2013-07-26T13:34:46-05:00 2012-12-31 990 2012-01-01 390813418 MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL INC MAYO 5075381297 1221 WHIPPLE STREET EAU CLAIRE WI 54703 PAUL BAMMEL 5075381297 2013-07-26 2012 2016-02-24 21:20:13Z RANDALL LINTON MD 1221 WHIPPLE STREET EAU CLAIRE WI 54703 288903734 0 X WWW.MAYOCLINICHEALTHSYSTEM.ORG X 1905 WI OPERATION OF A HOSPITAL. 11 5 2193 509 13716 274 3006734 3120190 264022907 276684924 3466428 5769264 2730401 2897955 273226470 288472333 5002051 5055062 0 0 99980687 106850254 0 0 861683 130633060 144672856 235615798 256578172 37610672 31894161 478448234 506036497 139304474 144549983 339143760 361486514 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 227462141 5000000 277456021 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 2012, MAYO CLINIC HEALTH SYSTEM SITES EMPLOYED APPROXIMATELY 1,000 PHYSICIANS AND 14,000 ALLIED HEALTH STAFF. IN ADDITION, MAYO CLINIC PHYSICIANS FROM MULTIPLE SPECIALTIES REGULARLY SEE PATIENTS AT THE MAYO CLINIC HEALTH SYSTEM FACILITIES. BESIDES HAVING HEALTH CARE FACILITIES IN 72 COMMUNITIES, THE SYSTEM INCLUDES 18 OWNED HOSPITALS, SIX OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH TWO ADDITIONAL HOSPITALS, AND CONTRACT MANAGEMENT AGREEMENTS WITH AN ADDITIONAL HOSPITAL AND NURSING HOME. SINCE ITS INCEPTION IN 1992, MAYO CLINIC HEALTH SYSTEM HAS GROWN FROM A NEW IDEA TO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN AMERICA. MAYO CLINIC HEALTH SYSTEM COMPLETES MORE THAN TWO-MILLION PATIENT VISITS ANNUALLY. IT ALSO SERVES AS A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS BEING RECOGNIZED SIX TIMES BY THE AMERICAN MEDICAL GROUP ASSOCIATION'S ACCLAIM AWARD PROGRAM (2005 ACCLAIM AWARD RECIPIENT AND FIVE-TIME ACCLAIM AWARD HONOREE). THE ACCLAIM AWARDS HONOR PHYSICIAN-LED ORGANIZATIONS DELIVERING CARE ALIGNED WITH THE IDEAL DELIVERY MODEL WHERE PATIENTS EXPERIENCE SAFE, RELIABLE, RESPONSIVE, READILY AVAILABLE AND INTEGRATED CARE. IN ADDITION, THE MINNESOTA COUNCIL FOR QUALITY HAS RECOGNIZED MAYO CLINIC HEALTH SYSTEM THREE TIMES FOR ITS PERFORMANCE EXCELLENCE EFFORTS. INDIVIDUAL MAYO CLINIC HEALTH SYSTEM LOCATIONS HAVE ALSO BEEN HONORED FOR THEIR COMMITMENT TO QUALITY, SAFETY, SERVICE, PERFORMANCE AND THEIR COMMUNITIES.PEOPLE IN MINNESOTA, IOWA AND WISCONSIN CAN HAVE PEACE OF MIND KNOWING THAT MAYO CLINIC HEALTH SYSTEM AND MAYO CLINIC PARTNER TO ENSURE HEALTHIER LIVES IN THE REGION. 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 2012, THE HOSPITAL SERVED 11,653 INPATIENTS. IN ADDITION, 82,392 PEOPLE RECEIVED OUTPATIENT MEDICAL CARE INCLUDING 22,688 PATIENTS TREATED IN THE EMERGENCY ROOM. THE HOSPITAL HAS 18 OPERATING ROOMS WHERE 10,640 SURGICAL PROCEDURES WERE PERFORMED IN 2012.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.IN ADDITION TO SERVING THE RESIDENTS OF EAU CLAIRE, THE HOSPITAL AND THE CLINIC HAVE EVOLVED INTO REGIONAL REFERRAL CENTERS WHICH OFFER A FULL RANGE OF MEDICAL SERVICES THROUGH A NETWORK OF RURAL COMMUNITY-BASED HEALTHCARE PROVIDERS IN SEVERAL LOCATIONS THROUGHOUT WEST-CENTRAL WISCONSIN, INCLUDING BARRON, BLOOMER, CAMERON, CHETEK, CHIPPEWA FALLS, COLFAX, MENOMONIE, MONDOVI, OSSEO AND PRAIRIE FARM. THE FACILITIES IN THESE OUTLYING RURAL COMMUNITIES ARE SMALL NONPROFIT CLINICS AND HOSPITALS OWNED BY ORGANIZATIONS THAT ARE CONTROLLED BY THE HOSPITAL AND ARE LIKEWISE EXEMPT UNDER SECTION 501(C)(3) OF THE CODE. 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 2012, THE HOSPITAL PROVIDED APPROXIMATELY $4,868,894 OF FINANCIAL ASSISTANCE (AT COST) TO PATIENTS. THE UNREIMBURSED COST OF SERVICES TO MEDICAID PATIENTS WAS APPROXIMATELY $8,449,825 AND THE UNREIMBURSED COST OF SERVICES TO PATIENTS UNDER OTHER MEANS TESTED GOVERNMENT PROGRAMS WAS APPROXIMATELY $1,278,279. THE UNREIMBURSED COST OF SERVICES TO MEDICARE PATIENTS WAS APPROXIMATELY $21,136,585.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. 1648540 772470 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. 486274 55062 1980 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 1,450 PEOPLE PARTICIPATED IN CHILDBIRTH CLASSES GIVEN FOR EXPECTANCT PARENTS AND THEIR CHILDREN IN 2012.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 ARE OFFERED EVERY THURSDAY TO AREA RESIDENTS. IN 2012, 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 170 WALKERS ARE PART OF THE "HEART 'N SOLE" WALKING CLUB AT THE MALL AND RECEIVE EXERCISE AND FITNESS TIPS IN A QUARTERLY NEWSLETTER.THE HOSPITAL AND THE CLINIC, IN PARTNERSHIP WITH THE EAU CLAIRE YMCA, OFFERS "CAMP WABI". THIS PROGRAM IS SPECIFICALLY FOR CHILDREN DEALING WITH OBESITY. IN A FUN, OUTDOOR SETTING, THESE CHILDREN (AGES 10-14) LEARN HOW TO MAKE LIFESTYLE CHANGES NECESSARY TO ACHIEVE A HEALTHY WEIGHT. THE CLINIC AND HOSPITAL CONTRIBUTE HALF OF THE COST OF THIS 12-DAY CAMP AND ALSO OFFER SCHOLARSHIP MONIES IF NEEDED. SPECIALISTS WITH EXPERTISE IN NUTRITION, BEHAVIOR THERAPY AND EXERCISE PHYSIOLOGY TAKE PART IN CAMP PLANNING AND PROGRAMMING. THIS IS THE SECOND YEAR THIS PROGRAM HAS BEEN OFFERED TO THE COMMUNITY.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 2012, HOSPITAL AND CLINIC EMPLOYEES RAISED $26,568 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 16 TEAMS, APPROXIMATELY 100 WALKERS, RAISED $16,000.THE HOSPITAL AND THE CLINIC WERE A CORPORATE SPONSOR FOR THE "EPILEPSY STROLL IN THE PARK" EVENT WHICH RAISED MORE THAN $23,900. THE HOSPITAL AND THE CLINIC ALSO SPONSORED THE "SHARE THE FLAME" EVENT AND RAISED ANOTHER $15,600 FOR THE EPILEPSY FOUNDATION.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.THE LIBRARY & AV SERVICES DEPARTMENT 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.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 509 COMMUNITY VOLUNTEERS PROVIDED APPROXIMATELY 53,485 HOURS OF DONATED TIME TO THE HOSPITAL IN 2012. 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 2012 IS VALUED AT APPROXIMATELY $1,184,158 BASED ON STATISTICS FROM THE INDEPENDENT SECTOR. 229596955 1 1 0 1 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 0 0 0 0 0 1 1 1 0 0 1 0 0 2193 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 0 0 WI X CORPORATE TAX UNIT 5075381297 200 FIRST STREET SW ROCHESTER MN 55905 BOLTON JEFFREY W 1.00 40.00 X 0 777777 59357 CLUMPNER DANIEL 1.00 0.00 X X 0 0 0 HORECKI MD RICHARD J 1.00 40.00 X X 0 379610 66133 LINTON MD RANDALL L 1.00 40.00 X X 0 576300 64577 MOORE EMILY 1.00 0.00 X 0 0 0 NESSE MD ROBERT E 1.00 40.00 X 0 688141 18683 OLSON RICK 1.00 0.00 X 0 0 0 PEDERSON DUANE 1.00 0.00 X 0 0 0 SANTRACH MD PAULA J 1.00 40.00 X 0 381010 52943 SIMPSON MD HENRY J 1.00 40.00 X 0 299001 45476 TOLANDER JANET 1.00 0.00 X 0 0 0 WAHL BETTE 1.00 0.00 X 0 0 0 BAMMEL PAUL M 1.00 40.00 X 0 300711 61408 DICKEY JOHN M 1.00 40.00 X 0 362803 64223 KILNESS RUTH A 1.00 40.00 X 0 75395 25597 FRANK LINDA A 40.00 0.00 X 191046 0 21149 POPE DENNIS W 40.00 0.00 X 213632 0 59024 WHITE PAMELA K 40.00 0.00 X 188764 0 32973 WITTROCK EDWARD A 40.00 0.00 X 195411 0 49149 HARELSTAD JULIA M 40.00 0.00 X 139243 0 20053 HITZKE RONALD S 40.00 0.00 X 157221 0 20279 JONES CAREY LEE 40.00 0.00 X 147219 0 26794 KNIGHT MARY M 40.00 0.00 X 175704 0 18842 WINTER MARK D 40.00 0.00 X 140427 0 29659 1548667 3840748 736319 54 0 1 0 MAYO FOUNDATION FOR MEDICAL EDUCATION & 200 FIRST STREET SW ROCHESTER MN 55905 PROCUREMENT/SUPPORT SERVICES 32332374 MCHS - EAU CLAIRE CLINIC INC PO BOX 1510 EAU CLAIRE WI 54702 MEDICAL/SUPPORT SERVICES 6593902 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 MEDICAL/SUPPORT SERVICES 4726660 MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 LAB SERVICES 657357 MMSI INC 200 FIRST STREET SW ROCHESTER MN 55905 CLAIMS PROCESSING 344965 9 59641 213578 2846971 19860 3120190 NET PATIENT REVENUE 620000 269621355 269621355 RENTS FROM AFFILIATES 531120 3569999 3569999 SHARED SERVICES REVENU 561000 2744555 2744555 EDUCATION REVENUE 611600 654279 654279 WOMEN'S HEALTH CENTER 621300 94736 94736 276684924 5603948 5603948 125421 164244 -38823 -38823 -38823 247284 81968 165316 165316 165316 23286 59641 20771 2515 2515 2215 10045 -7830 -7830 251767 154373 97394 97394 CAFETERIA/VENDING 722210 1373762 1373762 EMPLOYEE CHILDCARE 624410 1217064 1217064 MEDICAL RECORD FEES 541900 162751 162751 91122 9034 13716 68372 2844699 288472333 278230471 13716 7107956 X 5055062 5055062 951148 433932 517216 277575 130399 147176 91198023 81593817 9228882 375324 1873750 1739375 126257 8118 5953182 5332069 596263 24850 6596576 5870953 698577 27046 435480 273556 161924 143389 143389 684123 58 684065 6301 6301 41616 41616 33594907 30694302 2615341 285264 834533 6911 827262 360 13686652 11969826 1696122 20704 2230586 1163570 1067016 2299 2299 6114181 211807 5790221 112153 737148 584125 147548 5475 2060 1557 443 60 4283512 4283512 22289192 20973282 1314551 1359 327133 327133 MEDICAL SUPPLIES 40777927 40777927 BAD DEBT EXPENSE 10545920 10545920 MEDICAID SURCHARGE 7527515 7527515 EMPLOYEE EXPENSES 361875 62406 299294 175 46507 29341 16371 795 256578172 229596955 26119534 861683 6694 12661 72964 4414 3086521 2672410 43904545 42152661 26526 35086 861242 1049192 5830833 4852064 423149090 169222334 262035415 253926756 149625707 191153218 12997787 10178035 478448234 506036497 30939035 43132183 18307 0 87130000 83838874 21217132 17578926 139304474 144549983 X 334773226 357218964 3716268 3591935 654266 675615 339143760 361486514 478448234 506036497 X 31894161 8797791 -18349198 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6301 6301 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING. 20284787 21350 13702678 34008815 18368773 25066 1890948 20284787 12955759 11095 5401919 18368773 11636431 4299 1315029 12955759 14172465 31307 -2567341 11636431 0.97000 0.02000 0.01000 0 1 1 8995113 8995113 296001040 90031905 205969135 113362975 79190429 34172546 4789962 4789962 253926756 MAYO CLINIC INVESTMENT POOL 191153218 F 191153218 DUE TO AFFILIATES 17578926 17578926 X 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, LINE 2: AT DECEMBER 31, 2012 AND 2011, THE RESERVE FOR UNRECOGNIZED TAX BENEFITS WAS NOT SIGNIFICANT, AND AS A RESULT, THERE IS NO LONGER A RESERVE FOR UNRECOGNIZED TAX BENEFITS RECORDED FOR THE FILING ORGANIZATION. GOLF OUTING 82927 59641 23286 9755 5371 5645 82927 59641 23286 9755 5371 5645 20771 2515 1 1 X 1 X 1 X 1 1 1 0 1 1 4868894 4868894 0.01980 25375755 16925930 8449825 0.03430 6306705 5028426 1278279 0.00520 36551354 21954356 14596998 0.05930 373068 1980 371088 0.00150 1648540 772470 876070 0.00360 47577763 22344388 25233375 0.10260 58209 58209 0.00020 49657580 23118838 26538742 0.10790 86208934 45073194 41135740 0.16720 55000 55000 0.00020 55000 55000 0.00020 0 10545920 59594818 80307665 -20712847 X 1 1 1 1 MCHS - EAU CLAIRE HOSPITAL INC

1221 WHIPPLE STREET EAU CLAIRE WI 54703

X X X MCHS - EAU CLAIRE HOSPITAL INC 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X 1 1 X X X X X 1 0 X X X X X 1 X 0 0 3 MAYO CLINIC DIALYSIS (BARRON)

1222 E WODDLAND AVE BARRON WI 54812

DIALYSIS MAYO CLINIC DIALYSIS (EAU CLAIRE)

3845 LONDON ROAD EAU CLAIRE WI 54701

DIALYSIS MAYO CLINIC DIALYSIS (MENOMONIE)

407 21ST STREET SW MENOMONIE WI 54751

DIALYSIS 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 $ 10545920. PART II: THROUGH DONATIONS AND GRANTS TO PUBLIC, PRIVATE AND NONPROFIT ORGANIZATIONS, THE FILING ORGANIZATION ASSITS WITH SUSTAINING AND ENHANCING THE COMMUNITIES IT SERVES. PART III, LINE 4: THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP.BAD DEBT EXPENSE IS DETERMINED BASED ON GAAP AND IS EXPLAINED IN THE ACCOUNTS RECEIVABLE FOOTNOTE OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS.FOOTNOTES RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS CAN BE FOUND ON PAGES 6, 8, AND 9 OF MAYO CLINIC'S 2012 CONSOLIDATED AUDITED FINANCIAL STATEMENTS. 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 $21,136,585 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 REASONABLE ATTEMPTS TO COLLECT FROM INSURANCE COMPANIES AND OTHER THIRD-PARTY PAYORS. IN ADDITION, MAYO CLINIC AND ITS AFFILIATES ACCEPT REASONABLE PAYMENT PLANS FROM PATIENTS WHEN AN ACCOUNT IS THE PATIENT'S RESPONSIBILITY AND TRY TO IDENTIFY THOSE PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE IS OFFERED TO ANY PATIENT IF THE FACTS AND CIRCUMSTANCES SUGGEST THAT THE PATIENT DOES NOT HAVE THE ABILITY TO PAY THEIR BILL IN WHOLE OR IN PART. IN THE EVENT THAT AN ACCOUNT IS REFERRED TO A COLLECTION AGENCY, GUIDELINES ARE FOLLOWED; INCLUDING SUSPENDING ALL COLLECTION ACTIVITY IF A FINANCIAL ASSISTANCE APPLICATION HAS BEEN SUBMITTED AFTER THE ACCOUNT HAS BEEN REFERRED FOR COLLECTION. IF A COLLECTION AGENCY IDENTIFIES A PATIENT AS MEETING MAYO CLINIC'S FINANCIAL ASSISTANCE ELIGIBILTY CRITERIA OR THE PATIENT ASKS TO APPLY FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY IS SUSPENDED UNTIL MAYO REVIEWS THE ACCOUNT FOR FINANCIAL ASSISTANCE ELIGIBILITY BASED ON SUBMISSION OF REQUESTED INFORMATION. COLLECTION ACTIVITY WOULD ONLY RESUME IF MAYO WOULD TELL THE COLLECTION AGENCY TO PURSUE COLLECTIONS ON THE BALANCE OR PARTIAL BALANCE IF THERE WAS A CHARITY ADJUSTMENT. MCHS - EAU CLAIRE HOSPITAL, INC. PART V, SECTION B, LINE 14G: 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 CLAIRE HOSPITAL, INC. PART V, SECTION B, LINE 18E: FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE TO EVERY PATIENT VIA MAYO'S PUBLIC WEBSITE, FROM CUSTOMER SERVICE AND PATIENT ACCESS LOCATIONS, AND IS REFERENCED ON MAYO'S AUTHORIZATION FORMS AND STATEMENTS. IN ADDITION, BROCHURES ARE AVAILABLE IN THE ADMISSIONS AREA AND THE PROCESS OF HOW TO APPLY IS AVAILABLE ON THE MAYO CLINIC WEBSITE.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, MAYO DISCUSSES ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE.MONTHLY STATEMENTS ARE SENT TO PATIENTS THAT OUTLINE CURRENT CHARGES AND ACTIONS WITH INSURANCE AND INCLUDES INFORMATION ABOUT MAYO'S CHARITY CARE POLICY. SOME MAYO SITES UTILIZE ADVOCATES TO CONTACT THE PATIENT UPON DISCHARGE TO HELP THEM SECURE GOVENMENTAL ASSISTANCE OR FINANCIAL ASSISTANCE.EACH CHARITY CARE REVIEW IS DOCUMENTED IN MAYO'S BILLING SYSTEM AND COMMUNICATED TO THE PATIENT. COMPLETED CHARITY CARE FORMS ARE MAINTAINED EITHER IN PAPER OR ELECTRONIC FORMAT. THE PATIENT IS INFORMED REGARDING THE OUTCOME OF THE REVIEW.MAYO OFTEN IDENTIFIES CHARITY CARE OPPORTUNITIES AFTER THE PATIENT HAS BEEN DISMISSED. IN MANY CASES, THIS IS DUE TO LIMITED INSURANCE COVERAGE OR INSURANCE DENIALS AFTER THE SERVICE WAS PERFORMED. IN THESE CASES, WHEN A PATIENT EXPRESSES AN INABILITY TO PAY FOR THEIR SERVICES, STAFF WILL INITIATE A CHARITY REVIEW AS INDICATED BY THE FINANCIAL ASSISTANCE POLICY, WHICH IS AVAILABLE FOR EVERY PATIENT AT MAYOCLINIC.ORG. MCHS - EAU CLAIRE HOSPITAL, INC. PART V, SECTION B, LINE 20D: 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: MEASURES TO PUBLICIZE FINANCIAL ASSISTANCE POLICY:MAYO CLINIC IS COMMITTED TO OFFERING FINANCIAL ASSISTANCE TO ELIGIBLE PATIENTS WHO DO NOT HAVE THE ABILITY TO PAY FOR THEIR MEDICAL SERVICES IN WHOLE OR IN PART. IN ORDER TO ACCOMPLISH THIS CHARITABLE GOAL, MAYO CLINIC AND MAYO CLINIC HEALTH SYSTEM SITES WIDELY PUBLICIZE THIS POLICY IN THE COMMUNITIES THAT THE INDIVIDUAL MAYO CLINIC AFFILIATED SITES SERVE. MAYO CLINIC AFFILIATED SITES MAKE COPIES OF THIS POLICY AVAILABLE BY POSTING IT ON THEIR WEBPAGE INCLUDING THE ABILITY TO DOWNLOAD A COPY OF THE POLICY FREE OF CHARGE. INDIVIDUALS IN THE COMMUNITY SERVED WILL BE ABLE TO OBTAIN A COPY OF THE POLICY IN LOCATIONS THROUGHOUT EACH MAYO CLINIC AFFILIATED SITE OR UPON REQUEST. THE POLICY EXPLAINS THE FINANCIAL ASSISTANCE PROGRAM AND FACTORS AFFECTING ELIGIBILITY. WITHIN THE HOSPITAL FACILITY, A BROCHURE IS MADE AVAILABLE IN NUMEROUS LOCATIONS THROUGHOUT THE FACILITY WHICH DESCRIBES THE FINANCIAL ASSISTANCE POLICY, HOW TO APPLY FOR FINANCIAL ASSISTANCE, AND GIVES THE INTERNET ADDRESS WHERE THE COMPLETE POLICY CAN BE OBTAINED. PART VI, LINE 4: 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 $46,826 ACCORDING TO 2011 U.S. CENSUS BUREAU INFORMATION.ACCORDING TO A STATE OF WISCONSIN 2011 COUNTY PROFILE, APPROXIMATELY 15.1% 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 2012 COUNTY HEALTH RANKINGS WEBSITE, EAU CLAIRE COUNTY RANKS 19TH (OUT OF 72 COUNTIES) IN HEALTH OUTCOMES, RANKING FIFTH IN CLINICAL CARE AND ELEVENTH 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.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 VS. CLOSED STAFF MODEL - THE FILING ORGANIZATION'S STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.EMERGENCY ROOM - THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY. PART VI, LINE 6: THE 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. 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 INC 13025 8TH STREET OSSEO WI 54758 391029430 501(C)(3) 3000000 HEALTH CARE MAYO CLINIC HEALTH SYSTEM - HOME HEALTH & HOSPICE INC 4033 123RD STREET CHIPPEWA FALLS WI 54729 391491516 501(C)(3) 1500000 HEALTH CARE MAYO CLINIC HEALTH SYSTEM - SUPPORTIVE HOMECARE INC 4033 123RD STREET CHIPPEWA FALLS WI 54729 391686673 501(C)(3) 500000 HEALTH CARE MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE FOUNDATION INC 733 W CLAIREMONT AVENUE EAU CLIARE WI 54702 391633407 501(C)(3) 55000 GENERAL SUPPORT 4 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. 1 1 0 0 0 0 0 0 0 BOLTON JEFFREY W 0 693020 0 0 0 84757 0 37595 0 21762 0 837134 0 0 HORECKI MD RICHARD J 0 224598 0 11450 0 143562 0 25710 0 40423 0 445743 0 0 LINTON MD RANDALL L 0 515316 0 50000 0 10984 0 25710 0 38867 0 640877 0 0 NESSE MD ROBERT E 0 593641 0 0 0 94500 0 0 0 18683 0 706824 0 0 SANTRACH MD PAULA J 0 357788 0 0 0 23222 0 40067 0 12876 0 433953 0 0 SIMPSON MD HENRY J 0 299001 0 0 0 0 0 22500 0 22976 0 344477 0 0 BAMMEL PAUL M 0 271922 0 21332 0 7457 0 25710 0 35698 0 362119 0 0 DICKEY JOHN M 0 325896 0 25923 0 10984 0 25710 0 38513 0 427026 0 0 FRANK LINDA A 172110 0 17518 0 1418 0 0 0 21149 0 212195 0 0 0 POPE DENNIS W 195815 0 16009 0 1808 0 33522 0 25502 0 272656 0 0 0 WHITE PAMELA K 187687 0 0 0 1077 0 13948 0 19025 0 221737 0 0 0 WITTROCK EDWARD A 179028 0 14723 0 1660 0 30468 0 18681 0 244560 0 0 0 HARELSTAD JULIA M 139243 0 0 0 0 0 80 0 19973 0 159296 0 0 0 HITZKE RONALD S 157221 0 0 0 0 0 41 0 20238 0 177500 0 0 0 JONES CAREY LEE 144871 0 1500 0 848 0 7300 0 19494 0 174013 0 0 0 KNIGHT MARY M 100678 0 0 0 75026 0 17481 0 1361 0 194546 0 0 0 WINTER MARK D 137983 0 1500 0 944 0 8394 0 21265 0 170086 0 0 0 PART I, LINES 4A-B THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT FROM THE FILING ORGANIZATION. AMOUNT IS INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). - MARY M. KNIGHT - $38,326 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). - JEFFREY W. BOLTON - $80,495 - ROBERT E. NESSE, M.D. - $85,127 - PAULA J. SANTRACH, M.D. - $20,451 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. A WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY 391337855 97670GAA7 2008-04-10 90000000 TO FINANCE THE ACQUISITION & CONSTRUCTION OF HEALTH CARE FACILITIES 0 0 0 A 92530169 7644961 1003911 83881297 2010 0 0 1 1 A 0 1 1 0 1 0 0.00080 0.00240 0.00320 0 0 1 A 0 1 0 0 0 0 0 0 1 A 1 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. MCHS - PHARMACY & HOME MEDICAL TAXABLE AFFILIATE WITH BOARD OVERLAP 339857 RENTAL OF PROPERTY, PAYROLL TRANSACTIONS & SUPPLY PURCHASES 0 MMSI INC TAXABLE AFFILIATE WITH BOARD OVERLAP 19375610 CLAIMS PROCESSING SERVICES & PAYMENTS FOR MEDICAL SERVICES 0 KESSEA REITZNER FAMILY MEMBER OF LINDA FRANK, KEY EMPLOYEE 67106 EMPLOYMENT 0 PATRICIA POPE FAMILY MEMBER OF DENNIS POPE, KEY EMPLOYEE 147176 EMPLOYMENT 0 JANEL WITTROCK FAMILY MEMBER OF EDWARD WITTROCK, KEY EMPLOYEE 63293 EMPLOYMENT 0 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: BAMMEL, PAUL M. DICKEY, JOHN M. HORECKI M.D., RICHARD J. KILNESS, RUTH A. LINTON M.D., RANDALL L. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: BAMMEL, PAUL M. CLUMPNER, DANIEL DICKEY, JOHN M. KILNESS, RUTH A. LINTON M.D., RANDALL L. MOORE, EMILY PEDERSON, DUANE TOLANDER, JANET WAHL, BETTE THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: BOLTON, JEFFREY W. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUAL WHO IS ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: NESSE M.D., ROBERT E. THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: NESSE M.D., ROBERT E. SANTRACH M.D., PAULA J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: BOLTON, JEFFREY W. NESSE M.D., ROBERT E. THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: SIMPSON M.D., HENRY J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: BAMMEL, PAUL M. DICKEY, JOHN M. LINTON M.D., RANDALL L. NESSE M.D., ROBERT E. JEFFREY W. BOLTON AND ROBERT E. NESSE M.D. HAVE A BUSINESS RELATIONSHIP AS BOTH SERVE ON THE BOARD OF MMSI, A RELATED TAXABLE ENTITY. RANDALL L. LINTON M.D. AND EDWARD A. WITTROCK HAVE A BUSINESS RELATIONSHIP AS BOTH SERVE ON THE BOARD OF MAYO CLINIC HEALTH SYSTEM - PHARMACY & HOME MEDICAL, A RELATED TAXABLE ENTITY FORM 990, PART VI, SECTION A, LINE 3 MAYO CLINIC, MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, AND OTHER RELATED COMPANIES PROVIDE MANAGEMENT SERVICES TO THE ENTIRE SYSTEM OF ENTITIES. MAYO CLINIC HEALTH SYSTEM-EAU CLAIRE CLINIC ALSO PROVIDES MANAGEMENT SERVICES ON A REGIONAL BASIS THAT INCLUDES THE FILING ORGANIZATION. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS, COMPENSATION FOR THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES HAS BEEN DISCLOSED IN PART VII AND SCHEDULE J AS REQUIRED. FORM 990, PART VI, SECTION A, LINE 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. 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. THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY IN THE FALL FOR THE NEXT YEAR'S COMPENSATION. THE SALARY OF THE FILING ORGANIZATIONS'S CEO, CAO AND PHYSICIAN LEADERS ON THE BOARD OF THE FILING ORGANIZATION WERE REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR MAYO CLINIC HEALTH SYSTEM PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE MAYO CLINIC HEALTH SYSTEM ENTITIES. THE COMMITTEE IS COMPRISED OF MAYO EMPLOYEES, BUT IS INDEPENDENT FOR INTERNAL REVENUE CODE 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED (WITH RECUSAL WHERE APPROPRIATE). 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. THE FILING ORGANIZATION'S CEO, ALONG 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 INCLUDE REVIEW OF COMPARABILITY DATA FOR SIMILAR SIZED ORGANIZATIONS BY AN INDEPENDENT COMMITTEE OF THE BOARD (PUBLIC MEMBERS ONLY). SALARY RANGES FOR THE PAST YEAR AND RANGES FOR THE NEXT YEAR ARE REVIEWED FOR REASONABLENESS. CONTEMPORANEOUS MEETING MINUTES OF THE COMPENSATION COMMITTEE ARE KEPT ON FILE. 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. OTHER FEES FORM 990, PART IX, LINE 11G I/C PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 19,609,950. MANAGEMENT AND GENERAL EXPENSES 472,490. FUNDRAISING EXPENSES 136,257. TOTAL EXPENSES 20,218,697. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 11,084,352. MANAGEMENT AND GENERAL EXPENSES 2,142,851. FUNDRAISING EXPENSES 149,007. TOTAL EXPENSES 13,376,210. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FAS 158 PENSION ADJUSTMENT -18,376,795. FAS 136 AUDIT ADJUSTMENT 27,597. IN REGARDS TO FILING CERTAIN FOREIGN FORMS DISCLOSURE STATEMENT RELATED TO FORMS 5713: FORM 5713 HAS BEEN FILED BY THE FOLLOWING MEMBERS OF THE CONTROLLED GROUP: MAYO CLINIC (EIN: 41-6011702) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH (EIN: 41-1506440) MAYO HOLDING COMPANY (EIN: 41-1578020) MAYO CLINIC ARIZONA (EIN: 86-0800150) MAYO CLINIC JACKSONVILLE (EIN: 59-3337028) DISCLOSURE STATEMENT RELATED TO FORMS 5471: UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 5471, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN CORPORATIONS, AS A CATEGORY 4 AND 5 FILER WITH RESPECT TO CERTAIN CONTROLLED FOREIGN CORPORATIONS (CFCS). THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 5471 FOR THESE CFCS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT. TAXPAYER NAME: MAYO CLINIC ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 41-6011702 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED TAXPAYER NAME: MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 5471 WAS FILED: 41-1506440 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED DISCLOSURE STATEMENT RELATED TO FORMS 8865: UNDER THE CONSTRUCTIVE OWNERSHIP RULES OF IRC SECTIONS 958(A) AND (B), THE TAXPAYER IS REQUIRED TO FILE FORMS 8865, INFORMATION RETURN OF U.S. PERSONS WITH RESPECT TO CERTAIN FOREIGN PARTNERSHIPS, AS A CATEGORY 2 AND 3 FILER. THESE FILING REQUIREMENTS ARE OR WILL BE SATISFIED THROUGH THE FILING OF FORMS 8865 FOR THESE PARTNERSHIPS BY OTHER U.S. TAXPAYERS IDENTIFIED BELOW WHO HAVE THE SAME FILING REQUIREMENT. TAXPAYER NAME: MAYO CLINIC ADDRESS: 200 FIRST STREET SW, ROCHESTER, MN 55905 ID NUMBER OF U.S. TAX RETURN WITH WHICH FORM 8865 WAS FILED: 41-6011702 IRS SERVICE CENTER WHERE U.S. TAX RETURN WAS OR WILL BE FILED: E-FILED BLOOMER LAKEVIEW INC 2110 DUNCAN ROAD BLOOMER WI 54724 391450617 LOW INCOME HOUSING WI 501(C)(3) 7 MCHS--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 FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC 464 SOUTH ST JOSEPH AVENUE ARCADIA WI 54612 391322480 FUNDRAISING FOUNDATION WI 501(C)(3) 9 MCHS--FRANCISCAN HEALTHCARE INC 1 GOLD CROSS AMBULANCE SERVICE 200 FIRST STREET SW ROCHESTER MN 55905 411917516 AMBULANCE SERVICE MN 501(C)(3) 9 MFMER 1 LUTHER LAKESIDE APARTMENTS INC PO BOX 1510 EAU CLAIRE WI 54702 391409024 LOW INCOME HOUSING FOR ELDERLY WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC 200 FIRST STREET SW ROCHESTER MN 55905 416011702 PATIENT CARE - CLINIC MN 501(C)(3) 9 N/A 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 BOULEVARD 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 IN WAYCROSS INC 1900 TEBEAU STREET WAYCROSS GA 31501 581667166 HOSPITAL GA 501(C)(3) 3 MAYO CLINIC JACKSONVILLE 1 MAYO CLINIC HEALTH SYSTEM--ALBERT LEA 1000 FIRST DRIVE NW AUSTIN MN 55912 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 MCHS--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 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC 733 W CLAIREMONT AVE 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) 11-I MCHS--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 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC 700 WEST AVE SOUTH LA CROSSE WI 54601 391186647 FUNDRAISING FOUNDATION WI 501(C)(3) 7 MCHS--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 MCHS--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 MCHS--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 MCHS--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 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE 301 SECOND STREET NE NEW PRAGUE MN 56071 410723639 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO 1 MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC 1222 EAST WOODLAND AVENUE BARRON WI 54812 390920634 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC 13025 EIGHTH STREET PO BOX 70 OSSEO WI 54758 391029430 HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC 1 MAYO CLINIC HEALTH SYSTEM--OWATONNA 134 SOUTHVIEW ST 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--RED WING 701 HEWITT BOULEVARD RED WING MN 55066 411713783 PATIENT CARE SERVICES MN 501(C)(3) 3 MAYO CLINIC 1 MAYO CLINIC HEALTH SYSTEM--RED WING HOME HEALTH & HOSPICE 701 HEWITT BOULEVARD RED WING MN 55066 411539756 HOME HEALTHCARE SERVICES MN 501(C)(3) 7 MCHS--RED WING 1 MAYO CLINIC HEALTH SYSTEM--SPRINGFIELD 625 NORTH JACKSON AVENUE SPRINGFIELD MN 56087 411893827 HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--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 MCHS--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 MCHS--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 MCHS--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 MCHS--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 MFMER 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) 7 MAYO CLINIC -- SAINT MARYS HOSPITAL 1 RED WING SEMINARY HOME 701 HEWITT BOULEVARD RED WING MN 55066 411263419 RESIDENT CARE AND HOUSING MN 501(C)(3) 9 MCHS--RED WING 1 SATILLA HEALTH MANAGEMENT INC 1900 TEBEAU STREET WAYCROSS GA 31501 581717889 HEALTHCARE SERVICES GA 501(C)(3) 3 MCHS IN WAYCROSS INC 1 THE DOWNTOWN PLAZA 701 HEWITT BOULEVARD RED WING MN 55066 411532554 ELDERLY HOUSING MN 501(C)(3) 9 MCHS--RED WING 1 FRANKLIN HEATING STATION 119 THIRD ST SW ROCHESTER MN 55902 410264830 UTILITY MN N/A PHYSICIAN SOFTWARE SYSTEMS LLC 3333 WARRENVILLE ROAD SUITE 200 LISLE IL 60532 453414836 HEALTHCARE RELATED SOFTWARE IL N/A HEALTH TRADITION HEALTH PLAN 1808 EAST MAIN STREET ONALASKA WI 54650 391545987 MEDICAL SERVICES COMPANY WI N/A C 1 LOBSS NETWORK SUPPORT 2002 INC 200 FIRST STREET SW ROCHESTER MN 55905 481276150 ADMINISTRATIVE SERVICES MN N/A C 1 MAYO CLINIC GBS MAURITIUS 2ND FLOOR EBENE MEWS 57 EBENE CYBERCITY MP HEALTHCARE MANAGEMENT MP N/A C 1 MAYO CLINIC HEALTH SYSTEM--DECORAH CLINIC PHYSICIANS 907 MONTGOMERY STREET DECORAH IA 52101 411711329 PATIENT CARE - CLINIC IA N/A C 1 MAYO CLINIC HEALTH SYSTEM--FARIBAULT 635 FIRST STREET SE FARIBAULT MN 55021 411817179 PATIENT CARE - CLINIC MN N/A C 1 MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC 1221 WHIPPLE STREET EAU CLAIRE WI 54703 391528920 PHARMACY SERVICES WI N/A C 1 MAYO COLLABORATIVE SERVICES INC 200 FIRST STREET SW ROCHESTER MN 55905 411346366 REFERENCE LAB SERVICES MN N/A C 1 MAYO HOLDING COMPANY 200 FIRST STREET SW ROCHESTER MN 55905 411578020 HOLDING COMPANY MN N/A C 1 MAYO INSURANCE COMPANY LTD 200 FIRST STREET SW ROCHESTER MN 55905 SELF INSURANCE POOL CJ N/A C 1 MAYO MEDICAL LABORATORIES NEW ENGLAND INC 265 BALLARDVALE STREET WILMINGTON MA 01887 043323713 LABORATORY SERVICES MA N/A C 1 MAYO REGIONAL PRACTICES OF ARIZONA 13400 EAST SHEA BOULEVARD SCOTTSDALE AZ 85259 061190278 THIRD PARTY ADMINISTRATION SERVICES AZ N/A C 1 MMSI INC 21 FIRST STREET SW ROCHESTER MN 55905 411547003 THIRD PARTY ADMINISTRATION SERVICES MN N/A C 1 RESOUNDANT INC 221 1ST AVE SW ROCHESTER MN 55902 461661978 MANUFACTURING MEDICAL DEVICE COMPONENT MN N/A C 1 ROCHESTER AIRPORT COMPANY ROUTE 2 ROCHESTER MN 55902 410506870 AIRPORT MANAGEMENT MN N/A C 1 SATILLA HEALTH ENTERPRISES INC 1900 TEBEAU STREET WAYCROSS GA 31501 581717222 HEALTHCARE GA N/A C 1 SATILLA HEALTHNET INC 1900 TEBEAU STREET WAYCROSS GA 31501 582151076 HEALTH SERVICES GA N/A C 1 SATILLA REGIONAL SPECIALTY PHYSICIANS INC 1900 TEBEAU STREET WAYCROSS GA 31501 204363143 PHYSICIAN OFFICES GA N/A C 1 SIT ALPHA II BOND FUND LTD CLIFTON HOUSE 75 FORTH ST GRAND CAYMAN CJ KY1-1108 980648163 INVESTMENT MANAGEMENT CJ N/A C 1 SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION 13400 E SHEA BLVD SCOTTSDALE AZ 85259 860870505 COMMERCIAL PROPERTY OWNERS ASSOCIATION AZ N/A C 1 THE STABILE BUILDING OWNERS' ASSOCIATION 200 FIRST STREET SW ROCHESTER MN 55905 208994499 COMMERCIAL PROPERTY OWNERS ASSOCIATION MN N/A C 1 CHARITABLE LEAD TRUST CHARITABLE TRUST CA N/A T 1 PERPETUAL TRUST CHARITABLE TRUST ND N/A T 1 PERPETUAL TRUST CHARITABLE TRUST LA N/A T 1 PERPETUAL TRUST (2) CHARITABLE TRUST MA N/A T 1 PERPETUAL TRUST CHARITABLE TRUST MO N/A T 1 PERPETUAL TRUST CHARITABLE TRUST AZ N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST CO N/A T 1 CHARITABLE REMAINDER TRUST (6) CHARITABLE TRUST FL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST FL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST IL N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST LA N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST MI N/A T 1 CHARITABLE REMAINDER TRUST (68) CHARITABLE TRUST MN N/A T 1 CHARITABLE REMAINDER TRUST (77) CHARITABLE TRUST MN N/A T 1 CHARITABLE REMAINDER TRUST CHARITABLE TRUST NC N/A T 1 CHARITABLE REMAINDER TRUST (2) CHARITABLE TRUST TX N/A T 1 1 1 1 0 0 0 0 1 0 0 1 1 1 0 1 1 1 0 1 GOLD CROSS AMBULANCE SERVICE M 240000 GAAP MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC L 1251608 GAAP MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC O 780023 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC A 3100916 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC L 3273160 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC M 417752 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC O 14203711 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC P 6707724 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC S 711159 GAAP MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE FOUNDATION INC B 55000 GAAP MAYO CLINIC HEALTH SYSTEM--HOME HEALTH & HOSPICE INC B 1500000 GAAP MAYO CLINIC HEALTH SYSTEM--HOME HEALTH & HOSPICE INC L 63941 GAAP MAYO CLINIC HEALTH SYSTEM--HOME HEALTH & HOSPICE INC O 162108 GAAP MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC L 999033 GAAP MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC O 510344 GAAP MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC B 3000000 GAAP MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC L 541981 GAAP MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC O 359409 GAAP MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC A 79107 GAAP MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC H 127244 GAAP MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC O 57758 GAAP MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC L 4805911 GAAP MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC Q 79963 GAAP MAYO CLINIC HEALTH SYSTEM--RED WING L 401242 GAAP MAYO CLINIC HEALTH SYSTEM--SUPPORTIVE HOME CARE INC B 500000 GAAP MAYO COLLABORATIVE SERVICES INC M 657357 GAAP MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH H 102346599 GAAP MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH P 2737203 GAAP MMSI INC M 344965 GAAP MMSI INC S 19030645 GAAP