Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
MAYO CLINIC - METHODIST HOSPITAL
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
200 FIRST STREET SW
 
Room/suite
City or town, state or country, and ZIP + 4
ROCHESTER, MN55905
D Employer identification number

41-0739106
E Telephone number

G Gross receipts $ 579,238,341
F Name and address of principal officer:
JOHN H NOSEWORTHY MD
200 FIRST STREET SW
ROCHESTER,MN55905
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.MAYOCLINIC.ORG/METHODISTHOSPITAL
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1953
M State of legal domicile: MN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THE FILING ORGANIZATION IS A 794 BED ACUTE-CARE HOSPITAL.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 23
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 0
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 3,186
6 Total number of volunteers (estimate if necessary) ............. 6 369
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 259,494 1,933,157
9 Program service revenue (Part VIII, line 2g) ......... 539,826,213 573,333,999
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -43,418 -398,667
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 2,789,360 2,870,804
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 542,831,649 577,739,293
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,306,500 1,006,592
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 167,685,664 176,606,335
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 257,408,998 279,969,506
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 426,401,162 457,582,433
19 Revenue less expenses. Subtract line 18 from line 12....... 116,430,487 120,156,860
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 421,245,054 452,527,337
21 Total liabilities (Part X, line 26)............. 124,319,364 125,170,426
22 Net assets or fund balances. Subtract line 21 from line 20..... 296,925,690 327,356,911
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: 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.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 425,470,206 including grants of $   ) (Revenue $ 568,231,961 )
PATIENT CARE (SEE SCHEDULE O)PATIENT CARE: MAYO CLINIC - METHODIST HOSPITAL (MCMH) WORKS COLLABORATIVELY WITH AFFILIATED ENTITIES IN ROCHESTER (MAYO CLINIC AND MAYO CLINIC - SAINT MARYS HOSPITAL) TO FORM AN INTEGRATED MEDICAL CENTER DEDICATED TO PROVIDING COMPREHENSIVE DIAGNOSIS AND TREATMENT IN VIRTUALLY EVERY MEDICAL AND SURGICAL SPECIALTY. UTILIZING COMMON GOVERNANCE, SHARED SYSTEMS AND STANDARDIZED POLICIES AND PROCEDURES WHENEVER POSSIBLE, MCMH AND ITS AFFILIATED ENTITIES STRIVE TO PROVIDE CONSISTENT, HIGH QUALITY HEALTH CARE SERVICES AND KNOWLEDGE DELIVERY REGARDLESS OF WHERE AND HOW THESE ARE PROVIDED. MAYO CLINIC IS THE SOLE MEMBER OF MCMH.OVERALL GOVERNANCE FOR MAYO CLINIC AND ITS AFFILIATED ENTITIES IS PROVIDED BY A 31-MEMBER BOARD OF TRUSTEES COMPOSED OF A MAJORITY OF PUBLIC MEMBERS ALONG WITH MAYO CLINIC PHYSICIANS AND ADMINISTRATORS. THIS BOARD OF TRUSTEES ENSURES THE ENTIRE ORGANIZATION, INCLUDING MCMH, REMAINS TRUE TO ITS MISSION OF PROVIDING FOR THE HEALTH CARE NEEDS OF THE PUBLIC RATHER THAN FOR PRIVATE BENEFIT. A SEPARATE 23-MEMBER BOARD OF DIRECTORS PROVIDES GOVERNANCE AND POLICY DIRECTION FOR MCMH.MAYO CLINIC IS THE FIRST AND LARGEST INTEGRATED, NOT-FOR-PROFIT MEDICAL GROUP PRACTICE IN THE WORLD. ITS UNIQUE STYLE OF CARE BRINGS TOGETHER TEAMS OF EXPERTS TO PROVIDE HIGH-QUALITY, AFFORDABLE AND COMPASSIONATE CARE TO EACH PATIENT CONSISTENT WITH OUR PRIMARY VALUE - "THE NEEDS OF THE PATIENT COME FIRST". MAYO CLINIC'S MISSION IS "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". MCMH COMBINES ITS HERITAGE OF MEDICAL EXPERTISE, CAREFUL ATTENTION TO INDIVIDUAL PATIENT NEEDS AND THE EXPERTISE AND RESOURCES OF OUR AFFILIATED ENTITIES TO PROVIDE A THOROUGH AND PERSONAL APPROACH TO HEALTH CARE TO MEET THE NEEDS OF OUR PATIENTS.MCMH PROVIDES A BROAD RANGE OF SERVICES IN MOST MEDICAL SPECIALTIES. SOME OF THE TREATMENT AREAS UNIQUE TO MCMH INCLUDE: TRANSPLANT PROGRAMS FOR LIVER, KIDNEY, PANCREAS, BLOOD AND BONE MARROW; OBSTETRICS AND GYNECOLOGY (INCLUDING A PERINATAL CENTER FOR CARE OF HIGH-RISK PREGNANCIES), A WOMEN'S CANCER PROGRAM, AN INTRA-OPERATIVE RADIATION SURGICAL SUITE AND A SPECIAL UNIT FOR TREATING PSORIASIS AND OTHER DERMATOLOGICAL PROBLEMS. MCMH HAS 794 LICENSED BEDS, 11 BIRTHING UNITS, A 21 BED ICU AND 41 OPERATING ROOMS WHERE 27,837 SURGICAL PROCEDURES WERE PERFORMED IN 2012. DURING 2012, 16,760 PATIENTS WERE ADMITTED TO MCMH, FOR A TOTAL OF 75,649 PATIENT DAYS AND THERE WERE 2,096 OBSERVATION UNIT STAYS. MCMH OPERATES ON A NONDISCRIMINATORY BASIS, REGARDLESS OF RACE, COLOR, SEX, RELIGION OR NATIONAL ORIGIN. MCMH PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AND SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. CHARITY CARE IS ALSO PROVIDED FOR PATIENTS THAT ARE FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. IN 2012, THE COST OF CHARITY CARE PROVIDED WAS APPROXIMATELY $4,361,000. THE COST OF UNCOMPENSATED CARE PROVIDED TO LOW INCOME PATIENTS THROUGH MEDICAID WAS APPROXIMATELY $13,326,000. THIS AMOUNT INCLUDES A MEDICAID SURCHARGE OF $5,678,000 AND $5,149,000 PAID TO MINNESOTACARE (A PROGRAM THAT PROVIDES HEALTH CARE FOR LOW INCOME POPULATIONS). THE COST OF UNCOMPENSATED CARE PROVIDED THROUGH MEDICARE WAS APPROXIMATELY $12,037,000.
4b (Code:   ) (Expenses $ 212,206 including grants of $ 4,000 ) (Revenue $ 71,404 )
EDUCATION (SEE SCHEDULE O)EDUCATION: MCMH IS INTEGRAL TO THE EDUCATION PROGRAMS OF MAYO CLINIC'S COLLEGE OF MEDICINE, PROVIDING ESSENTIAL CLINICAL CARE EXPERIENCES FOR RESIDENTS, STUDENTS AND TRAINEES. AS A TEACHING HOSPTIAL, MCMH PROVIDED EDUCATIONAL EXPERIENCE TO THE MORE THAN 1,900 RESIDENTS OF MAYO SCHOOL OF GRADUATE MEDICAL EDUCATION. MCMH ALSO SPONSORS SEVERAL PROGRAMS TO FURTHER THE HOSPITAL'S COMMITMENT TO PROMOTING THE HIGHEST POSSIBLE QUALITY OF PATIENT CARE. THESE INCLUDE A DIETETIC INTERNSHIP PROGRAM, PHARMACY RESIDENCY PROGRAM, CHAPLAINCY INTERNSHIP PROGRAM, AND A NURSING EDUCATION PROGRAM.
4c (Code:   ) (Expenses $ 1,002,592 including grants of $ 1,002,592 ) (Revenue $ 2,943,099 )
COMMUNITY BENEFIT OTHER (SEE SCHEDULE O)COMMUNITY BENEFIT AND OTHER: MCMH PROVIDES A MULTITUDE OF COMMUNITY ACTIVITIES AND SERVICES THAT ARE HEAVILY SUBSIDIZED BY THE HOSPITAL. THESE ACTIVITIES INCLUDE: PERINATAL EDUCATION, WHICH OFFERS A WIDE SELECTION OF CLASSES TO HELP FAMILIES PLAN AND PREPARE FOR CHILDBIRTH AND CARE OF A BABY. THESE CLASSES INCLUDE: PRECONCEPTION, INFANT PASSENGER SAFETY, PRENATAL COMFORT MEASURES PLUS, WEEKEND PRENATAL, MAGNIFICENT MULTIPLES, CHILDBIRTH REVIEW, CESAREAN BIRTH, VAGINAL BIRTH AFTER CESAREAN, BREASTFEEDING, BREASTFEEDING: A CHOICE FOR THE WORKING MOM, WORKING MOMS BREASTFEEDING SUPPORT NETWORK, ADOPTIVE PARENT, GRANDPARENTING AND PREPARING CHILDREN TO ATTEND BIRTH. IN AGGREGATE, 237 CLASSES WITH 2,639 PARTICIPANTS WERE OFFERED IN 2012. OBSTETRICS TOURS ARE OFFERED THROUGHOUT THE YEAR. IN 2012, 49 TOURS WERE CONDUCTED WITH 363 PEOPLE ATTENDING.PRIVATE PRENATAL EDUCATION SESSIONS ARE AVAILABLE FOR WOMEN CONFINED TO BED REST AT HOME AND FAMILIES UNABLE TO TRAVEL LONG DISTANCES. IN ADDITION, INTERPRETERS ARE PROVIDED FOR OBSTETRIC TOURS AND EDUCATIONAL SESSIONS ARRANGED FOR SPEAKERS OF OTHER LANGUAGES. MEETING SPACE FOR THE FOLLOWING ORGANIZATIONS: PAP SUPPORT GROUP, TOASTMASTERS, AND TOPS; DAILY PUBLIC TOURS OF THE HOSPITAL; DAILY CHAPEL SERVICES; NED'S CAFETERIA (NUTRITION-EDUCATION-DINING) WHERE REGISTERED DIETICIANS PROVIDE CONSULTATION FOR PATIENTS, VISITORS AND EMPLOYEES.MCMH HAS A VERY ACTIVE AND ENGAGED AUXILIARY. IN 2012, 369 ACTIVE VOLUNTEERS PROVIDED 54,154 HOURS OF DONATED TIME AND HAD 94,334 SERVICE CONTACTS WITH PATIENTS, VISITORS AND STAFF OF MCMH. THE ESTIMATED VALUE OF THE TIME DONATED BY THESE AUXILIARY VOLUNTEERS WAS APPROXIMATELY $1,198,970 AS VALUED BY THE INDEPENDENT SECTOR'S AVERAGE ESTIMATED HOURLY VALUE OF SUCH SERVICE. MCMH AUXILIARY VOLUNTEERS SUPPORT ACTIVITIES ON BEHALF OF PATIENTS AND VISITORS TO THE HOSPITAL. SOME OF THE ACTIVITIES CONDUCTED BY THE AUXILIANS INCLUDE:STAFFING 4 INFORMATION DESKS THROUGHOUT THE HOSPITAL TO HELP VISITORS AND PATIENTS NAVIGATE THROUGH THE HOSPITAL.OPERATING THE HOSPITAL GIFT SHOP WITH THE PROCEEDS GOING TO THE GOOD SAMARITAN FUND WHICH ASSISTS NEEDY PATIENTS WITH THEIR MEDICAL EXPENSES. OFFERING HOSPITALITY SERVICES TO PATIENTS SUCH AS SERVICE TO FAMILIES AND VISITORS ON THE ONCOLOLGY/HEMATOLOGY AND TRANSPLANT UNITS WITH COFFEE AND CONVERSATION.MAKING BEREAVEMENT CLOTHING FOR NEONATES WHO DO NOT SURVIVE AND STUFFED ANIMALS FOR CHILDREN WHO ARE HAVING MEDICAL PROCEDURES.PROVIDING A SHOPPING CART SERVICE FOR PATIENTS.GIVING GENTLE, NON-THERAPUTIC HAND MASAGES FOR PATIENTS AND THEIR FAMILY MEMBERS.STAFFING THE PATIENT LIBRARY.ASSISTING FAMILY MEMBERS IN THE SURGICAL WAITING ROOM, OUT-PATIENT SURGERY AND GI PROCEDURE AREAS. PROVIDING VIGIL COMPANIONS TO PATIENTS IN THEIR LAST HOURS OF LIFE WHO HAVE NO FAMILY OR FRIENDS TO BE WITH THEM THROUGH A PROGRAM CALLED "NO-ONE DIES ALONE". IN 2012, 26 VOLUNTEERS PROVIDED 55 HOURS OF SERVICE TO 6 MCMH PATIENTS UNDER THIS PROGRAM.THE AUXILIARY ALSO ADMINISTERS THE MAYO CLINIC ERICKSON HAIR AND SKIN CARE CENTER TO PROVIDE PRODUCTS, SERVICES AND EDUCATION FOR PATIENTS EXPERIENCING THE COSMETIC SIDE EFFECTS OF CANCER TREATMENT. THE CENTER WAS DEVELOPED IN RESPONSE TO EMOTIONAL SUFFERING EXPERIENCED BY INDIVIDUALS WHO LOSE THEIR HAIR BECAUSE OF CHEMOTHERAPY OR OTHER CANCER TREATMENTS. THE CENTER, WHICH IS STAFFED BY 2 LICENSED COSMETOLOGISTS AND 16 AUXILIANS, PROVIDES WIGS AND CAPS AT NO COST TO PATIENTS. DURING 2012, THE CENTER SERVED 1,811 PATIENTS AND GAVE AWAY 354 WIGS AND 570 CAPS. IN ADDITION, THE CENTER PROVIDED "LOOK GOOD - FEEL BETTER" CLASSES FOR CANCER PATIENTS. IN 2012, 12 GROUP CLASSES WERE OFFERED, SERVING 61 PATIENTS.
(Code:   ) (Expenses $ 5,030,634 including grants of $   ) (Revenue $ 5,030,634 )
MAYO CLINIC - METHODIST HOSPITAL LEASES SPACE AND PROVIDES SUPPORT SERVICES TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE.
4d Other program services (Describe in Schedule O.)
(Expenses $ 5,030,634 including grants of $   ) (Revenue $ 5,030,634 )
4e Total program service expensesMediumBullet431,715,638
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
Yes
 
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........ Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV..................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
3,186
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
23
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
0
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
Yes
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
MN
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletCORPORATE TAX200 FIRST STREET SWROCHESTERMN55905 (507) 538-1297
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) AGERTER MD DAVID C........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 483,600 35,091
(2) CASCINO MD TERRANCE L........................................................................
DIRECTOR (1/1/12-7/31/12)
 1.00
.......................40.00 		X           0 476,728 44,395
(3) DESCHAMPS MD CLAUDE........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 595,530 58,492
(4) EVANS MD BRUCE A........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 255,944 12,618
(5) HARPER JR MD CHARLES M........................................................................
VICE CHAIR / DIRECTOR
 1.00
.......................40.00 		X   X       0 759,333 60,544
(6) HAYS MD J TAYLOR........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 244,628 62,045
(7) HAYWARD MARK J........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 227,549 39,782
(8) JOHNSON PAMELA O........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 269,651 46,606
(9) LA RUSSO MD NICHOLAS F........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 671,067 8,244
(10) NARR MD BRADLY J........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 522,662 60,647
(11) NESSE MD ROBERT E........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 688,141 18,683
(12) NOSEWORTHY MD JOHN H........................................................................
PRESIDENT / CEO / DIRECTOR
 1.00
.......................40.00 		X   X       0 1,692,329 55,870
(13) RIZZA MD ROBERT A........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 661,866 15,500
(14) ROCK MD MICHAEL G........................................................................
VICE CHAIR / DIRECTOR
 1.00
.......................40.00 		X   X       0 643,678 62,208
(15) SANTRACH MD PAULA J........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 381,010 52,943
(16) SAWYER NAN B........................................................................
SECRETARY / TREASURER / DIRECTOR
 1.00
.......................40.00 		X   X       0 404,098 47,463
(17) SCHMIDT BRADLEY D........................................................................
ASSISTANT TREASURER / DIRECTOR
 1.00
.......................40.00 		X   X       0 337,928 51,243
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) SIMMONS MD PATRICIA S........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 355,615 62,525
(19) STELLNER WINSTON L........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 165,686 34,846
(20) WARNER MD MARK A........................................................................
DIRECTOR (7/24/12-12/31/12)
 1.00
.......................40.00 		X           0 579,774 53,914
(21) WEIS SHIRLEY A........................................................................
VICE CHAIR / CAO / DIRECTOR
 1.00
.......................40.00 		X   X       0 971,605 59,023
(22) WILLIAMS MD AMY W........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 242,537 31,959
(23) WILLIAMSON MARY J........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 233,002 40,928
(24) YTTERBERG MD KAREN L........................................................................
DIRECTOR
 1.00
.......................40.00 		X           0 183,683 34,632
(25) BROWN WILLIAM A........................................................................
ASSISTANT TREASURER
 1.00
.......................40.00 		    X       0 210,372 56,925
(26) HUBERT SHERRY L........................................................................
ASSISTANT SECRETARY
 1.00
.......................40.00 		    X       0 241,289 49,176
(27) OVIATT JONATHAN J........................................................................
ASSISTANT SECRETARY
 1.00
.......................40.00 		    X       0 555,778 62,556
(28) BERGRUD KAREN J........................................................................
PHARMACY OPERATIONS ASSISTANT DIRECTOR
 40.00
.......................0.00 		        X   164,639 0 13,853
(29) CHRISTIANSEN PHILIP R........................................................................
PHARMACY OPERATIONS MANAGER
 40.00
.......................0.00 		        X   173,802 0 42,738
(30) JONES JARED J........................................................................
HOSPITAL PHARMACIST
 40.00
.......................0.00 		        X   158,773 0 25,808
(31) SISKA MARK H........................................................................
PHARMACY IT ASSISTANT DIRECTOR
 40.00
.......................0.00 		        X   166,499 0 28,623
(32) WOLF ROBERT C........................................................................
PHARMACOTHERAPY COORDINATOR
 40.00
.......................0.00 		        X   158,565 0 29,224
(33) COLLINS CRAIG C........................................................................
FORMER ASSISTANT TREASURER
 0.00
.......................40.00 		          X 0 236,296 60,425
(34) EHMAN MD RICHARD L........................................................................
FORMER VICE CHAIR
 0.00
.......................40.00 		          X 0 641,439 62,427
(35) FORBES MD GLENN S........................................................................
FORMER CHAIR
 0.00
.......................40.00 		          X 0 221,197 1,803
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 822,278 14,154,015 1,483,759
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet115
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
MAYO FOUNDATION FOR MEDICAL EDUCATION &200 FIRST STREET SWROCHESTERMN55905 AP PROCUREMENT AGENT 16,892,964
MAYO CLINIC HEALTH SYSTEM-FRANCISCAN ME700 WEST AVENUE SOUTHLACROSSEWI54601 GENERAL SERVICE 129,679
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet2
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 85,282
e Government grants (contributions)1e 1,847,755
f All other contributions, gifts, grants, and
similar amounts not included above1f 		120
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 1,933,157
Program Service Revenue Business Code
2a NET PATIENT REVENUE 620000 568,164,686 568,164,686    
b RENTAL REVENUE FROM AFFILIATES 531120 4,959,293 4,959,293    
c SHARED SERVICES REVENUE 561000 138,616 138,616    
d EDUCATION REVENUE 611600 71,404 71,404    
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 573,333,999
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 136,892     136,892
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   3,386
b Less: cost or other basis and sales expenses   538,945
c Gain or (loss)   -535,559
d Net gain or (loss)..........MediumBullet -535,559     -535,559
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a 732,307
b Less: cost of goods sold ..b 960,103
c Net income or (loss) from sales of inventory..MediumBullet -227,796 -155,304   -72,492
Miscellaneous Revenue Business Code
11a CAFETERIA/VENDING REVENUE 722210 3,094,522 3,094,522    
b MISC. REVENUE 900099 4,078 3,881   197
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 3,098,600
12 Total revenue. See Instructions......MediumBullet 577,739,293 576,277,098 0 -470,962
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 1,000,000 1,000,000
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 6,592 6,592
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees ....        
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 126,701,476 123,815,140 2,886,336  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 11,050,605 10,889,701 160,904  
9 Other employee benefits ....... 27,481,170 26,772,177 708,993  
10 Payroll taxes ........... 11,373,084 11,167,594 205,490  
11 Fees for services (non-employees):        
a Management ...... 97,945   97,945  
b Legal ......... 349,549   349,549  
c Accounting ...........        
d Lobbying ........... 12,787   12,787  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 98,249,755 77,100,402 21,149,353  
12 Advertising and promotion .... 13 13    
13 Office expenses ....... 12,756,272 12,714,833 41,439  
14 Information technology ...... 260,531 260,531    
15 Royalties ..        
16 Occupancy ........... 9,295,131 9,229,417 65,714  
17 Travel ............ 271,129 266,316 4,813  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 240,820 240,820    
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 19,438,440 19,436,391 2,049  
23 Insurance ..............        
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 121,427,878 121,427,878    
b BAD DEBT EXPENSE 6,414,730 6,414,730    
c MEDICAID SURCHARGE 5,677,944 5,677,944    
d MN CARE TAX 5,149,493 5,149,493    
e All other expenses 327,089 145,666 181,423  
25 Total functional expenses. Add lines 1 through 24e 457,582,433 431,715,638 25,866,795 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 17,551 1 17,664
2 Savings and temporary cash investments .........   2  
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 166,217,763 4 121,310,196
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 5,075,066 8 5,270,266
9 Prepaid expenses and deferred charges .......... 464,871 9 512,273
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 366,991,926
b Less: accumulated depreciation ..... 10b 195,926,119 175,213,236 10c 171,065,807
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ..... 12,283,073 12 12,837,731
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 61,973,494 15 141,513,400
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 421,245,054 16 452,527,337
Liabilities 17 Accounts payable and accrued expenses ......... 21,107,910 17 25,820,642
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 103,211,454 25 99,349,784
26 Total liabilities. Add lines 17 through 25......... 124,319,364 26 125,170,426
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 296,111,878 27 326,433,071
28 Temporarily restricted net assets ........... 351,213 28 411,141
29 Permanently restricted net assets ........... 462,599 29 512,699
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 296,925,690 33 327,356,911
34 Total liabilities and net assets/fund balances ........ 421,245,054 34 452,527,337
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
577,739,293
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
457,582,433
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
120,156,860
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
296,925,690
5
Net unrealized gains (losses) on investments ...............
5
274,361
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-90,000,000
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
327,356,911
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
MAYO CLINIC - METHODIST HOSPITAL
 
Employer identification number

41-0739106
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
MAYO CLINIC - METHODIST HOSPITAL
 
Employer identification number

41-0739106
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
MAYO CLINIC - METHODIST HOSPITAL
  		Employer identification number

41-0739106
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
MAYO CLINIC - METHODIST HOSPITAL
  		Employer identification number

41-0739106
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
MAYO CLINIC - METHODIST HOSPITAL
  		Employer identification number

41-0739106
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
MAYO CLINIC - METHODIST HOSPITAL
 
Employer identification number

41-0739106
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
12,787
j
Total. Add lines 1c through 1i ...............................
12,787
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE AMOUNT IN "OTHER ACTIVITIES" REPRESENTS A PORTION OF PROFESSIONAL DUES ATTRIBUTABLE TO LOBBYING.
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MAYO CLINIC - METHODIST HOSPITAL
 
Employer identification number

41-0739106
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 2,902,483 2,766,854 2,463,068 169,500 71,000
b Contributions ........ 50,100 113,832 21,060 1,887,555 100,000
c Net investment earnings, gains, and losses 470,526 21,797 282,726 406,012  
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		125,633       1,500
f Administrative expenses ....          
g End of year balance ...... 3,297,476 2,902,483 2,766,854 2,463,067 169,500
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet76.200 %
b
Permanent endowment SchDMd Bullet15.550 %
c
Temporarily restricted endowment SchDMd Bullet8.250 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   4,184,851 4,184,851
b Buildings ................   279,355,864 141,822,499 137,533,365
c Leasehold improvements ............        
d Equipment ................   83,448,132 54,100,541 29,347,591
e Other .................   3,079 3,079 0
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 171,065,807
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) DUE FROM AFFILIATES 141,513,400








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 141,513,400
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
DUE TO AFFILIATES 99,349,784








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 99,349,784
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR RESEARCH AND EDUCATION PROGRAMS.
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.
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MAYO CLINIC - METHODIST HOSPITAL
 
Employer identification number

41-0739106
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    4,361,433   4,361,433 0.970 %
b Medicaid (from Worksheet 3,
column a) .... 		    35,144,276 21,817,941 13,326,335 2.950 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		           
d Total Financial Assistance
and Means-Tested
Government Programs . 		    39,505,709 21,817,941 17,687,768 3.920 %
Other Benefits
            
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    17,803,608 4,195,950 13,607,658 3.020 %
g Subsidized health services
(from Worksheet 6) .. 		    51,239,461 38,216,268 13,023,193 2.890 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    1,000,000   1,000,000 0.220 %
j Total. Other Benefits ..     70,043,069 42,412,218 27,630,851 6.130 %
k Total. Add lines 7d and 7j .     109,548,778 64,230,159 45,318,619 10.050 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
6,414,686
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
146,967,286
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
163,534,072
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-16,566,786
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 MAYO CLINIC - METHODIST HOSPITAL
201 WEST CENTER STREET
ROCHESTER,MN55905 		X X   X            
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
MAYO CLINIC - METHODIST HOSPITAL
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1    
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20  
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3    
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4    
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5    
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7    
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a    
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?7
Name and address Type of Facility (describe)
1 MAYO CLINIC DIALYSIS LACROSSE
191 THEATER ROAD
ONALASKA,WI54650 		HOSPITAL BASED DIALYSIS FACILITY
2 MAYO CLINIC DIALYSIS ALBERT LEA
1705 SE BROADWAY
ALBERT LEA,MN56007 		HOSPITAL BASED DIALYSIS FACILITY
3 MAYO CLINIC DIALYSIS FAIRMONT
835 JOHNSON STREET
FAIRMONT,MN56031 		HOSPITAL BASED DIALYSIS FACILITY
4 MAYO CLINIC DIALYSIS OWATONNA
2200 NW 26TH STREET
OWATONNA,MN55060 		HOSPITAL BASED DIALYSIS FACILITY
5 MAYO CLINIC DIALYSIS WABASHA
1200 FIFTH GRANT BLVD
WABASHA,MN55981 		HOSPITAL BASED DIALYSIS FACILITY
6 MAYO CLINIC DIALYSIS DECORAH
901 MONTGOMERY STREET
DECORAH,IA52101 		HOSPITAL BASED DIALYSIS FACILITY
7 MAYO CLINIC DIALYSIS NE CLINIC
EAST CIRECLE DRIVE NE
ROCHESTER,MN55906 		HOSPITAL BASED DIALYSIS FACILITY
8
9
10
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
    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 $ 6414686.
    PART II: MAYO IS DEDICATED TO SUPPORTING THE HEALTH OF THE LOCAL COMMUNITIES NEAREST ITS FACILITIES AND TO POSITIVELY IMPACT LOCAL, REGIONAL AND NATIONAL HEALTH FOR ALL PEOPLE THROUGH PROLIFERATION OF ITS ADVANCES IN MEDICAL PRACTICE, RESEARCH AND EDUCATION. MAYO'S COMMUNITY BUILDING ACTIVITIES REFLECT ITS BELIEF THAT IN ADDITION TO TRADITIONAL MEDICAL CARE, COMMUNITY HEALTH IS LARGELY IMPACTED BY MANY SOCIETAL INFLUENCES, SUCH AS SOCIAL, LIFESTYLE, EDUCATIONAL, ECONOMIC AND ENVIRONMENTAL FACTORS.THROUGH ITS OFFICE OF COMMUNITY ENGAGEMENT, MAYO INVESTS IN, AND PARTNERS WITH, HUNDREDS OF COMMUNITY GROUPS AND ORGANIZATIONS TO ENSURE ITS LOCAL COMMUNITY IS, A WELCOMING, HEALTHY ENVIRONMENT, AND AN ENVIRONMENT THAT ATTRACTS AND SUSTAINS A DIVERSE WORKFORCE TO DELIVER THE BEST PATIENT CARE, RESEARCH AND EDUCATION FOR THE PROMOTION OF THE HEALTH AND WELL BEING OF PATIENTS AND THE GENERAL PUBLIC.AS PART OF ITS COMMUNITY CONTRIBUTIONS PROGRAM, MAYO PROVIDES FUNDING AND IN-KIND SUPPORT FOR NEW AND ONGOING PROGRAMS THAT ULTIMATELY SUPPORT HEALTH, SUCH AS BASIC HUMAN SERVICES, EDUCATION AND WORKFORCE DEVELOPMENT, YOUTH AND ELDERLY ENRICHMENT OPPORTUNITIES, THE ARTS AND CULTURAL ENRICHMENT, DIVERSITY, AND OTHERS. MAYO'S GUIDELINES FOR COMMUNITY CONTRIBUTIONS STATE THAT ITS PHILANTHROPIC SUPPORT AND COMMUNITY BUILDING ACTIVITIES SHOULD ADDRESS SIGNIFICANT AND EMERGENT NEEDS WITHIN THE COMMUNITY, ENHANCE MAYO'S CAPACITY TO MEET ITS MISSION, IMPROVE THE HEALTH OF INDIVIDUALS IN THE COMMUNITY, ENABLE LONG-TERM CAPACITY BUILDING AND SUSTAINABILITY TO MEET COMMUNITY NEEDS, AND DEMONSTRATE PARTNERSHIP BUILDING AND COLLABORATION WITH COMMUNITY PARTNERS.IN ADDITION TO DIRECT AND INDIRECT MONETARY AND IN-KIND SUPPORT, MAYO APPOINTS REPRESENTATIVES FROM ITS STAFF TO SERVE ON NONPROFIT BOARDS AND COMMUNITY TASK FORCES TO ENHANCE THE CAPACITY OF LOCAL ORGANIZATIONS FOR SUSTAINABILITY, COMMUNITY COLLABORATION, EFFICIENCY AND IMPACT. MAYO REPRESENTATIVES WORK WITH COMMUNITY GROUPS TO DEVELOP AND NURTURE A SHARED VISION TO SOLVE COMPLEX AND SYSTEMIC COMMUNITY CHALLENGES SUCH AS HUNGER, GANG ACTIVITY, YOUTH MENTORSHIP, EARLY CHILDHOOD DEVELOPMENT, DIVERSITY AND INCLUSIVENESS AND HEALTH CARE EDUCATION AND ACCESS.
    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.METHODOLOGY FOR SCHEDULE H, PART III, LINE 2:BAD DEBT EXPENSE IS DETERMINED BASED ON GAAP AND IS EXPLAINED IN THE ACCOUNTS RECEIVABLE FOOTNOTE OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS.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 $12,037,000 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 REPORTED ON LINE 7, IF ANY, 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.
MAYO CLINIC - METHODIST HOSPITAL   PART V, SECTION B, LINE 14G: WITH REGARD 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.
MAYO CLINIC - METHODIST HOSPITAL   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 GOVERNMENTAL 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.
MAYO CLINIC - METHODIST HOSPITAL   PART V, SECTION B, LINE 20D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 20% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL RATES OR THE BEST NEGOTIATED COMMERCIAL RATE.
    PART VI, LINE 2: MAYO CLINIC ATTRACTS PATIENTS FROM AREAS FAR BEYOND THE IMMEDIATE COMMUNITIES WHERE ITS FACILITIES ARE LOCATED, COMING FROM EVERY STATE AND NEARLY 135 FOREIGN COUNTRIES. BESIDES ITS PRINCIPAL FACILITIES LOCATED IN ROCHESTER, MN, PHOENIX AND SCOTTSDALE, AZ AND JACKSONVILLE, FL, MAYO CLINIC HAS A NETWORK OF COMMUNITY BASED HEALTH CARE PROVIDERS IN MORE THAN 70 COMMUNITIES THROUGHOUT MINNESOTA, IOWA, GEORGIA AND WISCONSIN. MAYO CLINIC SUPPORTS AND COORDINATES EFFORTS TO IMPROVE THE HEALTH AND WELL BEING WITHIN EACH OF THE COMMUNITIES IT SERVES AND ALSO CONDUCTS MEDICAL EDUCATION AND RESEARCH ACTIVITIES TO ADVANCE THE SCIENCE OF MEDICINE TO BENEFIT REGIONAL, NATIONAL AND INTERNATIONAL COMMUNITIES. IN ROCHESTER, MAYO CLINIC WORKS COLLABORATIVELY WITH ITS AFFILIATED ENTITIES (MAYO CLINIC-SAINT MARYS HOSPITAL AND MAYO CLINIC-METHODIST HOSPITAL) THROUGH COMMON GOVERNANCE AND SHARED SYSTEMS, POLICIES AND PROCEDURES TO MEET THE HEALTH CARE NEEDS OF THE LOCAL OLMSTED COUNTY COMMUNITY OF ALMOST 146,000 RESIDENTS. THESE ENTITIES ARE COLLECTIVELY REFERRED TO AS "MAYO" FOR PURPOSES OF THIS DESCRIPTION.MAYO'S EFFORTS TO ASSESS THE HEALTH CARE NEEDS OF THE RESIDENTS OF OLMSTED COUNTY REST ON FOUR GUIDING PRINCIPLES DEVELOPED WITH COMMUNITY PARTNERS AND AFFIRMED BY MAYO LEADERSHIP: 1.) HEALTH IS VALUED BY BOTH THE COMMUNITY AND MAYO. 2.) "HEALTH" IS DETERMINED BY BOTH MEDICAL AND NON-MEDICAL (E.G., SOCIAL AND BEHAVIORAL) FACTORS AND BOTH MUST BE ADDRESSED. 3.) MAYO IS COMMITTED TO PRODUCING MEASURABLE IMPROVEMENTS IN THE HEALTH OF ALL OLMSTED COUNTY RESIDENTS. 4.) STRATEGIES TO IMPROVE COMMUNITY HEALTH ARE BEST DETERMINED AND IMPLEMENTED THROUGH PARTNERSHIPS BETWEEN HEALTH CARE PROVIDERS, COMMUNITY MEMBERS, AND COMMUNITY BASED ORGANIZATIONS.WITH THESE PRINCIPLES AS THE BASIS OF ITS DECISION MAKING, AND CONSISTENT WITH ITS PRIMARY VALUE OF "THE NEEDS OF THE PATIENT COME FIRST," MAYO REGULARLY SEEKS INPUT TO COORDINATE EFFORTS TO ADDRESS COMMUNITY HEALTH NEEDS IN A TIMELY, EFFICIENT AND EFFECTIVE MANNER. MAYO ANNUALLY REVIEWS COMMUNITY HEALTH NEEDS ASSESSMENTS CONDUCTED BY THE PUBLIC HEALTH DEPARTMENT, SOCIAL SERVICES, AND OTHER COMMUNITY ORGANIZATIONS SUCH AS UNITED WAY AND THE SALVATION ARMY THAT SERVE BROAD COMMUNITY HEALTH NEEDS. THESE ASSESSMENTS ARE USED TO DETERMINE SERVICES CURRENTLY AVAILABLE AND TO IDENTIFY GAPS THAT CAN BE ADDRESSED IN MAYO'S RESPONSE TO MEET THE COMMUNITY'S HEALTH CARE NEEDS. MAYO ALSO PROVIDES SHARED LEADERSHIP FOR THE OLMSTED COUNTY COMMUNITY HEALTHCARE ACCESS COLLABORATIVE (CHAC). CHAC IS A MULTICULTURAL VOLUNTEER COALITION OF OVER 20 HEALTH CARE RELATED SERVICE PROVIDERS, PUBLIC HEALTH, SOCIAL SERVICE AND OTHER ORGANIZATIONS FROM THE GOVERNMENT, PRIVATE AND NOT-FOR-PROFIT SECTORS. CHAC WORKS TO ADDRESS HEALTH CARE NEEDS FOR ALL RESIDENTS OF OLMSTED COUNTY WITH SPECIAL EMPHASIS ON DIVERSE AND UNDER-RESOURCED POPULATIONS. PRIORITIES ARE ESTABLISHED BASED ON THE REVIEW OF COMMUNITY-WIDE HEALTH NEEDS; AN ANALYSIS OF EXISTING SERVICES AND BY IMPLEMENTING STRATEGIES TO CLOSE IDENTIFIED SERVICE GAPS. WITHIN MAYO, COMMUNITY HEALTH ASSESSMENT INITIATIVES ARE COORDINATED THROUGH THE COMMUNITY ENGAGEMENT COMMITTEE (CEC). CEC INCLUDES REPRESENTATIVES FROM MAYO PRACTICE, EDUCATION, AND RESEARCH ACTIVITIES AS WELL AS MEMBERS FROM THE COMMUNITY. THE ROLES OF THE CEC ARE TO MONITOR IMPLEMENTATION OF OVERALL MAYO COMMUNITY ENGAGEMENT STRATEGIES AND TO FOSTER THE DEVELOPMENT OF LONG-TERM, MUTUALLY BENEFICIAL RELATIONSHIPS BETWEEN MAYO AND THE COMMUNITY. CEC MEETS MONTHLY AND REPORTS REGULARLY TO THE MAYO PRESIDENT AND CEO AS WELL AS TO MAYO INSTITUTIONAL COMMITTEES. WITHIN THE PRACTICE FUNCTION OF MAYO, A COMMUNITY HEALTH COUNCIL (CHC) FACILITATES COMMUNITY ACCESS AND PARTICIPATION IN PATIENT CARE AND COMMUNITY OUTREACH INITIATIVES. CHC IS GUIDED BY CEC, WITH INPUT FROM THE COMMUNITY ADVISORY BOARDS (CAB).CHC IS PART OF AN INTEGRATED PRACTICE UNIT WITHIN MAYO THAT FOCUSES ON PRIMARY CARE DELIVERY FOR PATIENTS FROM THE COMMUNITY WHO REQUIRE DIFFERENT APPROACHES THAN THE PATIENTS WHO UTILIZE MAYO'S SPECIALTY CARE SERVICES. CHC SERVES TO OVERSEE, COORDINATE AND LINK INITIATIVES IN PRACTICE AND EDUCATION THAT HAVE THE POTENTIAL TO IMPACT THE COMMUNITY OR LOCAL HEALTH-RELATED SERVICE PROVIDERS. ALTHOUGH CHC IS PRIMARILY FOCUSED ON PRACTICE AND EDUCATION ACTIVITIES, IT HAS LINKS TO RESEARCH RESOURCES WHICH CAN BE DIRECTED TOWARDS COMMUNITY INITIATIVES THAT WOULD BENEFIT FROM A RESEARCH APPROACH OR TECHNICAL EXPERTISE. AN 18 MEMBER CAB CHAIRED BY COMMUNITY MEMBERS HELPS CHC IDENTIFY AND PRIORITIZE NEEDS, CONNECTS THE COMMUNITY TO MAYO PERSONNEL, REVIEWS PROPOSALS FOR MAYO OUTREACH ACTIVITIES, PROVIDES FEEDBACK ON THE RESULTS OF THESE ACTIVITIES AND GIVES INPUT FOR NEW PROGRAMS.FROM A RESEARCH PERSPECTIVE, MAYO'S CENTER FOR TRANSLATIONAL SCIENCE ACTIVITIES (CTSA, HTTP://CTSA.MAYO.EDU/COMMUNITY/INDEX.HTML) PLANS INPUT SESSIONS WITH LOCAL COMMUNITY GROUP REPRESENTATIVES TO IDENTIFY, PLAN AND CARRY OUT COMMUNITY-ENGAGED RESEARCH TO IMPROVE HEALTH OUTCOMES, ESPECIALLY FOR UNDERSERVED AND DIVERSE POPULATIONS. CTSA SUPPORTS SIGNIFICANT EFFORTS WITHIN MAYO'S CLINICAL RESEARCH UNIT TO INCREASE COMMUNITY INVOLVEMENT IN RESEARCH AND TO RECRUIT A DIVERSE POPULATION OF RESEARCH PARTICIPANTS. IN PARTNERSHIP WITH CTSA EDUCATION RESOURCES, CTSA HAS DEVELOPED A SERIES OF COMMUNITY ENGAGEMENT EDUCATION MODULES FOR RESEARCH INVESTIGATORS. THE SUM OF THESE EFFORTS, IN COORDINATION WITH MAYO PRACTICE AND EDUCATIONAL INITIATIVES, HAS RESULTED IN A VARIETY OF RESEARCH ACTIVITIES THAT INVOLVE NOT ONLY THE OLMSTED COUNTY COMMUNITY BUT ALSO OTHER COMMUNITIES THROUGHOUT THE REGION. EXAMPLES OF THESE ACTIVITIES INCLUDE COLLABORATIONS WITH OTHER HEALTH CARE PROVIDERS, PUBLIC HEALTH SERVICES, PUBLIC SCHOOLS AND UNIVERSITIES, CITY AND COUNTY GOVERNMENT AND COMMUNITY ORGANIZATIONS SUCH AS THE INTERCULTURAL MUTUAL ASSISTANCE ASSOCIATION, MIGRANT HEALTH SERVICES, OLMSTED COUNTY CHILD CARE RESOURCE AND REFERRAL, ELDER NETWORK, ROCHESTER SENIOR CENTER, IGLESIA DE DIOS EMMANUEL DE ROCHESTER, THE RED CROSS, ASIAN HEALTHCARE LEADERS ASSOCIATION, INDIAN HEALTH SERVICES, AND MANY OTHERS. ADDITIONALLY, THE CTSA HAS A NEWLY FORMED OFFICE FOR COMMUNITY ENGAGED RESEARCH (OCER). OCER WAS ESTABLISHED TO PROVIDE CONSULTATIVE SERVICES TO MAYO RESEARCHERS AND COMMUNITY PARTNERS TO INCREASE THE COMMUNITY ENGAGED RESEARCH EFFORTS IN OLMSTED COUNTY. IN ORDER TO INCREASE COMMUNITY ENGAGED RESEARCH AT MAYO AND TO DETERMINE AREAS OF INTEREST FROM THE COMMUNITY, A COMMUNITY ADVISORY BOARD WAS FORMED. MEMBERS OF THE BOARD COME FROM A VARIETY OF ETHNIC, RACIAL AND CULTURAL BACKGROUNDS. MEMBERSHIP ALSO INCLUDES TWO TRANSLATIONAL SCIENTISTS AT MAYO. THE CAB WORKS TO ENSURE COMMUNITY-ENGAGED AND COMMUNITY-PLACED RESEARCH AT MAYO IS OF HIGH QUALITY, RESPECTS COMMUNITY VALUES AND BENEFITS COMMUNITY MEMBERS. ONE CRITICAL COMPONENT TO IDENTIFY AND MEET THE NEEDS OF THE COMMUNITY IS SERVED BY THE ROCHESTER EPIDEMIOLOGY PROJECT (REP, HTTP://WWW.ROCHESTERPROJECT.ORG/), A COLLABORATION OF MAYO WITH OLMSTED MEDICAL CENTER AND ROCHESTER FAMILY MEDICINE CLINIC. REP LINKS TOGETHER NEARLY ALL THE MEDICAL RECORDS OF THE RESIDENTS OF OLMSTED COUNTY, MAKING IT POSSIBLE TO CONDUCT POPULATION-BASED RESEARCH OF MOST MEDICAL CONDITIONS. THIS UNIQUE RESEARCH INFRASTRUCTURE PROVIDES AN EXTENSIVE DATA REPOSITORY OF CARE DELIVERED TO COMMUNITY RESIDENTS FOR ALMOST HALF A CENTURY AND IS VIRTUALLY UNPARALLELED IN THE UNITED STATES. REP HAS BEEN USED BY HUNDREDS OF INVESTIGATORS TO DEVELOP STUDIES ON A WIDE RANGE OF MEDICAL CONDITIONS AND HAS RESULTED IN OVER 2,000 PUBLICATIONS SINCE 1966 AND INCREASINGLY IS EXPLORED JOINTLY WITH PARTNER COMMUNITY ORGANIZATIONS TO UNDERSTAND POPULATION LEVEL COMMUNITY CHARACERISTICS OF HEALTH AND WELLNESS.ANOTHER ELEMENT TO ASSESS COMMUNITY HEALTH NEEDS IS THE COMMUNITY CONTRIBUTIONS PROGRAM FACILITATED BY A COMMUNITY CONTRIBUTIONS COMMITTEE (CCC) WITHIN MAYO'S OFFICE OF COMMUNITY ENGAGEMENT. THIS PROGRAM CONSIDERS MONETARY AND IN-KIND REQUESTS FROM COMMUNITY ORGANIZATIONS THAT ALIGN WITH MAYO'S EFFORTS TO DIRECTLY OR INDIRECTLY PROMOTE HEALTH AND WELLNESS. SUCH REQUESTS FOR PHILANTHROPIC SUPPORT ARE CONSIDERED AND RESPONDED TO BASED ON PUBLISHED GUIDELINES AND PRIORITIES. BY MONITORING REQUESTS WITHIN SPECIFIC FOCUS AREAS, CCC IDENTIFIES NEEDS WITHIN VARIOUS SECTORS WITHIN THE COMMUNITY. REVIEW OF REQUESTS ALSO PROVIDES AN OPPORTUNITY FOR MAYO STAFF TO MEET WITH INDIVIDUAL ORGANIZATIONS TO BETTER UNDERSTAND NEEDS AND OPPORTUNITIES FOR COLLABORATION. MAYO PROVIDES CONSIDERABLE IN-KIND SUPPORT TO LOCAL ORGANIZATIONS IN THE FORM OF LEGAL, ADMINISTRATIVE, FACILITIES, FINANCIAL ANALYSIS, PRINTING, MARKETING AND OTHER AREAS OF EXPERTISE TO HELP BUILD THE CAPACITY AND SUSTAINABILITY OF COMMUNITY ORGANIZATIONS TO EFFECTIVELY SERVE THE NEEDS OF THE COMMUNITY.
    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: MAYO CLINIC SERVES THE POPULATION OF OLMSTED COUNTY IN MINNESOTA AS WELL AS A WIDER REGIONAL, NATIONAL AND EVEN INTERNATIONAL POPULATION. OLMSTED COUNTY HAS A POPULATION OF 144,248 RESIDENTS IN 60,495 HOUSING UNITS ACCORDING TO THE 2010 CENSUS. FOURTEEN PERCENT OF THESE RESIDENTS ARE NON-CAUCASIAN AND 74% LIVE WITHIN THE CITY OF ROCHESTER. THE MAJORITY OF MAYO CLINIC PATIENTS COME FROM A 150 MILE RADIUS OF ROCHESTER MINNESOTA HOWEVER A GREAT MANY MAYO CLINIC PATIENTS COME FROM OUTSIDE THE STATE OF MINNESOTA, INCLUDING ALL 50 STATES AND NEARLY 135 FOREIGN COUNTRIES. ALTHOUGH IT SERVES A WIDE RANGE OF HEALTH CARE NEEDS INCLUDING PRIMARY AND COMMUNITY CARE, MAYO CLINIC IS ESPECIALLY FOCUSED IN PROVIDING TERTIARY CARE AND SPECIALTY TREATMENT OF THE MORE UNUSUAL AND DIFFICULT MEDICAL CASES.
    PART VI, LINE 5: THIS FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES ARE LARGE, MULTI-FACETED, INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICES AND HEALTH SYSTEMS. AT MAYO CLINIC, DOCTORS FROM EVERY MEDICAL SPECIALTY WORK TOGETHER TO CARE FOR PATIENTS, JOINED BY COMMON SYSTEMS AND A PHILOSOPHY OF "THE NEEDS OF THE PATIENT COME FIRST". THE ORGANIZATIONS (INCLUDING HOSPITAL AND NON-HOSPITAL ENTITIES) WORK TOGETHER TO SERVE THEIR COMMUNITIES AT THE LOCAL, REGIONAL, NATIONAL, AND GLOBAL LEVELS. THIS COMMUNITY BENEFIT HAPPENS THROUGH ITS FOCUS ON PATIENT CARE, EDUCATION, AND RESEARCH. SPECIFICALLY, THE TAX-EXEMPT PURPOSE OF MAYO CLINIC AND ITS AFFILIATES IS THREE-FOLD:PRACTICE - PRACTICE MEDICINE AS AN INTEGRATED TEAM OF COMPASSIONATE, MULTI-DISCIPLINARY PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS WHO ARE FOCUSED ON THE NEEDS OF PATIENTS FROM OUR COMMUNITIES, REGIONS, THE NATION AND THE WORLD.EDUCATION - EDUCATE PHYSICIANS, SCIENTISTS AND ALLIED HEALTH PROFESSIONALS AND BE A DEPENDABLE SOURCE OF HEALTH INFORMATION FOR OUR PATIENTS AND THE PUBLIC.RESEARCH - CONDUCT BASIC AND CLINICAL RESEARCH PROGRAMS TO IMPROVE PATIENT CARE AND TO BENEFIT SOCIETY, INCLUDING PARTNERING WITH MAYO CLINIC HEALTH SYSTEM PRACTICES TO PERFORM PRACTICE-BASED RESEARCH DESIGNED TO IMPROVE PATIENT CARE.THROUGH ITS MISSION, MAYO CLINIC AND ITS AFFILIATES ENRICH THE COMMUNITIES IN WHICH THEY OPERATE AS WELL AS THE BROADER COMMUNITY - IMPROVING MEDICINE THROUGH RESEARCH, EDUCATING PHYSICIANS AND OTHER HEALTH CARE PROVIDERS, AND PROVIDING CARE AND SUPPORT TO PEOPLE IN NEED. PLEASE REFER TO THE PROGRAM SERVICE ACCOMPLISHMENTS ON FORM 990, PART III, FOR FURTHER DESCRIPTION OF THE FILING ORGANIZATION'S ACTIVITIES.SURPLUS FUNDS:MAYO CLINIC AND ITS AFFILIATES REINVEST THEIR NET OPERATING INCOME TO ADVANCE MEDICAL RESEARCH AND TEACH THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS, AS WELL AS TO ALLOW THE INDIVIDUAL ENTITY TO SUSTAIN ITS MISSION AND PREPARE FOR THE FUTURE. 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, EXPERIENCE, AND OTHER CRITERIA ESTABLISHED BY THE INDEPENDENT NOMINATING COMMITTEE OF THE BOARD OF TRUSTEES. AREAS OF EXPERTISE AND EXPERIENCE INCLUDE SUCH AREAS AS HEALTH CARE POLICY, RESEARCH, EDUCATION, BUSINESS, AND GOVERNMENT. THE FILING ORGANIZATION, WHICH IS CONTROLLED BY MAYO CLINIC, RELIES ON THE COMMUNITY REPRESENTATION OF THE MAYO CLINIC BOARD OF TRUSTEES TO FULFILL THIS REQUIREMENT. OPEN V. CLOSED STAFF MODEL: SEVERAL OF MAYO CLINIC'S HOSPITAL ENTITIES HAVE OBTAINED LETTER RULINGS APPROVING A STAFF MODEL IN WHICH ONLY MAYO CLINIC EMPLOYED PHYSICIANS ARE GIVEN STAFF PRIVILEGES IN ORDER TO MAINTAIN STANDARD METHODS OF PRACTICE AND PROTOCOLS. FOR THOSE ENTITIES, THE PHYSICIANS ARE SALARIED EMPLOYEES AND THUS THE ISSUE OF PRIVATE INUREMENT AND PRIVATE BENEFIT ADDRESSED BY THE OPEN STAFF REQUIREMENT ARE OTHERWISE ADDRESSED. THE FILING ORGANIZATION IS ONE OF THE ENTITIES WHICH OPERATES BASED ON THE CLOSED STAFF MODEL. EMERGENCY ROOM: THE PATIENTS OF THE FILING ORGANIZATION HAVE ACCESS TO AN EMERGENCY ROOM OPERATED BY A RELATED ENTITY ADJACENT TO OR IN CLOSE PROXIMITY TO THE FILING ORGANIZATION.
    PART VI, LINE 6: THIS ORGANIZATION IS PART OF A GROUP OF HEALTHCARE ENTITIES AFFILIATED WITH MAYO CLINIC. MAYO CLINIC IS THE FIRST AND LARGEST INTEGRATED, NOT-FOR-PROFIT GROUP PRACTICE IN THE WORLD. 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." MORE THAN 3,800 STAFF PHYSICIANS AND SCIENTISTS, 3,600 RESIDENTS, FELLOWS, AND STUDENTS, AND 50,900 ALLIED HEALTH STAFF WORK AT MAYO CLINIC, WHICH HAS SITES IN ROCHESTER, MINNESOTA, JACKSONVILLE, FLORIDA, AND SCOTTSDALE/PHOENIX, ARIZONA, AS WELL AS A REGIONAL NETWORK OF HOSPITALS AND CLINICS IN MINNESOTA, WISCONSIN, AND IOWA. COLLECTIVELY, MORE THAN HALF A MILLION PEOPLE ARE TREATED EACH YEAR.SPECIFICALLY, THE FILING ORGANIZATION PROVIDES HOSPITAL SERVICES AT THE ROCHESTER, MINNESOTA LOCATION. FOR MORE SPECIFIC DESCRIPTION, SEE THE RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O).
  PART VI, LINE 7 NEITHER THE FILING ORGANIZATION, NOR ANY RELATED ORGANIZATION, FILES A COMMUNITY BENEFIT REPORT WITH ANY STATE OTHER THAN THE EXTENT TO WHICH COMMUNITY BENEFIT INFORMATION IS INCLUDED IN OTHER REPORTING REQUIREMENTS SUCH AS INFORMATION PROVIDED ON THE MINNESOTA HOSPITAL ANNUAL REPORT OR TO THE WISCONSIN HOSPITAL ASSOCIATION.
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
MAYO CLINIC - METHODIST HOSPITAL
 
Employer identification number
41-0739106
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) HORMEL FOUNDATION
329 NORTH MAIN STREET STE 102L
AUSTIN,MN55912 		41-0694716 501(C)(3) 1,000,000       RESEARCH






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) FINANCIAL ASSISTANCE 2 2,592      
(2) NURSING SCHOLARSHIPS 4 4,000      










Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
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. NO ADDITIONAL MONITORING IS PERFORMED. TRANSFERS OR GRANTS TO TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED. MAYO CLINIC - METHODIST HOSPITAL PROVIDES SHORT-TERM FINANCIAL ASSISTANCE TO EMPLOYEES EXPERIENCING TEMPORARY HARDSHIPS. GRANTS ARE PROVIDED BASED ON A PROVEN NEED AND ARE NOT MONITORED. NURSING SCHOLARSHIPS ARE AVAILABLE TO EMPLOYEES OF MAYO CLINIC - METHODIST HOSPITAL AND THEIR DEPENDENTS TO OFFSET THE COST OF TUITION, BOOKS, OR OTHER EXPENSES RELATED TO ATTENDING A NURSING PROGRAM. SCHOLARSHIPS ARE SUBJECT TO FEDERAL AND STATE INCOME TAX WITHHOLDING AND ARE NOT MONITORED ONCE AWARDED TO THE RECIPIENT.
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MAYO CLINIC - METHODIST HOSPITAL
 
Employer identification number

41-0739106
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)AGERTER MD DAVID CDIRECTOR (i)
(ii)		 0
449,783 		0
0 		0
33,817 		0
19,707 		0
15,384 		0
518,691 		0
0
(2)CASCINO MD TERRANCE LDIRECTOR (1/1/12-7/31/12) (i)
(ii)		 0
387,950 		0
0 		0
88,778 		0
22,691 		0
21,704 		0
521,123 		0
0
(3)DESCHAMPS MD CLAUDEDIRECTOR (i)
(ii)		 0
517,039 		0
0 		0
78,491 		0
37,888 		0
20,604 		0
654,022 		0
0
(4)EVANS MD BRUCE ADIRECTOR (i)
(ii)		 0
251,806 		0
0 		0
4,138 		0
13 		0
12,605 		0
268,562 		0
0
(5)HARPER JR MD CHARLES MVICE CHAIR / DIRECTOR (i)
(ii)		 0
654,846 		0
0 		0
104,487 		0
39,557 		0
20,987 		0
819,877 		0
0
(6)HAYS MD J TAYLORDIRECTOR (i)
(ii)		 0
242,520 		0
0 		0
2,108 		0
39,941 		0
22,104 		0
306,673 		0
0
(7)HAYWARD MARK JDIRECTOR (i)
(ii)		 0
226,717 		0
0 		0
832 		0
23,594 		0
16,188 		0
267,331 		0
0
(8)JOHNSON PAMELA ODIRECTOR (i)
(ii)		 0
265,748 		0
0 		0
3,903 		0
32,848 		0
13,758 		0
316,257 		0
0
(9)LA RUSSO MD NICHOLAS FDIRECTOR (i)
(ii)		 0
568,961 		0
0 		0
102,106 		0
0 		0
8,244 		0
679,311 		0
0
(10)NARR MD BRADLY JDIRECTOR (i)
(ii)		 0
460,848 		0
0 		0
61,814 		0
37,484 		0
23,163 		0
583,309 		0
0
(11)NESSE MD ROBERT EDIRECTOR (i)
(ii)		 0
593,641 		0
0 		0
94,500 		0
0 		0
18,683 		0
706,824 		0
0
(12)NOSEWORTHY MD JOHN HPRESIDENT / CEO / DIRECTOR (i)
(ii)		 0
1,400,539 		0
0 		0
291,790 		0
40,843 		0
15,027 		0
1,748,199 		0
0
(13)RIZZA MD ROBERT ADIRECTOR (i)
(ii)		 0
565,468 		0
0 		0
96,398 		0
0 		0
15,500 		0
677,366 		0
0
(14)ROCK MD MICHAEL GVICE CHAIR / DIRECTOR (i)
(ii)		 0
554,737 		0
0 		0
88,941 		0
47,784 		0
14,424 		0
705,886 		0
0
(15)SANTRACH MD PAULA JDIRECTOR (i)
(ii)		 0
357,788 		0
0 		0
23,222 		0
40,067 		0
12,876 		0
433,953 		0
0
(16)SAWYER NAN BSECRETARY / TREASURER / DIRECTOR (i)
(ii)		 0
371,461 		0
0 		0
32,637 		0
37,719 		0
9,744 		0
451,561 		0
0
(17)SCHMIDT BRADLEY DASSISTANT TREASURER / DIRECTOR (i)
(ii)		 0
317,508 		0
0 		0
20,420 		0
35,672 		0
15,571 		0
389,171 		0
0
(18)SIMMONS MD PATRICIA SDIRECTOR (i)
(ii)		 0
335,852 		0
0 		0
19,763 		0
48,101 		0
14,424 		0
418,140 		0
0
(19)STELLNER WINSTON LDIRECTOR (i)
(ii)		 0
165,430 		0
0 		0
256 		0
14,242 		0
20,604 		0
200,532 		0
0
(20)WARNER MD MARK ADIRECTOR (7/24/12-12/31/12) (i)
(ii)		 0
496,698 		0
1,000 		0
82,076 		0
39,250 		0
14,664 		0
633,688 		0
0
(21)WEIS SHIRLEY AVICE CHAIR / CAO / DIRECTOR (i)
(ii)		 0
820,314 		0
0 		0
151,291 		0
44,546 		0
14,477 		0
1,030,628 		0
0
(22)WILLIAMS MD AMY WDIRECTOR (i)
(ii)		 0
234,905 		0
0 		0
7,632 		0
29,895 		0
2,064 		0
274,496 		0
0
(23)WILLIAMSON MARY JDIRECTOR (i)
(ii)		 0
232,074 		0
0 		0
928 		0
21,092 		0
19,836 		0
273,930 		0
0
(24)YTTERBERG MD KAREN LDIRECTOR (i)
(ii)		 0
181,488 		0
0 		0
2,195 		0
31,646 		0
2,986 		0
218,315 		0
0
(25)BROWN WILLIAM AASSISTANT TREASURER (i)
(ii)		 0
208,775 		0
0 		0
1,597 		0
35,696 		0
21,229 		0
267,297 		0
0
(26)HUBERT SHERRY LASSISTANT SECRETARY (i)
(ii)		 0
240,635 		0
0 		0
654 		0
27,239 		0
21,937 		0
290,465 		0
0
(27)OVIATT JONATHAN JASSISTANT SECRETARY (i)
(ii)		 0
486,490 		0
0 		0
69,288 		0
39,892 		0
22,664 		0
618,334 		0
0
(28)BERGRUD KAREN JPHARMACY OPERATIONS ASSISTANT DIRECT (i)
(ii)		 162,342
0 		0
0 		2,297
0 		73
0 		13,780
0 		178,492
0 		0
0
(29)CHRISTIANSEN PHILIP RPHARMACY OPERATIONS MANAGER (i)
(ii)		 164,028
0 		0
0 		9,774
0 		28,152
0 		14,586
0 		216,540
0 		0
0
(30)JONES JARED JHOSPITAL PHARMACIST (i)
(ii)		 150,786
0 		0
0 		7,987
0 		10,676
0 		15,132
0 		184,581
0 		0
0
(31)SISKA MARK HPHARMACY IT ASSISTANT DIRECTOR (i)
(ii)		 157,869
0 		0
0 		8,630
0 		216
0 		28,407
0 		195,122
0 		0
0
(32)WOLF ROBERT CPHARMACOTHERAPY COORDINATOR (i)
(ii)		 143,686
0 		0
0 		14,879
0 		11,413
0 		17,811
0 		187,789
0 		0
0
(33)COLLINS CRAIG CFORMER ASSISTANT TREASURER (i)
(ii)		 0
234,704 		0
0 		0
1,592 		0
31,423 		0
29,002 		0
296,721 		0
0
(34)EHMAN MD RICHARD LFORMER VICE CHAIR (i)
(ii)		 0
551,058 		0
0 		0
90,381 		0
41,823 		0
20,604 		0
703,866 		0
0
(35)FORBES MD GLENN SFORMER CHAIR (i)
(ii)		 0
74,397 		0
0 		0
146,800 		0
0 		0
1,803 		0
223,000 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
  PART I, LINE 4B THIS ENTITY OR ITS AFFILIATE HAS A SUPPLEMENTAL RETIREMENT PLAN (SRP) DESIGNED TO ROUGHLY APPROXIMATE AN EXTENSION OF THE BENEFITS UNDER THE MAYO PENSION PLAN TO INCOME ABOVE THE INTERNAL REVENUE CODE QUALIFIED PLAN LIMIT IN SECTION 401(A)(17). STARTING JANUARY 1, 2011, ALL SRP BENEFITS ARE PAID AS AN ANNUAL TAXABLE CASH PAYMENT. THE FOLLOWING INDIVIDUALS RECEIVED A PAYMENT FROM THE SUPPLEMENTAL RETIREMENT PLAN. AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III). AGERTER M.D., DAVID C. $ 27,454 CASCINO M.D., TERRANCE L. $ 50,702 DESCHAMPS M.D., CLAUDE $ 74,211 EHMAN M.D., RICHARD L. $ 83,284 EVANS M.D., BRUCE A. $ 1,072 FORBES M.D., GLENN S. $132,843 HARPER JR., M.D., CHARLES M. $ 89,902 JOHNSON, PAMELA O. $ 2,326 LA RUSSO M.D., NICHOLAS F. $ 88,846 NARR M.D., BRADLY J. $ 58,382 NESSE M.D., ROBERT E. $ 85,127 NOSEWORTHY M.D., JOHN H. $271,361 OVIATT, JONATHAN J. $ 65,197 RIZZA M.D., ROBERT A. $ 84,215 ROCK M.D., MICHAEL G. $ 81,615 SANTRACH M.D., PAULA J. $ 20,451 SAWYER, NAN B. $ 29,745 SCHMIDT, BRADLEY D. $ 18,459 SIMMONS M.D., PATRICIA S. $ 13,149 WARNER M.D., MARK A. $ 62,316 WEIS, SHIRLEY A. $145,708 WILLIAMS M.D., AMY W. $ 6,177
SUPPLEMENTAL INFORMATION PART III COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION. 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.
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MAYO CLINIC - METHODIST HOSPITAL
 
Employer identification number

41-0739106
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) MMSI INC
  		COMMON BOARD MEMBER 90,311,275 CAPITATION PAYMENTS/HEALTH BENEFIT PLAN   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
MAYO CLINIC - METHODIST HOSPITAL
 
Employer identification number

41-0739106
Identifier Return Reference Explanation
  FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: AGERTER M.D., DAVID C. CASCINO M.D., TERRANCE L. DESCHAMPS M.D., CLAUDE EVANS M.D., BRUCE A. HARPER JR., M.D., CHARLES M. HAYS M.D., J. TAYLOR HAYWARD, MARK J. LA RUSSO M.D., NICHOLAS F. NARR M.D., BRADLY J. NESSE M.D., ROBERT E. RIZZA M.D., ROBERT A. ROCK M.D., MICHAEL G. SANTRACH M.D., PAULA J. SAWYER, NAN B. SCHMIDT, BRADLEY D. SIMMONS M.D., PATRICIA S. WARNER M.D., MARK A. WILLIAMS M.D., AMY W. YTTERBERG M.D., KAREN L. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: BROWN, WILLIAM A. CASCINO M.D., TERRANCE L. DESCHAMPS M.D., CLAUDE HARPER JR., M.D., CHARLES M. HUBERT, SHERRY L. LA RUSSO M.D., NICHOLAS F. NARR M.D., BRADLY J. NESSE M.D., ROBERT E. NOSEWORTHY M.D., JOHN H. OVIATT, JONATHAN J. RIZZA M.D., ROBERT A. ROCK M.D., MICHAEL G. SAWYER, NAN B. SCHMIDT, BRADLEY D. SIMMONS M.D., PATRICIA S. WARNER M.D., MARK A. WEIS, SHIRLEY A. THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: BROWN, WILLIAM A. HUBERT, SHERRY L. NOSEWORTHY M.D., JOHN H. OVIATT, JONATHAN J. STELLNER, WINSTON L. WEIS, SHIRLEY A. WILLIAMSON, MARY J. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: HUBERT, SHERRY L. NESSE M.D., ROBERT E. NOSEWORTHY M.D., JOHN H. OVIATT, JONATHAN J. SAWYER, NAN B. SCHMIDT, BRADLEY D. WEIS, SHIRLEY A. THE FOLLOWING INDIVIDUAL IS EMPLOYED BY A RELATED ORGANIZATION: JOHNSON, PAMELA O. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: AGERTER M.D., DAVID C. BROWN, WILLIAM A. CASCINO M.D., TERRANCE L. DESCHAMPS M.D., CLAUDE EVANS M.D., BRUCE A. HARPER JR., M.D., CHARLES M. HAYS M.D., J. TAYLOR HAYWARD, MARK J. HUBERT, SHERRY L. LA RUSSO M.D., NICHOLAS F. NARR M.D., BRADLY J. NESSE M.D., ROBERT E. NOSEWORTHY M.D., JOHN H. OVIATT, JONATHAN J. RIZZA M.D., ROBERT A. ROCK M.D., MICHAEL G. SANTRACH M.D., PAULA J. SAWYER, NAN B. SCHMIDT, BRADLEY D. SIMMONS M.D., PATRICIA S. STELLNER, WINSTON L. WARNER M.D., MARK A. WEIS, SHIRLEY A. WILLIAMS M.D., AMY W. YTTERBERG M.D., KAREN L. ROBERT E. NESSE, M.D., JONATHAN J. OVIATT, AND MICHAEL G. ROCK, M.D. HAVE A BUSINESS RELATIONSHIP AS THEY SERVE AS AN OFFICER, DIRECTOR, OR TRUSTEE OF MMSI, INC. A RELATED TAXABLE ENTITY. NAN SAWYER, AND MARY J. WILLIAMSON HAVE A BUSINESS RELATIONSHIP AS THEY SERVE AS AN OFFICER, DIRECTOR, OR TRUSTEE OF MAYO COLLABORATIVE SERVICES, 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. 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 MEMBER OF THE CORPORATION IS MAYO CLINIC.
  FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BODY IS APPOINTED BY THE SOLE CORPORATE MEMBER.
  FORM 990, PART VI, SECTION A, LINE 7B ONLY THE SOLE MEMBER MAY AMEND, REPEAL OR ADD NEW BYLAWS.
  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 FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF MAYO CLINIC - METHODIST HOSPITAL'S GOVERNING BODY VIA US 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 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 SALARIES OF THE CHIEF EXECUTIVE OFFICER (CEO) AND CHIEF ADMINISTRATIVE OFFICER (CAO) WHICH ARE PAID BY AN AFFILIATE WERE REVIEWED BY THE MAYO CLINIC SALARY AND BENEFIT COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW. THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE ARIZONA, FLORIDA, AND ROCHESTER, MINNESOTA CAMPUSES. 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 SALARY AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION, AND GOVERNANCE (GOVERNANCE COMMITTEE) IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. THIS GROUP REVIEWS THE COMPENSATION AND BENEFITS FOR PHYSICIANS FROM ALL CAMPUSES, INCLUDING THE MAYO CLINIC HEALTH SYSTEM LOCATIONS, AS WELL AS CERTAIN SENIOR ADMINISTRATIVE AND EXECUTIVE LEADERSHIP (INCLUDING ALL PERSONS BELIEVED TO BE DISQUALIFIED PERSONS). THIS PROCESS ESTABLISHES ACCEPTABLE RANGES FOR VARIOUS POSITIONS, LEVELS, AND SPECIALTIES. THE COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. IN ADDITION, THE GOVERNANCE COMMITTEE DIRECTLY RETAINS AN INDEPENDENT THIRD-PARTY COMPENSATION CONSULTANT TO PROVIDE RELEVANT, CONTEMPORANEOUS BENCHMARK INFORMATION FOR A SMALL GROUP OF SENIOR PHYSICIAN, ADMINISTRATIVE, AND EXECUTIVE LEADERSHIP POSITIONS FOR WHICH AN INDIVIDUALIZED REVIEW AND RECOMMENDATION IS MADE.
  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 ORGANIZATIONS FORM 990 AND WOULD BE AVAILABLE UPON REQUEST OF THE FORM 990.
OTHER FEES FORM 990, PART IX, LINE 11G OTHER PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,104,179. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,104,179. EQUIPMENT MAINTENANCE : PROGRAM SERVICE EXPENSES 2,537,191. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,537,191. MEDICAL ADMINISTRATION : PROGRAM SERVICE EXPENSES 7,168,045. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,168,045. OUTSOURCED MEDICAL SERVICES : PROGRAM SERVICE EXPENSES 2,603,686. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,603,686. IC PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 55,388,611. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,388,611. TRANSCRIPTION SERVICES : PROGRAM SERVICE EXPENSES 600,453. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 600,453. OTHER PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 8,802,416. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,802,416. PRACTICE SUPPORT SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 19,816,906. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,816,906. IS PROGRAMMING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 228,268. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 228,268.
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CAPITAL TRANSFER TO MAYO CLINIC -90,000,000.
INDEPENDENT VOTING MEMBERS OF THE GOVERNING BODY 990, PART I, LINE 4 AND PART VI, LINE 1B THE BOARD OF TRUSTEES OF MAYO CLINIC, THE PARENT ENTITY OF THE MAYO CLINIC-AFFILIATED ENTITIES, IS COMPRISED OF MORE THAN 50% PUBLIC TRUSTEES.
IN REGARDS TO FILING CERTAIN FOREIGN FORMS SCHEDULE F, PART IV, LINES 3, 5, & 6 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
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MAYO CLINIC - METHODIST HOSPITAL
 
Employer identification number

41-0739106
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) BLOOMER LAKEVIEW INC

2110 DUNCAN ROAD

BLOOMER,WI54724
39-1450617 		LOW INCOME HOUSING WI 501(C)(3) 7 MCHS--CHIPPEWA VALLEY INC
 
Yes
 
(2) CHARTERHOUSE INC

200 FIRST STREET SW

ROCHESTER,MN55905
41-1405254 		RETIREMENT LIVING CENTER MN 501(C)(3) 9 MAYO CLINIC
 
Yes
 
(3) FRANCISCAN SKEMP FOUNDATION OF ARCADIA INC

464 SOUTH ST JOSEPH AVENUE

ARCADIA,WI54612
39-1322480 		FUNDRAISING FOUNDATION WI 501(C)(3) 9 MCHS--FRANCISCAN HEALTHCARE INC
 
Yes
 
(4) GOLD CROSS AMBULANCE SERVICE

200 FIRST STREET SW

ROCHESTER,MN55905
41-1917516 		AMBULANCE SERVICE MN 501(C)(3) 9 MFMER
 
Yes
 
(5) LUTHER LAKESIDE APARTMENTS INC

PO BOX 1510

EAU CLAIRE,WI54702
39-1409024 		LOW INCOME HOUSING FOR ELDERLY WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL INC
 
Yes
 
(6) MAYO CLINIC

200 FIRST STREET SW

ROCHESTER,MN55905
41-6011702 		PATIENT CARE - CLINIC MN 501(C)(3) 9 N/A
Yes
 
(7) MAYO CLINIC -- METHODIST HOSPITAL

200 FIRST STREET SW

ROCHESTER,MN55905
41-0739106 		HOSPITAL MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(8) MAYO CLINIC -- SAINT MARYS HOSPITAL

200 FIRST STREET SW

ROCHESTER,MN55905
41-0944601 		HOSPITAL MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(9) MAYO CLINIC ARIZONA

13400 EAST SHEA BOULEVARD

SCOTTSDALE,AZ85259
86-0800150 		HOSPITAL AND CLINIC AZ 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(10) MAYO CLINIC FLORIDA (A NONPROFIT CORPORATION)

4500 SAN PABLO ROAD

JACKSONVILLE,FL32224
59-0714831 		HOSPITAL FL 501(C)(3) 3 MAYO CLINIC JACKSONVILLE
 
Yes
 
(11) MAYO CLINIC HEALTH SYSTEM IN WAYCROSS INC

1900 TEBEAU STREET

WAYCROSS,GA31501
58-1667166 		HOSPITAL GA 501(C)(3) 3 MAYO CLINIC JACKSONVILLE
 
Yes
 
(12) MAYO CLINIC HEALTH SYSTEM--ALBERT LEA

1000 FIRST DRIVE NW

AUSTIN,MN55912
41-1404075 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(13) MAYO CLINIC HEALTH SYSTEM--AUSTIN

1000 FIRST DRIVE NW

AUSTIN,MN55912
41-0695606 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(14) MAYO CLINIC HEALTH SYSTEM--AUSTIN FOUNDATION

1000 FIRST DRIVE NW

AUSTIN,MN55912
30-0107471 		FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--AUSTIN
 
Yes
 
(15) MAYO CLINIC HEALTH SYSTEM--CANNON FALLS

1116 WEST MILL STREET

CANNON FALLS,MN55009
20-4156428 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(16) MAYO CLINIC HEALTH SYSTEM--CHIPPEWA VALLEY INC

1501 THOMPSON STREET

BLOOMER,WI54724
39-0980343 		HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC
 
Yes
 
(17) MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE CLINIC INC

733 W CLAIREMONT AVE PO BOX 1510

EAU CLAIRE,WI54702
39-1735831 		PATIENT CARE - CLINIC WI 501(C)(3) 3 MAYO CLINIC
 
 
No
(18) MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE FOUNDATION INC

733 W CLAIREMONT AVE PO BOX 1510

EAU CLAIRE,WI54702
39-1633407 		GRANTMAKING FOUNDATION WI 501(C)(3) 11-I MCHS--EAU CLAIRE CLINIC INC
 
 
No
(19) MAYO CLINIC HEALTH SYSTEM--EAU CLAIRE HOSPITAL INC

1221 WHIPPLE STREET

EAU CLAIRE,WI54703
39-0813418 		HOSPITAL WI 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(20) MAYO CLINIC HEALTH SYSTEM--FAIRMONT

800 MEDICAL CENTER DRIVE PO BOX 800

FAIRMONT,MN56031
41-0760836 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO
 
Yes
 
(21) MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION INC

700 WEST AVE SOUTH

LA CROSSE,WI54601
39-1186647 		FUNDRAISING FOUNDATION WI 501(C)(3) 7 MCHS--FRANCISCAN HEALTHCARE INC
 
Yes
 
(22) MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE FOUNDATION-SPARTA INC

310 WEST MAIN STREET

SPARTA,WI54656
39-1423234 		FUNDRAISING FOUNDATION WI 501(C)(3) 9 MCHS--FRANCISCAN HEALTHCARE INC
 
Yes
 
(23) MAYO CLINIC HEALTH SYSTEM--FRANCISCAN HEALTHCARE INC

700 WEST AVE SOUTH

LA CROSSE,WI54601
39-1411999 		HEALTHCARE SYSTEM PARENT WI 501(C)(3) 11-I MAYO CLINIC
 
Yes
 
(24) MAYO CLINIC HEALTH SYSTEM--FRANCISCAN MEDICAL CENTER INC

700 WEST AVE SOUTH

LA CROSSE,WI54601
39-0806374 		HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--FRANCISCAN HEALTHCARE INC
 
Yes
 
(25) MAYO CLINIC HEALTH SYSTEM--HOME HEALTH & HOSPICE INC

PO BOX 2060

EAU CLAIRE,WI54702
39-1491516 		HOME HEALTH AND HOSPICE CARE WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL INC
 
Yes
 
(26) MAYO CLINIC HEALTH SYSTEM--LAKE CITY

500 WEST GRANT STREET

LAKE CITY,MN55041
41-1906820 		HOSPITAL MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(27) MAYO CLINIC HEALTH SYSTEM--MANKATO

1025 MARSH STREET

MANKATO,MN56002
41-1236756 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(28) MAYO CLINIC HEALTH SYSTEM--MANKATO HEALTH CARE FOUNDATION

1025 MARSH STREET

MANKATO,MN56002
41-1663357 		FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--MANKATO
 
Yes
 
(29) MAYO CLINIC HEALTH SYSTEM--NEW PRAGUE

301 SECOND STREET NE

NEW PRAGUE,MN56071
41-0723639 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO
 
Yes
 
(30) MAYO CLINIC HEALTH SYSTEM--NORTHLAND INC

1222 EAST WOODLAND AVENUE

BARRON,WI54812
39-0920634 		HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC
 
Yes
 
(31) MAYO CLINIC HEALTH SYSTEM--OAKRIDGE INC

13025 EIGHTH STREET PO BOX 70

OSSEO,WI54758
39-1029430 		HOSPITAL AND CLINIC WI 501(C)(3) 3 MCHS--EAU CLAIRE HOSPITAL INC
 
Yes
 
(32) MAYO CLINIC HEALTH SYSTEM--OWATONNA

134 SOUTHVIEW ST

OWATONNA,MN55060
41-1862132 		PATIENT CARE - CLINIC MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(33) MAYO CLINIC HEALTH SYSTEM--RED CEDAR INC

2321 STOUT ROAD

MENOMONIE,WI54751
51-0190875 		HOSPITAL AND CLINIC WI 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(34) MAYO CLINIC HEALTH SYSTEM--RED WING

701 HEWITT BOULEVARD

RED WING,MN55066
41-1713783 		PATIENT CARE SERVICES MN 501(C)(3) 3 MAYO CLINIC
 
Yes
 
(35) MAYO CLINIC HEALTH SYSTEM--RED WING HOME HEALTH & HOSPICE

701 HEWITT BOULEVARD

RED WING,MN55066
41-1539756 		HOME HEALTHCARE SERVICES MN 501(C)(3) 7 MCHS--RED WING
 
Yes
 
(36) MAYO CLINIC HEALTH SYSTEM--SPRINGFIELD

625 NORTH JACKSON AVENUE

SPRINGFIELD,MN56087
41-1893827 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO
 
Yes
 
(37) MAYO CLINIC HEALTH SYSTEM--ST JAMES

1101 MOULTON PARSONS DR PO BOX 460

ST JAMES,MN56081
41-0797368 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO
 
Yes
 
(38) MAYO CLINIC HEALTH SYSTEM--ST JAMES HEALTH CARE FOUNDATION

1101 MOULTON PARSONS DR PO BOX 460

ST JAMES,MN56081
41-1444129 		FUNDRAISING FOUNDATION MN 501(C)(3) 7 MCHS--ST JAMES
 
Yes
 
(39) MAYO CLINIC HEALTH SYSTEM--SUPPORTIVE HOMECARE INC

PO BOX 2060

EAU CLAIRE,WI54702
39-1686673 		HOME HEALTH CARE WI 501(C)(3) 9 MCHS--EAU CLAIRE HOSPITAL INC
 
Yes
 
(40) MAYO CLINIC HEALTH SYSTEM--WASECA

501 NORTH STATE STREET

WASECA,MN56093
36-3606405 		HOSPITAL AND CLINIC MN 501(C)(3) 3 MCHS--MANKATO
 
Yes
 
(41) MAYO CLINIC JACKSONVILLE

4500 SAN PABLO ROAD

JACKSONVILLE,FL32224
59-3337028 		PATIENT CARE - CLINIC FL 501(C)(3) 7 MAYO CLINIC
 
Yes
 
(42) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH

200 FIRST STREET SW

ROCHESTER,MN55905
41-1506440 		CHARITABLE, EDUCATIONAL & SCIENTIFIC ACTIVITIES MN 501(C)(3) 9 MAYO CLINIC
 
Yes
 
(43) MAYO KLINIK STIFTUNG

60486 FRANKFURT AM MAIN
FRANKFURT    
GM
FUNDRAISING FOUNDATION GM     MFMER
 
Yes
 
(44) MILES AND SHIRLEY FITERMAN ENDOWMENT FUND FOR DIGESTIVE DISEASES

200 FIRST STREET SW

ROCHESTER,MN55905
41-2020392 		SUPPORT RESEARCH, PRACTICE & EDUCATION MN 501(C)(3) 11-I MAYO CLINIC
 
Yes
 
(45) POVERELLO FOUNDATION

200 FIRST STREET SW

ROCHESTER,MN55905
41-1494881 		FUNDRAISING FOUNDATION MN 501(C)(3) 7 MAYO CLINIC -- SAINT MARYS HOSPITAL
 
Yes
 
(46) RED WING SEMINARY HOME

701 HEWITT BOULEVARD

RED WING,MN55066
41-1263419 		RESIDENT CARE AND HOUSING MN 501(C)(3) 9 MCHS--RED WING
 
Yes
 
(47) SATILLA HEALTH MANAGEMENT INC

1900 TEBEAU STREET

WAYCROSS,GA31501
58-1717889 		HEALTHCARE SERVICES GA 501(C)(3) 3 MCHS IN WAYCROSS INC
 
Yes
 
(48) THE DOWNTOWN PLAZA

701 HEWITT BOULEVARD

RED WING,MN55066
41-1532554 		ELDERLY HOUSING MN 501(C)(3) 9 MCHS--RED WING
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) FRANKLIN HEATING STATION

119 THIRD ST SW
ROCHESTER,MN55902
41-0264830 		UTILITY MN MAYO CLINIC
  		EXCLUDED 40 8,031,776   No   Yes   15.950 %
(2) PHYSICIAN SOFTWARE SYSTEMS LLC

3333 WARRENVILLE ROAD SUITE 200
LISLE,IL60532
45-3414836 		HEALTHCARE RELATED SOFTWARE IL N/A
                  










Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) HEALTH TRADITION HEALTH PLAN

1808 EAST MAIN STREET
ONALASKA,WI54650
39-1545987 		MEDICAL SERVICES COMPANY WI N/A
 C       Yes  
(2) LOBSS NETWORK SUPPORT 2002 INC

200 FIRST STREET SW
ROCHESTER,MN55905
48-1276150 		ADMINISTRATIVE SERVICES MN N/A
 C       Yes  
(3) MAYO CLINIC GBS MAURITIUS

2ND FLOOR EBENE MEWS 57
EBENE CYBERCITY    
MP
HEALTHCARE MANAGEMENT MP N/A
 C       Yes  
(4) MAYO CLINIC HEALTH SYSTEM--DECORAH CLINIC PHYSICIANS

907 MONTGOMERY STREET
DECORAH,IA52101
41-1711329 		PATIENT CARE - CLINIC IA N/A
 C       Yes  
(5) MAYO CLINIC HEALTH SYSTEM--FARIBAULT

635 FIRST STREET SE
FARIBAULT,MN55021
41-1817179 		PATIENT CARE - CLINIC MN N/A
 C       Yes  
(6) MAYO CLINIC HEALTH SYSTEM--PHARMACY & HOME MEDICAL INC

1221 WHIPPLE STREET
EAU CLAIRE,WI54703
39-1528920 		PHARMACY SERVICES WI N/A
 C       Yes  
(7) MAYO COLLABORATIVE SERVICES INC

200 FIRST STREET SW
ROCHESTER,MN55905
41-1346366 		REFERENCE LAB SERVICES MN N/A
 C       Yes  
(8) MAYO HOLDING COMPANY

200 FIRST STREET SW
ROCHESTER,MN55905
41-1578020 		HOLDING COMPANY MN N/A
 C       Yes  
(9) MAYO INSURANCE COMPANY LTD

200 FIRST STREET SW
ROCHESTER,MN55905
 SELF INSURANCE POOL CJ N/A
 C       Yes  
(10) MAYO MEDICAL LABORATORIES NEW ENGLAND INC

265 BALLARDVALE STREET
WILMINGTON,MA01887
04-3323713 		LABORATORY SERVICES MA N/A
 C       Yes  
(11) MAYO REGIONAL PRACTICES OF ARIZONA

13400 EAST SHEA BOULEVARD
SCOTTSDALE,AZ85259
06-1190278 		THIRD PARTY ADMINISTRATION SERVICES AZ N/A
 C       Yes  
(12) MMSI INC

21 FIRST STREET SW
ROCHESTER,MN55905
41-1547003 		THIRD PARTY ADMINISTRATION SERVICES MN N/A
 C       Yes  
(13) RESOUNDANT INC

221 1ST AVE SW
ROCHESTER,MN55902
46-1661978 		MANUFACTURING MEDICAL DEVICE COMPONENT MN N/A
 C       Yes  
(14) ROCHESTER AIRPORT COMPANY

ROUTE 2
ROCHESTER,MN55902
41-0506870 		AIRPORT MANAGEMENT MN N/A
 C       Yes  
(15) SATILLA HEALTH ENTERPRISES INC

1900 TEBEAU STREET
WAYCROSS,GA31501
58-1717222 		HEALTHCARE GA N/A
 C       Yes  
(16) SATILLA HEALTHNET INC

1900 TEBEAU STREET
WAYCROSS,GA31501
58-2151076 		HEALTH SERVICES GA N/A
 C       Yes  
(17) SATILLA REGIONAL SPECIALTY PHYSICIANS INC

1900 TEBEAU STREET
WAYCROSS,GA31501
20-4363143 		PHYSICIAN OFFICES GA N/A
 C       Yes  
(18) SIT ALPHA II BOND FUND LTD

CLIFTON HOUSE 75 FORTH ST
GRAND CAYMAN   KY1-1108
CJ
98-0648163 		INVESTMENT MANAGEMENT CJ N/A
 C       Yes  
(19) SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION

13400 E SHEA BLVD
SCOTTSDALE,AZ85259
86-0870505 		COMMERCIAL PROPERTY OWNERS ASSOCIATION AZ N/A
 C       Yes  
(20) THE STABILE BUILDING OWNERS' ASSOCIATION

200 FIRST STREET SW
ROCHESTER,MN55905
20-8994499 		COMMERCIAL PROPERTY OWNERS ASSOCIATION MN N/A
 C       Yes  
(21) CHARITABLE LEAD TRUST

 
 
CHARITABLE TRUST CA N/A
 T       Yes  
(22) PERPETUAL TRUST

 
 
CHARITABLE TRUST ND N/A
 T       Yes  
(23) PERPETUAL TRUST

 
 
CHARITABLE TRUST LA N/A
 T       Yes  
(24) PERPETUAL TRUST (2)

 
 
CHARITABLE TRUST MA N/A
 T       Yes  
(25) PERPETUAL TRUST

 
 
CHARITABLE TRUST MO N/A
 T       Yes  
(26) PERPETUAL TRUST

 
 
CHARITABLE TRUST AZ N/A
 T       Yes  
(27) CHARITABLE REMAINDER TRUST

 
 
CHARITABLE TRUST CO N/A
 T       Yes  
(28) CHARITABLE REMAINDER TRUST (6)

 
 
CHARITABLE TRUST FL N/A
 T       Yes  
(29) CHARITABLE REMAINDER TRUST

 
 
CHARITABLE TRUST FL N/A
 T       Yes  
(30) CHARITABLE REMAINDER TRUST

 
 
CHARITABLE TRUST IL N/A
 T       Yes  
(31) CHARITABLE REMAINDER TRUST

 
 
CHARITABLE TRUST LA N/A
 T       Yes  
(32) CHARITABLE REMAINDER TRUST

 
 
CHARITABLE TRUST MI N/A
 T       Yes  
(33) CHARITABLE REMAINDER TRUST (68)

 
 
CHARITABLE TRUST MN N/A
 T       Yes  
(34) CHARITABLE REMAINDER TRUST (77)

 
 
CHARITABLE TRUST MN N/A
 T       Yes  
(35) CHARITABLE REMAINDER TRUST

 
 
CHARITABLE TRUST NC N/A
 T       Yes  
(36) CHARITABLE REMAINDER TRUST (2)

 
 
CHARITABLE TRUST TX N/A
 T       Yes  
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
Yes
 
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) MAYO CLINIC HEALTH SYSTEM--ALBERT LEA

 K 121,502 GAAP
(2) MAYO CLINIC HEALTH SYSTEM--FAIRMONT

 K 91,842 GAAP
(3) MAYO CLINIC HEALTH SYSTEM--FRANCISCAN MEDICAL CENTER INC

 K 118,271 GAAP
(4) MAYO CLINIC HEALTH SYSTEM--FRANCISCAN MEDICAL CENTER INC

 M 129,679 GAAP
(5) MAYO CLINIC HEALTH SYSTEM--MANKATO

 L 71,341 GAAP
(6) MAYO CLINIC HEALTH SYSTEM--OWATONNA

 K 91,350 GAAP
(7) MAYO FOUNDATION MEDICAL EDUCATION AND RESEARCH

 H 165,273,658 GAAP
(8) MAYO FOUNDATION MEDICAL EDUCATION AND RESEARCH

 O 153,735,685 GAAP
(9) MAYO FOUNDATION MEDICAL EDUCATION AND RESEARCH

 Q 2,630,684 GAAP
(10) MAYO FOUNDATION MEDICAL EDUCATION AND RESEARCH

 R 9,717,600 GAAP
(11) MMSI INC

 S 90,311,275 GAAP
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


Software ID:  
Software Version: