2013-05-03T16:50:48-05:00 2012-06-30 990 2011-07-01 261175213 Innovis Health LLC % KYLE DOROW INNO 7013643300 3000 32nd Ave S Fargo ND 58103 Kyle Dorow 2013-05-02 2011 2016-02-25 16:41:14Z Essentia Health West Gregory Glasner MD 3000 32nd Ave S Fargo ND 58103 273586245 false X www.essentiahealth.org X LLC 2007 DE We are called to make a healthy difference in people's lives. 13 7 2518 132 724826 251211 37133 45813 259134360 270973139 -2182423 -704791 2381354 2545581 259370424 272859742 250000 577502 0 0 144171719 151490833 0 0 0 116214756 133261017 260636475 285329352 -1266051 -12469610 206182462 220177623 201905639 230886064 4276823 -10708441 X WE ARE CALLED TO MAKE A HEALTHY DIFFERENCE IN PEOPLE'S LIVES. false false 205275235 577502 271940699 See schedule O 205275235 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true false true true false false false false false true false false true true false false false false false true true true false false true X 64 0 true 2518 true true true false false false false false false false false false X 13 7 false false false false true true true true true false false true true true true true true true true true true DE MN X KYLE DOROW 7013643273 1702 SOUTH UNIVERSITY DRIVE FARGO ND 58103 X Larry Leadbetter MD 40.0 X 203040 2725 36994 Thomas Mohs MD 40.0 X 318509 3850 42070 Michael Sheldon MD 60.0 X 298672 18850 40559 James Anderson 1.0 X X 1500 15600 0 Neal Hessen 1.0 X 1600 37750 0 Kevin Moug 1.0 X X 700 5600 0 Helen Keezer 1.0 X 900 4600 0 Benjamin Felty MD 60.0 X 147391 3850 27310 Joel Haugen MD 60.0 X 293206 11350 39177 Laurie Lewandowski 1.0 X 1300 3850 0 Robert Overmoe 1.0 X 1200 2250 0 Sr Luella Wegscheid 1.0 X 0 0 0 Sr Beverly Horn 1.0 X 0 0 0 CURT NOYES 1.0 X 0 0 0 ROBERT WROBLEWSKI MD 60.0 X 350580 0 42003 Gregory Glasner MD 60.0 X 612656 0 96602 Kevin Pitzer 60.0 X 484748 0 72246 Kyle Dorow 60.0 X 222509 0 58495 Ken Gilles 60.0 X 240009 0 68645 Peter Jacobson 60.0 X 268608 0 76569 Kristine Olson 60.0 X 192423 0 42430 Michael Briggs MD 60.0 X 351040 0 39661 Timothy Mahoney MD 60.0 X 692234 0 40053 Sharon Connell-Rick 60.0 X 172874 0 43887 Richard Vetter MD 60.0 X 442726 0 47878 Daniel Smith MD 40.0 X 1008252 0 40179 Jerome Sampson MD 40.0 X 877400 0 38487 Aaron Wright MD 40.0 X 869763 0 44003 Francis Cormier MD 40.0 X 855881 0 41161 BRADFORD SELLAND MD 30.0 X 1053435 0 38162 Todd Forkel 0.0 X 313167 0 39594 10276323 110275 1056165 247 true true false Sodexo Inc Affiliates 4880 Paysphere Circle CHICAGO IL 60674 Cafeteria & Hskpg 821934 Mayo Collaborative Services PO Box 9146 MINNEAPOLIS MN 55480 Lab Testing 614687 Prosource Billing Inc 250 14th Ave E SARTELL MN 56377 Collection agency 521515 MEDQUIST TRANSCRIPTION PO BOX 102467 ATLANTA GA 30368 TRANSCRIPTION 692455 RUSSEL HERDER 315 E RIVER ROAD BRAINERD MN 56401 ADVERTISING 479205 17 45813 45813 NET PATIENT REVENUE 621110 270988073 270420218 567855 INVESTMENT IN PHARMACY 621400 190223 176999 13224 INVESTMENT IN DIALYSIS 621400 50159 50159 INVESTMENT IN MEDICAL OFFICE BUILDING 621400 -255316 -255316 270973139 25196 25196 0 0 294862 143747 294862 143747 438609 143747 294862 -10709 7225 726503 -10709 -719278 -729987 -729987 0 0 0 CAFETERIA & VENDING SALES 722210 822636 822636 AFFILIATE SHARED SERVICE REVENUE 900099 967560 967560 GIFT SHOP 900099 158688 158688 158088 158088 2106972 272859742 271359620 724826 729483 577502 577502 0 0 0 6213042 2366975 3846067 0 120291244 94460606 25830638 5802875 4767699 1035176 11724875 6830412 4894463 7458797 5164488 2294309 0 39740 39740 68669 68669 11138 11138 0 2537 2537 17753433 10821746 6931687 1063316 2869 1060447 7623096 5074098 2548998 4099167 146986 3952181 0 4630560 321975 4308585 1315959 497073 818886 0 957514 604199 353315 6662445 6662445 0 14994520 14689555 304965 3024336 3024336 MEDICAL SUPPLIES 39604240 39487148 117092 BAD DEBT EXPENSE 14887221 14887221 AFFILIATE SUPPORT FEE 13572157 13572157 UNRELATED BUSINESS TAX 88200 88200 2862769 1462147 1400622 285329352 205275235 80054117 0 0 68484 11309021 2532176 0 0 37025532 53751458 94667 13334 0 0 2011292 3237812 4233913 5797002 1161199 716457 190595901 50936292 141011461 139659609 449853 450265 2194269 2107619 1113248 905499 1244962 1196362 4333045 9741546 206182462 220177623 30791050 34827493 0 0 0 0 151865176 150620058 0 0 0 0 3310129 2613148 0 0 15939284 42825365 201905639 230886064 X 4254328 -10730514 22495 22073 0 0 4276823 -10708441 206182462 220177623 X -12469610 -2515654 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 11138 11138 false false Schedule C, Part II-B Essentia Health West 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. 9426157 9426157 109370404 17846162 91524243 1554509 180955 1373554 66665370 32421767 34243603 3579460 487409 3092051 139659608 0 PAYABLES TO RELATED TAX-EXEMPT ORGS 25085301 NON CURRENT SWAP LIABILITY 8844293 PARK RAPIDS AREA PAYABLE 8849006 REAL ESTATE SPECIAL ASSESSMENT 46765 42825365 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. true true X true X true X true true true false true true 0 2611075 0 2611075 0.00970 0 22214217 17308657 4905560 0.01810 0 0 0 0 0.00000 0 24825292 17308657 7516635 0.02780 6 102 84852 0 84852 0.00030 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 6 102 84852 0 84852 0.00030 6 102 24910144 17308657 7601487 0.02810 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 14887221 146209 51187566 62462277 -11274711 X true true Red River Valley Dialysis Services 0.10000 0.20000 0.65000 Dakota Clinic Pharm Retail Pharmacy 0.49000 0.00000 0.00000 Park Rapids Area Clinic 0.50000 0.00000 0.00000 1 1 Essentia Health West

3000 32nd Ave Southwest Fargo ND 58103

X X X Essentia Health West 1 true true 150. true 300. true X X X X X X true false true false true X false false 15 Essentia Health 32nd Avenue Clinic

3000 32nd Avenue Southwest Fargo ND 58103

Multi-Specialty Clinic Essentia Health Wahpeton Clinic

275 South 11th Street Wahpeton ND 58075

Licensed ASC Surgical Center and Primary Care Clinic Essentia Health South University Clinic

1702 South University Drive Fargo ND 58103

Multi-Specialty Clinic Essentia Health Casselton Clinic

5 9th Avenue North Casselton ND 58102

Primary Care Clinic Essentia Health Hankinson Clinic

501 South Main Hankinson ND 58041

Primary Care Clinic Essentia Health Jamestown CLINIC

401 3rd Street Southeast Jamestown ND 58401

Primary Care Clinic Essentia Health Lisbon Clinic

819 Main Street Lisbon ND 58054

Primary Care Clinic Essentia Health Medina Clinic

600 Water Street East Medina ND 58467

Primary Care Clinic Essentia Health Menahga Clinic

212 Aspen Avenue Northeast Menahga ND 56464

Primary Care Clinic Essentia Health Moorhead Clinic

420 Center Avenue Moorhead MN 56560

Primary Care Clinic Essentia Helalth Park Rapids Clinic

705 Pleasant Rapids Clinic Park Rapids MN 56470

Primary Care Clinic Essentia Health Valley City Clinic

132 4th Avenue Northeast Valley City ND 58072

Primary Care Clinic Essentia Health Walker Clinic

Highway 371 Walker MN 56484

Primary Care Clinic Essentia Health West Acres Clinic

3902 13th Avenue South Fargo ND 58103

Primary Care Clinic Essentia Health West Fargo Clinic

1401 13th Avenue East West Fargo ND 58078

Primary Care Clinic Schedule H, Part VI, Line 1 Provide the description required for Part I, lines 3c, 6a, 7g, 7, column (f), 7; Part II; Part III, lines 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 For patients that meet the federal poverty guidelines thresholds, they will receive the appropriate charity care discount. For those that do not meet the federal poverty guideline thresholds, but have an excessive and catastrophic medical liability, the Catastrophic Community Benefit Financial Assistance Program will be applied. The Catastrophic Community Benefit Financial Assistance Program is designed for patients whose household income and assets may exceed the established traditional financial assistance guidelines, but have an excessive and catastrophic medical liability. Excessive and catastrophic medical liability is defined as a financial responsibility exceeding 30% of a family's gross income. Expense Qualification A. Multiply gross household family income by 30%. B. Determine allowable medical expenses. C. If (B) is greater than (A), than the expense qualification is met. Proceed to resource qualification. D. If (A) is greater than (B), patient is not eligible for Catastrophic Community Benefit Financial Assistance. Resource Qualification A. Subtract 30% of gross household family income from allowable medical expenses to determine excess medical expenses. B. Calculate available family assets by excluding from the asset values the following: 1. Primary residence 2. One motor vehicle 3. Retirement accounts 4. Other Assets - 1st $4000 family of one, $6000 for family of two, and $1500 for each additional family member. C. Compare the available family assets to the excess medical expense: 1. If assets are greater, the applicant is not eligible. 2. If assets are less, the applicant is eligible. Part I, line 6a Essentia Health West'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 West'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 $14,887,221. 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 WEST 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 WEST'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 WEST 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 West 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 West 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 VI, LINE 1 CONT PART V, LINE 11H NOT APPLICABLE PART V, LINE 13 Essentia Health West did not have language in their financial assistance policy stating how the policy was to be publicized as of year-end. Since year end, the policy has been revised to add language stating how the policy was to be publicized. Part VI, line 3 describes how Essentia Health West informed patients of the financial assistance policy. PART V, LINE 13G NOT APPLICABLE PART V, LINE 15E NOT APPLICABLE PART V, LINE 16E NOT APPLICABLE PART V, LINE 17E Not applicable. There were no checked boxes in Part V, Section B, Line 16. 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: We assess the community's needs through programs we offer, requests we receive, and staff involvement in their own communities. We collaborate with other community organizations such as The United Way and other local organizations, in common efforts to address community needs. For example, a local foundation researches and studies the educational needs for children around healthy lifestyles. The results of these studies are presented to Essentia Health West and, if a demonstrated need is identified, Essentia Health West then financially supports the initiatives that are suggested by the foundation in promoting these lifestyle program changes through diet and exercise and education in a program called Healthy Kids. Essentia Health West worked with two other organizations collaboratively in the fight against childhood obesity. Through financial donations from Essentia Health West, as well as staff time for educational seminars, both local organizations are able to continue to promote healthy lifestyle changes to help eliminate obesity in children through equipment purchases, education in the schools and after-school programs. Studies from the local organizations have shown that the support Essentia Health West provides helps in reducing local costs in our healthcare systems as well as increasing student achievement in the classroom. Essentia Health West also sponsors specific programs to help address children's health by financially supporting the Kids Program (a year-long program promoting physical activity) and the Youth Run at the annual Fargo Marathon. We also provide financial support to the United Way of Cass Clay based on their ongoing assessments of community needs, including (but not limited to) health-related issues in children and adults. It was also deemed that for a community our size, we should have an estimated 1,000 Automated External Defibrillators available in public areas. With the launch of our HeartSafe Fargo program, we are working to increase the awareness and maintenance of the current 248 while providing the opportunity for additional area businesses to become actively involved in the program. Training received for the device and all ages CPR can not only be used in a public environment, but in homes, schools, etc. so training of this program is an additional benefit to staff who participate. Part VI, line 3 Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's Financial Assistance policy: Essentia Health West has brochures which include charity care information as well as the Financial Assistance application located in all emergency room, urgent care, clinic, and surgery waiting areas. They are also located in the financial counseling offices. During the patient intake process, a patient screening is completed. If it is determined that the patient would be in need of assistance, information about charity care as well as governmental financial assistance programs would be provided. Essentia Health West has financial counselors on staff who have had training through local county agencies and the state (both MN and ND) to assist patients in Medicaid, Medicare and other assistance programs (including the charity care program) that may be available to them. Annual visits to divisional locations are made by the supervisor of the financial counseling staff to educate staff. All hospital staff have been trained to refer patients to the financial counselor. The financial counselors often assist patients with the application process, mailing and follow up. The financial assistance information will be provided patients upon discharge if a financial counselor was used during the patient's stay. Finally, the billing statements indicate that financial assistance is available and lists the financial counselor's contact information. 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 West is located in Fargo, ND. Essentia Health West is a part of the larger Essentia Health system, which is defined in Part VI, line 6. Essentia Health West operates 1 hospital and 15 clinics that serve the communities of Fargo, ND and Moorhead, MN. They also serve the surrounding communities including Casselton, Hankinson, Jamestown, Lisbon, Medina, Valley City and Wahpeton in North Dakota and Detroit Lakes, Fosston, Frazee, Lake Park, Mahnomen, Menahga, Park Rapids and Walker in Minnesota. The overall community is classified as a combination of Suburban and Rural. Essentia Health West and its related clinics cover a service region of approximately 418,000 people. The service region age distribution is 15.8% under the age of 18; 61.6% between the ages of 18 and 65; and 22.6% over the age of 65. The racial makeup of the service region is 92.7% Caucasian; 1.1% Black or African American; 2.6% American Indian or Alaskan Native; 1.0% Asian; 1.8% two or more races; and 0.8% other. The gender split ratio is 49.9% women and 50.1% men. The average income for the service area is approximately $55,000. Approximately 6.9% of the population falls below the federal poverty guidelines. Essentia Health West, along with Essentia Health is committed to serve patients regardless of their ability to pay. 5.8% net revenue dollars were from self pay patients. In addition, approximately 10.3% of their net revenue dollars were Medicaid recipients. As mentioned above, Essentia Health West is part of a larger system, Essentia Health. Essentia Health staffs hospitals and clinics in federally-recognized underserved areas and supports the health of its communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into its smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or are faced with other challenges that make it difficult to travel long distances for care. There are 13 other hospitals outside of the Essentia Health umbrella that service the community. 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: Many physicians, staff and senior administration of Essentia Health West serve on local boards/committees and donate their services free of charge or at a discounted rate. The Essentia Health West board is comprised of 6 Essentia Health West physicians, 2 members from outside the area and 5 volunteer local members of the community Essentia Health West serves. Essentia Health West 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. Any surplus funds at Essentia Health West have historically been re-directed back to our Capital Committee for allocation to pre-identified areas of need such as expansion and equipment needs. Examples of such projects include improved patient access to our Ophthalmology Dept, Neonatal Intensive Care Unit expansion, and the building of a new Medical/Surgical wing. Essentia Health West is active in community fundraising and sponsorship of events that promote healthy lifestyles and healthy communities. Surplus supplies are often donated to charities in need and different service lines are offered to the general public at no cost, i.e.: Tender Transitions, Diabetes Support Group, Gastric Bypass Support Groups. Essentia Health West 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 WEST 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 Not applicable true Essentia Health Foundation 502 E 2nd St Duluth MN 55805 271984704 501(c)(3) 375400 Program Support AMERICAN GOLD GYMNASTICS 2001 17th Ave S FARGO ND 58103 450333196 501(C)(3) 40000 Program Support MARCH OF DIMES-NORTH DAKOTA CHAPTER 1330 PAGE DRIVE SUITE 102 FARGO ND 58103 450341138 501(C)(3) 15000 Program Support FARGO MARATHON 405 W MAIN AVE WEST FARGO ND 58078 432043293 501(C)(3) 10000 Program Support AMERICAN DIABETES ASSOCIATION 1701 N BEAUREGARD ST ALEXANDRIA VA 22311 131623888 501(c)(3) 10000 Program Support CHAMBER OF COMMERCE-FARGO MOORHEAD PO BOX 2443 FARGO ND 581082443 450448041 501(c)(3) 7500 Program Support AMERICAN HEART ASSOCIATION 208 S LASALLE ST CHICAGO IL 60604 135613797 501(c)(3) 6000 Program Support 7 0 Schedule I, Part I, Line 2 Procedures for monitoring grants: Essentia Health West management reviews the grant activity by reviewing and documenting each expenditure request and approving the expense. X true true X X X X X false true false false false false false false false Larry Leadbetter MD 200353 2725 2549 0 138 0 16669 0 20325 0 240034 2725 0 0 Thomas Mohs MD 314555 3850 3864 0 90 0 21761 0 20309 0 360579 3850 0 0 Michael Sheldon MD 294733 18850 3849 0 90 0 21334 0 19225 0 339231 18850 0 0 Gregory Glasner MD 544870 0 64264 0 3522 0 71162 0 25440 0 709258 0 0 0 Kevin Pitzer 361792 0 118227 0 4729 0 69786 0 2460 0 556994 0 0 0 Kyle Dorow 179567 0 29399 0 13543 0 40485 0 18010 0 281004 0 0 0 Ken Gilles 203894 0 33613 0 2502 0 45464 0 23181 0 308654 0 0 0 Peter Jacobson 219110 0 46933 0 2565 0 46538 0 30031 345177 0 0 0 Kristine Olson 166518 0 25126 0 779 0 28204 0 14226 0 234853 0 0 0 Michael Briggs MD 323481 0 27163 0 396 0 22678 0 16983 0 390701 0 0 0 Timothy Mahoney MD 660667 0 31171 0 396 0 22678 0 17375 0 732287 0 0 0 Benjamin Felty MD 137343 3850 10000 0 48 0 12165 0 15145 0 174701 3850 0 0 Joel Haugen MD 270888 11350 22060 0 258 0 21235 0 17942 0 332383 11350 0 0 Todd Forkel 242619 0 46933 0 23615 0 20428 0 19166 0 352761 0 0 0 Sharon Connell-Rick 148143 0 24000 0 731 0 31213 0 12674 0 216761 0 0 0 Richard Vetter MD 414654 0 27982 0 90 0 22678 0 25200 0 490604 0 0 0 Daniel Smith MD 992857 0 15257 0 138 0 22678 0 17501 0 1048431 0 0 0 Jerome Sampson MD 866103 0 10901 0 396 0 22678 0 15809 0 915887 0 0 0 Aaron Wright MD 859124 0 10585 0 54 0 22678 0 21325 0 913766 0 0 0 Francis Cormier MD 855743 0 0 0 138 0 22678 0 18483 0 897042 0 0 0 ROBERT WROBLEWSKI MD 346091 0 4435 0 54 0 22678 0 19325 0 392583 0 0 0 BRADFORD SELLAND MD 1034753 0 8743 0 9939 0 22678 0 15484 0 1091597 0 0 0 Schedule J, Part I, Line 1a Benefits provided: During tax year 2011, as new employees relocating from other areas, current officer, Kyle Dorow, and former key employee, Todd Forkel, each received a housing allowance. This benefit was treated as taxable compensation to these individuals. Schedule J, Part I, Line 3 Establishing CEO's compensation: Essentia Health West relied on Essentia Health's, supporting organization of Essentia Health West, methods for establishing Essentia Health West's President's compensation: a compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board or compensation committee. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan: 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 participated in a supplemental nonqualified retirement plan during the year. None of these individuals received payment during the year. Ken Gilles (Essentia Health West) $0 Gregory Glasner, MD (Essentia Health West) $0 Peter Jacobson (Essentia Health West) $0 Kevin Pitzer (Essentia Health West) $0 Kyle Dorow (Essentia Health West) $0 Kristine Olson (Essentia Health West) $0 Sharon Connell-Rick (Essentia Health West) $0 Todd Forkel (Essentia Health West) $0 Essentia Health West's nonqualified retirement plan is offered to designated Essentia Health West's executives. There is a minimum two year vesting date, benefits are subject to income taxes upon vesting, and benefits are payable from Essentia Health West's general assets. CASS COUNTY NORTH DAKOTA 456002205 148047AT0 2008-05-02 62448178 2008D BONDS (See Sch O) false false false MN AGRICULTURAL AND ECONOMIC DEVELOPMENT BOARD 416007162 604920Z43 2008-05-02 42909274 2008E BONDS (See Sch O) false false false CASS COUNTY NORTH DAKOTA 456002205 148047AU7 2010-02-25 59573111 2008A REOFFERED BONDS (See Sch O) false false false WI HEALTH AND EDUCATION FACILITIES AUTHORITY 391337855 97710BSD5 2010-02-25 12854722 2008B REOFFERED BONDS (See Sch O) false false false 0 0 62448178 0 0 0 882145 1480840 0 60085193 0 0 2008 false false true true 0 0 27898317 0 0 0 744111 631009 0 26523197 0 0 2008 true false true true 0 0 22369703 0 0 0 0 0 0 0 22369703 0 2010 true false true true 0 0 4826948 0 0 0 0 0 0 0 4826948 0 2010 true false true true false false false false 0.00000 0.00000 0.00000 true false false false false 0.00000 0.00000 0.00000 true false false false false 0.00000 0.00000 0.00000 true false false false false 0.00000 0.00000 0.00000 true false false false 0 false 0 false false false false false 0 false 0 false false false false false 0 false 0 false false false false false 0 false 0 false false See Schedule O 0 MN AGRICULTURAL ADN ECONOMIC DEVELOPMENT BOARD 416007162 6049202H0 2010-02-25 165717405 2008C REOFFERED BONDS (See Sch O) false false false MN AGRICULTURAL AND ECONOMIC DEVELOPMENT BOARD 416007162 6049202M9 2010-06-25 109535000 2010 BONDS (See Sch O) false false false 1503723 0 62226886 0 0 0 713185 0 0 0 61513701 0 2010 true false true true 156233 0 3012859 0 0 0 12859 0 0 3000000 0 0 2011 true false false true false false false false 0.00000 0.00000 0.00000 true false false false false 0.00000 0.00000 0.00000 true false false false 0 false 0 false false false true false 0 false 0 false false See Schedule O 0 Benjamin Felty employment incentive X 15000 5000 false true true Kyle Dorow employment incentive X 25000 8334 false true true 13334 Kathleen Mahoney Related to Dr. Mahoney 22105 Employee of Essentia West false West Fargo Medical Property LLC See Schedule L Part V 266400 Leased Property false DMS Health Technologies See Schedule L Part V 632422 Independent Contractor false Schedule L, Part IV, line 2, Column b Relationship: Greg Glasner, MD, current officer, owns more than 5% of West Fargo Medical Property, LLC. Schedule L, Part IV, line 3, Column b Kevin Moug, Essentia Health West Board Director, is an officer of DMS Health Technologies. Form 990, Part III, Line 4 Program service accomplishments: Innovis Health dba Essentia Health West is organized and operated exclusively for charitable, scientific, and educational purposes. In furtherance of its purposes, Essentia Health West provides health care services in Minnesota and North Dakota through its 104 bed hospital and 15 clinics. The hospital offers a broad range of inpatient and outpatient services for its patients, including critical care, medical surgical care, pediatric services, neonatal intensive care, and maternity care. The hospital's emergency department is open 24 hours per day and is designed as a Level II Trauma Center. In accordance with the Federal Emergency Medical Treatment and Active Labor Act, any person who presents at the hospital seeking treatment of an emergency medical condition is given a medical screening and necessary stabilizing treatment regardless of the person's ability to pay. In addition to the hospital and clinics, Essentia Health West also operates pharmacies, optical centers, infusion therapy centers, outpatient surgery centers, and a cancer center. Beyond its clinical services, Essentia Health West also offers educational programs for the community, such as parenting classes and child safety programs such as bicycle helmet fitting, bicycle safety, and pedestrian safety. Essentia Health West also participates in continuing education programs for health care professionals. Essentia Health West employs over 1,600 full time equivalents. The hospital provided for over 30,000 hospital patient days during the fiscal year ended June 30, 2012. The clinic had over 492,000 encounters during the same time period. Essentia Health West provided over $2,600,000 in charity care as well as an additional $4,900,000 of costs incurred in excess of Medicaid payments received during the fiscal year ended June 30, 2012. Further community benefits provided during the fiscal year include community services of over $84,000. Form 990, Part V, LINE 1A 1099 Reporting: Beginning in 2011, vendor payments and Form 1099's were processed through Essentia Health on behalf of certain supported organizations. Form 990, Part VI, Line 6 Members of Organization: Essentia Health may elect one or more members of the governing body as described in Schedule O Part VI Line 7a. Essentia Health and Benedictine Sisters Benevolent Association have reserved powers with respect to Essentia Health West 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, Essentia Health shall appoint and remove Essentia Health West's governing body. Form 990, Part VI, Line 7b Members with right to approve governing body decision: Essentia Health West 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. The Benedictine Sisters Benevolent Association ("BSBA") also has certain reserved powers over all Catholic facilities within Essentia Health. BSBA's reserved powers are as follows: Mission. Authority to approve the mission, purpose and vision statements for Catholic facilities and entities within the System. Adherence to Ethical Religious Directives (ERDs). Authority to approve the methods, policies and procedures pertaining to the adherence of Catholic facilities and entities within the System to the ERDs, and to require the use of religious symbols, distinguishing elements and prayers. Official Catholic Directory. Authority to request the listing of qualified entities and facilities within the System in The Official Catholic Directory, subject to the approval of applicable Catholic authorities. Catholic Health Association. Authority to require Catholic facilities and entities within the System to join the membership of the Catholic Health Association of the United States. Alienation of Stable Patrimony or Ecclesiastical Goods. Authority to approve alienation of either stable patrimony or other ecclesiastical goods in the System if such goods involved in a specific transaction approved by Essentia Health pursuant to Section 2.8(g) or 2.8(h) of the Affiliation Agreement have a dollar value equal to or greater than 70% of the amount established from time to time that requires approval from the Holy See. Amendments. Authority to approve any amendments to the Articles of Incorporation or Bylaws of this corporation that would alter the number of Benedictine Sisters of St. Scholastica Monastery of Duluth or Benedictine Sisters Benevolent Association board of director members serving as members of this corporation's board of directors; authority to approve any amendments to the Articles of Incorporation or Bylaws of the Supported Organizations, as well as the Catholic Subsidiaries (as defined in the Affiliation Agreement), which could materially affect such entity's identity as a Catholic institution, including without limitation any amendment that would alter the number of Benedictine Sisters of St. Scholastica Monastery of Duluth or Benedictine Sisters Benevolent Association board of director members serving as members of such entity's board of directors; and authority to cause Essentia Health to make amendments to the Articles of Incorporation or Bylaws of the Supported Organizations, as well as the Catholic Subsidiaries, which amendments Benedictine Sisters Benevolent Association in good faith are necessary to preserve such entity's identity as a Catholic institution. Mission Effectiveness. Authority to approve annual plans and evaluations relating to mission effectiveness and chaplaincy for the Catholic facilities and entities within the System. Mergers and Dissolution. Subject to the approval of the Benedictine Sisters of St. Scholastica Monastery of Duluth, authority to approve a proposed merger, consolidation, liquidation, dissolution, or the disposition of all or substantially all the assets. Form 990, Part VI, Line 11a Form 990 Review process: The 2011 Form 990 including all schedules was reviewed by Essentia Health West'S MANAGEMENT AND GOVERNING BODY on FEBRUARY 26, 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 West'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 15 A&B Process for determining compensation: The Executive Compensation Committee of Essentia Health's board of directors is authorized to fulfill the board's responsibilities regarding executive compensation consistent with Essentia's mission, values and tax-exempt status, and the Executive Compensation Committee's Charter. The Executive Compensation Committee meets at least twice annually to carry out its responsibilities, which include, but are not limited to, establishing, reviewing and modifying, as appropriate, reasonable compensation and benefits for Essentia's Chief Executive Officer and his direct reports. The Executive Compensation Committee engages qualified independent compensation advisors to provide objective and impartial comparative data and to express opinions on total compensation reasonableness. The Executive Compensation Committee may request its independent advisors to: monitor comparability data and marketplace trends; make appropriate recommendations regarding salary ranges; and periodically review the market competitiveness of Essentia executive compensation packages. Prior to establishing or adjusting executive compensation, the Executive Compensation Committee will obtain and rely upon appropriate data as to comparability of the proposed compensation or adjustments. The Executive Compensation Committee will adequately document the basis for its determination concurrently with making those determinations. The Executive Compensation Committee minutes will include: the terms of the approved compensation and the date approved; the Executive Compensation Committee members present during the review, discussion and approval of the proposed compensation and those who voted on the proposed compensation; identification of the comparability data obtained and relied upon by the Executive Compensation Committee and how the data was obtained; any actions by a member of the Executive Compensation Committee having a conflict of interest; and documentation of the basis for the determination. The year this process was last undertaken for Essentia Health West's President and Chief Administrative Officer was 2010. The compensation of other Essentia Health West senior leadership is recommended by the President and Chief Administrative Officer of Essentia Health West Region and approved by the Executive Committee of the Essentia Health West Region Board of Directors. The annual compensation review process begins with an industry compensation survey completed by an external consulting group retained by the Essentia Health Board of Directors and coordinated by Essentia's Corporate Human Resources Department. The consultant's report encompasses: current compensation trends, significant market factors, regional/national salary surveys and the consultant's recommended changes to compensation levels and compensation plan methodology. Based on this data, the Chief Executive Officer of Essentia Health will make a recommendation of compensation adjustments for the Essentia Corporate Leadership Team, which includes the West Region President and Chief Administrative Officer, to the Essentia Health Compensation Committee, who will then act on these recommendations. A similar process is followed at Essentia Health West Region, the West Region President and Chief Administrative Officer recommending compensation adjustments to the Executive Committee of the Essentia Health West Board of Directors, who will then act on these recommendations. The year this process was last undertaken for Essentia Health West's Chief Financial Officer and Vice Presidents was 2012. The compensation of Essentia Health West physician leadership, including appointed Chief and Chair positions, is reviewed and approved by the West Region Board of Director's Executive Committee. The annual compensation review includes review and approval of the prior fiscal year's physician and provider compensation plan reconciliation summary, review and approval of the recommended current fiscal year's physician and provider compensation plan rates, adjustments and plan methodology. Compensation plan rates for the fiscal year are recommended by the West Region Physician and Provider Compensation Committee based on its review of multiple market surveys, regional competitive factors, and the annual budget process. The year this process was last undertaken Essentia Health West physician leadership was 2012. Form 990, Part VI, Line 19 Availability of governing documents, conflict of interest policy, & financial statements to the public: Essentia Health West makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Essentia Health West 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, 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: James Anderson: approximately 9 hour Neal Hessen: approximately 17 hours Laurie Lewandowski: approximately 7 hours Robert Overmoe: approximately 1 hour Sister Luella Weascheid: approximately 7 hours Sister Beverly Horn: approximately 3 hours Gregory Glasner, MD is employed by Essentia Health West as the Essentia Health West's President and Chief Medical Officer. 100% of his time is spent furthering the purpose of Essentia Health and related organizations. Kevin Pitzer is employed by Essentia Health West as Essentia Health West's Chief Administrative Officer. 100% of his time is spent furthering the purpose of Essentia Health and related organizations. Peter Jacobson is employed by Essentia Health West. 100% of his time is spent furthering the purpose of Essentia Health West and related organizations. Richard Vetter, MD is employed by Essentia Health West. 100% of his time is spent furthering the purpose of Essentia Health West and related organizations. Michael Sheldon, MD is employed by Essentia Health West. 100% of his time is spent furthering the purpose of Essentia Health West and related organizations. Joel Haugen, 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: Other Net Asset adjustments: ($2,025) Unrealized Gain / (Loss) on Non Trading Securities and Swaps: ($2,513,629) Schedule K Additional information/comments relating to the reporting of liabilities by related organizations: Essentia Health has an Obligated Group created under the Master Indenture which is composed of the following Members: Essentia Health, Critical Access Group, Essentia Health East, Essentia Health St. Joseph's Medical Center, Essentia Health St. Mary's-Detroit Lakes, Essentia Health St. Mary's Medical Center, Essentia Health Duluth, Essentia Health Polinsky Medical Rehabilitation Center, Essentia Health St. Mary's Hospital-Superior, Essentia Health Brainerd Specialty Clinic, Essentia Health Central, St. Mary's Innovis Health, The Duluth Clinic, Ltd. and Essentia Health West (the "Obligated Group Members" or the "Members of the Obligated Group"). The Members of the Obligated Group are jointly and severally obligated on all indebtedness evidenced or secured by Notes issued under the Master Indenture. The Series 2008D bonds are secured by Notes issued under the Master Indenture. The Obligated Group Members: The Duluth Clinic, Ltd. and Essentia Health are the conduit borrowers of the Series 2008D bonds. The Obligated Group Member, Essentia Health West, is an indirect beneficiary of the Series 2008D borrowing and has recorded the bond liability on its balance sheet which is consolidated with Essentia Health. The Series 2008E bonds are secured by Notes issued under the Master Indenture. The Obligated Group Members: Essentia Health East, The Duluth Clinic, Ltd., Essentia Health, Essentia Health St. Mary's Medical Center and Essentia Health Duluth are the conduit borrowers of the Series 2008E bonds. The conduit borrower, The Duluth Clinic, Ltd., has recorded a portion of the bond liability on its balance sheet which is consolidated with Essentia Health. The Obligated Group Member, Essentia Health West, is an indirect beneficiary of a portion of the Series 2008E borrowing and has recorded a portion of the bond liability on its balance sheet which is consolidated with Essentia Health. The Series 2008A reoffered bonds are secured by Notes issued under the Master Indenture. Essentia Health is the conduit borrower of the Series 2008A reoffered bonds and has recorded a portion of the bond liability on its balance sheet. The Obligated Group Members, Essentia Health West, The Duluth Clinic, Ltd., and Essentia Health St. Mary's-Detroit Lakes, are indirect beneficiaries of the Series 2008A reoffered borrowing and have recorded the bond liability on their balance sheets which are consolidated with Essentia Health. The Series 2008B reoffered bonds are secured by Notes issued under the Master Indenture. The Obligated Group Members: The Duluth Clinic, Ltd., Essentia Health and Essentia Health St. Mary's Hospital-Superior are the conduit borrowers of the Series 2008B reoffered bonds. The conduit borrowers, The Duluth Clinic, Ltd. and Essentia Health, have recorded a portion of the bond liability on their balance sheets which are consolidated with Essentia Health. The Obligated Group Members, Essentia Health West and Essentia Health St. Mary's-Detroit Lakes, are indirect beneficiaries of a portion of the Series 2008B reoffered borrowing and have recorded a portion of the bond liability on their balance sheets which are consolidated with Essentia Health. The Series 2008C reoffered bonds are secured by Notes issued under the Master Indenture. The Obligated Group Members: Essentia Health East, Essentia Health St. Joseph's Medical Center, Essentia Health St. Mary's-Detroit Lakes, The Duluth Clinic, Ltd., Essentia Health, and Essentia Health St. Mary's Medical Center, Inc. are the conduit borrowers of the Series 2008C reoffered bonds. The conduit borrowers, Essentia Health St. Mary's-Detroit Lakes, Essentia Health, and The Duluth Clinic, Ltd., have recorded a portion of the bond liability on their balance sheets which are consolidated with Essentia Health. The Obligated Group Member, Essentia Health West is an indirect beneficiary of a portion of the Series 2008C reoffered borrowing and has recorded a portion of the bond liability on its balance sheet which is consolidated with Essentia Health. The Series 2010 bonds are secured by Notes issued under the Master Indenture. The Obligated Group Members: The Duluth Clinic, Ltd., Essentia Health, Essentia Health St. Joseph's Medical Center, Essentia Health East, Essentia Health St. Mary's Medical Center and Essentia Health St. Mary's-Detroit Lakes are the conduit borrowers of the Series 2010 bonds. The conduit borrowers, The Duluth Clinic, Ltd., Essentia Health, Essentia Health St. Joseph's Medical Center, and Essentia Health St. Mary's-Detroit Lakes, have recorded a portion of the bond liability on their balance sheets which are consolidated with Essentia Health. The Obligated Group Member, Essentia Health West is an indirect beneficiary of a portion of the Series 2010 borrowing and has recorded a portion of the bond liability on its balance sheet which is consolidated with Essentia Health. SCHEDULE K, Part 1, Column (f) Description of purpose: Series 2008D: Refinance a portion of the acquisition of certain assets of Essentia Health West in connection with the affiliation of Essentia Health and Essentia Health West. SERIES 2008E: Refinance Series 1997 bonds issued December 18, 1997 to finance equipment purchases in Duluth, MN. Series 2008A Reoffered: Reoffer Series 2008 A-1 and A-2 bonds issued March 4, 2008 to refinance a portion of the acquisition of certain assets of Essentia Health West in connection with the affiliation of Essentia Health with Essentia Health West. Series 2008B Reoffered: Reoffer Series 2008 B-1 bonds issued March 4, 2008 to refund Series 1999B bonds issued May 18, 1999 for construction projects and equipment purchases in Superior, WI and various Duluth Clinic locations in northwestern Wisconsin. Series 2008C Reoffered: Reoffer Series 2008 C-5 and 2008 C-4A bonds issued March 4, 2008 to refund Series 2004 bonds issued March 19, 2004 for various acquisitions, construction projects, capital improvements and equipment purchases in Duluth, Brainerd, and Detroit Lakes, MN and refund Series 1999A bonds issued May 18, 1999 for various acquisitions, construction projects, capital improvements and equipment purchases in Brainerd, Detroit Lakes and Duluth, MN and various Duluth Clinic sites in northern Minnesota. Series 2010: Refund Series 1993C and 1993E bonds issued January 15, 1993 and refund Series 2008 C-3 and 2008 C-4B bonds issued March 4, 2008 to refund Series 2004 bonds issued March 19, 2004 for various acquisitions, construction projects, capital improvements and equipment purchases in Duluth, Brainerd, and Detroit Lakes, MN and various Duluth Clinic sites in northern Minnesota and finance various construction projects, capital improvements and equipment purchased in Brainerd, Detroit Lakes and Duluth, MN and various Duluth Clinic sites in northern Minnesota. SCHEDULE K, Part II, Line 3 Issue Price: Series 2008D, SERIES 2008E, Series 2008A Reoffered, Series 2008B Reoffered, Series 2008C Reoffered, and Series 2010 were issued by the Essentia Health Obligated Group. The issue price listed in Essentia Health West's Schedule K Part I Column (e) represents the Essentia Health Obligated Group's total borrowing. SCHEDULE K, Part II, Lines 3 through 12 Proceeds: Series 2008D, SERIES 2008E, Series 2008A Reoffered, Series 2008B Reoffered, Series 2008C Reoffered, and Series 2010 were issued by the Essentia Health Obligated Group. A portion of the Series 2008D, SERIES 2008E, Series 2008A Reoffered, Series 2008B Reoffered, Series 2008C Reoffered, and Series 2010 borrowing were allocated to Essentia Health West, an Essentia Health Obligated Group Member. The proceeds listed in Essentia Health West's Schedule K Part II Lines 3 through 12 represent Essentia Health West's allocated portion of the proceeds. SCHEDULE K, PART V Procedures to undertake corrective action: Written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program have been subsequently adopted. 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 & Clinics INC 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 Emerg SRvcs 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 First Care Medical Services 900 Hilligross Blvd SE Fosston MN 56542 410706143 Clinic/Hosp MN 501(c)(3) 3 Innovis true Minnesota Valley Health Center Inc 621 S 4th St Le Sueur MN 56058 410837659 Hospital/NURS MN 501(c)(3) 3 CAG true StBenedicts Fam 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 Svcs 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 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 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 true true false false false false false true true true true false true true true true true STMARY'S REGIONAL HEALTH CENTER P 14742457 Actual costs STMARY'S REGIONAL HEALTH CENTER K 163733 Actual costs STMARY'S REGIONAL HEALTH CENTER I 253780 Actual costs STMARY'S REGIONAL HEALTH CENTER J 98400 Actual costs FIRST CARE MEDICAL SERVICES p 2745669 Actual costs GRACEVILLE HEALTH CENTER P 819540 Actual costs BRIDGES MEDICAL CENTER P 304662 Actual costs SMDC MEDICAL CENTER O 4239362 actual costs ESSENTIA HEALTH FOUNDATION B 370000 Actual costs ESSENTIA HEALTH FOUNDATION P 315908 actual costs ESSENTIA HEALTH P 24955250 actual costs ESSENTIA HEALTH O 5016829 actual costs ESSENTIA HEALTH L 12291960 actual costs ESSENTIA HEALTH R 494144 actual costs ESSENTIA HEALTH N 3011503 actual costs ESSENTIA INSTITUTE OF RURAL HEALTH Q 1280197 actual costs SMDC MEDICAL CENTER P 1228964 actual costs SMDC MEDICAL CENTER N 119886 actual costs STMARY'S MEDICAL CENTER O 237779 actual costs The DULUTH CLINIC Ltd O 53405 actual costs The DULUTH CLINIC Ltd N 411790 actual costs STJOSEPH'S MEDICAL CENTER P 130508 actual costs BRAINERD MEDICAL CENTER Inc O 105975 actual costs St Mary's Medical Center p 69781 actual costs FORM 990, 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 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