2013-10-30T15:26:30-05:00 2012-12-31 990 2012-01-01 411713783 MAYO CLINIC HEALTH SYSTEM - RED WING MAYO 5075381297 701 HEWITT BLVD RED WING MN 55066 THOMAS J WITT MD 5075381297 2013-10-30 2012 2016-02-25 16:41:14Z X FKA FAIRVIEW RED WING HEALTH SERVICES THOMAS J WITT MD 701 HEWITT BLVD RED WING MN 55066 95383914 0 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1992 MN OPERATION OF A HOSPITAL AND THREE CLINICS. 13 5 785 196 0 0 0 797182 92445259 93899058 4579249 79423 184181 481889 97208689 95257552 0 17693 0 0 55772186 53894897 0 0 0 38000756 40141532 93772942 94054122 3435747 1203430 140582095 72098395 68822072 57444400 71760023 14653995 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. 1 0 80710299 94256992 PATIENT CARE (SEE SCHEDULE O):MAYO CLINIC HEALTH SYSTEM-RED WING (MCHS-RED WING) BECAME A MEMBER OF THE MAYO CLINIC HEALTH SYSTEM ON JULY 1, 2012. PRIOR TO THAT THEY WERE PART OF THE FAIRVIEW HEALTH SYSTEM AND WERE KNOWN AS FAIRVIEW RED WING HEALTH SERVICES. 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.AS PART OF THE MAYO CLINIC HEALTH SYSTEM, MCHS-RED WING OPERATES A CLINIC AND A HOSPITAL IN RED WING, MINNESOTA - ALONG WITH REGIONAL CLINICS IN ZUMBROTA, MINNESOTA AND ELLSWORTH, WISCONSIN. THE RED WING LOCATION COMBINES A CLINIC AND HOSPITAL INTO ONE STATE-OF-THE-ART FACILITY. OPENED IN 2011, THE MEDICAL CENTER HAS A 30-BED INPATIENT HOSPITAL CARE UNIT THAT INCLUDES INTENSIVE CARE AND A BIRTHING CENTER. CLINIC SERVICES INCLUDES: PRIMARY FAMILY SERVICES, SPECIALTY MEDICAL AND SPECIALTY SURGICAL SERVICES, URGENT AND EMERGENCY CARE AND REHABILITATION SERVICES. THE MEDICAL CENTER ALSO OFFERS THE LATEST IN DIAGNOSTIC TOOLS (I.E. CT SCAN, MRI, AND FULL LAB SERVICES). MCHS-RED WING IS A COMPLETE HEALTH CARE FACILITY FOR PATIENTS THROUGHOUT GOODHUE AND PIERCE COUNTIES. IN 2012 THE MEDICAL CENTER PROVIDED CARE TO 2,636 INPATIENTS FOR A TOTAL OF 4,503 PATIENT DAYS. PROVIDED TREATMENT FOR 10,855 EMERGENCY ROOM VISITS AND PROVIDED A TOTAL OF 145,184 CLINICAL ENCOUNTERS.MCHS-RED WING 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-RED WING PROVIDED APPROXIMATELY $445,118 IN FINANCIAL ASSISTANCE TO PATIENTS. THE UNREIMBURSED COST OF SERVICES TO MEDICAID PATIENTS WAS APPROXIMATELY $7,257,747 WHICH INCLUDES THE MEDICAID SURCHARGE OF $699,903 AND MNCARE TAX OF $1,199,327.THE UNREIMBURSED COST OF SERVICES TO MEDICARE PATIENTS DETERMINED BY USING INFORMATION FROM THE HOSPITAL'S MEDICARE COST REPORT WAS APPROXIMATELY $3,575,868. IF USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY, THE UNREIMBURSED COST OF SERVICES TO MEDICARE PATIENTS WAS APPROXIMATELY $6,549,576.MCHS-RED WING ALSO LEASES SPACE TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE. 1137273 17693 1772 COMMUNITY PROGRAMS (SEE SCHEDULE O):AS PART OF ITS ACTIVITIES, MCHS-RED WING PROVIDES VARIOUS SUPPORT GROUPS AND PROGRAMS TO THE COMMUNITY AT NO CHARGE. THESE GROUPS AND CLASSES INCLUDE DIABETIC EDUCATIONAL PROGRAMS, LIVING WELL WITH CHRONIC CONDITIONS CLASSES, OUTREACH FOR SENIOR CITIZENS THROUGH PARTNERS IN AGING PROGRAMS, AND PRENATAL CLASSES FOR EXPECTANT PARENTS. MCHS-RED WING ALSO CONDUCTED FLU SHOT CLINICS AND OFFERED DISCOUNTED MAMMOGRAMS TO WOMEN WHO QUALIFIED DURING THE MONTH OF OCTOBER.MCHS-RED WING OFFERED SPORTS PHYSICALS AT A REDUCED RATE FOR STUDENTS WHO ARE PARTICIPATING IN SPORTS THROUGH THE LOCAL SCHOOLS, CONCUSSION MANAGEMENT, AND STAFF ATTENDANCE AT HOME HIGH SCHOOL FOOTBALL GAMES TO RESPOND TO EMERGENCIES. MCHS-RED WING ALSO HAS A PROGRAM THAT ALLOWS LOCAL HIGH SCHOOL STUDENTS TO COME ON-SITE AND LEARN ABOUT HEALTH CARE RELATED CAREERS AND PARTICIPATE IN JOB SHADOWING EXPERIENCES. ALSO DURING 2012, MCHS-RED WING PROVIDED SCHOLARSHIP FUNDS TO SCHOOLS TO SUPPORT STUDENTS PURSUING A FIELD IN HEALTH CARE AND DONATIONS TO LOCAL CHARITIES OR COMMUNITY ORGANIZATIONS. COMMUNITY ORGANIZATIONS INCLUDE "LIVE HEALTHY RED WING" WHICH IS A COMMUNITY PARTNERSHIP MAKING POLICY AND ENVIRONMENTAL CHANGES TO IMPROVE NUTRITION AND ACTIVITY FOR OUR COMMUNITY.MCHS-RED WING ALSO RECEIVES DONATED SERVICES FROM VOLUNTEERS CONSISTING OF INDIVIDUALS AND ORGANIZATIONS THAT HELP ORGANIZE AND MANAGE ACTIVITIES FOR THE BENEFIT OF MCHS-RED WING'S PATIENTS, PATIENT'S FAMILIES, VISITORS AND STAFF. THE VOLUNTEERS OPERATE A GIFT SHOP, ASSIST PATIENTS AND GREET VISITORS. DURING 2012, VOLUNTEERS DONATED APPROXIMATELY 11,210 HOURS OF SERVICE. BASED ON 2012 INDEPENDENT SECTOR STATISTICS, THE APPROXIMATE VALUE OF THESE SERVICES WERE $248,189. 81847572 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 482 0 1 785 1 0 0 0 0 0 0 0 0 0 0 X 13 5 1 1 1 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0 0 MN WI X CORPORATE TAX 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 AGERTER MD DAVID C 1.00 40.00 X X 0 483600 35091 ALEXANDER MD JACK W 40.00 0.00 X 313346 0 38280 ANDERST DONNA 1.00 0.00 X 0 0 0 BECK JENNIFER 1.00 0.00 X 0 0 0 BODENSTEINER RICHARD 1.00 0.00 X 0 0 0 DEJONG MD AMY A 40.00 0.00 X 236073 0 35015 DOHERTY JOHN 1.00 40.00 X 0 310405 41762 FOOT III SILAS B 1.00 0.00 X X 0 0 0 HALEY BARBARA 1.00 0.00 X X 0 0 0 HANSON JOHN O 1.00 0.00 X 0 0 0 KETCHAM MD JEFFREY M 40.00 0.00 X X 618288 0 31879 KOCH MARK B 1.00 40.00 X 0 289086 16795 MURPHY DAVID D 1.00 0.00 X 0 0 0 PARKS DOUGLAS A 1.00 40.00 X X 0 189781 44522 PHILLIPPE PAULA 1.00 40.00 X 0 430949 63998 RIEGELMAN ROBERT 1.00 0.00 X X 0 0 0 SIMPSON MD HENRY J 1.00 40.00 X 0 299001 45476 WILLIAMS MD AMY W 1.00 40.00 X 0 242537 31959 WITT MD THOMAS J 1.00 40.00 X X 0 452522 63616 WORDELMAN SCOTT R 1.00 40.00 X X 0 413997 39152 LARSON MICHAEL J 40.00 0.00 X 247605 0 38437 PILOT DAVID L 1.00 40.00 X 0 196045 33934 DIMUNATION NANCY 40.00 0.00 X 209166 0 25139 BURTON MD ERIC W 40.00 0.00 X 464000 0 32943 EICH MD MATTHEW A 40.00 0.00 X 621666 0 29044 HUGHES MD EVERETT M 40.00 0.00 X 616027 0 36155 JOHNSON MD MICHAEL R 40.00 0.00 X 520271 0 35589 MCDEVITT MD CHRISTOPHER 40.00 0.00 X 425153 0 37879 4271595 3307923 756665 76 0 1 0 FAIRVIEW HEALTH SERVICES 400 STINSON BLVD MINNEAPOLIS MN 55413 MEDICAL SERVICES 4513650 MCKESSON INFORMATION SOLUTIONS 5995 WINDWARD PARKWAY ALPHARETTA GA 30005 SOFTWARE SERVICES 891504 CENTRAL MINNESOTA DIAGNOSTIC INC 150 10TH STREET NW MILACA MN 56353 RADIOLOGY SERVICES 749200 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 MEDICAL / SUPPORT SERVICES 508740 MIDWEST SURGICAL SERVICES 5575 WEST OLD SHOKOPEE ROAD BLOOMINGTON MN 55437 OPHTHALMOLOGY SERVICES 504645 14 6011 479290 311881 797182 NET PATIENT REVENUE 620000 93858413 93858413 RENTS FROM AFFILIATES 531120 22800 22800 OUTREACH REVENUE 620000 16073 16073 EDUCATION REVENUE 611600 1772 1772 93899058 116860 116860 155397 83400 71997 71997 71997 5525 42962 -37437 -37437 -37437 CAFETERIA / VENDING 722210 264857 264857 MEDICAL DIRECTOR FEES 541900 72096 63096 9000 MISCELLANEOUS REVENUE 900099 53100 29332 23768 19839 2421 17418 409892 95257552 94258764 0 201606 17693 17693 1793228 1507186 286042 78414 78414 43033234 39949652 3083582 2349272 2140334 208938 3840809 3265752 575057 2799940 2563740 236200 727221 106261 620960 147791 519 147272 650 650 7511273 4992940 2518333 182176 16542 165634 3686318 2671903 1014415 494251 8927 485324 1576503 1328200 248303 358928 321255 37673 7471 7471 3072838 3072444 394 3735752 3113165 622587 1569629 1569629 MEDICAL SUPPLIES 10038230 10038230 BAD DEBT EXPENSE 4496109 4496109 MN CARE TAX 1199327 1199327 MEDICAID SURCHARGE 699802 699802 637263 258527 378736 94054122 81847572 12206550 0 38726 5997545 13507022 14449606 0 51746 250440 132921 1153042 1266141 437861 558128 99733873 53892997 43463028 45840876 70981420 3029415 555855 10750556 216162 140582095 72098395 5817538 12458187 60722965 2281569 44986213 68822072 57444400 X 71748755 14357342 11268 296653 71760023 14653995 140582095 72098395 X 1203430 -279064 -4819129 -53211265 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 650 650 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. 3870887 3870887 66294945 33442939 32852006 29229431 20450058 8779373 338610 338610 45840876 DUE TO AFFILIATES 44986213 44986213 X 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. CAYMAN ISLANDS 0 0 CAYMAN ISLAND INVESTMENT - DISPOSED OF PRIOR TO YEAR END. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 X 1 X 120.000000000000 1 X 275.000000000000 1 1 0 1 1 445118 445118 0.00500 12975427 5717680 7257747 0.08100 13420545 5717680 7702865 0.08600 185861 185861 0.00210 658686 658686 0.00740 56400 56400 0.00060 900947 900947 0.01010 14321492 5717680 8603812 0.09610 236326 236326 0.00260 236326 236326 0.00260 0 4496109 14147425 17723293 -3575868 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM - RED WING

701 HEWITT BLVD RED WING MN 55066

X X X MAYO CLINIC HEALTH SYSTEM - RED WING 1 1 1 120.000000000000 1 275.000000000000 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 3 MCHS-RED WING

701 HEWITT BOULEVARD RED WING MN 55066

CLINIC MCHS-RED WING IN ELLSWORTH

530 CAIRNS STREET ELLSWORTH WI 54011

CLINIC MCHS-RED WING IN ZUMBROTA

1350 JEFFERSON DRIVE ZUMBROTA MN 55992

CLINIC PART I, LINE 6A: THE FILING ORGANIZATION BECAME AN AFFILIATE OF MAYO CLINIC ON JULY 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 $ 4496109. 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. 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.THE METHODOLOGY USED TO DETERMINE BAD DEBT EXPENSE (SCHEDULE H, PART III, LINE 2) IS 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 $6,549,576 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 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 - RED WING PART V, SECTION B, LINE 14G: IN REGARDS TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. MAYO CLINIC HEALTH SYSTEM - RED WING PART V, SECTION B, LINE 18E: FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE TO EVERY PATIENT VIA MAYO'S PUBLIC WEBSITE, FROM CUSTOMER SERVICE AND PATIENT ACCESS LOCATIONS, AND IS REFERENCED ON MAYO'S AUTHORIZATION FORMS AND STATEMENTS. IN ADDITION, BROCHURES ARE AVAILABLE IN THE ADMISSIONS AREA AND THE PROCESS OF HOW TO APPLY IS AVAILABLE ON THE MAYO CLINIC WEBSITE.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, MAYO DISCUSSES ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE.MONTHLY STATEMENTS ARE SENT TO PATIENTS THAT OUTLINE CURRENT CHARGES AND ACTIONS WITH INSURANCE AND INCLUDES INFORMATION ABOUT MAYO'S CHARITY CARE POLICY. SOME MAYO SITES UTILIZE ADVOCATES TO CONTACT THE PATIENT UPON DISCHARGE TO HELP THEM SECURE GOVENMENTAL ASSISTANCE OR FINANCIAL ASSISTANCE.EACH CHARITY CARE REVIEW IS DOCUMENTED IN MAYO'S BILLING SYSTEM AND COMMUNICATED TO THE PATIENT. COMPLETED CHARITY CARE FORMS ARE MAINTAINED EITHER IN PAPER OR ELECTRONIC FORMAT. THE PATIENT IS INFORMED REGARDING THE OUTCOME OF THE REVIEW.MAYO OFTEN IDENTIFIES CHARITY CARE OPPORTUNITIES AFTER THE PATIENT HAS BEEN DISMISSED. IN MANY CASES, THIS IS DUE TO LIMITED INSURANCE COVERAGE OR INSURANCE DENIALS AFTER THE SERVICE WAS PERFORMED. IN THESE CASES, WHEN A PATIENT EXPRESSES AN INABILITY TO PAY FOR THEIR SERVICES, STAFF WILL INITIATE A CHARITY REVIEW AS INDICATED BY THE FINANCIAL ASSISTANCE POLICY, WHICH IS AVAILABLE FOR EVERY PATIENT AT MAYOCLINIC.ORG. MAYO CLINIC HEALTH SYSTEM - RED WING PART V, SECTION B, LINE 20D: THE POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 53% 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: MAYO CLINIC HEALTH SYSTEM-RED WING (MCHS-RED WING) EMPLOYEES THROUGHOUT THE ORGANIZATION ASSESS THE NEEDS OF RED WING AND THE SURROUNDING COMMUNITIES THROUGH PERSONAL INTERACTION AND INVOLVEMENT WITH LOCAL SCHOOLS, CIVIC GROUPS AND HEALTH DEPARTMENTS AS WELL AS THROUGH THE COLLECTION AND ANALYSIS OF FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS.MCHS-RED WING EMPLOYEES MEET AND REMAIN IN CLOSE CONTACT WITH ADMINISTRATION AT THE RED WING SCHOOL SYSTEM. AS A RESULT OF THIS CLOSE INTERACTION, MCHS-RED WING PROVIDED SEVERAL SERVICES TO STUDENTS IN 2012 INCLUDING MATURATION CLASSES IN THE ELEMENTARY SCHOOLS AND MIDDLE SCHOOL, MOCK CRASH PARTICIPATION, CHEMICAL HEALTH INITIATIVE, SAFE ROUTES TO SCHOOLS DEVELOPMENT AND SEVERAL STAFF PRESENTATIONS ABOUT THEIR JOBS DURING HIGH SCHOOL CAREER CLASSES AT SCHOOL. THE REHABILITATION DEPARTMENT WORKS WITH THE LOCAL ATHLETIC DEPARTMENTS IN HIGH SCHOOL AND YOUTH SPORTS. MCHS-RED WING EMPLOYEES ALSO PARTICIPATE IN "EVERY HAND JOINED" WHICH IS A COLLECTIVE IMPACT INITIATIVE TO LIFT THE POTENTIAL OF ALL RED WING CHILDREN.MCHS-RED WING EMPLOYEES ARE STRONGLY CONNECTED WITH LOCAL CIVIC GROUPS. MANY EMPLOYEES ARE ACTIVE MEMBERS OF VARIOUS RED WING NON-PROFIT ORGANIZATIONS. MANY PROVIDE LEADERSHIP ON BOARDS WHILE OTHERS GIVE HEALTH CARE PRESENTATIONS TO THESE GROUPS. THIS PARTICIPATION NOT ONLY PROMOTES INVOLVEMENT IN THE COMMUNITY, BUT IT ALSO GIVES COMMUNITY MEMBERS A CHANCE TO ASK QUESTIONS, SHARE COMMENTS, CONCERNS OR OTHER SUGGESTIONS THEY MAY HAVE REGARDING THE MEDICAL CENTER.MCHS-RED WING ALSO WORKS WITH THE GOODHUE PUBLIC HEALTH ORGANIZATION TO DEVELOP RELATIONSHIPS AMONG HEALTH CARE PROVIDERS AND COMMUNITY LEADERS. THIS PARTNERSHIP PROMOTES THE ACTIVE REFERRAL OF PATIENTS TO LOCAL RESOURCES SUCH AS ACCESS TO HIGH QUALITY NUTRITIOUS FOODS, PHYSICAL ACTIVITY AND TOBACCO USE CESSATION PROGRAMS. MCHS-RED WING PARTICIPATED ON THE GOODHUE COUNTY PUBLIC HEALTH COMMUNITY HEALTH NEEDS ASSESSMENT IN 2012. MCHS-RED WING STAFF IS TRAINED TO IDENTIFY PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE PROGRAMS. THE ORGANIZATION HAS PROGRAMS IN PLACE FOR FINANCIAL ASSISTANCE TO HELP THOSE WHO ARE IN NEED OF HEALTH CARE BUT HAVE NO INSURANCE OR ARE NOT ABLE TO RECEIVE OTHER FINANCIAL ASSISTANCE. MCHS-RED WING ALSO PROVIDES FREE OR REDUCED COST SERVICES TO COMMUNITY MEMBERS THROUGH PREVENTATIVE HEALTH, SUPPORT FOR THE COUNTY WIDE FREE CLINIC (CARE CLINIC) AND FOOT CLINICS. AS THESE EXAMPLES OF INVOLVEMENT DEMONSTRATE, MCHS-RED WING IS CLOSELY CONNECTED WITH THE COMMUNITY. IN ADDITION TO THIS, MCHS-RED WING ACTIVELY SEEKS FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS THROUGH PRESS GANEY SURVEYS. THE SURVEY, WHICH IS ADMINISTERED BY PRESS GANEY, IS SENT TO A CROSS SECTION OF PATIENTS TO COMPILE USEFUL FEEDBACK ON WAYS MCHS-RED WING CAN IMPROVE CUSTOMER SERVICES AND DETERMINE WHETHER OR NOT THERE IS A NEED FOR NEW OR EXPANDED SERVICES. THE DATA FROM THE PRESS GANEY SURVEY IS REVIEWED AND ANALYZED BY MEMBERS OF QUALITY AND ADMINISTRATION DEPARTMENTS AS WELL AS MCHS-RED WING'S EMERGENCY ROOM (ER)/INPATIENT SATISFACTION TEAM, A TEAM DEDICATED TO IMPROVING PATIENT SATISFACTION IN THE ER AND HOSPITAL.THROUGH THESE VARIOUS AVENUES, MCHS-RED WING STAFF MEMBERS ACROSS MANY DEPARTMENTS STAY CONNECTED WITH THE COMMUNITY TO ASSESS THE HEALTH CARE NEEDS OF RED WING AND SURROUNDING AREAS. 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, 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-RED WING (MCHS-RED WING) HAS LOCATIONS IN RED WING AND ZUMBROTA, MINNESOTA AND ELLSWORTH, WISCONSIN. THE MAJORITY OF MCHS-RED WING SERVICE AREAS INCLUDE GOODHUE COUNTY IN SOUTHEASTERN MINNESOTA AND PIERCE COUNTY IN WEST CENTRAL WISCONSIN. THE MAIN CAMPUS, LOCATED IN RED WING, INCLUDES A HOSPITAL LICENSED FOR 50 BEDS AND A MULTI-SPECIALTY HOSPITAL-BASED CLINIC WITH 83 PROVIDERS SERVING RED WING AND SURROUNDING COMMUNITIES. ACCORDING TO THE UNITED STATES CENSUS BUREAU, THE 2012 POPULATION ESTIMATE FOR GOODHUE COUNTY (WHICH COMPRISES MOST OF RED WING SERVICE AREA) IS 46,336. A 2011 ESTIMATE REPORTS THAT 23.3% OF THE POPULATION IS UNDER 18 YEARS OLD, AND 16.9% IS 65 YEARS OLD OR OLDER. THE MEDIAN HOUSEHOLD INCOME IS $56,099, AND AN ESTIMATED 8.2% OF INDIVIDUALS ARE LIVING BELOW POVERTY LEVEL. PART VI, LINE 5: THE 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 CLINIC HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATION'S ACTIVITIES.SURPLUS FUNDS - MAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE.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 - 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 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.SPECIFICALLY, THE FILING ORGANIZATION PROVIDES HOSPITAL AND CLINIC SERVICES FOR RED WING, MINNESOTA AND THE SURROUNDING AREA.FOR MORE SPECIFIC DESCRIPTION, SEE THE RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). 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. X 1 1 1 1 0 0 0 0 0 0 0 AGERTER MD DAVID C 0 449783 0 0 0 33817 0 19707 0 15384 0 518691 0 0 ALEXANDER MD JACK W 254104 0 58792 0 450 0 17500 0 20780 0 351626 0 0 0 DEJONG MD AMY A 227969 0 6585 0 1519 0 16992 0 18023 0 271088 0 0 0 DOHERTY JOHN 0 300485 0 9920 0 0 0 29076 0 12686 0 352167 0 0 KETCHAM MD JEFFREY M 606149 0 6851 0 5288 0 10000 0 21879 0 650167 0 0 0 KOCH MARK B 0 279804 0 0 0 9282 0 322 0 16473 0 305881 0 0 PARKS DOUGLAS A 0 188612 0 0 0 1169 0 20335 0 24187 0 234303 0 0 PHILLIPPE PAULA 0 417642 0 12320 0 987 0 34756 0 29242 0 494947 0 0 SIMPSON MD HENRY J 0 299001 0 0 0 0 0 22500 0 22976 0 344477 0 0 WILLIAMS MD AMY W 0 234905 0 0 0 7632 0 29895 0 2064 0 274496 0 0 WITT MD THOMAS J 0 410870 0 0 0 41652 0 42967 0 20649 0 516138 0 0 WORDELMAN SCOTT R 0 269926 0 69900 0 74171 0 26466 0 12686 0 453149 0 43393 LARSON MICHAEL J 203859 0 43246 0 500 0 17500 0 20937 0 286042 0 0 0 PILOT DAVID L 0 196045 0 0 0 0 0 13937 0 19997 0 229979 0 0 DIMUNATION NANCY 160824 0 47842 0 500 0 14743 0 10396 0 234305 0 0 0 BURTON MD ERIC W 280823 0 6585 0 176592 0 17500 0 15443 0 496943 0 0 0 EICH MD MATTHEW A 614581 0 6585 0 500 0 17500 0 11544 0 650710 0 0 0 HUGHES MD EVERETT M 587148 0 6585 0 22294 0 17500 0 18655 0 652182 0 0 0 JOHNSON MD MICHAEL R 490331 0 6585 0 23355 0 17500 0 18089 0 555860 0 0 0 MCDEVITT MD CHRISTOPHER 418447 0 6256 0 450 0 17500 0 20379 0 463032 0 0 0 PART I, LINE 1A CHAMBER BUCKS ($25) WERE GIVEN TO ALL EMPLOYEES AND WERE GROSSED-UP. PART I, LINES 4A-B THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT FROM THE FILING ORGANIZATION. THE AMOUNT IS INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). - ERIC W. BURTON, M.D. - $176,592 THIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(A)(17). STARTING JANUARY 1, 2011, ALL SRP BENEFITS ARE PAID AS AN ANNUAL TAXABLE CASH PAYMENT. THE FOLLOWING INDIVIDUALS RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN. AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). DAVID C. AGERTER, M.D. $27,454 MARK B. KOCH $8,013 AMY W. WILLIAMS, M.D. $6,177 THOMAS J. WITT, M.D. $30,605 IN ADDITION, PRIOR TO AFFILIATION WITH MAYO CLINIC, SCOTT WORDELMAN PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN IN THE AMOUNT OF $43,393 THROUGH FAIRVIEW HEALTH SERVICES. 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. MICHAEL R JOHNSON MD HIGHLY COMPENSATED EMPLOYEE (TOP 5) SIGNING BONUS IN THE FORM OF A FORGIVABLE LOAN X 100000 51746 0 1 1 51746 ADA LARSON FAMILY MEMBER OF MICHAEL LARSON, OFFICER OF FILING ORGANIZATION 59985 EMPLOYMENT 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 AT THE END OF 2012, THE FILING ORGANZATION'S THREE SUBSIDIARIES AND A LOCAL AUXILIARY ORGANIZATION MERGED INTO THE FILING ORGANIZATION. AS A RESULT OF THE MERGERS, THE FILING ORGANIZATION WILL BEGIN PROVIDING HOME HEALTH & HOSPICE SERVICES, ALONG WITH PROVIDING HOUSING FOR ELDERLY RESIDENTS. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: PILOT, DAVID L. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: AGERTER M.D., DAVID C. KOCH, MARK B. PARKS, DOUGLAS A. THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: SIMPSON M.D., HENRY J. WITT M.D., THOMAS J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: SIMPSON M.D., HENRY J. WITT M.D., THOMAS J. THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: WITT M.D., THOMAS J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: AGERTER M.D., DAVID C. KOCH, MARK B. PARKS, DOUGLAS A. PILOT, DAVID L. THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: PHILIPPE, PAULA WORDELMAN, SCOTT R. DOHERTY, JOHN RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: PHILIPPE, PAULA WORDELMAN, SCOTT R. DOHERTY, JOHN FOOT III., SILAS B. MURPHY, DAVID D. FORM 990, PART VI, SECTION A, LINE 3 MAYO CLINIC, MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, AND OTHER RELATED COMPANIES PROVIDE MANAGEMENT SERVICES TO THE ENTIRE SYSTEM OF ENTITIES. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS, COMPENSATION FOR THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES HAS BEEN DISCLOSED IN PART VII AND SCHEDULE J AS REQUIRED. FORM 990, PART VI, SECTION A, LINE 4 ON JULY 1, 2012 THE FILING ORGANIZATION AFFILIATED WITH MAYO CLINIC. MINOR 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 CORPORATE MEMBER IS MAYO CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER ELECTS THE MEMBER DIRECTORS. THE MEMBER ELECTS COMMUNITY PHYSICIAN DIRECTORS FROM A SLATE NOMINATED BY THE MEDICAL STAFF. 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. 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 JULY 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. PRE-AFFILIATION WITH MAYO CLINIC, MANAGERS, DIRECTORS, AND SENIOR MANAGEMENT OF THE REPORTING ORGANIZATION WERE REQUIRED TO ANNUALLY COMPLETE FAIRVIEW'S DUTY OF LOYALTY AND CONFLICT OF INTEREST STATEMENT IN COMPLIANCE WITH FAIRVIEW'S CONFLICT OF INTEREST POLICY. DISCLOSURES WERE REVIEWED BY THE COMPLIANCE DEPARTMENT. CONFLICTS OF INTEREST BY BOARD MEMBERS WERE BROUGHT TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD ALONG WITH ADDITIONAL DETAILED INFORMATION, FOR SPECIFIC REVIEW. IN ADDITION, THE COMPLIANCE OFFICER COMPILED A SCHEDULE SHOWING REPORTED CONFLICTS OF INTEREST BY MANAGERS, DIRECTORS, AND SENIOR MANAGEMENT WHICH WAS ALSO PRESENTED TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARD FOR REVIEW AND DISCUSSION. ANY PROBLEMATIC ISSUES ARISING FROM THESE DISCLOSURES WERE DISCUSSED AND RESOLVED BY THE COMMITTEE. BOARD MEMBERS AND MANAGEMENT EMPLOYEES WERE EXPECTED TO UPDATE THEIR CONLFICTS AS NECESSARY DURING THE YEAR. AS OF JULY 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 AND THE BOARD SECRETARY, ALONG WITH SOME PHYSICIAN LEADERS ON THE BOARD OF THE FILING ORGANIZATION WERE REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO CLINIC HEALTH SYSTEM PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE MAYO CLINIC HEALTH SYSTEM ENTITIES. THE COMMITTEE IS COMPRISED OF MAYO EMPLOYEES, BUT IS INDEPENDENT FOR INTERNAL REVENUE CODE 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED (WITH RECUSAL WHERE APPROPRIATE). THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE THEN REVIEWS AND APPROVES THE COMPENSATION. FOR THOSE INDIVIDUALS FOR WHICH THE MAYO CLINIC HEALTH SYSTEM COMMITTEE CAN NOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE COMPENSATION AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. INFORMATION ON MAYO CLINIC HEALTH SYSTEM PHYSICIAN AND ADMINISTRATIVE LEADERSHIP COMPENSATION AND BENEFITS IS ALSO REVIEWED BY THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION AND GOVERNANCE (GOVERNANCE COMMITTEE), WHICH IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. PRE-AFFILIATION WITH MAYO CLINIC THE DETERMINATION OF EXECUTIVE COMPENSATION OF THE ORGANIZATION WAS PROCESSED BY THE HUMAN RESOURCES EXECUTIVE COMMITTEE AND INCLUDES A REVIEW OF COMPARABILITY DATA, REVIEW BY INDEPENDENT EXPERTS, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION PROCESS. 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: MARKET ADJUSTMENT RELATED TO AFFILIATION VALUATION -2,466,668. TRANSFER TO MAYO CLINIC (AFFILIATION COSTS) -19,000,000. MAYO CLINIC LOAN (AFFILIATION COSTS) -45,000,000. ASBESTOS LIABILITY ENTRY -95,180. YEAR END MERGER OF AFFILIATES INTO FILING ORGANIZATION 13,350,583. 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 HEWIT BOULEVARD RED WING MN 55066 411532554 ELDERLY HOUSING MN 501(C)(3) 9 MCHS--RED WING 1 FAIRVIEW FOUNDATION 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 411573810 FUNDRAISING TO SUPPORT FAIRVIEWS MISSION MN 501(C)(3) 7 FAIRVIEW HEALTH SERVICES 1 FAIRVIEW HEALTH SERVICES 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 410991680 HOSPITAL PATIENT SERVICES MN 501(C)(3) 3 FAIRVIEW HEALTH SERVICES 1 FAIRVIEW HOME CARE AND HOSPICE 2450 26TH AVE SOUTH MINNEAPOLIS MN 55406 411434246 HOME HEALTH CARE MN 501(C)(3) 9 FAIRVIEW HEALTH SERVICES 1 FAIRVIEW PHYSICIAN ASSOCIATES NETWORK 3400 WEST 66TH STREET MINNEAPOLIS MN 55435 411753325 CLINICAL INTEGRATION MN 501(C)(3) 9 FAIRVIEW HEALTH SERVICES 1 RANGE REGIONAL HEALTH SERVICES 750 EAST 34TH STREET HIBBING MN 55746 411293970 HOSPITAL PATIENT SERVICES MN 501(C)(3) 3 FAIRVIEW HEALTH SERVICES 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 BEHAVIORAL HEALTHCARE PROVIDERS 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 411805759 MENTAL HEALTH PRACTITIONERS MN N/A C 1 FAIRVIEW CLINICS 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 411761760 PHYSICIAN SERVICES MN N/A C 1 FAIRVIEW PHYSICIAN AND CLINIC SERVICES 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 411544996 PHYSICIAN SERVICES MN N/A C 1 FAIRVIEW SUBSIDIARY III (EXPRESS CARE) 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 205996177 PHYSICIAN SERVICES MN N/A C 1 MINNESOTA HEART 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 411598660 MEDICAL SERVICES MN N/A C 1 RIDGES DEVELOPMENT CO & SUBSIDIARY 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 411568579 LEASEHOLD MANAGEMENT MN N/A C 1 SURGICAL CONSULTANTS 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 410877307 MEDICAL SERVICES 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 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 FAIRVIEW PHARMACY SERVICE LLC Q 58544 GAAP MAYO CLINIC HEALTH SYSTEM--CANNON FALLS L 399269 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC M 413473 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC M 401242 GAAP MAYO CLINIC HEALTH SYSTEM--LAKE CITY L 823754 GAAP MMSI INC S 296086 GAAP RED WING DOWNTOWN PLAZA S 7736840 GAAP RED WING HOME HEALTH & HOSPICE S 3216827 GAAP RED WING HOME HEALTH & HOSPICE L 68750 GAAP RED WING SEMINARY HOME S 2338047 GAAP