2017-04-21T13:05:14-05:00 2016-06-30 990 2015-07-01 271984704 Essentia Health Foundation ESSE 2187861619 502 E 2nd St Duluth MN 55805 James Garvey Interim Executive Director 2187861619 2017-04-18 2015 2021-01-29 14:40:06Z James Garvey 407 E 3RD ST Duluth MN 55805 5003676 0 X www.essentiahealth.org X 2009 MN We are called to make a healthy difference in people's lives. 10 9 12 248 0 0 4628053 4385418 0 0 1403137 -485547 -102713 -79341 5928477 3820530 2261809 3309239 0 0 1130142 1065864 66594 74614 520359 570379 610685 4028924 5060402 1899553 -1239872 28485687 26883119 869839 929600 27615848 25953519 X We are called to make a healthy difference in people's lives. 0 0 3348000 3309239 Essentia Health Foundation is organized and shall be operated exclusively for charitable, educational, scientific, and religious purposes exclusively for the benefit of, to perform the functions of, or to carry out the purposes of certain Essentia Health Supported Organizations, and of the tax-exempt entities identified as supported organizations in their respective articles of incorporation.Essentia Health Foundation facilitates charitable fundraising for and on behalf of certain Essentia Health Supported Organizations. Fundraising is conducted by direct mail, special events, grants from foundations and donations from individuals. Companies, foundations, individuals, physicians and staff participate by giving to the foundation. Donations are given for a wide range of charitable needs of each of the supported organizations including patient care initiatives, capital improvements, equipment and supplies, community education and outreach, research, and employee assistance. In total, $2.6 million was given to the Foundation in 2016 by 6,273 donors, most of whom reside in communities served by Essentia Health. The Foundation's local advisory boards distributed $3.3 million to its supported organizations and community programs which improve community health.The organizations Essentia Health Foundation supports provide health care services to the general public as part of Essentia Health. Essentia Health, headquartered in Duluth, Minnesota, is a fully integrated health system serving patients in Minnesota, Wisconsin, North Dakota and Idaho. Essentia Health combines the strengths and talents of nearly 14,000 employees, including more than 1,800 physicians and advanced practitioners, who serve its patients and communities through the mission of being called to make a healthy difference in people's lives. Essentia Health, which includes several Catholic facilities, is guided by the values of quality, hospitality, respect, justice, stewardship and teamwork. Essentia Health delivers on its promise to be "Here With You" in 15 hospitals, over 60 clinics, seven long-term care facilities, three assisted living facilities, three independent living facilities, five ambulance services and one research institute. Essentia Health provides services predominantly in rural communities and is committed to eliminating geographic barriers to care. Many of Essentia Health's hospitals and clinics are located in communities that are federally recognized as being medically underserved. Essentia Health is accredited as an Accountable Care Organization by the National Committee for Quality Assurance. Essentia Health's hospitals have a total of 1,210 licensed beds which provided over 184,000 hospital patient days and over 620,000 outpatient visits during the fiscal year ended June 30, 2016. The clinics had over 1.6 million encounters during the same time period. During the fiscal year ended June 30, 2016, Essentia Health system provided total community benefits of over $131 million which included costs of providing charity care, costs in excess of Medicaid payments, Medicaid surcharge, MinnesotaCare tax, community services, health profession education, research, and cash and in-kind contributions. 3348000 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 1 1 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 X 0 0 1 12 1 0 0 0 0 0 1 1 0 0 0 0 X 10 9 0 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 0 0 MN AK AR CA CO FL GA IL KS KY MD MI MS NH NJ NM NC OR PA SC TN UT WV X Julie Thedens 2187863494 502 E 2nd St Duluth MN 55805 Cyndi Anderson Board Chair 1.00 3.00 X X 0 1150 0 Richard Brown Board Vice Chair 1.00 0.00 X X 0 0 0 Robert Bennett Board Director 1.00 0.00 X 0 0 0 Robert Erickson MD Board Director 1.00 0.00 X 0 514537 53781 Val Knudsen Board Director 1.00 0.00 X 0 0 0 Craig Nathan Board Director 1.00 0.00 X 0 0 0 Jim Rehder Board Director 1.00 0.00 X 0 0 0 Mike Seyfer Board Director 1.00 0.00 X 0 0 0 Jim Sinclair Board Director 1.00 0.00 X 0 0 0 Faye Witt Board Director 1.00 0.00 X 0 68945 0 Kimberly Ellingson Board Director thru 3/16 1.00 0.00 X 0 0 0 James Garvey Interim Executive Director 1.00 59.00 X 0 579243 82133 Steve Yorde Executive Director thru 4/16 60.00 0.00 X 253244 0 42833 Kyle Dorow Former Chief Financial Officer 0.00 60.00 X 0 305252 55321 Gregory Glasner MD Former President 0.00 60.00 X 0 665389 92716 253244 2134516 326784 1 1 1 0 0 103965 1922343 2359110 141341 4385418 419341 419341 3625 908513 -904888 -904888 -904888 172220 103965 261568 -89348 -89348 22880 13065 9815 9815 Securities Litigation 900099 192 192 192 3820530 0 0 -564888 2799257 2799257 442442 442442 67540 67540 298457 223843 74614 672233 389945 282288 25625 14352 11273 70118 29087 41031 74045 46919 27126 1100 1100 139006 139006 183634 166908 16726 37832 18065 19767 73387 45839 27548 10383 10383 49650 44757 4893 56477 41829 14648 8982 8982 Gift Annuity Installmen 38235 38235 Dues 4502 4502 Sales Tax 753 753 Licenses 664 664 6080 526 5109 445 5060402 3348000 1192043 520359 698625 700341 3172763 1828525 1356236 1303082 10873 6406 99598 51780 56800 47818 238771 238732 22896633 22700748 54986 57467 28485687 26883119 260787 178461 91901 45441 517151 705698 869839 929600 X 16600456 15352157 9890410 9241079 1124982 1360283 27615848 25953519 28485687 26883119 X -1239872 -368924 -1013 -52520 X 0 1 X 1 0 X 5474063 4680671 4374027 4606755 4302877 23438393 5474063 4680671 4374027 4606755 4302877 23438393 6528426 16909967 414701 1225015 1541853 1403137 -485547 4099159 27537552 0.61410 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 11015293 2315209 -11496 1384201 1333443 10601362 9854601 2610802 10806 1018530 442386 11015293 11528186 2290207 78244 936157 3105879 9854601 1548869 2031772 18319 1338589 4642185 11528186 17276950 -381 1403069 414631 15458869 0.00000 0.12830 0.87170 0 0 99598 51780 47818 47818 Pooled investment fund 22700748 F 22700748 Payables to related tax-exempt organizations 420798 Discounted Charitable Gift Annuity Contracts 284900 705698 Part V, Line 4: USES OF ORGANIZATION'S ENDOWMENT FUNDS: Essentia Health Foundation's intended uses of its endowment funds are to further the mission of Essentia Health and to support: Pilot studies from which the collected data may be used to pursue larger grants, program development start-up funds, and specialized healthcare need for activities that have primary impact in areas serviced by Essentia Health Hospitals and clinics. 1 South Asia 0 0 Grantmaking 67540 0 0 0 0 0 0 67540 0 67540 South Asia Grantmaking 67540 Check 1 0 0 0 0 0 0 0 Part I, Line 2: PROCEDURE FOR MONITORING THE USE OF GRANTS: ESSENTIA HEALTH FOUNDATION'S MANAGEMENT REVIEWS THE GRANT ACTIVITY BY REVIEWING AND DOCUMENTING EACH EXPENDITURE REQUEST AND APPROVING THE EXPENSE. ALL DISBURSEMENTS ARE MADE IN ACCORDANCE WITH FUND DESIGNATION AND PURPOSE. DISBURSEMENTS MUST BE CONSISTENT WITH THE MISSION STATEMENT AND PURPOSE OF THE ESSENTIA HEALTH FOUNDATION AS STATED IN ITS ORGANIZATIONAL DOCUMENTS. GRANT PROPOSALS ARE REVIEWED AT VARIOUS ASSOCIATED FOUNDATION COMMITTEES PRIOR TO DISBURSEMENT AND IN ACCORDANCE WITH THE FUND DISBURSEMENT PROCESS. Dinner/Auction 159385 68145 91240 6075 51885 26037 18492 14547 Dinner/Auction 23805 6183 17622 14657 7095 759 5 70565 22010 48555 57861 1281 11583 3064 14995 253755 96338 157417 6075 124403 1281 44715 21556 30301 228331 -70914 22880 375 11256 1434 0 22880 375 11256 1434 13065 9815 MN ID 0 Essentia Health Foundation is licensed in the State of MN. Essentia Health Foundation is not licensed in Idaho because the gaming activity for FY16 was below the limit Idaho requires for licensure. 0 0 0 0.14290 0.85710 Emilie Bowman 502 East 2nd Street Duluth MN 55805 0 See Schedule G Part IV X 0 SCHEDULE G, PART III, LINE 11 GAMING ACTIVITIES WITH NONMEMBERS: ESSENTIA HEALTH FOUNDATION DOES NOT HAVE ANY MEMBERS. SCHEDULE G, PART III, LINE 16 GAMING MANAGER INFORMATION: ESSENTIA HEALTH FOUNDATION CONDUCTED RAFFLES DURING THE YEAR AS PART OF FUNDRAISING EVENTS. BECAUSE THESE EVENTS WERE CONDUCTED IN VARIOUS LOCATIONS THROUGHOUT THE ESSENTIA HEALTH FOUNDATION NETWORK, SEVERAL EMPLOYEES SUPERVISED THE GAMING EVENTS. THESE EMPLOYEES PROVIDED THE FOLLOWING SERVICES: RECORDKEEPING, MONEY COUNTING, AND GENERAL OVERSIGHT OF THE GAMING OPERATION. THE NAMES AND GAMING-RELATED COMPENSATION, INCLUDING COMPENSATION FROM RELATED ORGANIZATIONS, ARE LISTED BELOW: MOLLY SKIFSTAD $1,524 KATHRYN MORGAN $651 LEANN MOUW $214 MARLYS OSWALD $202 DAVID JEREMIASON $164 1 Essentia Health 502 E 2nd St Duluth MN 55805 200360007 501(c)(3) 60365 Program Support Essentia Institute of Rural Health 502 E 2nd St Duluth MN 55805 271291124 501(c)(3) 323242 Program Support SMDC Medical Center 502 E 2nd St Duluth MN 55805 411878730 501(c)(3) 340766 Program Support St Mary's Medical Center 407 E 3rd St Duluth MN 55805 410695604 501(c)(3) 818360 Program Support The Duluth Clinic Ltd 400 E 3rd St Duluth MN 55805 410883623 501(c)(3) 19098 Program Support St Mary's Hospital of Superior 3500 Tower Ave Superior WI 54880 411811073 501(c)(3) 38605 Program Support Innovis Health LLC 3000 32nd Ave S Fargo ND 58103 261175213 501(c)(3) 245784 Program Support Bridges Medical Center 503 E 3rd St Duluth MN 55805 200479568 501(c)(3) 20555 Program Support Graceville Health Center 115 W 2nd St Graceville MN 56240 410726173 501(c)(3) 30530 Program Support St Mary's Regional Health Center 1027 Washington Ave Detroit Lakes MN 56501 411620386 501(c)(3) 72427 Program Support St Mary's EMS 1027 Washington Ave Detroit Lakes MN 56501 411805811 501(c)(3) 7313 Program Support St Joseph's Medical Center 523 N 3rd St Brainerd MN 56401 410695602 501(c)(3) 507512 Program Support St Mary's Hospital Inc PO Box 137 Cottonwood ID 83522 820226453 501(c)(3) 197056 Program Support Central Lakes College Foundation 501 W College Dr Brainerd MN 56401 237007111 501(c)(3) 7864 Program Support Lutheran Social Service of Minnesota 2485 Como Ave St Paul MN 55108 410872993 501(c)(3) 8000 Program Support Confidence Learning Center 1620 Mary Fawcett Memorial Dr East Gull Lake MN 56401 410985513 501(c)(3) 6220 Program Support Mission Township Firefighters Relief Association PO Box 327 Merrifield MN 56465 411385614 501(c)(3) 8216 Program Support Lakes Area Habitat for Humanity PO Box 234 1110 Wright St Brainerd MN 56401 411659149 501(c)(3) 14638 Program Support Brainerd Ecfe PTO for Isd 181 311 10th Ave NE Brainerd MN 56401 473671531 501(c)(3) 16295 Program Support Regents of the University of Minnesota University Ave SE STE 111 Minneapolis MN 55414 416007513 170(C)(1) 11044 Program Support City of Chisholm 316 Lake St W Chisholm MN 55719 416005047 City of Chisholm 6497 FMV/Cost Life Pak12 Health Monitor Program Support 20 1 Assist Essentia Health Patients & Community 171 96422 Assist Essentia Health Patients & Community 6143 185444 FMV Various items (Medical Supplies, Gas Gift Cards, Clothing, Groceries, etc.) Grief Support Group 408 7192 FMV Bereavement Roses Assist Essentia Health Employees in Financial Need 114 100402 Assist Essentia Health Employees in Financial Need 191 21650 FMV Gift Cards Scholarships 14 16850 Ostomy Supplies to Patients in Need 24 2455 FMV Ostomy Supplies Reach Out & Read, Books for Patients 5771 12027 FMV Books Part I, Line 2: PROCEDURE FOR MONITORING THE USE OF GRANTS: ESSENTIA HEALTH FOUNDATION'S MANAGEMENT REVIEWS THE GRANT ACTIVITY BY REVIEWING AND DOCUMENTING EACH EXPENDITURE REQUEST AND APPROVING THE EXPENSE. ALL DISBURSEMENTS ARE MADE IN ACCORDANCE WITH FUND DESIGNATION AND PURPOSE. GRANTS ARE MADE TO GOVERNMENT & NOT-FOR-PROFIT INSTITUTIONS OR ORGANIZATIONS, PRIMARILY TO MEMBERS OF THE ESSENTIA HEALTH SYSTEM AND AFFILIATED ORGANIZATIONS. DISBURSEMENTS MUST BE CONSISTENT WITH THE MISSION STATEMENT AND PURPOSE OF THE ESSENTIA HEALTH FOUNDATION AS STATED IN ITS ORGANIZATIONAL DOCUMENTS. GRANT PROPOSALS ARE REVIEWED AT VARIOUS ASSOCIATED FOUNDATION COMMITTEES PRIOR TO DISBURSEMENT AND IN ACCORDANCE WITH THE FUND DISBURSEMENT PROCESS. GRANTS AND OTHER ASSISTANCE TO INDIVIDUALS IS USED TO ASSIST ESSENTIA HEALTH PATIENTS AND COMMUNITY MEMBERS IN FINANCIAL NEED; TO ASSIST WITH COMMUNITY BASED PROGRAMS TO INCLUDE SUPPLIES, PREVENTION, AWARENESS, SUPPORT GROUPS OR EDUCATIONAL ACTIVITIES; OR TO PROVIDE SCHOLARSHIPS FOR THOSE IN THE MEDICAL FIELD. GRANT MONITORING OF SUCH ACTIVITIES ARE IN ACCORDANCE WITH PROCEDURES DEFINED ABOVE. X X X X 0 1 0 0 0 0 0 0 0 Robert Erickson MD Board Director 0 510063 0 1917 0 2557 0 21200 0 32581 0 568318 0 0 James Garvey Interim Executive Director 0 391900 0 181626 0 5717 0 62197 0 19936 0 661376 0 0 Steve Yorde Executive Director thru 4/16 201247 0 40217 0 11780 0 23384 0 19449 0 296077 0 6298 0 Kyle Dorow Former Chief Financial Officer 0 249685 0 54315 0 1252 0 30411 0 24910 0 360573 0 0 Gregory Glasner MD Former President 0 470808 0 191115 0 3466 0 66302 0 26414 0 758105 0 0 Part I, Line 3 ESTABLISHING CEO'S COMPENSATION: ESSENTIA HEALTH, AS A RELATED ORGANIZATION, USED THE FOLLOWING METHODS TO ESTABLISH ESSENTIA HEALTH FOUNDATION'S EXECUTIVE DIRECTOR'S COMPENSATION: A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. 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 vesting is automatic 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 individuals 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: Steve Yorde $6,298 Reported as Retirement and Other Deferred Compensation in Schedule J, Part II, Column C, Essentia Health made contributions, subject to the vesting terms, during the year into the supplemental nonqualified retirement plan on behalf of the following individuals listed in Form 990, Part VII, Section A, Line 1a: James Garvey $40,997 Steve Yorde $4,482 Kyle Dorow $9,306 Gregory Glasner, MD $49,414 X 7 1804 Cost or Selling X 64046 Cost or Selling X 14 3115 Cost or Selling X 90 12082 Cost or Selling X 5 16330 Cost or Selling X 1 100 Cost or Selling X 3 130 Cost or Selling X Auction Items 143 43734 Cost or Selling 0 1 0 Part I, Column (b): NUMBER OF CONTRIBUTIONS: ESSENTIA HEALTH FOUNDATION IS REPORTING THE NUMBER OF CONTRIBUTIONS. SCHEDULE M, PART I, COLUMN (D): METHOD: ESSENTIA HEALTH FOUNDATION USED THE COST OR SELLING PRICE OF DONATED PROPERTY TO DETERMINE AMOUNT REPORTED ON FORM 990, PART VIII, LINE 1G. FORM 990, PART I, LINE 16A PROFESSIONAL FUNDRAISING EXPENSES: THE AMOUNT LISTED REPRESENTS THE INTERNAL PROFESSIONAL FUNDRAISING COSTS AS REPORTED ON PART IX, COLUMN (D), LINE 5. IT DOES NOT REPRESENT FEES PAID TO EXTERNAL PROFESSIONAL FUNDRAISERS. FORM 990, PART V, LINE 1A 1099 REPORTING: CERTAIN VENDOR PAYMENTS AND FORM 1099'S WERE PROCESSED THROUGH ESSENTIA HEALTH ON BEHALF OF CERTAIN LEGAL ENTITIES COMPRISING ESSENTIA HEALTH. FORM 990, PART V, LINE 1C NO GAMING (GAMBLING) WINNINGS Form 990, Part VI, Section A, line 4 Significant Changes to Governing Documents: During the fiscal year ended June 30, 2016, the Articles of Essentia Health Foundation were amended to include Essentia Health Virginia, LLC as a supported organization. Form 990, Part VI, Section A, line 6 MEMBERS OF ORGANIZATION: ESSENTIA HEALTH IS THE SOLE MEMBER OF ESSENTIA HEALTH FOUNDATION AND MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY AS DESCRIBED IN SCHEDULE O, PART VI, LINE 7A. ESSENTIA HEALTH ALSO HAS RESERVED POWERS WITH RESPECT TO ESSENTIA HEALTH FOUNDATION AS DESCRIBED IN SCHEDULE O, PART VI, LINE 7B. Form 990, Part VI, Section A, line 7a MEMBER WITH RIGHT TO ELECT GOVERNING BODY: ESSENTIA HEALTH APPOINTS AND REMOVES ESSENTIA HEALTH FOUNDATION'S GOVERNING BODY. Form 990, Part VI, Section A, line 7b MEMBERS WITH RIGHT TO APPROVE GOVERNING BODY DECISION: ESSENTIA HEALTH FOUNDATION IS A SUBSIDIARY OF ESSENTIA HEALTH, WHOSE BOARD OF DIRECTORS HAS RESERVED POWERS WITH RESPECT TO THIS CORPORATION AND ITS SUBSIDIARIES, AND ALL OF THE OTHER DIRECT AND INDIRECT SUBSIDIARIES OF ESSENTIA HEALTH (COLLECTIVELY, THE "SYSTEM"). ESSENTIA HEALTH'S RESERVED POWERS ARE AS FOLLOWS: STRATEGIC AND BUSINESS PLANS. AUTHORITY TO CREATE, AND TO APPROVE, THE SYSTEM'S STRATEGIC AND BUSINESS PLANS. MISSION. AUTHORITY TO CREATE, AND TO APPROVE, THE MISSION, PURPOSE AND VISION STATEMENTS FOR ALL ENTITIES IN THE SYSTEM BY THE AFFIRMATIVE VOTE OF AT LEAST 67% OF THE ESSENTIA HEALTH BOARD OF DIRECTORS. DEBT. APPROVAL OF THE INCURRENCE OF DEBT BY, AND THE CREATION OF ALL MORTGAGES, LIENS, SECURITY INTERESTS, OR OTHER ENCUMBRANCES ON THE ASSETS OF, ALL ENTITIES IN THE SYSTEM IN EXCESS OF THE SINGLE OR ANNUAL AGGREGATE DOLLAR LIMITS PRESCRIBED IN WRITING BY THE ESSENTIA HEALTH BOARD OF DIRECTORS, AND THE AUTHORITY TO CAUSE ALL ENTITIES IN THE SYSTEM TO PARTICIPATE IN SYSTEM BORROWING. GOVERNING INSTRUMENTS. AUTHORITY TO CAUSE, AND TO APPROVE, AMENDMENTS OF THE ARTICLES OF INCORPORATION AND BYLAWS OF ALL ENTITIES IN THE SYSTEM. MERGERS AND ACQUISITIONS. AUTHORITY TO CAUSE, AND TO APPROVE, ALL MERGERS, CONSOLIDATIONS, AND DISSOLUTIONS OF ALL ENTITIES IN THE SYSTEM. AFFILIATIONS AND JOINT VENTURES. AUTHORITY TO CAUSE, AND TO APPROVE, ALL AFFILIATIONS, JOINT VENTURES AND OTHER ALLIANCES WITH THIRD PARTIES OF ALL ENTITIES IN THE SYSTEM. TRANSFER OF ASSETS WITHIN THE SYSTEM. AUTHORITY TO TRANSFER ASSETS, INCLUDING CASH, BETWEEN AND AMONG ENTITIES WITHIN THE SYSTEM; PROVIDED, HOWEVER, THAT ESSENTIA HEALTH SHALL NOT HAVE AUTHORITY TO REQUIRE ANY ENTITY IN THE SYSTEM TO TRANSFER ASSETS (A) THAT WOULD CAUSE SUCH ENTITY TO BE IN DEFAULT OF ITS COVENANTS OR OBLIGATIONS UNDER ANY BOND OR OTHER FINANCING DOCUMENTS; (B) FROM THE CATHOLIC ENTITIES TO THE SECULAR ENTITIES OR FROM THE SECULAR ENTITIES TO THE CATHOLIC ENTITIES IN A MANNER OR TO AN EXTENT THAT WOULD CAUSE THE CATHOLIC ENTITIES TO BE IN VIOLATION OF THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES (ERDS) IN THE JUDGMENT OF THE LOCAL ORDINARY; OR (C) SUCH THAT MONEY GENERATED BY SERVICES AT SECULAR FACILITIES WITHIN THE SYSTEM BY PROCEDURES THAT ARE CONTRARY TO THE ERDS WOULD BE USED AT THE CATHOLIC ENTITIES OR MONEY GENERATED BY CATHOLIC ENTITIES WOULD BE USED IN THE PROVIDING OF SERVICES CONTRARY TO THE ERDS AT SECULAR FACILITIES WITHIN THE SYSTEM. TRANSFER OF ASSETS OUTSIDE THE SYSTEM. AUTHORITY TO CAUSE, AND TO APPROVE, THE SALE, LEASE OR OTHER TRANSFER OF ASSETS OF ALL ENTITIES IN THE SYSTEM TO PARTIES OUTSIDE OF THE SYSTEM WHEN THE ASSET'S VALUE EXCEEDS THE SINGLE OR ANNUAL AGGREGATE DOLLAR LIMITS PRESCRIBED IN WRITING BY THE ESSENTIA HEALTH BOARD OF DIRECTORS. SERVICES. AUTHORITY TO CAUSE, AND TO APPROVE, THE ADDITION OF NEW SERVICES AND SERVICE LOCATIONS AND THE DISCONTINUANCE OF SERVICES AND SERVICE LOCATIONS WITHIN ALL ENTITIES IN THE SYSTEM. BUDGETS. APPROVAL OF CAPITAL AND OPERATING BUDGETS OF ALL ENTITIES IN THE SYSTEM. PROFESSIONAL SERVICES. SELECTION OF THE GENERAL LEGAL COUNSEL AND EXTERNAL AUDITORS OF ALL ENTITIES IN THE SYSTEM. ACQUISITIONS. AUTHORITY TO CAUSE, AND TO APPROVE, ALL ACQUISITIONS BY AND FORMATIONS OF ENTITIES IN THE SYSTEM. MARKETING. AUTHORITY TO IMPLEMENT SYSTEM-WIDE MARKETING AND PROMOTIONAL ACTIVITIES. COMPLIANCE PLANS. AUTHORITY TO CREATE, AND TO APPROVE, CORPORATE COMPLIANCE, SAFETY AND RISK MANAGEMENT PLANS FOR ENTITIES WITHIN THE SYSTEM. QUALITY PLAN. AUTHORITY TO CREATE, AND TO APPROVE, THE SYSTEM'S QUALITY PLAN. NON-BUDGETED PURCHASES. APPROVAL OF NON-BUDGETED CAPITAL PURCHASES AND LEASES IN EXCESS OF THE SINGLE OR ANNUAL AGGREGATE DOLLAR LIMITS PRESCRIBED IN WRITING BY ESSENTIA HEALTH FOR ENTITIES WITHIN THE SYSTEM. HUMAN RESOURCES. AUTHORITY TO CREATE HUMAN RESOURCE POLICIES AND PROCEDURES WITHIN THE SYSTEM. RESERVED POWERS. AUTHORITY TO CREATE ADDITIONAL ESSENTIA HEALTH RESERVED POWERS BY THE AFFIRMATIVE VOTE OF AT LEAST 80% OF THE ESSENTIA HEALTH BOARD OF DIRECTORS (EXCLUDING THE ESSENTIA HEALTH CEO); PROVIDED, HOWEVER, THAT ANY ADDITIONAL ESSENTIA HEALTH RESERVED POWERS SHALL NOT CONTRAVENE OR HINDER THE RESERVED POWERS OF BENEDICTINE SISTERS BENEVOLENT ASSOCIATION. Form 990, Part VI, Section B, line 11 FORM 990 REVIEW PROCESS: THE 2015 FORM 990, INCLUDING ALL SCHEDULES, WAS REVIEWED BY ESSENTIA HEALTH FOUNDATION'S MANAGEMENT AND GOVERNING BODY PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. EACH CURRENT DIRECTOR OF THE GOVERNING BODY RECEIVED A FINAL COPY OF THE 2015 FORM 990. ESSENTIA HEALTH FOUNDATION'S FINANCE MANAGER LED THE REVIEW OF THE FORM AND SCHEDULES AND ANY QUESTIONS WERE DISCUSSED. Form 990, Part VI, Section B, 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 Health'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 calendar 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 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, Section B, line 15a 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 Foundation's Interim Executive Director and Executive Director thru 4/16 was 2016. Form 990, Part VI, Section C, line 19 Availability of governing documents, conflict of interest policy, & financial statements to the public: Governing documents, conflict of interest policy, and financial statements are made available to the public upon request for the same period of disclosure as set forth in section 6104(d). The organization 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: Adjustment for Change in Value of Charitable Remainder Trust 317. Adjustment for Change in Value of Charitable Gift Annuity 27,980. Uncollectible Pledges -82,541. Net Asset Transfer with Related Org 1,724. Brainerd Lakes Integrated Health System 2024 S 6th St Brainerd MN 56401 371532145 Supporting org MN 501(c)(3) Line 11b, II Essentia Health 1 Brainerd Medical Center Inc 2024 S 6th St Brainerd MN 56401 371532148 Clinic MN 501(c)(3) Line 3 Brainerd Lakes Integrated Health System 1 Bridges Medical Center 503 E 3rd St Ste 400 Duluth MN 55805 200479568 Hospital/Clinic MN 501(c)(3) Line 3 Innovis Health LLC 1 Clearwater Valley Hospital and Clinics Inc 301 Cedar Orofino ID 83544 820497771 Hospital/Clinic ID 501(c)(3) Line 3 Critical Access Group 1 Critical Access Group 503 E 3rd St Ste 400 Duluth MN 55805 261219624 Supporting org MN 501(c)(3) Line 11b, II Essentia Health 1 Deer River Healthcare Center Inc 115 10th Ave NE Deer River MN 56636 410844574 Hospital/Clinic/Skilled Nursing Facility MN 501(c)(3) Line 3 St Mary's Duluth Clinic Health System 1 Essentia Health 502 E 2nd St Duluth MN 55805 200360007 Supporting org MN 501(c)(3) Line 11c, III-FI N/A 0 Essentia Institute of Rural Health 502 E 2nd St Duluth MN 55805 271291124 Research MN 501(c)(3) Line 4 The Duluth Clinic Ltd 1 First Care Medical Services 900 Hilligoss Blvd SE Fosston MN 56542 410706143 Hospital/Clinic/Skilled Nursing Facility MN 501(c)(3) Line 3 Innovis Health LLC 1 Graceville Health Center 115 West Second St Graceville MN 56240 410726173 Hospital/Clinic/Skilled Nursing Facility MN 501(c)(3) Line 3 Innovis Health LLC 1 Innovis Health LLC 3000 32nd Ave S Fargo ND 58103 261175213 Hospital/Clinic DE 501(c)(3) Line 3 Essentia Health 1 Midwest Medical Equipment and Supplies Inc 4418 Haines Rd Duluth MN 55811 411674021 Medical Equipment MN 501(c)(3) Line 9 St Mary's Medical Center 1 Northern Pines Medical Center 5211 Hwy 110 Aurora MN 55705 410841441 Hospital/Clinic/Skilled Nursing Facility MN 501(c)(3) Line 3 St Mary's Duluth Clinic Health System 1 Pine Medical Center 109 Court Ave S Sandstone MN 55072 411884597 Hospital/Skilled Nursing Facility MN 501(c)(3) Line 3 St Mary's Duluth Clinic Health System 1 Polinsky Medical Rehabilitation Center 530 E 2nd St Duluth MN 55805 410691275 Rehabilitation services MN 501(c)(3) Line 3 St Mary's Medical Center 1 SMDC Medical Center 502 E 2nd St Duluth MN 55805 411878730 Hospital/Clinic MN 501(c)(3) Line 3 St Mary's Duluth Clinic Health System 1 St Joseph's Medical Center 523 N 3rd St Brainerd MN 56401 410695602 Hospital/Clinic MN 501(c)(3) Line 3 Brainerd Lakes Integrated Health System 1 St Mary's Duluth Clinic Health System 407 E 3rd St Duluth MN 55805 411836633 Supporting org MN 501(c)(3) Line 11b, II Essentia Health 1 St Mary's EMS 1027 Washington Ave Detroit Lakes MN 56501 411805811 Emergency services MN 501(c)(3) Line 9 St Mary's Regional Health Center 1 St Mary's Hospital of Superior 3500 Tower Ave Superior WI 54880 411811073 Hospital/Clinic MN 501(c)(3) Line 3 St Mary's Medical Center 1 St Mary's Hospital Inc PO Box 137 Cottonwood ID 83522 820226453 Hospital/Clinic ID 501(c)(3) Line 3 Critical Access Group 1 St Mary's Innovis Health 1027 Washington Ave Detroit Lakes MN 56501 262861321 Pharmacy MN 501(c)(3) Line 3 Innovis Health LLC 1 St Mary's Medical Center 407 E 3rd St Duluth MN 55805 410695604 Hospital MN 501(c)(3) Line 3 St Mary's Duluth Clinic Health System 1 St Mary's Regional Health Center 1027 Washington Ave Detroit Lakes MN 56501 411620386 Hospital/Clinic/Skilled Nursing Facility MN 501(c)(3) Line 3 Innovis Health LLC 1 The Duluth Clinic Ltd 400 E 3rd St Duluth MN 55805 410883623 Clinic MN 501(c)(3) Line 3 St Mary's Duluth Clinic Health System 1 PMC-Gateway Imaging LLC 109 Court Ave S Sandstone MN 55072 261634764 Imaging Services MN N/A n/A 0 0 East Range Clinics Ltd (thru 11615) 910 6th Ave N Virginia MN 55792 410909915 Clinics MN N/A C 1 Essentia Health Insurance Services SPC Ltd PO Box 1159 Grand Cayman CJ 000000000 Self Indemnity CJ N/A C 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 ESSENTIA HEALTH B 60365 Actual Costs ESSENTIA HEALTH Q 100986 Actual Costs ESSENTIA INSTITUTE OF RURAL HEALTH B 323242 Actual Costs ESSENTIA INSTITUTE OF RURAL HEALTH P 303063 Actual Costs INNOVIS HEALTH LLC B 245784 Actual Costs INNOVIS HEALTH LLC C 367188 Actual Costs INNOVIS HEALTH LLC Q 60121 Actual Costs ST JOSEPH'S MEDICAL CENTER B 507512 Actual Costs ST JOSEPH'S MEDICAL CENTER C 230323 Actual Costs SMDC MEDICAL CENTER B 340766 Actual Costs SMDC MEDICAL CENTER Q 111365 Actual Costs ST MARY'S HOSPITAL INC B 197056 Actual Costs ST MARY'S MEDICAL CENTER B 818360 Actual Costs ST MARY'S MEDICAL CENTER C 1087107 Actual Costs ST MARY'S REGIONAL HEALTH CENTER B 72427 Actual Costs ST MARY'S REGIONAL HEALTH CENTER C 131942 Actual Costs ST MARY'S REGIONAL HEALTH CENTER Q 50417 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 and Supplies, Inc.; Essentia Health Medical Equipment & 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 EMS; Essentia Health St. Mary's Emergency Medical Services-Detroit Lakes 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