TY 2014 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) ANIL MD GOKHAN........................................................................ DIRECTOR	40.00 .......................0.00	X		480,174	51,844
(2) BINN MD MARTHA C........................................................................ DIRECTOR (7/1-12/31/2014)	40.00 .......................0.00	X		274,837	48,985
(3) ERICKSON ERIC B........................................................................ DIRECTOR	40.00 .......................0.00	X		222,966	38,241
(4) FITZGERALD MD KEVIN........................................................................ DIRECTOR	40.00 .......................0.00	X		272,968	54,112
(5) GRAU MD THOMAS J........................................................................ DIRECTOR	40.00 .......................0.00	X		283,519	23,759
(6) GRENISEN MD MARGARET M........................................................................ DIRECTOR	40.00 .......................0.00	X		231,846	37,955
(7) HAGER NICKIJO L........................................................................ DIRECTOR	40.00 .......................0.00	X		153,923	36,056
(8) HOLMAY DIANE K........................................................................ DIRECTOR	40.00 .......................0.00	X		224,242	57,871
(9) HUGHES PETER R........................................................................ DIRECTOR/REGION VP OF BUSINESS DEVELOPMENT	40.00 .......................0.00	X	X	250,307	67,320
(10) JOHNSON MD TIMOTHY J........................................................................ CEO/CHAIR/DIRECTOR/PHYSICIAN	40.00 .......................0.00	X	X	465,051	71,555
(11) JUNGCK MD MARK C........................................................................ DIRECTOR	40.00 .......................0.00	X		293,529	65,024
(12) KORDUCKI MD JANE M........................................................................ DIRECTOR	40.00 .......................0.00	X		252,469	64,597
(13) KRIEN MD JOSEPH S........................................................................ DIRECTOR	40.00 .......................0.00	X		280,884	54,759
(14) KRUMHOLZ MD ALAN J........................................................................ DIRECTOR (1/1-7/1/2014)	40.00 .......................0.00	X		160,466	68,349
(15) KRUSE JOSEPH J........................................................................ CAO/VICE CHAIR/SECRETARY/DIRECTOR	40.00 .......................0.00	X	X	330,319	68,233
(16) MOLLING DO PAUL E........................................................................ DIRECTOR	40.00 .......................0.00	X		272,241	55,106
(17) NOEL AMY J........................................................................ DIRECTOR	40.00 .......................0.00	X		217,628	60,995

(A) Name and business address	(B) Description of services	(C) Compensation
MAYO CLINIC 200 1ST STREET SW ROCHESTER,MN55905	HEALTHCARE SERVICES	4,398,428
FOWLER & HAMMER INC 313 MONITOR STREET LA CROSSE,WI54603	CONSTRUCTION	4,105,901
WEATHERBY LOCUMS 6541 NORTH FEDERAL HWY SUITE 800 FORT LAUDERDALE,FL33308	HEALTHCARE SERVICES	2,559,293
AMPHION MEDICAL SOLUTIONS 8301 EXCELSIOR DRIVE MADISON,WI53717	HEALTHCARE SERVICES	1,835,473
COULEE REGION MECHANICAL 2255 PALACE STREET LA CROSSE,WI54603	HEALTHCARE SERVICES	1,163,789
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 167

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 domestic organizations and domestic governments. See Part IV, line 21 ....	117,905	117,905
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....	6,633,447	4,602,633	2,030,814
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	711,701	711,701
7	Other salaries and wages ....	201,137,538	198,194,060	2,943,478
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	10,358,100	10,101,931	256,169
9	Other employee benefits .......	39,687,906	38,746,666	941,240
10	Payroll taxes ...........	13,169,928	12,862,483	307,445
11	Fees for services (non-employees):
a	Management ......	15,151,849		15,151,849
b	Legal .........	49,624		49,624
c	Accounting ...........	17,700		17,700
d	Lobbying ...........	8,393	8,393
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) ....	15,883,336	14,968,546	914,790
12	Advertising and promotion ....	1,074,038	328,631	745,407
13	Office expenses .......	14,780,639	14,287,352	493,287
14	Information technology ......	1,875,743		1,875,743
15	Royalties ..
16	Occupancy ...........	14,863,429	14,625,889	237,540
17	Travel ............	902,301	873,892	28,409
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	2,468,559	2,446,674	21,885
20	Interest ...........	724,905	724,905
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	13,893,632	13,393,088	500,544
23	Insurance ..............	1,007,453	1,007,453
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	UBI TAXES	12,812		12,812
b	MEDICAL SUPPLIES	53,496,310	53,496,310
c	BAD DEBT EXPENSE	17,963,683	17,963,683
d	MN CARE TAX	5,260,005	5,260,005
e	All other expenses	1,574,978	1,250,902	324,076
25	Total functional expenses. Add lines 1 through 24e	432,825,914	405,973,102	26,852,812	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 if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	32,700	1	23,376
2	Savings and temporary cash investments .........	68,341	2	73,151
3	Pledges and grants receivable, net ...........	22,390	3	11,520
4	Accounts receivable, net .............	70,465,604	4	74,678,557
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		1,734	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 .............	1,378,593	7	1,314,296
8	Inventories for sale or use ..............	7,591,383	8	7,364,027
9	Prepaid expenses and deferred charges ..........	18,323,569	9	16,768,240
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	279,230,902
b	Less: accumulated depreciation .....	10b	166,711,070	112,283,349	10c	112,519,832
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 .....	21,613,173	12	34,424,789
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	21,681,997	15	17,997,109
16	Total assets. Add lines 1 through 15 (must equal line 34)......	253,462,833	16	265,174,897
	17	Accounts payable and accrued expenses .........	44,722,932	17	75,005,260
18	Grants payable .................		18
19	Deferred revenue ................	986,945	19	856,977
20	Tax-exempt bond liabilities .............		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..	43,931	21	44,776
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....................	20,021,098	25	29,250,784
26	Total liabilities. Add lines 17 through 25.........	65,774,906	26	105,157,797
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	187,687,927	27	160,017,100
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets ...........		29
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	187,687,927	33	160,017,100
34	Total liabilities and net assets/fund balances ........	253,462,833	34	265,174,897

- TIN:

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.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

MAYO CLINIC HEALTH SYSTEM-FRANCISCAN
MEDICAL CENTER INC

Employer identification number

39-0806374

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

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)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.)..
11	Total support Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2013. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2014

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)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2013. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Name of the organization

MAYO CLINIC HEALTH SYSTEM-FRANCISCAN
MEDICAL CENTER INC

Employer identification number

39-0806374

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... 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 its Form 990PF, Part I, line 2, 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 2

Name of organization MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER INC

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 3

Name of organization MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER INC

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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 4

Name of organization
MAYO CLINIC HEALTH SYSTEM-FRANCISCAN
MEDICAL CENTER INC

Employer identification number

39-0806374

Part III

Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. 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

(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

(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

(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

(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) (2014)

Additional Data

Software ID:
Software Version:

- TIN:

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

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

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) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

MAYO CLINIC HEALTH SYSTEM-FRANCISCAN
MEDICAL CENTER INC

Employer identification number

39-0806374

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

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) 2014

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ......................................	Yes No

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(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) 2014

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)

Yes

(b)

Amount

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:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Yes

8,393

Total. Add lines 1c through 1i ...............................

8,393

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

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

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

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."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
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) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

MAYO CLINIC HEALTH SYSTEM-FRANCISCAN
MEDICAL CENTER INC

Employer identification number

39-0806374

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 value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

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)? .......................................

Yes No

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.

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.

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)

Revenue included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

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:

Revenue included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2014

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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 ....	18,026,118	16,637,491	15,943,228	16,028,434	15,824,272
b	Contributions ........	4,652	960,654	608,124	1,367,448	1,086,762
c	Net investment earnings, gains, and losses	140,263	1,100,771	632,787	-512,980	416,290
d	Grants or scholarships .....		672,798	546,648	939,674	1,298,890
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....	3,795,628
g	End of year balance ......	14,375,405	18,026,118	16,637,491	15,943,228	16,028,434

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. 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 .................		11,175,144		11,175,144
b	Buildings ................	163,430	176,690,549	104,053,036	72,800,943
c	Leasehold improvements ............
d	Equipment ................		85,693,137	62,407,206	23,285,931
e	Other .................		5,508,642	250,828	5,257,814
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					112,519,832

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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
(3)Other (A) MAYO POOLED INVESTMENTS	34,424,789	F








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	34,424,789

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(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.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) DUE FROM AFFILIATES				17,993,433
(2) FEDERAL INCOME TAXES				3,675







Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				17,997,109

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
DUE TO AFFILIATES		13,588,853
DEFERRED COMPENSATION LIABILITY		14,411,638
ASSET RETIREMENT OBLIGATION		1,250,293






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		29,250,784
2. Liability for uncertain tax positions. 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) 2014

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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 (losses) 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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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

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.

Return Reference	Explanation
PART IV, LINE 2B:	ASSISTED LIVING SECURITY DEPOSITS.
PART V, LINE 4:	THE ENDOWMENT FUNDS PROVIDE A STABLE FUNDING SOURCE FOR RESEARCH AND EDUCATION PROGRAMS.
PART X, LINE 2:	AT DECEMBER 31, 2014 AND 2013, 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) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Information about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization
MAYO CLINIC HEALTH SYSTEM-FRANCISCAN
MEDICAL CENTER INC

Employer identification number

39-0806374

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Form 990-EZ

filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total .................

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2014

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 TINY TIM (event type)	(b) Event #2 DRAGON BOAT FESTIVAL (event type)	(c) Other events 3 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . .	54,156	45,749	77,887	177,792
2	Less: Contributions . .	18,927		29,049	47,976
3	Gross income (line 1 minus line 2) . . .	35,229	45,749	48,838	129,816
4	Cash prizes . . .			1,586	1,586
5	Noncash prizes . .			35,818	35,818
6	Rent/facility costs . .
7	Food and beverages .	34,735		4,739	39,474
8	Entertainment . . .
9	Other direct expenses .	5,726	35,760	5,906	47,392
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........				124,270
11	Net income summary. Subtract line 10 from line 3, column (d)...........				5,546

Part III

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (add col.(a) through col.(c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d) ......... right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? ............

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2014

Page 3

Does the organization conduct gaming activities with nonmembers? .................

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? ..........................

YesNo

Indicate the percentage of gaming activities conducted in:

The organization's facility ......................

13a

An outside facility ........................

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

MAYO CLINIC HEALTH SYSTEM-FRANCISCAN
MEDICAL CENTER INC

Employer identification number

39-0806374

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other %

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: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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.

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"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

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? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) ..	2,406,474		2,406,474	0.580 %
b	Medicaid (from Worksheet 3, column a) ....	53,981,422	25,358,769	28,622,653	6.900 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	56,387,896	25,358,769	31,029,127	7.480 %
Other Benefits		951,435	100,702	850,733	0.210 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	951,435	100,702	850,733	0.210 %
f	Health professions education (from Worksheet 5) ..	3,906,325	1,192,333	2,713,992	0.650 %
g	Subsidized health services (from Worksheet 6) ..	11,256,470	6,715,768	4,540,702	1.090 %
h	Research (from Worksheet 7)	255,240	58,457	196,783	0.050 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	51,773		51,773	0.010 %
j	Total. Other Benefits ..	16,421,243	8,067,260	8,353,983	2.010 %
k	Total. Add lines 7d and 7j .	72,809,139	33,426,029	39,383,110	9.490 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	12,520	12,520	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	4,842	4,842	0 %
7	Community health improvement advocacy
8	Workforce development
9	Other	11,740	11,740	0 %
10	Total	29,102	29,102

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

17,963,683

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. ......

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

Enter total revenue received from Medicare (including DSH and IME).....

60,907,076

Enter Medicare allowable costs of care relating to payments on line 5.....

78,225,242

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-17,318,166

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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.......................

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) 2014

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?2 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITAL 700 WEST AVENUE SOUTH LA CROSSE,WI546014796 WWW.MAYOCLINICHEALTHSYSTEM.ORG 24	X	X	X		X
2	FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL 310 WEST MAIN STREET SPARTA,WI546562142 WWW.MAYOCLINICHEALTHSYSTEM.ORG 1009	X	X		X		X

Schedule H (Form 990) 2014

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)

	FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITA
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

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 12....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public? ..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.MAYOCLINICHEALTHSYSTEM.ORG/LOCATIONS/LA-CROSSE/ABOUT-US

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, 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) 2014

Page

Part VFacility Information (continued)

	FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITA
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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 all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

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 individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITA
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.........

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual 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? ................................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

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)

	FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

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 12....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public? ..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.MAYOCLINICHEALTHSYSTEM.ORG/LOCATIONS/SPARTA/ABOUT-US

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

If "Yes" (list url):

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Yes

12a

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)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, 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) 2014

Page

Part VFacility Information (continued)

	FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITAL	PART V, SECTION B, LINE 5: THE COALITION THAT CONDUCTED THE "COMPASS NOW" ASSESSMENT ON WHICH THIS CHNA IS BASED INCLUDED PARTICIPATION OF THE PUBLIC HEALTH DEPARTMENTS OF HOUSTON, LA CROSSE, MONROE, TREMPEALEAU, AND VERNON COUNTIES. THE "COMPASS NOW" ASSESSMENT RECEIVED INPUT FROM THE FOLLOWING SOURCES: RANDOMLY SELECTED HOUSEHOLD SURVEYS, KEY STAKEHOLDER MEETINGS, AND FOCUS GROUPS.
FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL	PART V, SECTION B, LINE 5: THE COALITION THAT CONDUCTED THE "COMPASS NOW" ASSESSMENT ON WHICH THIS CHNA IS BASED INCLUDED PARTICIPATION OF THE PUBLIC HEALTH DEPARTMENTS OF HOUSTON, LA CROSSE, MONROE, TREMPEALEAU, AND VERNON COUNTIES. THE "COMPASS NOW" ASSESSMENT RECEIVED INPUT FROM THE FOLLOWING SOURCES: RANDOMLY SELECTED HOUSEHOLD SURVEYS, KEY STAKEHOLDER MEETINGS, AND FOCUS GROUPS.
FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITAL	PART V, SECTION B, LINE 6A: THE COALITION THAT CONDUCTED THE "COMPASS NOW" ASSESSMENT ON WHICH THIS CHNA REPORT IS BASED INCLUDED MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER-LA CROSSE CAMPUS, MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER-SPARTA CAMPUS, GUNDERSEN LUTHERAN HEALTH SYSTEM, ST. JOSEPH'S HEALTH SERVICES-GUNDERSEN LUTHERAN, TOMAH MEMORIAL HOSPITAL, TRI-COUNTY MEMORIAL HOSPITAL, AND VERNON MEMORIAL HOSPITAL.
FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL	PART V, SECTION B, LINE 6A: THE COALITION THAT CONDUCTED THE "COMPASS NOW" ASSESSMENT ON WHICH THIS CHNA REPORT IS BASED INCLUDED MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER-LA CROSSE CAMPUS, MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER-SPARTA CAMPUS, GUNDERSEN LUTHERAN HEALTH SYSTEM, ST. JOSEPH'S HEALTH SERVICES-GUNDERSEN LUTHERAN, TOMAH MEMORIAL HOSPITAL, TRI-COUNTY MEMORIAL HOSPITAL, AND VERNON MEMORIAL HOSPITAL.
FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITAL	PART V, SECTION B, LINE 11: IDENTIFIED NEED - ALCOHOL USE:MAYO CLINIC HEALTH SYSTEM - LA CROSSE (MCHS - LA CROSSE) CONTINUES TO PROVIDE ALCOHOL AND OTHER DRUG TREATMENT AND PREVENTION SERVICES THAT ADDRESS THE NEEDS OF PATIENTS AND TO OPERATE BEHAVIORAL HEALTH RESIDENTIAL SERVICES IN LA CROSSE AND PRAIRIE DU CHIEN. COMMUNITY INVESTMENT DOLLARS WERE DESIGNATED TO PROGRAMS THAT PROMOTE ALCOHOL AND DRUG PREVENTION AND EDUCATION IN SCHOOLS AND THE COMMUNITY, INCLUDING D.A.R.E. PROGRAM, COULEE COUNCIL ON ADDICTIONS' TURNED LEAF FESTIVAL; HIGH SCHOOL PROM LOCK-INS; AND AT-RISK-YOUTH EVENTS. CASH CONTRIBUTIONS TOTALED $8,000. IN-KIND CONTRIBUTIONS TOTALED $550.IN KIND CONTRIBUTIONS INCLUDED: PARTNERING WITH AN AREA CHURCH TO PROVIDE "SOBERFEST", AN ALTERNATIVE FESTIVAL TO DRINKING; WORK WITH TRI-COUNTY HEROIN ADDICTION COALITION AS A TREATMENT RESOURCE FOR THE LAW ENFORCEMENT AGENCIES IN LA CROSSE, VERNON AND MONROE COUNTIES AND PRESENT A BI-ANNUAL PROGRAM "FAMILY ADJUSTMENTS TO LIVING WITH ADDICTION" TO COULEE COUNCIL ON ADDICTIONS.IN ADDITION, MCHS-LA CROSSE WORKED WITH THE HEALTH SCIENCE CONSORTIUM'S RISKY DRINKING BEHAVIORS COALITION OF COMMUNITIES, STUDENTS, PARENTS, GOVERNMENTS, AND BUSINESSES TO SUPPORT POLICIES AND FUNDING FOR PRACTICES THAT MAKE IT EASIER FOR THOSE WHO DRINK TO DO SO SAFELY.IDENTIFIED NEED - HEALTH CARE ACCESS :MCHS-LA CROSSE OPERATES ST. CLARE HEALTH MISSION, A FREE, BASIC HEALTH CARE CLINIC IN LA CROSSE THAT SERVES INDIVIDUALS WHO HAVE NO MEDICAL INSURANCE OR DO NOT QUALIFY FOR PUBLIC ASSISTANCE. THE CLINIC FILLS PRESCRIPTIONS WRITTEN AT THE MISSION FREE OF CHARGE AT THE ON-SITE PHARMACY. THE MISSION ALSO OPERATES A CONTINUITY CLINIC FOR INDIVIDUALS WITH UNSTABLE CHRONIC MEDICAL CONDITIONS THAT ARE REFERRED BY THE MISSION AND PROVIDES NUTRITION COUNSELING, DIABETIC EDUCATION, SMOKING CESSATION, FOOT CARE AND SPECIALTY MEDICAL CARE. MISSION REFERRED PATIENTS THAT REQUIRE SPECIALTY PROCEDURES OR SURGERY ARE TREATED AT THE LA CROSSE HOSPITAL.MCHS-LA CROSSE HOSPITAL STAFF SERVED AS CERTIFIED APPLICATION COUNSELORS TO FACILITATE ENROLLMENT OF VULNERABLE POPULATIONS IN HEALTHCARE MARKETPLACE EXCHANGES. ON THE LA CROSSE CAMPUS, TWO FULL-TIME STAFF HELPED BOTH PATIENTS AND NON-PATIENTS DURING THE FIRST 3 MONTHS OF 2014. THEY ASSISTED, IN PERSON, 331 INDIVIDUALS AND ANSWERED 441 HEALTH INSURANCE MARKETPLACE SUPPORT PHONE CALLS.MCHS-LA CROSSE ALSO CONTINUES TO PROVIDE PREVENTION AND TREATMENT SERVICES THAT ADDRESS OUR PATIENTS' NEEDS SUCH AS PARTICIPATING IN THE MINNESOTA BREAST AND CERVICAL CANCER PROGRAM THAT PROVIDES LOW-INCOME, UNINSURED OR UNDERINSURED WOMEN AND THE WISCONSIN WELL WOMAN PROGRAMS THAT PROVIDES WOMEN WITH LITTLE OR NO INSURANCE ACCESS TO SCREENINGS.MCHS-LA CROSSE DESIGNATED COMMUNITY INVESTMENT DOLLARS TO COMMUNITY PROGRAMS THAT IMPROVE ACCESS TO CARE INCLUDING BUS TRANSPORTATION THAT BRINGS DIALYSIS PATIENTS TO LA CROSSE FOR TREATMENT; AND LA CROSSE COUNTY'S STRONG SENIORS PROGRAMS WHICH TARGETS PHYSICAL FITNESS PROGRAMS FOR OLDER ADULTS. CASH CONTRIBUTIONS TOTALED $8,000.IDENTIFIED NEED - MENTAL HEALTH:MCHS-LA CROSSE CONTINUES TO OFFER MENTAL HEALTH TREATMENT AND PREVENTION SERVICES THAT ADDRESS THE NEEDS OF OUR PATIENTS AND PROVIDES RESIDENTIAL MENTAL HEALTH TREATMENT FOR YOUNG WOMEN WITH INFANTS AT GERARD HALL. MCHS-LA CROSSE SERVES AS A RESOURCE TO VITERBO UNIVERSITY STUDENTS WORKING TOWARD A MASTERS' DEGREE IN MENTAL HEALTH COUNSELING AND CONSULTS WITH STAFF ON VARIOUS COMMUNITY AGENCIES PROVIDING SHELTER/CARE TO VICTIMS OF DOMESTIC VIOLENCE.MCHS-LA CROSSE DESIGNATED COMMUNITY INVESTMENT DOLLARS TO COMMUNITY PROGRAMS THAT EDUCATE THE COMMUNITY ABOUT MENTAL ILLNESS. PROGRAMS INCLUDE A COUNTY DOCUMENTARY ABOUT ADOPTIVE CHILDREN WITH ABUSIVE CHILDHOODS AND A SUICIDE PREVENTION SUMMIT. CASH CONTRIBUTIONS TOTALED $1,250.IN ADDITION, MCHS-LA CROSSE PARTICIPATED IN A BROAD-BASED MENTAL HEALTH COALITION OF ORGANIZATIONS, PROVIDERS, AND CITIZENS. COALITION PROJECTS INCLUDE CREATING AWARENESS THAT SUICIDE IS A PREVENTABLE, PUBLIC HEALTH PROBLEM, IMPROVING OUTCOMES WHEN LAW ENFORCEMENT COMES IN CONTACT WITH INDIVIDUALS WITH MENTAL ILLNESS AND WORKING TO ENSURE THAT DISCHARGE PLANS AID WITH A SAFE TRANSITION BACK INTO THE COMMUNITY. IDENTIFIED NEED - OBESITY:MCHS-LA CROSSE OFFERS HEALTHY EATING, PHYSICAL ACTIVITY AND STRESS REDUCTION PROGRAMS THAT MEET THE NEEDS OF PATIENTS AND EMPLOYEES INCLUDING A COMMUNITY SUPPORTED AGRICULTURE (CSA) BENEFIT AS PART OF ITS HEALTH PLAN. MCHS-LA CROSSE ALSO PROVIDES LAND AND SUPPORT TO COMMUNITY PARTNERS (WASHBURN NEIGHBORHOOD GROUP AND HMONG MUTUAL ASSISTANCE ASSOCIATION) FOR GARDENS ON MAYO CLINIC HEALTH SYSTEM PROPERTY IN LA CROSSE AND ONALASKA.MCHS-LA CROSSE PARTNERED WITH WESTERN TECHNICAL COLLEGE, HILLVIEW URBAN AGRICULTURE CENTER AND LA CROSSE COMMUNITY FOUNDATION TO ENCOURAGE HEALTHY EATING AND TO CONDUCT COMMUNITY DEMONSTRATIONS ON ECONOMICAL WAYS TO USE LOCAL PRODUCE IN SLOW COOKERS. MCHS-LA CROSSE DESIGNATED COMMUNITY INVESTMENT DOLLARS TO COMMUNITY PROGRAMS THAT PROMOTE HEALTHY EATING. EXAMPLES INCLUDE HEALTHY SNACKS FOR NON-SCHOOL AND AFTER SCHOOL PROGRAMS AND MILK FOR THE SALVATION ARMY. CASH CONTRIBUTIONS TOTALED $5000.IN ADDITION, AS A FOUNDING PARTNER OF THE HEALTH SCIENCE CONSORTIUM, MCHS-LA CROSSE WORKS WITH ITS OBESITY TASK FORCE TO INCREASE PURCHASE AND CONSUMPTION OF FRUITS AND VEGETABLES AT LOCAL GROCERY STORES. MCHS-LA CROSSE CONTINUES AS A BUSINESS SITE FOR THE LA CROSSE COUNTY "HARVEST OF THE MONTH" PROGRAM.
FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL	PART V, SECTION B, LINE 11: IDENTIFIED NEED - ALCOHOL USE:MAYO CLINIC HEALTH SYSTEM - LA CROSSE IN SPARTA (MCHS SPARTA) CONTINUES TO PROVIDE ALCOHOL AND OTHER DRUG TREATMENT AND PREVENTION SERVICES THAT ADDRESS THE NEEDS OF ITS PATIENTS. IN KIND CONTRIBUTIONS INCLUDE: PARTICIPATION IN MONROE COUNTY ALCOHOL AND OTHER DRUG ABUSE INITIATIVE AND WORK WITH TRI-COUNTY HEROIN ADDICTION COALITION AS A TREATMENT RESOURCE FOR THE LAW ENFORCEMENT AGENCIES IN LA CROSSE, VERNON AND MONROE COUNTIES.IDENTIFIED NEED - ACCESS TO HEALTH CARE:MCHS SPARTA OPERATES ST. CLARE HEALTH MISSION, A FREE, BASIC HEALTH CARE CLINIC IN SPARTA THAT SERVES INDIVIDUALS WHO RESIDE IN MONROE COUNTY AND HAVE NO MEDICAL INSURANCE OR DO NOT QUALIFY FOR PUBLIC ASSISTANCE. PHYSICIANS AND STAFF VOLUNTEER AT THE CLINIC. THE CLINIC FILLS PRESCRIPTIONS WRITTEN AT THE MISSION FREE OF CHARGE AT THE ON-SITE PHARMACY. MCHS SPARTA HOSPITAL STAFF SERVED AS CERTIFIED APPLICATION COUNSELORS TO FACILITATE ENROLLMENT OF VULNERABLE POPULATIONS IN HEALTHCARE MARKETPLACE EXCHANGES. AT THE MONROE COUNTY SITES, DURING THE FIRST 3 MONTHS OF 2014, THE COUNSELORS HELPED PATIENTS AND NON-PATIENTS FOR 16 HOURS/WEEK IN SPARTA AND 16 HOURS/WEEK IN TOMAH. MCHS SPARTA ALSO CONTINUES TO PROVIDE PREVENTION AND TREATMENT SERVICES THAT ADDRESS PATIENTS' NEEDS AND PARTICIPATES IN THE WISCONSIN WELL WOMAN PROGRAMS PROVIDING WOMEN WITH LITTLE OR NO INSURANCE ACCESS TO SCREENINGS.MCHS SPARTA DESIGNATED COMMUNITY INVESTMENT DOLLARS TO PROGRAMS THAT ASSIST MONROE COUNTY SENIORS WITH TRANSPORTATION - MONROE COUNTY SENIOR BUS. CASH CONTRIBUTIONS TOTALED $1,000.IDENTIFIED NEED - MENTAL HEALTH:MCHS SPARTA CONTINUES TO OFFER MENTAL HEALTH TREATMENT AND PREVENTION SERVICES THAT ADDRESS THE NEEDS OF ITS PATIENTS. MCHS SPARTA PARTICIPATES IN MONROE COUNTY MENTAL HEALTH WORKGROUP INITIATIVES, WHICH INCLUDES INCREASING INDIVIDUAL AND COMMUNITY KNOWLEDGE OF DEPRESSION SYMPTOMS AND SUICIDE. MCHS SPARTA ALSO PARTICIPATES IN THE COUNTY'S EDUCATIONAL SESSIONS ON ANTI-BULLYING. MCHS SPARTA DESIGNATED COMMUNITY INVESTMENT DOLLARS TO COMMUNITY PROGRAMS THAT EDUCATE THE COMMUNITY ABOUT MENTAL ILLNESS - NAMI OF MONROE COUNTY. CASH CONTRIBUTION TOTALED $500.IDENTIFIED NEED - OBESITY:MCHS SPARTA CONTINUES TO OFFER HEALTHY EATING, PHYSICAL ACTIVITY AND STRESS REDUCTION PROGRAMS THAT MEET THE NEEDS OF PATIENTS AND EMPLOYEES INCLUDING A COMMUNITY SUPPORT AGRICULTURE (CSA) BENEFIT AS PART OF ITS HEALTH PLAN. MCHS SPARTA PARTICIPATED IN MONROE COUNTY PROGRAMS TO INCREASE INDIVIDUAL AND COMMUNITY KNOWLEDGE RELATED TO NUTRITION AND PHYSICAL ACTIVITY.IDENTIFIED NEED - DENTAL CARE ACCESS AND COST:MCHS SPARTA OPERATES AN ORAL SURGERY PROGRAM THAT PROVIDES DENTAL SURGERY ACCESS AND MINOR RESTORATIVE PROCEDURES TO PEDIATRIC PATIENTS WHO CANNOT FIND AN AREA DENTIST TO PROVIDE THESE SERVICES.
FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITAL	PART V, SECTION B, LINE 13H: THE REGIONAL PROXIMITY OF A PATIENT'S RESIDENCY IS A FACTOR FOR PRESCHEDULED SERVICES ONLY AND SECONDARY TO MEDICAL NEED. REGIONAL PROXIMITY IS NOT A FACTOR FOR EMERGENCY CARE PROVIDED.
FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL	PART V, SECTION B, LINE 13H: THE REGIONAL PROXIMITY OF A PATIENT'S RESIDENCY IS A FACTOR FOR PRESCHEDULED SERVICES ONLY AND SECONDARY TO MEDICAL NEED. REGIONAL PROXIMITY IS NOT A FACTOR FOR EMERGENCY CARE PROVIDED.
FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITAL	PART V, SECTION B, LINE 16I: 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.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES ANINABILITY TO PAY, ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERALFUNDING AS WELL AS CHARITY CARE ARE DISCUSSED WITH THE PATIENT.
FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL	PART V, SECTION B, LINE 16I: 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.UPON ADMISSION, IF THE PATIENT DOES NOT HAVE INSURANCE OR EXPRESSES AN INABILITY TO PAY, ALL AVAILABLE OPTIONS INCLUDING STATE AND FEDERAL FUNDING AS WELL AS CHARITY CARE ARE DISCUSSED WITH THE PATIENT.
FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITAL	PART V, SECTION B, LINE 20E: 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.
FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL	PART V, SECTION B, LINE 20E: 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.
FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITAL	PART V, SECTION B, LINE 22D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 20% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN OR EQUAL TO THE THREE BEST NEGOTIATED COMMERCIAL RATES.
FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL	PART V, SECTION B, LINE 22D: OUR POLICY ALLOWS FOR A MINIMUM DISCOUNT OF 20% TO ELIGIBLE INDIVIDUALS WHICH RESULTS IN AN AMOUNT LESS THAN OR EQUAL TO THE THREE BEST NEGOTIATED COMMERCIAL RATES.
PART V, SECTION B, LINE 16	FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITA PART V, SECTION B, LINE 16A WEBSITE:	SEE PART VI
FRANCISCAN MEDICAL CTR-LA CROSSE HOSPITA PART V, SECTION B, LINE 16B WEBSITE:	SEE PART VI
FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 16A WEBSITE:	SEE PART VI
FRANCISCAN MEDICAL CTR-SPARTA HOSPITAL PART V, SECTION B, LINE 16B WEBSITE:	SEE PART VI

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section D. 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?26
Name and address		Type of Facility (describe)
1	FRANCISCAN MEDICAL CENTER - LA CROSSE 800 WEST AVENUE SOUTH LA CROSSE,WI546014796	CLINIC, PHARMACY
2	ONALASKA CLINIC 191 THEATER ROAD ONALASKA,WI54650	CLINIC, BEHAVIORAL HEALTH CLINIC, PHARMACY, DME
3	TOMAH CLINIC 325 BUTTS AVENUE TOMAH,WI546600610	CLINIC, BEHAVIORAL HEALTH CLINIC
4	BEHAVIORAL HEALTH SERVICE-LA CROSSE 212 11TH STREET SOUTH LA CROSSE,WI54601	BEHAVIORAL HEALTH CLINIC
5	HOLMEN CLINIC 1303 MAIN STREET S HOLMEN,WI546369337	CLINIC, BEHAVIORAL HEALTH CLINIC
6	ARCADIA CLINIC 464 SOUTH ST JOSEPH AVENUE ARCADIA,WI546121499	CLINIC, BEHAVIORAL HEALTH CLINIC, DME
7	SPARTA CLINIC 310 WEST MAIN STREET SPARTA,WI546562142	CLINIC, BEHAVIORAL HEALTH CLINIC, DME
8	FRANCISCAN LA CROSSE CLINIC DME 620 SOUTH 11TH STREET LA CROSSE,WI546014711	DME
9	WAUKON CLINIC 105 EAST MAIN STREET WAUKON,IA52172	CLINIC
10	PRAIRIE DU CHIEN CLINIC 800 EAST BLACKHAWK AVENUE PRAIRIE DU CHIEN,WI53821	CLINIC, BEHAVORIAL HEALTH
11	PROFESSIONAL ARTS BUILDING 615 SOUTH 10TH STREET LA CROSSE,WI54601	ALLERGY, ORAL SURGERY
12	FRANCISCAN FAMILY HEALTH CLINIC 815 SOUTH 10TH STREET LA CROSSE,WI54601	FAMILY HEALTH CLINIC
13	FRANCISCAN-HOME CARE PHARMACY 700 WEST AVENUE SOUTH LA CROSSE,WI54601	PHARMACY
14	CALEDONIA CLINIC 701 NORTH PRAGUE STREET CALEDONIA,MN559211066	CLINIC, BEHAVIORAL HEALTH CLINIC, DME
15	LA CRESCENT CLINIC 524 NORTH ELM LA CRESCENT,MN559471027	CLINIC
16	FRANCISCAN OCCUPATIONAL HEALTH CLINIC 630 10TH STREET LA CROSSE,WI54601	OCCUPATIONAL HEALTH CLINIC
17	SIENA HALL 613 SOUTH 10TH STREET LA CROSSE,WI54601	BEHAVIORAL HEALTH
18	VILLAGE ON 9TH 621 SOUTH 9TH STREET LA CROSSE,WI54601	ELDERLY HOUSING
19	VILLA SUCCESS 121 PRAIRIE STREET PRAIRIE DU CHIEN,WI53821	BEHAVIORAL HEALTH
20	WOMEN'S LAAR HOUSE 1005 JACKSON STREET LA CROSSE,WI54601	BEHAVIORAL HEALTH
21	ST CLARE HEALTH MISSION 916 FERRY STREET LA CROSSE,WI54601	CLINIC
22	SCARSETH HOUSE 535 SOUTH 17TH STREET LA CROSSE,WI54601	BEHAVIORAL HEALTH
23	GROUP HOME I 518 10TH STREET SOUTH LA CROSSE,WI54601	BEHAVIORAL HEALTH
24	VILLAGE ON CASS 225 24TH STREET SOUTH LA CROSSE,WI54601	ELDERLY HOUSING
25	GERARD HALL 940 DIVISION STREET LA CROSSE,WI54601	MATERNITY HOME
26	WALMART CLINIC OPERATED BY FRANCISCAN HE 4622 MORMON COULEE RD LA CROSSE,WI54601	CLINIC

Schedule H (Form 990) 2014

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
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:	THE FOLLOWING NET COMMUNITY BENEFIT COST ATTRIBUTED TO A PHYSICIAN CLINIC WAS INCLUDED AS SUBSIDIZED HEALTH SERVICES: $1,168,263.
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 $ 17,963,683.
PART II, COMMUNITY BUILDING ACTIVITIES:	THROUGH DONATIONS AND GRANTS TO PUBLIC, PRIVATE, AND NONPROFIT ORGANIZATIONS, THE FILING ORGANIZATION ASSISTS WITH SUSTAINING AND ENHANCING THE COMMUNITIES IT SERVES.
PART III, LINE 2:	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.
PART III, LINE 4:	FOOTNOTES RELATED TO ACCOUNTS RECEIVABLE AND ALLOWANCE FOR DOUBTFUL ACCOUNTS CAN BE FOUND ON PAGES 5, 7, 8 AND 9 OF MAYO CLINIC'S 2014 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 $66,057,000 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 POTENTIALLY MEETING MAYO CLINIC'S FINANCIAL ASSISTANCE ELIGIBILITY 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 THE PATIENT IS DETERMINED TO BE INELIGIBLE FOR FINANCIAL ASSISTANCE OR IS ELIGIBLE FOR ONLY PARTIAL FINANCIAL ASSISTANCE AND DOES NOT AGREE TO PAY THE REMAINING BALANCE.
PART VI, LINE 2:	MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER COLLABORATES WITH PUBLIC AND PRIVATE GROUPS IN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. THESE GROUPS AND DATA SOURCES INCLUDE: 2012 COMMUNITY NEEDS ASSESSMENT IN PARTNERSHIP WITH THE GREAT RIVERS UNITED WAY AND GUNDERSON LUTHERAN MEDICAL CENTER;HEALTHIEST WISCONSIN 2020 (PLAN OF WI DHS); POPULATION HEALTH PROJECT OF THE LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM, WHICH COLLECTS AND ANALYZES DATA FROM A 20 COUNTY AREA THAT MIRRORS THE REPORTING ORGANIZATION'S SERVICE AREA. MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER ALSO HAS REPRESENTATION ON NUMEROUS LOCAL HEALTH ADVOCACY GROUPS THAT TARGET SPECIFIC DISEASES AND CONDITIONS (CHILDHOOD OBESITY, DIABETES, SMOKING CESSATION, SUICIDE PREVENTION, ETC.). WE USE INFORMATION AND DATA FROM THESE GROUPS AS WELL TO HELP PLAN EVENTS IN THE SERVICE AREA.
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 AND APPLICATIONS AVAILABLE BY POSTING IT ON THEIR WEBPAGE INCLUDING THE ABILITY TO DOWNLOAD A COPY OF THE POLICY AND APPLICATION 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. ADDITIONALLY, CHARITABLE CARE AND FINANCIAL ASSISTANCE IS REFERENCED ON PATIENT CORRESPONDENCE INCLUDING: THE MONTHLY STATEMENT OF ACCOUNT, ACCOUNT BALANCE LETTERS, AND LATE PAYMENT NOTIFICATIONS. ALL PATIENT CORRESPONDENCE REFERENCING CHARITABLE CARE AND FINANCIAL ASSISTANCE INCLUDE INTERNET, PHONE, AND MAILING ADDRESS CONTACT INFORMATION.
PART VI, LINE 4:	MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC. IS AN INTEGRATED HEALTHCARE DELIVERY SYSTEM THAT SERVES THE RESIDENTS OF BUFFALO, TREMPELEAU, JACKSON, MONROE, LA CROSSE, JUNEAU, VERNON, CRAWFORD, RICHLAND, SAUK, AND GRANT COUNTIES IN WISCONSIN, WABASHA, WINONA, FILLMORE, AND HOUSTON COUNTIES IN MINNESOTA, AND WINNESHIEK, AND ALLAMAKEE COUNTIES IN IOWA. THE CITIES OF LA CROSSE (50K) AND WINONA (35K) REPRESENT SMALL METROPOLITAN AREAS AND THE BALANCE OF THE SERVICE AREA IS EITHER RURAL OR SMALL TOWNS (500 TO 10K). THE SERVICE AREA INCLUDES A GROWING NUMBER OF HISPANIC AND HMONG RESIDENTS. THE AREA POPULATION ALSO TRENDS OLDER, POORER AND LESS EDUCATED THAN THE STATEWIDE AVERAGE.
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 ORGANIZATIONS 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:STAFF PRIVILEGES ARE GENERALLY EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. EMERGENCY ROOM:THE FILING ORGANIZATION MAINTAINS AN EMERGENCY ROOM 24 HOURS A DAY, 7 DAYS A WEEK, WHICH IS OPEN TO ALL WITHOUT REGARD TO THE ABILITY TO PAY.
PART VI, LINE 6:	THIS ORGANIZATION IS A PART OF MAYO CLINIC HEALTH SYSTEM (WHICH IS PART OF A LARGER GROUP OF ENTITIES AFFILIATED WITH MAYO CLINIC). THE MAYO CLINIC HEALTH SYSTEM IS DESCRIBED IN RESPONSE TO CORE FORM, PART III, STATEMENT OF PROGRAM ACCOMPLISHMENTS, LINE 4A (REPORTED IN SCHEDULE O). THAT STATEMENT ALSO DESCRIBES THE ROLES OF THE VARIOUS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED.
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 TO A STATE HOSPITAL ASSOCIATION.
PART V, SECTION B, LINES 16A, 16B, & 16C	URL OF THE FAP AND FAP APPLICATION:MAYOCLINICHEALTHSYSTEM.ORG/LOCATIONS/LA-CROSSE/BILLING/PAYMENT-POLICY

Schedule H (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

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.
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
MAYO CLINIC HEALTH SYSTEM-FRANCISCAN
MEDICAL CENTER INC

Employer identification number
39-0806374

Part I

General Information on Grants and Assistance

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? ....................................

Yes No

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 Domestic Organizations and Domestic Governments. 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 section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) VITERBO UNIVERSITY 900 VITERBO DRIVE LA CROSSE,WI54601	39-0978445	501(C)3	9,000	EDUCATION
(2) BOYS AND GIRLS CLUB OF GREATER LA CROSSE 1331 CLINTON STREET LA CROSSE,WI54603	39-6084791	501(C)3	10,020	SUPPORT MISSION
(3) SALVATION ARMY 223 NORTH 8TH STREET LA CROSSE,WI54601	36-2167910	501(C)3	6,040	SUPPORT MISSION
(4) MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE FOUNDATION INC 700 WEST AVENUE SOUTH LA CROSSE,WI54601	39-1186647	501(C)3	39,572	SUPPORT MISSION
(5) LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM 1300 BADGER STREET LA CROSSE,WI54601	39-1804725	501(C)3	40,733	SUPPORT MISSION

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2014

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. 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

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference

Explanation

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 AND/OR AFFILIATED TAX-EXEMPT ORGANIZATIONS WILL BE USED PURSUANT TO THE POLICIES AND PROCEDURES OF THE GRANTEE ORGANIZATIONS AND TO FURTHER THE EXEMPT PURPOSES OF THE GRANTEE ORGANIZATIONS. BOTH THE FILING ORGANIZATION AND THE GRANTEE ORGANIZATION MAINTAIN ADEQUATE BOOKS AND RECORDS OF SUCH TRANSFERS OR GRANTS. NO ADDITIONAL MONITORING IS PERFORMED.

Schedule I (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

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, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

MAYO CLINIC HEALTH SYSTEM-FRANCISCAN
MEDICAL CENTER INC

Employer identification number

39-0806374

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2014

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 in column(B) reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1ANIL MD GOKHANDIRECTOR	(i) (ii)	426,607 ............................... 0	0 ............................... 0	53,567 ............................... 0	19,608 ............................... 0	32,236 ............................... 0	532,018 ............................... 0	0 ............................... 0
2BINN MD MARTHA CDIRECTOR (7/1-12/31/2014)	(i) (ii)	215,474 ............................... 0	0 ............................... 0	59,363 ............................... 0	20,190 ............................... 0	28,795 ............................... 0	323,822 ............................... 0	0 ............................... 0
3ERICKSON ERIC BDIRECTOR	(i) (ii)	187,305 ............................... 0	0 ............................... 0	35,661 ............................... 0	25,190 ............................... 0	13,051 ............................... 0	261,207 ............................... 0	0 ............................... 0
4FITZGERALD MD KEVINDIRECTOR	(i) (ii)	269,037 ............................... 0	0 ............................... 0	3,931 ............................... 0	24,567 ............................... 0	29,545 ............................... 0	327,080 ............................... 0	0 ............................... 0
5GRAU MD THOMAS JDIRECTOR	(i) (ii)	275,956 ............................... 0	0 ............................... 0	7,563 ............................... 0	654 ............................... 0	23,105 ............................... 0	307,278 ............................... 0	0 ............................... 0
6GRENISEN MD MARGARET MDIRECTOR	(i) (ii)	224,052 ............................... 0	0 ............................... 0	7,794 ............................... 0	34,586 ............................... 0	3,369 ............................... 0	269,801 ............................... 0	0 ............................... 0
7HAGER NICKIJO LDIRECTOR	(i) (ii)	138,521 ............................... 0	0 ............................... 0	15,402 ............................... 0	23,342 ............................... 0	12,714 ............................... 0	189,979 ............................... 0	0 ............................... 0
8HOLMAY DIANE KDIRECTOR	(i) (ii)	198,807 ............................... 0	0 ............................... 0	25,435 ............................... 0	35,724 ............................... 0	22,147 ............................... 0	282,113 ............................... 0	0 ............................... 0
9HUGHES PETER RDIRECTOR/REGION VP OF BUSINESS DEVEL	(i) (ii)	213,270 ............................... 0	0 ............................... 0	37,037 ............................... 0	43,272 ............................... 0	24,048 ............................... 0	317,627 ............................... 0	0 ............................... 0
10JOHNSON MD TIMOTHY JCEO/CHAIR/DIRECTOR/PHYSICIAN	(i) (ii)	431,604 ............................... 0	0 ............................... 0	33,447 ............................... 0	44,933 ............................... 0	26,622 ............................... 0	536,606 ............................... 0	0 ............................... 0
11JUNGCK MD MARK CDIRECTOR	(i) (ii)	281,469 ............................... 0	0 ............................... 0	12,060 ............................... 0	41,673 ............................... 0	23,351 ............................... 0	358,553 ............................... 0	0 ............................... 0
12KORDUCKI MD JANE MDIRECTOR	(i) (ii)	247,604 ............................... 0	0 ............................... 0	4,865 ............................... 0	35,218 ............................... 0	29,379 ............................... 0	317,066 ............................... 0	0 ............................... 0
13KRIEN MD JOSEPH SDIRECTOR	(i) (ii)	272,583 ............................... 0	0 ............................... 0	8,301 ............................... 0	26,325 ............................... 0	28,434 ............................... 0	335,643 ............................... 0	0 ............................... 0
14KRUMHOLZ MD ALAN JDIRECTOR (1/1-7/1/2014)	(i) (ii)	143,572 ............................... 0	0 ............................... 0	16,894 ............................... 0	51,852 ............................... 0	16,497 ............................... 0	228,815 ............................... 0	0 ............................... 0
15KRUSE JOSEPH JCAO/VICE CHAIR/SECRETARY/DIRECTOR	(i) (ii)	245,195 ............................... 0	0 ............................... 0	85,124 ............................... 0	39,616 ............................... 0	28,617 ............................... 0	398,552 ............................... 0	0 ............................... 0
16MOLLING DO PAUL EDIRECTOR	(i) (ii)	271,256 ............................... 0	0 ............................... 0	985 ............................... 0	23,008 ............................... 0	32,098 ............................... 0	327,347 ............................... 0	0 ............................... 0
17NOEL AMY JDIRECTOR	(i) (ii)	186,578 ............................... 0	0 ............................... 0	31,050 ............................... 0	29,635 ............................... 0	31,360 ............................... 0	278,623 ............................... 0	0 ............................... 0
18RUSHLOW MD DAVID RDIRECTOR/CHIEF MEDICAL OFFICER	(i) (ii)	305,488 ............................... 0	0 ............................... 0	52,042 ............................... 0	28,868 ............................... 0	30,057 ............................... 0	416,455 ............................... 0	0 ............................... 0
19TIGGELAAR THOMAS HCFO/TREASURER/DIRECTOR	(i) (ii)	203,442 ............................... 0	0 ............................... 0	80,193 ............................... 0	35,169 ............................... 0	21,471 ............................... 0	340,275 ............................... 0	0 ............................... 0
20SAATHOFF BARBARA LVICE PRESIDENT OF LEGAL AFFAIRS	(i) (ii)	164,632 ............................... 0	0 ............................... 0	53,812 ............................... 0	31,917 ............................... 0	28,422 ............................... 0	278,783 ............................... 0	0 ............................... 0
21MAHANY DOUGLAS ARADIOLOGY ADMIN	(i) (ii)	4,042 ............................... 146,934	0 ............................... 0	0 ............................... 3,197	0 ............................... 0	1,761 ............................... 14,397	5,803 ............................... 164,528	0 ............................... 0
22MORRISSEY MD JOHN EPHYSICIAN	(i) (ii)	834,283 ............................... 0	0 ............................... 0	221,760 ............................... 0	41,789 ............................... 0	35,355 ............................... 0	1,133,187 ............................... 0	0 ............................... 0
23NOLTE DO CHARLES PPHYSICIAN	(i) (ii)	710,424 ............................... 0	0 ............................... 0	136,904 ............................... 0	27,220 ............................... 0	34,548 ............................... 0	909,096 ............................... 0	0 ............................... 0
24RADEMACHER MD DANA EPHYSICIAN	(i) (ii)	596,759 ............................... 0	0 ............................... 0	213,171 ............................... 0	29,208 ............................... 0	2,290 ............................... 0	841,428 ............................... 0	0 ............................... 0
25STEVENS MD MARK KPHYSICIAN	(i) (ii)	806,857 ............................... 0	0 ............................... 0	198,443 ............................... 0	43,982 ............................... 0	34,949 ............................... 0	1,084,231 ............................... 0	0 ............................... 0
26UY MD JONATHAN JPHYSICIAN	(i) (ii)	727,444 ............................... 0	0 ............................... 0	85,643 ............................... 0	33,190 ............................... 0	34,858 ............................... 0	881,135 ............................... 0	0 ............................... 0
27NESSE MD ROBERT EFORMER CHAIR	(i) (ii)	0 ............................... 749,175	0 ............................... 0	0 ............................... 117,701	0 ............................... 0	0 ............................... 19,647	0 ............................... 886,523	0 ............................... 0

Schedule J (Form 990) 2014

Page 3

Part III

Supplemental Information

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.

Return Reference	Explanation
PART I, LINE 1A	DAVID R. RUSHLOW M.D., RECEIVED TUITION REIMBURSEMENT AS GROSSED-UP TAXABLE COMPENSATION.
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.
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). ANIL M.D., GOKHAN $ 14,861 BINN M.D., MARTHA C. $ 426 FITZGERALD M.D., KEVIN $ 4,356 GRAU M.D., THOMAS J. $ 5,650 GRENISEN M.D., MARGARET M. $ 1,856 JOHNSON M.D., TIMOTHY J. $ 33,451 JUNGCK M.D., MARK C. $ 9,268 KRIEN M.D., JOSEPH S. $ 5,510 KRUMHOLZ M.D., ALAN J. $ 7,847 KRUSE, JOSEPH J. $ 4,999 MOLLING D.O., PAUL E. $ 3,327 MORRISSEY M.D., JOHN E. $191,271 NESSE M.D., ROBERT E. $106,863 NOLTE D.O., CHARLES P. $ 82,178 RADEMACHER M.D., DANA E. $116,567 RUSHLOW M.D., DAVID R. $ 5,568 STEVENS M.D., MARK K. $181,048 UY M.D., JONATHAN J. $ 83,790
PART II:	COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION.

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

MAYO CLINIC HEALTH SYSTEM-FRANCISCAN
MEDICAL CENTER INC

Employer identification number

39-0806374

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) 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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefiting 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) 2014

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) MICHAEL TIGGELAAR	FAMILY MEMBER OF THOMAS TIGGELAAR	47,957	COMPENSATION		No
(2) LORI JUNGCK	FAMILY MEMBER OF MARK C. JUNGCK M.D.	40,308	COMPENSATION		No
(3) NICHOLE J KRUSE	FAMILY MEMBER OF JOSEPH J. KRUSE	38,485	COMPENSATION		No
(4) ANJA DROGSETH	FAMILY MEMBER OF MARK C. JUNGCK M.D.	12,815	COMPENSATION		No
(5) JOHN W COCHRAN MD	FAMILY MEMBER OF MARGARET GRENISEN M.D.	316,925	COMPENSATION		No
(6) STACI M ANIL	FAMILY MEMBER OF GOKHAN ANIL M.D.	46,439	COMPENSATION		No
(7) BEN MY KRUSE	FAMILY MEMBER OF JOSEPH J. KRUSE	28,585	COMPENSATION		No
(8) JENIFER MAHANY	FAMILY MEMBER OF DOUGLAS A. MAHANY	62,176	COMPENSATION		No
(9) ROBIN L FITZGERALD	FAMILY MEMBER OF KEVIN FITZGERALD M.D.	10,802	COMPENSATION		No
(10) HEATHER MOLLING	FAMILY MEMBER OF PAUL E. MOLLING D.O.	41,940	COMPENSATION		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

MAYO CLINIC HEALTH SYSTEM-FRANCISCAN
MEDICAL CENTER INC

Employer identification number

39-0806374

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	BINN M.D., MARTHA C. TIGGELAAR, THOMAS H. KRUSE, JOSEPH J. KRUMHOLZ M.D., ALAN J. JOHNSON M.D., TIMOTHY J. HUGHES, PETER R. HAVE A BUSINESS RELATIONSHIP AS THEY SERVE AS AN OFFICER, DIRECTOR, OR TRUSTEE OF HEALTH TRADITION HEALTH PLAN, A RELATED TAXABLE ENTITY.
FORM 990, PART VI, SECTION A, LINE 3	MAYO CLINIC, MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, AND OTHER RELATED COMPANIES PROVIDE MANAGEMENT SERVICES TO THE ENTIRE SYSTEM OF ENTITIES. MAYO CLINIC HEALTH SYSTEM-FRANCISCAN MEDICAL CENTER, INC. ALSO PROVIDES MANAGEMENT SERVICES ON A REGIONAL BASIS THAT INCLUDES THE FILING ORGANIZATION. SINCE THE ENTITIES ARE RELATED ORGANIZATIONS, COMPENSATION FOR THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES HAS BEEN DISCLOSED IN PART VII AND SCHEDULE J AS REQUIRED.
FORM 990, PART VI, SECTION A, LINE 6	THE SOLE CORPORATE MEMBER IS MAYO CLINIC HEALTH SYSTEM-FRANCISCAN HEALTHCARE, INC.
FORM 990, PART VI, SECTION A, LINE 7A	THE GOVERNING BODY IS SUBJECT TO APPROVAL BY THE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7B	THE ARTICLES OF INCORPORATION PROVIDE THE SOLE CORPORATE MEMBER CERTAIN RESERVED POWERS IN AREAS SUCH AS AMENDMENT OF ARTICLES AND BYLAWS, CERTAIN LARGE TRANSACTIONS, AND OTHER KEY DECISIONS.
FORM 990, PART VI, SECTION B, LINE 11	THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY THE CHIEF FINANCIAL OFFICER AND FINANCE STAFF. A COPY OF THE FORM 990 IS THEN PROVIDED TO EACH MEMBER OF THE FILING ORGANIZATION'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.
FORM 990, PART VI, SECTION B, LINE 15	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, EXECUTIVE AND SENIOR ADMINISTRATIVE LEADERSHIP, ALONG WITH ALLIED HEALTH STAFF. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY OR REGIONAL LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY PRIOR TO IMPLEMENTATION OF THE RESPECTIVE COMPENSATION INCREASE. THE SALARIES AND BENEFIT PROGRAMS OF THE CHIEF EXECUTIVE OFFICER (CEO) AND THE CHIEF ADMINISTRATIVE OFFICER (CAO) WERE REVIEWED AND APPROVED BY THE PROCESS DESCRIBED BELOW FOR SENIOR ADMINISTRATIVE LEADERSHIP. THE COMPENSATION AND BENEFIT PROGRAMS FOR SENIOR ADMINISTRATIVE LEADERSHIP FOR ALL CAMPUSES, INCLUDING THE MAYO CLINIC HEALTH SYSTEM LOCATIONS, ARE REVIEWED AND APPROVED BY THE MAYO CLINIC BOARD OF TRUSTEES GOVERNANCE AND NOMINATING COMMITTEE. THE MAYO CLINIC BOARD OF TRUSTEES GOVERNANCE AND NOMINATING COMMITTEE IS COMPRISED OF NINE OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. THIS GROUP REVIEWS AND APPROVES THE COMPENSATION AND BENEFIT PROGRAMS FOR PHYSICIANS FROM ALL CAMPUSES, 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.
FORM 990, PART VI, SECTION C, LINE 19	THE FILING ORGANIZATION'S GOVERNING DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY IS AVAILABLE UPON REQUEST AND ALSO ON THE MAYOCLINIC.ORG WEBSITE. THE FILING ORGANIZATION IS A HOSPITAL AFFILIATED WITH MAYO CLINIC. AS SUCH, MAYO CLINIC'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO THE FILING ORGANIZATION'S FORM 990 AND WOULD BE AVAILABLE UPON REQUEST OF THE FORM 990.
FORM 990, PART XI, LINE 9:	PENSION-POST RETIREMENT (PER FASB A -46,954,286.
FILING OF CERTAIN FOREIGN FORMS	DISCLOSURE STATEMENT RELATED TO FORMS 5713: FORM 5713 HAS BEEN FILED BY THE FOLLOWING MEMBERS OF THE CONTROLLED GROUP: MAYO CLINIC (EIN: 41-6011702) MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH (EIN: 41-1506440) MAYO 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) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

MAYO CLINIC HEALTH SYSTEM-FRANCISCAN
MEDICAL CENTER INC

Employer identification number

39-0806374

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on 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" on 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?
(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	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) DESTINATION MEDICAL CENTER EDA 50 SOUTH SIXTH STREET SUITE 1500 MINNEAPOLIS,MN554021498 46-4893585	ECONOMIC DEVELOPMENT	MN	501(C)(3)	11-I	MAYO CLINIC	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 ARIZONA 13400 EAST SHEA BOULEVARD SCOTTSDALE,AZ85259 86-0800150	HOSPITAL AND CLINIC	AZ	501(C)(3)	3	MAYO CLINIC	Yes
(8) MAYO CLINIC FLORIDA (A NONPROFIT CORPORATION) 4500 SAN PABLO ROAD JACKSONVILLE,FL32224 59-0714831	HOSPITAL	FL	501(C)(3)	3	MAYO CLINIC JACKSONVILLE	Yes
(9) MAYO CLINIC HOSPITAL -- ROCHESTER 200 FIRST STREET SW ROCHESTER,MN55905 41-0944601	HOSPITAL	MN	501(C)(3)	3	MAYO CLINIC	Yes
(10) MAYO CLINIC JACKSONVILLE 4500 SAN PABLO ROAD JACKSONVILLE,FL32224 59-3337028	PATIENT CARE - CLINIC	FL	501(C)(3)	7	MAYO CLINIC	Yes
(11) 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
(12) MAYO KLINIK STIFTUNG 60486 FRANKFURT AM MAIN FRANKFURT GM	FUNDRAISING FOUNDATION	GM			MFMER	Yes
(13) MCHS IN WAYCROSS INC 1900 TEBEAU STREET WAYCROSS,GA31501 58-1667166	HOSPITAL	GA	501(C)(3)	3	MAYO CLINIC JACKSONVILLE	Yes
(14) MCHS--ALBERT LEA AND AUSTIN 1000 FIRST DRIVE NW AUSTIN,MN55912 41-1404075	HOSPITAL AND CLINIC	MN	501(C)(3)	3	MAYO CLINIC	Yes
(15) MCHS--AUSTIN FOUNDATION 1000 FIRST DRIVE NW AUSTIN,MN55912 30-0107471	FUNDRAISING FOUNDATION	MN	501(C)(3)	7	MCHS--ALBERT LEA AND AUSTIN	Yes
(16) MCHS--CANNON FALLS 32021 COUNTY ROAD 24 BLVD CANNON FALLS,MN55009 20-4156428	HOSPITAL AND CLINIC	MN	501(C)(3)	3	MAYO CLINIC	Yes
(17) MCHS--CHIPPEWA VALLEY INC 1501 THOMPSON STREET BLOOMER,WI54724 39-0980343	HOSPITAL AND CLINIC	WI	501(C)(3)	3	MCHS--EAU CLAIRE HOSPITAL INC	Yes
(18) MCHS--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
(19) MCHS--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
(20) MCHS--EAU CLAIRE HOSPITAL INC 1221 WHIPPLE STREET EAU CLAIRE,WI54703 39-0813418	HOSPITAL	WI	501(C)(3)	3	MAYO CLINIC	Yes
(21) MCHS--FAIRMONT 800 MEDICAL CENTER DRIVE PO BOX 800 FAIRMONT,MN56031 41-0760836	HOSPITAL AND CLINIC	MN	501(C)(3)	3	MCHS--MANKATO	Yes
(22) MCHS--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
(23) MCHS--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
(24) MCHS--FRANCISCAN HEALTHCARE INC 700 WEST AVE SOUTH LA CROSSE,WI54601 39-1411999	HEALTHCARE SYSTEM PARENT	WI	501(C)(3)	11-I	MAYO CLINIC	Yes
(25) MCHS--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
(26) MCHS--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
(27) MCHS--LAKE CITY 500 WEST GRANT STREET LAKE CITY,MN55041 41-1906820	HOSPITAL	MN	501(C)(3)	3	MAYO CLINIC	Yes
(28) MCHS--MANKATO 1025 MARSH STREET MANKATO,MN56002 41-1236756	HOSPITAL AND CLINIC	MN	501(C)(3)	3	MAYO CLINIC	Yes
(29) MCHS--MANKATO HEALTH CARE FOUNDATION 1025 MARSH STREET MANKATO,MN56002 41-1663357	FUNDRAISING FOUNDATION	MN	501(C)(3)	7	MCHS--MANKATO	Yes
(30) MCHS--NEW PRAGUE 301 SECOND STREET NE NEW PRAGUE,MN56071 41-0723639	HOSPITAL AND CLINIC	MN	501(C)(3)	3	MCHS--MANKATO	Yes
(31) MCHS--NORTHLAND INC 1222 EAST WOODLAND AVENUE BARRON,WI54812 39-0920634	HOSPITAL AND CLINIC	WI	501(C)(3)	3	MCHS--EAU CLAIRE HOSPITAL INC	Yes
(32) MCHS--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
(33) MCHS--OWATONNA 134 SOUTHVIEW ST OWATONNA,MN55060 41-1862132	PATIENT CARE - CLINIC	MN	501(C)(3)	3	MAYO CLINIC	Yes
(34) MCHS--RED CEDAR INC 2321 STOUT ROAD MENOMONIE,WI54751 51-0190875	HOSPITAL AND CLINIC	WI	501(C)(3)	3	MAYO CLINIC	Yes
(35) MCHS--RED WING 701 HEWITT BOULEVARD RED WING,MN55066 41-1713783	PATIENT CARE SERVICES	MN	501(C)(3)	3	MAYO CLINIC	Yes
(36) MCHS--SPRINGFIELD 625 NORTH JACKSON AVENUE SPRINGFIELD,MN56087 41-1893827	HOSPITAL AND CLINIC	MN	501(C)(3)	3	MCHS--MANKATO	Yes
(37) MCHS--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) MCHS--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) MCHS--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) MCHS--WASECA 501 NORTH STATE STREET WASECA,MN56093 36-3606405	HOSPITAL AND CLINIC	MN	501(C)(3)	3	MCHS--MANKATO	Yes
(41) 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
(42) POVERELLO FOUNDATION 200 FIRST STREET SW ROCHESTER,MN55905 41-1494881	FUNDRAISING FOUNDATION	MN	501(C)(3)	7	MAYO CLINIC HOSPITAL - ROCHESTER	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2014

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on 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	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) FRANKLIN HEATING STATION 119 THIRD ST SW ROCHESTER,MN55902 41-0264830	UTILITY	MN	N/A
(2) LATIGO PETROLEUM LLC PO BOX 14230 ODESSA,TX79768 36-4767494	OIL & GAS EXPLORATION	DE	N/A
(3) PHYSICIAN SOFTWARE SYSTEMS LLC 3333 WARRENVILLE ROAD SUITE 200 LISLE,IL60532 45-3414836	HEALTHCARE RELATED SOFTWARE	IL	N/A
(4) WATERSHED CAP INSTL PRTNRS III LP ONE MARITIME PLAZA SUITE 1525 SAN FRANCISCO,CA94111 46-2982848	INVESTMENT ACTIVITIES	DE	N/A

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on 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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) BWL HOLDINGS INC 1209 ORANGE STREET WILMINGTON,DE19801 47-2413749	OIL & GAS EXPLORATION	DE	N/A	C			Yes
(2) AMBIENT CLINICAL ANALYTICS INC 221 1ST AVE SW SUITE 202 ROCHESTER,MN55902 80-0928405	SOFTWARE	DE	N/A	C			Yes
(3) CAVALRY CLO III LTD PO BOX 1093 GT QUEENSGATE HOUSE S GRAND CAYMAN CJ	INVESTMENT ACTIVITIES	CJ	N/A	C			Yes
(4) CAVALRY CLO IV LTD PO BOX 1093 GT QUEENSGATE HOUSE S GRAND CAYMAN CJ	INVESTMENT ACTIVITIES	CJ	N/A	C			Yes
(5) GMO GLOBAL BOND INVESTMENT FUND 78 SIR JOHN ROGERSONS QUAY DUBLIN 2 EI	OTHER FINANCIAL INVESTMENT ACTIVITIES	EI	N/A				Yes
(6) HEALTH TRADITION HEALTH PLAN 1808 EAST MAIN STREET ONALASKA,WI54650 39-1545987	MEDICAL SERVICES COMPANY	WI	N/A	C			Yes
(7) LOBSS NETWORK SUPPORT 2002 INC 200 FIRST STREET SW ROCHESTER,MN55905 48-1276150	ADMINISTRATIVE SERVICES	MN	N/A	C			Yes
(8) MAYO CLINIC GBS MAURITIUS 2ND FLOOR EBENE MEWS 57 EBENE CYBERCITY MP	HEALTHCARE MANAGEMENT	MP	N/A	C			Yes
(9) MAYO CLINIC SUPPORT SERVICES TEXAS 200 FIRST STREET SW ROCHESTER,MN55905 47-1751102	HEALTH SERVICES	TX	N/A	C			Yes
(10) MAYO HOLDING COMPANY 200 FIRST STREET SW ROCHESTER,MN55905 41-1578020	HOLDING COMPANY	MN	N/A	C			Yes
(11) MAYO INSURANCE COMPANY LTD 200 FIRST STREET SW ROCHESTER,MN55905	SELF INSURANCE POOL	CJ	N/A	C			Yes
(12) MCHS--DECORAH CLINIC PHYSICIANS 907 MONTGOMERY STREET DECORAH,IA52101 41-1711329	PATIENT CARE - CLINIC	IA	N/A	C			Yes
(13) MCHS--PHARMACY & HOME MEDICAL INC 1221 WHIPPLE STREET EAU CLAIRE,WI54703 39-1528920	PHARMACY SERVICES	WI	N/A	C			Yes
(14) MMSI INC 21 FIRST STREET SW ROCHESTER,MN55905 41-1547003	THIRD PARTY ADMINISTRATION SERVICES	MN	N/A	C			Yes
(15) RESOUNDANT INC 221 1ST AVE SW ROCHESTER,MN55902 46-1661978	MANUFACTURING MEDICAL DEVICE COMPONENT	MN	N/A	C			Yes
(16) ROCHESTER AIRPORT COMPANY ROUTE 2 ROCHESTER,MN55902 41-0506870	AIRPORT MANAGEMENT	MN	N/A	C			Yes
(17) SATILLA HEALTHNET INC 1900 TEBEAU STREET WAYCROSS,GA31501 58-2151076	HEALTH SERVICES	GA	N/A	C			Yes
(18) SUPERBLOCK 3 PROPERTY OWNERS ASSOCIATION 13400 E SHEA BLVD SCOTTSDALE,AZ85259 86-0870505	COMMERCIAL PROPERTY OWNERS ASSOCIATION	AZ	N/A	C			Yes
(19) THE STABILE BUILDING OWNERS' ASSOCIATION 200 FIRST STREET SW ROCHESTER,MN55905 20-8994499	COMMERCIAL PROPERTY OWNERS ASSOCIATION	MN	N/A	C			Yes
(20) CHARITABLE LEAD TRUST	CHARITABLE TRUST	CA	N/A	T			Yes
(21) PERPETUAL TRUST	CHARITABLE TRUST	ND	N/A	T			Yes
(22) PERPETUAL TRUST	CHARITABLE TRUST	AZ	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) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	AZ	N/A	T			Yes
(27) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	CO	N/A	T			Yes
(28) CHARITABLE REMAINDER TRUST (9)	CHARITABLE TRUST	FL	N/A	T			Yes
(29) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	LA	N/A	T			Yes
(30) CHARITABLE REMAINDER TRUST (73)	CHARITABLE TRUST	MN	N/A	T			Yes
(31) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	NC	N/A	T			Yes
(32) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	NM	N/A	T			Yes
(33) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	NV	N/A	T			Yes
(34) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	NY	N/A	T			Yes
(35) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	TX	N/A	T			Yes
(36) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	WI	N/A	T			Yes
(37) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	CO	N/A	T			Yes
(38) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	IL	N/A	T			Yes
(39) CHARITABLE REMAINDER TRUST	CHARITABLE TRUST	MI	N/A	T			Yes
(40) CHARITABLE REMAINDER TRUST (70)	CHARITABLE TRUST	MN	N/A	T			Yes

Schedule R (Form 990) 2014

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on 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

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 . . . . . . . . . . . . . . . . . . . . . . .

Yes

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) HEALTH TRADITION HEALTH PLAN	R	31,845,812	GAAP
(2) MAYO CLINIC HOSPITAL - ROCHESTER (FORMERLY METHODIST HOSPITAL)	A	138,128	GAAP
(3) MAYO CLINIC HOSPITAL - ROCHESTER (FORMERLY METHODIST HOSPITAL)	L	100,122	GAAP
(4) MCHS-FRANCISCAN HEALTHCARE FOUNDATION INC	C	1,078,502	GAAP
(5) MCHS-FRANCISCAN HEALTHCARE FOUNDATION-SPARTA INC	C	120,155	GAAP
(6) MMSI INC	M	187,062	GAAP
(7) MMSI INC	S	2,723,159	GAAP

Schedule R (Form 990) 2014

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on 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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2014

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2014

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: HOSPITALS AND CLINICS
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	18
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 2014 (Part V, line 2a) ......	5	4,041
6	Total number of volunteers (estimate if necessary) .............	6	802
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	620,537
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	42,251

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	4,929,555	3,495,370
9	Program service revenue (Part VIII, line 2g) .........	423,585,845	446,428,272
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-209,060	-316,266
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	3,223,267	2,501,997
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	431,529,607	452,109,373
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	206,049	117,905
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)	261,552,893	271,698,620
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	158,790,671	161,009,389
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	420,549,613	432,825,914
19	Revenue less expenses. Subtract line 18 from line 12.......	10,979,994	19,283,459
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	253,462,833	265,174,897
21	Total liabilities (Part X, line 26).............	65,774,906	105,157,797
22	Net assets or fund balances. Subtract line 21 from line 20.....	187,687,927	160,017,100

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4a	(Code: ) (Expenses $ 400,779,227 including grants of $ ) (Revenue $ 443,993,643 )
	PATIENT CARE (SCHEDULE O)PATIENT CARE:MAYO CLINIC HEALTH SYSTEM FRANCISCAN MEDICAL CENTER, INC. (FMC) IS PART OF THE MAYO CLINIC HEALTH SYSTEM (MCHS), A FAMILY OF CLINICS, HOSPITALS AND HEALTH CARE FACILITIES SERVING COMMUNITIES IN MINNESOTA, IOWA, WISCONSIN AND GEORGIA. AS PART OF MAYO CLINIC, THE HEALTH SYSTEM OFFERS CARE DESIGNED FOR THE WHOLE BODY CLOSE TO THE PATIENT'S HOME WHEN THEY NEED IT. A MULTIDISCIPLINARY TEAM OF EXPERTS HAS READY ACCESS TO KNOWLEDGE, RESOURCES, AND EXPERTISE OF MAYO CLINIC AND COLLABORATES ON PROVIDING EXACTLY THE CARE THE PATIENT NEEDS.MCHS SITES EMPLOY APPROXIMATELY 1,000 PHYSICIANS AND 15,000 ALLIED HEALTH STAFF. IN ADDITION, MAYO CLINIC PHYSICIANS FROM MULTIPLE SPECIALTIES REGULARLY SEE PATIENTS AT HEALTH SYSTEM FACILITIES. BESIDES HAVING HEALTH CARE FACILITIES IN NEARLY 70 COMMUNITIES, MCHS INCLUDES 19 OWNED HOSPITALS, FIVE OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH ONE ADDITIONAL HOSPITAL, AND CONTRACT MANAGEMENT AGREEMENTS WITH TWO ADDITIONAL HOSPITALS AND ONE NURSING HOME. SINCE ITS INCEPTION IN 1992, MCHS HAS GROWN INTO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN THE UNITED STATES. MORE THAN 600,000 UNIQUE PATIENTS ACCOUNT FOR MORE THAN 2.6 MILLION VISITS ANNUALLY IN MCHS. IT IS ALSO A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS.FMC FULFILLS ITS MISSION THROUGH THE FOLLOWING LOCATIONS AND SERVICES:HOSPITALS: FMC HAS HOSPITALS IN LA CROSSE (248 BEDS) AND IN SPARTA (25 BEDS). THE HOSPITALS PROVIDE ACUTE HEALTH CARE SERVICES INCLUDING 24-HOUR EMERGENCY CARE, ADULT AND PEDIATRIC SURGERY, LABOR, DELIVERY, MATERNITY CARE, REHABILITATION SERVICES, AND HEALTH EDUCATION CLASSES. THE HOSPITALS HAD 7,687 INPATIENT ADMISSIONS, 925 DELIVERIES, AND 8,341 SURGERIES DURING 2014.SLEEP LAB: THE FMC SLEEP LAB HAS RECEIVED THE FULL FIVE-YEAR ACCREDITATION FROM AMERICAN ACADEMY OF SLEEP MEDICINE. THE FACILITY WAS APPROVED FOLLOWING A LENGTHY EXAMINATION PROCESS AND SITE VISIT THAT COVERED THE UNIT'S POLICIES, PROCEDURES, AND ACTIVITIES. EACH YEAR THE SLEEP LAB EVALUATES APPROXIMATELY 250 PATIENTS. THE ACCREDITATION WILL OPEN UP THE LAB AS A NEW CHOICE FOR PATIENTS FROM A BROADER RANGE OF INSURANCE PLANS.NATIONAL OUTCOMES MEASUREMENT SYSTEM: SINCE JANUARY 1999, THE SPEECH-LANGUAGE PATHOLOGISTS AT FMC HAVE BEEN TAKING PART IN A NATIONAL PROJECT THAT ALLOWS THEM TO TRACK PATIENT OUTCOMES AND COMPARE THEIR SERVICES WITH OTHER THERAPY PROGRAMS ACROSS THE STATE AND THE NATION. THE NATIONAL OUTCOMES MEASUREMENT SYSTEM PROJECT CONSISTS OF MAKING A SPECIAL ASSESSMENT OF THE PATIENT AT THE FIRST AND LAST VISIT. BY COMPARING SUCH FACTORS AS FUNCTIONALITY PRIOR TO CARE, NUMBER OF VISITS, NUMBER OF MINUTES OF CARE AND FUNCTIONALITY AT THE END OF THE SESSIONS, THERAPISTS CAN NOW ACCURATELY TRACK THE PROGRESS OF PATIENTS.CLINICS: FAMILY PRACTICE CLINICS PROVIDE OUTPATIENT SERVICES IN ARCADIA, GALESVILLE, LA CROSSE, ONALASKA, PRAIRIE DU CHIEN, SPARTA, AND TOMAH, WISCONSIN; WAUKON, IOWA; AND CALEDONIA AND LA CRESCENT MINNESOTA. AFFILIATION WITH MCHS ALLOWS MEMBERS OF THESE COMMUNITIES ACCESS TO VARIOUS SPECIALTY SERVICES SUCH AS:-OCCUPATIONAL HEALTH: THE SERVICES INCLUDE WORKERS' COMPENSATION SERVICES, DOT PHYSICALS, JOB SITE ASSESSMENTS, HEALTH AND SAFETY CONSULTATIONS, SIGNIFICANT EXPOSURE FOLLOW-UP, DISABILITY MANAGEMENT AND RETURN-TO-WORK PROGRAMS, DRUG TESTING SERVICES, BREATH ALCOHOL TESTING AND RESPIRATOR FIT TESTING.-ALLERGY: PATIENTS WITH ALLERGIC CONDITIONS AND PROBLEMS WITH IMMUNE RESPONSE ARE TREATED AND SERVICES INCLUDE BOTH CONSULTATIONS AND DIAGNOSTICS.-CARDIOLOGY: CARDIOLOGY SERVICES PROVIDED INCLUDE CARDIOLOGY ASSESSMENTS, CONSULTATIONS, AND FOLLOW-UPS.-GERIATRIC: SERVICES PROVIDED INCLUDE GERIATRIC CONSULTATIONS AND FOLLOW-UPS RELATED TO ALL ASPECTS OF SPECIALTY ELDER CARE INCLUDING DEMENTIA, MEMORY LOSS, MEDICATION MANAGEMENT, LONG-TERM CARE AND DISEASE MANAGEMENT.-PEDIATRIC NEUROLOGY: SERVICES PROVIDED INCLUDE PEDIATRIC NEUROLOGY CONSULTATIONS AND FOLLOW-UPS. PEDIATRIC NEUROLOGY PROVIDES SUB-SPECIALTY EXPERTISE FOR CHILDREN WITH DIFFICULT SEIZURE DISORDERS, HEADACHES, DEVELOPMENTAL DISORDERS AND HYPERACTIVITY AND LEARNING DISORDERS.HOME HEALTH: HOME HEALTH SERVICES PROVIDES HEALTH CARE SERVICES TO PATIENTS IN THE CONVENIENCE OF THEIR HOME, NURSING HOME, OR HOSPITAL ROOM. THE FIVE AREAS OF CARE PROVIDED ARE HOME CARE, HOSPICE, PHARMACY, HOME MEDICAL EQUIPMENT AND INFUSION THERAPY. HOME CARE: HOME CARE INCLUDES SERVICES OF SKILLED PROFESSIONAL NURSES WHO PROVIDE SPECIALIZED CARE AND TEACHING TO PATIENTS WITH ACUTE NEEDS SUCH AS WOUNDS, OSTOMIES, DIABETES MANAGEMENT, MEDICATION MANAGEMENT, AND INFUSION THERAPY INCLUDING CHEMO ADMINISTRATION. HOME HEALTH AIDES PROVIDE PERSONAL CARE AND ASSISTANCE WITH EXERCISE PROGRAMS. PHYSICAL THERAPISTS PROVIDE SPECIALIZED CARE AND TEACHING IN THE AREAS OF HOME THERAPEUTIC EXERCISE PROGRAMS, FUNCTIONAL/ACTIVITIES OF DAILY LIVING TRAINING, GAIT TRAINING, WHEELCHAIR FITTINGS AND THE USE OF ADAPTIVE EQUIPMENT. OCCUPATIONAL THERAPISTS PROVIDE SPECIALIZED CARE AND TEACHING PATIENTS HOW TO USE ADAPTIVE EQUIPMENT FOR ACTIVITIES OF DAILY LIVING, SAFETY ADAPTATIONS, FUNCTIONAL PROGRAMS, AND ENERGY CONSERVATION WITH DAILY TASKS. HOME CARE HAD 5,229 VISITS IN 2014.HOSPICE: HOSPICE USES A TEAM APPROACH TO CARING FOR PATIENTS WITH LIFE THREATENING ILLNESSES, PROVIDING SPECIALIZED CARE AND TEACHING AND ALSO FOCUSES ON PATIENTS' QUALITY OF LIFE AND DEATH WITH DIGNITY. THE TEAM CONSISTS OF SKILLED NURSES, HOME HEALTH AIDS, PHYSICAL THERAPISTS, OCCUPATIONAL THERAPISTS, SOCIAL WORKERS, CHAPLAINS AND VOLUNTEERS. BEREAVEMENT FOLLOW-UP AFTER A PATIENT'S DEATH IS AN ADDITIONAL BENEFIT FOR THE FAMILY. HOSPICE PROVIDES THE EQUIPMENT, MEDICATIONS AND SUPPLIES (RELATED TO THEIR LIFE THREATENING ILLNESS) NECESSARY TO ASSURE THE COMFORT OF PATIENTS IN THEIR FINAL DAYS IN FAMILIAR SURROUNDINGS WITH FAMILY AND FRIENDS. HOSPICE HAD 5,773 PATIENT VISITS DURING 2014.DEMENTIA CARE: FMC HAS DEVELOPED A COMPREHENSIVE DEMENTIA CARE PROGRAM FOR PEOPLE WITH DEMENTIA AND THEIR FAMILIES. THE PROGRAM PROVIDES DIAGNOSIS, TREATMENT, EDUCATION, SUPPORT SERVICES AND LONG-TERM FOLLOW-UP.HOME MEDICAL EQUIPMENT: LOCATED IN LA CROSSE, ARCADIA, SPARTA, AND TOMAH, THIS AREA OFFERS A FULL RANGE OF MEDICAL EQUIPMENT AND SUPPLIES INCLUDING BEDS, WALKERS, COMMODES, CANES, WHEELCHAIRS, SCOOTERS, SUPPLIES RELATED TO DIABETES, BREAST FEEDING, OSTOMY, AND SPORTS RELATED EQUIPMENT. RESPIRATORY THERAPISTS PROVIDE OXYGEN CONCENTRATORS AND PORTABLES, APNEA MONITORS, BI-PAPS AND CPAPS, NEBULIZERS, AS WELL AS OTHER RESPIRATORY NEEDS. OUR STAFF MEMBERS ARE TRAINED IN SEATING SYSTEMS FOR WHEELCHAIRS AND SCOOTERS. FREE DELIVERY AND SERVICE IS PROVIDED IN A 100-MILE RADIUS AROUND LA CROSSE. HOME MEDICAL HAD 6,604 PATIENT ENCOUNTERS IN 2014.HOME INFUSION THERAPY: THERE WERE 192 NEW PATIENTS SERVICED BY HOME INFUSION THERAPY DURING 2014.FMC PROVIDES CARE TO PERSONS COVERED BY BOTH MEDICARE AND MEDICAID AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. CHARITY CARE IS ALSO PROVIDED FOR PATIENTS THAT ARE FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THE COST OF CHARITY CARE PROVIDED IN 2014 WAS APPROXIMATELY $2,407,000. THE COST OF UNCOMPENSATED CARE PROVIDED LOW INCOME PATIENTS THROUGH MEDICAID WAS APPROXIMATELY $28,623,000 IN 2014. THIS SHORTFALL INCLUDES THE MEDICAID SURCHARGE OF $5,211,079 AND $48,926 IN TAXES PAID TO MINNESOTACARE, A PROGRAM THAT OFFERS HEALTHCARE ASSISTANCE TO LOW INCOME RESIDENTS OF MINNESOTA. THE UNREIMBURSED COST OF MEDICARE WAS $60,907,000 IN 2014.FMC VOLUNTARILY ENTERED INTO AN AGREEMENT WITH THE WISCONSIN ATTORNEY GENERAL RELATING TO CHARITY CARE. THE TERMS OF THE AGREEMENT INCLUDE AN AUTOMATIC DISCOUNT FOR UNINSURED PATIENTS, A PAYMENT CAP FOR THOSE UNINSURED PATIENTS THAT MEET THE ORGANIZATION'S CHARITY CARE CRITERIA, AND A COMMITMENT TO MAKE INFORMATION AVAILABLE TO PATIENTS REGARDING OUR CHARITY CARE PROGRAM. ADDITIONALLY, THE WI ATTORNEY GENERAL REVIEWED AND APPROVED OUR BILLING AND COLLECTION POLICIES AND PRACTICES.FMC ALSO LEASES SPACE TO AFFILIATED ORGANIZATIONS TO HELP FURTHER THEIR EXEMPT PURPOSE OF PROVIDING PATIENT CARE.

4b	(Code: ) (Expenses $ 4,161,565 including grants of $ 117,905 ) (Revenue $ 1,426,181 )
	EDUCATION AND RESEARCH (SCHEDULE O) EDUCATION AND RESEARCH:PROFESSIONAL EDUCATION IS AN INTEGRAL PART OF THE MISSION OF FMC AS EVIDENCED BY THE FOLLOWING PROGRAMS:LA CROSSE MEDICAL HEALTH SCIENCE CONSORTIUM: THE CONSORTIUM IS A PARTNERSHIP OF THE TWO HEALTHCARE PROVIDERS AND THREE POST SECONDARY EDUCATIONAL INSTITUTIONS IN LA CROSSE. THE PURPOSE OF THE CONSORTIUM IS TO CREATE OPPORTUNITIES FOR EDUCATION AND RESEARCH IN THE ALLIED HEALTH SCIENCES. THE MOST RECENT PROJECT OF THE CONSORTIUM WAS THE OPENING OF A $27 MILLION ALLIED HEALTH EDUCATION AND RESEARCH FACILITY IN LA CROSSE. LA CROSSE-MAYO FAMILY PRACTICE RESIDENCY: THE FAMILY PRACTICE RESIDENCY PROGRAM IS AFFILIATED WITH THE MAYO GRADUATE SCHOOL OF MEDICINE. ITS FOCUS IS TO GIVE RESIDENTS THE KNOWLEDGE, SKILLS, AND ATTITUDES NECESSARY FOR FUTURE PRACTICE IN AN EVER-CHANGING MEDICAL ENVIRONMENT. CLINICAL PASTORAL EDUCATION PROGRAM: THIS PROGRAM IS WORKING COLLABORATIVELY AND ECUMENICALLY TO PROVIDE PASTORAL EDUCATION FOR CLERGY AND LAY PEOPLE OF ALL FAITH TRADITIONS AND DENOMINATIONS. THE PROGRAM'S PROFESSIONAL CONSULTATION BOARD IS COMPRISED OF REPRESENTATIVES FROM A DIVERSITY OF FAITH AND COMMUNITY ORGANIZATIONS. AN EMPHASIS IS PLACED ON PROVIDING SPIRITUAL CARE IN AN INTER-DISCIPLINARY ENVIRONMENT THAT SERVES PEOPLE TRADITIONALLY PUSHED TO THE MARGINS OF THE COMMUNITY BY POVERTY, MENTAL ILLNESS, RACISM, VIOLENCE, OR OTHER SOCIOECONOMIC CONDITIONS.GERONTOLOGY CERTIFICATE PROGRAM: IN A JOINT EFFORT WITH THE UNIVERSITY OF WISCONSIN-LA CROSSE AND COMMUNITY AGENCIES, THIS NEW PROGRAM IS DESIGNED TO INCREASE THE SKILLS AND COMPETENCIES OF A BROAD RANGE OF PROFESSIONALS INCLUDING NURSES, NURSING ASSISTANTS, SOCIAL WORKERS, OCCUPATIONAL THERAPISTS, PHYSICAL THERAPISTS, PERSONAL CARE ASSISTANTS AND OTHERS. IT IS A DIRECT RESPONSE TO THE GROWING DEMAND PLACED ON AREA AGENCIES TO SERVE OUR RAPIDLY EXPANDING POPULATION OF OLDER ADULTS.ESTROGEN & WOMEN'S HEALTH: THIS IS AN EDUCATIONAL PROGRAM FOR THE MEDICAL COMMUNITY ON ADVANCES IN PREVENTION, DIAGNOSIS, AND TREATMENT OF DISEASES IN WOMEN. THE TOPIC OF ESTROGEN AND ITS ROLE IN WOMEN'S HEALTH ISSUES CONTINUES TO BE OF GREAT IMPORTANCE. A MULTIFACETED LEARNING APPROACH IS USED IN THIS COURSE, INCLUDING A LECTURE FORMAT TO SHARE THE LATEST RESEARCH, SAMPLE CASE PRESENTATIONS, AND GROUP DISCUSSION. THIS COURSE WAS DESIGNED FOR PHYSICIANS AND RESIDENTS IN FAMILY PRACTICE, INTERNAL MEDICINE AND OB/GYN, MEDICAL STUDENTS, PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, AND REGISTERED NURSES AND MIDWIVES.LA CROSSE COULEE REGION BRAIN TEAM: FMC MEMBERS SERVED ON THE LA CROSSE COULEE REGIONAL BRAIN TEAM, WHICH IS A COMMUNITY EFFORT TO ENCOURAGE PUBLIC DISCUSSION AND ACTIONS RELATED TO THE IMPORTANCE OF EARLY BRAIN DEVELOPMENT; TO FIND WAYS TO SUPPORT PARENTS/FAMILIES IN NURTURING THEIR CHILDREN; AND TO PROVIDE POSITIVE STIMULATING ENVIRONMENTS NECESSARY FOR LEARNING. IN COOPERATION WITH THE UNIVERSITY OF WISCONSIN-LA CROSSE, THE TEAM SURVEYED 1,200 AREA PROFESSIONALS WHO WORK WITH CHILDREN IN AN EFFORT TO DETERMINE THE LEVEL OF AWARENESS OF EARLY BRAIN DEVELOPMENT INFORMATION AND HOW THEIR PRACTICE IS AFFECTED. THE SURVEY RESULTS WILL BE USED TO DEVELOP ACTION PLANS WHICH MEET THE EDUCATIONAL NEEDS OF PROFESSIONALS WORKING WITH YOUNG CHILDREN. OTHER COULEE BRAIN TEAM EFFORTS INCLUDE ORGANIZATION OF A SPEAKERS BUREAU, MESSAGE-OF-THE-MONTH RELEASES TO MEDIA AND THE PRESENCE OF THE WISCONSIN'S BETTER BADGER BABY BUS TOUR AT RIVERFEST.HEALTH CAREER EXPLORATION: YOUNG MEN AND WOMEN INTERESTED IN HEALTH CAREERS HAVE AN OPPORTUNITY TO JOB SHADOW OR INTERN IN NUMEROUS PATIENT CARE AREAS WITHIN FMC.FMC ALSO OFFERS HEALTH AND WELLNESS EDUCATION FOR THE PUBLIC. PROGRAMS OFFERED BY FMC INCLUDE PRENATAL CARE, SMOKING CESSATION, SUPPORT GROUPS FOR CANCER, SUDDEN INFANT DEATH, NEUROLOGICAL DISORDERS, DIABETES EDUCATION, AND BASIC AND ADVANCED LIFE SUPPORT INSTRUCTION OR CPR.IN ADDITION TO EDUCATIONAL PROGRAMS, FMC HEALTHCARE PROFESSIONALS TEAM UP WITH SCIENTISTS AT MAYO CLINIC AND RESEARCH CENTERS ACROSS THE COUNTRY TO EVALUATE NEW TREATMENTS AND MAKE CUTTING EDGE TECHNOLOGIES AVAILABLE TO PATIENTS.

4c	(Code: ) (Expenses $ 1,032,310 including grants of $ ) (Revenue $ 1,088,723 )
	COMMUNITY BENEFIT(SCHEDULE O) COMMUNITY BENEFIT:IN KEEPING WITH ITS HISTORIC MISSION, FMC ENGAGES IN NUMEROUS EXTERNAL ACTIVITIES THAT PROMOTE HEALTH AND WELLNESS FOR THE MIND, BODY AND SPIRIT OF INDIVIDUALS IN THE COMMUNITIES IT SERVES. FMC NOT ONLY ENGAGES IN THESE ACTIVITIES AS A SYSTEM, BUT ALSO ENCOURAGES MEDICAL STAFF AND EMPLOYEES TO DO THE SAME. EXAMPLES INCLUDE:ST. CLARE HEALTH MISSION: THIS IS A FREE MEDICAL CLINIC WITH LOCATIONS ON THE FMC'S CAMPUSES IN LA CROSSE AND SPARTA. THE CLINIC SERVES PERSONS WHO HAVE NO MEDICAL INSURANCE AND DO NOT QUALIFY FOR PUBLIC ASSISTANCE AND IS STAFFED BY VOLUNTEER PHYSICIANS AND OTHER EMPLOYEES. THE CLINIC HAD 329 PATIENT VISITS IN 2014, WITH FMC EXPENDITURES OF $285,838 FOR THIS PROGRAM. WOMEN'S HEALTH:-MINNESOTA BREAST AND CERVICAL CANCER PROGRAM: THE MINNESOTA BREAST AND CERVICAL CANCER PROGRAM IS OFFERED TO PATIENTS AT THE CLINIC SITES IN MINNESOTA OR TO PATIENTS REFERRED TO LA CROSSE FROM A MINNESOTA CLINIC FOR MAMMOGRAMS OR THE FOLLOW-UP FOR BREAST OR CERVICAL CANCER PROCEDURES THAT CANNOT BE PROVIDED AT THOSE SITES. THIS PROGRAM SERVES LOW-INCOME WOMEN WHO ARE EITHER UNINSURED OR UNDERINSURED. THE GRANT WAS WRITTEN TO ADDRESS THE NEEDS OF WOMEN IN OUR RURAL MINNESOTA SITES WHO WERE NOT RECEIVING ADEQUATE PREVENTATIVE SERVICES. -WISCONSIN WELL WOMAN PROGRAM: OFFERED IN COOPERATION WITH THE STATE OF WISCONSIN AND LA CROSSE COUNTY, THIS PROGRAM HELPS WOMEN WITH LITTLE OR NO HEALTH INSURANCE GET BETTER ACCESS TO FREE SCREENINGS FOR BREAST CANCER, CERVICAL CANCER, DEPRESSION, DIABETES, DOMESTIC ABUSE, HEART DISEASE, HIGH BLOOD PRESSURE AND OSTEOPOROSIS. -SAFE PATH DOMESTIC ABUSE AND SEXUAL ASSAULT SERVICE: THIS PROGRAM STARTED IN 1996 AND IS FUNDED THROUGH THE OPERATING BUDGET OF FMC WITH A SIGNIFICANT GRANT FROM MCHS-FRANCISCAN HEALTHCARE FOUNDATION. THIS GROUP WORKS WITH THE EMERGENCY MEDICINE TRAUMA CENTER (EMTC) TO DEVELOP THE SEXUAL ASSAULT COMPONENT. THE PROGRAM PROVIDES THE VICTIM WITH ONE-ON-ONE ATTENTION OF A FEMALE NURSE PROVIDER TRAINED TO DO THE EXAM AND COLLECT FORENSIC EVIDENCE THAT IS NEEDED. FMC IS NOW A "DESIGNATED SEXUAL ASSAULT CENTER" IN WISCONSIN. JOINT COMMUNITY HEALTH INITIATIONS: FMC OFTEN COLLABORATES WITH GUNDERSEN LUTHERAN MEDICAL CENTER, COUNTY HEALTH DEPARTMENTS AND OTHER ORGANIZATIONS INTERESTED IN COMMUNITY HEALTH AND WELL-BEING ON NUMEROUS TOPICS, SUCH AS EDUCATION CONFERENCES, CHILD DEVELOPMENT MATERIALS, INFLUENZA VACCINATION EDUCATION ANNOUNCEMENTS, CHILD SAFETY, MEDICATION SAFETY, AND COMMUNITY HEALTH ASSESSMENT PROGRAMS.ADVANCE DIRECTIVES PROGRAM: ESTABLISHED IN COOPERATION WITH GUNDERSEN LUTHERAN, THE PROGRAM ASSISTS PATIENTS AND THEIR FAMILIES WITH END-OF-LIFE ISSUES AND DECISION-MAKING.FREE HEALTH CHECKS AND SCREENINGS: PHYSICIANS, HEALTH EDUCATORS, AND OTHER ALLIED HEALTH STAFF PROVIDE NUMEROUS HEALTH SCREENINGS AT EVENTS THROUGHOUT THE FMC SERVICE AREA. SUCH SCREENINGS INCLUDE BLOOD PRESSURE, CHOLESTEROL, BLOOD SUGAR, AND STROKE ASSESSMENTS.CORPORATE FINANCIAL SUPPORT: IN BEING A "GOOD CORPORATE CITIZEN", FMC ALSO PROVIDES FINANCIAL SUPPORT TO GROUPS WITHIN ITS SERVICE AREA WHO ARE ENGAGED IN COMMUNITY HEALTH AND WELLNESS, PUBLIC SAFETY, THE ARTS, EDUCATION AND QUALITY OF LIFE ISSUES. THESE ACTIVITIES INCLUDE: RUNS AND WALKS TO RAISE FUNDS FOR MEDICAL RESEARCH, PROGRAMS ON SELF ESTEEM FOR YOUNG WOMEN, FIRE SAFETY MATERIALS FOR SCHOOL CHILDREN, SELF-HELP OPPORTUNITIES FOR THE POOR AND UNDERPRIVILEGED, CONCERTS AND PERFORMANCES BY LOCAL ARTS GROUPS, AND SPONSORSHIPS OF LECTURES AND PROGRAMS ON HEALTH RELATED TOPICS.ALZHEIMER'S ASSOCIATION: FOR SEVERAL YEARS FMC HAS BEEN A SPONSOR OF THE ALZHEIMER'S ASSOCIATION'S MEMORY WALKS HELD EACH FALL AND ITS ANNUAL EDUCATION CONFERENCE. SEVERAL MAYO CLINIC PHYSICIANS HAVE PRESENTED AT THE ANNUAL CONFERENCE.AMERICAN CANCER SOCIETY: FMC WAS THE LEAD SPONSOR OF THE VERY FIRST LA CROSSE AREA ALL YOUTH RELAY FOR LIFE. THIS RELAY, MODELED AFTER THE SUMMER EVENT, AND ORGANIZED AND DESIGNED ESPECIALLY FOR HIGH SCHOOL STUDENTS, RAISED MORE THAN $20,000. THE DAFFODILS THAT DECORATE THE MARKET PLACE RESTAURANT EACH SPRING ARE ALSO PART OF FMC'S SUPPORT.AMERICAN HEART ASSOCIATION: STAFF FROM FMC'S CARDIOVASCULAR SERVICES PLAY A LEAD ROLE IN THE ORGANIZATION OF THE ANNUAL HEART WALK. FOR THE PAST SEVERAL YEARS, TEAMS FROM THE MEDICAL CENTER HAVE ALSO LED THE PACK IN FUNDS RAISED. FMC IS ALSO A LONGTIME SPONSOR OF THE FRIGID FIVE RUN HELD IN JANUARY.UNITED CEREBRAL PALSY: FMC HAS BEEN THE LEAD SPONSOR FOR THE ANNUAL CELEBRITY WAITER NIGHT.MULTIPLE SCLEROSIS: FMC WAS THE LEAD SPONSOR FOR THIS EVENT THAT WAS HELD IN APRIL. THIS EVENT HAS RAISED NEARLY $80,000 YEARLY THROUGH THE EFFORTS OF MORE THAN 800 WALKERS.UNITED FUND FOR THE ARTS AND HUMANITIES: THIS IS A CONSORTIUM OF TEN LOCAL ARTS AND HUMANITIES ORGANIZATIONS THAT CONTRIBUTE SIGNIFICANTLY TO THE QUALITY OF LIFE IN THE AREA. FMC IS A CONTRIBUTOR TO THIS ANNUAL CAMPAIGN.REPRESENTATION ON COMMUNITY BOARDS: FMC PROVIDES SUPPORT FOR PHYSICIANS AND EMPLOYEES WHO PARTICIPATE AT THE "BOARD OF DIRECTOR" LEVELS IN COMMUNITY SERVICE ORGANIZATIONS. ALL ARE ENCOURAGED TO IDENTIFY OPPORTUNITIES WHEREBY FMC CAN CONTRIBUTE ITS COLLECTIVE KNOWLEDGE AND EXPERTISE IN ASSISTING THESE COMMUNITY GROUPS TO MEET THEIR MISSIONS OF SERVICE.HEALTHTOUCH: WITH A TOUCH OF THE SCREEN, PATIENTS AND STAFF CAN NOW ACCESS ACCURATE, UP-TO-DATE INFORMATION ON MEDICATIONS, DISEASES AND WELLNESS TOPICS THANKS TO HEALTHTOUCH, AN INTERACTIVE KIOSK IN THE RESOURCE LIBRARY OF THE FAMILY HEALTH CLINIC.DISEASE MANAGEMENT STRATEGIES: FMC IS PARTICIPATING IN THE UNITED COULEE REGION INFLUENZA COALITION IN COOPERATION WITH GUNDERSEN LUTHERAN AND THE HEALTH DEPARTMENT IN AN EFFORT TO COLLABORATE ON IMPROVING THE IMMUNIZATION RATES IN THE COMMUNITY. FMC (VIA THE FRANCISCAN AUXILIARY WHICH IS PART OF FMC) RECEIVES DONATED SERVICES FROM COMMUNITY TEEN, COLLEGE, AND ADULT VOLUNTEERS. THE AUXILIARY WAS ORGANIZED IN 1952 TO "IMPROVE THE HEALTH OF INDIVIDUALS AND COMMUNITIES" THROUGH FUNDRAISING, SERVICE, COLLABORATION, ADVOCACY AND EDUCATION. AUXILIARY PROJECTS ARE ORGANIZED BY A BOARD OF DIRECTORS THAT MEETS MONTHLY DURING THE SCHOOL YEAR AND ARE SUPPORTED THROUGH THE VOLUNTEER EFFORTS OF MORE THAN 200 MEMBERS. MEMBERSHIP IS OPEN TO ALL INTERESTED COMMUNITY MEMBERS. SPECIFICALLY, THE AUXILIARY SUPPORTS PROGRAMS AND SERVICES TO ADDRESS UNMET HEALTHCARE NEEDS; EQUIPMENT AND SERVICES TO ENHANCE PATIENT CARE DELIVERY; NEEDY PATIENT ACCOUNTS; NURSING EDUCATION FOR WESTERN TECHNICAL COLLEGE AND VITERBO COLLEGE STUDENTS; AND COMMUNITY HEALTH AWARENESS AND EDUCATION PROJECTS. THE AUXILIARY ALSO STRIVES TO ENHANCE THE VISIBILITY OF FMC IN THE COMMUNITY. DURING 2014, APPROXIMATELY 802 VOLUNTEERS DONATED APPROXIMATELY 56,066 HOURS OF SERVICE VALUED AT APPROXIMATELY $1,293,443 BASED ON THE INDEPENDENT SECTOR'S VALUE OF VOLUNTEER TIME. THESE SERVICE HOURS WERE SPENT ORGANIZING AND MANAGING ACTIVITIES FOR THE BENEFIT OF PATIENTS, PATIENTS' FAMILIES, VISITORS AND STAFF.FMC OPERATES LIFELINE (AN EASY-TO-USE PERSONAL RESPONSE SERVICE) TO ENSURE THAT OLDER ADULTS LIVING AT HOME CAN GET QUICK ASSISTANCE WHENEVER IT MAY BE NEEDED - 24 HOURS A DAY, 365 DAYS A YEAR. WHEN THE PERSONAL HELP BUTTON IS PRESSED, A FMC MONITOR RESPONDS, ASSESSES THE SITUATION AND SUMMONS APPROPRIATE HELP.FMC ALSO OFFERS BOTH INDEPENDENT AND ASSISTED LIVING OPTIONS FOR SENIORS.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses405,973,102

(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
(A) Name and Title
(18) RUSHLOW MD DAVID R........................................................................ DIRECTOR/CHIEF MEDICAL OFFICER	40.00 .......................0.00	X					357,530	0	58,925
(19) TIGGELAAR THOMAS H........................................................................ CFO/TREASURER/DIRECTOR	40.00 .......................0.00	X	X				283,635	0	56,640
(20) SAATHOFF BARBARA L........................................................................ VICE PRESIDENT OF LEGAL AFFAIRS	40.00 .......................0.00		X				218,444	0	60,339
(21) MAHANY DOUGLAS A........................................................................ RADIOLOGY ADMIN	40.00 .......................0.00			X			4,042	150,131	16,158
(22) MORRISSEY MD JOHN E........................................................................ PHYSICIAN	40.00 .......................0.00				X		1,056,043	0	77,144
(23) NOLTE DO CHARLES P........................................................................ PHYSICIAN	40.00 .......................0.00				X		847,328	0	61,768
(24) RADEMACHER MD DANA E........................................................................ PHYSICIAN	40.00 .......................0.00				X		809,930	0	31,498
(25) STEVENS MD MARK K........................................................................ PHYSICIAN	40.00 .......................0.00				X		1,005,300	0	78,931
(26) UY MD JONATHAN J........................................................................ PHYSICIAN	40.00 .......................0.00				X		813,087	0	68,048
(27) NESSE MD ROBERT E........................................................................ FORMER CHAIR	0.00 .......................40.00					X	0	866,876	19,647

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	10,062,708	1,017,007	1,453,859

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b		1,444
c	Fundraising events....1c		47,976
d	Related organizations...1d		1,348,734
e	Government grants (contributions)1e		2,097,216

f	All other contributions, gifts, grants, and similar amounts not included above1f

g	Noncash contributions included in lines 1a-1f:$		15,838
h	Total. Add lines 1a-1f.......			3,495,370
			Business Code
2a	NET PATIENT REVENUE		620000	444,622,283	444,313,903	308,380
b	RESIDENT REVENUE		623000	768,348	768,348
c	RENTAL REVENUE FROM AF		531120	584,120	584,120
d	LIFELINE		621990	219,673	219,673
e	EDUCATION REVENUE		611600	175,391	175,391
f	All other program service revenue .			58,457	58,457
g	Total. Add lines 2a–2f........			446,428,272
3	Investment income (including dividends, interest, and other similar amounts).......			45,054		40,625	4,429
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	144,662
b	Less: rental expenses	328,463
c	Rental income or (loss)	-183,801
d	Net rental income or (loss).......			-183,801			-183,801
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses		361,320
c	Gain or (loss)		-361,320
d	Net gain or (loss)..........			-361,320			-361,320
8a	Gross income from fundraising events (not including $ 47,976 of contributions reported on line 1c). See Part IV, line 18 ..
	a		151,948
b	Less: direct expenses ...b		166,423
c	Net income or (loss) from fundraising events..			-14,475			-14,475
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		2,625
b	Less: direct expenses ...b		3,251
c	Net income or (loss) from gaming activities...			-626			-626
10a	Gross sales of inventory, less returns and allowances .
	a		158,903
b	Less: cost of goods sold ..b		157,810
c	Net income or (loss) from sales of inventory..			1,093			1,093
Miscellaneous Revenue			Business Code
11a	CAFETERIA/VENDING REVE		722210	1,855,876			1,855,876
b	MANAGEMENT FEE REVENUE		541610	374,000		200,000	174,000
c	MISC. REVENUE		900099	364,762	71,067	71,532	222,163
d	All other revenue ....			105,168	9,208		95,960
e	Total. Add lines 11a–11d ......			2,699,806
12	Total revenue. See Instructions......			452,109,373	446,200,167	620,537	1,793,299


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			32,700	1	23,376
2	Savings and temporary cash investments .........			68,341	2	73,151
3	Pledges and grants receivable, net ...........			22,390	3	11,520
4	Accounts receivable, net .............			70,465,604	4	74,678,557
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				1,734	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 .............			1,378,593	7	1,314,296
8	Inventories for sale or use ..............			7,591,383	8	7,364,027
9	Prepaid expenses and deferred charges ..........			18,323,569	9	16,768,240
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	279,230,902
b	Less: accumulated depreciation .....	10b	166,711,070	112,283,349	10c	112,519,832
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 .....			21,613,173	12	34,424,789
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			21,681,997	15	17,997,109
16	Total assets. Add lines 1 through 15 (must equal line 34)......			253,462,833	16	265,174,897
17	Accounts payable and accrued expenses .........			44,722,932	17	75,005,260
18	Grants payable .................				18
19	Deferred revenue ................			986,945	19	856,977
20	Tax-exempt bond liabilities .............				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..			43,931	21	44,776
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....................			20,021,098	25	29,250,784
26	Total liabilities. Add lines 17 through 25.........			65,774,906	26	105,157,797
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			187,687,927	27	160,017,100
28	Temporarily restricted net assets ...........				28
29	Permanently restricted net assets ...........				29
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........			187,687,927	33	160,017,100
34	Total liabilities and net assets/fund balances ........			253,462,833	34	265,174,897