR EMERGENCY CARE, ADULT AND PEDIATRIC SURGERY, LABOR, DELIVERY, MATERNITY CARE, REHABILITATION SERVICES, AND HEALTH EDUCATION CLASSES. THE HOSPITALS HAD 8,213 INPATIENT ADMISSIONS, 976 DELIVERIES, AND 8,440 SURGERIES DURING 2012.SLEEP LAB - THE FMCI SLEEP LAB HAS RECEIVED THE FULL FIVE-YEAR ACCREDITATION FROM AMERICAN ACADEMY OF SLEEP MEDICINE. THE FACILITY WAS APPROVED FOLLOWING A LENGTHY EXAMINATION PROCESS AND SITE VISIT THAT COVERED THE UNIT'S POLICIES, PROCEDURES AND ACTIVITIES. EACH YEAR THE SLEEP LAB EVALUATES APPROXIMATELY 250 PATIENTS. THE ACCREDITATION WILL OPEN UP THE LAB AS A NEW CHOICE FOR PATIENTS FROM A BROADER RANGE OF INSURANCE PLANS.NATIONAL OUTCOMES MEASUREMENT SYSTEM - SINCE JAN. 1999, THE SPEECH-LANGUAGE PATHOLOGISTS AT FMCI HAVE BEEN TAKING PART IN A NATIONAL PROJECT THAT ALLOWS THEM TO TRACK PATIENT OUTCOMES AND COMPARE THEIR SERVICES WITH OTHER THERAPY PROGRAMS ACROSS THE STATE AND THE NATION. THE NATIONAL OUTCOMES MEASUREMENT SYSTEM PROJECT CONSISTS OF MAKING A SPECIAL ASSESSMENT OF THE PATIENT AT THE FIRST AND LAST VISIT. BY COMPARING SUCH FACTORS AS FUNCTIONALITY PRIOR TO CARE, NUMBER OF VISITS, NUMBER OF MINUTES OF CARE AND FUNCTIONALITY AT THE END OF THE SESSIONS, THERAPISTS CAN NOW ACCURATELY TRACK THE PROGRESS OF PATIENTS.LACROSSE COULEE REGION BRAIN TEAM - FMCI MEMBERS SERVED ON THE LACROSSE COULEE REGIONAL BRAIN TEAM, WHICH IS A COMMUNITY EFFORT TO ENCOURAGE PUBLIC DISCUSSION AND ACTIONS RELATED TO THE IMPORTANCE OF EARLY BRAIN DEVELOPMENT; TO FIND WAYS TO SUPPORT PARENTS/FAMILIES IN NURTURING THEIR CHILDREN; AND TO PROVIDE POSITIVE STIMULATING ENVIRONMENTS NECESSARY FOR LEARNING. IN COOPERATION WITH THE UNIVERSITY OF WISCONSIN-LA CROSSE, THE TEAM SURVEYED 1,200 AREA PROFESSIONALS WHO WORK WITH CHILDREN IN AN EFFORT TO DETERMINE THE LEVEL OF AWARENESS OF EARLY BRAIN DEVELOPMENT INFORMATION AND HOW THEIR PRACTICE IS AFFECTED. THE SURVEY RESULTS WILL BE USED TO DEVELOP ACTION PLANS WHICH MEET THE EDUCATIONAL NEEDS OF PROFESSIONALS WORKING WITH YOUNG CHILDREN. OTHER COULEE BRAIN TEAM EFFORTS INCLUDE ORGANIZATION OF A SPEAKERS BUREAU, MESSAGE-OF-THE-MONTH RELEASES TO MEDIA AND THE PRESENCE OF THE WISCONSIN'S BETTER BADGER BABY BUS TOUR AT RIVERFEST.CLINICS - FAMILY PRACTICE CLINICS PROVIDE OUTPATIENT SERVICES AND ARE LOCATED IN THE FOLLOWING COMMUNITIES IN WISCONSIN, IOWA, AND MINNESOTA:WISCONSIN - ARCADIA, GALESVILLE, LACROSSE, ONALASKA, PRAIRIE DU CHIEN, SPARTA, TOMAHIOWA - WAUKONMINNESOTA - CALEDONIA, LACRESCENTAFFILIATION WITH THE LARGER MAYO CLINIC HEALTH SYSTEM ALLOWS ACCESS FOR MEMBERS OF THESE COMMUNITIES TO VARIOUS SPECIALTY SERVICES. SOME OF THESE SERVICES INCLUDE:OCCUPATIONAL HEALTH - THE SERVICES INCLUDE WORKERS' COMPENSATION SERVICES, DOT PHYSICALS, JOB SITE ASSESSMENTS, HEALTH AND SAFETY CONSULTATIONS, SIGNIFICANT EXPOSURE FOLLOW-UP, DISABILITY MANAGEMENT AND RETURN-TO-WORK PROGRAMS, DRUG TESTING SERVICES, BREATH ALCOHOL TESTING AND RESPIRATOR FIT TESTING.ALLERGY - PATIENTS WITH ALLERGIC CONDITIONS AND PROBLEMS WITH IMMUNE RESPONSE ARE TREATED AND SERVICES INCLUDE BOTH CONSULTATIONS AND DIAGNOSTICS.CARDIOLOGY - CARDIOLOGY SERVICES PROVIDED INCLUDE CARDIOLOGY ASSESSMENTS, CONSULTATIONS, AND FOLLOW-UPS.GERIATRIC - SERVICES PROVIDED INCLUDE GERIATRIC CONSULTATIONS AND FOLLOW-UPS RELATED TO ALL ASPECTS OF SPECIALTY ELDER CARE INCLUDING DEMENTIA, MEMORY LOSS, MEDICATION MANAGEMENT, LONG-TERM CARE AND DISEASE MANAGEMENT.PEDIATRIC NEUROLOGY - SERVICES PROVIDED INCLUDE PEDIATRIC NEUROLOGY CONSULTATIONS AND FOLLOW-UPS. PEDIATRIC NEUROLOGY PROVIDES SUB-SPECIALTY EXPERTISE FOR CHILDREN WITH DIFFICULT SEIZURE DISORDERS, HEADACHES, DEVELOPMENTAL DISORDERS AND HYPERACTIVITY AND LEARNING DISORDERS.SKILLED NURSING FACILITIES A SKILLED NURSING FACILITY IS LOCATED IN ARCADIA, WI (75 BED CAPACITY). HOME HEALTH - HOME HEALTH SERVICES PROVIDES HEALTH CARE SERVICES TO PATIENTS IN THE CONVENIENCE OF THEIR HOME, NURSING HOME, OR HOSPITAL ROOM. THE FIVE AREAS OF CARE PROVIDED ARE HOME CARE, HOSPICE, PHARMACY, HOME MEDICAL EQUIPMENT AND INFUSION THERAPY. HOME CARE - HOME CARE INCLUDES SERVICES OF SKILLED PROFESSIONAL NURSES WHO PROVIDE SPECIALIZED CARE AND TEACHING TO PATIENTS WITH ACUTE NEEDS SUCH AS WOUNDS, OSTOMIES, DIABETES MANAGEMENT, MEDICATION MANAGEMENT, AND INFUSION THERAPY INCLUDING CHEMO ADMINISTRATION. HOME HEALTH AIDES PROVIDE PERSONAL CARE AND ASSISTANCE WITH EXERCISE PROGRAMS. PHYSICAL THERAPISTS PROVIDE SPECIALIZED CARE AND TEACHING IN THE AREAS OF HOME THERAPEUTIC EXERCISE PROGRAMS, FUNCTIONAL/ACTIVITIES OF DAILY LIVING TRAINING, GAIT TRAINING, WHEELCHAIR FITTINGS AND THE USE OF ADAPTIVE EQUIPMENT. OCCUPATIONAL THERAPISTS PROVIDE SPECIALIZED CARE AND TEACHING PATIENTS HOW TO USE ADAPTIVE EQUIPMENT FOR ACTIVITIES OF DAILY LIVING, SAFETY ADAPTATIONS, FUNCTIONAL PROGRAMS, AND ENERGY CONSERVATION WITH DAILY TASKS. HOME CARE HAD 4,922 PATIENT ENCOUNTERS IN 2012.HOSPICE - HOSPICE USES A TEAM APPROACH TO CARING FOR PATIENTS WITH LIFE THREATENING ILLNESSES, PROVIDING SPECIALIZED CARE AND TEACHING AND ALSO FOCUSES ON PATIENTS' QUALITY OF LIFE AND DEATH WITH DIGNITY. THE TEAM CONSISTS OF SKILLED NURSES, HOME HEALTH AIDS, PHYSICAL THERAPISTS, OCCUPATIONAL THERAPISTS, SOCIAL WORKERS, CHAPLAINS AND VOLUNTEERS. BEREAVEMENT FOLLOW-UP AFTER THE PATIENT'S DEATH IS AN ADDITIONAL BENEFIT FOR THE FAMILY. HOSPICE PROVIDES THE EQUIPMENT, MEDICATIONS AND SUPPLIES (RELATED TO THEIR LIFE THREATENING ILLNESS) NECESSARY TO ASSURE THE COMFORT OF OUR PATIENTS IN THEIR FINAL DAYS IN FAMILIAR SURROUNDINGS WITH FAMILY AND FRIENDS. HOSPICE HAD 7,166 PATIENT ENCOUNTERS DURING 2012. PATIENT CARE (SCHEDULE O) CONTINUED.PATIENT CARE (CONTINUED)HOME MEDICAL EQUIPMENT - THIS AREA OFFERS A FULL RANGE OF MEDICAL EQUIPMENT AND SUPPLIES INCLUDING BEDS, WALKERS, COMMODES, CANES, WHEELCHAIRS, SCOOTERS, SUPPLIES RELATED TO DIABETES, BREAST FEEDING, OSTOMY, AND SPORTS RELATED EQUIPMENT. RESPIRATORY THERAPISTS PROVIDE OXYGEN CONCENTRATORS AND PORTABLES, APNEA MONITORS, BI-PAPS AND CPAPS, NEBULIZERS, AS WELL AS OTHER RESPIRATORY NEEDS. OUR STAFF MEMBERS ARE TRAINED IN SEATING SYSTEMS FOR WHEELCHAIRS AND SCOOTERS. THERE ARE LOCATIONS IN LACROSSE, ARCADIA, SPARTA, AND TOMAH. FREE DELIVERY AND SERVICE IS PROVIDED IN A 100-MILE RADIUS AROUND LA CROSSE. HOME MEDICAL HAD 6,016 PATIENT ENCOUNTERS IN 2012.HOME INFUSION THERAPY - THERE WERE 147 NEW PATIENTS SERVICED BY HOME INFUSION THERAPY DURING 2012.CHARITY CARE: FMCI PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS/RESIDENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. CHARITY CARE IS ALSO PROVIDED FOR PATIENTS THAT ARE FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THE COST OF CHARITY CARE PROVIDED IN 2012 WAS APPROXIMATELY $2,628,000. THE COST OF UNCOMPENSATED CARE PROVIDED LOW INCOME PATIENTS THROUGH MEDICAID WAS APPROXIMATELY $29,036,000 IN 2012. THIS SHORTFALL INCLUDES THE MEDICAID SURCHARGE AND TAXES PAID TO MN CARE AND WI FOR PROGRAMS THAT OFFER HEALTHCARE ASSISTANCE TO LOW INCOME POPULATIONS ALL OF WHICH TOTAL APPROXIMATELY $5,387,000. OTHER EXPENSES REPORTED ELSEWHERE: THE UNREIMBURSED COST OF MEDICARE WAS $47,674,000 IN 2012.FMCI VOLUNTARILY ENTERED INTO AN AGREEMEENT WITH THE WISCONSIN ATTORNEY GENERAL RELATING TO CHARITY CARE. THE TERMS OF THE AGREEMENT INCLUDE AN AUTOMATIC DISCOUNT FOR UNINSURED PATIENTS, A PAYMENT CAP FOR THOSE UNINSURED PATIENTS THAT MEET THE ORGANIZATION'S CHARITY CARE CRITERIA, AND A COMMITMENT TO MAKE INFORMATION AVAILABLE TO PATIENTS REGARDING OUR CHARITY CARE PROGRAM. ADDITIONALLY, THE WI ATTORNEY GENERAL REVIEWED AND APPROVED OUR BILLING AND COLLECTION POLICIES AND PRACTICES. 2991159 243771 494418 COMMUNITY ACTIVITIES & EDUCATIONAL PROGRAMS (SCHEDULE O) IN ADDITION TO THESE SERVICES AND IN KEEPING WITH ITS HISTORIC MISSION, FMCI ENGAGES IN NUMEROUS EXTERNAL ACTIVITIES THAT PROMOTE HEALTH AND WELLNESS FOR THE MIND, BODY AND SPIRIT OF INDIVIDUALS IN THE COMMUNITIES WE SERVE. FMCI NOT ONLY ENGAGES IN THESE ACTIVITIES AS A SYSTEM, BUT ALSO ENCOURAGES MEDICAL STAFF AND EMPLOYEES TO DO THE SAME. EXAMPLES INCLUDE:ST. CLARE HEALTH MISSION - THE MISSION IS A FREE MEDICAL CLINIC WITH LOCATIONS ON THE FMCI'S CAMPUSES IN LACROSSE AND SPARTA, AND SERVES PERSONS WHO HAVE NO MEDICAL INSURANCE AND DO NOT QUALIFY FOR PUBLIC ASSISTANCE. STAFFED BY VOLUNTEER PHYSICIANS AND OTHER EMPLOYEES, ST. CLARE HAS BECOME A MODEL FOR OTHER COMMUNITY CLINICS IN WISCONSIN. THE CLINIC HAD 4,789 PATIENT VISITS IN 2012, WITH FMCI EXPENDITURES OF $368,002 FOR THIS PROGRAM, WHICH DOES NOT INCLUDE THE VALUE OF THE MANY DONATED HOURS AND SUPPLIES. WOMEN'S HEALTH - MINNESOTA BREAST AND CERVICAL CANCER PROGRAM - THE MINNESOTA BREAST AND CERVICAL CANCER PROGRAM IS OFFERED TO PATIENTS AT THE CLINIC SITES IN MINNESOTA OR TO PATIENTS BEING SEEN IN LACROSSE FROM ONE OF THESE CLINICS FOR MAMMOGRAMS OR FOLLOW-UP BREAST OR CERVICAL CANCER PROCEDURES THAT CANNOT BE PROVIDED IN THOSE SITES. THIS PROGRAM SERVES LOW-INCOME WOMEN WHO ARE EITHER UNINSURED OR UNDERINSURED. THE GRANT WAS WRITTEN TO ADDRESS THE NEEDS OF WOMEN IN OUR RURAL MINNESOTA SITES WHO WERE NOT RECEIVING ADEQUATE PREVENTATIVE SERVICES. WISCONSIN WELL WOMAN PROGRAM - OFFERED IN COOPERATION WITH THE STATE OF WISCONSIN AND LACROSSE COUNTY, THIS PROGRAM HELPS WOMEN WITH LITTLE OR NO HEALTH INSURANCE GET BETTER ACCESS TO FREE SCREENINGS FOR BREAST CANCER, CERVICAL CANCER, DEPRESSION, DIABETES, DOMESTIC ABUSE, HEART DISEASE, HIGH BLOOD PRESSURE AND OSTEOPOROSIS. FMCI PILOTED AN EXPANDED VERSION OF THIS PROGRAM IN 2000 IN TWO DEPARTMENTS AT THE LACROSSE CAMPUS (THE CENTER FOR WOMEN'S HEALTH AND THE FAMILY HEALTH CLINIC). SAFE PATH DOMESTIC ABUSE AND SEXUAL ASSAULT SERVICE - STARTED IN 1996, THIS PROGRAM IS FUNDED THROUGH THE OPERATING BUDGET OF FMCI WITH A SIGNIFICANT GRANT FROM MCHS-FRANCISCAN HEALTHCARE FOUNDATION. IN ADDITION, IN 1999 AND 2000, THIS GROUP BEGAN WORKING WITH THE EMERGENCY MEDICINE TRAUMA CENTER (EMTC) TO DEVELOP THE SEXUAL ASSAULT COMPONENT. IN 2000, 6 NURSES WERE TRAINED TO DO SEXUAL ASSAULT NURSE EXAMS IN THE EMERGENCY ROOM. THE PROGRAM PROVIDES THE VICTIM WITH ONE-ON-ONE ATTENTION OF A FEMALE NURSE PROVIDER TRAINED TO DO THE EXAM AND COLLECT THE FORENSIC EVIDENCE THAT IS NEEDED. FMCI IS NOW A "DESIGNATED SEXUAL ASSAULT CENTER" IN WISCONSIN. THE SEXUAL ASSAULT COMPONENT HAS BEEN FUNDED BY THE FRANCISCAN SISTERS OF PERPETUAL ADORATION (ONE OF THE CORPORATE MEMBERS OF FMCI). SOME OF THE FUNDING HAS ALSO GONE TO PROVIDE FREE COUNSELING, MONEY FOR INCIDENTAL NECESSITIES WHEN WOMEN ARE FLEEING FROM THEIR HOMES WITHOUT MONEY OR CLOTHES, MONEY FOR NEW LOCKS ON THEIR HOME, AND SIMILAR ITEMS. ESTROGEN & WOMEN'S HEALTH - THIS IS AN EDUCATIONAL PROGRAM FOR THE MEDICAL COMMUNITY ON ADVANCES IN PREVENTION, DIAGNOSIS, AND TREATMENT OF DISEASES IN WOMEN. THE TOPIC OF ESTROGEN, AND ITS ROLE IN WOMEN'S HEALTH ISSUES, CONTINUES TO BE OF GREAT IMPORTANCE. A MULTIFACETED LEARNING APPROACH WILL BE USED IN THIS COURSE, INCLUDING LECTURE FORMAT TO SHARE THE LATEST RESEARCH, SAMPLE CASE PRESENTATIONS, AND GROUP DISCUSSION. TOPICS WILL INCLUDE IDENTIFYING THOSE WOMEN WITH RISK FACTORS FOR HORMONE REPLACEMENT THERAPY AND ALTERNATIVES TO STANDARD HORMONE REPLACEMENT REGIMES INCLUDING PHYTOESTROGEN / NATURAL ESTROGENS AND HOLISTIC THERAPIES. THIS COURSE WAS DESIGNED FOR PHYSICIANS AND RESIDENTS IN FAMILY PRACTICE, INTERNAL MEDICINE AND OB/GYN, MEDICAL STUDENTS, PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, AND REGISTERED NURSES AND MIDWIVES. LACROSSE MEDICAL HEALTH SCIENCE CONSORTIUM - THE CONSORTIUM IS A PARTNERSHIP OF THE TWO HEALTHCARE PROVIDERS AND THREE POST SECONDARY EDUCATIONAL INSTITUTIONS IN LACROSSE. THE PURPOSE OF THE CONSORTIUM IS TO CREATE OPPORTUNITIES FOR EDUCATION AND RESEARCH IN THE ALLIED HEALTH SCIENCES. THE MOST RECENT PROJECT OF THE CONSORTIUM WAS THE OPENING OF A $27 MILLION ALLIED HEALTH EDUCATION AND RESEARCH FACILITY IN LACROSSE (HEALTH SCIENCE CENTER). FUTURE PLANS CALL FOR A NETWORK OF HEALTH EDUCATION CENTERS IN RURAL COMMUNITIES IN THE CONSORTIUM'S 27 COUNTY SERVICE AREA. JOINT COMMUNITY HEALTH INITIATIONS - FMCI OFTEN COLLABORATES WITH GUNDERSEN LUTHERAN MEDICAL CENTER, COUNTY HEALTH DEPARTMENTS AND OTHER ORGANIZATIONS INTERESTED IN COMMUNITY HEALTH AND WELL-BEING ON NUMEROUS TOPICS, SUCH AS EDUCATION CONFERENCES, CHILD DEVELOPMENT MATERIALS, INFLUENZA VACCINATION EDUCATION ANNOUNCEMENTS, CHILD SAFETY, MEDICATION SAFETY, AND COMMUNITY HEALTH ASSESSMENT PROGRAMS.ADVANCE DIRECTIVES PROGRAM - ESTABLISHED IN COOPERATION WITH GUNDERSEN LUTHERAN, THE PROGRAM ASSISTS PATIENTS AND THEIR FAMILIES WITH END-OF-LIFE ISSUES AND DECISION- MAKING. THE PROGRAM WAS RECENTLY CITED AS ONE OF SIX MODEL PROGRAMS IN THE NATION.FREE HEALTH CHECKS AND SCREENINGS - PHYSICIANS, HEALTH EDUCATORS, AND OTHER ALLIED HEALTH STAFF PROVIDE NUMEROUS HEALTH SCREENINGS AT EVENTS THROUGHOUT THE MCHS-FRANCISCAN HEALTHCARE (FHI) SERVICE AREA. SUCH SCREENINGS INCLUDE BLOOD PRESSURE, CHOLESTEROL, BLOOD SUGAR, AND STROKE ASSESSMENTS.HEALTH AND WELLNESS EDUCATION FOR THE PUBLIC - PROGRAMS OFFERED THROUGH FMCI INCLUDE PRENATAL CARE, SMOKING CESSATION, SUPPORT GROUPS FOR CANCER, SUDDEN INFANT DEATH, NEUROLOGICAL DISORDERS, DIABETES EDUCATION, AND BASIC AND ADVANCED LIFE SUPPORT INSTRUCTION OR CPR.LACROSSE-MAYO FAMILY PRACTICE RESIDENCY - THE FAMILY PRACTICE RESIDENCY PROGRAM IS AFFILIATED WITH THE MAYO GRADUATE SCHOOL OF MEDICINE. ITS FOCUS IS TO GIVE RESIDENTS THE KNOWLEDGE, SKILLS, AND ATTITUDES NECESSARY FOR FUTURE PRACTICE IN AN EVER-CHANGING MEDICAL ENVIRONMENT. FMCI EXPENDITURES FOR THIS PROGRAM IN 2012 WERE $2,469,391. CLINICAL PASTORAL EDUCATION PROGRAM - REESTABLISHED IN 1999, THIS PROGRAM IS WORKING COLLABORATIVELY AND ECUMENICALLY TO PROVIDE PASTORAL EDUCATION FOR CLERGY AND LAY PEOPLE OF ALL FAITH TRADITIONS AND DENOMINATIONS. THE PROGRAM'S PROFESSIONAL CONSULTATION BOARD IS COMPRISED OF REPRESENTATIVES FROM A DIVERSITY OF FAITH AND COMMUNITY ORGANIZATIONS. THE PROGRAM IS COMMUNITY-BASED AND IS DESIGNED TO PROVIDE MINISTRY TRAINING IN NON-TRADITIONAL SETTINGS WHERE SPIRITUAL CARE MAY NOT CURRENTLY EXIST. AN EMPHASIS IS PLACED ON PROVIDING SPIRITUAL CARE IN AN INTER-DISCIPLINARY ENVIRONMENT THAT SERVES PEOPLE TRADITIONALLY PUSHED TO THE MARGINS OF THE COMMUNITY BY POVERTY, MENTAL ILLNESS, RACISM, VIOLENCE, OR OTHER SOCIOECONOMIC CONDITIONS.GERONTOLOGY CERTIFICATE PROGRAM - IN A JOINT EFFORT WITH THE UNIVERSITY OF WISCONSIN-LACROSSE AND COMMUNITY AGENCIES, THIS NEW PROGRAM IS DESIGNED TO INCREASE THE SKILLS AND COMPETENCIES OF A BROAD RANGE OF PROFESSIONALS INCLUDING NURSES, NURSING ASSISTANTS, SOCIAL WORKERS, OCCUPATIONAL THERAPISTS, PHYSICAL THERAPISTS, PERSONAL CARE ASSISTANTS AND OTHERS. IT IS A DIRECT RESPONSE TO THE GROWING DEMAND PLACED ON AREA AGENCIES TO SERVE OUR RAPIDLY EXPANDING POPULATION OF OLDER ADULTS. THIS PROGRAM REQUIRES CORE WORKSHOPS, ELECTIVE WORKSHOPS, AND A WORK PRACTICUM.CORPORATE FINANCIAL SUPPORT - IN BEING A "GOOD CORPORATE CITIZEN", FMCI ALSO PROVIDES FINANCIAL SUPPORT TO GROUPS WITHIN OUR SERVICE AREA WHO ARE ENGAGED IN COMMUNITY HEALTH AND WELLNESS, PUBLIC SAFETY, THE ARTS, EDUCATION AND QUALITY OF LIFE ISSUES. THESE ACTIVITIES INCLUDE: RUNS AND WALKS TO RAISE FUNDS FOR MEDICAL RESEARCH, PROGRAMS ON SELF ESTEEM FOR YOUNG WOMEN, FIRE SAFETY MATERIALS FOR SCHOOL CHILDREN, RECOGNITION FOR THE CONTRIBUTIONS OF OUR VOLUNTEER TEAM, SELF-HELP OPPORTUNITIES FOR THE POOR AND UNDERPRIVILEGED, CONCERTS AND PERFORMANCES BY LOCAL FINE ARTS GROUPS, AND SPONSORSHIPS OF LECTURES AND PROGRAMS ON HEALTH RELATED TOPICS.ALZHEIMER'S ASSOCIATION - FOR SEVERAL YEARS FMCI HAS BEEN A SPONSOR OF MEMORY WALKS HELD EACH FALL AND ITS ANNUAL EDUCATION CONFERENCE. SEVERAL MAYO CLINIC PHYSICIANS HAVE PRESENTED AT THE ANNUAL CONFERENCE.AMERICAN CANCER SOCIETY - FRANCISCAN MEDICAL CENTER WAS THE LEAD SPONSOR OF THE VERY FIRST LACROSSE AREA ALL YOUTH RELAY FOR LIFE. THIS RELAY, MODELED AFTER THE SUMMER EVENT, AND ORGANIZED AND DESIGNED ESPECIALLY FOR HIGH SCHOOL STUDENTS, RAISED MORE THAN $20,000. THE DAFFODILS THAT DECORATE THE MARKET PLACE RESTAURANT EACH SPRING ARE ALSO PART OF FMCI'S SUPPORT.AMERICAN HEART ASSOCIATION - STAFF FROM FMCI CARDIOVASCULAR SERVICES PLAY A LEAD ROLE IN THE ORGANIZATION OF THE ANNUAL HEART WALK. FOR THE PAST SEVERAL YEARS TEAMS FROM THE MEDICAL CENTER HAVE ALSO LED THE PACK IN FUNDS RAISED. THE MEDICAL CENTER IS ALSO A LONGTIME SPONSOR OF THE FRIGID FIVE RUN HELD IN JANUARY. 553361 25236 COMMUNITY ACTIVITIES & EDUCATIONAL PROGRAMS CONTINUED (SCHEDULE O): UNITED CEREBRAL PALSY - FRANCISCAN MEDICAL CENTER HAS BEEN THE LEAD SPONSOR FOR THE ANNUAL CELEBRITY WAITER NIGHT SINCE THIS EVENT FIRST CAME TO LACROSSE SIX YEARS AGO.MULTIPLE SCLEROSIS - FMCI WAS THE LEAD SPONSOR FOR THIS EVENT, HELD IN APRIL THAT HAS RAISED NEARLY $80,000 YEARLY THROUGH THE EFFORTS OF MORE THAN 800 WALKERS.UNITED FUND FOR THE ARTS AND HUMANITIES - UFAH IS A CONSORTIUM OF 10 LOCAL ARTS AND HUMANITIES ORGANIZATIONS THAT CONTRIBUTE SIGNIFICANTLY TO THE QUALITY OF LIFE IN THE AREA. FMCI IS ONE OF ONLY FOUR LOCAL BUSINESSES THAT HAS BEEN A CONTRIBUTOR TO THIS ANNUAL CAMPAIGN.HEALTH CAREER EXPLORATION - YOUNG MEN AND WOMEN INTERESTED IN HEALTH CAREERS HAVE AN OPPORTUNITY TO JOB SHADOW OR INTERN IN NUMEROUS PATIENT CARE AREAS WITHIN FMCI AND FHI. MANAGED BY THE VOLUNTEER SERVICES AREA, UPPER-CLASS HIGH SCHOOL STUDENTS MAY SPEND A DAY TO SEVERAL WEEKS GATHERING FIRST HAND EXPERIENCE WITH HEALTHCARE OPPORTUNITIES. REPRESENTATION ON COMMUNITY BOARDS - FHI PROVIDES SUPPORT FOR PHYSICIANS AND EMPLOYEES WHO PARTICIPATE AT THE "BOARD OF DIRECTOR" LEVELS IN COMMUNITY SERVICE ORGANIZATIONS. ALL ARE ENCOURAGED TO IDENTIFY OPPORTUNITIES WHEREBY FHI CAN CONTRIBUTE ITS COLLECTIVE KNOWLEDGE AND EXPERTISE IN ASSISTING THESE COMMUNITY GROUPS TO MEET THEIR MISSIONS OF SERVICE.HEALTHTOUCH - WITH A TOUCH OF THE SCREEN, PATIENTS AND STAFF CAN NOW ACCESS ACCURATE, UP-TO-DATE INFORMATION ON MEDICATIONS, DISEASES AND WELLNESS TOPICS THANKS TO HEALTHTOUCH, AN INTERACTIVE KIOSK INSTALLED IN 2000 IN THE RESOURCE LIBRARY OF THE FAMILY HEALTH CLINIC. THE DATA CAN BE READ ON SCREEN OR PRINTED FOR LATER REVIEW. SOME TOPICS EVEN OFFER BRIEF VIDEO CLIPS. HEALTHTOUCH OFFERS INFORMATION FROM SUCH TRUSTED SOURCES AS THE AMERICAN HEART ASSOCIATION, THE ARTHRITIS FOUNDATION AND THE CENTERS FOR DISEASE CONTROL. HEALTHTOUCH SERVICE IS PROVIDED FREE FOR PATIENTS, STAFF AND THE GENERAL PUBLIC THROUGH A GRANT FROM THE MCHS-FRANCISCAN HEALTHCARE FOUNDATION.DISEASE MANAGEMENT STRATEGIES - FMCI IS PARTICIPATING IN THE UNITED COULEE REGION INFLUENZA COALITION IN COOPERATION WITH GUNDERSEN LUTHERAN AND THE HEALTH DEPARTMENT IN AN EFFORT TO COLLABORATE ON IMPROVING THE IMMUNIZATION RATES IN THE COMMUNITY. DISEASE MANAGEMENT STRATEGIES TRANSLATES RESEARCH INTO PRACTICE BY INCORPORATING INTO PATIENT CARE THE "BEST PRACTICES" SUPPORTED BY LITERATURE THROUGH THE USE OF CONTINUOUS IMPROVEMENT TECHNIQUES. IN THIS PROCESS, FMCI STRIVES TO IMPROVE SERVICE, CLINICAL OUTCOMES, AND COST, WHICH ARE THREE FACTORS PATIENTS ASSOCIATE WITH QUALITY. DEMENTIA CARE - FMCI HAS DEVELOPED A COMPREHENSIVE DEMENTIA CARE PROGRAM FOR PEOPLE WITH DEMENTIA AND THEIR FAMILIES. THE PROGRAM PROVIDES DIAGNOSIS, TREATMENT, EDUCATION, SUPPORT SERVICES AND LONG-TERM FOLLOW-UP. IT RELIES ON THE COLLABORATIVE EFFORTS OF PRIMARY CARE PHYSICIANS, GERIATRIC, BEHAVIORAL HEALTH, AND NEUROLOGY PROFESSIONALS FOR A COMPLETE PLAN OF CARE. THE PROGRAM IS ALSO PART OF THE WISCONSIN ALZHEIMER'S INSTITUTE AT THE UNIVERSITY OF WISCONSIN-MADISON AND ITS STATEWIDE NETWORK OF DIAGNOSTIC AND REFERRAL CENTERS. COLLEAGUES AT MAYO CLINIC ALZHEIMER'S DISEASE RESEARCH CENTER, WHO ARE IN THE FOREFRONT OF CLINICAL RESEARCH AND STUDIES, ARE AVAILABLE FOR CONSULTATIONS AT ANY TIME, THUS ENABLING FMCI PATIENTS TO BE ON THE CUTTING EDGE OF COMMUNITY-BASED CARE, TREATMENT AND RESEARCH.VOLUNTEER ACTIVITIES: MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC. (VIA THE FRANCISCAN AUXILIARY WHICH IS PART OF FMCI) RECEIVES DONATED SERVICES FROM COMMUNITY TEEN, COLLEGE, AND ADULT VOLUNTEERS. THE AUXILIARY WAS ORGANIZED IN 1952 TO "IMPROVE THE HEALTH OF INDIVIDUALS AND COMMUNITIES" THROUGH FUNDRAISING, SERVICE, COLLABORATION, ADVOCACY AND EDUCATION. AUXILIARY PROJECTS ARE ORGANIZED BY A BOARD OF DIRECTORS THAT MEETS MONTHLY DURING THE SCHOOL YEAR AND ARE SUPPORTED THROUGH THE VOLUNTEER EFFORTS OF MORE THAN 200 MEMBERS. MEMBERSHIP IS OPEN TO ALL INTERESTED COMMUNITY MEMBERS. SPECIFICALLY, THE AUXILIARY SUPPORTS PROGRAMS AND SERVICES TO ADDRESS UNMET HEALTHCARE NEEDS; EQUIPMENT AND SERVICES TO ENHANCE PATIENT CARE DELIVERY; NEEDY PATIENT ACCOUNTS; NURSING EDUCATION FOR WWTC AND VITERBO COLLEGE STUDENTS; AND COMMUNITY HEALTH AWARENESS AND EDUCATION PROJECTS. THE AUXILIARY ALSO STRIVES TO ENHANCE THE VISIBILITY OF FMCI IN THE COMMUNITY.DURING 2012, APPROXIMATELY 750 VOLUNTEERS DONATED APPROXIMATELY 58,020 HOURS OF VOLUNTEER SERVICE THESE SERVICES WERE VALUED AT APPROXIMATELY $1,284,563 BASED ON THE INDEPENDENT SECTOR, A DIVISION OF THE POINTS OF LIGHT FOUNDATION, AVERAGE ESTIMATED HOURLY VALUE OF SUCH SERVICES. THESE SERVICE HOURS WERE SPENT ORGANIZING AND MANAGING ACTIVITIES FOR THE BENEFIT OF THE HOSPITAL'S AND NURSING HOME'S PATIENTS, PATIENTS' FAMILIES, VISITORS AND STAFF.FMCI ALSO OPERATES LIFELINE (AN EASY-TO-USE PERSONAL RESPONSE SERVICE) TO ENSURE THAT OLDER ADULTS LIVING AT HOME CAN GET QUICK ASSISTANCE WHENEVER IT MAY BE NEEDED - 24 HOURS A DAY, 365 DAYS A YEAR. WHEN THE PERSONAL HELP BUTTON IS PRESSED, A FMCI MONITOR RESPONDS, ASSESSES THE SITUATION AND SUMMONS APPROPRIATE HELP. 553361 25236 412324874 1 1 0 1 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 129 0 1 4016 1 1 1 0 0 0 0 0 0 0 0 0 X 20 0 1 1 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 MN WI X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 ANIL MD GOKHAN 40.00 0.00 X 486585 0 35531 FITZGERALD MD KEVIN 40.00 0.00 X 280043 0 46695 FLEISCHMANN MD ALAN 40.00 0.00 X 265545 0 64355 GRAU MD THOMAS J 40.00 0.00 X 280488 0 69542 GRENISEN MD MARGARET M 40.00 0.00 X 217999 0 31739 HAGER NICKIJO 40.00 0.00 X 140268 0 34271 HOLMAY DIANE 40.00 0.00 X 185263 0 51809 HUGHES PETER R 40.00 0.00 X X 241515 0 57991 JOHNSON MD TIMOTHY J 40.00 0.00 X X 419408 0 49471 JUNGCK MD MARK 40.00 0.00 X 319286 0 60493 KORDUCKI MD JANE M 40.00 0.00 X 229859 0 59738 KRIEN MD JOSEPH S 40.00 0.00 X 291642 0 46987 KRUMHOLZ MD ALAN 40.00 0.00 X 282315 0 72487 KRUSE JOSEPH J 40.00 0.00 X X 227274 0 53032 ERICKSON ERIC B 40.00 0.00 X 33021 0 753 MOLLING DO PAUL 40.00 0.00 X 278790 0 48843 NEMEC JOHN 40.00 0.00 X X 212171 0 41709 PACZKOWSKI RONALD R 40.00 0.00 X X 335976 0 64217 SCHAEFER DANIEL E 1.00 40.00 X 0 206281 16577 NOEL AMY J 40.00 0.00 X X 108023 0 36942 TIGGELAAR THOMAS H 40.00 0.00 X X 226414 0 53347 RUSHLOW MD DAVID R 40.00 0.00 X 281975 0 53488 BUTLER MD AARON M 40.00 0.00 X 799800 0 43988 MORRISSEY JOHN E 40.00 0.00 X 1264104 0 59060 NOLTE DO CHARLES P 40.00 0.00 X 973219 0 46762 RADEMACHER MD DANA E 40.00 0.00 X 911125 0 49268 STEVENS MD MARK K 40.00 0.00 X 1099325 0 61314 NESSE MD ROBERT E 0.00 40.00 X 0 688141 18683 10391433 894422 1329092 295 1 1 0 MAYO CLINIC 200 1ST STREET SW ROCHESTER MN 55905 HEALTHCARE & ADMIN 12163264 FOWLER & HAMMER INC 157 SUMMER STREET LACROSSE WI 54603 CONSTRUCTION 3892232 XCEL ENERGY PO BOX 8500 PHILADELPHIA PA 19178 UTILITIES 2089179 HARTFORD INSURANCE PO BOX 828 STEVENS POINT WI 54481 INSURANCE 2060060 DELTA DENTAL OF WISCONSIN PO BOX 0569 CAROL STREAM IL 60132 INSURANCE 2009848 184 78326 9802911 4405728 304909 1710 14591874 NET PATIENT REVENUE 620000 399323316 398789185 534131 EDUCATION REVENUE 611600 494418 494418 LIFELINE 621990 270779 270779 SHARED SERVICES REVENUE 561000 140098 140098 RESEARCH REVENUE 541700 25236 25236 400253847 1179736 1116580 63156 63156 63156 51835 190266 -138431 -138431 -138431 129932 78326 183790 -53858 -53858 7105 1710 5395 5395 277341 260945 16396 16396 CAFETERIA/VENDING REVENUE 722210 2103235 527136 1576099 MANAGEMENT FEE REVENUE 541610 486931 486931 MISC. REVENUE 900099 35623 30501 5122 67648 67648 2693437 417431816 399817865 1553320 1468757 243771 243771 6377300 4544148 1833152 1976572 1677605 298967 180960396 175860125 5100271 41645113 40323231 1321882 33031508 31985959 1045549 12115976 11675388 440588 152374 152374 30500 30500 8254 8254 35514569 26704510 8810059 768280 248583 519697 15797098 14512097 1285001 2763276 2763276 13150011 12916491 233520 862819 830680 32139 2402363 2364763 37600 788667 788667 13232329 12434825 797504 1440951 1440951 MEDICAL SUPPLIES 52142304 52142304 BAD DEBT EXPENSE 15025836 15025836 MN CARE & WI HEALTHCARE 5219499 5219499 DUES, LICENSES & SUBSCR 790778 547298 243480 856235 838143 18092 437296779 412324874 24971905 0 27156 31339 82539 73197 40115 47745 80929021 73318530 1442889 1442889 7515049 7523145 8365072 7351128 268617028 157897654 109606031 110719374 330772 330772 31940234 40853806 240278878 241691925 57210020 82613518 1296110 1230810 49734 54903 26081147 23331718 84637011 107230949 X 155641867 134460976 155641867 134460976 240278878 241691925 X -19864963 -100560 -1215368 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8254 8254 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. 0 1 X 15943228 608124 632787 546648 16637491 16028434 1367448 -512980 939674 15943228 15824272 1086762 416290 1298890 16028434 8421455 7660836 596750 854769 15824272 12396987 2161148 -1676307 4460373 8421455 0.77920 0.22080 0 1 1 10633484 10633484 175828694 99302730 76525964 82154850 58594924 23559926 110719374 DUE FROM AFFILIATES 40853806 40853806 DUE TO AFFILIATES 18126135 DEFERRED COMPENSATION LIABILITY 2632350 ASSET RETIREMENT OBLIGATION 2573233 23331718 X PART IV, LINE 2B: ARCADIA NURSING HOME RESIDENT FUNDS AND ASSISTED LIVING SECURITY DEPOSITS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR RESEARCH AND EDUCATION PROGRAMS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: AT DECEMBER 31, 2012 AND 2011, THE RESERVE FOR UNRECOGNIZED TAX BENEFITS WAS NOT SIGNIFICANT, AND AS A RESULT, THERE IS NO LONGER A RESERVE FOR UNRECOGNIZED TAX BENEFITS RECORDED FOR THE FILING ORGANIZATION. TINY TIM PROJECT 127542 69621 57921 18644 12279 28369 GERANIUM SALES 41147 41147 32187 9 37859 6994 30865 3557 88755 206548 76615 129933 18644 15836 149311 183791 -53858 1 1 X 1 X 1 X 1 1 0 1 1 2627820 2627820 0.00620 46235909 17199804 29036105 0.06880 48863729 17199804 31663925 0.07500 503012 52799 450213 0.00110 2476047 2476047 0.00590 3833090 2823162 1009928 0.00240 553361 553361 0.00130 12100 12100 0.00000 7377610 2875961 4501649 0.01070 56241339 20075765 36165574 0.08570 900 900 0.00000 22192 22192 0.00010 110000 110000 0.00030 883 883 0.00000 133975 133975 0.00040 0 15025836 47288033 56233475 -8945442 X 1 1 2 1 FRANCISCAN MEDICAL CTR-LACROSSE HOSPITAL

700 WEST AVENUE SOUTH LACROSSE WI 546014796

X X X X 2 FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL

310 WEST MAIN STREET SPARTA WI 546562142

X X X X FRANCISCAN MEDICAL CTR-LACROSSE HOSPITAL 1 1 1 100.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X 1 0 X X X X X 1 X 0 0 FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL 2 1 1 100.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X 1 0 X X X X X 1 X 0 0 27 FRANCISCAN MEDICAL CENTER - LACROSSE

800 WEST AVENUE SOUTH LACROSSE WI 546014796

CLINIC, PHARMACY ONALASKA CLINIC

191 THEATER ROAD ONALASKA WI 54650

CLINIC, BEHAVIORAL HEALTH CLINIC, PHARMACY, DME TOMAH CLINIC

325 BUTTS AVENUE TOMAH WI 546600610

CLINIC, BEHAVIORAL HEALTH CLINIC BEHAVIORAL HEALTH SERVICE-LACROSSE

212 11TH STREET SOUTH LACROSSE WI 54601

BEHAVIORAL HEALTH CLINIC HOLMEN CLINIC

1303 MAIN STREET S HOLMEN WI 546369337

CLINIC, BEHAVIORAL HEALTH CLINIC FRANCISCAN ARCADIA NURSING HOME

464 SOUTH ST JOSEPH AVENUE ARCADIA WI 546121499

NURSING HOME ARCADIA CLINIC

464 SOUTH ST JOSEPH AVENUE ARCADIA WI 546121499

CLINIC, BEHAVIORAL HEALTH CLINIC, DME SPARTA CLINIC

310 WEST MAIN STREET SPARTA WI 546562142

CLINIC, BEHAVIORAL HEALTH CLINIC, DME FRANCISCAN LACROSSE CLINIC DME

620 SOUTH 11TH STREET LACROSSE WI 546014711

DME WAUKON CLINIC

105 EAST MAIN STREET WAUKON IA 52172

CLINIC PRAIRIE DU CHIEN CLINIC

800 EAST BLACKHAWK AVENUE PRAIRIE DU CHIEN WI 53821

CLINIC, BEHAVORIAL HEALTH PROFESSIONAL ARTS BUILDING

615 SOUTH 10TH STREET LACROSSE WI 54601

ALLERGY, ORAL SURGERY FRANCISCAN FAMILY HEALTH CLINIC

815 SOUTH 10TH STREET LACROSSE WI 54601

FAMILY HEALTH CLINIC FRANCISCAN-HOME CARE PHARMACY

700 WEST AVENUE SOUTH LACROSSE WI 54601

PHARMACY CALEDONIA CLINIC

701 NORTH PRAGUE STREET CALEDONIA MN 559211066

CLINIC, BEHAVIORAL HEALTH CLINIC, DME LA CRESCENT CLINIC

524 NORTH ELM LA CRESCENT MN 559471027

CLINIC FRANCISCAN OCCUPATIONAL HEALTH CLINIC

630 10TH STREET LACROSSE WI 54601

OCCUPATIONAL HEALTH CLINIC SIENA HALL

613 SOUTH 10TH STREET LACROSSE WI 54601

BEHAVIORAL HEALTH VILLAGE ON 9TH

621 SOUTH 9TH STREET LACROSSE WI 54601

ELDERLY HOUSING VILLA SUCCESS

121 PRAIRIE STREET PRAIRIE DU CHIEN WI 53821

BEHAVIORAL HEALTH WOMEN'S LAAR HOUSE

1005 JACKSON STREET LACROSSE WI 54601

BEHAVIORAL HEALTH ST CLAIRE HEALTH MISSION

916 FERRY STREET LACROSSE WI 54601

CLINIC SCARSETH HOUSE

535 SOUTH 17TH STREET LACROSSE WI 54601

BEHAVIORAL HEALTH GROUP HOME I

518 10TH STREET SOUTH LACROSSE WI 54601

BEHAVIORAL HEALTH VILLAGE ON CASS

225 24TH STREET SOUTH LACROSSE WI 54601

ELDERLY HOUSING GERARD HALL

940 DIVISION STREET LACROSSE WI 54601

MATERNITY HOME WALMART CLINIC OPERATED BY FRANCISCAN HE

4622 MORMON COULEE RD LACROSSE WI 54601

CLINIC PART I, LINE 6A: THE ANNUAL REPORT FOR THE FILING ORGANIZATION IS PART OF A CONSOLIDATED REPORT PREPARED BY MAYO CLINIC. PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS).THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO-CHARGE RATIO. PART I, LINE 7G: THE FOLLOWING NET COMMUNITY BENEFIT COST ATTRIBUTED TO A PHYSICIAN CLINIC WAS INCLUDED AS SUBSIDIZED HEALTH SERVICES: $85,169. 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 $ 15025836. PART II: THE FILING ORGANIZATION MADE SEVERAL CONTRIBUTIONS TO CHARITABLE ORGANIZATIONS WITHIN THE COMMUNITY WHICH PROMOTED ECONOMIC DEVELOPMENT, COMMUNITY SUPPORT AND ENVIRONMENTAL IMPROVEMENTS. THE LARGEST BEING A $110,000 GRANT TO THE HILLVIEW URBAN AGRICULTURE CENTER AND $20,040 TO THE WAFER FOOD PANTRY. PART III, LINE 4: 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.FOOTNOTES RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS CAN BE FOUND ON PAGES 6, 8 AND 9 OF MAYO CLINIC'S 2012 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 $47,674,000 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. FRANCISCAN MEDICAL CTR-LACROSSE HOSPITAL PART V, SECTION B, LINE 14G: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 14G: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. FRANCISCAN MEDICAL CTR-LACROSSE HOSPITAL PART V, SECTION B, LINE 18E: FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE TO EVERY PATIENT VIA MAYO'S PUBLIC WEBSITE, FROM CUSTOMER SERVICE AND PATIENT ACCESS LOCATIONS, AND IS REFERENCED ON MAYO'S AUTHORIZATION FORMS AND STATEMENTS. IN ADDITION, BROCHURES ARE AVAILABLE IN THE ADMISSIONS AREA AND THE PROCESS OF HOW TO APPLY IS AVAILABLE ON THE MAYO CLINIC WEBSITE.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, MAYO DISCUSSES ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE.MONTHLY STATEMENTS ARE SENT TO PATIENTS THAT OUTLINE CURRENT CHARGES AND ACTIONS WITH INSURANCE AND INCLUDES INFORMATION ABOUT MAYO'S CHARITY CARE POLICY. SOME MAYO SITES UTILIZE ADVOCATES TO CONTACT THE PATIENT UPON DISCHARGE TO HELP THEM SECURE 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. FRANCISCAN MEDICAL CTR-LACROSSE HOSPITAL PART V, SECTION B, LINE 20D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 25% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE. FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 20D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 25% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE. PART VI, LINE 2: MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER COLLABORATES WITH PUBLIC AND PRIVATE GROUPS IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. THESE GROUPS AND DATA SOURCES INCLUDE: 2012 COMMUNITY NEEDS ASSESSMENT IN PARTNERSHIP WITH THE GREAT RIVERS UNITED WAY AND GUNDERSON LUTHERAN MEDICAL CENTER;HEALTHIEST WISCONSIN 2020 (PLAN OF WI DHS); POPULATION HEALTH PROJECT OF THE LACROSSE MEDICAL HEALTH SCIENCE CONSORTIUM, WHICH COLLECTS AND ANALYZES DATA FROM A 20 COUNTY AREA THAT MIRRORS THE REPORTING ORGANIZATION'S SERVICE AREA. MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER ALSO HAS REPRESENTATION ON NUMEROUS LOCAL HEALTH ADVOCACY GROUPS THAT TARGET SPECIFIC DISEASES AND CONDITIONS (CHILDHOOD OBESITY, DIABETES, SMOKING CESSATION, SUICIDE PREVENTION, ETC.). WE USE INFORMATION AND DATA FROM THESE GROUPS AS WELL TO HELP PLAN EVENTS IN THE SERVICE AREA. PART VI, LINE 3: MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY:MAYO CLINIC IS COMMITTED TO OFFERING FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY FOR THEIR MEDICAL SERVICES IN WHOLE OR IN PART. IN ORDER TO ACCOMPLISH THIS CHARITABLE GOAL, MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM SITES WILL WIDELY PUBLICIZE THIS POLICY IN THE COMMUNITIES THAT THE INDIVIDUAL MAYO CLINIC AFFILIATED SITES SERVE. MAYO CLINIC AFFILIATED SITES MAKE COPIES OF THIS POLICY AVAILABLE BY POSTING IT ON THEIR WEBPAGE INCLUDING THE ABILITY TO DOWNLOAD A COPY OF THE POLICY FREE OF CHARGE. INDIVIDUALS IN THE COMMUNITY SERVED WILL BE ABLE TO OBTAIN A COPY OF THE POLICY IN LOCATIONS THROUGHOUT EACH MAYO CLINIC AFFILIATED SITE OR UPON REQUEST. THE POLICY EXPLAINS THE FINANCIAL ASSISTANCE PROGRAM AND FACTORS AFFECTING ELIGIBILITY. WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. PART VI, LINE 4: MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC. IS AN INTEGRATED HEALTHCARE DELIVERY SYSTEM THAT SERVES THE RESIDENTS OF BUFFALO, TREMPELEAU, JACKSON, MONROE, LACROSSE, JUNEAU, VERNON, CRAWFORD, RICHLAND, SAUK, AND GRANT COUNTIES IN WISCONSIN, WABASHA, WINONA, FILLMORE, AND HOUSTON IN MINNESOTA, AND WINNESHIEK, AND ALLAMAKEE IN IOWA. THE CITIES OF LACROSSE (50K) AND WINONA (35K) REPRESENT SMALL METROPOLITAN AREAS AND THE BALANCE OF THE SERVICE AREA IS EITHER RURAL OR SMALL TOWNS (500 TO 10K). THE SERVICE AREA INCLUDES A GROWING NUMBER OF HISPANIC AND HMONG RESIDENTS. THE AREA POPULATION ALSO TRENDS OLDER, POORER AND LESS EDUCATED THAN THE STATEWIDE AVERAGE. PART VI, LINE 5: THIS FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION- EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO CLINIC HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATIONS ACTIVITIES.SURPLUS FUNDS:MAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE. COMMUNITY REPRESENTATION ON GOVERNING BODY:THE BOARD OF TRUSTEES IS THE GOVERNING BODY OF MAYO CLINIC. A MAJORITY OF ITS MEMBERS ARE EXTERNAL, INDEPENDENT TRUSTEES. IT HAS OVERALL RESPONSIBILITY FOR THE CHARITABLE, CLINICAL PRACTICE, SCIENTIFIC AND EDUCATIONAL MISSION AND PURPOSES OF MAYO CLINIC AND ITS AFFILIATES AS SET FORTH IN ITS ARTICLES OF INCORPORATION AND BYLAWS. BECAUSE OF MAYO CLINIC'S NATIONAL PRESENCE, THESE TRUSTEES ARE SELECTED BASED ON THEIR AREAS OF EXPERTISE, EXPERIENCE, AND OTHER CRITERIA ESTABLISHED BY THE INDEPENDENT NOMINATING COMMITTEE OF THE BOARD OF TRUSTEES. AREAS OF EXPERTISE AND EXPERIENCE INCLUDE SUCH AREAS AS HEALTH CARE POLICY, RESEARCH, EDUCATION, BUSINESS, AND GOVERNMENT. THE FILING ORGANIZATION, WHICH IS CONTROLLED BY MAYO CLINIC, RELIES ON THE COMMUNITY REPRESENTATION OF THE MAYO CLINIC BOARD OF TRUSTEES TO FULFILL THIS REQUIREMENT.OPEN V. CLOSED STAFF MODEL:STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. EMERGENCY ROOM:THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. PART VI, LINE 6: THIS ORGANIZATION IS A PART OF MAYO CLINIC HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO CLINIC HEALTH SYSTEM IS DESCRIBED IN RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). THAT STATEMENT ALSO DESCRIBES THE ROLES OF THE VARIOUS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED. PART VI, LINE 7 NEITHER THE FILING ORGANIZATION, NOR ANY RELATED ORGANIZATION, FILES A COMMUNITY BENEFIT REPORT WITH ANY STATE OTHER THAN THE EXTENT TO WHICH COMMUNITY BENEFIT INFORMATION IS INCLUDED IN OTHER REPORTING REQUIREMENTS SUCH AS INFORMATION PROVIDED ON THE MINNESOTA HOSPITAL ANNUAL REPORT OR TO THE WISCONSIN HOSPITAL ASSOCIATION. 1 VITERBO UNIVERSITY 900 VITERBO DRIVE LACROSSE WI 54601 390978445 501C3 9500 EDUCATION HILLVIEW URBAN AGRICULTURE CENTER 737 24TH STREET NORTH LACROSSE WI 54602 261891235 501C3 110000 SUPPORT MISSION WAFER INC 403 CAUSEWAY BOULEVARD LACROSSE WI 54603 391552632 501C3 20040 FOOD PANTRY MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE FOUNDATION INC 700 WEST AVENUE SOUTH LACROSSE WI 54601 391186647 501C3 58600 SUPPORT MISSION 4 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY WITH PROGRAMS THAT ENHANCE THE MISSION OF THE FILING ORGANIZATION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY THAT ADDRESS UNMET OR UNDER-FUNDED COMMUNITY NEEDS IN THE AREAS OF HEALTHCARE, EDUCATION, RESEARCH, DIVERSITY AND EQUALITY OF OPPORTUNITY. NO ADDITIONAL MONITORING IS PERFORMED. TRANSFERS OR GRANTS TO TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED. TRANSFERS OR GRANTS TO AFFILIATED TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED. 0 1 0 0 0 0 0 0 0 ANIL MD GOKHAN 264938 0 5738 0 215909 0 16147 0 19384 0 522116 0 0 0 FITZGERALD MD KEVIN 192774 0 3233 0 84036 0 21262 0 25433 0 326738 0 0 0 FLEISCHMANN MD ALAN 265533 0 0 0 12 0 40884 0 23471 0 329900 0 0 0 GRAU MD THOMAS J 273450 0 0 0 7038 0 45565 0 23977 0 350030 0 0 0 GRENISEN MD MARGARET M 133162 0 2386 0 82451 0 28789 0 2950 0 249738 0 0 0 HAGER NICKIJO 131015 0 0 0 9253 0 20782 0 13489 0 174539 0 0 0 HOLMAY DIANE 168196 0 0 0 17067 0 31161 0 20648 0 237072 0 0 0 HUGHES PETER R 241515 0 0 0 0 0 37707 0 20284 0 299506 0 0 0 JOHNSON MD TIMOTHY J 400440 0 0 0 18968 0 41978 0 7493 0 468879 0 0 0 JUNGCK MD MARK 227802 0 3233 0 88251 0 36330 0 24163 0 379779 0 0 0 KORDUCKI MD JANE M 153491 0 2496 0 73872 0 30262 0 29476 0 289597 0 0 0 KRIEN MD JOSEPH S 168742 0 3233 0 119667 0 22750 0 24237 0 338629 0 0 0 KRUMHOLZ MD ALAN 281269 0 0 0 1046 0 45650 0 26837 0 354802 0 0 0 KRUSE JOSEPH J 211568 0 0 0 15706 0 28888 0 24144 0 280306 0 0 0 MOLLING DO PAUL 195133 0 3233 0 80424 0 19874 0 28969 0 327633 0 0 0 NEMEC JOHN 150593 0 0 0 61578 0 38732 0 2977 0 253880 0 0 0 PACZKOWSKI RONALD R 223266 0 0 0 112710 0 44978 0 19239 0 400193 0 0 0 SCHAEFER DANIEL E 0 203738 0 0 0 2543 0 0 0 16577 0 222858 0 0 TIGGELAAR THOMAS H 200076 0 0 0 26338 0 30394 0 22953 0 279761 0 0 0 RUSHLOW MD DAVID R 280010 0 6559 0 -4594 0 25559 0 27929 0 335463 0 0 0 BUTLER MD AARON M 668928 0 19153 0 111719 0 21357 0 22631 0 843788 0 0 0 MORRISSEY JOHN E 906131 0 19153 0 338820 0 36429 0 22631 0 1323164 0 0 0 NOLTE DO CHARLES P 771451 0 19153 0 182615 0 23091 0 23671 0 1019981 0 0 0 RADEMACHER MD DANA E 647213 0 14086 0 249826 0 25291 0 23977 0 960393 0 0 0 STEVENS MD MARK K 891051 0 23462 0 184812 0 38377 0 22937 0 1160639 0 0 0 NESSE MD ROBERT E 0 593641 0 0 0 94500 0 0 1420 17263 1420 705404 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 INDIVIDUAL RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN. AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). ROBERT E. NESSE, M.D. $85,127 SUPPLEMENTAL INFORMATION PART III 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. COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. HEALTH TRADITION HEALTH PLAN COMMON BOARD MEMBER 25431637 CAPITATION PAYMENTS/MEDICAL INSURANCE PREMIUMS 0 MICHAEL TIGGELAAR EMPLOYMENT 37339 COMPENSATION PAID TO SON OF BOARD MEMBER, TOM TIGGELAAR 0 LORI JUNGCK EMPLOYMENT 30513 COMPENSATION PAID TO SPOUSE OF BOARD MEMBER, MARK JUNGCK, M.D. 0 NENA NEMEC EMPLOYMENT 89680 COMPENSATION PAID TO SPOUSE OF BOARD MEMBER, JOHN NEMEC 0 HEATHER MOLLING EMPLOYMENT 35030 COMPENSATION PAID TO SISTER-IN-LAW OF BOARD MEMBER, PAUL MOLLING, D.O. 0 JOHN W COCHRAN MD EMPLOYMENT 278546 COMPENSATION PAID TO SPOUSE OF BOARD MEMBER, MARGARENT M. GRENISEN, M.D. 0 STACI M ANIL EMPLOYMENT 51944 COMPENSATION PAID TO SPOUSE OF BOARD MEMBER, GOKHAN ANIL, M.D. 0 MAUREEN E GRENISEN EMPLOYMENT 10707 COMPENSATION PAID TO SISTER OF BOARD MEMBER, MARGARET M. GRENISEN, M.D. 0 MMSI INC COMMON BOARD MEMBER 2461992 CAPITATION PAYMENTS/HEALTH BENEFIT PLAN 0 BEN MY KRUSE EMPLOYMENT 14983 COMPENSATION PAID TO SON OF BOARD MEMBER/CAO, JOSEPH J. KRUSE 0 GREGORY PACZKOWSKI EMPLOYMENT COMPENSATION PAID TO SON OF BOARD MEMBER, RONALD R. PACZKOWSKI 0 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 IN 2012, THE MAJORITY OF THE SUPPORT SERVICES WITHIN THE REGIONAL HEALTH CARE DELIVERY SYSTEM WERE SHIFTED TO BEING PROVIDED BY THE FILING ORGANIZATION VERSUS MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE, INC., HOWEVER, MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEATHCARE INC.'S BOARD STILL MAINTAINS AN OVERSIGHT FUNCTION OVER THE ENTITIES. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: SCHAEFER, DANIEL E. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: NESSE M.D., ROBERT E. PETER R. HUGHES, TIMOTHY J. JOHNSON M.D., ALAN J. KRUMHOLZ M.D., JOSEPH J. KRUSE, AND THOMAS H. TIGGELAAR HAVE A BUSINESS RELATIONSHIP AS THEY SERVE ON THE BOARD OF HEALTH TRADITION HEALTH PLAN, A RELATED TAXABLE ENTITY. FORM 990, PART VI, SECTION A, LINE 3 MAYO CLINIC, MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, AND OTHER RELATED COMPANIES PROVIDE MANAGEMENT SERVICES TO THE ENTIRE SYSTEM OF ENTITIES. MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE, INC. ALSO PROVIDED MANAGEMENT SERVICES ON A REGIONAL BASIS THAT INCLUDED THE FILING ORGANIZATION FOR A PORTION OF THE YEAR. 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 HEALTH SYSTEM-FRANCISCAN HEALTHCARE, INC. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BODY IS SUBJECT TO APPROVAL BY THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE ARTICLES OF INCORPORATION PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS AMENDMENT OF ARTICLES AND BYLAWS, CERTAIN LARGE TRANSACTIONS, AND OTHER KEY DECISIONS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER AND FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FILING ORGANIZATIONS GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C MAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF THE MAYO CLINIC (AND/OR AFFILIATE) AND THE OUTSIDE ENTITY. ADDITIONAL CONFLICT OF INTEREST POLICIES AND PROCEDURES EXIST FOR CERTAIN ENTITIES CONCERNING RESEARCH CONTRACTS AND OTHER TYPES OF POTENTIAL CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY IN THE FALL FOR THE NEXT YEAR'S COMPENSATION. THE SALARY OF THE CAO, CEO AND PHYSICIAN LEADERS ON THE BOARD OF THE FILING ORGANIZATION WAS 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, THE FILING ORGANIZATION'S INTERNAL PROCESS FOR DETERMINING COMPENSATION FOR TOP MANAGEMENT OFFICIALS INCLUDED REVIEW OF COMPARABILITY DATA FOR SIMILAR SIZED ORGANIZATIONS BY AN INDEPENDENT COMMITTEE OF THE BOARD. SALARIES FOR THE PAST YEAR AND RANGES FOR THE NEXT YEAR WERE 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FAS 158 PENSION ADJUSTMENT -1,215,368. IN REGARDS TO FILING CERTAIN FOREIGN FORMS SCHEDULE F, PART IV, LINES 3, 5, & 6 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 HOLDING COMPANY (EIN: 41-1578020) 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 -- SAINT MARYS HOSPITAL 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 MAYO CLINIC HEALTH SYSTEM IN WAYCROSS INC 1900 TEBEAU STREET WAYCROSS GA 31501 581667166 HOSPITAL GA 501(C)(3) 3 MAYO CLINIC JACKSONVILLE 1 MAYO CLINIC HEALTH SYSTEM--ALBERT LEA 1000 FIRST DRIVE NW AUSTIN MN 55912 411404075 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--AUSTIN 1000 FIRST DRIVE NW AUSTIN MN 55912 410695606 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--AUSTIN FOUNDATION 1000 FIRST DRIVE NW AUSTIN MN 55912 300107471 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--AUSTIN 1 MAYO CLINIC HEALTH SYSTEM--CANNON FALLS 1116 WEST MILL STREET CANNON FALLS MN 55009 204156428 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC 1501 THOMPSON STREET BLOOMER WI 54724 390980343 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 390813418 HOSPITAL WI 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--FAIRMONT 800 MEDICAL CENTER DRIVE PO BOX 800 FAIRMONT MN 56031 410760836 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391411999 HEALTHCARE SYSTEM PARENT WI 501(C)(3) 11-I MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--LAKE CITY 500 WEST GRANT STREET LAKE CITY MN 55041 411906820 HOSPITAL MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--MANKATO 1025 MARSH STREET MANKATO MN 56002 411236756 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--MANKATO HEALTH CARE FOUNDATION 1025 MARSH STREET MANKATO MN 56002 411663357 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE 301 SECOND STREET NE NEW PRAGUE MN 56071 410723639 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC 1222 EAST WOODLAND AVENUE BARRON WI 54812 390920634 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--OWATONNA 134 SOUTHVIEW ST OWATONNA MN 55060 411862132 PATIENT CARE - CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC 2321 STOUT ROAD MENOMONIE WI 54751 510190875 HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--RED WING 701 HEWITT BOULEVARD RED WING MN 55066 411713783 PATIENT CARE SERVICES MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--RED WING HOME HEALTH & HOSPICE 701 HEWITT BOULEVARD RED WING MN 55066 411539756 HOME HEALTHCARE SERVICES MN 501(C)(3) 7 MCHS--RED WING 1 MAYO CLINIC HEALTH SYSTEM--SPRINGFIELD 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 411893827 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 -- SAINT MARYS HOSPITAL 1 RED WING SEMINARY HOME 701 HEWITT BOULEVARD RED WING MN 55066 411263419 RESIDENT CARE AND HOUSING MN 501(C)(3) 9 MCHS--RED WING 1 SATILLA HEALTH MANAGEMENT INC 1900 TEBEAU STREET WAYCROSS GA 31501 581717889 HEALTHCARE SERVICES GA 501(C)(3) 3 MCHS IN WAYCROSS INC 1 THE DOWNTOWN PLAZA 701 HEWITT BOULEVARD RED WING MN 55066 411532554 ELDERLY HOUSING MN 501(C)(3) 9 MCHS--RED WING 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 HEALTH TRADITION HEALTH PLAN 1808 EAST MAIN STREET ONALASKA WI 54650 391545987 MEDICAL SERVICES COMPANY WI N/A C 1 LOBSS NETWORK SUPPORT 2002 INC 200 FIRST STREET SW ROCHESTER MN 55905 481276150 ADMINISTRATIVE SERVICES MN N/A C 1 MAYO CLINIC GBS MAURITIUS 2ND FLOOR EBENE MEWS 57 EBENE CYBERCITY MP HEALTHCARE MANAGEMENT MP N/A C 1 MAYO CLINIC HEALTH SYSTEM--DECORAH CLINIC PHYSICIANS 907 MONTGOMERY STREET DECORAH IA 52101 411711329 PATIENT CARE - CLINIC IA N/A C 1 MAYO CLINIC HEALTH SYSTEM--FARIBAULT 635 FIRST STREET SE FARIBAULT MN 55021 411817179 PATIENT CARE - CLINIC MN N/A C 1 MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 391528920 PHARMACY SERVICES WI N/A C 1 MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 411346366 REFERENCE LAB SERVICES MN N/A C 1 MAYO HOLDING COMPANY 200 FIRST STREET SW ROCHESTER MN 55905 411578020 HOLDING COMPANY MN N/A C 1 MAYO INSURANCE COMPANY LTD 200 FIRST STREET SW ROCHESTER MN 55905 SELF INSURANCE POOL CJ N/A C 1 MAYO MEDICAL LABORATORIES NEW ENGLAND INC 265 BALLARDVALE STREET WILMINGTON MA 01887 043323713 LABORATORY SERVICES MA N/A C 1 MAYO REGIONAL PRACTICES OF ARIZONA 13400 EAST SHEA BOULEVARD SCOTTSDALE AZ 85259 061190278 THIRD PARTY ADMINISTRATION SERVICES AZ N/A C 1 MMSI INC 21 FIRST STREET SW ROCHESTER MN 55905 411547003 THIRD PARTY ADMINISTRATION SERVICES MN N/A C 1 RESOUNDANT INC 221 1ST AVE SW ROCHESTER MN 55902 461661978 MANUFACTURING MEDICAL DEVICE COMPONENT MN N/A C 1 ROCHESTER AIRPORT COMPANY ROUTE 2 ROCHESTER MN 55902 410506870 AIRPORT MANAGEMENT MN N/A C 1 SATILLA HEALTH ENTERPRISES INC 1900 TEBEAU STREET WAYCROSS GA 31501 581717222 HEALTHCARE GA N/A C 1 SATILLA HEALTHNET INC 1900 TEBEAU STREET WAYCROSS GA 31501 582151076 HEALTH SERVICES GA N/A C 1 SATILLA REGIONAL SPECIALTY PHYSICIANS INC 1900 TEBEAU STREET WAYCROSS GA 31501 204363143 PHYSICIAN OFFICES GA N/A C 1 SIT ALPHA II BOND FUND LTD CLIFTON HOUSE 75 FORTH ST GRAND CAYMAN CJ KY1-1108 980648163 INVESTMENT MANAGEMENT CJ N/A C 1 SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION 13400 E SHEA BLVD SCOTTSDALE AZ 85259 860870505 COMMERCIAL PROPERTY OWNERS ASSOCIATION AZ N/A C 1 THE STABILE BUILDING OWNERS' ASSOCIATION 200 FIRST STREET SW ROCHESTER MN 55905 208994499 COMMERCIAL PROPERTY OWNERS ASSOCIATION MN N/A C 1 CHARITABLE LEAD TRUST CHARITABLE TRUST CA N/A T 1 PERPETUAL TRUST CHARITABLE TRUST ND N/A T 1 PERPETUAL TRUST CHARITABLE TRUST LA N/A T 1 PERPETUAL TRUST (2) CHARITABLE TRUST MA N/A T 1 PERPETUAL TRUST CHARITABLE TRUST MO N/A T 1 PERPETUAL TRUST CHARITABLE TRUST AZ N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST CO N/A T 1 CHARITABLE REMAINDER TRUST (6) CHARITABLE TRUST FL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST FL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST IL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST LA N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST MI N/A T 1 CHARITABLE REMAINDER TRUST (68) CHARITABLE TRUST MN N/A T 1 CHARITABLE REMAINDER TRUST (77) CHARITABLE TRUST MN N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NC N/A T 1 CHARITABLE REMAINDER TRUST (2) CHARITABLE TRUST TX N/A T 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 DECORAH CLINIC L 201064 GAAP FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC C 293367 GAAP MAYO CLINIC - METHODIST HOSPITAL A 118271 GAAP MAYO CLINIC - METHODIST HOSPITAL L 129679 GAAP MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC B 58600 GAAP MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC C 1139495 GAAP MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC Q 387972 GAAP MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION-SPARTA INC C 57966 GAAP MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC L 58332 GAAP MAYO COLLABORATIVE SERVICE INC M 1465212 GAAP MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH L 105940 GAAP MMSI INC S 2461992 GAAP