First Care Medical Services

“Members of organization: essentia health west is the sole member of essentia health fosston. Members, the city of fosston and essentia health west, may elect one or more members of the governing body as described in schedule o part vi line 7a. Members, essentia health and essentia health west, have reserved powers with respect to essentia health fosston as described in schedule o part vi line 7b.”

“Members with right to elect governing body: the city of fosston appoints and removes one board member. Essentia health west apoints and removes essentia health fosston's remaining governing body.”

“Members with right to approve governing body decisions: essentia health fosston is a subsidiary of essentia health, whose board of directors has reserved powers with respect to this corporation and its subsidiaries, and all of the other direct and indirect subsidiaries of essentia health (collectively, the "system"). Essentia health's reserved powers are as follows: strategic and business plans. Authority to create, and to approve, the system's strategic and business plans. Mission. Authority to create, and to approve, the mission, purpose and vision statements for all entities in the system by the affirmative vote of at least 67% of the essentia health board of directors. Debt. Approval of the incurrence of debt by, and the creation of all mortgages, liens, security interests, or other encumbrances on the assets of, all entities in the system in excess of the single or annual aggregate dollar limits prescribed in writing by the essentia health board of directors, and the authority to cause all entities in the system to participate in system borrowing. Governing instruments. Authority to cause, and to approve, amendments of the articles of incorporation and bylaws of all entities in the system. Mergers and acquisitions. Authority to cause, and to approve, all mergers, consolidations, and dissolutions of all entities in the system. Affiliations and joint ventures. Authority to cause, and to approve, all affiliations, joint ventures and other alliances with third parties of all entities in the system. Transfer of assets within the system. Authority to transfer assets, including cash, between and among entities within the system; provided, however, that essentia health shall not have authority to require any entity in the system to transfer assets (a) that would cause such entity to be in default of its covenants or obligations under any bond or other financing documents; (b) from the catholic entities to the secular entities or from the secular entities to the catholic entities in a manner or to an extent that would cause the catholic entities to be in violation of the ethical and religious directives for catholic health care services (erds) in the judgment of the local ordinary; or (c) such that money generated by services at secular facilities within the system by procedures that are contrary to the erds would be used at the catholic entities or money generated by catholic entities would be used in the providing of services contrary to the erds at secular facilities within the system. Transfer of assets outside the system. Authority to cause, and to approve, the sale, lease or other transfer of assets of all entities in the system to parties outside of the system when the asset's value exceeds the single or annual aggregate dollar limits prescribed in writing by the essentia health board of directors. Services. Authority to cause, and to approve, the addition of new services and service locations and the discontinuance of services and service locations within all entities in the system. Budgets. Approval of capital and operating budgets of all entities in the system. Professional services. Selection of the general legal counsel and external auditors of all entities in the system. Acquisitions. Authority to cause, and to approve, all acquisitions by and formations of entities in the system. Marketing. Authority to implement system-wide marketing and promotional activities. Compliance plans. Authority to create, and to approve, corporate compliance, safety and risk management plans for entities within the system. Quality plan. Authority to create, and to approve, the system's quality plan. Non-budgeted purchases. Approval of non-budgeted capital purchases and leases in excess of the single or annual aggregate dollar limits prescribed in writing by essentia health for entities within the system. Human resources. Authority to create human resource policies and procedures within the system. Reserved powers. Authority to create addi”

“FORM 990 REVIEW PROCESS: THE 2014 FORM 990, INCLUDING ALL SCHEDULES, WAS REVIEWED BY ESSENTIA HEALTH FOSSTON'S MANAGEMENT AND GOVERNING BODY ON MARCH 28th, 2016 PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. EACH CURRENT DIRECTOR OF THE GOVERNING BODY RECEIVED A FINAL COPY OF THE 2014 FORM 990. ESSENTIA HEALTH FOSSTON'S CHIEF FINANCIAL OFFICER LED THE REVIEW OF THE FORM AND SCHEDULES AND ANY QUESTIONS WERE DISCUSSED.”

“Monitoring and enforcing Conflict of Interest policy: Essentia Health's comprehensive conflict of interest program prevents, detects and resolves actual conflicts of interests or the actual or potential appearance of such. Fiduciaries, defined as an Essentia Health board member/trustee, officer, board committee member, senior management employee, or any others considered to be in a position of influence, are covered under Essentia's conflict of interest program. Upon initial appointment, each fiduciary must complete an initial conflict of interest statement and disclosure questionnaire. At the conclusion of each fiscal year, each fiduciary must complete an annual conflict of interest statement and disclosure questionnaire. As needed, a fiduciary will update his/her most recently completed questionnaire each time the fiduciary becomes aware of a financial interest, a potential conflict, or change to any information that the fiduciary previously reported. Essentia Health's Chief Compliance Officer will collect the questionnaires and evaluate the disclosures. If a fiduciary has a potential conflict of interest, the Chief Compliance Officer or designee may request additional information from the fiduciary, the management team, and others. During the evaluation process, the Chief Compliance Officer may also consult with Essentia Health's Board and Audit Committee Chairs, senior management, legal department, or appropriate representatives from Essentia Health. The Chief Compliance Officer reports to the Essentia Health Audit Committee and the Essentia Health Board of Directors any actual or potential conflicts of interest disclosed by the fiduciary, along with recommended actions. The Essentia Health Board of Directors (or designee) will then determine whether to approve the situation or to implement special controls to manage the potential conflict of interest. The Chief Compliance Officer will then officially notify the fiduciary in writing of the board's decision. The decision of whether or not the disclosure constitutes a conflict will be at the Essentia Health Board of Director's (or designee) sole discretion, and its concern must be the welfare of Essentia Health and its affiliate(s) and the advancement of its purposes. When the Essentia Health Board of Directors (or designee) considers a Fiduciary's disclosure as a Conflict of Interest, special controls will be identified to manage, eliminate or reduce the likelihood and/or appearance of a conflict arising. Controls may include, but are not limited to: A. If the conflict involves an on-going matter or relationship, the Fiduciary must not participate in Board, Board committee or management discussions related to the conflict and must recuse themselves and if appropriate, withdraw, from any Board meeting or portion thereof where the matter is being discussed and during the vote on the potential Conflict of Interest. The Fiduciary may answer questions at the Board's or the Board Committee's request. B. If the conflict involves a specific transaction or decision, the Fiduciary will fully disclose their interest and all related material facts. The Board or committee of the Board will determine whether the contemplated transaction may be authorized as just, fair, and reasonable to Essentia Health or its affiliate(s). If the Board determines a conflict does not exist, the Fiduciary may proceed with the transaction; however, he or she will not be eligible to vote on related issues should they arise. If the Board determines a conflict does exist, the Fiduciary will be notified of the decision regarding whether the contemplated transaction will be authorized as just, fair, and reasonable.”

“PROCESS FOR DETERMINING COMPENSATION: The Essentia Health West Region Executive Compensation Committee of the Region's board of directors is authorized to fulfill the board's responsibilities regarding executive compensation consistent with Essentia's mission, values and tax-exempt status, and the Executive Compensation Committee's Charter. The Executive Compensation Committee meets annually to carry out its responsibilities, which include, but are not limited to, establishing, reviewing and modifying, as appropriate, reasonable compensation and benefits for designated Essentia executives who are officers or key employees of Essentia or any of its affiliates which may be paid by related organizations. The Executive Compensation Committee engages qualified independent compensation advisors to provide objective and impartial comparative data and to express opinions on total compensation reasonableness. The Executive Compensation Committee may request its independent advisors to: monitor comparability data and marketplace trends; make appropriate recommendations regarding salary ranges; and periodically review the market competitiveness of Essentia executive compensation packages. Prior to establishing or adjusting executive compensation, the Executive Compensation Committee will obtain and rely upon appropriate data as to comparability of the proposed compensation or adjustments. The Executive Compensation Committee will adequately document the basis for its determination concurrently with making those determinations. The Executive Compensation Committee minutes will include: the terms of the approved compensation and the date approved; the Executive Compensation Committee members present during the review, discussion and approval of the proposed compensation and those who voted on the proposed compensation; identification of the comparability data obtained and relied upon by the Executive Compensation Committee and how the data was obtained; any actions by a member of the Executive Compensation Committee having a conflict of interest; and documentation of the basis for the determination. The year this process was last undertaken for Essentia Health Fosston's Administrator/Regional Vice President and Chief Financial Officer was 2014. The compensation of Essentia Health West physician leadership, including appointed Chief and Chair positions, is reviewed and approved by the West Region Board of Director's Executive Committee. The annual compensation review includes review and approval of the prior fiscal year's physician and provider compensation plan reconciliation summary, review and approval of the recommended current fiscal year's physician and provider compensation plan rates, adjustments and plan methodology. Compensation plan rates for the fiscal year are recommended by the West Region Physician and Provider Compensation Committee based on its review of multiple market surveys, regional competitive factors, and the annual budget process. The year this process was last undertaken for Essentia Health West physician leadership was 2012.”

“Availability of governing documents, conflict of interest policy, & financial statements to the public: Governing documents, conflict of interest policy, and financial statements are made available to the public upon request. The organization is part of Essentia Health's consolidated financial statements which are included in Essentia Health's annual report posted on Essentia Health's web site.”

“Program service accomplishments: First Care Medical Services, dba Essentia Health Fosston, is organized & operated exclusively for charitable, educational and scientific purposes. 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. Essentia Health Fosston is a not-for-profit, community-based medical facility that operates critical access hospital, advanced life support ambulance service, clinics, nursing home and home health/hospice services in rural Northwest, Minnesota. All patients of the hospital and hospice receive service regardless of their ability to pay. Essentia Health Fosston, in fulfilling its responsibility to the community, provides support to other not-for-profit community organizations that also promote health improvement, offers education and health programs and outreach programs to the community, and support the community through employee volunteer efforts and donations. These include health fairs at which blood sugar, cholesterol and blood pressure screening were done, conducting health education on wellness and prevention to student groups, sponsoring health occupation students in experience chosen health care professionals work life, the American Cancer Society local Light Up A Night activity and other non-profit organizations in our community. Essentia Health Fosston also teaches prenatal classes and holds child car seat safety clinics. Diabetes, a rapidly growing disease concern is addressed by providing diabetic education and support groups to any community member that desires the information as well as those who have physician orders for the service. We actively participate in the regional bio-terrorism committee and work with the county as well to implement a coordinated plan followed by participation in exercises of the disaster plan in order to be more fully prepared in the event of disaster. Essentia Health Fosston employs approximately 200 full time equivalents. The hospital provided for over 2,000 hospital patient days and over 27,000 outpatient visits during the fiscal year ended June 30, 2015. The clinic had over 31,000 encounters during the same time period. Essentia Health Fosston provided over $278,000 in charity care as well as an additional $1,483,000 of costs incurred in excess of Medicaid payments received during the fiscal year ended June 30, 2015. Further community benefits provided during the fiscal year include community services of over $120,000, continuing education programs for health care professionals of over $29,000, and cash and in-kind donations of nearly $4,000.”

“1099 reporting: vendor payments and form 1099's were processed through essentia health on behalf of certain legal entities comprising essentia health system.”

“Other Changes in Net Assets: The total amount of other changes in net assets includes: Beneficial Interest in Foundation: ($32,547) Net Asset transfer with related organization; reallocated Balance Sheet item transferred to align with organizational structure: $5,019 Net Asset transfer with related organization; reallocated Income Statement item transferred to align with organizational structure: ($88,213) Total: ($115,741)”

“Consolidated A-133: Essentia Health Fosston, as part of Essentia Health's consolidated financial statements, was required and underwent a consolidated audit set forth in the Single Audit Act and OMB Circular A-133. The consolidated audit is reviewed by the Essentia Health Audit Committee.”