President

July 31, 2001

Tor Dahl

Tor Dahl & Associates

2202 Fifth Street, Suite 1240

White Bear Lake, MN 55110

Dear Dr. Dahl:

As we discussed, I have reflected upon the attributes of Tor Dahl & Associates’ engagement with Marshfield Clinic, and I convey those to you in this letter. Please feel free to share this letter with whomever you wish.

In 1997, after prolonged internal discussions on financial performance, organizational structure, and operations efficiencies, Marshfield Clinic decided to engage an external consultant for a comprehensive review. We received proposals from and interviewed a number of well-known consulting firms. We chose Tor Dahl & Associates because we felt it offered a unique approach, namely grass roots diagnostics and including people in the process who would be affected by the outcome.

The TDA engagement started in April, 1998 and ended in September, 1999. It included 208 detailed interviews with people at all levels, 1,700 additional surveys, 241 group feedback sessions, multiple additional seminars, and many individual briefings with leadership and others.

While the process required a major commitment of collective time and energy, it did get the entire organization focused on examination and acknowledgement of the problems and formulation of potential solutions. I felt that TDA’s diagnostic instruments were excellent. I felt that TDA’s message of inclusion, information sharing, teamwork, and emphasis on the importance of the work place environment were also appealing and effective.

Financial recovery started in mid 1999. Fiscal year 2000 was an excellent financial year for Marshfield Clinic. While there were many reasons for this, some unrelated to the engagement, average physician productivity, adjusted for Medicare RVU changes and fee increases, increased by over 5%. That gain appears to be holding into fiscal 2001.

Tor Dahl,

July 31, 2001

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Measured staff satisfaction increased and has continued to increase with each survey. Measured patient satisfaction, although always good, has also improved.

I wish you well.

Cordially,