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
2012
Open to Public Inspection
Name of the organization
SMDC Medical Center
 
Employer identification number

41-1878730
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) 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
(1) Essentia Health Virginia LLC
1101 9th St N
Virginia,MN55792
46-0909870 		Clinic/Hosp DE 1,185,399 28,128,938 SMDCMC
 










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to 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 entity?
Yes No
(1) BRAINERD LAKES INTEGRATED HEALTH SYSTEM

2024 S 6TH ST

BRAINERD,MN56401
37-1532145 		SUPPORT ORG MN 501(c)(3) 11 Type 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) DL SURGERY CENTER (thru 73112)

1027 WASHINGTON AVE

DETROIT LAKES,MN56501
26-3837203 		ASC MN 501(c)(3) 3 CAG
 
Yes
 
(6) Critical Access Group

503 E 3RD ST SUITE 400

DULUTH,MN55805
26-1219624 		SUPPORT ORG MN 501(c)(3) 11 Type II ESSENTIA
 
Yes
 
(7) FIRST CARE MEDICAL SERVICES

900 HILLIGOSS 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,MN56058
41-0837659 		HOSPITAL/NURS MN 501(c)(3) 3 CAG
 
Yes
 
(9) ST J0SEPHS MEDICAL CENTER

523 N 3RD ST

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

1027 WASHINGTON AVE

DETROIT LAKES,MN56501
41-1805811 		EMERG Srvcs MN 501(c)(3) 9 SMRHC
 
Yes
 
(11) ST MARYS HOSPITAL INC

P O BOX 137

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

1027 WASHINGTON AVE

DETROIT LAKES,MN56501
26-2861321 		CLINIC MN 501(c)(3) 3 Innovis
 
Yes
 
(13) ST MARYS REGIONAL HEALTH CENTER

1027 WASHINGTON AVE

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

502 E 2ND ST

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

502 E 2ND ST

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

3000 32nd Avenue

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

502 E 2ND ST

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

4418 HAINES ROAD

DULUTH,MN55811
47-1674021 		MEDical EQUIP MN 501(c)(3) 9 SMMC
 
Yes
 
(19) PINE MEDICAL CENTER

109 COURT AVE S

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

530 E 2ND ST

DULUTH,MN55805
41-0691275 		CLINIC MN 501(c)(3) 3 SMMC
 
Yes
 
(21) ST MARYS DULUTH CLINIC HEALTH SYSTEM

407 E 3RD ST

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

3500 TOWER AVE

SUPERIOR,WI54880
41-1811073 		CLINIC/HOSP WI 501(c)(3) 3 SMMC
 
Yes
 
(23) ST MARYS MEDICAL CENTER

407 E 3RD ST

DULUTH,MN55805
41-0695604 		HOSPITAL MN 501(c)(3) 3 SMDCHS
 
Yes
 
(24) THE DULUTH CLINIC LTD

400 E 3RD ST

DULUTH,MN55805
41-0883623 		CLINIC MN 501(c)(3) 3 SMDCHS
 
Yes
 
(25) Northern Pines Medical Center

5211 Hwy 110 Aurora

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

115 West Second St

Graceville,MN56240
41-0726173 		Clinic/Hosp MN 501(c)(3) 3 Innovis
 
Yes
 
(27) DEER RIVER HEALTHCARE CENTER INC

115 10TH AVE NE

DEER RIVER,MN56636
41-0844574 		HOSPITAL/NURS MN 501(c)(3) 3 SMDCHS
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Page 2
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 S
Sandstone,MN55072
26-1634764 		Imaging Servi MN NA
  		N/A 0 0     0     0 %












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) ESSENTIA HLTH INS SERVICES SPC LTD

94 Solaris Ave PO Box 69
GRAND CAYMAN,CAYMAN ISLANDSKY1-1102
CJ
000000000 		INSURANCE CJ NA
  		FOREIGN CORP 0 0 0 % Yes  
(2) East Range Clinics Ltd

910 6th Ave N
Virginia,MN55792
41-0909915 		Clinics MN NA
  		C Corp 0 0 0 % Yes  










Schedule R (Form 990) 2012
Page 3
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (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 Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
 
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
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-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) BRAINERD MEDICAL CENETER INC

 Q 60,180 Actual costs
(2) ESSENTIA HEALTH

 M 18,189,447 Actual costs
(3) ESSENTIA HEALTH

 P 20,660,714 Actual costs
(4) ESSENTIA HEALTH

 Q 8,572,851 Actual costs
(5) ESSENTIA HEALTH

 R 3,046,304 Actual costs
(6) ESSENTIA HEALTH

 S 320,299 Actual costs
(7) DEER RIVER HEALTHCARE CENTER

 Q 858,601 Actual costs
(8) ESSENTIA INSTITUTE OF RURAL HEALTH

 P 103,041 Actual costs
(9) ESSENTIA INSTITUTE OF RURAL HEALTH

 Q 733,327 Actual costs
(10) FIRST CARE MEDICAL SERVICES

 Q 804,591 Actual costs
(11) ESSENTIA HEALTH FOUNDATION

 B 160,000 Actual costs
(12) ESSENTIA HEALTH FOUNDATION

 C 87,899 Actual costs
(13) INNOVIS HEALTH LLC

 O 65,161 Actual costs
(14) INNOVIS HEALTH LLC

 P 92,477 Actual costs
(15) INNOVIS HEALTH LLC

 Q 3,317,192 Actual costs
(16) MIDWEST MEDICAL EQUIPMENT & SUPPLY INC

 Q 312,551 Actual costs
(17) NORTHERN PINES MEDICAL CENTER

 Q 952,264 Actual costs
(18) PINE MEDICAL CENTER

 N 81,667 Actual costs
(19) PINE MEDICAL CENTER

 P 349,022 Actual costs
(20) PINE MEDICAL CENTER

 Q 1,328,295 Actual costs
(21) POLINSKY MEDICAL REHABILITATION CENTER

 Q 1,939,682 Actual costs
(22) ST JOSEPH'S MEDICAL CENTER

 O 1,374,080 Actual costs
(23) ST JOSEPH'S MEDICAL CENTER

 P 111,114 Actual costs
(24) ST JOSEPH'S MEDICAL CENTER

 Q 1,901,042 Actual costs
(25) ST MARY'S HOSPITAL - SUPERIOR

 P 87,356 Actual costs
(26) ST MARY'S HOSPITAL - SUPERIOR

 Q 5,494,039 Actual costs
(27) ST MARY'S MEDICAL CENTER

 O 341,234 Actual costs
(28) ST MARY'S MEDICAL CENTER

 P 30,078,465 Actual costs
(29) ST MARY'S MEDICAL CENTER

 Q 42,356,668 Actual costs
(30) ST MARY'S REGIONAL HEALTH CENTER

 Q 782,323 Actual costs
(31) THE DULUTH CLINIC LTD

 J 1,123,494 Actual costs
(32) THE DULUTH CLINIC LTD

 K 139,465 Actual costs
(33) THE DULUTH CLINIC LTD

 P 4,463,661 Actual costs
(34) THE DULUTH CLINIC LTD

 Q 25,495,381 Actual costs
(35) THE DULUTH CLINIC LTD

 R 52,007 Actual costs
(36) VIRGINIA REGIONAL MEDICAL CENTER

 J 224,771 Actual costs
(37) VIRGINIA REGIONAL MEDICAL CENTER

 P 7,064,489 Actual costs
(38) VIRGINIA REGIONAL MEDICAL CENTER

 Q 763,505 Actual costs
Schedule R (Form 990) 2012
Page 4
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 section 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) 2012
Page 5
Schedule R (Form 990) 2012
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: The following Essentia Health entities have a doing business as name. 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 Deer River Healthcare Center, Inc.; Essentia Health Deer River 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. Joseph's Medical Center; Essentia Health St. Joseph's Medical Center 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 Medical Center; Essentia Health St. Mary's Medical Center St. Mary's Regional Health Center; Essentia Health St. Mary's-Detroit Lakes

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