FIRST CARE MEDICAL SERVICES: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: FIRST CARE MEDICAL SERVICES (EIN 41-0706143)
Tax period: 2011-07-01 to 2012-06-30
Filed: 2013-05-08
IRS object ID: 201301289349301945
Schema version: 2011v1.5
Source: Download XML · Original 990 at ProPublica

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

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-05-08T16:46:14-05:00	Timestamp
Tax Period End Date	2012-06-30	TaxPeriodEndDate
Return Type	990	ReturnType
Tax Period Begin Date	2011-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	410706143	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	First Care Medical Services	BusinessNameLine1

Field	Value	IRS element (for citing)
In Care Of Name	% KIM BODENSTEINER	InCareOfName
Name Control	FIRS	NameControl
Phone	2184351133	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	900 Hilligoss Blvd SE	AddressLine1
City	Fosston	City
State	MN	State
ZIP Code	56542	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	PATRICIA WANGLER	Name
Title	President	Title
Date Signed	2013-05-06	DateSigned

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-25 16:41:14Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

Field	Value	IRS element (for citing)
Business Name Line1	Essentia Health Fosston	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Patricia Wangler	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	900 HILLIGOSS BLVD SE	AddressLine1
City	Fosston	City
State	MN	State
ZIP Code	56542	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	21314778	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.essentiahealth.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1993	YearFormation
State Legal Domicile	MN	StateLegalDomicile
Activity Or Mission Description	We are called to make a healthy difference in people's lives.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	8	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	7	NbrIndependentVotingMembers
Total Nbr Employees	288	TotalNbrEmployees
Total Nbr Volunteers	174	TotalNbrVolunteers
Total Gross UBI	1375	TotalGrossUBI
Net Unrelated Business Txbl Income	-573	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	185354	ContributionsGrantsPriorYear
Contributions Grants Current Year	203756	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	19035671	ProgramServiceRevenuePriorYear
Program Service Revenue CY	20750168	ProgramServiceRevenueCY
Investment Income Prior Year	88294	InvestmentIncomePriorYear
Investment Income Current Year	85107	InvestmentIncomeCurrentYear
Other Revenue Prior Year	312078	OtherRevenuePriorYear
Other Revenue Current Year	273180	OtherRevenueCurrentYear
Total Revenue Prior Year	19621397	TotalRevenuePriorYear
Total Revenue Current Year	21312211	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	12640403	SalariesEtcPriorYear
Salaries Etc Current Year	14024972	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	6670024	OtherExpensePriorYear
Other Expenses Current Year	6892922	OtherExpensesCurrentYear
Total Expenses Prior Year	19310427	TotalExpensesPriorYear
Total Expenses Current Year	20917894	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	310970	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	394317	RevenuesLessExpensesCY
Total Assets BOY	19583198	TotalAssetsBOY
Total Assets EOY	19155466	TotalAssetsEOY
Total Liabilities BOY	12148540	TotalLiabilitiesBOY
Total Liabilities EOY	11369377	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	7434658	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	7786089	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	WE ARE CALLED TO MAKE A HEALTHY DIFFERENCE IN PEOPLE'S LIVES.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	17139850	Expense
Revenue	20969131	Revenue
Description	See Schedule O	Description
Total Program Service Expense	17139850	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	true	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	true	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	true	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	true	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	true	RelatedOrgControlledEntity
Transaction Related Entity	true	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	2	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	288	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	true	UnrelatedBusinessIncome
Form990-T Filed	true	Form990-TFiled
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	8	NbrVotingGoverningBodyMembers
Number Independent Voting Members	7	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	true	MembersOrStockholders
Election Of Board Members	true	ElectionOfBoardMembers
Decisions Subject To Approval	true	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	MN	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	KIM BODENSTEINER	NamePerson
Telephone Number	2184357633	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	900 HILLIGOSS BLVD SE	AddressLine1
City	Fosston	City
State	MN	State
ZIP Code	56542	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee
Robert Overmoe
Board Chair	1.0	X	X	0	0	0
Dave Hamre
Board Vice Chair	1.0	X	X	0	0	0
Barbara Muesing
Board Secretary	1.0	X	X	0	0	0
Chuck Lucken
Board Treasurer	1.0	X	X	0	0	0
Larry LePier
Board Director	1.0	X		0	0	0
Dean Anderson
Board Director	1.0	X		0	0	0
Edgar Olson
Board Director	1.0	X		0	0	0
Wesley Ofstedal MD
Board Director	60.0	X		0	358613	38161
Patricia Wangler
President	60.0		X	0	215909	50314
Kimberly Bodensteiner
CHIEF FINANCIAL OFFICER	40.0		X	115438	0	18379
Charles Winjum MD
Chief Medical Officer	60.0			0	392019	39503	X
Mary Kay Lane
CRNA	40.0			178179	0	20763		X
Lawrence Yunker
CRNA	40.0			160326	0	7930		X
Lynae Finseth
Clinical Service Executive	40.0			110838	0	5074		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	564781	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	966541	TotalReportableCompFrmRltdOrgs
Total Other Compensation	180124	TotalOtherCompensation
Number Individuals GT100 K	4	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Kraus-Anderson Construction
206 Beltrami Avenue	BEMIDJI	MN	56601	Bldg Construction	1987041
Shared Medical Technology
202 W Newton St	RICE LAKE	WI	54868	Ultrasound & Nuc Med	240005
Garden Valley Telephone Cooperative
210 Ross Ave PO Box 259	ERSKINE	MN	56535	phone srvs & maint	134240
DMS Health Technologies
1231 16th St N	FARGO	ND	58102	Mammogram Fees	119686
Quest Diagnostics
PO Box 12989	CHICAGO	IL	60693	lab professional fee	114247

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	6	NumberOfContractorsGT100K
Government Grants	33240	GovernmentGrants
All Other Contributions	170516	AllOtherContributions
Total Contributions	203756	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	PATIENT SERVICE REVENUE	Description
Business Code	621110	BusinessCode
Total Revenue Column	20750168	TotalRevenueColumn
Related Or Exempt Function Income	20748793	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	1375	UnrelatedBusinessRevenue

Field	Value	IRS element (for citing)
Total Program Service Revenue	20750168	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	83974	TotalRevenueColumn
Exclusion	$83,974	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Other	3700	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	2567	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Other	1133	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	1133	TotalRevenueColumn
Exclusion	$1,133	ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	ExclusionExclusionAmount
AMBULANCE SUBSIDY	900099	111502	111502
WRITTEN OFF ACCOUNT RECOVERIES	900099	102519	102519
DIETARY MEALS	722210	49134		$49,134

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	10025	TotalRevenueColumn
Related Or Exempt Function Income	4942	RelatedOrExemptFunctionIncome
Exclusion	$5,083	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	273180	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	21312211	TotalRevenueColumn
Related Or Exempt Function Income	20967756	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	1375	UnrelatedBusinessRevenue
Exclusion	$139,324	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	0	Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	0	Total

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	991051	Total
Program Services	660848	ProgramServices
Management And General	330203	ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	10614108	Total
Program Services	8604709	ProgramServices
Management And General	2009399	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	336403	Total
Program Services	273017	ProgramServices
Management And General	63386	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	794940	Total
Program Services	659051	ProgramServices
Management And General	135889	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	1288470	Total
Program Services	1128413	ProgramServices
Management And General	160057	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	8139	Total
Management And General	8139	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	25687	Total
Management And General	25687	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	1375	Total
Management And General	1375	ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	964511	Total
Program Services	759730	ProgramServices
Management And General	204781	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	5007	Total
Management And General	5007	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	1444522	Total
Program Services	1365602	ProgramServices
Management And General	78920	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	129866	Total
Management And General	129866	ManagementAndGeneral

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	865298	Total
Program Services	865298	ProgramServices

Travel Travel

Field	Value	IRS element (for citing)
Total	110631	Total
Program Services	90382	ProgramServices
Management And General	20249	ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	37962	Total
Program Services	24535	ProgramServices
Management And General	13427	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	31207	Total
Program Services	31207	ProgramServices

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	1071860	Total
Program Services	599500	ProgramServices
Management And General	472360	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	43179	Total
Program Services	31404	ProgramServices
Management And General	11775	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
MEDICAL SUPPLIES	684225	684225
BAD DEBT EXPENSE	538870	538870
MAINTENANCE & REPAIRS	481652	402253	79399
MN CARE TAX	193177	193177

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	255754	Total
Program Services	227629	ProgramServices
Management And General	28125	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	20917894	Total
Program Services	17139850	ProgramServices
Management And General	3778044	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	824170	BOY
EOY	1259697	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	3129688	BOY
EOY	1240945	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	3408474	BOY
EOY	3236521	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	242302	BOY
EOY	247577	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	77395	BOY
EOY	68497	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	23582457	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	11172249	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	11179876	BOY
EOY	12410208	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	618945	BOY
EOY	629629	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	102348	BOY
EOY	62392	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	19583198	BOY
EOY	19155466	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	2246505	BOY
EOY	1915558	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	4800	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	9385328	BOY
EOY	9102234	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	516707	BOY
EOY	346785	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	12148540	BOY
EOY	11369377	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	7429425	BOY
EOY	7728498	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	5233	BOY
EOY	57591	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	7434658	BOY
EOY	7786089	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	19583198	BOY
EOY	19155466	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	394317	ReconcilationRevenueExpenses
Reconcilation Other Changes	-42886	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	true	FederalGrantAuditRequired
Federal Grant Audit Performed	true	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbying
Total Direct Lobbying		TotalDirectLobbying
Total Lobbying Expenditures		TotalLobbyingExpenditures
Other Exempt Purpose Expenditures		OtherExemptPurposeExpenditures
Total Exempt Purpose Expenditures		TotalExemptPurposeExpenditures
Lobbying Nontaxable		LobbyingNontaxableAmount
Grassroots Nontaxable		GrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non Tx		TotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying Nontx		TotLobbyExpendMnsLobbyingNontx
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$1,375	OtherActivitiesAmount
Total Lobbying Expenditures IIB	1375	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3
Form4720 Filed4912 Tax	false	Form4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Schedule C, Part II-B	Identifier
Explanation	Lobbying Activity Explanation: Essentia Health Fosston pays dues to certain organizations related to the industry which have lobbying expenses. The amount listed is the percentage of the dues paid that were used for lobbying.	Explanation

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amts		ArtPublicExhibitionAmts
Held Works Of Art Amts		HeldWorksOfArtAmts
Agent Trustee Etc	false	AgentTrusteeEtc
Included On FS	true	IncludedOnFS
Current Year Minus3 Years		CurrentYearMinus3Years

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	56837	OtherCostOrOtherBasis
Book Value	56837	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	14133400	OtherCostOrOtherBasis
Depreciation	4687541	Depreciation
Book Value	9445859	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	243472	OtherCostOrOtherBasis
Depreciation	236939	Depreciation
Book Value	6533	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	8951046	OtherCostOrOtherBasis
Depreciation	6247769	Depreciation
Book Value	2703277	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	197702	OtherCostOrOtherBasis
Depreciation	0	Depreciation
Book Value	197702	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	12410208	TotalOfBookValueLandBuildings
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescription	AmountAmount
PAYABLES TO RELATED TAX-EXEMPT ORGS	$198,360
ASSET RETIREMENT OBLIGATION	$148,425

Field	Value	IRS element (for citing)
Total Of Amounts	346785	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifier

ExplanationExplanation

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 IV, Line 2B

Essentia Health Fosston acts as custodian for the funds of the residents. Resident trust funds totaled $4,800 at June 30, 2012.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	true	FPGReferenceFreeCare
Pcent150	X	Pcent150
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare
Pcent200 D	X	Pcent200D
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	false	ExpensesExceededBudget
Annual Community Benefit Report	true	AnnualCommunityBenefitReport
Report Publically Available	true	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Persons Served	34	PersonsServed
Total Community Benefit Expense	80117	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	80117	NetCommunityBenefitExpense
Percent Of Total Expense	0.00390	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Persons Served	0	PersonsServed
Total Community Benefit Expense	2113043	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2157127	DirectOffsettingRevenue
Net Community Benefit Expense	-44084	NetCommunityBenefitExpense
Percent Of Total Expense	0.00220	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Persons Served	0	PersonsServed
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Persons Served	34	PersonsServed
Total Community Benefit Expense	2193160	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2157127	DirectOffsettingRevenue
Net Community Benefit Expense	36033	NetCommunityBenefitExpense
Percent Of Total Expense	0.00170	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Persons Served	0	PersonsServed
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Persons Served	0	PersonsServed
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Persons Served	0	PersonsServed
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Persons Served	0	PersonsServed
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Persons Served	0	PersonsServed
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Persons Served	0	PersonsServed
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Persons Served	34	PersonsServed
Total Community Benefit Expense	2193160	TotalCommunityBenefitExpense
Direct Offsetting Revenue	2157127	DirectOffsettingRevenue
Net Community Benefit Expense	36033	NetCommunityBenefitExpense
Percent Of Total Expense	0.00170	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$538,870	BadDebtExpenseAmount
Amount Attributable To	2187	AmountAttributableTo
Amount Reimbursed By Medicare	4541416	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	4496451	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	44965	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Other	X	Other

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	ESSENTIA HEALTH FOSSTON	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	900 HILLIGROSS BLVD SE	AddressLine1
City	FOSSTON	City
State	MN	State
ZIP Code	56542	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Critical Access Hospital	X	CriticalAccessHospital
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	ESSENTIA HEALTH FOSSTON	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
Eligibility Criteria Explained	true	EligibilityCriteriaExplained
Uses FPG Free	true	UsesFPGFree
FPG Free Percent	150.	FPGFreePercent
Uses FPG Discounted	true	UsesFPGDiscounted
FPG Discount Percent	200.	FPGDiscountPercent
Explains Basis	true	ExplainsBasis
Income Level	X	IncomeLevel
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
Explains Application Method	true	ExplainsApplicationMethod
Includes Publicity Measures	true	IncludesPublicityMeasures
Posted In Admission Office	X	PostedInAdmissionOffice
Provided On Admission	X	ProvidedOnAdmission
Available On Request	X	AvailableOnRequest
Actions On Nonpayment	true	ActionsOnNonpayment
Collection Activities	false	CollectionActivities
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	5	NumberOfOtherFacilities

Other Facilities OtherFacilities (5 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
ESSENTIA HEALTH ERSKINE CLINIC
101 VANCE AVENUE SOUTH	ERSKINE	MN	56535	CLINIC
ESSENTIA HEALTH OKLEE CLINIC
400 GOVERNOR STREET	OKLEE	MN	56742	CLINIC
ESSENTIA HEALTH FOSSTON CLINIC
102 SATHER DRIVE	FOSSTON	MN	56542	CLINIC
ESSENTIA HEALTH FIRST CARE LIVING CENTER
900 HILLIGROSS BOULEVARD SOUTHEAST	FOSSTON	MN	56542	NURSING HOME
ESSENTIA HEALTH BAGLEY CLINIC
121 CENTRAL STREET WEST	BAGLEY	MN	56621	CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (8 entries)

IdentifierIdentifier	ExplanationExplanation
Schedule H, Part VI, Line 1	Provide the description required for Part I, lines 3c, 6a, 7g, 7, column (f), 7; Part II; Part III, lines 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: not applicable, organization uses Federal Poverty Guidelines. Part I, line 6a Essentia Health Fosston'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 Essentia Health Fosston's parent corporation. Part 1, line 7g Not applicable. Part I, line 7, column (f) Bad debt expense that was subtracted from total expense to obtain the % of community benefit to total expense amounted to $538,870. 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 ESSENTIA HEALTH FOSSTON 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 ESSENTIA HEALTH FOSSTON's financial assistance policy had the proper documentation been completed and filed. As that tracking was not in place during the fiscal year, ESSENTIA HEALTH FOSSTON 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 Essentia Health Fosston 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 Essentia Health Fosston 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 Each Essentia Health hospital is required to file a Medicare cost report 5 months after the close of their fiscal year. The cost report provides Medicare with information that is used to determine utilization and spending trends but also is used to set future payment rates for most Medicare services. If the interim payments paid to a hospital are higher or lower than the filed cost report allowable reimbursement there will be a settlement for that fiscal year. This can be due to changes in utilization or cost of providing services for Critical Access Hospitals (CAH) or differences between interim and final payment factors for Disproportionate Share, Bad Debts, or Indirect Medical Education for non-CAH hospitals. An estimate for these settlements is recorded at the close of the fiscal year. If the estimate varies from the final settlement received 6-7 months after the fiscal year ends then these amounts are recorded as prior year Medicare revenue. Part III, line 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: Essentia Health Fosston assesses our service area's needs through programs we offer, requests we receive, and staff involvement in their own communities. We also collaborate with other community organizations. Service usage patterns are monitored by administrators and doctors are consulted for needed care improvements in monthly medical staff meetings. Leadership participates in a variety of community activities which provide an opportunity to understand healthcare needs. An annual health fair is hosted to provide information and education to our community about health issues and to promote our healthcare services. We want to encourage our community members to take an active role in their own health care by taking steps towards a healthier lifestyle. We invite health-related organizations to present their information as well. Feedback is obtained from those who attend the health fair as to what information was beneficial to them. The fair is another forum where the hospital's staff can hear the needs of community members. The needs of the community are also assessed by review of diagnosis for which treatment was rendered over the course of a targeted range of time. Finally, market share reports are reviewed quarterly to identify trends and annually to develop strategy to address or augment the trends. These reports enable us to understand what we do not capture from our market and determine whether we need to add staff or change services.
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: We continue to supply patient information in our front lobby and various locations throughout the building, on all state programs as well as the facility's community care program. Also, during the admission process, the admitting clerk will verify insurance. If the admitting clerk identifies any patient as uninsured or underinsured, the admitting clerk shall notify the patient account representative. The patient account representative is then responsible to meet with each of these patients and determine what assistance options (Medicare, Medicaid, MinnCare, Insurance, etc.) may be available and appropriate for them. The patient account representative shall also review the "uncompensated care" and/or the "discount to the uninsured" program with them including an application form when appropriate.
Part VI, Line 4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves: Essentia Health Fosston is located in Fosston, MN. Essentia Health Fosston is a part of the larger Essentia Health system, which is defined in Part VI, line 6. Essentia Health Fosston operates 1 hospital, 4 clinics, nursing home, home health, hospice, life support ambulance service, and assisted living that serves the communities of Polk, Clearwater, Mahnomen, and Red Lake Counties which include the cities of Fosston, Erksine, McIntosh, Trail Mentor, Fertile, Winger, Lengby, Beltrami, Gully, Clearbrook, Bagley, Gonvick Leonard, Shevlin, Oklee, Red Lake Falls, Brooks, Plummer, Mahnomen, Bejou, Naytahwaush and Waubun. . The overall community is classified as Rural. Essentia Health Fosston and its related businesses cover a service region of approximately 21,000 people. The service region age distribution is 24.1% under the age of 18; 54.7% between the ages of 18 and 65; and 21.2% over the age of 65. The racial makeup of the service region is 88.1% Caucasian; 0.3% Black or African American; 7.4% American Indian or Alaskan Native; 0.4% Asian; 3.3% two or more races; and 0.5% other. The gender split ratio is 50.1% women and 49.9% men. The average income for the service area is approximately $48,000. Approximately 10.6% of the population falls below the federal poverty guidelines. Essentia Health Fosston, 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 17.6% of their net revenue dollars were Medicaid recipients. As mentioned above, Essentia Health Fosston 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: Essentia Health Fosston's board of directors is composed of volunteer representatives from the communities it serves. Essentia Health Fosston has an open Medical Staff, so any qualified physician of the community is allowed to apply. All applicants that apply must meet the credentialing standards and be approved by our governing board in order to come and provide services in our system. The organization does not have a surplus of funds, but rather reinvests in services provided through keeping equipment and practices state of the art and standardized with best practice. We also invest in our staff training and retention in order to ensure delivery of high quality care. Outcomes in all major service lines are producing outcomes in publicly reported indicators at the 90th percentile. In addition we actively seek participation in healthcare educational curriculums of local colleges and universities and currently are a training site for nurses. Administration had a Nursing Home Administration intern this past fall and winter and had a hospital administration intern this past summer as a commitment to future leadership training in healthcare. Essentia Health Fosston's mission is to make a healthy difference in the lives of people in the community. In order to accomplish this, a full array of services across the continuum of life and health needs has been established. Many of the services, in particular the nursing home and home health and hospice are subsidized from hospital operations. The 50 bed nursing home loses approximately $25.00 per occupied bed per day and runs at high occupancy, exceeding 96% average daily census. The organization provides community educational opportunities at no cost to the public through health fairs, targeted education session for specific diseases and conditions in order to further the mission. Essentia Health Fosston uses many volunteers to deliver a volume of services with estimated value of well over $100,000 annually in order to enable staff to be more efficient in service provided. A variety of media are used to reach the public on seasonal or problem health conditions of the community. One of the most promising opportunities at this time is working with the community on a community garden, a project that was start in collaboration with private industry, the Heritage Center and Essentia Health Fosston. The project is a promotion if healthy eating, increasing fresh vegetables in the diet. Another project that we are working on in conjunction with the City of Fosston and other civic groups is to construct a non-motorized exercise path around the town. This project has been planned and costed and various entities including Essentia Health Fosston Foundation and Essentia Health Staff are participating in raising funds for this health promotion project. Essentia Health Fosston is a part of a larger system Essentia Health. As a non-profit organization, Essentia Health is focused on reinvesting surplus revenues into medical training, programs and technology that improve patient care. We are also committed to eliminating geographic barriers to care. Two of the most significant investments in 2012 were in the areas of telehealth and electronic medical records, technologies that link rural patients and physicians with medical specialists at Essentia's medical centers in Fargo, ND, and Duluth, MN. We also continue to replace and upgrade facilities and technology, like MRIs, CT scanners and ambulatory infusion centers to ensure patients in rural communities have access to these services in their home communities. We are also investing in the development of medical homes, which are designed to improve health outcomes for patients, particularly those with chronic diseases. Much of this work is not fully reimbursed by state or federal programs, so Essentia Health assumes responsibility for medical home costs. We also support the health of our communities through active research and clinical trials through the Essentia Institute of Rural Health. Various Essentia Health organizations contributed approximately $5.5 million in support to the Institute over the past year. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans.
Part VI, Line 6	Essentia Health Fosston 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	Essentia Health Fosston files a community benefit report in Minnesota.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Written Employment Contract	X	WrittenEmploymentContract
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	true	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Wesley Ofstedal MD
0	355064	0	3291	0	258	0	22678	0	15483	0	396774	0	0
Patricia Wangler
0	182482	0	32157	0	1270	0	38826	0	11488	0	266223	0	0
Mary Kay Lane
178179	0	0	0	0	0	7623	0	13140	0	198942	0	0	0
Lawrence Yunker
160326	0	0	0	0	0	7390	0	540	0	168256	0	0	0
Charles Winjum MD
0	388791	0	2970	0	258	0	22678	0	16825	0	431522	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifier

ExplanationExplanation

Scheduel J, Part I, Line 3

Essentia Health Fosston relied on Critical Access Group's, related organization of Essentia Health Fosston, methods for establishing Essentia Health Fosston's President's compensation: written employment contract.

Scheduel 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 individual listed in Form 990, Part VII, Section A, Line 1a participated in a supplemental nonqualified retirement plan during the year. The individual did not received payment during the year. Patricia Wangler (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.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Field	Value	IRS element (for citing)
Name Person	Brittany Djernes	NamePerson

Field	Value	IRS element (for citing)
Relationship	Related to Larry Lepier	Relationship
Amount Of Transaction	22977	AmountOfTransaction
Description Of Transaction	See Part V	DescriptionOfTransaction
Sharing Of Revenues	false	SharingOfRevenues

Form990 Schedule L Part V Form990ScheduleLPartV

Field	Value	IRS element (for citing)
Identifier	Schedule L, Part IV, Column D	Identifier
Explanation	Description of transaction: Compensation of family member of board member	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifier	ExplanationExplanation
Form 990, Part III, Line 4	Program service accomplishments: First Care Medical Services dba Essentia Health Fosston is a not-for-profit, community-based medical facility that operates critical access hospital, advanced life support ambulance service, clinics, nursing home and home health/hospice services in rural Northwest, Minnesota. All patients of the hospital and hospice receive service regardless of their ability to pay. Essentia Health Fosston employs over 200 full time equivalents. Essentia Health Fosston provided charity care of over $80,000 during the fiscal year ended June 30, 2012. Essentia Health Fosston, in fulfilling its responsibility to the community, provides support to other not-for-profit community organizations that also promote health improvement, offers education and health programs and outreach programs to the community, and support the community through employee volunteer efforts and donations. In 2012 employees donated more than 2,230 hours to improve the community's knowledge and participation in health improvement and activities. These include health fairs at which blood sugar, cholesterol and blood pressure screening were done, conducting health education on wellness and prevention to student groups, sponsoring health occupation students in experience chosen health care professionals work life, the American Cancer Society local Light Up A Night activity and other non-profit organizations in our community. Essentia Health Fosston also teaches prenatal classes and holds child car seat safety clinics. Diabetes, a rapidly growing disease concern is addressed by providing diabetic education and support groups to any community member that desires the information as well as those who have physician orders for the service. We actively participate in the regional bio-terrorism committee and work with the county as well to implement a coordinated plan followed by participation in exercises of the disaster plan in order to be more fully prepared in the event of disaster. The hospital provided for over 2,000 hospital patient days and over 66,000 outpatient visits during the fiscal year ended June 30, 2012. The clinic had over 24,000 encounters during the same time period.
Form 990, Part VI, Line 6	Members of Organization: City of Fosston and Essentia Health West may elect one or more members of the governing body as described in Schedule O Part VI Line 7a. Essentia Health and Essentia Health West have reserved powers with respect to Essentia Health Fosston as described in Schedule O Part VI Line 7b.
Form 990, Part VI, Line 7a	Members with right to elect governing body: According to its Bylaws, the City of Fosston shall apoint and remove one board member and Essentia Health West shall appoint and remove all Essentia Health Fosston's remaining board members.
Form 990, Part VI, Line 7b	Members with Right to approve governing body decisions: Essentia Health Fosston 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. Essentia Health West shall have the following reserved powers over the West Region entities: Quality, Safety, and Service. Authority to recommend quality and safety initiatives and to review and execute approved quality and safety plans for the West Region. Mission, Vision and Values. Authority to create a mission and a vision that support the mission and vision of Essentia Health; responsibility to oversee the mission performance, including charity care, of all facilities within the West Region; responsibility to adopt the value of Essentia Health. Operating and Financial Performance. Responsibility to oversee the operating and financial performance of the West Region. Development of Budgets, Strategic Plans and Strategy Map. Authority to develop and recommend, based on Essentia Health targets, capital and operating budgets for the West Region and its facilities; authority to recommend, within the Essentia Health context, regional and local strategic plans for the West Region; authority to develop West Region governance strategy map and balanced scorecard within Essentia Health's system strategy to meet system goals. Execution of Approved Budgets and Strategic Plans. Responsibility to execute the approved capital and operating budgets and strategic and business plans for the West Region. Non-budgeted Expenditures. Authority to approve non-budgeted capital purchases and leases for West Region facilities within dollar limits defined by Essentia Health. Accreditation and Licensure. Responsibility to oversee accreditation and licensure compliance for the facilities of the West Region. Affiliations and Joint Ventures. Authority to recommend proposed affiliations, joint ventures and other alliances; responsibility to oversee negotiation and implementation of approved acquisitions and operation of all approved affiliations, joint ventures and other alliances with third parties within the West Region. Appointment of Directors. Authority to appoint or elect directors of the Direct Subsidiaries, and to remove such directors, with or without cause. Satisfaction. Responsibility to execute, evaluate and oversee patient, family and customer satisfaction with respect to services provided within the West Region and to ensure established goals are met. Job Satisfaction. Responsibility to oversee job satisfaction and staff morale within the West Region facilities. Human Resources. Responsibility to oversee implementation of Essentia Health human resource policies and procedures throughout the West Region. Compliance. Responsibility to execute the approved Essentia Health corporate compliance and risk management plans for the West Region. Credentialing. Responsibility to perform medical staff credentialing for the West Region facilities. Amendments. Authority to suggest proposed amendments to the Articles of Incorporation and Bylaws of the Direct Subsidiaries and any subsidiaries thereof. Compensation Plans. Responsibility to review and approve compensation of West Region executives and physicians for reasonableness and consistency with the law and Essentia Health's compensation philosophy. President/Chief Medical Officer. By action of the President of this Company, authority to appoint and remove, with or without cause, the President/Chief Medical Officer of any of the Direct Subsidiaries. Public Policy. Responsibility to support Essentia Health public policy and advocacy plans. Marketing. Responsibility to coordinate regional marketing and promotional activities consistent with Essentia Health marketing plans. Philanthropy. Responsibility to coordinate philanthropy within the West Region consistent with Essentia Health foundation policies. Professional Services. Responsibility to oversee West Region management's cooperation with external auditors and general legal counsel selected by Essentia Health and coordination of legal services through the Essentia Health Office of General Counsel. Catholic Facilities. Responsibility to oversee implementation of BSBA-approved methods, policies and procedures pertaining to adherence by the West Region Catholic facilities with the ERDs and use of religious symbols, distinguishing elements and prayers. Projects Involving Real Estate. Authority to recommend facility development projects, subject to the approval of Essentia Health; responsibility to oversee execution of approved development projects according to Essentia Health policies.
Form 990, Part VI, Line 11a	Form 990 review process: The 2011 Form 990 including all schedules was reviewed by Essentia Health Fosston's management and governing body on March 18, 2013 prior to filing with the Internal Revenue Service. Each current director of the governing body received a final copy of the 2011 Form 990. Essentia Health Fosston'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, Line 15a	Process for determining compensation: A formal review and approval of Essentia Health Fosston's President's compensation was subsequently performed July 2012.
Form 990, Part VI, Line 19	Availability of governing documents, conflict of interest policy, & financial statements to the public: Essentia Health Fosston makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Essentia Health Fosston 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 VII, Section A, Line 1a, Column B	Hours devoted to related organizations: The following individuals listed in Form 990, Part VII, Section A, Line 1a also devoted time each week to related organizations: Robert Overmoe: approximately 1 hour Wesley Ofstedal, MD is employed by Essentia Health West. 100% of his time is spent furthering the purpose of Essentia Health West and related organizations. Charles Winjum, MD is employed by Essentia Health West. 100% of his time is spent furthering the purpose of Essentia Health West and related organizations.
Form 990, Part XI, Line 5	Other Changes in Net Assets: The total amount of other changes in net assets includes: Unrealized gain on trading securities $2,308 Beneficial interest in Foundation ($45,194)
Form 990, Part XII, Line 3	Consolidated A-133: Essentia Health Fosston, 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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (28 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg
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
BRIDGES MEDICAL CENTER
201 9TH ST W	ADA	MN	56510	200479568	CLINIC/HOSP	MN	501(c)(3)	3	INNOVIS	true
CLEARWATER VALLEY HOSPITAL AND CLINICS
301 CEDAR	OROFINO	ID	83544	820497771	CLINIC/HOSP	ID	501(c)(3)	3	CAG	true
DIVINE MEDICAL SERVICES thru 10111
709 N LINCOLN	JEROME	ID	83338	202773717	EMGERG SRVS	ID	501(c)(3)	3	SBFMC	true
DL SURGERY CENTER
1027 WASHINGTON AVE	DETROIT LAKES	MN	56501	263837203	ASC	MN	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
MINNESOTA VALLEY HEALTH CENTER
621 S 4TH ST	LE SUEUR	MN	56058	410837659	HOSPITAL/NURS	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 JOSEPH'S MEDICAL CENTER
523 N 3RD ST	BRAINERD	MN	56401	410695602	CLINIC/HOSP	MN	501(c)(3)	3	BLIHS	true
ST MARY'S EMS
1027 WASHINGTON AVE	DETROIT LAKES	MN	56501	411805811	EMERG SRVS	MN	501(c)(3)	9	SMRHC	true
ST MARY'S HOSPITAL & CLINICS INC
PO BOX 137	COTTONWOOD	ID	83522	820226453	CLINIC/HOSP	ID	501(c)(3)	3	CAG	true
ST MARY'S INNOVIS HEALTH
1027 WASHINGTON AVE	DETROIT LAKES	MN	56501	262861321	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
ESSENTIA INSTITUTE OF RURAL HEALTH
502 E 2ND ST	DULUTH	MN	55805	271291124	RESEARCH	MN	501(c)(3)	4	ESSENTIA	true
INNOVIS HEALTH LLC
3000 32nd Avenue	FARGO	ND	58103	261175213	CLINIC/HOSP	DE	501(c)(3)	3	ESSENTIA	true
ESSENTIA HEALTH FOUNDATION
502 E 2ND ST	DULUTH	MN	55805	271984704	FOUNDATION	MN	501(c)(3)	7	ESSENTIA	true
MIDWEST MEDICAL EQUIPMENT & SUPPLY INC
4418 HAINES RD	DULUTH	MN	55811	411674021	MEDICAL EQUIP	MN	501(c)(3)	9	SMMC	true
PINE MEDICAL CENTER
109 COURT AVE S	SANDSTONE	MN	55072	411884597	HOSPITAL/NURS	MN	501(c)(3)	3	SMDCHS	true
POLINSKY MEDICAL REHABILITATION CENTER
530 E 2ND ST	DULUTH	MN	55805	410691275	CLINIC	MN	501(c)(3)	3	SMMC	true
SMDC MEDICAL CENTER
502 E 2ND ST	DULUTH	MN	55805	411878730	CLINIC/HOSP	MN	501(c)(3)	3	SMDCHS	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
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 MEDICAL CENTER
407 E 3RD ST	DULUTH	MN	55805	410695604	HOSPITAL	MN	501(c)(3)	3	SMDCHS	true
THE DULUTH CLINIC LTD
400 E 3RD ST	DULUTH	MN	55805	410883623	CLINIC	MN	501(c)(3)	3	SMDCHS	true
NORTHERN PINES MEDICAL CENTER
5211 HWY 110	AURORA	MN	55705	410841441	HOSPITAL/NURS	MN	501(c)(3)	3	SMDCHS	true
GRACEVILLE HEALTH CENTER
115 WEST SECOND ST	GRACEVILLE	MN	56240	410726173	CLINIC/HOSP	MN	501(c)(3)	3	INNOVIS	true

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	PMC-Gateway Imaging LLC	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	109 Court Ave S	AddressLine1
City	Sandstone	City
State	MN	State
ZIP Code	55072	ZIPCode

Field	Value	IRS element (for citing)
EIN	261634764	EIN
Primary Activity	Imaging Servi	PrimaryActivity
Legal Domicile State	MN	LegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	NA	BusinessNameLine1

Field	Value	IRS element (for citing)
Predominant Income Type	NONE	PredominantIncomeType
Share Of Total Income	0	ShareOfTotalIncome
Share Of EOY Assets	0	ShareOfEOYAssets
Code V	$0	CodeVAmount
Percentage Ownership	0.00000	PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Type Of EntityTypeOfEntity	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Percentage OwnershipPercentageOwnership	Address Line1AddressForeign/AddressLine1	Province Or StateAddressForeign/ProvinceOrState	CountryAddressForeign/Country	Postal CodeAddressForeign/PostalCode	Legal Domicile Foreign CountryLegalDomicileForeignCountry
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
				000000000	Insurance		na	Foreign Corp	0	0	0.00000	Buckingham Sq 720 W Bay Rd PO 69	Grand Cayman	CJ	KY1-1102	CJ

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	false	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	true	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	false	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	false	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	true	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	false	PerformOfServicesByOtherOrgs
Sharing Of Facilities	false	SharingOfFacilities
Sharing Of Paid Employees	true	SharingOfPaidEmployees
Reimbursement Paid To Other Org	true	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	false	OtherTransferToOtherOrg
Other Transfer From Other Org	true	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
ESSENTIA HEALTH
O	101269	actual costs
CRITICAL ACCESS GROUP
O	1463291	actual costs
INNOVIS HEALTH LLC
O	2745669	actual costs

Form990 Schedule R Part VII Form990ScheduleRPartVII

Field	Value	IRS element (for citing)
Identifier	SCHEDULE R, PART II, COLUMN (A)	Identifier
Explanation	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 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. 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	Explanation