2011-08-04T09:18:15-05:00 2010-12-31 990 2010-01-01 390813418 MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL INC MAYO 5075381297 1221 WHIPPLE STREET EAU CLAIRE WI 54703 PAUL BAMMEL 5075381297 2011-08-04 2010 2016-03-07 17:11:31Z FKA LUTHER HOSPITAL PAUL BAMMEL 1221 WHIPPLE STREET EAU CLAIRE WI 54703 249120356 0 X WWW.LUTHERMIDELFORT.ORG X 1905 WI OPERATION OF A HOSPITAL. 11 5 1985 434 0 0 6810210 1681860 240021329 241768393 622122 2340527 2849385 2820822 250303046 248611602 1817355 3090017 0 0 93466494 95008003 0 0 681147 110602472 111908096 205886321 210006116 44416725 38605486 421830571 455711720 141512684 136099786 280317887 319611934 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 187725456 2950000 242811134 PATIENT CARE - SEE SCHEDULE O:THE FILING ORGANIZATION (LUTHER HOSPITAL) CHANGED ITS LEGAL NAME TO MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC. EFFECTIVE MAY 23, 2011. LUTHER HOSPITAL (LUTHER) IS A MEMBER OF MAYO HEALTH SYSTEM. MAYO 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 HEALTH SYSTEM OFFERS OUTSTANDING CARE CLOSE TO HOME. PHYSICIANS AND STAFF IN MAYO HEALTH SYSTEM HAVE READY ACCESS TO THE KNOWLEDGE, RESOURCES, AND EXPERTISE OF MAYO CLINIC, YET CAN MEET PATIENTS' HEALTH CARE NEEDS LOCALLY. MAYO HEALTH SYSTEM IS PART OF THE COMMUNITY, FOCUSED ON IMPROVING THE HEALTH OF THE COMMUNITIES IN WHICH WE LIVE AND WORK. MAYO HEALTH SYSTEM TEAMS WITH MAYO CLINIC TO DELIVER UNPARALLELED HEALTH CARE TO COMMUNITIES THROUGH AN INTEGRATED NETWORK OF CLINICS AND HOSPITALS.MAYO HEALTH SYSTEM SITES EMPLOY APPROXIMATELY 800 PHYSICIANS AND 13,000 ALLIED HEALTH STAFF. IN ADDITION, MAYO CLINIC PHYSICIANS FROM MULTIPLE SPECIALTIES REGULARLY SEE PATIENTS AT THE MAYO HEALTH SYSTEM FACILITIES. BESIDES HAVING HEALTH CARE FACILITIES IN 70 COMMUNITIES, THE SYSTEM INCLUDES 17 OWNED HOSPITALS, SEVEN OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH THREE ADDITIONAL HOSPITALS, AND CONTRACT MANAGEMENT AGREEMENTS WITH TWO ADDITIONAL HOSPITALS AND ONE NURSING HOME. SINCE ITS INCEPTION IN 1992, MAYO HEALTH SYSTEM HAS GROWN FROM A NEW IDEA TO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN AMERICA. MAYO 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 HEALTH SYSTEM THREE TIMES FOR ITS PERFORMANCE EXCELLENCE EFFORTS. INDIVIDUAL MAYO 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 HEALTH SYSTEM AND MAYO CLINIC PARTNER TO ENSURE HEALTHIER LIVES IN THE REGION. LUTHER 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 2010, LUTHER SERVED 11,238 INPATIENTS. IN ADDITION, 79,245 PEOPLE RECEIVED OUTPATIENT MEDICAL CARE INCLUDING 20,506 PATIENTS TREATED IN THE EMERGENCY ROOM. LUTHER HAS 13 OPERATING ROOMS WHERE 9,869 SURGICAL PROCEDURES WERE PERFORMED IN 2010.LUTHER, IN AFFILIATION WITH MIDELFORT CLINIC (A RELATED OUTPATIENT CLINIC EXEMPT UNDER SECTION 501(C)(3) OF THE CODE), IS ONE OF THE MAIN PROVIDERS OF HEALTH CARE SERVICES IN THE SURROUNDING AREA. LUTHER IS LOCATED ADJACENT TO THE MAIN CAMPUS OF MIDELFORT CLINIC (MIDELFORT) IN EAU CLAIRE, WISCONSIN. THE AFFILIATED ORGANIZATIONS ARE LOCALLY REFERRED TO AS "LUTHER-MIDELFORT". LUTHER 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 2010, LUTHER PROVIDED APPROXIMATELY $2,418,665 OF FINANCIAL ASSISTANCE (AT COST) TO PATIENTS. THE UNREIMBURSED COST OF SERVICES TO MEDICAID PATIENTS WAS APPROXIMATELY $8,612,640 AND THE UNREIMBURSED COST OF SERVICES TO PATIENTS UNDER OTHER MEANS TESTED GOVERNMENT PROGRAMS WAS APPROXIMATELY $1,172,896.THE UNREIMBURSED COST OF SERVICES TO MEDICARE PATIENTS DETERMINED BY USING INFORMATION FROM LUTHER'S MEDICARE COST REPORT WAS APPROXIMATELY $8,586,915. IF USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY, THE UNREIMBURSED COST OF SERVICES TO MEDICARE PATIENTS WAS APPROXIMATELY $4,166,996.LUTHER, ALONG WITH MIDELFORT, 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 LUTHER-MIDELFORT'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 LUTHER-MIDELFORT'S BILLING AND COLLECTION POLICIES AND PRACTICES. 1367285 0 520015 MEDICAL EDUCATION - SEE SCHEDULE O:LUTHER, IN AFFILIATION WITH MIDELFORT, 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- LAKESHORE TECHNICAL COLLEGE (CLEVELAND, WI) - UNIVERSITY OF CINCINNATI - UNIVERSITY OF NEW ENGLAND (PORTLAND, MA)- UNIVERSITY OF MINNESOTA-DULUTH - COLLEGE OF ST. CATHERINE'S - COLLEGE OF ST. SCHOLASTICA - WINONA STATE UNIVERSITY - UNIVERSITY OF WISCONSIN-MILWAUKEE - UNIVERSITY OF MIAMI-OHIO - 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 IOWA - UNIVERSITY OF KANSAS - UNIVERSITY OF WISCONSIN - OSHKOSH - UNIVERSITY OF WISCONSIN - WHITEWATER - WASHINGTON UNIVERSITY - WESTERN MICHIGAN UNIVERSITY- ARGOSY UNIVERSITY- DES MOINES UNIVERSITY- FINLANDIA UNIVERSITYLUTHER ALSO ACTIVELY PROVIDES A CONTINUING EDUCATION PROGRAM FOR ITS MEDICAL STAFF. 448190 140017 0 COMMUNITY BENEFIT - SEE SCHEDULE O:LUTHER, OFTEN IN AFFILIATION WITH MIDELFORT CLINIC, PROVIDES COMMUNITY CLASSES, EDUCATIONAL OPPORTUNITIES AND SERVICES. THESE PROGRAMS AND CLASSES INCLUDE SEVERAL HEALTH RELATED TOPICS. ADDITIONAL INFORMATION FOR SOME OF THE SPECIFIC EVENTS ARE LISTED BELOW. APPROXIMATELY 1,000 PEOPLE PARTICIPATED IN CHILDBIRTH CLASSES GIVEN FOR EXPECTANT PARENTS AND THEIR CHILDREN IN 2010.EMPLOYEE HEALTHCARE PROFESSIONALS OFFER PRESENTATIONS ON A VARIETY OF HEALTHCARE TOPICS AT THE LOCAL BORDER BOOKSTORE DRAWING ANYWHERE FROM 15-45 PARTICIPANTS. IT'S AN INFORMAL, INFORMATIONAL DISCUSSION ON TOPICS IMPORTANT TO COMMUNITY MEMBERS.LUTHER-MIDELFORT SPONSORS A PERMANENT KIOSK IN THE MACY'S WING OF OAKWOOD MALL (A MAJOR SHOPPING CENTER) SINCE 1998. THE KIOSK IS STAFFED AT VARIOUS TIMES BY CLINICIANS AND EMPLOYEES WHO ARE AVAILABLE TO ANSWER CONSUMER QUESTIONS AND DISTRIBUTE HEALTH RELATED INFORMATION. THIS BOOTH DISPLAYS HEALTHCARE INFORMATION AND ANSWERS HEALTH-RELATED QUESTIONS THROUGH AN INTERACTIVE TOUCH-SCREEN COMPUTER AND BY THE PROFESSIONALS STAFFING THE BOOTH. FREE BLOOD PRESSURE SCREENING COMBINED WITH INFORMAL EDUCATION IS OFFERED EVERY THURSDAY TO AREA RESIDENTS. IN 2010, OVER 2,500 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 MONTHLY NEWSLETTER.TRAUMA SERVICE TEAMS HAVE PARTNERED WITH LOCAL BUSINESSES SINCE 1998 TO PRESENT "SAFETY CAMP" - AN OPPORTUNITY FOR AREA FOURTH GRADERS TO SPEND TWO FULL DAYS LEARNING ABOUT WATER SAFETY, BIKE SAFETY, ANIMAL SAFETY AND MANY OTHER TOPICS.IN 2010, LUTHER AND MIDELFORT EMPLOYEES RAISED $27,368 FOR THE "RELAY FOR LIFE" EVENT HELD TO BENEFIT THE AMERICAN CANCER SOCIETY. LUTHER-MIDELFORT WAS A CORPORATE SPONSOR FOR THE EVENT.LUTHER-MIDELFORT WAS A CORPORATE SPONSOR FOR THE "AMERICAN HEART WALK" TO RAISE MONEY FOR THE AMERICAN HEART ASSOCIATION. MORE THAN 20 TEAMS, APPROXIMATELY 250 WALKERS, RAISED $19,000.LUTHER-MIDELFORT WAS A CORPORATE SPONSOR FOR THE "EPILEPSY STROLL IN THE PARK" EVENT WHICH RAISED MORE THAN $21,000. LUTHER-MIDELFORT ALSO SPONSORED THE "SHARE THE FLAME" EVENT AND RAISED ANOTHER $16,000 FOR THE EPILEPSY FOUNDATION.THE HEALTH INFORMATION CENTER PROVIDES HEALTH-RELATED TAPES, MODELS, COMPUTER SOFTWARE, FREE 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 OFFERS HEALTH EDUCATION RESOURCE SERVICES, SUPPORT GROUPS AND SELF-REFERRED MAMMOGRAMS TO AREA WOMEN. SPIRITUAL CARE SERVICES ARE OFFERED THAT INCLUDE 24-HOUR ON-CALL, 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 PROGRAM.APPROXIMATELY 434 COMMUNITY VOLUNTEERS PROVIDED APPROXIMATELY 51,155 HOURS OF DONATED TIME TO LUTHER IN 2010. 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 2010 IS VALUED AT APPROXIMATELY $1,092,671 BASED ON STATISTICS FROM THE INDEPENDENT SECTOR. 189540931 1 1 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 1985 1 0 0 0 0 0 1 1 0 0 0 0 X 11 5 1 1 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 1 0 WI X CHRISTIE LOHKAMP 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 X CARRYER MD PETER W 1.00 X 0 1216809 9629 CLUMPNER DANIEL 1.00 X 0 0 0 DOVRE MD ERIK 1.00 X X 0 358462 28725 HORECKI MD RICHARD J 1.00 X X 0 292038 58136 KORSMO JEFFREY O 1.00 X 0 1190676 70174 LARSON THOMAS 1.00 X X 0 0 0 LINTON MD RANDALL L 25.00 X X 0 516417 58816 NESSE MD ROBERT E 1.00 X 0 1569297 211744 OLSON RICK 1.00 X 0 0 0 PEDERSON DUANE 1.00 X 0 0 0 SIMPSON MD HENRY J 1.00 X 0 262487 49497 SWENSEN MD STEPHEN J 1.00 X 0 1706088 137400 WAHL BETTE 1.00 X 0 0 0 BAMMEL PAUL M 25.00 X 0 267674 52432 DICKEY JOHN M 25.00 X 0 332295 52727 KILNESS RUTH A 1.00 X 0 75835 23104 FRANK LINDA A 50.00 X 207668 0 22992 POPE DENNIS W 50.00 X 202731 0 49053 WITTROCK EDWARD A 50.00 X 186054 0 45891 FINN PAUL E 40.00 X 127436 0 22334 GIERHART KENT H 40.00 X 129185 0 3197 HARELSTAD JULIA M 40.00 X 132405 0 19177 HITZKE RONALD S 40.00 X 152620 0 19094 JONES CAREY LEE 40.00 X 126408 0 21997 MACKEN MD PATRICK D X 0 307230 51267 1264507 8095308 1007386 45 1 1 0 MAYO FOUNDATION FOR MEDICAL EDUCATION & 200 FIRST STREET SW ROCHESTER MN 55905 PROCUREMENT/SUPPORT SERVICES 94971296 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 MEDICAL/SUPPORT SERVICES 6148890 MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 LAB SERVICES 497910 MMSI INC 200 FIRST STREET SW ROCHESTER MN 55905 CLAIMS PROCESSING 391858 MIDELFORT CLINIC PO BOX 1510 EAU CLAIRE WI 54702 MEDICAL/SUPPORT SERVICES 365765 6 166310 1465388 50162 866422 1681860 NET PATIENT REVENUE 620000 235198504 235198504 RENT FROM AFFILIATES 531120 3337290 3337290 SHARED SERVICES 561000 3220489 3220489 EDUCATION REVENUE 611600 12110 12110 241768393 2451317 2451317 120329 129541 -9212 -9212 -9212 25017 135807 -110790 -110790 -110790 30225 166310 99643 -69418 -69418 4045 4540 -495 -495 250114 139223 110891 110891 CAFETERIA/VENDING 722210 1432221 1432221 EMPLOYEE CHILDCARE 624410 1155723 1155723 MISCELLANEOUS 900099 136825 130535 6290 64287 64287 2789056 248611602 243331149 0 3598593 3090017 3090017 714389 230660 483729 81899988 72603234 9061481 235273 1155609 1066763 85340 3506 5375053 4778298 580980 15775 5862964 5174652 671309 17003 371989 276625 95364 17109 17109 22043 180 21863 19269 19269 25682563 23264146 2157541 260876 1291006 734 1290272 44594550 42912273 1621849 60428 1810216 870695 939521 5327503 4124139 1120138 83226 477638 419436 55876 2326 424682 424682 15548238 14520854 1025956 1428 173235 173235 BAD DEBT EXPENSE 8746465 8746465 MEDICAID INDIGENT TAX 7196464 7196464 EMPLOYEE EXPENSES 163044 61356 101688 DUES, LICENSES, ETC. 39962 28585 10071 1306 MISC. EXPENSE 2120 2120 210006116 189540931 19784038 681147 12956 107996 8186227 7722517 36237475 35103652 7805 8254 3550441 3240709 2635827 7034043 393350136 128278573 197096370 265071563 50948553 1800 111414928 129970452 11739989 7450734 421830571 455711720 22813554 23563482 35373 23043 90000000 90000000 28663757 22513261 141512684 136099786 X 270706164 310124320 8992035 8858414 619688 629200 280317887 319611934 421830571 455711720 X 38605486 688561 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 12955759 11095 5401919 18368773 11636431 4299 1315029 12955759 14172465 31307 -2567341 11636431 0.95000 0.03000 0.02000 0 1 1 8959109 8959109 275000432 65291777 209708655 94526491 62986796 31539695 14864104 14864104 265071563 MAYO CLINIC INVESTMENT POOL 129970452 F 129970452 DUE TO AFFILIATES 22513261 22513261 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, 2010 AND 2009 THERE WAS NO MATERIAL LIABILITY FOR UNRECOGNIZED TAX BENEFITS FOR THE FILING ORGANIZATION. GOLF OUTING 92239 69964 22275 12308 9405 4984 5227 HOLIDAY CELEBRATION 104296 96346 7950 30056 12469 15245 9949 196535 166310 30225 42364 21874 20229 15176 99643 -69418 1 1 1 X 1 X 1 1 0 1 1 2418665 2418665 0.01200 20750046 12137406 8612640 0.04280 6683085 5510189 1172896 0.00580 29851796 17647595 12204201 0.06060 273512 273512 0.00140 1367285 507905 859380 0.00430 51320165 30107400 21212765 0.10540 3124689 3124689 0.01550 56085651 30615305 25470346 0.12660 85937447 48262900 37674547 0.18720 0 2741417 43188263 51775179 -8586916 X 1 1 1 1 LUTHER HOSPITAL

1221 WHIPPLE STREET EAU CLAIRE WI 54703

X X X NOT REQUIRED 1 Part I, Line 3c: TO BE ELIGIBLE FOR DISCOUNTED CARE, THE FAMILY INCOME LIMIT MUST GENERALLY BE BETWEEN 201% AND 300% OF THE FEDERAL POVERTY GUIDELINES. OTHER FACTORS AFFECTING ELIGIBILITY ARE: 1) PATIENT'S INCOME (MORE LIKELY TO RECEIVE ASSISTANCE IF PATIENT'S INCOME IS BELOW THREE TIMES THE FEDERAL POVERTY GUIDELINES); 2) EVALUATION OF THE PATIENT'S SAVINGS, CHECKING, AND INVESTMENT ASSETS; 3) ASSESSMENT OF THE PATIENT'S PROPERTY (OTHER THAN THEIR PRIMARY RESIDENCE); 4) EVALUATION OF THE PATIENT'S MONTHLY EXPENSES; AND 5) OTHER CIRCUMSTANCES THAT THE PATIENT WOULD LIKE TO BE CONSIDERED. 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 $ 8746465. Part III, Line 4: FOOTNOTE FROM MAYO CLINIC 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.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.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 RESULTS IN A MEDICARE SHORTFALL OF $4,166,996. BOTH AMOUNTS ARE REPORTED IN THE CORE FORM, PART III, PROGRAM SERVICE ACCOMPLISHMENTS.THE MOST COMMON REASONS FOR A DIFFERENCE BETWEEN THE MEDICARE SURPLUS REPORTED ON SCHEDULE H AND THE MEDICARE SHORTFALL REPORTED ON THE CORE FORM, PART III INCLUDE: (1) INCLUSION OF MEDICARE ADVANTAGE REVENUE AND EXPENSES; (2) INCLUSION OF PART B REVENUE AND EXPENSES; (3) INCLUSION OF OTHER FEE SCHEDULE REVENUE; AND (4) SOME TIMING ISSUES.REASONS WHY MEDICARE SHORTFALL 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 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. COLLECTION ACTIVITY WOULD ONLY RESUME IF MAYO WOULD TELL THE COLLECTION AGENCY TO PURSUE COLLECTIONS ON THE BALANCE OR PARTIAL BALANCE IF THERE WAS A CHARITY ADJUSTMENT. Part 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. Part VI, Line 2: LUTHER HOSPITAL'S ADMINISTRATION, ALONG WITH MEMBERS OF THE LUTHER MIDELFORT FOUNDATION (A RELATED TAX-EXEMPT ORGANIZATION), WORK CLOSELY WITH LOCAL EDUCATIONAL INSTITUTIONS, AREA FREE CLINICS, NEIGHBORHOOD ASSOCIATIONS, CHARITIES, AND HEALTH DEPARTMENTS TO ASSESS HEALTHCARE NEEDS. MONETARY DONATIONS, SERVICES, EDUCATION, VOLUNTEERS AND GOODS ARE SUPPLIED ONCE THOSE NEEDS ARE ASSESSED. REQUESTS FOR ASSISTANCE ARE TRIAGED THROUGH THE LUTHER HOSPITAL'S CORPORATE COMMUNICATION DEPARTMENTS, AND EVALUATED BASED ON ANNUAL STRATEGY. PART OF THAT STRATEGY INCLUDES INPUT FROM THE RESPONSIBLE VICE PRESIDENT AND ULTIMATELY REVIEWED BY THE LUTHER MIDELFORT FOUNDATION ACCORDING TO THE DONATION REQUEST FLOWCHART. THE LUTHER MIDELFORT FOUNDATION'S ANNUAL STRATEGY IS BASED ON COMMUNITY HEALTH NEED, LUTHER HOSPITAL'S STRATEGIC INITIATIVES AND COMMUNITY ASSESSMENTS. Part VI, Line 3: ELIGIBILITY: THE CHARITY CARE INFORMATION BROCHURE IS PROMINENTLY DISPLAYED IN REGISTRATION AND PATIENT-ACCOUNT WAITING AREAS. THE BROCHURE EXPLAINS THE CHARITY CARE PROGRAM AND FACTORS AFFECTING ELIGIBILITY. IDENTIFICATION: THERE ARE A NUMBER OF WAYS A PATIENT CAN BE IDENTIFIED AND EVALUATED FOR CHARITY CARE ASSISTANCE.1. PATIENTS MAY REQUEST FINANCIAL ASSISTANCE.2. STAFF MAY REFER PATIENTS TO A FINANCIAL COUNSELOR.3. COLLECTION AGENCIES MAY REFER PATIENTS.4. BUSINESS/PATIENT FINANCIAL SERVICES MAY REFER PATIENTS TO A FINANCIAL COUNSELOR.5. PHYSICIANS MAY REFER PATIENTS.6. LOCAL GOVERNMENT AGENCIES MAY REFER PATIENTS.INDIGENT CARE: EMERGENCY ROOM PATIENTS WHO CANNOT PAY THEIR BILLS MAY BE CLASSIFIED AS "CHARITY" IF THEY DO NOT HAVE A JOB, MAILING ADDRESS, RESIDENCE, OR INSURANCE. CONSIDERATION MUST ALSO BE GIVEN TO CLASSIFYING EMERGENCY ROOM ONLY PATIENTS AS CHARITY IF THEY DO NOT PROVIDE ADEQUATE INFORMATION AS TO THEIR FINANCIAL STATUS. IN MANY INSTANCES, THESE PATIENTS ARE HOMELESS AND HAVE FEW RESOURCES TO COVER THE COST OF THEIR CARE.GOVERNMENTAL ASSISTANCE: IN DETERMINING WHETHER AN INDIVIDUAL QUALIFIES FOR CHARITY CARE, OTHER COUNTY OR GOVERNMENTAL ASSISTANCE PROGRAMS SHOULD ALSO BE CONSIDERED. MANY APPLICANTS ARE NOT AWARE THAT THEY MAY BE ELIGIBLE FOR PUBLIC HEALTH INSURANCE PROGRAMS.1. STAFF WILL HELP THE INDIVIDUAL DETERMINE ELIGIBILITY FOR GOVERNMENTAL OR OTHER ASSISTANCE, AS APPROPRIATE.2. PERSONS WHO ARE ELIGIBLE FOR PROGRAMS (SUCH AS STATE-SPONSORED MEDICAID) BUT WHO WERE NOT COVERED AT THE TIME THAT MEDICAL SERVICES WERE GRANTED MAY BE GRANTED CHARITY CARE, PROVIDED THAT THE PATIENT NOW APPLIES FOR GOVERNMENT ASSISTANCE. THIS MAY BE PRUDENT, ESPECIALLY IF THE PATIENT REQUIRES ONGOING SERVICES. Part VI, Line 4: LUTHER HOSPITAL 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 LUTHER HOSPITAL'S SERVICE AREA) IS APPROXIMATELY 99,000. OF THIS POPULATION, MORE THAN 94% ARE OF WHITE ETHNICITY; THE NEXT CLOSEST RACE PERCENTAGE IS ASIAN AT 2.8%. AVERAGE INCOME IN EAU CLAIRE COUNTY IS $48,483 ACCORDING TO 2009 U.S. CENSUS BUREAU INFORMATION. ACCORDING TO A STATE OF WISCONSIN 2009 COUNTY PROFILE, APPROXIMATELY 11.8% OF EAU CLAIRE INDIVIDUALS ARE LIVING BELOW THE POVERTY LEVEL. IN ADDITION, ACCORDING TO THE 2009 WISCONSIN FAMILY HEALTH SURVEY, APPROXIMATELY 11% OF THE EAU CLAIRE COUNTY POPULATION WAS UNINSURED FOR ALL OR PART OF THE PAST YEAR. AN ESTIMATED 11% ARE ON MEDICAID AND 10% RECEIVE MEDICARE COVERAGE.ACCORDING TO INFORMATION PROVIDED BY THE 2010 COUNTY HEALTH RANKINGS WEBSITE, EAU CLAIRE COUNTY RANKS 19TH (OUT OF 72 COUNTIES) IN HEALTH OUTCOMES, RANKING FIFTH IN CLINICAL CARE. ACCORDING TO THE LOCAL UNITED WAY, MAJOR HEALTH CONCERNS FACING OUR COMMUNITY ARE OBESITY, TOBACCO USE, MENTAL HEALTH ISSUES, ALCOHOL USE, AND DENTAL CARE.LUTHER HOSPITAL 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, LUTHER HOSPITAL PROVIDES 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 6: 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 7: 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). 1 OSSEO MEDICAL CENTER - MAYO HEALTH SYSTEM 13025 8TH STREET OSSEO WI 54758 391029430 501(C)(3) 2000000 HEALTH CARE NORTHWEST WISCONSIN HOME CARE 2620 STEIN BLVD EAU CLAIRE WI 54702 391491516 501(C)(3) 950000 HEALTH CARE LUTHER MIDELFORT FOUNDATION 733 WEST CLAIREMONT AVENUE EAU CLAIRE WI 54702 391633407 501(C)(3) 139107 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. 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. X 1 0 0 1 0 0 0 0 0 0 0 CARRYER MD PETER W 0 227574 0 0 0 989235 0 60 0 9569 0 1226438 0 421371 DOVRE MD ERIK 0 289143 0 18036 0 51283 0 0 0 28725 0 387187 0 0 HORECKI MD RICHARD J 0 239211 0 12334 0 40493 0 25170 0 32966 0 350174 0 0 KORSMO JEFFREY O 0 474109 0 0 0 716567 0 49365 0 20809 0 1260850 0 311546 LINTON MD RANDALL L 0 461263 0 52400 0 2754 0 25170 0 33646 0 575233 0 0 NESSE MD ROBERT E 0 448868 0 0 0 1120429 0 193896 0 17848 0 1781041 0 370682 SIMPSON MD HENRY J 0 262237 0 250 0 0 0 22050 0 27447 0 311984 0 0 SWENSEN MD STEPHEN J 0 544151 0 0 0 1161937 0 113301 0 24099 0 1843488 0 263338 BAMMEL PAUL M 0 245193 0 19719 0 2762 0 25170 0 27262 0 320106 0 0 DICKEY JOHN M 0 299227 0 29334 0 3734 0 25170 0 27557 0 385022 0 0 FRANK LINDA A 190305 0 13646 0 3717 0 181 0 22811 0 230660 0 0 0 POPE DENNIS W 186840 0 13330 0 2561 0 27927 0 21126 0 251784 0 0 0 WITTROCK EDWARD A 171312 0 12192 0 2550 0 25148 0 20743 0 231945 0 0 0 HARELSTAD JULIA M 129292 0 3035 0 78 0 768 0 18409 0 151582 0 0 0 HITZKE RONALD S 147570 0 3786 0 1264 0 502 0 18592 0 171714 0 0 0 MACKEN MD PATRICK D 0 255795 0 12942 0 38493 0 25170 0 26097 0 358497 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). IN 2010, THE COMPONENT OF THIS SRP BENEFIT THAT WAS DEFERRED COMPENSATION SUBJECT TO SECTIONS 409A AND 457(f) OF THE INTERNAL REVENUE CODE WAS TERMINATED. THIS PLAN TERMINATION TRIGGERED THE IMMEDIATE TAXATION OF THE ENTIRE SRP BENEFIT THAT HAS BEEN ACCRUED AND DEFERRED OVER EACH PARTICIPANT'S CAREER AT MAYO. STARTING JANUARY 1, 2011, ALL FUTURE SRP BENEFIT WILL BE PAID AS AN ANNUAL TAXABLE CASH PAYMENT THAT HAS NO SUBSTANTIAL RISK OF FORFEITURE. THE FOLLOWING INDIVIDUALS RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN EITHER AS A RESULT OF THE NORMAL OPERATION OF PLAN TERMS OR BECAUSE OF THE TERMINATION OF THE 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. THESE AMOUNTS HAVE BEEN ACCRUED OVER THE SPAN OF THE INDIVIDUAL'S CAREER AT MAYO. JEFFREY O. KORSMO - $712,972 STEPHEN J. SWENSEN, M.D. - $1,156,330 ROBERT E. NESSE, M.D. - $1,055,162 PETER W. CARRYER, M.D. - $982,163 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 7643161 1003911 83881297 1800 2010 0 0 1 1 0 0 0 0 0 0.00000 0.00040 0.00040 1 0 0 0 0 0 0 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 497910 LAB SERVICES 0 NORTHWEST HEALTH VENTURES INC BUSINESS RELATIONSHIP - BOARD OVERLAP 164256 RENTAL OF PROPERTY & PAYROLL TRANSACTIONS 0 KESSEA REITZNER FAMILY MEMBER OF LINDA FRANK, KEY EMPLOYEE 42154 EMPLOYMENT 0 PATRICIA POPE FAMILY MEMBER OF DENNIS POPE, KEY EMPLOYEE 119488 EMPLOYMENT 0 RANDY HARELSTAD FAMILY MEMBER OF JULIA HARELSTAD, TOP 5 HIGHEST PAID 119865 EMPLOYEMENT 0 BRIAN GIEHART FAMILY MEMBER OF KENT GIEHART, TOP 5 HIGHEST PAID 123971 EMPLOYMENT 0 JANEL WITTROCK FAMILY MEMBER OF EDWARD WITTROCK, KEY EMPLOYEE 69560 EMPLOYMENT 0 X 46504 FAIR MARKET VALUE X 1 4569 FAIR MARKET VALUE X LIFE INSURANCE POLICIES 2 815349 PRESENT VALUE 5 0 1 1 Method for Determining Number of Contributors: Part I, Column (b): FILING ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. 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/HAS A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: PAUL M. BAMMELL JOHN M. DICKEY ERIK DOVRE M.D. RICHARD J. HORECKI M.D. RUTH A. KILNESS RANDALL L. LINTON M.D. PATRICK D. MACKEN M.D. DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, THE FOLLOWING INDIVIDUALS: JEFFREY O. KORSMO ROBERT E. NESSE M.D. HAVE A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS: PETER W. CARRYER M.D. JEFFREY O. KORSMO ROBERT E. NESSE M.D. STEPHEN J. SWENSEN M.D. 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 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 LUTHER HOSPITAL. A NOMINATING COMMITTEE NOMINATES A SLATE OF COMMUNITY MEMBERS. THE PRESIDENT/CEO OF MIDELFORT CLINIC SERVES EX OFFICIO AND IS APPROVED BY THE PRACTICE COMMITTEE OF MIDELFORT CLINIC AND THE SOLE CORPORATE MEMBER. 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 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, line 15b THE FILING ORGANIZATION'S CEO, ALONG WITH OTHER TOP MANAGMENT OFFICIALS, ARE PAID BY MIDELFORT CLINIC (A RELATED OUTPATIENT CLINIC EXEMPT UNDER SECTION 501(C)(3) OF THE CODE). THE INTERNAL PROCESS USED BY BOTH MIDELFORT AND LUTHER FOR DETERMINING COMPENSATION FOR LUTHER'S CEO, OTHER TOP MANAGEMENT OFFICIALS AND KEY EMPLOYEES 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. THE SALARY OF THE CEO, CAO, AND BOARD VICE CHAIR WERE REVIEWED BY THE MAYO HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO HEALTH SYSTEM PHYSICIANS AND ADMINISTRATORS. THE MAYO HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE MAYO HEALTH SYSTEM ENTITIES. THE COMMITTEE IS COMPRISED OF MAYO EMPLOYEES, BUT IS INDEPENDENT FOR INTERNAL REVENUE CODE 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED (WITH RECUSAL WHERE APPROPRIATE). FOR THOSE INDIVIDUALS FOR WHICH THIS COMMITTEE CAN NOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE COMPENSATION AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. INFORMATION ON MAYO 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 ERIK DOVRE, M.D. - 50 HOURS PETER CARRYER, M.D. - 40 HOURS RUTH KILNESS - 50 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 gains on investments: 3,670,166. FASB 158 - PENSION ADJUSTMENT -2,981,605. Total to Form 990, Part XI, Line 5: 688,561. Form 990, Part XII, Line 2c: THERE WAS NO CHANGE IN THE PROCESS DURING THE YEAR. ALBERT LEA MEDICAL CENTER -- MAYO HEALTH SYSTEM 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 411404075 HOSPITAL AND CLINIC MN 501(c)(3) 3 MAYO CLINIC 1 AUSTIN MEDICAL CENTER -- MAYO HEALTH SYSTEM 1000 FIRST DRIVE NW AUSTIN MN 55912 410695606 HOSPITAL AND CLINIC MN 501(c)(3) 3 MAYO CLINIC 1 AUSTIN MEDICAL CENTER FOUNDATION 1000 FIRST DRIVE NW AUSTIN MN 55912 300107471 FUNDRAISING FOUNDATION MN 501(c)(3) 7 AUSTIN MEDICAL CENTER -- MAYO HEALTH SYSTEM 1 BARRON MEMORIAL MEDICAL CENTER -- MAYO HEALTH SYSTEM 1222 EAST WOODLAND AVE BARRON WI 54812 390920634 HOSPITAL AND CLINIC WI 501(c)(3) 3 LUTHER HOSPITAL 1 BLOOMER LAKEVIEW INC 2110 DUNCAN ROAD BLOOMER WI 54724 391450617 LOW INCOME HOUSING WI 501(c)(3) 7 BLOOMER MEMORIAL MEDICAL CENTER INC -- MAYO HEALTH SYSTEM 1 BLOOMER MEMORIAL MEDICAL CENTER INC -- MAYO HEALTH SYSTEM 1501 THOMPSON STREET BLOOMER WI 54724 390980343 HOSPITAL AND CLINIC WI 501(c)(3) 3 LUTHER HOSPITAL 1 CANNON FALLS MEDICAL CENTER -- MAYO HEALTH SYSTEM 1116 WEST MILL STREET CANNON FALLS MN 55009 204156428 HOSPITAL AND CLINIC MN 501(c)(3) 3 MAYO CLINIC 1 CHARTERHOUSE INC 200 FIRST STREET SW ROCHESTER MN 55905 411405254 RETIREMENT LIVING CENTER MN 501(c)(3) 9 MAYO CLINIC 1 FAIRMONT MEDICAL CENTER -- MAYO HEALTH SYSTEM 800 MEDICAL CENTER DRIVE PO BOX 800 FAIRMONT MN 56031 410760836 HOSPITAL AND CLINIC MN 501(c)(3) 3 MAYO CLINIC 1 FOUNTAIN LAKE TREATMENT CENTER 404 WEST FOUNTAIN STREET ALBERT LEA MN 56007 411404076 CHEMICAL DEPENDENCY TREATMENT MN 501(c)(3) 3 ALBERT LEA MEDICAL CENTER -- MAYO HEALTH SYSTEM 1 FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC 464 SOUTH JOHNSON STREET ARCADIA WI 54612 391322480 FUNDRAISING FOUNDATION WI 501(c)(3) 9 FRANCISCAN SKEMP HEALTHCARE INC 1 FRANCISCAN SKEMP FOUNDATION OF SPARTA INC 310 WEST MAIN STREET SPARTA WI 54656 391423234 FUNDRAISING FOUNDATION WI 501(c)(3) 9 FRANCISCAN SKEMP HEALTHCARE INC 1 FRANCISCAN SKEMP FOUNDATION INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391186647 FUNDRAISING FOUNDATION WI 501(c)(3) 11-II FRANCISCAN SKEMP HEALTHCARE INC 1 FRANCISCAN SKEMP HEALTHCARE INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391411999 HEALTHCARE SYSTEM PARENT WI 501(c)(3) 11-I MAYO CLINIC 1 FRANCISCAN SKEMP MEDICAL CENTER INC 700 WEST AVE SOUTH LA CROSSE WI 54601 390806374 HOSPITAL AND CLINIC WI 501(c)(3) 3 FRANCISCAN SKEMP 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 IMMANUEL-ST JOSEPH'S -- MAYO HEALTH SYSTEM 1025 MARSH STREET MANKATO MN 56002 411236756 HOSPITAL AND CLINIC MN 501(c)(3) 3 MAYO CLINIC 1 IMMANUEL-ST JOSEPH'S FOUNDATION -- MAYO HEALTH SYSTEM 1025 MARSH STREET MANKATO MN 56002 411663357 FUNDRAISING FOUNDATION MN 501(c)(3) 7 IMMANUEL-ST JOSEPH'S -- MAYO HEALTH SYSTEM 1 LAKE CITY MEDICAL CENTER - MAYO HEALTH SYSTEM 500 WEST GRANT STREET LAKE CITY MN 55041 411906820 HOSPITAL MN 501(c)(3) 3 MAYO CLINIC 1 LUTHER HOSPITAL 1221 WHIPPLE STREET EAU CLAIRE WI 54703 390813418 HOSPITAL WI 501(c)(3) 3 MAYO CLINIC 1 LUTHER LAKESIDE APARTMENTS INC 714 SOUTH BARSTOW STREET EAU CLAIRE WI 54701 391409024 LOW INCOME HOUSING WI 501(c)(3) 9 LUTHER HOSPITAL 1 LUTHER MIDELFORT FOUNDATION INC 733 W CLAIREMONT AVE PO BOX 1510 EAU CLAIRE WI 54702 391633407 GRANTMAKING FOUNDATION WI 501(c)(3) PF MIDELFORT CLINIC LTD -- MAYO HEALTH SYSTEM 0 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 JACKSONVILLE 4500 SAN PABLO ROAD JACKSONVILLE FL 32224 593337028 PATIENT CARE - CLINIC FL 501(c)(3) 7 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 200 FIRST STREET SW ROCHESTER MN 55905 416011702 PATIENT CARE - CLINIC MN 501(c)(3) 9 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 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 MIDELFORT CLINIC LTD -- MAYO HEALTH SYSTEM PO BOX 1510 EAU CLAIRE WI 54702 391735831 PATIENT CARE - CLINIC WI 501(c)(3) 3 MAYO CLINIC 0 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 NORTHWEST WISCONSIN HOMECARE INC PO BOX 2060 EAU CLAIRE WI 54702 391491516 HOME HEALTH AND HOSPICE CARE WI 501(c)(3) 9 LUTHER HOSPITAL 1 NORTHWEST WISCONSIN SUPPORTIVE HOMECARE INC PO BOX 2060 EAU CLAIRE WI 54702 391686673 HOME HEALTH CARE WI 501(c)(3) 9 LUTHER HOSPITAL 1 OSSEO MEDICAL CENTER INC -- MAYO HEALTH SYSTEM PO BOX 70 / 13025 EIGHTH STREET OSSEO WI 54758 391029430 HOSPITAL AND CLINIC WI 501(c)(3) 3 LUTHER HOSPITAL 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 RED CEDAR MEDICAL CENTER INC -- MAYO HEALTH SYSTEM 2321 STOUT ROAD MENOMONIE WI 54751 510190875 HOSPITAL AND CLINIC WI 501(c)(3) 3 MAYO CLINIC 1 SPRINGFIELD MEDICAL CENTER -- MAYO HEALTH SYSTEM 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 411893827 HOSPITAL AND CLINIC MN 501(c)(3) 3 IMMANUEL-ST JOSEPH'S -- MAYO HEALTH SYSTEM 1 ST JAMES MEDICAL CENTER -- MAYO HEALTH SYSTEM 1101 MOULTON PARSONS DR PO BOX 460 ST JAMES MN 56081 410797368 HOSPITAL AND CLINIC MN 501(c)(3) 3 IMMANUEL-ST JOSEPH'S -- MAYO HEALTH SYSTEM 1 ST JAMES MEDICAL CENTER FOUNDATION INC 1101 MOULTON PARSONS DR PO BOX 460 ST JAMES MN 56081 411444129 FUNDRAISING FOUNDATION MN 501(c)(3) 7 ST JAMES MEDICAL CENTER -- MAYO HEALTH SYSTEM 1 WASECA MEDICAL CENTER -- MAYO HEALTH SYSTEM 501 NORTH STATE STREET WASECA MN 56093 363606405 HOSPITAL AND CLINIC MN 501(c)(3) 3 IMMANUEL-ST JOSEPH'S -- MAYO HEALTH SYSTEM 1 MAYO KLINIK STIFTUNG 60486 FRANKFURT AM MAIN FRANKFURT GM FUNDRAISING FOUNDATION GM MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH 1 FRANKLIN HEATING STATION 119 THIRD ST SW ROCHESTER MN 55902 410264830 UTILITY MN N/A CANNON VALLEY CLINIC -- MAYO HEALTH SYSTEM 635 FIRST STREET SE FARIBAULT MN 55021 411817179 PATIENT CARE - CLINIC MN N/A C DECORAH CLINIC -- MAYO HEALTH SYSTEM 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 NORTHWEST HEALTH VENTURES INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 391528920 PHARMACY SERVICES WI N/A C OWATONNA CLINIC -- MAYO HEALTH SYSTEM 134 SOUTHVIEW OWATONNA MN 55060 411862132 PATIENT CARE - CLINIC MN 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 0 1 1 0 0 0 1 0 1 1 1 1 0 1 1 0 1 1 BARRON MEMORIAL MEDICAL CENTER - MAYO HEALTH SYSTEM K 1060177 GAAP BARRON MEMORIAL MEDICAL CENTER - MAYO HEALTH SYSTEM N 249639 GAAP BLOOMER MEMORIAL MEDICAL CENTER INC - MAYO HEALTH SYSTEM K 1253037 GAAP BLOOMER MEMORIAL MEDICAL CENTER INC - MAYO HEALTH SYSTEM N 383988 GAAP MIDELFORT CLINIC LTD - MAYO HEALTH SYSTEM R 372499 GAAP MIDELFORT CLINIC LTD - MAYO HEALTH SYSTEM K 3047333 GAAP MIDELFORT CLINIC LTD - MAYO HEALTH SYSTEM N 4986936 GAAP MIDELFORT CLINIC LTD - 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