Mayo Clinic Health System-Cannon Falls

“The following individual(s) is/are employed by a related organization: tarasovitch, james j. Resulting in a business relationship with the following individual(s) who is/are associated with the related organization as an officer, director, or trustee: whited m.d., brian l., koch, mark b. The following individual(s) is/are employed by a related organization: witt m.d., thomas j. Resulting in a business relationship with the following individual(s) who is/are associated with the related organization as an officer, director, or trustee: tarasovitch, james j., gudgell, stephen f., parks, douglas a., koch, mark b., agerter m.d., david c.”

“Mayo clinic, mayo foundation for medical education and research, and other related companies provide management services to the entire system of entities. Since the entities are related organizations, compensation for the officers, directors, key employees, and highest compensated employees has been disclosed in part vii and schedule j as required.”

“The sole member of the corporation is mayo clinic.”

“The governing body, the board of trustees, consists of nine persons elected as follows: (a) four community trustees elected by the cannon falls hospital district; (b) chair/ceo and vice chair elected by the board of trustees and approved by and elected by the sole member and three member trustees elected by the sole member; and (c) three member trustees elected by the sole member.”

“The bylaws also provide the sole member certain reserved powers in areas such as operations, capital, budget, amendment of articles or bylaws and debt decisions.”

“The filing organization has no committees with the authority to act on behalf of the board.”

“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 region chief financial officer and finance director, along with site 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.”

“Mayo clinic and its affiliates have a comprehensive conflict of interest policy applicable to all of the affiliated entities and to all directors, officers, and employees of those entities. All current and former officers, directors, trustees, key employees and highest compensated employees who we anticipate will be listed on a form 990 are asked to complete an "annual tax and compliance disclosure" form. This information is reviewed by both the corporate tax department and the office of conflict of interest review. All disclosures of current or proposed activity that require action under the policy are the subject of ongoing review and action through the office of conflict of interest review and the conflict of interest review board. Involved individuals are informed of all required action. Many types of relationships that could create conflicts of interest are prohibited. Other types of relationships are permitted subject to compliance with the management plan established by the conflict of interest review board. A common management strategy for permitted activities is to require bilateral recusal and appropriate documentation in the minutes of mayo clinic (and/or affiliate) and the outside entity. Additional conflict of interest policies and procedures exist for certain entities concerning research contracts and other types of potential conflicts.”

“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.”

“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.”

“Included in contribution and grants (line 8) is an equity transfer of $5,000,000 from mayo clinic to assist with the construction costs of a new medical center facility. This transfer is a one-time event. Revenue less expense from operations (line 19) make up the remaining $2,917,207 of the line's total $7,917,207.”

“I/c purchased services: program service expenses 3,333,620. Management and general expenses 2,489,583. Fundraising expenses 0. Total expenses 5,823,203. Other purchased services: program service expenses 857,887. Management and general expenses 76,158. Fundraising expenses 0. Total expenses 934,045.”

“Loss on uncollectible pledges -853. Pledge change -290,712.”

“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) 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”