2013-05-06T10:03:16-05:00 2012-06-30 990 2011-07-01 410837659 Minnesota Valley Health Center Inc % PAT SCHLEGEL MINN 5076653375 621 South 4th Street Le Sueur MN 56058 Patricia Schlegel 2013-05-03 2011 2016-02-25 16:41:14Z Patricia Townsdin 621 SOUTH 4TH STREET Le Sueur MN 56058 12608554 false X www.essentiahealth.org X 1959 MN Our mission is to provide community-based healthcare in an environment that fosters dignity, respect and excellence. 6 5 205 56 0 102068 92542 11301433 12365395 22251 16841 106741 132183 11532493 12606961 13847 7080 0 0 5949046 6199595 0 0 0 4920510 5723280 10883403 11929955 649090 677006 13330186 13844447 8932534 8579584 4397652 5264863 X Our mission is to provide community-based healthcare in an environment that fosters dignity, respect and excellence. false false 10396865 7080 12405064 See Schedule O 10396865 true true false true false false false false true false true false false true false true 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 12 0 true 205 true false false false false false false false false false false X 6 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 X RANDY BAUM 10.0 X X 0 0 0 KEITH MAETZOLD 5.0 X X 0 0 0 ROBERT BROEDER 5.0 X X 0 0 0 JOHN SKUBITZ 1.0 X 0 0 0 STEVE SMITH 1.0 X 0 0 0 JOSEPH SPINLER 1.0 X 0 0 0 MICHAEL HEDRIX 60.0 X 0 353852 88322 PATRICIA TOWNSDIN 60.0 X 0 125169 30802 PATRICIA SCHLEGEL 50.0 X 74066 0 10771 74066 479021 129895 0 false true false WAPITI MEDICAL GROUP PO BOX 92 NEWELL SD 57760 ER PHYSICIAN SRVS 731755 AEGIS THERAPIES INC PO BOX 8103 FORT SMITH AR 72902 PHYSICAL THERAPY 519825 OMNICARE PHARMACY PO BOX 715268 COLUMBUS OH 43271 PHARMACY SERVICES 264794 CENTRAL MINNESOTA DIAGNOSTIC INC PO BOX 158 MILACA MN 56353 CT SCAN SERVICES 185400 UNIVERSAL HOSPITAL SERVICES SDS-12-0940 PO BOX 86 MINNEAPOLIS MN 55486 MEDICAL EQUIP MAINT 117478 5 8280 84262 92542 PATIENT SERVICE REVENUE 621110 12365395 12365395 12365395 18434 18434 0 0 39905 39905 39905 39905 836 757 -836 -757 -1593 -1593 0 0 0 DIETARY/VENDING INCOME 722210 40577 40577 CMDI EQUITY PAYMENT 900099 39669 39669 TELEPHONE INCOME 900099 5655 5655 6377 6377 92278 12606961 12405064 109355 0 7080 7080 0 0 208834 208834 0 4739028 4101301 637727 75788 20308 55480 831495 707602 123893 344450 291192 53258 0 120 120 57083 57083 86 86 0 890 890 2203606 2203606 46360 46360 143051 89958 53093 171250 166112 5138 0 269394 261066 8328 31625 22338 9287 0 0 388344 388344 0 586198 586198 90300 90300 MEDICAL/DIETARY SUPPLIES 645723 645723 AFFILIATE SUPPORT FEE 262616 262616 DHS SURCHARGES-NH & HOSPITAL 260387 260387 BAD DEBT EXPENSE 248000 248000 318247 307350 10897 11929955 10396865 1533090 0 184763 407827 2174389 2825307 0 155174 1362840 1596997 0 0 0 0 1465571 191716 91458 101295 50653 48917 12503838 4990265 7156811 7513573 0 0 115135 111918 0 0 0 0 728566 891723 13330186 13844447 1372089 1378420 0 0 0 0 0 0 33707 31191 0 0 7466887 7169973 0 0 59851 0 8932534 8579584 X 3693923 4343670 35014 287979 668715 633214 4397652 5264863 13330186 13844447 X 677006 190205 X X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 86 86 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 1239680 822705 416975 5696866 49711 5647155 5324036 4064146 1259890 243256 53703 189553 7513573 BENEFICIAL INTEREST IN MN FDN 891723 891723 0 0 12606961 11929955 677006 -5884 196089 190205 867211 12579702 -5884 -5884 12585586 21375 21375 12606961 11929955 11929955 11929955 Schedule D, Part IV, Line 2B Minnesota Valley Health Center, Inc. acts as custodian for the funds of the residents. Resident trust funds totaled $16,463 at June 30, 2012. During that same time Minnesota Valley Health Center, Inc. holds $14,728 in a separate account for tenant security deposits for Sunrise Plaza. Schedule D, Part X ASC 740 footnote: Essentia Health has adopted Accounting Standards Codification 740, Income Taxes (formerly known as FASB Interpretation No. 48 (FIN 48), Accounting for Uncertainty in Income Tax - an interpretation of FASB Statement No. 109, Accounting for Income Taxes). The adoption of this interpretation had no material impact on the consolidated financial statements and therefore, Essentia Health's consolidated financial statements for fiscal year ended June 30, 2012 no longer includes an ASC 740 footnote. Schedule D, Part XI, Line 8 Other Changes in net assets: Change in beneficial interest of Minnesota Foundation: $196,089 Schedule D, Part XII, Line 4b Other Changes in Revenue: Restricted Grants & Contributions: $20,100 Restricted interest income: $1,275 true true X true X true X true true false true true 67 21972 0 21972 0.00190 957 1729398 2093539 -364141 0.03120 0 0 0 0 0.00000 1024 1751370 2093539 -342169 0.02930 1 102 6682 0 6682 0.00060 0 0 0 0 0.00000 1 410 21607 0 21607 0.00180 0 0 0 0 0.00000 0 0 0 0 0.00000 2 512 28289 0 28289 0.00240 2 1536 1779659 2093539 -313880 0.02690 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 true 248000 550 2467375 2442946 24429 X true true 1 1 Minnesota Valley Health Center

621 South 4th Street Le Sueur MN 56058

X X X X Minnesota Valley Health Center 1 true true 150. true 300. true X X X X X X X true true X X X X X true false true X false false 2 SunriZe Plaza

600 South 5th Street Le Sueur MN 56058

Independent Living Facility Gardenview Nursing Home

621 South 4th Street Le Sueur MN 56058

Nursing Home SCHEDULE H, Part VI, line 2 Provide the description required for Part I, lines 3c, 6a, 7g, 7, column (f), 7; Part II; Part III, lines 4, 8, 9b; Part V, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 18c, 18d, 19d, 20, 21: 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'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 via the website 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 Minnesota Valley Health Center'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 $248,000. 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 - Describe how the organization's community building activities, as reported in Part II, promote the health of the communities the organization serves: Not applicable. Part III, line 4 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 4 MINNESOTA VALLEY HEALTH CENTER is in the process of hiring a 3rd party to track bad debt accounts in order to presumptively quantify accounts within bad debt expense that would have qualified for financial assistance under MINNESOTA VALLEY HEALTH CENTER's financial assistance policy had the proper documentation been completed and filed. As that tracking was not in place during the fiscal year, MINNESOTA VALLEY HEALTH CENTER applied a high-level, conservative analytic review by taking the ratio of charitable allowances to gross patient revenue and multiplying with bad debt expense to arrive at an approximation of charity care that resides in bad debt. Part III, Line 4 Minnesota Valley Health Center 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 (Excerpt from the parent company's audit) Accounts receivable are stated at net realizable value. The allowance for uncollectible accounts is based upon management's ongoing assessment of historical and expected net collections for each major payor source considering historical business and economic conditions, trends in healthcare coverage, and other collection indicators. For receivables associated with private-pay patients, Essentia records a significant provision for uncollectible accounts in the period of service on the basis of its historical experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. Part III, line 8 The costing methodology used in determining the Medicare Allowable Cost reported in the organization's Medicare Cost Report is to take total Medicare costs from the general ledger system and then follow the instructions provided by Centers for Medicare Services (CMS) to back off all costs not allowable. From the Medicare allowable costs, any costs attributable to subsidized health services and costs attributable to GME were subtracted, if applicable. Part III, line 8 Minnesota Valley Health Center 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 11H NOT APPLICABLE. PART V, LINE 13G NOT APPLICABLE. PART V, LINE 15E NOT APPLICABLE. PART V, LINE 16E NOT APPLICABLE. PART V, LINE 17E NOT APPLICABLE. PART V, LINE 18C NOT APPLICABLE. PART V, LINE 18D NOT APPLICABLE. PART V, LINE 19D For patients known to qualify for the financial assistance program, discounts will be applied to billed amounts if the patient qualifies for discounted care and the billed amount will be fully discounted if the patient qualifies for free care. PART V, LINE 20 NOT APPLICABLE. PART V, LINE 21 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 Financial Assistance policy: Minnesota Valley Health Center 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 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 operates a 24 bed critical access hospital, 70 bed long-term care facility, and 37 units 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 92.7% Caucasian; 1.5% Black or African American; 0.4% American Indian or Alaskan Native; 1.3% Asian; 1.1% two or more races; and 3.0% other. 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, along with Essentia Health is committed to serve patients regardless of their ability to pay. 10.7% net revenue dollars were from self pay patients. In addition, approximately 20.6% of their net revenue dollars were Medicaid recipients. As mentioned above, Minnesota Valley Health Center 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, who has a clinic that is attached to our hospital. Minnesota Valley is an open Medical Staff, so any qualified physician of the community is allowed to apply. All applicants that apply must meet the credentialing standards and be approved by our governing board in order to come and provide services in our system. 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 loses an average of $300,000 a year providing care to the residents. During the year the nursing home set aside two beds and 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 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 and this too is assisted by the hospital services. We provide Adult Day Health Services for our community. This service is on the health center's campus which also consists of a 68 bed nursing home and 24 bed critical-access hospital. 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 for visiting specialists. We have volunteer members who deliver meals on wheels Monday through Fridays to community members who are in need of this service. At businesses request we go on site for occupational training as requested by the employer. 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, Food shelf drive, 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 a mini health fair for the community was done free of charge at the annual Retail and Business Expo that was held at the local community center. This was a joint event with the Mayo Clinic Health System - Mankato clinic that is in Le Sueur. We also have an updated website www.mvhc.org on which we are able to get info out to the community. 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 is part of Essentia Health, an integrated health system of 16 hospitals, 65 clinics and several long-term care 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 live-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, through the Essentia Institute of Rural Health. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans. 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 were using a fully-integrated EHR for patient care. Technology like the electronic health record and telehealth 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 Minnesota Valley Health Center files a community benefit report in Minnesota. true Nursing Home Scholarship Program 3 7080 Schedue I, Part III Procedures for monitoring grants: 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 X false true false false false false false false false MICHAEL HEDRIX 0 257782 0 60355 0 35715 0 44545 0 43777 0 442174 0 32949 PATRICIA TOWNSDIN 0 105096 0 19380 0 693 0 20284 0 10518 0 155971 0 0 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan: Amounts related to participating in a supplemental nonqualified retirement plan are reported in Schedule J, Part II, Column C, and amounts related to receiving payment from a supplemental nonqualified retirement plan are reported in Schedule J, Part II, Column B (iii). The following individuals listed in Form 990, Part VII, Section A, Line 1a received payment from a supplemental nonqualified retirement plan during the year: Michael Hedrix (Critical Access Group) $32,949 PATRICIA TOWNSDIN (Critical Access Group) $0 Critical Access Group's nonqualified retirement plan is offered to Critical Access Group executives. There is a minimum two year vesting date, benefits are subject to income taxes upon vesting, and benefits are payable from Critical Access Group's general assets. 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, 546 swing bed days, and 23,811 long term care days during the fiscal year ended June 30, 2012. There were 1,783 emergency room visits and 17,716 outpatient visits during the same time period. Also, during fiscal year 2012 there were 1,434 meals delivered to community members through the Meals on Wheels Program and 4,726 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 $21,000 in charity care during the fiscal year ended June 30, 2012. Further community benefits provided during the fiscal year include community services of over $6,000 and subsidized health services of over $21,000. Form 990,Part VI, Line 6 Members of Organization: City of Le Sueur and Critical Access Group may elect one or more members of the governing body as described in Schedule O Part VI Line 7a. 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 Member with right to elect governing body: According to its Bylaws, the City of Le Sueur shall appoint and remove one board member. Critical Access Group shall appoint and remove Minnesota Valley Health Center, Inc.'s remaining governing body. Form 990, Part VI, Line 7b Members with right to approve governing body decision: 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 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 Ethical and Religious Directives for Catholic Health Care Services would be used at the Catholic entities or money generated by Catholic entities would be used in the providing of services contrary to the Ethical and Religious Directives for Catholic Health Care Services 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, Section A, 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 2011 Form 990 including all schedules was reviewed by Minnesota Valley Health Center, Inc. management and governing body on April 23, 2013 prior to filing with the Internal Revenue Service. Each current director of the governing body received a copy of the 2011 Final 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: Interested persons annually disclose relationships which might lead to a conflict of interest by completing a conflict of interest disclosure form. Interested persons include any person in a position to exercise substantial influence over the organization. It includes but is not limited to any director, officer, management, employee, or committee member of Essentia Health or any of its affiliates. Essentia is responsible for the annual distribution of conflict of interest forms and review of disclosures for the governing bodies of Essentia and Essentia Operating Members and for senior management employees of Essentia. Transactions with parties with whom a conflict of interest exists may be undertaken only if all of the following are observed: the conflict of interest is fully disclosed; the interested person with the conflict of interest doesn't participate in the approval of such transactions; if practical or appropriate, a competitive bid or comparable valuation is obtained; and the board or committee of the board has determined that the transaction is in the best interest of the organization. Disclosure by any interested person other than a board or committee member should be made to the Chief Executive Officer (or if she/he is the one with the conflict, then to the board chair), who will bring the matter to the attention of the board or an appropriate committee of the board. Disclosure involving board or committee members should be made to the board chair (or if she/he is the one with the conflict, then to the board vice chair), who will bring these matters to the board or an appropriate committee of the board. The board or committee of the board will determine whether a conflict exists and if so, whether the contemplated transaction may be authorized as just, fair, and reasonable to Essentia or its affiliate(s). The decision of the board or a duly constituted committee of the board on these matters will be at its sole discretion, and its concern must be the welfare of Essentia and its affiliate(s) and the advancement of its purposes. The decision of the board is final. If the board determines a conflict does not exist, the interested person may proceed with the transaction; however, he/she will not be eligible to vote on related issues should they arise. If the board determines a conflict does exist, the interested person will be notified of the decision regarding whether the contemplated transaction will be authorized as just, fair, and reasonable. Form 990, Part VI, Section B, Line 15a 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's President was during 2009. 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. Part VII Section A Line 1a Column B Hours devoted to related organizations: The following individual listed in Form 990, Part VII, Section A, Line 1a also devoted time each week to related organizations: Michael Hedrix is employed by Critical Access Group as Critical Access Group Senior Vice President of Operations. 100% of his time is spent furthering the purpose of Critical Access Group and related organizations. Form 990, Part XI, Line 5 Other Changes in Net Assets: The total amounts of other changes in net assets include: Unrealized loss on trading securities: ($5,884) Change in Beneficial Interest of Minnesota Foundation: $196,089 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. BRAINERD LAKES INTEGRATED HEALTH SYSTEM 2024 S 6TH ST BRAINERD MN 56401 371532145 SUPPORT ORG MN 501(c)(3) 11 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 1027 WASHINGTON AVE DETROIT LAKES MN 56501 263837203 ASC MN 501(c)(3) 3 CAG true STBENEDICTS FAMILY MED CTR thru 10111 709 N LINCOLN JEROME ID 83338 820227163 CLINIC/HOSP ID 501(c)(3) 3 CAG true ST MARY'S HOSPITAL & CLINICS 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 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 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 HILLIGROSS 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) 11 III-FI NA false DIVINE MEDICAL SERVICES thru 10111 709 N LINCOLN JEROME ID 83338 202773717 EMERG SRVS ID 501(c)(3) 3 SBFMC true 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 PMC-Gateway Imaging LLC 109 Court Ave S Sandstone MN 55072 261634764 Imaging ServiCES MN NA NONE 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 Essentia Health Insurance Services SPC Buckingham Sq 720 W Bay Rd PO 69 Grand Cayman Cayman Islands CJ KY1-1102 000000000 Insurance CJ NA Foreign Corp 0 0 0.00000 false false true false false false false false false false false true false false true false false true Critical Access Group l 245580 actual costs Critical Access Group o 979078 actual costs Essentia Health o 200613 actual costs Schedule R, Part II, Column (a) Name: In 2011, many Essentia entities adopted a doing business as name as part of a system-wide rebranding strategy using the Essentia brand. 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 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