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MAYO CLINIC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MAYO CLINIC (EIN 41-1906820)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-07-31
IRS object ID
201322129349300327
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-07-31T12:46:29-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN411906820EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MAYO CLINIC HEALTH SYSTEM-LAKE CITYBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMAYONameControl
Phone5075381297Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1500 WEST GRANT STREETAddressLine1
CityLAKE CITYCity
StateMNState
ZIP Code55041ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSUSAN STIENEName
TitleSR OPERATIONS ADMINISTRATORTitle
Phone5075381297Phone
Date Signed2013-07-31DateSigned
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTHOMAS WITT MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1500 WEST GRANT STREETAddressLine1
CityLAKE CITYCity
StateMNState
ZIP Code55041ZIPCode
FieldValueIRS element (for citing)
Gross Receipts40993119GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.MAYOCLINICHEALTHSYSTEM.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1998YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionOPERATION OF A HOSPITAL, FOUR CLINICS AND A NURSING HOME.ActivityOrMissionDescription
Nbr Voting Members Governing Body9NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees328TotalNbrEmployees
Total Nbr Volunteers171TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year252719ContributionsGrantsPriorYear
Contributions Grants Current Year495609ContributionsGrantsCurrentYear
Program Service Revenue Prior Year38956737ProgramServiceRevenuePriorYear
Program Service Revenue CY40231457ProgramServiceRevenueCY
Investment Income Prior Year-12263InvestmentIncomePriorYear
Investment Income Current Year707InvestmentIncomeCurrentYear
Other Revenue Prior Year162431OtherRevenuePriorYear
Other Revenue Current Year155906OtherRevenueCurrentYear
Total Revenue Prior Year39359624TotalRevenuePriorYear
Total Revenue Current Year40883679TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year7075GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY7975GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year18045198SalariesEtcPriorYear
Salaries Etc Current Year20257985SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year92880TotalFundrsngExpCurrentYear
Other Expense Prior Year20257325OtherExpensePriorYear
Other Expenses Current Year20231072OtherExpensesCurrentYear
Total Expenses Prior Year38309598TotalExpensesPriorYear
Total Expenses Current Year40497032TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1050026RevenuesLessExpensesPriorYear
Revenues Less Expenses CY386647RevenuesLessExpensesCY
Total Assets BOY29900111TotalAssetsBOY
Total Assets EOY30783702TotalAssetsEOY
Total Liabilities BOY3378653TotalLiabilitiesBOY
Total Liabilities EOY3875597TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY26521458NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY26908105NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTO INSPIRE HOPE AND CONTRIBUTE TO HEALTH AND WELL-BEING BY PROVIDING THE BEST CARE TO EVERY PATIENT THROUGH INTEGRATED CLINICAL PRACTICE, EDUCATION, AND RESEARCH.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense27762232Expense
Revenue32752372Revenue
DescriptionPATIENT SERVICES (HOSPITAL & CLINICS) - SEE SCHEDULE O:MAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) IS A MEMBER OF THE MAYO CLINC HEALTH SYSTEM. MAYO CLINIC HEALTH SYSTEM IS A FAMILY OF CLINICS, HOSPITALS AND HEALTH CARE FACILITIES SERVING COMMUNITIES IN MINNESOTA, IOWA 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.MCHS-LAKE CITY OWNS AND OPERATES AN 18 BED CRITICAL ACCESS HOSPITAL SERVING LAKE CITY, MINNESOTA AND SURROUNDING COMMUNITIES. DURING THE YEAR ENDED DECEMBER 31, 2012, LAKE CITY HAD 279 MEDICAL/SURGICAL ADMISSIONS, 71 OBSTETRIC ADMISSIONS, 68 DELIVERIES, AND 137 SWING BED ADMISSIONS WITH AN AVERAGE DAILY CENSUS OF 8.39. IN ADDITION, THERE WERE 2460 EMERGENCY ROOM VISITS, 517 SAME DAY SURGERIES, AND ANCILLARY SERVICES INCLUDING LABORATORY, CARDIAC REHABILITATION, PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, POLYSOMNOGRAPHY STUDIES, AND RADIOLOGY SERVICES. RADIOLOGY SERVICES INCLUDED MAMMOGRAPHY, CT, MRI, AND ULTRASOUND.MCHS-LAKE CITY ALSO OWNS AND OPERATES FOUR CLINICS LOCATED IN ALMA, WISCONSIN AND IN LAKE CITY, PLAINVIEW AND WABASHA, MINNESOTA. THESE CLINICS ARE STAFFED BY TWELVE FAMILY MEDICINE PHYSICIANS, A GENERAL SURGEON, TWO PHYSICIAN ASSISTANTS, AND SIX NURSE PRACTITIONERS, INCLUDING A CERTIFIED NURSE-MIDWIFE. ON AN ANNUAL BASIS, THERE ARE APPROXIMATELY 60,680 PATIENT VISITS AMONG THE FOUR CLINIC LOCATIONS.MCHS-LAKE CITY CONTINUES TO PROVIDE A VENTILATOR PROGRAM TO ENSURE CONTINUUM OF CARE AND THE MOST APPROPRIATE PLACEMENT AND LEVEL OF CARE FOR VENTILATED AND OTHER PATIENTS REQUIRING A HIGH LEVEL OF RESPIRATORY CARE. THE ULTIMATE GOAL IS TO WEAN THE PATIENTS FROM THE VENTILATOR. MCHS-LAKE CITY HAS COMMITTED FIVE BEDS IN THE FACILITY FOR CARING FOR THIS KIND OF PATIENT POPULATION, ALONG WITH PROVIDING CLASSROOM AND SKILLS TRAINING FOR NURSING STAFF AND PROVIDERS. MCHS-LAKE CITY PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL ASSISTANCE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. SERVICES ARE ALSO PROVIDED TO BOTH MEDICAID AND MEDICARE PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. IN ADDITION, SERVICES ARE PROVIDED TO PATIENTS UNDER OTHER MEANS TESTED GOVERNMENT PROGRAMS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. IN 2012, MCHS-LAKE CITY PROVIDED APPROXIMATELY $321,000 IN FINANCIAL ASSISTANCE (AT COST) TO PATIENTS. THE UNREIMBURSED COST OF SERVICES TO MEDICAID PATIENTS WAS APPROXIMATELY $340,000. THE UNREIMBURSED COST OF SERVICES TO PATIENTS UNDER OTHER MEANS TESTED GOVERNMENT PROGRAMS WAS APPROXIMATELY $450,000. THE UNREIMBURSED COST OF SERVICES TO MEDICARE PATIENTS WAS APPROXIMATELY $1,980,000.LAKE CITY HAS APPROXIMATELY 171 VOLUNTEERS INCLUDING INDIVIDUALS AND SERVICE GROUPS WHO PROVIDED APPROXIMATELY 4,998 HOURS OF VOLUNTEER SERVICES DURING 2012. THEY STAFF THE INFORMATION DESK DIRECTING PATIENTS AND VISITORS TO THEIR DESTINATION AND PERFORM CLERICAL DUTIES FOR VARIOUS DEPARTMENTS IN THE MEDICAL CENTER. BASED ON THE 2012 INDEPENDENT SECTOR STATISTICS, THE APPROXIMATE VALUE OF THESE SERVICES IS $110,656.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense7305014Expense
Revenue6765593Revenue
DescriptionRESIDENT SERVICES (NURSING HOME) - SEE SCHEDULE OMAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) ALSO OWNS AND OPERATES A 90-BED NURSING HOME THAT SEEKS TO ENHANCE RESIDENT'S QUALITY OF LIFE BY HELPING INDIVIDUALS MAINTAIN THEIR HEALTH AND SELF-RELIANCE. RESIDENTS ARE PROVIDED WITH 24-HOUR NURSING CARE, A ROOM, NUTRITIONALLY WELL-BALANCED MEALS, SNACKS, HOUSEKEEPING AND LAUNDRY SERVICES, ACTIVITY PROGRAMS, AND SOCIAL SERVICES ASSISTANCE AS NEEDED OR REQUESTED. RESIDENTS ALSO HAVE ACCESS TO SPECIALIZED SERVICES SUCH AS REHABILITATION SERVICES, REGISTERED DIETICIAN SERVICES, BEAUTY AND BARBER SERVICES, TELEPHONE SERVICES AND TELEVISION/CABLE SERVICES FOR AN ADDITIONAL FEE. THE AVERAGE DAILY CENSUS FOR THE NURSING HOME IN 2012 WAS 80.43.THE NURSING HOME'S DIETARY DEPARTMENT PROVIDES MEALS ON A DAILY BASIS FOR THE LAKE CITY HOME DELIVERED MEALS PROGRAM. MEALS ARE DELIVERED BY LIONS CLUB VOLUNTEERS TO LAKE CITY RESIDENTS WHO HAVE BEEN REFERRED TO THE PROGRAM BY HEALTHCARE PROVIDERS. MCHS-LAKE CITY PROVIDES THE ADMINISTRATION FOR THE PROGRAM INCLUDING REGISTRATION, DIETARY PLANNING, MEAL PREPARATION, AND BILLING THIS SERVICE ALLOWS SENIOR CITIZENS AND OTHERS WITH MEDICAL NEEDS TO LIVE INDEPENDENTLY FOR LONGER THAN WOULD OTHERWISE BE POSSIBLE.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense18465Expense
Grants7975Grants
Revenue35673Revenue
DescriptionCOMMUNITY BENEFIT - SEE SCHEDULE O:MCHS-LAKE CITY ALSO OPERATES LIFELINE (AN EASY-TO-USE PERSONAL RESPONSE SERVICE) TO ENSURE THAT OLDER ADULTS LIVING AT HOME CAN GET QUICK ASSISTANCE WHENEVER IT MAY BE NEEDED - 24 HOURS A DAY, 365 DAYS A YEAR. WHEN THE PERSONAL HELP BUTTON IS PRESSED, A MCHS-LAKE CITY MONITOR RESPONDS, ASSESSES THE SITUATION AND SUMMONS APPROPRIATE HELP. THERE WERE APPROXIMATELY 100 SUBSCRIBERS TO THE PROGRAM DURING 2012.AS PART OF ITS ACTIVITIES, MAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) PROVIDES VARIOUS SUPPORT GROUPS AND PROGRAMS TO THE COMMUNITY AT NO CHARGE. THESE GROUPS AND CLASSES INCLUDE CARDIAC SUPPORT GROUPS, DIABETIC EDUCATIONAL PROGRAMS, A BREAST CANCER SUPPORT GROUP, OUTREACH FOR SENIOR CITIZENS, MENTORING PROGRAMS AND PRENATAL CLASSES FOR EXPECTANT PARENTS.MCHS-LAKE CITY OFFERED SPORTS PHYSICALS AT A REDUCED RATE FOR STUDENTS WHO ARE PARTICIPATING IN SPORTS THROUGH THE LOCAL SCHOOLS, A PREVENTATIVE INJURY TRAINING PROGRAM, FREE SKIN SCREENINGS AT LOCAL WRESTLING MEETS, AND STAFF ATTENDANCE AT HOME HIGH SCHOOL FOOTBALL GAMES TO RESPOND TO EMERGENCIES. MCHS-LAKE CITY ALSO HAS A PROGRAM THAT ALLOWS LOCAL HIGH SCHOOL STUDENTS TO COME ON-SITE AND LEARN ABOUT HEALTHCARE-RELATED CAREERS AND PARTICIPATE IN JOB SHADOWING EXPERIENCES. ALSO DURING 2012, MCHS-LAKE CITY PROVIDED $1,000 FOR SCHOLARSHIPS TO STUDENTS PURSUING A FIELD IN HEALTH CARE AND $6,975 IN DONATIONS TO LOCAL CHARITIES OR COMMUNITY ORGANIZATIONS.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Revenue831507Revenue
DescriptionMAYO CLINIC HEALTH SYSTEM-LAKE CITY LEASES SPACE AND PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Rev831507TotalOfOtherProgramServiceRev
Total Program Service Expense35085711TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109622NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees328NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members9NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters1LocalChapters
Policies Reference Chapters1PoliciesReferenceChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
States Where Copy Of Return Is FiledWIStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1CHRISTIE LOHKAMPBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5075381297TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1200 FIRST STREET SWAddressLine1
CityROCHESTERCity
StateMNState
ZIP Code55905ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
GARTNER PHILLIP A
DIRECTOR1.000.00X000
GRUBER JOHN
DIRECTOR (10/1/12-12/31/12)1.000.00X000
MAHN DAVID
DIRECTOR1.000.00X000
NYMAN MD MARK A
DIRECTOR1.0040.00X022316847196
PETERSON TAMMY
DIRECTOR (10/1-10/18)1.000.00X000
SCHAAL MELISSA
DIRECTOR1.000.00X000
SOLBERG MD JEREMY J
DIRECTOR/PHYSICIAN40.000.00X209192038479
SPANO MD DENNIS C
VICE-CHAIR/DIRECTOR/PHYSICIAN40.000.00X437350035907X
WILKINSON MD JOHN M
DIRECTOR1.0040.00X022714015739
WITT MD THOMAS J
CHAIR/DIRECTOR/PHYSICIAN40.002.00X4237932872963616X
AGERTER MD DAVID C
REGION CEO1.0040.00048360035091X
BIREN DAVID H
TREASURER1.0040.00016842017200X
KOCH MARK B
ASST. SECRETARY (2/16/12-12/31/12)1.0040.00028908616795X
KRAMER CHERYL A
SECRETARY(1/1-7/20/12)/ADMINISTRATOR40.000.0016031408285X
PARKS DOUGLAS A
REGION CAO1.0040.00018978144522X
PILOT DAVID L
REGION CFO1.0040.00019604533934X
STIENE SUSAN M
SECRETARY(7/21-12/31)/SR OP ADMIN40.000.00148909027504X
ADAMSON MD STEVEN C
FAMILY MEDICINE PHYSICIAN40.000.00278936036275X
PODEIN MD RIAN J
FAMILY MEDICINE PHYSICIAN40.000.00242787025235X
RENELT MD JOHN A
FAMILY MEDCINE PHYSICIAN40.000.00345925031793X
SCHWEND DO PHILLIP P
GENERAL SURGEON40.000.00297052042223X
STORLIE MD JESSICA M
FAMILY MEDICINE PHYSICIAN40.000.00241392018776X
BROWN MARK C
FORMER COO0.0040.00014300410999X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2785650TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1948973TotalReportableCompFrmRltdOrgs
Total Other Compensation549569TotalOtherCompensation
Number Individuals GT100 K25NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MAYO CLINIC
200 FIRST STREET SWROCHESTERMN55905MEDICAL & SUPPORT SERVICES1642203
MAYO CLINIC HEALTH SYSTEM-RED WING
701 HEWITT BOULEVARDRED WINGMN55066SUPPORT SERVICES823754
MAYO COLLABORATIVE SERVICES INC
200 FIRST STREET SWROCHESTERMN55905LAB SERVICES452804
REHAB GROUP EAST INC
7733 FORSYTH BLVD SUITE 2300ST LOUISMO63105MEDICAL SERVICES400946
SAINT ELIZABETH MEDICAL CENTER
1200 GRAND BLVD WWABASHAMN55981MEDICAL SERVICES279754
FieldValueIRS element (for citing)
Number Of Contractors GT100 K11NumberOfContractorsGT100K
Related Organizations123246RelatedOrganizations
Government Grants372363GovernmentGrants
Total Contributions495609TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE6200003195896531958965
NURSING HOME REVENUE62311067655936765593
SHARED SERVICES REVENUE561000780302780302
LAB REVENUE621510639719639719
RENT FROM AFFILIATES5311205120551205

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column35673TotalRevenueColumn
Related Or Exempt Function Income35673RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue40231457TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column1590TotalRevenueColumn
Exclusion$1,590ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real64772Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real63034Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real1738Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column1738TotalRevenueColumn
Exclusion$1,738ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other45523Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other46406Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-883Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-883TotalRevenueColumn
Exclusion-$883ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
CAFETERIA/VENDING722210101050101050
MEDICAL RECORDS5419002090820908
MISC. REVENUE9000991729716817$480

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column14913TotalRevenueColumn
Related Or Exempt Function Income14913RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue154168TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column40883679TotalRevenueColumn
Related Or Exempt Function Income40385145RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$2,925ExclusionAmount
FieldValueIRS element (for citing)
Info In Schedule O Part IXXInfoInScheduleOPartIX

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total6975Total
Program Services6975ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total1000Total
Program Services1000ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1550388Total
Program Services1205376ProgramServices
Management And General345012ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total372892Total
Program Services372892ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total14157978Total
Program Services11961196ProgramServices
Management And General2127047ManagementAndGeneral
Fundraising69735Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1101245Total
Program Services927183ProgramServices
Management And General169287ManagementAndGeneral
Fundraising4775Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2039235Total
Program Services1716915ProgramServices
Management And General313477ManagementAndGeneral
Fundraising8843Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1036247Total
Program Services872458ProgramServices
Management And General159295ManagementAndGeneral
Fundraising4494Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total5425897Total
Program Services5032470ProgramServices
Management And General393427ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total730Total
Management And General730ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total3880Total
Management And General3880ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total109Total
Management And General109ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total5981992Total
Program Services5577931ProgramServices
Management And General402571ManagementAndGeneral
Fundraising1490Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total44118Total
Management And General44118ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2133395Total
Program Services1821945ProgramServices
Management And General310392ManagementAndGeneral
Fundraising1058Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total716760Total
Management And General716760ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total790967Total
Program Services790967ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total209024Total
Program Services115134ProgramServices
Management And General91832ManagementAndGeneral
Fundraising2058Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total46632Total
Program Services42980ProgramServices
Management And General3652ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1068936Total
Program Services1068936ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total100140Total
Program Services100140ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
MEDICAL SUPPLIES22946482294648
MEDICAID SURCHARGE480757480757
MN CARE TAX346894346894
BAD DEBT EXPENSE329151329151

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total257042Total
Program Services19763ProgramServices
Management And General236852ManagementAndGeneral
Fundraising427Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total40497032Total
Program Services35085711ProgramServices
Management And General5318441ManagementAndGeneral
Fundraising92880Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY281919BOY
EOY296745EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY208512BOY
EOY23622EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY5872BOY
EOY3872EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6378831BOY
EOY6749225EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY202435BOY
EOY251623EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY709367BOY
EOY532866EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis24530989LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec11957231LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY12779409BOY
EOY12573758EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY9252855BOY
EOY10318472EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY80911BOY
EOY33519EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY29900111BOY
EOY30783702EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3299431BOY
EOY3747357EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY7916BOY
EOY23622EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY71306BOY
EOY104618EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3378653BOY
EOY3875597EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY26521458BOY
EOY26908105EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY26521458BOY
EOY26908105EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY29900111BOY
EOY30783702EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses386647ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$109OtherActivitiesAmount
Total Lobbying Expenditures IIB109TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationTHE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS
Explanation In Part XIIIXExplanationInPartXIII

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance5670BeginningOfYearBalance
Other Expenditures5670OtherExpenditures

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance5670BeginningOfYearBalance
End Of Year Balance5670EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5670BeginningOfYearBalance
End Of Year Balance5670EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5670BeginningOfYearBalance
End Of Year Balance5670EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance5670BeginningOfYearBalance
End Of Year Balance5670EndOfYearBalance
FieldValueIRS element (for citing)
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis191866OtherCostOrOtherBasis
Book Value191866BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis17042039OtherCostOrOtherBasis
Depreciation6666319Depreciation
Book Value10375720BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis7297084OtherCostOrOtherBasis
Depreciation5290912Depreciation
Book Value2006172BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings12573758TotalOfBookValueLandBuildings

Other Securities OtherSecurities

FieldValueIRS element (for citing)
DescriptionMAYO POOLED INVESTMENTSDescription
Book Value10318472BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Securities10318472TotalOfBookValueSecurities

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionINTERCOMPANY PAYABLESDescription
Amount$104,618Amount
FieldValueIRS element (for citing)
Total Of Amounts104618TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 2B:NURSING HOME RESIDENT TRUST ACCOUNT - RESIDENTS' FUNDS.
PART V, LINE 4:TO PROVIDE FINANCIAL SUPPORT FOR PROGRAMS AND SERVICES AT MAYO CLINIC HEALTH SYSTEM-LAKE CITY.DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:
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.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense320979TotalCommunityBenefitExpense
Net Community Benefit Expense320979NetCommunityBenefitExpense
Percent Of Total Expense0.00800PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4218533TotalCommunityBenefitExpense
Direct Offsetting Revenue3878324DirectOffsettingRevenue
Net Community Benefit Expense340209NetCommunityBenefitExpense
Percent Of Total Expense0.00850PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense1072989TotalCommunityBenefitExpense
Direct Offsetting Revenue622895DirectOffsettingRevenue
Net Community Benefit Expense450094NetCommunityBenefitExpense
Percent Of Total Expense0.01120PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense5612501TotalCommunityBenefitExpense
Direct Offsetting Revenue4501219DirectOffsettingRevenue
Net Community Benefit Expense1111282NetCommunityBenefitExpense
Percent Of Total Expense0.02770PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense17165TotalCommunityBenefitExpense
Direct Offsetting Revenue230DirectOffsettingRevenue
Net Community Benefit Expense16935NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense1530TotalCommunityBenefitExpense
Net Community Benefit Expense1530NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense12353473TotalCommunityBenefitExpense
Direct Offsetting Revenue6594524DirectOffsettingRevenue
Net Community Benefit Expense5758949NetCommunityBenefitExpense
Percent Of Total Expense0.14340PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense50TotalCommunityBenefitExpense
Net Community Benefit Expense50NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense12372218TotalCommunityBenefitExpense
Direct Offsetting Revenue6594754DirectOffsettingRevenue
Net Community Benefit Expense5777464NetCommunityBenefitExpense
Percent Of Total Expense0.14380PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense17984719TotalCommunityBenefitExpense
Direct Offsetting Revenue11095973DirectOffsettingRevenue
Net Community Benefit Expense6888746NetCommunityBenefitExpense
Percent Of Total Expense0.17150PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense1750TotalCommunityBuildingExpense
Net Community Building Expense1750NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Total Community Building Expense5175TotalCommunityBuildingExpense
Net Community Building Expense5175NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense6925TotalCommunityBuildingExpense
Net Community Building Expense6925NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$329,151BadDebtExpenseAmount
Amount Reimbursed By Medicare5341165AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare5339673CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall1492MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1MAYO CLINIC HEALTH SYSTEM - LAKE CITYBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1500 WEST GRANT STREETAddressLine1
CityLAKE CITYCity
StateMNState
ZIP Code55041ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1MAYO CLINIC HEALTH SYSTEM - LAKE CITYBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent100.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Other Actions TakenXOtherActionsTaken
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities5NumberOfOtherFacilities

Other Facilities OtherFacilities (5 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
MCHS - LAKE CITY (CARE CENTER)
500 WEST GRANT STREETLAKE CITYMN55041NURSING HOME
MCHS - LAKE CITY (LAKE CITY CLINIC)
500 WEST GRANT STREETLAKE CITYMN55041CLINIC
MCHS - LAKE CITY (WABASHA CLINIC)
1202 5TH GRANT BLVD WESTWABASHAMN55981CLINIC
MCHS - LAKE CITY (PLAINVIEW CLINIC)
275 1ST STREET SWPLAINVEIWMN55964CLINIC
MCHS - LAKE CITY (ALMA CLINIC)
204 SOUTH MAIN STREETALMAWI54610CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

ExplanationExplanationIdentifierIdentifier
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: $269,829.
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 $ 329151.
PART II: THE FILING ORGANIZATION MADE SEVERAL CONTRIBUTIONS TO CHARITABLE ORGANIZATIONS WITHIN THE COMMUNITY WHICH PROMOTED COMMUNITY SUPPORT AND ENVIRONMENTAL IMPROVEMENTS. THESE INCLUDED CONTRIBUTIONS TO THE LAKE CITY FOOD SHELF, BLUFFVIEW ELEMENTARY SCHOOL, THE LOCAL RELAY FOR LIFE, AND MEDICATION DISPOSAL PROJECTS.
PART III, LINE 4: 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 STATEMENTSTHE 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.
PART III, LINE 8: THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SURPLUS REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT (USING A MEDICARE COST REPORT STEP-DOWN METHODOLOGY). HOWEVER, USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY ACTUALLY RESULTS IN A MEDICARE SHORTFALL OF $1,980,000 AS REPORTED IN THE CORE FORM, PART III, PROGRAM SERVICE ACCOMPLISHMENTS.THE MOST COMMON REASONS FOR A DIFFERENCE BETWEEN THE MEDICARE SURPLUS REPORTED ON SCHEDULE H AND THE MEDICARE SHORTFALL REPORTED ON THE CORE FORM, PART III INCLUDE: (1) INCLUSION OF MEDICARE ADVANTAGE REVENUE AND EXPENSES; (2) INCLUSION OF PART B REVENUE AND EXPENSES; (3) INCLUSION OF OTHER FEE SCHEDULE REVENUE; AND (4) SOME TIMING ISSUES.REASONS WHY MEDICARE SHORTFALL REPORTED ON LINE 7, IF ANY, SHOULD BE TREATED AS COMMUNITY BENEFIT ARE: (1) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; (3) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND (4) THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS.
PART III, LINE 9B: MAYO CLINIC AND ITS AFFILIATES STRIVE TO ASSIST ALL PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION PRIOR TO ENLISTING THE ASSISTANCE OF A COLLECTION AGENCY BY MAKING REASONABLE ATTEMPTS TO COLLECT FROM INSURANCE COMPANIES AND OTHER THIRD-PARTY PAYORS. IN ADDITION, MAYO CLINIC AND ITS AFFILIATES ACCEPT REASONABLE PAYMENT PLANS FROM PATIENTS WHEN AN ACCOUNT IS THE PATIENT'S RESPONSIBILITY AND TRY TO IDENTIFY THOSE PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE IS OFFERED TO ANY PATIENT IF THE FACTS AND CIRCUMSTANCES SUGGEST THAT THE PATIENT DOES NOT HAVE THE ABILITY TO PAY THEIR BILL IN WHOLE OR IN PART. IN THE EVENT THAT AN ACCOUNT IS REFERRED TO A COLLECTION AGENCY, GUIDELINES ARE FOLLOWED; INCLUDING SUSPENDING ALL COLLECTION ACTIVITY IF A FINANCIAL ASSISTANCE APPLICATION HAS BEEN SUBMITTED AFTER THE ACCOUNT HAS BEEN REFERRED FOR COLLECTION. IF A COLLECTION AGENCY IDENTIFIES A PATIENT AS MEETING MAYO CLINIC'S FINANCIAL ASSISTANCE ELIGIBILTY CRITERIA OR THE PATIENT ASKS TO APPLY FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY IS SUSPENDED UNTIL MAYO REVIEWS THE ACCOUNT FOR FINANCIAL ASSISTANCE ELIGIBILITY BASED ON SUBMISSION OF REQUESTED INFORMATION. COLLECTION ACTIVITY WOULD ONLY RESUME IF MAYO WOULD TELL THE COLLECTION AGENCY TO PURSUE COLLECTIONS ON THE BALANCE OR PARTIAL BALANCE IF THERE WAS A CHARITY ADJUSTMENT.
PART V, SECTION B, LINE 14G: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED.MAYO CLINIC HEALTH SYSTEM - LAKE CITY
PART V, SECTION B, LINE 18E: FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE TO EVERY PATIENT VIA MAYO'S PUBLIC WEBSITE, FROM CUSTOMER SERVICE AND PATIENT ACCESS LOCATIONS, AND IS REFERENCED ON MAYO'S AUTHORIZATION FORMS AND STATEMENTS. IN ADDITION, BROCHURES ARE AVAILABLE IN THE ADMISSIONS AREA AND THE PROCESS OF HOW TO APPLY IS AVAILABLE ON THE MAYO CLINIC WEBSITE.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, MAYO DISCUSSES ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE.MONTHLY STATEMENTS ARE SENT TO PATIENTS THAT OUTLINE CURRENT CHARGES AND ACTIONS WITH INSURANCE AND INCLUDES INFORMATION ABOUT MAYO'S CHARITY CARE POLICY. SOME MAYO SITES UTILIZE ADVOCATES TO CONTACT THE PATIENT UPON DISCHARGE TO HELP THEM SECURE GOVENMENTAL ASSISTANCE OR FINANCIAL ASSISTANCE.EACH CHARITY CARE REVIEW IS DOCUMENTED IN MAYO'S BILLING SYSTEM AND COMMUNICATED TO THE PATIENT. COMPLETED CHARITY CARE FORMS ARE MAINTAINED EITHER IN PAPER OR ELECTRONIC FORMAT. THE PATIENT IS INFORMED REGARDING THE OUTCOME OF THE REVIEW.MAYO OFTEN IDENTIFIES CHARITY CARE OPPORTUNITIES AFTER THE PATIENT HAS BEEN DISMISSED. IN MANY CASES, THIS IS DUE TO LIMITED INSURANCE COVERAGE OR INSURANCE DENIALS AFTER THE SERVICE WAS PERFORMED. IN THESE CASES, WHEN A PATIENT EXPRESSES AN INABILITY TO PAY FOR THEIR SERVICES, STAFF WILL INITIATE A CHARITY REVIEW AS INDICATED BY THE FINANCIAL ASSISTANCE POLICY, WHICH IS AVAILABLE FOR EVERY PATIENT AT MAYOCLINIC.ORG.MAYO CLINIC HEALTH SYSTEM - LAKE CITY
PART V, SECTION B, LINE 20D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 8% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE.MAYO CLINIC HEALTH SYSTEM - LAKE CITY
PART VI, LINE 2: MAYO CLINIC HEALTH SYSTEM - LAKE CITY (MCHS-LAKE CITY) EMPLOYEES THROUGHOUT THE ORGANIZATION ASSESS THE NEEDS OF LAKE CITY AND THE SURROUNDING COMMUNITIES THROUGH PERSONAL INTERACTION AND INVOLVEMENT WITH LOCAL SCHOOLS, CIVIC GROUPS AND HEALTH DEPARTMENTS, AS WELL AS THROUGH THE COLLECTION AND ANALYSIS OF FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS. MCHS-LAKE CITY EMPLOYEES ARE ALSO STRONGLY CONNECTED WITH LOCAL CIVIC GROUPS. MANY EMPLOYEES ARE ACTIVE MEMBERS OF VARIOUS LAKE CITY ORGANIZATIONS, WHILE OTHERS GIVE HEALTHCARE PRESENTATIONS TO THESE GROUPS. THIS PARTICIPATION NOT ONLY PROMOTES INVOLVEMENT IN THE COMMUNITY, BUT ALSO GIVES COMMUNITY MEMBERS A CHANCE TO ASK QUESTIONS, SHARE COMMENTS, CONCERNS OR OTHER SUGGESTIONS THEY MAY HAVE REGARDING THE MEDICAL CENTER.MCHS-LAKE CITY ALSO WORKS WITH THE WABASHA PUBLIC HEALTH ORGANIZATION TO DEVELOP RELATIONSHIPS AMONG HEALTH CARE PROVIDERS AND COMMUNITY LEADERS. THIS PARTNERSHIP PROMOTES THE ACTIVE REFERRAL OF PATIENTS TO LOCAL RESOURCES SUCH AS ACCESS TO HIGH QUALITY NUTRITIOUS FOODS, PHYSICAL ACTIVITY AND TOBACCO USE CESSATION PROGRAMS.MCHS-LAKE CITY HAS THE TONY HEBERT MEMORIAL FUND IN PLACE TO HELP THOSE WHO ARE IN NEED OF HEALTHCARE, BUT HAVE NO INSURANCE OR ARE NOT ABLE TO RECEIVE OTHER FINANCIAL ASSISTANCE. MCHS-LAKE CITY ALSO PROVIDES PREVENTIVE HEALTH SCREENINGS AS THESE EXAMPLES OF INVOLVEMENT DEMONSTRATE, MCHS-LAKE CITY IS CLOSELY CONNECTED WITH THE COMMUNITY. IN ADDITION TO THIS, MCHS-LAKE CITY ACTIVELY SEEKS FEEDBACK FROM PATIENTS AND COMMUNITY MEMBERS THROUGH ITS PATIENT ADVISORY COUNCIL (PAC) AND PATIENT SATISFACTION SURVEYS. THE PAC IS A GROUP OF TEN COMMUNITY MEMBERS WHO SERVE AS A MCHS-LAKE CITY FOCUS GROUP TO PROVIDE FEEDBACK PRIOR TO THE IMPLEMENTATION OF NEW PROGRAMS AND SERVICES, ASSIST IN THE IDENTIFICATION OF OPPORTUNITIES THAT WILL IMPROVE PATIENT AND FAMILY SATISFACTION, PROVIDE TIMELY AND DIRECT INPUT INTO MCHS-LAKE CITY SYSTEM AND PROCESS CHANGES, OFFER INPUT TO LEADERSHIP IN THE PLANNING AND EVALUATION OF SERVICES, AND SERVE AS A VITAL LINK BETWEEN MCHS-LAKE CITY AND THE COMMUNITY. THROUGH THESE VARIOUS AVENUES, MCHS-LAKE CITY STAFF MEMBERS ACROSS MANY DEPARTMENTS STAY CONNECTED WITH THE COMMUNITY TO ASSESS THE HEALTHCARE NEEDS OF LAKE CITY AND SURROUNDING AREAS.
PART VI, LINE 3: MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY:MAYO CLINIC IS COMMITTED TO OFFERING FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY FOR THEIR MEDICAL SERVICES IN WHOLE OR IN PART. IN ORDER TO ACCOMPLISH THIS CHARITABLE GOAL, MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM SITES WIDELY PUBLICIZE THIS POLICY IN THE COMMUNITIES THAT THE INDIVIDUAL MAYO CLINIC AFFILIATED SITES SERVE. MAYO CLINIC AFFILIATED SITES MAKE COPIES OF THIS POLICY 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: MCHS-LAKE CITY HAS LOCATIONS IN LAKE CITY, PLAINVIEW AND WABASHA, MINNESOTA, AS WELL AS IN ALMA, WISCONSIN. THE MAJORITY OF MCHS-LAKE CITY'S SERVICE AREAS INCLUDE GOODHUE AND WABASHA COUNTIES IN SOUTHEASTERN MINNESOTA AND BUFFALO COUNTY IN SOUTHWESTERN WISCONSIN. THE MAIN CAMPUS, LOCATED IN LAKE CITY, HOUSES AN 18-BED CRITICAL ACCESS HOSPITAL, A 90-BED NURSING HOME AND A HOSPITAL-BASED CLINIC WITH EIGHT PROVIDERS THAT SERVES LAKE CITY AND SURROUNDING COMMUNITIES. ACCORDING TO THE UNITED STATES CENSUS BUREAU, THE 2011 POPULATION FOR WABASHA COUNTY (WHICH COMPRISES MOST OF LAKE CITY'S SERVICE AREA) IS 21,542. A 2012 ESTIMATE REPORTS THAT 23.4% OF THE POPULATION IS UNDER 18 YEARS OLD, AND 17.9% IS 65 YEARS OLD OR OLDER. THE MEDIAN HOUSEHOLD INCOME IS $51,227, AND AN ESTIMATED 7.1% OF INDIVIDUALS ARE LIVING BELOW POVERTY LEVEL.
PART VI, LINE 5: THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION - EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO CLINIC HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATION'S ACTIVITIES.SURPLUS FUNDS:MAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE. COMMUNITY REPRESENTATION ON GOVERNING BODY:THE BOARD OF TRUSTEES IS THE GOVERNING BODY OF MAYO CLINIC. A MAJORITY OF ITS MEMBERS ARE EXTERNAL, INDEPENDENT TRUSTEES. IT HAS OVERALL RESPONSIBILITY FOR THE CHARITABLE, CLINICAL PRACTICE, SCIENTIFIC AND EDUCATIONAL MISSION AND PURPOSES OF MAYO CLINIC AND ITS AFFILIATES AS SET FORTH IN ITS ARTICLES OF INCORPORATION AND BYLAWS. BECAUSE OF MAYO CLINIC'S NATIONAL PRESENCE, THESE TRUSTEES ARE SELECTED BASED ON THEIR AREAS OF EXPERTISE, WHETHER IN HEALTH CARE POLICY, BUSINESS, GOVERNMENT OR ANOTHER FIELD. IN ADDITION TO THIS COMMUNITY REPRESENTATION AT THE PARENT ENTITY, THE FILING ORGANIZATION ALSO INVOLVES LOCAL COMMUNITY MEMBERS ON ITS GOVERNING BODY. OPEN V. CLOSED STAFF MODEL:THE FILING ORGANIZATION'S STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.EMERGENCY ROOM:THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY.
PART VI, LINE 6: THIS ORGANIZATION IS A PART OF MAYO CLINIC HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO CLINIC HEALTH SYSTEM IS DESCRIBED IN RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). THAT STATEMENT ALSO DESCRIBES THE ROLES OF THE VARIOUS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.
PART VI, LINE 7: NEITHER THE FILING ORGANIZATION, NOR ANY RELATED ORGANIZATION, FILES A COMMUNITY BENEFIT REPORT WITH ANY STATE OTHER THAN THE EXTENT TO WHICH COMMUNITY BENEFIT INFORMATION IS INCLUDED IN OTHER REPORTING REQUIREMENTS SUCH AS INFORMATION PROVIDED ON THE MINNESOTA HOSPITAL ANNUAL REPORT OR TO THE WISCONSIN HOSPITAL ASSOCIATION.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (18 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
NYMAN MD MARK A
DIRECTOR02218700001298024610022586027036400
SOLBERG MD JEREMY J
DIRECTOR/PHYSICIAN20736600018260188230196560247671000
SPANO MD DENNIS C
VICE-CHAIR/DIRECTOR/PHYSICIAN2847140001526360238530120540473257000
WILKINSON MD JOHN M
DIRECTOR02236600003480097015642024287900
WITT MD THOMAS J
CHAIR/DIRECTOR/PHYSICIAN3821412872900416520403672600202883614844483169000
AGERTER MD DAVID C
REGION CEO044978300033817019707015384051869100
BIREN DAVID H
TREASURER01663220002098032017168018562000
KOCH MARK B
ASST. SECRETARY (2/16/12-12/31/12)027980400092820322016473030588100
KRAMER CHERYL A
SECRETARY(1/1-7/20/12)/ADMINISTRATOR1504080009906086081990168599000
PARKS DOUGLAS A
REGION CAO01886120001169020335024187023430300
PILOT DAVID L
REGION CFO01960450000013937019997022997900
STIENE SUSAN M
SECRETARY(7/21-12/31)/SR OP ADMIN1445760004333021824056800176413000
ADAMSON MD STEVEN C
FAMILY MEDICINE PHYSICIAN24132800037608029963063120315211000
PODEIN MD RIAN J
FAMILY MEDICINE PHYSICIAN19869600044091019139060960268022000
RENELT MD JOHN A
FAMILY MEDCINE PHYSICIAN213989000131936023705080880377718000
SCHWEND DO PHILLIP P
GENERAL SURGEON23375100063301034135080880339275000
STORLIE MD JESSICA M
FAMILY MEDICINE PHYSICIAN22275500018637010688080880260168000
BROWN MARK C
FORMER COO0141998040606000446706532015400300

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART I, LINE 1ASEVERAL BOARD MEMBERS 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 4BTHIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(A)(17). STARTING JANUARY 1, 2011, ALL SRP BENEFITS ARE PAID AS AN ANNUAL TAXABLE CASH PAYMENT. THE FOLLOWING INDIVIDUALS RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN. AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). STEVEN C. ADAMSON, M.D. $10,207 DAVID C. AGERTER, M.D. $27,454 MARK B. KOCH $8,013 JOHN A. RENELT, M.D. $6,591 PHILLIP P. SCHWEND, D.O. $2,659 DENNIS C. SPANO, M.D. $24,422 THOMAS J. WITT, M.D. $30,605
PART IIICOMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. 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.SUPPLEMENTAL INFORMATION

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
LAURA A STIENE
EMPLOYMENT19094COMPENSATION PAID TO DAUGHTER OF BOARD OFFICER, SUSAN M. STIENE0
LISA J GRUBER
EMPLOYMENT27412COMPENSATION PAID TO SPOUSE OF BOARD MEMBER, JOHN GRUBER0
MAUREEN T SULLIVAN-SPANO
EMPLOYMENT11175COMPENSATION PAID TO SPOUSE OF BOARD OFFICER/MEMBER, DENNIS C. SPANO, M.D.0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION A, LINE 2THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: BROWN, MARK C. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: AGERTER M.D., DAVID C. KOCH, MARK B. PARKS, DOUGLAS A. PILOT, DAVID L. THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: CIOTA M.D., MARK R. PILOT, DAVID L. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: AGERTER M.D., DAVID C. CIOTA M.D., MARK R. KOCH, MARK B. PARKS, DOUGLAS A. PILOT, DAVID L.
FORM 990, PART VI, SECTION A, LINE 3MAYO CLINIC, MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, AND OTHER RELATED COMPANIES PROVIDE MANAGEMENT SERVICES TO THE ENTIRE SYSTEM OF ENTITIES. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS, COMPENSATION FOR THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES HAS BEEN DISCLOSED IN PART VII AND SCHEDULE J AS REQUIRED.
FORM 990, PART VI, SECTION A, LINE 6THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION IS MAYO CLINIC.
FORM 990, PART VI, SECTION A, LINE 7ATHE SOLE CORPORATE MEMBER ELECTS THE GOVERNING BODY. ONE MEMBER IS ELECTED FROM A SLATE OF NOMINEES PROVIDED BY THE CITY COUNCIL OF LAKE CITY.
FORM 990, PART VI, SECTION A, LINE 7BTHE BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS DEBT, AMENDMENT OF THE BYLAWS, MERGERS, AND NEW SERVICES. AMENDMENTS OF THE ARTICLES OF INCORPORATION OR BYLAWS MUST BE APPROVED BY THE SOLE CORPORATE MEMBER.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE CHIEF 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 12CMAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF MAYO CLINIC (AND/OR AFFILIATE) AND THE OUTSIDE ENTITY. ADDITIONAL CONFLICT OF INTEREST POLICIES AND PROCEDURES EXIST FOR CERTAIN ENTITIES CONCERNING RESEARCH CONTRACTS AND OTHER TYPES OF POTENTIAL CONFLICTS.
FORM 990, PART VI, SECTION B, LINE 15THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS 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, THE REGIONAL CEO AND CAO, ALONG WITH PHYSICIAN LEADERSHIP ON THE BOARD WERE REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO CLINIC HEALTH SYSTEM PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE MAYO CLINIC HEALTH SYSTEM ENTITIES. THE COMMITTEE IS COMPRISED OF MAYO EMPLOYEES, BUT IS INDEPENDENT FOR INTERNAL REVENUE CODE 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED (WITH RECUSAL WHERE APPROPRIATE). FOR THOSE INDIVIDUALS FOR WHICH THIS COMMITTEE CAN NOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE COMPENSATION AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. INFORMATION ON MAYO CLINIC HEALTH SYSTEM PHYSICIAN AND ADMINISTRATIVE LEADERSHIP COMPENSATION AND BENEFITS IS ALSO REVIEWED BY THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION AND GOVERNANCE (GOVERNANCE COMMITTEE), WHICH IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. IN ADDITION TO THE ABOVE COORDINATED REVIEW PROCESSES CONDUCTED BY MAYO CLINIC AND ITS AFFILIATES, THE FILING ORGANIZATION ALSO HAS ITS OWN COMPENSATION REVIEW PROCESS THAT INCLUDES REVIEW BY AN INDEPENDENT COMPENSATION COMMITTEE, BENCHMARK/COMPARABILITY DATA AND APPROVAL BY BOARD OR COMPENSATION COMMITTEE. THE FILING ORGANIZATION'S REVIEW PROCESS COVERS BOTH A PHYSICIAN COMPENSATION PLAN AND AN ADMINISTRATOR COMPENSATION PLAN.
FORM 990, PART VI, SECTION C, LINE 19THE FILING ORGANIZATION'S GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST AND ALSO ON THE MAYOCLINIC.ORG WEBSITE. THE FILING ORGANIZATION IS A HOSPITAL AFFILIATED WITH MAYO CLINIC. AS SUCH, MAYO CLINIC'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THE FILING ORGANIZATION'S FORM 990 AND WOULD BE AVAILABLE UPON REQUEST OF THE FORM 990.
FORM 990, PART IX, LINE 11GOTHER FEES: PROGRAM SERVICE EXPENSES 1,774,900. MANAGEMENT AND GENERAL EXPENSES 402,571. FUNDRAISING EXPENSES 1,490. TOTAL EXPENSES 2,178,961. LAB FEES: PROGRAM SERVICE EXPENSES 1,368,828. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,368,828. SURGICAL FEES: PROGRAM SERVICE EXPENSES 922,888. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 922,888. REHAB AND NURSING FEES: PROGRAM SERVICE EXPENSES 691,029. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 691,029. RADIOLOGY AND CARDIOLOGY FEES: PROGRAM SERVICE EXPENSES 385,676. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 385,676. PHARMACY AND ANESTHESIA FEES: PROGRAM SERVICE EXPENSES 434,610. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 434,610.OTHER FEES
SCHEDULE F, PART IV, LINES 3, 5, & 6DISCLOSURE 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-FILEDIN REGARDS TO FILING CERTAIN FOREIGN FORMS

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (48 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNAAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityCountryAddressForeign/CountryLegal Domicile Foreign CountryLegalDomicileForeignCountry
BLOOMER LAKEVIEW INC
2110 DUNCAN ROADBLOOMERWI54724391450617LOW INCOME HOUSINGWI501(C)(3)7MCHS--CHIPPEWA VALLEY INC1
CHARTERHOUSE INC
200 FIRST STREET SWROCHESTERMN55905411405254RETIREMENT LIVING CENTERMN501(C)(3)9MAYO CLINIC1
FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC
464 SOUTH ST JOSEPH AVENUEARCADIAWI54612391322480FUNDRAISING FOUNDATIONWI501(C)(3)9MCHS--FRANCISCAN HEALTHCARE INC1
GOLD CROSS AMBULANCE SERVICE
200 FIRST STREET SWROCHESTERMN55905411917516AMBULANCE SERVICEMN501(C)(3)9MFMER1
LUTHER LAKESIDE APARTMENTS INC
PO BOX 1510EAU CLAIREWI54702391409024LOW INCOME HOUSING FOR ELDERLYWI501(C)(3)9MCHS--EAU CLAIRE HOSPITAL INC1
MAYO CLINIC
200 FIRST STREET SWROCHESTERMN55905416011702PATIENT CARE - CLINICMN501(C)(3)91N/A
MAYO CLINIC -- METHODIST HOSPITAL
200 FIRST STREET SWROCHESTERMN55905410739106HOSPITALMN501(C)(3)3MAYO CLINIC1
MAYO CLINIC -- SAINT MARYS HOSPITAL
200 FIRST STREET SWROCHESTERMN55905410944601HOSPITALMN501(C)(3)3MAYO CLINIC1
MAYO CLINIC ARIZONA
13400 EAST SHEA BOULEVARDSCOTTSDALEAZ85259860800150HOSPITAL AND CLINICAZ501(C)(3)3MAYO CLINIC1
MAYO CLINIC FLORIDA (A NONPROFIT CORPORATION)
4500 SAN PABLO ROADJACKSONVILLEFL32224590714831HOSPITALFL501(C)(3)3MAYO CLINIC JACKSONVILLE1
MAYO CLINIC HEALTH SYSTEM IN WAYCROSS INC
1900 TEBEAU STREETWAYCROSSGA31501581667166HOSPITALGA501(C)(3)3MAYO CLINIC JACKSONVILLE1
MAYO CLINIC HEALTH SYSTEM--ALBERT LEA
1000 FIRST DRIVE NWAUSTINMN55912411404075HOSPITAL AND CLINICMN501(C)(3)3MAYO CLINIC1
MAYO CLINIC HEALTH SYSTEM--AUSTIN
1000 FIRST DRIVE NWAUSTINMN55912410695606HOSPITAL AND CLINICMN501(C)(3)3MAYO CLINIC1
MAYO CLINIC HEALTH SYSTEM--AUSTIN FOUNDATION
1000 FIRST DRIVE NWAUSTINMN55912300107471FUNDRAISING FOUNDATIONMN501(C)(3)7MCHS--AUSTIN1
MAYO CLINIC HEALTH SYSTEM--CANNON FALLS
1116 WEST MILL STREETCANNON FALLSMN55009204156428HOSPITAL AND CLINICMN501(C)(3)3MAYO CLINIC1
MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC
1501 THOMPSON STREETBLOOMERWI54724390980343HOSPITAL AND CLINICWI501(C)(3)3MCHS--EAU CLAIRE HOSPITAL INC1
MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC
733 W CLAIREMONT AVE PO BOX 1510EAU CLAIREWI54702391735831PATIENT CARE - CLINICWI501(C)(3)3MAYO CLINIC0
MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE FOUNDATION INC
733 W CLAIREMONT AVE PO BOX 1510EAU CLAIREWI54702391633407GRANTMAKING FOUNDATIONWI501(C)(3)11-IMCHS--EAU CLAIRE CLINIC INC0
MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC
1221 WHIPPLE STREETEAU CLAIREWI54703390813418HOSPITALWI501(C)(3)3MAYO CLINIC1
MAYO CLINIC HEALTH SYSTEM--FAIRMONT
800 MEDICAL CENTER DRIVE PO BOX 800FAIRMONTMN56031410760836HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATO1
MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC
700 WEST AVE SOUTHLA CROSSEWI54601391186647FUNDRAISING FOUNDATIONWI501(C)(3)7MCHS--FRANCISCAN HEALTHCARE INC1
MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION-SPARTA INC
310 WEST MAIN STREETSPARTAWI54656391423234FUNDRAISING FOUNDATIONWI501(C)(3)9MCHS--FRANCISCAN HEALTHCARE INC1
MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC
700 WEST AVE SOUTHLA CROSSEWI54601391411999HEALTHCARE SYSTEM PARENTWI501(C)(3)11-IMAYO CLINIC1
MAYO CLINIC HEALTH SYSTEM--FRANCISCAN MEDICAL CENTER INC
700 WEST AVE SOUTHLA CROSSEWI54601390806374HOSPITAL AND CLINICWI501(C)(3)3MCHS--FRANCISCAN HEALTHCARE INC1
MAYO CLINIC HEALTH SYSTEM--HOME HEALTH & HOSPICE INC
PO BOX 2060EAU CLAIREWI54702391491516HOME HEALTH AND HOSPICE CAREWI501(C)(3)9MCHS--EAU CLAIRE HOSPITAL INC1
MAYO CLINIC HEALTH SYSTEM--LAKE CITY
500 WEST GRANT STREETLAKE CITYMN55041411906820HOSPITALMN501(C)(3)3MAYO CLINIC1
MAYO CLINIC HEALTH SYSTEM--MANKATO
1025 MARSH STREETMANKATOMN56002411236756HOSPITAL AND CLINICMN501(C)(3)3MAYO CLINIC1
MAYO CLINIC HEALTH SYSTEM--MANKATO HEALTH CARE FOUNDATION
1025 MARSH STREETMANKATOMN56002411663357FUNDRAISING FOUNDATIONMN501(C)(3)7MCHS--MANKATO1
MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE
301 SECOND STREET NENEW PRAGUEMN56071410723639HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATO1
MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC
1222 EAST WOODLAND AVENUEBARRONWI54812390920634HOSPITAL AND CLINICWI501(C)(3)3MCHS--EAU CLAIRE HOSPITAL INC1
MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC
13025 EIGHTH STREET PO BOX 70OSSEOWI54758391029430HOSPITAL AND CLINICWI501(C)(3)3MCHS--EAU CLAIRE HOSPITAL INC1
MAYO CLINIC HEALTH SYSTEM--OWATONNA
134 SOUTHVIEW STOWATONNAMN55060411862132PATIENT CARE - CLINICMN501(C)(3)3MAYO CLINIC1
MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC
2321 STOUT ROADMENOMONIEWI54751510190875HOSPITAL AND CLINICWI501(C)(3)3MAYO CLINIC1
MAYO CLINIC HEALTH SYSTEM--RED WING
701 HEWITT BOULEVARDRED WINGMN55066411713783PATIENT CARE SERVICESMN501(C)(3)3MAYO CLINIC1
MAYO CLINIC HEALTH SYSTEM--RED WING HOME HEALTH & HOSPICE
701 HEWITT BOULEVARDRED WINGMN55066411539756HOME HEALTHCARE SERVICESMN501(C)(3)7MCHS--RED WING1
MAYO CLINIC HEALTH SYSTEM--SPRINGFIELD
625 NORTH JACKSON AVENUESPRINGFIELDMN56087411893827HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATO1
MAYO CLINIC HEALTH SYSTEM--ST JAMES
1101 MOULTON PARSONS DR PO BOX 460ST JAMESMN56081410797368HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATO1
MAYO CLINIC HEALTH SYSTEM--ST JAMES HEALTH CARE FOUNDATION
1101 MOULTON PARSONS DR PO BOX 460ST JAMESMN56081411444129FUNDRAISING FOUNDATIONMN501(C)(3)7MCHS--ST JAMES1
MAYO CLINIC HEALTH SYSTEM--SUPPORTIVE HOMECARE INC
PO BOX 2060EAU CLAIREWI54702391686673HOME HEALTH CAREWI501(C)(3)9MCHS--EAU CLAIRE HOSPITAL INC1
MAYO CLINIC HEALTH SYSTEM--WASECA
501 NORTH STATE STREETWASECAMN56093363606405HOSPITAL AND CLINICMN501(C)(3)3MCHS--MANKATO1
MAYO CLINIC JACKSONVILLE
4500 SAN PABLO ROADJACKSONVILLEFL32224593337028PATIENT CARE - CLINICFL501(C)(3)7MAYO CLINIC1
MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
200 FIRST STREET SWROCHESTERMN55905411506440CHARITABLE, EDUCATIONAL & SCIENTIFIC ACTIVITIESMN501(C)(3)9MAYO CLINIC1
MAYO KLINIK STIFTUNG
FUNDRAISING FOUNDATIONMFMER160486 FRANKFURT AM MAINFRANKFURTGMGM
MILES AND SHIRLEY FITERMAN ENDOWMENT FUND FOR DIGESTIVE DISEASES
200 FIRST STREET SWROCHESTERMN55905412020392SUPPORT RESEARCH, PRACTICE & EDUCATIONMN501(C)(3)11-IMAYO CLINIC1
POVERELLO FOUNDATION
200 FIRST STREET SWROCHESTERMN55905411494881FUNDRAISING FOUNDATIONMN501(C)(3)7MAYO CLINIC -- SAINT MARYS HOSPITAL1
RED WING SEMINARY HOME
701 HEWITT BOULEVARDRED WINGMN55066411263419RESIDENT CARE AND HOUSINGMN501(C)(3)9MCHS--RED WING1
SATILLA HEALTH MANAGEMENT INC
1900 TEBEAU STREETWAYCROSSGA31501581717889HEALTHCARE SERVICESGA501(C)(3)3MCHS IN WAYCROSS INC1
THE DOWNTOWN PLAZA
701 HEWITT BOULEVARDRED WINGMN55066411532554ELDERLY HOUSINGMN501(C)(3)9MCHS--RED WING1

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNA
FRANKLIN HEATING STATION
119 THIRD ST SWROCHESTERMN55902410264830UTILITYMNN/A
PHYSICIAN SOFTWARE SYSTEMS LLC
3333 WARRENVILLE ROAD SUITE 200LISLEIL60532453414836HEALTHCARE RELATED SOFTWAREILN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (36 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityControlled OrgControlledOrgAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityCountryAddressForeign/CountryLegal Domicile Foreign CountryLegalDomicileForeignCountryPostal CodeAddressForeign/PostalCode
HEALTH TRADITION HEALTH PLAN
1808 EAST MAIN STREETONALASKAWI54650391545987MEDICAL SERVICES COMPANYWIN/AC1
LOBSS NETWORK SUPPORT 2002 INC
200 FIRST STREET SWROCHESTERMN55905481276150ADMINISTRATIVE SERVICESMNN/AC1
MAYO CLINIC GBS MAURITIUS
HEALTHCARE MANAGEMENTN/AC12ND FLOOR EBENE MEWS 57EBENE CYBERCITYMPMP
MAYO CLINIC HEALTH SYSTEM--DECORAH CLINIC PHYSICIANS
907 MONTGOMERY STREETDECORAHIA52101411711329PATIENT CARE - CLINICIAN/AC1
MAYO CLINIC HEALTH SYSTEM--FARIBAULT
635 FIRST STREET SEFARIBAULTMN55021411817179PATIENT CARE - CLINICMNN/AC1
MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC
1221 WHIPPLE STREETEAU CLAIREWI54703391528920PHARMACY SERVICESWIN/AC1
MAYO COLLABORATIVE SERVICES INC
200 FIRST STREET SWROCHESTERMN55905411346366REFERENCE LAB SERVICESMNN/AC1
MAYO HOLDING COMPANY
200 FIRST STREET SWROCHESTERMN55905411578020HOLDING COMPANYMNN/AC1
MAYO INSURANCE COMPANY LTD
200 FIRST STREET SWROCHESTERMN55905SELF INSURANCE POOLN/AC1CJ
MAYO MEDICAL LABORATORIES NEW ENGLAND INC
265 BALLARDVALE STREETWILMINGTONMA01887043323713LABORATORY SERVICESMAN/AC1
MAYO REGIONAL PRACTICES OF ARIZONA
13400 EAST SHEA BOULEVARDSCOTTSDALEAZ85259061190278THIRD PARTY ADMINISTRATION SERVICESAZN/AC1
MMSI INC
21 FIRST STREET SWROCHESTERMN55905411547003THIRD PARTY ADMINISTRATION SERVICESMNN/AC1
RESOUNDANT INC
221 1ST AVE SWROCHESTERMN55902461661978MANUFACTURING MEDICAL DEVICE COMPONENTMNN/AC1
ROCHESTER AIRPORT COMPANY
ROUTE 2ROCHESTERMN55902410506870AIRPORT MANAGEMENTMNN/AC1
SATILLA HEALTH ENTERPRISES INC
1900 TEBEAU STREETWAYCROSSGA31501581717222HEALTHCAREGAN/AC1
SATILLA HEALTHNET INC
1900 TEBEAU STREETWAYCROSSGA31501582151076HEALTH SERVICESGAN/AC1
SATILLA REGIONAL SPECIALTY PHYSICIANS INC
1900 TEBEAU STREETWAYCROSSGA31501204363143PHYSICIAN OFFICESGAN/AC1
SIT ALPHA II BOND FUND LTD
980648163INVESTMENT MANAGEMENTN/AC1CLIFTON HOUSE 75 FORTH STGRAND CAYMANCJCJKY1-1108
SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION
13400 E SHEA BLVDSCOTTSDALEAZ85259860870505COMMERCIAL PROPERTY OWNERS ASSOCIATIONAZN/AC1
THE STABILE BUILDING OWNERS' ASSOCIATION
200 FIRST STREET SWROCHESTERMN55905208994499COMMERCIAL PROPERTY OWNERS ASSOCIATIONMNN/AC1
CHARITABLE LEAD TRUST
CHARITABLE TRUSTCAN/AT1
PERPETUAL TRUST
CHARITABLE TRUSTNDN/AT1
PERPETUAL TRUST
CHARITABLE TRUSTLAN/AT1
PERPETUAL TRUST (2)
CHARITABLE TRUSTMAN/AT1
PERPETUAL TRUST
CHARITABLE TRUSTMON/AT1
PERPETUAL TRUST
CHARITABLE TRUSTAZN/AT1
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTCON/AT1
CHARITABLE REMAINDER TRUST (6)
CHARITABLE TRUSTFLN/AT1
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTFLN/AT1
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTILN/AT1
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTLAN/AT1
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTMIN/AT1
CHARITABLE REMAINDER TRUST (68)
CHARITABLE TRUSTMNN/AT1
CHARITABLE REMAINDER TRUST (77)
CHARITABLE TRUSTMNN/AT1
CHARITABLE REMAINDER TRUST
CHARITABLE TRUSTNCN/AT1
CHARITABLE REMAINDER TRUST (2)
CHARITABLE TRUSTTXN/AT1
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (9 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
MAYO CLINIC HEALTH SYSTEM--AUSTIN
M76710GAAP
MAYO CLINIC HEALTH SYSTEM--AUSTIN
P64727GAAP
MAYO CLINIC HEALTH SYSTEM--CANNON FALLS
L163363GAAP
MAYO CLINIC HEALTH SYSTEM--RED WING
M823754GAAP
MAYO COLLABORATIVE SERVICES INC
M454719GAAP
MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH
O15190567GAAP
MMSI INC
M242229GAAP
MMSI INC
R2491546GAAP
MMSI INC
S2272123GAAP