2014-04-30T11:04:50-05:00 2013-06-30 990 2012-07-01 410837659 Minnesota Valley Health Center Inc % PAT SCHLEGEL MINN 5076653375 621 South 4th Street Suite Le Sueur MN 56058 PATRICIA SCHLEGEL 2014-04-22 2012 2015-11-30 17:44:51Z Pamela Williams 621 SOUTH 4TH STREET Le Sueur MN 56058 11675058 false X www.mvhc.org X 1959 MN Our mission is to provide community-based healthcare in an environment that fosters dignity, respect and excellence. 7 5 243 10 0 92542 72669 12365395 11462918 16841 19058 132183 118908 12606961 11673553 7080 29700 0 0 6199595 6080392 0 0 0 5723280 5533896 11929955 11643988 677006 29565 13844447 13500946 8579584 8086926 5264863 5414020 X OUR MISSION IS TO PROVIDE COMMUNITY-BASED HEALTHCARE IN AN ENVIRONMENT THAT FOSTERS DIGNITY, RESPECT AND EXCELLENCE. false false 10239122 29700 11514026 See Schedule O 10239122 true true false true false false false false true false true false false true false false true true false false false false false false false false true true false true true false false false false false false false false false false false false false true true true false false true 13 0 true 243 true false false false false false false false false false false X 7 5 false false false false true true true true false false false true true true true true true true false false MN X PAT SCHLEGEL 5076653375 621 SOUTH 4TH STREET Le Sueur MN 56058 RANDY BAUM 10.0 0.0 X X 0 0 0 ROBERT BROEDER 5.0 0.0 X X 0 0 0 JOHN SKUBITZ 1.0 0.0 X 0 0 0 STEVE SMITH 1.0 0.0 X X 0 0 0 JOSEPH SPINLER 1.0 0.0 X 0 0 0 MICHAEL HEDRIX 1.0 59.0 X 0 330038 63788 PATRICIA TOWNSDIN 60.0 0.0 X X 0 127845 26545 PATRICIA SCHLEGEL 50.0 0.0 X 76041 0 10790 PAMELA WILLIAMS 60.0 0.0 X 75342 0 15209 151383 457883 116332 0 false true false WAPITI MEDICAL GROUP PO BOX 92 NEWELL SD 57760 ER PHYSICIAN SRVS 784535 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 PHYSICAL THERAPY 679173 OMNICARE PHARMACY PO BOX 715268 COLUMBUS OH 43271 PHARMACY SERVICES 269330 CENTRAL MINNESOTA DIAGNOSTIC INC PO BOX 158 MILACA MN 56353 CT SCAN SERVICES 112000 UNIVERSAL HOSPITAL SERVICES SDS-12-0940 PO BOX 86 MINNEAPOLIS MN 55486 MEDICAL EQUIP MAINT 130013 5 8355 64314 72669 PATIENT SERVICE REVENUE 621110 11462918 11462918 11462918 14178 14178 0 0 29251 29251 0 29251 29251 4985 1400 1505 4985 -105 4880 4880 0 0 0 CMDI EQUITY PAYMENT 900099 51108 51108 DIETARY/VENDING REVENUE 722514 33441 33441 TELEPHONE INCOME 900099 5029 5029 79 79 89657 11673553 11514026 86858 0 29700 29700 0 0 314461 314461 0 4567471 3981135 586336 107591 86334 21257 717401 616469 100932 373468 304557 68911 0 0 53676 53676 73 73 0 772 772 1654027 1627027 27000 42054 42054 101331 46830 54501 176105 167300 8805 0 227894 220842 7052 20537 11084 9453 0 15015 4930 10085 400163 400163 0 705450 705450 112402 112402 MEDICAL/DIETARY SUPPLIES 911990 911990 BAD DEBT EXPENSE 335000 335000 AFFILIATE SUPPORT FEE 261836 162338 99498 DHS SURCHARGES-NH & HOSPITAL 232815 232815 282756 282756 11643988 10239122 1404866 0 407827 359804 2825307 2582463 155174 164307 1596997 1949830 0 0 0 0 191716 150197 101295 98651 48917 34965 12550226 5519144 7513573 7031082 0 0 111918 121918 0 0 0 0 891723 1007729 13844447 13500946 1378420 1232090 0 0 0 0 0 0 31191 32512 0 0 7169973 6822324 0 0 0 0 8579584 8086926 X 4343670 4390496 287979 338839 633214 684685 5264863 5414020 13844447 13500946 X 29565 3586 116006 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 73 73 false Schedule C, Part II-B Lobbying 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. false true X 1239680 860577 379103 5878195 108676 5769519 5368622 4495007 873615 63729 54884 8845 7031082 BENEFICIAL INTEREST IN MN FDN 1007729 1007729 11690814 3586 29700 33286 11657528 16025 16025 11673553 11643988 11643988 11643988 Schedule D, Part IV, Line 2B Minnesota 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 2d Other Changes in Revenue: Release of Restricted Contribution: $29,700 Schedule D, Part XI, Line 4b Other Changes in Revenue: Restricted Contributions: $16,025 true true X true X true X true true false true true 71 29675 29675 0.00260 724 1748124 1941890 -193766 0.01710 795 1777799 1941890 -164091 0.01450 1 65 7860 7860 0.00070 1 76 61106 38978 22128 0.00200 2 141 68966 38978 29988 0.00270 2 936 1846765 1980868 -134103 0.01180 true 335000 1000 2547664 2522440 25224 X true true 1 1 Minnesota Valley Health Center Inc

621 South 4th Street Le Sueur MN 56058

www.mvhc.org X X X X Minnesota Valley Health Center Inc 1 true X X X X X X X X X X 12 true true true X X X X X X X X X X X false false true true 150. true 300. true X X X X X X X true true X X X X X true false X X X true X false false 2 Minnesota Valley Health Center Inc

621 South 4th Street Le Sueur MN 56058

Skilled Nursing Facility Sunrize Plaza

600 South 5th Street Le Sueur MN 56058

Senior Apartments 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 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 Cont Part 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 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: 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 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 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 4 Community 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 5 Provide 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 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: 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 7 If 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 8 If 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. true Nursing Home Scholarship Program 5 29700 Schedue I, Part III Procedures 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. X X X false true false false false false false false false MICHAEL HEDRIX 0 259344 0 30536 0 40158 0 32333 0 31455 0 393826 0 35375 PATRICIA TOWNSDIN 0 113128 0 12331 0 2386 0 14517 0 12028 0 154390 0 0 Form 990, Part I, Line 4b Supplemental 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 $6,618 Form 990, Part III, Line 4 Program 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 6 Members 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 7A Members 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 7B Governance, 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 8b Committees: There are no committees with authority to act on behalf of the governing body. FORM 990, PART VI, LINE 11A Form 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 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 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 15a Process 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 19 Availability 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 9 Other 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 3 Consolidated 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-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN CONTRACTORS TOTAL FEES:776181 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:THERAPY SERVICES TOTAL FEES:616470 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:REFERENCE LAB & XRAY FEES TOTAL FEES:117976 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:SCANNING SERVICES TOTAL FEES:116400 OTHER FEES FOR SERVICES FOR NON-EMPLOYEES FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL AND ER DIRECTOR FEES TOTAL FEES:27000 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 ST JOSEPH'S MEDICAL CENTER 523 N 3RD ST BRAINERD MN 56401 410695602 CLINIC/HOSP MN 501(c)(3) 3 BLIHS true CLEARWATER VALLEY HOSPITAL & CLINICS INC 301 CEDAR OROFINO ID 83544 820497771 CLINIC/HOSP ID 501(c)(3) 3 CAG true DL SURGERY CENTER (thru 73112) 1027 WASHINGTON AVE DETROIT LAKES MN 56501 263837203 ASC MN 501(c)(3) 3 CAG true ST MARY'S HOSPITAL INC PO BOX 137 COTTONWOOD ID 83522 820226453 CLINIC/HOSP ID 501(c)(3) 3 CAG true CRITICAL ACCESS GROUP 503 E 3RD ST STE 400 DULUTH MN 55805 261219624 SUPPORT ORG MN 501(c)(3) 11 Type II ESSENTIA true 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 AVE FARGO ND 58103 261175213 CLINIC/HOSP DE 501(c)(3) 3 ESSENTIA 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 BRIDGES MEDICAL CENTER 201 9TH ST W ADA MN 56510 200479568 CLINIC/HOSP MN 501(c)(3) 3 INNOVIS true ESSENTIA HEALTH FOUNDATION 502 E 2ND ST DULUTH MN 55805 271984704 FOUNDATION MN 501(c)(3) 7 ESSENTIA true FIRST CARE MEDICAL SERVICES 900 HILLIGOSS BLVD SE FOSSTON MN 56542 410706143 CLINIC/HOSP MN 501(c)(3) 3 INNOVIS true GRACEVILLE HEALTH CENTER 115 WEST SECOND ST GRACEVILLE MN 56240 410726173 CLINIC/HOSP MN 501(c)(3) 3 INNOVIS true ST MARY'S INNOVIS HEALTH 1027 WASHINGTON AVE DETROIT LAKES MN 56501 262861321 CLINIC 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 MIDWEST MEDICAL EQUIPMENT & SUPPLY INC 4418 HAINES RD DULUTH MN 55811 411674021 MEDICAL EQUIP MN 501(c)(3) 9 SMMC true NORTHERN PINES MEDICAL CENTER 5211 HWY 110 AURORA MN 55705 410841441 HOSPITAL/NURS MN 501(c)(3) 3 SMDCHS true PINE MEDICAL CENTER 109 COURT AVE S SANDSTONE MN 55072 411884597 HOSPITAL/NURS MN 501(c)(3) 3 SMDCHS true SMDC MEDICAL CENTER 502 E 2ND ST DULUTH MN 55805 411878730 CLINIC/HOSP MN 501(c)(3) 3 SMDCHS 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 POLINSKY MEDICAL REHABILITATION CENTER 530 E 2ND ST DULUTH MN 55805 410691275 CLINIC MN 501(c)(3) 3 SMMC true ST MARY'S HOSPITAL OF SUPERIOR 3500 TOWER AVE SUPERIOR WI 54880 411811073 CLINIC/HOSP WI 501(c)(3) 3 SMMC true ST MARY'S EMS 1027 WASHINGTON AVE DETROIT LAKES MN 56501 411805811 EMERG SRVS MN 501(c)(3) 9 SMRHC true DEER RIVER HEALTHCARE CENTER INC 115 10TH AVE NE DEER RIVER MN 56636 410844574 HOSPITAL/NURS MN 501(c)(3) 3 SMDCHS true PMC-Gateway Imaging LLC 109 Court Ave S Sandstone MN 55072 261634764 Imaging Servi MN NA N/A 0 0 0 0.00000 East Range Clinics Ltd 910 6th Ave N Virginia MN 55792 410909915 Clinics MN NA C Corp 0 0 0.00000 true Essentia Health Insurance Services SPC 94 Solaris Ave PO Box 69 Grand Cayman Cayman Islands CJ KY1-1102 000000000 Insurance CJ NA Foreign Corp 0 0 0.00000 true false false false false false false false false false false false true false false true false false true Critical Access Group M 261816 actual costs Critical Access Group P 911371 actual costs Essentia Health P 265207 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 & 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 Lakes