2013-11-07T14:58:04-06:00 2012-12-31 990 2012-01-01 410760836 MAYO CLINIC HEALTH SYSTEM-FAIRMONT MAYO 5075381297 800 MEDICAL CENTER DRIVE FAIRMONT MN 56031 JAMES J TARASOVITCH 5073852646 2013-11-07 2012 2016-02-25 16:41:14Z GREGORY KUTCHER MD 800 MEDICAL CENTER DRIVE FAIRMONT MN 56031 82604800 0 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1940 MN HOSPITAL, NURSING HOME, AND CLINICS 7 3 773 121 0 0 687010 1814016 76892396 80396932 -4866 -7722 346997 346379 77921537 82549605 25909 18718 0 0 49338189 48186790 0 0 158550 30659676 36058876 80023774 84264384 -2102237 -1714779 41921968 38852778 16681931 15327520 25240037 23525258 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 74065925 79005482 PATIENT SERVICES (SEE SCHEDULE O)PATIENT SERVICES: 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 - FAIRMONT IS A MEDICAL CENTER PROVIDING CARE TO PATIENTS IN THE CLINIC SETTING, THE EYE CLINIC, THE HOSPITAL, AND EMERGENCY ROOM. THE MEDICAL CENTER ALSO PROVIDES LONG-TERM CARE AND OTHER MEDICAL SERVICES TO THE COMMUNITY OF FAIRMONT, MINNESOTA, AND THE SURROUNDING SOUTH CENTRAL MINNESOTA AND NORTH CENTRAL IOWA SERVICE AREA. THE MEDICAL CENTER IS A "SOLE COMMUNITY HOSPITAL". THE MEDICAL CENTER'S OPERATIONS CONSIST OF A 57-BED ACUTE CARE HOSPITAL, AN ATTACHED 40-BED SKILLED CARE NURSING HOME, AN ATTACHED PROVIDER-BASED CLINIC WITH SATELLITE REGIONAL CLINICS LOCATED IN SHERBURN, MINNESOTA AND TRUMAN, MINNESOTA, CONVENIENT CARE CLINIC LOCATED IN THE WAL-MART STORE IN FAIRMONT, MINNESOTA, AND A SATELLITE CLINIC LOCATED IN ARMSTRONG, IOWA.THE MEDICAL CENTER'S MISSION, VISION AND VALUES STATEMENT IS LISTED BELOW:MISSION: 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.VISION: MAYO CLINIC WILL PROVIDE AN UNPARALLELED EXPERIENCE AS THE MOST TRUSTED PARTNER FOR HEALTH CARE.PRIMARY VALUE: THE NEEDS OF THE PATIENT COME FIRST.THE MEDICAL CENTER PROVIDES CHARITY CARE FOR PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THE MEDICAL CENTER ALSO PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. THE TOTAL COST OF CHARITY CARE PROVIDED IN 2012 WAS APPROXIMATELY $388,700. THE TOTAL COST OF UNCOMPENSATED CARE PROVIDED TO LOW INCOME PATIENTS THROUGH MEDICAID AND MINNESOTACARE (A STATE PROGRAM FOR PROVIDING MEDICAL CARE TO THE LOW INCOME POPULATION) WAS APPROXIMATELY $1,543,000. INCLUDED IN THIS AMOUNT IS THE MEDICAID SURCHARGE OF $557,160 AND THE MINNESOTACARE TAX OF $805,771.THE TOTAL UNREIMBURSED COST OF MEDICARE WAS APPROXIMATELY $10,399,000.MAYO CLINIC HEALTH SYSTEM - FAIRMONT ALSO OFFERS 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. 16075 16075 MEDICAL EDUCATON (SEE SCHEDULE O)MEDICAL EDUCATION:MAYO CLINIC HEALTH SYSTEM - FAIRMONT (MCHS-FAIRMONT) PROVIDES CLINICAL EXPERIENCE TO STUDENTS OF IOWA LAKES COMMUNITY COLLEGE, MINNESOTA WEST COMMUNITY COLLEGE, SOUTH CENTRAL COLLEGE, RIVERLAND COMMUNITY COLLEGE, AND PRESENTATION COLLEGE.MCHS - FAIRMONT PROVIDED $3,250 IN SCHOLARSHIPS TO LOCAL COMMUNITY STUDENTS PURSUING A HEALTH-RELATED CAREER. MCHS - FAIRMONT OFFERS NUMEROUS EDUCATIONAL SEMINARS, CLASSES AND OPPORTUNITIES FOR ITS PATIENTS, THEIR FAMILIES, EMPLOYEES, COMMUNITY MEMBERS, AND THE GENERAL PUBLIC. THE FOLLOWING IS A SAMPLING OF THE EVENTS THAT WERE OFFERED IN 2012: PARENTING CLASSES, FAMILY FUN FAIR, MARTIN COUNTY FAIR, SUPPORT GROUPS, CANCER, "SPEAKING OF" HEALTH BROADCAST; ON CAMPUS PRESENTATIONS; HOMETOWN HEALTH NEWSLETTER MAILINGS. 2643 2643 COMMUNITY CONTRIBUTIONS (SEE SCHEDULE O)COMMUNITY CONTRIBUTIONS:MAYO CLINIC HEALTH SYSTEM - FAIRMONT (MCHS-FAIRMONT) OFFERED BLOOD PRESSURE SCREENINGS AND FLU IMMUNIZATIONS TO THE COMMUNITY.MCHS-FAIRMONT PROVIDED FINANCIAL SUPPORT TO THE FAIRMONT CHAMBER OF COMMERCE AND LAKEVIEW HEALTH SERVICES. TOTAL DONATIONS IN 2012 WERE APPROXIMATELY $2,643.IN 2012, MCHS-FAIRMONT RECEIVED DONATED SERVICES FROM 117 VOLUNTEERS, WHO PROVIDED 10,790 VOLUNTEER HOURS, VALUED AT APPROXIMATELY $238,891 BASED ON THE INDEPENDENT SECTOR'S AVERAGE ESTIMATED HOURLY VALUE OF SUCH SERVICE. 1690395 MCHS-FAIRMONT LEASES SPACE AND PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE. 1690395 74084643 1 1 0 1 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 773 1 0 0 0 0 0 0 0 0 0 0 X 7 3 1 1 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 MN X CORPORATE TAX UNIT 5075381297 200 FIRST ST SW ROCHESTER MN 55905 BROLSMA GREG 1.00 0.00 X 0 0 0 BUNKERS MD BRIAN E 1.00 40.00 X 0 347327 11421 GAALSWYK MARK 1.00 0.00 X 0 0 0 GREEN MD JEFFREY P 40.00 0.00 X X 221427 0 28768 KUTCHER MD GREGORY R 1.00 40.00 X X 0 455629 43636 LARSON MARY 1.00 0.00 X 0 0 0 MORRIS MD MARIE E 40.00 0.00 X X 366288 0 43124 STRUCK ALLEN W 1.00 0.00 X X 0 0 0 BARTINGALE ROBERT F 40.00 0.00 X 221219 0 52033 GRACE RICHARD W 1.00 40.00 X 0 323845 29395 KOCH MARK B 1.00 40.00 X 0 289086 16795 TARASOVITCH JAMES J 1.00 40.00 X 0 265536 26828 HANSEN GAYLE B 40.00 0.00 X 248954 0 42068 BERTHELSEN MD STEPHEN O 40.00 0.00 X 579348 0 44139 GRAN MD CHRISTOPHER 40.00 0.00 X 420524 0 27792 HODGES MD LEROY W 40.00 0.00 X 561779 0 66482 RODRIGUEZ MD RUFUS R 40.00 0.00 X 940206 0 55579 SZUTZ MD TIMOTHY J 40.00 0.00 X 869989 0 63075 HAGEDORN MD STEVEN D 0.00 40.00 X 0 225850 59102 SUTER BRIAN E 40.00 0.00 X 176738 0 48317 4606472 1907273 658554 61 1 1 0 MAYO CLINIC HEALTH SYSTEM - MANKATO 1025 MARSH STREET MANKATO MN 56002 MEDICAL SERVICES 2916592 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 MEDICAL & ADMINISTRATIVE SVCS 2759685 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 55480 LAB SERVICES 269474 ELITE HOSPITALIST 350 11TH AVE STE 830 SAN DIEGO CA 92101 LOCUM PHYSICIANS 161136 COMPHEALTH INC- PHYSICIAN PO BOX 972651 DALLAS TX 75397 LOCUM PHYSICIANS 116875 7 5302 392467 1413842 2405 5302 1814016 NET PATIENT REVENUE 620000 61105340 61105340 LAB REVENUE 621510 17597197 17597197 SHARED SERVICES 561000 1559970 1559970 RENT FROM AFFILIATES 531120 130425 130425 LIFELINE 621990 4000 4000 80396932 230 230 8230 423 7807 7807 7807 5010 12962 -7952 -7952 -7952 29980 5302 15708 14272 14272 42407 26102 16305 16305 CAFETERIA/VENDING REVENUE 722210 243778 243778 MED RECORD/TRANSCRIPT 541900 51889 51889 MEDICAL DIRECTOR FEES 541900 9050 9050 3278 3278 307995 82549605 80695877 0 39712 X 15468 15468 3250 3250 1223880 410690 813190 70627 57526 13101 36362580 31984288 4260684 117608 2378322 2049614 321280 7428 5681153 4895961 767449 17743 2470228 2128818 333695 7715 94351 94351 70036 70036 10684748 8176811 2506500 1437 69410 2452 66958 3646040 3125250 518018 2772 2109194 1960724 148095 375 355349 237403 114474 3472 174980 172437 2543 392058 392058 2531455 2531455 710587 710587 MEDICAL SUPPLIES 9539685 9539685 BAD DEBT EXPENSE 3996589 3996589 MN CARE TAX 805771 805771 MEDICAID SURCHARGE 557160 557160 321463 236295 85168 84264384 74084643 10021191 158550 173886 5999 0 0 0 24268 14228440 13172523 0 0 1664016 1073530 1516889 1043720 52371958 32289720 21274049 20082238 3064688 3450500 41921968 38852778 5715493 4843589 3248 2786 10963190 10481145 16681931 15327520 X 23274350 21075336 1330339 1429506 635348 1020416 25240037 23525258 41921968 38852778 -1714779 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 0 1 5324 5324 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: MAYO CLINIC HEALTH SYSTEM - MANKATO (MCHS-MANKATO), THE PARENT COMPANY OF THE FILING ORGANIZATION, PROVIDES SUPPORT SERVICES TO THE FILING ORGANIZATION THAT INCLUDES PROVIDING INFORMATION OR EXPRESSING ITS CONCERN TO LEGISLATIVE BODIES AND GOVERNMENT OFFICIALS ON MATTERS DIRECTLY RELATED TO HEALTH, THE DELIVERY OF HEALTH CARE AND MEDICAL EDUCATION AND/OR RESEARCH. IN 2012, MCHS - MANKATO REPRESENTATIVES HAD SEVERAL MEETINGS WITH MEMBERS OF THE LEGISLATIVE AND EXECUTIVE BRANCHES OF GOVERNMENT TO DISCUSS ISSUES RELATING TO HEALTH CARE AND HEALTH CARE REFORM. THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. 0 1 X 1965688 484234 37602 37603 2449921 2103153 468387 -570 605282 1965688 1776123 261963 229353 164286 2103153 1466513 429655 54803 174848 1776123 1922455 -281424 174518 1466513 0.42000 0.58000 1 1 1 99580 99580 37721121 21801060 15920061 14551257 10488660 4062597 20082238 DUE FROM AFFILIATES 250386 DEFERRED COMPENSATION 1103650 INTEREST IN NET ASSETS OF FDN 2037420 CHARITABLE GIFT ANNUITY 59044 3450500 ASSET RETIRMENT OBLIGATION 43012 DUE TO AFFILIATES 9334483 DEFERRED COMPENSATION 1103650 10481145 X PART IV, LINE 2B: MAYO CLINIC HEALTH SYSTEM - FAIRMONT MAINTAINS A "RESIDENT TRUST" ACCOUNT/BANK ACCOUNT FOR THE RESIDENTS OF A 40 BED SKILLED NURSING HOME. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENTS ARE USED FOR CARDIAC REHAB, PASTORAL CARE, AND NURSING. 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. PALLATIVE CARE GALA 33232 5302 27930 5302 585 4393 1510 2610 33232 5302 27930 5302 585 4393 1510 2610 14400 13530 1 1 X 1 X 1 X 1 1 1 0 1 1 388721 388721 0.00480 12377997 10834840 1543157 0.01920 12766718 10834840 1931878 0.02400 22854 22854 0.00030 2875 2875 0.00000 2211220 1449198 762022 0.00950 2236949 1449198 787751 0.00980 15003667 12284038 2719629 0.03380 0 3996589 16517255 19703909 -3186654 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM-FAIRMONT

800 MEDICAL CENTER DRIVE FAIRMONT MN 56031

X X X CLINIC, NURSING HOME MAYO CLINIC HEALTH SYSTEM-FAIRMONT 1 1 1 100.000000000000 1 400.000000000000 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 5 MAYO CLINIC HEALTH SYSTEM-FAIRMONT

412 6TH STREET ARMSTRONG IA 50514

CLINIC MAYO CLINIC HEALTH SYSTEM-FAIRMONT

32 N MAIN STREET SHERBURN MN 56171

CLINIC MAYO CLINIC HEALTH SYSTEM-FAIRMONT

401 N 4TH AVE E TRUMAN MN 56088

CLINIC MAYO CLINIC HEALTH SYSTEM-FAIRMONT

411 S GROVE ST SUITE 3 BLUE EARTH MN 56013

PSYCHOLOGY SERVICES CLINIC MAYO CLINIC HEALTH SYSTEM-FAIRMONT

1250 GOEMANN ROAD FAIRMONT MN 56013

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 $ 3996589. 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.FOOTNOTES 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.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 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 APPROXIMATELY $10,399,000 AS REPORTED IN THE CORE FORM, PART III, PROGRAM SERVICE ACCOMPLISHMENTS.THE MOST COMMON REASONS FOR A DIFFERENCE BETWEEN THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H AND THE MEDICARE SHORTFALL REPORTED ON THE CORE FORM, PART III INCLUDE: (1) INCLUSION OF MEDICARE ADVANTAGE REVENUE AND EXPENSES; (2) INCLUSION OF PART B REVENUE AND EXPENSES; (3) INCLUSION OF OTHER FEE SCHEDULE REVENUE; AND (4) SOME TIMING ISSUES.REASONS WHY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT ARE: (1) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR 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-FAIRMONT 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-FAIRMONT 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-FAIRMONT 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 - FAIRMONT (MCHS-FAIRMONT) COLLABORATES WITH PUBLIC AND PRIVATE GROUPS IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. MCHS-FAIRMONT WORKS CLOSELY WITH THE HEALTH AND HUMAN SERVICES AGENCY THAT SERVES MARTIN AND FARIBAULT COUNTIES (MINNESOTA), WHICH IS MCHS-FAIRMONT'S MAIN SERVICE AREA, IN UNDERSTANDING THE NEEDS. DATA IS ALSO RESEARCHED, STUDIED, AND USED IN STRATEGIC PLANNING. DATA SOURCES INCLUDE COUNTY DATA, STATE DATA, AND MINNESOTA HOSPITAL ASSOCIATION DATA. IN ADDITION, MCHS-FAIRMONT PRESENTS PUBLIC EDUCATION EVENTS THROUGHOUT THE YEAR AND HAS LOCAL CABLE INFORMATIVE PROGRAMS. 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: MAYO CLINIC HEALTH SYSTEM - FAIRMONT IS AN INTEGRATED HEALTHCARE DELIVERY SYSTEM THAT SERVES THE RESIDENTS OF MARTIN, FARIBAULT, WATONWAN, AND JACKSON COUNTIES IN MINNESOTA AND KOSSUTH, EMMETT, AND PALO ALTO COUNTIES IN IOWA. THE MAIN CITY SERVED IS FAIRMONT, MINNESOTA WITH THE BALANCE OF THE SERVICE AREA BEING SMALL TOWNS OR RURAL AGRICULTURAL AREAS. THE AREA POPULATION IS TRENDING OLDER THAN THE STATEWIDE AVERAGE. THE MAIN INDUSTRY IN THE SERVICE AREA IS AGRICULTURAL BASED. 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. 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: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 ON THE MINNESOTA HOSPITAL ANNUAL REPORT OR TO THE MINNESOTA HOSPITAL ASSOCIATION. 1 MAYO CLINIC HEALTH SYSTEM - MANKATO 1025 MARSH ST MANKATO MN 56001 411236756 501(C)(3) 13200 STUDENT NURSING INTERN PROGRAM 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY WITH PROGRAMS THAT ENHANCE THE MISSION OF THE FILING ORGANIZATION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY THAT ADDRESS UNMET OR UNDER-FUNDED COMMUNITY NEEDS IN THE AREAS OF HEALTHCARE, EDUCATION, RESEARCH, DIVERSITY AND EQUALITY OF OPPORTUNITY. 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. SCHOLARSHIPS ARE FOR TUITION AND ARE PAID DIRECTLY TO THE COLLEGE THE RECIPIENT IS ATTENDING. X X X 1 1 0 1 0 0 0 0 0 0 0 BUNKERS MD BRIAN E 0 346098 0 0 0 1229 0 7500 0 3921 0 358748 0 0 GREEN MD JEFFREY P 219753 0 0 0 1674 0 20367 0 8401 0 250195 0 0 0 KUTCHER MD GREGORY R 0 455629 0 0 0 0 0 12500 0 31136 0 499265 0 0 MORRIS MD MARIE E 333893 0 0 0 32395 0 34723 0 8401 0 409412 0 0 0 BARTINGALE ROBERT F 209544 0 0 0 11675 0 37076 0 14957 0 273252 0 0 0 GRACE RICHARD W 0 323845 0 0 0 0 0 12500 0 16895 0 353240 0 0 KOCH MARK B 0 279804 0 0 0 9282 0 322 0 16473 0 305881 0 0 TARASOVITCH JAMES J 0 265536 0 0 0 0 0 10000 0 16828 0 292364 0 0 HANSEN GAYLE B 226923 0 0 0 22031 0 30163 0 11905 0 291022 0 0 0 BERTHELSEN MD STEPHEN O 457385 0 0 0 121963 0 30644 0 13495 0 623487 0 0 0 GRAN MD CHRISTOPHER 406832 0 0 0 13692 0 24992 0 2800 0 448316 0 0 0 HODGES MD LEROY W 490976 0 0 0 70803 0 35252 0 31230 0 628261 0 0 0 RODRIGUEZ MD RUFUS R 784971 0 0 0 155235 0 42784 0 12795 0 995785 0 0 0 SZUTZ MD TIMOTHY J 728641 0 0 0 141348 0 45674 0 17401 0 933064 0 0 0 HAGEDORN MD STEVEN D 0 222520 0 0 0 3330 0 36998 0 22104 0 284952 0 0 SUTER BRIAN E 162087 0 0 0 14651 0 20471 0 27846 0 225055 0 0 0 PART I, LINE 1A TRAVEL FOR A COMPANION WAS PROVIDED TO A BOARD MEMBER TO ATTEND THE INSTITUTE FOR HEALTH CARE IMPROVEMENT ANNUAL MEETING. IN 2012, HEALTH CLUB DUES TO "ANYTIME FITNESS" WERE PAID BY MAYO CLINIC HEALTH SYSTEM - FAIRMONT ON BEHALF OF PAID EMPLOYEES WHO MET THE ATTENDANCE REQUIRMENTS. TWO 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 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 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). STEPHEN O. BERTHELSEN, M.D. $ 73,809 CHRISTOPHER GRAN, M.D. $ 11,439 LEROY W. HODGES, M.D. $ 48,356 MARK B. KOCH $ 8,013 MARIE E. MORRIS, M.D. $ 21,090 RUFUS R. RODRIGUEZ, M.D. $144,196 TIMOTHY J. SZUTZ, M.D. $124,961 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. COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 2 BRIAN E. BUNKERS, M.D. IS EMPLOYED BY A RELATED ORGANIZATION RESULTING IN A BUSINESS RELATIONSHIP WITH MARK B. KOCH WHO IS ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE. THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: GRACE, RICHARD W. KUTCHER M.D., GREGORY R. TARASOVITCH, JAMES J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: BROLSMA, GREG GAALSWYK, MARK GRACE, RICHARD W. KOCH, MARK B. KUTCHER M.D., GREGORY R. MORRIS M.D., MARIE E. TARASOVITCH, JAMES J. BRIAN E. BUNKERS, M.D. AND MARK B. KOCH HAVE A BUSINESS RELATIONSHIP AS THEY SERVE AS AN OFFICER, DIRECTOR, OR TRUSTEE OF MAYO CLINIC HEALTH SYSTEM-FARIBAULT, A RELATED TAXABLE ENTITY. 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. MAYO CLINIC HEALTH SYSTEM - MANKATO ALSO PROVIDES MANAGEMENT SERVICES ON A REGIONAL BASIS THAT INCLUDES THE FILING ORGANIZATION. 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 IS MAYO CLINIC HEALTH SYSTEM - MANKATO. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER SHALL APPOINT/REPLACE THREE MEMBERS OF THE BOARD. THE REMAINING MEMBERS OF THE BOARD ARE NOMINATED THROUGH VARIOUS PROCESSES WITH APPROVAL BY THE BOARD OF DIRECTORS AND THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, DEBT DECISIONS AND AMENDMENT OF ARTICLES AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE 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. THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY. THE SALARY OF THE CEO AND CAO WERE REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS 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 REVIEWS, THE COMPENSATION COMMITTEE OF THE SOUTHWEST MINNESOTA REGION IS CHARGED WITH THE RESPONSIBILITY TO RECOMMEND TO THE SOUTHWEST MINNESOTA REGION BOARD OF DIRECTORS ON AN ANNUAL BASIS THE APPROPRIATE COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AND CHIEF ADMINISTRATIVE OFFICER AND TOTAL COMPENSATION STRATEGY FOR THE ORGANIZATION. THE COMPENSATION COMMITTEE IS CREATED BY A BOARD RESOLUTION. 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. OTHER FEES FORM 990, PART IX, LINE 11G OTHER PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 3,220,810. MANAGEMENT AND GENERAL EXPENSES 435,275. FUNDRAISING EXPENSES 1,426. TOTAL EXPENSES 3,657,511. I/C PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 4,956,001. MANAGEMENT AND GENERAL EXPENSES 2,071,225. FUNDRAISING EXPENSES 11. TOTAL EXPENSES 7,027,237. IN REGARDS TO FILING 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 HOLDING COMPANY (EIN: 41-1578020) 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 -- 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 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 1 0 0 0 0 1 0 1 1 0 1 1 MAYO CLINIC - 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