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MINNESOTA VALLEY HEALTH CENTER INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
MINNESOTA VALLEY HEALTH CENTER INC (EIN 41-0837659)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-04-30
IRS object ID
201411209349300726
Schema version
2012v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-04-30T11:04:50-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN410837659EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Minnesota Valley Health Center IncBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% PAT SCHLEGELInCareOfName
Name ControlMINNNameControl
Phone5076653375Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1621 South 4th StreetAddressLine1
Address Line2SuiteAddressLine2
CityLe SueurCity
StateMNState
ZIP Code56058ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePATRICIA SCHLEGELName
TitleCFOTitle
Date Signed2014-04-22DateSigned
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonPamela WilliamsNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1621 SOUTH 4TH STREETAddressLine1
CityLe SueurCity
StateMNState
ZIP Code56058ZIPCode
FieldValueIRS element (for citing)
Gross Receipts11675058GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.mvhc.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1959YearFormation
State Legal DomicileMNStateLegalDomicile
Activity Or Mission DescriptionOur mission is to provide community-based healthcare in an environment that fosters dignity, respect and excellence.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees243TotalNbrEmployees
Total Nbr Volunteers10TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year92542ContributionsGrantsPriorYear
Contributions Grants Current Year72669ContributionsGrantsCurrentYear
Program Service Revenue Prior Year12365395ProgramServiceRevenuePriorYear
Program Service Revenue CY11462918ProgramServiceRevenueCY
Investment Income Prior Year16841InvestmentIncomePriorYear
Investment Income Current Year19058InvestmentIncomeCurrentYear
Other Revenue Prior Year132183OtherRevenuePriorYear
Other Revenue Current Year118908OtherRevenueCurrentYear
Total Revenue Prior Year12606961TotalRevenuePriorYear
Total Revenue Current Year11673553TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year7080GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY29700GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6199595SalariesEtcPriorYear
Salaries Etc Current Year6080392SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year5723280OtherExpensePriorYear
Other Expenses Current Year5533896OtherExpensesCurrentYear
Total Expenses Prior Year11929955TotalExpensesPriorYear
Total Expenses Current Year11643988TotalExpensesCurrentYear
Revenues Less Expenses Prior Year677006RevenuesLessExpensesPriorYear
Revenues Less Expenses CY29565RevenuesLessExpensesCY
Total Assets BOY13844447TotalAssetsBOY
Total Assets EOY13500946TotalAssetsEOY
Total Liabilities BOY8579584TotalLiabilitiesBOY
Total Liabilities EOY8086926TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY5264863NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY5414020NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionOUR MISSION IS TO PROVIDE COMMUNITY-BASED HEALTHCARE IN AN ENVIRONMENT THAT FOSTERS DIGNITY, RESPECT AND EXCELLENCE.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense10239122Expense
Grants29700Grants
Revenue11514026Revenue
DescriptionSee Schedule ODescription
Total Program Service Expense10239122TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingtrueCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109613NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees243NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteesfalseMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledMNStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonPAT SCHLEGELNamePerson
Telephone Number5076653375TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1621 SOUTH 4TH STREETAddressLine1
CityLe SueurCity
StateMNState
ZIP Code56058ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
RANDY BAUM
BOARD PRESIDENT10.00.0XX000
ROBERT BROEDER
BOARD SECRETARY/TREASURER5.00.0XX000
JOHN SKUBITZ
BOARD DIRECTOR1.00.0X000
STEVE SMITH
BOARD VICE PRESIDENT1.00.0XX000
JOSEPH SPINLER
BOARD DIRECTOR1.00.0X000
MICHAEL HEDRIX
BOARD DIRECTOR1.059.0X033003863788
PATRICIA TOWNSDIN
Board Dir/President THRU 12/1260.00.0XX012784526545
PATRICIA SCHLEGEL
Chief Financial Officer50.00.0X76041010790
PAMELA WILLIAMS
Interim President60.00.0X75342015209
FieldValueIRS element (for citing)
Total Reportable Comp From Org151383TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs457883TotalReportableCompFrmRltdOrgs
Total Other Compensation116332TotalOtherCompensation
Number Individuals GT100 K0NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
WAPITI MEDICAL GROUP
PO BOX 92NEWELLSD57760ER PHYSICIAN SRVS784535
AEGIS THERAPIES INC
PO BOX 8103FORT SMITHAR72902PHYSICAL THERAPY679173
OMNICARE PHARMACY
PO BOX 715268COLUMBUSOH43271PHARMACY SERVICES269330
CENTRAL MINNESOTA DIAGNOSTIC INC
PO BOX 158MILACAMN56353CT SCAN SERVICES112000
UNIVERSAL HOSPITAL SERVICES
SDS-12-0940 PO BOX 86MINNEAPOLISMN55486MEDICAL EQUIP MAINT130013
FieldValueIRS element (for citing)
Number Of Contractors GT100 K5NumberOfContractorsGT100K
Government Grants8355GovernmentGrants
All Other Contributions64314AllOtherContributions
Total Contributions72669TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUEDescription
Business Code621110BusinessCode
Total Revenue Column11462918TotalRevenueColumn
Related Or Exempt Function Income11462918RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue11462918TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column14178TotalRevenueColumn
Exclusion$14,178ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real29251Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real29251Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column29251TotalRevenueColumn
Exclusion$29,251ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities4985Securities
Other1400Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other1505Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities4985Securities
Other-105Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column4880TotalRevenueColumn
Exclusion$4,880ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
CMDI EQUITY PAYMENT9000995110851108
DIETARY/VENDING REVENUE72251433441$33,441
TELEPHONE INCOME9000995029$5,029

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column79TotalRevenueColumn
Exclusion$79ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue89657TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column11673553TotalRevenueColumn
Related Or Exempt Function Income11514026RelatedOrExemptFunctionIncome
Exclusion$86,858ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total29700Total
Program Services29700ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total314461Total
Management And General314461ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total4567471Total
Program Services3981135ProgramServices
Management And General586336ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total107591Total
Program Services86334ProgramServices
Management And General21257ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total717401Total
Program Services616469ProgramServices
Management And General100932ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total373468Total
Program Services304557ProgramServices
Management And General68911ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total0Total

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total53676Total
Management And General53676ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total73Total
Management And General73ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total772Total
Management And General772ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1654027Total
Program Services1627027ProgramServices
Management And General27000ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total42054Total
Management And General42054ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total101331Total
Program Services46830ProgramServices
Management And General54501ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total176105Total
Program Services167300ProgramServices
Management And General8805ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total227894Total
Program Services220842ProgramServices
Management And General7052ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total20537Total
Program Services11084ProgramServices
Management And General9453ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total15015Total
Program Services4930ProgramServices
Management And General10085ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total400163Total
Program Services400163ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total705450Total
Program Services705450ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total112402Total
Program Services112402ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL/DIETARY SUPPLIES911990911990
BAD DEBT EXPENSE335000335000
AFFILIATE SUPPORT FEE26183616233899498
DHS SURCHARGES-NH & HOSPITAL232815232815

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total282756Total
Program Services282756ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11643988Total
Program Services10239122ProgramServices
Management And General1404866ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY407827BOY
EOY359804EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2825307BOY
EOY2582463EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY155174BOY
EOY164307EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1596997BOY
EOY1949830EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY191716BOY
EOY150197EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY101295BOY
EOY98651EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY48917BOY
EOY34965EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis12550226LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec5519144LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY7513573BOY
EOY7031082EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY111918BOY
EOY121918EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY891723BOY
EOY1007729EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY13844447BOY
EOY13500946EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1378420BOY
EOY1232090EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY31191BOY
EOY32512EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY7169973BOY
EOY6822324EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY8579584BOY
EOY8086926EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY4343670BOY
EOY4390496EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY287979BOY
EOY338839EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY633214BOY
EOY684685EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY5264863BOY
EOY5414020EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY13844447BOY
EOY13500946EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses29565ReconcilationRevenueExpenses
Reconciliation Unrealized Invest3586ReconciliationUnrealizedInvest
Reconcilation Other Changes116006ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement BothXFinancialStatementBoth
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredtrueFederalGrantAuditRequired
Federal Grant Audit PerformedtrueFederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$73OtherActivitiesAmount
Total Lobbying Expenditures IIB73TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierSchedule C, Part II-BIdentifier
ExplanationLobbying activity explanation: Minnesota Valley Health Center, Inc. pays dues to a certain organization related to the industry which has lobbying expenses. The amount listed is the percentage of the dues paid that were used for lobbying.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts
Agent Trustee EtcfalseAgentTrusteeEtc
Included On FStrueIncludedOnFS
Explanation In Part XIIIXExplanationInPartXIII
Current Year Minus3 YearsCurrentYearMinus3Years
Current Year Minus4 YearsCurrentYearMinus4Years
LandLand

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1239680OtherCostOrOtherBasis
Depreciation860577Depreciation
Book Value379103BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis5878195OtherCostOrOtherBasis
Depreciation108676Depreciation
Book Value5769519BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5368622OtherCostOrOtherBasis
Depreciation4495007Depreciation
Book Value873615BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis63729OtherCostOrOtherBasis
Depreciation54884Depreciation
Book Value8845BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7031082TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionBENEFICIAL INTEREST IN MN FDNDescription
Book Value1007729BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets1007729TotalBookValueOtherAssets
Tot Revenue Etc Audited Fincl Stmt11690814TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments3586NetUnrealizedGainsInvestments
Other Revenues29700OtherRevenues
Revenue Not Rptd F99033286RevenueNotRptdF990
Revenue Subtotal11657528RevenueSubtotal
Other Revenues Not Included16025OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt16025RevenueNotRptdOnFinStmt
Total Revenue Per Form99011673553TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt11643988TotExpensesEtcAuditedFinclStmt
Expenses Subtotal11643988ExpensesSubtotal
Total Expenses Per Form99011643988TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)

IdentifierIdentifierExplanationExplanation
Schedule D, Part IV, Line 2BMinnesota Valley Health Center, Inc. acts as custodian for the funds of the residents. Resident trust funds totaled $17,579 at June 30, 2013. During that same time Minnesota Valley Health Center, Inc. holds $14,933 in a separate account for tenant security deposits for Sunrise Plaza.
Schedule D, Part XI, Line 2dOther Changes in Revenue: Release of Restricted Contribution: $29,700
Schedule D, Part XI, Line 4bOther Changes in Revenue: Restricted Contributions: $16,025

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served71PersonsServed
Total Community Benefit Expense29675TotalCommunityBenefitExpense
Net Community Benefit Expense29675NetCommunityBenefitExpense
Percent Of Total Expense0.00260PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served724PersonsServed
Total Community Benefit Expense1748124TotalCommunityBenefitExpense
Direct Offsetting Revenue1941890DirectOffsettingRevenue
Net Community Benefit Expense-193766NetCommunityBenefitExpense
Percent Of Total Expense0.01710PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served795PersonsServed
Total Community Benefit Expense1777799TotalCommunityBenefitExpense
Direct Offsetting Revenue1941890DirectOffsettingRevenue
Net Community Benefit Expense-164091NetCommunityBenefitExpense
Percent Of Total Expense0.01450PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served65PersonsServed
Total Community Benefit Expense7860TotalCommunityBenefitExpense
Net Community Benefit Expense7860NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served76PersonsServed
Total Community Benefit Expense61106TotalCommunityBenefitExpense
Direct Offsetting Revenue38978DirectOffsettingRevenue
Net Community Benefit Expense22128NetCommunityBenefitExpense
Percent Of Total Expense0.00200PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served141PersonsServed
Total Community Benefit Expense68966TotalCommunityBenefitExpense
Direct Offsetting Revenue38978DirectOffsettingRevenue
Net Community Benefit Expense29988NetCommunityBenefitExpense
Percent Of Total Expense0.00270PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served936PersonsServed
Total Community Benefit Expense1846765TotalCommunityBenefitExpense
Direct Offsetting Revenue1980868DirectOffsettingRevenue
Net Community Benefit Expense-134103NetCommunityBenefitExpense
Percent Of Total Expense0.01180PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$335,000BadDebtExpenseAmount
Amount Attributable To1000AmountAttributableTo
Amount Reimbursed By Medicare2547664AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare2522440CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall25224MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Minnesota Valley Health Center IncBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1621 South 4th StreetAddressLine1
CityLe SueurCity
StateMNState
ZIP Code56058ZIPCode
FieldValueIRS element (for citing)
Website Addresswww.mvhc.orgWebsiteAddress
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Minnesota Valley Health Center IncBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
OtherXOther
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into AccounttrueTakeIntoAccount
Other FacilitiestrueOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Participate Community PlanXParticipateCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs AddressedfalseAllNeedsAddressed
Organization Incur Excise TaxfalseOrganizationIncurExciseTax
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent150.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent300.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Lowest Negotiated RatesXLowestNegotiatedRates
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Minnesota Valley Health Center Inc
621 South 4th StreetLe SueurMN56058Skilled Nursing Facility
Sunrize Plaza
600 South 5th StreetLe SueurMN56058Senior Apartments

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

IdentifierIdentifierExplanationExplanation
Part VI, line 1Provide 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 V, lines 1j, 3, 4, 5a, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, 22: Part I, line 3c In addition to the federal poverty guidelines for income, an asset test is also applied. For these purposes, household assets include: Cash held in savings accounts, checking accounts, safe deposit boxes, or homes; Value of trusts (including living trusts) the patient or guarantor has interest or ownership of equity in real estate; Cash value of stocks, bonds, treasury bills, certificates of deposit and money market accounts; Cash value of life insurance policies; Personal property held as an investment, such as jewelry, coin collections Vehicles other than an automobile of reasonable value used as the primary source of transportation; and Lump sum or one-time receipts of funds, such as inheritances, lottery winnings, insurance settlements. Minnesota Valley takes one quarter of the difference of household assets less a $75,000 allowance. These are known as qualified assets. To the extent that qualified assets exceed the patient's portion of the medical bills, the federal poverty guideline allowance will be reduced. Part I, line 6a Minnesota Valley Health Center, Inc.'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 www.essentiahealth.org. Essentia Health, headquartered in Duluth, Minn., is an integrated health system serving patients in Minnesota, Wisconsin, North Dakota and Idaho and is Minnestoa Valley Health Center, Inc.'s parent corporation. Part 1, line 7g There are no subsidized costs attributable to a physician clinic. 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 $335,000. 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 Not applicable. 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 Minnesota Valley Health Center, Inc. applied a high-level, conservative analytic review by taking the ratio of charitable allowances to gross patient revenue and multiplying against bad debt expense to arrive at an approximation of charity care that resides in bad debt. Part III, Line 3 Minnesota Valley Health Center, Inc. is 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 patient's 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 4 The page number of the audit that contains the footnote describing the organization's bad debt expense is page 7. Part III, line 8 The methodology used in determining the reported Medicare Allowable Costs 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. Part III, line 8 Minnesota Valley Health Center, Inc. is 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 8 not applicable. Part III, line 9b At any stage of the patient experience, including collections, a determination may be made that the patient qualifies for Financial Assistance. All collection efforts must be suspended while a patient's Financial Assistance application is being considered and until the patient is notified regarding the determination of eligibility. Once eligibility (or lack of eligibility) is determined, amounts still owed by patients will be collected in the same manner as all other patient bills. 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 VI, Line 1 ContPart V, line 3 Two 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 are the first step in addressing 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): City of Le Sueur, Community/Patient Focus Groups, First Choice Pharmacy, Hillside Court Public Housing, Le Sueur Assisted Living and Memory Care, Le Sueur Chamber of Commerce, Le Sueur County Public Health, Le Sueur News Herald, Mayo Clinic Health System - Le Sueur, Sibley County Public Health and Human Services, Sunrise Plaza Independent Living Apartments, and Youth Opportunities. 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 Le Sueur County Public Health and Sibley County Public Health and Human Services (names and titles available upon request) attended the Town Hall Meeting and provided input on intervention options for addressing the highest priority health need. The majority of MVHC's service area is rural. Given the known health disparities of rural populations, all attendees of the Community/Patient Focus Groups 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 and Intervention Planning Meetings serve more formal leadership or representative roles. An elected official of the City of Le Sueur (name and title available upon request) attended the Town Hall Meeting. An employee of Hillside Court Public Housing also attended the Town Hall Meeting (name and title available upon request). In Le Sueur and Sibley Counties, more than 90% of the residents are Caucasian. However, as attendees at the Community/Patient Focus Groups 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. As city elected officials represent the entire electorate, including minorities, minority populations were represented by the elected official of the City of Le Sueur as well. Part V, line 4 Minnesota Valley Health Center, Inc. is affiliated with Essentia Health. In the interest of efficiency, cost effectiveness, and alignment with Essentia Health population health strategies, the hospital facility's 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. Joseph's Medical Center in Brainerd, MN; Essentia Health St. Mary's Hospital-Superior in Superior, WI; St. Mary's Hospital, Inc. in Cottonwood, ID; Essentia Health St. Mary's Medical Center in Duluth, MN; and Essentia Health St. Mary's-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. The hospital facility did not collaborate with any other hospital facility outside of the Essentia Health System. Part V, line 5a The CHNA is posted under the "Community Health Needs Assessment" box on the hospital facility's homepage at http://www.mvhc.org Part V, line 5c 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, three were selected as the highest priority health needs that have/will be addressed over the next three years as a part of the hospital facility's implementation strategies. The hospital facility will not directly meet the four unprioritized health needs due to resource constraints. Rather than inadequately addressing all health needs, the hospital facility will focus resources, financial and otherwise, on their community's three prioritized health needs in order to foster success in meeting those health needs. Despite not directly meeting the unprioritized needs, interventions addressing the three prioritized health needs may partially address the unprioritized health needs that overlap with the prioritized health needs. If the unprioritized health needs remain in the next CHNA cycle, they may be directly addressed at that time. The four unprioritized health needs are as follows: Reduction of excessive/binge drinking Access to health care Preventative care Secondary prevention/screening Part V, line 10: Checked "Yes", so not applicable. Part V, Line 11: Checked "Yes", so not applicable. Part V, line 12h This box was not checked, so not applicable. Part V, line 14g This box was not checked, so not applicable. Part V, line 16e This box was not checked, so not applicable. Part V, line 17e This box was not checked, so not applicable. Part V, line 18e This box was not checked, so not applicable. Part V, line 19c This box was not checked, so not applicable. Part V, line 19d This box was not checked, so not applicable. Part V, line 20d For patients known to qualify for the financial assistance program, they are charged the same as their most common insurance payor. Part V, line 21 Answered "No" so not applicable. Part V, line 22 Answered "No" so not applicable.
Part VI, line 2Needs 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: Minnesota Valley Health Center, Inc. is a 24 bed critical access hospital located in Le Sueur, MN. Minnesota Valley Health Center works with one local primary care physician clinic in Le Sueur, Sibley County Public Health, Nicollet County Public Health and Le Sueur County Public Health agencies for assessing the needs of the rural communities in our area. These needs are determined on several different methods, but mostly based on what these agencies are actually seeing when they are working with their clients. This communication is ongoing throughout the year.
Part VI, line 3Describe 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 charity care policy: Minnesota Valley Health Center, Inc. communicates the availability of financial assistance in appropriate acute care settings such as Emergency Departments, registration areas, and the Business Office. Business office personnel are available at Minnesota Valley Health Center to help patients understand and apply for local, state and federal health care programs and the Minnesota Valley Health Center Financial Assistance Program. All Minnesota Valley Health Center employees are informed annually how to refer patients to apply for the Minnesota Valley Health Center financial assistance program. Annual staff education programs are provided to all Business office staff. Patients can request Financial Assistance information by calling the Financial Assistance patient information phone line on a 24-hour basis. Voicemail is available and all calls will be followed up within three working days. Uninsured patients are provided information regarding the availability of Financial Assistance on registration or admission to Minnesota Valley Health Center. Applications for assistance are available in acute care in-patient registration areas or via mail from the Business office. Contact phone numbers for assistance are also provided. Individuals other than the patient such as the patient's physician, family members, community or religious groups, social services, or hospital personnel may make requests for financial assistance on the patient's behalf.
Part VI, line 4Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves: Minnesota Valley Health Center, Inc. is located in Le Sueur, MN. Minnesota Valley is a part of the larger Essentia Health system, which is defined in Part VI, line 6. Minnesota Valley Health Center, Inc. operates a 24 bed critical access hospital, 68 bed long-term care facility, and a 37 unit HUD-subsidized low income housing for seniors that serve the communities of Le Sueur, Nicollet and Sibley counties. The overall community is classified as rural. Minnesota Valley and its related facilities cover a service region of approximately 28,000 people. The service region age distribution is 21.6% under the age of 18; 64.1% between the ages of 18 and 65; and 14.3% over the age of 65. The racial makeup of the service region is 97.2% Caucasian; 1.5% Black or African American; and 1.3% Asian. The gender split ratio is 49.9% women and 50.1% men. The average income for the service area is approximately $62,000. Approximately 6.2% of the population falls below the federal poverty guidelines. Minnesota Valley Health Center, Inc., along with Essentia Health is committed to serve patients regardless of their ability to pay. 8.3% net revenue dollars were from self pay patients. In addition, approximately 20.0% of their net revenue dollars were Medicaid recipients. As mentioned above, Minnesota Valley Health Center, Inc. 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 no other hospitals outside of the Essentia Health umbrella that service the community.
Part VI, line 5Provide any other information important to describing how the organization's hospitals or other health care facilities further its exempt purpose by promoting the health of the community: Our Board of Directors is a volunteer board which consists of local community members with a cross section of occupations. Our medical staff consists of our emergency room director and the providers from the Mayo Clinic Health System - Mankato. Minnesota Valley is an open Medical Staff; therefore 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 provide services in our system. Due to the low per diem rate which is set by the State for our nursing home, any surplus that is generated is being generated by the hospital services, which in turn keeps the nursing home open. The nursing home lost $731,000 this past year providing care to the residents. During the prior year, the nursing home set aside two beds and this year has de-licensed 10 more beds due to low occupancy and low reimbursement rates. The independent living apartments are also being assisted by the hospital to meet its cash flow needs to provide service to the tenants. Once the needs of the nursing home and the independent living apartments are met, any surplus cash is used to update medical equipment for both the hospital and the nursing home. Any and all emergency repairs or equipment needs that arise are taken care of immediately. We keep our daily rates affordable for our Adult Day Health Services, this too is assisted by the hospital services. Mayo Clinic Health System - Mankato moved out of the wing they were renting from the hospital and have built their own clinic which is attached to the hospital. The hospital is remodeling the vacated wing into an outpatient services area for visiting specialists. We have volunteer members who deliver meals on wheels Monday through Friday to community members who are in need of this service (1,180 were delivered last year). At the request of businesses, we go on site for occupational training. Flu shot clinics are held on site for the community. We have evening events for the community such as "Linked in Pink" for breast cancer awareness. We participate in local community events such as: Super Saturday Kids Event, Youth Safety Camp, School Supplies drive, winter clothing drive for school, Food shelf drive, and 5k walk/run events three times a year. We have the emergency helicopter here for events for the community to come and meet them and be aware of these services. During the past year Minnesota Valley Health Center, Inc., in collaboration with Mayo Clinic Health Systems - Mankato, had a booth at the annual Retail and Business Expo that was held at the local community center to educate the community on services available at the health center. The community is able to get information from our updated website: www.mvhc.org. This web site continually has new information being added to it.
Part VI, Line 6If 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: Minnesota Valley Health Center, Inc. is part of Essentia Health, an integrated health system of 16 hospitals, 65 clinics, eight long-term care facilities, two assisted living facilities, four independent living facilities 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 don't 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 are 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 the Epic electronic health record (EHR). The vast majority of Essentia's hospitals and clinics are using a fully-integrated EHR for patient care. Technology like the electronic health record and Essentia's 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, 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 to a 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 health care delivery, particularly in rural areas, in the years to come.
PART VI, LINE 7If applicable, identify all states with which the organization, or a related organization, files a community benefit report: Minnesota Valley Health Center files a community benefit report in Minnesota.
Part VI, Line 8If applicable, for each hospital facility in a facility reporting group provide the description required for Part V, Section B, Lines 1J, 3, 4, 5C, 6I, 7, 10, 11, 12H, 14G, 16E, 17E, 19C, 20D, 21, and 22: Not Applicable.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantNursing Home Scholarship ProgramTypeOfGrant
Number Of Recipients5NumberOfRecipients
Amount Of Cash Grant29700AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierSchedue I, Part IIIIdentifier
ExplanationProcedures for monitoring grants: Nursing Home scholarship program Minnesota Valley Health Center, Inc. provides scholarships for employees who are interested in pursuing an educational program which will lead to career advancement within the facility or within the field of long term care. To be eligible, employees must meet the following criteria: 1. Employee must work an average of 20 hours per week. 2. Employees must be enrolled in a qualified institution working towards an allowable program. 3. Scholarship monies may be used for required tuition, books, fees and any other required expenses. 4. Administrators, department supervisors and registered nurses are not eligible for the scholarship. 5. An employee must submit an application for the scholarship program to the Human Resources Department. The application will be reviewed by the human resources director, long term care administrator and chief financial officer and a decision will be made if the employee is to be awarded the scholarship. No payments will be issued for scholar awards until all appropriate documentation is received from the applicant and the qualified institution.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
MICHAEL HEDRIX
BOARD DIRECTOR02593440305360401580323330314550393826035375
PATRICIA TOWNSDIN
Board Dir/President THRU 12/12011312801233102386014517012028015439000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierForm 990, Part I, Line 4bIdentifier
ExplanationSupplemental nonqualified retirement plan: Essentia Health's nonqualified retirement plan is offered to designated Essentia Health executives. There is a minimum two year vesting date or automatically upon reaching retirement age, death, disability or involuntary termination without cause. Benefits are subject to income taxes upon vesting and payable from Essentia Health's general assets. Reported as Other Reportable Compensation in Schedule J, Part II, Column B (iii), the following individual 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: Michael Hedrix $35,375 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: Michael Hedrix $7,333 Patricia Townsdin $6,618Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (16 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
Form 990, Part III, Line 4Program service accomplishments: Minnesota Valley Health Center, Inc. is created & organized exclusively for charitable and educational purposes. Minnesota Valley Health Center, Inc. is created and organized to own, maintain, operate and conduct, directly or indirectly, and to assist and coordinate activities of facilities for health care, education, care for the aged and social services. Minnesota Valley Health Center, Inc. includes a hospital, outpatient specialty clinics, complete lab and radiology departments, a comprehensive physical, occupational and speech therapy department, extended care nursing facilities, an Adult Day Health Center, and independent living senior housing. Minnesota Valley Health Center, Inc. is the 3rd largest employer in a community of approximately 4,000. Minnesota Valley Health Center, Inc. is licensed for 24 beds, had 182 inpatient days, 351 swing bed days, and 21,331 long term care days during the fiscal year ended June 30, 2013. There were 1,852 emergency room visits and 15,397 outpatient visits during the same time period. Also, during fiscal year 2013 there were 1,180 meals delivered to community members through the Meals on Wheels Program and 4,561 meals were served to residents at the independent living apartments. The adult day health service saw an average of 6 clients a week. Minnesota Valley Health Center, Inc provided over $29,000 in charity care during the fiscal year ended June 30, 2013. Further community benefits provided during the fiscal year include community services of over $7,000 and subsidized health services of over $22,000.
Form 990, Part VI, Line 6Members of Organization: Critical Access Group is the sole member of Minnesota Valley Health Center, Inc. Members, City of LeSueur and Critical Access Group, may elect one or more members of the governing body as described in Schedule O Part VI line 7a. Member, Essentia Health, has reserved powers with respect to Minnesota Valley Health Center, Inc. as described in Schedule O Part VI line 7b.
Form 990, Part VI, Line 7AMembers with right to elect governing body: The City of LeSueur appoints and removes one board director. Critical Access Group appoints and removes Minnesota Valley Health Center Inc.'s remaining governing body.
FORM 990, PART VI, LINE 7BGovernance, Management, and Disclosures: Minnesota Valley Health Center, Inc. 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. 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 8bCommittees: There are no committees with authority to act on behalf of the governing body.
FORM 990, PART VI, LINE 11AForm 990 review process: The 2012 Form 990 including all schedules was reviewed by Minnesota Valley Health Center, Inc.'s management and governing body on April 22nd, 2014 prior to filing with the Internal Revenue Service. Each current director of the governing body received a final copy of the 2012 Form 990. Minnesota Valley Health Center, Inc.'s Chief Financial officer led the review of the form and schedules and any questions were discussed.
Form 990, Part VI, Line 12CMonitoring 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 or not 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 15aProcess for determining compensation: The organization has a compensation committee that uses compensation studies to determine the compensation of all employees including the President. Any salary adjustment for the President is reviewed and approved by the board of directors. The year this process was last undertaken for Minnesota Valley Health Center, Inc.'s President was 2013.
FORM 990, Part VI, Line 19Availability of governing documents, conflict of interest policy, & financial statements to the public: Minnesota Valley Health Center, Inc. makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Minnesota Valley Health Center, Inc. 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 XI, Line 9Other Changes in Net Assets: The total amount of other changes in net assets includes: Change in Beneficial Interest of Minnesota Foundation: $116,006
Form 990, Part XII, Line 3Consolidated A-133: Minnesota Valley Health Center, Inc., 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.
OTHER FEES FOR SERVICES FOR NON-EMPLOYEESDESCRIPTION:PHYSICIAN CONTRACTORS TOTAL FEES:776181FORM 990 PART IX LINE 11G
OTHER FEES FOR SERVICES FOR NON-EMPLOYEESDESCRIPTION:THERAPY SERVICES TOTAL FEES:616470FORM 990 PART IX LINE 11G
OTHER FEES FOR SERVICES FOR NON-EMPLOYEESDESCRIPTION:REFERENCE LAB & XRAY FEES TOTAL FEES:117976FORM 990 PART IX LINE 11G
OTHER FEES FOR SERVICES FOR NON-EMPLOYEESDESCRIPTION:SCANNING SERVICES TOTAL FEES:116400FORM 990 PART IX LINE 11G
OTHER FEES FOR SERVICES FOR NON-EMPLOYEESDESCRIPTION:MEDICAL AND ER DIRECTOR FEES TOTAL FEES:27000FORM 990 PART IX LINE 11G

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (27 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
BRAINERD LAKES INTEGRATED HEALTH SYSTEM
2024 S 6TH STBRAINERDMN56401371532145SUPPORT ORGMN501(c)(3)11 Type IIESSENTIAtrue
BRAINERD MEDICAL CENTER INC
2024 S 6TH STBRAINERDMN56401371532148CLINICMN501(c)(3)3BLIHStrue
ST JOSEPH'S MEDICAL CENTER
523 N 3RD STBRAINERDMN56401410695602CLINIC/HOSPMN501(c)(3)3BLIHStrue
CLEARWATER VALLEY HOSPITAL & CLINICS INC
301 CEDAROROFINOID83544820497771CLINIC/HOSPID501(c)(3)3CAGtrue
DL SURGERY CENTER (thru 73112)
1027 WASHINGTON AVEDETROIT LAKESMN56501263837203ASCMN501(c)(3)3CAGtrue
ST MARY'S HOSPITAL INC
PO BOX 137COTTONWOODID83522820226453CLINIC/HOSPID501(c)(3)3CAGtrue
CRITICAL ACCESS GROUP
503 E 3RD ST STE 400DULUTHMN55805261219624SUPPORT ORGMN501(c)(3)11 Type IIESSENTIAtrue
ESSENTIA INSTITUTE OF RURAL HEALTH
502 E 2ND STDULUTHMN55805271291124RESEARCHMN501(c)(3)4ESSENTIAtrue
INNOVIS HEALTH LLC
3000 32ND AVEFARGOND58103261175213CLINIC/HOSPDE501(c)(3)3ESSENTIAtrue
ST MARY'S DULUTH CLINIC HEALTH SYSTEM
407 E 3RD STDULUTHMN55805411836633SUPPORT ORGMN501(c)(3)11 Type IIESSENTIAtrue
BRIDGES MEDICAL CENTER
201 9TH ST WADAMN56510200479568CLINIC/HOSPMN501(c)(3)3INNOVIStrue
ESSENTIA HEALTH FOUNDATION
502 E 2ND STDULUTHMN55805271984704FOUNDATIONMN501(c)(3)7ESSENTIAtrue
FIRST CARE MEDICAL SERVICES
900 HILLIGOSS BLVD SEFOSSTONMN56542410706143CLINIC/HOSPMN501(c)(3)3INNOVIStrue
GRACEVILLE HEALTH CENTER
115 WEST SECOND STGRACEVILLEMN56240410726173CLINIC/HOSPMN501(c)(3)3INNOVIStrue
ST MARY'S INNOVIS HEALTH
1027 WASHINGTON AVEDETROIT LAKESMN56501262861321CLINICMN501(c)(3)3INNOVIStrue
ST MARY'S REGIONAL HEALTH CENTER
1027 WASHINGTON AVEDETROIT LAKESMN56501411620386CLINIC/HOSPMN501(c)(3)3INNOVIStrue
ESSENTIA HEALTH
502 E 2ND STDULUTHMN55805200360007SUPPORT ORGMN501(c)(3)11TypeIIIFINAfalse
MIDWEST MEDICAL EQUIPMENT & SUPPLY INC
4418 HAINES RDDULUTHMN55811411674021MEDICAL EQUIPMN501(c)(3)9SMMCtrue
NORTHERN PINES MEDICAL CENTER
5211 HWY 110AURORAMN55705410841441HOSPITAL/NURSMN501(c)(3)3SMDCHStrue
PINE MEDICAL CENTER
109 COURT AVE SSANDSTONEMN55072411884597HOSPITAL/NURSMN501(c)(3)3SMDCHStrue
SMDC MEDICAL CENTER
502 E 2ND STDULUTHMN55805411878730CLINIC/HOSPMN501(c)(3)3SMDCHStrue
ST MARY'S MEDICAL CENTER
407 E 3RD STDULUTHMN55805410695604HOSPITALMN501(c)(3)3SMDCHStrue
THE DULUTH CLINIC LTD
400 E 3RD STDULUTHMN55805410883623CLINICMN501(c)(3)3SMDCHStrue
POLINSKY MEDICAL REHABILITATION CENTER
530 E 2ND STDULUTHMN55805410691275CLINICMN501(c)(3)3SMMCtrue
ST MARY'S HOSPITAL OF SUPERIOR
3500 TOWER AVESUPERIORWI54880411811073CLINIC/HOSPWI501(c)(3)3SMMCtrue
ST MARY'S EMS
1027 WASHINGTON AVEDETROIT LAKESMN56501411805811EMERG SRVSMN501(c)(3)9SMRHCtrue
DEER RIVER HEALTHCARE CENTER INC
115 10TH AVE NEDEER RIVERMN56636410844574HOSPITAL/NURSMN501(c)(3)3SMDCHStrue

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1PMC-Gateway Imaging LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1109 Court Ave SAddressLine1
CitySandstoneCity
StateMNState
ZIP Code55072ZIPCode
FieldValueIRS element (for citing)
EIN261634764EIN
Primary ActivityImaging ServiPrimaryActivity
Legal Domicile StateMNLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeN/APredominantIncomeType
Share Of Total Income0ShareOfTotalIncome
Share Of EOY Assets0ShareOfEOYAssets
Code V$0CodeVAmount
Percentage Ownership0.00000PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnershipControlled OrgControlledOrgAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodeLegal Domicile Foreign CountryLegalDomicileForeignCountry
East Range Clinics Ltd
910 6th Ave NVirginiaMN55792410909915ClinicsMNNAC Corp000.00000true
Essentia Health Insurance Services SPC
000000000InsuranceNAForeign Corp000.00000true94 Solaris Ave PO Box 69Grand CaymanCayman IslandsCJKY1-1102CJ
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Critical Access Group
M261816actual costs
Critical Access Group
P911371actual costs
Essentia Health
P265207actual costs

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierSchedule R, Part II, Column (a)Identifier
ExplanationName: 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 & Supply 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 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 LakesExplanation