2011-05-12T16:18:02-05:00 2010-06-30 990 2009-07-01 410695604 St Mary's Medical Center STMA 2187861421 407 East Third Street Duluth MN 55805 BARBARA JOHNSON 2011-05-10 2009 2016-02-24 21:20:13Z BARBARA JOHNSON CFO 407 EAST THIRD STREET DULUTH MN 55805 367851450 false 0928 X smdc.org X 1888 MN St. Mary's Medical Center exist's to witness the love of God through compassionate and competent health services for all, especially the poor and powerless. 13 11 3302 1069 0 0 0 3329 354504910 355067369 -14986838 7111918 3230267 3140001 342748339 365322617 769361 15050 0 0 175389740 174683127 0 0 1270499 146934351 150750338 323093452 325448515 19654887 39874102 574936250 591801013 149987840 130624674 424948410 461176339 SEE SCHEDULE O false false 242793502 15050 355067369 SEE SCHEDULE O 242793502 true false false false false false false false false true false true false false false false false false false false true true false true false false false false false false true false false false false false false true true false false true 179 0 true 3302 true false false false false false false false false false 13 11 false false false false true true true true true false false true true true true true true true true false MN X BARBARA JOHNSON CFO 2187861421 407 EAST THIRD STREET DULUTH MN 55805 S KATHLEEN HOFER 60.0 X X 0 0 0 S SARAH SMEDMAN 10.0 X 0 0 0 FRANK JEWELL 10.0 X X 0 0 0 S LINDA WIGGINS 10.0 X 0 0 0 S MELANIE GAGNE 10.0 X 0 0 0 THOMAS C STENDER 10.0 X X 1045 0 0 ED J CRAWFORD 10.0 X 770 0 0 CAROL FARCHMIN MD 10.0 X 0 0 0 S MARY RAE HIGGINS 10.0 X 0 0 0 GEORGE F HOLLIDAY MD 60.0 X 0 198881 43533 ANDREW LISAK 10.0 X 0 0 0 JOSEPH J MIHALEK 10.0 X 660 0 0 KEVIN T STEPHAN MD 60.0 X 0 232721 37025 ROBERT NORMAN 60.0 X 0 531094 106313 BARBARA JOHNSON 60.0 X 0 82570 12252 MARIBETH OLSON 60.0 X 315421 0 76534 ALBERT J DEIBELE MD 60.0 X 0 700741 51251 ROCKLON CHAPIN 60.0 X 0 416411 59759 MICHAEL F MCAVOY 60.0 X 0 208541 51165 TERRI L RUBERG 60.0 X 198469 0 58571 MICHAEL C METCALF 60.0 X 0 422737 76772 HUGH P RENIER MD 60.0 X 353342 0 78421 STEVEN F JOHNSTON 60.0 X 184312 0 55677 MARY C SHAW 60.0 X 168882 0 51149 KAREN M ENGEN 40.0 X 161683 0 9770 ANNE M MEYER 40.0 X 153131 33734 DAVID H AMUNDSON 0.0 X 172427 0 8426 DENNIS W DASSENKO 60.0 X 0 324185 72089 DIANE T DAVIDSON 60.0 X 0 285092 60122 MICHAEL J MAHONEY 60.0 X 0 221023 47717 1710142 3623996 990280 95 true true false LAKE SUPERIOR LAUNDRY PO BOX 488 SUPERIOR WI 54880 LAUNDRY SERVICES 1279434 FRESENUIS MEDICAL CARE PO BOX 77000 DETROIT DETROIT MI 48277 DIALYSIS SERVICES 562846 AIM HEALTHCARE SERVICES PO BOX 292377 NASHVILLE TN 37229 MEDICAL CLAIMS SVCS 1243478 NORTHERN PRINTING AND PROMOTION INC 1914 W SUPERIOR ST DULUTH MN 55806 PRINTING SERVICES 584296 OTIS ELEVATOR COMPANY PO BOX 73579 CHICAGO IL 60673 ELEVATOR MAINT SVCS 344148 18 3329 3329 PATIENT REVENUE 621400 355067369 355067369 355067369 2025400 0 0 64540 64540 64540 64540 5065611 2215134 0 2194227 5065611 20907 5086518 5086518 0 0 784851 334606 450245 450245 CAFETERIA REVENUE 900099 1615509 1615509 CHILD CARE REVENUE 900099 293020 293020 PARKING REVENUE 812930 715193 715193 1494 1494 2625216 365322617 355067369 8226519 15050 15050 0 0 0 712139 712139 0 128768813 100635235 27691889 441689 13013777 3831417 9157540 24820 22866422 16002700 6812313 51409 9321976 7244697 2045518 31761 0 139396 139396 292768 292768 0 0 0 19129570 15034395 3946636 148539 315126 2630 310671 1825 71430634 64919063 6462665 48906 4960928 474014 4483417 3497 0 3528564 251319 3277245 1004685 680643 320555 3487 0 823124 197395 587672 38057 3347520 3347520 1947258 1947258 15571709 6092794 9474198 4717 282911 111219 171692 BAD DEBT EXPENSE 14772409 14469471 302938 MINNESOTA CARE TAX 3938349 3862887 75462 MEDICAL CARE SURCHARGE 2917637 2861546 56091 EQUIPMENT REPAIR 1904650 1052036 852459 155 DUES & SUBSCRIPTIONS 1341467 1079312 254868 7287 3101633 1316282 1321001 464350 325448515 242793502 81384514 1270499 56200293 13125793 4350192 18062139 49598577 45950582 6677173 235992920 7868280 7702819 867874 1171708 254697594 187015858 71580961 67681736 109653423 1796726 252625541 195605726 4577046 5027577 0 10486359 133818 574936250 591801013 40732494 42567846 25304999 0 1930000 0 82020347 88056828 149987840 130624674 X 424948410 461176339 424948410 461176339 574936250 591801013 X false true true X false X 1586106 1586106 153862848 111631597 42231251 98756656 74918259 23838397 491984 466002 25981 67681735 DEPR RESERVE LONG TERM POOL 185806454 F VHA COMMON STOCK 400000 C BOARD DESIGNATED RESERVE 1775476 F LTC RESERVE 7479989 F MISC OTHER SECURITIES 143807 C 195605726 0 MN CARE TAX PAYABLE 1377845 ACCRUED REAL ESTATE TAXES 87885 WORKERS COMP IBNR 6163108 PENSION LIABILITY 62745235 SMDC PENSION LIABILITY 9455158 BENEFIT PLAN LIABILITY 4577046 ASSET RETIRE OBLIGAT LIABILITY 841753 INTEREST SWAP LIABILITY 2739084 MISC OTHER LIABILITY 69714 88056828 SCHEDULE D PART X: FIN 48 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, 2010 no longer includes an ASC 740 footnote. true true X true X true X true true false true true 2535438 2535438 0.00780 97369587 79296625 18072962 0.05550 618955 618955 0.00190 100523980 79296625 21227355 0.06520 8 342 2618 2618 4 4506427 389715 4116712 0.01270 2 72953 72953 0.00020 1 15200 15200 0.00010 15 342 4597198 389715 4207483 0.01300 15 342 105121178 79686340 25434838 0.07820 true 6325546 0 102535138 97168111 5367027 X true true ST MARY'S MEDICAL CENTER

407 EAST THIRD STREET DULUTH MN 55805

X X X X The organization uses federal poverty guidelines. St. Mary's Medical Center's community benefit information is consolidated into the Essentia Health community benefit information which is included in the Essentia Health annual report. The annual report is made available to the public via the website at www.essentiahealth.org. Essentia Health, headquartered in Duluth, Minn., is an integrated health system serving patients in Minnesota, Wisconsin, North Dakota and Idaho and is St. Mary's Medical Center's parent corporation. The cost to charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to calculate cost for the following community benefits: 1) Charity Care; 2) Unreimbursed Medicaid; 3) Unreimbursed cots - other means-tested government Programs. Actual costs were used for the remainder of the community benefits reported. There are no subsidized costs attributable to a physician clinic. Bad debt expense that was subtracted from total expense to obtain the % of community benefit to total expense amounted to $14,772,409. Provide rationale and costing methodology used to determine amount reported in Part III, Lines 2 and 3: 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. Describe how the organization accounts for discounts and payments on patient accounts in determining bad debt expense. Also describe the method the organization uses to determine the amount that reasonable can be attributable to patients who likely would qualify for financial assistance under the organization's charity care policy if sufficient information had been available to make a determination of their eligibility: 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). Because this is our practice, we believe there is no known charity care within bad debt expense. Provide the text to the footnote of the organization's audited financial statements that describes the organization's bad debt expense: Excerpt from the parent company's audit) The provision for uncollectible accounts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payor category. The results of this review are then used to make any modifications to the provision for uncollectible accounts. After satisfaction of amounts due from insurance, Essentia Health follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Essentia. Describe the costing methodology used in determining the Medicare Allowable Cost reported in the organization's Medicare Cost Report as reflected in the amount reported in Part III, Line 6: 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. Describe, if applicable, the extent to which any shortfall reported in Part III, Line 7 should be treated as a community benefit and provide the rationale for the organization's opinion: St. Mary's Medical Center 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. At any stage of the patient experience, including collections, a determination may be made that the patient qualifies for Charity Care. All collection efforts must be suspended while a patient's Charity Care application is being considered and until the patient is notified regarding the determination of eligibility. The Charity Care Program policy will govern the handling of that patient's balance. Not applicable. St. Mary's Medical Center's parent corporation, SMDC Health System, provides significant financial support for a health-care needs assessment survey, called "Bridge to Health," which collects and analyzes population-based health data on adults in northeastern Minnesota and northwestern Wisconsin (hospital's primary service area). The Bridge to Health survey is conducted by Duluth, Minnesota-based non-profit that supports programs and activities which improve the physical health and mental well-being of underserved populations. We also provide financial support for the United Way of Greater Duluth's ongoing assessment of community needs, including (but not limited to) health-related issues in children and adults. The findings of these assessments are the basis for determining community programs supported by our organization. St. Mary's Medical Center has financial assistance packets that contain information about their charity care program as well as contact information on other federal and state government programs. These packets are distributed to patients once a financial need has been determined either through patient request or staff referrals. The charity care policy and application is available on the SMDC website at www.smdc.org. Because financial assistance packets are given to patients when a need is determined, they may be given to the patient at any point (admission, discharge, during the billing process). St. Mary's Medical Center has financial counselors on staff to assist patients in Medicaid, Medicare and other assistance programs (including the charity care program) that may be available to them. Contact information for the Financial Counselors is available on the SMDC website and is also included on the back of the billing statements. All hospital staff have been trained to refer patients to the financial counselor. The financial counselors often assist patients with the application process, mailing and follow up. St. Mary's Medical Center is located in Duluth, MN. St. Mary's is a part of the larger Essentia Health System, which is defined in Part VI, Line 7. St. Mary's Medical Center consists of 1 hospital that service the St. Louis county area. The overall community is classified as a combination of suburban and rural communities. St. Mary's and its related clinics cover a population of over 460,000 people. The service region consists of 17.08% of the population over the age of 65, 20.21% of the population under the age of 18, 7.03% of the population is of a minority racial background, almost a 50/50 split between genders, 49.18% of the population have a high school diploma or less. The average income of the service area is slightly below $53,000. Approximately 7.9% of the population falls below federal poverty guidelines. St. Mary's Medical Center, along with the rest of Essentia Health, is committed to serve patients regardless of their ability to pay. 2.3% of patients seen by St. Mary's or their corresponding clinics were uninsured patients. In addition, slightly more than 14% of their patients were Medicaid recipients. As mentioned above, St. Mary's Medical Center is part of a larger system, Essentia Health. Essentia Health staffs hospitals and clinics in federally-recognized underserved areas and supports the health of its communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into its smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or are faced with other challenges that make it difficult to travel long distances for care. There are 13 other hospitals outside of the Essentia Health umbrella that service the community. Not applicable. St. Mary's Medical Center's board of directors is composed of volunteer representatives from the community it serves. St. Mary's Medical Center 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. St. Mary's Medical Center is a part of the SMDC Health System. SMDC Health System's consolidated community benefits are summarized below: Benefits for person living in poverty: Charity care at cost $4,885,965 Cost-to-Charge Ratio Unreimbursed Medicaid $56,377,438 Cost-to-Charge Ratio Unreimbursed costs other means- tested government programs $1,066,229 Actual Costs Total Charity Care and Means- Tested Government Programs $62,329,632 Total Benefits for the broader community Community health improvement services & community benefit operations $2,618 Actual Costs Health professions education $5,839,665 Actual Costs Subsidized health services $72,953 Actual Costs Research $1,201,804 Actual Costs Financial & in-kind contributions $275,206 Actual Costs Total Other Benefits $7,392,246 Total Community building activities $242,045 Actual Costs Unpaid cost of public programs, Medicare $87,220,121 Cost-to-Charge Ratio Other care provided without compensation (bad debt) $18,044,106 Cost-to-Charge Ratio Discounts offered to uninsured patients $3,723,529 Actual Costs Taxes and fees $2,521,033 Actual Costs Total Community Benefit $181,472,712 Total St. Mary's Medical Center 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 will be linked via one central EHR by the end of 2011, thanks in part to significant investments made in 2010. 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 in 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. St. Mary's Medical Center is part of Essentia Health, an integrated health system of 17 hospitals, over 60 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 through active research and clinical trials, through the Essentia Institute of Rural Health. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans. Essentia Health is also serving patients through the aggressive implementation of the Epic electronic health record (EHR). Already in use in a number of Essentia Health's rural clinics and some hospitals, a fully-integrated EHR is scheduled to connect patients across the Essentia service region by 2012. 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. MN true PROGRAM FOR AID TO VICTIMS OF SEXUAL ASSAULT 32 E 1ST ST STE 200 DULUTH MN 55802 411350021 501(c)3 15000 PROGRAM SUPPORT 2010 1 0 DESCRIPTION OF ORGANIZATION PROCEDURES FOR MONITORING THE USE OF GRANTS: FORM 990, SCHEDULE I, PART 1, LINE 2- FOR GRANTS OVER $5,000 RECIPIENTS ARE REQUIRED TO PROVIDE A WRITTEN REPORT TO THE GRANT COMMITTEE. X X X true true false false false false false false false HUGH P RENIER MD 288458 0 51371 0 13513 0 49753 0 28668 0 431763 0 13513 0 DAVID H AMUNDSON 0 0 0 0 172427 0 0 0 8426 0 180853 0 28744 0 ROBERT NORMAN 0 377302 0 123763 0 30029 0 60196 0 46117 0 637407 0 29138 MARIBETH OLSON 257201 0 46390 0 11830 0 49320 0 27214 0 391955 0 11830 0 GEORGE F HOLLIDAY MD 0 198881 0 0 0 0 0 20512 0 23021 0 242414 0 0 KEVIN T STEPHAN MD 0 232721 0 0 0 0 0 23000 0 14025 0 269746 0 0 ALBERT J DEIBELE MD 0 700741 0 0 0 0 0 23000 0 28251 0 751992 0 0 ROCKLON CHAPIN 0 310325 0 106086 0 0 0 45721 0 14038 0 476170 0 0 MICHAEL F MCAVOY 0 176545 0 31996 0 0 0 31908 0 19257 0 259706 0 0 TERRI L RUBERG 161588 0 27584 0 9297 0 33899 0 24672 0 257040 0 9297 0 MICHAEL C METCALF 0 306907 0 115830 0 0 0 50184 0 26588 0 499509 0 0 STEVEN F JOHNSTON 120264 0 23241 0 40807 0 29000 0 26677 0 239989 0 8678 0 MARY C SHAW 142887 0 25995 0 0 0 30001 0 21148 0 220031 0 0 0 KAREN M ENGEN 161683 0 0 0 0 0 0 0 9770 0 171453 0 0 0 ANNE M MEYER 153131 0 0 6724 27010 186865 0 DENNIS W DASSENKO 0 232906 0 91279 0 0 0 48134 0 23955 0 396274 0 0 DIANE T DAVIDSON 0 205277 0 79815 0 0 0 34658 0 25464 0 345214 0 0 MICHAEL J MAHONEY 0 188769 0 32254 0 0 0 36990 0 10727 0 268740 0 0 SCHEDULE J EXPLANATIONS: METHOD FOR ESTABLISHING THE COMPENSATION OF COO: PART I, LINE 3- SMDC HEALTH SYSTEM RELIED ON THE FOLLOWING METHOD FOR ESTABLISHING THE COMPENSATION OF MARIBETH OLSON, COO: A COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SEVERANCE PAYMENT: PART I, LINE 4A- FORMER OFFICER, DAVID AMUNDSON, a former employee of related organization, St. Mary's Medical Center, RECEIVED PAYMENT TOTALING $145,987 IN TAX YEAR 2009 RELATED TO HIS TERMINATION. THE TERMINATION TERMS ARE JANUARY 7, 2008 UNTIL JULY 7, 2009. MR. AMUNDSON WILL RECEIVE PAY TOTALING $457,260 AND BENEFITS TOTALING $14,581 RELATED TO HIS TERMINATION. All other individuals listed as Formers in Form 990, Par VII, Section A, Line 1a remain employed within Essentia Health and its subsidiaries and are not receiving a severance payment. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: PART I, LINE 4B- THE FOLLOWING INDIVIDUALS LISTED IN FORM 990, PART VII, SECTION A, LINE 1A RECEIVED PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING THE YEAR: MARIBETH OLSON (ST. MARY'S DULUTH CLINIC HEALTH SYSTEM) $11,830 DAVID AMUNDSON (ST. MARY'S DULUTH CLINIC HEALTH SYSTEM) $28,744 STEVEN JOHNSTON (ST. MARY'S DULUTH CLINIC HEALTH SYSTEM) $ 8,678 HUGH RENIER (ST. MARY'S DULUTH CLINIC HEALTH SYSTEM) $13,513 TERRI RUBERG (ST. MARY'S DULUTH CLINIC HEALTH SYSTEM) $ 9,297 ROBERT NORMAN (ECHC) $29,138 ST. MARY'S DULUTH CLINIC HEALTH SYSTEM'S NONQUALIFIED PLAN IS OFFERED TO DESIGNATED ST. MARY'S DULUTH CLINIC HEALTH SYSTEM'S EXECUTIVES. THERE IS A MINIMUM TWO YEAR VESTING DATE, BENEFITS ARE SUBJECT TO INCOME TAXES UPON VESTING, AND BENEFITS ARE PAYABLE FROM ST. MARY'S DULUTH CLINIC HEALTH SYSTEM'S GENERAL ASSETS. ECHC'S NONQUALIFIED RETIREMENT PLAN IS OFFERED TO ECHC EXECUTIVES. THERE IS A MINIMUM TWO YEAR VESTING DATE, BENEFITS ARE SUBJECT TO INCOME TAXES UPON VESTING AND BENEFITS ARE PAYABLE FROM ECHC'S GENERAL ASSETS. Ryan M Olson Son of SMMC Officer 12565 Employee of SMMC false SCHEDULE O EXPLANATIONS: FORM 990, PART III: ORGANIZATION'S MISSION- St. Mary's Medical Center exists to witness to the love of God through compassionate and competent health services for all, especially the poor and powerless. As a Benedictine-sponsored Catholic organization, we promote the highest level of physical, emotional, and spiritual health and well-being for all persons, from the moment of conception until their providential end. As a member of the SMDC Health System, we help bring the soul and science of healing to the people we serve. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS: PART III LINE 4- St. Mary's Medical Center is organized and operated exclusively for charitable, scientific, and educational purposes. In furtherance of its purposes, St. Mary's Medical Center provides health care services in Minnesota through its 380 bed medical center. The hospital offers a broad range of inpatient and outpatient state-of-art services for its patients, including Level II Emergency (trauma) services, intensive care units, neurosurgery, medical surgical care, orthopedics, neuroscience, digestive health, family and pediatrics services, and heart and vascular services. In accordance with the Federal Emergency Medical Treatment and Active Labor Act, any person who presents at the hospital seeking treatment of an emergency medical condition is given a medical screening and necessary stabilizing treatment regardless of the person's ability to pay. Beyond its hospital services, St. Mary's Medical Center also offers educational programs for the community, such as parenting classes and child safety programs such as bicycle helmet fitting, bicycle safety, and pedestrian safety. St. Mary's Medical Center also participates in continuing education programs for health care professionals. St. Mary's Medical Center employs over 3,300 full time equivalents. The hospital provided for over 73,500 hospital patient days and over 40,400 emergency visits. St. Mary's Medical Center provided over $2,550,000 in charity care as well as an additional $11,200,000 of costs incurred in excess of Medicaid payments received during the fiscal year ended June 30, 2010. Further community benefits provided during the fiscal year include community services of over $4,500,000 and cash & in-kind donations of over $17,800. FORM 990 GOVERNANCE, MANAGEMENT, AND DISCLOSURE: PART VI LINE 6- St. Mary's Duluth Clinic Health System may elect one or more members of the governing body as described in Schedule O Part VI 7a. Essentia Health and Benedictine Sisters Benevolent Association have reserved powers with respect to St. Mary's Medical Center as described in Schedule O Part VI Line 7b. FORM 990 GOVERNANCE, MANAGEMENT, AND DISCLOSURE: PART VI LINE 7A- According to its Bylaws, St. Mary's Duluth Clinic Health System shall appoint and remove St. Mary's Medical Center's governing body. FORM 990 GOVERNANCE, MANAGEMENT, AND DISCLOSURE: PART VI LINE 7B- St. Mary's Medical Center 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. SCHEDULE O EXPLANATION CONTINUED: Acquisitions. Authority to cause, and to approve, all acquisitions by and formations of entities in the System. Marketing, Authority to implement System-wide marketing and promotional activities. Compliance Plans. Authority to create, and to approve, corporate compliance, safety and risk management plans for entities within the System. Quality Plan. Authority to create, and to approve, the System's quality plan. Non-Budgeted Purchases. Approval of non-budgeted capital purchases and leases in excess of the single or annual aggregate dollar limits prescribed in writing by Essentia Health for entities within the System. Human Resources. Authority to create human resource policies and procedures within the System. Reserved Powers. Authority to create additional Essentia Health reserved powers by the affirmative vote of at least 80% of the Essentia Health board of directors (excluding the Essentia Health CEO); provided, however, that any additional Essentia Health reserved powers shall not contravene or hinder the reserved powers of Benedictine Sisters Benevolent Association. The Benedictine Sisters Benevolent Association ("BSBA") also has certain reserved powers over all Catholic facilities within Essentia Health. BSBA's reserved powers are as follows: Subject to any approvals that are required under applicable canon law and the prior written notice to ECHC required by Section 2.10 of the Amended and Restated Affiliation Agreement by and among Benedictine Sisters Benevolent Association, Essentia Health, ECHC, and St. Mary's Duluth Clinic Health System dated as of December 21, 2007 (the "Affiliation Agreement"), and to Essentia Health as required by Section 2.11 thereof, Benedictine Sisters Benevolent Association shall have the following powers which shall be exercised by action of the Benedictine Sisters Benevolent Association board of directors unless otherwise provided with respect to all ecclesiastical goods and Catholic facilities and entities within the System (as defined in the Affiliation Agreement, as amended): Mission. Authority to approve the mission, purpose and vision statements for Catholic facilities and entities within the System. Adherence to Ethical Religious Directives (ERDs). Authority to approve the methods, policies and procedures pertaining to the adherence of Catholic facilities and entities within the System to the ERDs, and to require the use of religious symbols, distinguishing elements and prayers. Official Catholic Directory. Authority to request the listing of qualified entities and facilities within the System in The Official Catholic Directory, subject to the approval of applicable Catholic authorities. Catholic Health Association. Authority to require Catholic facilities and entities within the System to join the membership of the Catholic Health Association of the United States. Alienation of Stable Patrimony or Ecclesiastical Goods. Authority to approve alienation of either stable patrimony or other ecclesiastical goods in the System if such goods involved in a specific transaction approved by Essentia Health pursuant to Section 2.8(g) or 2.8(h) of the Affiliation Agreement have a dollar value equal to or greater than 70% of the amount established from time to time that requires approval from the Holy See. Amendments. Authority to approve any amendments to the Articles of Incorporation or Bylaws of this corporation that would alter the number of Benedictine Sisters of St. Scholastica Monastery of Duluth or Benedictine Sisters Benevolent Association board of director members serving as members of this corporation's board of directors; authority to approve any amendments to the Articles of Incorporation or Bylaws of the Supported Organizations, as well as the Catholic ECHC and SMDC Subsidiaries (as defined in the Affiliation Agreement), which could materially affect such entity's identity as a Catholic institution, including without limitation any amendment that would alter the number of Benedictine Sisters of St. Scholastica Monastery of Duluth or Benedictine Sisters Benevolent Association board of director members serving as members of such entity's board of directors; and authority to cause Essentia Health to make amendments to the Articles of Incorporation or Bylaws of the Supported Organizations, as well as the Catholic ECHC and SMDC Subsidiaries, which amendments Benedictine Sisters Benevolent Association in good faith are necessary to preserve such entity's identity as a Catholic institution. Mission Effectiveness. Authority to approve annual plans and evaluations relating to mission effectiveness and chaplaincy for the Catholic facilities and entities within the System. Mergers and Dissolution. Subject to the approval of the Benedictine Sisters of St. Scholastica Monastery of Duluth, authority to approve a proposed merger, consolidation, liquidation, dissolution, or the disposition of all or substantially all the assets. SCHEDULE O EXPLANATION CONTINUED: FORM 990 GOVERNANCE, MANAGEMENT, AND DISCLOSURE: PART VI LINE 11A- The 2009 Form 990 including all schedules were reviewed by St. Mary's Medical Center's management and St. Mary's Duluth Clinic Health System's governing body on May 4, 2011 prior to filing with the Internal Revenue Service. Each current director of the governing body received a copy of the 2009 Form 990. St. Mary's Medical Center's CFO led the review of the forms and schedules and any questions were discussed. FORM 990 GOVERNANCE, MANAGEMENT, AND DISCLOSURE: PART VI LINE 12C- 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. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN: PART VI, QUESTION 15A- The executive compensation committee of the board of directors of SMDC Health System fulfills the board's responsibility regarding compensation of SMDC Health System's (SMDC) executives consistent with SMDC's mission, values, and tax exempt status. The committee reviews and makes decisions based on information presented by the SMDC President and Chief Administrative Officer concerning the performance of the system and senior executives of SMDC. The committee provides oversight for incentive compensation program(s) in a manner consistent with the executive compensation philosophy, annually they evaluate the performance of SMDC against approved corporate goals and objectives, including a review of system results and supporting documentation for all members covered by the SMDC incentive compensation program and report such findings to the Essentia Health Executive Compensation Committee. The year this process was last undertaken for SMDC was 2008. OFFICES & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN: PART VI, QUESTION 15B- The executive compensation committee of the board of directors of SMDC Health System fulfills the board's responsibility regarding compensation of SMDC Health System's (SMDC) executives consistent with SMDC's mission, values, and tax exempt status. The committee reviews and makes decisions based on information presented by the SMDC President and Chief Administrative Officer concerning the performance of the system and senior executives of SMDC. The committee provides oversight for incentive SCHEDULE O EXPLANATION CONTINUED: compensation program(s) in a manner consistent with the executive compensation philosophy, annually they evaluate the performance of SMDC against approved corporate goals and objectives, including a review of system results and supporting documentation for all members covered by the SMDC incentive compensation program and report such findings to the Essentia Health Executive Compensation Committee. The year this process was last undertaken for SMDC was 2008. Essentia's Chief Financial Officer's compensation is determined by the Executive Compensation Committee of Essentia Health's Board of Directors. 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, 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 & modifying, as appropriate, reasonable compensation & benefits for Essentia's Chief Executive Officer. The executive compensation committee engages qualified independent compensation advisors to provide objective & impartial comparative data & to express opinions on total compensation reasonableness. The executive compensation committee may request its independent advisors to: monitor comparability data & marketplace trends; make appropriate recommendations regarding salary ranges; & periodically review the market competitiveness of Essentia's executive compensation packages. Prior to establishing or adjusting executive compensation, the executive compensation committee will obtain & 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 shall include: the terms of the approved compensation & the date approved; the executive compensation committee members present during the review, discussion & approval of the proposed compensation & those who voted on the proposed compensation; identification of the comparability data obtained & relied upon by the executive compensation committee & how the data was obtained; any actions by a member of the executive compensation committee having a conflict of interest; & documentation of the basis for the determination. The year this process was last undertaken for Essentia's CFO was 2008. FORM 990 GOVERNANCE, MANAGEMENT, AND DISCLOSURE: PART VI LINE 19-AVAILABILITY OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, & FINANCIAL STATEMENTS TO THE PUBLIC- St. Mary's Medical Center makes its governing documents, conflict of interest policy, and financial statements available to the public. St. Mary's Medical Center's governing documents, conflict of interest policy, and financial statements are available to the public upon request. St. Mary's Medical Center is part of Essentia Health's consolidated financials statements which are included in Essentia Health's annual report posted on Essentia Health's web site. HOURS DEVOTED TO RELATED ORGANIZATIONS: PART VII SECTION A LINE 1A COLUMN B- Robert Norman is employed by ECHC as Essentia Health's Chief Financial Officer. 100% of his time is spent furthering the purpose of Essentia Health and all related organizations. Barbara Johnson is employed by SMDC Medical Center as Chief Financial Officer. 100% of her time is spent furthering the purpose of SMDC Health System and all of it's related organizations. MariBeth Olson, is employed by St. Mary's Medical Center as Chief Operating Officer. 100% of her time is spent furthering the purpose of SMDC Health System and it's related organizations. Sister Kathleen Hofer is employed by St. Mary's Medical Center as Essentia Health's Senior Vice President, Benedictine Sponsorship. 100% of her time is spent furthering the purpose of Essentia Health and all related organizations. George Holliday, MD is employed by The Duluth Clinic, Ltd. 100% of his time is spent furthering the purpose of SMDC Health System and it's related organizations. Kevin Stephan, MD is employed by The Duluth Clinic, Ltd. 100% of his time is spent furthering the purpose of SMDC Health System and it's related organizations. Albert Deibele, MD is employed by The Duluth Clinic, Ltd. 100% of his time is spent furthering the purpose of SMDC Health System and it's related organizations. Rocklon Chapin, is employed by SMDC Medical Center as one of SMDC Health System's Executive Vice Presidents. 100% of his time is spent furthering the purpose of SMDC Health System and it's related organizations. Michael McAvoy, is employed by SMDC Medical Center as one of SMDC Health System's Vice Presidents. 100% of his time is spent furthering the purpose of SMDC Health System and it's related organizations. Terri Ruberg, is employed by St. Mary's Medical Center as one of SMDC Health System's Vice Presidents. 100% of her time is spent furthering the purpose of SMDC Health System and it's related organizations. Michael Metcalf, is employed by SMDC Medical Center as one of SMDC Health System's Executive Vice Presidents. 100% of his time is spent furthering the purpose of SMDC Health System and it's related organizations. Hugh Renier, MD, is employed by St. Mary's Medical Center as Vice President of Medical Affairs for St. Mary's Medical Center. 100% of his time is spent furthering the purpose of SMDC Health System and it's related organizations. SCHEDULE R, PART V COLUMN C: METHOD USED TO DETERMINE VALUE OF SERVICES, CASH, AND OTHER ASSETS- The methods used to determine the amounts in Schedule R Part V Column C were: -Reimbursement of actual costs -Fee Based upon expected costs BRAINERD LAKES INTEGRATED HEALTH SYSTEM 2024 S 6TH ST BRAINERD MN 56401 371532145 SUPPORT ORG MN 501 C 3 11 II ECHC 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 HOSPIT MN 501 C 3 3 ECHC CLEARWATER VALLEY HOSPITAL & CLINICS INC 301 CEDAR OROFINO ID 83544 820497771 CLINIC HOSPIT ID 501 C 3 3 ECHC DIVINE MEDICAL SERVICES 709 N LINCOLN JEROME ID 83338 202773717 EMERGENCY SER ID 501 C 3 3 SBFMC DL SURGERY CENTER 1027 WASHINGTON AVE DETROIT LAKES MN 56501 263837203 ASC MN 501 C 3 3 ECHC ECHC FOUNDATION 502 E 2ND ST DULUTH MN 55805 263359418 FOUNDATION MN 501 C 3 11 I ECHC FIRST CARE MEDICAL SERVICES 900 HILLIGROSS BLVD SE FOSSTON MN 56542 410706143 CLINIC HOSPIT MN 501 C 3 3 ECHC MINNESOTA VALLEY HEALTH CENTER 621 S 4TH ST LE SUEUR MN MN 56058 410837659 HOSPITAL NURS MN 501 C 3 3 ECHC ST BENEDICTS FAMILY MEDICAL CENTER 709 N LINCOLN JEROME ID 83338 820227163 CLINIC HOSPIT ID 501 C 3 3 ECHC ST JOSEPHS MEDICAL CENTER 523 N 3RD ST BRAINERD MN 56401 410695602 HOSPITAL MN 501 C 3 3 BLIHS ST MARYS EMS 1027 WASHINGTON AVE DETROIT LAKES MN 56501 411805811 EMERG HOSPITA MN 501 C 3 9 SMRHC ST MARYS HOSPITAL AND CLINICS INC P O BOX 137 COTTONWOOD ID 83522 820226453 CLINIC HOSPIT ID 501 C 3 3 ECHC ST MARYS INNOVIS HEALTH 1027 WASHINGTON AVE DETROIT MN 56501 262861321 CLINIC MN 501 C 3 3 ECHC ST MARYS REG HLTH CTR DBA INNOVIS HLTH 1027 WASHINGTON AVE DETROIT LAKES MN 56501 411620386 CLINIC HOSPIT MN 501 C 3 3 ECHC 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 HOSPIT DE 501 C 3 3 ESSENTIA INNOVIS HEALTH FOUNDATION 502 E 2ND ST DULUTH MN 55805 271984704 FOUNDATION MN 501 C 3 7 INNOVIS MIDWEST MEDICAL EQUIP & SUPPLY INC 4418 HAINES ROAD DULUTH MN 55811 411674021 MEDICAL EQUIP MN 501 C 3 9 SMDC PINE MEDICAL CENTER 109 COURT AVE S SANDSTONE MN 55072 411884597 CLINIC HOSPIT MN 501 C 3 3 SMDC POLINSKY MEDICAL REHABILITATION CENTER 530 E 2ND ST DULUTH MN 55805 410691275 CLINIC HOSPIT MN 501 C 3 3 SMMC SMDC MEDICAL CENTER 502 E 2ND ST DULUTH MN 55805 411878730 CLINIC HOSPIT MN 501 C 3 3 SMDC ST MARYS DULUTH CLINIC FOUNDATION 400 E 3RD ST DULUTH MN 55805 412016979 FOUNDATION MN 501 C 3 7 SMDC ST MARYS DULUTH CLINIC HEALTH SYSTEM 407 E 3RD ST DULUTH MN 55805 411836633 CLINIC HOSPIT MN 501 C 3 3 ESSENTIA ST MARYS HOSPITAL OF SUPERIOR 3500 TOWER AVE SUPERIOR WI 54880 411811073 CLINIC HOSPIT WI 501 C 3 3 SMMC THE DULUTH CLINIC LTD 400 E 3RD ST DULUTH MN 55805 410883623 CLINIC HOSPIT MN 501 C 3 3 SMDC PMC GATEWAY IMAGING LLC 109 COURT AVE SANDSTONE MN 55072 261634864 IMAGING SERVICES MN NA NONE 0 0 0 ESSENTIA HLTH INS SVCE SPC LTD BUCKINGHAM SQ 720W BAY RD POBX 69 GRAND CAYMAN CAYMAN ISLANDS CJ KY1 1102 000000000 INSURANCE CJ NA FOREIGN CORP 0 0 0.00000 EAST RANGE CLINICS LTD 910 6TH AVE N VIRGINIA MN 55792 410909915 CLINICS MN NA C CORP 0 0 0.00000 false true false false false false false false false false false false false false true true true true MIDWEST MEDICAL EQUIP & SUPPLY INC 41-1674021 P 3308491 THE DULUTH CLINIC LTD 41-0883623 R 322000000 THE DULUTH CLINIC LTD 41-0883623 P 85092 ST MARYS DULUTH CLINIC FOUND 41-2016979 P 507491 POLINSKY MEDICAL REH CTR 41-169275 P 11402266 SMDC MEDICAL CENTER 41-01878730 R 69000000 ST MARYS HOSPITAL OF SUPERIOR 41-1811073 Q 32288812 ST MARYS HOSPITAL OF SUPERIOR 41-1811073 R 26700000 ST MARYS HOSPITAL OF SUPERIOR 41-1811073 P 128583 THE DULUTH CLINIC LTD 41-0883623 O 86639 SMDC MEDICAL CENTER 41-01878730 O 461733 ESSENTIA INSTITUTE OF RURAL HEALTH 27-1291124 P 637375