FIRST CARE MEDICAL SERVICES: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization: FIRST CARE MEDICAL SERVICES (EIN 41-0706143)
Tax period: 2010-07-01 to 2011-06-30
Filed: 2012-05-10
IRS object ID: 201211319349301781
Schema version: 2010v3.7
Source: Download XML · Original 990 at ProPublica

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

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

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-05-10T13:40:52-05:00	Timestamp
Tax Period End Date	2011-06-30	TaxPeriodEndDate
Return Type	990	ReturnType
Tax Period Begin Date	2010-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	410706143	EIN

Name Name

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

Field	Value	IRS element (for citing)
Name Control	FIRS	NameControl
Phone	2184351133	Phone

US Address USAddress

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

Officer Officer

Field	Value	IRS element (for citing)
Name	Patricia Wangler	Name
Title	President	Title
Date Signed	2012-05-01	DateSigned

Field	Value	IRS element (for citing)
Tax Year	2010	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

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

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

Address Principal Officer US AddressPrincipalOfficerUS

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

Field	Value	IRS element (for citing)
Gross Receipts	19897884	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	www.essentiahealth.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1993	YearFormation
State Legal Domicile	MN	StateLegalDomicile
Activity Or Mission Description	We are called to make a healthy difference in people's lives.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	8	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	7	NbrIndependentVotingMembers
Total Nbr Employees	254	TotalNbrEmployees
Total Nbr Volunteers	186	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Net Unrelated Business Txbl Income	0	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	50094	ContributionsGrantsPriorYear
Contributions Grants Current Year	185354	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	11212785	ProgramServiceRevenuePriorYear
Program Service Revenue CY	19035671	ProgramServiceRevenueCY
Investment Income Prior Year	29034	InvestmentIncomePriorYear
Investment Income Current Year	88294	InvestmentIncomeCurrentYear
Other Revenue Prior Year	57962	OtherRevenuePriorYear
Other Revenue Current Year	312078	OtherRevenueCurrentYear
Total Revenue Prior Year	11349875	TotalRevenuePriorYear
Total Revenue Current Year	19621397	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	6565575	SalariesEtcPriorYear
Salaries Etc Current Year	12640403	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	4728360	OtherExpensePriorYear
Other Expenses Current Year	6670024	OtherExpensesCurrentYear
Total Expenses Prior Year	11293935	TotalExpensesPriorYear
Total Expenses Current Year	19310427	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	55940	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	310970	RevenuesLessExpensesCY
Total Assets BOY	13074169	TotalAssetsBOY
Total Assets EOY	19583198	TotalAssetsEOY
Total Liabilities BOY	6063448	TotalLiabilitiesBOY
Total Liabilities EOY	12148540	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	7010721	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	7434658	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	We are called to make a healthy difference in people's lives.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	16515521	Expense
Revenue	19254447	Revenue
Description	See Schedule O	Description
Total Program Service Expense	16515521	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	true	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	true	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	true	RelatedOrgControlledEntity
Transaction Related Entity	true	TransactionRelatedEntity
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	2	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	254	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	8	NbrVotingGoverningBodyMembers
Number Independent Voting Members	7	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	true	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	true	MembersOrStockholders
Election Of Board Members	true	ElectionOfBoardMembers
Decisions Subject To Approval	true	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	MN	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

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

Address US AddressUS

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

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

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Highest Compensated EmployeeHighestCompensatedEmployee
Robert Overmoe
Board Chairperson	1.0	X	X	0	0	0
Dave Hamre
Board Vice Chairperson	1.0	X	X	0	0	0
Barbara Muesing
Board Secretary	1.0	X	X	0	0	0
Chuck Lucken
Board Treasurer	1.0	X	X	0	0	0
Larry LePier
Board Director	1.0	X		0	0	0
Dean Anderson
Board Director	1.0	X		0	0	0
Edgar Olson
Board Director	1.0	X		0	0	0
Wesley Ofstedal MD
Board Director	60.0	X		0	408332	38179
Daniel McGinty
Board Director thru 1/11	60.0	X		0	499207	131505
Patricia Wangler
CEO	60.0		X	0	209024	60123
Kimberly Bodensteiner
CFO	40.0		X	140145	0	18723
Mary Kay Lane
CRNA	40.0			186968	0	20746	X
Lawrence Yunker
CRNA	40.0			186725	0	8279	X
Lynae Finseth
Clinical Service Executive	40.0			117049	0	5365	X
Diane Sundrud
HR/Sppt Srvc Line Leader	40.0			110295	0	17545	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	741182	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	1116563	TotalReportableCompFrmRltdOrgs
Total Other Compensation	300465	TotalOtherCompensation
Number Individuals GT100 K	5	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
Kraus-Anderson Construction
206 Beltrami Avenue	BEMIDJI	MN	56601	Bldg Construction	1950255
Shared Medical Technology
202 W Newton St	RICE LAKE	WI	54868	Ultrasound & Nuc Med	215464
Peterson Sheet Metal
3728 Bemidji Ave N	BEMIDJI	MN	56601	Bldg Construction	194571
DMS Health Technologies
1231 16th St N	FARGO	ND	58102	Mammogram Fees	137726
Steris Corporation
5960 Heisley Road	MENTOR	OH	44060	Equip Maintenance	125169

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	13	NumberOfContractorsGT100K
Government Grants	141575	GovernmentGrants
All Other Contributions	43779	AllOtherContributions
Noncash Contributions	4816	NoncashContributions
Total Contributions	185354	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	PATIENT SERVICE REVENUE	Description
Business Code	621110	BusinessCode
Total Revenue Column	19035671	TotalRevenueColumn
Related Or Exempt Function Income	19035671	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	19035671	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	82794	TotalRevenueColumn
Exclusion	$82,794	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

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

Royalties Revenue RoyaltiesRevenue

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

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	44230	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	44230	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	44230	TotalRevenueColumn
Exclusion	$44,230	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Other	281987	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	276487	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Other	5500	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	5500	TotalRevenueColumn
Exclusion	$5,500	ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

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

Net Income From Gaming NetIncomeFromGaming

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

Net Income Or Loss NetIncomeOrLoss

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

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	ExclusionExclusionAmount
AMBULANCE SUBSIDY	900099	108659	108659
WRITTEN OFF ACCOUNT RECOVERIES	900099	76749	76749
DIETARY MEALS	722210	46674		$46,674

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	35766	TotalRevenueColumn
Related Or Exempt Function Income	33368	RelatedOrExemptFunctionIncome
Exclusion	$2,398	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	267848	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	19621397	TotalRevenueColumn
Related Or Exempt Function Income	19254447	RelatedOrExemptFunctionIncome
Exclusion	$181,596	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	0	Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	0	Total

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	711515	Total
Program Services	321561	ProgramServices
Management And General	389954	ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	9732078	Total
Program Services	8564229	ProgramServices
Management And General	1167849	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	266332	Total
Program Services	234372	ProgramServices
Management And General	31960	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	713839	Total
Program Services	628178	ProgramServices
Management And General	85661	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	1216639	Total
Program Services	1070642	ProgramServices
Management And General	145997	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	6288	Total
Management And General	6288	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	43183	Total
Management And General	43183	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	1277	Total
Management And General	1277	ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	1154247	Total
Program Services	713647	ProgramServices
Management And General	440600	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	28075	Total
Management And General	28075	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	2116127	Total
Program Services	2033348	ProgramServices
Management And General	82779	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	26876	Total
Management And General	26876	ManagementAndGeneral

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	508068	Total
Program Services	508068	ProgramServices

Travel Travel

Field	Value	IRS element (for citing)
Total	85613	Total
Program Services	80476	ProgramServices
Management And General	5137	ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	75924	Total
Program Services	19740	ProgramServices
Management And General	56184	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	175497	Total
Program Services	175497	ProgramServices

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	961431	Total
Program Services	961431	ProgramServices

Insurance Insurance

Field	Value	IRS element (for citing)
Total	39115	Total
Management And General	39115	ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
BAD DEBT EXPENSE	419253	419253
MN CARE TAX	166699	166699
MAINTENANCE & REPAIRS	110280	93738	16542
EDUCATION	72395	63508	8887
MEMBERSHIP & DUES	36710	36710

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	642966	Total
Program Services	424424	ProgramServices
Management And General	218542	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	19310427	Total
Program Services	16515521	ProgramServices
Management And General	2794906	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	558213	BOY
EOY	824170	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	519240	BOY
EOY	3129688	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	2934907	BOY
EOY	3408474	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	226903	BOY
EOY	242302	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	108545	BOY
EOY	77395	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	21334504	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	10154628	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	7646928	BOY
EOY	11179876	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	1032428	BOY
EOY	618945	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	47005	BOY
EOY	102348	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	13074169	BOY
EOY	19583198	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	2067443	BOY
EOY	2246505	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	2983515	BOY
EOY	9385328	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	1012490	BOY
EOY	516707	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	6063448	BOY
EOY	12148540	EOY

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

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	7004830	BOY
EOY	7429425	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	5891	BOY
EOY	5233	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	7010721	BOY
EOY	7434658	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	13074169	BOY
EOY	19583198	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	310970	ReconcilationRevenueExpenses
Reconcilation Other Changes	112967	ReconcilationOtherChanges
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	true	FederalGrantAuditRequired
Federal Grant Audit Performed	true	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

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

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

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

Contributor Name Business ContributorNameBusiness

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

Contributor Address US ContributorAddressUS

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

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

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbying
Total Direct Lobbying		TotalDirectLobbying
Total Lobbying Expenditures		TotalLobbyingExpenditures
Other Exempt Purpose Expenditures		OtherExemptPurposeExpenditures
Total Exempt Purpose Expenditures		TotalExemptPurposeExpenditures
Lobbying Nontaxable		LobbyingNontaxableAmount
Grassroots Nontaxable		GrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non Tx		TotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying Nontx		TotLobbyExpendMnsLobbyingNontx
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$1,277	OtherActivitiesAmount
Total Lobbying Expenditures IIB	1277	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3
Form4720 Filed4912 Tax	false	Form4720Filed4912Tax

Form990 Schedule C Part IV Form990ScheduleCPartIV

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

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amts		ArtPublicExhibitionAmts
Held Works Of Art Amts		HeldWorksOfArtAmts

Land Land

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

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	8678180	OtherCostOrOtherBasis
Depreciation	4232507	Depreciation
Book Value	4445673	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	243472	OtherCostOrOtherBasis
Depreciation	235818	Depreciation
Book Value	7654	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	7784714	OtherCostOrOtherBasis
Depreciation	5686303	Depreciation
Book Value	2098411	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	4571301	OtherCostOrOtherBasis
Book Value	4571301	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	11179876	TotalOfBookValueLandBuildings
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescription	AmountAmount
PAYABLES TO RELATED TAX-EXEMPT ORGS	$374,582
ASSET RETIREMENT OBLIGATION	$142,125

Field	Value	IRS element (for citing)
Total Of Amounts	516707	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	Schedule D, Part X	Identifier
Explanation	ASC 740 footnote: Essentia Health has adopted Accounting Standards Codification 740, Income Taxes (formerly known as FASB Interpretation No. 48 (FIN 48), Accounting for Uncertainty in Income Tax - an interpretation of FASB Statement No. 109, Accounting for Income Taxes). The adoption of this interpretation had no material impact on the consolidated financial statements and therefore, Essentia Health's consolidated financial statements for fiscal year ended June 30, 2011 no longer includes an ASC 740 footnote.	Explanation

Schedule H IRS990ScheduleH

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

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Persons Served	62	PersonsServed
Total Community Benefit Expense	206933	TotalCommunityBenefitExpense
Direct Offsetting Revenue	60091	DirectOffsettingRevenue
Net Community Benefit Expense	146842	NetCommunityBenefitExpense
Percent Of Total Expense	0.00780	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	2052188	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1921641	DirectOffsettingRevenue
Net Community Benefit Expense	130547	NetCommunityBenefitExpense
Percent Of Total Expense	0.00690	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

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

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Persons Served	62	PersonsServed
Total Community Benefit Expense	2259121	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1981732	DirectOffsettingRevenue
Net Community Benefit Expense	277389	NetCommunityBenefitExpense
Percent Of Total Expense	0.01470	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	1056	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	1056	NetCommunityBenefitExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	15	PersonsServed
Total Community Benefit Expense	6360	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	6360	NetCommunityBenefitExpense
Percent Of Total Expense	0.00030	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

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

Research Research

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

Cash And In Kind Contributions CashAndInKindContributions

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

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	2	NumberOfActivitiesOrPrograms
Persons Served	15	PersonsServed
Total Community Benefit Expense	7416	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	7416	NetCommunityBenefitExpense
Percent Of Total Expense	0.00040	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	2	NumberOfActivitiesOrPrograms
Persons Served	77	PersonsServed
Total Community Benefit Expense	2266537	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1981732	DirectOffsettingRevenue
Net Community Benefit Expense	284805	NetCommunityBenefitExpense
Percent Of Total Expense	0.01510	PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Leadership Development LeadershipDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Coalition Building CoalitionBuilding

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Other Other

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$234,811	BadDebtExpenseAmount
Amount Attributable To	1000	AmountAttributableTo
Amount Reimbursed By Medicare	4387453	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	4344013	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	43440	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Other	X	Other

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

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

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

Name Name

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

Address Address

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

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

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

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

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

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

Other Facilities OtherFacilities (5 entries)

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

Form990 Schedule H Part VI Form990ScheduleHPartVI (7 entries)

IdentifierIdentifier	ExplanationExplanation
Schedule H, Part VI, Line 1	Provide the description required for Part I, lines 3c, 6a, 7g, 7, column (f), 7; Part II; Part III, lines 4, 8, 9b; Part V, lines 1j, 3, 4, 5c, 6i, 7, 11h, 13g, 15e, 16e, 18c, 18d, 19d, 20, 21: Part I, line 3c Not applicable. Part I, line 6a Essentia Health Fosston community benefit information is consolidated into the Essentia Health community benefit information which is included in the Essentia Health annual report. The annual report is made available to the public via the website at www.essentiahealth.org. Essentia Health, headquartered in Duluth, Minn., is an integrated health system serving patients in Minnesota, Wisconsin, North Dakota and Idaho and is Essentia Health Fosston's parent corporation. Part 1, line 7g Not applicable. Part I, line 7, column (f) Bad debt expense that was subtracted from total expense to obtain the % of community benefit to total expense amounted to $419,253. Part I, line 7 The cost to charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to calculate the costs for the following community benefits: Charity Care and Unreimbursed Medicaid. Actual costs were used for the remainder of the community benefits reported. Part II - Describe how the organization's community building activities, as reported in Part II, promote the health of the communities the organization serves: Not applicable. Part III, line 4 The costing methodology used to report bad debt expense at cost was the cost to charge ratio from Worksheet 2, Ratio of Patient Care Cost-to-Charges. The rationale for using the Cost-to-Charge ratio is that it is the most efficient way to calculate bad debt at cost. We believe this method materially represents the cost of bad debt. Part III, line 4 Discounts and charity care are accounted for as reductions to revenue, where bad debts are accounted for as operating expenses. 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 (reduction of revenue). Part III, Line 4 In order to estimate the amount of charity care that could potentially be included in bad debt expense, the ratio of charity care to gross patient revenue was multiplied by the bad debt at cost to arrive at the estimated amount of $1,000. Part III, Line 4 Essentia Health Fosston is a part of a larger organization, Essentia Health. Essentia Health and its member organizations incorporate the full value of the cost of bad debt as a community benefit. The rationale for the organization's opinion is similar to the rationale used by the American Hospital Association. There are extensive administrative challenges of verifying income and assets to determine charity care eligibility. There is also evidence that low-income patients account for the majority of bad debt expenses. Part III, line 4 The provision for uncollectible accounts is based upon management's ongoing assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators. The results of this assessment are used to make modifications to the provision for uncollectible accounts, if necessary. Essentia follows established guidelines for placing certain past-due patient balances with collection agencies, subject to certain restrictions on collection efforts as determined by Essentia. Effective July 1, 2011, Essentia will adopt new accounting guidance regarding the presentation and disclosure of patient service revenue, the provision for bad debts, and the allowance for doubtful accounts. The guidance requires healthcare entities to change the presentation of their statement of operations by reclassifying the provision for bad debts associated with patient service revenue from an operating expense to a deduction from patient service revenue (net of contractual allowances and discounts). Additionally, enhanced disclosures will be required surrounding the entity's policies for recognizing revenue and assessing bad debts. Essentia is evaluating new guidance and will make any additional required disclosures. Part III, line 8 The costing methodology used in determining the Medicare Allowable Cost reported in the organization's Medicare Cost Report is to take total Medicare costs from the general ledger system and then follow the instructions provided by Centers for Medicare Services (CMS) to back off all costs not allowable. From the Medicare allowable costs, any costs attributable to subsidized health services and costs attributable to GME were subtracted, if applicable. Part III, line 8 Essentia Health Fosston is a part of a larger organization, Essentia Health. Essentia Health and its member organizations incorporate the full value of the Medicare shortfall as a community benefit. The rationale for the organization's opinion is similar to the rationale used by the American Hospital Association. Providing care for the elderly and serving Medicare patients is an essential part of the community benefit standard. Medicare, like Medicaid, does not pay the full cost of care and it is likely to get worse. Many Medicare beneficiaries are poor and are eligible for Medicaid in addition to Medicare. Medicare underpayment must be shouldered by the hospital in order to continue treating the community's elderly and poor. These underpayments represent a real cost of serving the community. Part III, line 8 Each Essentia Health hospital is required to file a Medicare cost report 5 months after the close of their fiscal year. The cost report provides Medicare with information that is used to determine utilization and spending trends but also is used to set future payment rates for most Medicare services. If the interim payments paid to a hospital are higher or lower than the filed cost report allowable reimbursement there will be a settlement for that fiscal year. This can be due to changes in utilization or cost of providing services for Critical Access Hospitals (CAH) or differences between interim and final payment factors for Disproportionate Share, Bad Debts, or Indirect Medical Education for non-CAH hospitals. An estimate for these settlements is recorded at the close of the fiscal year. If the estimate varies from the final settlement received 6-7 months after the fiscal year ends then these amounts are recorded as prior year Medicare revenue. Part III, line 9b At any stage of the patient experience, including collections, a determination may be made that the patient qualifies for Financial Assistance. All collection efforts must be suspended while a patient's Financial Assistance application is being considered and until the patient is notified regarding the determination of eligibility. Once eligibility (or lack of eligibility) is determined, amounts still owed by patients will be collected in the same manner as all other patient bills.
Part VI, line 2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B: Essentia Health Fosston assesses our service area's needs through programs we offer, requests we receive, and staff involvement in their own communities. We also collaborate with other community organizations as well. Service usage patterns are monitored by administrators and doctors are consulted for needed care improvements in monthly medical staff meetings. Leadership participates in a variety of community activities which provide an opportunity to understand healthcare needs. An annual health fair is hosted to provide information and education to our community about health issues and to promote our healthcare services. We want to encourage our community members to take an active role in their own health care by taking steps towards a healthier lifestyle. We invite health-related organizations to present their information as well. Feedback is obtained from those who attend the health fair as to what information was beneficial to them. The fair is another forum where the hospital's staff can hear the needs of community members. The needs of the community are also assessed by review of diagnosis for which treatment was rendered over the course of a targeted range of time.
Part VI, line 3	Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's Financial Assistance policy: We have patient information in our front lobby on all state programs as well as the facility's community care program. During the admission process, the admitting clerk will verify insurance. If the admitting clerk identifies any patient as uninsured or underinsured, the admitting clerk shall notify the patient account representative. The patient account representative shall be responsible to meet with each of these patients and determine what assistance options (Medicare, Medicaid, MinnCare, Insurance, etc.) may be available. The patient account representative shall also review the "uncompensated care" and/or the "discount to the uninsured" program with them including an application form when appropriate.
Part VI, line 4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves: Essentia Health Fosston is located in Fosston, MN. Essentia Health Fosston is a part of the larger Essentia Health system, which is defined in Part VI, line 6. Essentia Health Fosston operates 1 hospital, 4 clinics, nursing home, home health, hospice, life support ambulance service, and assisted living that serves the communities of Polk, Clearwater, Mahnomen, and Red Lake Counties which include the cities of Fosston, Erksine, McIntosh, Trail Mentor, Fertile, Winger, Lengby, Beltrami, Gully, Clearbrook, Bagley, Gonvick Leonard, Shevlin, Oklee, Red Lake Falls, Brooks, Plummer, Mahnomen, Bejou, Naytahwaush and Waubun. The overall community is classified as Rural. Essentia Health Fosston and its related businesses cover a service region of approximately 21,000 people. The service region age distribution is 24.1% under the age of 18; 54.7% between the ages of 18 and 65; and 21.2% over the age of 65. The racial makeup of the service region is 88.1% Caucasian; 0.3% Black or African American; 7.4% American Indian or Alaskan Native; 0.4% Asian; 3.3% two or more races; and 0.5% other. The gender split ratio is 50.1% women and 49.9% men. The average income for the service area is approximately $48,000. Approximately 10.6% of the population falls below the federal poverty guidelines. Essentia Health Fosston, along with Essentia Health is committed to serve patients regardless of their ability to pay. 10.7% net revenue dollars were from self pay patients. In addition, approximately 17.6% of their net revenue dollars were Medicaid recipients. As mentioned above, Essentia Health Fosston is part of a larger system, Essentia Health. Essentia Health staffs hospitals and clinics in federally-recognized underserved areas and supports the health of its communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into its smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or are faced with other challenges that make it difficult to travel long distances for care. There are no other hospitals outside of the Essentia Health umbrella that service the community.
Part VI, line 5	Provide any other information important to describing how the organization's hospitals or other health care facilities further its exempt purpose by promoting the health of the community: Essentia Health Fosston's board of directors is composed of volunteer representatives from the communities it serves. Essentia Health Fosston has an open Medical Staff, so any qualified physician of the community is allowed to apply. All applicants that apply must meet the credentialing standards and be approved by our governing board in order to come and provide services in our system. The organization does not have a surplus of funds, but rather reinvests in services provided through keeping equipment and practices state of the art and standardized with best practice. We also invest in our staff training and retention in order to ensure delivery of high quality care. Outcomes in all major service lines are producing outcomes in publicly reported indicators at the 90th percentile. In addition we actively seek participation in healthcare educational curriculums of local colleges and universities and currently are a training site for nurses. Administration had a Nursing Home Administration intern this past fall and winter and had a hospital administration intern this past summer as a commitment to future leadership training in healthcare. Essentia Health Fosston's mission is to make a healthy difference in the lives of people in the community. In order to accomplish this, a full array of services across the continuum of life and health needs has been established. Many of the services, in particular the nursing home and home health and hospice are subsidized from hospital operations. The 50 bed nursing home loses approximately $25.00 per occupied bed per day and runs at high occupancy, exceeding 96% average daily census. The organization provides community educational opportunities at no cost to the public through health fairs, targeted education session for specific diseases and conditions in order to further the mission. Essentia Health Fosston uses many volunteers to deliver a volume of services with estimated value of well over $100,000 annually in order to enable staff to be more efficient in service provided. A variety of media are used to reach the public on seasonal or problem health conditions of the community. Essentia Health Fosston is a part of a larger system Essentia Health. As a non-profit organization, Essentia Health is focused on reinvesting surplus revenues into programs and technology that improve patient care. One of the most significant investments has been in the area of electronic health records, which are being rolled out across the health system's network of hospitals and clinics. The majority of Essentia hospitals and clinics were linked via one central EHR by the end of 2011. We also continue to replace and upgrade technology, ranging from CT scanners to robotic surgery devices that ensure patients in our predominantly rural communities have access to these needed 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 currently not reimbursed by state or federal programs, so Essentia Health assumes responsibility for medical home costs. We also support the health of our communities through active research and clinical trials through the Essentia Institute of Rural Health. Various Essentia Health organizations contributed almost $1.5 million in support to the Institute over the past year. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans.
Part VI, line 6	Essentia Health Fosston is part of Essentia Health, an integrated health system of 14 hospitals, 64 clinics and several long-term care facilities in four states: Minnesota, Wisconsin, North Dakota and Idaho. The health system serves a predominantly rural population whose median incomes generally fall below averages of the states where they live. The presence of our clinics and hospitals ensures that people with few economic resources don't have to drive an hour or more to receive basic (and in some cases live-saving) medical care. In addition to staffing hospitals and clinics in federally-recognized underserved areas, we support the health of our communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into our smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or are faced with other challenges that make it difficult to travel long distances for care. Our size and integrated structure allow us to offer patients services often found only in larger urban settings. Services ranging from chemotherapy and cancer clinical trials 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 communities with active research and clinical trials, through the Essentia Institute of Rural Health. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans. Essentia Health is also serving patients through implementation of the Epic electronic health record (EHR). By the end of FY 2011, the vast majority of Essentia's 14 hospitals and 64 clinics were using a fully-integrated EHR for patient care. A common electronic health record allows health professionals to share test results and consult with colleagues in real time across great distances. Medical information is no longer lost in the shuffle of paper records - an important consideration in a region where patients must often be transferred to a larger Essentia facility for complex surgeries or medical care. Essentia is also actively working with government agencies and insurers to develop innovative, cost-effective approaches to care that will improve health outcomes while reducing overall costs to patients and insurers. This innovation can be found in our use of remote home monitors for patients with congestive heart failure to a focus on using a team-based approach to helping patients manage chronic diseases. Essentia Health is committed to helping patients and their families lead active and fulfilling lives in the small and large communities where they live. We hope to become a model of health care delivery, particularly in rural areas, in the years to come.
Part VI, Line 7	Essentia Health Fosston files a community benefit report in Minnesota.

Schedule J IRS990ScheduleJ

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

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Wesley Ofstedal MD
0	380930	0	0	0	27402	0	22678	0	15501	0	446511	0	0
Daniel McGinty
0	367024	0	131062	0	1121	0	91206	0	40299	0	630712	0	0
Patricia Wangler
0	182252	0	25283	0	1489	0	46798	0	13325	0	269147	0	0
Kimberly Bodensteiner
140145	0	0	0	0	0	5797	0	12926	0	158868	0	0	0
Mary Kay Lane
186968	0	0	0	0	0	7820	0	12926	0	207714	0	0	0
Lawrence Yunker
186725	0	0	0	0	0	7753	0	526	0	195004	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Identifier	Scheduel J, Part I, Line 3	Identifier
Explanation	Essentia Health Fosston relied on Critical Access Group's, supporting organization of Essentia Health Fosston, methods for establishing CAG Essentia Health Fosston's CEO's compensation: written employment contract. Scheduel J, Part I, Line 4b Supplemental nonqualified retirement plan The following individuals listed in Form 990, Part VII, Section A, Line 1a received payment from a supplemental nonqualified retirement plan during the year: Daniel McGinty (Critical Access Group) $0 Patricia Wangler (Critical Access Group) $0 Critical Access Group's nonqualified retirement plan is offered to Critical Access Group executives. There is a minimum two year vesting date, benefits are subject to income taxes upon vesting, and benefits are payable from Critical Access Group's general assets.	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifier	ExplanationExplanation
Form 990, Part III, Line 4	Program service accomplishments: First Care Medical Services dba Essentia Health Fosston is a not-for-profit, community-based medical facility that operates critical access hospital, advanced life support ambulance service, clinics, nursing home and home health/hospice services in rural Northwest, Minnesota. All patients of the hospital and hospice receive service regardless of their ability to pay. Essentia Health Fosston employs over 178 full time equivalents. Essentia Health Fosston provided community services of over $1,000, education and workforce development of over $6,000, and charity care of over $146,000 during the fiscal year ended June 30, 2011. Essentia Health Fosston, in fulfilling its responsibility to the community, provides support to other not-for-profit community organizations that also promote health improvement, offers education and health programs and outreach programs to the community, and support the community through employee volunteer efforts and donations. In 2011 employees donated more than 2,198 hours to improve the community's knowledge and participation in health improvement and activities. These include health fairs at which blood sugar, cholesterol and blood pressure screening were done, conducting health education on wellness and prevention to student groups, sponsoring health occupation students in experience chosen health care professionals work life, the American Cancer Society local Light Up A Night activity and other non-profit organizations in our community. Essentia Health Fosston also teaches prenatal classes and holds child car seat safety clinics. Diabetes, a rapidly growing disease concern is addressed by providing diabetic education and support groups to any community member that desires the information as well as those who have physician orders for the service. We actively participate in the regional bio-terrorism committee and work with the county as well to implement a coordinated plan followed by participation in exercises of the disaster plan in order to be more fully prepared in the event of disaster. The hospital provided for over 2,000 hospital patient days and over 64,000 outpatient visits during the fiscal year ended June 30, 2011. The clinic had over 22,000 encounters during the same time period.
Form 990, Part VI, Section A, Line 4	Form 990 Significant Changes: During the fiscal year ended June 30, 2011, the Articles and Bylaws of Essentia Health Fosston were amended. Essentia Health West became the sole member of Essentia Health Fosston and now has reserved powers over Essentia Health Fosston. These reserved powers are discussed in further detail in Part VI, Line 7b. In addition, the amendments modified the number and composition of Essentia Health Fosston's governing body to include no less than three and no more than nine voting Directors.
Form 990, Part VI, Line 6	Members of Organization: City of Fosston and Essentia Health West may elect one or more members of the governing body as described in Schedule O Part VI Line 7a. Essentia Health and Essentia Health West have reserved powers with respect to Essentia Health Fosston as described in Schedule O Part VI Line 7b.
Form 990, Part VI, Line 7a	Members with right to elect governing body: According to its Bylaws, the City of Fosston shall apoint and remove one board member and Essentia Health West shall appoint and remove all Essentia Health Fosston's remaining board members.
Form 990, Part VI, Line 7b	Members with Right to approve governing body decisions: Essentia Health Fosston is a subsidiary of Essentia Health, whose Board of Directors has reserved powers with respect to this corporation and its subsidiaries, and all of the other direct and indirect subsidiaries of Essentia Health (collectively, the "System"). Essentia Health's reserved powers are as follows: Strategic and Business Plans. Authority to create, and to approve, the System's strategic and business plans. Mission. Authority to create, and to approve, the mission, purpose and vision statements for all entities in the System by the affirmative vote of at least 67% of the Essentia Health board of directors. Debt. Approval of the incurrence of debt by, and the creation of all mortgages, liens, security interests, or other encumbrances on the assets of, all entities in the System in excess of the single or annual aggregate dollar limits prescribed in writing by the Essentia Health board of directors, and the authority to cause all entities in the System to participate in System borrowing. Governing Instruments. Authority to cause, and to approve, amendments of the articles of incorporation and bylaws of all entities in the System. Mergers and Acquisitions. Authority to cause, and to approve, all mergers, consolidations, and dissolutions of all entities in the System. Affiliations and Joint Ventures. Authority to cause, and to approve, all affiliations, joint ventures and other alliances with third parties of all entities in the System. Transfer of Assets Within the System. Authority to transfer assets, including cash, between and among entities within the System; provided, however, that Essentia Health shall not have authority to require any entity in the System to transfer assets (a) that would cause such entity to be in default of its covenants or obligations under any bond or other financing documents; (b) from the Catholic entities to the secular entities or from the secular entities to the Catholic entities in a manner or to an extent that would cause the Catholic entities to be in violation of the Ethical and Religious Directives for Catholic Health Care Services in the judgment of the local ordinary; or (c) such that money generated by services at secular facilities within the System by procedures that are contrary to the Ethical and Religious Directives for Catholic Health Care Services would be used at the Catholic entities or money generated by Catholic entities would be used in the providing of services contrary to the Ethical and Religious Directives for Catholic Health Care Services at secular facilities within the System. Transfer of Assets Outside the System. Authority to cause, and to approve, the sale, lease or other transfer of assets of all entities in the System to parties outside of the System when the asset's value exceeds the single or annual aggregate dollar limits prescribed in writing by the Essentia Health board of directors. Services. Authority to cause, and to approve, the addition of new services and service locations and the discontinuance of services and service locations within all entities in the System. Budgets. Approval of capital and operating budgets of all entities in the System. Professional Services. Selection of the general legal counsel and external auditors of all entities in the System. Acquisitions. Authority to cause, and to approve, all acquisitions by and formations of entities in the System. Marketing, Authority to implement System-wide marketing and promotional activities. Compliance Plans. Authority to create, and to approve, corporate compliance, safety and risk management plans for entities within the System. Quality Plan. Authority to create, and to approve, the System's quality plan. Non-Budgeted Purchases. Approval of non-budgeted capital purchases and leases in excess of the single or annual aggregate dollar limits prescribed in writing by Essentia Health for entities within the System. Human Resources. Authority to create human resource policies and procedures within the System. Reserved Powers. Authority to create additional Essentia Health reserved powers by the affirmative vote of at least 80% of the Essentia Health board of directors (excluding the Essentia Health CEO); provided, however, that any additional Essentia Health reserved powers shall not contravene or hinder the reserved powers of Benedictine Sisters Benevolent Association. Essentia Health West shall have the following reserved powers over the West Region entities: Quality, Safety, and Service. Authority to recommend quality and safety initiatives and to review and execute approved quality and safety plans for the West Region. Mission, Vision and Values. Authority to create a mission and a vision that support the mission and vision of Essentia Health; responsibility to oversee the mission performance, including charity care, of all facilities within the West Region; responsibility to adopt the value of Essentia Health. Operating and Financial Performance. Responsibility to oversee the operating and financial performance of the West Region. Development of Budgets, Strategic Plans and Strategy Map. Authority to develop and recommend, based on Essentia Health targets, capital and operating budgets for the West Region and its facilities; authority to recommend, within the Essentia Health context, regional and local strategic plans for the West Region; authority to develop West Region governance strategy map and balanced scorecard within Essentia Health's system strategy to meet system goals. Execution of Approved Budgets and Strategic Plans. Responsibility to execute the approved capital and operating budgets and strategic and business plans for the West Region. Non-budgeted Expenditures. Authority to approve non-budgeted capital purchases and leases for West Region facilities within dollar limits defined by Essentia Health. Accreditation and Licensure. Responsibility to oversee accreditation and licensure compliance for the facilities of the West Region. Affiliations and Joint Ventures. Authority to recommend proposed affiliations, joint ventures and other alliances; responsibility to oversee negotiation and implementation of approved acquisitions and operation of all approved affiliations, joint ventures and other alliances with third parties within the West Region. Appointment of Directors. Authority to appoint or elect directors of the Direct Subsidiaries, and to remove such directors, with or without cause. Satisfaction. Responsibility to execute, evaluate and oversee patient, family and customer satisfaction with respect to services provided within the West Region and to ensure established goals are met. Job Satisfaction. Responsibility to oversee job satisfaction and staff morale within the West Region facilities. Human Resources. Responsibility to oversee implementation of Essentia Health human resource policies and procedures throughout the West Region. Compliance. Responsibility to execute the approved Essentia Health corporate compliance and risk management plans for the West Region. Credentialing. Responsibility to perform medical staff credentialing for the West Region facilities. Amendments. Authority to suggest proposed amendments to the Articles of Incorporation and Bylaws of the Direct Subsidiaries and any subsidiaries thereof. Compensation Plans. Responsibility to review and approve compensation of West Region executives and physicians for reasonableness and consistency with the law and Essentia Health's compensation philosophy. President/Chief Medical Officer. By action of the President of this Company, authority to appoint and remove, with or without cause, the President/Chief Medical Officer of any of the Direct Subsidiaries. Public Policy. Responsibility to support Essentia Health public policy and advocacy plans. Marketing. Responsibility to coordinate regional marketing and promotional activities consistent with Essentia Health marketing plans. Philanthropy. Responsibility to coordinate philanthropy within the West Region consistent with Essentia Health foundation policies. Professional Services. Responsibility to oversee West Region management's cooperation with external auditors and general legal counsel selected by Essentia Health and coordination of legal services through the Essentia Health Office of General Counsel. Catholic Facilities. Responsibility to oversee implementation of BSBA-approved methods, policies and procedures pertaining to adherence by the West Region Catholic facilities with the ERDs and use of religious symbols, distinguishing elements and prayers. Projects Involving Real Estate. Authority to recommend facility development projects, subject to the approval of Essentia Health; responsibility to oversee execution of approved development projects according to Essentia Health policies.
Form 990, Part VI, Line 11a	Form 990 review process: The 2010 Form 990 including all schedules was reviewed by Essentia Health Fosston's management and governing body on April 2nd, 2012 prior to filing with the Internal Revenue Service. Each current director of the governing body received a final copy of the 2010 Form 990. Essentia Health Fosston Chief Financial Officer led the review of the form and schedules and any questions were discussed.
Form 990, Part VI, Line 12c	Monitoring and enforcing Conflict of Interest policy: Interested persons shall annually disclose relationships which might lead to a conflict of interest by completing a conflict of interest disclosure form. Interested persons include any person in a position to exercise substantial influence over the organization. It includes but is not limited to any director, officer, management, employee, or committee member of Essentia Health or any of its affiliates. Essentia shall be responsible for the annual distribution of conflict of interest forms and review of disclosures for the governing bodies of Essentia and Essentia Operating Members and for senior management employees of Essentia. Transactions with parties with whom a conflict of interest exists may be undertaken only if all of the following are observed: the conflict of interest is fully disclosed; the interested person with the conflict of interest doesn't participate in the approval of such transactions; if practical or appropriate, a competitive bid or comparable valuation is obtained; and the board or committee of the board has determined that the transaction is in the best interest of the organization. Disclosure by any interested person other than a board or committee member should be made to the Chief Executive Officer (or if she/he is the one with the conflict, then to the board chair), who shall bring the matter to the attention of the board or an appropriate committee of the board. Disclosure involving board or committee members shall be made to the board chair (or if she/he is the one with the conflict, then to the board vice chair), who shall bring these matters to the board or an appropriate committee of the board. The board or committee of the board shall determine whether a conflict exists and if so, whether the contemplated transaction may be authorized as just, fair, and reasonable to Essentia or its affiliate(s). The decision of the board or a duly constituted committee of the board on these matters will be at its sole discretion, and its concern must be the welfare of Essentia and its affiliate(s) and the advancement of its purposes. The decision of the board is final. If the board determines a conflict does not exist, the interested person may proceed with the transaction; however, he/she will not be eligible to vote on related issues should they arise. If the board determines a conflict does exist, the interested person will be notified of the decision regarding whether the contemplated transaction will be authorized as just, fair, and reasonable.
Form 990, Part VI, Line 19	Availability of governing documents, conflict of interest policy, & financial statements to the public: Essentia Health Fosston makes its governing documents, conflict of interest policy, and financial statements available to the public. Essentia Health Fosston governing documents, conflict of interest policy, and financial statements are available to the public upon request. Essentia Health Fosston is part of Essentia Health's consolidated financial statements which are included in Essentia Health's annual report posted on Essentia Health's web site.
Form 990, Part VII, Section A, Line 1a, Column B	Hours devoted to related organizations: The following individual listed in Form 990, Part VII, Section A, Line 1a also devoted time each week to related organizations: Robert Overmoe: approximately 1 hour Daniel McGinty is employed by Critical Access Group as Essentia Health's Senior Vice President, Development and Critical Access Group President. 100% of his time is spent furthering the purpose of Essentia Health and its' related organizations. Wesley Ofstedal, MD is employed by Essentia Health West. 100% of his time is spent furthering the purpose of Essentia Health West and its' related organizations.
Form 990, Part XI, Line 5	Other Changes in Net Assets: The total amount of other changes in net assets includes: Unrealized gain on trading securities: $112,967
Form 990, Part XII, Line 3	Consolidated A-133: Essentia Health Fosston as part of Essentia Health's consolidated financial statements, was required and underwent a consolidated audit set forth in the Single Audit Act and OMB Circular A-133. The consolidated audit is reviewed by the Essentia Health Audit Committee.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (30 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1
BRAINERD LAKES INTEGRATED HEALTH SYSTEM
2024 S 6TH ST	BRAINERD	MN	56401	371532145	SUPPORT ORG	MN	501(C)(3)	11 II	ESSENTIA
BRAINERD MEDICAL CENTER INC
2024 S 6TH ST	BRAINERD	MN	56401	371532148	CLINIC	MN	501(C)(3)	3	BLIHS
BRIDGES MEDICAL CENTER
201 9TH ST W	ADA	MN	56510	200479568	CLINIC/HOSP	MN	501(C)(3)	3	INNOVIS
CLEARWATER VALLEY HOSPITAL AND CLINICS
301 CEDAR	OROFINO	ID	83544	820497771	CLINIC/HOSP	ID	501(C)(3)	3	CAG
DIVINE MEDICAL SERVICES
709 N LINCOLN	JEROME	ID	83338	202773717	EMGERG SRVS	ID	501(C)(3)	3	SBFMC
DL SURGERY CENTER
1027 WASHINGTON AVE	DETROIT LAKES	MN	56501	263837203	ASC	MN	501(C)(3)	3	CAG
ECHC FOUNDATION
502 E 2ND ST	DULUTH	MN	55805	263359418	FOUNDATION	MN	501(C)(3)	11 I	CAG
CRITICAL ACCESS GROUP
503 E 3RD ST STE 400	DULUTH	MN	55805	261219624	SUPPORT ORG	MN	501(C)(3)	11 II	ESSENTIA
MINNESOTA VALLEY HEALTH CENTER
621 S 4TH ST	LE SUEUR	MN	56058	410837659	HOSPITAL/NURS	MN	501(C)(3)	3	CAG
ST BENEDICT'S FAMILY MEDICAL CENTER
709 N LINCOLN	JEROME	ID	83338	820227163	CLINIC/HOSP	ID	501(C)(3)	3	CAG
ST JOSEPH'S MEDICAL CENTER
523 N 3RD ST	BRAINERD	MN	56401	410695602	CLINIC/HOSP	MN	501(C)(3)	3	BLIHS
ST MARY'S EMS
1027 WASHINGTON AVE	DETROIT LAKES	MN	56501	411805811	EMERG SRVS	MN	501(C)(3)	9	SMRHC
ST MARY'S HOSPITAL & CLINICS INC
PO BOX 137	COTTONWOOD	ID	83522	820226453	CLINIC/HOSP	ID	501(C)(3)	3	CAG
ST MARY'S INNOVIS HEALTH
1027 WASHINGTON AVE	DETROIT LAKES	MN	56501	262861321	CLINIC	MN	501(C)(3)	3	INNOVIS
ST MARY'S REGIONAL HEALTH CENTER
1027 WASHINGTON AVE	DETROIT LAKESM	MN	56501	411620386	CLINIC/HOSP	MN	501(C)(3)	3	INNOVIS
ESSENTIA HEALTH
502 E 2ND ST	DULUTH	MN	55805	200360007	SUPPORT ORG	MN	501(C)(3)	11 III-FI	NA
ESSENTIA INSTITUTE OF RURAL HEALTH
502 E 2ND ST	DULUTH	MN	55805	271291124	RESEARCH	MN	501(C)(3)	4	ESSENTIA
INNOVIS HEALTH LLC
1702 S UNIVERSITY DR	FARGO	ND	58103	261175213	CLINIC/HOSP	DE	501(C)(3)	3	ESSENTIA
ESSENTIA HEALTH FOUNDATION
502 E 2ND ST	DULUTH	MN	55805	271984704	FOUNDATION	MN	501(C)(3)	7	INNOVIS
MIDWEST MEDICAL EQUIPMENT & SUPPLY INC
4418 HAINES RD	DULUTHM	MN	55811	411674021	MEDICAL EQUIP	MN	501(C)(3)	9	SMDCHS
PINE MEDICAL CENTER
109 COURT AVE S	SANDSTONE	MN	55072	411884597	HOSPITAL/NURS	MN	501(C)(3)	3	SMDCHS
POLINSKY MEDICAL REHABILITATION CENTER
530 E 2ND ST	DULUTH	MN	55805	410691275	CLINIC	MN	501(C)(3)	3	SMMC
SMDC MEDICAL CENTER
502 E 2ND ST	DULUTH	MN	55805	411878730	CLINIC/HOSP	MN	501(C)(3)	3	SMDCHS
ST MARY'S DULUTH CLINIC FOUNDATION
400 E 3RD ST	DULUTH	MN	55805	412016979	FOUNDATION	MN	501(C)(3)	7	SMDCHS
ST MARY'S DULUTH CLINIC HEALTH SYSTEM
407 E 3RD ST	DULUTH	MN	55805	411836633	SUPPORT ORG	MN	501(C)(3)	11 II	ESSENTIA
ST MARY'S HOSPITAL OF SUPERIOR
3500 TOWER AVE	SUPERIOR	WI	54880	411811073	CLINIC/HOSP	WI	501(C)(3)	3	SMMC
ST MARY'S MEDICAL CENTER
407 E 3RD ST	DULUTH	MN	55805	410695604	HOSPITAL	MN	501(C)(3)	3	SMDCHS
THE DULUTH CLINIC LTD
400 E 3RD ST	DULUTH	MN	55805	410883623	CLINIC	MN	501(C)(3)	3	SMDCHS
NORTHERN PINES MEDICAL CENTER
5211 HWY 110	AURORA	MN	55705	410841441	HOSPITAL/NURS	MN	501(C)(3)	3	SMDCHS
GRACEVILLE HEALTH CENTER
115 WEST SECOND ST	GRACEVILLE	MN	56240	410726173	CLINIC/HOSP	MN	501(C)(3)	3	INNOVIS

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

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

Address US AddressUS

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

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

Direct Controlling Entity Name DirectControllingEntityName

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

Field	Value	IRS element (for citing)
Predominant Income Type	N/A	PredominantIncomeType
Share Of Total Income	0	ShareOfTotalIncome
Share Of EOY Assets	0	ShareOfEOYAssets
Code V	$0	CodeVAmount
Percentage Ownership	0.00000	PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Type Of EntityTypeOfEntity	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Percentage OwnershipPercentageOwnership	Address Line1AddressForeign/AddressLine1	Province Or StateAddressForeign/ProvinceOrState	CountryAddressForeign/Country	Postal CodeAddressForeign/PostalCode	Legal Domicile Foreign CountryLegalDomicileForeignCountry
East Range Clinics Ltd
910 6th Ave N	Virginia	MN	55792	410909915	Clinics	MN	na	C corp	0	0	0.00000
Essentia Health Insurance Services SPC
				000000000	Incurance		na	Foreign Corp	0	0	0.00000	Buckingham Sq 720 W Bay Rd PO 69	Grand Cayman	CJ	KY1-1102	CJ

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

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved
Innovis Health LLC
g	50100
Innovis Health LLC
o	2396739
Critical Access Group
o	1382953