2011-11-08T09:46:14-06:00 2010-12-31 990 2010-01-01 410760836 MAYO CLINIC HEALTH SYSTEM-FAIRMONT MAYO 5075381297 800 MEDICAL CENTER DRIVE FAIRMONT MN 56031 JAMES J TARASOVITCH 5073852646 2011-11-08 2010 2016-03-07 17:11:31Z fka FAIRMONT MEDICAL CENTER - MAYO GREGORY KUTCHER MD 800 MEDICAL CENTER DRIVE FAIRMONT MN 56031 81120773 0 X WWW.FAIRMONTMEDICALCENTER.ORG X 1940 MN HOSPITAL, NURSING HOME, AND CLINICS 8 4 1126 219 0 0 366732 383039 82323501 80313422 -4261 -57954 387387 389728 83073359 81028235 17578 12747 0 0 52002767 50748434 0 0 204617 30164296 29217930 82184641 79979111 888718 1049124 49468373 46623017 22616051 19199870 26852322 27423147 X TO INSPIRE HOPE AND CONTRIBUTIONS TO HEALTH AND WELL-BEING BY PROVIDING THE BEST CARE TO EVERY PATIENT THROUGH INTEGRATED CLINICAL PRACTICE, EDUCATION AND RESEARCH. 0 0 70106911 80471495 PATIENT SERVICES (SEE SCHEDULE O)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.PATIENT SERVICES: THE MEDICAL CENTER PROVIDES CARE TO PATIENTS IN THE CLINIC SETTING, THE FMC EYE CLINIC, THE HOSPITAL, EMERGENCY ROOM, LONG-TERM CARE, AND OTHER MEDICAL SERVICES TO THE COMMUNITY OF FAIRMONT, MINNESOTA, AND THE SURROUNDING SOUTH CENTRAL MINNESOTA AND NORTH CENTRAL IOWA SERVICE AREA. THE MEDICAL CENTER IS A "SOLE COMMUNITY HOSPITAL". THE MEDICAL CENTER'S OPERATIONS CONSIST OF A 57-BED ACUTE CARE HOSPITAL, AN ATTACHED 40-BED SKILLED CARE NURSING HOME, AN ATTACHED PROVIDER-BASED CLINIC WITH SATELLITE REGIONAL CLINICS LOCATED IN SHERBURN, MINNESOTA AND TRUMAN, MINNESOTA, CONVENIENT CARE CLINIC LOCATED IN THE WALMART STORE IN FAIRMONT, MINNESOTA, AND SATELLITE CLINICS LOCATED IN ARMSTRONG, IOWA, AND SWEA CITY, IOWA. THE MEDICAL CENTER'S MISSION, VISION AND VALUES STATEMENT IS LISTED BELOW:MISSION: TO PROVIDE HOPE AND CONTRIBUTE TO HEALTH AND WELL-BEING BY PROVIDING THE BEST CARE TO EVERY PATIENT THROUGH INTEGRATED CLINICAL PRACTICE, EDUCATION AND RESEARCH.VISION: MAYO CLINIC WILL PROVIDE AN UNPARALLELED EXPERIENCE AS THE MOST TRUSTED PARTNER FOR HEALTH CARE.PRIMARY VALUE: THE NEEDS OF THE PATIENT COME FIRST.FAIRMONT MEDICAL CENTER PROVIDES CHARITY CARE FOR PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. FAIRMONT MEDICAL CENTER ALSO PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. THE TOTAL COST OF CHARITY CARE PROVIDED IN 2010 WAS APPROXIMATELY $404,000. THE TOTAL COST OF UNCOMPENSATED CARE PROVIDED TO LOW INCOME PATIENTS THROUGH MEDICAID AND MINNESOTACARE (A STATE PROGRAM FOR PROVIDING MEDICAL CARE TO LOW INCOME POPULATION)WAS APPROXIMATELY $2,037,000. INCLUDED IS THIS AMOUNT IS THE MEDICAID SURCHARGE OF $619,154 AND THE MINNESOTACARE TAX OF $946,994.THE TOTAL UNREIMBURSED COST OF MEDICARE WAS APPROXIMATELY $6,362,000. 235694 1500 4582 MEDICAL EDUCATON (SEE SCHEDULE O)MEDICAL EDUCATION:FAIRMONT MEDICAL CENTER PROVIDES CLINICAL EXPERIENCE TO STUDENTS OF IOWA LAKES COMMUNITY COLLEGE, MINNESOTA WEST COMMUNITY COLLEGE, SOUTH CENTRAL COLLEGE, RIVERLAND COMMUNITY COLLEGE, AND PRESENTATION COLLEGE.FAIRMONT MEDICAL CENTER PROVIDED $1500 IN SCHOLARSHIPS TO LOCAL COMMUNITY STUDENTS PURSUING A HEALTH-RELATED CAREER.THE MEDICAL CENTER ALSO OFFERED BLOOD PRESSURE SCREENINGS, DEPRESSION SCREENINGS, AND FLU IMMUNIZATIONS TO THE COMMUNITY. FAIRMONT MEDICAL CENTER OFFERS NUMEROUS EDUCATIONAL SEMINARS, CLASSES AND OPPORTUNITIES FOR ITS PATIENTS, THEIR FAMILIES, EMPLOYEES, COMMUNITY MEMBERS, AND THE GENERAL PUBLIC. THE FOLLOWING IS A SAMPLING OF THE EVENTS THAT FAIRMONT MEDICAL CENTER OFFERS: WOMEN'S SEMINAR, PARENTING CLASSES, FAMILY FUN FAIR, MARTIN COUNTY FAIR, SUPPORT GROUPS, GRIEF, CANCER, DIABETES, SLEEP APNEA, "SPEAKING OF" HEALTH BROADCAST; ON CAMPUS PRESENTATIONS; HOMETOWN HEALTH NEWSLETTER MAILINGS. 11247 11247 COMMUNITY CONTRIBUTIONS (SEE SCHEDULE O)COMMUNITY CONTRIBUTIONS:FAIRMONT MEDICAL CENTER PROVIDES FINANCIAL SUPPORT TO THE AMERICAN CANCER SOCIETY, MARCH OF DIMES, PRESENTATION COLLEGE, AND AREA SCHOOLS FOR ATHLETIC AND OTHER YOUTH PROGRAMS. TOTAL DONATIONS IN 2010 WERE APPROXIMATELY $11,250.IN 2010, FAIRMONT MEDICAL CENTER RECEIVED DONATED SERVICES FROM 219 VOLUNTEERS, WHO PROVIDED 14,232 VOLUNTEER HOURS, VALUED AT APPROXIMATELY $303,996 BASED ON THE INDEPENDENT SECTOR'S AVERAGE ESTIMATED HOURLY VALUE OF SUCH SERVICE. 215482 FMC LEASES SPACE AND PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE. 215482 70353852 1 1 0 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 61 0 1 1126 1 0 0 0 0 0 0 0 0 0 0 X 8 4 1 1 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 1 0 0 0 MN X CORPORATE TAX UNIT 5075381297 200 FIRST ST SW ROCHESTER MN 55905 X BROLSMA GREG 1.00 X 0 0 0 BUNKERS MD BRIAN E 1.00 X 0 344767 53660 GAALSWYK MARK 1.00 X 0 0 0 GREEN MD JEFFREY P 40.00 X 225903 0 42191 HAGEDORN STEVEN 1.00 X X 0 217449 56036 KUTCHER MD GREGORY 10.00 X X 0 383913 36179 MANSKE LYNN 1.00 X 0 0 0 STRUCK ALLEN W 1.00 X X 0 0 0 VUOCOLO MD PHILIP 40.00 X X 793235 0 61052 GRACE RICHARD W 10.00 X 0 246470 16095 HANSEN GAYLE 40.00 X 185133 0 25478 PRIBYL STEPHEN J 40.00 X 211270 0 30272 SUTER BRIAN 40.00 X 161199 0 24879 TARASOVITCH JAMES J 10.00 X 0 196637 15325 MORRIS MD MARIE E 40.00 X 353885 0 57763 RODRIGUEZ MD RUFUS 40.00 X 1362132 0 291065 BERTHELSEN MD STEPHEN O 40.00 X 670098 0 79789 HODGES MD LEROY W 40.00 X 740751 0 74775 HOLMES MD WILLIAM F 40.00 X 1091942 0 111721 NEIST MD ROGER L 40.00 X 864129 0 128632 SZUTZ TIMOTHY 40.00 X 1709123 0 227318 HANSEN MD DUWAYNE 40.00 X 143323 0 9860 8512123 1389236 1342090 56 1 1 0 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 MEDICAL SERVICES 931843 IMMANUEL ST JOSEPHS - MAYO HEALTH SYSTEM PO BOX 873 MANKATO MN 56002 MEDICAL SERVICES 421973 MAYO COLLABORATIVE SERVICES INC PO BOX 9146 MINNEAPOLIS MN 55480 LAB SERVICES 317295 WILLIAM E BROWN 1708 N LINWOOD AVE APPLETON WI 54914 NURSING ADMINISTRATION 316909 ARNOLD CASWELL 24315 178TH STREET OKOBOJI IA 51335 ANESTHESIA SERVICES 267538 10 25341 144982 212716 383039 NET PATIENT REVENUE 620000 78234977 78234977 LAB REVENUE 621510 1856685 1856685 RENT FROM AFFILIATES 531120 159166 159166 SHARED SERVICES REV 561000 56316 56316 EDUCATION REVENUE 611600 4582 4582 1696 1696 80313422 34584 34584 11591 11591 11591 11591 92538 -92538 -92538 -92538 CAFETERIA/VENDING 722210 317387 317387 MEDICAL RECORDS 541900 55791 55791 MISC. REVENUE 900099 4959 4959 378137 81028235 80691559 0 -46363 11247 11247 1500 1500 3825458 322051 3503407 35977763 34890429 1011702 75632 2952723 2612168 334944 5611 5588358 4943819 633920 10619 2404132 2126849 272715 4568 165077 158629 6448 5168286 3686135 1478529 3622 305512 30810 197485 77217 11375772 10722013 636385 17374 609759 608937 822 2379640 2021004 358094 542 532772 434108 97577 1087 727237 727237 2990063 2990063 327635 326585 1050 BAD DEBT 2753862 2753862 MN CARE TAX 946993 946993 MEDICAID SURCHARGE 619154 619154 PROF LICENSES & DUES 172912 118058 54829 25 EMPLOYEE RELATED 143256 69767 73489 79979111 70353852 9420642 204617 4315921 3637188 1487073 128180 14685600 13029451 1640297 1671412 671190 1962249 54051163 30874065 24030620 23177098 2637672 3017439 49468373 46623017 5693724 5143492 9106052 7816275 14056378 22616051 19199870 X 25076199 25433785 1202303 1411066 573820 578296 26852322 27423147 49468373 46623017 X 1049124 -478299 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 3005 13662 14407 2260 0 573820 670 60701 56895 578296 519017 54803 573820 519012 5 519017 1.00000 1 1 1 99580 99580 39390893 20189977 19200916 14560690 10684088 3876602 23177098 DUE FROM AFFILIATES 17424 DEFERRED COMPENSATION 1010653 INTEREST IN NET ASSETS OF FDN 1989362 3017439 DUE TO AFFILIATES 13045725 DEFERRED COMPENSATION LIABILITY 1010653 14056378 Part IV, Line 1b: FAIRMONT MEDICAL CENTER HAS A 40 BED SKILLED NURSING HOME. THEY MAINTAIN A "RESIDENT TRUST" ACCOUNT/BANK ACCOUNT FOR THE NURSING HOME RESIDENTS. THE AMOUNT IS NOT INCLUDED ON FAIRMONT'S FINANCIALS. Description of Intended Use of Endowment Funds: Part V, Line 4: ENDOWMENTS ARE USED TO FURTHER THE CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSE OF THE MEDICAL CENTER. 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. 1 1 1 X 300.000000000000 1 X 1 1 1 0 1 1 404316 404316 0.00520 13718183 11681172 2037011 0.02640 14122499 11681172 2441327 0.03160 177525 177525 0.00230 235694 235694 0.00310 1403520 1283488 120032 0.00160 21346 21346 0.00030 1838085 1283488 554597 0.00730 15960584 12964660 2995924 0.03890 0 1491908 14993896 18013220 -3019324 X 1 1 1 1 FAIRMONT MEDICAL CENTER-MAYO HEALTH SYST

800 MEDICAL CENTER DRIVE FAIRMONT MN 56031

X X X CLINIC, NURSING HOME, HOME CARE, HOSPICE, SWING BED NOT REQUIRED 1 6 FAIRMONT MEDICAL CENTER-MAYO HEALTH SYST

412 6TH STREET ARMSTRONG IA 50514

CLINIC FAIRMONT MEDICAL CENTER-MAYO HEALTH SYST

32 N MAIN STREET SHERBURN MN 56171

CLINIC FAIRMONT MEDICAL CENTER-MAYO HEALTH SYST

401 N 4TH AVE E TRUMAN MN 56088

CLINIC FAIRMONT MEDICAL CENTER-MAYO HEALTH SYST

411 S GROVE ST SUITE 3 BLUE EARTH MN 56013

PSYCHOLOGY SERVICES CLINIC FAIRMONT MEDICAL CENTER-MAYO HEALTH SYST

207 3RD STREET NORTH SWEA CITY IA 50590

CLINIC FAIRMONT MEDICAL CENTER-MAYO HEALTH SYST

1250 GOEMANN ROAD FAIRMONT MN 56013

CLINIC Part I, Line 6a: THE ANNUAL REPORT FOR THE FILING ORGANIZATION IS PART OF A CONSOLIDATED REPORT PREPARED BY MAYO CLINIC. Part I, Line 7: A COST-TO-CHARGE RATIO (FROM WORKSHEET 2) IS USED TO CALCULATE THE AMOUNTS ON LINE 7A-7C (FINANCIAL ASSISTANCE, MEDICAID SHORTFALL, AND OTHER MEANS-TESTED GOVERNMENT PROGRAMS).THE AMOUNTS FOR LINES 7E-7I WOULD COME FROM THE BOOKS AND RECORDS OF SPECIFIC SEGMENTS OF THE ORGANIZATION AND WOULD NOT BE BASED ON A COST-TO-CHARGE RATIO. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 2753862. Part III, Line 4: FAIRMONT MEDICAL CENTER - MAYO HEALTH SYSTEM REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.ACCOUNTS RECEIVABLE FOR MEDICAL SERVICES - ACCOUNTS RECEIVABLE FOR MEDICAL SERVICES ARE STATED AT NET REALIZABLE VALUE. THE CLINIC ESTIMATES THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED ON HISTORIC WRITE-OFFS AND THE AGING OF THE ACCOUNTS. ACCOUNTS ARE WRITTEN OFF WHEN COLLECTION EFFORTS HAVE BEEN EXHAUSTED.BAD DEBT EXPENSE AT COST IS DETERMINED USING THE SAME COST-TO-CHARGE RATIO THAT IS USED TO CALCULATE CHARITY CARE AND MEDICAID SHORTFALL. DISCOUNTS AND ALLOWANCES ARE ACCOUNTED FOR SEPARATELY FROM BAD DEBT EXPENSE. Part III, Line 8: THE METHODOLOGY DESCRIBED IN THE INSTRUCTIONS TO SCHEDULE H, PART III, SECTION B, LINE 6 DOES NOT TAKE INTO ACCOUNT ALL COSTS INCURRED BY THE HOSPITAL AND DOES NOT REPRESENT THE TOTAL COMMUNITY BENEFIT CONFERRED IN THIS AREA. THE MEDICARE SHORTFALL REFLECTED ON SCHEDULE H, PART III, SECTION B WAS DETERMINED USING INFORMATION FROM THE ORGANIZATION'S MEDICARE COST REPORT (USING A MEDICARE COST REPORT STEP-DOWN METHODOLOGY). HOWEVER, USING A FINANCIAL STATEMENT COST-TO-CHARGE RATIO METHODOLOGY ACTUALLY RESULTS IN A MEDICARE SHORTFALL OF APPROXIMATELY $6,362,000 AS REPORTED IN THE CORE FORM, PART III, PROGRAM SERVICE ACCOMPLISHMENTS.THE MOST COMMON REASONS FOR A DIFFERENCE BETWEEN THE MEDICARE SHORTFALL REPORTED ON SCHEDULE H AND THE MEDICARE SHORTFALL REPORTED ON THE CORE FORM, PART III INCLUDE: (1) INCLUSION OF MEDICARE ADVANTAGE REVENUE AND EXPENSES; (2) INCLUSION OF PART B REVENUE AND EXPENSES; (3) INCLUSION OF OTHER FEE SCHEDULE REVENUE; AND (4) SOME TIMING ISSUES.REASONS WHY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT ARE: (1) ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS; (2) BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS; (3) THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS; AND (4) THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. Part III, Line 9b: MAYO CLINIC AND ITS AFFILIATES STRIVE TO ASSIST ALL PATIENTS IN MEETING THEIR FINANCIAL OBLIGATION PRIOR TO ENLISTING THE ASSISTANCE OF A COLLECTION AGENCY BY MAKING 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 2: FAIRMONT MEDICAL CENTER - MAYO HEALTH SYSTEM (FMC) COLLABORATES WITH PUBLIC AND PRIVATE GROUPS IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. FMC WORKS CLOSELY WITH THE HEALTH AND HUMAN SERVICES AGENCY THAT SERVES MARTIN AND FARIBAULT COUNTIES (MINNESOTA) WHICH IS FMC'S MAIN SERVICE AREA, IN UNDERSTANDING THE NEEDS. DATA IS ALSO RESEARCHED, STUDIED, AND USED IN STRATEGIC PLANNING. DATA SOURCES INCLUDE COUNTY DATA, STATE DATA, AND MINNESOTA HOSPITAL ASSOCIATION DATA. IN ADDITION, FMC PRESENTS PUBLIC EDUCATION EVENTS THROUGHOUT THE YEAR AND HAS LOCAL CABLE INFORMATIVE PROGRAMS. 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. MAYO CLINIC EMPLOYEES MAY REFER PATIENTS TO A FINANCIAL COUNSELOR.3. COLLECTION AGENCIES MAY REFER PATIENTS.4. THE BUSINESS SERVICES/PATIENT FINANCIAL SERVICES DEPARTMENT MAY REFER PATIENTS TO A FINANCIAL COUNSELOR.5. REFERRING PHYSICIANS MAY REFER PATIENTS.6. MAYO PHYSICIANS MAY REFER PATIENTS.7. 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. MAYO CLINIC 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: FAIRMONT MEDICAL CENTER - MAYO HEALTH SYSTEM IS AN INTEGRATED HEALTHCARE DELIVERY SYSTEM THAT SERVES THE RESIDENTS OF MARTIN, FARIBAULT, WATONWAN, AND JACKSON COUNTIES IN MINNESOTA AND KOSSUTH, EMMETT, AND PALO ALTO COUNTIES IN IOWA. THE MAIN CITY SERVED IS FAIRMONT, MINNESOTA WITH THE BALANCE OF THE SERVICE AREA BEING SMALL TOWNS OR RURAL AGRICULTURAL AREAS. THE AREA POPULATION IS TRENDING OLDER THAN THE STATEWIDE AVERAGE. THE MAIN INDUSTRY IN THE SERVICE AREA IS AGRICULURAL BASED. Part VI, Line 6: THIS FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST." THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION- EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATION'S ACTIVITIES.SURPLUS FUNDS:MAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE. COMMUNITY REPRESENTATION ON GOVERNING BODY:THE BOARD OF TRUSTEES IS THE GOVERNING BODY OF MAYO CLINIC. A MAJORITY OF ITS MEMBERS ARE EXTERNAL, INDEPENDENT TRUSTEES. IT HAS OVERALL RESPONSIBILITY FOR THE CHARITABLE, CLINICAL PRACTICE, SCIENTIFIC AND EDUCATIONAL MISSION AND PURPOSES OF MAYO CLINIC AND ITS AFFILIATES AS SET FORTH IN ITS ARTICLES OF INCORPORATION AND BYLAWS. BECAUSE OF MAYO CLINIC'S NATIONAL PRESENCE, THESE TRUSTEES ARE SELECTED BASED ON THEIR AREAS OF EXPERTISE, WHETHER IN HEALTH CARE POLICY, BUSINESS, GOVERNMENT OR ANOTHER FIELD. IN ADDITION TO THIS COMMUNITY REPRESENTATION AT THE PARENT ENTITY, THE FILING ORGANIZATION ALSO INVOLVES LOCAL COMMUNITY MEMBERS ON ITS GOVERNING BODY. OPEN V. CLOSED STAFF MODEL:STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.EMERGENCY ROOM: THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. Part VI, Line 7: THIS ORGANIZATION IS A PART OF MAYO CLINIC HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO CLINIC HEALTH SYSTEM IS DESCRIBED IN RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). THAT STATEMENT ALSO DESCRIBES THE ROLES OF THE VARIOUS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED. SCHEDULE H, 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 X 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. X X 1 1 X X X X 1 1 0 0 0 0 0 0 1 1 BUNKERS MD BRIAN E 0 250672 0 0 0 94095 0 27100 0 26560 0 398427 0 0 GREEN MD JEFFREY P 212870 0 0 0 13033 0 17399 0 24792 0 268094 0 0 0 HAGEDORN STEVEN 0 214842 0 0 0 2607 0 30887 0 25149 0 273485 0 0 KUTCHER MD GREGORY 0 346309 0 37604 0 0 0 12250 0 23929 0 420092 0 0 VUOCOLO MD PHILIP 421658 0 0 0 371577 0 36704 0 24348 0 854287 0 0 0 GRACE RICHARD W 0 230365 0 0 0 16105 0 733 0 15362 0 262565 0 0 HANSEN GAYLE 183602 0 0 0 1531 0 17921 0 7557 0 210611 0 0 0 PRIBYL STEPHEN J 191787 0 0 0 19483 0 27216 0 3056 0 241542 0 0 0 SUTER BRIAN 160199 0 0 0 1000 0 12096 0 12783 0 186078 0 0 0 TARASOVITCH JAMES J 0 192924 0 0 0 3713 0 0 0 15325 0 211962 0 0 MORRIS MD MARIE E 321246 0 0 0 32639 0 34471 0 23292 0 411648 0 0 0 RODRIGUEZ MD RUFUS 728893 0 0 0 633239 0 259318 0 31747 0 1653197 0 149509 0 BERTHELSEN MD STEPHEN O 647666 0 0 0 22432 0 63721 0 16068 0 749887 0 0 0 HODGES MD LEROY W 666306 0 50000 0 24445 0 45918 0 28857 0 815526 0 0 0 HOLMES MD WILLIAM F 363156 0 0 0 728786 0 92275 0 19446 0 1203663 0 66844 0 NEIST MD ROGER L 521726 0 0 0 342403 0 109770 0 18862 0 992761 0 120522 0 SZUTZ TIMOTHY 797502 0 0 0 911621 0 202333 0 24985 0 1936441 0 145307 0 HANSEN MD DUWAYNE 133437 0 0 0 9886 0 41 0 9819 0 153183 0 0 0 Part I, Line 1a TWO OF THE LISTED PERSONS RECEIVED AN AWARD OR OTHER TANGIBLE RECOGNITION THAT WAS TREATED AS TAXABLE COMPENSATION. PURSUANT TO INSTITUTIONAL POLICIES, CERTAIN SUCH AWARDS HAVE A TAX GROSS-UP APPLIED IN ORDER NOT TO DIMINISH THE RECOGNITION AND CELEBRATORY NATURE OF THE AWARD. MAYO CLINIC AND AFFILIATES HAVE A NON-QUALIFIED DEFERRED COMPENSATION PLAN (SEE SCHEDULE J, PART I, LINE 4b) THAT INCLUDES A PARTIAL TAX ADJUSTMENT FOR PAYMENTS FROM THE PLAN OTHER THAN THE CURRENT COMPENSATION COMPONENT. HEALTH CLUB DUES TO "ANYTIME FITNESS" WERE PAID BY FAIRMONT MEDICAL CENTER ON BEHALF OF PAID EMPLOYEES WHO MET THE ATTENDANCE REQUIRMENTS. Part I, Lines 4a-b IN 2010, DR. PHILIP VUOCOLO RECEIVED A SEVERENCE PAYMENT IN THE AMOUNT OF $361,333. THIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(a)(17). 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 YEARS FORM 990. THESE AMOUNTS HAVE BEEN ACCRUED OVER THE SPAN OF THE INDIVIDUAL'S CAREER AT MAYO. STEPHEN BERTHELSEN, M.D. $ 17,125 JEFFREY GREEN, M.D. $ 11,598 DUWAYNE HANSEN, M.D. $ 7,960 LEROY HODGES, M.D. $ 19,575 WILLIAM HOLMES, M.D. $720,381 MARIE MORRIS, M.D. $ 30,918 ROGER NEIST, M.D. $330,256 RUFUS RODRIGUEZ, M.D. $424,694 TIMOTHY SZUTZ, M.D. $902,483 PHILIP VUOCOLO, M.D. $ 7,125 Part I, Line 8 THE ORGANIZATION'S CEO, PHILIPP VUOCOLO M.D., WHO WAS HIRED IN 2008 WAS WORKING UNDER HIS INITIAL CONTRACT IN 2010 PRIOR TO LEAVING THE ORGANIZATION. IN ADDITION TO A REVIEW AT THE LOCAL LEVEL, 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. Supplemental Information Part III COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. MICHELE L BRENNAN-VUOCOLO SPOUSE OF OFFICER 62078 COMPENSATION 0 Form 990, Part VI, Section A, line 2 DUE TO OVERLAP OF BOARD MEMBERSHIP AND EMPLOYMENT ON RELATED EXEMPT ENTITIES, PHILIP VUOCOLO, M.D. HAS A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL(S): GRACE, RICHARD W. KUTCHER M.D., GREGORY TARASOVITCH, JAMES J. Form 990, Part VI, Section A, line 3 MAYO-AFFILIATED ENTITIES ROUTINELY DELEGATED VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO RELATED ENTITIES. Form 990, Part VI, Section A, line 6 THE SOLE CORPORATE MEMBER IS MAYO CLINIC ROCHESTER. Form 990, Part VI, Section A, line 7a THE SOLE CORPORATE MEMBER SHALL APPOINT/REPLACE THREE MEMBERS OF THE BOARD. Form 990, Part VI, Section B, line 11 THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER AND FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF FAIRMONT MEDICAL CENTER'S GOVERNING BODY VIA US MAIL, E-MAIL, OR DISTRIBUTION AT A BOARD MEETING. HIGHLIGHTS ARE PRESENTED TO BOARD MEMBERS, AND THE REVIEW IS DOCUMENTED IN MEETING MINUTES. ALL QUESTIONS ARE ADDRESSED PRIOR TO FILING THE FORM 990. Form 990, Part VI, Section B, line 12c MAYO CLINIC AND ITS AFFILIATES HAVE A COMPREHENSIVE CONFLICT OF INTEREST POLICY APPLICABLE TO ALL OF THE AFFILIATED ENTITIES AND TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES OF THOSE ENTITIES. ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES WHO WE ANTICIPATE WILL BE LISTED ON A FORM 990 ARE ASKED TO COMPLETE AN "ANNUAL TAX AND COMPLIANCE DISCLOSURE" FORM. THIS INFORMATION IS REVIEWED BY BOTH THE CORPORATE TAX DEPARTMENT AND THE OFFICE OF CONFLICT OF INTEREST REVIEW. ALL DISCLOSURES OF CURRENT OR PROPOSED ACTIVITY THAT REQUIRE ACTION UNDER THE POLICY ARE THE SUBJECT OF ONGOING REVIEW AND ACTION THROUGH THE OFFICE OF CONFLICT OF INTEREST REVIEW AND THE CONFLICT OF INTEREST REVIEW BOARD. INVOLVED INDIVIDUALS ARE INFORMED OF ALL REQUIRED ACTION. MANY TYPES OF RELATIONSHIPS THAT COULD CREATE CONFLICTS OF INTEREST ARE PROHIBITED. OTHER TYPES OF RELATIONSHIPS ARE PERMITTED SUBJECT TO COMPLIANCE WITH THE MANAGEMENT PLAN ESTABLISHED BY THE CONFLICT OF INTEREST REVIEW BOARD. A COMMON MANAGEMENT STRATEGY FOR PERMITTED ACTIVITIES IS TO REQUIRE BILATERAL RECUSAL AND APPROPRIATE DOCUMENTATION IN THE MINUTES OF MAYO CLINIC (AND/OR AFFILIATE) AND THE OUTSIDE ENTITY. ADDITIONAL CONFLICT OF INTEREST POLICIES AND PROCEDURES EXIST FOR CERTAIN ENTITIES CONCERNING RESEARCH CONTRACTS AND OTHER TYPES OF POTENTIAL CONFLICTS. FORM 990,PART VI, SECTION B, LINES 15A AND 15B: THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY. THE SALARY OF THE CEO AND CAO WHO WERE APPOINTED MID-YEAR WERE REVIEWED BY THE MAYO HEALTH SYSTEM COMPENSATION AND BENEFITS PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO HEALTH SYSTEM PHYSICIANS. 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 FIVE OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. Form 990, Part VI, Section C, line 18 FORM 990 IS AVAILABLE UPON REQUEST. Form 990, Part VI, Section C, line 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CONFLICT OF INTEREST POLICY IS AVAILABLE ON THE MAYO CLINIC WEBSITE, WWW.MAYOCLINIC.ORG. AVERAGE HOURS PER WEEK DEVOTED TO POSITION WITH RELATED ORGANIZATION FORM 990, PART VIII, SECTION A BRIAN E. BUNKERS M.D. 40.0 RICHARD W. GRACE 40.0 STEVEN HAGEDORN M.D. 40.0 GREGORY KUTCHER M.D. 40.0 JAMES J. TARASOVITCH 40.0 Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 16,945. DISCONTINUED HOME CARE & HOSPICE -708,483. CHANGE IN AMOUNT HELD BY FOUNDATION 213,239. Total to Form 990, Part XI, Line 5: -478,299. PART XII LINE 2C EXPLANATION 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 1 0 1 0 0 0 0 0 0 0 1 1 0 1 1 0 1 1 MAYO CLINIC A 62388 GAAP MAYO CLINIC - METHODIST HOSPITAL A 88890 GAAP MAYO CLINIC C 212716 GAAP MAYO CLINIC L 931843 GAAP MAYO COLLABORATIVE SERVICES INC L 317295 GAAP IMMANUEL ST JOSEPH'S - MAYO HEALTH SYSTEM N 389032 GAAP MAYO FOUNDATION FOR MEDICAL EDUCATION & RESEARCH N 34191142 GAAP AUSTIN MEDICAL CENTER - MAYO HEALTH SYSTEM O 52432 GAAP MAYO CLINIC Q 109404 GAAP MAYO FOUNDATION FOR MEDICAL EDUCATION & RESEARCH Q 194876 GAAP MMSI INC Q 5730978 GAAP