Mchs - Southwest Minnesota Region

“The following individuals are employed by a related organization: herrmann m.d., martin j. Morris m.d., marie e. Resulting in a business relationship with the following individuals who are associated with the related organization as an officer, director, or trustee: morris m.d., marie e. Grace, richard w. Koch, mark b. Brolsma, greg gaalswyk, mark the following individuals are employed by a related organization: cragun m.d., kevin t. Grace, richard w. Hebl m.d., james r. Koch, mark b. Spinner m.d., robert j. Resulting in a business relationship with the following individual who is associated with the related organization as an officer, director, or trustee: nesse m.d., robert e.”

“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 sole member elects the member directors. The sole member elects the community directors that have been approved by the board of directors and nominated by various nominating groups.”

“The bylaws provide the sole corporate member certain reserved powers in areas such as debt, amendment of the bylaws, mergers, and new services.”

“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 director of finance, the cfo and the administrator. 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 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 ceo, cao, and physician leadership were reviewed by the mayo clinic health system compensation and benefits committee pursuant to the process described below for mayo clinic health system - 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 the mayo clinic health system committee can not serve as the independent review, their compensation and benefits are reviewed by the governance committee (described below). The compensation and benefits committee uses comparability data (including third-party benchmarking surveys) in its review and documents decisions in its minutes. Information on mayo clinic health system physician and administrative leadership compensation and benefits is also reviewed by the mayo clinic committee on officer succession, compensation and governance (governance committee), which is comprised of seven of the external independent members of the mayo clinic board of trustees. 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 southwest minnesota 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 ceo and cao). 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.”

“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.”

“Ic purchased services : program service expenses 7,231,739. Management and general expenses 22,720,194. Fundraising expenses 0. Total expenses 29,951,933. Other purchased services: program service expenses 14,136,714. Management and general expenses 858,379. Fundraising expenses 28,405. Total expenses 15,023,498.”

“Medicaid surcharge : program service expenses 1,746,886. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,746,886. Employee related expense : program service expenses 131,100. Management and general expenses 331,462. Fundraising expenses 0. Total expenses 462,562. Dues/licenses/subscript : program service expenses 117,479. Management and general expenses 296,336. Fundraising expenses 450. Total expenses 414,265. Misc. Expense : program service expenses 45,129. Management and general expenses 0. Fundraising expenses 0. Total expenses 45,129. Exp allocated to affiliates: program service expenses -9,489,998. Management and general expenses -8,885,808. Fundraising expenses 0. Total expenses -18,375,806.”

“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”