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← FIRST CARE MEDICAL SERVICES

Form 990 for tax year 2022

Filed by FIRST CARE MEDICAL SERVICES.

Totals

Total revenue
$32,303,919
Total expenses
$30,509,690
Contributions and grants received
$290,732
Grants paid
$26,820
Program service revenue
$31,566,154
Investment income
$413,044
Other revenue
$33,989
Total assets, end of year
$36,417,479
Total liabilities, end of year
$10,055,059
Net assets or fund balances, end of year
$26,362,420
Program services expenses (Part IX)
$25,082,969
Management and general expenses
$5,426,721
Fundraising expenses
$0
Program service expenses (Part III)
$25,082,969

Program services were 82.2% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1e · Government grants (contributions)

    $175,123

  • 1f · All other contributions, gifts and grants

    $115,609

  • 2a · Program service revenue: PATIENT SERVICE REVENUE

    total $27,329,302 · related or exempt $27,327,609 · unrelated business $1,693

  • 2b · Program service revenue: SKILLED NURSING FACILITY REVENUE

    total $3,689,686 · related or exempt $3,689,686

  • 2c · Program service revenue: ASSISTED LIVING REVENUE

    total $547,166 · related or exempt $547,166

  • 3 · Investment income

    total $323,737 · excluded $323,737

  • 6a · Gross rents

    real property $330

  • 6b · Less rental expenses

    real property $0

  • 6c · Rental income or loss

    real property $330

  • 6d · Net rental income or loss

    total $330 · excluded $330

  • 7a · Gross sales of assets other than inventory

    securities $2,765,368

  • 7b · Less cost or other basis and sales expenses

    securities $2,673,678 · other assets $2,383

  • 7c · Gain or loss

    securities $91,690 · other assets -$2,383

  • 7d · Net gain or loss

    total $89,307 · excluded $89,307

  • 11a · Other revenue: CAFETERIA & VENDING

    total $31,937 · excluded $31,937

  • 11b · Other revenue: MISCELLANEOUS

    total $1,722 · excluded $1,722

  • 11e · Other revenue, total

    $33,659

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $26,820 · program services $26,820

  • 5 · Compensation of officers, directors and key employees

    total $895,458 · program services $535,132 · management and general $360,326

  • 6 · Compensation of disqualified persons

    total $131,371 · program services $131,371

  • 7 · Other salaries and wages

    total $12,260,001 · program services $11,250,969 · management and general $1,009,032

  • 8 · Pension plan contributions

    total $441,011 · program services $400,934 · management and general $40,077

  • 9 · Other employee benefits

    total $1,535,016 · program services $1,390,800 · management and general $144,216

  • 10 · Payroll taxes

    total $885,023 · program services $791,883 · management and general $93,140

  • 11b · Fees: legal

    total $3,488 · management and general $3,488

  • 11d · Fees: lobbying

    total $505 · management and general $505

  • 11f · Fees: investment management

    total $54,279 · management and general $54,279

  • 11g · Fees: other

    total $2,547,105 · program services $2,431,665 · management and general $115,440

  • 12 · Advertising and promotion

    total $4,676 · program services $164 · management and general $4,512

  • 13 · Office expenses

    total $1,272,123 · program services $821,888 · management and general $450,235

  • 14 · Information technology

    total $86,467 · program services $79,351 · management and general $7,116

  • 16 · Occupancy

    total $443,168 · program services $406,694 · management and general $36,474

  • 17 · Travel

    total $106,743 · program services $99,765 · management and general $6,978

  • 19 · Conferences, conventions and meetings

    total $31,543 · program services $12,978 · management and general $18,565

  • 20 · Interest

    total $327,303 · program services $327,303

  • 22 · Depreciation, depletion and amortization

    total $1,480,049 · program services $1,358,237 · management and general $121,812

  • 23 · Insurance

    total $117,072 · program services $112,394 · management and general $4,678

  • 24a · Other expenses: UNRELATED BUSINESS TAXE

    total -$625 · management and general -$625

  • 24b · Other expenses: AFFILIATE SUPPORT FEE

    total $3,502,788 · program services $1,699,903 · management and general $1,802,885

  • 24c · Other expenses: MEDICAL SUPPLIES

    total $1,832,639 · program services $1,832,639

  • 24d · Other expenses: AFFILIATE EXP & REV ALL

    total $1,057,939 · program services $38,562 · management and general $1,019,377

  • 24e · All other expenses

    total $1,467,728 · program services $1,333,517 · management and general $134,211

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $13,845 · end of year $15,910

  • 2 · Savings and temporary cash investments

    beginning of year $4,227,465 · end of year $3,274,196

  • 4 · Accounts receivable

    beginning of year $3,672,066 · end of year $3,838,397

  • 8 · Inventories for sale or use

    beginning of year $599,703 · end of year $582,949

  • 9 · Prepaid expenses and deferred charges

    beginning of year $88,821 · end of year $98,450

  • 10a · Land, buildings and equipment: cost or other basis

    $31,415,484

  • 10b · Land, buildings and equipment: accumulated depreciation

    $21,366,652

  • 10c · Land, buildings and equipment, net

    beginning of year $11,256,444 · end of year $10,048,832

  • 11 · Investments: publicly traded securities

    beginning of year $536,463 · end of year $564,238

  • 12 · Investments: other securities

    beginning of year $11,285,822 · end of year $13,457,690

  • 15 · Other assets

    beginning of year $3,312,174 · end of year $4,536,817

  • 17 · Accounts payable and accrued expenses

    beginning of year $2,592,778 · end of year $1,793,855

  • 19 · Deferred revenue

    beginning of year $131,719 · end of year $3,259

  • 21 · Escrow or custodial account liability

    beginning of year $12,490 · end of year $14,555

  • 23 · Secured mortgages and notes payable

    beginning of year $8,378,273 · end of year $8,030,047

  • 25 · Other liabilities

    beginning of year $204,591 · end of year $213,343

  • 27 · Net assets without donor restrictions

    beginning of year $23,473,135 · end of year $26,146,021

  • 28 · Net assets with donor restrictions

    beginning of year $199,817 · end of year $216,399

Mission and programs · 2022

Mission

WE ARE CALLED TO MAKE A HEALTHY DIFFERENCE IN PEOPLE'S LIVES.

  • FIRST CARE MEDICAL SERVICES, DBA ESSENTIA HEALTH FOSSTON, IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES. MORE SPECIFICALLY, ESSENTIA HEALTH FOSSTON IS CREATED AND ORGANIZED TO OWN, MAINTAIN, OPERATE AND CONDUCT, DIRECTLY OR INDIRECTLY, AND TO ASSIST AND COORDINATE ACTIVITIES OF FACILITIES FOR HEALTH CARE, EDUCATION, CARE FOR THE AGED AND SOCIAL SERVICES, INCLUDING CHARITABLE CARE TO PERSONS UNABLE TO PAY.ESSENTIA HEALTH FOSSTON HAS A 43 LICENSED BED CRITICAL ACCESS HOSPITAL AND PRIMARY CARE CLINICS THAT SERVE POLK COUNTY AND SURROUNDING COMMUNITIES. ESSENTIA HEALTH FOSSTON OFFERS REHABILITATIVE SERVICES, HOSPICE CARE, OBSTETRICS AND BIRTHING SERVICES, SURGICAL SERVICES, AND URGENT CARE. THE HOSPITAL IS DESIGNATED AS ACUTE STROKE READY.ESSENTIA HEALTH FOSSTON HAS A 50-BED SKILLED NURSING FACILITY CONNECTED TO THE HOSPITAL THAT SERVES PEOPLE WHO NEED SKILLED CARE BEYOND THE HOSPITAL AND WANT TO REMAIN IN THE COMMUNITY. IN ADDITION, PRAIRIE PINES COMMUNITY HOUSING PROVIDES INDEPENDENT LIVING APARTMENTS WITH A MENU OF SERVICES THAT CAN BE ASSESSED BASED ON NEED.ESSENTIA HEALTH FOSSTON EMPLOYS APPROXIMATELY 140 FULL TIME EQUIVALENTS. THE HOSPITAL PROVIDED 1,100 HOSPITAL PATIENT DAYS AND NEARLY 28,000 OUTPATIENT VISITS DURING THE FISCAL YEAR ENDED JUNE 30, 2023. THE CLINICS HAD 24,000 ENCOUNTERS AND THE SKILLED NURSING FACILITY PROVIDED OVER 11,000 RESIDENT DAYS DURING THE SAME TIME PERIOD.DURING THE FISCAL YEAR ENDED JUNE 30, 2023, ESSENTIA HEALTH FOSSTON PROVIDED THE FOLLOWING COMMUNITY BENEFITS: $324,000 IN CHARITY CARE, $1.3 MILLION COSTS IN EXCESS OF MEDICAID PAYMENTS, $21,000 IN COMMUNITY SERVICES, AND $25,000 IN HEALTH PROFESSION EDUCATION.

    Expenses $25,082,969 · Grants $26,820 · Revenue $31,566,154

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Cheryl White MD

    CHIEF MEDICAL OFFICER

    Total calculated
    $541,118
    From this org
    $0
    From related orgs
    $515,714
    Other
    $25,404
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $515,336 related
    Bonus
    $0
    Other
    $0 + $378 related
    Deferred
    $0 + $24,400 related
    Nontaxable benefits
    $0 + $1,004 related
    Filer's total
    $0 + $541,118 related

  • Maija Duppong

    NURSE PRACTITIONER

    Total calculated
    $329,276
    From this org
    $311,539
    From related orgs
    $0
    Other
    $17,737
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $311,452
    Bonus
    $0
    Other
    $87
    Deferred
    $14,112
    Nontaxable benefits
    $3,625
    Filer's total
    $329,276

  • Nicole Kiesow

    PHYSICIAN ASSISTANT

    Total calculated
    $307,820
    From this org
    $257,448
    From related orgs
    $0
    Other
    $50,372
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $257,361
    Bonus
    $0
    Other
    $87
    Deferred
    $13,443
    Nontaxable benefits
    $36,929
    Filer's total
    $307,820

  • Kari Hitchen

    CRNA

    Total calculated
    $291,992
    From this org
    $245,366
    From related orgs
    $0
    Other
    $46,626
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $245,023
    Bonus
    $0
    Other
    $343
    Deferred
    $11,732
    Nontaxable benefits
    $34,894
    Filer's total
    $291,992

  • Gregory Reese

    CRNA

    Total calculated
    $274,888
    From this org
    $239,146
    From related orgs
    $0
    Other
    $35,742
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $237,527
    Bonus
    $0
    Other
    $1,619
    Deferred
    $12,007
    Nontaxable benefits
    $23,735
    Filer's total
    $274,888

  • Kristi Widseth

    CRNA

    Total calculated
    $233,972
    From this org
    $187,725
    From related orgs
    $0
    Other
    $46,247
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $186,990
    Bonus
    $0
    Other
    $735
    Deferred
    $9,729
    Nontaxable benefits
    $36,518
    Filer's total
    $233,972

  • Kimberly Bodensteiner

    FINANCE DIRECTOR

    Total calculated
    $203,161
    From this org
    $180,104
    From related orgs
    $0
    Other
    $23,057
    Hours/week
    56 + 4 related

    Schedule J breakdown matched by us

    Base
    $179,431
    Bonus
    $0
    Other
    $673
    Deferred
    $9,212
    Nontaxable benefits
    $13,845
    Filer's total
    $203,161

  • Callen Weispfennig

    ADMINISTRATOR

    Total calculated
    $158,534
    From this org
    $138,197
    From related orgs
    $0
    Other
    $20,337
    Hours/week
    60

    Schedule J breakdown matched by us

    Base
    $115,889
    Bonus
    $15,000
    Other
    $7,308
    Deferred
    $0
    Nontaxable benefits
    $20,337
    Filer's total
    $158,534

  • Robert Overmoe

    BOARD CHAIR

    Total calculated
    $1,125
    From this org
    $0
    From related orgs
    $1,125
    Other
    $0
    Hours/week
    2

  • Dean Anderson

    BOARD SECRETARY/TREASURER

    Total calculated
    $0
    Hours/week
    2

  • Roy Dufault

    BOARD DIRECTOR

    Total calculated
    $0
    Hours/week
    1

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Compensation committee
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 8 · Paid under the initial-contract exception
  • 9 · Followed the rebuttable-presumption procedure

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments

The filer's explanations (Part III)

PART I, LINE 3
ESTABLISHING CEO'S COMPENSATION: ESSENTIA HEALTH, AS A RELATED ORGANIZATION, USED THE FOLLOWING METHODS TO ESTABLISH ESSENTIA HEALTH FOSSTON'S ADMINISTRATOR'S COMPENSATION: A COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
PART I, LINE 8
ESSENTIA HEALTH FOSSTON'S ADMINISTRATOR, CALLEN WEISPFENNIG, RECEIVED COMPENSATION DURING THE YEAR UNDER AN INITIAL EMPLOYMENT AGREEMENT SUBJECT TO THE INITIAL CONTRACT EXCEPTION. THROUGH THE ESSENTIA HEALTH EXECUTIVE COMPENSATION COMMITTEE, THIS COMPENSATION ARRANGEMENT WAS REVIEWED AND APPROVED BY INDEPENDENT PERSONS USING COMPARABILITY DATA AND DELIBERATIONS AND DECISIONS WERE DOCUMENTED.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • PMC-GATEWAY IMAGING LLC THRU 1132022

    N/A · IMAGING SERVICES · MN

  • HORSESHOE SURGERY CENTER LLC

    N/A · SURGERY CENTER · MN

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • ESSENTIA HEALTH INSURANCE SERVICES SPC LTD

    C · SELF INSURANCE · CJ · controlled entity

  • MID DAKOTA CLINIC INC

    C · CLINIC OPERATIONS CEASED 9/30/22 · ND · controlled entity

Provenance

Return type
form_990
Tax year
2022
Filed
1 May 2024
IRS schema version
2022v5.0
Source object
202421229349301512

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