Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012
BCheck if applicable:
CName of organization
St Mary's Medical Center
 
Doing Business As
Essentia Health St Mary's Medical
 
Number and street (or P.O. box if mail is not delivered to street address)
407 East Third Street
 
Room/suite
City or town, state or country, and ZIP + 4
Duluth, MN55805
D Employer identification number

41-0695604
E Telephone number

G Gross receipts $ 374,023,593
F Name and address of principal officer:
DANIEL NIKCEVICH MD
502 East 2nd Street
DULUTH,MN55805
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.essentiahealth.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1888
M State of legal domicile: MN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: St. Mary's Medical Center exists to witness the love of God through compassionate and competent health services for all, especially the poor and the powerless.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 14
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 8
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 3,565
6 Total number of volunteers (estimate if necessary) .... 6 1,168
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 756,951
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 146,962
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 0 28,584
9 Program service revenue (Part VIII, line 2g) ......... 366,498,961 363,604,769
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 16,698,577 5,097,598
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 3,994,666 4,627,700
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 387,192,204 373,358,651
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 1,155,238 2,413,542
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 178,786,819 157,535,798
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet406,642    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 155,117,592 174,986,431
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 335,059,649 334,935,771
19 Revenue less expenses. Subtract line 18 from line 12....... 52,132,555 38,422,880
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 657,811,770 917,017,373
21 Total liabilities (Part X, line 26)............. 104,903,459 376,927,744
22 Net assets or fund balances. Subtract line 21 from line 20..... 552,908,311 540,089,629
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: SEE SCHEDULE O
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 265,594,993 including grants of $ 2,413,542 ) (Revenue $ 363,604,769 )
SEE SCHEDULE O
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 265,594,993
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
0
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
3,565
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
14
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
8
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
MN
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
BARBARA JOHNSON CFO
407 EAST THIRD STREET
DULUTH,MN55805
(218) 786-1421
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) SISTER KATHLEEN HOFER
BOARD CHAIR
 60.0 X   X       0 0 0
(2) JOSEPH BIANCO MD
BOARD DIRECTOR
 60.0 X           0 319,946 50,905
(3) LAURA BOEHLKE-BRAY MD
BOARD DIRECTOR thru 12/11
 60.0 X           0 307,013 30,461
(4) DAVID GADDIE
BOARD TREASURER
 10.0 X   X       0 8,200 0
(5) NEAL HESSEN
BOARD DIRECTOR
 10.0 X           0 39,350 0
(6) ALAN HODNIK
BOARD DIRECTOR
 10.0 X           0 0 0
(7) SHERRY MATTSON
BOARD DIRECTOR
 10.0 X             10,400  
(8) THOMAS PATNOE MD
President & CMO THRU 4/12
 60.0 X   X       0 712,273 104,333
(9) SISTER DONNA SHROEDER
BOARD DIRECTOR
 10.0 X           0 0 0
(10) SUSAN STREITZ MD
BOARD DIRECTOR
 60.0 X           0 335,242 26,416
(11) SISTER MARY JOSEPHINE TORBORG
BOARD DIRECTOR
 10.0 X           0 0 0
(12) MICHAEL VAN SCOY MD
BOARD SECRETARY
 60.0 X   X       0 358,379 50,778
(13) CHUCK WALT
BOARD DIRECTOR
 10.0 X           0 5,800 0
(14) SISTER SARAH SMEDMAN
BOARD DIRECTOR
 10.0 X           0 0 0
(15) MELISSA NAJARIAN MD
BOARD DIRECTOR
 60.0 X           0 565,796 50,847
(16) DANIEL NIKCEVICH MD
PRESIDENT & CMO
 60.0 X   X       0 687,465 50,198
(17) BARBARA JOHNSON
CHIEF FINANCIAL OFFICER
 60.0     X       0 422,890 60,505
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) HUGH RENIER MD
VICE PRESIDENT MEDICAL AFFAIRS
 60.0       X     405,765 0 81,042
(19) MICHAEL METCALF
CHIEF ADMINISTRATIVE OFFICER
 60.0       X     0 526,817 88,755
(20) ANN WATKINS
VP SURGICAL SERVICES
 60.0       X     0 232,271 49,107
(21) SCOTT JOHNSON MD
CLINICAL CHIEF
 60.0       X     0 650,431 51,066
(22) Richard Spehar
Pharmacy Director
 60.0       X     151,160 0 86,407
(23) THERESA GUNNARSON MD
CLINICAL CHIEF
 60.0       X     0 492,967 55,917
(24) WILSON GINETE MD
SECTION CHAIR
 60.0       X     0 614,178 47,124
(25) BRAD DAVIS MD
SECTION CHAIR
 60.0       X     0 466,483 53,259
(26) Michael Mcavoy
VP Operation Hospital
 60.0       X     0 228,717 52,065
(27) Ruth Mccutcheon
Chief Operating Officer
 60.0       X     161,192 4,550 251
(28) MARY SHAW
CHIEF OPERATING OFFICER-SMHS
 60.0         X   191,886 0 58,202
(29) STEVE YORDE
CHIEF DEVELOPMENT OFFICER
 60.0         X   210,840 0 53,952
(30) KAREN ENGEN
REGISTERED NURSE
 60.0         X   145,462 0 77,240
(31) NANCY PURSI
REGISTERED NURSE
 60.0         X   151,304 0 80,717
(32) MARY ANN STARKOVICH-HIRSCH
REGISTERED NURSE
 60.0         X   143,197 1,250 109,455
(33) ROBERT NORMAN
CHIEF FINANCIAL OFFICER
 60.0           X 0 626,789 135,575
(34) MARIBETH OLSON
CHIEF OPERATING OFFICER
 0.0           X 395,008 0 31,385
(35) ROCKLON CHAPIN
EXECUTIVE VP HOSPITAL DIVISION
 0.0           X 0 444,640 59,943
(36) DENNIS DASSENKO
CHIEF INFORMATION OFFICER
 60.0           X 0 383,022 80,477
(37) DIANE DAVIDSON
SR VICE PRES HUMAN RESOURCES
 60.0           X 0 452,877 86,063
(38) MICHAEL MAHONEY
VP OF Public Policy
 60.0           X 0 286,234 57,651
(39) ALBERT DEIBELE MD
CLINICAL CHIEF
 60.0           X 0 610,192 55,199
(40) KIMBERLY BODDICKER MD
SECTION CHAIR
 60.0           X 0 607,827 41,943
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,955,814 10,401,999 1,917,238
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet109
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 13,317
e Government grants (contributions)1e 15,111
f All other contributions, gifts, grants, and
similar amounts not included above1f 		156
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 28,584
Program Service Revenue Business Code
2a PATIENT REVENUE 621,400 363,604,769 362,848,474 756,295  
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 363,604,769
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 4,674,163   656 4,673,507
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 62,460  
b Less: rental expenses 114,085  
c Rental income or (loss) -51,625  
d Net rental income or (loss).......MediumBullet -51,625     -51,625
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 472,842 6,400
b Less: cost or other basis and sales expenses   55,807
c Gain or (loss) 472,842 -49,407
d Net gain or (loss)..........MediumBullet 423,435     423,435
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a 968,155
b Less: cost of goods sold ..b 495,050
c Net income or (loss) from sales of inventory..MediumBullet 473,105     473,105
Miscellaneous Revenue Business Code
11a CAFETERIA REVENUE 722,210 2,503,437     2,503,437
b PARKING REVENUE 812,930 1,371,468     1,371,468
c CHILD CARE REVENUE 900,099 307,796     307,796
d All other revenue .... 23,519     23,519
e Total. Add lines 11a–11d ......MediumBullet 4,206,220
12 Total revenue. See Instructions....MediumBullet 373,358,651 362,848,474 756,951 9,724,642
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 2,392,542 2,392,542
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 21,000 21,000
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 1,873,643 1,222,513 651,130  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 269,801 42,238 227,563  
7 Other salaries and wages 118,782,802 108,969,646 9,595,130 218,026
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 8,801,280 4,098,923 4,693,631 8,726
9 Other employee benefits ....... 18,735,724 17,829,246 860,234 46,244
10 Payroll taxes ........... 9,072,548 7,940,295 1,115,843 16,410
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 294   294  
c Accounting ........... 0      
d Lobbying ........... 12,268   12,268  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 1,905,165   1,905,165  
g Other .......... 23,264,613 21,280,076 1,984,537  
12 Advertising and promotion .... 10,737 10,317   420
13 Office expenses ....... 10,096,423 7,453,204 2,630,887 12,332
14 Information technology ...... 1,195,055 862,538 332,319 198
15 Royalties .. 0      
16 Occupancy ........... 3,912,360 219,622 3,661,249 31,489
17 Travel ............ 1,044,475 870,181 169,505 4,789
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 490,813 278,693 206,031 6,089
20 Interest ........... -20,574   -20,574  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 11,393,762 5,470,869 5,922,871 22
23 Insurance .............. 380,018 380,018    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL SUPPLIES 61,388,806 61,388,806    
b AFFILIATE EXP/REV ALLOCATION 20,507,728 4,194,282 16,313,446  
c AFFILIATE SUPPORT FEE 16,539,036   16,539,036  
d BAD DEBT EXPENSE 12,950,036 12,949,959   77
e
f All other expenses 9,915,416 7,720,025 2,133,571 61,820
25 Total functional expenses. Add lines 1 through 24f 334,935,771 265,594,993 68,934,136 406,642
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 23,456,358 1 372,765
2 Savings and temporary cash investments ....... 5,971,573 2 70,046,065
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 61,806,608 4 53,078,014
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 234,186,582 7 187,626
8 Inventories for sale or use .............. 7,570,708 8 7,147,090
9 Prepaid expenses and deferred charges ............ 1,154,074 9 957,328
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 263,587,960
b Less: accumulated depreciation. ..... 10b 190,953,929 75,252,004 10c 72,634,031
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ...... 248,256,680 12 238,672,987
13 Investments—program-related. See Part IV, line 11 .. 0 13 600,000
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 157,183 15 473,321,467
16 Total assets. Add lines 1 through 15 (must equal line 34)... 657,811,770 16 917,017,373
Liabilities 17 Accounts payable and accrued expenses . 45,243,689 17 43,182,160
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 59,659,770 25 333,745,584
26 Total liabilities. Add lines 17 through 25..... 104,903,459 26 376,927,744
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 552,908,311 27 540,089,629
28 Temporarily restricted net assets ..... 0 28 0
29 Permanently restricted net assets ..... 0 29 0
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 552,908,311 33 540,089,629
34 Total liabilities and net assets/fund balances ..... 657,811,770 34 917,017,373
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
373,358,651
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
334,935,771
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
38,422,880
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
552,908,311
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-51,241,562
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
540,089,629
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
St Mary's Medical Center
 
Employer identification number

41-0695604
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
St Mary's Medical Center
 
Employer identification number

41-0695604
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
St Mary's Medical Center
  		Employer identification number

41-0695604
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
St Mary's Medical Center
  		Employer identification number

41-0695604
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
St Mary's Medical Center
  		Employer identification number

41-0695604
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
St Mary's Medical Center
 
Employer identification number

41-0695604
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
12,268
j
Total. Add lines 1c through 1i ...............................
12,268
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
No
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
SCHEDULE C, PART II-B   ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER PAYS DUES TO CERTAIN ORGANIZATIONS RELATED TO THE INDUSTRY WHICH HAVE LOBBYING EXPENSES. THE AMOUNT LISTED IS THE PERCENTAGE OF THE DUES PAID THAT WERE USED FOR LOBBYING.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
St Mary's Medical Center
 
Employer identification number

41-0695604
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   1,094,122 1,094,122
b Buildings ................   127,469,979 89,738,928 37,731,051
c Leasehold improvements ............        
d Equipment ................   130,647,901 100,600,411 30,047,490
e Other .................   4,375,958 614,590 3,761,368
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 72,634,031
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) INVESTMENT - VHA COMMON STOCK 		400,000 C

(B) POOLED INVESTMENT FUND 		238,272,987 F







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 238,672,987
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) DEFERRED COMPENSATION FUND 3,576,963
(2) RECEIVABLES TO TAX EXEMPT ORGS 469,744,504







Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 473,321,467
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
ASSET RETIREMENT OBLIGATION FIN 47 941,737
DEFINED BENEFIT PENSION LIABILITY 81,818,186
PAYABLES TO RELATED TAX EXEMPT ORGS 247,264,487
UNCLAIMED PROPERTY 143,211
BENEFIT PLAN LIABILITY 3,576,963
PATIENT EMERGENCY FUND 1,000



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 333,745,584
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
SCHEDULE D, PART X   ASC 740 footnote: Essentia Health has adopted Accounting Standards Codification 740, Income Taxes (formerly known as FASB Interpretation No. 48 (FIN 48), Accounting for Uncertainty in Income Tax - an interpretation of FASB Statement No. 109, Accounting for Income Taxes). The adoption of this interpretation had no material impact on the consolidated financial statements and therefore, Essentia Health's consolidated financial statements for fiscal year ended June 30, 2012 no longer includes an ASC 740 footnote.
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
St Mary's Medical Center
 
Employer identification number

41-0695604
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    2,225,325 0 2,225,325 0.690 %
b Medicaid (from Worksheet 3, column a) .....     55,617,521 37,237,158 18,380,363 5.710 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .     0 0 0  
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    57,842,846 37,237,158 20,605,688 6.400 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		8 635 1,462,474 377,804 1,084,670 0.340 %
f Health professions education
(from Worksheet 5) .. 		3   1,811,003 533,990 1,277,013 0.400 %
g Subsidized health services
(from Worksheet 6) .. 		    0 0 0  
h Research (from Worksheet 7)     0 0 0  
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     30,000 0 30,000 0.010 %
jTotal Other Benefits ... 11 635 3,303,477 911,794 2,391,683 0.750 %
kTotal. Add lines 7d and 7j. .. 11 635 61,146,323 38,148,952 22,997,371 7.150 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing     0 0 0 0 %
2 Economic development     0 0 0 0 %
3 Community support     0 0 0 0 %
4 Environmental improvements     0 0 0 0 %
5 Leadership development and training for community members     0 0 0 0 %
6 Coalition building     0 0 0 0 %
7 Community health improvement advocacy     0 0 0 0 %
8 Workforce development     1,902,208 0 1,902,208 0.590 %
9 Other     0 0 0 0 %
10 Total     1,902,208 0 1,902,208 0.590 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
12,950,036
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
87,445
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
102,507,779
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
112,062,390
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-9,554,611
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 ESSENTIA HEALTH ST MARY'S MEDICAL CENTER
407 EAST THIRD STREET
DULUTH,MN55805 		X X   X     X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
ESSENTIA HEALTH ST MARY'S MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
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.
3 Patient education of eligibility for assistance. 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.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
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 In addition to the federal poverty guidelines, an asset threshold test is also applied. Assets, excluding equity in home of $100,000, must be below $10,000 for a household of up to 2 and $20,000 for a household of 3 or more. Assets include bank accounts, IRAs, second vehicles, recreational vehicles, and any additional real estate. If after application of discount from charity care the patient's remaining balance still exceeds the patient's annual household income, an additional discount of 50% will be applied to the patient's remaining balance. If the remaining balance after the charity care discount is between 50 and 100% of the patient's annual household income, an additional discount of 25% will be applied to the patient's remaining balance. Minnesota residents whose household income is less than $125,000 may also be eligible for the MN Uninsured Discount for hospital bills. Part I, line 6a Essentia Health St. Mary's Medical Center 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 St. Mary's Medical Center'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 $12,950,036. 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: Physician Recruitment: Essentia Health St. Mary's Medical Center incurred expenses to recruit physicians to Duluth, MN which has been federally designated as a Medically Underserved Area. Part III, line 4 Discounts, charity care, and bad debt expense are accounted for as reductions to revenue. Bad debt expense on patient accounts would be identified as any balance on the account, less any previous payments and discounts, that has aged and is absent of any payments. If, during the collection process, it becomes known that the patient qualifies for charity care, the amounts included within bad debt expense would be reclassified to charity care. Part III, Line 4 Essentia Health St. Mary's Medical Center is in the process of hiring a 3rd party to track bad debt accounts in order to presumptively quantify accounts within bad debt expense that would have qualified for financial assistance under the Essentia Health St. Mary's Medical Center's financial assistance policy had the proper documentation been completed and filed. As that tracking was not in place during the fiscal year, Essentia Health St. Mary's Medical Center applied a high-level, conservative analytic review by taking the ratio of charitable allowances to gross patient revenue and multiplying with bad debt expense to arrive at an approximation of charity care that resides in bad debt. Part III, Line 4 Essentia Health St. Mary's Medical Center is a part of a larger organization, Essentia Health. Essentia Health and its member organizations incorporate the cost of bad debt as a community benefit. As a tax exempt hospital, we must provide the necessary services regardless of the patient's ability to pay for that care. In doing so, Essentia Health makes quality patient care available to all in our community, regardless of their economic means. Part III, line 4 (Excerpt from the parent company's audit) Accounts receivable are stated at net realizable value. The allowance for uncollectible accounts is based upon management's ongoing assessment of historical and expected net collections for each major payor source considering historical business and economic conditions, trends in healthcare coverage, and other collection indicators. For receivables associated with private-pay patients, Essentia records a significant provision for uncollectible accounts in the period of service on the basis of its historical experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. Part III, line 8 The costing methodology used in determining the Medicare Allowable Cost reported in the organization's Medicare Cost Report is to take total Medicare costs from the general ledger system and then follow the instructions provided by Centers for Medicare Services (CMS) to back off all costs not allowable. From the Medicare allowable costs, any costs attributable to subsidized health services and costs attributable to GME were subtracted, if applicable. Part III, line 8 Essentia Health 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 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 The policies and procedures for internal and external collection practices take into account the extent to which the patient qualifies for the Community Care Program and financial assistance, a patient's good faith effort to apply for a governmental program or for financial assistance from Essentia Health St. Mary's Medical Center and the patient's good faith effort to comply with his/her payment agreements. Essentia Health St. Mary's Medical Center offers extended payment plans to eligible patients and will not impose liens on primary residences. Essentia Health St. Mary's Medical Center trains its outside debt collection agencies and attorneys about the Community Care Program and how a patient may obtain more information about the Community Care Program or submit an application for Community Care. Essentia Health St. Mary's Medical Center requires its outside collection agencies and attorneys to refer patients who may be eligible for Community Care to Essentia Health St. Mary's Medical Center. If a patient has submitted application for Community Care after an account has been referred for collection activity, Essentia Health St. Mary's Medical Center and its outside debt collection agencies suspend all collection activity until the patient's Community Care application has been processed and Essentia Health St. Mary's Medical Center has notified the patient of its decision.
Part VI, line 1 cont   Part V, line 11h not applicable Part V, line 13g not applicable Part V, line 15e not applicable Part V, line 16e not applicable Part V, line 17e Not applicable. Part V, line 18c not applicable Part V, line 18d not applicable Part V, line 19d For patients known to qualify for the financial assistance program, discounts will be applied to billed amounts if the patient qualifies for discounted care and the billed amount will be fully discounted if the patient qualifies for free care. Part V, line 20 not applicable Part V, line 21 not applicable
Part VI, line 2   Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B: Essentia Health St. Mary's Medical Center's parent corporation, provides significant financial support for a health-care 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. The findings of the survey are the basis for determining community programs supported by our organization.
Part VI, line 3   Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's Financial Assistance policy: Essentia Health St. Mary's 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 Financial Assistance policy and application is available on the Essentia Health website at www.essentiahealth.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). Essentia Health 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 Essentia Health 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.
Part VI, line 4   Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves: Essentia Health St. Mary's 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 6. Essentia Health St. Mary's Medical Center operates 1 hospital that serves the St. Louis County area. The overall community is classified as suburban and rural. Essentia Health St. Mary's Medical Center covers a service region of approximately 465,000 people. The service region age distribution is 20.3% under the age of 18; 61.7% between the ages of 18 and 65; and 18.0% over the age of 65. The racial makeup of the service region is 92.3% Caucasian; 1.1% Black or African American; 3.9% American Indian or Alaskan Native; 0.6% Asian; 1.8% two or more races; and 0.3% other. The gender split ratio is 50.9% women and 49.1% men. The average income for the service area is approximately $51,000. Approximately 9.2% of the population falls below the federal poverty guidelines. Essentia Health St. Mary's Medical Center, along with Essentia Health is committed to serve patients regardless of their ability to pay. 1.6% net revenue dollars were from self pay patients. In addition, approximately 13.7% of their net revenue dollars were Medicaid recipients. As mentioned above, Essentia Health 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.
Part VI, line 5   Provide any other information important to describing how the organization's hospitals or other health care facilities further its exempt purpose by promoting the health of the community: Essentia Health St. Mary's Medical Center's board of directors is composed of volunteer representatives from the community it serves. Essentia Health 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. Essentia Health St. Mary's Medical Center is a part of the Essentia Health East Region. The Essentia Health East Region's consolidated community benefits are summarized below: Benefits for person living in poverty Charity care at cost $6,185,727.00 Cost-to-Charge Ratio Unreimbursed Medicaid $57,479,612.00 Cost-to-Charge Ratio Total Charity Care and Means-Tested Government Programs $63,665,339.00 Benefits for the broader community Community health improvement services and community benefit operations $1,089,607.00 Actual Costs Health professions education $1,914,518.00 Actual Costs Financial and in-kind contributions $354,293.00 Actual Costs Total Other Benefits $3,358,418.00 Community building activities $3,022,476.00 Actual Costs Unpaid cost of public programs, Medicare $82,437,123.00 Cost-to-Charge Ratio Other care provided without compensation (bad debt) $19,614,844.00 Cost-to-Charge Ratio Discounts offered to uninsured patients $4,312,053.00 Actual Costs Taxes and fees $2,577,350.00 Actual Costs Total Community Benefit $178,987,603.00 Essentia Health 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 medical training, programs and technology that improve patient care. We are also committed to eliminating geographic barriers to care. Two of the most significant investments in 2012 were in the areas of telehealth and electronic medical records, technologies that link rural patients and physicians with medical specialists at Essentia's medical centers in Fargo, ND, and Duluth, MN. We also continue to replace and upgrade facilities and technology, like MRIs, CT scanners and ambulatory infusion centers to ensure patients in rural communities have access to these services in their home communities. We are also investing in the development of medical homes, which are designed to improve health outcomes for patients, particularly those with chronic diseases. Much of this work is not fully reimbursed by state or federal programs, so Essentia Health assumes responsibility for medical home costs. We also support the health of our communities through active research and clinical trials through the Essentia Institute of Rural Health. Various Essentia Health organizations contributed approximately $5.5 million in support to the Institute over the past year. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans.
Part VI, line 6   Essentia Health St. Mary's Medical Center is part of Essentia Health, an integrated health system of 16 hospitals, 65 clinics and several long-term care facilities in four states: Minnesota, Wisconsin, North Dakota and Idaho. The health system serves a predominantly rural population whose median incomes generally fall below averages of the states where they live. The presence of our clinics and hospitals ensures that people with few economic resources don't have to drive an hour or more to receive basic (and in some cases live-saving) medical care. In addition to staffing hospitals and clinics in federally-recognized underserved areas, we support the health of our communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into our smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or are faced with other challenges that make it difficult to travel long distances for care. Our size and integrated structure allow us to offer patients services often found only in larger urban settings. Services ranging from chemotherapy to congestive heart failure management and hospice are available to patients in many of the rural communities we serve. Essentia Health also supports the health of our rural communities through active research and clinical trials, through the Essentia Institute of Rural Health. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans. Essentia Health is also serving patients through the use of the Epic electronic health record (EHR). The vast majority of Essentia's hospitals and clinics were using a fully-integrated EHR for patient care. Technology like the electronic health record and telehealth allows health clinicians to share test results and consult with colleagues in real time across great distances. Medical information is no longer lost in the shuffle of paper records - an important consideration in a region where patients must often be transferred to a larger Essentia facility for complex surgeries or medical care. Essentia is also actively working with government agencies and insurers to develop innovative, cost-effective approaches to care that will improve health outcomes while reducing overall costs to patients and insurers. This innovation can be found in our use of remote home monitors for patients with congestive heart failure to a focus on using a team-based approach to helping patients manage chronic diseases. Essentia Health is committed to helping patients and their families lead active and fulfilling lives in the small and large communities where they live. We hope to become a model of health care delivery, particularly in rural areas, in the years to come.
Part VI, Line 7   Essentia Health St. Mary's Medical Center files a community benefit report in Minnesota.
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
St Mary's Medical Center
 
Employer identification number
41-0695604
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Duluth Family Practice Center & Residency Prog330 N 8TH AVE EAST
DULUTH,MN55805 		23-7456795 501(C)3 1,426,900       PROGRAM SUPPORT
(2) ESSENTIA HEALTH FOUNDATION502 E 2ND STREET
DULUTH,MN55805 		27-1984704 501(C)(3) 933,542       PROGRAM SUPPORT
(3) PROGRAM FOR AID TO VICTIMS SEXUAL ASSAULT INC32 E 1ST STREET SUITE 200
DULUTH,MN55802 		41-1350021 501(C)(3) 30,000       PROGRAM SUPPORT


















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
3
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) SCHOLARSHIPS 8 21,000      













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
FORM 990, SCHEDULE I, PART 1, LINE 2   PROCEDURES FOR MONITORING USE OF GRANT FUNDS: ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER'S MANAGEMENT REVIEWS THE GRANT ACTIVITY BY REVIEWING AND DOCUMENTING EACH EXPENDITURE REQUEST AND APPROVING THE EXPENSE. Essentia Health St. Mary's Medical Center Auxiliary provides scholarships to individuals in the medical field. Scholarship winners are selected by the Auxiliary Scholarship Committee based on financial needs. In addition, students have to be accepted into their major/program, i.e. medical school, nursing program, physical therapy program, etc.
Schedule I (Form 990) 2011


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
St Mary's Medical Center
 
Employer identification number

41-0695604
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) HUGH RENIER MD (i)
(ii)		 305,027
0 		62,304
0 		38,434
0 		53,299
0 		27,743
0 		486,807
0 		33,157
0
(2) ROBERT NORMAN (i)
(ii)		 0
407,163 		0
141,928 		0
77,698 		0
79,658 		0
55,917 		0
762,364 		0
75,455
(3) BARBARA JOHNSON (i)
(ii)		 0
294,391 		0
119,283 		0
9,216 		0
54,040 		0
6,465 		0
483,395 		0
8,532
(4) MARIBETH OLSON (i)
(ii)		 120,443
0 		41,278
0 		233,287
0 		20,135
0 		11,250
0 		426,393
0 		30,589
0
(5) ROCKLON CHAPIN (i)
(ii)		 0
35,986 		0
0 		0
408,654 		0
41,008 		0
18,935 		0
504,583 		0
0
(6) MICHAEL METCALF (i)
(ii)		 0
393,711 		0
128,521 		0
4,585 		0
60,619 		0
28,136 		0
615,572 		0
0
(7) MARY SHAW (i)
(ii)		 158,733
0 		32,221
0 		932
0 		36,896
0 		21,306
0 		250,088
0 		0
0
(8) DENNIS DASSENKO (i)
(ii)		 0
281,038 		0
96,157 		0
5,827 		0
58,390 		0
22,087 		0
463,499 		0
0
(9) DIANE DAVIDSON (i)
(ii)		 0
272,021 		0
110,093 		0
70,763 		0
60,576 		0
25,487 		0
538,940 		0
69,706
(10) MICHAEL MAHONEY (i)
(ii)		 0
215,004 		0
49,057 		0
22,173 		0
45,364 		0
12,287 		0
343,885 		0
21,236
(11) JOSEPH BIANCO MD (i)
(ii)		 0
317,035 		0
2,304 		0
607 		0
24,500 		0
26,405 		0
370,851 		0
0
(12) LAURA BOEHLKE-BRAY MD (i)
(ii)		 0
303,806 		0
2,600 		0
607 		0
24,500 		0
5,961 		0
337,474 		0
0
(13) THOMAS PATNOE MD (i)
(ii)		 0
536,822 		0
174,761 		0
690 		0
72,023 		0
32,310 		0
816,606 		0
0
(14) SUSAN STREITZ MD (i)
(ii)		 0
329,944 		0
4,008 		0
1,290 		0
24,500 		0
1,916 		0
361,658 		0
0
(15) MICHAEL VAN SCOY MD (i)
(ii)		 0
353,866 		0
4,063 		0
450 		0
24,500 		0
26,278 		0
409,157 		0
0
(16) ANN WATKINS (i)
(ii)		 0
171,551 		0
34,894 		0
25,826 		0
29,019 		0
20,088 		0
281,378 		0
17,584
(17) SCOTT JOHNSON MD (i)
(ii)		 0
643,243 		0
6,498 		0
690 		0
24,500 		0
26,566 		0
701,497 		0
0
(18) ALBERT DEIBELE MD (i)
(ii)		 0
602,445 		0
7,057 		0
690 		0
24,500 		0
30,699 		0
665,391 		0
0
(19) KIMBERLY BODDICKER MD (i)
(ii)		 0
600,056 		0
7,501 		0
270 		0
24,500 		0
17,443 		0
649,770 		0
0
(20) STEVE YORDE (i)
(ii)		 175,830
0 		33,901
0 		1,109
0 		26,959
0 		26,993
0 		264,792
0 		0
0
(21) KAREN ENGEN (i)
(ii)		 143,801
0 		1,500
0 		161
0 		66,010
0 		11,230
0 		222,702
0 		0
0
(22) NANCY PURSI (i)
(ii)		 149,487
0 		1,500
0 		317
0 		70,853
0 		9,864
0 		232,021
0 		0
0
(23) Richard Spehar (i)
(ii)		 150,398
0 		0
0 		762
0 		77,921
0 		8,486
0 		237,567
0 		0
0
(24) MELISSA NAJARIAN MD (i)
(ii)		 0
558,664 		0
6,652 		0
480 		0
24,500 		0
26,347 		0
616,643 		0
0
(25) DANIEL NIKCEVICH MD (i)
(ii)		 0
680,351 		0
6,244 		0
870 		0
24,500 		0
25,698 		0
737,663 		0
0
(26) THERESA GUNNARSON MD (i)
(ii)		 0
486,894 		0
5,713 		0
360 		0
24,500 		0
31,417 		0
548,884 		0
0
(27) WILSON GINETE MD (i)
(ii)		 0
606,280 		0
7,598 		0
300 		0
24,500 		0
22,624 		0
661,302 		0
0
(28) BRAD DAVIS MD (i)
(ii)		 0
460,442 		0
5,411 		0
630 		0
24,500 		0
28,759 		0
519,742 		0
0
(29) MARY ANN STARKOVICH-HIRSCH (i)
(ii)		 140,605
1,250 		2,500
0 		92
0 		79,213
0 		29,980
262 		252,390
1,512 		0
0
(30) Michael Mcavoy (i)
(ii)		 0
192,348 		0
33,461 		0
2,908 		0
31,978 		0
20,087 		0
280,782 		0
0
(31) Ruth Mccutcheon (i)
(ii)		 161,000
4,550 		0
0 		192
0 		0
0 		251
0 		161,443
4,550 		0
0
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule J, Part I, Line 3   Establishing CEO's compensation: Essentia Health ST. MARY'S MEDICAL CENTER relied on Essentia Health, supporting organization of Essentia Health ST. MARY'S MEDICAL CENTER, methods for establishing Essentia Health ST. MARY'S MEDICAL CENTER's President/Chief Medical Officer compensation: a compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board or compensation committee.
Schedule J, Part I, Line 4a   Severance payment: Former key employee, Maribeth Olson, received payment totaling $169,344 in tax year 2011 related to her termination. The termination terms are from May 7, 2011 until May 7, 2012. Ms. Olson will receive pay totaling $302,031 related to her termination. Former key employee, Rocklon Chapin, a former employee of related organization Essentia Health Duluth, received payment totaling $274,800 in tax year 2011 related to his termination. The termination terms are from January 31, 2011 until July 31, 2012. Mr. Chapin will receive pay totaling $501,019 & benefits totaling $10,009 related to his termination. All other individuals listed as formers in Form 990, Part VII, Section A, Line 1a remain employed within Essentia Health and its subsidiaries and are not receiving a termination payment.
Schedule J, Part I, Line 4b   Supplemental nonqualified retirement plan: Amounts related to participating in a supplemental nonqualified retirement plan are reported in Schedule J, Part II, Column C, and amounts related to receiving payment from a supplemental nonqualified retirement plan are reported in Schedule J, Part II, Column B (iii). The following individuals listed in Form 990, Part VII, Section A, Line 1a received payment from a supplemental nonqualified retirement plan during the year: Thomas Patnoe, MD (Essentia Health East) $0 Maribeth Olson (Essentia Health East) $30,589 Robert Norman (Critical Access Group) $75,455 Rocklon Chapin (Essentia Health East) $0 Ann Watkins (Essentia Health East) $17,584 Dennis Dassenko (Essentia Health East) $0 Michael Mahoney (Essentia Health East) $21,236 Diane T. Davidson (Essentia Health East) $69,706 Michael Metcalf (Essentia Health East) $0 Barbara Johnson (Essentia Health East) $8,532 HUGH P. RENIER (ESSENTIA HEALTH EAST) $33,157 Michael McAvoy (ESSENTIA HEALTH EAST) $0 MARY C. SHAW (ESSENTIA HEALTH EAST) $0 STEVE YORDE (ESSENTIA HEALTH EAST) $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. Essentia Health East's nonqualified retirement plan is offered to designated Essentia Health East's executives. There is a minimum two year vesting date, benefits are subject to income taxes upon vesting, and benefits are payable from Essentia Health East's general assets.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
St Mary's Medical Center
 
Employer identification number

41-0695604
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Kathy Hessen Related to Neal Hessen 42,238 See Part V   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L, Part IV, Column D   Description of transaction: Compensation of family member of board member
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
St Mary's Medical Center
 
Employer identification number

41-0695604
Identifier Return Reference Explanation
Form 990, Part C   DOING BUSINESS AS: ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER
FORM 990, PART III LINE 1   ORGANIZATION'S MISSION: St. Mary's Medical Center exists to witness the love of God through compassionate and competent health services for all, especially the poor and the 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.
FORM 990, PART III, LINE 4   STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS: St. Mary's Medical Center dba Essentia Health St. Mary's Medical Center is organized and operated exclusively for charitable, scientific, and educational purposes. In furtherance of its purposes, Essentia Health 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, Essentia Health 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. Essentia Health St. Mary's Medical Center also participates in continuing education programs for health care professionals. Essentia Health St. Mary's Medical Center employs over 1,900 full time equivalents. The hospital provided for over 73,000 hospital patient days and over 43,000 emergency visits. Essentia Health St. Mary's Medical Center provided over $2,200,000 in charity care as well as an additional $18,380,000 of costs incurred in excess of Medicaid payments received during the fiscal year ended June 30, 2012. Further community benefits provided during the fiscal year include community services of over $1,080,000, continuing education programs for health care professionals of over $1,300,000, and cash and in-kind contributions of $30,000.
Form 990, Part V, Line 1a   1099 Reporting: Beginning in 2011, vendor payments and Form 1099's were processed through Essentia Health on behalf of certain supported organizations.
Form 990, Part VI, Section A, Line 4   SIGNIFICANT CHANGES: During the fiscal year ended June 30, 2012, the Articles of Essentia Health St. Mary's Medical Center were amended. Essentia Health and Benedictine sisters Benevolent Association have reserved powers over Essentia Health St. Mary's Medical Center. These reserved powers are discussed in further detail in Part VI, Line 7b. Essentia Health may amend the Articles of Essentia Health St. Mary's Medical Center.
Form 990, Part VI, Line 6   Members of Organization: ESSENTIA HEALTH EAST may elect one or more members of the governing body as described in Schedule O Part VI 7a. Essentia Health, Benedictine Sisters Benevolent Association, ESSENTIA HEALTH EAST, AND SPECIAL BOARD have reserved powers with respect to ESSENTIA HEALTH St. Mary's Medical Center 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, ESSENTIA HEALTH EAST shall appoint and remove ESSENTIA HEALTH St. Mary's Medical Center's governing body.
Form 990, Part VI, Line 7b   Member with right to approve governing body decision: Essentia Health 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. Acquisitions. Authority to cause, and to approve, all acquisitions by and formations of entities in the System. Marketing. Authority to implement System-wide marketing and promotional activities. Compliance Plans. Authority to create, and to approve, corporate compliance, safety and risk management plans for entities within the System. Quality Plan. Authority to create, and to approve, the System's quality plan. Non-Budgeted Purchases. Approval of non-budgeted capital purchases and leases in excess of the single or annual aggregate dollar limits prescribed in writing by Essentia Health for entities within the System. Human Resources. Authority to create human resource policies and procedures within the System. Reserved Powers. Authority to create additional Essentia Health reserved powers by the affirmative vote of at least 80% of the Essentia Health board of directors (excluding the Essentia Health CEO); provided, however, that any additional Essentia Health reserved powers shall not contravene or hinder the reserved powers of Benedictine Sisters Benevolent Association. The Benedictine Sisters Benevolent Association ("BSBA") also has certain reserved powers over all Catholic facilities within Essentia Health. BSBA's reserved powers are as follows: Mission. Authority to approve the mission, purpose and vision statements for Catholic facilities and entities within the System. Adherence to Ethical Religious Directives (ERDs). Authority to approve the methods, policies and procedures pertaining to the adherence of Catholic facilities and entities within the System to the ERDs, and to require the use of religious symbols, distinguishing elements and prayers. Official Catholic Directory. Authority to request the listing of qualified entities and facilities within the System in The Official Catholic Directory, subject to the approval of applicable Catholic authorities. Catholic Health Association. Authority to require Catholic facilities and entities within the System to join the membership of the Catholic Health Association of the United States. Alienation of Stable Patrimony or Ecclesiastical Goods. Authority to approve alienation of either stable patrimony or other ecclesiastical goods in the System if such goods involved in a specific transaction approved by Essentia Health pursuant to Section 2.8(g) or 2.8(h) of the Affiliation Agreement have a dollar value equal to or greater than 70% of the amount established from time to time that requires approval from the Holy See. Amendments. Authority to approve any amendments to the Articles of Incorporation or Bylaws of this corporation that would alter the number of Benedictine Sisters of St. Scholastica Monastery of Duluth or Benedictine Sisters Benevolent Association board of director members serving as members of this corporation's board of directors; authority to approve any amendments to the Articles of Incorporation or Bylaws of the Supported Organizations, as well as the Catholic Subsidiaries (as defined in the Affiliation Agreement), which could materially affect such entity's identity as a Catholic institution, including without limitation any amendment that would alter the number of Benedictine Sisters of St. Scholastica Monastery of Duluth or Benedictine Sisters Benevolent Association board of director members serving as members of such entity's board of directors; and authority to cause Essentia Health to make amendments to the Articles of Incorporation or Bylaws of the Supported Organizations, as well as the Catholic Subsidiaries, which amendments Benedictine Sisters Benevolent Association in good faith are necessary to preserve such entity's identity as a Catholic institution. Mission Effectiveness. Authority to approve annual plans and evaluations relating to mission effectiveness and chaplaincy for the Catholic facilities and entities within the System. Mergers and Dissolution. Subject to the approval of the Benedictine Sisters of St. Scholastica Monastery of Duluth, authority to approve a proposed merger, consolidation, liquidation, dissolution, or the disposition of all or substantially all the assets.
Form 990, Part VI, Line 7b cont   Essentia Health East also has certain reserved powers over all East facilities within Essentia Health. Essentia Health East's reserved powers are as follows: Oversight of quality, safety and service performance; Oversight of the mission performance; Oversight of the operating and financial performance; Development of capital and operating budgets and strategic plans; Execution of the approved capital and operating budgets and strategic and business plans; Oversight of accreditation and licensure compliance; Oversight of operation of all affiliations, joint ventures and other alliances with third parties, including such transactions with the medical staffs; Election of members to serve on the boards of the subsidiaries, (consistent with, and as provided for, in the applicable subsidiary's bylaws) and removal of such members with or without cause; Evaluation of the performance of subsidiary senior officers and; Evaluation of patient, family and customer satisfaction with respect to the services provided within the System; Evaluation of job satisfaction and staff morale within the System; Administration of human resource policies and procedures; Execution of the approved corporate compliance, safety and risk management plans; and Authority to comment on proposed amendments of the Articles of Incorporation and Bylaws, before such amendments are acted upon by BSBA or Essentia. Essentia Health St. Mary's Medical Center special board also has certain retained powers over Essentia Health St. Mary's Medical Center. Essentia Health St. Mary's Medical Center special board retained powers are as follows: Exclusive authority over ownership of the "St. Mary's Medical Center" name and logo, and approval over how and where such are used; Authority to ensure that the corporation and its Catholic Subsidiaries and their employees, contractors and medical staff adhere to the Ethical and Religious Directives as they apply to and within the Corporation and the Catholic Subsidiaries and will seek input from the General Member's Board of Directors as necessary; Authority to ensure the continuing use of prayers and religious symbols within the Corporation and its Catholic Subsidiaries; Authority to determine whether the Corporation and its Catholic Subsidiaries shall maintain membership in the Catholic Health Association ("CHA"); Authority to approve changes in the mission, purpose and vision statements of the Corporation; provided, however, that such changes shall become effective only upon the prior approval of the General Member and the Special Member. Authority to grant charitable contributions, to be funded by the General Member at levels comparable to those of the corporation for its fiscal year ending on 6-30-96, adjusted annually for inflation; and Authority to implement the Corporation's policy for indigent and charitable care, to be funded by the General Member at levels comparable to those of the Corporation for its fiscal year ending on 6-30-96, adjusted annually for inflation.
Form 990, Part VI, Line 11a   FORM 990 REVIEW PROCESS: The 2011 Form 990 including all schedules was reviewed by ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER's management and governing body on March 6, 2013 prior to filing with the Internal Revenue Service. Each current director of the governing body received a copy of the 2011 Form 990. ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER's Chief Financial Officer led the review of the form and schedules and any questions were discussed.
Form 990, Part VI, Line 12c   Monitoring and enforcing Conflict of Interest policy: Interested persons annually disclose relationships which might lead to a conflict of interest by completing a conflict of interest disclosure form. Interested persons include any person in a position to exercise substantial influence over the organization. It includes but is not limited to any director, officer, management, employee, or committee member of Essentia Health or any of its affiliates. Essentia is responsible for the annual distribution of conflict of interest forms and review of disclosures for the governing bodies of Essentia and Essentia Operating Members and for senior management employees of Essentia. Transactions with parties with whom a conflict of interest exists may be undertaken only if all of the following are observed: the conflict of interest is fully disclosed; the interested person with the conflict of interest doesn't participate in the approval of such transactions; if practical or appropriate, a competitive bid or comparable valuation is obtained; and the board or committee of the board has determined that the transaction is in the best interest of the organization. Disclosure by any interested person other than a board or committee member should be made to the Chief Executive Officer (or if she/he is the one with the conflict, then to the board chair), who will bring the matter to the attention of the board or an appropriate committee of the board. Disclosure involving board or committee members should be made to the board chair (or if she/he is the one with the conflict, then to the board vice chair), who will bring these matters to the board or an appropriate committee of the board. The board or committee of the board will determine whether a conflict exists and if so, whether the contemplated transaction may be authorized as just, fair, and reasonable to Essentia or its affiliate(s). The decision of the board or a duly constituted committee of the board on these matters will be at its sole discretion, and its concern must be the welfare of Essentia and its affiliate(s) and the advancement of its purposes. The decision of the board is final. If the board determines a conflict does not exist, the interested person may proceed with the transaction; however, he/she will not be eligible to vote on related issues should they arise. If the board determines a conflict does exist, the interested person will be notified of the decision regarding whether the contemplated transaction will be authorized as just, fair, and reasonable.
Form 990, Part VI, Line 15 A&B   Process for determining compensation: The Executive Compensation Committee of Essentia Health's board of Directors is authorized to fulfill the board's responsibilities regarding executive compensation consistent with Essentia's mission, values, tax-exempt status and with the Executive Compensation Committee 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 and his direct reports. 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 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 will 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 Health St. Mary's Medical Center's President/Chief Medical Officer and Chief Administrative officer was 2010. The Essentia Health Executive Compensation committee determines policy (establishes peer group, determines competitive ranking and establishes positioning of total compensation dependent upon performance) for all executives at the Vice President level or above. The Executive Compensation Committee of the Essentia Health East board of directors is authorized to fulfill the board's responsibility regarding executive compensation consistent with Essentia Health East's mission, values and tax-exempt status. It is bound by and relies upon the policy set by the Executive Compensation Committee of Essentia's board of directors. Annually, the Executive Compensation Committee of Essentia Health East's board of directors meets to review information presented by the Essentia Health East President and Chief Administrative Officer concerning the performance of the system and senior executives of Essentia Health East and to approve executive incentives based on system results and supporting documentation for all members covered by the Essentia Health East incentive compensation program and report such findings to the Executive Compensation Committee of Essentia's Board of Directors. The year a total compensation review process was undertaken for all Essentia Health East executives at the Vice President and above was 2012.
Form 990, Part VI, Line 19   Availability of governing documents, conflict of interest policy, & financial statements to the public: ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. ESSENTIA HEALTH ST. MARY'S MEDICAL CENTER 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: Neal Hessen: approximately 8 hours The following individuals spent 100% of their time furthering the purpose of Essentia Health East as a board director of Essentia Health Medical Equipment & Supplies, Essentia Health Sandstone, Essentia Health Polinsky Medical Rehabilitation Center, Essentia Health East, Essentia Health Duluth, Essentia Health St. Mary's Hospital-Superior and Essentia Health St. Mary's Medical Center: Alan Hodnik Chuck Walt David Gaddie Neal Hessen Sherry Mattson Sister Donna Shroeder Sister Mary Josephine Torborg Sister Sarah Smedman Thomas Patnoe, MD is employed by Essentia Health Duluth as Essentia Health's East's President and Chief Medical Officer. 100% of his time is spent furthering the purpose of Essentia Health and related organizations. Daniel Nikcevich, MD is employed by Essentia Health Duluth as Essentia Health East's President and Chief Medical Officer. 100% of his time is spent furthering the purpose of Essentia Health and related organizations. Sister Kathleen Hofer is employed by Essentia Health 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 related organizations. Joseph A. Bianco, MD is employed by The Duluth Clinic Ltd. 100% of his time is spent furthering the purpose of Essentia Health East and related organizations. Laura Boehlke-Bray, MD is employed by The Duluth Clinic Ltd. 100% of her time is spent furthering the purpose of Essentia Health East and related organizations. Susan Streitz, MD is employed by The Duluth Clinic Ltd. 100% of her time is spent furthering the purpose of Essentia Health East and related organizations. Michael Van Scoy, MD is employed by The Duluth Clinic Ltd. 100% of his time is spent furthering the purpose of Essentia Health East and related organizations. Melissa Najarian, MD is employed by The Duluth Clinic Ltd. 100% of her time is spent furthering the purpose of Essentia Health East and related organizations. Barbara Johnson is employed by Essentia Health Duluth as Chief Financial Officer. 100% of her time is spent furthering the purpose of Essentia Health East and related organizations. Ann Watkins is employed by Essentia Health Duluth as Vice President - Surgical Services. 100% of her time is spent furthering the purpose of Essentia Health East and related organizations. Michael Metcalf is employed by Essentia Health Duluth as Chief Administrative Officer. 100% of his time is spent furthering the purpose of Essentia Health East and related organizations. Hugh Renier, MD is employed by Essentia Health St. Mary's Medical Center. 100% of his time is spent furthering the purpose of Essentia Health East and related organizations. Scott Johnson, MD is employed by The Duluth Clinic Ltd. 100% of his time is spent furthering the purpose of Essentia Health East and related organizations. Theresa Gunnarson, MD is employed by The Duluth Clinic, Ltd. 100% of her time is spent furthering the purpose of Essentia Health East and related organizations. Wilson Ginete, MD is employed by The Duluth Clinic, Ltd. 100% of his time is spent furthering the purpose of Essentia Health East and related organizations. Brad Davis, MD is employed by The Duluth Clinic, Ltd. 100% of his time is spent furthering the purpose of Essentia Health East and related organizations. Michael Mcavoy is employed by Essentia Health Duluth as Vice President Operation- Hospital Based Physician Services. 100% of his time is spent furthering the purpose of Essentia Health East and related organizations. Ruth Mccutcheon is employed by Essentia Health St. Mary's Medical Center. 100% of her time is spent furthering the purpose of Essentia Health East and related organizations. Richard Spehar is employed by Essentia Health St. Mary's Medical Center. 100% of his time is spent furthering the purpose of Essentia Health East and related organizations. Mary Shaw is employed be Essentia Health St. Mary's Medical Center as Chief Operating Officer. 100% of her time is spent furthering the purpose of Essentia Health East and related organizations. Robert Norman is employed by Critical Access Group as Essentia Health's Chief Financial Officer. 100% of his time is spent furthering the purpose of Essentia Health and related organizations. Dennis Dassenko is employed by Essentia Health East as Chief Information Officer. 100% of his time is spent furthering the purpose of Essentia Health East and related organizations. Michael Mahoney is employed by Essentia Health Duluth as Essentia Health's Vice President, Government Affairs. 100% of his time is spent furthering the purpose of Essentia Health and related organizations. Albert Deibele, MD is employed by The Duluth Clinic Ltd. 100% of his time is spent furthering the purpose of Essentia Health East and related organizations. Kimberly A. Boddicker, MD is employed by The Duluth Clinic Ltd. 100% of her time is spent furthering the purpose of Essentia Health East and related organizations. Diane Davidson is employed by Essentia Health Duluth. 100% of her time is spent furthering the purpose of Essentia Health East and related organizations.
Form 990, Part IX, Line 24b   Affiliate expense and revenue allocation represents the portion of Essentia Health Duluth and The Duluth Clinic, Ltd. revenue and expense related to Essentia Health St. Mary's Medical Center, a related organization, which is allocated directly to Essentia Health St. Mary's Medical Center. Net affiliate (revenue) and expense allocation of $20,507,728 includes the following: Grants ($8,872), Program Service Revenue ($66,010), Investment Income ($239,125), Realized Loss $103,615, Miscellaneous Revenue $950,645, Contributions $258,168, Compensation $9,988,302, Accounting Fees ($10,014), Legal Fees $20,990, Investment Management Fees $79,825, Interest $2,556,236, Other Purchased Services $2,103,829, Advertising $247,655 Board Expenses $8,793, Conferences $123,773, Depreciation & Amortization $1,519,319 Information Technology $3,000,461, Insurance $155,618, Medical Supplies ($117,344), Occupancy ($1,418,410), Office Expenses $1,589,861, Travel $361,943, Unrelated Business Income Taxes $11,624, and Other Expenses ($713,154).
Form 990, Part XI, Line 5   Other Changes in Net Assets: The total amount of other changes in net assets includes: Pension and Post Retirement Liability Adjustments ($40,772,824) Payroll clearing - Other Net Asset adjustment $10,276 Net Asset transfer with related organizations; reallocated Balance Sheet items to more appropriate companies ($14,569) Unrealized Gain / (Loss) on Non Trading Securities ($10,464,445)
Form 990, Part XII, Line 3   Essentia Health St. Mary's Medical Center, 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.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
St Mary's Medical Center
 
Employer identification number

41-0695604
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) BRAINERD LAKES INTEGRATED HEALTH SYSTEM

2024 S 6TH ST

BRAINERD,MN56401
37-1532145 		SUPPORT ORG MN 501(C)(3) 11 II Essentia
 
Yes
 
(2) BRAINERD MEDICAL CENTER INC

2024 S 6TH ST

BRAINERD,MN56401
37-1532148 		CLINIC MN 501(c)(3) 3 BLIHS
 
Yes
 
(3) BRIDGES MEDICAL CENTER

201 9TH ST W

ADA,MN56510
20-0479568 		CLINIC/HOSP MN 501(c)(3) 3 Innovis
 
Yes
 
(4) CLEARWATER VALLEY HOSPITAL & CLINICS INC

301 CEDAR

OROFINO,ID83544
82-0497771 		CLINIC/HOSP ID 501(c)(3) 3 CAG
 
Yes
 
(5) DIVINE MEDICAL SERVICES thru 10111

709 N LINCOLN

JEROME,ID83338
20-2773717 		EMERG SRVCS ID 501(c)(3) 3 SBFMC
 
Yes
 
(6) DL SURGERY CENTER

1027 WASHINGTON AVE

DETROIT LAKES,MN56501
26-3837203 		ASC MN 501(c)(3) 3 CAG
 
Yes
 
(7) FIRST CARE MEDICAL SERVICES

900 HILLIGROSS BLVD SE

FOSSTON,MN56542
41-0706143 		CLINIC/HOSP MN 501(c)(3) 3 Innovis
 
Yes
 
(8) MINNESOTA VALLEY HEALTH CENTER

621 S 4TH ST

LE SUEUR MN,MN56058
41-0837659 		HOSPITAL/NURS MN 501(c)(3) 3 CAG
 
Yes
 
(9) ST BENEDICTS FAM MED CTR thru 10111

709 N LINCOLN

JEROME,ID83338
82-0227163 		CLINIC/HOSP ID 501(c)(3) 3 CAG
 
Yes
 
(10) ST JOSEPHS MEDICAL CENTER

523 N 3RD ST

BRAINERD,MN56401
41-0695602 		Clinic/Hosp MN 501(c)(3) 3 BLIHS
 
Yes
 
(11) ST MARYS EMS

1027 WASHINGTON AVE

DETROIT LAKES,MN56501
41-1805811 		EMERG SRVCS MN 501(c)(3) 9 SMRHC
 
Yes
 
(12) ST MARYS HOSPITAL AND CLINICS INC

PO BOX 137

COTTONWOOD,ID83522
82-0226453 		CLINIC/HOSP ID 501(c)(3) 3 CAG
 
Yes
 
(13) ST MARYS INNOVIS HEALTH

1027 WASHINGTON AVE

DETROIT,MN56501
26-2861321 		CLINIC MN 501(c)(3) 3 Innovis
 
Yes
 
(14) St Mary's Regional Health Center

1027 WASHINGTON AVE

DETROIT LAKES,MN56501
41-1620386 		CLINIC/HOSP MN 501(c)(3) 3 Innovis
 
Yes
 
(15) ESSENTIA HEALTH

502 E 2ND ST

DULUTH,MN55805
20-0360007 		SUPPORT ORG MN 501(c)(3) 11 III-FI NA
 
 
No
(16) ESSENTIA INSTITUTE OF RURAL HEALTH

502 E 2ND ST

DULUTH,MN55805
27-1291124 		RESEARCH MN 501(c)(3) 4 ESSENTIA
 
Yes
 
(17) INNOVIS HEALTH LLC

3000 32nd Avenue

FARGO,ND58103
26-1175213 		CLINIC/HOSP DE 501(c)(3) 3 ESSENTIA
 
Yes
 
(18) ESSENTIA HEALTH FOUNDATION

502 E 2ND ST

DULUTH,MN55805
27-1984704 		FOUNDATION MN 501(c)(3) 7 Essentia
 
Yes
 
(19) MIDWEST MEDICAL EQUIP & SUPPLY INC

4418 HAINES ROAD

DULUTH,MN55811
41-1674021 		MEDICAL EQUIP MN 501(c)(3) 9 SMMC
 
Yes
 
(20) PINE MEDICAL CENTER

109 COURT AVE S

SANDSTONE,MN55072
41-1884597 		Hospital/Nurs MN 501(c)(3) 3 SMDCHS
 
Yes
 
(21) POLINSKY MEDICAL REHABILITATION CENTER

530 E 2ND ST

DULUTH,MN55805
41-0691275 		Clinic MN 501(c)(3) 3 SMMC
 
Yes
 
(22) SMDC MEDICAL CENTER

502 E 2ND ST

DULUTH,MN55805
41-1878730 		CLINIC/HOSP MN 501(c)(3) 3 SMDCHS
 
Yes
 
(23) ST MARYS DULUTH CLINIC HEALTH SYSTEM

407 E 3RD ST

DULUTH,MN55805
41-1836633 		Support Org MN 501(c)(3) 11 II ESSENTIA
 
Yes
 
(24) ST MARYS HOSPITAL OF SUPERIOR

3500 TOWER AVE

SUPERIOR,WI54880
41-1811073 		CLINIC/HOSP WI 501(c)(3) 3 SMMC
 
Yes
 
(25) THE DULUTH CLINIC LTD

400 E 3RD ST

DULUTH,MN55805
41-0883623 		CLINIC MN 501(c)(3) 3 SMDCHS
 
Yes
 
(26) Critical Access Group

503 E 3rd St Ste 400

Duluth,MN55805
26-1219624 		Support Org MN 501(c)(3) 11 II Essentia
 
Yes
 
(27) Northern Pines Medical Center

5211 Hwy 110

Aurora,MN55705
41-0841441 		Hospital/Nurs MN 501(c)(3) 3 SMDCHS
 
Yes
 
(28) Graceville Health Center

115 West Second St

Graceville,MN56240
41-0726173 		Clinic/Hosp MN 501(c)(3) 3 Innovis
 
Yes
 
(29) Critical Care Services Inc

3010 Broadway St NE

Minneapolis,MN55413
41-1518013 		Support Org MN 501(c)(3) 11 III-FI NA
 
 
No
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) PMC GATEWAY IMAGING LLC

109 COURT AVE
SANDSTONE,MN55072
26-1634864 		IMAGING SERVIces MN NA
  		NONE 0 0     0     0 %












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) ESSENTIA HLTH INS SVCE SPC LTD
BUCKINGHAM SQ 720W BAY RD POBX 69
GRAND CAYMAN,CAYMAN ISLANDSKY1 1102
CJ
000000000 		INSURANCE CJ NA
  		FOREIGN CORP 0 0 0 %
(2) EAST RANGE CLINICS LTD
910 6TH AVE N
VIRGINIA,MN55792
41-0909915 		CLINICS MN NA
  		C CORP 0 0 0 %










Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) ESSENTIA HEALTH FOUNDATION

 P 1,100,826 ACTUAL COSTS
(2) CRITICAL CARE SERVICES

 R 200,000 ACTUAL COSTS
(3) ESSENTIA HEALTH

 O 1,322,664 ACTUAL COSTS
(4) ESSENTIA HEALTH

 P 429,101 ACTUAL COSTS
(5) ESSENTIA HEALTH

 L 16,539,036 ACTUAL COSTS
(6) ESSENTIA HEALTH

 R 915,405 ACTUAL COSTS
(7) ESSENTIA HEALTH

 N 1,024,956 ACTUAL COSTS
(8) ESSENTIA INSTITUTE OF RURAL HEALTH

 P 613,629 ACTUAL COSTS
(9) ESSENTIA INSTITUTE OF RURAL HEALTH

 I 99,996 ACTUAL COSTS
(10) ESSENTIA HEALTH FOUNDATION

 B 933,542 ACTUAL COSTS
(11) ESSENTIA HEALTH FOUNDATION

 C 175,505 ACTUAL COSTS
(12) SMDC MEDICAL CENTER

 O 48,516,731 ACTUAL COSTS
(13) SMDC MEDICAL CENTER

 P 57,131,011 ACTUAL COSTS
(14) SMDC MEDICAL CENTER

 N 7,753,562 ACTUAL COSTS
(15) SMDC MEDICAL CENTER

 L 310,823 ACTUAL COSTS
(16) SMDC MEDICAL CENTER

 K 66,040 ACTUAL COSTS
(17) THE DULUTH CLINIC Ltd

 P 18,973,279 ACTUAL COSTS
(18) THE DULUTH CLINIC Ltd

 O 3,007,197 ACTUAL COSTS
(19) PINE MEDICAL CENTER

 P 1,853,951 ACTUAL COSTS
(20) STMARY'S HOSPITAL OF SUPERIOR

 P 3,157,865 ACTUAL COSTS
(21) STMARY'S HOSPITAL OF SUPERIOR

 N 50,418 ACTUAL COSTS
(22) NORTHERN PINES MEDICAL CENTER

 P 1,320,220 ACTUAL COSTS
(23) NORTHERN PINES MEDICAL CENTER

 O 1,518,340 ACTUAL COSTS
(24) POLINSKY MEDICAL REHABILITATION CENTER

 P 9,208,889 ACTUAL COSTS
(25) MIDWEST MEDICAL EQUIPMENT AND SUPPLY

 P 691,290 ACTUAL COSTS
(26) MIDWEST MEDICAL EQUIPMENT AND SUPPLY

 O 1,778,964 ACTUAL COSTS
(27) INNOVIS HEALTH LLC

 P 237,779 ACTUAL COSTS
(28) STMARY'S HOSPITAL OF SUPERIOR

 J 73,950 ACTUAL COSTS
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
SCHEDULE R, PART II, COLUMN (A)   Name: In 2011, many Essentia entities adopted a doing business as name as part of a system-wide rebranding strategy using the Essentia brand. Legal Name; Doing Business As Name Brainerd Lakes Integrated Health System; Essentia Health Central Brainerd Medical Center, Inc.; Essentia Health Brainerd Specialty Clinic Bridges Medical Center; Essentia Health Ada First Care Medical Services; Essentia Health Fosston Graceville Health Center; Essentia Health Holy Trinity Hospital Innovis Health, LLC; Essentia Health West Midwest Medical Equipment & Supply Inc.; Essentia Health Medical Equipment and Supplies Northern Pines Medical Center; Essentia Health Northern Pines Pine Medical Center; Essentia Health Sandstone Polinsky Medical Rehabilitation Center; Essentia Health Polinsky Medical Rehabilitation Center SMDC Medical Center; Essentia Health Duluth St. Mary's Duluth Clinic Health System; Essentia Health East St. Mary's Hospital of Superior; Essentia Health St. Mary's Hospital-Superior St. Mary's Regional Health Center; Essentia Health St. Mary's-Detroit Lakes
Additional Data


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