STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

OKEFENOKEE HEALTH INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
OKEFENOKEE HEALTH INC (EIN 58-1667166)
Tax period
2015-01-01 to 2015-12-31
Filed
2016-11-08
IRS object ID
201613139349301756
Schema version
2015v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-11-08T12:27:03-06:00ReturnTs
Tax Period End2015-12-31TaxPeriodEndDt
Return Type990ReturnTypeCd
Tax Period Begin2015-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN581667166EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MAYO CLINIC HEALTH SYSTEM INBusinessNameLine1Txt
Business Name Line2WAYCROSS INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlMAYOBusinessNameControlTxt
Phone5075381297PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11900 TEBEAU STREETAddressLine1Txt
CityWAYCROSSCityNm
State AbbreviationGAStateAbbreviationCd
ZIP31501ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKEVIN M LOCKETTPersonNm
Person TitleCFOPersonTitleTxt
Phone5075381297PhoneNum
Signature2016-11-08SignatureDt
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerROGER FORGEYPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11900 TEBEAU STREETAddressLine1Txt
CityWAYCROSSCityNm
State AbbreviationGAStateAbbreviationCd
ZIP31501ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$182,803,772GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Group Exemption5983GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.MAYOCLINICHEALTHSYSTEM.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1985FormationYr
Legal Domicile StateGALegalDomicileStateCd
Activity Or MissionOPERATION OF A HOSPITAL, CLINICS, NURSING HOMES, A REHAB UNIT AND A SENIOR BEHAVIORAL UNIT.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee1496TotalEmployeeCnt
Total Volunteers73TotalVolunteersCnt
Total Gross UBI$20,925TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$2,097,771PYContributionsGrantsAmt
CY Contributions Grants$1,011,104CYContributionsGrantsAmt
PY Program Service Revenue$174,152,185PYProgramServiceRevenueAmt
CY Program Service Revenue$180,273,400CYProgramServiceRevenueAmt
PY Investment Income$60,458PYInvestmentIncomeAmt
CY Investment Income$56,420CYInvestmentIncomeAmt
PY Other Revenue$923,721PYOtherRevenueAmt
CY Other Revenue$824,133CYOtherRevenueAmt
PY Total Revenue$177,234,135PYTotalRevenueAmt
CY Total Revenue$182,165,057CYTotalRevenueAmt
PY Grants And Similar Paid$164,853PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$27,342CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$85,302,483PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$96,084,701CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$106,111,809PYOtherExpensesAmt
CY Other Expenses$107,230,521CYOtherExpensesAmt
PY Total Expenses$191,579,145PYTotalExpensesAmt
CY Total Expenses$203,342,564CYTotalExpensesAmt
PY Revenues Less Expenses-$14,345,010PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$21,177,507CYRevenuesLessExpensesAmt
Total Assets BOY$114,554,521TotalAssetsBOYAmt
Total Assets EOY$161,347,067TotalAssetsEOYAmt
Total Liabilities BOY$51,871,151TotalLiabilitiesBOYAmt
Total Liabilities EOY$119,841,204TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$62,683,370NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$41,505,863NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTO INSPIRE HOPE AND CONTRIBUTE TO HEALTH AND WELL-BEING BY PROVIDING THE BEST CARE TO EVERY PATIENT THROUGH INTEGRATED CLINICAL PRACTICE, EDUCATION, AND RESEARCH.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$184,933,601ExpenseAmt
Revenue$180,736,545RevenueAmt
DescPATIENT CARE (SEE SCHEDULE O):MAYO CLINIC HEALTH SYSTEM IN WAYCROSS (MCHS-WAYCROSS) IS PART OF THE MAYO CLINIC HEALTH SYSTEM. MAYO CLINIC HEALTH SYSTEM IS A FAMILY OF CLINICS, HOSPITALS AND HEALTH CARE FACILITIES SERVING COMMUNITIES IN MINNESOTA, IOWA, WISCONSIN AND GEORGIA. AS PART OF MAYO CLINIC, THE HEALTH SYSTEM OFFERS CARE DESIGNED FOR THE WHOLE BODY CLOSE TO THE PATIENT'S HOME, WHEN THEY NEED IT. A MULTIDISCIPLINARY TEAM OF EXPERTS HAS READY ACCESS TO KNOWLEDGE, RESOURCES, AND EXPERTISE OF MAYO CLINIC AND COLLABORATES ON PROVIDING EXACTLY THE CARE THE PATIENT NEEDS. MAYO CLINIC HEALTH SYSTEM SITES EMPLOY APPROXIMATELY 1,000 PHYSICIANS AND 15,000 ALLIED HEALTH STAFF. IN ADDITION, MAYO CLINIC PHYSICIANS FROM MULTIPLE SPECIALTIES REGULARLY SEE PATIENTS AT HEALTH SYSTEM FACILITIES. BESIDES HAVING HEALTH CARE FACILITIES IN MORE THAN 60 COMMUNITIES, MAYO CLINIC HEALTH SYSTEM INCLUDES 19 OWNED HOSPITALS, TWO OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH ONE ADDITIONAL HOSPITAL, AND CONTRACT MANAGEMENT AGREEMENTS WITH TWO ADDITIONAL HOSPITALS AND ONE NURSING HOME. SINCE ITS INCEPTION IN 1992, MAYO CLINIC HEALTH SYSTEM HAS GROWN INTO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN THE UNITED STATES. MORE THAN 600,000 UNIQUE PATIENTS ACCOUNT FOR MORE THAN 2.6 MILLION VISITS ANNUALLY IN MAYO CLINIC HEALTH SYSTEM. IT IS ALSO A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS. AS PART OF THE MAYO CLINIC HEALTH SYSTEM, MCHS-WAYCROSS SERVES A NINE-COUNTY REGION IN SOUTHEAST GEORGIA. MCHS-WAYCROSS OPERATES A 231-BED HOSPITAL, A 96-BED SKILLED NURSING FACILITY, A REHAB UNIT AND A PSYCHIATRIC UNIT IN WAYCROSS, GEORGIA ALONG WITH AN ADDITIONAL 78-BED SKILLED NURSING FACILITY IN BLACKSHEAR, GEORGIA. MCHS-WAYCROSS PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. SERVICES ARE ALSO PROVIDED TO MEDICAID AND MEDICARE PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES.FINANCIAL ASSISTANCE (AT COST) PROVIDED TO PATIENTS IN 2015 WAS APPROXIMATELY $5,187,700. THE COST OF UNCOMPENSATED CARE PROVIDED TO LOW INCOME PATIENTS THROUGH MEDICAID WAS APPROXIMATELY $10,428,700. THE COST OF UNCOMPENSATED CARE PROVIDED TO PATIENTS THROUGH MEDICARE WAS APPROXIMATELY $16,906,800. SATILLA ADVOCACY SERVICES, A RAPE CRISIS AND CHILD ADVOCACY CENTER, OPERATES UNDER THE UMBRELLA OF MCHS-WAYCROSS AND SERVES VICTIMS OF SEXUAL ASSAULT AND OTHER VIOLENT CRIMES IN THE SIX COUNTIES THAT MAKE UP THE WARE JUDICIAL CIRCUIT. A FULL RANGE OF SERVICES IS OFFERED FROM THE TIME A VICTIM REPORTS AN INCIDENT, INCLUDING EMERGENCY DEPARTMENT SERVICES, FOLLOW UP AT THE RAPE CRISIS/CHILD ADVOCACY CENTER, THERAPY AND SUPPORT BY OUR LEGAL ADVOCACY PERSONNEL. IN 2015, SATILLA ADVOCACY SERVED 603 NEW VICTIMS AND PRESENTED PREVENTION EDUCATION TO 13,688 PEOPLE.ALL REVENUE AFTER EXPENSES IS REINVESTED TO CARE FOR THE CITIZENS OF THE COMMUNITY THROUGH CLINICAL CARE, HEALTH PROGRAMS, STATE-OF-THE-ART TECHNOLOGY AND FACILITIES, AND TEACHING AND TRAINING OF MEDICAL PROFESSIONALS.APPROXIMATELY 73 COMMUNITY VOLUNTEERS PROVIDED APPROXIMATELY 9,617 HOURS OF DONATED TIME TO THE HOSPITAL IN 2015. VOLUNTEERS PROVIDE HOSPITALITY SERVICES TO PATIENTS, FAMILIES AND VISITORS. THE DONATED SERVICES PROVIDED BY THE VOLUNTEERS IN 2015 WERE VALUED AT APPROXIMATELY $226,580 BASED ON STATISTICS FROM THE INDEPENDENT SECTOR.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,203,800ExpenseAmt
Grant$27,342GrantAmt
Revenue$195,317RevenueAmt
DescCOMMUNITY PROGRAMS & HEALTH PROFESSIONS EDUCATION (SEE SCHEDULE O):CONSISTENT WITH ITS CHARITABLE MISSION, MCHS-WAYCROSS PROVIDES COMMUNITY BENEFIT TO THE COMMUNITY IT SERVES. FOR 2015, MCHS-WAYCROSS PROVIDED HEALTH EDUCATION AND HEALTH SUPPORT SERVICES. MANY OF THESE BENEFITS AND SERVICES ARE DESCRIBED BELOW.MCHS-WAYCROSS IS INVOLVED IN MANY ACTIVITIES AIMED AT EDUCATING THE COMMUNITY ABOUT HEALTH-RELATED TOPICS. EXAMPLES OF THESE ACTIVITIES INCLUDE A MONTHLY CALENDAR OF EVENTS AND CLASSES OFFERED AT THE HOSPITAL THAT IS DISTRIBUTED VIA EMAIL AND ADVERTISED IN LOCAL NEWSPAPERS. THE FOLLOWING ARE SOME OF THE CLASSES AND SEMINARS OFFERED DURING 2015. - SENIOR SAFETY DAY - PRENATAL CLASSES - DIABETES CLASSES - SMOKING CESSATION - WOMEN'S HEALTH BLITZ - CANCER SUPPORT GROUPTHE HOSPITAL STAFF PROVIDED BLOOD PRESSURE SCREENINGS, EDUCATIONAL PROGRAMS AND HEALTH SEMINARS TO RESIDENTS IN SCHOOLS, SENIOR CITIZENS CENTERS, SOCIAL CLUBS AND AT HEALTH FAIRS THROUGHOUT THE SERVICE AREA INCLUDING SENIOR SAFETY DAY, SWAMPFEST, AND PIERCE, BRANTLEY AND WARE COUNTY HIGH SCHOOL FOOTBALL GAMES. MCHS-WAYCROSS PROVIDED APPROXIMATELY $22,000 OF STAFF TIME AND SUPPLIES TO HELP PATIENTS ACCESS FREE MEDICATIONS THROUGH PHARMACEUTICAL COMPANIES' PRESCRIPTION ASSISTANCE PROGRAMS. MCHS-WAYCROSS OFFERED ENROLLMENT ASSISTANCE TO 339 PEOPLE IN THE COMMUNITY SO THEY WOULD BE ABLE TO ACCESS PUBLIC HEALTH PROGRAMS SUCH AS MEDICAID. IN 2015, MCHS-WAYCROSS WORKED WITH LOCAL COLLEGES AND TECHNICAL SCHOOLS TO OFFER CLINICAL ROTATIONS FOR A VARIETY OF HEALTHCARE PROFESSIONALS THAT INCLUDED PROVIDING A CLINICAL SETTING FOR STUDENTS THAT INCLUDED SIX HOURS PER STUDENT OF STAFF MENTORING. ORIENTATION, DRUG SCREENS, CRIMINAL BACKGROUND CHECKS AND SOCIAL SECURITY CHECKS WERE PROVIDED FOR ALL STUDENTS. IN ADDITION, RENT-FREE CLASSROOM SPACE WAS PROVIDED. MCHS-WAYCROSS PARTNERS WITH THE MEDICAL COLLEGE OF GEORGIA AT GEORGIA REGENTS UNIVERSITY TO SPONSOR A RESIDENCY PROGRAM. THIS PROGRAM SERVES AS A RESPONSE TO DECLINING NUMBERS OF PRIMARY CARE PHYSICIANS IN RURAL SOUTH GEORGIA COMMUNITIES AND THE REGION AND A DESIRE TO TRAIN PRIMARY CARE PHYSICIANS IN SETTINGS THAT WOULD FACILITATE THE CHOICE OF PRACTICE IN SMALL AND RURAL COMMUNITIES.IN 2015, CONTRIBUTIONS WERE MADE TO COMMUNITY PARTNERSHIP EVENTS SUCH AS THE AMERICAN CANCER SOCIETY, YMCA, OKEFENOKEE TECHNICAL COLLEGE FOUNDATION AND THE SOUTHEAST CANCER UNIT.AS A CORPORATE CITIZEN, MCHS-WAYCROSS TAKES A LEADERSHIP ROLE AND COLLABORATES WITH OTHER REGIONAL AGENCIES TO INSURE THE COMMUNITY IS PREPARED FOR DISASTER SHOULD IT STRIKE. IN 2015, MCHS-WAYCROSS PROVIDED OVER $83,000 OF SUPPORT TO REGIONAL EMERGENCY PREPAREDNESS.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$186,137,401TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit CounselingYes (1)CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan OutstandingYes (1)LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document117IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee1496EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business RlnYes (1)FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local ChaptersYes (1)LocalChaptersInd
Policies Reference ChaptersYes (1)PoliciesReferenceChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint VentureYes (1)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (1)WrittenPolicyOrProcedureInd
States Where Copy Of Return Is FldGAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CORPORATE TAX UNITBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone5075381297PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1200 FIRST STREET SWAddressLine1Txt
CityROCHESTERCityNm
State AbbreviationMNStateAbbreviationCd
ZIP55905ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
CALAMIA MD KENNETH T
DIRECTOR/PRESIDENT/CEO1.0040.00Yes (X)Yes (X)$0$409,587$72,647
CATCHINGS MD TIMOTHY T
DIRECTOR40.000.00Yes (X)$879,449$0$67,023
DAWSON MD NANCY L
DIRECTOR/VICE PRESIDENT1.0040.00Yes (X)Yes (X)$0$294,890$68,177
DYE MD JAMES W
DIRECTOR1.000.00Yes (X)$0$0$0
HERRIN OWEN
DIRECTOR1.000.00Yes (X)$0$0$0
HOFFMAN MARY J
DIRECTOR/SECRETARY/TREASURER/CAO1.0040.00Yes (X)Yes (X)$0$366,692$55,266
MUSIC ZA
DIRECTOR1.000.00Yes (X)$0$0$0
PRESUTTI DO RICHARD J
DIRECTOR/PRESIDENT/CEO1.0040.00Yes (X)Yes (X)$0$460,216$54,328
SWEAT HOLLI H
DIRECTOR/ASSISTANT SECRETARY40.000.00Yes (X)Yes (X)$190,401$0$53,791
WATERS MD DONALD
DIRECTOR1.000.00Yes (X)$0$0$0
BEARD TERESA B
ASSISTANT SECRETARY1.0040.00Yes (X)$0$111,389$33,191
LOCKETT KEVIN M
INTERIM CFO1.0040.00Yes (X)$0$165,792$47,001
RATHBUN JON
CFO1.0040.00Yes (X)$0$172,561$18,240
COCHON MD ARISTOTLE P
PHYSICIAN40.000.00$408,314$0$52,335Yes (X)
JHA MD ASIT K
PHYSICIAN40.000.00$760,450$0$55,932Yes (X)
LOTT MD MCGREGOR N
PHYSICIAN40.000.00$676,694$0$56,240Yes (X)
WYKSTRA MD DAVID J
PHYSICIAN40.000.00$591,241$0$53,897Yes (X)
BORDERS MD YOLANDA M
PHYSICIAN40.000.00$690,898$0$48,674Yes (X)
GRIFFIN MD HOWARD
PHYSICIAN40.000.00$672,537$0$8,734Yes (X)
JOHNSON MD KENNETH A
PHYSICIAN40.000.00$639,878$0$68,191Yes (X)
PILLAI MD DILIP P
PHYSICIAN40.000.00$720,837$0$67,659Yes (X)
SINGLETON MD BRIAN A
PHYSICIAN40.000.00$648,885$0$51,705Yes (X)
CROFT CHERYL R
FORMER OFFICER0.0040.00$0$243,699$57,954Yes (X)
LANGE MD STEPHEN M
FORMER OFFICER0.0040.00$0$606,363$57,915Yes (X)
SMITH JR WINDELL R
FORMER OFFICER0.0040.00$0$198,104$54,380Yes (X)
WALTERS ROBERT M
FORMER OFFICER0.0040.00$0$321,723$73,101Yes (X)
BAKER MD MICHAEL P
FORMER KEY EMPLOYEE40.000.00$265,602$0$66,604Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$7,145,186TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$3,351,016TotReportableCompRltdOrgAmt
Total Other Compensation$1,242,985TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K79IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (1)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
SODEXO INC
9801 WASHINGTON BLVDGAITHERABURYMD20878FOOD SERVICES$4,687,413
SOUTHEAST GEORGIA ANESTHESIA LLC
1900 TEBEAU STREETWAYCROSSGA31501ANESTHESIA SERVICES$2,140,586
MAYO CLINIC
200 FIRST STREET SWROCHESTERMN55905MEDICAL & SUPPORT SERVICES$1,145,544
DIAGNOSTIC PET LLC
1256 SHILOH ROADELLAVILLEGA31806PET SCANS$1,101,842
CERNER HEALTHCARE SOLUTIONS INC
2800 ROCKCREEK PKWYNORTH KANSAS CITYMO64117BILLING SERVICES$1,062,406
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K32CntrctRcvdGreaterThan100KCnt
Federated Campaigns$2,656FederatedCampaignsAmt
Related Organizations$89,973RelatedOrganizationsAmt
Government Grants$848,385GovernmentGrantsAmt
All Other Contributions$70,090AllOtherContributionsAmt
Total Contributions$1,011,104TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT REVENUE620000$180,078,083$180,057,158$20,925
EDUCATION REVENUE611600$195,317$195,317
FieldValueIRS element (for citing)
Total Program Service Revenue$180,273,400TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$431,540TotalRevenueColumnAmt
Exclusion$431,540ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$165,877RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$41,095RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$124,782RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$124,782TotalRevenueColumnAmt
Exclusion$124,782ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$222,500OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$597,620OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other-$375,120OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column-$375,120TotalRevenueColumnAmt
Exclusion-$375,120ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
VENDING/CAFETERIA722210$630,377$630,377
MISC. REVENUE900099$68,974$28,085$40,889
FieldValueIRS element (for citing)
Other Revenue Total$699,351OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$182,165,057TotalRevenueColumnAmt
Related Or Exempt Func Income$180,910,937RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$20,925UnrelatedBusinessRevenueAmt
Exclusion$222,091ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$27,342TotalAmt
Program Services$27,342ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$3,845,768TotalAmt
Program Services$3,845,768ProgramServicesAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$1,302,257TotalAmt
Program Services$1,212,493ProgramServicesAmt
Management And General$89,764ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$65,139,113TotalAmt
Program Services$58,386,526ProgramServicesAmt
Management And General$6,752,587ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$7,077,741TotalAmt
Program Services$6,344,033ProgramServicesAmt
Management And General$733,708ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$14,001,229TotalAmt
Program Services$12,549,804ProgramServicesAmt
Management And General$1,451,425ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$4,718,593TotalAmt
Program Services$4,229,444ProgramServicesAmt
Management And General$489,149ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$377,779TotalAmt
Management And General$377,779ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$41,622TotalAmt
Program Services$41,622ProgramServicesAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$686TotalAmt
Management And General$686ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$26,881,737TotalAmt
Program Services$24,144,000ProgramServicesAmt
Management And General$2,737,737ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$263,301TotalAmt
Program Services$52,278ProgramServicesAmt
Management And General$211,023ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$9,735,235TotalAmt
Program Services$6,167,694ProgramServicesAmt
Management And General$3,567,541ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$102,311TotalAmt
Program Services$1,741ProgramServicesAmt
Management And General$100,570ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,517,116TotalAmt
Program Services$2,293,396ProgramServicesAmt
Management And General$223,720ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$540,165TotalAmt
Program Services$416,477ProgramServicesAmt
Management And General$123,688ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,786TotalAmt
Management And General$1,786ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$7,928,948TotalAmt
Program Services$7,691,528ProgramServicesAmt
Management And General$237,420ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$258,857TotalAmt
Program Services$237,210ProgramServicesAmt
Management And General$21,647ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtManagement And GeneralManagementAndGeneralAmtProgram ServicesProgramServicesAmt
UNRELATED BUSINESS TAXE$167$167
BAD DEBT EXPENSE$28,585,438$28,585,438
MEDICAL SUPPLIES$27,848,011$27,848,011
MEDICAID SURCHARGE$1,661,407$1,661,407

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$485,955TotalAmt
Program Services$401,189ProgramServicesAmt
Management And General$84,766ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$203,342,564TotalAmt
Program Services$186,137,401ProgramServicesAmt
Management And General$17,205,163ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$87,818BOYAmt
EOY$236,728EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$580,841BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$36,117,364BOYAmt
EOY$33,870,024EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$55,084BOYAmt
EOY$30,546EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$246,600BOYAmt
EOY$126,216EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$3,057,772BOYAmt
EOY$2,909,978EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$36,532BOYAmt
EOY$188,922EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$147,647,610LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$84,153,989LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$64,179,799BOYAmt
EOY$63,493,621EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$435,621BOYAmt
EOY$44,746,960EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$4,362,664BOYAmt
EOY$4,281,064EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$5,394,426BOYAmt
EOY$11,463,008EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$114,554,521BOYAmt
EOY$161,347,067EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$25,039,029BOYAmt
EOY$28,719,615EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$8,964BOYAmt
EOY$5,122EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$654,689BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$22,685BOYAmt
EOY$44,253EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$26,145,784BOYAmt
EOY$91,072,214EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$51,871,151BOYAmt
EOY$119,841,204EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$62,605,118BOYAmt
EOY$41,466,869EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$78,252BOYAmt
EOY$38,994EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$62,683,370BOYAmt
EOY$41,505,863EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$114,554,521BOYAmt
EOY$161,347,067EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$21,177,507ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or ManagementYes (1)PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact LegislatorsYes (1)DirectContactLegislatorsInd
Direct Contact Legislators$30,265DirectContactLegislatorsAmt
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$19,122OtherActivitiesAmt
Total Lobbying Expenditures$49,387TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationDURING 2015, MCHS-WAYCROSS OR ITS CONSULTANTS HAD CONTACT WITH STATE GOVERNMENT OFFICIALS AND/OR THEIR STAFF TO DISCUSS VARIOUS HEALTH CARE RELATED ISSUES. THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtcInd
Incl Escrow Custodial Acct LiabYes (1)InclEscrowCustodialAcctLiabInd
Explanation ProvidedYes (X)ExplanationProvidedInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,263,459OtherCostOrOtherBasisAmt
Book Value$1,263,459BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$41,095InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis$83,580,436OtherCostOrOtherBasisAmt
Depreciation$42,350,815DepreciationAmt
Book Value$41,270,716BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,825,402OtherCostOrOtherBasisAmt
Depreciation$1,188,564DepreciationAmt
Book Value$1,636,838BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$58,393,657OtherCostOrOtherBasisAmt
Depreciation$40,614,610DepreciationAmt
Book Value$17,779,047BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,543,561OtherCostOrOtherBasisAmt
Book Value$1,543,561BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$63,493,621TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescMAYO POOLED INVESTMENTSDesc
Book Value$44,746,960BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$44,746,960TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDescBook ValueBookValueAmt
DUE FROM AFFILIATES$9,501,255
DEFERRED COMPENSATION$420,524
OTHER LONG TERM ASSETS$1,541,229
FieldValueIRS element (for citing)
Total Book Value Other Assets$11,463,008TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
DUE TO AFFILIATES$90,651,690
DEFERRED COMPENSATION$420,524
FieldValueIRS element (for citing)
Total Liability$91,072,214TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART IV, LINE 2B:NURSING HOME RESIDENT TRUST ACCOUNT - RESIDENTS' FUNDS.
PART X, LINE 2:AT DECEMBER 31, 2015 AND 2014, THE RESERVE FOR UNRECOGNIZED TAX BENEFITS WAS NOT SIGNIFICANT, AND AS A RESULT, THERE IS NO RESERVE FOR UNRECOGNIZED TAX BENEFITS RECORDED FOR THE FILING ORGANIZATION.
PART X, OTHER LIABILITIES (DUE TO AFFILIATES):THE DUE TO AMOUNT IS CURRENTLY CONTESTED BY THE WAYCROSS COMMUNITY DIRECTORS. MAYO CLINIC HAS INDICATED A WILLINGNESS TO NEGOTIATE THE BALANCE DUE IN THE CONTEXT OF A NEW AFFILIATION AND EXIT TRANSACTION THAT POSITIONS WAYCROSS FOR FUTURE SUCCESS.
PART X, OTHER LIABILITIES (DUE TO AFFILIATES):RECLASS OF NET RESERVES BETWEEN 2014 AND 2015. AT 12/31/14, $45,225,000 OF NET RESERVES WERE CARRIED AS AN OFFSET TO INTERCOMPANY LIABILITIES (INCLUDED ON FORM 990, PART X, LINE 25). IN 2015, THE NET RESERVES WERE SET UP IN AN INVESTMENT ACCOUNT (MAYO POOLED INVESTMENTS REFLECTED ON FORM 990, PART X, LINE 12) WITH A CORRESPONDING OFFSET TO INTERCOMPANY LIABILITIES (INCLUDED ON FORM 990, PART X, LINE 25).

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance Budget0FinancialAssistanceBudgetInd
Annual Community Bnft Report0AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,187,711TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$5,187,711NetCommunityBenefitExpnsAmt
Total Expense0.02970TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$33,423,690TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$22,995,038DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,428,652NetCommunityBenefitExpnsAmt
Total Expense0.05970TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$38,611,401TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$22,995,038DirectOffsettingRevenueAmt
Net Community Benefit Expns$15,616,363NetCommunityBenefitExpnsAmt
Total Expense0.08940TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$255,247TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$255,247NetCommunityBenefitExpnsAmt
Total Expense0.00150TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$759,209TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$145,976DirectOffsettingRevenueAmt
Net Community Benefit Expns$613,233NetCommunityBenefitExpnsAmt
Total Expense0.00350TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$18,685,985TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$5,878,961DirectOffsettingRevenueAmt
Net Community Benefit Expns$12,807,024NetCommunityBenefitExpnsAmt
Total Expense0.07330TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$18,716TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$18,716NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$19,719,157TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,024,937DirectOffsettingRevenueAmt
Net Community Benefit Expns$13,694,220NetCommunityBenefitExpnsAmt
Total Expense0.07840TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$58,330,558TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$29,019,975DirectOffsettingRevenueAmt
Net Community Benefit Expns$29,310,583NetCommunityBenefitExpnsAmt
Total Expense0.16780TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,430TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$1,430NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$67,986TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$67,986NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$92,126TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$92,126NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,630TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,630NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$6,456TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$6,456NetCommunityBenefitExpnsAmt
Total Expense0.00000TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$170,628TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$170,628NetCommunityBenefitExpnsAmt
Total Expense0.00090TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReportedInd
Bad Debt Expense$28,585,438BadDebtExpenseAmt
Reimbursed By Medicare$40,451,911ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$40,397,476CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$54,435MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MAYO CLINIC HEALTH SYSTEM IN WAYCROSSBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11900 TEBEAU STREETAddressLine1Txt
CityWAYCROSSCityNm
State AbbreviationGAStateAbbreviationCd
ZIP31501ZIPCd
FieldValueIRS element (for citing)
State License148-416StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MAYO CLINIC HEALTH SYSTEM IN WAYCROSSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts0CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.MAYOCLINICHEALTHSYSTEM.ORG/ABOUT-USOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt13ImplementationStrategyAdptYr
Strategy Posted Website0StrategyPostedWebsiteInd
Strategy AttachedYes (1)StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Other MethodYes (X)OtherMethodInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLMAYOCLINICHEALTHSYSTEM.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLMAYOCLINICHEALTHSYSTEM.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLMAYOCLINICHEALTHSYSTEM.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Other Actions TakenYes (X)OtherActionsTakenInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
MAYO CLINIC HEALTH SYSTEM IN WAYCROSSPART V, SECTION B, LINE 5: PRIMARY DATA COLLECTION METHODS INCLUDED INTERVIEWS AND FOCUS GROUPS WITH KEY COMMUNITY REPRESENTATIVES. THE PURPOSE OF THE INTERVIEWS AND FOCUS GROUPS WAS TO GAIN DIRECT INPUT REGARDING HEALTH NEEDS, INCLUDING PRIMARY AND CHRONIC DISEASE NEEDS AND HEALTH ISSUES ASSOCIATED WITH UNINSURED PERSONS, LOW INCOME PERSONS AND MINORITY GROUPS.IN ADDITION, COMMUNITY INPUT WAS GARNERED FROM THE COMMUNITY ADVISORY COMMITTEE, WHICH INCLUDED REPRESENTATIVES FROM THE WARE COUNTY HEALTH DEPARTMENT, THE WARE COUNTY CHILDREN'S INITIATIVE AND OTHER COMMUNITY ORGANIZATIONS.
MAYO CLINIC HEALTH SYSTEM IN WAYCROSSPART V, SECTION B, LINE 11: TO ADDRESS THE NEEDS OF THE COMMUNITY'S TOBACCO USAGE AND OBESITY, MAYO CLINIC HEALTH SYSTEM IN WAYCROSS (MCHS-WAYCROSS) ALONG WITH WARE AND PIERCE COUNTY SCHOOL SYSTEMS HAVE PARTNERED TOGETHER TO HELP LOCAL COMMUNITY SCHOOLS. MCHS-WAYCROSS UTILIZED THE PARTNERSHIP WITH THE SCHOOLS (MEMORIAL DRIVE AND BLACKSHEAR ELEMENTARY), AS A COLLABORATIVE EFFORT, BY ENGAGING IN EDUCATION PROGRAMS ABOUT OBESITY AND TOBACCO AS PART OF A SOLUTION TO EDUCATE YOUTH ON THE IMPORTANCE OF HEALTHY EATING AND LIFESTYLES. MCHS-WAYCROSS' RESPIRATORY DEPARTMENT OFFERS EDUCATION ON SMOKING AND GENERAL TOBACCO USE AS AN ONGOING PUBLIC EDUCATION PROGRAM OFFERED TO ALL RESPIRATORY PATIENTS AND THEIR FAMILIES REGARDLESS OF A REPORTED INCIDENCE OF SMOKING. ALL PATIENTS ARE PRESENTED WITH A DISCHARGE PACKET REGARDING THE USE OF TOBACCO AND SMOKING. MCHS-WAYCROSS CONTINUES TO PARTNER WITH THE YMCA IN SUPPORT OF CAMP REVEILLE, A CAMP FOR UNDERSERVED CHILDREN, TO PROMOTE HEALTHY EATING AND EXERCISE.IN 2015, MCHS-WAYCROSS PARTNERED WITH SOUTHEAST GEORGIA PEDIATRICS AND AGSOUTH CREDIT UNION TO HOST A FARM-TO-LUNCH FOR THE STUDENTS AT MEMORIAL DRIVE ELEMENTARY. THIS WAS AN EFFORT TO JOIN THE NATION IN CELEBRATING FARM-TO-SCHOOL MONTH IN OCTOBER AND WAS USED TO EXPOSE THE CHILDREN TO LOCAL, FRESH REAL FOOD AND TO HELP SUPPORT LOCAL FARMERS. MCHS-WAYCROSS SPONSORED SCHOOL IN THE COMMUNITY, ON WEDNESDAY, OCTOBER 7TH, 2015. MCHS-WAYCROSS REPRESENTATIVES, DR. JOHN PRESUTTI AND TONI NELSON, ATTENDED THE LUNCH THAT DAY AND HAD PHOTOGRAPHS TAKEN WITH THE KIDS ENJOYING A LOCAL BURGER, LOCAL LETTUCE/SALAD AND SOME FRESH LOCAL BLUEBERRY JUICE.TO ADDRESS THE ADULT POPULATION, MCHS-WAYCROSS REACHED OUT TO COMMUNITY MEMBERS AND COMMUNITY ORGANIZATIONS THROUGH THE USE OF EDUCATIONAL TALKS, LECTURES, AND PRESENTATIONS ON HEALTH ISSUES CONDUCTED BY PHYSICIANS AND CLINICAL STAFF.PHYSICIAN PRESENTATIONS TO THE COMMUNITY: - WAYCROSS ROTARY - DR. LIBERTIN - KIWANIS CLUB - DR. PURI - WAYCROSS ROTARY CLUB - DR. CAMSARI - ST. PETER'S BAPTIST CHURCH - DR. CATCHINGS - GREEN THUMB GARDEN CLUB - DR. REESE - BLACKSHEAR ROTARY CLUB - DR. COCHON - WAYCROSS ROTARY -DR. COCHON - SENIOR WEIR CENTER, DOUGLAS- DR. CALAMIA - WAYCROSS EXCHANGE CLUB - DR. PURI - KIWANIS CLUB - ANGIE MOODY - BLACKSHEAR ROTARY - DR. HUFF - WAYCROSS ROTARY - DR. HUFF - WAYCROSS WOMEN'S CLUB - DR. PRESUTTI - WAYCROSS RETIRED TEACHERS ASSOCIATION - DR. REESE - TRINITY METHODIST KINGAGERS - DR. REESE - WAYCROSS KIWANIS CLUB - TERRY ANDERSONTO ADDRESS ACCESS TO HEALTH CARE, MCHS-WAYCROSS IS VERY LIMITED IN WHAT IT IS CAPABLE OF DOING. NEW PHYSICIANS AND PHYSICIAN ASSISTANTS HAVE BEEN RECRUITED. TRANSPORTATION FOR THE CITIZENS OF WARE AND PIERCE COUNTY IS PROVIDED BY A LOCAL BUSINESS GROUP. THESE SERVICES TAKE THE ELDERLY AND UNDERSERVED CITIZENS TO DOCTOR APPOINTMENTS AND OTHER FUNCTIONS AS NEEDED.HOW MCHS-WAYCROSS SERVES ITS COMMUNITY: - FINANCIAL ASSISTANCE - UNREIMBURSED COSTS OF GOVERNMENT PROGRAMS - COMMUNITY HEALTH IMPROVEMENT - HEALTH PROFESSIONS EDUCATION - SUBSIDIZED HEALTH CARE - CASH/IN-KIND SUPPORT - COMMUNITY BUILDINGTO HELP BETTER SERVE THE NEEDS IN THE COMMUNITY, MCHS-WAYCROSS PLANS TO INCREASE ITS FOCUS ON TOBACCO CESSATION.
MAYO CLINIC HEALTH SYSTEM IN WAYCROSSPART V, SECTION B, LINE 13B: IF A PATIENT BALANCE EXCEEDS 25% OF THE ANNUAL HOUSEHOLD INCOME, BUT THE PATIENT DOES NOT QUALIFY BASED ON FPG, CHARITY WILL BE ADJUSTED TO A MINIMUM OF THE AMOUNT GENERALLY BILLED (AGB). THE AGB IS DETERMINED USING THE LOOK-BACK METHOD AND CALCULATED USING ALL CLAIMS ALLOWED BY PRIVATE PAY INSURERS (INCLUDING MEDICARE ADVANTAGE) AND MEDICARE (TRADITIONAL) FOR INPATIENT AND OUTPATIENT SERVICES FOR THE YEAR.
MAYO CLINIC HEALTH SYSTEM IN WAYCROSSPART V, SECTION B, LINE 13H: THE REGIONAL PROXIMITY OF A PATIENT'S RESIDENCY IS A FACTOR FOR PRESCHEDULED SERVICES ONLY AND SECONDARY TO MEDICAL NEED. REGIONAL PROXIMITY IS NOT A FACTOR FOR EMERGENCY CARE PROVIDED.
MAYO CLINIC HEALTH SYSTEM IN WAYCROSSPART V, SECTION B, LINE 15E: REFER PATIENT TO APPLY FOR MEDICAL ASSISTANCE.
MAYO CLINIC HEALTH SYSTEM IN WAYCROSSPART V, SECTION B, LINE 16I: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE ARE DISCUSSED WITH THE PATIENT.
MAYO CLINIC HEALTH SYSTEM IN WAYCROSSPART V, SECTION B, LINE 20E: FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE TO EVERY PATIENT VIA MAYO'S PUBLIC WEBSITE, FROM CUSTOMER SERVICE AND PATIENT ACCESS LOCATIONS, AND IS REFERENCED ON MAYO'S AUTHORIZATION FORMS AND STATEMENTS. IN ADDITION, SIGNS ARE POSTED IN THE ADMISSIONS AREA AND THE PROCESS OF HOW TO APPLY IS AVAILABLE ON THE MAYO CLINIC WEBSITE.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, MAYO DISCUSSES ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE.MONTHLY STATEMENTS ARE SENT TO PATIENTS THAT OUTLINE CURRENT CHARGES AND ACTIONS WITH INSURANCE AND INCLUDES INFORMATION ABOUT MAYO'S CHARITY CARE POLICY. SOME MAYO SITES UTILIZE ADVOCATES TO CONTACT THE PATIENT UPON DISCHARGE TO HELP THEM SECURE GOVERNMENTAL ASSISTANCE OR FINANCIAL ASSISTANCE.EACH CHARITY CARE REVIEW IS DOCUMENTED IN MAYO'S BILLING SYSTEM AND COMMUNICATED TO THE PATIENT. COMPLETED CHARITY CARE FORMS ARE MAINTAINED EITHER IN PAPER OR ELECTRONIC FORMAT. THE PATIENT IS INFORMED REGARDING THE OUTCOME OF THE REVIEW.MAYO OFTEN IDENTIFIES CHARITY CARE OPPORTUNITIES AFTER THE PATIENT HAS BEEN DISMISSED. IN MANY CASES, THIS IS DUE TO LIMITED INSURANCE COVERAGE OR INSURANCE DENIALS AFTER THE SERVICE WAS PERFORMED. IN THESE CASES, WHEN A PATIENT EXPRESSES AN INABILITY TO PAY FOR THEIR SERVICES, STAFF WILL INITIATE A CHARITY REVIEW AS INDICATED BY THE FINANCIAL ASSISTANCE POLICY, WHICH IS AVAILABLE FOR EVERY PATIENT AT MAYOCLINIC.ORG.
MAYO CLINIC HEALTH SYSTEM IN WAYCROSSPART V, SECTION B, LINE 22D: THE POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 70% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN USING THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE.
FieldValueIRS element (for citing)
Facility23FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (23 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - SATILLA CARE CENTER
1600 RIVERSIDE AVENUEWAYCROSSGA31501SKILLED NURSING FACILITY
2 - PIERCE COUNTY NURSING HOME
221 EAST CARTER AVENUEBLACKSHEARGA31516SKILLED NURSING FACILITY
3 - SATILLA REGIONAL REHAB INSTITUTE
2500 SATILLA PARKWAYWAYCROSSGA31501REHAB UNIT
4 - SENIOR BEHAVIORAL UNIT
1900 TEBEAU STREETWAYCROSSGA31501PSYCHIATRIC UNIT / BEHAVIORAL HEALTH
5 - MCHSW - FAMILY PSYCHIATRY
1707 CITY BOULEVARD SQUAREWAYCROSSGA31501PSYCHIATRY CLINIC
6 - MCHSW - NEUROLOGY
2101 TEBEAU STREETWAYCROSSGA31501NEUROLOGY CLINIC
7 - MCHSW - PULMONOLOGY
2005 PIONEER STREETWAYCROSSGA31501PULMONOLOGY CLINIC
8 - MCHSW - SURGICAL ASSOCIATES
1908 ALICE STREETWAYCROSSGA31501SURGICAL OFFICE
9 - MCHSW - ORTHOPEDICS
305 PINEVIEW DRIVEWAYCROSSGA31501ORTHOPEDICS CLINIC
10 - MCHSW - OPHTHALMOLOGY
413 LISTER STREETWAYCROSSGA31501OPTHALMOLOGY CLINIC
11 - MCHSW - CARDIOLOGY
2004 PIONEER STREETWAYCROSSGA31501CARDIOLOGY CLINIC
12 - MCHSW - INFECTIOUS DISEASES
411 LISTER STREETWAYCROSSGA31501INFECTIOUS DISEASES CLINIC
13 - MCHSW - OBGYN
505 CITY BLVDWAYCROSSGA31501OB/GYN CLINIC
14 - MCHSW - FAMILY MEDICINE
1921 ALICE STREETWAYCROSSGA31501FAMILY MEDICINE CLINIC
15 - MCHSW - EXPRESS CARE
1921 ALICE STREETWAYCROSSGA31501CONVENIENT CARE CLINIC
16 - MCHSW - HEMATOLOGYONCOLOGY
1706 ALICE STREETWAYCROSSGA31501HEMATOLOGY/ONCOLOGY CLINIC
17 - MCHSW - RADIATION ONCOLOGY
1451 CHURCH STREETWAYCROSSGA31501RADIATION ONCOLOGY CLINIC
18 - MCHSW - HEMATOLOGYONCOLOGY - DOUGLAS
SHIRLEY AVENUE SUITES XXX-XX-XXXXDOUGLASGA31535HEMATOLOGY/ONCOLOGY CLINIC
19 - MCHSW - OUTREACH CLINIC
396 KINGSLAND DRIVEFOLKSTONGA31537OUTREACH CLINIC
20 - MCSHW - FAMILY MEDICINE
808 BEACON STREETWAYCROSSGA31501PRIMARY CARE CLINIC
21 - MCSHW - HEMATOLOGYONCOLOGY
1206 ALICE STREETWAYCROSSGA31501HEMATOLOGY/ONCOLOGY CLINIC
22 - MCHSW - HEMATOLOGYONCOLOGY
101 SEYMOUR STDOUGLASGA31533HEMATOLOGY/ONCOLOGY CLINIC
23 - MCHSW - OUTPATIENT IMAGING CENTER
410 ZACHARY STREETWAYCROSSGA31501RADIOLOGY/IMAGING

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C:MEDICAL INDIGENCY MAY BE USED TO DETERMINE ELIGIBILITY. IF A PATIENT BALANCE EXCEEDS 25% OF THE ANNUAL HOUSEHOLD INCOME, BUT THE PATIENT DOES NOT QUALIFY BASED ON FPG, CHARITY WILL BE ADJUSTED TO A MINIMUM OF THE AMOUNT GENERALLY BILLED (AGB). THE AGB IS DETERMINED USING THE LOOK-BACK METHOD AND CALCULATED USING ALL CLAIMS ALLOWED BY PRIVATE PAY INSURERS (INCLUDING MEDICARE ADVANTAGE) AND MEDICARE (TRADITIONAL) FOR INPATIENT AND OUTPATIENT SERVICES FOR THE YEAR.
PART I, LINE 7:A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS).THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO-CHARGE RATIO.
PART I, LINE 7G:THE FOLLOWING NET COMMUNITY BENEFIT COST ATTRIBUTED TO A PHYSICIAN CLINIC WAS INCLUDED AS SUBSIDIZED HEALTH SERVICES: $1,958,116.
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 $ 28,585,438.
SCHEDULE H, PART I, LINE 5THE FILING ORGANIZATION ESTIMATES CHARITY CARE FOR FINANCIAL PLANNING PURPOSES ONLY. THE ESTIMATED AMOUNT OF CHARITY CARE DOES NOT INFLUENCE OR HAVE ANY IMPACT ON THE AMOUNT OF CHARITY CARE PROVIDED.
PART II, COMMUNITY BUILDING ACTIVITIES:THROUGH IN-KIND DONATIONS AND GRANTS TO PUBLIC, PRIVATE AND NONPROFIT ORGANIZATIONS, THE FILING ORGANIZATION ASSISTS WITH SUSTAINING AND ENHANCING THE COMMUNITIES IT SERVES BY ASSISTING IN COMMUNITY SUPPORT, ENVIRONMENTAL IMPROVEMENTS AND COMMUNITY IMPROVEMENT ADVOCACY.
PART III, LINE 2:PART III, SECTION A, LINE 1: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.METHODOLOGY FOR SCHEDULE H, PART III, LINE 2:BAD DEBT EXPENSE IS DETERMINED BASED ON GAAP AND IS EXPLAINED IN THE ACCOUNTS RECEIVABLE FOOTNOTE OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS.
PART III, LINE 4:FOOTNOTES RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS CAN BE FOUND ON PAGES 5, 7, 8 AND 9 OF MAYO CLINIC'S 2015 CONSOLIDATED AUDITED FINANCIAL STATEMENTS.
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). HOWEVER, USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY ACTUALLY RESULTS IN A MEDICARE SHORTFALL OF $16,906,800 AS REPORTED IN THE CORE FORM, PART III, PROGRAM SERVICE ACCOMPLISHMENTS.THE MOST COMMON REASONS FOR A DIFFERENCE BETWEEN THE MEDICARE SURPLUS 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 FINANCIAL ASSISTANCE 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 AND OTHER COMMUNITY BENEFIT NEEDS.
PART III, LINE 9B:MAYO CLINIC AND ITS AFFILIATES STRIVE TO ASSIST ALL PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION PRIOR TO ENLISTING THE ASSISTANCE OF A COLLECTION AGENCY BY MAKING REASONABLE ATTEMPTS TO COLLECT FROM INSURANCE COMPANIES AND OTHER THIRD-PARTY PAYORS. IN ADDITION, MAYO CLINIC AND ITS AFFILIATES ACCEPT REASONABLE PAYMENT PLANS FROM PATIENTS WHEN AN ACCOUNT IS THE PATIENT'S RESPONSIBILITY AND TRY TO IDENTIFY THOSE PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE IS OFFERED TO ANY PATIENT IF THE FACTS AND CIRCUMSTANCES SUGGEST THAT THE PATIENT DOES NOT HAVE THE ABILITY TO PAY THEIR BILL IN WHOLE OR IN PART. 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 POTENTIALLY MEETING MAYO CLINIC'S FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA OR THE PATIENT ASKS TO APPLY FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY IS SUSPENDED UNTIL MAYO REVIEWS THE ACCOUNT FOR FINANCIAL ASSISTANCE ELIGIBILITY BASED ON SUBMISSION OF REQUESTED INFORMATION. COLLECTION ACTIVITY WOULD ONLY RESUME IF THE PATIENT IS DETERMINED TO BE INELIGIBLE FOR FINANCIAL ASSISTANCE OR IS ELIGIBLE FOR ONLY PARTIAL FINANCIAL ASSISTANCE AND DOES NOT AGREE TO PAY THE REMAINING BALANCE.
PART VI, LINE 2:CONSISTENT WITH ITS CHARITABLE MISSION, MAYO CLINIC HEALTH SYSTEM IN WAYCROSS (MCHS-WAYCROSS) PROVIDES COMMUNITY BENEFIT TO THE COMMUNITY IT SERVES. A COMMUNITY BENEFIT IS A PLANNED, MANAGED, ORGANIZED, AND MEASURED APPROACH TO MEETING IDENTIFIED COMMUNITY HEALTH NEEDS. IT INVOLVES THE PARTICIPATION OF THE HEALTHCARE ORGANIZATION WORKING WITH THE COMMUNITY TO BENEFIT ITS RESIDENTS THROUGH PROGRAMS AND SERVICES THAT IMPROVE THEIR HEALTH STATUS AND QUALITY OF LIFE. MCHS-WAYCROSS IMPROVES THE HEALTH AND WELL BEING OF THE NINE-COUNTY SERVICE AREA IN SOUTHEAST GEORGIA THAT IT SERVES THROUGH CLINICAL SERVICES, EDUCATION, AND PARTNERSHIPS THAT BUILD HEALTH CAPACITY IN THE COMMUNITY. COMMUNITY BENEFITS ARE PROVIDED FOR ALL CITIZENS AS WELL AS FOR THE MEDICALLY UNDERSERVED. THE ORGANIZATION PAYS CLOSE ATTENTION TO THE NEEDS OF LOW INCOME AND OTHER VULNERABLE PERSONS AND THE COMMUNITY AT LARGE. THE HOSPITAL WORKS WITH COMMUNITY GROUPS TO IDENTIFY NEEDS STRENGTHEN EXISTING COMMUNITY PROGRAMS AND PLAN NEWLY NEEDED SERVICES. IT PROVIDES A WIDE ARRAY OF COMMUNITY BENEFIT SERVICES DESIGNED TO IMPROVE COMMUNITY HEALTH AND THE HEALTH OF INDIVIDUALS. MCHS-WAYCROSS WORKS TO INCREASE ACCESS TO HEALTH CARE, IN ADDITION TO PROVIDING FREE AND DISCOUNTED SERVICES TO PEOPLE WHO ARE UNINSURED AND UNDERINSURED. THE ORGANIZATION'S COMMUNITY BENEFIT PROGRAMS ARE DESIGNED TO RESPOND TO ASSESSED NEEDS AND ARE FOCUSED ON PREVENTION AND EDUCATION.
PART VI, LINE 3:MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY:MAYO CLINIC IS COMMITTED TO OFFERING FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY FOR THEIR MEDICAL SERVICES IN WHOLE OR IN PART. IN ORDER TO ACCOMPLISH THIS CHARITABLE GOAL, MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM SITES WIDELY PUBLICIZE THIS POLICY IN THE COMMUNITIES THAT THE INDIVIDUAL MAYO CLINIC AFFILIATED SITES SERVE. MAYO CLINIC AFFILIATED SITES MAKE COPIES OF THIS POLICY AND APPLICATIONS AVAILABLE BY POSTING IT ON THEIR WEBPAGE INCLUDING THE ABILITY TO DOWNLOAD A COPY OF THE POLICY AND APPLICATION FREE OF CHARGE. INDIVIDUALS IN THE COMMUNITY SERVED WILL BE ABLE TO OBTAIN A COPY OF THE POLICY IN LOCATIONS THROUGHOUT EACH MAYO CLINIC AFFILIATED SITE OR UPON REQUEST. THE POLICY EXPLAINS THE FINANCIAL ASSISTANCE PROGRAM AND FACTORS AFFECTING ELIGIBILITY. WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. ADDITIONALLY, CHARITABLE CARE AND FINANCIAL ASSISTANCE IS REFERENCED ON PATIENT CORRESPONDENCE INCLUDING: THE MONTHLY STATEMENT OF ACCOUNT, ACCOUNT BALANCE LETTERS, AND LATE PAYMENT NOTIFICATIONS. ALL PATIENT CORRESPONDENCE REFERENCING CHARITABLE CARE AND FINANCIAL ASSISTANCE INCLUDE INTERNET, PHONE, AND MAILING ADDRESS CONTACT INFORMATION.
PART VI, LINE 4:MCHS-WAYCROSS SERVES A NINE-COUNTY REGION IN SOUTHEAST GEORGIA. THE MAIN CAMPUS IS LOCATED IN WAYCROSS, GEORGIA (WARE COUNTY) AND INCLUDES A HOSPITAL, A SKILLED NURSING FACILITY, A REHAB UNIT AND A PSYCHIATRIC UNIT. AN ADDITIONAL SKILLED NURSING FACILITY IS LOCATED IN BLACKSHEAR, GEORGIA (PIERCE COUNTY).ACCORDING TO THE UNITED STATES CENSUS BUREAU, THE 2015 POPULATION ESTIMATE FOR WARE COUNTY (WHICH COMPRISES MOST OF WAYCROSS'S SERVICE AREA) IS 35,370. THE CENSUS BUREAU REPORTS THAT 23.9% OF THE POPULATION IS UNDER 18 YEARS OLD AND 16.5% IS 65 YEARS OLD OR OLDER. AN ESTIMATED 28.8% OF INDIVIDUALS ARE LIVING BELOW THE POVERTY LEVEL.
PART VI, LINE 5:THE FILING ORGANIZATION IS AN AFFILIATE OF THE MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION - EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATION'S ACTIVITIES.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, 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 VS. CLOSED STAFF MODEL - THE FILING ORGANIZATION'S STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS 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 6:THIS ORGANIZATION IS A PART OF MAYO CLINIC HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO CLINIC HEALTH SYSTEM IS DESCRIBED IN RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). THAT STATEMENT ALSO DESCRIBES THE ROLES OF THE VARIOUS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.
PART VI, LINE 7NEITHER 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 A STATE HOSPITAL ASSOCIATION.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PmtsYes (X)IdemnificationGrossUpPmtsInd
Housing Allowance Or ResidenceYes (X)HousingAllowanceOrResidenceInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Severance PaymentYes (1)SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (22 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
CALAMIA MD KENNETH T
DIRECTOR/PRESIDENT/CEO$0$370,831$0$0$0$38,756$0$56,562$0$16,085$0$482,234$0$0
CATCHINGS MD TIMOTHY T
DIRECTOR$830,450$0$0$0$48,999$0$55,646$0$11,377$0$946,472$0$0$0
DAWSON MD NANCY L
DIRECTOR/VICE PRESIDENT$0$285,989$0$0$0$8,901$0$53,360$0$14,817$0$363,067$0$0
HOFFMAN MARY J
DIRECTOR/SECRETARY/TREASURER/CAO$0$345,161$0$0$0$21,531$0$34,373$0$20,893$0$421,958$0$0
PRESUTTI DO RICHARD J
DIRECTOR/PRESIDENT/CEO$0$415,681$0$0$0$44,535$0$32,848$0$21,480$0$514,544$0$0
SWEAT HOLLI H
DIRECTOR/ASSISTANT SECRETARY$190,114$0$0$0$287$0$31,846$0$21,945$0$244,192$0$0$0
LOCKETT KEVIN M
INTERIM CFO$0$165,129$0$0$0$663$0$20,360$0$26,641$0$212,793$0$0
RATHBUN JON
CFO$0$95,980$0$0$0$76,581$0$8,612$0$9,628$0$190,801$0$0
COCHON MD ARISTOTLE P
PHYSICIAN$401,990$0$0$0$6,324$0$27,065$0$25,270$0$460,649$0$0$0
JHA MD ASIT K
PHYSICIAN$736,463$0$0$0$23,987$0$35,220$0$20,712$0$816,382$0$0$0
LOTT MD MCGREGOR N
PHYSICIAN$658,177$0$0$0$18,517$0$30,964$0$25,276$0$732,934$0$0$0
WYKSTRA MD DAVID J
PHYSICIAN$573,644$0$0$0$17,597$0$30,964$0$22,933$0$645,138$0$0$0
BORDERS MD YOLANDA M
PHYSICIAN$650,494$0$0$0$40,404$0$27,251$0$21,423$0$739,572$0$0$0
GRIFFIN MD HOWARD
PHYSICIAN$646,526$0$0$0$26,011$0$5,300$0$3,434$0$681,271$0$0$0
JOHNSON MD KENNETH A
PHYSICIAN$637,847$0$0$0$2,031$0$48,567$0$19,624$0$708,069$0$0$0
PILLAI MD DILIP P
PHYSICIAN$682,616$0$0$0$38,221$0$44,802$0$22,857$0$788,496$0$0$0
SINGLETON MD BRIAN A
PHYSICIAN$644,300$0$0$0$4,585$0$33,455$0$18,250$0$700,590$0$0$0
CROFT CHERYL R
FORMER OFFICER$0$242,163$0$0$0$1,536$0$41,303$0$16,651$0$301,653$0$0
LANGE MD STEPHEN M
FORMER OFFICER$0$518,151$0$0$0$88,212$0$33,930$0$23,985$0$664,278$0$0
SMITH JR WINDELL R
FORMER OFFICER$0$197,200$0$0$0$904$0$29,158$0$25,222$0$252,484$0$0
WALTERS ROBERT M
FORMER OFFICER$0$305,907$0$0$0$15,816$0$56,223$0$16,878$0$394,824$0$0
BAKER MD MICHAEL P
FORMER KEY EMPLOYEE$236,278$0$0$0$29,324$0$46,890$0$19,714$0$332,206$0$0$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 1AMICHAEL P. BAKER, M.D. RECEIVED LOAN FORGIVENESS WHICH WAS TREATED AS TAXABLE INCOME AND WAS GROSSED UP. HOUSING ALLOWANCES ARE PROVIDED WHEN JUSTIFIED BY BUSINESS NEED SUCH AS RELOCATION OR WORK ASSIGNMENT. IN 2015, DILIP P. PILLAI, M.D. RECEIVED A HOUSING ALLOWANCE THAT WAS TREATED AS TAXABLE INCOME AND WAS GROSSED UP. BRIAN A. SINGLETON, M.D. RECEIVED A HOUSING ALLOWANCE THAT WAS TREATED AS TAXABLE INCOME.
PART I, LINE 3THE 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.
PART I, LINES 4A-BPURSUANT TO A SEPARATION AGREEMENT, JON RATHBUN, FORMER CHIEF FINANCIAL OFFICER OF MAYO CLINIC FLORIDA / MAYO CLINIC JACKSONVILLE, RECEIVED THE FOLLOWING BENEFITS: PURCHASE OF HIS HOME AT APPRAISED FAIR MARKET VALUE, CASH COMPENSATION OF $65,757 (AN AMOUNT EQUAL TO 3 MONTHS' SALARY AND COBRA BENEFITS), AND AN AGREEMENT TO FORGO COLLECTION OF ANY RELOCATION OR MOVING EXPENSES THAT WERE SUBJECT TO POTENTIAL REPAYMENT ABSENT RETENTION. THIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(A)(17). STARTING JANUARY 1, 2011, ALL SRP BENEFITS ARE PAID AS AN ANNUAL TAXABLE CASH PAYMENT. THE FOLLOWING INDIVIDUALS RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN. AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). CALAMIA M.D., KENNETH T. $30,734 DAWSON M.D., NANCY L. $ 2,918 HOFFMAN, MARY J. $18,685 LANGE M.D., STEPHEN M. $70,388 PRESUTTI D.O., RICHARD J. $ 9,125 WALTERS, ROBERT M. $11,890 THIS ENTITY HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE ENTITY'S 403(B) PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(A)(17). THE FOLLOWING INDIVIDUALS RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN. AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). BORDERS M.D., YOLANDA M. $20,100 CATCHINGS M.D., TIMOTHY T. $43,948 COCHON M.D., ARISTOTLE P. $6,163 GRIFFIN M.D., HOWARD $11,361 JHA M.D., ASIT K. $23,521 LOTT M.D., MCGREGOR N. $18,212 PILLAI M.D., DILIP P. $18,185 WYKSTRA M.D., DAVID J. $17,362
PART II:COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION.

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

FieldValueIRS element (for citing)
PersonMICHAEL P BAKER MDPersonNm
Relationship With OrgFORMER KEY EMPLOYEERelationshipWithOrgTxt
Loan PurposeSIGN-ON BONUS SET-UP AS A FORGIVABLE LOANLoanPurposeTxt
Loan From OrganizationYes (X)LoanFromOrganizationInd
Original Principal$205,000OriginalPrincipalAmt
Balance Due$30,546BalanceDueAmt
Default0DefaultInd
Board Or Committee Approval0BoardOrCommitteeApprovalInd
Written AgreementYes (1)WrittenAgreementInd
FieldValueIRS element (for citing)
Total Balance Due$30,546TotalBalanceDueAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 2THE FOLLOWING INDIVIDUAL(S) IS/ARE EMPLOYED BY A RELATED ORGANIZATION: LOCKETT, KEVIN M. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL(S) WHO IS/ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: RATHBUN, JON, THE FOLLOWING INDIVIDUAL(S) IS/ARE EMPLOYED BY A RELATED ORGANIZATION: CALAMIA M.D., KENNETH T., BEARD, TERESA B., PRESUTTI D.O., RICHARD J., HOFFMAN, MARY J., DAWSON M.D., NANCY L., RATHBUN, JON RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL(S) WHO IS/ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: PRESUTTI D.O., RICHARD J., HOFFMAN, MARY J., DAWSON M.D., NANCY L., RATHBUN, JON, LOCKETT, KEVIN M.
FORM 990, PART VI, SECTION A, LINE 3MAYO CLINIC, MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, AND OTHER RELATED COMPANIES PROVIDE MANAGEMENT SERVICES TO THE ENTIRE SYSTEM OF ENTITIES. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS, COMPENSATION FOR THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES HAS BEEN DISCLOSED IN PART VII AND SCHEDULE J AS REQUIRED.
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF THIS CORPORATION SHALL BE MAYO CLINIC JACKSONVILLE (A NONPROFIT CORPORATION).
FORM 990, PART VI, SECTION A, LINE 7ATHE SOLE CORPORATE MEMBER APPOINTS MEMBERS TO THE BOARD OF DIRECTORS THROUGH MULTIPLE PROCESSES AS SPECIFIED IN THE BYLAWS.
FORM 990, PART VI, SECTION A, LINE 7BTHE ARTICLES AND BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, DEBT, AMENDMENT OF THE ARTICLES AND BYLAWS AND GENERAL OPERATION DECISIONS. THE COMMUNITY DIRECTORS HAVE THE AUTHORITY TO ENFORCE CERTAIN PROVISIONS OF THE INTEGRATION AGREEMENT.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE CHIEF ADMINISTRATIVE OFFICER AND FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FILING ORGANIZATION'S GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12CMAYO 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 15THE 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, EXECUTIVE AND SENIOR ADMINISTRATIVE LEADERSHIP, ALONG WITH ALLIED HEALTH STAFF. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY OR REGIONAL LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY PRIOR TO IMPLEMENTATION OF THE RESPECTIVE COMPENSATION INCREASE. THE COMPENSATION AND BENEFIT PROGRAM OF THE CHIEF EXECUTIVE OFFICER (CEO) WAS REVIEWED AND APPROVED BY THE PROCESS DESCRIBED BELOW FOR PHYSICIANS OF THE ARIZONA, FLORIDA, AND ROCHESTER, MINNESOTA CAMPUSES. THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION AND BENEFIT PROGRAMS FOR PHYSICIANS OF 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 SALARIES ARE REVIEWED (WITH RECUSAL WHERE APPROPRIATE). THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. FOLLOWING REVIEW BY THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE, THE COMPENSATION AND BENEFIT PROGRAMS FOR PHYSICIANS OF THE ARIZONA, FLORIDA, AND ROCHESTER, MINNESOTA CAMPUSES ARE REVIEWED AND APPROVED BY THE MAYO CLINIC BOARD OF TRUSTEES GOVERNANCE AND NOMINATING COMMITTEE. THE MAYO CLINIC BOARD OF TRUSTEES GOVERNANCE AND NOMINATING COMMITTEE IS COMPRISED OF NINE OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. THIS GROUP REVIEWS AND APPROVES THE COMPENSATION AND BENEFIT PROGRAMS FOR PHYSICIANS FROM ALL CAMPUSES, 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. THE SALARY AND BENEFIT PROGRAM OF THE CHIEF ADMINISTRATIVE OFFICER (CAO) WAS REVIEWED AND APPROVED BY THE PROCESS DESCRIBED BELOW FOR SENIOR ADMINISTRATIVE LEADERSHIP. THE COMPENSATION AND BENEFIT PROGRAMS FOR SENIOR ADMINISTRATIVE LEADERSHIP FOR ALL CAMPUSES, INCLUDING THE MAYO CLINIC HEALTH SYSTEM LOCATIONS, ARE REVIEWED AND APPROVED BY THE MAYO CLINIC BOARD OF TRUSTEES GOVERNANCE AND NOMINATING COMMITTEE. THE MAYO CLINIC BOARD OF TRUSTEES GOVERNANCE AND NOMINATING COMMITTEE IS COMPRISED OF NINE OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. THIS GROUP REVIEWS AND APPROVES THE COMPENSATION AND BENEFIT PROGRAMS FOR PHYSICIANS FROM ALL CAMPUSES, 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.
FORM 990, PART VI, SECTION C, LINE 19THE FILING ORGANIZATION'S GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST AND ALSO ON THE MAYOCLINIC.ORG WEBSITE. THE FILING ORGANIZATION IS A HOSPITAL AFFILIATED WITH MAYO CLINIC. AS SUCH, MAYO CLINIC'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THE FILING ORGANIZATION'S FORM 990 AND WOULD BE AVAILABLE UPON REQUEST OF THE FORM 990.
FORM 990, PART IX, LINE 11GI/C PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,105,838. MANAGEMENT AND GENERAL EXPENSES 107,589. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,213,427. OTHER PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 22,038,162. MANAGEMENT AND GENERAL EXPENSES 2,630,148. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 24,668,310.
FORM 990, PART XII, LINE 2B:INDIVIDUAL AUDIT STATEMENTS ARE BEING PREPARED FOR THE FILING ORGANIZATION BUT WERE NOT FINALIZED AS OF THE FILING OF THIS RETURN.
FILING OF CERTAIN FOREIGN FORMSDISCLOSURE STATEMENT RELATED TO FORMS 5713: FORM 5713 HAS BEEN FILED BY THE FOLLOWING MEMBERS OF THE CONTROLLED GROUP: MAYO CLINIC (EIN: 41-6011702) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH (EIN: 41-1506440) DISCLOSURE STATEMENT RELATED TO FORMS 5471: UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, AS A CATEGORY 4 AND 5 FILER WITH RESPECT TO CERTAIN CONTROLLED FOREIGN CORPORATIONS (CFCS). THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 5471 FOR THESE CFCS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT. TAXPAYER NAME: MAYO CLINIC ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 41-6011702 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED TAXPAYER NAME: MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 41-1506440 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED DISCLOSURE STATEMENT RELATED TO FORMS 8865: UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 8865, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN PARTNERSHIPS, AS A CATEGORY 2 AND 3 FILER. THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 8865 FOR THESE PARTNERSHIPS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT. TAXPAYER NAME: MAYO CLINIC ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 8865 WAS FILED: 41-6011702 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (39 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACdAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
CHARTERHOUSE INC
200 FIRST STREET SWROCHESTERMN55905411405254RETIREMENT LIVING CENTERMN501(C)(3)9MAYO CLINICYes (1)
DESTINATION MEDICAL CENTER EDA
50 SOUTH SIXTH STREET SUITE 1500MINNEAPOLISMN554021498464893585ECONOMIC DEVELOPMENTMN501(C)(3)11-IMAYO CLINICYes (1)
GOLD CROSS AMBULANCE SERVICE
200 FIRST STREET SWROCHESTERMN55905411917516AMBULANCE SERVICEMN501(C)(3)9MFMERYes (1)
LUTHER LAKESIDE APARTMENTS INC
PO BOX 1510EAU CLAIREWI54702391409024LOW INCOME HOUSING FOR ELDERLYWI501(C)(3)9MCHS--EAU CLAIRE HOSPITAL INCYes (1)
MAYO CLINIC
200 FIRST STREET SWROCHESTERMN55905416011702PATIENT CARE - CLINICMN501(C)(3)9Yes (1)N/A
MAYO CLINIC ARIZONA
13400 EAST SHEA BOULEVARDSCOTTSDALEAZ85259860800150HOSPITAL AND CLINICAZ501(C)(3)3MAYO CLINICYes (1)
MAYO CLINIC FLORIDA (A NONPROFIT CORPORATION)
4500 SAN PABLO ROADJACKSONVILLEFL32224590714831HOSPITALFL501(C)(3)3MAYO CLINIC JACKSONVILLEYes (1)
MAYO CLINIC HOSPITAL -- ROCHESTER
200 FIRST STREET SWROCHESTERMN55905410944601HOSPITALMN501(C)(3)3MAYO CLINICYes (1)
MAYO CLINIC JACKSONVILLE
4500 SAN PABLO ROADJACKSONVILLEFL32224593337028PATIENT CARE - CLINICFL501(C)(3)7MAYO CLINICYes (1)
MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
200 FIRST STREET SWROCHESTERMN55905411506440CHARITABLE, EDUCATIONAL & SCIENTIFIC ACTIVITIESMN501(C)(3)9MAYO CLINICYes (1)
MAYO CLINIC STIFTUNG
FUNDRAISING FOUNDATIONMFMERYes (1)60486 FRANKFURT AM MAINFRANKFURTGMGM
MCHS IN WAYCROSS INC
1900 TEBEAU STREETWAYCROSSGA31501581667166HOSPITALGA501(C)(3)3MAYO CLINIC JACKSONVILLEYes (1)
MCHS--ALBERT LEA AND AUSTIN
1000 FIRST DRIVE NWAUSTINMN55912411404075HOSPITAL AND CLINICMN501(C)(3)3MAYO CLINICYes (1)
MCHS--AUSTIN FOUNDATION
1000 FIRST DRIVE NWAUSTINMN55912300107471FUNDRAISING FOUNDATIONMN501(C)(3)7MCHS--ALBERT LEA AND AUSTINYes (1)
MCHS--CANNON FALLS
32021 COUNTY ROAD 24 BLVDCANNON FALLSMN55009204156428HOSPITAL AND CLINICMN501(C)(3)3MAYO CLINICYes (1)
MCHS--CHIPPEWA VALLEY INC
1501 THOMPSON STREETBLOOMERWI54724390980343HOSPITAL AND CLINICWI501(C)(3)3MCHS--EAU CLAIRE HOSPITAL INCYes (1)
MCHS--EAU CLAIRE CLINIC INC
733 W CLAIREMONT AVE PO BOX 1510EAU CLAIREWI54702391735831PATIENT CARE - CLINICWI501(C)(3)3MAYO CLINICYes (1)
MCHS--EAU CLAIRE FOUNDATION INC
733 W CLAIREMONT AVE PO BOX 1510EAU CLAIREWI54702391633407GRANTMAKING FOUNDATIONWI501(C)(3)11-IMCHS--EAU CLAIRE CLINIC INCYes (1)
MCHS--EAU CLAIRE HOSPITAL INC
1221 WHIPPLE STREETEAU CLAIREWI54703390813418HOSPITALWI501(C)(3)3MAYO CLINICYes (1)
MCHS--FAIRMONT
800 MEDICAL CENTER DRIVE PO BOX 800FAIRMONTMN56031410760836HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATOYes (1)
MCHS--FRANCISCAN HEALTHCARE FOUNDATION INC
700 WEST AVE SOUTHLA CROSSEWI54601391186647FUNDRAISING FOUNDATIONWI501(C)(3)7MCHS--FRANCISCAN HEALTHCARE INCYes (1)
MCHS--FRANCISCAN HEALTHCARE INC
700 WEST AVE SOUTHLA CROSSEWI54601391411999HEALTHCARE SYSTEM PARENTWI501(C)(3)11-IMAYO CLINICYes (1)
MCHS--FRANCISCAN MEDICAL CENTER INC
700 WEST AVE SOUTHLA CROSSEWI54601390806374HOSPITAL AND CLINICWI501(C)(3)3MCHS--FRANCISCAN HEALTHCARE INCYes (1)
MCHS--LAKE CITY
500 WEST GRANT STREETLAKE CITYMN55041411906820HOSPITALMN501(C)(3)3MAYO CLINICYes (1)
MCHS--MANKATO
1025 MARSH STREETMANKATOMN56002411236756HOSPITAL AND CLINICMN501(C)(3)3MAYO CLINICYes (1)
MCHS--MANKATO HEALTH CARE FOUNDATION
1025 MARSH STREETMANKATOMN56002411663357FUNDRAISING FOUNDATIONMN501(C)(3)7MCHS--MANKATOYes (1)
MCHS--NEW PRAGUE
301 SECOND STREET NENEW PRAGUEMN56071410723639HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATOYes (1)
MCHS--NORTHLAND INC
1222 EAST WOODLAND AVENUEBARRONWI54812390920634HOSPITAL AND CLINICWI501(C)(3)3MCHS--EAU CLAIRE HOSPITAL INCYes (1)
MCHS--OAKRIDGE INC
13025 EIGHTH STREET PO BOX 70OSSEOWI54758391029430HOSPITAL AND CLINICWI501(C)(3)3MCHS--EAU CLAIRE HOSPITAL INCYes (1)
MCHS--OWATONNA
134 SOUTHVIEW STOWATONNAMN55060411862132PATIENT CARE - CLINICMN501(C)(3)3MAYO CLINICYes (1)
MCHS--RED CEDAR INC
2321 STOUT ROADMENOMONIEWI54751510190875HOSPITAL AND CLINICWI501(C)(3)3MCHS--EAU CLAIRE HOSPITAL INCYes (1)
MCHS--RED WING
701 HEWITT BOULEVARDRED WINGMN55066411713783PATIENT CARE SERVICESMN501(C)(3)3MAYO CLINICYes (1)
MCHS--SPRINGFIELD
625 NORTH JACKSON AVENUESPRINGFIELDMN56087411893827HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATOYes (1)
MCHS--ST JAMES
1101 MOULTON PARSONS DR PO BOX 460ST JAMESMN56081410797368HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATOYes (1)
MCHS--WASECA
501 NORTH STATE STREETWASECAMN56093363606405HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATOYes (1)
MILES AND SHIRLEY FITERMAN ENDOWMENT FUND FOR DIGESTIVE DISEASES
200 FIRST STREET SWROCHESTERMN55905412020392SUPPORT RESEARCH, PRACTICE & EDUCATIONMN501(C)(3)11-IMAYO CLINICYes (1)
POVERELLO FOUNDATION
200 FIRST STREET SWROCHESTERMN55905411494881FUNDRAISING FOUNDATIONMN501(C)(3)7MAYO CLINIC HOSPITAL - ROCHESTERYes (1)
SATILLA HEALTH FOUNDATION INC
1900 TEBEAU STREETWAYCROSSGA31501582008998FUNDRAISING FOUNDATIONGA501(C)(3)11-III-FI0N/A
SATILLA REGIONAL MEDICAL CENTER AUXILIARY
410 DARLING AVENUEWAYCROSSGA31501586066381PROMOTE AND COMPLEMENT HEALTH CAREGA501(C)(3)11-I0N/A

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACd
FRANKLIN HEATING STATION
119 THIRD ST SWROCHESTERMN55902410264830UTILITYMNN/A
LATIGO PETROLEUM LLC
PO BOX 14230ODESSATX79768364767494OIL & GAS EXPLORATIONDEN/A
WATERSHED CAP INSTL PRTNRS III LP
ONE MARITIME PLAZA SUITE 1525SAN FRANCISCOCA94111462982848INVESTMENT ACTIVITIESDEN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (37 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmCountryForeignAddress/CountryCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
AMBIENT CLINICAL ANALYTICS INC
221 1ST AVE SW SUITE 202ROCHESTERMN55902800928405SOFTWAREDEN/ACYes (1)
BWL HOLDINGS INC
1209 ORANGE STREETWILMINGTONDE19801472413749OIL & GAS EXPLORATIONDEN/ACYes (1)
CAVALRY CLO III LTD
INVESTMENT ACTIVITIESN/ACYes (1)PO BOX 1093 GT QUEENSGATE HOUSE SGRAND CAYMANCJCJ
CAVALRY CLO IV LTD
INVESTMENT ACTIVITIESN/ACYes (1)PO BOX 1093 GT QUEENSGATE HOUSE SGRAND CAYMANCJCJ
GMO GLOBAL BOND INVESTMENT FUND
OTHER FINANCIAL INVESTMENT ACTIVITIESN/AYes (1)78 SIR JOHN ROGERSONS QUAYDUBLIN 2EIEI
HEALTH TRADITION HEALTH PLAN
1808 EAST MAIN STREETONALASKAWI54650391545987MEDICAL SERVICES COMPANYWIN/ACYes (1)
LOBSS NETWORK SUPPORT 2002 INC
200 FIRST STREET SWROCHESTERMN55905481276150ADMINISTRATIVE SERVICESMNN/ACYes (1)
MAYO CLINIC GBS MAURITIUS
HEALTHCARE MANAGEMENTN/ACYes (1)2ND FLOOR EBENE MEWS 57EBENE CYBERCITYMPMP
MAYO CLINIC SUPPORT SERVICES TEXAS
200 FIRST STREET SWROCHESTERMN55905471751102HEALTH SERVICESTXN/ACYes (1)
MAYO HOLDING COMPANY
200 FIRST STREET SWROCHESTERMN55905411578020HOLDING COMPANYMNN/ACYes (1)
MAYO INSURANCE COMPANY LTD
200 FIRST STREET SWROCHESTERMN55905SELF INSURANCE POOLN/ACYes (1)CJ
MCHS--DECORAH CLINIC PHYSICIANS
907 MONTGOMERY STREETDECORAHIA52101411711329PATIENT CARE - CLINICIAN/ACYes (1)
MCHS--PHARMACY & HOME MEDICAL INC
1221 WHIPPLE STREETEAU CLAIREWI54703391528920PHARMACY SERVICESWIN/ACYes (1)
MMSI INC
200 FIRST STREET SWROCHESTERMN55905411547003THIRD PARTY ADMINISTRATION SERVICESMNN/ACYes (1)
RESOUNDANT INC
221 1ST AVE SW SUITE 202ROCHESTERMN55902461661978MANUFACTURING MEDICAL DEVICE COMPONENTMNN/ACYes (1)
ROCHESTER AIRPORT COMPANY
200 FIRST STREET SWROCHESTERMN55905410506870AIRPORT MANAGEMENTMNN/ACYes (1)
SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION
13400 E SHEA BLVDSCOTTSDALEAZ85259860870505COMMERCIAL PROPERTY OWNERS ASSOCIATIONAZN/ACYes (1)
THE STABILE BUILDING OWNERS' ASSOCIATION
200 FIRST STREET SWROCHESTERMN55905208994499COMMERCIAL PROPERTY OWNERS ASSOCIATIONMNN/ACYes (1)
CHARITABLE LEAD TRUST
CHARITABLE TRUSTCAN/ATYes (1)
PERPETUAL TRUST
CHARITABLE TRUSTNDN/ATYes (1)
PERPETUAL TRUST
CHARITABLE TRUSTAZN/ATYes (1)
PERPETUAL TRUST
CHARITABLE TRUSTLAN/ATYes (1)
PERPETUAL TRUST (2)
CHARITABLE TRUSTMAN/ATYes (1)
PERPETUAL TRUST
CHARITABLE TRUSTMON/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTAZN/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTCON/ATYes (1)
CHARITABLE REMAINDER TRUST (8)
CHARITABLE TRUSTFLN/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTLAN/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTMAN/ATYes (1)
CHARITABLE REMAINDER TRUST (77)
CHARITABLE TRUSTMNN/ATYes (1)
CHARITABLE REMAINDER TRUST (2)
CHARITABLE TRUSTNCN/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTTXN/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTCON/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTILN/ATYes (1)
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTMIN/ATYes (1)
CHARITABLE REMAINDER TRUST (64)
CHARITABLE TRUSTMNN/ATYes (1)
CHARITABLE REMAINDER TRUST (7)
CHARITABLE TRUSTMNN/ATYes (1)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other OrgYes (1)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
S$663,885GAAP
MMSI
S$6,245,845GAAP