2013-11-05T13:04:03-06:00 2012-12-31 990 2012-01-01 581667166 MAYO CLINIC HEALTH SYSTEM IN WAYCROSS INC MAYO 5075381297 1900 TEBEAU STREET WAYCROSS GA 31501 MARY J HOFFMAN 5075381297 2013-11-05 2012 2016-02-25 16:41:14Z KENNETH T CALAMIA MD 1900 TEBEAU STREET WAYCROSS GA 31501 201384062 0 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1985 GA OPERATION OF A HOSPITAL, TWO NURSING HOMES, A REHAB UNIT AND A SENIOR BEHAVORIAL UNIT. 9 3 1647 104 6000 4175 617736 2963248 142211068 155306221 1424746 5532948 2793220 1482268 147046770 165284685 2500 75799 0 0 64514704 68906180 0 0 0 79462469 89006998 143979673 157988977 3067097 7295708 171139807 158645405 61321394 70576768 109818413 88068637 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 142656720 156148997 PATIENT CARE (SEE SCHEDULE O):MAYO CLINIC HEALTH SYSTEM IN WAYCROSS (MCHS-WAYCROSS) BECAME A MEMBER OF THE MAYO CLINIC HEALTH SYSTEM ON MARCH 1, 2012. 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, WISCONSIN AND GEORGIA CAN HAVE PEACE OF MIND KNOWING THAT MAYO CLINIC HEALTH SYSTEM AND MAYO CLINIC PARTNER TO ENSURE HEALTHIER LIVES IN THE REGION.AS PART OF THE MAYO CLINIC HEALTH SYSTEM, MCHS-WAYCROSS SERVES A NINE-COUNTY REGION IN SOUTHEAST GEORGIA. MCHS-WAYCROSS OPERATES A 231-BED HOSPITAL, A 96-BED SKILLED NURSING FACILITY, A REHAB UNIT AND A PSYCHIATRIC UNIT IN WAYCROSS, GEORGIA - ALONG WITH AN ADDITIONAL 78-BED SKILLED NURSING FACILITY IN BLACKSHEAR, GEORGIA. MCHS-WAYCROSS PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. SERVICES ARE ALSO PROVIDED TO MEDICAID AND MEDICARE PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. IN 2012, MCHS-WAYCROSS PROVIDED APPROXIMATELY $4,064,000 (AT COST) IN FINANCIAL ASSISTANCE TO PATIENTS. THE UNREIMBURSED COST OF SERVICES TO MEDICARE PATIENTS, DETERMINED BY USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY, WAS APPROXIMATELY $4,696,000.SATILLA ADVOCACY SERVICES, A RAPE CRISIS AND CHILD ADVOCACY CENTER, OPERATES UNDER THE UMBRELLA OF MCHS-WAYCROSS AND SERVES VICTIMS OF SEXUAL ASSAULT AND OTHER VIOLENT CRIMES IN THE SIX COUNTIES THAT MAKE UP THE WARE JUDICIAL CIRCUIT. A FULL RANGE OF SERVICES IS OFFERED FROM THE TIME A VICTIM REPORTS AN INCIDENT, INCLUDING EMERGENCY DEPARTMENT SERVICES, FOLLOW UP AT THE RAPE CRISIS/CHILD ADVOCACY CENTER, THERAPY, AND SUPPORT BY OUR LEGAL ADVOCACY PERSONNEL. IN 2012, SATILLA ADVOCACY SERVED 460 NEW VICTIMS AND PRESENTED PREVENTION EDUCATION TO 10,143 PEOPLE.ALL REVENUE AFTER EXPENSES IS REINVESTED IN MCHS-WAYCROSS'S MISSION TO CARE FOR THE CITIZENS OF THE COMMUNITY THROUGH CLINICAL CARE, HEALTH PROGRAMS, STATE-OF-THE-ART TECHNOLOGY AND FACILITIES, AND TEACHING AND TRAINING OF MEDICAL PROFESSIONALS.APPROXIMATELY 100 COMMUNITY VOLUNTEERS PROVIDED APPROXIMATELY 18,700 HOURS OF DONATED TIME TO THE HOSPITAL IN 2012. VOLUNTEERS PROVIDE HOSPITALITY SERVICES TO PATIENTS, FAMILIES AND VISITORS. THE DONATED SERVICES PROVIDED BY THE VOLUNTEERS IN 2012 IS VALUED AT APPROXIMATELY $414,600 BASED ON STATISTICS FROM THE INDEPENDENT SECTOR. 1890996 75799 291566 COMMUNITY PROGRAMS (SEE SCHEDULE O):CONSISTENT WITH ITS CHARITABLE MISSION, MCHS-WAYCROSS PROVIDES COMMUNITY BENEFIT TO THE COMMUNITY IT SERVES. FOR 2012, MCHS-WAYCROSS PROVIDED HEALTH EDUCATION AND HEALTH SUPPORT SERVICES THAT REACHED APPROXIMATELY 21,000 PEOPLE. MANY OF THESE BENEFITS AND SERVICES ARE DECRIBED BELOW.MCHS-WAYCROSS IS INVOLVED IN MANY ACTIVITIES AIMED AT EDUCATING THE COMMUNITY ABOUT HEALTH-RELATED TOPICS. EXAMPLES OF THESE ACTIVITIES INCLUDE A MONTHLY CALENDAR OF EVENTS AND CLASSES OFFERED AT THE HOSPITAL THAT IS DISTRIBUTED VIA EMAIL AND ADVERTISED IN LOCAL NEWSPAPERS. THE FOLLOWING ARE SOME OF THE CLASSES AND SEMINARS OFFERED DURING 2012. - CAMP HUFF N PUFF - DIABETES SCHOOL - SENIOR SAFETY DAY - SMOKING CESSATION - WOMEN'S HEALTH BLITZ - CANCER SUPPORT GROUPTHE HOSPITAL STAFF PROVIDED BLOOD PRESSURE SCREENINGS, EDUCATIONAL PROGRAMS AND HEALTH SEMINARS TO RESIDENTS IN SCHOOLS, SENIOR CITIZENS CENTERS, AND SOCIAL CLUBS AND AT HEALTH FAIRS THROUGHOUT THE SERVICE AREA INCLUDING SENIOR SAFETY DAY, SWAMPFEST AND PIERCE, BRANTLEY AND WARE COUNTY HIGH SCHOOL FOOTBALL GAMES. MCHS-WAYCROSS PROVIDED APPROXIMATELY $132,000 OF STAFF TIME AND SUPPLIES TO HELP 634 PATIENTS' ACCESS FREE MEDICATIONS THROUGH PHARMACEUTICAL COMPANIES' PRESCRIPTION ASSISTANCE PROGRAMS. MEDICATIONS PROVIDED BY THESE DRUG COMPANIES TOTALED OVER $175,000 THROUGH THIS PARTNERSHIP PROGRAM. MCHS-WAYCROSS OFFERED ENROLLMENT ASSISTANCE TO 449 PEOPLE IN THE COMMUNITY SO THEY WOULD BE ABLE TO ACCESS PUBLIC HEALTH PROGRAMS SUCH AS MEDICAID. IN 2012, MCHS-WAYCROSS WORKED WITH LOCAL COLLEGES AND TECHNICAL SCHOOLS TO OFFER CLINICAL ROTATIONS FOR A VARIETY OF HEALTHCARE PROFESSIONALS THAT INCLUDED PROVIDING A CLINICAL SETTING FOR 568 STUDENTS THAT INCLUDED SIX HOURS PER STUDENT OF STAFF MENTORING. ORIENTATION, DRUG SCREENS, CRIMINAL BACKGROUND CHECKS AND SOCIAL SECURITY CHECKS WERE PROVIDED FOR ALL STUDENTS. IN ADDITION, RENT-FREE CLASSROOM SPACE WAS PROVIDED. MCHS-WAYCROSS PARTNERS WITH THE MEDICAL COLLEGE OF GEORGIA AT GEORGIA REGENTS UNIVERSITY TO SPONSOR A RESIDENCY PROGRAM. THIS PROGRAM SERVES AS A RESPONSE TO DECLINING NUMBERS OF PRIMARY CARE PHYSICIANS IN RURAL SOUTH GEORGIA COMMUNITIES AND THE REGION AND A DESIRE TO TRAIN PRIMARY CARE PHYSICIANS IN SETTINGS THAT WOULD FACILITATE THE CHOICE OF PRACTICE IN SMALL AND RURAL COMMUNITIES.IN 2012, MCHS-WAYCROSS PROVIDED $75,799 IN CASH DONATIONS TO NON-PROFIT ORGANIZATIONS IN OUR SERVICE AREA INCLUDING THE SATILLA HEALTH FOUNDATION, THE AMERICAN CANCER SOCIETY, YMCA, OKEFENOKEE TECHNICAL COLLEGE FOUNDATION, WAYCROSS COLLEGE FOUNDATION, EASTER SEALS OF SOUTHERN GEORGIA AND THE SATILLA MIRACLE LEAGUE.AS A CORPORATE CITIZEN, MCHS-WAYCROSS TAKES A LEADERSHIP ROLE AND COLLABORATES WITH OTHER REGIONAL AGENCIES TO INSURE THE COMMUNITY IS PREPARED FOR DISASTER SHOULD IT STRIKE. IN 2012, THE MCHS-WAYCROSS PROVIDED OVER $55,000 OF SUPPORT TO REGIONAL EMERGENCY PREPAREDNESS. 144547716 1 1 0 1 0 0 0 0 1 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 135 0 1 1647 1 1 1 0 0 0 0 0 0 0 0 0 X 9 3 1 1 1 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0 1 1 GA X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 ALTMAN LEWIS F 1.00 0.00 X 0 0 0 BURGER MD CHARLES D 1.00 40.00 X 0 396293 54149 CALAMIA MD KENNETH T 1.00 40.00 X X 0 380555 64518 DENTON M ASHLEY 1.00 0.00 X 0 0 0 DYE MD JAMES W 1.00 0.00 X X 0 0 0 GANT BETTY O 1.00 0.00 X 0 0 0 GRIFFIN MD HOWARD 1.00 0.00 X 0 0 0 HERRIN OWEN 1.00 0.00 X X 0 0 0 LANDRUM ROBERT L 1.00 0.00 X 0 0 0 LANGE MD STEPHEN M 1.00 40.00 X 0 511471 65887 MUSIC ZA 1.00 0.00 X 0 0 0 PINCKNEY FRANKLIN L 1.00 0.00 X 0 0 0 ROWE ANGELA K 1.00 0.00 X 0 0 0 STEPHENS CC 1.00 0.00 X 0 0 0 TRIMM ROBERT M 40.00 0.00 X X 412415 0 23649 WALTERS ROBERT M 1.00 40.00 X X 0 299990 65845 WATERS MD DONALD 1.00 0.00 X 0 0 0 WATERS STEPHEN M 1.00 0.00 X X 0 0 0 BRIGHAM ROBERT F 1.00 40.00 X 0 516616 24095 HOFFMAN MARY J 1.00 40.00 X 0 279686 61176 WHEELER KATRINA T 40.00 0.00 X 167115 0 12393 SMITH JR WINDELL R 40.00 0.00 X 223814 0 18233 SWEAT HOLLI H 40.00 0.00 X 169115 0 15240 ADCOCK MD STEPHEN R 40.00 0.00 X 590853 0 16283 CATCHINGS MD TIMOTHY T 40.00 0.00 X 1061027 0 15832 FORDYCE MD JAMES W 40.00 0.00 X 668930 0 5317 WALSH MD THOMAS 40.00 0.00 X 712703 0 6752 WEHMANN MD THOMAS W 40.00 0.00 X 1145338 0 19904 5151310 2384611 469273 53 0 1 0 SOUTHEAST GEORGIA ANESTHESIA ASSOCIATES 410 DARLING AVENUE WAYCROSS GA 31501 ANESTHESIA SERVICES 3355528 ADVANCED ICU CARE INC PO BOX 671773 DALLAS TX 75267 MONITORING SERVICES 1350610 BENCURA INC 6478 PUTNAM FORD ROAD SUITE 16 WOODSTOCK GA 30189 THERAPY SERVICES 711952 EMCARE INC 7032 COLLECTION CENTER DRIVE CHICAGO IL 60693 MANAGEMENT SERVICES 549996 TOWERS WATSON PENNSYLVANIA PO BOX 822688 PHILADELPHIA PA 19182 RISK MANAGEMENT SERVICES 518526 27 6300 64897 2843640 48411 2963248 NET PATIENT REVENUE 620000 155306221 155306221 155306221 552707 552707 342664 6000 104523 0 238141 6000 244141 6000 238141 40973645 1450 35855991 138863 5117654 -137413 4980241 4980241 CAFETERIA \ VENDING 722210 736669 736669 PARTNERSHIP REVENUE 900099 344481 344481 MISC. REVENUE 900099 156977 53192 103785 1238127 165284685 156440563 6000 5874874 75799 75799 1041974 184355 857619 51002 15643 35359 48221705 44121779 4099926 1157401 1066517 90884 14866099 13401026 1465073 3567999 3233829 334170 741482 51347 690135 17804 17804 14050257 10714130 3336127 357535 13779 343756 7721315 6705651 1015664 3389219 2943205 446014 167377 116830 50547 72453 55525 16928 1591404 1591404 6624710 6598566 26144 1329190 1031066 298124 BAD DEBT EXPENSE 27986775 27986775 MEDICAL SUPPLIES 22293214 22293214 MEDICAID SURCHARGE 1565874 1565874 AMORTIZATION 330164 330164 768225 433434 334791 157988977 144547716 13441261 0 4801 108968 53817 4469137 22934624 28344947 798365 1709667 2205797 1163222 590717 135396215 73951025 59963316 61445190 47205429 -171203 38772944 2474836 38276134 19434504 171139807 158645405 20258732 24916310 140816 187224 30657416 30655897 25248 25012 10239182 14792325 61321394 70576768 X 109818413 87975841 92796 109818413 88068637 171139807 158645405 X 7295708 -2768744 2224505 -28501245 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 17804 17804 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 964742 964742 81744317 34993859 46750458 52622177 38957166 13665011 64979 64979 61445190 MAYO POOLED INVESTMENTS 38763963 F SATILLA RELIANT PSYCHIATRIC SERVICES, LLC -155324 C DIAGNOSTIC PET, LLC 86555 C PHOENIX HEALTH CARE MANAGEMENT SERVICES, INC. 77750 C 38772944 DUE FROM AFFILIATES 19150262 DEFERRED FINANCING COSTS 284242 19434504 DUE TO AFFILIATES 14792325 14792325 X PART IV, LINE 2B: NURSING HOME RESIDENT TRUST ACCOUNT - RESIDENTS' FUNDS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: AT DECEMBER 31, 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 125.000000000000 1 X 1 1 0 1 1 6769218 2704729 4064489 0.03130 6769218 2704729 4064489 0.03130 503836 503836 0.00390 960984 260198 700786 0.00540 2598368 681003 1917365 0.01470 126205 126205 0.00100 4189393 941201 3248192 0.02500 10958611 3645930 7312681 0.05630 358 358 0.00000 27268 27268 0.00020 55394 55394 0.00040 216174 216174 0.00170 777 777 0.00000 299971 299971 0.00230 0 27986775 42344826 38462584 3882242 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM IN WAYCROSS

410 DARLING AVENUE WAYCROSS GA 31501

X X X MAYO CLINIC HEALTH SYSTEM IN WAYCROSS I 1 1 1 125.000000000000 1 200.000000000000 1 X X X X X 1 1 X X X X X 1 0 X X X X X 1 X 0 0 5 SATILLA CARE CENTER

1600 RIVERSIDE AVENUE WAYCROSS GA 31501

SKILLED NURSING FACILITY PIERCE COUNTY NURSING HOME

221 EAST CARTER AVENUE BLACKSHEAR GA 31516

SKILLED NURSING FACILITY SATILLA REGIONAL REHAB INSTITUTE

2500 SATILLA PARKWAY WAYCROSS GA 31501

REHAB UNIT SENIOR BEHAVIORAL UNIT

1900 TEBEAU WAYCROSS GA 31501

PSYCHIATRIC UNIT / BEHAVIORAL HEALTH SENIOR BEHAVIORAL UNIT - MEMORY CLINIC

1707 BOULEVARD WAYCROSS GA 31501

PSYCHIATRIC UNIT / BEHAVIORAL HEALTH PART I, LINE 6A: THE FILING ORGANIZATION BECAME AN AFFILIATE OF MAYO CLINIC ON MARCH 1, 2012. 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 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 $ 27986775. PART II: THROUGH IN-KIND DONATIONS AND GRANTS TO PUBLIC, PRIVATE AND NONPROFIT ORGANIZATIONS, THE FILING ORGANIZATION ASSISTS WITH SUSTAINING AND ENHANCING THE COMMUNITIES IT SERVES BY ASSISTING IN ECONOMIC DEVELOPMENT, COMMUNITY SUPPORT, ENVIRONMENTAL IMPROVEMENTS, COMMUNITY IMPROVEMENT ADVOCACY AND WORKFORCE DEVELOPMENT. 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.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 SURPLUS REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT (USING A MEDICARE COST REPORT STEP-DOWN METHODOLOGY). HOWEVER, USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY ACTUALLY RESULTS IN A MEDICARE SHORTFALL OF APPROXIMATELY $4,696,000 AS REPORTED IN THE CORE FORM, PART III, PROGRAM SERVICE ACCOMPLISHMENTS.THE MOST COMMON REASONS FOR A DIFFERENCE BETWEEN THE MEDICARE SURPLUS 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. MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC PART V, SECTION B, LINE 14G: IN REGARDS TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, SIGNS ARE POSTED IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE AND PROVIDES CONTACT INFORMATION FOR PATIENT FINANCIAL REPRESENTATIVES WHICH CAN PROVIDE A COPY OF THE POLICY, ASSISTANCE IN APPLYING, ETC. MAYO CLINIC HEALTH SYSTEM IN WAYCROSS, INC 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, SIGNS ARE POSTED 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 IN WAYCROSS, INC PART V, SECTION B, LINE 20D: THE POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 40% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN USING THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERICIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE. PART VI, LINE 2: CONSISTENT WITH ITS CHARITABLE MISSION, MAYO CLINIC HEALTH SYSTEM IN WAYCROSS (MCHS-WAYCROSS) PROVIDES COMMUNITY BENEFIT TO THE COMMUNITY IT SERVES. A COMMUNITY BENEFIT IS A PLANNED, MANAGED, ORGANIZED, AND MEASURED APPROACH TO MEETING IDENTIFIED COMMUNITY HEALTH NEEDS. IT INVOLVES THE PARTICIPATION OF THE HEALTHCARE ORGANIZATION WORKING WITH THE COMMUNITY TO BENEFIT ITS RESIDENTS THROUGH PROGRAMS AND SERVICES THAT IMPROVE THEIR HEALTH STATUS AND QUALITY OF LIFE. MCHS-WAYCROSS IMPROVES THE HEALTH AND WELL BEING OF THE NINE-COUNTY SERVICE AREA IN SOUTHEAST GEORGIA THAT IT SERVES THROUGH CLINICAL SERVICES, EDUCATION, AND PARTNERSHIPS THAT BUILD HEALTH CAPACITY IN THE COMMUNITY. COMMUNITY BENEFITS ARE PROVIDED FOR ALL CITIZENS AS WELL AS FOR THE MEDICALLY UNDERSERVED. THE ORGANIZATION PAYS CLOSE ATTENTION TO THE NEEDS OF LOW INCOME AND OTHER VULNERABLE PERSONS AND THE COMMUNITY AT LARGE. THE HOSPITAL WORKS WITH COMMUNITY GROUPS TO IDENTIFY NEEDS, STRENGTHEN EXISTING COMMUNITY PROGRAMS AND PLAN NEWLY NEEDED SERVICES. IT PROVIDES A WIDE ARRAY OF COMMUNITY BENEFIT SERVICES DESIGNED TO IMPROVE COMMUNITY HEALTH AND THE HEALTH OF INDIVIDUALS. MCHS-WAYCROSS WORKS TO INCREASE ACCESS TO HEALTH CARE, IN ADDITION TO PROVIDING FREE AND DISCOUNTED SERVICES TO PEOPLE WHO ARE UNINSURED AND UNDERINSURED. THE ORGANIZATION'S COMMUNITY BENEFIT PROGRAMS ARE DESIGNED TO RESPOND TO ASSESSED NEEDS AND ARE FOCUSED ON PREVENTION AND EDUCATION. 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 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, SIGNS ARE POSTED IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE AND PROVIDES CONTACT INFORMATION FOR PATIENT FINANCIAL REPRESENTATIVES WHICH CAN PROVIDE A COPY OF THE POLICY, ASSISTANCE IN APPLYING, ETC. PART VI, LINE 4: MCHS-WAYCROSS SERVES A NINE-COUNTY REGION IN SOUTHEAST GEORGIA. THE MAIN CAMPUS IS LOCATED IN WAYCROSS, GEORGIA (WARE COUNTY) AND INCLUDES A HOSPITAL, A SKILLED NURSING FACILITY, A REHAB UNIT AND A PSYCHIATRIC UNIT. AN ADDITIONAL SKILLED NURSING FACILTIY IS LOCATED IN BLACKSHEAR, GEORGIA (PIERCE COUNTY).ACCORDING TO THE UNITED STATES CENSUS BUREAU, THE 2012 POPULATION ESTIMATE FOR WARE COUNTY (WHICH COMPRISES MOST OF WAYCROSS'S SERVICE AREA) IS 35,821. THE CENSUS BUREAU REPORTS THAT 23.5% OF THE POPULATION IS UNDER 18 YEARS OLD AND 15.5% IS 65 YEARS OLD OR OLDER. AN ESTIMATED 22.4% OF INDIVIDUALS ARE LIVING BELOW THE POVERTY LEVEL. PART VI, LINE 5: THIS FILING ORGANIZATION IS AN AFFILIATE OF THE MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION - EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATION'S ACTIVITIES.SURPLUS FUNDS - MAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE. COMMUNITY REPRESENTATION ON GOVERNING BODY - THE BOARD OF TRUSTEES IS THE GOVERNING BODY OF MAYO CLINIC. A MAJORITY OF ITS MEMBERS ARE EXTERNAL, INDEPENDENT TRUSTEES. IT HAS OVERALL RESPONSIBILITY FOR THE CHARITABLE, CLINICAL PRACTICE, SCIENTIFIC AND EDUCATIONAL MISSION AND PURPOSES OF MAYO CLINIC AND ITS AFFILIATES AS SET FORTH IN ITS ARTICLES OF INCORPORATION AND BYLAWS. BECAUSE OF MAYO CLINIC'S NATIONAL PRESENCE, THESE TRUSTEES ARE SELECTED BASED ON THEIR AREAS OF EXPERTISE, WHETHER IN HEALTH CARE POLICY, BUSINESS, GOVERNMENT OR ANOTHER FIELD. IN ADDITION TO THIS COMMUNITY REPRESENTATION AT THE PARENT ENTITY, THE FILING ORGANIZATION ALSO INVOLVES LOCAL COMMUNITY MEMBERS ON ITS GOVERNING BODY. OPEN VS. CLOSED STAFF MODEL - THE FILING ORGANIZATION'S 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: THE FILING 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. 1 SATILLA HEALTH FOUNDATION INC 1900 TEBEAU STREET WAYCROSS GA 31501 582008998 501(C)(3) 74508 COMMUNITY HEALTH 1 0 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. TRANSFERS OR GRANTS TO TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED. X 1 1 0 1 0 0 0 0 0 0 0 BURGER MD CHARLES D 0 352136 0 0 0 44157 0 31602 0 22547 0 450442 0 0 CALAMIA MD KENNETH T 0 352830 0 0 0 27725 0 45478 0 19040 0 445073 0 0 LANGE MD STEPHEN M 0 438938 0 0 0 72533 0 41791 0 24096 0 577358 0 0 TRIMM ROBERT M 342236 0 0 0 70179 0 12375 0 11274 0 436064 0 0 0 WALTERS ROBERT M 0 284663 0 0 0 15327 0 41909 0 23936 0 365835 0 0 BRIGHAM ROBERT F 0 457288 0 0 0 59328 0 246 0 23849 0 540711 0 0 HOFFMAN MARY J 0 273136 0 0 0 6550 0 32745 0 28431 0 340862 0 0 WHEELER KATRINA T 166560 0 0 0 555 0 7002 0 5391 0 179508 0 0 0 SMITH JR WINDELL R 189300 0 0 0 34514 0 8540 0 9693 0 242047 0 0 0 SWEAT HOLLI H 145932 0 0 0 23183 0 6722 0 8518 0 184355 0 0 0 ADCOCK MD STEPHEN R 530024 0 3000 0 57829 0 8701 0 7582 0 607136 0 0 0 CATCHINGS MD TIMOTHY T 875366 0 0 0 185661 0 12375 0 3457 0 1076859 0 0 0 FORDYCE MD JAMES W 573696 0 47200 0 48034 0 0 0 5317 0 674247 0 0 0 WALSH MD THOMAS 671824 0 25000 0 15879 0 0 0 6752 0 719455 0 0 0 WEHMANN MD THOMAS W 1046444 0 0 0 98894 0 12375 0 7529 0 1165242 0 0 0 PART I, LINE 1A AS A BENEFIT TO ITS EMPLOYEES, THE FILING ORGANIZATION SUBSIDIZED EMPLOYEE MEMBERSHIPS TO THE YMCA AND SIMILIAR HEALTH/FITNESS FACILITIES. SUCH SUBSIDIES ARE AVAILABLE TO ALL EMPLOYEES AND ARE NOT TREATED AS TAXABLE INCOME TO THE EMPLOYEES. FOR 2012, DR. THOMAS WALSH RECEIVED THIS BENEFIT. 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). - ROBERT F. BRIGHAM $ 55,113 - CHARLES D. BURGER, M.D. $ 32,230 - KENNETH T. CALAMIA, M.D. $ 3,492 - MARY HOFFMAN $ 5,541 - STEPHEN M. LANGE, M.D. $ 55,874 - ROBERT M. WALTERS $ 10,901 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. SUPPLEMENTAL INFORMATION PART III PART II: COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. GLORIA ALTMAN FAMILY RELATIONSHIP WITH LEWIS ALTMAN, DIRECTOR OF FILING ORGANIZATION 15643 GLORIA ALTMAN WAS EMPLOYED BY THE FILING ORGANIZATION DURING 2012. 0 DAVID DENTON FAMILY RELATIONSHIP WITH ASHLEY DENTON, DIRECTOR OF FILING ORGANIZATION 30340 DAVID DENTON WAS EMPLOYED BY THE FILING ORGANIZATION DURING 2012. 0 BLACKSHEAR FAMILY PRACTICE PC BUSINESS RELATIONSHIP WITH DONALD WATERS, DIRECTOR OF FILING ORGANIZATION 119766 DR. WATERS IS AN OFFICER OF BLACKSHEAR FAMILY PRACTICE, WHICH PROVIDED MEDICAL SERVICES TO THE FILING ORGANIZATION DURING 2012. 0 SATILLA REGIONAL SPECIALTY PHYSICIANS BUSINESS RELATIONSHIP DUE TO BOARD OVERLAP WITH FILING ORGANIZATION 196289 SEVERAL OF THE FILING ORGANIZATION'S BOARD MEMBERS ARE ALSO ON THE BOARD OF SATILLA REGIONAL SPECIALITY PHYSICIANS (AN AFFILIATED TAXABLE ENTITY). TRANSACTIONS INCLUDE RENTAL OF PROPERTY AND PROVISION OF SERVICES. 0 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: BRIGHAM, ROBERT F. BURGER M.D., CHARLES D. CALAMIA M.D., KENNETH T. HOFFMAN, MARY J. LANGE M.D., STEPHEN M. WALTERS, ROBERT M. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: BRIGHAM, ROBERT F. CALAMIA M.D., KENNETH T. HOFFMAN, MARY J. LANGE M.D., STEPHEN M. WALTERS, ROBERT M. THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: CALAMIA M.D., KENNETH T. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL WHO IS ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: BRIGHAM, ROBERT F. JAMES W. DYE M.D., BETTY O. GANT, ANGELA K. ROWE AND ROBERT M. TRIMM HAVE A BUSINESS RELATIONSHIP AS THEY SERVE AS AN OFFICER, DIRECTOR, OR TRUSTEE OF SATILLA HEALTH ENTERPRISES, A RELATED TAXABLE ENTITY. CHARLES D. BURGER M.D., KENNETH T. CALAMIA M.D., JAMES W. DYE M.D., OWEN HERRIN, STEPHEN M. LANGE M.D., Z.A. MUSIC, ROBERT M. TRIMM, ROBERT M. WALTERS AND DONALD WATERS M.D. HAVE A BUSINESS RELATIONSHIP AS THEY SERVE AS AN OFFICER, DIRECTOR, OR TRUSTEE OF SATILLA REGIONAL SPECIALITY PHYSICIANS, A RELATED TAXABLE ENTITY. DONALD WATERS, M.D. AND HOWARD GRIFFIN, M.D. HAVE A BUSINESS RELATIONSHIP. EACH HAS AN OWNERSHIP INTEREST IN SEPERATE BUSINESSES THAT HAVE BUSINESS TRANSACTIONS. 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 JACKSONVILLE ALSO PROVIDES MANAGEMENT SERVICES ON A REGIONAL BASIS THAT INCLUDES THE FILING ORGANIZATION. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS, COMPENSATION FOR THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES HAS BEEN DISCLOSED IN PART VII AND SCHEDULE J AS REQUIRED. FORM 990, PART VI, SECTION A, LINE 4 ON MARCH 1, 2012 THE FILING ORGANIZATION AFFILIATED WITH MAYO CLINIC. CHANGES WERE MADE TO THE ORGANIZATIONAL DOCUMENTS AS A RESULT OF THE AFFILIATION (I.E. CHANGE IN THE FILING ORGANIZATION'S LEGAL NAME, CHANGE IN THE FILING ORGANIZATION'S SOLE MEMBER, ETC.) FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THIS CORPORATION SHALL BE MAYO CLINIC JACKSONVILLE (A NONPROFIT CORPORATION). FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER APPOINTS MEMBERS TO THE BOARD OF DIRECTORS THROUGH MULTIPLE PROCESSES AS SPECIFIED IN THE BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B THE ARTICLES AND BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, DEBT, AMENDMENT OF THE ARTICLES AND BYLAWS, AND GENERAL OPERATION DECISIONS. THE COMMUNITY DIRECTORS HAVE THE AUTHORITY TO ENFORCE CERTAIN PROVISIONS OF THE INTEGRATION AGREEMENT. FORM 990, PART VI, SECTION A, LINE 8B THE FILING ORGANIZATION HAS NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. THEREFORE, THERE IS NO DOCUMENTATION FOR PART VI SECTION A LINE 8B. 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 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 THE FILING ORGANIZATION BECAME AN AFFILIATE OF MAYO CLINIC ON MARCH 1, 2012. 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. PRIOR TO AFFILIATION WITH MAYO CLINIC, THE CONFLICT OF INTEREST POLICY FOR THE FILING ORGANIZATION COVERED ALL BOARD MEMBERS AND ADMINISTRATIVE STAFF MEMBERS. THE DETERMINATION AND REVIEW OF WHETHER A CONFLICT EXISTED OR NOT WAS DONE AT THE BOARD OR COMMITTEE LEVEL IN WHICH THE MEMBER WAS INVOLVED. IN THE EVENT OF A CONFLICT, MEMBERS WERE EXCLUDED FROM DISCUSSION AND THE RIGHT TO VOTE. AS OF MARCH 1, 2012, 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 MAYO-EMPLOYED 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/PRESIDENT AND THE VICE PRESIDENT, ALONG WITH SOME ADDITIONAL OFFICERS OF THE FILING ORGANIZATION WERE REVIEWED BY THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE AND/OR THE MAYO CLINIC GOVERNANCE COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE ARIZONA, FLORIDA, AND ROCHESTER, MINNESOTA CAMPUSES. 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). FOR THOSE INDIVIDUALS FOR WHICH THIS COMMITTEE CAN NOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE SALARY AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION, AND GOVERNANCE (GOVERNANCE COMMITTEE) IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. THIS GROUP REVIEWS THE COMPENSATION AND BENEFITS FOR PHYSICIANS FROM ALL CAMPUSES, INCLUDING THE MAYO CLINIC HEALTH SYSTEM LOCATIONS, AS WELL AS CERTAIN SENIOR ADMINISTRATIVE AND EXECUTIVE LEADERSHIP (INCLUDING ALL PERSONS BELIEVED TO BE DISQUALIFIED PERSONS). THIS PROCESS ESTABLISHES ACCEPTABLE RANGES FOR VARIOUS POSITIONS, LEVELS, AND SPECIALTIES. THE COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. IN ADDITION, THE GOVERNANCE COMMITTEE DIRECTLY RETAINS AN INDEPENDENT THIRD-PARTY COMPENSATION CONSULTANT TO PROVIDE RELEVANT, CONTEMPORANEOUS BENCHMARK INFORMATION FOR A SMALL GROUP OF SENIOR PHYSICIAN, ADMINISTRATIVE, AND EXECUTIVE LEADERSHIP POSITIONS FOR WHICH AN INDIVIDUALIZED REVIEW AND RECOMMENDATION IS MADE. PRIOR TO AFFILIATION WITH MAYO CLINIC, THE FILING ORGANIZATION'S GOVERNING BODY UTILIZED DATA FROM MULTIPLE SOURCES INCLUDING WATSON/WYATT COMPENSATION SURVEY, CHATTAHOOCHEE HEALTH RESOURCES EXECUTIVE COMPENSATION SURVEY AND COUNSEL WITH HUMAN RESOURCES LEADER TO ESTABLISH COMPENSATION OF THE CEO AND ASSURE THAT CEO COMPENSATION WAS REASONABLE AND MARKET-BASED. THE CEO/PRESIDENT, ALONG WITH THE HUMAN RESOURCES LEADER, UTILIZED THE COMPENSATION SURVEYS MENTIONED ABOVE TO SET COMPENSATION FOR ALL OTHER OFFICERS, SUCH AS THE CFO, CONTROLLER OR KEY EMPLOYEES. THIS EVALUATION PROCESS OCCURRED ANNUALLY FOR ALL EXECUTIVE STAFF PRIOR TO AFFILIATION. 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: EQUITY TRANSFER TO TAXABLE SUBSIDIARY -35,500,000. MERGER OF SATILLA INSTITUTIONAL PHARMACY -65,960. VALUATION MARKET ADJUSTMENT RELATED TO AFFILIATION 7,064,715. IN REGARDS TO FILING 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 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 SATILLA HEALTH FOUNDATION INC 1900 TEBEAU STREET WAYCROSS GA 31501 522008998 FUNDRAISING FOUNDATION GA 501(C)(3) 11-III 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 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 MCHS IN WAYCROSS INC C 269039 1.00000 1 SATILLA HEALTHNET INC 1900 TEBEAU STREET WAYCROSS GA 31501 582151076 HEALTH SERVICES GA MCHS IN WAYCROSS INC C 1.00000 1 SATILLA REGIONAL SPECIALTY PHYSICIANS INC 1900 TEBEAU STREET WAYCROSS GA 31501 204363143 PHYSICIAN OFFICES GA MCHS IN WAYCROSS INC C -9426102 4241696 1.00000 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 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 MAYO COLLABORATIVE SERVICES M 517538 GAAP SATILLA REGIONAL SPECIALITY PHYSICIANS A 158137 GAAP