2011-11-03T12:40:47-05:00 2010-12-31 990 2010-01-01 411893827 MAYO CLINIC HEALTH SYSTEM-SPRINGFIELD MAYO 5075381297 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 JAMES J TARASOVITCH 5073856449 2011-11-03 2010 2016-03-07 17:11:31Z fka SPRINGFIELD MEDICAL CENTER - MAY GREGORY KUTCHER MD 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 16714828 0 X WWW.MAYOHEALTHSYSTEM.ORG X 1997 MN MEDICAL CLINIC, HOSPITAL, EMERGENCY ROOM AND DENTAL CLINIC 8 4 111 0 0 0 115708 61692 14375969 16553062 95216 85657 21357 11151 14608250 16711562 17137 32305 0 0 8321295 8510311 0 0 0 4975471 5732078 13313903 14274694 1294347 2436868 20716599 22894107 1662073 1402713 19054526 21491394 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 12781057 16551055 PATIENT CARE (SCHEDULE O)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.PATIENT CARE:SMC PROVIDES HEALTH, MEDICAL AND DENTAL SERVICES TO THE SPRINGFIELD, MINNESOTA, COMMUNITY AS WELL AS SURROUNDING COMMUNITIES. SERVICES ARE OFFERED THROUGH ITS HOSPITAL AND CLINICS IN SPRINGFIELD, MINNESOTA, AS WELL AS A SATELLITE MEDICAL CLINIC AT LAMBERTON, MINNESOTA. THERE WERE 1,783 PATIENTS TREATED IN THE EMERGENCY ROOM IN 2010, WHICH IS OPEN 24 HOURS A DAY. THERE WERE 593 ACUTE PATIENTS DISCHARGED FROM INPATIENT CARE DURING 2010, AND 16,715 PATIENT OFFICE VISITS TOOK PLACE AT THE MEDICAL CLINICS IN 2010. THE DENTAL CLINIC HAD 2,961 PATIENT VISITS IN 2010.THE CLINIC IN LAMBERTON SAW 1,325 PATIENTS IN 2010. THIS CLINIC PROVIDES A NEEDED HEALTH CARE ACCESS POINT TO A COMMUNITY OF 900, INCLUDING MANY WHO ARE ELDERLY.UNCOMPENSATED CARE:SMC PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. SMC IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED BASED ON ITS COST OF PROVIDING SERVICES FOR HOSPITAL MEDICARE PATIENTS.CHARITY CARE IS ALSO PROVIDED FOR PATIENTS THAT ARE FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THE COST OF CHARITY CARE PROVIDED IN 2010 WAS APPROXIMATELY $22,000. THE COST OF UNCOMPENSATED CARE IN 2010 PROVIDED TO OTHER GOVERNMENTAL AND LOW INCOME PATIENTS THROUGH MEDICAID WAS APPROXIMATELY $587,000. THIS AMOUNT INCLUDES THE MEDICAID SURCHARGE AND PAYMENT TO MINNESOTACARE (A PROGRAM THAT PROVIDES HEALTH CARE FOR LOW INCOME POPULATIONS). THE AMOUNT OF THE MEDICAID SURCHARGE AND MINNESOTACARE TAX PAID IN 2010 WAS APPROXIMATELY $250,000.SMC ALSO PROVIDES DISCOUNTS TO UNINSURED PATIENTS. THE TOTAL DISCOUNTS GIVEN IN 2010 WERE $43,000. 5815 EDUCATION (SCHEDULE O)EDUCATION:AS AN IMPORTANT COMPONENT OF THE AREAS' INFRASTRUCTURE, SMC IS INVOLVED IN SEVERAL DIFFERENT WAYS IN PROVIDING AND/OR SUPPORTING HEALTH CARE RELATED EDUCATION IN SPRINGFIELD AND THE SURROUNDING AREA. SMC HAS A TUITION SCHOLARSHIP PROGRAM THAT PROVIDES FUNDING, UP TO A TOTAL OF $15,000 OVER THREE YEARS, IF A PERSON AGREES TO A SET AMOUNT OF YEARS OF EMPLOYMENT. 3 PEOPLE WERE PROVIDED A TOTAL OF $5,000 IN 2010 UNDER THIS PROGRAM WHICH IS ONE OF THE BEST IDENTIFIED WAYS TO HELP PROVIDE STAFFING FOR OUR RURAL MEDICAL CENTER. UNFORTUNATELY, THIS PARTICULAR BENEFIT ONLY "COUNTS" IF IT IS MADE TO A PERSON WHO IS NOT YET OUR EMPLOYEE, THUS THE $5,000 IS NOT INCLUDED IN OUR OFFICIAL TALLY OF COMMUNITY BENEFITS SINCE ALL THREE INDIVIDUALS ASSISTED WERE ALREADY SMC EMPLOYEES.SMC PROVIDES MANY DIFFERENT EDUCATIONAL SEMINARS REGARDING SPECIFIC TOPICS, INCLUDING DIABETES CLASSES, CHILDBIRTH CLASSES, AND SIBLING CLASSES. BEGINNING IN 2008, SMC PIONEERED A COMMUNITY INITIATIVE TO ADDRESS CHILDHOOD OBESITY AND PARTNERED WITH LOCAL SCHOOLS, PUBLIC HEALTH AND THE LOCAL GROCERY STORE. INCLUDED IN THIS INITIATIVE WAS TO PROVIDE NUTRITION AND PHYSICAL ACTIVITY TALKS TO STUDENTS IN K-6TH GRADE. THERE HAVE ALSO BEEN OTHER AWARENESS ACTIVITIES SPONSORED BY SMC, SUCH AS BREAST HEALTH AWARENESS AND OTHER TOPICS THAT HAVE BEEN SHARED IN SOME MANNER WITH THE COMMUNITY AT NO CHARGE. IT IS ESTIMATED THAT COSTS FOR STAFF TIME AND MATERIALS ASSOCIATED WITH THESE VARIOUS EDUCATIONAL EPISODES AMOUNTED TO APPROXIMATELY $13,000 IN 2010. 37431 32305 COMMUNITY BUILDING/COMMUNITY HEALTH IMPROVEMENT SERVICES (SCHEDULE O)COMMUNITY BUILDING:SMC EMPLOYED 99 ALLIED HEALTH STAFF, 6 PHYSICIANS AND 1 DENTIST DURING 2010. IT IS IMPORTANT THAT EMPLOYEES OF SMC CONTRIBUTE TO THE COMMUNITY BY MEANS OF PROVIDING THEIR TIME TO WORTHWHILE CIVIC PROJECTS THAT IMPROVE THE OVERALL COMMUNITY PROFILE. MANY TIMES THIS ACTIVITY OCCURS DURING TYPICAL WORK TIME WHILE BEING COMPENSATED BY SMC, SUCH AS SERVING AS A MEMBER ON THE LOCAL AMBULANCE SERVICE. SOME OF THESE SETTINGS INCLUDE SMC EMPLOYEES WHO SERVE IN LEADERSHIP POSITIONS SUCH AS WITH THE SPRINGFIELD AREA CHAMBER OF COMMERCE OR THE SPRINGFIELD AREA CONVENTION & VISITORS BUREAU. SOME OF THE PROJECTS WORKED ON AS PART OF THESE ORGANIZATIONS ARE TO INCREASE TOURISM BY THE DEVELOPMENT OF A RECREATIONAL TRAIL SYSTEM AS WELL AS UTILIZING SMC MECHANICAL EQUIPMENT AND MAINTENANCE PERSONNEL TO CLEAN THE LOCAL TRAILS. SMC PARTICIPATES IN MANY WAYS AS A REGULAR BUSINESS MEMBER OF THE COMMUNITY. AS SUCH, THERE ARE OFTEN TIMES FINANCIAL CONTRIBUTIONS MADE, FOR EXAMPLE, TO HELP SPONSOR THE DISTRIBUTION OF HEALTH AND SAFETY BOOKS TO SCHOOL CHILDREN OR PERHAPS PARTICIPATION IN A BUSINESS EVENT SUCH AS THE ANNUAL HOME & GARDEN SHOW.SPRINGFIELD MEDICAL CENTER HAS INVESTED BOTH TIME AND RESOURCES ON EMERGENCY PREPAREDNESS FOR POSSIBLE BIO-TERRORISM IN CONJUNCTION WITH OTHER HOSPITALS AND PUBLIC HEALTH DEPARTMENTS WITHIN THE REGION. PART OF THIS TRAINING IS DONE WITH EMPLOYEES OF THE CITY OF SPRINGFIELD, INCLUDING REGULAR MEETINGS TO ORGANIZE DRILLS, HOLD DRILLS AND REVISE PLANS. COMMUNITY OUTREACH:SMC PROVIDES A NUMBER OF SERVICES AND PROGRAMS THROUGHOUT THE YEAR THAT HAVE THE GOAL OF IMPROVING COMMUNITY HEALTH STATUS. THE VAST MAJORITY OF THESE SERVICES AND PROGRAMS ARE PROVIDED FREE OR AT A NOMINAL CHARGE. SOME OF THESE PROGRAMS, SUCH AS THE ANNUAL FUN-RUN/WALK, ARE DONE IN AN ATTEMPT TO ENCOURAGE AREA RESIDENTS TO BEGIN A HABIT OF REGULAR PHYSICAL FITNESS. APPROXIMATELY 100 ATTENDEES PER YEAR PARTICIPATE IN THIS EVENT.SMC IS ALSO LOOKING TO PROMOTE SAFETY AS AN IMPORTANT COMPONENT OF PHYSICAL ACTIVITY. FOR MANY YEARS SMC HAS CONDUCTED AN ANNUAL BIKE HELMET SAFETY PROGRAM TO APPROPRIATELY SIZE AND SELL APPROXIMATELY 50 BIKE HELMETS AND PROVIDED THESE AT A NOMINAL CHARGE, APPROXIMATELY $8 PER HELMET, UP TO 75% OFF THE RETAIL PRICE. THIS PROGRAM IS WIDELY ADVERTISED PRIOR TO THE EVENT AND MANY SMC PERSONNEL PARTICIPATE DURING THE DISTRIBUTION EVENT. ROUTINELY ONE OF THE MOST VISIBLE EXAMPLES OF THIS COMMUNITY OUTREACH IS THE HEALTH FAIR THAT IS HELD EVERY OTHER YEAR DURING NATIONAL HOSPITAL WEEK. IT IS ESTIMATED THAT THE SUBTOTAL OF VARIOUS TYPES OF COMMUNITY OUTREACH ACTIVITIES AMOUNTED TO $6,000 OF EXPENSE DURING 2010.ALL TOTALED, CONSIDERING ACTUAL COSTS OF IN-KIND STAFF EXPENSES AND EXPENSES PAID BY SMC, THE COMBINED TOTAL FOR PATIENT CARE, EDUCATION, COMMUNITY BUILDING, AND COMMUNITY OUTREACH WAS AT LEAST $36,000 AND PROBABLY MUCH MORE. SMC CONTINUES TO GET BETTER AT TRACKING THIS TYPE OF INFORMATION THAT HISTORICALLY WAS NOT DOCUMENTED BECAUSE THE GOAL WAS TO PROVIDE ASSISTANCE AND SUPPORT WHERE IT WAS NEEDED AND NOT NECESSARILY TAKE CREDIT FOR BEING A GOOD CORPORATE CITIZEN. 12818488 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 111 1 0 0 0 0 0 0 0 0 0 0 X 8 4 1 1 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 0 MN X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 X CARDAMONE-RAYNER MD MARK 1.00 X 0 407467 36824 GRACE RICHARD 1.00 X X 0 246470 15578 LOOMIS TUCKER 1.00 X 0 0 0 OLSON KEITH 1.00 X 0 0 0 PIESCHEL SHARON 1.00 X X 0 0 0 ROSCOE MD BRANDON 40.00 X X 347352 0 26309 SCHMIT-CLINE MD ANNETTE 40.00 X X 294816 0 34603 WELLER PHIL 1.00 X X 0 0 0 WHITED MD BRIAN 1.00 X 0 293376 36159 KUTCHER MD GREGORY 1.00 X 0 383913 36179 OVIATT JD JONATHAN J 1.00 X 0 737491 171708 TARASOVITCH JIM 1.00 X 0 196637 15325 THORESON SCOTT 20.00 X 136580 0 32665 BEERS DDS ADAM 40.00 X 184792 0 29973 DAVIS MD THOMAS 40.00 X 298751 0 20498 DHAMI MD RANDEEP 40.00 X 309936 0 39473 HOLMAN MD HERBERT 40.00 X 209708 0 28305 SCHMITZ DO MICHAEL 40.00 X 273389 0 40544 RUPP MD WILLIAM C 1.00 X 0 820006 49246 2055324 3085360 613389 9 1 1 0 HEYMANN CONSTRUCTION COMPANY 210 3RD SOUTH STREET NEW ULM MN 560730606 CONSTRUCTION GENERAL 1526294 IMMANUEL ST JOSEPH'S-MAYO HEALTH SYSTEM 1025 MARSH STREET MANKATO MN 56001 PURCHASED SERVICES 977777 ST JOHN LUTHERAN HOME 201 S COUNTY ROAD 5 SPRINGFIELD MN 56087 PURCHASED SERVICES 186607 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 PURCHASED SERVICES 110347 4 47804 8759 5129 61692 NET PATIENT REVENUE 620000 16538847 16538847 RENT FROM AFFILIATES 531120 8400 8400 EDUCATION REVENUE 611600 5815 5815 16553062 84577 84577 1900 1900 1900 1900 1080 1080 1080 1080 1289 3266 -1977 -1977 MEDICAL DIRECTOR FEES 541900 6800 6800 MISC. REVENUE 900099 2203 1583 620 MEDICAL RECORD/TRANSCR 541900 1253 1253 972 972 11228 16711562 16556870 0 93000 32305 32305 872325 703080 169245 551946 551946 5431157 5116225 314932 186369 177948 8421 1058465 1004617 53848 410049 382387 27662 29694 29694 816074 651664 164410 42115 42115 1663695 1556750 106945 825610 386265 439345 340391 336523 3868 80877 67175 13702 53211 53211 1103941 1094446 9495 48097 48097 BAD DEBT EXPENSE 363786 363786 MN CARE TAX 164728 164728 MEDICAID SURCHARGE 84733 84733 EMPLOYEE RELATED EXPENS 57020 56977 43 DUES/LICENSES/SUBSCR 51106 27624 23482 7000 6098 902 14274694 12818488 1456206 0 350 350 44907 38197 115965 21641 3071512 2322704 102744 95471 79644 47933 17566753 6875579 9602296 10691174 7344374 9310126 354807 366511 20716599 22894107 1424404 841268 237669 561445 1662073 1402713 X 19034540 21491394 19986 0 19054526 21491394 20716599 22894107 2436868 0 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13284 13284 7703526 2807585 4895941 9849943 4067994 5781949 10691174 MAYO POOLED INVESTMENTS 9310126 F 9310126 DUE TO AFFILIATES 450116 DEFERRED COMPENSATION LIABILITY 111329 561445 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 0 1 X 450.000000000000 1 1 1 0 1 1 22144 22144 0.00160 1522922 935639 587283 0.04220 1545066 935639 609427 0.04380 14064 1096 12968 0.00090 17183 17183 0.00120 31247 1096 30151 0.00210 1576313 936735 639578 0.04590 6184 6184 0.00040 6184 6184 0.00040 0 217774 4980329 4925668 54661 X 1 1 1 1 SPRINGFIELD MEDICAL CENTER - MAYO HEALTH

625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087

X X X X NOT REQUIRED 1 2 SPRINGFIELD DENTAL CLINIC

602 NORTH JACKSON AVENUE SPRINGFIELD MN 56087

DENTAL CLINIC LAMBERTON CLINIC

310 SOUTH MAIN LAMBERTON MN 56152

CLINIC Part I, Line 3c: THE ORGANIZATION USES FEDERAL POVERTY GUIDELINES TO SET A MAXIMUM PAYMENT IN RELATION TO THE PATIENT'S INCOME. CONSIDERATION FOR 100% CHARITY CARE ADJUSTMENT (FREE CARE) IS GIVEN FOR CIRCUMSTANCES WHERE THE PATIENT IS UNEMPLOYED OR HAS NO SOURCE OF INCOME, DOES NOT HAVE A CURRENT PERMANENT RESIDENCE, OR HAS OTHER SIGNIFICANT FINANCIAL HARDSHIPS. Part I, Line 6a: THE ANNUAL REPORT FOR THE FILING ORGANIZATION IS PART OF A CONSOLIDATED REPORT PREPARED BY MAYO CLINIC. Part I, Line 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS).THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO-CHARGE RATIO. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 363786. Part II: SMC PARTICIPATES IN MANY WAYS AS A REGULAR BUSINESS MEMBER OF THE COMMUNITY. AS SUCH, THERE ARE OFTEN TIMES FINANCIAL CONTRIBUTIONS MADE, FOR EXAMPLE, TO HELP SPONSOR THE DISTRIBUTION OF HEALTH AND SAFETY BOOKS TO SCHOOL CHILDREN OR PERHAPS PARTICIPATION IN A BUSINESS EVENT SUCH AS THE ANNUAL HOME & GARDEN SHOW. Part III, Line 4: BAD DEBT EXPENSE AT COST IS DETERMINED USING THE SAME COST-TO-CHARGE RATIO THAT IS USED TO CALCULATE CHARITY CARE AND MEDICAID SHORTFALL. DISCOUNTS AND ALLOWANCES ARE ACCOUNTED FOR SEPARATELY FROM BAD DEBT EXPENSE.FROM CONSOLIDATED FINANCIAL STATEMENTS: ACCOUNTS RECEIVABLE FOR MEDICAL SERVICES - ACCOUNTS RECEIVABLE FOR MEDICAL SERVICES ARE STATED AT NET REALIZABLE VALUE. THE CLINIC ESTIMATES THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED ON HISTORIC WRITE-OFFS AND THE AGING OF THE ACCOUNTS. ACCOUNTS ARE WRITTEN OFF WHEN COLLECTION EFFORTS HAVE BEEN EXHAUSTED.SMC REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPALS (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP. Part III, Line 8: THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SURPLUS REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT (USING A MEDICARE COST REPORT STEP-DOWN METHODOLOGY).REASONS WHY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT ARE: (1) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR CHARITY CARE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; (3) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND (4) THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE OTHER COMMUNITY BENEFIT NEEDS. Part III, Line 9b: MAYO CLINIC AND ITS AFFILIATES STRIVE TO ASSIST ALL PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION PRIOR TO ENLISTING THE ASSISTANCE OF A COLLECTION AGENCY BY MAKING EVERY REASONABLE ATTEMPT TO COLLECT FROM INSURANCE COMPANIES AND OTHER THIRD-PARTY PAYORS. IN 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 8: 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 TO THE MINNESOTA HOSPITAL ASSOCIATION. Part VI, Line 2: ADMINISTRATION, ALONG WITH MEMBERS OF THE SPRINGFIELD BOARD OF DIRECTORS WORK WITH LOCAL BUSINESSES, COMMUNITY LEADERS, CHARITIES, AND HEALTH DEPARTMENTS TO ASSESS HEALTHCARE NEEDS. PROGRAMS AND SERVICES, MONETARY DONATIONS, EDUCATION, VOLUNTEERS AND GOODS ARE SUPPLIED ONCE THOSE NEEDS ARE ASSESSED. REQUESTS FOR ASSISTANCE ARE REVIEWED AND EVALUATED BY ADMINISTRATION AND THE SPRINGFIELD BOARD OF DIRECTORS. Part VI, Line 3: ELIGIBILITY: THE CHARITY CARE INFORMATION BROCHURE IS PROMINENTLY DISPLAYED IN REGISTRATION AND PATIENT-ACCOUNT 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. MAYO CLINIC EMPLOYEES MAY REFER PATIENTS TO A FINANCIAL COUNSELOR.3. COLLECTION AGENCIES MAY REFER PATIENTS.4. THE BUSINESS SERVICES/PATIENT FINANCIAL SERVICES DEPARTMENT MAY REFER PATIENTS TO A FINANCIAL COUNSELOR.5. REFERRING PHYSICIANS MAY REFER PATIENTS.6. MAYO PHYSICIANS MAY REFER PATIENTS.7. 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. MAYO CLINIC 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: SPRINGFIELD MEDICAL CENTER - MAYO HEALTH SYSTEM (SMC) IS LOCATED IN SPRINGFIELD, MINNESOTA. ITS SERVICE AREA INCLUDES BROWN COUNTY AND PORTIONS OF REDWOOD, WATONWAN, AND COTTONWOOD COUNTIES IN SOUTHWESTERN MINNESOTA. SMC IS A DESIGNATED CRITICAL ACCESS HOSPITAL FOR MEDICARE PURPOSES AND IS ONE OF THREE HOSPITALS IN BROWN COUNTY. THE POPULATION OF BROWN COUNTY (WHICH COMPRISES MOST OF SMC'S SERVICE AREA) IS APPROXIMATELY 26,000. ACCORDING TO 2008 CENSUS DATA, APPROXIMATELY 9% OF BROWN COUNTY INDIVIDUALS ARE LIVING BELOW THE POVERTY LEVEL. APPROXIMATELY 6% OF THE POPULATION IS UNINSURED. IN ADDITION, APPROXIMATELY 19% OF THE INDIVIDUALS LIVING IN BROWN COUNTY ARE OVER AGE 65. Part VI, Line 6: THIS HOSPITAL IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION- EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATION'S ACTIVITIES.SURPLUS FUNDS - 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.OPEN V. CLOSED STAFF MODEL - STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHSYICIANS IN THE COMMUNITY.EMERGENCY ROOM - THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. Part VI, Line 7: THIS ORGANIZATION IS A PART OF MAYO HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO 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. 1 FRIENDS OF BATAHOLA PO BOX 15204 BATON ROUGE LA 708955204 721513873 501(C)(3) 17183 BOOK VALUE MEDICAL SUPPLIES MEDICAL SUPPLIES FOR CULTURAL CENTER 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS 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. 0 1 0 0 0 0 0 0 0 CARDAMONE-RAYNER MD MARK 0 407467 0 0 0 0 0 9800 0 27024 0 444291 0 0 GRACE RICHARD 0 230365 0 0 0 16105 0 216 0 15362 0 262048 0 0 ROSCOE MD BRANDON 337356 0 9996 0 0 0 3369 0 22940 0 373661 0 0 0 SCHMIT-CLINE MD ANNETTE 289816 0 5000 0 0 0 12250 0 22353 0 329419 0 0 0 WHITED MD BRIAN 0 293376 0 0 0 0 0 12250 0 23909 0 329535 0 0 KUTCHER MD GREGORY 0 346309 0 37604 0 0 0 12250 0 23929 0 420092 0 0 OVIATT JD JONATHAN J 0 448008 0 0 0 289483 0 144702 0 27006 0 909199 0 146270 TARASOVITCH JIM 0 192924 0 0 0 3713 0 0 0 15325 0 211962 0 0 THORESON SCOTT 136580 0 0 0 0 0 7225 0 25440 0 169245 0 0 0 BEERS DDS ADAM 179792 0 5000 0 0 0 7604 0 22369 0 214765 0 0 0 DAVIS MD THOMAS 298751 0 0 0 0 0 9800 0 10698 0 319249 0 0 0 DHAMI MD RANDEEP 302736 0 7200 0 0 0 12250 0 27223 0 349409 0 0 0 HOLMAN MD HERBERT 209708 0 0 0 0 0 10469 0 17836 0 238013 0 0 0 SCHMITZ DO MICHAEL 266389 0 7000 0 0 0 12250 0 28294 0 313933 0 0 0 RUPP MD WILLIAM C 0 694131 0 0 0 125875 0 40938 0 8308 0 869252 0 118772 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. JONATHAN OVIATT $284,303 WILLIAM RUPP, M.D. $111,567 Supplemental Information Part III COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE CORE 990 PART VI SECTION B LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED. BRANDON ROSCOE MD RECRUITMENT X 30000 16672 0 1 1 16672 Form 990, Part VI, Section A, line 2 DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES: RICHARD GRACE GREGORY KUTCHER M.D. SHARON PIESCHEL JAMES TARASOVITCH HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: MARK CARDAMONE-RAYNER, M.D. GREGORY KUTCHER, M.D. JAMES TARASOVITCH BRIAN WHITED, M.D. DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES: JONATHAN OVIATT HAS A BUSINESS RELATIONSHIP WITH RICHARD GRACE. BOARD MEMBERS TUCKER LOOMIS AND SHARON PIESCHEL HAVE A BUSINESS RELATIONSHIP. Form 990, Part VI, Section A, line 3 MAYO-AFFILIATED ENTITIES ROUTINELY DELEGATED VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO RELATED ENTITIES. Form 990, Part VI, Section A, line 6 THE SOLE CORPORATE MEMBER IS IMMANUEL-ST. JOSEPH'S--MAYO HEALTH SYSTEM. Form 990, Part VI, Section A, line 7a THE MEMBER ELECTS THE MEMBER DIRECTORS. THE OTHER DIRECTORS ARE ELECTED BY THE MEMBER FROM NOMINEES APPROVED BY THE BOARD OF DIRECTORS. Form 990, Part VI, Section A, line 7b THE ARTICLES AND BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, AND DEBT, AMENDMENT OF THE ARTICLES AND BYLAWS, AND GENERAL OPERATION DECISIONS. Form 990, Part VI, Section B, line 11 THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE VICE PRESIDENT OF FINANCE, THE CFO AND THE ADMINISTRATOR. THE VICE PRESIDENT OF FINANCE, CFO AND/OR ADMINISTRATOR PRESENT HIGHLIGHTS OF THE 990 TO THE REGIONAL FINANCE COMMITTEE AND SITE BOARD PRIOR TO THE FILING OF THE RETURNS. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. HIGHLIGHTS ARE PRESENTED TO BOARD MEMBERS, AND THE REVIEW IS DOCUMENTED IN MEETING MINUTES. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990. Form 990, Part VI, Section B, line 12c MAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF MAYO CLINIC (AND/OR AFFILIATE) AND THE OUTSIDE ENTITY. ADDITIONAL CONFLICT OF INTEREST POLICIES AND PROCEDURES EXIST FOR CERTAIN ENTITIES CONCERNING RESEARCH CONTRACTS AND OTHER TYPES OF POTENTIAL CONFLICTS. Form 990, Part VI, Section B, line 15b 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 AND CAO 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 FIVE OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. THE COMPENSATION COMMITTEE IS CHARGED WITH THE RESPONSIBILITY TO RECOMMEND TO THE SOUTHWEST MINNESOTA REGION BOARD OF DIRECTORS ON AN ANNUAL BASIS THE APPROPRIATE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AND CHIEF ADMINISTRATIVE OFFICER AND TOTAL COMPENSATION STRATEGY FOR THE ORGANIZATION. THE COMPENSATION COMMITTEE IS CREATED BY A BOARD RESOLUTION. CORE PURPOSE: a. REVIEW AND RECOMMEND TO THE BOARD THE TOTAL COMPENSATION STRATEGY OF THE SOUTHWEST MINNESOTA REGION, CONSISTENT WITH THE ORGANIZATION'S MISSION AND VALUES. b. REVIEW AND RECOMMEND TO THE BOARD THE TOTAL COMPENSATION PROPOSALS TO ENSURE SUPPORT OF ORGANIZATIONAL STRATEGY. c. REVIEW COMPENSATION AND BENEFITS DATA IN CONJUNCTION WITH MAYO CLINIC SHARED SERVICES GOALS IN MAKING RECOMMENDATIONS TO THE BOARD FOR TOTAL COMPENSATION PLANS. d. REVIEW AND RECOMMEND TO THE BOARD FOR APPROVAL EXECUTIVE COMPENSATION INCLUDING INCENTIVE PLANS FOR THE CHIEF EXECUTIVE OFFICER AND CHIEF ADMINISTRATIVE OFFICER. e. REVIEW AND RECOMMEND TO THE BOARD ORGANIZATIONAL SEVERANCE GUIDELINES. f. MANAGEMENT MEMBERS OF THE COMMITTEE MAY NOT VOTE ON ACTIONS RELATED DIRECTLY TO MANAGEMENT COMPENSATION. g. ANNUALLY REVIEW THE PHYSICIAN COMPENSATION STRATEGY AND ITS EFFECTIVENESS. RECOMMEND TO THE BOARD THE STRATEGIES AND GUIDELINES FOR MERIT PAY, INCENTIVES, SEVERANCE PAY, CONTRACTUAL RELATIONSHIPS AND OTHER UNUSUAL COMPENSATION ARRANGEMENTS THAT MAY ARISE. h. PERFORM ANY OTHER DUTIES AND RESPONSIBILITIES AS THE BOARD MAY DEEM NECESSARY, ADVISABLE OR APPROPRIATE FOR THE COMMITTEE TO PERFORM. i. ANNUALLY REVIEW THE COMPENSATION COMMITTEE CHARTER AND RECOMMEND CHANGES TO THE BOARD. Form 990, Part VI, Section C, line 19 THE FILING ORGANIZATION'S GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST AND ALSO ON THE MAYOCLINIC.ORG WEBSITE. THE FILING ORGANIZATION IS A HOSPITAL AFFILIATED WITH MAYO CLINIC. AS SUCH, MAYO CLINIC'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THE FILING ORGANIZATION'S FORM 990 AND WOULD BE AVAILABLE UPON REQUEST OF THE FORM 990. AVERAGE HOURS PER WEEK DEVOTED TO POSITION WITH RELATED ORGANIZATION PART VII SECTION A MARK CARDAMONE-RAYNER, M.D. 40 HOURS RICHARD GRACE 40 HOURS GREGORY KUTCHER, M.D. 40 HOURS JONATHAN OVIATT 40 HOURS WILLIAM RUPP, M.D. 40 HOURS JAMES TARASOVITCH 40 HOURS BRIAN WHITED, M.D. 40 HOURS SCOTT THORESON 20 HOURS PART XI 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 0 0 1 0 0 0 0 0 1 0 1 1 0 1 1 0 0 1 MMSI INC K 747911 GAAP IMMANUEL ST JOSEPH'S - MAYO HEALTH SYSTEM L 977777 GAAP MAYO CLINIC L 110346 GAAP MAYO CLINIC R 83394 GAAP