2012-11-05T15:41:08-06:00 2011-12-31 990 2011-01-01 411404075 MAYO CLINIC HEALTH SYSTEM-ALBERT LEA MAYO 5075381297 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 DAVID L PILOT 5073774815 2012-11-05 2011 2016-02-24 21:20:13Z FKA ALBERT LEA MEDICAL CENTER-MAYO HEALTH SYSTEM MARK R CIOTA MD 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 137252535 0 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1981 MN HOSPITAL AND CLINICS 12 4 1389 272 0 0 1348530 2863950 129948350 131401614 1567720 2085674 737772 720417 133602372 137071655 701582 548476 0 0 78798192 80053246 0 0 0 46196286 50347066 125696060 130948788 7906312 6122867 153000253 155876941 12169183 9694149 140831070 146182792 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 110461531 131735846 PATIENT CARE (SCHEDULE O)PATIENT CARE:MAYO CLINIC HEALTH SYSTEM IS A FAMILY OF CLINICS, HOSPITALS AND HEALTH CARE FACILITIES SERVING COMMUNITIES IN MINNESOTA, IOWA AND WISCONSIN. AS PART OF MAYO CLINIC, MAYO CLINIC HEALTH SYSTEM OFFERS OUTSTANDING CARE CLOSE TO HOME. PHYSICIANS AND STAFF IN MAYO CLINIC HEALTH SYSTEM HAVE READY ACCESS TO THE KNOWLEDGE, RESOURCES, AND EXPERTISE OF MAYO CLINIC, YET CAN MEET PATIENTS' HEALTH CARE NEEDS LOCALLY. MAYO CLINIC HEALTH SYSTEM IS PART OF THE COMMUNITY, FOCUSED ON IMPROVING THE HEALTH OF THE COMMUNITIES IN WHICH WE LIVE AND WORK. MAYO CLINIC HEALTH SYSTEM TEAMS WITH MAYO CLINIC TO DELIVER UNPARALLELED HEALTH CARE TO COMMUNITIES THROUGH AN INTEGRATED NETWORK OF CLINICS AND HOSPITALS.IN 2011, MAYO CLINIC HEALTH SYSTEM SITES EMPLOYED APPROXIMATELY 900 PHYSICIANS AND 13,000 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, SEVEN OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH TWO ADDITIONAL HOSPITALS, AND CONTRACT MANAGEMENT AGREEMENTS WITH AN ADDITIONAL HOSPITAL AND NURSING HOME. SINCE ITS INCEPTION IN 1992, MAYO CLINIC HEALTH SYSTEM HAS GROWN FROM A NEW IDEA TO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN AMERICA. MAYO CLINIC HEALTH SYSTEM COMPLETES MORE THAN TWO-MILLION PATIENT VISITS ANNUALLY. IT ALSO SERVES AS A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS BEING RECOGNIZED SIX TIMES BY THE AMERICAN MEDICAL GROUP ASSOCIATION'S ACCLAIM AWARD PROGRAM (2005 ACCLAIM AWARD RECIPIENT AND FIVE-TIME ACCLAIM AWARD HONOREE). THE ACCLAIM AWARDS HONOR PHYSICIAN-LED ORGANIZATIONS DELIVERING CARE ALIGNED WITH THE IDEAL DELIVERY MODEL WHERE PATIENTS EXPERIENCE SAFE, RELIABLE, RESPONSIVE, READILY AVAILABLE AND INTEGRATED CARE. IN ADDITION, THE MINNESOTA COUNCIL FOR QUALITY HAS RECOGNIZED MAYO CLINIC HEALTH SYSTEM THREE TIMES FOR ITS PERFORMANCE EXCELLENCE EFFORTS. INDIVIDUAL MAYO CLINIC HEALTH SYSTEM LOCATIONS HAVE ALSO BEEN HONORED FOR THEIR COMMITMENT TO QUALITY, SAFETY, SERVICE, PERFORMANCE AND THEIR COMMUNITIES.PEOPLE IN MINNESOTA, IOWA AND WISCONSIN CAN HAVE PEACE OF MIND KNOWING THAT MAYO CLINIC HEALTH SYSTEM AND MAYO CLINIC PARTNER TO ENSURE HEALTHIER LIVES IN THE REGION.MAYO CLINIC HEALTH SYSTEM-ALBERT LEA (MCHS-AL) IS A MINNESOTA NON-PROFIT CORPORATION, TAX EXEMPT AS AN ORGANIZATION DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. TO JUSTIFY THIS TAX EXEMPT STATUS, MCHS-AL PROVIDES SCHOLARSHIPS, CHARITY CARE, INTERPRETING AND EDUCATIONAL SERVICES, AND VARIOUS OTHER COMMUNITY BENEFITS. MCHS-AL PROVIDES PRIMARY CARE NEEDS, INCLUDING FAMILY PRACTICE, INTERNAL MEDICINE, OB/GYN, PEDIATRICS AND GENERAL SURGERY. IN ADDITION, MCHS-AL ALSO PROVIDES SPECIALTY CARE IN CARDIOLOGY, DERMATOLOGY, NEUROLOGY, ONCOLOGY, OPHTHALMOLOGY, OPTOMETRY, OCCUPATIONAL HEALTH, PHYSICAL MEDICINE & REHAB, PSYCHIATRY, RHEUMATOLOGY, AUDIOLOGY, ALLERGY, ORTHOPEDICS, ENT, PSYCHOLOGY, PODIATRY, PHYSICAL THERAPY, WOUND CARE, UROLOGY, AND PLASTIC SURGERY. IN 2011, MCHS-AL HAD 165,154 CLINIC VISITS. MCHS-AL OPERATES REGIONAL CLINICS IN ALDEN, KIESTER, NEW RICHLAND, AND WELLS, MINNESOTA AND LAKE MILLS, IOWA.MCHS-AL INCLUDES A 77-BED HOSPITAL. DURING 2011, HOSPITAL INPATIENT DAYS TOTALED 7,141 WITH 862 ADDITIONAL DAYS FOR NEWBORN CARE AND 45,734 OUTPATIENT VISITS. MCHS-AL ALSO OPERATES AN AMBULANCE SERVICE STAFFED BY PARAMEDICS AND EMTS.AS PART OF THE MAYO CLINC HEALTH SYSTEM, MCHS-AL ACCESSES EMERGENCY MEDICAL HELICOPTER SERVICE THROUGHOUT SOUTHERN MINNESOTA AND NORTHERN IOWA. THE HELICOPTER PROVIDES RAPID PATIENT TRANSPORT TO THE APPROPRIATE HEALTH CARE FACILITY ALONG WITH DELIVERING HIGH-LEVEL CRITICAL CARE. MCHS-AL HAS AN ACTIVE NON-PROFIT AFFILIATE, FOUNTAIN LAKE TREATMENT CENTER (FLTC). MCHS-AL PROVIDES MANAGEMENT SERVICES AND SUPPORT SERVICES AND MAINTAINS AND OPERATES THE BUILDINGS THAT HOUSE THIS ENTITY. CONSOLIDATING THESE SERVICES ALLOWS FOR GREATER COST EFFICIENCY, ENABLING THE MCHS-AL AFFILIATE TO ENHANCE THE SCOPE AND AVAILABILITY OF THEIR HEALTH CARE SERVICES. MCHS-AL OPERATES ON A NONDISCRIMINATORY BASIS REGARDLESS OF RACE, COLOR, SEX, RELIGION OR NATIONAL ORIGIN.CHARITY CARE: MCHS-AL PROVIDES A VARIETY OF FINANCIAL ASSISTANCE OPTIONS TO PATIENTS WHO MEET ESTABLISHED CRITERIA. ITS ALMCARE PROGRAM ALLOWS PATIENTS WHO MEET FINANCIAL GUIDELINES TO ENROLL ANNUALLY TO RECEIVE CARE DISCOUNTS FROM 10 TO 100%, WITH A $5 CO-PAY FOR PRESCRIPTIONS. SERVICES ARE ALSO PROVIDED TO BOTH MEDICARE AND MEDICAID AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. THE COST OF CHARITY CARE PROVIDED DURING 2011 WAS $2,518,652 AND THE COST OF UNCOMPENSATED MEDICAID FOR 2011 WAS APPROXIMATELY $4,932,705. THE UNREIMBURSED COST OF MEDICARE WAS $10,676,969. ADDITIONALLY, THE UNREIMBURSED COST OF OTHER MEANS TESTED PROGRAMS (INCLUDING MINNESOTA CARE - A PROGRAM THAT OFFERS HEALTHCARE ASSISTANCE TO LOW INCOME POPULATIONS) WAS $1,758,532. 1395243 7000 8198 EDUCATION AND SUPPORT SERVICES (SCHEDULE O): EDUCATION AND SUPPORT SERVICES: MCHS-AL PROVIDES CONTINUING MEDICAL EDUCATION TO ITS STAFF. THERE ARE NUMEROUS HEALTH AND WELLNESS EDUCATION PROGRAMS, CLASSES AND SUPPORT GROUPS PROVIDED TO THE COMMUNITY THROUGHOUT THE YEAR. THESE CLASSES/SUPPORT GROUPS INCLUDE CHILDBIRTH PREPARATION CLASS, BABY PLACE TOURS, PRENATAL BREASTFEEDING EDUCATION, YOUNG PARENT CLASSES, INFANT & CHILD CARE SAFETY AND CPR, PRENATAL DIET HEALTH EDUCATION, BEREAVEMENT EDUCATION SUPPORT SERIES, CANCER SUPPORT GROUP, DIABETES SUPPORT GROUP, HYPERTENSION CLASS, PULMONARY/CARDIAC REHAB SUPPORT GROUP, RTS BEREAVEMENT SERVICES, STROKE SUPPORT GROUP, OSTOMY SUPPORT GROUP, MENTORS FOR HOPE, TOBACCO CESSATION SERVICES, SPORTS SCREENINGS, INDIVIDUAL SPORTS CONDITIONING AND SPORTS INJURY EVALUATIONS, ALL AT NO CHARGE.MCHS-AL PROVIDES CLASSES THROUGHOUT SOUTHEASTERN MINNESOTA. MCHS-AL ALSO PROVIDES FIRST AID, CPR, AND DEFIBRILLATOR TRAINING TO DAYCARE PROVIDERS AND INDUSTRIES IN THE AREA AND HELPS MAINTAIN THEIR SKILLS ON A REGULAR BASIS. MCHS-AL, VIA THE COMMUNITY TRAINING CENTER (IN ASSOCIATION WITH THE AMERICAN HEART ASSOCIATION), PROVIDES CPR AND ACLS CLASSES AND SUPPORT TO AREA BASIC LIFE SUPPORT AND ADVANCE LIFE SUPPORT PROVIDERS AND INSTRUCTORS. IN COLLABORATION WITH LOCAL AGENCIES AND GOVERNMENT, WE PROVIDE EMERGENCY PREPAREDNESS TRAINING. MCHS-AL AMBULANCE ALSO PROVIDES FREE EVENT COVERAGE FOR VARIOUS COMMUNITY ACTIVITIES. MCHS-AL'S PATIENT EDUCATION CENTER PROVIDES FREE BLOOD PRESSURE CHECKS AND HEALTH RESOURCES FOR THE COMMUNITY. LOCATED WITHIN THE FRONT CORRIDOR, THE CENTER'S LIBRARY AREA INCLUDES EASY ACCESS FOR COMMUNITY MEMBERS TO WRITTEN LITERATURE, DVDS, VCR TAPES, AND AUDIOTAPES AND USE OF FOUR PUBLIC COMPUTERS ALLOW PATIENTS A DIVERSE MEANS OF GETTING AND RECEIVING PATIENT EDUCATION ON A VARIETY OF MEDICAL AND HEALTH-RELATED SUBJECTS. ALSO LOCATED IN THE PATIENT EDUCATION CENTER IS MCHS-AL'S PATIENT ADVOCATE. SHE IS A CERTIFIED SENIOR HEALTH INSURANCE PROGRAM VOLUNTEER WHO FACILITATES MEDICATION ASSISTANCE FOR THOSE UNABLE TO AFFORD MEDICATION PRESCRIBED. SHE ALSO ASSISTS MEDICARE PARTICIPANTS ENROLLING IN THE PART D PLAN. EXPLAINING INSURANCE AND CLARIFYING INSURANCE ISSUES ARE ALSO OFFERED THROUGH THE PATIENT ADVOCATE. WITH THE DEVELOPMENT OF ALMCARE, SHE WORKS CLOSELY WITH THE FINANCE DEPARTMENT IN EDUCATING AND FOLLOWING UP WITH UNINSURED OR UNDERINSURED PATIENTS THAT ARE ACCEPTED INTO THIS PROGRAM.FREE EDUCATION PROGRAMS INCLUDE: - 10 HEALTH EDUCATION PROGRAMS - 52 HEALTH TALK RADIO PROGRAMS - 4 WELLNESS FAIRS AT LOCAL BUSINESSES - 1 WOMEN'S HEALTH SYMPOSIUM MCHS-AL ALSO PROVIDES PATIENT & FAMILY SOCIAL SERVICES, FREE HEALTH ASSESSMENTS AND SCREENINGS, COUNSELING SERVICES, FREE INTERPRETING SERVICES, AND SPACE FOR COMMUNITY MEETINGS AND SUPPORT GROUPS. SOME EXAMPLES OF THESE SERVICES ARE PROVIDED BELOW. 379449 257090 48067 COMMUNITY SUPPORT (SCHEDULE O): COMMUNITY SUPPORT: MCHS-AL HAS A HOME HEALTH PROGRAM IN WHICH PRIMARILY ELDERLY PATIENTS WITH CIRCULATORY, RESPIRATORY AND OTHER HEALTH PROBLEMS ARE PROVIDED ASSISTANCE WITH PERSONAL CARES AND ACTIVITIES OF DAILY LIVING. DURING 2011, THE HOME HEALTH PROGRAM SERVED 346 PATIENTS.MCHS-AL ALSO PROVIDES A HOSPICE FOR THE FAMILIES OF TERMINAL PATIENTS. IN 2011, 215 FAMILIES WERE SERVICED BY THIS HOSPICE.MCHS-AL OPERATES A PAIN CLINIC THAT SERVES THOSE INDIVIDUALS WITH PAIN UNRESPONSIVE TO CONVENTIONAL PAIN CONTROL MEASURES. DURING THE YEAR 2011, THE PROGRAM'S ANESTHESIOLOGIST AND THE ASSISTING RN'S HELPED 819 PATIENTS.MCHS-AL PROVIDES FREE SPORTS PHYSICALS TO STUDENT ATHLETES. DURING 2011, IT PROVIDED PHYSICALS TO 327 CHILDREN.MCHS-AL SPONSORS A SCHOLARSHIP PROGRAM FOR HIGH SCHOOL SENIORS AND NON-TRADITIONAL STUDENTS FROM THE MCHS-AL SERVICE AREA WHO ARE ENTERING THE HEALTHCARE FIELD. IN THE YEAR ENDING DECEMBER 31, 2011, 10 SCHOLARSHIPS WERE AWARDED TOTALING $7,000. IN ADDITION, MCHS-AL PROVIDES MEETING SPACE AND SPONSORS VARIOUS "ON-SITE" EDUCATION PROGRAMS INCLUDING SHADOWING, PRECEPTORSHIPS, AND INTERNSHIPS. THE ESTIMATED COST OF SUPERVISION AND SPACE FOR THESE PROGRAMS IS $1,401,172. MCHS-AL IS AN ACTIVE MEMBER OF THE COMMUNITY, SUPPORTING SUCH COMMUNITY SERVICES AS SENIOR RESOURCES, FREEBORN COUNTY FAMILY SERVICES COLLABORATIVE, RIVERLAND COMMUNITY COLLEGE, UNITED WAY, ALBERT LEA FAMILY Y, AREA FOOD SHELVES, MEALS ON WHEELS, NUMEROUS YOUTH ACTIVITIES, AND SEVERAL OTHER HEALTH-RELATED ORGANIZATIONS. DURING 2011, MCHS-AL MADE CASH AND EQUIPMENT DONATIONS TOTALING OVER $257,000 TO VARIOUS CHARITABLE AND COMMUNITY ORGANIZATIONS. ITS COMMUNITY INVOLVEMENT PROGRAM ALLOWS STAFF TO VOLUNTEER EIGHT HOURS ANNUALLY DURING WORK TIME. IN 2011, 89 MCHS-AL VOLUNTEERS PROVIDED 452 HOURS OF SERVICES TO ENDORSED COMMUNITY PROGRAMS AND PROJECTS. THE VALUE OF THIS DONATED TIME IS $9,850 BASED ON THE INDEPENDENT SECTORS AVERAGE ESTIMATED VALUE OF SUCH SERVICES. MCHS-AL ALSO BENEFITS FROM COMMUNITY VOLUNTEERS IN ITS AUXILIARY, HOSPICE AND FLTC PROGRAMS AND AS MOVERS AT THE FRONT INFORMATION DESK. DURING 2011, VOLUNTEERS DONATED APPROXIMATELY 14,282 HOURS TO THE MEDICAL CENTER. THE VALUE OF THIS DONATED TIME IS $311,205 BASED ON THE INDEPENDENT SECTORS AVERAGE ESTIMATED VALUE OF SUCH SERVICES. THESE SERVICE HOURS WERE PRIMARILY SPENT ORGANIZING AND MANAGING ACTIVITIES FOR THE BENEFIT OF THE MEDICAL CENTER'S PATIENTS, PATIENTS' FAMILIES, VISITORS, AND STAFF. 339457 284386 293236 RESEARCH AND OTHER ACTIVITIES: MCHS-AL STAFF WORK WITH MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM PHYSICIAN INVESTIGATORS TO COORDINATE CLINICAL RESEARCH STUDIES. IN 2011, MCHS-AL PARTICIPATED IN A NUMBER OF RESEARCH PROJECTS TO IMPROVE THE HEALTH OF OUR COMMUNITIES. 339457 284386 293236 112575680 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 29 0 1 1389 1 0 0 0 0 0 0 0 0 0 0 X 12 4 0 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 MN X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 X AGERTER MD DAVID C 1.00 X 0 439287 46318 CIOTA MD MARK R 40.00 X X 861046 0 44353 CRUZ-LARES LINDA 1.00 X 0 0 0 FUNK MICHAEL S 1.00 X 0 0 0 GABRIELSON SHARON R 1.00 X 0 166660 36971 HEINZ MD DIETER 40.00 X X 351109 0 43573 KEPPLE-JOHNSON JANE K 1.00 X 0 0 0 MILLER MD ROBERT C 1.00 X X 0 489366 42689 RIZZO MD MARCO 1.00 X 0 529139 38256 ROUTH LORI J 40.00 X 134972 0 11866 SAVELKOUL DONALD 1.00 X 0 0 0 VERDOORN JUDY D 1.00 X X 0 0 0 PARKS DOUGLAS A 4.00 X 0 174599 36434 PILOT DAVID L 16.00 X 187660 0 33075 WALDHOFF STEPHEN C 40.00 X 0 249049 54308 BUCKMASTER DPM ROY W 40.00 X 259694 0 35478 ECKSTROM MD MICHAEL T 40.00 X 867368 0 42930 GRZYBOWSKI MD JOHN A 40.00 X 317418 0 41072 LARSON VIRGINIA 40.00 X 156852 0 34288 LOMBARDI MD JOSEPH M 40.00 X 334140 0 40908 STOLTENBERG MD HEIDI G 40.00 X 193285 0 33912 ULRICH MD MICHAEL D 40.00 X 337537 0 43958 UNDERDAHL STEVE L 40.00 X 163150 0 13886 WAGGONER MD JULIAN R 40.00 X 517999 0 50052 BOYCE MD CORY A 40.00 X 646445 0 41828 GUJRAL MD SAROJ K 40.00 X 574508 0 36717 LOTTS MD JEFFREY P 40.00 X 577024 0 47798 SKORIN JR DO LEONID 40.00 X 750460 0 35549 THORN MD STEPHEN 40.00 X 559160 0 14720 SHELHAMER MD LEONARD E 40.00 X 236575 0 33500 8026402 2048100 934439 79 1 1 0 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 PATIENT/ADMIN SERVICES 4721527 MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 LAB SERVICES 780887 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 PHYSICIAN SERVICES 636057 SERVICE 1ST BANK OF NEVADA 8363 W SUNSET RD STE 350 LAS VEGAS NV 89113 LOAN COLLECTION 463183 MASON CITY CLINIC 250 S CRESCENT DR MASON CITY IA 50401 MEDICAL SERVICES 438552 21 2370 7689 2839891 14000 2863950 NET PATIENT REVENUE 620000 128821084 128821084 SHARED SERVICES 561000 2239284 2239284 RENT FROM AFFILIATES 531120 284981 284981 MEALS ON WHEELS 624210 48067 48067 EDUCATION REVENUE 611600 8198 8198 131401614 2128378 2128378 5670 45027 -39357 -39357 -39357 443 43147 -42704 -42704 -42704 7839 7689 0 7839 7839 445 0 445 445 152263 92706 59557 59557 CAFETERIA/VENDING REVE 722210 587487 587487 MEDICAL RECORD/TRANSCR 541900 87991 87991 MISC. REVENUE 900099 10455 8255 2200 6000 6000 691933 137071655 132085347 0 2122358 541476 541476 7000 7000 5151582 4321249 830333 1899108 180272 1718836 54802429 49045695 5756734 3863811 3452333 411478 10492655 9375391 1117264 3843661 3434329 409332 739675 739675 94349 94349 5571 5571 9410285 7271106 2139179 165006 11098 153908 5649797 4216607 1433190 3022941 3022941 2557515 2428112 129403 558441 452632 105809 247303 245340 1963 45712 45712 5315779 5145787 169992 1268155 1268155 MEDICAL SUPPLIES 16242330 16242330 BAD DEBT EXPENSE 2173056 2173056 MN CARE TAX 1521358 1521358 MEDICAID SURCHARGE 467429 467429 862364 729213 133151 130948788 112575680 18373108 0 535539 237343 0 0 20655239 25537157 2506561 2531108 3080860 2657360 100451658 44393589 58242191 56058069 59836100 61405884 8143763 7450020 153000253 155876941 9307871 6705759 0 0 2861312 2988390 12169183 9694149 X 139494445 145194739 1035082 686510 301543 301543 140831070 146182792 153000253 155876941 X 6122867 -771145 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 301543 301543 301543 301543 230192 71351 301543 299260 -69068 230192 1.00000 0 1 1 4192536 4192536 62247027 25677492 36569535 34012095 18716097 15295998 56058069 MAYO CLINIC INVESTMENT POOL 61405884 F 61405884 DEFERRED COMPENSATION LIABILITY 1783208 DUE TO AFFILIATES 192996 ASSET RETIREMENT OBLIGATION 1012187 2988390 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR EDUCATION AND PATIENT SUPPORT. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: AT DECEMBER 31, 2011 AND 2010, THERE WAS NO MATERIAL LIABILITY FOR UNRECOGNIZED TAX BENEFITS FOR THE FILING ORGANIZATION. WALK/RUN 2859 2859 MEMORIES AGLOW 4830 4830 4 7839 7839 15528 7689 7839 7839 1 1 X 1 X 1 X 1 1 0 1 1 1 2518652 2518652 0.01960 16865985 11933280 4932705 0.03830 2652147 893615 1758532 0.01370 1 22036784 12826895 9209889 0.07160 23 75511 122359 122359 0.00100 6 218 1388243 8198 1380045 0.01070 6603170 3848629 2754541 0.02140 55071 51063 4008 0.00000 16 506 257090 257090 0.00200 45 76235 8425933 3907890 4518043 0.03510 46 76235 30462717 16734785 13727932 0.10670 1 399 399 0.00000 2 38475 38475 0.00030 3 55 4158 4158 0.00000 2 1673 1673 0.00000 2 150 1236 1236 0.00000 10 205 45941 45941 0.00030 0 2173056 23031783 30584141 -7552358 X 1 1 1 1 MAYO CLINIC HEALTH SYSTEM - ALBERT LEA

404 WEST FOUNTAIN STREET ALBERT LEA MN 56007

X X X MAYO CLINIC HEALTH SYSTEM - ALBERT LEA 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X X 1 0 1 0 0 7 MCHS AT HEALTH REACH

1705 SE BROADWAY ALBERT LEA MN 56007

OUTPATIENT PHYSICAL THERAPY MCHS - ALBERT LEA IN LAKE MILLS

309 S 10TH AVE LAKE MILLS IA 50450

CLINIC MCHS - ALBERT LEA IN NEW RICHLAND

318 FIRST ST SW NEW RICHLAND MN 56072

CLINIC MCHS - ALBERT LEA IN ALDEN

192 WASHINGTON AVE ALDEN MN 56009

CLINIC MCHS - ALBERT LEA IN WELLS

301 S BROADWAY WELLS MN 56097

CLINIC MCHS - ALBERT LEA IN KIESTER

120 N MAIN ST KIESTER MN 56051

CLINIC MCHS - EXPRESS CARE IN ALBERT LEA

2708 BRIDGE AVE ALBERT LEA MN 56007

EXPRESS CARE CLINIC PART I, LINE 6A: THE ANNUAL REPORT FOR THE FILING ORGANIZATION IS PART OF A CONSOLIDATED REPORT PREPARED BY MAYO CLINIC. PART I, LINE 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS).THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO-CHARGE RATIO. PART I, LINE 7G: THE FOLLOWING NET COMMUNITY BENEFIT COST ATTRIBUTED TO A PHYSICIAN CLINIC WAS INCLUDED AS SUBSIDIZED HEALTH SERVICES: $1,638,157. 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 $ 2173056. PART II: COMMUNITY BUILDING IS AN ESSENTIAL MAYO CLINIC HEALTH SYSTEM - ALBERT LEA (MCHS-AL) ACTIVITY. ON ITS LEADERSHIP DASHBOARD, BOTH COMMUNITY BUILDING AND COMMUNITY INVOLVEMENT ARE METRICS MEASURED MONTHLY. THE ORGANIZATION'S COMMUNITY INVOLVEMENT POLICY ENCOURAGES STAFF TO VOLUNTEER EIGHT HOURS ANNUALLY DURING WORK TIME. STAFF MAY CHOOSE FROM MCHS-AL ENDORSED COMMUNITY PROGRAMS AND RECEIVE THEIR REGULAR SALARIES WHILE VOLUNTEERING ON WORK TIME.IN 2011, OVER 129 STAFF VOLUNTEERED A TOTAL OF 636 HOURS FOR COMMUNITY PROGRAMS AND PROJECTS SUCH AS SALVATION ARMY, RED CROSS, SCHOOL PROJECTS, FOOD SHELVES AND CAR SEAT CLINICS. CRITERIA FOR COMMUNITY INVOLVEMENT:CANCER-RELATED ACTIVITY CHAMBER OR COMMUNITY BUILDING ACTIVITY HEALTH EDUCATION OR HEALTH SCREENING ACTIVITYSENIOR RESOURCES OR NURSING HOME/ASSISTED LIVING ACTIVITYSOCIAL SERVICES ACTIVITYYOUTH-RELATED OR SCHOOL ACTIVITYMCHS-AL'S 2011 LEADERSHIP ROLE AND STAFF INVOLVEMENT IN THE COMMUNITY'S BLUE ZONES/VITALITY PROJECT, FOR EXAMPLE, HELPED CREATE WALKING MOAIS (NEIGHBORHOOD OR WORK GROUPS THAT SOCIALIZE THROUGH WALKING,) WALKING SCHOOL BUSES, COMMUNITY GARDENING, PURPOSE WORKSHOPS, OPEN DOOR FAITH INITIATIVES, TOBACCO-FREE WORKPLACES AND SCHOOL FOOD IMPLEMENTED BY COMMUNITY VOLUNTEERS. ONGOING RECRUITMENT OF PARTICIPANTS COULD YIELD UP TO 33% PARTICIPATION TO THE CITY'S ADULT POPULATION WHICH, IN TURN, COULD LEAD TO AS MANY AS 10,000 YEARS ADDED TO PEOPLE'S LIVES, AS THEY COMMIT TO MAKING HEALTHY LIFESTYLE CHANGES. IN ADDITION, MCHS-AL ENCOURAGES INVOLVEMENT IN COMMUNITY BOARDS AND SPECIAL PROJECTS, LENDING EXPERTISE TO OUTSIDE GROUPS AND BRINGING BACK FRESH PERSPECTIVES AND FEEDBACK TO MCHS-AL INITIATIVES AND OPERATIONS. IN 2011, MCHS-AL STAFF PARTICIPATED IN THESE LOCAL BOARDS: ALBERT LEA BUSINESS DEVELOPMENT CENTER, ALBERT LEA PORT AUTHORITY, CONVENTION AND VISITOR'S BUREAU, CHAMBER OF COMMERCE, COMMUNITY FOUNDATION, EDUCATION FOUNDATION, FAMILY "Y", CURRICULUM COMMITTEE, COMMUNITY CHILD CARE BOARD, RED CROSS, MARCH OF DIMES, RELAY FOR LIFE, SALVATION ARMY, BOARD OF AGING, UNITED WAY, RIVERLAND FOUNDATION, FREEBORN COUNTY FAMILY SERVICES COLLABORATIVE, THORNECREST RETIREMENT CENTER, ALONG WITH OTHER SPECIAL PROJECT COMMITTEES. PART III, LINE 4: THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.ACCOUNTS RECEIVABLE FOR MEDICAL SERVICES - ACCOUNTS RECEIVABLE FOR MEDICAL SERVICES ARE STATED AT NET REALIZABLE VALUE. THE CLINIC ESTIMATES THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED ON HISTORIC WRITE-OFFS AND THE AGING OF THE ACCOUNTS. ACCOUNTS ARE WRITTEN OFF WHEN COLLECTION EFFORTS HAVE BEEN EXHAUSTED.BAD DEBT EXPENSE AT COST IS DETERMINED USING THE SAME COST-TO-CHARGE RATIO THAT IS USED TO CALCULATE FINANCIAL ASSISTANCE AND MEDICAID SHORTFALL. DISCOUNTS AND ALLOWANCES ARE ACCOUNTED FOR SEPARATELY FROM BAD DEBT EXPENSE. 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 $10,676,969 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 EVERY REASONABLE ATTEMPT 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. 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 ELIGIBILITY BASED ON SUBMISSION OF REQUESTED INFORMATION. COLLECTION ACTIVITY WOULD ONLY RESUME IF MAYO WOULD TELL THE COLLECTION AGENCY TO PURSUE COLLECTIONS ON THE BALANCE OR PARTIAL BALANCE IF THERE WAS A CHARITY ADJUSTMENT. MAYO CLINIC HEALTH SYSTEM - ALBERT LEA PART V, SECTION B, LINE 13G: WITH REGARD TO THE POSTINGS WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMBEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. MAYO CLINIC HEALTH SYSTEM - ALBERT LEA PART V, SECTION B, LINE 19D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 10% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE. PART VI, LINE 2: MAYO CLINIC HEALTH SYSTEM - ALBERT LEA'S COMMUNITY RELATIONS COMMITTEE SETS PRIORITY AREAS FOR MCHS-AL INVOLVEMENT AND CHARITABLE CONTRIBUTIONS. CURRENT CRITERIA FOR CONTRIBUTIONS INCLUDE:1. IMPROVING QUALITY OF LIFE2. PROMOTING YOUTH POTENTIAL3. IMPROVING COMMUNITY HEALTH AND WELLNESS4. PARTNERING FOR COMMUNITY GROWTH AND DEVELOPMENTMAYO CLINIC HEALTH SYSTEM - ALBERT LEA (MCHS-AL) PARTNERS WITH LOCAL GOVERNMENT, PUBLIC HEALTH, SOCIAL SERVICE AGENCIES, SCHOOLS, VITALITY PROJECT AND OTHER GROUPS TO DETERMINE COMMUNITY NEEDS. ALTHOUGH MCHS-AL DOES NOT CONDUCT AN INDEPENDENT ANNUAL NEEDS ASSESSMENT, THE ORGANIZATION REVIEWS LOCAL DATA AND ANECDOTAL INFORMATION FROM ITS PARTNERS TO SET PRIORITY AREAS FOR COMMUNITY NEED. BASED ON THAT INFORMATION, THE FIT FOREVER CHILDHOOD OBESITY PREVENTION PROGRAM WAS DEVELOPED IN 2008 WITH MANY OF THOSE PARTNERS, WHERE MCHS-AL TOOK THE LEAD AND CONTINUES TO DONATE RESOURCES AND STAFF TIME WITH IDENTIFIED INITIATIVES. IN ADDITION, MCHS-AL'S COMMUNITY INVOLVEMENT PROGRAM, WHERE STAFF IS ALLOWED EIGHT HOURS ANNUALLY TO VOLUNTEER DURING WORK TIME, IS ALSO BASED ON IDENTIFIED COMMUNITY NEEDS. PART VI, LINE 3: MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY:MAYO CLINIC IS COMMITTED TO OFFERING FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY FOR THEIR MEDICAL SERVICES IN WHOLE OR IN PART. IN ORDER TO ACCOMPLISH THIS CHARITABLE GOAL, MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM SITES WILL WIDELY PUBLICIZE THIS POLICY IN THE COMMUNITIES THAT THE INDIVIDUAL MAYO CLINIC AFFILIATED SITES SERVE. MAYO CLINIC AFFILIATED SITES WILL MAKE A COPY 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 - ALBERT LEA IS THE SOLE HEALTH CARE PROVIDER IN FREEBORN COUNTY AND THE ONLY PROVIDER IN THE COMMUNITIES OF ALDEN, KIESTER AND NEW RICHLAND, MINNESOTA. FOUNTAIN CENTERS, AS A REGIONAL CHEMICAL DEPENDENCY TREATMENT CENTER, SERVES PATIENTS WITHIN AN 80 MILE RADIUS OF ALBERT LEA.MCHS-AL'S PRIMARY SERVICE AREA IS FREEBORN COUNTY, WITH A POPULATION OF ABOUT 31,000. AN ESTIMATED 21,000 UNIQUE PATIENTS WERE SEEN ANNUALLY AT MCHS-AL FROM 2007 THROUGH 2009. THE VARIANCE AMONG THOSE YEARS IS LESS THAN 2%. CUSTOMER GROUPS ARE COMPRISED OF MEDICARE PATIENTS, BUSINESS AND INDUSTRY LOCATED WITHIN A 20-MILE RADIUS, HEALTH PLANS INCLUDING MCHS-AL AND, GENERALLY, INDIVIDUAL PATIENTS SEEKING PRIMARY CARE. MAYO CLINIC HEALTH SYSTEM - ALBERT LEA, CARDIOLOGY, FOUNTAIN CENTERS, ORTHOPEDICS, OB/GYN AND WOUND CARE DEPARTMENTS REPRESENT UNIQUE SPECIALTY MARKETS REACHING BEYOND MCHS-AL'S TRADITIONAL MARKET AREA.FREEBORN COUNTY POPULATION CHARACTERISTICS (2010 ESTIMATE)AGE:PEOPLE UNDER 5 YEARS - 6.3% PEOPLE UNDER 18 YEARS - 20.8%PEOPLE 65 AND OLDER - 20.3%ALL OTHERS - 52.6% ETHNICITY:BLACK - 0.7%HISPANIC OR LATINO - 7.3%WHITE, NON HISPANIC - 90.7%ASIAN - .7%ALL OTHERS - .6%HOUSEHOLDS:TOTAL HOUSEHOLDS - 13,375 PERSONS PER HOUSEHOLD - 2.4MEDIAN HOUSEHOLD INCOME - $43,637PEOPLE BELOW POVERTY LEVEL - 8.6% PART VI, LINE 5: THIS FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION- EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO CLINIC HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATION'S ACTIVITIES.SURPLUS FUNDS - MAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE. THE BOARD OF TRUSTEES IS THE GOVERNING BODY OF MAYO CLINIC. A MAJORITY OF ITS MEMBERS ARE EXTERNAL, INDEPENDENT TRUSTEES. IT HAS OVERALL RESPONSIBILITY FOR THE CHARITABLE, CLINICAL PRACTICE, SCIENTIFIC AND EDUCATIONAL MISSION AND PURPOSES OF MAYO CLINIC AND ITS AFFILIATES AS SET FORTH IN ITS ARTICLES OF INCORPORATION AND BYLAWS. BECAUSE OF MAYO CLINIC'S NATIONAL PRESENCE, THESE TRUSTEES ARE SELECTED BASED ON THEIR AREAS OF EXPERTISE, WHETHER IN HEALTH CARE POLICY, BUSINESS, GOVERNMENT OR ANOTHER FIELD. IN ADDITION TO THIS COMMUNITY REPRESENTATION AT THE PARENT ENTITY, THE FILING ORGANIZATION ALSO INVOLVES LOCAL COMMUNITY MEMBERS ON ITS GOVERNING BODY. OPEN V. CLOSED STAFF MODEL - STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHSYICIANS IN THE COMMUNITY.EMERGENCY ROOM - THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. PART VI, LINE 6: THIS ORGANIZATION IS A PART OF MAYO CLINIC HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO CLINIC HEALTH SYSTEM IS DESCRIBED IN RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). THAT STATEMENT ALSO DESCRIBES THE ROLES OF THE VARIOUS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED. PART VI, LINE 7 NEITHER THE FILING ORGANIZATION, NOR ANY RELATED ORGANIZATION, FILES A COMMUNITY BENEFIT REPORT WITH ANY STATE OTHER THAN THE EXTENT TO WHICH COMMUNITY BENEFIT INFORMATION IS INCLUDED IN OTHER REPORTING REQUIREMENTS SUCH AS INFORMATION PROVIDED ON THE MINNESOTA HOSPITAL ANNUAL REPORT OR TO THE WISCONSIN HOSPITAL ASSOCIATION. 1 ALBERT LEA FAMILY YMCA 2021 W MAIN ST ALBERT LEA MN 56007 411000679 501(C)(3) 10000 FURTHER EXEMPT PURPOSE UNITED WAY OF FREEBORN COUNTY 341 S BROADWAY ALBERT LEA MN 56007 410956396 501(C)(3) 18000 FURTHER EXEMPT PURPOSE FOUNTAIN LAKE TREATMENT CENTER 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 411404076 501(C)(3) 397868 FURTHER EXEMPT PURPOSE CITY OF ALBERT LEA 221 E CLARK STREET ALBERT LEA MN 56007 416004922 GOVT 5000 COMMUNITY BENEFIT FREEBORN COUNTY HISTORICAL SOCIETY 1031 BRIDGE AVENUE ALBERT LEA MN 56007 410872543 501(C)(3) 7000 COMMUNITY BENEFIT NAEVE HEALTH CARE FOUNDATION 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 411989509 501(C)(3) 10000 FURTHER EXEMPT PURPOSE 5 1 SCHOLARSHIPS 10 7000 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. FEDERAL AWARDS THAT ARE SUBCONTRACTED TO OTHER ORGANIZATIONS ARE MONITORED BY THE FILING ORGANIZATION AS PRESCRIBED IN OMB CIRCULAR A-133. NO ADDITIONAL MONITORING IS PERFORMED. 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. X X X 1 1 0 0 0 0 0 0 0 AGERTER MD DAVID C 0 341092 0 0 0 98195 0 32194 0 14124 0 485605 0 94907 CIOTA MD MARK R 861046 0 0 0 0 0 17150 0 27203 0 905399 0 0 0 GABRIELSON SHARON R 0 165658 0 0 0 1002 0 15443 0 21528 0 203631 0 0 HEINZ MD DIETER 351109 0 0 0 0 0 17150 0 26423 0 394682 0 0 0 MILLER MD ROBERT C 0 444151 0 0 0 45215 0 21221 0 21468 0 532055 0 43178 RIZZO MD MARCO 0 498493 0 0 0 30646 0 18288 0 19968 0 567395 0 28294 PARKS DOUGLAS A 0 173183 0 0 0 1416 0 13141 0 23293 0 211033 0 0 PILOT DAVID L 187660 0 0 0 0 0 13374 0 19701 0 220735 0 0 0 WALDHOFF STEPHEN C 0 243356 0 0 0 5693 0 38104 0 16204 0 303357 0 638 BUCKMASTER DPM ROY W 259694 0 0 0 0 0 17150 0 18328 0 295172 0 0 0 ECKSTROM MD MICHAEL T 867368 0 0 0 0 0 17150 0 25780 0 910298 0 0 0 GRZYBOWSKI MD JOHN A 317418 0 0 0 0 0 17150 0 23922 0 358490 0 0 0 LARSON VIRGINIA 156852 0 0 0 0 0 11150 0 23138 0 191140 0 0 0 LOMBARDI MD JOSEPH M 334140 0 0 0 0 0 17150 0 23758 0 375048 0 0 0 STOLTENBERG MD HEIDI G 193285 0 0 0 0 0 13859 0 20053 0 227197 0 0 0 ULRICH MD MICHAEL D 337537 0 0 0 0 0 17150 0 26808 0 381495 0 0 0 UNDERDAHL STEVE L 163150 0 0 0 0 0 11285 0 2601 0 177036 0 0 0 WAGGONER MD JULIAN R 517999 0 0 0 0 0 17150 0 32902 0 568051 0 0 0 BOYCE MD CORY A 646445 0 0 0 0 0 17150 0 24678 0 688273 0 0 0 GUJRAL MD SAROJ K 574508 0 0 0 0 0 17150 0 19567 0 611225 0 0 0 LOTTS MD JEFFREY P 577024 0 0 0 0 0 17150 0 30648 0 624822 0 0 0 SKORIN JR DO LEONID 750460 0 0 0 0 0 17150 0 18399 0 786009 0 0 0 THORN MD STEPHEN 116879 0 0 0 442281 0 8182 0 6538 0 573880 0 0 0 SHELHAMER MD LEONARD E 236575 0 0 0 0 0 16417 0 17083 0 270075 0 0 0 PART I, LINES 4A-B IN 2011, DR. STEPHEN THORN RECEIVED A SEVERANCE PAYMENT IN THE AMOUNT OF $442,821. 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). A PORTION OF THE AMOUNT MAY BE INCLUDED IN SCHEDULE J, PART II, COLUMN (F) IF DISCLOSED ON A PRIOR YEAR'S FORM 990. DAVID C. AGERTER, M.D. $ 94,907 ROBERT C. MILLER, M.D. $ 43,178 MARCO RIZZO, M.D. $ 28,294 STEPHEN C. WALDHOFF $ 638 SUPPLEMENTAL INFORMATION PART III 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. JULIE C SAVELKOUL SPOUSE OF DONALD SAVELKOUL, BOARD MEMBER 35285 EMPLOYMENT 0 BEVERLY A LOMBARDI MD SPOUSE OF JOSEPH M. LOMBARDI M.D., KEY EMPLOYEE 92766 EMPLOYMENT 0 PHILLIP HANSON SPOUSE OF HEIDI G. STOLTENBERG M.D., KEY EMPLOYEE 42798 EMPLOYMENT 0 PETERSON SAVELKOUL KOLKER HAEDT & BENDA LTD DON SAVELKOUL IS A LISTED PERSON AND MEMBER OF THE BOARD 10003 LEGAL SRVC 0 FORM 990, PART VI, SECTION A, LINE 3 MAYO-AFFILIATED ENTITIES ROUTINELY DELEGATED VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO RELATED ENTITIES. FORM 990, PART VI, SECTION A, LINE 4 THE FILING ORGANIZATION MERGED WITH FOUNTAIN LAKE TREATMENT CENTER (FLTC) AT YEAR END OF 2011 AND EXERCISED THE ARTICLES OF MERGER. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS MAYO CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER ELECTS TRUSTEES TO THE BOARD FORM 990, PART VI, SECTION A, LINE 7B AMENDMENT OF ARTICLES OR BYLAWS REQUIRE APPROVAL BY BOTH THE GOVERNING BODY AND THE SOLE CORPORATE MEMBER. THE BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL, BUDGET, AND DEBT DECISIONS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE SITE FINANCE STAFF AND THE SITE ADMINISTRATOR. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FILING ORGANIZATION'S GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. HIGHLIGHTS ARE PRESENTED TO BOARD MEMBERS, AND THE REVIEW IS DOCUMENTED IN MEETING MINUTES. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C MAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF MAYO CLINIC (AND/OR AFFILIATE) AND THE OUTSIDE ENTITY. ADDITIONAL CONFLICT OF INTEREST POLICIES AND PROCEDURES EXIST FOR CERTAIN ENTITIES CONCERNING RESEARCH CONTRACTS AND OTHER TYPES OF POTENTIAL CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY IN THE FALL FOR THE NEXT YEAR'S COMPENSATION. THE SALARY OF THE CEO, CAO, BOARD VICE CHAIR, TREASURER AND SEVERAL BOARD MEMBERS WERE REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO CLINIC HEALTH SYSTEM PHYSICIANS. THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE MAYO CLINIC HEALTH SYSTEM ENTITIES. THE COMMITTEE IS COMPRISED OF MAYO EMPLOYEES, BUT IS INDEPENDENT FOR INTERNAL REVENUE CODE 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED (WITH RECUSAL WHERE APPROPRIATE). THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE THEN REVIEWS AND APPROVES THE COMPENSATION. FOR THOSE INDIVIDUALS FOR WHICH THE MAYO CLINIC HEALTH SYSTEM COMMITTEE CAN NOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE COMPENSATION AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. INFORMATION ON MAYO CLINIC HEALTH SYSTEM PHYSICIAN AND ADMINISTRATIVE LEADERSHIP COMPENSATION AND BENEFITS IS ALSO REVIEWED BY THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION AND GOVERNANCE (GOVERNANCE COMMITTEE), WHICH IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. IN ADDITION TO THE ABOVE COORDINATED REVIEW PROCESSES CONDUCTED BY MAYO CLINIC AND ITS AFFILIATES, MCHS-AL ALSO HAS ITS OWN COMPENSATION REVIEW PROCESS THAT INCLUDES REVIEW BY AN INDEPENDENT COMPENSATION COMMITTEE, BENCHMARK/COMPARABILITY DATA, AND DETERMINATION OF REASONABLENESS. MCHS-AL REVIEW PROCESS COVERS BOTH THE PHYSICIAN COMPENSATION PLAN AND THE ADMINISTRATOR COMPENSATION PLAN. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE NOT AVAILABLE FOR PUBLIC INSPECTION. FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE CONFLICT OF INTEREST POLICY IS 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. AVERAGE HOURS PER WEEK DEVOTED TO POSITION WITH RELATED ORGANIZATION PART VII SECTION A SHARON GABRIELSON 40.00 DAVID C. AGERTER, M.D. 40.00 ROBERT C. MILLER, M.D. 40.00 MARCO RIZZO, M.D. 40.00 DOUGLAS A. PARKS 37.00 DAVID L. PILOT 25.00 STEPHEN C. WALDHOFF 1.00 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -614,807. OTHER CHANGES IN NET ASSETS-990 -156,338. TOTAL TO FORM 990, PART XI, LINE 5: -771,145. INDEPENDENCE FORM 990 PART VI LINE 1B THE BOARD OF TRUSTEES OF MAYO CLINIC, THE PARENT ENTITY OF THE MAYO CLINIC-AFFILIATED ENTITIES, IS COMPRISED OF MORE THAN 50% PUBLIC TRUSTEES. BLOOMER LAKEVIEW INC 2110 DUNCAN ROAD BLOOMER WI 54724 391450617 LOW INCOME HOUSING WI 501(C)(3) 7 MAYO CLINIC HEALTH SYSTEM--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 FOUNTAIN LAKE TREATMENT CENTER 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 411404076 CHEMICAL DEPENDENCY TREATMENT MN 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--ALBERT LEA 1 FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC 464 SOUTH JOHNSON STREET ARCADIA WI 54612 391322480 FUNDRAISING FOUNDATION WI 501(C)(3) 9 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC 1 GCAS 200 FIRST STREET SW ROCHESTER MN 55905 411917517 AMBULANCE SERVICE MN 501(C)(3) 9 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 1 GOLD CROSS AMBULANCE SERVICE 200 FIRST STREET SW ROCHESTER MN 55905 411917516 AMBULANCE SERVICE MN 501(C)(3) 9 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 1 GOLD CROSS AMBULANCE INC 200 FIRST STREET SW ROCHESTER MN 55905 391942957 AMBULANCE SERVICE MN 501(C)(3) 9 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 1 LUTHER LAKESIDE APARTMENTS INC 714 SOUTH BARSTOW STREET EAU CLAIRE WI 54701 391409024 LOW INCOME HOUSING WI 501(C)(3) 9 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 416011702 PATIENT CARE - CLINIC MN 501(C)(3) 9 MAYO CLINIC 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 BLVD 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--ALBERT LEA 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC 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) PF MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391186647 FUNDRAISING FOUNDATION WI 501(C)(3) 11-II MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE 301 SECOND STREET NORTHEAST NEW PRAGUE MN 56071 410723639 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC 1222 EAST WOODLAND AVE BARRON WI 54812 390920634 HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC PO BOX 70 / 13025 EIGHTH STREET OSSEO WI 54758 391029430 HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--OWATONNA 134 SOUTHVIEW 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--SPRINGFIELD 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 411893827 HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO CLINIC HEALTH SYSTEM--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 MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 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) 11-I MAYO CLINIC -- SAINT MARYS HOSPITAL 1 SOUTHERN METRO MEDICAL CLINICS INC 301 MAIN STREET NEW PRAGUE MN 56071 411623632 FAMILY PRACTICE CLINICS MN 501(C)(3) 9 MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE 1 FRANKLIN HEATING STATION 119 THIRD ST SW ROCHESTER MN 55902 410264830 UTILITY MN N/A MAYO CLINIC HEALTH SYSTEM--FARIBAULT 635 FIRST STREET SE FARIBAULT MN 55021 411817179 PATIENT CARE - CLINIC MN N/A C MAYO CLINIC HEALTH SYSTEM--DECORAH CLINIC PHYSICIANS 907 MONTGOMERY STREET DECORAH IA 52101 411711329 PATIENT CARE - CLINIC IA N/A C FIOS THERAPEUTICS INC 200 FIRST STREET SW ROCHESTER MN 55905 711029189 RESEARCH MN N/A C HEALTH TRADITION HEALTH PLAN 1808 EAST MAIN STREET ONALASKA WI 54650 391545987 MEDICAL SERVICES COMPANY WI N/A C LOBSS NETWORK SUPPORT 2002 INC 200 FIRST STREET SW ROCHESTER MN 55905 481276150 ADMINISTRATIVE SERVICES MN N/A C MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 411346366 REFERENCE LAB SERVICES MN N/A C MAYO HOLDING COMPANY 200 FIRST STREET SW ROCHESTER MN 55905 411578020 HOLDING COMPANY MN N/A C MAYO INSURANCE COMPANY LTD 200 FIRST STREET SW ROCHESTER MN 55905 SELF INSURANCE POOL CJ N/A C MAYO MEDICAL LABORATORIES NEW ENGLAND INC 265 BALLARDVALE STREET WILMINGTON MA 01887 043323713 LABORATORY SERVICES MA N/A C MAYO REGIONAL PRACTICES OF ARIZONA 13400 EAST SHEA BOULEVARD SCOTTSDALE AZ 85259 061190278 THIRD PARTY ADMINISTRATION SERVICES AZ N/A C MHS SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 411282517 EQUIPMENT & REAL ESTATE LEASING MN N/A C MMSI INC 21 FIRST STREET SW ROCHESTER MN 55905 411547003 THIRD PARTY ADMINISTRATION SERVICES MN N/A C MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 391528920 PHARMACY SERVICES WI N/A C PHYSICIAN AND HOSPITAL PRACTICES INC 4500 SAN PABLO ROAD JACKSONVILLE FL 32224 930926631 HEALTH SERVICES FL N/A C ROCHESTER AIRPORT COMPANY ROUTE 2 ROCHESTER MN 55902 410506870 AIRPORT MANAGEMENT MN N/A C SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION 13400 E SHEA BLVD SCOTTSDALE AZ 85259 860870505 COMMERCIAL PROPERTY OWNERS ASSOCIATION AZ N/A C THE STABILE BUILDING OWNERS' ASSOCIATION 200 FIRST STREET SW ROCHESTER MN 55905 208994499 COMMERCIAL PROPERTY OWNERS ASSOCIATION MN N/A C MAYO CLINIC GBS MAURITIUS 2ND FLOOR EBENE MEWS 57 EBENE CYBERCITY MP HEALTHCARE MANAGEMENT MP N/A C CHARITABLE LEAD TRUST (1) CHARITABLE TRUST CA N/A T PERPETUAL TRUST (1) CHARITABLE TRUST ND N/A T PERPETUAL TRUST (1) CHARITABLE TRUST LA N/A T PERPETUAL TRUST (2) CHARITABLE TRUST MA N/A T PERPETUAL TRUST (1) CHARITABLE TRUST MO N/A T PERPETUAL TRUST (1) CHARITABLE TRUST AZ N/A T CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST CO N/A T CHARITABLE REMAINDER TRUST (6) CHARITABLE TRUST FL N/A T CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST FL N/A T CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST IL N/A T CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST LA N/A T CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST MI N/A T CHARITABLE REMAINDER TRUST (66) CHARITABLE TRUST MN N/A T CHARITABLE REMAINDER TRUST (82) CHARITABLE TRUST MN N/A T CHARITABLE REMAINDER TRUST (1) CHARITABLE TRUST NC N/A T CHARITABLE REMAINDER TRUST (2) CHARITABLE TRUST TX N/A T 1 0 1 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 MAYO CLINIC -- METHODIST HOSPITAL A 128457 GAAP MMSI INC R 6120903 GAAP MAYO CLINIC HEALTH SYSTEM--AUSTIN P 79379 GAAP FOUNTAIN LAKE TREATMENT CENTER P 1703677 GAAP FOUNTAIN LAKE TREATMENT CENTER G 2047902 GAAP MAYO CLINIC -- SAINT MARYS HOSPITAL L 182145 GAAP MAYO COLLABORATIVE SERVICES INC L 780868 GAAP MMSI INC Q 11130681 GAAP MAYO CLINIC HEALTH SYSTEM--AUSTIN O 130048 GAAP MAYO CLINIC HEALTH SYSTEM--AUSTIN N 446132 GAAP