Form 990 for tax year 2022

Revenue

Part VIII, the statement of revenue.

• 1d · Related organizations

  $14,693

• 1e · Government grants (contributions)

  $124,842

• 1f · All other contributions, gifts and grants

  $2,579

• 2a · Program service revenue: INPATIENT AND OUTPATIENT REVENUES

  total $39,109,350 · related or exempt $39,082,180 · unrelated business $27,170

• 2b · Program service revenue: FITNESS & WELLNESS

  total $214,094 · related or exempt $214,094

• 2c · Program service revenue: EQUITY SHARE IN CENTRAL MN DIAGNO

  total $206,342 · related or exempt $206,342

• 3 · Investment income

  total $261,231 · excluded $261,231

• 6a · Gross rents

  real property $1,000

• 6b · Less rental expenses

  real property $0

• 6c · Rental income or loss

  real property $1,000

• 6d · Net rental income or loss

  total $1,000 · excluded $1,000

• 7a · Gross sales of assets other than inventory

  securities $2,461,725 · other assets $278,895

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

  securities $2,380,103 · other assets $5,685

• 7c · Gain or loss

  securities $81,622 · other assets $273,210

• 7d · Net gain or loss

  total $354,832 · excluded $354,832

• 11a · Other revenue: SISU NOTE RECOVERY

  total $170,241 · excluded $170,241

• 11b · Other revenue: CAFETERIA & VENDING

  total $73,792 · excluded $73,792

• 11c · Other revenue: MISCELLANEOUS

  total $1,254 · excluded $1,254

• 11e · Other revenue, total

  $245,287

Functional expenses

Part IX, the statement of functional expenses.

• 1 · Grants to domestic organizations and governments

  total $15,000 · program services $15,000

• 5 · Compensation of officers, directors and key employees

  total $585,480 · management and general $585,480

• 6 · Compensation of disqualified persons

  total $30,201 · management and general $30,201

• 7 · Other salaries and wages

  total $13,963,511 · program services $12,936,206 · management and general $1,027,305

• 8 · Pension plan contributions

  total $586,069 · program services $540,340 · management and general $45,729

• 9 · Other employee benefits

  total $2,152,709 · program services $1,904,825 · management and general $247,884

• 10 · Payroll taxes

  total $974,570 · program services $878,686 · management and general $95,884

• 11b · Fees: legal

  total $28 · management and general $28

• 11d · Fees: lobbying

  total $564 · management and general $564

• 11f · Fees: investment management

  total $33,319 · management and general $33,319

• 11g · Fees: other

  total $2,999,249 · program services $2,607,582 · management and general $391,667

• 12 · Advertising and promotion

  total $896 · program services $682 · management and general $214

• 13 · Office expenses

  total $1,905,316 · program services $1,680,640 · management and general $224,676

• 14 · Information technology

  total $33,971 · program services $31,472 · management and general $2,499

• 16 · Occupancy

  total $695,859 · program services $644,664 · management and general $51,195

• 17 · Travel

  total $138,251 · program services $124,770 · management and general $13,481

• 19 · Conferences, conventions and meetings

  total $16,046 · program services $6,724 · management and general $9,322

• 20 · Interest

  total $984,955 · program services $984,955

• 22 · Depreciation, depletion and amortization

  total $3,142,449 · program services $2,911,257 · management and general $231,192

• 23 · Insurance

  total $314,273 · program services $301,139 · management and general $13,134

• 24a · Other expenses: UNRELATED BUSINESS TAX

  total -$494 · management and general -$494

• 24b · Other expenses: AFFILIATE SUPPORT FEE

  total $4,078,524 · program services $1,979,308 · management and general $2,099,216

• 24c · Other expenses: MEDICAL SUPPLIES

  total $4,078,209 · program services $4,078,209

• 24d · Other expenses: AFFILIATE EXPENSE & REV

  total $2,475,153 · program services $307,979 · management and general $2,167,174

• 24e · All other expenses

  total $1,837,409 · program services $1,551,019 · management and general $286,390

Balance sheet

Part X, book values.

• 1 · Cash, non-interest-bearing

  beginning of year $965,960 · end of year $989,424

• 2 · Savings and temporary cash investments

  beginning of year $5,971,937 · end of year $1,393,521

• 4 · Accounts receivable

  beginning of year $4,326,374 · end of year $4,465,609

• 7 · Other notes and loans receivable

  beginning of year $597,634 · end of year $642,186

• 8 · Inventories for sale or use

  beginning of year $1,107,833 · end of year $1,095,127

• 9 · Prepaid expenses and deferred charges

  beginning of year $75,690 · end of year $66,454

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

  $34,556,305

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

  $5,194,760

• 10c · Land, buildings and equipment, net

  beginning of year $32,313,999 · end of year $29,361,545

• 11 · Investments: publicly traded securities

  beginning of year $37,362 · end of year $37,362

• 12 · Investments: other securities

  beginning of year $10,152,641 · end of year $11,981,545

• 15 · Other assets

  beginning of year $2,220,869 · end of year $1,488,839

• 17 · Accounts payable and accrued expenses

  beginning of year $7,455,325 · end of year $2,193,355

• 19 · Deferred revenue

  beginning of year $99,274 · end of year $0

• 23 · Secured mortgages and notes payable

  beginning of year $34,417,155 · end of year $33,496,689

• 25 · Other liabilities

  beginning of year $2,201,721 · end of year $2,058,473

• 27 · Net assets without donor restrictions

  beginning of year $13,596,824 · end of year $13,773,095

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 MOOSE LAKE'S ADMINISTRATOR'S COMPENSATION: A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.

PART I, LINES 4A-B

SEVERANCE PAYMENT: FORMER OFFICER MICHAEL YOUSO RECEIVED PAYMENTS TOTALING $149,989 IN CALENDAR YEAR 2022 RELATED TO A TERMINATION AGREEMENT. UNDER THE TERMS OF THE AGREEMENT, YOUSO WILL RECEIVE PAY TOTALING $250,016 & BENEFITS TOTALING $17,414 FROM JULY 31, 2021 TO JULY 31, 2022. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: ESSENTIA HEALTH'S NONQUALIFIED RETIREMENT PLAN IS OFFERED TO DESIGNATED ESSENTIA HEALTH EXECUTIVES. THERE IS A MINIMUM FOUR YEAR VESTING DATE, OR VESTING IS AUTOMATIC UPON REACHING RETIREMENT AGE, DEATH, DISABILITY OR INVOLUNTARY TERMINATION WITHOUT CAUSE. BENEFITS ARE SUBJECT TO INCOME TAXES UPON VESTING AND PAYABLE FROM ESSENTIA HEALTH'S GENERAL ASSETS. REPORTED AS OTHER REPORTABLE COMPENSATION IN SCHEDULE J, PART II, COLUMN B (III), THE FOLLOWING INDIVIDUALS LISTED IN FORM 990, PART VII, SECTION A, LINE 1A RECEIVED PAYMENT OF THE VESTED BENEFIT FROM THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING THE YEAR: BRADLEY BEARD $63,788 THOMAS WITT, MD $87,616 KEVIN BOREN $32,212 MICHAEL LARSON $20,200 REPORTED AS RETIREMENT AND OTHER DEFERRED COMPENSATION IN SCHEDULE J, PART II, COLUMN C, ESSENTIA HEALTH MADE CONTRIBUTIONS, SUBJECT TO THE VESTING TERMS, DURING THE YEAR INTO THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN ON BEHALF OF THE FOLLOWING INDIVIDUALS LISTED IN FORM 990, PART VII, SECTION A, LINE 1A: BRADLEY BEARD $74,083 WILLIAM HEEGAARD, MD $78,203 THOMAS WITT, MD $42,735 KEVIN BOREN $24,669 KRISTA SKORUPA, MD $30,398 MICHAEL LARSON $26,289

PART I, LINE 8

INITIAL CONTRACT EXCEPTION: ESSENTIA HEALTH MOOSE LAKE'S CRNAS, JAMES MACH, JR. AND ERIN LAVEAU-ALLEN, RECEIVED COMPENSATION DURING THE YEAR UNDER INITIAL EMPLOYMENT AGREEMENTS SUBJECT TO THE INITIAL CONTRACT EXCEPTION. THROUGH THE ESSENTIA HEALTH PHYSICIAN AND PROVIDER COMPENSATION COMMITTEE, THESE COMPENSATION ARRANGEMENTS WERE REVIEWED AND APPROVED BY INDEPENDENT PERSONS USING COMPARABILITY DATA AND DELIBERATIONS AND DECISIONS WERE DOCUMENTED. ESSENTIA HEALTH MOOSE LAKE'S REGIONAL NURSING DIRECTOR, SHANNON SNYDER, RECEIVED COMPENSATION DURING THE YEAR UNDER AN INITIAL EMPLOYMENT AGREEMENT SUBJECT TO THE INITIAL CONTRACT EXCEPTION. THROUGH AN AUTHORIZED BODY OF THE ORGANIZATION, THIS COMPENSATION ARRANGEMENT WAS REVIEWED AND APPROVED BY INDEPENDENT PERSONS USING COMPARABILITY DATA AND DELIBERATIONS AND DECISIONS WERE DOCUMENTED.

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