Civic Intelligence

Mayo Clinic Health System-Supportive Home Care Inc

990 • Fiscal year 2013 • EIN 39-1686673

Jan 01, 2013 to Dec 31, 2013 • Filed on Aug 29, 2014

PO Box 206054702

(507) 538-1297

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

73rd percentile

0.28x

Higher debt load relative to assets than 73% of similar nonprofits.

2013 filings • 501(c)3 • $500k-$1M nonprofits • Source year 2013

Liabilities / Revenue

63rd percentile

0.11x

Higher debt load relative to revenue than 63% of similar nonprofits.

2013 filings • 501(c)3 • $500k-$1M nonprofits • Source year 2013

Net Margin

16th percentile

-16%

Higher net margin than 16% of similar nonprofits.

2013 filings • 501(c)3 • $500k-$1M nonprofits • Source year 2013

Top Officer Pay

99th percentile

$656,895

Higher top officer pay than 99% of similar nonprofits.

Top officer pay equals 97.5% of source-year revenue.

2013 filings • 501(c)3 • $500k-$1M nonprofits • Source year 2013

Asset Growth

5th percentile

-36%

Faster asset growth than 5% of similar nonprofits.

2013 filings • 501(c)3 • $500k-$1M nonprofits • Annualized from 2012 to 2013

Revenue Growth

Score unavailable

No value available

No earlier valid filing was available within the previous three public years.

Source year 2013

Assets

Down

$250,744

Down $139,166 (-36%) from 2012

Net Assets

Down

$179,371

Down $108,385 (-38%) from 2012

Liabilities

Down

$71,373

Down $30,781 (-30%) from 2012

Revenue

$673,759

No earlier filing loaded for comparison.

Expenses

Up

$782,144

Up $167,759 (+27%) from 2012

Net Income

-$108,385

No earlier filing loaded for comparison.

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$400K$200K$0-$200KAssets 2010: $68,172Liabilities 2010: $101,167Net Assets 2010: -$32,9952010Assets 2011: $282,944Liabilities 2011: $71,818Net Assets 2011: $211,1262011Assets 2012: $389,910Liabilities 2012: $102,154Net Assets 2012: $287,7562012Assets 2013: $250,744Liabilities 2013: $71,373Net Assets 2013: $179,3712013Assets 2014: $0Liabilities 2014: $0Net Assets 2014: $02014

Highlighted filing

2013

Assets$250,744
Liabilities$71,373
Net Assets$179,371

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$1.0M$500K$0-$500KExpenses 2010: $560,9292010Expenses 2011: $438,8892011Expenses 2012: $614,3852012Revenue 2013: $673,759Expenses 2013: $782,144Net Income 2013: -$108,3852013Revenue 2014: $67,490Expenses 2014: $125,615Net Income 2014: -$58,1252014

Highlighted filing

2013

Revenue$673,759
Expenses$782,144
Net Income-$108,385
Jump To
Filing Snapshot
Filing Period
Jan 1, 2013 to Dec 31, 2013
Signed
Aug 29, 2014
Return Version
2013v3.0
Gross Receipts
$673,759
Mission and Program Overview

Mission

To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education, and research.

Supportive care, medical house call, geriatric care management and integrative therapy services

Balance Sheet Detail
LineBeginningEndChange
Assets
Investments Other Securities$307,439$133,830▼ $173,609
Accounts Receivable$66,031$115,904▲ $49,873
Savings and Temporary Cash Investments$4,492$587▼ $3,905
Cash and Non-Interest-Bearing Accounts$0$0→ $0
Total Assets$389,910$250,744▼ $139,166
Other Assets Total$11,948$423▼ $11,525
Liabilities
Other Liabilities$76,961$71,373▼ $5,588
Accounts Payable and Accrued Expenses$25,193$0▼ $25,193
Total Liabilities$102,154$71,373▼ $30,781
Net Assets / Fund Balance
Unrestricted Net Assets$287,756$179,371▼ $108,385
Total Net Assets Fund Balance$287,756$179,371▼ $108,385
Total Liabilities and Net Assets / Fund Balance$389,910$250,744▼ $139,166

Asset Categories

AssetBook ValueDepreciationBasis
Other Securities$133,830--
Compensation and Service Providers

Employees

NameTitleOtherTotal
Bammel Paul MDir/pres(1/1-5/15)/treas(5/15-12/31)/regional CFO$371,534$371,534
Wittrock Edward aDir/v. Pres(1/1-5/15 )/president(5/15-12/31)$259,170$259,170
Foster Pamela KDir/treas(1/1-5/15)/secy(5/15-12/31)$148,380$148,380
Pope Patricia JAdministrator(1/1-2/15/13)$40,551$40,551

Board Members and Trustees

NameTitle
Wittrock Edward aDir/v. Pres(1/1-5/15 )/president(5/1
Bammel Paul MDir/pres(1/1-5/15)/treas(5/15-12/31)
Frank Linda aDir/secy(1/1-5/15)/v. Pres(5/15-12/31)
Dickey John MRegional CAO
Linton Md Randall LRegional CEO
Revenue and Support

Revenue Composition

Contributions and Grants
$400,000
Program Service Revenue
$200,100
Investment Income
$14
Other Revenue
$73,645
Change in Net Assets
$-108,385
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Salaries, Compensation, and Employee Benefits$458,614
Other Expenses$323,530
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Other Salaries and Wages$355,539$2,557-$358,096
Fees for Services Other$297,338$2,901-$300,239
Other Employee Benefits$75,497$1,997-$77,494
Travel$23,111--$23,111
Payroll Taxes$12,271$350-$12,621
Pension Plan Contributions$10,403--$10,403
Other Expenses$180--$180
Total Functional Expenses$774,339$7,805$0$782,144
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Due to Affiliates$71,373
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
No
Other officer compensation reviewed
No
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
Yes

Governance Explanations

Form 990, Part VI, Section A, Line 2

The following individuals are employed by a related organization: bammel, paul m. Dickey, john m. Linton m.d., randall l. Resulting in a business relationship with the following individuals who are associated with the related organization as an officer, director, or trustee: bammel, paul m. Dickey, john m. Linton m.d., randall l. The following individuals are employed by a related organization: foster, pamela k. Pope, patricia j. Wittrock, edward a. Resulting in a business relationship with the following individuals who are associated with the related organization as an officer, director, or trustee: bammel, paul m. Dickey, john m. Linton m.d., randall l. Wittrock, edward a. Linton m.d., randall l., wittrock, edward a. Have a business relationship as they serve as an officer, director, or trustee of mchs--pharmacy & home medical, inc., a related taxable entity.

Form 990, Part VI, Section A, Line 3

Mayo clinic, mayo foundation for medical education and research, and other related companies provide management services to the entire system of entities. Mayo clinic health system - eau claire hospital, inc. And mayo clinic health system - eau claire clinic, inc. Provide 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 - eau claire hospital inc.

Form 990, Part VI, Section A, Line 7A

Three of the four board members are appointed by the sole corporate member.

Form 990, Part VI, Section A, Line 7B

The sole corporate member has the right to amend the articles or bylaws.

Form 990, Part VI, Section A, Line 8B

There are no committees with the authority to act on behalf of the board. Hence, there is no documentation for part vi section a line 8b.

Form 990, Part VI, Section B, Line 11

The form 990 is prepared by mayo corporate tax with assistance from site accounting staff. The tax return goes through two levels of review within the corporate tax unit. It is then reviewed by finance staff and the cfo. 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 and administrative leadership. In addition to any review and approval that may take place at the local entity level, the following independent approval process occurs annually in the fall for the next year's compensation. The salaries of the president/regional ceo and the regional chief administrative officer were reviewed by the mayo clinic health system compensation and benefits committee pursuant to the process described below for physician and administrative leadership. The mayo clinic health system compensation and benefits committee initially reviews the compensation of physicians and administrative leadership for the mayo clinic health system entities. The committee is comprised of mayo employees, but is independent for internal revenue code 4958 for the individuals whose salary is reviewed (with recusal where appropriate). The mayo clinic salary and benefits committee then reviews and approves the compensation. For those individuals for which this committee cannot serve as the independent review, their compensation and benefits are reviewed by the governance committee (described below). The compensation and benefits committee uses comparability data (including third-party benchmarking surveys) in its review and documents decisions in its minutes. Information on mayo clinic health system physician and administrative leadership compensation and benefits is also reviewed by the mayo clinic committee on officer succession, compensation and governance (governance committee), which is comprised of seven of the external independent members of the mayo clinic board of trustees. In addition to the above coordinated review process conducted by the mayo clinic health system compensation and benefits committee and/or the mayo clinic governance committee, the northwest wisconsin region of the mayo clinic health system (which includes the filing organization) also has its own compensation review and approval processes for the region's senior leadership and physicians (which includes the president/regional ceo and the regional chief administrative officer). The processes include review of comparability data for similar sized organizations by an independent committee consisting of public board members only. Salary ranges for the past year and ranges for the next year are reviewed for reasonableness. Contemporaneous meeting minutes of the compensation committee are kept on file.

Form 990, Part VI, Section C, Line 19

The filing organization's governing documents are not available to the public. The conflict of interest policy is available upon request and also on the mayoclinic.org website. The financial statements are available upon request.

Filing and Contact Details

Filer

EIN
39-1686673
Phone
5075381297

Signing Officer

Name
Paul M Bammel
Title
CFO
Phone
7158385270
Signed
2014-08-29

Organization Details

Principal Officer
Randall L Linton Md
Formed
1990
Legal Domicile
Wi
Voting Board Members
4
Independent Board Members
1
Employees
0
Volunteers
1
Supplemental Narrative

Additional Explanations

Form 990, Part IX, Line 11G

Ic purchased services: program service expenses 290,386. Management and general expenses 2,901. Fundraising expenses 0. Total expenses 293,287. Other purchased services: program service expenses 6,952. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,952.

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

Financial Statement Notes

PART X, LINE 2:

At december 31, 2013 and 2012, 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.

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IRS990/Desc0PATIENT CARE (SEE SCHEDULE O):PATIENT CARE: MAYO CLINIC HEALTH SYSTEM - SUPPORTIVE HOMECARE (MCHS-SHC) IS A MEMBER OF THE MAYO CLINIC HEALTH SYSTEM. IT IS A WISCONSIN NONPROFIT CORPORATION, TAX EXEMPT AS AN ORGANIZATION DESCRIBED IN SEC. 501(C)(3) OF THE INTERNAL REVENUE CODE. THE CORPORATION PROVIDES SERVICES TO THE RESIDENTS OF 14 COUNTIES IN NORTHWESTERN WISCONSIN.MAYO CLINIC HEALTH SYSTEM IS A FAMILY OF CLINICS, HOSPITALS AND HEALTH CARE FACILITIES SERVING COMMUNITIES IN MINNESOTA, IOWA AND 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. MAYO CLINIC HEALTH SYSTEM SITES EMPLOY APPROXIMATELY 1000 PHYSICIANS AND 14,000 ALLIED HEALTH STAFF. IN ADDITION, MAYO CLINIC PHYSICIANS FROM MULTIPLE SPECIALTIES REGULARLY SEE PATIENTS AT HEALTH SYSTEM FACILITIES. BESIDES HAVING HEALTH CARE FACILITIES IN MORE THAN 70 COMMUNITIES, MAYO CLINIC HEALTH SYSTEM INCLUDES 18 OWNED HOSPITALS, SIX OWNED NURSING HOMES, PHYSICIAN SERVICE AGREEMENTS WITH TWO ADDITIONAL HOSPITALS, AND CONTRACT MANAGEMENT AGREEMENTS WITH AN ADDITIONAL HOSPITAL AND NURSING HOME. SINCE ITS INCEPTION IN 1992, MAYO CLINIC HEALTH SYSTEM HAS GROWN INTO ONE OF THE MOST SUCCESSFUL REGIONAL HEALTH CARE SYSTEMS IN THE UNITED STATES. MORE THAN 600,000 UNIQUE PATIENTS ACCOUNT FOR MORE THAN 2.5 MILLION VISITS ANNUALLY IN MAYO CLINIC HEALTH SYSTEM. IT IS ALSO A NATIONAL LEADER IN QUALITY AND SAFETY EFFORTS. MCHS-SHC PLAYS A VITAL ROLE IN THE HEALTH AND WELL-BEING OF EAU CLAIRE RESIDENTS AND THE SURROUNDING COMMUNITIES BY OFFERING SUPPORTIVE CARE, MEDICAL HOUSE CALL, GERIATRIC CARE MANAGEMENT AND INTEGRATIVE THERAPY SERVICES. THIS INCLUDES FIVE BRANCH LOCATIONS. DISCIPLINES INCLUDE NON-TRADITIONAL NURSING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, DIETARY, SPIRITUAL CARE AND SUPPORTIVE CARE. MCHS-SHC HAD OVER 1,000 UNDUPLICATED PATIENTS WITH ALMOST 2,300 VISITS FOR 2013.MCHS-SHC PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS/RESIDENTS AT SUBSTANTIAL DISCOUNTS FROM STANDARD FEES. CHARITY CARE IS AVAILABLE TO PATIENTS FINANCIALLY UNABLE TO PAY FOR SERVICES PROVIDED. THE UNCOMPENSATED COST OF MEDICARE WAS APPROXIMATELY $441,000. THE UNCOMPENSATED COST OF OTHER MEANS TESTED GOVERNMENT PROGRAMS WAS APPROXIMATELY $13,000. MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE CLINIC, INC. AND MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC. VOLUNTARILY ENTERED INTO AN AGREEMENT WITH THE WI 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 OUR PATIENTS REGARDING OUR CHARITY CARE PROGRAM. ADDITIONALLY, THE WI ATTORNEY GENERAL REVIEWED AND APPROVED OUR BILLING AND COLLECTION POLICIES AND PRACTICES.
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IRS990ScheduleA/Form990ScheduleAPartIVGrp/ExplanationTxt0CONSULTING REVENUE - 2011 AMOUNT: $ 6,273. 2012 AMOUNT: $ 23,160. 2013 AMOUNT: $ 73,645. MISCELLANEOUS REVENUE - 2012 AMOUNT: $ 410.
IRS990ScheduleA/Form990ScheduleAPartIVGrp/FormAndLineReferenceDesc0SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME:
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IRS990ScheduleD/SupplementalInformationDetail/ExplanationTxt0AT DECEMBER 31, 2013 AND 2012, 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.
IRS990ScheduleD/SupplementalInformationDetail/FormAndLineReferenceDesc0PART X, LINE 2:
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IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm0BAMMEL PAUL M
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm1WITTROCK EDWARD A
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm2DICKEY JOHN M
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/PersonNm3LINTON MD RANDALL L
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt0DIR/PRES(1/1-5/15)/TREAS(5/15-12/31)
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt1DIR/V. PRES(1/1-5/15 )/PRESIDENT(5/1
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt2REGIONAL CAO
IRS990ScheduleJ/RltdOrgOfficerTrstKeyEmplGrp/TitleTxt3REGIONAL CEO
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IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt0THE 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.
IRS990ScheduleJ/SupplementalInformationDetail/ExplanationTxt1COMPENSATION PAID TO BOARD MEMBERS IS PRIMARILY FOR PROFESSIONAL RESPONSIBILITIES AS PHYSICIANS, ADMINISTRATORS, OR EMPLOYEES OF THE ORGANIZATION.
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc0SCHEDULE J, PART I, LINE 3
IRS990ScheduleJ/SupplementalInformationDetail/FormAndLineReferenceDesc1SCHEDULE J, PART III
IRS990ScheduleJ/SupplementalNonqualRtrPlanInd00
IRS990/ScheduleORequiredInd01
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt0THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: BAMMEL, PAUL M. DICKEY, JOHN M. LINTON M.D., RANDALL L. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: BAMMEL, PAUL M. DICKEY, JOHN M. LINTON M.D., RANDALL L. THE FOLLOWING INDIVIDUALS ARE EMPLOYED BY A RELATED ORGANIZATION: FOSTER, PAMELA K. POPE, PATRICIA J. WITTROCK, EDWARD A. RESULTING IN A BUSINESS RELATIONSHIP WITH THE FOLLOWING INDIVIDUALS WHO ARE ASSOCIATED WITH THE RELATED ORGANIZATION AS AN OFFICER, DIRECTOR, OR TRUSTEE: BAMMEL, PAUL M. DICKEY, JOHN M. LINTON M.D., RANDALL L. WITTROCK, EDWARD A. LINTON M.D., RANDALL L., WITTROCK, EDWARD A. HAVE A BUSINESS RELATIONSHIP AS THEY SERVE AS AN OFFICER, DIRECTOR, OR TRUSTEE OF MCHS--PHARMACY & HOME MEDICAL, INC., A RELATED TAXABLE ENTITY.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt1MAYO CLINIC, MAYO FOUNDATION FOR MEDICAL EDUCATION AND RESEARCH, AND OTHER RELATED COMPANIES PROVIDE MANAGEMENT SERVICES TO THE ENTIRE SYSTEM OF ENTITIES. MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL, INC. AND MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE CLINIC, INC. PROVIDE 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt2THE SOLE CORPORATE MEMBER IS MAYO CLINIC HEALTH SYSTEM - EAU CLAIRE HOSPITAL INC.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt3THREE OF THE FOUR BOARD MEMBERS ARE APPOINTED BY THE SOLE CORPORATE MEMBER.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt4THE SOLE CORPORATE MEMBER HAS THE RIGHT TO AMEND THE ARTICLES OR BYLAWS.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt5THERE ARE NO COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. HENCE, THERE IS NO DOCUMENTATION FOR PART VI SECTION A LINE 8B.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt6THE FORM 990 IS PREPARED BY MAYO CORPORATE TAX WITH ASSISTANCE FROM SITE ACCOUNTING STAFF. THE TAX RETURN GOES THROUGH TWO LEVELS OF REVIEW WITHIN THE CORPORATE TAX UNIT. IT IS THEN REVIEWED BY FINANCE STAFF AND THE CFO. 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt7MAYO 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.
IRS990ScheduleO/SupplementalInformationDetail/ExplanationTxt8THE FILING ORGANIZATION IS AN AFFILIATE OF MAYO CLINIC. MAYO CLINIC AND ITS AFFILIATES HAVE A COORDINATED PROCESS FOR REVIEWING AND APPROVING COMPENSATION AND BENEFITS FOR PHYSICIANS AND ADMINISTRATIVE LEADERSHIP. IN ADDITION TO ANY REVIEW AND APPROVAL THAT MAY TAKE PLACE AT THE LOCAL ENTITY LEVEL, THE FOLLOWING INDEPENDENT APPROVAL PROCESS OCCURS ANNUALLY IN THE FALL FOR THE NEXT YEAR'S COMPENSATION. THE SALARIES OF THE PRESIDENT/REGIONAL CEO AND THE REGIONAL CHIEF ADMINISTRATIVE OFFICER WERE REVIEWED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE PURSUANT TO THE PROCESS DESCRIBED BELOW FOR PHYSICIAN AND ADMINISTRATIVE LEADERSHIP. THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE INITIALLY REVIEWS THE COMPENSATION OF PHYSICIANS AND ADMINISTRATIVE LEADERSHIP FOR THE MAYO CLINIC HEALTH SYSTEM ENTITIES. THE COMMITTEE IS COMPRISED OF MAYO EMPLOYEES, BUT IS INDEPENDENT FOR INTERNAL REVENUE CODE 4958 FOR THE INDIVIDUALS WHOSE SALARY IS REVIEWED (WITH RECUSAL WHERE APPROPRIATE). THE MAYO CLINIC SALARY AND BENEFITS COMMITTEE THEN REVIEWS AND APPROVES THE COMPENSATION. FOR THOSE INDIVIDUALS FOR WHICH THIS COMMITTEE CANNOT SERVE AS THE INDEPENDENT REVIEW, THEIR COMPENSATION AND BENEFITS ARE REVIEWED BY THE GOVERNANCE COMMITTEE (DESCRIBED BELOW). THE COMPENSATION AND BENEFITS COMMITTEE USES COMPARABILITY DATA (INCLUDING THIRD-PARTY BENCHMARKING SURVEYS) IN ITS REVIEW AND DOCUMENTS DECISIONS IN ITS MINUTES. INFORMATION ON MAYO CLINIC HEALTH SYSTEM PHYSICIAN AND ADMINISTRATIVE LEADERSHIP COMPENSATION AND BENEFITS IS ALSO REVIEWED BY THE MAYO CLINIC COMMITTEE ON OFFICER SUCCESSION, COMPENSATION AND GOVERNANCE (GOVERNANCE COMMITTEE), WHICH IS COMPRISED OF SEVEN OF THE EXTERNAL INDEPENDENT MEMBERS OF THE MAYO CLINIC BOARD OF TRUSTEES. IN ADDITION TO THE ABOVE COORDINATED REVIEW PROCESS CONDUCTED BY THE MAYO CLINIC HEALTH SYSTEM COMPENSATION AND BENEFITS COMMITTEE AND/OR THE MAYO CLINIC GOVERNANCE COMMITTEE, THE NORTHWEST WISCONSIN REGION OF THE MAYO CLINIC HEALTH SYSTEM (WHICH INCLUDES THE FILING ORGANIZATION) ALSO HAS ITS OWN COMPENSATION REVIEW AND APPROVAL PROCESSES FOR THE REGION'S SENIOR LEADERSHIP AND PHYSICIANS (WHICH INCLUDES THE PRESIDENT/REGIONAL CEO AND THE REGIONAL CHIEF ADMINISTRATIVE OFFICER). THE PROCESSES INCLUDE REVIEW OF COMPARABILITY DATA FOR SIMILAR SIZED ORGANIZATIONS BY AN INDEPENDENT COMMITTEE CONSISTING OF PUBLIC BOARD MEMBERS ONLY. SALARY RANGES FOR THE PAST YEAR AND RANGES FOR THE NEXT YEAR ARE REVIEWED FOR REASONABLENESS. CONTEMPORANEOUS MEETING MINUTES OF THE COMPENSATION COMMITTEE ARE KEPT ON FILE.

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