2015-05-04T15:14:00-05:00 2014-06-30 ERNST & YOUNG US LLP 41 S HIGH ST 1100 HUNTINGTON CTR COLUMBUS OH 43215 990 2013-07-01 411878730 SMDC Medical Center % KEVIN BOREN SMDC 2187271421 502 EAST 2ND STREET Suite DULUTH MN 55805 KEVIN BOREN CFO 2015-04-30 Diane L Bean P00104972 2013 2016-03-07 17:11:31Z Essentia Health Duluth BARBARA WESSBERG 502 East 2nd Street DULUTH MN 55805 476172543 false X www.essentiahealth.org X 1997 MN WE ARE CALLED TO MAKE A HEALTHY DIFFERENCE IN PEOPLES'S LIVES. 14 7 2853 283 1261179 216791 548336 695618 401982679 464652117 2486936 3131156 2916289 6866490 407934240 475345381 1557436 1468633 0 0 282225730 291440412 0 0 0 124889187 170970542 408672353 463879587 -738113 11465794 649503160 644413276 545408685 527533929 104094475 116879347 X WE ARE CALLED TO MAKE A HEALTHY DIFFERENCE IN PEOPLE'S LIVES. false false 370855305 1468633 468394595 See schedule O 370855305 true true false true false false false false true true true true false true true false false true false false true true false false false false true true true false true false false false true false false true true false false false false true true true true false false true X 39 0 true 2853 true true true false false false false false false false false false X 14 7 false false false false true true true true true false false true true true true true true true true false MN X KEVIN BOREN 2187861009 532 EAST 1ST STREET DULUTH MN 55805 X Sister Kathleen Hofer Board Chair Thru 12/13 1.4 14.6 X X 0 0 0 Joseph Bianco MD Board Secretary 1.4 58.6 X X 0 305914 56274 David Gaddie Board Treasurer Thru 1/14 1.4 11.6 X X 0 38800 0 Alan Hodnik Board Director 1.4 8.6 X 0 0 0 Sherry Mattson Board Treasurer 1.4 8.6 X X 0 9900 0 Sister Donna Shroeder Board Director 1.4 8.6 X 0 0 0 Sister Sarah Smedman Board Director 1.4 8.6 X 0 0 0 Susan Streitz MD Board Director Thru 12/13 1.4 58.6 X 0 322643 27386 Sister Mary Josephine Torborg Board Director 1.4 8.6 X 0 0 0 Michael Van Scoy MD Board Secretary Thru 11/13 1.4 58.6 X X 0 333473 53084 Chuck Walt Board Chair 1.4 11.6 X X 0 6400 0 DANIEL NIKCEVICH MD BOARD DIRECTOR 1.4 58.6 X 833775 0 133109 DANIEL MARKHAM BOARD DIRECTOR Thru 1/14 1.4 8.6 X 0 4800 0 Michael Maddy MD Board Director 1.4 58.6 X 0 299386 46423 Laura Trombino MD Board Director 51.6 8.4 X 0 386144 55254 Howard Klatzky Board Director 1.4 8.6 X 0 0 0 Joseph Leoni Board Director 1.4 8.6 X 0 0 0 Joseph Mihalek Board Director 1.4 8.6 X 0 2600 0 Thomas Renier Board Director 1.4 8.6 X 0 0 0 ROBERT NORMAN Interim CFO thru 01/14 1.4 58.6 X 0 777091 91274 BARBARA WESSBERG ADMINISTRATOR 58.6 1.4 X 212864 0 21499 Kevin Boren Chief Financial Officer 1.4 58.6 X 0 0 0 MICHAEL METCALF EXECUTIVE VP CLINICAL OPS 1.4 58.6 X 500438 0 95297 ANN WATKINS VP SURGICAL SERVICES 1.4 58.6 X 230340 0 48122 CYNTHIA SORENSEN VP MEDICAL SPECIALTIES 1.4 58.6 X 231278 0 55868 MICHAEL MCAVOY VP HOSPITAL OPS THRU 10/13 1.4 58.6 X 249554 0 42732 TIMOTHY ZAGER MD DULUTH CLINIC PRESIDENT 1.4 58.6 X 450958 0 86936 Scott Johnson MD Clinical Chief 1.4 58.6 X 0 693934 56475 THERESA GUNNARSON MD CLINICAL CHIEF 1.4 58.6 X 0 578083 56406 JUSTIN HILL MD Clinical Chief 1.4 58.6 X 0 669672 46918 SANDRA MCCARTHY CHIEF NURSING OFFICER 1.4 58.6 X 399728 0 53754 BRIAN KONOWALCHUK MD CLINICAL CHIEF 1.4 58.6 X 0 456944 48039 JEFFREY LYON MD Section Chair 1.4 58.6 X 0 292031 48720 VINCENT OHAJU MD CLINICAL CHIEF 1.4 58.6 X 0 718037 54105 ANNE STEPHEN MD CLINICAL CHIEF 1.4 58.6 X 0 271238 53475 HUGH RENIER MD VP MEDICAL AFFAIRS 1.4 58.6 X 0 386862 83329 James Garvey EVP Hospital Ops & Admin 1.4 58.6 X 349833 0 71450 DANIEL MCGINTY CHIEF ADMIN OFFICER Thru 8/13 1.4 58.6 X 621770 0 34481 HARVEY ANDERSON VICE PRESIDENT FACILITIES 60.0 0.0 X 224382 0 44442 Daniel Milbridge Regional Administrator 60.0 0.0 X 234886 0 37091 David Moyer MD Physician 60.0 0.0 X 275166 0 52066 Leah Becicka MD Physician 60.0 0.0 X 335376 0 35728 THOMAS PATNOE MD President & CMO thru 4/12 60.0 0.0 X 0 550295 55129 BARBARA JOHNSON CFO thru 6/13 0.0 0.2 X 322036 0 33185 ALBERT DEIBELE MD CLINICAL CHIEF 0.0 0.0 X 0 234096 35307 THOMAS KAISER MD CLINICAL CHIEF 0.0 60.0 X 0 573553 51284 RICHARD SPEHAR PHARMACY DIRECTOR 0.0 60.0 X 0 162861 14983 BRAD DAVIS MD SECTION CHAIR 1.4 58.6 X 0 513964 56080 5472384 8588721 1835705 109 true true false Iron Range Rehab Center 901 N 9th St Suite 100 VIRGINIA MN 55792 PT/OT Services 939106 Cardinal Health 1330 Enclave Parkway HOUSTON TX 77077 Pharmacy Management 792075 Rehab Group Management Services PO Box 502096 ST LOUIS MO 63105 Inpt Rehab Mgmt 373961 R A Construction Snowplow PO Box 18034 DULUTH MN 55811 Snowplow 187228 Steven Feltman 3908 Golf Course Rd GRAND RAPIDS MN 55744 Financial Services 168850 6 316045 282405 97168 4306 695618 PATIENT REVENUE 621110 457906465 457434979 471486 NURSING HOME REVENUE 623000 6745652 6745652 464652117 1163657 1163657 0 0 391025 391025 0 391025 391025 2329975 25705 388181 2329975 -362476 1967499 1967499 0 4294 4587 -293 -293 1150898 434394 716504 596957 119547 MSA REVENUE DULUTH FAMILY PRACTICE 541900 3742478 3742478 CAFETERIA REVENUE 900099 1686871 156759 1530112 COFFEE CART REVENUE 900099 133256 133256 196649 35977 160672 5759254 475345381 467923109 1261179 5465475 X 1461986 1461986 0 6647 6647 0 8095167 4729125 3366042 826083 682799 143284 230423806 206233361 24190445 11906727 9162268 2744459 26565276 21328265 5237011 13623353 11391799 2231554 0 399189 399189 17716 17716 18832 18832 0 357949 357949 19907906 10070115 9837791 831643 5714 825929 12852043 5984984 6867059 14084562 320861 13763701 0 9465595 186514 9279081 2343207 1415280 927927 0 549519 466954 82565 -32512 -32512 0 17914694 17467967 446727 4761235 4761235 MEDICAL SUPPLIES 40414401 40329185 85216 AFFILIATE SUPPORT FEE 36553024 9595169 26957855 BAD DEBT EXPENSE 23190814 23190814 UNRELATED BUSINESS TAX 68274 68274 -12727549 2064263 -14791812 463879587 370855305 93024282 0 7444587 1464847 117512472 91656457 78988 3500 57106251 53759703 0 83333 0 0 552541 18610 4599351 5053553 6436042 6502580 210784134 133158939 78755122 77625195 0 0 41511961 73072915 0 0 0 0 335505845 335172583 649503160 644413276 59801757 41455085 390000 200000 0 0 0 0 15566 15355 0 0 1036848 1305366 7276139 6148780 476888375 478409343 545408685 527533929 X 104055679 116863073 4796 -17726 34000 34000 104094475 116879347 649503160 644413276 X 11465794 3206359 -1887281 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 6000 false true 12832 18832 false Schedule C, Part II-B Lobbying Activity Explanation: Line 1g: ESSENTIA HEALTH DULUTH WAS AN ADVOCATE SPONSOR THROUGH THE DULUTH AREA CHAMBER OF COMMERCE FOR THE 2014 "DULUTH & ST. LOUIS COUNTY AT THE CAPITAL DAYS" EVENT. REPRESENTATIVES FROM ESSENTIA HEALTH, ALONG WITH OTHER REGIONAL BUSINESSES AND CITIZENS, MET FACE-TO-FACE WITH MN LEGISLATORS TO DISCUSS ISSUES AFFECTING OUR COMMUNITIES AND HEALTHCARE. Line 1i: Essentia Health Duluth pays dues to certain organizations related to the industry which have lobbying expenses. The amount listed is the percentage of the dues paid that were used for lobbying. false true X 34000 34000 34000 34000 34000 34000 34000 34000 34000 34000 1.00000 false false 1323171 1323171 48894631 30178535 18716096 4416403 194837 4221566 149278153 101204309 48073844 6871776 1581258 5290518 77625195 POOLED INVESTMENT FUND 73072915 F 73072915 RECEIVABLES TO TAX EXEMPT ORGS 335172583 335172583 0 PAYABLES TO RELATED TAX-EXEMPT ORGS 469592395 DEFINED BENEFIT PENSION LIABILITY 5886001 ASSET RETIREMENT OBLIGATION(FIN 47) 455412 UNCLAIMED PROPERTY 251088 PATIENT EMERGENCY FUND 2950 POST RETIREMENT BENEFIT NON PENSION 2221497 478409343 Schedule D, Part IV, Line 2B ESSENTIA HEALTH DULUTH ACTS AS CUSTODIAN FOR THE FUNDS OF THE NURSING HOME RESIDENTS. NURSING HOME RESIDENT TRUST FUNDS TOTALED $15,355 AT JUNE 30, 2014. Schedule D, Part V Endowment Fund intended uses: The endowment fund is a permanently restricted fund used to establish the Miller Memorial Hospital. true Central America and the Caribbean Send agents to seminar 4323 Europe (Including Iceland and Greenland) Send agents to seminar 1407 North America Send agents to seminar 3454 9184 9184 Sub-Saharan Africa MEDICAL MISSIONS 6647 Supplies COST 1 0 false false false false false false Schedule F, Part I, Line 2 ESSENTIA HEALTH DULUTH PROVIDED GRANT MONIES TO A DOMESTIC ORGANIZATION FOR THE PURPOSE OF PROVIDING ASSISTANCE TO A DESIGNATED FOREIGN ORGANIZATION THAT DEMONSTRATED THE MISSION OR VALUES OF ESSENTIA HEALTH. THE BOARD APPROVES GRANT MONIES TO COMMUNITY ORGANIZATIONS THAT MAKE A HEALTHY DIFFERENCE IN THE NORTHLAND. THE BOARD ALSO APPROVES GRANTS FOR HEALTHCARE INITIATIVES THAT MAKE A POSITIVE DIFFERENCE IN THE LIVES OF PATIENTS IN THE AREA IT SERVES. THE BOARD IS PROVIDED AN ANNUAL REPORT OF THE USE OF FUNDS. GRANT RECIPIENTS ARE REQUIRED TO PROVIDE A WRITTEN REPORT FOR GRANTS OVER $5,000. true true X true X 160. true X 310. true true true false true true 2406009 2406009 0.00550 74386774 41021077 33365697 0.07570 76792783 41021077 35771706 0.08120 58842 58842 0.00010 732859 284531 448328 0.00100 622500 622500 0.00140 1414201 284531 1129670 0.00250 78206984 41305608 36901376 0.08370 1 68000 68000 0.00020 1 390895 390895 0.00090 1 7000 7000 1 10000 10000 1 747 747 1 179183 179183 0.00040 6 655825 655825 0.00150 true 23190814 66162718 116805570 -50642852 X true true 2 1 ESSENTIA HEALTH DULUTH 502 EAST SECOND STREET DULUTH MN 55805 WWW.ESSENTIAHEALTH.ORG 365767 X X X X 2 ESSENTIA HEALTH VIRGINIA 901 9TH STREET NORTH VIRGINIA MN 55792 WWW.ESSENTIAHEALTH.ORG 365431 X X X ESSENTIA HEALTH DULUTH 1 true X X X X X X X X X X 12 true true true X See Part V, Section C X X X X X X X X false false true true 160. true 310. true X X X X X X X X true true X X X X X X true false X X X X true X false false ESSENTIA HEALTH VIRGINIA 2 true X X X X X X X X X X 12 true true true X See Part V, Section C X X X X X X X X false false true true 160. true 310. true X X X X X X X X true true X X X X X X true false X X X X true X false false Part V, Line 1j The Community Health Needs Assessment also includes a Community Health Profile. The profile is based on data from the Behavioral Risk Factors Surveillance System and the University of Wisconsin Population Health Institute County Health Rankings. Part V, Line 3 Essentia Health Duluth: Community/Patient Focus Groups were held for community members to identify and prioritize their community health needs. In addition, persons were consulted at Town Hall Meetings, which was designed to address each prioritized health need. During the Town Hall Meeting, intervention options for meeting the health need were presented, and participants identified an option for their community. Individuals from the following organizations attended the Town Hall Meeting (names and titles available upon request): Arrowhead Regional Development Commission, Denfeld High School, Community Health Board, Duluth Community Garden Program, Duluth Local Initiatives Support Corporation, Fair Food Access Campaign, Generations Health Care Initiatives, Healthy Duluth Area Coalition, Lake Superior College, Institute for a Sustainable Future, Lake Superior Community Health Center, Minnesota Department of Health, St. Louis County Public Health and Human Services, St. Lukes, University of Minnesota Duluth, Walgreens, Whole Foods Co-op, YMCA, and Zeppa Family Foundation. See the CHNA posted on the website listed in Part V, Line 5a for a list of organizations that were invited to, but did not attend the town hall meetings. Employees of the Minnesota Department of Health, St. Louis County Public Health and Human Services, and the Community Health Board (names and titles available upon request) attended the Town Hall Meeting and provided input on the intervention options for addressing the highest priority health need. A wide variety of individuals attended the Community/Patient Focus Groups, including those from medically underserved, low-income, and minority populations and populations with chronic disease needs. Furthermore, Community/Patient Focus Group participants were instructed to consider themselves as representatives of the community-at-large, which would include those previously-listed populations. While 92% of individuals in St. Louis County are Caucasian, data stratified by race/ethnicity were also presented at the Community/Patient Focus Groups. Essentia Health Virginia: A Community/Patient Focus Group was held for community members to identify and prioritize their community health needs. In addition persons were consulted at Town Hall Meetings, which was designed to address each prioritized health need. During the Town Hall Meeting, intervention options for meeting the health need were presented, and participants selected the option best suited to their community. Individuals from the following organizations attended the Town Hall Meeting (names and titles available upon request): Arrowhead Economic Opportunity Agency, Community/Patient Focus Group, Hibbing High School, Home Town Focus, Mesabi Community College, Parkview Learning Center, and St. Louis County Public Health and Human Services Department. See the CHNA posted on the website listed in Part V, Line 5a for a list of organizations that were invited to, but did not attend the town hall meetings. An employee of St. Louis County Public Health and Human Services (name and title available upon request) attended the Town Hall Meeting and provided input on the intervention options for addressing the highest priority health need. While St. Louis County is 36.5% rural according to the 2012 UWPHI County Health Rankings data, the majority of Essentia Health Virginia's northern St. Louis County service area is rural. Given the known health disparities of rural populations, all attendees of the community/Patient Focus Group and Town Hall Meetings are representatives and/or members of medically-underserved and low income populations, as well as populations with chronic disease needs. Community/Patient Focus Group participants were specifically instructed to consider themselves as representatives of the community-at-large. Participants at the Town Hall Meetings served more formal leadership or representative roles. The Arrowhead Economic Opportunity Agency is "established as a Community Action Program (CAP) for the northeast Minnesota counties of St. Louis, Lake, and Cook." In St. Louis County, 92.0% of individuals are Caucasian. However, as attendees at the Community/Patient Focus Group were instructed to act as representatives of the entire community, and data stratified by race/ethnicity were presented, health needs of minority populations were considered. Part V, Line 4 Essentia Health Duluth and Essentia Health Virginia are affiliated with Essentia Health. In the interest of efficiency, cost effectiveness, and alignment with Essentia Health population health strategies, the hospital facilitys CHNA was conducted in a coordinated process with fourteen other Essentia Health hospital facilities. While still allowing for tailoring to each particular hospital facility, procedures were standardized across hospital facilities. The hospital facilities included in this coordinated process are: Essentia Health Ada in Ada, MN; Clearwater Valley Hospital and Clinics, Inc. in Orofino, ID; Essentia Health Deer River in Deer River, MN; Essentia Health Virginia in Virginia, MN; Essentia Health Holy Trinity Hospital in Graceville, MN; Essentia Health West in Fargo, ND; Minnesota Valley Health Center, Inc. in Le Sueur, MN; Essentia Health Northern Pines in Aurora, MN; Essentia Health Sandstone in Sandstone, MN; Essentia Health Duluth in Duluth, MN; Essentia Health St. Josephs Medical Center in Brainerd, MN; Essentia Health St. Marys Hospital-Superior in Superior, WI; St. Marys Hospital, Inc. in Cottonwood, ID; Essentia Health St. Marys Medical Center in Duluth, MN; and Essentia Health St. Marys-Detroit Lakes in Detroit Lakes, MN. Since Essentia Health West joined the collaborative effort on February 1, 2013, not all aspects of the Essentia Health West CHNA are coordinated with those of the other hospital facilities. Essentia Health St. Marys Medical Center did and will collaborate more closely with one of the Essentia Health hospital facilities in particular Essentia Health Duluth in Duluth, MN by holding joint Community/Patient Focus Groups, Town Hall Meetings, and Intervention Planning Meetings. Additional collaboration between the two hospital facilities will occur throughout intervention implementation as the hospital facilities will execute joint interventions for each priority health need. The hospital facility did not collaborate with any other hospital facility outside of the Essentia Health System. Part V, Line 5a Essentia Health Duluth: The CHNA is posted under the "Community Benefit/CHNA" tab on the hospital facility's homepage at: http://www.essentiahealth.org/Duluth/Find-a-Clinic/Essentia-HealthDuluth-M illerDwan-Building-41.aspx Essentia Health Virginia: The CHNA is posted under the "Community Benefit/CHNA" tab on the hospital facility's homepage at: http://www.essentiahealth.org/EssentiaHealth-Virginia/Find-a-Clinic/Essent ia-HealthVirginia-211.aspx Part V, Line 5d Links to the report were emailed to the Minnesota Hospital Association (MHA) to catalog the assessments and make them available on their website to help members meet IRS requirements for wide dissemination of reports. The MHA will also analyze the assessments to identify common themes, issues and needs on a statewide and regional basis. Finally, the MHA will use the catalog as a vehicle for connecting hospitals with similar community needs with one another to explore joint implementation strategies, information sharing, or resources for making their community benefit activities as influential as possible. Part V, Line 6i This box was not checked, so not applicable. Part V, Line 7 Seven health needs were identified through the CHNA. Of those health needs, the highest priority health need has and will continue to be addressed over the next three years as a part of the hospital facilitys implementation strategy. The hospital facility will not directly meet the six unprioritized health needs due to resource constraints. Rather than inadequately addressing all health needs, the hospital facility will focus resources, financial and otherwise, on optimizing the first intervention for the communitys highest priority health need while the Health System collectively builds the necessary resources and capacity for population health improvement in order to foster success in meeting the health need. Despite not directly meeting the unprioritized needs, interventions addressing the highest prioritized health need may partially address the unprioritized health needs that overlap with the prioritized health need. If the unprioritized health needs remain in the next CHNA cycle, they may be directly addressed at that time. The six unprioritized health needs are as follows: 11 Essentia Health DULUTH CLINIC-3RD STREET 400 EAST 3RD STREET Duluth MN 55805 MULTI-SPECIALTY CLINIC Essentia Health Duluth Clinic-1ST STREET 420 EAST 1ST STREET Duluth MN 55805 MULTI-SPECIALTY CLINIC Essentia Health DULUTH Clinic-2ND STREET 402 EAST 2ND STREET DULUTH MN 55805 MULTI-SPECIALTY CLINIC Essentia Health WEST DULUTH CLINIC 4212 GRAND AVENUE Duluth MN 55807 MULTI-SPECIALTY CLINIC Essentia Health LAKEWALK CLINIC 1502 LONDON ROAD Duluth MN 55812 MULTI-SPECIALTY CLINIC Essentia Health LAKESIDE CLINIC 4621 EAST SUPERIOR STREET Duluth MN 55804 MULTI-SPECIALTY CLINIC Essentia Health HERMANTOWN Clinic 4855 WEST ARROWHEAD ROAD HERMANTOWN MN 55811 MULTI-SPECIALTY CLINIC Essentia Health Proctor Clinic 211 South Boundary Ave Proctor MN 55810 MULTI-SPECIALTY CLINIC ESSENTIA HEALTH VIRGINIA CARE CENTER 901 9TH STREET NORTH VIRGINIA MN 55792 SKILLED NURSING FACILITY ESSENTIA HEALTH VIRGINIA CLINIC 1101 9TH STREET NORTH VIRGINIA MN 55792 MULTI-SPECIALTY CLINIC ESSENTIA HEALTH VIRGINIA MEDICAL ARTS CLINIC 901 9TH STREET NOR VIRGINIA MN 55792 OBGYN CLINIC Schedule H, Part VI, Line 1 Provide the description required for Part I, lines 3c, 6a, 7g, 7, column (f), 7; Part II; Part III, lines 2, 3, 4, 8, 9b: Part I, Line 3c Assets will be considered along with the patients income to determine eligibility for the Financial Assistance Program. To be eligible, reportable assets may not exceed $15,000 for a household of one (1), or $25,000 for a household of two (2) or more. Assets may include, but are not limited to, such items as checking and savings accounts, IRAs, 401(k)s; value of additional cars that exceed the number of working members in the household, equity in recreational vehicles and additional property, etc. Part I, Line 6a Essentia Health Duluth's and Essentia Health Virginia's community benefit information is consolidated into the Essentia Health community benefit information which is included in the Essentia Health annual report. The annual report is made available to the public at http://www.essentiahealth.org/Main/Annual-Report.aspx. Essentia Health, headquartered in Duluth, Minn., is an integrated health system serving patients in Minnesota, Wisconsin, North Dakota and Idaho and is Essentia Health Duluth parent corporation. Part I, Line 7g Not Applicable. Part I, Line 7, Column (f) Bad debt expense that was subtracted from total expense to obtain the % of community benefit to total expense amounted to $23,190,814. Part I, Line 7 The cost to charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to calculate the costs for the following community benefits: Charity Care and Unreimbursed Medicaid. Actual costs were used for the remainder of the community benefits reported. Part II About half of the community building activities reported are physician recruitment expenses. The hospital facility is located in a federally-designated medically underserved area and as such includes physician recruitment as a community building activity per the recommendation of the Catholic Health Association Community Benefit Guide. The other half represents contributions to organizations that are performing community building activities. Examples include donations to a not-for-profit organization that provides low income home loans, the public school system, the local soup kitchen, the local food bank, and the United Way. Part III, Line 2 Discounts, charity care, and bad debt expense are accounted for as reductions to revenue. Bad debt expense on patient accounts would be identified as any balance on the account, less any previous payments and discounts, that has aged and is absent of any payments. If, during the collection process, it becomes known that the patient qualifies for charity care, the amounts included within bad debt expense would be reclassified to charity care. Part III, Line 3 Essentia Health Duluth and Essentia Health Virginia are a part of a larger organization, Essentia Health. Essentia Health and its member organizations incorporate the cost of bad debt as a community benefit. As a tax exempt hospital, we must provide the necessary services regardless of the patients ability to pay for that care. In doing so, Essentia Health makes quality patient care available to all in our community, regardless of their economic means. Part III, Line 3 Essentia Health Duluth and Essentia Health Virginia provide both full and partial charity care through their traditional application process. Full charity care is a complete write-off of eligible gross hospital and clinic charges while "partial" is a portion of eligible charges. Each are determined respectively based on the patient's income in relation to the Federal Poverty Guidelines. Essentia Health also recognizes that it is not feasible, or sometimes necessary, for all patients to complete financial assistance applications and provide documentation required through the traditional process. Essentia Health Duluth and Essentia Health Virginia implemented an alternative documentation and presumptive process using a tool that identifies accounts that automatically qualify for charity care and reclassified those accounts to charity care allowance. As a result, we estimate $0 of patient accounts written off to bad debt would qualify for charity care. Part III, Line 4 The page number of the audit that contains the footnote describing the organization's bad debt expense is page 12. Part III, Line 8 The methodology used in determining the reported Medicare Allowable Cost begins with the hospital's general ledger system. The costs are obtained from the general ledger and then adjusted and reported in accordance with Centers for Medicare Services (CMS) "cost finding" guidelines as published in their Provider Reimbursement Manual. Once the Medicare allowable costs are determined from the hospital's cost report, any costs attributed to subsidized health services, and Medical Education, are removed and reported separately. Part III, Line 8 Each Essentia Health hospital is required to file a Medicare cost report 5 months after the close of their fiscal year. The cost report provides Medicare with information that is used to determine utilization and spending trends but also is used to set future payment rates for most Medicare services. If the interim payments paid to a hospital are higher or lower than the filed cost report allowable reimbursement there will be a settlement for that fiscal year. This can be due to changes in utilization or cost of providing services for Critical Access Hospitals (CAH) or differences between interim and final payment factors for Disproportionate Share, Bad Debts, or Indirect Medical Education for non-CAH hospitals. An estimate for these settlements is recorded at the close of the fiscal year. If the estimate varies from the final settlement received 6-7 months after the fiscal year ends then these amounts are recorded as prior year Medicare revenue. Part III, Line 8 Essentia Health Duluth and Essentia Health Virginia are a part of a larger organization, Essentia Health. Essentia Health and its member organizations incorporate the full value of the Medicare shortfall as a community benefit. The rationale for the organization's opinion is providing care for the elderly and serving Medicare patients is an essential part of the community benefit standard. Medicare, like Medicaid, does not pay the full cost of care and it is likely to get worse. Many Medicare beneficiaries are poor and are eligible for Medicaid in addition to Medicare. Medicare underpayment must be shouldered by the hospital in order to continue treating the community's elderly and poor. These underpayments represent a real cost of serving the community. Part III, Line 9b The policies and procedures for internal and external collection practices take into account the extent to which the patient qualifies for the Financial Assistance Policy (FAP) and financial assistance, a patient's good faith effort to apply for a governmental program or for financial assistance from Essentia Health Duluth and Essentia Health Virginia and the patient's good faith effort to comply with his/her payment agreements. Essentia Health Duluth and Essentia Health Virginia offer extended payment plans to eligible patients and will not impose liens on primary residences nor will we report patients to a credit rating agency for outstanding patient bills. Essentia Health Duluth and Essentia Health Virginia will not charge a patient gross amount of charges for any uninsured treatment. Uninsured discounts will be applied to the gross charges prior to any FAP or other discounts. At any time Essentia Health Duluth and Essentia Health Virginia recognize that a patient may be eligible for State or Federal programs, a representative will assist the patient in obtaining information about those programs or provide contact information for those programs. Essentia Health Duluth and Essentia Health Virginia contract with an outside patient advocacy agency, which may provide assistance to the uninsured patient in applying to certain State and Federal programs. At any stage of the patient experience and up through the collection process, the patient may express a concern that they are unable to pay their bill in full or meet the payment plan requirements. At that time, the patient will be given every opportunity to complete and submit an application for financial assistance. Essentia Health Duluth and Essentia Health Virginia train their outside debt collection agencies and attorneys about the Financial Assistance Policy and how a patient may obtain more information about the FAP or submit an application for financial assistance. Essentia Health Duluth and Essentia Health Virginia require their outside collection agencies and attorneys to refer patients who may be eligible for financial assistance to Essentia Health Duluth and Essentia Health Virginia. If a patient has submitted an application for financial assistance after an account has been referred for collection activity, Essentia Health Du Part VI, line 2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B: Essentia Health Duluth: In addition to the needs assessment, we assess community health needs through the programs we offer, requests we receive and staff involvement in their own communities. We collaborate with other community organizations such as the United Way, Community Health Care Boards and Community Health Plan Steering Committees and other local organizations in common efforts to address community health care needs. We are continually reviewing the data distributed by the state and counties on mortality, life expectancy, and health behaviors to identify areas of disparity. This information can then be used in future planning of programing and service expansion. We also continue to expand our programs on care coordination and telemedicine for individuals with chronic conditions to optimize the care delivered and keep people out of the hospital. The Essentia Health Primary Care Patient and Family Advisory Council is another mechanism that is used to assess the community health care needs. The goals of the council include the following: 1. Strengthen communications among patients, families and care givers, and staff 2. Advocate for patient and family centered care 3. Foster accountability for a health care environment that is safe, accessible and supportive 4. Improve coordination of quality care 5. Provide input and feedback to Essentia leadership, physicians and staff 6. Facilitate a positive relationship between Essentia Health and the community. Another area that plays a key role in the assessment is the Essentia Health Foundation. Through the Foundation's fund raising efforts the Newborn Intensive Care Unit at St. Marys Medical Center was totally renovated, which enabled Essentia to provide state of the art care to the smallest and most vulnerable patients we serve. Essentia Health Virginia: In addition to the recently conducted Community Health Needs Assessment, Essentia Health Virginia participates in monthly mental health meetings including several local health care facilities as well as representatives of the county to discuss how mental health services across northern Minnesota can be improved upon. Essentia Health Virginia also assesses the community's needs through programs offered, requests received, and staff involvement in the community. The Essentia Health Virginia Patient and Family Advisory Council is another mechanism that is used to assess the community health care needs. The goals of the council include the following: 1. Strengthen communications among patients, families and care givers, and staff 2. Advocate for patient and family centered care 3. Foster accountability for a health care environment that is safe, accessible and supportive 4. Improve coordination of quality care 5. Provide input and feedback to Essentia leadership, physicians and staff 6. Facilitate a positive relationship between Essentia Health and the community. Part VI, line 3 Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's Financial Assistance policy: Essentia Health Duluth and Essentia Health Virginia make information on its Financial Assistance Policy (FAP) readily available to the patient. Information about financial assistance programs is available on the Essentia Health (parent company) website (www.essentiahealth.org) where the Information and application is easily accessible to be viewed, downloaded and printed at no charge to the patient. Notices on the availability of financial assistance are conspicuously posted in emergency room departments. Financial assistance information is available during the pre-admission financial screening, at the time of registration and prior to a hospital discharge. Information about the FAP is in all collection letters and patient statements. FAP information and/or applications is made available to appropriate community health services agencies and other organizations that assist people in need. Essentia Health Duluth and Essentia Health Virginia educate staff members who work closely with patients providing direct patient treatment and who work in admissions, billing and collections, about the existence of the FAP and how a patient may obtain more information. Annual education/awareness of the FAP is provided to ensure all employees with patient contact are aware of the program and how patients can obtain additional information. Clinical and hospital staff who provide direct patient care have knowledge of the FAP and know to direct patients to a Registration Interviewer or Business Office Representative. Registration staff have an understanding of the policy, knowledge of where the related documents are located and where to direct the patient for more information on the FAP. Designated employees (Financial Counselors; Patient Accounts Representatives) have a thorough understanding of the FAP and offer the information on the FAP to those patients who make an inquiry about the program or are determined through a financial screening that the patient may be eligible for this program. Patient advocacy services also inform the patient about the availability of assistance. A request for financial assistance may be made by the patient, a patient's guarantor, a family member, close friend, or associate of the patient, subject to applicable privacy laws. Essentia Health Duluth and Essentia Health Virginia respond to any oral or written requests for more general information on the FAP made by a patient or any interested party. Part VI, line 4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves: Essentia Health Duluth: Essentia Health Duluth is located in Duluth, MN. Essentia Health Duluth is a part of the larger Essentia Health system, which is defined in Part VI, line 6. Essentia Health Duluth operates 1 hospital and 8 clinics that serve the St. Louis County area. The overall community is classified as suburban and rural. Essentia Health Duluth covers a service region of approximately 465,000 people. The service region age distribution is 20.0% under the age of 18; 61.6% between the ages of 18 and 65; and 18.4% over the age of 65. The racial makeup of the service region is 91.2% Caucasian; 1.1% Black or African American; 0.6% Asian; 1.3% Hispanic; and 5.8% other, predominantly Native American. The gender split ratio is 49.9% women and 50.1% men. The average income for the service area is approximately $56,000. Approximately 9.2% of the population falls below the federal poverty guidelines. Essentia Health Duluth, along with Essentia Health is committed to serve patients regardless of their ability to pay. Approximately 1.8% gross revenue dollars were from self pay patients. In addition, approximately 17.1% of their gross revenue dollars were Medicaid recipients. As mentioned above, Essentia Health Duluth is part of a larger system, Essentia Health. Essentia Health staffs hospitals and clinics in federally-recognized underserved areas and supports the health of its communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into its smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or are faced with other challenges that make it difficult to travel long distances for care. There are 13 other hospitals outside of the Essentia Health umbrella that service the community. Essentia Health Virginia: Essentia Health Virginia is located in Virginia, MN. Essentia Health Virginia is a part of the larger Essentia Health system, which is defined in Part VI, line 6. Essentia Health Virginia operates 1 hospital, 2 clinics, and a skilled nursing facility that serve northern St. Louis County. The overall community is classified as rural. Essentia Health Virginia covers a service region of approximately 28,000 people. The service region age distribution is 19.3% under the age of 18; 60.3% between the ages of 18 and 65; and 20.4% over the age of 65. The racial makeup of the service region is 93.8% Caucasian; 0.7% Black or African American; 0.4% Asian; 0.9% Hispanic; and 4.2% other, predominantly Native American. The gender split ratio is 49.8% women and 50.2% men. The average income for the service area is approximately $52,000. Essentia Health Virginia, along with Essentia Health is committed to serve patients regardless of their ability to pay. 2.3% gross revenue dollars were from self pay patients. In addition, approximately 14.2% of their gross revenue dollars were Medicaid recipients. As mentioned above, Essentia Health Virginia is part of a larger system, Essentia Health. Essentia Health staffs hospitals and clinics in federally-recognized underserved areas and supports the health of its communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into its smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or are faced with other challenges that make it difficult to travel long distances for care. There is 1 other hospital outside of the Essentia Health umbrella that services the community. Part VI, line 5 Provide any other information important to describing how the organizations hospitals or other health care facilities further its exempt purpose by promoting the health of the community: Essentia Health Duluth: Essentia Health Duluths board of directors is composed of volunteer representatives from the communities it serves. Essentia Health Duluth has an open medical staff, so any qualified physician of the community is allowed to apply. All applicants that apply must meet the credentialing standards and be approved by our governing board in order to come and provide services in our system. In addition, the hospital facility provides on-site clinical experiences for medical students, nurses, therapists, technicians and other healthcare vocations. We reinvest in the organization by acquiring the latest state of the art equipment and by investing in programs that are needed in our community. Essentia Health Duluth provides support and education to the community. The hospital facility uses many volunteers to deliver a volume of services in order to enable staff to be more efficient in services provided. A variety of media are used to reach the public on seasonal or problem health conditions in the community. Throughout the past year we have also increased our focus on developing partnerships with public health, school districts, and the local police department to improve the health of the community. Essentia Health Duluth is active in the community and sponsors events that promote healthy lifestyles and health communities. In January we started to offer free Pre-Diabetes Prevention Programs to people in the community. This is a year-long program of education and support to enable people to make lifestyle changes and become healthier, hopefully avoiding development of diabetes. We also worked with our community partners to apply and procure a Department of Health grant to become an Accountable Community for Health. The project will focus on an elementary school where families who are socio-economically challenged reside and will provide for community health workers and medical, dental, and mental health services will be brought to the school community. Essentia Health Duluth is a part of the Essentia Health East Region. Essentia Health East Regions consolidated community benefits are summarized below: Benefits for person living in poverty Charity care at cost $7,296,000 Cost-to-Charge Ratio Unreimbursed Medicaid $73,537,000 Cost-to-Charge Ratio Total Charity Care and Means-Tested Government Programs $80,833,000 Benefits for the broader community Community health improvement services and community benefit operations $2,901,000 Actual Costs Health professions education $2,132,000 Actual Costs Financial and in-kind contributions $623,000 Actual Costs Total Other Benefits $5,656,000 Unpaid cost of public programs, Medicare $99,345,000 Cost-to-Charge Ratio Other care provided without compensation (bad debt) $28,110,000 Cost-to-Charge Ratio Discounts offered to uninsured patients $2,907,000 Actual Costs Taxes and fees $2,495,000 Actual Costs Total Community Benefit $219,346,000 Essentia Health Virginia: Essentia Health Virginia's board of directors is composed of volunteer representatives from the communities it serves. Essentia Health Virginia has an open Medical Staff, so any qualified physician of the community is allowed to apply. All applicants that apply must meet the credentialing standards and be approved by the governing board. Annually the organization develops an operating and capital budget based upon the services it will deliver to meet the healthcare needs in the community. Any surplus would be applied against the prioritized needs to maintain existing programs and services or the development of new ones. Essentia Health Virginia provides support and education to the community. The hospital facility uses many volunteers to deliver a volume of services in order to enable staff to be more efficient in services provided. Essentia Health Virginia contributes to projects that help promote health and wellness within the community. Examples of this are Project Care, Pre-diabetes program and a contribution to a community walking trail. Essentia Health Duluth and Essentia Health Virginia are a part of Essentia Health, a fully integrated health system with facilities in Minnesota, Wisconsin, North Dakota and Idaho. As a non-profit organization, Essentia Health reinvests surplus revenues into medical training, programs and technology that improve patient care. Essentia provides services predominantly in rural communities and is committed to eliminating geographic barriers to care. We strive to provide high-quality, patient-centered care close to home for the communities we serve. We continue to upgrade facilities and technology, such as MRIs, CT scanners and surgery suites, to ensure patients in rural communities have nearby access to these services. In addition, we have embarked on several major construction projects, which include a new $50 million wing for our Fargo hospital. Essentia Health was one of the first Accountable Care Organizations in the country to receive the highest level of accreditation from the National Committee for Quality Assurance (NCQA). As an ACO, Essentia is committed to meeting the Triple Aim of improving care and population health, while reducing the overall costs for patients and society as a whole. The formation of our ACO, along with ongoing management and process improvement, represents a significant investment for Essentia. Since a majority of healthcare costs are directly related to caring for patients who have chronic conditions, Essentia has developed medical homes, which are designed to improve health outcomes for patients, especially those with chronic diseases. Much of this work is not fully reimbursed by state or federal programs. Essentia supports the health of our communities through active research and clinical trials through the Essentia Institute of Rural Health. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans. Various Essentia Health organizations contributed approximately $4.25 million in support to the Institute during the past year. The Essentia Institute of Rural Health also coordinates our community health needs assessment program. Across our system, Essentia offers community members the opportunity to take part in a National Diabetes Prevention Program, which was designed by the Centers for Disease Control and Prevention. Participants receive the year-long program at no cost, and learn valuable information and skills for making important lifestyle changes. These new healthy habits help participants lose weight and become more active, which is vital in the prevention of diabetes and other chronic diseases. Part VI, Line 6 If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served: Essentia Health Duluth and Essentia Health Virginia are part of Essentia Health, an integrated health system with 16 hospitals, 66 clinics, eight long-term care facilities, two assisted living facilities, five independent living facilities, five ambulance services and one research institute in four states: Minnesota, Wisconsin, North Dakota and Idaho. The health system serves a predominantly rural population whose median incomes generally fall below averages of the states where they live. The presence of our clinics and hospitals ensures that people with few economic resources dont have to drive an hour or more to receive basic (and in some cases life-saving) medical care. In addition to staffing hospitals and clinics in federally recognized underserved areas, we support the health of our communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into our smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or faced with other challenges that make it difficult to travel long distances for care. Our size and integrated structure allow us to offer patients services often found only in larger urban settings. Services ranging from chemotherapy to congestive heart failure management and hospice are available to patients in many of the rural communities we serve. Essentia Health also supports the health of our rural communities through active research and clinical trials by the Essentia Institute of Rural Health. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans. Essentia Health is also serving patients through the use of our electronic health record (EHR). The vast majority of Essentias hospitals and clinics are using a fully-integrated EHR for patient care. Technology like the electronic health record and Essentias telehealth program allows health clinicians to share test results and consult with colleagues in real time across great distances. Medical information is no longer lost in the shuffle of paper records an important consideration in a region where patients must often be transferred to a larger Essentia facility for complex surgeries or medical care. Essentia is also actively working with government agencies and insurers to develop innovative and cost-effective approaches to care that will improve health outcomes while reducing overall costs to patients and insurers. This innovation can be found in our use of remote home monitors for patients with congestive heart failure and our focus on using a team-based approach to helping patients manage chronic diseases. Essentia Health is committed to helping patients and their families lead active and fulfilling lives in the small and large communities where they live. We hope to become a model of healthcare delivery, particularly in rural areas, in the years to come. PART VI, LINE 7 If applicable, identify all states with which the organization, or a related organization, files a community benefit report: Essentia Health Duluth and Essentia Health Virginia file a community benefit report in Minnesota. true BOYS & GIRLS CLUB OF the Northland 102 S 29th Ave W 200 DULUTH MN 55816 410969947 501(C)3 15000 Program Support DULUTH Area CHAMBER OF COMMERCE 5 West 1 st Street DULUTH MN 55802 410225910 501(C)6 10000 PROGRAM SUPPORT CHURCHES UNITED IN MINISTRY 102 W 2ND ST DULUTH MN 55802 411227969 501(C)3 26900 Program Support FIRST WITNESS Child Abuse RESOURCE CENTER 4 W 5TH ST DULUTH MN 55806 411737291 501(C)3 20500 PROGRAM SUPPORT GRANT COMMUNITY SCHOOL 108 East 6th St DULUTH MN 55805 412002724 501(C)3 25000 Program Support KIDS CLOSET of Duluth 727 Central Avenue DULUTH MN 55807 201878745 501(c)3 8000 Program Support Gloria Dei Lutheran Church 326 11th Ave Two Harbors MN 55616 410786046 501(C)3 22000 Program Support MEN AS PEACEMAKERS 205 W 2ND ST Suite 15 DULUTH MN 55802 411841689 501(C)3 11050 Program Support MILLER DWAN FOUNDATION 502 E 2ND ST DULUTH MN 55805 237396466 501(C)3 51000 Program Support NORTHERN WATERS PARISH NURSE MINISTRY 3500 Tower Ave SUPERIOR WI 54880 392001278 501(C)3 7000 Program Support NORTHLAND FOUNDATION 202 W SUPERIOR ST Ste 610 DULUTH MN 55802 411554455 501(C)3 50000 Program Support NORTHWOODS WOMEN INC P O BOX 88 ASHLAND WI 54806 391364912 501(C)3 8000 Program Support PROGRAM FOR AID TO VICTIMS OF SEXUAL ASSAULT INC 32 E 1ST ST STE 200 DULUTH MN 55802 411350021 501(C)3 20000 PROGRAM SUPPORT Range Respite Project Inc 1309 20th St S Virginia MN 55792 411726790 501(C)3 22000 Program Support SECOND HARVEST NORTHERN LAKES FOOD BANK 4503 AIRPARK BLVD DULUTH MN 55811 363479964 501(C)3 26000 Program Support UNITED WAY OF GREATER DULUTH 424 W Superior St Ste 402 DULUTH MN 55802 410857077 501(C)3 20000 Program Support UNITED WAY OF NORTHEASTERN MINNESOTA 229 W LAKE ST CHISHOLM MN 55719 410908454 501(C)3 21250 Program Support CAMEROON HEALTHCARE DEVELOPMENT PROGRAM 3417 RILEY RD DULUTH MN 55803 272513866 501(C)3 25000 Program Support YOUTH FOR CHRIST USA INC 7670 S VAUGHN CT ENGLEWOOD CO 80155 362193619 501(c)3 15000 Encounter Youth Center MARCH OF DIMES FOUNDATION 1275 Mamaroneck Ave WHITE PLAINS NY 10605 131846366 501(c)3 10000 Program Support CENTER AGAINST SEXUAL & DOMESTIC ABUSE INC 2231 CATLIN AVE SUPERIOR WI 54880 391478768 501(c)3 45000 Program Support DAMIANO CENTER 206 W 4TH ST DULUTH MN 55806 411453521 501(c)3 12000 Program Support LIFE HOUSE 102 W FIRST ST DULUTH MN 55802 411704840 501(c)3 45000 Program Support ESSENTIA HEALTH FOUNDATION 502 E 2ND ST DULUTH MN 55805 271984704 501(c)3 50200 Employee Fund JUST KIDS DENTAL PO BOX 146 TWO HARBORS MN 55616 272311353 501(c)3 45000 Program Support SOAR CAREER SOLUTIONS 205 W 2ND ST 101 DULUTH MN 55802 411449179 501(c)3 20000 Program Support GREATER DOWNTOWN COUNCIL 5 WEST 1ST ST DULUTH MN 55802 411467228 501(c)6 8145 Program Support REGENTS OF THE UNIVERSITY OF MINNESOTA UNIVERSITY AVE SE SUITE 111 MPLS MN 55414 416007513 501(C)3 76300 PROGRAM SUPPORT UNIVERSITY OF MINNESOTA DULUTH 1049 UNIVERSITY DRIVE DULUTH MN 55812 416007513 501(C)3 35500 PROGRAM SUPPORT ONE ROOF COMMUNITY HOUSING 12 EasT 4TH STREET DULUTH MN 55805 411678328 501(C)3 25000 PROGRAM SUPPORT DULUTH PLAYHOUSE 506 W MICHIGAN STREET DULUTH MN 55802 410694692 501(C)3 20000 PROGRAM SUPPORT HARTLEY NATURE CENTER 3001 WOODLAND AVE DULUTH MN 55803 363507636 501(C)3 7000 Education program YMCA of Duluth 32 East First St Ste 202 Duluth MN 55802 410696493 501(c)3 10000 Program Support Local Initiatives Support Company 733 Third Ave New York NY 10017 133030229 501(c)3 35000 Program Support Lake Superior Community 4325 Grand Avenue Duluth MN 55807 237167576 501(c)3 215000 Program Support Independent School District 131 9th Avenue Proctor MN 55810 416003748 501(c)3 21950 Program Support Healthshare Inc 130 W Superior St Ste 700 Duluth MN 55802 262722248 501(c)3 200000 Program Support Duluth Running Company 1026 E Superior St Duluth MN 55802 870799289 S Corp 6900 Program Support Duluth Family Practice Center 330 N 8th Ave E Duluth MN 55805 237456795 501(c)4 5426 Program Support Laurentian Chamber of Commerce 704 North 6th Ave Ste B Virginia MN 55792 510456882 501(c)6 5700 Program Support 38 2 Schedule I, Part I, Line 2 Essentia Health Duluth provides grant monies to organizations that demonstrate the mission or values of Essentia Health. The Board approves grant monies to community organizations that make a healthy difference in the Northland. The Board also approves grants for healthcare initiatives that make a positive difference in the lives of patients in the area it serves. The Board is provided an annual report of the use of funds. Grant recipients are required to provide a written report for grants over $5,000. X true true X X X X X false true false false false false false false true true ROBERT NORMAN Interim CFO thru 01/14 0 435704 0 122489 0 218898 0 67637 0 23637 0 868365 0 60185 BARBARA JOHNSON CFO thru 6/13 197655 0 88700 0 35681 0 29333 0 3852 0 355221 0 34120 0 THOMAS PATNOE MD President & CMO thru 4/12 0 547888 0 0 0 2407 0 25500 0 29629 0 605424 0 0 MICHAEL METCALF EXECUTIVE VP CLINICAL OPS 383432 0 111150 0 5856 0 67500 0 27797 0 595735 0 0 0 ANN WATKINS VP SURGICAL SERVICES 183708 0 27089 0 19543 0 27051 0 21071 0 278462 0 11403 0 CYNTHIA SORENSEN VP MEDICAL SPECIALTIES 191862 0 25921 0 13495 0 27021 0 28847 0 287146 0 12388 0 MICHAEL MCAVOY VP HOSPITAL OPS THRU 10/13 204189 0 29526 0 15839 0 25971 0 16761 0 292286 0 10473 0 ALBERT DEIBELE MD CLINICAL CHIEF 0 233458 0 0 0 638 0 22235 0 13072 0 269403 0 0 THOMAS KAISER MD CLINICAL CHIEF 0 567692 0 0 0 5861 0 25500 0 25784 0 624837 0 0 TIMOTHY ZAGER MD DULUTH CLINIC PRESIDENT 345725 0 99750 0 5483 0 62781 0 24155 0 537894 0 0 0 Scott Johnson MD Clinical Chief 0 692388 0 0 0 1546 0 25500 0 30975 0 750409 0 0 Joseph Bianco MD Board Secretary 0 305279 0 0 0 635 0 25500 0 30774 0 362188 0 0 Susan Streitz MD Board Director Thru 12/13 0 321282 0 0 0 1361 0 25500 0 1886 0 350029 0 0 Michael Van Scoy MD Board Secretary Thru 11/13 0 332632 0 0 0 841 0 25500 0 27584 0 386557 0 0 DANIEL NIKCEVICH MD BOARD DIRECTOR 658077 0 171516 0 4182 0 105070 0 28039 0 966884 0 0 0 BARBARA WESSBERG ADMINISTRATOR 185947 0 25394 0 1523 0 15562 0 5937 0 234363 0 0 0 RICHARD SPEHAR PHARMACY DIRECTOR 0 162120 0 0 0 741 0 6155 0 8828 0 177844 0 0 THERESA GUNNARSON MD CLINICAL CHIEF 0 577122 0 0 0 961 0 25500 0 30906 0 634489 0 0 JUSTIN HILL MD Clinical Chief 0 669042 0 0 0 630 0 25500 0 21418 0 716590 0 0 BRAD DAVIS MD SECTION CHAIR 0 513167 0 0 0 797 0 25500 0 30580 0 570044 0 0 DANIEL MCGINTY CHIEF ADMIN OFFICER Thru 8/13 312309 0 116495 0 192966 0 15300 0 19181 0 656251 0 102865 0 HARVEY ANDERSON VICE PRESIDENT FACILITIES 192599 0 26534 0 5249 0 26319 0 18123 0 268824 0 0 0 SANDRA MCCARTHY CHIEF NURSING OFFICER 306837 0 88350 0 4541 0 41947 0 11807 0 453482 0 0 0 BRIAN KONOWALCHUK MD CLINICAL CHIEF 0 456566 0 0 0 378 0 20400 0 27639 0 504983 0 0 JEFFREY LYON MD Section Chair 0 290947 0 0 0 1084 0 25500 0 23220 0 340751 0 0 VINCENT OHAJU MD CLINICAL CHIEF 0 716271 0 0 0 1766 0 25500 0 28605 0 772142 0 0 ANNE STEPHEN MD CLINICAL CHIEF 0 270837 0 0 0 401 0 25262 0 28213 0 324713 0 0 HUGH RENIER MD VP MEDICAL AFFAIRS 0 305246 0 43847 0 37769 0 54328 0 29001 0 470191 0 33228 Michael Maddy MD Board Director 0 297943 0 0 0 1443 0 25051 0 21372 0 345809 0 0 Laura Trombino MD Board Director 0 383996 0 0 0 2148 0 25500 0 29754 0 441398 0 0 James Garvey EVP Hospital Ops & Admin 309627 0 17575 0 22631 0 59198 0 12252 0 421283 0 0 0 Daniel Milbridge Regional Administrator 228592 0 0 0 6294 0 11690 0 25401 0 271977 0 0 0 David Moyer MD Physician 274933 0 0 0 233 0 24913 0 27153 0 327232 0 0 0 Leah Becicka MD Physician 334988 0 0 0 388 0 25459 0 10269 0 371104 0 0 0 Schedule J, Part I Line 1 Benefits provided: During tax year 2013, charter travel was used on occasion by one board officer, one officer, two key employees, and one former key employee for travel between Essentia Health's Corporate office in Duluth, MN and Essentia Health's supported organizations. Many of Essentia Health's supported organizations are located in rural areas which do not have direct commercial flights available. Charter travel ensures efficient use of Essentia Health's board directors' and employees' time. The use of charter travel is not treated as taxable compensation to these individuals as all travel was business related. Schedule J, Part I, Line 3 Establishing CEO's compensation: Essentia Health Duluth relied on Essentia Health's, supporting organization of Essentia Health Duluth, methods for establishing Essentia Health Duluth's ADMINISTRATOR'S compensation: a compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board or compensation committee. SCHEDULE J, PART I, LINE 4B Supplemental nonqualified retirement plan: Essentia Healths nonqualified retirement plan is offered to designated Essentia Health executives. There is a minimum two year vesting date, or vesting is automatic upon reaching retirement age, death, disability or involuntary termination without cause. Benefits are subject to income taxes upon vesting and payable from Essentia Healths general assets. Reported as Other Reportable Compensation in Schedule J, Part II, Column B (iii), the following individuals listed in Form 990, Part VII, Section A, Line 1a received payment of the vested benefit from the supplemental nonqualified retirement plan during the year: Barbara Johnson 34,120 Robert Norman 60,185 Ann Watkins 11,403 Cynthia Sorensen 12,388 Michael McAvoy 10,473 Hugh Renier, MD 33,228 Daniel McGinty 102,865 Reported as Retirement and Other Deferred Compensation in Schedule J, Part II, Column C, Essentia Health made contributions, subject to the vesting terms, during the year into the supplemental nonqualified retirement plan on behalf of the following individuals listed in Form 990, Part VII, Section A, Line 1a: Daniel Nikcevich, MD 79,570 Barbara Johnson 4,975 Barbara Wessberg 4,796 Robert Norman 52,337 Ann Watkins 5,911 Cynthia Sorensen 4,362 Michael McAvoy 2,110 Sandra McCarthy 29,197 Hugh Renier, MD 28,828 James Garvey 59,198 Timothy Zager, MD 37,281 Michael Metcalf 42,000 Harvey Anderson 4,323 Schedule J, Part I, Line 8 Initial contract exception: Essentia Health Duluth's Executive Vice President Hospital Operations, James Garvey, received compensation during the year under an initial employment agreement subject to the initial contract exception. Through the Executive Compensation Committee of Essentia Health's board of directors, this compensation arrangement was reviewed and approved by independent persons using comparability data and deliberations and decisions were documented. Leah Becicka MD EMPLOYEE See Part V X 125000 83333 false true true 83333 Sheri Mattson Related to Sherry Mattson 44281 See Part V false Sarah Johnson Related to Scott Johnson 81375 See Part V false Dani Raze Related to Joseph Leoni 23473 See Part V false Fryberger Buchanan Smith See Part V 273108 Legal Services false Schedule L, Part II, Column C, Line 1 Purpose of Loan: Employment Incentive Schedule L, Part IV, Column D, Lines 1 & 3 Description of transaction: Compensation of family member of board director Schedule L, Part IV, Column D, Line 2 Description of transaction: Compensation of family member of key employee Schedule L, Part IV, Column B, Line 4 Joseph Mihalek, Board Director, owns more than 5% of Fryberger, Buchanan, Smith & Frederick, P.A. Form 990, Part III, Line 4 Program service accomplishments: SMDC Medical Center dba Essentia Health Duluth is organized and operated exclusively for charitable, scientific, and educational purposes. In furtherance of its purposes, Essentia Health Duluth provides health care services in Minnesota through its 165 bed hospital and 8 clinics. The hospital offers a broad range of inpatient and outpatient services for its patients, including medical surgical care, behavioral health, rehabilitation, orthopedics, neuroscience, digestive health, family and pediatrics services, and heart and vascular services. In accordance with the Federal Emergency Medical Treatment and Active Labor Act, any person who presents at the hospital seeking treatment of an emergency medical condition is given a medical screening and necessary stabilizing treatment regardless of the person's ability to pay. In addition to the hospital and clinics, Essentia Health Duluth also operates pharmacies, optical centers, infusion therapy centers, outpatient surgery centers, and a cancer center. Beyond its clinical services, Essentia Health Duluth also offers educational programs for the community, such as parenting classes and child safety programs such as bicycle helmet fitting, bicycle safety, and pedestrian safety. Essentia Health Duluth also participates in continuing education programs for health care professionals. Essentia Health Duluth employs over 2,000 full time equivalents. The hospital provided for over 26,600 hospital patient days and over 37,500 outpatient visits during the fiscal year ended June 30, 2014. The clinics had over 476,000 encounters during the same time period. Essentia Health Duluth provided over $2,171,000 in charity care as well as an additional $28,420,000 of costs incurred in excess of Medicaid payments received during the fiscal year ended June 30, 2014. Further community benefits provided during the fiscal year include cash and in-kind donations of over $622,000 and continuing education programs for health care professionals of over $296,000. Essentia Health Duluth is the sole member of Essentia Health Virginia, LLC. Essentia Health Virginia, LLC is organized exclusively for charitable, scientific, and educational purposes. In furtherance of its purposes, Essentia Health Virginia, LLC provides health care services in Minnesota through its 83 bed hospital and 90 bed skilled nursing facility. The hospital offers a broad range of inpatient and outpatient services for its patients, including medical surgical care, rehabilitation, orthopedics, diabetes care, sleep lab, family and pediatric services, and heart and vascular services. In accordance with the Federal Emergency Medical Treatment and Active Labor Act, any person who presents at the hospital seeking treatment of an emergency medical condition is given a medical screening and necessary stabilizing treatment regardless of the person's ability to pay. The clinic offers a broad range of outpatient services for its patients, including family practice, obstetrics and gynecology, cancer center, orthopedics, digestive health, family, pediatrics services, weight management, and heart and vascular services. Essentia Health Virginia, LLC employs over 530 full time equivalents. The hospital provided for over 6,400 patient days and over 12,000 emergency visits during the fiscal year ended June 30, 2014. The clinic had over 75,000 encounters during the same time period and the skilled nursing facility provided over 28,000 resident days. Essentia Health Virginia, LLC provided over $234,000 in charity care as well as an additional $4,945,000 of costs incurred in excess of Medicaid payments received during the fiscal year ended June 30, 2014. Further community benefits provided during the fiscal year include continuing education programs for health care professionals of over $151,000. Form 990, Part V, Line 1A 1099 Reporting: VENDOR PAYMENTS AND FORM 1099'S WERE PROCESSED THROUGH ESSENTIA HEALTH ON BEHALF OF CERTAIN LEGAL ENTITIES COMPRISING ESSENTIA HEALTH SYSTEM. ESSENTIA HEALTH VIRGINIA, LLC, DISREGARDED ENTITY OF ESSENTIA HEALTH DULUTH, PROCESSED VENDOR PAYMENTS AND FORM 1099'S. THE NUMBER ON PART V, LINE 1A REPRESENTS THESE PAYMENTS. Form 990, Part V, Line 1C NO GAMING (GAMBLING) WINNINGS Form 990, Part VI, Line 6 Members of Organization: MEMBER, ESSENTIA HEALTH EAST, MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY AS DESCRIBED IN SCHEDULE O PART VI LINE 7A. MEMBERS, ESSENTIA HEALTH AND ESSENTIA HEALTH EAST, HAVE RESERVED POWERS WITH RESPECT TO ESSENTIA HEALTH DULUTH AS DESCRIBED IN SCHEDULE O PART VI LINE 7B. Form 990, Part VI, Line 7A Members with right to elect governing body: ESSENTIA HEALTH EAST APPOINTS AND REMOVES ESSENTIA HEALTH DULUTH'S GOVERNING BODY. Form 990, Part VI, Line 7B MEMBER WITH RIGHT TO APPROVE GOVERNING BODY DECISION: ESSENTIA HEALTH DULUTH IS A SUBSIDIARY OF ESSENTIA HEALTH, WHOSE BOARD OF DIRECTORS HAS RESERVED POWERS WITH RESPECT TO THIS CORPORATION AND ITS SUBSIDIARIES, AND ALL OF THE OTHER DIRECT AND INDIRECT SUBSIDIARIES OF ESSENTIA HEALTH (COLLECTIVELY, THE "SYSTEM"). ESSENTIA HEALTH'S RESERVED POWERS ARE AS FOLLOWS: STRATEGIC AND BUSINESS PLANS. AUTHORITY TO CREATE, AND TO APPROVE, THE SYSTEM'S STRATEGIC AND BUSINESS PLANS. MISSION. AUTHORITY TO CREATE, AND TO APPROVE, THE MISSION, PURPOSE AND VISION STATEMENTS FOR ALL ENTITIES IN THE SYSTEM BY THE AFFIRMATIVE VOTE OF AT LEAST 67% OF THE ESSENTIA HEALTH BOARD OF DIRECTORS. DEBT. APPROVAL OF THE INCURRENCE OF DEBT BY, AND THE CREATION OF ALL MORTGAGES, LIENS, SECURITY INTERESTS, OR OTHER ENCUMBRANCES ON THE ASSETS OF, ALL ENTITIES IN THE SYSTEM IN EXCESS OF THE SINGLE OR ANNUAL AGGREGATE DOLLAR LIMITS PRESCRIBED IN WRITING BY THE ESSENTIA HEALTH BOARD OF DIRECTORS, AND THE AUTHORITY TO CAUSE ALL ENTITIES IN THE SYSTEM TO PARTICIPATE IN SYSTEM BORROWING. GOVERNING INSTRUMENTS. AUTHORITY TO CAUSE, AND TO APPROVE, AMENDMENTS OF THE ARTICLES OF INCORPORATION AND BYLAWS OF ALL ENTITIES IN THE SYSTEM. MERGERS AND ACQUISITIONS. AUTHORITY TO CAUSE, AND TO APPROVE, ALL MERGERS, CONSOLIDATIONS, AND DISSOLUTIONS OF ALL ENTITIES IN THE SYSTEM. AFFILIATIONS AND JOINT VENTURES. AUTHORITY TO CAUSE, AND TO APPROVE, ALL AFFILIATIONS, JOINT VENTURES AND OTHER ALLIANCES WITH THIRD PARTIES OF ALL ENTITIES IN THE SYSTEM. TRANSFER OF ASSETS WITHIN THE SYSTEM. AUTHORITY TO TRANSFER ASSETS, INCLUDING CASH, BETWEEN AND AMONG ENTITIES WITHIN THE SYSTEM; PROVIDED, HOWEVER, THAT ESSENTIA HEALTH SHALL NOT HAVE AUTHORITY TO REQUIRE ANY ENTITY IN THE SYSTEM TO TRANSFER ASSETS (A) THAT WOULD CAUSE SUCH ENTITY TO BE IN DEFAULT OF ITS COVENANTS OR OBLIGATIONS UNDER ANY BOND OR OTHER FINANCING DOCUMENTS; (B) FROM THE CATHOLIC ENTITIES TO THE SECULAR ENTITIES OR FROM THE SECULAR ENTITIES TO THE CATHOLIC ENTITIES IN A MANNER OR TO AN EXTENT THAT WOULD CAUSE THE CATHOLIC ENTITIES TO BE IN VIOLATION OF THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES (ERDS) IN THE JUDGMENT OF THE LOCAL ORDINARY; OR (C) SUCH THAT MONEY GENERATED BY SERVICES AT SECULAR FACILITIES WITHIN THE SYSTEM BY PROCEDURES THAT ARE CONTRARY TO THE ERDS WOULD BE USED AT THE CATHOLIC ENTITIES OR MONEY GENERATED BY CATHOLIC ENTITIES WOULD BE USED IN THE PROVIDING OF SERVICES CONTRARY TO THE ERDS AT SECULAR FACILITIES WITHIN THE SYSTEM. TRANSFER OF ASSETS OUTSIDE THE SYSTEM. AUTHORITY TO CAUSE, AND TO APPROVE, THE SALE, LEASE OR OTHER TRANSFER OF ASSETS OF ALL ENTITIES IN THE SYSTEM TO PARTIES OUTSIDE OF THE SYSTEM WHEN THE ASSET'S VALUE EXCEEDS THE SINGLE OR ANNUAL AGGREGATE DOLLAR LIMITS PRESCRIBED IN WRITING BY THE ESSENTIA HEALTH BOARD OF DIRECTORS. SERVICES. AUTHORITY TO CAUSE, AND TO APPROVE, THE ADDITION OF NEW SERVICES AND SERVICE LOCATIONS AND THE DISCONTINUANCE OF SERVICES AND SERVICE LOCATIONS WITHIN ALL ENTITIES IN THE SYSTEM. BUDGETS. APPROVAL OF CAPITAL AND OPERATING BUDGETS OF ALL ENTITIES IN THE SYSTEM. PROFESSIONAL SERVICES. SELECTION OF THE GENERAL LEGAL COUNSEL AND EXTERNAL AUDITORS OF ALL ENTITIES IN THE SYSTEM. APPROVAL OF PARENT BOARDS. APPROVAL OF THE ELECTION AND REMOVAL, WITH OR WITHOUT CAUSE, OF 100% OF THE CAG AND SMDC BOARDS OF DIRECTORS (WHO SHALL BE ELECTED BY THE METHODS SET FORTH IN THE CAG AND SMDC GOVERNING DOCUMENTS, RESPECTIVELY, SUBJECT TO ESSENTIA'S APPROVAL). ACQUISITIONS. AUTHORITY TO CAUSE, AND TO APPROVE, ALL ACQUISITIONS BY AND FORMATIONS OF ENTITIES IN THE SYSTEM. MARKETING. AUTHORITY TO IMPLEMENT SYSTEM-WIDE MARKETING AND PROMOTIONAL ACTIVITIES. COMPLIANCE PLANS. AUTHORITY TO CREATE, AND TO APPROVE, CORPORATE COMPLIANCE, SAFETY AND RISK MANAGEMENT PLANS FOR ENTITIES WITHIN THE SYSTEM. QUALITY PLAN. AUTHORITY TO CREATE, AND TO APPROVE, THE SYSTEM'S QUALITY PLAN. NON-BUDGETED PURCHASES. APPROVAL OF NON-BUDGETED CAPITAL PURCHASES AND LEASES IN EXCESS OF THE SINGLE OR ANNUAL AGGREGATE DOLLAR LIMITS PRESCRIBED IN WRITING BY ESSENTIA HEALTH FOR ENTITIES WITHIN THE SYSTEM. HUMAN RESOURCES. AUTHORITY TO CREATE HUMAN RESOURCE POLICIES AND PROCEDURES WITHIN THE SYSTEM. RESERVED POWERS. AUTHORITY TO CREATE ADDITIONAL ESSENTIA HEALTH RESERVED POWERS BY THE AFFIRMATIVE VOTE OF AT LEAST 80% OF THE ESSENTIA HEALTH BOARD OF DIRECTORS (EXCLUDING THE ESSENTIA HEALTH CEO); PROVIDED, HOWEVER, THAT ANY ADDITIONAL ESSENTIA HEALTH RESERVED POWERS SHALL NOT CONTRAVENE OR HINDER THE RESERVED POWERS OF BENEDICTINE SISTERS BENEVOLENT ASSOCIATION. Form 990, Part VI, Line 7B Continued ESSENTIA HEALTH EAST ALSO HAS CERTAIN RESERVED POWERS OVER ALL EAST FACILITIES WITHIN ESSENTIA HEALTH. ESSENTIA HEALTH EAST'S RESERVED POWERS ARE AS FOLLOWS: QUALITY, SAFETY AND SERVICE. AUTHORITY TO RECOMMEND QUALITY AND SAFETY INITIATIVES AND TO REVIEW AND EXECUTE APPROVED QUALITY AND SAFETY PLANS FOR THE EAST REGION. MISSION, VISION AND VALUES. AUTHORITY TO CREATE A MISSION AND A VISION THAT SUPPORT THE MISSION AND VISION OF ESSENTIA HEALTH; RESPONSIBILITY TO OVERSEE THE MISSION PERFORMANCE, INCLUDING CHARITY CARE, OF ALL FACILITIES WITHIN THE EAST REGION; RESPONSIBILITY TO ADOPT THE VALUES OF ESSENTIA HEALTH. OPERATING AND FINANCIAL PERFORMANCE. RESPONSIBILITY TO OVERSEE THE OPERATING AND FINANCIAL PERFORMANCE OF THE EAST REGION. DEVELOPMENT OF BUDGETS, STRATEGIC PLANS AND STRATEGY MAP. AUTHORITY TO DEVELOP AND RECOMMEND, BASED ON ESSENTIA HEALTH TARGETS, CAPITAL AND OPERATING BUDGETS FOR THE EAST REGION AND ITS FACILITIES; AUTHORITY TO RECOMMEND, WITHIN THE ESSENTIA HEALTH CONTEXT, REGIONAL AND LOCAL STRATEGIC PLANS FOR THE EAST REGION; AUTHORITY TO DEVELOP EAST REGION GOVERNANCE STRATEGY MAP AND BALANCED SCORECARD WITHIN ESSENTIA HEALTH'S SYSTEM STRATEGY TO MEET SYSTEM GOALS. EXECUTION OF APPROVED BUDGETS AND STRATEGIC PLANS. RESPONSIBILITY TO EXECUTE THE APPROVED CAPITAL AND OPERATING BUDGETS AND STRATEGIC AND BUSINESS PLANS FOR THE EAST REGION. NON-BUDGETED EXPENDITURES. AUTHORITY TO APPROVE NON BUDGETED CAPITAL PURCHASES AND LEASES FOR EAST REGION FACILITIES WITHIN DOLLAR LIMITS DEFINED BY ESSENTIA HEALTH. ACCREDITATION AND LICENSURE. RESPONSIBILITY TO OVERSEE ACCREDITATION AND LICENSURE COMPLIANCE FOR THE FACILITIES OF THE EAST REGION. AFFILIATIONS, ACQUISITIONS AND JOINT VENTURES. AUTHORITY TO RECOMMEND PROPOSED AFFILIATIONS, ACQUISITIONS, JOINT VENTURES AND OTHER ALLIANCES; RESPONSIBILITY TO OVERSEE NEGOTIATION AND IMPLEMENTATION OF APPROVED ACQUISITIONS AND OPERATION OF ALL APPROVED AFFILIATIONS, JOINT VENTURES AND OTHER ALLIANCES WITH THIRD PARTIES WITHIN THE EAST REGION. APPOINTMENT OF DIRECTORS. AUTHORITY TO APPOINT OR ELECT DIRECTORS OF THE DIRECT SUBSIDIARIES, AND TO REMOVE SUCH DIRECTORS, WITH OR WITHOUT CAUSE. PRESIDENT. AUTHORITY TO ADVISE THE CEO OF ESSENTIA HEALTH REGARDING THE APPOINTMENT, REMOVAL AND PERIODIC EVALUATION OF THE PRESIDENT OF SMDC. SATISFACTION. RESPONSIBILITY TO EXECUTE, EVALUATE AND OVERSEE PATIENT, FAMILY AND CUSTOMER SATISFACTION WITH RESPECT TO SERVICES PROVIDED WITHIN THE EAST REGION AND TO ENSURE ESTABLISHED GOALS ARE MET. JOB SATISFACTION. RESPONSIBILITY TO OVERSEE JOB SATISFACTION AND STAFF MORALE WITHIN THE EAST REGION FACILITIES. HUMAN RESOURCES. RESPONSIBILITY TO OVERSEE IMPLEMENTATION OF ESSENTIA HEALTH HUMAN RESOURCE POLICIES AND PROCEDURES THROUGHOUT THE EAST REGION. COMPLIANCE. RESPONSIBILITY TO EXECUTE THE APPROVED ESSENTIA HEALTH CORPORATE COMPLIANCE AND RISK MANAGEMENT PLANS FOR THE EAST REGION. CREDENTIALING. RESPONSIBILITY TO PERFORM MEDICAL STAFF CREDENTIALING FOR THE EAST REGION FACILITIES. NOMINATIONS. AUTHORITY TO NOMINATE PERSONS FOR APPOINTMENT TO THE SMDC BOARD OF DIRECTORS BY BENEDICTINE SISTERS BENEVOLENT ASSOCIATION AND ESSENTIA HEALTH. AMENDMENTS. AUTHORITY TO SUGGEST PROPOSED AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THIS CORPORATION, THE DIRECT SUBSIDIARIES, AND ANY SUBSIDIARIES THEREOF. COMPENSATION PLANS. RESPONSIBILITY TO REVIEW AND APPROVE COMPENSATION OF EAST REGION EXECUTIVES AND PHYSICIANS FOR REASONABLENESS AND CONSISTENCY WITH THE LAW AND ESSENTIA HEALTH'S COMPENSATION PHILOSOPHY. PRESIDENT/CHIEF MEDICAL OFFICER. BY ACTION OF THE PRESIDENT OF THIS CORPORATION, AUTHORITY TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, THE PRESIDENT/CHIEF MEDICAL OFFICER OF ANY OF THE DIRECT SUBSIDIARIES. PUBLIC POLICY. RESPONSIBILITY TO SUPPORT ESSENTIA HEALTH PUBLIC POLICY AND ADVOCACY PLANS. MARKETING. RESPONSIBILITY TO COORDINATE REGIONAL MARKETING AND PROMOTIONAL ACTIVITIES CONSISTENT WITH ESSENTIA HEALTH MARKETING PLANS. PHILANTHROPY. RESPONSIBILITY TO COORDINATE PHILANTHROPY WITHIN THE EAST REGION CONSISTENT WITH ESSENTIA HEALTH FOUNDATION POLICIES. PROFESSIONAL SERVICES. RESPONSIBILITY TO OVERSEE EAST REGION MANAGEMENT'S COOPERATION WITH EXTERNAL AUDITORS AND GENERAL LEGAL COUNSEL SELECTED BY ESSENTIA HEALTH AND COORDINATION OF LEGAL SERVICES THROUGH THE ESSENTIA HEALTH OFFICE OF GENERAL COUNSEL. CATHOLIC FACILITIES. RESPONSIBILITY TO OVERSEE IMPLEMENTATION OF BSBA-APPROVED METHODS, POLICIES AND PROCEDURES PERTAINING TO ADHERENCE BY THE EAST REGION CATHOLIC FACILITIES WITH THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES AND USE OF RELIGIOUS SYMBOLS, DISTINGUISHING ELEMENTS AND PRAYERS. PROJECTS INVOLVING REAL ESTATE. AUTHORITY TO RECOMMEND FACILITY DEVELOPMENT PROJECTS, SUBJECT TO THE APPROVAL OF ESSENTIA HEALTH; RESPONSIBILITY TO OVERSEE EXECUTION OF APPROVED DEVELOPMENT PROJECTS ACCORDING TO ESSENTIA HEALTH POLICIES. Form 990, Part VI, Line 11A Form 990 review process: THE 2013 FORM 990, INCLUDING ALL SCHEDULES, WAS REVIEWED BY ESSENTIA HEALTH DULUTH'S MANAGEMENT AND GOVERNING BODY ON MARCH 4, 2015 PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. EACH CURRENT DIRECTOR OF THE GOVERNING BODY RECEIVED A COPY OF THE 2013 FORM 990. ESSENTIA HEALTH DULUTH'S CHIEF FINANCIAL OFFICER LED THE REVIEW OF THE FORM AND SCHEDULES AND ANY QUESTIONS WERE DISCUSSED. Form 990, Part VI, Line 12c Monitoring and enforcing Conflict of Interest policy: Essentia Health's comprehensive conflict of interest program prevents, detects and resolves actual conflicts of interests or the actual or potential appearance of such. Fiduciaries, defined as an Essentia Health board member/trustee, officer, board committee member, senior management employee, or any others considered to be in a position of influence, are covered under Essentia's conflict of interest program. Upon initial appointment, each fiduciary must complete an initial conflict of interest statement and disclosure questionnaire. At the conclusion of each fiscal year, each fiduciary must complete an annual conflict of interest statement and disclosure questionnaire. As needed, a fiduciary will update his/her most recently completed questionnaire each time the fiduciary becomes aware of a financial interest, a potential conflict, or change to any information that the fiduciary previously reported. Essentia Health's Chief Compliance Officer will collect the questionnaires and evaluate the disclosures. If a fiduciary has a potential conflict of interest, the Chief Compliance Officer or designee may request additional information from the fiduciary, the management team, and others. During the evaluation process, the Chief Compliance Officer may also consult with Essentia Health's Board and Audit Committee Chairs, senior management, legal department, or appropriate representatives from Essentia Health. The Chief Compliance Officer reports to the Essentia Health Audit Committee and the Essentia Health Board of Directors any actual or potential conflicts of interest disclosed by the fiduciary, along with recommended actions. The Essentia Health Board of Directors (or designee) will then determine whether to approve the situation or to implement special controls to manage the potential conflict of interest. The Chief Compliance Officer will then officially notify the fiduciary in writing of the board's decision. The decision of whether or not the disclosure constitutes a conflict will be at the Essentia Health Board of Director's (or designee) sole discretion, and its concern must be the welfare of Essentia Health and its affiliate(s) and the advancement of its purposes. When the Essentia Health Board of Directors (or designee) considers a Fiduciary's disclosure as a Conflict of Interest, special controls will be identified to manage, eliminate or reduce the likelihood and/or appearance of a conflict arising. Controls may include, but are not limited to: A. If the conflict involves an on-going matter or relationship, the Fiduciary must not participate in Board, Board committee or management discussions related to the conflict and must recuse themselves and if appropriate, withdraw, from any Board meeting or portion thereof where the matter is being discussed and during the vote on the potential Conflict of Interest. The Fiduciary may answer questions at the Board's or the Board Committee's request. B. If the conflict involves a specific transaction or decision, the Fiduciary will fully disclose their interest and all related material facts. The Board or committee of the Board will determine whether the contemplated transaction may be authorized as just, fair, and reasonable to Essentia Health or its affiliate(s). If the Board determines a conflict does not exist, the Fiduciary may proceed with the transaction; however, he or she will not be eligible to vote on related issues should they arise. If the Board determines a conflict does exist, the Fiduciary will be notified of the decision regarding whether the contemplated transaction will be authorized as just, fair, and reasonable. Form 990, Part VI, Line 12 POLICY APPLIES TO DISREGARDED ENTITY, ESSENTIA HEALTH VIRGINIA, LLC. Form 990, Part VI, Line 13 POLICY APPLIES TO DISREGARDED ENTITY, ESSENTIA HEALTH VIRGINIA, LLC. Form 990, Part VI, Line 14 POLICY APPLIES TO DISREGARDED ENTITY, ESSENTIA HEALTH VIRGINIA, LLC. Form 990, Part VI, Line 15 POLICY APPLIES TO DISREGARDED ENTITY, ESSENTIA HEALTH VIRGINIA, LLC. FORM 990, PART VI, LINE 15 A&B PROCESS FOR DETERMINING COMPENSATION: The Executive Compensation Committee of Essentia Health's board of directors is authorized to fulfill the board's responsibilities regarding executive compensation consistent with Essentia's mission, values and tax-exempt status, and the Executive Compensation Committee's Charter. The Executive Compensation Committee meets at least twice annually to carry out its responsibilities, which include, but are not limited to, establishing, reviewing and modifying, as appropriate, reasonable compensation and benefits for designated Essentia executives who are officers or key employees of Essentia or any of its affiliates which may be paid by related organizations. The Executive Compensation Committee engages qualified independent compensation advisors to provide objective and impartial comparative data and to express opinions on total compensation reasonableness. The Executive Compensation Committee may request its independent advisors to: monitor comparability data and marketplace trends; make appropriate recommendations regarding salary ranges; and periodically review the market competitiveness of Essentia executive compensation packages. Prior to establishing or adjusting executive compensation, the Executive Compensation Committee will obtain and rely upon appropriate data as to comparability of the proposed compensation or adjustments. The Executive Compensation Committee will adequately document the basis for its determination concurrently with making those determinations. The Executive Compensation Committee minutes will include: the terms of the approved compensation and the date approved; the Executive Compensation Committee members present during the review, discussion and approval of the proposed compensation and those who voted on the proposed compensation; identification of the comparability data obtained and relied upon by the Executive Compensation Committee and how the data was obtained; any actions by a member of the Executive Compensation Committee having a conflict of interest; and documentation of the basis for the determination. The year this process was last undertaken for Essentia Health Duluth's Interim Chief Financial Officer, Chief Nursing Officer, Executive Vice President Hospital Operations, Duluth Clinic President, and Executive Vice President of Clinical Operations was 2014. The year this process was last undertaken for Essentia Health Duluths Administrator, Chief Financial Officer, Vice President Surgical Services, Vice President Medical Specialties, Vice President Hospital Operations, and Vice President Medical Affairs was 2013. Form 990, Part VI, Line 19 Availability of governing documents, conflict of interest policy, and financial statements to the public: Governing documents, conflict of interest policy, and financial statements are made available to the public upon request. The organization is part of Essentia Health's consolidated financial statements which are included in Essentia Health's annual report posted on Essentia Health's web site. Form 990, Part IX, Line 24E Affiliate Expense and Revenue Allocation: Essentia Health Duluth allocates out certain revenue and expenses to Essentia Health St. Mary's Medical Center, The Duluth Clinic, Ltd, Essentia Health Polinsky Medical Rehabilitation Center, and Essentia Health St. Mary's Hospital-Superior, related organizations. Net affiliate revenue and expense allocation of ($26,733,190) includes the following: Grants 19,417 Program Service Revenue (265,901) Investment Income (58,455) Misc Revenue (479,558) Contributions (846,087) Compensation (12,600,996) Payroll Taxes (757,105) Pension Plan Contributions (665,537) Accounting Fees (56,954) Legal Fees (218,049) Interest 3,757,463 Other Purchased Services (2,082,259) Advertising (419,040) Conferences/Conventions/Meetings (295,459) Depreciation & Amortization (172,749) Information Technology (6,791,741) Insurance 61,352 Medical Supplies 66,305 Occupancy 613,653 Office Expenses (2,888,094) Travel (310,362) Unrelated Business Income Tax (18,380) Other Expenses (208,002) Other Employee Benefits (2,116,652) Form 990, Part XI, Line 9 Other Changes in Net Assets: The total amount of other changes in net assets includes: Change in discount on City of Virginia Payable: ($153,108) Change in minimum pension liability: ($59,117) Net Asset transfer with related organizations; reallocated Balance Sheet items transferred to align with organizational structure: $826,329 Net Asset transfer with related organizations; reallocated Income Statement items transferred to align with organizational structure: ($2,603,442) Opening Balance Equity - Virginia Volunteers Auxiliary: $102,057 Total: ($1,887,281) Form 990, Part XII, Line 3 Consolidated A-133: ESSENTIA HEALTH DULUTH, as part of Essentia Health's consolidated financial statements, was required and underwent a consolidated audit set forth in the Single Audit Act and OMB Circular A-133. The consolidated audit is reviewed by the Essentia Health Audit Committee. Form 990, Part VII, Section B INDEPENDENT CONTRACTORS: VENDOR PAYMENTS FOR ESSENTIA HEALTH DULUTH ARE PROCESSED THROUGH ESSENTIA HEALTH, SUPPORTING ORGANIZATION OF ESSENTIA HEALTH DULUTH, WHILE ESSENTIA HEALTH VIRGINIA, LLC, DISREGARDED ENTITY OF ESSENTIA HEALTH DULUTH, PROCESSED ITS OWN VENDOR PAYMENTS. THE INFORMATION IN PART VII, SECTION B REPRESENTS THE PAYMENTS MADE ON BEHALF OF ESSENTIA HEALTH VIRGINIA, LLC. Essentia Health Virginia LLC 502 E 2nd St Duluth MN 55805 460909870 Clinic/Hosp DE 1712475 30384310 SMDCMC BRAINERD LAKES INTEGRATED HEALTH SYSTEM 2024 S 6TH ST BRAINERD MN 56401 371532145 SUPPORT ORG MN 501(c)(3) 11 Type II Essentia true BRAINERD MEDICAL CENTER INC 2024 S 6TH ST BRAINERD MN 56401 371532148 CLINIC MN 501(c)(3) 3 BLIHS true BRIDGES MEDICAL CENTER 503 E 3rd St Ste 400 Duluth MN 55805 200479568 CLINIC/HOSP MN 501(c)(3) 3 Innovis true CLEARWATER VALLEY HOSPITAL & CLINICS INC 301 CEDAR OROFINO ID 83544 820497771 CLINIC/HOSP ID 501(c)(3) 3 CAG true Critical Access Group 503 E 3RD ST SUITE 400 DULUTH MN 55805 261219624 SUPPORT ORG MN 501(c)(3) 11 Type II ESSENTIA true FIRST CARE MEDICAL SERVICES 900 HILLIGOSS BLVD SE FOSSTON MN 56542 410706143 CLINIC/HOSP MN 501(c)(3) 3 Innovis true MINNESOTA VALLEY HEALTH CENTER Inc 621 S 4TH ST LE SUEUR MN 56058 410837659 HOSPITAL/NURS MN 501(c)(3) 3 CAG true ST JOSEPH'S MEDICAL CENTER 523 N 3RD ST BRAINERD MN 56401 410695602 Clinic/Hosp MN 501(c)(3) 3 BLIHS true ST MARY'S EMS 1027 WASHINGTON AVE DETROIT LAKES MN 56501 411805811 EMERG Svcs MN 501(c)(3) 9 SMRHC true ST MARY'S HOSPITAL INC P O BOX 137 COTTONWOOD ID 83522 820226453 CLINIC/HOSP ID 501(c)(3) 3 CAG true ST MARY'S INNOVIS HEALTH 1027 WASHINGTON AVE DETROIT LAKES MN 56501 262861321 pharmacy MN 501(c)(3) 3 Innovis true ST MARY'S REGIONAL HEALTH CENTER 1027 WASHINGTON AVE DETROIT LAKES MN 56501 411620386 CLINIC/HOSP MN 501(c)(3) 3 Innovis true ESSENTIA HEALTH 502 E 2ND ST DULUTH MN 55805 200360007 SUPPORT ORG MN 501(c)(3) 11TypeIIIFI NA false ESSENTIA INSTITUTE OF RURAL HEALTH 502 E 2ND ST DULUTH MN 55805 271291124 RESEARCH MN 501(c)(3) 4 ESSENTIA true INNOVIS HEALTH LLC 3000 32nd Avenue S FARGO ND 58103 261175213 CLINIC/HOSP DE 501(c)(3) 3 ESSENTIA true Essentia HEALTH FOUNDATION 502 E 2ND ST DULUTH MN 55805 271984704 FOUNDATION MN 501(c)(3) 7 Essentia true MIDWEST MEDICAL EQUIP AND SUPPLIES INC 4418 HAINES ROAD DULUTH MN 55811 471674021 MEDical EQUIP MN 501(c)(3) 9 SMMC true PINE MEDICAL CENTER 109 COURT AVE S SANDSTONE MN 55072 411884597 Hospital/Nurs MN 501(c)(3) 3 SMDCHS true POLINSKY MEDICAL REHABILITATION CENTER 530 E 2ND ST DULUTH MN 55805 410691275 Rehab Service MN 501(c)(3) 3 SMMC true ST MARY'S DULUTH CLINIC HEALTH SYSTEM 407 E 3RD ST DULUTH MN 55805 411836633 Support Org MN 501(c)(3) 11 Type II ESSENTIA true ST MARY'S HOSPITAL OF SUPERIOR 3500 TOWER AVE SUPERIOR WI 54880 411811073 CLINIC/HOSP MN 501(c)(3) 3 SMMC true ST MARY'S MEDICAL CENTER 407 E 3RD ST DULUTH MN 55805 410695604 HOSPITAL MN 501(c)(3) 3 SMDCHS true THE DULUTH CLINIC LTD 400 E 3RD ST DULUTH MN 55805 410883623 CLINIC MN 501(c)(3) 3 SMDCHS true Northern Pines Medical Center 5211 Hwy 110 Aurora MN 55705 410841441 Hospital/Nurs MN 501(c)(3) 3 SMDCHS true Graceville Health Center 115 West Second St Graceville MN 56240 410726173 Clinic/Hosp MN 501(c)(3) 3 Innovis true DEER RIVER HEALTHCARE CENTER INC 115 10TH AVE NE DEER RIVER MN 56636 410844574 Hosp/CLin/NH MN 501(c)(3) 3 SMDCHS true PMC-Gateway Imaging LLC 109 Court Ave S Sandstone MN 55072 261634764 Imaging Services MN NA n/A 0 0 0 ESSENTIA HEALTH INSURANCE SERVICES SPC 94 Solaris Ave PO Box 69 GRAND CAYMAN CJ 000000000 Self Indemnity CJ NA FOREIGN CORP 0 0 true East Range Clinics Ltd 910 6th Ave N Virginia MN 55792 410909915 Clinics MN NA C Corp 0 0 true false true true false false false false false true true true true true false true true true true true Bridges Medical Center Q 398529 Actual costs Brainerd Medical Center Inc Q 95513 Actual costs The Duluth Clinic Ltd I 804007 Actual costs The Duluth Clinic Ltd P 18994747 Actual costs The Duluth Clinic Ltd Q 28850465 Actual costs The Duluth Clinic Ltd R 55234 Actual costs Deer River Healthcare Center INC P 173781 Actual costs DEER RIVER HEALTHCARE CENTER INC Q 3151587 Actual costs Essentia Health I 846136 Actual costs Essentia Health M 36553024 Actual costs Essentia Health P 17531594 Actual costs Essentia Health Q 14133099 Actual costs Essentia Health R 1672465 Actual costs Essentia Health Foundation B 50200 Actual costs Essentia Health Foundation C 306245 Actual costs Essentia Health Foundation P 111560 Actual costs Essentia Health Foundation Q 308022 Actual costs Essentia Institute of Rural Health P 66331 Actual costs Essentia Institute of Rural Health Q 1057189 Actual costs First Care Medical Services P 74201 Actual costs Innovis Health LLC P 50951 Actual costs Innovis Health LLC Q 4275352 Actual costs Midwest Medical Equip and Supplies Inc Q 665293 Actual costs Northern Pines Medical Center P 78778 Actual costs Northern Pines Medical Center Q 1581311 Actual costs Northern Pines Medical Center R 424900 Actual costs Pine Medical Center P 81403 Actual costs Pine Medical Center Q 1635512 Actual costs Polinsky Medical Rehabilitation Center P 118249 Actual costs Polinsky Medical Rehabilitation Center Q 2821992 Actual costs St Joseph's Medical Center O 886007 Actual costs St Joseph's Medical Center P 51096 Actual costs St Joseph's Medical Center Q 924875 Actual costs St Mary's Hospital of Superior P 364613 Actual costs St Mary's Hospital of Superior Q 6601987 Actual costs St Mary's Medical Center O 62677 Actual costs St Mary's Medical Center P 18860358 Actual costs St Mary's Medical Center Q 52181164 Actual costs SCHEDULE R, PART II, COLUMN (A), Name The following Essentia Health entities have a doing business as name. Legal Name; Doing Business As Name Brainerd Lakes Integrated Health System; Essentia Health Central Brainerd Medical Center, Inc.; Essentia Health Brainerd Specialty Clinic Bridges Medical Center; Essentia Health Ada Deer River Healthcare Center, Inc.; Essentia Health Deer River First Care Medical Services; Essentia Health Fosston Graceville Health Center; Essentia Health Holy Trinity Hospital Innovis Health, LLC; Essentia Health West Midwest Medical Equipment and Supplies, Inc.; Essentia Health Medical Equipment and Supplies Northern Pines Medical Center; Essentia Health Northern Pines Pine Medical Center; Essentia Health Sandstone Polinsky Medical Rehabilitation Center; Essentia Health Polinsky Medical Rehabilitation Center SMDC Medical Center; Essentia Health Duluth St. Joseph's Medical Center; Essentia Health St. Joseph's Medical Center St. Mary's Duluth Clinic Health System; Essentia Health East St. Mary's EMS; Essentia Health St. Mary's Emergency Medical Services-Detroit Lakes St. Mary's Hospital of Superior; Essentia Health St. Mary's Hospital-Superior St. Mary's Medical Center; Essentia Health St. Mary's Medical Center St. Mary's Regional Health Center; Essentia Health St. Mary's-Detroit Lakes