2011-08-04T09:24:34-05:00 2010-12-31 990 2010-01-01 510190875 MAYO CLINIC HEALTH SYSTEM - RED CEDAR INC MAYO 5075381297 2321 STOUT ROAD MENOMONIE WI 54751 JEANIE LUBINSKY 5075381297 2011-08-04 2010 2016-02-24 21:20:13Z FKA RED CEDAR MEDICAL CENTER JEANIE LUBINSKY 2321 STOUT ROAD MENOMONIE WI 54751 82091428 0 X WWW.RCMC-MHS.ORG X 1976 WI RED CEDAR MEDICAL CENTER (RCMC) OPERATES A HOSPITAL & CLINIC. 11 5 740 237 17949 -445 178204 143199 77728982 80677607 383794 617348 595260 616671 78886240 82054825 10650 7292 0 0 45525765 48072549 0 0 111079 25328792 26256867 70865207 74336708 8021033 7718117 82923904 91745126 7246918 9400836 75676986 82344290 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 67936458 0 81221086 PATIENT CARE (SEE SCHEDULE O):RED CEDAR MEDICAL CENTER - MAYO HEALTH SYSTEM (RCMC) IS A MEMBER OF THE MAYO HEALTH SYSTEM. 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. AS PART OF THE MAYO HEALTH SYSTEM, RCMC OPERATES A CLINIC AND A HOSPITAL IN MENOMONIE, WISCONSIN - ALONG WITH REGIONAL CLINICS IN GLENWOOD CITY AND ELMWOOD, WISCONSIN. RCMC'S CLINICS PROVIDE PRIMARY CARE, INCLUDING FAMILY PRACTICE, INTERNAL MEDICINE, OB/GYN, PEDIATRICS AND GENERAL SURGERY. IN ADDITION, SPECIALTY CARE IN OCCUPATIONAL MEDICINE, BEHAVIORAL HEALTH, ORTHOPEDICS, PODIATRY AND NUTRITIONAL EDUCATION ARE ALSO PROVIDED. DURING 2010, THERE WERE 98,594 CLINIC VISITS. RCMC'S HOSPITAL IS A 25-BED CRITICAL ACCESS HOSPITAL PROVIDING MEDICAL, SURGICAL, MATERNITY, EMERGENCY AND CRITICAL CARE SERVICES TO AREA RESIDENTS. IN 2010, 2,005 PATIENTS WERE ADMITTED, 3,172 SURGICAL PROCEDURES WERE PERFORMED AND 8,954 PATIENTS USED THE HOSPITAL'S EMERGENCY ROOM.IN CONJUNCTION WITH MAYO CLINIC AND ITS AFFILIATES, RCMC IS ABLE TO PROVIDE EMERGENCY MEDICAL HELICOPTER SERVICE THROUGHOUT THE REGION. THE HELICOPTER PROVIDES RAPID PATIENT TRANSPORT TO THE APPROPRIATE HEALTHCARE FACILITY ALONG WITH DELIVERING HIGH-LEVEL CRITICAL CARE.RCMC ALSO OPERATES LIFELINE (A EASY-TO-USE PERSONAL RESPONSE SERVICE) TO ENSURE THAT OLDER ADULTS LIVING AT HOME CAN GET QUICK ASSISTANCE WHENEVER IT MAY BE NEEDED - 24 HOURS A DAY, 365 DAYS A YEAR. WHEN THE PERSONAL HELP BUTTON IS PRESSED, A RCMC MONITOR RESPONDS, ASSESSES THE SITUATION AND SUMMONS APPROPRIATE HELP. THERE WERE 496 SUBSCRIBERS TO THE PROGRAM DURING 2010.RCMC PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. SERVICES ARE ALSO PROVIDED TO MEDICAID AND MEDICARE PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. IN 2010, RCMC PROVIDED APPROXIMATELY $945,110 IN FINANCIAL ASSISTANCE TO PATIENTS. THE UNREIMBURSED COST OF MEDICAID PATIENTS WAS APPROXIMATELY $6,230,967. 174529 7292 39506 OTHER COMMUNITY PROGRAMS (SEE SCHEDULE O):IN 2010, RCMC PROVIDED VARIOUS COMMUNITY SERVICES AND EDUCATIONAL OFFERINGS TO AREA RESIDENTS. SOME OF THESE ACTIVITIES ARE DESCRIBED BELOW. A FREE CLINIC PROVIDING HEALTH CARE TO THE UNDERPRIVILEGED OF THE COMMUNITY IS HOUSED AT RCMC. OFFICE SPACE, STORAGE AND SERVICES ARE PROVIDED TO THE FREE CLINIC AT OR BELOW COST OR FREE OF CHARGE. RCMC ALSO CONDUCTED THREE BLOOD DRIVES TO BENEFIT THE AMERICAN RED CROSS, DONATING STAFF TIME, FACILITIES AND SUPPORT. THE VALUE OF THE STAFF TIME, FACILITIES AND SUPPORT FOR FOR THESE ACTIVITIES IS APPROXIMATELY $43,771. THE MEDICAL CENTER'S REGISTERED DIETICIAN HAS ESTABLISHED A WORKING RELATIONSHIP WITH THE WISCONSIN INTERSCHOLASTIC ATHLETIC ASSOCIATION, SPEAKING AT SEVERAL CONFERENCES ON THE IMPORTANCE OF PROPER NUTRITION FOR ATHLETES. RCMC ALSO PROVIDED SPORTS PHYSICALS TO 235 STUDENTS AT DISCOUNTED RATES. RCMC SUPPORTS SUCH COMMUNITY PROGRAMS AS THE UNITED WAY AND THE AMERICAN CANCER SOCIETY'S RELAY FOR LIFE. IN ADDITION, RCMC DONATED $1,542 TO LOCAL CHARITES/COMMUNITY GROUPS AND PROVIDED $5,750 IN SCHOLARSHIPS TO GRADUATING HIGH SCHOOL SENIORS WHO ARE ENTERING COLLEGE OR A VOCATIONAL PROGRAM FOR A HEALTH-RELATED FIELD OF STUDY. IN ADDITION TO THE ABOVE, RCMC SERVED OVER 8,147 PEOPLE BY SPONSORING THE FOLLOWING PROGRAMS IN 2010:- AQUACISE CLASSES- DIABETES SUPPORT GROUP SESSIONS- DIABETES PREVENTION CLASSES- CAREGIVER SUPPORT GROUP SESSIONS- HEART DISEASE SUPPORT GROUP SESSIONS- BEREAVEMENT SUPPORT GROUP SESSIONS- SMOKING CESSATION - CELIAC DISEASE PRESENTATIONS- CPR / FIRST AID PROGRAMS- FAMILY / PARENTING / PRENATAL EDUCATION PROGRAMS- HEALTH FAIRS- SLEEP APNEA / DEPRIVATION PROGRAMS- BLOOD PRESSURE / BLOOD SUGAR SCREENINGS- WOMEN'S HEALTH EDUCATION PROGRAMS- ATHLETIC TRAINING OUTREACH- COMMUNITY OUTREACH EVENTS- BUSINESS OUTREACH EVENTS- SENIOR EDUCATION & OUTREACH PROGRAMS- CHOLESTEROL SCREENING EVENTS- CHILDREN'S HEALTH & SAFETY EVENTRCMC ALSO RECEIVES DONATED SERVICES FROM THE RED CEDAR MEDICAL CENTER VOLUNTEERS WHICH IS COMPRISED OF INDIVIDUALS AND ORGANIZATIONS THAT HELP ORGANIZE AND MANAGE ACTIVITIES FOR THE BENEFIT OF RCMC'S PATIENTS, PATIENT'S FAMILIES, VISITORS AND STAFF. THE VOLUNTEERS OPERATE A GIFT SHOP, ASSIST PATIENTS AND GREET VISITORS. DURING 2010, VOLUNTEERS DONATED APPROXIMATELY 16,436 HOURS OF SERVICE. BASED ON 2010 INDEPENDENT SECTOR STATISTICS, THE APPROXIMATE VALUE OF THESE SERVICES WERE $351,073. 68110987 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 79 0 1 740 1 1 1 0 0 0 0 1 1 0 0 0 0 X 11 5 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 0 WI MN X CHRISTIE LOHKAMP 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 X CARRYER MD PETER W 1.00 X 0 1216809 9629 IMSANDE KRISTIN 1.00 X 0 0 0 JACOBSON ROSEMARY 1.00 X 0 0 0 JOHNSON ELNA 1.00 X 0 0 0 LINTON MD RANDALL L 1.00 X 0 516417 58816 NESSE MD ROBERT E 1.00 X 0 1569297 211744 THOMPSON RALPH 1.00 X 0 0 0 WITT MD THOMAS J 1.00 X 0 529729 79102 FREY NEAL 1.00 X 0 0 0 KRYSHAK WILLIAM 1.00 X 0 0 0 LINDBERG STEVEN J 40.00 X 181893 0 35735 LUBINSKY JEANENNE M 40.00 X 143262 0 12894 NELSON MD CARRIE J 40.00 X 215385 0 28984 RUSTAD CHRISTOPHER D 1.00 X 0 120624 22258 SIMPSON MD HENRY J 40.00 X 262487 0 49497 DEYO-SVENDSEN MD MARK E 40.00 X 254292 0 25692 LEE MD ROBERT K 40.00 X 351745 0 50827 MCNALLY DO PAUL D 40.00 X 770361 0 49535 RICH MD NATHAN L 40.00 X 355936 0 37758 THIRUMALAI MD SRIDHAR 40.00 X 517990 0 46395 WAHLGREN MD VAN E 40.00 X 446235 0 25581 3499586 3952876 744447 56 0 1 0 MIDELFORT CLINIC 733 W CLAIREMEONT AVE EAU CLAIRE WI 54701 MEDICAL SERVICES 2782935 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 MEDICAL SERVICES 1282883 LUTHER HOSPITAL 1221 WHIPPLE STREET EAU CLAIRE WI 54702 MEDICAL SERVICES 971233 COMPUTERIZED MEDICAL IMAGING INC 719 W HAMILTON AVE STE B EAU CLAIRE WI 54701 MEDICAL SERVICES 681110 MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 LAB SERVICES 238340 11 1806 2933 77430 61030 2558 143199 NET PATIENT REVENUE 620000 80416919 80416919 LIFELINE 621990 135409 135409 RENTS FROM AFFILIATES 531120 125279 125279 80677607 631915 631915 14567 -14567 -14567 -14567 5944 2933 727 5217 5217 3118 3251 -133 -133 18870 18058 812 812 CAFETERIA/VENDING 722210 275505 275505 CONSULTING SERVICES 541610 234192 219012 15180 MISC. REVENUE 900099 64971 55130 9841 36107 33338 2769 610775 82054825 81260592 17949 633085 1542 1542 5750 5750 1210121 649147 560974 7945 7945 35962834 33202064 2701201 59569 2924562 2691630 226667 6265 5647672 5179689 440729 27254 2319415 2096613 218104 4698 269423 269423 30075 30075 7821551 7054190 760818 6543 172690 13300 159390 10142247 9928211 208916 5120 221910 221910 1298222 1298222 282698 245265 37408 25 21956 21956 2414231 2267422 145710 1099 568447 568447 BAD DEBT EXPENSE 2564785 2564785 DUES, LICENSES, ETC. 177207 147413 29288 506 MEDICAID SURCHARGE 120735 120735 EMPLOYEE EXPENSES 107622 13485 94137 MISC. EXPENSE 43068 33176 9892 74336708 68110987 6114642 111079 3461 3230 1113730 412070 77027 10720 9155400 10207491 25000 308250 174500 1554655 1615290 156226 1215713 49719333 21333969 28362829 28385364 38090950 48683068 4101376 1012680 82923904 91745126 6599431 8325906 16862 141534 630625 933396 7246918 9400836 X 75599959 82333570 77027 10720 75676986 82344290 82923904 91745126 X 7718117 -1050813 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2230745 304769 111659 4131 2419724 1730538 516013 15806 2230745 2748041 -863469 137402 16632 1730538 1.00000 0 1 1 608398 608398 35264866 11272183 23992683 13532253 10061786 3470467 313816 313816 28385364 MAYO CLINIC POOLED INVESTMENTS 48683068 F 48683068 INTERCOMPANY PAYABLES 27716 DEFERRED COMPENSATION LIABILITY 905680 933396 Description of Intended Use of Endowment Funds: Part V, Line 4: TO SUPPORT MEDICAL PROGRAMS AND RELATED SERVICES THAT BENEFIT THE COMMUNITY SERVED BY RED CEDAR MEDICAL CENTER - MAYO HEALTH SYSTEM. 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 1 1 X 1 X 1 1 0 1 1 945110 945110 0.01320 10950600 4719633 6230967 0.08680 11895710 4719633 7176077 0.10000 130758 39506 91252 0.00130 5750 5750 0.00010 9132351 6395707 2736644 0.03810 45313 45313 0.00060 9314172 6435213 2878959 0.04010 21209882 11154846 10055036 0.14010 0 1391913 0 12650770 12326126 324644 X 1 1 1 1 RED CEDAR MEDICAL CENTER

2321 STOUT ROAD MENOMONIE WI 54751

X X X X NOT REQUIRED 1 3 GLENWOOD CITY CLINIC

219 EAST OAK AVENUE GLENWOOD WI 54013

CLINIC ELMWOOD CLINIC

236 EAST SPRINGER AVENUE ELMWOOD WI 54740

CLINIC RED CEDAR MEDICAL CENTER

2321 STOUT ROAD MENOMONIE WI 54751

CLINIC, PHARMACY, PHYSICAL REHAB Part I, Line 6a: THE ANNUAL REPORT FOR THE FILING ORGANIZATION IS PART OF A CONSOLIDATED REPORT PREPARED BY MAYO CLINIC. Part I, Line 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS).THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO-CHARGE RATIO. Part I, Line 7g: THE FOLLOWING NET COMMUNITY BENEFIT COST ATTRIBUTED TO PHYSICIAN CLINICS THAT WERE INCLUDED IN SUBSIDIZED HEALTH SERVICES WERE $687,000. 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 $ 2564785. Part III, Line 4: FOOTNOTE FROM MAYO CLINIC CONSOLIDATED AUDITED FINANCIAL STATEMENTS: 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.BAD DEBT EXPENSE AT COST IS DETERMINED USING THE SAME COST TO CHARGE RATIO THAT IS USED TO CALCULATE FINANCIAL ASSISTANCE AND MEDICAID SHORTFALL. DISCOUNTS AND ALLOWANCES ARE ACCOUNTED FOR SEPARATELY FROM BAD DEBT EXPENSE.THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP. Part III, Line 8: THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SHORTFALL REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT (USING A MEDICARE COST REPORT STEP-DOWN METHODOLOGY).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 CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS. Part III, Line 9b: MAYO CLINIC AND ITS AFFILIATES STRIVE TO ASSIST ALL PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION PRIOR TO ENLISTING THE ASSISTANCE OF A COLLECTION AGENCY BY MAKING EVERY REASONABLE ATTEMPT TO COLLECT FROM INSURANCE COMPANIES AND OTHER THIRD-PARTY PAYORS. 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. 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. 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. Part VI, Line 2: RCMC'S VISION STATEMENT SPEAKS TO CREATING A HEALTHIER COMMUNITY BY PROVIDING EXCEPTIONAL CARE. WHILE RCMC'S PATIENT CARE EFFORTS FOCUS ON THOSE WHO UTILIZE ITS SERVICES, RCMC'S COMMUNITY SUPPORT EXTENDS TO THE POPULATION AT LARGE. IN ITS CURRENT STRATEGIC PLAN, RCMC IDENTIFIED UNMET COMMUNITY HEALTH NEEDS AS A STRATEGIC ISSUE, AND ESTABLISHED A COMMUNITY HEALTH DISCOVERY TEAM. THIS TEAM (CONSISTING OF REPRESENTATIVES FROM THE FREE CLINIC OF THE GREATER MENOMONIE AREA, THE MENOMONIE COMMUNITY HEALTH FOUNDATION, THE DUNN COUNTY HEALTH DEPARTMENT, AND RCMC) IS CHARGED WITH IDENTIFYING, EVALUATING, AND PRIORITIZING UNMET COMMUNITY HEALTH NEEDS, AND MAKING RECOMMENDATIONS TO RCMC'S OPERATIONS COMMITTEE AND BOARD OF DIRECTORS ABOUT INTERVENTIONS THAT RCMC SHOULD CONSIDER.RCMC'S COMMUNITY HEALTH DISCOVERY TEAM HAS STRATIFIED HEALTH CARE NEED WITHIN OUR GEOGRAPHIC REGION BASED ON MULTIPLE INPUTS INCLUDING: 2006 DUNN COUNTY COMMUNITY HEALTH ASSESSMENT, FOCUS GROUPS, INTERVIEWS WITH KEY PLAYERS, AND REVIEW OF PERTINENT LITERATURE ("WE CAN DO BETTER-IMPROVING THE HEALTH OF THE AMERICAN PEOPLE," NEJM, 9/07). THESE IDENTIFIED NEEDS ARE THEN FILTERED AND PRIORITIZED BASED ON CONSISTENCY WITH RCMC'S VISION/MISSION/VALUES, ABILITY OF RCMC TO IMPACT NEED IDENTIFIED, AND PATIENT COMMUNITY/BENEFIT.RCMC'S COMMUNITY EDUCATION COMMITTEE DEVELOPED A PROCESS TO DELIVER EDUCATIONAL PROGRAMMING AND FREE OR LOW-COST HEALTH SCREENINGS TO THE COMMUNITY AT LARGE, WITH A SUBSET OF PROGRAMMING TARGETING WOMEN WITHIN THE SERVICE AREA THROUGH WOMEN'S CIRCLE OF CARE PROGRAMMING. COMMUNITY EDUCATION OFFERINGS ARE WELL-RECEIVED. Part VI, Line 3: ELIGIBILITY: THE CHARITY CARE INFORMATION BROCHURE IS PROMINENTLY DISPLAYED IN REGISTRATION AND PATIENT WAITING AREAS. THE BROCHURE EXPLAINS THE CHARITY CARE PROGRAM AND FACTORS AFFECTING ELIGIBILITY. IDENTIFICATION: THERE ARE A NUMBER OF WAYS A PATIENT CAN BE IDENTIFIED AND EVALUATED FOR CHARITY CARE ASSISTANCE.1. PATIENTS MAY REQUEST FINANCIAL ASSISTANCE.2. STAFF MAY REFER PATIENTS TO A FINANCIAL COUNSELOR.3. COLLECTION AGENCIES MAY REFER PATIENTS.4. BUSINESS/PATIENT FINANCIAL SERVICES MAY REFER PATIENTS TO A FINANCIAL COUNSELOR.5. PHYSICIANS MAY REFER PATIENTS.6. LOCAL GOVERNMENT AGENCIES MAY REFER PATIENTS.INDIGENT CARE: EMERGENCY ROOM PATIENTS WHO CANNOT PAY THEIR BILLS MAY BE CLASSIFIED AS "CHARITY" IF THEY DO NOT HAVE A JOB, MAILING ADDRESS, RESIDENCE, OR INSURANCE. CONSIDERATION MUST ALSO BE GIVEN TO CLASSIFYING EMERGENCY ROOM ONLY PATIENTS AS CHARITY IF THEY DO NOT PROVIDE ADEQUATE INFORMATION AS TO THEIR FINANCIAL STATUS. IN MANY INSTANCES, THESE PATIENTS ARE HOMELESS AND HAVE FEW RESOURCES TO COVER THE COST OF THEIR CARE.GOVERNMENTAL ASSISTANCE: IN DETERMINING WHETHER AN INDIVIDUAL QUALIFIES FOR CHARITY CARE, OTHER COUNTY OR GOVERNMENTAL ASSISTANCE PROGRAMS SHOULD ALSO BE CONSIDERED. MANY APPLICANTS ARE NOT AWARE THAT THEY MAY BE ELIGIBLE FOR PUBLIC HEALTH INSURANCE PROGRAMS.1. STAFF WILL HELP THE INDIVIDUAL DETERMINE ELIGIBILITY FOR GOVERNMENTAL OR OTHER ASSISTANCE, AS APPROPRIATE.2. PERSONS WHO ARE ELIGIBLE FOR PROGRAMS (SUCH AS STATE-SPONSORED MEDICAID) BUT WHO WERE NOT COVERED AT THE TIME THAT MEDICAL SERVICES WERE GRANTED MAY BE GRANTED CHARITY CARE, PROVIDED THAT THE PATIENT NOW APPLIES FOR GOVERNMENT ASSISTANCE. THIS MAY BE PRUDENT, ESPECIALLY IF THE PATIENT REQUIRES ONGOING SERVICES. Part VI, Line 4: RED CEDAR MEDICAL CENTER (RCMC) IS LOCATED IN MENOMONIE, WISCONSIN. ITS SERVICE AREA INCLUDES PORTIONS OF DUNN, ST. CROIX, PEPIN AND PIERCE COUNTIES IN WESTERN WISCONSIN. RCMC HAS THE ONLY ACUTE CARE HOSPITAL IN MENOMONIE,WHICH IS A DESIGNATED CRITICAL ACCESS HOSPITAL FOR MEDICARE PURPOSES. IT ALSO HAS A CLINIC IN MENOMONIE, ELMWOOD AND GLENWOOD CITY. ACCORDING TO 2000 CENSUS DATA, THE POPULATION OF DUNN COUNTY, WHICH COMPRISES MOST OF RCMC'S SERVICE AREA, IS APPROXIMATELY 40,000. ACCORDING TO 2005 CENSUS DATA, APPROXIMATELY 9.4% OF DUNN COUNTY INDIVIDUALS ARE LIVING BELOW POVERTY LEVEL. IN ADDITION, ACCORDING TO THE 2005-2007 WISCONSIN FAMILY HEALTH SURVEY, APPROXIMATELY 14% OF THE DUNN COUNTY POPULATION WAS UNINSURED FOR ALL OR PART OF THE PAST YEAR. DUNN COUNTY IS A FEDERALLY-DESIGNATED MEDICALLY-UNDERSERVED AREA (OR STATE-DESIGNED HEALTH PROFESSIONAL SHORTAGE AREA). Part VI, Line 6: THIS FILING ORGANIZATION IS AN AFFILIATE OF THE MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION - EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO 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.MAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE. 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. THE FILING ORGANIZATION'S STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.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 7: THIS FILING ORGANIZATION IS A PART OF MAYO CLINIC HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO CLINIC HEALTH SYSTEM IS DESCRIBED IN RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). THAT STATEMENT ALSO DESCRIBES THE ROLES OF THE VARIOUS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.SPECIFICALLY, THE FILING ORGANIZATION PROVIDES HOSPITAL AND CLINIC SERVICES FOR MENOMONIE, WISCONSIN AND THE SURROUNDING AREA.FOR MORE SPECIFIC DESCRIPTION, SEE THE RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). 1 SCHOLARSHIPS FOR STUDENTS ENTERING INTO A HEALTH CARE RELATED FIELD OF STUDY. 8 5750 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. FEDERAL AWARDS THAT ARE SUBCONTRACTED TO OTHER ORGANIZATIONS ARE MONITORED BY THE FILING ORGANIZATION AS PRESCRIBED IN OMB CIRCULAR A-133. NO ADDITIONAL MONITORING IS PERFORMED. TRANSFERS OR GRANTS TO TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. THE FILING ORGANIZATION MAINTAINS 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. HEALTH CAREER SCHOLARSHIP AWARDEES MUST SUBMIT GRADES/TRANSCRIPTS AND PROOF OF REGISTRATION. X 0 1 X X X 0 1 0 0 0 0 0 0 0 CARRYER MD PETER W 0 227574 0 0 0 989235 0 60 0 9569 0 1226438 0 421371 LINTON MD RANDALL L 0 505163 0 8500 0 2754 0 25170 0 33646 0 575233 0 0 NESSE MD ROBERT E 0 448868 0 0 0 1120429 0 193896 0 17848 0 1781041 0 370682 WITT MD THOMAS J 0 331834 0 0 0 197895 0 68203 0 10899 0 608831 0 52480 LINDBERG STEVEN J 181643 0 250 0 0 0 16877 0 18858 0 217628 0 0 0 LUBINSKY JEANENNE M 143012 0 250 0 0 0 12894 0 0 0 156156 0 0 0 NELSON MD CARRIE J 215135 0 250 0 0 0 19502 0 9482 0 244369 0 0 0 SIMPSON MD HENRY J 262237 0 250 0 0 0 22050 0 27447 0 311984 0 0 0 DEYO-SVENDSEN MD MARK E 254042 0 250 0 0 0 22050 0 3642 0 279984 0 0 0 LEE MD ROBERT K 326090 0 25655 0 0 0 18931 0 31896 0 402572 0 0 0 MCNALLY DO PAUL D 770111 0 250 0 0 0 22050 0 27485 0 819896 0 0 0 RICH MD NATHAN L 355686 0 250 0 0 0 9510 0 28248 0 393694 0 0 0 THIRUMALAI MD SRIDHAR 517740 0 250 0 0 0 22050 0 24345 0 564385 0 0 0 WAHLGREN MD VAN E 445985 0 250 0 0 0 22050 0 3531 0 471816 0 0 0 Part I, Line 1a GROUP TERM LIFE INSURANCE GROSSED UP FOR PHYSICIANS AND ADMINISTRATOR. Part I, Line 1b FOR 2010, THE FILING ORGANIZATION FOLLOWED AN UNWRITTEN POLICY THAT PROVIDED GROSS-UP PAYMENTS FOR GROUP TERM LIFE INSURANCE FOR PHYSICIANS AND ADMINISTRATOR. FOR FUTURE YEARS, THE ABOVE POLICY WILL BE WRITTEN AND STATE THE CONDITIONS, ELIGIBILITY AND TREATMENT OF ANY GROSS-UP PAYMENTS PROVIDED. 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). 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. PETER CARRYER, M.D. - $982,163 ROBERT NESSE, M.D. - $1,055,162 THOMAS WITT, M.D. - $167,417 Supplemental Information Part III Part I, Line 3: IN ADDITION TO THE PROCESS FOLLOWED BY THE FILING ORGANIZTION, THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE CORE 990, PART VI, SECTION B, LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED. Supplemental Information Part III Part II: COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. ROBERT LEE MD RECRUITMENT X 50000 25000 0 0 1 25000 MAYO COLLABORATIVE SERVICES INC BOARD OVERLAP 238340 LAB SERVICES 0 ANNA FREY FAMILY RELATIONSHIP 5972 EMPLOYMENT 0 LEE ANN FREY FAMILY RELATIONSHIP 46520 EMPLOYEMENT 0 BREMER BANK BOARD OVERLAP 48620 BANKING TRANSACTIONS 0 Form 990, Part VI, Section A, line 2 DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT BY RELATED EXEMPT ENTITY, DR. ROBERT NESSE HAS A BUSINESS RELATIONSHIP WITH DR. PETER CARRYER AND CHRISTOPHER RUSTAD. Form 990, Part VI, Section A, line 3 THE FILING ORGANIZATION IS AFFILIATED WITH MAYO CLINIC. MAYO-AFFILIATED ENTITIES ROUTINELY DELEGATED VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO RELATED ENTITIES. Form 990, Part VI, Section A, line 4 THE BYLAWS WERE CHANGED TO DELETE SECTIONS RELATED TO THE DISSOLUTION OF THE MENOMONIE COMMUNITY HEALTH FOUNDATION, A SUPPORTING ORGANIZATION. Form 990, Part VI, Section A, line 6 THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION IS MAYO CLINIC. Form 990, Part VI, Section A, line 7a MAYO CLINIC, THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION ELECTS THE COMMUNITY DIRECTORS, THE MAYO DIRECTORS, AND THE VOTING PHYSICIAN DIRECTORS. Form 990, Part VI, Section A, line 7b THE ARTICLES AND BYLAWS OF THE FILING ORGANIZATION PROVIDE THE SOLE CORPORATE MEMBER, MAYO CLINIC, CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, DEBT, AMENDMENT OF ARTICLES AND BYLAWS, AND GENERAL OPERATION DECISIONS. Form 990, Part VI, Section B, line 11 THE FORM 990 FOR THE FILING ORGANIZATION IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER AND FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FILING ORGANIZATION'S GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. 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 THE FILING ORGANIZATION IS AFFILIATED WITH MAYO CLINIC. 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, line 15 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. THE SALARY OF THE CEO, CAO, AND BOARD VICE CHAIR 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. IN ADDITION TO THE ABOVE COORDINATED REVIEW PROCESSES CONDUCTED BY MAYO CLINIC AND ITS AFFILIATES, THE FILING ORGANIZATION ALSO HAS ITS OWN COMPENSATION REVIEW PROCESS THAT INCLUDES REVIEW BY AN INDEPENDENT COMPENSATION COMMITTEE AND BENCHMARK/COMPARABILITY DATA. THE FILING ORGANIZATION'S REVIEW PROCESS COVERS BOTH A PHYSICIAN COMPENSATION PLAN AND AN ADMINISTRATOR COMPENSATION PLAN. 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. Form 990, Part VII, Section A, Average Hours Per Week Devoted to Position with Related Organizations: PETER CARRYER, M.D. - 40 HOURS RANDALL LINTON, M.D. - 40 HOURS ROBERT NESSE, M.D. - 40 HOURS THOMAS WITT, M.D. - 40 HOURS CHRISTOPHER RUSTAD - 40 HOURS Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 156,577. CHANGE IN THE NET ASSETS OF FOUNDATION -1,207,390. Total to Form 990, Part XI, Line 5: -1,050,813. 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 MENOMONIE COMMUNITY HEALTH FOUNDATION INC PO BOX 237 MENOMONIE WI 54751 391895685 GRANTMAKING FOUNDATION WI 501(c)(3) 11-I RED CEDAR MEDICAL CENTER INC -- MAYO HEALTH SYSTEM 1 MAYO KLINIK STIFTUNG 60486 FRANKFURT AM MAIN FRANKFURT GM FUNDRAISING FOUNDATION GM MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 0 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 - 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