2014-10-27T13:16:14-05:00 2013-12-31 990 2013-01-01 411906820 MAYO CLINIC HEALTH SYSTEM-LAKE CITY MAYO 5075381297 500 WEST GRANT STREET LAKE CITY MN 55041 JAMES J TARASOVITCH CFO 5075381297 2014-10-27 2013 2015-11-30 17:44:51Z THOMAS WITT MD 500 WEST GRANT STREET LAKE CITY MN 55041 40805806 0 5983 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1998 MN OPERATION OF A HOSPITAL, FOUR CLINICS AND A NURSING HOME. 9 4 328 159 0 0 495609 495412 40231457 40110493 707 -17620 155906 143056 40883679 40731341 7975 7601 0 0 20257985 18433220 0 0 107384 20231072 22910592 40497032 41351413 386647 -620072 30792054 29971969 3883949 3683936 26908105 26288033 X TO INSPIRE HOPE AND CONTRIBUTE TO HEALTH AND WELL-BEING BY PROVIDING THE BEST CARE TO EVERY PATIENT THROUGH INTEGRATED CLINICAL PRACTICE, EDUCATION, AND RESEARCH. 0 0 27378579 0 33062549 PATIENT SERVICES (HOSPITAL & CLINICS) - SEE SCHEDULE O:MAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) IS A MEMBER OF THE MAYO CLINC 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 1000 PHYSICIANS AND 14,000 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 70 COMMUNITIES, MAYO CLINIC HEALTH SYSTEM INCLUDES 18 OWNED HOSPITALS, SIX OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH TWO ADDITIONAL HOSPITALS, AND CONTRACT MANAGEMENT AGREEMENTS WITH AN ADDITIONAL HOSPITAL AND 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 2.5 MILLION VISITS ANNUALLY IN MAYO CLINIC HEALTH SYSTEM. IT IS ALSO A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS.MCHS-LAKE CITY OWNS AND OPERATES AN 18 BED CRITICAL ACCESS HOSPITAL SERVING LAKE CITY, MINNESOTA AND SURROUNDING COMMUNITIES. DURING THE YEAR ENDED DECEMBER 31, 2013, LAKE CITY HAD 225 MEDICAL/SURGICAL ADMISSIONS, 71 OBSTETRIC ADMISSIONS, 71 DELIVERIES, AND 161 SWING BED ADMISSIONS WITH AN AVERAGE DAILY CENSUS OF 9.66. IN ADDITION, THERE WERE 2625 EMERGENCY ROOM VISITS, 503 SAME DAY SURGERIES, AND ANCILLARY SERVICES INCLUDING LABORATORY, CARDIAC REHABILITATION, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, POLYSOMNOGRAPHY STUDIES, AND RADIOLOGY SERVICES. RADIOLOGY SERVICES INCLUDED MAMMOGRAPHY, CT, MRI, AND ULTRASOUND.MCHS-LAKE CITY ALSO OWNS AND OPERATES FOUR CLINICS LOCATED IN ALMA, WISCONSIN AND IN LAKE CITY, PLAINVIEW AND WABASHA, MINNESOTA. THESE CLINICS ARE STAFFED BY TWELVE FAMILY MEDICINE PHYSICIANS, A GENERAL SURGEON, TWO PHYSICIAN ASSISTANTS, AND SIX NURSE PRACTITIONERS, INCLUDING A CERTIFIED NURSE-MIDWIFE. ON AN ANNUAL BASIS, THERE ARE APPROXIMATELY 52,280 PATIENT VISITS AMONG THE FOUR CLINIC LOCATIONS.MCHS-LAKE CITY CONTINUES TO PROVIDE A VENTILATOR PROGRAM TO ENSURE CONTINUUM OF CARE AND THE MOST APPROPRIATE PLACEMENT AND LEVEL OF CARE FOR VENTILATED AND OTHER PATIENTS REQUIRING A HIGH LEVEL OF RESPIRATORY CARE. THE ULTIMATE GOAL IS TO WEAN THE PATIENTS FROM THE VENTILATOR. MCHS-LAKE CITY HAS COMMITTED ELEVEN BEDS IN THE FACILITY FOR CARING FOR THIS KIND OF PATIENT POPULATION, ALONG WITH PROVIDING CLASSROOM AND SKILLS TRAINING FOR NURSING STAFF AND PROVIDERS. MCHS-LAKE CITY 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 BOTH MEDICAID AND MEDICARE PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. IN ADDITION, SERVICES ARE PROVIDED TO PATIENTS UNDER OTHER MEANS TESTED GOVERNMENT PROGRAMS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. IN 2013, MCHS-LAKE CITY PROVIDED APPROXIMATELY $631,000 IN FINANCIAL ASSISTANCE (AT COST) TO PATIENTS. THE UNREIMBURSED COST OF SERVICES TO PATIENTS UNDER OTHER MEANS TESTED GOVERNMENT PROGRAMS WAS APPROXIMATELY $372,000 WHICH INCLUDES MNCARE TAX OF $356,395.LAKE CITY HAS APPROXIMATELY 155 VOLUNTEERS INCLUDING INDIVIDUALS AND SERVICE GROUPS WHO PROVIDED APPROXIMATELY 4,590 HOURS OF VOLUNTEER SERVICES DURING 2013. THEY STAFF THE INFORMATION DESK DIRECTING PATIENTS AND VISITORS TO THEIR DESTINATION AND PERFORM CLERICAL DUTIES FOR VARIOUS DEPARTMENTS IN THE MEDICAL CENTER. BASED ON THE 2013 INDEPENDENT SECTOR STATISTICS, THE APPROXIMATE VALUE OF THESE SERVICES IS $103,505. 8074229 0 7011395 RESIDENT SERVICES (NURSING HOME) - SEE SCHEDULE OMAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) ALSO OWNS AND OPERATES A 90-BED NURSING HOME THAT SEEKS TO ENHANCE RESIDENT'S QUALITY OF LIFE BY HELPING INDIVIDUALS MAINTAIN THEIR HEALTH AND SELF-RELIANCE. RESIDENTS ARE PROVIDED WITH 24-HOUR NURSING CARE, A ROOM, NUTRITIONALLY WELL-BALANCED MEALS, SNACKS, HOUSEKEEPING AND LAUNDRY SERVICES, ACTIVITY PROGRAMS, AND SOCIAL SERVICES ASSISTANCE AS NEEDED OR REQUESTED. RESIDENTS ALSO HAVE ACCESS TO SPECIALIZED SERVICES SUCH AS REHABILITATION SERVICES, REGISTERED DIETICIAN SERVICES, BEAUTY AND BARBER SERVICES, TELEPHONE SERVICES AND TELEVISION/CABLE SERVICES FOR AN ADDITIONAL FEE. THE AVERAGE DAILY CENSUS FOR THE NURSING HOME IN 2013 WAS 85.70.THE NURSING HOME'S DIETARY DEPARTMENT PROVIDES MEALS ON A DAILY BASIS FOR THE LAKE CITY HOME DELIVERED MEALS PROGRAM. MEALS ARE DELIVERED BY LIONS CLUB VOLUNTEERS TO LAKE CITY RESIDENTS WHO HAVE BEEN REFERRED TO THE PROGRAM BY HEALTHCARE PROVIDERS. MCHS-LAKE CITY PROVIDES THE ADMINISTRATION FOR THE PROGRAM INCLUDING REGISTRATION, DIETARY PLANNING, MEAL PREPARATION, AND BILLING. THIS SERVICE ALLOWS SENIOR CITIZENS AND OTHERS WITH MEDICAL NEEDS TO LIVE INDEPENDENTLY FOR LONGER THAN WOULD OTHERWISE BE POSSIBLE. 48891 7601 37521 COMMUNITY BENEFIT - SEE SCHEDULE O:MCHS-LAKE CITY ALSO OPERATES LIFELINE (AN EASY-TO-USE PERSONAL RESPONSE SERVICE) TO ENSURE THAT OLDER ADULTS LIVING AT HOME CAN GET QUICK ASSISTANCE WHENEVER IT MAY BE NEEDED - 24 HOURS A DAY, 365 DAYS A YEAR. WHEN THE PERSONAL HELP BUTTON IS PRESSED, A MCHS-LAKE CITY MONITOR RESPONDS, ASSESSES THE SITUATION AND SUMMONS APPROPRIATE HELP. THERE WERE APPROXIMATELY 90 SUBSCRIBERS TO THE PROGRAM DURING 2013.AS PART OF ITS ACTIVITIES, MAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) PROVIDES VARIOUS SUPPORT GROUPS AND PROGRAMS TO THE COMMUNITY AT NO CHARGE. THESE GROUPS AND CLASSES INCLUDE CARDIAC SUPPORT GROUPS INCLUDING 80 PARTICIPANTS IN CARDIAC REHAB PHASE 3 AND 132 PARTICIPANTS IN CARDIAC SUPPORT GROUP, DIABETIC EDUCATIONAL PROGRAMS, A BREAST CANCER SUPPORT GROUP, OUTREACH FOR SENIOR CITIZENS WHERE OUTREACH NURSES CONDUCTED BLOOD PRESSURE AND BLOOD SUGAR SCREENING FOR 1,366 PERSONS, MENTORING PROGRAMS AND PRENATAL CLASSES FOR EXPECTANT PARENTS.MCHS-LAKE CITY OFFERED SPORTS PHYSICALS AT A REDUCED RATE FOR STUDENTS WHO ARE PARTICIPATING IN SPORTS THROUGH THE LOCAL SCHOOLS, A PREVENTATIVE INJURY TRAINING PROGRAM, CONCUSSION SCREENING FOR 22 STUDENTS, FREE SKIN SCREENINGS AT LOCAL WRESTLING MEETS, AND STAFF ATTENDANCE AT HOME HIGH SCHOOL FOOTBALL GAMES TO RESPOND TO EMERGENCIES. MCHS-LAKE CITY ALSO HAS A PROGRAM THAT ALLOWS LOCAL HIGH SCHOOL STUDENTS TO COME ON-SITE AND LEARN ABOUT HEALTHCARE-RELATED CAREERS AND PARTICIPATE IN JOB SHADOWING EXPERIENCES. 55 STUDENTS PARTICIPATED IN HEALTH CAREER CLASS PRESENTATIONS. ALSO DURING 2013, MCHS-LAKE CITY PROVIDED $2,000 FOR SCHOLARSHIPS TO STUDENTS PURSUING A FIELD IN HEALTH CARE AND $5,601 IN DONATIONS TO LOCAL CHARITIES OR COMMUNITY ORGANIZATIONS. 120537 MAYO CLINIC HEALTH SYSTEM-LAKE CITY LEASES SPACE AND PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE. 120537 35501699 1 1 0 1 0 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 22 0 1 328 1 0 0 0 0 0 0 0 0 0 0 X 9 4 1 1 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 0 MN WI X CHRISTIE LOHKAMP 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 GARTNER PHILLIP A DIRECTOR 1.00 0.00 X 0 0 0 GRUBER JOHN DIRECTOR 1.00 0.00 X 0 0 0 KEENAN AARON DIRECTOR (10/7-12/31/13) 1.00 40.00 X 0 139123 28004 MAHN DAVID DIRECTOR 1.00 0.00 X 0 0 0 SCHAAL MELISSA DIRECTOR 1.00 0.00 X 0 0 0 SOLBERG MD JEREMY J DIRECTOR 40.00 0.00 X 228043 0 33298 SPANO MD DENNIS C VICE-CHAIR / DIRECTOR 40.00 0.00 X 488350 0 46036 WILKINSON MD JOHN M DIRECTOR 1.00 40.00 X 0 229100 15685 WITT MD THOMAS J CHAIR / DIRECTOR 40.00 0.00 X X 439005 0 53366 AGERTER MD DAVID C REGION CEO 1.00 40.00 X 0 494245 16310 BIREN DAVID H TREASURER 1.00 40.00 X 0 168919 22512 GUDGELL STEPHEN F RIVER CORRIDOR CAO (6/12-12/31) 1.00 40.00 X 0 186840 20159 KOCH MARK B ASSISTANT SECRETARY 1.00 40.00 X 0 316763 13860 PARKS DOUGLAS A REGION CAO 1.00 40.00 X 0 203383 46538 PILOT DAVID L REGION CFO (1/1-4/26/13) 1.00 40.00 X 0 83823 13356 STIENE SUSAN M SECRETARY 40.00 0.00 X 160118 0 41408 TARASOVITCH JAMES J REGION CFO (4/26-12/31/13) 1.00 40.00 X 0 266706 27577 LARSON MICHAEL J RIVER CORRIDOR CAO (1/1-6/12) 0.00 40.00 X 0 128358 19760 ADAMSON MD STEVEN C PHYSICIAN 40.00 0.00 X 324874 0 44249 RENELT MD JOHN A PHYSICIAN 40.00 0.00 X 356646 0 50637 SCHWEND DO PHILLIP P PHYSICIAN 40.00 0.00 X 257703 0 57677 STORLIE MD JESSICA M PHYSICIAN 40.00 0.00 X 270302 0 35629 TAYLOR DO ROBERT PHYSICIAN 20.00 20.00 X 158249 91970 24558 BROWN MARK C FORMER COO 0.00 40.00 X 0 147073 32813 2683290 2456303 643432 29 1 1 0 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 MEDICAL & SUPPORT SERVICES 1148363 CENTREX REHAB 1007 E 14TH ST MINNEAPOLIS MN 55404 PURCHASE SERVICES 365090 SAINT ELIZABETH MEDICAL CENTER 1200 GRAND BLVD W WABASHA MN 55981 MEDICAL SERVICES 320610 MAYO CLINIC HEALTH SYSTEM-RED WING 1407 W 4TH ST PO BOX 134 RED WING MN 55066 PROFESSIONAL SERVICES 279024 SODEXO OPERATIONS LLC 4880 PAYSPHERE CIRCLE CHICAGO IL 60674 MANAGEMENT FEES 175877 7 673 76806 396670 21263 495412 NET PATIENT REVENUE 620000 32941040 32941040 NURSING HOME REVENUE 623110 7011395 7011395 SHARED SERVICES REVENU 561000 83707 83707 LIFELINE 621990 37521 37521 RENTAL FROM AFFILIATES 531120 36830 36830 40110493 1003 1003 62527 55842 6685 6685 6685 18623 -18623 -18623 -18623 11047 0 11047 11047 CAFETERIA/VENDING REVE 722210 104838 101023 3815 MEDICAL RECORD/TRANSCR 541900 11468 11468 MISC. REVENUE 900099 9018 9018 125324 40731341 40232002 0 3927 X 5601 5601 2000 2000 1489622 1288096 201526 461190 461190 12324716 11853358 389901 81457 727410 693123 30136 4151 2515912 2397323 104233 14356 914370 871271 37882 5217 6020209 5598491 421718 36787 36787 8555 8555 198 198 9118399 5253344 3865055 5497 5497 2045337 1849755 194820 762 113804 113804 766619 766619 161940 121545 39470 925 40537 40537 884802 742502 142300 156291 156291 MEDICAL SUPPLIES 2317810 2317810 MEDICAID SURCHARGE 529941 529941 MN CARE TAX 356395 356395 BAD DEBT EXPENSE 177928 177928 169543 18381 150646 516 41351413 35501699 5742330 107384 296745 106645 23622 24435 3872 3872 6749225 6598418 0 19167 251623 507270 532866 387178 25035077 12996792 12573758 12038285 10318472 9974879 41871 311820 30792054 29971969 3747357 2928295 23622 24435 112970 731206 3883949 3683936 X 26908105 26288033 26908105 26288033 30792054 29971969 -620072 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 198 198 0 PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. MAYO CLINIC HEALTH SYSTEM-LAKE CITY PROVIDES INFORMATION OR EXPRESSES ITS CONCERNS TO LEGISLATIVE BODIES AND GOVERNMENT OFFICIALS ON MATTERS DIRECTLY RELATED TO HEALTH, THE DELIVERY OF HEALTH CARE AND MEDICAL EDUCATION AND/OR RESEARCH. IN 2013, MCHS-LAKE CITY REPRESENTATIVES HAD A MEETING WITH MEMBERS OF THE LEGISLATIVE AND EXECUTIVE BRANCHES OF GOVERNMENT TO DISCUSS ISSUES RELATING TO HEALTH CARE AND HEALTH CARE REFORM. 0 1 X 191866 191866 26775 17737262 7368162 10395875 7079174 5628630 1450544 12038285 MAYO POOLED INVESTMENTS 9974879 F 9974879 DUE TO AFFILIATES 731206 731206 X PART IV, LINE 2B: NURSING HOME RESIDENT TRUST ACCOUNT - RESIDENTS' FUNDS. PART X, LINE 2: AT DECEMBER 31, 2013 AND 2012, THE RESERVE FOR UNRECOGNIZED TAX BENEFITS WAS NOT SIGNIFICANT, AND AS A RESULT, THERE IS NO LONGER A RESERVE FOR UNRECOGNIZED TAX BENEFITS RECORDED FOR THE FILING ORGANIZATION. 1 1 X 1 X 1 X 1 1 1 0 1 1 630556 630556 0.01530 983715 611544 372171 0.00900 1614271 611544 1002727 0.02430 20638 1550 19088 0.00050 28253 28253 0.00070 6531218 1552314 4978904 0.12090 6867 6867 0.00020 6586976 1553864 5033112 0.12230 8201247 2165408 6035839 0.14660 4609 4609 0.00010 5836 5836 0.00010 17890 17890 0.00040 28335 28335 0.00060 0 177928 10278273 10491480 -213207 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM - LAKE CITY 500 WEST GRANT STREET LAKE CITY MN 55041 WWW.MAYOCLINICHEALTHSYSTEM.ORG 20693 X X X X MAYO CLINIC HEALTH SYSTEM - LAKE CITY 1 1 X X X X X X X 13 1 1 1 X HTTP://MAYOCLINICHEALTHSYSTEM.ORG/ABOUT-U X X X 0 0 1 1 100.000000000000 1 300.000000000000 1 X X X X X X X X 1 1 X X X X X 1 0 X X X X X 1 X 0 0 MAYO CLINIC HEALTH SYSTEM - LAKE CITY PART V, SECTION B, LINE 3: INPUT WAS PROVIDED BY THE HEALTHY COMMUNITIES SUPERVISOR AND COMMUNITY HEALTH SPECIALIST OF THE PUBLIC HEALTH DIVISION OF GOOD COUNTY HEALTH AND HUMAN SERVICES AND THE DIRECTOR OF WABASHA COUNTY PUBLIC HEALTH. IN ADDITION, INPUT WAS RECEIVED FROM KEY INFORMANT INTERVIEWS, COUNTY-WIDE MAIL SURVEYS, LOCAL FOCUS GROUPS, AND SURVEYS COMPLETED BY THE SCHOOL DISTRICTS, AND THE CHEMICAL HEALTH INITIATIVE. MAYO CLINIC HEALTH SYSTEM - LAKE CITY PART V, SECTION B, LINE 4: MAYO CLINIC HEALTH SYSTEM-CANNON FALLS, MAYO CLINIC HEALTH SYSTEM-LAKE CITY AND MAYO CLINIC HEALTH SYSTEM-RED WING COLLABORATED ON THE CHNA WHICH ENCOMPASSES THE COUNTIES THAT THE THREE HOSPITALS SERVE. MAYO CLINIC HEALTH SYSTEM - LAKE CITY PART V, SECTION B, LINE 7: DENTAL HEALTH, CHEMICAL HEALTH AND TOBACCO USE WERE IDENTIFIED AS NEEDS BUT WILL NOT BE ADDRESSED AS THEY ARE BEING ADDRESSED BY OTHER COMMUNITY ORGANIZATIONS. MAYO CLINIC HEALTH SYSTEM - LAKE CITY PART V, SECTION B, LINE 12I: 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 - LAKE CITY PART V, SECTION B, LINE 14G: 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. MAYO CLINIC HEALTH SYSTEM - LAKE CITY PART V, SECTION B, LINE 18E: 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, BROCHURES ARE AVAILABLE 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 GOVENMENTAL 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 - LAKE CITY PART V, SECTION B, LINE 20D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 8% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE. 5 MCHS - LAKE CITY (CARE CENTER) 500 WEST GRANT STREET LAKE CITY MN 55041 NURSING HOME MCHS - LAKE CITY (LAKE CITY CLINIC) 500 WEST GRANT STREET LAKE CITY MN 55041 CLINIC MCHS - LAKE CITY (WABASHA CLINIC) 1202 5TH GRANT BLVD WEST WABASHA MN 55981 CLINIC MCHS - LAKE CITY (PLAINVIEW CLINIC) 275 1ST STREET SW PLAINVEIW MN 55964 CLINIC MCHS - LAKE CITY (ALMA CLINIC) 204 SOUTH MAIN STREET ALMA WI 54610 CLINIC PART I, LINE 6A: THE ANNUAL REPORT FOR THE FILING ORGANIZATION IS PART OF A CONSOLIDATED REPORT PREPARED BY MAYO CLINIC. PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS).THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO-CHARGE RATIO. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 177,928. PART II, COMMUNITY BUILDING ACTIVITIES: THROUGH DONATIONS AND GRANTS TO PUBLIC, PRIVATE AND NONPROFIT ORGANIZATIONS, THE FILING ORGANIZATION ASSISTS WITH SUSTAINING AND ENHANCING THE COMMUNITIES IT SERVES. PART III, LINE 2: 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, 6, 8 AND 9 OF MAYO CLINIC'S 2013 CONSOLIDATED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE SHORTFALL REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT (USING A MEDICARE COST REPORT STEP-DOWN METHODOLOGY).REASONS WHY MEDICARE SHORTFALL REPORTED ON LINE 7, IF ANY, 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 MEETING MAYO CLINIC'S FINANCIAL ASSISTANCE ELIGIBILTY CRITERIA OR THE PATIENT ASKS TO APPLY FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY IS SUSPENDED UNTIL MAYO REVIEWS THE ACCOUNT FOR FINANCIAL ASSISTANCE ELIGIBILITY BASED ON SUBMISSION OF REQUESTED INFORMATION. COLLECTION ACTIVITY WOULD ONLY RESUME IF MAYO WOULD TELL THE COLLECTION AGENCY TO PURSUE COLLECTIONS ON THE BALANCE OR PARTIAL BALANCE IF THERE WAS A CHARITY ADJUSTMENT. PART VI, LINE 2: MAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) EMPLOYEES THROUGHOUT THE ORGANIZATION ASSESS THE NEEDS OF LAKE CITY AND THE SURROUNDING COMMUNITIES THROUGH PERSONAL INTERACTION AND INVOLVEMENT WITH LOCAL SCHOOLS, CIVIC GROUPS AND HEALTH DEPARTMENTS, AS WELL AS THROUGH THE COLLECTION AND ANALYSIS OF FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS.MCHS-LAKE CITY EMPLOYEES ARE ALSO STRONGLY CONNECTED WITH LOCAL CIVIC GROUPS. MANY EMPLOYEES ARE ACTIVE MEMBERS OF VARIOUS LAKE CITY ORGANIZATIONS, WHILE OTHERS GIVE HEALTHCARE PRESENTATIONS TO THESE GROUPS. THIS PARTICIPATION NOT ONLY PROMOTES INVOLVEMENT IN THE COMMUNITY, BUT ALSO GIVES COMMUNITY MEMBERS A CHANCE TO ASK QUESTIONS, SHARE COMMENTS, CONCERNS OR OTHER SUGGESTIONS THEY MAY HAVE REGARDING THE MEDICAL CENTER. MCHS-LAKE CITY ALSO WORKS WITH THE WABASHA PUBLIC HEALTH ORGANIZATION TO DEVELOP RELATIONSHIPS AMONG HEALTH CARE PROVIDERS AND COMMUNITY LEADERS. THIS PARTNERSHIP PROMOTES THE ACTIVE REFERRAL OF PATIENTS TO LOCAL RESOURCES SUCH AS ACCESS TO HIGH QUALITY NUTRITIOUS FOODS, PHYSICAL ACTIVITY AND TOBACCO USE CESSATION PROGRAMS. MCHS-LAKE CITY HAS THE TONY HEBERT MEMORIAL FUND IN PLACE TO HELP THOSE WHO ARE IN NEED OF HEALTHCARE, BUT HAVE NO INSURANCE OR ARE NOT ABLE TO RECEIVE OTHER FINANCIAL ASSISTANCE. MCHS-LAKE CITY ALSO PROVIDES PREVENTIVE HEALTH SCREENINGS AS THESE EXAMPLES OF INVOLVEMENT DEMONSTRATE, MCHS-LAKE CITY IS CLOSELY CONNECTED WITH THE COMMUNITY. IN ADDITION TO THIS, MCHS-LAKE CITY ACTIVELY SEEKS FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS THROUGH ITS PATIENT ADVISORY COUNCIL (PAC) AND PATIENT SATISFACTION SURVEYS. THE PAC IS A GROUP OF TEN COMMUNITY MEMBERS WHO SERVE AS A MCHS-LAKE CITY FOCUS GROUP TO PROVIDE FEEDBACK PRIOR TO THE IMPLEMENTATION OF NEW PROGRAMS AND SERVICES, ASSIST IN THE IDENTIFICATION OF OPPORTUNITIES THAT WILL IMPROVE PATIENT AND FAMILY SATISFACTION, PROVIDE TIMELY AND DIRECT INPUT INTO MCHS-LAKE CITY SYSTEM AND PROCESS CHANGES, OFFER INPUT TO LEADERSHIP IN THE PLANNING AND EVALUATION OF SERVICES, AND SERVE AS A VITAL LINK BETWEEN MCHS-LAKE CITY AND THE COMMUNITY.THROUGH THESE VARIOUS AVENUES, MCHS-LAKE CITY STAFF MEMBERS ACROSS MANY DEPARTMENTS STAY CONNECTED WITH THE COMMUNITY TO ASSESS THE HEALTHCARE NEEDS OF LAKE CITY AND SURROUNDING AREAS. 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. PART VI, LINE 4: MCHS-LAKE CITY HAS LOCATIONS IN LAKE CITY, PLAINVIEW AND WABASHA, MINNESOTA, AS WELL AS IN ALMA, WISCONSIN. THE MAJORITY OF MCHS-LAKE CITY'S SERVICE AREAS INCLUDE GOODHUE AND WABASHA COUNTIES IN SOUTHEASTERN MINNESOTA AND BUFFALO COUNTY IN SOUTHWESTERN WISCONSIN. THE MAIN CAMPUS, LOCATED IN LAKE CITY, HOUSES AN 18-BED CRITICAL ACCESS HOSPITAL, A 90-BED NURSING HOME AND A HOSPITAL-BASED CLINIC WITH EIGHT PROVIDERS THAT SERVES LAKE CITY AND SURROUNDING COMMUNITIES. ACCORDING TO THE UNITED STATES CENSUS BUREAU, THE 2011 POPULATION FOR WABASHA COUNTY (WHICH COMPRISES MOST OF LAKE CITY'S SERVICE AREA) IS 21,542. A 2012 ESTIMATE REPORTS THAT 23.4% OF THE POPULATION IS UNDER 18 YEARS OLD, AND 17.9% IS 65 YEARS OLD OR OLDER. THE MEDIAN HOUSEHOLD INCOME IS $51,227, AND AN ESTIMATED 7.1% OF INDIVIDUALS ARE LIVING BELOW POVERTY LEVEL. PART VI, LINE 5: THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION - EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO CLINIC 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 V. 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 7 NEITHER THE FILING ORGANIZATION, NOR ANY RELATED ORGANIZATION, FILES A COMMUNITY BENEFIT REPORT WITH ANY STATE OTHER THAN THE EXTENT TO WHICH COMMUNITY BENEFIT INFORMATION IS INCLUDED IN OTHER REPORTING REQUIREMENTS SUCH AS INFORMATION PROVIDED TO A STATE HOSPITAL ASSOCIATION. X X X 1 1 X X X 0 1 0 0 0 0 0 0 0 KEENAN AARON DIRECTOR (10/7-12/31/13) 0 138678 0 0 0 445 0 8547 0 19457 0 167127 0 0 SOLBERG MD JEREMY J DIRECTOR 200611 0 0 0 27432 0 12731 0 20567 0 261341 0 0 0 SPANO MD DENNIS C VICE-CHAIR / DIRECTOR 310016 0 0 0 178334 0 19841 0 26195 0 534386 0 0 0 WILKINSON MD JOHN M DIRECTOR 0 224926 0 0 0 4174 0 57 0 15628 0 244785 0 0 WITT MD THOMAS J CHAIR / DIRECTOR 389692 0 0 0 49313 0 37363 0 16003 0 492371 0 0 0 AGERTER MD DAVID C REGION CEO 0 431194 0 0 0 63051 0 136 0 16174 0 510555 0 0 BIREN DAVID H TREASURER 0 166786 0 0 0 2133 0 0 0 22512 0 191431 0 0 GUDGELL STEPHEN F RIVER CORRIDOR CAO (6/12-12/31) 0 170702 0 0 0 16138 0 151 0 20008 0 206999 0 0 KOCH MARK B ASSISTANT SECRETARY 0 305711 0 0 0 11052 0 230 0 13630 0 330623 0 0 PARKS DOUGLAS A REGION CAO 0 198505 0 0 0 4878 0 18728 0 27810 0 249921 0 0 STIENE SUSAN M SECRETARY 152484 0 0 0 7634 0 24125 0 17283 0 201526 0 0 0 TARASOVITCH JAMES J REGION CFO (4/26-12/31/13) 0 266706 0 0 0 0 0 10200 0 17377 0 294283 0 0 ADAMSON MD STEVEN C PHYSICIAN 244855 0 25000 0 55019 0 26334 0 17915 0 369123 0 0 0 RENELT MD JOHN A PHYSICIAN 210334 0 0 0 146312 0 21942 0 28695 0 407283 0 0 0 SCHWEND DO PHILLIP P PHYSICIAN 230751 0 0 0 26952 0 31482 0 26195 0 315380 0 0 0 STORLIE MD JESSICA M PHYSICIAN 234658 0 0 0 35644 0 9434 0 26195 0 305931 0 0 0 TAYLOR DO ROBERT PHYSICIAN 68188 84802 50000 0 40061 7168 11668 11668 764 458 170681 104096 0 0 BROWN MARK C FORMER COO 0 146748 0 0 0 325 0 4616 0 28197 0 179886 0 0 PART I, LINE 1A IN 2013, AS A BENEFIT TO ITS EMPLOYEES, THE FILING ORGANIZATION SUBSIDIZED EMPLOYEE MEMBERSHIPS TO THE YMCA AND SIMILAR HEALTH/FITNESS FACILITIES. THIS WAS TREATED AS TAXABLE COMPENSATION TO THE INDIVIDUAL. FOR 2013, DR. JEREMY J. SOLBERG RECEIVED THIS BENEFIT. THE PERSONAL SERVICES THAT WERE PROVIDED ARE INCOME TAX PREPARATION SERVICES THAT, IN ACCORDANCE WITH MAYO POLICY, ARE AVAILABLE TO MAYO CLINIC STAFF. SEVERAL OF THE CURRENT AND FORMER OFFICERS, DIRECTORS, AND KEY EMPLOYEES LISTED ON THIS RETURN RECEIVED THIS SERVICE, WHICH WAS TREATED AS TAXABLE COMPENSATION TO THE INDIVIDUALS. ONE OF THE LISTED PERSONS RECEIVED AN AWARD OR OTHER TANGIBLE RECOGNITION THAT WAS TREATED AS TAXABLE COMPENSATION. PURSUANT TO INSTITUTIONAL POLICIES, CERTAIN SUCH AWARDS HAVE A TAX GROSS-UP APPLIED IN ORDER NOT TO DIMINISH THE RECOGNITION AND CELEBRATORY NATURE OF THE AWARD. PART I, LINE 4B THIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(A)(17). 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). STEVEN C. ADAMSON, M.D. $5,869 DAVID C. AGERTER, M.D. $57,612 MARK B. KOCH $8,890 JOHN A. RENELT, M.D. $4,750 PHILLIP P. SCHWEND, D.O. $12,717 DENNIS C. SPANO, M.D. $35,463 THOMAS J. WITT, M.D. $39,948 PART I, LINE 3 THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE CORE 990 PART VI SECTION B LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED. PART III: COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. STORLIE MD JESSICA M EMPLOYEE SIGNING BONUS X 25000 4167 0 1 1 RENELT MD JOHN A EMPLOYEE SIGNING BONUS X 50000 15000 0 1 1 19167 LAURA S MARQUARDT EMPLOYMENT 52380 COMPENSATION PAID TO DAUGHTER OF BOARD OFFICER, SUSAN M. STIENE 0 LISA J GRUBER EMPLOYMENT 29432 COMPENSATION PAID TO SPOUSE OF BOARD MEMBER, JOHN GRUBER 0 MAUREEN T SULLIVAN-SPANO EMPLOYMENT 10255 COMPENSATION PAID TO SPOUSE OF BOARD OFFICER/MEMBER, DENNIS C. SPANO, M.D. 0 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: PILOT, DAVID L. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: TARASOVITCH, JAMES J. AGERTER M.D., DAVID C. KOCH, MARK B. PARKS, DOUGLAS A. THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: TARASOVITCH, JAMES J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL WHO IS ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: KOCH, MARK B. FORM 990, PART VI, SECTION A, LINE 3 MAYO 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 6 THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION IS MAYO CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER ELECTS THE GOVERNING BODY. ONE MEMBER IS ELECTED FROM A SLATE OF NOMINEES PROVIDED BY THE CITY COUNCIL OF LAKE CITY. FORM 990, PART VI, SECTION A, LINE 7B THE BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS DEBT, AMENDMENT OF THE BYLAWS, MERGERS, AND NEW SERVICES. AMENDMENTS OF THE ARTICLES OF INCORPORATION OR BYLAWS MUST BE APPROVED BY THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 8B THE FILING ORGANIZATION HAS A PHYSICIAN COMPENSATION COMMITTEE, A DELEGATED COMMITTEE OF THE BOARD, THAT MAKES RECOMMENDATIONS TO THE BOARD OF DIRECTORS. THE COMMITTEE HAS NO AUTHORITY TO ACT ON BEHALF OF THE BOARD, THEREFORE, THERE IS NO DOCUMENTATION FOR PART VI, SECTION A, LINE 8B. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER AND FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF 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 12C MAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF MAYO CLINIC (AND/OR AFFILIATE) AND THE OUTSIDE ENTITY. ADDITIONAL CONFLICT OF INTEREST POLICIES AND PROCEDURES EXIST FOR CERTAIN ENTITIES CONCERNING RESEARCH CONTRACTS AND OTHER TYPES OF POTENTIAL CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15A THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY IN THE FALL FOR THE NEXT YEAR'S COMPENSATION. THE SALARY OF THE BOARD CHAIRMAN AND THE CORRIDOR CAO WERE REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO CLINIC HEALTH SYSTEM PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE MAYO CLINIC HEALTH SYSTEM ENTITIES. THE COMMITTEE IS COMPRISED OF MAYO EMPLOYEES, BUT IS INDEPENDENT FOR INTERNAL REVENUE CODE 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED (WITH RECUSAL WHERE APPROPRIATE). FOR THOSE INDIVIDUALS FOR WHICH THIS COMMITTEE CAN NOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE COMPENSATION AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. INFORMATION ON MAYO CLINIC HEALTH SYSTEM PHYSICIAN AND ADMINISTRATIVE LEADERSHIP COMPENSATION AND BENEFITS IS ALSO REVIEWED BY THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION AND GOVERNANCE (GOVERNANCE COMMITTEE), WHICH IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. IN ADDITION TO THE ABOVE COORDINATED REVIEW PROCESS CONDUCTED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE AND/OR THE MAYO CLINIC GOVERNANCE COMMITTEE, THE FILING ORGANIZATION ALSO HAS ITS OWN COMPENSATION REVIEW AND APPROVAL PROCESS FOR SENIOR LEADERSHIP AND PHYSICIANS. THE PROCESS INCLUDES REVIEW OF COMPARABILITY DATA FOR SIMILAR SIZED ORGANIZATIONS BY AN INDEPENDENT COMMITTEE CONSISTING OF PUBLIC BOARD MEMBERS ONLY. SALARY RANGES FOR THE PAST YEAR AND RANGES FOR THE NEXT YEAR ARE REVIEWED FOR REASONABLENESS. CONTEMPORANEOUS MEETING MINUTES OF THE COMPENSATION COMMITTEE ARE KEPT ON FILE. FORM 990, PART VI, SECTION C, LINE 19 THE FILING ORGANIZATION'S GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST AND ALSO ON THE MAYOCLINIC.ORG WEBSITE. THE FILING ORGANIZATION IS A HOSPITAL AFFILIATED WITH MAYO CLINIC. AS SUCH, MAYO CLINIC'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THE FILING ORGANIZATION'S FORM 990 AND WOULD BE AVAILABLE UPON REQUEST OF THE FORM 990. FORM 990, PART IX, LINE 11G I/C PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 6,900,396. MANAGEMENT AND GENERAL EXPENSES 29,692. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,930,088. OTHER PURCHASED SERVICES : PROGRAM SERVICE EXPENSES -1,647,053. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -1,647,053. OTHER PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,835,363. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,835,363. FILING OF CERTAIN FOREIGN FORMS DISCLOSURE 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) MAYO CLINIC ARIZONA (EIN: 86-0800150) MAYO CLINIC JACKSONVILLE (EIN: 59-3337028) 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 BLOOMER LAKEVIEW INC 2110 DUNCAN ROAD BLOOMER WI 54724 391450617 LOW INCOME HOUSING WI 501(C)(3) 7 MCHS--CHIPPEWA VALLEY INC 1 CHARTERHOUSE INC 200 FIRST STREET SW ROCHESTER MN 55905 411405254 RETIREMENT LIVING CENTER MN 501(C)(3) 9 MAYO CLINIC 1 FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC 464 SOUTH ST JOSEPH AVENUE ARCADIA WI 54612 391322480 FUNDRAISING FOUNDATION WI 501(C)(3) 9 MCHS--FRANCISCAN HEALTHCARE INC 1 GOLD CROSS AMBULANCE SERVICE 200 FIRST STREET SW ROCHESTER MN 55905 411917516 AMBULANCE SERVICE MN 501(C)(3) 9 MFMER 1 LUTHER LAKESIDE APARTMENTS INC PO BOX 1510 EAU CLAIRE WI 54702 391409024 LOW INCOME HOUSING FOR ELDERLY WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 416011702 PATIENT CARE - CLINIC MN 501(C)(3) 9 N/A 1 MAYO CLINIC -- METHODIST HOSPITAL 200 FIRST STREET SW ROCHESTER MN 55905 410739106 HOSPITAL MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HOSPITAL-- ROCHESTER 200 FIRST STREET SW ROCHESTER MN 55905 410944601 HOSPITAL MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC ARIZONA 13400 EAST SHEA BOULEVARD SCOTTSDALE AZ 85259 860800150 HOSPITAL AND CLINIC AZ 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC FLORIDA (A NONPROFIT CORPORATION) 4500 SAN PABLO ROAD JACKSONVILLE FL 32224 590714831 HOSPITAL FL 501(C)(3) 3 MAYO CLINIC JACKSONVILLE 1 MCHS IN WAYCROSS INC 1900 TEBEAU STREET WAYCROSS GA 31501 581667166 HOSPITAL GA 501(C)(3) 3 MAYO CLINIC JACKSONVILLE 1 MCHS--ALBERT LEA AND AUSTIN 1000 FIRST DRIVE NW AUSTIN MN 55912 411404075 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MCHS--AUSTIN FOUNDATION 1000 FIRST DRIVE NW AUSTIN MN 55912 300107471 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--ALBERT LEA AND AUSTIN 1 MCHS--CANNON FALLS 1116 WEST MILL STREET CANNON FALLS MN 55009 204156428 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MCHS--CHIPPEWA VALLEY INC 1501 THOMPSON STREET BLOOMER WI 54724 390980343 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MCHS--EAU CLAIRE CLINIC INC 733 W CLAIREMONT AVE PO BOX 1510 EAU CLAIRE WI 54702 391735831 PATIENT CARE - CLINIC WI 501(C)(3) 3 MAYO CLINIC 0 MCHS--EAU CLAIRE FOUNDATION INC 733 W CLAIREMONT AVE PO BOX 1510 EAU CLAIRE WI 54702 391633407 GRANTMAKING FOUNDATION WI 501(C)(3) 11-I MCHS--EAU CLAIRE CLINIC INC 0 MCHS--EAU CLAIRE HOSPITAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 390813418 HOSPITAL WI 501(C)(3) 3 MAYO CLINIC 1 MCHS--FAIRMONT 800 MEDICAL CENTER DRIVE PO BOX 800 FAIRMONT MN 56031 410760836 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MCHS--FRANCISCAN HEALTHCARE FOUNDATION INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391186647 FUNDRAISING FOUNDATION WI 501(C)(3) 7 MCHS--FRANCISCAN HEALTHCARE INC 1 MCHS--FRANCISCAN HEALTHCARE FOUNDATION-SPARTA INC 310 WEST MAIN STREET SPARTA WI 54656 391423234 FUNDRAISING FOUNDATION WI 501(C)(3) 9 MCHS--FRANCISCAN HEALTHCARE INC 1 MCHS--FRANCISCAN HEALTHCARE INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391411999 HEALTHCARE SYSTEM PARENT WI 501(C)(3) 11-I MAYO CLINIC 1 MCHS--FRANCISCAN MEDICAL CENTER INC 700 WEST AVE SOUTH LA CROSSE WI 54601 390806374 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--FRANCISCAN HEALTHCARE INC 1 MCHS--HOME HEALTH & HOSPICE INC PO BOX 2060 EAU CLAIRE WI 54702 391491516 HOME HEALTH AND HOSPICE CARE WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL INC 1 MCHS--LAKE CITY 500 WEST GRANT STREET LAKE CITY MN 55041 411906820 HOSPITAL MN 501(C)(3) 3 MAYO CLINIC 1 MCHS--MANKATO 1025 MARSH STREET MANKATO MN 56002 411236756 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MCHS--MANKATO HEALTH CARE FOUNDATION 1025 MARSH STREET MANKATO MN 56002 411663357 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--MANKATO 1 MCHS--NEW PRAGUE 301 SECOND STREET NE NEW PRAGUE MN 56071 410723639 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MCHS--NORTHLAND INC 1222 EAST WOODLAND AVENUE BARRON WI 54812 390920634 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MCHS--OAKRIDGE INC 13025 EIGHTH STREET PO BOX 70 OSSEO WI 54758 391029430 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MCHS--OWATONNA 134 SOUTHVIEW ST OWATONNA MN 55060 411862132 PATIENT CARE - CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MCHS--RED CEDAR INC 2321 STOUT ROAD MENOMONIE WI 54751 510190875 HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC 1 MCHS--RED WING 701 HEWITT BOULEVARD RED WING MN 55066 411713783 PATIENT CARE SERVICES MN 501(C)(3) 3 MAYO CLINIC 1 MCHS--SPRINGFIELD 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 411893827 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MCHS--ST JAMES 1101 MOULTON PARSONS DR PO BOX 460 ST JAMES MN 56081 410797368 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MCHS--ST JAMES HEALTH CARE FOUNDATION 1101 MOULTON PARSONS DR PO BOX 460 ST JAMES MN 56081 411444129 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--ST JAMES 1 MCHS--SUPPORTIVE HOMECARE INC PO BOX 2060 EAU CLAIRE WI 54702 391686673 HOME HEALTH CARE WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL INC 1 MCHS--WASECA 501 NORTH STATE STREET WASECA MN 56093 363606405 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC JACKSONVILLE 4500 SAN PABLO ROAD JACKSONVILLE FL 32224 593337028 PATIENT CARE - CLINIC FL 501(C)(3) 7 MAYO CLINIC 1 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 200 FIRST STREET SW ROCHESTER MN 55905 411506440 CHARITABLE, EDUCATIONAL & SCIENTIFIC ACTIVITIES MN 501(C)(3) 9 MAYO CLINIC 1 MAYO KLINIK STIFTUNG 60486 FRANKFURT AM MAIN FRANKFURT GM FUNDRAISING FOUNDATION GM MFMER 1 MILES AND SHIRLEY FITERMAN ENDOWMENT FUND FOR DIGESTIVE DISEASES 200 FIRST STREET SW ROCHESTER MN 55905 412020392 SUPPORT RESEARCH, PRACTICE & EDUCATION MN 501(C)(3) 11-I MAYO CLINIC 1 POVERELLO FOUNDATION 200 FIRST STREET SW ROCHESTER MN 55905 411494881 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MAYO CLINIC HOSPITAL - ROCHESTER 1 FRANKLIN HEATING STATION 119 THIRD ST SW ROCHESTER MN 55902 410264830 UTILITY MN N/A PHYSICIAN SOFTWARE SYSTEMS LLC 3333 WARRENVILLE ROAD SUITE 200 LISLE IL 60532 453414836 HEALTHCARE RELATED SOFTWARE IL N/A GMO GLOBAL BOND INVESTMENT FUND 78 SIR JOHN ROGERSONS QUAY DUBLIN 2 EI OTHER FINANCIAL INVESTMENT ACTIVITIES EI N/A 0 HEALTH TRADITION HEALTH PLAN 1808 EAST MAIN STREET ONALASKA WI 54650 391545987 MEDICAL SERVICES COMPANY WI N/A C 0 LOBSS NETWORK SUPPORT 2002 INC 200 FIRST STREET SW ROCHESTER MN 55905 481276150 ADMINISTRATIVE SERVICES MN N/A C 0 MAYO CLINIC GBS MAURITIUS 2ND FLOOR EBENE MEWS 57 EBENE CYBERCITY MP HEALTHCARE MANAGEMENT MP N/A C 0 MCHS--DECORAH CLINIC PHYSICIANS 907 MONTGOMERY STREET DECORAH IA 52101 411711329 PATIENT CARE - CLINIC IA N/A C 0 MCHS--PHARMACY & HOME MEDICAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 391528920 PHARMACY SERVICES WI N/A C 0 MCHS PHYSICIANS IN WAYCROSS INC 1900 TEBEAU STREET WAYCROSS GA 31501 204363143 PHYSICIAN OFFICES GA N/A C 0 MAYO HOLDING COMPANY 200 FIRST STREET SW ROCHESTER MN 55905 411578020 HOLDING COMPANY MN N/A C 0 MAYO INSURANCE COMPANY LTD 200 FIRST STREET SW ROCHESTER MN 55905 SELF INSURANCE POOL CJ N/A C 0 MMSI INC 21 FIRST STREET SW ROCHESTER MN 55905 411547003 THIRD PARTY ADMINISTRATION SERVICES MN N/A C 0 RESOUNDANT INC 221 1ST AVE SW ROCHESTER MN 55902 461661978 MANUFACTURING MEDICAL DEVICE COMPONENT MN N/A C 0 ROCHESTER AIRPORT COMPANY ROUTE 2 ROCHESTER MN 55902 410506870 AIRPORT MANAGEMENT MN N/A C 0 SATILLA HEALTHNET INC 1900 TEBEAU STREET WAYCROSS GA 31501 582151076 HEALTH SERVICES GA N/A C 0 SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION 13400 E SHEA BLVD SCOTTSDALE AZ 85259 860870505 COMMERCIAL PROPERTY OWNERS ASSOCIATION AZ N/A C 0 THE STABILE BUILDING OWNERS' ASSOCIATION 200 FIRST STREET SW ROCHESTER MN 55905 208994499 COMMERCIAL PROPERTY OWNERS ASSOCIATION MN N/A C 0 DESTINATION MEDICAL CENTER ECONOMIC DEVELOPMENT AGENCY 50 SOUTH SIXTH STREET SUITE 1500 MINNEAPOLIS MN 554021498 464893585 ECONOMIC DEVELOPMENT MN N/A C 0 CAVALRY CLO III LTD PO BOX 1093 GT QUEENSGATE HOUSE S GRAND CAYMAN CJ INVESTMENT ACTIVITIES CJ N/A C 0 CHARITABLE LEAD TRUST (2) CHARITABLE TRUST CA N/A T 0 CHARITABLE LEAD TRUST CHARITABLE TRUST MN N/A T 0 CHARITABLE LEAD TRUST CHARITABLE TRUST IL N/A T 0 PERPETUAL TRUST CHARITABLE TRUST ND N/A T 0 PERPETUAL TRUST CHARITABLE TRUST AZ N/A T 0 PERPETUAL TRUST CHARITABLE TRUST LA N/A T 0 PERPETUAL TRUST (2) CHARITABLE TRUST MA N/A T 0 PERPETUAL TRUST CHARITABLE TRUST MN N/A T 0 PERPETUAL TRUST CHARITABLE TRUST MO N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST AZ N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST CO N/A T 0 CHARITABLE REMAINDER TRUST (7) CHARITABLE TRUST FL N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST LA N/A T 0 CHARITABLE REMAINDER TRUST (76) CHARITABLE TRUST MN N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NC N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST TX N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST CO N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST IL N/A T 0 CHARITABLE REMAINDER TRUST CHARITABLE TRUST MI N/A T 0 CHARITABLE REMAINDER TRUST (72) CHARITABLE TRUST MN N/A T 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH Q 16338209 GAAP MMSI INC R 2866228 GAAP MMSI INC S 2480214 GAAP MAYO CLINIC HEALTH SYSTEM-CANNON FALLS S 285346 GAAP MAYO CLINIC HEALTH SYSTEM-RED WING R 1045722 GAAP MAYO CLINIC HEALTH SYSTEM-ALBERT LEA & AUSTIN L 56628 GAAP