2012-07-26T10:35:09-05:00 2011-12-31 990 2011-01-01 390813418 MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL INC MAYO 5075381297 1221 WHIPPLE STREET EAU CLAIRE WI 54703 PAUL BAMMEL 5075381297 2012-07-26 2011 2016-02-24 21:20:13Z FKA LUTHER HOSPITAL RANDALL LINTON MD 1221 WHIPPLE STREET EAU CLAIRE WI 54703 273897165 0 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1905 WI OPERATION OF A HOSPITAL. 11 5 2098 482 0 0 1681860 3006734 241768393 264022907 2340527 3466428 2820822 2730401 248611602 273226470 3090017 5002051 0 0 95008003 99980687 0 0 709694 111908096 130633060 210006116 235615798 38605486 37610672 455711720 478448234 136099786 139304474 319611934 339143760 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 210243226 5002000 264888559 PATIENT CARE - SEE SCHEDULE O:MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC. (THE HOSPITAL) IS A MEMBER OF THE MAYO CLINIC 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 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.THE HOSPITAL IS A 304-BED HOSPITAL WHICH IS A REGIONAL CENTER FOR CARDIAC SURGERY AND NEUROSURGERY AND WHICH ALSO EMPHASIZES BEHAVIORAL HEALTH, ONCOLOGY, ORTHOPEDICS AND WOMEN'S HEALTH. IN 2011, THE HOSPITAL SERVED 11,874 INPATIENTS. IN ADDITION, 80,871 PEOPLE RECEIVED OUTPATIENT MEDICAL CARE INCLUDING 21,195 PATIENTS TREATED IN THE EMERGENCY ROOM. THE HOSPITAL HAS 18 OPERATING ROOMS WHERE 10,187 SURGICAL PROCEDURES WERE PERFORMED IN 2011.THE HOSPITAL, IN AFFILIATION WITH MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE CLINIC (THE CLINIC), IS ONE OF THE MAIN PROVIDERS OF HEALTH CARE SERVICES IN THE SURROUNDING AREA. THE CLINIC IS A RELATED OUTPATIENT CLINIC EXEMPT UNDER SECTION 501(C)(3) OF THE CODE. THE HOSPITAL IS LOCATED ADJACENT TO THE MAIN CAMPUS OF THE CLINIC IN EAU CLAIRE, WISCONSIN. THE AFFILIATED ORGANIZATIONS ARE LOCALLY THOUGHT OF AS ONE HEALTHCARE ORGANIZATION. THE HOSPITAL 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 2011, THE HOSPITAL PROVIDED APPROXIMATELY $3,673,270 OF FINANCIAL ASSISTANCE (AT COST) TO PATIENTS. THE UNREIMBURSED COST OF SERVICES TO MEDICAID PATIENTS WAS APPROXIMATELY $10,084,650 AND THE UNREIMBURSED COST OF SERVICES TO PATIENTS UNDER OTHER MEANS TESTED GOVERNMENT PROGRAMS WAS APPROXIMATELY $1,872,268.THE UNREIMBURSED COST OF SERVICES TO MEDICARE PATIENTS DETERMINED BY USING INFORMATION FROM THE HOSPITAL'S MEDICARE COST REPORT WAS APPROXIMATELY $158,894. IF USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY, THE UNREIMBURSED COST OF SERVICES TO MEDICARE PATIENTS WAS APPROXIMATELY $6,571,900.THE HOSPITAL, ALONG WITH THE CLINIC, VOLUNTARILY ENTERED INTO AN AGREEMENT WITH THE WISCONSIN ATTORNEY GENERAL RELATING TO CHARITY CARE. THE TERMS OF THE AGREEMENT INCLUDE AN AUTOMATIC DISCOUNT FOR UNINSURED PATIENTS, A PAYMENT CAP FOR THOSE UNINSURED PATIENTS THAT MEET THE HOSPITAL'S CHARITY CARE CRITERIA, AND A COMMITMENT TO MAKE INFORMATION AVAILABLE TO PATIENTS REGARDING THE CHARITY CARE PROGRAM. ADDITIONALLY, THE WISCONSIN ATTORNEY GENERAL REVIEWED AND APPROVED THE HOSPITAL'S BILLING AND COLLECTION POLICIES AND PRACTICES. 1303998 0 534409 MEDICAL EDUCATION - SEE SCHEDULE O:THE HOSPITAL, IN AFFILIATION WITH THE CLINIC, HAS NUMEROUS AGREEMENTS WITH EDUCATIONAL ORGANIZATIONS TO PROVIDE FORMAL EDUCATION AND EXPERIENCE FOR STUDENTS STUDYING TO BECOME HEALTHCARE PROFESSIONALS. CURRENTLY THESE AGREEMENTS ARE WITH THE FOLLOWING ORGANIZATIONS:- UNIVERSITY OF WISCONSIN MEDICAL SCHOOL- UNIVERSITY OF WISCONSIN-MADISON- UNIVERSITY OF WISCONSIN-EAU CLAIRE - CHIPPEWA VALLEY TECHNICAL COLLEGE - UNIVERSITY OF WISCONSIN-LACROSSE- WESTERN WISCONSIN TECHNICAL COLLEGE OF LACROSSE- UNIVERSITY OF MINNESOTA-MINNEAPOLIS- UNIVERSITY OF CINCINNATI - UNIVERSITY OF MINNESOTA-DULUTH - COLLEGE OF ST. CATHERINE'S - COLLEGE OF ST. SCHOLASTICA - WINONA STATE UNIVERSITY - UNIVERSITY OF WISCONSIN-STOUT - WI TECHNICAL COLLEGE-RICE LAKE - WI TECHNICAL COLLEGE-NEW RICHMOND - MAYO CLINIC SCHOOL OF HEALTH RELATED SCIENCES- CONCORDIA UNIVERSITY - LAKE SUPERIOR COLLEGE - UNIVERSITY OF WISCONSIN - OSHKOSH - ARGOSY UNIVERSITY- DES MOINES UNIVERSITY- FINLANDIA UNIVERSITY- CARROLL UNIVERSITY- CREIGHTON UNIVERSITY- GLOBE UNIVERSITY- NORTHEAST WISCONSIN TECHNICAL COLLEGE- VITERBO UNIVERSITY- AT STILL UNIVERSITY- COLORADO STATE UNIVERSITY- FRONTIER SCHOOL OF MIDWIFERY- GEORGE WASHINGTON UNIVERSITY- INVER HILLS/CENTURY COLLEGE- KAPIOLANI COMMUNITY COLLEGE- KAPLAN UNIVERSITY- KEISER UNIVERSITY- MILWAUKEE AREA TECHNICAL COLLEGE- MINNESOTA STATE COMMUNITY & TECHNICAL COLLEGE- VANDERBILT UNIVERSITY- WALDEN UNIVERSITYTHE HOSPITAL ALSO ACTIVELY PROVIDES A CONTINUING EDUCATION PROGRAM FOR ITS MEDICAL STAFF. 421466 51 1320 COMMUNITY BENEFIT - SEE SCHEDULE O:THE HOSPITAL, OFTEN IN AFFILIATION WITH THE CLINIC, PROVIDES COMMUNITY CLASSES, EDUCATIONAL OPPORTUNITIES AND SERVICES. THESE PROGRAMS AND CLASSES INCLUDE SEVERAL HEALTH RELATED TOPICS. ADDITIONAL INFORMATION REGARDING SOME OF THE SPECIFIC EVENTS ARE LISTED BELOW. APPROXIMATELY 1,050 PEOPLE PARTICIPATED IN CHILDBIRTH CLASSES GIVEN FOR EXPECTANCT PARENTS AND THEIR CHILDREN IN 2011.EMPLOYEE HEALTHCARE PROFESSIONALS OFFER PRESENTATIONS ON A VARIETY OF HEALTHCARE TOPICS MONTHLY, DRAWING ANYWHERE FROM 40-75 PARTICIPANTS. PRESENTATIONS ARE INFORMAL AND OFFER DISCUSSION TOPICS IMPORTANT TO COMMUNITY MEMBERS. SINCE 1998, THE HOSPTIAL AND CLINIC HAVE SPONSORED A PERMANENT KIOSK IN THE MACY'S WING OF OAKWOOD MALL (A MAJOR SHOPPING CENTER). THE KIOSK IS STAFFED AT VARIOUS TIMES BY CLINICIANS AND EMPLOYEES WHO ARE AVAILABLE TO ANSWER CONSUMER QUESTIONS AND DISTRIBUTE HEALTH RELATED INFORMATION. FREE BLOOD PRESSURE SCREENINGS, COMBINED WITH INFORMAL EDUCATION IS OFFERED EVERY THURSDAY TO AREA RESIDENTS. IN 2011, OVER 2,000 SCREENINGS WERE CONDUCTED FREE OF CHARGE. HEALTH FAIRS AND OTHER SPECIAL EVENTS ARE HELD SEVERAL TIMES THROUGHOUT THE YEAR TO OFFER COMMUNITY MEMBERS THE OPPORTUNITY TO LEARN ABOUT NUTRITION, EXERCISE AND SEVERAL OTHER TOPICS. MORE THAN 150 WALKERS ARE PART OF THE "HEART 'N SOLE" WALKING CLUB AT THE MALL AND RECEIVE EXERCISE AND FITNESS TIPS IN A QUARTERLY NEWSLETTER.THE TRAUMA DEPARTMENT HAS PARTNERED WITH LOCAL BUSINESSES SINCE 1998 TO PRESENT "SAFETY CAMP" - AN OPPORTUNITY FOR AREA FOURTH GRADERS TO SPEND TWO DAYS LEARNING ABOUT WATER SAFETY, BIKE SAFETY, ANIMAL SAFETY AND MANY OTHER TOPICS. ADDITIONALLY, THE DEPARTMENT OFFERS A BIANNUAL CAR CONTROL CLASS - A PROGRAM DESIGNED TO PROVIDE TEEN DRIVERS WITH REAL-WORLD ACCIDENT SITUATIONS IN A SAFE ENVIRONMENT AND THEN LEARN HOW TO CORRECT THEM.THE TRAUMA DEPARTMENT ALSO PROVIDES ONGOING OUTREACH PROGRAMS INCLUDING PROM TRAUMA SIMULATIONS AT AREA HIGH SCHOOLS, CONCUSSION AWARENESS PRESENTATIONS, DRIVERS' EDUCATION PRESENTATIONS, DISTRIBUTION OF FIRST-AID KITS TO LOCAL YOUTH SPORTS PROGRAMS, AND CAR SEAT CHECKS FOR NEW OR EXPECTANT PARENTS. THE DEPARTMENT ALSO PROVIDES FREE BICYCLE HELMETS AND CAR SEATS TO PATIENTS.IN 2011, HOSPITAL AND CLINIC EMPLOYEES RAISED $34,652 FOR THE "RELAY FOR LIFE" EVENT HELD TO BENEFIT THE AMERICAN CANCER SOCIETY. THE HOSPITAL AND THE CLINIC WERE A CORPORATE SPONSOR FOR THE EVENT.THE HOSPITAL AND THE CLINIC WERE A CORPORATE SPONSOR FOR THE "AMERICAN HEART WALK" TO RAISE MONEY FOR THE AMERICAN HEART ASSOCIATION. MORE THAN 20 TEAMS, APPROXIMATELY 200 WALKERS, RAISED $17,000.THE HOSPITAL AND THE CLINIC WERE A CORPORATE SPONSOR FOR THE "EPILEPSY STROLL IN THE PARK" EVENT WHICH RAISED MORE THAN $24,000. THE HOSPITAL AND THE CLINIC ALSO SPONSORED THE "SHARE THE FLAME" EVENT AND RAISED ANOTHER $17,800 FOR THE EPILEPSY FOUNDATION.THE HEALTH INFORMATION CENTER PROVIDES HEALTH-RELATED VIDEOS, MODELS, COMPUTER SOFTWARE, PRINTED HEALTH INFORMATION, AND OTHER EDUCATIONAL MATERIALS FOR AREA RESIDENTS TO USE FREE OF CHARGE TO INCREASE HEALTH AWARENESS WITHIN THE COMMUNITY.THE "HERS" WOMEN'S CENTER REGULARLY REACHES OUT TO WOMEN OF ALL AGES IN THE COMMUNITY BY PROVIDING FREE HEALTH INFORMATION AND EDUCATION REGARDING SELF-BREAST EXAMS AT LOCAL HEALTH FAIRS, OAKWOOD MALL, AND TO GIRL SCOUT TROOPS.SPIRITUAL CARE SERVICES INCLUDE 24-HOUR ON-CALL SERVICES, INCLUDING DAILY CARE ROUNDS, DAILY PATIENT AND FAMILY VISITS, ASSISTANCE WITH END-OF-LIFE DECISIONS, BEREAVEMENT SUPPORT, LIAISON WITH COMMUNITY CLERGY AND INSTRUCTION IN CLINICAL PASTORAL EDUCATION.APPROXIMATELY 482 COMMUNITY VOLUNTEERS PROVIDED APPROXIMATELY 55,018 HOURS OF DONATED TIME TO THE HOSPITAL IN 2011. VOLUNTEER ACTIVITIES INCLUDED STAFFING THE AUXILIARY-OPERATED COFFEE AND GIFT SHOPS AND PROVIDING HOSPITALITY SERVICES TO PATIENTS, FAMILIES AND VISITORS. THE DONATED SERVICES PROVIDED BY THE VOLUNTEERS IN 2011 IS VALUED AT APPROXIMATELY $1,198,842 BASED ON STATISTICS FROM THE INDEPENDENT SECTOR. 211968690 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 0 0 1 0 0 2098 1 0 0 0 0 0 1 1 0 0 0 0 X 11 5 1 1 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 WI X CHRISTIE LOHKAMP 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 X BOLTON JEFFREY W 1.00 X 0 715940 50237 CLUMPNER DANIEL 1.00 X 0 0 0 HORECKI MD RICHARD J 1.00 X X 0 328168 62270 KORSMO JEFFREY O 1.00 X 0 306813 42089 LARSON THOMAS 1.00 X X 0 0 0 LINTON MD RANDALL L 25.00 X X 0 535571 62753 NESSE MD ROBERT E 1.00 X 0 750263 15004 OLSON RICK 1.00 X 0 0 0 PEDERSON DUANE 1.00 X 0 0 0 SIMPSON MD HENRY J 1.00 X 0 274871 45611 SWENSEN MD STEPHEN J 1.00 X 0 660394 48407 WAHL BETTE 1.00 X 0 0 0 BAMMEL PAUL M 25.00 X 0 279544 56293 DICKEY JOHN M 25.00 X 0 344388 56100 KILNESS RUTH A 1.00 X 0 73838 24802 FRANK LINDA A 50.00 X 224703 0 25378 POPE DENNIS W 50.00 X 208005 0 23501 WITTROCK EDWARD A 50.00 X 190727 0 23522 BAKER THOMAS F 40.00 X 133247 0 1379 GIERHART KENT H 40.00 X 134119 0 2949 HARELSTAD JULIA M 40.00 X 136987 0 19226 HITZKE RONALD S 40.00 X 160283 0 19721 WINTER MARK D 40.00 X 132354 0 27268 1320425 4269790 606510 48 0 1 0 MAYO FOUNDATION FOR MEDICAL EDUCATION & 200 FIRST STREET SW ROCHESTER MN 55905 PROCUREMENT/SUPPORT SERVICES 36270858 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 MEDICAL/SUPPORT SERVICES 5057081 MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 LAB SERVICES 522154 MCHS - EAU CLAIRE CLINIC INC PO BOX 1510 EAU CLAIRE WI 54702 MEDICAL/SUPPORT SERVICES 425017 MMSI INC 200 FIRST STREET SW ROCHESTER MN 55905 CLAIMS PROCESSING 377421 6 149451 2272346 584937 52791 3006734 NET PATIENT REVENUE 620000 257452298 257452298 RENT FROM AFFILIATES 531120 3556336 3556336 SHARED SERVICES 561000 2904248 2904248 WOMEN'S HEALTH CENTER 621300 100264 100264 EDUCATION REVENUE 611600 9761 9761 264022907 3491392 3491392 124709 113485 11224 11224 11224 261806 286770 -24964 -24964 -24964 46733 149451 103183 -56450 -56450 3860 4564 -704 -704 259406 162693 96713 96713 CAFETERIA/VENDING 722210 1343850 1343850 EMPLOYEE CHILDCARE 624410 1181775 1181775 MISC. REVENUE 900099 88967 57531 31436 65026 65026 2679618 273226470 265424288 0 4795448 5002051 5002051 695836 250081 445755 220823 97812 123011 85605375 76321706 9006013 277656 2166902 1921175 238793 6934 5112994 4571993 524408 16593 6178757 5478086 680899 19772 375454 260111 115343 38197 272 37925 929591 929591 42076 42076 26704731 24769760 1680917 254054 803622 6142 797480 11304334 9566410 1705416 32508 2292003 1249032 1042971 750 750 5825055 1887831 3843954 93270 525509 417744 103188 4577 1730 1212 478 40 4715604 4715503 101 21190695 19900349 1288976 1370 209104 209104 MEDICAL SUPPLIES 38984403 38984403 BAD DEBT EXPENSE 8752448 8752448 MEDICAID SURCHARGE 7514824 7514824 EMPLOYEE EXPENSES 371087 55040 315223 824 51843 34851 14896 2096 235615798 211968690 22937414 709694 107996 6694 72964 7722517 3086521 35103652 43904545 8254 26526 3240709 861242 7034043 5830833 410586578 148551163 265071563 262035415 1800 129970452 149625707 7450734 12997787 455711720 478448234 23563482 30939035 23043 18307 90000000 87130000 22513261 21217132 136099786 139304474 X 310124320 334773226 8858414 3716268 629200 654266 319611934 339143760 455711720 478448234 X 37610672 -18078846 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 18368773 25066 1890948 20284787 12955759 11095 5401919 18368773 11636431 4299 1315029 12955759 14172465 31307 -2567341 11636431 0.95000 0.02000 0.03000 0 1 1 8726869 8726869 285669111 77259935 208409176 107114916 71291228 35823688 9075682 9075682 262035415 MAYO CLINIC INVESTMENT POOL 149625707 F 149625707 DUE TO AFFILIATES 21217132 21217132 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INTEREST EARNED ON THE FILING ORGANIZATION'S ENDOWMENT FUNDS WILL BE APPLIED TOWARDS CAPITAL EXPENDITURES IN SUBSEQUENT FISCAL YEARS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: AT DECEMBER 31, 2011 AND 2010 THERE WAS NO SIGNIGICANT LIABILITY FOR UNRECOGNIZED TAX BENEFITS FOR THE FILING ORGANIZATION. GOLF OUTING 94377 70174 24203 18775 10001 5489 2333 HOLIDAY CELEBRATION 101807 79277 22530 30667 1000 16578 4100 14240 196184 149451 46733 49442 11001 22067 4100 16573 103183 -56450 1 1 X 1 X 1 X 1 1 1 0 1 1 3673270 3673270 0.01620 23371190 13286540 10084650 0.04450 3446769 1574501 1872268 0.00830 30491229 14861041 15630188 0.06900 388862 1320 387542 0.00170 1303998 524648 779350 0.00340 54127132 30210600 23916532 0.10540 5034605 5034605 0.02220 60854597 30736568 30118029 0.13270 91345826 45597609 45748217 0.20170 0 8752448 0 49984376 50143270 -158894 X 1 1 1 1 MCHS - EAU CLAIRE HOSPITAL INC

1221 WHIPPLE STREET EAU CLAIRE WI 54703

X X X MCHS - EAU CLIARE HOSPITAL INC 1 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X X X 1 0 1 X 0 0 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: THERE WAS NO NET COMMUNITY BENEFIT COST ATTRIBUTED TO PHYSICIAN CLINICS THAT WERE INCLUDED IN SUBSIDIZED HEALTH SERVICES. 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 $ 8752448. PART III, LINE 4: FOOTNOTE FROM MAYO CLINIC 2011 CONSOLIDATED AUDITED FINANCIAL STATEMENTS: 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.METHODOLOGY FOR SCHEDULE H, PART III, LINE 2:BAD DEBT EXPENSE IS DETERMINED BASED ON GAAP AND IS EXPLAINED IN THE ACCOUNTS RECEIVABLE FOOTNOTE OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS.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. 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 $6,571,900. BOTH AMOUNTS ARE 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, 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. MCHS - EAU CLIARE HOSPITAL, INC. PART V, SECTION B, LINE 13G: IN REGARDS 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. MCHS - EAU CLIARE HOSPITAL, INC. PART V, SECTION B, LINE 19D: THE POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 50% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN USING THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERICIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE. PART VI, LINE 2: THE FILING ORGANIZATION'S ADMINISTRATION, ALONG WITH MEMBERS OF THE MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE FOUNDATION (A RELATED TAX-EXEMPT ORGANIZATION) WORK CLOSELY WITH LOCAL EDUCATIONAL INSTITUTIONS, THE LOCAL UNITED WAY AGENCY, AREA FREE CLINICS, CHARITIES AND HEALTH DEPARTMENTS TO ASSESS HEALTH CARE NEEDS. MONETARY DONATIONS, SERVICES, EDUCATION, VOLUNTEERS AND GOODS ARE SUPPLIED ONCE THOSE NEEDS ARE ASSESSED. REQUESTS FOR ASSISTANCE ARE TRIAGED THROUGH THE PUBLIC AFFAIRS DEPARTMENT AND EVALUATED BASED ON ANNUAL STRATEGY. PART OF THAT STRATEGY INCLUDES INPUT FROM THE RESPONSIBLE VICE PRESIDENT AND ULTIMATELY REVIEWED BY THE FOUNDATION ACCORDING TO THE DONATION REQUEST FLOWCHART. THE FOUNDATION'S ANNUAL STRATEGY IS BASED ON COMMUNITY HEALTH NEED, THE ORGANIZATION'S STRATEGIC INITIATIVES AND COMMUNITY ASSESSMENTS. PART VI, LINE 3: 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: THE FILING ORGANIZATION IS LOCATED IN EAU CLAIRE, WISCONSIN PRIMARILY SERVING RESIDENTS OF EAU CLAIRE COUNTY. SECONDARY SERVICE AREAS INCLUDE PEOPLE IN THE COUNTIES OF BARRON, BUFFALO, CHIPPEWA, DUNN AND TREMPEALEAU.THE POPULATION OF EAU CLAIRE COUNTY (WHICH COMPRISES MOST OF THE FILING ORGANIZATION'S SERVICE AREA) IS APPROXIMATELY 99,000. OF THIS POPULATION, MORE THAN 93% ARE OF WHITE ETHNICITY; THE NEXT CLOSEST RACE PERCENTAGE IS ASIAN AT 3.3%. AVERAGE INCOME IN EAU CLAIRE COUNTY IS $45,846 ACCORDING TO 2010 U.S. CENSUS BUREAU INFORMATION.ACCORDING TO A STATE OF WISCONSIN 2010 COUNTY PROFILE, APPROXIMATELY 14.7% OF EAU CLAIRE INDIVIDUALS ARE LIVING BELOW THE POVERTY LEVEL. AN ESTIMATED 11% ARE ON MEDICAID AND 10% RECEIVE MEDICARE COVERAGE.ACCORDING TO INFORMATION PROVIDED BY THE 2011 COUNTY HEALTH RANKINGS WEBSITE, EAU CLAIRE COUNTY RANKS 19TH (OUT OF 72 COUNTIES) IN HEALTH OUTCOMES, RANKING FIFTH IN CLINICAL CARE AND SIXTH IN HEALTH FACTORS. THIS SAME WEBSITE SHOWS THAT APPROXIMATELY 11% OF EAU CLAIRE COUNTY ADULTS WERE UNINSURED.A RECENT UNITED WAY REPORT SHOWS THAT MAJOR HEALTH CONCERNS FACING OUR COMMUNITY ARE OBESITY, TOBACCO USE, MENTAL HEALTH ISSUES, ALCOHOL USE AND LACK OF DENTAL CARE.THE FILING ORGANIZATION IS ONE OF TWO MAJOR HOSPITALS IN THE EAU CLAIRE AREA, AND IS THE ONLY VERIFIED TRAUMA CENTER IN NORTHWEST WISCONSIN. BY MAINTAINING LEVEL II VERIFICATION FROM THE AMERICAN COLLEGE OF SURGEONS, WE PROVIDE THE HIGHEST LEVEL OF TRAUMA CARE AVAILABLE IN THE REGION.EAU CLAIRE COUNTY IS A FEDERALLY-DESIGNATED, MEDICALLY-UNDERSERVED AREA INDICATING A SIGNIFICANT SHORTAGE OF PRIMARY CARE PHYSICIANS FOR THE POPULATION ALONG WITH A SHORTAGE OF DENTISTS PROVIDING CARE TO THE LOW-INCOME POPULATION. PART VI, LINE 5: THIS FILING ORGANIZATION IS AN AFFILIATE OF THE 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 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.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. THE FILING ORGANIZATION'S STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.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 FILING 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.SPECIFICALLY, THE FILING ORGANIZATION PROVIDES HOSPITAL SERVICES AT ITS EAU CLAIRE, WISCONSIN LOCATION. FOR MORE SPECIFIC DESCRIPTION, SEE THE RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). 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 MAYO CLINIC HEALTH SYSTEM - OAKRIDGE 13025 8TH STREET OSSEO WI 54758 391029430 501(C)(3) 3000000 HEALTH CARE MAYO CLINIC HEALTH SYSTEM - HOME HEALTH & HOSPICE 4033 123RD STREET CHIPPEWA FALLS WI 54729 391491516 501(C)(3) 1502000 HEALTH CARE MAYO CLINIC HEALTH SYSTEM - SUPPORTIVE HOMECARE 4033 123RD STREET CHIPPEWA FALLS WI 54729 391686673 501(C)(3) 500000 GENERAL SUPPORT 3 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FILING ORGANIZATION CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY WITH PROGRAMS THAT ENHANCE THE MISSION OF THE FILING ORGANIZATION. THE FILING ORGANIZATION ONLY CONSIDERS REQUESTS FOR FUNDING AND IN-KIND SUPPORT TO ORGANIZATIONS IN THE COMMUNITY THAT ADDRESS UNMET OR UNDER-FUNDED COMMUNITY NEEDS IN THE AREAS OF HEALTHCARE, EDUCATION, RESEARCH, DIVERSITY AND EQUALITY OF OPPORTUNITY. 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 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 1 1 0 1 0 0 0 0 0 0 0 BOLTON JEFFREY W 0 624800 0 0 0 91140 0 29749 0 20488 0 766177 0 85363 HORECKI MD RICHARD J 0 224336 0 8435 0 95397 0 25170 0 37100 0 390438 0 0 KORSMO JEFFREY O 0 265451 0 0 0 41362 0 24113 0 17976 0 348902 0 27019 LINTON MD RANDALL L 0 472794 0 50000 0 12777 0 25170 0 37583 0 598324 0 0 NESSE MD ROBERT E 0 546068 0 0 0 204195 0 0 0 15004 0 765267 0 193896 SIMPSON MD HENRY J 0 274271 0 600 0 0 0 14700 0 30911 0 320482 0 0 SWENSEN MD STEPHEN J 0 567370 0 0 0 93024 0 28003 0 20404 0 708801 0 86647 BAMMEL PAUL M 0 255446 0 18052 0 6046 0 25170 0 31123 0 335837 0 0 DICKEY JOHN M 0 310821 0 21921 0 11646 0 25170 0 30930 0 400488 0 0 FRANK LINDA A 195748 0 26501 0 2454 0 0 0 25378 0 250081 0 0 0 POPE DENNIS W 191726 0 13716 0 2563 0 0 0 23501 0 231506 0 0 0 WITTROCK EDWARD A 175803 0 12584 0 2340 0 0 0 23522 0 214249 0 0 0 HARELSTAD JULIA M 134431 0 2556 0 0 0 0 0 19226 0 156213 0 0 0 HITZKE RONALD S 151854 0 7029 0 1400 0 0 0 19721 0 180004 0 0 0 WINTER MARK D 130763 0 1500 0 91 0 0 0 27268 0 159622 0 0 0 PART I, LINE 1A TAX INDEMNIFICATION AND GROSS-UP PAYMENTS: THE FILING ORGANIZATION MAY REQUIRE THE USE OF CELLULAR PHONES BY SOME OF ITS EMPLOYEES TO FULFILL THEIR JOB DUTIES. IF THE SERVICE IS APPROVED AS NECESSARY TO PERFORM MAJOR FUNCTIONS OF A JOB, THERE IS A GROSS-UP ADDED TO HELP OFFSET THE TAX IMPACT OF ADDING THE SERVICE COST TO TAXABLE WAGES. THE FILING ORGANIZATION FOLLOWED A WRITTEN POLICY ALLOWING FOR THE GROSS-UP ON THE USE OF CELLULAR PHONES BY EMPLOYEES. PART I, LINE 4B THE FILING ORGANIZATION 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. JEFFREY W. BOLTON - $85,363 STEPHEN J. SWENSEN, M.D. - $86,647 JEFFREY O. KORSMO - $27,019 ROBERT E. NESSE, M.D. - $193,896 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION FOR ESTABLISHING THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE CORE 990 PART VI SECTION B LINE 15 FOR FURTHER INFORMATION REGARDING THE PROCESS UTILIZED. SUPPLEMENTAL INFORMATION PART III PART II: COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97670GAA7 2008-04-10 90000000 TO FINANCE THE ACQUISITION & CONSTRUCTION OF HEALTH CARE FACILITIES 0 0 0 92530169 7644961 1003911 83881297 2010 0 0 1 1 0 0 1 0 1 0 0.00000 0.00140 0.00140 1 0 0 0 0 0 0 X PART II, LINE 3: THE DIFFERENCE BETWEEN THE ISSUE PRICE REPORTED IN PART I AND THE TOTAL PROCEEDS OF ISSUE REPORTED IN PART II IS INVESTMENT EARNINGS. MAYO COLLABORATIVE SERVICES INC BUSINESS RELATIONSHIP - BOARD OVERLAP 522154 LAB SERVICES 0 MCHS - PHARMACY & HOME MEDICAL BUSINESS RELATIONSHIP - BOARD OVERLAP 12903457 RENTAL OF PROPERTY, PAYROLL TRANSACTIONS & SUPPLY PURCHASES 0 MMSI INC BUSINESS RELATIONSHIP - BOARD OVERLAP 15672885 CLAIMS PROCESSING SERVICES & PAYMENTS FOR MEDICAL SERVICES 0 KESSEA REITZNER FAMILY MEMBER OF LINDA FRANK, KEY EMPLOYEE 41134 EMPLOYMENT 0 PATRICIA POPE FAMILY MEMBER OF DENNIS POPE, KEY EMPLOYEE 123011 EMPLOYMENT 0 JANEL WITTROCK FAMILY MEMBER OF EDWARD WITTROCK, KEY EMPLOYEE 56678 EMPLOYMENT 0 X 52791 FAIR MARKET VALUE 0 1 1 THIRD PARTY USE: PART I, LINE 32B: AS AN AFFILIATE OF MAYO CLINIC, THE FILING ORGANIZATION MAY USE MAYO CLINIC'S DEVELOPMENT OFFICE TO SOLICIT, PROCESS OR SELL NON-CASH GIFTS. IN ADDITION, THE FILING ORGANIZATION MAY USE A THIRD-PARTY INVESTMENT BROKER TO SELL STOCK GIFTS RECEIVED. FORM 990, PART VI, SECTION A, LINE 2 DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUALS: PAUL M. BAMMEL DANIEL CLUMPNER JOHN M. DICKEY THOMAS LARSON RANDALL L. LINTON M.D. RICK OLSON DUANE PEDERSON BETTE WAHL HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: PAUL M. BAMMELL JOHN M. DICKEY RICHARD J. HORECKI M.D. RUTH A. KILNESS RANDALL L. LINTON M.D. DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUALS: JEFFREY W. BOLTON ROBERT E. NESSE M.D. HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL: JEFFREY W. BOLTON DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUALS: JEFFREY W. BOLTON JEFFREY O. KORSMO ROBERT E. NESSE M.D. STEPHEN J. SWENSEN M.D. HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: JEFFREY O. KORSMO ROBERT E. NESSE M.D. STEPHEN J. SWENSEN M.D. DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUALS: RANDALL L. LINTON M.D. ROBERT E. NESSE M.D. HENRY J. SIMPSON M.D. HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL: HENRY J. SIMPSON M.D. DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED TAXABLE ENTITIES, THE FOLLOWING INDIVIDUALS: JEFFREY W. BOLTON ROBERT E. NESSE M.D. HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: JEFFREY W. BOLTON ROBERT E. NESSE M.D. DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED TAXABLE ENTITIES, THE FOLLOWING INDIVIDUALS: THOMAS LARSON RANDALL L. LINTON M.D. EDWARD A. WITTROCK HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: THOMAS LARSON RANDALL L. LINTON M.D. EDWARD A. WITTROCK FORM 990, PART VI, SECTION A, LINE 3 THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO-AFFILIATED ENTITIES ROUTINELY DELEGATED VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO RELATED ENTITIES. FORM 990, PART VI, SECTION A, LINE 4 THE FILING ORGANIZATION CHANGED ITS GOVERNING DOCUMENTS IN 2011 TO REFLECT A NAME CHANGE. THIS NAME CHANGE WAS PREVIOUSLY COMMUNICATED TO AND APPROVED BY THE IRS DURING THE TAX YEAR. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE FILING ORGANIZATION IS MAYO CLINIC. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER ELECTS OR APPROVES ALL MEMBERS OF THE GOVERNING BODY OF THE FILING ORGANIZATION. A NOMINATING COMMITTEE NOMINATES A SLATE OF COMMUNITY MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE ARTICLES AND BYLAWS PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS CAPITAL BUDGET, DEBT, AMENDMENT OF THE ARTICLES OR BYLAWS, AND GENERAL OPERATION DECISIONS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 FOR THE FILING ORGANIZATION 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 U.S. 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 THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. 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 THE 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, LINES 15A & 15B: THE FILING ORGANIZATION'S CEO, ALONG WITH WITH OTHER TOP MANAGEMENT OFFICIALS, ARE PAID BY MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE CLINIC (A RELATED OUTPATIENT CLINIC EXEMPT UNDER SECTION 501(C)(3) OF THE CODE). THE INTERNAL PROCESS USED AT THE LOCAL LEVEL FOR DETERMINING COMPENSATION FOR THE FILING ORGANIZATION'S CEO AND OTHER TOP MANAGEMENT OFFICIALS INCLUDED REVIEW OF COMPARABILITY DATA FOR SIMILAR SIZED ORGANIZATIONS BY AN INDEPENDENT COMMITTEE OF THE BOARD (PUBLIC MEMBERS ONLY). SALARIES FOR THE PAST YEAR AND RANGES FOR THE NEXT YEAR WERE REVIEWED FOR REASONABLENESS. CONTEMPORANEOUS MEETING MINUTES OF THE COMPENSATION COMMITTEE ARE KEPT ON FILE. THE FILING ORGANIZATION IS ALSO 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 FILING ORGANIZATION'S CEO, CAO, AND BOARD VICE CHAIR 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 ADMINISTRATORS. 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. FORM 990, PART VI, SECTION C, LINE 19 THE FILING ORGANIZATION'S GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST AND ALSO ON THE MAYOCLINIC.ORG WEBSITE. THE FILING ORGANIZATION IS A HOSPITAL AFFILIATED WITH MAYO CLINIC. AS SUCH, MAYO CLINIC'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THE FILING ORGANIZATION'S FORM 990 AND WOULD BE AVAILABLE UPON REQUEST OF THE FORM 990. FORM 990, PART VII, SECTION A, AVERAGE HOURS PER WEEK DEVOTED TO POSITION WITH RELATED ORGANIZATIONS: PAUL BAMMEL - 25 HOURS JOHN DICKEY - 25 HOURS RICHARD HORECKI, M.D. - 50 HOURS JEFFREY BOLTON - 40 HOURS RUTH KILNESS - 40 HOURS JEFFREY KORSMO - 40 HOURS RANDALL LINTON, M.D. - 25 HOURS HENRY SIMPSON, M.D. - 40 HOURS STEPHEN SWENSEN, M.D. - 40 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,130,384. UNCOLLECTIBLE PLEDGE -1,494,207. FAS 158 PENSION ADJUSTMENT -15,454,255. TOTAL TO FORM 990, PART XI, LINE 5: -18,078,846. 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 MU HEALTHCARE MANAGEMENT MU 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 1 0 0 0 0 1 1 0 0 1 1 0 1 1 0 0 1 MAYO COLLABORATIVE SERVICES INC L 522154 GAAP MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH G 98665139 GAAP MMSI INC L 377421 GAAP GOLD CROSS AMBULANCE INC L 240000 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC O 5523543 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC N 5170979 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC L 425017 GAAP MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC N 134197 GAAP MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC N 101672 GAAP MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC B 3000000 GAAP MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC N 278144 GAAP MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC N 56156 GAAP MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC G 104566 GAAP MAYO CLINIC HEALTH SYSTEM--HOME HEALTH & HOSPICE INC B 1502000 GAAP MAYO CLINIC HEALTH SYSTEM--SUPPORTIVE HOME CARE INC B 500000 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC H 160994 GAAP MMSI INC R 15295465 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC R 764587 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC K 3254234 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC N 5871816 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC A 3100916 GAAP MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC K 1052943 GAAP MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC N 293790 GAAP MAYO CLINIC HEALTH SYSTEM--HOME HEALTH & HOSPICE INC N 114200 GAAP MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC K 535445 GAAP MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC N 167182 GAAP MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC K 1269919 GAAP MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC N 451495 GAAP MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC K 985808 GAAP MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC A 79107 GAAP