2011-07-08T08:08:49-05:00 2010-12-31 990 2010-01-01 391411999 MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE INC MAYO 5075381297 700 WEST AVENUE SOUTH LA CROSSE WI 54601 Thomas Tiggelaar 5075381297 2011-06-07 2010 2016-02-24 21:20:13Z FKA FRANCISCAN SKEMP HEALTHCARE INC THOMAS TIGGELAAR 700 WEST AVENUE SOUTH LA CROSSE WI 54601 1251044 0 X WWW.MAYOHEALTHSYSTEM.ORG X 1982 WI PROVIDE SUPPORT TO ENTITIES WITHIN THE ORGANIZATION. 15 6 0 0 0 0 428456 7994 279534 335038 972492 908012 0 0 1680482 1251044 77230 1903120 0 0 2908640 3429055 0 0 0 3789522 2672552 6775392 8004727 -5094910 -6753683 37588320 38075014 42463783 49689933 -4875463 -11614919 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 1850000 1850000 335038 SEE SCHEDULE OFRANCISCAN SKEMP HEALTHCARE, INC. IS A MEMBER OF THE MAYO HEALTH SYSTEM. IN 2010, FRANCISCAN SKEMP HEALTHCARE, INC. PROVIDED A CAPITAL CONTRIBUTION TO MAYO CLINIC IN THE AMOUNT OF $1,850,000.MAYO 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 HEALTH SYSTEM OFFERS OUTSTANDING CARE CLOSE TO HOME. PHYSICIANS AND STAFF IN MAYO HEALTH SYSTEM HAVE READY ACCESS TO THE KNOWLEDGE, RESOURCES, AND EXPERTISE OF MAYO CLINIC, YET CAN MEET PATIENTS' HEALTH CARE NEEDS LOCALLY. MAYO HEALTH SYSTEM IS PART OF THE COMMUNITY, FOCUSED ON IMPROVING THE HEALTH OF THE COMMUNITIES IN WHICH WE LIVE AND WORK. MAYO HEALTH SYSTEM TEAMS WITH MAYO CLINIC TO DELIVER UNPARALLELED HEALTH CARE TO COMMUNITIES THROUGH AN INTEGRATED NETWORK OF CLINICS AND HOSPITALS.MAYO HEALTH SYSTEM SITES EMPLOY APPROXIMATELY 800 PHYSICIANS AND 13,000 ALLIED HEALTH STAFF. IN ADDITION, MAYO CLINIC PHYSICIANS FROM MULTIPLE SPECIALTIES REGULARLY SEE PATIENTS AT THE MAYO HEALTH SYSTEM FACILITIES. BESIDES HAVING HEALTH CARE FACILITIES IN 70 COMMUNITIES, THE SYSTEM INCLUDES 17 OWNED HOSPITALS, SEVEN OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH THREE ADDITIONAL HOSPITALS, AND CONTRACT MANAGEMENT AGREEMENTS WITH TWO ADDITIONAL HOSPITALS AND ONE NURSING HOME. SINCE ITS INCEPTION IN 1992, MAYO HEALTH SYSTEM HAS GROWN FROM A NEW IDEA TO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN AMERICA. MAYO 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 HEALTH SYSTEM THREE TIMES FOR ITS PERFORMANCE EXCELLENCE EFFORTS. INDIVIDUAL MAYO 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 HEALTH SYSTEM AND MAYO CLINIC PARTNER TO ENSURE HEALTHIER LIVES IN THE REGION. 53120 53120 IN 2010, FRANCISCAN SKEMP HEALTHCARE PROVIDED FINANCIAL SUPPORT TO VARIOUS LOCAL NONPROFIT ORGANIZATIONS. 1903120 1 1 0 0 0 0 0 0 0 0 1 1 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 1 149 0 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 6 1 1 0 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 262381 38024 CHAMBERLAIN MARK 1.00 X X 0 0 0 HOLMES MD DAVID 1.00 X 0 2258997 21476 JOHANSEN MD KEITH L 1.00 X 0 455392 76259 JOHNSON MD TIMOTHY J 1.00 X X 0 338141 24454 KRIEN MD JOSEPH S 1.00 X 0 271764 51005 KUTT SISTER DAWN 1.00 X 0 0 0 LARSON MD DAVID E 1.00 X 0 2161119 16172 LOHR MD ROBERT H 1.00 X 0 233188 58548 NESSE MD ROBERT E 1.00 X X 0 1569297 211744 NIELAND SISTER IRENE 1.00 X 0 0 0 O'BRIEN MD MICHAEL 1.00 X 0 246197 47083 QUILLIN PHIL 1.00 X 0 0 0 SAUNDERS MD MICHAEL 1.00 X 0 206536 49269 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 293376 36159 PACZKOWSKI RONALD R 1.00 X 0 407602 57577 TIGGELAAR THOMAS H 1.00 X 0 217337 46696 0 8921327 734466 0 0 1 0 FOWLER & HAMMER INC 157 SUMMER STREET LACROSSE WI 54603 CONSTRUCTION SERVICES 4986341 MAYO FDN FOR MED EDUCATION & RESEARCH 200 FIRST STREET SW ROCHESTER MN 55905 ADMINISTRATIVE SERVICES 1477943 MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 MEDICAL SERVICES 1433067 REMEDY MEDICAL SERVICES SC 3587 GATEWAY DRIVE EAU CLAIRE WI 54701 MEDICAL SERVICES 1305546 SIEMENS MEDICAL SOLUTIONS PO BOX 75571 CHARLOTTE NC 28275 MEDICAL SERVICES 1019401 63 7994 7994 SHARED SERVICES REVENU 561000 335038 335038 335038 908012 908012 1251044 335038 0 908012 1903120 1903120 2669265 2669265 624368 624368 135422 135422 1477943 1477943 5691 5691 20551 20551 12926 12926 214725 214725 1050 1050 226797 226797 34975 34975 164394 164394 435986 435986 1002 1002 42807 42807 DUES, LICENSES AND SUBS 33705 33705 8004727 1903120 6101607 0 26553 225668 186844 1110804 1226612 102332 95950 3505 6382 18946996 20548894 17301347 16079729 37588320 38075014 7331614 6574734 1138422 35132169 41976777 42463783 49689933 X -4875463 -11614919 -4875463 -11614919 37588320 38075014 X -6753683 14227 X X 0 1 1 X 0 X X X 0 0 0 FRANCISCAN SKEMP MEDICAL CENTER INC 390806374 3 1 53120 FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC 391322480 9 1 0 FRANCISCAN SKEMP FOUNDATION OF SPARTA INC 391423234 9 1 0 FRANCISCAN SKEMP FOUNDATION INC 391186647 7 1 0 MAYO CLINIC 416011702 9 1 1850000 5 1903120 Schedule A, Part IV, Supplemental Information: SCHEDULE A, PART 1, LINE 11H (VIII) FRANCISCAN SKEMP HEALTHCARE, INC. (FSH), IN SUPPORT OF THE PROGRAMS AND PURPOSES OF FRANCISCAN SKEMP MEDICAL CENTER, PROVIDED GRANTS TO THE LACROSSE MEDICAL HEALTH SCIENCE CONSORTIUM TO SUPPORT REGIONAL HEALTHCARE INITIATIVES, TO VITERBO COLLEGE IN SUPPORT OF ITS NURSING PROGRAM, TO CHILEDA FOUNDATION FOR YOUTH WITH COGNITIVE CHALLENGES WHOSE BEHAVIOR CANNOT BE SUPPORTED WITHIN OTHER PROGRAMS AND TO MAYO CLINIC FOR CAPITAL CONTRIBUTION. IN ADDITION FSH PROVIDES MANAGEMENT, ADMINISTRATIVE AND PURCHASING SERVICES FOR THE BENEFIT OF ITS SUPPORTING ORGANIZATIONS, FRANCISCAN SKEMP MEDICAL CENTER AND THE RELATED FOUNDATIONS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 102332 95950 6382 6382 MAYO POOLED INVESTMENTS 20548894 F 20548894 DUE FROM AFFILIATES 14479729 INVESTMENT IN LACROSSE HEALTH SCIENCE CONSORTIUM 1600000 16079729 DUE TO AFFILIATES 41976777 41976777 Description of Uncertain Tax Positions Under FIN 48: Part X: AT DECEMBER 31, 2010 AND 2009, THERE WAS NO MATERIAL LIABILITY FOR UNRECOGNIZED TAX BENEFITS FOR THE FILING ORGANIZATION. 1 LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM 1300 BADGER STREET SUITE 3065 LA CROSSE WI 54601 391804725 501(c)(3) 27760 SUPPORT OF REGIONAL HEALTHCARE INITIATIVES VITERBO COLLEGE INC 900 VITERBO DRIVE LA CROSSE WI 54601 390978445 501(c)(3) 20000 SCHOOL OF NURSING CONTRIBUTION CHILEDA FOUNDATION INC 1825 VICTORY LANE LA CROSSE WI 54601 391396599 501(c)(3) 5000 SUPPORT OF MISSION MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 416011702 501(C)(3) 1850000 CAPITAL SUPPORT 4 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 FRANCISCAN SKEMP GRANTS ISSUED MUST MEET THE GUIDELINES OF THE FRANCISCAN SKEMP FOUNDATION GRANTS 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 247788 0 0 0 14593 0 15781 0 22243 0 300405 0 10227 HOLMES MD DAVID 0 462597 0 5000 0 1791400 0 0 0 21476 0 2280473 0 356155 JOHANSEN MD KEITH L 0 243809 0 2250 0 209333 0 52734 0 23525 0 531651 0 11679 JOHNSON MD TIMOTHY J 0 338141 0 0 0 0 0 9240 0 15214 0 362595 0 0 KRIEN MD JOSEPH S 0 232056 0 28339 0 11369 0 27271 0 23734 0 322769 0 371 LARSON MD DAVID E 0 379715 0 0 0 1781404 0 392 0 15780 0 2177291 0 558191 LOHR MD ROBERT H 0 228942 0 0 0 4246 0 34223 0 24325 0 291736 0 0 NESSE MD ROBERT E 0 448868 0 0 0 1120429 0 193896 0 17848 0 1781041 0 370682 O'BRIEN MD MICHAEL 0 245463 0 0 0 734 0 24072 0 23011 0 293280 0 0 SAUNDERS MD MICHAEL 0 206536 0 0 0 0 0 27261 0 22008 0 255805 0 0 WHITED MD BRIAN L 0 293376 0 0 0 0 0 12250 0 23909 0 329535 0 0 PACZKOWSKI RONALD R 0 304616 0 0 0 102986 0 38307 0 19270 0 465179 0 25664 TIGGELAAR THOMAS H 0 217337 0 0 0 0 0 25375 0 21321 0 264033 0 0 Part I, Line 4a 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). IN 2010, THE COMPONENT OF THIS SRP BENEFIT THAT WAS DEFERRED COMPENSATION SUBJECT TO SECTIONS 409A AND 457(f) OF THE INTERNAL REVENUE CODE WAS TERMINATED. THIS PLAN TERMINATION TRIGGERED THE IMMEDIATE TAXATION OF THE ENTIRE SRP BENEFIT THAT HAS BEEN ACCRUED AND DEFERRED OVER EACH PARTICIPANT'S CAREER AT MAYO. STARTING JANUARY 1, 2011, ALL FUTURE SRP BENEFIT WILL BE PAID AS AN ANNUAL TAXABLE CASH PAYMENT THAT HAS NO SUBSTANTIAL RISK OF FORFEITURE. THE FOLLOWING INDIVIDUALS RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN EITHER AS A RESULT OF THE NORMAL OPERATION OF PLAN TERMS OR BECAUSE OF THE TERMINATION OF THE 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. THESE AMOUNTS HAVE BEEN ACCRUED OVER THE SPAN OF THE INDIVIDUAL'S CAREER AT MAYO. ROBERT ALBRIGHT D.O. $13,715 DAVID HOLMES M.D. $1,782,444 KEITH L. JOHANSEN M.D. $206,423 JOSEPH S. KRIEN M.D. $11,369 DAVID E. LARSON M.D. $1,771,891 ROBERT E. NESSE M.D. $1,055,162 MICHAEL O'BRIEN M.D. $734 RONALD R. PACZKOWSKI $102,986 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 142826 MANAGEMENT FEE 0 Form 990, Part VI, Section A, line 2 DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUALS: TIMOTHY J. JOHNSON M.D. JOSEPH S. KRIEN M.D. DAVID E. LARSON M.D. ROBERT E. NESSE M.D. RONALD R. PACZKOWSKI THOMAS H. TIGGELAAR HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: TIMOTHY J. JOHNSON M.D. JOSEPH S. KRIEN M.D. MICHAEL O'BRIEN M.D. RONALD R. PACZKOWSKI MICHAEL SAUNDERS M.D. THOMAS H. TIGGELAAR DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUAL: ROBERT E. NESSE M.D. HAS A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: ROBERT ALBRIGHT D.O. DAVID HOLMES M.D. KEITH L. JOHANSEN M.D. DAVID E. LARSON M.D. ROBERT H. LOHR M.D. ROBERT E. NESSE M.D. JOSEPH S. KRIEN M.D., ROBERT H. LOHR M.D., AND BRIAN L. WHITED M.D. ARE ALSO ON THE BOARD OF HEALTH TRADITION HEALTH PLAN. 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 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. THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY. THE SALARY OF THE CEO 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 PHYSICIANS. THE MAYO HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE MAYO 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). FOR THOSE INDIVIDUALS FOR WHICH THIS COMMITTEE CAN NOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE COMPENSATION AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. INFORMATION ON MAYO 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 FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS AVAILABLE UPON REQUEST. CONFLICT OF INTEREST POLICY IS AVAILABLE ON MAYOCLINIC.ORG WEBSITE. FORM 990 PART VII SECTION A AVERAGE HOURS PER WEEK DEVOTED TO POSITION WITH RELATED ORGANIZATION: DAVID E. LARSON, M.D. 40.0 DAVID HOLMES, M.D. 40.0 JOSEPH S. KRIEN, M.D. 40.0 KEITH L. JOHANSEN, M.D. 40.0 MICHAEL O'BRIEN, M.D. 40.0 MICHAEL SAUNDERS, M.D. 40.0 ROBERT C. ALBRIGHT 40.0 ROBERT E. NESSE, M.D. 40.0 ROBERT LOHR, M.D. 40.0 THOMAS H. TIGGELAAR 40.0 BRIAN L. WHITED M.D. 40.0 RONALD R. PACZKOWSKI 40.0 TIMOTHY J. JOHNSON M.D. 40.0 Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 14,227. FORM 990 PART XII, LINE 2C THERE WAS NO CHANGE IN THE PROCESS DURING THE YEAR. ALBERT LEA MEDICAL CENTER -- MAYO HEALTH SYSTEM 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 411404075 HOSPITAL AND CLINIC MN 501(c)(3) 3 MAYO CLINIC 1 AUSTIN MEDICAL CENTER -- MAYO HEALTH SYSTEM 1000 FIRST DRIVE NW AUSTIN MN 55912 410695606 HOSPITAL AND CLINIC MN 501(c)(3) 3 MAYO CLINIC 1 AUSTIN MEDICAL CENTER FOUNDATION 1000 FIRST DRIVE NW AUSTIN MN 55912 300107471 FUNDRAISING FOUNDATION MN 501(c)(3) 7 AUSTIN MEDICAL CENTER -- MAYO HEALTH SYSTEM 1 BARRON MEMORIAL MEDICAL CENTER -- MAYO HEALTH SYSTEM 1222 EAST WOODLAND AVE BARRON WI 54812 390920634 HOSPITAL AND CLINIC WI 501(c)(3) 3 LUTHER HOSPITAL 1 BLOOMER LAKEVIEW INC 2110 DUNCAN ROAD BLOOMER WI 54724 391450617 LOW INCOME HOUSING WI 501(c)(3) 7 BLOOMER MEMORIAL MEDICAL CENTER INC -- MAYO HEALTH SYSTEM 1 BLOOMER MEMORIAL MEDICAL CENTER INC -- MAYO HEALTH SYSTEM 1501 THOMPSON STREET BLOOMER WI 54724 390980343 HOSPITAL AND CLINIC WI 501(c)(3) 3 LUTHER HOSPITAL 1 CANNON FALLS MEDICAL CENTER -- MAYO HEALTH SYSTEM 1116 WEST MILL STREET CANNON FALLS MN 55009 204156428 HOSPITAL AND CLINIC MN 501(c)(3) 3 MAYO CLINIC 1 CHARTERHOUSE INC 200 FIRST STREET SW ROCHESTER MN 55905 411405254 RETIREMENT LIVING CENTER MN 501(c)(3) 9 MAYO CLINIC 1 FAIRMONT MEDICAL CENTER -- MAYO HEALTH SYSTEM 800 MEDICAL CENTER DRIVE PO BOX 800 FAIRMONT MN 56031 410760836 HOSPITAL AND CLINIC MN 501(c)(3) 3 MAYO CLINIC 1 FOUNTAIN LAKE TREATMENT CENTER 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 411404076 CHEMICAL DEPENDENCY TREATMENT MN 501(c)(3) 3 ALBERT LEA MEDICAL CENTER -- MAYO HEALTH SYSTEM 1 FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC 464 SOUTH JOHNSON STREET ARCADIA WI 54612 391322480 FUNDRAISING FOUNDATION WI 501(c)(3) 9 FRANCISCAN SKEMP HEALTHCARE INC 1 FRANCISCAN SKEMP FOUNDATION OF SPARTA INC 310 WEST MAIN STREET SPARTA WI 54656 391423234 FUNDRAISING FOUNDATION WI 501(c)(3) 9 FRANCISCAN SKEMP HEALTHCARE INC 1 FRANCISCAN SKEMP FOUNDATION INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391186647 FUNDRAISING FOUNDATION WI 501(c)(3) 11-II FRANCISCAN SKEMP HEALTHCARE INC 1 FRANCISCAN SKEMP HEALTHCARE INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391411999 HEALTHCARE SYSTEM PARENT WI 501(c)(3) 11-I MAYO CLINIC 1 FRANCISCAN SKEMP MEDICAL CENTER INC 700 WEST AVE SOUTH LA CROSSE WI 54601 390806374 HOSPITAL AND CLINIC WI 501(c)(3) 3 FRANCISCAN SKEMP 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 IMMANUEL-ST JOSEPH'S -- MAYO HEALTH SYSTEM 1025 MARSH STREET MANKATO MN 56002 411236756 HOSPITAL AND CLINIC MN 501(c)(3) 3 MAYO CLINIC 1 IMMANUEL-ST JOSEPH'S FOUNDATION -- MAYO HEALTH SYSTEM 1025 MARSH STREET MANKATO MN 56002 411663357 FUNDRAISING FOUNDATION MN 501(c)(3) 7 IMMANUEL-ST JOSEPH'S -- MAYO HEALTH SYSTEM 1 LAKE CITY MEDICAL CENTER - MAYO HEALTH SYSTEM 500 WEST GRANT STREET LAKE CITY MN 55041 411906820 HOSPITAL MN 501(c)(3) 3 MAYO CLINIC 1 LUTHER HOSPITAL 1221 WHIPPLE STREET EAU CLAIRE WI 54703 390813418 HOSPITAL WI 501(c)(3) 3 MAYO CLINIC 1 LUTHER LAKESIDE APARTMENTS INC 714 SOUTH BARSTOW STREET EAU CLAIRE WI 54701 391409024 LOW INCOME HOUSING WI 501(c)(3) 9 LUTHER HOSPITAL 1 LUTHER MIDELFORT FOUNDATION INC 733 W CLAIREMONT AVE PO BOX 1510 EAU CLAIRE WI 54702 391633407 GRANTMAKING FOUNDATION WI 501(c)(3) PF MIDELFORT CLINIC LTD -- MAYO HEALTH SYSTEM 0 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 JACKSONVILLE 4500 SAN PABLO ROAD JACKSONVILLE FL 32224 593337028 PATIENT CARE - CLINIC FL 501(c)(3) 7 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 200 FIRST STREET SW ROCHESTER MN 55905 416011702 PATIENT CARE - CLINIC MN 501(c)(3) 9 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 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 MIDELFORT CLINIC LTD -- MAYO HEALTH SYSTEM PO BOX 1510 EAU CLAIRE WI 54702 391735831 PATIENT CARE - CLINIC WI 501(c)(3) 3 MAYO CLINIC 0 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 NORTHWEST WISCONSIN HOMECARE INC PO BOX 2060 EAU CLAIRE WI 54702 391491516 HOME HEALTH AND HOSPICE CARE WI 501(c)(3) 9 LUTHER HOSPITAL 1 NORTHWEST WISCONSIN SUPPORTIVE HOMECARE INC PO BOX 2060 EAU CLAIRE WI 54702 391686673 HOME HEALTH CARE WI 501(c)(3) 9 LUTHER HOSPITAL 1 OSSEO MEDICAL CENTER INC -- MAYO HEALTH SYSTEM PO BOX 70 / 13025 EIGHTH STREET OSSEO WI 54758 391029430 HOSPITAL AND CLINIC WI 501(c)(3) 3 LUTHER HOSPITAL 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 RED CEDAR MEDICAL CENTER INC -- MAYO HEALTH SYSTEM 2321 STOUT ROAD MENOMONIE WI 54751 510190875 HOSPITAL AND CLINIC WI 501(c)(3) 3 MAYO CLINIC 1 SPRINGFIELD MEDICAL CENTER -- MAYO HEALTH SYSTEM 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 411893827 HOSPITAL AND CLINIC MN 501(c)(3) 3 IMMANUEL-ST JOSEPH'S -- MAYO HEALTH SYSTEM 1 ST JAMES MEDICAL CENTER -- MAYO HEALTH SYSTEM 1101 MOULTON PARSONS DR PO BOX 460 ST JAMES MN 56081 410797368 HOSPITAL AND CLINIC MN 501(c)(3) 3 IMMANUEL-ST JOSEPH'S -- MAYO HEALTH SYSTEM 1 ST JAMES MEDICAL CENTER FOUNDATION INC 1101 MOULTON PARSONS DR PO BOX 460 ST JAMES MN 56081 411444129 FUNDRAISING FOUNDATION MN 501(c)(3) 7 ST JAMES MEDICAL CENTER -- MAYO HEALTH SYSTEM 1 WASECA MEDICAL CENTER -- MAYO HEALTH SYSTEM 501 NORTH STATE STREET WASECA MN 56093 363606405 HOSPITAL AND CLINIC MN 501(c)(3) 3 IMMANUEL-ST JOSEPH'S -- MAYO HEALTH SYSTEM 1 MAYO KLINIK STIFTUNG 60486 FRANKFURT AM MAIN FRANKFURT GM FUNDRAISING FOUNDATION GM MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 1 FRANKLIN HEATING STATION 119 THIRD ST SW ROCHESTER MN 55902 410264830 UTILITY MN N/A CANNON VALLEY CLINIC -- MAYO HEALTH SYSTEM 635 FIRST STREET SE FARIBAULT MN 55021 411817179 PATIENT CARE - CLINIC MN N/A C DECORAH CLINIC -- MAYO HEALTH SYSTEM 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 NORTHWEST HEALTH VENTURES INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 391528920 PHARMACY SERVICES WI N/A C OWATONNA CLINIC -- MAYO HEALTH SYSTEM 134 SOUTHVIEW OWATONNA MN 55060 411862132 PATIENT CARE - CLINIC MN 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 1 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 1 1 FRANCISCAN SKEMP FOUNDATION INC C 7194 GAAP FRANCISCAN SKEMP MEDICAL CENTER INC L 35120 GAAP HEALTH TRADITION HEALTH PLAN K 142826 GAAP MAYO CLINIC B 1850000 GAAP MAYO CLINIC R 14227 GAAP MAYO CLINIC A 908012 GAAP MAYO CLINIC K 192212 GAAP MAYO FOUNDATION FOR MEDICAL EDUCATION & RESEARCH L 1477943 GAAP FRANCISCAN SKEMP MEDICAL CENTER INC O 3293633 GAAP HEALTH TRADITION HEALTH PLAN Q 26767142 GAAP FRANCISCAN SKEMP MEDICAL CENTER INC R 26767142 GAAP