2014-04-29T16:58:59-05:00 2013-06-30 ERNST & YOUNG US LLP 41 S HIGH ST 1100 HUNTINGTON CTR COLUMBUS OH 43215 990 2012-07-01 411620386 St Mary's Regional Health Center % RYAN HILL STMA 2188475611 1027 Washington Ave Suite Detroit Lakes MN 56501 RYAN HILL 2014-04-21 6142327414 2012 2015-11-30 17:44:51Z ESSENTIA HEALTH STMARY'S-DETROIT LA Peter Jacobson 1027 Washington Ave Detroit Lakes MN 56501 78783982 false 0928 X www.essentiahealth.org X 1988 MN SEE SCHEDULE O 13 10 878 185 54050 -4801 105913 84279 77585197 77083615 235998 1112032 381195 346473 78308303 78626399 209964 173055 0 0 43415239 44170338 0 0 0 35698223 33090503 79323426 77433896 -1015123 1192503 99098648 96995402 68276133 63188260 30822515 33807142 X SEE SCHEDULE O false false 50830368 173055 67213260 See Schedule O 8365732 7985173 See Schedule O 1690111 1885182 See Schedule O 60886211 true true false true false false false false false false true true false false true false false true false false false false false false false false true true true false true true false false false false false false false false false false false false false false false true true true false false true X 0 0 878 true true true false false false false false false false false false X 13 10 false false false false true true true true true false false true true true true true true true true false MN X RYAN HILL 2188470852 1027 WASHINGTON AVE Detroit Lakes MN 56501 Cyndi Anderson 1.7 3.3 X X 0 2200 0 Bruce Hein 1.7 3.3 X X 0 1800 0 Rhoda Hooper 1.7 3.3 X 0 1550 0 Laurie Lewandowski 1.7 4.3 X X 0 5575 0 Sister Pauline Micke 1.7 3.3 X 0 0 0 Sister Luella Wegscheid 1.7 3.3 X 0 0 0 James ANDERSON 1.7 6.3 X X 0 21000 0 laverne moltzan 1.7 3.3 X 0 1700 0 CURT NOYES 1.7 4.3 X 0 2950 0 NATHAN FETTING 1.7 3.3 X 0 0 0 ANITA JONASON MD 36.6 3.4 X 0 182584 20238 JARED AELONY DPM 36.6 3.4 X 0 165474 38205 JAMES CHRISTENSEN MD 36.6 3.4 X 0 326261 38455 Ryan Hill 46.6 13.4 X 177196 34362 37625 Peter Jacobson 53.6 6.4 X 0 325211 68648 Jean Evans 60.0 0.0 X 157319 0 9143 Abigail Ring MD 60.0 0.0 X 0 208295 37196 Richard Vetter MD 1.7 58.3 X 0 408662 71439 Robert Koshnick MD 60.0 0.0 X 0 211861 36993 Christy Brinkmann 40.0 0.0 X 139628 0 9264 Linda Sethre 40.0 0.0 X 125049 0 23654 Diana Johnson 40.0 0.0 X 147889 0 21012 CONNIE KOVALA 40.0 0.0 X 112415 0 15982 CINDY SWENSON 40.0 0.0 X 107924 0 18079 Thomas Thompson 0.0 0.0 X 0 294590 0 Bradley Refsland MD 0.0 40.0 X 0 117961 29814 RICHARD MARTIN MD 0.0 0.0 X 0 276162 29697 967420 2588198 505444 10 true true false 0 74017 10262 84279 HOSPITAL/CLINIC SERVICES 621110 67213260 67159210 54050 NURSING CENTER SERVICES 623000 7985173 7985173 ASSISTED & INDEPENDENT LIVING SERVICES 623000 1885182 1885182 77083615 407940 407940 0 0 88202 88202 0 88202 88202 857075 4600 157583 857075 -152983 704092 704092 0 0 0 CAFETERIA & VENDING SALES 722514 164273 164273 LIFELINE EMERGENCY ALARMS 621610 76779 76779 RELEASE OF INFORMATION 900099 12186 12186 5033 5033 258271 78626399 77029565 54050 1458505 173055 173055 0 0 0 621391 621391 306649 306649 35452641 29236740 6215901 1530216 1270434 259782 3874272 2859050 1015222 2385169 1891246 493923 0 15672 15672 21430 21430 601 601 0 133777 133777 4519160 2054786 2464374 38790 8985 29805 2061249 1178899 882350 127633 60791 66842 0 1422035 1184870 237165 332889 279565 53324 0 132202 69095 63107 2209721 2209721 0 4348527 4348527 852518 852518 MEDICAL SUPPLIES 8355973 7587738 768235 AFFILIATE SUPPORT FEE 3480743 982614 2498129 BAD DEBT EXPENSE 2429683 2429683 UBI TAXES 7000 7000 2600900 2200894 400006 77433896 60886211 16547685 0 140387 171204 17568 3424736 0 0 15707687 9496139 0 0 0 0 0 32880 2029834 2113078 164522 130380 95635380 36548586 59091260 59086794 1932615 884621 19148963 20887888 0 0 0 0 865812 767682 99098648 96995402 6458113 6192469 0 0 0 0 54543644 29900035 0 0 0 0 1318355 25554185 0 0 5956021 1541571 68276133 63188260 X 30822515 33807142 0 0 0 0 30822515 33807142 99098648 96995402 X 1192503 1907352 -115228 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 601 601 false Schedule C, Part 11-B ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES 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. 4373915 4373915 70396917 23963500 46433417 19713947 12180626 7533321 1150601 404460 746141 59086794 POOLED INVESTMENT FUND 20887888 F 20887888 0 NON CURRENT SWAP LIABILITY 716184 ASSET RETIREMENT OBILIGATION 286774 PAYABLES TO RELATED TAX-EXEMPT ORGS 538613 1541571 true true X true X true X true true false true true 0 693444 0 693444 0.00930 0 14059598 10573051 3486547 0.04650 0 0 0 0 0.00000 0 14753042 10573051 4179991 0.05580 13 3806 35847 0 35847 0.00050 8 484 244744 0 244744 0.00330 0 0 0 0 0.00000 0 0 0 0 0.00000 4 20 416670 0 416902 0.00560 25 4310 697261 0 697493 0.00940 25 4310 15450303 10573051 4877484 0.06520 0 0 0 0 0.00000 0 0 0 0 0.00000 1 70 378 0 378 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 0 0 0 0 0.00000 1 0 2098 0 2098 0.00000 2 35 184519 0 184519 0.00250 0 0 0 0 0.00000 4 105 186995 0 186995 0.00250 true 2429683 18536320 17997472 538848 X true true 1 1 ESSENTIA HEALTH STMARY'S-DETROIT

LAKES 1027 WASHINGTON AVE DETROIT LAKES MN 56501

www.essentiahealth.org X X X ST MARY'S REGIONAL HEALTH CENTER 1 true X X X X X X X X X X 12 true true true X X X X X X X X X X X false false 0 true true 150. true 300. true X X X X X X X true true X X X X X X true false X X X true X false false 11 ESSENTIA HEALTH STMARY'S-DETROIT LAKES

CLINIC 1027 Washington Ave DETROIT LAKES MN 56501

MULTI-SPECIALTY CLINIC ESSENTIA Health STMARY'S-PELICAN RAPIDS

CLINIC 301 NORTH BROADWAY PELICAN RAPIDS MN 56572

MULTI-SPECIALTY CLINIC ESSENTIA HEALTH STMARY'S-FRAZEE CLINIC

300 MAIN AVENUE EAST FRAZEE MN 56544

PRIMARY CARE CLINIC ESSENTIA Health STMARY'S-LAKE PARK

CLINIC 1005 FIRST STREET LAKE PARK MN 56554

PRIMARY CARE CLINIC ESSENTIA HEALTH STMARY'S-MAHNOMEN

CLINIC 117 NORTH MAIN STREET MAHNOMEN MN 56557

PRIMARY CARE CLINIC ESSENTIA HEALTH STMARY'S THERAPY CENTER

112 LINCOLN AVENUE DETROIT LAKES MN 56501

THERAPY CENTER ESSENTIA HEALTH OAK CROSSING

1040 LINCOLN AVENUE DETROIT LAKES MN 56501

SKILLED NURSING FACILITY ESSENTIA Health LINCOLN PARK ASSISTED

LIVING 208 OAK STREET DETROIT LAKES MN 56501

ASSISTED LIVING APARTMENTS ESSENTIA Health LINCOLN PARK SENIOR

APARTMENTS 207 PARK STREET DETROIT LAKES MN 56501

SENIOR APARTMENTS Essentia Health WINCHESTOR

1051 WASHINGTON AVENUE DETROIT LAKES MN 56501

SENIOR APARTMENTS ESSENTIA HEALTH STMARY'S-DETROIT LAKES

HOME HEALTH 1027 WASHINGTON AVENUE DETROIT LAKES MN 56501

HOME HEALTH 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 St. Mary's Detroit Lake's community benefit information is consolidated into the Essentia Health community benefit information which is included in the Essentia Health annual report. The annual report is made available to the public at www.essentiahealth.org. Essentia Health, headquartered in Duluth, Minn., is an integrated health system serving patients in Minnesota, Wisconsin, North Dakota and Idaho and is Essentia Health St. Mary's Detroit Lake'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 $2,429,683. 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 The majority of the community building activities reported are physician recruitment expenses. The hospital facility is located in a federally-designated medically underserved area and as such includes physician recruitment as a community building activity per the recommendation of the Catholic Health Association Community Benefit Guide. PART III, LINE 2 Discounts, charity care, and bad debt expense are accounted for as reductions to revenue. Bad debt expense on patient accounts would be identified as any balance on the account, less any previous payments and discounts, that has aged and is absent of any payments. If, during the collection process, it becomes known that the patient qualifies for charity care, the amounts included within bad debt expense would be reclassified to charity care. PART III , LINE 3 Essentia Health St. Mary's Detroit LakeS engaged 3rd party to analyze the organization's bad debt for the year and identify patient accounts that would qualify for charity care. Once identified, those patient accounts were reclassified to the charity care allowance out of bad debt. Moving into the next fiscal year, Essentia Health St. Mary's Detroit LakeS will be using a tool that identifies accounts that would qualify for charity care automatically and reclasses those accounts to charity care allowance. As a result, we estimate $0 of patient accounts written off to bad debt would qualify for charity care. PART III, LINE 3 Essentia Health St. Mary's Detroit LakeS is a part of a larger organization, Essentia Health. Essentia Health and its member organizations incorporate the cost of bad debt as a community benefit. As a tax exempt hospital, we must provide the necessary services regardless of the patient's ability to pay for that care. In doing so, Essentia Health makes quality patient care available to all in our community, regardless of their economic means. Part III, line 4 The page number of the audit that contains the footnote describing the organization's bad debt expense is page 12. Part III, line 8 The methodology used in determining the reported Medicare Allowable Costs begins with the hospital's general ledger system. The costs are obtained from the general ledger and then adjusted and reported in accordance with Centers for Medicare Services (CMS) "cost finding" guidelines as published in their Provider Reimbursement Manual. Once the Medicare allowable costs are determined from the hospital's cost report, any costs attributed to subsidized health services, and Medical Education, are removed. Part III, line 8 Essentia Health St. Mary's Detroit Lakes 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. SCHEDULE H, PART VI, LINE 1 cont PART V, LINE 1J The Community Health Needs Assessment also includes a Community Health Profile. The profile is based on data from the Behavioral Risk Factors Surveillance System and the University of Wisconsin Population Health Institute County Health Rankings. PART V, LINE 3 A Community/Patient Focus Group was held for community members to identify and prioritize their community health needs. In addition, persons were consulted at Town Hall Meetings, which are the first step in addressing each prioritized health need. During the Town Hall Meeting, intervention options for meeting the health need were presented, and participants selected the option best suited to their community. Individuals from the following organizations attended the Town Hall Meeting (names and titles available upon request): Becker County Human Services, Chamber of Commerce, City of Frazee, Community/Patient Focus Group, Detroit Lakes Community and Cultural Center, Detroit Lakes School District, Frazee-Vergas Community Education, Kiwanis, Lakes Crisis Center, Mahube-Otwa Community Action Partnership, Midwest Bank, PartnerSHIP 4 Health, ProSystems, and Rotary. See the CHNA posted on the website listed in Part V, Line 5a for a list of organizations that were invited to, but did not attend the town hall meetings. An employee of Becker County Human Services (name and title available upon request) attended the Community/Patient Focus Group and the Town Hall Meeting and provided input on the community's Priority health needs and intervention options for addressing the highest priority health need. Employees of PartnerSHIP 4 Health (names and titles available upon request), attended the Town Hall Meeting and provided input on the intervention options for addressing the highest priority health need. Individuals from PartnerSHIP 4 Health also attended the Intervention Planning Meeting. Their special knowledge of or expertise in public health derives from their affiliation with a regional Statewide Health Improvement Program. Employees of Becker County Community Health (names and titles available upon request) attended the Intervention Planning Meeting. The majority of Essentia Health St. Mary's-Detroit Lakes' service area is rural. Given the known health disparities of rural populations, all attendees of the Community/Patient Focus Group and Town Hall Meetings are representatives and/or members of medically-underserved and low income populations, as well as populations with chronic disease needs. Community/Patient Focus Group participants were specifically instructed to consider themselves as representatives of the community-at-large. Participants at the Town Hall and Intervention Planning Meetings serve more formal leadership or representative roles. An elected official of the City of Frazee attended the Town Hall Meeting, as well as the Community/Patient Focus Group. Individuals affiliated with Mahube-Otwa Community Action Partnership attended the Community/Patient Focus Group, Town Hall Meeting, and Intervention Planning Meeting. The Mahube-Otwa Community Action Partnership is a Community Action Agency that assists low income individuals and families to acquire useful skills and knowledge, gain access to new opportunities and achieve economic self-sufficiency. In Becker, Hubbard, and Otter Tail Counties, 87.5% or more of the residents are Caucasian. However, as attendees at the Community/Patient Focus Group were instructed to act as representatives of the entire community, and data stratified by race/ethnicity were presented, health needs of minority populations were considered. As city elected officials represent the entire electorate, including minorities, minority populations were represented by the elected official of the City of Frazee as well. PART V, LINE 4 Essentia Health St. Mary's Detroit Lakes is affiliated with Essentia Health. In the interest of efficiency, cost effectiveness, and alignment with Essentia Health population health strategies, the hospital facility's CHNA was conducted in a coordinated process with fourteen other Essentia Health hospital facilities. While still allowing for tailoring to each particular hospital facility, procedures were standardized across hospital facilities. The hospital facilities included in this coordinated process are: Essentia Health Ada in Ada, MN; Clearwater Valley Hospital and Clinics, Inc. in Orofino, ID; Essentia Health Deer River in Deer River, MN; Essentia Health Virginia in Virginia, MN; Essentia Health Holy Trinity Hospital in Graceville, MN; Essentia Health West in Fargo, ND; Minnesota Valley Health Center, Inc. in Le Sueur, MN; Essentia Health Northern Pines in Aurora, MN; Essentia Health Sandstone in Sandstone, MN; Essentia Health Duluth in Duluth, MN; Essentia Health St. Joseph's Medical Center in Brainerd, MN; Essentia Health St. Mary's Hospital-Superior in Superior, WI; St. Mary's Hospital, Inc. in Cottonwood, ID; Essentia Health St. Mary's Medical Center in Duluth, MN; and Essentia Health St. Mary's Detroit Lakes in Detroit Lakes, MN. Since Essentia Health West joined the collaborative effort on February 1, 2013, not all aspects of the Essentia Health West CHNA are coordinated with those of the other hospital facilities. The hospital facility did not collaborate with any other hospital facility outside of the Essentia Health System. PART V, LINE 5A The CHNA is posted under the "Community Benefit/CHNA" tab on the hospital facility's homepage at http://www.essentiahealth.org/StMarysDetroitLakes/FindaClinic/Essentia-Hea lth-St-MarysDetroit-Lakes-81.aspx PART V, LINE 5C Links to the report were emailed to the Minnesota Hospital Association (MHA) to catalog the assessments and make them available on their website to help members meet IRS requirements for wide dissemination of reports. The MHA will also analyze the assessments to identify common themes, issues and needs on a statewide and regional basis. Finally, the MHA will use the catalog as a vehicle for connecting hospitals with similar community needs with one another to explore joint implementation strategies, information sharing , or resources for making their community benefit activities as influential as possible. PART V, LINE 6I This box was not checked, so not applicable. PART V, LINE 7 Seven health needs were identified through the CHNA. Of those health needs, three were selected as the highest priority health needs that have/will be addressed over the next three years as a part of the hospital facility's implementation strategies. The hospital facility will not directly meet the four unprioritized health needs due to resource constraints. Rather than inadequately addressing all health needs, the hospital facility will focus resources, financial and otherwise, on their community's three prioritized health needs in order to foster success in meeting those health needs. Despite not directly meeting the unprioritized needs, interventions addressing the three prioritized health needs may partially address the unprioritized health needs that overlap with the prioritized health needs. If the unprioritized health needs remain in the next CHNA cycle, they may be directly addressed at that time. The four unprioritized health needs are as follows: -Reduction of excessive/binge drinking -Immunizations -Preventative care -Secondary prevention/screening Part V, Line 10 Checked "Yes", so not applicable. Part V, line 11 Checked "Yes", so not applicable. Part V, line 12H This box was not checked, so not applicable. PART V, LINE 14G This box was not checked, so not applicable. Part V, line 16e This box was not checked, so not applicable. Part V, line 17e This box was not checked, so not applicable. Part V, line 18E This box was not checked, so not applicable. Part V, line 19C This box was not checked, so not applicable. Part V, line 19d This box was not checked, so not applicable. Part V, line 20D For patients known to qualify for the financial assistance program, they are charged the same as their most common insurance payor. Part V, line 21 not applicable AS "NO" WAS CHECKED. PART V, LINE 22 Not applicable as "No" was checked. 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 St. Mary's Detroit Lakes assesses community needs through a variety of methods. One way is through an outside patient satisfaction vendor, PROFESSIONAL RESOURCE CONSULTANTS. Comments made through these telephone surveys will occasionally indicate an unmet community health need. Additionally, we encounter feedback from the patients we serve through the normal course of business that informs us of the need for new services or unmet community health needs. We also hold focus groups with community members to assess the care they (or a family member) received while in our facility. From the comments received, we develop action plans to address their concerns. We have a very active community relations committee whose purpose is to develop educational programs for our community members. In FY 13, we hosted 11 community programs with a total of 351 people attending . We routinely survey those in attendance to learn what other health care issues they are interested in learning about. From those comments, we plan our following year of educational opportunities. In addition, we had 16 speaker's bureau programs. 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 St Mary's Detroit Lakes 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 St Mary's Detroit Lakes 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 has 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 to 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. Essentia Health St Mary's Detroit Lakes has Financial Counselors who are available to patients with questions regarding payment of their medical bills. All staff have been trained to refer patients to the Financial Counselors and we have literature throughout the hospital and medical office buildings in regards to our Community Benefit Programs. Financial Counselors educate patients on different options of government programs and charity care as well as referrals to public health for additional services that St Mary's Regional Health Center may not be able to provide. 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 St. Mary's Detroit Lakes is located in Detroit Lakes, MN. Essentia Health St. Mary's Detroit Lakes is a part of the larger Essentia Health system, which is defined in Part VI, line 6. Essentia Health St. Mary's Detroit Lakes operates 1 hospital, 5 clinics, 2 senior living buildings, 1 skilled nursing facility, 1 assisted living building, a therapy center and home health that serves the communities of Detroit Lakes, Lake Park, Mahnomen, Frazee and Park Rapids . The overall community is classified as Rural. Essentia Health St. Mary's Detroit Lakes and its related facilities cover a service region of approximately 34,000 people. The service region age distribution is 23.5% under the age of 18; 57.7% between the ages of 18 and 65; and 18.8% over the age of 65. The racial makeup of the service region is 86.0% Caucasian; 0.4% Black or African American; 0.4% Asian; 1.2% Hispanic; and 12.0% other, predominately Native American. The gender split ratio is 49.9% women and 50.1% men. The average income for the service area is approximately $60,000. Approximately 7.0% of the population falls below the federal poverty guidelines. Essentia Health St. Mary's Detroit Lakes, along with Essentia Health is committed to serve patients regardless of their ability to pay. 5.9% net revenue dollars were from self pay patients. In addition, approximately 20.3% of their net revenue dollars were Medicaid recipients. As mentioned above, Essentia Health St. Mary's Detroit Lakes 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 St. Mary's Detroit Lakes' Board of Directors is composed of volunteer representatives from the community it serves. Essentia Health St. Mary's Detroit Lakes 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 Board of Directors in order to come and provide services in our system. We participate in an annual blood screening drive at the facility, and also take that service out to certain large businesses in town. We provide for numerous community education events through our speaker's bureau on various health topics. We reinvest in the organization by acquiring the latest state of the art equipment and by investing in programs that are needed in our community including same-day walk-in clinic, hospitalist program, chemotherapy, a new urology service, mental health services, and a pain clinic service. Essentia Health St. Mary's Detroit Lakes' community health improvement services provide support and education in the community. Some examples are: breastfeeding support group facilitation/planning, childbirth education classes, health fair, infant massage, nursing student clinicals and student interns. In addition, we support a community kid's summer bike ride. We partner with our local community center and encourage exercise thru biking by inviting kids to bike a designated path/distance. Our funding of this keeps the cost minimal for those participating. Essentia Health St. Mary's Detroit Lakes 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. One of the most significant investments in 2013 was the development of Essentia Health's Accountable Care Organization and its accreditation by the National Committee for Quality Assurance (NCQA). A cornerstone of federal healthcare reform, ACOs are designed to improve care while reducing overall costs for patients and society as a whole. We also continue to replace and upgrade facilities and technology, like MRIs, CT scanners and surgery suites 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. 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 $4.75 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 If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served: Essentia Health St. Mary's Detroit Lakes is part of Essentia Health, an integrated health system of 16 hospitals, 65 clinics, eight long-term care facilities, two assisted living facilities, four independent living facilities in four states: Minnesota, Wisconsin, North Dakota and Idaho. The health system serves a predominantly rural population whose median incomes generally fall below averages of the states where they live. The presence of our clinics and hospitals ensures that people with few economic resources don't have to drive an hour or more to receive basic (and in some cases life-saving) medical care. In addition to staffing hospitals and clinics in federally-recognized underserved areas, we support the health of our communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into our smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or are faced with other challenges that make it difficult to travel long distances for care. Our size and integrated structure allow us to offer patients services often found only in larger urban settings. Services ranging from chemotherapy to congestive heart failure management and hospice are available to patients in many of the rural communities we serve. Essentia Health also supports the health of our rural communities through active research and clinical trials by the Essentia Institute of Rural Health. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans. Essentia Health is also serving patients through the use of the Epic electronic health record (EHR). The vast majority of Essentia's hospitals and clinics are using a fully-integrated EHR for patient care. Technology like the electronic health record and Essentia's telehealth program allows health clinicians to share test results and consult with colleagues in real time across great distances. Medical information is no longer lost in the shuffle of paper records - an important consideration in a region where patients must often be transferred to a larger Essentia facility for complex surgeries or medical care. Essentia is also actively working with government agencies and insurers to develop innovative, cost-effective approaches to care that will improve health outcomes while reducing overall costs to patients and insurers. This innovation can be found in our use of remote home monitors for patients with congestive heart failure to a focus on using a team-based approach to helping patients manage chronic diseases. Essentia Health is committed to helping patients and their families lead active and fulfilling lives in the small and large communities where they live. We hope to become a model of health care delivery, particularly in rural areas, in the years to come. Part VI, Line 7 IF APPLICABLE, IDENTIFY ALL STATES WITH THE ORGANIZATION, OR A RELATED ORGANIZATION FILES A COMMUNITY BENEFIT REPORT: Essentia Health St. Mary's Detroit Lakes files a community benefit report in Minnesota. PART VI, LINE 8 IF APPLICABLE, FOR EACH HOSPITAL FACILITY IN A FACILITY REPORTING GROUP PROVIDE THE DESCRIPTION REQUIRED FOR PART V, SECTION B, LINES 1J, 3, 4, 5C, 6I, 7, 10, 11, 12H, 14G, 16E, 17E, 18E, 19C, 19D, 20D, 21 AND 22: NOT APPLICABLE true United Way of Becker County 803 Roosevelt Ave Detroit Lakes MN 56501 237225418 501(c)(3) 8000 Program Support DETROIT LAKES COMMUNITY & CULTURAL CENTER 826 SUMMIT AVENUE DETROIT LAKES MN 56501 411970351 501(c)(3) 14295 Program Support ESSENTIA HEALTH FOUNDATION 502 E 2ND STREET DULUTH MN 55805 271984704 501(c)(3) 139098 PROGRAM SERVICE 3 0 Schedule I, Part I, Line 2: Procedures for monitoring use of grant funds: Essentia Health St. Mary's-Detroit Lakes management reviews the grant activity by reviewing and documenting each expenditure request and approving the expense. X X X X X true true false false false false false false false Jean Evans 148970 0 7851 0 498 0 7713 0 1430 0 166462 0 0 0 Abigail Ring MD 0 208135 0 0 0 160 0 18482 0 18714 0 245491 0 0 Thomas Thompson 0 0 0 0 0 294590 0 0 0 0 0 294590 0 0 Ryan Hill 165806 34362 11254 0 136 0 9545 0 28080 0 214821 34362 0 0 Bradley Refsland MD 0 116955 0 0 0 1006 0 11448 0 18366 0 147775 0 0 Peter Jacobson 0 258503 0 42525 0 24183 0 43201 0 25447 0 393859 0 18403 Richard Vetter MD 0 395358 0 12600 0 704 0 45000 0 26439 0 480101 0 0 Robert Koshnick MD 0 211259 0 0 0 602 0 19030 0 17963 0 248854 0 0 Diana Johnson 125157 0 6922 0 15810 0 6863 0 14149 0 168901 0 0 0 ANITA JONASON MD 0 181440 0 0 0 1144 0 15296 0 4942 0 202822 0 0 JARED AELONY DPM 0 165320 0 0 0 154 0 15866 0 22339 0 203679 0 0 JAMES CHRISTENSEN MD 0 324868 0 0 0 1393 0 22467 0 15988 0 364716 0 0 RICHARD MARTIN MD 0 274880 0 0 0 1282 0 9393 0 20304 0 305859 0 0 Schedule J, Part I, Line 3 Methods used to establish President's compensation: Essentia Health St. Mary's-Detroit Lakes relied on Essentia Health'S, RELATED organization of Essentia Health St. Mary's-Detroit Lakes, methods for establishing Essentia Health St. Mary's-Detroit Lakes 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 4a Severance paymenT: Former officer, Thomas Thompson, received payment totaling $294,590 in tax year 2012 related to his termination. The termination term is from July 1, 2011 to June 21, 2013. Mr. Thompson will receive pay totaling $539,308 & benefits totaling $24,160 related to his termination. Current highest compensated employee, Diana Johnson, received payment totaling $15,213 in tax year 2012 related to her termination. The termination terms are from November 6, 2012 until February 3, 2013. Ms. Johnson will receive pay totaling $32,961 & benefits totaling $2,522 related to her termination. All other individuals listed as Formers in Form 990, Part VII, Section A, Line 1a remain employed within Essentia Health and its subsidiaries and are not receiving a termination payment. SCHEDULE J, PART I, LINE 4B Supplemental nonqualified retirement plan: Essentia Health's nonqualified retirement plan is offered to designated Essentia Health executives. There is a minimum two year vesting date or automatically upon reaching retirement age, death, disability or involuntary termination without cause. Benefits are subject to income taxes upon vesting and payable from Essentia Health's general assets. Reported as Other Reportable Compensation in Schedule J, Part II, Column B (iii), the following individual listed in Form 990, Part VII, Section A, Line 1a received payment of the vested benefit from the supplemental nonqualified retirement plan during the year: PETER JACOBSON $18,403 Reported as Retirement and Other Deferred Compensation in Schedule J, Part II, Column C, Essentia Health made contributions, subject to the vesting terms, during the year into the supplemental nonqualified retirement plan on behalf of the following individual listed in Form 990, Part VII, Section A, Line 1a: PETER JACOBSON $20,701 A Cass County North Dakota 456002205 148047AU7 2010-02-25 59573111 Srs 2008 A Reoffered (See PART VI) false false false B WI Health and Education Facilities Authority 391337855 97710BSD5 2010-02-25 12854722 Srs 2008 B Reoffered (See PART VI) false false false C MN Agricultural and Economic Development Board 416007162 6049202H0 2010-02-25 165717405 Srs 2008 C Reoffered (See PART VI) false false false D MN Agricultural and Economic Development Board 416007162 6049202P2 2011-03-29 25491071 Srs 2011 (See PART VI) false false false A 0 0 4438197 0 0 0 0 0 0 0 4438197 0 2010 true false true true B 0 0 957677 0 0 0 0 0 0 0 957677 0 2010 true false true true C 454823 0 12345946 0 0 0 141497 0 0 0 12204449 0 2010 true false true true D 0 0 12104361 0 0 0 169314 0 0 11735722 0 199325 2013 false false false true A false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true B false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true C false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true D false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true A false false true false false false 0 false 0 false true B false false true false false false 0 false 0 false true C false false true false false false 0 false 0 false true D false false false true false false 0 false 0 false true A true B true C true D true SCHEDULE K 0 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 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 2011 bonds are secured by Notes issued under the Master Indenture. The Obligated Group Members: Essentia Health, Essentia Health Central and Essentia Health St. Mary's-Detroit Lakes are the conduit borrowers of the Series 2011 bonds. The conduit borrower Essentia Health St. Mary's-Detroit Lakes has recorded a portion of the bond liability on its balance sheet which is consolidated with Essentia Health. The Obligated Group Member, Essentia Health St. Joseph's Medical Center, is an indirect beneficiary of a portion of the Series 2011 borrowing and has recorded a portion of the bond liability on its balance sheet which is consolidated with Essentia Health. Part 1, Column (f) Description of purpose: 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 2011: Refinance prior note used for capital improvements to skilled nursing facility located at 1027 Washington Ave and finance various construction projects and equipment purchases in Baxter, Frazee, and Pelican Rapids, MN. Part II, line 3 total proceeds not identical to Part I, Column (e): SERIES 2008A REOFFERED, SERIES 2008B REOFFERED, SERIES 2008C REOFFERED, AND SERIES 2011 were issued by the Essentia Health Obligated Group. The issue price listed in ST. MARY'S REGIONAL HEALTH'S Schedule K Part I Column (e) represents the Essentia Health Obligated Group's total borrowing. In addition, the Series 2011 total proceeds are not identical to the issue price listed in Part I, column (e) due to investment earnings. Part II, Lines 3 through 12 Proceeds: Series 2008A Reoffered, Series 2008B Reoffered, Series 2008C Reoffered, AND SERIES 2011 were issued by the Essentia Health Obligated Group. A portion of the Series 2008A Reoffered, Series 2008B Reoffered, Series 2008C Reoffered, AND SERIES 2011 borrowing were allocated to Essentia Health ST. MARY'S-DETROIT LAKES, an Essentia Health Obligated Group Member. The proceeds listed in Essentia Health ST. MARY'S-DETROIT LAKEs' Schedule K Part II Lines 3 through 12 represent Essentia Health ST. MARY'S-DETROIT LAKEs' allocated portion of the proceeds. PART IV, LINE 1C, Column D DATE REBATE COMPUTATION WAS PERFORMED: 3/20/2013 PART IV, LINE 1C FORM 990, PART C DOING BUSINESS AS: ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES FORM 990, PART I, LINE 1 ORGANIZATION'S MISSION OR MOST SIGNIFICANT ACTIVITIES: Throughout Essentia Health, we are called to make a healthy difference in people's lives. As a member of the Essentia Health family, St. Mary's Regional Health Center's mission as a Catholic, Benedictine sponsored facility is to promote Christ's ministry of holistic healing for all human life with special concern for the poor and powerless. FORM 990, PART III LINE 1 ORGANIZATION'S MISSION: Throughout Essentia Health, we are called to make a healthy difference in people's lives. As a member of the Essentia Health family, St. Mary's Regional Health Center's mission as a Catholic, Benedictine sponsored facility is to promote Christ's ministry of holistic healing for all human life with special concern for the poor and powerless. FORM 990, PART III, LINE 4 PROGRAM SERVICE ACCOMPLISHMENTS: St. Mary's Regional Health Center dba Essentia Health St. Mary's-Detroit Lakes is created & organized exclusively for charitable, religious, educational & scientific purposes. Essentia Health St. Mary's-Detroit Lakes is created & organized to own, maintain, operate & conduct, directly or indirectly, & to assist & coordinate activities of facilities for health care, education, care for the aged & social services in accordance with the charitable works tradition of the Roman Catholic Church. In keeping with this specific purpose, all works shall be carried out in accordance with the charism of the Benedictine Sisters Benevolent Association, a Minnesota nonprofit corporation. Essentia Health St. Mary's-Detroit Lakes employs over 420 full time equivalents. Essentia Health St. Mary's-Detroit Lakes provided over $693,000 in charity care and over $3,486,000 of costs incurred in excess of Medicaid payments received during the fiscal year ended June 30, 2013. Further community benefits provided during the fiscal year include community services of over $35,000, education and workforce development of over $244,000, and cash & in-kind donations of over $416,000. FORM 990, PART III, LINE 4A: Essentia Health St. Mary's-Detroit Lakes hospital is a modern facility licensed for 87 beds. The hospital features a 12-bed women's unit with four birthing rooms, three operating rooms, 24 hour CRNA services, x-ray, CT, mobile MRI, & lab. The hospital provided for nearly 6,000 hospital patient days during the fiscal year ended June 30, 2013. Essentia Health St. Mary's-Detroit Lakes is certified as a Level III Trauma Hospital meeting the high standards of clinical equipment & staff training. Essentia Health St. Mary's-Detroit Lakes provides multi-specialty Clinic services to a wide array of patients in four different communities in Detroit Lakes, MN. Clinic services include Primary Care, Obstetrics, Orthopedics, Podiatry, General Surgery, Geriatrics, and Psychology. The clinic had over 71,500 encounters during the fiscal year ended June 30, 2013. The service area for Essentia Health St. Mary's-Detroit Lakes includes Becker County, which is one of the poorest counties in MN. The patients served by Essentia Health St. Mary's-Detroit Lakes include a large indigent population that is culturally and financially diverse. FORM 990, PART III, LINE 4B: St. Mary's Nursing Center provides a loving atmosphere where all residents are treated with the utmost dignity by a specialized team of physicians, nurses, therapists, social workers, & chaplains. The Memory Care Program promotes a calm & therapeutic environment tailored to meet the unique needs of individuals & their families dealing with progressive dementia. Resident days were over 33,000 during the fiscal year ended June 30, 2013. FORM 990, PART III, LINE 4C: Essentia Health St. Mary's-Detroit Lakes assisted living offers independent living with assistance & senior housing offers independent living unless assistance is requested. The secure apartments provide a modern, comfortable living environment supported by services & amenities to offer seniors choices to enhance their health & quality of life. FORM 990, PART V, LINE 1A 1099 Reporting: Vendor payments and Form 1099's were processed through Essentia Health on behalf of certain legal entities comprising Essentia Health system. FORM 990, PART VI, LINE 6 Members of Organization: ESSENTIA HEALTH WEST is the sole member of ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES. Member, ESSENTIA HEALTH WEST, may elect one or more members of the governing body as described in Schedule O Part VI Line 7a. Members, ESSENTIA HEALTH, BENEDICTINE SISTERS BENEVOLENT ASSOCIATION, AND ESSENTIA HEALTH WEST have reserved powers with respect to ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES as described in Schedule O Part VI Line 7b. FORM 990, PART VI, LINE 7A Members with right to elect governing body: ESSENTIA HEALTH WEST appoints and removes ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES's governing body. FORM 990, PART VI, LINE 7B Member with right to approve governing body decision: ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES is a subsidiary of Essentia Health, whose Board of Directors has reserved powers with respect to this corporation and its subsidiaries, and all of the other direct and indirect subsidiaries of Essentia Health (collectively, the "System"). Essentia Health's reserved powers are as follows: Strategic and Business Plans. Authority to create, and to approve, the System's strategic and business plans. Mission. Authority to create, and to approve, the mission, purpose and vision statements for all entities in the System by the affirmative vote of at least 67% of the Essentia Health board of directors. Debt. Approval of the incurrence of debt by, and the creation of all mortgages, liens, security interests, or other encumbrances on the assets of, all entities in the System in excess of the single or annual aggregate dollar limits prescribed in writing by the Essentia Health board of directors, and the authority to cause all entities in the System to participate in System borrowing. Governing Instruments. Authority to cause, and to approve, amendments of the articles of incorporation and bylaws of all entities in the System. Mergers and Acquisitions. Authority to cause, and to approve, all mergers, consolidations, and dissolutions of all entities in the System. Affiliations and Joint Ventures. Authority to cause, and to approve, all affiliations, joint ventures and other alliances with third parties of all entities in the System. Transfer of Assets Within the System. Authority to transfer assets, including cash, between and among entities within the System; provided, however, that Essentia Health shall not have authority to require any entity in the System to transfer assets (a) that would cause such entity to be in default of its covenants or obligations under any bond or other financing documents; (b) from the Catholic entities to the secular entities or from the secular entities to the Catholic entities in a manner or to an extent that would cause the Catholic entities to be in violation of the Ethical and Religious Directives for Catholic Health Care Services (ERDs) in the judgment of the local ordinary; or (c) such that money generated by services at secular facilities within the System by procedures that are contrary to the ERDs would be used at the Catholic entities or money generated by Catholic entities would be used in the providing of services contrary to the ERDs at secular facilities within the System. Transfer of Assets Outside the System. Authority to cause, and to approve, the sale, lease or other transfer of assets of all entities in the System to parties outside of the System when the asset's value exceeds the single or annual aggregate dollar limits prescribed in writing by the Essentia Health board of directors. Services. Authority to cause, and to approve, the addition of new services and service locations and the discontinuance of services and service locations within all entities in the System. Budgets. Approval of capital and operating budgets of all entities in the System. Professional Services. Selection of the general legal counsel and external auditors of all entities in the System. Acquisitions. Authority to cause, and to approve, all acquisitions by and formations of entities in the System. Marketing. Authority to implement System-wide marketing and promotional activities. Compliance Plans. Authority to create, and to approve, corporate compliance, safety and risk management plans for entities within the System. Quality Plan. Authority to create, and to approve, the System's quality plan. Non-Budgeted Purchases. Approval of non-budgeted capital purchases and leases in excess of the single or annual aggregate dollar limits prescribed in writing by Essentia Health for entities within the System. Human Resources. Authority to create human resource policies and procedures within the System. Reserved Powers. Authority to create additional Essentia Health reserved powers by the affirmative vote of at least 80% of the Essentia Health board of directors (excluding the Essentia Health CEO); provided, however, that any additional Essentia Health reserved powers shall not contravene or hinder the reserved powers of Benedictine Sisters Benevolent Association. The Benedictine Sisters Benevolent Association ("BSBA") also has certain reserved powers over Essentia Health's Catholic facilities. 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 and Religious Directives for Catholic Health Care Services (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; provided, however, that it is the intent of the parties that this provision not be applied to restrict or to impede Essentia from acting and making decisions on behalf of the system in the ordinary course of business but be applied to prevent the transfer of substantial assets of Catholic entities within the system to support the secular entities within the system without the prior approval of BSBA. 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 BSBA board of director members serving as members of such entity's board of directors; authority to approve any amendments to the Articles of Incorporation or Bylaws of Essentia's Catholic Subsidiaries 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 BSBA 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 Essentia's Catholic Subsidiaries, which amendments BSBA 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. dissolution, or the disposition of all or substantially all the assets. FORM 990, PART VI, LINE 7B cont. 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 2012 Form 990 including all schedules was reviewed by ESSENTIA HEALTH ST. MARY'S-DETROIT LAKE's management and governing body on March 10, 2014 prior to filing with the Internal Revenue Service. Each current director of the governing body received a copy of the 2012 Form 990. ESSENTIA HEALTH ST. MARY'S-DETROIT LAKE's Chief Financial Officer led the review of the form and schedules and any questions were discussed. FORM 990, PART VI, LINE 12C Monitoring and enforcing Conflict of Interest policy: Essentia Health's comprehensive conflict of interest program prevents, detects and resolves actual conflicts of interests or the actual or potential appearance of such. Fiduciaries, defined as an Essentia Health board member/trustee, officer, board committee member, senior management employee, or any others considered to be in a position of influence, are covered under Essentia's conflict of interest program. Upon initial appointment, each fiduciary must complete an initial conflict of interest statement and disclosure questionnaire. At the conclusion of each fiscal year, each fiduciary must complete an annual conflict of interest statement and disclosure questionnaire. As needed, a fiduciary will update his/her most recently completed questionnaire each time the fiduciary becomes aware of a financial interest, a potential conflict, or change to any information that the fiduciary previously reported. Essentia Health's Chief Compliance Officer will collect the questionnaires and evaluate the disclosures. If a fiduciary has a potential conflict of interest, the Chief Compliance Officer or designee may request additional information from the fiduciary, the management team, and others. During the evaluation process, the Chief Compliance Officer may also consult with Essentia Health's Board and Audit Committee Chairs, senior management, legal department, or appropriate representatives from Essentia Health. The Chief Compliance Officer reports to the Essentia Health Audit Committee and the Essentia Health Board of Directors any actual or potential conflicts of interest disclosed by the fiduciary, along with recommended actions. The Essentia Health Board of Directors (or designee) will then determine whether to approve the situation or to implement special controls to manage the potential conflict of interest. The Chief Compliance Officer will then officially notify the fiduciary in writing of the board's decision. The decision of whether or not the disclosure constitutes a conflict or not will be at the Essentia Health Board of Director's (or designee) sole discretion, and its concern must be the welfare of Essentia Health and its affiliate(s) and the advancement of its purposes. When the Essentia Health Board of Directors (or designee) considers a Fiduciary's disclosure as a Conflict of Interest, special controls will be identified to manage, eliminate or reduce the likelihood and/or appearance of a conflict arising. Controls may include but are not limited to: A.If the conflict involves an on-going matter or relationship, the Fiduciary must not participate in Board, Board committee or management discussions related to the conflict and must recuse themselves and if appropriate, withdraw, from any Board meeting or portion thereof where the matter is being discussed and during the vote on the potential Conflict of Interest. The Fiduciary may answer questions at the Board's or the Board Committee's request. B.If the conflict involves a specific transaction or decision, the Fiduciary will fully disclose their interest and all related material facts. The Board or committee of the Board will determine whether the contemplated transaction may be authorized as just, fair, and reasonable to Essentia Health or its affiliate(s). If the Board determines a conflict does not exist, the Fiduciary may proceed with the transaction; however, he or she will not be eligible to vote on related issues should they arise. If the Board determines a conflict does exist, the Fiduciary will be notified of the decision regarding whether the contemplated transaction will be authorized as just, fair, and reasonable. Form 990, Part VI, Line 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 designated Essentia executives who are officers or key employees of Essentia or any of its affiliates which may be paid by related organizations. 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 St. Mary's-Detroit Lakes PRESIDENT 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 ST. MARY'S-DETROIT LAKES makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. ESSENTIA HEALTH ST. MARY'S-DETROIT LAKES is part of Essentia Health's consolidated financial statements which are included in Essentia Health's annual report posted on Essentia Health's web site. FORM 990, Part XI Line 9 Other Changes in Net Assets: The total amount of other changes in net assets includes: Net Asset transfers with related organizations; reallocated Balance Sheet items transferred to align with organizational structure: $455,606 Net Asset transfers with related organizations; reallocated Income Statement items transferred to align with organizational structure: ($570,834) Total: ($115,228) Brainerd Lakes Integrated Health System 2024 S 6th St Brainerd MN 56401 371532145 Support ORG MN 501(C)(3) 11 TYPE II ESSENTIA true Brainerd Medical Center Inc 2024 S 6th St Brainerd MN 56401 371532148 Clinic MN 501(C)(3) 3 BLIHS true 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 DL Surgery Center THRU 712 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 TYPE II Essentia 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 SrvCS MN 501(C)(3) 9 SMRHC true St Mary's Hospital 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 Essentia Health 502 E 2nd St Duluth MN 55805 200360007 Support ORG MN 501(C)(3) 11TYPEIIIFI NA false Innovis Health LLC 3000 32ND AVE Fargo ND 58103 261175213 Clinic/Hosp DE 501(C)(3) 3 Essentia true Midwest Medical Equipment & Supply Inc 4418 Haines Rd Duluth MN 55811 411674021 Medical Equip MN 501(C)(3) 9 SMMC true SMDC Medical Center 502 E 2nd St Duluth MN 55805 411878730 Clinic/Hosp MN 501(C)(3) 3 SMDCHS true Pine Medical Center 109 Court Ave S Sandstone MN 55072 411884597 HOSPITAL/NURS MN 501(C)(3) 3 SMDCHS true Polinsky Medical Rehabilitation Center 530 E 2nd St Duluth MN 55805 410691275 Clinic MN 501(C)(3) 3 SMMC true St Mary's Duluth Clinic Health System 407 E 3rd St Duluth MN 55805 411836633 SUPPORT ORG MN 501(C)(3) 11 TYPE II Essentia true 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 First Care Medical Services 900 Hilligoss 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 Essentia Institute of Rural Health 502 E 2nd St Duluth MN 55805 271291124 Research MN 501(C)(3) 4 Essentia true ESSENITA Health Foundation 502 E 2nd St Duluth MN 55805 271984704 Foundation MN 501(C)(3) 7 ESSENTIA 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 DEER RIVER HEALTHCARE CENTER INC 115 10TH AVE NE DEER RIVER MN 56636 410844574 HOSPITAL/NURS MN 501(C)(3) 3 SMDCHS true PMC-Gateway Imaging LLC 109 Court Ave S Sandstone MN 55072 261634764 Imaging ServiCES MN NA N/A 0 0 0 0.00000 Essentia Health Insurance Services SPC 94 Solaris Ave PO Box 69 Grand Cayman CAYMAN ISLANDS CJ KY1-1102 000000000 Insurance CJ NA Foreign Corp 0 0 0.00000 true East Range Clinics LTD 910 6th Ave N Virginia MN 55792 410909915 Clinics MN NA C CORP 0 0 0.00000 true false true true false false false false false true true true true true false true true true true true ESSENTIA HEALTH FOUNDATION B 139098 Actual costs ESSENTIA HEALTH FOUNDATION C 74017 Actual costs INNOVIS HEALTH LLC I 235490 Actual costs INNOVIS HEALTH LLC J 100400 Actual costs ESSENTIA HEALTH M 3480743 Actual costs BRIDGES MEDICAL CENTER O 118784 Actual costs CRITICAL ACCESS GROUP P 1937506 Actual costs ESSENTIA HEALTH P 1743035 Actual costs Innovis Health LLC P 19629830 Actual costs SMDC MEDICAL CENTER P 782323 Actual costs ST MARY'S MEDICAL CENTER P 111805 Actual costs ESSENTIA HEALTH Q 538481 Actual costs ST MARY'S EMS Q 222171 Actual costs INNOVIS HEALTH LLC Q 306935 Actual costs ST MARY'S INNOVIS HEALTH Q 84114 Actual costs St Mary's Innovis Health R 172418 Actual costs CRITICAL ACCESS GROUP S 107819 Actual costs ESSENTIA HEALTH S 58482 Actual costs ST MARY'S INNOVIS HEALTH S 102041 Actual costs ST MARY'S INNOVIS HEALTH J 120000 Actual costs Form 990, Schedule R, Part II, Column a The following Essentia Health entities have a doing business as name. Legal Name; Doing Business As Name Brainerd Lakes Integrated Health System; Essentia Health Central Brainerd Medical Center, Inc.; Essentia Health Brainerd Specialty Clinic Bridges Medical Center; Essentia Health Ada Deer River Healthcare Center, Inc.; Essentia Health Deer River First Care Medical Services; Essentia Health Fosston Graceville Health Center; Essentia Health Holy Trinity Hospital Innovis Health, LLC; Essentia Health West Midwest Medical Equipment & Supply Inc.; Essentia Health Medical Equipment and Supplies Northern Pines Medical Center; Essentia Health Northern Pines Pine Medical Center; Essentia Health Sandstone Polinsky Medical Rehabilitation Center; Essentia Health Polinsky Medical Rehabilitation Center SMDC Medical Center; Essentia Health Duluth St. Joseph's Medical Center; Essentia Health St. Joseph's Medical Center St. Mary's Duluth Clinic Health System; Essentia Health East St. Mary's Hospital of Superior; Essentia Health St. Mary's Hospital-Superior St. Mary's Medical Center; Essentia Health St. Mary's Medical Center St. Mary's Regional Health Center; Essentia Health St. Mary's-Detroit Lakes