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← ESSENTIA HEALTH SURGERY CENTERS

Form 990 for tax year 2022

Filed by ESSENTIA HEALTH SURGERY CENTERS.

Totals

Total revenue
$1,648,864
Total expenses
$7,422,587
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$1,648,864
Investment income
$0
Other revenue
$0
Total assets, end of year
$3,473,609
Total liabilities, end of year
$9,247,332
Net assets or fund balances, end of year
-$5,773,723
Program services expenses (Part IX)
$6,170,761
Management and general expenses
$1,251,826
Fundraising expenses
$0
Program service expenses (Part III)
$6,170,761

Program services were 83.1% 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.

  • 2a · Program service revenue: OUTPATIENT REVENUES

    total $1,648,864 · related or exempt $1,648,864

Functional expenses

Part IX, the statement of functional expenses.

  • 7 · Other salaries and wages

    total $1,281,514 · program services $1,253,561 · management and general $27,953

  • 8 · Pension plan contributions

    total $36,324 · program services $36,324

  • 9 · Other employee benefits

    total $240,202 · program services $204,340 · management and general $35,862

  • 10 · Payroll taxes

    total $94,808 · program services $92,065 · management and general $2,743

  • 11d · Fees: lobbying

    total $3,958 · management and general $3,958

  • 11g · Fees: other

    total $402,784 · program services $142,734 · management and general $260,050

  • 12 · Advertising and promotion

    total $118 · management and general $118

  • 13 · Office expenses

    total $232,369 · program services $187,030 · management and general $45,339

  • 14 · Information technology

    total $1,919 · program services $1,877 · management and general $42

  • 16 · Occupancy

    total $2,384,742 · program services $2,332,725 · management and general $52,017

  • 17 · Travel

    total $1,561 · program services $1,561

  • 19 · Conferences, conventions and meetings

    total $39,489 · management and general $39,489

  • 22 · Depreciation, depletion and amortization

    total $25,864 · program services $25,300 · management and general $564

  • 24a · Other expenses: AFFILIATE SUPPORT FEE

    total $1,478,148 · program services $717,345 · management and general $760,803

  • 24b · Other expenses: MEDICAL SUPPLIES

    total $1,077,547 · program services $1,077,547

  • 24c · Other expenses: BAD DEBT EXPENSE

    total $60,865 · program services $60,865

  • 24d · Other expenses: MN CARE TAX

    total $27,390 · program services $27,390

  • 24e · All other expenses

    total $32,985 · program services $10,097 · management and general $22,888

Balance sheet

Part X, book values.

  • 2 · Savings and temporary cash investments

    end of year $840,022

  • 4 · Accounts receivable

    end of year $842,632

  • 8 · Inventories for sale or use

    end of year $1,356,208

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

    $455,515

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

    $25,864

  • 10c · Land, buildings and equipment, net

    beginning of year $0 · end of year $429,651

  • 15 · Other assets

    end of year $5,096

  • 17 · Accounts payable and accrued expenses

    end of year $242,236

  • 25 · Other liabilities

    beginning of year $0 · end of year $9,005,096

  • 29 · Capital stock, trust principal or current funds

    beginning of year $0 · end of year $0

  • 30 · Paid-in or capital surplus, or land, building or equipment fund

    beginning of year $0 · end of year $0

  • 31 · Retained earnings, endowment or other funds

    beginning of year $0 · end of year -$5,773,723

Mission and programs · 2022

Mission

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

  • ESSENTIA HEALTH SURGERY CENTERS IS ORGANIZED AND OPERATED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES, SERVING AS THE OPERATIONAL PARENT OF THE ESSENTIA HEALTH ENTITIES OWNING AND/OR OPERATING AMBULATORY SURGERY CENTERS, INCLUDING CHARITABLE CARE TO PERSONS UNABLE TO PAY.ESSENTIA HEALTH SURGERY CENTERS IS THE SOLE MEMBER OF ESSENTIA HEALTH SURGERY CENTERS-DULUTH, LLC DBA ESSENTIA HEALTH SURGERY CENTER-MILLER HILL, ESSENTIA HEALTH SURGERY CENTERS-MINNESOTA, LLC, AND ESSENTIA HEALTH SURGERY CENTERS-NORTH DAKOTA, LLC. ESSENTIA HEALTH SURGERY CENTER-MILLER HILL HAS 4 OPERATING ROOMS AND OFFERS A VARIETY OF OUTPATIENT SURGERIES AND SERVICES INCLUDING EAR, NOSE & THROAT, EYE, GENERAL, GYNECOLOGIC, ORTHOPEDIC, AND UROLOGIC.ESSENTIA HEALTH SURGERY CENTER-MILLER HILL EMPLOYS APPROXIMATELY 15 FULL TIME EQUIVALENTS. THE SURGERY CENTER PROVIDED APPROXIMATELY 500 OUTPATIENT SURGERIES DURING FISCAL YEAR ENDED JUNE 30, 2023.DURING THE FISCAL YEAR ENDED JUNE 30, 2023, ESSENTIA HEALTH SURGERY CENTER-MILLER HILL PROVIDED THE FOLLOWING COMMUNITY BENEFIT: $752,000 COSTS IN EXCESS OF MEDICAID PAYMENTS.

    Expenses $6,170,761 · Revenue $1,648,864

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

Listed in Part VII

  • BRADLEY BEARD

    BOARD VICE CHAIR

    Total calculated
    $1,069,895
    From this org
    $0
    From related orgs
    $932,410
    Other
    $137,485
    Hours/week
    2 + 58 related

    Schedule J breakdown matched by us

    Base
    $0 + $600,630 related
    Bonus
    $0 + $256,508 related
    Other
    $0 + $75,272 related
    Deferred
    $0 + $98,483 related
    Nontaxable benefits
    $0 + $39,002 related
    Filer's total
    $0 + $1,069,895 related

  • AL HURLEY

    PRESIDENT/BOARD CHAIR

    Total calculated
    $716,910
    From this org
    $0
    From related orgs
    $624,072
    Other
    $92,838
    Hours/week
    2 + 58 related

    Schedule J breakdown matched by us

    Base
    $0 + $421,495 related
    Bonus
    $0 + $179,556 related
    Other
    $0 + $23,021 related
    Deferred
    $0 + $68,251 related
    Nontaxable benefits
    $0 + $24,587 related
    Filer's total
    $0 + $716,910 related

  • KENNETH FARRELL MD

    BOARD DIRECTOR

    Total calculated
    $664,615
    From this org
    $0
    From related orgs
    $602,681
    Other
    $61,934
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $600,359 related
    Bonus
    $0
    Other
    $0 + $2,322 related
    Deferred
    $0 + $24,400 related
    Nontaxable benefits
    $0 + $37,534 related
    Filer's total
    $0 + $664,615 related

  • ROBERT WROBLEWSKI MD

    BOARD DIRECTOR

    Total calculated
    $631,642
    From this org
    $0
    From related orgs
    $605,633
    Other
    $26,009
    Hours/week
    1 + 59 related

    Schedule J breakdown matched by us

    Base
    $0 + $604,661 related
    Bonus
    $0
    Other
    $0 + $972 related
    Deferred
    $0 + $24,400 related
    Nontaxable benefits
    $0 + $1,609 related
    Filer's total
    $0 + $631,642 related

  • KEVIN BOREN

    VICE PRESIDENT, FINANCE/BD TREASURER

    Total calculated
    $617,463
    From this org
    $0
    From related orgs
    $528,452
    Other
    $89,011
    Hours/week
    2 + 58 related

    Schedule J breakdown matched by us

    Base
    $0 + $394,711 related
    Bonus
    $0 + $85,550 related
    Other
    $0 + $48,191 related
    Deferred
    $0 + $49,069 related
    Nontaxable benefits
    $0 + $39,942 related
    Filer's total
    $0 + $617,463 related

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 · Independent compensation consultant
  • 3 · Compensation survey or study
  • 3 · Approval by the board or compensation committee
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 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
  • 8 · Paid under the initial-contract exception

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 SURGERY CENTERS' PRESIDENT'S COMPENSATION: A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
PART I, LINE 4B:
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 AL HURLEY $13,160 KEVIN BOREN $32,212 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 AL HURLEY $44,418 KEVIN BOREN $24,669

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

No itemized grants to organizations 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.

Disregarded entities

Part I: entities that legally are the filer and file no return of their own.

Related partnerships

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

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
8 May 2024
IRS schema version
2022v5.0
Source object
202411299349303426

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