2012-06-08T13:34:53-05:00 2011-12-31 990 2011-01-01 391411999 MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE INC MAYO 5075381297 700 WEST AVENUE SOUTH LA CROSSE WI 54601 Thomas Tiggelaar 5075381297 2012-06-08 2011 2016-02-24 21:20:13Z FKA FRANCISCAN SKEMP HEALTHCARE INC TIMOTHY J JOHNSON MD 700 WEST AVENUE SOUTH LA CROSSE WI 54601 640800 0 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1982 WI PROVIDE SUPPORT TO ENTITIES WITHIN THE ORGANIZATION. 14 5 0 6 0 0 7994 6748 335038 634052 908012 0 0 0 1251044 640800 1903120 98565 0 0 3429055 4482419 0 0 0 2672552 1034748 8004727 5615732 -6753683 -4974932 38075014 3194075 49689933 19788336 -11614919 -16594261 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 634052 SEE SCHEDULE OMAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE, INC. IS A MEMBER OF THE MAYO CLINIC HEALTH SYSTEM. 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 ASSOCIATIONS 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. 98565 98565 ORIGINALLY ORGANIZED IN 1982, MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE, INC.'S PRIMARY PURPOSE IS TO PROVIDE COORDINATION, PLANNING, DEVELOPMENT, RESOURCE ALLOCATION AND OTHER ADMINISTRATIVE AND SUPPORT SERVICES TO VARIOUS SUBSIDIARIES AND AFFILIATES WITHIN THE REGIONAL HEALTH CARE DELIVERY SYSTEM. IN 2011, MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE, INC. PROVIDED FINANCIAL SUPPORT TO VARIOUS LOCAL NONPROFIT ORGANIZATIONS BY PROVIDING GRANTS AND SCHOLARSHIPS IN THE AMOUNT OF $98,565. 98565 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 131 0 1 0 0 0 0 0 0 0 0 0 0 0 X 14 5 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 X CORPORATE TAX UNIT 5075381297 200 FIRST ST SW ROCHESTER MN 55905 X ALBRIGHT DO ROBERT 1.00 X 0 253715 39054 CHAMBERLAIN MARK 1.00 X X 0 0 0 HOLMES MD DAVID 1.00 X 0 486684 17504 JOHANSEN MD KEITH L 1.00 X 0 280864 46446 JOHNSON MD TIMOTHY J 1.00 X X 0 389738 16308 KORDUCKI MD JANE 1.00 X 0 214997 19227 KRIEN MD JOSEPH S 1.00 X 0 294427 20423 KUTT SISTER DAWN 1.00 X 0 0 0 LARSON MD DAVID E 1.00 X 0 237369 1462 NIELAND SISTER IRENE 1.00 X 0 0 0 O'BRIEN MD MICHAEL 1.00 X 0 262609 19768 PIERCE FATHER MARK 1.00 X 0 0 0 SLEIK THOMAS 1.00 X 0 0 0 WEISENBECK SISTER MARLENE 1.00 X X 0 0 0 WHITED MD BRIAN L 1.00 X 0 320018 37675 PACZKOWSKI RONALD R 1.00 X 0 285273 16805 TIGGELAAR THOMAS H 1.00 X 0 219530 16080 NESSE MD ROBERT E 1.00 X 0 750263 15004 0 3995487 265756 0 1 1 0 FOWLER & HAMMER INC 157 SUMMER STREET LACROSSE WI 54603 CONSTRUCTION SERVICES 4706176 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 ADMINISTRATIVE SERVICES 3420269 REMEDY MEDICAL SERVICES SC 3587 GATEWAY DRIVE EAU CLAIRE WI 54701 MEDICAL SERVICES 2004342 MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 LAB SERVICES 1257415 SIEMENS MEDICAL SOLUTIONS PO BOX 75571 CHARLOTTE NC 28275 MEDICAL SERVICES 1019401 177 6698 50 6748 SHARED SERVICES REVENU 561000 634052 634052 634052 640800 634052 0 0 98565 98565 3602708 3602708 717824 717824 161887 161887 4900 4900 11286 11286 140000 140000 6062 6062 298199 298199 21530 21530 243456 243456 36364 36364 203617 203617 532 532 1002 1002 26022 26022 DUES, LICENSES AND SUBS 41778 41778 5615732 98565 5517167 0 26553 0 186844 143543 1226612 1300730 102332 96952 6382 5380 20548894 16079729 1744422 38075014 3194075 6574734 2840376 1138422 1046160 41976777 15901800 49689933 19788336 X -11614919 -16594261 -11614919 -16594261 38075014 3194075 X -4974932 -4410 X 0 1 1 X 0 X X X 0 0 0 MAYO CLINC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER INC 390806374 3 1 1 1 98565 FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC 391322480 9 1 0 1 0 FRANCISCAN HEALTHCARE FOUNDATION-SPARTA 391423234 9 1 0 1 0 MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE FOUNDATION INC 391186647 7 1 0 1 0 4 98565 Schedule A, Part IV, Supplemental Information: SCHEDULE A, PART I, LINE 11H (VIII) MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE INC., IN SUPPORT OF THE PROGRAMS AND PURPOSES OF MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC., PROVIDED GRANTS TO THE LACROSSE MEDICAL HEALTH SCIENCE CONSORTIUM TO SUPPORT REGIONAL HEALTHCARE INITIATIVES, THE LACROSSE COMMUNITY THEATRE AND THE MYRICK HIXON ECOPARK WHICH IS AN INDEPENDENT, NON-PROFIT ORGANIZATION THAT HAS EDUCATED MORE THAN 120,000 CHILDREN WITH PROGRAMS THAT ARE DESIGNED TO ENHANCE LEARNING THROUGH HANDS-ON, EXPERIENTIAL INQUIRY AND PLAY BASED EDUCATION. IN ADDITION, FRANCISCAN HEALTHCARE PROVIDES MANAGEMENT, ADMINISTRATIVE AND PURCHASING SERVICES FOR THE BENEFIT OF ITS SUPPORTING ORGANIZATIONS, FRANCISCAN MEDICAL CENTER AND THE RELATED FOUNDATIONS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 102332 96952 5380 5380 DUE FROM AFFILIATES 144422 INVESTMENT IN LACROSSE HEALTH SCIENCE CONSORTIUM 1600000 1744422 DUE TO AFFILIATES 15901800 15901800 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 LACROSSE MEDICAL HEALTH SCIENCE CONSORTIUM INC 1725 STATE STREET MAIN HALL 105 LACROSSE WI 54601 391804725 501(c)(3) 50000 SUPPORT OF REGIONAL HEALTHCARE INITIATIVES LACROSSE COMMUNITY THEATRE 118 5TH AVENUE NORTH LACROSSE WI 54601 391035843 501(c)(3) 35916 SUPPORT OF COMMUNITY NON-PROFIT THEATRE MYRICK HIXON ECOPARK INC 789 MYRICK PARK DRIVE LACROSSE WI 54601 391476960 501(c)(3) 10000 SUPPORT OF COMMUNITY NON-PROFIT PARK 3 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY WITH PROGRAMS THAT ENHANCE THE MISSION OF THE FILING ORGANIZATION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY THAT ADDRESS UNMET OR UNDER-FUNDED COMMUNITY NEEDS IN THE AREAS OF HEALTHCARE, EDUCATION, RESEARCH, DIVERSITY AND EQUALITY OF OPPORTUNITY. ALL GRANTS ISSUED MUST MEET THE GUIDELINES OF THE FRANCISCAN HEALTHCARE FOUNDATION'S GRANT ALLOCATION POLICY. ALL SUCCESSFUL GRANT APPLICANTS WILL RECEIVE A GRANT EVALUATION FORM APPROXIMATELY SIX MONTHS AFTER FUNDS ARE ALLOCATED BY THE FOUNDATION. INPUT RECEIVED THROUGH THE EVALUATION PROCESS WILL BE USED TO ASSESS THE EFFECTIVENESS OF THE FOUNDATION'S GRANT-MAKING PROGRAM. THE FOUNDATION'S GRANT ALLOCATIONS PROGRAM OPERATES IN CONFORMANCE WITH FEDERAL, STATE, AND OTHER LEGAL REQUIREMENTS, AND IN ACCORD WITH THE ORGANIZATION'S ARTICLES OF INCORPORATION. AT NO TIME WILL THE FOUNDATION AWARD OR DISTRIBUTE FUNDS IN A MANNER THAT WOULD JEOPARDIZE THE ORGANIZATION'S NOT-FOR-PROFIT STATUS, OR UTILIZE FUNDS IN A MANNER INCONSISTENT WITH BENEFACTOR INTENT. 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 ALBRIGHT DO ROBERT 0 252820 0 0 0 895 0 19026 0 20028 0 292769 0 0 HOLMES MD DAVID 0 467102 0 5000 0 14582 0 0 0 17504 0 504188 0 0 JOHANSEN MD KEITH L 0 249414 0 2250 0 29200 0 29442 0 17004 0 327310 0 26236 JOHNSON MD TIMOTHY J 0 389568 0 0 0 170 0 0 0 16308 0 406046 0 0 KORDUCKI MD JANE 0 214714 0 0 0 283 0 0 0 19227 0 234224 0 0 KRIEN MD JOSEPH S 0 280071 0 0 0 14356 0 0 0 20423 0 314850 0 13457 LARSON MD DAVID E 0 226160 0 0 0 11209 0 0 0 1462 0 238831 0 0 O'BRIEN MD MICHAEL 0 262300 0 0 0 309 0 0 0 19768 0 282377 0 230 WHITED MD BRIAN L 0 320018 0 0 0 0 0 12250 0 25425 0 357693 0 0 PACZKOWSKI RONALD R 0 285030 0 0 0 243 0 0 0 16805 0 302078 0 0 TIGGELAAR THOMAS H 0 219167 0 0 0 363 0 0 0 16080 0 235610 0 0 NESSE MD ROBERT E 0 546068 0 0 0 204195 0 0 0 15004 0 765267 0 193896 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 YEARS FORM 990. KEITH L. JOHANSEN M.D. $26,236 JOSEPH S. KRIEN M.D. $13,457 ROBERT E. NESSE M.D. $193,896 MICHAEL O'BRIEN M.D. $230 Supplemental Information Part III THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE THE DISCLOSURE ON SCHEDULE O FOR THE CORE 990 PART VI SECTION B LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED. COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. HEALTH TRADITION HEALTH PLAN TAXABLE AFFILIATE WITH BOARD OVERLAP 145957 MANAGEMENT FEE 0 Form 990, Part VI, Section A, line 2 DUE TO OVERLAP OF MAYO CLINIC BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUAL: NESSE M.D., ROBERT E. HAS A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: ALBRIGHT D.O., ROBERT HOLMES M.D., DAVID JOHANSEN M.D., KEITH L LARSON M.D., DAVID E DUE TO OVERLAP OF MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC. BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUALS: JOHNSON M.D., TIMOTHY J. KORDUCKI M.D., JANE M. KRIEN M.D., JOSEPH S. LARSON M.D., DAVID E. NESSE M.D., ROBERT E. PACZKOWSKI, RONALD R. TIGGELAAR, THOMAS H. HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: JOHNSON M.D., TIMOTHY J. KORDUCKI M.D., JANE M. KRIEN M.D., JOSEPH S. O'BRIEN M.D., MICHAEL PACZKOWSKI, RONALD R. TIGGELAAR, THOMAS H. DUE TO OVERLAP OF MAYO CLINIC HEALTH SYSTEM-MANKATO BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUAL: NESSE M.D., ROBERT E. HAS A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL: WHITED M.D., BRIAN L. DUE TO OVERLAP OF HEALTH TRADITION HEALTH PLAN BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUALS: JOHNSON M.D., TIMOTHY J. TIGGELAAR, THOMAS H. WHITED M.D., BRIAN L. HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: JOHNSON M.D., TIMOTHY J. TIGGELAAR, THOMAS H. WHITED M.D., BRIAN L. 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 THERE ARE TWO MEMBERS OF THE CORPORATION, MAYO CLINIC AND THE CONGREGATION OF SISTERS OF THE THIRD ORDER OF SAINT FRANCIS OF PERPETUAL ADORATION. Form 990, Part VI, Section A, line 7a MEMBERS SHALL MAKE APPOINTMENTS TO THE BOARD OF DIRECTORS Form 990, Part VI, Section A, line 7b BOTH MEMBERS RETAIN CERTAIN RESERVED POWERS EITHER SOLELY, OR REQUIRING UNANIMOUS APPROVAL OF BOTH MEMBERS. THE AREAS COVERED BY THESE RESERVED POWERS INCLUDE MISSION, VISION, AND VALUES, AMENDMENT OF GOVERNING DOCUMENTS, COMPENSATION, AND INCURRENCE OF DEBT. CERTAIN ACTIONS ARE SUBJECT TO EXCLUSIVE CONTROL OF THE CLASS A MEMBER. CERTAIN ACTIONS ARE SUBJECT TO EXCLUSIVE CONTROL OF THE CLASS B MEMBER. 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 FILING ORGANIZATION'S 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 THE MAYO CLINIC (AND/OR AFFILIATE) AND THE OUTSIDE ENTITY. ADDITIONAL CONFLICT OF INTEREST POLICIES AND PROCEDURES EXIST FOR CERTAIN ENTITIES CONCERNING RESEARCH CONTRACTS AND OTHER TYPES OF POTENTIAL CONFLICTS. FORM 990, PART VI, SECTION B, LINES 15A-B: 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 YEARS COMPENSATION. THE SALARIES OF THE CEO, THE CAO, AND SEVERAL BOARD MEMBERS WERE REVIEWED BY THE MAYO HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO HEALTH SYSTEM PHYSICIAN AND ADMINSTRATIVE 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 ORGANIZATIONS GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC, THE FORM 990 AND THE FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST AND ALSO ON THE MAYOCLINIC.ORG WEBSITE. FORM 990 PART VII SECTION A AVERAGE HOURS PER WEEK DEVOTED TO POSITION WITH RELATED ORGANIZATION: ROBERT C. ALBRIGHT, D.O. 40.0 DAVID HOLMES, M.D. 40.0 KEITH L. JOHANSEN, M.D. 40.0 TIMOTHY J. JOHNSON M.D. 40.0 JANE KORDUCKI, M.D. 40.0 JOSEPH S. KRIEN, M.D. 40.0 DAVID E. LARSON, M.D. 40.0 ROBERT E. NESSE, M.D. 40.0 MICHAEL O'BRIEN, M.D. 40.0 RONALD R. PACZKOWSKI 40.0 THOMAS H. TIGGELAAR 40.0 BRIAN L. WHITED M.D. 40.0 Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -4,410. 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 MU HEALTHCARE MANAGEMENT MU 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 1 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 HEALTH TRADITION HEALTH PLAN K 145957 GAAP MAYO CLINIC HEALTH SYSTEM--DECORAH CLINIC PHYSICIANS K 92799 GAAP MAYO CLINIC HEALTH SYSTEM--FRANCISCAN MEDICAL CENTER INC O 4514762 GAAP HEALTH TRADITION HEALTH PLAN Q 25752984 GAAP MAYO CLINIC HEALTH SYSTEM--FRANCISCAN MEDICAL CENTER INC R 27864118 GAAP MAYO COLLABORATIVE SERVICES INC Q 1257415 GAAP MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH K 67689 GAAP