2011-11-15T13:17:19-06:00 2010-12-31 990 2010-01-01 410739106 MAYO CLINIC - METHODIST HOSPITAL MAYO 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 Bradley D Schmidt 5075381297 2011-11-15 2010 2016-03-07 17:11:31Z JOHN H NOSEWORTHY MD 200 FIRST STREET SW ROCHESTER MN 55905 534706968 0 X WWW.MAYOCLINIC.ORG/METHODISTHOSPITAL X 1953 MN MAYO CLINIC - METHODIST HOSPITAL IS A 794 BED ACUTE-CARE FACILITY. 22 0 2915 358 0 0 452686 54981 468551458 530876253 -437292 42034 2788117 2706545 471354969 533679813 1007000 1711500 0 0 156522903 176409074 0 0 0 210670398 234298046 368200301 412418620 103154668 121261193 466050954 380478083 116952726 109941305 349098228 270536778 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 378188640 527726110 PATIENT CARE (SEE SCHEDULE O)PATIENT CARE: MAYO CLINIC - METHODIST HOSPITAL WORKS COLLABORATIVELY WITH AFFILIATED ENTITIES IN ROCHESTER, MN (MAYO CLINIC AND MAYO CLINIC - SAINT MARYS HOSPITAL) TO FORM AN INTEGRATED MEDICAL CENTER DEDICATED TO PROVIDING COMPREHENSIVE DIAGNOSIS AND TREATMENT IN VIRTUALLY EVERY MEDICAL AND SURGICAL SPECIALTY. UTILIZING COMMON GOVERNANCE AND SHARED SYSTEMS, POLICIES AND PROCEDURES WHENEVER POSSIBLE, MCMH AND ITS AFFILIATED ENTITIES IN ROCHESTER STRIVE TO PROVIDE CONSISTENT, HIGH QUALITY HEALTH CARE SERVICES AND KNOWLEDGE DELIVERY REGARDLESS OF WHERE AND HOW THESE ARE PROVIDED. MAYO CLINIC IS THE SOLE MEMBER OF MCMH.OVERALL GOVERNANCE FOR MAYO CLINIC AND ITS AFFILIATED ENTITIES IS PROVIDED BY A 31-MEMBER BOARD OF TRUSTEES COMPOSED OF A MAJORITY OF PUBLIC MEMBERS ALONG WITH MAYO CLINIC PHYSICIANS AND ADMINISTRATORS. THIS BOARD OF TRUSTEES ENSURES THE ENTIRE ORGANIZATION, INCLUDING MCMH, REMAINS TRUE TO ITS MISSION OF PROMOTING THE COMMON GOOD BY PROVIDING FOR THE HEALTH CARE NEEDS OF THE PUBLIC RATHER THAN FOR PRIVATE BENEFIT. A SEPARATE BOARD OF DIRECTORS PROVIDES GOVERNANCE AND POLICY DIRECTION FOR MCMH.MAYO CLINIC IS THE FIRST AND LARGEST INTEGRATED, NOT-FOR-PROFIT MEDICAL GROUP PRACTICE IN THE WORLD. ITS UNIQUE STYLE OF CARE BRINGS TOGETHER TEAMS OF EXPERTS TO PROVIDE HIGH-QUALITY, AFFORDABLE AND COMPASSIONATE CARE TO EACH PATIENT CONSISTENT WITH OUR PRIMARY VALUE - "THE NEEDS OF THE PATIENT COME FIRST". MAYO CLINIC'S MISSION IS "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". MCMH COMBINES OUR HERITAGE OF MEDICAL EXPERTISE, CAREFUL ATTENTION TO INDIVIDUAL PATIENT NEEDS AND THE EXPERTISE AND RESOURCES OF OUR AFFILIATED ENTITIES IN ROCHESTER TO PROVIDE A THOROUGH AND PERSONAL APPROACH TO HEALTH CARE TO MEET THE NEEDS OF OUR PATIENTS.MCMH PROVIDES A BROAD RANGE OF SERVICES IN MOST MEDICAL SPECIALTIES. SOME OF THE TREATMENT AREAS UNIQUE TO THE HOSPITAL INCLUDE: TRANSPLANT PROGRAMS FOR LIVER, KIDNEY, PANCREAS, BLOOD AND BONE MARROW; OBSTETRICS AND GYNECOLOGY (INCLUDING A PERINATAL CENTER FOR CARE OF HIGH-RISK PREGNANCIES), A WOMEN'S CANCER PROGRAM, AN INTRA-OPERATIVE RADIATION SURGICAL SUITE AND A SPECIAL UNIT FOR TREATING PSORIASIS AND OTHER DERMATOLOGICAL PROBLEMS. MCMH HAS 794 LICENSED BEDS AND 41 OPERATING ROOMS WHERE 26,368 SURGICAL PROCEDURES WERE PERFORMED IN 2010. DURING 2010, 16,496 PATIENTS WERE ADMITTED TO MCMH. MCMH OPERATES ON A NONDISCRIMINATORY BASIS, REGARDLESS OF RACE, COLOR, SEX, RELIGION OR NATIONAL ORIGIN. MCMH PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AND SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. CHARITY CARE IS ALSO PROVIDED FOR PATIENTS THAT ARE FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. IN 2010:THE COST OF CHARITY CARE PROVIDED WAS APPROXIMATELY $4,826,800. THE COST OF UNCOMPENSATED CARE PROVIDED TO LOW INCOME PATIENTS THROUGH MEDICAID WAS APPROXIMATELY $11,800,000.THE COST OF UNCOMPENSATED CARE PROVIDED THROUGH MEDICARE WAS APPROXIMATELY $7,188,000. 290052 4000 130823 EDUCATION (SEE SCHEDULE O)EDUCATION: MCMH IS INTEGRAL TO THE EDUCATION PROGRAMS OF MAYO CLINIC'S COLLEGE OF MEDICINE, PROVIDING ESSENTIAL CLINICAL CARE EXPERIENCES FOR RESIDENTS, STUDENTS AND TRAINEES. AS A TEACHING HOSPTIAL, MCMH PROVIDED EDUCATIONAL EXPERIENCE TO MORE THAN 1,400 RESIDENTS OF THE MAYO GRADUATE SCHOOL OF MEDICINE IN 2010. MCMH ALSO SPONSORS SEVERAL PROGRAMS TO FURTHER THE HOSPITAL'S COMMITMENT TO PROMOTING THE HIGHEST POSSIBLE QUALITY OF PATIENT CARE. THESE INCLUDE A DIETETIC INTERNSHIP PROGRAM, PHARMACY RESIDENCY PROGRAM, CHAPLAINCY INTERNSHIP PROGRAM, AND A NURSING EDUCATION PROGRAM. 4280360 1707500 2820826 COMMUNITY BENEFIT OTHER (SEE SCHEDULE O)COMMUNITY BENEFIT AND OTHER: MCMH PROVIDES A MULTITUDE OF COMMUNITY ACTIVITIES AND SERVICES THAT ARE HEAVILY SUBSIDIZED BY THE HOSPITAL. THESE ACTIVITIES INCLUDE:*PERINATAL EDUCATION, WHICH OFFERS A WIDE SELECTION OF CLASSES TO HELP FAMILIES PLAN AND PREPARE FOR CHILDBIRTH AND CARE OF A BABY. THESE CLASSES INCLUDE: PRECONCEPTION, INFANT PASSENGER SAFETY, PRENATAL, PRENATAL: COMFORT MEASURES PLUS, WEEKEND PRENATAL, MAGNIFICENT MULTIPLES, YOUNG MOM'S CLINIC, CHILDBIRTH REVIEW, CESAREAN BIRTH, VAGINAL BIRTH AFTER CESAREAN, BREASTFEEDING, BREASTFEEDING: A CHOICE FOR THE WORKING MOM, WORKING MOMS BREASTFEEDING SUPPORT NETWORK, ADOPTIVE PARENT, GRANDPARENTING AND PREPARING CHILDREN TO ATTEND BIRTH. IN AGGREGATE, 244 CLASSES WERE OFFERED IN 2010 WITH 2,518 PARTICIPANTS. *OBSTETRICS TOURS ARE OFFERED THROUGHOUT THE YEAR. IN 2010, 37 TOURS WERE CONDUCTED WITH 162 PARTICIPANTS.*PRIVATE PRENATAL EDUCATION SESSIONS ARE AVAILABLE FOR WOMEN CONFINED TO BED REST AT HOME AND FAMILIES UNABLE TO TRAVEL LONG DISTANCES. IN ADDITION, INTERPRETERS ARE PROVIDED FOR OBSTETRIC TOURS AND EDUCATIONAL SESSIONS ARRANGED FOR SPEAKERS OF OTHER LANGUAGES. *MEETING SPACE FOR THE FOLLOWING ORGANIZATIONS: PAP SUPPORT GROUP,TOASTMASTERS, AND TOPS.*DAILY PUBLIC TOURS OF THE HOSPITAL.*DAILY CHAPEL SERVICES.*NED'S CAFETERIA (NUTRITION-EDUCATION-DINING) WHERE REGISTERED DIETICIANS PROVIDE CONSULTATION FOR PATIENTS, VISITORS, AND EMPLOYEES.MCMH HAS A VERY ACTIVE AND ENGAGED AUXILIARY. IN 2010, 358 ACTIVE VOLUNTEERS PROVIDED 48,518 HOURS OF DONATED TIME AND HAD 166,441 CONTACTS IN SERVICE TO THE PATIENTS, VISITORS AND STAFF OF MCMH. THE ESTIMATED VALUE OF THE TIME DONATED BY THESE METHODIST HOSPITAL AUXILIARY VOLUNTEERS WAS APPROXIMATELY $1,036,300 (BASED ON THE AVERAGE VALUE DETERMINED BY THE INDEPENDENT SECTOR ORGANIZATION FOR 2010). METHODIST HOSPITAL AUXILIARY VOLUNTEERS RECEIVED OVER $250,000 FROM MCMH AND MAYO CLINIC IN 2010 TO SUPPORT ACTIVITIES ON BEHALF OF PATIENTS AND VISITORS TO THE HOSPITAL.SOME OF THE ACTIVITIES CONDUCTED BY THE AUXILIANS INCLUDE:*STAFFING 4 INFORMATION DESKS THROUGHOUT THE HOSPITAL TO HELP VISITORS AND PATIENTS NAVIGATE THROUGH THE HOSPITAL.*OPERATING THE HOSPITAL GIFT SHOP WITH THE PROCEEDS GOING TO THE GOOD SAMARITAN FUND WHICH ASSISTS NEEDY PATIENTS WITH THEIR MEDICAL EXPENSES. IN 2010, THE GOOD SAMARITAN FUND PROVIDED APPROXIMATELY $133,000 OF FINANCIAL ASSISTANCE TO MCMH PATIENTS.*OFFERING HOSPITALITY SERVICES TO PATIENTS SUCH AS SERVICE TO FAMILIES AND VISITORS ON THE ONCOLOLGY/HEMATOLOGY AND TRANSPLANT UNITS WITH COFFEE AND CONVERSATION.*MAKING BEREAVEMENT CLOTHING FOR NEONATES WHO DO NOT SURVIVE AND STUFFED ANIMALS FOR CHILDREN WHO ARE HAVING MEDICAL PROCEDURES.*PROVIDING A SHOPPING CART SERVICE FOR PATIENTS.*GIVING GENTLE, NON-THERAPUTIC HAND MASSAGES FOR PATIENTS AND THEIR FAMILY MEMBERS.*STAFFING THE PATIENT LIBRARY.*ASSISTING FAMILY MEMBERS IN THE SURGICAL WAITING ROOM, OUT-PATIENT SURGERY AND GI PROCEDURE AREAS. THE AUXILIARY ALSO ADMINISTERS THE MAYO CLINIC ERICKSON HAIR AND SKIN CARE CENTER TO PROVIDE PRODUCTS, SERVICES AND EDUCATION FOR PATIENTS EXPERIENCING THE COSMETIC SIDE EFFECTS OF CANCER TREATMENT. THE CENTER WAS DEVELOPED IN RESPONSE TO EMOTIONAL SUFFERING EXPERIENCED BY INDIVIDUALS WHO LOSE THEIR HAIR BECAUSE OF CHEMOTHERAPY OR OTHER CANCER TREATMENTS. THE CENTER, WHICH IS STAFFED BY 2 LICENSED COSMETOLOGISTS AND 16 AUXILIANS, PROVIDES WIGS AND CAPS AT NO COST TO PATIENTS. DURING 2010, THE CENTER SERVED 1,038 PATIENTS AND GAVE AWAY 255 WIGS AND 826 CAPS AND BERETS. IN ADDITION, THE CENTER PROVIDED "LOOK GOOD - FEEL BETTER" CLASSES FOR CANCER PATIENTS. IN 2010, 12 GROUP CLASSES WERE OFFERED, SERVING 53 PATIENTS. THE TOTAL COST OF THE CENTER IN 2010 WAS APPROXIMATELY $103,500. 3019320 3019320 SPACE LEASED TO AFFILIATES (SEE SCHEDULE O)SPACE LEASED TO AFFILIATES: MCMH LEASES SPACE TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE. 3019320 3019320 385778372 1 1 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 0 0 2915 1 0 0 0 0 0 0 0 0 0 0 X 22 0 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 MN X CORPORATE TAX 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 X CARRYER MD PETER W 1.00 X 0 1216809 9629 CASCINO MD TERRANCE L 1.00 X 0 827596 149352 DECKER MD WYATT W 1.00 X 0 545983 68622 DESCHAMPS MD CLAUDE 1.00 X 0 1376283 97280 EVANS MD BRUCE A 1.00 X 0 260267 40023 FRUSTI DOREEN K 1.00 X 0 288022 25785 HARPER JR MD CHARLES M 1.00 X X 0 604851 343117 HERMAN MD DAVID C 1.00 X 0 901932 95441 LA RUSSO MD NICHOLAS F 1.00 X 0 2510873 10733 LANDWEHR MARY ELLEN 1.00 X 0 42738 28869 NARR MD BRADLY J 1.00 X 0 1261355 93321 NOSEWORTHY MD JOHN H 1.00 X X 0 1637388 802177 RIZZA MD ROBERT A 1.00 X 0 2398719 15408 ROCK MD MICHAEL G 1.00 X X 0 1919897 205556 ROGER MD VERONIQUE L 1.00 X 0 853964 83022 SANTRACH MD PAULA J 1.00 X 0 433106 59335 SAWYER NAN B 1.00 X X 0 503199 63004 SCHMIDT BRADLEY D 1.00 X X 0 300232 109103 STELLNER WINSTON L 1.00 X 0 153950 27192 WARNER MD MARK A 1.00 X 0 1582422 97097 WEIS SHIRLEY A 1.00 X X 0 1355446 323373 WILLIAMS MD AMY W 1.00 X 0 278197 24887 BROWN WILLIAM A 1.00 X 0 209109 54338 HUBERT SHERRY L 1.00 X 0 235832 44725 OVIATT JONATHAN J 1.00 X 0 737491 171708 BERGRUD KAREN J 40.00 X 156991 0 13252 ROWEKAMP GREGORY T 40.00 X 137121 0 41282 SISKA MARK H 40.00 X 155233 0 38247 WEISS WILLIAM T 40.00 X 149896 0 35393 WOLF ROBERT C 40.00 X 147676 0 20982 BRIGHAM ROBERT F X 0 741182 24883 EHMAN MD RICHARD L X 0 2133609 109509 FORBES MD GLENN S X 0 5376501 13920 KORSMO JEFFREY O X 0 1190676 73174 OLSEN MD KERRY D X 0 2586322 110259 RUMMANS MD TERESA A X 0 322237 33514 SCHWENK MD NINA M X 0 549170 44186 WILSON MD WALTER R X 0 654304 17140 COLLINS CRAIG C X 0 216104 47742 JOHNSON PAMELA O X 0 204750 42708 STIRN SUSAN L X 0 147357 34360 746917 36557873 3743648 106 1 1 0 MAYO FOUNDATION FOR MEDICAL EDUCATION & 200 FIRST STREET SW ROCHESTER MN 55905 ACCOUNTS PAYABLE PROCUREMENT AGENT 19313009 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 RENT 4346966 ALBERT LEA MEDICAL CENTER -- MAYO HEALTH 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 RENT 122340 FRANCISCAN SKEMP MEDICAL CENTER INC 700 WEST AVE SOUTH LA CROSSE WI 54601 RENT 110220 4 50208 4773 54981 NET PATIENT REVENUE 620000 527726110 527726110 RENTAL REVENUE FROM AF 531120 3019320 3019320 EDUCATION REVENUE 611600 130823 130823 530876253 101097 101097 46741 105804 -59063 -59063 -59063 703548 921351 -217803 -103522 -114281 CAFETERIA/VENDING REVE 722210 2908993 2908993 MISC. REVENUE 900099 15355 15355 2924348 533679813 533697079 0 -72247 1700000 1700000 11500 11500 136403861 133908024 2495837 4092590 4017706 74884 25773917 25302394 471523 10138706 9953194 185512 29885 17258 12627 51672 51672 72648529 49585004 23063525 638 638 118798102 118780424 17678 115592 115592 8644442 8596312 48130 302486 301352 1134 231692 231692 366152 366152 16982243 16979551 2692 2767 2767 BAD DEBT EXPENSE 6217252 6217252 MEDICAID SURCHARGE 5194789 5194789 MN CARE TAX 4418419 4418419 DUES, LICENSES AND SUBS 170635 5405 165230 EMPLOYEE RELATED EXPENS 122751 72947 49804 412418620 385778372 26640248 0 14600 14600 121855952 77760888 3546121 4172360 319638 263093 339786121 169861482 166808139 169924639 12177206 12593266 161329298 115749237 466050954 380478083 14519869 13728335 15864185 12100000 86568672 84112970 116952726 109941305 X 348562193 269775722 266535 398657 269500 362399 349098228 270536778 466050954 380478083 X 121261193 -199822643 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2290358 21060 249283 2560701 169500 1753275 367583 2290358 71000 100000 1500 169500 0.85850 0.14150 0 1 1 4184851 4184851 255417859 123397009 132020850 80179434 46460496 33718938 3977 3977 0 169924639 DUE FROM AFFILIATES 115749237 115749237 DUE TO AFFILIATES 84112970 84112970 Description of Intended Use of Endowment Funds: Part V, Line 4: THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR RESEARCH AND EDUCATION PROGRAMS. 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 X 1 X 1 X 1 1 1 0 1 1 4826760 4826760 0.01190 23995726 12199336 11796390 0.02900 28822486 12199336 16623150 0.04090 13856945 130823 13726122 0.03380 28663091 20459366 8203725 0.02020 1700000 1700000 0.00420 44220036 20590189 23629847 0.05820 73042522 32789525 40252997 0.09910 0 2772167 132625864 145092488 -12466624 X 1 1 1 1 MAYO CLINIC - METHODIST HOSPITAL

201 WEST CENTER STREET ROCHESTER MN 55905

X X X NOT REQUIRED 1 6 MAYO DIALYSIS LACROSSE

191 THEATER ROAD ONALASKA WI 54650

HOSPITAL BASED DIALYSIS FACILITY MAYO DIALYSIS ALBERT LEA

1705 SE BROADWAY ALBERT LEA MN 56007

HOSPITAL BASED DIALYSIS FACILITY MAYO DIALYSIS FAIRMONT

835 JOHNSON STREET FAIRMONT MN 56031

HOSPITAL BASED DIALYSIS FACILITY MAYO DIALYSIS OWATONNA

2200 NW 26TH STREET OWATONNA MN 55060

HOSPITAL BASED DIALYSIS FACILITY MAYO DIALYSIS WABASHA

1200 FIFTH GRANT BLVD WABASHA MN 55981

HOSPITAL BASED DIALYSIS FACILITY MAYO DIALYSIS DECORAH

901 MONTGOMERY STREET DECORAH IA 52101

HOSPITAL BASED DIALYSIS FACILITY 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: THERE WAS NO NET COMMUNITY BENEFIT COST ATTRIBUTED TO PHYSICIAN CLINICS THAT WERE INCLUDED IN SUBSIDIZED HEALTH SERVICES. 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 $ 6217252. Part III, Line 4: 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.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.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. 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). HOWEVER, USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY ACTUALLY RESULTS IN A MEDICARE SHORTFALL OF $7,188,000 AS REPORTED IN THE CORE FORM, PART III, PROGRAM SERVICE ACCOMPLISHMENTS.THE MOST COMMON REASONS FOR A DIFFERENCE BETWEEN THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H AND THE MEDICARE SHORTFALL REPORTED ON THE CORE FORM, PART III INCLUDE: (1) INCLUSION OF MEDICARE ADVANTAGE REVENUE AND EXPENSES; (2) INCLUSION OF PART B REVENUE AND EXPENSES; (3) INCLUSION OF OTHER FEE SCHEDULE REVENUE; AND (4) SOME TIMING ISSUES.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 - METHODIST HOSPITAL IS AN AFFILATE OF MAYO CLINIC. 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 CLINICS 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. 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: MAYO CLINIC ATTRACTS PATIENTS FROM AREAS FAR BEYOND ITS IMMEDIATE COMMUNITIES. PATIENTS COME TO MAYO CLINIC FROM EVERY STATE AND MANY FOREIGN COUNTRIES. BESIDES ITS PRINCIPAL CLINICAL AND HOSPITAL FACILITIES IN ROCHESTER, MINNESOTA, MAYO CLINIC HAS A NETWORK OF COMMUNITY BASED HEALTH CARE PROVIDERS IN OVER 70 COMMUNITIES THROUGHOUT SOUTHERN MINNESOTA, NORTHERN IOWA AND WEST CENTRAL WISCONSIN. IN ADDITION, MAYO CLINIC HAS FACILITIES IN SCOTTSDALE AND PHOENIX, ARIZONA AS WELL AS JACKSONVILLE, FLORIDA. MAYO CLINIC SUPPORTS AND COORDINATES EFFORTS TO IMPROVE THE HEALTH AND WELL BEING WITHIN EACH OF THE COMMUNITIES IT SERVES AS WELL AS CONDUCTING MEDICAL EDUCATION AND RESEARCH ACTIVITIES TO ADVANCE THE SCIENCE OF MEDICINE TO BENEFIT A BROAD RANGE OF REGIONAL, NATIONAL AND INTERNATIONAL COMMUNITIES. MAYO CLINIC - METHODIST HOSPITAL WORKS COLLABORATIVELY, THROUGH COMMON GOVERNANCE, WITH ITS AFFILIATED ENTITIES (MAYO CLINIC AND MAYO CLINIC - SAINT MARYS HOSPITAL) TO MEET THE HEALTH CARE NEEDS OF THE LOCAL OLMSTED COUNTY COMMUNITY OF APPROXIMATELY 120,000 RESIDENTS. THESE ENTITIES ARE COLLECTIVELY REFERRED TO AS "MAYO" FOR PURPOSES OF THIS DESCRIPTION.MAYO'S EFFORTS TO ASSESS THE HEALTH CARE NEEDS OF THE LOCAL OLMSTED COUNTY COMMUNITY REST ON FOUR GUIDING PRINCIPLES DEVELOPED IN CONJUNCTION WITH COMMUNITY PARTNERS AND AFFIRMED BY MAYO CLINIC LEADERSHIP:1. HEALTH IS VALUED BY BOTH THE COMMUNITY AND MAYO CLINIC.2. "HEALTH" IS DETERMINED BY BOTH MEDICAL AND NON-MEDICAL (E.G., SOCIAL AND BEHAVIORAL) FACTORS - AND BOTH CATEGORIES OF FACTORS MUST BE ADDRESSED.3. MAYO CLINIC IS COMMITTED TO PRODUCING MEASURABLE IMPROVEMENTS IN THE HEALTH OF ALL OLMSTED COUNTY RESIDENTS, AND BEYOND.4. STRATEGIES TO IMPROVE COMMUNITY HEALTH ARE BEST DETERMINED AND IMPLEMENTED THROUGH PARTNERSHIPS BETWEEN HEALTH CARE PROVIDERS AND COMMUNITY MEMBERS.WITH THESE PRINCIPLES AS THE BASIS OF ITS DECISION MAKING, AND CONSISTENT WITH ITS PRIMARY VALUE OF "THE NEEDS OF THE PATIENT COME FIRST," MAYO CLINIC'S APPROACH TO ASSESS THE NEEDS OF THE COMMUNITY IS ORGANIZED INTO TWO MAIN FUNCTIONS: 1) MECHANISMS TO ENGAGE AND UTILIZE INPUT FROM THE COMMUNITY AND 2) MECHANISMS TO SUPPORT AND COORDINATE INITIATIVES WITHIN MAYO CLINIC.TO ENGAGE AND UTILIZE INPUT FROM THE COMMUNITY, MAYO ANNUALLY REVIEWS COMMUNITY NEEDS ASSESSMENTS CONDUCTED BY THE OLMSTED COUNTY PUBLIC HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS THAT SERVE BROAD COMMUNITY HEALTH NEEDS, SUCH AS OLMSTED COUNTY UNITED WAY AND THE SALVATION ARMY. THE INFORMATION IN THESE ASSESSMENTS ARE USED TO DETERMINE HEALTH CARE SERVICES AVAILABLE AND TO IDENTIFY GAPS THAT CAN BE ADDRESSED IN MAYO'S RESPONSE TO THE HEALTH CARE NEEDS OF THE COMMUNITY. IN ADDITION, MAYO PROVIDES SHARED LEADERSHIP FOR THE OLMSTED COUNTY COMMUNITY HEALTHCARE ACCESS COLLABORATIVE (CHAC). CHAC IS A COMMUNITY-BASED MULTICULTURAL VOLUNTEER COALITION OF OVER 20 HEALTH CARE RELATED SERVICE PROVIDERS, INCLUDING PHYSICIAN AND HOSPITAL PRACTICES (OF WHICH MAYO IS THE LARGEST), PUBLIC HEALTH, SOCIAL SERVICE, AND OTHER ORGANIZATIONS FROM THE GOVERNMENT, PRIVATE AND NOT-FOR-PROFIT SECTORS. CHAC WORKS TO IDENTIFY AND ADDRESS THE ISSUES OF HEALTH AND CARE FOR ALL PEOPLE IN OLMSTED COUNTY, WITH SPECIAL EMPHASIS ON DIVERSE AND UNDER-RESOURCED POPULATIONS. PRIORITIES ARE ESTABLISHED BASED ON REVIEW OF COMMUNITY-WIDE NEEDS, AN ANALYSIS OF EXISTING HEALTH CARE SERVICES AND BY IDENTIFYING STRATEGIES AND INITIATIVES TO CLOSE HEALTH GAPS. THE PLANNING PROCESS FOR CHAC ACTIVITY OCCURS THROUGH A COMMON COMMUNICATION AND VETTING PROCESS, INCLUDING MONTHLY MEETINGS AND A PUBLICLY ACCESSIBLE WEB SITE (WWW.CHACMN.ORG ) SUPPLEMENTED BY INPUT FROM THE CHAC COMMUNITY ADVISORY BOARD (CAB). THE CHAC CAB IS CURRENTLY COMPRISED OF 25 MEMBERS DRAWN FROM DIVERSE REPRESENTATIVES OF RACIAL, ETHNIC, GENDER ORIENTATION, RELIGIOUS, GEOGRAPHIC, SOCIOECONOMIC AND OTHER GROUPS THAT MAKE UP THE COMMUNITY. ACTIVITIES OF THE CHAC CAB INCLUDE ASSISTING WITH SETTING PRIORITIES FOR HEALTH IMPROVEMENT PROJECTS, PROVIDING INPUT TO COLLABORATIVE PROJECTS AMONG OLMSTED COUNTY HEALTH CARE SERVICE PROVIDERS AS THEY ARE DEVELOPED AND FACILITATING COMMUNICATION BETWEEN PROVIDERS AND THE COMMUNITY AS PROJECTS ARE CARRIED OUT.WITHIN MAYO, COORDINATION OF COMMUNITY ENGAGEMENT INITIATIVES IS ACCOMPLISHED THROUGH A COMMUNITY HEALTH COUNCIL (CHC) GUIDED BY AN INSTITUTIONAL COMMUNITY ENGAGEMENT COMMITTEE WITH INPUT FROM COMMUNITY ADVISORY BOARDS. THESE GROUPS ENSURE THE GUIDING PRINCIPLES ARE FOLLOWED AND FACILITATE COMMUNITY ACCESS TO AND PARTICIPATION IN MAYO CLINIC PATIENT CARE ACTIVITIES AND COMMUNITY OUTREACH INITIATIVES. THE CHC IS PART OF AN INTEGRATED PRACTICE UNIT THAT FOCUSES ON PRIMARY CARE PROCESSES AND DELIVERY FOR THE LOCAL AND REGIONAL POPULATIONS WHICH REQUIRE DIFFERENT APPROACHES TO CARE DELIVERY THAN THOSE PATIENTS WHO UTILIZE MAYO'S SPECIALTY CARE SERVICES. THE CHC SERVES TO OVERSEE, COORDINATE AND LINK INITIATIVES IN PRACTICE AND EDUCATION THAT HAVE THE POTENTIAL TO IMPACT THE COMMUNITY OR COMMUNITY HEALTH-RELATED SERVICE PROVIDERS. ALTHOUGH THE CHC IS PRIMARILY FOCUSED ON PRACTICE AND EDUCATIONAL ACTIVITIES, IT HAS LINKS TO RESEARCH RESOURCES WHICH CAN BE DIRECTED TOWARDS COMMUNITY CONCERNS OR INITIATIVES THAT WOULD BENEFIT FROM A RESEARCH APPROACH OR TECHNICAL EXPERTISE. AN 18 MEMBER CAB CHAIRED BY COMMUNITY MEMBERS HELPS THE CHC IDENTIFY AND PRIORITIZE COMMUNITY NEEDS, CONNECTS COMMUNITY MEMBERS AND ORGANIZATIONS TO MAYO CLINIC PERSONNEL, REVIEWS PROPOSALS FOR MAYO CLINIC OUTREACH ACTIVITIES, PROVIDES FEEDBACK ON THE RESULTS OF THESE ACTIVITIES AND GIVES INPUT FOR NEW PROGRAMS.THE COMMUNITY ENGAGEMENT COMMITTEE (CEC) REPORTS DIRECTLY TO INSTITUTIONAL LEADERS AND INCLUDES COMMUNITY REPRESENTATION SO THAT THE COMMUNITY VOICE IS HEARD. THE ROLES OF THE CEC ARE TO FORMULATE AND MONITOR IMPLEMENTATION OF OVERALL MAYO COMMUNITY ENGAGEMENT STRATEGIES AND TO FOSTER THE DEVELOPMENT OF LONG-TERM, BIDIRECTIONAL, MUTUALLY BENEFICIAL RELATIONSHIPS BETWEEN MAYO AND THE LOCAL OLMSTED COUNTY COMMUNITY. THE CEC MEETS MONTHLY AND HAS REGULAR REPORTS DIRECTLY TO THE MAYO CLINIC PRESIDENT AND CEO AS WELL TO INSTITUTIONAL GOVERNANCE COMMITTEES.FROM A RESEARCH PERSPECTIVE, MAYO'S CENTER FOR TRANSLATIONAL SCIENCE ACTIVITY (CTSA, HTTP://CTSA.MAYO.EDU/COMMUNITY/INDEX.HTML) PLANS CONFERENCES AND INPUT SESSIONS WITH LEADERS AND REPRESENTATIVES OF LOCAL COMMUNITY GROUPS TO IDENTIFY, PLAN AND CARRY OUT COMMUNITY BASED RESEARCH TO IMPROVE HEALTH OUTCOMES AMONG UNDERSERVED POPULATIONS. CTSA SUPPORTS SIGNIFICANT EFFORTS WITHIN THE CLINICAL RESEARCH UNIT AT MAYO CLINIC TO INCREASE COMMUNITY INVOLVEMENT IN RESEARCH TO IMPROVE HEALTH AND TO RECRUIT A DIVERSE POPULATION OF RESEARCH SUBJECTS. IN PARTNERSHIP WITH CTSA EDUCATION RESOURCES, CTSA HAS DEVELOPED AND DEPLOYED A SERIES OF CONTINUING EDUCATION MODULES IN COMMUNITY ENGAGEMENT FOR RESEARCH INVESTIGATORS. THESE EFFORTS HAVE RESULTED IN A VARIETY OF COMMUNITY-ENGAGED RESEARCH ACTIVITIES THAT INVOLVE NOT ONLY THE LOCAL OLMSTED COUNTY COMMUNITY BUT ALSO OTHERS THROUGHOUT THE REGION. EXAMPLES OF THESE ACTIVITIES INCLUDE COLLABORATIONS AND PARTNERSHIPS WITH OTHER PROVIDERS, PUBLIC HEALTH SERVICES, PUBLIC SCHOOLS AND UNIVERSITIES, CITY AND COUNTY GOVERNMENT AND COMMUNITY ORGANIZATIONS SUCH AS THE INTERCULTURAL MUTUAL ASSISTANCE ASSOCIATION, MIGRANT HEALTH SERVICES, OLMSTED COUNTY CHILD CARE RESOURCE AND REFERRAL, ELDER NETWORK, ROCHESTER SENIOR CENTER, IGLESIA DE DIOS EMMANUEL DE ROCHESTER, THE RED CROSS, ASIAN HEALTHCARE LEADERS ASSOCIATION, INDIAN HEALTH SERVICES AND MANY OTHERS.ONE CRITICAL COMPONENT OF THESE EFFORTS IS THE ROCHESTER EPIDEMIOLOGY PROJECT (REP, HTTP://WWW.ROCHESTERPROJECT.ORG/), A COLLABORATION OF MAYO CLINIC WITH OLMSTED MEDICAL CENTER AND ROCHESTER FAMILY MEDICINE CLINIC. THE REP LINKS TOGETHER NEARLY ALL THE MEDICAL RECORDS OF THE RESIDENTS OF OLMSTED COUNTY, MAKING IT POSSIBLE TO CONDUCT POPULATION-BASED RESEARCH OF MOST DISEASES AND MEDICAL CONDITIONS. THIS UNIQUE RESEARCH INFRASTRUCTURE PROVIDES AN EXTENSIVE DATA REPOSITORY OF MEDICAL CARE DELIVERED TO COMMUNITY RESIDENTS FOR ALMOST HALF A CENTURY AND IS VIRTUALLY UNPARALLELED IN THE UNITED STATES. THE REP HAS BEEN USED BY HUNDREDS OF INVESTIGATORS FOR DEVELOPING STUDIES ON A WIDE RANGE OF MEDICAL CONDITIONS AND HAS RESULTED IN OVER 2,000 PUBLICATIONS SINCE 1966. Part VI, Line 3: CHARITY CARE EDUCATIONAL MATERIALS PROVIDE CONTACT NUMBERS AND LOCATIONS TO OBTAIN MORE INFORMATION ON THE PROGRAMS OFFERED. PATIENTS AND/OR THEIR PROVIDERS CAN REQUEST CHARITY CARE EVALUATIONS PRIOR TO THEIR SERVICES, DURING THEIR CARE, OR AFTER SERVICES HAVE BEEN RECEIVED. MAYO CLINIC - METHODIST HOSPITAL (MCMH) INFORMS PATIENTS OF CHARITY CARE PROGRAMS THROUGH A NUMBER OF DIFFERENT MECHANISMS: * ON-LINE - MCMH PROVIDES ITS CHARITY POLICY ON ITS WEB SITE: HTTP://WWW.MAYOCLINIC.ORG/BILLING-RST/CHARITY.HTML* VIA PAPER - MCMH'S CHARITY POLICY BROCHURES ARE AVAILABLE IN ALL OUTPATIENT AND INPATIENT LOCATIONS AS WELL AS ON PATIENT BILLING STATEMENTS.* IN PERSON - CHARITY CARE OPTIONS ARE DISCUSSED WITH FINANCIAL COUNSELORS DURING THE ADMISSIONS INTERVIEW PROCESS OR AT THE PATIENT'S REQUEST DURING THEIR EPISODE OF CARE.* VIA PHONE - CHARITY CARE MAY BE INITIATED THROUGH A CUSTOMER SERVICE CALL CENTER SHOULD THE NEED ARISE. Part VI, Line 4: MAYO CLINIC - METHODIST HOSPITAL SERVES THE POPULATION OF OLMSTED COUNTY IN MINNESOTA AS WELL AS A WIDER REGIONAL, NATIONAL, AND EVEN INTERNATIONAL POPULATION. ALTHOUGH THE FILING ORGANIZATION SERVES A WIDE RANGE OF NEEDS INCLUDING PRIMARY CARE, IT IS PARTICULARLY KNOWN FOR ITS TERTIARY CARE AND TREATMENT OF THE MORE UNUSUAL AND DIFFICULT MEDICAL CASES. Part VI, Line 6: THIS FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION- EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO 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. COMMUNITY REPRESENTATION ON GOVERNING BODY:THE BOARD OF TRUSTEES IS THE GOVERNING BODY OF MAYO CLINIC. A MAJORITY OF ITS MEMBERS ARE EXTERNAL, INDEPENDENT TRUSTEES. IT HAS OVERALL RESPONSIBILITY FOR THE CHARITABLE, CLINICAL PRACTICE, SCIENTIFIC AND EDUCATIONAL MISSION AND PURPOSES OF MAYO CLINIC AND ITS AFFILIATES AS SET FORTH IN ITS ARTICLES OF INCORPORATION AND BYLAWS. BECAUSE OF MAYO CLINIC'S NATIONAL PRESENCE, THESE TRUSTEES ARE SELECTED BASED ON THEIR AREAS OF EXPERTISE, EXPERIENCE, AND OTHER CRITERIA ESTABLISHED BY THE INDEPENDENT NOMINATING COMMITTEE OF THE BOARD OF TRUSTEES. AREAS OF EXPERTISE AND EXPERIENCE INCLUDE SUCH AREAS AS HEALTH CARE POLICY, RESEARCH, EDUCATION, BUSINESS, AND GOVERNMENT. THE FILING ORGANIZATION, WHICH IS CONTROLLED BY MAYO CLINIC, RELIES ON THE COMMUNITY REPRESENTATION OF THE MAYO CLINIC BOARD OF TRUSTEES TO FULFILL THIS REQUIREMENT. OPEN V. CLOSED STAFF MODEL: SEVERAL OF MAYO CLINIC'S HOSPITAL ENTITIES HAVE OBTAINED LETTER RULINGS APPROVING A STAFF MODEL IN WHICH ONLY MAYO CLINIC EMPLOYED PHYSICIANS ARE GIVEN STAFF PRIVILEGES IN ORDER TO MAINTAIN STANDARD METHODS OF PRACTICE AND PROTOCOLS. FOR THOSE ENTITIES, THE PHYSICIANS ARE SALARIED EMPLOYEES AND THUS THE ISSUE OF PRIVATE INUREMENT AND PRIVATE BENEFIT ADDRESSED BY THE OPEN STAFF REQUIREMENT ARE OTHERWISE ADDRESSED. THE FILING ORGANIZATION IS ONE OF THE ENTITIES WHICH OPERATES BASED ON THE CLOSED STAFF MODEL. EMERGENCY ROOM: THE PATIENTS OF THE FILING ORGANIZATION HAVE ACCESS TO AN EMERGENCY ROOM OPERATED BY A RELATED ENTITY ADJACENT TO OR IN CLOSE PROXIMITY TO THE FILING ORGANIZATION. Part VI, Line 7: THIS ORGANIZATION IS PART OF A GROUP OF HEALTHCARE ENTITIES AFFILIATED WITH MAYO CLINIC. MAYO CLINIC IS THE FIRST AND LARGEST INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICE IN THE WORLD. 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." MORE THAN 3,300 PHYSICIANS, SCIENTISTS AND RESEARCHERS AND 46,000 ALLIED HEALTH STAFF WORK AT MAYO CLINIC, WHICH HAS SITES IN ROCHESTER, MINNESOTA, JACKSONVILLE, FLORIDA, AND SCOTTSDALE/PHOENIX, ARIZONA, AS WELL AS A REGIONAL NETWORK OF HOSPITALS AND CLINICS IN MINNESOTA, WISCONSIN, AND IOWA. COLLECTIVELY, MORE THAN HALF A MILLION PEOPLE ARE TREATED EACH YEAR.SPECIFICALLY, THE FILING ORGANIZATION PROVIDES HOSPITAL SERVICES AT THE ROCHESTER, MINNESOTA LOCATION. FOR MORE SPECIFIC DESCRIPTION, SEE THE RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). 1 HORMEL FOUNDATION 329 NORTH MAIN STREET STE 102L AUSTIN MN 55912 410694716 501(c)(3) 1000000 RESEARCH AMERICARES FOUNDATION INC 88 HAMILTON AVE STAMFORD CT 06902 061008595 501(c)(3) 100000 FURTHERANCE OF EXEMPT PURPOSE AMERICAN RED CROSS - SOUTHEAST MINNESOTA CHAPTER 310 14TH STREET SE ROCHESTER MN 55904 410693841 501(c)(3) 200000 FURTHERANCE OF EXEMPT PURPOSE UNITED WAY OF OLMSTED COUNTY INC 903 W CENTER STREET SUITE 100 ROCHESTER MN 55902 410695594 501(c)(3) 100000 FURTHERANCE OF EXEMPT PURPOSE DIRECT RELIEF INTERNATIONAL 27 SOUTH LA PATERA LANE SANTA BARBARA CA 93117 951831116 501(c)(3) 100000 FURTHERANCE OF EXEMPT PURPOSE AMERICAN REFUGEE COMMITTEE 430 OAK GROVE ST SUITE 204 MINNEAPOLIS MN 55403 363241033 501(c)(3) 100000 FURTHERANCE OF EXEMPT PURPOSE THE SALVATION ARMY 10 W ALGONQUIN DES PLAINES IL 60016 362167910 501(c)(3) 100000 FURTHERANCE OF EXEMPT PURPOSE 7 FINANCIAL ASSISTANCE 3 7500 NURSING SCHOLARSHIPS 4 4000 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: AS A PRIVATE TRUST FOR THE PUBLIC GOOD, MAYO IS DEDICATED TO GIVING BACK TO THE COMMUNITIES IN WHICH ITS EMPLOYEES LIVE AND WORK. MAYO INVESTS RESOURCES RESPONSIBLY TO PRODUCE THE BEST OUTCOMES FOR PATIENT CARE, EDUCATION, RESEARCH, COMMUNITY ENRICHMENT AND SUSTAINABILITY. GRANT APPLICATIONS ARE REVIEWED AND PRIORITIZED IN HOW THEY: - ADDRESS SIGNIFICANT AND EMERGENT COMMUNITY NEEDS - ALIGN WITH MAYO'S MISSION - IMPROVE HEALTH OF INDIVIDUALS IN COMMUNITY - DEMONSTRATE PARTNERSHIP AND COLLABORATION BUILDING - ENABLE LONG TERM CAPACITY BUILDING AND SUSTAINABILITY MONITORING OF GRANTS GIVEN IS DEPENDENT ON TYPE. LARGER MULTI-YEAR AND CAPITAL GRANTS ARE MONITORED FOR ACHIEVEMENT OF STATED GOALS WITHIN THE GRANT AGREEMENT. SINGLE-YEAR OPERATIONAL AND PROGRAMMATIC GRANTS ARE NOT MONITORED AFTER THE FUNDS HAVE BEEN DISPERSED; HOWEVER, ADDITIONAL FUNDING REQUESTS ARE CONSIDERED BASED ON USE AND OUTCOMES OF PREVIOUSLY AWARDED GRANTS. MAYO CLINIC - METHODIST HOSPITAL PROVIDES SHORT-TERM FINANCIAL ASSISTANCE TO EMPLOYEES EXPERIENCING TEMPORARY HARDSHIPS. GRANTS ARE PROVIDED BASED ON A PROVEN NEED AND ARE NOT MONITORED. NURSING SCHOLARSHIPS ARE AVAILABLE TO EMPLOYEES OF MAYO CLINIC - METHODIST HOSPITAL AND THEIR DEPENDENTS TO OFFSET THE COST OF TUITION, BOOKS, OR OTHER EXPENSES RELATED TO ATTENDING A NURSING PROGRAM. SCHOLARSHIPS ARE SUBJECT TO FEDERAL AND STATE INCOME TAX WITHHOLDING AND ARE NOT MONITORED ONCE AWARDED TO THE RECIPIENT. 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 CASCINO MD TERRANCE L 0 375365 0 0 0 452231 0 128753 0 20599 0 976948 0 115118 DECKER MD WYATT W 0 388688 0 0 0 157295 0 32295 0 36327 0 614605 0 21265 DESCHAMPS MD CLAUDE 0 491134 0 0 0 885149 0 76802 0 20478 0 1473563 0 217329 EVANS MD BRUCE A 0 242484 0 0 0 17783 0 19194 0 20829 0 300290 0 0 FRUSTI DOREEN K 0 279242 0 0 0 8780 0 5822 0 19963 0 313807 0 0 HARPER JR MD CHARLES M 0 485249 0 0 0 119602 0 318175 0 24942 0 947968 0 26724 HERMAN MD DAVID C 0 419134 0 0 0 482798 0 67476 0 27965 0 997373 0 53259 LA RUSSO MD NICHOLAS F 0 548795 0 0 0 1962078 0 0 0 10733 0 2521606 0 574666 NARR MD BRADLY J 0 434372 0 0 0 826983 0 70566 0 22755 0 1354676 0 55619 NOSEWORTHY MD JOHN H 0 923109 0 0 0 714279 0 787806 0 14371 0 2439565 0 135942 RIZZA MD ROBERT A 0 518396 0 0 0 1880323 0 0 0 15408 0 2414127 0 507546 ROCK MD MICHAEL G 0 513177 0 0 0 1406720 0 186461 0 19095 0 2125453 0 273517 ROGER MD VERONIQUE L 0 439381 0 0 0 414583 0 80238 0 2784 0 936986 0 8044 SANTRACH MD PAULA J 0 308968 0 0 0 124138 0 40959 0 18376 0 492441 0 67577 SAWYER NAN B 0 318929 0 0 0 184270 0 54549 0 8455 0 566203 0 53929 SCHMIDT BRADLEY D 0 294409 0 0 0 5823 0 93661 0 15442 0 409335 0 7122 STELLNER WINSTON L 0 153408 0 0 0 542 0 8035 0 19157 0 181142 0 0 WARNER MD MARK A 0 448256 0 2000 0 1132166 0 79136 0 17961 0 1679519 0 332191 WEIS SHIRLEY A 0 724309 0 0 0 631137 0 305748 0 17625 0 1678819 0 233413 WILLIAMS MD AMY W 0 224211 0 0 0 53986 0 22823 0 2064 0 303084 0 240 BROWN WILLIAM A 0 202397 0 0 0 6712 0 31260 0 23078 0 263447 0 0 HUBERT SHERRY L 0 234961 0 0 0 871 0 18984 0 25741 0 280557 0 0 OVIATT JONATHAN J 0 448008 0 0 0 289483 0 144702 0 27006 0 909199 0 146270 BERGRUD KAREN J 151890 0 0 0 5101 0 771 0 12481 0 170243 0 0 0 ROWEKAMP GREGORY T 130776 0 0 0 6345 0 11694 0 29588 0 178403 0 0 0 SISKA MARK H 148121 0 0 0 7112 0 15166 0 23081 0 193480 0 0 0 WEISS WILLIAM T 131896 0 0 0 18000 0 9945 0 25448 0 185289 0 0 0 WOLF ROBERT C 133770 0 0 0 13906 0 6542 0 14440 0 168658 0 0 0 BRIGHAM ROBERT F 0 396045 0 0 0 345137 0 1455 0 23428 0 766065 0 179161 EHMAN MD RICHARD L 0 517519 0 0 0 1616090 0 86191 0 23318 0 2243118 0 362112 FORBES MD GLENN S 0 739662 0 0 0 4636839 0 0 0 13920 0 5390421 0 1607705 KORSMO JEFFREY O 0 474109 0 0 0 716567 0 49365 0 23809 0 1263850 0 311546 OLSEN MD KERRY D 0 467724 0 0 0 2118598 0 94673 0 15586 0 2696581 0 363447 RUMMANS MD TERESA A 0 229769 0 0 0 92468 0 30957 0 2557 0 355751 0 22911 SCHWENK MD NINA M 0 266546 0 0 0 282624 0 30953 0 13233 0 593356 0 74549 WILSON MD WALTER R 0 288512 0 0 0 365792 0 0 0 17140 0 671444 0 228841 COLLINS CRAIG C 0 214905 0 0 0 1199 0 19846 0 27896 0 263846 0 0 JOHNSON PAMELA O 0 203626 0 0 0 1124 0 20128 0 22580 0 247458 0 0 STIRN SUSAN L 0 146004 0 0 0 1353 0 19608 0 14752 0 181717 0 0 Part I, Line 4b THIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(a)(17). 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. BRIGHAM, ROBERT F. $ 341,469 BROWN, WILLIAM A. $ 4,763 CARRYER M.D., PETER W. $ 982,163 CASCINO M.D., TERRANCE L. $ 444,899 DECKER M.D., WYATT W. $ 92,821 DESCHAMPS M.D., CLAUDE $ 880,061 EHMAN M.D., RICHARD L. $1,610,763 EVANS M.D., BRUCE A. $ 13,356 FORBES M.D., GLENN S. $4,622,658 FRUSTI, DOREEN K. $ 3,093 HARPER JR., M.D., CHARLES M. $ 114,518 HERMAN M.D., DAVID C. $ 479,900 KORSMO, JEFFREY O. $ 712,972 LA RUSSO M.D., NICHOLAS F. $1,944,644 NARR M.D., BRADLY J. $ 822,361 NOSEWORTHY M.D., JOHN H. $ 701,661 OLSEN M.D., KERRY D. $2,109,529 OVIATT, JONATHAN J. $ 284,303 RIZZA M.D., ROBERT A. $1,868,043 ROCK M.D., MICHAEL G. $1,396,812 ROGER M.D., VERONIQUE L. $ 412,109 RUMMANS M.D., TERESA A. $ 89,758 SANTRACH M.D., PAULA J. $ 120,728 SAWYER, NAN B. $ 180,734 SCHMIDT, BRADLEY D. $ 3,104 SCHWENK M.D., NINA M. $ 279,155 WARNER M.D., MARK A. $1,127,408 WEIS, SHIRLEY A. $ 623,849 WILLIAMS M.D., AMY W. $ 52,160 WILSON M.D., WALTER R. $ 356,931 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. OWATONNA CLINIC -- MAYO HEALTH SYSTEM COMMON BOARD MEMBERS 62277 SERVICES AND RENT 0 Form 990, Part VI, Section A, line 2 DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT BY RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUALS: BROWN, WILLIAM A. CARRYER M.D., PETER W. CASCINO M.D., TERRANCE L. DECKER M.D., WYATT W. DESCHAMPS M.D., CLAUDE EHMAN M.D., RICHARD L. EVANS M.D., BRUCE A. FORBES M.D., GLENN S. FRUSTI, DOREEN K. HARPER JR., M.D., CHARLES M. HERMAN M.D., DAVID C. HUBERT, SHERRY L. JOHNSON, PAMELA O. KORSMO, JEFFREY O. LA RUSSO M.D., NICHOLAS F. LANDWEHR, MARY ELLEN NARR M.D., BRADLY J. NOSEWORTHY M.D., JOHN H. OLSEN M.D., KERRY D. OVIATT, JONATHAN J. RIZZA M.D., ROBERT A. ROCK M.D., MICHAEL G. ROGER M.D., VERONIQUE L. ROWEKAMP, GREGORY T RUMMANS M.D., TERESA A. SANTRACH M.D., PAULA J. SAWYER, NAN B. SCHMIDT, BRADLEY D. SCHWENK M.D., NINA M. SISKA, MARK H. STELLNER, WINSTON L. STIRN, SUSAN L. WARNER M.D., MARK A. WEIS, SHIRLEY A. WEISS, WILLIAM T. WILLIAMS M.D., AMY W. HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: BROWN, WILLIAM A. CARRYER M.D., PETER W. CASCINO M.D., TERRANCE L. DECKER M.D., WYATT W. DESCHAMPS M.D., CLAUDE EHMAN M.D., RICHARD L. EVANS M.D., BRUCE A. FORBES M.D., GLENN S. FRUSTI, DOREEN K. HARPER JR., M.D., CHARLES M. HERMAN M.D., DAVID C. HUBERT, SHERRY L. JOHNSON, PAMELA O. KORSMO, JEFFREY O. LA RUSSO M.D., NICHOLAS F. LANDWEHR, MARY ELLEN NARR M.D., BRADLY J. NOSEWORTHY M.D., JOHN H. OLSEN M.D., KERRY D. OVIATT, JONATHAN J. RIZZA M.D., ROBERT A. ROCK M.D., MICHAEL G. ROGER M.D., VERONIQUE L. ROWEKAMP, GREGORY T RUMMANS M.D., TERESA A. SANTRACH M.D., PAULA J. SAWYER, NAN B. SCHMIDT, BRADLEY D. SCHWENK M.D., NINA M. SISKA, MARK H. STELLNER, WINSTON L. STIRN, SUSAN L. WARNER M.D., MARK A. WEIS, SHIRLEY A. WEISS, WILLIAM T. WILLIAMS M.D., AMY W. THE FOLLOWING BUSINESS RELATIONSHIPS EXIST AS A RESULT OF OFFICERS, DIRECTORS, AND KEY EMPLOYEES OF MAYO CLINIC - METHODIST HOSPITAL WHO ALSO SERVE ON THE BOARDS OF OTHER AFFILIATED ENTITIES: PETER W. CARRYER, M.D., BRUCE A. EVANS, M.D., C. MICHEL HARPER, M.D., JONATHAN J. OVIATT, NAN B. SAWYER AND BRADLEY D. SCHMIDT ARE ALSO BOARD MEMBERS OR OFFICERS OF MAYO COLLABORATIVE SERVICES, INC. BRADLEY D. SCHMIDT, JONATHAN J. OVIATT, AND NAN SAWYER ARE ALSO BOARD MEMBERS OR OFFICERS OF MAYO HOLDING COMPANY. PETER W. CARRYER, M.D. AND JONATHAN J. OVIATT ARE ALSO BOARD MEMBERS OR OFFICERS OF MHS SERVICES, INC. Form 990, Part VI, Section A, line 3 MAYO-AFFILIATED ENTITIES ROUTINELY DELEGATE VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO RELATED ENTITIES. Form 990, Part VI, Section A, line 6 MAYO CLINIC IS THE SOLE CORPORATE MEMBER. Form 990, Part VI, Section A, line 7a THE GOVERNING BODY IS APPOINTED BY THE SOLE CORPORATE MEMBER. Form 990, Part VI, Section A, line 7b ONLY THE SOLE MEMBER MAY AMEND, REPEAL OR ADD NEW BYLAWS. 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 ASSISTANT TREASURER AND FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF MAYO CLINIC - METHODIST HOSPITAL'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 AN AFFILIATE OF 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. THE SALARY OF THE CHIEF EXECUTIVE OFFICER (CEO) AND CHIEF ADMINISTRATIVE OFFICER (CAO) WHICH IS PAID BY AN AFFILIATE WAS REVIEWED BY THE MAYO CLINIC SALARY AND BENEFIT COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW. THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE ARIZONA, FLORIDA, AND ROCHESTER, MINNESOTA CAMPUSES. 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 SALARY AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. FOR THE CHIEF EXECUTIVE OFFICER AND CHIEF ADMINISTRATIVE OFFICER OF MAYO CLINIC (ALONG WITH OTHER SENIOR LEADERSHIP POSITIONS), THE COMMITTEE DIRECTLY RETAINS AN INDEPENDENT THIRD-PARTY COMPENSATION CONSULTANT WHO ANNUALLY PROVIDES A WRITTEN REPORT CONTAINING A SUMMARY OF RELEVANT, CONTEMPORANEOUS BENCHMARK INFORMATION AND RECOMMENDATIONS REGARDING THE LEVEL OF COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AND CHIEF ADMINISTRATIVE OFFICER THAT WOULD BE REASONABLE IN LIGHT OF THE BENCHMARK INFORMATION. THE GOVERNANCE COMMITTEE CAREFULLY REVIEWS THE BENCHMARK INFORMATION, DISCUSSES IT DIRECTLY WITH THE CONSULTANT IN AN EXECUTIVE SESSION THAT THE CHIEF EXECUTIVE OFFICER AND CHIEF ADMINISTRATIVE OFFICER DO NOT ATTEND, DISCUSSES RECOMMENDED COMPENSATION AND BENEFITS FOR THE CHIEF EXECUTIVE OFFICER AND CHIEF ADMINISTRATIVE OFFICER, CONFIRMS THAT THE RECOMMENDED COMPENSATION AND BENEFITS ARE REASONABLE IN LIGHT OF THE BENCHMARK DATA, AND PROVIDES FINAL APPROVAL OF THE RECOMMENDED AMOUNTS. THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION, AND GOVERNANCE (GOVERNANCE COMMITTEE) IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. THIS GROUP REVIEWS THE COMPENSATION AND BENEFITS FOR PHYSICIANS FROM ALL CAMPUSES, INCLUDING THE MAYO HEALTH SYSTEM LOCATIONS, AS WELL AS CERTAIN SENIOR ADMINISTRATIVE AND EXECUTIVE LEADERSHIP (INCLUDING ALL PERSONS BELIEVED TO BE DISQUALIFIED PERSONS). THIS PROCESS ESTABLISHES ACCEPTABLE RANGES FOR VARIOUS POSITIONS, LEVELS, AND SPECIALTIES. THE COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. IN ADDITION, THE GOVERNANCE COMMITTEE DIRECTLY RETAINS AN INDEPENDENT THIRD-PARTY COMPENSATION CONSULTANT TO PROVIDE RELEVANT, CONTEMPORANEOUS BENCHMARK INFORMATION FOR A SMALL GROUP OF SENIOR PHYSICIAN, ADMINISTRATIVE, AND EXECUTIVE LEADERSHIP POSITIONS FOR WHICH AN INDIVIDUALIZED REVIEW AND RECOMMENDATION IS MADE. Form 990, Part VI, Section C, line 19 CONFLICT OF INTEREST POLICY IS ON THE MAYOCLINIC.ORG WEBSITE. FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990. GOVERNING DOCUMENTS ARE NOT MADE PUBLICLY AVAILABLE. FORM 990 AVAILABLE UPON REQUEST AND ON GUIDESTAR.ORG WEBSITE. AVERAGE HOURS PER WEEK DEVOTED TO POSITION WITH RELATED ORGANIZATION PART VII SECTION A BROWN, WILLIAM A. 40 HRS BRIGHAM, ROBERT F. 40 HRS CARRYER M.D., PETER W. 40 HRS CASCINO M.D., TERRANCE L. 40 HRS COLLINS, CRAIG C. 40 HRS DECKER M.D., WYATT W. 40 HRS DESCHAMPS M.D., CLAUDE 40 HRS EHMAN M.D., RICHARD L. 40 HRS EVANS M.D., BRUCE A. 40 HRS FORBES M.D., GLENN S. 40 HRS FRUSTI, DOREEN K. 40 HRS HARPER M.D., C. MICHEL 40 HRS HERMAN M.D., DAVID C. 40 HRS HUBERT, SHERRY L. 40 HRS JOHNSON, PAMELA O. 40 HRS KORSMO, JEFFREY O. 40 HRS LANDWEHR, MARY ELLEN 40 HRS LARUSSO M.D., NICHOLAS F. 40 HRS NARR M.D., BRADLEY J. 40 HRS NOSEWORTHY M.D., JOHN H. 40 HRS OLSEN M.D., KERRY D. 40 HRS OVIATT, JONATHAN J. 40 HRS RIZZA M.D., ROBERT A. 40 HRS ROCK M.D., MICHAEL G. 40 HRS ROGER M.D., VERONIQUE L. 40 HRS RUMMANS M.D., TERESA A. 40 HRS SANTRACH M.D., PAULA J. 40 HRS SAWYER, NAN B. 40 HRS SCHMIDT, BRADLEY D. 40 HRS SCHWENK M.D., NINA M. 40 HRS STELLNER, WINSTON L. 40 HRS STIRN, SUSAN L. 40 HRS WARNER M.D., MARK A. 40 HRS WEIS, SHIRLEY A. 40 HRS WILLIAMS M.D., AMY W. 40 HRS WILSON M.D., WALTER R. 40 HRS Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 177,357. TRANSFER OF CAPITAL TO MAYO CLINIC -200,000,000. Total to Form 990, Part XI, Line 5: -199,822,643. PART XII LINE 2C EXPLANATION THERE WAS NO CHANGE IN THE PROCESS DURING THE YEAR. INDEPENDENT VOTING MEMBERS OF THE GOVERNING BODY 990, PART I, LINE 4 AND PART VI, LINE 1B THE BOARD OF TRUSTEES OF MAYO CLINIC, THE PARENT ENTITY OF THE MAYO CLINIC-AFFILIATED ENTITIES, IS COMPRISED OF MORE THAN 50% PUBLIC TRUSTEES. 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 MAYO CLINIC EXCLUDED 8223176 0 1 0.15950 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 1 0 0 1 0 1 0 1 1 1 1 1 ALBERT LEA MEDICAL CENTER -- MAYO HEALTH SYSTEM J 122340 GAAP FAIRMONT MEDICAL CENTER -- MAYO HEALTH SYSTEM J 84104 GAAP FRANCISCAN SKEMP MEDICAL CENTER INC J 110220 GAAP OWATONNA CLINIC -- MAYO HEALTH SYSTEM J 50000 GAAP MAYO CLINIC C 50208 GAAP MAYO FOUNDATION MEDICAL EDUCATION AND RESEARCH G 156903306 GAAP MAYO CLINIC J 4346966 GAAP ALBERT LEA MEDICAL CENTER -- MAYO HEALTH SYSTEM L 62319 GAAP FRANCISCAN SKEMP MEDICAL CENTER INC L 97070 GAAP MAYO FOUNDATION MEDICAL EDUCATION AND RESEARCH N 133570815 GAAP MAYO CLINIC O 61148400 GAAP MAYO CLINIC P 485909 GAAP MAYO FOUNDATION MEDICAL EDUCATION AND RESEARCH R 8262490 GAAP MAYO CLINIC - SAINT MARYS HOSPITAL P 330884 GAAP MAYO CLINIC R 36808810 GAAP MAYO CLINIC R 153939 GAAP OWATONNA CLINIC -- MAYO HEALTH SYSTEM L 12277 GAAP FAIRMONT MEDICAL CENTER -- MAYO HEALTH SYSTEM L 43192 GAAP MAYO FOUNDATION MEDICAL EDUCATION AND RESEARCH P 2147095 GAAP MAYO CLINIC Q 200000000 GAAP