2012-11-06T12:57:10-06:00 2011-12-31 990 2011-01-01 411893827 MAYO CLINIC HEALTH SYSTEM-SPRINGFIELD MAYO 5075381297 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 JAMES J TARASOVITCH 5073856449 2012-11-06 2011 2016-02-24 21:20:13Z FKA SPRINGFIELD MEDICAL CENTER - MAYO HEALTH SYSTEM GREGORY KUTCHER MD 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 17062356 0 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1997 MN MEDICAL CLINIC, HOSPITAL, EMERGENCY ROOM AND DENTAL CLINIC 8 4 90 4 0 0 61692 49030 16553062 16559866 85657 97572 11151 333316 16711562 17039784 32305 7713 0 0 8510311 9030364 0 0 0 5732078 7067786 14274694 16105863 2436868 933921 22894107 23898807 1402713 1473492 21491394 22425315 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 14768036 16862422 PATIENT CARE (SCHEDULE O)PATIENT CARE:MAYO CLINIC HEALTH SYSTEM IS A FAMILY OF CLINICS, HOSPITALS AND HEALTH CARE FACILITIES SERVING COMMUNITIES IN MINNESOTA, IOWA 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 2011, MAYO CLINIC HEALTH SYSTEM SITES EMPLOYED APPROXIMATELY 900 PHYSICIANS AND 13,000 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, SEVEN OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH TWO ADDITIONAL HOSPITALS, AND CONTRACT MANAGEMENT AGREEMENTS WITH AN ADDITIONAL HOSPITAL AND NURSING HOME. SINCE ITS INCEPTION IN 1992, MAYO CLINIC HEALTH SYSTEM HAS GROWN FROM A NEW IDEA TO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN AMERICA. MAYO CLINIC HEALTH SYSTEM COMPLETES MORE THAN TWO-MILLION PATIENT VISITS ANNUALLY. IT ALSO SERVES AS A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS BEING RECOGNIZED SIX TIMES BY THE AMERICAN MEDICAL GROUP ASSOCIATION'S ACCLAIM AWARD PROGRAM (2005 ACCLAIM AWARD RECIPIENT AND FIVE-TIME ACCLAIM AWARD HONOREE). THE ACCLAIM AWARDS HONOR PHYSICIAN-LED ORGANIZATIONS DELIVERING CARE ALIGNED WITH THE IDEAL DELIVERY MODEL WHERE PATIENTS EXPERIENCE SAFE, RELIABLE, RESPONSIVE, READILY AVAILABLE AND INTEGRATED CARE. IN ADDITION, THE MINNESOTA COUNCIL FOR QUALITY HAS RECOGNIZED MAYO CLINIC HEALTH SYSTEM THREE TIMES FOR ITS PERFORMANCE EXCELLENCE EFFORTS. INDIVIDUAL MAYO CLINIC HEALTH SYSTEM LOCATIONS HAVE ALSO BEEN HONORED FOR THEIR COMMITMENT TO QUALITY, SAFETY, SERVICE, PERFORMANCE AND THEIR COMMUNITIES.PEOPLE IN MINNESOTA, IOWA AND WISCONSIN CAN HAVE PEACE OF MIND KNOWING THAT MAYO CLINIC HEALTH SYSTEM AND MAYO CLINIC PARTNER TO ENSURE HEALTHIER LIVES IN THE REGION.MAYO CLINIC HEALTH SYSTEM - SPRINGFIELD (MCHS-SPRINGFIELD)PROVIDES HEALTH, MEDICAL AND DENTAL SERVICES TO THE SPRINGFIELD, MINNESOTA, COMMUNITY AS WELL AS SURROUNDING COMMUNITIES. SERVICES ARE OFFERED THROUGH ITS HOSPITAL AND CLINICS IN SPRINGFIELD, MINNESOTA, AS WELL AS A BRANCH MEDICAL CLINIC AT LAMBERTON, MINNESOTA. THERE WERE 1,737 PATIENTS TREATED IN THE EMERGENCY ROOM IN 2011, WHICH IS OPEN 24 HOURS A DAY. THERE WERE 554 ACUTE PATIENTS DISCHARGED FROM INPATIENT CARE DURING 2011, AND 16,410 PATIENT OFFICE VISITS TOOK PLACE AT THE MEDICAL CLINICS IN 2011. THE DENTAL CLINIC HAD 3,005 PATIENT VISITS IN 2011. THE CLINIC IN LAMBERTON SAW 1,336 PATIENTS IN 2011. THIS CLINIC PROVIDES A NEEDED HEALTH CARE ACCESS POINT TO A COMMUNITY OF 900, INCLUDING MANY WHO ARE ELDERLY.UNCOMPENSATED CARE:MCHS-SPRINGFIELD PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. MCHS-SPRINGFIELD IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED BASED ON ITS COST OF PROVIDING SERVICES FOR HOSPITAL MEDICARE PATIENTS.CHARITY CARE IS ALSO PROVIDED FOR PATIENTS THAT ARE FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THE COST OF CHARITY CARE PROVIDED IN 2011 WAS APPROXIMATELY $28,000. THE COST OF UNCOMPENSATED CARE IN 2011 PROVIDED TO OTHER GOVERNMENTAL AND LOW INCOME PATIENTS THROUGH MEDICAID WAS APPROXIMATELY $581,900. THIS AMOUNT INCLUDES THE MEDICAID SURCHARGE AND PAYMENT TO MINNESOTACARE (A PROGRAM THAT PROVIDES HEALTH CARE FOR LOW INCOME POPULATIONS). THE AMOUNT OF THE MEDICAID SURCHARGE AND MINNESOTACARE TAX PAID IN 2011 WAS APPROXIMATELY $238,000.MCHS-SPRINGFIELD ALSO PROVIDES DISCOUNTS TO UNINSURED PATIENTS. THE TOTAL DISCOUNTS GIVEN IN 2011 WERE $34,000. 4000 8304 EDUCATION (SCHEDULE O)EDUCATION:AS AN IMPORTANT COMPONENT OF THE AREAS' INFRASTRUCTURE, MCHS-SPRINGFIELD IS INVOLVED IN SEVERAL DIFFERENT WAYS IN PROVIDING AND/OR SUPPORTING HEALTH CARE RELATED EDUCATION IN SPRINGFIELD AND THE SURROUNDING AREA. MCHS-SPRINGFIELD HAS A TUITION ASSISTANCE PROGRAM THAT PROVIDES FUNDING FOR INDIVIDUALS TO ENHANCE THEIR EDUCATION IN A HEALTH CARE RELATED FIELD. FIVE PEOPLE WERE PROVIDED A TOTAL OF $16,000 IN 2011 UNDER THIS PROGRAM WHICH IS ONE OF THE BEST IDENTIFIED WAYS TO HELP PROVIDE STAFFING FOR OUR RURAL MEDICAL CENTER. UNFORTUNATELY, THIS PARTICULAR BENEFIT ONLY "COUNTS" IF IT IS MADE TO A PERSON WHO IS NOT YET OUR EMPLOYEE, THUS THE $16,000 IS NOT INCLUDED IN OUR OFFICIAL TALLY OF COMMUNITY BENEFITS SINCE ALL FIVE INDIVIDUALS ASSISTED WERE ALREADY MCHS-SPRINGFIELD EMPLOYEES.MCHS-SPRINGFIELD PROVIDES MANY DIFFERENT EDUCATIONAL SEMINARS REGARDING SPECIFIC TOPICS, INCLUDING DIABETES CLASSES, CHILDBIRTH CLASSES, AND SIBLING CLASSES. BEGINNING IN 2008, MCHS-SPRINGFIELD PIONEERED A COMMUNITY INITIATIVE TO ADDRESS CHILDHOOD OBESITY AND PARTNERED WITH LOCAL SCHOOLS, PUBLIC HEALTH AND THE LOCAL GROCERY STORE. INCLUDED IN THIS INITIATIVE WAS TO PROVIDE NUTRITION AND PHYSICAL ACTIVITY TALKS TO STUDENTS IN K-6TH GRADE. THERE HAVE ALSO BEEN OTHER AWARENESS ACTIVITIES SPONSORED BY MCHS-SPRINGFIELD, SUCH AS BREAST HEALTH AWARENESS AND OTHER TOPICS THAT HAVE BEEN SHARED IN SOME MANNER WITH THE COMMUNITY AT NO CHARGE. IT IS ESTIMATED THAT COSTS FOR STAFF TIME AND MATERIALS ASSOCIATED WITH THESE VARIOUS EDUCATIONAL EPISODES AMOUNTED TO APPROXIMATELY $4,000 IN 2011. 34355 7713 834 COMMUNITY BUILDING/COMMUNITY HEALTH IMPROVEMENT SERVICES (SCHEDULE O)COMMUNITY BUILDING:MCHS-SPRINGFIELD EMPLOYED 92 ALLIED HEALTH STAFF, 4 PHYSICIANS AND 1 DENTIST AT THE END OF 2011. IT IS IMPORTANT THAT EMPLOYEES OF MCHS-SPRINGFIELD CONTRIBUTE TO THE COMMUNITY BY MEANS OF PROVIDING THEIR TIME TO WORTHWHILE CIVIC PROJECTS THAT IMPROVE THE OVERALL COMMUNITY PROFILE. MANY TIMES THIS ACTIVITY OCCURS DURING TYPICAL WORK TIME WHILE BEING COMPENSATED BY MCHS-SPRINGFIELD. SOME OF THESE SETTINGS INCLUDE MCHS-SPRINGFIELD EMPLOYEES WHO SERVE IN LEADERSHIP POSITIONS SUCH AS WITH THE SPRINGFIELD AREA CHAMBER OF COMMERCE OR THE SPRINGFIELD AREA CONVENTION & VISITORS BUREAU. SOME OF THE PROJECTS WORKED ON AS PART OF THESE ORGANIZATIONS ARE TO INCREASE TOURISM BY THE DEVELOPMENT OF A RECREATIONAL TRAIL SYSTEM OR UTILIZING MCHS-SPRINGFIELD MECHANICAL EQUIPMENT AND MAINTENANCE PERSONNEL TO CLEAN THE LOCAL TRAILS. MCHS-SPRINGFIELD PARTICIPATES IN MANY WAYS AS A REGULAR BUSINESS MEMBER OF THE COMMUNITY. AS SUCH, OFTEN TIMES FINANCIAL CONTRIBUTIONS ARE MADE, FOR EXAMPLE, TO HELP SPONSOR THE DISTRIBUTION OF HEALTH AND SAFETY BOOKS TO SCHOOL CHILDREN OR PERHAPS PARTICIPATE IN A BUSINESS EVENT SUCH AS THE ANNUAL HOME & GARDEN SHOW.MCHS-SPRINGFIELD HAS INVESTED BOTH TIME AND RESOURCES ON EMERGENCY PREPAREDNESS FOR POSSIBLE BIO-TERRORISM IN CONJUNCTION WITH OTHER HOSPITALS AND PUBLIC HEALTH DEPARTMENTS WITHIN THE REGION. PART OF THIS TRAINING IS DONE WITH EMPLOYEES OF THE CITY OF SPRINGFIELD, INCLUDING REGULAR MEETINGS TO ORGANIZE DRILLS, HOLD DRILLS AND REVISE PLANS. COMMUNITY OUTREACH:MCHS-SPRINGFIELD PROVIDES A NUMBER OF SERVICES AND PROGRAMS THROUGHOUT THE YEAR THAT HAVE THE GOAL OF IMPROVING COMMUNITY HEALTH STATUS. THE VAST MAJORITY OF THESE SERVICES AND PROGRAMS ARE PROVIDED FREE OR AT A NOMINAL CHARGE. SOME OF THESE PROGRAMS, SUCH AS THE ANNUAL FUN-RUN/WALK, ARE DONE IN AN ATTEMPT TO ENCOURAGE AREA RESIDENTS TO BEGIN A HABIT OF REGULAR PHYSICAL FITNESS. APPROXIMATELY 100 ATTENDEES PER YEAR PARTICIPATE IN THIS EVENT AND BEGINNING IN 2011 A CHILDREN'S WALK WAS INITIATED FOLLOWING THE FUN/RUN EVENT.MCHS-SPRINGFIELD IS ALSO LOOKING TO PROMOTE SAFETY AS AN IMPORTANT COMPONENT OF PHYSICAL ACTIVITY. FOR MANY YEARS MCHS-SPRINGFIELD HAS CONDUCTED AN ANNUAL BIKE HELMET SAFETY PROGRAM TO APPROPRIATELY SIZE AND SELL APPROXIMATELY 50 BIKE HELMETS AND PROVIDED THESE AT A NOMINAL CHARGE, APPROXIMATELY $8 PER HELMET, UP TO 75% OFF THE RETAIL PRICE. THIS PROGRAM IS WIDELY ADVERTISED PRIOR TO THE EVENT AND MANY MCHS-SPRINGFIELD PERSONNEL PARTICIPATE DURING THE DISTRIBUTION EVENT. ROUTINELY ONE OF THE MOST VISIBLE EXAMPLES OF THIS COMMUNITY OUTREACH IS THE HEALTH FAIR THAT IS HELD EVERY OTHER YEAR DURING NATIONAL HOSPITAL WEEK. IT IS ESTIMATED THAT THE SUBTOTAL OF VARIOUS TYPES OF COMMUNITY OUTREACH ACTIVITIES AMOUNTED TO $21,000 OF EXPENSE DURING 2011.ALL TOTALED, CONSIDERING ACTUAL COSTS OF IN-KIND STAFF EXPENSES AND EXPENSES PAID BY MCHS-SPRINGFIELD, THE COMBINED TOTAL FOR PATIENT CARE, EDUCATION, COMMUNITY BUILDING, AND COMMUNITY OUTREACH WAS AT LEAST $33,000 AND PROBABLY MUCH MORE. MCHS-SPRINGFIELD CONTINUES TO GET BETTER AT TRACKING THIS TYPE OF INFORMATION THAT HISTORICALLY WAS NOT DOCUMENTED BECAUSE THE GOAL WAS TO PROVIDE ASSISTANCE AND SUPPORT WHERE IT WAS NEEDED AND NOT NECESSARILY TAKE CREDIT FOR BEING A GOOD CORPORATE CITIZEN. 14806391 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 1 0 0 0 0 1 1 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 90 1 0 0 0 0 0 0 0 0 0 0 X 8 4 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 MN X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 X CARDAMONE-RAYNER MD MARK 1.00 X 0 444814 40532 GRACE RICHARD W 5.00 X X 0 296178 28627 LOOMIS TUCKER 1.00 X 0 0 0 OLSON KEITH 1.00 X X 0 0 0 PIESCHEL SHARON 1.00 X X 0 0 0 ROSCOE MD BRANDON 40.00 X X 446867 0 35819 SCHMIT-CLINE MD ANNETTE 40.00 X X 340511 0 32414 WELLER PHIL 1.00 X X 0 0 0 KUTCHER MD GREGORY R 5.00 X 0 423800 42574 OVIATT JONATHAN J 1.00 X 0 597819 55898 TARASOVITCH JAMES J 5.00 X 0 230999 25645 THORESON SCOTT 40.00 X 186871 0 38059 BEERS DDS ADAM 40.00 X 189357 0 31404 DAVIS MD THOMAS 40.00 X 318716 0 20556 DHAMI MD RANDEEP 40.00 X 215068 0 25100 HOLMAN MD HERBERT 40.00 X 192384 0 22075 ROSCOE MD NICO D 40.00 X 170379 0 4928 RUPP MD WILLIAM C 1.00 X 0 740718 8205 SCHMITZ DO MICHAEL 40.00 X 147415 0 19011 2207568 2734328 430847 13 1 1 0 MAYO CLINIC HEALTH SYSTEM - MANKATO 1025 MARSH STREET MANKATO MN 56001 PURCHASED SERVICES 1661967 ST JOHN LUTHERAN HOME 201 S COUNTY ROAD 5 SPRINGFIELD MN 56087 PURCHASED SERVICES 234572 HEYMANN CONSTRUCTION COMPANY 210 3RD SOUTH STREET NEW ULM MN 560730606 CONSTRUCTION GENERAL 146449 VISTA STAFFING SOLUTIONS INC 275 EAST 200 SOUTH SALT LAKE CITY UT 84111 LOCUMS 135891 MAYO CLINIC HEALTH SYSTEM - WASECA 501 NORTH STATE STREET WASECA MN 56093 PURCHASED SERVICES 113004 6 32451 13579 3000 49030 NET PATIENT REVENUE 620000 16549462 16549462 EDUCATION REVENUE 611600 8304 8304 RENT FROM AFFILIATES 531120 2100 2100 16559866 110219 110219 1850 0 1850 1850 1850 9925 22572 -12647 -12647 -12647 3557 0 3557 3557 MISC. REVENUE 900099 312084 310844 1240 MEDICAL DIRECTOR FEES 541900 14975 14975 CAFETERIA/VENDING REVE 722210 791 791 59 59 327909 17039784 16871560 0 119194 7713 7713 1080540 855611 224929 556193 556193 5679879 5373107 306772 247124 231143 15981 1040311 997385 42926 426317 398063 28254 228720 228720 2013427 1814525 198902 28542 5575 22967 877029 792043 84986 510000 510000 300855 258425 42430 65799 54641 11158 46127 40244 5883 1160690 1153075 7615 50506 50506 MEDICAL SUPPLIES 1012476 1018745 -6269 BAD DEBT EXPENSE 475638 475638 MN CARE TAX 153430 153430 MEDICAID SURCHARGE 84767 84767 59780 26068 33712 16105863 14806391 1299472 0 350 390 38197 73591 21641 0 2322704 1565969 0 16676 95471 157615 47933 52045 17150319 7570868 10691174 9579451 9310126 12365152 366511 87918 22894107 23898807 841268 887513 561445 585979 1402713 1473492 X 21491394 22182380 0 750 0 242185 21491394 22425315 22894107 23898807 933921 0 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 0 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: MAYO CLINIC HEALTH SYSTEM - MANKATO (MCHS-MANKATO), THE PARENT COMPANY OF THE FILING ORGANIZATION, PROVIDES SUPPORT SERVICES TO THE FILING ORGANIZATION THAT INCLUDES PROVIDING INFORMATION OR EXPRESSING ITS CONCERN TO LEGISLATIVE BODIES AND GOVERNMENT OFFICIALS ON MATTERS DIRECTLY RELATED TO HEALTH, THE DELIVERY OF HEALTH CARE AND MEDICAL EDUCATION AND/OR RESEARCH. IN 2011, MCHS - MANKATO REPRESENTATIVES HAD SEVERAL MEETINGS WITH MEMBERS OF THE LEGISLATIVE AND EXECUTIVE BRANCHES OF GOVERNMENT TO DISCUSS ISSUES RELATING TO HEALTH CARE AND HEALTH CARE REFORM. 0 242185 242185 1.00000 0 1 1 13284 13284 7671556 3216271 4455285 9465479 4354597 5110882 9579451 MAYO POOLED INVESTMENTS 12365152 F 12365152 DUE TO AFFILIATES 498061 DEFERRED COMPENSATION LIABILITY 87918 585979 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR HEALTHCARE IN THE COMMUNITY. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: AT DECEMBER 31, 2011 AND 2010, THERE WAS NO SIGNIFICANT LIABILITY FOR UNRECOGNIZED TAX BENEFITS FOR THE FILING ORGANIZATION. 1 CENTRAL AMERICA AND THE CARIBBEAN 0 0 PROGRAM SERVICE MEDICAL SUPPLIES GIVEN TO SUPPORT ORGANIZATION PROVIDING MEDICAL SERVICES TO THOSE IN NEED. 6809 0 0 0 0 0 0 6809 0 6809 CENTRAL AMERICA AND THE CARIBBEAN SUPPORT TO PROVIDE MEDICAL HELP TO THOSE IN NEED 6809 MEDICAL SUPPLIES COST 1 0 0 0 0 0 0 0 PROCEDURE FOR MONITORING GRANTS OUTSIDE THE U.S.: SCHEDULE F, PART I, LINE 2: THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS THAT ENHANCE THE MISSION OF THE FILING ORGANIZATION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS THAT ADDRESS UNMET OR UNDER-FUNDED NEEDS IN THE AREAS OF HEALTHCARE, EDUCATION, RESEARCH, DIVERSITY AND EQUALITY OF OPPORTUNITY. 1 1 X 1 X 1 X 450.000000000000 1 1 1 0 1 1 28128 28128 0.00180 1575231 993341 581890 0.03720 1603359 993341 610018 0.03900 5985 834 5151 0.00030 7532 7532 0.00050 13517 834 12683 0.00080 1616876 994175 622701 0.03980 20657 20657 0.00130 20657 20657 0.00130 0 475638 5534919 5479264 55655 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM-SPRINGFIELD

625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087

X X X X MAYO CLINIC HEALTH SYSTEM - SPRINGFIELD 1 1 1 100.000000000000 1 450.000000000000 1 X X X X X X 1 1 X X X X X 1 0 1 X 0 0 2 SPRINGFIELD DENTAL CLINIC

602 NORTH JACKSON AVENUE SPRINGFIELD MN 56087

DENTAL CLINIC LAMBERTON CLINIC

310 SOUTH MAIN LAMBERTON MN 56152

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 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 $ 475638. PART II: MCHS-SPRINGFIELD PARTICIPATES IN MANY WAYS AS A REGULAR BUSINESS MEMBER OF THE COMMUNITY. AS SUCH, OFTEN TIMES FINANCIAL CONTRIBUTIONS ARE MADE, FOR EXAMPLE, TO HELP SPONSOR THE DISTRIBUTION OF HEALTH AND SAFETY BOOKS TO SCHOOL CHILDREN OR PERHAPS PARTICIPATE IN A BUSINESS EVENT SUCH AS THE ANNUAL HOME & GARDEN SHOW. PART III, LINE 4: FOOTNOTE FROM MAYO CLINIC 2011 CONSOLIDATED AUDITED FINANCIAL STATEMENTS:ACCOUNTS RECEIVABLE FOR MEDICAL SERVICES - ACCOUNTS RECEIVABLE FOR MEDICAL SERVICES ARE STATED AT NET REALIZABLE VALUE. THE CLINIC ESTIMATES THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED ON HISTORIC WRITE-OFFS AND THE AGING OF THE ACCOUNTS. ACCOUNTS ARE WRITTEN OFF WHEN COLLECTION EFFORTS HAVE BEEN EXHAUSTED.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.MCHS-SPRINGFIELD REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPALS (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 SURPLUS REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT (USING A MEDICARE COST REPORT STEP-DOWN METHODOLOGY).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 CHARITY CARE 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 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 EVERY REASONABLE ATTEMPT 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. 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 - SPRINGFIELD PART V, SECTION B, LINE 13G: 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 - SPRINGFIELD PART V, SECTION B, LINE 19D: 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: ADMINISTRATION, ALONG WITH MEMBERS OF THE MAYO CLINIC HEALTH SYSTEM - SPRINGFIELD BOARD OF DIRECTORS, WORK WITH LOCAL BUSINESSES, COMMUNITY LEADERS, CHARITIES, AND HEALTH DEPARTMENTS TO ASSESS HEALTHCARE NEEDS. PROGRAMS AND SERVICES, MONETARY DONATIONS, EDUCATION, VOLUNTEERS AND GOODS ARE SUPPLIED ONCE THOSE NEEDS ARE ASSESSED. REQUESTS FOR ASSISTANCE ARE REVIEWED AND EVALUATED BY ADMINISTRATION AND THE MAYO CLINIC HEALTH SYSTEM - SPRINGFIELD BOARD OF DIRECTORS. PART VI, LINE 3: MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY:MAYO CLINIC IS COMMITTED TO OFFERING FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY FOR THEIR MEDICAL SERVICES IN WHOLE OR IN PART. IN ORDER TO ACCOMPLISH THIS CHARITABLE GOAL, MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM SITES WILL WIDELY PUBLICIZE THIS POLICY IN THE COMMUNITIES THAT THE INDIVIDUAL MAYO CLINIC AFFILIATED SITES SERVE. MAYO CLINIC AFFILIATED SITES WILL MAKE A COPY 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 - SPRINGFIELD (MCHS-SPRINGFIELD)IS LOCATED IN SPRINGFIELD, MINNESOTA. ITS SERVICE AREA INCLUDES BROWN COUNTY AND PORTIONS OF REDWOOD, WATONWAN, AND COTTONWOOD COUNTIES IN SOUTHWESTERN MINNESOTA. MCHS-SPRINGFIELD IS A DESIGNATED CRITICAL ACCESS HOSPITAL FOR MEDICARE PURPOSES AND IS ONE OF THREE HOSPITALS IN BROWN COUNTY. THE POPULATION OF BROWN COUNTY (WHICH COMPRISES MOST OF MCHS-SPRINGFIELD'S SERVICE AREA) IS APPROXIMATELY 26,000. ACCORDING TO 2008 CENSUS DATA, APPROXIMATELY 9% OF BROWN COUNTY INDIVIDUALS ARE LIVING BELOW THE POVERTY LEVEL. APPROXIMATELY 6% OF THE POPULATION IS UNINSURED. IN ADDITION, APPROXIMATELY 19% OF THE INDIVIDUALS LIVING IN BROWN COUNTY ARE OVER AGE 65. 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.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 V. CLOSED STAFF MODEL:STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.EMERGENCY ROOM: THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. PART VI, LINE 6: THIS ORGANIZATION IS A PART OF MAYO CLINIC HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO CLINIC HEALTH SYSTEM IS DESCRIBED IN RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). THAT STATEMENT ALSO DESCRIBES THE ROLES OF THE VARIOUS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED PART VI LINE 7: NEITHER THE FILING ORGANIZATION, NOR ANY RELATED ORGANIZATION, FILES A COMMUNITY BENEFIT REPORT WITH ANY STATE OTHER THAN THE EXTENT TO WHICH COMMUNITY BENEFIT INFORMATION IS INCLUDED IN OTHER REPORTING REQUIREMENTS SUCH AS INFORMATION PROVIDED ON THE MINNESOTA HOSPITAL ANNUAL REPORT OR TO THE WISCONSIN HOSPITAL ASSOCIATION. 1 FRIENDS OF BATAHOLA PO BOX 54821 CINCINNATI OH 45254 721513873 501(C)(3) 6809 COST MEDICAL SUPPLIES MEDICAL SUPPLIES TO HELP THOSE IN NEED IN A FOREIGN COUNTRY 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS THAT ENHANCE THE MISSION OF THE FILING ORGANIZATION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS THAT ADDRESS UNMET OR UNDER-FUNDED NEEDS IN THE AREAS OF HEALTHCARE, EDUCATION, RESEARCH, DIVERSITY AND EQUALITY OF OPPORTUNITY. 0 1 0 0 0 0 0 0 0 CARDAMONE-RAYNER MD MARK 0 444814 0 0 0 0 0 12250 0 28282 0 485346 0 0 GRACE RICHARD W 0 263178 0 33000 0 0 0 12250 0 16377 0 324805 0 0 ROSCOE MD BRANDON 436867 0 0 0 10000 0 9800 0 26019 0 482686 0 0 0 SCHMIT-CLINE MD ANNETTE 340511 0 0 0 0 0 12250 0 20164 0 372925 0 0 0 KUTCHER MD GREGORY R 0 363800 0 60000 0 0 0 12250 0 30324 0 466374 0 0 OVIATT JONATHAN J 0 474858 0 0 0 122961 0 32930 0 22968 0 653717 0 115199 TARASOVITCH JAMES J 0 230999 0 0 0 0 0 9316 0 16329 0 256644 0 0 THORESON SCOTT 186871 0 0 0 0 0 9788 0 28271 0 224930 0 0 0 BEERS DDS ADAM 189357 0 0 0 0 0 7779 0 23625 0 220761 0 0 0 DAVIS MD THOMAS 318716 0 0 0 0 0 9800 0 10756 0 339272 0 0 0 DHAMI MD RANDEEP 215068 0 0 0 0 0 10778 0 14322 0 240168 0 0 0 HOLMAN MD HERBERT 192384 0 0 0 0 0 9592 0 12483 0 214459 0 0 0 ROSCOE MD NICO D 160379 0 0 0 10000 0 4928 0 0 0 175307 0 0 0 RUPP MD WILLIAM C 0 720745 0 0 0 19973 0 117 0 8088 0 748923 0 0 SCHMITZ DO MICHAEL 147415 0 0 0 0 0 6940 0 12071 0 166426 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). A PORTION OF THE AMOUNT MAY BE INCLUDED IN SCHEDULE J, PART II, COLUMN (F) IF DISCLOSED ON A PRIOR YEAR'S FORM 990. JONATHAN OVIATT $115,199 SUPPLEMENTAL INFORMATION PART III COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. 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. BRANDON ROSCOE MD RECRUITMENT X 30000 6676 0 1 1 NICO ROSCOE MD RECRUITMENT X 30000 10000 0 1 1 16676 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: MARK CARDAMONE-RAYNER, M.D. RICHARD GRACE GREGORY KUTCHER, M.D. JAMES TARASOVITCH RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: RICHARD GRACE GREGORY KUTCHER M.D. SHARON PIESCHEL JAMES TARASOVITCH RICHARD GRACE IS EMPLOYED BY A RELATED ORGANIZATION RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: JONATHAN OVIATT WILLIAM RUPP, M.D. BOARD MEMBERS TUCKER LOOMIS AND SHARON PIESCHEL HAVE A BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 3 MAYO-AFFILIATED ENTITIES ROUTINELY DELEGATED VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO RELATED ENTITIES. FORM 990, PART VI, SECTION A, LINE 4 THE FILING ORGANIZATION CHANGED ITS GOVERNING DOCUMENTS IN 2011 TO REFLECT A NAME CHANGE. THIS NAME CHANGE WAS PREVIOUSLY COMMUNICATED TO AND APPROVED BY THE IRS DURING THE TAX YEAR. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS MAYO CLINIC HEALTH SYSTEM - MANKATO. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER ELECTS THE MEMBER DIRECTORS. THE OTHER DIRECTORS ARE ELECTED BY THE MEMBER FROM NOMINEES APPROVED BY THE BOARD OF DIRECTORS. 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, AND DEBT, AMENDMENT OF THE ARTICLES AND BYLAWS, AND GENERAL OPERATION DECISIONS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE VICE PRESIDENT OF FINANCE, THE CFO AND THE ADMINISTRATOR. THE VICE PRESIDENT OF FINANCE, CFO AND/OR ADMINISTRATOR PRESENT HIGHLIGHTS OF THE 990 TO THE REGIONAL FINANCE COMMITTEE AND SITE BOARD PRIOR TO THE FILING OF THE RETURNS. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. HIGHLIGHTS ARE PRESENTED TO BOARD MEMBERS, AND THE REVIEW IS DOCUMENTED IN MEETING MINUTES. 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 SALARY OF THE CEO AND CAO WERE REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO CLINIC HEALTH SYSTEM PHYSICIANS. THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE MAYO CLINIC HEALTH SYSTEM ENTITIES. THE COMMITTEE IS COMPRISED OF MAYO EMPLOYEES, BUT IS INDEPENDENT FOR INTERNAL REVENUE CODE 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED (WITH RECUSAL WHERE APPROPRIATE). THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE THEN REVIEWS AND APPROVES THE COMPENSATION. FOR THOSE INDIVIDUALS FOR WHICH THE MAYO CLINIC HEALTH SYSTEM COMMITTEE CAN NOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE COMPENSATION AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. INFORMATION ON MAYO CLINIC HEALTH SYSTEM PHYSICIAN AND ADMINISTRATIVE LEADERSHIP COMPENSATION AND BENEFITS IS ALSO REVIEWED BY THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION AND GOVERNANCE (GOVERNANCE COMMITTEE), WHICH IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. IN ADDITION TO THE ABOVE REVIEWS, THE COMPENSATION COMMITTEE OF THE SOUTHWEST MINNESOTA REGION IS CHARGED WITH THE RESPONSIBILITY TO RECOMMEND TO THE SOUTHWEST MINNESOTA REGION BOARD OF DIRECTORS ON AN ANNUAL BASIS THE APPROPRIATE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AND CHIEF ADMINISTRATIVE OFFICER AND TOTAL COMPENSATION STRATEGY FOR THE ORGANIZATION. THE COMPENSATION COMMITTEE IS CREATED BY A BOARD RESOLUTION. CORE PURPOSE: A. REVIEW AND RECOMMEND TO THE BOARD THE TOTAL COMPENSATION STRATEGY OF THE SOUTHWEST MINNESOTA REGION, CONSISTENT WITH THE ORGANIZATION'S MISSION AND VALUES. B. REVIEW AND RECOMMEND TO THE BOARD THE TOTAL COMPENSATION PROPOSALS TO ENSURE SUPPORT OF ORGANIZATIONAL STRATEGY. C. REVIEW COMPENSATION AND BENEFITS DATA IN CONJUNCTION WITH MAYO CLINIC SHARED SERVICES GOALS IN MAKING RECOMMENDATIONS TO THE BOARD FOR TOTAL COMPENSATION PLANS. D. REVIEW AND RECOMMEND TO THE BOARD FOR APPROVAL EXECUTIVE COMPENSATION INCLUDING INCENTIVE PLANS FOR THE CHIEF EXECUTIVE OFFICER AND CHIEF ADMINISTRATIVE OFFICER. E. REVIEW AND RECOMMEND TO THE BOARD ORGANIZATIONAL SEVERANCE GUIDELINES. F. MANAGEMENT MEMBERS OF THE COMMITTEE MAY NOT VOTE ON ACTIONS RELATED DIRECTLY TO MANAGEMENT COMPENSATION. G. ANNUALLY REVIEW THE PHYSICIAN COMPENSATION STRATEGY AND ITS EFFECTIVENESS. RECOMMEND TO THE BOARD THE STRATEGIES AND GUIDELINES FOR MERIT PAY, INCENTIVES, SEVERANCE PAY, CONTRACTUAL RELATIONSHIPS AND OTHER UNUSUAL COMPENSATION ARRANGEMENTS THAT MAY ARISE. H. PERFORM ANY OTHER DUTIES AND RESPONSIBILITIES AS THE BOARD MAY DEEM NECESSARY, ADVISABLE OR APPROPRIATE FOR THE COMMITTEE TO PERFORM. I. ANNUALLY REVIEW THE COMPENSATION COMMITTEE CHARTER AND RECOMMEND CHANGES TO THE BOARD. 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. AVERAGE HOURS PER WEEK DEVOTED TO POSITION WITH RELATED ORGANIZATION PART VII SECTION A MARK CARDAMONE-RAYNER, M.D. 40 HOURS RICHARD GRACE 35 HOURS GREGORY KUTCHER, M.D. 35 HOURS JONATHAN OVIATT 40 HOURS WILLIAM RUPP, M.D. 40 HOURS JAMES TARASOVITCH 35 HOURS BLOOMER LAKEVIEW INC 2110 DUNCAN ROAD BLOOMER WI 54724 391450617 LOW INCOME HOUSING WI 501(C)(3) 7 MAYO CLINIC HEALTH SYSTEM--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 FOUNTAIN LAKE TREATMENT CENTER 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 411404076 CHEMICAL DEPENDENCY TREATMENT MN 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--ALBERT LEA 1 FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC 464 SOUTH JOHNSON STREET ARCADIA WI 54612 391322480 FUNDRAISING FOUNDATION WI 501(C)(3) 9 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC 1 GCAS 200 FIRST STREET SW ROCHESTER MN 55905 411917517 AMBULANCE SERVICE MN 501(C)(3) 9 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 1 GOLD CROSS AMBULANCE SERVICE 200 FIRST STREET SW ROCHESTER MN 55905 411917516 AMBULANCE SERVICE MN 501(C)(3) 9 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 1 GOLD CROSS AMBULANCE INC 200 FIRST STREET SW ROCHESTER MN 55905 391942957 AMBULANCE SERVICE MN 501(C)(3) 9 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 1 LUTHER LAKESIDE APARTMENTS INC 714 SOUTH BARSTOW STREET EAU CLAIRE WI 54701 391409024 LOW INCOME HOUSING WI 501(C)(3) 9 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 416011702 PATIENT CARE - CLINIC MN 501(C)(3) 9 MAYO CLINIC 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 BLVD 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--ALBERT LEA 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC 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) PF MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391186647 FUNDRAISING FOUNDATION WI 501(C)(3) 11-II MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE 301 SECOND STREET NORTHEAST NEW PRAGUE MN 56071 410723639 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC 1222 EAST WOODLAND AVE BARRON WI 54812 390920634 HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC PO BOX 70 / 13025 EIGHTH STREET OSSEO WI 54758 391029430 HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--OWATONNA 134 SOUTHVIEW 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--SPRINGFIELD 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 411893827 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 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) 11-I MAYO CLINIC -- SAINT MARYS HOSPITAL 1 SOUTHERN METRO MEDICAL CLINICS INC 301 MAIN STREET NEW PRAGUE MN 56071 411623632 FAMILY PRACTICE CLINICS MN 501(C)(3) 9 MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE 1 FRANKLIN HEATING STATION 119 THIRD ST SW ROCHESTER MN 55902 410264830 UTILITY MN N/A MAYO CLINIC HEALTH SYSTEM--FARIBAULT 635 FIRST STREET SE FARIBAULT MN 55021 411817179 PATIENT CARE - CLINIC MN N/A C MAYO CLINIC HEALTH SYSTEM--DECORAH CLINIC PHYSICIANS 907 MONTGOMERY STREET DECORAH IA 52101 411711329 PATIENT CARE - CLINIC IA N/A C FIOS THERAPEUTICS INC 200 FIRST STREET SW ROCHESTER MN 55905 711029189 RESEARCH MN N/A C HEALTH TRADITION HEALTH PLAN 1808 EAST MAIN STREET ONALASKA WI 54650 391545987 MEDICAL SERVICES COMPANY WI N/A C LOBSS NETWORK SUPPORT 2002 INC 200 FIRST STREET SW ROCHESTER MN 55905 481276150 ADMINISTRATIVE SERVICES MN N/A C MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 411346366 REFERENCE LAB SERVICES MN N/A C MAYO HOLDING COMPANY 200 FIRST STREET SW ROCHESTER MN 55905 411578020 HOLDING COMPANY MN N/A C MAYO INSURANCE COMPANY LTD 200 FIRST STREET SW ROCHESTER MN 55905 SELF INSURANCE POOL CJ N/A C MAYO MEDICAL LABORATORIES NEW ENGLAND INC 265 BALLARDVALE STREET WILMINGTON MA 01887 043323713 LABORATORY SERVICES MA N/A C MAYO REGIONAL PRACTICES OF ARIZONA 13400 EAST SHEA BOULEVARD SCOTTSDALE AZ 85259 061190278 THIRD PARTY ADMINISTRATION SERVICES AZ N/A C MHS SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 411282517 EQUIPMENT & REAL ESTATE LEASING MN N/A C MMSI INC 21 FIRST STREET SW ROCHESTER MN 55905 411547003 THIRD PARTY ADMINISTRATION SERVICES MN N/A C MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 391528920 PHARMACY SERVICES WI N/A C PHYSICIAN AND HOSPITAL PRACTICES INC 4500 SAN PABLO ROAD JACKSONVILLE FL 32224 930926631 HEALTH SERVICES FL N/A C ROCHESTER AIRPORT COMPANY ROUTE 2 ROCHESTER MN 55902 410506870 AIRPORT MANAGEMENT MN N/A C SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION 13400 E SHEA BLVD SCOTTSDALE AZ 85259 860870505 COMMERCIAL PROPERTY OWNERS ASSOCIATION AZ N/A C THE STABILE BUILDING OWNERS' ASSOCIATION 200 FIRST STREET SW ROCHESTER MN 55905 208994499 COMMERCIAL PROPERTY OWNERS ASSOCIATION MN N/A C MAYO CLINIC GBS MAURITIUS 2ND FLOOR EBENE MEWS 57 EBENE CYBERCITY MP HEALTHCARE MANAGEMENT MP N/A C CHARITABLE LEAD TRUST (1) CHARITABLE TRUST CA N/A T PERPETUAL TRUST (1) CHARITABLE TRUST ND N/A T PERPETUAL TRUST (1) CHARITABLE TRUST LA N/A T PERPETUAL TRUST (2) CHARITABLE TRUST MA N/A T PERPETUAL TRUST (1) CHARITABLE TRUST MO N/A T PERPETUAL TRUST (1) CHARITABLE TRUST AZ N/A T CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST CO N/A T CHARITABLE REMAINDER TRUST (6) CHARITABLE TRUST FL N/A T CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST FL N/A T CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST IL N/A T CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST LA N/A T CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST MI N/A T CHARITABLE REMAINDER TRUST (66) CHARITABLE TRUST MN N/A T CHARITABLE REMAINDER TRUST (82) CHARITABLE TRUST MN N/A T CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST NC N/A T CHARITABLE REMAINDER TRUST (2) CHARITABLE TRUST TX N/A T 0 0 1 0 0 0 0 0 1 0 0 1 0 0 1 0 0 1 MMSI INC R 703068 GAAP MAYO CLINIC HEALTH SYSTEM - WASECA L 113004 GAAP