2013-10-28T09:03:05-05:00 2012-12-31 990 2012-01-01 410695606 MAYO CLINIC HEALTH SYSTEM-AUSTIN MAYO 5075381297 1000 FIRST DRIVE NW AUSTIN MN 55912 MARK R CIOTA MD 5073776352 2013-10-28 2012 2016-02-25 16:41:14Z X MARK R CIOTA MD 1000 FIRST DRIVE NW AUSTIN MN 55912 120557802 0 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1896 MN OPERATION OF A HOSPITAL AND CLINICS. X 10 5 1127 116 0 0 593023 2312557 109138025 115678811 1488869 2009501 411970 453147 111631887 120454016 53025 40737 0 0 67344192 74885349 0 0 143555 39434975 37489486 106832192 112415572 4799695 8038444 137279966 0 13637360 0 123642606 0 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 102088478 115131794 PATIENT CARE - SEE SCHEDULE OMAYO 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, MAYO CLINIC HEALTH SYSTEM-AUSTIN (MCHS-AUSTIN) OPERATES A HOSPITAL AND CLINIC IN AUSTIN, MINNESOTA - ALONG WITH REGIONAL CLINICS IN THE MINNESOTA COMMUNITIES OF ADAMS, BLOOMING PRAIRIE, GRAND MEADOW AND LEROY. MCHS-AUSTIN IS PRESENTLY LICENSED FOR 82 BEDS WITH AN AVERAGE DAILY CENSUS OF 36. MCHS-AUSTIN EMPLOYS APPROXIMATELY 1,000 INDIVIDUALS. THIS EMPLOYEE TOTAL INCLUDES, AMONG OTHER STAFF, 69 PHYSICIANS, 5 PHYSICIAN ASSISTANTS, 2 AUDIOLOGISTS, 20 NURSE PRACTITIONERS AND 2 OPTOMETRISTS. MCHS-AUSTIN PRIMARLY SERVES MOWER COUNTY, WHICH HAS A POPULATION OF 39,372, AND THE SURROUNDING RURAL COMMUNITIES.IN 2012, THERE WERE 3,337 PATIENTS ADMITTED, 368,937 ANCILLARY OUTPATIENT PROCEDURES AND 146,183 CLINIC VISITS. IN ADDITION TO PROVIDING PRIMARY CARE (INCLUDING FAMILY PRACTICE, INTERNAL MEDICINE, OB/GYN, PEDIATRICS, AND GENERAL SURGERY), MCHS-AUSTIN PROVIDES SPECIALTY CARE SERVICES IN ALLERGY, AUDIOLOGY, BEHAVIORAL HEALTHCARE, CARDIOLOGY, DERMATOLOGY, ENDOCRINOLOGY, ENT, GASTROENTEROLOGY, SLEEP, PAIN, HOME HEALTH/HOSPICE, NEUROLOGY, ONCOLOGY, OPHTHALMOLOGY, ORTHOPEDIC SURGERY, PODIATRY, PSYCHIATRY, RHEUMATOLOGY, AND UROLOGY. MCHS-AUSTIN ALSO PROVIDES PROGRAMS IN ALTERNATIVE MEDICINE, INCLUDING A PAIN CLINIC, SPORTS MEDICINE, AND MASSAGE THERAPY.MCHS-AUSTIN PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. IN ADDITION, SERVICES ARE ALSO PROVIDED TO PATIENTS UNDER OTHER MEANS-TESTED GOVERNMENT PROGRAMS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES.IN 2012, MCHS-AUSTIN PROVIDED APPROXIMATELY $1,781,000 (AT COST) OF CHARITY CARE TO PATIENTS. THE UNREIMBURSED COST OF SERVICES PROVIDED TO MEDICAID PATIENTS WAS APPROXIMATELY $2,741,000. THIS SHORTFALL INCLUDES THE MEDICAID SURACHARGE OF $454,654 AND TAXES OF $1,411,569 PAID TO MN CARE FOR PRGRAMS THAT OFFER HEALTHCARE ASSISTANCE TO LOW INCOME POPULATIONS. THE UNREIMBURSED COST OF SERVICES PROVIDED TO PATIENTS UNDER OTHER MEANS-TESTED GOVERNMENT PROGRAMS WAS $1,536,000. OTHER PATIENT CARE SERVICES OFFERED BY MCHS-AUSTIN: A TOBACCO CESSATION CLINIC THAT HELPS INDIVIDUALS ON A ONE-ON-ONE BASIS QUIT SMOKING, IN ADDITION TO PROVIDING SUPPORT AND EDUCATION. A LIFE CLINIC HEALTH STATION THAT PROVIDES INFORMATION AND TOOLS THAT ALLOWS THE PATIENT TO MONITOR THEIR OWN HEALTH. IT ALLOWS INDIVIDUALS TO MEASURE BLOOD PRESSURE, PULSE, WEIGHT, AND BODY MASS INDEX.24-HOUR INTERPRETER SERVICE TO PATIENTS, AND A FULLTIME INTERPRETER SERVICE LIAISON TO RUN THE PROGRAM AND PROVIDE CONTINUED IMPROVEMENTS IN PATIENT SATISFACTION. A SUPPORT GROUP FOR FAMILY MEMBERS WHO HAVE EXPERIENCED THE DEATH OF A LOVED ONE IS PROVIDED BY MCHS-AUSTIN'S HOSPICE PROGRAM. OTHER SERVICES THAT ARE PROVIDED BY THE HOSPICE PROGRAM INCLUDE HOSPICE CARE, SKILLED NURSING CARE, PERSONAL CARE/HOME MAKER SERVICES, THERAPY, NUTRITION SUPPORT, PHARMACY SERVICES, MEDICAL SOCIAL WORK SERVICES, PHYSICIAN DIRECTED SERVICES, CLERGY VOLUNTEERS, AND BEREAVEMENT SUPPORT. MCHS-AUSTIN'S CRIME VICTIMS RESOURCE CENTER (CVRC) PROVIDES SUPPORT, EDUCATION, AND ADVOCACY TO VICTIMS OF CRIME. CVRC IS FUNDED THROUGH A STATE GRANT AND THROUGH THE UNITED WAY OF MOWER COUNTY. PROGRAMS INCLUDE THE GENERAL CRIME, DOMESTIC VIOLENCE COMMUNITY ADVOCACY AND SEXUAL ASSAULT COMMUNITY ADVOCACY. MCHS-AUSTIN HAS A GREETER AT THE FRONT ENTRANCE TO HELP PATIENTS IN AND OUT OF VEHICLES AND DIRECTS THEM TO THEIR DESTINATIONS WITHIN THE MEDICAL CENTER. MCHS-AUSTIN ALSO OFFERS FREE TRANSPORTATION TO AND FROM THE MEDICAL CENTER FOR THOSE AGES 65 OR OLDER OR FOR THOSE WITH A DISABILITY. 96736 HEALTH PROFESSIONAL EDUCATION - SEE SCHEDULE OMCHS-AUSTIN PROVIDES CLINICAL EXPERIENCE FOR THE REGISTERED NURSE AND LICENSED PRACTICAL NURSE PROGRAMS, WHICH ARE OFFERED THROUGH AREA COLLEGES. 420541 40737 63340 COMMUNITY OUTREACH - SEE SCHEDULE O PHYSICIANS AND PHYSICAL THERAPISTS FROM MCHS-AUSTIN PROVIDED MEDICAL COVERAGE AT VARIOUS LOCAL HIGH SCHOOL SPORTING EVENTS, IN ADDITION, MCHS-AUSTIN'S MEDICAL TRAINER HAS OFFICE HOURS AT THE AUSTIN HIGH SCHOOL THROUGHOUT THE YEAR SO KIDS CAN COME IN AFTER SCHOOL TO HAVE ISSUES LOOKED AT THAT MAY HAVE HAPPENED AT AN EVENT OR PRACTICE. MCHS-AUSTIN'S PHYSICAL THERAPY DEPARTMENTS IN THE REHAB SERVICES AREA GAVE SPORTS PHYSICALS TO LOCAL AND SURROUNDING AREA STUDENT ATHLETES. A FEW MCHS-AUSTIN PHYSICIANS PARTICIPATE IN THE PUBLIC HEALTH "OPEN DOOR CLINIC". THE "OPEN DOOR CLINIC" PROVIDES ANNUAL EXAMS AND VARIOUS TESTING TO TEENAGERS THROUGH AGE 24 IN THE COMMUNITY. MCHS-AUSTIN STAFF VOLUNTEERED AND PARTICIPATED AS A TEAM IN THE MARCH OF DIMES WALK AMERICA WALK-A-THON AND IN THE MOWER COUNTY RELAY FOR LIFE EVENT THAT HELPS RAISE FUNDS FOR CANCER RESEARCH AND EDUCATION. IN ADDITION, MCHS-AUSTIN PARTICIPATED IN THE ANNUAL UNITED WAY CAMPAIGN. MCHS-AUSTIN SPONSORS A "HEART N' SOLE" MALL WALKING PROGRAM. "HEART N' SOLE" IS A FREE PROGRAM FOR ANYONE INTERESTED IN PARTICIPATING AT THE OAK PARK MALL IN AUSTIN. PARTICIPANTS KEEP TRACK OF THEIR TIMES THEY WALK AND CAN RECEIVE A FREE PROGRAM T-SHIRT, ALONG WITH BEING ENTERED INTO A MONTHLY DRAWING FOR A $25 MALL GIFT CERTIFICATE. MCHS-AUSTIN TEAMED WITH THE MOWER COUNTY FAIR BOARD TO HELP SPONSOR HAND-WASHING STATIONS AT THE MOWER COUNTY FAIR.MCHS-AUSTIN HOSPICE HELD AN ANNUAL "MEMORIAL" SERVICE. THE HOSPICE MEMORIAL CELEBRATION IS AN OPPORTUNITY FOR GRIEVING PEOPLE TO COME TOGETHER FOR A TIME OF SHARING, HEALING, PRAYER, AND FELLOWSHIP.THE TOBACCO CESSATION CLINIC OFFERED FREE CARBON MONOXIDE SCREENING TO ALL STAFF AND VISITORS DURING THE GREAT AMERICAN SMOKEOUT. MCHS-AUSTIN STAFF SPOKE AT SEVERAL EVENTS DURING THE YEAR AND SERVED ON THE BOARDS OF VARIOUS AGENCIES IN THE COMMUNITY. MCHS-AUSTIN ALSO PREPARED THE MEALS FOR THE LOCAL "MEALS ON WHEELS" PROGRAM AND DONATED USED EQUIPMENT TO VARIOUS ENTITIES DURING THE YEAR.MCHS-AUSTIN SPONSORS PRENATAL CLASSES, SIBLING CLASSES, ADOLESCENT HEALTH AWARENESS CLASSES, SMOKING CESSATION CLASSES AND WELLNESS PROGRAMS FOR COMMUNITY PARTICIPATION.MCHS-AUSTIN SENDS OUT A QUARTERLY NEWSLETTER "HOMETOWN HEALTH" TO ALL MAILBOXES IN ITS SERVICE AREA TO KEEP EVERYONE INFORMED OF NEW SERVICES, EDUCATION/PREVENTION AND PATIENT CARE RELATED INFORMATION.THE CRIME VICTIMS RESOURCE CENTER (CVRC) OF MCHS-AUSTIN GOES INTO THE SCHOOL SYSTEM AND PRESENTS THE EDUCATION ON TOUCH. THIS INCLUDES TWO DVDS ON APPROPRIATE TOUCH, INAPPROPRIATE TOUCH AND PERSONAL BODY SAFETY. THERE IS ALSO A QUESTION AND ANSWER SESSION THE STUDENTS PARTICIPATE IN.THE DAWN PROJECT (DEPRESSION AWARENESS AND WELLNESS NETWORK) SPONSORED ONE DAY OF CODE YELLOW TRAINING TO AREA STUDENTS IN THE SURROUNDING AREA. THE CODE YELLOW TRAINING IS AN ALL DAY WORKSHOP WHERE YOUTH LEARN ABOUT THE WARNING SIGNS, SYMPTOMS, CAUSES AND TREATMENT OPTIONS FOR DEPRESSION. THE STUDENTS ALSO LEARN ABOUT SUICIDAL THOUGHTS AND BEHAVIORS AND HOW TO PREVENT SUICIDE.MCHS-AUSTIN PHYSICIANS AND STAFF HELD THEIR 12TH ANNUAL "WOMEN'S WORKSHOP" TO DISCUSS CANCER SCREENINGS, MEMORY AND AGING, AND MAKING HEALTHY FOOD CHOICES. OTHER TOPICS INCLUDED DISCUSSIONS ON HOW WOMEN CAN HELP WITH BEING MORE SATISIFIED WITH THEIR SERVICE AT MCHS-AUSTIN.MCHS-AUSTIN NURSES HAVE TAKEN ON AN INITATIVE CALLED ENCARE (EMERGENCY NURSES CANCEL ALCOHOL RELATED EMERGENCIES) TO EDUCATE YOUNG ADULTS IN THE AREA ON THE CONSEQUENCES OF ALCOHOL. THE NURSES PRESENTED TO STUDENTS AGES 14 TO 18 IN MANY AREA SCHOOLS. TOPICS COVERED DURING THE PRESENTATIONS INCLUDE THE IMPORTANCE OF SEAT BELTS, DRINKING AND DRIVING, PEER PRESSURE, CRASH CONTRIBUTIONS OF SLEEPINESS AND INATTENTIVE DRIVING, AND VARIOUS CRASH CONDITIONS.MCHS-AUSTIN AUDIOLOGY AND SPEECH PATHOLOGY HELD AN OPEN HOUSE FOR BETTER HEARING AND SPEECH MONTH AND SCHEDULED FREE HEARING SCREENINGS FOR STAFF AND THE PUBLIC.MCHS-AUSTIN ALSO PROVIDED PATIENT EDUCATION AND PURCHASED VARIOUS EDUCATIONAL AND INFORMATIONAL ADVERTISMENTS.IN 2012, MCHS-AUSTIN RECEIVED DONATED SERVICES FROM 105 AUXILIARY MEMBERS, WHO PROVIDED 9,975 VOLUNTEER HOURS, VALUED AT APPROXIMATELY $220,847 BASED ON THE INDEPENDENT SECTOR'S AVERAGE ESTIMATED HOURLY VALUE OF SUCH SERVICE.IN 2012, MCHS-AUSTIN'S CVRC RECEIVED DONATED SERVICES FROM 6 VOLUNTEERS, WHO PROVIDED 6,644 VOLUNTEER HOURS, VALUED AT APPROXIMATELY $147,098 BASED ON THE INDEPENDENT SECTOR'S AVERAGE ESTIMATED HOURLY VALUE OF SUCH SERVICE. MCHS-AUSTIN COLLABORATES WITH INDIVIDUALS, GROUPS AND ORGANIZATIONS WITHIN MOWER COUNTY TO PROMOTE WELL LIVING. THIS INITIATIVE, KNOWN AS MOWER REFRESHED, PROMOTES AND SUPPORTS EFFORTS THAT MAKES THE HEALTHY CHOICE EASIER FOR EVERY CITIZEN. MOWER REFRESHED FOCUSES ON 4 STRATEGIC GROUPS: HEALTHIER CHOICES, MENTAL FITNESS, WORKFORCE WELLNESS, AND COMMUNITY CONNECTIONS. 942498 MCHS-AUSTIN LEASES SPACE AND PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE. IN ADDITION, IN 2012 MCHS-AUSTIN MERGED WITH MAYO CLINIC HEALTH SYSTEM-ALBERT LEA, TRANSFERRING ALL ASSETS AND LIABILITIES TOTALING $134,395,080. 942498 102605755 1 1 0 1 0 0 0 0 0 1 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 1 1 0 0 1 102 0 1 1127 1 0 0 0 0 0 0 0 0 0 0 X 10 5 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 MN X MAYO CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 AGERTER MD DAVID C 1.00 40.00 X X 0 483600 35091 ALBERTS JOHN 1.00 0.00 X X 0 0 0 BUNKERS MD BRIAN E 1.00 40.00 X X 0 347327 11421 CIOTA MD MARK R 1.00 40.00 X X 0 787325 45329 CRANDALL DAVE 1.00 0.00 X X 0 0 0 CUNNINGHAM MD PETER L 40.00 0.00 X 325718 0 40794 FLINCHBAUGH DO ROBERT T 1.00 40.00 X 0 235888 49009 GABRIELSON SHARON R 1.00 40.00 X 0 184552 47325 MONSON REV GLENN L 1.00 0.00 X 0 0 0 POTACH BRENDA 1.00 0.00 X 0 0 0 RAY GARY 1.00 0.00 X 0 0 0 DANKERT SHERI S 40.00 0.00 X 146790 0 31966 KOCH MARK B 1.00 40.00 X 0 289086 16795 PARKS DOUGLAS A 1.00 40.00 X 0 189781 44522 PILOT DAVID L 1.00 40.00 X 0 196045 33934 REES ADAM C 40.00 0.00 X 259999 0 41801 ACCURSO MD JOSEPH M 20.00 20.00 X 258650 354462 41111 COPPES MD JOHN B 40.00 0.00 X 337198 0 37346 HOLTZ MD SCOTT A 40.00 0.00 X 308394 0 40098 KLEIS DO KEITH R 40.00 0.00 X 293680 0 43630 KUBAS MD STEVE M 40.00 0.00 X 256201 0 40758 NORDENG RODNEY L 40.00 0.00 X 150269 0 32893 WOLD MD LESTER E 40.00 0.00 X 293256 600 21099 YOUNG DO NATHAN P 40.00 0.00 X 266549 0 20890 ENGMAN MD STEVEN J 40.00 0.00 X 678774 0 42202 HECTORNE MD KATHLEEN J 40.00 0.00 X 483022 0 29801 KIRSCH MD MATTHEW J 40.00 0.00 X 733102 0 42462 MIZRACHI MD VICTOR N 40.00 0.00 X 607862 0 45983 STOFFEY DO ROBERT D 40.00 0.00 X 606665 0 40566 JOHNSON MD TIMOTHY J 0.00 40.00 X 0 419408 49471 DUBE MD CYNTHIA M 40.00 0.00 X 232336 0 27651 HOLTZ MD CAROL P 40.00 0.00 X 187792 0 20632 6426257 3488074 974580 102 1 1 0 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 ADMIN & MEDICAL SERVICES 4307637 MEDICAL DOCTOR ASSOCIATES PO BOX 277185 ATLANTA GA 30384 MEDICAL SERVICES 780234 MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 LAB SERVICES 484028 MASON CITY CLINIC PC 250 S CRESENT DR MASON CITY IA 50401 COLLECTION SERVICE 270958 CEDAR VALLEY SERVICES INC 2111 4TH ST NW AUSTIN MN 55912 LAUNDRY SERVICES 268968 15 25386 755 352288 1933248 880 2312557 NET PATIENT REVENUE 620000 114699808 114699808 SHARED SERVICES REVENUE 561000 861398 861398 RENTAL REVENUE FROM AFFILIATES 531120 81100 81100 MEALS ON WHEELS REVENUE 624210 35584 35584 EDUCATION REVENUE 611600 921 921 115678811 2002754 2002754 17457 27114 -9657 -9657 -9657 7727 980 6747 6747 6747 2576 0 2576 2576 77099 75692 1407 1407 CAFETERIA/VENDING REVENUE 722210 421455 421455 MEDICAL RECORD/TRANSCRIPTION FEES 541900 31245 31245 MISC. REVENUE 900099 6121 6121 458821 120454016 116137632 0 2003827 40737 40737 3275386 2611668 663718 631403 533760 97643 55864727 53032131 2817894 14702 3807560 3585357 222203 7547343 7102331 440168 4844 3758930 3532457 218924 7549 228233 228233 46970 46970 770 770 8757852 8373709 384143 95446 22713 60777 11956 4178213 3216798 956892 4523 2959647 2959647 2217278 2209297 7961 20 73837 73837 648367 563560 84079 728 1810 1810 3371821 2909036 462785 867138 867138 MEDICAL SUPPLIES 10681227 10681227 MN CARE TAX 1411569 1411569 BAD DEBT EXPENSE 1204978 1204978 MEDICAID SURCHARGE 454654 454654 289676 176988 111098 1590 112415572 102605755 9666262 143555 3227 0 22500 0 0 17849867 0 0 0 0 1799250 0 1980464 0 0 42937138 0 0 65312963 0 0 0 7374557 0 137279966 0 9387608 0 95195 0 15442 0 4139115 0 13637360 0 X 112247155 0 11334687 0 60764 0 123642606 0 137279966 0 X 8038444 2691135 -134372185 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 770 770 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. 60764 8850 69614 58770 1994 60764 52823 1075 4872 58770 46888 886 5049 52823 68353 -10465 11000 46888 0 1 1 0 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR SCHOLARSHIP PROGRAMS. THE ENDOWMENT FUNDS WERE MERGED INTO MAYO CLINIC HEALTH SYSTEM-ALBERT LEA AND AUSTIN AT YEAR END AND ARE THERFORE SHOWING A ZERO ENDING BALANCE ON THIS RETURN. 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. 1 1 X 1 X 1 X 1 1 1 0 1 1 1780759 1780759 0.01600 16397368 13657058 2740310 0.02460 2376843 841064 1535779 0.01380 20554970 14498122 6056848 0.05440 384367 26835 357532 0.00320 96736 96736 0.00090 20408381 13425436 6982945 0.06280 36174 36174 0.00030 20925658 13452271 7473387 0.06720 41480628 27950393 13530235 0.12160 1 25000 512 512 0.00000 15009 7972 7972 0.00010 1 40009 8484 8484 0.00010 0 1204978 16693143 20481501 -3788358 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM-AUSTIN

1000 FIRST DRIVE NW AUSTIN MN 55912

X X MAYO CLINIC HEALTH SYSTEM - AUSTIN 1 1 1 100.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X 1 0 X X X X X 1 X 0 0 7 MCHS-AUSTIN EYE CLINIC

510 SECOND STREET NW AUSTIN MN 55912

EYE CLINIC MCHS-AUSTIN-ADAMS

908 WEST MAIN STREET ADAMS MN 55909

REGIONAL CLINIC MCHS-AUSTIN WEST CAMPUS

101 14TH STREET NW AUSTIN MN 55912

CHEMICAL DEPENDENCY MCHS-AUSTIN HOME HEALTH

408 4TH AVENUE NW AUSTIN MN 55912

HOME HEALTH AND HOSPICE OFFICES MCHS-AUSTIN-GRAND MEADOW

113 MAIN STREET GRAND MEADOW MN 55936

REGIONAL CLINIC MCHS-AUSTIN-LEROY

671 EAST MAIN LEROY MN 55951

REGIONAL CLINIC MCHS-AUSTIN-BLOOMING PRAIRIE

405 EAST MAIN BLOOMING PRAIRIE MN 55917

REGIONAL CLINIC PART I, LINE 6A: THE ANNUAL REPORT FOR THE FILING ORGANIZATION IS PART OF A CONSOLIDATED REPORT PREPARED BY MAYO CLINIC. PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS).THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO-CHARGE RATIO. PART I, LINE 7G: THE FOLLOWING NET COMMUNITY BENEFIT COST ATTRIBUTED TO A PHYSICIAN CLINIC WAS INCLUDED AS SUBSIDIZED HEALTH SERVICES: $2,155,564. 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 $ 1204978. PART II: THE ORGANIZATION'S COMMUNITY SUPPORT EXPENSES RELATE TO THE AUSTIN CHAMBER OF COMMERCE AMBASSADORS, THE HORMEL NATURE CENTER, THE MOWER COUNTY RED CROSS BLOOD DRIVE AND THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE IN MOWER COUNTY. THE ORGANIZATION'S ECONOMIC DEVELOPMENT EXPENSES RELATE TO THE DEVELOPMENT CORPORATION OF AUSTIN. PART III, LINE 4: 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.METHODOLOGY FOR SCHEDULE H, PART III, LINE 2:BAD DEBT EXPENSE IS DETERMINED BASED ON GAAP AND IS EXPLAINED IN THE ACCOUNTS RECEIVABLE FOOTNOTE OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS.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. 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 $4,310,000 AS REPORTED IN THE CORE FORM, PART III, PROGRAM SERVICE ACCOMPLISHMENTS.THE MOST COMMON REASONS FOR A DIFFERENCE BETWEEN THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H AND THE MEDICARE SHORTFALL REPORTED ON THE CORE FORM, PART III INCLUDE: (1) INCLUSION OF MEDICARE ADVANTAGE REVENUE AND EXPENSES; (2) INCLUSION OF PART B REVENUE AND EXPENSES; (3) INCLUSION OF OTHER FEE SCHEDULE REVENUE; AND (4) SOME TIMING ISSUES.REASONS WHY MEDICARE SHORTFALL REPORTED ON LINE 7, IF ANY, SHOULD BE TREATED AS COMMUNITY BENEFIT ARE: (1) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; (3) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND (4) THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. PART III, LINE 9B: MAYO CLINIC AND ITS AFFILIATES STRIVE TO ASSIST ALL PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION PRIOR TO ENLISTING THE ASSISTANCE OF A COLLECTION AGENCY BY MAKING REASONABLE ATTEMPTS TO COLLECT FROM INSURANCE COMPANIES AND OTHER THIRD-PARTY PAYORS. IN ADDITION, MAYO CLINIC AND ITS AFFILIATES ACCEPT REASONABLE PAYMENT PLANS FROM PATIENTS WHEN AN ACCOUNT IS THE PATIENT'S RESPONSIBILITY AND TRY TO IDENTIFY THOSE PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE IS OFFERED TO ANY PATIENT IF THE FACTS AND CIRCUMSTANCES SUGGEST THAT THE PATIENT DOES NOT HAVE THE ABILITY TO PAY THEIR BILL IN WHOLE OR IN PART. IN THE EVENT THAT AN ACCOUNT IS REFERRED TO A COLLECTION AGENCY, GUIDELINES ARE FOLLOWED; INCLUDING SUSPENDING ALL COLLECTION ACTIVITY IF A FINANCIAL ASSISTANCE APPLICATION HAS BEEN SUBMITTED AFTER THE ACCOUNT HAS BEEN REFERRED FOR COLLECTION. IF A COLLECTION AGENCY IDENTIFIES A PATIENT AS MEETING MAYO CLINIC'S FINANCIAL ASSISTANCE ELIGIBILTY CRITERIA OR THE PATIENT ASKS TO APPLY FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY IS SUSPENDED UNTIL MAYO REVIEWS THE ACCOUNT FOR FINANCIAL ASSISTANCE ELIGIBILITY BASED ON SUBMISSION OF REQUESTED INFORMATION. COLLECTION ACTIVITY WOULD ONLY RESUME IF MAYO WOULD TELL THE COLLECTION AGENCY TO PURSUE COLLECTIONS ON THE BALANCE OR PARTIAL BALANCE IF THERE WAS A CHARITY ADJUSTMENT. MAYO CLINIC HEALTH SYSTEM - AUSTIN PART V, SECTION B, LINE 14G: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. MAYO CLINIC HEALTH SYSTEM - AUSTIN PART V, SECTION B, LINE 18E: FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE TO EVERY PATIENT VIA MAYO'S PUBLIC WEBSITE, FROM CUSTOMER SERVICE AND PATIENT ACCESS LOCATIONS, AND IS REFERENCED ON MAYO'S AUTHORIZATION FORMS AND STATEMENTS. IN ADDITION, BROCHURES ARE AVAILABLE IN THE ADMISSIONS AREA AND THE PROCESS OF HOW TO APPLY IS AVAILABLE ON THE MAYO CLINIC WEBSITE.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, MAYO DISCUSSES ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE.MONTHLY STATEMENTS ARE SENT TO PATIENTS THAT OUTLINE CURRENT CHARGES AND ACTIONS WITH INSURANCE AND INCLUDES INFORMATION ABOUT MAYO'S CHARITY CARE POLICY. SOME MAYO SITES UTILIZE ADVOCATES TO CONTACT THE PATIENT UPON DISCHARGE TO HELP THEM SECURE GOVENMENTAL ASSISTANCE OR FINANCIAL ASSISTANCE.EACH CHARITY CARE REVIEW IS DOCUMENTED IN MAYO'S BILLING SYSTEM AND COMMUNICATED TO THE PATIENT. COMPLETED CHARITY CARE FORMS ARE MAINTAINED EITHER IN PAPER OR ELECTRONIC FORMAT. THE PATIENT IS INFORMED REGARDING THE OUTCOME OF THE REVIEW.MAYO OFTEN IDENTIFIES CHARITY CARE OPPORTUNITIES AFTER THE PATIENT HAS BEEN DISMISSED. IN MANY CASES, THIS IS DUE TO LIMITED INSURANCE COVERAGE OR INSURANCE DENIALS AFTER THE SERVICE WAS PERFORMED. IN THESE CASES, WHEN A PATIENT EXPRESSES AN INABILITY TO PAY FOR THEIR SERVICES, STAFF WILL INITIATE A CHARITY REVIEW AS INDICATED BY THE FINANCIAL ASSISTANCE POLICY, WHICH IS AVAILABLE FOR EVERY PATIENT AT MAYOCLINIC.ORG. MAYO CLINIC HEALTH SYSTEM - AUSTIN PART V, SECTION B, LINE 20D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 10% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE. PART VI, LINE 2: THE MISSION, VISION AND VALUES OF MAYO CLINIC HEALTH SYSTEM-AUSTIN (MCHS-AUSTIN), ITS NON-PROFIT STATUS AND COMMUNITY BOARD MEMBERSHIP ALL WORK TOGETHER TO FOCUS MCHS-AUSTIN ON THE HEALTH AND WELL-BEING OF ITS COMMUNITIES. THE FOUNDATION OF MCHS-AUSTIN'S BUSINESS IS PRIMARY CARE; ALL COMMUNITIES WHERE MCHS-AUSTIN HAS A PRESENCE ARE KEY COMMUNITIES.MCHS-AUSTIN ANTICIPATES COMMUNITY CONCERNS BY UTILIZING INPUT FROM COMMUNITY-BASED BOARD OF TRUSTEE MEMBERS, PATIENT FOCUS GROUPS, PATIENT SURVEYS AND MEETINGS WITH MAJOR EMPLOYERS IN ITS SERVICE AREA. ALL OF THESE RESOURCES HELP ALIGN MCHS-AUSTIN'S PLANNING PROCESSES TO ADDRESS FUTURE COMMUNITY NEEDS.MCHS-AUSTIN'S VALUE OF CARING FOR THE COMMUNITY REPRESENTS ITS COMMITMENT TO MAKING THE COMMUNITY A HEALTHIER PLACE FOR ALL. THIS COMMITMENT IS EXHIBITED THROUGH MCHS-AUSTIN'S PROVISION OF HIGH-QUALITY HEALTH CARE SERVICES AND TO ITS COMMITMENT OF CONTRIBUTING TO A HEALTHY ENVIRONMENT. ANY AREAS OF CONCERN OR IDENTIFIED ISSUES WOULD BE BROUGHT THROUGH THE STRATEGIC PLANNING PROCESS AS PART OF THE STRENGTHS / WEAKNESSES / OPPORTUNITIES / THREATS (SWOT) ANALYSIS.BOARD MEMBERS ALSO ARE INFORMED BY EXTERNAL REPORTING FROM SOURCES SUCH AS THE JC, CAP, AND HEALTHGRADES. MANY OF THESE REPORTS INCLUDE BENCHMARK COMPARISONS. PERHAPS THE MOST IMPORTANT SOURCE OF INFORMATION FOR MCHS-AUSTIN'S BOARD IS THEIR ABILITY TO LISTEN TO THE VOICE OF THE COMMUNITY. FIFTY PERCENT OF MCHS-AUSTIN'S BOARD MEMBERSHIP IS MADE UP OF INDEPENDENT COMMUNITY MEMBERS FROM VARIED BACKGROUNDS.MINNESOTA DEPARTMENT OF HEALTH STATISTICS ARE ALSO USED TO IDENTIFY KEY COMMUNITY HEALTH CARE NEEDS AND POTENTIAL GAPS. DATA IS REVIEWED TO DETERMINE AREAS OF NEED WHICH ARE THEN INCORPORATED INTO THE STRATEGIC PLANNING PROCESS. THESE NEEDS ARE DISCUSSED AND PRIORITIZED AT ANNUAL STRATEGIC PLANNING SESSIONS.MANY TIMES COMMUNITY NEEDS ARE OBVIOUS, SUCH AS A LARGE ELDERLY AND NURSING HOME POPULATION. OTHER NEEDS ARE IDENTIFIED THROUGH RECOGNIZED DEMOGRAPHIC CHANGES AND SHIFTS IN THE PATIENT POPULATION, SUCH AS THE INCREASE IN HISPANIC AND NON-WHITE PATIENTS. ADDITIONALLY, NEEDS ARE IDENTIFIED BY LISTENING TO PATIENTS, EMPLOYERS, SCHOOLS AND THE LARGER VOICE OF SOCIETY AS THEY EXPRESS AREAS OF CONCERN.MCHS-AUSTIN'S STRATEGIC CHALLENGES: IMPROVING PATIENT SATISFACTION, IMPROVING QUALITY AND SAFETY, IMPROVING PATIENT ACCESS, AND SUCCESSFUL IMPLEMENTATION OF STANDARIZED ELECTRONIC MEDICAL RECORD(EMR) WERE IDENTIFIED THROUGH THE STRATEGIC PLANNING PROCESS AS AN OUTCOME OF THE SWOT ANALYSIS. THROUGH THIS PROCESS MCHS-AUSTIN REVIEWS DATA ON A LOCAL BASIS (SCHOOL DISTRICT, MAYO CLINIC HEALTH SYSTEM, PUBLIC HEALTH PARTNERSHIPS, ETC.), A STATEWIDE BASIS (MN HOSPITAL ASSOCIATION, MN DEPARTMENT OF HEALTH, LEGISLATIVE UPDATES, ETC.) AND A NATIONAL BASIS (PRESS GANEY, HEALTHCARE ADVISORY BOARD, ETC.) TO DETERMINE HOW IT IS PERFORMING AND TO IDENTIFY IMPROVEMENTS NEEDED TO ACHIEVE ITS MISSION, VISION AND VALUES. THESE ARE THEN RESTATED AS STRATEGIC CHALLENGES.COMMON TRENDS OR THEMES ARE SUMMARIZED AND PRESENTED AT THE STRATEGIC PLANNING RETREAT. THESE TRENDS ARE PULLED FROM LOCAL, STATE, AND NATIONAL DATA. SMALL GROUPS OR BREAKOUT TEAMS ARE ASKED TO HIGHLIGHT ANY MISSING SWOT ISSUES NOT PREVIOUSLY IDENTIFIED AND THEN TO IDENTIFY 3 TO 5 OF THE MOST CRITICAL OR IMPORTANT SWOT ELEMENTS TO BE CONSIDERED. FINALLY, A VOTING PROCESS IS UTILIZED TO HIGHLIGHT THE MOST CRITICAL ITEMS TO BE ADDRESSED AS ACTION PLANS AND STRATEGIES ARE DEVELOPED FOR THE UPCOMING CYCLE.EARLY INDICATIONS OF RISKS OR MAJOR SHIFTS ARE IDENTIFIED THROUGH ANALYSIS AND PRESENTATION PRIOR TO STRATEGIC PLANNING SESSIONS. INFORMATION IS GATHERED AND BINDERS ARE SHARED WITH RETREAT PARTICIPANTS. PLANNING FOR 2012 HIGHLIGHTED THE FOLLOWING TOPICS:- NATIONAL TRENDS- STATE AND LOCAL DATA- ACO'S AND MEDICAL HOME OVERVIEW- OUT-MIGRATION MARKET SHARE- QUALITY UPDATE - MAYO EXPECTATIONS- SERVICE UPDATE - MAYO EXPECTATIONS- FINANCE UPDATE - MAYO EXPECTATIONS- MAYO CLINIC HEALTH SYSTEM REGIONALIZATION EFFORTS- INPUT FROM DEPARTMENTS REGARDING CHALLENGES AND OPPORTUNITIESDURING THE ANNUAL BUDGETING PROCESS AND ON AN ONGOING BASIS, SERVICE LINE LEADERS EVALUATE SUSTAINABILITY. THE BUDGETING PROCESS FORCES LEADERS TO DETERMINE IF IT IS FEASIBLE TO MAINTAIN A SERVICE WITHIN THE ORGANIZATION AND IDENTIFY NEW SERVICES THAT SHOULD BE CONSIDERED TO SERVE COMMUNITY NEEDS. 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-AUSTIN (MCHS-AUSTIN) HAS LOCATIONS IN THE MINNESOTA COMMUNITIES OF AUSTIN, BLOOMING PRAIRIE, LEROY, ADAMS AND GRAND MEADOW. THE MAJORITY OF MCHS-AUSTIN'S SERVICE AREA INCLUDES MOWER, EASTERN FREEBORN, AND SOUTHERN STEELE COUNTIES IN SOUTH CENTRAL MINNESOTA AND NORTHERN MITCHELL COUNTY IN IOWA. ITS MAIN CAMPUS, LOCATED IN AUSTIN, INCLUDES A CLINIC AND A HOSPITAL THAT SERVES AUSTIN AND SURROUNDING COMMUNITIES.ACCORDING TO THE UNITED STATES CENSUS BUREAU, THE 2011 POPULATION ESTIMATE FOR MOWER COUNTY (WHICH COMPRISES MOST OF MCHS-AUSTIN'S SERVICE AREA) IS 39,427. A 2011 ESTIMATE REPORTS THAT 25.1% OF THE POPULATION IS UNDER 18 YEARS OLD AND 17.8% IS 65 YEARS OLD OR OLDER. THE 2011 MEDIAN HOUSEHOLD INCOME IS $46,827 AND AN ESTIMATED 14.2% OF INDIVIDUALS ARE LIVING BELOW POVERTY LEVEL. PART VI, LINE 5: THIS FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION- EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO CLINIC HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATION'S ACTIVITIES.SURPLUS FUNDSMAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE. COMMUNITY REPRESENTATION ON GOVERNING BODYTHE BOARD OF TRUSTEES IS THE GOVERNING BODY OF MAYO CLINIC. A MAJORITY OF ITS MEMBERS ARE EXTERNAL, INDEPENDENT TRUSTEES. IT HAS OVERALL RESPONSIBILITY FOR THE CHARITABLE, CLINICAL PRACTICE, SCIENTIFIC AND EDUCATIONAL MISSION AND PURPOSES OF MAYO CLINIC AND ITS AFFILIATES AS SET FORTH IN ITS ARTICLES OF INCORPORATION AND BYLAWS. BECAUSE OF MAYO CLINIC'S NATIONAL PRESENCE, THESE TRUSTEES ARE SELECTED BASED ON THEIR AREAS OF EXPERTISE, WHETHER IN HEALTH CARE POLICY, BUSINESS, GOVERNMENT OR ANOTHER FIELD. IN ADDITION TO THIS COMMUNITY REPRESENTATION AT THE PARENT ENTITY, THE FILING ORGANIZATION ALSO INVOLVES LOCAL COMMUNITY MEMBERS ON ITS GOVERNING BODY. OPEN V. CLOSED STAFF MODEL STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.EMERGENCY ROOM THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. PART VI, LINE 6: MAYO CLINIC HEALTH SYSTEM:THIS ORGANIZATION IS A PART OF MAYO CLINIC HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO CLINIC HEALTH SYSTEM IS DESCRIBED IN RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). THAT STATEMENT ALSO DESCRIBES THE ROLES OF THE VARIOUS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED. SCHEDULE H, PART VI, LINE 7 NEITHER THE FILING ORGANIZATION, NOR ANY RELATED ORGANIZATION, FILES A COMMUNITY BENEFIT REPORT WITH ANY STATE OTHER THAN THE EXTENT TO WHICH COMMUNITY BENEFIT INFORMATION IS INCLUDED IN OTHER REPORTING REQUIREMENTS SUCH AS INFORMATION PROVIDED ON THE MINNESOTA HOSPITAL ANNUAL REPORT OR TO THE WISCONSIN HOSPITAL ASSOCIATION. 1 UNITED WAY OF MOWER COUNTY PO BOX 605 AUSTIN MN 55912 410831896 501(C)(3) 8000 SUPPORT OF MISSION THE HORMEL FOUNDATION 329 N MAIN ST SUITE 102L AUSTIN MN 55912 410694716 501(C)(3) 10000 CHILD CARE EXPANSION PROJECT 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY WITH PROGRAMS THAT ENHANCE THE MISSION OF THE FILING ORGANIZATION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY THAT ADDRESS UNMET OR UNDER-FUNDED COMMUNITY NEEDS IN THE AREAS OF HEALTHCARE, EDUCATION, RESEARCH, DIVERSITY AND EQUALITY OF OPPORTUNITY. NO ADDITIONAL MONITORING IS PERFORMED. TRANSFERS OR GRANTS TO TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED. TRANSFERS OR GRANTS TO AFFILIATED TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED. 0 1 0 0 0 0 0 0 0 AGERTER MD DAVID C 0 449783 0 0 0 33817 0 19707 0 15384 0 518691 0 0 BUNKERS MD BRIAN E 0 346098 0 0 0 1229 0 7500 0 3921 0 358748 0 0 CIOTA MD MARK R 0 787325 0 0 0 0 0 17500 0 27829 0 832654 0 0 CUNNINGHAM MD PETER L 325164 0 554 0 0 0 20000 0 20794 0 366512 0 0 0 FLINCHBAUGH DO ROBERT T 0 234731 0 0 0 1157 0 25008 0 24001 0 284897 0 0 GABRIELSON SHARON R 0 183859 0 0 0 693 0 21238 0 26087 0 231877 0 0 DANKERT SHERI S 145099 0 1691 0 0 0 11566 0 20400 0 178756 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 PILOT DAVID L 0 196045 0 0 0 0 0 13937 0 19997 0 229979 0 0 REES ADAM C 257076 0 2923 0 0 0 20000 0 21801 0 301800 0 0 0 ACCURSO MD JOSEPH M 257242 285867 1408 0 0 68595 20000 0 7407 13704 286057 368166 0 0 COPPES MD JOHN B 335303 0 1895 0 0 0 20000 0 17346 0 374544 0 0 0 HOLTZ MD SCOTT A 307759 0 635 0 0 0 20000 0 20098 0 348492 0 0 0 KLEIS DO KEITH R 292464 0 1216 0 0 0 20000 0 23630 0 337310 0 0 0 KUBAS MD STEVE M 255474 0 727 0 0 0 20000 0 20758 0 296959 0 0 0 NORDENG RODNEY L 148535 0 1734 0 0 0 11869 0 21024 0 183162 0 0 0 WOLD MD LESTER E 287436 600 5820 0 0 0 20000 0 1099 0 314355 600 0 0 YOUNG DO NATHAN P 265975 0 574 0 0 0 20000 0 890 0 287439 0 0 0 ENGMAN MD STEVEN J 677376 0 1398 0 0 0 20000 0 22202 0 720976 0 0 0 HECTORNE MD KATHLEEN J 481740 0 1282 0 0 0 20000 0 9801 0 512823 0 0 0 KIRSCH MD MATTHEW J 731060 0 2042 0 0 0 20000 0 22462 0 775564 0 0 0 MIZRACHI MD VICTOR N 606454 0 1408 0 0 0 20000 0 25983 0 653845 0 0 0 STOFFEY DO ROBERT D 605257 0 1408 0 0 0 20000 0 20566 0 647231 0 0 0 JOHNSON MD TIMOTHY J 0 400440 0 0 0 18968 0 41978 0 7493 0 468879 0 0 DUBE MD CYNTHIA M 231841 0 495 0 0 0 18206 0 9445 0 259987 0 0 0 HOLTZ MD CAROL P 187437 0 355 0 0 0 14939 0 5693 0 208424 0 0 0 PART I, LINE 4B THIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(A)(17). STARTING JANUARY 1, 2011, ALL SRP BENEFITS ARE PAID AS AN ANNUAL TAXABLE CASH PAYMENT. THE FOLLOWING INDIVIDUALS RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN. AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). DAVID C. AGERTER, M.D. $27,454 MARK B. KOCH $8,013 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE CORE 990 PART VI SECTION B LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED. COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. RHODA REES SPOUSE OF OFFICER, ADAM REES 65349 EMPLOYMENT 0 CAROL P HOLTZ MD SPOUSE OF KEY EMPLOYEE, SCOTT A. HOLTZ, M.D. 208424 EMPLOYMENT 0 SCOTT A HOLTZ MD SPOUSE OF FORMER KEY EMPLOYEE, CAROL P. HOLTZ, M.D. 348492 EMPLOYMENT 0 ALL ASSETS, LIABILITIES AND NET ASSETS WERE MERGED INTO RELATED ENTITY 2012-12-31 134395080 BOOK VALUE AT END OF YEAR 411404075 MAYO CLINIC HEALTH SYSTEM-ALBERT LEA AND AUSTIN 1000 1ST DRIVE NW AUSTIN MN 55912 501(C)(3) 1 1 0 0 1 1 1 1 0 PART I, LINE 2E: SOME OF THE BOARD OF DIRECTORS FOR MAYO CLINIC HEALTH SYSTEM-AUSTIN ARE THE SAME MEMBERS FOR MAYO CLINIC HEALTH SYSTEM-ALBERT LEA AND AUSTIN, WHICH IS THE SURVIVING ENTITY IN THE MERGER OF THE TWO ORGANIZATIONS. PART I, LINE 7C: THE REPORTING ORGANIZATION DID NOT HAVE ANY TAX EXEMPT BOND LIABILITIES. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: BUNKERS M.D., BRIAN E. 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: CIOTA M.D., MARK R. 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. CIOTA M.D., MARK R. GABRIELSON, SHARON R. KOCH, MARK B. PARKS, DOUGLAS A. PILOT, DAVID L. BRIAN E. BUNKERS, M.D. AND MARK B. KOCH HAVE A BUSINESS RELATIONSHIP AS THEY SERVE AS AN OFFICER, DIRECTOR, OR TRUSTEE OF MAYO CLINIC HEALTH SYSTEM-FARIBAULT, A RELATED TAXABLE ENTITY. RODNEY L. NORDENG AND GARY RAY HAVE A BUSINESS RELATIONSHIP AS THEY SERVE ON THE AUSTIN COMMUNITY BANK ADVISORY BOARD. 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 ARTICLES OF MERGER WERE PREPARED FOR MAYO CLINIC HEALTH SYSTEM-AUSTIN'S MERGER WITH AND INTO MAYO CLINIC HEALTH SYSTEM-ALBERT LEA. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS MAYO CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER ELECTS THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE FILING ORGANIZATION'S BYLAWS PROVIDE MAYO CLINIC, THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION, CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET AND DEBT DECISIONS. MAYO CLINIC, THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION, MAY AMEND THE FILING ORGANIZATION'S ARTICLES AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER AND FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FILING ORGANIZATIONS GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C MAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF 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. THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY IN THE FALL FOR THE NEXT YEAR'S COMPENSATION. THE SALARIES OF THE CEO, REGION CAO, ALONG WITH PHYSICIAN BOARD LEADERSHIP WERE REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO CLINIC HEALTH SYSTEM-PHYSICIAN AND ADMINISTRATIVE LEADERSHIP. THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE MAYO CLINIC HEALTH SYSTEM ENTITIES. THE COMMITTEE IS COMPRISED OF MAYO EMPLOYEES, BUT IS INDEPENDENT FOR INTERNAL REVENUE CODE 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED (WITH RECUSAL WHERE APPROPRIATE). THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE THEN REVIEWS AND APPROVES THE COMPENSATION. FOR THOSE INDIVIDUALS FOR WHICH THE MAYO CLINIC HEALTH SYSTEM COMMITTEE CAN NOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE COMPENSATION AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. INFORMATION ON MAYO CLINIC HEALTH SYSTEM PHYSICIAN AND ADMINISTRATIVE LEADERSHIP COMPENSATION AND BENEFITS IS ALSO REVIEWED BY THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION AND GOVERNANCE (GOVERNANCE COMMITTEE), WHICH IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. 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: MCHS-AUSTIN MERGER INTO MCHS-ALBERT LEA -134,395,080. CHANGE IN NET ASSETS OF AUSTIN FOUNDATION 22,895. IN REGARDS TO FILING CERTAIN FOREIGN FORMS SCHEDULE F, PART IV, LINES 3, 5, & 6 DISCLOSURE STATEMENT RELATED TO FORMS 5713: FORM 5713 HAS BEEN FILED BY THE FOLLOWING MEMBERS OF THE CONTROLLED GROUP: MAYO CLINIC (EIN: 41-6011702) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH (EIN: 41-1506440) MAYO HOLDING COMPANY (EIN: 41-1578020) MAYO CLINIC ARIZONA (EIN: 86-0800150) MAYO CLINIC JACKSONVILLE (EIN: 59-3337028) DISCLOSURE STATEMENT RELATED TO FORMS 5471: UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, AS A CATEGORY 4 AND 5 FILER WITH RESPECT TO CERTAIN CONTROLLED FOREIGN CORPORATIONS (CFCS). THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 5471 FOR THESE CFCS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT. TAXPAYER NAME: MAYO CLINIC ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 41-6011702 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED TAXPAYER NAME: MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 41-1506440 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED DISCLOSURE STATEMENT RELATED TO FORMS 8865: UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 8865, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN PARTNERSHIPS, AS A CATEGORY 2 AND 3 FILER. THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 8865 FOR THESE PARTNERSHIPS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT. TAXPAYER NAME: MAYO CLINIC ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 8865 WAS FILED: 41-6011702 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED BLOOMER LAKEVIEW INC 2110 DUNCAN ROAD BLOOMER WI 54724 391450617 LOW INCOME HOUSING WI 501(C)(3) 7 MCHS--CHIPPEWA VALLEY INC 1 CHARTERHOUSE INC 200 FIRST STREET SW ROCHESTER MN 55905 411405254 RETIREMENT LIVING CENTER MN 501(C)(3) 9 MAYO CLINIC 1 FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC 464 SOUTH ST JOSEPH AVENUE ARCADIA WI 54612 391322480 FUNDRAISING FOUNDATION WI 501(C)(3) 9 MCHS--FRANCISCAN HEALTHCARE INC 1 GOLD CROSS AMBULANCE SERVICE 200 FIRST STREET SW ROCHESTER MN 55905 411917516 AMBULANCE SERVICE MN 501(C)(3) 9 MFMER 1 LUTHER LAKESIDE APARTMENTS INC PO BOX 1510 EAU CLAIRE WI 54702 391409024 LOW INCOME HOUSING FOR ELDERLY WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 416011702 PATIENT CARE - CLINIC MN 501(C)(3) 9 N/A 1 MAYO CLINIC -- METHODIST HOSPITAL 200 FIRST STREET SW ROCHESTER MN 55905 410739106 HOSPITAL MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC -- SAINT MARYS HOSPITAL 200 FIRST STREET SW ROCHESTER MN 55905 410944601 HOSPITAL MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC ARIZONA 13400 EAST SHEA BOULEVARD SCOTTSDALE AZ 85259 860800150 HOSPITAL AND CLINIC AZ 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC FLORIDA (A NONPROFIT CORPORATION) 4500 SAN PABLO ROAD JACKSONVILLE FL 32224 590714831 HOSPITAL FL 501(C)(3) 3 MAYO CLINIC JACKSONVILLE 1 MAYO CLINIC HEALTH SYSTEM IN WAYCROSS INC 1900 TEBEAU STREET WAYCROSS GA 31501 581667166 HOSPITAL GA 501(C)(3) 3 MAYO CLINIC JACKSONVILLE 1 MAYO CLINIC HEALTH SYSTEM--ALBERT LEA 1000 FIRST DRIVE NW AUSTIN MN 55912 411404075 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--AUSTIN 1000 FIRST DRIVE NW AUSTIN MN 55912 410695606 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--AUSTIN FOUNDATION 1000 FIRST DRIVE NW AUSTIN MN 55912 300107471 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--AUSTIN 1 MAYO CLINIC HEALTH SYSTEM--CANNON FALLS 1116 WEST MILL STREET CANNON FALLS MN 55009 204156428 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC 1501 THOMPSON STREET BLOOMER WI 54724 390980343 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC 733 W CLAIREMONT AVE PO BOX 1510 EAU CLAIRE WI 54702 391735831 PATIENT CARE - CLINIC WI 501(C)(3) 3 MAYO CLINIC 0 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE FOUNDATION INC 733 W CLAIREMONT AVE PO BOX 1510 EAU CLAIRE WI 54702 391633407 GRANTMAKING FOUNDATION WI 501(C)(3) 11-I MCHS--EAU CLAIRE CLINIC INC 0 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 390813418 HOSPITAL WI 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--FAIRMONT 800 MEDICAL CENTER DRIVE PO BOX 800 FAIRMONT MN 56031 410760836 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391186647 FUNDRAISING FOUNDATION WI 501(C)(3) 7 MCHS--FRANCISCAN HEALTHCARE INC 1 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION-SPARTA INC 310 WEST MAIN STREET SPARTA WI 54656 391423234 FUNDRAISING FOUNDATION WI 501(C)(3) 9 MCHS--FRANCISCAN HEALTHCARE INC 1 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391411999 HEALTHCARE SYSTEM PARENT WI 501(C)(3) 11-I MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN MEDICAL CENTER INC 700 WEST AVE SOUTH LA CROSSE WI 54601 390806374 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--FRANCISCAN HEALTHCARE INC 1 MAYO CLINIC HEALTH SYSTEM--HOME HEALTH & HOSPICE INC PO BOX 2060 EAU CLAIRE WI 54702 391491516 HOME HEALTH AND HOSPICE CARE WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--LAKE CITY 500 WEST GRANT STREET LAKE CITY MN 55041 411906820 HOSPITAL MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--MANKATO 1025 MARSH STREET MANKATO MN 56002 411236756 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--MANKATO HEALTH CARE FOUNDATION 1025 MARSH STREET MANKATO MN 56002 411663357 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE 301 SECOND STREET NE NEW PRAGUE MN 56071 410723639 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC 1222 EAST WOODLAND AVENUE BARRON WI 54812 390920634 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC 13025 EIGHTH STREET PO BOX 70 OSSEO WI 54758 391029430 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--OWATONNA 134 SOUTHVIEW ST OWATONNA MN 55060 411862132 PATIENT CARE - CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC 2321 STOUT ROAD MENOMONIE WI 54751 510190875 HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--RED WING 701 HEWITT BOULEVARD RED WING MN 55066 411713783 PATIENT CARE SERVICES MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--RED WING HOME HEALTH & HOSPICE 701 HEWITT BOULEVARD RED WING MN 55066 411539756 HOME HEALTHCARE SERVICES MN 501(C)(3) 7 MCHS--RED WING 1 MAYO CLINIC HEALTH SYSTEM--SPRINGFIELD 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 411893827 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--ST JAMES 1101 MOULTON PARSONS DR PO BOX 460 ST JAMES MN 56081 410797368 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--ST JAMES HEALTH CARE FOUNDATION 1101 MOULTON PARSONS DR PO BOX 460 ST JAMES MN 56081 411444129 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--ST JAMES 1 MAYO CLINIC HEALTH SYSTEM--SUPPORTIVE HOMECARE INC PO BOX 2060 EAU CLAIRE WI 54702 391686673 HOME HEALTH CARE WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--WASECA 501 NORTH STATE STREET WASECA MN 56093 363606405 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC JACKSONVILLE 4500 SAN PABLO ROAD JACKSONVILLE FL 32224 593337028 PATIENT CARE - CLINIC FL 501(C)(3) 7 MAYO CLINIC 1 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 200 FIRST STREET SW ROCHESTER MN 55905 411506440 CHARITABLE, EDUCATIONAL & SCIENTIFIC ACTIVITIES MN 501(C)(3) 9 MAYO CLINIC 1 MAYO KLINIK STIFTUNG 60486 FRANKFURT AM MAIN FRANKFURT GM FUNDRAISING FOUNDATION GM MFMER 1 MILES AND SHIRLEY FITERMAN ENDOWMENT FUND FOR DIGESTIVE DISEASES 200 FIRST STREET SW ROCHESTER MN 55905 412020392 SUPPORT RESEARCH, PRACTICE & EDUCATION MN 501(C)(3) 11-I MAYO CLINIC 1 POVERELLO FOUNDATION 200 FIRST STREET SW ROCHESTER MN 55905 411494881 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MAYO CLINIC -- SAINT MARYS HOSPITAL 1 RED WING SEMINARY HOME 701 HEWITT BOULEVARD RED WING MN 55066 411263419 RESIDENT CARE AND HOUSING MN 501(C)(3) 9 MCHS--RED WING 1 SATILLA HEALTH MANAGEMENT INC 1900 TEBEAU STREET WAYCROSS GA 31501 581717889 HEALTHCARE SERVICES GA 501(C)(3) 3 MCHS IN WAYCROSS INC 1 THE DOWNTOWN PLAZA 701 HEWITT BOULEVARD RED WING MN 55066 411532554 ELDERLY HOUSING MN 501(C)(3) 9 MCHS--RED WING 1 HIRSH FAMILY FOUNDATION 108 NORTH MAIN STREET AUSTIN MN 55912 411749842 FUNDRAISING FOUNDATION MN 501(C)(3) 11-I 0 HORMEL FOUNDATION 329 N MAIN ST SUITE 102L AUSTIN MN 55912 410694716 FUNDRAISING FOUNDATION MN 501(C)(3) 11-I 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 N/A C 1 SATILLA HEALTHNET INC 1900 TEBEAU STREET WAYCROSS GA 31501 582151076 HEALTH SERVICES GA N/A C 1 SATILLA REGIONAL SPECIALTY PHYSICIANS INC 1900 TEBEAU STREET WAYCROSS GA 31501 204363143 PHYSICIAN OFFICES GA N/A C 1 SIT ALPHA II BOND FUND LTD CLIFTON HOUSE 75 FORTH ST GRAND CAYMAN CJ KY1-1108 980648163 INVESTMENT MANAGEMENT CJ N/A C 1 SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION 13400 E SHEA BLVD SCOTTSDALE AZ 85259 860870505 COMMERCIAL PROPERTY OWNERS ASSOCIATION AZ N/A C 1 THE STABILE BUILDING OWNERS' ASSOCIATION 200 FIRST STREET SW ROCHESTER MN 55905 208994499 COMMERCIAL PROPERTY OWNERS ASSOCIATION MN N/A C 1 CHARITABLE LEAD TRUST CHARITABLE TRUST CA N/A T 1 PERPETUAL TRUST CHARITABLE TRUST ND N/A T 1 PERPETUAL TRUST CHARITABLE TRUST LA N/A T 1 PERPETUAL TRUST (2) CHARITABLE TRUST MA N/A T 1 PERPETUAL TRUST CHARITABLE TRUST MO N/A T 1 PERPETUAL TRUST CHARITABLE TRUST AZ N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST CO N/A T 1 CHARITABLE REMAINDER TRUST (6) CHARITABLE TRUST FL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST FL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST IL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST LA N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST MI N/A T 1 CHARITABLE REMAINDER TRUST (68) CHARITABLE TRUST MN N/A T 1 CHARITABLE REMAINDER TRUST (77) CHARITABLE TRUST MN N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NC N/A T 1 CHARITABLE REMAINDER TRUST (2) CHARITABLE TRUST TX N/A T 1 1 0 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 MAYO CLINIC HEALTH SYSTEM--ALBERT LEA O 295154 GAAP MAYO CLINIC HEALTH SYSTEM--ALBERT LEA P 589022 GAAP MAYO CLINIC HEALTH SYSTEM--AUSTIN FOUNDATION C 352048 GAAP MAYO CLINIC HEALTH SYSTEM--CANNON FALLS Q 132098 GAAP MAYO CLINIC HEALTH SYSTEM--LAKE CITY L 76710 GAAP MAYO CLINIC HEALTH SYSTEM--LAKE CITY Q 64727 GAAP MAYO CLINIC HEALTH SYSTEM--OWATONNA O 86612 GAAP MAYO CLINIC HEALTH SYSTEM--OWATONNA Q 50698 GAAP MAYO COLLABORATIVE SERVICES INC M 484028 GAAP MMSI INC M 241108 GAAP MMSI INC S 7245331 GAAP