2013-10-28T08:57:16-05:00 2012-12-31 990 2012-01-01 411404075 MAYO CLINIC HEALTH SYSTEM-ALBERT LEA AND AUSTIN MAYO 5075381297 1000 FIRST DRIVE NW AUSTIN MN 55912 MARK R CIOTA MD 5073776352 2013-10-28 2012 2016-03-07 17:11:31Z X FKAMCHS-ALBERT LEA MARK R CIOTA MD 1000 FIRST DRIVE NW AUSTIN MN 55912 145188824 0 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1981 MN HOSPITAL AND CLINICS 12 4 1394 208 0 0 2863950 2632354 131401614 139504634 2085674 2198778 720417 748586 137071655 145084352 548476 171792 0 0 80053246 88680264 0 0 123698 50347066 54399165 130948788 143251221 6122867 1833131 155876941 316846724 9694149 30630711 146182792 286216013 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. 1 0 122346304 138525940 PATIENT CARE (SCHEDULE O)PATIENT CARE:MAYO CLINIC HEALTH SYSTEM IS A FAMILY OF CLINICS, HOSPITALS AND HEALTH CARE FACILITIES SERVING COMMUNITIES IN MINNESOTA, IOWA AND WISCONSIN. AS PART OF MAYO CLINIC, MAYO CLINIC HEALTH SYSTEM OFFERS OUTSTANDING CARE CLOSE TO HOME. PHYSICIANS AND STAFF IN MAYO CLINIC HEALTH SYSTEM HAVE READY ACCESS TO THE KNOWLEDGE, RESOURCES, AND EXPERTISE OF MAYO CLINIC, YET CAN MEET PATIENTS' HEALTH CARE NEEDS LOCALLY. MAYO CLINIC HEALTH SYSTEM IS PART OF THE COMMUNITY, FOCUSED ON IMPROVING THE HEALTH OF THE COMMUNITIES IN WHICH WE LIVE AND WORK. MAYO CLINIC HEALTH SYSTEM TEAMS WITH MAYO CLINIC TO DELIVER UNPARALLELED HEALTH CARE TO COMMUNITIES THROUGH AN INTEGRATED NETWORK OF CLINICS AND HOSPITALS.IN 2012, MAYO CLINIC HEALTH SYSTEM SITES EMPLOYED APPROXIMATELY 1,000 PHYSICIANS AND 14,000 ALLIED HEALTH STAFF. IN ADDITION, MAYO CLINIC PHYSICIANS FROM MULTIPLE SPECIALTIES REGULARLY SEE PATIENTS AT THE MAYO CLINIC HEALTH SYSTEM FACILITIES. BESIDES HAVING HEALTH CARE FACILITIES IN 72 COMMUNITIES, THE 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 FROM A NEW IDEA TO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN AMERICA. MAYO CLINIC HEALTH SYSTEM COMPLETES MORE THAN TWO-MILLION PATIENT VISITS ANNUALLY. IT ALSO SERVES AS A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS BEING RECOGNIZED SIX TIMES BY THE AMERICAN MEDICAL GROUP ASSOCIATION'S ACCLAIM AWARD PROGRAM (2005 ACCLAIM AWARD RECIPIENT AND FIVE-TIME ACCLAIM AWARD HONOREE). THE ACCLAIM AWARDS HONOR PHYSICIAN-LED ORGANIZATIONS DELIVERING CARE ALIGNED WITH THE IDEAL DELIVERY MODEL WHERE PATIENTS EXPERIENCE SAFE, RELIABLE, RESPONSIVE, READILY AVAILABLE AND INTEGRATED CARE. IN ADDITION, THE MINNESOTA COUNCIL FOR QUALITY HAS RECOGNIZED MAYO CLINIC HEALTH SYSTEM THREE TIMES FOR ITS PERFORMANCE EXCELLENCE EFFORTS. INDIVIDUAL MAYO CLINIC HEALTH SYSTEM LOCATIONS HAVE ALSO BEEN HONORED FOR THEIR COMMITMENT TO QUALITY, SAFETY, SERVICE, PERFORMANCE AND THEIR COMMUNITIES.PEOPLE IN MINNESOTA, IOWA AND WISCONSIN CAN HAVE PEACE OF MIND KNOWING THAT MAYO CLINIC HEALTH SYSTEM AND MAYO CLINIC PARTNER TO ENSURE HEALTHIER LIVES IN THE REGION.MAYO CLINIC HEALTH SYSTEM-ALBERT LEA (MCHS-AL) IS A MINNESOTA NON-PROFIT CORPORATION, TAX EXEMPT AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. TO JUSTIFY THIS TAX EXEMPT STATUS, MCHS-AL PROVIDES SCHOLARSHIPS, CHARITY CARE, INTERPRETING AND EDUCATIONAL SERVICES, AND VARIOUS OTHER COMMUNITY BENEFITS. MCHS-AL PROVIDES PRIMARY CARE NEEDS, INCLUDING FAMILY MEDICINE, INTERNAL MEDICINE, OB/GYN, PEDIATRICS AND GENERAL SURGERY. IN ADDITION, MCHS-AL ALSO PROVIDES SPECIALTY CARE IN CARDIOLOGY, DERMATOLOGY, NEUROLOGY, ONCOLOGY, OPHTHALMOLOGY, OPTOMETRY, OCCUPATIONAL HEALTH, PHYSICAL MEDICINE & REHAB, PSYCHIATRY, RHEUMATOLOGY, AUDIOLOGY, ALLERGY, ORTHOPEDICS, ENT, PSYCHOLOGY, PODIATRY, PHYSICAL THERAPY, WOUND CARE, UROLOGY, AND PLASTIC SURGERY. IN 2012, MCHS-AL HAD 157,079 CLINIC VISITS. MCHS-AL OPERATES REGIONAL CLINICS IN ALDEN, KIESTER, NEW RICHLAND, AND WELLS, MINNESOTA AND LAKE MILLS, IOWA.MCHS-AL INCLUDES A 77-BED HOSPITAL. DURING 2012, HOSPITAL INPATIENT DAYS TOTALED 6,417 WITH 818 ADDITIONAL DAYS FOR NEWBORN CARE AND 45,340 OUTPATIENT VISITS. MCHS-AL ALSO OPERATES AN AMBULANCE SERVICE STAFFED BY PARAMEDICS AND EMTS.AS PART OF THE MAYO CLINC HEALTH SYSTEM, MCHS-AL ACCESSES EMERGENCY MEDICAL HELICOPTER SERVICE THROUGHOUT SOUTHERN MINNESOTA AND NORTHERN IOWA. THE HELICOPTER PROVIDES RAPID PATIENT TRANSPORT TO THE APPROPRIATE HEALTH CARE FACILITY ALONG WITH DELIVERING HIGH-LEVEL CRITICAL CARE. FOUNTAIN CENTERS IS AN MCHS-AL PROGRAM FOR SUBSTANCE ABUSE AND ADDICTION. ITS MAIN CAMPUS IN ALBERT LEA OFFERS RESIDENTIAL AND OUTPATIENT TREATMENT, SUPPORT AND AFTERCARE PROGRAMS. CURRENTLY, FOUNTAIN CENTERS ALSO OFFERS OUTPATIENT PROGRAMS IN FAIRMONT, FARIBAULT, JACKSON, MANKATO, OWATONNA, ROCHESTER AND WASECA AND REACHES FAR OUTSIDE OF MCHS-AL SERVICE AREA TO MEET CHEMICAL DEPENDENCY TREATMENT NEEDS IN SOUTHERN MINNESOTA. MCHS-AL OPERATES ON A NONDISCRIMINATORY BASIS REGARDLESS OF RACE, COLOR, SEX, RELIGION OR NATIONAL ORIGIN.CHARITY CARE: MCHS-AL PROVIDES A VARIETY OF FINANCIAL ASSISTANCE OPTIONS TO PATIENTS WHO MEET ESTABLISHED CRITERIA. ITS ALMCARE PROGRAM ALLOWS PATIENTS WHO MEET FINANCIAL GUIDELINES TO ENROLL ANNUALLY TO RECEIVE CARE DISCOUNTS FROM 10% TO 100%, WITH A $5 CO-PAY FOR PRESCRIPTIONS. SERVICES ARE ALSO PROVIDED TO BOTH MEDICARE AND MEDICAID AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. THE COST OF CHARITY CARE PROVIDED DURING 2012 WAS $1,654,000 AND THE COST OF UNCOMPENSATED MEDICAID FOR 2012 WAS APPROXIMATELY $7,205,300. REPRESENTED IN THE UNCOMPENSATED MEDICAID AMOUNT IS THE MEDICAID SURCHAGE OF $426,374 AND MNCARE TAX OF $1,584,009. THE UNREIMBURSED COST OF MEDICARE WAS $16,254,400. 1164341 15750 9402 EDUCATION AND SUPPORT SERVICES (SCHEDULE O): EDUCATION AND SUPPORT SERVICES: MCHS-AL PROVIDES CONTINUING MEDICAL EDUCATION TO ITS STAFF. THERE ARE NUMEROUS HEALTH AND WELLNESS EDUCATION PROGRAMS, CLASSES AND SUPPORT GROUPS PROVIDED TO THE COMMUNITY THROUGHOUT THE YEAR. THESE CLASSES/SUPPORT GROUPS INCLUDE CHILDBIRTH PREPARATION CLASS, BABY PLACE TOURS, PRENATAL BREASTFEEDING EDUCATION, YOUNG PARENT CLASSES, INFANT & CHILD CARE SAFETY AND CPR, PRENATAL DIET HEALTH EDUCATION, BEREAVEMENT EDUCATION SUPPORT SERIES, CANCER SUPPORT GROUP, DIABETES SUPPORT GROUP, HYPERTENSION CLASS, PULMONARY/CARDIAC REHAB SUPPORT GROUP, RTS BEREAVEMENT SERVICES, STROKE SUPPORT GROUP, OSTOMY SUPPORT GROUP, MENTORS FOR HOPE, TOBACCO CESSATION SERVICES, SPORTS SCREENINGS, INDIVIDUAL SPORTS CONDITIONING AND SPORTS INJURY EVALUATIONS, ALL AT NO CHARGE.MCHS-AL PROVIDES CLASSES THROUGHOUT SOUTHEASTERN MINNESOTA. MCHS-AL ALSO PROVIDES FIRST AID, CPR, AND DEFIBRILLATOR TRAINING TO DAYCARE PROVIDERS AND INDUSTRIES IN THE AREA AND HELPS MAINTAIN THEIR SKILLS ON A REGULAR BASIS. MCHS-AL, VIA THE COMMUNITY TRAINING CENTER (IN ASSOCIATION WITH THE AMERICAN HEART ASSOCIATION), PROVIDES CPR AND ACLS CLASSES AND SUPPORT TO AREA BASIC LIFE SUPPORT AND ADVANCE LIFE SUPPORT PROVIDERS AND INSTRUCTORS. IN COLLABORATION WITH LOCAL AGENCIES AND GOVERNMENT, WE PROVIDE EMERGENCY PREPAREDNESS TRAINING. MCHS-AL AMBULANCE ALSO PROVIDES FREE EVENT COVERAGE FOR VARIOUS COMMUNITY ACTIVITIES. MCHS-AL'S PATIENT EDUCATION CENTER PROVIDES FREE BLOOD PRESSURE CHECKS AND HEALTH RESOURCES FOR THE COMMUNITY. LOCATED WITHIN THE FRONT CORRIDOR, THE CENTER'S LIBRARY AREA INCLUDES EASY ACCESS FOR COMMUNITY MEMBERS TO WRITTEN LITERATURE, DVDS, VCR TAPES, AND AUDIOTAPES AND USE OF FOUR PUBLIC COMPUTERS ALLOW PATIENTS A DIVERSE MEANS OF GETTING AND RECEIVING PATIENT EDUCATION ON A VARIETY OF MEDICAL AND HEALTH-RELATED SUBJECTS. ALSO LOCATED IN THE PATIENT EDUCATION CENTER IS MCHS-AL'S PATIENT ADVOCATE. SHE IS A CERTIFIED SENIOR HEALTH INSURANCE PROGRAM VOLUNTEER WHO FACILITATES MEDICATION ASSISTANCE FOR THOSE UNABLE TO AFFORD MEDICATION PRESCRIBED. SHE ALSO ASSISTS MEDICARE PARTICIPANTS ENROLLING IN THE PART D PLAN. EXPLAINING INSURANCE AND CLARIFYING INSURANCE ISSUES ARE ALSO OFFERED THROUGH THE PATIENT ADVOCATE. WITH THE DEVELOPMENT OF ALMCARE, SHE WORKS CLOSELY WITH THE FINANCE DEPARTMENT IN EDUCATING AND FOLLOWING UP WITH UNINSURED OR UNDERINSURED PATIENTS THAT ARE ACCEPTED INTO THIS PROGRAM.FREE EDUCATION PROGRAMS INCLUDE: - 10 HEALTH EDUCATION PROGRAMS - 52 HEALTH TALK RADIO PROGRAMS - 4 WELLNESS FAIRS AT LOCAL BUSINESSES - 1 WOMEN'S HEALTH SYMPOSIUM MCHS-AL ALSO PROVIDES PATIENT & FAMILY SOCIAL SERVICES, FREE HEALTH ASSESSMENTS AND SCREENINGS, COUNSELING SERVICES, FREE INTERPRETING SERVICES, AND SPACE FOR COMMUNITY MEETINGS AND SUPPORT GROUPS. SOME EXAMPLES OF THESE SERVICES ARE PROVIDED BELOW. 272578 156042 52058 COMMUNITY SUPPORT (SCHEDULE O): COMMUNITY SUPPORT: MCHS-AL HAS A HOME HEALTH PROGRAM IN WHICH PRIMARILY ELDERLY PATIENTS WITH CIRCULATORY, RESPIRATORY AND OTHER HEALTH PROBLEMS ARE PROVIDED ASSISTANCE WITH PERSONAL CARES AND ACTIVITIES OF DAILY LIVING. DURING 2012, THE HOME HEALTH PROGRAM SERVED 313 PATIENTS.MCHS-AL ALSO PROVIDES A HOSPICE FOR THE FAMILIES OF TERMINAL PATIENTS. IN 2012, 244 FAMILIES WERE SERVICED BY THIS HOSPICE.MCHS-AL PROVIDES FREE SPORTS PHYSICALS TO STUDENT ATHLETES. DURING 2012, IT PROVIDED PHYSICALS TO 310 CHILDREN.MCHS-AL SPONSORS A SCHOLARSHIP PROGRAM FOR HIGH SCHOOL SENIORS AND NON-TRADITIONAL STUDENTS FROM THE MCHS-AL SERVICE AREA WHO ARE ENTERING THE HEALTHCARE FIELD. IN THE YEAR ENDING DECEMBER 31, 2012, 15 SCHOLARSHIPS WERE AWARDED TOTALING $15,750. IN ADDITION, MCHS-AL PROVIDES MEETING SPACE AND SPONSORS VARIOUS "ON-SITE" EDUCATION PROGRAMS INCLUDING SHADOWING, PRECEPTORSHIPS, AND INTERNSHIPS. THE ESTIMATED COST OF SUPERVISION AND SPACE FOR THESE PROGRAMS IS $1,176,569. MCHS-AL IS AN ACTIVE MEMBER OF THE COMMUNITY, SUPPORTING SUCH COMMUNITY SERVICES AS SENIOR RESOURCES, FREEBORN COUNTY FAMILY SERVICES COLLABORATIVE, RIVERLAND COMMUNITY COLLEGE, UNITED WAY, ALBERT LEA FAMILY 'Y', AREA FOOD SHELVES, MEALS ON WHEELS, NUMEROUS YOUTH ACTIVITIES, COMMUNITY DEVELOPMENT PROJECTS AND SEVERAL OTHER HEALTH-RELATED ORGANIZATIONS. DURING 2012, MCHS-AL MADE CASH AND EQUIPMENT DONATIONS TOTALING OVER $176,000 TO VARIOUS CHARITABLE AND COMMUNITY ORGANIZATIONS. ITS COMMUNITY INVOLVEMENT PROGRAM ALLOWS STAFF TO VOLUNTEER EIGHT HOURS ANNUALLY DURING WORK TIME. IN 2012, 89 MCHS-AL VOLUNTEERS PROVIDED 546 HOURS OF SERVICES TO ENDORSED COMMUNITY PROGRAMS AND PROJECTS. THE VALUE OF THIS DONATED TIME IS $12,088 BASED ON THE INDEPENDENT SECTORS AVERAGE ESTIMATED VALUE OF SUCH SERVICES. MCHS-AL ALSO BENEFITS FROM COMMUNITY VOLUNTEERS IN ITS AUXILIARY, HOSPICE AND FLTC PROGRAMS AND AS MOVERS AT THE FRONT INFORMATION DESK. DURING 2012, VOLUNTEERS DONATED APPROXIMATELY 12,917 HOURS TO THE MEDICAL CENTER. THE VALUE OF THIS DONATED TIME IS $285,982 BASED ON THE INDEPENDENT SECTORS AVERAGE ESTIMATED VALUE OF SUCH SERVICES. THESE SERVICE HOURS WERE PRIMARILY SPENT ORGANIZING AND MANAGING ACTIVITIES FOR THE BENEFIT OF THE MEDICAL CENTER'S PATIENTS, PATIENTS' FAMILIES, VISITORS, AND STAFF. 64901 1602803 RESEARCH AND OTHER ACTIVITIES: MCHS-AL STAFF WORK WITH MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM PHYSICIAN INVESTIGATORS TO COORDINATE CLINICAL RESEARCH STUDIES. IN 2012, MCHS-AL PARTICIPATED IN A NUMBER OF RESEARCH PROJECTS TO IMPROVE THE HEALTH OF OUR COMMUNITIES. MAYO CLINIC HEALTH SYSTEM - ALBERT LEA LEASES SPACE AND PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE. 64901 1602803 123848124 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 38 0 1 1394 1 0 0 0 0 0 0 0 0 0 0 X 12 4 0 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 1 1 MN X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 AGERTER MD DAVID C 1.00 40.00 X X 0 483600 35091 CIOTA MD MARK R 40.00 0.00 X X 787325 0 45329 CRUZ-LARES LINDA A 1.00 0.00 X 0 0 0 FUNK MICHAEL S 1.00 0.00 X 0 0 0 GABRIELSON SHARON R 1.00 40.00 X 0 184552 47325 HEINZ MD DIETER 40.00 0.00 X X 432579 0 43818 KEPPLE-JOHNSON JANE K 1.00 0.00 X 0 0 0 MILLER MD ROBERT C 1.00 40.00 X X 0 526186 54533 RIZZO MD MARCO 1.00 40.00 X 0 556328 46010 ROUTH LORI J 40.00 0.00 X 140137 0 12829 SAVELKOUL DONALD 1.00 0.00 X 0 0 0 VERDOORN JUDY D 1.00 0.00 X X 0 0 0 KOCH MARK B 1.00 40.00 X 0 289086 16795 PARKS DOUGLAS A 1.00 40.00 X 0 189781 44522 PILOT DAVID L 40.00 0.00 X 196045 0 33934 WALDHOFF STEPHEN C 1.00 40.00 X 0 261303 64796 ECKSTROM MD MICHAEL T 40.00 0.00 X 983223 0 43898 GRZYBOWSKI MD JOHN A 40.00 0.00 X 343135 0 41818 LOMBARDI MD JOSEPH M 40.00 0.00 X 341163 0 27892 ULRICH MD MICHAEL D 40.00 0.00 X 337987 0 49635 BOYCE MD CORY A 40.00 0.00 X 641158 0 42218 LOTTS MD JEFFREY P 40.00 0.00 X 549750 0 48891 OTT MD JAMES W 40.00 0.00 X 552094 0 46333 SCHULZ MD JOHN M 40.00 0.00 X 563402 0 43826 SKORIN DO LEONID 40.00 0.00 X 956556 0 36537 SHELHAMER MD LEONARD E 40.00 0.00 X 244007 0 34096 BUCKMASTER DPM ROY W 40.00 0.00 X 275700 0 36139 LARSON VIRGINIA 40.00 0.00 X 163507 0 34258 STOLTENBERG MD HEIDI G 40.00 0.00 X 209211 0 37048 UNDERDAHL STEVE L 40.00 0.00 X 168399 0 15253 WAGGONER MD JULIAN R 40.00 0.00 X 390337 0 45020 8275715 2490836 1027844 81 1 1 0 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 PATIENT/ADMIN SERVICES 4896927 MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 LAB SERVICES 762375 MEDICAL DOCTOR ASSOCIATES PO BOX 277185 ATLANTA GA 30384 PROFESSIONAL FEES 382469 LCM PATHOLOGISTS PO BOX 5134 SIOUX FALLS SD 57117 LAB SERVICES 217733 SODEXO INC AND AFFILIATES PO BOX 70060 CHICAGO IL 60673 MANAGEMENT FEES 199453 11 3440 4569 549568 2074777 743 2632354 NET PATIENT REVENUE 620000 108345383 108345383 LAB REVENUE 621510 29506574 29506574 SHARED SERVICES REVENU 561000 1316198 1316198 RENT FROM AFFILIATES 531120 275019 275019 MEALS ON WHEELS 624210 52058 52058 9402 9402 139504634 2195401 2195401 13000 26587 -13587 -13587 -13587 3377 0 3377 3377 3377 6106 4569 2724 3382 3382 2735 743 1992 1992 137086 74418 62668 62668 CAFETERIA/VENDING 722210 596713 596713 MEDICAL RECORD FEES 541900 81890 81890 MISC. REVENUE 900099 9528 6966 2562 6000 6000 694131 145084352 140190203 0 2261795 156042 156042 15750 15750 3860747 3380972 479775 1599352 1599352 63061415 55850876 7210539 4173465 3705068 468397 11645598 10339220 1306378 4339687 3852635 487052 714029 320070 393959 123086 123086 1447 1447 1638 1638 11561166 8406792 3030676 123698 203480 198183 5297 6177266 5134915 1042351 3661544 3661544 2303627 2139998 163629 794731 590286 204445 333441 323401 10040 48791 48791 5331749 4752925 578824 1065468 1065468 MEDICAL SUPPLIES 16312517 16312517 BAD DEBT EXPENSE 3100971 3100971 MN CARE TAX 1584008 1584008 MEDICAID SURCHARGE 426374 426374 653832 543510 110322 143251221 123848124 19279399 123698 237343 598193 23637 8494 25537157 40488516 2531108 4630662 2657360 3412816 210848399 95690748 56058069 115157651 61405884 134852792 20000 7450020 17653963 155876941 316846724 6705759 20497539 89750 14654 2988390 10028768 9694149 30630711 X 145194739 273838565 686510 12006291 301543 371157 146182792 286216013 155876941 316846724 X 1833131 3805010 134395080 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1447 1447 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. 301543 69614 371157 301543 301543 301543 301543 230192 71351 301543 299260 -69068 230192 1.00000 0 1 1 5116505 5116505 140582489 52114007 88468482 65149405 43576741 21572664 115157651 MAYO POOLED INVESTMENTS 134852792 F 134852792 DUE FROM AFFILIATES 2157424 DEFERRED COMPENSATION 6852777 INTEREST IN NET ASSETS OF FDN 4509151 PARTNERSHIP INVESTMENT 61287 STRATEGIC PROPERTY INVESTMENTS 755090 INTEREST IN NET ASSETS OF FDN-AUSTIN MERGER 3318234 17653963 OTHER LIABILITIES 1056129 DUE TO AFFILIATES 2049864 DEFERRED COMPENSATION LIABILITY 6922775 10028768 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR EDUCATION AND PATIENT SUPPORT. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: AT DECEMBER 31, 2012 AND 2011, 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 0 1 1 1653968 1653968 0.01180 21518688 14313352 7205336 0.05140 23172656 14313352 8859304 0.06320 133536 133536 0.00100 1164341 1164341 0.00830 7098450 3507074 3591376 0.02560 5638 4620 1018 0.00000 198305 198305 0.00140 8600270 3511694 5088576 0.03630 31772926 17825046 13947880 0.09950 12329 12329 0.00010 200 2425 2425 0.00000 5492 5492 0.00000 70 823 823 0.00000 270 21069 21069 0.00010 0 3100971 23204514 29948515 -6744001 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM - ALBERT LEA

404 WEST FOUNTAIN STREET ALBERT LEA MN 56007

X X X MAYO CLINIC HEALTH SYSTEM - ALBERT LEA 1 1 1 100.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X 1 0 X X X X X 1 X 0 0 7 MCHS AT HEALTH REACH

1705 SE BROADWAY ALBERT LEA MN 56007

OUTPATIENT PHYSICAL THERAPY MCHS - ALBERT LEA IN LAKE MILLS

309 S 10TH AVE LAKE MILLS IA 50450

CLINIC MCHS - ALBERT LEA IN NEW RICHLAND

318 FIRST ST SW NEW RICHLAND MN 56072

CLINIC MCHS - ALBERT LEA IN ALDEN

192 WASHINGTON AVE ALDEN MN 56009

CLINIC MCHS - ALBERT LEA IN WELLS

301 S BROADWAY WELLS MN 56097

CLINIC MCHS - ALBERT LEA IN KIESTER

120 N MAIN ST KIESTER MN 56051

CLINIC MCHS - EXPRESS CARE IN ALBERT LEA

2708 BRIDGE AVE ALBERT LEA MN 56007

EXPRESS CARE 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 7G: THE FOLLOWING NET COMMUNITY BENEFIT COST ATTRIBUTED TO A PHYSICIAN CLINIC WAS INCLUDED AS SUBSIDIZED HEALTH SERVICES: $3,591,376. 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 $ 3100971. PART II: COMMUNITY BUILDING IS AN ESSENTIAL MAYO CLINIC HEALTH SYSTEM - ALBERT LEA (MCHS-AL) ACTIVITY. THE ORGANIZATION'S COMMUNITY INVOLVEMENT POLICY ENCOURAGES STAFF TO VOLUNTEER EIGHT HOURS ANNUALLY DURING WORK TIME. STAFF MAY CHOOSE FROM MCHS-AL ENDORSED COMMUNITY PROGRAMS AND RECEIVE THEIR REGULAR SALARIES WHILE VOLUNTEERING ON WORK TIME.IN 2012, 89 STAFF VOLUNTEERED A TOTAL OF 546 HOURS FOR COMMUNITY PROGRAMS AND PROJECTS SUCH AS SALVATION ARMY, RED CROSS, SCHOOL PROJECTS, FOOD SHELVES AND HEALTH FAIRS. CRITERIA FOR COMMUNITY INVOLVEMENT INCLUDES:CANCER-RELATED ACTIVITY CHAMBER OR COMMUNITY BUILDING ACTIVITY HEALTH EDUCATION OR HEALTH SCREENING ACTIVITYSENIOR RESOURCES OR NURSING HOME/ASSISTED LIVING ACTIVITYSOCIAL SERVICES ACTIVITYYOUTH-RELATED OR SCHOOL ACTIVITYMCHS-AL'S 2012 STAFF INVOLVEMENT IN THE COMMUNITY'S VITALITY PROJECT, FOR EXAMPLE, INCREASE WELLNESS OPPORTUNITES IN THE SCHOOLS, WORKPLACE AND IN LOCAL RESTAURANTSIN ADDITION, MCHS-AL ENCOURAGES INVOLVEMENT IN COMMUNITY BOARDS AND SPECIAL PROJECTS, LENDING EXPERTISE TO OUTSIDE GROUPS AND BRINGING BACK FRESH PERSPECTIVES AND FEEDBACK TO MCHS-AL INITIATIVES AND OPERATIONS. IN 2012, MCHS-AL STAFF PARTICIPATED IN THESE LOCAL BOARDS: ALBERT LEA BUSINESS DEVELOPMENT CENTER, ALBERT LEA PORT AUTHORITY, CONVENTION AND VISITOR'S BUREAU, CHAMBER OF COMMERCE, COMMUNITY FOUNDATION, FAMILY "Y", CURRICULUM COMMITTEE, COMMUNITY CHILD CARE BOARD, RED CROSS, RELAY FOR LIFE, SALVATION ARMY, UNITED WAY, RIVERLAND FOUNDATION, FREEBORN COUNTY FAMILY SERVICES COLLABORATIVE, ALONG WITH OTHER SPECIAL PROJECT COMMITTEES. PART III, LINE 4: THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.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 STATEMENTSFOOTNOTES RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS CAN BE FOUND ON PAGES 6, 8 AND 9 OF MAYO CLINIC'S 2012 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 SHORTFALL REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT (USING A MEDICARE COST REPORT STEP-DOWN METHODOLOGY). HOWEVER, USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY ACTUALLY RESULTS IN A MEDICARE SHORTFALL OF $16,254,400 AS REPORTED IN THE CORE FORM, PART III, PROGRAM SERVICE ACCOMPLISHMENTS.THE MOST COMMON REASONS FOR A DIFFERENCE BETWEEN THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H AND THE MEDICARE SHORTFALL REPORTED ON THE CORE FORM, PART III INCLUDE: (1) INCLUSION OF MEDICARE ADVANTAGE REVENUE AND EXPENSES; (2) INCLUSION OF PART B REVENUE AND EXPENSES; (3) INCLUSION OF OTHER FEE SCHEDULE REVENUE; AND (4) SOME TIMING ISSUES.REASONS WHY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT ARE: (1) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR 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. MAYO CLINIC HEALTH SYSTEM - ALBERT LEA PART V, SECTION B, LINE 14G: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMBEROUS 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 - ALBERT LEA 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 - ALBERT LEA PART V, SECTION B, LINE 20D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 10% 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. PART VI, LINE 2: MAYO CLINIC HEALTH SYSTEM - ALBERT LEA'S COMMUNITY RELATIONS COMMITTEE SETS PRIORITY AREAS FOR MCHS-AL INVOLVEMENT AND CHARITABLE CONTRIBUTIONS. CURRENT CRITERIA FOR CONTRIBUTIONS INCLUDE:1. IMPROVING QUALITY OF LIFE2. PROMOTING YOUTH POTENTIAL3. IMPROVING COMMUNITY HEALTH AND WELLNESS4. PARTNERING FOR COMMUNITY GROWTH AND DEVELOPMENTMAYO CLINIC HEALTH SYSTEM - ALBERT LEA (MCHS-AL) PARTNERS WITH LOCAL GOVERNMENT, PUBLIC HEALTH, SOCIAL SERVICE AGENCIES, SCHOOLS, VITALITY PROJECT AND OTHER GROUPS TO DETERMINE COMMUNITY NEEDS. ALTHOUGH MCHS-AL DID NOT CONDUCT AN INDEPENDENT ANNUAL NEEDS ASSESSMENT IN 2012, THE ORGANIZATION REVIEWS LOCAL DATA AND ANECDOTAL INFORMATION FROM ITS PARTNERS TO SET PRIORITY AREAS FOR COMMUNITY NEED. BASED ON THAT INFORMATION, THE FIT FOREVER CHILDHOOD OBESITY PREVENTION PROGRAM DEVELOPED IN 2008 CONTINUES, WITH MCHS AS LEAD ORGANIZATION, PARTNERING WITH THE ALBERT LEA AREA SCHOOLS, ALBERT LEA FAMILY "Y" AND OTHER COMMUNITY GROUPS AND DONATING FUNDS AND STAFF TIME TO KEEP THE PROJECT GOING. IN ADDITION, MCHS-AL'S COMMUNITY INVOLVEMENT PROGRAM, WHERE STAFF IS ALLOWED EIGHT HOURS ANNUALLY TO VOLUNTEER DURING WORK TIME, IS ALSO BASED ON IDENTIFIED COMMUNITY NEEDS. 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 AVAILABLE BY POSTING IT ON THEIR WEBPAGE INCLUDING THE ABILITY TO DOWNLOAD A COPY OF THE POLICY 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: AT THE END OF THE YEAR IN 2012, MAYO CLINIC HEALTH SYSTEM - ALBERT LEA MERGED WITH MAYO CLINIC HEALTH SYSTEM - AUSTIN AS REFLECTED IN THE END-OF-YEAR BALANCE SHEET ITEMS. HOWEVER, THE 2012 ACTIVITIES OF MCHS-AUSTIN ARE SEPARATELY REPORTED ON ITS FINAL RETURN, THE 2012 990. MAYO CLINIC HEALTH SYSTEM - ALBERT LEA IS THE SOLE HEALTH CARE PROVIDER IN FREEBORN COUNTY AND THE ONLY PROVIDER IN THE COMMUNITIES OF ALDEN, KIESTER, WELLS, AND NEW RICHLAND, MINNESOTA, ALONG WITH LAKE MILLS, IOWA. FOUNTAIN CENTERS, AS A REGIONAL CHEMICAL DEPENDENCY TREATMENT CENTER, SERVES PATIENTS WITHIN AN 80 MILE RADIUS OF ALBERT LEA.MCHS-AL'S PRIMARY SERVICE AREA IS FREEBORN COUNTY, WITH A POPULATION OF ABOUT 31,000. AN ESTIMATED 21,000 UNIQUE PATIENTS WERE SEEN ANNUALLY AT MCHS-AL FROM 2007 THROUGH 2009. THE VARIANCE AMONG THOSE YEARS IS LESS THAN 2%. CUSTOMER GROUPS ARE COMPRISED OF MEDICARE PATIENTS, BUSINESS AND INDUSTRY LOCATED WITHIN A 20-MILE RADIUS, HEALTH PLANS INCLUDING MCHS-AL AND, GENERALLY, INDIVIDUAL PATIENTS SEEKING PRIMARY CARE. MAYO CLINIC HEALTH SYSTEM - ALBERT LEA, CARDIOLOGY, FOUNTAIN CENTERS, ORTHOPEDICS, OB/GYN AND WOUND CARE DEPARTMENTS REPRESENT UNIQUE SPECIALTY MARKETS REACHING BEYOND MCHS-AL'S TRADITIONAL MARKET AREA.FREEBORN COUNTY POPULATION CHARACTERISTICS (2012 ESTIMATE)AGE:PEOPLE UNDER 5 YEARS - 5.8% PEOPLE UNDER 18 YEARS - 21.8%PEOPLE 65 AND OLDER - 20.7%ALL OTHERS - 51.7% ETHNICITY:BLACK - 1.0%HISPANIC OR LATINO - 9.1%WHITE, NON HISPANIC - 87.9%ASIAN - 1.0%ALL OTHERS - 1.0%HOUSEHOLDS:TOTAL HOUSEHOLDS - 14,229 PERSONS PER HOUSEHOLD - 2.33MEDIAN HOUSEHOLD INCOME - $43,447PEOPLE BELOW POVERTY LEVEL - 11.2% PART VI, LINE 5: THIS FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION- EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO 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. THE BOARD OF TRUSTEES IS THE GOVERNING BODY OF MAYO CLINIC. A MAJORITY OF ITS MEMBERS ARE EXTERNAL, INDEPENDENT TRUSTEES. IT HAS OVERALL RESPONSIBILITY FOR THE CHARITABLE, CLINICAL PRACTICE, SCIENTIFIC AND EDUCATIONAL MISSION AND PURPOSES OF MAYO CLINIC AND ITS AFFILIATES AS SET FORTH IN ITS ARTICLES OF INCORPORATION AND BYLAWS. BECAUSE OF MAYO CLINIC'S NATIONAL PRESENCE, THESE TRUSTEES ARE SELECTED BASED ON THEIR AREAS OF EXPERTISE, WHETHER IN HEALTH CARE POLICY, BUSINESS, GOVERNMENT OR ANOTHER FIELD. IN ADDITION TO THIS COMMUNITY REPRESENTATION AT THE PARENT ENTITY, THE FILING ORGANIZATION ALSO INVOLVES LOCAL COMMUNITY MEMBERS ON ITS GOVERNING BODY. OPEN V. CLOSED STAFF MODEL - STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHSYICIANS IN THE COMMUNITY.EMERGENCY ROOM - THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. PART VI, LINE 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 ON THE MINNESOTA HOSPITAL ANNUAL REPORT OR TO THE WISCONSIN HOSPITAL ASSOCIATION. 1 UNITED WAY OF FREEBORN COUNTY 341 S BROADWAY ALBERT LEA MN 56007 410956396 501(C)(3) 20000 FURTHER EXEMPT PURPOSE FREEBORN COUNTY HISTORICAL SOCIETY 1031 BRIDGE AVENUE ALBERT LEA MN 56007 410872543 GOVT-FREEBORN COUNTY 7000 COMMUNITY BENEFIT 2 SCHOLARSHIPS 15 15750 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY WITH PROGRAMS THAT ENHANCE THE MISSION OF THE FILING ORGANIZATION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY THAT ADDRESS UNMET OR UNDER-FUNDED COMMUNITY NEEDS IN THE AREAS OF HEALTHCARE, EDUCATION, RESEARCH, DIVERSITY AND EQUALITY OF OPPORTUNITY. TRANSFERS OR GRANTS TO TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED. TRANSFERS OR GRANTS TO AFFILIATED TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED. 0 1 0 0 0 0 0 0 0 AGERTER MD DAVID C 0 449783 0 0 0 33817 0 19707 0 15384 0 518691 0 0 CIOTA MD MARK R 787325 0 0 0 0 0 17500 0 27829 0 832654 0 0 0 GABRIELSON SHARON R 0 183859 0 0 0 693 0 21238 0 26087 0 231877 0 0 HEINZ MD DIETER 432579 0 0 0 0 0 17500 0 26318 0 476397 0 0 0 MILLER MD ROBERT C 0 475539 0 0 0 50647 0 27579 0 26954 0 580719 0 0 RIZZO MD MARCO 0 518597 0 0 0 37731 0 24641 0 21369 0 602338 0 0 ROUTH LORI J 140137 0 0 0 0 0 9774 0 3055 0 152966 0 0 0 KOCH MARK B 0 279804 0 0 0 9282 0 322 0 16473 0 305881 0 0 PARKS DOUGLAS A 0 188612 0 0 0 1169 0 20335 0 24187 0 234303 0 0 PILOT DAVID L 196045 0 0 0 0 0 13937 0 19997 0 229979 0 0 0 WALDHOFF STEPHEN C 0 251096 0 0 0 10207 0 45379 0 19417 0 326099 0 0 ECKSTROM MD MICHAEL T 983223 0 0 0 0 0 17500 0 26398 0 1027121 0 0 0 GRZYBOWSKI MD JOHN A 343135 0 0 0 0 0 17500 0 24318 0 384953 0 0 0 LOMBARDI MD JOSEPH M 341163 0 0 0 0 0 17500 0 10392 0 369055 0 0 0 ULRICH MD MICHAEL D 337987 0 0 0 0 0 17500 0 32135 0 387622 0 0 0 BOYCE MD CORY A 641158 0 0 0 0 0 17500 0 24718 0 683376 0 0 0 LOTTS MD JEFFREY P 549750 0 0 0 0 0 17500 0 31391 0 598641 0 0 0 OTT MD JAMES W 552094 0 0 0 0 0 17500 0 28833 0 598427 0 0 0 SCHULZ MD JOHN M 563402 0 0 0 0 0 17500 0 26326 0 607228 0 0 0 SKORIN DO LEONID 956556 0 0 0 0 0 17500 0 19037 0 993093 0 0 0 SHELHAMER MD LEONARD E 244007 0 0 0 0 0 16828 0 17268 0 278103 0 0 0 BUCKMASTER DPM ROY W 275700 0 0 0 0 0 17500 0 18639 0 311839 0 0 0 LARSON VIRGINIA 163507 0 0 0 0 0 11620 0 22638 0 197765 0 0 0 STOLTENBERG MD HEIDI G 209211 0 0 0 0 0 15220 0 21828 0 246259 0 0 0 UNDERDAHL STEVE L 168399 0 0 0 0 0 11760 0 3493 0 183652 0 0 0 WAGGONER MD JULIAN R 390337 0 0 0 0 0 17500 0 27520 0 435357 0 0 0 PART I, LINE 4B THIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(A)(17). 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). DAVID C. AGERTER, M.D. $ 27,454 ROBERT C. MILLER, M.D. $ 46,975 MARCO RIZZO, M.D. $ 35,907 STEPHEN C. WALDHOFF $ 743 MARK KOCH $ 8,013 SUPPLEMENTAL INFORMATION PART III 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. JULIE C SAVELKOUL SPOUSE OF DONALD SAVELKOUL, BOARD MEMBER 63426 EMPLOYMENT 0 BEVERLY A LOMBARDI MD SPOUSE OF JOSEPH M. LOMBARDI M.D., KEY EMPLOYEE 90640 EMPLOYMENT 0 PHILLIP HANSON SPOUSE OF HEIDI G. STOLTENBERG M.D., KEY EMPLOYEE 68943 EMPLOYMENT 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 AT THE END OF THE YEAR IN 2012, MAYO CLINIC HEALTH SYSTEM-ALBERT LEA MERGED WITH MAYO CLINIC HEALTH SYSTEM-AUSTIN. THE ACTIVITIES OF MCHS-AUSTIN WILL BE REPRESENTED ON THEIR SEPARATE RETURN, ONLY THE BALANCE SHEET ITEMS ARE IDENTIFIED ON THE MCHS-ALBERT LEA RETURN. 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 4 THE FILING ORGANIZATION MERGED WITH MAYO CLINIC HEALTH SYSTEM - AUSTIN AT YEAR END OF 2012 AND EXERCISED THE ARTICLES OF MERGER. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS MAYO CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER ELECTS TRUSTEES TO THE BOARD FORM 990, PART VI, SECTION A, LINE 7B AMENDMENT OF ARTICLES OR BYLAWS REQUIRE APPROVAL BY BOTH THE GOVERNING BODY AND THE SOLE CORPORATE MEMBER. THE BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, AND DEBT DECISIONS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE SITE FINANCE STAFF AND THE SITE ADMINISTRATOR. 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 15B THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY IN THE FALL FOR THE NEXT YEAR'S COMPENSATION. THE SALARY OF THE CEO, CAO, BOARD VICE CHAIR, TREASURER AND SEVERAL BOARD MEMBERS 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). THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE THEN REVIEWS AND APPROVES THE COMPENSATION. FOR THOSE INDIVIDUALS FOR WHICH THE MAYO CLINIC HEALTH SYSTEM 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 PROCESSES CONDUCTED BY MAYO CLINIC AND ITS AFFILIATES, MCHS-AL ALSO HAS ITS OWN COMPENSATION REVIEW PROCESS THAT INCLUDES REVIEW BY AN INDEPENDENT COMPENSATION COMMITTEE, BENCHMARK/COMPARABILITY DATA, AND DETERMINATION OF REASONABLENESS. MCHS-AL REVIEW PROCESS COVERS BOTH THE PHYSICIAN COMPENSATION PLAN AND THE ADMINISTRATOR COMPENSATION PLAN. FORM 990, PART VI, SECTION C, LINE 19 THE FILING ORGANIZATION'S GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST, AS IS THE CONFLICT OF INTEREST POLICY, WHICH IS 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: MCHS-AUSTIN MERGER INTO MCHS-ALBERT LEA 134,395,080. INDEPENDENCE FORM 990 PART VI LINE 1B THE BOARD OF TRUSTEES OF MAYO CLINIC, THE PARENT ENTITY OF THE MAYO CLINIC-AFFILIATED ENTITIES, IS COMPRISED OF MORE THAN 50% PUBLIC TRUSTEES. IN REGARDS TO FILING CERTAIN FOREIGN FORMS SCHEDULE F, PART IV, LINES 3, 5, & 6 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) 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 -- SAINT MARYS HOSPITAL 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 MAYO CLINIC HEALTH SYSTEM IN WAYCROSS INC 1900 TEBEAU STREET WAYCROSS GA 31501 581667166 HOSPITAL GA 501(C)(3) 3 MAYO CLINIC JACKSONVILLE 1 MAYO CLINIC HEALTH SYSTEM--ALBERT LEA 1000 FIRST DRIVE NW AUSTIN MN 55912 411404075 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--AUSTIN 1000 FIRST DRIVE NW AUSTIN MN 55912 410695606 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--AUSTIN FOUNDATION 1000 FIRST DRIVE NW AUSTIN MN 55912 300107471 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--AUSTIN 1 MAYO CLINIC HEALTH SYSTEM--CANNON FALLS 1116 WEST MILL STREET CANNON FALLS MN 55009 204156428 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC 1501 THOMPSON STREET BLOOMER WI 54724 390980343 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 390813418 HOSPITAL WI 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--FAIRMONT 800 MEDICAL CENTER DRIVE PO BOX 800 FAIRMONT MN 56031 410760836 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391411999 HEALTHCARE SYSTEM PARENT WI 501(C)(3) 11-I MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--LAKE CITY 500 WEST GRANT STREET LAKE CITY MN 55041 411906820 HOSPITAL MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--MANKATO 1025 MARSH STREET MANKATO MN 56002 411236756 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--MANKATO HEALTH CARE FOUNDATION 1025 MARSH STREET MANKATO MN 56002 411663357 FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE 301 SECOND STREET NE NEW PRAGUE MN 56071 410723639 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC 1222 EAST WOODLAND AVENUE BARRON WI 54812 390920634 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--OWATONNA 134 SOUTHVIEW ST OWATONNA MN 55060 411862132 PATIENT CARE - CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC 2321 STOUT ROAD MENOMONIE WI 54751 510190875 HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--RED WING 701 HEWITT BOULEVARD RED WING MN 55066 411713783 PATIENT CARE SERVICES MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--RED WING HOME HEALTH & HOSPICE 701 HEWITT BOULEVARD RED WING MN 55066 411539756 HOME HEALTHCARE SERVICES MN 501(C)(3) 7 MCHS--RED WING 1 MAYO CLINIC HEALTH SYSTEM--SPRINGFIELD 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 411893827 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 -- SAINT MARYS HOSPITAL 1 RED WING SEMINARY HOME 701 HEWITT BOULEVARD RED WING MN 55066 411263419 RESIDENT CARE AND HOUSING MN 501(C)(3) 9 MCHS--RED WING 1 SATILLA HEALTH MANAGEMENT INC 1900 TEBEAU STREET WAYCROSS GA 31501 581717889 HEALTHCARE SERVICES GA 501(C)(3) 3 MCHS IN WAYCROSS INC 1 THE DOWNTOWN PLAZA 701 HEWITT BOULEVARD RED WING MN 55066 411532554 ELDERLY HOUSING MN 501(C)(3) 9 MCHS--RED WING 1 THE HIRSH FAMILY FOUNDATION 108 NORTH MAIN STREET AUSTIN MN 55912 411749842 FUNDRAISING FOUNDATION MN 501(C)(3) 11-I N/A 0 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 HEALTH TRADITION HEALTH PLAN 1808 EAST MAIN STREET ONALASKA WI 54650 391545987 MEDICAL SERVICES COMPANY WI N/A C 1 LOBSS NETWORK SUPPORT 2002 INC 200 FIRST STREET SW ROCHESTER MN 55905 481276150 ADMINISTRATIVE SERVICES MN N/A C 1 MAYO CLINIC GBS MAURITIUS 2ND FLOOR EBENE MEWS 57 EBENE CYBERCITY MP HEALTHCARE MANAGEMENT MP N/A C 1 MAYO CLINIC HEALTH SYSTEM--DECORAH CLINIC PHYSICIANS 907 MONTGOMERY STREET DECORAH IA 52101 411711329 PATIENT CARE - CLINIC IA N/A C 1 MAYO CLINIC HEALTH SYSTEM--FARIBAULT 635 FIRST STREET SE FARIBAULT MN 55021 411817179 PATIENT CARE - CLINIC MN N/A C 1 MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 391528920 PHARMACY SERVICES WI N/A C 1 MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 411346366 REFERENCE LAB SERVICES MN N/A C 1 MAYO HOLDING COMPANY 200 FIRST STREET SW ROCHESTER MN 55905 411578020 HOLDING COMPANY MN N/A C 1 MAYO INSURANCE COMPANY LTD 200 FIRST STREET SW ROCHESTER MN 55905 SELF INSURANCE POOL CJ N/A C 1 MAYO MEDICAL LABORATORIES NEW ENGLAND INC 265 BALLARDVALE STREET WILMINGTON MA 01887 043323713 LABORATORY SERVICES MA N/A C 1 MAYO REGIONAL PRACTICES OF ARIZONA 13400 EAST SHEA BOULEVARD SCOTTSDALE AZ 85259 061190278 THIRD PARTY ADMINISTRATION SERVICES AZ N/A C 1 MMSI INC 21 FIRST STREET SW ROCHESTER MN 55905 411547003 THIRD PARTY ADMINISTRATION SERVICES MN N/A C 1 RESOUNDANT INC 221 1ST AVE SW ROCHESTER MN 55902 461661978 MANUFACTURING MEDICAL DEVICE COMPONENT MN N/A C 1 ROCHESTER AIRPORT COMPANY ROUTE 2 ROCHESTER MN 55902 410506870 AIRPORT MANAGEMENT MN N/A C 1 SATILLA HEALTH ENTERPRISES INC 1900 TEBEAU STREET WAYCROSS GA 31501 581717222 HEALTHCARE GA N/A C 1 SATILLA HEALTHNET INC 1900 TEBEAU STREET WAYCROSS GA 31501 582151076 HEALTH SERVICES GA N/A C 1 SATILLA REGIONAL SPECIALTY PHYSICIANS INC 1900 TEBEAU STREET WAYCROSS GA 31501 204363143 PHYSICIAN OFFICES GA N/A C 1 SIT ALPHA II BOND FUND LTD CLIFTON HOUSE 75 FORTH ST GRAND CAYMAN CJ KY1-1108 980648163 INVESTMENT MANAGEMENT CJ N/A C 1 SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION 13400 E SHEA BLVD SCOTTSDALE AZ 85259 860870505 COMMERCIAL PROPERTY OWNERS ASSOCIATION AZ N/A C 1 THE STABILE BUILDING OWNERS' ASSOCIATION 200 FIRST STREET SW ROCHESTER MN 55905 208994499 COMMERCIAL PROPERTY OWNERS ASSOCIATION MN N/A C 1 CHARITABLE LEAD TRUST CHARITABLE TRUST CA N/A T 1 PERPETUAL TRUST CHARITABLE TRUST ND N/A T 1 PERPETUAL TRUST CHARITABLE TRUST LA N/A T 1 PERPETUAL TRUST (2) CHARITABLE TRUST MA N/A T 1 PERPETUAL TRUST CHARITABLE TRUST MO N/A T 1 PERPETUAL TRUST CHARITABLE TRUST AZ N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST CO N/A T 1 CHARITABLE REMAINDER TRUST (6) CHARITABLE TRUST FL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST FL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST IL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST LA N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST MI N/A T 1 CHARITABLE REMAINDER TRUST (68) CHARITABLE TRUST MN N/A T 1 CHARITABLE REMAINDER TRUST (77) CHARITABLE TRUST MN N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NC N/A T 1 CHARITABLE REMAINDER TRUST (2) CHARITABLE TRUST TX N/A T 1 1 0 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 MAYO CLINIC -- METHODIST HOSPITAL A 121502 GAAP MAYO CLINIC -- SAINT MARYS HOSPITAL M 166140 GAAP MAYO CLINIC HEALTH SYSTEM--AUSTIN R 134395080 GAAP MAYO CLINIC HEALTH SYSTEM--AUSTIN O 295154 GAAP MAYO CLINIC HEALTH SYSTEM--AUSTIN Q 589022 GAAP MAYO CLINIC HEALTH SYSTEM--OWATONNA P 184444 GAAP MAYO COLLABORATIVE SERVICES INC M 762375 GAAP MMSI INC R 11028991 GAAP MMSI INC S 7347060 GAAP