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ObjectId: 202441249349300929 - Submission: 2024-05-03
TIN: 41-1620386
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
22
Open to Public Inspection
Name of the organization
ST MARY'S REGIONAL HEALTH CENTER
Employer identification number
41-1620386
Part I
Identification of Disregarded Entities.
Complete if the organization answered "Yes" on 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
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 entity?
Yes
No
(1)
BRAINERD LAKES INTEGRATED HEALTH SYSTEM
2024 S 6TH ST
BRAINERD
,
MN
56401
37-1532145
SUPPORTING ORG
MN
501(C)(3)
LINE 12B, II
ESSENTIA HEALTH
Yes
(2)
BRAINERD MEDICAL CENTER INC
2024 S 6TH ST
BRAINERD
,
MN
56401
37-1532148
CLINIC
MN
501(C)(3)
LINE 3
BRAINERD LAKES INTEGRATED HEALTH SYSTEM
Yes
(3)
BRIDGES MEDICAL CENTER
201 9TH ST W
ADA
,
MN
56510
20-0479568
HOSPITAL/CLINIC
MN
501(C)(3)
LINE 3
INNOVIS HEALTH LLC
Yes
(4)
DEER RIVER HEALTHCARE CENTER INC
115 10TH AVE NE
DEER RIVER
,
MN
56636
41-0844574
HOSPITAL/CLINIC/SKILLED NURSING FACILITY
MN
501(C)(3)
LINE 3
ST MARY'S DULUTH CLINIC HEALTH SYSTEM
Yes
(5)
ESSENTIA HEALTH
502 E 2ND ST
DULUTH
,
MN
55805
20-0360007
SUPPORTING ORG
MN
501(C)(3)
LINE 12C, III-FI
N/A
No
(6)
ESSENTIA HEALTH FOUNDATION
502 E 2ND ST
DULUTH
,
MN
55805
27-1984704
FOUNDATION
MN
501(C)(3)
LINE 7
ESSENTIA HEALTH
Yes
(7)
ESSENTIA HEALTH MOOSE LAKE
4572 COUNTY ROAD 61
MOOSE LAKE
,
MN
55767
84-5099016
HOSPITAL/CLINIC
MN
501(C)(3)
LINE 3
ST MARY'S DULUTH CLINIC HEALTH SYSTEM
Yes
(8)
ESSENTIA HEALTH SURGERY CENTERS
502 E 2ND ST
DULUTH
,
MN
55805
88-1577422
SURGERY CENTER
MN
501(C)(3)
LINE 3
ESSENTIA HEALTH
Yes
(9)
ESSENTIA INSTITUTE OF RURAL HEALTH
502 E 2ND ST
DULUTH
,
MN
55805
27-1291124
RESEARCH
MN
501(C)(3)
LINE 4
THE DULUTH CLINIC LTD
Yes
(10)
FIRST CARE MEDICAL SERVICES
900 HILLIGOSS BLVD SE
FOSSTON
,
MN
56542
41-0706143
HOSPITAL/CLINIC/SKILLED NURSING FACILITY
MN
501(C)(3)
LINE 3
INNOVIS HEALTH LLC
Yes
(11)
GRACEVILLE HEALTH CENTER
115 WEST 2ND ST
GRACEVILLE
,
MN
56240
41-0726173
HOSPITAL/CLINIC/SKILLED NURSING FACILITY
MN
501(C)(3)
LINE 3
INNOVIS HEALTH LLC
Yes
(12)
INNOVIS HEALTH LLC
3000 32ND AVE S
FARGO
,
ND
58103
26-1175213
HOSPITAL/CLINIC
DE
501(C)(3)
LINE 3
ESSENTIA HEALTH
Yes
(13)
MIDWEST MEDICAL EQUIPMENT AND SUPPLIES INC
502 E 2ND ST
DULUTH
,
MN
55805
41-1674021
MEDICAL EQUIPMENT
MN
501(C)(3)
LINE 10
ST MARY'S MEDICAL CENTER
Yes
(14)
NORTHERN PINES MEDICAL CENTER
5211 HWY 110
AURORA
,
MN
55705
41-0841441
HOSPITAL/CLINIC/SKILLED NURSING FACILITY
MN
501(C)(3)
LINE 3
ST MARY'S DULUTH CLINIC HEALTH SYSTEM
Yes
(15)
PINE MEDICAL CENTER
705 LUNDORFF DR S
SANDSTONE
,
MN
55072
41-1884597
HOSPITAL
MN
501(C)(3)
LINE 3
ST MARY'S DULUTH CLINIC HEALTH SYSTEM
Yes
(16)
POLINSKY MEDICAL REHABILITATION CENTER
530 E 2ND ST
DULUTH
,
MN
55805
41-0691275
REHABILITATION SERVICES
MN
501(C)(3)
LINE 3
ST MARY'S MEDICAL CENTER
Yes
(17)
SMDC MEDICAL CENTER
502 E 2ND ST
DULUTH
,
MN
55805
41-1878730
HOSPITAL/CLINIC
MN
501(C)(3)
LINE 3
ST MARY'S DULUTH CLINIC HEALTH SYSTEM
Yes
(18)
ST JOSEPH'S MEDICAL CENTER
523 N 3RD ST
BRAINERD
,
MN
56401
41-0695602
HOSPITAL/CLINIC
MN
501(C)(3)
LINE 3
BRAINERD LAKES INTEGRATED HEALTH SYSTEM
Yes
(19)
ST MARY'S DULUTH CLINIC HEALTH SYSTEM
502 E 2ND ST
DULUTH
,
MN
55805
41-1836633
SUPPORTING ORG
MN
501(C)(3)
LINE 12B, II
ESSENTIA HEALTH
Yes
(20)
ST MARY'S EMS
1027 WASHINGTON AVE
DETROIT LAKES
,
MN
56501
41-1805811
EMERGENCY SERVICES
MN
501(C)(3)
LINE 10
INNOVIS HEALTH LLC
Yes
(21)
ST MARY'S HOSPITAL OF SUPERIOR
3500 TOWER AVE
SUPERIOR
,
WI
54880
41-1811073
HOSPITAL/CLINIC
MN
501(C)(3)
LINE 3
ST MARY'S MEDICAL CENTER
Yes
(22)
ST MARY'S INNOVIS HEALTH
1027 WASHINGTON AVE
DETROIT LAKES
,
MN
56501
26-2861321
PHARMACY
MN
501(C)(3)
LINE 3
INNOVIS HEALTH LLC
Yes
(23)
ST MARY'S MEDICAL CENTER
402 E 2ND ST
DULUTH
,
MN
55805
41-0695604
HOSPITAL
MN
501(C)(3)
LINE 3
ST MARY'S DULUTH CLINIC HEALTH SYSTEM
Yes
(24)
THE DULUTH CLINIC LTD
400 E 3RD ST
DULUTH
,
MN
55805
41-0883623
CLINIC
MN
501(C)(3)
LINE 3
ST MARY'S DULUTH CLINIC HEALTH SYSTEM
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2022
Page 2
Schedule R (Form 990) 2022
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 THRU 1132022
705 LUNDORFF DR S
SANDSTONE
,
MN
55072
26-1634764
IMAGING SERVICES
MN
N/A
N/A
No
No
(2)
HORSESHOE SURGERY CENTER LLC
1542 GOLF COURSE ROAD
GRAND RAPIDS
,
MN
55744
20-2137172
SURGERY CENTER
MN
N/A
N/A
No
No
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
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
ESSENTIA HEALTH INSURANCE SERVICES SPC LTD
PO BOX 1159
GRAND CAYMAN
CJ
000000000
SELF INSURANCE
CJ
N/A
C
Yes
(2)
MID DAKOTA CLINIC INC
502 E 2ND ST
DULUTH
,
MN
55805
45-0311334
CLINIC OPERATIONS CEASED 9/30/22
ND
N/A
C
Yes
Schedule R (Form 990) 2022
Page 3
Schedule R (Form 990) 2022
Page
3
Part V
Transactions With Related Organizations.
Complete if the organization answered "Yes" on 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
Yes
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
No
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
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
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
No
o
Sharing of paid employees with related organization(s)
............................
1o
No
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 related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
BRIDGES MEDICAL CENTER
A
3,600
ACTUAL COSTS
(2)
ESSENTIA HEALTH
M
17,614,716
ACTUAL COSTS
(3)
ESSENTIA HEALTH
P
10,632,346
ACTUAL COSTS
(4)
ESSENTIA HEALTH
R
12,000,000
ACTUAL COSTS
(5)
ESSENTIA HEALTH FOUNDATION
B
234,163
ACTUAL COSTS
(6)
ESSENTIA HEALTH FOUNDATION
C
101,934
ACTUAL COSTS
(7)
FIRST CARE MEDICAL SERVICES
A
5,580
ACTUAL COSTS
(8)
GRACEVILLE HEALTH CENTER
A
3,000
ACTUAL COSTS
(9)
INNOVIS HEALTH LLC
A
763,677
ACTUAL COSTS
(10)
INNOVIS HEALTH LLC
Q
15,496,280
ACTUAL COSTS
(11)
INNOVIS HEALTH LLC
S
20,100,000
ACTUAL COSTS
(12)
MIDWEST MEDICAL EQUIPMENT AND SUPPLIES INC
A
27,504
ACTUAL COSTS
(13)
ST JOSEPH'S MEDICAL CENTER
P
92,400
ACTUAL COSTS
(14)
ST MARY'S EMS
A
120,000
ACTUAL COSTS
(15)
ST MARY'S INNOVIS HEALTH
A
120,000
ACTUAL COSTS
Schedule R (Form 990) 2022
Page 4
Schedule R (Form 990) 2022
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) 2022
Page 5
Schedule R (Form 990) 2022
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference
Explanation
SCHEDULE R, PART II, COLUMN (A):
THE FOLLOWING ESSENTIA HEALTH ENTITIES HAVE A DOING BUSINESS AS NAME: LEGAL NAME; DOING BUSINESS AS NAME 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 AND SUPPLIES, INC.; ESSENTIA HEALTH MEDICAL EQUIPMENT & 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 EMS; ESSENTIA HEALTH EMS 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
Schedule R (Form 990) 2022
Additional Data
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