Mayo Clinic-Methodist Hospital

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Three-digit plan number (PN)	001
Effective date of plan	1972-02-01
Business code	622000
Sponsor’s telephone number	5072840126
Plan sponsor’s mailing address	200 FIRST STREET SW, ROCHESTER, MN, 55905
Plan sponsor’s address	200 FIRST STREET SW, ROCHESTER, MN, 55905

Plan administrator’s name and address

Administrator’s EIN	410739106
Plan administrator’s name	MAYO CLINIC METHODIST HOSPITAL
Plan administrator’s address	200 FIRST STREET SW, ROCHESTER, MN, 55905
Administrator’s telephone number	5072840126

Number of participants as of the end of the plan year

Active participants	505
Retired or separated participants receiving benefits	125
Other retired or separated participants entitled to future benefits	13
Deceased participants whose beneficiaries are receiving or are entitled to receive benefits	6
Number of participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	6

Signature of

Role	Plan administrator
Date	2010-10-15
Name of individual signing	WILLIAM BROWN
Valid signature	Filed with authorized/valid electronic signature